Two items relevant to long COVID

One of the tricky issues in studying in long COVID is: how widely do researchers cast their net? Initial reports acknowledged that people who were hospitalized and in intensive care may take a while to get back on their feet. But the number of people who had SARS-CoV-2 infections and were NOT hospitalized, yet experienced lingering symptoms, may be greater. A recent report from the United Kingdom, published in PLOS Medicine, studied more than Read more

All your environmental chemicals belong in the exposome

Emory team wanted to develop a standard low-volume approach that would avoid multiple processing steps, which can lead to loss of material, variable recovery, and the potential for Read more

Signature of success for an HIV vaccine?

Efforts to produce a vaccine against HIV/AIDS have been sustained for more than a decade by a single, modest success: the RV144 clinical trial in Thailand, whose results were reported in 2009. Now Emory, Harvard and Case Western Reserve scientists have identified a gene activity signature that may explain why the vaccine regimen in the RV144 study was protective in some individuals, while other HIV vaccine studies were not successful. The researchers think that this signature, Read more

public health

Predictive Health: Lessons learned from H1N1

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 Emory’s fifth annual predictive health symposium, “Human Health: Molecules to Mankind,” del Rio discussed his experiences in Mexico, what we’ve learned, and what novel H1N1 has to do with predictive health. View a video of his presentation and five lessons learned. 

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 “social distancing,” these actions led to a decrease in cases, an important lesson, says del Rio. The public knew what to do, they were cooperative, and what’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 Organization had earlier mandated that countries draw up influenza pandemic plans. “Those plans were incredibly helpful in getting people to work together, communicate, and know what to do,” says del Rio.  Interestingly, the plans in Mexico and the United States were aimed at a virus projected to originate from an avian source from southeastern Asia. “It was not developed for a swine virus coming from inside the country,” explained del Rio.

Novel H1N1, even though it’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. That’s important, says del Rio, because the characteristics of its genes determine how symptoms, susceptibility, and immunity manifest themselves.

“What we’re seeing nowadays is the new strain has crowded out the seasonal influenza virus,” he says. Thus far, most of the deaths from novel H1N1 have been in children, young adults, and pregnant women. “The people who are dying are a very different group than in previous flu seasons,” says del Rio. 

Carlos del Rio, MD

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 there’s a challenge for health workers: how do you continue to communicate in an effective way. “One thing you say one day may be contradicted the next day because you have new information. How do you make people understand that you weren’t lying to them before, but you have updated information and that information is continuously changing.”

In trying to predict what’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.

“A 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.” says del Rio. “And 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 we’re seeing the same thing happening this time around.”

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Costs will rise as rates of obesity in the U.S. grow

Today’s news points to a study on projected obesity costs released by Kenneth E. Thorpe, PhD, Robert W. Woodruff professor and chair of health policy at Rollins School of Public Health, and colleagues from Emory. The unique study departs from looking at historical costs of obesity and uses an econometric model developed by Thorpe and team to estimate the growth of health care costs over time that are linked to changes in obesity rates.

Obesity costs rising

Obesity costs rising

Using nationally representative data on adults, the study estimates the effect of the increasing prevalence of obesity on total direct health care costs in the next decade. The report is titled “The Future Costs of Obesity: National and State Estimates of the Impact of Obesity on Direct Health Care Expenses.”

The report was commissioned by three groups – the UnitedHealth Foundation, the Partnership for Prevention and the American Public Health Association – in conjunction with their annual America’s Health Rankings report.

Major findings from the report include:

  • Obesity is growing faster than any previous public health issue our nation has faced. If current trends continue, 103 million American adults will be considered obese by 2018.
  • The United States is expected to spend $344 billion on health care costs attributable to obesity in 2018 if rates continue to increase at their current levels. Obesity‐related direct expenditures are expected to account for more than 21 percent of the nation’s direct health care spending in 2018.
  • If obesity levels were held at their current rates, the United States could save an estimated $820 per adult in health care costs by 2018 ‐ a savings of almost $200 billion dollars.

