Share on Facebook Email A brief period of postnatal visual deprivation, when early in life, drives a rewiring of the brain areas involved in visual processing, even if the visual restoration is completed well before the baby reaches one year of age, researchers at the University of Trento, McMaster University, and the University of Montreal revealed today in Current Biology.Scientists have long known that the functional neural architecture for perception and cognition strongly depends upon plasticity: in other words, our brain has the capacity to change and adapt as a result of experience. As a number of neuroimaging studies show, the early onset of permanent blindness alters the response of the neurons of the visual cortex and causes a cortical compensatory re-organization in the occipital lobe. This lobe, where visual functions are typically located, becomes active during the processing of auditory stimuli. The recruitment of visual areas for auditory tasks is sometimes thought to underlie the better performance in processing inputs from other senses observed in congenitally blind people.What was not clear yet was whether a short and transient period of postnatal visual deprivation is sufficient to trigger crossmodal reorganization that persists after years of visual experience. In order to answer that question, the researchers characterized the brain responses to auditory stimuli in 11 adults who had been treated for congenital cataracts in both eyes. These adults had been deprived of all patterned vision from birth until the cataracts were removed surgically and the eyes fitted with appropriate contact lenses that restored nearly normal visual input. The age at treatment varied from 9 days to just under 8 months of age. The control group consisted of 11 visually normal adults. Share Share on Twitter LinkedIn Pinterest “The cataract-recovery participants had been blind for less than 8 months, but their blindness occurred at birth, during the most sensitive period for brain development. They showed enhanced auditory-driven activity in focal visual regions”, explained study leader Olivier Collignon, who undertook the work at University of Trento and the University of Montreal. “Thus, a short and transient period of visual deprivation early in life leads to enduring large-scale crossmodal reorganization of the brain circuitry typically dedicated to vision. This compellingly highlights the role early postnatal experience plays in shaping the functional architecture of the brain”.Crossmodal plasticity in the case of blindness is a vital brain mechanism for compensating for visual deprivation, but the mechanism can have also negative effects on visual restoration, because it might interfere, to a certain extend, with the optimal resettlement of the regained sensory inputs. “Crossmodal plasticity may therefore be considered as a two-edged sword”, Collignon added. The existence of auditory responses in the occipital cortex of cataract-recovery patients, as observed in the study, therefore poses crucial questions regarding how these non-visual inputs coexist or even interfere with visual functions. Olivier Collignon and his collaborators are now investigating further how this crossmodal reorganization might contribute to the impaired visual abilities observed in cataract-reversal patients. Resolving this crucial question may impact on how visual training programs are developed for visual restoration.
Previous studies in male rats have identified particular brain regions that are important for the stress relief, including the basolateral amygdala and prefrontal cortex. The researchers looked at protein markers of activity (FosB/deltaFosB and pCREB) in these brain regions to see if the sugar drink altered these protein levels similarly in male and female rats. FosB/deltaFosB was increased in the amygdala of males who were given the sugar drink compared to those drinking only water. Female rats also showed this increase in amygdala FosB/deltaFosB after the sugar drink, but only when they were in the proestrus/estrus stage of their cycle. In contrast, amygdala pCREB was increased by the sugar drink in males but not females. Instead amygdala pCREB varied across the estrous cycle in female rats and was unaffected by sugar drink. These different patterns show that comfort eating has some similar effects in male and female brains, but also has unique effects in the female brain that vary across the hormonal cycle. Pursuing these findings could lead to different strategies that could be useful for women and men who habitually eat to manage stress. Share on Twitter Share on Facebook LinkedIn Researchers at the University of Cincinnati have found that the brain networks that mediate stress relief after eating highly palatable foods may vary between males and females, and may also depend on the stage of the estrous cycle. The study performed by Ann Egan, a doctoral candidate in the University of Cincinnati Neuroscience Graduate Program in the laboratory of Dr. Yvonne Ulrich-Lai, PhD, used a rodent model of ‘comfort food’ to investigate the neurocircuitry behind this phenomenon. The research is to be presented this week at the Annual Meeting of the Society for the Study of Ingestive Behavior (SSIB), the foremost society for all aspects of eating and drinking behavior.“We know that both men and women eat tasty foods as a strategy to reduce stress, and in fact there is some evidence that suggests that women may be more prone to this ‘comfort food’ style of eating,” explained Egan. “This study is important because it suggests that males and females may be using slightly different brain regions, and the stress relief in females may also be affected by the stage of the estrous cycle. This can help us understand how eating behaviors can affect men and women differently, and how eating behaviors are affected by fluctuating hormone levels.”The researchers used a rodent model that is based on human snacking patterns. Female rats were given twice-daily access to a small amount of a sweet sugar drink for 14 days, while other female rats were only given water as a control. Then rats were subjected to a stress test, and their stress hormone response was measured. Similar to previous studies done in male rats, female rats that had been given the sugar solution had a lower stress hormone response to the stress challenge. However, in the female rats the reduced stress response only occurred if the rats were in the proestrus/estrus stage of their estrous cycle, when levels of estrogen are high. Email Pinterest Share
Physical pain can sometimes be as effective as other strategies in reducing psychological distress, according to new research published in the journal Emotion.Self-injurious behavior among adolescents with mental health problems is a serious public health concern around the world, but the new findings indicate that the use of benign physical pain to regulate emotion is common outside of this population as well.“I had been studying body-based coping skills for people who struggle with regulating their emotions, such as smiling, rhythmic tapping, and deep breathing. I became interested in the topic of pain because a great deal of the literature on non-suicidal self-injury (NSSI) indicates that one reason people engage in self-injurious behavior is to regulate extreme emotional states,” said study author Ashley Doukas, a clinical instructor at NYU Langone Health. Share Email LinkedIn Share on Facebook Share on Twitter Pinterest “An incidental finding in many of the studies looking at NSSI proxies (such as non-harmful pressure, heat, and cold) is that the healthy ‘control’ populations also report reductions in negative emotion after receiving a painful stimulus. This got me thinking that pain itself might be the primary mechanism in self-regulation, rather than the injurious component, per se.”