Medical mission to Ukraine; protecting the knee joint; quest to defeat a virus: Upstate Medical University's HealthLink on Air for Sunday, Dec. 4, 2022

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a facial plastic and reconstructive surgeon tells about a medical mission trip to Ukraine.

Sherard Tatum, MD: ... We did have sirens go off a few times. You know, in a hospital, people tend to ignore that because if you're operating, you don't just run out of the room and go into the basement. ...

Host Amber Smith: An orthopedic surgeon talks about taking care of aging knees.

Zachary Vredenburgh, MD: ... Your muscles are going to weaken and get a little bit smaller, a little bit atrophied, as you do get older, although you can prevent that by staying active. ...

Host Amber Smith: And a researcher seeks volunteers for a study about the dengue virus.

Adam Waickman, PhD: ... Before the causative agent of dengue fever was known, it was referred to as breakbone fever because the muscle pains and the bone pains associated with that infection can be so intense. ...

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, an orthopedic surgeon discusses how to take care of aging knees. Then, a research scientist tells about his study of the dengue virus. But first, the medical director of facial plastic and reconstructive surgery at Upstate tells about operating on soldiers and civilians in Ukraine.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." Dr. Sherard Tatum has devoted his career to the reconstruction of children and adults with deformities of the face, head and neck. He recently returned to Syracuse from a medical mission to Ukraine, which has been under attack by Russian forces since February 2022, and he agreed to tell about his trip. Dr. Tatum is a professor of otolaryngology and pediatrics and medical director of facial plastic and reconstructive surgery. Welcome back to "HealthLink on Air," Dr. Tatum.

Sherard Tatum, MD: Thank you very much.

Host Amber Smith: Now this trip was organized through the American Academy of Facial Plastic and Reconstructive Surgery, is that right?

Sherard Tatum, MD: That's correct. We have a not-for-profit arm of the academy, called Face to Face, and it's been around for about 30 years. We travel all over the world doing reconstructive surgery, mostly for congenital work, some trauma and occasionally, war injuries.

Host Amber Smith: So, like birth defects or like you say, war injuries or trauma. What other countries has the team traveled to?

Sherard Tatum, MD: Well, it's not just one team. There are numerous teams, and we've been all over Southeast Asia, Eastern Europe, South America. There's a fair number of trips to go to Africa. Wherever there's a need, we try to get into. India.

Host Amber Smith: Have previous trips been to countries in an active war?

Sherard Tatum, MD: Yeah. It's been a while, but we were in Yugoslavia for that conflict in the mid-1990s. We were in El Salvador for a conflict in the early 1990s.

Host Amber Smith: Now, before we get into the trip too much, I wanted to ask if you can give a short description of what the academy is.

Sherard Tatum, MD: Well, the academy is basically a trade organization. It's the largest organization of facial plastic surgeons in the world. And like other trade organizations, it advocates for the membership and for public health and wellbeing of the patient population.

Host Amber Smith: When did the idea of a mission trip to Ukraine take root?

Sherard Tatum, MD: Well, once we realized that the war wasn't going to be quick, and the casualties started mounting up, from our previous experience in war zones, we knew what kind of civilian and military injuries there would be and that they would be needing help. So we thought we would try to offer that.

Host Amber Smith: Was there an academy member from Ukraine, or in Ukraine, who helped organize the trip?

Sherard Tatum, MD: There are several Ukrainian American people involved in the trip, inside and outside of the academy.

Host Amber Smith: Logistically, how did the group decide on a nine-day mission split between two different hospitals?

Sherard Tatum, MD: We typically try to have about five days of surgery, and there's usually a triage day in the beginning and unpacking and getting all the equipment ready, and particularly going into a war zone, you don't know exactly what the ground transportation is going to be like. So we allowed a couple of days travel on either side of the surgery days.

Host Amber Smith: Now, besides yourself and five other surgeons, there were 10 additional staff. What were their roles?

Sherard Tatum, MD: There were several administrative people who were part of some of these other organizations like Razom and Heal the Children Northeast that helped us. And they were responsible for getting the paperwork done to get us approval with the Ukrainian Health Ministry and getting us across the borders and just things like arranging hotels and meals. And then in the day-to-day work we had nurses and OR (operating room) techs who would help us just like they would at home with passing instruments and organizing all the supplies we need in the middle of cases and between cases.

Host Amber Smith: So the medical staff, were you all volunteering your time?

Sherard Tatum, MD: Yes.

Host Amber Smith: But the academy arranged, like, the travel and the housing and stuff? So you weren't involved in that part of it?

Sherard Tatum, MD: Well, the academy didn't do that because they don't have the connections in Ukraine. We were actually working with agencies that have presence in Ukraine to help sort of organize the on-the-ground activities.

Host Amber Smith: Who arranged for medical supplies and gear? Did you bring all of that that you needed from the U.S.?

