New Coronavirus News from 24 Oct 2021

New COVID-19 subvariant is spreading in UK: What we know [WSAV-TV, 24 Oct 2021]

by: Michael Bartiromo

(NEXSTAR) — A new offshoot of the COVID-19 delta variant was responsible for approximately 6% of cases in the United Kingdom as of late September, according to officials with the U.K. Health Security Agency.

The subvariant, known as AY.4.2, is not yet a variant of concern (VOC) or even a variant of interest (VOI), though officials confirmed that cases appeared to be on an “increasing” trajectory in an Oct. 15 report.

“A Delta sublineage newly designated as AY.4.2 is noted to be expanding in England,” the UK Health Security Agency wrote in its report. “It is now a signal in monitoring and assessment has commenced.”

WHO: Europe the only region with rise in COVID-19 last week
Researchers have determined that AY.4.2 contains two spike mutations — A222V and Y145H — that have already been observed in other variants. Neither of those mutations, however, had been observed in any variant deemed to be a VOC, or variant of concern.

Commenting on the mutations, Prof. Francois Balloux of the UCL Genetics Institute in London told the U.K.’s Science Media Centre that the presence of both A222V and Y145H does not necessarily mean AY.4.2 is more transmissible than other variants, though he said it’s possible.

“Neither mutation is a priori an obvious candidate for increased viral transmissibility, but we have learnt that mutations can have different, sometimes unexpected, effects in different strains,” said Balloux on Tuesday.

On Twitter, Balloux further noted that AY.4.2 might actually be “intrinsically more transmissible,” citing its unchanged trajectory of rising cases, as well as the areas of the UK where cases have been observed. (Infections don’t seem “region-specific,” he said).

Outside of the U.K. and Denmark, cases of AY.4.2 currently appear to be rarer, though reports indicate cases have now been observed in the U.S., Canada, and Israel.

Still, concerns are rising in the U.S. Former FDA commissioner Scott Gottlieb tweeted on Sunday that “urgent research” is needed to determine the transmissibility of the subvariant, as well as its possible resistance to vaccines.

“This is not a cause for immediate concern but a reminder that we need robust systems to identify, characterize new variants,” Gottlieb added. “This needs to be a coordinated, global priority for COVID, same as similar international efforts have become standard practice in influenza.”

Remarking on the release of the U.K. Health Security Agency’s findings, a representative for the prime minister has said the government is also “keeping a very close eye on” the numbers.

FDA says Pfizer COVID vaccine looks effective for young kids
“There’s no evidence [to suggest increased transmissibility], but as you would expect, we’re monitoring it closely and won’t hesitate to take action if necessary,” the representative told Sky News.

While it’s unclear for certain whether the AY.4.2 subvariant is more transmissible, U.K. health officials are investigating the possibility of transmissibility and immunity-evading traits.

Balloux, for one, does not yet believe AY.4.2 is an “obvious” candidate for elevation to a VOC.

“The emergence of yet another more transmissible strain would be suboptimal,” he told the Science Media Centre. “Though, this is not a situation comparable to the emergence of Alpha and Delta that were far more transmissible (50% or more) than any strain in circulation at the time. Here we are dealing with a potential small increase in transmissibility that would not have a comparable impact on the pandemic.”

Covid: Labour calls for Plan B measures in England [BBC News, 24 Oct 2021]

Michael Savage, Robin McKie and James Tapper

Councils consulted over support for measures such as vaccine passports amid warnings by senior doctors that NHS faces winter illness ‘triple whammy’

Labour is calling on the government to bring in its Plan B measures to tackle Covid in England, including advice to work from home and compulsory masks.

Shadow chancellor Rachel Reeves also told the BBC the vaccine programme was "stalling" and needed to work better.

But Chancellor Rishi Sunak said the data did not currently suggest "immediately moving to Plan B".

The measures, which aim to protect the NHS from "unsustainable pressure", also includes mandatory Covid passports.

Plan A, which is currently in place, involves offering booster jabs to the most vulnerable, a single dose to healthy 12 to 15-year-olds and encouraging unvaccinated people to get jabbed.
The NHS Confederation and the British Medical Association are among the groups who have called for some restrictions to be reintroduced in England, amid rising cases.

Meanwhile in Wales, ministers are to consider whether to extend the use of Covid passes for a wider range of venues.
• What is Plan B for Covid this winter?
• When can I get my Covid booster jab?
• Why are UK Covid cases so high?

Ms Reeves told BBC One's Andrew Marr Show: "I think the first thing is the government have got to do more to make Plan A work.

"If the scientists are saying work from home and masks, we should do that. So get A working better because the vaccination programme has been stalling, and introduce those parts of Plan B.

"But there are also things not in A or B that need to be done, like paying statutory sick pay from day one and also better ventilation in public spaces."

Asked whether Plan B should be introduced now, she said: "Yes, but let's not let the government off the hook with Plan A either."

A Conservative Party spokesman said it was the third time Labour had changed its position on Plan B in four days.

Appearing on the same programme, Mr Sunak was also asked whether it was time to bring in the government's back-up plan.

"We're monitoring everything, but at the moment the data does not suggest that we should be immediately moving to Plan B, but of course we will keep an eye on that and the plans are ready," he said.

The chancellor also said reintroducing the furlough scheme was "not on the cards because we don't envisage having to impose significant economic restrictions in the way that we had to over the last year".

He added that the vaccine rollout was the "first line of defence" and the booster campaign was the best way to protect people through the winter.

More than 325,000 booster jabs were given in England on Saturday - the biggest daily figure for boosters yet, NHS England chief executive Amanda Pritchard tweeted.

Prof Adam Finn, a member of the government's Joint Committee on Vaccination and Immunisation (JCVI), said the vaccination programme by itself was not enough "to bring things under control".

"We do need to have people using lateral flow tests, avoiding contact with large numbers of people in enclosed spaces, using masks, all of those things now need to happen if we're going to stop this rise and get things under control soon enough to stop a real meltdown in the middle of the winter," he told Sky News' Trevor Phillips On Sunday.

Asked if the government should move to Plan B now, he said: "Well, some kind of Plan B."
The Liberal Democrats said it looked "increasingly likely" Covid restrictions would have to be reintroduced because of the "government's bungling and inaction".

Dr Katherine Henderson, president of the Royal College of Emergency Medicine, told the programme emergency departments were "already struggling to cope", with large queues of ambulances waiting outside hospitals.

Analysis
by Jim Reed

One in 55 people in England had Covid last week, according to the latest ONS figures, the highest rate since the end of January.

Demands for compulsory mask wearing, vaccine passports and more working from home have been growing - backed by many doctors and people representing NHS trusts.

Labour's position has not been altogether clear on this.

When asked by Andrew Marr whether Plan B should be introduced "now", shadow chancellor Rachel Reeves agreed. But she also suggested the priority should be accelerating the rollout of booster vaccines to the over-50s and first jabs to teenagers.

On the same programme, Chancellor Rishi Sunak repeatedly ruled out reimposing stricter measures "immediately" - perhaps suggesting a slight change of tone from senior ministers.

The key measure to watch for is pressure on hospitals.

As things stand, there are currently 6,405 people being treated for Covid on wards in England. The number has been rising but is still no higher than it was in mid-September - and well below the 34,000 seen in January.

In minutes of a meeting of the government's Scientific Advisory Group for Emergencies (Sage) on 14 October, which were published on Friday, the scientists said restrictions should be prepared for "rapid deployment" and that acting earlier could reduce the need for stricter measures over a longer time period.

They said that out of the government's back-up measures, advising people to work from home was likely to have the most impact on the spread of Covid.

Stricter rules are already in place in other parts of the UK, with masks compulsory in some settings in Scotland, Wales and Northern Ireland.

On Sunday, the UK reported 39,962 new cases - the first time in 12 days that cases have dropped below 40,000.

There were also another 72 deaths reported within 28 days of a positive test.
In other developments:
• Former US Secretary of State Hillary Clinton told the BBC it was "imperative" Boris Johnson did what he could to stop rising Covid cases in the UK, as she called on the prime minister to introduce mandatory vaccines for places such as restaurants and offices
• Parents are being urged to get their children vaccinated over the half-term break, with families now able to book appointments for 12 to 15-year-olds online at normal vaccination centres
• New rules allowing fully vaccinated travellers returning to England to take lateral flow tests instead of more expensive PCR tests have come into force

New evidence has emerged that the government is paving the way to implement “plan B” measures in England to combat the spread of Covid-19, amid warnings from health chiefs that a “vortex of pressures” is encircling the NHS.

In the clearest sign to date that Whitehall is actively considering additional measures, the Observer has learnt that the UK Health Security Agency (UKHSA) contacted local authorities on Friday to canvass their level of support for the “immediate rollout of the winter plan – plan B”.

The disclosure comes as senior doctors warn that operations are already being cancelled due to NHS staffing shortages and scientists warn of “a triple whammy” of respiratory illnesses this winter, with Covid, flu and respiratory syncytial virus (RSV), which causes cold-like symptoms but can be serious for children and older adults.

Boris Johnson has so far publicly resisted suggestions that he should order the implementation of plan B, a menu of measures which includes the use of vaccine passports at higher-risk venues and mass gatherings, as well as legally mandating the use of face masks in some settings.

However, in a memo marked “official – sensitive”, the agency states that it was urgently seeking the views of council chief executives and leaders to be fed directly into the Cabinet Office.
“This is a tight turnaround as you might appreciate and so a response by close of play would be really helpful,” it states.

A UKHSA spokesperson said they would not comment on leaks, adding: “It is part of UKHSA’s role to provide advice to the government on the ongoing response to the pandemic.” A government spokesperson said: “We are monitoring all the data closely, and the prime minister has been clear that it does not yet show that plan B is necessary. But it is ready should we need to act to avoid a rise in hospitalisations which would put unsustainable pressure on the NHS.”

Downing Street is still hoping that an accelerated booster jab programme can fend off the need for additional measures.

The prime minister on Saturday issued a desperate call to arms for everyone over 50 to have a booster jab when offered one. “Vaccines are our way through this winter,” Johnson said. “We’ve made phenomenal progress but our job isn’t finished yet, and we know that vaccine protection can drop after six months. To keep yourself, your loved ones, and everyone around you safe, please get your booster when you get the call.

“This is a call to everyone, whether you’re eligible for a booster, haven’t got round to your second dose yet, or your child is eligible for a dose – vaccines are safe, they save lives, and they are our way out of this pandemic.”

A further 44,985 Covid cases were reported on Saturday, more than 4,000 fewer than the previous day. Another 135 deaths were reported in England. It came as one of the government’s scientific advisers said he feared another “lockdown Christmas”. Prof Peter Openshaw, a member of the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag), said putting measures in place now in order to “get transmission rates right down” was key to having “a wonderful family Christmas where we can all get back together”.

Despite ministerial claims that thousands of beds remain available in the NHS, senior doctors said that operations were already being cancelled. Dr Stephen Webb, president of the Intensive Care Society, said: “In many places, the planned urgent surgery that needs to be done is being cancelled. This is not because of a lack of physical beds, it’s because of a lack of staffing to be able to open those beds. We’ve heard about urgent cardiac surgery being cancelled, major bowel surgery being cancelled, because these patients needs post-operative intensive care beds. That’s not just in one or two areas – that’s across the country.”

NHS officials warned that Covid pressures were adding to staffing issues, efforts to deal with surgery backlogs, long waits in emergency departments and difficulties caused by other infections. “It’s a whole bundle of issues coming together, which form a vortex of pressure,” said Saffron Cordery, the deputy chief executive of NHS Providers. “What Covid has done is exacerbated these challenges and thrown some extra things in.”

Matthew Taylor, the chief executive of the NHS Confederation, who has already called for plan B measures, said: “You [the government] have got to recognise that we need a national mobilisation. You’ve got to recognise there is a health and care crisis coming over the next three or four months and accept it, acknowledge it and encourage the public to do everything they can to help. We may need to just get used to the fact that the booster campaign needs to happen every six months and prepare for that, so I welcome the fact that government has stepped up the message there.”

A senior scientist also warned that the nation faces “a triple whammy” of respiratory illnesses this winter. On top of Covid and flu, comes the threat from disease triggered by RSV, one of the most common causes of coughs and colds in winter. For most people, infection causes mild respiratory illness but in the very young and the elderly, RSV infections can trigger severe illnesses such as bronchiolitis and pneumonia and can lead to hospitalisation and even death.
“We had very few – almost no cases – of RSV last year and that is a worry,” said virologist Prof David Matthews of Bristol University. “Immunity to RSV only lasts a couple of years after previous infections. Because of lockdown RSV rates were very low in the UK last winter. That means there is very little RSV immunity left in the population. For good measure there is no RSV vaccine to protect against the disease.”

The country is now highly vulnerable to RSV infections, Matthews said. “That is a real worry because infections are very capable of putting both the elderly and the very young in hospital and at present we probably have very little immunity to the disease.

“Together with influenza and Covid-19 we are facing a triple whammy this winter, one that could have a grim impact on the NHS. It is extremely worrying. It is another reason we need to keep Covid cases to a minimum and get vaccines – boosters and for children – into as many people as possible.”

Covid news: Cases rise by 40,000 as people urged to use masks and tests to prevent ‘real meltdown’ [The Independent, 24 Oct 2021]

By Tom Batchelor

Covid rates in the UK are “astonishingly high” and have become “unacceptable”, a leading virus expert who advises the government has said, as pressure builds on ministers to reintroduce restrictions.

Professor Peter Openshaw, a member of the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag), told BBC Radio 4’s Today programme: “What we’re facing at the moment is unacceptable, we’ve got roughly one in 55 people infected, which is an astonishingly high rate compared to most other west European countries.”

He described elements included in plan B – such as mandatory use of face masks and work-from-home instructions – as “sensible” and said they need not be “very disruptive”.

Sajid Javid, the health secretary, said last week that new cases could reach 100,000 a day, but Downing Street has insisted there is still spare capacity in the NHS and that plan B will only be activated if it comes under “significant pressure”.

Get your booster jab, NHS and government tell public
A senior health chief has urged people to get their Covid booster jab as the NHS sends out a further two million invites this week.

NHS medical director Professor Stephen Powis said infection rates are rising, while the government again ruled out a move to its coronavirus plan B despite calls to bring in measures to curb the spread of the virus.

NHS England said more than 5 million people have already been given the additional jab since the vaccination programme began administering them last month.

And on Sunday, it said more than 800,000 people had their booster in the past 72 hours.
Tom Batchelor25 October 2021 08:11

20 minutes ago

Covid cases ‘astonishingly high’ and plan B is ‘sensible’, says virus expert
Professor Peter Openshaw, a member of the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag), has been speaking to BBC Radio 4’s Today programme.

He suggested ministers should be giving “clear leadership” on the issue of face masks and working from home in order to curb the spread of the Covid.

Prof Openshaw said: “I don’t think it’s a binary go for plan B or nothing, it’s very clear that the measures that are in included in plan B are sensible and not very disruptive.

“It’s not problematic to give clear leadership about the use of face masks, and working at home if you can is also not particularly disruptive for many people.

“Those measures are likely to lead to a pretty good reduction in the really unacceptable number of cases that we’ve got at the moment.

“To my mind, the introduction of vaccine passports is also fine - it’s been accepted very easily in most other western European countries.

“It’s very sensible, if you were going into a crowded indoor space and knew everyone there had been fully vaccinated and perhaps had had a rapid test on the day, you’d feel much more secure about going into that space.”

He added: “What we’re facing at the moment is unacceptable we’ve got roughly one in 55 people infected, which is an astonishingly high rate compared to most other west European countries.

“This is connected with the lack of clear messaging about sensible measures that we should all be taking in order to reduce the spread of infection.”

Britain reports highest weekly COVID-19 cases since July [Reuters UK, 24 Oct 2021]

By David Milliken

LONDON, Oct 23 (Reuters) - Britain recorded the highest number of new cases of COVID-19 since July over the past week, government figures showed on Saturday, a day after Prime Minister Boris Johnson played down the prospect of a return to lockdown.

Some 333,465 people in Britain tested positive for COVID-19 over the past seven days, up 15% on the previous week and the highest total since the seven days to July 21.

Daily figures showed there were 44,985 new cases on Saturday, down from 49,298 on Friday. Daily death figures were only available for England, and showed 135 fatalities within 28 days of a positive test.

Deaths have risen by 12% over the past week, and the total since the start of the pandemic now stands at 139,461, the second highest in Europe after Russia.

While vaccination and better medical treatment have sharply reduced deaths compared with previous waves of the disease, hospitals are already stretched and Britain's current death rate is far higher than many of its European neighbours.

Government health advisors said on Friday that preparations should be made for the possible reintroduction of measures to slow the spread of the disease, such as working from home, as acting early would reduce the need for tougher measures later.

Johnson, however, said he did not expect a return to lockdown.

"We see absolutely nothing to indicate that is on the cards at all," he said on Friday.

Why Are U.K. COVID Cases Soaring? [New York Magazine, 24 Oct 2021]

By Paola Rosa-Aquino

Last Thursday, three months after the U.K. celebrated Freedom Day and ended COVID-19 restrictions, the country recorded more than 50,000 infections — the highest number of daily cases since mid-July. Weeks from the onset of winter, infection and hospitalization rates are more than six times higher than other large nations in Europe, while the death rate is three times greater. The U.K.’s health minister warned this week that, lacking fast action to curb the spread of the virus, cases could climb as high as 100,000 a day heading into the winter. Below is a look at the factors that may be contributing to the surge.

Prematurely Lifting COVID-19 Restrictions
Virtually all of the nation’s restrictions were lifted in July thanks to the progress in its vaccine rollout, as Prime Minister Boris Johnson urged Britons to “begin to learn to live with this virus.” Now, Johnson has admitted that the level of COVID-19 cases is “high” and he is “watching the numbers very carefully every day.” However, he has insisted he is “sticking with our plan.”

Meanwhile, health experts are pressing the British government to reimpose those social restrictions — such as wearing masks in crowded indoor spaces — as cases rise and hospitals fill. On Wednesday, the NHS Confederation, which represents organizations in the country’s health service, urged the government to move to its “Plan B” raft of measures, which include the use of vaccine passports and mandatory face masks in crowded and enclosed spaces. So far, the government has ruled out the move.

“The relaxation [of rules] that happened over summer was a fairly drastic month going from, you know, quite, quite tight measures to very few restrictions,” Ravi Gupta of the Cambridge Institute of Therapeutic Immunology and Infectious Disease told NBC News. “And I think that, in retrospect, a more graded approach may have prevented the surge that we’re seeing.”

Waning Immunity and Vaccine Efficacy There’s been concern that protection from catching the virus wanes over time. The U.K. started its vaccination campaign in December of last year, before many other countries, suggesting they’ll be one of the first to see a drop in vaccine-based immunity. The country also largely relied on the AstraZeneca vaccine, which has been found to protect slightly less well against infection and transmission than available mRNA vaccines.

On Saturday, Johnson issued a desperate call to arms for everyone over 50 to have a booster jab when offered one. “We’ve made phenomenal progress but our job isn’t finished yet, and we know that vaccine protection can drop after six months,” he said. “To keep yourself, your loved ones, and everyone around you safe, please get your booster when you get the call.”

Slow Booster Rollout
Britain lifted most COVID restrictions thanks to the progress in its vaccine rollout. Initially, it outpaced most countries in vaccinations and set the narrative for Johnson’s Freedom Day. But the country is struggling to repeat those early successes, namely in its efforts to get teens vaccinated and roll out booster shots to elderly and at-risk people. “England’s booster rollout is failing to keep pace with the rollout of first and second vaccine doses,” John Roberts, a consultant at the COVID-19 Actuaries Response group, which tracks vaccination figures, warned in a statement last Monday. “It’s clear that accelerating the booster rollout is vital to reduce the pressure on health services and minimize COVID-related deaths this autumn and winter,” he added.

More than a month after the booster rollout began, fewer than half of fully vaccinated Britons over 80 years old have received their third shot. At the current pace, the 22 million people that make up the country’s higher-risk groups won’t have received boosters until late January, despite initial government promises that the people would have that additional layer of protection by winter.

Spread of the Delta Plus variant
The resurgence of COVID-19 cases comes as a new Delta Plus variant – formally known as AY.4.2 — accounts for nearly 8 percent of recently sequenced cases in the U.K. Preliminary evidence suggests that this variant could be up to 15 percent more transmissible than the original Delta strain, which remains by far the most dominant variant in terms of global circulation. Last week, the U.K. government elevated Delta Plus to a “variant under investigation.”

The U.K. prime minister’s spokesman told Sky News that “[AY.4.2] is something we’re keeping a very close eye on,” while adding that there was no evidence that the strain could more easily spread. “There’s no evidence for that, but as you would expect, we’re monitoring it closely and won’t hesitate to take action if necessary,” he added.

Outside of the U.K., there have been few cases of the Delta Plus variant. Still, former U.S. Food and Drug Administration commissioner Scott Gottlieb tweeted on Sunday that “urgent research” was needed to determine if the new variant was more transmissible and better at evading immune defenses. CDC Director Rochelle Walensky said in an interview on Sunday that the agency is watching the Delta Plus variant “very carefully.”

New Coronavirus News from 21 Oct 2021

UK government accused of being 'willfully negligent' as Covid cases mount [CNN, 21 Oct 2021]

By Rob Picheta

London (CNN)Britain's doctors' union has accused Boris Johnson's government of being "willfully negligent" in its handling of the latest wave of the Covid-19 pandemic, as ministers refuse to introduce mitigation measures despite the country recording more than 50,000 new infections on Thursday.

The United Kingdom has recently registered far more cases than most of Europe, and its rates of hospitalizations and deaths have failed to substantially decline since the summer, when the country lifted almost all of its remaining restrictions.

On Thursday it reported 52,009 new infections, the highest mark since July.

The government has nonetheless ruled out moving to its "Plan B" approach, which would see the introduction of vaccine passports and mandates in line with many European countries.

"We are sticking with our plan," Boris Johnson said Thursday. "The numbers of infections are high but we are within the parameters of what the predictions were."

But in a scathing intervention on Wednesday, the British Medical Association (BMA) said Johnson's government "has taken its foot off the brake, giving the impression that the pandemic is behind us and that life has returned to normal."

"It is willfully negligent of the Westminster Government not to be taking any further action to reduce the spread of infection, such as mandatory mask wearing, physical distancing and ventilation requirements in high-risk settings, particularly indoor crowded spaces," it said.

"These are measures that are the norm in many other nations."

Britain's Health Secretary Sajid Javid admitted on Wednesday that cases could reach 100,000 a day this winter, but said the government would not implement its Plan B measures "at this point."

The number of patients admitted to hospitals in the UK has been steadily increasing since the beginning of October, though it remains far below the wave of infections last winter that forced a lengthy nationwide lockdown.

"Thanks to the vaccination program, yes the link between cases and hospitalizations and deaths has significantly weakened. But it's not broken," Javid said at a news conference on Wednesday. "This pandemic is not over," he added.

But the BMA said the country is "rapidly approaching a position where, yet again, the Government is delaying for too long, and equivocating over taking action."

"This is the time to learn the lessons of the past and act fast, or else we will face far more extreme measures later," the body said.

Its warning followed a similar message by the NHS Confederation, which represents providers of the country's National Health Service (NHS). Last month was the busiest September in the history of the service, according to official figures, and there are fears that the winter months will again push its hospitals towards capacity.

Almost 140,000 people have died due to Covid-19 in the UK, according to official figures, the worst death toll in western Europe and the eighth highest globally.

In July, Prime Minister Johnson controversially ended England's remaining pandemic restrictions. Pubs, bars and large events have been able to operate as normal there since, without a vaccination requirement or a requirement that people wear masks. But infections have failed to decline markedly since then and now are spiking.

Despite a swift start to vaccinating its population, the UK now has the 13th highest vaccine rate in Europe and the government has faced criticism over the speed of its booster shot program and the availability of vaccines for 12 to 17-year-olds.

Cuts to overseas aid thwart UK efforts to fight Covid pandemic [The Guardian, 21 Oct 2021]

By Patrick Wintour

Government watchdog finds £3.5bn cut has damaged attempts to tackle virus in poorer countries

Cuts to the government’s overseas aid budget of more than £3.5bn have undermined the quality of the UK’s efforts to slow the global Covid-19 pandemic, ministers’ own aid spending watchdog has found.

It is the first official UK assessment of how the cuts to the Official Development Assistance (ODA) budget have damaged the British contribution to the fight against Covid in poorer countries, with a number of such programmes having been “reduced or closed, increasing the burden on developing countries and placing vulnerable groups at increased risk”.

As a result, the Independent Commission for Aid Impact (ICAI) says, the “ability of the UK aid programme to respond flexibly to the evolving pandemic has been reduced”.

The report, looking into the first 16 months of ministers’ response to Covid, finds that from November 2020 the “scale of the budget cuts required to meet the reduction of the aid spending target from 0.7% to 0.5% of UK gross national income meant that many areas of aid spending linked to the pandemic response were affected”.

It says decisions on where to cut “were mostly taken centrally, with overseas networks and spending teams closest to the programmes providing advice. They did not always reflect the substantial volume of evidence and analysis on pandemic-related risks and vulnerabilities that had been collected”.

It points out that by March 2021, one year into the pandemic, the UN had estimated that 12 million women had seen interruption in their access to contraceptives, leading to 1.4 million unwanted pregnancies.

Yet the report points out that in April 2021 the UK government announced its decision to reduce funding by 85% to UNFPA Supplies Partnership, the UN’s flagship programme focused on expanding access to reproductive health services.

The report concludes: “Programmes that would have mitigated the long-term damage of the pandemic … have been reduced or closed, as well as long-term investments delivering good value for money, which have been ended.”

It cites a 27% decrease in funding for “social safety nets” for Syrian refugee families in Jordan as another example of a cut that went against the available guidance. The report warns that it is not yet clear how much of the vaccine help given by the UK will qualify as ODA or instead have to come from other budgets.

The report points out that as of October 2021 less than 2% of the populations in Sudan and Zambia have been vaccinated. It also says too many specialist staff were mandated to return to the UK at a time when their skills were needed. Development staff were reallocated to work on consular issues for British nationals.

The ICAI commissioner, Sir Hugh Bayley, said: “The Covid-19 pandemic has reversed development gains made in many of the world’s poorest countries, pushing an additional 97 million people into extreme poverty.

“The UK’s early aid response was strong and made an important contribution to global efforts to develop vaccines. It is important that the government now builds on this to accelerate the supply of Covid-19 vaccines to developing countries and to ensure they are used to protect the most vulnerable people.”

The report says ministers pivoted funds and rapidly allocated £733m of UK aid by mid-April 2020, making the UK one of the largest donors during the early phase of the international response.

But it says the distribution of vaccines to poor countries has been disappointing and this, coupled with the challenges of delivery within vulnerable countries, “highlights the need for the UK to continue to build on its initial investment”.

Morocco bans UK flights due to Covid cases rising [BBC News, 21 Oct 2021]

By Caroline Davies

Morocco has banned flights to and from the UK due to the coronavirus pandemic.

Several UK airlines and holiday companies have been told by the Moroccan government that flights will be suspended from 23:59 BST on Wednesday until further notice.

Flights between Morocco and Germany and the Netherlands have also been suspended.

The BBC has contacted the Moroccan embassy and tourism office, as well as the UK Foreign Office for comment.

Latest figures from the European Centre for Disease Prevention and Control said that Morocco's weekly rate of reported coronavirus cases on 14 October stood at 10.4 per 100,000 people, compared with 445.5 per 100,000 people in the UK.

On Tuesday, the UK reported 43,738 new Covid-19 infections, with new cases above 40,000 for seven days in a row. The number of patients in hospital rose by 10% in a week to 7,749 on Monday.

Another 223 deaths were recorded, the largest number since March, although daily figures are often higher on Tuesdays.

The UK government updated its advice on travel to Morocco to state that the Moroccan government has suspended direct flights between the UK and Morocco for an unspecified period of time.

UK passengers are not banned from travelling from the country, but must travel via a third country to do so.

The advice states that UK travellers will need to provide proof that they have been fully vaccinated for at least two weeks or a negative PCR test taken no more than 48 hours before boarding.

They will also be asked to present a Public Health Passenger form to the Moroccan authorities on arrival.

Airline cancellations
EasyJet has said that it was told this morning. It has cancelled its outbound flights from the UK, Germany and Netherlands to Morocco until 30 November.

The airline had two flights operating from Manchester and Gatwick to Marrakech, which it will operate as "ferry flights" for return customers due to travel back to the UK today.

It said that, ahead of receiving further guidance from the Moroccan government, it intends to fly inbound flights in the coming days as repatriation flight options.

"We are contacting all customers whose flights are cancelled with their options, which include a free of charge transfer, receiving a voucher or a refund," an EasyJet statement said.

British Airways has cancelled a flight from Heathrow to the same destination, meanwhile holiday operator Tui confirmed it had also been contacted by the Moroccan government.

Tui said: "We are contacting customers in departure date order to discuss their options, which include amending to another destination or a full refund. We would like to thank our customers for their patience and understanding during this time."

The tour operator said it currently has about 2,000 UK travellers in Morocco, but hasnot yet confirmed whether it will need to bring these passengers back early.

The flight ban will affect families in England and Wales who booked half-term holidays in Morocco for next week.

Morocco's National Office of Airports said the policy will remain in place "until further notice".
The UK's Foreign Office has updated its advice on travel to Morocco to include the latest development.

It says that passengers returning to the UK from Morocco should contact their airline or tour operator to arrange an alternative route via a third country, such as Spain or France, where flights are operating as normal.

'I don't feel confident travelling abroad'
Alison Sedgewick is currently on holiday in Agadir, off the south-western coast of Morocco, with her husband and son.

On Thursday, they were due to return from their first holiday in the two and a half years since her son was born.

"You couldn't write it… the one week we've chosen to go away and they've closed the borders while we're here," she said.

However, Ms Sedgewick added she felt hopeful that because she booked a package holiday with Tui, things would get sorted out swiftly. She said she received a "holding message" from the tour operator, telling her she will hear more information within 24 hours.

"I'm hoping it'll be a bit sooner than that because the bus to the airport is supposed to be picking us at half six tomorrow evening," she added.

While she joked that her main concern is ensuring she doesn't run out of nappies for her son, Ms Sedgewick said she did feel put off the idea of travelling during the upcoming winter months.

"We debated doing a city break in November or December but I don't feel confident travelling abroad over winter because things like this might become more common," she said.

'Not very encouraging'
Meanwhile, Peter Mercer, the owner of the Dar Zaman boutique hotel in Marrakech, said that several guests were "rushing around" and attempting to return to the UK on Wednesday before the ban came into place.

"It's going to have a major impact, not just from the UK but also the flights from Germany and the Netherlands," he said.

"It's not very encouraging because we're suddenly back to where we were in March 2020. In terms of our business model, it is worrying. People perhaps will lose faith in travel because restrictions can be imposed with little notice."

While Mr Mercer said that he agrees with the Moroccan government's actions to reduce the spread of coronavirus, he hopes any restrictions on travel will be short-term.

Fading vaccine immunity threatens Britain’s restriction-free co-existence with COVID-19 [Sydney Morning Herald, 21 Oct 2021]

By Bevan Shields

London: Fading vaccine immunity is fuelling a spike in coronavirus cases in Britain, with the country’s early rollout success now working against it.

Weeks from the onset of winter, infection and hospitalisation rates in the United Kingdom are more than six times higher than large nations in Europe, while the death rate is three times greater.

The “unusual and slightly worrying” situation, as described by Health Security Agency head Jenny Harries on Wednesday, looms as a test of the government’s determination to live with the virus and keep its economy and society functioning as normal. It will also be closely monitored by other countries that started their inoculation programs much later than the UK and might soon encounter their own waning immunity complications.

New cases hit 44,000 on Wednesday — up 16 per cent on the previous week. Most were detected in children and younger adults.

Warning daily infections could soon rise to 100,000, Health Secretary Sajid Javid resisted calls for the government to implement its “Plan B” winter contingency which would reintroduce some restrictions such as mandatory indoor mask-wearing.

“This pandemic is not over,” Javid said. “Thanks to vaccinations, the link between cases, hospitalisations and deaths has significantly weakened but it is not broken.

“We must all remember this virus must be with us for the long term, and it remains a threat to our loved ones and the progress we’ve made to getting our nation closer to normal life.”

Experts stressed the AstraZeneca, Pfizer and Moderna vaccines were still hugely effective at preventing the vast majority of hospitalisations and deaths, but there was growing evidence that protection from catching the virus wanes six months after a second shot.

The Financial Times calculated that 75 per cent of older people in the UK had gone five months since their second jab, compared to 35 per cent in Italy and France.

Mask-wearing is also much less common in Britain than on the continent. However, in Scotland, where masks are compulsory in public venues and schools, case rates are higher than in England, where face coverings are not.

Asked why it did not make sense to make masks mandatory in English venues, Javid replied: “We still feel it was the right decision to try to learn to live with this virus.”

NHS England medical director Professor Steve Powis said concerns about fading immunity should not discourage people from getting their first and second dose, and a booster shot if over 50 years of age or clinically vulnerable.

“It’s a natural phenomenon that immunity reduces over time - it will occur,” he told reporters.
“And that’s exactly why we are recommending a booster dose is an important part of our armament particularly as we go into winter.”

The UK has rolled out about 4 million booster jabs but has faced criticism it has moved too slowly on that program and the rollout of vaccines to children.

Overall, 79 per cent of people aged 12 and over in the UK have had two doses.

Eastern Europe is also battling a surge in infections, with funeral directors in Romania unable to keep up with demand. On Wednesday, Russian President Vladimir Putin endorsed a week-long workplace shutdown to curb fatalities.

The Russian government earlier announced a record 1028 deaths for the previous 24 hours, although the true figure is thought to be much higher.

Romania is registering 19 daily deaths per million people - one of the highest rates in the world and 10 times higher than the rate in Britain.

Deaths in the UK are hovering at an average of 140 per day.

As the northern winter approaches, medicos are worried about a perfect storm of high coronavirus cases, resurgent flu season and huge backlog of procedures caused by lockdowns in 2020 and 2021.

About 8000 people are in hospital with COVID - nowhere near the deadly first and second waves and well below what the government’s expert advisory committee had projected for this time of year.

Two doses of the Pfizer or AstraZeneca vaccine are estimated to be 96 per cent and 92 per cent effective against hospitalisation with the Delta variant, respectively.

Paul Moss, a professor of haematology at the University of Birmingham’s Institute of Immunology, said reinfection was “something that will have to live with society around the world”.

“What we’re seeing is that the antibody levels after the second vaccine are waning. There’s some evidence we’re seeing about a four-to-fivefold fall after the second vaccine over several months, and we are seeing a slight increase in breakthrough infections.

“But what’s relatively reassuring is protection against very severe illness and death remains very high.”

Moss said the severity of reinfection was less severe because people have built up immunity and antibodies.

Russia orders new business shut-down amid record daily COVID-19 deaths [CBS News, 21 Oct 2021]

BY MARY ILYUSHINA

Moscow — Russian President Vladimir Putin told his country's employers on Wednesday that they would have to shut down again for a week from the end of October — the most dramatic step by his government in months aimed at stemming the country's surging coronavirus epidemic. During a meeting with senior officials, Putin backed a proposal to mandate "non-working" days from October 30 until November 7.

Workers will be paid during the shutdown, Putin said, as he ordered an expansion of COVID-19 testing to try and more efficiently identify virus cases.

"Our main task now is to protect the lives of citizens and, as far as possible, minimize the spread of coronavirus infection," Putin said.

He announced the new measure shortly after Russia announced yet another record number of daily coronavirus deaths, and a day after the Kremlin accepted, for the first time, a "share of responsibility" for the country's lackluster vaccination campaign.

Only about 32% of Russia's total population is fully vaccinated against COVID-19, according to official data, despite the shots being widely available since the beginning of the year. About 57% of Americans are fully vaccinated, by comparison.

The halting uptake of vaccines in Russia has kept hospitalization and death rates high. Russia reported 34,073 new COVID-19 infections on Wednesday and set a grim new record with 1,028 fatalities. The United Kingdom, in contrast, where about 66% of the population is fully vaccinated, is still seeing very high daily case numbers — over 40,000 each day for about a week — but the daily death toll from the virus has hovered for weeks around 150.

"There is a tradition to blame the government for everything," Kremlin spokesperson Dmitry Peskov told reporters on a Tuesday conference call. "Of course, the government always feels and acknowledges its share of responsibility."

Peskov accepted that "not everything that needed to be done was done in terms of the information campaign of the lack of alternatives to and the importance of vaccination," but he added that "a more responsible approach is required from all citizens of the country."

Mistrust of the vaccines has been widespread in Russia, fueled in part by officials appearing on state television early in the pandemic and downplaying the seriousness of COVID-19.

The majority of Russia's regions have seen case numbers rise fast since September, prompting authorities to revert to stricter control measures.

During a government meeting on Tuesday, Deputy Prime Minister Tatiana Golikova appealed to Putin to make the week starting October 30 a "non-working" week, to keep people at home in a bid to slow the spread of the virus. In confirming his decision to enact the plan on Wednesday, Putin ordered officials in regions with particularly high case rates to assess the situation bring in the business closures even sooner, from October 23.

The capital accounts for 21% of Russia's more than 8 million officially reported cases.
Moscow's mayor has announced plans to reintroduce remote working, along with a vaccination mandate for workers in service industries, and other measures, from next week. All employers will be obliged to have at least 30% of their staff work from home for the next four months, until February 25, 2022, Mayor Sergey Sobyanin wrote on his website.

Employees who have been vaccinated or recovered recently from a COVID infection, along with medical and other critical workers, will be exempt from the requirements.

According to Sobyanin, the number of new cases being registered in the Moscow region since the summer has increased four-fold, and the number of hospitalizations tripled.

"I'm well aware of how tedious and uncomfortable the current restrictions are, but there's simply no other way to protect you from serious illness," he wrote, adding a targeted appeal to older Muscovites, whom he said had been reluctant to get the shots.

"Please get vaccinated. That's how you will protect your health and be able to maintain your usual lifestyle," the mayor said.

The tightening of restrictions in the capital area comes as most of Russia's federal 85 regions introduce vaccine mandates for various groups. Digital passes, to show vaccination or COVID test status via a QR code on personal phones, are also required to access many public venues across the country.

UK health experts urge government to implement covid 'Plan B' [The Washington Post, 21 Oct 2021]

By Annabelle Timsit

Public health experts in the United Kingdom are calling on the government to reintroduce some coronavirus restrictions as cases climb — far outstripping those of its Western European neighbors — despite the country’s high vaccination coverage.

The U.K.’s coronavirus case count could rise to as high as 100,000 a day, Health Secretary Sajid Javid said at a news conference Wednesday. But that was not grounds for the government to abandon its “Plan A,” he said, and impose more restrictions — at least not yet.

“We think it is the right decision to learn to live with this virus,” such as “asking people to take more responsibility” for measures such as masks and vaccinations, Javid said.

Other public health experts warn that Britain is, once more, facing a critical juncture: impose restrictions now before this wave becomes too big to contain.

“We are right on the edge — and it is the middle of October,” Matthew Taylor, chief executive of the National Health Service Confederation, a group representing the health-care systems in England, Wales and Northern Ireland, told the Guardian newspaper Tuesday. “It would require an incredible amount of luck for us not to find ourselves in the midst of a profound crisis over the next three months.”

Prime Minister Boris Johnson ended the lockdown in England on July 19, declaring it “Freedom Day.” Since then, the country has lifted most restrictions, with no legal mask requirement in most settings, including schools, and nothing approaching a universal vaccine mandate, in sharp contrast with some other European countries.

How vaccine-skeptic France and Germany came to support near-mandates
In a speech in September laying out his government’s plan for autumn and winter, Johnson said he would like things to continue that way, with an emphasis on promoting vaccinations, booster doses and frequent testing, rather than reintroducing restrictions. However, he outlined a pandemic “Plan B” that he said could be necessary if the publicly funded NHS became overwhelmed. Some restrictions could then be introduced, including advising people to work from home, legally mandating face coverings in certain settings again, and bringing about mandatory covid passports.

Now, as the United Kingdom this week recorded its highest number of deaths from the coronavirus since March, health experts are warning of a “winter crisis” and have begun urging the government to not just implement “Plan B” — but to go further with “Plan B Plus.”

The government should ensure “clear communications to the public that the level of risk has increased,” Taylor’s organization said in a news release, and call on the public to “mobilise around the NHS and do whatever they can to support frontline services this winter,” including by getting booster shots and volunteering.

“Many of these measures, particularly around mask-wearing and covid-19 certification, are already common in parts of Europe where the prevalence of the disease is lower,” the group added.

However, the government, which has been keen to reopen the economy, has insisted that its approach is working. Business Secretary Kwasi Kwarteng said Wednesday that it was not the time for Plan B, adding: “What we want to do is manage the situation as it is — we don’t want to go back into lockdown and further restrictions. I would rule that out.”

The Cabinet Office said in an emailed statement: “The vaccination programme has significantly weakened the link between cases, hospitalisations and deaths and will continue to be our first line of defence against COVID-19.”

“We always knew the coming months would be challenging, which is why we set out our plan for Autumn and Winter last month.”

UK faces calls for ‘Plan B’ with virus cases high and rising
Daily case numbers are the highest they have been since July — 49,156 people were reported to have tested positive for the coronavirus in Britain on Monday. And “the problem is a lot worse than the daily figures suggest,” said Robert West, a professor of health psychology at University College London who is part of the government’s Scientific Pandemic Insights Group on Behaviors.

This is because not everyone who has contracted the virus is aware of it, particularly if they do not have symptoms, and some people may test positive but not report their result to public health bodies. The Office for National Statistics estimates that the true number of infections in England, in the week ending on Oct. 9, was closer to 1 in 60 people in the country.

And while hospitalizations and deaths remain low, they are climbing. According to the government, in the United Kingdom as a whole, 954 people were recorded to have died of covid-19 in the past seven days, a 21 percent week-on-week increase, while 6,074 people were reported to have been admitted to a hospital because of covid-19 in the seven days leading up to Saturday, an 11 percent week-on-week increase.

Experts say three major trends may have led Britain to this point: loosened public health restrictions, the relative success of vaccination campaigns and the natural evolution of the virus.

The government went into “an explicitly post-pandemic mode” and did not do enough to mitigate risks after Johnson ended lockdown, said Danny Altmann, professor of immunology at Imperial College London. This created a “perfect storm” once the more contagious delta variant began to spread, while schools reopened, immunity from the coronavirus vaccines began to diminish and the weather got cooler.

