DOCSLIB.ORG

The Convalescent Sera Option for Containing COVID-19

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

The convalescent sera option for containing COVID-19 Arturo Casadevall, Liise-anne Pirofski J Clin Invest. 2020. https://doi.org/10.1172/JCI138003. Viewpoint As of early 2020, humanity is confronting a pandemic in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 causes coronavirus disease, abbreviated as COVID-19. At the time of this writing, SARS-CoV-2 is spreading in multiple countries, threatening a pandemic that will affect billions of people. This virus appears to be a new human pathogen. Currently there are no vaccines, monoclonal antibodies (mAbs), or drugs available for SARS-CoV-2, although many are in rapid development and some may be available in a short time. This Viewpoint argues that human convalescent serum is an option for prevention and treatment of COVID-19 disease that could be rapidly available when there are sufficient numbers of people who have recovered and can donate immunoglobulin-containing serum. Passive antibody therapy Passive antibody therapy involves the administration of antibodies against a given agent to a susceptible individual for the purpose of preventing or treating an infectious disease due to that agent. In contrast, active vaccination requires the induction of an immune response that takes time to develop and varies depending on the vaccine recipient. Thus, passive antibody administration is the only means of providing immediate immunity to susceptible persons. Passive antibody therapy has a storied history going back to the 1890s and was the only means of treating certain infectious diseases prior to the development of antimicrobial therapy in […] Find the latest version: https://jci.me/138003/pdf The Journal of Clinical Investigation VIEWPOINT The convalescent sera option for containing COVID-19 Arturo Casadevall1 and Liise-anne Pirofski2 1Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA. 2Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA. As of early 2020, humanity is confront- tection is viral neutralization. However, and provide protection against infection. ing a pandemic in severe acute respiratory other mechanisms may be possible, such Depending on the antibody amount and syndrome coronavirus 2 (SARS-CoV-2). as antibody-dependent cellular cytotoxic- composition, the protection conferred by SARS-CoV-2 causes coronavirus disease, ity and/or phagocytosis. Possible sources the transferred immunoglobulin can last abbreviated as COVID-19. At the time of of antibody for SARS-CoV-2 are human from weeks to months. this writing, SARS-CoV-2 is spreading in convalescent sera from individuals who multiple countries, threatening a pandemic have recovered from COVID-19, mAbs, Historical precedents that will affect billions of people. This virus or preparations generated in certain ani- In the early twentieth century convalescent appears to be a new human pathogen. Cur- mal hosts, such as genetically engineered sera was used to stem outbreaks of viral rently there are no vaccines, monoclonal cows that produce human antibody (4). diseases such as poliomyelitis (8), measles antibodies (mAbs), or drugs available for Although many types of preparations are (9, 10), mumps (11), and influenza (12). A SARS-CoV-2, although many are in rapid or will soon be under development, the retrospective meta-analysis of eight studies development and some may be available only antibody type that is currently avail- on the use of convalescent sera involving in a short time. This Viewpoint argues that able for immediate use is that found in 1703 patients during the 1918 H1N1 influ- human convalescent serum is an option for human convalescent sera (Figure 1). As enza virus pandemic suggested that those prevention and treatment of COVID-19 more individuals contract COVID-19 and who received serum had lower mortality disease that could be rapidly available recover, the number of potential donors (13). Although the efficacy of convalescent when there are sufficient numbers of peo- will continue to increase. sera varied with the virus and the study, ple who have recovered and can donate A general principle of passive antibody there was consensus at the time that this immunoglobulin-containing serum. therapy is that it is more effective when intervention was useful, and it was used in used for prophylaxis than for treatment numerous outbreaks. It is noteworthy that Passive antibody therapy of disease. When used for therapy, anti- historically, convalescent sera were devel- Passive antibody therapy involves the body is most effective when administered oped and used in many cases without the administration of antibodies against a given shortly after the onset of symptoms. The means to measure