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The battle against bacterial infections and the diseases they cause is one sadly where the bacteria are becoming stronger and the human is becoming weaker. Bacteria constantly are able to mutate to become resistance to the defense mechanisms such as antibiotics that we put into our body. According to the CDC 2019 Antibiotic Resistance Report more than 2.8 million antibiotic infections occur in the US and more than 35,000 people die in response. A rise in resistant infection puts more people at risk and threatens the progress antibiotics have made in healthcare. As more people are exposed to antibiotics bacteria are more capable to gain resistance to those drugs causing a continuous rush and need for the development for new antibiotics. Yet these bacteria are able to obtain resistance faster than we can develop drugs. Bacteria are now one step ahead of us, as we used to be one step ahead from them. This is a foot race to combat these fatal infections and propel the healthcare industry.

The CDC divides the prevalent resistant microbes into three categories in regard to threat to humans: Urgent Threats, Serious Threats, Concerning Threats. There is a watch list for bacteria that is on the verge of becoming a major resistance threat, however it is important to focus on these as well to avoid further resistance development. C. difficile is on the Urgent Threat list, there are approximately 223,900 infections per year and 12,800 per year. C. difficile is a superbug which is a strain of bacteria that is resistant to several types of antibiotics. C. difficile is present in the gut microbial but as antibiotics are used to treat other infections it can attack the healthy microbial and allow the C. difficile to become activated. C. difficile is a double whammy as it is developing increased antibiotic resistance and is also caused by the use of antibiotics. Antibiotics can make infected persons sicker because they kill the C. Difficile but also the good bacteria that keep the C. Difficile in balance which allows C. Difficile to grow without competition. C. Difficile is now one of the three top superbugs identified by the CDC.

C. Difficile is also is hard to kill by disinfectants so if C. Difficile is on surfaces in hospitals the hospital grade disinfectants are unable to kill it. This gives opportunity to develop not just antibiotics to fight the super bug but rise to disinfectants that can combat super bugs. Because often these infections are spread from surface contact, so combating them from transmitting is one way to eliminate a super bug all together. It is important that the drug development and healthcare industries look beyond medication development to fight off superbugs. They need to be innovative and work to kill the superbugs off of the surfaces where they are transmitted such as in hospitals and nursing homes. We need to combat these superbugs where they least expect it and it is in environments where they are weaker which is on exposed surfaces before they are transmitted into the human body where they can thrive and replicate without competition.

The number of those infected by resistant bacteria is only going to increase if we do not work to improve the lifespan of antibiotics. At this point, time is not on our side as bacteria are able to evolve resistance early of development. It is crucial to get ahead of the bacteria before we have no proper medication to combat bacterial infections. A way to achieve this is to reduce human dependence on medications and relying on antibiotics to be a “quick fix” to their infections even when they might not even have a bacterial infection. As humans increase their exposure to antibiotics bacteria increase their resistance. This direct relationship is why it is crucial for humans to combat these superbugs in unconventional methods.

There has been constant research and experimentation in regards to the HPV vaccine. In 2006, the FDA approved a HPV vaccination is a two dose shot that is administered between the ages of 11 and 26. It can prevent almost 90% of HPV-related cancers. It has its strongest immune response towards the younger ages of 11 and 12 before the person is exposed to the virus. The second dose is to be given six – twelve months after the first. However, the vaccine is not as effective when both doses are not administered. Only half of American adolescents have been fully vaccinated against HPV. America is one of the leaders in healthcare and healthcare innovation yet only 50% of adolescents are fully vaccinated for HPV. This stems from physician’s not strongly urging parents to receive the vaccine or parents lacking the knowledge or needing more information about it. More than 50% of adolescents do not complete the two dose vaccination. Now this is in America, imagine in low and middle income countries where healthcare is poor and medical resources are limited. They are now more susceptible to HPV and the cancers that arise from it because of their lack of resources and the inefficiency of a two dose vaccine. Two dose vaccines are inconvenient and require a health provider than truly stays on top of their patients’ medical records and encourage vaccinations. However many providers, including my own, was passive in the promotion of the HPV vaccine. I am thankful to have a protective mom, who insisted I receive the vaccine because better to be protected rather than sorry.

