New Delhi: Patients with heart failure who are vaccinated against Covid-19 are 82 per cent more likely to live longer than those who are not vaccinated, a new study said on Saturday. The study presented at Heart Failure 2024, a scientific congress of the European Society of Cardiology (ESC), used the Korean National Health Insurance Service database to obtain information on vaccinations and clinical outcomes.
Participants who received two or more doses of the Covid-19 vaccine were described as "vaccinated", and those who were not vaccinated or had received just one dose were defined as "unvaccinated".
Heart Failure is a life-threatening syndrome affecting more than 64 million people globally.
In this large study of patients with heart failure, Covid-19 vaccination was associated with a lower likelihood of contracting the infection, being admitted to hospital because of heart failure, or dying from any cause during a six-month period compared with remaining unvaccinated, said study author Dr Kyeong-Hyeon Chun of the National Health Insurance Service Ilsan Hospital, Republic of Korea.
The study comprised 651,127 heart failure patients over the age of 18. The average age was 69.5 years, and 50 per cent were female. Of the whole study population, 538,434 (83 per cent) were classified as vaccinated, and 112,693 (17 per cent) as unvaccinated.
The researchers found that vaccination was associated with an 82 per cent lower risk of all-cause mortality, 47 per cent lower risk of hospitalisation for heart failure, and 13 per cent reduced risk of Covid-19 infection compared with no vaccination.
Regarding cardiovascular complications, vaccination was associated with significantly lower risks of stroke, heart attack, myocarditis/pericarditis, and venous thromboembolism compared to no vaccination, the researchers mentioned.
"The study provides strong evidence to support vaccination in patients with heart failure. However, this evidence may not be applicable to all patients with heart failure, and the risks of vaccination should be considered in patients with unstable conditions," Chun said.
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Heart failure, a life-threatening condition affecting over 64 million people globally, is a heavy burden to bear. But amidst the bleakness, a beacon of hope emerges from surprising quarters: the COVID-19 vaccine.
New research unveiled at the Heart Failure 2024 congress in Lisbon suggests this vaccine could drastically improve the odds for heart failure patients, reducing their risk of death by a staggering 82 percent.
Patients with heart failure should be vaccinated against COVID-19 to protect their health, noted Dr. Kyeong-Hyeon Chun, the studys lead author. This isnt mere speculation. The research, a comprehensive analysis of over 650,000 Korean heart failure patients, reveals a stark contrast between those vaccinated and those not.
The vaccinated group experienced a much lower risk of not only death but also hospitalization due to heart failure and even contracting COVID-19 in the first place. This revelation is groundbreaking, given that previous research had primarily focused on the vaccines safety in heart failure patients, not its potential to extend their lives.
This study was remarkable for its sheer size and comprehensive approach. It drew upon the Korean National Health Insurance Service database, a vast repository of health information that encompasses a significant majority of the Korean population. This allowed researchers to access an enormous sample size, ensuring the studys findings were statistically robust and generalizable.
To further enhance the validity of their results, researchers carefully matched vaccinated and unvaccinated patients based on a variety of factors, including age, sex, socioeconomic status, and pre-existing health conditions. This meticulous matching process ensured that the two groups were as similar as possible, eliminating potential confounding variables and isolating the effects of vaccination.
The outcomes of this rigorous study were undeniable. After six months, the data revealed that vaccination led to a substantial reduction in the risk of death from any cause, hospitalization due to heart failure, and COVID-19 infection itself. Furthermore, the vaccinated group exhibited a significantly lower risk of experiencing severe cardiovascular events such as stroke, heart attack, and blood clots.
This is more than just a statistic. Its a potential turning point in how we approach heart failure. While the COVID-19 vaccines primary role has been to protect against the virus, this study suggests it could be a powerful weapon in the fight against heart failure itself.
This was the first analysis of COVID-19 vaccine effectiveness in a large population of heart failure patients, and the first to show a clear benefit from vaccination, Dr. Chun emphasized. This study isnt just about numbers; its about real lives saved, hospitalizations prevented, and the potential for a brighter future for millions battling heart failure.
While the studys findings are undoubtedly a significant step forward in understanding the potential benefits of COVID-19 vaccination for heart failure patients, its crucial to approach these results with a nuanced perspective.
The study population, while extensive, was primarily based in Korea, and the specific demographics and healthcare practices of that region might not perfectly translate to other populations worldwide. Additionally, the studys median follow-up period of six months, while substantial, doesnt capture the long-term effects and potential complications of vaccination for heart failure patients.
Furthermore, heart failure is a complex and heterogenous condition with varying degrees of severity and underlying causes. While the study accounted for numerous factors, such as age and co-morbidities, it might not have captured the full spectrum of individual differences that could influence the vaccines effectiveness and safety. For instance, patients with specific genetic predispositions, allergies, or those undergoing particular treatments might experience different responses to the vaccine.
Therefore, its imperative for individuals diagnosed with heart failure to view this study as a starting point for a more personalized conversation with their healthcare provider. This dialogue should involve a detailed examination of the patients medical history, current health status, and individual risk factors.
