Outbreak of the measles, SURPRISE? Not really

If you don’t vaccinate your children, they are bound to get infected. And yet, the whole world is amazed by the outbreaks of the measles. News feeds from USA, Europe, Philippines and developing countries have been breaking stories all around. Pictures of sweet little children covered in red spots are collecting likes and dislikes everywhere. But seriously, why the surprise? This is exactly what was to be expected.

It’s real simple action-reaction. We let ignorant parents decide against lifesaving vaccinations (action), the immunization coverage drops in a region, et voilà, an outbreak emerges (reaction). Let me give an example that even the most reluctant anti-vax parent should understand.
If you promise your birthday girl a Frozen themed party, but last-minute you cancel it and you burn the Princess Elsa dress in front of her eyes (action); your kid will cry (reaction).
If you promise her that she will have a healthy life, but you are not vaccinating her; your kid may become deaf, blind, get brain swelling or pneumonia, and these are only the long-term effects of measles. What would she say to her parents when after a life of struggles she gets to celebrate her 18^th birthday; ‘thank you and let it go’ in sign language?

One mother asked on Twitter how she could protect her unvaccinated daughter against the measles outbreak in her town. It was a serious question. The mother’s post went viral and luckily for the right reason, she was ridiculed. Something along these lines: ‘don’t worry, just bathe her on the seventh night of full moon in a cocktail of 75% tomato juice, 20% biological bleach, 4% morning pee of a virgin mother, 1% stardust with a hint of basil, while singing Heal the World in B-minor and she’ll be fine …’.

How are people still not understanding how things work? Maybe we should ask Disney to make a movie about it, where no princess is vaccinated, a bad prince causes an epidemic and all the princesses die so there will be no kingdoms and fairytales anymore, only republics, presidents and prime ministers. Wow, certain hit in the cinema’s, expected December 2019 in all Imax theaters in 3D: ‘Beauties and the Measles’.

One more time:

1. Vaccinations prevent horrible disease outbreaks to emerge (also read: polio, tetanus, rabies)
2. Vaccinations prevent death in both children and adults
3. Vaccinations are only useful BEFORE the child/person gets sick
4. Vaccinations do NOT cause autism (f*cking Wakefield!)
5. Vaccinations are safe for your children
6. Not vaccinating your child means that you put the lives of your and other children at risk.

If you disagree with any of these statements than please read my previous blog about the facts about vaccinations. And let me warn you, if we continue down this selfdestructive path, more outbreaks will follow.

Who knows, maybe that’s a good thing. We might get to see ‘Diphtheria and the Seven Dwarfs’ or ‘LEGO Movie 3: It’s a smallpox after all’.

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Death by Tetanus: it started with a bicycle.

Wednesday 8 am, Moshi, Tanzania
A 26-year old man is brought in. He is severely ill and has difficulty breathing. He can’t open his mouth. The man looks frightened. His mother confirms our suspicions. She tells us that a week ago her son hit a rock with his bicycle and fell. One of the old, rusty spokes poked in his leg and inflicted a wound. This wound healed normally but this morning he became severely ill. This man has tetanus.

Tetanus

Tetanus is an infectious disease caused by the bacteria Clostridium tetani that is characterized by muscle spasms. These spasms can get very severe and cause the classic opisthotonus; the body arches backward and the mouth is in lockjaw. It is fatal in 10% of the cases, mostly due to respiratory failure because of the spasms.

Tetanus can be transmitted by animal bites but also by simple rusty accidents. Bicycle, motorbike and car accidents are very common causes of tetanus and this is the reason that you get a vaccine after you had an accident like this. Because yes, you can get vaccinated against these bacteria. The only problem is that the vaccine needs to be updated every 10 years. If your last vaccination is older, you might need a booster dose. But luckily, if you ever had a vaccine the chances of survival are greater than if you never got any vaccinations.

To try to save patients like this, we normally do four things.

