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>> OKAY.
GOOD AFTERNOON.
WE'LL GET STARTED.
SEVERAL PEOPLE ASKED ME FROM
TIME TO TIME WHY DO WE PASS
THESE BOOKS AROUND AND RECORD,
WRITE DOWN?
IT'S NOT REALLY KEEP TRACK OF
ATTENDANCE PER SE, IF YOU ATTEND
AT LEAST HALF THE SESSIONS AND
THEN ASK AN ELECTRONIC -- PASS
AN ELECTRONIC FINAL EXAM THAT WE
GIVE WHICH IS NOT SOMETHING
YOU'RE GOING TO LOSE A GREAT
DEAL OF SLEEP OVER AND YOU CAN
TAKE IT SEVERAL TIMES, IF YOU DO
THAT YOU GET A CERTIFICATE AND
FOR SOME PEOPLE THAT'S SOME --
FOR SOME PEOPLE THAT'S A REAL
INTEREST AND IMPORTANCE,
PARTICULARLY POST DOCS AND
STUDENTS.
YOU GET WHAT?
(OFF MIC)
>> THAT'S FOR THE -- YEAH BUT
THE REASON WHY WE DO IT, IT'S A
VERY INTERESTING PHENOMENA.
FOR EXAMPLE, IF THERE WAS A
TOPIC ON THE FIRST SESSION THAT
DEALS WITH INFECTIOUS DISEASES,
THERE'S A HUGE NUMBER OF PEOPLE
FROM THE ALLERGY AND INFECTIOUS
DISEASE INSTITUTE AND OTHERS WHO
COME.
THEN LET'S SUPPOSE THE NEXT WEEK
IS, I DON'T KNOW, MULTIPLE
SCLEROSIS.
WHAT'S REALLY INTERESTING IS
THAT 25% OR SO OF THE PEOPLE WHO
CAME TO THE ID LECTURE COME BACK
THE SECOND WEEK AND THEN THERE
ARE A WAVE OF PEOPLE FROM NINDS
AND ABOUT A THIRD OF THEM AND
FROM THE FIRST GROUP COME BACK.
SO WE'RE INTERESTED IN FINDING
OUT WHAT IS THE LEARNING
EXPERIENCE?
WHY DO PEOPLE DO THIS IF IT'S
NOT IN THEIR SPECIFIC AREA OF
DISCIPLINE.
THERE'S A GRADUATE STUDENT WHO
IS WRITING A GRADUATE THESIS ON
THE SUBJECT OF 11 YEARS OF DATA
LIKE THIS.
AND INTERVIEWING PEOPLE.
SO IT'S QUITE REVEALING.
SO TODAY WE'RE GOING TO HAVE A
DISCUSSION OF PERTUSSIS AND MIND
READING ABOUT THIS -- IN MY
READING I WAS INTRIGUED TO LEARN
THAT AS EXPANDED ITS SCOPE FROM
BEING A DISEASE OF NEWBORNS AND
INFANTS THAT MORE AND MORE
ADULTS ARE AFFECTED BY INFECTION
WITH BORDETELLA PERTUSSIS.
SO THE SPECTRUM IS CHANGING.
I KEEP WONDERING, YOU KNOW, HOW
MANY INTERNISTS -- WELL, I DON'T
KNOW HOW MANY INTERNISTS EVEN
RECOGNIZE IT WHEN IT APPEARS IN
AN ADULT POPULATION.
BUT THERE ARE VERY INTERESTING
QUESTIONS THAT ARISE REGARDING
PREVENGES AFFECTIVE VACCINE,
WHAT IS IS AN EFFECTIVE VACCINE
AND SO FORTH.
SO THESE ARE GOING TO BE THE
THEMES OF TODAY'S PRESENTATIONS.
SO WE'RE GOING TO LEAD OFF WITH
ALEXANDRA FREEMAN.
ALEXANDRA, THAT'S WHAT I SAID.
DISPL YOU SAID ALEC ZAHN
>> MY BEST FRIEND AND SEVERE
CONSCIOUS IS IN THE AUDIENCE.
ALEXANDRA, PARDON ME.
ALEXANDRA GRADUATED FROM
GEORGETOWN MEDICAL SCHOOL WITH
HONORS TRAINED IN PEDIATRICS AT
-- AT YALE AND NEWHAVEN AND
NORTHWESTERN AND CAME TO NIH IN
2004 IN THE CLINICAL CENTER.
WHERE SHE'S A STAFF CLINICIAN
AND HAS DONE REALLY A WHOLE
SERIES OF REMARKABLE STUDIES,
NOT SPECIFICALLY WITH REGARD TO
PERTUSSIS BUT HAS A CONSIDERABLE
EXPERIENCE IN THE BROAD AREAS OF
PEDIATRICS.
THEN OUR SECOND SPEAKER IS MY
OLDER BROTHER JOHN ROBINS, WHO
IS -- NOW YOU CAN CLOSE YOUR
EARS, JOHN, IS A HERO TO MANY OF
US BECAUSE THROUGH THE YEARS HE
AND RACHEL SNEERSON HAVE HERE AT
THE NIH, BEFORE THAT WE FIRST
MET AT ALBERT EINSTEIN MANY,
MANY YEARS AGO.
BUT WHILE HERE AT NIH THEY
DEVELOPED SERIES OF VACCINES
PARTICULARLY AGAINST HO MOVE
FLOWS INFLUENZA TYPE B WHICH HAD
DRAMATIC EFFECTS THROUGHOUT THE
WORLD.
I DON'T KNOW HOW MANY HUNDREDS
OF THOUSANDS OR MAYBE IT'S IN
MILLIONS OF CHILDREN WHO HAVE
BEEN LITERALLY PROTECTED BY THIS
VACCINE FROM EVEN THE LETHAL
EFFECTS OF INFECTION WITH HO
HOMOFLOUS HEPATITIS B VACCINE.
NOT THE VIRUS.
AND A VARIETY OF INFECTIOUS
DISEASES USING NOVEL TECHNIQUES.
THE GREAT PERSEVERANCE THAT IS
NECESSARY IN ORDER TO BRING
THESE THINGS INTO THE APPLICABLE
WORLD, IT IS NOT ENOUGH TO DO
SOMETHING IN THE LABORATORY.
SOMETIMES THE HARDEST WORK IS IS
WHAT FLOWS BEFORE IT CAN BE
BROUGHT INTO CLINICAL PRACTICE.
SO IN ACKNOWLEDGEMENT OF THIS,
JOHN AND RACHEL RECEIVED THE
ALBERT LASKER AWARD FOR
EXCELLENCE IN CLINICAL MEDICAL
RESEARCH.
WHO HAS THEIR AWARD.
ALBERT SAY -- SABAN GOLD MEDAL.
MEMBERS OF THE ACADEMY, ET
CETERA, ET CETERA, SO IT'S A
GREAT PLEASURE TO WELCOME UNCLE,
BROTHER, GRANDFATHER, TO WELCOME
BACK FOR THE SECOND SPEAKER.
YOU CAN TALK ABOUT THAT TOO.
SO ALEXANDRA, THANK YOU.
>> I THANK YOU SO MUCH.
LET ME TURN THIS ON.
I DO HAVE A LITTLE BIT OF LARN
JIETIS SO HOPEFULLY EVERYONE CAN
HEAR ME, I DON'T THINK I HAVE
PERTUSSIS.
I HAVE VACCINATED A FEW YEARS
AGO AND SHOULD BE OKAY.
ANY WARE, GREAT TO TALK ABOUT
PERTUSSIS BECAUSE MY TRAINING IS
PEDIATRIC INFECTIOUS DISEASE AN
OVER THE YEARS I HAVE SEEN
THROUGH BEING PEDIATRIC RES
DEBIT THROUGH FELLOWSHIP AND ON
AND OFF SINCE, HAVE SEEN
INDIVIDUALS WITH PERTUSSIS,
BABIES TO ADULT WHOSE HAVE COME
IN.
AND THAT'S GETTING ME MORE BACK
TO MY ROOTS OF MY TRAINING TO
TALK ABOUT THIS.
I WANTED TO START WITH A VIDEO
OF A BYE-BYE THAT HAS PER TUS AT
THIS.
I KNOW SOMETIMES IN THIS COURSE
I SPOKE A FEW YEAR AGO AND
BROUGHT IN A PATIENT WITH A
STAFF INFECTION.
I DIDN'T HAVE SOMEONE TO BRING
IN, WE DON'T WANT SOMEONE
SITTING HERE WITH PERTUSSIS AND
I DID HAVE SOMEONE RECENTLY IN
THE AREA WITH PERTUSSIS, BUT
SHOWING THE BABY THAT HAS THE
FULL BLOWN DISEASE WOULD BE
BENEFICIAL FOR EVERYBODY.
IT WAS FROM A VACCINE FILM THAT
WAS PRODUCED.
THEY' MAKING A VERSION SOON I
WAS ABLE TO CONNECT HER WITH
PEDIATRIC DISEASE DOCTOR THAT I
TRAINED WITH WHO WAS ABLE TO
ACCESS AND FIND A BABY FOR THEM
TO COME.
I'M GOING TO SHOW THIS QUICKLY.
WE'LL START TALKING.
>> SUDDENLY LIFE --
>> THE BABY OF INTEREST.
>> HERE IS A BABY, A MONTH AND A
HALF OLD WITH TUSSIS.
-- WITH PERTUSSIS
P
>> WHAT'S HARD ABOUT THIS IS NOT
THERAPIES LIKE THIS WHEN THE
BABY IS COUGHING LIKE THIS.
>> (INAUDIBLE) IS SEVEN WEEKS
OLD.
HE WAS DUE TO BE VACCINATE AID
GAINS WHOOPING COUGH THE NEXT
WEEK BUT THE GERM GOT TO HIM
FIRST.
HIS MOTHER BROUGHT HIM TO THE
HOSPITAL TWO DAYS AGO.
WHAT STARTED AS RUNNY NOSE AND
SLIGHT COUGH HAS BECOME
FRIGHTENING EPISODES WHERE HE'S
STRUGGLING TO BREATHE.
>> THE BABIES ARE BROUGHT TO THE
THE HOSPITAL SO THEY CAN BE
SUCTIONED BECAUSE IT'S HARD TO
COUGH YOU HAVE THE THICK MOW
COWS AND P ALSO FOR OXYGEN, THEY
STOP BREATHING AND OXYGEN LEVELS
GO DOWN.
>> HIS COLOR TURNED TO BLUE AND
HE WASN'T BREATHING.
SHE HAULED HIM TO THE ROOM
OUTSIDE THE FRESH AIR AND PAT ON
HIS BACK TO GET BACK TO NORMAL
AND THEN SHE CALLED THE
AMBULANCE.
THE AMBULANCE CAME SO ALL THE
(INAUDIBLE) TO SEE WHAT'S -- THE
WHOOPING COUGH.
>> WHOOPING COUGH OR PERTUSSIS
AS IT'S KNOWN CAN BE LIFE
THREATENING FOR BABIES.
ONE IN FOUR BABIES HOSPITALIZED
HAVE SERIOUS COMPLICATIONS LIKE
PNEUMONIA.
ONE IN 250 DIE.
THERE'S NO MEDICAL CURE.
ANTIBIOTICS ARE USED TO REDUCE
THE CHANCE OF INFECTING OTHERS
BUT AUSTIN'S TINY BODY MUST
FIGHT INFECTIONS.
