Mass. General Launches Trial Of Old TB Vaccine For Type 1 Diabetes

A blood test to check glucose levels (Alden Chadwick/Flickr Creative Commons)

A blood test to check glucose levels (Alden Chadwick/Flickr Creative Commons)

Type 1 diabetes, the autoimmune form that usually strikes young people, is big and getting bigger: As many as 3 million Americans may have it, and their numbers are growing quickly and mysteriously.

So any promise of potential progress is a big deal, and it was splashy news back in 2012 when Dr. Denise Faustman, director of the Immunobiology Laboratory at the Massachusetts General Hospital, reported positive results for a test of a tuberculosis vaccine called BCG — Bacillus Calmette-Guerin — in a tiny trial of three longtime diabetes patients. Of particular appeal: BCG has been around for nearly a century, has been shown to be safe and, long since generic, is also cheap.

Now, Faustman has just announced the launch of a far bigger human clinical trial, aiming for 150 patients from ages 18 to 65. Though BCG is known as a vaccine, the trial will use it not to prevent diabetes but to try to reverse the disease — at least partially — in patients who already have it.

Dr. Faustman’s research, funded mainly by the Iacocca Foundation, has been considered somewhat controversial, so the results of the new trial — which is expected to last five years and is a “Phase II” trial to assess how effective the treatment is — could lay that debate to rest.

Our conversation, lightly edited:

So how do you see the headline here? And should it begin ‘This is not a cure’? What’s your main message to the public?

I think the main point of what we’re doing is: These are the first trials trying to intervene immunologically in people with long-standing autoimmunity and trying to reverse the disease, but doing it with a cheap, inexpensive, hundred-year-old drug.

Dr. Denise Faustman, director of the Immunobiology Laboratory at Massachusetts General Hospital (Courtesy MGH)

Dr. Denise Faustman, director of the Immunobiology Laboratory at Massachusetts General Hospital (Courtesy MGH)

But how would you calibrate the promise, or hope, of how well this might work for people?

It’s interesting because these trials, although we were kind of the first in the world to start in Phase I, they’ve caught on, on a global basis — using repeat BCG in diverse autoimmune diseases, such as multiple sclerosis, such as Sjögren’s disease. So, although we were kind of lonely to begin with, suggesting this hundred-year-old drug might have major therapeutic impacts, we’re not so lonely anymore. In fact, in Europe, there are Phase III trials going on in multiple sclerosis.

So, we’re seeing clinical effects in patient populations where people thought it wasn’t possible to reverse or partially reverse a disease. So we’re pretty hopeful that this inexpensive way might make a significant dent on the clinical course of a disease and do it at incredible cost savings to the public.

So, does that go as far as possible ‘cure’? Continue reading

Elmo’s New Buddy, The Surgeon General, And Other Health Chiefs Urge Vaccines


Vivek H. Murthy, video star and Friend of Elmo. Who’d have thought, back when Dr. Murthy’s appointment to be the U.S. surgeon general was facing political fire, that this would be the sequel? But there he is in a popular new video, cavorting with Elmo. Okay, not cavorting, but rather working nicely together with Elmo to help promote vaccinations while the recent Disneyland measles outbreak is still fresh in memory.

And Dr. Murthy’s big-city colleagues are also going visual to promote vaccinations: Public health chiefs from Los Angeles County to Boston are just out with a series of videos in which they personally urge their residents to get their kids immunized. See the full collection here, including Boston’s Huy Nguyen (below). The videos, part of the Big Cities Health Coalition, are aimed at health districts with a combined population of 14 million.

Recent history: When President Obama proposed Dr. Murthy, then at Brigham and Women’s Hospital, as surgeon general in late 2013, colleagues showered him with praise and said they expected him to be a progressive and visible leader. Then, last year, opposition from gun groups — Murthy had expressed support for gun control in the wake of the Newtown shootings — held up and threatened to scuttle his confirmation. But in December, in a squeaker vote, he got the nod.

