key: cord-0753948-9umoz2eo
authors: Mortimer, Philip P.
title: What should virologists be teaching their students?
date: 2020-02-16
journal: Rev Med Virol
DOI: 10.1002/rmv.2098
sha: bc7877714d2c82ca0865fb62e03e154946908a92
doc_id: 753948
cord_uid: 9umoz2eo

nan

tions has been made sharper than ever. Suppression and cure of virus infections is beginning to be realised, spread of important viral pathogens is being interrupted, and the eradication of a few of them has largely been realised if not universally so.

In all these instances goals can only be achieved if Society's leaders are persuaded that the benefits are desirable, cost-effective and, as appropriate, urgent. The academic virologist must therefore regard clinical and public health advocacy as at least as important as dwelling upon his/her particular loci of research, and they must offer their students a broad grasp of the ecology of virus infections. For almost all of their students this will be more important than the minutiae of virus genomics. The students of today are the clinical decisiontakers of tomorrow, and they need to understand the interface between virus pathogens and humans.

It is salutary to reflect on some poor virological decision-making of the last two decades, its underlying intentions, and its unintended consequences. Each could be said to represent an experiential failure in the teaching of virology as it applies to clinical medicine and public health. An egregious example was the acceptance for publication in 1998 of a paper about the supposed consequences for 12 children in the aftermath of their MMR vaccination. That single article has done untold damage to world immunisation schedules which shows little sign of abating. When this outcome was analysed in-depth in 2010 1 a basic question had not, even by then, been answered satisfactorily, that is, 'How was an ambitious clinical researcher's urge to publish allowed to override proper caution when the claims made were so implausible?' Attenuated vaccine strains, from Jenner's vaccinia and Theiler's 17D yellow fever vaccine through to MMR should not have been expected to cause complications never seen in the equivalent wild infections unless there was much firmer evidence.

Another recent failure has been in the use of the oral neuraminidase inhibitor oseltamivir (tamiflu). UK Departments of Health proposed that tamiflu should be prescribed to influenza-vulnerable groups as a prophylactic on a continuing basis. This was an expensive error due to the failure to give a strong and specific indication for its use. An antiviral for influenza is only likely to be effective if part of very timely treatment, or prophylactically as soon as an exposure is recognised.

Health authorities worldwide are struggling to persuade at-risk groups and health workers to accept yearly influenza vaccination; however, the vaccine on offer is one scarcely different from that which first came into use 70 years ago and is not always effective.

The case both for using NGS to make a faster choice of a new vaccine strain, and for novel approaches to vaccine production, is undeniable.

Influenza A remains the most likely pandemic threat of all. More resources need to be dedicated to making a better vaccine and more timely vaccination, and more persuasive tactics need to be found in support of vaccine acceptance.

Some basic virological truths remain ill-understood by the medical profession. One is the speed and scale with which viruses propagate themselves, and the implications for onward transmission of viral pathogens, whether "horizontally" or from mother to child. For example, hepatitis B carriers can have a blood virus burden of ten orders of magnitude per millilitre, that is, a hundred million virions. Even for those viruses that the immune response quickly suppresses viraemia may transiently be superabundant, and it is then that most transmissions will occur. It would also be helpful to more narrowly define the incubation periods of virus infections avoiding making them impractically wide, as well as identifying when infectiousness is likely to be greatest. Antiviral combinations are now being found that will suppress viraemia, often to the point at which transmission is negated. These have, for instance, opened up opportunities to interrupt the spread of HIV. 2 In England and Wales, reported incidence of HIV has almost quartered since 2012, 3 tion then came into prominence. 8, 9 None of this catalogue of virological problems needs rocket science to explain them or respond to them; but in the few weeks that virologists are allotted to educate medical and other students the emphasis must be on virus ecology. The means of virus exposure, susceptibility, and transmissibility; of virus treatment and prophylaxis; and of scope for control of virus spread and even elimination: these are the knowledge base needed by future decision-takers, whether to be used at the bedside or in the contexts of national and international public health. Educating the students who are not going to be virologists is the academic virologist's greatest challenge. 

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