“Furthermore, it made me think that benign forms of pain might be used to self-regulate more widely by the general population, yet go unnoticed due to the lack of a shock factor that NSSI has. We wanted to see if, given the choice, people without NSSI histories would voluntarily inflict pain to cope with negative emotions,” Doukas explained.In the study, the researchers exposed 60 individuals to upsetting images and provided them with two cognitive strategies and two physical methods to cope with negative emotion. The participants were told they could reduce distress by either thinking of something other than the picture, changing the meaning of the picture in their mind, self-administering a painful shock, or self-administering a painless electrical stimulation.Doukas and her colleagues found that 67.5% of participants elected for the painful shock at least once. During 16 trials, the participants chose the painful stimulation between 0 to 13 times, with an average of twice per person. In addition, the painful stimulation as rated as equally effective in regulating negative emotion compared with other coping strategies.Doukas hopes that the findings “de-stigmatize those who engage in self-injurious behavior. There is a lot of shame and hiding when people engage in self-injurious behavior, and well-meaning people might not understand why people do it.”“While of course we do not want people to put themselves at risk for infection or accidental death, the fact is that human beings use pain to manage their emotions all the time — think of an intense massages to relax, and putting extra hot sauce on tacos to make them more intense and enjoyable. While the injurious aspect of NSSI can be alarming to many, the infliction of pain on oneself may not be inherently pathological, and may actually be making good use of some basic biological responses to pain, such as endorphins,” she told PsyPost.In a replication of previous research, the researchers also had the participants sit alone in an empty room for 10 minutes, and instructed them not to sleep, read, or use their cell phone. The participants were, however, allowed to self-administer painful or painless electrical stimulation as frequently as they wished.Approximately 60% of the participants decided to painfully shock themselves at least once. The number of times participants chose to receive the painful electrical stimulation ranged from 0 to 69, with an average of about 13.“In understanding the self-regulatory function of pain to either reduce intense negative emotions, or induce emotions during an unpleasant state of emotional numbing (such as boredom), we can better understand how clinical and non-clinical populations cope with negative emotions,” Doukas said.“Perhaps voluntarily inflicting pain exists on a spectrum from ‘healthy’ to ‘unhealthy’, and it is the behavior (e.g. cutting), and not the mechanism of action (i.e., pain) that might determine where that boundary lies. In destigmatizing pain and recognizing its potential to be helpful, we can broaden our understanding of now clinical and non-clinical populations might use the biological response to pain to help them get through the day a bit better.”Of course, the researchers are not endorsing self-injury as a method of coping with emotional distress.“Our hope is that our research, and research like it, can expand treatment options for those who do engage in dangerous NSSI behavior like cutting or burning skin. For example, one possibility might be integrating TENS units (electrical stimulation devices which are often used in physical therapy settings) into a harm reduction treatment plan,” Doukas explained.“By removing stigma, and looking at the behavior from a neutral scientific standpoint, we hope that both clinicians and the lay public can understand not only why clinical populations engage in NSSI, but how to treat it more effectively. I would also caution people against purchasing a TENS unit and/or self-inflicting pain without first consulting their physician about whether it is safe for them.”The study, “Hurts So Good: Pain as an Emotion Regulation Strategy“, was authored by Ashley M. Doukas, Wendy M. D’Andrea, Wesley E. Gregory, Brandon Joachim, Kellie A. Lee, Gabriella Robinson, Steven J. Freed, Vivian Khedari-DePierro, Kendall A. Pfeffer, McWelling Todman, and Greg J. Siegle.
Email LinkedIn Share on Facebook Pinterest Share on Twitter Share A new study suggests that engaging with negative content on social media can lead to reduced activation of the prefrontal cortex and impairments in executive functioning. The findings were published in Social and Affective Neuroscience.While it has been established that emotional stimuli can affect cognition, little is known about the neural consequences of consuming emotionally-arousing content on social media. Researchers Sarah M. Tashjian and Adriana Galván set out to explore this topic, by examining the cognitive consequences of reading negative, discriminatory tweets published by President Trump.“As political attitudes in the United States become more polarized, the potential for engaging with perceived negative content on social media increases. A New York Times analysis estimated over half of President Trump’s 11,000+ tweets since becoming President involved attacks, with 1,421 of those 5,889 attacks levied against minority groups and immigrants (Shear et al., 2019),” Tashjian and Galván say. An experimental study was conducted among 57 adults between the ages of 18 and 29. The participants were selected if they belonged to at least one historically marginalized group by way of ethnicity, gender identity, or sexual orientation. The subjects were assigned to read either a set of real tweets published by Trump that were discriminatory in nature (negative tweet condition) or a set of real tweets that discussed neutral topics and appeared to come from a fictitious account (neutral tweet condition).Both before and after reading the tweets, subjects completed 30 trials of a spatial reasoning task involving mental rotation, while whole-brain functional magnetic resonance imaging (fMRI) data was recorded. Participants also rated their affect across several states including anger, depression, disgust, and fear/anxiety.As was expected, those reading the negative tweets experienced worsening affect after reading the tweets compared to those who read the neutral tweets.Interestingly, it was found that those who read the neutral tweets showed improvements on the mental rotation task as they completed more trials. Those who read Trump’s discriminatory tweets, however, showed no improvements throughout the trials following exposure to the tweets.Using fixed-effects general linear models, the researchers compared the subjects’ whole-brain activation following the tweet exposure to whole-brain activation at baseline. Then, researchers estimated neural habituation, that is, “greater response decrement over the course of stimuli presentation.”The brain scans showed decreased activation in the dorsolateral prefrontal cortex (dlPFC) throughout tweet exposure.(Photo credit: National Institutes of Health)Importantly, subjects who reported worsening negative affect after reading the tweets displayed increased dlPFC habituation. Moreover, participants who displayed greater dlPFC habituation did not improve on the mental rotation task throughout the post-tweet trials, while those who showed less habituation did.As the researchers explain, the dorsolateral prefrontal cortex is a region associated with cognition and the control of emotions, and emotional distraction has been found to disrupt activation of the dlPFC. “There are several mechanisms by which emotionally charged information can interfere with executive resources. First, threats elicit attempts to regulate negative emotions, taxing resources like the dlPFC through implicit and automatic emotion regulation (Braunstein et al., 2017),” the authors relate.Although their study focused on negative affect, the researchers acknowledge that positive emotions can also affect executive functioning — an interesting topic for future research.As Tashjian and Galván remark, “Results demonstrate that widely read tweets may have deleterious effects on executive functioning in a large segment of the population: historically marginalized identity groups.”The study, “Dorsolateral prefrontal cortex response to negative tweets relates to executive functioning”, was authored by Sarah M. Tashjian and Adriana Galván.
