Cervical cancer vaccine and politics as ususal

As mentioned in the comments to this post, there is a brewing controversy over upcoming guidelines outlining who should receive the “cervical cancer vaccine,” a vaccine against the human papilloma virus (HPV). Briefly, the HPV vaccine is a highly effective (100% in a 2-year clinical trial) vaccine which is targeted against two specific serotypes of the human papilloma virus: HPV 16 and HPV 18. Together, these types cause about 70% of cervical cancers in the United States. Previously, Bridget Maher of the Family Research Council, a leading Christian lobby group, has said this about the HPV vaccine:

“Giving the HPV vaccine to young women could be potentially harmful, because they may see it as a licence to engage in premarital sex,” Maher claims, though it is arguable how many young women have even heard of the virus.

Why all this resistance to the vaccine? HPV is a virus that can be spread by “ordinary” sexual transmission, but it can also be spread by skin contact–meaning condoms are not 100% effective in preventing transmission of the virus. As Maher also mentioned, therefore, abstinence is the best way to prevent HPV. No one is arguing this fact, as far as I know. Nevertheless, these conservative groups seem poised to fight use of this vaccine in teenage girls. Today’s Washington Post has an article on the issue, here.

Because the vaccine protects against a sexually transmitted virus, many conservatives oppose making it mandatory, citing fears that it could send a subtle message condoning sexual activity before marriage. Several leading groups that promote abstinence are meeting this week to formulate official policies on the vaccine.

In the hopes of heading off a confrontation, officials from the companies developing the shots — Merck & Co. and GlaxoSmithKline — have been meeting with advocacy groups to try to assuage their concerns.

The jockeying reflects the growing influence that social conservatives, who had long felt overlooked by Washington, have gained on a broad spectrum of policy issues under the Bush administration. In this case, a former member of the conservative group Focus on the Family serves on the federal panel that is playing a pivotal role in deciding how the vaccine is used.

“What the Bush administration has done has taken this coterie of people and put them into very influential positions in Washington,” said James A. Morone Jr., a professor of political science at Brown University. “And it’s having an effect in debates like this.”

This isn’t small potatoes we’re dealing with here. As mentioned in the article, cervical cancer strikes more than 10,000 U.S. women each year, and kills more than 3,700. These are 3,700 preventable deaths. And as one who isn’t sooo far out of her teens, even as an infectious disease geek during that time, I had essentially no understanding of HPV. Sure, we learned about sexually transmitted diseases, but most of our sex education class was devoted to, “can this make me pregnant? Can this? How about this?” kind of topics. I can guarantee that probably 75% of my class had no clue what HPV even stood for, much less had an idea that infection could lead to cancer. And the equation of vaccination leading to more promiscuity? C’mon. I’d love to hear any 16-year-old girl rationalize her sexual activity could increase because she was now vaccinated against one particular STD. If she knows enough to understand HPV, then she should also know that there’s still HIV, chlamydia, syphillis, herpes, hepatitis B, and others out there, and that infection with those can lead to sterility or even death.

The article notes:

The [conservative Family Research Council] is planning to meet on Wednesday to discuss the issue. On the same day, the Medical Institute for Sexual Health in Austin, which advises conservative groups on sexuality and health issues, is convening a one-day meeting to develop a position statement.

One can only hope that those who actively say they advocate a “culture of life” will put their money where their mouth is, and show that they value those 3,700 women who die of cervical cancer each year–deaths that may soon be completely preventable.

More academic journals discussing ID

(And not in a supportive way). PZ and Orac discussed a recent New England Journal of Medicine editorial critical of intelligent design. Though the article had several shortcomings, it’s always a bonus to see other scientists treating ID as a valid threat (not in the scientific sphere, of course, but in the “hearts and minds” of the populace). Now the Journal of Clinical Investigation, another fairly heavy-hitter as far as medical journals go, recommends to its readers, Don’t be stupid about intelligent design. Kudos to them…now come the nitpicks. 🙂
Continue reading “More academic journals discussing ID”

New vaccine recommendations coming

Doctors recommend hepatitis shot for kids

Hepatitis A is a virus that causes (obviously) hepatitis, as well as jaundice, fatigue, nausea, fever, loss of appetite, and diarrhea. It’s often spread fecal-orally; that is, you put something in your mouth that has fecal contamination. (Just makes you want to run to the bathroom and brush your teeth, doesn’t it?) It also can be spread via sexual contact and shared needles (or other contact with blood or body fluids). It’s estimated that there are ~40,000 acute cases of Hep A per year, with many of them going undiagnosed. It’s one of those diseases that you don’t hear about until there’s an outbreak (like this one), but it causes a significant amount of morbidity in the U.S. every year. Hence, the new recommendations:

The Advisory Committee on Immunization Practices, which helps set federal vaccination guidelines, voted unanimously to recommend that a two-dose vaccination be given young children. The panel’s recommendations are routinely adopted by federal health officials and are influential to doctors.