>> ANYWAY, I THINK THAT GIVES
YOU THE FLAVOR OF THIS ILLNESS.
THAT REPRESENTATIVE OF THE
BABIES US AS PEDIATRICIANS HAVE
TO BRING INTO THE HOSPITAL
SOMETIMES AND SEEING KIND OF THE
HELPLESS.
NOW IF I CAN GET THIS BACK UP TO
THE VIEWING.
I CAN DO RIGHT THERE.
MCINTOSH VERSUS MAC.
ANY BAY, I WAS GOING TO TALK
ABOUT THE HISTORY OF PERTUSSIS,
MICROBIOLOGY, CLINICAL FEATURE,
DIAGNOSIS, TREATMENT SOME
IMPACTS OF DIAGNOSIS HAVE BEEN
THE OTHER THING WE'LL SPEAK MORE
ABOUT VACCINATION.
SO I'LL TALK ABOUT OTHER
BORDETELLA SPECIES AND JUST
TOUCH ON VACCINE PREVENTABLE
ILLNESSES.
THE PERTUSSIS IS A VERY OLD
DISEASE THAT HAS GOTTEN
ATTENTION IN RECENT YEARS WHILE
WE HAVE SEEN THIS INCREASE IN
INCIDENCE.
AS THE ADOLESCENTS AND ADULTS
HAVE BEEN RECOGNIZED HAVE MORE
INFECTIONS BUT THEN BASED ON TO
THE BABY.
THERE WAS FIRST RECOGNIZED IN
THE MIDDLE AGES AS THE SCOTTISH
FOR (INAUDIBLE), THERE'S GREAT
-- THE FIRST EPIDEMIC WRITTEN
ABOUT AND DESCRIBED WAS IN 1578
IN PARIS, ABOUT A CENTURY LATER
NAMED AS PERTUSSIS SO I DON'T
KNOW IF YOU HAVE DISCUSSED RUE
MATTIC FEVER BUT (INAUDIBLE) IS
WHAT HE WAS BETTER KNOWN FOR.
HE NAMED THAT PERTUSSIS SO I WAS
LOOKING THIS UP.
THE BACTERIA IS ISOLATED IN THE
BEGINNING OF THE 1900s AND THE
VEEP WAS DEVELOPED IN THE
1930s WHICH MADE A HUGE IMPACT
IN TERMS OF INCIDENCE OF THIS
DISEASE.
RECENTLY THERE'S BEEN THIS
RESURGENCE OF THE INFECTION.
NOW WE'RE GETTING TO GET UNDER
MORE CONTROL AGAIN.
SO WHAT IS PERTUSSIS?
IT WAS BORDETELLA PERTUSSIS,
IT'S A GRAM NEGATIVE ROD AND
IT'S VERY FASTIDIOUS, IT'S HARD
TO GROW, NEEDS SPECIAL MEDIA
WHICH HAS CHARCOAL IN IT TO
GROW, TAKES LONGER THAN STREP.
AND IT ONLY AFFECTS HUMANS
COMPARED TO OTHER BORDETELLA PEE
SHIES.
I'LL TALK ABOUT OTHER SPECIES
LATER BORDETELLA.
IT DOESN'T HAVE A KNOWN
ENVIRONMENTAL RESERVOIR.
SO IT'S ACTUALLY AN INFECTION
QUITE AMENABLE TO VACCINATION.
BECAUSE IT'S NOT SOMETHING
THAT'S COMING FROM EITHER
ANIMALS IN THE ENVIRONMENT THAT
IS HARDER TO DEAL WITH AS
VACCINATION.
AND IT'S PATHOGENESIS IS DRIVEN
BY SEVERAL TOXINS THAT
CONTRIBUTE TO THE DISEASE WHICH
I'LL TOUCH ON A LITTLE BIT.
SO THIS IS KIND OF A COOL 3-D
IMAGE OF BAS LAND YOU CAN SEE
THE BACTERIA IN GREEN WHEN YOU
GET INFECTED WITH THIS.
THE BACTERIA ACTUALLY ATTACHES
WITH ADHERENCE FACTORS, HEMOGLUE
TIN AND WHICH ARE TARGETED IN A
LOT OF VACCINES AND PROBABLY
WILL BE DISCUSSED LATER.
THEN DO PARALYZE BACILLI, SOME
OF THE VIRULENCE TOXINS.
SO THIS IS A BACTERIA THAT
REALLY USES A LOT OF TOXINS AND
SEVERAL TOXINS ARE ACTUALLY THEN
TARGETEDDED IN THE VACCINE TO
CREATE THE DISEASE.
SOME OF THESE WORK AGAINST THE
CHEMOTAXIS OF IP FLAMTORY CELLS
LIKE LYMPHOCYTES THE INITIAL
HOST OF INFECTION AND OTHERS
WORK MORE ON ACTUAL CILIA AND
THE RESPIRATORY EPITHELIUM
CAUSING THE CELL TO SLOUGH OFF
INTO THE SMALL AIRWAYS.
I LISTED SOME HERE.
ADEN LACE SIGH CLAYS WHICH IS
INVOLVED IN MAKING THE WHITE
BLOOD CELLS, THE NEUTRA PHIL
LYMPHOSITES NOTS GET THE
BACTERIA ON THE EPIPTHELIAL
CELLS.
THE RESPIRATORY EPITHELIAL
CELLS, PERTUSSIS TOXINS WHICH IS
THE MOST FAMOUS PERTUSSIS TOXIN
AND TARGETED IN THE VACCINES.
THAT BINDS WITH CELL MEMBRANE,
WORKS ALSO ON THE CHEMOTAXIS BUT
ALSO INVOLVED IN OTHER AREAS
THROUGHOUT THE BODY.
THIS IS INTERESTING, LARRY ABOUT
THIS, HOW IT CAN AFFECT THE
PANCREAS AND RESULT IN A HIGH
INSULIN STATE.
IF YOU HAVE TOO MUCH INSULIN
YOUR GLUCOSE GOES DOWN, MAKE THE
BABIES MORE HYPOGLYCEMIC.
THIS ALSO CAUSES A BIG LYMPHO
SITE -- LYMPHOCYTOSIS YOU
SEE IN THE CHILDREN WITH THIS
INFECTION IN TERMS OF BLOOD
COUNT.
YOU SEE HIGH LYMPHOSITE COUNT.
WHERE YOU SEE OTHER BACTERIA
INFECTIONS LIKE PNEUMOCOKESIS OR
OTHER CAUSES OF MATERIAL,
PNEUMONIA, WE SEE LOTS OF NEUTRA
PHILS.
THEN THERE'S TRACHEAL ENDOTOXIN
WHICH DAMAGES AND KILL IT IS
SILLIATED RESPIRATORY EPITHELIAL
CELLS AND CAUSES THEM TO SLOUGH
OFF INTO THE SMALL AIRWAYS.
AND THAT CONTRIBUTES TO THE
THICK MUCOUS THESE BABIES HAVE,
WHIED BLOOD CELLS BUT ALSO THE
AIRWAY CELLS ACTUALLY COMING
INTO THE SMALL AIRWAYS STRIKING
THAT AND MAKING IT DIFFICULT TO
COUGH OUT.
SO IN TERMS OF CLINICAL
PRESENTATION, THIS IS A VERY
CONTAGIOUS BACTERIA.
WHEN YOU HAVE SOMEONE IN YOUR
HOUSEHOLD THAT HAS PERTUSSIS,
ABOUT 75, 80% OF HOUSEHOLD
CONTACTS WILL GET IP FECTED.
-- INFECTED IF NOT VACCINATED.
THEN THERE'S A WEEK OR TEN DAY
BFERS YOU GET SICK.
IN THE BEGINNING OF THE ILLNESS
IS THE (INAUDIBLE) STAGE.
MORE JUST LIKE A COLD.
THAT'S THE PROBLEM BECAUSE THIS
IS WHEN YOU'RE SUPER INFECTIOUS
WHEN YOU'RE INFECTING EVERYONE
ELSE YOU'RE ACTING LIKE YOU HAVE
A COLD.
WHICH IS WHY BACK OF MY HEAD I
BETTER NOT HAVE PERTUSSIS
TALKING ABOUT THIS.
SO THESE INDIVIDUALS WILL HAVE
RUNNY NOSE, RED EYES, YOUR
SNEEZING, COUGHING A LITTLE BIT.
SO REALLY BEGINNING PHASE IS
MORE LIKE A COLD.
IT'S RARE TO HAVE A FEVER, IT
ACTS LIKE A REGULAR COLD AT THAT
POINT.
THE NEXT STAGE IS MORE CLASSIC,
YOU START THINKING ABOUT
PERTUSSIS THE (INAUDIBLE) STAGE.
THIS GOES ON AND ON AND ON WITH
THE COUGH, COUGH, COUGH.
AND LEAD TO THE NAME OF THIS
ILLNESS AS THE HUNDRED DAY
COUGH.
SO THE FIRST FEW WEEKS
CONTAGIOUS.
THEN THROUGH ANTIBIOTICS OR YOUR
IMMUNE RESPONSE THE BACTERIA IS
KILLED AND PEOPLE BECOME LESS
INFECTIOUS AFTER THE FIST FEW
WEEKS.
BUT THIS IS WHERE YOU HAVE THE
HORRIBLE PARTS OF THE COUGH AND
TRYING TO CLEAR OUT THAT MUCOUS
THAT IS MADE FROM THE
RESPIRATORY EPITHELIAL CELLS AND
THE WHITE BLOOD CELLS MANY THE
AIRWAYS.
SO YOU HAVE THE COUGH COUGH
COUGH THEN THE BIG WHOOP WHICH I
CAN'T DO WITH MY VOICE RIGHT
NOW, AS YOU TRY TO CATCH YOUR
BREATH TO HAVE ANOTHER BIG
SERIES OF COUGHS.
YOU'RE TRYING TO GET THAT BIG
AIRWAY PRESSURE IN AND THEN
COUGH COUGH COUGH OF COUGH CO.
THIS IS USUALLY REALLY BAD AND
IT GOES ON FOR WEEKS AND WEEKS
AND WEEKS.
AGAIN, THINGS LIKE FEVER NOT
THAT COMMON BUT THIS CAN HAVE A
LOT OF COMPLICATIONS AT THIS
STAGE, AT THIS PACE, INCLUDING
PEOPLE CLASSICALLY THROW UP AT
THE END OF THOSE LONG BURSTS OF
COUGHS.
THEN YOU START TO GET BETTER.
SO FOR THE NEXT COUPLE OF WEEKS
IT'S CALLED THE CONVALESCENT
PHASE AND THOSE GO DOWN AND DOWN
IN TERMS OF FREQUENCY.
BUT AT THAT POINT IF YOU GET
EXPOSED TO SOMETHING ELSE
CIRCULATING IN THE IMMUNITY, AND
HAVE A LITTLE INFECTION WITH ONE
OF THE COMMON COLDS, AGAIN YOU
CAN ENTER THE PHASE OF HAVING
(INAUDIBLE) AGAIN.
YOU CAN SEE THE POOR BABY THERE
WITH THIS HORRIBLE COUGH.
