By Lisa Brown
SPH researcher: Florida outbreak “was only a matter of time”
On July 29, the Florida Department of Public Health reported the first localized cases of Zika virus in the United States, in Miami, Florida. Because the virus has been linked to microcephaly—babies born with small heads and neurological deficits—and to other syndromes like Guillain-Barré (a disorder where the body’s immune system attacks the nerves, leading often to temporary paralysis), the Centers for Disease Control and Prevention (CDC) released an unusual—some say unprecedented—travel alert, advising pregnant women not to travel to Miami’s Wynwood neighborhood, where the virus was found.
David Hamer, a School of Public Health professor of global health, a School of Medicine professor of medicine, and principal investigator for the global infectious disease surveillance network GeoSentinel, has been tracking the current Zika outbreak from its earliest days. BU Today spoke to Hamer about the news from Miami, what this means for summer travelers, and the next steps for scientists studying Zika.
Caption David Hamer, a School of Public Health professor of global health and School of Medicine professor of medicine, has been tracking the current Zika outbreak. Photo by Cydney Scott
BU Today: What’s going on in Miami?
Hamer: They’ve found some people who have become locally infected, who have not traveled outside of Miami. And that seems to have triggered a house-to-house investigation, where they’re trying to identify people who have been symptomatic, or even those who have not been symptomatic, and testing them for Zika. And by doing that testing, they encountered 4 cases initially, and it has increased to 17. And several of those people were asymptomatic, so they discovered them by doing blood testing.
Did they get it from a mosquito in Miami or from something else in Miami?
I think the public health authorities are fairly confident that it’s from a locally infected mosquito, as opposed to sexual transmission.
Were you surprised to hear about these cases?
It was just a matter of time. The mosquitoes are definitely there in much of Miami, or much of Florida, for that matter.
Which mosquitoes are people worried about, and how far north can they go?
Everybody’s worried about both Aedes aegypti and Aedes albopictus, but so far it seems like most of the transmission has been through Aedes aegypti. And its range seems to extend up to maybe Georgia, South Carolina, Louisiana. It’s basically a few states in the South, and then it crosses over to Texas, New Mexico, Arizona, but not much further north. Whereas Aedes albopictus extends all the way up to Pennsylvania and New Jersey. It’s much more widespread across the United States.
What do we know now about sexual transmission?
It’s definitely an evolving story. There’s evidence of carriage of the virus in semen—I think there are some cases that have lasted a little more than two months.
I thought semen regenerated continuously. So why is the virus sticking around for so long and where is it actually staying?
I don’t really know. I’m not sure we really understand. The other question is: Is it hanging out somewhere within a woman in the genital tract also? And we don’t know. But now there’s definitely an interest in that, trying to understand where it’s carried and for how long.
Do you think that the sexual transmission might turn out to be a bigger factor in the spread of Zika than mosquitoes?
No, I think mosquitoes are going to remain the real major form of spread, but that sexual transmission is going to make it more complicated. I think there’s going to be a lot more data coming out soon to understand where it’s carried, what allows it to propagate, and how it persists.
Concern is focused on pregnant women or women thinking about getting pregnant, but Guillain-Barré is also an issue. Are other groups at risk? Should people cancel their travel plans to Florida?
I probably would not recommend that people change their travel plans, except to this one specific area within Miami. I think the people who should think twice are somebody who’s pregnant, somebody who’s planning to become pregnant in the next 6 to 12 months, or the significant other (the spouse or male partner) of that person. And that’s really it. We don’t know what the risk factors are for Guillain-Barré syndrome. It probably occurs in only a few people per thousand cases of Zika, so it’s a rare complication. And even though it’s worrisome and potentially dangerous, potentially even life-threatening, it tends to come on quickly and resolve quickly.
It sounds like there are still a lot of unanswered questions about Zika.
Yes, there’s a lot happening quickly. It’s exciting in a sad way, but I think we’ll see more. I think we’ll learn more, and then the real question is: are we going to see more? And I suspect we will.
