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3rd COVID-19 vaccine dose increased protection in transplant patients, study shows – Global News

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Mike Willis was intrigued when he heard about a study aimed at determining the effectiveness of third-dose COVID-19 vaccine boosters for organ transplant recipients.

As a heart transplant patient who takes immune-suppressing medication every 12 hours, Willis said the chance to potentially boost his protection against COVID-19 made it easy for him to volunteer.

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“I had zero antibodies after two doses,” said the 66-year-old, adding he was delighted to learn the double-blind study had given him a third dose instead of a placebo. “So anything (is) higher than nothing.”

Researchers at the University Health Network who led the study say findings released Wednesday suggest a third-dose booster is the “best way to increase protection” in transplant recipients.

And as the highly transmissible Delta variant drives cases in parts of the country, they say there’s more urgency to ensure transplant patients, who often don’t mount a sufficient immune response with a normal two-dose series, can augment their protection.

“As I see it, there are transplant patients that are completely unprotected right now, even though they’ve had two doses,” said Dr. Deepali Kumar, director of transplant infectious diseases at UHN and joint-senior author of the study.

“If we can offer them a third dose to have a better chance of protection, I believe we should.”


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Canada’s top doctor says discussion on COVID-19 booster shots still ‘evolving’


Canada’s top doctor says discussion on COVID-19 booster shots still ‘evolving’

The study, published in the New England Journal of Medicine, looked at levels of different types of antibodies as well as T-cell responses in 120 transplant patients in Ontario and found increases in the majority of those who received a third vaccine dose.

UHN said the study is the first randomized placebo-controlled trial of COVID-19 boosters in transplant patients. Researchers compared 60 participants who received a third shot of the Moderna vaccine to 60 who got a placebo.

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Previous studies, including one from the United States earlier this summer, suggested third doses could amplify immune responses in some transplant patients but did not include a control group.

“It’s really hard to know if something’s working unless you do that,” said Dr. Atul Humar, the medical director of the Ajmera Transplant Centre and the study’s other joint-author.

“We had seen data that maybe there was a benefit, but I think this is the definitive study which shows a clear benefit.”

Ontario’s Ministry of Health said Wednesday it would “continue to actively review the evidence and provide updated guidance as required.”


‘Great immune response’

All participants in the study were fully vaccinated with Moderna and none had previous COVID-19 infections. Half of the participants received a third Moderna shot two months after their second dose.

Just over half, or 55 per cent, of those who received a third dose saw their antibody response rate reached at least 100 units per millilitre, compared to 18 per cent for the placebo group.

Read more:
COVID-19 booster shot might be needed by winter, Moderna says as study continues

Kumar said previous modelling suggested 100 units “might be protective.” In healthy people, antibody levels after two doses typically reach 1,000 to 10,000 units per millilitre, Kumar said, and some of the transplant study participants showed similar numbers.

“So that was actually very exciting,” she said. “We were able to get a great immune response with a third dose.”

Kumar added that those who didn’t reach the 100-unit benchmark could still have boosted protection following a third dose.

The study also found 60 per cent of the three-dose group developed neutralizing antibodies that help identify the COVID-19 virus. T-cell responses, which help the immune system prevent severe disease, were also more robust in the three-dose group.


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Kumar said only mild side effects were reported with the booster.

Moderna was chosen because the vaccine has a higher dose than Pfizer-BioNTech’s, Kumar said, adding that previous studies from flu shot effectiveness suggested a higher-dose influenza vaccine was more successful in transplant patients.

She said more studies would be needed to see how Pfizer recipients respond. A national study by the same UHN team will look at blood samples of transplant patients who received either Pfizer or Moderna as their third dose.

Read more:
3rd dose of established COVID-19 vaccine best way to fight Delta variant: BioNTech

“I think theoretically (Pfizer) would have a similar response but it would be hard to say without a head-to-head comparison,” Kumar said.

While Willis’ antibody levels rose significantly after his third Moderna shot, he said he likely isn’t as fully protected as a healthy person with two doses.

Willis acquired his new heart in 2015 after he developed myocarditis, a scarring of the heart muscles, following a previous viral infection. He’s had to be careful about exposing his weakened immune system to pathogens since.