Its only through such a comprehensive and individualized approach that the potential benefits and risks of COVID-19 vaccination can be accurately assessed and tailored to each patients unique circumstances.
The COVID-19 vaccine, initially hailed as a shield against a deadly virus, may now be a lifeline for those grappling with heart failure. Its not just about fighting the virus; its about bolstering the heart, reducing complications, and ultimately, increasing the odds of survival.
If you or someone you know is living with heart failure, this research is a call to action. Talk to your doctor about the potential benefits of the COVID-19 vaccine. It could be a simple step towards a longer, healthier life.
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A big Korean analysis of people with heart failure has revealed substantial positive impacts of getting vaccinated against COVID-19.
The study was drawn from the Korean National Health Insurance Service database, which covers nearly all residents of the country.
It contained 651,127 patients aged 18 years or older with heart failure.
The study found heart failure patients who are vaccinated against COVID-19 have an 82% greater likelihood of living longer than those who are not vaccinated; a 47% lower risk of hospitalisation for heart failure and 13% reduced risk of COVID-19 infection, compared with people who were not vaccinated.
The research was presented at Heart Failure 2024, a scientific congress of the European Society of Cardiology, in Lisbon, Portugal.
Heart failure is a life-threatening syndrome affecting more than 64 million people worldwide.
Patients with heart failure should be vaccinated against COVID-19 to protect their health, says study author Dr. Kyeong-Hyeon Chun of the Ilsan Hospital, Goyang, in the Republic of Korea. In this large study of patients with heart failure, COVID-19 vaccination was associated with a lower likelihood of contracting the infection, being admitted to hospital because of heart failure, or dying from any cause during a six-month period compared with remaining unvaccinated.
Previous studies have shown that COVID-19 outcomes are worse in patients with heart failure compared to those without heart failure.
Participants who received two or more doses of COVID-19 vaccine were defined as vaccinated, and those who were not vaccinated or had received just one dose were defined as unvaccinated.
The average age of people drawn from the data was 69.5 years and 50% were women. Of the total study population, 538,434 (83%) were defined as vaccinated and 112,693 (17%) as unvaccinated.
The researchers performed 1:1 matching of vaccinated and unvaccinated patients according to age, sex, other health conditions (e.g. high blood pressure, diabetes, high cholesterol, etc.), income, and region of residence. This resulted in 73,559 vaccinated patients and 73,559 unvaccinated patients for the comparative analyses.
In addition to lower mortality rates, vaccination was associated with significantly lower risks of stroke, heart attack, myocarditis/pericarditis, and venous thromboembolism compared to people who were not vaccinated.
Chun says this is believed to be the first analysis of COVID-19 vaccine effectiveness in a large population of heart failure patients, and the first to show a clear benefit from vaccination for that cohort.
The study provides strong evidence to support vaccination in patients with heart failure. However, this evidence may not be applicable to all patients with heart failure, and the risks of vaccination should be considered in patients with unstable conditions, Chun says.
This story is part of CBC Health's Second Opinion, a weeklyanalysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven't subscribed yet, you can do that byclicking here.
While there's no sign a dangerous form of bird flu has gained the ability to transmit between humans, the steady spread of the virus to new species of mammals most recently, dairy cattle throughout the U.S. suggests H5N1 is closer to us than ever before.
Officials are quick to note that without a few key evolutionary leaps, this pathogen won't spark a human health crisis. Dr. Michael Ryan, executive director of the World Health Organization's (WHO) health emergencies program, said as much during remarks on Wednesday.
"Nobody is suggesting that H5N1 is the new, next pandemic. I don't believe anybody can predict that," he said.
"But it's certainly concerning when a virus like this begins to infect multiple mammalian species, which means the virus that is adapting to [animals] that are more like us than birds, and therefore there's a higher level of alert."
Given the risks, WHO officials say that behind-the-scenes processes are in place, including agreements with drugmakers, to produce "billions" of H5N1 vaccine doses within the first year of a pandemic,should this virus gain the ability to spread between humans.
Other scientists warn that's easier said than done, given the complexities involved in manufacturing and distributing a new set of vaccines.
"Even though we have a massive global infrastructure capable of producing flu vaccines we will never be ready for a pandemic," McMaster University immunologist and vaccine researcher Matthew Miller said.
The spread of H5N1 throughout cattle herds across at least nine U.S. states is the latest curve ball froma virus that's proven adept at latching onto new hosts, raising questions over whether the world is prepared for more surprises.
U.S. farm workers in multiple states may now be in regular contact with infected cattle, as officials are monitoring at least 260 people for symptoms amid growing concerns that limited testing could be masking the true scale of the outbreak, both in cows and in humans. (On Friday,the U.S. federal government did announce major funding to expand testing efforts, which includes paying up to $75 to farm workers who take part in studies.)
Early research, which hasn't yet been peer reviewed, also suggests the cells in cows' mammary glands can be infected by both avian and human influenza viruses. Scientists warn that scenario may provide a viral mixing vessel, fuelling the development of adaptations that hike the risk to human hosts.
