The Disease Detectives

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The Disease Detectives Unraveling How Viruses Go Viral
Hundley, Kris
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University Press of Florida
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The experts at UF’s Emerging Pathogens Institute make it their mission answering baffling questions such as how is a pig-borne disease transmitted in a Muslim country, what kinds of parasites do Florida ticks carry and how has a cholera strain from Nepal evolved in Haiti?

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GATORBYTES THE DISEASE DETECTIVESUnraveling How Viruses Go ViralKris Hundley


M Or they worry about a deadly vir us like Ebola after it shows But scientists at the University of Floridas Emer ging Pathogens Institute are always anticipating the next possible epidemic, tracking viruses and bacteria that can trigger a fast Like scientists before them who devised ways to rid the world of smallpox, EPIs researchers are working on ways to eradicate malaria from Zambia, control cholera in Haiti, and Their work involves identifying disease-carrying micr o organisms that are constantly evolving, becoming ever more ria and viruses is continually changing, its population growing, tious disease, said a perfect example of this dynamic is the Eb ola crisis in which a virus present in monkeys and fruit bats for thousands of years suddenly crossed over to humans in West


2 Kris Hundley There were more than 19,000 reported Ebola cases and more To understand how diseases emerge and are transmitted, EPIs researchers analyze a pathogens genetic structure in the lab, then create computer models that show how the virus or Finally, the scientists at EPI collaborate with colleagues down the hall and around the world to design ways to intervene and researchers: How is a pig-borne disease transmitted in a Muslim country? What kinds of parasites do Florida ticks carry? Founded in 2006, EPI has about 200 investigators, drawn $55 million, four-story facility thats equal parts high-tech labs rapher next to a pediatrician next to an epidemiologist next to building was deliberately designed to encourage the collabora tion needed to move infectious disease research from the lab to Understanding why and how new pathogens emerge re -


The Disease Detectives 3quires a multidisciplinary approach, with the ability to move from basic genetics to global public health, said Morris, who was previously interim dean of the University of Marylands to build a strong interdisciplinary spirit and to play on each searcher, puts it this way: If you only have a bunch of labs, you The institute, which r eports to UFs vice president of re search, has received more than $90 million in grants over the It got people on campus talking to each other who hadnt only a few weeks when a casual conversation with an agricultural engineer triggered an idea about a possible new strategy He had some inter esting approaches to forecasting that EPIs researchers have studied pathogens that cause disease in plants, animals, and humansfrom salmonella in tomatoes


4 Kris Hundley But theyr e also working on issues as crucial to Floridas Morris, EPIs dir ector, said the centers holistic approach to infectious disease is applicable whether the outbreak occurs in world where pathogens can travel at the speed of a commercial Whats going on in Mongolia may be here in a week, he Applying EPIs Strategy to EbolaThat lesson was reinforced during the Ebola epidemic, when a single airline passenger unwittingly carried the virus from showed how the strategies honed at EPI can be applied regard decades constructing and analyzing mathematical models of and analyzed vaccine trials for everything from dengue fever perts to help design upcoming Ebola vaccine trials, they called on Longini, who is now on temporary assignment at WHO


The Disease Detectives 5 Longinis assignment: Determine the best ways to evaluate shown in early trials to be safe and trigger an immune response fectiveness of a new vaccine; in this case researchers hope to get expects that frontline hospital and burial workers will get the ily members and other close contacts of infected patients in an In Liberia, which has had the highest number of deaths from Ebola, the model will be a classic randomized control trial, with groups of people at risk of exposure selected at random to re against a control group thats been inoculated with a compari try who have exposure risk will receive one of the two vaccines on a staggered schedule, called a stepped wedge will be stopped and the successful vaccine will be given to all 2014 with colleagues from around the world was wearing on -


6 Kris Hundley Though there had been about 30 outbreaks of Ebola since where poverty and civil wars have weakened the public health with epidemics, Longini and his colleagues at EPI also know the threat and have recommended against what might seem ders, indiscriminate quarantining of health-care workers, and widespread airport screening of passengers, they argue, might Eben Kenah, an epidemiologist and biostatistician at EPI, r e members crossing the border between India and Bangladesh Kenah, who is studying the potential for transmission of computer models for a living, you develop an intuition for what


The Disease Detectives 7 Draconian r esponses to disease outbreaks will trap people in place, encourage people to lie and make it more complicated Pigs, Ducks, Birds, and a Deadly Virus strain of viral encephalitis traditionally has been transmitted virus from the pig that can cause severe neurological damage Muslim country where the pig population is minimal? On the other side of Pulliams graphic are possible answers: drawings of ducks, pigeons, and chickens that, in lab tests, have most important, whats the best way to control this disease? Health before coming to UF in 2011, has spent a couple of years But recently shes been sidetracked by a more pressing issue: In mid-October, she was one of the authors of a letter in the Lancet, a leading medical journal, that posed this question: What about the people who are infected with the Ebola virus but do not get sick?