Second in a series marking the 1-year anniversary of novel H1N1 pandemic influenza. The first, on the virus itself, appeared Apr 23.Apr 26, 2010 (CIDRAP News) – Among the many surprises of the 2009 H1N1 flu pandemic—its emergence at the end of a flu season, its unexpected toll of mild illness, its almost-complete replacement of circulating seasonal strains—was its reversal of years of received wisdom on how vaccines would be needed to respond.Researchers had predicted, for instance, that to be protected against a novel strain, most members of the population would require two doses of vaccine containing the new pandemic strain. And because that many doses of vaccine would stress the existing vaccine-manufacturing system, other researchers had predicted that the addition of dose-sparing adjuvants to the new vaccine would be crucial to stretch out scarce supplies of newly made antigen.Neither turned out to be true.To the great relief of health authorities, most members of the population turned out to need only one dose of the novel vaccine, though whether the youngest children needed two became a matter for international disagreement. And because that move freed up so many doses of antigen, the United States’ long reluctance to test and license adjuvants used in flu vaccines in Europe did not become the bad bet that many flu experts had feared.By September 2009, Australian researchers were reporting in the New England Journal of Medicine that—contrary to predictions—one dose of a 15-microgram vaccine made from the novel strain produced an acceptable immune response in 97% of adults who received it.By November, the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH) was reporting that the single-dose regimen was equally protective for pregnant women, who were emerging as one of the groups at highest risk of serious complications from the novel virus.But US health authorities continued to caution that children younger than 10, another group at higher risk for pandemic complications, should continue to receive two doses of the new vaccine, because only 55% of children in those age-groups had produced a protective immune response after one dose.That recommendation brought the United States into conflict with the World Health Organization (WHO), which only 3 days earlier had recommended giving young children a single dose as a way of extending the vaccine to as many children as possible. When asked about the discrepancy, Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC), said: “If the data show a difference, we will reconsider our recommendations. . . . We’re sticking with what the [Advisory Committee on Immunization Practices] has recommended.”A second report by the same Australian group, published in late December, found an adequate immune response in infants and young children after one dose, but that finding did not change US policy.Other long-held predictions, however, turned out to be all too accurate. The fragile egg-based manufacturing system for flu vaccine, which had gone without significant innovation for 50 years, proved inadequate to manufacturing the new vaccine. The newly isolated pandemic strain did not grow well in chicken eggs—something that also had happened in the past for seasonal vaccine strains—and the resulting slowdown in manufacturing and delivery strained public confidence and allowed anti-vaccine sentiment to build.At the same time, long-recognized bottlenecks in flu-vaccine production, including lack of capacity in the post-manufacturing “fill and finish” step that puts vaccine into vials, slowed the industry’s process for getting the new antigen out to the marketplace.In mid-summer 2009, federal officials had predicted they would be able to release 120 million doses of novel vaccine by October, with millions more doses to follow each week. By mid-August, that prediction was scaled back to 45 million doses by mid-October. And on Oct. 21, Health and Human Services (HHS) Secretary Kathleen Sebelius was grilled by Congress regarding the slow start to vaccine delivery: Only 12.8 million doses had become available.In testimony, Sebelius blamed both the new virus’s slow growth in eggs, and also production problems on some new manufacturing lines. “We anticipate that number [of doses] growing exponentially as we move into the season,” she said. By early November we’re confident that vaccine will be far more widely available. There’ll be enough vaccine so every American who wants to can be vaccinated.”But by the end of 2009, Americans who had urgently pursued the vaccine when it was supposed to be delivered had turned away from seeking it. By this February, the CDC said in April, 229 million doses of antigen had been ordered, about 162 million had been “fill-finished,” about 126 million had been put into distribution, and somewhere between 81 and 91 million doses had been administered.That accounting made it clear that some millions of doses—the CDC could not, by April 1, say how many—were likely to be discarded because they are subject to strict expiration dates once packaged. (The Washington Post estimated the amount of vaccine discarded could reach more than 71 million doses.)In a speech last week, Sebelius called the overpromising of vaccine one of the pandemic’s “teachable moments” for her department. “We wanted to make sure the American people knew what we knew when we knew it, but we raised expectations too high,” she said. Sebelius did not, however, specify how HHS would alter its approach in the future.But additional millions of doses that remain in bulk form may last long enough to be combined into next fall’s seasonal vaccine, giving manufacturers a head start on that always-unpredictable process—provided the circulating virus does not mutate over the summer to make the retained antigen unusable.”It is theoretically possible that some of that antigen could be the H1N1 component of a trivalent vaccine,” Dr. Anne Schuchat, director of the CDC’s National Center for Immunizations and Respiratory Diseases, said in a briefing April 1. “Plans around that particular decision are under discussion between the Department of Health and Human Services and the individual manufacturers.”See also:Apr 23 CIDRAP News story “H1N1 LESSONS LEARNED: Pandemic underscored influenza’s