Are Flu Vaccines Unsafe? What You Should and Should not Do to Protect Yourself From the Flu Virus

When is the last time you got a flu vaccine? Do you get one every year? This is considered by many to be an extremely unsafe practice. But why is that?

Did you know that around eighty percent of people that receive flu shots get an unsafe dose of mercury. Mercury, is an extremely dangerous substance, so its presence should not be taken lightly. Mercury, especially in children, causes brain damage, and is often linked to causing autism. Vaccine makers note that there products often create an unsafe amount of mercury, but the CDC still continues to recommend people get the shot.

About 80% of these flu vaccines contain Mercury, a dangerous metal. The metal is in a chemical called thimerosal. Thimerosal is a anti-bacterial and anti-fungal that contains high doses of mercury. It is used so companies can send large containers of their drug without having to worry about it becoming contaminated.

But is the mercury in the vaccine enough to cause harm? Yes! A typical 0.5 milliliter flu shot contains 25 micrograms – or 50,000 parts per billion of mercury. The EPA classifies a liquid with 200 parts per billion of mercury as hazardous waste. The limit for drinking water is 2 parts per billion. That is 25,000 times more mercury than we are expected to drink and we are putting it in our blood streams, so it does not even have a chance of being filtered out.

Hopefully by now you see why flu shots or flu vaccines are not safe. But, it is still important to come up with something to prevent the flu. Some people say to just wash your hands often, but it is obvious you can still get it, due to the majority of time not spent washing your hands.

Doctors, now, are starting to swear by supplements. These supplements boost your immune system, not only preventing all the flu viruses, but many other things like the common cold or other common ailments.

Vaccine McCarthyism. What If the Vaccine Paradigm Itself Is Deliberately Flawed? | Global Research

This article was first published on GR on January 2015.

Within the mainstream medical and scientific community there is an unassailable pseudo-truth that vaccines are safe and effective, whether administered individually or in combination. Within the vaccine injured children and autism movements there is also an unchallenged belief that vaccines are effective but not always safe. In this case, vaccine-injured children or adult family members were simply one of the rare cases where they received a hot lot vaccine or possessed biomolecular abnormalities, such as mitochondria dysfunction, and suffered the consequences. Even many parents with two children developing neurological complications after vaccination, will continue to follow the recommended vaccine schedule. Any medical physician, scientist, nurse, public health advocate, politician, or journalist who questions the myth of vaccine safety and efficacy are often immediately attacked, ridiculed, and designated a conspirator.  In fact, the pro-vaccine propaganda machine sends forth articulate doctors and university scientists to engage in ad hominin personal attacks against vaccine dissenters. 

However, what if all of these individuals and their organizations, their shadow lobbying foundations and think tanks, are wrong? What if the vaccine paradigm itself is flawed? What if vaccines have never been soundly confirmed to be safe and effective? What if the CDC, vaccine manufacturers, and the leading vaccine advocates knew of these discrepancies and contradictions, yet intentionally ignored them against the public interests and the well being of the American population?  After several decades of studying the scientific literature regarding vaccines, following the money trails, and interviewing many dozens of toxicologists, immunologists, research physicians, pediatricians, and medical journalists the vaccine paradigm can now be accurately deconstructed with real independent science. The year, 2014, has been a particularly dismal year for the pro-vaccine movement. We are presenting the science that has unfolded during the past twelve months as indicative of a collapse in the modern vaccine paradigm.

Last year, 2014, may well be the watershed year marking the demise of the vaccine era.  Without any recent credible and sound biological science to support their claims for vaccines’ efficacy and safety, the vaccine complex and its federal allies have been forced to rely upon courts of law and the ignorance of an inept mainstream media to further promulgate their flawed mythologies to advance the vaccine agenda.

Rarely does a whistleblower emerge from the federal health agencies. Government and corporate entities that are notoriously hierarchical, such as the CDC, FDA, and Health and Human Services, ruthlessly prevent dissention from their ranks. In the Obama era, when whistleblowers are persecuted more than ever before, it is an act of great courage for a person to come forth and reveal government malfeasance, corruption, and criminal behavior.  Therefore, it was a shocking surprise last year when a senior epidemiologist at the CDC, Dr. William Thompson, acted upon his moral conscience and released thousands of pages of CDC documents with research data to Congress that unveil the agencies long history of fraudulent studies and medical cover-ups that hid the serious failures and health risks of vaccines.

Dr. Thompson is a distinguished scientist who has worked at the CDC since 1998. Prof. Brian Hooker, a specialist in molecular and cellular systems, and the first person to be contacted by Dr. Thompson, stated during a recent broadcast that the released documents are not simply a smoking gun. Rather it is a “wildfire.”  Dr. Thompson is currently cooperating with members of a Congressional subcommittee. Thousands of American parents with vaccine damaged children, suffering from permanent neurological impairment and autism, await a trial that will finally bring to justice many of the nation’s top health officials.

Dr. Thompson, who co-authored and published research on vaccine thimerosal mercury—still included in some vaccines, especially the influenza vaccine—has  admitted he was part of the CDC’s conspiracy to obscure scientific evidence proving thimerosal and the MMR vaccine as causal factors for autism.  During an interview on the Autism Media Channel, he stated that he would never give his pregnant wife a flu shot because of its high concentration of mercury.  “I don’t know why they still give it to pregnant women,” Dr. Thompson stated. “That’s the last person I would give mercury to.”[1]   After reviewing some of the CDC data received by Dr. Thompson, as well as data records acquired through freedom of information submissions, Prof. Hooker discovered that the CDC has known since 2001 that children exposed to thimerosal in utero were 800 percent more likely to regress into autism.  This data was intentionally excluded from the CDC paper published in the journal Pediatrics in an effort to disprove a thimerosal-autism association.  During the radio broadcast, Prof. Hooker unearthed evidence that the CDC has known for a decade that children receiving the MMR vaccines on schedule were nearly 300 percent more likely to regress into autism compared to children whose parents decided to withhold the vaccine until after the child was older.

Americans are rapidly losing confidence in the CDC. According to National Consumers League poll, over two-thirds of Americans believe vaccines cause autism, which the CDC categorically denies.[2] Almost two months after the media reported on the Thompson revelations, a CBS News poll showed public approval of the CDC nosedived to 37%, down from 60% the previous year. Vaccine apologists and the major media claim this large decrease is due to the CDC’s dismal handling of the Ebola crisis; however, Thompson’s whistleblowing received over 750 million Twitter impressions indicating that vaccine efficacy and safety is far more on the public’s mind.[3] Positive endorsement of the CDC would plummet further if the public knew the full extent of CDC officials lying to Congress and their conspiracy to commit medical fraud for over a dozen years. Imagine the tens of thousands of children and families who would have been saved from life-long neurological damage and immeasurable suffering if the CDC was not indebted to protecting the toxic products of the pharmaceutical industry and was serving the health and well-being of American children?

