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.

Measuring up a Vaccine: The Meningitis B Immune Response Study

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. Continue reading Measuring up a Vaccine: The Meningitis B Immune Response Study

Suspected Measles Case Reported On-Campus; Student Had Been Vaccinated

Preliminary testing has suggested that a University student could have a case of the measles, Princeton’s University Health Services announced in an email to the student body late Wednesday afternoon.

The email stated that 99.5% of the student body has been vaccinated against the disease. The student with the suspected case is among those who had been immunized against the measles, according to University Spokesperson Martin Mbugua. Continue reading Suspected Measles Case Reported On-Campus; Student Had Been Vaccinated

The Politicization of Disease

By Cailin Hong

Senator and 2016 presidential hopeful Ted Cruz (R-TX) made media waves this October when he criticized the Obama Administration’s response to Ebola cases reported in the US.

“I remain concerned we don’t see sufficient seriousness on the part of the federal government about protecting the American public and doing everything possible to ensure that people infected with Ebola do not come to the Unites States,” he said, advocating for an air travel ban for those coming to the United States from regions afflicted with the virus.

“The administration is not treating [the outbreak] with the gravity it deserves.”

Cruz was just one of many Republicans – including Senator Rand Paul (R-KY) and Governor Rick Perry (R-TX) – denouncing the current administration’s ineffectiveness at the height of what was a highly competitive, highly partisan midterm campaign season.

The debate has now become progressively polarized, with Republicans blaming the president for being unauthoritative and Democrats arguing that the GOP-pushed NIH and CDC budget cuts were the true causes of U.S.’s unorganized response to the outbreak. Analysts from Politico, CNBC, and local news sources suggested that Ebola could play a decisive role in the weeks leading up to the midterm election, which was exactly what happened as Ebola became the highlight of many divisive debates.

Political polarity surrounding disease is nothing new, particularly in the partisan U.S. With the global outbreak of avian flu in 2006, a whopping 76 percent of Republicans were confident in the Bush Administration’s response to the crisis, compared to just 52 percent of Democrats. In 2009, however, Democrats were nearly twice as likely as to support the vaccine for the influenza strain H1N1 (“swine flu”) proposed by the Obama Administration as compared to Republicans. The trend continued in 2014, with 76 percent of Democrats confident in Obama’s Ebola response compared to 54 percent of Republicans.

This pattern suggests an informational gap, or even misinformation, on half of the American public, and a tendency to defer to the authority of ideologically-aligned political leadership. This trend also extends into non-health related issues, with Republicans and Democrats tending to support the policies of their respective administration. Thus, contrary to the suggestions of Ebola-focused political commentators, although elections may raise the stakes and drive politicians to increasingly partisan rhetoric to differentiate themselves from the opposing side, the partisan history of public health perception suggests that, at least for the American public, political allegiance trumps support for specific disease policies.

When the public gets their views on disease outbreaks from the rhetoric put forth by politicians, the claims made by politicians and their incentives for making those claims become more important than ever. The real danger, therefore, lies not in the polarization of disease, but in its politicization.

The archetypical case comes from the 1976 fiasco, in which President Gerald Ford hastily ordered a massive nationwide vaccination campaign against swine flu, the largest vaccination campaign in US history. Rushed and haphazardly organized, the vaccine was prematurely approved and linked to over fifty cases of Guillain-Barre syndrome, a paralyzing neurological disease associated with vaccination. Although studies by the CDC only found that the vaccine increased occurrences of the syndrome by one case per 100,000 individuals, the fiasco caused a long-lasting distrust of federal public health initiatives.

Arthur M. Silverstein, professor of ophthalmic immunology at Johns Hopkins, argues that the poor planning and unprecedented, even uncalled for, sense of urgency was a failed attempt by Ford to shed his pusillanimous image and secure his re-election by taking swift, authoritative action. Contrarily, Ford’s political opportunism compounded by the financial and medical blunder of the H1N1 campaign provoked large public criticism, which gave him a reputation for incompetence that cost him the election.

Ukraine provides a more modern example when, in 2009, Prime Minister Yulia Tymoshenko led a series of quarantines, school closures, and bans on mass gatherings in response to what she touted to be the plague of the century (again, swine flu), despite statements to contrary by the World Health Organization. Tymoshenko was concurrently running for president, and the crisis gave her an opportunity to demonstrate her competence and decisiveness. Conversations with her campaign advisors later revealed Tymoshenko deliberately exaggerated and politicized fears of the strain to portray the presidential hopeful as a “white knight” and distract the public from the government’s failure to improve Ukraine’s dismal economy. During a chaotic period in which citizens were forced out of the public sphere and paralyzed by fear on an impending pandemic, even international media defaulted to the politician’s hysterical campaigning over the word of the WHO.

The political ramifications of disease and pandemics’ utility as a political tool are undeniable. A deep scare can create a sense of urgency that forces the public to put faith in their central leadership and divert attention from other government failures. The consequences could range from long-lasting damage to the legitimacy of public health concerns, as was the case with Ford, to political manipulations that undermine democracy, as seen with Tymoshenko.

This is not to suggest that all disease outbreaks are securitized threats constructed by ruthless politicians; rather, the severity and sensitivity of political rhetoric surrounding disease should underlie the importance of a transparent, informative public health policy that transcends popular sound bites and media frenzy.  Striving to understand the political stakes a party may have in presenting epidemic in a certain light should help the public cast a critical lens over the extent to which popular rhetoric may be trusted.

