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Pandemic Preventionby Ruth SoRelle, M.P.H. In 1968, a new strain of flu hit Hong Kong hard and promised to take a devastating path around the world. Federal officials called on former colleagues at Baylor College of Medicine to help in evaluating a new vaccine to halt the pandemic.
Dr. Robert Couch, BCM distinguished service professor of molecular virology and microbiology, remembers that he began to test the virus and a new vaccine in a special isolation unit at The Methodist Hospital in hopes of forestalling it before it could hit U.S. shores. "While I was doing that, the virus was found already active in California," he said. The Hong Kong flu spread across the globe and deaths in the United States peaked in December 1968 and January 1969. Deaths totaled 33,800—making it the mildest among 20th century outbreaks. Yet the ability of the BCM researchers to mobilize quickly impressed federal officials, and in 1968 the first vaccine evaluation unit at BCM was funded. With one short hiatus, it has operated with federal backing ever since. Its founder, Couch, is reticent about "blowing the unit's horn," but he admits that the federal Vaccine Treatment and Evaluation Unit (VTEU) at BCM made "seminal contributions toward establishing the safety and value of FluMist©," a nasally administered live-virus flu vaccine. "We were also the group that was the strongest to support its use as a children's vaccine," he said. "That led to its being licensed for use in adults and children." Dr. Paul Glezen, a professor of molecular virology and microbiology, continues to work with FluMist© in children, exploring whether vaccinating youngsters can reduce the disease's spread. In its early days, the vaccine unit focused most of its activities on rhinoviruses and respiratory viruses such as influenza, and respiratory syncytial virus that can be deadly to infants. Today, it has broadened its scope with a focus on pertussis, gastrointestinal ailments, maternal immunization and biodefense concerns. Dr. Wendy Keitel, a BCM associate professor of molecular virology and microbiology, said the team itself—M.D.s, Ph.D.s, nurses, physician assistants and technical and administrative staff—is responsible for the unit's success. Some of the work extends outside that of the federal grant itself. Couch oversees the viral respiratory pathogens research unit, while Keitel is the VTEU director. The VTEU was involved in translational research before the term was popular. In the late 1980s, it was involved in testing the first vaccines against AIDS and HIV. Older diseases are also a focus. When reactions to whooping cough vaccine prompted a push to develop safer, more effective vaccines, Keitel herself supervised a study of five different vaccines at three different dosages in adults. Keitel and her colleagues are active participants in studies of vaccines against the so-called avian influenza or bird flu. The work proved that adults, who had already been vaccinated against the disease as children, could develop strong immunity with the new vaccine at dosages relatively smaller than those given to infants. Recently, the Advisory Committee on Immunization Practices (to the U.S. Centers for Disease Control and Prevention) advised giving booster doses of vaccine to teens because of outbreaks occurring in this group of youngsters. A newer focus of the center is biodefense—an outgrowth of the terrorism concerns that arose out of the tragedy of 9/11 and the anthrax letters that killed five people in the fall of 2001. "The government asked us to reconsider our original contract proposal and to expand our capability to respond to public health disasters," said Keitel. The VTEU tested existing smallpox vaccines to determine if they could be protective when diluted. The findings by Couch and Dr. Robert Atmar were positive and would have enabled the government to stretch existing stockpiles if smallpox was unleashed as a weapon. Under a contract with the Centers for Disease Control, Keitel is looking at ways to simplify vaccination against anthrax, now a complicated procedure involving six doses of vaccine given under the skin at scheduled intervals with a yearly booster. Through an NIH study, Keitel is testing two new potential anthrax vaccines that have the potential for making the vaccine more potent and safer. Another biodefense project is developing a vaccine against tularemia, a potentially serious illness caused by a bacterium usually found in rodent, rabbits and hares. She and her colleague Dr. Hana El Sahly are studying the safety of a new lot of a previously used Russian vaccine and looking at new ways to administer the vaccine. Flu remains a major concern of the unit, and Keitel and her colleagues are active participants in studies of vaccines against the so-called avian influenza or bird flu. The one of most concern today, H5N1 virus, is widespread in birds and causes severe and often fatal illness in people. "In the face of a pandemic, everyone in the world would need to be vaccinated," she said. Some of her work is designed to find out if supplies can be stretched in an emergency. Responding to another kind of infectious disease emergency, Dr. Herbert DuPont, principal investigator of the gastrointestinal unit, focuses on viruses and bacteria that afflict the GI tract. DuPont, director for the Center for Infectious Disease at The University of Texas School of Public Health and a clinical professor of medicine at BCM, is looking at a particular form of Escherecia coli called enteroaggregative E. coli, which has been shown to be a major cause of diarrhea. In studies in Zambia, he and colleagues found that it is the major reason that AIDS victims in Africa die of wasting. He and his colleagues are looking for genetic peculiarities that make some people more susceptible. Equally important is a study of noroviruses, best known for the Norwalk virus or "cruise ship" disease led by Drs. Mary Estes and David Graham, both of BCM. An estimated 23 million cases of disease from norovirus occur in the United States each year. That is 10 times more cases than from the next most common form of bacterial diarrhea. Estes and Graham also hope to develop a form of the norovirus that can be given to volunteers testing vaccines. Estes is currently developing vaccine models. Dr. Carol J. Baker's unit is unique in the United States. She seeks to find way to immunize mothers against disease in order to protect their infants. Immunizing pregnant women is always a touchy subject, but Baker, professor of pediatrics and molecular virology and microbiology, points out that it can be an effective way of protecting newborns in the critical first few months. "There is an epidemic increase in whooping cough in young infants who have not yet been immunized against the disease," she said. In studies, she and her colleagues have shown that many U.S. women lack enough pertussis antibodies to protect themselves and their infants. She proposes using the new pertussis vaccines for adults in pregnant women as a test of whether they can then pass on protective immunity to them in the first few months of life. Baker has spent much of her professional career working on group B streptococcus, an infection that is devastating to newborns. Currently, mothers who carry this infection receive antibiotics intravenously during labor to prevent passage of the disease to their infants. She has a candidate vaccine for a maternal immunization available, but getting it tested in women has proven unworkable—a problem that is increasingly frustrating. "We have not immunized one person," she said. While she understands the concerns about safety, she also knows that infants are dying who might be saved if their mothers were immunized. It's a two-for-one act. For Baker, it's the parents and babies who "keep her going." For Keitel, it's the "brave souls who participate in her studies" that draw her passion. "I love working with volunteers. We could not do this without the spirit of participation we find in all of them," she said. Most physicians count the lives they have saved in tens or hundreds. For those who work with vaccines, the body count is much higher—in the millions—and if the future promises more challenges, it also promises the opportunity of saving even more lives. |
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Baylor College of Medicine: Making a Difference in the Community
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Volume 1, Issue 3, Fall 2005 |
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