UK’s first human Brucella canis case confirmed

UK’s first human Brucella canis case confirmed

The European Scientific Counsel Companion Animal Parasites (ESCCAP) called for compulsory testing of imported dogs after the UK’s first case of dog-to-human transmission of Brucella canis (B canis). This causes an infectious disease called canine brucellosis, with a variety of reproductive consequences for both sexes. For female dogs, abortion and failure to conceive are common. For male dogs, abnormal semen quality and painful testicles are likely. Both sexes might experience lethargy, weight loss, and lameness.  

The UK’s first dog-to-human transmission was recorded when a rescue dog from Belarus infected her owner. Moosha, a German shepherd cross, began to abort her puppies three days after arriving at her new foster home. The initial fear was that Moosha had rabies, but she was diagnosed with canine brucellosis two months later. Eventually her owner contracted the disease and was hospitalised. All four of her dogs had to be euthanised as three contracted the disease and the fourth was at high risk. This case represents both the first dog-to-dog transmission and the first dog-to-human transmission recorded in the UK. 

Dr Ian Wright, Guideline director for ESCCAP, stated that “the zoonotic risk is low but as this case demonstrates, very real.” 

“Ideally, testing should be compulsory for dogs being imported into the UK from endemic countries” 

He outlined the key signs that veterinary professionals should be aware of: “vets, nurses, and owners should also be aware of relevant clinical signs in imported dogs. These include infertility, abortion, endometritis, epididymitis and orchitis, and scrotal oedema.” 

A spokesperson for Defra stated that it was working closely with the UKHSA to “ensure all those in contact with this shipment of dogs were aware of the associated human and animal health risks”. The spokesperson emphasised that “strict checks” are in place, including a requirement for rabies vaccination and “relevant tests or treatments prior to travel”.  

To participate in veterinary science discussions at the World Vaccine Congress in Europe this year, buy your tickets here.
 

WHO updates guidance for Tuberculosis response

WHO updates guidance for Tuberculosis response

In August 2022 the WHO announced new guidance to “support national strategic planning” for tuberculosis (TB) responses. This guidance was described as a culmination of the “latest WHO guidelines” by Dr Tereza Kasaeva, Director of WHO’s Global Tuberculosis Programme.  

“It highlights the importance of comprehensive and inclusive engagement of relevant stakeholders and partners”.  

This guidance was produced to “better align with global commitments” and recent developments in TB and public health. It updated the 2015 “Toolkit” to provide a “national strategic plan for TB prevention, care, and control.” A national strategic plan (NSP) “guides the national TB response through interventions within and beyond the health sector”. It does this by identifying priorities for health authorities and stakeholders and how these can be coordinated across “various sectors”.  

“The NSP translates global, regional, and national commitments into national and subnational targets and activities to be implemented to achieve these targets and provides the basis for mobilisation of domestic and external resources”.  

The foreword to this guidance states the global intention of reducing TB deaths and incidence by 90% and 80% respectively from 2015 to 2030. Among the means of achieving this are a “commitment to ambitious targets for TB treatment and prevention”.  

Within the guidance is a table of “Pillars, principles and components of the end TB strategy”. This comprises four pillars: 

  1. Government stewardship and accountability, with M&E. 
  2. Strong coalition with civil society organisations and communities. 
  3. Protection and promotion of human rights, ethics, and equity. 
  4. Adaptation of the strategy and targets at country level, with global collaboration. 

The pillars and components are as follows: 

Integrated, patient-centred care and prevention: 
  • Early diagnosis of TB including universal DST and systematic screening of contacts and high-risk groups. 
  • Treatment of all people with TB including drug-resistant TB, and patient support. 
  • Collaborative TB/HIV activities, and management of comorbidities. 
  • Preventative treatment of people at high risk, and vaccination against TB. 
Bold policies and supportive systems: 
  • Political commitment with adequate resources for TB care and prevention. 
  • Engagement of communities, civil society organisations, and public and private care providers. 
  • UHC policy, and regulatory frameworks for case notification, vital registration, quality and rational use of medicines, and infection control. 
  • Social protection, poverty alleviation, and actions on other determinants of TB. 
Intensified research and innovation: 
  • Discovery, development, and rapid uptake of new tools, interventions, and strategies.  
  • Research to optimise implementation and impact and promote innovations.  

Dr Tereza Kasaeva will be speaking at the World Vaccine Congress in Europe in October 2022; get your tickets to the Congress here.  

UK’s JCVI updates Covid-19 booster programme

UK’s JCVI updates Covid-19 booster programme

In August 2022 the UK’s Joint Committee on Vaccination and Immunisation (JCVI) published advice on the boosters that will be used for each group in autumn. The JCVI emphasised that every option on the list provides protection against “severe illness” from Covid-19. Furthermore, the Committee highlighted the need to get a booster before winter.  

