IDWeek: Understanding the genome opens an age of opportunity and action

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Science Speaks is at IDWeek 2019 Oct. 2-6, covering the joint annual meeting of the Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, the HIV Medical Association, and the Pediatric Infectious Diseases Society in Washington, DC.

WASHINGTON, DC – What if one fast-growing body of knowledge about the most essential part of our make-up could be tapped into to open new avenues to understanding, diagnosing, curing, preventing, even predicting the infections that make this a small world?

That is what is happening now, National Institutes of Health Director Dr. Francis Collins said in an opening session talk titled From Outbreaks to -Omics; Revolutionizing the Infectious Diseases Landscape in the Age of Big Data.

Controversial when it began in 1990, the Human Genome Project has opened possibilities across the fields of medicine, he noted. In infectious diseases they include the development of rapid diagnostics, approaches to curing HIV, expanded understanding of the microbiome’s potential to cause, exacerbate and ameliorate disorders, and a new way to pinpoint the consequences of social determinants of health.

The director, who blogs about all of these, was followed by a speaker who showed how some of it works on the ground, with a look back at the West Africa Ebola epidemic that spread across three countries before it met a cohesive response. Sparked by the infection of one child bitten by a fruit bat near Christmas of 2013,  Dr. Pardis C. Sabeti, of Harvard’s TH Chan School of Public Health recounted, the virus had spread across Guinea and into Liberia by April of 2014. It was only after it entered Sierra Leone, she added, that it became clear something had changed, with the virus spreading “like wildfire.”

The limited resources with which it had been met and the density of the population it now encountered explained some of the accelerated speed with which the virus was spreading then, Dr. Pardis acknowledged. But an analysis of the genome from nearly 60 patients added the understanding that the virus was mutating quickly: “While the virus had more opportunity to move from human to human,” Dr. Pardis said, “it was also improving its ability to do so.”

This knowledge was critical to developing both vaccines and treatments, she said. The analysis also confirmed that the virus now threatening countries across West Africa, and traveling to nations around the world, including the U.S., had started its journey when a child in a Guinean village disturbed a tree inhabited by bats. This knowledge  — confirming that all the transmissions since then had occurred from human to human, informed messaging during the emergency from warnings to avoid monkeys and bats to precautions to take in human interactions.

Dr. Pardis still thinks about how close the crisis came to becoming exponentially worse, “a massive tragedy on the precipice of a cataclysm,” she said.

“We need to be faster, better,” she added. Understanding the genetics of diseases that spread opens the way, she said, to “detect, connect, engage, empower, and overcome.”

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