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The CDC reports on a recent E. coli outbreak. Clover sprouts were the culprit for this outbreak of E.coli spanning from January to March of 2020. Chicago Indoor Garden recalled all of their products containing sprouts as they were found to be contaminated with E. coli O103. Large restaurant chains like Jimmy Johns discontinued the use of sprouts on their sandwiches. While sprouts are a known source of food-borne illness, thoroughly cooking them greatly reduces the likelihood of being infected with the bacteria. During this outbreak, 25 people were infected across 2 states, and two individuals were hospitalized.

Symptoms of an E.coli infection include fever, stomach cramps, and diarrhea. Individuals usual become ill from strains of this organism that produce Shiga toxin (aka STEC). Some infections caused by STEC can result in a complication with the kidneys called hemolytic uremic syndrome. In most cases, E.coli infections are not treated with antibiotics and symptoms are usually managed with measures of fluid replacement.

Another article from US News reports on another E. coli outbreak of 2020 from romaine lettuce sourced in the California area. This outbreak was more widespread and infected a total of 167 individuals. Unfortunately, 85 people had to be hospitalized and 15 of those individuals developed hemolytic uremic syndrome. Who knew eating veggies could be so dangerous? Even though the US Food and Drug Administration has given the “all clear” to resume eating romaine lettuce, I don’t need an excuse to stay away from salads just a little while longer.

The FDA reports on a monoclonal drug called basiliximab, or more commonly known as, Simulect®. Drugs in this class work by using monoclonal antibodies. Monoclonal antibodies are produced when an antigen in injected into an animal, the animal’s immune system responds by producing antibodies, and the B cells are isolated and fused with malignant plasma cells. The fusion of these two cells is called a hybridoma. The B cell provides the genes that code for specific antibody production while the malignant plasma cells offer the ability to divide continuously. The byproducts of this process can be harnessed and used in a variety of monoclonal medications.

Simulect®, or basiliximab, is a monoclonal drug that is administered via injection. This drug serves as an immunosuppressant and is given to kidney transplant patients. By suppressing the patient’s immune system, the likelihood of organ rejection is much lower. This drug is given in two doses, one within two hours of surgery, and one 4 days after. This medication works by preventing binding with IL-2 receptors on the surface of activated T cells and therefore limiting the effectiveness of the immune response.

This medication has the following possible side effects; nausea, stomach pain, diarrhea, constipation, or redness/pain at the site of injection. Individuals with a hypersensitivity may experience anaphylaxis characterized by; tachycardia, hypotension, dyspnea, wheezing, and respiratory failure, in which case the treatment should be suspended immediately. Because this drug compromises the adaptive immune system, individuals will be more susceptible to other infections and should take the necessary precautions. Also, the FDA warns that it is still unknown whether or not this medication will have a long lasting effect on the immune system and the ability to respond to antibodies.

Believe it or not, all medical research and advancements did not come to a screeching halt when the Covid-19 pandemic set in. While the news media has completely ignored all other medical advancements, let me shed some light on what has been happening the last few months. The National Institutes of Health describes a new discovery regarding mycobacterium tuberculosis. According to new research, they have found a rather simple way to improve efficacy of the tuberculosis vaccine. It turns out, that changing the route of vaccination administration from intradermal to intravenous greatly improves the effectiveness. The study has shown that when the vaccine is given intravenously, the critical number of T cells in the lungs is much higher. T cells are a critical portion of the immune system and this simple discovery is a huge step forward in the field of TB research.

MdLinx comments on another great medical innovation of 2020, peanut immunotherapy. Many children experience fatal allergies to peanuts and it is a constant worry for parents that they may be accidentally exposed in day to day life. But, this new immunotherapy technique uses medical grade peanut protein in a pill form to slowly desensitize patients. They start with a micro-dose and very slowly build up the amount of exposure. 75% of patients were able to handle up to a 300mg dose by the end of the therapy treatment. Even though this is only equivalent to around one peanut, this could prevent life threatening responses to accidental exposures.