For adults 18+: 
  • Moderna mRNA (Spikevax) bivalent Omicron BA.1/Original ‘wild-type’ vaccine 
  • Moderna mRNA (Spikevax) Original ‘wild-type’ vaccine 
  • Pfizer-BioNTech mRNA (Comirnaty) Original ‘wild-type’ vaccine 
  • Novavax Matrix-M adjuvanted wild-type vaccine (Nuvaxovid) “may be used when no alternative clinically suitable UK-approved COVID-19 vaccine is available” 
For young people 12-17: 
  • Pfizer-BioNTech mRNA (Comirnaty) Original ‘wild-type’ vaccine 
For children 5-11: 
  • Pfizer-BioNTech mRNA (Comirnaty) Original ‘wild-type’ vaccine paediatric formulation 

Professor Wei Shen Lim, Chair of Covid-19 immunisation for the JCVI, stated that “all of the available booster vaccines offer very good protection against severe illness from Covid-19″. 

“It is important that everyone who is eligible takes up a booster this autumn, whichever vaccine is on offer.” 

Dr Mary Ramsay, Head of Immunisation at UKHSA, suggested that although cases were “relatively low at present” she expected to see an increase in circulation “during the winter months”.  

To hear from speakers from Moderna, Pfizer, and Novavax at the World Vaccine Congress in Barcelona 2022 click here to get your tickets.  

Avian influenza restrictions lifted in the UK

Avian influenza restrictions lifted in the UK

In August 2022 the UK’s Chief Veterinary Office, Professor Christine Middlemiss, appealed to bird keepers to maintain enhanced biosecurity measures after an avian influenza outbreak. Restrictions lifted on 16th August, but Professor Middlemiss is keen to ensure that people remain vigilant. 

In November 2021 authorities implemented an avian influenza prevention zone (AIPZ) across Great Britain. This required bird keepers, from keepers of poultry or pets to commercial flocks, to take “additional biosecurity precautions”. Further restrictions enforced this with a requirement to keep birds housed from November 2021 to May 2022.  

The Department for Environment, Food, and Rural Affairs (Defra) warned of the UK’s largest ever flu outbreak. Over 130 cases have been confirmed since October 2021. Professor Middlemiss emphasised that although the restrictions had been lifted, bird keepers should continue to follow “enhanced measures”.  

“Now we are in the summer months and experiencing higher temperatures, the risk to poultry has now been reduced…the time is right to lift the [AIPZ].” 

She thanked all bird keepers for their “hard work” in upholding “high biosecurity standards for many months”. However, she reminded keepers of “localised areas of risk”. Furthermore, she insisted that it is “vital that everyone keeps biosecurity and cleanliness at the forefront of their minds to keep their flocks safe”. If members of the public or keepers suspect disease they are advised to contact the Defra helpline.

Vaccination

As of 2021 the government continues to advise against vaccination of “poultry and most captive birds”.  

“Vaccination is not a routine control measure and is a practice restricted by legislation.” 

Among the reasons stated against vaccination, the government cites transmission of avian influenza from vaccinated birds. Additionally, influenza viruses “mutate rapidly, which could render a vaccine less useful”. Handling and welfare implications for the birds are also suggested difficulties.

The government states that “early reporting, rapid action, biosecurity, culling, and surveillance remain the most effective” means of prevention.  

To participate in discussions on avian influenza at the World Vaccine Congress in Europe 2022, click here for tickets.  

UK approves Moderna’s dual vaccine against Covid

UK approves Moderna’s dual vaccine against Covid

The UK Medicines and Healthcare products Regulatory Agency (MHRA) announced in August 2022 that it approved Moderna’s bivalent vaccine, Spikevax Bivalent Original/Omicron, against two forms of Covid. Dr June Raine, chief executive of the MHRA, stated that the “first generation” vaccines “continue to provide important protection against the disease”. However, the candidate presents exciting opportunities for the UK. 

“What this bivalent vaccine gives us is a sharpened tool in our armoury”. 

The UK is the first to approve the dual vaccine, which targets the original virus and the newer Omicron variant. It is predicted to be available during the autumn as a booster, and we can expect 13 million doses by the end of the year. Moderna will begin supplying doses in the next few weeks. The vaccine also awaits approval in Australia, Canada, and the EU. 

In June 2022 Moderna announced that the vaccine was safe. It also offered a “superior antibody response” in trials. The dose “increased neutralising geometric mean titers against Omicron approximately 8-fold above baseline levels.” Furthermore, it “elicited potent neutralising antibody responses against the Omicron subvariants”.  

Stephane Bancel, CEO of Moderna, is “delighted” at the approval of the vaccine.  

“This represents the first authorisation of an Omicron-containing bivalent vaccine, this bivalent vaccine has an important role to play in protecting people in the UK”. 

The UK government’s independent science advisory body also approved the vaccine. Professor Sir Munir Pirmohamed, chair of the Commission on Human Medicines, reported that the Commission “independently reviewed the data” and agreed with the decision taken by MHRA.  

“This novel bivalent vaccine represents the next step in the development of vaccines to combat the virus”. 

Moderna will partner with The Vaccine Taskforce, UKHSA, and the NHS, to make the vaccine available in the UK. However, we will need to see further action to share the vaccine more widely if it is to have a tangible effect. 

