Meningitis in Kent, and sonic hedgehogs

0:00Here at Blue Apron, we know exactly how hectic school nights can be. That's why we created a assemble and bake. Delicious one-pan meals that make family dinner simple. Just assemble the pre-chopped ingredients and put the pan in the oven to bake. Then you're free to help out with that last minute diorama. Shop assemble and bake at blueaprin.com. Get 50% off your first two orders with code apron 50. Terms and conditions apply. Visit blueaprin.com slash terms for more. All engine running, I'm so genius. Get this. Welcome to the show where we bring you science. What that which I mean is discovery is the most questions we've had. Technology unbelievable. Without further ado, this is the Naked Scientist. Hello, welcome to the Naked Scientist podcast. The program that brings you the biggest breakthroughs and also talks to the major movers and shakers in the words of science, technology and medicine. I'm Chris Smith and coming up this week.

1:00A massive meningitis outbreak in the UK. What's behind it and what's being done to stop it? Also, how thousands of old tumour samples could help scientists fight rising rates of bowel cancer in young people and a sound way to save the much-loved European hedgehog that's falling victim to road traffic. Up first this week, health officials have described a sudden outbreak of meningitis in Kent as unprecedented. It follows the deaths of a university student and also a sixth form pupil in the English County with more than a dozen other cases reported. At the root of the outbreak is a strain of the Nasirium meningitis or meningococcus bacterium called Men-B. It usually sits harmlessly in the noses and throats of a significant proportion of the population, maybe a quarter of some age groups carry it, and it spreads between individuals through close personal contact.

2:02Occasionally, though, for reasons we don't understand, it becomes virulent, invasive and deadly, entering the bloodstream to cause septicemia and the tissue layers around the nervous system to cause meningitis. It's a public health emergency and officials are now racing to identify potential contacts and offer them protective doses of antibiotics. Dominic Kelly is a pediatric infectious disease consultant and vaccinologist with the Oxford vaccine group. The meningococcus comes in different types and we give them a letter to differentiate them, A, B, C, W, Y, things like that. The letter refers to a capsule of the bacteria. Historically, back in the 1990s, Syrogroup C, we call them Syrogroup C, meningococcus was a big cause of disease, but we had a vaccine for that introduced in the late 1990s, which really has controlled that type of the meningococcus very well. The types were left with the type in the UK that has caused most disease over the subsequent years has been the type B.

3:08Infants and young children have the highest rates of disease, but there's also been a higher rate in adolescents, students over the years. We think that is something to do with transmission rather than perhaps a weakness of immunity in that age group that in mid-adolescence, early adulthood, people are having many more social contacts and perhaps are more close-knit nature. So their exposure and ability to meet lots of people means that they transmit these organisms more readily and that's probably why you have a higher number of cases of disease anyway in that age group. Extraordinary thing though is that if you go and pick people at random from the population in this particular age group, you can find as many in some cases as one in four who are carrying this bacterium in their nose and throat and they don't have meningitis. So why do we have this situation where some people can just have this nasty bug in them and on them and they're completely

4:08fine and then the next person gets it and they go down with meningitis. Well that's a really interesting question and I guess the first point you make reflects the fact that this organism for the most part causes very little trouble to most people and passes from person to person without causing disease and the disease is only in a minority of people exposed, probably even in this outbreak where disease rates are much higher, it's only a small number of the people who actually had the organism that get disease. Why a particular individual gets disease is still not well understood. There are genetic factors probably about their immunity, there may be things to do with the dose they get. There are some risk factors such as smoking which make you a bit more susceptible but if we don't understand especially well why a single individual gets disease when others haven't but yes the organism normally exists just as a commensal almost a carinizing organism just passing from person to person and disease is almost an accidental by

