Author Interviews, Infections, JAMA / 21.10.2020
Surveillance for Human Prion Disease
MedicalResearch.com Interview with:
Liliana Sanchez-Gonzalez MD, MPH
Medical Epidemiologist
Dengue Branch – Division of Vector Borne Diseases
Centers for Disease Control and Prevention
San Juan, PR
MedicalResearch.com: What is the background for this study? Would you briefly explain the significance of prion disease?
Response: Prion diseases are neurodegenerative diseases that occur in animals and humans. These diseases are caused by an infectious agent known as a prion. While the accuracy of diagnostic tests using cerebrospinal fluid or brain imaging from living patients has improved greatly in recent years, analysis of brain tissue is still necessary to confirm the diagnosis of these diseases.
[caption id="attachment_55692" align="alignleft" width="300"] This tissue slide shows sponge-like lesions in the brain tissue of a classic CJD patient.[/caption]
Human prion disease cases are rare, but always fatal. There have been around 500 reported cases annually in the US in recent years. A very small percentage of human prion disease cases are acquired, meaning they are caused by an exposure to the infectious agent from an external source. The most well-known acquired human prion disease is variant Creutzfeldt-Jakob disease (vCJD), which was first described in the United Kingdom in 1996 and linked to consumption of contaminated beef from cattle with the animal prion disease bovine spongiform encephalopathy (BSE, or “mad cow” disease).
The only US state where classic BSE has been reported is Washington, where an infected dairy cow was imported from Canada in 2003. Beef from the slaughtered cow was processed for human consumption, and beef from cattle slaughtered the same day at the involved slaughter plant was recalled. After this incident, the Washington State Department of Health, in collaboration with the US Centers for Disease Control and Prevention and the National Prion Disease Pathology Surveillance Center (NPDPSC), implemented enhanced human prion disease surveillance. All patients with positive results from tests conducted at the NPDPSC are investigated. We present the results of 12 years of human prion disease surveillance, from 2006 to 2017, plus results of surveillance for vCJD through July 2020.
This tissue slide shows sponge-like lesions in the brain tissue of a classic CJD patient.[/caption]
Human prion disease cases are rare, but always fatal. There have been around 500 reported cases annually in the US in recent years. A very small percentage of human prion disease cases are acquired, meaning they are caused by an exposure to the infectious agent from an external source. The most well-known acquired human prion disease is variant Creutzfeldt-Jakob disease (vCJD), which was first described in the United Kingdom in 1996 and linked to consumption of contaminated beef from cattle with the animal prion disease bovine spongiform encephalopathy (BSE, or “mad cow” disease).
The only US state where classic BSE has been reported is Washington, where an infected dairy cow was imported from Canada in 2003. Beef from the slaughtered cow was processed for human consumption, and beef from cattle slaughtered the same day at the involved slaughter plant was recalled. After this incident, the Washington State Department of Health, in collaboration with the US Centers for Disease Control and Prevention and the National Prion Disease Pathology Surveillance Center (NPDPSC), implemented enhanced human prion disease surveillance. All patients with positive results from tests conducted at the NPDPSC are investigated. We present the results of 12 years of human prion disease surveillance, from 2006 to 2017, plus results of surveillance for vCJD through July 2020.
Dr. KantersA[/caption]
Response: A watershed moment for the fight against HIV was the antiretroviral treatment (ART) scale-up that made HIV treatments available around the world. While HIV activism led to its initiation, two key ingredients to the ART scale-up were the advent of a once-daily single-pill HIV treatment and the creation of the World Health Organization (WHO) clinical guidelines for treatment and prevention of HIV. The HIV treatment in question combines three drugs in a single pill and centers around a drug called efavirenz.
The WHO guidelines use a public health framework, which is to say that it uses a treatment algorithm that is both equitable and simple enough to allow some task-shifting to less specialized workers. As such, the guidelines suggest a single preferred treatment for people initiating HIV treatment. While resource rich countries can use a personalized medicine approach, many settings where HIV is endemic cannot.
In 2015, our review found strong evidence that a newer HIV drug, called dolutegravir, was better than efavirenz in respect to efficacy, tolerability and safety; however, there was not enough evidence to support its use in key populations, such as people with HIV-tuberculosis co-infections and pregnant women. For this and other reasons, the WHO could not recommend its use as the preferred treatment at initiation.
Since then, we have continued to dynamically assess the evidence to determine the best treatment to have as the preferred ART for first-time HIV treatment. This is the culmination of 6 years of work and its findings have helped the WHO change its recommended preferred first-line therapy from an efavirenz-based ART to a dolutegravir-based ART. 
Dr. Profeta[/caption]
Paola Profeta, PhD
Professor of Public Economics, Department of Social and Political Sciences
Bocconi University
Director, Msc Politics and Policy Analysis, Bocconi University
Coordinator, Dondena Gender Initiative, Dondena Research Center
President, European Public Choice Society
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We interview more than 20000 men and women in 8 OECD countries in two periods during the lockdown.
