As the weather gets warmer and schools wind down for the year, many around the metro Atlanta area begin making plans for summer vacation and travel.
Eco-touring or â€œgiving backâ€ trips have become popular, as have mission trips to developing and underserved countries. Both types of travel can enrich the lives of the travele rs and give a vacation experience. But before boarding the plane or boat, experts say donâ€™t forget pre-travel care and immunizations.
Emory’s TravelWell clinic, located at Emory University Hospital Midtown, provides pre-travel care before journeying abroad, including a travel health education, immunizations, as well as medications, if illness occurs while traveling. The clinic also offers post-travel care, if needed, once back home.
Phyllis Kozarsky, MD
Phyllis Kozarsky, MD, medical director of TravelWell, says, â€œTravelers need to get the proper travel health education, including immunizations and prophylaxis medications, to safeguard themselves against preventable diseases and illness before leaving the country.â€
The clinic has been caring for local travelers for 22 years â€“ missionaries, families, students, educators and business men and women traveling abroad, many for extended stays. It also cares for immigrants and refugees coming into the country who need these services.
Dr. Carlos del Rio possesses a keen view of how the novel H1N1 virus emerged last spring. Del Rio was in Mexico as the virus established itself south of the border. Its rapid, far-reaching spread marked the first influenza pandemic of the 21st century.
During Emoryâ€™s fifth annual predictive health symposium, “Human Health: Molecules to Mankind,” del Rio discussed his experiences in Mexico, what weâ€™ve learned, and what novel H1N1 has to do with predictive health.Â View a video of his presentation and five lessons learned.Â
Only a day after the virus was identified, on April 23, Mexican authorities closed schools, called off sporting events, and canceled religious gatherings. Known as â€œsocial distancing,â€ these actions led to a decrease in cases, an important lesson, says del Rio. The public knew what to do, they were cooperative, and whatâ€™s more, they applied a lot of peer pressure when it came to hand washing and sneezing hygiene.
Another lesson learned: preparation paid off. Anticipating a pandemic, The World Health OrganizationÂ had earlier mandated that countries draw up influenza pandemic plans. â€œThose plans were incredibly helpful in getting people to work together, communicate, and know what to do,â€ says del Rio.Â Interestingly, the plans in Mexico and the United States were aimed at a virus projected to originate from an avian source from southeastern Asia. â€œIt was not developed for a swine virus coming from inside the country,â€ explained del Rio.
Novel H1N1, even though itâ€™s thought of as a swine virus is in fact only about 47% swine–30% from North American swine and 17% from Eurasian swine. The virus also contains human and avian strains. Thatâ€™s important, says del Rio, because the characteristics of its genes determine how symptoms, susceptibility, and immunity manifest themselves.
â€œWhat weâ€™re seeing nowadays is the new strain has crowded out the seasonal influenza virus,â€ he says. Thus far, most of the deaths from novel H1N1 have been in children, young adults, and pregnant women. â€œThe people who are dying are a very different group than in previous flu seasons,â€ says del Rio.Â
Carlos del Rio, MD
Del Rio says a lot was learned early on about the novel virus thanks to frequent and transparent international communication. This flu pandemic is really the first to occur in this era of 24-hour newscasts and the Internet. So thereâ€™s a challenge for health workers: how do you continue to communicateÂ in an effective way. â€œOne thing you say one day may be contradicted the next day because you have new information. How do you make people understand that you werenâ€™t lying to them before, but you have updated information and that information is continuously changing.”
In trying to predict whatâ€™s in store for the current flu pandemic, researchers are looking back at past pandemics. Last century, there were three major flu pandemics. The largest and most important was the 1918 pandemic.
â€œA couple of things that happened back then are very important: one was there was a second wave that was actually much more severe and much more lethal than the first one.â€ says del Rio. â€œAnd over the summer, the virus actually changed. It started very much like it did this time. It started in the spring and then we had a little blip, and then we had a big blip in the second wave, and then almost a third wave. So, clearly influenza happens in waves, and weâ€™re seeing the same thing happening this time around.â€
Del Rio is uniquely equipped to address HIV prevention and intervention. As the former chief of medicine at Grady Memorial Hospital, Atlantaâ€™s safety-net hospital, he witnessed firsthand patients affected by the disease. He says there ought to be incentives for people to stay healthy instead of barriers to staying healthy.