5:08product. How are they managing the outbreak? What's the the strategy to protect people in the short term and then stamp this out in the days to weeks following? People who are ill, the priority is to get into hospital, give them antibiotics and deal with their immediate illness but very rapidly after that because this organism is spreading from person to person, the public health organization, the health security agency would be informed of the case from the hospital and their first priorities identify close contacts of those individuals. So often in the hospital we're contacted while we're still managing the case by public health and either we're asked to try and compile this or they will talk to the individual or their families and identify who's been in close contact and the reason for that is so they can give antibiotics to reduce the chance that their contacts who may well be carrying the organism will actually get disease and what's interesting is it's a disease with a very short incubation so if you acquire the bacteria and if you're going to get ill

6:14usually it's we're going to be within a week or so of that initial contact so there's a real priority on public health identifying contacts quickly and offering them appropriate antibiotics and begin to look at the spread and whether any common themes common places those people have been to and I think the interesting thing in Kent was that identified a nightclub where a lot of them had been to so could begin to look more closely at the spread and identify a wider group of people who might get risk. Where do vaccines come in then? Because that is also being spoken about quite a lot. There's also a big campaign to vaccinate thousands of students in the Kent area and it's also leading to a run on people accessing the vaccine privately in pharmacies and so on across the country to the extent that some have actually now said they've run out of vaccine so where does vaccination come in in the fight against this? We have vaccines for many of the strains of the meningococcus but men B which is this strain has been more difficult to develop vaccines

7:19but over the last 20 years there's been extensive research and development of a vaccine against men B so we're in a very fortunate situation at this point in time to the last 10 years where we've actually got two different men B vaccines that cover around 80% of the strains and we have an infant program in the UK offering vaccines to infants and vaccines haven't been offered to add a lessons up till now as routine because the number of cases in adolescents and early adulthood have been low enough that it actually was not felt to be worthwhile to immunize hundreds of thousands of people a year to prevent very very few cases. The situation changes when you've got an outbreak like this there is an increased rate of disease for some time after an initial index case and there may be ongoing chains of transmission and so if you've got an outbreak that's continuing on a scale that's likely or could go on for weeks and months then vaccines coming to play and the strategy for vaccines requires quite a lot of thought on the public health authorities part

8:26to identify groups of people who in the weeks and months ahead may be at higher risk because of the communities they're mixing in that have had a higher rate of disease and so what I understand in the the kent outbreak is that they are doing a targeted vaccine program around the groups of people who've been most likely to to to contain cases of meningococcus. The interesting thing about vaccines though is they are particularly for the men be vaccine you probably need two doses for full effect and you only begin to get real protection two three four weeks after the vaccines so one dose four weeks later you have a little bit of effect but you need a second dose and it'll be two or three weeks afterwards so these aren't the main stay of the immediate response which is detecting cases treating them antibiotics for close contacts Dominic Kelly with the Oxford vaccine group and the current guidance is that the risk elsewhere in the country hasn't changed so there are no grounds to seek vaccination for people who are farther afield but everyone should

9:29nevertheless remain vigilant for signs and symptoms which include a flu-like illness fever headache next stiffness photophobia that's pain caused by exposure to bright lights and a purple rash that doesn't disappear when you press on it with a glass if you have any of those symptoms please don't delay ask for some help we're going to discuss schizophrenia now which is a chronic mental health condition characterized by hallucinations delusions and disorganized thinking there's currently no diagnostic test for schizophrenia though so the diagnosis is usually made clinically and this can limit our ability to tell apart different disease processes that might have different prognoses and also different treatment responses but now US researchers have identified two potential bio markers which do appear to signal the condition Bonnie Firestein conducted the study so many years ago we started researching schizophrenia but we were looking at things like how chemicals and cells

10:30change when you have schizophrenia so we used what we call post-boredom or after death brain samples from patients and we found that some of these molecules in cells were elevated so then we ask the question well what if we looked at living human beings who are experiencing schizophrenia and could we somehow detect the increases or even other types of changes to these molecules or chemicals in cells without having to wait until unfortunately they pass we want to be able to figure out can we help diagnose early on can we help figure out what medications will help them and that's what led to this study do we have a problem doing that at the moment then diagnosing people who actively have schizophrenia yes we do so there are different ways that or different domains that psychiatrist will use to diagnose somebody with schizophrenia and in these domains they look