BUT WHAT WE HAVE RECOGNIZED OVER
THE LAST SERIES OF YEARS,
ATYPICAL PRESENTATIONS ARE
REALLY COMMON IN ADOLESCENTS AND
ADULTS VACCINATE WHEN THEY WERE
CHILDREN, THEY HAVE SOME
PROTECTION AND THEY OFTEN DON'T
HAVE THAT CLASSIC CASE AND
CLASSIC PRACTICES OF COUGH SO
THEY'RE MUCH MORE MILD THAT'S
WHY IT'S MISSED AND CAN BE
PASSED ON TO THE BABY NOT
VACCINATED.
IN BABIES LIKE WHEN YOU SAW THAT
BABY WITH THAT COUGHING, THEY
DON'T HAVE THAT CHEST STRENGTH
TO COME UP WITH THOSE BIG
WHOOPS.
THEY CAN'T MAKE THAT HIGH
PRESSURE.
THEY DON'T HAVE THE WHOOP.
UNFORTUNATELY THEY THEN HAVE
MORE OF THE -- BECAUSE THE
PRESSURE IS IS REALLY GET THAT
THICK MUCOUS OUT.
THEY END UP HAVING MORE PERIODS
OF APNEA WHERE THEY HAVE THE
OXYGEN LEVELS GO DOWN AND THEY
STOP BREATHING.
AND THAT LEADS TO LOTS OF
COMPLICATIONS.
SO HALF OF BABIES WILL END UP
BEING IN THE HOSPITAL, MOSTLY
BECAUSE THEY JUST CAN'T CLEAR
THOSE SECRETIONS AND OXYGEN
LEVELS GO DOWFNLT TWO-THIRDS
WITH APNEA, THEY STOP BREATHING,
A QUARTER WITH PNEUMONIA, FROM
THE PERTUSSIS OR FROM OTHER
INFECTIONS THEN AS CO-INFECTION,
AND MEMBERS WITH SEIZURES AN
ENCEPHALOPATHY, DISCUSSION OVER
YEAR WHETHER THAT'S TOX IMMUNE
MEDIATED OR NOT, MORE RELATED TO
OXYGEN LEVELS DROPPING LEADING
TO SEIZURES OR BRAIN DAMAGE FROM
THAT. AND 1.6% OF BABIES DIE
FROM THIS.
THERE'S LOTS OF COMPLICATIONS
WHEN YOU COUGH THAT MUCH AND
HAVING THOSE CHANGES IN PRESSURE
INSIDE YOUR CHEST.
YOU CAN SEE THE CHILD HERE HAS
SUB SUB CONJUNCTIVAL
HEMORRHAGES.
BURSTING BLD VESSEL, BRUISING
UNDER THE EYES FROM COUGHING.
YOU CAN DROP A LUNG HAVE
PNEUMOTHORAX FROM HAVING ALL THE
PRESSURE, OTHER THINGS LIKE
HERNIAS OR *** PROLAPSE,
PULMONARY HYPERTENSION IS FOUND
TO BE COMMON IN THE BABIES SO
WHEN YOU'RE OXYGEN LEVELS ARE
LOW, THEN THE PULMONARY OF LUNG
BLOOD VESSELS CONSTRICT AND
RIGHT SIDE HEART WORKS HARDER TO
GET THE BLOOD THROUGH TO THE
AIRWAYS.
AND RIB FRACTURES FROM COUGHING
SO MUCH.
SO WHY IS THIS SUCH A PROBLEM
FOR BABIES?
THE INCIDENCE RECENT YEARS IS
ACTUALLY A LOT, THE ADOLESCENTS,
THE YOUNG ADULTS ARE HAVING SO
MUCH INFECTION, THAT MADE PEOPLE
REALIZE THAT THE IMMUNITY WAS
BEGINNING TO WANE OFF AND THESE
PEOPLE WERE THE RESERVOIRS BUT
BABIES THAT ENUP IN THE HOSPITAL
AND BABIES THAT ARE DYING WITH
THIS ILLNESS.
FEW REASONS.
WITHIN IS WE START VACCINATING
THE BABIES AT TWO MONTHS OLD BUT
THEIR INITIAL IMMUNE RESPONSES
ARE NOT GREAT AND A LOT OF
BABIES ARE GETTING SICK BEFORE
THEY GET THEIR FIRST VACCINATION
BUT FOR THAT FIRST YEAR, THE
IMMUNITY IS NOT AS GOOD AS
CHILDREN LATER ON.
THEN MOMS THROUGH THE PLACENTA
PASS ON A LOT OF IMMUNE GLOBULIN
TO BABIES BUT IF THE MOM HASN'T
BEEN VACCINATED IN A WHILE, MOM
WASN'T VACCINATED SINCE THE MOM
WAS A CHILD, THAT BABY DIDN'T
HAVE THAT MATERNAL PROTECTION
WHICH IS WHY NOW WE'RE BEGINNING
TO TARGET PREGNANT WOMEN AND
WITH EACH PREGNANCY THEY'RE
TRYING TO VACCINATE MOM TO GIVE
THAT TRANSPLACENTAL COVERAGE FOR
THE BABIES.
THE BABIES DON'T HAVE THE
STRENGTH TO COUGH OUT THE
MUCOUS.
AND BABIES GET SICK A LOT SO YOU
KNOW ALL YOU NEED IS PERTUSSIS
AND THEN HAVE RSV, A SIGNIFICANT
VIRAL INFECTION FOR BABIES AT
THE SAME TIME.
AND YOU HAVE A DOUBLE HIT AND A
LOT OF TROUBLE WITH OXYGEN
LEVELS.
SO SOME IS KNOWN ABOUT THE
PATHOLOGY OF THIS ILLNESS
BECAUSE OF FATAL CASES.
OFTEN THERE IS SOME SORT OF
PNEUMONIA, THE SMALLER AIRWAYS
THEN INVOLVED.
EITHER WITH PERTUSSIS OR WITH
OTHER BACTERIA CAUSING A
SECONDARY INFECTION.
AND THAT AIRWAY IS -- KIND OF
THE SMALLER AIRWAYS, AS WELL AS
RESPIRATORY EPITHELIAL CELLS
THAT INVOLVED INTO THE AIRWAY.
PULMONARY EDEMA IS COMMON IN
BLEEDING, A LOT FROM HYPOXIA
LEADING TO LEADING TO SWELLING
IN THE AIRWAYS AND SMALL
VESSELS.
YOU CAN SEE HERE THE BRONCHUS.
THIS WOULD BE AN AIRWAY,
BRONCHIAL AIRWAY.
THIS SHOULD BE AIR WITH NO CELLS
INSIDE THERE, THIS IS ALL FILLED
WITH EPITHELIAL CELLS AND WITH
INFLAMMATORY CELLS.
THIS IS WHAT THE BABIES ARE
TRYING TO COUGH UP.
HOW DO WE DIAGNOSE PERTUSSIS?
THE MAIN THING IS MAKING SURE
SOMEONE THINKS ABOUT IT.
WHEN YOU HAVE AN ADOLESCENT OR
ADULT COMING IN WITH SOMETHING
YOU THINK OF AS A CHILDHOOD
ILLNESS THEY ACTUALLY THINK THIS
COUGH IS IS GONE ON A LITTLE TOO
LONG AND LOOKING FOR PERTUSSIS.
THE GOLD STANDARD HAS BEEN
CULTURE, NOW WE HAVE ALL THESE
FANCY TECHNIQUES THAT ARE MORE
SENSITIVE, CULTURE IS LESS
COMMON COMPARED TO THE PCR.
BUT THE CULTURE, IS A LITTLE
TRICKY, YOU HAVE TO GET A
SPECIAL SWAB.
HERE WE GET THE MEDIA, WE BRING
IN TO THE CLINIC.
AND WE ACTUALLY PUT THE SWAB
IMMEDIATELY IN THAT CULTURE
MEDIA.
THAT CULTURE MEDIA, AS I SAID
BEFORE, THESE ARE HARD BACTERIA
TO GROW.
THEY'RE A LITTLE FAST DIDIOUS.
YOU NEED CHARCOAL IN THE MEDIA.
IT HAS A LOT OF BACTERIA IN YOUR
NOSE LIKE STAPH AND STREP.
THE MEDIA CONTAINS ANTIBIOTICS
THAT KILL OTHER BACTERIA THAT
LETS THIS BACTERIA GROW.
IF YOU GROW IN CULTURE, IT'S
EXTREMELY SPECIFIC.
YOU GROW YOU CAN IDENTIFY,
EVERYTHING IS GOOD.
BUT THE SENSITIVITY IS REALLY
NOT GREAT AND OVER TIME AFTER
THOSE FIRST COUPLE OF WEEKS OF
ILLNESS, THE SENSITIVITY GOES
WAY DOWN IN TERMS OF DIAGNOSING
BY CULTURE.
SO THOSE FIRST COUPLE OF WEEKS
WHEN YOU ACT LIKE YOU HAVE A
COLD, NO ONE WILL THINK ABOUT
IT.
THEN YOU ONLY HAVE A WEEK OR TWO
TO GET YOUR DIAGNOSIS BY
CULTURE.
SO PCR IS DONE MUCH MORE
COMMONLY NOW AND WHEN WE SEND
THIS TO THE CLINICAL SENOR WE
ACTUALLY SEND PCR AS WELL.
AND THEN WITH PCR YOU CAN PICK
UP THE DEAD BACK TOREIA TOO.
SO IF THE PERSON IS ON
ANTIBIOTICS OR IMMUNE RESPONSE
IS GETTING THAT BACTERIA TO BE
LESS VIABLE YOU CAN STILL PICK
THIS UP BY PCR SO YOUR
SENSITIVITY GOES WAY UP, IT IS
PRETTY SPECIFIC.
IT'S A LITTLE CROSS REACTIVITY
WITH OTHER BORDETELLA, BUT STILL
GOOD.
THAT PUTS YOU A FEW MORE WEEKS
INTO DIAGNOSIS PERIOD.
ZOOLOGY SLOBBING AT THE ANTIBODY
RESPONSE TO THE ACTUAL
INFECTION.
AND THIS IS DONE MUCH MORE IN
EPIDEMIOLOGIC STUDIES THAN
DIAGNOSIS, IN PART A LITTLE
TRICKY.
ONE COMES TO YOUR OFFICE, YOU
GET ANTIBODY, IF THAT PERSON IS
VACCINATED AT SOME POINT IT
MAYBE POSITIVE BUT YOU NEED TO
SEE IS -- NOT AS POSITIVE
ANTIBODY AND FOUR WEEKS LATER
SEEING A MORE POSITIVE RESULT AS
THAT RESPONSE GOES UP BUT IF
YOU'RE JUST TRYING TO KP CAPTURE
SOMEONE IN CLINIC AND DIAGNOSE
IT'S MORE DIFFICULT SO USE MORE
EPIDEEM LOGICALLY.
JUST KIND OF IN THE CLINICAL
SETTING ALSO WE GET BLOOD WORK
AND CBC, SUPER HIGH LYMPHOSITE
COUNTS.
IF WE GET A CHEST X-RAY MOST
TIMES NORMAL.
THERE SHOWS A LITTLE BIT ABOUT
THE TIMING.
WITH CULTURE, THE FIRST COUPLE
OF WEEKS OF ILLNESS WHEN YOU'RE
NOT THINKING AIN'T IT BECAUSE IT
HASN'T GONE ON THAT LONG TO
THINK ABOUT IT.
