Killing two birds with one stone: A new vaccine to fight rabies and MERS-Cov

In 2003, the world was faced with a serious biological threat. The severe acute respiratory syndrome (SARS) virus hit the scene in China and quickly spread to 28 countries across the globe. The reason for the rapid and global spread lay in the very nature of the virus' infection. It can be spread by close person-to-person contact through respiratory droplets produced when an infected person sneezes or coughs, and the initial symptoms of disease are very non-specific. This allowed the virus to easily be carried via international travel throughout the world. While the number of cases quickly rose to a total of 8,098 within 6 months, the global response was also rapid. The World Health Organization quickly activated their global alert system and began aiding countries in identifying and quarantining those infected and at risk. Thanks to this global response, SARS was quickly handled. However, this virus showed the world how at-risk we are to respiratory viruses in an age of increasing global travel.

Since the 2003 SARS outbreak, scientists have been on the look-out for the SARS virus and other related viruses in an attempt to minimize outbreaks. These viruses are part of a family known as Coronaviridae, specifically the coronavirus sub-section of this family (a typical virion is shown to the right). They are single-stranded, positive sense RNA viruses, which means that as soon as the virus invades a host cell, it can begin making its own proteins and progeny immediately without the need for time for replication or transcription of the genetic material. The coronaviruses that cause respiratory syndromes infect the cells of the lungs, leading to severe and sometimes deadly pneumonia.

In 2012, a novel coronavirus was identified in Saudi Arabia; it was named the Middle East Respiratory Syndrome Coronavirus (MERS-CoV). It quickly spread to the United Kingdom through travel. While the MERS-CoV has never caused an outbreak as large as that of the SARS virus, it has also not been contained as successfully. MERS-CoV outbreaks have continued to pop up from 2012 to now, with the most recent outbreak update coming just last week from Saudi Arabia. The MERS-CoV outbreaks have caused a total of 1,905 confirmed cases in 27 countries, with 677 deaths. The severe pneumonia caused by MERS-coV is more deadly than that caused by SARS and other coronoviruses, leading to the alarmingly high 37% death rate.

There are currently no vaccines and no treatments for MERS-CoV. Quarantining those infected and using additional precautions when treating these patients have been the only successful preventative measures to reduce spread. The biggest problem for complete elimination of this virus is that, unlike the SARS virus, the MERS-CoV can also infect an animal that has frequent contact with humans: camels. In many parts of the globe, camels are essential for transportation and play a pivotal role in the economy. Since camels have been shown to be a reservoir for the MERS-CoV, and people in these regions need to continue to have close contact with these animals, the virus has an easy route to re-enter the human population even with the implementation of the same control measures that were so successful with the SARS virus.

The MERS-CoV can be spread from camels to humans in many ways.

Recent work has focused on elimination of virus from the camel population as a course of action to reduce human infections. Starting with a rabies vaccine, which has long been given to animals and is well-tolerated, a group in the United States has shown that immunity to both rabies and MERS-CoV can be achieved in mice. In order to do this, they took a piece of the MERS-CoV spike protein and fused it to the rabies G protein. This allowed a portion of the MERS-CoV to be incorporated into the rabies virus vaccine particles for delivery to the mice. After receiving the immunization, mice were challenged with the MERS-CoV and were found to be protected from infection. The researchers also found high levels of neutralizing antibodies against both MERS-CoV and the rabies virus in the blood of the mice.

While this vaccine candidate is still in the early stages of development, the successful use of the previously tested and approved rabies vaccine as a backbone may provide a way to shorten the timeline to implementation of the vaccine for animals on a larger scale. This could provide a way to start to eliminate the MERS-CoV reservoir and begin to reduce outbreaks in people across the globe. While other research groups are still searching for human vaccination and treatment strategies that will greatly improve our ability to decrease disease severity and save lives, dealing with this large camel reservoir will be an essential step before disease elimination and eradication can truly be considered.

Measles on The Oregon Trail and now

"John has measles." Our journey along The Oregon Trail wraps up with a member of our party falling ill with the measles virus. This leads to the stereotypical measles rash, along with fever and coughing. The mortality rate from measles tends to be low in developed countries, but in places of poverty and food shortages, the mortality rate can be as high as 28%. One of the biggest problems with measles is that it is highly contagious and can be spread through the air. There is also no treatment for this disease, leaving disease prevention as the best strategy for dealing with the measles.

