Week 10 + 11; Day 28-33
Week 10 + 11; Day 28-33 Biology 233
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Week 10 Week 9; Day 27 4/8/2016: no notes. EXAM 3: Day 28 4/11/2016: The 1918 Flu Project Pedagogy And Findings: 1918 Influenza Virus In The News During The Time Of This Study. What Was Unique About The 1918 Spanish Flu?: ● It killed 2040 year olds. ● It killed fast (23 days). ● Hemorrhagic symptoms. Oshkosh, Wisconsin in 1918 population: approx. 33,000. ● World War I was going on. ● Soldiers were getting ready to be sent by ship to the war. ● Maybe some of the people who were in the prime of their lives were not as healthy as we thought. ● No immunity = a really bad disease. ● The first soldier that died in WWI did not die by spanish flu. ● Dr. Lockhart: a doctor at what is ca“Winnebago Mental Health” today. ○ In the past, it was cal“Northern Insane Asylum.” 1918 “Spanish” Influenza Pandemic : ● Estimates range from 2150 million people (WWI took 9 million lives). ● True members can never be known. ● Many places that were bludgeoned by the flu did not keep mortality statistics. ● Even in the U.S. efforts at tabulating deaths were complicated by the fact that there were no definitive tests in those days to confirm flu. ● Spread faster than any plague in history. ○ Took 7 days to sweep across America. ○ Took 3 months to sweep around the world. How Deadly Was It? : ● Killed more people in less time than all the plagues in history. ● In Alaska, 60% of the Eskimo population was wiped out. ● Islands in the South Pacific (where respiratory illness is uncommon and nonlethal lost 20% of their populations. ● 25x more deadly than other influenza viruses. ● Killed 2.5% of its victims (normally 0.1% of those who get the flu die). THIS NUMBER IS WRONG SO DO NOT MEMORIZE. Where Did It Come From? ● Experts Discuss Two Waves Of Influen : ○ Wave 1: ■ Tourist Season, San Sebastian, Spain, February, 918: ● Nothing alarming, 3 days or so of fever, aches and pains. ● Highly contagiousnearly everyone exposed, became ill. ● Seemed to strike young, healthy adults. ■ The rest of the world fell ill. The name of “Spanish Flu” may have stuck because Spain did not censor its news reports, unlike other European countries. Spain’s flu, was no secret. ○ Wave 2 At Nearly The Same Ti: ■ U.S. Army Base, Midwest (Fort Riley, Kansas), March 918: ● Spread to Europe. ● 15th U.S. cavalry. ● In the lungs of soldiers headed for WWI. Oshkosh, Wisconsin knew the flu was coming. Influenza was/is airborne. Timeline Of Influenza Epidemic Oshk sh: ● The worst month is October. ● October 5:10 casereportedatient zewas a young man who grew up in Oshkosh. He was livingIllino as a car maker. He was 1819 years old and decided to join the army. ● October 7: First 2 deaths. ● October 10:63 casereported. Flower shortage. Library was closed. ● October 15 440 casereportedanin effect: no public gatherings (funerals, meetings, saloon, restaurant curfew). ● October 26: Many vaccinated with Anthnfluenza serum from Mayo hospital. ● October 31: Whiskey gets inning. Said to be effective against Influenza. ● November 2: Ban to be lifted soon. Situation 014 cases to da . Oshkosh, Wisconsin Armistice Day November 11, 1918. ● The war was coming to an end. ● Everyone was so excited about this, that they forgot about the flu that was going around. Timeline Of Influenza Epidemic Oshk sh: ● November 11: “Terms Of Armistice.” Oshkosh got up early to show joy at the good news. ● November 12: Pease parade big. Spirit runs high. ● November 15: Flu cases growing. ● November 23: City keeps lid on. Closing ban remains. ● November 25: Now it is smallpox 12 cases quarantined. ● November 29: Disease is abating, ban will be lifted. ● November 30: Influenza ban lifted. ● December 3: Schools reopen. Attendance was about 75%. ● December 11: Total cases to d083 ● December 18: Flu climbs up a bit. ● December 24: Raise of smallpox ban. ● December 