Nobody wants to contract theMarburgvirus.
It's one of the deadliest viruses we know of, with case fatality rates of around 88%. Its unlucky victims can expect to suffer symptoms similar to those caused by fellow filovirusEbola fever, joint pain, body weakness, stomach pain, diarrhoea. Bloody vomit and faeces, along with spontaneous bleeding from the nose, gums, vagina, and the holes left by hypodermic needles might follow. Death on day eight or nine of symptoms is typical.
The bad news: since the virus's advent in the late 1960s, there have been several grisly outbreaks on the African continent,withtwooccurring in 2023 alone. There isno proven treatment.
The good news: scientists are working on a vaccine.
One candidate vaccine, developed by the Sabin Vaccine Institute, iscurrently undergoing phase 2 trialsat the Makerere University Walter Reed Project (MUWRP) in Kampala, Uganda.VaccinesWorkcaught up with Dr Betty Mwesigwa, the principal investigator on that trial, to learn more.
Following on from encouraging phase 1 trials conducted in the United States, the ongoing trial a randomised, placebo-controlled, double-blind study has so far enrolled more than 20 of the targeted 63 healthy volunteers aged between 18 and 50 years of age, Mwesigwa says. (They have only so far recruited from the younger cohort.)Sixty-two otherswill be recruited at a second study site in Kenya the Kenya Medical Research Institute in Siaya.
But Dr Mwesigwa is quick to clarify that nobody is injecting anybody with Marburg: killed, modified, or otherwise.
"It's crucial to understand that this vaccine doesn't use a live or killed form of the actual germ. These vaccines for infectious diseases, especially those with no cure and which are fatal, are produced artificially in a laboratory," she explains. The vaccines contain mimics of the germ, and when the body encounters these mimics, it reacts as if facing the real threat, fostering immunity without the risk of contracting the actual infection.
The Marburg vaccine, like many, butnot all, others, operates preventively, Mwesigwa explains, meaning that it is administered before an individual contracts the infection. The aim is to sensitise the body to the germ, prompting the production of defensive elements metaphorically, immune 'soldiers' equipped to combat the infection.
Over time, this new army of 'soldiers' naturally diminishes, but the body retains a memory of the germ. In the event of future exposure, the body responds rapidly and effectively, ready to combat the familiar threat.
The current trial's job is to evaluate safety and the ability of the vaccine to stimulate immune responses, Mwesigwa says. The researchers are looking to assess the magnitude of the response and its duration understanding, in other words, how many 'soldiers' the body mobilises, their effectiveness, and how long they persist all of which is crucial information.
"When examining immune responses, we consider both their breadth and frequency. The breadth signifies the range of threats the immune system can combat whether it's one, two, or several," she adds.
Understanding whether a response is modest or robust, identifying its peak and duration, is "paramount in our pursuit of a successful outcome", says Mwesigwa.
If the predefined objectives are successfully met, Sabin who chose MUWRP as its partner for the phase 2 trial may opt to proceed to phase 3.
However, typically, phase 3 trials necessitate an outbreak setting with a sizable population at high risk, but not yet infected. Vaccination is administered, and subsequent infections are closely monitored to test efficacy. "So, if we got a Marburg outbreak after this trial we would be able to give it to people and test efficacy," says Mwesigwa speaking theoretically.
That's not unfeasible Uganda has seen four Marburg outbreaks, in 2017, 2014, 2012 and 2007.
But anticipating a fifth a necessarily frightening prospect is not the only option. While an outbreak setting is an ideal proving ground for a vaccine in for phase 3 trials, in its absence, extrapolating data from animal trials and phase 2 becomes crucial.
But getting to that point is still a big "if". While the team hopes for the best outcomes, they also acknowledge that finding vaccines for infectious diseases is not easy, and that the process to find an efficacious and safe one is a long and uncertain road.
At the MUWRP site, for instance, they have previously conducted a trial for a combination vaccine comprising the antigens for Ebola Zaire, Marburg, Ebola Sudan, Tai Forest and Ebola Bundibugyo viruses.
Although the combination vaccine demonstrated safety in trials, Mwesigwa says, the immune responses observed were not highly protective. The combination vaccine's efficacy against each virus individually was uncertain, necessitating separate evaluations for each disease. That combination vaccine has not made it to market but lessons were learned and will be used for future vaccines.
The current Marburg candidate, of course, is already partway down the road to proving itself. The phase I trials conducted in the US found it safe and capable of eliciting rapid and robust immune responses the promising rationale for this next evaluation.
And if it isn't the vaccine's first rodeo, it certainly isn't Mwesigwa's.
Currently serving as the Deputy Executive Director at MUWRP, Mwesigwa is a medical doctor by background, with an expertise in clinical research, a master's degree in clinical trials and 20 years of experience on the job. After participating in more than a dozen clinical trials, Mwesigwa says vaccines are a crucial curb on infectious diseases both those we know, and those yet to emerge.
