Superhero for a Small Planet

One morning in April 2007, in the Atlanta headquarters of the Centers for Disease Control and Prevention (CDC), obstetrician/gynecologist Denise Jamieson got a call. It was her colleague, Sonja Rasmussen (M.D. ’90), a pediatrician and clinical geneticist. Even though they worked in different departments and divisions located miles apart – Rasmussen in Birth Defects and Developmental Disabilities, and Jamieson in Reproductive Health – they shared a passion for maternal and child wellness, as well as epidemiology.

“I’ve been thinking,” said Rasmussen. “We really need to be looking at what an influenza pandemic would mean for pregnant women.”

Jamieson raised her eyebrows; there hadn’t been a worldwide influenza outbreak since the Hong Kong flu killed 1 million people in 1968. What was the likelihood of that happening now?

Rasmussen politely pushed back: “You know, this is what we need to be focused on. Come see what I’ve collected.”

That weekend, Jamieson began going through the thick stack of papers she’d picked up at her colleague’s office. Rasmussen was a voracious, discerning reader of monthly medical journals. If she was concerned about a potential flu pandemic, she must have good reason.

By the end of her reading marathon, Jamieson was speed-dialing her friend: “Oh, my goodness, we really need to do this!”

Quickly, the pair teamed up with a CDC flu expert to write a background paper on the topic. Not satisfied, Rasmussen summoned national experts in 2008 to formulate a public health approach to safeguarding pregnant and postpartum women and their infants during an influenza epidemic, the first such guidelines in CDC history. Key to the plan was getting pregnant women vaccinated – a tough hill to climb since historically fewer than 30 percent of this group get flu shots, for fear of harming their developing baby.

The new guidelines had not yet been released when the first cases of pandemic influenza were announced in April 2009. Originating in Mexico and dubbed “swine flu” by the media, H1N1 influenza A was descended from the deadly 1918-19 Spanish flu that killed about 50 million people. Unlike other flu viruses, H1N1 targeted healthy people and posed a serious risk of death to pregnant and postpartum women if they did not receive antiviral treatment, ideally within 48 hours of symptoms.

The CDC took immediate action, developing the virus to be used in a vaccine and publishing the pregnancy guidelines online that very week.

“We realized it was critical we rush the guidance out quickly so it could be used,” says Jamieson now chair of Emory University’s Department of Gynecology and Obstetrics.

As part of a social media “public health nerd campaign,” CDC promoted cartoons of its prominent scientists as superheroes, including Rasmussen (shown here on Twitter in April 2017).

It wasn’t a moment too soon: The second person to die from H1N1 that month was an otherwise healthy pregnant woman.

Although H1N1 claimed between 151,700 and 574,400 lives worldwide in 2009-2010, the CDC’s new focus on maternal health prevented severe complications and deaths among expectant mothers, with vaccination levels in this at-risk group rising to a new high of 50 percent, thanks to Rasmussen’s initiative.

For her part, Rasmussen says the CDC is loath to toot its horn. Everyone there, herself included, is just doing their job, she says.

But her colleagues are not so reticent about the role Rasmussen played.

“Sonja’s foresight and leadership led to a sea change at the CDC in recognizing the importance of protecting pregnant women in an outbreak,” says Jamieson. “I can’t say enough about her.

“She’s brilliant and forward-thinking and innovative and caring and smart, and incredibly passionate about what she does.”

The H1N1 crisis launched Rasmussen as a leader in public health. During her 20-year-long career at the CDC, she served as deputy director of its Influenza Coordination Unit, oversaw the Emergency Operations Center during its response to the 2014 Ebola outbreak in West Africa and directed its Division of Public Health Information Dissemination.

Most memorably, Rasmussen led the CDC’s analysis in 2016 confirming that the Zika virus causes microcephaly in developing fetuses, supporting a huge public-health response to protect expectant mothers from this devastating mosquito-borne disease.

Now, after retiring from the CDC in June 2018, Rasmussen has returned to her alma mater – this time, as a professor in UF’s departments of pediatrics and epidemiology.

“I got to do some wonderful things at CDC, but I always planned to come back here,” she says. “Really, my whole career was due to my start at UF.

“As a student, I was very interested in population health and epidemiology, and people at UF were willing to let me follow those interests. Now I just want to give back.”

Lessons from Down Syndrome & Polio

Born in 1958 and raised in Wadena, Minnesota, one of four siblings, Sonja Rasmussen learned early that when it comes to health, not everyone is dealt a fair hand.

Little brother Mark had Down syndrome; father Lowell Rasmussen contracted polio a year after Sonja’s birth, leaving him paralyzed from the waist down. Watching two members of her family cope with disabilities sparked Sonja’s desire to help others.

“It sounds like a cliché, but I wanted to make a difference in people’s lives,” she says.

Like everyone else in the U.S. in the 1960s, young Sonja could find scant information about her brother’s condition, known then as “Mongolism.”

“I wondered, ‘How long is he going to survive?” she remembers. “What is his adulthood going to be like? Am I going to have a baby with Down syndrome?”

Sonja Rasmussen, center, says her lifelong interest in infectious diseases and genetics began with her family’s health challenges. Father Lowell Rasmussen battled polio in 1959; little brother Mark was born with Down syndrome. Photo courtesy Sonja Rasmussen

Although Sonja’s mother, Mary June, was a nurse, she couldn’t answer those questions either; understanding of the genetics behind Down syndrome was still in its infancy, as was amniocentesis. Sonja’s need for answers drew her to a career in genetic counseling.

“I wanted other families to have that information I didn’t have,” says Rasmussen.