PCR GIVES YOU A LITTLE MORE
TIME, YOUR THIRD WEEK OF BAD
COUGH, SOMEONE IS THINKING MAYBE
THIS ISN'T JUST A COLD.
SEROLOGY IS LATER ON BUT THAT IS
IS USED MUCH MORE FOR
EPIDEMIOLOGIC STUDIES.
I WANT TO THROW IN TOO, COMPARED
TO THE FLU THIS DOESN'T HAVE THE
SEASONAL VARIATION, NOT LIKE A
PERTUSSIS SEASON, THERE'S
OUTBREAKS SEVERAL YEARS.
HOW DO WE TREAT PERTUSSIS?
THE QUICKER YOU TREAT THE MORE
IMACT YOU HAVE.
SO YOU HAVE TO THINK ABOUT IT
AND IF YOU THINK IT'S THAT YOU
START TREATING BEFORE THE TEST
COMES BACK.
SOME TESTS TAKE SEVERAL DAYS TO
COME BACK.
AFTER THE FIRST COUPLE OF WEEKS
YOU WON'T IMPACT THE ILLNESS AT
ALL, WHAT THEY WERE SAYING IN
THAT VIDEO, AT THAT POINT WHEN
THE BABY IS COUGHING A FEW
WEEKS, ACTUALLY THAT'S MORE
INFLAMMATORY RESPONSE THAN
CAUSING SLOUGHING OF EPITHELIUM
COWS CAUSING THE SYMPTOMS.
THE VIABILITY IS IT NOT AS
IMPORTANT.
SEVERAL WEEKS INTO THIS ILLNESS.
SO YOU NEED TO TREAT EARLY IF
YOU'RE ACTUALLY GOING TO AFFECT
THE PATIENT SYMPTOMS.
BUT WE STILL TREAT BECAUSE IF
THERE'S ANY BACTERIA THERE YOU
WANT TO MAKE SURE ALL THOSE
BACTERIA DIE SO THEY DO NOT PASS
TO OTHER PEOPLE.
IMPORTANT TO TREAT MORE
INFECTIVITY AFTER THE FIRST
COUPLE OF WEEKS WHICH IS WHEN
YOU PICK THIS UP.
IN PERTUSSIS IS KILLED IN FIVE
DAYS SO WITHIN THAT PERIOD OF
TIME WHEN PERSON IS AT WORK,
SCHOOL, MYSELF AND MANY OTHERLY
IN ADDITIONS HAVE TAKEN MULTIPLE
COURSE MOST COMMONLY LIKE A
ZPAC, A COMMON ANTI-BOYIOTIC,
WELL TOLERATED.
MACRO E RIT FLOW MYSIN WAS THE
OLDER ONE THAT PEOPLE USED TO
GET BUT NOT AS WELL TOLERATED AS
NEWER ANTIBIOTIC.
IF SOMEONE CAN'T TOLERATE THEM
BACTRIM CAN BE USED.
UNFORTUNATELY THERE'S NOT GREAT
TREATMENT FOR THE ACTUAL COST.
GIVING LIKE MED TREATMENT OF
ALBUT,ROL, IT'S MORE OXYGEN
FLUIDS, NUTRITION.
POST EXPOSURE PROF LACKSIS IS
IMPORTANT.
SO WHEN YOU HAVE SOMEONE
DIAGNOSED PRODUCTIVE MAKING SURE
THOSE AROUND THAT INDIVIDUAL GET
TREATED.
THE CLINICIANS TAKING CARE OF
THE PATIENT, IF YOU WEREN'T
WEARING A MASK, AND OTHER HIGH
RISK INDIVIDUALS USUALLY THE
HOUSEHOLD CONTACTS, PREGNANT
WOMEN, THE PREGNANT WOMEN IS NOT
THAT PREGNANCY HAS A WORST CASE
PERTUSSIS, TO MAKE SURE THE
PERSON IS NOT INFECTIOUS WHEN
THE BABY IS BORN.
INDIVIDUALS WITH BETTER IMMUNE
COMPROMISE, IT HAS AS SAID
BEFORE A VERY -- VERY
CONTAGIOUS, A VERY HIGH
HOUSEHOLD CONTEXT.
THE HOUSEHOLD ATTACK RATE.
IT'S PRETTY STURDY.
I FOUND (INAUDIBLE) MUCOUS FOR
THREE DAYS.
IT'S A LOOT.
SO JUST ONE THING THAT HAPPENED.
IN MY TRAINING, SO WE TALKED
ABOUT AT TIME IS THERE'S
OUTBREAK OF PERTUSSIS, THERE WAS
EXPOSURE NEONATAL INTENSE SHY
CARE UNIT SO THEY ENDED UP
GIVING THE BABIES IN THE NICU
ERYTHROMYSIN FOR PROF LACKSIS.
A FEW WEEKS LATER THERE WAS A
SPIKE IN (INDISCERNIBLE)
HYPERTROPHY THICKENED AND BABIES
COME IN THROWING UP.
THEN THEY HAVE (INAUDIBLE) AND
THEY' FINE BUT A STUDY AT THE
TIME LINKED ERYTHROMYSIN TO PIE
LOURIC STENOSIS.
TRUE IN OTHER CASES AS WELL.
SINCE THAT TIME THE BABIES ARE
SUPPOSED TO GET AZIT THROW
MYSIN.
THERE'S NOT THAT MANY OUTBREAKS
TO TELL WHETHER OR NOT THAT'S
THE SAME BUT KIND OF AN
INTERESTING ASSOCIATION.
ERYTHROMYSIN IS A PROMO UNTILTY
MEDICINE THIS IS AN ANCIENT
ILLNESS.
IN RECENT P YEARS IT'S BECOME A
REALLY BIG PROBLEM AGAIN AND IN
2012 THEY REPORTED THE MOST
CASES SINCE 1950 OF PERTUSSIS.
SOME OF THAT IS WE HAVE PCR NOW
AND DIDN'T HAVE PCR IN 1970 TO
DIAGNOSE PERTUSSIS.
SOME OF THAT IS RECOGNITION OF
ATYPICAL CASES BUT SOME ALSO
BECAUSE OF PEOPLE NOT
VACCINATING AS MUCH FOR
VACCINATION.
IN THE LAST COUPLE OF YEARS AGO
THERE'S 41,000 REPORTED CASES
AND 18 DEATHS IN OUR COUNTRY.
THAT'S A FAIR AMOUNT AND THE
DEATHS ARE ALL MOSTLY BABIES.
THE SMALL BABIES WHO HAVEN'T
GOTTEN ENOUGH VACCINE AND
INCREASES IN CASES MORE
ADOLESCENTS AND ADULTS WHO HAVE
THE MORE ATYPICAL CASE.
OR ATYPICAL COURSE.
AND THERE'S A COUPLE OF STATES
WHERE THERE'S THESE OUTBREAKS
THAT SKEWED THE DATA.
IT'S NOT UNCOMMON, THEY DID SOME
OF THOSE SEROLOGIC STUDIES IN
THE '80s AND '90s AND P
FOUND A QUARTER OF ADULTS WHO
CAME IN FOR MORE THAN FIVE DAYS
WERE POSITIVE.
AND SEEMED TO HAVE PERTUSSIS.
SO I THINK IT'S JUST AS GREAT A
RECOGNITION IN RECENT YEARS THAT
THIS IS IS A BIG PROBLEM,
REALIZING THAT FOR THOSE OF US
VACCINATED AS KIDS THAT VACCINE
IMMUNITY DID WANE AND NOW WE'RE
GOING AND GETTING NEW SHOTS TO
GET PROTECTION.
IT IS SHOWING PERTUSSIS OVER THE
YEARS.
THAT THE INITIAL VACCINES WERE
1930s, AND THEN THEY GOT
BETTER VACCINATIONS.
BUT IT REALLY WORKED.
THE CASES CAME DOWN AND
EVERYTHING WAS GOOD UNTIL RECENT
YEARS.
YOU CAN SEE HERE MORE THAN
18-YEAR-OLDS WAY UP, DIFFERENT
AGES WITH THAT INCREASE.
ALSO THE BABIES, WE WORRY ABOUT
BECAUSE BABIES ARE DYING WITH
THIS ILLNESS, AND ALSO HAS H A
BIG ECONOMIC IMPACT AND BUG
IMPACT ON KIDS IN SCHOOL.
THEY DID A STUDY IN
MASSACHUSETTS AND FOUND MOST
ADOLESCENTS AND ADULTS WERE
SEEING THE DOCTOR TWICE FOR
THIS.
80% OR BOTH MISSED WORK AND
SCHOOL.
A LOT OF WORK.
MEAN OF 9.8 DAYS AND ADOLESCENTS
5 DAYS A SCHOOL.
WHICH IS A LOT.
AND PARENTS OF AD LESSENS ARE
MISSING WORK SO IT HAS A BIG
SORB ECONOMIC IMPACT.
IT'S ALSO A HUGE INTERNATIONAL
PROBLEM.
THE NUMBERS WE'RE DISCUSSING IN
THIS COUNTRY ARE NOTHING
COMPARED TO AROUND THE WORLD
WHERE THIS IS MORE ENDEMIC AND
VACCINATION RATES ARE MUCH LESS
THERE ARE MANY DEATHS, 195,000
DEATH AS YEAR IN CHILDREN.
SO I WANTED TO MENTION A COUPLE
OF OTHER SIMILAR TO PERTUSSIS.
BECAUSE SOMETIMES THIS COMES UP
TOO.
AND I THINK MORE AND MORE IN
RECENT YEARS NOW THAT WE HAVE
BETTER WAYS TO IDENTIFY
BACTERIA, WE'RE RECOGNIZING MORE
-- THE OTHER BORDETELLA SPECIES.
I PUT THIS IN BECAUSE BORDETELLA
PERTUSSIS, THE PATIENT I SAW A
FEW WEEKS AGO SCARRENING LEGS
AND (INAUDIBLE) I GOT A SPUTUM
COULD CHU, HE'S HAVING SURGERY
TODAY ON HIS SPINE, AT A
DIFFERENT HOSPITAL SO I WANTED
TO MAKE SURE I KNEW WHAT WAS
THERE TO TREAT IT AND HE GOT
BORDETELLA PARAPERTUSSIS.
THIS IS ACTUALLY A MORE PRETTY
SIMILAR.
IT HAS LESS ALL THE TOXINS WITH
ALL THAT SOME OF THE MORE
PRONOUNCED SYMPTOMS USUALLY
SHORTER COURSE LESS SEVERE,
DOESN'T HAVE THE BIG
LYMPHOCYTOSIS.
CULTURE EASIER TO GROW.
MANAGEMENT LESS CLEAR BUT IF YOU
DON'T GIVE PERFECT ANTIBIOTIC
THESE INDIVIDUALS GET BETTER.
I GAVE MY PATIENTS ERROR
QUINOLONE AND HOPEFULLY HE'S
DOING WELL IN SURGERY TODAY.
THEY HAVE ALSO RECOGNIZED SOME
MORE SEVERE CASES THOUGH OF
PERTUSSIS HAVE CO-INFECTION WITH
BORDETELLA PARAPERTUSSIS.
