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- Smallpox Redux? [JOURNAL ARTICLE]
- JAMA Dermatol 2014 Sep 17.
- Enhancing the Teaching of Evolution in Public Health. [JOURNAL ARTICLE]
- Evolution (N Y) 2011 Dec; 4(4):567-573.
Public health courses are emerging as popular undergraduate offerings, especially at universities with schools of public health. It is important to note that evolution has shaped the burden of disease in the modern world in which we practice and educate for public health. Human cultures and technologies have modified life on Planet Earth and have co-evolved with myriad other species, including microorganisms, plant and animal sources of food, invertebrate vectors of disease, and intermediate bird, mammal, and primate hosts. Molecular mechanisms of evolution have produced differential resistance or susceptibility to infectious agents, including malaria, plague, smallpox, TB, measles, and diarrheal and respiratory diseases. The domestication of sheep and cattle led to natural selection in favor of human populations able to digest milk throughout life through persistence into adulthood of lactase enzyme expression in the intestine, a major story of anthropology. The emergence of a "Western diet" of dairy, refined cereal grains, refined sugars, vegetable oils, alcoholic beverages, salt, and omega-6-rich meats has dramatically altered glycemic load, fatty acid composition, macro-nutrients, acid-base balance, sodium/potassium ratio, and fiber content. This is a major story of nutrition and disease. The results include epidemics of atherosclerotic cardiovascular disease, obesity, diabetes, high blood pressure, osteoporosis, certain cancers, and bowel, inflammatory, and autoimmune disorders. Another interesting phenomenon is the selection of excessive hemostatic activity from platelets and the plasma clotting proteins; what was protective against death from bleeding after injuries among hunter-gatherers or from pregnancy-related hemorrhage now contributes to thrombosis underlying heart attacks and strokes. Conversely, there is little pressure against hemostasis and thrombosis since deaths from these causes occur mostly after the reproductive years of life. Learning about evolution over millennia for humans and over hours or days for microbes enlivens the experience of understanding evolutionary biology in public health context.
- [How serious is the smallpox threat?]. [Journal Article]
- Dtsch Med Wochenschr 2014 Jul; 139(30):1506-7.
- New smallpox vaccines for an ancient scourge. [Journal Article]
- Mo Med 2014 Jul-Aug; 111(4):332-6.
The potential use of variola virus, a Class A agent of bioterrorism, remains a concern. In an effort to prepare for a possible smallpox outbreak due to an intentional release of variola, the U.S. government and industry have been evaluating vaccines stored in the National Strategic Stockpile including cell culture grown ACAM2000 and modified vaccinia Ankara, IMVAMUNE, in clinical studies. This paper discusses smallpox vaccines studies conducted at the Saint Louis University Center for Vaccine Development.
- Is it time to destroy the smallpox virus? [Letter]
- Science 2014 Aug 29; 345(6200):1010.
- Spread of vaccinia virus through shaving during military training, Joint Base San Antonio-Lackland, TX, June 2014. [Journal Article]
- MSMR 2014 Aug; 21(8):2-6.
Although naturally occurring smallpox virus was officially declared eradicated in 1980, concern for biological warfare prompted the U.S. Government in 2002 to recommend smallpox vaccination for select individuals. Vaccinia, the smallpox vaccine virus, is administered into the skin, typically on the upper arm, where the virus remains viable and infectious until the scab falls off and the epidermis is fully intact, typically 2-4 weeks. Adverse events following smallpox vaccination may occur in the vaccinee, in individuals who have contact with the vaccinee (i.e., secondary transmission), or in individuals who have contact with the vaccinee's contact (i.e., tertiary transmission). In June 2014 at Joint Base San Antonio-Lackland, TX, two cases of inadvertent inoculation of vaccinia and one case of a non-viral reaction following vaccination occurred in the security forces training squadron. This includes the first reported case of shaving as the likely source of autoinoculation after contact transmission. This paper describes the diagnosis and treatment of these cases, the outbreak investigation, and steps taken to prevent future transmission.
- John bartlett and bioterrorism. [Journal Article]
- Clin Infect Dis 2014 Sep 15.:S76-9.
