Herpes Virus Reactivation in Astronauts During Spaceflight | Hacker News Reader

Herpes Virus Reactivation in Astronauts During Spaceflight

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108 pointsdaegloe93 comments

Space is cool, but I didn't see any gravity related controls nor any other space specific controls.

Consider that the relationship between stress (HPA axis, etc.) and viral activation is pretty well known. Models of chronic rodent stress include constant loud noise, uncomfortable environmental scale (open spaces versus "comfortable" places with places to hide/nest), weird lighting and temperature, "violent" (freaking them out, not hurting them) handling, etc. These rodent models seem pretty similar to "put humans in a cramped little box, shake them around and mess with their sleep and eating schedules".

There's nothing novel and space specific here except for "going to space is stressful" and it doesn't take a rocket scientist to figure that out.

I would humbly suggest submarine crews as control group.

Canned air, tight space, weird sleep cycles, noise and artificial light. Submarine crews are even more isolated because they can't contact families while underway.

Or even saturation divers. https://en.wikipedia.org/wiki/Saturation_diving

I'd imagine this whole "being strapped to a ton of explosives and using them to fly" moment is a tad bit more extreme and stressful than a submarine dive.

After that, they both have similar constant stress factors, but imho the launch alone is probably way more than what anybody on a submarine would go through.

The crew quarters are literally between the missile launch tubes, which sure they aren’t exploding under you, but still.

Nuclear submarines?

I suspect that far more rockets have undergone rapid, unplanned disassembly than nuclear submarines. And when they do, the death rate is very high.

Also airline crews? They get to do their high-pressure job in lower-than-normal air pressure, they get shaken around in a tin can and their sleep schedules are shot to hell.

But they can at least leave their cabins every couple of hours for a a couple of hours or days.

I mean you are right, but in the articles I read, their hypothesis is exactly about stress.

FTAA - "Larger quantities and increased frequencies for these viruses were found during spaceflight as compared to before or after flight samples and their matched healthy controls." Further details such as graphs, p values, and references are also provided.

The article doesn't mention, among possible stressors, that spacecraft are always operated at reduced air pressure and high oxygen fraction, and low humidity.

The problem is, nobody knows which factors are actually responsible for downregulating immune system activity, because every astronaut gets all of them.

A few ought to be variable. Sleep deprivation ought to be entirely avoidable, but NASA cannot quite manage not scheduling more to do in a day than there is day.

ISS, Soyuz and soon the crewed Dragon 2 all operate at sea-level air pressure with standard o2 partial pressure. Apollo was the last high oxygen environment.

"The problem is, nobody knows which factors are actually responsible for downregulating immune system activity, because every astronaut gets all of them." They could check? Might be a good idea to know before they send Astronauts to Mars or something?

None of your examples are space dependent, and compared to SLS, slightly cheaper.

ISS is at 1 atmosphere, except in the airlock when preparating for a spacewalk.

Reminder that the stigma against herpes is a pharmaceutical marketing creation from the mid 1970s:

https://en.wikipedia.org/wiki/Herpes_simplex#Society_and_cul...

>Pedro Cuatrecasas states, "during the R&D of acyclovir, marketing [department of Burroughs Wellcome] insisted that there were 'no markets' for this compound. Most had hardly heard of genital herpes..." Thus, marketing the medical condition—separating the 'normal cold sore' from the 'stigmatized genital infection' was to become the key to marketing the drug, a process now known as 'disease mongering'.

>Much of the hysteria and stigma surrounding herpes stems from a media campaign beginning in the late 1970s and peaking in the early 1980s. Multiple articles were worded in fear-mongering and anxiety-provoking terminology, such as the now-ubiquitous "attacks", "outbreaks", "victims", and "sufferers". At one point, the term "herpetic" even entered the popular lexicon. The articles were published by Reader's Digest, U.S. News, and Time magazine, among others. A made-for-TV movie was named Intimate Agony. The peak was when Time magazine had 'Herpes: The New Scarlet Letter' on the cover in August 1982, forever stigmatizing the word in the public mind.

Note also though that Wikipedia claims that genital herpes infection rate increased dramatically during the 1970s. If true, it's not surprising that it would be relatively unknown before the increase and stigmatized after. HIV wasn't stigmatized in the 70s either.

"The stigma against" is exclusively a US bound thing. I consume a lot of media (Plus memes) from the US, and people make a real fuss about it.

In my country people give it the same importance as a simple cold.

"In my country" with no context and not even a name for your country? I'm disinclined to believe that your anecdote accurately describes any country.

I like how you've inverted the common "US represents the world" fallacy by literally asserting that your herpes-blind nation is representative of the entire world exclusive of the US.

Judging from the content on the linked wikipedia page for Herpes Simplex it strikes me as absurd that one would categorize it with the simple cold.

