All posts by PPHR

Gun Violence: A disease?

By David Landeta

Recently, media reports of gun violence incidents have become alarmingly frequent across America. On October 1, a gunman opened fire at Oregon’s Umpqua Community College. Ten people were killed, including the perpetrator, Christopher Harper-Mercer, marking yet another mass shooting on a college campus.

The latest incident that caught media attention was the San Bernardino shooting on December 2, when a progressive community in California was shocked by the actions of a Muslim-American couple, who left fourteen people dead at a social services facility. Yet, citizens responded not just by paying tribute and condolences to the victims, but also by buying more guns for self-defense.

The call for gun regulation and reform has gained support as we see more and more gun violence perpetrations. But one factor has been ignored: the idea of treating gun violence as America’s newest and deadliest epidemic.

The health care industry has been demanding efforts to launch research towards gun reform and if they can indeed treat the gun violence issue as an epidemic for decades. Yet, the Center for Disease Control and Prevention is still banned from conducting research on gun violence. The support of this ban is headed by Appropriations Committee of the U.S. House of Representatives, which rejected the appeal, claiming that “a gun is not a disease.” This proposition gives Congress the ability to allow funding and was rejected once again.

Physicians tried once again to lift the ban of gun violence research by presenting this issue to Congress. On the December 2, the morning prior to the San Bernardino shooting, the Washington Post reported that the non-profit organization called Doctors for America entered Capitol Hill and proclaimed their petition, signed by 2,000 physicians nationwide. The group demanded for the government to “view gun violence as a public health epidemic and research ways to solve it – as the country would with any disease causing the deaths of thousands of Americans each year.” [4] In addition, they are demanding a 20-year lift on banning gun control research.

Hopefully, Congress may finally realize the importance of gun violence research from a health care perspective in the wake of mass shootings that terrorize our society.

Gene Editing: What it means for the future of medicine

BY ALEXANDER V. SHAHIN

Earlier this month, an international group of scientists convened at Washington, D.C. and gave the green light for human gene editing research, even on germline cells. However, in their statement, they warned researchers to be careful, highlighting the need for “appropriate regulatory oversight.”

This news represents a landmark decision for the future of human gene editing. In recent years, scientists have developed increasingly sophisticated techniques for manipulating nucleic acid. In particular, the CRISPR/Cas system has emerged as a powerful new tool that has made it possible to insert, delete, or alter DNA cheaper and quicker than ever before.

This system uses the enzyme Cas9, which bacteria usually produce to fight off viral infections. Recently, an alternative enzyme called Cpf1 was identified that may potentially prove to be an even more powerful tool in gene editing.

The thought of being able to modify human DNA in order to cure genetic diseases seems like something out of a sci-fi movie. The truth, however, is that genetic editing of the human body is already underway in patients. Recently, researchers at a company called Sangamo biopharmaceuticals announced that they would begin clinical trials using the CRISPR/Cas system to replace a mutant copy of the Factor IX gene in hemophiliacs. Earlier this year, a gene-editing tool known as TALENs was successful in treating a baby girl with leukemia. Furthermore, gene editing has already been used to engineer different crops and livestock.

There are many in the scientific community who remain skeptical of these new gene-editing technologies. Some researchers believe that tampering with an organism’s genome could have unforeseen, negative side effects. This is especially worrisome in germline editing, where any genetic change could be passed along to future generations. There are also many who question whether tinkering with the human genome is ethical.

These are all important questions that should be kept in minds as we move into the future of gene editing research. These new technologies have the potential to revolutionize medicine in the coming years, but it’s our responsibility to make sure it is used correctly. Of course, there is still a lot to learn before these technologies such as CRISPR/Cas become mainstream in clinical research.

However, the promises they have shown in their early days reveal a bright future for the field. We might be a long way off from living in a world of designer babies, but gene editing is already having a significant impact on people’s lives and will, hopefully, continue to do so in the near future.

