{"id":6214,"date":"2011-11-08T22:01:10","date_gmt":"2011-11-09T02:01:10","guid":{"rendered":"https:\/\/esa.org\/esablog\/?p=6214"},"modified":"2011-11-08T22:01:10","modified_gmt":"2011-11-09T02:01:10","slug":"chickenpox-sweeties-and-the-social-ecology-of-infectious-disease","status":"publish","type":"post","link":"https:\/\/esa.org\/esablog\/2011\/11\/08\/chickenpox-sweeties-and-the-social-ecology-of-infectious-disease\/","title":{"rendered":"Chickenpox sweeties and the social ecology of infectious disease"},"content":{"rendered":"

This post contributed by Liza Lester, ESA communications officer<\/em><\/p>\n

\u00a0<\/p>\n

\"What<\/a><\/p>\n

No one speaks for the endangered poliomyelitis. No one raises money to protect the last survivors, as health workers stalk the virus through its last redoubts in India, Pakistan, Nigeria and Afghanistan. On the contrary, the WHO spends billions on hunting it to extinction<\/a>. But the virus has held out longer than expected.<\/p>\n

Joshua Michaud, policy analyst at the Kaiser Foundation, thinks the polio fighters are falling behind. Guinea worm will be the next scourge to fall, he said on an AAAS panel engaged to discuss Infectious Disease: Challenges to Eradication<\/a> on Monday. Why have efforts with guinea worm been so successful? a precocious Georgetown student wanted to know. Biology was on our side.<\/p>\n

There is no vaccine for guinea worm, and no medicine to cure infection. To extract the worm, you must wind it slowly around a stick as it emerges through a sore in your leg (an oft-repeated story holds that the treatment has not changed since the Egyptians of the XVIII dynasty described it in 1550 BCE, though the source appears to have been exaggerated<\/a>). The process is excruciating, and it takes weeks.<\/p>\n

But we know key details of the worm\u2019s biology that the ancient Egyptians did not.<\/p>\n

Basic technology and careful hygiene can defeat the worm. Larvae harbor in the bodies of invisible copepods, \u201cwater flies\u201d tiny enough to swallow. Once swallowed, female larvae nestle against the long limb bones of their hosts, growing up to a meter in length over the course of a year. They surface inside a burning ulceration that sends their victims running for a dip in a cool pond\u2014and the next generation of larvae escape to start the cycle of life anew.<\/p>\n

The good news, said Michaud, is that guinea worm does not have another host. It has no environmental bolt hole to hide in while under siege, only to emerge when health forces are not looking. It needs humans. And affected people are visibly affected.<\/p>\n

Break the cycle for one year, and you can free a communal water source, and its community, from the worm. Copapods may be microscopic, but a simple nylon strainer on the end of a drinking tube saves you from swallowing them (although not bacterial and viral parasites that might also lurk there, interjected Dennis Carroll, in charge of avian flu and other emerging threats at USAID). Help the infected, persuade them to stay out of drinking water sources when their worm breaches, and you break the cycle. Success requires the help and good will of village elders<\/a>. The Carter Foundation has been courting good will and promoting local efforts tirelessly since 1986. President Carter even negotiated a Guinea Worm Cease-Fire<\/a> in Sudan in 1995, to help locals cope with a slate of infectious diseases.<\/p>\n

\u201cThe last case of smallpox was in Somalia. Imagine trying to carry out a vaccination campaign in Somalia today,\u201d said Michaud.<\/p>\n

Eradication campaigns require public goodwill. Which is not always forthcoming. Warzones and disaster areas are holdfasts for disease, their populations dangerous and hungry, and lacking in organization and basic services. Foreign visitors with needles and vials aren\u2019t necessarily trusted. Reports of CIA shenanigans<\/a> in the guise of vaccination programs do not help with trust.<\/p>\n

In 2003, polio flared in Nigeria following rumors that that the West was using the WHO immunization program to sterilize Muslim girls and spread HIV. Nigerian travelers sparked spot fires in other countries that took years and millions of dollars to put out. The program didn\u2019t get back on track, said Josh Rosenthal, until Saudi Arabia got on board, and told Muslims, \u201cIf you want to do the Hajj, if you want to come to Mecca, you have to be vaccinated.\u201d Rosenthal is director of the NIH\u2019s Fogarty International Center.<\/p>\n

Polio earned its place in the eradication crosshairs as much for its weaknesses as its dangers. Like guinea worm, it needs humans. But aspects of its biology also hinder the vaccination effort. Polio is a harder sell because it doesn\u2019t kill enough.<\/p>\n

