[ Silence ]
>> Welcome to the third lecture in the series
Global Diseases Voices from the Vanguard.
Voices from the Vanguard is a joint
effort between the Center for Tropical
and Emerging Global Diseases and the Knight
Chair in Health and Medical Journalism,
Pat Thomas for the Grady College
of Journalism and Mass Communications
with assistance from the office
of Provost and I'm very glad
that all of you are here tonight.
Thank you for coming, it
is a very lovely spring evening.
As most of you know this lecture
series is intended to help create
and strengthen the interest
in global health that exists
across the breadth of the UGA campus.
Both speakers thus far in
this year's series Eric Gotteson
and Zeda Rosenberg have provided their front line
visions of how they think people can make a
difference in global health and
tonight Dr. Roger Glass the director of
the NIH's Fogarty International Center
and a world renown expert on rotaviruses is
here to share his insights into the realities,
the challenges and the opportunities
to improve global health.
Before I ask Dr. Phil Williamson the dean of UGA's
College of Public Health to introduce Dr. Glass,
I'd like to first remind you of
two things, actually three things
and one is this is a blue card event and
so seek out the person for that,
second on April 24th we will wind up this
years Voices from the Vanguard with one
of the actual voices, someone who speaks
on this, Nick Thompson the spokesperson
for the World Health Organization in the area
of global infectious diseases will be here,
that's April 24th and I hope you will all
plan to be here and just respect him.
And then the last thing is as always
there will be a reception next door
and that will be following tonight's lecture.
Now I am pleased to ask Dean
Williams to introduce our speaker.
[ Pause ]
>> We are very pleased to have Dr.
Roger Glass visit UGA and I would
like to tell you just a little bit about him.
He received his undergraduate degree
from Harvard College and his MD degree
from Harvard Medical School
and his Masters of Public Health
from Harvard School of Public Health.
He also earned a PhD in microbiology in Sweden.
He has spent the last 30 years working in
several positions between the CDC and NIH.
Through both the good times and the bad
times Dr. Glass has been on the front line
of rotavirus research and provided [inaudible]
public health including working with [inaudible] scientists
and epidemiologists and some public health policy majors.
His research is targeted at the
neurological studies for the introduction
of rotavirus vaccine and he has maintained field
studies throughout the world including studies
in countries such as India,
Bangladesh, Brazil, Mexico,
Russia, Vietnam, and China just to name a few.
A complete listing of his awards and memberships
would be too extensive to do here tonight.
But just to give you a few of them,
he is a member of the Institute
of Medicine and National Academy,
a member of the American Academy of Microbiology
and he received the outstanding service medal
from the US Public Health Service.
He has authored and coauthored over 400 publications and
he is fluent in lectures in five languages.
Last June, Dr. Glass began his current duties as
Director for the Fogarty International Center
and Associate Director for
International research at NIH.
As many of you know the
Fogarty International Center,
is the international component of the NIH
and address global health challenges.
Tonight Dr. Glass will be discussing global
health and the 21st Century: Lessons from Rotavirus.
Please join me in welcoming Dr. Glass.
[ Applause ]
>> Thank you.
Thank you very much dean. I'm delighted to be
here today particularly because when I came
in the door I saw the writing in chalk on the
door step that said, "For Everything in Love."
Is that why you came?
How many of you have actually
heard of rotavirus?
Raise your hands, oh my gosh I'm amazed.
You know when I went back to
the CDC in 1986 to talk about,
to having worked in Bangladesh and NIH.
I went to the director of the CDC and I asked
him about rotavirus and he was welcoming me back
and I spent an hour telling him all
about rotavirus the disease and its prevention
with my work in Bangladesh and afterwards he
wrote me a note welcoming me back and he wrote
to me as the chief of the retrovirus laboratory.
He didn't know the difference
between a retrovirus and a rotavirus
and when they both start with R and I realized
that I had an upward battle to attack.
So I am going to talk to you a little bit
about my love of rotavirus if you will.
