If youre like an estimated 99% of people born before 1980, chances are youve had the varicella-zoster virus, which causes chickenpox. It usually shows up in childhood with a trademark itchy and crusty rash, though it can strike at any time, with or without symptoms.
Many people who got chickenpox as a child have long since forgotten about it or perhaps never knew they had it in the first place. But fast forward a few decades and you may experience a potentially painful and long lasting complication: herpes zoster, also called shingles.
There is a shingles vaccine. The Food and Drug Administration (FDA) approved Shingrix in 2017 after finding it safe and highly effective at preventing shingles. But its mostly recommended for people ages 50 and over.
Read on to learn about the reasons behind the over-age-50 rule and a few exceptions to that rule.
The Centers for Disease Control and Prevention (CDC) recommends the shingles vaccine for people with healthy immune systems who are ages 50 and over. This is because your immune system becomes less robust as you age, so your risk of developing shingles increases.
The CDC also recommends the vaccine for people ages 19 and over who are immunocompromised. This means they have a weakened immune system.
Shingrix is a vaccine that contains an inactive form of the herpes zoster virus. It helps you develop an immunity to the active virus.
Adults receive the vaccine in two separate doses. Generally, healthy adults over age 50 get their second dose 2 to 6 months after the first dose. Immunocompromised adults may get the second dose sooner.
There is no maximum age for getting Shingrix.
Shingles is caused by a reactivation of the varicella-zoster virus, which is the virus that causes chickenpox.
When you get chickenpox and recover, the varicella-zoster virus doesnt go away. Instead, it stays dormant in your nerve cells. As you get older, your body is less able to fight off viruses. During this time, the virus can reactivate.
The hallmark sign of shingles is a pronounced rash of painful blisters filled with clear fluid. It usually shows up on one side of the body, especially on the head, neck, or torso. That said, it can appear anywhere on your body.
Other symptoms include:
The blisters typically start healing within 7 to 10 days and go away within a month. Yet the condition can sometimes cause persistent nerve pain, called postherpetic neuralgia (PHN).
PHN may affect the same area where you had the shingles rash. It can persist for months or years, become intensely painful, and sometimes interfere with daily life.
About 1 million people get shingles each year. The risk of getting shingles gets higher as you get older. In fact, people ages 65 or over are three times more likely to get shingles than younger people.
According to the CDC, 1 in 3 people will get shingles in their lifetime. Shingles is more common in women than in men, and it is more common in white people than in Black people.
Risk factors for shingles include:
Certain conditions or medications that affect your bodys immunity also increases your risk, particularly:
People born after 1995 are less likely to get shingles because they are less likely overall to get chickenpox. That year, a vaccine was released, which reduced chickenpox transmission significantly.
You can get shingles after vaccination with the chickenpox vaccine, but its less likely than if you got chickenpox.
Depending on when you get Shingrix, the vaccine is more than 90% effective in preventing shingles and PHN.
Chickenpox and shingles are caused by the same virus, varicella-zoster. When you recover from chickenpox, the virus stays in the cells in your nervous system.
It can become active again if your body is no longer able to suppress it. It spreads down nerve fibers and up to your skin, causing a rash, inflammation, burning, and pain.
A doctor will examine the rash on your skin and ask you about your symptoms. This is usually how healthcare professionals diagnose shingles.
A healthcare professional may remove some fluid from a blister for testing, but typically this is not necessary.
Vaccination is the key to preventing shingles. The CDC recommends:
According to the CDC, you should get the vaccine even if, in the past, you:
Creating and maintaining healthy lifestyle habits such as stress management, a healthy diet, regular exercise, and getting plenty of sleep can also help prevent or lessen flare-ups.
Shingles can be painful but the blisters often begin to heal within a week. Your skin usually clears up within a month.
People who develop PHN can have it for months or years afterward, but not everyone who has shingles will develop PHN.
Healthcare professionals can help treat shingles and shorten its duration with prescription antiviral drugs. These can also reduce your likelihood of having PHN.
Most people only get shingles once, though it is possible to get it again.
Shingrix is not recommended for adults under age 50 who have a healthy immune system.
It is recommended for adults ages 19 or over who are immunocompromised, such as people with an immune-related health condition or who are receiving immunosuppressive agents, which are medications that reduce the bodys immune response. These medications may help prevent organ rejection after an organ transplant and treat other medical conditions.
Its recommended that you get a second dose between 2 and 6 months after the first. But, if you have waited longer than 6 months, according to the CDC, you will not have to start over. Just get your second dose as soon as possible.
Yes. You can still catch the varicella-zoster virus if youve never had chickenpox, and that may cause shingles.
Immunity stays strong for at least 7 years and is more than 90% effective at preventing shingles and PHN among people ages 50 and over, per the CDC. It is between 68% to 91% effective in immunocompromised adults over age 18.
Most people dont develop side effects from the shingles vaccine, but some can occur. The vaccine is injected into your arm, so pain and soreness at the injection site are common.
The FDA also issued a warning in 2021 that there may an association between receiving the vaccine and developing Guillain-Barr Syndrome (GBS), though the relationship is poorly understood and more research is needed.
GBS is a rare condition in which your bodys immune system attacks part of the nervous system.
No, the CDC recommends that all people over age 50 get the shingles vaccine.
You should not get Shingrix if you:
Shingles is a painful condition caused by the same virus as chickenpox. The virus can remain dormant in your nervous system for decades before reactivating.
There is one FDA-approved vaccine that prevents shingles and its complications. Its usually given to adults over age 50 or to those ages 19 or over who have compromised immune systems. Your doctor may be able to prescribe it to you sooner depending on your circumstances.
If you do get shingles, it usually goes away within a month. Yet its possible to develop PHN that lasts for months or years. Your healthcare professional may be able to prescribe antiviral drugs that will shorten the duration of the shingles infection and help prevent PHN.
