Chief of Viral Diseases in New York
Dr Kirsten St. George
Bachelor of Applied Science in Medical Technology
Masters of Applied Science (Medical Laboratory Science)
Doctor of Philosophy (Infectious Diseases and Microbiology)
Chief, Viral Diseases, Wadsworth Center, New York State Department of Health
As the Chief of Viral Diseases for the biggest state public health lab in the United States, Dr Kirsten St. George is responsible for detecting, researching and informing the relevant authorities on viral diseases, including Zika and influenza.
Dr St. George has made a prominent and positive impact in science during her career spanning more than 35 years and has worked in laboratories in multiple countries. From basic research, to clinical laboratory medicine, to reducing the fatality rate of high-risk transplant patients, to now leading a public health virology laboratory and regulatory authority on 300 clinical labs.
Her career achievements were recently recognised at the Clinical Virology Symposium in Georgia, US, where Dr St. George was presented with the 2017 Diagnostic Virology Award – an international honour which acknowledges an individual whose contributions to viral diagnosis have had a major impact on the discipline.
The Wadsworth Center’s Virology Laboratory conducts surveillance, outbreak investigations and reference testing, develops new testing methods, performs viral evolution and genomic research and trains post-graduate students and fellows. The Laboratory also holds several national reference center contracts, for example providing weekly influenza surveillance data, including full viral genomic sequence, to the Centers for Disease Control and Prevention (CDC) in Atlanta, on samples from 22 of the US states. The laboratory holds similar federal contracts for measles, mumps, gastroenteric and other viruses.
Additionally, they play a key role in response efforts when there are major new pathogen events, such as Zika. The lab developed Zika tests in 2015, tested more than 11,000 suspected Zika cases in 2016, and has published several papers on the virus.
“When Zika emerged in Central and South America, it initially was a matter of responding to an outbreak situation. But it’s gone on so long that it’s no longer an outbreak response – this is the new normal, this is dealing with a new huge disease situation as we have dealt with dengue fever,” says Dr St George.
“However, the disease incidence is decreasing. Whether there is going to be another wave - we are yet to see. Or if we [the United States] get more local transmission – they’re the things we are now watching closely.
“The Wadsworth Lab has always been pretty famous for developing lab methods and detection techniques, and with the assistance of funding we have been able to develop a large panel of viral detection methods.
“In my field, the speed of diagnosis has been one of the biggest changes as well as the volume of data that we are able to quickly collect.
“Previously, it would take months to see genetic changes in viruses – we would have to grow the virus and then biologically test them. Now, with rapid advances in technology, we perform ‘next generation sequencing’ which means we collect genomic sequence data and we can get the virus information in days, a week at most, and sent to the CDC the following day.
“When my Assistant Director for Research was starting to use next generation sequencing, I said to him that the speed of the technology is now so powerful that he generates more virus sequence data in a week than I generated during my entire PhD.”
Among the changes she has seen in Virology, Dr St. George commented on two that she expects to continue:
- “With the new sequencing technology and the associated data, there are some important decisions that we need to make. Having the ability to generate huge databases of sequence data, there is a temptation to keep doing it and yet it is vastly exceeding the capability to analyse it properly. So to just keep generating more and more data starts to become pointless. We have to sit back and think about what we are going to do with it, and not just dump more data into the database – especially if it’s not curated, it’s not annotated, it’s not edited properly – and there is a lot of that going on. This is a powerful area that has the potential to be very useful.
- “On the other end of the scale we have increased miniaturisation of diagnostic tools. With these powerful field deployable devices, we are moving away from big labs and big core facilities. People can go out into the field and to the bedside with equipment that can do highly sophisticated things and spit out a lot of test results very rapidly. The middle has gone - it’s instantaneous. There are new sequencing devices that are as small as a mouse trap, and you can carry one in your pocket and record the data on a computer immediately. These are incredible.”
Dr St. George’s career started at UniSA where she graduated with a Master’s Degree in Applied Science and worked in basic science and research in Adelaide before moving to Tasmania to work in diagnostic medicine.
“That was a fabulous experience, I had a wonderful director, Dr Richard Tucker, who I still correspond with from time to time. He was a wonderful clinical mentor and I learnt a lot from him.”
After five years, she was awarded a Fellowship by the Abbott Company to work at the University of Pittsburgh Medical Center, the biggest transplant centre in the world at the time.
“They were performing more than 800 transplants a year.
“Transplant recipients experience major problems with viral infections, and as a virologist it was the perfect place to explore virology studies.
“With paediatric haematology transplant cases, and infections such as cytomegalovirus, we had fatality rates as high as 30% in the high-risk groups. With new treatment regimens and trials, the fatality rates were down to 5%. Some of those trials took years, but when you get Drops of 25% in fatality rates – that’s incredibly rewarding.”
While Dr St. George was assisting the Director of the Virology Department in overseeing all of the applied research programs – in collaboration with the infectious disease physicians, the transplant surgeons, and industry scientists - she completed her PhD on the side. The Director, Dr Charles Rinaldo, is, she says, “a brilliant immunologist and virologist, as well as a great research mentor.”
However, “By the time I had finished my PhD, I was at the extreme end of tired. I needed a good rest. I was well into my 40s, I thought, I could just give up science and grow flowers instead.
“I was very fortunate to be able to take two months off and come back to Australia to think about my options. I decided to leave academic medicine and go into public health. The opportunity of Director of Virology at Wadsworth was a big attraction. I went there in 2004 and in 2008 I was promoted to Lab Chief.”
Yet despite her indisputably impressive career, Dr St. George remains humble and continually credits her successes to the teams she works closely with.
“Nobody works as an individual. My achievements are the collective work of many collaborators and teams over the years.
“It has been very rewarding building a really solid team at the Wadsworth Centre, and mentoring young scientists and seeing them grow and develop and achieving in their own right. I take pride in their work, it is tremendously rewarding.”
Her best piece of advice for mentoring and leading such a large and dynamic team is to provide them with opportunities and trust her staff.
“Provide them with opportunities to let them grow and develop and trust them. Let them do it. Once you give them a project, don’t micromanage it. Be there to support them and come to you but don’t get in their way. Let them go with it and trust them to take care of it.”
After a fulfilling career, Dr St. George plans on retiring back in Adelaide where her family lives.
“I’ve missed my friends, family and Cornish pasties. No one knows what a pasty is in New York!”