None of these signals are a smoking gun that H5N1 will evolve to sustain transmission in a human population. Yet the possibility is always present, even if the virus's next moves remain somewhat unpredictable.
In response to questions from CBC News, WHO officials stressed that there are two H5N1 vaccine candidates already available that could be used in a pandemic scenario, along with options targeting other forms of avian influenza.
There's no need to begin manufacturing these shots now, the WHO's Ryan said. Scaling up to produce pandemic vaccines would also mean a trade-off where manufacturers are forced to hit pause on annual shots for other strains.
"You can't just press the button and begin producing pandemic [H5N1] vaccines," Ryan said. "You have to stop producing your seasonal vaccine, and all of you out there know how life-saving that vaccine is... so this requires very careful consideration."
Some countries have H5N1 vaccines already on hand, including the U.S., which has two types of shots that are well matched with the currently circulating strain in dairy cattle. Both candidate vaccines are available to manufacturers, according to the U.S. Centers for Disease Control and Prevention (CDC).
The CDC is also testing human blood samples from people previously vaccinated with H5N1-based vaccines to see how it reacts to virus samples taken from the recent human case in Texas. So far, their research suggests vaccination "will offer good cross-protection against cattle outbreak viruses."
Here in Canada where no cases have been reported yet in dairy cattle federal officials say they're not acquiring a fixed stockpile of shots, since any changes in the virus that would allow it to transmit between humans could "fundamentally influence the antigen required for a human vaccine."
Currently, there are two H5N1 vaccines authorized in Canada, based on strains from previous outbreaks. The Public Health Agency of Canada (PHAC) also has agreementswith several vaccine manufacturers, both domestic and international, the agency noted in a statement.
A GlaskoSmithKline facility in Quebec, for instance, produces seasonal flu shots each year, and one of its subsidiaries also developed one of the country's two authorized H5N1 shots. That vaccine is approved for use in children six months of age and older, and nospecial safety concerns were identified in clinical studies, according to Health Canada's regulatory decision on its use.
"Under these contracts, the vaccine production process would be triggered by a WHO pandemic influenza declaration or a decision by the Government of Canada that influenza vaccine manufacturers switch from seasonal to pandemic influenza vaccine production," PHAC's statement continued.
While those preparations paint a rosy picture of countries' ability to rapidly respond, Miller, from McMaster, stressesthat the process from testing to manufacturing to shipping is complex and lengthy, even in a best-case scenario.
He pointed to the COVID-19 pandemic, during which drugmakers raced to develop brand-new vaccines for a never-before-seen threat. The pace of those trials was astounding; shots began rolling out in some countries as early as December2020.
Yet, a year later, infections and deaths soared to new heights thanks to the highly contagious Omicron variant, even as vaccination campaigns kept rolling out through the population.
It wasn't because the shots weren't effective, Miller added, "but because the virus evolves, and that causes problems."
The explosive spread of H5N1 among dairy cattle in mere months also points to how fast this kind of situation can change. Miller agreesthat while it's a simple switch to start producing pandemic-based vaccines, manufacturing and distributing eight billion global doses can't possibly happen overnight.
And the challenges don't stop there. Jillian Kohler, a professor at the University of Toronto whose research focuses on global access to essential medicines, says nationalism and rampant misinformation would surely complicate vaccination efforts in the event of another pandemic.
"There are a lot of variables that could easily derail getting vaccines out. And it's not just getting vaccines out, it's getting people to accept the vaccines."
Vaccine equity, she says, also remains a major issue. During the COVID pandemic, wealthier countries Canada included had an oversupply of vaccines, while others went without. And in 2022, when mpox spread worldwide for the first time, vaccines rolled out in many higher-income countries, yet the hardest-hit regions of Africa didn't have any shots.
Without learning lessons from those prior crises, Kohler warned much of the world could be sidelined during vaccination campaigns if H5N1 ever makes its human-to-human leap.
She also questioned the role of private industry in preventing pandemics, including decisions over which shots and customers to prioritize at any given time.
"Why are we relying on drugmakers to make the policy decisions that should be in the hands of government?" Kohler asked.
"To put trust in the industry to make sure we get the vaccines out in a timely fashion is repeating a mistake that we had before."
In May 2020, Catherine Green gained a new lab partner. The chatty Oxford University scientist had spent four months working 18-hour days trying to develop a vaccine for Covid, which was ripping through the population and crippling the economy with a devastating lockdown.
Then the FTSE 100 pharma company AstraZeneca came calling. The company offered to use its heft to scale up and manufacture the promising jab that Green and her colleagues had developed.
It was initially a frosty marriage. We felt a bit of trepidation that teaming up with a pharmaceutical giant would mean someone else making large profits off the back of our efforts, Green recalled in her book Vaxxers, co-written with Sarah Gilbert, professor of vaccinology at Oxford University. A dejected Green
Pictured: A collage of vaccines and cancer cells/Taylor Tieden for BioSpace
Oncology remains the major focus area in R&D for large pharma companies as global spending in the area continues to grow. Immunotherapies, in particular, have quickly become some of the best-selling products on the market.Seeking ever more efficacious treatments, companies are now eyeing cancer vaccines, which experts say could be more powerful than other immunotherapies and may even provide a preventative measure against certain malignancies.