unpredictability”Greenberg ME, Lai MH, Hartel GF, et al. Response to a monovalent 2009 influenza A (H1N1) vaccine. N Engl J Med 2009 Dec 17;361(25):2405-13 Epub 2009 Sep 10. [Full text]Nov 2, 2009, NIAID statement “Initial results show pregnant women mount strong immune response to one dose of 2009 H1N1 flu vaccine”Nov 2, 2009, NIAID statement “Updated results: In youngest children, a second dose of 2009 H1N1 influenza vaccine elicits robust immune response”Oct 30, 2009, WHO Pandemic (H1N1) 2009 briefing note 14: “Experts advise WHO on pandemic vaccine policies and strategies” http://www.who.int/csr/disease/swineflu/notes/briefing_20091030/en/index.htmlNolan T, McVernon J, Skeljo M, et al. Immunogenicity of a monovalent 2009 influenza A(H1N1) vaccine in infants and children. JAMA 2010;303(1) Epub 2009 Dec 21 [Full text]Aug 14, 2009, CIDRAP News story “http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/aug1409vaccine.html”Oct 21, 2009, Senate Committee on Homeland Security and Governmental Affairs, “H1N1 flu: monitoring the nation’s response” (includes Sebelius testimony).Apr 1 CDC press briefing transcript
Oct 6, 2010One fourth of kids under 2 received full seasonal flu vaccinationOnly about a quarter of children under 2 years old were fully vaccinated against influenza during the most recent non-pandemic flu season, according to US Centers for Disease Control and Prevention (CDC) statistics released today. The CDC’s Advisory Committee on Immunization Practices in 2002 first encouraged seasonal flu vaccination in children aged 6 to 23 months, and then in 2004 recommended vaccination for this age-group. From September through December 2008, 41.5% of children in that age-group received at least one dose of the vaccine, with only 24.7% receiving complete two-dose protection. States with more than 40% receiving full vaccine coverage were Massachusetts, 45.9%; Rhode Island, 43.9%; Vermont, 43.6%; New Hampshire, 43.3%; Wisconsin, 41.2%; and Minnesota, 41.1%. Full coverage fell below 15% in three states: California, 14.9%; Arkansas, 14.2%; and Mississippi, 8.7%.Oct 6 CDC reportOrgan-transplant patients hit hard by pandemic H1N1Organ transplant recipients who were infected with pandemic 2009 H1N1 flu had higher mortality rates than the general population, with poorer outcomes in those whose treatment was delayed, according to a recent study. Researchers studied 77 transplant patients from 10 centers, 35 of whom were suspected novel H1N1 cases, 19 probable, and 23 confirmed. Six of them (7.8%) died, compared with CDC estimates of much less than 1% mortality in the general population and about 5% in hospitalized patients. Time from the onset of symptoms to the first visit and treatment was “significantly longer” in 34 patients who were admitted to a medical ward and 10 admitted to intensive care, compared with the 33 ambulatory patients.Oct 1 Transplantation abstractMRSA stalks Maine lobstering villageHealth officials in Maine suspect that lobster fishing activities have contributed to a methicillin-resistant Staphylococcus aureus (MRSA) outbreak that has affected about 30 people in an island fishing community over the past two summers, the Associated Press (AP) reported today. Dr Stephen Sears, Maine’s state epidemiologist, told the AP that there’s no indication that MRSA is linked to lobsters but that multiple small hand traumas that occur in activities such as hauling lobster traps and cutting bait could allow the pathogen to gain a foothold on the island. Some fishermen and other island residents have been treated multiple times, but no deaths have been reported, according to the AP. Sears said it’s difficult to determine how MRSA came to the island community of Vinalhaven. He told the AP that the pathogen isn’t transmitted by seafood and that it doesn’t usually survive in sea water or on beaches at levels high enough to cause human infections.Oct 6 AP story
Jul 10, 2012 (CIDRAP News) – As researchers continue to sort out safety issues surrounding the monovalent vaccine used during the 2009 H1N1 flu pandemic, two new reports focusing mainly on an adjuvanted version suggest that immunization was safe for babies born to vaccinated pregnant women and that it was linked to a small but significant risk of Guillain-Barre syndrome (GBS) in some patients.Both reports appear in the latest issue of the Journal of the American Medical Association (JAMA) and focus on an AS03-adjuvanted vaccine made by GlaxoSmithKline.In the pregnancy study, Danish researchers studied a cohort of infants born in Denmark between Nov 2, 2009, and Sep 30, 2010. They obtained mothers’ 2009 H1N1 vaccination status from a national database. The AS03-adjuvanted split virus vaccine was the only one used in Denmark.Denmark’s pandemic flu vaccination campaign launched on Nov 2, 2009, with pregnant women in the priority group. Pregnant women with underlying conditions were urged to get vaccinated during their first trimester, and those without such conditions were advised to receive it during the second or third trimester.Using a cohort of 53,432 infants, researchers compared fetal outcomes among mothers who were and were not vaccinated. The main adverse outcomes they looked at were major birth defects, preterm birth, and smallness for gestational age.Of the group, 6,989 babies were exposed to the vaccine during pregnancy, all but 345 of them in the second or third trimester.The researchers found no association between vaccination during pregnancy and major birth defects, preterm birth, or fetal growth restriction.The small number of babies exposed to the vaccine during the first trimester allowed the researchers to exclude only the larger risks, but even in that high-risk group, the results were reassuring, the authors said.They wrote that while other studies have looked at fetal safety of H1N1 vaccination, theirs was the first to directly compare outcomes from vaccinated and unvaccinated mothers.The results might be generalizable to nonadjuvanted vaccines because they contain identical viral antigens, though antigen doses and manufacturing processes may vary, the investigators wrote, adding that the results don’t extend to vaccines that used other adjuvants.The safety data on babies born to vaccinated mothers may have implications for future