Currently, researchers are working on developing a single dose HPV vaccine. The Costa-Rica HPV Vaccine Trial provided data that one dose of the HPV vaccine could provide durable protection against HPV vaccine. Although the study who received the one dose was small and not randomly selected it provided possibility that one dose can produce enough antibodies to provide protection. The one dose was able to elicit a 9-times higher antibody response than just a natural response to the infection. The importance of a one dose HPV vaccine is that it would be able to be distributed even further to low income countries because now one dose can be given to more patients rather than two doses for select patients. A single dose strategy could have major effects on public health. As it could cause the development of herd immunity which would protect women who cannot receive the vaccine. The next steps for the trial is to utilize a larger and random subject pool to further prove their data. This trial will help eradicate a public health epidemic because if we can make vaccines easier and more efficient it will be cheaper and quicker to distribute them.

There is also a 3 dose vaccine. Which is just extreme and unfeasible in low income countries. In more recent studies by the NIH, the single dose vaccine against incident and persistent of the vaccine targeted HPV types had similar effects as the triple dose vaccine. A study done by Human Vaccine and Immunotherapeutics demonstrated that the three dose had 100% efficacy in preventing cervical intraepithelial neoplasia 3 who where at risk for HPV infection.

A single shot vaccine would also have major improvements in America. However, America needs to focus on physicians; physicians need to positively and assertively recommend the vaccine to patients. Americans are not going to do more than they have to do. Also the constant threat of the anti-vaxx movement grows the belief that if there is not a dire need of a vaccine often Americans will not get it. This one dosage vaccine could catapult the US towards its 80% vaccination goal. The importance of 80% is that at this level it is very difficult for a virus to spread in a population providing herd immunity.

It is crucial to educate parents on the importance of vaccines. Especially vaccines that can have the potential to eradicate a virus. HPV vaccinations that have the potential of eradicating HPV related cancers such as cervical. The key word here is prevention. Through early vaccination, we can protect our youth and work further towards the eradication of the disease. However the passiveness of doctors is standing in our way. We need our doctors to ensure, patients understand the importance of the vaccine. Vaccinating children is one of the most cost effective and feasible ways to prevent HPV as healthcare costs only rise as more people are in the hospital for cancer treatments.

In all studies observed, the best response to the vaccines is acheieved when it is obtained at the beginning of adolescents at age 11 or 12.

The Measles had been declared eliminated in the United States in 2000. It is still considered eliminated even though of the frequent occurrence of measles in small pockets of the United States throughout the years. The World Health Organization defines the measles elimination as “the absence of endemic measles virus transmission in a defined geographical area (e.g. region or country) for at least 12 months in the presence of a surveillance system that has been verified to be performing well.” This definitions requires an endemic to occur, the small flare ups of the measles are not considered endemics allowing the US to keep their elimination status. However the United States is at risk for losing their elimination status because of the influence of the anti-vaxx movement. Even if the United States loses their elimination status there is still a low risk to obtain the measles in the United States. Yet it would look really bad for the United States, an international leader and power, to lose its elimination status on the basis of the anti-vaxx movement. A movement based off poor and faulty scientific practice. Ultimately it would be embarrassing and threaten the legitimacy of United States’ medical research. To then, cause a downward spiral of the medical advancements achieved in the world.

In 2019, 1,282 cases of measles were reported in the US. However it is not just a reemergence in the united states it is a global problem as more than 140,000 people died from the measles last year. How did we get here? Vaccination rates are declining as more people believe the “cons” of vaccines are worst than the pros. Yes “cons” because there are no major threats of the MMRV or MMR vaccine to a person. There is no connection to autism or mental handicaps. As of 2019, only 69% of Americans think the risk of the side effects of the MMR are low this is the same as the study conducted in 2016. We are supposed to be advancing the education to the public on vaccines not allowing it to remain stagnant. It is important to educate the people. 93% of people with a postgraduate degree state the health benefits of the MMR vaccine are very high while only 68% of those with a high school degree agree. It is important to focus educational efforts on those who have limited educational experience to increase the 68%. By educating those who lack the resources to do so, will increase the rate of vaccination and help eradicate measles.