11:30for things like hallucinations or hearing voices or not having interest in the things that people used to have interest in or having memory problems but the problem is that they're two-fold one is that it's difficult and more subjective to say that someone has schizophrenia in fact schizophrenia is on a spectrum there are schizophrenia effective disorders meaning that they're similar to schizophrenia but not quite schizophrenia the second problem is often medications that are prescribed do not work and it's trial and error and the third and biggest issue is that let's say Chris you and I unfortunately both have schizophrenia the reasons for us having schizophrenia could be different so there is a component that is genetic and there's a component that's also environmental but the genetic component it's not like when you have a certain disease where you have a problem with one gene and that's it your diagnosis to develop that disease in fact it's a lot more subtle so we can have different genes that confer what we call a risk for schizophrenia and the basis the biological

12:36basis for your schizophrenia could be different than mine so they might converge and have different what we call pathways in the cells different ways of signaling that might be very similar between you and me but the reason for it could be a little bit different and what you think you have some markers that can be used to diagnose people who have schizophrenia yes so what we did is we grouped different ages races and both sexes and then we looked for these biomarkers or these chemicals or markers or molecules in cheek cells that were elevated in patients with schizophrenia versus a population of control patients without schizophrenia who are age, race and gender matched how many of these markers are there well we focused on two of them so right now we have two that we were able to confirm are indeed increased in patients with schizophrenia and correlate with symptoms and also with learning and memory issues so for example if you look at patients with

13:41schizophrenia and they have an elevated level of something called sp4 that's just the name of the chemical and it's mRNA which tells the cell to make that chemical for example we see that the more that a patient with schizophrenia has the worse that they do on learning and memory tasks and the worse their symptoms of schizophrenia are so there are two of these there's the sp4 mRNA which I just described and then there's something called heat shock protein 60 which is a molecule or chemical in the cell that helps and acts as a chaperone for other chemicals and takes them throughout the cell and puts them where they should be or helps them degrade and go away and so the more of this also marker we see that patients with schizophrenia do worse and they have worse symptoms one of the interesting but also frustrating things about diagnosing schizophrenia it's one of those disorders that comes on a bit later in life once people get into their teenage or late teenage

14:45early 20s and then again there's a peak later in life as well isn't there do you see your marker's correlating with the behavior changing or are your markers always positive and therefore they could help us to spot people early so that is an excellent excellent question we do not know so this was considered a very large pilot study although it's not a large study overall we had 27 patients who were already diagnosed with schizophrenia and what we'd like to do is now extend this for either patients who are showing signs or looking at just patients who are of adolescents or late teen age which is probably easier to do in a double patient so we would say 18 to early 20s and be able to screen and see if people develop schizophrenia the other question we have is do medications alter the amount of these chemicals these biomarkers or markers in the cell we would hypothesize that perhaps if there is a medication that helps somebody with their symptoms

15:50or with their running in memory that somehow that would decrease these markers but these are things that we have to look at going beyond this initial study and how sensitive and specific are these markers just for schizophrenia because when we look at a range of other things like the genetic risk for effective disorders like depression for example there's a huge overlap in risk factors environmental risk factors family risk factors genetic risk factors have you got discrete markers here or do you think that the lines are going to get blurred and so you're going to end up diagnosing some depressed people with schizophrenia by accident so I think part of it is that we need a combination of these biomarkers it's not a single biomarker it might not even be the two we found it might be five or ten I think that they're going to be overlapping biomarkers because a lot of these neuro we call neuro cognitive disorders so disorders where you have changes to personality or changes to learning and memory there's a lot of overlap and so the question is how do you diagnose one versus the other it might be that we have to combine with symptomology but it's an

