Category Archives: Stephen Goldstein

All articles written by Stephen Goldstein

New Podcast: Vincent Munster, Frontline Global Health Scientist

Me Steve Vincent Munster
Me, Steve, & Vincent at the American Society for Virology 2016 Annual Conference, Virginia Tech

Learn what it’s like to be a scientist on the frontlines of viral outbreaks like MERS (Middle Eastern Respiratory Syndrome) and Ebola with our guest Dr. Vincent Munster, Chief, Virus Ecology Unit at Rocky Mountain Labs at the National Institutes of Health. The Virus Ecology Unit combines traditional bench work at their state of the art facilities in Montana with work right where the outbreaks are happening, like Africa, the Middle East, and the Caribbean.  Vincent was on the frontlines of the Ebola outbreak in Africa & was part of the unit to test patients for the virus. His lab also does research into MERS, including a transmission blocking vaccine for camels, and development of mouse & monkey models. We also feature friend & colleague Stephen Goldstein, PhD candidate working on MERS in the lab of Susan Weiss at the University of Pennsylvania. This was recorded at the American Society for Virology annual meeting at Virginia Tech.

Tune in to hear Vincent’s story on what it was like to be a scientist in Africa at the height of the Ebola outbreak and his cutting edge work on MERS. Truly an inspirational scientist who’s focusing on improving global health!

Download the podcast directly here.
Check us out on iTunes here.
Please like PHU on Facebook & Follow us on Twitter!

Links:
1) Viral Ecology Unit NIH profile (includes more info on Vincent)
2) NIH Laboratory of Virology, Heinz Feldmann, Profile
3) Centers for Disease Control info page on MERS
4) World Health Organization info page on MERS
5) MERS & Camels summary by Vincent Racaniello
6) Susan Weiss Faculty Page, Penn
7) CDC “About Ebola”
8) Ebola Outbreak Map 2014

Me Steve Vincent Munster night

 

 

New podcast! Stephen Goldstein On MERS & the American Society for Virology Meeting

Steve GoldsteinIn our latest podcast, Nina meets up with former Hopkins colleague Stephen Goldstein at the 2015 American Society for Virology (ASV) meeting in London, Ontario, Canada. Stephen is now a PhD Candidate at the University of Pennsylvania in the lab of Dr. Susan Weiss and studies Middle East Respiratory Syndrome (MERS) coronavirus.  Stephen and Nina talk about ASV, the MERS outbreak and the coronavirus research community, and how to build your Twitter following. Stephen also tells us about his non-traditional path towards obtaining a PhD and studying MERS-CoV.

You can access the podcast by clicking here or by subscribing on iTunes. You can also check out our app for easy access on the go.

Show links:
– Great open access review on the MERS outbreak
– Check out Dr. Weiss’ Penn profile here
– “Assessing the Science of Ebola Transmission” by Stephen Goldstein in The Atlantic
- “Middle East respiratory virus came from camels, not terrorists” by Stephen Goldstein in The Conversation
- “Why people without symptoms aren’t going to give you Ebola” by Stephen Goldstein in The Conversation
American Society for Virology and the 2015 meeting in Canada
– National Academy of Sciences: Science & Entertainment Exchange

 

HIV vaccine failure: What does the future hold?

A major HIV vaccine trial has been suspended due to concerns that recipients of the vaccine may have been at increased risk of contracting HIV. This is the second time a trial with this vaccine-design has been suspended for similar reasons. This vaccine was made of an adenovirus-5 virus genetically engineered to express HIV proteins. When administered, researchers hoped recipients would develop an immune response against the HIV proteins, and become immune to infection with HIV. In human trials, recipient groups are followed after vaccination, and the incidence of new HIV infections in the recipient groups is compared with the incidence in a group that did not receive the vaccine.

In the most recent trial 392 individuals received the vaccine, of which 21 went on to contract HIV. In contrast, 386 people received a placebo, and only 9 contracted HIV. Researchers found these results to be statistically significant, and were therefore ethically obligated to stop the trial immediately.

This represents a significant blow for adenovirus-5 based vaccines. One of the problems may be that most people are exposed to adenovirus-5 earlier in life, as it is responsible for many common colds. More than 80% of sub-Saharan Africans, one of the most at-risk populations has pre-existing immunity to adenovirus-5.

One hypothesis for why this phenomenon has been observed is that vaccinating individuals with an adenovirus-5 based vaccine may stimulate a strong immune response among those with prior immunity. HIV preferentially infects activated T-cells, so the response to adenovirus-5  may expand the pool of HIV-susceptible cells. Whatever the exact biological reason, adenovirus-5 may be off the table as a vaccine vector.