To hear from speakers from Moderna at the World Vaccine Congress in Europe 2022 follow the link to get your tickets.  

Langya (LayV) henipavirus emerges in China

Langya (LayV) henipavirus emerges in China

Langya (LayV) is a henipavirus, the genus that includes the Hendra and Nipah viruses. According to an article in New Scientist it appears to be “most closely related to Mojiang henipavirus”, which was linked to the onset of severe pneumonia and death in three men in 2012. The virus was discovered when a group of patients with fever and a “recent history of animal exposure” were monitored in Eastern China. LayV was identified in a throat swab from one of these patients.  

Later analysis revealed that 35 known cases of LayV have been detected in the Shandong and Henan provinces of China between 2018 and 2021. No evidence of human transmission has been found so far, but the sample size is too small to rule this out. Researchers tested 25 species of animals and found 27% of the 262 shrews surveyed had “detectable levels of LayV”. This suggests that the natural reservoir may be shrews. 

Dr Olivier Restif of the University of Cambridge stated that LayV is unlikely to spread between people: 

“I don’t think this has much pandemic potential.” 

As so few cases have been detected over recent years, researchers are not seriously concerned about transmission. Professor Francois Balloux of University College London states echoes Dr Restif’s sentiment: 

“The virus is unlikely to be something that passes from person to person easily and can easily cause an epidemic or pandemic.” 

However, he does predict that the “most likely source” of future pandemics will be zoonotic spillover. He warns that we must be better prepared for another episode in the “coming decades”. The CDC estimates that 3 out of 4 new or emerging diseases in people will come from animals. The UN has also warned that climate change and wildlife exploitation will lead to an increase in such diseases.  

To join experts in discussing future pandemics at the World Vaccine Congress in Europe 2022 click here to get your tickets!

The monkeypox vaccine: how much do we know?

The monkeypox vaccine: how much do we know?

As monkeypox cases across the world continue to increase, rollouts of the one licensed vaccine are under pressure. In the UK, questions about the number of doses were posed in a letter written by LGBTQ+ groups. In the US, NIH scientists have started to explore “fractional dosing”. The Modified vaccinia Ankara (MVA) that was previously licensed for monkeypox in Canada and the US has been approved by EU counterparts. However, in August 2022, an article in Science called into question the longevity and efficacy of the vaccine. The author, Kai Kupfershmidt, explored the options going forward.  

Originally developed by Bavarian Nordic as a smallpox vaccine, MVA is known to help against monkeypox. Yet “ethical and logistical complexities” of the current crisis are making it hard to establish how much protection it provides. It is difficult to execute “placebo-controlled clinical trials” as the vaccine is already licensed and demand is high.  

Initial evidence that smallpox vaccines might protect against monkeypox emerged in a study in the 1980s. It appeared that smallpox vaccination was “86% effective at preventing monkeypox” among contacts of patients with monkeypox in the Democratic Republic of Congo. As the study was limited, MVA was developed as a “safer alternative” to the older vaccine. Although it was licensed, “its efficacy has barely been tested in people”. Furthermore, its role in “preventing sexual transmission” has not been explored.  

The recommendation of a randomised trial is “ethically dicey”. Therefore, other options must be explored. One cohort in France is using MSM “already enrolled in a study of sexually transmitted diseases – and deemed at high risk of monkeypox”. They will get MVA in the next 2 months, and the researchers will compare infection rates either side of vaccination. A “test-negative” study is also under consideration. This involves investigation of people getting tested for monkeypox, comparing the numbers of vaccinated patients among the positive and negative groups. Dr Michael Marks, of the London School of Hygiene and Tropical Medicine, suggests that this is “probably the strongest nonrandomised approach”.  

Unfortunately, this approach requires “good linkage between testing and vaccination data”. Furthermore, these data can’t demonstrate immunity over time, or “whether disease severity is different among the vaccinated and unvaccinated”.  

Dr Will Nutland, co-founder of Prepster, suggests that these unanswered questions will continue to complicate messaging to high-risk groups. However, he wants to impress upon everyone the importance of getting vaccinated.  

“It is better to receive some level of protection than no protection at all.”  

To participate in a day of monkeypox discussion at the World Vaccine Congress in Europe 2022 head here to get your tickets! 

Pan-coronavirus vaccine hopes boosted by cold immunity

Pan-coronavirus vaccine hopes boosted by cold immunity

Scientists at La Jolla Institute for immunology in California have concluded that patients with a stronger immune response to the coronaviruses that cause cold-like symptoms may be “better protected against covid-19″. This offers the hope that a pan-coronavirus vaccine might be within reach. As researchers scramble to find novel methods of providing immunity, these results provide exciting potential. 

An article in New Scientist states that the study analysed blood samples collected before the emergence of covid-19. Multiple samples were collected from each patient over 6 months to 3 years. The team explored the response of the immune cells in these samples to four coronaviruses as well as the SARS-CoV-2 strain. They combined the blood with peptides from the coronaviruses and measured the T-cell and antibody responses that resulted. They found the responses to be “stable and persistent for all four” of the coronaviruses. Furthermore, they established that the immune responses were not due to “regular re-infections”.  