Situation at a glance
In the past few months, there have been several genetically linked Sabin-like type 2 poliovirus (SL2) detections from environmental samples in the United Kingdom of Great Britain and Northern Ireland (hereafter the United Kingdom) and the United States of America.
In the United Kingdom, since February 2022, the WHO Global Polio Laboratory Network (GPLN) located at the National Institute for Biological Standards and Control (NIBSC) in London has consistently detected Sabin-like type 2 poliovirus isolates in sewage samples collected from London. Samples collected on 24 and 31 May had sufficient mutations to qualify as vaccine derived polio virus type 2 (VDPV2). Subsequently, due to a new detection of the virus more than two months later, these samples were classified as circulating VDPV2 on 8 August. As of 5 September, no human case associated with VDPV2 has been reported in the United Kingdom.
In the United States of America, Sabin-like type 2 poliovirus has been consistently detected in environmental samples collected between 21 April to 26 August 2022 from Rockland County, New York State, and nearby counties. In late July, a case of VDPV2 was reported in an unvaccinated individual in Rockland County, who presented with paralysis. The case had no recent history of international travel. This is the first case of poliomyelitis reported in the country since 2013. Due to detection of environmental viral sequences (collected on 3 August and 11 August) containing more than five nucleotide changes, and both linked to the case reported in Rockland County these viruses are now being classified as circulating VDPV2.
The virus detected in environmental samples in New York State, United States of America is genetically linked to viruses detected in sewage samples from London, United Kingdom and in sewage samples collected between January to June 2022 from Jerusalem District, Israel1.
Figure-1 Detection of genetically linked cVDPV2 isolates in the United Kingdom and the United States of America from February to August 2022
Epidemiology of Poliomyelitis
Polio is a highly infectious disease that largely affects children under five years of age, causing permanent paralysis (approximately 1 in 200 infections) or death (5-10% of those paralyzed).
The virus is transmitted from person-to-person, mainly through the fecal-oral route or, less frequently, by a common vehicle (e.g., contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and cause paralysis and death. Initial symptoms of polio include fever, fatigue, headache, vomiting, stiffness of the neck and pain in the limbs. In a small proportion of cases, the disease causes paralysis, which is often permanent. There is no cure for polio but it can be prevented by immunization.
The incubation period is usually 710 days but can range from 435 days. Up to 90% of those infected are either asymptomatic or experience only mild symptoms and the disease often goes unrecognized.
Vaccine-derived poliovirus is a well-documented type of poliovirus that has mutated from the strain originally contained in the oral polio vaccine (OPV). The OPV contains a live, weakened form of poliovirus. On rare occasions, when replicating in the gastrointestinal tract, OPV strains genetically change and may spread in communities that are not fully vaccinated against polio, especially in areas where there is poor hygiene, poor sanitation, or overcrowding. Further changes occur as these viruses spread from person to person. The lower the population immunity, the longer this virus survives and the more genetic changes it undergoes. In very rare instances, the vaccine-derived virus can genetically change into a form that can paralyze this is what is known as a vaccine-derived poliovirus (VDPV).
The detection of VDPV in at least two different sources and at least two months apart, that are genetically linked, showing evidence of transmission in the community, should be classified as circulating vaccine-derived poliovirus type 2 (cVDPV2). cVDPV2 continues to affect different areas of the world.
WHO, in coordination with national authorities, will continue to evaluate the genetic and epidemiological situation to determine the possible spread of the virus and the potential risk associated with these isolates detected from different locations around the world.
The United Kingdom Health Security Agency (UKHSA) is conducting further investigations including assessing the public health risk and implementing response measures. These measures include:
The emergence of cVDPV2 in the United Kingdom and in the United States of America is a reminder that until polio is eradicated, polio-free countries will remain at risk of polio re-infection or re-emergence. The detection of this VDPV2 strain underscores the importance of;
maintaining high levels of routine polio vaccination coverage at all levels and in all communities to minimize the risk and consequences of any poliovirus circulation.
having sensitive surveillance systems for the timely detection of VDPV importation or VDPV emergence.
Based on the WHO UNICEF estimates, the vaccine coverage for three routine doses of polio vaccine evaluated in children aged 12 months in the United Kingdom and United States of America were 93% and 92% respectively in 2021.
WHO will continue to support the ongoing investigation, risk assessment and outbreak response by national authorities.
WHO reiterates to all Member States the importance of reaching and maintaining polio vaccination coverage of more than 95% in each district or municipality; maintaining high quality for three main surveillance indicators: acute flaccid paralysis (AFP) rate, percentage of cases investigated within 48 hours, and percentage of cases with an adequate sample; optimizing supplementary (environmental and enterovirus) poliovirus surveillance and updating national poliovirus outbreak response plans in order to rapidly detect and respond to new virus importations or VDPV emergence to minimize the consequences of poliovirus transmission and facilitate a rapid response.
The thirty-second polio IHR Emergency Committee meeting held in June 2022, convened under the International Health Regulations (2005), agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months.
Researchers at Tel Aviv University have reported that they effectively eradicated glioblastoma using a method based on their discovery of two critical mechanisms in the brain that support tumour growth and survival: one protects cancer cells from the immune system, while the other supplies the energy required for rapid tumour growth. The work found that both mechanisms are controlled by brain cells called astrocytes, and in their absence, the tumour cells die and are eliminated.
A paper detailing this work was published in the scientific journal Brain
Researchers at University College London (UCL) and Great Ormond Street Hospital (GOSH) have been awarded a 1.2 million grant from Great Ormond Street Hospital Childrens Charity (GOSH Charity) to develop a new treatment for an aggressive type of brain tumour, diffuse midline glioma (DMG), until recently known as diffuse intrinsic pontine glioma (DIPG). They will be using a patients own immune system to attack the cancer cells.
The team will use CAR T-cells (patient immune cells engineered to recognise and eradicate cancer cells) in a clinical study for up to 12 patients with DMG at GOSH.
