Precision public health to inhibit the contagion of disease and move toward a future in which microbes spread health

Abstract

Antimicrobial resistance continues to outpace the development of new chemotherapeutics. Novel pathogens continue to evolve and emerge. Public health innovation has the potential to open a new front in the war of “our wits against their genes” (Joshua Lederberg). Dense sampling coupled to next generation sequencing can increase the spatial and temporal resolution of microbial characterization while sensor technologies precisely map physical parameters relevant to microbial survival and spread. Microbial, physical, and epidemiological big data could be combined to improve prospective risk identification. However, applied in the wrong way, these approaches may not realize their maximum potential benefits and could even do harm. Minimizing microbial-human interactions would be a mistake. There is evidence that microbes previously thought of at best “benign” may actually enhance human health. Benign and health-promoting microbiomes may, or may not, spread via mechanisms similar to pathogens. Infectious vaccines are approaching readiness to make enhanced contributions to herd immunity. The rigorously defined nature of infectious vaccines contrasts with indigenous “benign or health-promoting microbiomes” but they may converge. A “microbial Neolithic revolution” is a possible future in which human microbial-associations are understood and managed analogously to the macro-agriculture of plants and animals. Tradeoffs need to be framed in order to understand health-promoting potentials of benign, and/or health-promoting microbiomes and infectious vaccines while also discouraging pathogens. Super-spreaders are currently defined as individuals who play an outsized role in the contagion of infectious disease. A key unanswered question is whether the super-spreader concept may apply similarly to health-promoting microbes. The complex interactions of individual rights, community health, pathogen contagion, the spread of benign, and of health-promoting microbiomes including infectious vaccines require study. Advancing the detailed understanding of heterogeneity in microbial spread is very likely to yield important insights relevant to public health.

Archiving time series sewage samples as biological records of built environments

“…The consideration of houses and cities as bodies was an important part of new and influential conceptualizations in public health that began in late nineteenth-century England and continue to influence architecture and urban design [ 28 , 29 ]. Cross-fertilization between innovations of precision medicine as applied to individual patient care and “precision public health” are especially relevant in the context of infectious disease (and in a hopeful future, of infectious health [ 30 , 31 ]). Biological archiving of samples has promise in both contexts of individuals and of environments, be they built, natural, or any combination.…”

Ethical challenges in pathogen sequencing: a systematic scoping review

“…Consequences may include stigmatization, penalties, economic risks, problems with interpersonal relationships (e.g. inadvertent disclosure of infidelity), emotional distress and the capacity for discrimination 19 , 21 , 22 , 24 , 25 , 27 , 30 , 32 , 37 – 39 . There was also concern that sequencing could lead to serious legal consequences, particularly with regards to the criminalization of HIV transmission 14 , 15 , 17 , 22 , 24 , 28 , 34 , 35 .…”

“…Overall, there was broad support for further work in defining the conditions for collection use and storage of data and samples 2 , 27 , 30 , 32 , 37 and for policy and legal clarity to aid the ethical implementation of these technologies. This will require more work to carefully assess and understand risks 39 ; research to decide how much individual privacy might be risk in the name of public health 31 ; consideration of alternative strategies required to mitigate this risk, such as suppression of data in the public domain where it may cause serious harm; and adjustments to communication plans 14 .…”

“…In some cases, this was balanced by a number of practical challenges to telling people the truth, such as: risk of fear mongering 19 ; information needed for legal proceedings in public interest 14 ; and the fact that it may be difficult to adequately inform the public and/or ensure full understanding 20 . None-the-less, there was a clear recommendation in the literature to raise public awareness and understanding of these techniques 19 , 22 , 30 , and for early and meaningful community engagement 15 , 22 , 32 , 34 prior to conducting sequencing studies. This was seen as particularly important when working with vulnerable groups or when the risks of participation are high.…”

Editorial: the airborne microbiome - implications for aerosol transmission and infection control – special issue

“…The contributions are a mixture of primary research, reviews and commentaries, including: new methods to explore environmental niches where such microbes may grow [1], their detection and characterisation in the human host [2–4], which pathogens are present in the respiratory tract and can be exhaled in human breath to potentially spread via the airborne route [5, 6], and some strategies for their control [7]. Finally, a historical-to-current overview explores human-microbial interactions, including problems with sampling and detection methods, drug resistance, the role of super-spreaders and issues around research funding [8].…”