 

Polio outbreak in Ukraine: consequences and lessons

BY AVA TORJANI

Beginning September 2015, two cases of polio were reported in southwestern Ukraine, paralyzing a 4-year old and 10-month old, according to the Global Polio Eradication Initiative. After its first occurrence in Europe over the last five years, polio has stirred significant distress amongst healthcare officials and the Ukraine government due to the alarmingly low population of vaccinated children, which is currently at fifty percent. The World Health Organization (WHO) has urged Ukraine to declare a state of emergency in order to avoid further spread of the disease to bordering countries including Romania, Hungary, Poland, and Slovakia.

Polio is a highly infectious disease caused by poliovirus, which can be transmitted from person to person via ingestion of infected feces. It predominantly affects children under the age of five and is characterized by symptoms of fever, headache, and vomiting. Initially replicating in the intestine, the virus can invade the immune system and cause paralysis.

Thankfully, several vaccines against polio exist. So how exactly did this menacing disease reappear? The vaccine itself contains a weakened form of the virus, which boosts our immune system so that we can fight off the real virus if we ever catch it. However, the weakened virus may undergo mutation and grow stronger—a problem for those who are not vaccinated, but not for those who are.

Up until now, there have been no new reported cases of Polio, according to the Global Polio Eradication Initiative. However, the World Health Organization is still urging Ukraine to declare a state of emergency for several reasons. Firstly, there is no cure to polio, which makes it very difficult to treat successfully if contracted. Also, an outbreak can have devastating consequences due to the large number of countries bordering Ukraine.

As a result—with the aid of WHO, CDC, UNICEF, Gates Foundation and Rotary International—the Ukrainian government launched a polio vaccine campaign in October, whose initial goal was to vaccinate ninety percent of children aged five and under. Unfortunately, only sixty percent of these children were vaccinated by early November.

What is obstructing the campaign’s path towards this goal?

The most significant explanation corresponds to anti-vaccination attitudes amongst Ukrainians, in particular a Ukrainian lobby group that claims the vaccines against polio are unsafe and should be destroyed. In addition, the majority of parents are not well informed about the disease, with only eighteen percent of Ukrainian mothers knowing that polio is actually dangerous. Physicians are also liable to the potential consequences of vaccines and are therefore reluctant to administer them; if a child dies within thirty days of receiving the vaccine, it is considered as the sole cause of death. In Ukraine, the physician who administered the vaccine can consequently have their license suspended or can be sent to jail. However, the driving reason for low immunization rates for polio is the insufficient supply of its vaccines. According to the Global Alliance Vaccine Initiative, Ukraine buys these vaccines locally rather than internationally, which means that the supply is generally low and the costs are accordingly much higher.

These obstructions are yet another driving reason for WHO’s insistence that Ukraine declares a state of emergency. “The declaration would mobilize other government divisions to support the vaccination campaign,” claims Oliver Rosenbauer, a spokesperson for the WHO polio eradication program. Nevertheless, the vaccine campaign has created a greater public awareness of the importance of immunizing against polio and other infectious diseases.

Although it’s a costly lesson, this incident teaches us all about the importance of public health awareness for diseases, their treatments and their cures. The optimistic outlook of this incident focuses on the long-term goal of improving Ukraine’s immunization system in order to prevent future outbreaks of disease.

Has fear of the “meng” gone extinct?

By Lily Reisigner

November of 2015 marked the two-year anniversary of the last meningitis B case on the Princeton University campus. While fear of contracting the life-threatening virus has been almost eliminated among the student body, University health officials and the CDC still deem the issue an ongoing concern and continue to recommend that all incoming students receive the vaccination.

The 1,322 new students who arrived on campus this September, however, had one less cause for concern than those of years past: both versions of the meningitis B vaccine administered by University Health Services are now approved by the United States Food and Drug Administration.