One year after Lowell Rasmussen battled polio, the US Surgeon General authorized the first oral polio vaccine (OPV), which made it easier to administer the life-saving protocol en masse. Americans excitedly lined up under posters of the smiling CDC “Wellbee” to receive their dose of OPV – among them, Sonja and her siblings. The powerful protection the Rasmussen children now enjoyed contrasted painfully with their father’s day-to-day challenges.

“That [contrast] made me realize vaccines can really make a difference,” she says. “It’s ironic to me that some people now are more afraid of the vaccines than the diseases; that’s because they have never seen the conditions firsthand.”

Rasmussen’s father refused to let polio define him. While the children were young, he returned to college and got certified as a teacher, joining the business faculty of Wadena Area Technical Institute (now Minnesota State Community and Technical College). He rose to eventually become its president.

“He was very proud that by the time he finished, the institute was a college,” says Rasmussen.

“Incredible Dedication”

Sonja Rasmussen earned a bachelor of science in biology and mathematics from the University of Minnesota Duluth in 1981, followed by a master’s in medical genetics from the University of Wisconsin, Madison, in 1983. While her first choice was to remain in the Wisconsin/Minnesota area after graduation, jobs for genetic counselors in the north Midwest were few, so she gave away her snow shoes and headed to Florida. There she landed her desired position in UF’s Department of Pediatrics, Division of Genetics.

From 1983 to 1986, Rasmussen fulfilled a childhood dream by counseling patients and families about birth defects and their causes, and conducted research on fetal alcohol syndrome.

From there, she enrolled in UF’s College of Medicine. She earned her doctorate in medicine in 1990, doing her residency in pediatrics at Massachusetts General Hospital, with postdoc training in clinical genetics.

As a medical student, Rasmussen was inspired by her UF teachers’ exemplary commitment to serving their students and patients. The dual role of professor/practicing clinician was one she could envision herself filling one day.

Among her role models was Dr. Timothy Flynn, recently retired as senior associate dean for clinical affairs, to whom Rasmussen was assigned for her first clinical rotation – in surgery at UF Shands.

“I remember having this really sick patient and being up for 24 hours, taking care of her, shadowing Dr. Flynn on his rounds,” says Rasmussen. “I will never forget his incredible dedication.”

That give-it-your-all Gator spirit was what made College of Medicine faculty stand out. “Our professors poured everything into teaching students,” she says, “making sure that we were going to be people who could go out and make a difference in the world.”

A Force for Public Health

In 1998 Rasmussen was working as a clinical instructor in UF’s pediatric department, lecturing on genetics and evaluating patients, when she got a call from a friend at the CDC: The federal agency needed a senior staff fellow in their Birth Defects and Pediatric Genetics Branch, the perfect fit for her training and experience.

Her understanding of genetics, birth defects and pediatrics would soon have profound impacts on public-health decisions made for the U.S. population, as well as for people around the world.

Rasmussen’s work at the CDC began in the areas of birth defects, maternal health and children’s health. It broadened to tackling worldwide infections like H1N1 and the 2014 Ebola outbreak, for which she and her staff were thanked in person by President Obama. In her last three years with the agency, she served as editor-in-chief of the Morbidity and Mortality Weekly Report (MMWR), known as “the voice of CDC.” During those years, she authored or coauthored 200 scientific papers, many with Jamieson (the two researchers might be considered the dynamic duo of that CDC era).

“And then at the end of my career, I got back to Zika,” Rasmussen says. “That emergency brought together everything I knew: birth defects, maternal and child health, infectious diseases and emergency response.”

Rasmussen’s historic role in protecting pregnant women and their infants during pandemics did not go unnoticed by the CDC. In April 2017, the federal agency launched a colorful social media campaign, “Public Health Heroes,” featuring its star scientists as cartoon superheroes. Rasmussen is immortalized in a blue outfit and billowing red cape, with a Superman-like MMWR logo on her chest. Her character bears more than a little resemblance to Elastigirl in Pixar’s “Incredibles” films.

Given Rasmussen’s abilities to stretch her talents and “save the day” across multiple disciplines and disaster fronts, the homage is fitting.

Elasti-Prof

Since 2018, Rasmussen has been “Elasti-prof” at UF, with a full professorship in both the Department of Pediatrics and the Department of Epidemiology. Her schedule sees her examining young patients in UF Health clinic rooms and lecturing in front of whiteboards in the College of Medicine and College of Public Health and Health Professions. She couldn’t be happier to finally follow in the busy footsteps of the professor/clinicians who inspired her in her 20s.

“I’m thrilled to be able to see patients again, and I’m thrilled to be teaching in a class,” she says.

Likewise, many UF students in the healthcare professions are excited to have the Sonja Rasmussen on hand to explain how CDC scientists unraveled the Zika mystery and tackled the “largest, most severe and most complex Ebola epidemic” in history, to borrow the words of the World Health Organization.

Rasmussen (left) wears a UF Medicine sweatshirt while holding her infant daughter, Amelia Watson, in 1993. Watson (right), wears the same sweatshirt 22 later as she proudly shows her acceptance letter to the UF College of Medicine. Photo courtesy Sonja Rasmussen

Rasmussen’s UF homecoming has a sweet cherry on top: Her daughter, Amelia Watson, is now in her fourth year of medical school at UF.

“I think that Amelia being a student here kind of pushed the timing of my move to UF,” she says. “Otherwise, I might have spent a few more years at CDC. But I wanted to spend this time with Amelia because those last couple of years in med school are when you start seeing patients at a higher percent of your time.

“It’s such an exciting time in your medical career, when you’re moving from books to people.”

In the end, Rasmussen wants UF students and alumni to know that life does not go in a straight line; however, if you stick with your passions, it will take you farther than you could ever dream.

“The College of Medicine gave me the basis I needed,” she says, “the network, the knowledge and the drive to do anything I set my mind to.

“You can do anything you want with your UF degree. Go out and do it.”