MMRV/MMR Vaccine

It is important to obtain vaccines because they protect beyond the targeted disease. The MMR/MMRV vaccine provides your body protection from the complications that arise with the measles. Measles have complications such as pneumonia, hepatitis, and viral meningitis. This is because the presence of the measles in the body leaves the body weak and susceptible to outside infections. It is crucial to obtain both doses of the MMR/MMRV vaccine to complete immunity. Obtaining one dose, still leaves you at risk for the complications. A case of measles complicated by hepatitis the person only received one dose the same as another case which resulted in appendicitis and meningitis. This is why is it important to be on top of your immunization records and be sure to obtain all of your immunizations on time. It is simple steps like this that can lead to the eradication of measles.

Polio is becoming harder and harder to find. An amazing feat thanks to vaccines and joint efforts of government agencies, local communities, organizations and more. 2019 marked very monumental moments in the movement towards complete eradication of Polio in the world. It marked the 25th anniversary of the Americas’ polio free status. Most importantly the Global Certification Commission’s certified the eradication of the WPV3 which is a a wild type poliovirus. Two out of three wild type polioviruses are now eradicated. WPV2 was eradicated in 1999. WPV1 is now only present in circulation in Afghanistan and Pakistan.

This is a worldwide movement. The eradication of polio relies on people receiving their vaccinations. It is the vaccinations that will protect the children and secure herd immunity from the disease. The opportunity to eradicate polio is at our fingertips and we must not let this opportunity slip between them. Although you might not live in a country where polio is circulating you are still a major player in the end of the disease. By receiving your vaccination you are closing the gaps and ensuring all children are protected. You never know where you will travel, or who you will talk to or come into contact with. Do us all a favor and get yourself and your loved ones vaccinated. Do it for the kids and do it for those who cannot protect themselves.

The Vaccines Behind It:

There are two vaccines for polio:

1. Oral Polio Vaccine (OPV)
   • Bivalent: targets type 1 and 3
   • Trivalent: targets all 3 types
2. Inactivated Polio Vaccine (IPV)

OPV is an oral drop and is the main preventative measure against polio in many parts of the world. OPV is not commonly used and has been no longer licensed in the US since 2000 because of the link to vaccine derived poliovirus. Circulating Vaccine Derived Poliovirus (cVDPV) which stems form a mutated version of OPV which can spread from person to person and cause paralysis. This type of polio is often derived from the trivalent vaccine because it is caused by a mutation in the type 2 vaccine derived virus. There is now a call to switch to bivalent OPV in countries where OPV is administered because it is more powerful against 1 and 3 and does not have severe risk of paralysis. Since the there is no more wild type 2 polio in the world there is no need for a vaccine to target type 2 especially when there are complex and serious medical complications that can arise from them. It is the trivalent OPV vaccine that could prevent the full eradication of the poliovirus. Ironic, how the vaccine could stand in the way of its elimination. But that shows the importance of medical advancements and research as we understand more about viruses we are able to more efficiently eradicate them.

Only OPV is linked to vaccine derived poliovirus. They are extremely rare and occur because the supplemental vaccines are poorly administered where there is a high risk for polio. Notice, in the picture below how cVDPV is present in the Middle East, Africa and southeast Asia. All locations with very low vaccination rates for the poliovirus as well as limited access to adequate healthcare systems to administer proper vaccines. IPV does not cause vaccine derived poliovirus which is a supporting reason why the United States has been stayed poliovirus free for 25 years.

IPV is just as effective as OPV. IPV is a booster shot and requires multiple administrations over time. Two doses provides 90% immunity while three doses provide 99% immunity. This is how we are going to eliminate poliovirus. Is it doing our job as humans to vaccinate ourselves and our children. The less people vaccinate the more prevalent a disease becomes. The work of modern vaccines has put us too far in the movement of eradication of polio for us to go back now simply because of an anti-vaxx movement based on false claims.