This BU Today story was written by Barbara Moran.
Program welcomes undergrads from around country
Marissa Baccas says she is a shy person, not a fan of public speaking, but get her talking about the School of Medicine STaRS program, and she has plenty to say.
“When I first got to the lab, I felt out of place,” says Baccas, a rising senior majoring in chemistry at Fayetteville State University. “This is all new stuff to me here, it’s all DNA and PCR [polymerase chain reaction]. As time went by, I read papers, asked questions, watched when they were performing experiments. I learned a lot. Now I’m doing work on my own in the lab.”
STaRS (Summer Training as Research Scholars) is a 10-week summer program that brings together rising juniors and seniors from underrepresented minorities at colleges all over the United States to do biomedical research in Medical Campus labs. Most students plan to apply to PhD, MD, or especially, MD/PhD programs. The program also supports first- or second-year MED students from underrepresented minorities seeking more lab experience—six of them this year.
Baccas wants to go to medical school to become a neonatologist and medical researcher. Her STaRS project explores the way certain proteins affect cardiac marker genes in mice, as part of the larger research program in the lab of Isabel Dominguez, a MED assistant professor of medicine. It’s the kind of project that Baccas would not get as an undergraduate at Fayetteville.
Which is the point of STaRS: it accepts people from different schools so they can experience better, higher, more advanced research.
The STaRS experience was ideal for Baccas, says Dominguez, given her career goals. It exposed her to embryonic development and taught her molecular biology techniques that she will need in her career toolbox.
It has also been good for her personally. “She has opened up so much,” Dominguez says. “She’s joking and interacting with people in the laboratory, and she’s asking questions and volunteering information. She’s gained confidence in herself.”
The program, which started in 2010, is currently funded by a $750,000 five-year grant from the National Heart, Lung and Blood Institute of the National Institutes of Health. It is run through MED’s Division of Graduate Medical Sciences. The undergraduates in the program receive a $4,800 stipend, campus housing, and travel expenses. Medical students get $9,060, but no housing. Each of their labs receives $1,000 to cover supplies and other lab expenses.
“These are students that are not only doing well in college, but also have a drive to excel in whatever they are doing,” says STaRS director Maria Ramirez, a MED associate professor of medicine and assistant dean of diversity and multicultural affairsThis year, the program has 19 students: 10 undergraduates from schools ranging from Brown and Duke to lesser known institutions such as West Chester University of Pennsylvania and Tougaloo College, 3 undergrads supported by their home institutions, and the 6 MED students.
Each student is assigned to a lab that aligns with his or her own interests and is mentored by a faculty member. They get a basic grounding in the lab environment from a grad student or a postdoc supervisor, then move on to their own research projects.
The students all take part in a journal club, where they discuss their lab experiences, and they will present their final work at a symposium today. They will also present their work at the national Annual Biomedical Research Conference for Minority Students in Tampa, Fla., in November.
“I’m interested in being a physician and possibly a physician-scientist,” says Denston Carey, Jr., a rising senior at West Chester majoring in cell and molecular biology. Carey is studying neurons in the barrel cortex of mice, the part of the brain that plays a role in whisker sensation. It’s part of the research of PhD candidate Teresa Guillamon-Vivancos (MED’17), Carey’s lab mentor.
Both are supervised by Jennifer Luebke (MED’90), a MED associate professor and vice chair of anatomy and neurobiology. On a practical level, says Luebke, Carey is tackling a labor-intensive part of Guillamon-Vivancos’ project, which has to be done quickly. Because he’s a fast learner, he has made a substantial contribution, she says. And then, in part because he’s the youngest person in the lab, he brings intangible benefits: a certain energy and enthusiasm and his own individual perspective. “We all learn from each other, and that’s always a good thing,” Luebke says.
For many of the undergraduates, it is their first exposure to the cutting-edge technology and collaborative experience at a place like the Medical Campus.