Until last October, the only meningitis vaccine administered to Princeton students was Bexsero, which did not receive FDA approval until January of this year. Bexsero requires an initial dose followed a second dose within six months of the first for full protection. Prior to its approval, Princeton University and the University of California, Santa Barbra were the only two locations in the United States permitted to administer the vaccine. These exceptions were made in an effort to prevent further outbreaks of the potentially fatal disease on college campuses.

For Jack Finlay, a member of the Class of 2018, the lack of FDA approval was not a concern when he received both doses of Bexsero last fall. “It didn’t bother me that the shot wasn’t legal in the US mainly because it is approved for use in Western Europe, whose quality of health I consider to be on the same level as in the US,” said Finlay.

“I don’t really think that the shot is necessary, but it is a good safety precaution to take, just in case the disease were to return to the Princeton campus.”

In the October of 2014, however, the FDA approved an alternative drug called Trumemba. Upon Trumemba’s approval, Princeton immediately stocked the vaccine in McCosh Health Center. Students who received only one dose of the University-administered Bexsero vaccine offered in 2013 and 2014 would need to receive all 3 doses of Trumemba to be fully protected against meningitis B.

Although receiving the meningitis B vaccine is completely voluntary for members of the class of 2019, freshmen are “highly recommended” but not required to get vaccinated, according to University Health Services.

Current freshman Carolyn MacFarlane, a member of the Varsity Swimming and Diving Team, decided to get the shot, explaining,

“I just don’t want to get meningitis, especially with the diving season at stake if I got sick.”

Carolyn seems to echo the general consensus among the freshman class, a majority of whom attended the vaccination clinics held in Frist at the beginning of the year. Bexsero is currently the vaccine of choice on campus.

While the global market for meningitis vaccines is predicted to triple in the next five years, it remains to be seen whether other universities will follow Princeton’s precedent and offer vaccination against meningitis or if the threat to college campuses will die out entirely.

Interview: What Went Wrong with Ebola?

By Daniel Liu

The current Ebola crisis has claimed over ten thousand lives in West Africa, and continues to cause hundreds of new infections every week. Yet, media coverage of the crisis had been meager up until the summer of 2014, an entire half-year after the start of the outbreak in late 2013. The world’s delayed reaction has generated criticism for both public i
gnorance and for lackluster government response. But where did we go wrong? What could we have done differently that may have changed the course of this epidemic?

Adel Mahmoud
Princeton Professor Adel Mahmoud. Photo courtesy of Princeton University.

To get a better understanding of these difficult questions, we spoke with Princeton University’s Adel Mahmoud, a professor in both The Woodrow Wilson School of Public and International Affairs and The Department of Molecular Biology. Professor Mahmoud’s research focuses on the causes and emergence of infectious diseases, as well as the discovery, development, and global deployment and use of vaccines.

Question: What was the biggest shortcoming of the US and West African governments’ response to the Ebola crisis?

Answer: We were coming from behind in the response. This is a virus that we have known to exist since 1976. We know that it happens in outbreaks. We know that when it happens, the immediate need is for facilities to take care of patients and to deliver healthcare in a way whereby you don’t infect healthcare workers. The knowledge of how to deal with the issue is not rocket science, and it’s not new.

Late in 2013, when the outbreak first started, we should have immediately been pursuing identification, isolation, barrier nursing—and we could have influenced the course of events. In some ways that’s not very helpful because it’s historical. Now, when we are in the middle of the dilemma, the US says we’re going to send a few hundred of our troops, and we’re going to build facilities to take care of patients. That’s very well and good. The problem is, these things take time. And in the meantime, the infection is progressing, and the transmission is happening.

It would be unfair to ask “why didn’t [West African governments] respond better?” We today are facing a very serious challenge because most of the resources, most of the attention is going towards Ebola now, but what about all the other diseases that are there? What are you going to do with the polio campaign? What are you going to do with the immunization campaign? The resources are very limited, and there is no question today—there is a shift to put it for Ebola. The depth of resources and the depth of capabilities is very thin. You suck it in one direction, you lose it in other direction.