With results from a study at Stanford University in the USA already showing promise of CAR T-cell therapy in DMG, it is hoped that this clinical trial at GOSH will be a crucial first step in developing effective CAR T-cell treatments for DMG and other high-risk brain tumours that can be devastating to families.
A New Human Fetal Brain Atlas Decodes the Origin and Formation of Brain Cancer. Medulloblastomas are classified into four major subgroups. Three main groups originate from the cerebellum, and one is from the dorsal brainstems lower rhombic lip. In this research, rodent models have been used to help understand the origins of cerebellar tumorigenesis. An analysis of their molecular, cellular, and histological models has aided research in studying brain tumours and this could help scientists plan for better outcomes.
Recent research has uncovered a unique metabolic vulnerability in the sphingolipid pathways of gliomas that possess the IDH1 mutation. Sphingolipids are a family of lipid signalling molecules that play a variety of second messenger functions in cellular regulation. The two primary metabolites, sphingosine-1-phosphate (S1P) and ceramide, maintain a rheostat balance and play opposing roles in cell survival and proliferation. Altering the rheostat such that the pro-apoptotic signalling of the ceramides outweighs the pro-survival S1P signalling in glioma cells diminishes the hallmarks of cancer and enhances tumour cell death. This review discusses the sphingolipid pathway to identify the enzymes that can be most effectively targeted to alter the sphingolipid rheostat and enhance apoptosis in gliomas.
The World Health Organization (WHO) has published the fifth edition of the Classification of Tumors of the Central Nervous System (CNS). This 2021 update introduces major improvements that will have an important influence on clinical care and research of brain tumours, especially diffuse gliomas. It will provide clinicians with more accurate guidance on prognosis and optimal therapy for patients and ensure that more homogenous patient populations are enrolled in clinical trials, potentially facilitating the development of more effective therapies.
This is paid for content and offers a review of the mechanisms of T cellmicroglia interactions and discusses a collaboration fostering heterogeneity and immunosuppression in brain cancers.
Surveys:
A new comprehensive statistical report on childhood and adolescent brain tumours ages 0-19 years has been published. The Central Brain Tumor Registry of the United States (CBTRUS) Statistical Report: Paediatric Brain Tumour Foundation Childhood and Adolescent Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 20142018 comprehensively describes the current population-based incidence of primary malignant and non-malignant brain and other CNS tumours in children and adolescents ages 019 years, collected and reported by central cancer registries covering approximately 100% of the United States population.
Brain tumour patients and COVID-19 vaccines: results of an international survey. A total of 965 unique surveys were completed from 42 countries of an anonymous 31-question online survey conducted in the summer of 2021. The survey was open to adult brain tumour patients over the age of 18. The purpose of this study was to determine if brain tumour patients and their caregivers have received a COVID-19 vaccine and explore their thoughts and opinions on these vaccines.
Opportunities:
There is an opportunity to join Professor Oliver Hanemann at our University of Plymouth research Centre as a research focused lecturer meanwhile Kings College London are looking for an enthusiastic Postdoctoral Research Associate to lead a project on ultrasound-mediated paediatric brain tumour treatment using drug-loaded thermosensitive liposomes.
New Believe Magazine out now if the clinicians amongst you would like to have the opportunity to have the Believe Magazine (full of fundraising/campaigning/research news) available to view in public spaces at your clinics please let me know and we will send a box over to you.
Finally this week why not make the most of the Autumn weather and join us for our national Walk of Hope which is taking place on Saturday 24thSeptember. This year, we want to make it our biggest Walk of Hope yet and we need your help. Were hosting official Brain Tumour Research walks in Hamilton, Leicester, Leeds, Luton, New Forest, Oxfordshire, Pershore, Stockport, and Stoke Hammond. You can join these or take part in your own walk the main thing is that its time to step forward towards a cure, together
Related reading:
If you found this story interesting or helpful,sign up to our weekly e-newsand keep up to date with all the latest from Brain Tumour Research.
Nearly 50 Republican lawmakers, led by Rep. Mike Johnson (R-La.), have called on theDepartment of Defense (DOD) to withdraw its COVID-19 vaccine mandate for military members, citing concerns over the mandates impact onthe readiness of the U.S. Armed Forces.
In a letter toSecretary of Defense Lloyd Austin dated Sept. 15 (pdf), lawmakers, includingReps. Chip Roy (R-Texas) and Thomas Massie(R-Ky.), expressed their grave concerns over the impact of the mandate, particularly with regard to theU.S. Army.
As a result of your mandate, eight percent of the Armys approximately 1 million soldiers face expulsion, Army recruiters cannot meet their FY22 target, and the Army has cut its projected FY23 end strength by 12,000 soldiers, they wrote.
Referring to Russias ongoing invasion of Ukraine, lawmakers noted that the U.S. military currently facesa self-imposed readiness crisis.
Citing sparse data from the Department of Army, they noted that at least 40,000 National Guardsmen, 20,000 Army Reservists, and at least 15,000 Active Army Soldiers have not yet received a COVID-19 shot and subsequently face being discharged from service.
The Department of Defenses own Covid response page indicates that approximately 900,000 soldiers are fully vaccinated out of the 1 million soldiers in the Army, Army Reserve, and Army National Guard, they wrote.
Lawmakers pointed totestimony delivered in July byVice Chief of Staff of the Army, Gen. Joseph Martin, before theHouse Armed Services Committee. During that testimony,Martin stated that less than 20,000 people werefacing discharge for refusing to take the COVID-19 vaccine, much less than the initial figures that officials had provided.
However, lawmakers in their letter to the DODnoted that the Army has not published official data pertaining to the number of unvaccinated service members in months.
The opaqueness of the Department continues to frustrate Members of Congress attempting to perform oversight of the Executive Branch, they wrote, noting that their repeated inquiries remain unanswered.
Republicans also pointed to the thousands of servicemembers that have been left in limbo while they await a formal judgment regarding their medicalexemptions to the vaccine.