THIS ONE IS SOMETHING WE COME
ACROSS MORE THAN PERTUSSIS,
BORDETELLA (INDISCERNIBLE) WHICH
IS KETTLE COUGH BUT THIS ALSO
CAN INFECT PEOPLE AS WELL SO
REALLY COMMON WHERE DOGS WHEN
THEY'RE OFF HANGING OUT TOGETHER
CAN ALSO INFECT THEM, WE SEE IT
EVERY COUPLE OF YEARS WITH
CHRONIC LUNG DISEASE,
IMMUNOCOMPROMISED HOST THAT I
OFTEN SEE IN MY CLINICAL
PRACTICE.
I THINK WE'RE BEGINNING TO
RECOGNIZE MORE BORDETELLA THAT
WE NEVER THOUGHT WERE PATHOGENS
THAT ARE CAUSING A PROBLEM.
THIS IS ACTUALLY FROM A PATIENT
THAT -- NOT ON THE PAPER BUT I
WAS INVOLVED WITH THIS PATIENT,
I WAS IN OUR CLINICAL GROUP AND
ADMITTED HERE.
AND WE RECOGNIZE THE PATIENT HAD
BORDETELLA PETRI COMPLICATED
UNDERLYING DISEASE AND SAW THESE
BETTER IMMUNE RESPONSES, SHE WAS
INCREASING ANTIBODIES, SHE WAS
RESPONDING TO THIS AS A
PATHOGEN.
AND SHE WOULD GET BETTER WHEN WE
TREATED HER.
AND I WANTED TO END BY
HIGHLIGHTING THAT I THINK
PERTUSSIS IS A GOOD EXAMPLE,
THAT THERE IS A REASON THAT
PEOPLE HAVE DONE THESE
VACCINATIONS THAT PEOPLE COME UP
WITH VACCINATIONS.
AND I THINK THOSE LIKE ME WHO
HAVE DONE OUR TRAINING IN THE
POST VACCINE WORLD WHERE WE
DON'T SEE THESE INFECTIONS, THEN
WE HEAR AB THESE COMING BACK
EVERY ONCE IN A WHILE AND
SOMETIMES NEED TO BE REMINDED
HOW SEVERE THESE CAN BE.
THIS IS MEASLES AND JUST SHOWING
THERE ARE MEASLES CASES REPORTED
EVERY YEAR AND I THOUGHT WHAT
WAS INTERESTING HERE, I GOT THIS
FROM CDC, THIS IS KIND OF THE
IMPORTED ONES IN THIS COLOR.
THESE ARE FROM OUR COUNTRY.
YOU CAN SEE THESE HIGHER
INCIDENCE OF MEASLES BEING
TRANSMITTED IN THIS COUNTRY.
WE ESTIMATED PEOPLE STOPPED
VACCINATING 2.7 MILLION MEASLES
DEATH WOULD HAPPEN EACH YEAR.
AND SO MEASLES IS AN INFECTION
PEOPLE CAN DIE OF, THAT THEY ARE
DYING OF AROUND THE WORLD.
AND EVEN IN OUR COUNTRY THREE
OUT OF EVERY THOUSAND WITH
MEASLES WOULD BE EXPECTED TO
DIE.
MUMPS HAS BEEN IN THE NEWS A LOT
OVER THE LAST COUPLE OF YEARS.
WITH OUTBREAKS HAPPENING IN
CLOSE QUARTER COMMUNITIES EITHER
IN COLLEGES, THERE'S AN OUTBREAK
IN NEW YORK AND SOME OF THE
ORTHODOX COMMUNITIES THERE.
WHERE VACCINATION COMPLETE.
YOU CAN SEE HERE, THIS
RESURGENCE A LITTLE BIT OF MUMPS
SOMETIMES WITH VACCINATION WE
CAN MAKE DISEASES ALMOST
OBSOLETE, THEY HAVE BEEN POLIO,
TRYING TO ERADICATE POLIO.
YOU CAN SEE FROM AMAZING
PROGRESS IN THERE THE ORAL POLIO
VACCINE THEY USE NOW TO TARGET
THESE REMAINING COUNTRIES WITH
POLIO.
OF COURSE IT'S ALWAYS IMPORTANT
TO GET OUR FLU SHOTS.
SO THANK YOU VERY MUCH.
NOW I THINK WE'RE GOING TO HEAR
MORE ABOUT THE VACCINE.
>> THANK YOU VERY MUCH.
>> I MADE IT WITH MY VOICE NOT
WORKING.
>> WE HAVE SOME QUESTIONS OR
COMMENTS?
>> YOU HAVE THE STATISTIC ON
INCIDENCE OF MEASLES WITHOUT THE
VACCINE.
WHAT WOULD BE THE INCIDENCE OF
WHOOPING COUGHS AND NUMBER OF
DEATHS IF NO ONE WERE GETSING
VACCINATESSED
>> THAT'S GREAT.
I HAD SOME OF THE PRE--- I DID
HAVE ALL THAT HERE BECAUSE OF
THE -- I THOUGHT IT WOULD BE
HIGHLIGHTED MORE IN THE
FOLLOWING THERE WE GO.
YOU CAN SEE HERE THOUGH THAT THE
INCIDENCE, THIS IS PER THOUSAND,
THESE ARE THE YEARS HERE BEFORE
VACCINATION.
WITH THE INCIDENCE, IT WAS
REALLY, REALLY COMMON.
THIS WAS 200 PER THOUSAND KIDS
-- I MEAN THOUSAND PEOPLE.
IT WAS A VERY COMMON INFECTION.
MOST WOULD GET WHOOPING COUGH.
THAT'S -- AND BACK THEN NOT SURE
HOW MANY PEOPLE BABIES DIED BUT
ABOUT 1% OF BABIES CAN DIE WITH
THIS ILLNESS.
SO IT WAS A SIGNIFICANT ILLNESS.
>> ANY OTHER QUESTIONS?
>> PERTUSSIS IS LIKE EVERYONE
GOT PERTUSSIS.
AND THERE WERE DEATHS.
>> OKAY.
SO THERE WILL BE AN OPPORTUNITY
AT THE END TO ASK MORE QUESTIONS
OF ALEXANDRA.
SO JOHN, DO YOU WANT TO -- THE
NAMES ON THIS LIST ARE PEOPLE
WHO MADE MAJOR CONTRIBUTIONS TO
THE STUDY.
AND HAPPY TO HAVE AT LEAST ONE
OF THE MAJOR CONTRIBUTORS
SITTING THERE, JOANNE.
(INAUDIBLE) COMES FROM SWEDEN,
VIRGINIA (INDISCERNIBLE) COMES
FROM OTTAWA, CANADA.
AND GROUP WORKED VERY WELL AND
VERY COOPERATIVELY WITH EACH
OTHER.
OUT'S A PLEASURE WATCHING IT.
I NEED HELP.
OH, YOU CAN'T SEE THE OTHER
STUFF.
ALL RIGHT.
EXCUSE ME.
I'M SORRY.
JUST A LITTLE HISTORY BECAUSE
THIS THING REMINDS ME A LITTLE
OF PERTUSSIS.
BEFORE WORLD WAR II GENERALLY
REALIZED THEY WANTED TO HAVE
SOME SOCIAL ARREST IN THE UNITED
STATES SO THEY FIGURED THEY
COULD REDUCE THE SUPPLY OF
BANANAS EASILY BECAUSE BANANAS
CAME FROM SEVERAL PLACES IN
CENTRAL AMERICA AND THEY WERE
SHIPPED ON WHITE PAINT SHIPS, IT
WAS CALLED A GREAT WHITE FLEET.
THAT'S ALMOST LIKE HAVING A
TARGET PUT ON THEM.
SO PRETTY SOON WE HAD NO
BANANAS.
WORLD WAR II PASSED AND PEOPLE
NOT EATING BANANAS.
IN THOSE DAYS, BANANAS WERE EAT
P BEN BY POOR PEOPLE BECAUSE
EACH BANANA WOULD BE A MEAL.
I TAKE TEN SETS OF BAY --
ASSOCIATES SAID THEY WERE
CHEAPER.
JUST FOR FUN DID YOU GUYS SEE
THE GODFATHER?
THE GUY WHO WAS SENT P TO
SICILY?
HIS REAL NAME WAS GUISEPPI JER
RON MOW AND HE WAS KNOWN AS JOE
BANANAS.
THE NEW YORK TIMES HAD A HOE YES
WE HAD NO BANANAS TODAY.
ANYHOW, TAKE A LOOK AT THE
INTEREST IN THE SCIENTIFIC
MEDICAL COMMUNITY TO PERTUSSIS.
I JUST COP P PIED THIS FROM THE
COMPUTER.
STILL VERY ACTIVELY STUDIED
THOUGH THIS VACCINE IS QUITE
OLD.
WE HAVE A GOOD VACCINE, BUT IT'S
NOT COMPLETE.
I'M GOING TO TALK TO YOU ABOUT
THE HISTORY OF ITS DEVELOPMENT,
AND HOW WE'VE TRIED TO IMPROVE
IT.
THIS IS A SHOW THAT'S
INTERNATIONALLY KNOWN, THIS IS
HOW YOU SAY PERTUSSIS IN
CHINESE.
SHAW, HOW DO YOU SAY IT?
IN CHINESE.
GOOD.
ALL RIGHT.
WE HAVE S PERT.
WHEN I FIRST SHOWED THIS AT THE
UNIVERSITY OF PITTSBURG THERE'S
A FAMOUS VIROLOGIST IN THE
AUDIENCE NAMED MONTEHO.
I PUT THE SLIDE UP AND HE WAS
FROWNING.
I SAID WHAT'S THE MATTER?
IS THAT WRONG?
HE SAID NO, HE SAID IT'S UPSIDE
DOWN.
AND AS THAT YOUNG LADY JUST TOLD
YOU, THERE ARE THREE STRAINS
THAT WERE STUDIED INITIALLY ONLY
ONE, ONLY ONE SECRETES TOXIN.
THEY ALL HAVE THE GENOME FOR THE
TOXIN BUT DON'T SECRETE IT.
PARAPATOSIS CAUSES A DISEASE IN
HUMANS, NOT SO SEVERE.
(INDISCERNIBLE) CAUSES DISEASE
IN SEVERELY TREATED PEOPLE BUT
IT'S RARE.
MOSTLY DISEASE OF CATTLE AND
DOGS.
I DON'T KNOW ANYTHING ABOUT THE
OTHER FOUR.
HOW DO VACCINES WORK?
THEY DON'T CURE DISEASE, THEY
PREVENT DISEASE.
THEY PREVENT DISEASE YOU HAVE TO
HAVE A CRITICAL AMOUNT OF IGG
ANTIBODY THROUGH THE PROTECTIVE
ANTIGEN.
IN THIS CASE UP TO DATE, THE
ONLY PROTECTIVE ANTIGEN OF
BORDETELLA PERTUSSIS IN THE
VACCINE IS THE TOXIN.
HAS NOTHING TO DO WITH IMMUNITY.
THEY'RE FILLING UP SPACE.
LOOK AT THE PROBLEM.
THIS IS US, UNITED STATES DURING
THE TEN YEARS PERTUSSIS WAS
LEADING CAUSE OF DEATH AND
CHILDHOOD, MAJOR CAUSE OF DEATH
AT ALL AGES.
LOOK AT IT COMPARED TO
DIPHTHERIA.
MY FAMILY GREW UP IN LOWER EAST
SIDE AND MY TWO AUNTS, THE OLEST
AUNTS DIED OF DIPHTHERIA ON THE
LOW OR EAST SIDE CH IT'S A
DIFFERENT AGE.