antibody titers or knowl- agent to a susceptible individual for the pur- reason for temporal variation in efficacy edge about viral serotypes, and in clinical pose of preventing or treating an infectious is not well understood but could reflect studies that did not meet modern criteria disease due to that agent. In contrast, active that passive antibody works by neutraliz- for randomization or blinding. vaccination requires the induction of an ing the initial inoculum, which is likely to More recently, convalescent serum immune response that takes time to develop be much smaller than that of established was used during viral epidemics. In the and varies depending on the vaccine recip- disease (5). Another explanation is that 2009–2010 H1N1 influenza virus pan- ient. Thus, passive antibody administration antibody works by modifying the inflam- demic, convalescent serum antibody is the only means of providing immediate matory response, which is also more eas- preparations obtained by apheresis were immunity to susceptible persons. Passive ily achieved during the initial immune used to treat individuals with severe H1N1 antibody therapy has a storied history going response, a stage that may be asymptom- 2009 infection requiring intensive care back to the 1890s and was the only means atic (6). As an example, passive antibody (14). Serum-treated individuals manifest- of treating certain infectious diseases prior therapy for pneumococcal pneumonia was ed reduced respiratory viral burden, serum to the development of antimicrobial thera- most effective when administered shortly cytokine responses, and mortality (14). py in the 1940s (1, 2). Experience from prior after the onset of symptoms, and there was Convalescent serum was also used in the outbreaks with other coronaviruses, such as no benefit if antibody administration was 2013 West African Ebola epidemic. A small SARS-CoV-1, shows that such convalescent delayed past the third day of disease (7). nonrandomized study in Sierra Leone sera contain neutralizing antibodies to the For passive antibody therapy to be revealed significantly longer survival for relevant virus (3). effective, a sufficient amount of anti- those treated with convalescent whole In the case of SARS-CoV-2, the antic- body must be administered. When giv- blood relative to those who received stan- ipated mechanism of action by which pas- en to a susceptible person, this antibody dard treatment (15). Two patients trans- sive antibody therapy would mediate pro- will circulate in the blood, reach tissues, ferred to the United States and treated with a combination of convalescent serum and an experimental drug also survived Conflict of interest: The authors have declared that no conflict of interest exists. Copyright: © 2020, American Society for Clinical Investigation. (16). There is anecdotal evidence from the Reference information: J Clin Invest. https://doi.org/10.1172/JCI138003. H5N1 (17, 18) and H7N9 (19) avian flu out- jci.org 1 VIEWPOINT The Journal of Clinical Investigation Figure 1. Schematic of the use of convalescent sera for COVID-19. An individual who is sick with COVID-19 and recovers has blood drawn and screened for virus-neutralizing antibodies. Following identification of those with high titers of neutralizing antibody, serum containing these virus-neutralizing anti- bodies can be administered in a prophylactic manner to prevent infection in high-risk cases, such as vulnerable individuals with underlying medical condi- tions, health care providers, and individuals with exposure to confirmed cases of COVID-19. Additionally, convalescent serum could potentially be used in individuals with clinical disease to reduce symptoms and mortality. The efficacy of these approaches is not known, but historical experience suggests that convalescent sera may be more effective in preventing disease than in the treatment of established disease. breaks that use of convalescent sera was 500 mL convalescent serum, resulting in istration is that it can prevent infection effective, with all patients surviving. a reduction in serum virus titer, and each and subsequent disease in those who are Although every viral disease and epi- survived (21). Three patients with MERS at high risk for disease, such as vulnera- demic is different, these experiences pro- in South Korea were treated with convales- ble individuals with underlying medical vide important historical precedents that cent serum, but only two of the recipients conditions, health care providers, and are both reassuring and useful as humani- had neutralizing antibody in their serum those with exposure to confirmed cases ty now confronts the COVID-19 epidemic. (22). The latter study highlights a chal- of COVID-19.
Recommended publications
  • 10 Top Researchers at AECOM

