Most people turn to Google to search for news on Justin Bieber, baseball scores, and who got kicked off Top Chef last night. But users of the search engine also turn to Google for medical advice, typing in symptoms and conditions as a sort of pre-screening tool before making the call to the doctor’s office. These health-related searches inspired the creation of Google Flu Trends, an official tool of the website that estimates influenza incidence and spread via the dynamics of searches for flu symptoms, medications, and other related terms. With some complicated mathematics, Google developed a formula predicting flu activity that closely matched actual surveillance data, an achievement deemed worthy of publication in Nature.

The success of Google Flu Trends have prompted scientists to wonder if other diseases can be similarly watched by tracking search engine data. But while everyone knows about the flu (even if it is often mistakenly blamed for illnesses caused by other bugs), more obscure diseases might not be as easily captured by such a strategy. Take the case of methicillin-resistant Staphylococcus aureus, the medical mouthful better known as MRSA. Though MRSA is the most common cause of human infections, with 94,000 cases in 2005, it isn’t usually part of the layperson’s medical vocabulary. But because the CDC surveillance system for MRSA only covers 9 sites, a team of researchers from the University of Chicago and the University of Colorado set out to see if Google searches would suffice as a higher resolution alarm system for public health observers.

“If we had a comprehensive, linked electronic-health-records system that researchers had access to, we wouldn’t need it,” senior author Diane Lauderdale, professor of epidemiology, told Wired. “There are systems like that in Scandinavian countries, where you can analyze disease factors in all kinds of ways. But you can’t do that in the U.S.”

As reported in Emerging Infectious Diseases, Lauderdale, Vanja Dukic and Michael David measured the frequency of Google searches for “MRSA” and “staph” (because many news stories refer to the bacteria as drug-resistant or antibiotic-resistant staph) between 2004 and 2008. The group also charted appearances by MRSA in the media, to control for the influence of the news upon searches, and used data from a consortium of hospitals to serve as a measure for MRSA hospitalizations over the time period. Other challenges, such as the frequent mis-spelling of “mersa” and the infrequent correct spelling of “methicillin” were also taken into account.

The data showed a steady rise in the number of searches for MRSA, staph, and even “mersa” that mirrored the increase in hospitalizations for MRSA over that same time period. Surprisingly, media reports about the drug-resistant bacteria were not very influential on the number of searches, except for the coverage of a 2007 CDC report that MRSA caused nearly 19,000 deaths in the year 2005 - which prompted a spike of Googling. As such, the team was able to create a model using the Google queries that predicted the rate of MRSA hospitalization with considerable accuracy, as reflected by the red and pink lines in the graph above.

Interestingly, Google searches for MRSA steadily increased at the same time as one group of MRSA infections declined. A study published last year examining the rates of hospital-acquired or health care-associated MRSA cases found a reduction from 2005 to 2008 as medical facilities stepped up preventative measures against the bacteria. The Google trend may thus reflect increases in the more alarming community-acquired form of MRSA, as spotlighted in Maryn McKenna’s Superbug. With a new prediction model, public health experts can keep an eye on the search engine trends to try to pinpoint outbreaks, even on a local level, before patients begin arriving in hospital emergency rooms with severe infections.

“If we knew the rate was two or three times higher in one city than another, that could be an influence on public health campaigns,” said Lauderdale in Wired.

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Dukic VM, David MZ, Lauderdale DS. Internet queries and methicillin-resistant Staphylococcus aureus surveillance. Emerg Infect Dis. 2011 Jun

A Magic 8-Ball for Cardiac Arrest

Cardiac arrest is one of the most common ways that people die, and hospitals need to be constantly vigilant about the threat of heart stoppage in their patients. So physicians have long sought to develop a way of predicting who is most at risk for cardiac arrest when checked into the hospital, such that extra care and surveillance can be taken. At the 2011 international meeting of the American Thoracic Society, held this past week in Denver, two Medical Center fellows presented research refining these early warning systems to make them a more effective hospital tool.