IT'S STILL IMPORTANT WHEN RANKED
AGAINST OTHER DISEASES
THROUGHOUT THE WORLD, NOT IN THE
UNITED STATES, IT'S STILL A
MAJOR CAUSE OF DISEASE.
AND THIS IS JUST RECENT.
WE STILL HAVE PERTUSSIS TO DEAL
WITH.
PERTUSSIS IS THE ONLY VACCINE
PREVENTABLE DISEASE THAT IS WITH
US AND LOOKS LIKE IT'S ON THE
RISE.
BY THE WAY, I DON'T THINK
INCIDENCE IS INCREASED I THINK
IT'S NONSENSE, I THINK WE'RE
JUST RECOGNIZING THE DISEASE IN
THE OLD AGE GROUP.
LET ME TELL YOU SOMETHING ABOUT
THE DISEASE.
IT MEANS SEVERE OR PER ONYCHAS
COUGH.
NO BLOOD CULTURES, IT DOESN'T
ENTER THE CIRCULATION.
IT JUST SITS OPT SURFACE OF THE
UPPER -- ON THE SURFACE OF THE
UPPER RESPIRATORY TRACT.
IT'S A MUCOSAL DISEASE BUT THE
ONLY THING THAT WILL PREVENT IT
IS SERUM IGG TO THE TOXIN.
MY SLIDE IS BETTER THAN YOURS.
I GOT THIS SENT TO ME BY A WOMAN
IN FRANCE NAMED (INAUDIBLE).
THAT'S THE ORIGINAL MEDIA.
BUT IT'S NOT BECAUSE IT NEEDS
BLOOD, IT'S BECAUSE BORDETELLA
PERTUSSIS DOESN'T HAVE OX
DAYTIVE PATHWAYS.
OX DAYTIVE PATHWAYS.
IT'S ALL MICROOXIDATION.
THAT'S THE REASON IT TAKES SEVEN
OR EIGHT DAYS TO GROW.
IT'S THE ALBUMIN IN THE BLOOD
THAT ABSORBS THE FA THETY ACIDS
THE ORGANIZISMS MAKE.
YOU DON'T NEED BLOOD.
BUT BLOOD CONTAINS ALBUMIN.
ALBUMIN OR CHARCOAL BE DO IT BY
ITSELF.
THIS WAS DISCOVERED IN 1906.
THEY DIDN'T HAVE EMAIL IN THOSE
DAYS, YOU HAD TO GO TO LIBRARY
AND READ A BOOK.
NO ONE DOES THAT ANY MORE.
IT'S AN ANCIENT ART.
BUT DESPITE THE FACT IT WAS SUCH
A SEVERE DISEASE THAT DANISH
GOVERNMENT CONTRACTED WITH A GUY
NAMED MATSON TO STUDY IT AND HE
MADE A VACCINE WHICH WAS A FLUID
CULTURE OF BLOOD AND THE
ORGANISM.
AND THEY INJECT IT IN THE FAIR
ROW ISLANDS.
I DON'T KNOW IF YOU KNOW ABOUT
THOSE, THEY'RE OFF THE COAST OF
NORWAY, THERE'S NO BEACHES.
EVEN TODAY IT'S DANGEROUS TO
LAND ON THE FAR ROW ISLANDS,
VERY DIFFICULT BUT THEY DID A
STUDY, THEY DID TWO EXPERIMENTS
AND WHEN THEY PUT THEM TOGETHER
THEY CONCLUDED EVEN WITH THIS
PRIMITIVE VACCINE IT WOULD
PREVENT PERTUSSIS.
YOU CAN PREVENT PERTUSSIS BY
VACCINATION.
NOW, TWO WOMEN CHANGED THE
FIELD.
FIRST WAS CAROL (INDISCERNIBLE)
AND GRACE ELDERRING AND THEY
WORKED AT THE MICHIGAN STATE
DEPARTMENT OF HEALTH, AND THEY
DEVISED A TEST FOR MEASURING THE
AFFECT OF INJECTION OF
BORDETELLA PERTUSSIS IN MICE.
LATER MARGARET PITMAN SPENT
ALMOST HALF A LIFETIME ALLOWING
(INAUDIBLE) TO BE DEVELOPED TO
THIS TEST.
MARGARET WORKED IN BUILDING 29
FOR MOST OF HER PROFESSIONAL
LIFE AND VERY FRIENDLY WITH HER.
OF COURSE SHE DIED.
JUST TWO THINGS I WOULD LIKE TO
TELL YOU ABOUT HER.
SHE GOT A TICKET DRIVING TO WORK
WHEN SHE WAS 92 YEARS OLD, FOR
SPEEDING.
ANYONE GOT ANYTHING BETTER THAN
THAT?
MORE IMPORTANT YOU LIKE CHINESE
-- SHE LIKED CHINESE FOOD, SO
VERY OFTEN WITH THOSE, SHE WAS A
WONDERFUL PERSON.
INTELLECTUAL GIANT.
STUDYING THE EFFECTIVENESS OF
THE VACCINE, VERSUS THE YEUN TAJ
GIVEN BY THE TEST, AND WITH THIS
TECHNIQUE NOW OF BEING ABLE TO
PREDICT THE EFFICACY OF THE
VACCINE, EVERYTHING CHANGED.
LET ME TELL YOU ABOUT THE TEST,
IT'S BEEN MALIGNED.
YOU PNEUMORECOGNIZE AN ANIMAL BY
INTERPERITONEAL INFECTION TO
PREVENT RESPIRATORY INFECTION.
AND AFTER THE ANIMAL IS INJECTED
YOU INJECT THE INTRACEREBRALLY
WITH THE ORGANISM TWO WEEKS
LATER.
AND IT WORKS.
BECAUSE EITHER WITH THE DISEASE
OR TEST, THE ORGANISM DON'T GO
INTO THE BLOOD, THEY GO TONAL
PLACE ON SURFACE OF THE VEPT KLS
ON THE SURFACE OF THE CILIA OF
THE RESPIRATORY TRACT.
IT'S A MALIGN TEST THAT'S JUST
NOT RIGHT, IT'S NONSENSE.
LET ME SAY SOMETHING TO YOU.
THE FIRST VACCINES WERE THE
WHOLESALE VACCINES AND THEY
CAUSED MISCHIEF.
THIS IS THE UNIVERSITY OF
CINCINNATI AND THE PEED WRA
TRICK WARDS AND ALL THE THE
WHOLESALE VACCINE WAS NEVER
RECOMMENDED FOR ADULTS.
NOT SHOWN ON THE SLIDE, I DON'T
KNOW WHY DIDN'T PUT IT BUT I
TALKED TO (INAUDIBLE) WHEN HE
WAS ALIFE AND ME SAID THREE
NURSES LOST THEIR MEMORY FOR
FOUR OR FIVE DAYS.
SO WE DON'T INJECT INTO ADULTS,
IT CAUSE REACTS IN CHILDREN BUT
NOTHING SERIOUS.
JUST UNPLEASANT.
THAT'S A PICTURE, MARGARET SHE
WAS SOME PERSON.
OF COURSE SHE LIKED CHINESE
FOOD.
OUR NEXT CONTRIBUTION WAS TO
POINT OUT THAT YOU COULD ASSIGN
SPECIFIC BIOLOGIC ACTIVITIES TO
COMPONENT TO THE VACCINE.
THAT CHANGED EVERYTHING.
BECAUSE NOW THE JEANETTE CYST
AND BIOLOGISTS LOOK FOR
INDIVIDUAL COMPONENTS RATHER
THAN WORKING WITH WHOLESALES.
NOW I'M GOING TO SKIP A COUPLE
OF DECADES.
YOU WON'T MIND.
PERTUSSIS VACCINE IS NOT ONE
THING.
THE AKYLILA VACCINES O MIX CHRS
AN PEOPLE WANT TO ADD THINGS TO
THEM.
LSM AS COMPLEX AS CHICKEN SOUP.
WE DON'T HAVE ONE THING TO TALK
ABOUT.
P UNFORTUNATELY SOMETHING
IMPORTANT IS OVERLOOKED.
THE ONLY COMPONENT OF CELLULAR
VACCINES OF ACELLULAR VACCINES
THE ONLY COMPONENT THAT INDUCES
IMMUNITY IS PERTUSSIS TOXIN
ANTIBODIES.
NOTHING ELSE WORKS.
FRDZ AND THE PROOF IS JUST
OVERWHEN HE WILL MING.
THIS IS TAKEN FROM AN ARTICLE
STUDYING ONE BATCH OF VACCINE,
LOOK AT THE BOTTOM YOU SEE ALL
THE EXPERTS ARE THERE.
AND THEY MEASURED ANTIBODIES,
TAKE A LOOK.
THERE'S NO ANTIBODIES TO THE
SINGLE GLUTENIN.
IT WAS A MUTANT.
NEVER INTRODUCED ANTIBODYINGS TO
HEMOGLUTE ANYONE AND TEN YEARS
THE VACCINE WAS USED THE MOST
FREQUENTLY USED VACCINE BECAUSE
THEY THOUGHT IT WAS THE BEST.
FHA IS STILL IN THE VACCINE.
BANANAS.
AN EQUATE.
ANOTHER COMPONENT IN THE VACCINE
THAT'S STILL THERE IS
PROTECTANT.
THERE'S NO SCIENTIFIC REASONING
FOR THAT AT ALL.
AND WHAT'S HAPPENED RECENTLY IS
PROTECT NEGATIVE STRAINS OF
PERTUSSIS FOUND IN THE UNITED
STATES, ALL OVER THE WORLD NOW,
CHINA REPORTS EVERY EUROPEAN
COUNTRY THIS IS ARE VIRULENT AS
THE PROTECTANT POSITIVE STRAINS
AND I WILL SHOW YOU YOU CAN'T
INDUCE IMMUNITY WITH ANTIBODIES
TO THIS COMPONENT.
THIS NEW VACCINE NOSHING WITH
ANOTHER COMPONENT -- THERE ARE
TWO PROTEINS IN THE VACCINE THIS
CONTAINS FIVE COMPONENTS, NO
DIFFERENCE BETWEEN THREE
COMPONENTS AND FIVE COMPONENTS.
NO STATISTICALLY VALID REASON IS
THERE'S AN INTERESTING STORY
ABOUT PERIPERTUSSIS AND
PERTUSSIS.
JIM SHERRY WORKS IN LOS ANGELES
OR SAN FRANCISCO ONE OF THOSE
PLACES, IT DOES INDUCE
ANTIBODIES TO IT.
EXCUSE ME.
BUT IT DOES MAKE ANTIBODIES TO
FSA AND TO SUR FACTTANT AT THE
SAME PACE BUT IT DOESN'T PROTECT
AND DOESN'T MAKE ANTIBODIES TO
PERTUSSIS TOXIN AND WE STILL
HAVE THE JUNK IN THE VACCINE,
DOESN'T SEEM TO BE ANY WAY TO
GET RID OF IT.
THIS IS A LITTLE DETAIL OF YOUR
SLIDES THERE, IT'S THE ONLY ONE
LOOK AT THE TOP BARS, THOSE ARE
A DISEASE IN INFANTS AND
CHILDREN.
THEN LOOK AT THE BOTTOM AND YOU
SEE ANTIBODIES TO ADULTS.
