Microbiology for Smarties

Last week, I discussed hesitancy towards the miracle that is vaccination. I mentioned how many parents are hesitant to vaccinate their children due to skepticism. This skepticism is due to alleged links made between certain vaccines and cognitive development. This week, I will be discussing the man who is pretty much the literal driving force behind vaccine hesitancy– Mr. Andrew Wakefield.

Wakefield’s Experimental Method

According to a Science-Based Medicine post, Andrew Wakefield is a British scientist who, in 1998, published an experiment in the Lancet paper. Wakefield’s experiment almost instantly triggered the anti-vax movement (which is still a thing people!!) because his “results” “indicated” that the MMR vaccine is “linked” to autism. I use quotes because it turns turns out that his “experiment” was bogus. According to an NCBI post, Wakefield picked and choose the results that corresponded with this hypothesis, had an insignificant sample size, and received bias funding for the project. His paper indicated a close connection between the MMR vaccine and autism, a mental disability resulting in poor cognitive development and communication, in children. This had a big impact on the public because upon the release of this paper, MMR vaccination rates went down, according to the NCBI article. We know from my last blog post that this left a lasting impact that we still see today, over 20 years later. People are skeptical about getting vaccines, causing their rates to go down. Of course vaccines aren’t perfect but I think its completely unacceptable to publish scientific findings and influence the world in a false way. I really have no sympathy for this man lol.

According to his Lancet paper, Wakefield experiment started with a question as to whether historically normally-developed children could get digestive tract inflammation and/or regressive development when given the Measles, Mumps, and Rubella vaccine (MMR). His hypothesis was essentially that an inflamed digestive tract caused by MMR leads to “behavior change in some children”, aka mental issues. His experiment consisted of an insignificant sample size of only 12 children, aged 3-10. He claimed to have compared his experimental results to five colon biopsies of healthy children, around the same age and location of his test children. There was no controlled group studied, meaning no untreated group of children were arranged in Wakefield’s experiment to compare results between treated and untreated children. This makes his “results” that much more inaccurate. Data was collected when monitoring the vaccinated children for months, indicate bowl and behavioral changes that occurred. The children’s physicians and parents observed major changes in behavior, interactions, and mood and this data was recorded. His data indicated general abnormal changes in behavior and bowl months after vaccination. Wakefield then concluded that, indeed, there was a strong positive correlation between MMR vaccines in children and the onset of digestive inflammation and cognitive regression. His hypothesis was correct according to his “findings”. He went on to share this precious information with the world by publishing it to Lancet journal.

Many things about Wakefields experiment, as I mentioned, were both unethical and experimentally wrong. The children included in his study actually all had a history of autism PRIOR to Wakefield’s experiment, according to the Science-Based Medicine article. That means he choose children who literally ALREADY HAD the illness that he was trying to prove that MMR would give them.

An important aspect of many experiments is called a double-blind procedure. A double-blind experiment means neither the participants nor the experimenter knows who is treated and who is not. As you can imagine, this ensures that all results and observations aren’t coming from a preconceived expectation/biases. In Wakefield’s study, this was not the case according to a The Guardian article. Both Wakefield and the children involved knew about the treatment being imposed and therefore were aware of what is “expected” to happen (behavioral changes, etc). If you expect something to happen you will look for it, skewing the accuracy of results! This is yet another factor that makes his experiment not credible. Wakefield, through just one experiment, truly altered the world’s perception on vaccines.

Unless you live under a rock (no shame tho), you have most likely heard about the back and forth worldwide debate about vaccines. Vaccines are shots given in efforts to immunize an individual from certain fatal diseases. Most vaccines introduce the patient’s immune system to a latent or weakened form of a pathogen. When your body is exposed to a pathogen, it will “remember it”, make antibodies, and be able to fight it off if it is ever reintroduced to the body. AKA vaccines help you to not die from some viruses or bacteria.

The controversy lies between two opposing beliefs. Some people think vaccination is a precious innovation and the only route to go. Others are hesitant to give their children vaccines due to their belief of harmful repercussions. Whether you are pro or anti-vax, we can all agree on one thing– we want to live a long and healthy life; the mechanism for such a life, however, is the topic of debate.

The Reason For Hesitancy

The reason why so many people are hesitant to vaccinate their children is because of distrust in the healthcare system. According to a recent NPR article, many parent’s simply do not trust “mainstream medicine” and believe it should be questioned. The article includes an interview between a medical anthropologist and an anti-vax parent. This vaccine-hesitant parent, and I assume most others, does not believe in following the crowd but rather doing research and making decisions based on their best judgement. While I do respect this level of wokeness, when it comes to vaccines and a person’s health, the benefits outweigh the potential harms.