Question: In retrospect, what could the world have done differently to diminish the extent of the Ebola crisis?

Answer: There are a few things that would have changed the nature of what we have seen in West Africa. For example, we have been working on candidate vaccines for Ebola for the last fifteen to twenty years. Rather than working on a candidate, testing it in a couple of experimental animals, and throwing it in the freezer, what we should have done is to take these vaccine candidates, examine which is the best, take them through phase I, and take them through phase II, so you know you have an effective vaccine in the freezer. You face an outbreak like this, then you only have two steps: scale up, and deploy. What we’re doing today is, taking candidates from the lab, going through phase I, and then phase II, and only then would we be able to scale up and deploy. You really have to invest some effort in getting ready. And getting ready does not mean you spend billions and billions making things that nobody would use. No—getting ready means that you have explorations, and you have the first couple of steps to put you in a much more capable position to respond. Have a candidate drug available. That’s the difference.

Question: The CDC has set recommendations that individuals who have been potentially exposed to Ebola be monitored for twenty-one days, but not quarantined. A few states in the US, such as New Jersey and Connecticut, have ignored these guidelines by instating mandatory quarantines anyways. In fact, this issue has been contested in Maine’s district courts, which ruled against the mandatory quarantines. Do quarantines here in the US serve a real public health benefit, or are these states just acting out of fear?

Answer: The difficulty in answering this question is related to assessing the risk of someone coming from an Ebola-infected area. What is the risk that that individual would have the infection? That’s the first serious question you have the answer. And if the risk is high, then I would say quarantine is a reasonable approach; for example, a healthcare worker who was delivering care to Ebola patients in a West African country. In quarantine we’re not asking people to be put in jail, we’re just saying: stay home for twenty-one days. For the sake of public health safety, that is not an undue burden. But if the exposure is marginal, or if the contact is marginal, then monitoring temperature for the twenty-one days is a reasonable approach. When you are in the heat of the battle and people are just yelling and screaming at each other, logic gets lost. The issue here is very simple: assess the risk, and if the risk is reasonable, then put the person in isolation.

Question: In many West African countries, there is a very negative image of Public Health workers. Many families are reluctant to hand their loved ones over to be transported to hospitals because it is seen as a death sentence. How can Public Health Policy be used to address these social issues to change public perception of the disease?

Answer: When you have a village in West Africa, and several people drop dead, and then you have a team descend upon them in moon suits—what do you expect? You are injecting fear, immediately. Ebola happened in countries where they have known Ebola, and it has been around, in and out, for some time. But as long as it is not the disease of the day, no one wants to talk about it. So we lost ground, the ground of public education, of information, of dissemination, of trust. Those are the issues that make people part of the solution. People are not the enemy here!

What we have to consider is a campaign of education, of context, of information dissemination, by local people who are trusted in the community. Explaining, what are these moon suits? How is this disease transmitted? What is Ebola? Unfortunately, when you are in the heat of the battle and you have thousands of people in West Africa dying—that element gets forgotten. But it needs to be brought back on the forefront. These are countries with suspicion about the health profession, with suspicion about Western medicine, with suspicion about vaccines. We can’t just say “we’re going to build a hospital, and we’re going to put you in quarantine, and we’re going to do this and that.” You need real human interaction at a very personal level.

Question: Senegal and Nigeria have successfully contained and ended their outbreaks of Ebola. Is this success a reflection of proper public health response, and if so, which ones?

Answer: In some ways, you have to say yes. Obviously, they did not face a major outbreak—but they managed to control it by, basically, quarantining all the patients and their contacts. It’s all about the proper isolation, and the proper care. And the proper care today is not specific therapies; the proper care is fluids, electrolytes, and maintaining body function, which we physicians learned how to do years back. It’s an issue of getting these well-known techniques of medical treatment deployed.