So where does Ebola lie in all this? Recently, Media Matters reported that news coverage of Ebola dropped from nearly 1,000 segments in the month leading up to the election to 49 in the two weeks that followed. While Ted Cruz is right to warn the public of the political handling of Ebola, exactly which of these two we should be more concerned about—the politics or the disease—remains to be seen.

Endnotes:

[1] http://dallasmorningviewsblog.dallasnews.com/2014/10/rick-perry-vs-ted-cruz-on-ebola-whos-exhibiting-stronger-leadership.html/

[2] Shephard, Steve. “Democrats in danger over Ebola.” Politico. Web. 20 Oct 2014. http://www.politico.com/story/2014/10/politico-poll-ebola-democrats-112017.html

[3] Myrow, Stephen. “Will Ebola affect the outcome of the election?” CNBC. Web. 17 Oct 2014. http://www.cnbc.com/id/102098189#.

[4] Memoli, Michael. “Ebola scare is the latest issue to cloud midterm election debate.” LA Times. Web. 17 Oct 2014. http://www.latimes.com/nation/politics/politicsnow/la-pn-ebola-politics-20141017-story.html

[5] Nyhan, Brendan. “The Partisan Divide on Ebola Preparedness.” The New York Times. 16 Oct 2014. http://www.nytimes.com/2014/10/17/upshot/the-partisan-divide-on-ebola-preparedness.html?abt=0002&abg=1

[6] Baum, Matthew. “Red State, Blue State, Flu State.” Web. http://www.hks.harvard.edu/fs/mbaum/documents/RedStateBlueStateFluState_JHPPL.pdf

[7] Nyhan

[8] Sencer, David and Donald Miller. “Reflections on the 1976 Swine Flu Vaccination Program.” National Institute of Health. Web. Jan 2006. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291400/

[9] Sencer and Miller

[10] “Guillain-Barre Syndrome.” CDC. Web. 22 Oct 2014. http://www.cdc.gov/flu/protect/vaccine/guillainbarre.htm#what3

[11] Spitzer, Robert. “Review: Pure Politics and Impure Science” Adminstrativ Science Quarterly, Vol. 29, No. 2. Web. Jun 1984. http://www.jstor.org/stable/2393193

[12] Ioffe, Julia. “Ukraine’s Phantom Flu.” Foreign Policy. http://www.foreignpolicy.com/articles/2009/11/25/ukraines_phantom_flu

[13] Ioffe.

[14] Gertz, Matt and Rob Savillo. “Ebola Coverage on TV News Plummeted After Midterms.” Media Matters. Web. 19 Nov 2014. http://mediamatters.org/research/2014/11/19/report-ebola-coverage-on-tv-news-plummeted-afte/201619

Ebola: Why Quarantine?

A handful of states, in response to the Ebola outbreak, are imposing a mandatory quarantine on health care workers returning to the United States from Ebola zones amid fears of the virus spreading outside West Africa.[1]

New Jersey Governor Chris Christie and New Jersey officials now require that travelers coming through Newark Liberty International Airport be categorized as either high risk, some risk, or low risk. Continue reading Ebola: Why Quarantine?

The Politicization of Disease

Senator and 2016 presidential hopeful Ted Cruz (R-TX) made media waves this October when he criticized the Obama Administration’s response to Ebola cases reported in the US. “I remain concerned we don’t see sufficient seriousness on the part of the federal government about protecting the American public and doing everything possible to ensure that people infected with Ebola do not come to the Unites States,” he said, advocating for an air travel ban for those coming to the United States from regions afflicted with the virus. “The administration is not treating [the outbreak] with the gravity it deserves.”

Cruz was just one of many Republicans – including Senator Rand Paul (R-KY) and Governor Rick Perry (R-TX) – denouncing the current administration’s ineffectiveness at the height of what was a highly competitive, highly partisan midterm campaign season. Continue reading The Politicization of Disease

First Monthly Public Health Table

1. Care to spice up dinner time? 
2. Feeling a significant lack of casual public health discussion in your life? 
3. Want to learn about something meaningful in the comfort of Whitman’s common dining hall?
If you answered yes or were even unsure about any of those questions, then JOIN US!
Don’t overthink it and just come on over.
The Princeton Public Health Review (PPHR) is having its first monthly public health table!
Monday, December 8
6:30-8:00 PM
Whitman Common Dining Hall
**featuring**
Yi-Ching Ong, PhD from the Global Health Department
 presenting new non-profit models for pharmaceuticals and drug development for neglected diseases!

Timothy Buschman, Winner of the 2014 NIH Director’s New Innovator Award

Timothy Buschman, assistant professor at the Princeton Neuroscience Institute and Department of Psychology, was awarded the New Innovator Award. This grant is awarded to “early stage investigators of exceptional creativity proposing research of uncommonly high potential impact.”

Buschman’s project, entitled “Developing an Adaptive Cognitive Prosthetic to Replace Damaged Brain Regions”, is the creation of a hierarchal algorithm that uses a neural or behavioral feedback system to learn. Continue reading Timothy Buschman, Winner of the 2014 NIH Director’s New Innovator Award

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