Speaking of potential harms, vaccine hesitation arises from lots of debate regarding potential “side effects”. Autism is the primary concern among hesitant parents who believe there is a link between vaccination and brain development. Medicine has time after time debunked this myth. According to an article on The Hill, there has been no connection found between autism and vaccines (specifically the controversial MMR vaccine). The article mentions that even isolated population-based studies have shown there to be no decline in the rates of autism in the absence of vaccines. Simply, prenatal development and other genetic components cause autism, not a measles vaccine. Still, many skeptical parent’s aren’t taking the chance. Some people even opt out of childhood vaccinations due to religious reasons.

The Comeback of Measles?

According to a recent BBC article, The World Health Organization reports a 30% worldwide rise in the rates of Measles over the past couple years. This is thought to directly correlate with rising hesitancy towards vaccines. This makes sense. Those who have access to vaccines but don’t get them will increase their own risks of the illness (i.e, Measles) and therefore increase the spread to others. In the case of Measles, a life-threatening and extremely contagious viral infection, there has been an increase in incidents in the U.S, Europe, and Russia specifically, according to the BBC article. I believe that those who have access to vaccines, like many of these first-world countries, should take advantage of it! I know these numbers would decrease if only people took advantage of their privileges.

To combat this rising issue of vaccine hesitancy, many small steps must be taken. According to a Frontiers article, media and television is the most effective way to get any word out. I have even noticed stations are make more of an effort to broadcast educational discussions about vaccines in efforts to combat hesitancy. The same article also mentions how millennials tend to be more in favor of vaccines and modern medicine in general, so targeting millennials and getting them on board can be a promising long-term solution to vaccine hesitancy. The article also mentions how Herd Immunity is a huge reason to get more people vaccinated. Getting many people vaccinated can positively impact even those without access to advanced healthcare. In my opinion, it doesn’t matter how much money or effort it will take to promote vaccination, it should be done for the sake of the world as a whole.

For nearly a century, we humans have depended on our secret weapon for cure of many otherwise lethal bacterial infections. Antibiotics, which are naturally produced by bacteria and fungi, are now available to treat countless infections and illnesses associated with harmful bacteria. It’s safe to say that natural and synthetic antibiotics save more lives than Batman ever could. So, you may be wondering, “what’s the issue”? The issue isn’t the antibiotics themselves, it is resistance to them that could potentially diminish all antibiotic effectiveness as we know it.

What Is Antibiotic Resistance?

Antibiotic resistance is a fairly simple concept. Antibiotic resistance, or not being impacted by the antibiotic, can be innate or acquired. Innate means the bacteria naturally have some sort of structural or chemical property that inhibits the action of a certain antibiotic. Antibiotics are used to kill harmful bacteria, and they generally do so very well (if the proper antibiotic is given). Sometimes, however, some of the bacteria the antibiotic is acting against is resistant to the drug. When the few resistant ones survive while the others die, these ones remain and multiply or horizontally transferring their resistant genes (aka conjugation) to others nearby. Thus, a whole village of bacteria resistant to that antibiotic is created. This, and the spontaneous mutation that can randomly occur in bacterial genes, are called acquired resistance. According to a recent BBC article, overprescribing, casually prescribing, and improper use of antibiotics, are all things that can lead to a bacteria strain becoming an incurable superbug.

Resistance is actually a really scary thing. According to the BBC article, there has been a 35% increase in antibiotic-resistant blood infections in England. Over the past four years, England’s cases of sepsis, or bacteria in the blood, have increasingly become harder to treat due to resistance. While this article discusses the UK, the same issue is present in the United States and many other medically-advanced nations. Perhaps if more studies were conducted on alternative treatments or procedures for some bacterial illnesses, we could mitigate antibiotic resistance. If we continue at the rate we’re going, we may never be able to use antibiotics for treatment of deadly infections. The Center for Disease Control, luckily, is advocating for this awareness.

Resistant Organisms

One known resistant organism that is increasing becoming a red flag in the medical community is Neissera gonorrhoeae. This is what causes the ever-so-feared STD, gonorrhea. According to the CDC, more strains of gonorrhea have increasingly developed a resistance to nearly every drug used to treat it, including Cephalosporin. According to a CDC video, many cases of gonorrhea do not cause symptoms but the consequences of having it can still be life-threatening. Resistance in N. gonorrhoeae is thought to be acquired rather than innate, then continuously spread. But don’t panic just yet– there’s still hope. Antibiotic treatment is still available, although not in variety. I think Neissera gonorrhoeae is one of the best case scenario of an antibiotic-resistant organism because of how easily it can be refrained from spreading. It is important to use proper protection and know your sexual partner’s STI history, if any. Stay safe, kids.

In contrast to N. gonorrhoeae, some organisms are resistant because of their genetic makeup. In the case of CREs, their family lineage grants them drug resistance. Isn’t that great.

