Vol. 38, No. 18

1-24-2008
By: Kristen Convery

Preparing for the threat

John Reeve remembers a time when infectious diseases seemed like a worry of the past.

Penicillin, widely used to heal soldiers’ infections during World War II, had become a wonder drug, turning fatal illnesses into curable ailments.

“Infectious diseases were pretty much, you go to a doctor, you get a prescription,” said Reeve, chair of Ohio State’s Department of Microbiology. “There really was no debate. Antibiotics fixed it.”

By the 1970s and ’80s, antibiotics had become such a panacea that patients often went to their doctors demanding the drugs, and physicians often obliged.

Farmers also saw an opportunity. They began treating cows, pigs and chickens with antibiotics, which made the animals grow more quickly and prevented illnesses.

“The world became saturated in antibiotics,” Reeve said. “Essentially, a good thing became too much of a good thing.”

Infections evolved into antibiotic-resistant “superbugs,” and suddenly, the drugs that had treated illnesses for decades were no longer strong enough.

By the 1980s, it was clear that the glory days of antibiotics were over. Staph and urinary tract infections lingered in hospital patients. HIV/AIDS was discovered. Infectious diseases were back.

As patients try to protect themselves from the current crop of diseases — and worry about the next — Ohio State offers hope. The university’s Public Health Preparedness for Infectious Diseases program aims to reverse what Reeve called “a history of complacency” in dealing with infectious disease.

Ohio State has committed $4.8 million to the program as part of its Targeted Investment in Excellence initiative. (See sidebar, following page.) Six colleges — Public Health; Medicine; Veterinary Medicine; Pharmacy; Biological Sciences; and Food, Agricultural, and Environmental Sciences — are participating.

Their ambitious goal is to speed up research on food pathogens, avian flu, anthrax and other infectious diseases. The accelerated efforts are expected to lead to improved detection and better monitoring of diseases, as well as new diagnostic tools and therapies.

Other expected benefits are vaccines for human and animal diseases, including those resulting from bioterrorism and natural hazards, and safer foods.

“We have to do better than react,” Reeve said. “We have to be prepared.”

Scientists at the university are convinced that if anyone can do it, it’s Ohio State.

“It’s not like Harvard can do it. It’s not like [Johns] Hopkins can do it,” said Stanley Lemeshow, dean of the College of Public Health. “You can count on one hand other colleges in the U.S. that can pull together the kind of diversity and expertise that we have.”

Angela Polley woke up one morning with chest pain and an achy body. She had trouble breathing and generally felt bad. The Columbus woman had recently been diagnosed with double pneumonia, and her labored breathing scared her enough to send her back to the doctor.

At the door to the office, her doctor told a nurse, “Put a mask on her.” Polley panicked: “I thought, ‘Oh my God, what is going on?’” An ambulance whisked her to the hospital, where she was given a sedative and told she had active pulmonary tuberculosis, a contagious airborne bacterial infection commonly spread when an infected person coughs or sneezes.

Polley was discharged from the hospital a week later with strict instructions: “You couldn’t leave your house; you had to be in one room so nobody else could get it. It was awful. You felt like a prisoner in your own home.”

Ten months of drug treatment followed — at the peak, Polley was taking 10 pills a day — along with visits from home health care nurses that Polley describes as her salvation during a tense time.

Polley is more cautious now. She carries hand sanitizer with her, and she doesn’t hesitate to ask patients at the kidney center where she works to cover their mouths when they talk or wash their hands after they sneeze. But she also knows that an infectious disease — even a serious one like her pulmonary tuberculosis — is treatable.

In Larry Schlesinger’s dream world, the nightly news would feature more stories like Polley’s and fewer hyped-up reports of infectious diseases such as bird flu.

Schlesinger, director of the Ohio State Medical Center’s Division of Infectious Diseases, and other experts concede that pandemic bird flu is a scary possibility. But they stress that it’s just that — a possibility. The fear about bird flu is that it will mutate in a way that makes it transmissible from person to person.

“Honestly, no one really knows whether the current avian influenza will break out. It keeps bubbling and simmering at a low level,” said Frank Holtzhauer, director of the Ohio Center for Public Health Preparedness. “It depends on who you ask.”

Schlesinger said that for the average person, the threat of bird flu “pales in comparison to some of the crises we face” from other diseases, such as infections arising from hospital stays.

And therein lies a contradiction, where the success stories Schlesinger wishes more people would hear about — like Polley’s victory over pulmonary tuberculosis — collide with what he admits is the prospect of a major public health crisis.

Researchers in Ohio State’s infectious diseases program say any number of circumstances might bring about such a crisis. A zoonotic disease could break out, with animals transmitting it to humans. World travelers could quickly spread a disease that otherwise might be confined to a small area. A naturally occurring disease, such as the flu, could mutate and become highly virulent. A biological terrorist could introduce an infectious disease in order to wreak social and economic havoc.

The scientists aren’t just dreaming up scenarios of doom. They’re also working across their six colleges to find solutions.

Take the research area of bioterrorism. The College of Medicine and the College of Veterinary Medicine have been awarded $1 million from the National Institutes of Health to study the basic biology of microorganisms that could be used as agents of war. The researchers will study the organisms that cause anthrax and tularemia (“rabbit fever”), which was used as a weapon during World War II.

A public health researcher participated in a study funded by the U.S. Army that found a better way to analyze airborne germs in low concentrations. The new method replaces a procedure that carried the risk of underestimating the threat of illness.

Tracking diseases is another facet of the research picture. A graduate student working under Bill Saville, chair of the Department of Veterinary Preventive Medicine, recently studied zoonotic disease surveillance. “Can we detect disease in animals that might prevent a large outbreak in humans?” Saville asked. “It’s far from being complete, but it looks really promising.”

Administrators for the Public Health Preparedness Program now are weighing 11 proposals for grant money, including interdisciplinary studies of drug-resistant staph, disaster response training and the detection of and preparation for bird flu.

“Many investigators stated that if it weren’t for the requirement for cross-college collaboration, they would not have made these connections outside their colleges,” said Program Manager Eric Lutz.

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