1. Open the wound from the bicycle accident and surgically remove all possible infected tissue. The bacteria produce toxins that cause the symptoms. So even if the wound looks healed and clean, the toxins still might be present, causing harm. Not easy to convince surgeons to open-up a closed wound but trust me, if you explain the situation, they will help you.
2. Give antibiotics that kill the bacteria
3. Give immunoglobulins. This is a special type of medicine where you give immune cells against a disease directly to the patient. We have some diseases where this has a very good effect like rabies and tetanus.
4. Give him the best supportive care

Wednesday to Friday morning, Moshi, Tanzania

After talking a lot with the surgeons, they opened the wound (step 1: check) and we started the antibiotics (step 2: check).
But now the trouble started. In an earlier post about rabies I mentioned that immunoglobulins are expensive and not always available; Tetanus has the same problem. Unlucky for the man is that we had a similar patient just a few days earlier. We were able to get immunoglobulins from Nairobi, Kenia (close to Moshi) for that patient. It was their last vial. Our 26-old man needed to get his immunoglobulins from Dar-es-Salam. It is in Tanzania, but much further away and thus much more expensive for the family to get it. In other words: they couldn’t get these very important immunoglobulins that might save his life (step 3: no check).

Friday 1.30 pm, Moshi, Tanzania

After two days of supportive therapy (step 4: check) the man is slipping away. We resuscitate for 60 minutes but there is no response. He dies.

It all started with that bicycle. Or did it start much earlier? When he didn’t get the childhood vaccinations? Maybe they were not available, maybe his family never could afford it.

But if you are not yet vaccinated and the vaccinations are available and affordable: get your tetanus shot.

Don’t let a simple bicycle kill you.

 

Picture: Opisthotonus in a patient suffering from tetanus. Painting by Sir Charles Bell, 1809.

A new hope

It’s been one year since my very first post. Over the past year I have thrown some random topics into the world all related to my true love: infectious diseases (ok, except for husband and children). But we’re a year further now and it’s time to get some more direction in where we need to go in life. Over the year I noticed what interested you most and what I enjoyed writing about most so that combination will be the focus in this brand new year. Drum roll please….

1. Vaccinations

You probably know by now that I am a huge fan of vaccines. They are wonderful things that prevent so much agony and death that I still don’t understand why this discussion is even starting. But it is.

The religious arguments I sort of understand. However, the reason “god will save my child” always reminds me of this joke. There is a man that just had a shipwreck and he is floating in the big ocean hoping for God to save him. After a while a boat comes up to him and offers to get him aboard. “No thank you”, the man answers, “God will save me”. After a day another boat comes and again the man declines help saying the god will save him. After rejecting the third boat the man drowns. He goes to heaven and upon meeting God he asks, “God, why didn’t you save me?”, God answers “I send you three boats you moron”.

The educated vaccines-are-poison and vaccines-cause-death people I don’t get. Arguments don’t count for them. They stopped listening to science. In this topic I will keep enlightening you about facts about vaccines and the diseases prevented by them.

2. How your body works

So many times my husband asks me “it hurts here *pointing somewhere on his abdomen* what is there?”. Or tells me “my kidneys and liver are hurting me”. And I just sigh, give him a kiss and a paracetamol and tell him everything will be ok. But honestly, so many people have no idea how their bodies actually work. What is pain? Or itching? What is a spleen and pancreas? Why do you need them? And, probably will attract the most readers, what about sex? How does a penis work? Can you urinate while it’s erected? What is the prostate? How can women ejaculate (need to do some extra research on this…)? Well, all these questions will be answered in this topic.

3. News

Infectious diseases sometimes hit the news. A big flu epidemic inspired the “8 things you thought you knew about the flu”. Or the whole antibiotic resistance crisis that is on our doorstep. If it’s in the news, it’s nice to know a little bit more about the subject to make sure you are well prepared to impress your co-workers, friends or significant others. In this topic I will discuss something that’s in the news at that moment.

There you have it. Nicely organized three topics that I will alternate to make sure all of you get what you want. You can’t always get what you want, but if you try sometime you find, you get what you need.

Polio: take my breath a-a-ah-hah-ah-way

Breathing. Think about it for a second. You breathe in, you breathe out. No effort. Magical.

