Published by
Stanford Medicine

Category

Infectious Disease

Infectious Disease, Research, Science, Stanford News

Science Friday-style podcast explains work toward a universal flu vaccine

Science Friday-style podcast explains work toward a universal flu vaccine

I had the pleasure of teaching a class this fall to a group of mostly chemistry and chemical engineering graduate students, helping them improve their skills communicating about their science with the public. For her assignment, graduate student Julie Fogarty recorded this Science Friday-style segment on work taking place in the lab of chemical biologist and bioengineer James Swartz, PhD. Swartz and colleagues are trying to develop a universal flu vaccine that would eliminate the need to get a new vaccine each year – something all of us would probably appreciate. (Here I’m thinking about my colleague Michelle Brandt, who recently suffered the woes of not finding time to get her kids vaccinated.)

Julie’s brother Skyped in for his role as Science Friday host extraordinaire Ira Flatow in this segment, while Julie played the enthusiastic and articulate guest. It’s often difficult to explain complex science in audio format, but Julie does a fantastic job explaining the work in way that is very visual. I love her description of the flu virus as a little mushroom.

(A previous blog entry featured another student, Rhiannon Thomas-Tran, who produced a great video about her work.)

Previously: Working to create a universal flu vaccine, Graduate student explains pain research in two-minute video and How one mom learned the importance of the flu shot – the hard way

Global Health, Infectious Disease, Microbiology, Public Health, Videos

'Tis the season for norovirus

'Tis the season for norovirus

The week before Thanksgiving, some kind of stomach bug, which I suspect was norovirus, spread like wildfire among my daughter’s daycare. Several of her classmates became sick and like dominos so did the parents, including us.

So I was more than sympathetic when I came across this video by John Green (of the vlogbrothers fame and author of “The Fault in Our Stars”) about his family’s Thanksgiving troubles with a norovirus infection that seems to have left no GI system untouched in their household.

Winter, from about November to April, is prime norovirus season. The treacherous illness, which as Green says “has amazing superpowers,” spreads when you come into contact with feces or vomit of an infected person. It can take less than a pinhead of virus particles to make this happen. Unlike other viruses, it can live on surfaces for surprising long periods, which is how a reusable grocery bag caused an outbreak among a girls soccer team in 2012. Plus, an infected person can continue to shed the virus for about three or four days after recovering. It’s possible to disinfect after an infection, but it’s a pretty intense job.

Given these characteristics it’s not surprising that this tiny virus (even by virus standards) causes about 20 million illnesses each year. Although for most people it’s a mild illness, for the very young,  old or those with compromised immune systems—it can be severe. About 56,000-71,000 people are hospitalized and 570-800 die from norovirus infections.

The situation is worse in developing countries, where, as Green points out, rehydration therapy is harder to come by for the most vulnerable. About 200,000 deaths are caused by norovirus infections in poor parts of the world.

In his typical funny and thoughtful style, Green talks about what lack of simple—and cheap—rehydration therapy means for many on our planet. It’s one more thing that it’s easy to take for granted, and one more thing to be thankful for.

Previously: Stanford pediatrician and others urge people to shun raw milk and products and Science weighs in on food safety and the three-second rule

Infectious Disease, Parenting, Pediatrics, Public Health

How one mom learned the importance of the flu shot – the hard way

How one mom learned the importance of the flu shot - the hard way

tamiflu‘Wow, I’m a pathetic sight,’ I thought as I stepped out of the bright fluorescent light onto the rainy pavement, fumbling with my half-open umbrella and crying. I was coming from Walgreens, clutching on to a crisp white paper bag containing Tamiflu and bottles of Children’s Tylenol (cherry and grape) and re-playing in my head the comments a pharmacist had just made to me. “Did they not get their flu shots?” she had asked, not unkindly, as she packaged up my loot. “Is that why your kids got sick?” Hence my (guilty and big) tears.

My two girls – ages eight and five – had indeed not gotten their flu shot. I had meant to take them in – I’m a super-organized mama who usually follows doctors’ orders to a tee, the type who carefully monitored and recorded the contents of her newborns’ diapers for weeks and who typically schedules well-child exams as close to her kids’ actual birthday as possible. And yet time slipped away from me this fall, I hadn’t taken them in (no excuses – just life), and earlier that day my oldest had tested positive for a particularly nasty type of Influenza A. Hours later we were called by the girls’ school: The little one was now sick with a high fever (and likely the flu). The doctor suggested we start her on Tamiflu, too, and hope for the best.