"Even new infections will come because of population growth and continuous interference with the ecosystem. People need [a place] to live, and we are interfering a lot with animal space. The interaction is likely to bring infections we have never known and thought about. That's why surveillance is critical," she explains.
Developing vaccines quickly will be crucial. Often, she says, by the time an outbreak is diagnosed and identified, lives have already been lost. "But if we had vaccines, much like the systematic roll-out of childhood vaccines, it would be easy to have populations that are prepared against the diseases we know, and then maybe we wait to fight the ones we don't know yet," she says.
Being part of that mission of discovery clearly motivates Mwesigwa but not at the expense of concern for the well-being of trial volunteers.
"For me, the most beautiful part so far, [is] that the studies I have led or been part of we don't have major side-effects, which are like deaths of participants or [participants left] with disabilities. That is overwhelmingly pleasing."
State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming Puerto Rico US Virgin Islands Armed Forces Americas Armed Forces Pacific Armed Forces Europe Northern Mariana Islands Marshall Islands American Samoa Federated States of Micronesia Guam Palau Alberta, Canada British Columbia, Canada Manitoba, Canada New Brunswick, Canada Newfoundland, Canada Nova Scotia, Canada Northwest Territories, Canada Nunavut, Canada Ontario, Canada Prince Edward Island, Canada Quebec, Canada Saskatchewan, Canada Yukon Territory, Canada
Zip Code
Country United States of America US Virgin Islands United States Minor Outlying Islands Canada Mexico, United Mexican States Bahamas, Commonwealth of the Cuba, Republic of Dominican Republic Haiti, Republic of Jamaica Afghanistan Albania, People's Socialist Republic of Algeria, People's Democratic Republic of American Samoa Andorra, Principality of Angola, Republic of Anguilla Antarctica (the territory South of 60 deg S) Antigua and Barbuda Argentina, Argentine Republic Armenia Aruba Australia, Commonwealth of Austria, Republic of Azerbaijan, Republic of Bahrain, Kingdom of Bangladesh, People's Republic of Barbados Belarus Belgium, Kingdom of Belize Benin, People's Republic of Bermuda Bhutan, Kingdom of Bolivia, Republic of Bosnia and Herzegovina Botswana, Republic of Bouvet Island (Bouvetoya) Brazil, Federative Republic of British Indian Ocean Territory (Chagos Archipelago) British Virgin Islands Brunei Darussalam Bulgaria, People's Republic of Burkina Faso Burundi, Republic of Cambodia, Kingdom of Cameroon, United Republic of Cape Verde, Republic of Cayman Islands Central African Republic Chad, Republic of Chile, Republic of China, People's Republic of Christmas Island Cocos (Keeling) Islands Colombia, Republic of Comoros, Union of the Congo, Democratic Republic of Congo, People's Republic of Cook Islands Costa Rica, Republic of Cote D'Ivoire, Ivory Coast, Republic of the Cyprus, Republic of Czech Republic Denmark, Kingdom of Djibouti, Republic of Dominica, Commonwealth of Ecuador, Republic of Egypt, Arab Republic of El Salvador, Republic of Equatorial Guinea, Republic of Eritrea Estonia Ethiopia Faeroe Islands Falkland Islands (Malvinas) Fiji, Republic of the Fiji Islands Finland, Republic of France, French Republic French Guiana French Polynesia French Southern Territories Gabon, Gabonese Republic Gambia, Republic of the Georgia Germany Ghana, Republic of Gibraltar Greece, Hellenic Republic Greenland Grenada Guadaloupe Guam Guatemala, Republic of Guinea, Revolutionary People's Rep'c of Guinea-Bissau, Republic of Guyana, Republic of Heard and McDonald Islands Holy See (Vatican City State) Honduras, Republic of Hong Kong, Special Administrative Region of China Hrvatska (Croatia) Hungary, Hungarian People's Republic Iceland, Republic of India, Republic of Indonesia, Republic of Iran, Islamic Republic of Iraq, Republic of Ireland Israel, State of Italy, Italian Republic Japan Jordan, Hashemite Kingdom of Kazakhstan, Republic of Kenya, Republic of Kiribati, Republic of Korea, Democratic People's Republic of Korea, Republic of Kuwait, State of Kyrgyz Republic Lao People's Democratic Republic Latvia Lebanon, Lebanese Republic Lesotho, Kingdom of Liberia, Republic of Libyan Arab Jamahiriya Liechtenstein, Principality of Lithuania Luxembourg, Grand Duchy of Macao, Special Administrative Region of China Macedonia, the former Yugoslav Republic of Madagascar, Republic of Malawi, Republic of Malaysia Maldives, Republic of Mali, Republic of Malta, Republic of Marshall Islands Martinique Mauritania, Islamic Republic of Mauritius Mayotte Micronesia, Federated States of Moldova, Republic of Monaco, Principality of Mongolia, Mongolian People's Republic Montserrat Morocco, Kingdom of Mozambique, People's Republic of Myanmar Namibia Nauru, Republic of Nepal, Kingdom of Netherlands Antilles Netherlands, Kingdom of the New Caledonia New Zealand Nicaragua, Republic of Niger, Republic of the Nigeria, Federal Republic of Niue, Republic of