While the march towards the eradication of measles has been well underway for many years, cases have begun to rise in number again recently. Just this week, an outbreak occurred in Los Angeles County, infecting 20 people so far. A vaccine for measles was developed in the 1960's, leading to a sharp decline in the number of cases in the U.S. almost immediately in the late 1960's. Global efforts to increase vaccination have been funded by the American Red Cross, the United Nations, the Centers for Disease Control, UNICEF, and the World Health Organization. The measles vaccine has also been improved over the years to provide better immunity to those vaccinated, giving us the MMR (measles-mumps-rubella) vaccine of today. Thanks to these efforts, measles deaths worldwide had decreased to just 164,000 in 2008.

Unfortunately, in 1998 a paper was written by Wakefield, et al. in The Lancet, showing a link between the MMR vaccine and autism. Although this paper was retracted by 10 of the 12 authors in 2004 and completely retracted by The Lancet in 2010, the publicity this paper received raised doubts for many parents about the safety of the vaccine for their children. Many people may still be unaware that in 2011, the authors of the paper were found guilty of deliberate fraud, which they had committed by picking and choosing what data to include in the paper. As a result, Andrew Wakefield, the lead author of the paper, had his United Kingdom medical license revoked. Even with the retraction and the slew of studies that followed, showing repeatedly no link between the vaccine and autism, parents have continued to voice concerns about vaccinating their children.

For a vaccine to eliminate disease, 100% vaccination is not essential. In vaccination there is a concept known as herd immunity, which has been defined as "the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease." When a high percentage of the population is immune, the virus cannot be introduced or spread well because it will encounter too many hosts that are not susceptible to infection. For herd immunity to work for the measles, generally about 95% of the population needs to be vaccinated and immune. There have long been religious organizations that have opposed vaccination, as well as immunocompromised individuals who were not eligible for vaccination. Even with these small groups of people, high enough vaccination rates were reached to achieve herd immunity in many countries. Unfortunately, the recent increases in the number of parents actively choosing to not vaccinate their children due to fears of autism or other complications and the number of parents who simply do not see the benefit of vaccination and opt out has led to a decrease in the vaccination levels. This has made herd immunity much less effective, allowing cases of measles to increase again.

While the scientific community has repeatedly performed studies to test the safety of vaccines and found that there is no link between the MMR vaccine and autism, the negative publicity from the Wakefield, et al. paper has severely damaged the reputation of this vaccine. Re-educating the public about the safety and necessity of this, and other, vaccines has become a major priority in the wake of the number of measles outbreaks in Europe and the U.S. in recent years. With no treatment for measles, the MMR vaccine remains the only real hope for protecting the population from this highly contagious, yet preventable, disease.

More diarrheal disease plagues The Oregon Trail

"James has died of dysentery." Another common diarrheal disease you likely remember from The Oregon Trail, dysentery is caused by the consumption of contaminated water, like cholera and typhoid. There are actually two different forms of dysentery; one form is caused by Shigella bacteria (also known as shigellosis), and the other is caused by Entamoeba histolytica, an amoebic parasite. E. histolytica causes milder disease, but is more difficult to treat than that caused by the Shigella bacteria. No matter which form of dysentery you have, the symptoms can include anything from mild diarrhea to severe, bloody diarrhea with a fever, cramps, vomiting, and even pain and complications outside the intestines.

Dysentery has been known as a disease for quite some time, with case reports dating back to the 1200s. In light of the recent presidential inauguration in the United States, it is interesting to note that one of our own U.S. presidents suffered from dysentery on the very day of his inauguration. In the weeks leading up to James Buchanan's inauguration in 1857, he came down with dysentery. He spent the two weeks before March 4, inauguration day, in seclusion in an attempt to be well enough for the ceremony. He even turned down a dinner invitation from the famed Jefferson Davis in a letter in which Buchanan said he was "now living with great caution." Buchanan was well enough by March 4 to be successfully sworn in without incident.

While dysentery is considered a fairly rare disease in modern times, it is still estimated that there are 170 million cases each year, along with 14,000 deaths. A recent increase of cases in Zimbabwe has caught much public attention. Corruption within the country has led to a suspected misuse of funds within the government. The Movement for Democratic Change party (MDC), which currently holds the presidency and other governmental positions, has been accused of using the country's money to buy cars and fund their 2018 political campaign instead of building infrastructure and dealing with water sanitation issues. Because proper water sanitation is essential for preventing a disease like dysentery, critics of the government believe the members of the MDC are responsible for the current cases of both typhoid and dysentery that have been spreading through Zimbabwe.