The anti-vaccination movement has become a global health and public health epidemic. It has brought back diseases such as the measles from almost complete eradication. In response to the increasing prevalence of the anti-vaxx movement. The Center for Disease Control and Prevention has developed an initiative “Vaccinate with Confidence” to strengthen the confidence in parents to vaccinate their children. The program has three major priorities:

1. Protect Communities
2. Empower families
3. Stop Myths

In these priorities the CDC is working with major partners to reinstall confidence into people in regards to vaccines. The most important one is Stop Myths. It is myths and disproven research articles that piloted the anti-vaxx movement causing it to spread like a wildfire. The myths need to be eliminated in order to regain trust of those who refuse to vaccinate themselves and their children. It is only until the fear of vaccinations is removed, that we can fully eradicate the diseases that were once almost gone.

Why we cannot believe everything on the internet!

Yes, this is a blog post on the internet. It is up to you as a reader to analyze and determine the truth in my posts. But always take everything posted in on the internet with a grain of salt. Social media is one of the most dangerous developments of this generation. It allows information to be spread without a check for accuracy or accreditation. It is how the anti-vaxx movement spread fast and efficiently. People are quick to believe personal stories rather than do research in scholarly journals. Opinionated posts about the linkage to autism and vaccines and parents sharing their stories on why they do not vaccinate their children only added oil to the fire of the anti-vaxx movement.

Now social media platforms are taking control and charge of the situation. Instagram has blocked potent hashtags such as #vaccinescauseaids and it will began to ban more hashtags associated with misleading information. However people have become creative with hashtags to avoid the bans with hashtags such as #vaccineinjuryawareness. This lead Instagram to develop a pop-up that would appear on content containing vaccine misinformation. YouTube has removed ads from anti-vaccination videos, which means the videos will not make any more. Twitter has enabled the search result for vaccine related to topics to be linked to the Department of Health and Human Services first.

Although people should not be going to social media for research on vaccines it is considered a primary news outlet for the upcoming generations. This causes an increased gap between where scientific information is and where the public is going for information. It is important to close that gap. Major health organizations are now developing social media campaigns and platforms to spread correct and proven information to the masses in order to combat the false claims and exaggerations of the anti-vaxx movement.

The CDC will begin to work with social media companies to promote correct vaccine information. Its goal is to engage with the companies to contain the spread of misinformation and ensure the proper information is being shared. The CDC is fighting the anti-vaxx movement with grassroots initiatives and word of mouth publicity the same way the anti-vaxx movement got its wind.

A Final Note:

Think before you speak and think before you post because you never know who will take what you say to heart.

A Holistic Approach. There is more to a human than the cells it is composed of. There are millions of small microbes living within and on a person that makes a person who they are. It impacts their weight, their moods, their mental state and overall wellbeing. These microbes have a dynamic relationship with the human (host) and it is impacting the efficiency of drugs and how drugs should be administered. The increased understanding of the Microbiota has lead to the development of two new fields: Pharmacomicrobiomics and Pharmacometabolmics. The microbiome regulates host health and disease. It is a mediator of drug action. It is the host associated microbiomes that regulate human bodily functions. It is important to take the whole person into consideration when developing a drug plan for them. The microbiome is a living ecosystem on and in our bodies. They are major players in the efficiency of drug administration and how drugs are spread within the body. Understanding a person’s microbiota will enable a more personalized drug treatment plan.

The Holobiont

The Holobiont now must be taken into consideration when discussing the drug efficiency and the host. Holobiont is the host and the many other living species living in or around it and together they form a ecological unit. It summarizes the host-microbiota interactions. The key word in this definition is living. The living organisms are able to adapt and react with the drugs taken by the host and overall impact the effectiveness. It provides a holistic approach to the person. Pharmacomicrobiomics embodies this concept. It now looks at a person beyond its genetic makeup. It will create drugs that encompasses the microbial function and how drugs will impact that.

