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Community Support Worker Program Helps Ethiopian HIV Patients Remain Engaged in Care

April 28, 2017 - 11:54am

Alan Lifson, M.D., M.P.H. Epidemiology and Community Health Professor with the University of Minnesota School of Public Health has spent the last seven years working on HIV programs in Ethiopia with long-time collaborators, in order to help support national and regional health bureaus in implementation of the Ethiopian national HIV/AIDS Strategy.

A major challenge identified by the health bureaus, and presented to Dr. Lifson’s partners, the Ethiopian office of the National Alliance of State and Territorial AIDS Directors (NASTAD), was that of all new HIV patients, a significant proportion (almost one in five according to one study) were lost to follow-up within the first year after initially entering care.

Lifson said there are a number of factors keeping HIV-positive patients in Ethiopia from staying on track with treatment.  “Many patients don’t really understand what HIV is or what their treatment consists of. Others are reluctant to come to the clinic because of feared stigma or because they find navigating the care system somewhat intimidating. Some patients stop treatment because of often mild side effects after starting HIV drugs. For others, distance to the clinic or other competing priorities can serve as barriers to accessing care”.

To mitigate those barriers, Lifson and his colleagues decided to test a one-year pilot community-based intervention in rural southern Ethiopia. Community support workers who were themselves HIV positive were hired and trained to provide a variety of services for other HIV patients who were newly diagnosed and entering into care. Support workers were assigned to the same villages or neighborhoods where their clients lived, and made regular community-based visits. Their support services included: education about HIV and healthy living, personal counseling, and facilitated communication with the HIV Clinic to help address patient medical concerns. Support workers encouraged clients to attend their regular doctor appointments and always take their medication, as well as providing overall social and personal support, which is often lacking.

“Many of these clients feel stigmatized and isolated by their diagnosis. They have no one else to talk to about their situation, and no one to go to for advice. These support workers have already walked in their shoes as someone living with HIV – they can provide firsthand knowledge from their own experiences and invaluable support that can’t be found anywhere else,” Lifson said.

The program has been extremely successful. After one year, 94% of patients were still retained in care. After excluding those patients who transferred early or who died (typically those who already had advanced HIV disease and who were ill before beginning HIV treatment), 100% remained engaged with their assigned support worker.

“The results really speak for themselves. I’m so humbled by the people that I met by working on this project, including their tremendous dedication to helping others. Every time I travel to Ethiopia, it is an incredibly positive experience, and gratifying to know that this project has helped make a difference in the lives of people with HIV,” Lifson said.

The results have been so positive that Lifson and his colleagues are expanding the program. They’re initiating a new community-based five-year study at 32 different hospitals and health clinics with over 1,700 patients to see if the same benefits can be seen with programs on a much larger scale.

“Expanding this intervention into new and diverse communities can certainly pose new challenges, but if we show that this community-based approach is successful, it could be applied to other HIV programs as well as programs for other diseases not only in Africa but elsewhere,” Lifson said.

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What You Should Know About Tuberculosis

January 19, 2017 - 1:07pm

Recent reports of Tuberculosis, a disease long thought of as a ‘thing of the past’ have sparked many questions among the public – What is it? Will I catch it? How can I prevent it?

Heath Talk asked pediatric infectious disease expert Mark R. Schleiss, M.D., professor within the University of Minnesota Medical School, to provide more information about this scary sounding infection.

What is Tuberculosis and how is it contracted?

Tuberculosis (TB) is a bacterial infection caused by an organism known as Mycobacterium tuberculosis. It is an infection as old as humankind. By some estimates, before the 19th century, one in seven people in human history died of TB. Since the beginning of the 19th century, more than a billion people have died from the disease.

TB is spread from person-to-person, almost always by inhaling respiratory secretions associated with coughing or breathing. Except for one form called “endobronchial tuberculosis,” it is not as contagious in children as it is in adults.

If someone is on treatment for tuberculosis, they are no longer contagious.

TB is often thought of as “a thing of the past.” Why has a new case(s) resurfaced?

TB could better characterized as a disease that is “forgotten but not gone.” It never vanished or disappeared from the landscape. With better surveillance, public health measures, nutrition, improved standards of living, and prophylactic medications for individuals with exposure and/or early infection with tuberculosis, we saw dramatic decreases in the disease in the US in the last 50-75 years. But, tuberculosis was never eradicated. It is common for cases to surface periodically in schools, hospitals, and other public places. The continued existence of human reservoirs of TB underscores the need for public health surveillance and screening programs.

How can people prevent the transmission of TB?

The most effective way to prevent transmission is to periodically be screened if you are in a high-risk profession or if you are potentially exposed to individuals with infection. Health care professionals, for example, often require annual screening for the disease, which can be accomplished by a simple blood test or skin test. This is important because when you first acquire a TB infection, you are usually healthy and have no symptoms. The infection can be “latent” – meaning the infection can be present without symptoms. Individuals who have acquired TB are at high risk of having their latent infection transform into an active, contagious infection. Once the infection is active, the individual usually has a cough, and can spread the bacteria to others. Therefore, aggressive screening of high-risk individuals, and a form of treatment called “prophylactic” treatment, is the best way to prevent transmission. Prophylactic treatment is antibiotic treatment given to someone who is infected, but asymptomatic. A chest X-ray is often helpful in assessing the status of TB infection. Prophylactic treatment is known to prevent progression to active, contagious disease.

What role do vaccines play in stopping TB? How effective is TB vaccine?