Although dysentery has existed for hundreds of years, our approach to treatment now is not very different from times gone by. Typically, dysentery clears by itself, so the only remedy is to provide a patient with fluids to prevent dehydration. While antibiotics can be prescribed for dysentery caused by Shigella, instances of antibiotic resistance in Shigella have been on the rise since the 1940s, making many classes of drugs ineffective. Recent work has found that probiotics may play a role in helping to reduce disease duration and intensity in Shigella dysentery, but further work will be required before probiotics can be used for patient treatment.. Treatment of amoebic dysentery, on the other hand, is still almost purely reliant on simply relieving the symptoms.

As has been highlighted in the cases of cholera, typhoid, and dysentery, sanitary drinking water is the key for the prevention of disease. While many countries are focusing efforts on improving water sanitation, it is a long road to improve an entire country's infrastructure enough to provide all residents with clean water. But support for these initiatives continues to pour in from other countries and private foundations alike, keeping alive the hope for a future with clean drinking water for all.

Further down the trail....Mary has died of typhoid

"Mary has died of typhoid." Yet another disease you may remember encountering on The Oregon Trail in childhood, typhoid fever, or simply typhoid, is also still a major public health concern today. Affecting an estimated 20.6 million people and causing 223,000 deaths a year, typhoid is caused by the bacterium Salmonella enterica serovar Typhi (S. Typhi). The bacteria is often spread through contaminated water or from person-to-person contact. In places where clean water and sanitation are standard, the disease has been essentially eliminated. But in developing countries, it remains a major threat.

The most recent outbreak of typhoid occurred just last week in the city of Masvingo, Zimbabwe. Areas where the disease is endemic and can lead to outbreaks include Southeast Asia, Africa, and South America.  Travel to and from these areas also allows for the transmission of the bacteria to industrialized nations and can cause local outbreaks. Although there are currently two approved vaccines against S. Typhi, both have drawbacks that prevent them from being used en masse. The protective efficacy of the vaccines is sub-optimal and ranges from 40%-70%, largely dependent upon age and location. Additionally, the protection from the vaccines is short-lived, averaging 2-3 years for one vaccine and 5-7 years for the other. A further complication is that both vaccines need to be stored with refrigeration until they are used. Transport and storage under these conditions are major difficulties in countries where electricity is a supreme luxury.

Without a reliable vaccine, the major way to fight the disease is through the use of antibiotics. Chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole, very common antibiotics, have historically been used to stop the infection, and this strategy was highly successful for many years. However, in recent years, a new threat has emerged to thwart these efforts. In the 1970s, cases of S. Typhi that were resistant to these antibiotics began to emerge. We now face the threat of multi-drug resistant S. Typhi, making disease treatment much more difficult.

In light of the rising drug resistance, many have begun to see wide-spread vaccination as the best strategy to fight typhoid. Others argue that improving water sanitation will have the greatest effect on decreasing disease prevalence. One thing is certain: either strategy will require a large investment of funds to be achieved.

The Bill & Melinda Gates Foundation is leading the way in the funding arena and has identified the elimination of typhoid as a public health problem by 2035 as a goal. The Gates Foundation recently gave over half a million dollars to Yale University to explore and determine the cost-effectiveness of typhoid vaccination strategies. Additionally, The Gates Foundation gave a $36.9 million grant earlier this month to a collaboration between the Maryland School of Medicine Center for Vaccine Development, the Oxford Vaccine Group, and PATH, a non-profit public health organization, to accelerate the development of a new vaccine to be used in young children. The goal is to develop a vaccine with more long-lasting protection than the two currently available. The Gates Foundation is also providing funds to increase surveillance for typhoid in South Asia and Africa.

While the Gates Foundation is leading the way to fund the vaccination strategy, other groups are focusing on improving water sanitation. The United States Agency for International Development (USAID) features water and sanitation as one of its main avenues of focus, with sponsored projects underway in large portions of Africa and Southeast Asia. The World Bank has also been sponsoring projects to improve water quality and health throughout the world. Additionally, UNICEF has been a major player in the increased access to clean water that has over the past decade. Many other smaller non-profits have also played a role in this endeavor.