Next, researchers combined the samples with SARS-CoV-2. This revealed that the samples with the stronger T-cell immune responses to the previous four coronaviruses had the strongest response to SARS-CoV-2. However, this wasn’t the same for antibody levels.  

Dr Ricardo da Silva Antunes of La Jolla Institute stated the importance of using pre-pandemic samples. This enabled the researchers to see “pre-existing immune memory”. The genetic similarity of SARS-CoV-2 to the four common cold-like coronaviruses invited the possibility that T-cell responses “induced by prior coronaviruses” might protect against the current SARS-CoV-2.  

Despite these findings, Dr da Silva Antunes says that the “link” between these two categories of coronavirus is “still not clear”. The participants with stronger immune responses to the common cold-like coronaviruses were not guaranteed to experience less severe covid-19.  

For Professor Mala Maini of University College London, these findings add to the growing evidence that T-cell immune responses to common cold-like coronaviruses influence our SARS-CoV-2 responses. She and her colleagues are working towards a pan-coronavirus vaccine. In 2021 she stated that a “vaccine that can induce T-cells to recognise and target infected cells expressing [replication proteins]” might be able to eliminate “early SARS-CoV-2″ as well as “other coronaviruses” that will infect humans in the future.  

To learn about approaches to developing a pan-coronavirus vaccine get your tickets to the World Vaccine Congress in Europe 2022.  

Lyme disease vaccine candidate proceeds to Phase III study

Lyme disease vaccine candidate proceeds to Phase III study

Lyme disease is a systemic infection transmitted to humans by infected ticks, caused by the Borrelia burgdorferi bacteria. It is the most common vector-borne illness in the Northern Hemisphere. According to the CDC, state health departments report 30,000 cases each year. However, recent estimates suggest that it infects closer to 476,000 people annually in the US.  

Lyme disease often goes untreated due to misinterpretation of early symptoms. It then causes serious complications to the joints, the heart, or the nervous system. 

“The medical need for vaccination against Lyme disease is steadily increasing as the geographic footprint of the disease widens.” 

Pfizer’s response was to initiate a collaborative approach with Valneva. VLA15 is currently the only Lyme disease candidate in clinical development. It is an “investigational multivalent protein subunit vaccine”. Targeting the outer surface protein of the disease-causing bacteria, the vaccine is expected to inhibit the bacterium’s ability to “leave the tick and infect humans”. The vaccine addresses the most common OspA serotypes prevalent in North America and Europe.  

In studies to date, VLA5 “demonstrated a strong immune response and satisfactory safety profile”. This next phase of development requires up to 6,000 participants above the age of 5. The trial takes place across 50 sites in areas where the disease is “highly endemic”

“Pending successful completion of the Phase III study, Pfizer could potentially submit a Biologics License Applications (BLA) to the FDA and Marketing Authorisation Application (MAA) to the EMA in 2025.” 

Valneva and Pfizer started this collaboration in April 2020. The agreement states that Pfizer makes a $25 million “milestone payment” to Valneva at the start of the Phase III study. 

Dr Juan Carlos Jaramillo, CMO of Valneva, suggested that Lyme disease comprises a “high unmet medical need”. Dr Annaliesa Anderson of Pfizer agrees that “providing a new option for people to help protect themselves” is “more important than ever”. She hopes that progressing the vaccine to Phase III will provide “positive evidence” in support of the candidate.

To hear from Dr Anderson and representatives from Valneva at the World Vaccine Congress in Europe 2022 click here to get tickets.  

UKHSA under vaccine pressure as monkeypox continues

UKHSA under vaccine pressure as monkeypox continues

British LGBTQ+ groups across a spectrum of political parties wrote to the UK’s Health and Social Care Secretary Steve Barclay in August 2022 to demand urgent action against monkeypox. The letter stated that the UKHSA “has procured just over half” the required quantity of doses for 125,000 people.  

Unless action is taken, the authors are concerned that monkeypox will become “endemic in the UK”, presenting a serious health risk. It would also “exacerbate the health inequalities already experience by gay and bisexual men and other men who have sex with men” they stated.  

The letter was co-ordinated by the Terrence Higgins Trust, a UK-based sexual health charity. Ceri Smith, head of policy at the trust, identified the detrimental effects of the outbreak on other sexual health services, including STI testing and treatment, as well as contraceptive services. It is estimated that “up to 30% of sexual health appointments have been displaced” due to the pressure applied to the health service by monkeypox.  

The UKHSA suggested in early August that there were “early signs that the outbreak is plateauing”. However, the UK has one of the highest number of cases across the world, and vaccine delivery is being hindered. The doses of the vaccine that have already been procured are currently being delivered “in batches” to individuals at “higher risk”.  