The Thompson whistleblowing case is the tip of the iceberg and now putting the vaccine establishment into a panic. Nevertheless, 2014 was a dreadful year for the vaccine establishment and other medical revelations provide further encouragement for parents to withhold or refuse vaccination.

The Council of Foreign Relations Mistakenly Proves the Largest Outbreaks of Infectious Diseases Are Within the Most Highly Vaccinated Populations.

An early 2014 report released by the Council of Foreign Relations to identify countries with the highest rates of disease outbreaks, accidently revealed that the most highly vaccinated populations are also those with the greatest number of outbreaks for those same infectious diseases.  This was especially the case for measles, mumps, rubella, polio and pertussis outbreaks.  The US, Canada, the European Union, Australia and New Zealand, and Japan—each with the highest number of mandated vaccines—led the list of nations. The Office of Medical and Scientific Justice, which analyzed the report, concluded that the Council’s report clearly suggests the theory of “herd immunity” is failing or was flawed to begin with.  Given the repeated incidences of infectious outbreaks in populations with 94% or more vaccine compliance, and the emergence of new viral strains, the concept of herd immunity should be forgotten. The Office offers several possibilities to explain the report: 1) vaccines are increasingly becoming ineffective and causing “immune dysfunction,” and 2) “vaccine antigen responses” may be reprogramming viruses while weakening the immune systems of the most vaccinated individuals.[4]

Another World Health Organization Influenza Debacle 

Predicting the particular influenza strains to protect populations has never been a fine art.  We might remember the doom and gloom scenarios spread by the WHO and CDC over the H1N1 swine flu in 2009. The federal agencies of warning for a viral apocalypse, which never occurred, had as much credibility as Y2K and New Age Mayan predictions at the turn of the millennium.  At their best, flu vaccines remain around 60% efficacy according to official health statistics. However, the World Health Organization’s predictions for this year’s flu strains were a bust. The match was such a failure that the CDC was forced to warn the American public that the 2014-2015 flu vaccine was only 23% effective, off by 77%.[5]  Given that the 2012-2013 flu season was only 27% effective for the 65 years-plus age group, it can be estimated that this year’s flu shot is near useless for the elderly. Predictive methodologies to determine which flu strains emerge during any given influenza season have more in common with primitive mathematical divination than sound science.  For the 1992-1993 and 1997-1998 seasons, the vaccine concoction of flu strains was only 16% effective. Katherine Severyn, who monitors the actual WHO prediction results and compares them with CDC claims has stated that, “depending upon the study cited, [flu] vaccine efficacy actually ranges from a low of 0%.” [6]

Year after year, the US government spends approximately a billion dollars to purchase flu vaccines from the pharmaceutical cartel. Year after year, these vaccines prove to be capable of immunizing only a modest portion of the population. Since the CDC estimates it will have purchased 151-156 million flu shots to dump off this year, there is little else it can do except fudge science, release misleading propaganda and continue to distribute a useless snake oil.

More Bad News for the Influenza Vaccine

An ineffective seasonal vaccine is the least of the flu shots problems.  In December 2014, the Department of Justice released its report outlining compensation paid out to vaccine injured victims.  Based upon the statistics, the flu vaccine has been shown to be the most dangerous reported. Fifty-nine percent of awarded flu vaccine injuries were for Guillain-Barre Syndrome.[7]

Although, a final report of injuries and death from this year’s influenza vaccines won’t be made public until the end of 2015, the 2013-2014 vaccines accounted for over 93,000 adverse reactions, including 8,888 hospitalizations and 1,080 deaths according to the government’s Vaccine Adverse Events Reporting System (VAERS).[8] By the CDC’s own omission, the VAERS database only accounts for approximately 10% of adverse vaccine events. Do the math and the actual number far outweighs reported complications from contracting wild flu viruses.

Although, earlier research has shown that influenza vaccines contribute to adverse inflammatory cardiovascular alternations, which are lethal to senior citizens, and significant inflammation in pregnant women that may be associated with an increase in pre-term births and preeclampsia, new studies published in 2014 should raise further alarm:

A team of Finnish scientists at Finland’s National Institute for Health and Welfare, recorded 800 cases of narcolepsy associated with Glaxo’s flu vaccine Pandemix.  Vaccine ingredients other than the viral antigen or engineered component, are most often believed to be the primary culprits to adverse vaccine reactions. The Finnish research, on the other hand, indicated that the Glaxo vaccine’s altered viral nucleotide likely contributed to the sudden rise in sleeping sickness.[9] Dr. Paul Offit, the premier media celebrity for the vaccine establishment, has repeatedly made claims that infants can safely withstand tens of thousands of viral antigens; therefore, according to Offit, parents should not fear innumerable vaccinations at a single time.  This new finding on the contrary, sends a warning to all pregnant women and parents that it is not simply vaccines’ many toxic ingredients that pose worry, but the bioengineered viral components are also potentially life threatening.

For almost a decade, the CDC has known influenza vaccines are ineffective in the elderly but continues to market them without hesitation. Hence in November 2014, five senior citizens at an assisted living facility in Dacula, Georgia, died within week after all residents were vaccinated.[10] During the previous year’s flu vaccine trials, Sanofi Pasteur’s  Fluzone killed 23 elderly participants during the vaccine trial. Nevertheless, the vaccine was approved and continues to be marketed towards senior citizens.[11]

The Mumps Vaccine: Another Useless Shot

The question whether the mumps vaccine should have ever been put on the market has been debated since the 1950s. Over fifty years ago the nation’s chief federal epidemiologist, E.H. Lossing, warned that the mumps vaccine, which doesn’t provide lifelong immunity, would create a far more medically dangerous and costlier problem for people who become infected as adults.[12] At its best, the mumps vaccine may protect a person for 2 years, according to Dr. Greg Poland, head of the Mayo Clinic’s Vaccine Research Group.[13]  In 2014, there were over 1000 mumps cases and all outbreaks occurred in highly vaccinated populations.[14] It was far worse in 2006, writes Lawrence Solomon for the Huffington Post. During that year 84% of the 6,500 mumps cases were fully vaccinated young adults.  Among the almost 450 mumps cases in the American South last year, only 3 were unvaccinated.  What is more disturbing, researchers at the Bordeaux University Hospital in France, found that vaccinated adults were contracting a particularly malignant strain of mumps that contributed to meningitis, inflammation of the testicles, and hearing impairment.[15]

Secondary Transmission of Measles from a Fully Vaccinated Woman

A study published in a 2014 issue of the journal Clinical Infectious Diseases confirmed that not only may measles occur in vaccinated individuals, but a 2011 measles outbreak in New York City may have had its source in a fully vaccinated individual. Not only did the vaccinated woman, dubbed “Measles Mary”, contract the disease, but she also passed it to four others, two who were vaccinated. This is the first confirmed medical case of secondary measles transmission causing an outbreak. Earlier in the year, another study confirmed that individuals vaccinated against pertussis can be infectious carriers of the virus and can likely infect others who either do not respond immunologically to the pertussis vaccine or who are unvaccinated.[16]

The conclusion is that the B. pertussis vaccinated individual now endangers the health of the unvaccinated and vaccinated alike.