My guilt, as I watched my kindergartener later cry out in pain (when my husband asked what she wanted for Hanukkah, in an effort to get her mind off her sickness, she moaned, “I just want to feel better”), was practically all-consuming. How could we have not taken them in? I kept asking myself. I go every year, and I always follow the pediatrician’s recommendations about vaccines. I believe in the importance of vaccines. So what was I thinking?

Later that evening, after the kids (following much negotiation and crying) agreed to take their “yucky”-tasting Tamiflu and had finally gotten to sleep, I took to Facebook, where friends and acquaintances sweetly tried to cheer me up and came to my defense. The girls might have gotten sick even if they had gotten a flu shot, some suggested. (Although: This year’s vaccine offers protection from this particular strain.) They could have had a reaction from the shot itself, someone pointed out. (Yet: My kids have never experienced side-effects from being vaccinated.) The pharmacist was just trying to fill a quota for flu shots or make you feel bad, one old college friend suggested. (But: The pharmacist actually wasn’t being pushy or judgmental with her question; she seemed more curious than anything.)

The bottom line is that I messed up and didn’t come through in protecting my kids this time around. It was a hard pill to swallow. But what comforted me in the end was the thought that my daughters’ illness is temporary and in the grand scheme of things, not all that bad. I am blessed for my children’s overall good health (I know many parents have to face far, far worse things than the flu), and I am blessed to have the resources that enable us to see a good doctor and purchase not-inexpensive antivirals.

The experience, also, reminded me of some valuable lessons. A parent – or anyone, really – should never take good health for granted. And one should never become complacent about disease and illness prevention.

I’m fairly confident this is the last year my girls will ever go without a flu shot.

Previously: Side effects of childhood vaccines are extremely rare, new study finds, The earlier the better: Study makes vaccination recommendations for next flu pandemic, Working to create a universal flu vaccine, Ask Stanford Med: Answers to your questions about seasonal influenza and European experts debunk six myths about flu shot
Photo by kanonn

Biomed Bites, Genetics, Infectious Disease, Videos

Ending enablers: Stanford researcher examines genes to find virus helpers

Ending enablers: Stanford researcher examines genes to find virus helpers

Here’s this week’s Biomed Bites, a weekly feature that highlights some of Stanford’s most innovative research and introduces Scope readers to scientists in a variety of biomedical disciplines.

Viruses, by their very definition, are dependent. They can’t dive into a body and wreak havoc by themselves — they need a little help, and that help often comes from our own genes. But which genes do viruses use to reproduce and thrive? Which genes are the enablers?

Stanford microbiologist Jan Carette, PhD, is patiently trying to figure that out — using the process of elimination. Here’s Carette in the video above:

In our lab, we have developed a new technique where we take away each of the individual genes and then measure very precisely which of the genes are important for the virus… If we know which are the targets of the human genes, we can start creating a whole new class of antiviral reagents that target the human genes and not so much the virus genes as is commonly done…

This technique might lead to treatments for viruses such as influenza A, Ebola or yellow fever. Said Carette: “The research that we’re doing can have a direct effect on human health… We can impact the lives of many people that are affected by viral disease.”

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Exploiting insect microbiomes to curb malaria and dengue, Found: Ebola’s entry point into human cells and Personal molecular profiling detects diseases earlier

In the News, Infectious Disease, Medical Education, Medicine and Society, Patient Care

A doctor’s attire – what works best?

A doctor’s attire – what works best?

Lab CoatsDoes what your doctor wear matter to you? You may simply want your doctor to be competent and compassionate, but a recent article in The Atlantic points out some subtle issues in the effects a doctor’s dress may have. Most people seem to prefer “formal” to “casual,” but the author recalls being put off by a well-coiffed female doctor dressed in a smart business suit. But if there’s such a thing as too formal, a doctor in cut-off shorts and a tee isn’t likely to get too many repeat patients either.

I’m pregnant and I have a toddler, so I’ve had more than the average number of visits to the doctor in the past couple of years. I also like clothes and notice what people are wearing, but even I had to stop and think about what, if anything, I remembered about what my OB/GYN or my daughter’s pediatrician (both women) wore during recent visits. Mostly I remember slacks and simple blouses, or in the unforgiving summer heat typical in this area, something a little lighter. My daughter’s pediatrician also has a couple of small Disney character toys attached to her name tag to entertain the youngest patients.