The lessons that I've learned from rotavirus
and global health and how that's led me
to my current job, but before I begin,
I'm amazed that you've all come to hear
about diarrheal diseases before
dinner so we'll move on.
My undergraduate major was in the history of medicine and
history of science and I was very interested
in the epidemiology of Cholera because cholera
is at the basis of epidemiology and global health.
You know the quarantine system and the public
health service hospitals in the US were all based
around cholera and epidemiology really came from
John Snow identifying the broad street pump here
in London in 1854 plotting out these little cases of Cholera
and showing that epidemiology could link these
to the pump and that by removing the pump
handle you could actually stop the disease
and stop an epidemic.
So I figured that epidemiology was really simple
and I should go off and study cholera
and see why we still had a problem of cholera in
the world today and also from the early studies
of cholera there was a first vaccine for enteric
disease, a cholera vaccine here developed
in 1893, never very effective but it was still
the basis of immunology of an enteric disease
of a potentially vaccine preventable disease
and finally it was because of this pump
that I thought that if I went to a
cholera endemic area like Bangladesh,
like Ganges Delta I might actually be able
to take the handle off the pump
if you will and stop cholera.
So after I was at CDC for a couple of
years I went off to Bangladesh with my wife
to see what we could do to
stop cholera in the world.
This was a naive mission of a young
person, so it's not so bad to be naive
and young and here's what we saw.
It's basically the same pump and
the same children getting the same water and getting cholera
so I figured that this would be an easy match.
A patient with cholera has severe
dehydrating diarrhea, they can lose 10 percent
of their weight in liquids in 12 to 24 hours.
So if you're a 60 kg person and you
lose 6 liters you're on deaths doorstep
and this is what happens with the disease.
It's now completely treatable by rehydration
with intravenous fluids and water
and salt solutions but in 1960 this was
not so, it was a highly fatal disease.
So here's a young girl and you can see
that she is so depleted that she's shocky,
her eyes are sunkin, she
has tinting of her skin
under the doctor's hand and
she's at death's doorstep.
With oral rehydration she can get up and
walk away, so it's with this that I got
into diarrheal diseases and tried to look at
how important were diarrheal diseases in the world today.
Now when you listen to CDC and
our spokesmen around the country,
every year we have had a different
epidemic, Smallpox, Ebola, West Nile fever,
and the like, anthrax. But in fact these
are not the real killers in the world.
The real killers are the diarrheal
diseases, Malaria, Tuberculosis,
acute respiratory diseases, things that are
much less sexy but much more important.
So here I began to look at where diarrhea fit
into the, into the leading causes of mortality
and after ARI in children, diarrhea is the next
major cause of disease in the world and of these
about 20 to 45 percent of these diarrheal deaths
are from rotavirus, much more them cholera.
So I scratch my head and I think a lesson for
you all is where's your next job going to take you
and how are you going to earn money and
I decided that if I was going to work
on cholera it would be hard to find a
lot of cholera cases when I came back
to the United States, I better work on something
that was global and that which is global is rotavirus.
So this background really led me to go to NIH
and then to begin to work on rotaviruses.
Well and the one feature of
rotavirus which is very important is
that it's a democratic disease,
and what do I mean by democratic?
It affects blacks and whites, rich
and poor, everyone gets rotavirus.
In fact every one of you in the audience has
had rotavirus in your first few years of life
and probably have been infected multiple
times since, although without any symptoms.
But that first infection can cause a severe
dehydrating diarrhea that can be lethal
in a small percentage of cases, well
here's rotavirus, it's the most common cause
of severe diarrhea in children, it's
a democratic virus and of course
in this republican administration, I was
advised that I should call it an equal opportunity virus,
not a democratic virus so
I have to change this slide
or leave it till the next
administration perhaps.
First infections are asymptomatic, there's
good evidence of natural immunity,
there're limited strains in circulation and of course
my son got rotavirus the day I started the
rotavirus lab at the CDC and why would my son
get rotavirus, you know we have a clean house,
we wash our hands, there's
clean water, there's good food.
Why does my son get rotavirus?