16:54excellent question and I think that one of the control groups for the next study would be patients with bipolar disorder for example or patients with depression what are the differences between the patients with schizophrenia versus one of these other disorders and that will help us narrow down again my guess is that it's going to be more than two markers that will allow us to distinguish between schizophrenia and one of these other disorders but do I think it's 10,000? no I do not I think that it's going to be manageable we just need to extend this study really interesting that was Bonnie Faustine she's based at the University of Kentucky the study was recently published in Science Advances my perfect day as sand saltwater and friends but my moderate to severe plaque psoriasis can take me out of the moment now I'm all in with clearer skin thanks to skyrizzy risen chism at rissa a prescription only 150 milligram injection for adults who are candidates for systemic or phototherapy with skyrizzy most people saw a 90 percent clearer skin and many were even 100 percent plaque

17:58free at four months skyrizzy is just four doses a year after two starter doses don't use if allergic to skyrizzy serious allergic reactions increased infections or lower ability to fight that may occur before treatment get checked for infections and tuberculosis tell your doctor about any flu-like symptoms or vaccines thanks to skyrizzy there's nothing on my skin and that means everything ask your doctor about skyrizzy the number one dermatologist prescribed biologic in psoriasis visit skyrizzy.com or call 1-866 skyrizzy to learn more the naked scientist podcast is produced in association with Spitfire cost-effective voice internet and IP engineering services for UK businesses find out how Spitfire can empower your at Spitfire.co.uk Music in the program is sponsored by Epidemic Sound perfect music for audio and video productions this is the naked scientist podcast with me

19:05Chris Smith still to come how researchers are trying to keep much-loved European hedgehogs safe from road traffic but first we're in London where researchers say that thousands of tumour samples which have been stored in a hospital for over seven decades could help us to understand why bowel cancer cases are on the up among young people under 50. The scientists at the Institute of Cancer Research are examining these samples to determine what is causing the current uptick and how we might be able to tackle it in future. I've been speaking with the ICR's Trevor Graham. The number of cases of bowel cancer in young people that's adults under the age of 50 and often these people are in their 20s or 30s is rising rapidly. We don't know why this is the case and if we're going to prevent this rising bowel cancer in young adults we we need to know what the causes. When did we first spot this was happening? The data is really clear looking back to about the 90s you can start to see the increase in the data and I think one of the numbers which I find

20:06really striking is the number of cases of bowel cancer in adults under the age of 50 is doubled since the 90s so in the data we have today it's extremely clear this rise is going on and what's the study you have in mind to try and get underneath this? We know that something has changed in our environment or the way that we live our lives that's causing this increase I mean it can't be human genetics because that doesn't change over a few decades you know that something that changes very very slowly through generations so there's something out there or something in the way that we live our lives which has changed and we want to figure out what that is. Our plan is we found this incredible archive of bowel cancer samples that existed in a London hospital and been kept in a in a dusty basement room for many decades have been stored there we think for almost a hundred years now and by looking in these old samples from cancers they collected and people have surgery say in the 1950s and the 1960s and comparing those to cancers from people of our surgery in the

21:07present day we can start to interrogate them and look at what's changed through the decades we can do histopathology which means looking at the cells under the microscope and the structure of the cells is really well preserved but we can also get DNA out and look at what's going on in the genome of the cancer cells. Well that was what I wanted to ask because is it the same disease although we're seeing more diagnosis of bowel cancer in younger adults now is that the same disease that was knocking around 50-60 years ago or is there something else different and therefore by comparing these older specimens are we literally doing an apples with apples comparison or something else changed. Absolutely something has changed there are lots of hypotheses out there about what's driving this increase in bowel cancer in adults under the age of 50 you know these range from you know changes in our diet to perhaps the amount of exercise we do you know some people think it could be something to do with microplastics there's even ideas it could be something to do

22:07with air pollution there's a whole host of things that it could be one of the leading ideas where I think the evidence is best is that there's a change in the bugs that live in our bowels the gut microbiome and there's a particular kind of bug that's more common in people's bowels today and we think was rare in the past although we're not entirely sure which is a type of E. coli and this particular type of E. coli is known to damage the lining of the bowel and at that damage we think might be the driver of our cancer in young adults and in the specimens you have can you get a cross section of the microbes that that person would have had in their bowel when that specimen was collected so you get both the microbiome as well as the person's genome can you see that that's correct so we can see both the microbiome and the genome but actually where we're going to look is not directly at the microbiome we're just going to try and look for the damage that the bugs have done if they are indeed there so the kind of damage that the bugs do is to mutate the DNA of