There’s a middle ground that doctors have to strike that may be tricky depending on their specialty, their hospital or clinic’s dress codes (Mayo Clinic requires all docs to dress in a business suit) among other things. And that’s not even considering the issue of how a doctor’s clothes can spread infectious disease. From the article:

The definition of what counts as professional clothing is also in flux, thanks to increasing knowledge of infectious risks. Earlier this year, the Society for Healthcare Epidemiology Association (SHEA) published new guidelines for healthcare-personnel attire in hospital settings. Their goal was to balance the need for professional appearance with the obligation to minimize potential germ transmission via clothing and other doodads like ID badges and jewelry and neckties that might touch body parts or bodily fluids. The SHEA investigators’ take-home points regarding infection: White coats should be washed weekly, at the minimum; neckties should be clipped in place (70 percent of doctors in two studies admitted to having never had a tie cleaned); and institutions should strongly consider a “bare below the elbow” (BBE) policy, meaning short sleeves and no wristwatches or jewelry. Although the impact on reducing the risk of infections remains to be determined, it’s considered potentially significant enough that a number of countries have adopted BBE requirements for all clinicians. (And it leaves me wondering: When will the Mayo clinic update its dress code to short-sleeved business suits?)

The other factor doctors have to consider is that the “business casual” that I’ve seen on most doctors may need to be upgraded for more formal meetings – something I’d never considered as a patient. Again from the article:

Last week, two days in a row, I ran into a colleague who’s a pediatrician. The first day, she wore a beige pantsuit (I’d label it formal, or business) and looked fairly corporate. I wondered to myself if she realized that her clothes were sending a message to her patients, a message that indicated that her medical practice was a business and that she wielded the power. The next day, she wore a loose-fitting knee-length navy dress (professional informal, perhaps, or smart casual). I asked her if she had seen patients the first day. She had not; it was a day of meetings, and when I told her I was writing about doctors’ clothing, she laughed. “When you’re seeing patients,” she said, “you have to look like you’re not afraid to get dirty.”

I’m not sure how I would have reacted if at our first appointment our pediatrician had worn a formal business suit. At the very least, I would have felt under-dressed (jeans and tees are my de facto uniform these days), but I would have likely judged her as cool or somehow distant, not suited to working with kids. Which may prove nothing, but only hint that that the best attire is the kind that your patients don’t notice.

Previously: NY bill proposes banning white coats, ties for doctors
Photo by Pi

Global Health, Infectious Disease, Stanford News

Back home from Liberia, Stanford physician continues to help in fight against Ebola

Back home from Liberia, Stanford physician continues to help in fight against Ebola

Colin Bucks - 560

Earlier this fall, we shared the story of Stanford physician Colin Bucks, MD, who, as a volunteer with the International Medical Corp, treated some 130 patients with Ebola in Liberia. Bucks is home now (he emerged from a 21-day home isolation on Nov. 14) but is still helping from afar. As reported by Inside Stanford Medicine:

Since his return to California, Bucks has been much in demand as a member of a small cadre of clinicians who have had direct experience with Ebola. He’s been working with health professionals at universities and nonprofits around the world who are doing research on new approaches to combating the disease, tracking trends in the epidemic and developing new designs for protective gear, which are cumbersome and stifling, he said.

“The heat stress is massive,” he said. “Your vision is limited. So anything we can do to improve PPE [personal protective equipment] will help improve patient care.”

During his quarantine, he said he did not have a moment of boredom; he was on the phone for 15 hours at a stretch consulting with health experts across the country on Ebola preparedness and on the needs in West Africa…

Previously: Stanford physician shares his story of treating Ebola patients in Liberia

Biomed Bites, Immunology, Infectious Disease, Research, Stanford News

Figuring out a parasite's secrets – insights from studying Toxoplasma gondii

Figuring out a parasite's secrets - insights from studying Toxoplasma gondii

Welcome to Biomed Bites, a weekly feature that highlights some of Stanford’s most innovative research and introduces Scope readers to innovators in a variety of disciplines. 

You’ve probably heard that pregnant women shouldn’t get near the litter box. The reason is that many kitties carry a parasite called Toxoplasma gondii, which is transmitted through their feces. The parasite infects about 2 billion people worldwide, according to Stanford microbiologist John Boothroyd, PhD.