Fortunately, HIV vaccines with different designs are in development or in clinical trial, such as those based off of vaccinia virus, alphaviruses, and human cytomegalovirus, which in monkeys actually led to complete elimination of the virus, which has not been seen before.

The latest results raised a critically important ethical question. The first is whether we need to suspend trials of new HIV vaccine designs until we better understand what has happened with these vaccines. It’s simply unacceptable to immunize people with a vaccine that may increase their risk of contracting such a serious disease. More attention could be paid to therapeutics while this goes on, as we know how to control HIV, but still have no way of curing infected individuals in a practical way.

Let us know what you think!

Scary monkey viruses? No, not really

An article published in US News & World Report last week on an exciting possible therapy for Ebola virus disease contains some of the worst scientific misinformation we’ve yet come across. Worse, the author, Jeff Nesbit, links to a similar article he wrote last year for US News & World Report, disseminating the same nonsense.

Last week’s article is ostensibly about a new antibody-based therapy for Ebola virus infection developed by U.S. military scientists. This therapeutic candidate, an antibody cocktail that cured several monkeys suffering from Ebola virus disease, truly is an exciting scientific discovery. Both articles, however, go on to discuss something even more frightening than Ebola, the threat of Simian hemorrhagic fever virus  (SHFV), jumping from non-human primates to people.

There are several problems with both the fearmongering premise and Nesbit’s background information. Nesbit starts his SHFV rant by discussing previous jumps of viruses from animals to humans like this:

 “Deadly, virulent viruses have jumped species from nonhuman primates such as chimpanzees to the human species three times in history: the SIV virus that almost certainly led to the worldwide AIDS pandemic, the SV-40 “cancer” virus that was accidentally included in polio vaccines in the 1950s, and the deadly Ebola virus.”

 This is bad, bad science writing, with some truth buried within wildly inaccurate history. It’s true that HIV is derived from simian immunodeficiency viruses, but that’s about as far as this paragraph gets without going off the rails. SV40 virus is indeed a simian virus that may have come to infect humans. We know, for example, that old polio vaccine stocks were contaminated with this virus, and that SV40 has been shown to cause cancer in small lab animals. Calling it the “cancer” virus, however, is inaccurate and inflammatory. Studies in the U.S. and Denmark, along with a larger analysis by the National Cancer Institute, have found no evidence that SV40 causes cancer in humans. Finally, we come to the easiest allegation to knock down, that Ebola virus jumped from non-human primates to people. In fact, the strongest evidence we have suggests that fruit bats are the reservoirs of Ebola and other similar viruses. It’s true that Ebola virus infects non-human primates in the wild and in captivity, but the source of any particular Ebola outbreak has never been identified, and it is decidedly not a virus harbored by primates.

It also needs to be point out that while the article rattles off two terrible examples of viruses that have crossed from animals into people, saying it’s happened three times in history is just silliness. It’s actually estimated that up to 75% of emerging diseases in humans came from animals. The list includes, aside from Nesbit’s three examples, Nipah virus, influenza viruses, rabies virus, and West Nile virus. We could go on, but won’t.

Next on the author’s agenda is convincing you that SHFV might be the next human plague:

“Because it is a close cousin to Ebola, biodefense researchers are also looking at SHFV. Both Chinese and U.S. researchers assume, for now, that it might be benign and a way to study the Ebola virus. And if it jumps to the human species — just as SIV, SV-40 and Ebola did — then the human species is nearly defenseless against it.”

From the top, SHFV actually is not a close cousin of Ebola at all. They cause a somewhat similar disease, but are virologically quite distinct. They share neither, a species, genus, family, or order. SHFV is an arterivirus, whereas Ebola is a filovirus. They have nothing in common in terms of shape or genome structure, and have drastically different replication cycles. SHFV is studied because the course of disease is similar, but it’s in fact a well-known virus, prized in the lab specifically because it does not infect humans, or human cells in the lab.  There’s really no reason to consider SHFV an impending threat,  and, accordingly, it’s studied in low biocontainment facilities. It’s true that we would be immunologically defenseless against SHFV were it to infect humans, but that’s true of most emerging pathogens, and not unique to this situation at all. We at PHU would never sit here and say SHFV could never infect a human, as viruses do make the species jump, as we’ve seen. But you can bet that for the virus to be studied in low containment that the risks have been evaluated, and the focus here should be on how SHFV can help us understand and treat disease in humans, not how it might make us sick itself. The article does close this way:

“And if it jumps to the human species — just as SIV, SV-40 and Ebola did — then the human species is nearly defenseless against it. But if it doesn’t — or can’t — jump from primates to us, then it just as equally could hold the key to a defense against the quite deadly Ebola virus.”