flu seasons and pandemics, especially when adjuvants are needed to achieve adequate immune response, the researchers said.In the second study, researchers analyzed enhanced GBS surveillance that Quebec health officials ordered during the 2009 H1N1 vaccine campaign. The investigation was ordered by the province’s chief medical officer under the Quebec Public Health Act. Quebec’s pandemic flu vaccine campaign launched on Oct 26, 2009, targeting everyone age 6 months and older. About 96% of vaccinated Quebec residents received the AS03-adjuvanted vaccine, and vaccination status was verified with provincial registries.The population-based cohort study followed patients over a 6-month period from October 2009 through March 2010. Physicians were urged to report suspected and confirmed GBS cases. Patients’ records were reviewed by a physician, with assistance from adult and pediatric neurologists. Reviewers were blinded to the immunization status of the cases.Over the study period, researchers identified 83 confirmed GBS cases, including 25 patients who had been vaccinated 8 or fewer weeks before symptom onset, most (19 of 25) of whom were vaccinated 4 or fewer weeks before GBS onset.For those with GBS onset 8 or fewer weeks after vaccination, the relative risk was 1.80 (95% confidence interval, 1.2 to 2.87), and for those with the earlier onset the risk was 2.75 (95% CI, 1.63 to 4.62).Overall, the team found that the number of GBS cases linked to vaccination was about 2 per 1 million doses. They observed a cluster of cases shortly after the vaccine campaign started, which they said wasn’t likely to have been caused by flu infection. The group found no excess risk in people younger than 50.For comparison, a US study of GBS in recipients of the unadjuvanted 2009 H1N1 vaccine found that there were about 0.8 excess cases of GBS per 1 million vaccinations, which is similar to that for the seasonal flu vaccine. A similar study in five European countries that used an adjuvanted vaccine found that vaccination probably didn’t increase the GBS risk, but investigators couldn’t rule out a slightly greater chance of suffering from the condition.The Quebec researchers concluded that the adjuvanted 2009 H1N1 vaccine was linked to a small but significant GBS risk, but they said the benefits of immunization probably outweighed the risks.In an accompanying JAMA editorial that addressed both of the studies, two infectious disease experts said it’s important to assess the potential pandemic vaccine risks to fetuses as well as adults. The authors are Mark Steinhoff, MD, director of the Global Health Center at Cincinnati Children’s Hospital Medical Center, and Noni MacDonald, MD, MSc, professor of pediatrics and computer sciences at Dalhousie University in Halifax, Nova Scotia.”Taken together, these studies partially assuage concerns about the safety of adjuvanted pandemic influenza vaccines during pregnancy,” they wrote. “However, more studies are needed examining other types of vaccine adjuvants.”They noted that observational studies of vaccines can be limited by biases and confounding by indication, adding that future studies with improved statistical design are needed to confirm the findings, such as prospective follow-up studies using virologic end points with adjustments for selection, seasonality, and other biases.Pasternak B, Svanstrom H, Molgaard-Nielsen D, et al. Risk of adverse fetal outcomes following administration of a pandemic influenza A (H1N1) vaccine during pregnancy. JAMA 2012 Jul 11;308(2):165-74 [Abstract]DeWals P, Deceunick G, Toth E, et al. Rick of Guillain-Barre syndrome following H1N1 influenza in Quebec. JAMA 2012 Jul 11;308(2):175-81[Abstract]Steinhoff MC, MacDonald NE. Influenza pandemics—pregnancy, pathogenesis, and perinatal outcomes, editorial. JAMA 2012 Jul 11;308(2):184-85[Extract]See also:Jun 2, 2010, CIDRAP News story “CDC: GBS risk similar for H1N1 and seasonal flu vaccines”Jul 13, 2011, CIDRAP News story “Study: adjuvanted H1N1 vaccines had little effect on GBS risk”
Aug 16, 2012CDC renews its call for flu shots for everyone older than 6 monthsThe US Centers for Disease Control and Prevention today published its official recommendations on influenza vaccination for the 2012-13 flu season, renewing its advice that everyone at least 6 months old should be immunized, an advisory it first issued in 2010. The recommendations, prepared by the Advisory Committee on Immunization Practices (ACIP), were published in the Aug 17 Morbidity and Mortality Weekly Report (MMWR), released today. The document includes a minor adjustment in the recommendation on dosing for children aged 6 months through 8 years: that those who have received two or more doses of seasonal flu vaccine since Jul 1, 2010, need just one dose for this season, but the rest need two doses. Among other things, the document includes recommendations about flu vaccination for people with a history of egg allergy. It also notes that a quadrivalent flu vaccine made by MedImmune, containing two influenza B strains to cover both B lineages, was approved in February but is not expected to be available until the 2013-14 season.Aug 17 MMWR articleJun 20 CIDRAP News story on ACIP recommendationsStudy: Antiviral drugs effective in pandemic, post-pandemic flu periodsAlthough clinical symptoms in those infected with pandemic 2009 H1N1 flu (pH1N1) in Japan in 2010-11 were slightly more severe and peak body temperature was significantly higher in young patients than during the previous year’s pandemic, the effectiveness of neuraminidase inhibitors (NIs) like oseltamivir (Tamiflu) remained high, according to a study today in Influenza and Other Respiratory Viruses. Researchers analyzed clinical symptoms and fever data after the first dose of an NI for 365 patients with pH1N1 in 2009-10 and 388 patients who had either pH1N1, H3N2, or influenza B in 2010-11. They found that peak body temperature were significantly higher for pH1N1 patients younger than 20 years in 2010-11 compared with 2009-10. In addition, the percentage of pH1N1 patients with loss of appetite or fatigue was significantly higher in the later season. The team found the percentage of patients without fever after 48 hours of NI treatment was significantly higher for pH1N1 than for the