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A Shot in the Arm

Vaccination comes of age

Polio has lost its punch. Another scourge, measles, is largely conquered, too.

Two cases of diphtheria were reported in the United States in 2000, a disease that once killed 14,000 people every year. Times were when tetanus took hundreds of thousands of lives worldwide. In 2000, tetanus claimed just 26 lives in America.

These are among the miracles of modern medicine. Vaccines made each miracle possible.

But the work of vaccines is hardly over, says Richard K. Zimmerman, associate professor in the Department of Family Medicine in the School of Medicine. Preventable diseases still claim too many lives, he says. What’s different is that vaccination is no longer kid’s stuff, especially when it comes to influenza.

Flu is one of the oldest and most commonly known diseases. It is also often regarded as little more than a nuisance. That’s a mistake.

According to a recent article in the Journal of the American Medical Association, flu claimed the lives of some 36,000 people annually during the 1990s. And that’s not all.

The flu virus mutates, allowing it to spread quickly worldwide. For example, some estimates place the death toll from the Spanish flu pandemic of 1918 at 50 million. Smaller flu outbreaks in 1957 and 1968, combined, claimed the lives of at least one million people in the United States. By comparison, the outbreak of severe acute respiratory syndrome, or SARS, has killed 800 people.

Zimmerman is not alone in his worries about flu. Scientist Klaus Stohr, who heads the World Health Organization’s influenza program and leads the agency’s fight against SARS, recently told the Wall Street Journal that compared to a flu pandemic, “SARS will be something to smile about.” Stohr also says the world is grossly unprepared for the next global outbreak of flu.

That’s where Zimmerman comes in. As a researcher, doctor at an inner-city health clinic, and member of the Advisory Committee on Immunization Practices at the U.S. Centers for Disease Control and Prevention (CDC), Zimmerman has been a tireless advocate for expanded adult vaccination.

He knows that immunization saves lives. But less than 70 percent of the elderly received flu shots last year, says Zimmerman, who also holds an academic appointment in the Department of Behavioral and Community Health Sciences in the Graduate School of Public Health.

Overall, health officials believe that wider immunization could prevent as many as 30,000 deaths each year. Among nursing home residents, flu shots are estimated to be 80 percent effective in preventing flu death and 50 to 60 percent effective in keeping these patients out of the hospital, according to the CDC’s Advisory Committee on Immunization Practices.

Three years ago, as a member of the Commission on Clinical Policies Research of the American Academy of Family Physicians, Zimmerman guided the academy’s decision to lower the recommended age for getting flu shots to 50 from 65. A year later, the CDC adopted the recommendation.

The flu is not the only condition that can be minimized through vaccination. Some 10,000 deaths each year are attributed to pneumococcal infection. Health officials say that pneumonia immunization of high-risk people, including those with conditions like diabetes, could reduce mortality by up to half.

The immunization statistics point to a fundamental question: Why don’t more people get vaccinated? In a 2002 study funded by the federal Agency for Healthcare Research and Quality, Zimmerman and co-investigators looked for answers. Here’s what the study found:

Simple, inexpensive changes could mean dramatic increases in the number of people vaccinated. Patient reminders, free vaccines for the uninsured, and allowing nurses to give the shots without first getting doctor permission, increased the number of shots given by 34 percent at one inner-city clinic and 114 percent at another clinic, Zimmerman says.

Not surprisingly, an expert panel from the National Academy of Sciences recently urged the federal government to require all health insurance policies to pay for vaccines and to subsidize vaccines for those uninsured.

As for vaccination reminders, Zimmerman has found it’s not only patients who need reminding. Working with a software programmer and colleagues, Zimmerman last year developed a vaccination schedule that healthcare professionals can download from the Web site, www.immunizationed.org. The Group on Immunization Education sponsors the Web site, funded by an educational grant from the CDC.