The success of the country’s vaccination program may also be a factor in the rising number of cases right now. While much is still unknown about how coronavirus vaccines work, studies suggest their efficacy could be reduced over time. Because many people were vaccinated early, immunity to infections could be going down around now, said West, of University College London, just as people begin to spend more time indoors, potentially increasing transmission.
The virus mutates naturally over time, so some of the rising cases could also be explained by “basic biology and timeline,” Altmann said. “Not only were we early, we were also at the front of the queue for importation of delta variant, so we’ve had much longer for it to percolate,” he said, adding that the same is true for AY4.2, a new variant sometimes known as “delta plus” that is “expanding” in England, according to the latest official analysis.

What we know about the delta-plus coronavirus variant
And while nearly 79 percent of those older than 12 have been fully vaccinated, efforts to vaccinate school-age children have progressed more slowly — even though infections are rising in that age group. The latest official data shows an estimated 8.9 percent of children in England in what roughly translates to sixth to 10th grade were infected.

While the government has remained reluctant to reintroduce covid restrictions, it has said it will keep “a very close eye” on case numbers.

It has delayed implementing covid measures in the past, partly out of concern that the public would not comply, according to a recent scathing review of the British response to the pandemic. In that review, lawmakers concluded that the government underestimated people’s willingness to comply with restrictions and erred in delaying a lockdown as a result.
Now, some health experts say the public would be willing to accept more restrictions again if they are sold as common-sense measures.

Research shows most people would be willing to start wearing masks again “if you make it very clear in your communications why and when to do it,” West said.

Altmann had a more blunt assessment: “I don’t understand how people can get bored of avoiding death.”

UK reports almost 50000 new COVID cases, 179 deaths [Reuters UK, 21 Oct 2021]

by Michael Holden & Estelle Shirbon

LONDON, Oct 20 (Reuters) - Britain reported 49,139 new COVID-19 cases on Wednesday and 179 more deaths within 28 days of a positive test, official data showed.

The number of new cases has been rising rapidly, with infections in the last seven days up 17% compared to the week before.

Deep within the UK’s shocking Covid data, there may be reasons for optimism [The Guardian, 21 Oct 2021]

By Ian Sample

Analysis: soaring cases in schools are adding to the pool of the immune – which could soon see some community infections fall

It is hard to be upbeat about the latest numbers. The government’s Covid dashboard is awash with red and upward-pointing arrows. New cases have climbed 17% on the week. Hospital admissions are up 11% and deaths have increased by 21%. This is not where we wanted to be nearly two years into the pandemic – and 10 months into the most successful mass vaccination campaign in the history of the NHS.

So is this what we have to get used to? Nearly 1,000 hospital admissions a day, and nearly 1,000 deaths a week? There are so many forces at work in a pandemic, operating on different timescales, pushing in opposite directions, that reliable predictions are a fantasy. But delve into the data and there are, perhaps, some reasons for optimism.

With so many adults well protected after vaccination, infection, or both, the primary driver for the UK epidemic is the infection rate among schoolchildren. Data from the Office for National Statistics show that cases soared in secondary schools when they reopened after the summer.
This was bound to happen: in England at least, protective measures in schools were minimal; the decision to vaccinate healthy children came later than elsewhere, and the process has been difficult and slow.

The ONS estimates that for the week ending 9 October, 8.1% of children in school years 7 to 11 would have tested positive for coronavirus. This equates to about 5% becoming infected every week and adding to the pool of the immune. Before schools went back after the summer, a substantial minority of children in London may have had antibodies to the virus. With natural infections building on that immunity for weeks, cases may soon start to fall. And since schoolchildren are seeding infections into the community, national cases may follow suit.

But England is not London, and not all children are equally protected. In London, fresh cases of Covid are barely increasing, suggesting the capital may be close to a peak – at least for now. In the south-west, where immunity in children is thought to have been much lower before schools went back, cases are rising fast. If herd immunity starts to drive cases down, it will happen city by city, region by region, not in a coordinated wave across the UK. As ever, other factors muddy the waters, not least mixing patterns among adults. In London, for example, home-working rates are far higher than in many other places, keeping exposure levels down.

One question modellers are keen to answer is how much can Scotland tell us. When secondary schools in Scotland opened in mid- to late August, the percentage of students testing positive rose sharply. Depending on the age group, the rates peaked at 8%-10% before cases started to fall. At the same time, in early September, national cases fell sharply. Daily cases in Scotland more than halved in a month.

England may follow suit in the weeks ahead, but there is uncertainty. Scotland was faster to vaccinate schoolchildren, so their immunity before returning to school may have been higher than for children in England. If the tide has started to turn in teenagers in England, the first sign may be a slowing of infections in the ONS data this Friday.

Not that that will be the end of it. Vaccines are good at preventing severe disease but do far less to stop the virus from spreading, and immunity is steadily waning, especially in vulnerable people. Meanwhile, children are the only ones close to pre-epidemic levels of contact with others. Adults have not returned to anything like previous levels of mixing, though it is starting to increase. To top it all, as Chris Whitty, England’s chief medical officer, would say, “winter is coming”. All could drive further waves in infections.

John Edmunds, a member of Sage and professor in the faculty of epidemiology and population health at the London School of Hygiene & Tropical Medicine, said while the epidemic has looked relatively stable over the past few months, “this has masked large changes under the surface, with rises and falls in levels of immunity in different age groups being generated by different processes – levels of immunity are rapidly increasing in children due to sky-high infection rates, whereas immunity is falling in older age groups who were vaccinated earlier in the year”.

He added: “How these dynamics play out is very difficult to predict right now, but it is clear that speeding up the vaccine rollout in children and boosters in adults will help both in the short and longer term.”

New Coronavirus News from 20 Oct 2021

New COVID-19 subvariant is spreading in the UK: What we know [KXAN.com, 20 Oct 2021]

by: Michael Bartiromo

(NEXSTAR) – A new offshoot of the COVID-19 delta variant was responsible for approximately 6% of cases in the United Kingdom as of late September, according to officials with the U.K. Health Security Agency.

The subvariant, known as AY.4.2, is not yet a variant of concern (VOC) or even a variant of interest (VOI), though officials confirmed that cases appeared to be on an “increasing” trajectory in an Oct. 15 report.

FDA authorizes Moderna and J&J booster shots, OKs mix and match
“A Delta sublineage newly designated as AY.4.2 is noted to be expanding in England,” the UK Health Security Agency wrote in its report. “It is now a signal in monitoring and assessment has commenced.”

Researchers have determined that AY.4.2 contains two spike mutations — A222V and Y145H — that have already been observed in other variants. Neither of those mutations, however, had been observed in any variant deemed to be a VOC, or variant of concern.

Commenting on the mutations, Prof. Francois Balloux of the UCL Genetics Institute in London told the U.K.’s Science Media Centre that the presence of both A222V and Y145H does not necessarily mean AY.4.2 is more transmissible than other variants, though he said it’s possible.

“Neither mutation is a priori an obvious candidate for increased viral transmissibility, but we have learnt that mutations can have different, sometimes unexpected, effects in different strains,” said Balloux on Tuesday.

On Twitter, Balloux further noted that AY.4.2 might actually be “intrinsically more transmissible,” citing its unchanged trajectory of rising cases, as well as the areas of the UK where cases have been observed. (Infections don’t seem “region-specific,” he said).

Outside of the U.K. and Denmark, cases of AY.4.2 currently appear to be rarer, though reports indicate cases have now been observed in the U.S., Canada, and Israel.

Still, concerns are rising in the U.S. Former FDA commissioner Scott Gottlieb tweeted on Sunday that “urgent research” is needed to determine the transmissibility of the subvariant, as well as its possible resistance to vaccines.

“This is not a cause for immediate concern but a reminder that we need robust systems to identify, characterize new variants,” Gottlieb added. “This needs to be a coordinated, global priority for COVID, same as similar international efforts have become standard practice in influenza.”

Remarking on the release of the U.K. Health Security Agency’s findings, a representative for the prime minister has said the government is also “keeping a very close eye on” the numbers.
“There’s no evidence [to suggest increased transmissibility], but as you would expect, we’re monitoring it closely and won’t hesitate to take action if necessary,” the representative told Sky News.

White House details plans to vaccinate 28M children age 5-11
While it’s unclear for certain whether the AY.4.2 subvariant is more transmissible, U.K. health officials are investigating the possibility of transmissibility and immunity-evading traits.

Balloux, for one, does not yet believe AY.4.2 is an “obvious” candidate for elevation to a VOC.

“The emergence of yet another more transmissible strain would be suboptimal,” he told the Science Media Centre. “Though, this is not a situation comparable to the emergence of Alpha and Delta that were far more transmissible (50% or more) than any strain in circulation at the time. Here we are dealing with a potential small increase in transmissibility that would not have a comparable impact on the pandemic.”

As U.K. Covid Cases Surge, Israel Offers Lesson in Boosters [Bloomberg, 20 Oct 2021]

By Gwen Ackerman

As Covid-19 cases soar again in the U.K., officials could look to a country that’s moved past a similar crisis for a possible roadmap.

The search for answers in Israel may be useful, health experts say, because both countries were among the fastest in the world with their vaccination programs, yet were similarly quick to lift lockdown restrictions. And just as Israel experienced a spike in cases in June, so the U.K. is now, having just reported the biggest single daily jump in infections in three months.

Booster Dose Slashes Rates of Covid Infection in Israeli Study
Israel’s response to its renewed outbreak was to roll out an aggressive booster program, a decision that appears to have quelled the worst of the outbreak within weeks.

And while there are too many other variables to draw hard-and-fast conclusions -- from vaccine type and timings to age-group prioritizing, social-distancing rules and mask-wearing -- it may offer one stand-out lesson for the U.K: People should get their boosters.

Another Shot
Cases dropped after the booster shot was rolled out

“Israel was the first country to have a mass vaccination campaign and it was the first to experience the full impact of waning immunity” and the mass susceptibility that followed, said Ran Balicer, the Tel Avi-based chairman of Israel’s national Covid-19 advisory team. Other countries that vaccinated later will go through the same thing, “unless they use the lessons learned here and consider the booster campaign,” he said.

Standing Out
U.K. case rate is far higher than other major European countries

Britain has a booster program that began in late September. It’s open to people 50 and older, and is focusing on the elderly in that age group, as well as other vulnerable people. In Israel, the rollout extended to people 12 and above within weeks of its Aug. 1 launch.

U.K. to Begin Covid Booster Drive for Over-50s Next Week (2)

The surge in infections in the U.K. has left the country behind other major European nations, in terms of both case rate and deaths, according to Bloomberg’s tracker.

“We’re starting to see indications that hospitalizations and death rates are increasing,” U.K Prime Minister Boris Johnson’s official spokesman, Max Blain, told reporters on Tuesday.
“Clearly we are keeping a very close eye on rising case rates. The most important message for the public to understand is the vital importance of the booster program.”

The latest Covid updates
Make sense of the headlines and the outbreak's global response with the Coronavirus Daily.

Last month, U.K. ministers unveiled a contingency plan if cases surge, including measures such as mandatory face masks, vaccine certificates and advice to work from home. The National Health Service Confederation, which speaks for the health care system, has urged the government to enact that plan “without delay,” but on Wednesday, Business Secretary Kwasi Kwarteng told Times Radio that the time hadn’t come for that.

U.K. Expands Vaccine Access for Children After Surge in Schools
In Israel, officials are optimistic that they’re putting the delta wave behind. Serious coronavirus cases continue to drop now that almost 3.9 million people out of an eligible 5.2 million have received a third dose.

“It’s possible to say, cautiously, that we are quelling the fourth wave, the delta wave, but it’s not over until it’s over,” Prime Minister Naftali Bennett said Sunday.

A new Delta descendant is rising in the UK. Here's what to know [CNN, 20 Oct 2021]

By Tara John

This is the weekly edition of CNN's coronavirus newsletter. Look out for your roundup every Wednesday. If you haven't subscribed yet, sign up here.

(CNN)British and international authorities are closely monitoring a subtype of the Delta variant that is causing a growing number of infections in the United Kingdom.

This descendant of the Delta variant, known as AY.4.2, accounted for an estimated 6% of cases in the week of September 27 -- the last week with complete sequencing data -- and is "on an increasing trajectory," a report by the UK Health Security Agency said.

Little is known about AY.4.2. Some experts have suggested it could be slightly more transmissible than the original Delta variant, though that has not yet been confirmed. While it accounts for a growing number of infections, it is not yet classified in the UK as a "variant of concern." It currently remains rare beyond Britain, with a small number of cases being recorded in Denmark and the US, expert Francois Balloux told the Science Media Center (SMC) on Tuesday.

"As AY.4.2 is still at fairly low frequency, a 10% increase its transmissibility could have caused only a small number of additional cases. As such it hasn't been driving the recent increase in case numbers in the UK," Balloux, Professor of Computational Systems Biology and Director at the UCL Genetics Institute, told the SMC.

While new variants have repeatedly overtaken one another to become the dominant strain globally in the past year, experts say it is too soon to know whether AY.4.2 will become significant. In the UK, "Delta very rapidly in a matter of weeks" outpaced the Alpha variant by the summer, Deepti Gurdasani, a senior epidemiology lecturer at Queen Mary University of London, told CNN. "That's not what we're seeing here, we're seeing sort of a slow increase in proportion that suggests that it's not hugely more transmissible, it might be slightly more transmissible.

Balloux agreed, telling SMC that "this [is] not a situation comparable to the emergence of Alpha and Delta that were far more transmissible (50% or more) than any strain in circulation at the time. Here we are dealing with a potential small increase in transmissibility that would not have a comparable impact on the pandemic."

AY.4.2 has caught the attention of public health experts across the pond. In a series of tweets Sunday, former US Food and Drug Administration Commissioner Dr. Scott Gottlieb called for "urgent research" into this Delta offshoot and said it was a "reminder that we need robust systems to identify, characterize new variants."

The emergence of AY.4.2 in Britain, however, points to what scientists have warned throughout the pandemic: soaring transmission can create new variants. The UK has had the highest rate of daily Covid-19 cases and deaths per million people in Western Europe since most pandemic restrictions were dropped in the summer. On Tuesday, it reported 223 Covid-19 deaths, the highest daily figure since early March, and health leaders are urging the government to reintroduce measures such as mask mandates in enclosed spaces to help ease the pressure on the health system.

The "whole problem with this approach to living with the virus and allowing between 30,000 to 50,000 cases a day -- which has been the UK's case rate since [the summer] -- is the [virus's] evolution will continue ... we need to suppress cases and suppress the virus," Gurdasani said.
YOU ASKED. WE ANSWERED.

Q: When vaccinated people die from Covid-19, how do you explain that vaccines are still worth taking?

A: We need to start with science and what the research shows, according to CNN Medical Analyst Dr. Leana Wen. The Covid-19 vaccines are extraordinarily effective in preventing illness and especially severe disease, she said.

The most recent data from the US Centers for Disease Control and Prevention (CDC) shows that they reduce the likelihood of testing positive for Covid-19 by six-fold and the likelihood of death by 11-fold, she added.

"That means that if you are vaccinated, you are six times less likely to get Covid-19 than someone who's unvaccinated. And you are 11 times less likely to die from Covid-19 compared to an unvaccinated person. That's really excellent," she said.

"However, the Covid-19 vaccines do not protect you 100%. No vaccine does, just likely virtually no medical treatment is 100% effective. That doesn't mean the vaccine doesn't work, or that you shouldn't take it."

Send your questions here. Are you a health care worker fighting Covid-19? Message us on WhatsApp about the challenges you're facing: [phone].

READS OF THE WEEK
Why Colin Powell's cancer likely reduced his protection from the Covid-19 vaccine
Colin Powell, the first Black US secretary of state, died Monday from complications of Covid-19. Experts say his death shows how important it is for more people to get vaccinated and stop the spread of the virus, Jen Christensen reports.

Powell was fully vaccinated, but a source close to the matter confirmed to CNN he had multiple myeloma, a type of blood cancer that would have affected his immune response to the vaccine, and made it difficult to fight the virus. Peggy Cifrino, Powell's chief of staff, said Powell, 84, also had Parkinson's disease, a neurodegenerative disorder.

Although the Covid-19 vaccines provide strong protection against severe disease and death in healthy people, multiple myeloma patients are among the immunocompromised groups who may not respond as well, studies have shown. One study published in Nature in July showed that only 45% of multiple myeloma patients developed an adequate response to the vaccine, while 22% had a partial response. One-third had no response.

Despite Powell representing a high-risk population group, some conservative media figures have dishonestly seized on his death to cast doubt on the effectiveness of Covid-19 vaccines, Oliver Darcy writes.

These doctors are spreading misinfo about vaccines
Dr. Christiane Northrup was a frequent guest on The Oprah Winfrey Show -- an Ivy League-educated obstetrician-gynecologist who often spoke about women's health and holistic medicine. She was a media darling, and in 2013 made Reader's Digest's annual list of the 100 most trusted people in America.

But Northrup is also among a small group of doctors who have emerged as a huge source of misinformation -- whether as social-media influencers or family doctors meeting with patients in person -- about Covid-19 vaccines, which have thus far proven the most effective weapon against the deadliest pandemic in 100 years, Rob Kuznia, Scott Bronstein, Curt Devine and Drew Griffin report.

Moscow orders unvaccinated over-60s to stay home for 4 months
Millions of Russians face strict new Covid-19 restrictions from this week, after a slow vaccination drive, an overwhelmed health care system, and widespread mistrust in government combined to plunge the country into its most deadly phase of the pandemic to date, Anna Chernova and Rob Picheta report.

On Tuesday, Moscow's mayor ordered all unvaccinated residents over 60, as well as unvaccinated people "suffering from chronic diseases," to remain home for four months until late February as the city grapples with a growing crisis.

The national government has also proposed introducing a non-working week at the start of November, but senior figures have started openly admitting that the situation is dire as Russians head towards a bleak winter.

Russia has recorded its highest numbers of daily cases and deaths multiple times in recent days, and registered 1,002 official fatalities on Sunday -- the first time the country has crossed the four-digit deaths barrier so far.

Experts point towards a lagging vaccination program and a failure in government messaging as factors behind the surge, which is now threatening to deluge hospitals across the country.
"I think the country is now falling into disaster," Vasily Vlassov, a Russian epidemiologist and former adviser to the World Health Organization (WHO), told CNN.

TOP TIP
The test-to-stay approach in US schools
The CDC is working with select school districts across the nation to evaluate the practice of the test-to-stay approach.

This type of policy would prioritize testing to monitor students who may have been exposed to Covid-19, allowing students to continue to attend classes if they test negative, instead of having to quarantine. But there are many health experts who agree that quarantines are still necessary.

In an email to CNN, CDC said it views test-to-stay as a "promising practice" and that it's "working with multiple jurisdictions implementing test to stay to evaluate the effectiveness of this strategy." But it's not clear when that guidance could be available. Read more about it here.

UK health minister says Covid cases may hit 100,000 a day in winter, no contingency measures for now [CNBC, 20 Oct 2021]

By Sam Meredith

LONDON — U.K. Health Secretary Sajid Javid on Wednesday said that the government won’t be implementing the so-called plan B strategy of its fall-winter Covid plan, defying warnings from health leaders that the country risks “stumbling into a winter crisis.”

“We are looking closely at the data and we won’t be implementing our plan B of contingency measures at this point,” Javid said, speaking at the government’s first coronavirus news conference in more than a month.

“But we will be staying vigilant, preparing for all eventualities while strengthening our vital defenses that can help us fight back against this virus.”

Javid said the NHS was “performing with distinction,” acknowledging that the health service was seeing greater pressure but rejected the suggestion that it was unsustainable.

“We will do what it takes to make sure that this pressure doesn’t become unsustainable and that we don’t allow the NHS to become overwhelmed.”

Javid said that winter poses the “greatest threat” to the recovery from Covid, adding that cases could yet climb as high as 100,000 per day.

It comes shortly after the National Health Service Confederation, which represents organizations across the U.K. health-care sector, warned some Covid restrictions must be reintroduced “without delay” if the government is to keep people healthy and prevent hospitals from becoming overwhelmed this winter.

This is because the NHS is seeing a “worrying” increase in Covid cases in hospitals and the community as it prepares for a busy winter period, they added.

The U.K. recorded 49,139 new Covid cases on Wednesday, according to the latest government data, and 179 deaths within 28 days of a positive test.

The seven-day average of new Covid cases in the U.K. has jumped from around 34,000 at the beginning of October. Meanwhile, the number of people in the hospital who have Covid has surged by 11% in a week.

To date, the U.K. has recorded more than 8.5 million Covid cases and 139,265 deaths, according to data compiled by Johns Hopkins University. The U.K. ranks among the countries with the highest death tolls worldwide.

Making matters worse, potentially, is a new mutation of the delta variant that British experts are watching closely.

Downing Street said earlier this week that it was closely monitoring rising cases, but the Cabinet had not yet discussed contingency measures.

Business Secretary Kwasi Kwarteng told Sky News on Wednesday that it was not yet time for the government’s so-called Plan B strategy, saying the focus should be on administering more booster shots instead.

Kwarteng also ruled out the prospect of another national lockdown.

Rising cases across Europe
Officials from the World Health Organization on Wednesday noted the rise in cases across Europe, including in the U.K., blaming it at least in part on the easing of Covid restrictions.

“The Northern Hemisphere is heading into another winter, and just need to be a little concerned about that uptick across Europe as we enter the late, late, deep autumn,” Dr. Mike Ryan, head of the WHO’s emergencies programs, said in a Q&A. “As societies are opening up, we’re seeing those numbers rise, and in a number of countries, we’re already seeing the health system begin to come under pressure, we’re seeing the number of available ICU beds decreasing.”

Last month, the government outlined its fall-winter plan for tackling the coronavirus crisis, setting out a series of measures designed to avert the need for more lockdowns. These include vaccine uptake, test, trace and isolate, supporting the NHS and social care, government guidance and communication, and embracing an international approach to the pandemic.

If the NHS was deemed to be at risk of coming under unsustainable pressure, Javid said those contingency measures could kick in across England. That includes the possibility of making masks mandatory in certain settings, vaccine passports for events and encouraging remote working.

Health and care policy is devolved across the U.K., with different provisions made in Wales, Scotland and Northern Ireland.

The UK has more new Covid-19 cases than France, Germany, Italy and Spain combined [CNN, 20 Oct 2021]

By Rob Picheta

London (CNN)Last December, as the first of several worrying Covid-19 variants ripped through the United Kingdom, Prime Minister Boris Johnson made the unwelcome decision to cancel Christmas plans for millions of Brits.

"We are sacrificing our chance to see loved ones this Christmas, so we have a better chance of protecting their lives so we can see them at future Christmases," Johnson said, taking a potentially career-defining step that he had ruled out just days earlier.

Ten months later, the UK's attitude towards Covid-19 has changed beyond recognition.
Virtually all of England's restrictions were lifted in July, with the events and hospitality sectors returning to full capacity as Johnson urged Britons to "begin to learn to live with this virus."

But the Delta variant -- more transmissible still than the Alpha strain which wrecked last year's festivities -- has not gone away.

The country has quietly endured stubbornly high cases, hospitalizations and deaths when compared to the rest of Europe. Britain has registered nearly half a million cases in the past two weeks -- and almost 50,000 on Monday -- more than France, Germany, Italy and Spain combined. The UK reported 223 deaths on Tuesday, the highest daily figure since early March.

Johnson has strayed from much of the European Union in his approach; while a number of countries on the continent have introduced vaccine passports, England halted its original plan to do so. Mask-wearing and social distancing and other measures are no longer required by law in Britain.

That contrasts with far stricter measures in several European nations, where proof of vaccination or a negative test are needed to visits bars and restaurants or work in several fields, including healthcare.

Hospitals in Britain are now close to buckling once again under the strain of new admissions.
And the country's early vaccination success risks being undone by a stuttering rollout of booster shots and shots for children.

"Exceptional policies lead to exceptional outcomes," Deepti Gurdasani, an epidemiologist at Queen Mary University in London, told CNN. "It's very predictable. This is a consequence of opening everything up."

"We're approaching winter, and things are only going to get worse," she added.

Some things may yet shut back down; Johnson's spokesperson admitted on Monday that a "challenging" winter lies ahead, and the Prime Minister has refused to rule out a return of mask mandates or stronger restrictions to protect the country's National Health Service (NHS) in the coming weeks.

But experts -- including Johnson's own health care chiefs -- are clamoring for a more urgent change in approach.

The NHS Confederation, which represents providers of the service, urged the government on Wednesday to move to its "Plan B" raft of measures, which would include European-style vaccination passes and more mask mandates. But the government has ruled out that move for now, only insisting it was closely watching the case figures.

"There's a whole series of ways (in which) we're out of line with western Europe and the rest of the world," said Martin McKee, professor of European Public Health at the London School of Hygiene & Tropical Medicine.

"We've seen in other European countries that collective measures make a big difference," he said. "We should be asking ourselves: Are we right? (Because) there's no evidence that we are."
A stuttering vaccine rollout

The driver behind Britain's renewed optimism in the new year was its vaccination program, which outpaced most countries in its initial scale and set the narrative for what Johnson portrayed as Britain's triumphant emergence from the pandemic.

But the country is struggling to repeat those early successes as it attempts to vaccinate adolescents and roll out booster shots to elderly and at-risk people.

"England's booster rollout is failing to keep pace with the rollout of first and second vaccine doses," John Roberts, a consultant at the Covid-19 Actuaries Response group which tracks vaccination figures, warned in a statement on Monday.

More than a month after booster shots began, less than half of twice-vaccinated over-80s have received a top-up. "It's clear that accelerating the booster rollout is vital to reduce the pressure on health services and minimise Covid-related deaths this autumn and winter," he said.

The group estimated that, at current pace, the 22 million people that make up the country's higher-risk groups won't be triple-vaccinated until late January, despite initial government promises that the program would protect people for the winter.

Vaccines continue to reduce the number of Covid-19 patients who need hospital treatment, but waning immunity makes the pace of the rollout particularly important. The majority of over-40s in Britain were originally vaccinated with the partially homegrown Oxford-AstraZeneca vaccine, whose efficacy against the Delta variant has been shown to be lower than Pfizer and Moderna's shots.

A preprint of a study by Public Health England (PHE) found that the shot's protection against infection fell from 66.7% to 47% after 20 weeks, compared to a drop from 90% to 70% for the Pfizer vaccine. Separate PHE research found that AstraZeneca's efficacy against hospitalization from Delta slipped from just above 90% to just under 80% after 140 days, while its efficacy against death remained close to 90%. Pfizer remained above 90% in both metrics.

Many experts blame the lack of momentum in the UK's vaccination drive on months' worth of positive reassurances from Johnson's government.

"All of the government's messaging and actions suggest that we're out of danger," Gurdasani said.

"There's been a lot of messaging that the pandemic is essentially over, so a lot of people are thinking: "why bother?" added McKee.

There are concerns too at the other end of the age spectrum, as the NHS works to vaccinate over-12s and avoid a repeat of the rampant transmission in schools that disrupted much of the summer term in June and July.

That program suffered a false start amid conflicting early advice from the country's scientific bodies; whereas France, for example, began vaccinating under-18s in June, the British government only green lit the move in September.

1.2 million teenagers have now been given one dose of a vaccine and just 260,000 have seen two doses in England.

"The problem is not that adolescents don't want to take it. There are many who are desperate to get it, but are not being offered it at school yet," Gurdasani said.

Schools have complained about a lack of vaccinating staff, and England's delay in allowing adolescents to visit national vaccine centers has seen it fall behind Scotland in inoculating the age group.

"There's a loss of direction here," McKee said. "It's not clear who's in charge."

Britain's hospitals brace for a bleak winter
Britain's Covid-19 rates soar above much of Europe's, but its mitigation measures remain minimal.

"The government is totally dependent on the vaccination program, which is now going on in a very half-hearted way," McKee said. "There really needs to be an urgent review of where we are different from other countries, and an assessment: should we be different? What is the rationale?"

McKee joined many experts in calling for a package of measures that mirror the continent.

Several European countries, including France and Italy, have rolled out Covid-19 passes and required vaccination for healthcare workers, while many more still employ mask mandates in crowded spaces that the UK does not.

Johnson, by contrast, has walked back initial plans to introduce similar measures. "Vaccine passes have an important role to play; the French and the Italian experience show that they do," McKee said. Cases have remained low in both countries since the measures were introduced.

Health care is devolved in the UK and vaccine passes have been announced in Wales and Scotland. Johnson is meanwhile keeping them in reserve under its "Plan B" scenario for England -- but with such high infection rates every day, many wonder why Plan A is still in effect.

"We have extremely high infection rates in children (and) they've spilled over into the elderly population," Gurdasani said. "We're approaching winter, and things are only going to get worse."

Covid fatigue amongst the public is another challenge. Mass events are underway with no vaccination requirements and little trace of the pandemic still remains on British high streets during busy periods.

Just 40% of Britons still regularly practice social distancing, compared to 62% in mid-July and 85% in April, according to the Office for National Statistics. The same recurring study has also found a gradual decline in mask-wearing.

For some, that trend is alarming. "We've had 30 to 40,000 cases every day for months now. There's no other country that's tolerating that ... (but) it's been normalized" in the UK, Gurdasani said.

The steady stream of hospitalizations has not dramatically surged in the past two months, but has not noticeably declined either; official figures show more than 700 new patients entering facilities every day.

That leaves hospitals, already struggling to work through a backlog of treatments that were delayed during the pandemic, anxiously awaiting another winter surge.

Last week, NHS England said more people were waiting for treatment than at any time since it started keeping records -- 5.7 million -- while health care staff battled the busiest September on record this year.

"There is no doubt the NHS is running hot, with the highest ever number of patients seen in A&E in September, 14-times as many covid patients in hospital compared to the same month last year and record 999 ambulance calls," Professor Stephen Powis, the NHS national medical director, said of the figures.

Which direction the winter takes is still not inevitable. "There's so many unknowns," McKee said, noting that previous anticipated spikes in infections this year have not materialized.

But experts and hospital staff fear a further strain. "It's not a place where most healthcare workers want to be," added Gurdasani. "It really scares me that we're in this place ahead of the winter."

And, as the year winds down, the nature of Britain's second pandemic Christmas remains unclear.

Nipah Outbreak News in Bangladesh and elsewhere since 4 Aug till 14 Oct 2021

A researcher at Oxford warns of a virus that threatens a new pandemic [Mediarun Search, 14 Oct 2021]

By Camelia Kirk

Nipah virus is one of the next pandemic threats, warns an Oxford scientist who developed a vaccine for AstraZeneca Against COVID-19, Sarah Gilbert.
According to her, there is still no vaccine for this virus, and studies that were underway had to be interrupted due to the Covid-19 pandemic.

“If we had a delta type of Nipah virus, we would suddenly have a highly transmissible virus with a 50 per cent mortality rate,” Sarah Gilbert said during an event at the Cheltenham Festival of Literature in the UK.

Credit: Dr_Microbe/istockResearchers fear that the Nipah virus may lead to a new pandemic
Nipah tops the list of ten priority diseases identified by the World Health Organization (WHO).Who is the) have been identified as potential sources of future epidemics.

virus made a A recent victim in India Hundreds of nearby contacts were forced into isolation to contain a potential outbreak.

What is the Nipah virus?
It is a zoonotic disease, i.e. transmitted from animal to human. It is usually transmitted by eating fruit contaminated with saliva or urine from infected bats, which are the natural reservoir for this virus.

Transmission can also occur directly from person to person or from contact with infected pigs.

Since its discovery in Malaysia among pig farmers, the virus has caused some outbreaks in Asia among humans. In addition to India and Malaysia, cases have also been recorded in Indonesia. In Brazil, there is no record yet.

Signs and symptoms
The incubation period (ranging from infection to onset of symptoms) is believed to be 4 to 14 days.

Nipah virus causes flu-like symptoms such as fever, cough, sore throat, body aches, fatigue and difficulty breathing.

Also, in more severe cases, it can cause the brain to swell and the condition to progress into a coma.

The mortality rate is estimated to be around 40% to 75%. There is no specific treatment, only supportive treatment to relieve symptoms.

How the Nipah virus jumped from humans to animals has shaped the search for covid's origins [The Washington Post, 14 Oct 2021]

By Karin Brulliard and Ben Guarino

The virus had lurked for years, lacking only one thing it needed to inflict widespread human death: a perfect opportunity.

U.S. coronavirus cases tracker and map

In late 1998, it got it. The virus arrived in central Malaysia by air, inside furry bats that alighted on the boughs of fruit trees swaying over pig farms. The bats, messy eaters, dropped their half-consumed meals. The swine, undiscerning eaters, gobbled up the leftovers. The virus, ready to move, hopped into the pigs and passed through their coughs to the humans who worked with them.

Why the world should be worried about India’s Nipah virus outbreak [OPB News, 13 Oct 2021]

By Kamala Thiagarajan

In 2018, we reported how the South Indian state of Kerala beat back the deadly Nipah virus.
Local filmmakers and musicians even made a celebratory music video about it. Three years later, the state is faced with yet a new case of Nipah — its third outbreak since 2018 — and it couldn’t have come at a worse time. Kerala, known for its palm-lined beaches on the Arabian Sea, is still reeling after a caseload of 4 million COVID infections since the pandemic began.

The Nipah virus is making news again after tragic reports that a 12-year-old boy died of the disease on Sept. 5, in Kerala's Kozhikode district. He had been admitted to a private hospital after running a high fever and showing symptoms of encephalitis — swelling of the brain.

While figuring out how to prevent and treat the Nipah virus is very much a work in progress, there have been advances.

Nonetheless, Nipah remains a concern, not just in India but for the entire planet. The World Health Organization classifies it as a "virus of concern" for future epidemics because "each year it spills over from its animal reservoir into humans," says Dr. Stephen Luby, professor of infectious disease at Stanford University. And when humans are infected it can be transmitted from person-to-person.

But the virus is not as transmissible as some other viruses. "There are occasional Nipah superspreaders who infect a lot of people," says Luby. "But the average transmission rate is less than one person per infection.

"However, each time a person is infected, the virus is in an environment that selects for human adaptation and transmissibility. The risk is that a new strain that is more efficiently transmitted person-to-person could generate a devastating outbreak. Indeed, since 70% of people who are infected with Nipah virus die, such a strain could represent the worst pandemic humanity has ever faced."

That's why, he says, it's important to "continue to invest in strategies to reduce the risk of spillover and to develop countermeasures across a range of high-risk pathogens."

Still a mysterious virus
Following the boy's death, public health authorities swung into action, contact tracing friends, family and health workers. They identified and isolated 251 people, including 30 close family members. Eleven samples from those in close contact with the boy were sent for testing, and on Aug. 8; they were negative. But how this child contracted Nipah is still unclear.

"It's really difficult to establish the cause of the boy's illness," says Dr. Thekkumkara Surendran Anish, associate professor of community medicine at the Government Medical College in Thiruvananthapuram. "The infected patient was just too sick to tell us anything about what he ate or did. That's why it's all speculation."

In the two strains of Nipah encountered so far — originating in Malaysia in 1999 and later in Bangladesh — pigs and fruit bats are believed to be the intermediary hosts. "One plausible theory is that those who've been infected [in Kerala] ate food or fruit contaminated with bat saliva or excreta," says Anish.

When reports emerged that the boy could have possibly contracted Nipah from eating the rambutan — a tropical fruit with thick red spines resembling lychee that grew around his home — sales of the fruit plunged in Kerala. But the fear that the fruit is the cause of the disease is pure speculation and without evidence, experts say.

By contrast, information about the route of virus' spread has been established in prior outbreaks. In strains of Nipah originating in Malaysia in 1999 and later in Bangladesh, pigs and fruit bats are believed to be the intermediary hosts, says Anish.

"We have a very clear understanding of how Nipah virus moves from fruit bats into people," says Luby. "Bats are attracted to raw date palm sap that is harvested during the wintertime.
When people drink raw date palm sap that has been contaminated by bats, they are at risk of contracting Nipah." The World Health Organization calls the drink a "likely source" of outbreaks in humans in India and Bangladesh.

Survival rates are low
While it is possible to recover, the virus has a high fatality rate.

In 2018, when Nipah emerged for the first time in Kerala, only two of the 19 infected people survived. When it was detected again in 2019, a 23-year-old man was infected, but swift isolation ensured the virus did not spread to others in his community. The patient survived.

"[With] COVID, you are most infectious before the symptoms set in," says Anish. "Once they do, your ability to infect other people wanes. But that's not the case with Nipah. When the symptoms set in, you start spreading the virus." In areas more prone to Nipah infections (Bangladesh, Malaysia, India, and Singapore) being aware of this can help, he says.

After the current case was identified, COVID precautions have helped control the spread of Nipah in Kerala, says Dr. K Puthiyaveettil Aravindan, a former professor of pathology at the Government Kozhikode Medical College. "Hospital workers were already kitted out in full protective equipment. People were masked." Since the virus is spread from human-to-human through bodily fluids, physical distancing and masking helped.

The virus is not, however, as transmissible as some other viruses. "There are occasional Nipah superspreaders who infect a lot of people," says Luby. "But the average transmission rate is less than one person per infection."

Hopes for treatment and a vaccine
With all the concerns about Nipah, efforts to develop a vaccine are ongoing. "There are several promising Nipah virus [vaccine] candidates that have demonstrated high efficacy in animals," says Luby. In addition, CEPI, the Coalition for Epidemic Preparedness Innovations, is supporting human trials of multiple vaccine candidates.

One study on vaccines, a pre-print, focused on the effectiveness of ChAdOx1 — a multipurpose vaccine vector which can be customized to carry DNA from a wide variety of pathogens. In a trial on African green monkeys, it proved effective when tailored against the Nipah virus.

While the vaccine is still in clinical trials, there's also a non-patented drug called M 102.4 developed by Christopher C. Broder, a professor of immunology and microbiology at Uniformed Services University of the Health Sciences. It's a monoclonal antibody that can attach to proteins in a virus and render it ineffective.

"Suppose you get a massive dose of a virus in your body. It's a matter of time before the pathological process begins and it damages your cells," says Anish. "You don't have time to depend on the immune reaction generated by a vaccine at that point. In this narrow window [before you develop symptoms], you can use an agent that can neutralize the virus."

During Kerala's 2018 outbreak, M 102.4 was flown in from Queensland, Australia for use on an emergency basis. At the time, it had not been tested on humans. Since then, initial tests in humans have been successful. In a study published by The Lancet, Phase I clinical trials in humans have shown the drug can neutralize Nipah.

In case of any major outbreak, health authorities in Kerala and elsewhere now can use the antibody to get it under control, says Aravindan.

A virus on the move
It's likely that other Indian states may be affected, too. "Kerala can't be the only hot spot" says Aravindan. "It's possible that the health system in other states may not be catching these infections at all."

He also has concerns about future spread. Genetic changes in the virus are likely, making hosts out of new species of bats and making the virus more transmissible among humans, he says. He adds that Nipah could emerge as a global problem similar to COVID due to international trade, global travel and climate change that causes bats to seek new habitats.

For those reasons, he says, it's imperative "to analyze which species [of bats] could be infected, the places they're located" and whether there might be additional intermediary host animals.

For now, the Nipah virus scare in Kerala seems to be under control. But "as long as there's a lot we don't know, the possibility of an epidemic can't be ruled out," Anish says.

Hendra virus: New type uncovered in flying foxes - Outbreak News Today [Outbreak News Today, 13 Oct 2021]

A paper detailing the findings has been published just days after the new genetic type (HeV-g2) was detected in a horse near Newcastle in New South Wales, the most southern case of Hendra yet recorded.

Hendra virus can be transmitted from flying foxes to horses, and from horses to people.
Previous studies had found the virus in flying foxes in Queensland and parts of New South Wales. After monitoring flying fox samples from 2013-2021, researchers at CSIRO’s Australian Centre for Disease Preparedness (ACDP) found the new genetic type in flying foxes in Victoria, South Australia, and Western Australia.

ACDP is a World Organisation for Animal Health (OIE) reference laboratory for Hendra and Nipah virus diseases. Reference expert and CSIRO scientist Dr Kim Halpin said spillover of the disease from flying foxes to horses has still only been reported in Queensland and New South Wales.

“However, because Hendra Virus Genotype 2 is so genetically similar to the original Hendra virus, there is a potential risk to horses wherever flying foxes are found in Australia,” Dr Halpin said.

“It’s important to note that Hendra has never been reported to spread directly from flying foxes to humans – it’s always been transmitted from infected horses to humans. We expect this new genetic type would behave the same way.

“And given the similarities, while more research is needed, we expect the existing Hendra virus vaccine for horses should work against this new type too.

“This finding really underscores the importance of research into flying foxes – it’s crucial to helping us understand and protect Australians against the viruses they can carry.”

Another project, called “Horses as Sentinels”, led by the University of Sydney and CSIRO and funded by a Biosecurity Innovation Program grant from the Department of Agriculture, Water and the Environment, detected the same genetic type earlier this year in samples collected from a horse from Queensland in 2015. Results of this research are available in preprint.

Dr Steve Dennis, President of Equine Veterinarians Australia, said the findings are a reminder there’s a risk of Hendra virus wherever there are flying foxes and horses.

Oxford jab creator says vaccine development has gone ‘backwards’ [Evening Standard, 12 Oct 2021]

By
Rod Minchin

Professor Dame Sarah Gilbert says her team is struggling to raise money to develop vaccines against already known diseases.

Lessons have not been learnt from the coronavirus pandemic in the need to properly fund the development of vaccines into other infectious diseases, one of the creators of the Oxford AstraZeneca jab has said.

Professor Dame Sarah Gilbert said her team was struggling to raise the money needed to develop vaccines against diseases already known about, yet alone those yet to emerge.

She said the Covid-19 pandemic should have taught us that vaccines must be stockpiled in case diseases mutated and became highly infectious.

We learned in the pandemic that we could do things faster, we could do things better, we want to be applying those lessons, but we still need to get the funding in place to do that
Before starting work on the Oxford-AstraZeneca vaccine in January last year, Dame Sarah said she had been working on vaccines for the Nipah virus, Lassa fever and Mers.

During an event at the Cheltenham Literature Festival with Oxford colleague Dr Catherine Green, Dame Sarah said her work had gone “backwards” since the pandemic.

“We’ve actually gone backwards in terms of the work we’re doing on development of vaccines for the outbreak pathogens before the pandemic,” she said.

“It’s just really slowed right down, trying to get that moving again is really difficult and the funding still isn’t there to move that on.

“We learned in the pandemic that we could do things faster, we could do things better, we want to be applying those lessons, but we still need to get the funding in place to do that.

“We need stockpiles of vaccines against these pathogens we already know about because how’s it going to look if suddenly there’s a big Nipah outbreak that starts to spread around the world?

“We’ve known about that for years and we started making a vaccine five years ago, but we haven’t done it yet, it’s not finished.”