Earlier, a far greater blow against the efficacy of the measles vaccine came when Dr. Gregory Poland, Editor in Chief of the journal Vaccine and founder of the Mayo Clinic’s Vaccine Research Group, published a surprising statement that the measles vaccine has a poor record of efficacy. Despite the high 95% measles vaccination compliance of children entering kindergarten, and the CDC’s propaganda that the vaccine has defeated the virus, measles outbreaks are rising. For the first half of 2014, there were 16 large measles outbreaks in the US. Dr. Poland does not believe this is due to unvaccinated individuals, but because of the failure of the vaccine.[17]

These types of vaccine failures, which are also occurring far more frequently in pertussis outbreaks, further puts to rest the herd immunity hypothesis.

A Bad Year for the Pertussis Vaccine

Outbreaks of whooping cough have been increasing annually. However, state and local health authorities investigating and gathering statistics on pertussis outbreaks are discovering the highest numbers of infected persons among the vaccinated.  Mississippi, with the highest vaccination rate in the country, has shown significant increases in whooping cough cases, with only 9% of those infected being unvaccinated. Across the nation, the most highly infected are those who have received three or more pertussis shots and boosters.

However, it was in Australia last year that the government’s National Center for Immunization and Research of Vaccine Preventable Diseases found that the pertussis vaccine effectiveness is waning far more rapidly than expected, even among vaccinated 3 year olds.[18]

While the mainstream media and the vaccine establishment have launched a brutal campaign to blame unvaccinated individuals for the recent upsurge in pertussis infections, the CDC has publicly announced the contrary. Dr. Anne Schuchat from the CDC has stated, “We know there are places around the country where there are large numbers of people we aren’t vaccinated. However, we don’t think those exemptors are driving this current wave. We think it is a bad thing that people aren’t getting vaccinated or exempting, but we cannot blame this wave on that phenomenon.”[19]  What Americans need to know is that more virulent strains of B. pertussis have emerged that are not covered by current DpT vaccines. Earlier, Australian immunologists suggested that the emergence of a new vaccine-resistant B. pertussis strain may be due to over vaccination. What the world is witnessing with antibiotic resistant organisms, due to the over use and abuse of antibiotic medications, is similarly occurring with viruses targeted by vaccines.

Would You Like Some Depression with Your Rubella Vaccine?

It is common to feel out of sorts and depressed when feeling ill and under the weather. But might a vaccine be the cause for the depression? In 2014 medical departments at Hebrew University in Israel and the Max Planck Institute for Psychiatry in Germany, two of the world’s most distinguished institutes, published a double blind study revealing that teenage girls vaccinated with attenuated rubella virus had a statistically significant increase of induced bouts of depression up to ten weeks. The increase in post-vaccine depression occurred among girls in lower socioeconomic brackets. Today with over 50% of school age children in America living in poverty, the rubella vaccine is now contributing to serious psychological episodes and problems that are repeatedly reported in the mainstream psychological literature.[20]

Put a Hold on that Hepatitis B Vaccine`

Although an association between multiple sclerosis and the hepatitis B vaccine has been debated for over 15 years, the CDC continues to categorically deny this relationship.  However, a 2014 retrospective French study investigating the sudden spike in multiple sclerosis cases since 1993, identified France’s mass Hepatitis B vaccination program as the perpetuator for a doubling of MS cases within a few years. MS is a demyelinating disease of the nerves. The French scientists suspect that a vaccine protein contributed to the breakdown of myelin.  Again, it is not only the non-viral ingredients we should be scared about. In the US there are 10,000 new cases of MS annually, and infants are vaccinated with the hepatitis B vaccine immediately after birth.[21]

The Safety of Paul Offit’s Rotateq Vaccine Questioned, Again

Sayer Ji, editor of GreenMedInfo, noted that the Rotateq vaccine against the rotavirus, developed by Paul Offit for Merck, contained a live simian retrovirus that has likely infected millions of children around the world. The study was published in the prestigious Journal of Virology in 2010. Yet a more recent 2014 study published in Advances in Virology identified another viral contaminant in Offit’s vaccine: a baboon endogenous virus “likely due to the monkey cell line in which Rotateq was produced from.”  Only time will tell whether Offit’s contaminated vaccine will have the impact of the tainted polio vaccine with the carcinogenic S40 virus.[22]

Exposing the Fraud of the Human Papilloma Vaccine (HPV)

A paper out of the University of California at Berkeley and appearing in the October 2013 issue of Molecular Cytogenetics came to public attention last year to suggest that cervical cancer may not be caused by the human papilloma virus. If the theory is correct that may prove that the HPV vaccines Gardasil and Cervarix do not prevent cervical cancer at all.[23]

Moreover, researchers at the University of Guelph in Canada reported that the HPV vaccine acts upon a “mechanism” by which the vaccine is altering transmission leading to higher oncogene expression among vaccinated girls. The implications from this research is that the vaccine is driving the evolution of viral virulence, similar to what is being observed with vaccines for pertussis, mumps and measles.[24]

Chickenpox Vaccine is Shown to Increase Disease Rates

Again, 2014 has been a dismal year for the pro-vaccine community. Even the chickenpox vaccine, long thought to be safe and effective, is failing with the others.  Back in 2005, South Korea mandated the varicella vaccine to all children under15 months. Regardless of the country’s 97% compliance—well, above herd immunity’s claims to eradicate infectious disease—chickenpox infections have not declined and in fact have increased three-fold between 2006 and 2011.[25]

Conclusion

The vaccine establishment is desperate. The ghosts of their fraudulent science, manipulated research, misleading propaganda across mainstream media and in the blogosphere are returning to haunt them. The pro-vaccine pundits are rapidly losing credibility as increasing numbers of parents and young adults educate themselves about vaccine efficacy and their health risks.  If it were left for an open scientific debate between pro-vaccinators and those opposing vaccines, the former would not have sound science on their side.

It is time for a national debate to end vaccine madness. As further research emerges, as the vaccine paradigm is further stripped away, future generations will be looking back upon vaccination as a barbaric, primitive practice.