Boothroyd, who also serves as the associate vice provost for graduate education, directs a lab that has uncovered some of the basic biology of this single-celled protozoan parasite. Here’s Boothroyd in the video above:

Most of the time, this causes no significant disease, very few symptoms and probably something that most of these people will never know they were infected with. Occasionally, however, this parasite can cause devastating disease. It can affect the brain of the unborn child, it can cause severe neurological problems, it can even kill the developing fetus.

Toxoplasmosis, or infection with the parasite, can also cause serious complications in immunocompromised individuals. Boothroyd said he was drawn to the study of the T. gondii because it is clinically significant — he has the opportunity to help millions of people: “I wanted something where I felt the work we were doing was worth the many, many hours that I and the people I worked with put in to the daily effort.” T. gondii is also related to the Plasmodium parasites that cause malaria and some of the work from Boothroyd’s lab has been translated into insights into malaria.

Boothroyd’s team also identified the T. gondii protein that triggers the immune response in humans. With that knowledge, the investigators were able to insert the gene coding for that protein into yeast, letting the yeast produce the protein, “instead of having to grow the parasite in literally hundreds of thousands of mice a year and then killing those mice to get the parasite,” Boothroyd said. He went on to explain:

The situation in which Toxoplasma presents the most significant problem for the doctor and for the patient is in the pregnant woman. The challenge becomes first, is she infected, and if so, has the parasite crossed the placenta and reached the fetus. And third, what is the consequence of the infection in the fetus? All three of those we have addressed through our work.

Although much about the parasitic diseases remains unknown, Boothroyd is glad he picked T. gondii to focus on: “I think we’ve been able to do some real good with this work.”

Learn more about Stanford Medicine’s Biomedical Innovation Initiative and about other faculty leaders who are driving biomedical innovation here.

Previously: Stanford microbiologist’s secret sauce for disease detection, Cat guts, car crashes and warp-speed Toxoplasma infections and Patrick House discusses Toxoplasma gondii, parasitic mind control and zombies

Infectious Disease, Research, Stanford News

Stanford scientist Lucy Shapiro: "It never occurred to me to question the things I wanted to do"

Stanford scientist Lucy Shapiro: "It never occurred to me to question the things I wanted to do"

Lucy ShapiroIn the mid-1920s, Pearl Meister Greengard died giving birth to her son, the Nobel prize-winning scientist Paul Greengard, PhD. Decades later, Greengard and his wife established a prize to honor the very best female scientists, named after his missing mother. Although prizes abound in science, this is one of those prizes that scientists hold in the highest esteem. Today, Stanford developmental biologist Lucy Shapiro, PhD, will be awarded the 2014 Pearl Meister Greengard Prize. Shapiro revolutionized the understanding of the bacterial cell as an engineering paradigm whose cell division leads to the generation of diversity, a phenomenon fundamental to all life. She spoke recently about this award.

Like other accomplished scientists, you’ve won many awards. How does this one stack up?

It is very special. It’s the only big deal award for a woman  – I’m just so tremendously honored. Paul Greengard felt that women do not get their just due as real leaders in science, so the whole point of this award is to recognize women scientists with significant achievements, or breakthroughs in science.

It’s not just a prize for women in science, it’s a prize for actually doing something transformative in the field of biomedical sciences.

Did you have role models?

I had many role models. When I started out a whole bunch of years ago, there were woman at Albert Einstein College of Medicine that had an enormous effect on my life. Really smart, accomplished women with families who were full professors. It made a difference in the trajectory of my career.

Another role model was Barbara McClintock, PhD. She never married, never had any children, and she was an unbelievably brilliant scientist. She was my role model not necessarily because she was a woman, her influence was simply being a great scientist.

There’s another part to this, one that’s hard to write about, but is critical. It’s particularly critical for women to be extremely confident. You have to know what you are good at and to not feel in any way threatened. One of the major things my parents instilled in me was a sense of confidence and a feeling that I can do anything.

It never occurred to me to question the things I wanted to do. Other people’s remarks rolled off like rainwater – I didn’t care. One of the things I tell my women students and postdocs is to act confident, even if you don’t feel confident.

It’s hard to be a female scientist

That’s not always true. It depends on your goals and your mindset and how you’re willing to live your life. I think that to be a good scientist, you have to have a deep passion for it that supersedes all kinds of stuff. Were there roadblocks or difficulties? Of course. I know that for all top scientists, the unchanging, deep passion, the central core of their life, is their science. That doesn’t mean that we are not mothers and grandmothers and part of society and complete people. But the real core, the passion is our lab.