Some have waited for nearly a year to learn if they will be forcibly discharged for their sincerely held religious beliefs or medical concerns, lawmakers wrote.
Furthermore, according to current Army policy, even those few soldiers who receive permanent exemptions will be treated as second-class soldiers for the rest of their careerseach of them requires approval from the Undersecretary of the Army to travel, change assignments, or even attend training courses away from their home station, they wrote.
According to U.S Army fragmentary orderspublishedby Fox News, the Army has barred unvaccinated soldiers from official travel unless they receive the undersecretarys approval.
The Department has abused the trust and good faith of loyal servicemembers by handling vaccine exemptions in a sluggish and disingenuous manner, lawmakers said.
They then questioned who would replace the roughly 75,000 soldiers if they were to be discharged from the Army. Martin said in July that if a shortfall in Army troop size were to persist, it could have an impact on readiness.
Citing Army Secretary Christine Wormuths interview with NBC News earlier this year in which she noted that the Army has only met 52 percent of its recruiting goal for the fiscal year 2022, they asked, How will it recruit another 75,000 troops beyond its annual target to account for vaccine-related discharges?
In that same interview,Wormuth said she believes the Army would end up roughly12,000 to 15,000 recruits short this year.
The data is now clear. The Department of Defenses Covid vaccine mandate is deleterious to readiness and the militarys ability to fight and win wars, lawmakers concluded. The vaccine provides negligible benefit to the young, fit members of our Armed Forces, and the mandates imposition is clearly affecting the Departments ability to sustain combat formations and recruit future talent.
We urge you to immediately revoke your Covid-19 vaccine mandate for all servicemembers, civilian personnel, and contractors and re-instate those who have already been discharged.
As of July 1, 2022, under the Biden administrations vaccine mandate,members of the Army National Guard and U.S. Army Reserve who are not vaccinated and do not have an approved exemption are unable toparticipate in federally funded drills and training and will not receive pay or retirement credit.
BidensCOVID-19 vaccine mandate has been in place across the entire military since last year and the White House has defended the move, stating that mass vaccination will help stem the spread of the virus.
The Epoch Times has contacted the Department of Defense for comment.
Follow
Katabella Roberts is a news writer for The Epoch Times, focusing primarily on the United States, world, and business news.
Vaccination centres across Scotland are to receive replacement syringes after warnings needles supplied with a new Omicron targeting Covid vaccine were unfit for purpose.
NHS staff complained about the dose administering devices that came with the Moderna Spikevax Bivalent jab that is the first that has been approved to target two strains of the virus.
Vaccinators said the needles bend when they try to pierce vials of the vaccine.
It comes as Scottish Covid rates increase for second week in a row.
National Services Scotland, the body that provides supplies and advice to the NHS across the country, said alternative products would be sought to avoid any disruption to the vaccination programme that has already begun its autumn rollout.
Following complaints, the UK Health Security Agency (UKHSA) which has procured the Moderna jab across the four-nations, said it would supply a different needle and syringe as a precautionary measure.
At this time we are not issuing a product recall, but this decision will allow us time to fully investigate the issues raised, said Gareth Thomas, deputy director of vaccines and countermeasures at UKHSA.
National Services Scotlands director of national procurement said that the new needles would be sent out across Scotland while the feedback received is investigated.
Gordon Beattie said: We can confirm that UKHSA have communicated to us today that as a precautionary measure, they are arranging for alternative combined needles and syringes to be supplied in Scotland whilst they investigate the feedback received about the combined needles and syringes that were recently brought into use.
The alternative product is virtually identical to the one successfully used as part of the Covid programme with the Pfizer vaccine, UKHSA said.
We are aware that some NHSE sites are experiencing some problems with the use of the new needle and syringe being supplied for administrating the Moderna bivalent vaccine, the UKHSAs Mr Thomas said.
The Medicines and Healthcare products Regulatory Agency (MHRA) authorised Modernas bivalent vaccine, which targets both the original Covid strain and the Omicron variant, on August 15.
Known as mRNA-1273.214, the dose is an updated version of the Moderna vaccine which is already in use for first, second and booster doses.
The Office for National Statistics (ONS) Coronavirus Infection Survey found around one in 45 people in Scotland had the virus in the week to September 5, up from one in 50 the week before.
The most recent figure equates to around 2.16% of the population, or an estimated 113,500 people.
According to the ONS, Scotland has the highest rates of Covid-19 of any country in the UK, with Northern Ireland showing around one in 55 people are infected, England one in 85 and Wales one in 110.
The autumn flu and Covid vaccination programme is under way for thousands of people across Scotland.
Health Boards are prioritising care homes at the beginning of the roll out; with residents and staff first to receive their jabs.
Health and social care workers and carers will be invited to book their combined flu/Covid-19 appointment using the online portal, with a range of sites/times available to choose from.
How others receive their jab will depend on a number of factors. Full details are available on the Scottish Government website.
The Pandemic Response Accountability Committee, one of the three oversight bodies created by the CARES Act, launched a new data initiative this week to display information about COVID funding.
These new agency funding profiles enable the public to see the total amount of pandemic relief money that nearly 40 federal agencies received, and the specific programs funded, said a press release. They also include relevant oversight work from federal offices of inspectors general, whose audits and investigations alert the public and policymakers of any fraud, waste, and abuse.
Robert Westbrooks, executive director of the committee, said this new website feature reflects our dual responsibilities of transparency and oversight. Here are some of the other recent headlines you might have missed.
Despite various layers of control from the Small Business Administration, individuals with foreign IP addresses were able to access the application system for the economic injury disaster loan program for COVID relief, the agencys watchdog said in a report this week. SBA received millions of attempts to submit COVID-19 EIDL applications from foreign IP addresses and stopped most of them; however, the agency processed more than 233,000 of these applications from March 20, 2020 to November 12, 2021, our review period, said the report. Although applicants that reside overseas may qualify for this assistance, transnational crime entities in foreign countries have fraudulently obtained funding from this and other U.S. programs in the past.
