Zika: Emergence of a New Epidemic

Electron micrograph of Zika virus particles.

Electron micrograph of Zika virus particles.

You’d have to be living under a rock for the last few weeks to have missed the fact that a new virus—called Zika—has been making headlines. In reality, Zika is not a new virus at all, however its effects in the last six months in Brazil and other south American countries has been utterly alarming. Worst, one of its most terrible of its outcomes strikes the most fragile of us—unborn infants.

The Zika virus was discovered in 1947 in the Zika Forest in Uganda. It is one of a number of viruses in the Flaviviridae family which includes dengue virus and West Nile virus. By far, the main method of transmission is via the mosquito Aedes aegypti, therefore the areas of mosquito-borne Zika infection follow the natural distribution of Aedes aegypti in an equatorial band around the planet. Historically, disease caused by Zika has been considered mild and mostly trivial with four out of five infected people never knowing they were ever infected. Those who develop symptoms usually present with a low grade fever, joint and muscle pain, and headaches lasting from approximately two to seven days. Since there is no effective medicine or vaccine, symptoms are treated directly—rest, plenty of fluids, and acetominophen to ease the aches and pains. For most patients that is sufficient, and severe disease and death were extremely rare.

However, a disturbing picture emerged from Brazil last November when the news broke that 4,000 babies had been born in 2015 with microcephaly—a birth defect in newborns with abnormally small heads and incomplete brain development. Compared to the normal average of 150 babies born with microcephaly in a single year, this is a staggering increase. While we’re still waiting for definitive evidence that this increase is due to the Zika virus, Zika was first identified in the country in May of 2015, and some pregnant women at the time showed evidence of the virus’ RNA genome, leading public health officials to infer that Zika was responsible. Late last week, Columbia reported three people who died of Guillain-Barré syndrome—a disorder where the body’s immune system attacks the peripheral nerves causing muscle weakness and paralysis—following Zika infection.

Recently, the World Health Organization took the significant step of defining Zika as a ‘Public Health Emergency of International Concern’. However, it is difficult to make recommendations about Zika since the virus is not well studied. Less than 200 scientific papers mention Zika, only a handful of which are notable for significant information. And the fact that so much is still unknown—all methods of transmission, life cycle of the virus, where it replicates inside the body, and what body fluids it can be found in and for how long—ties the hands of public health officials who are trying their best to prepare people on how best to protect themselves. The virus has been found in saliva, blood, semen, and urine, leading to warnings about sexual transmission, pregnant woman kissing anyone other than their partner, and to blood banks setting restrictions on blood donations in a window following travel to Zika-ravaged countries. Some countries, like El Salvador, have even suggested to women that they refrain from getting pregnant for the next two years, a difficult issue in a Catholic country where most methods of birth control are forbidden. At this point, the main preventative strategy is to avoid travel in the twenty-six countries with documented Zika infections. If not, avoidance of mosquito bites is the next best thing, by using bug spray, wearing long sleeves and pants to cover the skin, and sleeping in rooms with window screens or air-conditioning.

This story has struck a personal note in my day job as a manager of an infectious diseases lab. Flaviviruses are one of our main areas of study, with past projects including major NIH studies of both West Nile and dengue fever. In fact, dengue virus is carried by the same mosquito as Zika, opening up the possibility of co-infection or super infection (infection of a second virus following infection of the first). While the West Nile study was of North American cases, the more recent dengue fever study involved cases and controls from Central and South America and southeast Asia. Currently, we’re looking at the tens of thousands of samples in our freezers from that study and wondering how many of them might also contain Zika. Discussions are already well under way and we hope to join the fight against Zika very soon. We’re certainly better situated to hit the ground running than most labs considering our existing sample bank, and we have high hopes that we can make a meaningful contribution.

So where do we go from here? First and foremost, remember all the public health agencies are doing their best to keep people safe. It’s a damned if you do and damned if you don’t situation—people will be upset if recommended precautions seem too severe, or if they turn out to be too lax as additional information is discovered.  They’re doing their very best based on extremely limited information. And while for the majority of people, Zika is not likely to be a major health concern, for the sake of those that are more significantly affected, it behooves us all to be diligent to protect the vulnerable.

Photo credit: Wikimedia Commons

Happy Canada Day and a Summer Hiatus

Hello and a happy Canada Day from beautiful Massachusetts!

I hear you cry—you’re in the the U.S. on Canada Day? Yes, my daughters and I are currently in Massachusetts on a research trip for the fifth book in the Abbott and Lowell Forensic Mysteries. And thus begins my summer hiatus from blogging as we take some time off to travel and research, and then as I launch back into the current manuscript because my end-of-summer deadline is starting to tick rather loudly. So I’ll be taking the month of July off from blogging as I concentrate on my writing. But I’ll be back come the first week of August.