A vaccine for TB exists. In fact, it’s the most widely used vaccine in the world today! We do not use it in the US (with rare exceptions). One reason is that the prevalence of tuberculosis is low in the US compared to the developing world. A second reason is that the vaccine is not very effective. The vaccine does not prevent acquisition or spread of tuberculosis. However, the vaccine when given to very young infants is able to confer enough immunity to prevent development of life-threatening forms of tuberculosis. Thus, since it saves lives, use of the vaccine in newborns is warranted in parts of the world where tuberculosis is common. We need a better vaccine – one that would completely prevent infection and eventually wipe tuberculosis off the map (as was accomplished with an effective smallpox vaccine). Improved vaccines for TB are being studied by many scientists around the world. This is a high-priority area for future research.

Can TB be transmitted even if people have the vaccine?

The vaccine unfortunately does not prevent infection and, with the exception of severe life-threatening forms of TB in babies, the vaccine does not even prevent disease. Therefore, it’s critical that someone exposed to TB, or who presents with symptoms and signs of disease compatible with TB, be evaluated for infection and considered as a candidate for treatment – irrespective of their vaccination history.

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Advancing toward Cytomegalovirus vaccination

January 11, 2017 - 10:53am

It’s among the most common infectious diseases, difficult to detect and is the leading cause of deafness in children. This relatively unknown disease is called Cytomegalovirus (CMV).

By age 40, the majority of adults have contracted the virus, according to the Centers for Disease Control and Prevention. For most people, it doesn’t present a problem.

But for women who contract the disease while pregnant, their babies have a huge risk of long-term complications because they can acquire the infection in a process called congenital transmission. This causes many long-term problems for the newborn, particularly cognitive deficiencies and hearing loss.

While there’s no current vaccine for CMV, new research in Clinical and Vaccine Immunology shows there now may be a viable path forward for future immunization to prevent congenital transmission to the newborn.

The study, led by Mark R. Schleiss, MD, professor in the University of Minnesota Medical School’s Department of Pediatrics, found that two proteins when used together during vaccination significantly decreased guinea pig fetuses’ chances of contracting CMV in utero.

“No one knows how to protect against this common disease that has potential to hurt many people’s quality of life,” said Schleiss. “So discovering a possible way to achieve immunity down the road is an advancement for the field of infectious disease.”

More specifically, a non-replicating “vector“ virus was used to deliver the CMV gene products, or antigens, to the immune system as a vaccine. While the vector virus is incapable of causing disease, it delivers the antigens and bolsters the immune system. Schleiss compared the previous leading protein candidate vaccine glycoprotein B (gB) delivered alone, and a novel combination with a CMV protein pp65 (a T cell target). This combination approach known as a bivalent vaccine was more effective in protecting against congenital CMV infection than either individual protein given alone, likely because the combination approach induced both B & T cells. The combination improved guinea pig pup survival and reduced infection when compared to either monovalent vaccine.

In the animal model, the control group that did not receive the bivalent vaccine had a mortality rate of about 93 percent. However, mortality rate for the group that received the bivalent vaccine was just 8 percent.

Beyond testing safety and efficacy, Schleiss added that the infectious disease community will explore the duration of its benefits in the animal model, as well as whether the immunity protects across the multiple strains of CMV.

“Like all science, this finding represents another ’building block’ toward the goal of an optimized vaccine”, he said. “But it’s a building block that we think could be very helpful in figuring out how to protect kids and improve their chances at a happy, healthy life.”

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Facts vs. Myths: Why you should get a flu shot

November 29, 2016 - 3:16pm

It’s flu season. The flu vaccine has been available since early fall, but there’s still plenty of time to vaccinate yourself and protect others.

It’s called herd immunity; by vaccinating yourself, you lessen the risk for infants or immunosuppressed people unable to get the shot more susceptible to infection. When most people in a community are vaccinated, it contains the disease and prevents an outbreak.

It’s a team approach, similar to the way a group of animals fights off a predator.

The Minnesota Department of Health recommends everyone 6 months and older receive the flu vaccine, excluding those who are immunosuppressed. Not sure where to go? Many clinics and pharmacies offer the flu shot for free, and it’s covered by most insurance companies. Some even offer perks for getting it done. Find a location near you. 

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Scientists find new way to improve MERS vaccines

November 22, 2016 - 4:00pm

Since the Middle East Respiratory Syndrome (MERS) was identified in 2012, more than 1,800 people have been infected with the virus that causes MERS, and the fatality rate is a concerning 36 percent. There’s still no approved MERS vaccine for humans. However, promising new research reported in Nature Communications this week may help pave the way for a human vaccine – and give hope for a new era of protection against similar viral infections.

The study was led by Fang Li, associate professor in the Department of Pharmacology at the University of Minnesota Medical School, in collaboration with Lanying Du and Shibo Jiang from New York Blood Center; Yusen Zhou from Beijing Institute of Microbiology and Epidemiology; Chien-Te Tseng from the University of Texas; and Stanley Perlman from the University of Iowa.

Professor Li and colleagues identified a region on an existing MERS vaccine that causes the body’s immune system to generate ineffective antibodies, which distract it from generating effective antibodies. In mouse models, this prevented the vaccine from working well. But, by blocking that region and stopping the distraction, the researchers could be one step closer to making a MERS vaccine viable for humans.

There are two types of commonly used viral vaccines. The first type uses whole particles of the virus that have been inactivated or attenuated to nearly harmless levels, which then spark an immune response when injected into a person or animal. By exposing the immune system to those particles, the body builds up virus-specific antibodies to prevent infection.

Another common type of vaccine is called a subunit vaccine. As the name suggests, this type only uses bits of virus proteins – not whole particles of the virus – to prompt the best response after injection. Because this type of vaccine uses only small bits of the virus, there’s no chance of infecting the host.

“Subunit vaccines are a compelling method to protect humans from virus infections because there’s no chance for inadvertent infections and they can be made and transported with relative ease.” said Li, “But they have shortcomings, too, and don’t always work as well as we want them to.”