A holistic approach, calls for an expanded view of a person. It will expand the realm of drug development. It will call for the need for more pharmacists and researchers. However this brings an increased challenge as the human microbiota is constantly changing and evolving as a person changes environment, eats differently, exercise patterns and so much more.

Why Does the Microbiota Matter?

The gut microbiota is interconnected to the brain. It regulates brain development and the alternation in the composition gut microbiome has been linked to mental disorders such as anxiety, bipolar disorder and depression. However it is a double edged sword because the medications used to treat these disorders also inhibit the growth of gut bacteria. The same gut bacteria that helps maintain homeostasis within the body. This interconnectedness calls for an increase in the understanding of the microbiota to improve and enhance drugs.

The microbiome has also been linked to major human diseases such as obesity, hypertension, diabetes, cancer and inflammatory bowel disease. For obesity, the dietary habits of a person influence the composition of the gut microbiome. The microbes in the gut helps break down food and turns it into nutrients that we can use. However foods high in fat take longer to digest and impact the composition of the microbiota essential to maintaining everyday life. In terms of cancer, the microbiome has accounted for approximately 20% of all cases of cancer worldwide. There is now potential for microbiome based therapeutics to treat cancer. The microbiome can be critical in improving patient response to immunotherapy. Immunotherapy targets the immune system to enable it to recognize and target cancer cells. It is going to be interesting to see how the understanding the microbiome enhances cancer research and treatment practices down the road.

Time for New

This is an exciting time in the field of pharmacy and drug research. Pharmacists will now be able to cater drug development beyond what is it is today. It will be exciting to see the connections between microbiome and drug development grow past its infancy. We will be able to fight against some of the most fatal diseases such as cancer and hypertension. This is a time for new approaches and responses to diseases. It is once we fully understand the microbiome we will fully be able to understand the human body.

We are in the midst of the 5th unofficial season, flu season. Flu, short for Influenza is a viral infection of the lower respiratory track. The flu season, occurs each year due to antigenic drift. During replication, a mutation often only changes one amino acid in the within the spikes of the influenza virus. However this one minuscule change is responsible for each flu season having a slightly different strain of the flu. So do you know what is important? Receiving your flu vaccination every flu season, because the immunity your body gained to the flu last year will not be as effective or effective at all to this new strain. Although little protection is better than none, wouldn’t more be better than a little. The CDC suggests that the flu reduces the risk of illness by 40%-60% among the overall population when the vaccine viruses are representative to those spreading in the community. Getting your flu shot is not just protecting you, but those around you because influenza is obtained by inhaling aerosolized respiratory secretions or from fomites. So the less you spread the flu, the less others around you can get it.

The trivalent flu vaccine for the 2019-2020 flu will protect against the following 3 strains of the flu:

• A/Brisbane/02/2018 (H1N1)pdm09-like virus
• A/Kansas/14/2017 (H3N2)-like virus
• B/Colorado/06/2017-like (Victoria Lineage) virus

The quadrivalent vaccine contains the the 3 viruses above and the following:

• B/Phuket/3073/2013-like (Yamagata Lineage) virus

Extensive research is done by the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) to suggest the strains of flu that will be most common each year. Then they come to a consensus on which strains should be considered in the the vaccines.

There is something great about the flu shot besides the protection from the flu. There are multiple options for the flu shot:

• Standard dose flue shot: inactivated influenza vaccine
• High-dose shots: for people 65 and older
  • High dose shots contain four times the antigen of standard flu shots. Antigen is the component of the vaccine that helps the body build up protection. It is developed to give older people a better immune response to the flu.
• Shots with adjuvant: for people 65 years and older
  • Adjuvant is a component that helps create a stronger immune response.
• Shots made with virus grown in cell culture: no eggs involved
  • For those allergic to eggs because most inactivated influenza vaccines are made by growing the virus in eggs.
• Shots that are made with a vaccine production technology that actually does not require the use of the flu virus
  • Vaccines are created synthetically. By injecting a host line cell with the virus DNA for making hemagglutinin which triggers the human body to create antibodies to target the virus and a baculovirus. This recombinant virus causes the host line cells to rapidly produce the HA antigen then the antigen is collected in bulk and repackaged as the vaccine. It does not use eggs.
• Live attenuated influenza vaccine (LAIV): attenuated live virus given by nasal spray
  • this option is not available for the 2019-2020 season

