IamA professor of microbiology at Boston University School of Medicine, and an expert on vaccines and infectious diseases. AMA!

Hi Paul,

David Hamilton here! Being in Puerto Rico we were hit with the ZIKA virus and the resulting cases of microcephaly. Do you know what stage vaccine development is at and whether it is still progressing as a priority? Thanks and great AmA

NIH have a experimental DNA vaccine in Phase 2 trial (check this out it's interesting an mentions Puerto Rico - https://www.nih.gov/news-events/news-releases/phase-2-zika-vaccine-trial-begins-us-central-south-america).

This illustrates priority

We urgently need a safe and effective vaccine to protect people from Zika virus infection...” —Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases (NIAID)

I'm greedy so I'm going to ask a second question.

Do you foresee the progress being made with the CRISPR program as an indication that humans will eventually be able to render ourselves genetically immune to illnesses that have historically killed hundreds of millions of people?

although CRIPSR is exciting ... I believe in the "creativity" of evolution to "find a way" around our most innovative interventions ... that's what we need to be on the ball understanding as much as we can about infectious disease that's why I #LoveVirology

The worst measles outbreak in Minnesota since 1990 has just been declared over. Do you feel that the anti-vaccine campaign in the USA has not been taken seriously enough and more needs to be done to educate? With movies such as Vaxxed being produced and celebrities endorsing the campaign it has me concerned.

Difficult to know if it's a campaign per se ... but the reality is that there are small groups comprised of vocal anti-vaccine folks who either don't vaccinate or want to rewrite facts about when and how vaccines should be administered. This creates havoc, as evidenced in MN, and will continue as bigger numbers of unvaccinated kids are present in the US. Unfortunately, when these numbers increase, it is almost certain someone will die. Just look at the outbreaks in Europe, Germany for example had a big outbreak and one vaccine-preventable death.

Education demands having an openness to facts, if these and robust scientific data are ignore we end up with the tragedy that is widespread infection by a highly infectious pathogen.

Theoretically, could a virus be manufactured to effect only a certain race and thus be weaponized against them?

My dumb, fat, racist coworker believes that sickle cell anemia is such a thing.

And yes, I told him SCA is not a virus.

First and foremost weaponizing biologicals is prohibited by the Geneva Protocol, so although this is an interesting question it's in the realms of the non-permissible, regardless of race, gender etc. I guess in theory this might be possible but how, and more importantly why, anyone would consider this is the bigger question.

It's good you pointed out about SCA, and you're totally correct. I'd keep engaging positively, it's always better to talk, disagree and still stay talking!

Im really late, so this will probably be buried. My professor once told me that there are no major genetic differences between human "races", which is why that word isnt scientifically accepted for humans. Is that true? There are so many obvious noticeable differences, I cant believe that the genetic material is almost identical.

Keep in mind that the genes that make up our physical appearance are only an infinitesimal percentage of all the genes we have. Our genes contain the entire set of instructions to build a functional human. When people say "race" they are usually talking about things like skin color, hair color, hair texture, eye color, and certain facial features. While many different genes determine these features, they are vastly outnumbered by the genes that do literally everything else required to make humans grow, live, and reproduce. That's a lot of information.

From a human ancestry perspective - way back, all humans lived in Africa and there was quite a bit of genetic diversity. A small number of them left Africa and spread throughout the rest of the world. Those small groups ended up more inbred/less genetically diverse, and their populations grew from that small pool. Today, there is still more genetic diversity in Africa than the rest of the world combined. But many people would put all black Africans in one racial group.

Another way to look at it: A black person whose family has been in the U.S. for 4 generations is more likely to be genetically similar to a white person whose family has also been here that long than to a black person in Africa who did not have any ancestors in the U.S. But we would classify both black people as the same race, unlike the two people from the U.S.