In the first study, pulmonary and critical care fellow Gordon E. Carr connected cardiac arrest with another frequent sight on the hospital ward: pneumonia. Carr’s study found that patients admitted with pneumonia are at elevated risk of cardiac arrest over the next three days after admission, and that almost 40 percent of these cardiac arrests occurred while the patient was outside of the intensive care unit. “We found a compelling signal that some patients with pneumonia may develop cardiac arrest outside of the ICU, without apparent shock or respiratory failure,” Carr said in a press release. “If this is true, then we need to improve how we assess risk in pneumonia.”

Adding extra caution about cardiac arrest to the care of patients with pneumonia is a specific way to improve surveillance. But to apply to more patients, a broader scale is needed, one that can be easily assembled from the vital signs that are already routinely measured in the wards. One such scale, called the Modified Early Warning Score or MEWS was tested by pulmonary and critical care fellow Matthew Churpek as a predictor of cardiac arrest, who found it to be better at predicting a cardiac arrest in the next 48 hours than any individual vital sign. But MEWS was designed for general risk of death, not specifically for cardiac arrest, and Churpek suggested a more specialized risk score could be calculated for use by hospitals. The benefits of such a measure, he said in a press release, would be immense.

“Rapid response teams are a complex and resource-intensive intervention, so providing evidence-based criteria for their activation is crucial,” Churpek said. “Our patients will do better if we can detect who is at high risk early enough to intervene and prevent a cardiac arrest.”

Doctors Against Ronald McDonald

Childhood obesity is a growing problem in the United States, and doctors point the finger of blame directly at increased consumption of junk food and fast food. Chains such as McDonalds have made noise about making their food healthier, especially for children, by posting calorie counts on menus and offering snacks such as apples and carrots instead of fries. But according to an open letter signed by over 500 health care professionals and placed in newspapers around the country this week, they have not done enough.

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In physics, there’s nothing better than an unexpected result. Wednesday, Fermilab scientists unveiled the graph at left and caused figurative rioting in the streets of the physics community, confirming months of rumors about an exciting new result from the suburban Chicago facility (You can watch video of the presentation here). It’s a big score in the final days of Fermilab’s Tevatron accelerator, which is due to close later this year due to budget cuts and the ascendancy of the more powerful CERN Large Hadron Collider in Switzerland.

The buzzworthy peak was the result of collision experiments where Fermilab scientists expected to see a W boson and two quarks, elementary particles that are part of the Standard Model of physics. But the experiments produced something additional, something unexpected, something unusual: a bump. Particle physicists spend their whole life chasing bumps, as Sean Carroll of Fermilab explains at his Discover Magazine blog, because they are “often a signature of a new particle that has been produced and then quickly decayed.” The anomaly could thus be a previously undiscovered particle that is not predicted by the Standard Model (apparently it is too large to be the elusive Higgs boson), forcing a re-write of the core theory of modern physics. Even if it’s not a new particle, some say an incorrect prediction like this one could mean that some of the rules of the Standard Model may need to be tweaked.

But despite the excitement, caution still reigns - as Dennis Overbye wrote in the New York Times, “The key phrase, everyone agrees, is ‘if it holds up.’” The chance that it is just a statistical anomaly is less than 1 in 1375, the researchers said. With that kind of data, biologists (whose 1 in 20 standards were lampooned effectively by the science comic xkcd this week) would already be popping champagne, but it’s not good enough for physicists - past findings of that strength have disappeared with further scrutiny. If additional experiments still being analyzed push the chance of error to 1 in a million, the true celebration will begin, and the finding could be the most important piece of new physics in decades.

Scientific Shutdown

Fortunately, that analysis will continue even in the face of a threatened government shutdown, the Fermilab website assures. But if a budget agreement isn’t reached by midnight tonight, business won’t continue as usual for many scientists, beginning with the 6,000 employees of the National Institutes of Health. As for extramural research that relies upon federal dollars, most ongoing clinical trials will be unperturbed, experts said. But Johns Hopkins researchers said that no new clinical trials will be able to start during the shutdown, and the Medical Center’s Richard Schilsky told MedPageToday that he’s concerned about obtaining experimental drugs from the National Cancer Institute.