So if you are older, scared of needles, or allergic to eggs there really is no excuse to not get your flu vaccine because look at all the options you have. Be sure to talk to your health care provider regarding the proper flu vaccination for you. Therefore you can protect yourself and protect those who cannot protect themselves. Those under the age of 6 months should not receive the vaccine.

The CDC does not have the flu vaccine effectiveness estimates for the season yet. However the flu’s antigenic characterization is updated in FluView each week. The most important updates is that indicators of overall severity are not high at the point in the season. Visits to healthcare providers for flu like illness was at 6%. The mortality rate for deaths attributed to pneumonia and influenza is 7.1% for it to be an epidemic it must be at 7.2%. CDC estimates that there has been 22 million flu illnesses and 12,000 deaths from the flu so far this season. Still the flu vaccination is the BEST way to prevent the flu and its serious complication.

If you do think you have come down with the flu it is important to stay home and rest because most people have mild illness and do not need medical care. However if you are at high risk of flu complications it is important to see your doctor for an antiviral drugs. They work best when begun within 48 hours of getting sick. If you do not have high risk, it is up to the discretion of your health care provider to prescribe you a antiviral drug.

Overall, the influenza vaccine CANNOT cause the influenza virus. However it is still possible to obtain the flu even if you did get vaccinated. It is possible if you were exposed to the virus shortly before you were vaccinated or before the body gained protection. Or you have been exposed to a flu virus not in the vaccine. The protection of the flu vaccine varies widely and strongly is based on the immune system of the individual. So please do not blame the flu shot for you coming down with the flu. There are many outside factors that can cause the flu and the flu shot is not one. Protect yourself this flu season wash your hands often, stay away from those with the flu and most importantly get your flu shot!!!

As the coronavirus is increasingly spreading, so is racism. Many Chinese citizens are not only falling victim to disease, but falling victim to cruel and unnecessary racism. They are not responsible for the Coronavirus. If anything there should be racism and anti-sentiment towards the bats that were the initial hosts of the virus. However, everyone seems to forget about the bat that started all of this? The 2019 nCoV is a beta-coronavirus, meaning their origin is in bats. It was through strain mutation it was able to be transmitted to humans. Then through further mutation human to human transmission was possible. This spread of transmission is very rare. It has been seen with MERS and SARS in the past. The nCoV has signs of going though antigenic shift because there has been changes in what the virus infects and how it is transmitted between animals to people then to people to people.

Did the French go too far?

On a French newspaper there were offensive headlines “Yellow Alert” and “New Yellow Peril?” Yellow Peril is an old racist ideology of the 19th century in Western Countries towards Asians.

Although the newspaper claims they had no intent on being racist. They perpetuated one of the main racist stereotypes of the Asian culture by utilizing the term “yellow.” The increase in anti-Chinese sentiment is unfortunate and truly disgusting. However racism is a longstanding protection and defense mechanism. Instead of people doing their part in further preventing the spread of the virus, they are turning to habits that only segregate us as people.

An Update on the 2019 nCoV

In the newest report by the World Health Organization there has been 34,886 confirmed cases. This is 3419 new cases from the last report. It has reached 24 countries including the United States, Canada, certain European countries, Australia and more. Its greatest incidence is still in China, with 34,598 of the 34,886 confirmed cases. There are 288 confirmed cases outside of China.

Viral Sequencing

An important update to the virus is the posting of the full genome of the virus. It was posted to GenBank, which is the NIH genetic Sequencing database. Scientists were able to compare the sequences to the virus of those infected in the United States to those in China. It was similar to the initial sequence, which is now suggesting a single recent emergence of the virus from an animal reservoir. There are many links of infection to seafood and live animal markets suggesting animal-to person spread. So where is the need for racism? It is not humans only transmitting the disease. Animals are a main player in the spread of the coronavirus.