In my personal opinion, I feel very comforted by the fact that the medical community is continuing to push forward in research even given our current situation with Covid-19. It gives me some reassurance that after this pandemic settles, the rest of medical advancements won’t be stunted for months to come due to lack of attention. Instead, the fight to bettering health care as a whole has seamlessly continued, even in a state of emergency.

An article from Vox describes how the CDC has begun using blood tests to check for coronavirus immunity. How does this work? Well, we all know that the use of nose swabs allows us to detect if a person is experiencing an active Covid-19 infection. But, a blood test will allow us to detect if a person had been exposed to the virus, even if they did not become symptomatic. We are able to do this by testing for certain types of antibodies. Antibodies are proteins that are made by our immune system that bind to antigen (like the coronavirus) to fight infection.

If an individual has these antibodies in their blood, that is a good indicator that they did in-fact come into contact with Covid-19 and they would have some immunity if they came into contact with the same virus again. Testing for people who have these protective antibodies is a good first step in releasing people from a strict “stay at home” order. This is unless the virus mutates, in which case, an individual’s protective antibodies will no longer recognize the virus and we are back at square one. If an individual had IgM (Ig=immunoglobulin: another word for antibody) antibody titers, it would most likely mean they are actively fighting an infection in their bloodstream. If an individual had high IgG titers, it would most likely mean that they were infected with Covid-19 but are probably no longer contagious, and now have long lasting immunity against the virus. IgG titers can also be indicative of a very late stage infection. Levels of IgG are even higher if the individual comes into contact with the same pathogen again, but their immune response will be much quicker and precise.

A Mass Device article discusses the significance of antibody tests during this pandemic. Antibody tests, also know as serology tests, are readily available unlike the current swabs needed to test for Covid-19. They are much more cost effective and can give accurate results in as little as fifteen minutes. This testing method is urged not to be used as the sole method of coronavirus detection but has been approved under the public health emergency guidance, even though FDA approval is still pending. The unique advantage of serology testing is the ability to differentiate between infected individuals, asymptomatic infected individuals, and individuals who are immune and safe to go about their daily lives. Hopefully the information gathered from these rapid antibody tests will help to “flatten the curve”!

An article by Praveen Duddu summarizes the series of clinical trials going on world wide. Everyone has their fingers crossed, hoping one of these pharmaceutical companies will stumble across the perfect mix and will be able to stop this pandemic. So far, there has been a combination of efforts, some trying to repurpose and combine preexisting drugs, and some starting from scratch.

Favilavir was the first approved coronavirus drug in China. This drug is an antiviral that has proved effectiveness in treating Covid-19 when administered to 70 patients in a clinical trial. In the United States, emergency use of Chloroquine, a drug typically used to treat malaria and arthritis, has been approved but is still being tested in several different clinical trials. Another approach being taken involves using Fusogenix drugs, a “drug delivery platform [that uses] a proteo-lipid vehicle that introduces genetic payload directly into the cells”. They are using this vehicle to transfer epitopes from the SARS virus that is hopefully similar enough to illicit an immune response that will provide protection against Covid-19.

There are several other promising avenues of treatment that can be utilized from veteran SARS-CoV-2 labs because of their similarity to the novel coronavirus. Ralph Baric, a UNC professor, has studied RNA viruses for over 35 years. His team were some of the first to respond with a plausible solution to this pandemic. They have done extensive research and offer remdesivir—Gilead’s drug as a potential prevention and treatment against Covid-19. This pitch is still “leading the pack” compared to other SARS-CoV-2 treatment options. This drug is currently being tested in several clinical trials. I am very proud of the work that this University is doing and I must add, even admits a pandemic… #GDTBATH (it is a great day to be a tarheel)!