THAT IS BEING REPORTED, I FEEL
CONFIDENT FINDING FOR THE FIRST
TIME BECAUSE PEOPLE ARE THINKING
ABOUT IT.
WE WORKED ON PERTUSSIS HOW MANY
YEARS AGO, 30 YEARS AGO?
300, SEEMS LIKE IT.
THREE PEOPLE IN AREA WE ARE
GROWING THE ORGANISM CALLED
PERTUSSIS.
ONE POOR LADY COUGHED ALL THE
WAY OUT WITH HER HUSBAND WHEN
THEY DROVE TO CALIFORNIA WITH
PERTUSSIS.
WE BUILT THE STRAIN TO
MICROBIOLOGY LAB WHICH STILL IS
IS ONE OF THE BEST IN THE
WOFERLD.
SHE SAID WE DON'T KNOW HOW TO
GROW PERTUSSIS.
WHAT ARE YOU GROWING ON?
THAT WAS THE SATE OF THE ART IN
THE COUNTRY T. THAT'S CHANGED.
WE HAVE KNOWN THIS FOR YEARS,
THERE ARE MANY ARTICLES LIKE
THIS.
COUGHING IS LESS SEVERE, LESS
FREQUENT, PEOPLE DONE GO TO THE
HOSPITAL, THEY DON'T DIE WITH
IT.
BUT I HAVE A FRIEND, A CLOSE
FRIEND, CHILDHOOD FRIEND FROM
HIGH SCHOOL.
HE'S A PROFESSOR AT CLOVER
UNIVERSITY MEDICAL SCHOOL WHO
COUGHED FOR 200 DAYS, BROKE TWO
RIBS, HAD A PNEUMOTHORAX WITH
PERTUSSIS.
VERY UNPLEASANT.
WHY HAVING THIS DISEASE?
WE HAVE AN EFFECTIVE VACCINE
THAT'S SAFE, DOESN'T CAUSE MY
REACTIONS, THAT ARE SERIOUS, NO,
NO REACTS ASSOCIATED WITH
PERTUSSIS VACCINE HAVE BEEN
REPORTED SERIOUS.
NONE.
THESE ARE THE CAUSES OF CHILDREN
NOT GETTING IT.
SO CALLED PERSONAL COMPLETIONS.
YOU HAVE TO LISTEN TO ONE OF
THESE GUYS WHO GOES AROUND AND
MAKE AS LIVING TALKING ABOUT HOW
TERRIBLE IS THE VACCINE AN IT
CAUSES AUTISM.
THEY HAVE HUGE FEES, $20,000 A
TALK.
AND THEY WORK VERY LITTLE.
I MEAN YOU CON STANLEY HEAR TALK
ABOUT HOW DANGEROUS IT IS.
IT'S NOT.
SAFE VACCINE.
BUT SEE WHAT HAPPENS WHEN YOU
DON'T GET IT?
YOUR RISK GOES UP AT LEAST 20
FOLD.
AT LEAST 20-FOLD.
AND MANY ADULTS ARE NOT GETTING
IT TODAY FOR MANY REASONS.
INTERNISTS ARE USUALLY NOT HIP
ABOUT GIVING VACCINES.
THEY DON'T THINK ABOUT IT TOO
MUCH.
BUT THIS MYTH THAT IT CAUSES
DISEASE COMES FROM THOSE DAYS OF
WHOLESALE VACCINES WITH ADVERSE
REACTIONS.
OUR FRIENDS IN SWEDEN DID LITTLE
TO ACCOUNT FOR WHILE WE WERE
HAVING THE FEELING WE SHOULDN'T
ALLOW ADULTS TO GET IT.
I'LL TELL YOU WHY SOON BUT
BRIEFLY, THIS IS THE
COMPLICATIONS OF ADULTS GETTING
PERTUSSIS.
DONE BY HIGH QUALITY INTERNISTS
IN SWEDEN.
CAN YOU IMAGINE COUGHING SO MUCH
YOU HAVE A RIB FRACTURE?
IF YOU HAD NOT HAD PERTUSSIS AND
YOU DIDN'T GET VACCINATED, IF
YOU VACCINATED FOR THE FIRST
TIME OVER AGE 12, YOU'RE NOT
PROTECTED.
ONE INJECTION OF THE CURRENT
VACCINE DOESN'T INDUCE
PROTECTIVE LEVELS OF PERTUSSIS
TOXIN ANTIBODY.
ANYONE NOT AGREE WITH THAT?
WHAT IS THE CAUSE OF THESE
INCREASED NUMBERS OF CASES?
TWO REASONS, IT'S DEFICIENCIES
IN THIS CURRENT VACCINE WHICH IS
A GOOD SAFE VACCINE THAT PERMIT
THESE CASES TO OCCUR.
THE DURATION OF ACTION IS IS
DIFFERENT BECAUSE ALL COMPONENTS
IN THE PERTUSSIS VACCINE ARE
PROTEINS AND PROTEINS DO NOT IP
DEUCE LIFE LONG LEVELS OF
ANTIBODIES.
PROTEINS DO NOT IP DEUCE LIFE
LONG LEVELS OF ANTIBODIES.
-- INDUCE LIFE LONG LEVELS OF
ANTIBODIES.
WHY?
THIS IS STUDY FROM BRUCE MEAD
WHO SHOWED THE ACTION OF
PERTUSSIS TOXIN ON CELLS THAT
WERE ACT CRATEVATED BY LPS, THE
MORE TOXIN YOU ADD THE LESS
EFFECTIVE THE CELLS ARE.
NOTICE HOW MANY NANOGRAMS OF
TOXIN NEED TO BE ADDED TO THESE
CULTURES.
TO SHOW THE EFFECT SO THE AFFECT
OF ANTI-TOXIN IS TO PREVENT
PERTUSSIS TOXIN FROM
IMMOBILIZING WHITE BLOOD CELLS.
THIS IS NOT A CYTOTOXIN, IT
DOESN'T PREVENT A SYSTEMIC
DISEASE.
IT ISN'T SYSTEMIC, IT'S LOCAL.
SO THAT'S SOME OF THE PROBLEMS
ENCOUNTERED IN MAKING AND
EVALUATING PERTUSSIS VACCINES.
AND MORE RECENTLY, INVESTIGATORS
HAVE SHOWN THE (INDISCERNIBLE)
PERTUSSIS ORGANISMS ARE NOT
DEAD.
THEY REDUCED THE NUMBER BUT
THEY'RE NOT DEAD.
THAT COULD EXPLAIN WHY TWO CASES
OR THREE CASES OF PERTUSSIS ARE
NOT RARE AND THE ORGANISM IS
STILL CIRCULATING.
THAT IS EASY TO FIND OUT,
PERTUSSIS OCCURS LIKE MEASLES,
IN CYCLES.
IN OUR COUNTRY, IT'S TRY ANNUAL
CYCLES BECAUSE AFTER PERTUSSIS
OCCURRED, THE PEOPLE DON'T GET
DISEASE FOR A WHILE AND WHEN
THAT NUMBER GOES UP AGAIN,
THEY'RE INFECTED.
IF YOU DO THIS EXPERIMENT IN
GREEN LANDER IN ICELAND THE
CYCLE IS 7 TO 8 YEARS.
THAT'S THE DENSITY OF THE
POPULATION.
THAT COUNTS.
THIS IS THE LEVEL OF PERTUSSIS
TOXIN ANTI-GUYS IN A POPULATION
STUDIED -- ANTI-GUYS IN A
POPULATION OUT -- ANTIBODIES IN
A POPULATION OUT WEST WITH
(INDISCERNIBLE) AND COLLEAGUES.
THE LEVEL GOES DOWN SO THAT
PRETTY SOON AFTER TWO, THREE,
FOUR YEARS OF LIVING THERE'S NO
MORE PROTECTIVE LEVELS.
AND THE DISEASE CAN OCCUR AGAIN
EVEN AFTER DISEASE.
SO THIS IS A FULLY MY RECOGNIZED
COMMUNITY IN MICHIGAN WORK THEY
GOT DISEASE AGAIN.
UNFORTUNATELY THIS IS NOT
COMMONLY APPRECIATED, NOT TALKED
ABOUT.
PERTUSSIS DOES NOT CONFER LIFE
LONG IMMUNITY TO DISEASE.
AND HERE YOU CAN SEE WHAT
HAPPENS TO ANTI-PROTEIN
ANTIBODIES.
IN TETANUS THESE ARE SUBURBAN
ADULTS AND WELL MY RECOGNIZED
COMMUNITY IN MINNESOTA AND WHEN
THEY TOOK (INAUDIBLE) IN 50, 60
YEARS OF AGE, LOOK AT THE
LEVELS, WAY BELOW PROTECTED
LEVELS SO WHY DON'T WE HAVE
DIPHTHERIA?
ANYONE KNOW?
WE HAVE NO ANTIBODIES.
DON'T KNOW?
THE ORGANISMS DISAPPEAR.
ONCE MY RECOGNIZED THE
(INAUDIBLE) DISI -- IMMUNIZED --
THERE'S NO DIPHTHERIA AROUND THE
UNITED STATES EXCEPT A BUNCH OF
DRUNK PEOPLE THAT IMMIGRATE HERE
IN THE COUNTRY.
IF YOU LOOK AT ANTIBODIES OF
POLYSACCHARIDES, THESE ARE NOT
OVER LONG TERM, THIS IS OUR
STUDY, COLLEAGUE STUDY.
SEE THE LEVEL OF ANTIBODY IN THE
MY RECOGNIZED GROUP IS SAME AS
NORMAL.
WHY?
BECAUSE IT'S A HIGHLY CROSS
REACTIVE SUBSTANCE AND WE'RE
CONTINUALLY IMMUNIZED BY
ORGANISMS OTHER THAN THE
PATHOGEN.
THERE'S A LOVELY ARTICLE IN THE
1930s BY MAXWELL FINLAND WHO
SHOWED IN PEOPLE THEY DULLTURED
EVERY MONTH FOR SEVERAL YEARS,
THEY FOUND PNEUMOCOCUSS TYPE 3,
INDUCED BY OTHER ANTIBODIES BUT
THAT DOES NOT COVER THE PROTEIN.
PROTEIN IS TOO SPECIFIC, TOO
HIGHLY CONSERVATIVE.
ALL RIGHT.
NOW WE'RE GOING TO GET TO THE
POINT OF THE VACCINE.
DO WE HAVE TIME?
WE HARDLY STARTED.
IF YOU HAVE THE DISEASE YOU MAKE
ANTIBODIES.
IT'S IMMUNOGENIC.
IT DOES INDUCE ANTIBODIES
SPECIFIC TO THE INFECTING AGENT.
PERTUSSIS MAKES ANTIBODIES TO
THE LOS OF PERTUSSIS.
AND PARAPERTUSSIS MAKES
ANTIBODIES TO THE LOS OF
PARAPERTUSSIS.
BUT THESE ANTI-PROTEIN
ANTIBODIES DO NOT KILL THE
BACTERIA.
SO NOT ONLY DO THEY NOT LAST
LONG, AND WE HAVE DISEASE AGAIN,
THEY DON'T KILL THE BACTERIA,
THAT'S WHY THE BACTERIA IS
CIRCULATE.
AND WE STIMULATED TO WORK ON
THIS, BY THE EFFORTS OF AN
INVESTIGATOR ALLISON WISE WHO
HAS WRITTEN EXTENSIVELY ON THE
SUBJECT.
