Dr. Kevin Most: Viruses – The Good, The Bad and The Ugly

Doc Most readies the meds.

It feels like yesterday we were discussing the flu season and the accuracy of the vaccine against the flu virus. We know the impact the influenza virus makes if the vaccine is not a good match or if an individual is not vaccinated. We know how important most vaccines are for children, we have eliminated polio with the widespread use of a vaccine. Many childhood illnesses have been stamped out or minimized with vaccines. A vaccine is an injection of a small part of a virus into our body. The small part of the virus cannot cause the illness and it teaches our body to look for the whole virus when present and fight the virus.

When a virus enters our body, often thru our nose or mouth, it wreaks havoc by entering or healthy cells and multiplies and damages them or causes them to stop functioning and kills them. The virus will often destroy more cells it lives off of as it multiplies and does more damage. The damaged cells are then exposed to the rest of the body. Since it is a healthy human cell not much more happens except the body working on clearing the debris and the virus. Viruses are unique in that they like certain parts of the body, they attack specific healthy cells based on the type of virus. Rhinovirus likes the respiratory tract, Norovirus likes the intestines, the list goes on. This is why we get the symptoms we get with each specific viral infection.

The Good

We now know what viruses do to the body and that they are unique to specific cells. Researchers are now saying, “If a virus attacks a specific cell, why cant we teach one to attack a cancer cell?” This is called on Oncolytic Virus Therapy. Researchers are looking at several dozen viruses to help them fight cancer and in many cases it will be a doubled effect. Here is how it works, a virus is genetically manipulated to identify a cancer cell. The virus is then injected into the body, in some cases the virus is injected directly into the tumor. The virus finds the cancer cell and attacks and enters it, it multiplies and destroys the cancer cell. The destroyed cell now has been damaged which allows the bodies own immune system to start to fight the cancer as well. It now teaches the body what to look for, which is why it looks promising in preventing reoccurrences as well. The beauty of this therapy is that it may allow for fighting of tumors that are very small and spread and not amenable to surgery. It may be used in cases where a tumor is removed but we could not get the entire tumor. There are many studies going on currently using viruses to fight many cancers including brain cancers, breast cancers and bone cancers. Currently there is one available and approved to fight melanoma. This won’t be the magic bullet to fight all cancers but it certainly will give us another tool as this technology is advanced.

The Bad

We know many viruses can cause many illnesses. We have discussed many of them and the importance of vaccines. The recent measles outbreaks show us just how bad these can be. How a single individual can expose hundreds of people just by walking thru an airport. We know that some viruses can cause a “simple cold” to spread thru a work place and how influenza can knock us out for 10 days and in some cases longer. We know that some viruses can cause life time disabilities. They can be bad but the simple act of a vaccine can eliminate that risk and protect infants who cannot be vaccinated yet.

Vaccines essentially help our own immune system to learn faster and to be ready for a full infection. Think of vaccines as taking a prep test for the SAT, at the course they teach you how to take the test and they have some practice questions that are similar to what will be on the test but not exact. After you take the course, you are a bit more prepared for the test. Your mind knows what to look for, how long it should take and what to do. When the test comes, you sit next to someone who did not take the prep course, they are essentially the unvaccinated, they don’t know what to expect until they start the first question. You are prepared to know what to look for and how to handle the questions and the length of the test so you are pacing yourself based on the info you learned. The individual who did not take the course is spending time and energy trying to figure out how to answer the questions and how to pace their responses, thus they have a more difficult time with the test. The vaccine essentially preps your body for the full infection in the future.

We know there are some Viruses we have discussed, that for many of us are more a nuance than a full blown illness. West Nile Virus comes to mind, 80% of individuals will have symptoms so mild they won’t even notice them but for a small portion of the population it can be life threatening. Many people think that the recent outbreaks of measles is nothing more than an inconvenience, however when you understand how devastating the simple viral infection can be you understand the world wide concern.

The Ugly – Ebola and HIV

Ebola

You may remember a few years ago the first outbreak of Ebola and the concern that was felt across the country. Hospitals, health systems and government health spent billions to make sure we were ready for the possible outbreak in the US. We all remember the video of the patient being brought to the US for treatment, TV shots from helicopters, health care workers in space suits all of the drama that goes along with it. I wonder how many of us know that half way around the world they are fighting an outbreak of Ebola that has been going on for a year with little hope that it is close to being contained. This outbreak in the Republic of Congo has been present for over a year, has resulted in close to 2,000 deaths. The concern now is that this outbreak will spread beyond the single country it is now limited to as it moves to more populated areas and closer to the borders of surrounding countries. Estimates have it that potentially 75,000 individuals may be exposed over the next 5 months.

Do we have a vaccine for Ebola? That is a great question. A vaccine was developed in 2014 and was put thru the initial testing for simple safety, the testing for effectiveness was delayed because at the time there were not enough new cases of Ebola to conduct the large study needed to show how effective it is. So now we are at a place where the vaccine is still experimental, so there is not a huge supply of the vaccine, yet the outbreak is so large they need more vaccine than is available so now they are concerned that they will run out of the experimental vaccine. There is no shortage of vaccine now, but depending on how the outbreak spreads, that concern may become a reality. Plans are being drafted to consider using reduced dosing. This outbreak should give them great data on a vaccine that appears at first glance to be effective.

One other concern is that many have distrust for the government and health department and are thus declining the vaccine

The treatment continues to be education, awareness and understanding the routes of transmission. Things as simple as frequent handwashing and good hygiene are needed to slow this spread. A big concern is that the amount of money that is expected to be needed to curb the spread of this outbreak. It is expected to need close to $60 million just to limit the spread to other countries, this is a fraction of what is needed to treat and control the disease in the Congo. As you can imagine many on this side of the world are not aware and thus not donating dollars to this cause. It may take a patient with Ebola getting to the US to get the attention of the public and generate some donations.

HIV

HIV treatment has made some great advancements since it was first recognized. What used to be an infection that caused death in most cases has become a disease that can be managed and controlled with unique anti viral medications. These medications keep the virus in check and minimize the ability for it to spread. The virus is still very common in Africa, is some areas the infection rate each estimated 30% of the population. Without the current medications we would be seeing deaths in numbers we could not imagine.

But all is not good as in Africa now we are seeing resistance rates to some of the medications approaching 10%, in other words the HIV virus has mutated in some cases and the drugs are no longer effective. This is troublesome as even though the resistance rate is that high the medications continue to be used as it is available and working on a majority of patients. The downside is this continued use will allow the mutated strain to continue to spread making the chance of these drugs working on others in the future drops.

We need more research and new drugs to help fight and control this illness before it gets to be a worldwide problem

So you can see not all viruses are necessarily bad and in fact they may be a great tool for us to fight cancer. The importance of fighting the viruses we can protects us individually but also those around us, and that we still have a ways to go to fight and contain some very ugly viruses

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