There is very exciting promise in the field of immunotherapy for new personalized treatments against cancer. Finally- a step away from harsh chemotherapy that knocks out the good cells along with the bad! Caleb Perez and Michele De Palma describe a study regarding personalized vaccines that use dendritic cells derived from the patient in order to combat cancerous tumors. By creating a vaccine that uses the patient’s own dendritic cells, their immune system can be reprogrammed. The dendritic cells are modified ex-vivo in order to accomplish this.

Dendritic cells are the target for this therapy because of the unique qualities they play in immune defense. These cells are able to uptake and present tumor related antigens, circulate between lymphoid and non-lymphoid tissue, and well as control inflammation. These qualities make dendritic cells an ideal candidate for therapy and should ideally provide long lasting anti-tumor control. However, clinical trials using dendritic vaccines have showed underwhelming results. These dendritic cells were unable to overcome the immunosuppressive nature of the tumors. Issues were seen with a lack of antigen presentation and cytokine release. New methods of dendritic cell vaccination are still being explored.

T cell therapy is another emerging treatment option that shows great promise. T cell therapy has been used to treat patients with B-cell acute lymphoblastic leukemia as well as adults with B-cell non-Hodgkin lymphoma. The cost of these treatments, however, is often a limiting factor for many people. These treatments range from $375,000-$475,000. This price may seem jarring at first, but seems less daunting when put into comparison with normal treatment costs. T cell therapy has been associated with less time in the hospital and fewer emergency visits making the overall price more comparable to a tradition treatment regime. Hopefully, as these alternative treatments become even more precise and effective, they will become more widespread and less cost prohibitive.

Unfortunately, World TB Day isn’t as exciting as it sounds. Tuberculosis isn’t something to celebrate, but let’s see what progress has been made in the world recently regarding this nasty disease . The CDC says that the theme for this year’s World TB Day is, “It’s TIME”. “Time for what?” you might wonder. It’s time to eliminate the disease. The plan to accomplish this is a relatively simple one: test and treat latent TB infections. A large population of individuals in the US currently have latent TB infections and they are at risk for developing TB disease in the future. The best way to prevent this is to test and treat patients who have a latent TB infection. This will prevent further progression of the disease. Elimination of the disease would also be furthered by testing and treating individuals with active TB infections.

You may be wondering, “what’s the difference between latent TB infection and TB disease anyways?”. Well, an individual with a latent TB infection will most likely test positive if given a TB test but they are not sick and do not show any symptoms. This is because they have the bacteria in their body, but their immune system is keeping the bacteria from multiplying. This is called a latent TB infection. But, if an individual has a weak immune system, they won’t be able to keep the bacteria from multiplying. Once this happens, it is considered an “active infection” and symptoms will progress. This series of events are characterized by TB disease. Individuals in this stage are highly contagious and will experience a variety of symptoms. In both cases, however, individuals are in need of treatment.

The World Health Organization has taken a huge initiative to end TB by 2030. This initiative’s success depends greatly on global access to preventative measures against this disease, including; education, testing, and funding of other TB programs. The WHO comments on the importance of maintaining this initiative even during the chaos of the current Covid-19 outbreak. After all, “COVID-19 is highlighting just how vulnerable people with lung diseases and weakened immune systems can be” as stated by WHO Director General. With that perspective in mind, it is just as important to maintain effective treatments and TB services along with funding the national programs that are battling TB and trying to eliminate this disease’s existence once and for all. We can only handle one respiratory pandemic at a time, so let’s keep TB under control.

Who knew 2020 would be full of such chaos! I am trying to adjust to my new normal. As of yesterday, I have moved out of my dorm room and I am settled in back at home. Although my last year living in a dorm room has been cut short, I cant say i’m too upset about kissing my twin bed goodbye… or my roommate. However, I can say that I will miss my structured schedule back at school, regardless of how busy it might have been. With everything up in the air, I wouldn’t mind having some organization.

I never wanted to be homeschooled but that seems to be our new reality. Im sure I will get back into the swing of things. But right now, it’s a little after noon and i’m laying in my bed writing this blog post, still in my pajamas from the night before, and coming to the realization that I have forgotten how to be a microbiology student- YIKES! My biggest fear is not being able to focus on school work while at home… there are so many distractions. Hopefully after a week or so of doing this homeschool thing I will find a schedule that helps me stay on track. In the mean time- I will try to stay off Tik Tok and squeeze in an at-home workout every now and again.