And now here he is, living up to predictions that he would be “visible” — and on “Sesame Street,” no less. After Elmo gets his vaccination in the video above, he (it?) says, “That was so easy! Why doesn’t everyone get a vaccination?” Dr. Murthy strokes his chin: “That’s a good question, Elmo, that’s a good question…”

Do You Really Need That Tetanus Booster? One Man’s Ordeal

A patient suffering from tetanus (painting by Sir Charles Bell, 1809, via Wikimedia Commons)

A patient suffering from tetanus (painting by Sir Charles Bell, 1809, via Wikimedia Commons)

By David C. Holzman
Guest Contributor

I didn’t think it was a big deal. I’d stepped on a shell in Wellfleet Harbor, and it had sliced into my foot, and drawn blood. Heck, I didn’t even think tetanus bacteria hung out in salt water — they like soil, especially if the icing atop its cake is manure. But my anguished Jewish mother was all “get over to AIM [the local health clinic] right away, before lockjaw has a chance to set in.”

Of course, the power of the Jewish Mother to inflict fear and guilt is legendary. So I ultimately hauled my derriere over to AIM. But there was a problem.

I had first learned I was allergic to tetanus shots when I was 17 — two decades earlier. I don’t remember what I’d stepped on, but I’d ended up having to go back to AIM a couple of hours after the tetanus shot, so that they could check out the hives that had sprouted from feet to nether regions to scalp. While I was in no immediate danger, I was advised that the specter of anaphylactic shock loomed over any future tetanus shots.

But now at AIM once again, I wasn’t anticipating a problem because a year after the hives, I’d stepped on something on a trip in England. But the nice doctor who had given me that injection swore that he’d quit the profession if the preventive shot he’d given me with the tetanus shot failed to protect me from hives, or any other reaction.

So I figured the docs at AIM would also know what to give me to prevent a reaction. But instead, they gave me some gobbledygook about how I should really wait until I got home — which was Washington, D.C. at the time — and let my own doc give me the shot. But the docs at Group Health, my then-HMO, were equally stymied by my predicament. Continue reading

What’s The Vaccination Rate At Our School? Mass. Parents Can Now Look It Up

CLICK TO ENLARGE: A sample from the Massachusetts Department of Public Health's compilation of school immunization rates, recently made public

CLICK TO ENLARGE: A sample from the Massachusetts Department of Public Health’s compilation of school immunization rates, recently made public

Amid the current Disneyland-vector measles outbreak and the new spotlight it’s putting on vaccine gaps, many a parent is wondering: What’s the vaccination rate at my own child’s school? What are the chances that my kid will come into contact with an unvaccinated kid? And does our school make the cut-off for “herd immunity,” that desirable state when so many people are vaccinated that even if a bug gets in, it’s unlikely to spread?

USA Today has published a beautifully granular look-up tool of vaccination rates broken down by school, with data for 13 states, including Massachusetts. Its interface lets you look up a specific school by typing in its name.

But we in Massachusetts are particularly data-rich, in that the state Department of Public Health has just recently posted a spreadsheet of all our schools, grouped together by town; that means we can not only check a particular school’s rate but also compare it with its neighbors’.

The full state list of schools and their kindergarten vaccination rates is here, in an easy format that looks like the spreadsheet shown above.

So what are we to make of these numbers, particularly if our own school’s rate looks low?

I spoke with Pejman Talebian, chief of the immunization service at the state’s Department of Public Health. My biggest takeaway: If your school’s numbers look low, don’t freak out. It could be an artifact of under-reporting, particularly if the numbers of vaccine exemptions are low. But there are, he said, pockets of concern, particularly on Cape Cod and in western Massachusetts, where the numbers of exemptions tend to be high and vaccination rates lower than desired.

Our conversation, lightly edited:

What would you hope that parents and school communities do with this data?

We hope that it starts conversations around immunization. And we hope that in areas of the state where there are lower rates, and higher rates of exemptions, it prompts more conversations between health care providers in those communities, local health officials in those communities, and the community as a whole — that they talk about the benefits of immunization, prompting folks to potentially reconsider their stance around immunization. Hopefully, it will lead to more individuals seeking to be fully vaccinated.

“These pockets are not in lower-income city areas, they generally tend to be in middle and upper middle class communities.”

– Pejman Talebian,
state Department of Public Health

Is there anything that communities should be sure not to do?