You have to stay true to what you know to be the core of your life. Do more obstacles get thrown at women? I suppose that’s true. But I haven’t had a life of that.

I don’t want to make this award all about women. Yes, of course, it’s been given because I’m a woman scientist. But it’s also because I’ve done something meaningful as a scientist.

Continue Reading »

Global Health, History, HIV/AIDS, Infectious Disease

A doctor’s dilemma: to help or hold back from treating dangerous infections

If, like me, you’ve wondered why a doctor or nurse would decide to volunteer to help patients with often fatal infectious diseases like Ebola, The New York Times Magazine ran an essay today by Stanford physician and author Abraham Verghese, MD, MACP, in which he addresses, among other issues, the tension for clinicians between self-preservation and the impulse to help.

We doctors feel the pull. But each of us has reasons to stay back, reasons that get bigger as we age

He begins with his time treating patients in a hospital in India, detailing his encounters with tuberculosis, malaria, and filariasis among other diseases, but his description of his fear of and his reflections of his encounter with his first rabies patient is poignant:

I felt terribly sorry for this man who was old enough to be my father. Squatting by his mat, I was ashamed of my earlier fear and hesitation. I was glad to spend some time with him. By the next morning he was comatose and convulsing. By nightfall, he’d transcended the mortal world.

He  goes on to discuss his work with HIV patients in the 1980s, and the fear that surrounded the disease at the time. Many physicians donned full protective gear, even though researchers had determined, even in the early days of the epidemic, that the disease wasn’t spread via casual contact. Verghese connects these fears to current fears about Ebola, but doesn’t blame physicians who are cautious. He also documents his own impulses:

I have the urge to sign up, to head to Liberia or Sierra Leone; the call for doctors seems personally addressed to me. When I tell my mother, who is in her 90s, that I am thinking of volunteering in West Africa, she clutches my hand and says: “Oh, no, no, no. Don’t go!” I’m secretly pleased.

….

We doctors feel the pull. But each of us has reasons to stay back, reasons that get bigger as we age: children, partners, parents, grants.

Verghese captures the conundrum facing doctors and nurses who want to help, but who are – for a  variety of reasons – pulled away.

Previously: Ebola: This outbreak is differentStanford physician shares his story of treating Ebola patients in Liberia and Dr. Paul Farmer: We should be saving Ebola patients

Ebola, Global Health, In the News, Infectious Disease

Ebola: This outbreak is different

Ebola: This outbreak is different

15038945315_7613c40e54_zMisinformation about Ebola blankets the web. To clarify priorities, and spur action, Stanford global health specialist Michele Barry, MD, penned a strongly worded essay published today in Boston Review:

In the United States, the few cases imported have incited irrational fear which is not only unwarranted but actually undermines an appropriate response to the outbreak. By focusing on quarantine, we are ignoring the need for centralized public health systems and training to deal with inevitable cases of Ebola.

Ebola is not spread through air, water or food, but end-stage sick patients can have over a billion viral particles in a cubic centimeter — or about a fifth of a teaspoon — of blood making contact with bodily fluids highly contagious.

This Ebola outbreak is different, she says. Previously, the virus stayed close to its forest reservoir in Central Africa. Now, it’s in large cities, spreading through heavily populated areas that have been decimated by poverty and conflict.

As the virus spread, the World Health Organization was slow to respond, Barry writes. “The WHO was alerted to the cluster of cases in Guinea by March, but did not sound the alarm until August. Why did this happen?”

And what, now, can be done?

In actuality, the solution to this Ebola crisis is not drugs, mass quarantine, vaccines or even airdrops of personal protective gear. The real reasons this outbreak has turned into an epidemic are weak health systems and lack of workforce; any real solution needs to address these structural issues.

We have the tools to spot emerging outbreaks and to stop them. We know how to prevent transmission of Ebola. Orchestrating an international response, however, one that considers the welfare of patients and healthcare workers, the resilience of healthcare systems and the triumph of reason — that needs some work.

Previously: Stanford physician shares his story of treating Ebola patients in Liberia, How to keep safe while operating on Ebola patients and Ebola: A look at what happened and what can be done
Photo from the European Commission DG ECHO

Stanford Medicine Resources: