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Tag: Pandemic

  • The path to a better tuberculosis vaccine runs through Montana

    The path to a better tuberculosis vaccine runs through Montana

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    A team of Montana researchers is playing a key role in the development of a more effective vaccine against tuberculosis, an infectious disease that has killed more people than any other.

    One effort is underway at the University of Montana Center for Translational Medicine. The center specializes in improving and creating vaccines by adding what are called novel adjuvants. An adjuvant is a substance included in the vaccine, such as fat molecules or aluminum salts, that enhances the immune response, and novel adjuvants are those that have not yet been used in humans. Scientists are finding that adjuvants make for stronger, more precise, and more durable immunity than antigens, which create antibodies, would alone.

    Eliciting specific responses from the immune system and deepening and broadening the response with adjuvants is known as precision vaccination. “It’s not one-size-fits-all,” said Ofer Levy, a professor of pediatrics at Harvard University and the head of the Precision Vaccines Program at Boston Children’s Hospital. “A vaccine might work differently in a newborn versus an older adult and a middle-aged person.”

    The ultimate precision vaccine, said Levy, would be lifelong protection from a disease with one jab. “A single-shot protection against influenza or a single-shot protection against covid, that would be the holy grail,” Levy said.

    Jay Evans, the director of the University of Montana center and the chief scientific and strategy officer and a co-founder of Inimmune, a privately held biotechnology company in Missoula, said his team has been working on a TB vaccine for 15 years. The private-public partnership is developing vaccines and trying to improve existing vaccines, and he said it’s still five years off before the TB vaccine might be distributed widely.

    It has not gone unnoticed at the center that this state-of-the-art vaccine research and production is located in a state that passed one of the nation’s most extreme anti-vaccination laws during the pandemic in 2021. The law prohibits businesses and governments from discriminating against people who aren’t vaccinated against covid-19 or other diseases, effectively banning both public and private employers from requiring workers to get vaccinated against covid or any other disease. A federal judge later ruled that the law cannot be enforced in health care settings, such as hospitals and doctors’ offices.

    In mid-March, the Bill & Melinda Gates Medical Research Institute announced it had begun the third and final phase of clinical trials for the new vaccine in seven countries. The trials should take about five years to complete. Research and production are being done in several places, including at a manufacturing facility in Hamilton owned by GSK, a giant pharmaceutical company.

    Known as the forgotten pandemic, TB kills up to 1.6 million people a year, mostly in impoverished areas in Asia and Africa, despite its being both preventable and treatable. The U.S. has seen an increase in tuberculosis over the past decade, especially with the influx of migrants, and the number of cases rose by 16% from 2022 to 2023. Tuberculosis is the leading cause of death among people living with HIV, whose risk of contracting a TB infection is 20 times as great as people without HIV.

    “TB is a complex pathogen that has been with human beings for ages,” said Alemnew Dagnew, who heads the program for the new vaccine for the Gates Medical Research Institute. “Because it has been with human beings for many years, it has evolved and has a mechanism to escape the immune system. And the immunology of TB is not fully understood.”

    The University of Montana Center for Translational Medicine and Inimmune together have 80 employees who specialize in researching a range of adjuvants to understand the specifics of immune responses to different substances. “You have to tailor it like tools in a toolbox towards the pathogen you are vaccinating against,” Evans said. “We have a whole library of adjuvant molecules and formulations.”

    Vaccines are made more precise largely by using adjuvants. There are three basic types of natural adjuvants: aluminum salts; squalene, which is made from shark liver; and some kinds of saponins, which are fat molecules. It’s not fully understood how they stimulate the immune system. The center in Missoula has also created and patented a synthetic adjuvant, UM-1098, that drives a specific type of immune response and will be added to new vaccines.

    One of the most promising molecules being used to juice up the immune system response to vaccines is a saponin molecule from the bark of the quillay tree, gathered in Chile from trees at least 10 years old. Such molecules were used by Novavax in its covid vaccine and by GSK in its widely used shingles vaccine, Shingrix. These molecules are also a key component in the new tuberculosis vaccine, known as the M72 vaccine.

    But there is room for improvement.

    “The vaccine shows 50% efficacy, which doesn’t sound like much, but basically there is no effective vaccine currently, so 50% is better than what’s out there,” Evans said. “We’re looking to take what we learned from that vaccine development with additional adjuvants to try and make it even better and move 50% to 80% or more.”

    By contrast, measles vaccines are 95% effective.

    According to Medscape, around 15 vaccine candidates are being developed to replace the BCG vaccine, and three of them are in phase 3 clinical trials.

    One approach Evans’ center is researching to improve the new vaccine’s efficacy is taking a piece of the bacterium that causes TB, synthesizing it, and combining it with the adjuvant QS-21, made from the quillay tree. “It stimulates the immune system in a way that is specific to TB and it drives an immune response that is even closer to what we get from natural infections,” Evans said.

    The University of Montana center is researching the treatment of several problems not commonly thought of as treatable with vaccines. They are entering the first phase of clinical trials for a vaccine for allergies, for instance, and first-phase trials for a cancer vaccine. And later this year, clinical trials will begin for vaccines to block the effects of opioids like heroin and fentanyl. The University of Montana received the largest grant in its history, $33 million, for anti-opioid vaccine research. It works by creating an antibody that binds with the drug in the bloodstream, which keeps it from entering the brain and creating the high.

    For now, though, the eyes of health care experts around the world are on the trials for the new TB vaccines, which, if they are successful, could help save countless lives in the world’s poorest places.




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • Global disease burden study highlights COVID-19 impact and health inequities

    Global disease burden study highlights COVID-19 impact and health inequities

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    Rates of early death and poor health caused by HIV/AIDS and diarrhea have been cut in half since 2010, and the rate of disease burden caused by injuries has dropped by a quarter in the same time period, after accounting for differences in age and population size across countries, based on a new study published in The Lancet. The study measures the burden of disease in years lost to early death and poor health. The findings indicate that total rates of global disease burden dropped by 14.2% between 2010 and 2019. However, the researchers found that the COVID-19 pandemic interrupted these downward trends: rates of disease burden increased overall since 2019 by 4.1% in 2020 and by 7.2% in 2021. This is the first study to measure premature death and disability due to the COVID-19 pandemic globally and compare it to other diseases and injuries. 

    The study reveals how healthy life expectancy, which is the number of years a person can expect to live in good health, rose from 61.3 years in 2010 to 62.2 years in 2021. Pinpointing the factors driving these trends, the researchers point to rapid improvements within the three different categories of disease burden: communicable, maternal, neonatal, and nutritional diseases; non-communicable diseases; and injuries. Among communicable, maternal, neonatal, and nutritional diseases, the burden of disease declined for neonatal disorders (diseases and injuries that appear uniquely in the first month of life), lower respiratory infections, diarrhea, malaria, tuberculosis, and HIV/AIDS between 2010 and 2021, ranging from reductions of 17.1% for neonatal disorders to 47.8% for HIV/AIDS. In the category of non-communicable diseases, disease burden from stroke dropped by 16.9%, while disease burden from ischemic heart disease fell by 12.0% during this period. 

    For injuries, the years of healthy life lost due to road injuries was slashed by nearly a quarter (22.9%), while disease burden from falls was reduced by 6.9%. Progress in reducing disease burden varied by countries’ Socio-demographic Index – a measure of income, fertility, and education – underscoring inequities. For example, the burden of disease due to stroke dropped by 9.6% from 2010 to 2021 in countries with the lowest Socio-demographic Index, but it declined faster – by 24.9% – among countries with higher Socio-demographic Index. 

    Our study illuminates both the world’s successes and failures. It demonstrates how the world made huge strides in expanding treatment for HIV/AIDS and combatting vaccine-preventable diseases and deaths among children under 5. At the same time, it shows how COVID-19 exacerbated inequities, causing the greatest disease burden in countries with the fewest resources, where health systems were strained and vaccines were difficult to secure. Governments should prioritize equitable pandemic preparedness planning and work to preserve the momentum that we’ve seen in improving children’s health.” 


    Dr. Alize Ferrari, Affiliate Associate Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Honorary Associate Professor at the School of Public Health at the University of Queensland, and co-first author of the study

    The research presents updated estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The GBD 2021 study analyzes incidence, prevalence, years lived with disability (years lived in less-than-ideal health), and disability-adjusted life years (lost years of healthy life) at global, regional, national, and subnational levels. It presents estimates of health and health loss in age-adjusted rates and total rates per 100,000 people. The study provides globally comparable measures of healthy life expectancy and is the first study to fully evaluate burden of disease amid the first two years of the COVID-19 pandemic. COVID-19 was the single leading cause of disease burden worldwide in 2021, accounting for 7.4% of total disease burden globally. 

    The study also examined how the COVID-19 pandemic affected males and females differently. The researchers found that males were more likely than females to die of COVID-19; the age-standardized disease burden rate for COVID-19 among males was nearly twice that of females. However, the secondary effects of the COVID-19 pandemic, including long COVID and mental disorders, hit females hardest. For example, females were twice as likely as males to develop long COVID. Depression, which increased sharply during the pandemic, was most likely to affect females between ages 15 and 65. Looking at differences between age groups, COVID-19 caused the most disease burden in older adults. For COVID-19, adults 70 years and older had more than double the levels of disease burden compared to adults between the ages of 50 and 69. 

    The study highlights not only the diseases and injuries that cut life short and cause poor health, and how the burden of disease from different causes has changed over time, but also examines how these patterns differ across countries and regions. “In essence,” the authors write, the study “provides a comprehensive toolkit to inform and enhance decision-making processes across various levels of governance and practice.” 

    GBD 2021 shines a light on the different causes of disease burden, showing which ones have improved and which are stagnating or worsening. It also tallies the number of years that people are living healthy lives. Healthy life expectancy rose significantly in 59 countries and territories between 2010 and 2021, with the greatest improvements in countries ranking lowest on the Socio-demographic Index, jumping from 52.2 years in 2010 to 54.4 years in 2021. In contrast, healthy life expectancy showed minimal change among countries in the highest levels of the Socio-demographic Index, decreasing slightly from 68.9 years in 2010 to 68.5 years in 2021. The findings on healthy life expectancy demonstrate that even though people are living longer lives all over the world, they aren’t spending all those years in good health. The researchers found that the main causes of poor health were low back pain, depressive disorders, and headache disorders. 

    “With low back pain, the leading cause of poor health globally, we see that the existing treatments aren’t working well to address it,” said Dr. Damian Santomauro, Affiliate Assistant Professor of Health Metrics Sciences at IHME; Stream Lead at Queensland Centre for Mental Health Research; Adjunct Fellow at the School of Public Health at the University of Queensland; and co-first author of the study. “We need better tools to manage this major cause of global disease burden.” 

    “In contrast, for depressive disorders, we know what can work: therapy, medication, or both in combination for an adequate period of time. However, most people in the world have little or no access to treatment, unfortunately,” he said. “Considering how depression increased dramatically during the COVID-19 pandemic, it’s urgent to ensure that everyone with this disorder can get treatment.” 

    Another way to understand what is making people ill is by looking at which diseases are growing fastest. GBD 2021 reveals that diabetes experienced the most rapid growth among the different causes of poor health, what the researchers call years lived with disability. Age-adjusted years lived with disability due to diabetes rose by 25.9% between 2010 and 2021. Poor health from diabetes increased in every country and territory that the researchers studied. 

    “Diabetes is a major contributor to stroke and ischemic heart disease, which are among the top three causes of disease burden worldwide,” said Dr. Theo Vos, Professor Emeritus at IHME and one of the study’s senior authors. “Without intervention, more than 1.3 billion people in the world will be living with diabetes by 2050. To counter the threat of diabetes, we must ensure that people in all countries can access preventive care and treatment, including to anti-obesity medications, which can lower a person’s risk of developing diabetes.” 

    Source:

    Institute for Health Metrics and Evaluation

    Journal reference:

    GBD 2021 Diseases and Injuries Collaborators., (2024) Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. doi.org/10.1016/S0140-6736(24)00757-8.

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  • 1 in 5 older Canadian adults with diabetes developed functional limitations during the pandemic

    1 in 5 older Canadian adults with diabetes developed functional limitations during the pandemic

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    Researchers found that approximately 1 in 5 older Canadian adults with diabetes and no pre-pandemic functional limitations developed functional limitations for the first time during the COVID-19 pandemic. Functional limitations refer to difficulties with basic mobility-related tasks, such as walking two to three blocks, standing up from a chair, or climbing stairs. In comparison, only one in eight of their peers without diabetes developed functional limitations during the pandemic.

    Functional status is an important predictor of longevity and quality of life among older adults, and individuals with diabetes face a higher risk of functional decline than the general population. Because the pandemic exacerbated many risk factors for functional decline, such as social isolation and physical inactivity, we wanted to examine changes in functional status among this population.”


    Andie MacNeil, first author, research assistant at the Factor-Inwentash Faculty of Social Work (FIFSW) and the Institute for Life Course and Aging at the University of Toronto

    The study’s sample came from the Canadian Longitudinal Study on Aging, a national longitudinal study of older Canadians. Respondents with diabetes were 53% more likely to develop at least one functional limitation during the pandemic compared to respondents without diabetes. Even after taking into account major risk factors for functional decline, such as such as physical activity, obesity, smoking, and other chronic health conditions, older adults with diabetes still faced a 28% higher risk of developing functional limitations.

    “It is important for health professionals to encourage their older patients, particularly those with diabetes, to engage in behaviours that can help maintain their functional status, such as regular physical activity,” said co-author Susanna Abraham Cottagiri, doctoral candidate at the School of Medicine at Queens University.”

    The study also found that socioeconomic factors were associated with functional limitations among older adults with and without diabetes. When compared to those with an annual household income of $100,000 or more, older adults with diabetes with an income of $20,000 or less had a 5-fold higher risk of developing at least one functional limitation. Even among those without diabetes, those with an income of $20,000 or less had double the risk of developing at least one functional limitation compared to those with an annual income of $100,000 or more.

    “While socioeconomic status is an important predictor of functional decline among those both with and without diabetes, the magnitude of this relationship is much greater for respondents with diabetes,” said co-author Ying Jiang, a senior epidemiologist at the Public Health Agency of Canada.

    The authors also examined the probabilities of functional limitations across various patient characteristics such as sex, diabetes status, and household income, and then stratified into several risk factors, such as age, physical activity level, smoking status, multimorbidity, and weight. Across various patient profiles, socioeconomic status was a consistent driver of functional status.

    Co-author Professor Paul Villeneuve at the Department of Neuroscience and the CHAIM Research Centre, Carleton University, hypothesized the possible reason for this pattern: “People with low socioeconomic status face disproportionate stressors over their lifetime that may adversely impact their physical functioning in older age, such as working more physically demanding jobs, worse nutrition, and living in areas with less greenspace and walkability.”

    The researchers hope these findings can be used to inform interventions to promote better physical functioning among middle age and older adults.

    “Combining lifestyle approaches that integrate physical activity with nutrition interventions have been shown to improve physical function in older adults with diabetes” said co-author Margaret de Groh, scientific manager at the Public Health Agency of Canada.

    “Poverty remains a major barrier to nutrition and food security,” said senior author Professor Esme Fuller-Thomson at the University of Toronto’s FIFSW and director of the Institute for Life Course & Aging. “It is important to think about broader strategies to decrease poverty and improve food access in Canada in order to promote better physical functioning among older adults.”

    The study was published this week in the Canadian Journal of Diabetes. The study included 6,045 participants of the Canadian Longitudinal Study on Aging (CLSA) who were free from functional limitations in the 2015-2018 wave of data collection and who provided information on their functional status during the COVID-19 pandemic (September–December 2020). This research was supported, in part, by the Canadian Institutes of Health Research (CIHR) grant #172862 (PI Esme Fuller-Thomson).

    Source:

    Journal reference:

    MacNeil, A., et al. (2024) Incident Functional Limitations Among Older Adults With Diabetes During the COVID-19 Pandemic: An Analysis of Prospective Data From the Canadian Longitudinal Study on Aging. Canadian Journal of Diabetes. doi.org/10.1016/j.jcjd.2024.02.005.

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  • New study sheds light on the relationship between race and mental health stigma in college students

    New study sheds light on the relationship between race and mental health stigma in college students

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    A new study by a counseling researcher at New York Institute of Technology sheds light on the relationship between race and mental health stigma. The findings could help college counseling and wellness professionals better understand students’ cultural experiences and the barriers they may face in seeking mental health treatment. 

    Data shows that mental health challenges continue to be a growing concern among college students, with students of color remaining an underserved and understudied group. In addition, while mental health worsened among all student groups during the COVID-19 pandemic, students of color were particularly vulnerable. 

    Now, as seen in the Journal of College Student Mental Health, a new study led by Nayoung Kim, Ph.D., assistant professor of psychology and counseling at New York Institute of Technology, investigates how college students across different races perceive mental health treatment.

    Kim, a faculty member in the university’s Mental Health Counseling, M.S. program, and a researcher from Palo Alto University analyzed survey responses from 747 college students across the United States. Some responses were collected before the COVID-19 pandemic, as part of an earlier study, while others were collected after the pandemic’s onset.

    In both evaluations, students were asked to self-identify their race as Caucasian/White, African American/Black, Hispanic/Latinx, Asian/Asian American, American Indian/Native American, or Multiracial. The students then self-assessed statements regarding their perceptions on various mental health topics, with each statement having an individual scale (one to five, for example) correlating with whether they agreed or disagreed. Topics included:

    • Self-stigma: an individual’s negative attitudes toward themselves, and shame about mental health issues. Students reacted to statements like “I would feel inadequate if I went to a therapist for psychological help,” and “It would make me feel inferior to ask a therapist for help.”

    • Public stigma: the perceived negative attitudes of others about mental health issues. Students responded to statements regarding whether others would “think of you in a less favorable way,” and “think bad things of you” if they learned that the student was seeking mental health treatment.

    • Social support: having other people, including friends and family, to turn to in times of need or crisis. Sample statements included “I get the emotional help and support I need from my family,” and “I can count on my friends when things go wrong.”

    • Perceived discrimination: may take the form of microaggressions or environmental displays of prejudice and systemic racism. Students were presented with statements like “People act like you are not as smart,” and “You are treated with less respect than others.”

    The findings revealed that Asian/Asian American students had higher levels of self-stigma and public stigma compared to other groups, suggesting they may delay seeking help for mental health challenges. Given this, the researchers suggest that counselors offer these students a focused intervention to help address mental health issues promptly.

    On a positive note, college students who were enrolled during the pandemic, across all races, showed decreased levels of self-stigma. This suggests that increased mental health awareness resulting from the pandemic reduced shame associated with seeking mental health treatment.

    Given this, the researchers note that, at the administrative level, it is essential to educate the campus community about stigma and potential psychological distress that can impact students’ well-being. Doing so could significantly impact whether students feel empowered to seek help.

    “Our findings are particularly helpful for college counseling centers, which could benefit by tailoring counseling services to provide support for racial and ethnic minority students,” says Kim, whose clinical and supervision experiences include school, college, and community counseling settings. “With a deeper understanding of students’ cultural experiences, college counselors can also facilitate group counseling sessions that delve into the complexities of mental health stigma and create a safe and inclusive space where students can express their perspectives, acquire effective coping strategies, and gain insights into the impact of that stigma.”

    Source:

    New York Institute of Technology

    Journal reference:

    Kim, N., & Chen, S.-Y. (2024). Relationship Between Mental Health Stigma, Perceived Discrimination, and Social Support: Focusing on Racial Groups and COVID-19. Journal of College Student Mental Health. doi.org/10.1080/28367138.2024.2333371.

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  • Study shows potential for universal flu vaccine with broad antibody response

    Study shows potential for universal flu vaccine with broad antibody response

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    A recent study published in the journal Nature Communications observed antibody breadth and effector functions as important immune correlates that can be used to develop universal influenza vaccines. This vaccine could be effective against all influenza virus strains, even those having pandemic potential.

    Study: Influenza antibody breadth and effector functions are immune correlates from acquisition of pandemic infection of children. Image Credit: Africa Studio / ShutterstockStudy: Influenza antibody breadth and effector functions are immune correlates from acquisition of pandemic infection of children. Image Credit: Africa Studio / Shutterstock

    Background

    Children are particularly vulnerable to influenza viruses that cause seasonal epidemics and sporadic pandemics. Seasonal influenza epidemics not only lead to an upsurge in hospital admissions but also increase mortality rates in older adults with comorbidities. Many studies have shown that seasonal influenza vaccines provide limited protection against influenza viruses that have the potential to cause a pandemic. However, the 2009 H1N1 pandemic (pH1N1) revealed the effectiveness of seasonal vaccines in protecting children and older adults from the infection. This protection could be due to cross-reactive antibody responses. 

    Compared to children, adults possess additional immune correlates, such as T-cell responses and non-neutralizing antibody functions. This is the reason why children require higher concentrations of HAI antibodies for an equivalent amount of immune protection from the infection. To design a next-generation vaccine, it is important to identify immune correlates of protection. In the context of pH1N1 infection, HA-stem-specific antibodies play a crucial role in providing protection, which is mediated by the Fc Receptor (FcR) function. 

    Some antibodies that can cross-react between pandemic, seasonal, and avian influenza viruses could reduce the severity of influenza virus infection. In this context, serum antibodies, particularly IgG, can facilitate effector functions, such as directing immune cells to kill infected cells, engulfing infected cells via antibody-dependent phagocytosis (ADCP), and promoting antibody-dependent cellular cytotoxicity (ADCC). These functions are mediated by Fc gamma receptors (FcγR) 3a and FcγR2a.

    Mechanistically, FcγR 3a and FcγR2a employ macrophages and natural killer (NK) cells to remove viruses-infected cells. Cross-reaction of ADCC antibodies has been associated with targeting conserved antigenic sites of influenza virus hemagglutinin (HA), the Nucleoprotein (NP), and Matrix 1 (M1).

    About the Study

    The current study identified several gaps in research regarding antibody effector functions. For instance, few studies have assessed the vaccine-induced ADCC changes, longitudinal durability of vaccine-induced antibody FcR binding and isotype changes, and the alterations in HA-specific antibody responses with vaccination and infection. The currently performed randomized placebo control trial (RCT) investigated the influenza-specific antibody breadth and function of seasonal (S1) H1N1 vaccination and pH1N1 infection.

    The antibody features, particularly HAI titer, from seasonal vaccination that could have helped in reducing or delaying contraction of pH1N1 were assessed using selected archived samples. These samples were collected from NCT00792051, a randomized placebo-controlled trial and its follow-up study that used school children between 6 and 17 years old. 

    A subset of children who received any influenza vaccination in Year 1 (V1) or not (placebo-V0) was selected for secondary analyses, which helped determine the effectiveness of vaccination against pH1N1 infection.

    Study Findings

    The current study indicated that non-neutralizing antibodies are highly cross-reactive between different influenza strains and subtypes, which could play an important role in reducing the incidence and severity of infection.

    Detecting antibody functions other than HAI is vital to developing next-generation vaccines. This study identified the serological correlates that play an important role in protecting children from pandemic infection. In 2009, when schools were closed for two months, H1N1 transmission was low. However, soon after schools reopened in September 2009, more than 50% of the students were infected within a few months. A very low community uptake of the monovalent pH1N1 vaccine has been documented.

    The half-life of different antibody subclasses alters significantly. The current study observed that seasonal vaccination enhances Fc effector functions of pH1N1 specific NP, HA, and neuraminidase (NA) antibodies. However, their function was short-term as it waned off within one year of vaccination. A greater antibody decline was observed in unvaccinated children.

    Seasonal vaccination did not boost FcR effector functions to other seasonal-specific antibody responses. Unvaccinated, uninfected children also exhibited increased FcR-mediated effector functions of pandemic-specific NA, HA, and NP antibodies. These children displayed a higher antibody level of NK cell function. pH1 antibodies against H3-HA responses were associated with cross-reactive avian H5-specific IgG, FcγR2a, and FcγR3a responses. This finding implies that cross-reactive responses are less focused and are not trained by seasonal virus exposure of other groups. 

    Considering the experimental results, vaccination and prior infection are not associated with the lack of infection in unvaccinated, uninfected children or susceptibility of V1S1 children. More research is required to understand the host factors leading to these outcomes.

    Results also indicated that group 2 H3 HA-specific IgG3 antibodies are negative predictors of infection. However, seasonal H1 and pH1-IgG3 antibodies before infection were positively associated and, therefore, protected against infection.

    Conclusions

    This study shows how universal influenza vaccines, effective against seasonal to pandemic viruses, can be developed. Antibody breadth and FcR effector functions are two important immune correlates that could be exploited to develop this vaccine.

    Journal reference:

    • Jia, J. Z. et al. (2024) Influenza antibody breadth and effector functions are immune correlates from acquisition of pandemic infection of children. Nature Communications. 15(1), 1-15. DOI: 10.1038/s41467-024-47590-0, https://www.nature.com/articles/s41467-024-47590-0

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  • Study reveals shocking rise in opioid deaths among Canadian youth

    Study reveals shocking rise in opioid deaths among Canadian youth

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    Premature deaths related to opioids doubled between 2019 and 2021 across Canada, with more than 1 in 4 deaths among young adults aged 20–39 years attributable to opioids, according to new research published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.231339.

    Opioid-related deaths have continued to increase over the past decade across Canada, with 6222 deaths occurring in 2021. This trend worsened during the COVID-19 pandemic, although the scale and rapidity of increases varied across provinces and territories. These changes have been attributed primarily to the unregulated drug supply, which became increasingly volatile and unpredictable during the pandemic.

    During the COVID-19 pandemic, the loss of life from opioid toxicities has worsened in nearly every part of Canada, with Alberta, Saskatchewan, and Manitoba experiencing enormous increases in deaths -; particularly among their younger population. Without adequate investments in widespread, accessible treatment and harm-reduction programs, and broader social supports like housing, these preventable deaths are having devastating effects on communities across the country.”


    Dr. Tara Gomes, senior author on the study, and scientist at Unity Health Toronto

    To understand the trends and impact of opioid-related deaths, researchers looked at data on accidental deaths from opioid toxicity across 9 provinces and territories in Canada: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, and the Northwest Territories. In just 3 years (2019–2021) the annual number of opioid-related deaths rose from 3007 to 6222. More striking is the number of years of life lost (YLL) to premature death from opioid toxicity, which more than doubled in Canada over the study period, reaching over a quarter of a million in 2021 (256 336 YLL).

    “Alarmingly, 1 in 31 deaths among people aged 85 and younger were attributed to opioids in 2021, a number that increases to 1 in 4 deaths among young adults aged 20–39,” said Shaleesa Ledlie, Leslie Dan Faculty of Pharmacy, University of Toronto. “This scale of opioid-related harm -; particularly among young people -; is unprecedented and illustrates the magnitude of this public health crisis across the country.”

    Although the concentration of harm in younger populations was consistent across the 9 Canadian provinces and territories included in this study, some provinces were disproportionately affected. For example, in Alberta, nearly half of all deaths among those aged 20–39 were opioid-related.

    In Canada, access to social supports and health care services was severely reduced or restricted during the pandemic, resulting in changes in patterns of drug use and accessibility of community-based services for people who use drugs. However, despite the reopening of services in recent years, the rates of opioid-related deaths remain elevated across the country, identifying an urgent need to work with communities to scale up services designed to support people who use drugs.