Question: How much responsibility should the US take in fighting Ebola in affected West African Nations? What would be the best way to help?

Answer: The best thing that the US can offer is scientific know-how. The current front candidates for Ebola vaccines all came from the US. I would have liked to have seen them partially developed earlier, but the first thing that the US can offer, is scientific input. The second is exactly what President Obama did, which is to deploy humanitarian support in situations where it is urgently needed. There aren’t many other countries that can match what the US can do in this regard. The third element is financial support. I think we are doing all three.

Question: How significant of a role have NGOs such as Doctors without Borders (MSF) played in containing Ebola?

Answer: They are an essential element of the response. Developing countries have a very complicated agenda to face the future and—don’t take this as an insult or as a criticism—their ability to spend on the infrastructure for health is limited. So when something like [Ebola] comes up, it taxes the total capability of these countries. They can’t do it their own! They need support from abroad.
Private, non-profit organizations have the ability to move quickly. The edge of advantage of MSF is that they can deploy doctors tomorrow. That’s phenomenally important.

Question: What can we learn from the Ebola epidemic when addressing future public health crises?

Answer: There are quite a few lessons. One of them is that the threat of microbes to the human population is a constant feature of life on earth. If it is not Ebola, it will be something else. We have no other alternative but to learn how to predict, and how to get ready, and how to respond. It’s one thing to have noticed that Ebola has started—that was the end of 2013. It’s another to try to face it in the middle of 2014. Where have we been?

Second, what elements of response do you have? You should have had some ideas of vaccines, some ideas of drugs beforehand. Most of these infections are going to emerge in areas that are not 100% prepared to deal with it. The world has to be prepared to respond, and Ebola showed that the world was not. The virus was running around amok in Guinea in 2013, and no one talked about it. We started waking up in the middle of 2014. Come on guys, where have you been? The world was caught unprepared.

The Spread of Chagas Disease in Latin America

By Francisca Bermudez

Although Chagas disease has only recently emerged as a possible public health concern in some southern states of the U.S., this infectious disease has been a major threat of high priority for health officials throughout many nations of Latin America for many years.

Prevalent in countries such as Mexico and Brazil, Chagas disease, also known as American trypanosomiasis, is a potentially life-threatening tropical parasitic infection caused by the protozoan parasite Trypanosoma cruzi (T. cruzi) found mostly in endemic areas of Central and South America. According to the Center for Disease Control and Prevention (CDC), it is estimated that as many as 8 million people suffer from this disease worldwide, many of whom are unaware of their condition.

Most victims are infected by this parasite in the same way: through contact with the feces of triatomine bugs, also known as “kissing bugs”. As described by the CDC, they are known as “kissing bugs” because they tend to feed on people’s faces; after they ingest blood, they defecate on the person, infecting them with the T. cruzi parasite. While usually transmitted to animals and people by insect vectors, Chagas disease can also spread through congenital transmissions, contaminated blood transfusions, infected organ transplants, or even laboratory accidents.

Chagas disease has spread quickly over the years and has recently become so widespread in areas of Latin America that many now feel it has become a “public health emergency”6.This is because Chagas disease, in its later stages, can often result in chronic diseases and even death.

In an interview, Dr. Juan Mejia, Secretary General of the Latin American Society of Cardiovascular and Thoracic Surgery, explains that besides causing gastrointestinal disease such as “megacolon” or “megaesophagus,” Chagas disease can also lead to severe cardiac disease and can “cause acute myopericarditis as well as chronic fibrosing myocarditis”.

According to Dr. Mejia, “Chagas myocarditis is the most common cause of non-ischemic cardiomyopathy in Latin America”. In fact, of the people suffering from Chagas disease, according to the World Health Organization, approximately 30% of chronically infected people develop cardiac abnormalities7.