I know so many people have much larger issues during this time of overwhelming uncertainty and so I am grateful to only be worried about school. Im grateful that my family is healthy, they are all able to work from home, and we have food on the table. If I could offer any words of advice they would be: “just take it one day at a time and we will figure out the rest later”. After all, with the future so unknown, that’s all we can do. On a lighter note: who could’ve ever guessed that in 2020 gas would be under $2.00 a gallon, law enforcement would be regulating toilet paper sales, and hand sanitizer would be the new hot commodity on the black market.

https://cheezburger.com/10812421/fourteen-hand-sanitizer-memes-for-the-germaphobes-among-us

In an article from the International Journal of Surgery, they announce that the Covid-19 outbreak has been declared a “global health emergency” by the World Health Organization. This has led to an “all hands on deck” mentality and many countries are mobilizing large sums of money towards the efforts of containing this virus. Companies based in the United States have launched Covid-19 test kits, the UK has donated to research that is aiming to find a vaccine, and the EU has also been a large financial donor for research. While it is encouraging to see so many countries putting in collective efforts, the number of new cases are still rising. The US has put a lockdown on entry into the country for those who have traveled to high risk areas and China is debating on whether or not to close their border completely. The financial security of China hangs in the balance of this decision.

Currently, there is still no effective treatment for Covid-19. In China, some medical professionals are prescribing neurominadase inhibitors to infected individuals. This course of treatment is commonly seen in treating influenza and may be more commonly recognized as the antiviral, “Tamiflu”. However, they have no evidence that this course of action is effective. Regardless, the mortality rate remains relatively low around 3%. This is much lower than mortality rate of MERS and SARS, very similar viruses, that have mortality rates up to 34.4%.

A Life Sciences article comments on Covid-19 compared to MERS and SARS, which are known to be more aggressive forms of the coronavirus. There are current studies being conducted that are examining Covid-19’s RdRp mechanisms and how it can be targeted using antivirals that are used to treat similar RNA viruses. After sequencing the genome of Covid-19, they discovered that over 97% of Covid-19’s RdRp is identical to that of SARS HCoV. This knowledge is a huge step forward in the possibilities of effective treatments against Covid-19. It would be much more efficient to find preexisting medications to treat this strain instead of having to develop something new amidst this epidemic. This study was able to conclude that preexisting medications (Sofosbuvir, Ribavirin, and Remdisivir) may have promising results in treating the newly emerged strain of coronavirus by blocking the function of the viruses RdRp. However, further research needs to be done to determine if a combination of these drugs could potentially stop the emergence of new Covid-19 infections.

Human Papilloma Virus

A recent papillomavirus research study discusses the HPV vaccination and the necessary doses. Currently, the HPV vaccine requires a series of three doses for adolescents 15 years and older and a series of 2 doses for those 15 years and younger. Vaccination for HPV is a rising global initiative. But unfortunately, the three dose requirement is a huge logistical and financial limitation for developing countries who need the vaccine the most.

Recent observations have determined that vaccine induced protection is present even when there are small amounts of detectable antibodies. This raises the question if the HPV vaccine can become a two series vaccine for all age groups. Trials have shown that two and three dose series have comparable titres or levels of immunity. More research needs to be done to confirm this idea. However, I find this very promising and could potentially bring protection to a huge population of those who would otherwise not have access.

Another article describes an interesting approach inline with the same HPV vaccination initiative in a middle school in rural Texas. This rural middle school had very low HPV vaccination rates and became the home to a school-based vaccination program. This program involved physician led HPV education and vaccinations. This program proved to be very successful and HPV vaccination and completion rates were higher than schools in the surrounding area who had not undergone intervention. What a cool and creative way to bring health care to underserved populations!