Li and colleagues observed for the first time that when subunit vaccines are taken out of the context of the whole virus particles, these vaccine molecules created large exposed surface areas of the virus structure that were previously buried. These exposed areas on the subunit vaccines appeared to cause a reaction that distracted the immune system from leveraging the effective parts of the vaccines.

To reduce this unintended immune system response, Li and colleagues identified and then masked one of the most unfavorable regions of the vaccine that distracted the immune system. They then measured the resulting immune response in mice and noted significantly enhanced efficacy of vaccination. By masking this unfavorable region, the immune system could focus on producing large amounts of effective antibodies. They believe this concept can be replicated in other subunit vaccines to boost efficacy, improving protection against diseases like HIV, Ebola and influenza.

“The finding can potentially facilitate the design and development of vaccines against other life-threatening viruses,” said Li. “In a world where new viruses keep emerging and re-emerging, this study holds the promise to making subunit vaccines a valuable tool to combat virus infections.”

This research was performed using funding from National Institutes of Health grant numbers R01AI089728, R01AI110700, PO1Ai060699, R01AI98775, U01AI124260, R21AI109094.

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UMN researchers collaborate on Ebola ZMapp clinical trial published in NEJM

October 17, 2016 - 8:32am

A recent study in the New England Journal of Medicine revealed potential benefits of ZMapp, an experimental immune-based treatment for Ebola studied within the PREVAIL II trial.

Previous research has shown that ZMapp was effective in non-human primate studies.

The study, published in the New England Journal of Medicine, was written by the PREVAIL II Group. James Neaton, Ph.D.Joseph Koopmeiners, Ph.D., and Jacquie Neuhaus Nordwall, M.S., of the School of Public Health, are all part of the writing group for the study, and cited authors. Several researchers in the Division of Biostatistics also contributed to the study.

Two University of Minnesota physicians, David Boulware, M.D., M.P.H., and Hope Pogemiller, M.D., M.P.H., of the Medical School, also participated in the study group. Pogemiller and Quy Ton, a physician who worked for the University in 2015, spent several months in West Africa collecting data.

“This study provided useful safety and efficacy data from a well-done randomized trial on an experimental treatment for Ebola,” Neaton said. “While missing statistical significance, the data were sufficient to lead the drug (ZMapp) to be recommended for emergency use if there is a future epidemic.”

The controlled, randomized trial spanning March to November 2015 involved 72 Ebola patients from Sierra Leone, Guinea, Liberia and the United States. 35 patients received the standard of care, which produced a 37 percent mortality rate. 36 patients received the standard of care as well as the drug, which produced a 22 percent mortality rate (One person left the study early).

According to the National Institutes of Health (NIH), the relative difference in mortality between the two groups was 38 percent lower for those who received ZMapp.  The difference did not reach statistical significance.

“I would view the results from this study in an optimistic light. We were able to show that there was a greater than 90% probability that the drug had efficacy,” Richard Davey, M.D., told CIDRAP news. Davey is the deputy clinical director of the National Institute of Allergy and Infectious Diseases (NIAID), and the lead author on the study.

“It also established that one can conduct a properly designed randomized trial in a very difficult setting: the setting of an epidemic and a setting with very limited resources,” Neaton said.

The study was covered by several news outlets, including the LA Times, CNN, Fox News, STAT and more.

Read more.

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Arkansas mumps outbreak raises concerns here in Minn.

October 11, 2016 - 3:08pm

The Arkansas Department of Health is investigating a mumps outbreak, possibly infecting more than 400 people, most of them children. This raises concerns right here in our state.

Mark Schleiss, M.D., professor with the University of Minnesota Medical School, said even though these potential cases are happening in a different state, it is still a big issue for those living in Minnesota. Mumps can be a serious infection with long-term consequences.

“Kids with mumps are miserable. Fever, headache, malaise and of course the tell-tale swelling in the neck (the parotid gland) are signs of infection,” said Schleiss.

As of October 10, 476 total cases of mumps were under investigation in Arkansas according to the Arkansas Department of Health. There are 13 workplaces and 3 school districts impacted. In response to the outbreak, the state’s health department is requiring students in the affected schools with vaccine exemptions for the MMR (Mumps, Measles, and Rubella) vaccine to be excluded from school for 26 days from the date of exposure and until the outbreak has ended. Students who receive the recommended doses of MMR vaccine may return to school immediately.

The Arkansas Department of Health also previously noted in its initial analysis of immunization history in mid-September that over 18% of the cases in these children were completely unimmunized.

Schleiss said the typically the vaccines are highly effective, however there have been some outbreaks in recent years including in the upper Midwest, such as Iowa and Minnesota.

“It will be important to continue to deduce if these cases were in fully, partially, or unimmunized children. Usually two doses of vaccine (MMR) are required for protection,” said Schleiss. “It is striking how high the percentage of unimmunized children with disease was in the initial analysis of this outbreak. Failing to vaccinate our children puts them at risk – and puts other children at risk.”

Schleiss said as parents hear about this outbreak in Arkansas, it is a good reminder of what to look for in their own children. The illness is spread typically by respiratory route and via secretions and close person-to-person contact, including sneezing, coughing, talking, and other close contact.

“The world is a small place and with travel, the disease could easily be introduced into Minnesota if it hasn’t already,” Schleiss said. “Parents owe it to their children, and to other children in their schools and communities, to prevent this infection through the use of the simple, safe and effective MMR vaccine.”

 

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CIDRAP joins global alliance to fight antimicrobial resistance

September 22, 2016 - 4:18pm

The Center for Infectious Disease Research and Policy (CIDRAP) is helping pave the way for a new era of global involvement to ensure sustainable access to effective antimicrobials.

CIDRAP is one of the 9 founding organizations of CARA – Conscience of Antimicrobial Resistance Accountability- a new alliance which will be introduced at the UN General Assembly High-Level Meeting on Antimicrobial Resistance.