So he’s reined himself in at the end. We think it’s too late though; there didn’t need to be even a sentence suggesting you should fear SHFV. And the author certainly didn’t need to lump SV40 in with SIV and Ebola again, considering it’s never made someone sick. This is just the kind of article that makes us bang our heads on our desks, so we decided to make ourselves feel better by making sure you don’t believe more than a word or two of it. If you do want to learn more about the new Ebola therapy US News ostensibly reported on, here’s a much better article from NBC. It’s actually quite cool. The actual article in Science Translational Medicine can be found here.

-Steve

Politics, Warlords, and Polio

Lost in the frequent media coverage of emerging disease such as H5N1 and H7N9 flu, along with MERS-CoV, is the return of an old and deadly human disease, polio, in places it normally doesn’t belong. As The New York Times reports today, polio is making a comeback in Central Asia and the Horn of Africa. As of 2013 polio is considered endemic in only three countries, Afghanistan, Pakistan, and Nigeria. However, the number of cases in other countries has risen markedly this year.

Pakistan, which had reported 29 cases of polio by this date in 2012, is actually slightly behind that pace this year, reporting 24. However, these cases are occurring in areas from which vaccination teams have been barred by Taliban-associated warlords. Additionally, multiple instances of violence against polio vaccinators have been reported. Vaccinators have been barred from these areas following the revelation that the CIA previously (an ill-advisedly) conducted a vaccination campaign with the express purpose of collecting DNA from Osama bin-Laden’s purported children. Not only did it not work, but the doctor who ran the campaign is in jail, and it has cost tens of thousands of children access to polio vaccine. Consider it a warning against the political manipulation of  public health campaigns, particularly ones with such high stakes.

Where polio is really surging, however, is in in the Horn of Africa. In 2012 Kenya, Somalia, and Ethiopia recorded a total of zero polio cases, while this year they have reported 121, with 108 of those in Somalia. Evidently this is due to al-Shabbab militia leaders barring vaccination teams from carrying out their functions; the reasoning seems to be vague. Whatever the reason, the result is that 192 cases of polio have been reported worldwide in 2013 compared to 105 by this date in 2012. The threat may seem confined to countries you’ll never visit, but it’s not. Just this year poliovirus has been repeatedly detected in Israeli sewer systems, indicating that the virus is circulating there. So far no cases of poliomyelitis have been identified, and Israel has the resources and will for a mass re-vaccination campaign. Nevertheless, this incident makes clear that if polio still lurks in the developing world, it’s really just on our doorstep.

The World Health Organization was due to announce a new polio eradication target date of 2018. That target date may be in jeopardy if vaccination teams continue to be barred from critical areas in Pakistan and Somalia. However, you can find all the information on the eradication campaign here, along with surveillance data from 2012 and 2013.  The WHO fact sheet on poliovirus and poliomyelitis can be found here. For particularly detailed information on the disease, virology, and epidemiology of polio, the CDC is, as always, an excellent resource. Their polio page can be found here.

-Steve

What does mosquito season mean for you?

With summer well under way and mosquitos out in force, this is the time of year when public health professional start to worry about mosquito-borne diseases. The world’s most famous and deadly mosquito-borne disease, malaria, isn’t a problem here in the U.S., but others are. Eastern equine encephalitis virus, La Crosse virus, St. Louis encephalitis virus and others all caused multiple cases of encephalitis last summer, but West Nile virus remains the leading cause of viral encephalitis nation-wide, which was heavily covered in the media in 2012.

Last year was particularly notable for the number of West Nile virus cases recorded, causing 5,674 of the 5,780 mosquito-borne illnesses reported to the CDC in 2012. Of these 5,674, 2,969 (51%) were designated as neuroinvasive, meaning encephalitis or other neurological complications. 270 patient with neuroinvasive West Nile virus disease died (9%), representing a high mortality rate for viral infection. Considering that less than 1% of West Nile infections are believed to result in neuroinvasive disease it’s certain that non-neuroinvasive disease were drastically underreported, and more than 100,000 people may have actually been sickened by West Nile virus.