“The biggest issue for us would be studies of investigational drugs being supplied by the National Cancer Institute,” he said in an email. “Many times we have to order drugs for each unique patient to be treated, and if NCI shuts down and can’t ship the drug, then we can’t treat the patient!”

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RN Debbie Pienta of the Student Care Center at the University of Chicago gives a flu shot. (Photo by Yvette Marie Dostatni)

Until last year, the advent of the new influenza season was a pretty routine event on the health care calendar. Around October, people would be urged to receive vaccinations against the viral strains expected to plague North America in the coming months, with young children and older adults encouraged more strongly to get their annual shot. Other folks received their vaccine with all the enthusiasm of a trip to the dentist - something you know is good for you, but not exactly an urgent concern.

That all changed last year, thanks to the novel H1N1 virus, aka swine flu, aka the global flu pandemic. Suddenly, seasonal flu clinics used to a slow trickle of customers were faced with lines out the door and around the block, as the combination of limited H1N1 vaccine supply and media hysteria created unusual demand. Caught short by the late-breaking new strain, suppliers had to prepare a separate vaccine for the H1N1 virus, requiring people to get stuck with a needle twice for full protection.

The good news heading into the 2010-11 flu season is that many of those logistical headaches have been resolved. With no new strains rearing their head since last year, vaccine makers were able to consolidate protection against H1N1 and two seasonal strains into one injection or nasal spray. The Centers for Disease Control and Prevention recommendations have also been simplified: all people above the age of 6 months are advised to get the flu vaccine, full stop. All signs this season also point to better preparedness across the board from government and private organizations dispensing the vaccines - local Walgreens in Chicago were advertising vaccine availability well in mid-September.

To raise awareness of vaccine availability on the University of Chicago campus, ScienceLife talked to two of our flu experts: Stephen Weber, medical director of infection control at the Medical Center, and Ken Alexander, chief of pediatric infectious diseases. Here’s a few of their answers about this coming flu season and the research taking place one year post-epidemic.

Q: If 2010-11 is expected to be a routine flu season, what does that mean?

Weber: A regular flu season doesn’t mean that it’s easy or that people don’t get sick. We have to remember that while flu is a very common illness, folks who are not vaccinated are at an increased risk.

In many resepects we return to our usual state of flu awareness and preparedness. Bearing in mind, we are talking about infections that kill 24,000 Americans each year, and that’s not something that we want to neglect or that we want to be anything but vigilant about. We have an opportunity to save lives, and whether it happens to be a pandemic or a seasonal year, we still have an important responsibility.

Q: Why is it especially important for parents of infants to be immunized against flu?

Alexander: It’s the notion of a “cocoon.” The idea here is that babies under 6 months don’t respond well to flu vaccine, so we don’t get give shots. So you have this window of vulnerability, and babies are at high risk. With cocoon immunization, if can’t immunize the kid, we can immunize everybody around the child.

There are good data on pertussis transmission to babies, that they receive the virus one-third of the time from the mother, a quarter of the time from dad, and a quarter from their grandparents. Flu is probably pretty much the same, and the idea is we can protect them if we immunize people around the baby.

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With the weather cooling and the kids back in school, the media coverage of the H1N1 flu - last spring’s “swine flu” - is building back to a fever pitch, if you’ll pardon the pun. As expected, colleges immediately found themselves dealing with campus outbreaks, and elementary and high schools have also already seen flu cases in the first few days of the school year.

In April, scientists knew very little about the nature of this novel H1N1 strain, and the worst-case scenarios suggested by some flu experts fueled the frenzy over whether this virus could be as deadly as the 1918 pandemic that killed as many as 100 million people worldwide. Now, six months later, there has been a lot more time to study the virus, observe its movements through the Southern Hemisphere’s flu season, develop and test vaccines and estimate the damage us citizens of the Northern Hemisphere can expect as a our flu season traditionally begins in October.