CARA’s goals hit on five key factors: surveillance, preserving effectiveness, universal access, innovation and accountability. The alliance plans to set goals to achieve specific objectives such as universal access to antibiotics, particularly in lower income countries which lack access, and to support innovation to encourage the development of new antimicrobials.

“This newly formed alliance is expected to grow, both in number and in impact. We here at CIDRAP are pleased to be one of the founding organizations of such an essential initiative during a time where the health of the global population is undoubtedly threatened by increasing antimicrobial resistance,” said Michael Osterholm, Regents Professor and Director of CIDRAP.

In July 2016, CIDRAP launched a new initiative called the Antimicrobial Stewardship Project (ASP). It’s aimed at creating an authoritative and credible resource for healthcare providers engaged in antimicrobial stewardship, and addresses the CARA goal of “preserving [antimicrobial] effectiveness.” As part of CARA, CIDRAP will continue to be a critical informational platform for healthcare providers on the frontlines of the antimicrobial resistance crisis.

Other founding organizations include:

  • Antibiotic Resistance Action Center (ARAC), the George Washington University
  • British Society for Antimicrobial Chemotherapy (BSAC)
  • Center for Disease Dynamics, Economics & Policy (CDDEP)
  • Center for Global Development (CGD)
  • German Center for Infection Research (DZIF)
  • The Pew Charitable Trusts
  • Norwegian Institute of Public Health (NIPH)
  • World Alliance Against Antibiotic Resistance (WAAAR)

 

 

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Meningitis B vaccine study raises questions about vaccine response in recent New Jersey university outbreak

July 22, 2016 - 10:42am

A new study from the University of Minnesota’s School of Public Health found that only 66 percent of college students who received the recommended two doses of the meningococcal group B vaccine Bexsero® (4CMenB) had evidence of a detectable immune response against an outbreak strain.

The study was conducted during an ongoing outbreak at a New Jersey university in 2014. While no cases of meningitis B were reported among the vaccinated students during the outbreak and all vaccines had evidence they had developed some immunity, the findings suggest the meningitis B vaccine may have limited impact on certain strains.

“Epidemiologists play a critical role in evaluating the impact of vaccines,” said Nicole Basta, Ph.D., lead author of the study and assistant professor in the University of Minnesota School of Public Health. “Conducting studies of novel vaccines allows us to go beyond clinical trials and investigate critical questions about how broadly protective new vaccines are. This was a rare opportunity to investigate the immune response to the vaccine during an ongoing outbreak.”

Read more about the study.

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In The News: U.S. Senators, UMN faculty discuss Zika virus threat

May 26, 2016 - 12:55pm

Zika virus is gaining attention in the United States as mosquito season arrives. According to the Minnesota State Health Commissioner, the virus will, in one way or another, affect every state in the U.S. in the coming months.

The virus, carried and transmitted by infected Aedes mosquitoes, poses a major threat to pregnant woman and can cause extreme birth defects in unborn babies. Zika virus has also been linked to cause Guillain-Barré syndrome in certain infected patients. The virus can also be transmitted sexually, though the strain only stays in the body for a short period of time, reducing the chances for person-to-person transmission.

Though no mosquitoes of this kind typically live within Minnesota’s boarders, the importance of prevention and awareness is high.

U.S. Senators Amy Klobuchar and Al Franken visited the University of Minnesota to discuss the immediate concern of the Zika virus in Minnesota and to talk about preventative steps. Joining the senators for the discussion were leading experts on Zika and infectious disease, including University of Minnesota faculty members and representatives from the Minnesota Department of Health.

“The mosquito season is upon us in Minnesota,” Senator Klobuchar told the Star Tribune, “and we’re starting to see this virus in the United States.”

The Centers for Disease Control & Prevention are monitoring almost 300 pregnant women in U.S. territories who tested positive for the virus after traveling abroad. In recent months, Zika spread quickly throughout South and Central America, and was brought into the States by winter travelers that were bitten by the infected mosquitoes.

Michael Osterholm, Ph.D., M.P.H., director of the Center of Infectious Disease Research & Policy, assured the senators any Zika outbreaks occurring within the United States would be in isolated clusters and the immediate risk of the Zika virus in Minnesota remains low.

A main conversation of the table, however, was the backlog of Zika testing for concerned patients and travelers. Currently, medical facilities cannot keep up with testing requests from patients who may have been in contact with the virus. Better surveillance, tracking, and infrastructure needs to be prepared to identify the virus and protect people nationwide.

Earlier in May, Klobuchar and Franken helped pass a bill in the Senate, asking Washington for $1.1 billion in emergency funding to fight the Zika virus. Since then, The House has approved a $622 million bill contributing to the cause, which is intended to last through September.

More on this story: 

Star TribuneKARE 11WCCOFox 9, or check out our storify.

Read More

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Breastfeeding at work: challenges and opportunities for Minnesota’s mothers

Health Talk recommends: Measles, the most infectious of all infectious diseases

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Drop the vitamin C: The truth about colds

November 10, 2015 - 3:29pm

Dripping noses and choruses of coughs can be heard in hallways and homes as fall settles in, a season often considered ripe for colds.

The truth is colds hit year round. In fact, adults probably come down with two or three infections per year. Children, especially those hitting the classroom or settling in at day care, often see up to six colds a year.

“It’s considered one of the most common infectious diseases in humans,” said Mark Schleiss, M.D., co-director of the Center for Infectious Diseases and Microbiology Translational Research at the University of Minnesota. “Colds are generally caused by a virus called rhinovirus, and there are about 100 unique types of rhinoviruses. You can build immunity to them, but there are a lot of different strains so it’s hard to beat it completely.”

Schleiss is a practicing pediatrician and sees plenty of colds, so we checked in for the inside scoop on how to treat – and avoid – the common cold.