Scientists believe Nipah virus has the potential to cause a pandemic and recently a 12-year-old boy died in India having become infected.

“Something everybody is very much aware of now, is how as SARS-CoV-2 has spread through the world,” Dame Sarah said.

“It’s mutated, it’s evolved and what we’ve ended up with is the Delta variant which is very highly transmissible.

“If we get a Delta variant of Nipah virus then suddenly we’ve got a highly transmissible virus with a 50% fatality rate.”

Dame Sarah said vaccines of known diseases needed to be stockpiled and health workers in areas where there are outbreaks needed to be vaccinated quickly.

“We can make vaccines, we can have stockpiles, we can immunise the health care workers in the regions where the outbreaks are most likely to happen,” she told the festival.

“To protect the healthcare workers themselves and that’s really important because we want them to be able to go and do their job and respond to the start of a new outbreak.

“But if we don’t protect them, they get infected and then it’s often healthcare workers inadvertently spread the outbreak because they go back to their communities or their homes and then they’re infected and they spread it.

“We have to make sure they’re fully protected, and you can do that with really good personal protective equipment, but you do much better if you have a vaccine.”

Nipah virus that kills HALF its victims is ‘next pandemic threat’, warns Covid jab scientist [The Sun, 12 Oct 2021]

By Vanessa Chalmers

THE Nipah virus, which kills at least half of victims, is one of the world’s next pandemic threats, an expert has warned.

Oxford vaccine creator Professor Dame Sarah Gilbert said there is no vaccine against the virus which causes brain swelling.

But should it evolve to spread at a faster rate, as Covid has learned to do, it could be disastrous.

Dame Sarah said: “Something everybody is very much aware of now, is how as SARS-CoV-2 has spread through the world.

“It’s mutated, it’s evolved and what we’ve ended up with is the Delta variant which is very highly transmissible.

“If we get a Delta variant [evolved to be more transmissible] of Nipah virus then suddenly we’ve got a highly transmissible virus with a 50 per cent fatality rate.”

During an event at the Cheltenham Literature Festival, Dame Sarah said her team was struggling to raise the money needed to develop vaccines against diseases already known about, yet alone those yet to emerge.

Before starting work on the Oxford-AstraZeneca vaccine in January last year, Dame Sarah said she had been working on vaccines for the Nipah virus, Lassa fever and Mers.

But her work has gone “backwards” since the pandemic.

Dame Sarah said: “We learned in the pandemic that we could do things faster, we could do things better, we want to be applying those lessons, but we still need to get the funding in place to do that.

“We need stockpiles of vaccines against these pathogens we already know about because how’s it going to look if suddenly there’s a big Nipah outbreak that starts to spread around the world?

“We’ve known about that for years and we started making a vaccine five years ago, but we haven’t done it yet, it’s not finished.”

Nipah is "top of the list" of ten priority diseases that the World Health Organisation (WHO) has identified as potential sources of future epidemics

The health agency said in 2018 “there is an urgent need for accelerated research and development for the Nipah virus”.

Scientists have previously told The Sun Nipah could “absolutely be the cause of a new pandemic”.

The southern Indian state of Kerala had to stop a potential outbreak of the virus in September.

It came after a 12-year-old boy died of the disease, prompting isolation of hundreds of close contacts.

Two healthcare workers who nursed the boy were admitted to hospital.

Initially the virus may cause a fever, headache, and respiratory symptoms, before escalating to brain swelling and a coma.

The outbreak was the fifth in India since 2001, according to the WHO, with others centered in South East Asia.

Outbreaks tend to occur when humans catch Zipah from an animal, making it what's called a zoonotic disease.

Cases have been blamed on contact with sick pigs or by eating fruit that is contaminated with saliva or urine from infected bats.

There is potential that places like Cambodia, Indonesia, Madagascar, the Philippines and Thailand are at risk because there are known areas where bats live.

Bangladesh adds additional Nipah virus case/death to 2020 tally - Outbreak News Today [Outbreak News Today, 9 Oct 2021]

No country has reported more human Nipah virus cases in the past two decades than Bangladesh, which the Institute of Epidemiology, Disease Control and Research (IEDCR) has reported more than 300 since 2001.

During the past month, the IEDCR added another case/death on the 2020 tally, bringing the total cases to seven and deaths to five.

There was no explanation or additional details where this case came from or the circumstances involved.

This website reported 6 cases/4 deaths on January 30, 2020. When we reported the totals to date in 2021 on September 10, (2 cases/0 deaths), the 2020 totals were the same.

Nipah infection: no official word on proposed bat surveillance in Kerala [The Hindu, 5 Oct 2021]

Animal Husbandry Department yet to get any official directive
The Animal Husbandry Department is yet to get any official directive on the proposed surveillance of bats on river banks from Kasaragod to Ernakulam against the backdrop of recurring cases of Nipah infection in the state.

The infection was reported in Kerala thrice in two years since 2018. Kozhikode reported the first outbreak and a single case and a death occurred here in September this year too. Some of the victims in 2018 were from Malappuram district. In 2019, another single case was reported in Ernakulam district. Incidentally, it has been a month since Mohammed Hashim, the 12-year-old native of Pazhoor near Chathamangalam in the district, succumbed to the infection.

K.K. Baby, District Coordinator, Animal Disease Control Project Office, Kozhikode, said here on Tuesday that the periodic surveillance was supposed to be a joint exercise by the Veterinary, Forest, and Health departments. It was to determine the presence of the Nipah virus. The State Institute of Animal Diseases too was planned to be roped in. The proposal was moved by Health Minister Veena George. “There is no official word on the bat surveillance,” he added. The Health Department too does not seem to have any idea about it.

Nipah virus antibodies (IgG antibodies) were detected in bat samples collected by the National Institute of Virology, Pune, from Kodiyathoor and Thamarassery recently. A sample belonging to the Pteropus species, collected from Thamarassery, was found to have the antibodies, while similar ones were detected in another sample from the Rousettus species collected from Kodiyathoor. The results of over 50 bat samples collected as part of the outbreak investigation are still awaited. There is lack of clarity on further epidemiological studies. Also, how the virus got transmitted to humans is yet to be conclusively proven. Public health experts have been demanding a permanent surveillance system to detect similar zoonotic infections.

Nipah outbreak in the neighbourhood: Activate alert mode in Nepal [The Himalayan Times, 4 Oct 2021]

By DR PUSHPA R JOSHI

An analysis of the recently experienced pandemics and endemics shows that the evolution of human civilisation and thereby encroachment of the wild habitats by humans for settlements and agricultural practices, climate change and excessive deforestation have resulted in the spilling over of the new viruses from wild animals to domestic animals and humans
Nepal has not yet completely resuscitated from the ongoing COV- ID-19 pandemonium, and the menace of another potential endemic is hovering over the country. Recently, an outbreak of Nipah virus (NiV) infection was reported in neighbouring India, 23 years after the first ever cases of it were identified on pig farms in Malaysia in 1998. The first casualty of the recent outbreak was a 12-year-old boy from Kozhikode district in Kerala on September 5. Since then, NiV infection has claimed at least 20 lives and is rapidly spreading in the southern state of India.

Taking a leaf out of the recent experiences with COVID-19, the Ministry of Health and Population (MoHP) has issued a press statement stating that the risk of the virus's propagation in Nepal through the open borders could not be ruled out. Therefore, the concerned authority needs to remain on high alert to cope with the unprecedented adversity of NiV.

NiV infection is a zoonotic illness that is transmitted to humans from animals as well as through contaminated food or directly from person-to-person. The natural reservoir of the virus is the fruit bat. The World Health Organisation (WHO) has classified NiV as a virus of concern for future epidemics as the virus seems to be frequently spilling over from its animal reservoir into humans.

NiV infection presents itself with non-specific symptoms ranging from mild to severe course of illness. The common symptoms are fever and headache along with signs of respiratory illness – cough, sneezing, sore throat, breathlessness and a tight chest. The symptoms typically appear in 4-14 days after exposure to the virus.

In severe cases, a stage of brain encephalitis may follow; the symptoms include drowsiness, disorientation and mental confusion. This severe condition can rapidly progress to a coma within 24-48 hours. A convenient way of diagnosis of the disease is not available; the confirmatory diagnosis relies entirely on sophisticated molecular techniques.

Prophylaxis through drugs or vaccines against the virus has not been approved so far. Therefore, appropriate precautions are the only currently available prevention options.

In light of reoccurrence of NiV infection, amidst the ongoing COVID-19 mayhem, it has raised disquiet of scientists. In fact, over the last century, researchers have been subtly acknowledging the increasing outbreaks of infectious diseases at regular intervals.

Ebola, H1N1-influenza (swine flu), severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), avian influenza and COVID-19 are the recent infectious diseases that our generation has already experienced, either as endemic or as a pandemic, in the first quarter of the 21st century.

A study on global trends in emerging infectious diseases published in Nature in 2008 reveals that almost two-thirds of all infectious diseases are zoonotic in nature, and more than 70 per cent of known infectious diseases have originated in wildlife.

There is an understanding that the reconnaissance of increasing frequency of these outbreaks in recent times is due to advancement in scientific approaches as well as improved surveillance and technological prowess in identifying new viruses.

However, a careful analysis of the recently experienced pandemics and endemics shows that the evolution of human civilisation and thereby encroachment of the wild habitats by humans for settlements and agricultural practices, climate change and excessive deforestation have resulted in the spilling over of the new viruses from wild animals to domestic animals and humans.

In addition, intensive animal husbandry in the form of poultry, pig farming and cattle rearing has severely increased this risk. The so-called wet markets where animals are slaughtered in unhygienic conditions are also breeding beds for transmission of zoonotic diseases.

Another factor that has contributed in the rapid transmission of infectious diseases is the ruthless increase of the human population over the years. The dense clustering of humans, especially in urban areas, is encouraging the outbreaks to spread like a wildfire. Large scale people's movement and increased frequency of livestock and goods transport in modern times have also contributed in the rapid transmission of contagious viruses across continents.

Coming back to NiV infection, the disease is said to have been transmitted to humans from bats that are omnipresent in all continents.

However, bats typically prefer warmer temperatures, and hence, countries like Nepal and other south Asian countries are territorial habitats of bats. Although NiV infection is not yet reported in Nepal, the risk of a possible outbreak anytime soon cannot be ruled out. Therefore, ecologists, scientists, health care professionals and sociologists should be well prepared to tackle the possible adversities of NiV infection.

It is high time an alert mode was activated immediately in Nepal.

The recent experiences in COVID management should be taken as a launching pad for the productive management of a possible NiV outbreak and unprecedented outbreaks of other infectious diseases in the future.

The first and the foremost requirement is a wellequipped centralised diagnostic facility for novel bacterial and viral infection within the country. In addition, the government should be prepared to clog the porous borders as soon as the threat of the spread of the infectious diseases prevails in the neighbourhood.

Simultaneously, a long-term rapid action task force comprising public health experts should be constituted, and the concerned authorities should act according to their suggestions.

This is not yet too late for Nepal; however, time is running out swiftly.

One month after losing only son to Nipah, Hashim's parents return home [Mathrubhumi English, 2 Oct 2021]

By Gopika Girish

On October 5, it turns one month since 12-year-old Hashim Mohammad succumbed to Nipah virus.

Pazhur: “We thought it was an ordinary fever and sore throat. Even the doctors assured the same. We believed he would come back home,” Aboobacker could not hold his tears. On October 5, it turns one month since 12-year-old Hashim Mohammad succumbed to Nipah virus. Two days back, Hashim’s parents Aboobacker and Vaheedha completed 21 days of quarantine and returned to their house in Pazhur, where their one and only child Hashim had lived. Now their house remains empty and silent without his noises or mischieves.

Vaheedha recollected that Hashim started showing symptoms of fever and sore throat on August 27. She gave him paracetamol and went to bed. His temperature kept rising. On 29th, she took him to a private clinic in Eranhimavu and gave him antibiotic medicines as suggested by doctors.

But along with rising temperature, he started vomiting badly by August 30. On 31st morning, they took the boy to EMS hospital and conducted an antigen test. The test showed negative results but they took him to Santhi hospital for RT-PCR test. However, the RT-PCR test result also was negative. But his oxygen level kept dipping and they shifted him to Kozhikode Medical college in an ambulance.

Vaheedha said he was conscious throughout the period even though his body was growing weaker every second. He was admitted to ward 30 on account of fever. Vaheedha’s heart still aches when she remembers the irresponsible attitude of the duty doctors in MCH.

“Hashim started showing signs of epilepsy. The house surgency doctors did not give enough care even after he started foaming at mouth. The next day, they only conducted CT scan and X-ray. But by then, his condition was deteriorating. His muscles became stiff, he started biting his tongue and clenching his teeth.

The doctors from MCH asked to shift him to a private hospital as there were not enough ventilators for children. On September 1, they shifted him to the ventilator of MIMS hospital. Before his case worsened, he requested me to return home. I took him to the urinal. But I could not feed him any food. I felt like holding him again but fate stopped me,” Vaheedha opened up.

Musthafa, Hashim’s uncle, said that the tests for Nipah were conducted 2-3 days after admitting him in the hospital. The doctors didn't even take a wild guess of Nipah virus infection.

All of his relatives unanimously agreed that they are clueless about how he was infected with the virus because Hashim was a very calm and quiet child. He never liked climbing a tree or eating anything found lying on the ground, they said.

The goat and the rambutan

The goat in his house showed some weird symptoms after skipping food and water for a few days. The samples of the goat were collected by the health experts, but there was nothing serious in the tests.

Also, he had eaten a rambutan brought from his relative’s house before he was affected with fever. But his mother said that the rambutan was eaten by everyone in their house and close relatives in the neighbourhood. But no one had any diseases or even a headache. The bats......

His father said that Hashim had helped him to collect betel nuts from their surroundings a few days back. There are many palm and guava trees where bats are usually found. The Kodiyathur panchayat, from where the antibodies of Nipah were found from 100 bats, is next to Pazhur panchayat.

The fear-stricken Pazhur

The locals said that after September 5, Pazhur panchayat was totally closed for weeks. The people were living in fear without moving out of their their house. There were 188 people in the contact list of Hashim and 20 in the close contacts list.

Since everyone tested negative, the panchayat gradually resumed to its normal state. To their bad, now the bats have been found with antibodies of Nipah. The people of Pazhur are undergoing a trauma currently. They request the government for clearing out the bats without harming any humans.

The financial help from government The Chief Minister has announced financial assistance to Hashim's family. The boy's father had applied for Rs 2,42, 603 as hospital expenses. His father, Aboobacker, is a manual labourer. Abdurahiman, a former ECG technician at Kozhikode Medical College, also demanded that the mother, who had studied up to class 10, be given a job to support her family, who were devastated by the death of their only son.

Antibodies against Nipah found in bat samples from north Kerala, says Veena George [Hindustan Times, 30 Sep 2021]

Results of samples collected from bats after the death of a 12-year-old boy in north Kerala on September 6 have confirmed the presence of antibodies against the Nipah virus, state health minister Veena George said in Thiruvananthapuram on Wednesday.

The minister said after the death of the boy a team from the National Institute of Virology (NIV) had taken samples of many species of bats from the area and the samples indicated the presence of antibodies against the virus in two varieties. She said the latest results have given credence to the theory that bats are the main carriers of the Nipah virus.

The health department was on high alert after the third outbreak of Nipah, the first being in 2018 in Kozhikode and the second in Ernakulam in 2019. It cordoned off the entire area and samples were collected from all houses. Around 800 samples were checked in two days and all turned positive. Like earlier outbreaks, it was localised and contained effectively.

“The NIV has conveyed to us about the presence of IgG antibody in some. We are expecting more results in the coming days,” the minister said. She said different studies conducted by NIV, the Indian Council of Medical Research and National Institute of High Security Animal Diseases will continue. She said though the 21-day incubation period was over the department will observe a double incubation period of 42 days to declare the area Nipah free.

After the death of the boy, his parents said he had eaten rambutan fruit before taking ill and authorities have asked people not to eat fruits picked from the ground. But samples of half-eaten fruits did not show any signs of contamination during initial tests. Later authorities warned people not to disturb bat habitat in panic.

Reeling under the high number of Covid-19 cases, the state contributed more than 60 per cent of the country’s total cases for about four months. Amid Covid-19, the Nipah outbreak had really jolted the state. Experts said the strict protocol in place due to Covid-19, like masking, physical distancing and no overcrowding, helped the state to blunt the impact of the zoonotic disease.

Kozhikode reported the Nipah infection for the second time in three years-- in 2018 it claimed 17 lives in the district. Two persons also survived the infection. And in 2019 a youth tested positive for the zoonotic disease in Ernakulam but he was also nursed back to life after long hospitalization.

After the first outbreak in 2018, many promises like setting up of a high-end animal testing lab, virology institute, a scientific study on bats (chiropterology) and a treatment protocol for separate zoonotic diseases were made. Experts say most of these remained only promises.
“Since zoonotic diseases recur frequently in the state it needed an integrated approach and team of experts from all fields to study it,” said Dr N M Arun, an internal medicine expert.

Experts like him want a proactive strategy to face the increasing threat of recurring zoonotic diseases and not wait for the outbreak to act. The state needs to strengthen its surveillance system backed by enough scientific studies, they say.

It is a fact that zoonotic diseases have recurred at regular intervals in the state in the last three years. Many cases of Kyasnur forest disease (monkey fever), avian influenza, swine flu and anthrax were reported. Thousands of ducks were culled in Alappuzha two years ago to check the spread of avian influenza.

“We need a permanent mechanism for early detection of such diseases and early warning to the people. More research is also needed in the area,” said Dr Prejit Nambiar, a teacher at the Kerala Veterinary and Animal Sciences University, who specialises in zoonosis and food safety.
He said a close interaction is necessary between medical experts, veterinary professionals, environmental scientists and wildlife professionals to tackle zoonotic diseases.

Nipah virus in Kerala, India: WHO details - Outbreak News Today [Outbreak News Today, 26 Sep 2021]

In a follow-up on the Nipah virus case and death in Kerala state, India earlier this month, the World Health Organization published a Disease Outbreak News Friday that provides some additional information:

On 4 September 2021, the Kerala State Health department reported an isolated case of Nipah virus disease in Kozhikode district, Kerala state, India. Nipah has a relatively high case fatality ratio, and is an emerging zoonotic disease of public health importance in the South East Asia and Western Pacific WHO Regions.

This is the fifth outbreak of the disease in India (Siliguri town in 2001, followed by a second outbreak in Nadia district in 2007, both in West Bengal state. In 2018, an outbreak was reported in Kozhikode district, and in 2019, another outbreak in Kochi district, both in Kerala state).

On 29 August, a 12 year-old boy developed low grade fever, and the family sought care at a local health care facility. On 31 August, he was transferred to several hospitals as his condition deteriorated. On 1 September, the patient’s condition continued to deteriorate, and the family requested his transfer to another hospital in Kozhikode.

Bangladesh reports two Nipah virus cases in 2021

On 3 September, plasma, serum and cerebrospinal fluid samples were sent to the National Institute of Virology in Pune, India. On 4 September, the presence of Nipah virus in the plasma, cerebrospinal fluid and serum samples was confirmed by real-time polymerase chain reaction (RT-PCR) and IgM antibodies was confirmed in the plasma sample by ELISA serology test. On 5 September, the patient died and a safe burial and cremation were performed the same day in Kozhikode.

As of 6 September, epidemiological investigations identified contacts, including health care workers and close family members, who were placed under quarantine.

The current isolated case was reported in a rural area in Kerala state where an outbreak was previously reported in 2018. India has experienced and contained Nipah virus disease outbreaks in the past and has demonstrated the capacity to carry out outbreak control activities, including case identification, laboratory testing, case management, contact tracing and risk communication. This event is an isolated case and the risk is low at national level and low at the regional level.

Inside Kerala’s Pazhur Village – Where Nipah Broke Out And Was Contained [Outlook India, 19 Sep 2021]

A discipline earned while tackling Covid-19 may have saved Kerala from a wide outbreak of Nipah. Despite thin resources, the state health machinery kicked in to put checks in place. The outbreak, most probably spiraled out of bat-bitten Rambutan fruits.

Little did Vichutti from Pazhur village of Kerala's Kozhikode district know that the rambutan fruits he picked from his tiny patch of land alongside the River Iruvazhinji would put the entire country in a panic mode.

A tree-climber by occupation, Vichutti, whose official name is Vayoli Abubakkar, was happy to see rambutan, which is otherwise a rare fruit in this area, giving yield for the first time on his tree this year. After that, he went to the riverside quite frequently, picked the fruits and gave them to his 12-year-old son Muhammad Hashim.

On the morning of Sunday, September 5, Vichutti’s village woke up to the news that Hashim died due to Nipah infection, the first such case in Kerala after the state reported and controlled the virus outbreak from the same district in May 2018 that had claimed 17 lives.

The village has now been put under a complete lockdown with police deployment on all entry points. The villagers and the health department suspect bat-bitten rambutan fruits as the primary source of the virus outbreak. Outlook visited the riverside the day Hashim died – a 20-minute walk from his residence.

A kaccha road alongside an areca nut field takes you to the riverside where the rambutan tree stands. By evening, the ground beneath the tree is strewn with bird-bitten fruits.

“You can find a lot of bats here,” said Amjad, a neighbour, adding, “I had seen the boy’s father coming here a couple of times recently.”

On September 14, the Kerala government eased restrictions in Pazhur’s neighbouring villages as no new cases were reported even after the incubation period of 14 days and the samples of the close contacts of the deceased child tested negative.

Restrictions in Pazhur, which is Ward-9 in Chathamangalam panchayat, however, still continues.

“Ward 9 in the Chathamangalam panchayat will continue to be a containment zone. The decision was taken as per the direction of the medical board and the expert committee," state health minister Veena George said in a release.

Pazhur has 625 families. The village also had 49 ‘guest workers’ (an official terminology to describe migrant workers) but all of them left for their native places since the Covid-19 outbreak, EP Valsala, the elected member representing Ward-9, told Outlook.

Did Covid-19 experience help tackle Nipah?
Valsala says things didn’t go out of control here while dealing with the Nipah outbreak thanks to people’s experience of Covid-19.

“People were already wearing masks and following other Covid-19 protocols, which might have helped prevent spread of Nipah as well,” she said.

A similar line was echoed by Chathamangalam panchayat president Olikkal Gafoor and Junior Health Inspector (JHI) Abdu Rasheed, whose jurisdiction covers Pazhur basic section area, which includes Ward-9 and four other neighboring wards.

Rasheed also recalled how the situation caused panic in the pre-Covid times back in 2018 when Nipah outbreak was reported in Perambra in the same district. The Kozhikode Medical College, which is always a busy place, had worn a deserted look. People, scared of infection, had avoided every public place. There was 19 confirmed infections and 17 deaths with a fatality rate of 89.4 per cent. Two earlier Nipah outbreaks were reported in India in 2007 and 2001-- both cases in West Bengal.

Speaking to Outlook, Health Minister of Kerala, Veena George acknowledged Covid-19 protocol as a factor that possibly helped in preventing spread of Nipah virus infection. However she also added that dealing with two consecutive pandemics at a time had already exhausted the health system of the state. Kerala was already reporting one of the highest spikes in Covid-19 cases in the country.

The minister said she received confirmation about the Nipah virus infection from the National Institute of Virology (NIV) in Pune, which had tested the boy’s sample, at around 10 pm on September 4. She immediately informed the matter to the Chief Minister, Pinarayi Vijayan.
Within half an hour, an online meet was conducted with the health secretary, Kozhikode district collector, district medical officer and all other key officials. Three cabinet ministers from Kozhikode district were also present.

“The boy’s condition was very critical at that time,” the minister said.

“Sixteen committees were formed in the meeting, an action plan was created that included contact tracing, field surveillance, psycho-social support and so on,” she said.

The minister left for Kozhikode from the state capital Thiruvananthapuram the same night at 12 am.

“We were cautious not to create panic among the people but at the same time we wanted to get done with the initial contact tracing by early morning the next day,” she said. The boy was taken to one private doctor’s clinic and four hospitals including the government medical college in Kozhikode before he finally succumbed to the virus.

“It would have been a painful exercise to bother the boy’s parents at their moment of grief to extract information about each and every contact person. Considering that, we issued an institutional route map and traced all persons including the health workers and the drivers who had come in contact with the boy,” the minister said, adding, “The night of September 4 was crucial. We took all important decisions on that night itself.”

On the morning of September 5, a control room was opened in Kozhikode. The government declared areas within 3 kms radius of the boy’s house as containment zone. Also, Covid-19 vaccination was suspended in the district for 48 hours. The health department converted the Covid-19 pay ward in the Kozhikode medical college to a Nipah ward and an ICU was also kept ready anticipating any more cases. Treatment facility and medicine availability were ensured. Additional staffs were deployed and the health department also gave special training to health workers from doctors – of both government and private sectors – to ASHA workers in the district.

“More importantly, a Nipah lab was set up in Kozhikode medical college by special teams from Pune and Alappuzha,” Veena George said.

“There would be more symptomatic people as Covid pandemic was also prevailing. Any delay in testing samples could have caused more stress. Immediately setting up a lab was very crucial, she said. Also, mobile labs were set up for Covid testing in Nipah containment zone which enabled swab collection at home. "

“We ensured that we were fully prepared and equipped to identify new cases, prevent any further spread and to deal with new patients if any,” the minister said.

“Along with contact tracing, it was equally important to identify the source of infection as well,” Veena Geroge said. "The health department conducted field surveillance and house-to-house survey in the affected area. We called panchayat presidents and all-party leaders and formed volunteer groups for the survey. It was primarily intended to find unreported fever, unusual deaths and animal diseases in the past one month," she said. A central team was called for bat surveillance. They identified bat habitat across the river in the neighbouring Kodiyathur panchayat.

“Bats spread more virus when they are stressed. Hence, it was important not to scare bats,” said Veena George.

Besides rambutan, areca nuts are also suspected to have caused infection. The area has a large number of areca nut trees. The boy’s father is a coconut collector and climbs the coconut trees.

There are high chances of the boy getting infected by bat-bitten areca nuts. A goat in the boy’s house was rumoured to have died. However, it was later found that the animal was alive but had fallen ill a month ago. This goat’s samples are also sent for testing. “We are expecting those test results soon,” Veena George said.

As the state’s health machinery started rolling out on the night of September 4 itself, it took no time to reach action on the ground zero.

JHI Rasheed said he located the boy’s house with the help of local RRT member Anees MK on the same night at around 10:30 immediately after he got an alert from his department. Panchayat President Gafoor said the police and health officials blocked the entry points to the village the same night itself.

A microphone announcement was arranged for people’s awareness the next morning. Notices were distributed at houses for precaution.

The survey was conducted in 12,500 houses in Chathamangalam panchayat alone. The panchayat president said free food kits were distributed in ward-9 for the families of daily wagers who were hit by the sudden lockdown. A 11-member RRT team was formed to distribute basic items to households so that families could stay indoors.

According to JHI Rasheed, the boy started suffering from fever and headache on the night of August 27. His parents gave him paracetamol tablets on 27th and 28th. On 29th morning, when he was not improving, the parents took him to a private doctor’s clinic in the neighboring area.

The doctor prescribed Azithromycin 250 mg for three days. However, he started developing throat pain, woke up at 2 am on 30th and vomited twice. The ASHA worker of the area contacted the parents and suggested to go for a Covid-19 test.

The parents observed the boy on 30th. On Tuesday, August 31, they took him by an auto rickshaw to the nearby EMS hospital in Mukkam and conducted antigen test. In the same auto, they took him to another private hospital in the neighbouring Omassery to conduct RTPCR test.

From there, the same day, he was taken to the government medical college in Kozhikode by an ambulance. By the time, he had developed high-grade fever and fits. The boy’s mother later told local media that the boy was moved to yet another private hospital after the medical college asked the family to shift him from there citing non-availability of ICU. Hashim’s mother was reportedly feverish on the day the boy died, which had sent alarm bells.

However, the next day she said she was alright.

Asked if Pazhur was a success story or would it be too early to say so, health minister Veena George said “Things are under control after the 21 days’ incubation period. However, we should wait for another 21 days to be sure.”

The minister said the state has to be fully prepared to control Nipah outbreak in future. A BSL Level 3 lab in Kozhikode medical college will be set up soon, she said.

Experts Say Nipah Virus Has Potential To Be Another Pandemic — With A Higher Death Toll [Scary Mommy, 15 Sep 2021]

Earlier this month, a twelve-year-old boy in Kerala’s Kozhikode district in India died from the Nipah virus, a virus that most people probably never heard of. A virus that, according to experts, has the potential to become another global pandemic with a significantly higher death toll.

Approximately 70 percent of people who are infected with the Nipah virus die, says Dr. Stephen Luby, a professor of infectious disease at Stanford University. When the virus first appeared in Malaysia in 1999, it killed more than 100 of the approximately 300 people that had been infected. When it emerged in Kerala in 2018, only two of the nineteen people who’d contracted Nipah survived.

Often even survivors are left to suffer. Many are left with long-term consequences, including “persistent convulsions and personality changes,” according to the CDC.

For those reasons and others, the World Health Organization declared Nipah a “virus of concern” and experts are urging more research and attention.

Nipah Virus Is A Zoonotic Virus
Similar to coronavirus, Nipah is a zoonotic virus, which means it can spread between animals and people. Generally, transmission happens when a person consumes contaminated food or comes into direct contact with an infected animal. Fruit bats “are the natural carriers of Nipah.” Once Nipah spreads from an animal to a person, that person can go on to infect other humans.

Though it’s still uncertain, experts believe contaminated food caused this current outbreak.
“One plausible theory is that those who’ve been infected [in Kerala] ate food or fruit contaminated with bat saliva or excreta,” Dr. Thekkumkara Surendran Anish, associate professor of community medicine at the Government Medical College in Thiruvananthapuram told NPR.

Nipah Is Not Easily Transmissible…Yet

The good news—if there can ever be good news when discussing a deadly virus—is that Nipah virus is not very transmissible.

“There are occasional Nipah superspreaders who infect a lot of people,” says Luby. “But the average transmission rate is less than one person per infection.”

Considering we’re currently fighting a highly contagious respiratory virus with a highly infection variant, that’s news we want.

However, that good news might (only might) be temporary. Luby notes that, “[E]ach time a person is infected, the virus is in an environment that selects for human adaptation and transmissibility. The risk is that a new strain that is more efficiently transmitted person to person could generate a devastating outbreak.”

As we’ve learned too well—viruses mutate. And when they mutate, they could spell even more trouble.

Availability Of Vaccines Or Treatments
Unfortunately, we don’t yet have a cure or vaccine for Nipah virus, though there is hope on the horizon. (Once again, let’s take a moment to thanks scientists and doctors who work tirelessly to protect us from current and potential pandemics!)

Alongside a potential vaccine candidate, researchers are looking to a drug called M 102.4. One study found that in Phase I clinical trials, the drug was able to neutralize Nipah.

Neutralizing the virus before it can cause damage is important, considering how troubling Nipah virus symptoms can become. Initial symptoms include fever and headache, which can last for three days or up to two weeks. After that, an infected person can expect sore throat, cough, and respiratory issues. Soon thereafter (too soon), the symptoms turn severe. Nipah can cause swelling in the brain cells, which leads to drowsiness, confusion, and potentially coma and death.

The CDC notes that remdesivir (also used against COVID-19) has shown some effectiveness in nonhuman primates when given prophylactically after exposure.
If Nipah Goes Global…

The Nipah virus is seemingly currently under control in Kerala, but experts warn we can’t let down our guard. “[A]s long as there’s a lot we don’t know, the possibility of an epidemic can’t be ruled out,” Anish says.

Prevention is key. Along with “standard infection control measures,” the CDC encourages anyone who lives in an area where Nipah outbreaks have occurred to practice good hand hygiene, avoid sick bats and avoid anywhere where bats roost, avoid consuming raw date palm syrup, avoid consuming fruits potentially contaminated by bats, and avoid contact with blood or fluids of any person infected with Nipah.

Likewise, the WHO urges anyone consuming fruit or fruit products (like raw date palm juice) to wash thoroughly and peel the fruit before consuming it in order to decrease the risk of international transmission. Also, discard any fruit with signs of bat bites.

Right now, Nipah has been identified in Malaysia (during the 1999 outbreak) and Bangladesh and India. As our world shrinks due to international travel and trade, and as climate change forces bats into new habitats, that could change.

“We observe [fruit bats] here [in Cambodia] and in Thailand, in markets, worship areas, schools and tourist locations like Angkor Wat – there’s a big roost of bats there,” Veasna Duong, head of virology at the Institut Pasteur research lab in Phnom Penh, Cambodia told the BBC’s Future program. “In a normal year, Angkor Wat hosts 2.6 million visitors. That’s 2.6 million opportunities for Nipah virus to jump from bats to humans annually in just one location.”

From there, it’s not hard to imagine one of those 2.6 million opportunities hopping on an international flight and leading to another global pandemic. One that’s a lot deadlier and a lot harder to treat.

Bangladesh reports two Nipah virus cases in 2021 [Outbreak News Today, 10 Sep 2021]

With all the news surrounding the death of a Kerala state, India child from Nipah virus earlier this week, the Bangladesh Institute of Epidemiology, Disease Control and Research (IEDCR) just updated their Nipah case count for 2021.

According to their data, two Nipah virus cases have been reported in Bangladesh this year, down from six in 2020.

No deaths were recorded and no details were released about the patients, the dates or their location.

This brings Bangladesh’s Nipah totals since 2001 to 321 cases and 225 deaths, accounting for a 70 percent fatality rate.

Nipah virus is one of the pathogens in the World Health Organization R&D Blueprint list of epidemic threats needing urgent R&D action. Nipah virus was first identified during an outbreak of disease that took place in Malaysia in 1998. Both animal-to-human and human-to-human transmission have been documented. Well more than 600 cases of Nipah virus human infections have been reported since the Malaysia outbreak. Subsequent outbreaks in India and Bangladesh have occurred with high case fatality.

Authorities race to contain deadly Nipah virus outbreak in India [CBS News, 7 Sep 2021]

BY ARSHAD R. ZARGAR

New Delhi — Authorities in India's southern Kerala state are racing to contain an outbreak of the Nipah virus. The virus, which is not related to the coronavirus behind the current global pandemic and is far more deadly, killed a 12-year-old boy in Kerala over the weekend, prompting stepped-up efforts to trace his contacts. New infections have been confirmed.

The boy was admitted to a hospital a week ago with high fever. As his condition worsened and doctors suspected inflammation of his brain (encephalitis), his blood samples were sent to the National Institute of Virology, where tests confirmed a Nipah infection. He died early on Sunday.

Government authorities have stepped up contact tracing efforts, identifying, quarantining and testing people who may have come into contact with the young victim. According to the state's health minister, Veena George, 188 people who came into contact with the boy had been identified by Monday. Of them, 20 were considered high-risk primary contacts — primarily his family members, all of whom were being held under strict quarantine or hospitalized.

Two healthcare workers who came into contact with the victim were already showing symptoms of Nipah infection by Monday. They were admitted to a hospital and their blood samples sent for testing.

Climate change's role in the COVID pandemic
Authorities sealed off the area within about a two-mile radius of the boy's home, and they were screening people for symptoms in all adjoining districts of Kerala state. The neighboring state of Tamil Nadu was also on high alert for any suspect cases of fever.

This is the second time in three years that a Nipah virus outbreak has been reported in Kerala, which is also reeling under a high rate of COVID-19 infections. The state reports about 68% of India's approximately 40,000 new cases every day.

What is Nipah virus?
Like the coronavirus, Nipah is a zoonotic virus, or one that is transmitted from animals to humans. Transmission generally occurs when humans either come into direct contact with the animals, or through consumption of contaminated food. But a high number of human-to-human transmission cases of Nipah have also been reported.

Fruit bats of the family Pteropodidae — commonly known as the "flying fox" — are the natural carriers of Nipah. They are known to transmit the virus to other animals including pigs, dogs, cats, goats, horses and sheep.

An infected human typically shows symptoms including fever and headache for anywhere between three days and two weeks, followed by a cough, sore throat and respiratory issues.

The condition later progresses swiftly to swelling in the brain cells, leading to drowsiness, confusion, and then possible coma and death.

There is no cure or vaccine for Nipah yet, and patients are only given supportive medical care.
According to the World Health Organization, up to 75% of Nipah infections prove fatal. The mortality rate for the coronavirus, by comparison, is believed to be about 2%. About 20% of survivors experience neurological symptoms that can persist, including seizures and personality changes.

A wider threat?
The Nipah virus was first discovered in Malaysia in 1999 during an outbreak among pig farmers. Since then, there have been multiple outbreaks — all of them in South and Southeast Asia. In all, it is known to have killed more than 260 people.

A 2004 Bangladesh outbreak was traced back to humans consuming date palm sap that had been contaminated by infected fruit bats. The last outbreak in India, which hit Kerala in 2018, killed 17 of the 18 people who caught it. Those infections were all traced back to fruit bats found dead in the water of a family's well.

Nipah is considered less contagious than the coronavirus, but its much higher mortality rate, a longer incubation period of up to 45 days, and its ability to infect a much wider variety of animals all make Nipah a cause of significant concern for epidemiologists trying to predict and prevent the next pandemic.

Veasna Duong, head of virology at the Institut Pasteur research lab in Phnom Penh, Cambodia, has studied human-bat interactions in the region, and he told the BBC earlier this year that the close proximity that people and bats find themselves in at markets and other crowded places across Asia poses a serious risk.

"This kind of exposure might allow the virus to mutate, which might cause a pandemic," Duong told the BBC's Future program, adding that in some circumstances, the virus could even find a host to carry it out of Asia.

"We observe [fruit bats] here and in Thailand, in markets, worship areas, schools and tourist locations like Angkor Wat – there's a big roost of bats there," he told the BBC's Future program. "In a normal year, Angkor Wat hosts 2.6 million visitors. That's 2.6 million opportunities for Nipah virus to jump from bats to humans annually in just one location."

Scientists warn that as the climate warms and humans destroy more natural habitat of species like the fruit bats in Asia, opportunities for new zoonotic variants to emerge increase.

The WHO says in its note on the Nipah virus that, "the risk of international transmission via fruits or fruit products (such as raw date palm juice) contaminated with urine or saliva from infected fruit bats can be prevented by washing them thoroughly and peeling them before consumption. Fruit with signs of bat bites should be discarded."

Norway and Malaysia team up to further research the Nipah virus [ScandAsia.com, 4 Aug 2021]

by Mette Larsen

Norway’s Coalition for Epidemic Preparedness Innovations (CEPI), has teamed up with Malaysia’s Universiti Malaya (UM), Malaysia, to further research and gain a wider scientific understanding of the Nipah virus, media Biospectrum Asia writes.

The Nipah virus (NiV) is zoonotic, meaning that it can spread between animals and people. Fruit bats also called flying foxes, are the animal reservoir for NiV in nature and Biospectrum Asia writes that the Nipah virus is one of the deadliest pathogens known to infect humans.

To explore the Nipah virus more and to characterize and better understand immune responses generated against the virus, UM will work to collect biological material from Nipah survivors. To carry out the research, UM will collaborate with physicians and healthcare workers who responded to the first-ever documented Nipah virus outbreak in Malaysia in 1998/1999.

Under the new partnership, CEPI will be providing funding of $188.000 towards UM’s work and because Nipah outbreaks often are sporadic with few survivors, the work is set to provide critical new information on Nipah immunology that has not previously been studied.

Zoonotic Bird Flu News since 8 Sep till 28 Oct 2021

China reports 3 more human cases of H5N6 bird flu [BNO News, 28 Oct 2021]

Three more people in mainland China have tested positive for H5N6 bird flu, officials say.

Experts have called for increased surveillance amid a rising number of human cases during the past few months.

The Guangdong Provincial Health Commission said in a statement on Thursday that a 52-year-old man from Dongguan City had tested positive for H5N6 bird flu. “The patient is currently being treated at a designated hospital in Dongguan,” the commission said.

Other details about the man’s condition were not immediately released, and the statement from the health commission did not say how the man was infected. It said the risk of human-to-human transmission is believed to be low.

Another case was reported in Yongzhou in Hunan Province, where a farmer has been hospitalized in critical condition. The 66-year-old man fell ill in late September and samples collected from poultry in his backyard were found to be positive for bird flu (H5), according to the World Health Organization (WHO).

Another case, involving a 58-year-old woman from Hunan Province, was disclosed by Chinese officials at a WHO meeting in September, according to a new report from the agency. The woman fell ill on August 28 but the case had not been reported to the public. Details about her condition have not been released.

Chinese officials are providing only limited information about human cases of H5N6 bird flu and it often takes weeks before cases are publicly reported by WHO. Most cases are first reported by the Hong Kong Health Department, which is closely monitoring human cases.

Only 52 people have been infected with H5N6 bird flu since the first confirmed case in 2014, but 20 of them were reported during the past 4 months, and more than half of all cases were reported this year alone. Click here for a list of all human cases to date.

H5N6 bird flu is known to cause severe illness in humans of all ages and has killed nearly half of those infected, according to WHO. There are no confirmed cases of human-to-human transmission but a 61-year-old woman who tested positive in July denied having contact with live poultry.

A study which was published by China’s Center for Disease Control in September identified several mutations in two recent cases of H5N6 bird flu. “The increasing trend of human infection with avian influenza virus has become an important public health issue that cannot be ignored,” the researchers warned.

Thijs Kuiken, professor of comparative pathology at Erasmus University Medical Center in Rotterdam, also expressed concern about the rising number of cases. “It could be that this variant is a little more infectious (to people) … or there could be more of this virus in poultry at the moment and that’s why more people are getting infected,” Kuiken said on Tuesday, according to Reuters.

Earlier this month, a WHO spokesperson said increased surveillance is “urgently required” to better understand the rising number of human cases. The spokesperson added that the risk of human-to-human transmission remains low because H5N6 has not acquired the ability for sustained transmission among humans.

Meanwhile, a report from the European CDC expressed concern about the detection of H5N6 viruses with markers for mammal adaptation. “The additional reports of transmission events to mammals, e.g. seals and a fox as well as seroepidemiological evidence of transmission to wild boar, could indicate evolutionary processes, including mammal adaptation with the possibility to acquire the ability to transmit to humans,” the report said.

Bird flu strikes endangered S.African cormorants [Macau Business, 28 Oct 2021]

Bird flu is ravaging South Africa’s endangered Cape cormorants, killing as much as five percent of the world’s remaining population, a conservation group said Wednesday.

“We know that we have over 12,000 dead cormorants so far, which is most likely underreported,” said Katta Ludynia, research manager for the Southern African Foundation for the Conservation of Coastal Birds.

The long-necked birds live along the coast from South Africa to Angola, and they number only 234,000 adults.