Expanding the vaccination recommendation to all the states could prevent 100,000 cases and 20 deaths in the lifetimes of children vaccinated in one year. The direct costs of the vaccine program, currently at $22 million, would increase to $134 million.

Also new is the recommendation to add pertussis to the tetanus-diptheria booster shot for adults. Bordatella pertussis is the cause of whooping cough, a rare disease now but one that caused a lot of misery (and a lot of mortality) in the pre-vaccine years. Children are still vaccinated against it, but there are 2 problems: 1) insufficient vaccine coverage, as parents refuse to have their children vaccinated due to religious objections or fear of side effects, and 2) infection of infants before the vaccination has elicited immunity. The bad thing about pertussis is that the vaccine wears off after 5 years or so, meaning that adults have little or no immunity. This isn’t a big deal for we “grown-ups,” as pertussis doesn’t cause such serious disease in adults. What it’s a problem for are adults who are around incompletely vaccinated infants or children: if the adult is a carrier, they can pass the bacterium to a child, causing illness in the recipient. And there has been a resurgence of pertussis in recent years:

Since pregnant women are one group that will be in contact with both unvaccinated infants and waaaay too much fecal material, they’re an ideal target for both of these vaccines. I’ve already passed along the recommendations to my expectant sister so that she can discuss it with her M.D.

“God is to engineering what Michael Brown is to hurricane relief”

That’s my new favorite anti-ID quote, spoken by Mark Blumberg, at the University of Iowa Freethinkers’ panel discussion on intelligent design last evening. Dr. Blumberg was discussing what a piss-poor design the human vertebral column is, and concluded his talk with the comment above. The other speakers, Scott Robinson and Evan Fales, also did a great job of conveying the issues. On the ID side was physicist Fred Skiff,one of the “dissenters from Darwinism.” I’m sure Skiff is a nice guy and apparently a good physicist, but…wow. A biologist, he ain’t. He conflated abiogenesis with evolution, wrote off anything that’s “macroevolution” as being “overly reductionist,” said scientists claim that science is a worldview (and that’s in textbooks?), made a complete strawman of those opposed to teaching ID (suggesting that scientists want to “make it illegal to challenge a scientific theory”), and then pissed off both the scientists and philosophers by saying that Epicurial materialism equals hedonism.

The best question blunder of the evening came from a pro-ID student who was trying to respond to Blumberg’s comments that physicists (and others) shouldn’t tell biologists what to teach. Both Blumberg and Robinson are officially listed in the department of Psychology, so this student tried to tell them that they were just as unqualified to speak on evolution as Dr. Skiff. Guess he slept through the part where they both talked about their graduate training in basic biology (Robinson even discussed his background in paleontology and zoology at length). Boo-yah.

What the hell is going on with Tularemia? or, a Rant about public health problems

It’s situations like this that really irk me.

I mentioned the tularemia detection in DC here almost 2 weeks ago, already annoyed that there hadn’t been more information about it. There has been some discussion on the ProMed list, but it’s hardly been a blip in the mainstream media. Yesterday, there was an article in Salon further discussing it.

The background:

On Sept. 24, 2005, tens of thousands of protesters marched past the White House and flooded the National Mall near 17th Street and Constitution Avenue. They had arrived from all over the country for a day of speeches and concerts to protest the war in Iraq. It may have been the biggest antiwar rally since Vietnam. A light rain fell early in the day and most of the afternoon was cool and overcast.

Unknown to the crowd, biological-weapons sensors, scattered for miles across Washington by the Department of Homeland Security, were quietly doing their work. The machines are designed to detect killer pathogens. Sometime between 10 a.m. on Sept. 24 and 10 a.m. on Sept. 25, six of those machines sucked in trace amounts of deadly bacteria called Francisella tularensis. The government fears it is one of six biological weapons most likely to be used against the United States.