Thorpe says, “At a time when Congress is looking for savings in health care, this data confirms what we already knew: obesity is where the money is. Because obesity is related to the onset of so many other illnesses, stopping the growth of obesity in the U.S. is vital not only to our health, but also to the solvency of our health care system.”

The Partnership to Fight Chronic Disease, co-directed by Thorpe, says that a top priority must be addressing the obesity epidemic through meaningful, evidence-based approaches, including:

  • Removing barriers and empowering Americans to take control of their health.
  • Educating Americans to see being obese as a serious medical condition that significantly heightens their risk for other health problems
  • Ensuring that fear about the stigma of obesity does not eclipse the need to combat it
  • Redesigning our health care system to treat obesity like a preventable medical condition
  • Engaging employers and communities to get them invested in promoting wellness

Follow Thorpe on his Health Reform Blog.

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Managing heart disease and diabetes in South Asia

Illnesses such as diabetes and heart disease are affecting increasing numbers of young people in developing countries. In light of this worrisome trend, K. M. Venkat Narayan, MD, and his colleagues are launching a new center of excellence aimed at preventing and controlling heart disease and diabetes in India and Pakistan.

K.M. Venkat Narayan, MD

K.M. Venkat Narayan, MD

It’s essentially a center of excellence for cardiac metabolic disease prevention and control in South Asia with Emory playing a very important role in the project, says Narayan, professor of global health and epidemiology at Emory’s Rollins School of Public Health and professor of medicine in Emory School of Medicine.

The primary partner of this grant will be the public health foundation of India, New Delhi. Emory is the developed country academic partner working with other network partners, namely, the Madras Diabetes Research Foundation in Chennai, India and the Aga Khan University in Karachi, Pakistan.

The center will focus on surveillance, prevention of mortality stemming from cardiovascular disease and diabetes, and training young investigators in the field of diabetes and cardiovascular disease prevention and control.

It’s estimated that by 2030, the number of people with diabetes will reach 400 million worldwide, double today’s number, says Narayan. Cardiovascular disease is a major cause of death among people with diabetes with 80 percent of deaths from chronic diseases worldwide occurring in low and middle-income countries.

What is particularly worrying about developing countries is that diseases like diabetes are hitting younger people, says Narayan. The implications, he says, are young people who would otherwise be economically productive must leave the labor market. In addition, in India, one person having diabetes uses 25 percent of the family’s income just for his own treatment. The economic impact and the health impact are enormous, says Narayan. Read more in Emory Public Health magazine.

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Students and faculty aid CDC for H1N1 response

Last spring, as H1N1 avian influenza spread across the globe, the Centers for Disease Control and Prevention put out a call asking students to assist. Within three days, 85 students from Emory’s Rollins School of Public Health (RSPH) had volunteered.

RSPH students Nick Schaad (left) and Michael Marrone

RSPH students Nick Schaad (left) and Michael Marrone

Nick Schaad was among the students authorized to help man the CDC’s Emergency Operations Center at the height of the novel H1N1 outbreak. Once the CDC began to identify influenza clusters, students began conducting phone surveys.

Schaad says he was involved in the St. Francis prep school survey in New York. Students and staff member who were sick with any flu-like symptoms were identified. The team called them and asked about the size of their household, what they might have done to protect themselves, and any recent travel. The goal was to learn as much possible about H1N1 in advance of the fall flu season.

Like the students they teach, RSPH faculty became engaged in the H1N1 epidemic. Last spring, Emory physician and microbiologist Keith Klugman, MD, PhD, was recruited to join the CDC’s Team B, which includes experts from outside the CDC to quickly review and inform the agency’s efforts. CDC created Team B in the early 2000s to cope with the growing complexity of public health emergencies.

Keith Klugman, MD, PhD

Keith Klugman, MD, PhD

Klugman says his role included the bacterial complications of influenza. Evidence from 1918, notes Klugman, clearly shows that the great majority of deaths were due to bacterial complications of the flu. In other words, the flu itself could occasionally cause death on itss own. But it caused death mostly by facilitating a synergistic lethality between itself and bacteria.