Sherard Tatum, MD: Yeah. I mean, they had some things, but we were doing some pretty sophisticated reconstruction. We had patient-specific custom titanium implants made by a company called Materialise to help us reconstruct the bone defects from the injuries. We had a lot of sutures from Johnson and Johnson. We had headlights that were donated and a lot of plating sets. Those are little titanium brackets and screws that are used to put bone back together. Those those came from Synthes and from Stryker.

Materialise is a Belgian rapid prototyping company, and they have a small medical arm. And they're masters at 3D printing. So they made all these implants for us. They donated them, and they were there waiting for us when we got there. We spent a couple of months reviewing CT scans for all the patients and we went over them with the Materialise people, and then they made these titanium replacements for the bone that was blown away by the projectiles.

Host Amber Smith: So that's how you knew what size implants ... they were custom made for each patient.

Sherard Tatum, MD: Yeah, they were 3D printed based on the CAT scans.

Host Amber Smith: Wow. Very interesting.

Sherard Tatum, MD: Yeah, it's pretty cool technology.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Dr. Sherard Tatum. Dr. Tatum is a professor of otolaryngology and pediatrics, and he's the medical director of facial plastic and reconstructive surgery at Upstate, and he recently returned from a medical mission to Ukraine.

So, Dr. Tatum, I wanted to ask why you were willing, individually, yourself, to consider going into this war zone.

Sherard Tatum, MD: Well, as you might imagine, I had to get permission from my wife. But she was very supportive. It's just been a regular, not necessarily war zones, but these mission trips have just been a regular part of my career since it began. It just feels right. And there are people that need help, and we have the ability to help. We have a lot here in this country, and I think we can share a little bit.

Host Amber Smith: So you sort of have to put aside your fears or worries about personal safety?

Sherard Tatum, MD: A little bit. But we researched this pretty carefully. The city we went to hadn't been hit by a missile strike since February, and we really didn't see any overt signs of war other than sandbags and those hedgehog anti-tank things (a large metal device designed to stop tanks).

Host Amber Smith: Did you know the other five surgeons before this trip?

Sherard Tatum, MD: I knew about three of them. There were a couple of people that were new to me. Most of the rest of the team was from New York City. They all knew each other.

Host Amber Smith: So how do you go about packing for a trip? What did you bring?

Sherard Tatum, MD: We had to pack pretty light because we were carrying bags of supplies with us too. So you don't take a lot of great clothes, just some simple stuff to get back and forth from the hotel to the hospital every day. And everything else was medical supplies.

Host Amber Smith: I understand there were 34 patient consults, and 31 of those patients required surgery. What can you tell us about the patients? Were they adults or children?

Sherard Tatum, MD: They were almost all adults. I think we had one child who had some facial burns, scars that we did some work with. But everybody else had penetrating maxilla facial trauma. That means they were hit in the face with projectiles, either bullets or shrapnel from explosions. I think about maybe two-thirds were soldiers, and one third were civilians. Or maybe half and half, something like that.

Host Amber Smith: Are the injuries there, is there any need to take care of them immediately after they occur, or can they wait for months to have reconstruction done?

Sherard Tatum, MD: Well, they have aid stations and military hospitals and whatnot near the front lines. So these people get patched up as best they can. But they don't have people with our expertise at the front line. These cases are not as important as when people come in with life-threatening injuries. So they just put band-aids on for these problems. Like one of the guys we took care of had his foot blown off, and somebody had to stop that bleeding and get him hooked up with a prosthesis and whatnot. So the stuff we're doing is not life saving. It might be life altering, but it's not life saving.

Host Amber Smith: How did the hospitals in Ukraine compare with those in the U.S.?

Sherard Tatum, MD: The hospitals are great. They have a lot of supplies. Sometimes they don't have some of the fancier stuff that we bring. But the anesthesia was excellent. The support staff were very good. They had good intensive care units for some of the more complicated cases we did. So we were very happy with establishing a relationship with these people.

Host Amber Smith: Now these patients, what is recovery going to be like for them? you did the surgery, but then you're leaving the country. Do you hand them off to another physician that stays in Ukraine?

Sherard Tatum, MD: Well, technology now really allows you to do so much. We did all of this work through the otolaryngology department at the hospital. And, they would go around every day and take pictures of the patients if they had questions about how things looked or how things were healing, and we had numerous video conferences with them to go over how the patients were doing, and we helped troubleshoot a few complications. We were almost right there with them, even though we were gone, for several weeks, until all the patients were able to be discharged.

Host Amber Smith: That's amazing. Well, what impression did you have of the country of Ukraine?