On Wednesday, the Justice Department announced it established three COVID fraud strike force teams, which will operate out of the U.S. Attorneys Offices in the Southern District of Florida, the District of Maryland, and jointly between the Central and Eastern Districts of California. These strike force teams will build on the departments historic enforcement efforts to deter, detect, and disrupt pandemic fraud wherever it occurs, said Attorney General Merrick Garland, in a statement. Since the start of this pandemic, the Justice Department has seized over $1.2 billion in relief funds that criminals were attempting to steal and charged over 1,500 defendants with crimes in federal districts across the country, but our work is far from over.
Members of the teams include prosecutors and agents from the Labor, SBA, Homeland Security inspector general offices, FBI, Secret Service, Homeland Security Investigations, Internal Revenue Service Criminal Investigations, and the U.S. Postal Inspection Service. The Pandemic Response Accountability Committee and the Special Inspector General for Pandemic Recovery are also helping.
The Centers for Disease Control and Preventions advisory committee on immunization practices will meet next month, during which a voteis planned to make recommendations on the child/adolescent immunization schedule and COVID -19 vaccines, which could mean the updated booster shot, per a notice in the Federal Register. Also, a vote on Vaccines for Children (a federally funded program that provides free vaccines to children who might not otherwise get vaccines) on COVID-19 vaccine is scheduled.
The U.S. Attorneys Office for the Southern District of Texas announced on Tuesday what it believes to be the countrys first False Claims Act settlement with a Paycheck Protection Program lender. The False Claims Act is a Civil War-era law to protect the government from being defrauded.
Help us understand the situation better. Are you a federal employee, contractor or military member with information, concerns, etc. about how your agency is handling the coronavirus? Email us at newstips@govexec.com.
Africalagged in genome sequencing during the first two years of the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, with increased funding, over 100,000 genomes have now been sequenced from this continent.
A new study sums up the results of genomic surveillance so far, indicating how the variants of concern of the virus have spread while indicating future directions for response readiness.
Africa appeared to be relatively spared of high cases and deaths during the ongoing pandemic, with approximately 11 million cases out of a global total of over600 million and a quarter of a million deaths out of over 6.4 million deaths worldwide.
However, as the virus continued to change and mutate, new variants emerged that showed, in some cases, higher transmissibility and infectivity or virulence. Immune escape mutations were identified in some variants, making them capable of increased spread even among vaccinated or previously infected populations. These were called variants of concern (VOC), and so far, there have been five of them Alpha, Beta, Gamma, Delta, and Omicron.
Of these, Beta and Omicron were first detected in Africa, though the other two also caused significant cases on this continent. In response to the growing threat posed by the emergence of VOCs, samples were collected from multiple sites for sequencing. However, in April 2020, only 20 African countries had this capability.
As global supply chains petered out, these efforts stopped towards the end of the year. After the first 10,000, an analysis showed some missing areas, in response to which increased funds poured into the building of increased infrastructure and training staff for genomic surveillance.
Both the Africa Centers for Disease Control (Africa CDC) and the regional office of the WHO in Africa (or WHO AFRO) shared the responsibility for this, aided by many other individuals and organizations. The result was that another 90,000 sequences were uploaded from April 2021 to March 2022.
To put this in perspective, less than 4000 sequences of the human immunodeficiency virus (HIV) and 12,000 influenza sequences have been uploaded so far, despite their presence in Africa in alarming numbers for many years.
The current study, published in Science, explores the contribution of genomic sequencing to the scientific understanding of COVID-19 in this continent and alsointroduces global public health measures via the ability to pick up new variants early enough.
The data demonstrates multiple waves of infection, different in scale and period from country to country. After the first two waves, dominated by B.1 and Alpha variants, however, Delta and Omicron swept across Africa in grim succession.
Different strains predominated in various parts of Africa, such as C.36 and C.36.3, which caused 40% of infections in Egypt, vs. B.1.160 lineage in Tunisia. In both cases, these gave way to Delta during the third wave.
In South Africa, Beta dominated the second wave instead of Alpha. Interestingly, though the C.1.2 variant showed signs of immune escape, it failed to make a significant impact against the Delta background.
Other lineages that competed with Alpha included B.1.525 and A.23.1, which were finally outcompeted by later emerging VOCs. The differences in lineage by region could be due to virus genetics, human mobility, competition between co-circulating lineages, and immunity levels.
Delta caused the greatest impact, causing over a third of all infections in Africa, according to many analysts. Beta caused about one in seven, and Alpha only about 4% overall. Omicron, which is still spreading, caused over a fifth of all infections, as judged by genomic sequencing.
Unlike the earlier VOCs, Omicron became prominent against a background of high infection and vaccination rates, with high associated immunity levels. Along with its lower intrinsic virulence, Omicron has led to fewer deaths than other VOCs, corresponding to the lower South African mortality rate during this wave.
The first part of the pandemic was caused by strains belonging to the B.1 clade, or ancestral viruses, which were then replaced by the first cluster of VOCs from late 2020 onwards: Alpha, Beta, and then, in 2021, Delta and Omicron. While Alpha and Beta circulated mostly in distinct regions of Africa, Delta and Omicron dominated infections in Africa beginning soon after their emergence.
The data comes from combining epidemiologic data with genomic sequencing data, along with information on the temporal and size-related characteristics of these waves. However, some countries have tested only one in ten million population, while others have tested over 10,000 per ten million, indicating grossly heterogeneous testing rates.
Interestingly, countries with high testing rates have reported higher case rates as well, but under-reporting continues to be a reality, as in the rest of the world. Increased reporting was achieved largely by the use of relatively inexpensive sequencing technology.
There is an urgent need to increase sequencing capacity, with 16 countries still lacking local sequencing facilities while many others have limited capacity. Three premier sequencing centers, and multiple regional sequencing hubs, have been set up to help consolidate resources in a few countries to maximize sequencing across the whole continent. These centers helped mostly sub-Saharan countries by handling the whole of the local sequencing efforts in some countries like Angola and Namibia, but also cooperating with local sequencing efforts during waves.