Although much has changed since 1918, the bacteria that caused so many deaths still exist but are susceptible to antibiotics.

Klugman notes the evolution of the flu. He says so far it’s generally been moderate. However, by mixing with the circulating flu in the Southern Hemisphere, it could mutate and become resistant to the first line of flu drugs. It could also become more severe. Says Klugman, “We must remain ever vigilant.”

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Curiosity about health and a borderless world

Developing effective HIV prevention and intervention programs in the most affected communities is a challenge globally as well as locally. It’s also a challenge that Emory infectious disease specialist Carlos del Rio, MD, is addressing as newly appointed chair of the Rollins School of Public Health’s Hubert Department of Global Health.

Carlos del Rio, MD

Carlos del Rio, MD

Del Rio is uniquely equipped to address HIV prevention and intervention. As the former chief of medicine at Grady Memorial Hospital, Atlanta’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.

In the Republic of Georgia, the Emory AITRP and the Emory-Georgia Tuberculosis Research Training Program, another NIH/Fogarty program led by RSPH adjunct faculty member and Emory School of Medicine professor  Henry Blumberg, MD, has helped build research capacity in HIV, hepatitis, and tuberculosis research.

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Paris “Hands Over” to Atlanta for AIDS Vaccine 2010

Eric Hunter, PhD

Eric Hunter, PhD

As the AIDS Vaccine 2009 conference concluded today in Paris with more than 1,000 scientists in attendance, Eric Hunter, PhD, co-director of the Emory Center for AIDS Research (CFAR) and a Georgia Research Alliance Eminent Scholar, accepted the “hand over” for next year’s international conference in Atlanta.

The Emory CFAR will serve as local Atlanta host of AIDS Vaccine 2010, which takes place next Sept. 28 to Oct. 1, led by the Global HIV Vaccine Enterprise. The conference will bring scientists, community advocates, funders and policy makers from around the world to Atlanta to hear cutting edge scientific results, exchange new ideas, educate future leaders and engage a diverse group of scientists in the quest for an AIDS vaccine.

A number of Emory scientists were in attendance in Paris at AIDS Vaccine 2009. Hunter was interviewed by several news organizations, including the Lehrer News Hour and Science magazine, about the results of a recently concluded AIDS vaccine trial conducted by the United States and Thailand. The complete results of the trial were released at the meeting and also published online this week by the New England Journal of Medicine.

Hunter was among 22 scientists who initially had criticized the trial in a 2004 Science editorial. After seeing the full results and analysis of the trial this week, Hunter commented from the Paris meeting:

“The complete data from the trial indicate that it was modestly effective in preventing HIV-1 infection. However, it will likely be difficult to establish the mechanism by which the vaccine protected participants and additional studies will be needed. This positive result, though, gives a much needed boost to efforts aimed at developing an HIV-1 vaccine and takes the field from the position of perhaps an impossible goal to a possible goal.”

Hunter will chair AIDS Vaccine 2010 in Atlanta, along with co-chairs James Curran, MD, MPH, dean, Rollins School of Public Health; Carlos del Rio, MD, Hubert professor and chair of the Hubert Department of Global Health, Rollins School of Public Health; and Harriet Robinson, PhD, senior vice president of research and development, GeoVax and emeritus professor of microbiology and immunology, Yerkes National Primate Research Center, Emory University.

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Why vaccine compliance matters

An outbreak of measles in the state of Washington last year sickened 19 children. Of those who fell ill, 18 had something in common—they were not vaccinated.

Saad Omer aims to increase vaccine compliance to prevent childhood diseases.

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 Medicine article, 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 Omer’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.

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Remembering Grace Crum Rollins

Grace Crum Rollins

Grace Crum Rollins

She was quiet and small in stature but firm in her beliefs. Grace Crum Rollins made good on her late husband’s promise of helping construct a building to house Emory’s School of Public Health. In 1994, the Grace Crum Rollins Building became the permanent home for the school that Emory named for her extraordinary family.