NOTES

1  http://naturalsociety.com/epidemiologist-cdc-says-never-give-pregnant-wife-flu-shot/

2  http://www.nclnet.org/survey_one_third_of_american_parents_mistakenly_link_vaccines_to_autism

3  http://naturalsociety.com/american-public-officially-loses-faith-cdc/

4  http://whitetv.se/sv/inget-fritt-medium-i-sverige/1106-council-on-foreign-relations-cfr-visar-att-ovaccinerade-aer-friskare-aen-vaccinerade.html  (Sweden)

5  http://america.aljazeera.com/articles/2014/12/3/flu-vaccine-ineffective.html

6  Richard Gale and Gary Null, “Flu Vaccines: Are They Effective and Safe?”  Progressive Radio Network, September 28, 2009

7  http://healthimpactnews.com/2015/why-are-so-many-healthy-people-dying-from-the-flu-after-receiving-the-flu-shot/#sthash.21InKK2H.dpuf

8  http://www.thelibertybeacon.com/2014/11/11/last-years-flu-vaccine-killed-and-injured-over-93000-us-citizens-will-this-year-be-any-different/

9  http://www.globalresearch.ca/finnish-scientists-identify-link-between-glaxosmithklines-swine-flu-vaccine-pandemrix-and-narcolepsy/5423154

10  http://healthimpactnews.com/2014/6-seniors-die-after-flu-shot-at-assisted-care-center-in-georgia/

11  http://healthimpactnews.com/2013/23-seniors-died-after-receiving-this-years-flu-shot-sold-by-pharmacies/

12  http://www.huffingtonpost.ca/lawrence-solomon/mumps-in-nhl_b_6351358.html

13  http://www.forbes.com/sites/tarahaelle/2014/12/16/nhl-mumps-outbreak-whats-up-with-the-vaccine/

14  http://www.ncbi.nlm.nih.gov/pubmed/25391635

15  http://cid.oxfordjournals.org/content/early/2014/02/27/cid.ciu105

16  http://cid.oxfordjournals.org/content/early/2014/02/27/cid.ciu105

17  http://www.washingtonpost.com/national/health-science/measles-cases-are-spreading-despite-high-vaccination-rates-whats-going-on/2014/06/23/38c86884-ea97-11e3-93d2-edd4be1f5d9e_story.html

18  http://articles.mercola.com/sites/articles/archive/2012/04/17/pertussis-vaccine-for-whooping-cough-effects.aspx

19  http://www.cdc.gov/media/releases/2012/t0719_pertussis_epidemic.html

20  http://www.ncbi.nlm.nih.gov/pubmed/11268375

21  http://link.springer.com/article/10.1007%2Fs12026-014-8574-4#page-1

22  http://www.greenmedinfo.com/blog/breaking-news-millions-children-infected-vaccine-safety-experts-rotateq-vaccine

23  http://sanevax.org/hpv-not-cause-cervical-cancer/

24  http://www.ncbi.nlm.nih.gov/pubmed/25429011

25  http://naturalsociety.com/97-compliance-chicken-pox-vaccine-still-causes-outbreaks/

Synthetic Horsepox Research Raises Questions Of Ethics and Safety : Shots

Smallpox virus, colorized and magnified in this micrograph 42,000 times, is the real concern for biologists working on a cousin virus — horsepox. They’re hoping to develop a better vaccine against smallpox, should that human scourge ever be used as a bioweapon.



Chris Bjornberg/Science Source


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Chris Bjornberg/Science Source

Smallpox virus, colorized and magnified in this micrograph 42,000 times, is the real concern for biologists working on a cousin virus — horsepox. They’re hoping to develop a better vaccine against smallpox, should that human scourge ever be used as a bioweapon.



Chris Bjornberg/Science Source

In the brave new world of synthetic biology, scientists can now brew up viruses from scratch using the tools of DNA technology.

The latest such feat, published last month, involves horsepox, a cousin of the feared virus that causes smallpox in people. Critics charge that making horsepox in the lab has endangered the public by basically revealing the recipe for how any lab could manufacture smallpox to use it as a bioweapon.

The scientist who did the work, David Evans of the University of Alberta in Canada, has said his team had to synthesize horsepox because they wanted to study the virus and there was no other way to get it.

There was another possibility, NPR has learned. Evans could have done research on a specimen of horsepox collected from the wild, but he didn’t pursue that alternative.

He says using the natural virus might have prevented the pharmaceutical company he is working with from commercializing horsepox as a new vaccine for smallpox. But the head of the company told NPR that he had not been aware that this stored sample of horsepox was potentially available — and would not have wanted to synthesize the virus from scratch if he had known.

“There was some confusion,” Evans told NPR, “probably my fault although I’d thought we’d discussed it back around 2014.”

If he didn’t talk about it with the company, Evans says, it’s because his own inquiries had convinced him that the stored virus “wasn’t suitable for our goals.”

Evans says the virus-making techniques his team has developed will advance the field of pox viruses, to help turn them into new vaccines or therapies for diseases like cancer.

“To say that somehow we shouldn’t take advantage of the technology that’s out there — and which is being used in all sorts of different ways in all areas of biology — and put off limits, somehow, one virus” doesn’t make a whole lot of sense to me,” he says.

University of Alberta microbiologist David Evans, right, and his research associate Ryan Noyce, created the synthetic horsepox virus.

Melissa Fabrizio/Courtesy of University of Alberta


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Melissa Fabrizio/Courtesy of University of Alberta

University of Alberta microbiologist David Evans, right, and his research associate Ryan Noyce, created the synthetic horsepox virus.

Melissa Fabrizio/Courtesy of University of Alberta

“I mean, someone had to bite the bullet and do this,” Evans adds. “But now that I’ve done it, my colleagues in this field can go forward and do their experiments. I’m a big boy. I’m used to the occasional bit of abuse rolled at me. And it doesn’t particularly bother me that much.”

For more than a decade, policymakers and biologists have been debating how to oversee new advances that might be misused to create germs that could — by accident or on purpose — start a global outbreak.

Despite lots of expert committees, new rules and heated debates, the horsepox experiment was done by a privately funded group that simply presented their lab-created virus to the world as a fait accompli.

Does the world need a ‘safer’ smallpox vaccine?

While the company that funded the work says its synthetic horsepox has potential as a safer smallpox vaccine, some biosecurity experts question whether there is any need for one. Despite that, the government currently offers financial incentives that would allow a company to make huge profits from developing a new smallpox vaccine.

“This is a little bit crazy. We have a very problematic, difficult decision to make about the reasonableness and appropriateness of this work, and it’s being pushed forward by those that have obvious conflicts of interest in a for-profit motive,” says Dr. David Relman, a microbiologist at Stanford University who tried, without success, to stop a scientific journal from publishing the details.

Smallpox is an often deadly, contagious disease that holds a unique place in medical history. Back in the 18th century, biologist Edward Jenner invented vaccination by giving people a less-virulent, related pox virus to generate an immune response that protected them from smallpox.

An unprecedented global vaccination campaign wiped out smallpox by 1980, making it the first disease ever eradicated. The virus that causes smallpox now is supposed to reside only in two locations: secure labs in the U.S. and in Russia. The U. S. government also stockpiles smallpox vaccine, in case the virus ever gets used as a weapon.