I wouldn’t take one data point around one specific school and assume there’s definitely a concern or definitely a problem. This is all self-reported information and some of it may not be a true reflection of what is the actual immunization coverage in the school. So if you do see a school with what appears to be very low immunization rates, that doesn’t mean that that school is definitely ripe for an outbreak tomorrow and that’s a major concern. It should just prompt questions and conversations with school health staff and with the community, ensuring the population is being properly vaccinated.

How long have we had this data? When did it go public? Continue reading

One Doctor Asks: Why Are We Arguing About Measles Vaccines In 2015?

By Dr. Rebecca Weintraub
Guest Contributor

This week, as I juggled work, family and shoveling, I prepared a lecture on promoting equity in health delivery. My first slide is a picture of the Ebola virus, and as of this morning, my last slide is a map of the ongoing measles outbreak. That’s because this week, we’ve heard a clear public health message from both President Obama and Surgeon General Vivek Murthy: Vaccines are safe and effective.

Why is this message being repeated in 2015?

As a mother and physician, I am dismayed that all Americans are not practicing this guidance based on evidence from 40 years ago. Vaccines are safe and effective. There is no link between vaccines and autism.

In 1757, Dr. Francis Home proved the infectious nature of measles and detected the virus in blood. The highly contagious virus spreads via droplets and replicates within the newly infected person for 14 days. The symptoms include high fever, red eyes, runny nose and cough. A few days after the onset of these symptoms, “Koplick’s” spots—bluish markings on the inside of the cheek—appear. Then, a rash starts at the head and travels to the feet. The infected person is contagious for four days before and after the onset of the rash. We test suspected cases for antibodies against the virus. After confirmation, the treatment is supportive, including rehydration, nutritional support, medicines to reduce fever, antibiotics for superimposed infections, and Vitamin A supplementation. Once the measles infection has taken hold, there is no cure.

We’ve made tremendous strides in the discovery and development of new vaccines. In 2000, the Centers for Disease Control and Prevention declared the measles virus eliminated. But now, there are over 100 confirmed cases of measles across 14 states. Our most vulnerable populations are at risk of contracting an entirely preventable disease. This is not only an issue of choice, but an issue of health equity and our role as global citizens.

So now we can, and must, eradicate measles… again. We can learn from Mississippi and West Virginia, which have been at the forefront of new vaccination efforts. Continue reading

Why The Current, Post-Eradication Measles Outbreak Is So Infuriating

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

Back of female with measles/ Wellcome Library, London. Wellcome Images/flickr

That certain parents refuse to get their kids vaccinated isn’t new. But suddenly, it’s news. And it’s troubling. I’m a big supporter of “crunchy” parenting, but not when it puts other people’s children (and mine) at risk. The current measles outbreak has infuriated many parents and medical professionals who, fuming, wonder why we are arguing about a virus that was already eliminated here in the U.S. 15 years ago.

So, here’s one such parental rant on the topic by Alicair Peltonen, an administrative assistant at the Harvard School of Public Health and a journalism student at the Harvard Extension School.

By Alicair Peltonen
Guest Contributor

When I was in elementary school, one of my favorite books was called “The Value of Believing In Yourself,” by Spencer Johnson, MD. It was part of a children’s book series meant to teach lessons through the life stories of historical figures. The Value of Believing In Yourself was about Louis Pasteur and his quest to develop the rabies vaccine.

That book still stands as my most cherished source for the science of immunity. Even with a bachelor’s degree in biology, a career spent working in scientific and medical research and a current job in the immunology department of a prestigious graduate school, I still picture all viruses as scruffy black blobs with scary pink faces and foaming fangs. And vaccines are the steadfast soldiers in uniform with huge mustaches and bayonets that are sent in to get the bad guys. How on earth could anyone be more scared of the soldiers than the black blobs?

I have kids. I know all about fear. Those first days with my oldest daughter were magic, but it was a dark magic. It came with visions of this tiny creature I was now in charge of falling off my lap as I breast-fed or rolling face-first into a crib bumper. I imagined a hundred ways she could be injured or worse — and I imagined all the ways it would be my fault.