Until 1997, the subject of bioterrorism was not discussed within the medical community and deliberately ignored in national planning efforts. Biological weapons were regarded as "morally repulsive." This complacency stemmed from a 1972 Biological Weapons Convention where all countries agreed to cease offensive biological weapons research. In the 1990s, however, the Soviet Union was discovered to have an extensive bioweapons program and a Japanese religious cult sought to launch an anthrax attack on Tokyo. Biological weapons such as smallpox and anthrax had the potential to cause a national catastrophe. However, little was done until John Bartlett in 1997 led a symposium and program to educate the medical community and the country of the need for definitive bioweapons programs. It was highly persuasive and received a final stimulus when the anthrax attack occurred in the United States in 2001.
- Safety and immunogenicity of modified vaccinia Ankara as a smallpox vaccine in people with atopic dermatitis. [JOURNAL ARTICLE]
- Vaccine 2014 Aug 19.
Following vaccination with traditional smallpox vaccines or after exposure to vaccinated individuals, subjects with atopic dermatitis (AD) can develop eczema vaccinatum, a severe disease with disseminated eruption of pustular contagious lesions. Alternative smallpox vaccines with an improved safety profile would address this unmet medical need.An open-label controlled Phase I clinical trial was conducted to investigate the safety and immunogenicity of modified vaccinia Ankara (MVA) in 15 healthy subjects compared to 45 subjects with either mild allergic rhinitis, a history of AD or presenting with mild active AD. MVA was given (Week 0 and 4) by a subcutaneous injection during a 28-week observation period.No serious adverse event was reported and vaccinations with MVA did not lead to any clinically relevant skin reactions in AD subjects. Unsolicited administration site reactions did not show any trends compared to the healthy subject group. The majority of adverse reactions were mild to moderate, and all reactions were transient and resolved without intervention. The majority of vaccinees had seroconverted by ELISA (80-93%) and PRNT (69-79%) already two weeks after the first vaccination, increasing to 100% after the second immunization, with peak GMT above 1000 and 145 for ELISA and PRNT, respectively.MVA was equally well tolerated and immunogenic in all enrolled subjects with mild to moderate pain and redness at the injection site being the most frequent adverse reactions. There were no differences in the safety or immunogenicity profile of MVA in healthy subjects or those with AD or allergic rhinitis. The study has confirmed MVA as a promising smallpox vaccine candidate and demonstrated in a small study population that the vaccine has a similar safety and immunogenicity profile in healthy subjects and people with active AD. Clinical trials registration: NCT00189917.
- The challenges of challenge experiments. [Historical Article, Journal Article]
- N Engl J Med 2014 Aug 21; 371(8):695-7.
- Chickenpox in poland in 2012. [Journal Article]
- Przegl Epidemiol 2014; 68(2):201-4.
A number of chickenpox cases, occurring especially in children, indicates the rationale for the use of chickenpox vaccinations. In Poland since 2002, chickenpox vaccination is included in the National Immunisation Programme as recommended.To assess epidemiological situation of chickenpox in Poland in 2012 in comparison to previous years.The descriptive analysis was based on data retrieved from routine mandatory surveillance system and published in the annual bulletins "Infectious diseases and poisonings in Poland in 2012" and "Vaccinations in Poland in 2012" (Czarkowski MP i in., Warszawa 2013, NIZP-PZH i GIS). National Immunisation Programme for year 2012 was also used.In 2012, 208 276 cases of chickenpox were registered in Poland. The highest number of cases was reported in Śląskie voivodeship, the lowest in Podlaskie voivodeship. Mumps incidence was 540.5 per 100 000 and was higher than in 2011 (448.7). The highest incidence was recorded in children aged 4 years (7 611.5 per 100 000). The chickenpox incidence among men (570.7) was higher than among women (512.2). The incidence among rural residents (553.9) was higher than among urban residents (531.8). Number of cases hospitalized due to mumps was 1 361. Number of people vaccinated against chickenpox was 56 213.In 2012, there was an increase in the incidence of smallpox in Poland. This trend is continuing since 2004, which can be partly explained by improved surveillance of the disease.