MMI Undergraduate Club Meeting Minutes, Wednesday, November 1, 2006

Announcements:

• Children’s Hospital volunteers: Thursday 11/6 at 6 pm (helping the kids with crafts) => get there by 5:30
• Ronald McDonald House: December 6.  Meet there by 4:30 (it’s over by the University Hospital)
• Charity Ball: organizer’s meeting November 5^th at 7 pm in 2241 Chamberlain. 
• Get a flu shot!  They’re free for students and will be offered at UHS
• Help others get a flu shot! Clinic during the month of November- ask Allie for details
• Research grant writing seminar: December 5 6 pm in here (408 SMI)
• We need designs for T-shirts! Submit yours to Mike. 

Dr. Maki: Section Head of Infectious Disease at UW

• Research on the pathology and prevention of nosocomial infections
• Trained in internal med, drafted during Vietnam War.
• Sent to CDC in Atlanta
• There are very few training programs for clinical infectious disease
• Became part of academic intelligence service (doctors and scientists try to prevent infectious disease and public health threats in the US)
• After the war, granted a fellowship in infectious disease in Boston
• Became faculty member at UW: patient care/teaching/research
• Patient Care: Complicated infections, oversees 12 infectious disease MD’s and other scientists
• Teaching: post-doc and medical students
• Research: nosocomial infections, mechanisms of resistance

Resistance: an overview

• It’s only been ~75 years since the age of antibiotics began- an evolutionary blink of an eye!
• 1930’s very little known treatments for disease/few vaccines/ infectious disease leading cause of death.
• "Plagues" have been bothersome since the beginning; may have co-evolved with humans.
• Pasteur (1840’s)–conceived the idea that illness caused by microorganisms and proved this clearly  Also, the first "immunologist." The first vaccine he created was against rabies.

Next 50 years:

• Explosion of research in these areas
• Most bacterial pathogens were identified by the late 20^th century
• Also ID’ed viruses and few fungi
• Parasites–a more modern area of research
• Prions–still not well understood (lots of research now)

Infectious Diseases?

• Symptoms often non-specific
• Most contagious or infectious to others
• Most are preventable
• Thorough patient history absolutely essential
• Most common in respiratory tract (upper more common, lower more serious)
• Pneumonias among the most serious
• Endocarditis: fatal without antibiotic treatment
• Blood infections can be very difficult to treat
• By 1970’s, the Surgeon General thought infectious diseases were a "closed" chapter of human history, and that this threat had been eradicated.

Max Finland (and others) studied resistance

Advances in the 20^th Century:

• Impact of epidemiology and public health: drop in death rate before 1950’s because of control and prevention of infectious disease
• First antibiotics: 1950’s
• ICU and transplants came into general use at same time

TB killed 1/300 in 19^th century.  Incidence steadily dropped before drugs were available because of quarantines.   TB still a major problem in developing countries.  Resurged in the 1980’s in US because of AIDS and susceptibility to TB.

Over the years, many antibiotics became available. Originally, only 3-4.  Now, over 160.
...But at what price?

Antibiotic resistance:

• Only 2 known bacteria with no known resistance; syphilis and group A strep.
• Staph: first known resistance in 1980's (MSRA).  Today, common and worldwide.
• Strep. pneumoniae: susceptible to penicillin until 1990’s, now most are resistant.

Reasons?

• In vivo vs. in vitro affects of antibiotics on microorganism.
• 1/3 patients given incorrect antibiotic.
• High multiplication rate of bacteria- mutations easy to find. 
• Hatural selection, etc.  Also, sharing of resistance plasmids between species.
• Between 25-50% of prescribed antibiotics are unnecessary or inappropriate (ie for virals) – overused and dosages not completed.

Vaccines:

• Smallpox: most deadly microorganism in history. 
• The smallpox vaccine uses attenuated virus to inoculate.
• 1965: 30 million died from small pox/year.  Endemic in many places.
• Because only host is humans, easy to eradicated.  UN and WHO worldwide effort => gone by 1977 (last case)   Most important public health triumph of the 20^th century

Polio:

• 30,000 children infected every year in 1950's.
• First vaccine to undergo national campaign.  Within several months, virtually eliminated; no known cases in North America among those who were vaccinated.
• Groups that oppose vaccination, incidences are still high.

What happens if you stop immunizing?

eg Soviet Union:  During most of Cold War, central government imposed vaccination.  Gorbachev's glasnost policy (1988) meant to encourage openness and democracy.  Led to a rapid deterioration of infrastructure.  Children no longer consistently immunized.  By 1993, over 50,000 reported cases of diphtheria (had been nearly zero prior to 1988).

Bioterrorism:

• Virtually no one has immunity to smallpox anymore (the vaccines from the 1970's have lost efficacy and children born from the 1980's on were not vaccinated). 
• When USSR broke up, lots of smallpox went unaccounted for; it could have fallen into dangerous hands.
• Fortunately, lots of vaccine is available.

Understanding the Molecular Mechanisms of Disease:

Eg. tetanus toxin is a neurotoxin-paralysis.  Attenuated toxin used as a vaccine starting in 1950s, but needs booster dose.

Questions from Club members to Dr. Maki:

Any vaccines against MSRA?

• Very frustrating and futile
• The antigen has been cloned to make vaccine with limited success.  It will take a long time to become commercially available.

Why so many ineffective antibiotic treatments?

• Lot of unnecessary use! This is becoming less common as resistance is better understood and diagnosis is more accurate with molecular techniques.
• Not finishing full course of Rx, using for viral infections, etc.

What are your thoughts on antibacterial soaps/gels?

• NOT GOOD!
• lead to resistance and possibly higher toxicity
• Alcohol gels okay, though.  And regular hand washing!

Will development of new antibiotics keep up with resistance?

• Yes, but probably will be a "close race"
• More importantly, we need better antivirals against aggressive respiratory viruses.