These cardiac abnormalities, Dr. Mejia states, can often include “cardiac arrhythmia, left ventricular enlargement, and chronic heart insufficiency”. In addition, Chagas disease often leads to cardiomyopathy as a result of “chronic myocardial aggression” along with “chronic inflammation and fibrosis of the heart,” he adds.

Due to these mentioned cardiac complications, Chagas disease, throughout the Americas in recent years, has emerged as one of the leading causes of heart disease in the region.

According to Dr. Mejia, this epidemic of Chagas disease – one of the leading causes of heart failure in Central and South America – has quickly spread throughout Latin America and is “typical of Andean, semi, and tropical countries”. Noting that “the transmission of Chagas disease is related to the insect family of Triatominae,” he explains that these insects usually “live in hovels where they are able to multiply without the risk of predators.” For this reason, we commonly see the spread of Chagas disease in places where “kissing bugs” thrive, which is mostly in mud dwellings in undeveloped areas in Latin America.

While this epidemic has mainly affected those living in Central and South America, the CDC has recently reported that Chagas disease is now progressively spreading to other areas of the world9. As a result, due the mentioned serious cardiac complications, it appears that Chagas disease will continue to be a major public health concern in the long run. However, it is possible that it will now have an impact not only in the lives of people in Latin America, but also in the lives of people in many other parts of the world as well.

Lessons from Polio in Nigeria

By: Tristan Lim

At the end of the twenty-fifth year of the Global Polio Eradication Initiative, only three polio-endemic countries remain in the world – a drastic difference from the more than 125 countries struggling to control polio in 1988. One of these remaining countries is one of the most populous in the world: Nigeria.

Located in West Africa, Nigeria has made ongoing efforts to eradicate polio since 1988 as part of the Global Polio Eradication Initiative. As of 2014, the Nigeria Polio Eradication Emergency Plan (NPEEP) has identified six strategic priorities in eradicating polio: enhancing the quality of supplemental immunization activities, implementation of special strategies to reach underserved populations, adoption of special approaches for security challenges areas, improving outbreak responses, enhancing routine immunization and in-between round activities, and enhancing surveillance.

The NPEEP’s efforts have brought about important achievements in the ongoing battle to eradicate polio. In 2013 alone, Nigeria saw a marked reduction of at least 56% in Type 1 wild polio virus cases compared to those in 2012 and witnessed the disappearance of Type 3 wild polio virus with no cases in 2013. However, Nigeria’s six-pronged plan has led to an unexpected outcome in regards to another nearby epidemic.

In recent months, the Ebola epidemic has ravaged countries in West Africa such as Sierra Leone, Liberia, and Nigeria. On July 20th, Nigeria’s Ebola outbreak began when Liberian-American Patrick Sawyer flew into Lagos. Nineteen confirmed cases and one probable case stem from Sawyer’s case, the most recent of which was detected August 31. As of October 20th, the World Health Organization has officially declared Nigeria Ebola-free after having passed the mandatory period of forty-two days after the last confirmed case of the virus being discharged from the hospital.

The World Health Organization Country Representative, Dr. Rui Gama Vaz, highlighted the importance of having an established public health infrastructure system by observing that, “As the most populous country in Africa and its newest economic powerhouse, Nigeria stands at a high risk for the spread of the Ebola virus disease”.

With the construction of public health infrastructure to battle polio, Nigeria has developed a more centralized approach to handling health crises that provided the country a head start over other West African countries. The NPEEP’s strategies such as instituting a centralized National Polio Eradication Emergency Operations Center and improving strategies to reach underserved populations have effectively created a surveillance system that was easily implemented to monitor new Ebola cases.

Many lessons concerning emergency responses and decision-making can be learned from Nigeria’s success in containing Ebola. As the world continues to watch the Ebola health crisis take place in West Africa, Nigeria is a prime example of the importance of public health infrastructure. Development of emergency operations centers and surveillance systems in the rest of the West African countries may lend themselves to further preventing the spread of Ebola. While these lessons from Nigeria may be late to the war on Ebola, they still provide a resounding model of centralized public health infrastructure that may prevent future epidemics from occurring.