The Department of Health and Social Care insisted that thousands of vaccines have already been administered and that the NHS is “working to rapidly invite those at greatest risk”. Partners such as the NHS and UKHSA are working together to “share targeted, non-stigmatising communications with the LGBTQ+ community”. This comes amidst viral debates on whether the virus should be classified an STI, and how messaging should be delivered to the public to protect vulnerable communities without further placing them at risk of discrimination or stigmatisation.  

Further to efforts to support sexual health services, the Department of Health and Social Care has stated that it will provide “more than £3.4 billion through the Public Health Grant”. This will enable local authorities to invest in “essential frontline sexual health services”.  

To participate in the monkeypox workshop at the World Vaccine Congress in Barcelona in 2022 follow this link to secure tickets.

Antimicrobial resistant bacteria discovered in new-borns

Antimicrobial resistant bacteria discovered in new-borns

A study in Nature Microbiology explored links between the presence of antimicrobial resistant bacteria isolated from mothers and their new-borns across 7 countries. The study was coordinated by Professor Tim Walsh at the Ineos Oxford Institute for Antimicrobial Research and the Oxford Department of Biology. It revealed that antimicrobial resistant bacteria are present in neonates after “just a few hours of life”. Furthermore, it found examples of transmission of “sepsis-causing resistant bacteria within hospitals from mothers to babies”. 

Almost 7 million potentially serious bacterial infections occur in new-borns. This results in over 550,000 neonatal deaths annually, many of which occur in LMICs. In these locations “scarce resources can limit the capacity to diagnose and treat sepsis”. This is exacerbated by the rise of AMR, estimated to cause 5 million deaths a year across the globe.  

In this study, Drs Maria Carvalho and Kirsty Sands joined an international network to explore the presence of antibiotic resistance genes (ARGs) in the gut microbiota in mothers and babies across 7 LMICs in Africa and South Asia. Under the Burden of Antibiotic Resistance in Neonate from Developing Societies study, BARNARDS, 35,040 mothers and 36,285 neonates were recruited.  

The researchers collected 18,148 rectal swabs and grew the bacteria from these samples. The intention was to “assess the presence of clinically important ARGS” in this population. The authors found many samples carried genes “linked to antibiotic resistance”, which indicates how prevalent AMR is in these settings. It is notable that the researchers found these ARGS to be present in neonates “within hours of birth”. This suggests that “initial colonisation of the new-borns with antibiotic-resistant bacteria occurred at the birth or soon after, likely through contact with the mother of from the hospital environment.” 

Furthermore, the study explored “risk factors associated with the carriage of ARGs”. This included features linked to “water, sanitation, and hygiene (WASH), and prior infections”. They found that better hand hygiene reduced the risk of carrying resistance genes, whereas the risk was increased if “mothers had reported an infection” or took antibiotics in the 3 months preceding the start of the study.  

The findings of the study demonstrate the importance of understanding ARG transmission in preventing neonatal sepsis. Additionally, they highlight the need for access to “safe water, sanitation, and good hygiene” to protect neonates in LMICs. Professor Walsh reflected that the “incidence of AMR carriage” is “extremely worrying”.

“Clearly this research poses many questions about transmission an also about the acquisition of these drug-resistant strains might impact on the growth of the baby”. 

For Dr Rabaab Zahra, who led the study in Islamabad, the study “raises concerns about our policies on antibiotics use, along with hygiene and infection control practices in healthcare facilities.” The study also had an effect in Kano, Nigeria. Dr Fatima Modibbo suggested that until the study, “blood cultures were not routinely implemented”. Since then, patterns in blood cultures have led to “lifesaving changes” and a “reduction in neonatal mortality rates”.  

For a day of AMR discussion at the World Vaccine Congress in Europe 2022 head to this page to get your tickets.

Emerging emergencies require top authority

Emerging emergencies require top authority

In July 2022 the Director-General of the WHO, Dr Tedros Adhanom Ghebreyesus, declared monkeypox to be a Public Health Emergency of International Concern (PHEIC). This is the seventh of its kind since 2005.  

The PHEIC is overseen by the International Health Regulations (IHR) and is declared when the outbreak is an “extraordinary event; when it constitutes a public health risk to other states through international spread; and when a coordinated international response is potentially required.” 

The IHR formed a technical Emergency Committee (EC), comprising experts in the appropriate field of each disease. The EC informs the WHO Director-General whether a disease should be described as a PHEIC. In the previous 6 PHEICs the Director-General has taken the advice of the EC. However, in the most recent situation, the Director-General took his own initiative against the vote of the EC.  

Writing in The Lancet in August 2022, Dr Clare Wenham and Dr Mark Eccleston-Turner reflected that the decision of the Director-General to overrule the EC demonstrates the WHO is a “politically engaged actor, capable of embracing and engaging with political considerations”. They suggest that this “dimension” shows a “commitment to protecting traditionally marginalised groups from technical decision-making bodies”.  

“The decision to declare monkeypox a PHEIC is a much-needed development for an increasingly politicised WHO” 

Drs Wenham and Eccleston-Turner further suggest that during the Covid-19 pandemic the WHO lost “influence and authority” due to the deviance of member states from WHO recommendations. Therefore, the PHEIC declaration might be considered an “attempt to reclaim some authority in global disease control”.  