other two strains, but overall NI effectiveness remained high in both seasons and for all strains.Aug 16 Influenza Other Respi Viruses abstractFDA approves trial of intradermal H5N1 vaccine with adjuvant The US Food and Drug Administration has cleared the way for a phase 1 trial of an intradermal H5N1 flu vaccine containing an adjuvant, which will be the first clinical test of such a product, according to the vaccine’s developers. The announcement was made today by the Infectious Disease Research Institute (IDRI), a Seattle-based nonprofit group, and Medicago, a Quebec-based biopharmaceutical company. The organizations said the testing could lead to a vaccine that could be self-administered in the event of a flu pandemic. “Our idea is to ultimately produce a one-dose vaccine that you could give yourself—imagine a flu vaccine that you can easily administer using a simple, painless microneedle device arriving in your mailbox,” said Darrick Carter, PhD, vice president of IDRI’s Adjuvant Technology Program. The vaccine combines a virus-like particle antigen made by Medicago with IDRI’s Glucopyranosyl Lipid A (GLA) adjuvant. Plans for the trial call for enrolling 100 adults, who will receive the vaccine either intradermally or intramuscularly. The research is funded by the Pentagon’s Defense Advanced Research Projects Agency.Aug 16 IDRI-Medicago press releaseVietnam reports six H5N1 outbreaksVietnam has confirmed six new outbreaks of highly pathogenic H5N1 avian flu in village poultry flocks, leading to the culling of more than 7,000 birds, according to a report filed with the World Organization for Animal Health (OIE) yesterday. Dates of outbreak onset varied from Jul 26 to Aug 11, and all the affected villages are in Nam Dinh province in the northern part of the country. Susceptible flocks ranged from 100 to 3,612 birds, and a total of 7,702 poultry were destroyed to prevent disease spread. The report did not specify how many birds were infected or died from the disease.Aug 15 OIE report
A contact of Nigeria’s first Ebola patient fled quarantine in August and passed the disease to a doctor, who subsequently infected at least two other people, offering a textbook example of how not to deal with the disease, the World Health Organization (WHO) reported today.The episode extended Ebola’s reach in Nigeria from Lagos, the capital, to Port Harcourt, the country’s oil hub on the southeastern coast. Because of the number of people exposed to the doctor, the outbreak in Port Harcourt could grow bigger than the original outbreak in Lagos, the WHO said.Meanwhile, a trio of United Nations (UN) and WHO officials today again stressed the urgent need to expand the international response to West Africa’s Ebola epidemic, but insisted that the governments of the affected countries must remain in charge of efforts within their borders. The officials estimated that the international effort will cost at least $600 million.Port Harcourt casesA sick airline passenger, Patrick Sawyer, spread Ebola virus to Nigeria when he flew from Liberia to Lagos on Jul 20; he died on Jul 25. One of Sawyer’s close contacts in Lagos fled the city, where he was under quarantine, to seek treatment in Port Harcourt, the WHO said in today’s statement.The contact was treated from Aug 1 to 3 by a male physician at a Port Harcourt hotel. The physician fell ill on Aug 11, but for 2 days afterward he continued treating patients at his private clinic, operating on at least two of them, the WHO said.On Aug 13 his symptoms worsened, and he then stayed home until he was hospitalized on Aug 16, the WHO said. He died on Aug 22, and his Ebola virus disease (EVD) was confirmed on Aug 27 by a lab at Lagos University Teaching Hospital.After he got sick, the doctor had numerous contacts with others, both before and after his hospitalization, the WHO said. In the hospital, members of his church visited him and performed a healing ritual said to involve the laying on of hands, and he was attended by most of the hospital staff.The two people who caught the virus from the physician are his wife, also a doctor, and another patient at the hospital where he was treated, according to the WHO, which did not describe their conditions. Other hospital staff members are being tested.”Given these multiple high-risk exposure opportunities, the outbreak of Ebola virus disease in Port Harcourt has the potential to grow larger and spread faster than the one in Lagos,” the agency said.It said Nigerian health workers and WHO epidemiologists are monitoring more than 200 contacts, including about 60 believed to have had high-risk or very high-risk exposures.The Port Harcourt cases apparently raise Nigeria’s Ebola count to at least 20 cases and 7 deaths. The latest WHO general update on Ebola in West Africa, on Aug 28, put Nigeria’s tally at 17 cases and 6 deaths.Nigeria respondsThe WHO said the Nigerian government has taken a number of emergency steps in response to the new cases, with support from the WHO, the UN Children’s Fund, and Medecins Sans Frontieres (MSF).The government has activated an Ebola emergency operations center, set up a 26-bed isolation facility, and put 21 teams to work on contact tracing. The emergency center is supported by the US Centers for Disease Control and Prevention (CDC).In addition, the WHO and local officials are assessing public measures at airport gates and other ports of entry in Port Harcourt.But the agency warned that security problems and public fear of Ebola “create serious problems that could hamper response operations,” with military escorts needed when moving patients into the Ebola treatment center.WHO, UN officials underline urgencyAt a press briefing in Washington, DC, today, WHO and UN officials again stressed the need to accelerate the response to West Africa’s Ebola crisis.”We’re not in a position where we can afford to lose a day, because the outbreak is currently moving ahead of efforts to control it,” said David Nabarro, MD, senior UN system coordinator for Ebola disease.Nabarro, who just returned from a needs assessment trip to West Africa with the WHO’s Keiji Fukuda, MD, said, “We need on the order of three to four times what is currently in place” in the way of resources to battle the epidemic.He estimated that it will cost “at