You breathe in: to get oxygen in your body and to your brain and muscle tissues, you breathe out; to remove the carbondioxide out of your body. You breathe in, … Breathing is actually for so much more, for speaking, laughing, singing. Without breathing this would all be impossible. Quite extraordinary that you go through life without realizing how amazing this actually is. The only time when you realize it is when it’s not easy. When you get a cold and your nose is blocked. And of course, there are more devastating diseases that turn off the effortlessness of breathing and will challenge you to find new ways of surviving. Let’s go deeper into one of them.  But before I forget: you breathe out.

Joni Mitchell and Neil Young, they can sing right? Donald Sutherland, what a President in the Hunger Games huh? And maybe a real one, President Franklin D. Roosevelt (I say maybe because we’re actually not so sure we agree with the medics from that time). Yes, they all had polio. Challenging them, and their breathing, in ways you can’t imagine.

Poop in your mouth

Polio is a viral infection caused by the poliovirus and can be spread from person to person and fecal-orally. Or in plain English: poop in your mouth. Sounds disgusting? It doesn’t mean you have to literally eat poop. If you don’t wash your hands after you did your number two and subsequently eat a cookie, well done, you completed the fecal-oral route. The cookie is just an example, although we all like those chocolate ones with bigger chunks in them or the one with the pink glazing, instead of cookie you should read: contaminated food or water.

Odin: Whosoever holds this hammer, if he be worthy shall posses the power of thor(ax)

About 1% of polio infections result in severe muscle weakness and the inability to move. This weakness can be quite sudden, occurring over just a matter of hours to days. The muscle weakness usually starts with the legs and could move up to unable the diaphragm. Your diaphragm is a big muscle that separates your thorax from your abdomen. If you breathe in you can either expand your thorax or expand your abdomen (try both of them for a while, I know you want to). Your diaphragm is part of that choice. Without your diaphragm, breathing will be challenging. You will have a high risk of dying. It may even explain the last look of Donald Sutherland in “Invasion of the Body Snatchers”, staring with mouth and eyes fully open.

But it all fairness, it’s ‘only’ the 1%. Most people don’t get the muscle weakness and actually recover fully. Nothing wrong with a bit of drama, ain’t it. I know you want to read about tragedies, deaths and deformities. You are disgu… great, just keep breathing, here we go.

Iron (lung) Man

The most common thing people think about when talking about polio is the iron lung. This is a machine designed to create differences in pressure and thus expanding your thorax, allowing you to breathe. Before mechanical ventilation, this was a great way to keep patients alive if they suffered from any cause of muscle weakness. If you want to see the impact of polio muscle weakness and the iron lung, I can definitely recommend the movie “The sessions”. It’s about sex so that might trigger you to actually go watch it. Oh, and it was nominated for an Oscar and Golden Globe.

“Don’t it always seem to go / That you don’t know what you’ve got / Till it’s gone”

We live in a great world – wars, strange presidents and climate change aside. We live in a world where we can actually prevent diseases like polio. Even the small chance of paralyzes from this devastating disease is flushed away with simple, yet effective, vaccination!

Be grateful that you – yeah you – carelessly decide not to wash your hands – you know who you are – after doing your number two – you must love to eat …, never mind. That we can choose to take a risk for abdominal discomfort by eating on the streets in a developing country (always the best place to eat, honestly). Trust me, without vaccinations, you would think twice. Cause you just might have risked your ability to breathe!

It’s still endemic in Afghanistan and Pakistan and with the ongoing war in Syria, their immunization practices have changed. Luckily in all these countries, the need for vaccination is on everyone’s agenda and still the number of cases is declining. Maybe eventually we can live in a world where Polio is, just like smallpox, a thing of the past.

See, I told you how much you should appreciate your ability to breathe. Now for all those children, mothers, fathers, babies, brothers and sisters that can’t breathe as easily as you can, let’s just focus for one minute. You breathe in, you breathe out. You breathe in, you breathe out. You breathe in, …… There, I got you meditating, I gave you knowledge and you are appreciating what your body can do. You breathe out.