26: Epidemic is getting weak. Bio 315 (Virology) Undergraduate Assignmen : ● Use of death certificates, newspapers, diaries and school yearbooks. ● Students would draw from a hat and give the story for the one in which they picked. LOL Letters ● “Little Old Ladies.” ● Letters sent to our professor from survivors of Influenza. Cytokine Storm: ● A potentially fatal immune reaction consistositive feedback lobetween cytokines andimmune cell, with highly elevated levels of various cytokines. In the lungs, fluids and immune cells suacrophages may accumulate and eventually block off the airways, potentially resulting in death. Healthcare workers at risk for contracting the flu. Morbidity/Mortality Rates Spanish Influ nza: ● Winnebago City Deaths 182 ● Other “Probable Deaths” 46 ● WWI Soldiers: 56; Half of these died in camps. ● Winnebago City Cases/Newspaper Record: 2083 ● Winnebago City Cases/Public Health Recor: 100 Public Health Records Register Of Reports Of Contagious Disease Winnebago Co: ty ● Number Of Cases And When: ○ November 1918: 100 ○ December 1918: 0 ○ January 1919: 7 ○ February 1919: 7 ○ March 1919: 0 ○ April 1919: 0 ○ May 1919: 0 ○ June 1919: 0 ○ The reportings/ers were not very good. Numbers Of Influenza Related Deaths At Hospital In Winnebago County : ● Alexian Brothers Hospita: 1 ● Emergency Hospital: 4 ● MercyHospita 7 ● Northern Hospital (Insane Asylum) 15 ● Saint Mary’s Hospita: 5 ● Southside Hospital: 2 ● Sunny View Isolation Sanitarium: 3 ● Theda Clark Hospital (Neenah): 17 Day 29 4/13/2016: The 1918 Flu Project Pedagogy And Findings Continued: For Exam: Symptoms. Difference between this flu and regular flu. Incubation period. Infectious dose = 1,0002,000 particles. 1918 Spanish Influenza In The U.S: ● Killed 675,000 Americans. ● 4.39/1000 National Average. U.S. Records: ● March, 1918 Ford Motor Company: ○ 1000 workers called in sick with the flu. ● AprilMay, 1918 San Quentin Prison: ○ 500 to 1,900 prisoners. Flu Remedies/Pharmacists : ● Dr. Perry W. Dought, Stout, WI. ● 1918 Day Book And Financial Records. ● August: 35 prescriptions. ● September: 55 prescriptions. ● October: 293 prescriptions. Profit was the highest in this month. ● November: 176 prescriptions. ● December: 120 prescriptions. The Deadly Strain Returned The Following Year In Oshkosh: ● During the months of Jan. and Feb. 1920, there was 49 Influenza related deaths in Winnebago City. ● 31 of these were Oshkosh residents. ● The 1920 Influenza produced the same deteriorating physical effects as in 1918. You can survive 3 minutes without air (on average). 3 days without water. And 30 days without food. *KNOW FOR TEST* Cycle Of Avian Influenza Viruses In Animals: Shore Birds → Waterfowl → Domestic Birds → Mammals (primarily swine) → Humans. Mortality Rate: 5060%, within 12 weeks after onset of symptoms. Day 30 4/15/2016: Microbes In The News Update Elizabethkingia Case In Illinois ● Claimed lives in Wisconsin, Michigan and Illinois same strain in all states. ● Elizabethkingia found in soil and water. ● Investigators now interviewing family members. ○ Communityacquired infection. Chapter 10 Viral And Prion Diseases: The Influenza pandemic of 1918 killed 50 to 100 million people worldwide in a single year. Biology Of Influenza ● Influenza symptoms are coldlike, with headache, high fever, muscle pain, severe cough, and congestion. ● The disease usually disappears within 2 weeks. ● Infects humans and other species, including seals, dogs, pigs, and birds (particularly ducks). Transmission of Influenza: ● Transmitted through droplets/aerosol. ○ Sneezing, coughing. ● Fomites play a secondary role. ● Conditions of cooler temperatures and low humidity favor transmission. ● Crowding, close intermingling favors transmission. ○ Example: nursing homes, classrooms, army barracks. ● Infectious Dose: inhaled 1,0002,000 viruses. ● RNought (how many more people are going to get sick) : 13. Influenza Strains And