About 500 are dying every day from avian influenza, but not all beaches are monitored and some corpses may have washed out to sea, Ludynia said.

The strain of bird flu is not dangerous to humans, but spreads quickly through cormorant colonies.

The deaths include many chicks, as this is the breeding season.

The bird flu outbreak comes as cormorants are already under pressure from declining fish stocks, especially those of sardines.

Lack of food may have weakened their defences, helping to account for the high death toll.

Early this year, hundreds of cormorant chicks were abandoned in a startling incident that conservationists said may have also been caused by hunger.

“There is very high commercial fishing pressure on sardines, but there have also been environmental pressures related to climate change,” Ludynia said.

Bird flu cannot be treated in cormorants. Ludynia said the only solution is to stop the spread by removing carcasses quickly and euthanising birds that show symptoms before they can spread it further.

AI outbreak in the Netherlands prompts nationwide housing order [Poultry World, 27 Oct 2021]

By Fabian Brockotter

An outbreak of highly pathogenic H5 Avian Influenza on a farm in the middle of the Netherlands has prompted the Dutch department of agriculture to implement a nationwide housing order for all commercially held poultry as of 26th of October 2021.

Near the town of Zeewolde highly pathogenic bird flu (H5) was diagnosed at a farm with organic laying hens. The Ministry of agriculture confirmed that it concerns a farm with 2 houses, 1 with approximately 24,000 birds, the other with approximately 12,000. In 1 house the hens showed signs of bird flu. Samples were tested and found positive for HPAI serotype H5.

Nationwide measures
As a result of this outbreak and due to increasing finds of dead wild birds in Northern parts of the Netherlands and of infected wild birds in Germany, the agriculture minister has implemented a nationwide housing order for commercially kept poultry as of 12 noon on 26 October. In this way it wants to reduce the risk of the bird flu virus being introduced from wild birds to other farms in the Netherlands.

Transport restrictions
To prevent the virus from spreading, the birds on the infected farm in Zeewolde are being culled by the authorities. Minister Schouten has also immediately announced transport restrictions for poultry farms in a zone of 10 kilometers around the affected farm in Zeewolde.
This transport ban applies to poultry, eggs, poultry manure and used litter, as well as other animals and animal products from commercial poultry farms. There are no other poultry farms within a radius of 1 kilometer around the infected farm. There are 6 other poultry farms in the area of 3 kilometers around the farm. These farms are sampled and examined for bird flu. There are 9 other poultry farms within the 10-kilometre zone which are affected by the transport restrictions.

Germany reports bird flu outbreak at goose farm [TODAY, 27 Oct 2021]

PARIS - Germany reported an outbreak of highly pathogenic H5N1 bird flu at a goose farm in the northern part of the country, the World Organisation for Animal Health (OIE) said on Wednesday.

The outbreak at a farm of 663 birds in Brunsbüttel in Schleswig-Holstein, started on Oct. 22 and was confirmed on Oct. 23, the OIE said, citing a report from German authorities. REUTERS

Sharp increase in avian flu cases in PRC sparks concern [台北時報, 27 Oct 2021]

A sharp increase in the number of people in China infected with avian influenza, or bird flu, this year is raising concern among experts, who say a previously circulating strain appears to have changed and might be more infectious to people.

China has reported 21 human infections with the H5N6 subtype of avian influenza this year to the WHO, compared with only five last year, it said.

Although the numbers are much lower than the hundreds infected with H7N9 in 2017, the infections are serious, leaving many critically ill and at least six dead.

“The increase in human cases in China this year is of concern. It’s a virus that causes high mortality,” said Thijs Kuiken, professor of comparative pathology at Erasmus University Medical Centre in Rotterdam, Netherlands.

Most of the cases had come into contact with poultry and there are no confirmed cases of human-to-human transmission, said the WHO, which highlighted the rise in cases in a statement on Oct. 4.

It said further investigation was “urgently” required to understand the risks and the increase in infections in people.

Since then, a 60-year-old woman in Hunan Province was admitted to hospital in a critical condition with H5N6 influenza on Oct. 13, a Hong Kong government statement said.

While human H5N6 cases have been reported, no outbreaks of H5N6 have been reported in poultry in China since February last year.

China is the world’s biggest poultry producer and the top producer of ducks, which act as a reservoir for flu viruses.

The Chinese Center for Disease Control and Prevention (CDC) could not be reached for comment on the rise in H5N6 cases in humans. However, a study published on its Web site last month said that the “increasing genetic diversity and geographical distribution of H5N6 pose a serious threat to the poultry industry and human health.”

Avian influenza viruses constantly circulate in domestic and wild birds, but rarely infect people. However, the evolution of the viruses, which have increased as poultry populations grow, is a major concern because they could change into a virus that spreads easily between people and cause a pandemic.

The largest number of H5N6 infections have been in Sichuan Province, although cases have also been reported in neighboring Chongqing and Guangxi, as well as Guangdong, Anhui and Hunan provinces.

At least 10 were caused by viruses genetically very similar to the H5N8 virus that ravaged poultry farms across Europe last year and also killed wild birds in China. That suggests the latest H5N6 infections in China might be a new variant.

“It could be that this variant is a little more infectious [to people] ... or there could be more of this virus in poultry at the moment and that’s why more people are getting infected,” Kuiken said.

China vaccinates poultry against avian influenza, but the vaccine used last year might only partially protect against emerging viruses, preventing large outbreaks, but allowing the virus to keep circulating, said Filip Claes, regional laboratory coordinator at the Emergency Centre for Transboundary Animal Diseases at the Food and Agriculture Organization.

Scores of seabirds dying as Dyer Island becomes new hotspot for avian flu [TimesLIVE, 26 Oct 2021]

The outbreak of avian influenza among wild seabirds in the Western Cape is enduring, with Dyer Island in the Overberg now the major hotspot.

Anton Bredell, the minister for local government, environmental affairs and development planning in the Western Cape, said on Tuesday all efforts are being taken to manage the situation, with the primary focus on responding swiftly to areas where dead and sick birds are found and then implementing a cleanup.

“Dyer Island is an important wild bird breeding colony in the Overberg region. Sadly we continue to find roughly 500 birds per day on the island dying or dead.”

By far the majority of the dead birds reported during the outbreak are Cape Cormorants, he said.

The Disaster Management Centre has asked the public across the province to report unusual behaviour or mortalities in any birds to their local municipality, conservation authority or state veterinarian. The SPCA and NSPCA may also be contacted.

Ghana government approves over GH¢40m to contain bird flu - Minister [Ghana Business News, 26 Oct 2021]

Government has approved GH¢43,984,017.70 to the Ministry of Food and Agriculture to combat the Highly Pathogenic Avian Influenza (HPAI) and strengthen institutional capacity against any future occurrences.

The amount will cover the procurement of 33 cross country 4×4 vehicles, 275 motorbikes, compensation payments to farmers, active disease surveillance of domestic and wild birds’ population, stamping out, de-contamination and disposal materials, among others.

Approved has also been given for the urgent recruitment of 1100 veterinary officers for effective prevention, detection and control of animal diseases in the country.

Dr Owusu Afriyie Akoto, the Minister of Food and Agriculture, who announced this on Monday at a media briefing in Accra, said 50 per cent of the officers would be recruited immediately, while the rest would be taken over a two-year period -2023 and 2024.

The Minister said a nine-member Ministerial Committee with membership from allied institutions would be established to oversee the effective implementation of an action developed for containing the HPAI.

The Committee will be supported by three-member committees at the regional and district levels for coordination, monitoring and evaluation purposes.

Dr Akoto said the interventions were necessary because the disease had reached emergency proportions and needed to be contained with all the urgency and seriousness it deserved to save lives and cost.

He said the economic cost to Government in terms of loss of livelihoods of farmers, production, productivity and investments, particularly the Government’s Rearing for Food and Initiative, would bring the poultry industry down to its knees and compromise the self-sufficiency agenda of the nation in food production.

Ghana has experienced HPAI outbreaks in 2007, 2015, 2018 and 2021, leading to a high mortality of birds running into thousands, loss of livelihoods and investments.

Records from the Ministry indicate that in the 2015 outbreak, a total of 148,000 birds were destroyed nationwide; the highest till date.

The 2021 outbreak was recorded in July, out of which seven out of the 16 regions were affected with a total of 261, 137 birds destroyed through culling and natural deaths.

HPAI is a virulent zoonotic disease easily transferable from birds to humans. It occurs through direct contact with infected birds, contaminated feed, fomites and interaction between farm hands.

Avian influenza - Bird flu identified at a wildbird rescue centre in Worcestershire [GOV.UK, 26 Oct 2021]

The risk of public health from the virus is very low and poses a very low food safety risk for UK consumers

The UK Chief Veterinary Officer has confirmed a case of avian influenza (bird flu) at a wildbird rescue centre in Worcestershire today.

Wild birds migrating to the UK from mainland Europe during the winter months can carry the disease and this can lead to cases in poultry and other captive birds.

All birds on site will be humanely culled. A 3km and 10km temporary control zone has also been put in place around the infected premises to limit the risk of the disease spreading.

UK Health Security Agency advises that the risk to public health from the virus is very low and the Food Standards Agency has made clear that bird flu poses a very low food safety risk for UK consumers. The premises does not supply poultry, meat or eggs to the commercial food chain.

UK Chief Veterinary Officer Christine Middlemiss said:
H5N1 avian influenza has been confirmed at a wildbird rescue centre in Worcestershire. We have taken swift action to limit the spread of the disease and any birds at risk of infection will now be humanely culled.

UK Health Security Agency has confirmed that the risk to public health is very low and the Food Standards Agency has said that bird flu poses a very low risk to food safety for UK consumers.

As we move into the higher risk period over winter bird keepers should pay extra attention to the health of their birds. Anybody who suspects disease should report it to their vet or APHA immediately. The best way to tackle this disease is for poultry keepers to ensure that they have strong biosecurity measures in place.

Dr Gavin Dabrera, Consultant Epidemiologist, UK Health Security Agency, said:
Avian influenza is primarily a disease of birds and the risk to the general public’s health is very low. The regional UKHSA Health Protection Team is working closely with Defra to closely monitor the situation and will be providing health advice to persons at the site as a precaution.
It is generally important to not touch any sick or dead birds and to make sure to wash your hands thoroughly with soap after contact with any animal.

A Food Standards Agency spokesperson said:
On the basis of the current scientific evidence, the Food Standard Agency advises that, avian influenzas pose a very low risk to UK consumers through the food chain.

Properly cooked poultry and poultry products, including eggs, remain safe to eat.

A detailed investigation is in progress to determine the most likely source of this outbreak.

There are some simple measures that all poultry keepers should take to protect their birds against the threat of avian flu. These apply to people running a large commercial farm, keeping a few hens in their back garden and those rearing game birds.

These include:
• Keep the area where birds live clean and tidy, control rats and mice and regularly clean and disinfect any hard surfaces
• Keep chickens and turkeys completely separate from ducks and geese
• Conduct regular maintenance checks on their sheds
• Clean moss off the roofs, empty gutters and remove vegetation between sheds where birds are kept
• Draw up contingency plans for storing bedding and dealing with pests
• Place birds’ feed and water in fully enclosed areas that are protected from wild birds, and remove any spilled feed regularly
• Put fencing around outdoor areas where birds are allowed and limit their access to ponds or areas visited by wild waterfowl
• Clean and disinfect footwear before and after entering premises where birds are kept
Poultry keepers and members of the public should report dead wild birds to the Defra helpline on 03459 33 55 77 and keepers should report suspicion of disease to APHA on 03000 200 301. Keepers should familiarise themselves with our avian flu advice.

Dutch order poultry indoors after avian flu outbreak [Phys.org, 26 Oct 2021]

Dutch health authorities on Tuesday ordered all poultry to be kept indoors to curb an outbreak of highly contagious bird flu.

The decision comes after the H5 strain of bird flu was discovered at a poultry farm in the central Flevoland province, the Dutch agriculture department said.

"About 36,000 birds were also slaughtered on the farm to prevent the virus from spreading," it added in a statement.

The outbreak is the second to hit the Netherlands this year after a similar outbreak in February when a southern turkey farm was infected.

The Netherlands was worst hit in 2003, when a deadly strain of H7N7 avian influenza broke out, killing at least one person and infecting 255 flocks, leading to the culling of 30 million birds according to the National Library of Medicine.

Rise in H5N6 bird flu may be explained by more-infectious variant, experts worry [Livescience.com, 26 Oct 2021]

By Nicoletta Lanese
China has reported 21 cases of the H5N6 subtype of bird flu this year, compared with only five last year, leaving experts concerned that the strain currently circulating is more infectious than past versions of the virus, Reuters reported.
Scientists first identified H5N6 avian influenza in poultry in Laos in 2013, according to a 2020 report in the journal Emerging Infectious Diseases (EID). And since 2014, a total of 49 confirmed cases of humans infected with H5N6 have been reported to the World Health Organization (WHO), according to the WHO's Avian Influenza Weekly Update.
The 21 cases reported in China this year have resulted in at least six deaths and left many of the remaining infected people critically ill. "The increase in human cases in China this year is of concern. It's a virus that causes high mortality," Thijs Kuiken, a professor of comparative pathology at Erasmus University Medical Center in Rotterdam, Netherlands, told Reuters. According to the EID report, human H5N6 infections have a 67% mortality rate.
Related: Going viral: 6 new findings about viruses

The WHO has confirmed that, among the 21 infected individuals in China, most came into contact with poultry, and there have been no confirmed cases of human-to-human transmission, Reuters reported.
"Currently available epidemiologic and virologic evidence suggest that A(H5N6) influenza viruses have not acquired the ability of sustained transmission among humans, thus the likelihood of human-to-human spread is low," a WHO spokesperson told BNO News on Oct. 5. The spokesperson also stated that wider geographical surveillance of affected areas in China and nearby regions is "urgently required" to understand the recent uptick in human cases.
It could be that the H5N6 currently circulating is a new variant that infects humans more easily than past versions of the virus, Kuiken told Reuters. Or there may be a significant increase in H5N6 among poultry, which could result in more human exposure to the virus.

Rise in human bird flu cases in China shows risk of fast-changing variants: experts [Reuters, 26 Oct 2021]

By Dominique Patton

BEIJING, Oct 26 (Reuters) - A jump in the number of people in China infected with bird flu this year is raising concern among experts, who say a previously circulating strain appears to have changed and may be more infectious to people.

Over 10 500 endangered seabirds killed by avian flu outbreak in Western Cape, authorities say [News24, 23 Oct 2021]

By Nicole McCain

Around 500 endangered Cape cormorants a day are dying of avian flu on Dyer Island.

Off the Western Cape coast, the island is home to a breeding colony of Cape cormorants and has been hardest hit by an outbreak of avian flu.

The outbreak was announced by the Western Cape government last week.

The disease appeared to be concentrated among sea birds in the western and southern parts of the province, News24 previously reported.

As of Friday, more than 10 500 Cape cormorants have died.

The country had less than 60 000 breeding pairs before the outbreak.

According to Local Government, Environmental Affairs and Development Planning MEC Anton Bredell, Dyer Island remained the worst-affected area.

He added the outbreak remained a "very complex situation".

"These are wild seabirds, and there are reports coming in from various areas across the coastal region of the province, which is a very large area to manage. We are very grateful for the teamwork and efforts given by multiple partners in managing this situation."

Avian influenza is a highly contagious viral disease. There is no cure and no preventative treatment. Treating affected birds is futile and poses a serious risk of disease spread.
Therefore, sick birds are euthanised.

Bredell said reports of dead seals in some coastal regions were unrelated to the avian flu outbreak.

"Recent reports of dead seals found along some coastal regions are not currently a cause for concern as there is no evidence suggesting these deaths may be as a result of exposure to the avian influenza.

Bird flu outbreak on Dyer Island causing mass deaths [Mail and Guardian, 20 Oct 2021]

By Eunice Stoltz

An outbreak of avian influenza has been recorded on Dyer Island, situated off the coast of Gansbaai in the Overberg area of the Western Cape, that has led to the mass death of wild seabirds.

The province’s local government, environmental affairs and development planning MEC, Anton Bredell, said the outbreak has occurred because the island is a breeding colony “where the birds are in close proximity to one another”.

Managed by CapeNature, Dyer Island is internationally recognised as an Important Bird Area (IBA) and hosts the vulnerable African penguins, endangered bank cormorant and roseate tern, among others.

“At the moment the Cape cormorant species is most affected, however, we are particularly concerned about the bank cormorant, a unique species of cormorant which is extremely rare and may also be affected,” Bredell said in a press statement on Tuesday.

In an earlier statement announcing the outbreak on 14 October, the Southern African Foundation for the Conservation of Coastal Birds (Sanccob) said that “the first Cape cormorants were only diagnosed with this disease in mid-September and cases have increased very rapidly over the last week. Careful surveillance is being done wherever Cape cormorants congregate.”

According to Sanccob, mitigation measures include the removal of carcasses and sick birds, which are euthanised because they could further spread the virus.

“The next 14 days will be critical, and we continue to ask the public to work with us and not to approach or transport any sick or dead birds,” said Bredell, adding: “It is a very complex situation to manage considering these are wild seabirds all along the coast of the Western Cape.”

Other hotspots include De Mond Nature Reserve and the Bergrivier municipality, where the outbreak was first recorded.

A strain of bird flu was first detected in wild seabirds in May this year, but the mass fatalities recorded since 14 October are believed to be as a result of the start of the breeding season.
Over the past weekend, an estimated 700 dead birds were recovered daily across the province where organisations such as Sanccob, SANParks and BirdLife South Africa as well as local veterinarians removed dead and sick birds.

The virus does not pose a risk to people, but they can transmit it from infected birds to healthy ones when their clothes or hands are contaminated. Members of the public are urged to report unusual mortalities in any birds to their local municipality, conservation authority or state veterinarian here.

Macau reports new human case of H5N6 bird flu in Hunan [The Poultry Site, 20 Oct 2021]

Macau’s Health Bureau (SSM) released a statement saying that a case of H5N6 avian influenza has been identified in a 60-year-old patient in Hunan province, China.

The statement says that the patient is in a 60-year-old female farmer who lives in Changde, a city in northern Hunan. She began displaying symptoms on 3 October and was admitted to hospital on 13 October. She is still in critical condition. Health authorities believe that she contracted bird flu after coming in contact with dead poultry.

prefecture-level city in the northwest of Hunan. The statement said that the patient started to feel unwell on October 3 and was hospitalised on October 13, pointing out that she was still in critical condition yesterday. The statement underlined that the patient had contact with dead poultry.

Chinese health authorities are encouraging the public to abide by biosecurity protocols and avoid contact with poultry droppings and dead birds.

Farmers urged to prepare for bird flu risk this winter [FarmingUK, 13 Oct 2021]

Poultry farmers and keepers are being urged to prepare for this winter's potential bird flu outbreaks after dozens of cases were reported last year.

The UK is currently free from avian flu, but over the last year 26 outbreaks were confirmed in kept poultry and captive birds and in over 300 wild birds.

In response, UK-wide measures were introduced to protect poultry from infection from wild birds, including a requirement to temporarily house birds and a ban on bird gatherings.

As winter approaches, the risk of migratory wild birds infecting domestic poultry will rise, according to the UK's four Chief Veterinary Officers' new warning.

They said it was therefore 'vital' that poultry farmers and bird keepers took urgent action to improve biosecurity standards.

In a joint statement, the CVOs said: “As winter approaches we need to be ready for the increased risk of disease that migrating birds pose to our flocks.

“We encourage keepers across the UK to implement strong biosecurity practices now, including regular shed maintenance checks, cleaning and disinfecting footwear and signing up for our email and text alerts.

"Making these tasks a regular fixture of your disease control plans now will make a significant difference in the fight against avian flu this winter and for years to come.”

Bird keepers have been told to maintain good biosecurity practises, such as cleaning footwear, feeding birds indoors, and minimising contact with wild birds.

Farmers and keepers should register their birds on the Great Britain Poultry Register (GBPR), the CVOs said. For those with 50 or more birds, this is a legal requirement.

It comes after British scientists developed a new bird flu vaccine, which they say could provide rapid protection and reduce the virus's spread substantially.

The new vaccine generates a faster and stronger immune response in chickens against the H9N2 strain, compared to the current industry standard inactivated virus vaccine.

Professor Munir Iqbal, of the Pirbright Institute said: "Our improved vaccine could help prevent the spread of flu, which is essential for protecting poultry welfare, increasing food production, and reducing the risk of avian influenza spreading to humans."

Results revealed that the vaccine was both fast acting and effective, with birds producing antibody responses as early as six days after vaccination.

They also shed significantly less flu virus when challenged with a natural flu strain, indicating the birds would be less likely to spread infection.

Elsewhere in the world, Russia confirmed in February the first case of bird flu strain H5N8 being passed from poultry to humans.

The cases, discovered in seven poultry plant workers based in south Russia, were reported to the World Health Organisation (WHO).

Outbreaks of the highly contagious H5N8 strain were reported in the UK last winter, but only in poultry.

Avian influenza strains such as H5N1, H7N9 and H9N2 have been known to spread to humans.

Russia reports severe bird flu at two poultry farms, OIE says [Successful Farming, 13 Oct 2021]

by Sybille de La Hamaide,& Gus Trompiz

PARIS, Oct 13 (Reuters) - Russia has reported outbreaks of highly pathogenic bird flu at two poultry farms in the southern part of the country, the World Organisation for Animal Health (OIE) said on Wednesday.

Citing a report from Russia's veterinary authorities, the Paris-based OIE said the virus found was of serotype H5 but gave no further details.

Russia, China each report one case of bird flu among humans this year [TASS, 11 Oct 2021]

According to Anna Popova, the incidents have been registered and acknowledged by the World Health Organization

KAZAN, October 11./TASS/. One episode where a human was infected with bird flu was reported in Russia this year, and one more was recorded in China this past summer, Chief of Russia’s sanitary watchdog, Anna Popova, told journalists on Monday.

"This year, two cases of the bird flu virus getting into the human population were reported.

These incidents have been registered and acknowledged by the World Health Organization. [One] in the Russian Federation <…>, and this past summer, the same episode was reported in China," said Popova, who heads the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing.

Earlier, Popova said that the system of monitoring a possible trans-species transmission of flu, in particular from birds to humans, had been organized in Russia.

Highly Pathogenic Avian Influenza A(H5N1) Virus in Wild Red Foxes, the Netherlands, 2021 [CDC, 11 Oct 2021]

BY JACKIE LINDEN

With their respective poultry sectors hard hit by highly pathogenic avian influenza (HPAI) in the 2020-2021 season, authorities in France and Poland are making preparations to avoid a repeat of the massive losses incurred.

Jolianne M. Rijks , Hanna Hesselink, Pim Lollinga, Renee Wesselman, Pier Prins, Eefke Weesendorp, Marc Engelsma, Rene Heutink, Frank Harders, Marja Kik, Harry Rozendaal, Hans van den Kerkhof, and Nancy Beerens

Abstract
We detected infection with highly pathogenic avian influenza A(H5N1) virus clade 2.3.4.4b in 2 red fox (Vulpes vulpes) cubs found in the wild with neurologic signs in the Netherlands. The virus is related to avian influenza viruses found in wild birds in the same area.

On May 10, a red fox Vulpes vulpes cub (cub 1) displaying abnormal behavior was found in Bellingwolde, the Netherlands, and taken into care of a wildlife rescue center. Upon entry, the 6- to 8-week-old cub was slightly dehydrated and showed at intervals of <30 minutes lip retraction, rapid opening and closing of mouth, excessive salivation, skin twitching, head shaking, and body tremors (Figure; Video). The cub first seemed to improve, but on May 12 it reacted aggressively when touched. Subsequently, we observed difficult swallowing and labored breathing. The cub seemed blind and stopped eating. As the situation further deteriorated, we humanely euthanized the cub on May 16. On May 13, the center received another 6- to 8-week-old red fox cub (cub 2) found ≈900 m from cub 1. Cub 2 was hypothermic and dehydrated. It had seizures and died overnight.

Retrospectively, we concluded that the mother of the cubs was likely a vixen found walking circles on May 10, ≈975 m direct distance from cub 1 and ≈90 m from cub 2. The vixen reacted very aggressively to capture, responding to sound but blind. The vixen had a fresh elbow fracture, probably caused by a road traffic accident. We humanely euthanized her the same day and sent her carcass for destruction.

Although rabies lyssavirus is unlikely in the Netherlands, European bat 1 lyssavirus is endemic in serotine bats (Eptesicus serotinus) (1). To exclude lyssavirus infection in the fox cubs, we performed a direct fluorescent antibody test on smears of brain tissue in accordance with World Organisation for Animal Health (OIE) protocol
(https://www.oie.int/fileadmin/Home/eng/Health_standards/tahm/3.01.17_RABIES.pdfExternal Link). Test results were negative.

Subsequently, we tested brain samples for avian influenza virus by using a PCR detecting the influenza A virus matrix gene, followed by the subtype-specific H5-PCR on the hemagglutinin gene, as described previously (2). The samples from both cubs tested positive (Table), and we subtyped the virus as highly pathogenic avian influenza (HPAI) influenza virus A subtype H5N1.
We isolated the HPAI H5N1 virus from the brain of cub 1 by inoculation of the samples into 10-day-old embryonated special pathogen–free chicken eggs.

During April–May 2021, large numbers of dead barnacle geese (Branta leucopsis) were reported in the northern part of the Netherlands, and later other species of waterfowl and birds of prey were also found dead. A selected number of dead wild birds were submitted for AI diagnostics and tested positive for HPAI H5N1 virus. We performed whole-genome sequencing of the HPAI H5N1 viruses found in wild birds and the 2 foxes as previously described (3) and conducted genetic and phylogenetic analyses to study the relationship between these viruses. Phylogenetic analysis of the gene segments (Appendix 1 Figure 1–8) showed the viruses detected in wild birds and the 2 foxes were in the same cluster and highly related. We classified the viruses as H5 clade 2.3.4.4b viruses, which were related to other HPAI H5N1 viruses detected in wild birds and poultry in Europe during 2020–2021. The HPAI H5N1 viruses detected in the foxes were not related to zoonotic H5N1 strains infecting humans in Asia and did not contain any known zoonotic mutations (data not shown). The sequences of the viruses detected in cub 1 (GISAID [https://www.gisaid.orgExternal Link] accession no. EPI_2194218) and cub 2 (GISAID accession no. EPI_2194219) were identical; the closest related virus was identified in a white-tailed eagle (Haliaeetus albicilla) near the village of Noordlaren. We observed only 6 aa differences: mutations A152T and T521I in polymerase basic protein 2 (PB2); M644V in polymerase basic protein 1; A336T in nucleoprotein; L22S in neuraminidase protein; and D209N in nonstructural protein (Appendix 1 Figure 1–8). Whether these changes are associated with adaptation of the avian virus to mammal species remains unknown.

These 2 cases of infection with H5N1 clade 2.3.4.4b virus in wild red fox cubs underscore the need to raise awareness that HPAI viruses are not only zoonotic but also infect other mammal species. HPAI infection should be on the list of differential diagnoses for animals that have signs of respiratory or neurologic disease. The detection of virus in the brain suggests systemic infection of the cubs. The clinical signs were largely consistent with those reported in other natural infections of carnivores with HPAI H5 subtypes (4–7). Whether the fox cubs were infected through the parents or by eating infected bird carcasses is unclear (cubs start eating solid food at 4 weeks of age). Carnivores are known to be at risk for avian influenza virus infection upon ingesting infected birds (4,5,8). We did not test for virus shedding in these cubs, but virus shedding has been observed in experimental infection of 6- to 10-month-old red foxes with HPAI H5N1 clade 2.2 virus (8).

The United Kingdom reported infection of a red fox and seals in an animal shelter with a related HPAI H5N8 clade 2.3.4.4b virus (9), and Russia reported infection in poultry workers (10). These findings suggest that HPAI H5 clade 2.3.4.4b viruses may sporadically transmit from birds to mammals, including humans. Virus evolution and adaptive mutations must be closely monitored to rapidly identify viruses with increased zoonotic potential.

Dr. Rijks is a postdoctoral researcher at the Dutch Wildlife Health Centre in Utrecht, the Netherlands. Her primary research interests are wildlife diseases and epidemiology.

Acknowledgments
We acknowledge the authors and submitting laboratories of the sequences from the GISAID EpiFlu Database (Appendix 2).

References
1. Van der Poel WH, Van der Heide R, Verstraten ER, Takumi K, Lina PH, Kramps JA. European bat lyssaviruses, The Netherlands. Emerg Infect Dis. 2005;11:1854–9. DOI
2. Beerens N, Heutink R, Bergervoet SA, Harders F, Bossers A, Koch G. Multiple reassorted viruses as cause of highly pathogenic avian influenza A(H5N8) virus epidemic, the Netherlands, 2016. Emerg Infect Dis. 2017;23:1974–81. DOI
3. Beerens N, Heutink R, Pritz-Verschuren S, Germeraad EA, Bergervoet SA, Harders F, et al. Genetic relationship between poultry and wild bird viruses during the highly pathogenic avian influenza H5N6 epidemic in the Netherlands, 2017-2018. Transbound Emerg Dis. 2019;66:1370–8. DOI
4. Marschall J, Hartmann K. Avian influenza A H5N1 infections in cats. J Feline Med Surg. 2008;10:359–65. DOI
5. Songserm T, Amonsin A, Jam-on R, Sae-Heng N, Pariyothorn N, Payungporn S, et al. Fatal avian influenza A H5N1 in a dog. Emerg Infect Dis. 2006;12:1744–7. DOI
6. Lee K, Lee EK, Lee H, Heo GB, Lee YN, Jung JY, et al. Highly pathogenic avian influenza A(H5N6) in domestic cats, South Korea. Emerg Infect Dis. 2018;24:2343–7.
7. Hu T, Zhao H, Zhang Y, Zhang W, Kong Q, Zhang Z, et al. Fatal influenza A (H5N1) virus Infection in zoo-housed Tigers in Yunnan Province, China. Sci Rep. 2016;6:25845.
8. Reperant LA, van Amerongen G, van de Bildt MW, Rimmelzwaan GF, Dobson AP, Osterhaus AD, et al. Highly pathogenic avian influenza virus (H5N1) infection in red foxes fed infected bird carcasses. Emerg Infect Dis. 2008;14:1835–41. DOI
9. ProMED. Avian influenza (45): Europe (UK, Croatia) seal, fox, wild bird, HPAI H5N8. ProMED 2021 Mar 17. http://www.promedmail.orgExternal Link, archive no. 20210317.8252821.
10. ProMED. Avian influenza, human (02): Russia, H5N8, first case. ProMED 2021 Feb 21. http://www.promedmail.orgExternal Link, archive no. 20210221.8204014.

Russia, China each report one case of bird flu among humans this year [TASS, 11 Oct 2021]

According to Anna Popova, the incidents have been registered and acknowledged by the World Health Organization

KAZAN, October 11./TASS/. One episode where a human was infected with bird flu was reported in Russia this year, and one more was recorded in China this past summer, Chief of Russia’s sanitary watchdog, Anna Popova, told journalists on Monday.

"This year, two cases of the bird flu virus getting into the human population were reported.

These incidents have been registered and acknowledged by the World Health Organization.
[One] in the Russian Federation <…>, and this past summer, the same episode was reported in China," said Popova, who heads the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing.

Earlier, Popova said that the system of monitoring a possible trans-species transmission of flu, in particular from birds to humans, had been organized in Russia.

WHO calls for surveillance to explain rise in human cases of H5N6 bird flu [BNO News, 5 Oct 2021]

The World Health Organization (WHO) says increased surveillance is urgently required to better understand what’s behind a recent spike in human cases of H5N6 bird flu in mainland China.

Only 48 people have been infected with H5N6 bird flu since the first confirmed case in 2014, but a third of those were reported in mainland China during the past 3 months alone. Half of all cases were reported during the past 12 months.

“Wider geographical surveillance in the China affected areas and nearby areas is urgently required to better understand the risk and the recent increase of spill over to humans,” a WHO spokesperson told BNO News.

H5N6 bird flu is known to cause severe illness in humans of all ages and has killed more than half of those infected. While there are no confirmed cases of human-to-human transmission, a 61-year-old woman who tested positive in July denied having contact with live poultry.

“Currently available epidemiologic and virologic evidence suggest that A(H5N6) influenza viruses have not acquired the ability of sustained transmission among humans, thus the likelihood of human-to-human spread is low,” WHO said.

The spokesperson added: “Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of global surveillance to detect virological, epidemiological and clinical changes associated with circulating influenza viruses that may affect human (or animal) health and timely virus and information sharing for risk assessment.”

A study published by China’s Center for Disease Control in September reported several mutations in two cases of H5N6 and described the spread of the virus as a “serious threat” to the poultry industry and human health.

“The increasing trend of human infection with avian influenza virus has become an important public health issue that cannot be ignored,” the researchers said.

On Thursday, a report from the European CDC expressed concern about the detection of H5N6 viruses with markers for mammal adaptation. “The additional reports of transmission events to mammals, e.g. seals and a fox as well as seroepidemiological evidence of transmission to wild boar, could indicate evolutionary processes, including mammal adaptation with the possibility to acquire the ability to transmit to humans,” the report said.

Gain-of-function research: all in the eye of the beholder [Salon, 28 Sep 2021]

By CHARLES SCHMIDT

Should work done on coronaviruses in Wuhan, China, be considered “gain-of-function” research? Opinions differ

In 2012, the National Institutes of Health (NIH) organized a meeting after two laboratories independently reported eye-opening results. In both labs, researchers had managed to alter the avian H5N1 flu virus so it could spread through the air among ferrets, an animal often used in virology to model the development and spread of pathogens in mammals. This particular flu virus kills 60 percent of the humans it infects, but the virus's spread is limited to those who eat or handle infected poultry. The new lab-altered viruses, on the other hand, had been mutated in ways that allow them to spread on air droplets like seasonal flu.

At the NIH meeting, researchers applied a new term — gain-of-function — to this type of high-risk research, which can have the effect of making viruses more deadly, more transmissible, or otherwise more able to flourish. Proponents say this research is essential for developing new therapies and vaccines and understanding how viruses cause pandemics. But critics say any insights from these experiments aren't worth the risk of a lab-created virus reaching the outside world. The debate has only grown more heated in the context of this current pandemic, with some asking whether SARS-CoV-2 could have escaped from the Wuhan Institute of Virology in China, where researchers studied coronaviruses.

During Congressional hearings in May and July, Sen. Rand Paul of Kentucky accused the NIH and Anthony Fauci, the long-time director of the NIH's National Institute of Allergy and Infectious Diseases (NIAID), of supporting the Wuhan facility's studies, which Paul claimed were in violation of a temporary federal pause on gain-of-function research funding announced in 2014. Fauci denied the experiments in question were, in fact, gain-of-function — a response that prompted Paul to retort that he was "trying to obscure responsibility for 4 million people dying around the world from a pandemic."

There's no evidence NIH-funded research sparked the pandemic. But the dispute underscores widespread confusion surrounding gain-of-function research, which is now a flashpoint in the broader debate over lab experiments with dangerous viruses. That Paul and Fauci could arrive at such different conclusions about the same work gets to the heart of a thorny problem: When it comes to gain-of-function research, "no one agrees on what it is," says Nicholas Evans, an associate professor of philosophy at the University of Massachusetts, Lowell, who specializes in biosecurity and pandemic preparedness.

In the most basic sense, gain-of-function, or GOF, research refers to the introduction of a mutation that enhances a gene's functional properties — farmers have arguably practiced it for thousands of years through plant breeding. But definitions applied in virology have also narrowed over time, such that some researchers now maintain that in the strictest sense of the term — increasing virulence or transmissibility in humans — "no GOF experiments have been performed," says Stanley Perlman, a virologist at the University of Iowa.

Absent consensus, public views on gain-of-function are vulnerable to polarized rhetoric, and policy makers continue to struggle with how to regulate the research. "No one knows exactly what counts as gain-of-function, so we disagree as to what needs oversight, much less what that oversight should be," Evans says.

During the H5N1 research, Ron Fouchier, from Erasmus University Medical Center in Rotterdam, the Netherlands, and Yoshihiro Kawaoka, from the University of Wisconsin, Madison and the University of Tokyo, both virologists, wanted to understand how pandemic flu viruses might evolve. Working in biosafety level-3 labs used for studies of dangerous pathogens that might transmit through the air, they used a variety of techniques to alter the virus' genome, introducing changes that altered its behavior. The results from both labs showed that with only a few gene mutations, H5N1 could become an airborne spreader in mammals without having to go through the typical process of combining with other viruses in an intermediate host, such as a pig or rodent.

Although the changes to the virus also appeared to make it less virulent — none of the ferrets infected with the viruses through the air died — the finding confirmed that H5N1 poses a pandemic threat; it also created an international uproar, and many scientists were divided over the experiments. Some expressed support. Fauci, for instance, during a press conference marking publication of the Fouchier paper, acknowledged the possibility that a scientist working with an altered virus might become infected, causing an outbreak or even a pandemic.
Still, the benefits of "stimulating thought and pursuing ways to understand better the transmissibility, adaptation, pathogenicity" of H5N1, he added, "far outweigh the risk." Others accused Fouchier and Kawoaka of being reckless, prompting the two virologists and their colleagues to agree to a temporary moratorium on the research.

Then in 2014, in the wake of a series of biosafety incidents involving microbiology experiments at U.S. government facilities, including one in which samples of a relatively benign avian flu virus were inadvertently contaminated with H5N1 by influenza researchers at the Centers for Disease Control and Prevention, the NIH announced a pause on new funding for gain-of-function studies. According to the U.S government's phrasing, the pause was specifically directed at "gain-of-function research projects that reasonably may be anticipated to confer attributes to influenza, MERS [Middle East Respiratory Syndrome], and SARS [Severe Acute Respiratory Syndrome] viruses such that the resulting virus" is either more deadly or better able to spread in mammals.

In all, 18 laboratories were affected. Their new grant funding was frozen, and researchers in these labs were asked to put their gain-of-function work on hold while a team of experts undertook what became a three-year effort to craft new federal oversight policies.

During this time, however, and with Fauci's approval, the NIAID continued to supply funding to the Wuhan investigators, who were trying to predict where the next coronavirus outbreak might come from. During his July spat with Fauci, Paul singled out a 2017 research paper co-authored by Peter Daszak, president of the EcoHealth Alliance, a New York-based nonprofit group through which the NIAID money was channeled. (EcoHealth's press officer, Robert Kessler, declined to make anyone available for an interview, and said in an email: "We've not conducted gain-of-function research, so aren't really good authorities to speak on the subject.")

Over the course of the five-year project, the investigators took fecal samples from cave bats in Yunnan, China, about 1,000 miles southwest of Wuhan, and isolated close relatives of the coronavirus that causes SARS. Then, using a method called reverse genetics, they attached surface "spike" proteins from those newly identified microbes to a different SARS-like coronavirus called WIV1. (Coronaviruses, including SARS-CoV-2, use their spikes to attach to other cells and initiate an infection, but for these experiments the researchers used an engineered form of WIV1 that lacked spike proteins of its own).

Daszak and the Wuhan team wanted to know if these lab creations — called chimeras — could infect human airway cells. As it turned out, several could, which suggested that natural coronaviruses outfitted with the the same spikes used in making the chimeras might also be able to infect people. This information, the team concluded presciently, "highlights the necessity of preparedness for future emergence of SARS-like diseases."

Citing this research, Paul said that the Wuhan scientists had manipulated coronaviruses that only infect animals in nature so that they "gain the function of infecting humans." These experiments, he claimed, "fit the definition of the research that the NIH said was subject to the pause." Fauci disagreed, countering that the Kentucky senator, long a thorn in the side of federal agencies working on Covid responses, did "not know what he was talking about."

So who was right? There is no consensus within the research community. The NIAID declined to make Fauci or anyone else available to Undark for an interview, but embedded in Paul's argument are two points of contention among scientists. One is the question of whether the backbone virus, WIV1, fits within any of the three viral categories specified in the pause.

WIV1 is about 90 percent genetically similar to the virus that causes SARS disease in people, but it is not a SARS virus per se. Richard Ebright, a molecular biologist at Rutgers University and a staunch critic of gain-of-function research, claimed in an email to Undark that the pause was "expressly intended by policy makers to refer to clades (e.g., groups) of viruses, and not a single virus." Seen this way, WIV1, being in the SARS-like clade, would have been subject to the pause's funding restrictions.

When Undark asked NIAID to comment, media relations staff replied by email that the pause applied specifically to "all influenza viruses as well as two specific coronaviruses: MERS and SARS-CoV-1 [which is a more precise term for the virus that causes SARS]." When Undark put that response to Ebright, he responded that the NIAID was "lying, brazenly" since the actual 2014 policy language never made this distinction. Susan Weiss, a microbiologist who works with coronaviruses at the University of Pennsylvania, points out that "there's the letter of the law and the spirit of the law," but as to which applies in this debate, she adds, "I don't know."
The second point of contention is whether the chimeras generated in Wuhan were enhanced in ways that made them more deadly or transmissible than WIV1 itself. WIV1 in its natural, unmodified form already infects human cells in a dish, so replacing its own spikes with those from other coronaviruses adds no gain of function in that respect. Still, some chimeras were more pathogenic in exposed mice than unmodified WIV1, according to experimental summaries obtained and published by The Intercept on Sept. 9, as part of its ongoing Freedom of Information Act litigation against the NIH: "Three chimeras produced 10,000 times more virus in the mice's lung tissue than unmodified WIV1, and one caused the mice to lose significant weight."

According to the grant's stipulations, the researchers at that point should have ceased the experiments. But The Intercept reported that the NIH concluded the restrictions on GOF research did not apply in this case, and there is no evidence that the research was stopped. Whether the chimeras would also be more pathogenic in people is unclear. No WIV1 infections in people have been reported, so its ability to spread and cause disease among humans is also unknown. Perlman says that just because the virus and its engineered chimeras infect isolated human cells in a petri dish does not mean they can infect cells in an actual person, where viruses are subject to immune defenses and other challenges.

"We don't know what it will take" to infect humans, Perlman says. "That's where the murkiness lies."

* * *
In 2017, after deliberating during the three years of the pause, the U.S. Department of Health and Human Services, which oversees the NIH, produced an oversight system that didn't even mention gain-of-function. Called the PC30 Framework, the system focused instead on how and whether to fund projects on so-called "enhanced potential pandemic pathogens," or PPPs.
Where the pause was limited to influenza, MERS, and SARS viruses, the PC30 Framework had a broader scope: PPPs could include any highly transmissible pathogen that can spread uncontrollably and cause widespread human disease and death. Enhanced PPPs were defined as having been altered to become even more transmissible and deadly. (Natural pathogens either circulating in nature or recovered from it were excluded from the policy, as were efforts to sequence pathogens or use them to make vaccines.)

