Micro: Ch. 24 SG

discuss the progression of hepatitis B?

- The hepatitis B virus enters the body through a break in the skin, mucous membrane, or by injection into the blood stream. Eventually, it reaches the liver cells (hepatocytes), where it multiplies and releases viruses into the blood during an incubation period of 4-24 weeks (7 weeks avg). The majority of those infected exhibit few overt symptoms and eventually develop immunity to HBV. But some people experience malaise, fever, chills, anorexia, abdominal discomfort, and diarrhea. In more severe diseases, the symptoms and aftermath of hepatic damage vary widely. Fever, jaundice, rashes, and arthritis are common reactions, and smaller number develop glomerulonephritis. Most patients experience a complete liver regeneration and restored function. A small percentage of patients develops chronic liver disease in the form of necrosis or cirrhosis. Chronic hepatitis is 200 times more likely to develop liver cancer.

-is it effective? (find the package insert for the vaccine for chicken pox online (find the package insert))

1 dose is 82% effective

b. in adults what percentage of people have been infected with EBV? (5. Epstein Barr Virus - Mononucleosis)

By midlife, 90% to 95% of all people, regardless of geographic region, show serological evidence of infection.

Herpes Virus: HHV-6 and HHV-7

Clinical Syndromes: Roseola

Herpes Virus: HHV-5

Common name: Cytomegalovirus Clinical Syndromes: Neonatal birth defects

Herpes Virus: HHV-4

Common name: Epstein Barr Clinical Syndromes: Mononucleosis

Herpes Virus: HHV-1

Common name: HSV-1 Clinical Syndromes: Fever Blisters

Herpes Virus: HHV-2

Common name: HSV-2 Clinical Syndromes: Genital Herpes

Herpes Virus: HHV-8

Common name: KSHV Clinical Syndromes: Kaposi's Sarcoma

Herpes Virus: HHV-3

Common name: VZV Clinical Syndromes: Chicken pox / Shingles

Smallpox as a Bioterrorist agent. (Smallpox - Variola)

D.A. Henderson contends that "Of all the potential organisms that might be used in Bioterrorism, this is probably the most formidable and I think we should do everything we possibly can to mitigate against the risk of that virus being released at any time in any way." A civilian program director for the Soviet Union has stated that the Soviet Union produced large quantities of smallpox and had successfully adapted the virus for distribution in missiles and bombs. As indicated earlier, many officials feared that scientists from the Soviet lab took virus with them when the lab lost funding. Rumors of a dessicating jar found after the first Gulf War with smallpox written in Arabic have fueled the suspicions that Saddam Hussein had been working with smallpox. After September 11, 2001, there was and still is a growing concern that smallpox could be used as a bioterrorist agent. This concern was reinforced by the use of Anthrax in mailings in 2001. Since smallpox vaccination is no longer routinely practiced, many people under 50 years of age have never been vaccinated and remain susceptible to the virus. The Bush administration contemplated a mass vaccination program in 2003. However, money was spent to increase our preparedness to the use of smallpox as a bioterrorist agent by increasing production of vaccine, research and development in the areas of new vaccine, better use of the old vaccine and updating and releasing a smallpox response plan

Vaccination (Prevention - Smallpox - Variola)

Edward Jenner, an English physician noted that cows developed a mild form of the disease known as cowpox. Blister-like lesions appeared on the udders of cows. Dairy maids, who milked these cows, would develop blister-like lesions on the hands but never seemed to contract smallpox. Without knowing much about the immune system, Jenner suggested that cowpox might provide immunity to smallpox. On May 14, 1796, he inoculated James Phipps (son of Jenner's "unpropertied" gardener) with a fresh cowpox lesion from the hand of dairy maid, Sarah Nelmes. James became mildly ill but recovered. Six weeks later, Jenner injected James with pus from a smallpox pustule. Phipps did not become ill. The process of injecting cowpox process (known as vaccination) was much safer than variolation and became a common method for the prevention of smallpox. Several countries instituted compulsory vaccination, requiring smallpox vaccination of all their citizens. This compulsory vaccination program was challenged in the US Supreme Court case of Jacobsen v. State of Massachusetts in 1905. The Supreme Court justices ruled that in matters of public health, the state does have the right to act as a police state.