This is what people mean when they say that race is socially constructed, not biologically constructed. Here is an oldish but somewhat useful NY times article on the subject: http://www.nytimes.com/2000/08/22/science/do-races-differ-not-really-genes-show.html

This is a super reply ... thanks

have you ever played the game Plague in your free time?

I have not ... sounds interesting though

Hi :) What would be your best arguments when trying to convince anti vaxxers?

Facts ... just hard scientific facts that #vaccineswork ...

Look at this infographic ... it's when an image is worth 1000 words or three days of cyclical discussion ...

http://www.sciencemag.org/news/2017/04/here-s-visual-proof-why-vaccines-do-more-good-harm

this is also a great article ... http://www.sciencemag.org/news/2017/04/can-skeptical-parents-be-persuaded-vaccinate

Do you think that the world is prepared to handle the reemergence of ancient superviruses that have laid dormant in permafrost? Will global warming have as large a role to play in the spreading of these illnesses as some experts contend?

Also ... we shouldn't forget about bacteriophages in ancient ice ... it's not unreasonable to imagine that there couldn't be a lot of them released into the oceans and they could infect useful bacteria. The problem is we just don't know what is out there which is why pathogen discovery is very important ... preparation is everything ...

Not many of these "super" viruses are known (ie. smallpox, flu), however scientists have obtained copies of the 1918 influenza virus form burial sites, so it is possible that viable viruses could be obtained. It is certainly a concern with climate change and warming of these areas with permanent frost. I certainly agree that climate change has affected the spread of infections due to the spread of vectors (like mosquitoes) to broader areas, and longer warm seasons the facilitate this spread. Moreover, as humans spread into areas that were previously wild, they interact wth environments that can facilitate spread of various diseases.

When you say that viable material could be obtained, do you mean with the intent of creating a vaccine?

Yes of course ... RNA was isolated from the tissues of someone who was well preserved in the frost ... with that sequence it's possible to "resurrect" the virus that killed over 40 million people ... that's why working in high-containment laboratories is really important - see http://www.twiv.tv/threading-the-neidl/ NEIDL

Here's the press report - https://www.newscientist.com/article/dn8103-us-scientists-resurrect-deadly-1918-flu/

Here's the paper - https://www.ncbi.nlm.nih.gov/pubmed/16210530

and here's the abstract

Abstract

"The pandemic influenza virus of 1918-1919 killed an estimated 20 to 50 million people worldwide. With the recent availability of the complete 1918 influenza virus coding sequence, we used reverse genetics to generate an influenza virus bearing all eight gene segments of the pandemic virus to study the properties associated with its extraordinary virulence. In stark contrast to contemporary human influenza H1N1 viruses, the 1918 pandemic virus had the ability to replicate in the absence of trypsin, caused death in mice and embryonated chicken eggs, and displayed a high-growth phenotype in human bronchial epithelial cells. Moreover, the coordinated expression of the 1918 virus genes most certainly confers the unique high-virulence phenotype observed with this pandemic virus."

Pineapple

It makes me feel sad and mad ... people only want to do the best for their kids ... so they do their "own research" that seems to be the right thing to do ... the challenge if you don't have the training to weigh the evidence ... that's why looking at reputable sources is critical

Is original antigenic sin a big problem for vaccine safety and efficacy?

The idea that it prevents a secondary immure response is questionable. Here's a great PLoS Pathogens paper about OaS and influenza

http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1005806

Are there any new vaccines to diseases that are in the pipeline/close to being approved for the public in the near future?

Takeda are undertaking a Phase 3 trial of a Dengue vaccine involving 20,000 healthy children between the ages of 4 and 16 years living in dengue-endemic countries in Latin America and Asia.

Sorry to hear about you child having severe nut allergy ... this is certainly a challenge

In short NO ... look at some of our other answers for causation and association ... vaccines don't cause autism ... But they do cause the body to make a good immune responses and these are very helpful in fighting disease

When can we expect the zombie disease to escape and end the world? Or more realistically, what are the chances of a truly devastating virus spreading and killing half the population?

what is it with the world and zombies ;)

Well plague killed about 60% of people in Europe (although those were different times). There's an interesting theory about the Christmas Island rats http://www.abc.net.au/science/articles/2008/11/06/2412216.htm which might have been wiped out.