More daunting for del Rio is preventing disease on a global scale, much of which rests on changing unhealthy behaviors related to diet, exercise, smoking, and sex. He says we know very little about how to implement population-wide behavior change, and we need to learn more.
Del Rio says growing human capital to strengthen research capacity in resource-constrained countries is also key. Since 1998, the NIH/Fogarty International Center has funded the Emory AIDS Training and Research Program (AITRP) to build capacity in Armenia, the Republic of Georgia, Ethiopia, Mexico, Rwanda, Vietnam and Zambia. Led by del Rio, AITRP brings a select group of young scientists to Emory each year for advanced training. Emory faculty also train and mentor scientists in these countries.
The training program has opened avenues to improving health. In Ethiopia, del Rio helped expand HIV testing among the police force and bring antiretroviral therapy into the community for people living with HIV.
An outbreak of measles in the state of Washington last year sickened 19 children. Of those who fell ill, 18 had something in commonâ€”they were not vaccinated.
Saad Omer aims to increase vaccine compliance to prevent childhood diseases.
For Emory Rollins School of Public Health researcher Saad Omer, the Washington outbreak is a perfect example of the effect on an entire community when individuals are unimmunized. His research aims to shed light on ways to encourage increased vaccine compliance for adults and their children.
Omer says vaccine-preventable diseases such as measles, influenza, and pertussis often start among persons who forego vaccinations, spread rapidly within unvaccinated populations, and also spread to other subpopulations.
In a recent New England Journal of Medicinearticle, Omer and his colleagues reviewed evidence from several states showing that vaccine refusal due to nonmedical reasons puts children in communities with high rates of refusal at higher risk for infectious diseases such as measles and whooping cough.
Even children whose parents do not refuse vaccination are put at risk because “herd immunity” normally protects children who are too young to be vaccinated, who can’t be vaccinated for medical reasons, or whose immune systems do not respond sufficiently to vaccination.
Research findings indicate that everyone who lives in a community with a high proportion of unvaccinated individuals has an elevated risk of developing a vaccine-preventable disease.
Read more about Omerâ€™s research on vaccine refusals in the fall 2009 issue of Public Health magazine.
Omer also discusses the importance of vaccinating against the H1N1 virus in an Oct. 16 article in The New York Times.
â€œA few years ago a decision was made to fund a center for emergency preparedness and response,â€ says Steinberg. â€œHaving CEPAR, headed by Dr. Alex Isakov, gave us a leg up on preparing for this pandemic. Concern about the avian flu a few years ago sparked a pandemic plan and an antiviral plan. Having those plans on board helped us hit the gate running with the swine flu.â€
To listen to Steinbergâ€™s own words about novel H1N1 and its effect on the current flu season, access Emory’s new Sound Science podcast.
An expert in infectious disease, Steinberg says three key factors go into the making of a pandemic. â€œA virus can cause a pandemic when it can cause significant disease, when itâ€™s a new virus to which people donâ€™t have any immunity, and when the virus has the capacity to spread from person to person,â€ Steinberg says. â€œThe novel H1N1 virus appears to meet all three of these characteristics.â€
Steinberg cautions that the word pandemic has a horrible connotation. â€œWe think of the 1918 pandemic that killed 50 to 100 million people worldwide, more people than were killed during World War I itself,â€ says Steinberg. â€œBut there are pandemics in which the bumps in mortality have been modest.â€
The H1N1 virus spreads from person to person via large droplets, the ones that fall quickly onto surfaces. These viruses can be spread by being close to an infected person who is coughing or sneezing or by touching contaminated surfaces. Thatâ€™s why hand washing reduces the chance of infection.
Thus far, the novel strain of H1N1 has been relatively mild. Most of those infected have recovered without hospitalization or medical care, but according to the CDC some groups are at higher risk and should be vaccinated first. These include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years, and people ages 25 through 64 who have chronic health conditions.
Initial supplies of the nasal mist H1N1 vaccine are expected to be available this week, followed soon by the injectable vaccine. The regular seasonal flu vaccine will not provide protection against the novel H1N1 strain, so people will need both vaccines.
The latest CDC statistics on HIV/AIDS estimate more than 1.1 million persons in the United States are living with diagnosed or undiagnosed HIV/AIDS. HIV gradually attacks the immune system and causes AIDS, the final stage of HIV infection.