Other facilities outside Africa have also been pressed into service to increase surveillance, especially for West and North African countries.
Ultimately, a mix of strategies from local sequencing, collaborative resource sharing among African countries and sequencing with academic collaborators outside the continent helped close surveillance blind spots.
Even with low levels of sequencing, representative sampling over time has helped maintain genomic surveillance and detect variants in time, including Beta and Omicron. Moreover, the turnaround time is being reduced progressively from, for instance, ~180 days to 50 days from October 2020 to one year later.
This is favored by using local sequencing networks compared to regional or external facilities, which indicates the need to invest in the latter. The travel bans that followed the detection and reporting of the Beta and Omicron VOCs show how countries could hesitate to report such data in the future. If sequencing can be performed only outside the country, this will inevitably lead to the absence of surveillance in such situations.
Thus, encouraging local sequencing capacity will help generate timely and regular data for local and regional decision making. This would allow emerging variants to be detected early enough to allow time to interrupt their spread.
For example, Beta was detected three months after its origin, but for Omicron, it was within five weeks. Moreover, the World Health Organization declared the latter a VOC within 72 hours of depositing its sequence in the database.
Sequencing efforts should be built up, not just for SARS-CoV-2 but other new or re-introduced pathogens, including Ebola, measles, and H1N1 influenza. According to Africa CDC, over 200 infectious disease outbreaks occur annually in this continent.
Beyond the current pandemic, continued investment in diagnostic and sequencing capacity for these pathogens could serve the public health of the continent well into the 21st century.
PARIS Frances national health body warned on Friday of a resurgence of COVID-19 cases in the country, and urged people to continue to get vaccinated to protect themselves against the virus.
The Sante Publique France (SPF) body said that during the week of Sept 5-Sept 11, there had been 186 confirmed COVID cases for every 100,000 people in France a figure up 12% versus the previous week representing an average of around 18,000 new cases per day.
Earlier this week, Emer Cooke the executive director for the European Medicines Agency (EMA) watchdog told a Reuters Next Newsmaker interview that people in Europe should take whatever COVID-19 booster vaccine is available to them, given expectations of an autumn rise in infections.
New infections have been steadily rising since 10 days and the seven-day moving average of daily new cases reached an almost five-weeks high of 24,042 on Thursday.
Bobby Jackson narrowly survived his COVID-19 infection, but the effects on his body still linger.
SAGINAW, Mich. (WJRT) - For some, COVID-19 almost feels like a distant memory. But many are still struggling with the virus's effect on their lives.
Two years ago, 51-year-old Bobby Jackson of Saginaw survived a months-long battle with severe COVID-19. In 2022, he's still on oxygen and the effects of COVID-19 are still affecting his daily life.
"Some stuff just tastes horrible. Some stuff I can't taste, or even smell. So, it's very difficult," said Jackson.
He realized in early 2021 that he had long COVID.
"They said it usually takes like two months. You should be back to normal after the COVID. And it never, ever, ever came back," Jackson said.
On a daily basis, Jackson deals with aches, fatigue and numbness. But the most visible change is his oxygen pump, which he has to wear 24/7.
"My levels keep dropping. It's at like 88% oxygen levels, which is really low," Jackson said.
For perspective, the average person's blood oxygen level should be at 95%. Without his pump, Jackson gets dizzy and short of breath. He said that limitation has fundamentally changed his daily life.
"There was times I used to walk the block. There was times I could cut the grass or things of that nature. Now I can't," Jackson said.
When he can go outside, his mobile backpack's charge only lasts six hours. It's why he's so thankful for the little things.
"Mainly just walking. Being able to walk now, like being able to get into the kitchen, stand, and cook meals. There was a period I wasn't even able to do that," Jackson said.
But he and his wife, Tracy, say there's at least one upside: it's made their marriage stronger than ever before.
"I mean we, you know, are here for each other. We know, you know, what we have to do to get through it together," said Tracy.
Bobby said he and his doctors are still working on a path towards recovery. And while he doesn't plan on resuming his original career as a nurse assistant, he's taking college classes to get ready for managerial work.
Flint-area Dr. Bobby Mukkamala said the exact cause of Long COVID is still unknown. He said long-term symptoms can seemingly strike anyone whether they were hospitalized like Jackson or just had mild symptoms.
To avoid the risk, Mukkamala encourages people to get the fall booster shot, which he said will provide greater protection as the country enters flu season.
"And so the vaccine, while it has some efficacy- the original vaccine- for this new strain. It's not nearly as effective as this bivalent vaccine, which is specifically made to- one: cover the original. And they added to it coverage for this new variant. So it's much more effective, according to the data," said Mukkamala.
The Genesee County Health Department is already providing bivalent COVID-19 booster shots. A calendar for clinics, as well as information for immunization appointments, can be found here.
Background
False-negative results derived from RT-PCR tests for diagnosing coronavirus disease (COVID-19) have raised questions about whether to consider them the gold standard for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Using an imperfect gold standard to assess other diagnostic tests would never let the other tests show better diagnostic performance. The best strategy in such cases is to do an agreement analysis, and this study aims to estimate the agreement between real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and rapid antigen test (RAT) for COVID-19 detection.
A retrospective study was done using paired data of individuals tested for COVID-19, both by RT-PCR and RAT, obtained from the virology laboratory of Government Bundelkhand Medical College, Sagar, Madhya Pradesh, India. A sample size of 93 was calculated, and the data were abstracted in a data abstraction sheet. Variables included were results of RT-PCR and RAT, age, gender, presence of symptoms, test kit used, and the time duration between sampling for RT-PCR and RAT. Apart from descriptive statistics, keeping in mind the binary outcome of RT-PCR and RAT, Cohens kappa was calculated for agreement analysis. A p-value of <0.05 was considered significant.