However, the tension between the Director-General and the EC may present member states with the opportunity to ignore recommendations from the WHO. It is hoped that the declaration might generate “increased support, vaccine production, and more equitable access to such vaccines or medical countermeasures”. 

“The PHEIC is the switch to turn on action” 

The authors note that the field, so “dominated by evidence-based decision making” will require more than the “assumption of the normative power of the PHEIC”. As we observe consecutive emergencies, we can discern the effectiveness of their nominal updates. Will monkeypox countermeasures be generated in a more collaborative fashion because of this decision? Unfortunately, only time will tell.  

To participate in a day of monkeypox discussion at the World Vaccine Congress in Europe 2022 click here to get your tickets!

Monkeypox doses stretched to the limit by NIH scientists

Monkeypox doses stretched to the limit by NIH scientists

As cases of monkeypox increase, it is evident that vaccine demand is greater than the supply. Although the FDA had previously indicated sufficient supply for double doses, scientists at the NIH are exploring alternatives to a two-shot regime in order to increase access to JYNNEOS, the vaccine licensed for use against monkeypox in the United States.  

The intention is to explore “fractional dosing”, using a fifth of the recommended dosage per person, as well as single dosage. They will compare the results with the current programme of two doses, 28 days apart. The study should provide answers as early as November, with potential to alleviate the strain on vaccine supply if positive.  

As of August 2022, more than 80 countries have recorded over 25,000 confirmed cases of monkeypox. At least 6,600 of these are from the United States. Despite this, the FDA and CDC have “stressed that the vaccine should be used as licensed”. However, there are suggestions that generous dosage recommendations from vaccine manufacturers might lend themselves to fractional dosing.  

Fractional dosing has been used effectively in previous outbreak situations, such as the 2016 yellow fever outbreak in Angola and the Democratic Republic of the Congo. At that time, global supplies of the vaccine were stretched thin and the WHO recommended doses a fifth of their usual quantity.  

The tension between dose quantity and quality raises questions about our preparedness for outbreaks of disease. Dr John Beigel of NIAID stated that there isn’t a “consistent message” but that some were getting “one dose now for six months or maybe longer”.

As the outbreak spirals, doses of the vaccine have yet to reach the “source”. Will we see another pandemic of vaccine selfishness, or will we work collaboratively to spread the vaccine as evenly as possible? 

To participate in a day of monkeypox discussion at the World Vaccine Congress in Europe 2022 head here to get your tickets!

Experimental RSV vaccine promise shown in mice

Experimental RSV vaccine promise shown in mice

The respiratory syncytial virus (RSV) infects almost all children before they turn 2 years old. The pathogen causes bronchiolitis chest infection, for which there are no approved treatments. RSV is estimated to kill over 59,000 children under 5 each year, and there are currently no vaccines against it.  

However, this might be about to change, according to research by Professor Ofer Levy and Dr Simon van Haren. Alongside colleagues they have developed an adjuvanted vaccine containing a fragment of a protein that RSV uses to enter cells: F protein.  

Professor Levy suggested that this vaccine was the “magic sauce” to provide infant immunity, certainly in the 12 mice that they tested on. These mice were given the vaccine or a saline solution before exposure to RSV. The mice that were given the vaccine displayed no virus in their lungs. Furthermore, the nasal concentration of RSV in vaccinated mice was “100 times lower than in the control mice”.  

Levy reported: 

“The adjuvant combination robustly enhanced antibody and useful T-cell responses and indicated protection against RSV infection in infant mice.” 

The study was limited by the fact that the mice were adults at the time of completion, whereas RSV causes bronchiolitis in young children. In fact, it was suggested in a 2017 study that “45% of hospital admissions and in-hospital deaths due to RSV-ALRI occur in children younger than 6 months”.  Thus, the next step will be non-human primates and then people, says Levy. Although humans and mice “have many similarities” they are “very different systems”. The ambition is to start human trials “within five years”.

To hear from Professor Levy on the role adjuvants in vaccines at the World Vaccine Congress in Europe 2022 follow this link!

WHO’s new infection guidelines for “key populations”

WHO’s new infection guidelines for “key populations”

In July 2022 the WHO published new guidelines on “HIV, viral hepatitis, and STI prevention, diagnosis, treatment, and care for key populations”. These guidelines were officially launched at the AIDS 2022 Conference in Canada.  

The guidelines outline a public health response to HIV, viral hepatitis, and STIs for 5 key populations: 

  • Men who have sex with men (MSM) 
  • Trans and gender diverse people 
  • Sex workers 
  • People who inject drugs 
  • People in prisons and other closed settings 

Erika Castellanos, Director of programmes at the global Action for Trans Equality (GATE) emphasised the importance of prioritising these key populations “in every setting”. She hopes to “reach them first with prevention, testing, and treatment”, prioritising them in funding programmes.  