I went straight to my local Isis Maternity (a wonderful organization that no longer exists) and signed up for new mommy classes. Those classes were an education for me, not in what to do as a new parent, but what not to do. All the women I sat criss-cross applesauce with were lovely, caring, engaged moms who were genuinely searching for the best way to rear happy, healthy child. And every single one of them was irrationally afraid of one thing. And those “things” were all different. Continue reading

How To Talk To Parents Who Oppose Measles Vaccines? We Don’t Know

In this Jan. 29 photo, pediatrician Charles Goodman vaccinates 1-year-old Cameron Fierro with the measles-mumps-rubella vaccine, or MMR vaccine, at his practice in Northridge, Calif. The measles outbreak that originated at Disneyland in December has prompted politicians to weigh in and parents to voice their vaccinations views on Internet message boards. (Damian Dovarganes/AP)

In this Jan. 29 photo, pediatrician Charles Goodman vaccinates 1-year-old Cameron Fierro with the measles-mumps-rubella vaccine, or MMR vaccine, at his practice in Northridge, Calif. The measles outbreak that originated at Disneyland in December has prompted politicians to weigh in and parents to voice their vaccinations views on Internet message boards. (Damian Dovarganes/AP)

Suddenly, measles is political. The Disneyland outbreak has turned the long-simmering issue of parents who decline vaccinations for their kids into a political hot potato, to the point that the New York Times just did a round-up of where potential presidential candidates stand on vaccination. (Classic Hillary Rodham Clinton tweet: “The science is clear: The earth is round, the sky is blue, and #vaccineswork. Let’s protect all our kids.”)

My thought: Great. The topic is already rife with fear and anger and parental conflict, and now we’re adding politics? And I wondered: Is there, in fact, a known way to discuss vaccine resistance constructively? When a pediatrician faces a hesitant parent, or when I encounter a parent in my community who fails to get a child vaccinated?

I asked Dr. Barry Bloom, an infectious diseases expert at the Harvard School of Public Health, who co-authored an editorial in the journal Science — “Addressing Vaccine Hesitancy” — and was also recently featured here: “Talking The Talk On Vaccines.” His reply:

One of the amazing things is that we don’t know the answer to your question. I chaired a meeting at the American Academy of Arts and Sciences on the subject of trust in vaccines. We brought in lots of people — from state governments, doctors — to find the answer to your question: What do we know about how to persuade people that it is in kids’ best interest to protect them against diseases they’ve never seen?

My take is that the answer is two-fold:

One, not everyone is the same. There are a myriad of reasons that people give when questioned about why they don’t vaccinate kids, or delay vaccinations. So there’s no one-size answer that will fit all.

The vast majority of people listen to their doctors — they’re very important — and they do what is recommended because they believe doctors wouldn’t want to harm their kid.

Then there’s a very small group of people who, for a variety of ideological, certainly not scientific, reasons, are opposed in any manner, shape or form to being told what to do, to having government make requirements for school entry, and so on.

The third part of that is people who are responding to discredited publications claiming that vaccines cause bad things to happen. I have to say when I saw one of the physicians in Congress, Rand Paul, say that he had heard vaccines cause neurological or psychological damage, I was absolutely stunned, because there’s no data to support that whatsoever. Continue reading

Why You Really Need A Flu Shot (Even Though The Vaccine Isn’t Great)

(WFIU Public Radio/Flickr)

(WFIU Public Radio/Flickr)

By Richard Knox

This flu season is shaping up to be a bad one. And this year’s vaccine doesn’t work very well against the most common flu virus going around. So should you even bother getting a flu shot?

Yes. Putting it a different way: My wife, my daughters and I will. And the evidence says you’d be somewhere between slightly foolish and dangerously blasé if you don’t — depending on your personal risk factors.

I know there are naysayers — the Internet is full of them. “I recommend that my patients of all ages not take these incessantly promoted immunizations, primarily because of their lack of effectiveness,” writes blogger Dr. John McDougall. He says he’s not one of those across-the-board vaccine deniers but just doesn’t think flu vaccines (of any given year) are worth taking.