Have a great month and I’ll see you then!

Photo Credit: Jamie McCaffrey

Meet the Dannas!

There’s been a lot of talk this past week about my oldest brother Mychael. Both of my brothers are film composers, but on Thursday morning, Mychael was honoured with two Oscar nominations for his work on Life of Pi– Best Original Score and Best Song. There was a lot of discussion about family talents, so I thought this week it might be a fun break to introduce you to the multitalented Danna family.

It all starts here with Edith and Frank Danna (1932-1978). Born and bred in Winnipeg, they were married in 1955 before moving to Southern Ontario in 1958 with newborn Mychael. A teacher and an accountant by trade, it was their love of the arts that set their children up for success. Both sang (Mom still does; we sing together in a choir), and Dad played the piano and had a love of performing in amateur musical theater. I think it’s fair to say that we owe everything to them—a love of reading that translated into two academics and authors, and our musical talents, enhanced by piano and voice lessons, which led to two professional musicians.

Mychael is the oldest of the Danna children. After earning his B.A. in Composition at the University of Toronto, he went on to work at the McLaughlin Planetarium, compose several New Age albums and begin a career in film composition. With five television shows, more than seventy-five film scores and multiple Genie, Gemini, and BMI Film and Television Awards to his credit, as well as a BAFTA and two Oscar nominations for next month, Mychael has a very impressive career.

And then, of course, there’s his win from two nights ago, when he took home the Golden Globe for Best Original Score for Life of Pi:

Elizabeth is the family languages expert and scholar with a Ph.D. in New Testament Studies from Durham University. She is an active member of the Crossroads Center ministry, and, as part of her academic writing and speaking career, she wrote ‘From Gethsemane to Penetecost: A Passion Study’. She has also assisted Mychael in lyric translations for use in some of his soundtracks.

Brother Jeff is also a composer, and scores a mix of film and live action and animated television. He has eight TV series, over forty movies and several Gemini awards to his credit. His current TV series, Continuum, starts airing on SyFy on January 16th and season two will air in Canada starting in May.

Mychael and Jeff have worked together on many projects, from the TV series Camelot, to their Celtic CDs (Billboard’s Top Ten A Celtic Tale and A Celtic Romance), to several television and feature films.

And then there’s me. As you can see, in a family full of arts majors, I was the odd man out with my science/math degree. But even in the scientist, the artistic spirit was apparently never far from the surface.

The future Danna generation is not without talent as well—a skilled photographer, a stage actor, a biologist (finally someone following in mom’s science geek shoes!), a couple of hockey stars, and a burgeoning piano virtuoso. Look out world, here come the Dannas!

And now it’s time to announce our winner from last week’s Rafflecopter draw of the very first ARC of DEAD, WITHOUT A STONE TO TELL IT. I’m pleased to announce that our winner (picked via random.org) was entry #68—Sherri Mitchen—for her entry on January 12 at 6:47pm! Congrats, Sherri, and enjoy!

Photo credit: Jordan Strauss/Invision/AP

A Writer with a Day Job

I’m going on a bit of a tangent this week and breaking away from my usual theme of forensics and writing to touch on another aspect of my life—my day job. Like many writers out there, writing may be my passion, but I have a responsibility to help my husband support our family financially, so I work full time. I worked in the field of HIV research for 20 years, but last winter my lab downsized, and I started looking for a new position. Last July, I joined a dynamic research group specializing in infectious diseases. We study a range of diseases, including pneumococcal infections and influenza, but our big project is a very large, international study of dengue fever.

In the map above, the areas in blue indicate the current risk for dengue virus infection, and the pins in red indicate areas where the disease is spreading or has been carried by travellers. Currently 40% of the world’s population lives in areas where the virus is endemic, leading to an estimated 50 million cases of dengue fever annually. Of those cases, 500,000 patients require hospitalization and 20,000 – 25,000 patients die of the disease. The virus spreads to humans by two types of mosquitos and the incidence of the disease matches the geography inhabited by these insects. Because of global warming and the northern spread of the Aedes Albopictus mosquito into the southeastern United States, the CDC has classified the dengue virus as a Biodefense Category A pathogen; a category that encompasses the most dangerous of the infectious diseases due to their easy transmission, high mortality rate and lack of effective treatment.

The large majority of patients infected with dengue virus show no symptoms at all or only present with a mild illness including fever, aches, a mild skin rash and joint pain—leading to the colloquial name for this disease: bone break fever. But approximately 5% progress to severe illness, and a subset of those exhibit life-threatening disease (dengue hemorrhagic fever and dengue shock syndrome), including symptoms such as platelet loss, abdominal bleeding, fluid accumulation in the chest, low blood pressure and organ dysfunction. There are four main serotypes of dengue virus, but previous infection with one serotype doesn’t protect you from the other three. In fact, a subsequent infection with a different serotype significantly increases the chances of life-threatening disease. Once infected, there is no effective anti-viral treatment, and all hospital staff can do is keep the patient hydrated.