What we do know is pathogens are transmissible and they emerge and evolve. That why knowing your enemy is so important - it's why we need to work with them safely and in containment.

Any advice for new scientists in infectious disease? I am about to head off for an M.Phil @ Cambridge in their Department of Pathology, followed by a Ph.D in Molecular and Cell Biology @ Berkeley. Very interested in virology and bioinformatics!

I'm envious ... soundly wonderful and two fantastic places to study. Advice ... be nosey ... ask lots and lots of questions ... be intrigued by the experiments that don't give you the answer you hypothesized ... love the discipline ... and work hard ... 99% perspiration and 1% inspiration ... and play ... it's the best job in the world ... we are very, very lucky people ... always be thankful for that!

How do you respond to people who still dispute the importance of vaccines and introduce the autism argument? Is it even worth reasoning with these people or will they just reject facts in favor of fear?

Of course we need to acknowledge their concerns - the worst thing is to demonize "the other" and not engage with people who disagree with us and it's our responsibility, as people who appreciate what vaccines have done for humanity, to advocate for vaccines. We have to explain and frame the discussion with accepted science and hope that people are ready to have facts as foundation.

Desperately hard even to grow the virus

Takeda are working on it http://www.foodsafetynews.com/2016/06/takedas-norovirus-vaccine-first-to-reach-human-trials/

... and here's a nice state of the art paragraph ...

Noroviruses (NoVs) are one of the leading causes of acute gastroenteritis, including both outbreaks and endemic infections. The development of preventive strategies, including vaccines, for the most susceptible groups (children <5years of age, the elderly and individuals suffering crowding, such as military personnel and travelers) is desirable. However, NoV vaccine development has faced many difficulties, including genetic/antigenic diversity, limited knowledge on NoV immunology and viral cycle, lack of a permissive cell line for cultivation and lack of a widely available and successful animal model. Vaccine candidates rely on inoculation of virus-like particles (VLPs) formed by the main capsid protein VP1, subviral particles made from the protruding domain of VP1 (P-particles) or viral vectors with a NoV capsid gene insert produced by bioengineering technologies. Polivalent vaccines including multiple NoV genotypes and/or other viruses acquired by the enteric route have been developed. A VLP vaccine candidate has reached phase II clinical trials and several others are in pre-clinical stages of development. In this article we discuss the main challenges facing the development of a NoV vaccine and the current status of prevailing candidates.

https://www.ncbi.nlm.nih.gov/m/pubmed/28668568/

It's always safer to get the vaccine than the disease ... I say give it to boys as well ...

Hello ! What is your opinion on aluminium based adjuvants in vaccines ?

Here's what CDC says ... aluminum is used in some U.S. vaccines.

Aluminum gels or aluminum salts are vaccine ingredients that have been used in vaccines since the 1930s. Small amounts of aluminum are added to help the body build stronger immunity against the germ in the vaccine. Aluminum is one of the most common metals found in nature and is present in air, food, and water. The amount of aluminum present in vaccines is low and is regulated by the U.S. Food and Drug Administration (FDA).

Here's the paper https://vaccinepapers.org/wp-content/uploads/FDA-aluminum-paper.pdf

"Exposure of the general population to aluminum occurs primarily through the consumption of food, antacids, and buffered analgesics".

Here's a calculator to determine how much is in your bodyhttps://www.webelements.com/aluminium/biology.html

It hasn't been reworked because it's a fantastic product ... before it was introduced millions of kids were dying ... now there's "only" about 140,000 children die of measles a year ... of its not broke ... and it ain't ... don't fix it

We talked a little bit about his earlier with respect to melting ice potentially liberating old pathogens - this seems to me to be easily in the bounds of probability! Zoonotic infections are common ... a lot of human pathogens started off "life" in other animals

Thank you for doing AMA! I am also interested in microbiology.