8 Kris Hundley from future infection? If youre in public health, you generally dont care about the a barrier of people with immunity around the ill, which could Pulliam had worked on Ebola following pr evious outbreaks More recently, she and the coauthors of the Lancet letter reviewed studies from earlier Ebola outbreaks and estimated that somewhere between 20 and 60 percent of Ebola virus infections Pulliam said she and her coauthors, led by postdoctoral fel article in part so that people designing clinical trials of the new Ebola vaccines, including EPI colleague Ira Longini, would take We want the clinical trials to include baseline blood sam plingtaken before participants are given the vaccinebecause its important to know how many people have been infected In a separate interview Longini was unable to say how is sues raised in the Lancet But Pulliam said the authors have received some interest from researchers in Dallas who are discussing plans to test peo Pulliam said being at EPI has given her both the time and the


The Disease Detectives 9contacts to pursue questions like the ones raised in the Lancet UF is one of the few places in the country wher e you have colleges of medicine, veterinary medicine, agriculture, and public health, plus a great basic biology department, right here Tick Patrol who has studied diseases ranging from dengue fever in Bra Were going to track the distribution of ticks in Florida and roparasites including viruses, so lets go get the ticks and see ida Keys to sand-loving dog ticks in the Panhandle, the project will catalogue previously unknown disease threats and propose In addition to addr essing a compelling public health issue,


10 Kris Hundley grind them up and do wet lab work to identify the microor ganisms, then theyll do computer modeling showing where were at most risk for an outbreak of Lyme disease up to a year geography, including soil types and forested areas, to pinpoint where the black-legged ticks that carry the disease would be We were able to show that one area of the county had 20 times the risk of Lyme disease because of the land cover, Hired under UFs Preeminence Plan, funded specially by is enthusiastic about making the sophisticated research being can forecast viral outbreaks and, most critically, intervene early In the Baltimor e tick project, for instance, his model made it possible for the makers of a vaccine against Lyme disease to


The Disease Detectives 11 predict dengue fever outbreaks by testing mosquitos for the vi for the virus but not be carrying enough of it to transmit to hu lic health system in Ukraine was put on hold in February 2014 who was impressed by the resourcefulness of Ukrainian scien Its the quality and quantity of people here that brought me to Cholera and Superbugs EPI, has a bright pink sticky note on the cabinet above his com


12 Kris Hundley Haiti, but it still survives in the water, is the danger of epidemic over? tor as well as scientists in Haiti, who have been working on this destroyed the countrys already fragile water and sanitation the bacteria from early cholera cases there only to discover it Using samples of the bacteria fr om both cholera victims and tracked its continuing evolution through sequencing of its ge showing how the bacteria has mutated over time and been There are fewer clinical cases now, but were still able to re is will Haiti be able to eradicate the disease or will the environ ment serve as a reservoir for future outbreaks?


The Disease Detectives 13 The answer he and other researchers hope, will help Haitian between EPI and the Haitian government is improved monitor ing of wells that were built by foreign aid groups after the 2010 The easiest thing for an outside group to do is build wells, been working at the Florida Department of Health in Duval responsible for more than 80,000 infections and 11,000 deaths in His detective work starts in the lab, analyzing samples of the bacteria, which mutates as it reproduces, to identify the rela We wanted to identify it down to its social security number


14 Kris Hundley teen cases originally suspected to part of the same outbreak in ing patterns of the neonatal unit and even the location of the introduced from patients, visitors, and family members who innocuously harbor the bacteria and unsuspectingly spread them to neonates who are highly susceptible to severe infec By analyzing 24 months of Florida data on retail and mailages one to four had the highest rate of antibiotic prescriptions, nearly double the state average, equating to two antibiotic pre has shown that up to half of all antibiotics are unnecessarily The hypothesis is that ther es an association between the rates of antibiotic prescribing and the prevalence of antibiotic


The Disease Detectives 15Stopping the Flu at HomeIn the 1980s, long before he was designing trials for Ebola vac cines, EPIs Ira Longini created a computer model that pre dicted if a community simply vaccinated 70 percent of its school It was the same thinking that had led to the eradication of mass of those most likely to transmit the disease, in order to nize enough school children to prevent them from carrying the cination program led by a team of EPI researchers in collabora raise the vaccination rate among the countys school-age popu in public health, to run the program and build community sup -


16 Kris Hundley countless hours every year at back-to-school fairs and school car lines, talking to parents and encouraging them to get their program, EPI interns go to elementary schools dressed in bright The inoculations, using a nasal spray vaccine pr ovided by the county health department, take place in October, with the cine and administrative costs per student, part of which is re higher than the national average: close to 65 percent among elementary school students, 50 percent in middle school, and reports show vaccination rates among privately insured chil Working with her advisors at EPI, Tran recently had a paper published in PLOS ONE an open access medical journal, on


The Disease Detectives 17 have a big impact on the number of people over 65 who came Tran hopes the PLOS ONE article sparks more discussion coordination among the handful of existing programs around healthy school children based on the result of computer models its with public health departments or private companies that


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