The first therapeutic cancer vaccine was approved in 2010, and Dendreons Provenge is still the only therapy of this type on the market. But interest in the space is growing as certain candidates enter late-stage clinical trials.
Its definitely a competitive area, said Scot Ebbinghaus, vice president of clinical research at Merck, which is developing mRNA-4157/V940 in partnership with Moderna. But competition is a good thing for patients. It makes us work harder and smarter. We look carefully at what our competitors are doing and keep this mind when we are developing our plans.
Ebbinghaus explained that both cancer vaccines and immunotherapies, such as Mercks blockbuster Keytruda (pembrolizumab), act on the T cells, which fight cancer. The way PD-1 inhibitors work is they take the brakes off of those cells. The vaccines work by presenting tumor-specific antigens to the immune system, which activates even more anti-tumor T cells, potentially allowing pembrolizumab to have a stronger effect, he told BioSpace.
Merck and Modernas vaccine is one of the most advanced candidates in development. mRNA-4157/V940 is currently being explored as a combination treatment with Keytruda, with Phase III trials underway in high-risk melanoma and non-small cell lung cancer (NSCLC). In Phase IIb trials for melanoma, the combination treatment was able to reduce the risk of recurrence or death by 49% compared to Keytruda alone.
What we have seen so far suggests that these drugs could be really useful in patients who have had cancer surgery and preventing recurrence, Ebbinghaus said. This is a very large population of patients with an unmet need to reduce the risk of cancer recurrence.
Another potential advantage of this therapeutic approach, based on the data the partners have seen so far, is that the safety profile is similar to that of standard vaccines, Ebbinghaus added. This means pain at the injection site or mild fever, which he said is preferable to the adverse events associated with chemotherapy. These milder adverse events could also allow the vaccines to be delivered in situations where a patients health does not allow for exposure to harsher treatments, he noted.
Some vaccine candidates in mid- to late-stage development, such as an mRNA product being pursued by BioNTech and Roche/Genentech, are being tested in combination with chemotherapy. Now in Phase II trials, the mRNA vaccine is administered along with Roches checkpoint inhibitor Tecentriq and chemo against pancreatic cancer.
Another company developing a portfolio of cancer vaccines is CureVac, which announced in April that it would collaborate with MD Anderson on early-stage research. A CureVac spokesperson told BioSpace over email that the company is developing two approaches: an off-the-shelf platform tailored to patients with specific cancer types, and a fully personalized approach that would be based on a patients individual tumor genomic profile.
The MD Anderson partnership is based on the first method and the tumor antigens shared across different cancer indications. The collaboration will use whole genome sequencing in combination with short- and long-read RNA sequencing to identify promising antigens, the spokesperson said, adding that the aim is to go beyond the current state-of-the-art antigen space.
Along with the aforementioned therapeutic vaccines, research is also ongoing into developing preventive vaccines. The former are designed to treat an existing cancer, while the latter aim to help the immune system recognize and destroy cancer cells before they can gain a foothold in the body.
Cancer Research UK (CRUK) recently announced it would provide funding to researchers at the University of Oxford, the Francis Crick Institute and University College London to develop a preventive lung cancer vaccine. The research could lead to the first vaccine for people at high risk of developing the disease, such as current or previous smokers aged 5574. The vaccine, known as LungVax, is based on the same technology that was employed in AstraZenecas COVID-19 vaccine.
Hattie Brooks, a science engagement manager at CRUK, explained how the vaccine could potentially work. The vector has been modified to express a protein, known as a neoantigen, that appears in lung cancer cells as they first become cancerous, Brooks told BioSpace. LungVax will train the body that the neoantigen is a danger and that this protein is a red flag for cancer. This allows the immune system to recognize the neoantigen as a threat and destroy the cells before the cancer has had time to develop.
Unlike some therapeutic vaccines, the preventive vaccine could be used alone in those individuals with the highest risk of developing cancer, potentially preventing the disease from occurring and negating the need for treatment. If it proves to be promising, LungVax will be moved into clinical trials. In the U.K. alone, there are 48,500 new cases of lung cancer diagnosed every year.
While preventive vaccines are still early-stage, excitement around cancer vaccines more broadly continues to grow as therapeutic vaccines move through mid- and late-stage clinical development. It will not be long before the potential of this approach is either realized or dealt a blow.
For Mercks part, Ebbinghaus said the company has seen enough promise in the data from mRNA-4157/V940 that it is already in discussion with Moderna for further clinical programs looking ahead to 2025 and beyond.
Ben Hargreaves is a freelance science journalist based in Tosse, France. Reach him onLinkedIn.
Six lives every minute. Thats the number saved by vaccines, according to a study by the World Health Organisation and published in the Lancet earlier this year. That equates to 154million people over the past 50 years alone. And the vast majority of lives saved in that half century 101million were those of infants.