The possibility of creating a new, safer vaccine is why a pharmaceutical company executive named Dr. Seth Lederman wanted to get his hands on horsepox. He says historical writings suggest that Jenner’s vaccine against smallpox, which was derived from cowpox, actually originated in a pox disease that infected horses.

Trouble was, Lederman had no way of getting horsepox, which is believed to be extinct in nature. At one time, the U. S. Department of Agriculture held a sample. But when Lederman asked, that agency said it no longer had the virus.

Lederman knew Evans, an expert in pox viruses, and the two discussed the possibility of synthesizing horsepox from pieces of made-to-order DNA. Lederman and his company in New York, Tonix Pharmaceuticals, decided to give it a go and fund the effort.

“It was so unlikely that it would work, that maybe we didn’t spend as much time as you might think on the implications of it,” says Lederman, “although we were certainly mindful of the implications of it, and we followed all the applicable regulations in Canada,” where the work was done.

The team ordered bits of DNA from a commercial firm for about $100,000. Evans and colleague Ryan Noyce figured out how to stitch the pieces together, using tricks like helper viruses, to generate infectious horsepox by the summer of 2016.

Asked whether he would have been interested in synthesizing horsepox if he had known it was possible to obtain a sample of the natural virus, Lederman told NPR: “No. A primary rationale for the need for the synthesis is that a natural isolate of horsepox was not thought to be available for vaccine research.”

Unbeknownst to him, however, there was one available.

CDC had a sample of ‘natural’ horsepox virus

In 2014, Evans had tracked down the old USDA sample, which had moved to the Centers for Disease Control and Prevention. He contacted the CDC and was told the process of getting the natural virus would start with something known as a material transfer agreement.

“Dr. Evans indicated that he was working with a New York-based company and they would likely be the ones to request an MTA,” says Dr. Inger Damon, director of the Division of High-Consequence Pathogens and Pathology at the CDC.

But that didn’t happen. “No further request was received,” says Damon, who notes that the CDC often works with commercial companies that are developing new tests, treatments and vaccines.

A natural virus might be harder to ‘commercialize’

Evans told NPR that the CDC would have supplied him with its horsepox virus for research, but he saw a potential problem. The virus sample was collected back in 1976 from sick Mongolian horses, and Evans worried that some forgotten restriction on sharing or using the virus might crop up later on and become a problem for Tonix’s effort to sell horsepox as a new smallpox vaccine.

“It’s a major problem if one hopes to have any future commercial ‘freedom to operate,’ ” says Evans. “That’s why it would not be suitable for vaccine research if one hoped eventually to commercialize the virus.”

That wasn’t the explanation he has given in the past for why he had to synthesize the virus.

In a report last month describing the work, he and his colleagues stated that natural horsepox may be extinct and that the only known specimen was “unavailable for investigation.”

And he recently told a group of scientists that making the virus was the “solution” to the “problem” of not being able to get access to the one known strain of horsepox.

“We were wondering if we could find out more about this virus but the challenge is that there was one stock of it which was unobtainable,” Evans said at a meeting in Singapore in 2017. “And so we thought, well, could we have a stab at trying to make that?”

After having dropped the conversation with the CDC about horsepox in 2014, Evans contacted the CDC again in March 2016 to once again request access to its stored virus.

“He reached out to see if he could obtain the virus from CDC to compare with a virus he was working on,” says Damon. “It is our understanding that his work to re-create the horsepox virus had begun.”

The company that funded that work didn’t find out that the CDC’s sample of natural virus existed until February 2017. That’s when Lederman says they saw a reference to it in a scientific article that had been published a few months before. At that point, the horsepox synthesis was a done deal, and Lederman now sees its advantages.

“While the CDC virus would be experimentally interesting (and we’d still like to get some), from what I understand now, concerns over its origins might create challenges from a product development perspective,” Lederman told NPR in an email.

‘Something that investors understand’

If Tonix’s horsepox virus gets approved by the Food and Drug Administration as a smallpox vaccine, the company could get a lucrative reward: a special voucher that the government gives to companies that have developed medical countermeasures against potential security threats.

Such vouchers can be used to speed up the government’s review of any new drug, and they are fully transferable to other pharmaceutical companies. That means they can be sold, potentially for hundreds of millions of dollars.

“It’s certainly something that investors understand,” says Lederman, whose company highlighted this possibility in a press release about its horsepox work.

Some biodefense experts are questioning whether it makes sense for the government to incentivize this kind of research, especially given the biosecurity concerns.

“We believe that the creation of horsepox demonstrates the need for dialogue in the biodefense arena about the need for another smallpox vaccine,” they recently wrote in the journal Health Security.

Not even Evans seems sure that horsepox will end up being useful as a better smallpox vaccine. “I don’t know. Depending on the day of the week, I could argue either side of the equation,” says Evans.

Surprise at WHO meeting: Synthetic pox virus a fait accompli

Since 2001, according to the World Health Organization, Evans served on a special committee that provides global oversight of research with the remaining, closely-held stocks of smallpox. Research on no other pathogen gets this kind of international scrutiny.

A debate over whether the last stocks of smallpox should be destroyed has gone on for years. But advances in DNA technology seemed to be quickly making that question moot. After all, it was becoming increasingly feasible that someone could re-create a smallpox virus in the lab.

In November 2016, in a last-minute addition to the agenda of the committee’s annual meeting, Evans made an unscheduled presentation to reveal that he had made horsepox, a large pox virus like smallpox, from scratch.

Synthetic biologist Drew Endy, of Stanford University, had just been brought onto the WHO’s smallpox committee to help it consider the implications of new technologies for virus creation. He was stunned to hear this news at the first meeting he ever attended.

“It was a unilateral act,” says Endy. “And so I found it to be, from a personal perspective, shocking in a way.”

Some members of the WHO committee have devoted their entire professional lives to wiping smallpox from the face of the Earth, he notes, and suddenly Evans had forced them to confront the fact that reality had changed.

At the meeting, Evans stated that his rationale for the work was to show that the re-creation of a pox virus was not just a theoretical possibility, according to Asheena Khalakdina, a technical officer at the WHO.

She said that in 2017, when Evans declared his relationship with Tonix and his work on the development of a smallpox vaccine, the WHO rescinded his membership on the smallpox committee.

“I don’t get any personal financial gain from Tonix commercializing a smallpox vaccine,” Evans told NPR, though he does work as a consultant for the company. “The work was done on contract and they own the virus.”

In 2015, Evans served on another WHO working group to look at how emerging DNA technology would affect the ability to re-create smallpox. His conflict of interest disclosure for that noted that he was discussing a possible research contract with a company interested in synthesizing a pox virus. “They knew I was doing this,” Evans says.