As both vaccine and water and sanitation improvements occur, our ability to battle this age-old pathogen will increase. Using both strategies simultaneously allows for the most rapid and sustainable progress toward S. Typhi elimination. With the continued investment of groups like the Gates Foundation and USAID, the goal of typhoid elimination as a public health problem by 2035 might just be achievable.

Cholera: Not just a problem on The Oregon Trail

"Sally has died of cholera." This was a common problem in the game The Oregon Trail that many people remember from childhood. Tragically, cholera is still a major public health problem in countries around the world today. Cholera is caused by the bacterium Vibrio cholerae, which is shed in fecal matter from an infected individual and is often transmitted via contamination of water sources. In countries with poor sanitation and a lack of clean water, this can lead to significant and deadly outbreaks.

Fast-forward from the days of the Oregon Trail to present-day Haiti. The country has suffered multiple tragedies in recent years. In 2010, they were rocked with a devastating earthquake; now, in 2016, they suffered the wrath of Hurricane Matthew. In light of these recent disasters, there have been humanitarian efforts from the United Nations and other relief organizations. Unfortunately, in the wake of the U.N.'s help after the 2010 earthquake, Haiti experienced its first cholera outbreak.

Before 2010, the small nation of Haiti had not been exposed to cholera. The citizens had not had the disease, and no immunity to the pathogen existed there. The first case of cholera was reported in mid-October 2010 in the region of the country along the Meille River. The disease quickly became rampant, with a hospital 60 miles away from the first case reporting new cases every 3.5 minutes within just 2 days. Since then, the outbreak has affected nearly 800,000 people and caused more than 9,000 deaths according to the official numbers; however, many experts fear the true impact has been far greater due to poor case reporting.

Flooding and destruction from Hurricane Matthew on October 4, 2016, have done nothing to help the situation. As many Haitians have lost their homes and their sources of fresh water, cholera has been on the rise again. Flooding has led to increases in contaminated waterways, leaving much of the water unsafe for consumption. Within four days of the storm passing through, officials were reporting 62 cases and 13 deaths from cholera.

The issue of how cholera came to be endemic in Haiti has been a topic of heated debate in the past few years. Many have blamed the U.N.'s Nepalese peacekeeping troops for bringing the bacteria with them into the country following the 2010 earthquake. The U.N. has denied any potential responsibility for the outbreak for years, even in the face of lawsuits from families of those who had died. Others hypothesized that increases in the temperature and salinity of the rivers throughout Haiti had allowed bacteria that may have been living in a dormant state in coastal waters to populate these rivers after the earthquake.

Scientific evidence, however, has been on the side of those who blame the U.N.'s peacekeeping troops for the introduction of the disease. Genetic analyses by whole genome sequencing of the bacteria found in Haiti in 2010 showed that this strain was highly similar to the strain found in Nepal in 2010. Additional studies using multiple-locus variable number tandem repeat analysis (aka DNA fingerprinting), a technique that looks at the number of times a DNA sequence is repeated at specific loci in the genome, also suggested a match between the Nepalese and Haitian strains.

On August 18, 2016, after 6 years of denial, the U.N. finally acknowledged that they did play a role in the initial outbreak. Farhan Haq, the deputy spokesman for the U.N. secretary general, said "over the past year, the U.N. has become convinced that it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera...[a] new response will be presented publicly within the next two months."

The latest chapter in this story comes with the announcement on October 24 that the U.N. is working on a plan to spend about $400 million on cholera in Haiti. Roughly $200 million will be spent on cholera elimination efforts, while the other $200 million will be given directly to families or communities affected by the disease. The full details of the plan are expected to be solidified in the coming weeks. However, questions remain over how the money for this plan will materialize. U.N. member states have already expressed discomfort with paying money to directly compensate victims, as this is not within the purview of the normal development work the U.N. is chartered to perform.

While the final details of the U.N.'s action plan remain to be worked out, it looks like Haiti will be receiving some much-needed support to aid in their cholera elimination efforts in the near future. As the country rebuilds after Hurricane Matthew, water sanitation will be a major focus for the nation. With financial support and help from the U.N., experts are hopeful that cholera can be eliminated fairly quickly from Haiti. That would serve as a major beacon of hope for a nation that has borne the brunt of tragedies for too long.