It was the Englishman Edward Jenner who noted that people infected with cowpox were immune to the more deadly smallpox. In 1786 he created the first vaccine, by using matter from a cowpox sore to inoculate against smallpox. In the 200 odd years since, weve developed and rolled out vaccines for a large number of once deadly or debilitating diseases.
Yet we now seem to have become so complacent about the benefits that people are eschewing vaccines entirely. Which makes them and to an extent all of us much more vulnerable to disease.
The current whooping cough outbreak has rightly got parents scared. It is the worst we have seen for 40 years. Many adults have also succumbed to it, suffering the so-called 100 day cough.
The UK Health Security Agency (UKHSA) has confirmed there were 2,793 cases of whooping cough reported as of the end of March and five babies have tragically died from the infection.
The current whooping cough outbreak has rightly got parents scared. It is the worst we have seen for 40 years, writes Dr Max
There is always a lag between deaths and the publication of official figures, so it seems inevitable the real number will already be higher. It was reported in this paper last week that paediatric intensive care units are on surge capacity because of whooping cough and measles, meaning they are full to bursting.
There are several factors at work here. Yes, the problem may be down, in part, to reduced community immunity caused by lockdowns. But theres no doubt that it has also been fuelled by a rise in the number of parents refusing to get their babies and toddlers vaccinated, and some pregnant women declining the jab too.
With uptake over the past 12 months not much above 90 per cent for the six-in-one jab given to babies which also protects against diphtheria and polio we are rapidly losing the blanket coverage we need to keep whooping cough at bay. In London its down to 86 per cent.
Vaccine refusal has been a problem since the 1990s, when unfounded fears over the MMR triple jab saw uptake slump
In fact vaccine refusal has been a problem for many years. It started back in the late 1990s with the panic caused by Andrew Wakefield, a doctor who wrong linked the jab for measles, mumps and rubella with autism. Thats been categorically disproved, of course, and Wakefield was struck off the medical register (although he continues as a vocal anti-vaxxer). But the idea that vaccines can be dangerous persists. Many parents still have a niggling worry.
Youd think those who were most hesitant would be from less-educated backgrounds, perhaps because they dont understand the science or are unaware how crucial vaccination is to their childs health. But in fact research suggests the opposite is true. With MMR, for example, some of the lowest rates of uptake of the vaccine are in some of the most wealthy regions. This suggests that groups of people who are typically educated, and otherwise pro-active on health matters, are actively turning their backs on vaccines.
This feels to me like part of a wider trend. Ive certainly noticed in middle class patients a growing sense that they know best when it comes to their health. They dont blindly trust doctors or experts anymore, and are often resistant to, or sceptical of, health campaigns because they dont like being told what to do.
This lack of trust has been heightened by social media. People are bombarded by misinformation and downright lies online and too many believe them.
Its all too easy to get sucked into forums run by people who think they know more than doctors.
Add the sense of superiority one sometimes finds among middle class patients a reluctance to defer to those with medical qualifications and youve got a vaccine refuser.
Theres another, more nebulous problem: people are tired of vaccines after Covid.
Humans tend to have a short attention span and after the monumental push to get people vaccinated back in 2020, they are simply bored with hearing about jabs and how important they are. They arent prioritising it.
I worry that scepticism about vaccines will only get worse in the wake of revelations that, while saving millions of lives worldwide, the AstraZeneca Covid jabs have been found to be linked to potentially serious complications.
Scientists do test vaccines rigorously pharmaceutical companies cant afford not to.
One of mankinds greatest advances was the development of a method of scientific inquiry that tests hypotheses and all new medical treatments in as objective a way as possible. And we know the childhood jab for whooping cough is safe.
If we are to avoid further surges in infectious diseases, doctors have to better engage with those who are vaccine sceptics. Its vital that the misinformation and misunderstandings are discussed openly. We should never be scared of debate.
While its unlikely to change the view of die-hard anti-vaxxers, it will hopefully expose some of the falsehoods that are circulating about the whooping cough vaccine, and help those who are hesitant or confused make an informed choice about protecting their child.
Damian Hurley, 22, had to direct his mother, Elizabeth Hurley, 58, in a sex scene in his new film
Most people find the idea of their parents having sex as, well, something theyd rather not think about. But imagine if you not only had to think about it but choreograph the action too?
Damian Hurley, 22, had to do just that when he directed his mother, Elizabeth Hurley, 58, in his new film. Talking afterwards, Liz said: Everyone knows its not actually sexy to shoot any kind of intimate scene... Damian made it so comfortable. It was nothing. Im sure shes right, but even so. There is something slightly icky about your child being involved like this.
Part of me loves how the two of them are close they seem more like friends than mother and son but Im not totally onboard with him taking racy pictures of her posing in bikinis to promote her beachwear either. I cant help thinking theres something to be said for boundaries.
As you get older, a fall can have devastating consequences. As bones become brittle, even a simple trip can result in a fracture.
One in three people aged over 65 and half of those aged over 80 will suffer at least one fall a year, costing the UK an estimated 4.4billion annually.
Thats why I love a new programme called Finding Your Feet, designed by British Judo. Its a course, taught by judo trainers, which takes18 different judo techniques and adapts them for elderly people at risk of falling.
