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Bird flu has been defying dogma for decades. What now?

May 9, 2024
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Morning Rounds Writer and Podcast Producer
Good morning! A lot of the news today revolves around animals (birds, cows, and dogs) and food (milk, hot dogs, and the like) so read on to start digesting it all.

h5n1 bird flu

Today in bird flu: A historically surprising virus and potentially asymptomatic cows

MOLLY FERGUSON FOR STAT

Twenty-seven years ago today, a 3-year-old boy in Hong Kong developed a sore throat, spiked a temperature, and started to cough. Within two weeks, he died of acute respiratory distress caused by viral pneumonia. The toddler, who'd had contact with sick chickens, had been infected with H5N1 bird flu. It was the beginning of an outbreak that would kill 17 other children.

The Hong Kong outbreak was a shock to influenza researchers who believed avian flu viruses were rare and caused exceedingly mild disease. But it was only the first time the H5N1 virus would pull off the unexpected. In the nearly three decades since, flu scientists have tracked this virus with both vigilance and dread, learning through hard experience that it is not to be underestimated. Read more from STAT's Helen Branswell on how the virus continues to surprise scientists, and why that is so worrying.

As H5N1 now spreads in U.S. dairy cattle, federal agencies have asked farmers to discard any milk from infected animals. But as scientists began finding virus fragments in commercially available milk (reminder: evidence shows that pasteurization inactivates H5N1) it begged the question: How? The most plausible and also the most concerning scenario is that visibly sick cows, the ones with strange looking milk and flu-like malaise, are just the tip of the outbreak, STAT's Megan Molteni reports. Read her story on the possibility of asymptomatic cows infected with H5N1.


cardiovascular health

Cell therapy fails to slow early type 1 diabetes — but there are lessons to learn

Tolerance is the holy grail in calming autoimmune disease. In type 1 diabetes, misguided immune fighters attack beta cells in the pancreas that produce insulin, the hormone that controls blood glucose. A paper out yesterday in Science Translational Medicine describes a Phase 2 clinical trial that infused a version of patients' own regulatory T-cells — white blood cells that tamp down friendly fire — into 110 children newly diagnosed with type 1 diabetes. The so-called Tregs (say it almost like T. rex) were intended to preserve their remaining insulin-making cells.

It didn't work. But the negative finding still yielded insights. "It answered some remaining questions in the field of whether just simply increasing the number of polyclonal Tregs is sufficient for efficacy, and it is not," said senior author C. Alice Long of the Benaroya Research Institute. As Jay Skyler of the University of Miami said, "We're going to need to have a combination of approaches." STAT's Liz Cooney has more


pets

To keep rabies at bay, CDC tightens restrictions on importing dogs

Every year, about a million dogs are imported to the U.S. from other countries. But starting on August 1, any dog traveling here must follow new rules, the Centers for Disease Control and Prevention announced yesterday. Among other requirements, fluffy pals coming from countries with a high risk of dog rabies (CDC lists over 100) must be vaccinated against the zoonotic viral disease.

The U.S. eliminated dog rabies 17 years ago with the implementation of a vaccine. By enacting stricter regulations, the CDC hopes to prevent the disease from being reintroduced here. Domestic dogs are responsible for virtually all cases where rabies is transmitted to humans, and once symptoms appear, the disease is almost always fatal. If you're thinking about importing a dog or traveling abroad with your American pup (including service animals), CDC has a tool called "DogBot" to help you figure out how the rules apply to you.



first opinion

The hidden population of young caregivers

Two young children help an adult lift another adult out of bed.

LM OTERO/AP 

Out of 48 million caregivers in the U.S., an estimated 14 million are younger than 24. The burden of unpaid caregiving is increasingly falling on young people, write two first-year medical students in a new First Opinion essay. They know because they have each been young caregivers themselves.

"One of us helped care for her twin brother with autism, who needs help with various activities of daily living. The other helped care for her grandmother, who lives in the shadows of Alzheimer's disease," they write. "Both of us found these experiences deeply meaningful, but we have also observed ways in which caregiving can be quite challenging." Read more on the impact of "parentification" and how to support young caregivers.


nutrition

Are ultra-processed foods bad for me? 

Eating more ultra-processed food (like hot dogs — industrially built, with a bunch of ingredients one might not immediately identify as "food") is associated with higher rates of death, according to a study published yesterday in the BMJ. Researchers analyzed data from over 100,000 health care workers across the U.S. and found that the top quarter of ultra-processed food consumers had a 4% higher mortality rate than the lowest quarter. Their rate of dying from causes other than cancer or cardiovascular diseases was 9% higher. 

The connection between these foods and mortality was actually weaker than some previous studies, perhaps because the authors didn't count distilled alcohol in the category; better adjustments for smoking history would further reduce the association, according to an editorial. Most dietary guidelines already advise limiting intake of ultra-processed foods, but the category doesn't need to be banned, wrote authors of both the research and editorial. The global focus, the editorial argues, needs to be on protecting nutritional and public health policies from the influence of powerful food companies.


artificial intelligence

A protein-predicting AI grows up, with an eye on advancing drug discovery

Yesterday Google released AlphaFold 3, the latest version of its artificial intelligence system for aiding in structural biology research and drug discovery. The model's initial breakthrough was to predict protein structure. Now, the creators report in Nature, it's capable of accurately mapping the interaction of a much wider universe of biomolecules — including RNA, DNA, ions, and residues. 

Biologists anticipating the model's release said its new capabilities represent a fundamental advance in the plodding work of untangling the mechanisms of disease. But it remains to be seen whether it will significantly advance the precision of drug research, or lower the sky high failure rates of late-stage clinical trials. Read more from STAT's Casey Ross.


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What we're reading

  • Landmark study of cancer in Black women launches in 20 states, aiming to be largest ever, NBC News

  • Brain worms are more common than you think. Here's what doctors who've treated them say, STAT
  • Revolving doors: board memberships, hedge funds, and the FDA chiefs
    responsible for regulating industry, The BMJ
  • A new cholera vaccine will increase supply, but will it be enough to manage global outbreaks? STAT

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