Sherard Tatum, MD: It's a beautiful country. It is very similar to Upstate New York. It's got rolling hills, very plush, cool, lot of water, a lot of fields of various crops. And then the cities are, a lot of them are sort of old European-style cities that are beautiful, and there are some walled cities and lots of old churches and that sort of thing. The people were very impressive. They are incredibly warm and welcoming, and their bravery was standout for me. The military people who were injured, the first question after we operated on them was, when can they get back to their comrades and fighting? They were very brave, and the civilian folks are just as brave.

Host Amber Smith: Does the news coverage that we see on TV in the U.S. resemble what you saw on the ground?

Sherard Tatum, MD: I think so. The news coverage tends to show sort of the acutely damaged areas. And I guess what you see when you go there is that those areas are just piling up. You know, there's just more and more damage upon damage and more and more injuries piling up and death. That part's pretty sad.

Host Amber Smith: So during your stay, where did you sleep, and what did you eat? I mean, are restaurants open? Are hotels open?

Sherard Tatum, MD: Yeah, the city we were in was pretty much business as usual. There was a curfew. They turn all the lights off at 10 o'clock. But yeah, the restaurants and the hotel were very nice, and they were open for business.

Host Amber Smith: And while you were there, did you hear air raid sirens or shelling, or ...?

Sherard Tatum, MD: We did have sirens go off a few times. They, you know, in a hospital, people tend to ignore that because if you're operating, you don't just run out of the room and go into the basement. They had this system that would send an alarm over your cell phone too, when they thought there was a threat. We saw one plane fly over. And we're not sure what that was. But there were no explosions.

Host Amber Smith: So just getting to Ukraine, you had to drive into Ukraine, right?

Sherard Tatum, MD: Yeah, it's not safe to fly. We flew into Krakow, Poland, which is on the eastern border of Poland, Western border of Ukraine. And then we spent the night there and got in a bus the next day and drove to Ivano-Frankivsk, which is the city we were in. And that took about 12 or 14 hours.

Host Amber Smith: Now the people, are the people there constantly on edge?

Sherard Tatum, MD: No, I did not feel that. I was taking a picture one evening of I think it was the main administrative building for the city, and a guard came over and asked me not to do that, and that was about the only interaction I had with anybody military at all.

Host Amber Smith: Now we've heard President (Volodymyr) Zelenskyy asking for more military aid. Do you think the country is in need of more medical aid, as well?

Sherard Tatum, MD: Yeah, they could certainly use more aid. We're in the process of organizing several trips over the next few months to different cities to try to increase the aid effort that we're offering.

Host Amber Smith: Well, Dr. Tatum, thank you for making time to tell us about this. It's really interesting and amazing.

Sherard Tatum, MD: Well, sure, Amber. Thank you.

Host Amber Smith: My guest has been Dr. Sherard Tatum. He's Professor of pediatrics and otolaryngology and medical director of facial plastic and reconstructive surgery at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Are knees supposed to creak and pop as you get older? Next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

As we get older, knee pain becomes more common, but there are things we can do to postpone or potentially prevent knee problems. Here to talk with me about how, is Dr. Zachary Vredenburgh. He's an assistant professor of orthopedic surgery at Upstate.

Welcome back to "HealthLink on Air," Dr. Vredenburgh.

Zachary Vredenburgh, MD: Thanks for having me.

Host Amber Smith: What is the average age of patients who come to see you with knee problems brought on by wear and tear as opposed to sports injuries or traumatic injuries?

Zachary Vredenburgh, MD: So, in general, that population's going to be a little bit older, naturally, as the more active patients with acute injuries tend to just be younger because those are the people that are more active in playing sports.

But usually these people with wear and tear, you know, "My knee just got sore or achy one day for no real reason," those tend to be in their 50s, 60s, 70s -- those decades of life, usually.

Host Amber Smith: Does that wear-and-tear patient population, is it evenly divided between people who live a very active lifestyle and those who are more sedentary, or not?

Zachary Vredenburgh, MD: What I see is usually it's more active people because that's the reason that they're noticing it. That's the reason that they're uncomfortable, or they want to go back to their walking a couple of blocks a day or running half marathons, even into their 50s and 60s.

So, it's usually the more active people, though there are some people that really for no reason, from their perspective, start having pain. But it could be that they just have bad arthritis, and even minimal daily activities bother them.

Host Amber Smith: Is it pretty evenly divided between men and women?

Zachary Vredenburgh, MD: I'd say so, just from my perspective, but in general, arthritis, I think, has a little bit of a skew towards women. So if you're talking strictly from arthritis perspective, it'd be a little bit more female, but pretty even all in all.

Host Amber Smith: So my question is, does being active, such as being a regular runner, does that help protect your knees, or does it set you up for problems later on?

Zachary Vredenburgh, MD: It's a little bit of a double-edged sword or a kind of a loaded question maybe, because running a lot and doing highly physical things can put more load and more force onto your joints, which over time can cause you to feel it more. But at the same time, being active and doing active things obviously helps keep your weight down, and anything to keep your weight down is helpful for the health of your joints in the long run, as well as just movement and active motion is good for your cartilage, in your knees and in your hips and ankles.