Now, all of that sounds quite frightening, but public health professionals are doing everything they can, and telling you what to do, to minimize the chance of this happening to you. County and State public health departments have already started conducting extensive surveillance, trapping and testing mosquitos for West Nile virus. When the virus is detected, local communities often commence pesticide spraying to kill adult mosquitos capable of transmitting the virus. If this kind of spraying is going to be conducted in your community, you WILL be notified and, although pesticides are generally not harmful to people, you’ll be advised to stay inside during praying out of an abundance of caution.

That’s what the government is doing, but there’s plenty you can do too. You can help with surveillance by reporting any dead birds you come across to local health departments, as these may indicate circulating virus in the area. A critical measure you can implement at home is regularly emptying standing water from birdbaths, kiddie pools, unused tires and any other receptacle where water accumulates. These objects are prime mosquito breeding grounds, and failing to keep them clean will absolutely lead to more mosquitos around your house. Keep down the number of mosquitos, and you keep down the risk of West Nile infection.

There’s also plenty you can do to protect yourself and your family. Wearing inect repellant containing up to 50% DEET is always important when spending time outdoors in the summer, and for instructions on proper application and safety information, the CDC website is very informative. Additionally, while a burden, wearing long sleeves and pants offers additional protection. The CDC recommends it, but we all know most people aren’t listening to that advice, especially me. Insect repellant is the practical way to go here.

You will likely start to see West Nile virus mentioned in the media more and more over the next few weeks and months, particularly if this season looks like last season. However, keep in mind the chances of being infected are low, and only 20% of infected people get sick at all! Less than 1% of these will get neuroinvasive disease. With the highest risk part of the year approaching it is worth your time to learn what the symptoms of West Nile infection are (flu-like), and what to do if you suspect you or a family member has West Nile virus disease (call your doctor immediately). For more detailed information, look to the CDC West Nile virus page.

The important thing is to be aware of what you can do to protect yourself from mosquito bites, and get out and enjoy the summer. West Nile virus infection is serious, but it shouldn’t keep you out of the pool, off the golf course, or away from the beach.

-Steve

When the media goes out of its way to scare you

This week a new paper was published reporting the results of a study on H7N9 influenza virus transmission among ferrets.  Ferrets are frequently used as an animal model of influenza transmission among mammals, but claims that they are truly predictive of what will occur in humans are false.

NBC News, however, doesn’t necessarily want you to know that. They have published an article about this new study titled “H7N9 bird flu spreads much like ordinary flu”. Seasonal influenza viruses, and the 2009 H1N1 pandemic virus both spread readily through the air in both humans and ferrets. However, the H7N9 virus used in this new study spread readily only between ferret kept in the same cage. Of three ferrets in a nearby cage, all showed signs of illness, but only 2 produced antibodies and only 1 shed virus in nasal secretions, which is required for further transmission. This was despite directed airflow from the infected ferrets to the nearby cage, a situation obviously not replicated in the real world. In addition, transmission between pigs was inefficient, along with transmission between pigs and ferrets.

By way of comparison, when the 2009 influenza virus was used, all three ferrets in the nearby cage became infected, produced antibodies, and shed virus in nasal secretions. Therefore, the claim that avian H7N9 virus transmitted in the same way as a human influenza virus is demonstrably false. In essence, the study confirmed what we have already observed about H7N9 in humans. Mammals in extended, direct contact with each other (such as family members or ferrets housed together) can transmit the virus. People in casual contact likely don’t.

To be fair, the NBC article makes this clear within the body of the article, but their headline writers went way overboard, in a way that seems designed to frighten. For a more detailed explanation of why this new study shouldn’t alarm us, visit Vincent Racaniello’s virology blog. The H7N9 virus could certainly mutate to transmit more efficiently between people, but this latest study is a long way from showing that it already has that capability.

Stay tuned to PHU for more information on influenza in the near future, including virus biology, mutation, disease, treatment and pandemic potential.

-Steve

 

News and Notes

With everyone in PHU-land pretty busy now, we wanted to post some snippets of the latest news along with some brief (and we mean brief) analysis and direct you where to go to learn more.

NIH has released details of the federal budget sequester impact, and it isn’t pretty. The overall budget has been cut by 5%, and almost 1,400 awarded grants are being canceled, 700 of which would have funded completely new research. Additionally, continuing grants may be cut up to 10%, and will no longer be increased annually to keep pace with inflation.