How Severe is It?

The severity of the illness varies case by case. The reports have ranged from mild to severe and overall death. People are found to be most contagious when they are symptomatic because as a respiratory disease it is spread through the inhalation of virus containing secretions. The CDC recommends to help lower this threat to get your flu shot. This preventative action helps stop the spread of germs. So once again, there is even more benefit to obtaining your flu shot this year.

With the outbreak of the coronavirus in China many people, are identifying and correlating it to China and Chinese citizens. However the coronaviruses is actually a large family of viruses that cause illness. It is not a sole virus stemming from Wuhan china. That branch is defined as the novel coronavirus (nCoV) is novel because it has not been previously identified in humans. The identification of the coronavirus with the Chinese has lead to unintentional racism and exclusion. There is a fine line between protection and discrimination. As anti-Chinese sentiment has been seen in numerous places such as UC Berkeley where an Instagram post stated that xenophobia is a possible reaction to the spread of the coronavirus. This post is giving an “okay” to racism being a proper response to a disease outbreak. This only divides our nation more and inhibits the progress to contain the epidemic and instills fear into Asian-American citizens. It is condemning racism within college campuses and is appalling to see.

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What is a Coronavirus?

Coronaviruses are zoonotic. They are spread between animals and people. The World Health Organization claims that there are several known coronaviruses circulating in animals that have not yet infected humans. The severity of coronaviruses varies from each strand. They range from the common cold to the Severe Acute Respiratory Syndrome. The Lancet claims the nCoV is suggested to be linked to the SARS virus strands: bat-SL-CoVZC45 and bat-SL-CoVZXC21 which are both bat derived strained SARS viruses. The bat strain SARS were collected in 2018 in Zhoushan Eastern China. The Lancet reports that there was an 88% sequence identity to the virus. Coronaviruses initially spread from animal to human and then it is spread from human to human on a continuum.

Symptoms and Transmission of nCoV

The CDC reports 3 confirmed symptoms of the nCoV including Fever, cough and shortness of breath. It has Incubation period ranging from 2 – 14 days. This medium length incubation period allows for mass unknown spreading of the disease. This is why the disease has been spreading rapidly and has been hard to contain within China. It is spread via respiratory droplets produced when the infected coughs or sneezes. This is very similar to the spread of the common cold and flu. The initial symptoms align with those of the common cold which can allow for a misdiagnosis by the infected and allow for an increased spread because people might assume they simply have a cold or the flu. The droplets is a form of indirect transmission. It is crucial for the prevention of the spread of the disease for people to wash their hands frequently and cover their mouth when they cough or sneeze. People should do this all the time but it is extremely important now.

Importance of Separating Origin and Person

When disease outbreaks occur it is important to not correlate a disease with an ethnicity or nationality because of the origins of the disease. We often become unknowingly insensitive towards racial groups where disease outbreaks occur. This often stems from personal protection but it is important to be sensitive to those going through such a traumatic and intense time. Especially as America is a cultural melting pot we should be sympathetic and not racist. This current xenophobia exhibited in America is similar to the racism and xenophobia towards Africans which occurred during the Ebola outbreaks in 2011. Blatant racism was shown through memes, jokes, exclusion and commentary. So as scientists and epidemiologists attempt to identify and contain this strain of coronavirus it is important for us to remain respectful and sympathetic to the infected because it could happen to any of us.

Andrew Wakefield, the man with the claim that scared hundreds of thousands. Through his study he linked the Measles Mumps and Rubellas (MMR) vaccine to the development of neuropsychiatric dysfunction as well as gastrointestinal disease in children. Now his claims sparked fear in many parents and led to the decrease in the distribution of the MMR vaccine.