    10 Top Researchers at AECOM

    TEN LEADING EINSTEIN RESEARCHERS AND THEIR ACCOMPLISHMENTS INFECTIOUS DISEASE John Blanchard, Ph.D., has identified a promising new treatment for extensively drug-resistant tuberculosis (XDR-TB), a dangerous form of the disease caused by strains of TB bacteria that have become resistant to virtually all antibiotics. In 2009, Dr. Blanchard reported that a combination of two drugs (clavulanate and meropenem) was highly effective in halting the growth of XDR-TB in John Blanchard, Ph.D. John Condeelis, Ph.D. Ekaterina Dadachova, Ph.D. laboratory culture. Since then, his drug combination has saved the lives of several patients with XDR-TB and will soon be formally evaluated in two human trials, in South Africa and Belgium. Dr. Blanchard is professor of biochemistry and the Dan Danciger Professor of Biochemistry. Arturo Casadevall, M.D., Ph.D., is one of the world’s leading microbiologists, well known for his diverse and innovative scientific inquiries. His work on Arturo Casadevall, M.D., Ph.D Vern Schramm, Ph.D. Joseph Sparano, M.D. fungal melanin, for example, has opened up the possibility of using this pigment in novel CANCER ways to protect against radiation exposure. Thanks to a highly John Condeelis, Ph.D., anatomy and structural biology Casadevall, M.D., Ph.D., Dr. productive research partnership is a leading expert on imaging department, scientific director of Dadachova developed radio- with colleague Ekaterina the tumor microenvironment— the analytical imaging facility, immunotherapy for metastatic Dadachova, Ph.D., he has the microscopic site where tumor co-director of the Gruss Lipper melanoma—a treatment developed a targeted therapy cells interact with surrounding Biophotonics Center, and the strategy that has shown promise for metastatic melanoma that cells.
  • Anti-Thymocyte Globulin (Atg) and Ciclosporin (Csa)

    Anti-Thymocyte Globulin (Atg) and Ciclosporin (Csa)

    Myeloid group ANTI-THYMOCYTE GLOBULIN (ATG) AND CICLOSPORIN (CSA) INDICATION ATG and CSA is indicated for patients who require treatment for aplastic anaemia (AA) but who are not eligible for sibling donor BMT. This includes (note references to severity are based on the modified Camitta criteria): Patients with non-severe aplastic anaemia who are dependent on red cell and/or platelet transfusions. Patients with severe aplastic anaemia (SAA) or very SAA who are > 35-50 years of age. Patients with SAA or very SAA disease who lack an HLA-compatible sibling donor. Protocol may be used in selected patients with hypoplastic marrow conditions. Patients with severe AA who are ≤ 35 years old and have a HLA identical sibling donor, should be treated with allogenic bone marrow transplantation as soon as possible after diagnosis. TREATMENT INTENT Prolong survival Provide a rapid (within 3 months) and sustained improvement in peripheral blood counts Restore haematopoiesis PRE-ASSESSMENT 1. ATG should only used by physicians familiar with administering ATG. Medical and nursing teams must be aware of the side effects and how to treat promptly and appropriately. 2. ATG is highly immunosuppressive - only use in centres with at least level 2 facilities. Patients should be nursed in a single or double isolation room, as an inpatient. 3. Risk of transfusion-associated GvHD following treatment with ATG is unclear, therefore irradiated blood components are currently recommended. It is not known how long the use of irradiated products This is a controlled document and therefore must not be changed Page 1 of 9 ML.2 ATG & CSA Authorised by Myeloid Lead Oct 2019 V.4.1 Prof Adam Mead Myeloid group should be continued, but it may be reasonable to continue while patients are still taking CSA following ATG therapy.
  • Continuous Time Individual-Level Models of Infectious Disease: Epiilmct