For these populations, “social, legal, structural, and other contextual factors” increase vulnerability and “obstruct access” to essential services. The new guidelines address the importance of identifying and trying to overcome structural barriers.  

Dr Meg Doherty, the Director of WHO’s Global HIV, Hepatitis, and STI Programmes commented on recent data from UNAIDS: 

“around 70% of new HIV infections occur among key populations and their partners.” 

She identifies “limited access, inadequate coverage, and poor quality of services” that undermine HIV, hepatitis, and STI responses globally.  

The guidelines also offer recommendations for service delivery, such as online interventions and peer navigators, who will “guide members of key population groups through health services”. Other recommendations include “addressing chemsex”, increasing HCV testing for people at risk of infection, and providing immediate HCV treatment to newly infected patients.  

As data emerge from UNAIDS that reveal Covid-19’s detrimental effect on other health crises these recommendations are timely. Will they have a tangible effect, or will these populations continue to suffer higher infection rates?

Northern Europe’s novel hepatitis nightmare

Northern Europe’s novel hepatitis nightmare

In April 2022, cases of acute hepatitis of “unknown origin” in children were reported across the WHO European Region. Several cases also appeared in the Region of the Americas. In July 2022 the total number of reported cases was at least 1,000 in 35 countries. At least 22 patients have died, and several children have required liver transplants. However, liver transplantation is only possible in a few highly specialised centres, so it is imperative that we identify cases and find an effective treatment.

In an investigation by the University of Glasgow and University College London researches examined samples from 26 children with the hepatitis. Of the 26 samples, 25 children were also infected with the parvovirus AAV2 (adeno-associated virus 2). This is highly contagious but is “not known for causing illness”. Therefore the Glasgow group had to probe further for the answer to this mysterious hepatitis.  

The Economist reported in July 2022 that in 8 of 9 children with the  new hepatitis “they found variations in the Human Leukocyte Antigen gene”. These were “not commonly found in the 58 comparison children”. These variations are geographically concentrated in northern Europe, where the majority of these “strange hepatitis” have been observed.  

The WHO stated that additional work was required to continue identifying cases and determining the cause. In doing so, it hopes to “further refine control and prevention actions”.  

The Lancet described the rise of “conspiracy theories”, which attribute these novel cases to the Covid-19 vaccines. The vaccines have been “categorically ruled out”. Many of the children with the hepatitis were too young to receive a Covid-19 vaccine.  

Our post marking World Hepatitis Day 2022 explores the vaccine solutions to hepatitis available across the world. As a new threat emerges it will be critical that a cause can be identified, and treatment or preventative measures can be implemented, quickly and equitably. So far, the global community has not demonstrated such a practical approach. 

Hear from our WVC 2022 speaker: Dr James Crowe

Hear from our WVC 2022 speaker: Dr James Crowe

Dr James E. Crowe, Director of the Vanderbilt Vaccine Centre at Vanderbilt University and presenter at the World Vaccine Congress 2022 explained how new discoveries in the fight against influenza, including the targeted use of human monoclonal antibodies, may lead to a “universal” flu vaccine.  

“Almost certainly, we now have the capability to make influenza vaccines and antibodies that will be more broadly protective than the ones we have been using and will work better than what we now have.” 

He expects a “lot of promise in the next 3 to 5 years” for “better and longer” antibodies. This, he hopes, will take us closer to a “universal influenza vaccine”.

Novel research on human monoclonal antibodies has revealed new sites of vulnerability in the flu virus. This research coincides with Dr Crowe’s work as Chief Scientist for the Advanced Human Epidemic Antibody Defences 100 programme (AHEAD 100). 

“You would think that all the places on the influenza virus that could be targeted would already be known by now, but we are still finding new sites of vulnerability. That’s exciting because these newly identified sites offer new potential targets for a universal vaccine.”   

 He realises that “there’s a lot of benefit from having that second protein in a vaccine” and identifies an opportunity to “optimise the form and amount” in vaccine candidates. Neuraminidase-based immunity, therefore, is a “lot more important than we knew”

Although experts are concerned about vaccine fatigue Dr Crowe warns that the “flu periodically will cause pandemics greater in size and impact than COVID”. Flu, he says, kills “tens of thousands of people in the US” each year, and “that should be preventable”.

 To see Dr James Crowe at the World Vaccine Congress in 2023 click here to get your tickets!

Back to the past: Polio pops up again in 2022

Back to the past: Polio pops up again in 2022

Although unrelated vaccine-like polio is found in the UK sewage every year, recent samples were different to the rest. They were related and contained mutations, implying human infection, possibly through poor hygiene. This strain is likely to be vaccine derived. The UKHSA suggests “investigations will aim to establish if any community transmission is occurring”. As alarming as this development sounds, experts are saying that continued vaccination efforts will mean this form poses a low risk.  

The WHO’s Global Polio Eradication Initiative (GPEI) suggests that 86% of people in London are vaccinated against polio. However, recent decreases in routine vaccination uptake might mean that the virus continues to pass around.  Global efforts to eradicate polio through vaccination campaigns have involved over $17 billion over three decades. Despite this, vaccine hesitancy, political instability, and “lack of adequate health infrastructure” pose challenges to the GPEI.  