what viruses are responsible (human papilloma virus (HPV) - Papilloma)

HPV 6, 11, 16, 18, and 31 16 and 18 are ones most common to cause cancer

World-wide Eradication (Smallpox - Variola)

In 1967, the World Health Organization initiated a Global Eradication Program under the direction of Dr. Donald A. Henderson. At that time, there were 10 million cases of smallpox annually with 2 million deaths. The characteristics of the virus that helped facilitate the eradication project include the fact that smallpox was not a zoonotic illness, i.e., humans are the only known reservoir. Therefore, if the disease could be eliminated from the human reservoir, the disease would be history. Additionally, the vaccine did not require refrigeration and the administration of the vaccine does not require extensive medical knowledge. The vaccine serum is administered by pricking the skin with a bi-furcated (two pronged needle). Finally, the strategy for eradication was surveillance and containment. Once the disease was recognized in an area (and it is a highly recognizable disease - Following Sept. 11, 2001, I heard a news report of a case of putative smallpox in the emergency room at Leavenworth KS. The case was quickly determined to be a various serious case of chickenpox but this episode emphasized the fact that physicians have not been trained in the diagnosis of smallpox in a very long while.), a WHO team would move in and vaccinate all individuals within a radius around the disease and move out in concentric circles, a technique known as ring vaccination. Since immunity could be raised very rapidly in an individual (within a 3-5 day period), a ring of immune individuals could block the spread of the infection in a community. With no susceptible individuals, the epidemic would essentially burn itself out. Four years later, 4 countries only were reporting cases of smallpox in comparison to 31 countries when the program began. The last naturally occurring case of smallpox occurred in 1977 in Somalia. In 1979, the WHO issued a certificate of eradication for smallpox, the first disease to be eradicated from the wild. There have been two cases of laboratory acquired smallpox in recent times. One was in 1973 at the London School of Hygiene and Tropical Medicine. The second case was in 1978, in a medical photographer at the University of Birmingham, whose office was over the laboratory. At the time of eradication, only the Soviet Union and the United States had viable stocks of Variola virus. A committee recommended that the remaining stocks of smallpox virus be destroyed by midnight on June 30, 1999. Official stockpiles of smallpox virus were stored in earthquake proof freezers at the Centers for Disease Control and Prevention in Atlanta and in the State Research of Virology and Biotechnology, known as Vector in the former Soviet Union. However, since the break up of the Soviet Union, it is not clear of the fate of the Soviet vials of smallpox. Reports have circulated that the Soviet Union had experimented with the weaponization of smallpox. Difficulty in accounting for some of these stocks have aroused suspicions that some Russian scientists may have taken viral stocks with them when they left the laboratory or distributed them to rogue states, such as North Korea and Iraq. D.A. Henderson, the former director of the Global Eradication Program supports the destruction of the virus and he argues that the United States should take the moral high ground in destroying the virus. The "case for destroying the virus rests on minimizing -- hopefully, eliminating -- the risk that the smallpox virus would ever plague mankind. Smallpox kills about 30% of those afflicted; there is no treatment." Since an overwhelming majority of nations (74 of 79 countries of the World Health Assembly) favored the destruction of the virus, he fears the U.S. would become a "pariah". On the other side of the argument, many people have argued against the destruction of the virus because our knowledge of anti-viral drugs could be advanced by the study of the virus.

-is it safe? (find the package insert for the vaccine for chicken pox online (find the package insert))