Theyll beshown how to improve their balance and how to fall safely. Its a brilliant idea.
This new range of handmade organic products uses lots of natural ingredients. My favourite is the sweet sleep magnesium butter which you rub on the bottom of your feet 20 minutes before going to bed.
Theres evidence to suggest that magnesium improves sleep by acting on certain chemicals in the brain, such as NMDA, GABA and melatonin, which affect how relaxed or tired a person feels.
A bunch of symptoms, which may persist many months or even years after an acute COVID infection has cleared, have been described in the medical literature with increasing frequency since the onset of the pandemic. This constellation of findings has been dubbed long COVID. Long COVIDs effects on the brain, in particular, have certainly been in the news, and its also been popping up in the medical literature. So, whats the relationship between coronavirus (and the vaccine) and neurological long COVID?
Neurological long COVID
In their excellent 2024 paper, Spanish researchers reported on their experience with patients suffering neuropsychological symptoms and signs which persisted long after the acute COVID-19 infection had cleared. The scientist evaluated more than a hundred patients whod been diagnosed with coronavirus. Eighty of the volunteers continued to suffer from persistent problems and the other twenty had recovered completely.
The subjects underwent psychological and neurological examinations as well as MRI scans. About half of the patients diagnosed in the Spanish study with long COVID had significant memory problems. About a quarter of them had problems thinking, which included language issues (fluency of speech), attention disorder, and the ability to mentally process any kind of intellectual challenge at a normal speed (slow or labored cognition). In 2023, Croatian researchers elucidated the more common clinical aspects of neurological long COVID. Based on an analysis of more than 200 patients, the Croatian doctors determined that long COVID is more common in women than men. Affected patients often suffer from a constellation of symptoms, which might include headaches, problems thinking clearly, loss of smell, numbness, tiredness, dizziness, and insomnia.
Long COVID also altered brain anatomy in many affected patients. The Spanish researchers discovered that, compared to the twenty patients whod completely recovered from COVID, the eighty who suffered persistent neurological symptoms demonstrated MRI abnormalities. The white matter (the cables that connect different parts of the central nervous system) of those who suffered long COVID was disrupted over wide swathes of the brain. Whats more, MRI disclosed that the gray matter (the thinking part of the brain) of a significant cohort of neurological long COVID patients had wasted away in the left-sided posterior superior temporal gyrus (a part of the brain crucial for language comprehension).
Are vaccines protective against neurological long COVID?
The largest study (by far) that examined the relationship between vaccination and the development of long COVID was performed by a multinational group of scientists (American, Japanese, and British) in 2023. These researchers evaluated the medical records of more than 600,000 people. Unfortunately, their efforts werent focused on neurological long COVID (most of their long COVID patients reported only tiredness and shortness of breath), but I believe the conclusions may be extrapolated. The scientists discovered two important facts. Firstly, those who were vaccinated enjoyed a significantly lower chance of developing long COVID. Secondly, for those who were already suffering from long COVID, additional vaccinations (boosters) didnt cause symptom exacerbation.
Can vaccines cause neurological long COVID?
As of April 2023, a multinational team of Swiss and German scientists pointed out that, globally, thered already been 760 million cases of confirmed COVID-19 and more than 13 billion doses of vaccine administered. These researchers acknowledged the existence of a significant number of people whod been injected with an mRNA-based vaccine and later developed a syndrome similar to long COVID. The manuscripts authors cautioned the medical establishment against poo-pooing this adversely affected portion of the population by lumping them with those derogatorily referred to as anti-vaxxers.
In 2022, Saudi Arabian doctors described complications related to COVID-19 vaccines, specifically those that were likely to result in long-term neurological problems. Their report centered on three major classes of issues. Firstly, the scientists described post-vaccination cerebral venous thrombosis (blood clots in the vessels of the brain), which was often accompanied by a significant incidence of stroke. Secondly, the doctors were confronted with post-vaccination Guillain-Barr Syndrome (a potentially progressive paralysis of the legs, arms, and diaphragm (breathing muscles). Lastly, the researchers observed several patients who suffered from post-vaccination Miller-Fisher Syndrome (a disorder where the immune system attacks nerves that control the movement of the face and eyes).
A 2023 publication described the MRI findings in patients who suffered neurological complications after receiving COVID-19 vaccines. The doctors who cared for patients throughout Iran reviewed almost 90 scientific studies and reported numerous deleterious imaging sequelae of vaccinations. The most commonly observed brain injury was related to minor or major strokes. The researchers also observed (sometimes severely destructive) inflammation in widespread areas of the brain and spine.
You can plainly see that our understanding of neurological long COVID is evolving. We are learning more and more about the causes and symptoms of the dreaded syndrome. The jury is still out as to the degree of benefit or culpability of vaccines in relation to neurological long COVID.
Marc Arginteanuis a neurosurgeon and author ofAzazels Public House.
(Bloomberg) -- Novavax Inc. shares surged after the company signed a $1.2 billion licensing agreement with Sanofi that includes commercializing a combined Covid-19 and flu shot.