“I think it gives them a different idea: ‘I can leave home, I can be successful, I can go to school here,’ versus staying in an area where they’re comfortable,” says program administrator Lynese Wallace (CGS’09, SAR’11, SPH’17). “It gives them confidence, to say, ‘I can do something new that might be a little scary at first, but overcome whatever challenges might come with that and be successful.’”
The MED students started and finished their STaRS time a little early to accommodate their fall semester class schedules. Joanna Ortega (MED’19) used antibody strains to test for correction of a gene in the liver, hoping to learn if gene-splicing efforts had worked. She decided to enter the program to get a research background that she did not get as an undergrad at the University of the Incarnate Word.
The students also improve in areas such as creating a presentation and public speaking, with the help of workshops run through StaRS. “I saw a lot of developmental workshops I felt would help me in my future. I really wanted a stronger sense of how to present well, which is going to be a useful skill,” Ortega says.
“I come from a state school, so I haven’t really had the opportunity to be involved with a research lab that’s really doing things that are going to make a difference,” Carey says.
“It’s like a whole new world that opened up to me.”
This BU Today story was written by Joel Brown. Photos by Cydney Scott.
A MBTA pass subsidy benefit of 35-50 percent is now available to all regular faculty and staff who order a monthly MBTA pass through Boston University. Please view the rules and regulations
View the list of monthly MBTA pass types and costs and to enroll in the program please visit the BU employee subsidized MBTA pass application. You may print it out and return the completed form to the Transportation Office at 710 Albany St. or fax to 617-638-6816
The deadline to order your September MBTA pass is now August 14. Those currently enrolled in the MBTA pass program do not need to fill out the form. Payroll will automatically adjust the price with the new subsidy.
For more information please visit the TranSComm website.
A Diversity Advisory Group has been established on the Medical Campus. The group, conceived by Rafael Ortega, MD, BUSM Associate Dean for Diversity and Multicultural Affairs, includes members from the Schools of Medicine, Dental Medicine and Public Health as well as Boston Medical Center.
The Group will serve as a bi-directional communication channel between the Offices of Diversity in the three schools and the hospital, and the respective diversity-related domains. It will be a sounding board to discuss diversity-related matters on Campus, and to provide balanced guidance.
The creation of the Group is in concert with BUSM’s strategic planning goals. Several student organizations are represented, including the Latino Medical Student Association (LMSA), the National Medical Student Association (NMSA), and the Muslim Student Organization respectively representing Hispanic, Black and Muslim students. Advisory group membership includes: Chioma Anyikwa (BUSM ll/NMSA); Barbara Catchings (BMC/Human Resources); Sheila Chapman (BUSM/Medicine); Yvette Cozier (BUSPH/Diversity and Inclusion and Assistant Professor, Epidemiology) ; Larry Dunham (GSDM/Diversity & Multicultural Affairs and Clinical Assistant Professor, General Dentistry); Jason Hall (BUSM/Surgery); Faryal Hussain (GSDM lll/Muslim Student Organization); David Keough (BUMC/BUSM Communications); Justin McCummings (BMC/Minority Recruitment); Michael Paasche-Orlow (BUSM/Medicine); Lucero Paredes (BUSM ll/LMSA); Jason Sherer (Medicine Resident/EMSSP); Ann Zumwalt (BUSM/Anatomy & Neurobiology).
If you would like more information about the Group, please contact Rafael Ortega.
Patricia Hibberd wants to leverage technology to save young lives
When Patricia Hibberd looks at her smartphone, she sees a chance to save young lives.
Hibberd, the new chair of the School of Public Health’s Department of Global Health, has been working in Malawi, India, and Pakistan to develop a low-cost thermal imaging system for smartphones that would help to detect bacterial pneumonia in children in countries where standard chest X-rays are not available. The prospect of giving resource-strapped clinicians a way to diagnose the world’s leading cause of death of children under age 5 marks a new chapter in her 25-year quest to stem childhood pneumonia, sepsis, diarrhea, and other illnesses.