Journal editors debated risks of publishing the work

With the horsepox virus re-created, and the WHO committee informed, the researchers pursued publication of the work in a scientific journal. That is routine practice for biologists, to ensure that others can reproduce and validate the science.

But biologists have argued in recent years over whether it’s wise to openly publish details of research that might be misused to produce a bioweapon.

Evans says his university’s lawyers reviewed his manuscript to make sure that publishing it wouldn’t break any laws and consulted with Canada’s foreign affairs and public health agencies.

“Without publishing the work, there’s really no way for us to communicate with investors and partners,” says Lederman, at Tonix. What’s more, a patent application would make it all public anyway.

A couple of science journals didn’t want the manuscript — and at least one of them noted that it would raise biosecurity concerns.

But a journal called PLOS One took the paper and put it through a small review panel that is supposed to screen research that might pose risks to the public if it were published.

The chair of that committee is Grant McFadden, an expert on poxviruses at Arizona State University. He also serves on the WHO’s smallpox committee and says he knows Evans well. “Everyone in the pox virus community pretty much knows everyone else,” says McFadden.

He saw no problem with publishing, because in his view, the advance just built on virus-making technologies that were already described in the open scientific literature. He and the other half-dozen members of the journal’s special review committee spent a couple of weeks discussing the paper by email and did not request any additional input from outside security experts.

“We felt we had enough, sufficient internal expertise to make a call,” McFadden tells NPR. “At the end of the day, everyone who weighed in was convinced that the scientific value of the paper outweighed the concerns.”

After all, he says, labs like his are already using more traditional DNA technologies to generate modified pox viruses. Going the fully-synthetic, made-to-order route could more efficiently generate pox viruses with multiple genetic alterations in the future. And if the FDA ever had to consider a modified pox virus as a therapy, creating it from scratch could make the review process more straightforward.

“There are going to be multiple scientific issues in the future where making a synthetic virus from scratch might be the best strategy to get at the question,” says McFadden.

But just because a journal editor has expertise in the science, that doesn’t mean they understand how to assess a biosecurity threat, says Arturo Casadevall, a microbiologist at Johns Hopkins University who is editor-in-chief of a journal called mBio.

“They cannot evaluate the degree to which that information may be misapplied by others,” says Casadevall, who wants to see a national security board set up so that journal editors have somewhere to go for guidance.

“Perhaps this paper,” he says, “will lead to some additional soul-searching and some action.”

Concerned onlookers lobbied to block publication

As word got out that the synthetic pox virus paper was about to be published, worried outsiders began to contact the journal, urging its editors to reconsider.

“I did not see, until a few days before publication, letters that had been sent to the journal expressing great concern,” says Ron Atlas, a microbiologist and emeritus professor at the University of Louisville who serves on the review committee that gave the OK to publish the work. “I don’t think that those letters would have changed my opinion of the research, but there were several very strong letters that said, ‘Do not publish this.’ “

One of the letter writers was Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health. “Anything that lowers the bar for creating smallpox in the world,” says Inglesby, “is a dangerous path.”

Another letter asked why some details couldn’t be held back to at least allow time for a broader discussion. “I thought that that was a very reasonable question to be asking,” says Relman, “prior to publication of the details of how one essentially remakes smallpox.”

McFadden disputes claims that publishing the manuscript would give some terrorist or rogue nation helpful tips.

“If you talk to people in synthetic biology that are professional constructors of novel genomes,” says McFadden, “they would tell you that the technical advance was fairly minor in this case.”

At least one synthetic biologist disagrees with that assessment.

“I think it’s incorrect to assert that it’s a nothing-burger,” says Endy, who adds that he honestly doesn’t want to get specific and draw attention to the most new and potentially useful virus-making tricks. “There are things in this paper that I wouldn’t know how to do and had never been done before.”

What is H1N1 (Swine Flu) And How Does it Affect Your Immune Health?

H1N1, also known as swine flu, has become a phrase that has stuck fear around the world, yet many people still do not understand how it compares to the seasonal influenza virus. The H1N1 virus is a new influenza A virus that is composed of what scientists call a quadruple reassortant, meaning it made up of several different genetic strains of viruses including two genes from influenza viruses normally circulated in the European and Asian pig populations, one gene from avian influenza and one gene from human influenza.

Contrary to some initial fears, the H1N1 virus is not spread via the food chain, but instead is a respiratory disease spread by contact with infected individuals. It is spread just as the seasonal influenza virus is passed through infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces.

Who Is At Risk?

When the epidemic was first discovered, panic set in, closing schools. People immediately went to the emergency room rather than the family doctor. Since then, the panic has subsided and most experts suggest only going to the doctor if certain symptoms are present including shortness of breath, difficulty breathing, or fever that lasts for more than three days. Parents with young children who are ill are encouraged to seek medical care if a child has fast or labored breathing, continuing fever or seizures.

About 70 percent of people who have been hospitalized with H1N1 virus have had one or more medical conditions that placed them in the 'high risk' category for serious seasonal flu-related complications. These conditions include pregnancy, diabetes, heart disease, asthma and kidney disease.

Yearly influenza epidemics can seriously affect all age groups, but the highest risk of complications occur among children younger than age two, adults age 65 or older and people of any age with certain medical conditions. Illness with the new H1N1 virus has ranged from mild to severe. The vast majority of people who have contracted H1N1 have recovered without medical treatment, yet hospitals and deaths have occurred.

The First Lines Of Defense

Vaccination is recommended by the CDC as the first line of defense to prevent the disease or severe consequences from the H1N1 virus. Vaccinations have been proven to prevent 70 to 90 percent of influenza-specific illness. Among the elderly, the vaccine reduces severe illnesses and complications by up to 60 percent and deaths by 80 percent.

Seniors (adults 65 years and older) are prioritized for antiviral treatment to limit risk of complication if they contract the flu. While your age could mean you have a lower risk of getting the flu, certain risk conditions (COPD, diabetes, etc.) mean if you get sick, you may have a higher risk of complications from any influenza.

However, some groups of people should avoid getting vaccinated for health reasons. These groups include anyone who is allergic to chicken eggs or any other component of the vaccine, anyone who has had an adverse reaction to flu vaccinations in the past, and anyone who has had Guillain-Barre Syndrome.

Aside from vaccinations, the second line of defense in fighting flu is good hygiene. Since it is is spread via hand to mouth and nose contact, hand washing is essential. Hands should be washed frequently and thoroughly for at least 20 seconds. Hand sanitizers are also effective at fighting flu viruses. People who have H1N1 are wise to sneeze into their sleeve rather than hands to prevent transmitting the germs.

Fighting Flu By Boosting Immune Health

It's impossible to not be exposed to seasonal or H1N1 flu at some point, but that does not need to mean that everyone who is exposed will become ill. Boosting immunity before coming in contact with the virus can help ward it off.

