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HICprevent

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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Reality in film, fantasy in politics

January 12th, 2015

The Biblical aphorism that lives on in modern translation to describe someone who does “not suffer fools gladly” usually infers an impatience with ignorance, particularly as it impedes true progress. Meet Stan Deresinski, MD, FACP, FIDSA, editor of one of our sister publications Infectious Disease Alert. In a column in the current issue, the clinical professor of medicine at Stanford University, gives a thumbs up (with key caveat) to the latest Hollywood attempt to capture a global epidemic: "Contagion." “The mutated virus causing the epidemic, called MEV-1 (it is unstated, but perhaps standing for "meningoencephalitis virus-1") is clearly modeled on the Nipah virus, which was first identified in Malaysia in 1988-1999 and whose natural host is a flying fox, a type of frugivorous bat,” Deresinski writes. “Nipah outbreaks in Asia have been associated with contact with pigs, but also with human-to-human transmission and with eating contaminated fruit and fruit juices, such as raw date palm juice. Clinical illness starts with influenza-like symptoms with, in some cases, progression to pneumonia and to encephalitis, often ushered in by seizures with progression to coma in 24-48 hours. There is no known effective treatment and no vaccine is available.”

As those in the field of infection control are well aware, infectious diseases and outbreaks in filmdom are typically given a few superpowers to move things along: “Let’s go, we’re not making Ben Hur here people! Where are all the extras on vents?” Sure enough, Deresinski finds that the otherwise “amazingly realistic” science in the flick takes a similar liberty: “The initial spread of the virus is remarkably fast, probably unrealistically so,” he writes. “In addition, 57 versions of the vaccine are tested in primates before an effective one is developed. The vaccine undergoes unspecified further testing, is manufactured and distributed — all within a few months. This remarkable celerity may prove feasible at some time in the future, but not yet.”

Ok, Hollywood is generally getting on board with accuracy, but what about politicians? Not so much, Deresinski finds, blistering U.S. Rep Michelle Bachman’s (R-Minn) fact-free attack on the vaccine for human papillomavirus (HPV). “HPV causes, among other malignancies, most of the more than 200,000 cervical cancers that occur in the world each year, most in developing countries where screening is not routinely performed,” Deresinski writes. “In the United States, where Pap screening is the rule, there are, nonetheless, 12,000 cases and 4,000 deaths each year. An effective preventive vaccine has been available for several years and is recommended for administration to girls beginning at age 11 years (and as early as age 9 years) — ideally before sexual debut, since HPV is the most prevalent sexually transmitted infection in the United States and the vaccine does not protect against existing infection. The quadrivalent vaccine also protects against genital warts and recently received approved for use in males as young as 9 years of age. Importantly, the vaccine, which does not contain live virus, has an impressive safety record.1

“Despite this safety record, Rep. Bachman, a graduate of the Oral Roberts School of Law, in a recent Republican candidates' debate, called the vaccine `dangerous’ and spoke of the `poor innocent little girls’ upon whom it was inflicted,” he continues. “The following day she went on to relay an unsubstantiated story about a girl who `became mentally retarded’ after receiving the vaccine. Associated statements by her and some of her fellow candidates also contained the implication that any public health mandate constituted an unconstitutional denial of freedom. As an apparently charter member of the seemingly expanding cult of `denialism’ — the rejection of science and its methods and of objective reality itself — perhaps these statements should have been expected. They, nonetheless, have the potential to cause enormous damage by causing individuals to reject the vaccine for themselves or their children. Will the denialists take responsibility for the resultant deaths?” Wow, what a great moral question. And don’t forget this vaccine has an emerging role in protecting boys as well from oral cancers. But I won’t even go near an assessment of the possible audience reactions if the debate moderator asked Bachman and other HPV critics: “Aren’t you resistant to this HPV vaccine because you fear it will encourage earlier sexual activity? Experts say that is not the case, but even if it was is that not a better alternative to your child acquiring cancer?” Reference 1. Gee J, et al. Monitoring the safety of quadrivalent human papillomavirus vaccine: Findings from the Vaccine Safety Datalink. Vaccine 2011 Sep 9; Epub ahead of print. http://www.ncbi.nlm.nih.gov/pubmed/21907257