Although it's not curable, there are a lot of good, cheap treatments available, and many people can go long periods of time with no symptoms.

Consider the line from the Wikipedia page:

"Worldwide rates of either HSV-1 or HSV-2 are between 60% and 95% in adults."

If infection rates are that high, it's probably not that big of a deal for most people.

Most of that 60-95% is oral, though. Genital infection rates are far lower, at <20% in the US.

It's also associated with Alzheimer's disease, which is a horrible way to die. It can cause blindness and death, particularly in newborns. I don't think it wise to dismiss herpes as just something mild or inevitable.

Gingivitis is associated with Alzheimer's disease, too.

Everyone gets it. It just goes away, often for years. There's no cure. Like colds.

> There's no cure. Like colds.

Colds resolve in a few days to a week. There is absolutely a cure, just not one in pill form.

Most HSV outbreaks also resolve in a few days to a week, and either never recur at all or recur extremely infrequently.

The outbreak resolves. The infection does not. And recurrence of HSV is quite common.

Speak for yourself, I don't have any form of HSV. One advantage to being a quiet friendless nerd throughout my youth was never catching chickenpox.

Not having chickenpox (and not being vaccinated for it) isn't really an advantage. Chickenpox as an adult is serious business: complications like pneumonia and encephalitis are much more common, and there's a significantly higher risk of death or hospitalization (75% of deaths from chickenpox are in adults, despite < 10% of the cases being in adults). You're also at higher risk for shingles if you catch it as an adult than as a child. Chickenpox is extremely contagious; it's airborne, can be transmitted just from being in the same area as someone with the disease for 15 minutes, and over 90% of people exposed will come down with the illness.

If you didn't get it as a kid you really should get vaccinated for it as an adult. Being exposed to the attenuated form of HHV-3 in the vaccine is way safer than actually catching the disease.

How do you know? Have you had HSV blood tests?

In my 20s. I suppose it's remotely possible that I contracted HSV since then without ever having any symptoms, but my understanding of HSV is that with all forms the initial infection is obvious so that's quite unlikely.

We're not talking about HPV, which I (and you) very likely have wether we know it or not, without vaccination.

It's more likely than you think.

"Oral herpes infection is mostly asymptomatic, and the majority of people with HSV-1 infection are unaware they are infected." [1]

[1] From https://www.who.int/news-room/fact-sheets/detail/herpes-simp...

>I suppose it's remotely possible that I contracted HSV since then without ever having any symptoms

It actually is. Most people are asymptomatic, or their symptoms are so mild that they confuse them for a pimple.

https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm

I'll announce my scarlet letter to make a point. I was recently tested for HSV and came back positive for HSV-2. I've never been tested before so I have no idea how long I've had it, but it was a surprise because I've had zero symptoms. In fact, I figured it was a false positive so I got re-tested.

No, almost 40% of us do not get it. This is not something inevitable. I don't have any family member with the symptoms.

You realize most people don't get any symptoms, right? Many people contract it as a kid (a kiss from a relative) and their immune system suppresses it. Unless you get an HSV blood test you will not know.

Even blood tests are unreliable. IIRC, IgG tests are quite reliable but not every clinic does them. Many clinics default to an IgM test, which are useless[0]. The gold standard here is the Western Blot test

[0]: https://drjengunter.wordpress.com/2013/06/17/igm-blood-test-...

widespread cold sores in a given society i think have 2 pronged effect:

1. a something widespread does usually have naturally higher societal acceptance

2. [IANAD] kind of "de-facto" vaccination/immunization. For example i (like many many Russians) have occasional cold sores (once in a 1-4 years, in CA seems to be less frequently than back in Russia) since childhood. I've had it on both sides of my lips which probably means that i have both - HSV1 and HSV2. That also means that i never going to get it anywhere else on my body (once any one site in the body gets infected with herpes the rest of the body develops immunity)

From descriptions genital herpes seems to be worse than lip cold sores. In US (at least in CA) i see no people with cold sores, so the majority of the population is most probably susceptible to the infection. Given that sexual contact is a frequent transmission method in adulthood (while not a factor in childhood), i'm not surprised that for US population "herpes" statistically means and happens as "genital herpes" (while i haven't heard about such a thing back in Russia where we get it early in the childhood as cold sores on lips).

>I've had it on both sides of my lips which probably means that i have both - HSV1 and HSV2. That also means that i never going to get it anywhere else on my body (once any one site in the body gets infected with herpes the rest of the body develops immunity

This is all contrary to my understanding.

You can definitely spread either strain to other areas of your body. You can spread it around your mouth more and transfer it from your mouth to your genitals.

Thinking you can't get it more will not lead to pleasant outcomes.

To clarify: you don't spread herpes around your mouth or genitals, because that's not where herpes takes up latency.