The retiree from Guelph, Ont., said he still follows the usual safety measures like physical distancing and mask-wearing, especially indoors with strangers. But when he’s with people he knows who are fully vaccinated, he can feel more at-ease.

Like many transplant patients, Willis relies on those around him to get vaccinated themselves to lessen the chance he’ll be exposed to the virus.

“If it wasn’t for that I might be a hermit,” he said.

 

© 2021 The Canadian Press

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Flu surges on heels of RSV, COVID-19 to overwhelm children’s hospitals in Canada – Stettler Independent

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A flu season that started early, hospitalized far more children than usual and overwhelmed emergency departments has revealed that Canada’s health-care system is chronically underfunded when it comes to the most vulnerable citizens, a pediatric infectious diseases specialist says.

Dr. Jesse Papenburg, who works at Montreal Children’s Hospital, said a system that was already struggling with a surge of respiratory syncytial virus, or RSV, on the heels of COVID-19 is now overwhelmed in much of the country.

“Certainly, Ontario and Alberta in particular have been hit very hard with an early and really quite explosive influenza season in pediatrics when it comes to more severe disease requiring complex hospitalization. And we’re also observing in Montreal as well that our influenza admissions are really starting to pick up,” he said.

The last week of November saw the highest number of pediatric hospitalizations for a single week in the past decade, said Papenburg, who is also an investigator for IMPACT, a program that monitors hospitalizations for vaccine-preventable diseases at 12 children’s hospitals across the country.

A typical flu season sees about 1,000 kids admitted to hospital. Due to pandemic public health measures, he said last season saw only 400 and there were none the season before that.

Up to the end of November, over 700 children had been hospitalized with the H3N2 strain of the flu, which typically takes a toll on older adults. But the season could continue until March or April, Papenburg said of the unexpected epidemic.

“When you’re already stretched to the limit under normal circumstances and there’s something exceptional that takes place, it really has a greater impact on the type of care that we can deliver to Canadian children,” he said. “It’s unacceptable, in my view, that this is happening, that we are having to delay important surgeries for children because we need those resources for dealing with acute respiratory infections.”

While the number of RSV hospitalizations is stabilizing, there’s still a “significant burden of disease requiring complex hospitalization,” he said of the Montreal hospital.

Alex Munter, president of Ottawa pediatric hospital CHEO, said the Red Cross will be helping take some of the pressure off critical-care staff starting this week.

He said two teams of nine people will work rotating overnight shifts and that some will be porters while others get supplies or sit with patients.

“Having these Red Cross teams on-site will allow us to send back redeployed staff to their home base,” he said.

“The test positivity rate last week for flu was 30 per cent compared to 10 per cent at the end of October. That’s a big increase and it’s still climbing so flu hospitalizations are increasing and RSV is plateauing,” Munter said.

CHEO, including its emergency department and urgent care clinic, is also getting help from pediatricians, family doctors and nurses in the community while some patients are being transferred to adult hospitals, Munter said.

“We can’t run our hospital this way in perpetuity. I think the moral of the story here is that we have undersized child and youth health system in Canada.”

SickKids in Toronto continues to see high patient volumes in the pediatric intensive care unit and since November has reduced the number of surgeries so staff can be redeployed to provide care in that unit.

“We have been co-ordinating closely with other hospital partners that have the ability to care for some pediatric patients,” the hospital said in a statement, adding it is not currently seeking staffing support from external organizations.

Dr. Shazma Mithani, an emergency room doctor at both the Stollery Children’s Hospital and Royal Alexandra Hospital in Edmonton, said a temporary closure of a pediatric hospice in Calgary is “tragic” as staff are being diverted to a children’s hospital.

“It means that kids who are dying are not getting the palliative and comfort care that they deserve and need, and that acute care is taking priority over that,” Mithani said.

Federal Health Minister Jean-Yves Duclos has said Ottawa recently gave provinces an additional $2 billion as calls grow for both levels of government to do more to help hospitals facing unprecedented challenges.

Mithani said funding has to be targeted for children’s hospitals and could also go to staffing after-hours clinics, for example.