So, those things are going to be helpful in the long run, too. So, I don't think there's one, exactly right answer for that.

Host Amber Smith: Is it normal for knees to start popping and cracking when you move as you get older?

Zachary Vredenburgh, MD: It definitely can be, and it's not always necessarily a sign that something bad or ominous is about to happen.

We say that clicking, cracking, catching, all those types of symptoms, however you're going to describe it, are very nonspecific. They could mean just there's some air in there. It could be a little bit of inflammation. It could be a whole litany of things that are not concerning at all to us.

But it's really when those things start to become painful that our interest gets a little bit more piqued, or we go digging a little bit deeper. Or if the symptoms are more than just cracking, it's a true kind of catching or locking of the knee, and that can signify if there's something getting stuck in there or something that can be fixed.

Host Amber Smith: Is it normal that cartilage is going to thin out as a person gets older?

Zachary Vredenburgh, MD: Yeah, that's definitely a natural part of aging. There's not a whole lot you can do to necessarily prevent it, and it's a little bit unpredictable in terms of how fast or to what rate or what degree the cartilage does thin or wear out.

Host Amber Smith: What's likely to happen to muscles and ligaments as we age?

Zachary Vredenburgh, MD: So naturally, your muscles are going to weaken and get a little bit smaller, a little bit atrophied, as you do get older, although you can prevent that by staying active, continuing with strengthening exercises, things like that. The ligaments become a little bit more brittle, so a little bit more prone to injury, but as you lower your activity level, you worry a little bit less about those being injured and more just about the generalized kind of wearing out of the knee.

Host Amber Smith: If someone has a hip problem or a hip injury, is that liable to impact the knee, as well?

Zachary Vredenburgh, MD: This is something I see all the time, I'd say, is that someone comes in, and I see them one week for a hip or knee problem -- it can be either one. And then a few weeks later, a few months later, that problem's better. But now it's the adjacent joint.

So, I think it is very common that once your gait gets altered, or you have a problem in one joint, that things can migrate as the other joints are picking up the slack.

Host Amber Smith: So everything's connected?

Zachary Vredenburgh, MD: Yes, it definitely is. Like the song "Head, Shoulders, Knees and Toes."

Host Amber Smith: Well, let's talk about the things that can go wrong with knees over the course of time.

What's the most common complaint you hear from patients with wear-and-tear issues?

Zachary Vredenburgh, MD: It's generally a soreness and swelling after a long day of being on your feet or walking around. A lot of these people feel stiff in the morning, and then once you get into, like, a small amount of activity, just walking a little bit, it actually sometimes feels a little bit better.

But again, at the end of the day, it's often swollen, painful, sore, achy, sometimes some of that catching and clicking that you're talking about, those seem to be the most major for anyone without an acute injury. And I think people sometimes are surprised because they come in and they say, "You know, I didn't do anything. And then all of a sudden on this day, at this time, my knee started hurting. And something must have happened."

But what's really happened is they've had arthritis, and they've had arthritis for a long time, and there's just going to be one date and one time where all of a sudden it starts bothering them, and even though it's often pinpointed to a specific point in time, it's not a specific injury, but it still seems to happen acutely.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with orthopedic surgeon Dr. Zachary Vredenburgh about how to care for our knees as we age.

I understand that osteoarthritis is one of the five leading causes of disability among seniors. What is that and is it inevitable as we age?

Zachary Vredenburgh, MD: Osteoarthritis is basically the wearing out of the cartilage in whatever joint we're talking about. We're talking about the knee today, but it's when the cartilage starts to thin or fragment or soften, and it is a natural part of aging.

Not everyone ends up getting arthritis, but it is a natural thing that just does happen, for -- it can be a multitude of reasons.

Host Amber Smith: If we had a parent or grandparent with osteoarthritis, does that make us more susceptible?

Zachary Vredenburgh, MD: Yes. There is definitely a genetic component, and, again, it's not a one-to-one, where if your mom and dad both had arthritis, you're going to have it for sure, but there's definitely a strong predisposition to genetics in causing people to have arthritis later in life.

Host Amber Smith: If we have it in our hands, say, does that set us up for a chance that we would also develop it in another joint, like our knee?

Zachary Vredenburgh, MD: There does seem to be some correlation, but what we often think about when you start complaining of multiple joint complaints of swelling or inflammation or especially of some arthritis, we often think about the more systemic causes, like a rheumatoid arthritis or something like that, and that's different than osteo.

So osteoarthritis would just be arthritis that just kind of happens, maybe traumatic in nature, but rheumatoid arthritis or some of the more rheumatologic conditions that can cause arthritis are because of a systemic inflammatory-type process, which is treated a little bit differently.