HSV takes up latency in usually either the dorsal root ganglion (which typically presents with lesions in the genital region), or in the trigeminal ganglion which typically presents with oral lesions.

You are right that infection with one strain does not necessarily grant immunity to infection with another strain.

It is also not true that oral lesions necessarily indicate HSV1 infection, and that genital lesions necessarily indicate HSV2 infection.

Source: https://www.ncbi.nlm.nih.gov/books/NBK47447/

>That also means that i never going to get it anywhere else on my body (once any one site in the body gets infected with herpes the rest of the body develops immunity)

Do you have a source for that? I have somewhat suspected that was the case based on some other things I've heard, but I have been unable to find any real sources on it.

not really - it was some years ago that i just sat down and googled around exploring the issue. Similar conclusions:

https://www.washingtonpost.com/news/speaking-of-science/wp/2...

"But as people gained awareness of the contagious nature of cold sores, they became more cautious about exposing young children to a skin outbreak. That means more and more of us get to adulthood without any HSV immunity.

On the one hand, that makes the younger generation more susceptible to HSV-2 -- one won't 100 percent protect you from contracting the other, but they have some antibodies in common. On the other hand, it means that more and more people get their first exposure to HSV-1 not through kissing, but through oral sex."

"I've had it on both sides of my lips which probably means that i have both - HSV1 and HSV2"

This is definitely not true. HSV2 showing up on lips is extremely uncommon. I've had HSV1 for my entire life and any area of my mouth is fair game, as so is the inside of my nose.

I find this fascinating. Never heard the claim before that lip herpes grants immunity to genital outbreaks.

Also, whats source of such common early childhood herpes in Russia? Kissing from infected relatives? Given lethality of neonatal herpes it seems unlikely to be interuterine transmission.

I've heard that claim, and I have subsequently heard it disproven.

The peak was when Time magazine had 'Herpes: The New Scarlet Letter' on the cover in August 1982

It's was actually "Today's scarlet letter: Herpes."

https://goo.gl/images/hVd6um

Sad when people can't do a simple Google search to verify most easily verifiable claims.

Did you update the wikipedia article with the correct citation? Its easy to complain on HN, takes a little more effort to correct misinformation for future internet users.

I've never been able to successfully alter a Wikipedia article, even for something as simple as a typo correction.

Bots always revert my changes within seconds.

Did you update the wikipedia article with the correct citation?

Nope. And for reasons I've outlined elsewhere on HN.

https://news.ycombinator.com/item?id=19400846

I updated it.

Why so confrontational? It's a simple mistake, and relatively harmless since the meaning is not at all changed.

Agreed, but the article itself from that issue is titled "The New Scarlet Letter"[1]. The statement from Wikipedia seems to conflate the cover line with the article itself.

[1] http://content.time.com/time/subscriber/article/0,33009,1715...

I am surprised to see this data, because my impression was that you essentially had to be a physically and mentally flawless human being to go into space.

Over 60% of humanity has HSV-1 [1], aka "cold sores" virus. When people "get tested", they generally don't even check for it unless you request it, because it would create unjustified concern.

[1] See https://www.who.int/news-room/detail/28-10-2015-globally-an-...

Don't forget that the Herpes family also includes Herpes/Varicella Zoster, aka Chickenpox; and it also can be awakened by stress.

So almost 40% of humanity does not have HSV-1.

Astronaut selection is already severe. You don't get selected if you have tuberculosis, diabetes, amputations, or deafness. Once selected, you won't go on the launch if you are sick with the flu.

It doesn't seem like HSV-1 needs to be a problem in space. Simply add that to the gigantic list of conditions that prevent space travel.

I highly doubt that HSV-1 is anywhere near 60% in the pool of astronaut candidates. Disease presence is correlated: if you have one, you probably have another. Since lots of other diseases would already be disqualifying, adding HSV-1 to the checklist won't strike off very many potential astronauts.

It's related to age, as you would expect from any contagious virus that's ubiquitous in the environment and doesn't go away. 0.01% of newborns have HSV-1 [1]; 90% of 50-year-olds have it [2]. The 40% of humanity without HSV-1 are largely under 30. Your typical astronaut is much more likely to be towards the 40-50 year old end of the scale.

[1] https://www.merckmanuals.com/professional/pediatrics/infecti...

[2] https://www.hopkinsmedicine.org/healthlibrary/conditions/adu...

It says "90 percent of adults have been exposed to the virus by age 50", but I didn't think that exposure necessarily meant infection.

> I highly doubt that HSV-1 is anywhere near 60% in the pool of astronaut candidates. Disease presence is correlated: if you have one, you probably have another. Since lots of other diseases would already be disqualifying, adding HSV-1 to the checklist won't strike off very many potential astronauts.

Dude, I've had cold sores since I was a child. There's no relationship between HSV-1 and other diseases.