    Continuous Time Individual-Level Models of Infectious Disease: Epiilmct

    Continuous Time Individual-Level Models of Infectious Disease: EpiILMCT Waleed Almutiry Vineetha Warriyar K V Rob Deardon Qassim University Uinversity of Calgary University of Calgary Abstract This paper describes the R package EpiILMCT, which allows users to study the spread of infectious disease using continuous time individual level models (ILMs). The package provides tools for simulation from continuous time ILMs that are based on either spatial demographic, contact network, or a combination of both of them, and for the graphical summarization of epidemics. Model fitting is carried out within a Bayesian Markov Chain Monte Carlo (MCMC) framework. The continuous time ILMs can be implemented within either susceptible-infected-removed (SIR) or susceptible- infected-notified-removed (SINR) compartmental frameworks. As infectious disease data is often partially observed, data uncertainties in the form of missing infection times - and in some situations missing removal times - are accounted for using data augmentation techniques. The package is illustrated using both simulated and an experimental data set on the spread of the tomato spotted wilt virus (TSWV) disease. Keywords: EpiILMCT, infectious disease, individual level modelling, spatial models, con- tact networks, R. 1. Introduction Innovative mathematical and mechanistic approaches to the modelling of infectious dis- eases are continuing to emerge in the literature. These can be used to understand the spread of disease through a population - whether homogeneous or heterogeneous - and enable researchers to construct predictive models to develop control strategies to disrupt arXiv:2006.00135v1 [stat.AP] 30 May 2020 disease transmission. For example, Deardon et al. (2010) introduced a class of discrete time individual-level models (ILMs) which incorporate population heterogeneities by modelling the transmission of disease given various individual-level risk factors.
  • The Basic Reproduction Number As a Predictor for Epidemic Outbreaks in Temporal Networks

    The Basic Reproduction Number As a Predictor for Epidemic Outbreaks in Temporal Networks

    The basic reproduction number as a predictor for epidemic outbreaks in temporal networks Petter Holme1,2,3 and Naoki Masuda4 1Department of Energy Science, Sungkyunkwan University, 440-746 Suwon, Korea 2IceLab, Department of Physics, Umeå University, 90187 Umeå, Sweden 3Department of Sociology, Stockholm University, 10961 Stockholm, Sweden 4Department of Engineering Mathematics, University of Bristol, BS8 1UB, Bristol, UK E-mail address: [email protected] Abstract The basic reproduction number R₀—the number of individuals directly infected by an infectious person in an otherwise susceptible population—is arguably the most widely used estimator of how severe an epidemic outbreak can be. This severity can be more directly measured as the fraction people infected once the outbreak is over, Ω. In traditional mathematical epidemiology and common formulations of static network epidemiology, there is a deterministic relationship between R₀ and Ω. However, if one considers disease spreading on a temporal contact network—where one knows when contacts happen, not only between whom—then larger R₀ does not necessarily imply larger Ω. In this paper, we numerically investigate the relationship between R₀ and Ω for a set of empirical temporal networks of human contacts. Among 31 explanatory descriptors of temporal network structure, we identify those that make R₀ an imperfect predictor of Ω. We find that descriptors related to both temporal and topological aspects affect the relationship between R₀ and Ω, but in different ways. Introduction The interaction between medical and theoretical epidemiology of infectious diseases is probably not as strong as it should. Many results in the respective fields fail to migrate to the other.
  • I Have Spots and My Skin Burns