Host Amber Smith: Do they have the same symptoms, rheumatoid arthritis and osteoarthritis?

Zachary Vredenburgh, MD: In general, yeah. You're going to have joint pain, joint swelling, stiffness. Sometimes the rheumatologic processes can be a little bit more aggressive or abrupt in happening, and it's not my area of expertise, but the medications these days seem to be doing a much greater job of controlling patients from having rheumatoid degenerative joint disease.

They still might have other symptoms, but the arthritis and the need for joint replacements and things like that seem to have really gone down, as the medications have become better to treat those conditions.

Host Amber Smith: So focusing on osteoarthritis, can anything be done to prevent it, once symptoms emerge?

Zachary Vredenburgh, MD: In short, not really.

You can treat the symptoms, and that's what we aim to do with all the conservative treatments, things like anti-inflammatory medications, doing low-impact activities, so you're not feeling the pounding on the joints over and over again, keeping a nice, healthy weight, because your knee sees multiple times your body weight, so even a couple of pounds, up or down, one way or the other, can have a big effect on how much force you're feeling in the knee. As well as, for that matter, physical therapy to help off-load the knee joint and strengthen the muscles around it, so you're feeling less force.

Host Amber Smith: Are knee replacements ever a treatment for someone with osteoarthritis?

Zachary Vredenburgh, MD: Yeah, so that is the end treatment, if you really go through a lot of conservative treatments. There's other things; you could have a whole, hours-long talk on treatment of knee arthritis. But if you get through a lot of other things, there's some types of injections that you can try, some nerve ablations, other medications that are a little bit newer and still really being studied.

But if you get to the point where nothing's really helping anymore, then your replacement becomes, really, the ultimate solution, but also obviously with more risk.

Host Amber Smith: Are you usually able to get some relief to patients without having to go all the way to a knee replacement?

Zachary Vredenburgh, MD: In my practice, I don't do knee replacements.

I'll often treat these patients up until the point they end up saying, "Hey, enough is enough, and I think replacing my knee might be the only option." But I definitely see a lot of these people who, their symptoms are greatly improved and good enough, and even if it's not for the rest of their life, for five or 10 years, they can be active and happy and do the things that they need to do without having to have some of the restrictions that you may have to have after a knee replacement or the surgery and the recovery time when they're still at a younger age, I think, is worth it.

Host Amber Smith: Now what about the people who were athletes in high school and college? If they had injuries to their knee back when they were in their teens and young 20s, are they more likely to have problems when they hit their 40s and 50s and older with the knee?

Zachary Vredenburgh, MD: There's some specific injuries that definitely have a correlation with causing arthritis later in life.

So things like having had a fracture, broken bone, into your knee joint, we call a tibial plateau fracture, especially if it's not perfectly reduced or perfectly aligned, can cause problems.

ACL injuries: We know anyone who injuries their ACL (anterior cruciate ligament, in the knee), which is the surgery that we do all the time, no matter what, those patients seem to have a higher rate of arthritis later in life.

Other broken bones, things that make the alignment in the lower extremity, can put more force on the knee and cause problems with arthritis. So there are definitely certain injuries that can lead to more arthritis.

But a lot of times, just the day-to-day, or "I played a lot of basketball when I was younger" -- we don't really know that that causes arthritis. It's more these specific instances where you have major injuries to your knee.

Host Amber Smith: Well, let's talk about what things people can do as adults to help preserve their knee function.

How important is weight control? And does 20 pounds make a difference?

Zachary Vredenburgh, MD: Yeah, I'm a big believer in maintaining a healthy weight, one to keep the force off the joint to possibly lower the symptoms that you're having and also maybe the progression of arthritis. So that really hasn't been born out well in the (medical) literature.

And 20 pounds, I'm sure, would make a big difference. I even try to get people, if you can even just lose 5 pounds, I think that can have a big deal on your overall well-being of your knee and also just how it feels.

Host Amber Smith: How do you recommend maintaining muscle strength and range of motion?

Zachary Vredenburgh, MD: I think working with therapists is really a key point of that.

I think sometimes people think, "How's this going to help me? It's not changing arthritis, you're just strengthening. You're not affecting the joint itself, but it really seems to have good results, both just anecdotally with what I see in the office, but also .In the literature. It's pretty strongly supported by our (orthopedic) academy as well.

Even if you just go to a therapist a few times and learn some of the exercises and some of the techniques that they're teaching you, and then bringing those to the gym or to your home exercise or things like that, those are all great ways to stay active and also to keep the strength in your knee.

Host Amber Smith: Does footwear impact how well our knees absorb the impact of our movements? I'm thinking about running or even just walking.

Zachary Vredenburgh, MD: Yeah. I would say so. Anything where you're going to have more cushion, to an extent, is going to be helpful in off-loading the knee and absorbing loads. There are some people, though, that argue that we weren't born with sneakers on our feet, so maybe barefoot is the best way to go. And I think there's still some debate or there's, if you've seen the shoes that are made to look like your bare foot, there's some back and forth about what the best thing to wear on your feet is.