It's not clearly from clean water,
poor sanitation or anything like that,
we really don't know enough about
transmission of this virus but we do know
that because we can't stop it in our
country with clean water and clean food,
that vaccines represent a
way to prevent this disease.
So here's a child in Mexico with, a
cute, unhappy child who had for 12 hours,
severe vomiting episodes, 8 episodes of
vomiting, couldn't hold a thing down.
Followed by diarrheal episodes,
about 20 in the 12 hour period
and here the child is getting IV's to
prevent shock and to be rehydrated.
It's a very severe disease in the small
number of children and here when this child,
this is an autopsy from a child who died and the
intestine is all broken up and what you see
in the intestinal cells, all of these
little dots here are the viruses,
they completely invaded and taken over the
cell of this child's intestine causing death.
So it can be a very severe and fatal disease.
Well where does rotavirus kill?
And here is the distribution of diarrheal deaths
from rotavirus and you can see that there are
about a 100 thousand in India alone.
Most of the deaths are in South Asia about
150 thousand in Sub Saharan Africa,
about 20 thousand in Latin America.
So if we had a vaccine and we have vaccines now.
These vaccines will be most helpful to prevent
death in Sub Saharan Africak, Asia, South Asia.
But in the US and Europe and Australia, Japan,
they would really not stop diarrheal deaths,
we don't have them, but they would
stop hospitalizations, clinic visits,
doctor visits and the cost incurred.
Well here's the disease burden and as
I look around now at the importance
of diarrheal diseases in general,
this is really key
Every child here, gets rotavirus. About 114 million episodes a
year of rotavirus diarrhea.
About one in five children will have to go
to a doctor or clinic to get rehydrated
because the disease is that severe.
About one in fifty or so will need treatment as
inpatients because the disease is severe enough
to require intravenous and about
1 in 200 to 1 in 300 will die
of their disease in their developing world.
So this is clearly an important cause of death,
about five percent of all deaths in children
under five will be from rotavirus, so
it's because of this huge disease burden
that I really saw this as a priority.
Well when I went back to CDC we had no
data on rotavirus in the United States,
and you know in the government if you can't document
how important your disease is compared
to someone else's disease, you know, you're
cooked, you just can't make it.
So we had to go out with few resources
and few people and figure out what the burden
of rotavirus was in the US,
so here's what we did.
We looked at hospitalizations for children under
five years of age, here you see it here by month
for a 20 year period from about 1979 to, 79 to
1998, 1997 and you can see each year there are
about 200 thousand children
hospitalized for diarrheal diseases,
that's about 10 to 12 percent of all
hospitalizations of children in the US,
a huge number. And of those there's this winter
seasonal pattern each year in children
under 5 and that's seasonality is most
apparent in children from 6 months,
7 months, to 2 years of age
and there's a little bit at two2br/> to 3 years and then it goes away.
So a big seasonal peak in
winter, and we've now learned that,
that seasonal peak of winter
diarrhea is rotavirus.
Well if we were to have a vaccine, and we have
a vaccine this year 2006 for the first time,
what would we expect to happen in a few
years. Well if we're right and you can watch this
in the next few years, we would
expect this curve to flatten out,
those big winter seasonal peaks of
diarrhea hospitalizations to go away
and we would have a nice flat
line where a third lesser,
40 percent fewer cases,
hospitalization for diarrhea.
Furthermore in the first year of this program
we hope that these, this light blue curve of children
under 1 year will go away by the end
of this year or sometime next year,
so this is one of the ways we
are going to monitor the impact
of a national immunization program.
So our disease burden in the US has very
few deaths but lots of hospitalizations
at an incredible cost about, over a billion
dollars a year. And it's with this type of data
that we were able to convince American
pediatricians and the advisory committee
on immunization policy in the US
to take rotavirus vaccines for,
as a program for a globe, for US immunization,
universal immunization of all children,
so if any of you have small brothers or
sisters or nieces or nephews who are just born
or under 1 they should be getting
a rotavirus vaccine this year.