Fighting flu and enhancing immune health is possible by building immunity with vitamin C, zinc and elderberry extract. Vitamin C increases the production of infection-fighting white blood cells and antibodies that coat cell surfaces, preventing the entry of viruses. Zinc increases the production of white blood cells that fight infections and helps them fight more aggressively while also assisting white cells release more antibodies.

Perhaps one of the most promising immunity boosters is elderberry extract. Research conducted at the University of Oslo has demonstrated that products containing elderberry extract also helped in the prevention of the influenza virus by preventing viruses from attaching to host cells, thereby preventing infection.

Good hygiene, vaccination and immune support such as vitamin C, zinc and products containing elderberry extract provide several of the required bacteria to fight the H1N1 virus.

ID specialists search for ways to reach homeless

People who are homeless are more vulnerable to many infectious diseases than the general population and harder to reach for treatment.

Diseases like tuberculosis, hepatitis, HIV/AIDS, STDs and others affect people who are homeless at higher rates than they do most others. The disparity in the burden of disease is due to a variety of factors, including a lack of health care access and coverage, substance abuse, a lack of shelter and sanitation, sex work, and crowding in shelters.

“Anything that you can catch by being in close proximity to other people tends to be more common in people who are homeless,” Kelly Doran, MD, an assistant professor of population health and emergency medicine at New York University School of Medicine and an ED physician at Bellevue Hospital in New York City, told Infectious Disease News. “People who are homeless also tend to have a variety of factors that may sometimes lead to them having weaker immune systems. They have higher rates of co-occurring substance use, mental health issues and other chronic medical conditions, all of which put them at risk for infectious diseases as well.”

A vulnerable population

Several studies have shown the extreme gap in infectious disease prevalence between homeless people and the general population. One, published in The Lancet in 2014, analyzed literature from high-income countries in North America, Europe and Oceania over a roughly 10-year period.

The researchers found that the prevalence of hepatitis C was as high as 36% among homeless people, compared with just 2% in the general population. Rates of infection with hepatitis B reached 30% among homeless people vs. less than 1% of the general population. Rates of TB (8% vs. 0.032%) HIV (21% vs. 0.6%) and scabies (56% vs. < 1%) were also significantly higher among people who are homeless.

Matthew M. Zahn

In another study published in The Lancet in 2017, researchers similarly analyzed literature from high-income countries between 2005 and 2015. They found that, among men, homeless people had almost three times the infectious disease-associated mortality rate as the general population, and homeless women had more than a fivefold increase in mortality risk compared with women in the general population.

HCV is especially prevalent among homeless people in the United States, according to HHS, which estimates that 22% to 53% of the population is infected. Doran said most homeless people are not injection drug users — a significant driver of the HCV epidemic — but it is still a problem among that population.

“There is a minority, but still important, group of homeless people who do use injection drugs or other drugs, and alcohol,” Doran said. Injection drug use is definitely more prevalent among homeless people, but in general, the most common infections they face are more similar to what the rest of us face,” she explained, pointing out that they are more susceptible to diseases like pneumonia and influenza as well.

Jeffrey D. Klausner, MD, MPH, a professor of medicine and public health at the University of California, Los Angeles David Geffen School of Medicine and Fielding School of Public Health, said skin and soft issue infections also commonly affect homeless people.

Other threats include “infections related to poor hygiene like staphylococcal infections and those related to poor sanitation like water-borne diseases or hepatitis A,” Klausner said. “Traditionally, TB is a concern among the homeless due to crowded living conditions and comorbid conditions like diabetes, smoking and substance use. Rates of TB in homeless persons in Los Angeles, for example, are about 100 cases per 100,000 population, more than 30 times the national average.”

Matthew M. Zahn, MD, medical director of epidemiology at the Orange County, California, Health Care Agency and chair of the Infectious Diseases Society of America’s Public Health Committee, added shigellosis to the mix of diseases affecting the homeless population. An outbreak of the disease, caused by a Shigella bacterium that can be spread through poor hygiene, hit the homeless population in Orange County several years ago, Zahn said. He also listed norovirus and MRSA outbreaks as potential threats.

A months-long outbreak of HAV that began among homeless residents in San Diego illustrated the severity with which infectious diseases can strike the population and become widespread. The outbreak began in November 2016 and spread throughout California. A major driver of the outbreak was the disease’s spread among homeless people, although it affected nonhomeless people as well.

Kelly Doran

By the end of 2017, the California Department of Public Health counted 686 total cases of HAV, including 447 hospitalizations and 21 deaths, resulting from the outbreak. San Diego County saw the vast majority of cases — 577 — and 20 deaths.

Points of contact

During the California HAV outbreak, health care professionals had more contact with homeless people than normal. According to Zahn, homeless people are ordinarily more concerned with issues other than their health, making outreach difficult.

“For people who are homeless, even significant health issues like hepatitis A may be far down on their list of concerns,” he said. “Keeping themselves and their families fed, warm and safe is often priority one. That means that when you conduct health outreach, it is not a simple population to reach.”

To overcome that barrier, Zahn suggested visiting homeless shelters and speaking to people about their health conditions, risks for diseases and the steps they can take to protect themselves. Zahn said he has also visited homeless shelters in the past to educate staff in basic hygiene practices to help prevent the spread of disease. Correctional and mental health care facilities are other settings in which homeless people can be reached, Zahn said, because these are the settings in which they often encounter the health care system.

However, a place that is a frequent point of contact between health care providers and homeless people is the ER. Zahn said it is important for ID specialists to educate ER staff about emerging and ongoing disease threats among those without shelter. It is also important, he said, to thoroughly address those patients’ needs at that time.

“If homeless people are seen in the ER and their needs are met, then that’s a great outcome,” Zahn said. “But if their needs are not met and they leave the ER, conducting follow-up and care is extremely difficult.”

Jeffrey D. Klausner

Doran said specialists play an important role for HIV-infected people who are homeless.

“Some people who are homeless strongly value the relationships they have with their HIV doctors,” Doran explained. “For more rare or complex conditions such as TB, there is certainly an important role for the expertise of infectious disease specialists.”

Doran stressed that ID specialists can increase health care access for homeless people by accepting Medicaid, which she said is their largest insurer. Allowing flexible schedules and walk-in hours and having case managers on site are other ways to improve health care for the homeless population.

She also said specialists can consult the National Health Care for the Homeless Council, a network of thousands of providers, patients and advocates working to improve access to comprehensive health care and secure housing for homeless people. Specialists can visit the organization’s website for resources to help homeless people and to find out if the group operates any clinics for homeless people in their communities, Doran said.

Klausner recommended a compassionate, nonjudgmental approach to the control of infectious diseases in the homeless population. To that end, clinicians should engage in mobile outreach and help ED staff in treating homeless people. He also recommended educating colleagues and civic leaders about the risk factors homeless people face.