    I Have Spots and My Skin Burns

    I have spots and my skin burns Patient presentation History Differential diagnosis Examination Investigations Discussion Treatment Final Outcome References Evaluation - Questions & answers MCQs Patient presentation Peter, a 60 year-old Caucasian policeman, complains of a painful burning sensation in his lower extremities lasting for several months. Lower limbs petechiae (small purple/red hemorrhagic spots) appeared one week ago. Acknowledgement This case study was provided by Prof. Olivier Boyer (M.D., Ph.D., Head of the Department of Immunology and Biotherapy, Rouen University Hospital, France) and Dr. Maëlle Le Besnerais (M.D., Assistant Professor of Internal Medicine, Rouen University Hospital, France) of the Faculty of Medicine of Rouen, Normandy University, France. The authors would like to thank David Saadoun, Odile Goria, Lucie Guyant-Maréchal and Fabienne Jouen for their critical reading of this case study, Isabelle Duval for the development of pictures and Laetitia Demoulins for technical assistance. We are grateful to Nikki Sabourin-Gibbs, Rouen University Hospital, for her help in editing the manuscript. Immunopaedia.org.za History Peter complains of chronic fatigue and aching joints which started several months ago. He denies significant alcohol consumption and intravenous drug abuse. He received a blood transfusion after a gunshot injury to his arm 35 years ago. He reports distal paraesthesia (tingling or numbness) of both legs and painful burning in both feet which has progressed to the lower and upper limbs. Knee pain wakes him up at night. Past medical history None No allergies Surgical history Appendix removed at 10 years old Arm gunshot injury 35 years ago Family history His father has hypertension and type 2 diabetes Travel history He traveled to Thailand 25 years ago Social history Policeman, married, two children Medication None Differential diagnosis IgA vasculitis Polyarteritis nodosa ANCA-associated vasculitis (eg.
  • Epidemic Models

    Epidemic Models

    Chapter 9 Epidemic Models 9.1 Introduction to Epidemic Models Communicable diseases such as measles, influenza, and tuberculosis are a fact of life. We will be concerned with both epidemics, which are sudden outbreaks of a disease, and endemic situations, in which a disease is always present. The AIDS epidemic, the recent SARS epidemic, recurring influenza pandemics, and outbursts of diseases such as the Ebola virus are events of concern and interest to many peo- ple. The prevalence and effects of many diseases in less-developed countries are probably not as well known but may be of even more importance. Every year mil- lions, of people die of measles, respiratory infections, diarrhea, and other diseases that are easily treated and not considered dangerous in the Western world. Diseases such as malaria, typhus, cholera, schistosomiasis, and sleeping sickness are endemic in many parts of the world. The effects of high disease mortality on mean life span and of disease debilitation and mortality on the economy in afflicted countries are considerable. We give a brief introduction to the modeling of epidemics; more thorough de- scriptions may be found in such references as [Anderson & May (1991), Diekmann & Heesterbeek (2000)]. This chapter will describe models for epidemics, and the next chapter will deal with models for endemic situations, but we begin with some general ideas about disease transmission. The idea of invisible living creatures as agents of disease goes back at least to the writings of Aristotle (384 BC–322 BC). It developed as a theory in the sixteenth century. The existence of microorganisms was demonstrated by van Leeuwenhoek (1632–1723) with the aid of the first microscopes.
  • Commentary Inducing Autoimmune Disease to Treat Cancer

    Commentary Inducing Autoimmune Disease to Treat Cancer

    Proc. Natl. Acad. Sci. USA Vol. 96, pp. 5340–5342, May 1999 Commentary Inducing autoimmune disease to treat cancer Drew M. Pardoll Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2196 For many years, visions for development of successful immu- colleagues (6) discovered that the target for a melanoma- notherapy of cancer revolved around the induction of immune specific CD81 T cell clone grown from a melanoma patient was responses against tumor-specific ‘‘neoantigens.’’ However, as wild-type tyrosinase, a melanosomal enzyme selectively ex- demonstrated in a recent paper in the Proceedings by Overwijk pressed in melanocytes and responsible for one of the steps in et al. (1), the generation of tissue-specific autoimmune re- melanin biosynthesis. Subsequently, a number of investigators sponses represents an approach to cancer immunotherapy that found that their melanoma-specific CD81 T cells indeed is gaining momentum. Thus, a new principle in cancer therapy recognized melanocyte-specific antigens rather than melano- states that the ability to induce tissue-specific autoimmunity ma-specific antigens (7–10). Most of these antigens appear to will allow for the treatment of many important cancers. be melanosomal proteins, and a number of them, including The original focus on tumor-specific neoantigens derived tyrosinase, TRP-1, TRP-2, and gp100, are involved in melanin from a number of findings. Vaccination-challenge experiments biosynthesis. Other melanosomal proteins such as MART1y performed between carcinogen-induced murine tumor models Melan A have no known function but are nonetheless mela- typically demonstrated that autologous tumors vaccinated nocyte-specific tissue differentiation antigens.
  • Penicillin Allergy Guidance Document