Because the novel H1N1 pandemic is such a fast-developing and important topic, much of the research into it is happening at an accelerated pace and is being disclosed to the public more quickly and openly than is typical for the traditionally slow march of science. Other sites have done excellent overviews of influenza in general and what we know about this particular strain or have followed every turn of this story. Below are summaries for a few of the main H1N1 subtopics.

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Much of the latest news on the H1N1 virus, colloquially known as swine flu, indicates that the next flu season has the potential to be unusually rough. In some ways the last flu season never really ended; the Centers for Disease Control and Prevention report that 20 states are still seeing widespread or regional flu activity, with H1N1 accounting for the vast majority of cases.

The coming flu season could fall within normal ranges, but CDC planners are bracing in case it resembles an especially bad pandemic year, such as 1957. The details on how H1N1 affects patients are still coming in. Certain populations appear to be at high risk for severe symptoms and, occasionally, death. Widely covered today was a Lancet report that suggested pregnant women may be more susceptible to the virus, with a higher rate of hospitalization and an elevated death rate in the pandemic’s early days. Between mid-April and mid-June, six pregnant women (including one in Chicago) died from the novel flu strain, 13% of the 45 American deaths reported during that time period.

The authors of the Lancet paper recommend that pregnant women receive antiviral medication, such as Tamiflu, as soon as possible after developing flu symptoms - none of the six deceased patients addressed in the paper received antivirals until at least 48 hours after illness onset.

But the best way to protect pregnant women from the flu strain when it likely returns in force this fall is through vaccination. The H1N1 story of the summer has been the frantic race by governments and scientists around the world to have a vaccine against the strain ready in time for the Northern Hemisphere’s next flu season. Manufacturers told an FDA panel last week that about 100 million vaccines could be ready in the U.S. by mid-October, but with roughly 300 million Americans, not everyone is going to be immediately vaccinated and priorities will have to be set.

That sober reality set the stage for a fascinating meeting today in Atlanta, where the federal Advisory Committee on Immunization Practices - a panel of doctors, scientists and public health experts - attempted to pick and choose which groups deserved the first crack at the limited vaccine supply. Given the numbers released yesterday, it was no surprise to find pregnant women in the top priority group for this fall’s vaccinations. Also given priority in the ACIP’s recommendations were caregivers for children younger than 6 months (who cannot themselves be immunized), healthcare and emergency medical personnel, children and young adults from 6 months to 24 years old and adults with chronic medical conditions.

Added together, that’s about 150 million people, roughly half the U.S. population. But with compliance among the priority groups expected to be far below 100% (it’s only around 40% for the regular old seasonal flu), it’s thought that the initial batch of 100 million will suffice, even if each person needs two doses to be fully protected, which experts predict may be necessary. As more vaccines become available, people between 25 and 64 will get it next. Those above 65 years old, who have seemed less affected by H1N1, are in the third, lowest priority group.

Much of the debate Wednesday (helpfully webcast on the government’s flu.gov website) centered over whether the younger population targeted in the first wave of vaccinations should be capped at age 19 or age 24. The argument of some panelists: college kids are as good at spreading viruses as they are at sleeping in late. Others argued that colleges are also an excellent distribution system for getting vaccines to this particular population. So young adults will join the front of the queue for the first batch.

The effects of H1N1 on different age groups appear to vary in a striking way, according to epidemiology discussed at the meeting. With nearly 44,000 American cases of H1N1 now documented, elderly folks appear to be less susceptible to the strain than younger populations. That observation runs counter to the pattern in most flu seasons, when senior citizens are more sensitive to the effects of seasonal strains and thus are heavily encouraged to get the yearly vaccine. At a CDC press conference announcing the panel’s recommendations, Assistant Surgeon General Anne Schuchat urged American seniors to get the seasonal flu vaccine as usual this coming fall. But for the H1N1 vaccine, they’ll be at the back of the line behind their children and grandchildren.

(Not to be a scaremonger, but for a gripping tale of H1N1 overseas, see this article by New York Times reporter Sheryl Gay Stolberg and her daughter Olivia Robinson, who contracted the virus while on a school trip to China)