    Source:

    Canadian Medical Association Journal

    Journal reference:

    Ledlie, S., et al. (2024) Opioid-related deaths between 2019 and 2021 across 9 Canadian provinces and territories. CMAJ. doi.org/10.1503/cmaj.231339.

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  • Nearly 1 in 4 adults dumped from Medicaid are now uninsured, survey finds

    Nearly 1 in 4 adults dumped from Medicaid are now uninsured, survey finds

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    Nearly a quarter of adults disenrolled from Medicaid in the past year say they are now uninsured, according to a survey released Friday that details how tens of millions of Americans struggled to retain coverage in the government insurance program for low-income people after pandemic-era protections began expiring last spring.

    The first national survey of adults whose Medicaid eligibility was reviewed during the unwinding found nearly half of people who lost their government coverage signed back up weeks or months later — suggesting they should never have been dropped in the first place.

    While 23% reported being uninsured, an additional 28% found other coverage — through an employer, Medicare, the Affordable Care Act’s insurance marketplace, or health care for members of the military, the survey by KFF found.

    “Twenty-three percent is a striking number especially when you think about the number of people who lost Medicaid coverage,” said Chima Ndumele, an associate professor of health policy at the Yale University School of Public Health.

    Going without insurance even for a short period of time can lead people to delay seeking care and leave them at financial risk when they do.

    Seven in 10 adults who were disenrolled during the unwinding process say they became uninsured at least temporarily when they lost their Medicaid coverage.

    Adrienne Hamar, 49, of Plymouth Meeting, Pennsylvania, said she struggled to enroll in an Affordable Care Act marketplace plan this winter after the state informed her that she and her two children no longer qualified for Medicaid. They had been enrolled since 2020. She said phone lines were busy at the state’s marketplace and she couldn’t complete the process online.

    Hamar, who works as a home health aide, and her children were uninsured in March. But since April 1, they’ve been enrolled in a marketplace plan that, with the help of government subsidies, costs $50 a month for the family.

    “I was very relieved,” she said. Unsure of their insurance status, Hamar said, her 23-year-old daughter delayed getting a dental checkup.

    Hamar’s struggles were common, the survey found.

    Of adults enrolled in Medicaid before the unwinding, about 35% who tried to renew their coverage described the process as difficult, and about 48% said it was at least somewhat stressful.

    About 56% of those disenrolled say they skipped or delayed care or prescriptions while attempting to renew their Medicaid coverage.

    “People’s current insurance status is likely to be very much in flux, and we would expect at least some of the people who say they are currently uninsured to reenroll in Medicaid — many say they are still trying — or enroll in other coverage within a short period of time,” said Jennifer Tolbert, a co-author of the KFF report and the director of KFF’s State Health Reform and Data Program.

    The survey didn’t include children, and the KFF researchers said their findings therefore couldn’t be extrapolated to determine how the Medicaid unwinding has affected the overall U.S. uninsured rate, which hit a record low of 7.7% in early 2023. Nearly half of enrollees in Medicaid and the related Children’s Health Insurance Program are children.

    The unwinding, in which states are reassessing eligibility for Medicaid among millions of Americans who enrolled before or during the pandemic and dropping those who no longer qualify or did not complete the renewal process, won’t be completed until later this year. Enrollment in Medicaid and CHIP grew to a record of nearly 94.5 million in April of last year, three years after the federal government prohibited states from cutting people from their rolls during the covid-19 public health emergency.

    Nationally, states have disenrolled about 20 million people from Medicaid in the past year, most of them for procedural reasons such as failure to submit required paperwork. That number is expected to grow, as states have a few more months to redetermine enrollees’ eligibility.

    Among adults who had Medicaid prior to the start of the unwinding, 83% retained their coverage or reenrolled, while 8% found other insurance and 8% were uninsured. The share left uninsured was larger in states that have not expanded Medicaid under the ACA (17%) than in states that have (6%). Forty states have expanded Medicaid to cover everyone with an income under 138% of the federal poverty rate, or $31,200 for a family of four this year.

    The KFF survey found that nearly 1 in 3 disenrolled adults discovered only when they sought health care — such as going to a doctor or a pharmacy — that they had been dropped from Medicaid.

    Indira Navas of Miami found out that her 6-year-old son, Andres, had been disenrolled from Florida’s Medicaid program when she took him to a doctor appointment in March. She had scheduled Andres’ appointment months in advance and is frustrated that he remains uninsured and his therapy for anxiety and hyperactivity has been disrupted.

    Navas said the state could not explain why her 12-year-old daughter, Camila, remained covered by Medicaid even though the children live in the same household with their parents.

    “It doesn’t make sense that they would cover one of my children and not the other,” she said.

    Kate McEvoy, executive director of the National Association of Medicaid Directors, said the sheer volume of millions of people being redetermined for eligibility has overwhelmed some state call centers trying to support enrollees.

    She said states have tried many ways to communicate with enrollees, including through public outreach campaigns, text, email, and apps. “Until the moment your coverage is at stake, it’s hard to penetrate people’s busy lives,” she said.

    The KFF survey, of 1,227 adults who had Medicaid coverage in early 2023 prior to the start of the unwinding on April 1, 2023, was conducted between Feb. 15, 2024, and March 11, 2024. The margin of sampling error was plus or minus 4 percentage points.

    KFF Health News correspondent Daniel Chang contributed to this article.




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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  • Quality dementia care in nursing homes: Lessons from the pandemic

    Quality dementia care in nursing homes: Lessons from the pandemic

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    No one associated with nursing homes – as residents or their families, friends, staff or administrators – is unaware of the massive impact of the pandemic on these facilities which provide essential services to a growing number of older adults, many living with cognitive impairment.