Norfolk Island Northern Mariana Islands Norway, Kingdom of Oman, Sultanate of Pakistan, Islamic Republic of Palau Palestinian Territory, Occupied Panama, Republic of Papua New Guinea Paraguay, Republic of Peru, Republic of Philippines, Republic of the Pitcairn Island Poland, Polish People's Republic Portugal, Portuguese Republic Puerto Rico Qatar, State of Reunion Romania, Socialist Republic of Russian Federation Rwanda, Rwandese Republic Samoa, Independent State of San Marino, Republic of Sao Tome and Principe, Democratic Republic of Saudi Arabia, Kingdom of Senegal, Republic of Serbia and Montenegro Seychelles, Republic of Sierra Leone, Republic of Singapore, Republic of Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia, Somali Republic South Africa, Republic of South Georgia and the South Sandwich Islands Spain, Spanish State Sri Lanka, Democratic Socialist Republic of St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan, Democratic Republic of the Suriname, Republic of Svalbard & Jan Mayen Islands Swaziland, Kingdom of Sweden, Kingdom of Switzerland, Swiss Confederation Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand, Kingdom of Timor-Leste, Democratic Republic of Togo, Togolese Republic Tokelau (Tokelau Islands) Tonga, Kingdom of Trinidad and Tobago, Republic of Tunisia, Republic of Turkey, Republic of Turkmenistan Turks and Caicos Islands Tuvalu Uganda, Republic of Ukraine United Arab Emirates United Kingdom of Great Britain & N. Ireland Uruguay, Eastern Republic of Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam, Socialist Republic of Wallis and Futuna Islands Western Sahara Yemen Zambia, Republic of Zimbabwe
Blantyre, Malawi
The Malawi government and the World Health Organization launched a new COVID-19 vaccination campaign on Monday in 10 of the countrys 29 districts. This is partly in response to new cases confirmed in the past three weeks in several districts across the country.
Nsanje District in southern Malawi currently leads in the number of COVID-19 cases recorded this year.
George Mbotwa, spokesperson for the district health office, said the district has registered 17 new cases in the past three weeks and some are health workers.
Initially there were two, but we had up to eight cases that were health workers, he said. Some of them have now been confirmed as negative, and others are being followed up to ensure that they are fully recovered before they can resume work.
By Monday, Malawi cumulatively recorded 89,202 confirmed COVID-19 cases, including 2,686 deaths, since the first cases were confirmed in the country in April 2020.
Malawis Ministry of Health says the new vaccination campaign will help boost the number of people getting the COVID-19 vaccine. Vaccination rates in some areas of Malawi are as low as 40%.
It also says the WHO-funded campaign would help avoid waste of the vaccine as was the case in 2020 when the government destroyed nearly 20,000 expired AstraZeneca doses.
Many of those doses expired due to vaccine hesitancy amid concerns of its safety and efficacy.
However, recent government public health campaigns on the importance of COVID-19 shots have helped defeat that hesitancy.
Mary Chawinga, a mother of two of Machinjiri Township in Blantyre, said she has had the vaccine and is awaiting a booster.
And I am ready to take my children, because prevention is better than [a] cure they say, Chawinga said. You never know how the wave will be like this time around considering the way it was way back in 2020. We have had it in 2021, and now this is 2024.
Another mother of two, Habeeba Nyasulu, said she received the COVID-19 doses during the first campaign and encourages others to get the shot.
I know that we are not safe until everyone is safe, she said. So, let others also receive the vaccine. I know that the vaccine does not prevent us from getting infected, but it helps us when we contract it not to be critically ill.
Maziko Matemba is a community health care ambassador in Malawi, said the COVID-19 threat is still present in the country.
Malawi didnt vaccinate a required number of people against COVID-19, because the targeted population was about 11 million Malawians, Matemba said. But we were less than half about 2 or 3 million Malawians who were able to get vaccinated.
Matemba said the country now needs to have the vaccine in the right places and encourage more people to get vaccinated.
The Ministry of Health says the new campaign targets 10 of the countrys 29 health districts that have recently recorded new cases. These include Machinga, Blantyre, Dowa, Mzimba and Nsanje districts.
This article has been reviewed according to ScienceX's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility:
fact-checked
peer-reviewed publication
trusted source
proofread
close
The COVID-19 pandemic was an especially harrowing time for pregnant people and new parents.
The uncertainties about how the new coronavirus could affect a pregnant person and their developing fetusnot to mention being cut off from support networksleft many expecting parents feeling isolated and anxious.