 

 

 

HIV: PrEPare for the future

One day I read the magazine “Hello Gorgeous”, a glossy magazine about living with HIV. And I got a lot of looks, you know what I mean, not the ones you hope to get. Will this ever change? How I sometimes wish that I could just to take a quick glimpse into the future and know how everything will turn out. Just like I have this urge to skip to the part in the book where the killer reveals itself. But I never do. What fun is reading when you know the ending, what fun would living be when you know it all? So, I speculate and think about now and the future. And today, I think about the future of HIV.

The Future is now

What kind of world would it be if we would use pills to prevent ourselves from getting HIV?

Well, it is the world we live in now. As we speak healthy men who have sex with men (thus have the greatest risk), are given anti-HIV medication before they have unprotected intercourse in order to prevent them from getting the virus. The name: Pre Exposure Prophylaxis or in short; PrEP. And yes people, it’s a great success in the Netherlands. Instead of swallowing MDMA before going to a Dancefestival, men are PrEP-ing up before going to “party”. And it’s expanding to other countries as well (the usage of PrEP I mean, not parties, well, maybe those too, but…, never mind).

Now I know the most common response: we’re enabling people to have sex without a condom, it only protects against one STD, can’t they just wear condoms instead of taking medications that can have side effects? Oh wait, those were the responses to the contraceptive pill. They only protect against a child and certainly are invented to give us the freedom to protect ourselves to that one particular “STD”. However strange this “new” intervention might seem, maybe in the future we will look back and conclude it’s actually not so different than what we were already doing.

And whilst we’re there, in that future I mean, let’s check if my following HIV predictions came true.

I predict a second spike in HIV infections

With the lack of fear for HIV, I really think we will get a second peak in infections.

But why is this really a problem, I hear you say. Isn’t HIV a chronic disease nowadays that takes just one tablet once a day, so why bother, you add. Well, maybe you’re right (thanks for reading my previous post), … but maybe this will convince you:

There is not just one type of HIV, there are more with different resistance patterns.

If you go through life thinking “I already have HIV so let’s lose the condoms and have some fun”, I would say DON’T. You might attract a new different type of HIV, giving you a high viral load again. This type might be resistant to the drugs you were taking for your own type. Yes, HIV can become resistant to medications just like bacteria. And if that happens and we don’t find a way to cure the virus, we end up with a virus we’re not able to control any longer. And we’re Back to the Eighties, where the first HIV infected people suffered and died.

A different argument not “to shop” for HIV, is that having HIV makes you more susceptible for other diseases, especially other STD’s. Nowadays gonorrhea is becoming more and more difficult to treat and when (not if) the second HIV peak comes, there will definitely also be a gonorrhea outbreak that is not easily cured.

I’m confident that HIV has still unknown tricks to show us. It’s waiting, lurking in the dark…

I predict there will never be a HIV vaccine

Making vaccines is extremely difficult. In general researchers need three things from a disease in order to make a good vaccine.

1. You can get a natural immunity for it. This means that some people recover from the disease by themselves or there are people known who just don’t get infected.
   HIV: Nobody has developed natural immunity against HIV.
2. You have to be able to manipulate the pathogen in order to make sure it doesn’t really infect you. You want a vaccine to be safe, not to give you a deadly infection.
   HIV: No manipulation has fully succeeded to make it safe.
3. You have to get sick from it.
   HIV: Nobody is sick because of HIV. Weird, but true. HIV doesn’t make you sick. It affects your immune system making it inoperable but the virus itself doesn’t cause a disease.

These things in combination with the fact that HIV mutates faster than the X men, outsmarting our immune system and all the different known subtypes, you can imagine the challenge. The attempts to make a vaccine have not been successful and unfortunately, I predict they never will be.

Let’s find a vaccine against stigma

One day I read the magazine “Hello Gorgeous”, a glossy magazine about living with HIV. And I got a lot of looks, you know what I mean, not the ones you hope to get. And that is unfair and unnecessary. If my predictions come true, which I don’t hope of course, HIV is here to stay. It’s a part of our past, present and yes, also our future. Let’s deal with it, accept and not be judgmental about it. My idealistic self would like to urge you to go to a public place and read something that clearly has HIV stated on it to get people used to it. But maybe the best vaccine against it, is just not to give in to stigma.
If you see me or anyone else read the magazine, don’t give that look. Just smile or give a friendly nod. Or, why not, let me be the idealistic hippy my husband always I am for once, let’s hug.