23:14the cells and make up the lining of the bowels that means to change the genetic code and once those changes have happened they're fixed they're there and the DNA of course is copied and passed on each time the cells renew in the in the bowel and produce the offspring cells to renew the bowels so if the bugs do damage at some point in life we can see that damage later and because we think the damage causes the cancers to grow in the first place it's changing the DNA of the cells and the lining of the bowel that makes the cancers grow we can look in the cancer and ask are the mutations we see in the cancer are they the ones that are likely to have been caused by the bugs themselves if you do get a hit and it does look like that is the case that there is evidence that something is shifted in the microbiome of today compared with yesterday and that's what's driving the damage to the intestine and that's what's causing the cancers what does that tell us about what we need to do to address the problem then that tells us we need to do something about the bugs

24:18so the kind of things we might be able to do are to have a test where we can check young adults possibly even children to see if they have evidence of this damage from the bad bugs and then if people did have the evidence we might think about screening them later in their life to see if bowel cancers are developing so we could have screening just for the people we think are particularly at risk of early onset bowel cancer another thing to say is that our microbiome is shaped by the way we live our life particularly by our diet and the amount of exercise we do is shaped by many of the factors in our lives and so it may be that we can find some intervention you know dietary supplement or something which promotes some bugs in our bowel and gets rid of the bad ones so we might be able to change the microbiome to prevent their bad bugs getting hold in the first place how long do you think it's going to take you to work your way through the samples and therefore when should we be phoning you up next to hear what you found well research is an open ended thing so it's

25:23very difficult to be exactly precise about the timescale here but I think within a few years time we should have been able to look at the genomes of hundreds of cases collected over the many decades leading today we're going to focus starting in the 1950s when the NHS was created and when lots of samples started to be stored in the archive there and take samples from the 50s 60s 70s 80s so on up until the present day and look across time and I think it would take us a few years to do that well so yeah come back in a couple of years and hopefully we'll know what's going on and I shall put that date in my diary to call Trevor back at the Institute of Cancer Research in London and find out what he has found European hedgehogs are much loved but they've been engraved decline lately largely because of road traffic which is leading to a third of deaths but new research has now demonstrated that these animals can hear very high frequency ultra sound which raises hopes that in-car sound repellents might help to keep them away from roads and being run

26:26over in the first place Oxford University's Sophie Land Rasmussen is dubbed Dr Hedgehog and she has the story so the European Hedgehog is declining all over Europe and in the UK alone it's estimated that three out of four hedgehogs have disappeared from the rural areas since the turn of the century so it's a very worrying and massive decline their decline is caused by a multitude of factors but the most important one is traffic it's estimated that one out of three hedgehogs are being run over by cars every year so this was the problem I set out to try and solve to save the hedgehogs and how are you going about it what's the solution apart from banning cars which is being practical yes so I couldn't ban cars I wouldn't be very successful with that so I decided I wanted to look into the possibility of creating sound repellents for cars to actually avoid having the hedgehogs

27:26avoid thirping out in front of the cars for that I needed to understand what hedgehogs can hear so we could actually target the sound repellents at hedgehogs all right so what as the cars come along they're making some kind of sound that the hedgehogs can hear and that warms them because makes sounds anyway so will this work well we don't know that yet but we need to understand how to really target these potential sound repellents at hedgehogs and we also need to investigate which sounds actually scare the hedgehogs so it would make sense to just have the car emit any sound so this is something we have to look into in the next step of the research what sort of sound do you contemplating using then well I really don't know that yet but I know for example that the hedgehogs hate the sound of juggling keys for example and also velcro but perhaps we could also use a distress call from a hedgehog to warn off the others and have the sound repellents play that would this not