An electron micrograph showing a cluster of dengue virus particles

The mystery with dengue infection is why there is so much variability in the range of symptoms. Over 80% of those infected have either no symptoms (many don’t even know they’ve ever been infected) or only very mild symptoms. So what causes some people to progress to severe or fatal disease? Our team hypothesizes that there are common genetic variations in certain genes that affect the immune system and how it responds to the infection, and it is these variations that predispose some individuals to dengue hemorrhagic fever. To this end, we are studying over 9,000 participants from 10 international sites including Mexico, Nicaragua, Vietnam, Columbia and Sri Lanka over a 5 year period. We’ll look at the patients’ DNA, RNA and serum to identify variations in their genes and antibodies. Ideally, we’ll find a specific gene or genes that affect the way the body reacts to dengue infection.

The long-term goal in dengue research has always been to produce a vaccine or treatment that will assist those most at risk for serious infection. Hopefully, armed with this information, we’ll be able to drastically reduce the number of 25,000 dead annually.

Photo credit: DengueMap and Wikimedia Commons

The End of a Personal Era

Tomorrow marks the end of an era for me. After working for over twenty years at the university and over nineteen years with my current supervisor, my job is ending due to lack of research funds. It’s difficult financial times for funding currently, and many labs are downsizing in extreme ways. From a lab that consisted of twelve to fourteen staff and students for many years, mine will now be reduced to simply two.

There’s two ways to look at this opportunity. One is negative ― I’m out of a job, which was never part of my long term financial plan. But the other is twofold and purely positive: 1) this is an opportunity to try something new within my field, and 2) while I’m looking for a new position, I’ll have the luxury of being able to write full time.

If I’m honest, it’s the second option that gives me the most pleasure. Family responsibilities dictate that I go back to the working world, at least for now while I’m early in my writing career, but, if money wasn’t an issue, what I’d really love to do is write full time. The thought of being able to buckle down and work exclusively on my WIP brings me great joy. Instead of completing the first draft in three or four months, I could likely have it completed in six weeks, maybe less. I’d also like to spend more time cultivating my craft ― reading more widely, reading more craft books, and simply having the time to let the creativity flow instead of shoehorning it into free minutes and forcing its appearance. I think the quality of my writing will improve given more time to simply breathe. I’d also like to take some time for me and will use this opportunity to be more active, something I’ve had to sacrifice for my writing time for too long.

I’ve worked the same job for twenty years, so the thought of doing something different, while a little scary, is also refreshing. What will the future hold? I’m not sure. But there’s something to be said for an interesting and varied journey.

Photo credit: hpaich

Thanking Those Who Inspired Us

Last Friday, StoryCorps was promoting a National Day of Listening where they encouraged participants to tweet their thanks to any teacher who’d been a significant inspiration in their lives. One particular teacher immediately came to my mind, but 140 characters didn’t seem sufficient to convey the impact she had in my life.

I was at a career crossroads in Grade 13 ― whether to follow the rest of my Bachelor of Arts-oriented family to study the oboe and orchestral music, or to follow my interest in maths and sciences toward a Bachelor of Science degree. Then I had the good fortune to end up in Miss Potts’ Grade 13 biology class.

Miss Potts was a bit of an odd duck, but her students loved her for it. She had two somewhat quirky scientific loves ― sperm cells and mitochondria. If she could find a way to work either into the lesson, she would. During most classes, one or both structures would end up on the black board, usually including five or six feet of wavy sperm tail. She even had a stamp similar to the one illustrated above. If the ‘Beautiful!’ mitochondrion appeared on your test or paper, it was the sign that you’d done exceptional work. Most of all, her passion for biology shone through clearly, and we eagerly absorbed her enthusiasm. Coming to her class always guaranteed an interesting and entertaining lesson. And, through it all, her genuine interest in her students and her love of teaching marked her as the very best kind of teacher.

Miss Potts not only set my feet in the direction of science, but she also made me think seriously about teaching as a profession. In the end, bench research was my calling, but I can thank her for solidifying my career decision, eventually leading to twenty years in the field of HIV research.

So, to Miss Potts, thank you. For all the hours at the bench or at the hood, trying to beat a pathogen that still ravages the planet, destroying lives and families, and leaving millions of children orphaned, thank you. For the second career that developed, taking my love of science and turning it into a professional career writing crime fiction, thank you. It’s unlikely that either would have happened if you hadn’t entered my life.

Who was the teacher or adult who had the most impact in your life? I’d love to hear about how he or she made a difference for you.