Had any viruses broked out from your lab?

Luckily viruses are very easy to contain and they don't have big fists to break through walls and freezers ;)

Remember we bring viruses in from outside the lab to work with them in the first place. There are many, many rules and regulations to help us work with dangerous pathogens safely. Bringing them into the lab and "cooling them down" in terms of making them less virulent is one of the biggest achievements in modern medicine i.e. making vaccines.

Still we have a healthy respect for these amazing pathogens. As much as we love our jobs we use all the best engineering and personal protection to keep them well away from infecting us, or indeed anyone else.

Pleasure / it's sure hard trawling through literature like this - the aluminum calculator was just for fun but it's fascinating - always loved the fact there's enough iron in us to make a medium sized nail

What are your thoughts about the virus in the Divison? Is it a plausible senario?

as I understand it that was smallpox ... it's a very sensible scenario to chose for a game like this ... reading about the game almost makes me want to try it out ... if you play ... enjoy!

It is it shows the amazing impact vaccines have had on society - they really do work

Pineapple on pizza or no?

NO!

Lol I agree. Keep up the good work. Thanks.

YES!

Great question ... shape is everything in biology ... when an antibody in your body "sees" a pathogen it's does it by recognizing the special shape of it. Viruses are "shape shifters" their genetics helps them change a lot ... that's why finding bits which are structurally the same (conserved) is a great way to beat them ... think of Achilles' heel ;)

It's too simplistic to say dumb but I guess one might consider it not so clever to ignore hard scientific facts - Andrew Wakefield will have to answer for himself ... measles is a killer and children who have not been vaccinated in the developed world are now dead ... I find that just so very l, very sad since the disease is totally vaccine preventable

I'm with him ;)

Best place in the world for biomedical sciences and hopefully well soon have the opportunity to work with biosafety level 2, 3 and 4 viruses in the same building at BU - check out NEIDL http://www.twiv.tv/threading-the-neidl/

What food do you like?

zombies ... food ... :)

If coffee was a food ... it would be at the foundation of my food pyramid

Thanks for pointing that out ... it literally made my day ... he's American btw ;)

Through college what classes or activities made you realize what you want to work as in your future?

I loved organic chemistry - and the small molecules like ammonia and methane naturally drew me to bigger ones like DNA and RNA ... viruses are just big organic assemblies ... their simplicity packed with their punch for me is simply beautiful! I studied biochemistry and genetics which combined this all very nicely!

Malaria would be fantastic - great program btw my senior scientist did a masters there and he's now staff at NEIDL

Yup ... I know ;)

Depends what you want to do - research, teaching, technical - you've tons of transferable skills as well

Fascinating question ... whatever we found would have to be able to infect an astronaut ... because viruses travel in people ... the don't do anything other than 'exist' outside their host

There's tons of great vaccine research outside the US (if that's the jurisdiction your thinking of) India for example have fantastic facilities with SII. However, the reality is they still be to be licensed for the US market and meet all FDA standards

These are two toughies for sure ... the efforts made and money spent on HIV vaccines illustrates the massive challenges involved ... still ... we persist and I'm sure creative scientists will come up with novel solutions ... it's a big task for sure

It's certainly a hypothesis .. let's hope s/he isn't right eh :)

Nope - they are just very, very fortunate

In my opinion they are taking a risk and experimenting with their children using unproven regimens - this is not without risk.

Never to late to come to the party! I understand you worry about costs, time and effort! However, if you've got the interest and talent - just dream a little and think of the amazing things you might do - don't "waste" that brain!