There were many inconsistencies and issues with Wakefield’s study that led to Lancet’s retraction of the study in 1998. In this article published by the NIH it discusses the numerous issues with the creditability of Wakefield’s study. The cohort Wakefield studied had no control subjects. This led to the debate if the MMR disease was casual or coincidental. A control is an scientific experiment is one that does not receive the independent variable, the MMR vaccine, as is used as a comparison for the data. Without a control in this study, there is no concrete evidence in the linkage of autism and the MMR vaccine.

An Inconsistency

The Indian Journal of Psychiatry reports, Wakefield’s cohort was also extremely small with 12 children with 8 children showing signs of autism. The cohort was 11 boys and 1 girl. The mean age was 6 but ranged from 3-10. It is important in scientific studies to maintain as many constants as possible to ensure that is the independent variable that is actually the cause of the claim. The uneven distribution of gender in the study raises a flag to the accuracy of the findings. Reported by the National Autistic Society boys are more likely to become autistic than girls. By picking 11 boys for the study, Wakefield was further setting himself up for success in his study rather than being scientifically thorough and correct. The study took place in England, where there already was a high rate of autism. The vaccination is given at the same time when autism typically presents itself at ages 1-2 which can lead to a coincidental assumption.

The Red Flag

The large red flag with Wakefields study that the cohort was self referred. In the article by BMJ is quoted that Wakefield was looking for children who are showing symptoms of possible Crohn’s disease and symptoms of intestinal damage and the Royal Free clinic asked parents if they could be put in contact with Wakefield. This shows a bias in the study as not a random cohort of children were picked. Children with a possible predisposition to intestinal damage that could lead to Autism were picked. These children also had parents who believed it was the MMR vaccine that caused their child’s development. This defaces the scientific integrity of the study as he picked children that would most likely support his hypothesis rather than disprove it.

The Motive

The British Medical Journal published a series of articles exposing the fraudulent actions of Wakefield. Wakefield’s bias and selective choice of data was taken place to achieve financial gain. His greed got in the way of accuracy and scientific integrity and set the world back in terms of medical progress and immunity. His fraudulent actions set fear across the world and made detrimental blows to the medical and epidemiological advancements. As diseases that were almost extinct are now resurfacing because of decreased herd immunity.

The Debunking

The centering of the MMR vaccine on the cause of autism has failed to be proven true through numerous epidemiological and biological studies. In numerous studies published by the NIH, there was no direct correlation found to the connection of MMR vaccine in Autism. Wakefield’s claims were redacted by the Lancet. However his study had made major impacts on the vaccination world as we knew it. Wakefield’s study increased the research on the MMR vaccine and autism in hopes to rid of the belief in many parents that vaccine puts their child at risk for autism. However there is an increasing prevalence of the Anti-Vax movement and less parents are vaccinating their kids because of fear of psychological damage. The BMJ reports that in 2011 United kingdom was below the 95% vaccination level to ensure herd immunity of MMR. In 2008 the measles was considered endemic in England for the first time in 14 years. This is primarily because of the article Wakefield posted and the media frenzy that arose from it. This fear prevents the eradication of diseases because those not vaccinating are now spreading the disease in places where they were almost gone. Hundreds of thousands of children in the UK are unprotected due to the fear instilled in the parents. The CDC reports that in 2019 the United States has had the greatest case of measles reported since 1992. The CDC claims that measles is more likely to spread and cause outbreaks where groups of people are unvaccinated. Vaccinations are not just for personal protection but for the protection of all. It is important as a civilization to do all we can to protect ourselves and each other. It is especially important to protect those who cannot protect themselves such as the immunocompromised.

Correlation Does Not Mean Causation

This is the most important lesson to learn through Wakefield’s study. He correlated the development of autism to the reception of the MMR vaccine. However the vaccine has more benefits than it does disservices and it is crucial to the public health of the world. It is important as researchers in the health field to implement fair and unbiased research studies to provide concrete evidence for their claims. Because as seen with Wakefield’s study his incomplete and inconsistent data, sparked fear in parents all across the globe regardless of its falseness. So it is true what they say; all it takes is one.