It can take years for a person infected with HIV to reach this stage. Having AIDS means that the virus has weakened the immune system to the point at which the body has a difficult time fighting infection. Early HIV diagnosis is vital, so people who are infected can fully benefit from available live-saving treatments.
David J. Malebranche, MD
This critical message is the foundation of a new campaign titled â€œTreatment is Power.â€ David J. Malebranche, MD, MPH, assistant professor of medicine at Emory University School of Medicine and internist at Grady Memorial Hospital is an expert voice for the campaign by Gilead Sciences. Listen to Malebranche on a public service announcement (MP3).
Malebranche says opportunity is unique in reaching people living with HIV. It is geared toward reducing the stigma and fear associated with taking medications that slow down the virus and helps individuals realize the many quality of life improvements associated with early treatment.
As a nationally recognized speaker and advocate, the idea that â€œtreatment is powerâ€ is not a new theme for Malebranche. Fostering a close working doctor-patient relationship is one Malebranche aggressively promotes at the Ponce Infectious Disease Center – a local AIDS clinic in downtown Atlanta, where he delivers comprehensive care to uninsured patients living with HIV/AIDS.
He says early treatment is an essential part of the fight against HIV.
From 2006-2008, Malebranche served on the Presidential Advisory Council on HIV/AIDS, which provides recommendations to the President and the U.S. Department of Health and Human Services regarding national and international HIV/AIDS programs and policies. He conducts research exploring the social, structural and cultural factors influencing sexual risk-taking and HIV testing practices among black men.
As Georgia’s immigrant and refugee communities grow, so do Georgia’s cases of infectious tropical diseases. Also known as neglected tropical diseases, these illnesses are endemic in some low-resource countries and cause considerable disability and dysfunction.
Carlos Franco-Paredes, MD, MPH
Carlos Franco-Paredes, MD, MPH, a researcher and clinician at the Emory TravelWell Clinic at Emory’s midtown campus, provides pre- and post-travel health care to international travelers, including faculty, staff, students, business travelers and missionaries. Franco-Paredes, an expert in infectious diseases, also treats immigrants and refugees affected by neglected tropical diseases. He and colleagues recently received funding to study the epidemiology and treatment outcomes of tropical infectious diseases in immigrant and refugee communities in Georgia.
With a grant from the Healthcare Georgia Foundation, Franco-Paredes and his colleagues are assessing the prevalence and the outcomes of hepatitis B, Chagas disease and leprosy.
In fact, the clinic is the main referral center for leprosy in the region, and physicians there currently care for about 25 patients with leprosy, a chronic disease. Most of the cases are found in foreign-born individuals, particularly patients from Central and South America and Asia.
Franco-Paredes’ collaborators include Uriel Kitron, PhD, Emory professor and chair, Environmental Studies, and Sam Marie Engle, senior associate director, Emory’s Office of University Community Partnerships.
To hear Franco-Paredes’ own words about his research into neglected tropical diseases, listen to Emoryâ€™s Sound Science podcast.
A new method of rapidly producing highly targeted monoclonal antibodies could soon be used to rapidly diagnose H1N1 influenza. Just a month after vaccinating people with a seasonal flu vaccine, the researchers were able to use just a few tablespoons of the vaccinated individuals’ blood to generate antibodies against that specific strain of flu. The research was published last spring in Nature.
The scientists believe their discovery could be applied to any infectious disease. By using a few drops of blood from infected people, they could isolate antibodies to rapidly diagnose a newly emerging flu strain such as H1N1.
There are many variations of H1N1, says Rafi Ahmed, director of the Emory Vaccine Center and a Georgia Research Alliance Eminent Scholar, but this technology could be used to identify a very specific strain, such as the one weâ€™re dealing with in the current pandemic. The diagnostic tests available now are not specific to any particular H1N1 strain.
Ahmed and his colleagues, including postdoctoral fellow Jens Wrammert, and Patrick Wilson from the University of Chicago, hope their work will lead to a new, specific test for H1N1 within the next several months.
Conventional methods of making human monoclonal antibodies are time-consuming and laborious, says Ahmed. For example, one method involves sifting through human B cells â€”white blood cells that make human antibodiesâ€”and then looking for specific cells that make the right antibodies.
Not only is the new method quicker and less cumbersome, it could be applied to almost any infectious disease. In any kind of emerging infection, speed is essential, says Ahmed.
To listen to Ahmed describe the new monoclonal antibody method, listen to Emoryâ€™s Sound Science podcast.