\u201cEradication of smallpox gave rise to a glow of optimism,\u201d said Rosenthal. But Polio is not the spotted fever. It isn\u2019t as virulent, and doesn\u2019t present with a dramatic, hideous rash. For every child paralyzed by polio, 200 have no symptoms at all\u2014but are infectious. The bar to achieving herd immunity is higher. And smallpox killed 30% of its victims.<\/p>\n

\u201cPolio is not that,\u201d said Carroll, shaking his mane of hair. \u201cDiseases of morbidity never gain the same gravitas with the public as diseases of mortality.\u201d Or hideousness. How do you get people to trust, to cooperate, when they don\u2019t think their kids are sick?<\/p>\n

Carroll thinks it\u2019s the wrong question. \u201cPolio is a disease of poor sanitation. Vaccines allow you to get around the systemic problems.\u201d Sometimes. But eradication campaigns divert limited local resources from basic health. Locals are already trying to cope with malnutrition, enteric disease, and sanitation all of which feed back negatively on polio risk, and vaccination success. Why not invest eradication dollars into systemic improvements? \u201cI don\u2019t believe in eradication. I think it\u2019s fool\u2019s gold.\u201d<\/p>\n

NPR science reporter Richard Harris, on hand to moderate and generally keep the conversation interesting (with notable success), said, \u201cI think this is the first time a panel has all agreed that the challenges we\u2019re here to talk about don\u2019t have to be met!\u201d The audience liked that. The rest of the panel looked uncommitted.<\/p>\n

What about misinformation, the audience wanted to know. How do you combat social media? How do you explain the statistics of herd immunity? We inform, said the panel. What about lack of trust at home? Harris prompted. Does it undermine global efforts? Are people not afraid of infectious disease anymore? \u201cWe hear people saying, \u2018I don\u2019t know anyone who\u2019s had whooping cough, it\u2019s a thing of the past.\u2019\u201d<\/p>\n

None of the panelists looked eager to bite on domestic affairs. They ventured that human papillomavirus vaccination is an awkward topic to discuss with parents. No one wants to think about their kids having carnal knowledge, in the future, or ever, said Michaud.<\/p>\n

\u201cIs it a non-starter in the current wave of vaccine suspicion?\u201d asked Harris.<\/p>\n

The men on stage looked blankly at the audience. When regularly working with people struggling to secure access to medicine and clean water, it may be hard to wrap your mind around news of parents sending chickenpox lollipops<\/a> through the mail to secure access to infection (pox parties being, apparently, in short supply). In their realm, public health is more of a community movement than an evocation of consumer choice. The dynamics, social and biological, of a mild disease isn\u2019t their challenge.<\/p>\n

\n

Photo: A sign warns those with Guinea worm disease not to enter the water in Taha, Ghana, March 2006. Credit: The Carter Center\/E. Staub<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

This post contributed by Liza Lester, ESA communications officer \u00a0 No one speaks for the endangered poliomyelitis. No one raises money to protect the last survivors, as health workers stalk the virus through its last redoubts in India, Pakistan, Nigeria and Afghanistan. On the contrary, the WHO spends billions on hunting it to extinction. But the virus has held out…<\/p>\n","protected":false},"author":36,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1114],"tags":[1311,1045,709,1312,1313,65,631,192,973,1314,935],"class_list":["post-6214","post","type-post","status-publish","format-standard","hentry","category-ecology-about-town","tag-carter-center","tag-drinking-water","tag-extinction","tag-global-health","tag-guinea-worm","tag-infectious-disease","tag-public-health","tag-sanitation","tag-society","tag-vaccination","tag-worm"],"_links":{"self":[{"href":"https:\/\/esa.org\/esablog\/wp-json\/wp\/v2\/posts\/6214","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/esa.org\/esablog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/esa.org\/esablog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/esa.org\/esablog\/wp-json\/wp\/v2\/users\/36"}],"replies":[{"embeddable":true,"href":"https:\/\/esa.org\/esablog\/wp-json\/wp\/v2\/comments?post=6214"}],"version-history":[{"count":0,"href":"https:\/\/esa.org\/esablog\/wp-json\/wp\/v2\/posts\/6214\/revisions"}],"wp:attachment":[{"href":"https:\/\/esa.org\/esablog\/wp-json\/wp\/v2\/media?parent=6214"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/esa.org\/esablog\/wp-json\/wp\/v2\/categories?post=6214"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/esa.org\/esablog\/wp-json\/wp\/v2\/tags?post=6214"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}