A committee at the Department of Health and Human Services is now tasked with making final decisions about what is and is not a gain of function experiment. But longtime critics of federal oversight still aren't pleased. Ebright claims that apart from two projects carried over from prior to 2017¬ — the Fouchier and Kawaoka research on H5N1 — there are no public records of any reviews being performed, suggesting that "the NIH doesn't flag projects for review, nullifying the policy."

Arturo Casadevall, a microbiologist at the Johns Hopkins Bloomberg School of Public Health, co-authored a 2020 editorial in the journal mBIO, reporting that both PC30 reviews to date have been made behind closed doors, despite guidance from the White House at the time the framework was released encouraging a transparent process.

Transparency could ensure that reviewers are free of conflicts of interest. But given the politics surrounding gain-of-function, the possibility that others may use public information for nefarious purposes, and the way researchers associated with gain-of-function have been attacked in the press and on social media, transparency might also deter potential reviewers from participating. In an email to Undark, Casadevall acknowledged that "some people in the coronavirus field have gotten death threats." Still, he added, "it should possible to open the documents and conclusion of the review while shielding the reviewers. This is what we do in an academic literature peer review."

The broader public was recently offered a glimpse of peer review when a quasi-anonymous group of self-described "Twitter detectives" released a grant proposal EcoHealth submitted to the Defense Research Projects Agency (DARPA) in early 2018. EcoHealth and its partners, which included the Wuhan Institute of Virology, wanted to inoculate wild bats in China with proteins from chimeric coronaviruses, reasoning that vaccinated bat immune systems would block viral replication and thus lessen the risk of the virus spilling over into local populations. According to the leaked documents, whose authenticity has only been indirectly verified, DARPA rejected the $14 million proposal, in part over concerns that the way the researchers proposed to engineer the viruses would put it in the GOF category.

Gain-of-function research accounts for just a tiny sliver of the federal research portfolio, and the scientists who spoke with Undark were hard pressed to identify many important discoveries made through this line of research.

Casadevall cited the work of Fouchier and Kawaoka, which, he says, showed unequivocally that H5N1 had the capacity of airborne spread among mammals. "You could not have learned by any other experiments," he says. "Now we know that humanity faces a huge threat from all this bird flu; it just hasn't happened yet." And some pointed to the work of Ralph Baric, a virologist at the University of North Carolina, who pioneered the experimental techniques used in Wuhan.
Through a spokesperson, Baric declined to be interviewed for this article, citing a request from his university that he refrain from speaking to the press. Yet in a recent interview with MIT Technology Review, he claimed that this experimental method was instrumental in allowing him to identify high-risk SARS-like coronaviruses and test drugs against them. Fauci asserted in a 2012 editorial that the need to stay ahead of pandemic threats is the primary justification for gain-of-function research. However, Simon Wain-Hobson, a microbiologist at the Pasteur Institute in Paris, counters that "no one can predict the next pandemic, and if you can't do that, then the whole raison d'etre for gain-of-function falls apart."

Jesse Bloom, an evolutionary biologist who works on virology at the Fred Hutchinson Cancer Research Institute, agrees. "When you talk about an experiment in which the consequences of an accident are a global pandemic — it's really hard to even put that into a risk-benefit analysis," he says. SARS-CoV-2, he added, emerged in Wuhan "right under the noses of people doing this work, and nothing they did was useful in stopping it."

For his part, Casadevall steers towards the middle ground, and worries that if society overreacts against gain-of-function research, the field might become over-regulated, and then the experiments will never get done. "Not all pathogens have the same pandemic potential," he says. "And it would be really good if humanity knew which ones are more dangerous."
* * *
UPDATE: An earlier version of this piece incorrectly suggested that evolutionary biologist Jesse Bloom believed gain-of-function experiments being conducted in the Soviet Union might have caused the 1977 global epidemic of H1N1 flu. Bloom never said this, and the reference has been removed.

The risk of avian influenza transmission from wild waterfowl to poultry is negligible [Floridanewstimes.com, 28 Sep 2021]

A study by Wageningen Bioveterinary Research (WBVR) shows that the risk of airborne transmission of the highly pathogenic avian influenza virus from infected wild birds is negligible. The study paid particular attention to the aerial movement of particles from wild waterfowl droppings near poultry farms during the avian influenza risk season (October-March). We also considered aerosolation, in which the exhaled breath and cough of wild waterfowl infected with the avian influenza virus invade the ventilation system of the poultry farm. As a precaution, it is important to remove the carcasses of wild waterfowl and other wild birds that have died from highly pathogenic avian influenza from their habitat as soon as possible. Otherwise, corpse-eating scavengers may disperse their feathers. Dead wild bird feathers, and wild birds that have died from highly pathogenic avian influenza, contain the virus, which can survive for long periods of time in those feathers.

Introducing the virus into poultry
“Wild waterfowl such as ducks, geese, swans and seagulls are a natural repository of avian influenza virus. These wild waterfowl excrete the avian influenza virus when infected, which is important for introducing the virus into poultry. Can play a role in wild duck bird If you are infected with bird flu, it can invade those poultry farms if they accumulate near the poultry farms. For example, it can be attached to boots, clothing, or utensils, bedding can be brought outside the poultry house, or it can be brought in through a rat or rat with dung on its fur or legs.

In addition, previous experience suggests that the avian influenza virus can be transported from one farm to another if it is produced in large quantities by a large number of infected chickens in the poultry house. The project investigated whether the avian influenza virus could infect the poultry from wild birds infected near the poultry, “said Armin Elbers, research project leader and senior epidemiologist at WBVR.

Risk analysis
The focus of this risk analysis of aerial transmission of highly pathogenic avian influenza virus from aerosols produced by the exhalation or cough of wild waterfowl contaminated feces or wild waterfowl infected with the avian influenza virus is so. It may be mitigated by using a windbreak mesh selected for the risk of a flu route.

In this study, a semi-quantitative risk analysis was performed by extensive literature review and field experiments were performed to investigate the potential for aerial movement of falling particles of birds during the high-risk avian influenza season. Identified the relevant building block.

Czech Republic reports H5 bird flu outbreak, first since May [Nasdaq, 28 Sep 2021]

By Robert Muller

PRAGUE, Sept 28 (Reuters) - The Czech Republic recorded an H5 bird flu outbreak at a small, non-commercial farm in the central region of the country, killing five geese of the nearly 30-bird flock, the State Veterinary Administration said on Tuesday.

The rest of the flock had to be culled and a protective perimeter was established around the farm to monitor poultry movements, the administration said.
It is the first bird flu case in the country since May.

S China's Dongguan reports one case of H5N6 avian flu [Global Time, 23 Sep 2021]

Dongguan, in South China's Guangdong Province, reported one new case of H5N6 bird flu on Tuesday, the second confirmed case in the province after a woman was infected with the virus on August 19 in Huizhou. Experts assessed that the case was a random and the risk of transmission of the virus is low at the current stage.

According to the Health Commission of Guangdong Province, the diagnosed patient surnamed Li, a 53-year-old male, is currently being treated at a designated hospital in Dongguan.

Experts pointed out that the H5N6 avian influenza virus is highly pathogenic to fowls. Since it was first discovered in poultry in China in 2008, it has gradually replaced the H5N1 avian influenza as the main virus prevalent in China's poultry farms and live poultry markets.

But in its natural state, the H5N6 avian influenza virus mainly infects birds and infections in humans rarely occur. As of the end of March 2021, only 25 human infections have been reported worldwide, and all are dispersed cases.

On April 12, the H5N6 avian flu was found in wild birds in Shenyang, a city in Northeast China's Liaoning Province, which marked the first confirmed cases of the flu in China this year.

After May 2014, H5N6 human infection cases have been reported in several places in China, including Sichuan, Guangdong, Yunnan and Jiangxi provinces, where at least four people have died.

Experts from the Health Commission of Guangdong Province concluded that the emergence of the case was random and the risk of transmission of the virus is relatively low now. However, they warned that although the H5N6 avian influenza virus rarely infects humans, it should be given high priority and remain under surveillance to avoid the spread of the epidemic by human factors.

Introduction of infection routes for bird flu season 2020-2021 investigated [Mirage News, 16 Sep 2021]

Commissioned by the Ministry of Agriculture, Nature and Food Quality, Utrecht University in collaboration with the Netherlands Food and Consumer Product Safety Authority (NVWA), Sovon, Wageningen Bioveterinary Research (WBVR), and Royal GD researched the entry routes of the highly pathogenic bird flu in the 2020-2021 season. It reviewed the results from source and contact research, estimates of the entry time, and virus similarities for the infected farms.

Additionally, the biosecurity and numbers and types of wild birds were determined on-site.
WVBR conducted a genetic analysis that examined the similarities between the viruses found on the 12 farms that were infected. The genome sequences from the viruses found in poultry and wild birds were defined and compared. It demonstrated that there was an identical virus at the farms in Altforst and Puiflijk. It may be that these two farms were infected from the same source, but it cannot be excluded that the virus was transported between the farms. The viruses at the other ten farms were not identical and were related to viruses found in wild birds. This means independent introductions from wild birds caused the infection at those farms. This study shows that swift diagnostics and repression of the virus is very effective in the Netherlands which resulted in no or very limited spread to other farms during the HPAI H5N8 epidemic in 2020-2021.

France facing highly contagious virus as flu spreads across Europe - warning issued [Daily Express, 16 Sep 2021]

By KATIE HARRIS

A BIRD flu outbreak has been discovered in France as the virus spreads in Europe.

The outbreak in Aisne was announced by officials on Wednesday evening. It comes as the virus is spreading in Europe with cases detected in Belgium and Luxembourg.

A statement said: "A clinical suspicion has just been confirmed today by the national reference laboratory in a farmyard located in the town of Aubenton.

"Like several European countries, France is facing a new episode of highly pathogenic avian influenza (HPAI)."

The origin of the outbreak in Aisne is the "purchase of poultry in a Belgian market", according to officials.

Anyone who has bought birds from markets in Florenville, Arlon, Chimay, Tournai, Bastogne, Charleroi, Anderlecht is being urged to consult a vet if animals show symptoms of the virus.

However, a ban has not been imposed on the movement of poultry.

The prefecture is calling for "everyone's vigilance" in order to "detect any possible case at the first signs".

It comes after France raised its bird flu alert last week following the discovery of the H5N8 strain among ducks, hens, turkeys and pigeons at a household in the Ardennes region.
The ministry said the animals were slaughtered as a precaution.

It said: "The health situation regarding highly pathogenic avian influenza is worrying.

"Since August 1, 25 cases have been detected in Europe among wild and captive birds."
Two cases were also reported last week in Belgium.

One was at a bird merchant and one at a private home.

Another was detected at a home in Luxembourg that has been linked to the merchant in Belgium.

The latest cases prompted France to increase its risk assessment to "moderate" from "negligible".

The change means poultry will be kept indoors in some areas.

Tatarstan is under threat of the bird flu — RealnoeVremya.com [Realnoe vremya, 13 Sep 2021]

By Sergey Afanasyev

“Private farms are the weakest link, there is zero protection”

Veterinarians have urged Tatarstan farmers to “urgently slaughter” mature poultry. The goal is to prevent the appearance and spread of a highly pathogenic flu bird in the republic.

“There was a dull in summer, thank God, but migratory wild birds in autumn are a direct threat of spreading the flu, especially in the last years. The highly pathogenic flu is especially dangerous,” warned vice head of the Main Veterinary Office of the Tatarstan Cabinet of Ministers Gabdulkhak Motygullin.

The functionary urged directors of poultry farms, especially small private farms, do not “self-diagnose,” if the poultry are dying or behaving strangely (refuse to eat), urgently go to regional veterinary services.

“While the owner is doing experiments with drugs, we can miss the precious time to localise the flu,” Motygullin noted.

Countrymen and farmers, especially large farms, must isolate their poultry from wild migratory birds, particularly wild ducks. In 2020, precisely the latter became the cause of the spread of the bird flu in Tatarstan. Veterinarians also urge farmers to protect their farms because in case of infection and an outbreak, all the poultry will have to be burnt

“In Tatarstan, we have a lot of poultry, about 18 million commercial poultry. Private farms are the weakest link, there is zero protection, therefore their poultry cannot have access to water.”

As veterinarians are controlling the situation in the republic, more than ten outbreaks of the bird flu have been registered in Astrakhan, Rostov, Chelyabinsk, Tyumen, Krasnodar Oblasts and in Dagestan and Tuva. Specialists emphasise that though the viral disease hits the vascular and central nervous system, there might be no bird flu symptoms, it is nearly impossible to diagnose this disease after the poultry dies.

“We cannot redirect the birds”
According to orders of the Russian Ministry of Agriculture, owners must keep the poultry enclosed without contact with wild birds. They also must provide access to their birds on specialists’ every request and inform agencies in case of mortality or strange behaviour.

Poultry are prohibited from being brought from other regions without the authorities’ consent and corresponding documents. Those who sell the poultry, first of all, must regularly disinfect transport.

Vice head of the Tatarstan office of Russia’s agriculture watchdog Yevgeny Ivanov noted that the situation in Russia is relatively not bad, 18 flu outbreaks have been registered. To compare, in Europe, they total over 500, around the world, there have been more than 1,000 cases in 2021. But this also concerns specialists because Tatarstan farmers buy pedigree poultry mainly in Europe. Samples are taken to prevent the virus from entering the territory of Russia during customs clearance.

“The situation is calm now. But the threat persists. The bird flu started to spread in Tatarstan in 2020 precisely in Chelyabinsk, gradually it came here together with migratory birds,” Ivanov paid attention.”

Tatarstan is in a risk zone due to its location at the confluence of two rivers, the Volga and Kama Rivers, said Rinat Chispiyakov, vice director of the Animal and Vegetal Life Protection Office of the Tatarstan Cabinet of Ministers and head of the Tatarstan State Committee for Biological Resources. According to him, the republic has very rich waters, this is why wild bird migration arteries cross our republic. All migratory birds stop by in Tatarstan in autumn, thus increasing the risk of bringing the bird flu.

“There were several cases of the flu that arrived in Tatarstan in spring because a part of birds remains in the republic for nesting: geese, swans... In autumn, the birds will transit our republic.
And then their number will be bigger, hundreds of millions of birds. Unfortunately, we can do nothing, we cannot redirect the birds, so we have to invite hunters,” Chispiyakov claimed.”

“Now we have half a million swine in Tatarstan, however, there is no treatment for the fever”
African swine fever (ASF) is another dangerous seasonal disease that is directly linked with the Tatarstan Agro-Industrial Complex. Here there situation is by far worse, it is already spreading at a high speed across Russia: 68 outbreaks are in quarantine, including Tatarstan’s
neighbours Mari El and Samara Oblast. One fever outbreak is so far known in Tatarstan, which is in Novosheshminsk District, at Krasnovidovo farm where the quarantine declared in summer will soon be lifted.

“African fever is dangerous, infection a hundred per cent leads to death. If a swine survives, it becomes a virus carrier. In Tatarstan, now we have half a million swine, moreover, there is no treatment for the fever. I recommend banning an outdoor swine enclosure for farmers and other animal owners. Rodents, gnats, the soil can transmit this infection,” Gabdulkhak Motygullin explains.

To solve the problem, veterinarians closely worked with swine resellers in Tatarstan so that the latter will obtain a sales permit in Mercury system. At the same time, wild boars, key infection transmitters, are killed. There used to be a lot of boars in the republic, more than 4,000. In 2021, 890, or 0,13 per 1,000 hectares, have left. To prevent the appearance of the fever in swine enterprises of Tatarstan, it is necessary to reduce the population of the wild boar, functionaries justify themselves: “Otherwise, we won’t save this production.” Sadly, the virus got to the wild fauna in Tatarstan. Yevgeny Ivanov noted that African fever was first registered precisely in Russia, back in 2007. Since then, the virus seized the whole world, first reaching Europe (Germany, Latvia and so on), in 2018, it got to China. Ultimately, African swine fever has made its way to Northern America in 2021.

All boars won’t be killed, as few as a thousand will remain
According to head of the Tatarstan State Committee for Biological Resources Rinat Chispiyakov, AFS first got to Tatarstan in 2020. As a result, supervisory agencies create 20-kilometre buffer zones on the perimeter of the republic’s border. In the case of the outbreak in the same Novosheshminsk District, in Krasnovidovo, a 100-kilometre territory was in quarantine (hunting is still banned there, 24 swine were destroyed). Then, the buffer zones expanded: 20-kilometre zones are created around large swine farms and 10-kilometre areas around others.

Nevertheless, veterinarians and ecologists believe that the boars as species won’t go extinct in Tatarstan. There is a norm: 1,000 head for the whole territory of the republic, no more (a risk of fever). “There must not be boars” around swine farms to rule out infection. Also, it was noted at the press conference that “it is physically impossible to wipe out boars.”

Specialists urged farmers not to hope for some compensation from the authorities after the slaughter of both their poultry and swine. Since due to the coronavirus epidemic the budget was adopted with a big deficit, the state may not have the money for such compensation.

Functionaries also said that 1,500 head of cattle, 2,500 swine and about 150,000 poultry are weekly brought to Tatarstan.

France raises bird flu alert level after severe form of virus detected [Euronews, 10 Sep 2021]

France has raised its bird flu alert level after a severe strain of the virus was detected on a northern farm.

A severe strain of the virus was reported this week at a private household in the Ardennes region, near the border with Belgium.

The French Ministry of Agriculture announced that it had immediately raised the risk level in the country to "moderate".

Birds and poultry have also been and quarantined in sensitive areas from Friday, the ministry added.

The new case comes less than a week after France officially announced the end of the influenza outbreak that saw more than 3.5 million birds culled last winter.

But the ministry said in a statement that the reports of the infection did not call into question their actions.

The new highly contagious H5N8 strain of avian influenza was found at a private property, where the birds are not sold. All the animals have now been euthanised to prevent further cases.

Since the beginning of September, two cases of H5N8 have also been declared in Belgium, while another linked case of the virus was also found in Luxembourg.

Since the beginning of August, 25 cases have been detected in wildlife and other captive birds in Europe, French authorities say.

By raising the risk level from "negligible" to "moderate", France has ordered that all poultry must be kept inside shelters and has issued a ban on any public bird competitions. Animals in zoos that cannot be confined must also be vaccinated under the measures.

The ministry said that all the measures taken on Friday would be accompanied by "daily clinical surveillance in all farms".

Between November and May, France had recorded nearly 500 outbreaks of avian influenza in poultry farms, mainly in the southwest of the country.

Bird flu outbreaks can prompt importing countries, notably in Asia, to impose trade restrictions on poultry products. France is the world's largest producer of duck foie gras, with annual sales estimated at €2 billion.

Will the H10N3 Avian Flu Strain, Now in Humans, Become the Next Pandemic? [BioSpace, 8 Sep 2021]

By Gail Dutton

The first human case of a new strain of avian flu was diagnosed in China in late May. Chinese health authorities say there is a low risk of contagion. After China notoriously underreported COVID-19 mortality, can this new assurance be trusted?

Dubbed H10N3, this strain of bird flu is a subtype of the Influenza A virus. It was diagnosed May in a 41-year-old man in Jiangsu province. The man developed symptoms April 23, was admitted to a hospital April 28, and diagnosed a month later. A few days ago, China’s National Health Authority announced he was ready to be discharged, according to coverage by The Wall Street Journal.

There was no information about how the man contracted the H10N3 virus, but the public was advised to avoid contact with sick poultry.

That advice was based on previous outbreaks of other strains of avian flu – notably Asian lineage H7N9 and HPAI Asian lineage H5N1. Those incidents occurred after close contacts with infected poultry, according to the Centers for Disease Control & Prevention (CDC). So far, however, there is no evidence of human-to-human transmission for the H10N3 strain, and the Chinese government says contact tracing efforts have not identified any other cases.

So far, so good.

Of course, China has a history of downplaying outbreaks. The SARS-CoV-2 virus that caused COVID-19 was responsible for illnesses as early as October 2019 that weren’t reported until late December 2019. Even then, the risk was minimized until other nations realized the severity of the situation.

Estimates of mortality figures in Wuhan, based on crematorium activity in January and February of 2020, for example, suggested 10-fold more deaths than normal. Early in the COVID-19 outbreak, China cracked down on scientists by requiring extra scrutiny on academic research papers relating to the cause of the pandemic before determining whether they could be published, CNN reported in April 2020. This spring, leaked documents revealed the underreporting of serious adverse conditions by China’s health authorities.

Since the beginning of the pandemic, Johns Hopkins University’s COVID-19 tracker reports that nearly 172 million people have been infected and nearly 3.7 million have died, globally, from COVID-19. It reports 103,094 cases of COVID-19 in China and 4,846 deaths from a population of 1.4 billion people, versus the 33.3 million U.S. cases and 6,723 deaths from a population of nearly 327 million.

The severe acute respiratory syndrome (SARS) outbreak that began in November 2002 in Guangdong province is another example. At the time, SARS was an unknown virus and physicians didn’t understand what was going on. Reporting was slow and the Chinese government admitted underreporting the numbers. Eventually, 8,096 people died in 26 nations.
Sometimes, of course, it’s right to merely keep an eye on things. Although the 2009 outbreak of a strain of H1N1 killed between nearly 152,700 and 575,400 worldwide, according to CDC estimates, the G4 strain of the H1N1 virus that emerged in 2020 still seems to be relatively benign despite having potentially pandemic-causing characteristics.

Hopefully, the H10N3 virus that just jumped to human will be a similarly uneventful infectious disease. After both SARS and COVID-19, however, the world is wary.

Avian influenza strains often originate in Asia and rarely spread to human populations. The H10N3 strain of the influenza virus is likely to follow that pattern. Even among birds it is rare, Filip Claes, regional laboratory coordinator for the United Nation's Emergency Center for Transboundary Animal Diseases, told Reuters.

Rarity doesn’t affect lethality, though.

A prior strain of H5N1 first was detected in geese in 1996 before jumping to humans in 1997. Only about 700 human cases have been reported since that jump. Those cases, however, had a 60% mortality rate. Mortality was highest among people between the ages of 10 and 19, the CDC reported, most likely because older adults still had immunity from a related virus that swept the U.S. decades earlier.

Unless the H10N3 virus becomes easily transmissible among humans, it doesn’t pose a significant health threat to the world’s human population. As Adolfo Garcia-Sastre, a professor at the department of microbiology at Icahn School of Medicine at Mount Sinai in New York told the Wall Street Journal, “It is highly likely that this infection just represents one of the rare incidents of human infection with an avian influenza virus, without any more consequences.”

Avian Influenza A(H5N6) Case Confirmed in Mainland China [PrecisionVaccinations, 8 Sep 2021]

By Karen McClorey Hackett

(Precision Vaccinations)

The Government of the Hong Kong Special Administrative Region of China's Centre for Health Protection (CHP) announced today it is monitoring a human case of avian influenza A(H5N6) in the Mainland. The patient is in serious condition.

The case involves a 48-year-old woman living in Liuzhou, Guangxi, China, who had contact with live domestic poultry before the onset of symptoms. She is in serious condition, says the CHP.
Avian influenza (Bird Flu) is the disease caused by influenza type A viruses in animals. These viruses occur naturally among birds and domestic poultry.

"All novel influenza A infections, including H5N6, are notifiable infectious diseases in Hong Kong," a spokesman for the CHP said.

Travelers to China's Mainland or other affected areas must avoid visiting wet markets, live poultry markets, or farms. They should be alert to the presence of backyard poultry when visiting relatives and friends.

Travelers should also avoid purchasing live or freshly slaughtered poultry and avoid touching poultry/birds or their droppings. Furthermore, they should strictly observe personal and hand hygiene when visiting any place with live poultry.

Humans do not normally contract Avian flu viruses; however, human infections have occurred and are very lethal. From 2014 to date, China Mainland health authorities have reported 42 human cases of avian influenza A(H5N6).

The European Medicines Agency conditionally Authorized AstraZeneca's Pandemic influenza vaccine (P/LAIV) H5N1 in May 2017 to prevent influenza in an officially declared pandemic in children and adolescents.

The annual 'flu shot' does not offer protection against Avian influenza viruses, says the U.S. FDA.

Bird flu hits Tumu [Modern Ghana, 8 Sep 2021]

The Sissala East Municipal Department of Agriculture has announced the outbreak of Avian Influenza, otherwise known as Bird Flu, at Tumu in the Upper West Region.

“On 3rd September, 2021, bird carcasses sent to the Accra Veterinary Laboratory tested positive for Avian Influenza from a commercial poultry farm in Tumu, Sissala East Municipality,” it said.

A statement issued and copied to the Ghana News Agency (GNA) by Mr Eric Tergu, the Sissala East Municipal Veterinary Officer, said the farm had been quarantined and biosecurity had been strengthened.

It said depopulation and disinfection of the farm was underway and that additional control measures being implemented included ban on movement in and out of the farm.

The statement said veterinary staff in the Municipality had also intensified surveillance for the disease and expressed confidence that stakeholders would collaborate with the Veterinary Services to prevent its spread.

Bird Flu is a viral zoonotic disease of chicken, turkey, guinea fowl, and other avian species, especially migratory waterfowl.

The disease is of public health importance because it can affect human beings as well.
Socio-economically it causes heavy losses in affected commercial poultry farms due to its ability to cause high morbidity and mortality.

Ghana had outbreaks of Avian Influenza in 2007, 2015, 2016 and 2018.

This year's outbreak has affected the Volta, Greater Accra, Central, Ashanti, Western and Western North regions and now the Upper West Region.

Zoonotic Swine Flu News since 28 Jan till 12 Oct 2021

Wyoming Department of Health: Don't Overlook Need for Flu Shot [K2 Radio, 12 Oct 2021]

By Nick Perkins

Though the COVID-19 pandemic has certainly taken center stage in terms of vaccine warnings, influenza (otherwise known as the flu) is still something to be taken seriously. As is the need for the flu shot.

The Wyoming Department of Health said that the need for flu shots remains extremely important to help protect Wyoming residents from influenza, despite a relatively quiet flu season last year.

“As the next flu season begins, we know flu shots remain the first and most important step in influenza protection,” said Dr. Alexia Harrist, state health officer and state epidemiologist with WDH. “Flu vaccines are safe and reduce illness, hospitalizations and deaths. Everyone six months of age and older should receive a flu shot.”

In a press release sent out Tuesday, the department of health stated that they have received "sporadic reports of flu from across Wyoming in recent weeks."

Influenza is a respiratory illness, with symptoms ranging from a simple cough, to a fever, a sore throat, a runny or stuffy nose, headache, extreme fatigue, muscle or body aches, and more. The flu can come on suddenly, and it is contagious.

The department noted that while most healthy people can recover from the flu, they can also spread it to people who are not as healthy and who are more at-risk for complications from the flu.

The flu, in many ways, is similar to COVID-19 and the two virus circulating at the same time could see a spike in flu or COVID-related deaths, which emphasizes the importance of getting both the flu and the COVID-19 vaccine.

Especially vulnerable people (IE: those who sometimes can't just 'get over' the flu) include young children, pregnant women, individuals with chronic health conditions such as asthma, diabetes, or heart and lung disease, and more. This sector also includes people 65 years and older, as well as healthcare workers and people who live with, care for, or are in contact with high-risk individuals.

“As we begin a new flu season, we expect influenza will circulate while COVID-19 remains a threat,” Harrist said. “Unfortunately, the pandemic continues to put a strain on our healthcare system. While we are unable to predict how much flu we’ll see in Wyoming this season, we are concerned about the combined impact of both influenza and COVID-19 on our hospitals and on our state’s residents. Both flu and COVID-19 can result in serious illness and that’s one reason testing is helpful. Testing can help guide treatment and care."

Harrist said that it's safe to kill two birds with one stone (or two viruses with one trip to the pharmacy) by getting the COVID vaccine, including then recently authorized booster doses, and the Flu vaccine at the same time. In fact, the department noted, many testing options (like the ones run through the Wyoming Public Health Lab) can detect influenza and COVID-19 in the same sample.

It takes approximately two weeks after receiving the vaccine for it to begin offering protection.
Last year, there were significantly fewer cases of influenza in Wyoming and beyond. The reasons for this can be argued, but the general consensus seems to be that, because of COVID-19, individuals were being much more cautious in their behaviors and activities.

“Reported flu activity was unusually low over the past flu season. Looking back, it appears the precautions intended to slow the spread of COVID-19 also likely reduced the impact of influenza significantly,” Harrist said. “People were not traveling as much, they weren’t socializing as frequently, they were often wearing masks and they were taking extra care with measures such as handwashing and cleaning.”

As precautions seem to settle down (less mask-wearing, for instance), it's entirely possible for the number of flu cases to skyrocket, which is why getting your flu shot is a quick, easy, and relatively painless way to keep yourself and others healthy.

The Wyoming Department of health noted that vaccines are available in many locations, including public nursing offices, workplaces, doctors' offices, pharmacies, retail stores, and more. Flu shots are generally covered by most insurance plans.

Additionally, the department said, Wyoming's public vaccine programs, which are available at participating providers, can help to protect some adults and children from "vaccine-preventable diseases, such as influenza, at little to no cost for eligible patients."

While much is still unknown about the coronavirus and the future, what is known is that the currently available vaccines have gone through all three trial phases and are safe and effective.

It will be necessary for as many Americans as possible to be vaccinated in order to finally return to some level of pre-pandemic normalcy, and hopefully these 30 answers provided here will help readers get vaccinated as soon they are able.

'Gainesville Plague': Flu symptoms widespread on campus [The Independent Florida Alligator, 11 Oct 2021]

By J.P. Oprison
The increase in cases follows a near flu-free year during the COVID-19 pandemic

Coughs, runny noses and sore throats are now common symptoms for many UF students.
After a decrease of flu cases in 2020, students are once again catching the “Gainesville Plague” three months into the semester.

Cold and flu season reaches UF every year and is often referred to as the “Gainesville Plague,” said Ronald Berry, director of the Student Health Care Center. Students seem to use the label because the illness spreads quickly, leaving many sick in a short span of time, he said.

However, last year there were fewer flu cases worldwide because of precautions taken to protect against COVID-19. The number of flu cases last flu season was so small Berry said the SHCC didn’t keep track of how many there were.

Flu cases are rising now, Berry said, partly because of a lack of mandated precautions at UF, such as mask wearing and social distancing.

Jack Nelson, a 20-year-old UF graphic design junior, said he’s noticed students in his graphic design program falling ill. In the last three weeks, the attendance in Nelson’s class dropped to almost half, he said.

He said he has been sick for about a month, since the day of the first UF football game, with a sore throat and congestion.

“Since then I’ve had those same symptoms, they’ve gotten a little worse here and there,” Nelson said. “It feels like I’m basically just on cruise control.”

In September, 1,440 students with symptoms were seen at UF’s infection units, which were created when COVID-19 first hit, Berry said. The unit performed 545 COVID-19 tests: 5% came back positive. Of all strep tests, 16% were positive, and of all flu tests, just 1% were positive.
Most of the students probably have colds, Berry said.

UF set up several infection units across campus to reduce spread as flu season began, and the Student Health Care Center added appointment slots for flu shots. More students have been visiting the units this past month, Berry said.

To stay safe as illnesses spread, Berry said students should continue to wear masks and social distance. With a rapid flu test, students can receive flu medicine within the first couple of days of infection for a faster recovery. Berry also recommends students get their flu shot and COVID-19 vaccine.

“We recommend getting the flu shot early in the flu season, which is the fall,” Berry said. “That covers you into the spring.”

It’s possible the flu could get worse, he said. Flu cases in Gainesville usually peak in January when students return to campus from Winter break because it spreads more easily in cold weather.

In Fall 2019, there were 191 flu cases through December. January 2020 also saw 191 cases, followed by another 100 total cases in February and March. During that flu season, 60% of all cases were in the Spring semester, he said.

But right now, students like Jeremy Rutenberg, a 21-year-old UF mechanical engineering junior, said he has friends who’ve been sick for the past two weeks with cold symptoms, such as a runny nose, coughing and headaches. However, he isn’t worried about getting sick.

“I stay away from people who are sick, definitely wash my hands regularly,” Rutenberg said.

Kyle Giovanniello, a 19-year-old UF aerospace engineering sophomore, said he’s worried about the Gainesville Plague continuing to spread, even though he first heard of it this semester.
Because his three roommates got sick with it quickly, he thinks it’s highly contagious.
“But it doesn’t seem like it’s that bad, so I’m not too worried about the severity of it,” Giovanniello said.

Jacob Hutchinson, a 21-year old UF instrumental performance senior, said he isn’t worried about the sickness either. He said some might think the spread is worse than it is because people are more aware of symptoms with the COVID-19 pandemic. For example, more people could be self-quarantining when they have symptoms.

“I don’t think that I would avoid going out or anything for the Gainesville Plague alone,” Hutchinson said.

Flu practically vanished last year. Now doctors are bracing for potential ‘twindemic’ of flu and covid-19 spikes. [The Washington Post, 8 Oct 2021]

by Fenit Nirappil

Health officials are urging Americans to get their flu shots, warning the flu season that didn’t materialize when most of society was shut down last year could come roaring back and strain hospitals in the months ahead.

Survey data released Thursday found slightly more than half of American adults plan to be vaccinated against influenza. That’s not much of a change from pre-pandemic surveys conducted by the National Foundation for Infectious Diseases, but health authorities are alarmed because some evidence points to a potentially more severe flu season. Experts say Americans have built up less natural immunity against influenza because so few were infected in 2020.

“This low flu activity was likely due to the widespread implementation of covid-19 preventive measures like masks, physical distancing and staying home,” Centers for Disease Control and Prevention Director Rochelle Walensky said in a Thursday briefing announcing flu vaccination efforts.

“Because of so little disease last year, population immunity is likely lower, putting us all at risk of increased disease this year,” she added.


The United States already saw a similar pattern with the spring and summer resurgence of common viruses including respiratory syncytial virus, known as RSV. Hospitals reported surprisingly high numbers of toddlers coming in with severe cases, likely because they were not exposed as infants in the early months of lockdown.

Flu viruses may also roar back with more opportunities to spread this fall and winter in reopened schools, workplaces and businesses, especially where masks are not mandated.
Hospitals already battling simultaneous pediatric spikes in covid-19 and RSV fear oxygen and staffing will be stretched thin if flu and coronavirus admissions surge together in the months ahead — a dreaded scenario they avoided during the last winter surge.

Covid cases among children are soaring. In Tennessee, kids are largely unmasked
The fears are especially acute after hospital systems, especially in the South, struggled to manage the summer wave of covid-19 admissions, said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association.

She noted some hospitals, including in Florida and California, were running out of oxygen because of the heavy demand from covid-19 patients struggling to breathe. Hospital leaders also fear burnout among doctors, nurses and respiratory therapists who have been on the front lines of the pandemic and have been growing frustrated as they confront coronavirus surges that robust vaccinations would have prevented.

“The same specialists who would care for covid patients are among those who would be caring for flu patients as well,” Foster said last week. “We don’t want those individuals to be so overworked they cannot appropriately care for you, regardless of what brought you into the hospital.”

The Cedars-Sinai health-care system in Southern California, which battled a devastating coronavirus surge in the winter but had zero flu cases, is among the hospitals urging people to get coronavirus vaccinations and flu shots to prevent spikes of both.

“It would be worst-case scenario,” said Soniya Gandhi, an infectious-disease physician and vice president for medical affairs. “There are several hospitals (nationally) operating at full capacity. And that’s now. So going into the winter, the best way to protect and preserve that hospital capacity is for individuals to be vaccinated as much as possible.”

Flu seasons are notoriously difficult to predict. While experts agree another nonexistent season is unlikely, other evidence suggests the upcoming one could be typical or milder than normal.
Some experts say the remnants of coronavirus-containing measures, from school mask mandates to office reopenings delayed until next year, could block the virus from circulating as it would in a normal year.

How the delta surge upended back-to-office plans
The public may have also learned some good infectious-disease practices after more than 18 months of pandemic life. The National Foundation for Infectious Diseases survey found that nearly half of respondents were more likely to stay home when sick because of the pandemic and slightly more would wear masks in some crowded situations.

The survey was also conducted in early August before the late summer surge in coronavirus cases brought more attention to the pandemic’s continued dangers and before public health authorities could launch an extensive flu vaccine drive.

“None of us can predict whether it will be mild, moderate or severe flu season, but we are certain that there will be flu activity,” said William Schaffner, medical director of the National Foundation for Infectious Diseases. “We certainly don’t want a twindemic, both covid and influenza.”

Public health authorities are worried that parents may let their guard down about the flu. While one child died in the 2020-21 flu season, nearly 200 did the year before.

Walensky cited new estimates showing that about 59 percent of children ages 6 months to 17 years received a flu shot the past season, a slight decline from the previous season. She attributed the decrease to disruptions in routine medical care during the pandemic.

Regulators could authorize the Pfizer-BioNTech coronavirus vaccine for children between the ages of 5 and 12 as soon as November, paving the way for some children to receive flu and coronavirus shots at the same time. Doctors are urging parents to bring their children in for flu shots earlier with flu season already starting in much of the country.

Brandi Freeman, a pediatrician at the University of Colorado School of Medicine, said parents have already been pushing for flu shots since August, although the first shipment didn’t arrive until this month.

The demand is welcome news to a pediatrician emerging from an unusually busy summer and not expecting much of a break with schools back in session and kids becoming exposed to viruses for the first time.

“We are trying to restructure our clinic, restructure our staffing to be able to accommodate what we expect to be a pretty intense season,” Freeman said.

The summer coronavirus surge has started to ebb, but delta’s danger remains
She’s also told parents to expect doctors to be overwhelmed trying to figure out which respiratory virus is making which child sick, especially if multiple infections spike at once. The more viruses a child has been vaccinated against, the easier that detective work becomes.

Children’s Healthcare of Atlanta, one of many hospitals throughout the Southeast reporting a spike in pediatric RSV cases over the summer, is preparing for the possibility of a similar surge in pediatric flu cases after the Thanksgiving and Christmas holidays.

“One of the challenges we face is because we thankfully did not have a very active flu season last year, some parents feel flu is not a concern,” said Andi Shane, the hospital system’s medical director of infectious disease. “I think it’s important we understand what happened last year was great in the sense we didn’t have a lot of transmission … but we may have less immunity.”

Why easing COVID restrictions could prompt a fierce flu rebound [Nature, 7 Oct 2021]

By Nicola Jones

As pandemic restrictions ease, other respiratory viruses are returning in unexpected ways.

The COVID-19 pandemic is continuing to have unusual and unexpected effects on a number of respiratory diseases — some have been quashed, others have ploughed through and still more are rebounding off-season. These fluxes are complicating medical responses to the pandemic, but also providing scientists with an opportunity to study how these viruses spread.

As cold-and-flu season ostensibly starts in the Northern Hemisphere, researchers warn to expect the unexpected. “If anyone tells you they know, they don’t know,” says epidemiologist John Paget at the Netherlands Institute for Health Services Research in Utrecht. Most agree that influenza will eventually rebound, possibly fiercely, as travel restrictions and societal interventions designed to curb the coronavirus, such as mask wearing, wane. “Once we let our good health practices lapse, then flu is likely to hit hard,” says Robert Ware, a clinical epidemiologist at Griffith University in Queensland, Australia.

Seasonal flu typically kills 290,000–650,000 people a year worldwide. But for most of 2020 and 2021, it practically vanished from much of the globe. FluNet, a tool for tracking global virological data on influenza maintained by the World Health Organization, shows that the proportion of positive flu tests has remained roughly flat since April 2020, despite increased surveillance (see ‘Viral shift’).

Flu break
The United States recorded just 646 flu deaths in the 2020–21 season — the annual average is in the tens of thousands — and there was only one paediatric flu death. Australia has had no seasonal influenza deaths so far in 2021, compared with between 100 and 1,200 in previous years.

The decline in flu has persisted despite the variable lifting of social interventions to curb coronavirus. This hammers home the importance of international travel in bringing flu to any given country, says Richard Webby at St. Jude Children’s Research Hospital in Memphis, Tennessee. “It says a lot about seeding events and how important they are,” he says. Flu has continued to circulate at low levels in the tropics, researchers note, so will probably spread from there once borders reopen.

Pandemic response measures also seem to have suppressed some bacterial infections, including those that cause pneumonia and meningitis and are associated sepsis1. But some viruses have behaved differently. Rhinoviruses, for example, a major cause of the common cold, continued to spread throughout the pandemic, and infections even shot up in some countries2, possibly because these viruses aren’t as susceptible as many others to measures such as surface cleaning and hand washing, and because they faced little competition from other respiratory viruses. There is emerging evidence that these mild viruses might protect people from more serious diseases during infection3,4.

And some typical winter viruses have bounced back out of season. Infections caused by common human coronaviruses (another major common-cold culprit) and parainfluenza viruses were at very low levels in the United States in 2020 but started to rise to pre-pandemic levels in spring 2021 — an unusual time for colds to hit. Likewise, infections with respiratory syncytial virus (RSV), which usually causes mild cold symptoms but is also responsible for about 5% of deaths in children under 5 worldwide, were at a historic low for a year and then started rising months later than usual, in April 2021. RSV infections were still climbing at the end of August (see ‘Strong rebound’).

Off-season peaks
The strangely timed bumps might be related to school reopenings, according to a report from the US Centers for Disease Control and Prevention (CDC)5, along with a build-up of susceptible, unexposed infants in the absence of a vaccine (RSV vaccines are under development).

Off-season RSV peaks have been seen elsewhere, too, in countries including South Africa, Japan, Australia and the Netherlands. In Western Australia, an RSV peak in December 2020 was 2.5 times larger than the July peak for 20196. A steep onset of disease doesn’t necessarily translate to more cases overall, however: the total number of RSV cases in Queensland was lower than usual, Ware notes, “but because all the cases came close together it was much more intense”, putting strain on health resources.

It would be worrying to see rebound effects caused by a build-up of immunologically naive people in seasonal flu, researchers caution. Around the world, there are signs of circulating H3N2, H1N1 and B influenza viruses, says Amber Winn, an epidemiologist in the CDC’s Division of Viral Diseases in Atlanta, Georgia. A wave of influenza B infections in winter 2019–20, she notes, contributed to a record number of paediatric flu deaths that season. “That’s why getting your flu vaccine this season may be especially important,” she says.
doi: https://doi.org/10.1038/d41586-021-02558-8

References
1. Brueggemann, A. B. et al. Lancet Digital Health 3, E360–E370 (2021).
2. Takashita, E. et al. Influenza Other Respir. Viruses 15, 488–494 (2021).
3. Van Leuven, J. T. et al. Preprint at bioRxiv https://doi.org/10.1101/2020.11.06.371005 (2021).
4. Dee, K. et al. J. Infect. Dis. 224, 31–38 (2021).
5. Olsen, S. J. et al. Morbid. Mortal. Weekly Rep. 70, 1013–1019 (2021).
6. Foley, D. A. et al. Arch. Dis. Child. https://doi.org/10.1136/archdischild-2021-322507 (2021).

