An Ancient Virus is Making a Comeback

 The U.S. Agency for International Development (USAID) was recently dismantled by the Trump administration. Supporters say its $30 billion budget was rife with fraud and waste. But nearly a billion of those dollars went to fund emergency-response teams in 30 countries who spotted outbreaks of dangerous bacteria and viruses.

Why should the U.S. invest so much to stop disease in foreign countries? Obvious moral reasons aside, outbreaks overseas often become our problem. You can debate if the coronavirus started in a wet market or a lab, but one way or another, it started in China. When something rare like polio does appear in the U.S., it's usually linked to international travel. And if an ancient bacteria is reborn, a USAID scientist would spot it in the local population and snuff it out before it has a chance to land in the United States.

How likely is it that an ancient deadly bacteria emerges in the world? Turns out, pretty likely. It's happening right now. The deadly bacteria Salmonella Typhi is making news again.

It's lived with us for centuries -- actually, it's lived in us. It's the rare kind of Salmonella that only uses humans as hosts. Scientists trace its existence as far back as Ancient Greece. In 2006, they found the bacteria in the DNA of people buried 2,500 years ago in mass graves in Athens. These people died from illness caused by Salmonella Typhi. 

The U.S. Agency for International Development (USAID) was recently dismantled by the Trump administration. Supporters say its $30 billion budget was rife with fraud and waste. But nearly a billion of those dollars went to fund emergency-response teams in 30 countries who spotted outbreaks of dangerous bacteria and viruses.

Why should the U.S. invest so much to stop disease in foreign countries? Obvious moral reasons aside, outbreaks overseas often become our problem. You can debate if the coronavirus started in a wet market or a lab, but one way or another, it started in China. When something rare like polio does appear in the U.S., it's usually linked to international travel. And if an ancient bacteria is reborn, a USAID scientist would spot it in the local population and snuff it out before it has a chance to land in the United States.

How likely is it that an ancient deadly bacteria emerges in the world? Turns out, pretty likely. It's happening right now. The deadly bacteria Salmonella Typhi is making news again. 

It's lived with us for centuries -- actually, it's lived in us. It's the rare kind of Salmonella that only uses humans as hosts. Scientists trace its existence as far back as Ancient Greece. In 2006, they found the bacteria in the DNA of people buried 2,500 years ago in mass graves in Athens. These people died from illness caused by Salmonella Typhi. 

Of course, citizens in ancient Athens knew nothing about bacteria. They only knew the symptoms. The infected developed fevers without warning, followed by vomiting, extreme thirst, and skin ulcers. Many died in a week, others suffered longer. If you survived, you likely ended up with permanent damage -- loss of fingers, toes, or even eyesight. But there weren't many survivors. Bodies piled up in homes and streets. The bacteria killed an astounding one-third of the city's population.

Thucydides, a historian who survived the plague, wrote, "people died like sheep. No fear of gods or law stopped them."

In 450 BCE, they called it the Plague of Athens. Today it's known by a different name: typhoid fever.

You may have heard of Typhoid Mary. She was the cook in the 1900's who carried the salmonella typhi bacteria, but never saw it develop into a fever. In fact, Mary appeared perfectly healthy. It's just, everyone around her kept dying. Every family she worked for got typhoid fever and many had their lives ended because they hired this supposedly healthy cook.

Authorities finally figured it out: Mary was the source of these outbreaks. Unfortunately for her, at the time there was no cure. If you got typhoid fever, you would likely die from it. Antibiotics had yet to be discovered. The only solution was to quarantine Mary for the rest of her life. To this day, the term "Typhoid Mary" is used to describe someone who unknowingly spreads harm.

That all changed in the 1940s when antibiotics arrived. And particularly in the 1960s with modern cures like ampicillin and ciprofloxacin. As the bacteria evolved and new strains emerged, new drugs were developed to fight it. As recently as the 1990s new multi-drug resistant strains were evolving, and at every turn, science worked to get one step ahead of the fever.

The bacteria itself has never gone away. It still lives in us, and sometimes turns into a deadly fever. We find 350-500 cases a year, mostly in South Asia. And when we find them, we're able to contain them. But it's an ongoing battle -- this ancient bacteria survived so long because it mutates, and evolves. New strains emerge stronger, more resistant to known cures.

In 2022, Scientists found 18 typhoid bacteria samples in Western India that had a disturbing genetic twist. When researchers looked at the bacteria's DNA, they discovered all the samples belonged to a common strain known as H58, but they carried a new combination of plasmids (small pieces of DNA that bacteria use to share resistance). One of these plasmids had genes that protect the bacteria from antibiotics, specifically ceftriaxone -- the key antibiotic relied on to cure Typhoid Fever. Suddenly there was a strain resistant to the known cure, and it was spreading.

There is a backup cure called azithromycin. But scientists noticed a disturbing trend: between 2021 and 2023, there was a steady increase in the amount of the drug needed to stop the bacteria from growing. This is a warning sign. The bacteria is adapting again.

Azithromycin is one of the few backup drugs left for treating typhoid fever when others stop working.

Seems wise for the White House to keep a few scientists out there in the world to watch for these outbreaks, grab the most current DNA samples, and develop new ways to fight the bacteria as fast as possible. 

Before the next Typhoid Mary lands at an airport near you.