    In “Learning from the experience of dementia care for nursing home residents during the pandemic,” an editorial published in the Journal of the American Geriatrics Society, Regenstrief Institute and Indiana University School of Medicine researcher-clinician Kathleen Unroe, M.D., MHA, M.S., and University of Utah College of Nursing faculty member Gail Towsley, PhD, NHA, focus on the continual need to integrate quality dementia-specific care into nursing homes.

    “Nursing home leaders [during the pandemic] had to balance competing demands including pressures to off-load hospitals by admitting new patients, as well as responsibilities to protect staff and established residents. The constant assessment of risks versus benefits often resulted in trade-offs between safety (or at least, what was believed at the time provided safety) and quality of life,” the editorial notes.

    The authors highlight the uncertainties and stressors faced by extended care providers and those for whom they care, focusing on challenges including resident social isolation, staff recruitment, training and retention as well as the troublesome conflict between best practice infection control and best practice dementia care.

    A majority of people who receive care in nursing homes have cognitive impairment. High-quality care for people with cognitive impairment, including people with a diagnosis of dementia, should be person-centered, which requires knowing a person’s goals for their care and their treatment preferences and making sure that those goals and preferences are documented and then met, including for those with limited ability or even no ability to participate in these discussions anymore.”


    Kathleen Unroe, M.D., MHA, M.S., researcher-clinician

    “People in nursing homes are, by the nature of living in a nursing home, often isolated from their community, their prior neighborhoods and contacts as well as their families,” she added. “We need to take extra steps to make sure that we maintain these important connections, making it as easy as possible for people to come and participate in life in the nursing home and for people to be able to leave the facility and participate in life in their neighborhoods and with their families.”

    According to Dr. Unroe, the pandemic highlighted:

    • Need for dementia care specific staff training

    • Value of telehealth communication

    • Importance of expansion of family’s role in nursing home care

    In 2022, the National Academies of Sciences, Engineering and Medicine issued “The National Imperative to Improve Nursing Home Quality,” which noted “the devastating impact of the COVID-19 pandemic on nursing home residents and staff has renewed attention to the long-standing weaknesses that impede the provision of high-quality nursing home care.” The report calls for the Centers for Medicare and Medicaid Services (CMS) and states to improve oversight of nursing homes to avoid a repeat of failures that occurred during the COVID-19 pandemic.

    Highlighting the importance of exploration of opportunities to “coalesce around solutions” to solve persistent challenges in nursing home settings, Drs. Unroe and Towsley conclude, “While the pandemic included lessons we wish we did not have to experience, we have an opportunity to shift our practices and re-focus on high quality dementia care.”

    Source:

    Journal reference:

    Unroe, K. T., & Towsley, G. L. (2024). Learning from the experience of dementia care for nursing home residents during the pandemic. Journal of the American Geriatrics Society. doi.org/10.1111/jgs.18771.

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  • Older adults’ social patterns shift post-pandemic, study finds

    Older adults’ social patterns shift post-pandemic, study finds

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    Years after the U.S. began to slowly emerge from mandatory COVID-19 lockdowns, more than half of older adults still spend more time at home and less time socializing in public spaces than they did pre-pandemic, according to new University of Colorado Boulder research. 

    Participants cited fear of infection and “more uncomfortable and hostile” social dynamics as key reasons for their retreat from civic life.

    “The pandemic is not over for a lot of folks,” said Jessica Finlay, an assistant professor of geography whose findings are revealed in a series of new papers. “Some people feel left behind.”

    The study comes amid what the U.S. Surgeon General recently called an ‘epidemic of loneliness’ in which older adults-; especially those who are immune compromised or have disabilities-; are particularly vulnerable.

    We found that the pandemic fundamentally altered neighborhoods, communities and everyday routines among aging Americans and these changes have long-term consequences for their physical, mental, social and cognitive health.”


    Jessica Finlay, assistant professor of geography, University of Colorado at Boulder

    ‘I just can’t go back’

    As a health geographer and environmental gerontologist, Finlay studies how social and built environments impact health as we age.

    In March 2020 as restaurants, gyms, grocery stores and other gathering places shuttered amid shelter-in-place orders, she immediately wondered what the lasting impacts would be. Shortly thereafter, she launched the COVID-19 Coping Study with University of Michigan epidemiologist Lindsay Kobayashi. They began their research with a baseline and monthly survey. Since then, nearly 7,000 people over age 55 from all 50 states have participated.

    The researchers check in annually, asking open-ended questions about how neighborhoods and relationships have changed, how people spend their time, opinions and experiences of the COVID-19 pandemic, and their physical and mental health.

    “We’ve been in the field for some incredibly pivotal moments,” said Finlay, noting that surveys went out shortly after George Floyd was murdered in May 2020 and again after the attack on the U.S. Capitol on Jan. 6, 2021.

    Collectively, the results paint a troubling picture in which a substantial portion of the older population remains isolated even after others have moved on. 

    In one paper published in February in the journal Wellbeing, Space and Society, 60% of respondents said they spend more time in their home while 75% said they dine out less. Some 62% said they visit cultural and arts venues less, and more than half said they attend church or the gym less than before the pandemic.

    While that survey was taken two years ago, the most recent survey taken in spring 2023 showed similar trends, with more than half of respondents still reporting that their socialization and entertainment routines were different than they were pre-pandemic. 

    In another paper titled “I just can’t go back,” 80% of respondents reported that there are some places they are reluctant to visit in person anymore.

    “The thought of going inside a gym with lots of people breathing heavily and sweating is not something I can see myself ever doing again,” said one 72-year-old male.