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Novavax will receive $500 million in upfront payments as well as a further $700 million if all development, regulatory and launch milestones are met, according to a statement Friday. Novavax, which will receive tiered royalties on any vaccine sales, said Sanofi is also taking a minority equity stake of about 5% in the US company.
Novavax shares rose as much as 146% in early trading in New York and the stock is on track for its biggest one-day increase on record. The stock was trading at $10.30 a share on Friday, although this is still well off a peak of about $320 in early 2021.
The pact links two big players in the vaccine world that both missed out on the rush to develop and commercialize Covid shots quickly during the pandemic. Amid various setbacks, Sanofi and Novavax ceded tens of billions of dollars in sales to nimbler messenger-RNA developers including the Pfizer-BioNTech alliance and Moderna Inc.
Now, Sanofi will have the rights to drive sales of Novavaxs Covid-19 shot worldwide from next year, except for in India, Japan and South Korea, where Novavax already has advance purchasing agreements. The French drugmaker also has the sole license to use Novavaxs protein-based Covid shot in combination with its flu shot, which it said will offer patients enhanced convenience and protection against two serious respiratory viruses.
Sanofi will also have a non-exclusive license to use Novavaxs Matrix-M adjuvant in other vaccine products. Novavax will still have the right to develop its own combined Covid-flu vaccine at its own cost.
Shares of Sanofi rose slightly in early trading in Paris. The stock was down about 5% in the past 12 months through Thursdays close.
The deal is a boost for Novavax which is in the midst of restructuring its business after a difficult 2023 when it had to issue a going concern warning about its ability to continue operating. Novavax reported a first-quarter net loss of $148 million, compared with a $294 million loss a year earlier.
Read More: Novavax Falls After Warning of Substantial Doubt Over Future
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At first glance the deal seems surprising for Sanofi but its likely a strategic move, said Mila Bankovskaia, a Bloomberg Intelligence analyst.
Moderna and Pfizer are both assessing mRNA-based combination vaccines, and though Sanofi believes its non mRNA-based flu product wont be improved, the potential to offer a non-mRNA-based combination as an alternative looks a sensible move, she said.
(Updates with shares.)
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Bird flu
The H5N1 virus has been devastating bird populations, and is now infecting mammals too. Is human-to-human transmission next? And are we ready for another pandemic?
Sat 11 May 2024 01.00 EDT
Over the past four years, a silent pandemic has been raging. One in which the death toll is believed to number in the hundreds of millions, but which has received remarkably little attention until now.
The pandemic in question is bird flu, the H5N1 strain of influenza, which since 2020 has moved far beyond the avian world and into mammals ranging from dairy cattle to domestic pets, and species that live on our doorsteps, such as foxes. The viruss presence has been detected on every continent, even Antarctica. While it has yet to evolve the capability of spreading between humans, alarm bells were raised last month after a dairy farm worker in Texas contracted H5N1, seemingly from cattle.
It would appear to be the first known case of bird flu jumping to humans from another mammal. There is increasing concern at the scientific and public health levels, says Dr Gregory Poland, director of the Mayo Clinics vaccine research group, who has previously compared the rising infection rates among animals to the rumbles prior to an earthquake.
While H5N1 is well known for its devastating impact on wild bird populations and poultry farms in the US as of 5 May, 91m farmed birds have been infected in the US across 48 states Poland has been particularly alarmed by reports of pet cats contracting the virus from cattle and becoming seriously ill or dying. We have very little research to tell us how this is all occurring in cattle, and how it is being spread, he says.
In the UK, the virologist Prof Paul Digard and his team at the Roslin Institute in Edinburgh were awarded an additional 3.3m grant last year to ramp up their research into bird flu, and assess the risk the current strain of H5N1 might pose to humans.
Flu is constantly evolving, and it is clear that a couple of years ago, the current strain of bird flu changed to become supercharged, says Digard. Now that it seems to be fairly widespread in the cow population in the US, thats a much more direct route where it could transmit to people and gain the adaptations it needs to go pandemic.
The Roslin teams task is to figure out the precise changes in the viral sequence that seem to be allowing it to infect cows, and then test the strain on human cells and mini-organs in the lab. The ultimate goal will be to make predictions about whether it is starting to become more dangerous to humans and to animals that live in close proximity to us, and to feed that information back to the relevant public health authorities.
If the findings spark concern, it could provide the government with more evidence to start bolstering national supplies of flu vaccines. Last year, reports emerged that the UK Health Security Agency had run a procurement exercise to source suitable jabs, while the US has accumulated a national reserve of four types of flu vaccine that could provide some protection against H5N1 in case of any future outbreak. But even this stockpile would not be sufficient for the entire country, and Digard explains that governments face a desperately difficult decision when it comes to balancing the economic cost of vaccines against trying to ensure that they are as ready as possible for an outbreak.
The issue is trying to decide when to pull the trigger for go, he says. Because if you wait until its already a pandemic, then youre playing catchup, and you know that youre not going to be able to make enough vaccine quickly to protect everybody.