 

One dog bite away from death; Rabies and why life is unfair

A couple of weeks ago I witnessed the most terrible infection I have ever seen. It also reminded me, in a hardcore fashion, of the difference between living in a Western country or being raised in a low resource environment. What was it about? Dogs, bites, rabies. The bottom-line of this blog? Sometimes life is unfair.

A young boy was brought to the clinic on the Thai/Myanmar border one month after he had been bitten by a street dog. The father had killed the dog immediately, but they hadn’t come to the clinic for care. 

I’ve worked for seven years in Dutch hospitals dealing with patients. Some severely ill, some having a hard time accepting they weren’t (frustratingly big group). All these patients have one thing in common; they never worried about costs of diagnostics and treatment. They live in a country where all necessary (and sometimes unnecessary) tests can be done and almost all therapies are paid for.

On the Thai/Myanmar border things are different. Not all the tests and treatments are available, and those that are cost money. Might not be a lot of money in the eyes of the Westerners, but here many families don’t have money. People don’t come to the hospitals because they are afraid of what it will cost, or they wait too long to come.

When the family did come, it was too late. The boy suffered from rabies. A disease that you can’t diagnose until you have symptoms and once you have symptoms, death is inevitable.

Rabies is transmitted from mammals. Usually dogs or cats but also bats and monkeys. They bite you or lick you and the virus goes into your nerve-system, starting its travels towards the brain. When it reaches the brain, it’s over. The whole travel is asymptomatic for the patient and no blood test is helpful. When it reaches the brain, most of the time the patients become highly agitated, raging and the jaw muscles stop functioning causing patients to drool. But the most interesting feature is that they become afraid of water. Yes, really.

When I offered a bottle of water to the small boy after he didn’t drink for two days he turned his head away. The boy was captivated by fear.  It was a terrible sight.

Prevention
There are two ways of preventing rabies; Pre-exposure and Post-exposure. With Pre-exposure you get three vaccines now and if you ever get bitten, go to a clinic/hospital within 48 hours and get Post-exposure vaccinations, no special immunoglobulins injection needed. Post-exposure means you go to a clinic within 24 hours after a bite to get a special immunoglobulins injection, followed by a series of vaccinations. Then you’re ok.
I used to think that the only advantage of the Pre-exposure was that you gain some time. And you can always reach a hospital within 24 hours nowadays, right? So, go Post-exposure… Well, my opinion changed.
Working first in Africa and now here, I see that the immunoglobulines that you absolutely need are very expensive and not available in most clinics. Time is scarce. This means that you have to travel to one of the bigger cities to get your treatment or even fly to a different country. Most of the tourists will be able to do that, albeit with effort and money (and probably nagging about the healthcare system). For locals this is not an option. Immunoglobulins already cost about a month salary here, just like the needed other vaccines. Add the travel costs and the hospitalization costs and families are bankrupted. Families with maybe five or more children. So not only time, also money is scarce. On the Thai/Myanmar border that is a dark and unfair combination.

The boy died the same night that he came to our clinic. A different and conflicting emotion rose, it was a sad feeling of being glad. Glad that the small young boy didn’t have to suffer much longer. That the family didn’t have to suffer much longer. The family didn’t complain, they were calm in the whole situation and they appreciated everything we tried to do, knowing what the outcome was going to be.

What a privilege to get vaccines easily, to get tests done if needed, to be able to get a diagnosis and a treatment  within 24 hours if needed. Appreciate what you have, because some don’t have the same privileges. They are one dog bite away from death. And yes, that’s life and it is unfair.

 

 

 

What everybody should know about vaccinations

Vaccinations, most of us are confronted with them at least once in our lives. Whether it is because of a child vaccination program or because you’re planning a trip to a far away country. Questions about vaccinations: most of us should ask them, but we rarely do. And those who want to find some answers often find the wrong information. They base their views and decisions on serious misconceptions and some decide, as a result, not to vaccinate their children. And meanwhile people in many countries all over the world are very glad that they can prevent their children from dying or getting really sick. Quite a contrast.
This blog is dedicated to all people that need some serious, truthful answers about vaccines.