More recently, a patient in New York developed paralysis from the virus for the first time since 2013. Officials believe that the patient was exposed to an individual who received a weakened live virus vaccine. As the patient was not vaccinated it had a severe effect. Americans are mostly vaccinated with several doses from the age of two months, so this is an unlikely but not impossible occurrence. However, Dr Jennifer Nuzzo warns that “this isn’t normal.”* She suggests that if people are vaccinated, they needn’t worry, but it is “really important” that everyone’s vaccinations are up to date.  

The WHO states that “as long as a single child remains infected”, children across the world are “at risk”. While polio continues to lurk in sewage and appears every few years in some countries, Afghanistan and Pakistan continue to report cases. Some of the key blockers in Pakistan include a ban on polio vaccines by a militant campaign that linked the threat of the US military to the vaccination programme. While these misconceptions exploit natural vaccine hesitancy, there can be no end to vaccine-preventable diseases. 

*To hear DrPH Nuzzo at the World Vaccine Congress in Washington in 2023, click here to get your tickets!

Rabies results from Oxford University trial

Rabies results from Oxford University trial

On 28th July 2022 researchers from the University of Oxford reported positive results from a Phase I clinical trial of a newly developed single shot rabies vaccine. This emerges in a field of more costly multiple-dose vaccines. Funding for the trial comes from the UK Medical Research Council and the Engineering and Physical Sciences Research Council.  

The trial (RAB001) took place at university facilities. 12 volunteers took part: 3 received a low dose, 3 a medium dose, and 6 received a high dose of the shot. The researchers observed “strong immune responses”. Of these medium and high dose volunteers, quantities of the rabies neutralising antibodies exceeded the WHO threshold within two months. Furthermore, beyond the predicted vaccine side effects there were no serious safety issues raised.  

The vaccine is a simian adenovirus-vectored candidate based on the ChAdOx2 vector. This is not dissimilar to the techniques used in the recent Oxford-AstraZeneca Covid-19 vaccine. The Phase Ib/II trial is ongoing in Tanzania, with results expected later in 2022.  

Professor Sandy Douglas, Chief Investigator of the trial at the Jenner Institute stated: 

“We’re absolutely delighted with these early results – the vaccine has performed even better than we had expected. The problems with existing rabies vaccines are that they are expensive and require multiple doses.” 

Additionally, he is hopeful that expanding the trials would demonstrate the vaccine’s potential to be affordable and effective.  

Dr Daniel Jenkin, Lead Clinical Research Fellow for the trial, commented on the “modern vaccine technology” that could become a key player in the prevention of “tens of thousands of rabies deaths” each year.  

According to the WHO, rabies infection costs the US $8.6 billion each year, in addition to the human cost. Thus the WHO is leading “United Against Rabies” to push for no human deaths from “dog-mediated rabies” by 2030. Perhaps this vaccine is a vital, cost-efficient step in that direction.  

To participate in the discussion of veterinary science at the World Vaccine Congress in Europe this year, buy your tickets here.

A universally acknowledged flu requires a universal vaccine

A universally acknowledged flu requires a universal vaccine

Literary references aside, flu is about as universal a truth as it gets; each year ‘flu season’ rears its ugly head and sweeps across the world, killing up to 650,000 people worldwide. Repeated efforts to track, prepare, and manage each outbreak consume time and money throughout the year, with annual vaccines typically protecting against only a few strains of the virus, which then mutates throughout flu season.

However, fresh hope for the development of a “universal” flu vaccine or antibody combination is appearing although the term “universal” itself is under debate. Some argue that it should cover all strains in the current season. Some think it should mean strains in a subsequent season, or have so-called backwards coverage of prior strains, while others suggest that it should ideally cover strains likely to cause a future pandemic.  

Dr James Crowe, Director of the Vanderbilt Vaccine Centre at Vanderbilt University reckons that achieving any kind of “universal” is closer than we might think: “there’s a lot of promise in the next three to five years”.* He suggests that novel research on human monoclonal antibodies has revealed new sites of vulnerability in the virus. This is promising because “these newly identified sites offer new potential targets for a universal vaccine”. These innovations are also focusing on an understudied protein on the surface of the virus called neuraminidase. 

Most research in the past century has addressed the other abundant protein, hemagglutinin, but turning our attention more to neuraminidase might be fruitful, says Dr Crowe: “there’s a lot of benefit from having that second protein in a vaccine…so neuraminidase-based immunity is a lot more important than we knew”.  

Experts have expressed concern about “vaccine fatigue” after the public burnout over Covid-19 vaccines. To Dr Crowe, however, the seriousness of influenza should not be underestimated. He said that “flu periodically will cause pandemics greater in size and impact than Covid” but even in an ordinary year the “tens of thousands” of flu-related deaths in the US should be preventable.  

 *To see Dr James Crowe at the World Vaccine Congress in 2023 click here to get your tickets!