Host Amber Smith: Well, Dr. Vredenburgh, I thank you for making time for this interview.

Zachary Vredenburgh, MD: You're welcome. Thanks for having me again.

Host Amber Smith: My guest has been Dr. Zachary Vredenburgh. He's an assistant professor of orthopedic surgery at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," Syracuse scientists are researching the dengue virus. Find out how you can get involved.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink. on Air."

About half of the world's population is at risk of becoming infected with dengue virus through the bite of an infected mosquito. Researchers are trying to develop a vaccine or medications that would protect humans from this disease, and a trial related to those efforts is underway at Upstate Medical University.

Here to tell us more about that is Adam Waickman. He's an assistant professor of microbiology and immunology at Upstate, and much of his research is focused on viral pathogens.

Welcome to "HealthLink on Air," Dr. Waickman.

Adam Waickman, PhD: Good afternoon, Amber. Pleasure to be here.

Host Amber Smith: I'd like to start with a description of the disease caused by the dengue virus. Is that dengue fever?

Adam Waickman, PhD: Correct, yes. So infection with dengue virus causes flu-like symptoms. You will get headache, fever, rash, eye pain. In fact, back before the causative agent of dengue fever was known, it was referred to as breakbone fever because the muscle pains and the bone pains associated with that infection can be so intense that that's the colloquial name that was given to this disease.

Host Amber Smith: So it's known to be painful.

Adam Waickman, PhD: Correct. So the bone pain and the headache and the rash and the muscle pain can be quite painful.

Host Amber Smith: A person would get this from the bite of an infected mosquito. Once the person's infected, can they spread it to other people?

Adam Waickman, PhD: Correct. The most common method of transmission, as you said, is when a mosquito feeds on someone who is ill, who has virus in their blood, and then that mosquito goes and flies away and feeds on someone who lives in the same household or lives in a neighboring household and then feeds again on someone who's not infected and then passes the virus to that person when the mosquito starts to feed and spits a little bit into the person to start that feeding process.

So it's very rare for someone to directly transmit the virus from one person to another. And the most common method of transmission is from a mosquito.

Host Amber Smith: This dengue virus, isn't it mostly a tropical disease?

Adam Waickman, PhD: Correct. So most of the transmission of the virus is really limited and really driven by where the vector, the mosquito that can transmit the virus, can be found. And at this point, the Aedes aegypti and Aedes albopictus mosquitoes are found primarily, as you said, in the Tropics, so South America, South and Central America, Southeast Asia, Asia and parts of Africa.

But there are colonies of these mosquitoes that are found in the Southern and Southeastern United States, so Texas, Florida, Georgia. There are populations of these Aedes mosquitoes that can be found there, and there are periodic outbreaks of dengue in those areas. Small, but still present.

Host Amber Smith: I understand there are four different types of dengue. Can you tell us about the differences?

Adam Waickman, PhD: Correct, so there are four distinct, we call them serotypes of dengue, and this is really what makes dengue interesting and challenging from a virologic and an immunologic perspective.

So what we refer to when we refer to something as having a serotype, that means if you're infected with that serotype of dengue, generally you cannot be infected again with that serotype. However, you do not necessarily have protection against those other serotypes of dengue. So for example, if I was infected with dengue one, it is thought that I now have lifelong protection from dengue one. However, I am still susceptible to being infected with dengue two, three, or four at some later point in life. So this means that these are genetically, meaning the genome of these viruses are distinct, but also immunologically, meaning that the immune system can tell the difference between these serotypes of dengue.

Host Amber Smith: So how do you make a vaccine or a medication that'll take care of all four of them at once, or can you even do that?

Adam Waickman, PhD: So this has been the perennial challenge. This has been the massive lift that we have been trying to achieve as a vaccine and immunology community for the last 40 years.

Because you're right, we have to not only generate immunity against one virus, we have to generate immunity against four viruses simultaneously. And what makes this even more challenging, is that a unique feature of dengue virus is that, as I mentioned before, you can be infected with one virus, and be protected against infection from that same virus for life, but that infection with one serotype actually puts you at greater risk of severe disease if you're later infected with one of the other serotypes. So this has significant implications for vaccine development because if you do a poor job of generating immunity against one of these four or two of these four or three of these four serotypes, you may actually put someone at greater risk of developing disease than they would've been before.

Host Amber Smith: Would it be a medication you would take before you're infected, or would it be a medication that someone would take once they are already sick with the disease?

Adam Waickman, PhD: The hope for the vaccine community and the dengue community is to develop a safe and protective vaccine that can be provided before anyone is infected.