1. What exactly is a vaccine?

A vaccine is simply said a way to train your immune system to get familiar with a disease (virus, bacteria or parasite) and to train your immune system to kill that disease. Familiarize with killing it? You don’t mean? … Hold on? … Are they…? … Indeed, vaccines contain material of the infectious disease you don’t want. But before you start shaking and get a panic attack: this vaccine is designed not to cause you harm. It is like a boxer standing before you who is unable to punch back. Let’s say the material inside the vaccine is this Boxer. In most cases this Boxer is injected in your system, sometimes it’s oral.

With some diseases you just need to show your immune system the Boxer once (for example Meningitis). With other diseases the immune system needs to see the Boxer a couple of times (Hepatitis A or B). And sometimes you need to repeat the vaccination every so often to keep your immune system on their toes (DTP).

2. Do you get sick after vaccination?

It is possible, yes, to feel sick for a while. Most vaccines use dead material of the infectious disease. Some vaccines, like yellow fever, use a living virus that has been disabled from multiplying or making you sick. After getting the vaccination, your immune system starts to work, potentially causing some flu like symptoms. This happens more with “living” vaccines than dead vaccines. Other risks of vaccination are a local skin infection where the needle entered the skin and a rash.

Remember: the vaccine is designed not to cause harm. It is your fist that hurts after hitting the Boxer, the Boxer still didn’t hit you back.

3. Is there toxic material in vaccinations? Is a vaccine “poison”?

Do you eat bananas? Did you have a body when you were a child? Are you worried about this? If not, don’t worry about vaccines.
In vaccines they use chemical stuff like thimerosal (a form of mercury but not as toxic as mercury, only used in a few vaccines), formaldehyde and aluminum. Fruits, vegetables, grains and cheese also contain amounts of these toxic agents and actually contain higher dosages of it. A banana contains approximately 16.3 mg/kg formaldehyde, a two-year old child makes formaldehyde in its own body in a dosage of 1.1 mg and a vaccine uses less than 0.1mg in total.

Conclusion: yes, there are toxic ingredients in vaccines necessary to make them effective. But they are non-harmful for your body and the dosage of these toxins is lower than all other stuff you are already confronted with. But, ok, when your not convinced, you should stop eating bananas and you definitely need to get rid of your body.

4. If everyone is getting vaccinated, why should I give it to my children?

Well, for starters, the whole idea of vaccination is a so-called herd immunization. This means that in a group of 100, if 99 people are vaccinated, the one that isn’t (because he couldn’t get the vaccine for different reasons) is protected  through the others. This is the case for many diseases that need a human to transmit the infection. This could mean you don’t have to vaccinate your children, but there is a downfall. More and more people are choosing not to vaccinate, dropping the “herd immunization” and thus increasing the risk of a new epidemic. My advice: if you have a young baby, don’t let them near unvaccinated kids!
There are also infections that you get from, for instance, a simple bicycle accident (Tetanus). Without the vaccinations against it (you need more than one), you’re in trouble, and I’m talking about serious youmightdie-trouble.
Another argument is that maybe your child is at one stage to old to get sick from a virus, say Measles, but they can carry the virus and infect other children that did not get the vaccine yet, thus endangering them.
Lastly, the world is getting smaller and smaller, you/your children are likely to go traveling and trust me, those diseases that you don’t take seriously? They kill people in some of the countries you/they plan to visit.

5. Can I reduce the pain of vaccination by giving my child something?

Yes, after the vaccination you give your child a very pretty bandage from Frozen or whatever other favorite character (my husband still buys Harry Potter bandages for me). Then you give them, depending on their age, a nice little snack and tell him/her how brave they were and how proud you are. Done.

6. Does vaccinating increase the risk of autism or other neurological diseases?

No.