CDC director warns the U.S. is at risk of a severe flu season this year [CNBC, 6 Oct 2021]

By Berkeley Lovelace Jr.

Centers for Disease Control and Prevention influenza experts are concerned that the United States could be at risk for a severe flu season this year, Director Dr. Rochelle Walensky warned Wednesday.

That’s because the U.S. population may now have reduced immunity against influenza after seasonal flu cases reached an all-time low last year when large parts of the nation were shut down, Walensky told reporters during a White House press briefing.

During the 2020-2021 flu season, there were very few flu cases, “largely because of masking and physical distancing and other prevention measures put in place for the Covid-19 pandemic,” she said.

The next flu season will be a ‘whopper,’ former FDA chief Scott Gottlieb says
There were around 2,000 flu cases last influenza season, according to data reported to the CDC. By comparison, the 2019-2020 flu season saw an estimated 35 million cases, according to the agency.

Walensky urged Americans to get shots for both Covid and the flu, saying vaccinations are not just important for ending the pandemic but also preventing other infectious diseases. An increase in flu infections this winter could put an additional burden on the nation’s health-care system, increasing stress on health care workers who are already fighting a high number of hospitalizations due to Covid, she said.

About 69,000 Americans are currently in inpatient beds with Covid, according to the Department of Health and Human Services.

“We continue to see many hospitals and intensive care units across the country at full capacity,” Walensky said. “Each year in the United States, influenza can claim between 12,000 and 52,000 lives and result in 140,000 to 710,000 hospitalizations.”

She said it is safe and effective to get vaccines for Covid and the flu at the same time.

“We need as many people as possible to be vaccinated for influenza, so that we can provide protection for those who are at most risk, such as adults who are over 65, those of any age who have chronic health conditions such as asthma, heart disease or diabetes, and children, especially under five who are at risk of severe complications from the flu,” she said.

The Flus Return Puts Health Officials In Uncharted Territory [Patch.com, 22 Apr 2021]

By Andy Nguyen

Public health measures in response to the coronavirus all but stopped the flu but, it's poised for a comeback.

ACROSS AMERICA — The flu all but disappeared in the United States after large numbers of Americans stayed home in response to the coronavirus. However, as the country begins to reopen, it's not a question of if the flu will return but when, health officials say.

As the United States entered into fall last year, there were fears the country would see a "twindemic" with the nation battling both the flu and COVID-19 at the same time. But, the "twindemic" never happened, and the flu season all but disappeared, according to a report from The New York Times.

Since September, the Centers for Disease Control and Prevention has logged around 2,000 cases of the flu in the country. Under normal circumstances, the number of cases in that same time frame would be around 206,000, according to The Times.

Scientists credit the measures implemented by health agencies responding to the coronavirus as a key reason the country saw the dramatic reduction in flu cases. But they don't know if any one action, like more frequent handwashing or vigilant masking wearing in public, was a contributing factor.

With more people getting vaccinated against COVID-19 and returning to normal activities like going out to eat and spending time with friends, the flu's return is inevitable, according to The Times. Scientists aren't sure what the flu will look like when it does come back.

"We're in uncharted territory," Richard Webby, a virologist at St. Jude Children's Research Hospital in Memphis, Tennessee, told The Times. "We haven't had an influenza season this low, I think as long as we've been measuring it. So what the potential implications are is a bit unclear."

It's estimated that 9 million to 45 million people nationwide get the flu each year, according to the CDC. Of that amount, around 12,000 to 61,000 people die from it.

The flu's dormancy has made it difficult to determine how to tailor the annual flu vaccine. With fewer people getting sick, scientists have had trouble predicting which flu strains the vaccine should protect against, The Times reported.

Because of this uncertainty and the low rates of infection, scientists theorize the return of the flu may lead to larger outbreaks across America. They'll likely also occur outside the normal flu season.

However, there is an upside, according to The Times.

Because the flu hasn't been circulating as much during the pandemic, flu strains haven't been able to mutate, and it could mean the current vaccine will still be effective.

Taiwan records first flu death this season [Focus Taiwan News Channel, 30 Mar 2021]

By Elizabeth Hsu

Taipei, March 30 (CNA) Taiwan's Centers for Disease Control (CDC) on Tuesday reported the first influenza death of the current season, which started last October.

The patient, in his 80s, had multiple chronic illnesses, including diabetes and high blood pressure, and had previously suffered a stroke, CDC physician Lin Yung-ching (林詠青) said at a press conference held by the Central Epidemic Command Center.

The man, who had not received the seasonal flu vaccine, was hospitalized in southern Taiwan on March 21 with breathing problems and vomiting, Lin said. The patient was later diagnosed with aspiration pneumonia and was transferred to an intensive care unit, Lin added.

On March 25, the man tested positive for the A-type flu virus, and he died two days later of severe flu complications that included kidney failure and septic shock, Lin said.

CDC data shows that since the beginning of the flu season in October last year, two severe flu cases have been reported, one of which was an H3N2 virus infection.

The number of severe flu cases and deaths so far this season has been much lower than in the past four seasons, when severe cases ranged between 360 and 966 and deaths were 56-159, according to the data.

As of March 28, 52.5 percent of Taiwan's over-65 population had been vaccinated against seasonal flu, under a government-funded inoculation program that started last October, while 51.1 percent of pre-school children had received the shots, the CDC said in a press release Tuesday.

The flu season in Taiwan usually lasts from October to March.

'Swine flu' case reported in North Carolina - Outbreak News Today [Outbreak News Today, 27 Mar 2021]

The Centers for Disease Control and Prevention (CDC) reported a case of human infection with a novel influenza A virus, or “swine flu” in North Carolina, in their latest FluView report.

According to the report ending March 20, the individual was infected with an influenza A(H1N1) variant (A(H1N1)v) virus in 2020. The patient is an adult > 18 years of age, was not hospitalized, and has recovered from their illness.

An investigation into the source of the infection revealed that the patient worked with and had daily contact with swine. No human-to-human transmission has been identified in association with this patient.

While this variant virus infection was not identified until 2021, it represents the first influenza A(H1N1)v virus identified from a specimen collected in the United States in 2020 (during the 2020-21 season). No influenza A(H1N1)v virus infections have been identified in specimens collected in 2021 thus far.

When an influenza virus that normally circulates in swine is detected in a person, it is called a variant influenza virus and is labeled with a ‘v’.

Influenza viruses such as H1N1(v) and other related variants are not unusual in swine and can be directly transmitted from swine to people and from people to swine.

When humans are in close proximity to live swine, such as in barns and livestock exhibits at fairs, movement of these viruses can occur back and forth between humans and animals.

The illnesses resulting from H1N1(v) infection are similar to seasonal influenza. Symptoms include fever, muscle aches, decreased energy, coughing, runny nose, and sore throat.

Pirbright study creates swine flu antibodies that can improve human flu vaccine [The Pig Site, 5 Mar 2021]

The Pirbright Institute has generated the first pig antibodies against swine flu that could improve human health treatments and guide flu vaccine selection.

HUMAN

The Pirbright Institute has generated the first pig antibodies against swine influenza (flu) that protect against infection and recognise the same parts of the flu virus as human antibodies. This indicates they could be used to develop and assess human antibody therapies and their delivery methods. The pig antibodies also have the potential to improve how flu virus evolution is monitored and inform decisions about annual flu vaccine selection.

Antibodies form a vital part of the immune system’s response and help to fight off infections by latching on to important parts of invading microorganisms to neutralise them. In the case of flu viruses, many antibodies target a protein on the surface of the virus called haemagglutinin, which then prevents the virus from entering cells and replicating.

Pirbright scientists worked in collaboration with the University of Oxford, The Francis Crick Institute and The Pirbright Livestock Antibody Hub to generate pig antibodies in the laboratory (known as monoclonal antibodies, or mAbs). These are the first pig mAbs to be generated which target the influenza virus.

These mAbs recognise the same two main sites of the flu virus haemagglutinin protein that are targeted by human antibodies, and were found to be just as effective at neutralising the swine flu strain that caused the 2009 pandemic. Pigs that were treated with one of the mAbs prior to infection were protected from severe disease and the flu virus was eliminated from their lungs. This indicates that the mAbs have great therapeutic potential and could be used to evaluate mAb delivery methods.

This work reinforces the use of pigs as powerful model to predict human responses in infection and vaccination.

PROFESSOR JOHN HAMMOND, LEADER OF THE PIRBRIGHT LIVESTOCK ANTIBODY HUB
Ferrets are commonly used as models to monitor flu virus evolution and to design or select vaccines that will provide the best protection against human seasonal flu strains. However, ferret antibodies only recognise one of the two main haemagglutinin sites that human antibodies target. The findings in the study, published in PLOS Pathogens, demonstrate that pig mAbs are more closely matched to human antibodies and could therefore improve the reliability of human vaccine selection.

Dr Elma Tchilian, Mucosal Immunology Group Leader at Pirbright, said: “These data demonstrate that pigs and humans, which are both natural hosts for influenza viruses, generate very similar immune responses. This makes the pig an excellent translational model for testing novel vaccines and monoclonal antibody delivery methods.”

Professor John Hammond, leader of The Pirbright Livestock Antibody Hub, added: “These results are a fantastic demonstration of how The Pirbright Livestock Antibody Hub can promote the use of new tools and methods, providing the opportunity to examine detailed antibody responses to inform the next generation of vaccines and therapies. This work reinforces the use of pigs as powerful model to predict human responses in infection and vaccination.”

Belgium has no flu epidemic, health authorities say [The Brussels Times, 14 Feb 2021]

The number of visits to the doctor for influenza symptoms since the Summer of 2020 is higher than in previous years, due to the novel Coronavirus, but there is no flu epidemic for the moment in Belgium, Sciensano notes in a press release.

These trends can also be seen in Europe and the rest of the world, the public health institute added.

For an outbreak of flu to be considered an epidemic, the number of weekly visits to a general practitioner must he higher than a certain epidemic threshold, while at least 20% of patients’ breath samples need to test positive for the flu virus.

This year, “despite the number of samples analysed, the number testing positive for flu is much lower than in previous winters,” Sciensano reported.

It is impossible to tell flu symptoms from those linked to the novel Coronavirus, so the public health institute can only base its assessment on the spread of flu on the number of positive lab tests and positivity rates among patients with flu symptoms.

Thus far, “very few positive laboratory results for flu have been registered in Belgium,” Sciensano said in its press release. Other monitoring networks, such as nursing homes and hospitals, “have also not reported any positive sample for the flu virus,” it added, concluding that “the flu epidemic is therefore not here, for now.”

The small number of flu infections is likely due to the hygiene and preventive measures taken against the novel Coronavirus. Moreover, more people took the flu vaccine in Autumn.

Laboratory test results for other respiratory infections are also down this winter.

Why the Flu Season Basically Disappeared This Year [Healthline, 11 Feb 2021]

by Julia Ries & Michael Crescione

• Flu season has been mild this year, thanks to the mitigation measures used to contain COVID-19, such as physical distancing and mask wearing.
• School and office closures also contributed to the unusually inactive flu season.
• The mitigation measures curbed influenza activity even though COVID-19 surged.

Last summer, infectious disease specialists warned that the COVID-19 pandemic could spiral into a “twindemic” when seasonal influenza hit.

But that nightmare scenario never unfolded. The flu didn’t get a strong footing in the United States this season and a twindemic never struck.

COVID-19 is likely far more contagious than the flu.

Because the virus that causes seasonal influenza spreads via respiratory droplets, the safety precautions used to prevent COVID-19, such as mask wearing and physical distancing, also helped cut down flu activity.

What drove down flu activity?

Due to influenza’s short incubation period and widespread population immunity, the measures used to stop the spread of COVID-19 also caused flu activity to drastically drop.

Between Oct. 1 and Jan. 30, only 155 people in the United StatesTrusted Source have been hospitalized with the flu.

That’s a 98 percent decrease from the same window of timeTrusted Source in the 2019-2020 flu season in which 8,633 people were hospitalized with the flu.

The precautions used to prevent COVID-19 ended up drastically reducing influenza transmission.

Both are respiratory infections that spread via aerosol droplets.

“Any precaution you take to avoid COVID will also reduce your risk of contracting an influenza virus. Hand washing, social distancing, and wearing masks are certainly driving down cases of the flu,” said Dr. Casey Kelley, a family medicine physician and the founder and medical director of Case Integrative Health in Chicago.

School and office closures led to a drop in transmission

The closure of schools also contributed to this year’s low flu activity.

According to Kelley, children have less immunity to the flu since their immune systems haven’t been exposed to many pathogens.

SchoolsTrusted Source are also high-contact environments, making kids particularly susceptible to catching and transmitting the flu.

Past evidenceTrusted Source suggests kids are the number one source responsible for bringing the flu into householdsTrusted Source.

Like schools, offices are flu hotspots.

Flu germsTrusted Source can live on common surfaces — like doorknobs or the copy machine — for up to 24 hours. They also shoot through the air when a person coughs, sneezes, or exhales.

“Public transit, office buildings and business travel are all high-contact events that are down significantly [this year],” Kelley said.

Stories from a Past Pandemic [Scientific American, 28 Jan 2021]

Readers write in about their ancestors’ experiences during the 1918 flu
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A recent Scientific American feature explores how the catastrophic 1918 influenza pandemic seemed to quickly slip from public discourse. The event killed more than 50 million people worldwide, yet it takes up comparatively little space in society’s “collective memory.” The article considers, by analogy, how the current COVID-19 pandemic might be remembered by future generations. Scientific American accompanied the feature with a call for letters telling the stories of families affected by the 1918 crisis. Below are some examples of what we received.

READERS RESPOND

For what it’s worth, and because you asked for notes about this: my grandfather died in what I believe was the second wave of the pandemic on September 24, 1918. He was 26 and otherwise very healthy. He had two daughters, aged two and under one. The older daughter was my mother, and of course, she and her sister never knew their father in any real sense. My grandmother was deeply affected by his death, as you can imagine, and she always seemed to believe that he had caught a cold and that she could have done more to save him. This made her deeply anxious, more or less permanently, about the health of everyone in the family and especially me—I was named after my grandfather and was very close to her—and I always hid any cold that I had from her. In lots of ways, my grandfather’s death reverberated through the generations: it had a real effect on my mother and, eventually, me. His name was Samuel Rubinson, born August 15, 1892.

Samuel Guttenplan
Professor emeritus of philosophy, Birkbeck, University of London

Regarding the lack of collective memory of the 1918 pandemic, I had the same question when I heard of the pandemic and that my grandmother had died during it. It was the only family story ever told about her. Gone at 38, leaving five small children. My father was nine years old. In my book, Influenza and Inequality: One Town’s Tragic Response to the Great Epidemic of 1918, I wrote of this lack of memory. My book covers the epidemic, and epidemic behavior, in one small town—Norwood, Mass. I have dozens of personal stories in there, stories I heard from survivors, families and descendants. I believe that this lack of collective memory is linked in large part to the population of victims: the majority were young, foreign-born and poor.
Influenza did not discriminate but, like today, those who could afford to stay home and avoid infection were the privileged. Then, as now, it was marginal communities—those who lived and worked in hazardous environments and lacked medical access—who were struck down. In 1918 Hispanics and Asians in California; Mexicans in New Mexico and Texas; Polish, Italian and Irish immigrants in northern cities; and, as always, Native Americans and Black individuals were the most severely affected. Children left orphaned were often adopted by others and never told of their history. And, of course, unlike today, the majority of victims were between 20 and 40 years old. Who was going to remember young, poor immigrants? Who was going to build a memorial or write a history for such outcasts? They were nameless, voiceless and, as one scholar noted, “rapidly replaced.” Another early historian of the 1918 epidemic wrote, “If the pandemic had killed one or more of the really famous figures of the nation or the world it would have been remembered.... Spanish influenza characteristically killed young adults and therefore rarely men in position of great authority.” That’s no defense. Hopefully, today’s victims will not be so invisible and easily forgotten.

Patricia J. Fanning
Professor emeritus of sociology, Bridgewater State University

I just read your article on the 1918 flu (the University of Washington sent it out on our daily newsletter because you interviewed a U.W. faculty member), and I noted the call for stories about ancestors at the end.

It’s funny, that very “forgetting” rang true for me and my family, too. I just spoke with my 91-year-old grandmother about 10 days ago, and she told me that her father (my great-grandfather, Georg Monsen) survived the 1918 pandemic but that his older brother, the older brother's wife and their two kids all died of it. I’ve been alive for four decades and am close to my grandmother, but I never heard any of this history until now. Plus, she said that her father had hearing loss for the rest of his life because of the effects of that flu, as did other members of the family that had it but survived. This all took place in western Norway, where my grandmother is originally from.

Tabitha Grace Mallory
Henry M. Jackson School of International Studies, University of Washington

I’m 71 years old. During my college years, I’d stay at my grandmother’s house almost every weekend. Grandmother and her sister, Anita, shared the house. On Sunday, we’d all go to the local Methodist church that my dad had helped build when he was younger.

One day, back home from church, my Great-Aunt Anita told me that after World War I, her whole family died from the 1918 flu: her husband and children. She believed, very strongly, that God had punished her, and she did not know why.

She still went to church and prayed.

She never talked about it again. If she’d told me how many children she’d had, I don’t remember.

My Grandmother and Aunt Anita have since passed away.

Steven Oliver
via e-mail

My great-grandfather, Navy Captain John King, made it through the Great War and died of influenza on a hospital ship off City Island in New York City. My grandmother (his daughter) used to take me to lunch on City Island. We always had to drive to the end of the avenue, where we could look across the Long Island Sound and East River to where the ship had been.

Grandma would recall her mother asking to be driven there to remember—remember her husband coming home from war and then being on that ship and never coming home again. After this the family (mom and four kids) moved to Baltimore, and Great-Grandma became an expert seamstress to pay the bills.

Karen Romano Young
via e-mail

Among the 675,000 people in the U.S. who lost their lives 102 years ago were nearly all of my great-grandmother’s immediate family. Both of her parents and a brother died. Her first husband and their one-year-old daughter died the same day in October 1918 and were buried together in the same coffin. After losing them, she wrote a letter to the local newspaper thanking friends and neighbors for helping to see her through the devastation. At the age of only 22, she was pregnant with her second child, a son who would never know his father. She also had to raise her younger siblings who survived. Later, she remarried. I am descended from that second marriage.

This happened in Oklahoma, a state that is currently dealing with spikes of COVID-19 and very sporadic mask compliance—with no statewide mandate in place. It’s demoralizing that a century after the 1918 pandemic, I have to ask: What have we learned? That those who do not learn from history are doomed to repeat it.

Shannon Leigh O’Neil
via e-mail

My dad would have been about 16 years old when the 1918 influenza both took his own father's life and sickened him. I was a child when he told me that, as the disease faded, “all [his] hair fell out.” It would be interesting to know if hair loss (head, body or both) was common in survivors of that disease. I’ve read it can follow high fevers.

In 1920 my father—with, by then, an abundant resupply of hair—entered the U. S. Naval Academy. No doubt at least some of his classmates were also influenza survivors. I’m inclined to believe that in the process of bonding with one another, they would have shared their “collective memories” of experiencing “the flu.”

It was routine, in this bonding process, for the men to confer on one another rather graphic or comic nicknames, which sometimes stuck with their recipients. I sometimes wonder whether a fellow survivor in my dad’s unit, being less blessed than my dad with an exuberant regrowth of hair, gave him the nickname that would follow him for the rest of his Navy career: “Woof.”

At age 75, I’m at the tail end of those who were spared by vaccination from the terrible scourges of smallpox, tetanus and diphtheria. But we had to experience for ourselves—and risk the complications—of illnesses now rarely seen in the developed world: measles, rubella, chicken pox, mumps, polio. Such experiences have certainly generated moments of collective memory.
It may not be like surviving the sinking of the Titanic—but each of these epidemics brought a potentially catastrophic aura, and each marked the families who suffered through them.

Elizabeth R. Hatcher
Topeka, Kan.

My paternal grandmother was born in 1900 in Conshohocken, just outside of Philadelphia, to immigrants from Molise, Italy. She was the fourth of 13 children. She was a strong women with few stories. Yet when I was a youngster in the 1960s, several times she told me a short one: “When I was 18 [years old], four of my younger [siblings] died during the [Great Influenza].
They were buried in a mass grave along the cemetery wall. My father died a few years later from a weakened heart.” I am a fairly good amateur family genealogist, having uncovered many family facts, but I have been unable to track this one down well. From the local newspaper and records from the area’s Catholic cemetery, I have confirmed a substantial two-week spike in deaths in Conshohocken shortly after the peak in Philadelphia in the fall. For those two weeks, the front page of the local newspaper was split vertically down the middle: one side covered the Great War, and the other side, the “Spanish flu.” My great-grandfather did indeed die in 1925. For the past five decades, family stories from remote relatives only know of nine children, not 13. Unfortunately, I don’t know the four other children’s names or genders, as I cannot find them in the 1910 census. And by 1920 they are dead—no death certificates. I need to keep working at it.

Michael F. Iademarco
Rear admiral and assistant surgeon general, U.S. Public Health Service
Director, Center for Surveillance, Epidemiology, and Laboratory Services, U.S. Centers for Disease Control and Prevention

First flu-associated death reported in Washoe County [KRNV My News 4, 28 Jan 2021]

RENO, Nev. (News 4 & Fox 11) — A man in his 60s is the first influenza-associated death in Washoe County for the current flu season and the first flu-associated death since December of 2019.

According to the Washoe County Health District, the man had underlying health conditions.
The latest influenza surveillance report (Week 2), shows nine flu hospitalizations reported by area hospitals and medical care providers.

In contrast, during Week 2 of the 2019-2020 surveillance report (Page 66 of 100), there were three flu-associated deaths and 90 hospitalizations reported.

“We have seen far fewer flu hospitalizations and deaths reported than in previous years,” District Health Officer Kevin Dick said. “However, with COVID-19 still being transmitted in our community, the same mitigations measures apply and we strongly encourage you to get a flu shot. It’s not too late. Having a flu shot will help prevent getting the flu and also will lead to less-severe symptoms if you do get it.”

With the flu season extending into May, the district is urging people to get a flu shot, as it is not too late.

If you anticipate receiving the COVID-19 vaccine, be advised that there must be a minimum interval of 14 days before or after administration with any other vaccine, including the flu shot.

According to the health district, while the flu shot cannot be guaranteed to keep you from getting the flu, those who do get a flu shot typically experience less severe symptoms if they do get the flu and are more likely to recover faster than if they had not received immunization for flu.

According to the Centers for Disease Control and Prevention (CDC), seasonal influenza in the United States in lower than usual for this time of year.

Malaria vaccine development since 5 Mayr 2021

Africans Welcome New Malaria Vaccine. But Is It a ‘Game Changer'? [The New York Times, 7 Oct 2021]

By Abdi Latif Dahir

The arsenal of weapons to use against malaria, which kills hundreds of thousands of people annually, just grew bigger.

NAIROBI, Kenya — When babies are born in western Kenya, where malaria is rife, many mothers are sent home from the hospital with one all-important baby gift: a bed net treated with insecticide.

“Malaria is our number one health problem,” said Mathews Ajwala, a community health worker who gives out the nets to ward off malarial mosquitoes that can cause severe illness and death. More than 400,000 people died of malaria worldwide in 2019, and two-thirds of those were children in Africa under age 5.

So when the World Health Organization on Wednesday announced that it had approved the world’s first malaria vaccine, African parents, government officials and health workers like Mr. Ajwala celebrated the moment as a milestone in the fight against a scourge that has plagued humans for millennia.

“This vaccine will be a big game-changer,” Mr. Ajwala said in a telephone interview.

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TRANSCRIPT

A ‘Historic Day’: W.H.O. Approves First Malaria Vaccine
Dr. Tedros Adhanom Ghebreyesus, the World Health Organization’s director general, said the long-awaited vaccine was a breakthrough for science and could save tens of thousands of young lives each year.

As some of you may know, I started my career as a malaria researcher, and I longed for the day that we would have an effective vaccine against this ancient and terrible disease. And today is that day — an historic day. Today, W.H.O. is recommending the broad use of the world’s first malaria vaccine. This recommendation is based on results from an ongoing pilot program in Ghana, Kenya and Malawi that has reached more than 800,000 children since 2019. This long-awaited malaria vaccine is a breakthrough for science, child health and malaria control. Using this vaccine, in addition to existing tools to prevent malaria, could save tens of thousands of young lives each year.


The vaccine, the first developed for any parasitic disease, was widely discussed on social media and on radio and television stations on Thursday. Many across the continent took pride in the fact that African scientists, research institutions and citizens helped provide and interpret the data that eventually led to the approval of the vaccine. The W.H.O. endorsement was based on the results of more than 2.3 million doses administered since 2019 to about 800,000 children in Kenya, Malawi and Ghana.

But Africans were also coming to grips with the fact that the vaccine alone will not solve the malaria problem.

In clinical trials, the vaccine, made by the British pharmaceutical company GlaxoSmithKline, was effective at reducing severe malaria by only 30 percent in the first year after it was administered, according to the W.H.O. — though some experts put the figure at closer to 50 percent.

To be effective, four doses of the vaccine must be administered starting at the age of 5 months — which could pose logistical problems since delivering vaccines on the continent is already a challenge.

“The vaccine saves lives but it will not be a silver bullet,” said Dr. Githinji Gitahi, the chief executive officer for Amref Health Africa, a nongovernmental organization.

The vaccine, called Mosquirix, targets the deadliest malaria parasite and the most common in Africa — Plasmodium falciparum. While the vaccines are a “huge addition to the fight” against malaria, said Dr. Gitahi, health officials will still have to deploy “a Swiss cheese strategy,” which includes insecticide-treated bed nets and indoor spraying.

Faith Walucho is the mother of an 11-month-old who was recently diagnosed with malaria. The 29-year-old trader of used clothing in the city of Kisumu in western Kenya said she received the news about the vaccines “with a lot of happiness.” In Kenya, an estimated 10,700 deaths from malaria are recorded annually, and Kisumu, on the shores of Lake Victoria, is one of the high-malaria regions where the vaccine was tested.

As soon as she’s able to get a dose for her daughter, Ms. Walucho said, “I will run” to get it.
In Malawi’s capital, Lilongwe, Jenala Mwafulirwa, a 52-year-old mother of five, welcomed the news of the vaccine, saying that too many children in her family had been lost to the disease, particularly in rural areas where access to health care is limited.

“This vaccine has come at the right time,” she said.

But in some places, people voiced skepticism about the vaccine, in part because of mistrust of the World Health Organization.

“I wonder why they want to help Africa,” said Mamadou Tounkara, a 40-year-old-teacher in Senegal’s capital, Dakar. He asked why the W.H.O. did not instead fund better hygiene and sanitation systems. “If W.H.O. wants to help eradicate this disease, they can do it without the vaccine.”

Yet public health officials say the vaccine, which has been in development for more than 30 years, has already proved to be an important weapon in the war against the disease.

Lilyana Dayo, a malaria program officer in Kisumu county, said the pilot testing reduced the effects of malaria by 18 percent.

At the Kisumu County hospital, the vaccine has helped free up beds that could be used for other ailments, said Salome Situma, a pediatric nurse. Hospitals in the county had been overwhelmed a few months ago as the third wave of the coronavirus pandemic, fueled by the Delta variant, swept Kenya and the continent.

“I feel privileged to be part of the system that is achieving and heading in the right direction,” Mr. Situma said.

Dr. Gitahi says the main challenge facing the malaria vaccine will be how to efficiently distribute it, not just to regions with moderate to high transmission, but also to conflict zones where malaria is endemic. Health officials will also have to figure out, he says, how best to balance and match malaria vaccination with other child immunization campaigns like polio and measles.
“That’s really the big policy question,” he said.

It is unclear how soon the vaccine will be widely available in Africa, said Dr. John Nkengasong, the director of the Africa Centers for Disease Control and Prevention, at a news conference on Thursday. He said the Africa C.D.C. will be talking with the W.H.O.

But many hope that when the vaccine is available, it will turn the tide on the disease once and for all.

When he was 5 years old, George Owino said he got so sick with malaria that his parents worried whether he would ever recover. Two of his three children — now ages 24, 21 and 18 — also got severely ill with the disease over the years.

“When people are told the vaccines are being rolled out, they should come out,” Mr. Owino said. “It’s a huge relief.”

Novel vaccination regimen shown to be effective in preventing malaria [European Pharmaceutical Review, 5 May 2021]

By Hannah Balfour

A three-dose regimen of Plasmodium falciparum sporozoites under chemoprophylaxis (PfSPZ-CVac) was shown to be safe, well tolerated and highly effective in a Phase II trial.

Researchers have shown that a new, condensed immunisation with Plasmodium falciparum (Pf) sporozoites under chemoprophylaxis (PfSPZ-CVac) regimen is highly effective and immunogenic, as well as safe and well tolerated.

Sanaria’s PfSPZ-CVac is a live vaccine consisting of Pf malaria parasites in the sporozoite phase of life and is administered at the same time as patients receive an antimalarial drug. The sporozoites quickly enter the liver after the injection, where they develop and multiply for 6 days, and then emerge into the blood. The drugs kill the parasites as soon as they emerge from the liver and thus, prime the immune system against many parasitic proteins, leaving the individual’s immune system highly effective at killing malaria parasites in the liver, preventing infection and disease.

While immunisation with PfSPZ-CVac is the most efficacious approach to malaria vaccination, so far, its implementation has been hampered by the complex chemoprophylaxis regimen, with patients requiring 13 visits to achieve immunisation, and missing evidence for efficacy against heterologous infection.

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In a new double-blinded, randomised, placebo-controlled study, investigators evaluated a condensed PfSPZ-CVac immunisation regimen in malaria-naive volunteers. The new regimen only requires three vaccinations, instead of 13.

The study enrolled 18 patients, 13 to receive direct venous inoculation of 1.1 × 105 aseptic, purified, cryo-preserved PfSPZ (PfSPZ Challenge) of the PfNF54 strain and five to receive placebo (saline), both with simultaneous oral administration of 10 mg/kg chloroquine base. The primary endpoints of the trial were safety and vaccine efficacy tested by controlled human malaria infection (CHMI) using the highly divergent, heterologous strain Pf7G8 found in South America.

Twelve weeks following immunisation, 10 participants in the vaccine group were protected against heterologous CHMI, while all participants receiving placebo develop parasitaemia, thus the risk difference was 77 percent. Immunisation was shown to induce 18-fold higher anti-Pf circumsporozoite protein (PfCSP) antibody levels in protected than in unprotected vaccinees, with such antibodies shown to be strongly associated with protection by protein microarray assessment.

PfSPZ-CVac was found to be well tolerated, with self-limiting grade 1–2 headaches, pyrexia and fatigue that diminish with each vaccination. As a result, the investigators concluded that their condensed regimen is highly efficacious, safe, well tolerated and highly immunogenic.

“With this study, we have reached a new important milestone in the development of an effective malaria vaccine. With only three immunisations over four weeks, we achieved very good protection against malaria,” explained Professor Peter Kremsner, who has helped to advance the malaria research field at the German Center for Infection Research (DZIF) since its inception.

DZIF co-ordinates translational infection research in Germany and provides strategic direction. It has 35 research institutions working together against the global threat of infectious diseases, the Tübingen site co-ordinates the research area Malaria.

The study was published in Nature Communications.

Tubingen study raises hope for effective malaria vaccine [EurekAlert, 5 May 2021]

Sanaria PfSPZ-CVac" is a live vaccine consisting of infectious Plasmodium falciparum (Pf) malaria parasites that are injected into the subject at the same time as they receive an antimalarial drug. The parasites quickly enter the liver where they develop and multiply for 6 days, and then emerge into the blood As soon as the parasites leave the liver, the drug kills them immediately. Thus, the immune system of the vaccinated subject is primed against many parasite proteins and becomes highly effective at killing malaria parasites in the liver to block infection and prevent disease.

"With this study, we have reached a new important milestone in the development of an effective malaria vaccine. With only three immunizations over four weeks, we achieved very good protection against malaria," explains Prof. Peter Kremsner, who has helped to advance the malaria research field at the DZIF since its inception. His team was able to develop a new immunization regimen that significantly reduces vaccine administration compared to previous studies. The number of visits required by a subject for complete immunization has been reduced from 13 to three. Importantly, the team showed that vaccination with parasites from Africa could protect against genetically diverse parasites from South America.

Proof of efficacy was provided using the controlled human malaria infection (challenge) regimen developed by the Tubingen and Sanaria teams. Here, the test subjects were infected with parasites after immunization. If immunization against the parasites was successful, the parasites would be specifically killed by the immune system. If the immune protection is incomplete and the parasites multiply, the test subjects are treated before any symptoms of disease appear. Ten of 13 subjects vaccinated in this study were completely immune to the infection.

"The vaccine produces a high level of different antibodies and immune cells in the body that can recognize both the injected parasites and antigens of the subsequent liver stage. These antibodies and immune cells contribute to the strong protective immunity" explains Dr. Rolf Fendel.

With an estimated 229 million infections and 409,000 deaths worldwide in 2019, malaria is one of the world's most important and dangerous infectious diseases. It is caused by parasites transmitted to humans through the bites of infected female mosquitoes. Children under the age of five are the most vulnerable group affected by malaria, accounting for 67 percent (274,000) of all malaria deaths worldwide in 2019.

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About Sanaria Inc.
Sanaria is a biotechnology company based in Rockville, Maryland (USA) that is developing whole parasite PfSPZ vaccines to protect against malaria in collaboration with the University Hospital of Tubingen, Germany. Sanaria's vaccines have been shown to be highly protective against Plasmodium falciparum infections in humans. Sanaria's vaccines will be used to prevent malaria in individuals and in combination with other malaria control measures to stop malaria transmission and eliminate malaria.

About the DZIF

The German Center for Infection Research (DZIF) coordinates translational infection research in Germany and provides strategic direction. Its mission is to translate results from basic infectious disease research into clinical research and bring them to patients. 35 DZIF research institutions work together against the global threat of infectious diseases. The Tubingen site coordinates the research area Malaria with site spokesperson Prof. Peter Kremsner, and co-coordinators are active at the site for Gastrointestinal Infections, Hospital Germs and Antibiotic-Resistant Bacteria and New Antibiotics.

Promising malaria vaccine enters final stage of clinical testing in West Africa [EurekAlert, 5 May 2021]

R21/Matrix-M becomes the second malaria vaccine candidate ever to start a phase III licensure trial

? R21/Matrix-M becomes the second malaria vaccine candidate ever to start a phase III licensure trial
? This builds on the recent finding of high level efficacy of this vaccine in a phase IIb trial in children in Burkina Faso, published today in The Lancet
? The first phase III trial doses were administered by the team at the Malaria Research and Training Centre, Bamako, Mali, one of five trial sites across West and East Africa
? The malaria vaccine was designed at the Jenner Institute, University of Oxford, who have partnered with the Serum Institute of India for commercial development

The annual death toll from malaria is over 400,000, with most of these deaths amongst children in sub-Saharan Africa. There has been little improvement noted in the last 5 years despite the large amounts of funding allocated to bed nets, insecticide spraying and antimalarial drugs. An efficacious vaccine is needed to try and reach the WHO goal of reducing malaria deaths by at least 90% by 2030.

R21/Matrix-M, a malaria vaccine developed at the Jenner Institute, University of Oxford, showed efficacy of 77% over 12 months in a recently reported phase IIb trial. First vaccinations have now begun in Mali in a larger phase III trial which is hoped to lead to licensure of this malaria vaccine by 2023. This phase III trial will assess efficacy and safety in 4800 children across five sites in Burkina Faso, Kenya, Mali and Tanzania. This is a double-blind, randomised, controlled trial where participants, aged 5-36 months, will receive three vaccinations 4 weeks apart and a booster vaccination 1 year later. The vaccine is being assessed in areas of differing malaria transmission and seasonality.

The University of Oxford has partnered with Serum Institute of India Pvt Ltd. (SIIPL) for the manufacturing of R21/Matrix-M to ensure provision of low high volumes of low-cost vaccine, and access in countries where it is required the most. SIIPL has confirmed its commitment to the provision of >200 million doses per year after licensure, which will be adequate supply for children most at risk of malaria in sub-Saharan Africa.

Quotes

Professor Adrian Hill, Director of the Jenner Institute, University of Oxford said: "The start of a phase III licensure trial is always an import milestone in the development of a vaccine. This large malaria trial is the culmination of many years of laboratory research and assessment of numerous candidate vaccines in early-stage clinical trials with large numbers of collaborators."

Professor Alassane Dicko, Head of the Bougouni Clinical Research Unit, MRTC-P, USTTB and Malian Principal Investigator said: "We are very pleased to see the enthusiasm with which the communities of Bougouni received the first doses of this new candidate malaria vaccine. We are hopeful that the encouraging Phase 2 results will be confirmed in this larger Phase 3 trial".
Professor Abdoulaye Djimde, Director of the Malaria Research and Training Centre - Parasito (MRTC-P), University of Science, Techniques and Technologies of Bamako (USTTB), said: "We are thrilled to be the first site to enroll volunteers in the Phase 3 trial of this very promising R21 vaccine. We will utilize our more than two decades of experience in malaria vaccine testing towards successful completion of this trial"

Professor Halidou Tinto, Principal Investigator of the Nanoro, Burkina Faso trial site, said: "This is a very important moment in the development of the R21 malaria vaccine candidate. We hope that the public-private partnership behind this pivotal Phase III trial will confirm the high efficacy and good safety profile seen in our phase II trial in Nanoro. The five African institutions involved in this partnership have here a historic role to play. We are all committed to work hard in order to generate data that will provide regulators and policy makers with the evidence needed to support the registration of this vaccine. If successful, this vaccine should be made available as quickly as possible to complement existing malaria prevention tools''

Professor Jean Bosco Ouedraogo, Principal Investigator at The Institute of Sciences and Techniques in Bobo-Dioulasso, Burkina Faso said: "The R21 vaccine is a promising malaria prevention tool to help accelerate malaria elimination, particularly in high burden countries in Africa. The Phase II trial demonstrated high vaccine efficacy in children and I'm proud that it was done in Burkina Faso. I am really happy to be part of this key new trial to evaluate the vaccine's safety and efficacy in an area of perennial transmission near Bobo-Dioulasso."

Dr Umesh Shaligram, Chief Scientist at the Serum Institute of India said: "Malaria has been one of the most difficult diseases to make an effective vaccine against. We are committed to ensuring that the supply of this very promising vaccine, manufactured here in Pune, India, meets public health needs by supplying over 200 million doses annually."

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About Malaria
The World Health Organisation (WHO) estimates that malaria causes over 400,000 deaths each year globally and progress in reducing malaria mortality has stalled in recent years. Most deaths are amongst children in Africa where very high transmission rates are found in many countries. 229 million cases of clinical malaria were reported in 2019. Current malaria control measures include the use of insecticide treated bed net, insecticide spraying and seasonal malaria chemoprevention where drug are administered monthly to children at time of highest transmission. No vaccine has been licensed for widespread use although efforts to develop vaccines have spanned over fifty years. Over 100 malaria vaccine candidates have entered clinical trials over recent decades but none has previously shown the >75% efficacy targeted by World Health Organization's Malaria Vaccine Technology Roadmap. It is likely that an effective vaccine could add to the current control measures and have significant impact. Vaccines could have many applications: reduction of disease and death in malaria endemic areas; contributions to malaria elimination and eventual eradication; protection of malaria-naive travellers to malaria-endemic regions.

About Vaccine Clinical Trials

Vaccine clinical trials are used to test if new vaccines are safe and effective. A phase I trial aims to test the safety of a new vaccine, a phase II tests the new vaccine to see if it is safe and effective and a phase III tests this in larger numbers to provide further safety and efficacy data.

About the University of Science, Techniques and Technologies of Bamako, Mali

The Malaria Research and Training Center - Parasitology Section (MRTC-P) within the University of Science, Techniques and Technologies of Bamako, is a renowned African-led research institution which is divided into several research units, including the Bougouni and Ouelessebougou Clinical Research Units and many others. During the past 20 years, MRTC-P in collaboration with the US National Institutes of Health, University of Maryland, EDCTP, Wellcome Trust, London School of Hygiene and Tropical Medicine, University of Oxford, African Academy of Sciences, WHO and others has built state-of-the-art facilities including several clinical research sites, parasite culture facilities, insectaries, genomic data storage and bioinformatics facilities.

About the Jenner Institute:
The Jenner Institute is based within the Nuffield Department of Medicine, University of Oxford, and is headquartered at the Old Road Campus Research Building, in Headington, Oxford. The Jenner Institute also supports senior vaccine scientists, known as Jenner Investigators, within many other departments across the University of Oxford, as well as externally within The Pirbright Institute and the Animal and Plant Health Agency.

The Jenner Institute brings together investigators who are designing and developing numerous vaccines to generate an exceptional breadth of scientific know-how and critical mass, whilst still allowing the individual investigators to remain independent and accountable to their funders and stakeholders.

The Jenner Institute is supported by the Jenner Vaccine Foundation, a UK registered charity and is advised by the Jenner Institute Scientific Advisory Board.

About the University of Oxford

Oxford University has been placed number 1 in the Times Higher Education World University Rankings for the fifth year running, and at the heart of this success is our ground-breaking research and innovation.

Oxford is world-famous for research excellence and home to some of the most talented people from across the globe. Our work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of our research sparks imaginative and inventive insights and solutions.

Through its research commercialisation arm, Oxford University Innovation, Oxford is the highest university patent filer in the UK and is ranked first in the UK for university spinouts, having created more than 200 new companies since 1988. Over a third of these companies have been created in the past three years.

Malaria vaccine 'first to meet WHO efficacy target' [Medical Xpresst, 5 May 2021]

by Abdel Aziz Nabaloum

A malaria vaccine candidate tested on children in West Africa has shown an efficacy of around 77 percent, say scientists, hailing it as a breakthrough in the fight against the disease.

Malaria causes more than 400,000 deaths a year globally, according to the World Health Organization (WHO), mostly among children in Sub-Saharan Africa.

The R21/Matrix-M vaccine, developed by the Clinical Research Unit of Nanoro (CRUN),Burkina Faso and their partners at the University of Oxford in the UK, is the first malaria vaccine to reach the 75 percent efficacy target set by the WHO.

Researchers recruited 450 children aged five to 17 months in the area of Nanoro, central Burkina Faso, and divided them into three groups for the Phase IIb trial.