So, to prevent anyone from ever becoming infected and prevent them from developing symptoms and prevent them from being sick. That, as I said, is a high bar, but there are also efforts to try to develop drugs and other therapies that can be given if someone is exposed or early on, when someone is displaying early symptoms of dengue infection, to limit the disease and blunt the severity of the infection.

Ninety percent of dengue infections are asymptomatic, so ninety percent of the time when someone is actually infected, they don't have any symptoms or very, very mild symptoms.

Of that, so let's say 400 million people are infected a year. Between 50 million and 100 million people become symptomatically ill every year. Of that, 500,000 people may develop severe dengue. Of that, 20,000 to 70,000 die. So it's a very steep pyramid where the risk factors for moving from one category to another category are not well understood.

But again, having that preexisting immunity is one risk factor.

Host Amber Smith: Are there any dengue treatments that have been approved for use yet?

Adam Waickman, PhD: So there is currently one approved dengue vaccine, but it has restrictions on who can use it. So, as I mentioned, having one dengue infection can actually put you at risk of developing more severe disease should you become infected again.

So, the vaccine that is currently available, called Dengvaxia, is available and only licensed for use in people that have previously been exposed or have some amount of anti-dengue immunity. So what this vaccine can do is take someone who has some level of preexisting dengue immunity and boost it to a level where it's protective or mostly protective from infection, however It's not licensed to be used in someone who has no immunity, out of concern that you may put them into a window where they are at risk of developing more severe disease, should they become infected.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Adam Waickman. He's an assistant professor of microbiology and immunology at Upstate who researches viral pathogens, and he's involved with a clinical trial related to the dengue virus.

Now, you're involved in this dengue trial that's underway at Upstate, but it's not a vaccine trial. Can you explain to us what it is?

Adam Waickman, PhD: Yes. So, we have two programs that we are running here at Upstate, the first of which is that we have been involved in a consortium effort with a large group of partners, including U.S. Army and other academic institutions to develop what's called a dengue human challenge model, or for short, DHIM. And what this model seeks to do is to expose volunteers to a highly attenuated (weakened) strain of dengue that makes people a little bit sick. They get a fever, they get a rash, they have virus in circulation, but then it resolves very quickly in a very well-understood way, and the goal with this is to develop a tool that we can then test vaccines and test drugs in a controlled fashion before we roll them out to large clinical trials out in the field, as it were.

Because one of the challenges, as you mentioned in your introduction, there are close to 400 million, 500 million infections a year. But it's really hard to know when and where that infection is going to occur. So it can be very hard to run a trial where we're trying to see if a drug or a vaccine prevents an infection.

So by having this controlled challenge model, we can very precisely know, "This is when we gave the drug," or "This is when we gave the vaccine," and then infect people in a controlled fashion with this attenuated virus to see does this drug, or does this vaccine, prevent disease or prevent infection.

Host Amber Smith: I've seen billboards recruiting people for this trial. How many people will be participating all told, and in Syracuse and other sites?

Adam Waickman, PhD: We're really just hitting our stride. So, we have, over the last eight years, infected close to 30 volunteers with these attenuated strains of dengue virus.

And right now we're running clinical trials where we're looking to recruit dozens of more volunteers. So this is a program that we're really excited about because we now have this incredibly powerful tool that we're hoping can help cure this disease that causes so much suffering, in predominantly children, around the world.

Host Amber Smith: What are the requirements to be able to participate, and are there any disqualifiers?

Adam Waickman, PhD: The main criteria for being able to participate in the study is that you have to be between 18 and 55 years of age at time of enrollment and not have any preexisting immunity to dengue itself, so you shouldn't have traveled to a dengue endemic area recently.

If you want more information about this study and see if you might be qualified for participating in this study, there can be more information found in the link below (in the posting for this interview on the website). Or you can call our lead recruiter for more information at 315-464-9869.

Host Amber Smith: What can participants expect? Because I'm curious how much time this will take, and where they have to go, and what the visits are like.

Adam Waickman, PhD: Everything is run out of our research unit at the Upstate Community (Hospital) campus (on Onondaga Hill). The first thing you would do is, you'd come in for a screening visit, where you'd meet the team, and we'd do some routine questions to get to know you and get to know your medical history and some blood work to be able to see, again, do you have the antibody profile that makes you eligible for this study? And also just some routine screening to make sure that you're healthy enough to participate in the study.

If you're enrolled in the study, the first two weeks of the study involve very frequent visits, where after infection, we'll have you come in and check in with the team, make sure that you're feeling OK. There's going to be blood draws for us to be able to follow how much virus is in your blood and how your immune system is responding to the infection. And also if you're taking a drug to limit the infection, this will be an opportunity for you to take that drug under the supervision of the study staff.

After that first two- or three-week intensive period, there's then going to be periodic follow-ups where, again, we're checking to see how you're doing and how your immune system has responded to the infection. And generally after a month, there's periodic follow-up. And most of these studies we close out after six months with just one final visit for us to be able to do a final check and see how your immune system responded to the infection, and at that point, that's it.