Can colds be prevented?

The best way to prevent colds is good, old fashioned hand washing, along with keeping clear of folks who are doing the coughing and sneezing.

“The only way to prevent a cold is to avoid letting the cells in your nasal passages come in contact with the virus,” said Schleiss. “You can protect yourself by practicing good hand hygiene and avoiding close, personal contact with people infected with the virus.”

Once the virus is in your nasal mucous, it’s generally too late to prevent a cold. However, good health habits, such as plenty of sleep and good eating habits, may help your body battle back.

One good note: you might be tempted to load up on vitamin C or other remedies promising protection from cold viruses. Schleiss says science shows this just doesn’t work.

“Vitamin supplements and similar products will not prevent a cold, unfortunately,” said Schleiss. “Studies show vitamin C is no different than a placebo in preventing the effects of the virus.”

If you’re feeling sick, stay home. Protect your friends and neighbors!

What to do when the cold settles in

Zinc could be a good bet, if you catch the cold right in the beginning.

“Interestingly, zinc does seem to shorten the duration and severity of a cold if taken early in the illness,” Schleiss said. “The effect is modest, and may only shorten your cold by about thirty percent, but there’s pretty good evidence it works.”

Some folks find nasal decongestants helpful, but these should be used sparingly to protect the long term health of the nasal passages.

Avoid products containing anti-histamines and Echinacea. Neither has been shown to help handle colds.

Don’t starve a fever, but feel free to feed your cold

The old saying is “starve a fever, feed a cold,” but neither is particularly solid medical advice.

The thinking was digestion could raise the body’s temperature, which could be dangerous to someone already feverish. Conversely, colds were thought to be caused by a body being too cold, so the metabolism boost would bring someone back to health. Each, it turns out, is a myth.

“However, I will say that my mother makes the best chicken soup I’ve ever had in my life, and I am always grateful for an opportunity to coax her into making some,” said Schleiss. “A cold might be a blessing in disguise for that reason alone.”

One more fun fact

Human colds are uniquely human! Our rhinoviruses don’t jump from species to species, like some influenza strains. However, many mammals get colds and seem to have their own unique, species-specific rhinoviruses.

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Educational activities to replace bird exhibitions at the 2015 Minnesota State Fair

August 26, 2015 - 10:59am

Earlier this Spring, highly pathogenic avian influenza (HPAI) hit Minnesota, killing more than 9 million poultry and birds across 100 farms. Animal health officials decided to close poultry exhibits at a variety of events including the 2015 Minnesota State Fair, leaving fair-goers and 4H members disappointed, but the decision will minimize the risk of spreading the virus further.

“The step was necessary to help protect the health of our birds,” said Beth Thompson, D.V.M., assistant director of the Minnesota Board of Animal Health. “The showing of poultry and birds is important to many, however, all groups were involved in the decision and supported the conclusion.”

There is still a lot researchers are learning about HPAI, and while there are no current cases, bringing poultry together in one place could increase the risk of new cases.

The virus is naturally carried by wild waterfowl, but is deadly to domestic poultry, especially turkeys. Minnesota is the top turkey producing state in the country, and contains many broilers and egg layers. Infection is possible among poultry regardless of the type or size of production system including backyard flocks and exhibition type poultry, says Sally Noll, Ph.D., from the Department of Animal Science. Experts expect additional cases of the poultry-threatening HPAI to emerge as birds migrate in the fall.

Carol Cardona, D.V.M., from the College of Veterinary Medicine, told MPR News the avian flu kills 100 percent of infected birds as they don’t form the antibodies necessary to ward off the virus before they die.

“There’s never been so many infected farms all at the same time, either by introduction or farm-to-farm spread,” said Cardona.

“If there are no poultry and birds at the State Fair, we know that we have cut down on spread of the virus and are keeping birds healthy,” said Thompson. “It is an opportunity to teach about this virus and other diseases.”

Projects and activities within the poultry barns will replace the exhibitions to teach the public about the behind-the-scenes aspects of raising and showing poultry. The suspension of the exhibitions will provide the opportunity for State Fair attendees to learn more about the challenges of HPAI.

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UMN doctor awarded collaborative grant to study newborn hearing screening and CMV screening in Minnesota

August 24, 2015 - 10:44am

A new grant will enable the collaboration between the Children’s Hospitals and Clinics of Minnesota and the University of Minnesota Medical Center. The research will allow further evaluation of newborn infants failing hearing screenings for cytomegalovirus (CMV).

Typically asymptomatic, CMV is the most common congenital infection among children and is responsible for 30 percent of childhood hearing loss cases.

“Research on CMV is important due to the major impact this virus has on a child’s health,” said Mark Schleiss, M.D., professor of pediatrics and director of the division of infectious diseases and immunology at the University of Minnesota Medical School. “Finding new ways to control CMV infection in newborn infants is essential.”

The study will allow parents of referred newborns at the University of Minnesota Medical Center and Allina Health to be tested before being discharged from the hospital.

Many infants acquire CMV after birth, often during breastfeeding, so testing after 21 days can be a challenge. Hearing-impaired infants need to be tested for CMV in the immediate newborn period to determine if they were infected before birth, since CMV infection acquired after birth does not cause hearing loss. The point-of-care testing approach will help identify newborns who were truly infected before birth, and who may benefit from treatment.

“This grant will develop and implement a model for testing newborns for CMV if they fail their newborn hearing screening,” said Schleiss. “This will allow earlier detection, anticipatory guidance, and administration of antiviral therapy. It is an important first step toward possible universal newborn screening for CMV infection.”

The treatment of congenital CMV infection with the antiviral drug, Ganciclovir, can improve hearing and enhance neurodevelopmental outcomes for infants born with the infection. Currently, infants aren’t screened for CMV at birth.

