My big concern is because we are so intensely privatizing this rollout and relying on pharmacies, we really are giving our wealthier folks more access to this vaccine.

Amesh Adalja

There is always going to be a risk of infection with blood produc... by Amesh Adalja

There is always going to be a risk of infection with blood products.

We are fighting a disease now in 2019 that should have been off the table in the 1960s with the development of the vaccine, it should be viewed as an embarrassment that so many Americans have turned away from vaccines that we are having a record year for measles.

Anthrax is a zoonotic disease with human cases often tied to animal exposure. For example, multiple cases have occurred at African drumming events when individuals were exposed to animal drum skins that contained anthrax spores, because of the risk of spillover into humans, it is crucial to monitor animal anthrax outbreaks and delimit the exposure of humans while promptly administering post-exposure antibiotics to those exposed. It is also important to emphasize Anthrax is a major biowarfare threat and being prepared for outbreaks of animal origin directly enhances abilities to respond to a potential bioattack using anthrax.

Not even the exposure we had in 2001, we're talking about the Sup... by Amesh Adalja

Not even the exposure we had in 2001, we're talking about the Super Bowl or something like that.

What's dangerous is when it's in something that's being directly injected into a person, that bacteria doesn't have to go through any kind of barrier. It's a superhighway into the bloodstream.

There are certain bacterial genes that are more worrisome than others, that are much harder to treat, these genes are lurking in American patients and they are spreading in hospitals and health care facilities.

There is a whole confluence of issues that may be resulting in mo... by Amesh Adalja

There is a whole confluence of issues that may be resulting in more cases being reported.

Antibiotics resistance isn’t just something that happened after t... by Amesh Adalja

Antibiotics resistance isn’t just something that happened after the discovery of penicillin.

There may be limits to what antibiotic stewardship can do. by Amesh Adalja

There may be limits to what antibiotic stewardship can do.

A lot of that material from the birth or the spontaneous abortion or miscarriage of the livestock can transmit it. The main way that people get it is because they inhale material from the birthing of a livestock animal, that’s why you have to take certain precautions when you are working with a cow in the birthing process to make sure that you don’t inhale the material from the birth that may contain the Q fever bacteria.

Q fever is a rare diagnosis to make, it’s not terribly common, but that’s because not many people think about it, so they aren’t testing for it with the same frequency.

Q fever is something that is well-known to be transmitted to people via livestock, especially around the issues in birth.

If antibiotic resistance continues to increase, all of the stuff that’s part of modern medicine and done routinely will become more dangerous.

Our toolbox against CRE is very small. by Amesh Adalja

Our toolbox against CRE is very small.

The risk-benefit calculation [of many medical procedures] could be altered if the rise in antibiotic resistance continues.

There are other infections -- for example, syphilis -- that spread through other ways other than sexual transmission.

I don't think we have enough information at this point to completely classify it. I think there's some suggestions, but there's more study that needs to be done, there are other infections -- for example, syphilis -- that spread through other ways other than sexual transmission.

Some of the resource-poor countries where these diseases are endemic sometimes have a clearer path to getting these tests in people's hands than in the United States, where there's so much regulation and it's so hard to do a point-of-care test, i do think there's an advantage to having these tests in endemic countries so that people can get diagnoses quickly.

It would be great if Quest and LabCorp could do it. It'd be great if there were kits that people could put in sexually transmitted infection clinics to definitively diagnose, but I don't think right now you're hampering the public health response, just because there's no other orthopoxvirus circulating.

I think that more diagnostic tests closer to patients is better. Commercial assays are even better, but the fact is, there are no other orthopoxviruses out there right now.