least $600 million and maybe a lot more to get the necessary support to the countries to get this under control.”Today’s briefing followed a meeting in New York yesterday at which UN and other officials addressed UN member states to emphasize the seriousness of the Ebola situation in West Africa and urged them to send aid to the region.Fukuda, the WHO’s assistant director-general for health security and environment, said he and Nabarro met with a wide range of officials and people at all levels during their visit to Monrovia, Liberia, and Freetown, Sierra Leone.The main message they heard was about the lack of capacity to respond to the epidemic, including the lack of treatment centers, vehicles, protective equipment, and funds, he said.”But of all things that are low in capacity, the most important is that we don’t have enough people on the ground,” including nurses, doctors, drivers, contact investigators, Fukuda said.Aside from Nabarro’s cost estimate, he, Fukuda, and WHO Director-General Margaret Chan, MD, MPH, declined to estimate just how many health workers or other types of resources are needed. They noted previously announced goals of reversing the trend in cases within 3 months and stopping transmission in 6 to 9 months.They also stressed the obstacles caused by the Ebola-inspired cancellations of airline flights to Liberia, Sierra Leone, and Guinea. Chan said she has talked with experts from around the world who are willing to go to the region to provide infection control and clinical care, but because of flight cancellations, “We are unable to deploy them.”Reporters asked the three officials why, given the magnitude or the problem, they weren’t calling for more of a military-style, “command and control” response, like the “massive mobilization” coordinated by the US Navy in response to the 2004 tsunami in Aceh, Indonesia.Nabarro replied that he believes it is possible to cope with the situation “with the institutions and resources we have,” but added that scaling up the response sufficiently and fast enough is very difficult. “Over the next few days we are changing the way the WHO and UN works on this issue, and talking to governments to get them fully invested,” he said. “We are talking to all other groups that could provide support.”He commented further, “The governments of the affected countries are in charge; our role is to help them do the job they need to do.” He added that the UN aims to do all it can to ensure that responders are protected from infection.Chan echoed the point about national sovereignty saying, “I don’t think any government in this world will accept a takeover by others. So whatever we are doing, we are supporting national authorities to take the leadership.”UK patient releasedIn other developments, Royal Free Hospital in London today announced the release of William Pooley, a British nurse who contracted EVD in Sierra Leone and was treated at the hospital for 10 days. His treatment included the experimental drug ZMapp, which has been given to several other patients, including two Americans.In addition, Nancy Writebol, an American missionary and medical worker who was flown back to the United States after contracting EVD in Liberia, talked about her illness and recovery at a press conference today. She was hospitalized at Emory University in Atlanta and was released Aug 19.Writebol, who worked for the SIM (Service in Mission), said she initially thought she had malaria and was tested and treated for that disease. She said there were many times when she thought she wouldn’t survive.She said she didn’t know if the ZMapp she received was what cured her, but suggested it was more the overall combination of treatment, prayers, and support from others that saw her through the illness.Meanwhile, Bruce Johnson, president of SIM, identified the SIM worker who was recently infected with Ebola in Liberia as Rick Sacra, MD, a Boston doctor, according to a WSOC-TV news report on Writebol’s press conference. Johnson said Sacra is in good spirits and communicating with his family by phone and the Internet, the story said.Also today, the WHO released a list of 197 experts and officials who will take part in a WHO meeting in Geneva the next 2 days to discuss how experimental treatments and vaccines should be used in the Ebola epidemic.In addition, the biopharmaceutical company Chimerix announced today that its investigational antiviral drug brincidofovir has shown in vitro activity against Ebola virus. The findings came in testing by the CDC and the US National Institutes of Health, the company said in a press release.Chimerix said phase 3 trials of brincidofovir as a treatment for cytomegalovirus and adenovirus are currently under way. The company noted it will have representatives at the WHO meeting on Ebola treatments this week.See also: Sep 3 WHO statement on situation in NigeriaAudio recording of Sep 3 UN press briefingSep 3 press release on release of William Pooley from Royal Free Hospital, LondonSep 3 WSOC-TV story on Nancy Writebol comments (with video link)WHO’s list of participants in Sep 4-5 meeting on Ebola interventionsSep 3 Chimerix press release
In Liberian study, Ebola virus persisted in semen of 9% of male survivorsA study in Liberia has produced more evidence of persistence of the Ebola virus in semen after patients’ recovery from the disease, with some of them still testing positive more than a year after recovery and greater age indicated as a possible risk factor.The findings come from Liberia’s Men’s Health Screening Program, in which male Ebola survivor are offered semen testing and counseled about safe sex, according to a report yesterday in The Lancet Global Health.In the study, men and boys ages 15 and older were tested for Ebola RNA by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). They graduated from the program after receiving two consecutive negative semen test results. Data obtained between Jul 7, 2015, and May 6, 2016, were included in the study.Of 429 participants, 38 (9%) had at least one positive semen test for Ebola RNA, and 24 (63%) of these tested positive a year or longer after their recovery. The longest interval between discharge from treatment and collection of a positive sample was 565 days.Among participants who provided samples