Zika Buzz

The Zika virus was first described in 1947. It is a fairly stable virus, unlike the frequently mutating influenza virus. It is mostly a mosquito-borne virus, but the mosquitoes aren’t the only source of buzz surrounding Zika. Recently, in South America, there has been a significant increase in Zika diagnosis and babies born with microcephaly – a major birth defect due to mother-to-child transmission in the womb. While there is no definite proof that Zika is causing microcephaly, the correlation is apparently strong: During the Zika epidemic in Brazil over the past four months, microcephaly cases there rocketed to 3,500, and 46 babies died. For comparison, there were only 147 cases altogether in 2014.

There is a tremendous lack of accurate information with regards to Zika. Even though it was discovered nearly 70 years ago, it hasn’t been studied much simply because the illness it causes in humans was unremarkable. In fact, most cases (60–80%) of Zika are asymptomatic. When symptoms do appear, they tend to be mild, generally 4-7 days of joint pain, rash, and/or fever. It is only recently that a correlation between infection and microcephaly has been noted, and thus the current buzz about Zika.

Like other pandemics, the Zika is spreading quickly and unexpectedly resulting in panic and feelings of helplessness. Similar panic happened with swine flu (2009), avian flu, SARS, Ebola etc.

WHO declares emergency – What’s Next?

There is no vaccine currently available against Zika, so initially the focus for prevention will be vector control – avoiding mosquito bites. Of course, for years global health authorities have tried to control mosquitoes, as they are vectors for other infectious diseases including malaria, dengue, and chikungunya. But mosquito control is difficult. Aedes aegypti, the mosquito species in question, can breed in just a few drops of standing water.

Over the past few days, I have spent some significant time researching the Zika virus.

I don’t expect developing a vaccine will be challenging. While Zika is an RNA virus, like the flu, it is actually quite a stable virus unlike the more frequently mutating flu virus. This means vaccine development is a relatively simple process. There are many methods for producing a vaccine with high effectiveness. These vaccines are based on attenuated pathogens or their external proteins.

Even producing large amounts likely won’t take too long thanks to recent advances in this field. The delay will be regulatory – for very compelling reasons, a vaccine is given to healthy people and a new vaccine must be thoroughly tested for safety and for efficacy in human clinical trials before it goes to market. Consequently, even with the increased attention, and WHO’s declaration of a public health emergency, it will likely be many years, most likely a decade, until a vaccine is available.

I also expect there will be intensive studies to confirm (or perhaps disprove) the direct  link between Zika and microcephaly. Hopefully we’ll soon know the cause.

(Image source CDC http://www.cdc.gov/zika/geo/index.html)

The Race is on for a Universal Flu Vaccine

For much of the United States, winter means cold weather, snow, sleet and friendly reminders to get flu shots. Indeed, vaccinations remain an important aspect when it comes to combatting a deadly and costly public health issue that causes approximately 23,000 deaths in the United States each year and global loss of life for up to 500,000 people, according to the World Health Organization (WHO).

The impact of influenza is massive. Each year in the USA it infects up to 20 percent of the population and results in 200,000 hospitalizations. Given the magnitude of the problem, some might be surprised to learn the effectiveness of flu vaccinations varies markedly from year to year. For example, vaccine effectiveness was estimated at roughly 20 percent during the 2014-15 flu season, a dire situation that compelled Congress to hold hearings in February and November last year regarding the nation’s preparedness for uncontrolled flu outbreaks.

Last year’s low effectiveness rates for flu vaccinations did have an upside. The public has paid more attention to the scientific community’s quest for an innovative flu vaccine that will lead to lower flu-related mortality and hospitalization rates.

The race is on for better and broader flu vaccines

“Universal” vaccination is a broad term favored by media, but it speaks directly to potential vaccines that may one day broadly protect against all or most strains of flu virus. As reported by Science and Nature Medicine during August, progress is well underway, foreshadowing possible advances that are significantly better than today’s flu vaccination process, which is not only largely ineffective, but also highly inefficient.

The existing seasonal flu vaccination requires six months of lead time to develop the inoculation while relying on production processes that utilize 1940s-era technology. The end product typically does not provide protection against newly appearing ‘pandemic’ strains of the virus, which explains why public health officials were wholly unprepared for the outbreak of Swine Flu back in 2009.

Generally speaking, there are three influenza types known as A, B and C. Type A flu virus is found in human and non-human species and responsible for pandemic outbreaks (avian and swine flu) as well as strains that are behind widely-reported annual flu outbreaks. There are 25 known type A “subtypes” alone. Type B flu is found only in humans and may cause less severe symptoms than type A and do not create pandemics. Type C causes mild, cold-like symptoms.

The flu shots that primary care physicians prescribe each year have very low effectiveness rates for a simple reason. The WHO has to make a prediction about the dominant flu strain far in advance of flu season due to the six-month-long production cycle for vaccinations. Unfortunately, this “educated guess” approach results in frequent discrepancies between the specific flu strains used to manufacture the vaccine and the dominant strains of flu that circulate in any given season. As reported by the CDC, the 2014-15 flu season yielded the lowest flu vaccine effectiveness rate for the general population over the past five years due to a “mismatch” between the flu vaccination and the actual dominant strain.

The challenge for scientists is to move away from the existing estimation model. In addition to being inefficient, these vaccines are based on creation of antibodies that are ineffective against intracellular flu pathogens – microorganisms contained within cells. Antibodies can’t bind to and thereby neutralize the flu virus when it is located inside cells. This scenario accounts for the ineffectiveness of vaccination against a multitude of flu strains that are subject to frequent and unpredictable mutations.

Further, current vaccines are only effective against the virus when located in certain parts of the body, outside of the cells. As a result, the vaccine is ineffective once the virus has invaded the body and moved inside cells. Even if the vaccine happens to be a perfect match for the season’s flu virus, the current vaccine is akin to a boxer sent into the fight with one hand tied behind its back.

Finding a solution is not an easy task

Science’s answer to the challenge posed by the flu virus is the creation of a vaccine that acts against a denominator that is common to every influenza strain. One approach that holds great promise is called “cell-mediated immunity.” This approach stimulates the immune system to activate white blood cells within the human body for the purpose of eradicating different pathogens.

Unlike the current approach of growing antibodies over a period of months, cell-mediated immunity encourages the body to use its own cells in removing infected cells and thereby more efficiently halts the flu virus.

There are several benefits to flu vaccines that utilize the science of cell-mediated immunity. This type of vaccine will induce long-lasting protection. It will be available any time of the year. It will be manufactured on demand with a short-production cycle that is far more efficient than the current six-month process. And it will also target pandemic Type A influenza strains that cannot be conquered by the current vaccination process.

Flu exacts a terrible annual death toll on the world’s human population. Data from the National Institute of Health shows that every year more people receive vaccinations but are not better protected. The silver lining is the scientific community’s response. One day soon, your doctor’s friendly reminder to get a flu shot will come with real assurance that the inoculation will protect most, if not all, people from the dangerous consequences of the flu.

[This article is a reproduction of Dr. Babecoff’s article originally published in The Huffington Post]