"It was a very surreal time," says Jenny Doyle, a Toronto mom who gave birth to her first child, Elliott, in 2020 and spent hours researching how the first vaccines made available the following year might affect her and her child. "At the time, vaccines for infants were still so far away. I remember hoping that some of the protection I'd received from my vaccine would pass through to Elliott."
Now, new findings from a study led by researchers at the University of Toronto and its partner hospitals suggest that is the case.
Published in the American Journal of Clinical Nutrition, the study looked for antibodies against SARS-CoV-2 in breast milk from three different cohorts: individuals who contracted COVID-19 while pregnant or nursing, routine milk bank donors and individuals who received two doses of the COVID-19 vaccine while pregnant or nursing.
The researchers detected antibodies in breast milk from roughly half of the people in the COVID-19 positive cohort. That's compared to less than 5 percent of routine milk bank donors, who did not have any known exposures to COVID-19. In the vaccinated cohort, they found that antibodies levels were higher in people who had received the Moderna vaccine compared to those who had received the Pfizer-BioNTech vaccine. Unexpectedly, people who had shorter intervals between their first and second doses had higher antibody levels than those who waited longer between their immunizations.
"That finding definitely surprised me," says Samantha Ismail, the study's first author who completed her master's degree in the lab of Deborah O'Connor, the Earle W. McHenry Professor and chair of Temerty Medicine's department of nutritional sciences. "In [blood] serum, it's the other way around where longer intervals between doses typically result in higher antibody levels, suggesting that something different is happening in this lactating population."
In addition to Ismail and O'Connor, the study was led by Sharon Unger, medical director of the Roger Hixon Ontario Human Milk Bank at Sinai Health and a U of T professor of medicine and nutritional sciences, and Susan Poutanen, microbiologist and infectious disease consultant and Sinai Health and U of T associate professor of laboratory medicine and pathobiology.
The team took the study one step further by showing that some breast milk samples could prevent SARS-CoV-2 from infecting cells in a lab setting. Within the COVID-19 positive cohort, milk that contained antibodies against the virus were more likely to be neutralizing and immunization with the Moderna vaccine was associated with a stronger neutralizing capacity than the Pfizer-BioNTech vaccine.
The researchers also found a small but significant number of breast milk samples that prevented SARS-CoV-2 infection despite having undetectable levels of antibodies, suggesting that there could be other components in human milk that are active against SARS-CoV-2.
While these findings provide strong evidence to support the potential protective effects of human milk, Ismail cautions that the study alone is not enough to prove that breast milk provides tangible protection against COVID-19.
"COVID-19 vaccination and infection result in antibodies in human milk that have neutralizing capacity, but we don't know for sure how the neutralizing capacity seen in the lab translates to protection in infants," says Ismail, who is now a second-year medical student at U of T.
She points out that previous studies have shown a clear protective effect of antibodies in human milk against other viruses like enterovirus and rotavirus. To date, such studies have not been done with COVID-19.
Even so, the findings provide reassuring news to parents like Doyle, who breastfed her son longer than she had intended to ensure that he was still getting breast milk when she received her second COVID-19 vaccine.
"Trying to figure out how to protect this tiny being in that scary and bleak time, I was grasping at every little piece of information and whatever little piece of hope we had."
More information: Samantha Ismail et al, SARS-CoV-2 antibodies and their neutralizing capacity against live virus in human milk after COVID-19 infection and vaccination: prospective cohort studies, The American Journal of Clinical Nutrition (2023). DOI: 10.1016/j.ajcnut.2023.10.008
Journal information: American Journal of Clinical Nutrition
A new study found the risk of developing respiratory distress (RD) among SARS-CoV-2 exposed uninfected (SEU) full-term neonates to be uniquely high. However, the study also found that maternal vaccination reduced the incidence of the condition. Findings from the UCLA-led study were published in Nature Communications.1
Although prior research has examined links between RD and SEU neonates, the associations have often been attributed to well-studied risk factors like maternal hypoxia and multiorgan failure that cause premature delivery. Addressing a gap in the relevant literature, investigators noted that these previously cited factors do not apply to cases of RD among infants born at full term.
Using information about the clinical features of RD in SEU infants, the effect of maternal vaccination on infant RD, and proteomic measures to identify unique proteins expressed in SEU infants, investigators explored the impact of in utero COVID-19 exposure on the development of RD among full-term neonates.
We found unusually high rates of respiratory distress shortly after birth in the full-term babies born to mothers who had COVID-19 during pregnancy, said Karin Nielsen, MD, senior study author and professor of pediatrics in the division of pediatric infectious diseases at the David Geffen School of Medicine at UCLA in a press release.2 The mothers had not been vaccinated prior to acquiring COVID, indicating that vaccination protects against this complication.