Yes I agree - need to show hard evidence why they work - sometimes people will never be conceived and we need to leave it at that and try our best not to make it personal - that never works - constructive engagement is always best

Also, I have an opening for a post-doc and thought I would take advantage of this AMA to tell you all. Needs to be immunology based. Email me if interested. I hope you may be out there?

would you employ me?

All good ... it's such a problem there's even a prize

https://longitudeprize.org/challenge

The problem On average antibiotics add 20 years to each person’s life.

The development of antibiotics has been vital to our survival, yet the rise of antimicrobial resistance is threatening to make them ineffective in the future.

The World Health Organization estimates that antibiotics treatments add an average of 20 years to all of our lives. But in the 80 years since the discovery of penicillin, our overuse of antibiotics has put pressure on bacteria to evolve resistance, leading to the emergence of untreatable superbugs that threaten the basis of modern medicine.

Nope ... I look at the data ... appreciate the massive decrease in infections and consider that the systematically performed clinical trials did what they were supposed to do ... efficacy is everything and the current schedules are pretty efficacious I'd say! That's why we shouldn't mess and go a la carte - it's illogical imo

We talked a little bit about presenting facts ... but of course emotions get on the way ... people just want to do the right thing for their kids so I understand even though I don't agree

That's why I feel sorry for people who look at the false and scaremongering antiVaxx claims ... ultimately engage, engage and engage again

No idea ... if they do ... ask a manufacturer

Have a listen to this ... there's a TWIV for everything

http://www.twiv.tv/tag/dengue/

Enjoy

I love my job ... it's like getting paid to do my hobby ... I consider myself very fortunate

They end up turning open minded and scientifically interested people off ...

Never over promised ... it's unfair

YES ;)

Absolutely ... when I think how hard it is to engineer a virus ... and how big our genomes our ... is certainly want to give the potential problems a lot of consideration

Did you ever catch a school hockey game with Jack Eichel?

Unfortunately ... I did not ...

But I did read a lot about Penguins getting mumps ;)

https://www.washingtonpost.com/news/early-lead/wp/2014/12/26/two-more-pittsburgh-penguins-have-the-mumps-as-nhl-outbreak-continues/?utm_term=.5ea14f8d8fc8

what do you think if i told you that antibiotics will eliminate all humans?

I would think that this would be a very hard theory to test

I have not ... it's sounds great

Yup ... I'd happy drink from the same glass as my buddy!

Totally agree

Sometimes laboratories take summer interns it's tough in infections diseases since there are so many strict rules for biosafety - that said one of my best technicians came directly from BU and he volunteered in my laboratory

I am not familiar with that work of literature

Absolutely here I am getting the needle in NEIDL @10queues

https://twitter.com/10queues/status/789116664914862080

Vaccination is a social contract - you're friend is trying to be Charlie from the chocolate factor and win the golden ticket - problem is herd immunity "demands" others vaccine so there ain't too many golden tickets / I'd argue keep those for the very small number of immunosuppressed kids who just CAN'T be vaccinated

What was the motivation behind causing autism in kids?

hard question to understand ... if you mean, "why do people imagine there is an association?" it's simply because we are hard wired to look for a reason when something happens ... we vaccinate for measles at 15 months (=1) autism manifests at about the same time (=1) but this is a great example when 1+1 doesn't equal 2.

There's a huge difference between association and causation ... makes sense?

Does that mean you deny the concept of regressive autism?

Where all authorities (parents and doctors) agree that infant development appears to be normal until a certain age (often associated with the receipt of a vaccine), at which point the infant appears to regress?

Does the medical field deny that concept now and think that all autism begins at birth - if we can find the right clues to spot it?

I'm not an autism expert - so I can't comment on regressive autism. However, as you note - associated (not caused) and it's critical to separate these two.

For example people used to associated autism with arrival of a second child in the absence of birth control, let's say 11-15 months after the first. This again just happens to be when MMR is administered - but as I said above here's a 1+1 doesn't equal 2! Sorry to labor point but association and cause are so, so different!