Tularemia is a naturally-occurring, albeit rare, disease. The bacterium, Francisella tularensis, can infect a wide variety of animals, and can be spread in a number of ways: via ticks, contact with infected animals (this used to be a disease that was fairly common in hunters and trappers, and is nicknamed “rabbit fever”), drinking contaminated water, and airborne spread if the pathogen is aerosolized in some manner. (When I was first taking infectious disease epidemiology, it was mentioned that at least one pulmonary case was due to a rabbit puree which had been created when an infected rabbit was run over by a lawn mower. Similar cases in landscapers have been documented in Martha’s Vineyard). It also is a potential biowarfare agent, due to the fact that it can spread fairly easily via aerosol, and that the infectious dose is incredibly low: as few as 10 inhaled organisms can cause disease.

So, when this bug was detected in 6 sensors in our nation’s capital, at the same time as a large march in the area, wouldn’t you think that would be some headline news? Hell, at least the second section?

Yet it’s barely a blip on the nation’s radar. Even many infectious disease folks I’ve spoken to haven’t heard of it, and certainly the public at large is largely ignorant that anything happened. And that would be fine–I understand very well the conflicting desire to inform people about what was detected by the sensors, and at the same time, to educate them about how the tests work, the false positive rate, and other issues so that no one freaks out about something that may turn out to be a false alarm. But some of the revelations in this article are stunning. For example:

The DHS scrambled for three days to confirm just what may have been in the air that day. On Sept. 27, it turned for help to the Centers for Disease Control and Prevention. The CDC did its own tests, and on Sept. 30 — six days after the deadly pathogens set off the sensors and well into the incubation period for tularemia — alerted public health officials across the country to be on the lookout for tularemia, the deadly disease caused by F. tularensis.

“It is alarming that health officials … were only notified six days after the bacteria was first detected,” House Government Reform chairman Tom Davis, R-Va., wrote in an Oct. 3 letter to Homeland Security Secretary Michael Chertoff. “Have DHS and CDC analysts been able to determine if the pathogen detected was naturally occurring or the result of a terrorist attack?”

(Emphasis mine) 6 days for notification of health officials? These are the very people who should be warned ASAP. They should, theoretically, have some training in bioterrorist events, and know that in the early stages, it’s pretty unlikely that a positive sensor means a bioterrorist attack, so the “public fear” issues that may keep some reporters from holding a story back shouldn’t apply there. It should have been especially critical to notify them, as people from all over the country had flocked to the peace rally right where all those detectors went off. Luckily, tularemia isn’t spread person-to-person, but the local health departments should have at least been put on alert to keep an eye out for potential cases.

Moving on,

“It is not unreasonable that this is a natural occurrence,” says Von Roebuck, spokesman for the CDC. “There are still no cases of tularemia.”

I’ll discuss his “no cases” assertion a bit later, but regarding the naural occurrence scenario, sure, it’s not totally unreasonable. I’ve seen estimates from 150,000 to 300,000 people involved in the September rally; lots of people around, kicking up dust. Would it be enough, though, and is tularemia even present in D.C.? Ideally, when any environmental sensors of this type are installed, the background levels of contamination should be determined first, so you know how much “noise” there is in the environment. I don’t know if this was done with tularemia in D.C. (though I have to say, I doubt it). Had it been, we could already have data on the presence of naturally-occurring tularemia there. For instance, there certainly are a lot of squirrels in that area, and tularemia may be endemic in them. Testing of the rodent population there could further that hypothesis. One could also look at the molecular epidemiology of the pathogen population to see if the strain(s?) of tularemia isolated from the sensors matched up with ones found naturally in D.C. I’d assume some of this is being done now–at least, I hope it is.

BUT–according to the Salon article, those marchers would have to have been kickin’ up some major dust:

There was another troubling thing. One of the sensors that went off was located at the Lincoln Memorial on the far western end of the Mall. Another was located near Judiciary Square, roughly two miles to the east and two blocks north of the Mall. A third was at the Army’s Fort McNair, more than two miles from the Lincoln Memorial down the Potomac River past the Mall, on the point of land where the Washington Channel and Anacostia River meet. The locations of the other three sensors have not been disclosed.

It seems pretty unlikely that the soil could have been that contaminated, yet they’d never had a sensor pick this up before.

As far as the earlier assertion that there haven’t been any cases, well, maybe there have, maybe not. Tularemia is also one of those pathogens that causes a “flu-like illness:” fever, chills, headache, muscle aches, cough, and weakness, with serious cases progressing to pneumonia and respiratory failure. It’s very treatable with antibiotics, so it’s certainly possible that many people have simply gone to their physician and were treated without ever having the causative pathogen isolated. The Salon article found several people who reported symptoms similar to those caused by F. tularensis; some went to the doctor, at least one did not. Had more been made of this in the national media, perhaps more people would have checked in with their physicians, and we could at least have samples to test for the bacterium. As it stands now, we don’t know whether people were really infected, or not; and if they were, whether it was due to an actual terrorist event, or not.