Funded by Children’s Hospitals and Clinics of Minnesota’s Internal Research Grant Program, the research partnership will include the Division of Pediatric Infectious Diseases at the University of Minnesota and Timothy Lander, M.D., from the Children’s Hospitals and Clinics.

“This award represents an important collaboration between the two institutions, and hopefully will serve as a positive example for future interactions between our institutions,” said Schleiss.

Parents with questions about their child’s newborn hearing screening process should talk to their pediatrician or primary care provider.

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From tick to sick: the search for a Lyme disease diagnosis

July 31, 2015 - 10:47am

A blacklegged tick, just the size of a poppy seed, perches on the tip of a leaf. It stands poised with its limbs outstretched, ready to latch onto its next prey.

It’s barely noticeable, but looks essentially harmless; just another tiny bug that will leave itchy red bumps up and down your legs. But that bite carries a greater threat: Lyme disease.

Lyme disease is the most common tick-borne illness, and generally causes a circular rash, joint pain and flu-like symptoms. The Centers for Disease Control and Prevention (CDC) estimates that it affects about 300,000 people in the U.S. each year. There were more than 1,400 confirmed cases of Lyme disease in Minnesota in 2013, and it has been found in four times as many counties in 2013 compared to 1993 nationwide. It’s most commonly diagnosed in the Northeast and upper Midwest.

It’s spreading, but there’s still a lot scientists and physicians don’t know about Lyme disease.  Health Talk spoke with faculty at the University of Minnesota Medical School Duluth to learn more.

On the bacteria that causes Lyme disease…

We contract Lyme disease through Ixodes scapularis, commonly known as the deer tick or blacklegged tick. When they bite, they spit saliva into the body, which transfers Borrelia burgdoferi (Borrelia), the bacteria that causes Lyme disease. The saliva also protects Borrelia from macrophages that eat up viruses and bacteria. Borrelia just slide off and infect the body. Macrophages normally stimulate an immune response, but they can’t find the bacteria. As they multiply, the coating disappears, but at that point it has spread throughout the body.

On Lyme disease diagnosis…

It can be hard for physicians to detect Lyme disease because Borrelia elude an immune response. In other words, they hide.

“Early on, a test could be normal even if you have Lyme disease,” said Jacob Prunuske, M.D., associate professor of family medicine and community health at the University of Minnesota Medical School Duluth.

The test looks for Borrelia antibodies, which develop when the immune system kicks into gear. Most patients develop antibodies within a month of infection, but for about 20 percent of patients, they can take much longer to show up. While symptoms may be present, the test can be negative. And the rash, the telltale sign of Lyme disease, doesn’t develop in about 20-30 percent of patients.

“Aside from the rash, the main symptoms are fever, fatigue, joint pain and muscle aches. That could really be any type of virus,” Prunuske said. “It can be easy to miss Lyme disease in that context.”

On Lyme disease prevention…

The only foolproof way to prevent Lyme disease is to stay inside, but avoiding the outdoors is unrealistic.

“Check yourself for ticks,” Prunuske said. “Wear long pants and shirts to minimize exposed skin for ticks to bite.”

Ticks generally need to be latched to the body for at least 24 hours to pass on Borrelia. Even so, it’s important to regularly check for ticks and remove them quickly.

Our experts gave these CDC-recommended tick tips to keep in mind:

1. DO use a tweezers. Grasp as close to the skin as possible.

2. DON’T twist, jerk or shake in the process, or parts of the tick’s mouth (and the bacteria) could remain lodged in the skin. Do not burn them off and don’t try to crush the tick with your hands or feet.

3. DO clean the site of the bite with rubbing alcohol or soap and water.

4. DON’T wait to tell your doctor.

5. DO save the tick and send in for testing. This can help researchers, and could help your doctor identify Lyme disease sooner.

Lynne Bemis, Ph.D., Benjamin Clarke, Ph.D., Amy Prunuske, Ph.D., with the department of biomedical sciences are all researching Borellia, exploring how the bacteria move through the body and interact with antibiotics. They also hope to develop a more accurate test for diagnosing Lyme disease. Read more about their research and other UMN projects examining tick and vector-borne diseases.

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In the News: HPV vaccine has slow entry into public health policy

July 17, 2015 - 2:05pm

It’s been nearly a decade since the human papillomavirus (HPV) vaccination was introduced, yet vaccination rates are still very low. A recent JAMA report showed the HPV vaccine has had a more difficult time making its way into public health policy than other vaccinations.

According to recent data from the CDC, only 37.6 percent of American teenage girls have received the series of HPV vaccinations, and only 13.9 percent of teenage boys. Only two states, Virginia and, as of next month, Rhode Island, require the vaccination for middle school enrollment.

The JAMA report showed the vaccine for chickenpox was required in 21 states and the meningococcal virus vaccine was required in 38 states at the eight-year mark of their releases. Even the hepatitis B vaccine, which similar to HPV, prevents a sexually transmitted infection that causes cancer, was required in 36 states.

So why is the HPV vaccination not more widely accepted?

At the time of its release in 2006, the vaccination was only approved for girls, targeting 11 and 12-year-olds as a way to prevent the sexually transmitted infection that causes cervical cancer. Lacking a vaccine for boys, the HPV vaccine became associated with female sexuality.

The initial language used in policy discussions surrounding the HPV vaccination led people to believe the vaccine would increase sexual activity among young women, says Sarah Gollust, Ph.D., assistant professor in the School of Public Health, in a recent NPR article.

Gollust, along with her colleague Erika Franklin Fowler at Wesleyan University, conducted a comprehensive analysis of news media coverage of the vaccine.“Our research found the news media commonly emphasized political controversy in the first two years following FDA approval of the vaccine in 2006,” said Gollust. “This controversy frame for the HPV vaccine could have effects on how the public, or even health care providers, think about the vaccine.”