The data on 100 participants suspected to be infected with COVID-19 (58 male and 42 female) with a mean age of 39.8 (19.0) years were analysed. The number of discordant pairs was eight. Cohens kappa showed substantial agreement between RT-PCR and RAT, =0.646, (95% CI 0.420 to 0.871), p<0.001.
Considering the ease of conducting RAT with quick results and substantial agreement with RT-PCR, RAT could be a better choice in detecting SARS-CoV-2 and, hence, COVID-19 disease on a large scale.
Rapid and accurate diagnostic tests are crucial for controlling any communicable disease; the same goes for the coronavirus disease (COVID-19) pandemic. Quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) is recommended by the World Health Organization (WHO) as the reference test for the laboratory diagnosis of COVID-19 [1]. Researchers have developed other forms of diagnostic tools, such as antigen-detection diagnostic tests. Generally, the ease-of-use and rapid turnaround time of antigen-detecting rapid diagnostic tests (RDTs) offer to decrease the delays in diagnosis by shifting to decentralised testing of patients with early symptoms [2]. The Indian Council of Medical Research (ICMR) published an advisory regarding the use of the rapid antigen test (RAT) on June 14, 2020, and since then it has been used extensively [3].
No test is expected to produce 100% accurate results. Ideally, a new test is compared with an existing "gold standard" and parameters like sensitivity, specificity, and predictive values of the new test are calculated. There are reports of false-negative RT-PCR results in patients with COVID-19 during the pandemic course [1]. An early study [4] showed that the sensitivity of RT-PCR varies from 68% to 100%, and the specificity is 98.9%, but several authors [5,6] have pointed out the poor performance of this technique, particularly in terms of sensitivity. According to Liu et al., the positivity rate of RT-PCR could be as low as 38% [5] (i.e., not better than chance). The accuracy of the result depends on the site and the quality of sampling as well. Li et al. in a recent study [7] also found a high rate of false-negative RT-PCR results, which were tested on specimens collected from 610 hospitalised patients from Wuhan, China. Thus, using RT-PCR as a reference standard would constitute using an imperfect gold standard. This would never let the other test show a better diagnostic performance. The additional patients identified would be regarded as false positives. With the use of chest computed tomography (CT) scans as a diagnostic method, the same mistake has also been made [8,9].In such a scenario, instead of calculating the sensitivity, specificity, and predictive values of the test (which would require one of the tests to be the gold standard), the best strategy would be to measure the degree of agreement (using the Kappa coefficient) between the two tests [10], i.e., neither of the two tests is considered to be the reference, and therefore, any discrepancies could be linked to either of the tests. Studies determining agreement between these tests are lacking in the literature. This study aims to estimate the agreement between RT-PCR and RAT for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), i.e., COVID-19 infection.
We conducted a retrospective record-based study between July 2021 and August 2021 after getting clearance from the Institutional Ethics Committee, Government Bundelkhand Medical College, Sagar, Madhya Pradesh, India (IECBMC/2021/24). Data was collected from the virology laboratory of the Government Bundelkhand Medical College from August 2020 to December 2020. It is prudent to mention here that vaccinations against COVID-19 in India started in January 2021. Hence, subjects in this study were unvaccinated for COVID-19. This tertiary care centre caters to a population from both urban and rural areas, and being a referral centre for COVID-19, it has facilities for both RT-PCR and rapid antigen tests. Patients, during their course of management, undergo both tests as per protocol. The study population consisted of people suspected of being infected by COVID-19 (who had symptoms) or contacts of confirmed cases (who could have been asymptomatic) identified through contact tracing.
We included only those subjects who had undergone both RT-PCR and RAT tests. The maximum acceptable duration between both tests was set to three days. We believe that three days is short enough to not have affected the severity of the condition and hence the diagnosis. The subjects and investigators were blinded to the result of the first test in cases where the second test was RAT. In those instances where RAT was conducted initially, it was not possible to blind the participant. Those subjects with data showing faulty sample collection (from sites other than the prescribed site) were excluded. Standard procedures were followed for conducting RT-PCR and RAT as recommended by the ICMR.
The kit used for RAT was the STANDARD Q COVID-19 Ag detection kit (SD Biosensor Inc., South Korea), and for RT-PCR, VIRALDTECT-II (Genes2Me Pvt. Ltd., India). All RT-PCR samples were oropharyngeal and all RAT samples were nasopharyngeal, as recommended by the manufacturer.
The minimum required sample size was calculated using the formula for determining Cohens kappa, where we took the proportion of positive rating by rater one (i.e., RT-PCR) as 68% (sensitivity) [4], the proportion of positive rating by rater two (i.e., RAT) as 50% (sensitivity) [3], and assumed =85% at 95% CI with 10% precision. It was calculated to be 93. We took 100 subjects. Universal sampling was done, and subjects were included or excluded as per the criteria set above.
Data were abstracted in a data abstraction sheet designed with the help of Epi Info software (version 7.2.4.0, CDC, Atlanta) for Windows. We abstracted data on results of RT-PCR and RAT (positive and negative), age, sex, the test kit used, the time duration between samples taken for RT-PCR and RAT, and the presence of symptoms (cough, fever, sore throat, and generalised body ache) from the records of subjects for further analysis. Participants were classified as "symptomatic" if any of the symptoms were present. We used IBM Statistical Package for Social Sciences (SPSS) software (IBM Corp., released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.) for data analysis. Qualitative variables were summarised using percentages, and quantitative variables were summarised using mean (SD) and median (IQR). Keeping in mind the binary outcome of RT-PCR and RAT, Cohens Kappa Coefficient () and agreement percentage (accuracy) were calculated. Kappa was classified as <0.00: poor, 0.00-0.20: slight agreement, 0.21-0.40: fair agreement, 0.41-0.60: moderate agreement, 0.61-0.80: substantial agreement, and 0.81-1.00: almost perfect agreement [11]. P-values <0.05 were considered significant throughout. All digital records were password protected, and only the chief investigator had access to them. The reporting was done as per the guidelines for reporting reliability and agreement studies (GRRAS) checklist [12].
