Getting closer to an RSV vaccine
RSV is the No. 1 cause of pneumonia deaths in children worldwide and one of the top causes of infant hospitalization in the U.S. Most are infected in the first year of life.
Crafting a vaccine against RSV (respiratory syncytial virus) has been a minefield for 50 years, but researchers here and at Children's Healthcare believe they have found a possible solution.
As they reported in the Dec. 21 issue of Nature Communications, they have engineered a version of RSV that is highly attenuated—weakened in its ability to cause disease—yet potent in its ability to induce protective antibodies. When used as a vaccine, it can protect mice and cotton rats from RSV infection.
"Our research shows that it's possible to attenuate RSV without losing any immunogenicity," says senior author Martin Moore (pediatric infectious diseases). "This is a promising live-attenuated vaccine candidate."
The next steps, he says, are to produce a clinical grade lot of the vaccine and conduct a phase 1 study of safety and immunogenicity in infants.
Past efforts to develop a vaccine have met with frustration. In the 1960s, an attempt to develop a vaccine by chemically inactivating RSV, as in a standard flu shot, backfired. Exposure to this vaccine actually made natural RSV infection in infants worse. More recently, a clinical trial of a protein-only RSV vaccine in older adults showed disappointing results.
Several successful vaccines against other viruses, like measles, polio, and mumps, have been created by weakening the viruses in cell culture. Weakening RSV in this way hasn't worked out satisfactorily, says Moore. "It turns out that for RSV, the natural virus does not induce a lot of immunity itself."
Instead, Moore and his colleagues engineered RSV to enhance production of a key protein, called F (for fusion). F is critical for RSV's ability to enter cells and is the target of several vaccines in development. By making mutations in the viral gene that encodes F, the researchers also made the virus more stable with respect to heat, which could help vaccine manufacturing and distribution. At the same time, the researchers removed or weakened several other viral genes that promote infection and suppress the immune system. One measure of this is that the modified virus, called OE4, stimulates high levels of antibody production.
Emory has optioned the vaccine technology to a startup company, Meissa Vaccines, Inc, which was co-founded by Moore, who serves as chief scientific officer.
Read more about how the team made the re-engineered virus less likely to mutate back to its original form and how they determined through viral structural visualization that OE4 is both highly immunogenic and highly attenuated.—Quinn Eastman
Advocating for nurses and patients
|Suzanne Staebler (left) and new DNP graduate Susan Swanson with Rep. Rick Williams from Milledgeville.
On January 12, 75 nurses from Emory and other health systems gathered "under the gold dome" for a legislative kickoff day sponsored by the Georgia Nurses Association (GNA). Their mission: to deliver care packages and a personal message about 2017 legislative priorities to every Georgia lawmaker. Each nurse was assigned two to four legislators, whom they tracked down and spoke with in the hallways outside the House and Senate chambers.
"It's easier to connect with legislators at the beginning of the session," the nursing school's Suzanne Staebler told the group of nurses who shadowed her that day. "The further into the session, the harder it is to connect with them. Legislators are less willing to step out of the chamber to meet you, especially if there's a vote coming."
Staebler is at home in the advocacy arena, having led national nursing organizations and held major fellowships in health policy. In addition to directing Emory's Neonatal Nurse Practitioner Program, she directs advanced practice for GNA. Whatever the setting, she can take the bull by the horns.
"I'm from Texas, and I can rope a calf," she told Representative Vernon Jones upon running into him at the state capitol. She then segued to tell him about this year's legislative priorities, including the licensure compact, which would speed up the licensing process for nurses from other compact states and allow them to enter Georgia's nursing workforce more quickly.
Jones was familiar with the idea. "You're talking about reciprocity," he said. Similar to a driver's license, compact licensure allows nurses to receive reciprocity in accordance with state standards of practice. Currently, 25 states offer compact licensure, including North Carolina, South Carolina, and Tennessee, which all border Georgia. In times of disaster, compact licensure would allow nurses from those states to assist quickly.
"Compact licensure is key to getting resources here to take care of our citizens," Staebler emphasized. "It also helps rural counties by giving them more flexibility to recruit nurses."
|Mary Gullatte, Julie Swann
By mid-afternoon, the nurses at the capitol had accomplished their mission, including Emory Healthcare's Mary Gullatte, corporate director of nursing innovation and research. Gullatte has walked the capitol hallways many times, initially in support of prescriptive authority, which became Georgia law in 2006.