In total, 221 pregnant persons with COVID-19 and 199 COVID-19 exposed infants were included for analysis in the longitudinal cohort study conducted between April 2020 and August 2022. Among 151 (68%) mothers that were unvaccinated, 16% (23) experienced severe or critical disease, whereas only 4% (3) of vaccinated mothers experienced severe or critical disease, demonstrating the protection that vaccination grants against disease severity.
Although none of the infants tested positive for SARS-CoV-2 at birth, 17% (34) were diagnosed with RD. Maternal vaccination before COVID-19 infection was associated with a significantly lower rate of respiratory distress in infants; among the 34 infants born with RD, only 15% (5) were born to vaccinated mothers (P = .012). In contrast, 41% (63) of infants without RD were born to vaccinated mothers.
Study results also demonstrated that the prevalence of severe or critical COVID-19 in mothers was significantly higher among infants with RD (21%) compared to those without RD (6%) (P = .009). Investigators noted that when pregnant patients received at least 1 mRNA vaccine dose prior to SARS-CoV-2 infection, the odds of developing RD among neonates decreased by 67% (OR: 0.33, 95% CI: 0.100.96).
Proteomic evaluation found that exposure to SARS-CoV-2 activated an inflammatory cascade that dysregulated the ciliary function pathway and amplified immunoglobulin E production among neonates.1
Whereas prior research has studied the link between premature infants and RD, current results offer insight into how the condition presents at a later gestational age.
Not only do our results show higher rates of respiratory distress in SARS-CoV-2 exposed uninfected infants when compared to the general population, but we observed more cases of respiratory distress at later gestational ages than anticipated, when neonates should presumably have more mature lung anatomy, said investigators.
In light of study findings demonstrating the benefit of COVID-19 vaccination on the health of both mother and infant, investigators emphasized the importance of public health interventions as they contribute to improved well-being among the parties.
Our findings can help inform the mechanisms by which maternal SARS-CoV-2 infection during pregnancy may impact fetal development and neonatal outcomes, investigators wrote. Moreover, our study highlights the importance of public health interventions and vaccination efforts that target pregnant individuals due to the potential for lasting effects on the health of both the mother and the infant.
Danish seniors who received the quadrivalent (four-strain) high-dose influenza vaccine (QIV-HD) had fewer hospitalizations for flu and other conditions compared to their peers who received the standard quadrivalent flu vaccine (QIV-SD), according to a post-hoc analysis published late last week in Clinical Microbiology and Infection.
The trial took place during the Northern Hemisphere's 2021-22 flu season. Researchers enrolled 12,477 participants, 6,245 who received QIV-HD and 6,232 who got the QIV-SD. Overall mean age was 71.1, and 47.1% were women. Just over 20% had underlying cardiovascular disease.
The researchers looked at a number of outcomes when comparing the two groups, beginning 14 days after vaccination until May 2022. Hospitalizations for pneumonia or influenza, respiratory hospitalizations, cardiorespiratory hospitalizations, cardiovascular hospitalizations, all-cause hospitalizations, and all-cause death.
The investigators found that receiving QIV-HD was associated with lower rates of hospitalization for flu and pneumonia10 events in the QIV-HD group compared with 33 in the QIV-SD group. Incidence rate ratio (IRR) was 0.30 (95% confidence interval [CI], 0.14 to 0.64), meaning 60% greater protection.
Trends favoring QIV-HD were observed over time, even before the flu season was under way. The team found the first statistically significant reductions in flu and pneumonia hospitalizations by the third calendar week of 2022. There were 5 such events in the QIV-HD group versus 15 in the QIV-SD group. IRR was 0.33 (95% CI, 0.11 to 0.94).
The researchers concluded that the impact on less specific outcomes outside of influenza circulation periods supports earlier findings, including from similar trivalent (three-strain) flu vaccines, that suggest broader effects from flu vaccination.
"Our exploratory results correspond to a number needed to treat of 65 (95% CI 35-840) persons vaccinated with QIV-HD compared with QIV-SD to prevent one additional all-cause hospitalisation per season," the authors wrote. "Further research is needed to confirm these hypothesis-generating findings."
CLEVELAND, Ohio -- With flu season in full swing, the Cleveland chapter of the Alzheimers Association is urging residents to keep their vaccines up to date.
Apart from the protection against influenza -- by either preventing catching the disease or reducing the severity of its impact -- experts now believe the vaccination against flu may have strong benefits in helping prevent the onset of Alzheimers and other dementias.
Annual flu vaccinations offer protection against the flu virus, but we are discovering that they also improve long-term health outcomes, such as reducing our risk for Alzheimers, cardiac arrest and hospitalizations due to diabetes, said Mary Ertle, program director for the Alzheimers Association Cleveland Area and Greater East Ohio chapters.
Flu vaccines may not prevent someone from getting the flu, but they will lessen symptoms and reduce hospitalizations, she said.