“X-ray machines are not going to magically appear in the health clinics of poor countries. We can’t wait for that,” Hibberd says. “Smartphones are everywhere. This is about giving clinicians the tools they need to save lives, now.”
A physician and epidemiologist, Hibberd came to SPH this summer from Harvard University, where she has been a professor of global health at the Harvard T.H. Chan School of Public Health and professor of pediatrics at Harvard Medical School. She also has headed the Division of Global Health in the Department of Pediatrics at Massachusetts General Hospital (MGH).
A native of Liverpool, England, who earned her PhD from the University of Leicester and her MD from Harvard in 1986—six years after coming to the US—Hibberd has spent much of her research career tackling the alarming rates of morbidity and mortality among women and children in the developing world. Over the last 15 years, she has collaborated with researcher Archana Patel in India on ways to reduce the rates of neonatal sepsis and pneumonia, as a leader of the National Institutes of Health’s Global Network for Women’s and Children’s Health Research at MGH. The group’s most important contributions have included the early recognition of severe hypoxemia and treatment with oxygen for children with pneumonia in resource-constrained settings, and the development of point-of-care diagnostics for neonatal sepsis.
Hibberd also is a Paul G. Rogers Society Ambassador for Global Health Research and chair of the Data and Safety Monitoring Board for the Centers for Disease Control and Prevention’s STRIVE Trial, which is testing a vaccine to prevent Ebola in Sierra Leone.
The author of more than 250 scientific articles, many on pediatric health, Hibberd says she plans to continue her own research work at BU, while supporting the many projects underway in the global health department. She cites as one of her reasons for coming to BU SPH Dean Sandro Galea’s commitment to “leverage new technologies, such as bioinformatics, to drive a new agenda for public health.”
She recently spoke with BU Today about her research interests and what excites her about the new position.
BU Today: You’ve had a long career focused on preventing and treating childhood diseases. How did you become interested in that area of research?
Hibberd: As an infectious diseases physician and epidemiologist, my main interest has always been to make a real difference in childhood mortality. To do that, I have to follow the reasons why children unacceptably keep dying. Today, in 2016, babies die in the first month of life, mostly because of infections, or sepsis, and between two and 59 months, because of pneumonia. This was true in the 1990s—and unfortunately, it’s still true now. To me, that is just not OK.
There are vaccines that prevent pneumonia in children, as long as they survive to age two months. These vaccines are available for all babies in the US, Europe, and Australia, but they’re not widely available in resource-limited settings.
I keep asking the doctors in these places, “Don’t people donate vaccines for the babies here?” Sometimes, the answer is yes. They’ll say, “I got a gift of 100 vaccines—so what I am supposed to do? Save the lives of 33 babies, as each baby needs three doses of the conjugate pneumococcal vaccine and three doses of the Haemophilus influenzae [type] b vaccine? Or should I try and save 50 babies who get two doses of each vaccine, even though that is not recommended?” That’s a terrible decision for a clinician to have to make. In the developed world, these are not decisions that any doctor faces.
You’ve focused on the diagnosis side, more than the vaccine side. Why?
While we figure out how to make sure vaccines are available for all babies, we still need to find and treat babies who are sick and can be treated for the infections that vaccines should prevent.
What everyone forgets is that pneumonia and sepsis in babies are among the most difficult diagnoses to make—even here in Boston, never mind in remote rural villages in sub-Saharan Africa and Asia. The way I think about this is that we need to improve diagnosis of serious infection in babies everywhere, in Boston and beyond. And, at the same time, we need to get lifesaving vaccines to that beyond.
I’m delighted that I will be moving our NIH-funded Global Network grant to BU and continuing the work on early detection and treatment of pneumonia and sepsis. We’re going to continue looking for the best ways to recognize infants at risk as early as possible—in the home—so that they are brought for treatment as quickly as possible.