Zahn said outreach efforts are crucial but require resources and funding.

“It’s really resource intensive,” he said. “For public health and for any group reaching out to the homeless, they’re doing very important work. But it has to be funded and supported adequately. If it’s not, you’re just not going to serve their needs.” – by Joe Green

Disclosures: Doran, Klausner and Zahn report no relevant financial disclosures.

People who are homeless are more vulnerable to many infectious diseases than the general population and harder to reach for treatment.

Diseases like tuberculosis, hepatitis, HIV/AIDS, STDs and others affect people who are homeless at higher rates than they do most others. The disparity in the burden of disease is due to a variety of factors, including a lack of health care access and coverage, substance abuse, a lack of shelter and sanitation, sex work, and crowding in shelters.

“Anything that you can catch by being in close proximity to other people tends to be more common in people who are homeless,” Kelly Doran, MD, an assistant professor of population health and emergency medicine at New York University School of Medicine and an ED physician at Bellevue Hospital in New York City, told Infectious Disease News. “People who are homeless also tend to have a variety of factors that may sometimes lead to them having weaker immune systems. They have higher rates of co-occurring substance use, mental health issues and other chronic medical conditions, all of which put them at risk for infectious diseases as well.”

A vulnerable population

Several studies have shown the extreme gap in infectious disease prevalence between homeless people and the general population. One, published in The Lancet in 2014, analyzed literature from high-income countries in North America, Europe and Oceania over a roughly 10-year period.

The researchers found that the prevalence of hepatitis C was as high as 36% among homeless people, compared with just 2% in the general population. Rates of infection with hepatitis B reached 30% among homeless people vs. less than 1% of the general population. Rates of TB (8% vs. 0.032%) HIV (21% vs. 0.6%) and scabies (56% vs. < 1%) were also significantly higher among people who are homeless.

Matthew M. Zahn

In another study published in The Lancet in 2017, researchers similarly analyzed literature from high-income countries between 2005 and 2015. They found that, among men, homeless people had almost three times the infectious disease-associated mortality rate as the general population, and homeless women had more than a fivefold increase in mortality risk compared with women in the general population.

HCV is especially prevalent among homeless people in the United States, according to HHS, which estimates that 22% to 53% of the population is infected. Doran said most homeless people are not injection drug users — a significant driver of the HCV epidemic — but it is still a problem among that population.

PAGE BREAK

“There is a minority, but still important, group of homeless people who do use injection drugs or other drugs, and alcohol,” Doran said. Injection drug use is definitely more prevalent among homeless people, but in general, the most common infections they face are more similar to what the rest of us face,” she explained, pointing out that they are more susceptible to diseases like pneumonia and influenza as well.

Jeffrey D. Klausner, MD, MPH, a professor of medicine and public health at the University of California, Los Angeles David Geffen School of Medicine and Fielding School of Public Health, said skin and soft issue infections also commonly affect homeless people.

Other threats include “infections related to poor hygiene like staphylococcal infections and those related to poor sanitation like water-borne diseases or hepatitis A,” Klausner said. “Traditionally, TB is a concern among the homeless due to crowded living conditions and comorbid conditions like diabetes, smoking and substance use. Rates of TB in homeless persons in Los Angeles, for example, are about 100 cases per 100,000 population, more than 30 times the national average.”

Matthew M. Zahn, MD, medical director of epidemiology at the Orange County, California, Health Care Agency and chair of the Infectious Diseases Society of America’s Public Health Committee, added shigellosis to the mix of diseases affecting the homeless population. An outbreak of the disease, caused by a Shigella bacterium that can be spread through poor hygiene, hit the homeless population in Orange County several years ago, Zahn said. He also listed norovirus and MRSA outbreaks as potential threats.

A months-long outbreak of HAV that began among homeless residents in San Diego illustrated the severity with which infectious diseases can strike the population and become widespread. The outbreak began in November 2016 and spread throughout California. A major driver of the outbreak was the disease’s spread among homeless people, although it affected nonhomeless people as well.

Kelly Doran

By the end of 2017, the California Department of Public Health counted 686 total cases of HAV, including 447 hospitalizations and 21 deaths, resulting from the outbreak. San Diego County saw the vast majority of cases — 577 — and 20 deaths.

Points of contact

During the California HAV outbreak, health care professionals had more contact with homeless people than normal. According to Zahn, homeless people are ordinarily more concerned with issues other than their health, making outreach difficult.

“For people who are homeless, even significant health issues like hepatitis A may be far down on their list of concerns,” he said. “Keeping themselves and their families fed, warm and safe is often priority one. That means that when you conduct health outreach, it is not a simple population to reach.”

PAGE BREAK

To overcome that barrier, Zahn suggested visiting homeless shelters and speaking to people about their health conditions, risks for diseases and the steps they can take to protect themselves. Zahn said he has also visited homeless shelters in the past to educate staff in basic hygiene practices to help prevent the spread of disease. Correctional and mental health care facilities are other settings in which homeless people can be reached, Zahn said, because these are the settings in which they often encounter the health care system.

However, a place that is a frequent point of contact between health care providers and homeless people is the ER. Zahn said it is important for ID specialists to educate ER staff about emerging and ongoing disease threats among those without shelter. It is also important, he said, to thoroughly address those patients’ needs at that time.

“If homeless people are seen in the ER and their needs are met, then that’s a great outcome,” Zahn said. “But if their needs are not met and they leave the ER, conducting follow-up and care is extremely difficult.”

Jeffrey D. Klausner

Doran said specialists play an important role for HIV-infected people who are homeless.

“Some people who are homeless strongly value the relationships they have with their HIV doctors,” Doran explained. “For more rare or complex conditions such as TB, there is certainly an important role for the expertise of infectious disease specialists.”

Doran stressed that ID specialists can increase health care access for homeless people by accepting Medicaid, which she said is their largest insurer. Allowing flexible schedules and walk-in hours and having case managers on site are other ways to improve health care for the homeless population.

She also said specialists can consult the National Health Care for the Homeless Council, a network of thousands of providers, patients and advocates working to improve access to comprehensive health care and secure housing for homeless people. Specialists can visit the organization’s website for resources to help homeless people and to find out if the group operates any clinics for homeless people in their communities, Doran said.

Klausner recommended a compassionate, nonjudgmental approach to the control of infectious diseases in the homeless population. To that end, clinicians should engage in mobile outreach and help ED staff in treating homeless people. He also recommended educating colleagues and civic leaders about the risk factors homeless people face.

Zahn said outreach efforts are crucial but require resources and funding.

“It’s really resource intensive,” he said. “For public health and for any group reaching out to the homeless, they’re doing very important work. But it has to be funded and supported adequately. If it’s not, you’re just not going to serve their needs.” – by Joe Green

Disclosures: Doran, Klausner and Zahn report no relevant financial disclosures.