For doctors, the complete schedule of various vaccinations is a Palm Pilot click away. The vaccination-schedule Web site averages between 10,000 and 12,000 visits per month that, based on the immunization research, is playing an important role in helping save tens of thousands of lives annually.

—Kris B. Mamula

The Marshall Plan

Pitt student wins prestigious fellowship

She was babysitting at the Iranian family’s house when the stone crashed through the baby’s window, shattering the tranquil afternoon. It thudded near the crib. Woke the child. The neighborhood bully wasn’t making a political statement. He just needed a scapegoat, any scapegoat, during the Iran hostage crisis of 1979.

Standing above the glass shards, Sara Aros, then 12, knew enough to understand what had happened. “While I couldn’t articulate it at the time, I recall thinking about this family who had been so kind to me, had been good neighbors, and I simply felt embarrassed.”

Now 35, Aros reflects on her childhood in the Pittsburgh area and her babysitting and paper routes that gave her a glimpse into the lives of her international neighbors: the Iranian cardiologist, the Russian physics professor, and the teacher who came to America seeking political asylum from China.

Those memories helped to nurture an international curiosity that led to three weeks of criss-crossing Europe earlier this year. This was no sightseeing trip. While overseas, Aros (KGSB ’03) found herself shaking hands with business leaders and lunching with parliament members in cities like Barcelona, Warsaw, Berlin, Stockholm, and Brussels.

It hardly cost her a Euro. Aros was one of 63 students nationwide selected for the American Marshall Memorial Fellowship from the German Marshall Fund (GMF) of the United States. This American institution stimulates the exchange of ideas and promotes cooperation between the United States and Europe in the spirit of the postwar Marshall Plan.

The Marshall fellowships, like the one Aros won, aim to educate the next generation of American leaders about Europe and the global challenges both sides face.

When in Europe, Aros hopped subways or high-heeled it over cobblestone streets to get to sessions GMF had arranged for her. There were at least six meetings daily—with professors, journalists, women’s activists, trade union reps, citizens. She says the days were so dizzying, she often crashed before she could lift her pen to her nightly journal.

For her, the high point came in Poland, when Grazyna Paturalska, a member of the Polish Parliament and president of the Polish Association of Women Entrepreneurs (PAWE), stayed late one Friday evening to answer all of Aros’ questions. Paturalska is one of only a handful of women in Polish government.

Before taking office, she co-owned a steel company outside of Warsaw, which enabled her to share experiences of being an entrepreneur, a mother, a wife, and a politician.

Aros, who aspires to be an entrepreneur, found the conversation motivating, not just by the words, but by the chance to communicate, regardless of borders.

—Jonathan Szish

Breakthroughs in the Making

Marriage of Ideas: When researchers Yuan Chang and Patrick Moore found a way in 1993 to isolate a specific DNA signature found only in Kaposi’s sarcoma, they had no idea they would be immersed in cancer research 10 years later. These two understand patience.

After meeting in medical school in 1981, they dated before moving to opposite coasts of the country. Moore went to work for the Centers for Disease Control and Prevention in Atlanta, Chang to the University of California, San Francisco, for a pathology internship.

Yet, they still imagined marriage was on their horizon. After eight years of working in separate locations throughout the world, they stopped postponing the inevitable and were married, but only after Moore agreed to sell his motorcycle.

Four years later, the couple sat at the kitchen table, puzzling over Kaposi’s sarcoma, the most common cancer in AIDS patients. Combining Moore’s background in epidemiology and Chang’s in pathology, they discussed how they might work together to find the cause of the disease.

The DNA signature they would isolate turned out to be a minute portion of the genome of the Kaposi’s sarcoma-associated herpesvirus. This discovery and follow-up studies earned them the Charles S. Mott Prize, one of the world’s most prestigious awards for cancer research.

As codirectors of the molecular virology program at the University of Pittsburgh’s Cancer Institute, Moore and Chang continue to work, as they had before, toward new insights about cancer-causing viruses—together.

—Keith Bandelin


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