28:29be extremely unpopular with people the amazing thing is that we discovered that hedgehogs can hear everything between four kilohertz and 85 kilohertz humans can hear up to 20 kilohertz and everything above that is considered ultrasound our dogs can hear up to 45 kilohertz our cats up to 65 kilohertz and this means that because the hedgehog can hear such high frequency ultrasound we can actually target sound repellents that wouldn't bother us or our pets that we wouldn't be able to hear they might hit bats though might know because bats use same sort of sound regimes yes so bats and mice and rats could be affected and this is something really important we have to look into in the future to make sure that the sound repellents wouldn't have any harmful effects to hedgehogs but also you know to bats we don't want to evict bats from our gardens because I'm

29:34imagining that the sound repellents could also be placed on robotic lawnmowers and garden streamers that may also hurt the hedgehogs so so we need to look into any potential negative effects of these sound repellents as well why do hedgehogs hear these very high sound regimes what purpose does it serve for them I mean it was a surprise to me to find that they actually heard such high frequency ultrasound and they heard best around 40 kilohertz and this is really interesting because I've often wondered why hedgehogs don't have that many sounds they have like a whistling sound when the hoglets the juvenile hedgehogs are calling for their mothers and they have a hissing sound like when they tell each other to go away and then they have a very high scream when they're in worrying distress and this is of course an awful sound but other than that they don't

30:34communicate a lot verbally or at least it seems so to us but since they hear best in ultra sound they may also be communicating in ultra sound and we just can't hear it do the hedgehogs react in the way you would hope as in if we had cars or vehicles going along the road or lawnmowers or streamers producing these sounds does it deter the hedgehogs from coming near would it make them run away because what we don't want is just to scare them and make them stressed and then they'll still run in front of the car so this is the next step of the research and I'm really hoping to catch the attention of the car industry here and have them reach out finance the research and collaborate with me so that we can help each other save the hedgehogs by creating efficient and harmful sound repellors for hedgehogs and have they made positive noises about that not yet but we'll see what happens I'm really hoping to hear from them because to me it's a no brainer to have them support this research as it is their products that are killing

31:39most hedgehogs a year and and if we want to stop this decline of the hedgehogs if we want the hedgehogs to be in the wild for future generations to experience then we need to stop this decline and the most efficient way would be to reduce the amount of road-killed hedgehogs every year so if you're listening and you think you can help out then do get in touch with Sophie Lund-Rasmussen she's at the University of Oxford and she just published that work in biology letters that's it for today do tune in on Tuesday though when we're going to be exploring the race to return to the moon and what either the US or China are going to need to sustain the mission regardless of who gets their first meanwhile thanks to all of you who are supporting our program with your donations we really appreciate this we read all your messages and I do write back to everyone personally to say thank you but here publicly thank you to all of you this really helps and we're really grateful and if you're enjoying the program and you would like to get behind us

32:40and show us your support we would love that please go to nakedscientist.com forward slash donate we'd also like to ask you if you are getting your podcasts and places like Apple or Spotify do please leave us a review and send us some thoughts comments and feedback we really appreciate hearing from you I'm Chris Smith thanks for listening and from all of us here at the naked scientist team until next time goodbye oh my perfect day at sand saltwater and friends but my moderate to severe plaque's rises can take me out of the moment now I'm all in with clearer skin thanks to skyrizzy risen chism at rissa a prescription only 150 milligram injection for adults who are candidates for systemic or phototherapy with skyrizzy most people saw a 90 percent clearer skin and many were

33:45even 100 percent plaque free at four months skyrizzy is just four doses a year after two starter doses don't use if allergic to skyrizzy serious allergic reactions increased infections or lower ability to fight that may occur before treatment get checked for infections and tuberculosis tell your doctor about any flu-like symptoms or vaccines thanks to skyrizzy there's nothing on my skin and that means everything ask your doctor about skyrizzy the number one dermatologist prescribed biologic in psoriasis visit skyrizzy.com or call 1-866 skyrizzy to learn more