Using two waves from 8 OECD countries, we find that women are more likely to perceive the pandemic as a very serious health problem, to agree with restraining measures and to comply with public health rules, such as using facemasks. This gender differences are less strong for married individuals and for individuals who have been directly exposed to COVID, for instance by knowing someone who was infected.
Response: The background for this study involves the associations of household rules and parental awareness with youth tobacco use using data from the Population Assessment Tobacco and Health Study. Health concerns regarding non-cigarette tobacco products, specifically e-cigarettes, have been on the rise. We wanted to explore whether parents are up to date with the trends of popular tobacco products today and what role they may play in youth tobacco cessation and prevention.
The main findings of the study revealed that parents less often suspected their children’s tobacco use if their children reported using only e-cigarettes, and other non-cigarette tobacco products, when compared with cigarettes. Additionally, we found that youth who agreed with their parents that their home has strict rules for tobacco use were less likely to initiate of tobacco use compared to youth who had different understanding of the rules from their parents or youth from households with more permissive household rules. 
Dr. Lanza[/caption]
Isabella Lanza, PhD
Associate Professor of Human Development
California State University, Long Beach
MedicalResearch.com: What is the background for this study? What are the main findings? Response: This is the first study to examine both nicotine vaping and cannabis vaping trajectories across adolescence and young adulthood, which allowed us to assess whether poly-substance vaping is common among adolescents and young adults. Poly-substance vaping (nicotine and cannabis vaping) was reported among a significant proportion of participants in the study (25% were identified as poly-substance vapers). For those that either escalated to frequent nicotine vaping use in adolescence or initiated frequent nicotine vaping use in young adulthood, the probability of engaging in cannabis vaping was very high (85%+).
Dr. Garg[/caption]
Dr. Madhur Garg, MD MBA
Clinical director, Radiation Oncology
Montefiore Health System and Professor
Departments of Otorhinolaryngology - Head & Neck Surgery - and Urology
Albert Einstein College of Medicine
MedicalResearch.com: What is the background for this study?
Response: The Bronx was hit particularly hard with Covid-19 - making up one of the highest per capita cases and deaths in the country. Montefiore Health System and Albert Einstein College of Medicine, care for a large population of ethnic minorities (non-Hispanic Black and Hispanic individuals make up 65% of our patient population).
Dr. Pollard[/caption]
Michael S. Pollard, Ph.D.
Professor, Pardee RAND Graduate School
Senior Sociologist
RAND Corporation
Santa Monica, CA 90407-2138
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There are ample anecdotal jokes and stories about increased alcohol use during COVID-19 and stay-at-home orders. Our study provides robust longitudinal evidence that people drank more frequently, and for women in particular, more heavily, and with more negative consequences, during the initial stages of COVID-19 compared to their own behaviors from a year earlier (May/June 2020 compared to May/June 2019). Women’s alcohol consumption was most significantly changed, with a 17% increase in number of days drinking, and a 41% increase in days of binge drinking (when they had four or more drinks in a couple of hours). This means that, nationally, one in five women drank heavily one more day a month than the same time in 2019, on average. Women also reported a 39% increase in alcohol-related problems, such as “I took foolish risks” or “I failed to do what was expected of me” because of drinking alcohol.
Melanie Leung[/caption]
Melanie Leung, M.D.,C.M. candidate 2021
4th-year medical student at McGill University
Division of Allergy and Clinical Immunology
Department of Pediatrics, Montreal Children’s Hospital
McGill University Health Centre, Montreal, QC, Canada
Dr. Moshe Ben-Shoshan, MD, MSc
Pediatric allergist and immunologist at the MCH (Montreal Children’s Hospital) and
Scientist at the Research Institute of the MUHC (McGill University Health Center)
MedicalResearch.com: What is the background for this study?
Response: In Canada, up to 9% of children have at least 1 food allergy. Anaphylaxis is the most severe and potential life-threatening manifestation of food allergy. Peanuts and tree nuts are the main culprits in food-induced anaphylaxis and account for most fatal cases in North America.
Public awareness about peanut and nut anaphylaxis can help to prevent and to act promptly, in the case of anaphylactic reaction. However, the best timing for public awareness campaigns remained unknown, as no previous study looked at the potential association between specific times of the year, such as public holidays, and the incidence of peanut and tree nut anaphylaxis. Our aim was to evaluate the risk of peanut and tree nut-induced anaphylaxis on Halloween, Christmas, Easter, Diwali, Chinese New Year, and Eid al-Adha.
Data was collected from 1390 pediatric cases of peanut or nut-induced anaphylaxis across Canada (Newfoundland & Labrador, Quebec, Ontario, and British Columbia), from 2011 to 2020. 62% of children were boys and the median age was 5.4 years. We compared the average daily number of cases during each holiday and compared it to the rest of the year (i.e.: non-holiday period).