SHE SAID MAYBE YOU SHOULD MAKE A
BACTERIA SIDAL ANTIBODY, TOOK
ABOUT FIVE YEARS.
FIRST FIVE ARE THE TOUGHEST.
THE POLYSACCHARIDES OF
BORDETELLA PERTUSSIS ARE
DIFFERENT THAN ALL OTHER GRAM
NEGATIVE PATHOGENS WE WORK WITH.
IF WE CAN TAKE A PICTURE OF
SURFACE OF BORDETELLA PERTUSSIS
COMPARE TO OTHERS HERE IS WHAT
WE WOULD FIND.
THE OUTER LAYER OF THE
POLYSACCHARIDE BORDETELLA
PERTUSSIS DOES NOT HAVE IT.
THE NEXT LAYER IS LPS.
THAT CONSISTS OF TWO COMPONENTS.
THE SPECIFIC POLYSACCHARIDE AND
LIPID.
THEN IF WE GO BELOW LPS WITH A
CORE -- NOT A POLYSACCHARIDE,
OLIGOSACCHARIDE.
IN PERTUSSIS IT'S ONLY 10 OR 11
SUGARS.
PROBABLY WHY WHEN YOU GET
DISEASE YOU DON'T GET TOO MUCH
PROTECTION BECAUSE IT'S NOT A
GOOD IMMUNOGENERAL, IT'S SMALL.
YOU DON'T HAVE TO MEMORIZE THIS,
AND YOU CAN STILL GET COURT NAME
IN A BOOK.
I WANTED TO SHOW YOU THE
OLIGOSACK RIDES ARE BORDETELLA
BRONCHOSEPTICA ARE ALMOST
IDENTICAL.
THEY'RE NOT REPEATING UNITS.
COME POSED OF UNUSUAL SACK
RIDES, AND WHAT IS IMPORTANT YOU
LOOK AT THE END OF THIS SO
CALLED CHAIN IT'S A
TRISACCHARIDE.
THREE SACCHARIDES ARE PRESENT IN
BORDETELLA BRONCHO SEPTICA AND
PERTUSSIS.
THEY'RE IDENTICAL.
IF YOU DO POLY(INAUDIBLE) GEL
ELECTROPHORESES, ALL THE
PERTUSSIS AND BRONCHO SEPTICA
HAVING SOMETHING CALLED BANDA.
IT'S PRESENT ON MOST PERTUSSIS,
NOT ALL.
IF IT DOES CIALT HAVE BAND ARC,
THAT TRISACCHARIDE, IT IS NOT
VIRULENT.
THIS IS WHAT THE (INAUDIBLE)
LOOKS LIKE ON BRONCHO SEPTICA,
YOU CAN SEE THE TRISACCHARIDE AT
THE END AND WE THINK NOW WE KNOW
WHAT THE PROTECTIVE SITE ON THE
MOLECULE IS.
WE THINK IT'S THE SACCHARIDE AND
THIS GLUCOSE WHICH IS
GLUCOSAMINE, WE DON'T KNOW ABOUT
GLAK TOES BECAUSE WE HAVEN'T GOT
A MUTE FOR IT YET.
I WOULD LIKE TO EXPLAIN THE
ORGANIC CHEMISTRY OF IT TO YOU
BUT IF ANY OF YOU KNOW ORGANIC
CHEMISTRY YOU'LL KNOW HOW LITTLE
I KNOW.
BUT TO MAKE THIS CONJUGATE, MAKE
THE SACCHARIDE IMMUNOGENIC WE
HAD TO BIND IT TO A PROTEIN.
SO IF YOU TAKE A PROTEIN AND
TREAT IT WITH THIS COMPOUND,
THIS REGION FALLS OFF AND THIS
IS THE COMPOUND YOU GET.
IF YOU TAKE LOS OF A LIPO
SACCHARIDE, TREAT WITH ACIDIC
ACID, UNDER MILD CONDITIONS THE
(INAUDIBLE) FALLS OFF NOW IT'S
JUST A SACCHARIDE WITH NO
BIOLOGIC ACTIVITY ASSOCIATED
WITH THE LIPID.
AND IF YOU MIX THIS MATERIAL
WITH THIS UNUSUAL COMPOUND, YOU
ENTER DEUCE THE OXENE MOIETY
WHICH IS VERY ACTIVE AND THESE
TWO BIND AT ROOM TEMPERATURE AND
AT REASONABLE CONCENTRATIONS AND
VERY QUICKLY AND VERY STABLE.
SO NOW WE HAVE PROTEIN WHICH
HERE WE USE BSA AND THE REASON
WE USE BOVINE SERUM IS IT'S
CHEAP AND STABLE AND WE DON'T
HAVE TO WORRY ABOUT MAKING A
BIOLOGICALLY ACTIVE PROTEIN FOR
THE MOMENT.
THIS BSA IS NOW ATTACHED TO THE
OLIGOSACCHARIDE BY THIS OXENE
LINKAGE.
BRONCHO SEPTICA YOU SEE IT HAS
THREE OR FOUR OF THOSE
TRISACCHARIDES.
BUT IT IS POSSIBLE TO ISOLATE
ONE WITH ONE OF THESE
TRISACCHARIDES AT THE EDGE,
PURIFY BIT GEL FILTRATION, NOT
DIFFICULT, MAKE IT HIGHLY
PURIFIED.
AND THEN IF YOU INJECT IT HERE
IS WHAT YOU FIND.
IF THERE ARE THREE OR FOUR
TRISACCHARIDES, EXCUSE ME, TWO
TO FOUR, YOU DON'T GET ANTIBODY.
IF THERE'S ONE, IT'S THE IN
ACETYL GLUCOSAMINE.
IT HAS TO HAVE ONE TRISACCHARIDE
NEXT TO THE REST OF THE
MOLECULES.
AND THIS IS WHAT IT TAKES TO
MAKE A VACCINE, THERE'S SMOG
WRONG HERE.
THIS SHOULD BE RED.
YOU WATCH ME WORK A COMPUTER,
YOU'LL UNDERSTAND WHY I MISSED
IT.
I'M AN AUTHENTIC COMPUTER
DINOSAUR.
IF YOU HAVE THE RIGHT
CONCENTRATION, OF THE
OLIGOSACCHARIDE ON THE PROTEIN
AND IT'S THE CORRECT LENGTH YOU
MAKE BACTERIA SIDAL ANTIBODY,
THESE MATERIALS WERE INJECTED AT
A FRACTION OF THE PROPOSED HUMAN
DOSE, NO ADJUVANT, NO
INTRAVENOUS INJECTION.
NO INTRAPERITONEAL INJECTION.
YOU SEE THE LEVELS OF BACTERIA
SIDAL ANTIBODIES.
WE WANTED TO PUT THEM ON TO A
USEFUL PROTEIN BECAUSE IT'S A
CONJUGATE SO RATHER THAN USING
ALBUMIN WE PLAN TO USE A MUTANT
PERTUSSIS TOXIN SO WE CAN MAKE
ANTI-TOXIC IMMUNITY AND
ANTI-BACTERIA SIDAL ANTIBODIES.
ONE MOLECULE INDUCING BOTH
PROTECTIVE ACTIONS.
THAT'S WHAT WE SUGGEST.
WE THINK IT WON'T BE DIFFICULT
WE THINK IF WE MAKE A BORDETELLA
PERTUSSIS, LIPO OLIGOSACCHARIDE,
PERTUSSIS TOXIC COMPOUND WILL
HAVE SOMETHING THAT WILL ACT AS
AN ANTI-TOXIN INP DEUCER AND
ALSO BE BACTERIA SIDAL AND
REDUCE THE ORGANISMS TO ALMOST
NOTHING IN THE POPULATION.
THANK YOU.
[APPLAUSE]
I GOT TO SIT DOWN.
I CAN'T STAND
>> ANY COMMENTS?
DO YOU HAVE -- THERE YOU ARE.
(OFF MIC)
>> ALEXANDRA SAID NO
ENVIRONMENTAL RESERVOIR FOR
BORDETELLA.
>> YES.
>> SO DID ANYBODY TRY COMPARING
PCR AND SIR LOGICAL DATA TO
FIGURE OUT E SEW TEARIC IMAGE?
>> IT'S BEEN LOOKED AT BUT NEVER
FOUND.
IF YOU FIND BORDETELLA PERTUSSIS
ORGANISMS, I DON'T KNOW ABOUT
THE PCR.
YOU HAVE PERTUSSIS.
ASYMPTOMATIC CARRIER, CAN'T FIND
THEM.
I ACTUALLY MEANT IF HUMANS CAN
CARRY BRONCHIOLE SEPTIAC OPPOSED
TO DOGS CARRYING PERTUSSIS.
>> PERTUSSIS IS AN INHABITANT
AND HABITAT FOR HUMANS ONLY
UNDER NATURAL CIRCUMSTANCES
>> SO DOGS WOULD CARRY IT
ASYMPTOMATICALLY.
>> NO.
THEY WILL CARRY IT
>> JOHN, BECAUSE THE ORGANISM IS
IN THE ENVIRONMENT, DO YOU SEE
OR IS THERE ANY INDICATION
THERE'S NATURAL BOOSTING DURING
ADULTHOOD?
BECAUSE YOU'RE GIVEN THREE --
YOU'RE GIVING --
>> IT DOESN'T MATTER.
>> BUT TO THE PERTUSSIS TOXIN.
PROBABLY DOES OCCUR, MILD
PERTUSSIS AS YOU KNOW PEOPLE
JUST DONE THINK OF IT.
IT'S NOT EASY TO BE BY CULTURE.
>> SO IT MAYBE HAPPENING BUT
WE'RE NOT DETECTING IT
APPROPRIATELY.
>> I BET YOU AT LEAST HALF THE
CASES OF PERTUSSIS ARE NOT
DIAGNOSED.
>> THAT'S PROBABLY I WOULD SAY
THAT'S TRUE.
SO BASED ON WHERE WE ARE WITH
CURRENT TECHNOLOGY, SHOULD WE BE
RECOMMENDING BOOSTER SHOTS?
>> YES.
>> YOU THINK I'M SMART?
YOU'RE ASKING -- NO MATTER WHAT
YOU ANSWER THERE WILL BE SOMEONE
WHO SAYS NO, NO, NO, NO, NO.
I HAVE LEARNED.
I DON'T KNOW.
I WOULD SAY PROBABLY EVERY TEN
YEARS OR EVERY 15 YEARS.
I CAN'T ANSWER YOU.
ADULT IMMUNOIZATION IS STILL A
PRACTICE THAT HAS NOT RECEIVED
ACTIVE PARTICIPATION BY THE
ADULTS.
(OFF MIC)
>> NO.
IT'S BECAUSE DIAGNOSIS.
NO, THERE'S NO GOOD STUDIES.
THE ONE STUDY OF THE WHOLESALE
ACELLULAR VACCINE WAS MADE BY
(INAUDIBLE) WHEN THEY HAVE AS
YET UNDIAGNOSED PROBLEM,
INJECTING (INAUDIBLE).
>>
(OFF MIC)
[LAUGHTER]
>> IF THERE ARE NO OTHER
QUESTIONS OR COMMENTS, I WANT TO
THANK YOU BOTH VERY VERY MUCH.
[APPLAUSE]
>> THANK YOU.