She said people planning large indoor gatherings over Christmas and for New Year’s Eve should consider scaling back, while schools should transition to temporary online learning if they have a large number of viral illnesses

Health officials also need to make a concerted effort to educate the public on the importance of vaccination amid misinformation on social media, Mithani said.

“The most vulnerable people in our society are suffering as a result of the decisions that adults made. That’s what’s happening here, that kids are suffering from the poor decisions of adult decision-makers who can’t seem to do the right thing in order to protect our kids.”

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B.C. to start public push to get more kids vaccinated against flu as cases climb – Energeticcity.ca

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VANCOUVER — British Columbia health officials are urging parents to get their young children vaccinated against influenza ahead of the holiday season as the province deals with crowded emergency rooms.

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Provincial health officer Dr. Bonnie Henry said after two years of low rates of flu, mostly due to travel restrictions, the province is seeing a “dramatic increase” in illness and it arrived sooner than normal. 

“We know, much more than COVID, influenza can cause more severe illness in children, especially young children, and it can lead to secondary bacterial infections with things like streptococcus and pneumococcus that can cause very severe pneumonia,” she said Monday.

“And so that’s the concern that we have now.”

Henry said there is still time for people to get a flu vaccine to protect themselves and their children, especially as the holiday season approaches. 

“We’re starting to see the impact of a large number of children who haven’t been exposed to influenza for a few years and a small proportion of them are getting severely ill,” she said.

“So now’s the time to really make a difference and get that vaccine now.”

According to the most recent numbers from the B.C. Centre for Disease Control, for the week of Nov. 20, 169 patients were in BC Children’s Hospital with some form of a respiratory virus. Of those, 71 had influenza.

Henry said the province started seeing influenza numbers climb about two weeks ago and that the flu season typically lasts about two months.

While the province is on track for a record number of people getting their flu shot this year, Dr. Penny Ballem, with BC Vaccine Operations, said Monday that only 20 per cent of children under five have been vaccinated.

The government will be using its provincial health registry to contact parents in an attempt to increase that number.

Ballem said they’ll be sending texts and emails to the families of about 150,000 children under five who are not part of the province’s vaccine booking system and inviting them to make appointments.

She said there’s also a significant social media campaign from the government and health authorities encouraging people to get vaccinated.

Health Minister Adrian Dix said visits to provincial emergency rooms had been averaging 6,700 per day, but that is now peaking up to 6,900 patients daily, with extra pressure on BC Children’s and Fraser Health hospitals. 

B.C. Children’s briefly called a code orange on Saturday, a step sometimes used in mass casualty events. It was lifted 28 minutes later.

Dix said it was determined the code did not need to be enacted in order to make the mandatory overtime call-out, which was required at the time.

This report by The Canadian Press was first published Dec. 5, 2022.

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B.C. ramps up appeal to vaccinate as influenza surges in children – Times Colonist

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The province is ramping up its flu-shot campaign, especially for young children, as hospital emergency departments deal with a flu-driven spike in visits.

Provincial health officer Dr. Bonnie Henry said the province is seeing a “dramatic increase” in cases of Influenza A, particularly H3N2, which can cause severe illness, especially in children.

The surge began about two weeks ago and while it’s leveling off in older teens, it continues to spike in younger children who — along with seniors — are most susceptible to serious illness and complications.

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Henry, speaking at a news conference in Vancouver Monday with Health Minister Adrian Dix, said it’s not too late for vaccination to make a difference. “We can blunt that and we can prevent that ongoing transmission to older adults as we come together over the holiday season, which is often when we see our influenza peaking.”

Prior to the COVID-19 pandemic, the flu season usually lasted six weeks to two months, peaking after the winter holidays when people gather indoors. Typically in Canada every year, 15,000 to 20,000 people would be hospitalized with the flu and 2,500 to 3,000 would die.

Now, however, it’s surging earlier and the number of cases of Influenza A is way up, said Henry.

Children’s hospitals across the country have seen a surge in patients, including those affected by COVID-19, flu and respiratory syncytial virus, or RSV, for which there is no vaccine.