Annual flu vaccines protect against four different viruses, based on the strains that are expected to be dominant this season. Some flu seasons are worse than others, depending upon which viruses are circulating.
Ertle added that recent research published in the Journal of Alzheimers Disease, a study of nearly 2 million participants showed that people who do not get vaccinated against influenza have a 60 percent higher chance of developing Alzheimers or another dementia than people who get their flu shot.
She said it is not clear why the flu vaccine resulted in such a substantial reduction in the risk of developing Alzheimers at this stage, but it is thought that the vaccine might train the immune system to respond to beta-amyloid protein plaques -- a key part of Alzheimers pathology.
Researchers found the protective association between the flu vaccine and the risk of Alzheimers was strongest for those who received their first vaccine at a younger age.
There are 493,000 people caring for 220,000 Ohioans aged 65 and older living with Alzheimers disease, according to the Alzheimers Association.
Those concerned about themselves or a loved one can contact the Alzheimers Association Cleveland Area Chapter at 216-342-5556 to schedule a care consultation and be connected to local resources.
Cell-based influenza vaccine development and distribution may be more effective for reduced disease burden among children as well as more cost-efficient than egg-based vaccine options, according to findings from a new model analysis.1
Data derived from a Taiwan-based age-stratified static model interpreting base case and high egg-based vaccine adaptation scenarios predicted that switching from a primary national plan of egg-based vaccines to cell-based vaccines for the flu would significantly reduce the impact of the seasonal virus at a lesser production and distribution cost. The findings warrant consideration toward adopting the model as a vaccination policy specifically for the pediatric population, investigators noted.
Led by Chia-Yu Chi, of the National Institute of Infectious Diseases and Vaccinology under the National Health Research Institutes in Taiwan, the team of investigators designed a prediction model to compare the cost-effectiveness of cell-based versus egg-based quadrivalent flu vaccines in the pediatric population aged 6 months to 17 years old, under Taiwans national immunization program. Though cell-based options have been included in the national program since 2020, there had been no previous analysis into its cost-related benefit among the pediatric populationwhich would help to potentially optimize national vaccination strategies for such children.
Compared with (egg-based vaccines), cell-based quadrivalent influenza vaccine is anticipated to have improved fidelity to the vaccine strains selected by the World Health Organization (WHO), which, in turn, is expected to result in improved vaccine efficacy, they wrote. The vaccine efficacy advantages of (cell-based) may be more pronounced against A/H3N2 and in seasons in which egg adaptation occurs during the egg-based manufacturing process. Several real-world studies also suggest that (cell-based) may be more effective than standard-dose egg-based influenza vaccines in preventing influenza and influenza-related outcomes, particularly in seasons in which egg adaptation occurs, across various age ranges.
Chi and colleagues model exposed patients to different probabilities of flu infection based on model entry-based vaccination status, with assumptions being made that all patients infected with influenza would be initially treated at outpatient facilities or emergency departments (EDs), and that some patients would require inpatient care dependent on infection severity ands risk of death. Their outcomes included total cases of flu, ED visits, flu-related complications, hospitalizations, deaths and quality-adjusted life years (QALYs). Both medical (vaccination and treatment related) and societal costs (relevant transportation, productivity loss, and premature death) were factored into cost outcomes.
The team conducted deterministic and probabilistic sensitivity analyses, with an incremental cost-effective ratio (ICER) threshold of $99,177 USD per QALY.
Their analysis showed that cell-based quadrivalent flu vaccines would prevent 15,665 flu cases, 2244 complicated cases, and 259 hospitalizations annually compared to egg-based quadrivalent flu vaccines.
Though vaccination total costs were approximately $4.5 million USD greater with cell-based vaccines, the model showed the option would save approximately $990,000 USD in treatment costs due to flu infections among pediatric patients annually versus the egg-based vaccine. Regarding societal costs, the cell-based vaccines were predicted to save Taiwan more than $1.4 million USD annually through reduced caregiver, transportation and premature death costs, versus egg-based vaccines.
In combined medical and societal costs, the predictive model suggested cell-based vaccines ($96.6 million USD) would be within approximately $2 million USD annually compared to egg-based vaccines ($94.5 million USD) in treating pediatric influenza in Taiwan annually. The team additionally observed improved QALY (n = 70 annually) with cell-based vaccines versus egg-based vaccines. Whats more, predictive data suggest the medical and economic benefits of a cell-based quadrivalent vaccine would be even greater in seasons with a high egg adaptation observed in the circulating flu strain.
To the best of our knowledge, this is the first study to compare the cost-effectiveness of (cell-based) versus (egg-based quadrivalent flu vaccines) in the Taiwanese pediatric immunization strategy, investigators noted. We have employed valid and effective modeling design that is deemed adequate to assess influenza strategies and our findings appear to be directionally consistent with the conclusions from previously published studies in the general population. Based on our study, universal vaccination with quadrivalent influenza vaccines in the Taiwanese pediatric (6 months to 17 years) population could help reduce the burden of influenza and associated health costs.