    Penicillin Allergy Guidance Document

    Penicillin Allergy Guidance Document Key Points Background Careful evaluation of antibiotic allergy and prior tolerance history is essential to providing optimal treatment The true incidence of penicillin hypersensitivity amongst patients in the United States is less than 1% Alterations in antibiotic prescribing due to reported penicillin allergy has been shown to result in higher costs, increased risk of antibiotic resistance, and worse patient outcomes Cross-reactivity between truly penicillin allergic patients and later generation cephalosporins and/or carbapenems is rare Evaluation of Penicillin Allergy Obtain a detailed history of allergic reaction Classify the type and severity of the reaction paying particular attention to any IgE-mediated reactions (e.g., anaphylaxis, hives, angioedema, etc.) (Table 1) Evaluate prior tolerance of beta-lactam antibiotics utilizing patient interview or the electronic medical record Recommendations for Challenging Penicillin Allergic Patients See Figure 1 Follow-Up Document tolerance or intolerance in the patient’s allergy history Consider referring to allergy clinic for skin testing Created July 2017 by Macey Wolfe, PharmD; John Schoen, PharmD, BCPS; Scott Bergman, PharmD, BCPS; Sara May, MD; and Trevor Van Schooneveld, MD, FACP Disclaimer: This resource is intended for non-commercial educational and quality improvement purposes. Outside entities may utilize for these purposes, but must acknowledge the source. The guidance is intended to assist practitioners in managing a clinical situation but is not mandatory. The interprofessional group of authors have made considerable efforts to ensure the information upon which they are based is accurate and up to date. Any treatments have some inherent risk. Recommendations are meant to improve quality of patient care yet should not replace clinical judgment.
  • Letters to the Editor

    Letters to the Editor

    LETTERS TO THE EDITOR Complications of plasma exchange in after percutaneous insertion of a subclavian central ve- thrombotic thrombocytopenic nous catheter from pneumothorax and hemorrhage. Two purpura-hemolytic uremic syndrome: patients suffered cardiac arrest with pulseless electrical a study of 78 additional patients activity: one from an anaphylactic reaction to plasma and The frequency of patients treated with plasma exchange the other from pericardial hemorrhage and tamponade, (PE) for thrombotic thrombocytopenic purpura- presumably due to cardiac perforation by an internal hemolytic uremic syndrome (TTP-HUS) increased seven- jugular catheter insertion guidewire. fold from 1981 to 1997.1 Therefore, the morbidity and Other major catheter-related complications included mortality due to PE is an increasingly important consid- one patient with a retroperitoneal hemorrhage following eration in management decisions for patients with clini- femoral catheter insertion and seven patients with cath- cally suspected TTP-HUS. Some studies have described eter thrombosis that prevented PE and/or required place- few complications associated with PE,2 but our previous ment of a new central venous catheter; two of these seven report on 71 consecutive patients with clinically sus- patients had catheter-related venous thrombosis requir- pected TTP-HUS treated with PE from 1996 to 1999 dem- ing systemic anticoagulation. Ten patients developed sys- onstrated a major complication rate of 30 percent, in- temic infection: eight had blood cultures positive for the cluding two deaths.3 This report describes our experience presence of bacteria (Staphylococcus aureus [five], Staph- during the subsequent 3 years, 1999 to 2002, with 78 con- ylococcus epidermidis [three]); the two patients with secutive patients.
  • Clustering of Susceptible Individuals Within Households Can Drive an Outbreak: an Individual-Based Model Exploration

