It is one of my earliest childhood memories: I am three years old and standing by a bathtub, furiously scratching the itchy lesions just recently slimed with fluorescent pink calamine lotion in a vain attempt to alleviate the misery of chickenpox. Thanks to a wildly successful vaccine that has now vanquished what was once a ubiquitous viral infection, my memories of chickenpox are a woeful experience that few children today will ever experience.
In America, perhaps one to three people will die of the infection every year, and yet anywhere from 40,000 to 50,000 people will receive post-exposure vaccination to avoid the dreadful possibility of fatal infection with rabies.
We humans are walking clouds of bacteria, traveling in our own effluvium as we pinball among our day-to-day activities, cross-pollinating our family and friends with our own microbial flora.
But what about sneezing, one of man’s sillier bodily functions, and one that seems tailor-made for direct inoculation of friend and foe? This protective reflex that clears irritants from our nasal passages also serves as a wet phlegmy bullet train for bacteria and viruses to travel upon as they escape the dank tunnels of our airways. And so how exactly do microbes capitalize on this high velocity emission?
A massive heat wave in the tundra of northern Siberia has ushered a twentieth century anthrax outbreak into the modern age. Over the past two months, the population of the isolated Yamal-Nenets region has been caught off guard by a pair of unprecedented emergencies, first in the form of a punishing heat wave with temperatures reaching 95F (35C), quickly followed by an anthrax outbreak as the 75-year-old corpses of infected reindeer have thawed from their permafrost biohazard coffins.
“A lot kills, a little cures,” wrote the father of toxicology, and botulinum toxin is the poster child for this important pharmaceutical concept. Depending on the dosage and route, this potent bacterial toxin is either a devastating foodborne poison – one of the most deadly toxins known to man, capable of causing paralyzing death – or a wildly popular wrinkle antidote, harnessed and wielded in the pursuit of clearer skin.
In September of 1939, Nazi Germany invaded Poland, marking the beginning of World War II in Europe. By the war’s end in 1945, Poland had suffered the deaths of more than five and a half million citizens – a fifth of her pre-war population – with the majority of these the victims of war crimes at the hands of the Germans. A large community in southeastern Poland, however, escaped persecution and the horrors of deportation and death thanks to an ingenious ruse employed by two Polish physicians. With the help of a sham “vaccine,” Drs. Eugene Lazowski and Stanisław Matulewicz fabricated a fictional epidemic that would save the lives of thousands.
Flushing a vein with a liter of saline is standard protocol in clinics and hospitals. To receive fluids intravenously is an ubiquitous therapeutic, a common tool to alleviate many conditions, so standard that there are even businesses that offer an IV and a bag of saline as a cure for the common hangover.
Intravenous fluid resuscitation relies on the principle of replenishing our precious bodily fluids through delivery directly into the blood vessels, but where did this concept come from? How did a remedy that breaches the skin and veins, violating the sanctity of the human body to inject a liter of foreign substance enter the medical armamentarium? It has its origins in mankind’s quest to defeat a bacteria infamous for causing such prolific diarrhea that it causes fatal shock: cholera.
Epidemics do not simply appear out of nowhere. They can simmer for months, isolated within a small segment of a population, escaping the notice of the public health community before boiling over into the larger community, triggering the identification of a spreading contagion. Too often, those individuals who recognize a nascent threat of outbreak and sound the alarm do not receive the public recognition they deserve.
The New England Journal of Medicine recently published a short letter on two cases of vaccine-derived polio infection that arose in a German pediatric cancer ward three years ago. Two severely immunocompromised girls from the Middle East – one from Libya and the other from Saudi Arabia – had traveled with their families seeking specialized medical treatment in Germany.
There’s nothing quite like syphilis. The sexually transmitted bug that sullied Christopher Columbus’ journey either to the New World or his return back to the Old – we’re still debating this grand chicken-or-egg epidemiological mystery – has deranged the minds of dictators and kings, was once a leading cause of committed hospitalizations to the psych ward, and even sparked fashion trends among members of the European royal courts who sought to cloak its debilitating, tell-tale symptoms (1).