On Monday, children’s critical care beds in the province were at 63 per cent capacity, with high acuity/pediatric ICU beds at 85 per cent. (On the Island, the numbers were slightly lower: Children’s critical care bed capacity at Nanaimo Regional General Hospital was at 44 per cent capacity and Victoria General Hospital was at 50 per cent. High acuity/pediatric ICU beds at Victoria General Hospital were at 60 per cent capacity.)

At B.C. Children’s Hospital, where ER wait times were reported as 10 hours on Friday and nine on Saturday, a “code orange” that’s generally used for disasters and mass-casualty incidents was called at 6:35 a.m. Saturday and cancelled 28 minutes later.

Dix said the alert was based on information “available at the time” and promptly cancelled with new information.

Henry said while other respiratory viruses, including RSV, are levelling off in B.C., pediatricians and children’s hospitals are reporting more severe influenza and in some cases complications from influenza. Many children haven’t been exposed to the flu virus during the restrictions of the pandemic and thus haven’t built immunity.

Prime Minster Justin Trudeau said Monday he is “extremely worried” about a rise in respiratory illnesses among children as hospitals across the country report they are struggling to keep up with high volumes of patients.

Trudeau said it’s everyone’s responsibility to get vaccinated against both COVID-19 and influenza. He said health officials will consider measures such as mandatory masks.

Influenza A H3N2, which causes more severe illness, particularly in children age five and younger, is the main strain in circulation. Influenza is more concerning in young children than COVID because it can lead to secondary bacterial infections such as streptococcus or pneumococcus that can cause serious bacterial pneumonia, said Henry.

The vaccine offered this year includes H1N1 and H3N2 and two B strains, and appears to be a “very good” match to the virus circulating, offering 50 to 70 per cent protection against infection and illness, said Henry.

In B.C., influenza vaccine is free to anyone six months and older through health clinics, doctors’ offices, and pharmacies — with enhanced vaccines for seniors and FluMist for children who can’t tolerate needles.

So far, about 1.5 million British Columbians — including more than 50 per cent of those age 65 and older — have been vaccinated, using about 70 per cent of the current vaccine stock, with more expected.

However, only 20 per cent of children ages six months to 11 are vaccinated against the flu, and just 15 per cent of those age 12 to 17, said Dix, who urged parents to vaccinate their children. “What we’re seeing amongst children is a more significant influenza season by a very significant margin than last year and that reflects on the presentation at emergency departments.”

Emergency room visits in September and October of about 6,700 have increased to 6,800 to 6,900, he said.

Dr. Penny Ballem, executive lead of Immunized B.C. vaccine operations, said the province will host a vaccination blitz Dec. 9, 10, and 11 to get more people vaccinated through pharmacists, family doctors or health authority clinics designed for children, with thousands of appointments available on the GetVaccinated system.

The province will also send out emails and texts to the families of about 150,000 children age 5 and younger inviting them to make appointments.

B.C. Green Leader Sonia Furstenau, MLA for Cowichan Valley, called on the province to take steps beyond vaccination, including focusing on ventilation, masks and physical distancing.

A high number of children and teachers are missing school because they are sick, children’s wards and ERs are overwhelmed, and operations for children and infants are being cancelled, said Furstenau at a news conference Monday at the Pan Pacific Hotel in Vancouver. “I am deeply concerned for children and families in this province right now,” she said.

Dr. Sanjiv Gandhi, a pediatric cardiovascular and thoracic surgeon at B.C. Children’s Hospital who joined Furstenau at the news conference, said mandating masks is a reasonable and effective tool that should be used in addition to vaccination.

As a heart surgeon, Gandhi said, he’s seeing kids with viral infections who are sicker than he’s seen in decades. “We have all the tools to change the trajectory of this horrible situation — and it’s horrible. The only missing ingredient is courage, the courage for our leaders to be transparent to the public about what’s happening in our hospitals.”

Henry said masking in schools now is “very unlikely” to have any effect on the trajectory of the several viruses that are circulating.

Masks continue to be required in health-care settings, she said, but a general mask mandate is a “heavy handed” measure used as a “last resort when it’s something that is absolutely needed, everywhere, all the time.”

ceharnett@timescolonist.com

>>> To comment on this article, write a letter to the editor: letters@timescolonist.com

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