Vaccines ● Influenza has two types of surface antigenic protein spikes. ○ H (hemagglutinin)spikes attach the virus to epithelial cells of the respiratory (sialic acid) mucosa and aid in viral entry into these cells. ○ N (neuraminidase)spikes play a role in the release of new virions from cells. ● 3 Types/Categories Of Influenza Viruse : ○ Influenza A: ■ Causes epidemics and pandemics. ■ Infects animals, birds, humans, etc. ○ Influenza B: ■ Less severe, causes epidemics, no animal reservoir. ○ Influenza C: ■ Causes mild respiratory illness in humans. ● Influenza surface antigens undergo two types of antigenic change. ○ Antigenic Shif (type A only): a major, abrupt antigenic change in the H or N spikes; results from the recombination of genetic material from cells infected with different viral strains creates a “new” Influenza strain. ○ Antigenic Drif: results from the slow accumulation of mutations affecting the antigenicity of H and N antigens. Specific antibodies against the H and N proteins are protective, but these proteins are capable of rapid evolutionary change. Antigenic shift results in rapid evolution of new strains of Influenza virus. Influenza Strains And Vaccines Continued: ● Influenza Antiviral Drugs: ○ Block Influenza neuraminidase activity. ○ Must be taken within 48 hours after symptoms to reduce severity of illness. ● Zanamivir (Relenza/injectio FDA approved. ● Oseltamivir (Tamiflu/pill fo, FDA approved. ● Peramivir, Emergency approvalduring H1N1 pandemic of 2009. The Coming Flu Pandemic?: ● Antigenic shifts of Influenza A. ● Johan Hultin. ● 1918 Influenza research. ● Why so deadly? The First Flu Pandemic Of The TwentyFirst Century: ● Major pandemics occurred in 1918, 1957, and 1968. ● Pandemics happen every 3040 years. ● The world currently faces the threat of a potential pandemic. ● 2009 H1N1 swine influenza pandemic. ○ Epicente Mexico. ○ AprilDecembe: 208 countries. ○ Deaths in U 7,500 to 12,000. Week 11 Day 31 4/18/16: Microbes In The Ne : ● Earthquake in Japan. ● 7.2 magnitude. ● 42+ dead. ● 1000+ injured. ● What infectious diseases will surface? ● InfectioTriangl AIDS: ● AIDS acquired immunodeficiency syndrome. ● Caused by thuman Immunodeficiencvirus (HIV). ● Appeared in CDC’s Morbidity and Mortality Weekl982 ort in 1 ● Ispandemic, has spread throughout the world, particularly in Africa. ● Diagnosed By Certain Signs And Symptoms: ○ HIV positive. ○ Low CD4+ (helper T cell) cell count (below 200). ○ One or morepportunistinfection(bacterial, viral, protozoal, and fungal). ○ Swollen lymph nodes, sudden weight loss, and a rare vascular cancer called Kaposi’s sarcoma (caused by herpes v us). Biology Of HIV: ● HIV is a retrovirus. ○ Its RNA genome reversetranscribeinto DNA. ○ New virus particles are released from udding by b ○ At least Two Types Of HIV: ■ HIV: is the most common cause of AIDS worldwide. ■ HIV: is the most common cause of AIDS in West Africa. Origins Of AIDS: ● Genetic studies link HIV to the chimpanzee Pan troglodytes. ● The first welldocumented case of AIDS occurred in an African man in 1959; he was diagnosed decades after his death. ● Two Researchers Claimed Discovery Of HIV: ○ Luc Montagnier of the Pasteur Institute in Paris. ○ Robert Galloof the National Institute of Health. ● The 2008 Nobel Prize in Physiology or Medicine was awarded to Montagnier and his colleague Francoise BarreSinoussi. Transmission Of AIDS: ● HIV can be transmitted in five ways: ○ Sexualcontact with an infected partner: male to male, male to female, female to male, or female to female. ○ Contact with contaminated blood or blood products. ○ Sharing bloodcontaminated needles and syringe as with IV drug use (high frequency of transmission) or by accidental needle stick in health provider (0.5% risk of transmission). ○ Transmitted from mother to child: ■ Through passage of HIV across the placenta (about a 25% risk of mother does not take antivirals, 2% risk if mother