    Clustering of Susceptible Individuals Within Households Can Drive an Outbreak: an Individual-Based Model Exploration

    medRxiv preprint doi: https://doi.org/10.1101/2019.12.10.19014282; this version posted December 14, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Clustering of susceptible individuals within households can drive an outbreak: an individual-based model exploration Elise Kuylen1,2,*, Lander Willem1, Jan Broeckhove3, Philippe Beutels1, and Niel Hens1,4 1Centre for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium 2Discipline Group Computer Sciences, Hasselt University, Hasselt, Belgium 3IDLab, Department of Mathematics and Computer Science, University of Antwerp, Antwerp, Belgium 4I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium *[email protected] ABSTRACT When estimating important measures such as the herd immunity threshold, and the corresponding efforts required to eliminate measles, it is often assumed that susceptible individuals are uniformly distributed throughout populations. However, unvaccinated individuals may be clustered in a variety of ways, including by geographic location, by age, in schools, or in households. Here, we investigate to which extent different levels of within-household clustering of susceptible individuals may impact the risk and persistence of measles outbreaks. To this end, we apply an individual-based model, Stride, to a population of 600,000 individuals, using data from Flanders, Belgium. We compare realistic scenarios regarding the distribution of susceptible individuals within households in terms of their impact on epidemiological measures for outbreak risk and persistence.
  • Lesson 1 Introduction to Epidemiology

    Lesson 1 Introduction to Epidemiology

    Lesson 1 Introduction to Epidemiology Epidemiology is considered the basic science of public health, and with good reason. Epidemiology is: a) a quantitative basic science built on a working knowledge of probability, statistics, and sound research methods; b) a method of causal reasoning based on developing and testing hypotheses pertaining to occurrence and prevention of morbidity and mortality; and c) a tool for public health action to promote and protect the public’s health based on science, causal reasoning, and a dose of practical common sense (2). As a public health discipline, epidemiology is instilled with the spirit that epidemiologic information should be used to promote and protect the public’s health. Hence, epidemiology involves both science and public health practice. The term applied epidemiology is sometimes used to describe the application or practice of epidemiology to address public health issues. Examples of applied epidemiology include the following: • the monitoring of reports of communicable diseases in the community • the study of whether a particular dietary component influences your risk of developing cancer • evaluation of the effectiveness and impact of a cholesterol awareness program • analysis of historical trends and current data to project future public health resource needs Objectives After studying this lesson and answering the questions in the exercises, a student will be able to do the following: • Define epidemiology • Summarize the historical evolution of epidemiology • Describe the elements of a case
  • Group Icon 2019 Speaker Biographies

    Group Icon 2019 Speaker Biographies

    A University Symposium: Promoting Credibility, Reproducibility and Integrity in Research March 29, 2019 | Columbia University | Speaker Biographies Speaker Biographies* Howard Bauchner, MD was appointed the 16th Editor in Chief of JAMA and The JAMA Network in 2011. Prior to coming to JAMA, Howard was a Professor of Pediatrics and Public Health at Boston University School of Medicine and Editor in Chief of Archives of Disease in Childhood (2003- 2011). At BUSM he was Vice-Chair of Research for the Department of Pediatrics and Chief, Division of General Pediatrics. He is a member of the National Academy of Medicine (formerly the Institute of Medicine) and an honorary fellow of the Royal College of Paediatrics and Child Health, United Kingdom. At JAMA Howard has focused on improving and expanding clinical content, using electronic/digital approaches to enhance communication, and ensuring a commitment to innovation. Since his arrival in 2011 followers on social medical (twitter and Facebook) have increased from 13,000 to approximately 700,000 and the electronic table of contents is now distributed to close to 750,000 individuals each week. In print, via eTOC, and social media JAMA now reaches over 1.5M physicians each week worldwide. Views (PDF and HTML) have increased from 10M in 2011 to 32M in 2017 (50% from outside the U.S.) and podcast downloads have increased from 300,000 in 2014 to 2.2M in 2017. The print journal was redesigned for the first time in over 20 years and website has been updated twice. All 9 of the specialty journals were renamed (Archives of Pediatrics became JAMA Pediatrics), and 3 new journals have been launched – JAMA Oncology (2015), JAMA Cardiology (2016), and JAMA Network Open (2018).