One group of 150 received the vaccine with a low dose of the Matrix-M adjuvant, which helps create a stronger immune response. Another group of 150 received the vaccine at a higher dose of adjuvant, while the last group of 150 received the rabies vaccine as a control vaccine.

Halidou Tinto, principal trial investigator at the CRUN, said: "Once we vaccinated them with three doses one month apart […], we followed them in each group to see how they were going to behave in terms of vaccine safety, tolerance, but also efficacy."

The subjects in the study reported no serious side effects from the vaccine, which was found to be safe and can be manufactured at low cost on a large scale, they added.

Despite more than 100 vaccine candidates entering clinical trials in recent decades, none have previously reached the target of 75 percent efficacy which the WHO set as a target to be achieved by 2030.

The Serum Institute of India, which has manufactured the vaccine, says it will be able to deliver more than 200 million doses of the vaccine once it is approved by regulators.

Epidemiologist Gauthier Tougouri, coordinator of the National Malaria Control Program in Burkina Faso, hailed the study as a great achievement in the fight against malaria.

Last year the country recorded more than 11 million cases of malaria and almost 4,000 malaria-related deaths, including pregnant women and children, official figures show.

A larger Phase III trial will now be conducted involving 4,800 children aged five to three years in four countries.

"I hope that the forthcoming results will confirm phase two of the study so that we can reach the 2030 target for the elimination of malaria," said Tougouri.

In Burkina Faso, children will be recruited for the next phase in Nanoro and Dande, in the south-west of the country from next month.

"It is important for us to see if such a vaccine, tested in an area like Nanoro which has a transmission of medium duration, will give the same effectiveness in an area like Dande where the transmission is much longer," explained Tinto.

Researchers hope that by testing the vaccine in different contexts on a larger number ofchildren, its efficacy will be confirmed and the vaccine can be considered for registration.

Charlemagne Ouedraogo, Minister of Health for Burkina Faso, said the findings offer hope for the elimination of malaria in the country and across the continent.

"We believe that the solution against malaria will come from Burkina.We encourage the team to continue the thirdphase to give us results that will allow us to go further so that a vaccine is put on the market that will allow us to reduce morbidity and mortality from malaria," he said.

Ida Sawadogo, program officer atthe Access toEssential Medicines Network, said: "We have been waiting for this for years and we are happy that at last a vaccine is being found against this disease which is the number one killer in our country."

Malaria vaccine development since 27 Apr till 4 May 2021

Malaria vaccine WHO-approved for Africa [The Northern Daily Leader, 7 Oct 2021]

By Maria Cheng

The world's first malaria vaccine should be given to children across Africa, the World Health Organization has recommended, in a move that officials hope will spur stalled efforts to curb the spread of the parasitic disease.

WHO director-general Tedros Adhanom Ghebreyesus called it "a historic moment" after a meeting in which two of the UN health agency's expert advisory groups endorsed using the vaccine.

"Today's recommendation offers a glimmer of hope for the continent, which shoulders the heaviest burden of the disease. And we expect many more African children to be protected from malaria and grow into healthy adults," said Dr Matshidiso Moeti, WHO's Africa director, on Wednesday.

WHO said its decision was based largely on results from ongoing research in Ghana, Kenya and Malawi that tracked more than 800,000 children who have received the vaccine since 2019.

The malaria vaccine known as Mosquirix was developed by GlaxoSmithKline in 1987. While it's the first to be authorised, it does have challenges: the vaccine is only about 30 per cent effective, requires up to four doses and its protection fades after several months.

Still, given the extremely high burden of malaria in Africa - where the majority of the world's more than 200 million cases a year and 400,000 deaths a year occur - scientists say the vaccine could still have a major impact.

"This is a huge step forward," said Julian Rayner, director of the Cambridge Institute for Medical Research, who was not part of the WHO decision. "It's an imperfect vaccine, but it will still stop hundreds of thousands of children from dying."

Rayner said the vaccine's impact on the spread of the mosquito-borne disease was still unclear, but pointed to coronavirus vaccines as an encouraging example.

"The last two years have given us a very nuanced understanding of how important vaccines are in saving lives and reducing hospitalisations, even if they don't directly reduce transmission," he said.

WHO said side effects were rare, but sometimes included a fever that could result in temporary convulsions.

Azra Ghani, chair of infectious diseases at Imperial College London, said she and colleagues estimate that the introduction of the malaria vaccine in African children might result in a 30 per cent reduction overall: up to 8 million fewer cases and as many as 40,000 fewer deaths per year.

WHO Approves First-Ever Malaria Vaccine: 'A Historical Event' [Yahoo Eurosport UK, 7 Oct 2021]

By Julie Mazziotta

The World Health Organization approved the first-ever vaccine to prevent malaria on Wednesday, a shot that could save tens of thousands of lives each year, particularly in sub-Saharan Africa where cases of the mosquito-borne disease are high.

The new vaccine, called Mosquirix, helps the immune system fight off a malaria pathogen common in Africa. It not only is the first vaccine to prevent malaria, but the first to prevent a parasitic disease.

WHO endorsed the vaccine for children in sub-Saharan Africa and other regions with malaria.

The disease kills around half a million people each year, mostly in Africa. The majority of those deaths — 260,000 — are in children under age 5.

The vaccine was 50% effective at preventing severe malaria in clinical trials during the first year of testing. That efficacy dropped down to nearly zero after four years, but the immediate impacts of the vaccine on areas struggling with malaria cases made it worthwhile.

"I do expect we will see that impact," said Dr. Mary Hamel, the lead of WHO's malaria vaccine implementation program, according to The New York Times.

Dr. Pedro Alonso, director of the WHO's global malaria program, said in a statement that news of the vaccine's effectiveness is "a historical event," after a hundred years of research into a parasite vaccine.

"It's a huge jump from the science perspective to have a first-generation vaccine against a human parasite," he added.

The vaccine requires three doses in babies between 5 and 17 months, followed by a fourth dose around 18 months later. After initial clinical trials, it was added to the usual immunization courses in Kenya, Malawi and Ghana, and more than 2.3 million doses have been administered so far, to more than 800,000 children. Hamel said that more than 90% of children in those areas are now protected against malaria.

"We have long hoped for an effective malaria vaccine and now, for the first time ever, we have such a vaccine recommended for widespread use," said Matshidiso Moeti, WHO's regional director for Africa. "Today's recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease and we expect many more African children to be protected from malaria and grow into healthy adults."

First malaria vaccine could be rolled out to billions as World Health Organisation experts give approval [Sky News, 7 Oct 2021]

By Thomas Moore

The new jab prevents 30% of severe cases of malaria, even in areas with high uptake of other measures, such as bed nets impregnated with insecticide.

The first vaccine against malaria could be rolled out to billions of people after key advisers to the World Health Organisation (WHO) gave it the green light.

Experts on the WHO's advisory bodies for immunisation and malaria concluded the vaccine Mosquirix could save tens of thousands of lives every year.

Recommended byDr Tedros Adhanom Ghebreyesus, WHO's director-general, said he had started his career as a malaria researcher and had "longed for the day that we would have an effective vaccine against this ancient and terrible disease".

He said: "Today is that day. An historic day. Today the WHO is recommending the broad use of the world's first malaria vaccine.

"This long-awaited malaria vaccine is a breakthrough for science, child health and malaria control. Using this vaccine in addition to existing tools to prevent malaria could save tens of thousands of young lives each year."

The vaccine is now expected to get the nod from WHO itself and funding for millions of doses will then be considered by Gavi, the Vaccine Alliance, which ensures low-income countries have access to life-saving jabs.

Meanwhile, Gavi along with global health agency Unitaid and the Global Fund to Fight AIDS, Tuberculosis and Malaria have welcomed WHO's recommendation, adding that it "marks a historic acheivement in our fight against malaria".

The decision by the Strategic Advisory Group of Experts on Immunization and the Malaria Policy Advisory Group to back widespread deployment follows a pilot roll-out in Ghana, Kenya and Malawi.

More than 800,000 children in the three countries have been given at least one dose of the vaccine since 2019 as part of the normal childhood immunisation programme

Dr Matshidiso Moeti, WHO's regional director for Africa, said: "Today's recommendation offers a glimmer of hope for the continent.

"We expect many more African children will be protected from malaria and grow into healthy and productive adults."

The real-world test of the jab showed it prevented 30% of severe cases of malaria even in areas with high uptake of other measures, such as bed nets impregnated with insecticide.
It also proved safe, with high acceptance by families.

Malaria resulted in 409,000 deaths in 2019, the vast majority of them in sub-Saharan Africa.
The disease kills one child every two minutes.

Mosquirix acts against Plasmodium falciparum, which is carried by the Anopheles mosquito and is the deadliest of all the malaria parasites.

Developing a vaccine has proved a major challenge because the parasite is far more complex than a virus or bacteria.

The vaccine primes the immune system to fight the malaria parasite the moment it's been injected into the blood by a mosquito bite.

ANALYSIS BY THOMAS MOORE, SCIENCE CORRESPONDENT Forget lions, tigers and sharks. It’s the tiny mosquito that kills more people than any other creature. The insect is a flying incubator of viruses and parasites – and the most feared of all is Plasmodium falciparum. The organism is just a single cell, a protozoa, but it’s far more complex than a bacteria or virus. It takes on several forms in its shape-shifting life cycle that flits from mosquito to humans and back again. For vaccine developers it has proved an elusive foe. It’s able to slip past the immune system by using a combination of stealth and deception. But has it now finally met its match?

It stops the parasite infecting liver cells where it would normally mature and multiply before causing potentially deadly disease.

The vaccine's effectiveness is low compared to jabs for other diseases, but malaria claims so many lives that the WHO believes it will still prevent tens of thousands of deaths every year.

Professor Dyann Wirth, chair of WHO Malaria Policy Advisory Group said: "This is the first ever vaccine for a human parasite and demonstrates that a vaccine is possible for this challenging infection.

"While ongoing threats to our existing tools, drug-resistant parasites and insecticide resistant mosquitoes, innovation is needed not just to create new tools but to better tailor our current tools to achieve maximum impact.

"The malaria parasite is a formidable foe and while we are excited by this recent development, major battles remain."

Bed nets have been the main means of preventing malaria until now, with deaths falling 60% in the first 15 years of this century as they became widely distributed.

But progress has stalled with under half of all African households having enough nets for the whole family.

The pilot study of the vaccine showed it was given to two-thirds of children without a net, adding another layer of protection.

More effective vaccines are in development, including one by the same Oxford University team behind the AstraZeneca COVID jab.

A trial on several hundred children released earlier this year showed it prevented 77% of cases, making it even more effective than the Mosquirix shot.

A larger phase three study involving 5,000 children is now being planned.

WHO recommends malaria vaccine for use in children [Ars Technica, 7 Oct 2021]

By JOHN TIMMER

While the efficacy is under 50 percent, it should still save numerous lives.

On Wednesday, the World Health Organization (WHO) announced a first: it was recommending a vaccine against malaria for administration to children. The decision follows a program started in 2019 in three African countries, which eventually saw over 800,000 children vaccinated.

The vaccine itself is called RTS,S/AS01, or Mosquirix, and it checks all the boxes for conspiracy theorists, having been developed by a large pharmaceutical company (GlaxoSmithKline) with support from the Gates Foundation. The vaccine is based on proteins found on the surface of the most common malarial parasite, and it requires four doses starting when children are less than a year old. Development of the vaccine started in 1987, and testing of its efficacy dates back to 2014. With over 2.3 million doses administered, it has a solid safety profile, and it has shown an efficacy between 30 and 50 percent in different trials.

That may not seem all that great, especially compared to the numbers we've all watched many of the COVID-19 vaccines produced. But the WHO estimates that over a quarter-million children under the age of 5 die of malaria every year in Africa alone, with many others falling seriously ill. As such, even a 30 percent efficacy can have a substantial impact.

The WHO analysis also considered a number of additional factors, all of which weighed in favor of its use. These include its cost effectiveness and the ability to deliver the vaccine to even difficult-to-reach populations.

Mosquirix's wider distribution, however, will now be dependent on the international health community, which is already struggling with finding the funding and resources to ensure that developing nations get sufficient COVID-19 vaccines.

Meanwhile, there have been some very early trials of additional vaccines that are reporting higher efficacy levels. If those results hold up in larger trials and in actual use in Africa, RTS,S could just be the first in a string of good news for one of humanity's deadlier plagues.

UPDATE 1-WHO backs rollout of malaria vaccine for African children [Reuters.com, 7 Oct 2021]

By Maggie Fick, Aaron Ross

NAIROBI (Reuters) -The World Health Organization (WHO) said on Wednesday the only approved vaccine against malaria should be widely given to African children, potentially marking a major advance against a disease that kills hundreds of thousands of people annually.

The WHO recommendation is for RTS,S - or Mosquirix - a vaccine developed by British drugmaker GlaxoSmithKline.

Since 2019, 2.3 million doses of Mosquirix have been administered to infants in Ghana, Kenya and Malawi in a large-scale pilot programme coordinated by the WHO. The majority of those whom the disease kills are under age five.

That programme followed a decade of clinical trials in seven African countries.

“This is a vaccine developed in Africa by African scientists and we’re very proud,” said WHO director-general Tedros Adhanom Ghebreyesus.

“Using this vaccine in addition to existing tools to prevent malaria could save tens of thousands of young lives each year,” he added, referring to anti-malaria measures like bed nets and spraying to kill mosquitoes that transmit the disease.

One of the ingredients in the Mosquirix vaccine is sourced from a rare evergreen native to Chile called a Quillay tree. Reuters reported on Wednesday here that the long-term supply of these trees is in question.

Malaria is far more deadly than COVID-19 in Africa. It killed 386,000 Africans in 2019, according to a WHO estimate, compared with 212,000 confirmed COVID-19 deaths in the past 18 months.

The WHO says 94% of malaria cases and deaths occur in Africa, a continent of 1.3 billion people. The preventable disease is caused by parasites transmitted to people by the bites of infected mosquitoes. Symptoms include fever, vomiting and fatigue.

The vaccine’s effectiveness at preventing severe cases of malaria in children is only around 30%, but it is the only approved vaccine. The European Union’s drugs regulator approved it in 2015, saying its benefits outweighed the risks.

“This is how we fight malaria, layering imperfect tools on top of each other,” said Ashley Birkett, who leads global malaria vaccine work at Path, a non-profit global health organization that has funded development of the vaccine with GSK and the three-country pilot.

Another vaccine against malaria called R21/Matrix-M that was developed by scientists at Britain’s University of Oxford showed up to 77% efficacy in a year-long study involving 450 children in Burkina Faso, researchers said in April. It is still in the trial stages.

GSK welcomed the WHO recommendation.

“This long-awaited landmark decision can reinvigorate the fight against malaria in the region at a time when progress on malaria control has stalled,” Thomas Breuer, GSK’s chief global health officer, said in a statement.

GSK shares held steady in New York following the announcement, which came after the close of trading in its London-listed shares.

FUNDING CHALLENGE
The recommendation was jointly announced in Geneva by the WHO’s top advisory bodies for malaria and immunization, the Malaria Policy Advisory Group and the Strategic Advisory Group of Experts on Immunization.

Experts said the challenge now would be mobilising financing for production and distribution of the vaccine to some of the world’s poorest countries.

GSK has to date committed to produce 15 million doses of Mosquirix annually up to 2028 at a cost of production plus no more than 5% margin.

A global market study led by the WHO this year projected demand for a malaria vaccine would be 50 to 110 million doses per year by 2030 if it is deployed in areas with moderate to high transmission of the disease.

The GAVI vaccine alliance, a global public-private partnership, will consider in December whether and how to finance the vaccination programme.

“As we’ve seen from the COVID vaccine, where there is political will, there is funding available to ensure that vaccines are scaled to the level they are needed,” said Kate O’Brien, director of WHO’s Department of Immunization, Vaccines and Biologicals.

A source familiar with planning for the vaccine’s development said the price per dose was not yet set, but would be confirmed after GAVI’s funding decision and once there is a clear sense of demand.

The WHO’s decision had personal meaning for Dr. Rose Jalong’o, a vaccinology specialist at the Kenyan health ministry.

“I suffered from malaria as a child, and during my internship, and during my clinical years I attended to children in hospital because of severe malaria who needed blood transfusion and unfortunately some of them died,” she said.

“It’s a disease I have grown up with and, seeing all this in my lifetime, it’s an exciting time.”

World's First Malaria Vaccine Approved By WHO [NDTV, 7 Oct 2021]

"Today, WHO is recommending the broad use of the world's first malaria vaccine," the agency's director general Tedros Adhanom Ghebreyesus said.

Geneva, Switzerland:
The World Health Organization on Wednesday endorsed the RTS,S/AS01 malaria vaccine, the first against the mosquito-borne disease that kills more than 400,000 people a year, mostly African children.

The decision followed a review of a pilot programme deployed since 2019 in Ghana, Kenya and Malawi in which more than two million doses were given of the vaccine, first made by the pharmaceutical company GSK in 1987.

After reviewing evidence from those countries, the WHO said it was "recommending the broad use of the world's first malaria vaccine", the agency's director general Tedros Adhanom Ghebreyesus said.

The WHO said it was recommending children in sub-Saharan Africa and in other regions with moderate to high malaria transmission get four doses up to the age of two.

Every two minutes, a child dies of malaria, the agency said.

More than half of malaria deaths worldwide are in six sub-Saharan African countries and almost a quarter are in Nigeria alone, according to 2019 WHO figures.

Symptoms include fever, headaches and muscle pain, then cycles of chills, fever and sweating.
Findings from the vaccine pilot showed it "significantly reduces severe malaria which is the deadly form by 30 percent," said Kate O'Brien, Director of WHO's Department of Immunization, Vaccines and Biologicals.

The vaccine is "feasible to deliver", she added and "it's also reaching the unreached... Two thirds of children who don't sleep under a bed net in those countries are now benefiting from the vaccine."

Many vaccines exist against viruses and bacteria but this was the first time that the WHO recommended for broad use a vaccine against a human parasite.

The vaccine acts against plasmodium falciparum -- one of five malaria parasite species and the most deadly.

"From a scientific perspective this is a massive breakthrough," said Pedro Alonso, Director of the WHO Global Malaria Programme.

'Glimmer of hope'
Matshidiso Moeti, the WHO regional director for Africa said Wednesday's recommendation "offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease."

The estimated cost of malaria in sub-Saharan Africa is over 12 billion dollars a year, Alonso said at a news conference following the announcement.

Before the newly recommended vaccine can reach children in need, the next step will be funding.

"That will be the next major step... Then we will be set up for scaling of doses and decisions about where the vaccine will be most useful and how it will be deployed," said O'Brien.

Gavi vaccine alliance said in a statement after the WHO announcement that "global stakeholders, including Gavi, will consider whether and how to finance a new malaria vaccination programme for countries in sub-Saharan Africa."

The fight against malaria received a boost in April when researchers from Britain's Oxford University announced that their Matrix-M vaccine candidate had become the first to surpass the WHO's threshold of 75-percent efficacy.

Germany's BioNTech, which developed a coronavirus vaccine with US giant Pfizer, also said it aimed to start trials for a malaria vaccine next year using the same breakthrough mRNA technology.

The WHO also hopes this latest recommendation will encourage scientists to develop more malaria vaccines.

1CommentsThe RTS,S/AS01 is "a first generation, really important one," said Alonso, "but we hope... it stimulates the field to look for other types of vaccines to completement or go beyond this one."

The World May Finally Have a Malaria Vaccine That Works [Interesting Engineering, 6 Oct 2021]

By Brad Bergan

For thousands of years, malaria has wrought havoc. But it could be nearing its end.
We may finally have an effective vaccine against malaria.

A novel drug called RTS,S has finally received approval from the World Health Organization, and will soon roll out across sub-Saharan Africa, according to an initial report from the BBC.

The vaccine's effectiveness was proven six years ago, and now it's finally ready to save lives.

New Malaria vaccine could save 'tens of thousands' of lives The vaccine's pilot programs took place in Ghana, Kenya, in addition to Malawi, and the World Health Organization's (WHO's) Director-General Tedros Adhanom Ghebreyesus said this marked a "historic day," adding that "tens of thousands of young lives could be saved" by the vaccine every single year, according to the BBC report. Malaria is an extremely dangerous parasite that invades and body, subsequently destroying blood cells to reproduce and spread via blood-sucking mosquitoes. There have been ways to reduce the spread, like drugs that kill the parasite, insecticides that kill the means of transfer (the mosquitoes), and bed nets to prevent the parasitic bugs from injecting or sucking the malaria parasite into and out of human bloodstreams.

But there remain roughly 230 million cases of malaria linked to 400,000 deaths from the vicious illness, roughly 95% of which is centered in Africa, where more than 260,000 kids have died from infection in 2019 alone. Immunity takes years upon years of repeated infection to build immunity to malaria, and this immunity is only minimal, merely reducing your chances of becoming extremely ill from contraction. The recently approved vaccine was put through a pilot program, during which Kwame Amponsa-Achiano assessed the vaccine for effectiveness and feasibility, according to the report. "It is quite an exciting moment for us, with large scale vaccination I believe the malaria toll will be reduced to the barest minimum," said Amponsa-Achiano, in the report.

The malaria vaccine takes four doses, administered at a young age
Amponsa-Achiano regularly contracted malaria as a child, and this spurred his will to become a doctor in Ghana. "It was distressing, almost every week you were out of school, malaria has taken a toll on us for a long time," he said in the BBC report. There exist more than 100 variants of the malaria parasite, but the RTS,S vaccine specifically targets the most common and deadly one in the entire continent of Africa: plasmodium falciparum. Back in 2015, trials showed that the vaccine can prevent four in 10 malaria cases, leading to a sharp drop of one-third in the number of kids needing blood transfusions. But not everyone had full confidence in the novel vaccine, since it takes four full doses to become fully effective.

The first three doses are administered one month apart from one another, at five, six, and seven months old, with a final booster shot given at the age of roughly 18 months, according to the report. The results of the pilot revealed that the vaccine is safe, and linked to a 30% reduction in severe cases of the illness, and it showed no substantially negative side effects apart from those expected from routine vaccines. Most crucially, it's cost-effective, which means it has the potential to be accessible by official bodies capable of helping the general populations most at-risk in Africa. This is a gigantic step in the right direction in the fight to end malaria. Time will tell whether the vaccine proves effective against future variants of the parasite.

WHO backs rollout of malaria vaccine for African children [Thomson Reuters Foundation, 6 Oct 2021]

By Maggie Fick and Aaron Ross

NAIROBI, Oct 6 (Reuters) - The World Health Organization (WHO) said on Wednesday the only approved vaccine against malaria should be widely given to African children, potentially marking a major advance against a disease that kills hundreds of thousands of people annually.

The WHO recommendation is for RTS,S - or Mosquirix - a vaccine developed by British drugmaker GlaxoSmithKline.

Since 2019, 2.3 million doses of Mosquirix have been administered to infants in Ghana, Kenya and Malawi in a large-scale pilot programme coordinated by the WHO. The majority of those whom the disease kills are aged under five.

That programme followed a decade of clinical trials in seven African countries.

"This is a vaccine developed in Africa by African scientists and we're very proud," said WHO director-general Tedros Adhanom Ghebreyesus.

"Using this vaccine in addition to existing tools to prevent malaria could save tens of thousands of young lives each year," he added, referring to anti-malaria measures like bed nets and spraying.

Malaria is far more deadly than COVID-19 in Africa. It killed 386,000 Africans in 2019, according to a WHO estimate, compared with 212,000 confirmed deaths from COVID-19 in the past 18 months.

The WHO says 94% of malaria cases and deaths occur in Africa, a continent of 1.3 billion people. The preventable disease is caused by parasites transmitted to people by the bites of infected mosquitoes; symptoms include fever, vomiting and fatigue.

The vaccine's effectiveness at preventing severe cases of malaria in children is only around 30%, but it is the only approved vaccine. The European Union's drugs regulator approved it in 2015, saying its benefits outweighed the risks.

"This is how we fight malaria, layering imperfect tools on top of each other," said Ashley Birkett, who leads global malaria vaccine work at Path, a non-profit global health organization that has funded the development of the vaccine with GSK and the three-country pilot.

Another vaccine against malaria, developed by scientists at Britain's University of Oxford and called R21/Matrix-M, showed up to 77% efficacy in a year-long study involving 450 children in Burkina Faso, researchers said in April, but it is still in the trial stages.

GSK also welcomed the WHO recommendation.

"This long-awaited landmark decision can reinvigorate the fight against malaria in the region at a time when progress on malaria control has stalled," Thomas Breuer, Chief Global Health Officer, said in a statement.

GSK shares held steady in New York following the announcement, which came after the close of trading in its London-listed shares.

FUNDING CHALLENGE
The recommendation was jointly announced in Geneva by the WHO's top advisory bodies for malaria and immunization, the Malaria Policy Advisory Group and the Strategic Advisory Group of Experts on Immunization.

Experts said the challenge now would be mobilising financing for production and distribution of the vaccine to some of the world's poorest countries.

GSK has to date committed to produce 15 million doses of Mosquirix annually, in addition to the 10 million doses donated to the WHO pilot programmes, up to 2028 at a cost of production plus no more than 5% margin.

A global market study led by the WHO this year projected demand for a malaria vaccine would be 50 to 110 million doses per year by 2030 if it is deployed in areas with moderate to high transmission of the disease.

The GAVI vaccine alliance, a global public-private partnership, will consider in December whether and how to finance the vaccination programme.

"As we've seen from the COVID vaccine, where there is political will, there is funding available to ensure that vaccines are scaled to the level they are needed," said Kate O'Brien, Director of WHO's Department of Immunization, Vaccines and Biologicals.

A source familiar with planning for the vaccine's development said the price per dose was not yet set, but would be confirmed after GAVI's funding decision and once there is a clear sense of demand for the vaccine.

The WHO's decision had personal meaning for Dr. Rose Jalong'o, a vaccinology specialist at the Kenyan health ministry.

"I suffered from malaria as a child and during my internship, and during my clinical years I attended to children in hospital because of severe malaria who needed blood transfusion and unfortunately some of them died."

"It's a disease I have grown up with and, seeing all this in my lifetime, it's an exciting time."
(Reporting by Maggie Fick in Nairobi and Aaron Ross in Dakar; Editing by Katharine Houreld, Mark Potter and Emelia Sithole-Matarise)

The World Health Organization Approves First Malaria Vaccine [Technology Networks, 6 Oct 2021]

The World Health Organization (WHO) is recommending widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to high P. falciparum malaria transmission. The recommendation is based on results from an ongoing pilot programme in Ghana, Kenya and Malawi that has reached more than 800 000 children since 2019.

“This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”

Malaria remains a primary cause of childhood illness and death in sub-Saharan Africa. More than 260 000 African children under the age of five die from malaria annually.

In recent years, WHO and its partners have been reporting a stagnation in progress against the deadly disease.

"For centuries, malaria has stalked sub-Saharan Africa, causing immense personal suffering,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We have long hoped for an effective malaria vaccine and now for the first time ever, we have such a vaccine recommended for widespread use. Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease and we expect many more African children to be protected from malaria and grow into healthy adults.”
WHO recommendation for the RTS,S malaria vaccine

Based on the advice of two WHO global advisory bodies, one for immunization and the other for malaria, the Organization recommends that:

WHO recommends that in the context of comprehensive malaria control the RTS,S/AS01 malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by WHO. RTS,S/AS01 malaria vaccine should be provided in a schedule of 4 doses in children from 5 months of age for the reduction of malaria disease and burden.

'A Historical Event': WHO Endorses First-Ever Malaria Vaccine [The Daily Beast, 6 Oct 2021]

By Corbin Bolies

The World Health Organization endorsed the first vaccine to prevent malaria Wednesday, giving an important stamp of approval in the quest to eradicate the deadly disease. The vaccine, made by GlaxoSmithKline, works by targeting the deadliest malaria pathogen, with studies showing it is 50 percent effective at preventing serious malaria in the first year. No data has emerged on its efficacy in preventing deaths, but a WHO expert told The New York Times its efficacy in preventing severe malaria is “a reliable proximal indicator of mortality.” The vaccine is also the first known vaccine produced against parasites, which cause diseases much more severe than bacteria or viruses. Some countries have shown consternation over whether to adopt a vaccine with a lower efficacy level, but Dr. Pedro Alonso, the head of WHO’s global malaria program, called the release “a historical event.”

“It’s a huge jump from the science perspective to have a first-generation vaccine against a human parasite,” Alonso said. The disease kills about 500,000 people a year, most of them kids in Africa.

UN: African children should get world's 1st malaria vaccine [Santa Rosa Press Democrat, 6 Oct 2021]

By MARIA CHENG

LONDON — The World Health Organization on Wednesday endorsed the world's first malaria vaccine and said it should be given to children across Africa in the hope that it will spur stalled efforts to curb the spread of the parasitic disease.

WHO Director-General Tedros Adhanom Ghebreyesus called it “a historic moment” after a meeting in which two of the U.N. health agency’s expert advisory groups recommended the step.

"Today’s recommendation offers a glimmer of hope for the continent, which shoulders the heaviest burden of the disease. And we expect many more African children to be protected from malaria and grow into healthy adults,” said Dr. Matshidiso Moeti, WHO's Africa director.
WHO said its decision was based largely on results from ongoing research in Ghana, Kenya and Malawi that tracked more than 800,000 children who have received the vaccine since 2019.

The vaccine, known as Mosquirix, was developed by GlaxoSmithKline in 1987. While it’s the first to be authorized, it does face challenges: The vaccine is only about 30% effective, it requires up to four doses, and its protection fades after several months.

Still, scientists say the vaccine could have a major impact against malaria in Africa, home to most of the world’s more than 200 million cases and 400,000 deaths per year,
“This is a huge step forward,” said Julian Rayner, director of the Cambridge Institute for Medical Research, who was not part of the WHO decision. “It’s an imperfect vaccine, but it will still stop hundreds of thousands of children from dying.”

Rayner said the vaccine’s impact on the spread of the mosquito-borne disease was still unclear, but pointed to those developed for the coronavirus as an encouraging example.

“The last two years have given us a very nuanced understanding of how important vaccines are in saving lives and reducing hospitalizations, even if they don’t directly reduce transmission,” he said.

Dr. Alejandro Cravioto, head of the WHO vaccine group that made the recommendation, said designing a shot against malaria was particularly difficult because it is a parasitic disease spread by mosquitoes.

“We’re confronted with extraordinarily complex organisms,” he said. “We are not yet in reach of a highly efficacious vaccine, but what we have now is a vaccine that can be deployed and that is safe.”

WHO said side effects were rare, but sometimes included a fever that could result in temporary convulsions.

Sian Clarke, co-director of the Malaria Centre at the London School of Hygiene and Tropical Medicine, said the vaccine would be a useful addition to other tools against the disease that might have exhausted their utility after decades of use, like bed nets and insecticides.

“In some countries where it gets really hot, children just sleep outside, so they can’t be protected by a bed net,” Clarke said. “So obviously if they’ve been vaccinated, they will still be protected.”

In recent years, little significant progress has been made against malaria, Clarke said.

“If we’re going to decrease the disease burden now, we need something else,” she explained.

Azra Ghani, chair of infectious diseases at Imperial College London, said she and colleagues estimate that giving the malaria vaccine to children in Africa might result in a 30% reduction overall, with up to 8 million fewer cases and as many as 40,000 fewer deaths per year.

“For people not living in malaria countries, a 30% reduction might not sound like much. But for the people living in those areas, malaria is one of their top concerns,” Ghani said. “A 30% reduction will save a lot of lives and will save mothers (from) bringing in their children to health centers and swamping the health system.”

The WHO guidance would hopefully be a “first step” to making better malaria vaccines, she said. Efforts to produce a second-generation malaria vaccine might be given a boost by the messenger RNA technology used to make two of the most successful COVID-19 vaccines, those from Pfizer-BioNTech and Moderna, she added.

“We’ve seen much higher antibody levels from the mRNA vaccines, and they can also be adapted very quickly,” Ghani said, noting that BioNTech recently said it would begin researching a possible malaria shot. “It’s impossible to say how that may affect a malaria vaccine, but we definitely need new options to fight it.”

WHO Backs Widespread Use Of First Malaria Vaccine [Forbes, 6 Oct 2021]

By Kimberlee Speakman

TOPLINE

The World Health Organization endorsed the safety and efficacy of the world’s first malaria vaccine on Wednesday, clearing the way for it to be rolled out to treat children in sub-Saharan Africa and other regions that are hard-hit by the disease, which is one of the leading killers in low-income countries.

KEY FACTS

WHO expert advisory groups on vaccines and malaria said the RTS,S/AS01 vaccine, also known as Mosquirix, which was developed by GlaxoSmithKline, was recommended based off results of a pilot program involving more than 800,000 children in Ghana, Kenya and Malawi.
The pilot program showed the vaccine was cost effective and helped to reduce the incidence of life-threatening severe cases of malaria by 30% in areas where other preventative measures were being taken.

BIG NUMBER

More than 260,000. That is approximately how many children under the age of 5 die of malaria in Africa annually, according to the WHO.

CRUCIAL QUOTE

“Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease, and we expect many more African children to be protected from malaria and grow into healthy adults,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

WHAT TO WATCH OUT FOR

The WHO said it will make funding decisions for a broader rollout of the vaccine, and countries will need to decide whether they want to adopt the vaccine.

KEY BACKGROUND

GlaxoSmithKline, said it has been working to create a vaccine that would help protect against malaria for 30 years. The company first made a breakthrough in 1996 with the RTS,S/AS01 vaccine, which protected six out of seven volunteers in an initial trial. Additional studies in 1999 on adults in Gambia and in 2004 on Mozambique children also proved that the vaccine was effective. Based on various trials, the company submitted a regulatory application with the European Medicines Agency last year, taking the first step to getting the vaccine approved for widespread use.

WHO approves first malaria vaccine [Spectrum News, 6 Oct 2021]

By Rachel Gotbaum

Regina Rabinovich, the director of the Malaria Elimination Initiative at ISGlobal and a visiting scholar at Harvard University, joined The World's host Marco Werman to discuss the advancement.

Malaria kills hundreds of thousands of people every year. Most of them live in sub-Saharan Africa, and overwhelmingly, it's children younger than 5 years old who die of malaria.
But on Wednesday, Dr. Tedros Ghebreyesus, the head of the World Health Organization, made an announcement that he called "historic."

"Malaria has been with us for millennia, and the dream of a malaria vaccine has been a long-held, but unattainable, dream," he said. "Today, the RTS,S malaria vaccine — more than 30 years in the making — changes the course of public health history."

It's a vaccine against malaria that is safe for children. To discuss the latest advancement, Regina Rabinovich, the director of the Malaria Elimination Initiative at ISGlobal and a visiting scholar at Harvard University, joined The World's host Marco Werman.

Marco Werman: So, this vaccine for malaria has been called a game changer. Why is that?

Regina Rabinovich: It's been called a game changer, well, it's the first malaria vaccine we've ever been able to develop. And then, it adds a totally different approach to attacking the disease by strengthening the immune system of children so that they are protected from the severe effects of an infection.

But, this vaccine does not prevent transmission of malaria. Is that important?

It is important, and we have other tools. It's important to note that all of the trials have been done on top of giving children bed nets and sprays where that is the recommended approach with insecticides. Those kill the mosquito. But this protects the baby.

And it's a vaccine that's safe for children. Remind us why this focus on children getting this vaccine is so significant.

Well, over time, as children get a number of infections, they develop partial immunity. And as adults in Africa who have been exposed frequently, they tend to get very mild disease, unless they are immunocompromised or pregnant. So, the ones that get very severe disease tend to be children in highly endemic areas, where there's a lot of disease, are the children less than five. So, protecting them from severe disease, from hospitalization and from dying is a huge value for global health and for impact on child health.

So, I had malaria several times, once really bad, and it lays you out, leads to massive lack of productivity. Not to mention, lives lost, if that happens. How many lives could be saved by this vaccine?

That part is still an evolving story. This pilot program that they are doing will continue its ongoing evaluation for two more years. The indication is that it does decrease mortality. It clearly prevents severe malaria, and it decreases the need for hospitalization in children.

Remind us, who are the people around the world who continue to be affected by malaria in 2021? Where are they and how many are there?

There are approximately 200 million cases reported a year — 200 million. And of those, about 400,000 die. So, this is not a disease that is everywhere, like a pandemic, like COVID-19. There are countries in Asia, Latin America and Africa — especially Africa — that bear the highest burden.

Well, we heard Dr. Tedros earlier calling this malaria vaccine historic. How excited are you by this news today?

Well, I'm extremely excited. I think it's overwhelming, actually. It is a dream for the community that we would be able to tackle this disease, not only with partially effective nets and insecticides and treatments, but also with the creation of immunity in those most fragile.

UN endorses world's 1st malaria vaccine, experts estimate it could prevent 40000 deaths per year [4029tv, 6 Oct 2021]

By MARIA CHENG

The World Health Organization on Wednesday endorsed the world's first malaria vaccine and said it should be given to children across Africa in the hope it will spur stalled efforts to curb the spread of the parasitic disease.

WHO Director-General Tedros Adhanom Ghebreyesus called it "a historic moment" after a meeting in which two of the U.N. health agency's expert advisory groups recommended the step.

"Today's recommendation offers a glimmer of hope for the continent, which shoulders the heaviest burden of the disease. And we expect many more African children to be protected from malaria and grow into healthy adults," said Dr. Matshidiso Moeti, WHO's Africa director.

WHO said its decision was based largely on results from ongoing research in Ghana, Kenya and Malawi that tracked more than 800,000 children who have received the vaccine since 2019.

The vaccine, known as Mosquirix, was developed by GlaxoSmithKline in 1987. While it's the first to be authorized, it does face challenges: The vaccine is only about 30% effective, it requires up to four doses, and its protection fades after several months.

Still, scientists say the vaccine could have a major impact against malaria in Africa, home to most of the world's more than 200 million cases and 400,000 deaths per year.

"This is a huge step forward," said Julian Rayner, director of the Cambridge Institute for Medical Research, who was not part of the WHO decision. "It's an imperfect vaccine, but it will still stop hundreds of thousands of children from dying."

Rayner said the vaccine's impact on the spread of the mosquito-borne disease was still unclear, but pointed to those developed for the coronavirus as an encouraging example.

US revokes emergency use of malaria drugs vs. coronavirus
"The last two years have given us a very nuanced understanding of how important vaccines are in saving lives and reducing hospitalizations, even if they don't directly reduce transmission," he said.

Dr. Alejandro Cravioto, head of the WHO vaccine group that made the recommendation, said designing a shot against malaria was particularly difficult because it is a parasitic disease spread by mosquitoes.

"We're confronted with extraordinarily complex organisms," he said. "We are not yet in reach of a highly efficacious vaccine, but what we have now is a vaccine that can be deployed and that is safe."

WHO said side effects were rare, but sometimes included a fever that could result in temporary convulsions.

Sian Clarke, co-director of the Malaria Centre at the London School of Hygiene and Tropical Medicine, said the vaccine would be a useful addition to other tools against the disease that might have exhausted their utility after decades of use, like bed nets and insecticides.

"In some countries where it gets really hot, children just sleep outside, so they can't be protected by a bed net," Clarke said. "So obviously if they've been vaccinated, they will still be protected."

Study finds no benefit, higher death rate in patients taking malaria drug for COVID-19
In recent years, little significant progress has been made against malaria, Clarke said.

"If we're going to decrease the disease burden now, we need something else," she explained.
Azra Ghani, chair of infectious diseases at Imperial College London, said she and colleagues estimate that giving the malaria vaccine to children in Africa might result in a 30% reduction overall, with up to 8 million fewer cases and as many as 40,000 fewer deaths per year.

"For people not living in malaria countries, a 30% reduction might not sound like much. But for the people living in those areas, malaria is one of their top concerns," Ghani said. "A 30% reduction will save a lot of lives and will save mothers [from] bringing in their children to health centers and swamping the health system."

The WHO guidance would hopefully be a "first step" to making better malaria vaccines, she said. Efforts to produce a second-generation malaria vaccine might be given a boost by the messenger RNA technology used to make two of the most successful COVID-19 vaccines, those from Pfizer-BioNTech and Moderna, she added.

"We've seen much higher antibody levels from the mRNA vaccines, and they can also be adapted very quickly," Ghani said, noting that BioNTech recently said it would begin researching a possible malaria shot. "It's impossible to say how that may affect a malaria vaccine, but we definitely need new options to fight it."

The world's 1st malaria vaccine gets a green light from the World Health Organization [Iowa Public Radio, 6 Oct 2021]

By Jason Beaubien

AILSA CHANG, HOST:
The World Health Organization has given the green light for the rollout of the world's first vaccine against malaria. The WHO's director general calls it a historic moment. Malaria kills hundreds of thousands of people every year, and most of those deaths are children under the age of five in Africa. Joining us now to talk about this development is NPR global health correspondent Jason Beaubien.

Hi, Jason.

JASON BEAUBIEN, BYLINE: Hey, Ailsa.

CHANG: So tell us more about this vaccine. Like, just how big of a deal is this?

BEAUBIEN: You know, it is a big deal. Malaria - it not only kills a quarter of a million children in sub-Saharan Africa every year, it makes a lot of other people sick. It hurts the economy. You know, it's a major burden on some of the poorest countries in the world. So for lots of reasons, a malaria vaccine has been this huge goal of health officials. The head of the WHO, Tedros Adhanom Ghebreyesus, who you just mentioned - he knows a lot about malaria. And he was one of the people gushing about the significance of this today.

(SOUNDBITE OF ARCHIVED RECORDING)

TEDROS ADHANOM GHEBREYESUS: I started my career as a malaria researcher. And I longed for the day that we would have an effective vaccine against this ancient and terrible disease. And today is that day - an historic day.

CHANG: Whoa, what is he saying there? Are we talking about eradicating malaria completely - like, wiping it out entirely with this vaccine?

BEAUBIEN: No, not at all.

CHANG: OK.

BEAUBIEN: And that's where this story gets a little bit messy.

CHANG: What do you mean by that?

BEAUBIEN: So yes, this vaccine is a first. But it's got some significant drawbacks. First, it's only about 30% effective at preventing kids from getting hospitalized. Overall, it's only roughly 40% effective in blocking infection, so that's fairly low.

CHANG: Yeah.

BEAUBIEN: Second, it's a complicated vaccine to administer. It's a series of four injections, and the first three shots - they have to be given a month apart to infants after the infants have reached five months of age, and the fourth one - the final injection - then has to be given a year later. And then after all that, the protection from the vaccine wanes fairly quickly.
CHANG: OK. So it's complicated. Why is there so much excitement about this then? Like, why is the WHO calling this historic?