How promising is the thermal imaging technology you’ve been piloting?
We have some very impressive results here at home, and some exciting preliminary data from India and Malawi. Basically, the technology allows us to diagnose children who have pneumonia caused by bacteria by identifying asymmetric hot spots of high temperatures in the lungs, caused by localized inflammation.
We are studying how to use this technology in urgent-care outpatient clinics and emergency departments in our own backyard, while also conducting rigorous studies to determine whether thermal imaging can be used by first-level health care workers in developing countries to diagnose and start treatment with antibiotics as early, and as appropriately, as possible. This is work we will continue with collaborators across BU, including Muhammad Zaman, a College of Engineering professor of biomedical engineering on the Charles River Campus.
What excites you most about being at SPH?
There is a palpable excitement about public health, in Boston and in the broader community, since Dean Galea arrived. This is a time when the public health agenda is coming to a kind of crossroads: concern over communicable diseases is being overshadowed by attention to noncommunicable, chronic diseases. But we are not done with communicable diseases, by any means. Zika and Ebola remind us of that. So we have to do more, and get more right fast.
Dean Galea and the SPH faculty are focused on pushing the public health community to pursue this dual agenda in innovative ways. I so want to be part of that.
This BU Today story was written by Lisa Chedekel.
If you were unable to attend the Conversation: Race and Violence, watch the video.
The BUSM Office of Diversity and Multicultural Affairs invites all members of the BUMC/BMC community to participate in an open and candid dialog about race and violence. The targeted police shootings in Dallas at a peaceful protest in response to videos showing two African-American men shot by police in Louisiana and Minnesota has sparked ongoing contention across the country.
This event will be co-moderated by Associate Dean of Multicultural Affairs and Professor of Anesthesiology Rafael Ortega, MD, and Chief & Chair of Psychiatry and Assistant Dean of Multicultural Affairs David Henderson, MD.
Please join us for the conversation.
Wednesday, July 13
BUMC Instructional Building, L112
After 18 years as Director of the Slone Epidemiology Center, Allen A. Mitchell, MD, professor of Epidemiology and Pediatrics, has decided to step down, effective Sept. 1. Mitchell was a founding member of the Drug Epidemiology Unit (now known as the Slone Epidemiology Center) led by Drs. Dennis Slone and Samuel Shapiro that came to BU in 1975. He became the director in 1998, when Slone was elevated to a Medical Campus Center. An internationally recognized leader in the epidemiologic study of drug safety in pediatric and pregnant populations, Mitchell founded and led the Birth Defects Study for 39 years. . He also developed risk management assessments for Accutane/isotretinoin and thalidomide in pregnancy and a large-simple trial of ibuprofen safety involving 84,000 children recruited through a pediatric office practice-based research network. In addition to bringing major studies to Slone, Mitchell promoted rigorous science to serve the public health and provided a supportive environment with the sense of comity, friendship, and family that characterize Slone. He will continue his research activities at Slone as Director Emeritus.
David W. Kaufman, ScD, professor of Epidemiology, has been appointed the next Slone Director. Kaufman came to BU in 1975 as a research associate at Slone and was ultimately promoted to professor of Epidemiology at SPH and Associate Director of Slone in 1998. His early career focused on studies of drugs in cancer and heart disease and other conditions. In the 1980s Kaufman was co-investigator of the International Agranulocytosis and Aplastic Anemia Study, which enrolled several hundred cases in seven countries with these rare but often drug-induced blood dyscrasias.
Subsequently he directed the largest epidemiological investigation to date of aplastic anemia (with more than 500 cases enrolled in Thailand), as well as studies of Stevens-Johnson syndrome and toxic epidermal necrolysis in four European countries, and of anaphylaxis in Spain, Hungary, India and Sweden. He has also published studies of analgesics and upper gastrointestinal bleeding and of end-stage renal disease in three regions of the U.S.