    Those who said they still go to public places like grocery stores reported that they ducked in and out quickly and skipped casual chitchat. 

    “It’s been tough,” said one 68-year-old female. “You don’t stop and talk to people anymore.”

    Many respondents reported that they were afraid of getting infected with a virus or infecting young or immune-compromised loved ones, and said they felt “irresponsible” for being around a lot of people.

    Some reported getting dirty looks or rude comments when wearing masks or asking others to keep their distance-; interpersonal exchanges that reinforced their inclination to stay home.

    Revitalizing human connection

    The news is not all bad, stresses Finlay.

    At least 10% of older adults report exercising outdoors more frequently since the pandemic. And a small but vocal minority said that their worlds had actually opened up, as more meetings, concerts and classes became available online.

    Still, Finlay worries that the loss of spontaneous interactions in what sociologists call “third places” could have serious health consequences.

    Previous research shows that a lack of social connection can increase risk of premature death as much as smoking 15 cigarettes a day and exacerbate mental illness and dementia.

    “For some older adults who live alone, that brief, unplanned exchange with the butcher or the cashier may be the only friendly smile they see in the day, and they have lost that,” Finlay said.

    Societal health is also at risk.

    “It is increasingly rare for Americans with differing sociopolitical perspectives to collectively hang out and respectfully converse,” she writes. 

    Finlay hopes that her work can encourage policymakers to create spaces more amenable to people of all ages who are now more cautious about getting sick – things like outdoor dining spaces, ventilated concert halls or masked or hybrid events.

    She also hopes that people will give those still wearing masks or keeping distance some grace.

    “It is a privilege to be able to ‘just get over’ the pandemic and many people, for a multitude of reasons, just don’t have that privilege. The world looks different to them now,” she said. 

    “How can we make it easier for them to re-engage?”

    Source:

    University of Colorado at Boulder

    Journal reference:

    Finlay, J., et al. (2024). Altered Place Engagement since COVID-19: A Multi-Method Study of Community Participation and Health among Older Americans. Wellbeing, Space and Society. doi.org/10.1016/j.wss.2024.100184.

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  • Congress likely to kick the can on covid-era telehealth policies

    Congress likely to kick the can on covid-era telehealth policies

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    Federal lawmakers face a year-end deadline to solidify or scuttle an array of covid-era payment changes for telehealth services that include allowing people to stay in their homes to see a doctor or therapist.

    During the hearing in early March, Wenstrup and other House members offered personal anecdotes on how telehealth, home visits, and remote monitoring helped their patients, relatives, and constituents. Wenstrup, a Republican from Ohio who is also a podiatric surgeon and a retired Army reservist, told the audience: “Patients are less anxious and heal better when they can be at home.”

    Most of the proposals focus on how Medicare covers telehealth services. But the rules affect patients on all types of insurance plans because typically private insurers and some government programs follow Medicare’s example. Without congressional action, virtual health care services like audio-only calls or meeting online with specialty doctors — such as an occupational therapist — could end. The bills would also continue to allow rural health clinics and other health centers to offer telehealth services while waiving a requirement for in-person mental health visits.

    Telehealth use ballooned in the early months of the covid-19 pandemic and grew into a household term. The practice has become a popular issue for lawmakers on both sides of the aisle.

    In one U.S. Census Bureau survey conducted from April 2021 to August 2022, Medicare and Medicaid enrollees reported using telehealth visits the most — 26.8% and 28.3%, respectively. The survey of nearly 1.2 million adults also found that Black patients and those earning less than $25,000 reported high rates of telehealth use. Notably, people of color were more likely to use audio-only visits.

    Ensuring access to telehealth services “is the best public policy,” said Debbie Curtis, a vice president of McDermott+Consulting, a Washington, D.C.-based health care lobbying firm. “It’s the best business outcome. It’s the best patient care outcome.”

    But it’s a presidential election year and Congress is a “deadline-driven organization,” Curtis said. She expects that Congress will be “kicking the can” past the November election.

    Kyle Zebley, senior vice president of public policy at the American Telemedicine Association who also lobbies on Capitol Hill, said Congress “might well be in that lame-duck period.” “This is no way to run a health care system on a popular bipartisan issue,” he said.

    In January, lawmakers — including senators from Mississippi and South Dakota — sent a letter to the Biden administration urging the White House to work quickly with Congress to ensure payments continue for Medicare patients who use telehealth, “especially for rural and underserved communities.”

    Maya Sandalow, a senior policy analyst for the Bipartisan Policy Center, a Washington, D.C.-based think tank, said lawmakers and policymakers are likely to consider a temporary extension of the payments rather than permanent changes.

    “Research is still coming out that covers more recent years than the acute effects of the pandemic,” Sandalow said. The center expects to release policy recommendations in the coming months.

    Questions being considered include which kind of health care services are best for audio-only and video visits. Sandalow said researchers are also weighing how telehealth can “expand access to affordable, high-quality care while ensuring in-person options remain for patients.”

    In North Dakota, Sanford Health’s David Newman said virtual care is often the only way some of his patients in the western part of the state can get sub-specialty care, such as with behavioral health.

    Newman, an endocrinologist and Sanford’s medical officer of virtual care, said 10% to 20% of his patients are seen virtually during the summer, as compared with about 40% in the winter months because “the weather can be so bad” that roads are impassable.

    In winters past, Newman would sit around “doing nothing for a day” because patients couldn’t visit him. Now, he has a full clinic using telehealth technology.

    “I tell my patients that if you can make a restaurant reservation or if you can order a pizza online, you can do a virtual visit,” Newman said.




    Kaiser Health NewsThis article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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