on antivirals). ■ Transmission to child via contact with contaminated blood and secretions during birth. ■ Transmission via breast milk containing the virus. ○ Premastication pre chewing food for infants (does not happen in the U.S.). AIDS The Disease: ● HIV depletes the number of Thelper cells, resulting in the individual’s becoming immunocompromised and vulnerable to opportunistic diseases caused by an array of microbes. ● HIV positive individuals, with rare exceptions, progress to clinical AIDS over an incubation period that can vary from a few years to 15 years or longer. ● The CDC describes four stages to HIV infection: ○ The prodromalstage is characterized by fever, diarrhea, rash, aches, headaches, lymphadenopathy, and fatigue, lasting a few weeks to a few months. ○ The latencyperiod, which can last from two to fifteen years (av: 10 years); persons may be asymptomatic but they can infect others and usually have detectable antiHIV antibodies in their blood. ○ The lymphadenopathy, with swollen lymph nodes, recurrent fevers, night sweats, persistent diarrhea and cough, extreme fatigue, possible neurological impairment, and opportunistic infections. ○ Conversion tAIDS; death is likely within a few years, repeated opportunistic infections result as the immune system is severely weakened with the CD4+ Tcell count dropping below 200. OpportunisticInfection ● Mycobacterium TB. ● Herpe Simplex Virus. ● Cytomegalovirus. ● VaricellaZoster Virus. ● EpsteinBarr Virus. ● Pneumocystis Jirovecii. ● Candida Albicans. ● Mycobacterium Avium. Cause Of AIDS: ● Evidence That HIV Causes AIDS (Based On Koch’s Postulates): ○ 1.pidemiologicaassociation: the suspected cause must be strongly associated with the dis(virtually all AIDS patients are HIV+). ○ 2.Isolatio: the pathogen can be isolatedand propagatedoutside the host (true in virtually all AIDS cases tested). ○ 3.ransmissionpathogenesis: transfer of the suspected pathogen to an uninfected host, human, or animals results in disease idemonstrated in accidental infection of laband healthworkers, blood transfusion recipients, children of HIV+ mothers, etc.). ○ 4.Reisolat: the pathogen must be reisolated from the infected host and be identical to the original patrue in AIDS cases tested). AIDS Treatment And Prevention: ● Treatment: ○ Despite great cost and effort in AIDS research, the goals of prevention and cure will not be met in the near future. ○ To prevent or cure AIDS any drug or vaccine must interfere with some aspect of HIV’s life cycle. ○ AZT (the first clinically safe and effective antiHIV drug) inhibits the reverse transcriptase and blocks synthesis of DNA from RNA. ■ AZT resembles a building block of viral DNA synthesis, and when it is mistakenly used by the virus DNA synthesis stops. ○ ProteaseInhibitor are approved for treating HIV infection and act by interfering with the processing of viral proteins used in assembly. ○ TheAIDS cocktai” or highly acute antiretroviral therapy, uses two reverse transcriptase inhibitors and one protease inhibitor. AntiHIV therapies target HIV adsorption, entry of reverse transcriptase, assembly of new virions, etc. Day 32 4/20/16: Charlie Sheen: ● November 17, 2015. ● Diagnose approx. 2010. ● Revealed HIV status. ● Today SHOW interview with Matt Lauer. HIV And Seniors: ● Growing problem. ● Sexual performance meds= seniors having sex. ● Symptoms Of Aging Mimic AIDS: ○ Fatigue. ○ Pain. ○ Night sweats. ○ Infections. ● Doctors may not think to test for HIV. ● Remember we watched: Dirty Bird Special (supplemental video). HIV Epidemic In Small Town Austin Of Indiana: ● Over 180 cases (Austin pop appro. 