Measuring up a Vaccine: The Meningitis B Immune Response Study

By Daniel Liu

This past November, students from Princeton University’s incoming freshman class lined up atop Icahn Laboratory’s Oval Lounge to participate in an immune response study to the meningitis B vaccine. That clinic was the second round of a large-scale public health study being conducted by Professor Nicole Basta, an infectious disease epidemiologist in the Department of Ecology and Evolutionary Biology.

After nine cases of meningitis B broke out at Princeton in 2013, University Health Services (UHS) worked with the Centers for Disease Control and Prevention (CDC) to approve an emergency vaccination campaign. The vaccine, called Bexsero, was approved by the Food and Drug Administration for use in the U.S., as of January 2015.

Professor Basta saw Princeton’s vaccination campaign as a unique opportunity to study the impact and efficacy of the Bexsero vaccine. Last April, after the first round of vaccination, she enrolled 600 students among the undergraduate classes to participate—some who received both doses of the vaccine, some who received only one, and some who received neither. Each participant would give a blood sample and complete a brief questionnaire.

“We wanted to understand how well-protected individuals would be against the outbreak strain, as a way to measure the impact of the vaccination campaign on campus”

“We wanted to understand how well-protected individuals would be against the outbreak strain, as a way to measure the impact of the vaccination campaign on campus,” Basta says. “The main question we’re trying to answer with these studies is really two-fold. First, we want to assess the immune response to Bexsero among university students following the outbreak. Second, we are interested in understanding how broadly protective the vaccine is against other meningococcal B strains.”

To answer the question of immune response, Basta plans on analyzing student blood samples using what is known as a serum bactericidal antibody assay (SBA). The SBA is a functional assay where each participant’s blood serum is reacted with meningitis B bacteria. The vaccine’s effectiveness can then by measured by looking at how well antibodies in the serum kill the bacteria at varying dilutions. “The SBA is really the gold standard for measuring immune response. It is what the FDA requires for licensure of meningococcal vaccines.” Collaborating with Basta are researchers at the Vaccine Evaluation Unit (VEU) of Public Health England, as well as a group led by Professor Alexander Ploss of the Department of Molecular Biology.

Basta notes that meningococcal B bacteria vary considerably from one outbreak to another. Bexsero was thus developed as a recombinant vaccine, meaning that it contains fragments from four different outbreak strains, so as to offer the broadest range of protection. “Princeton’s outbreak strain matched two of the four components in the vaccine, so it is likely that it will be highly protective,” she says.

Sarah Hanna ’15 is a current senior in the Department of Ecology and Evolutionary Biology working with Professor Basta on the study. She has been doing analysis on the social aspect of the vaccination campaign, which looks into why some students don’t return to get the second dose, or elect not to get vaccinated at all. The most frequently cited reasons were “I was worried about experiencing side effects,” followed by “I was not particularly concerned about the disease.” Among students who received neither dose, the “Other” option was also prevalent, often citing religious reasons or herd immunity. Hanna notes that it is not yet known which of these differences are statistically significant, though the analysis should be available soon.

Despite the students who elected not to get vaccinated, coverage rates were phenomenally high, with 95% of the undergraduate class receiving the first dose last year, 93% of whom went on to get the second dose.

“Princeton has done a fantastic job in trying to maximize all the resources that they had at their disposal to prevent the outbreak from continuing, both in terms of the social campaigns and the vaccination campaign,” says Basta. “What we are learning will help us know in the future if it makes sense to follow these same types of public health interventions when other outbreaks occur.”

Basta hopes to have a preliminary report out within a month, and plans on doing presentations around campus for curious students. Her study is funded by the Program on U.S. Health Policy and the Health Grand Challenge in the Center for Health and Wellbeing at the Woodrow Wilson School.