Not for everyone but for most people yes. Those who should avoid are people who have ever had a life-threatening allergic reaction to a previous dose of chickenpox vaccine or any ingredient of the vaccine, including gelatin or the antibiotic neomycin. People who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting chickenpox vaccine. Pregnant women and they should wait to get chickenpox vaccine until after they have given birth. Women should not get pregnant for 1 month after getting chickenpox vaccine. People should check with their doctor about whether they should get chickenpox vaccine if they: Have HIV/AIDS or another disease that affects the immune system; Are being treated with drugs that affect the immune system, such as steroids, for 2 weeks or longer; Have any kind of cancer; Are getting cancer treatment with radiation or drugs; Recently had a transfusion or were given other blood products. People should check with their doctor about whether they should get chickenpox vaccine if they have immune conditions in first degree relatives (parents, siblings) that can be inherited (called immunodeficiencies).Most children who have family members with immune system problems can safely get varicella vaccine, as long as they themselves have a healthy immune system.Generally speaking, anyone with a damaged immune system should not get live vaccines, such as chickenpox vaccine. But most immune system problems are not related to the patient's family. They come from illnesses such as cancer, or from medications such as chemotherapy drugs. But there are some rare immune conditions that can run in the family. So children whose parents or brothers or sisters have one of these conditions should be screened before getting chickenpox vaccine to make sure they haven't inherited it. Children with a family history of these conditions can get the chickenpox vaccine if they are found not to have the conditions themselves.

JC and BK (Polyoma)

Progressive multifocal leukoencephalopathy (PML) is an uncommon but generally fatal infection by JC virus that attacks accessory brain cells and gradually demyelinizes certain parts of the cerebrum. Infection with BK viruses, usually associated with renal transplants, causes complications in urinary function. By the time PML is diagnosed, the patient is usually immunocompromised with extensive brain damage. A prevention for BK infection is to treat all renal transplant patients with human leukocyte interferon.

History (Smallpox - Variola)

Smallpox is an age-old disease, dating back to 10,000 BC in Africa and Asia. Pock marks suggestive of smallpox have been found in the mummified remains of Rameses V circa, 1570 BC. It was described in China around 200 BC and spread to Europe during the Middle Ages. The Europeans brought the disease to the New World and Native Americans had no resistance to smallpox and quickly fell ill. Cortez easily conquered the Aztec Empire in 1521 as a result of smallpox. Evidence suggests that whole Indian villages were wiped out as a result of smallpox. During the French and Indian War, British soldiers distributed blankets from smallpox to the Iroquois Indians, wiping out about 50% of some tribes. During the American Revolution, several smallpox epidemics severely hindered the American Troops in and around Boston and Quebec. The smallpox outbreak in Boston became so serious that General Washington had his troops inoculated, using a technique known as variolation. As a consequence, many soldiers became ill from the inoculation. George Washington kept this variolation a secret, fearing if the British found out, they would attack his troops while they were ill and recovering from the process. Fortunately, the secret was well kept.

Characteristics of Smallpox (Smallpox - Variola)

Smallpox, also known as, variola is in the poxviridae family of viruses. There are two types, variola major and variola minor. Variola major kills about 30% while Variola minor rarely causes death. Variola minor differs from Variola major by 10 genes. Transmission of smallpox required direct and fairly prolonged person to person transmission or direct contact with body fluids or contaminated objects such as bedding or clothing. It is not believed to be transmitted on the air, contrary to descriptions related in Richard Preston's book, Demon in the Freezer. The route of entry for the disease is through the respiratory route. It will be transmitted through the blood and lymph and may infect internal organs in addition to growth in the epidermal layers of the skin. The disease is most contagious from the rash but the disease may be communicable in some individuals from the fever stage.

Current Smallpox vaccine (Smallpox - Variola)

The current smallpox vaccination has not changed much since Edward Jenner's time. It is still a live, vaccinia virus which has been freeze-dried to aid in the vaccine's stability. The length of protection provided from the vaccination is approximately 3-5 years. Longer term protection may be afforded those individuals who have had multiple vaccinations. Reports indicate the vaccination is 95% effective in protecting from the virus. The vaccine may provide protection within 3-5 days following exposure. The vaccine is administered by pricking the skin with a bifurcated needle which has been dipped in serum. A red itchy bump forms, which becomes a scab. These scab eventually dry up and fall off, but will leave a scar. There are some side effects associated with the vaccine. Under normal circumstances, the individual exhibits a sore arm, fever and body aches. In about 1,000 in 1 million individuals may show serious but not life-threatening reactions. Life threatening reactions are observed in 14-52 out of 1,000,000 and 1 or 2 individuals out of 1,000,000 will die from the vaccination. Recommendations indicate that people suffering from eczema or atopic dermatitis, those with weakened immune systems and individuals with heart condition with or without symptoms should not receive the vaccination. The last case of smallpox occurred in the U.S. in 1949. Routine smallpox vaccination stopped in 1972 in the U.S. A risk to benefit analysis demonstrated that your chances of being infected with smallpox in the United States were smaller than the risk of side effects from the shot. A quick analogy is getting smallpox in the US was like being hit by a car on a rural highway, highly unlikely.