Mrs. Rollins, whose generosity led the Rollins School of Public Health to become one of the nation’s premier schools in its field, died on August 8 at age 98.

Dean James Curran says, “Essentially, the school would not be what it is today without her family. Our faculty, students, and alumni are part of her legacy.”

Grace Crum married O. Wayne Rollins during the Depression. They worked hard, lived simply, and never bought anything on credit. When Wayne was hospitalized for an appendectomy, Grace knitted to pay his bill.

Years later, Forbes magazine would count him among the nation’s greatest business leaders. In what is considered one of the first leveraged buyouts, Wayne bought Orkin Exterminating in 1964. The family’s business grew to encompass oil and gas services, security systems, and real estate.

Also in 1964, Wayne and Grace moved to Atlanta with their sons Randall and Gary. The couple became involved at Emory through the Candler School of Theology and Wayne’s role as a university trustee. With a lead gift to the School of Medicine, they enabled construction of the O. Wayne Rollins Research Center, doubling Emory’s laboratory space. Upon learning that the School of Public Health needed a building, Wayne volunteered his support but died unexpectedly in 1991. Less than a year after his death, Grace and her sons fulfilled his promise by contributing $10 million for construction.

The Rollins attend an Emory event

Wayne and Grace Rollins attend an Emory event

Other gifts followed, including a $50 million lead gift through the O. Wayne Rollins Foundation for a second public health building. The Claudia Nance Rollins Building, which is named for Wayne’s mother, will open in 2010 and more than double the physical size of the school.

The idea of creating the first public health building appealed to Wayne Rollins’ entrepreneurial spirit. With just 20 faculty and 500 graduates, it was a risky endeavor, Curran says.

“Mrs. Rollins kept that commitment” notes Curran. “Today the school has 200 faculty and more than 5,000 alumni in 90 countries.”

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As China grows, so does Emory

Peking University

Peking University in Beijing, China

The meteoritic rise of China in the world has seen a corresponding rise in the number of partnerships between Emory and Chinese universities and researchers.

In February 2009, Emory, Georgia Tech, and Peking University announced a joint biomedical engineering PhD program. Representatives from the schools have been laying the groundwork for this program during the past five years.  In the Fall of 2009, members of the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University traveled to Beijing to finalize the program details with the Department of Biomedical Engineering at Peking University (PKU). Faculty collaborations have been funded by seed grants and, as a result, several new research projects are already underway.

Public health units at Emory are also reaching out to China. In February 2009, it was announced that Emory University has received a $14 million, five-year grant from The Bill & Melinda Gates Foundation to help reduce the burden of tobacco use in China. The Emory Global Health Institute, in collaboration with the Tobacco Technical Assistance Consortium (TTAC) of Emory’s Rollins School of Public Health, will establish the Emory Global Health Institute — China Tobacco Partnership.

China is likewise reaching out to Emory. According to the international business news site Global Atlanta, delegates from China’s Shandong province recently came to Atlanta to meet with health care professionals, public health officials, educational institutions and legislators.The group visited the the Emory Spine Center, where they met with acupuncturists using traditional Chinese techniques alongside new therapies.

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Emory and the CDC

Centers for Disease Control and Prevention Headquarters

Centers for Disease Control and Prevention Headquarters

Today, as Dr. Thomas Frieden takes the helm of the Centers for Disease Control and Prevention (CDC), Emory’s own Dr. Kenneth Thorpe is providing expert commentary on President Barack Obama’s decision to name the former New York City health commissioner to the position and discussing what type of impact Frieden could make in the cheap oakley future.

The CDC, located adjacent to the Emory University campus, has strong ties to the university, including former CDC director, Dr. Jeffrey Koplan, who now heads Emory’s Global Health Institute. Many within the Emory’s Rollins School of Public Health have strong connections to the CDC.

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