>Dude, I've had cold sores since I was a child. There's no relationship between HSV-1 and other diseases.

Repeated (chronic) bacterial or viral wounding doesn't result in increased cancer risks? I find that hard to believe.

>I highly doubt that HSV-1 is anywhere near 60% in the pool of astronaut candidates. Disease presence is correlated: if you have one, you probably have another. Since lots of other diseases would already be disqualifying, adding HSV-1 to the checklist won't strike off very many potential astronauts.

I took exception to the claim that having cold sores meant you were otherwise "diseased". Can it have long term effects? Yes, but I don't believe an increased long term cancer risk means you're not able to become an astronaut.

so are you saying that you have data to show correlation between HSV 1 and other diseases? Please share.

Herpes and Alzheimer's https://www.theatlantic.com/science/archive/2018/07/herpes-v...

more on HN: https://hn.algolia.com/?query=herpes%20alzheimer&sort=byPopu...

HHV–6 is pointed out as causing the same issue - according to wikipedia HHV-6B is in pretty much every person.

The estimates I've seen were more 1/3 to 1/2 of people being infected but it is very common because most people engage in unprotected kissing with a number of partners. I have, in fact, never heard of anyone using a barrier while kissing so I don't think you can expect that someone with HSV-1 to also have other diseases.

My sex ed class taught me to use a dental dam for protection while kissing. I guess some people got abstinence-only classes, but most of us were taught how to stay safe.

I've also known multiple people in the USA who actually succeeded with abstinence. They did not kiss or spend time alone with the opposite sex until their wedding day.

IMHO the abstinence looks easier, but the use of protection is being taught.

Sounds like one of those "the cure is worse than the disease" situations.

Almost like they wanted the next most useless thing to abstinence, complicated process.

40% of humanity is under 20 years old. They will get it by the time they grow up to be an astronaut.

Okay, so otherwise qualified and highly skilled people should not be allowed into space due to a potentially minor skin condition. Makes sense. What if they break out with severe acne on the way to the launch pad?

How severe? If the acne is really severe, yes indeed they don't go to space.

Space travel is like that. At something like $20,000,000 per person, going to a difficult work environment, being picky is important.

"amputations"

Leg amputations sound to me like they could be a potential advantage in space.

Is it a circulation thing, or swimming out of a flooding capsule thing?

They don't mention simplex B, which makes me wonder if it cancels you out.

At first I thought this was going to be about breakouts of shingles on the ISS, the thought of which nearly put me off spaceflight entirely. What a relief!

Interesting to me personally because I'd never heard before that HSV-1 reactivation was stress-linked.

It's well known that stress weakens the immune system[1]. So it's not a surprise that stress might encourage dormant infections (such as HSV-1) to enjoy a resurgence.

[1] https://www.apa.org/research/action/immune

I get canker sores [0] only during periods of extremely high stress or sleep deprivation.

[0]https://en.wikipedia.org/wiki/Aphthous_stomatitis

Speaking anecdotally, sleep deprivation is the biggest immune system damper for me. Often it’s hard for me to judge the effects of stress per se, because sleep deprivation also leads to stress and vice versa.

If you ever had chicken pox, high stress can re-activate the dormant virus, and it reactivates as "shingles". There is a vaccine that came out a few years ago to suppress it from happening.

I think the vaccine is only covered by insurance (USA) for people over 50 in most cases. If you are lucky enough to have coverage, get the vaccine. Shingles as an otherwise healthy 42 year old was no picnic, I can't imagine how bad it must be for someone older or more immuno-compromised.

AFAICT both the options for shingles vaccination are just variants on the chickenpox vaccine - one being more directly just a high dose of it.

This doesn't undermine anything you say, I'm just bemused at the lag time between the chickenpox vaccine (1984) and Zostavax (2006).

Had chicken pox in my 30s. Not good. The shingles vaccine isn’t expensive, thank heaven. It’s a quarter century later and my mom got shingles at about this age…

NASA could send a control group of astronauts to space with NO duties and see if it has any effect on health (relative to those with “jobs”). Space travel is surely stressful, but perhaps the additional pressure of having tight schedules and deliverables is an additional stress?

Absence of duties, schedules and deliverables can be quite a stress factor as well. I would not be surprised if that control group would end up suffering even more from being locked up in a free-falling can.

That seems like it would be an extremely expensive experiment.

Make it a rich person, call it space tourism and you could make it profitable.

That makes me think of Richard Garriott [0].

[0] https://en.wikipedia.org/wiki/Richard_Garriott#Spaceflight

I get cold sores when I fly commercial airlines.

"Filthy stinking astronauts" -- upright citizens brigade https://www.youtube.com/watch?v=zK-30442RII

I was thinking "space herpes," but couldn't remember what movie it was from.

Ice Pirates.

https://www.youtube.com/watch?v=-me2inj1nNw

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