Feeling safe yet?

In September, I wrote a post over on Panda’s thumb discussing the 2001 anthrax attacks; y’know, the ones that were very obviously bioterrorism, yet we still have no clue about. And today on Effect Measure, Revere discusses administration policies (specifically, funding cuts) and their effects on public health and beyond:

The cuts are independent of the concern for influenza. They are a consequence of the wrecking-ball policies of the Bush Administration and the Republican-controlled congress (and shame to the democrats who helped). You don’t stop a wrecking-ball in mid-swing. It has too much inertia and will continue to destroy critical infrastructure even as bandaids like supplementary avian flu funding try to cover the worst of the damage.

It’s not just public health. It’s dams, bridges, levees, the shredded safety-net for our most vulnerable neighbors. While pursuing military adventures abroad and obsessed with terrorists at home, the BushCo’s left us defenseless and dangerously vulnerable in our own homes, workplaces and communities.

(Emphasis mine). And that’s exactly the problem. We keep hearing over and over how we’re “fighting the terrorists” and “taking the war to them,” yada yada yada, yet we may have just been attacked in our own national capital with a real WMD, and no one’s paying attention. All the attention to avian flu has been great, but the Powers That Be really need to wake up and realize that if they really want to do something to increase our safety, they should be investing more money here at home in better public health programs that will benefit everyone, instead of throwing some money here and there at different hot topics and hoping that will make them go away–it’s crystal clear that’s simply not working.

Intro to prions at Panda’s Thumb

Andrea Bottaro has an excellent review of prion genetics over at Panda’s Thumb. Prions are, of course, the transmissible agents that cause diseases such as kuru and Creutzfeldt-Jakob in humans, and related disease such as “mad cow” disease, scrapie, and chronic wasting disease in animals. Though there was initially much controversy about these agents in the early years (most notably, because they did not contain any nucleic acids), Bottaro notes that this is a “heresy” that the science community has embraced (similar to the ulcer & Helicobacter connection I mentioned a couple weeks ago):

Spurred by a host of new findings in molecular and cellular biology, in recent years an increasing number of determined biologists have come to envision processes that contradict century-old biological assumptions and seem to defy the expectations of Darwinian evolutionary theory…

Naaah, I am not talking about ID. I am talking about prions, the specter of Jean Baptiste de Lamarck, and “heretical” views about biology. And what must be truly baffling for conspiracy-minded ID advocates, the inflexible “Darwinist orthodoxy” seems to positively dig this “heresy”. Now, that must hurt…

And as I pointed out here, this is yet one more reason why, if ID proponents really want to teach a “controversy,” they should lay off evolutionary theory and attack the germ theory of disease.

Water, water everywhere, and not a drop to drink

In the October issue of Emerging Infectious Diseases, James Hughes and Jeffrey Koplan discuss the problem of safe water. Hazardous drinking water and poor sanitation is something that gets brought up when there’s a disaster (like Katrina, or the tsunami earlier this year), but many people don’t realize that a large portion of the earth’s population has to deal with this situation everyday.

Unsafe water is a global public health threat, placing persons at risk for a host of diarrheal and other diseases as well as chemical intoxication. Unsanitary water has particularly devastating effects on young children in the developing world. Each year, >2 million persons, mostly children <5 years of age, die of diarrheal disease. For children in this age group, diarrheal disease accounted for 17% of all deaths from 2000 to 2003, ranking third among causes of death, after neonatal causes and acute respiratory infections. Severe, prolonged diarrheal disease can also lead to malnutrition and impaired physical and cognitive development. Nearly 90% of diarrhea-related deaths have been attributed to unsafe or inadequate water supplies and sanitation --conditions affecting a large part of the world's population. An estimated 1.1 billion persons (one sixth of the world’s population) lack access to clean water and 2.6 billion to adequate sanitation.

(Emphasis mine). Just incredible. The rest of the article discusses activities targeted at addressing this travesty, but notes:

The United States currently ranks last among the 22 member countries of the Development Assistance Committee of the Organization for Economic Cooperation and Development in net official development assistance provided to developing countries, when such assistance is measured as a percentage of gross national income.

Again, this is an area where you can use your voice and your vote to help make a difference. For the amount of money spent on projects like this, the benefit is enormous.