To understand why I think he’s wrong — even this year, when vaccine effectiveness is expected to be even lower than usual — you need to know something about the situation we’re all in.

Several viruses circulate during any given flu season. And flu viruses are always changing — sometimes not so much from year to year; sometimes in a bunch of little ways (a phenomenon called genetic “drift”); and sometimes in a big, sudden way, called a “shift,” which touches off pandemics.

Drifts Or Shifts?

Public health researchers constantly monitor flu virus mutations. But even the smartest flu dudes can’t know in advance when they’ll happen, or whether mutations will be drifts or shifts.

This year, one of the flu viruses outwitted them. Or, since viruses can’t have intentions, it’s better to say that random genetic drift in that viral strain, called H3N2, happened in late March. That’s a bad time in the annual cycle of vaccine production.

Just a few weeks earlier, leading flu specialists gathered at the World Health Organization in Geneva and decided that this season’s vaccine (for the Northern Hemisphere) should contain the same viruses as last year’s — two type-A viruses (an H1N1 that caused the pandemic of 2009 and has stuck around since, and an H3N2 that first appeared in Texas two years ago) and two type-B flu viruses.

Late-Breaking Mutant

Making each year’s flu vaccine is a complicated business that waits on no virus. The recipe has to be decided in February to get the chosen viruses growing in hundreds of millions of special chicken eggs, the first step in vaccine production. Continue reading

Not Kitten Around: Cat Vaccine May Someday Treat Allergies In Humans

Belal Khan/Flickr

Belal Khan/Flickr

By Nicole Tay
CommonHealth Intern

I love cats.

Unfortunately, feline biology doesn’t quite agree with my own. So, while I would love nothing more than to snuggle up to an adorable furball of histamines, my itchy eyes and swelling throat protest. Like me, an estimated 10 percent of the population is allergic to cats — more specifically, allergic to the fel d 1 protein found in a cat’s saliva and sweat. This protein accounts for about 95 percent of all allergic symptoms in cat-sensitive humans.

The normal function of fel d 1 remains unknown, however, in humans. It can trigger an allergic (itchiness, sneezing, hives, etc.) or even asthmatic immune response. Through the cat’s regular self-grooming, the protein spreads all over the animal’s fur, which in turn ends up, well, everywhere.

But researchers at the Swiss company HypoPet, in partnership with U.K.-based Benchmark, may someday offer relief for us allergy-prone cat lovers. In a recent news release, Benchmark announced the development of a new cat vaccine which targets and neutralizes the fel d 1 protein. Continue reading

A Surprising New View Of Flu: Rethinking The 1918 Pandemic

Giving treatment to influenza patient at the U.S. Naval Hospital. New Orleans, Louisiana, Circa 1918. (Navy Medicine/Flickr)

Giving treatment to influenza patient at the U.S. Naval Hospital. New
Orleans, Louisiana, Circa 1918. (Navy Medicine/Flickr)

By Richard Knox
Guest Contributor

Ever since 1918, the world has wondered why a novel flu virus touched off an explosive pandemic that killed as many as 50 million people – most of them healthy young adults — and whether it could happen again.

Flu researchers today report some surprising news: They say the 1918 virus was no super-bug. Instead, its deadliness had to do with how very different it was from the flu viruses circulating 25 or 30 years before, when the young adults of 1918 were first exposed to the flu.

Indeed, the new study says it’s that first childhood exposure that determines how people will fight off – or fall prey to – every other flu virus they will encounter in a lifetime.

That’s a very different way of looking at flu, both pandemics and regular seasonal outbreaks.

Much of the current emphasis is on the virus itself. Scientists around the world are doing controversial “gain-of-function” experiments – adding and subtracting pieces of genes from flu strains to see what mutations make some viruses so virulent.

Instead of focusing on flu virus itself, authors of a paper published Monday in the Proceedings of the National Academy of Sciences say scientists and public health experts should pay attention to the vulnerabilities of different age groups to any new flu virus – and how those immune gaps might be filled in by targeted vaccine strategies.

“Childhood exposure seems to give kick-ass immunity to that kind of flu virus for many, many decades,” says evolutionary biologist Michael Worobey of the University of Arizona, the paper’s lead author. Continue reading