A Carbapenem-resistant Enterobacteriaceae (CRE) is a gram-negative bacterium in the Enterobacteriaceae family, including species of Klebsiella, E.coli, and salmonella. According to the CDC, CREs are known to be very resistant to Carbapenem, a strong drug typically used as the “last resort” for a variety of bacterial infections. CREs are resistant as they produce carbapenemases (i.e, klebsiella pneumoniae carbapenemase) that break down the antibiotic. The same article also mentions how CRE infections are healthcare-related, which basically means they tend to occur due to extensive hospital treatments. Salmonella enterica is a common CRE threat. According to a Health article, there was an outbreak of Salmonella last year by a highly resistant and virulence strain of S.enterica. This strain sickened nearly 92 people nationwide and is resistant to 12 different antibiotics. As we learned in class, Salmonella typically goes away without antibiotic treatment; I’m curious to know if these resistant strains would be able to do that, or if they are too virulent to be left alone. In this case, treatment was mainly achieved through combination therapy.

Salmonella is transmitted through contaminated poultry to humans. In contrast, Gonorrhea is transmitted from human to human. Similar to Gonorrhea, Salmonella can be easily prevented through the proper cooking and handling of poultry. Both resistant organisms also do have some sort of treatment, including combination therapy; however, the alarming rates of resistance must continue to be monitored and contained.

Yes, you read that correctly. And yes, it’s true. The poop of a healthy individual could potentially save the life of a patient fighting a severe gastrointestinal disease. Your poop is more important than you think! Here’s what I mean by that…

As we have discussed in class, we humans have billions of tiny microorganisms, mainly bacteria, living in our gut in a community called a “microbiota”. For as much as we love to hate bacteria, these ones actually help us survive. They take on essential roles like Vitamin K and B synthesis, and digestion. Without them, our health would suffer. That’s where FMT, or Fecal Microbiota Transfer, comes in. According to an article on WebMD, FMT is the process of taking healthy feces loaded with “good” microbiota and transferring it to a patient with an illness that has eliminated their healthy microbiota. By doing this, healthy microorganisms are represented in the gut of ill individuals. The same WebMD article discusses the story of a young girl battling Crohn’s disease, an intestinal illness. Years after an FMT, her symptoms seemed to have resolved. Sounds great right? I think so. My only concern is how long this magical “cure” will last, or if there’s a catch. I am very curious as to how this girl’s story will unfold 5 or 10 years from now. Regardless, this poop-y innovation is pretty freakin awesome.

Which Diseases Can Poop Treat?

Unfortunately, poop is not the simple answer to all diseases. Along with Crohn’s disease, FMT has been known to successfully treat Clostridium difficile infections (CDIs), according to an NCBI journal. The journal describes the successful FMT treatment of ten patients with recurring CDI. Because both CDI’s and Crohn’s are problems related to the bowels and the diminishing of microbiota, it can be assumed that other stubborn illnesses could also be treated with FMTs. This could include severe Gastric Ulcers, E. coli gastroenteritis, or Salmonella infections, all of which harm the gastrointestinal tract. Obesity could also possibly be helped with microbiota manipulation; healthy gut microbiota is known to play a productive role in obese patients, according to a journal by the European Journal of Clinical Nutrition. Basically, any disease that harms the body’s natural gut microbiota seems fair game for a fecal transfer; however, a FMT may do more harm than good on some diseases so testing is necessary.

Although fecal microbiota transfer is a fairly new and uncertain concept in the medical world, I think the idea sounds very promising. The articles and journals I have read give me the impression that this is a fairly harmless yet beneficial procedure. But again, there are still many questions left unanswered. The best method of giving the transplant is still unknown (pills or injections or colonoscopies or who-knows-what). Future implications from this transfer are not certain. The justification of this approach as oppose to other available medication is still unknown. Hopefully with time, these answers can be solved and innovate the future of healthcare.

CRAAP!

CRAAP is a funny acronym that describes the general guidelines to follow when selecting informational sources. CRAAP stands for current, relevant, authoritative, accurate, and purpose. These are meant to be questions you ask yourself about the source to determine whether or not it is reliable and should be used. Professors usually make us (students) abide by the rules of CRAAP to ensure we are spreading the correct information. In a world full of fake news and sketchiness, CRAAP is here to help!

I believe all my sources used in this post abided by CRAAP standards. My information was pulled from a scholarly journal (EJCN), a nationally recognized site (NCBI), and WebMD, a source that is credible and endorsed by many professionals; therefore, they all seem very authoritative. All my sources were relevant to my topic and contained information I used to further the my discussion. My sources were all posted in the last six months, making them current. Finally, there is no bias language or information that I could sense in any of these sources. The sole purpose of these articles is to inform the reader and provide information/statistics on current medical findings.

“Education is the most powerful weapon which you can use to change the world.” -Nelson Mandela