4,200). ● Linked to injection drug use. ● Generations of families inject Opana or heroin together. ● WORST HIV epidemic in state history. ● Many reusing needles 300 times. ● Tied to people injecting liquefied form of a painkiller Opana. ● Governor has authorized a needle exchange program. ● Needleexchange program available for one year to try to reduce the number of HIV infections about 80% of cases also have HCV infection (hepatitis C virus). This Can Happen Here!: ● Winnebago county. ● 5 people died over weekend of February 67th, 2016. ● Heroin overdose. ● 4 men, 1 woman. ● Two in 30s. ● Three in 50s. ● City of Rockford. UW Oshkosh Campus: ● December 17, 2016. ● Former UW Oshkosh football player Dexter Charles. ○ Delivered the heroin that killed Oshkosh woman. ● Charged with homicide by heroin. ○ May, 2014 overdose of 22 year old Oshkosh woman Deanna M. Lake. AIDS In Africa, Caribbean, Eastern Europe, And Central Asia: ● Since the late 1970s, over 20 million Africans have died from AIDS. ● AIDS has left millions of children orphaned. ● Life expectancy in some African countries is less than 40 years. ● Hospital wards are overburdened. ● AIDS victims may be told to “go home and die,” because there are no drugs to help. ● In 1992, Brazil started producing its own AIDS drugs and distributing them free of charge. ○ Government laboratories now produce at least five AIDS drugs. ○ The number of AIDSrelated deaths in Rio de Janeiro and Sao Paulo, the country’s hot spots of AIDS has plummeted. ● The Caribbean has the second highest HIV prevalence after subSaharan Africa. ● New infections in the Caribbean region decreased by 25% in the Dominican Republic and Jamaica and by 12% in Haiti. ● Decline associated with HIV prevention services for pregnant women. ● Regions in Eastern Europe and Central Asia do not fit the pattern of decline or stabilization of HIV infections. ● The number of people living with HIV in Eastern Europe and Central Asia rose 250% from 2001 to 2010. ● Russian Federation and the Ukraine have the fastestgrowing number of HIV cases. AIDS In The United States: ● The U.S. has one of the largest populations of HIVinfected in the world. ● The annual number of new infections remains relatively stable. ● As of March, 2012: ○ 1.7 million people in the U.S. have been infected with HIV since the start of the epidemic in 1981. ○ 619,000 have died. ○ 1.2 million people living with HIV by the end of 2008. ■ 61% among men who have sex with men. ■ 46% of those living with HIV in the U.S. are African Americans. ■ 1 in 5 people do not know they are infected with HIV. The Future Of AIDS: ● We do not know when the AIDS epidemic will end or when an effective AIDS treatment or vaccine will be found. ● Active research in all phases of HIV infection and AIDS is under way, sponsored by the private and public sectors. HIV and Influenza are discussed in Chapter 16 (current plagues). Gastroenteritis: ● Gastroenteritis is characterized by stomach and abdominal pain, diarrhea, vomiting, and abdominal cramps. ● Rotaviruses: *NOT ON TEST* ○ About 200,000 ER visits a year in the U.S. ● Noroviruses (Norwalk and Norwalklike viruses: ○ Infectiousdose< 10 viral particles. ○ Viruses can persist in the environment. ○ Naked viruses = no envelope. ○ Viruses continue to be shed after recovery. ○ Outbreaks associated with cruise ships, food service workers, hospitals, etc. ○ There are many different strains. ● Hepatitis A: ○ Usually mild and selflimiting, with an abrupt onset. ○ Unusual, as recovery is usually complete without chronic infection. ○ Transmission is by the fecaloral route, from contaminated food and drinking water. ○ Approx. 