There has been a study in the 1998 by Andrew Wakefield in 12 patients (yes, just two more than the total of your fingers, at least I hope so, if not, it wasn’t my intention to offend you, what happened? you shouldn’t play with fireworks or chainsaws or … boomerangs… we need to move on) that claimed that the MMR (Mumps, Measles, Rubella) vaccine was linked to autism. That’s what everyone remembers. What we don’t remember is that this particular researcher had in fact made up the entire study. Wakefield had been funded by lawyers who were engaged with parents in lawsuits against vaccine-producing companies. The journal (Lancet, big medical journal) exonerated Wakefield and his colleagues on charges of ethical violations, deliberate fraud and scientific misconduct. The study was formally retracted from publication, the man was fired and can never conduct research again. Many follow up studies have been conducted and none ever found this negative effect of vaccinations. In short, boomerang, we need to move on.

7. Finally, what diseases are vaccine preventable?

Well that’s a lot. Are you ready? Sit back, read or skip and trust the advice your government provides…

To date we have effective vaccines against:
Diphtheria (a severe throat infection, especially children die), Haemophilis influenzae B (can cause meningitis in young children, deadly), Hepatitis A (severe infection), Hepatitis B (can cause chronic infection and cancer), Human Papiloma virus (HPV, can give cervical cancer to women), Influenza virus (flu, prevents severe infection, yearly update, see previous blog), Japanese encephalitis (deadly), Measles (deadly), Meningococcal disease (meningitis, deadly), Mumps (deadly and boys can get infertile), Pertussis (whooping cough, for young children deadly), Pneumococcal disease (pneumonia, deadly for young children and fragile patients), Polio (paralyses or death), Rotavirus (deadly for young children in developing countries), Rubella (deadly), Tetanus (pretty common bacteria, causes spasms and eventually death), Smallpox (deadly but eliminated, see first blog), Yellow fever (deadly, no treatment)

Vaccinations we have that are not 100% effective:
Rabies (deadly, after a bite need booster vaccinations), Tuberculosis (prevents severe infection but does not prevent infection itself), Typhoid fever (severe infection, 70% effectiveness).

And luckily, more and more vaccines are coming.

Don’t be afraid of vaccines. Please don’t, it saves not only your own live, but also those of people surrounding you. Should you ever be in doubt however, look into a mirror and understand: you are beating Mohammed Ali, you are beating Mike Tyson, you are a Boxing Champion!

Malaria: the search for a vaccine

After my previous blog, we all understand the basics of malaria. It is the parasite that kills, not the bad air from swamps or your armpits. And although we have some medicine to cure Malaria, humanity still didn’t find a vaccine to prevent catching one of the biggest infectious diseases out there. And that isn’t because nobody is looking for it or nobody is investing money in the research. On the contrary, finding a Malaria vaccine is like finding a needle in a haystack and then try to learn that needle to do a trapeze act. In short, it’s hard work.

Why and who needs a vaccine?

Well, a vaccine is not primarily for the people with a bit of money that want to see the Big Five. As nice as it seems that you can travel without taking these often expensive, sometime hallucinating medications, we need to take a wider perspective. A vaccine is needed to prevent children deaths. That’s what counts in these countries. Especially now that more and more Malaria parasites turn out to be resistant to our anti malaria pills.

How to train your dragon… uh, no, how to train your immune system step 1

In Nijmegen, the Netherlands, years ago, a research group found a couple of students to participate in their “can we train our immune system to recognize Malaria” study. They treated them with anti malaria pills and deliberately infected them with Malaria a couple of times. Then they stopped the medication. Now the real challenge began, without any prophylactic therapy all subjects were exposed to the Malaria once again. Just to see if the immune system had actually seen the parasite previously under treatment. Turns out: your immune system rocks! Even with the anti malaria pills it was able to get a good look at Malaria and remember what it looked like. The unfortunate thing was that this memory didn’t last very long. But it was a promising start.

How to train your immune system step 2

Now that we knew the immune system could be trained, researchers wanted to train it with a vaccine, a RTS,S vaccine. It took about 30 years to develop, but eventually they could test this vaccine in African children. They had really nice results, preventing serious Malaria in about 30% of the children. In a world where previously all malaria infected person died, this was good news! But, just like the Nijmegen group, they found that the immune systems memory weaned and the immune system needed to be exposed to the vaccine, and thus to malaria, in order to keep it working. Better than nothing, but not the holy grail humanity was looking for.