Approval for the vaccination for teenage boys came three years after the approval for girls and was not added to the list of recommendations until 2011.

“If they had waited until it was recommended for both boys and girls, perhaps that would have made a big difference,” Gollust said. “No other vaccine is required for just one gender, so it felt like there was something different about this one.”

Gollust says the previous controversy over the vaccination is still lingering, possibly contributing to hesitation among pediatricians to recommend a HPV vaccine involving adolescent sexuality. The recommendation from a doctor is a significant factor in the decision to vaccinate.

“I think the biggest place to push here now is on the provider conversation, having providers discuss the vaccine with their patients as they would discuss any other vaccine,” Gollust said.

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Expert Perspective: CDC decides on permissive recommendation for strain B meningococcal vaccination

June 29, 2015 - 2:00pm

The Center for Disease Control (CDC) chose not to mandate a newly-developed vaccine for a meningitis substrain Neisseria meningitidis, but to leave the decision to vaccinate up to parents and children with physician recommendations. Meningococcal meningitis is a serious condition which can be incredibly dangerous if not treated quickly. Vaccines for the strains A, C, Y and W-135 have been a part of vaccination requirements for over 10 years, while the vaccine for the serogroup B strain, Neisseria meningitidis, was developed last year. Questions about the vaccination requirements were raised amidst growing concerns linked to recent B-strain outbreaks.

Health Talk spoke with Mark Schleiss, M.D., professor in the Medical School and Director of the Division of Infectious Diseases and Immunology, about the decision.

“We previously had vaccinations for the more common meningococcal strains, however, being immune to one strain does not mean a person has immunity to all the other strands,” said Schleiss. “Even though meningitis is a relatively rare disease, the strain B vaccination is a significant advancement.”

Meningococcal meningitis travels extremely quickly and is important to treat immediately. Symptoms can include a sudden fever, headache, rash, vomiting and an altered mental status. Though rare, it can be serious.

The vaccination for the four strains has been recommended for 11-to-12-year-olds since 2005, and the CDC decided last week that the MenB immunization will be classified as a Category B, or ‘permissive’ vaccination. Parents and their children will have the decision to choose if they want to receive the vaccination after a health care professional evaluates their risk.

“This level of recommendation brings a great deal of uncertainty,” said Schleiss. “It is much more clear for parents and adolescents to understand the benefits of the vaccination and the risks of not receiving it when a stronger recommendation is present. The second tier categories can have less of an impact on the public.”

A person is at a higher risk for meningitis if they are consistently exposed to a large amount of people. The bacteria groups circulate among people, so face-to-face contact with others in confined areas can increase a person’s risk. The biggest peak of diseases is in infancy, late adolescence and early adult adulthood.

“While the decision to give universal recommendations comes down to the financial aspects of the vaccination for the rare disease, we need to go beyond cost to consider the unpredictable nature of meningitis and the high fatality rate,” said Schleiss.

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UMN scientists identify two mutations critical for MERS transmission from bats to humans

June 10, 2015 - 2:45pm

Researchers have identified two critical mutations allowing the deadly Middle East Respiratory Syndrome (MERS) virus to transmit from bats to humans. The findings were published in the most recent edition of the Journal of Virology.

Leading the research was Fang Li, Ph.D., associate professor of Pharmacology at the University of Minnesota Medical School. Graduate students Yang Yang and Chang Liu from Professor Fang Li’s lab participated in the research. The study was conducted in collaboration with Shibo Jiang, M.D. , Ph.D., and Lanying Du, Ph.D., from the New York Blood Center, Zhengli Shi, Ph.D., from Chinese Academy of Sciences, and Ralph Baric, Ph.D., from the University of North Carolina.

MERS is in the same virus family as Severe Acute Respiratory Syndrome (SARS) responsible for a global epidemic in 2003. MERS was first diagnosed in 2012, and has since infected over 1100 people. The illness is deadly in about 40 percent of people who contract it. Recently, MERS has spread to South Korea, where the numbers of infected cases and quarantined people are rapidly rising.

Last year, Li and his colleagues published a paper in Proceedings of the National Academy of Sciences, revealing bats as the likely native reservoir for MERS virus.

In this new study, researchers compared the sequences of MERS virus and MERS-like bat viruses, and found two mutations were sufficient to change MERS-like bat viruses from being unable to infect human cells to efficiently infecting human cells. For viruses to infect host cells, they first need to attach to a receptor on the host cell surface, and then are activated by host enzymes, called proteases, triggering the fusion of viruses and host cells. The two mutations in MERS virus allowed the virus to be activated by human proteases, and hence played a critical role in the bat-to-human transmission of MERS virus.

Li’s previous research, published in Science in 2005, showed two mutations were critical for SARS to transmit from its animal reservoir in palm civets to humans. Different from the two mutations identified in MERS, the two mutations identified in SARS allowed the virus to attach to the human receptor with much enhanced affinity. Therefore, MERS and SARS have used two different evolutionary strategies to achieve efficient infections of human cells.

Based on these studies, Li stresses it is critical for scientists to examine the different evolutionary strategies used by viruses so scientists can understand how viruses transmit from animal reservoirs to humans.

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Tuning into Social Networks to Prevent and Contain Disease

June 1, 2015 - 11:19am

As the College of Veterinary Medicine’s first and only disease ecologist, Meggan Craft, Ph.D., is a pioneer in the study of how disease spreads through animal populations. She has used mathematical models to track the spread of distemper in African lions and is currently working on a five-year collaborative project to discover what types of mountain lion contacts lead to the transmission of infectious disease.

Craft is one of the early adopters of technology that looks at how social networks—prides of lions, pods of whales, or herds of cattle—contact one another within their social network and in neighboring networks. Called contact modeling, this tool is being adopted at a rapid rate worldwide, and Craft is helping researchers make the best use of the method.