50% of cases are subclinical. ○ Good handwashing and sanitation is most effective at control. ○ Diagnosis is based on detection of antibodies in the blood. ○ No specific treatment, but a vaccine is available. Day 33 4/22/16: Gastroenteritis: ● Most cases of polio are asymptomatic, but a small number result in paralysis. ● Replication in nerve cells causes paralytic poliomyelitis and limb deformities. ● Transmission is from person to person, direct fecaloral contact, by indirect contact with infectious saliva or contaminated water. Airborne Viral Diseases: ● Usually spread through respiratory droplets from an infected person to a susceptible person. ○ Respiratory syncytial virus (RSV). ○ Common cold. ○ Measles. ○ Mumps. ○ German measles (rubella). ○ Chickenpox and shingles. ○ Hantavirus pulmonary syndrome. ○ Severe acute respiratory syndrome (SARS). ○ Smallpox. ○ Influenza covered in Chapter 16 (current plagues). Respiratory Syncytial Virus (RSV): ● Highly contagious anndemic worldwide. ● RSV is the common cause of two serious respiratory diseasronchiolitand pneumonia and is lifethreatening to infants with preexisting lung or heart conditions. ● The symptoms of the infection are nonspecific (fever, runny nose, ear infection, and pharyngitis). ● Outbreaks are a threat in pediatric wards and in nurseries. ● Frequent and careful hand washing decreases the transmission. ● Treatment is largely supportive, and oxygen therapy may be necessary in some cases. ● The antiviral drribaviri may be administered as an aerosol. ● There is no vaccine. Common Cold: ● About half of all colds are caused by two RNA viruses: ○ Rhinoviruses ○ Coronaviruses. ● Symptoms are sneezing, coughing, sore throat, stiffness, and malaise. ● Within some viral groups there may be over 100 different strains. ● Transmission is by droplets and fomites (hands, doorknobs, etc). ● Most cold viruses possess mechanisms for attachment to nasal passages. ● Diagnosis of a cold is symptombased. ● The illness is generally mild and selflimiting. Figure 10.06. Enterovirus diseases during the summer time. They are “naked”. Table 10.02 STUDY FOR EXAM. Measles (Rubella), Mumps, And German Measles (Rubella): ● Each is of these childhood illnesses is caused by a specific RNA virus in the Paramyxoviridae family. ● The MR vaccine was introduced in 1968. ○ MMR consists of a mixture of live, attenuated measles, mumps, and German measles viruses. ○ The vaccine has drastically reduced the incidence of these diseases, but immunization remains necessary to maintain herd immunity. Measles (Rubeola): ● Highly infectious; humans are the only reservoir. ● Transmission by respiratory droplets, exacerbated by: ○ Overcrowding. ○ Low levels of herd immunity. ○ Malnutrition. ○ Poor medical care. ● Symptoms are coldlike, with the early developmeoplik’s spotin the mouth followed by a red rash on the face that spread to the extremities and most of the body. ● Measles is usually mild and selflimiting, but one in 500 children develops potentially fatal complications, including pneumonia, ear infections, brain damage, and seizures. ● It is a significant cause of death in developing countries. ● Immunity from infection is lifelong, and lasts 20 years. ● MMR controversial vaccine. ● Andrew Wakefield: lead researcher of the 1he Lancetreport suggesting MMR vaccine caused autism. ● The Lancet report was retracted in 2012. ○ Wakefield was found guilty of unethical medical practice and scientific misconduct. Mumps : ● Humans are the only natural hosts for the virus. ● Most commonly infects children under the age 15. ● Infection of tparotid glancauses a large swelling on one or both sides of the face. ● Many children are asymptomatic. ● The virus can spread to the testes, ovaries, meninges, heart, and kidneys. ● COmplications (rare) include sterility (males) and deafness. Rubella (German Measles): ● A highly infectious RNA virus, it is the mildest rashforming virus. ● Endemic worldwide. ● Transmitted usually by respiratory secretions (urine also). ● Asymptomatic carriers may transmit the virus. ● The characteristic rash starts on the face and progresses down the trunk and to the extremities; it resolves in about three days. ● Prenatal transmission of rubella can cause cardiac lesions, deafness, ocular lesions resulting in blindness, and mental and physical retardation. ● Immunization has been very successful, declared eradicated from the United States in 2004.
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