BEAUBIEN: Yeah. I mean, to be clear, this is the first vaccine ever developed against a parasitic human disease. So that's a big deal. Many vaccines - they work against infections from viruses or bacteria. Parasites are far more complex organisms. GlaxoSmithKline has been working on this vaccine since the 1980s, so you can see some of how difficult it has been to develop a vaccine...

CHANG: Yeah.

BEAUBIEN: ...Like this. The other reason there's so much excitement about this is that malaria is so devastating in many of these places. You know, if you could cut out 30% to 40% of the cases, that's a massive win on the public health front. You know, and there's the potential to be saving hundreds of thousands of lives in the years to come.
CHANG: Absolutely. OK, so what happens now? Like, is this vaccine going to be widely available all across Africa?

BEAUBIEN: And again, that's where things are also a bit complicated. It's still not clear where the money's going to come from to fund a wide-scale rollout, particularly in sub-Saharan Africa. GlaxoSmithKline says they're going to be making doses available at just over cost. You know, but many of these countries - they don't have the money to be buying one more vaccine right now. So the next step is for the WHO, Gavi, the Vaccine Alliance and other international actors to try to raise money so that it can be widely deployed, particularly in sub-Saharan Africa.

CHANG: That is NPR's Jason Beaubien.
Thank you, Jason.

BEAUBIEN: You're welcome, Ailsa.

WHO greenlights the world's first malaria vaccine — but it's not a perfect shot [WYPR, 6 Oct 2021]

By Jason Beaubien

The world's arsenal against malaria just got a fancy new bazooka. But it's not the easiest weapon to deploy, it only hits its target 30 to 40% of the time, and it's not yet clear who's going to pay for it.

The weapon in question is the RTS,S vaccine from GlaxoSmithKline, which on Wednesday got the green light from the World Health Organization for widespread use.

This is not only the first authorized malaria vaccine, it's also the first vaccine ever approved for use against a parasitic disease in humans.

The recommendation comes after RTS,S showed positive results in a pilot program in Ghana, Kenya and Malawi. The vaccine cut malaria cases by 40% and reduced hospitalizations of the potentially deadly disease by nearly a third.

Tedros Adhanom Ghebreyesus, WHO's director general, called the approval of RTS,S a historic moment.

"The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control," he said.

RTS,S won regulatory approval from the European Medicines Agency back in 2015 but WHO wanted to wait for the results of this latest pilot program before recommending it for use in countries with moderate to high levels of malaria transmission. The expectation is that it will be used primarily in sub-Saharan Africa, where the mosquito-borne disease is one of the top killers of children, claiming nearly a quarter of a million lives each year.

"This opens up a whole new avenue for malaria control," says David Schellenberg of WHO's Global Malaria Program, who says that RTS,S gives health officials a new powerful tool to fight the disease.

Combined with bed nets, spraying for mosquitoes and new drugs, the vaccine could have a major impact in places where malaria remains a chronic problem, Schellenberg says.

Matshidiso Moeti, WHO regional director for Africa, says she's delighted by the new recommendation.

"For centuries, malaria has stalked sub-Saharan Africa, causing immense personal suffering," Moeti said during the announcement. Nearly 95% of all malaria cases globally occur in Africa.

"Now for the first time ever, we have a [malaria] vaccine recommended for widespread use.
Today's recommendation, therefore, offers a glimmer of hope for the continent," she said.

But the vaccine won't be rolling out across Africa tomorrow. It's still unclear where the money to purchase doses will come from. Also it's a complicated vaccination to administer, requiring four injections spread out over the first two years of a child's life. And given that it only prevents malaria 30 to 40% of the time, this vaccine is far less effective than health officials had hoped.

Pedro Alonso, head of WHO's Global Malaria Program, says part of the problem is that malaria is a complicated disease. "This is a parasitic disease," he points out. The parasite life cycle plays out in multiple stages in different parts of the human body and in the mosquito hosts.
"This is orders of magnitude more complex in terms of the biology of the causative organism [than a virus]," he says.

Decades of research have gone into developing RTS,S. Alonso would love to see a vaccine that's 95% effective in preventing malaria but says the scientific community is still a long way off from developing that: "But what we do have right now is a vaccine that can be deployed, that is accepted, that is safe and that can have a massive impact in terms of lives saved and episodes of malaria averted."

Countries that decide to move forward with administering RTS,S still need to figure out how to pay for it and how to integrate it into their childhood immunization schedules. GlaxoSmithKline had donated 10 million doses of the vaccine for pilot programs and has now pledged to deliver 15 million doses a year at a price of 5% above cost. Eventually GSK says it plans to transfer production to a producer in India.

World's first malaria vaccine gets WHO recommendation : Goats and Soda [NPR, 6 Oct 2021]

By JASON BEAUBIEN

The world's arsenal against malaria just got a fancy new bazooka. But it's not the easiest weapon to deploy, it only hits its target 30 to 40% of the time, and it's not yet clear who's going to pay for it.

The weapon in question is the RTS,S vaccine from GlaxoSmithKline, which on Wednesday got the green light from the World Health Organization for widespread use.

This is not only the first authorized malaria vaccine, it's also the first vaccine ever approved for use against a parasitic disease in humans.

The recommendation comes after RTS,S showed positive results in a pilot program in Ghana, Kenya and Malawi. The vaccine cut malaria cases by 40% and reduced hospitalizations of the potentially deadly disease by nearly a third.

Tedros Adhanom Ghebreyesus, WHO's director general, called the approval of RTS,S a historic moment.

"The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control," he said.

RTS,S won regulatory approval from the European Medicines Agency back in 2015 but WHO wanted to wait for the results of this latest pilot program before recommending it for use in countries with moderate to high levels of malaria transmission. The expectation is that it will be used primarily in sub-Saharan Africa, where the mosquito-borne disease is one of the top killers of children, claiming nearly a quarter of a million lives each year.

"This opens up a whole new avenue for malaria control," says David Schellenberg of WHO's Global Malaria Program, who says that RTS,S gives health officials a new powerful tool to fight the disease.

Combined with bed nets, spraying for mosquitoes and new drugs, the vaccine could have a major impact in places where malaria remains a chronic problem, Schellenberg says.

Matshidiso Moeti, WHO regional director for Africa, says she's delighted by the new recommendation.

"For centuries, malaria has stalked sub-Saharan Africa, causing immense personal suffering," Moeti said during the announcement. Nearly 95% of all malaria cases globally occur in Africa.
"Now for the first time ever, we have a [malaria] vaccine recommended for widespread use.
Today's recommendation, therefore, offers a glimmer of hope for the continent," she said.
But the vaccine won't be rolling out across Africa tomorrow. It's still unclear where the money to purchase doses will come from. Also it's a complicated vaccination to administer, requiring four injections spread out over the first two years of a child's life. And given that it only prevents malaria 30 to 40% of the time, this vaccine is far less effective than health officials had hoped.

Pedro Alonso, head of WHO's Global Malaria Program, says part of the problem is that malaria is a complicated disease. "This is a parasitic disease," he points out. The parasite life cycle plays out in multiple stages in different parts of the human body and in the mosquito hosts.
"This is orders of magnitude more complex in terms of the biology of the causative organism [than a virus]," he says.

Decades of research have gone into developing RTS,S. Alonso would love to see a vaccine that's 95% effective in preventing malaria but says the scientific community is still a long way off from developing that: "But what we do have right now is a vaccine that can be deployed, that is accepted, that is safe and that can have a massive impact in terms of lives saved and episodes of malaria averted."

Countries that decide to move forward with administering RTS,S still need to figure out how to pay for it and how to integrate it into their childhood immunization schedules. GlaxoSmithKline had donated 10 million doses of the vaccine for pilot programs and has now pledged to deliver 15 million doses a year at a price of 5% above cost. Eventually GSK says it plans to transfer production to a producer in India.

First Malaria Vaccine Approved by W.H.O. [The New York Times, 6 Oct 2021]

By Apoorva Mandavilli
Malaria kills about 500,000 people each year, about half of them children in Africa. The new vaccine isn’t perfect, but it will help turn the tide, experts said.

A ‘Historic Day’: W.H.O. Approves First Malaria Vaccine

Dr. Tedros Adhanom Ghebreyesus, the World Health Organization’s director general, said the long-awaited vaccine was a breakthrough for science and could save tens of thousands of young lives each year.

As some of you may know, I started my career as a malaria researcher, and I longed for the day that we would have an effective vaccine against this ancient and terrible disease. And today is that day — an historic day. Today, W.H.O. is recommending the broad use of the world’s first malaria vaccine. This recommendation is based on results from an ongoing pilot program in Ghana, Kenya and Malawi that has reached more than 800,000 children since 2019. This long-awaited malaria vaccine is a breakthrough for science, child health and malaria control. Using this vaccine, in addition to existing tools to prevent malaria, could save tens of thousands of young lives each year.

The world has gained a new weapon in the war on malaria, among the oldest known and deadliest of infectious diseases: the first vaccine shown to help prevent the disease. By one estimate, it will save tens of thousands of children each year.
Malaria kills about half a million people each year, nearly all of them in sub-Saharan Africa — including 260,000 children under 5. The new vaccine, made by GlaxoSmithKline, rouses a child’s immune system to thwart Plasmodium falciparum, the deadliest of five malaria pathogens and the most prevalent in Africa.

The World Health Organization on Wednesday endorsed the vaccine, the first step in a process that should lead to wide distribution in poor countries. To have a malaria vaccine that is safe, moderately effective and ready for distribution is “a historic event,” said Dr. Pedro Alonso, director of the W.H.O.’s global malaria program.

Malaria is rare in the developed world. There are just 2,000 cases in the United States each year, mostly among travelers returning from countries in which the disease is endemic.

The vaccine, called Mosquirix, is not just a first for malaria — it is the first developed for any parasitic disease. Parasites are much more complex than viruses or bacteria, and the quest for a malaria vaccine has been underway for a hundred years.

“It’s a huge jump from the science perspective to have a first-generation vaccine against a human parasite,” Dr. Alonso said.

In clinical trials, the vaccine had an efficacy of about 50 percent against severe malaria in the first year, but the figure dropped close to zero by the fourth year. And the trials did not directly measure the vaccine’s impact on deaths, which has led some experts to question whether it is a worthwhile investment in countries with countless other intractable problems.

But severe malaria accounts for up to half of malaria deaths and is considered “a reliable proximal indicator of mortality,” said Dr. Mary Hamel, who leads the W.H.O.’s malaria vaccine implementation program. “I do expect we will see that impact.”

A modeling study last year estimated that if the vaccine were rolled out to countries with the highest incidence of malaria, it could prevent 5.4 million cases and 23,000 deaths in children younger than 5 each year.

A recent trial of the vaccine in combination with preventive drugs given to children during high-transmission seasons found that the dual approach was much more effective at preventing severe disease, hospitalization and death than either method alone.

The malaria parasite, carried by mosquitoes, is a particularly insidious enemy, because it can strike the same person over and over. In many parts of sub-Saharan Africa, even those where most people sleep under insecticide-treated bed nets, children have on average six malaria episodes a year.

Even when the disease is not fatal, the repeated assault on their bodies can permanently alter the immune system, leaving them weak and vulnerable to other pathogens.

Malaria research is littered with vaccine candidates that never made it past clinical trials. Bed nets, the most widespread preventive measure, cut malaria deaths in children under 5 only by about 20 percent.

Against that backdrop, the new vaccine, even with modest efficacy, is the best new development in the fight against the disease in decades, some experts said.

“Progress against malaria has really stalled over the last five or six years, particularly in some of the hardest hit countries in the world,” said Ashley Birkett, who heads malaria programs at PATH, a nonprofit organization focused on global health.

With the new vaccine, “there’s potential for very, very significant impact there,” Dr. Birkett said.
Mosquirix is given in three doses between ages 5 and 17 months, and a fourth dose roughly 18 months later. Following clinical trials, the vaccine was tried out in three countries — Kenya, Malawi and Ghana — where it was incorporated into routine immunization programs.

More than 2.3 million doses have been administered in those countries, reaching more than 800,000 children. That bumped up the percentage of children protected against malaria in some way to more than 90 percent, from less than 70 percent, Dr. Hamel said.

“The ability to reduce inequities in access to malaria prevention — that’s important,” Dr. Hamel said. “It was impressive to see that this could reach children who are currently not being protected.”

It took years to create an efficient system to distribute insecticide-treated bed nets to families. By contrast, including Mosquirix among routine immunizations made it surprisingly easy to distribute, Dr. Hamel added — even in the midst of the coronavirus pandemic, which prompted lockdowns and disrupted supply chains.

“We aren’t going to have to spend a decade trying to figure out how to get this to children,” he said.

This week, a working group of independent experts in malaria, child health epidemiology and statistics, as well as the W.H.O.’s vaccine advisory group, met to review data from the pilot programs and to make their formal recommendation to Dr. Tedros Adhanom Ghebreyesus, director-general of the W.H.O.

“We still have a very long road to travel, but this is a long stride down that road,” Dr. Tedros said at a news conference on Wednesday.

The next step is for Gavi, the global vaccine alliance, to determine that the vaccine is a worthwhile investment. If the organization’s board approves the vaccine — not guaranteed, given the vaccine’s moderate efficacy and the many competing priorities — Gavi will purchase the vaccine for countries that request it, a process that is expected to take at least a year.

But as with Covid-19, problems with vaccine production and supply could considerably delay progress. And the pandemic has also diverted resources and attention from other diseases, said Deepali Patel, who leads malaria vaccine programs at Gavi.

“Covid is a big unknown in the room in terms of where capacity is currently in countries, and rolling out Covid-19 vaccines is a huge effort,” Ms. Patel said. “We’re really going to have to see how the pandemic unfolds next year in terms of when countries will be ready to pick up all of these other priorities.”

New vaccine candidate provides breakthrough in the fight against malaria [News-Medical.Net, 4 May 2021]

A malaria vaccine candidate tested on children in West Africa has shown an efficacy of around 77 per cent, say scientists, hailing it as a breakthrough in the fight against the disease.

Malaria causes more than 400,000 deaths a year globally, according to the World Health Organization (WHO), mostly among children in Sub-Saharan Africa.

The R21/Matrix-M vaccine, developed by the Clinical Research Unit of Nanoro (CRUN), Burkina Faso and their partners at the University of Oxford in the UK, is the first malaria vaccine to reach the 75 per cent efficacy target set by the WHO.

Researchers recruited 450 children aged five to 17 months in the area of Nanoro, central Burkina Faso, and divided them into three groups for the Phase IIb trial.

One group of 150 received the vaccine with a low dose of the Matrix-M adjuvant, which helps create a stronger immune response. Another group of 150 received the vaccine at a higher dose of adjuvant, while the last group of 150 received the rabies vaccine as a control vaccine.
Halidou Tinto, principal trial investigator at the CRUN, said:
Once we vaccinated them with three doses one month apart […], we followed them in each group to see how they were going to behave in terms of vaccine safety, tolerance, but also efficacy."

The subjects in the study reported no serious side effects from the vaccine, which was found to be safe and can be manufactured at low cost on a large scale, they added.

Despite more than 100 vaccine candidates entering clinical trials in recent decades, none have previously reached the target of 75 percent efficacy which the WHO set as a target to be achieved by 2030.

The Serum Institute of India, which has manufactured the vaccine, says it will be able to deliver more than 200 million doses of the vaccine once it is approved by regulators.

Epidemiologist Gauthier Tougouri, coordinator of the National Malaria Control Programme in Burkina Faso, hailed the study as a great achievement in the fight against malaria.

Last year the country recorded more than 11 million cases of malaria and almost 4,000 malaria-related deaths, including pregnant women and children, official figures show.

A larger Phase III trial will now be conducted involving 4,800 children aged five to three years in four countries.

"I hope that the forthcoming results will confirm phase two of the study so that we can reach the 2030 target for the elimination of malaria," said Tougouri.

In Burkina Faso, children will be recruited for the next phase in Nanoro and Dande, in the south-west of the country from next month.

"It is important for us to see if such a vaccine, tested in an area like Nanoro which has a transmission of medium duration, will give the same effectiveness in an area like Dande where the transmission is much longer," explained Tinto.

Researchers hope that by testing the vaccine in different contexts on a larger number of children, its efficacy will be confirmed and the vaccine can be considered for registration.

Charlemagne Ouedraogo, Minister of Health for Burkina Faso, said the findings offer hope for the elimination of malaria in the country and across the continent.

"We believe that the solution against malaria will come from Burkina. We encourage the team to continue the third phase to give us results that will allow us to go further so that a vaccine is put on the market that will allow us to reduce morbidity and mortality from malaria," he said.

Ida Sawadogo, program officer at the Access to Essential Medicines Network, said: "We have been waiting for this for years and we are happy that at last a vaccine is being found against this disease which is the number one killer in our country."

Novel vaccine 77 percent effective in preventing malaria, finds study [European Pharmaceutical Review, 27 Apr 2021]

By Hannah Balfour

The R21 vaccine candidate, when administered with 50mg of adjuvant, was found to be 77 percent effective in preventing malaria in children over 12 months.

New data suggests that Novavax’s malaria vaccine candidate, R21, is 77 percent effective in preventing malaria in children. According to the company, such high protective efficacy could make it an important tool for the eradication of malaria globally. The Phase IIb trial data was published in Preprints with The Lancet.

The Phase IIb randomised, controlled, double-blind trial was conducted in Burkina Faso and recruited 450 participants from an area called Nanoro, with highly seasonal malaria transmission.

In three study arms, participants aged five to 17 months received 5mg of R21 with either 25mg or 50mg of Matrix-M adjuvant, or a rabies vaccine (control). Participants were given three doses at four-week intervals and a final, fourth dose one year later. The safety, immunogenicity and efficacy of the vaccine were evaluated over one year.

The researchers reported that the vaccine efficacy at six months was 77 percent in the higher adjuvant dose group and 71 percent in the lower adjuvant dose group. After a year, the efficacy in the higher adjuvant dose group remained at 77 percent. This is significantly higher than the RTS,S/AS01 vaccine, the most effective malaria vaccine candidate to date, which was found to have 55.8 percent efficacy over 12 months in African children.

Both adjuvant dosage levels were reportedly well tolerated, with no severe reactions. In addition, participants vaccinated with R21/Matrix-M showed high titers of malaria-specific anti-NANP antibodies 28 days after the third vaccination, which were almost doubled with the higher adjuvant dose. Though antibody titers waned over time, after the fourth dose administered one year later, they were boosted to levels similar to the peak titers achieved following the primary series of vaccinations.

“These significant results support our high expectations for the potential of this vaccine, which included reaching the World Health Organization (WHO)-stated goal for a malaria vaccine with at least 75 percent efficacy,” said Adrian Hill, Lakshmi Mittal and Family Professorship of Vaccinology; Director of the Jenner Institute at the University of Oxford; Co-Director, Oxford Martin Programme on Vaccines and co-author of the publication. “With the commitment by our commercial partner, Serum Institute of India, to manufacture at least 200 million doses annually in the coming years, we believe this vaccine could have a major public health impact.”

Under the licensing agreement, the Matrix-M component of the malaria vaccine will be manufactured by Novavax and supplied to SII, which has rights to use Matrix-M in the vaccine in regions where the disease is endemic and will pay Novavax royalties on its market sales of the vaccine. Additionally, Novavax will have commercial rights to sell and distribute the SII-manufactured vaccine in certain countries, primarily in the travellers’ and military vaccine markets.

There were an estimated 229 million cases of malaria worldwide in 2019, with an estimated 409,000 deaths. Children under the age of five are the most vulnerable, accounting for 67 percent of deaths worldwide in 2019. A Phase 3 trial of the vaccine has begun recruitment across five trial sites in four countries of differing malaria transmission rates and seasonality in Africa to study large-scale safety and efficacy.

R21 was created by the University of Oxford and includes Novavax’ Matrix-M adjuvant. It is licensed and manufactured by the Serum Institute of India (SII).

New Coronavirus News from 28 Sep 2021

Dr. Fauci offers an important point about COVID vaccine [Deseret News, 28 Sep 2021]

By Herb Scribner

What makes the COVID-19 pandemic so different than the 1918 flu?

It’s no question that the ongoing COVID-19 pandemic has reached the levels of the 1918 influenza pandemic. Recent data suggests that the COVID-19 deaths have srupassed deaths from the 1918 flu, after all.

But Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said there’s a major difference between what happened in 1918 and now, and it does not have to do with population size.

Rather, the current pandemic has a simple tool to slow the spread of COVID-19 — a vaccine.
That was something that did not exist during the 1918 pandemic.
• “It’s important that back in 1918, they did not have vaccines,” Fauci told the Takeout. “We now have a highly effective tool to blunt this outbreak and to essentially crush it if we get ourselves in this country and the rest of the world vaccinated. So there’s a similarity in the extraordinary number of deaths in both of these now, historic pandemics, but a really important difference is that we have a tool now that we did not have back then. That’s the reason why it should impress upon everyone who’s listening to us now realize why it’s so important to take advantage of that tool.”

What’s the deadliest outbreak in American history? You’re living in it
Indeed, the U.S. reached a grim milestone when you compare the two pandemics. The coronavirus has killed more Americans than the flu pandemic did from 1918 to 1919, as I wrote for the Deseret News.

In fact, the 1918-1919 flu pandemic killed about 675,000 people in the United States, per The Guardian. The U.S. has firmly surpassed that number over the last two weeks.
• Of course, the U.S. population was about one-third of the size back then and the flu was concentrated mostly in Europe.
• But the COVID-19 outbreak “is by any measure a colossal tragedy in its own right, especially given the incredible advances in scientific knowledge since then and the failure to take maximum advantage of the vaccines available this time,” according to The Guardian.
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New Coronavirus News from 1 Oct 2021

One-on-one with Dr. Fauci: ‘Expect the unexpected’ [National Geographic, 1 Oct 2021]

National Geographic interviewed Anthony Fauci about his personal history, his career, and his role in health crises from HIV/AIDS to COVID-19.

Excerpts from Fauci—Expect the Unexpected: Ten Lessons on Truth, Service, and the Way Forward. The National Geographic book was drawn from interviews for the documentary film Fauci; proceeds from the book benefit conservation.

I was born on Christmas Eve, 1940. As my father tells the tale ... the obstetrician who was taking my mother through her pregnancy happened to have been at a black-tie cocktail party.
And when my mother went into labor, apparently it was pretty quick. My father brought her to Brooklyn Hospital, and he remembers the doctor walking in with a tux on. He had to get into the delivery room very quickly, so he just washed his hands and put the scrubs over the tux ... We always joked about it at home: Just how much had he had to drink before he actually came in to deliver me?
***
Anthony Fauci was almost five years old in 1945 when the United States detonated atomic bombs over the cities of Hiroshima and Nagasaki, unleashing catastrophic damage and spurring Japan’s surrender to the Allies.

That moment when I saw my mother reading the New York Daily News with the big picture on the front page of the devastation in Hiroshima was a memorable moment for me. I had played war games as a child, where the good guys were the GIs and the bad guys were the Japanese, and when I saw the destruction in Japan, I thought, Wow, hey, that’s great.

But I saw in my mother something that puzzled me at first ... Many decades later I still remember that scene in the living room in our apartment in Brooklyn. I can picture my mother sitting on the couch looking at the paper and me looking over her knee. She was really sad.
That was a defining moment, understanding that you can feel empathy toward people who are very different from you—even people who might officially be the enemy.
***
We lived above my father’s pharmacy. I would deliver prescriptions on my bicycle around the neighborhood, and my sister would help out behind the counter. I had a Schwinn bicycle with a basket up in front, and I used to do it for tips. You would zip around the neighborhood, park your bike, knock on the door, deliver, and they would give you a 25-cent tip. That was a big tip!

You’d meet different people, and I got an appreciation of what illness was—you knew they were ill from the way they looked. That was my first introduction to illness and medicine. And helping out in the store, I got a better perspective of the family unit because we all worked together.

The documentary film Fauci explores the life and career of America’s top infectious disease expert. From National Geographic Documentary Films, it begins streaming on Disney+ October 6.
***
Fauci spent his early childhood in the Bensonhurst section of Brooklyn, New York, in a neighborhood he describes as “99.9 percent Italian American.” All four of his grandparents had emigrated from Italy via Ellis Island, then moved from the Lower East Side of Manhattan to raise their families in Brooklyn, where Fauci’s parents met and married.

In the summer, when the windows were open, the smells were everywhere—mostly tomato sauce and sausages being cooked. And it was just something that becomes part of you.
Whenever I happen to smell that now, decades and decades and decades later, it’s an immediate flashback. It puts me right on 79th Street and New Utrecht Avenue, and you just can’t escape it. There was a certain feeling of freedom—fresh air and sunshine and being outdoors on the streets of Brooklyn. It was the safest place in the world to be because all of the storekeepers would be sitting down with their little chairs in front of their shops, watching the kids go by. No one would in their wildest dreams imagine trying to intimidate any of these kids because the entire neighborhood was kind of like a protective squad. We felt perfectly secure all the time. It was an extremely happy childhood.
***
Fauci attended the prestigious Regis High School in Manhattan and went on to Holy Cross, an all-male college in Worcester, Massachusetts. By then, he already knew he was on a pathway to becoming a doctor.

In college I worked every single summer in construction as what’s called a mason tender, who helps a bricklayer (you carry the cement, you carry the bricks, you clean up). I already knew then I wanted to go to Cornell’s medical school, and it was just by happenstance that I got picked to work on the construction of the Samuel J. Wood Library at the medical school, right on York Avenue and East 69th Street in New York City. One day I decided I would get up the courage to go inside.

When the other construction guys sat down for lunch on the wall, whistling at the nurses going by, I walked up the steps and walked in. I looked into the auditorium, and I remember saying to myself, Wow, this is amazing. All of a sudden, the security guard who’s standing at the door comes over to me, a big guy. He says, “Can I help you, sonny?” Sonny. He called me sonny.
I say, “Oh, I’m just looking around here.”

He says, “You got concrete all over your boots. Why don’t you just step outside?” I looked at him, a little bit indignant. I said, “Someday I’m going to be a student in this medical school.”
He looked at me with a straight face and he says, “Yes, sonny. Someday I’m going to be police commissioner of New York City.”

But a year later I was a student there.

(Stopping Pandemics: An exclusive National Geographic event with Dr. Fauci and other experts)
***
When you’re a physician, it’s just as important to know human nature as it is to know human physiology. The most important thing in the care of a patient is caring for the patient. You’ve really got to care about them as a person, not as a statistic or as somebody that you’re going to bill or somebody that’s one of a number of people.
***
Let me give you a personal example of the kinds of dramatic evolutions and changes that can occur totally beyond your control and that can profoundly impact the direction of your career and your life.

In 1968 I finished my medical training in internal medicine at the New York Hospital-Cornell Medical Center. That very same year, noted public health scholars ... were opining and even testifying before the United States Congress that with the advent of antibiotics, vaccines, and public health measures, the war against infectious diseases had been won, and we should focus our efforts on other areas of research and public health.

As fate would have it, at that time I was on my way to begin, of all things, a fellowship for training in infectious diseases at the National Institutes of Health. I remember reflecting as I drove from New York City to the NIH in Bethesda, Maryland, with the words of the wise pundits resonating in my mind, that I felt somewhat ambivalent about my career choice, to say the least. Was I entering into a disappearing subspecialty? I sort of felt like I was going to Miami to become a ski instructor.

Fortunately for my career, but unfortunately and sadly for the world, even surgeons general are not always correct. Indeed, 13 years later, in 1981, the AIDS epidemic had emerged and transformed my professional career, if not my entire life.
***
You must be prepared at any moment to enter uncharted territory, to expect the unexpected, and where possible, seize the opportunities.
***
Fauci was working as one of the leading researchers on immunology and autoimmune diseases at the National Institutes of Health in 1981 when an unidentified infectious disease came onto his radar. The scientific publication Morbidity and Mortality Weekly Report (MMWR), published by the Centers for Disease Control and Prevention, reported that five gay men from Los Angeles with no apparent underlying illnesses had developed a very rare pneumonia called Pneumocystis pneumonia.

I was sitting in my little office on the 11th floor of the NIH Clinical Center on a hot summer day, the first week in June, when I saw the report. I had been studying drugs that suppressed the immune system, and we were seeing Pneumocystis cases. So I said, “There’s something strange going on here,” and put it into my desk drawer.

One month later, on the fifth of July of 1981, another MMWR appears on my desk. This time, 26 men. Amazingly, all gay men. Not only from Los Angeles, but from San Francisco and New York, who not only had Pneumocystis pneumonia but had Kaposi’s sarcoma: a tumor, a cancer seen in people whose immune system is dramatically damaged.

I remember looking at that and going, Oh my God, this is a brand-new infectious disease. I actually got goose bumps. I had no idea what the cause of the infection was, but I did know it destroys the immune system. As a physician/scientist trained in infectious diseases and immunology, if ever there was the disease that was made for me, it’s this.

I made a decision then that I was going to completely change the direction of my research. I had been extremely successful in my career, and my mentors, the people who recruited me here years ago, told me I was crazy. They said, “Why are you throwing away a promising career to go chasing after a disease that’s a fluke?” I decided that I was going to do it anyway. I felt obliged to explain it to the world.

Unfortunately, it turned out that I was right. It exploded into one of the most extraordinary pandemics in the history of our civilization.
(How devastating pandemics change us)
***
Homophobia was clearly pervasive at the outbreak of AIDS. Because I was spending most of my time with sick gay men, I would see homophobia in society—and by association as their physician be on the receiving end of homophobic attacks.

I don’t think I ever had any element of homophobia or even any inkling of that in me. I think it gets back to my parents and their tolerance for other people. Empathy was a big component of my growing up in the family in which I grew up—and again, it was solidified and underscored in the training, in Jesuit training in high school and in college.

I have always felt an empathy towards people who were being treated unfairly, as well as the unfairness of the prejudice against a person whose sexual persuasion is beyond their control. It’s just who they are. The injustice of that dominated my attitude about what homophobia was and is. It made me angry to see people have that attitude. It made me a defender of someone’s right to be who they are.
***
My optimism is that there are going to be bad actors and there are going to be better angels.
But I think there are more better angels than bad actors.
***
I’m really not afraid of very many things. But what I’m most concerned about is not getting the opportunity to finish the things that I started decades ago and to add the finishing touches. I would like to see the defining public health challenge of my professional career, HIV, ended as an epidemiological pandemic. Everyone thought ... we could cure or eradicate AIDS. And that turned out to be very difficult and could actually be impossible. I don’t think we’re going to eradicate HIV—in fact, I know we’re not—but I think we can almost eliminate it gradually throughout the world. First in countries that have more resources, like the developing countries, but then, ultimately, in sub-Saharan Africa ... My fear is that I may not necessarily see that. But I hope I do. And I think I will.
***
Fauci’s work at the NIH made him uniquely prepared to face the coronavirus pandemic: He had already worked on treatment and prevention efforts for the Zika virus, Ebola, anthrax, pandemic flu, HIV, tuberculosis, and others. But he’s acutely aware of the public’s short memory. We say we learn from experience, but how can we make sure that’s really true?

I think when you get further and further away from a really profoundly defining event, the impact of that just attenuates. In 1918, during the Spanish flu pandemic, my father was eight years old. I’m sure the horror of that year and a half influenced him as he got into his teenage years and his 20s and his 30s. And then it probably got less and less, but he never forgot it.

For those of us like myself who only read about it as a vague story in a history book, it doesn’t have the same impact of being there yourself or being intimately connected with someone who experienced it ...

World War II ended when I was five years old. The people who came back from the war and the experience they had could never be translated to people 40 years later: What do you mean you were in a place where you invaded an island and 10,000 of your friends got killed?

I don’t think not understanding is a failing. It’s just the way life is. Unless you’re connected with something directly, it doesn’t mean much to you. The COVID-19 epidemic is like nothing we have experienced in the past 102 years. Let us not forget that we were not as prepared as we thought we were or as we should have been. So let’s get to being able to say, “Never again.
We’re never going to let this happen again.” What I’m afraid of as we get out of this is that it’s going to be five years from now, 10 years from now, and people are just going to either forget or not care how this outbreak completely gripped the world. They’re going to forget.

And I say this with a little bit of despair: that we’ve always been aware of health disparities.
We’re always aware that African Americans and Hispanics get the short end of the stick when it has to do with diseases. And their disproportionate burden with COVID-19 now is staring us right in the face.

Let us make a commitment that in the next three or four decades, we’re going to do something about that. Sounds great. But five years from now some other problem is going to come along, and we’re going to forget about COVID-19.
***
I have worked with seven presidents over the course of 11 terms. I learned from the very beginning, you’re doomed to failure if you are afraid of not getting asked back, if you’re afraid of saying something that’s going to get somebody upset. Nobody wants the president of the United States to be upset with you.

During the Trump administration, every once in a while, I would say something that they didn’t like, and then I would be off television for a week or so. But I would always come back. I didn’t want to lose that. I didn’t want to lose the direct messaging to the American public.

Donald J. Trump and I kind of liked each other. I don’t know ... maybe it was the having-New-York-in-common thing ... And we developed, as I think both of us have described, an interesting relationship, a good relationship. But more than once, as we would get into the press conferences, I would have to fine-tune something that he said. That seemed to be surprisingly OK until things started to get a little bit more tense. And yet when I would see him two days later in the Oval Office, it was like we were buddies again. I don’t think he had a deliberate, malicious disdain for science. I think he just didn’t think it was important. It’s not even disdain; it’s a disregard ...

I felt my job was to do whatever I can to get us out of this outbreak. So, leaving was not an option. The only option I had was to take the chance, right in that venue, to contradict him. I could either keep quiet, which would be violating my own principles, or leave, which would have meant I can’t do any good anymore. I felt the only way I could maintain scientific integrity was to speak up.

It was clear that my message to the American public was contrary to his message, so he allowed the legions around him to try and undermine my credibility. On the other hand, he had this interesting, complicated relationship with me, and I really don’t think he wanted to hurt me.
I think he was torn by the fact that, deep down, he knew that what I was saying was true. He liked me, but what I was saying was unacceptable to him.
***
One of the things that still completely baffles me is the lack of acceptance by some people in this country that COVID is a problem. There are people who think that this is a hoax, that this is some made-up thing for one reason or another, when the facts are staring us right in the face.
That tells me that we have some fundamental lesions in this country that need to be addressed and healed. I know that people who are feeling that way are looking at me and saying I’m the crazy one. But I’m sorry, I have to call you on this. That’s crazy to think that this is not real.
***
I hope that if historians look back at what I’ve done in my life, they see a life of commitment to having a positive impact on society. And I have had some degree of success in doing so.
Maybe somebody many, many years from now goes back and reads about this and says, Hey, that guy was pretty good.

This story appears in the November 2021 issue of National Geographic magazine.

COVID-19 origins: Closest viruses to SARS-CoV-2 found in Laos [Medical News Today, 1 Oct 2021]

by Hannah Flynn

Since SARS-CoV-2, the virus that causes COVID-19, was first detected in Wuhan, China, in December 2019, there have been global efforts to determine its origins.
As the pandemic was thought to originate in Wuhan, many efforts have foc
used on China, with the assumption that, as the virus was first detected there, it probably started there.

Now, two papers under review by the journal Nature and published as preprints are casting some doubt on these assumptions and indicate that in order to discover the origins of the virus, researchers may have to look farther afield.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

Infecting human cells
One of the reasons SARS-CoV-2 is so infectious is a region on its spike protein that gives it its ability to bind to a receptor present on the surface of many human cells called ACE2.

In a paper submitted to Nature, researchers from the Pasteur Institute in Paris, France, and from Laos have now reported finding viruses with receptor binding domains very similar to those found on SARS-CoV-2 in cave bats in North Laos.

The researchers took blood, saliva, anal feces, and urine samples from 645 bats from 46 different species found in limestone caves in North Laos, which is close to the Southwest China border.

They discovered three separate virus strains in three different species of Rhinolophus bat, commonly known as horseshoe bat. RNA sequencing revealed that these viruses were over 95% identical to SARS-CoV-2, and one, the closest virus to SARS-CoV-2 found so far, was 96.8% similar.

Further experiments showed that the receptor binding domain of the viruses had a high affinity for human ACE2 receptors. This was comparable to the affinity of SARS-CoV-2 strains that scientists discovered at the beginning of the pandemic, suggesting these viruses could infect humans directly.

Last year, scientists detected a similar virus in Yunnan, in Southwest China. It was 96.1% similar to SARS-CoV-2, meaning the present paper describes the closest virus detected yet.

Prof. Edward Holmes from the University of Sydney, Australia, who has studied the emergence and spread of SARS-CoV-2 but was not involved in this research, told Medical News Today the paper was “really significant.”

“In my opinion, these viruses won’t just be found in bats and pangolins. Ecology isn’t like that. I suspect that they will also be found in other mammalian species but have not yet been sampled,” Prof. Holmes said.

“Some of these Laotian viruses are extremely close to SARS-CoV-2 in the key receptor binding domain (part of the spike protein) of the virus. This means that the functional core of the virus exists in nature, so there is no need to think that the virus was somehow created or adapted in a lab.” – Prof. Edward Holmes

Not the ‘China virus’ after all?
Further doubt was cast on the assumption that the virus responsible for the COVID-19 pandemic originated in Wuhan with another preprint submitted to Nature.

A study by a team from the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing has suggested that SARS-CoV-2-related viruses are “extremely rare” in bats in China, after taking nose and anal swabs from over 13,000 bats between 2016 and 2021 at 703 locations across the country.

The paper also showed that SARS-CoV-2 was undetectable in samples taken from Wuhan Huanan Market, 40 days after the closure of the market, which was due to fears that the initial infection event had occurred there.

Authors conclude that further research should be done south and southwest of China to determine whether the SARS-CoV-2 virus originated there.

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Finding the origins of SARS-CoV-2
One of the reasons it has been so hard to establish where the coronavirus originated is viral genomes that change through a process called recombination, rather than just through mutations. Viral recombination occurs when two different strains infect the same host cell.
As they replicate in the same cell, they can interact, and the virus progeny they generate can have some genes from both parents. This can make it hard to work out the lineage of that virus.

“Recombination seems to be important for how these viruses evolve overall,” Spyros Lytras, an evolutionary virologist from the University of Glasgow in the United Kingdom, told MNT.

“So, essentially we are saying these viruses switch bits of their genome all the time, and the new viruses from Laos really highlight that. Even though [these viruses] are found in the same place, the same cave essentially, they all have different bits of their genome that have different combinations of recombinant parts.”

Merck says COVID-19 pill cuts risk of death, hospitalization [Associated Press, 1 Oct 2021]

By MATTHEW PERRONE

WASHINGTON (AP) — In a potential leap forward in the global fight against the pandemic, drugmaker Merck said Friday that its experimental pill for people sick with COVID-19 reduced hospitalizations and deaths by half.

If cleared by regulators, it would be the first pill shown to treat COVID-19, adding a whole new, easy-to-use weapon to an arsenal that already includes the vaccine.

The company said it will soon ask health officials in the U.S. and around the world to authorize the pill’s use. A decision from the U.S. Food and Drug Administration could come within weeks after that, and the drug, if it gets the OK, could be distributed quickly soon afterward.

All other COVID-19 treatments now authorized in the U.S. require an IV or injection. A pill taken at home, by contrast, would ease pressure on hospitals and could also help curb outbreaks in poorer and more remote corners of the world that don’t have access to the more expensive infusion therapies.

“This would allow us to treat many more people much more quickly and, we trust, much less expensively,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University who was not involved in the research.

Merck and its partner Ridgeback Biotherapeutics said early results showed patients who received the drug, molnupiravir, within five days of COVID-19 symptoms had about half the rate of hospitalization and death as those who received a dummy pill.

The study tracked 775 adults with mild-to-moderate COVID-19 who were considered high risk for severe disease because of health problems such as obesity, diabetes or heart disease. The results have not been reviewed by outside experts, the usual procedure for vetting new medical research.

Among patients taking molnupiravir, 7.3% were either hospitalized or died at the end of 30 days, compared with 14.1% of those getting the dummy pill. After that time period, there were no deaths among those who received the drug, compared with eight in the placebo group, according to Merck.

The results were so strong that an independent group of medical experts monitoring the trial recommended stopping it early.

Company executives said they plan to submit the data to the FDA in the coming days.

Even with the news of a potentially effective new treatment, experts stressed the importance of vaccines for controlling the pandemic, given that they help prevent transmission and also reduce the severity of illness in those who do get infected.

White House coronavirus coordinator Jeff Zients said that vaccination will remain the government’s main strategy for controlling the pandemic. “We want to prevent infections, not just wait to treat them when they happen,” he said.

Dr. Anthony Fauci, the government’s foremost authority on infectious diseases, called the results from Merck “very good news.”

Merck only studied its drug in people who were not vaccinated. But FDA regulators may consider authorizing it for broader use in vaccinated patients who get breakthrough COVID-19 symptoms.

Andrew Pekosz of Johns Hopkins University predicted vaccines and antiviral drugs would ultimately be used together to protect against the worst effects of COVID-19.

“These shouldn’t be seen as replacements for vaccination — the two should be seen as two strategies that can be used together to significantly reduce severe disease,” said Pekosz, a virology specialist.

Patients take four pills of molnupiravir twice a day for five days. Side effects were reported by both groups in the Merck trial, but they were slightly more common among those who received a dummy pill. The company did not specify the problems.

Earlier study results showed the drug did not benefit patients who were already hospitalized with severe disease. That’s not surprising, given that antiviral drugs are most effective when used before the virus ramps up in the body.

The U.S. has approved one antiviral drug, remdesivir, for COVID-19, and allowed emergency use of three antibody therapies that help the immune system fight the virus. But all the drugs are expensive and have to given by IV or injection at hospitals or clinics, and supplies have been stretched by the latest surge of the delta variant.

The antibody drugs have been shown to reduce hospitalization and death by roughly 70% when given to high-risk patients, roughly 20 percentage points more than Merck’s pill. But experts cautioned against comparing results from the two, given the preliminary nature of Merck’s data.

Health experts, including Fauci, have long called for a convenient pill that patients could take when COVID-19 symptoms first appear, much the way Tamiflu is given to help speed recovery from the flu.

Like other antivirals, Merck’s pill works by interfering with the virus’s ability to copy its genetic code and reproduce itself.

The U.S. government has committed to purchasing enough pills to treat 1.7 million people, assuming the FDA authorizes the drug. Merck said it can produce pills for 10 million patients by the end of the year and has contracts with governments worldwide. The company has not announced prices.

Several other companies, including Pfizer and Roche, are studying similar drugs and could report results in the coming weeks and months.

Merck had planned to enroll more than 1,500 patients in its late-stage trial before the independent board stopped it early. The results reported Friday included patients across Latin America, Europe and Africa. Executives estimated 10% of patients studied were from the U.S.
___
This story has been updated to correct that patients take eight pills per day, not two.