“Contact models provide a good framework and informational tool for researchers who want to combine real-world data on contacts and disease modeling in order to understand the spread of the disease and how that can impact wildlife, domestic animal populations, and humans,” says Craft.

Due to the increasing use of these models, Craft decided to review how well these models have performed over the past 10 years and how scientists can make even better use of them in the future.

Her recent work, “Infectious Disease Transmission and Contact Networks in Wildlife and Livestock,” was published in April 2015 in the prestigious journal Philosophical Transactions, the world’s first journal dedicated to science. Philosophical Transactions published its first issue in 1665.

“The paper looks at some of the questions these models have addressed, what the models are good for, where they need work, and areas for future research,” notes Craft.

The models Craft reviewed were primarily used for specific case studies, one with a host and a specific pathogen. She discovered that these models are particularly good at using social structure and complex movement patterns to help inform scientists about disease transmission.

“They are a good tool when you know something about the social structure of the animal population you want to study,” she says.

Traditional models assume that everyone within a population has an equal opportunity to contact everyone else in that population, which is often not realistic, she says. For example, in 2009 and 2011, Craft devised a model that helped her determine that hyenas and jackals were likely involved in the spread of distemper in African lions by incorporating pride structure into her model of disease spread. The model provided a look at how the disease should have spread through the population, but that was not what the real outbreak looked like, which tipped Craft off that other carnivores were likely responsible for spreading the disease.

Another new technology, proximity collars, are providing researchers with good data on animal movement and contact in the wild, which is increasing interest among scientists in using contact models.

For example, Craft is using data collected from proximity collars worn by raccoons and creating a contact model to understand how rabies is being spread through the raccoon population in suburban Chicago.

One of the challenges Craft found when reviewing the models is the mismatch between the social network constructed in the model and the pathogen of interest. For instance, if a virus is only infectious for two days, the model needs to reflect that.

“In this example, the model would need to be constructed on a two-day time scale to represent every other animal the infected host comes into contact with over a two-day period, not, for example, a full year,” Craft says. “Using a full-year time scale greatly overestimates the number of animals that could become infected.”

Lack of data on either contact behavior or pathogens can also present challenges.

“It’s an exciting time to bring together mathematical modelers, veterinarians, and field biologists in an effort to understand how best to predict and contain disease spread,” says Craft. “The resulting information can also help us develop more targeted control strategies.”

Once it is known which individuals are most likely to spread disease through the most contacts, such as pride lions, for example, then scientists know which cats to vaccinate to contain the spread of the disease.

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In the news: No link between MMR vaccine and autism, even for children at risk for autism

April 22, 2015 - 8:09am

In a new study published in JAMA, researchers yet again found no link between the MMR vaccine and autism, even for kids who are at risk for developing autism.

According to Forbes, “the likelihood of developing autism was actually lower for those at-risk children if they received the vaccine, though that finding was not statistically significant and no one would suggest that vaccination reduces autism risk. What vaccination reduces is disease, the kinds that can disable and kill children and the kind that is even more likely to cause serious complications in children with neurological conditions.”

The study’s findings were not surprising to infectious disease experts, including Mark Schleiss, M.D., a pediatric infectious disease physician at the University of Minnesota.

“In addition to providing further evidence of vaccine safety, specifically MMR, this study dispels another myth: namely, that there’s a subset of children who are somehow genetically or biologically predisposed to have an adverse reaction to MMR,” Schleiss said. “This is very useful because it provides parents with more reassurance about vaccinating children with neurodevelopmental issues – children who are particularly vulnerable to many vaccine-preventable diseases – and their siblings.”

According to Schleiss, one of the more concerning aspects of the study was that it happened in the first place. “Unfortunately, precious resources were invested in proving what we already knew – that MMR vaccine is safe and doesn’t trigger autism – because of the sham and fraud promulgated by Wakefield,” Schleiss said. “We must now focus those resources on legitimate scientific hypotheses about autism.”

Note: It is National Infant Immunization Week. Learn how you can protect your baby from 14 serious diseases before age 2.

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In the News: Ebola vaccine needs fast track

February 18, 2015 - 8:30am

According to a recent Star Tribune article, “More than 23,000 people suffered suspected infections and more than 14,000 died in the current Ebola outbreak, but the number of new cases has slowed in recent weeks.” Although Ebola may be slowing down in the headlines, the epidemic is far from over. Experts suggest health officials shouldn’t be drawing back on testing and creating vaccines for this highly deadly virus.

Michael Osterholm, Ph.D., M.P.H., an infectious disease expert and director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP), told the Star Tribune that “waiting for another global scare to ramp up vaccine efforts won’t work.” Osterholm, joined by 25 other international leaders in infectious disease, also known as “Team B,” are advocating for a pace of vaccine development that would be considered the fastest in human history.

The group, in coordination with CIDRAP and the Wellcome Trust, published a report outlining recommendations on accelerating the development of Ebola vaccines.

Challenges to accelerating the search for Ebola vaccines range from figuring out the right vaccine dose to insuring that the product is safe and that it can then be produced in sufficient quantities.

“The dwindling number of Ebola patients in Liberia is welcome news,” said Osterholm in an article on USA TODAY. However, he then goes on to express concerns for ruling vaccines as successful when the number of cases are declining. In an article published on MPR he states, “If you don’t have a large number of cases it’s going to take much longer before you can actually determine: Does this vaccine work or not?”

Team B works independently from the regulators, manufacturers and public health agencies involved in the vaccine development currently underway, allowing for more outlook on the development process. “We think that we are able to bring a slightly different perspective that is complementary to what’s going on,” said Osterholm. “So if there’s something being missed, it can be readily picked up.”

For further recommendations regarding Ebola vaccine development read the full report here.

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