They concluded that national policymakers may want to consider the findings of this and supplementary clinical and economic-based evaluations in their work toward a more optimized pediatric influenza vaccination strategy.
Reference
Chi CY, Cheng MF, Ko K, et al. Cost-effectiveness analysis of cell-based versus egg-based quadrivalent influenza vaccines in the pediatric population in Taiwan. J Med Virol. 2024;96(1):e29279. doi:10.1002/jmv.29279
Flu vaccination rates are down across the country, including in East Tennessee.
KNOXVILLE, Tenn. Flu vaccination rates are continuing to drop, including in East Tennessee.
According to the Centers for Disease Control and Prevention, around 155 million doses of the flu vaccine were distributed by the end of last year, compared to more than 170 million doses around two years ago.
The CDC is still listing Tennessee as "very high" when it comes to flu-like activity. That's the highest ranking a state can get.
Flu vaccination rates are down across the country and Dr. Corinne Tandy, the division director of epidemiology for the Knox County Health Department, said it's no different in Tennessee.
"Flu shot coverage has always been a little bit tricky because it changes every year. You have to do it every year," said Dr. Tandy. "And so it's hard to say exactly why people may be getting vaccinated less right now. But, we have seen an overall decline in several other vaccinations since the COVID pandemic. And so it might be related."
Dr. Tandy said in Knox County, flu and other respiratory illness activity was starting to go down ahead of a recent winter storm.
"We are fairly confident that it's not necessarily due to people not getting tested because of the snow," said Dr. Tandy. "So, we're seeing a decrease in other respiratory viruses like RSV, and COVID, as well."
But now that people are back to their normal schedules, that could change.
"It's really going to depend a lot on the community level circulating, you know. Because folks may go back to school, for example, or some other, you know, kind of larger gathering like that," said Dr. Tandy. "And you know, it may spread through there. So we may see some blips, but it may not in some communities, and we may see it in others. So I'm not sure if we're going to see a small bump in those cases. I wouldn't be surprised if we saw a little bit of a bump, but we seem to be starting the back end of the season. It looks like we've probably gone past the peak of the season, but flu season can be unpredictable."
She says flu activity is also something that is not directly tracked.
"We don't get reports of individual cases of influenza, but pharmacies and stuff keep track of prescribing practices," said Dr. Tandy. "But sometimes, it's always a little tricky because sometimes people get prescribed, not the correct medicine. And it could be the flu, but maybe not. And so it's a little hard to use those. That's why we try to use these indicators of like, 'Okay, people are visiting the doctor with fever and respiratory symptoms.' That way, we're not only thinking about flu, but we're thinking about all the other stuff that is going around. And so we'd like to keep an eye on that level of activity rather than those specific indicators."
She also said she can't say for certain if there is a link between high flu activity and low vaccination rates, but those who do get vaccinated have a lower risk of severe illness.
"In really severe respiratory seasons when we're about middle of the season, when people are getting more sick, we're seeing more cases. I think that kind of prompts some people to say, 'You know what? I will get vaccinated,'" she said.
Dr. Tandy also said although the peak of flu season is coming to an end, it is still not too late to get a flu shot. Flu season usually ends in late March or April.
California's relaxed COVID isolation guidance marks a milestone in public health messaging about the pandemic: Even newly infected people no longer need to isolate if they have no symptoms, or they can leave home sooner if the illness starts improving quickly.
California's stance is even looser than that of the U.S. Centers for Disease Control and Prevention, which advises isolating for at least five days after the onset of symptoms or, if asymptomatic, after the first positive test.
The changing recommendations, which have gained attention as the winter COVID wave shows signs of cresting in California, underscores the evolving nature of the coronavirus threat.
But they come with one vital warning. Health officials say infected people who venture out need to mask up. If they don't, they could easily transmit the coronavirus to others.
Read more: 'If it's COVID, Paxlovid'? For many, it should be easier to get. Here's what to know about antivirals
Dr. Peter Chin-Hong, a UC San Francisco infectious disease expert, said he thinks California's new isolation guidance makes sense, but "the only sort-of worry I have is that people are not going to do the mask part, but they're just going to focus on the fact that you don't have to stay home for five days.
"People focus on what has changed, but they don't focus on what hasn't changed," Chin-Hong said. "Masks should really be part of normal life, like if you're sick or you have symptoms, put the mask on regardless of what you have; it could be COVID, a cold, RSV, influenza."
The guidance says masks should be well-fitting and have optimal filtration; ideally, an N95, KN95 or KF94 model.
Read more: California relaxes COVID isolation guidance. What you need to know
It's also important that those who do have symptoms test themselves.
"Some days, it might be an allergy, but some days it might be that you did pick up COVID," said Dr. Daisy Dodd, an infectious diseases specialist with Kaiser Permanente Orange County.
