First Response

Epidemiologist Anne Rimoin diagnoses a patient in the field.

Back in Westwood, a similar diligence on the part of clinicians and others on the medical front line could detect new disease threats, argues David Pegues

, a professor of clinical medicine and the director of the UCLA Hospital Epidemiology Program. For example, Pegues advocates the coordinated collection of emergency room discharge data — which contains vital diagnostic information, such as viral culture results — and other readily available electronic data.

A "Surge" Protector

"If you could filter that data, you'd come up with a better idea of what is going on," he says. In addition, Pegues would like to see hospitals actively encouraging clinicians to routinely take cultures from all individuals with symptoms of influenza-like illness. It's not enough, he says, to diagnose a case of influenza based only on the presence of fever, headache, chills, muscle ache and other flu symptoms; viral diagnostic tests should be used to determine exactly with what organisms and strains patients are infected.

UCLA professor of epidemiology Scott Layne and his colleagues are now setting up a unique, first-of-its-kind laboratory to perform that analysis. UCLA's High Speed, High Volume Laboratory Network for Infectious Diseases, created in collaboration with Los Alamos National Laboratory, is being designed to track bio-terrorism attacks and infectious disease outbreaks in near real time, and dramatically decrease the time needed for vaccine production. When it is completed next year, the fully automated laboratory, also known as the rapid throughput lab, will analyze bar-coded samples collected nearly anywhere in the world, and have the capacity to determine the full genetic sequence of some 50 viruses per day. One benefit of the new lab is that it will have the ability to quickly analyze huge numbers of samples of anthrax and other agents of bioterror, a capacity known as "surge" ability.

The lab's speed is vital for studying influenza because of the high genetic variability among flu subtypes and their propensity to quickly mutate (which is why new vaccines must be developed yearly). "We currently don't know what makes a particular flu virus virulent and a threat," says Layne, who is also the principal investigator of CRISAR. "The premise of the new lab is that with enough information, we'll start to be able to make sense out of these viruses. Right now, we're kind of looking at the world through a pinhole camera. It works, but it doesn't give us a full view. Infectious diseases are a real threat to us and we need to have a much better view," he says.

Layne and the rapid throughput lab have also been recruited to analyze tens of thousands of samples of the influenza viruses endemic to 10 species of common North American migratory birds, as part of a huge survey being conducted in collaboration with UCLA's Institute of the Environment, led by Institute Acting Director and Director of the Center for Tropical Research Tom Smith — who was also in Africa doing hands-on science as this story was being written.

Influenza A viruses, those that cause disease in humans, are thought to be perpetuated in wild birds. The birds, which don't usually show any symptoms of infection, serve as reservoirs for the organisms — particularly for H5N1, or "bird flu," the highly infectious and deadly influenza A subtype that researchers are most worried could mutate into a strain capable of causing the next influenza epidemic. The birds shed huge quantities of virus into the environment that can then infect other animals, including humans.

"Migratory land birds move across the country; in the fall, they go south, in the spring, they go north. If they are infected with avian influenza, they could be spreading it long distances, and to birds of other species," says biologist John Pollinger, an associate director of the institute's Center for Tropical Research and a collaborator on the bird surveillance program. "We're trying to figure out to what extent these guys have flu, and what types of flu they have," he says.

We live in a new and dangerous world. The United States has already seen some of the havoc that can be unleashed via bio-terror attacks. And it has watched with trepidation as viral flu outbreaks begin to take more and more human lives around the world. That's why America needs a disease early-warning system. And why a small army of Bruin science action heroes is determined to find and build just such a safeguard.

"The science of disease forecasting is still in its infancy, but we're not going to wait until it is perfect," concludes Nathan Wolfe. "We need to start doing something now."

Published Jan 1, 2008 8:00 AM