The not-so-loving kissing bug

As fall approaches and the weather begins to cool from the stifling heat of summer, we all like to spend a bit more time outside enjoying the air. Unfortunately, this is the perfect time for insects who like to feed on our blood and potentially carry disease to come out and join us. Most people think of ticks and mosquitoes when they think of insects that carry disease, but there is another major player in the Americas: the Triatominae, also known as the kissing bug. This little creature can carry a parasite known as Trypanosoma cruzi, which causes Chagas disease.

The Triatominae insect, aka the kissing bug, that
can carry the Trypanosoma cruzi parasite that
causes Chagas disease.
Image from Snopes.com

Chagas disease is a major global health threat, with 70 million people at risk of exposure and approximately 5.7 million people becoming infected each year. The disease mainly affects Latin America, but thanks to population flows and increases in vector populations, the disease has been spreading to the north, with cases reported in the US in Texas, in Canada, and even in Europe. The disease exists in two phases, the acute phase and the chronic phase. During acute infection, there are large numbers of parasites in the blood, but symptoms are few and non-specific. There can be fever, headache, swollen lymph nodes, or even completely asymptomatic cases. As the disease transitions into the chronic phase, the parasites sequester into the muscle of the heart and digestive tract. This can result in severe cardiac and digestive disorders, which can last for years after the original infection began. Most dangerously, heart failure can result, causing death.

Treatment for Chagas disease remains a major issue. There are very effective treatments for the acute phase, with almost 100% efficacy, but these treatments are underutilized. Treatment requires rapid diagnosis of the disease, which is often difficult due to the non-descript or non-existent symptoms. Also, the drugs need to be administered over a very long duration, 60-90 days, leading to low follow-through rates for treatment to completion. Unfortunately, there are currently no treatments for the chronic phase.

Current work being done at the University of Georgia is working to address one of these problems. They are focused on developing affordable diagnostic tests that can be used anywhere to diagnose Chagas disease in the acute phase. Their efforts focus on increasing the number of T. cruzi antibodies being detected in the test in order to allow for a more sensitive test. Not only will the test help identify people who have the disease, but it will also improve the ability to monitor how well a person is responding to treatment, hopefully allowing for decreases in treatment times.

Beyond the work at the University of Georgia focusing on improving diagnostics, there has also been a lot of effort into developing new treatments for Chagas disease. The Drugs for Neglected Diseases Initiative has chosen Chagas as one of their focus diseases and has been working on new therapeutics to treat both the acute and chronic phases of disease. Their goal is to develop an orally administrated treatment that will require less than 30 days of administration by 2020. They have moved into a Phase II proof of concept study with two different treatment options, with results expected late this year and early next year.

While advances are being made in detection and treatment of Chagas in humans, there are also many animals that are threatened by this disease. Chagas disease can also affect both wild and domestic animals, making elimination of the parasite reservoir impossible. Notably, Chagas disease in dogs is known to be frequently fatal, causing the same heart failure and cardiac symptoms seen in humans with chronic Chagas disease. For dogs, there is currently no available treatment for the disease. 

The best way to deal with Chagas for the time being is the prevent it. Insecticide spraying is encouraged by the World Health Organization and has been shown to decrease the incidence of disease. Also, being able to identify the Triatominae insects when they are seen can help people avoid areas where they could become susceptible to being bitten. These bugs are known to enjoy living in hay, woodpiles, and under porches, so avoiding these areas can help reduce transmission of the parasite. 

To protect yourself and your furry friends this fall, be sure to be on the lookout for the kissing bug. One kiss from this little love bug may just be your worst first date ever.  

Amanda Elmore and Team USA's victory in the Olympic W8+ is cause for excitement, but the health risks they faced to achieve this feat are not

Rio de Janeiro. Already well known for its vibrant culture and nightlife, this Brazilian city has also become known for sports this month as they play host to the Games of the 31st Olympiad. Many brand new athletic facilities were created specifically for these games, and Brazil poured a projected $18 billion or more into bringing these games to life. Even more funding was supplied by sponsors, like Coca Cola. Unfortunately, not all sports venues could be made ideal.

Guanabara Bay and Copacabana Beach off the coast of Rio are the sites of five aquatic events in this year's games: sailing, rowing, canoe sprinting, the triathlon, and marathon swimming. In addition to hosting these great sporting events, these waterways also play host to many unwelcome guests: multi-drug resistant bacteria and viruses of many varieties.