The novel coronavirus (nCoV) that emerged last year is back in the news just as the H7N9 outbreak in China seems to be waning. Although it has caused many fewer cases than H7N9, nCoV has killed 50% of patients (20/40) and seems more transmissible between people. The latest cases include two healthcare workers who became sick after treating a patient confirmed to have nCoV. Transmission to healthcare workers is always a concern with emerging disease outbreaks, as it demonstrates transmissibility and opens the door to possible hospital-associated amplification of the outbreak. The CDC has extensive information on this outbreak and on the virus behind it. (Update-proposed official name: Middle Eastern Respiratory Syndrome coronavirus—MERS-CoV)

Angelina Jolie’s double mastectomy made headlines this week, as she made a brave, and increasingly common decision to undergo this major preventive procedure after finding out she was genetically predisposed to developing breast cancer. On the scientific side, this represents a fantastic collaboration of genetics and clinical medicine. The bigger question is should all women have this option? Testing for the gene mutations Angelina Jolie carries costs $4,000, and is only covered by insurance in “high risk” women, those over 45 and with multiple breast cancer cases in their families. This will only become a bigger issue as we associate more and more disease with particular genetic mutations.

Also in the news is that suicides by active members of the military and veterans are at record levels. The timeline of this increase coincides with increased incidence of concussion and other traumatic brain injury due to the wars in Iraq and Afghanistan. However, the suicide rate also highlights the lack of access to mental healthcare for many Americans, both veterans and not.

Finally, and likely of interest to many of you, new research also identified a link between prescription painkiller use and erectile dysfunction. If you needed one more reason to only take narcotics as closely directed by a doctor, there it is.

-Steve

Can Federal Budget Cuts Make You Sick?

The answer is…they sort of might. The New York Times reported today that safety inspections of imported foodstuffs have declined markedly over the last several years. Both the USDA, which inspects meat and poultry, and the FDA, which inspects everything else, have been hit hard by budget cuts.

USDA inspections were spared in the recent budget sequester, but budget cuts in previous years have taken a toll, with an 18% decrease in funding for foreign inspections since 2010. In 2009 the USDA conducted inspections in 32 countries, and per today’s New York Times article, that number is now down to 10. Similarly, the FDA is able to inspect only 2.3% of the food shipped here from abroad every year.

Can this affect you? It very well might. According to this report, the CDC determined that foodborne disease outbreaks were more than twice as common between 2005 and 2010 compared to 1998 and 2004. Outbreaks of foreign origin figured prominently in these incidents. Just within the past two years a salmonella outbreak traced to Mexican cucumbers sickened 73, and Mexican papayas, Guatemalan cantaloupes, and Turkish pinenuts have also been implicated. Additionally, 2.5 million pounds of Canadian beef reached the U.S. market in 2012.

We at PHU have talked a lot about the importance of both basic and applied science research towards fighting disease, but funding programs like food safety are just as important, especially in the near term. Bird flu and novel coronaviruses can sound frightening, but we are all a lot more likely to get sick from our food, a risk that increases as safety inspections become more infrequent. As basic science researchers we are often inclined to focus on recent hits to the NIH or CDC budgets, but as our latest podcast should make clear, public health policy decisions can be just as impactful. No one should die because of something in his or her food; let’s hope Congress hears that message as well.

-Steve

Are we close to curing AIDS?

This week the New York Times published an excellent article putting in context many of the recently reported breakthroughs on HIV/AIDs research. The article details three exciting developments in HIV research that have occurred over the last few years.

One of these is the famed Berlin patient, actually a 46 year-old American named Timothy Ray Brown. Mr. Brown was already HIV+ when he was diagnosed with leukemia and received in a bone marrow transplant in Berlin in 2008. Mr. Brown’s bone marrow donor happened to have a rare genetic mutation that makes his cells resistant to infection by HIV. Mr. Brown, following the transplant, has reaped this benefit, and is HIV and symptom-free five years later, and with no anti-retroviral treatment.

The second development detailed was the “functionally cured” baby described in a PHU post by Nick last month. This baby was born HIV+ but immediately given anti-retroviral therapy. Almost a year later without continued treatment, the baby remains virus-free. The third development came out of France last year when 14 individuals were identified as HIV-free two years or more after stopping treatment. All of these reports demonstrate that the outcome of interaction between HIV (or any virus) and the host is always defined by the unique genetics of each individual, as well as by the virus.

Current anti-retroviral treatment can target many stages of the HIV lifecycle, but the goal is to prevent replication of the virus. We still don’t know how to train the immune system to kill infected cells that constitute the reservoir of HIV in a host. Understanding how the immune systems of these individuals not only prevented HIV replication but actually cleared the virus may allow us to adapt these strategies for use in the vast majority of HIV+ individuals who will require lifelong anti-retroviral therapy. Funding this kind of basic research and applying its findings to the clinic may, one day, save millions of lives.

-Steve