More recently, Kaufman and Mitchell led the Slone Survey, a US population-based survey of medication use. Kaufman also studied Oxalobacter formigenes (an oxalate-metabolizing bacterium found in about 40 percent of the normal population) and calcium oxalate kidney stones, and developed a nationwide registry that followed patients with myeloma and myelodysplastic syndromes through the course of their illness. Currently, he is co-PI for a large-scale, behavioral surveillance program of acetaminophen users, focusing on patterns and correlates of overdose.
Kaufman earned his MS and ScD in epidemiology from Harvard TC Chan School of Public Health. He has served on the Medical Campus IRB since 2000, and as Chair of the Orange Panel since 2011.
BUSM’s Dr. Jane Mendez, surgery, is in the running as one of People’s (en Espanol) 25 Most Influential Latina Women! Nominated by her sister Laura Posada, wife of former major league baseball player Jorge Posada, Mendez is highlighted for her years of service as a breast cancer surgeon at BMC and associate professor of surgery at BUSM. “It’s a privilege to heal others,” says Mendez. “I love helping other women.”
Your vote decides who deserves to be a part of this list! Click and VOTE for DR. MENDEZ today!
Why do African-American women die at a higher rate and experience more aggressive breast tumors than white women? Researchers from Boston University’s Slone Epidemiology Center (SEC) have received funding from the National Cancer Institute (NCI) to explore this question. The new grant is based on the premise that having a better understanding of the biology of breast cancer in African-American women will lead to better prevention and treatment.
“Identifying genetic variants related to breast cancer in African-American women will further our knowledge of the disease and may ultimately lead us to better treatments and opportunities for prevention,” said Julie R. Palmer, ScD, senior epidemiologist at BU’s SEC and professor of epidemiology at BUSPH, who is leading the study at BU.
Breast cancer is not a single disease, but a combination of distinct disease subtypes, with varying risk factors and clinical outcomes. However, the reasons for differences in breast cancer biology and disparities in incidence and mortality rates between white and African-American women are not well understood, and existing studies have not been large enough to provide sufficient statistical power to elucidate genetic factors associated with how breast cancers develop. The size and power of this new study could help address the current lack of scientific understanding.
“Health disparities are a problem of great concern for the NCI and one that we are zeroing in on as evidenced by this grant,” said acting director of the NCI, Douglas Lowy, M.D.
This study will seek to identify novel genes and gene pathways that influence breast cancer in African-American women.
This multicenter study will pool data, bio-specimens, and expertise from 18 previous studies of breast cancer among women of African ancestry. The investigators will determine whether genetic variants may be associated with increased risk. Specifically, they will examine:
- The association between genetic variants and the risk of estrogen receptor-negative breast cancer and estrogen receptor-positive breast cancers
- How genetic variants affect major breast cancer biological pathways and whether the effects may differ between African-American women and white women
In addition to Palmer, the research team is being led by Wei Zheng, MD, PhD, from Vanderbilt University, Nashville and Christopher Haiman, ScD, from the University of Southern California, Los Angeles. Experts from five other institutions will join them in gathering information and biospecimens from 20,000 breast cancer cases
Palmer’s major research interest is the etiology of breast cancer, with a particular focus on African American women. She was instrumental in designing and implementing the Black Women’s Health Study, a cohort study of 59,000 women, and has served as co-investigator of the study since its inception in 1995. She is the director of genetics research in the Black Women’s Health Study and has spearheaded efforts to use DNA from study participants in studies of the genetics of breast cancer, other cancers, lupus, uterine fibroids, type 2 diabetes, and sarcoidosis.
She is one of the three multiple principal investigators who organized a collaborative NCI Program Project AMBER (African American Breast Cancer Epidemiology and Risk) Consortium, which combines data, germline DNA and tumor tissue samples from four epidemiologic studies of breast cancer in African American women for identification of factors related to specific breast cancer subtypes.
Reference: Breast Cancer Genetic Study in African-Ancestry Populations. Grant Number 1R01CA202981-01