Host Amber Smith: So, participants, they're investing a little bit of their time in this. Do they get compensated?

Adam Waickman, PhD: Yes, there is financial compensation for participation in these studies. And again, more information about that can be found on the website linked below.

Host Amber Smith: So all of the participants will be injected with dengue, a watered down form of dengue?

Adam Waickman, PhD: Correct. So all participants in our challenge studies do receive an infection with the virus. If you're participating in a study where we're testing a vaccine or a drug, you may receive the vaccine, you may receive the drug, or you may receive a placebo, a control (a fake medication), for that.

Host Amber Smith: What are the risks to someone who has this injected into their body?

Adam Waickman, PhD: The risks are you do develop symptoms of a mild dengue infection. About half the volunteers that participate in these studies so far without any additional treatment, they have a headache, they have a fever, they'll develop a rash that will last three to five days, and they self-resolve, and at this point, every volunteer that we've had involved in these studies, those symptoms have been treated with, rest and just over-the-counter painkillers.

Host Amber Smith: So, participants will have an immunity to dengue afterward? Is that right?

Adam Waickman, PhD: They will have generated an immune response to dengue, but we can't say that this is going to be a protective immune response against that serotype because the virus that we use for this challenge is very attenuated.

Again, we want this to be a safe, controlled experience, so we don't have the data to say that this infection is going to provide protective immunity, but it does certainly generate a very robust anti-dengue immune profile.

Host Amber Smith: Besides the compensation, what are the rewards for someone to be involved in this?

Adam Waickman, PhD: These studies that we're doing are designed to try to come up with a vaccine or come up with a drug that is going to be incredibly impactful for billions of people. There's, as we mentioned a couple times, there's 500 million infections a year, and again, most of the individuals that have symptomatic severe disease are children, in the Tropics and Subtropics around the world.

So our hope and one of our goals is to be able to develop a vaccine or develop a drug that is going to provide some relief and break this cycle where we have so many children, so many people around the world getting sick from this disease. So by participating in this type of trial, you're providing an incredibly valuable service to the world community, trying to prevent and treat this very, very impactful disease.

Host Amber Smith: Does the information from your study get shared with researchers around the globe, in other countries where this is a bigger concern than it is here? How does that get shared?

Adam Waickman, PhD: All of our studies that we run here are published in peer-review journals, and as part of that process, the underlying data generated from the trial are made publicly available, so researchers from around the world can see what happened in our study.

And also we have extensive collaborations with groups from around the world in dengue endemic areas, where we're working with them to identify the questions and identify the tools that we can use to help best answer the questions that are impacting their communities.

Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Waickman.

Adam Waickman, PhD: It's been my pleasure. Thank you so much.

Host Amber Smith: I want to let listeners know again, the phone number to call for more information is 315-464-9869.

My guest has been Adam Waickman, an assistant professor of microbiology and immunology at Upstate who is involved in research into the dengue virus.

I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Corey McGraw from Upstate Medical University. What's the outlook for someone with multiple sclerosis?

Corey McGraw, MD: You know, the outlook for folks who are diagnosed with MS is very good. We live in an era of MS treatments in which we fully expect patients to have no disease activity. So that means no additional attacks of neurological disability called relapses, no new scars on their MRIs. We call those lesions. No progression of disability. And this is our current goal in MS care, for all of our patients.

Host Amber Smith: You've been listening to neurologist Corey McGraw from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Mick Cochrane is a writer and professor at Canisius College in Buffalo, New York. His poem "His Back Pocket" is dedicated to Dr. Joseph Leach, an oncologist in Minnesota, but it celebrates all physicians who keep patients hopeful and engaged through the roughest patches and yet stay realistic and honest and bear witness with their patients.

"His Back Pocket"

Don't worry he always says I've got

something else in my back pocket

he's got clinical trials he's got

off-label he's got stuff from Sloan

Kettering he's got what Lance

Armstrong juiced his team with

he's got more milestones he

tells you he's got your twins'

graduations he's got some new

theories his back pocket has

back pockets who's your tailor

you ask and he just laughs he has

your next birthday he's got Gamma

Knife and gene therapy and some

cocktail the Mayo Brothers don't

know about yet he's such a modest

magician he's got your trip

to California he's got stories

about remission like you

wouldn't believe he's got something

for nausea and pain and numbness

and tingling in your extremities

but you both know there's always

a last thing even in the deepest

pocket "time is an ocean"

you know what he's got

to show you "but it ends at the shore"

not today but soon you can see its outlines

almost feel the weight of the last

thing he will produce from his back

pocket

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air" -- how exercise can stave off dementia.

If you missed any of today's show or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel. This is your host, Amber Smith, thanking you for listening.