"The best way to make policy change is from the inside out," says Gullatte, a longtime state and national nursing organization leader. "Legislators need and want to hear about issues that are important to us to help them decide how to vote on health care legislation, whether it has to do with patients or our profession."
Three years ago, Gullatte proposed formation of the Emory Nurse Legislative Council (ENLC) to coalesce EHC nurses and nursing faculty and students around health advocacy. The group meets quarterly and last fall hosted a health care advocacy forum featuring Senator Renee Unterman and Representative Sharon Cooper, two of three nurses who serve as Georgia legislators.
When Gullatte proposed the ENLC, she did so with one caveat. "I didn't want to be the one to lead it," she says. "I wanted to mentor other nurses interested in changing health policy."
EHC nurses Julie Swann and Barbara Hill stepped up to co-chair the council. Swann attended her first state legislative session in 2015. "It's a great way to get your foot in the door and talk with legislators about what's important to nursing," says Swann, VP of patient services and CNO for Emory Saint Joseph's Hospital.
Last year, Governor Deal signed a law raising the penalty for assaulting emergency services and hospital emergency room personnel. Hill, an ER nurse, was key in revitalizing the bill that Deal signed. It's one of the laws that other EHC nurses have supported and discussed in the workplace.
"Assaulting nurses and others in the ER is now a felony," says Swann. "We have to consider what we do at the bedside to make sure we're upholding the law to its full capacity. Does it apply to all patients? What if it's a patient who lashes out because they are ill or hurt and don't know any better? And what if it's a patient who intentionally tries to harm you? We have to put a context around it to educate nurses about it."
Staebler is equally intent on teaching nursing students how to be strong advocates at the start of their careers. In her policy, ethics, and law course, she invites legislative staffers and lobbyists to critique her students' presentations. Students often accompany her to the state capitol to talk with legislators.
Those visits "help nurses and nursing students develop tools for their tool kit later on," Staebler says. "So many things can impact their practice. We have to know how to advocate for our profession and our patients. We have to be our own voice."—Pam Auchmutey
New EUH bridge opens next month, old bridge demo begins
The sleek new bridge concourse connecting the original Emory University Hospital building with buildings on the other side of Clifton Road is slated to open Monday, February 20, marking a major milestone toward opening of the new hospital tower later this year.
Because the new tower itself will not be open yet next month, only the lower level of the bridge will be accessible.
The bridge's lower and upper levels connect to the second and third floors, respectively, of each hospital building. The bridge's lower level connects to an area of the new tower allowing access to clinics A and B and Winship. The bridge's upper level is expected to be operational in April.
When the new bridge opens next month, foot traffic will transition immediately from the old to the new bridge. The old bridge will close for demolition, with tear-down tentatively scheduled to begin the last weekend in February, starting Friday evening, February 24, after rush hour (date and time dependent on weather). Access to Clifton Road and to the new bridge will be restricted over this weekend, with restrictions expected to be lifted on Sunday evening, February 26. Watch for more details in an all-Emory email, including a traffic advisory, that will be sent closer to February 24.
The bridge's lower level will be for public and staff use, and the upper level will be used for patient transportation.
New ICU at EUH Midtown
Last month, Emory University Hospital Midtown opened a new 18-bed, state-of-the-art intensive care unit, complete with e-ICU technology, a team "theater" for patient observation, and spacious rooms.
"The large rooms allow for families to stay with loved ones, while giving providers plenty of space to care for the patient in designated 'clinical zones,'" says Susan Kill, specialty director of critical care services.
Twelve of the 18 beds in the unit are open, with the remaining six beds to open later this year. Six of the beds are negative-pressure rooms, which prevent contaminated air from leaving the room. Three of the rooms have special lifts for bariatric patients.
The unit's observation theater has eight TV screens affixed to the wall, allowing interdisciplinary teams to round and discuss patient care while monitoring different patients in their rooms.
The unit also includes a family welcome center, a family conference room, a staff conference room for education, and a staff retreat area, complete with aroma therapy, couches for relaxing, and a massage chair for stress relief.
"We also included extra amenities for our staff to give them a place to relax during their breaks," says Cheryle Collins, unit director. "Caring for extremely sick patients in an ICU can be very stressful, so making sure staff have downtime in a positive environment is important."
The new unit brings new job opportunities for the nursing profession. Additional critical care nurses and other nursing staff are being hired to work in the new ICU and throughout other parts of the hospital. Read more.