more than 90 days after recovery, those older than 40 were significantly more likely to have a positive test than were younger men (P = 0.0004), the report says.The study also suggests that the counseling part of the program has been effective, as 84 of 113 men who reported not using condoms at enrollment reported using them at their first follow-up visit. Also, 176 of 385 participants who initially said they were sexually active reported abstinence at the first follow-up.In an accompanying commentary, two experts said the findings must be interpreted cautiously, since the authors could not do cell culture isolation to confirm the presence of viable Ebola virus, as opposed to just residual viral RNA.But the commentators, Daniel Bausch, MD, MPH&TM, of the Tulane School of Public Health and Tropical Medicine in New Orleans, and Ebola survivor Ian Crozier, MD, of the Infectious Diseases Institute in Kampala, Uganda, added that sexual transmission more than 6 months after recovery has been documented in Liberia. Therefore, they advise that male Ebola survivors should continue to follow advice to abstain from sex or use condoms until RT-PCR semen testing is repeatedly negative.Aug 30 Lancet Glob Health report Aug 30 Lancet Glob Health commentary First case of MERS confirmed in Saudi Arabia in 6 daysThe Saudi Arabia Ministry of Health (MOH) reported a case of MERS-CoV infection today after 5 days of no new cases. In the last 6 weeks, there’s been a slowdown of MERS diagnoses in the country, which has been battling an outbreak of the respiratory disease since 2012.According to the MOH, a 40-year-old man from Al Hofuf is in critical condition after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus). The MOH described the expatriate as having contact with camels.Direct and indirect contact with camels is a known risk factor for contracting MERS, but researchers do not yet know how the animals pass the disease to humans.Saudi Arabia’s MERS case count has now reached 1,449, including 610 deaths and 3 patients still being treated, according to the MOH.Aug 31 MOH update PAHO reports 1,428 more chikungunya cases in Central, South AmericaIn its most recent weekly update late last week, the Pan American Health Organization (PAHO) reported 1,428 new suspected or confirmed chikungunya cases, lifting the total in the Americas this year to 252,154.Weekly increases have varied, and some countries report several weeks worth of cases at a time, while some go several weeks with reporting any. For comparison, in the previous 2 weeks PAHO reported increases of 32,492 and 3,100 cases, respectively.Most of the newly reported cases were from Costa Rica, El Salvador, Honduras, Colombia, and Venezuela. One more death was reported, putting that total for the year at 55.Aug 26 PAHO updateIn other chikungunya developments, researchers from the Philippines, where the disease is endemic, yesterday reported that in an outbreak, rising antibodies approaching 50% seem to signal the end of the event. Their observation came from active febrile illness surveillance in the city of Cebu during 2012 to 2014.They made weekly telephone calls, made home visits, and collected blood samples. They reported their findings in Emerging Infectious Diseases.Overall chickungunya incidence during the second year was significantly lower than the first year: 2.84 cases per 100 person years, compared with 12.32 cases per 100 person years. The authors said the change was driven by a drop in subclinical infections across all age-groups. Prevalence of neutralizing antibodies rose significantly, from 28% at the beginning of the first surveillance year to 42% at the start of the second year.The investigators said the seroprevalence level was higher than the 10% to 30% reported at the end of a major outbreak on St. Martin in the Caribbean, but they said the neutralizing test they used in the Philippines was more sensitive and might account for the difference.Aug 30 Emerg Infect Dis report Commercial farm in China reports H5N6 avian fluA commercial farm in TaijiangCounty, China, today reported an outbreak of H5N6 avian flu, according to the World Organization for Animal Health (OIE). TaijiangCounty is located in Guizhou province, in the southwestern part of the country.More than 16,000 birds were destroyed after 7,167 poultry on the farm died from the disease and 10,113 were infected, for a total loss of 23,884 birds. The outbreak is continuing, and officials will provide updates after an investigation is completed. The outbreak appears to have a 30% mortality rate and a 71% case-fatality rate.H5N6 is a highly pathogenic avian flu virus that has caused 15 human infections in China, including 8 deaths, the most recent in January.Aug 31 OIE report Jan 11 CIDRAP news story on most recent case Seqirus reports FDA approval of its second quadrivalent flu vaccineThe vaccine manufacturer Seqirus announced this week that it has gained US Food and Drug Administration (FDA) approval of its second quadrivalent (four-strain) influenza vaccine, Afluria Quadrivalent, for use in adults.Seqirus is offering both Afluria Quadrivalent and Flucelvax Quadrivalent, a cell-based vaccine that won FDA approval in May, for use in the 2016-17 flu season in the United States, according to a press release. Seqirus was formed to combine the flu vaccine operations of CSL and Novartis when CSL bought Novartis’s US flu vaccine business in 2015.Afluria Quadrivalent is an inactivated vaccine that contains two influenza A and two influenza B strains, the company noted. It comes in single-dose, preservative-free pre-filled syringes. In a randomized controlled trial with 3,449 participants, the vaccine was shown to be non-inferior to two trivalent inactivated flu vaccines for all flu strains targeted, the company said.Trivalent flu vaccines contain two type A strains and one type B. Several flu vaccine makers have added quadrivalent products to their lines in recent years because of the difficulty of predicting which of the two influenza B lineages will be more common in any given season.Seqirus offers a trivalent formulation of Afluria that is available in a needle-free injector. The company announcement does not mention a needle-free version of Afluria Quadrivalent. Aug 29 Seqirus press release