If H5N1 did start spreading among people, the good news is that the world has plenty of recent experience when it comes to rolling out large-scale vaccination programmes. More than 13bn doses of Covid-19 vaccines have now been administered, covering 70% of the worlds population, while at the height of the 2009 swine flu outbreak, around 3bn vaccine doses were churned out.
According to the US Centers for Disease Control and Prevention (CDC), there are two candidate vaccines against a related strain of flu viruses that could be shipped within weeks, if necessary. Various manufacturers also have special dispensations from regulators to update their flu vaccines with relevant targets from the H5N1 strain, without needing to seek new licensing.
The World Health Organization (WHO) says its estimates suggest that 4-8bn doses of influenza vaccines could be produced within a year in an H5N1 pandemic. Experts say that would require a significant expansion of the global capacity for making flu vaccines, placed at about 1.2bn doses.
Remember that it takes two doses, three to four weeks apart, to achieve protective immunity, says Poland. You can quickly do the maths and see where that leaves us.
While manufacturers have been working on H5N1 vaccines since the mid-2000s, research has always indicated that they pose a much greater technical challenge than the seasonal flu vaccines distributed each year. In particular, the jabs seem to require a far larger dose to generate a sufficient immune response. A dose of the H5N1 vaccine candidate manufactured by the French pharmaceutical company Sanofi is 90 micrograms, six times the size of a typical seasonal flu vaccine. Poland says this would make it far more challenging to produce the jab at the scale required.
The WHOs capacity predictions may be relying on ramping up the production of adjuvanted vaccines. These utilise an additional ingredient, or adjuvant, which is combined with the vaccine to boost the immune response, enabling a far smaller dose, and one that is easier to produce in large quantities. The pharmaceutical company GSK says that its pandemic influenza vaccine Adjupanrix, which uses an adjuvant, has a dose of 3.75 micrograms. In 2022, we signed a contract with the EUs Health Emergency Preparedness and Response Authority for the reservation of future production and supply of 85m doses of Adjupanrix, the company says. In the event of an influenza pandemic declared by the WHO, this will ensure the ready production and supply of Adjupanrix to 12 EU member states.
However, speed of production could still prove to be a bottleneck. In the event of an H5N1 pandemic, the WHO estimates that 79% of the vaccines produced would be made using traditional gold-standard technologies, which require incubation in chicken eggs. While a Sanofi spokesperson said that during the 2009 swine flu pandemic, vaccines were produced within three months, egg-based platforms are known to be more time-consuming: the process can take up to six months.
Instead, messenger RNA (mRNA) technology, which proved so invaluable in generating Covid-19 vaccines, could once again be a vital tool, with the platform known to be faster and more efficient than older egg-based technologies. Current clinical trials by both Moderna and GSK and CureVac working in collaboration are testing H5N1 vaccines in people. However, given past difficulties in stimulating sufficient immune responses to H5N1, Digard says there is insufficient data to examine the possible effectiveness of mRNA vaccines.
Its technology that is potentially applicable to this, he says. I dont think we have the data yet to say that it works as well.
Given that H5N1 is still largely confined to the animal population, one idea for reducing transmission and limiting the potential for jumping to humans may be vaccinating poultry and farm animals on a mass scale. However, Karen Grogan, an associate professor at the University of Georgias Poultry Diagnostic and Research Center, is not convinced this would make a significant difference.
Vaccination of commercial poultry would not decrease the amount of viable virus in the environment since there is so much being shed by wild birds, she says. The spread into dairy cattle is likely linked to wild birds on those dairies. There are no approved H5N1 vaccines for use in farm animals or household pets; those would need to be developed, which is a process that takes around four years.
If there is an H5N1 pandemic, Poland predicts that healthcare services around the world would have to rely partially on antiviral medication for the first six months of the outbreak, until sufficient vaccine stocks became available to provide full population-level coverage. According to the CDC, analysis of the strains circulating among cows show that the virus should be susceptible to the current range of antivirals that are approved against flu.
But whether its stockpiling antivirals or instructing pharmaceuticals companies to switch to H5N1 vaccine production, Digard says that governments face a difficult dilemma when it comes to how best to respond to the bird flu threat.
All this costs money, he says. Its a very delicate juggling act. With vaccines, for example, if we begin diverting all the vaccine production to make H5N1 jabs, that means we dont make the seasonal flu vaccines. So if you start an H5N1 vaccine programme prematurely, youve disrupted the supply of seasonal flu vaccines which are still needed.
Although the prevalence of H5N1 in the wild is worrying, Digard is keen to point out that, while the virus is widely reported as having a fatality rate of 52% in humans, based on 882 cases of infections between January 2003 and December 2023, it does appear to have become much less pathogenic for people in recent years.
There have been human cases in the UK over the last couple of years, but theyve been really mild and generally asymptomatic, he says. Im not minimising the risk if this did go pandemic, even with a very mild virus, people would end up dying because of the sheer numbers who get infected. Even swine flu, which is the mildest flu pandemic we have records for, still killed hundreds of thousands of people. But it wouldnt be a science-fiction style pandemic.
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