We shortlisted 124 subjects, out of which 24 were excluded owing to incomplete information or other lacunae. Data on 100 subjects were finalised for analysis, which met all the inclusion and exclusion criteria. Fifty-eight (58%) were males and 42 (42%) were females, with ages ranging from two to 88 years. The mean age was 39.8 (SD 19.0) years; the median age was 39 years (IQR 25.5-55 years).
Out of 100 subjects, 13 tested positive and 87 tested negative on both RT-PCR and RAT, with eight discordant pairs. Cohens kappa showed substantial agreement, =0.646, (95% CI 0.420 to 0.871), p<0.001 (Table 1).
The Kappa varied with the intervals between taking samples for tests. Figure 1 shows this variation when the sample was collected on the same day and with a one-day difference, with accuracies of 95.1% and 88.9%, respectively. Both were statistically significant, with p-values <0.000 and <0.001 respectively.
When stratified based on the presence or absence of symptoms, 31 participants were symptomatic, having at least one of the symptoms, and 69 were asymptomatic. The corresponding kappa values were =0.59 (95% CI 0.28 to 0.91), p<0.001 and =0.64 (95% CI 0.27 to 1.0), p<0.001, showing moderate and substantial agreement among symptomatic and asymptomatic participants, respectively.
On RT-PCR, out of 13 participants who tested positive and 87 who tested negative, respectively, nine (69.2%) and 22 (25.3%) were symptomatic. Likewise, on the RAT, out of 13 participants who tested positive and 87 who tested negative, the number of symptomatic participants was eight (61.5%) and 23 (26.4%), respectively.
This study investigated the agreement between these two tests for SARS-CoV-2 detection with the help of Cohens Kappa [11]. Since the commencement of RAT testing in India, few reliable kits have been available. At that time, an independent two-site study of the sole available or stand-alone antigen detection assay in India, STANDARD Q COVID-19 Ag detection kit, was performed to assess its sensitivity, specificity, and practicality of application as a point-of-care test for early detection of SARS-CoV-2. However, the agreement between the two tests was not tested or mentioned. There are very few studies that have evaluated the agreement between these two tests. The majority of the papers available in the literature have evaluated diagnostic accuracy mainly using sensitivity and specificity [13-16]. With a Cohens kappa, =0.646, (95% CI 0.420 to 0.871), p<0.001, our study showed a substantial agreement between the two tests.
Jskelinen et al. [17] evaluated the performance of three rapid diagnostic tests (RDTs), viz., Sofia, STANDARD Q and Panbio and found overall agreements of 84.57%, 84.85%, and 86.32%, respectively, with a kappa value of 0.636, 0.633, and 0.660, respectively. This is similar to the results of our study on the STANDARD Q COVID-19 Ag detection kit. The study by Pea M et al. [18] on 854 asymptomatic individuals from the Chilean region calculated an accuracy of 97.04% with a kappa value of 0.78 (95% CI 0.70-0.86), which showed better performance than that of our study. Felipe PrezGarca et al. [19] did a retrospective comparative evaluation between two antigen rapid diagnostic tests (Ag-RDTs), viz., Panbio and SD-Biosensor, for detection of SARS-CoV-2 and found agreement in accuracy and values of 80.9% and 0.596 and 82.6% and 0.646, respectively. The results were similar to our study. They also concluded that RDTs were excellent for the diagnosis of high viral load samples and those early in the disease.
Risti M et al. [20] evaluated the clinical performance of the STANDARD Q COVID-19 Ag Test (SD Biosensor, Gyeonggi-do, South Korea) by analysing prospectively collected data on 120 symptomatic patients and concluded a strong agreement between the STANDARD Q COVID-19 Ag Test and RT-PCR with a kappa of 0.852 and a pooled accuracy of 92%, whereas our study reported a similar agreement percentage and a =0.59 (95% CI 0.28 to 0.91), p<0.001 among symptomatic patients. This difference could be explained by the fact that they included suspects who were in their first five days of illness, whereas our sample included a mix of suspects who had samples taken on various days after symptoms began.
Among the studies done in India, the strength of agreement between these two tests ranged from moderate to almost perfect. A prospective study [21] done among 756 patients from a district hospital in North India shows a substantial agreement like ours with a value of 0.6482 (95% CI: 0.5801 to 0.7163). However, Pandey et al. found moderate agreement between these two tests [22]. The reported value in their retrospective study was 0.57. Whereas, a value of 0.86 was reported by Gupta et al. in their study, which showed almost perfect agreement between RAT and RT-PCR [23].
In contrast, findings by Amer RM et al. in their cross-sectional study [24] on 83 COVID suspects showed much less agreement with a kappa of 0.3 (95% CI 0.16-0.59) and an accuracy of 75.9%, recommending against using RAT alone for COVID-19 diagnosis. With a smaller sample size in the Amer RM study, this sharp contrast between results needs to be interpreted carefully.
Owing to the pandemic, logistical hurdles, and the retrospective nature of the study, we did not have control over the quality of samples for both tests. However, we considered only those participants for whom the sample was taken from the recommended site as mentioned by the kit manufacturer. We also could not consider the order in which the tests were conducted. However, we did take into account the time difference (in days) between collecting samples for the respective tests. The time interval between symptom onset and sample collection could not be recorded, even though the number of subjects included in the analysis is more than the minimum required sample size calculated with the given precision. However, evidence from a larger sample study would have been more conclusive.
Evaluating the ease of conducting tests, the quick results, the lack of requiring a laboratory setup, the affordability, and the substantial agreement (=0.646, 95% CI 0.420 to 0.871, 92% agreement accuracy) with RT-PCR, we conclude that RAT may be a better choice for detecting SARS-CoV-2 and hence COVID-19 disease on a large scale. However, larger prospective studies would be needed to substantiate our findings.