The Brazilian government has been aware for years that raw sewage has rushed into their waterways from the cities. In their bid to bring the Olympics to Rio, Brazil pledged to put forth $4 billion to deal with their water contamination issues. Unfortunately, due to a "budget crisis" they were only able to invest $170 million before the Games began. The results of this lack of funding may end up having devastating effects on the health of athletes at these games.

A study published by Renata Cristina Picao's group in Brazil in 2015 looked specifically at the bacterial populations of the water from the beaches surrounding Rio de Janeiro. They studied a total of 18 water samples from different regions along the coastline. Of these isolates, only one had bacteria with susceptibility to imipenem, a common drug used to treat bacterial infections in this area. Resistance rates to other popular drugs were also alarmingly high, with 77.8% of the isolates showing bacteria with resistance to cefotaxime, 50% showing resistance to cefepime, 27.8% showing resistance to gentamicin and amikacin, and 5.6% showing resistance to ciprofloxacin. With drug resistance running rampant in the bacteria that call this water home, being on or, even worse, in this water may pose a significant health threat to athletes.

Possibly an even larger threat than the bacteria in these waters are the viruses that can also be found. Hepatitis A virus can be found in human waste, and experts speculate that ~60% of Brazilian adults are exposed to the virus. In waters that contain large amounts of human waste, like the ones the athletes will be exposed to, the risk of infection is significant. The CDC recommends that all travelers to Brazil, not just those who will be exposed to the water, receive the Hepatitis A vaccine. With appropriate use of the vaccine, an outbreak of Hepatitis A can likely be prevented, though some have questioned whether or not the vaccine will protect against the local strains of the virus.

In addition to Hepatitis A virus, water tests have found alarmingly high levels of multiple types of adenovirus, which can cause severe gastrointestinal problems and do not have vaccines. Fernando Spilki, a Brazilian virologist, performed water testing for the Associated Press and found levels of adenovirus from 14 million to 1.7 billion virions per liter of water. To put this in perspective, California officials become concerned about their water quality if the level rises to just 1,000 virions per liter.

Many may wonder why, with the popularity of these beaches among Brazilians, there has not been a major viral outbreak or an outbreak of multi-drug resistant bacteria in the region already. The answer likely lies in the fact that these native-born and raised Brazilians have been exposed to these bacteria and viruses from a very young age, allowing their bodies to develop a successful immune response to the pathogens. However, the same immunity will not exist for the foreign athletes who will be exposed to these waters.

In the year leading up to these games, some athletic groups have already trained and raced on these waters. Many documented athletes experiencing illness. The World Junior Rowing Championships were held in Rio in 2015, and the U.S. team documented 13 rowers who suffered gastrointestinal illness following the event. The Australian sailing team has trained on the waters around Rio for the past several months, and they also have had athletes fall ill with gastrointestinal problems.

Though independent water testing has identified the water as potentially hazardous to health, the International Olympic Committee has maintained that the water is safe enough for the events to be held. The World Health Organization (WHO) has recognized that the water quality is less-than-ideal, and has issued several statements for travelers warning them of the potential for infection if exposure to contaminated water occurs. Additionally, the WHO has recognized that sites in the Guanabarra Bay, where sailing, rowing, and canoe sprinting take place, do not always meet the standards of safety, based on bacterial testing. As a precaution, they recommend that for all bodies of water "all athletes should cover cuts and grazes with waterproof plasters prior to exposure, try to avoid swallowing the water, wash/shower as soon as possible after exposure and, as far as possible, minimize their time in the water and avoid going in the water after heavy rainfall if possible." In events like the triathlon, where the swim portion is upwards of 20 minutes, and the marathon swim, which can take 2 hours or more to complete, minimizing time in the water is not always a viable option.

In light of the potential health risks, athletes and spectators alike will need to use increased caution regarding the Rio games. Monitoring for illness is going to be critical to prevent severe illnesses from developing. Many have focused on the potential threat of Zika virus at these games, but the threat of the multi-drug resistant bacteria and viruses in the waters should not be forgotten. All can cause significant problems and really ruin the Olympic experience. Perhaps next time the Olympic Committee will be more skeptical of selecting a location with such serious health concerns unless they are willing to chip in some funds to help the country address the situation. Such a gesture would not only have a positive impact on the athletes, but more importantly, it would have a sustained impact on the residents of the host country for years after the conclusion of the Games.


--On a side note, I'm so proud of my former teammate Amanda Elmore and the entire U.S. W8+ for dominating and winning gold at Rio!! Boiler Up!