How to train your immune system step 3

Now the Dutch are hitting the news again. A new vaccine is made and is being tested in, amongst other countries, the Netherlands. The problem with the other vaccines appears to be that in the vaccine only some of the Malaria particles are used to train the immune system. But this is not good enough. The immune system needs more to ensure a long-lasting recognition. The new vaccine is supposed to be made from an inactivated whole parasite. Yes, you read it correctly, a whole Malaria parasite that has been modified to not go into hiding in your liver and not invade your blood cells. Pretty impressive right? Could work. Hopefully this vaccine wont take 30 years to get past all the safety and effectiveness tests!

So there you have it, the long long long search for a Malaria vaccine and the training of an immune system. Remaining questions that we want to get the answer to these coming years are: 1. Will this new vaccine give long lasting protection for the people that need it the most? 2. Will it help for all types of Malaria?

For now, don’t wait for this vaccine and do travel to Africa and see the animals, I can highly recommend it. Just take your prophylactic malaria pills.

Smallpox and the start of vaccinations

“Good old days”?! Not if you talk about infectious diseases. Being an infectious disease specialist before the last century would have been a dramatically frustrating profession. Even the simplest of infections could not be effectively treated.

In the 16th century there was an impressing global epidemic of smallpox, which is caused by the variola virus. This disease had been causing problems on and of for quite some time already and never failed to cause multiple deaths among the infected patients. The Inca population in South America was hit pretty bad in those days, the mortality among these people was 60-90%, and this was at the same time that the Spanish conquistadors were attacking them. So perhaps we could say that almost the entire continent of South America speaks Spanish not due to those Spanish horsemen, but in fact as a result of the variola virus.

The difficult situation with the smallpox is that the symptoms are very vague, some muscle aches, fatigue and fever. In this first stage of the disease patients are actually really contagious, so not recognizing the symptoms in time results in major problems and spread of the virus. After about 2 weeks the patient can get the classic skin leasions.

The only thing that the people in the 16th century could do to try to decrease the severity of the disease was a so called “inoculation with variola” (variolation). This meant that an attenuated virus was put on the skin in the hope that your body would start an immune response without actually killing you. In the work up for this “treatment”, children would be starved and about a liter of blood taken from them (don’t ask me why). After the variolation, the child would be locked in a barn until the disease had subsided or the child had died. Congrats for the ones that survived, I hope they had some good psychiatrists to regain their trust in humanity…

On a beautiful day in 1798 (don’t really know if it was, just sounds nicer), an English doctor called Edward Jenner was fed up with this torture of children. He too had undergone the variolation “treatment” and probably never got over the horror (again, total speculation). There had to be another way!

He noticed that the milkmaids of that time appeared to be immune to the smallpox. He thought that this might be due to the fact that they had probably been exposed to the, not so sickening, cow-pox. He decided to test this theory. He found a “volunteer” named James Phipps -the 8 years old son of his gardner- and injected him with the pus he had scraped from a cow-pock blister from a milkmaid. I mean, that just sounds like a brilliant idea, doesn’t it? Anyway, after some time he tried to infect the child with variola using the old “variolation” method but our little James didn’t get sick.

I can’t say that this was the most ethical way of investigating, but it was effective and had huge consequences for the world as we know it. Dr Jenner has written everything down in his book “An inquiry into the causes and effects of the Variolae vaccinae; a disease discovered in some of the Western Counties of England, particularly Gloucestershire, and known by the name of the cow pox”. Which is, like the title suggests, a real briefly written page turner…

From that day forward the procedure to prevent small pox would be to infect somebody with the cow-pox virus called “inoculation with vaccinia”, later “vaccination” after the word vacca that means cow in Latin. This particular vaccination could be terminated in 1980 when, thanks to intensive effort of the WHO, small pox was eradicated. OK, truth be told, it’s still present in 2 laboratories in Russia and the USA so maybe we should continue to take good care of our cows, just to be sure…