-what is the duration of immunity? (find the package insert for the vaccine for chicken pox online (find the package insert))

Unknown

Adenoviruses have just been responsible for several deaths, several in pediatric rehab hospitals. One death was in a Freshman college student at the University of Maryland. What adenovirus was responsible for these deaths?

pneumonia

President Bill Clinton in 1999 (World-wide Eradication - Smallpox - Variola)

refused to destroy the remaining vials in the U.S. Clinton argued that retaining the viral stocks would allow the U.S. to research new vaccines and new anti-viral drugs.

Variolation (Prevention - Smallpox - Variola)

was a method of prevention practiced by the Chinese and the Turks. Pus-like material from lesions was injected into the skin of a non-immune person. This process known as variolation, would hopefully cause a mild form of smallpox, resulting in life-long immunity to the individual. However, severe cases of smallpox could also result and may spread through the community. The death rate from variolation was 2-10%. Mary Wortley Montagu, wife of the British Ambassador to Turkey brought the technique back to England. Before the Princess of Wales allowed her children to undergo the variolation procedure, she required two trials. One trial involved six prisoners and the second trial involved 6 orphan children. The technique was introduced to the American colonies in 1721 by Cotton Mather. This procedure was demonstrated in the second program of the John Adams mini-series on HBO, when Abigail had the children vaccinated during an outbreak of smallpox in the Boston area. In some cultures, crusted pocks would be ground and sniffed. Individuals received hopefully a mild case of smallpox but in many instances, these cases were debilitating and the individuals could spread smallpox.

Prevention (Smallpox - Variola)

Variolation Vaccination

Can Chinese Tai Chi prevent Shingles?

We all know that exercise is a good thing. It builds strength, endurance and cardiovascular health. One Chinese form of physical and aerobic exercise for attaining good health is through Tai Chi. Tai Chi involves a series of slow and deliberate body movements that purport to produce a calm and tranquil mind. In 2003, researchers announced that Tai Chi Chih, a low impact form of Tai Chi boosts shingles immunity in the elderly. Can Tai Chi do this? The theory goes that when a person's immunity is compromised or wanes as one ages, the individual is susceptible to more infections. For example, it is true that individuals over 50 are more prone to recurrent Shingles attacks as the varicella-zoster virus (VZV) reactivates because it may no longer be kept in check by the immune system. Tress and other trauma also can intensify the reactivation, Therefore, Michael R. Irwin and colleagues at UCLA"s Neuropsychiatric Institute decided to examine if Tai Chi could reduce the levels of stress and thereby boost a person's immunity - and reduce the chances of shingles. Thirty-six men and women over 60 were enrolled in the study. Half were started on a 15-week program of Tai Chi Chih. The other half were asked to postpone the program for 15 weeks. After the 15 week period, analysis indicated the Tai Chi group had a 50 percent increase over the control group in immune memory functions for the shingles virus. The researchers state that the increase was sufficient to actually help prevent shingles from reoccurring. Because Tai Chi did not improve physical movement within the group, Irwin speculates that Tai Chi's calming influence reduces stress levels which could boost immune system function—including keeping VZV in check. Such studies are a part of a growing field called psychoneuroimmunology, which looks at the relationships between the nervous system and the immune system. Professor Irwin believes if memory to the VZV can be maintained, memory to other infections might also be maintained as one ages. The Verdict: This was a small study involving only 36 volunteers. A more thorough study would be to follow groups of Tai Chi Chih volunteers and monitor how many actually report a flare-up of shingles compared to the general population. Still this study does support the mind-body connection as a way to maintain good health.