California's new guidance says that people who have COVID-19 symptoms need to isolate and test themselves. An early negative test may not mean the person doesn't have COVID; the CDC suggests testing again two and four days after the onset of symptoms.
Those who test positive but remain asymptomatic need not isolate but must wear a high-quality mask when around others for 10 days after the first positive test.
Those who do develop symptoms such as a cough, sore throat, runny nose or body aches can end their isolation period once their symptoms are mild and improving, provided they havent had a fever for 24 hours without using medication. Still, they need to wear a mask for 10 days after the onset of symptoms.
Whether symptomatic or not, those with COVID can stop wearing a mask before 10 days if they test negative on two consecutive rapid tests, taken at least one day apart.
Los Angeles County also recommends waiting for a negative rapid test before leaving isolation within the 10 days following the first symptoms. A negative rapid test result is not needed on Day 11 or after.
Some experts have criticized California's looser isolation guidance. On social media, Michael Mina, chief science officer for eMed and an epidemiologist formerly with the Harvard T.H. Chan School of Public Health, wrote that it "essentially encourages" infectious people to "return to work/school & infect others."
"It is outrageous," Mina wrote. "They advise: if no fever, but blazing positive rapid test, no worries, go back to work/school!"
Mina suggested that a better approach would be to ask people to isolate for a period "no more and no less" than they are a risk to others a decision that can be made when the person tests negative on a rapid test as they recover. Rapid test results are "real personalized empirical data correlated with being infectious," Mina wrote.
Others note that the new state guidance hasn't resulted in a severe public backlash. And many residents haven't been following official guidance for a long time anyway, thinking it doesn't make sense to stay home if they feel fine.
"That's part of the thing: People are doing this anyway, so you might as well give them best practices," Chin-Hong said, stressing mask use for those infected.
Read more: Here's why some high-risk patients aren't getting drugs to combat COVID
The guidance, issued Jan. 9, has been echoed by local officials in recent weeks amid a significant wave of coronavirus infections. State and national data posted by the CDC suggest that levels of the virus in sewage are at the highest point since the first Omicron wave two winters ago.
The wave of illness has been noticeable in causing more workers to call in sick. Many describe miserable illnesses with intensely sore throats that feel like they're studded with shards of glass, coughing fits that leave them winded and body aches that make them feel as if they've been hit by a truck.
California clinicians this winter have noted patients who tested positive for COVID-19 and flu at the same time.
Notably, there are fewer incidents of severe acute COVID-19 illness than there were in the early years of the pandemic. New COVID-19 hospitalizations are at the lowest points for a winter season since the pandemic began. It's likely that vaccinations, natural immunity from past infections and the development of medications such as Paxlovid have made the disease much less risky. However, any bout with the illness presents the risk of developing into long COVID.
Lower levels of severe illness were a big part of California's rationale for loosening the isolation guidance. Prior guidelines were set when Californians "had little immunity" and there were a "large number of hospitalizations and deaths that overwhelmed our healthcare systems," officials wrote. "We are now at a different point in time with reduced impacts from COVID-19 compared to prior years."
Read more: With COVID on the rise, your at-home test may be taking longer to show a positive result
California's winter wave appears to have either plateaued or started to decline.
For the week to Jan. 20, there were 2,975 new COVID-19 hospitalizations, down 10% from the prior week. The seasonal high thus far was 3,746 for the week that ended Dec. 30. This was lower than the prior winter's peak of 5,260 during the last week of 2022.
The first two winters of the pandemic were the most deadly for California and strained hospital systems. The peak for new hospitalizations during the first winter was 16,663, for the week that ended Jan. 9, 2021.
In Los Angeles County, virus levels in wastewater appear to be plateauing. For the week that ended Jan. 13, the most recent available, levels reached 67% of last winter's peak.
However, in the San Jose area, virus levels as of Jan. 21 were at their highest level for the winter, comparable to the first Omicron wave two years ago.
Statewide data from Kaiser Permanente indicate that COVID-19 may be plateauing, flu is on the way up, and respiratory syncytial virus might be starting to come down, Dodd said.
In L.A. County, flu and RSV levels have lowered but remain elevated, the Department of Public Health said.
Dodd continues to recommend COVID-19, flu and RSV immunizations.
While COVID-19 has become less deadly, it remains a significant public health challenge. Since Oct. 1, at least 24,000 COVID-19 deaths have been reported nationally, including at least 1,900 in California.
"COVID-19 continues to cause more hospitalizations than influenza and respiratory syncytial virus," the CDC said in a statement last week.
Flu is also playing a significant role at emergency rooms.
"Right now, more people are going to emergency departments to get care and being diagnosed with flu than COVID-19," the CDC said.
Sign up for Essential California for news, features and recommendations from the L.A. Times and beyond in your inbox six days a week.
This story originally appeared in Los Angeles Times.
