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How new treatments could quiet the ‘perfect storm’ of respiratory viruses

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As a virus leaves some babies under the age of two wheezing — adding to the pressure on Canada’s hospitals — drug makers are working on new treatment and vaccine options for the illness.

Respiratory syncytial virus, or RSV, gets the “S” in its name for large cells known as syncytia that form when infected cells fuse. Syncytia are prone to die off and plug up airways, leading to respiratory distress, Dr. Clement Lee, a pediatrician at Newton-Wellesley Hospital in Newton, Mass., said in a recent Twitter thread.

For most healthy people, though, the highly contagious virus feels like an ordinary cold.

Dr. Rod Lim, medical director for the pediatric emergency department at Children’s Hospital in London, said while many infants weather RSV just fine, the virus tends to present in young children almost like asthma, with wheezing.

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Before the COVID-19 pandemic, children were commonly exposed to RSV between November and March. By two years of age, it’s estimated 90 per cent of us have been infected.

But this year, RSV arrived early in parts of Canada and the U.S., based on swabs of those in the hospital — it even circulated in the summer.

“We’re seeing viruses circulate at different times than we have,” Lim said at a virtual briefing hosted by the Ontario Medical Association.

“It’s a little bit of a perfect storm right now.”

Dr. Rod Lim, who heads the pediatric emergency department at the Children’s Hospital at London Health Sciences Centre, says the higher number of patients, staffing challenges and supply chain issues have combined to make the hospital busier. (Submitted by Rod Lim)

Protecting babies

Lim’s emergency department was built for about 100 visits a day, and on Tuesday, there were 280 visits, forcing staff to look for alternate spaces to care for people, he said.

Staffing challenges and supply chain issues for medications to reduce pain and fever are adding to the burden, he added.

WATCH | Easing anxiety over kids’ pain reliever supplies:

 

Shortage of children’s painkillers causes anxiety for parents

6 days ago

Duration 2:03

Parents across Canada are growing increasingly anxious as a shortage of children’s painkillers that began this summer shows no signs of easing.

“If I had an ideal world, [it] would definitely not allow babies to get RSV and to get any kind of infections for the first two to three months,” Lim said.

Eram Chhogala, a registered nurse working in emergency rooms in the Greater Toronto Area, said she’s seeing families show up with multiple children needing treatment.

“We’re talking whole families of four, maybe even six,” Chhogala recalled in an interview. “You have, say, for example, three kids all with cough and fever. Three patients that require treatment for a fever.”

When the parents are asked if they gave Tylenol or Advil, they say, “Sorry, we couldn’t, because there was nothing left and we tried going everywhere,” the nurse said.

What’s more, RSV is circulating at the same time as the flu, COVID-19 and common cold viruses like rhinovirus and enterovirus are giving people fever, cough and other symptoms.

The risk of RSV getting down into the lower respiratory tract is always greatest during your first infection, says Dr. Jesse Papenburg. (Submitted by Owen Egan)

Why infants are most vulnerable

Dr. Jesse Papenburg, a pediatric infectious diseases physician at the Montreal Children’s Hospital of the McGill University Health Centre, said infants are particularly vulnerable to respiratory infections. In part, that’s because airways and thoracic or chest muscles get stronger as they grow.

“The risk of the virus getting down into the lower respiratory tract is always greatest during your first infection” with RSV, Papenburg said in an interview. “The way your body can handle that lower respiratory tract infection is very different when … you’re two years old versus when you’re two weeks old.”

Papenburg said his hospital is also extraordinarily busy with a surge in respiratory viruses, which adds to wait times. As well, elective surgeries get cancelled to free up staffed beds in intensive care and elsewhere.

The positivity rate for RSV was above 25 per cent last month, which he called extremely unusual.

Treatment pipeline opens

Infants are born susceptible to RSV because they don’t have antibodies to fight off the infection, Papenburg said.

Drug maker GSK is developing a vaccine program for pregnant individuals as well as older adults, an age group Papenburg said is also now considered at risk for complications from RSV.

Moderna said it plans a Phase 3 clinical trial of an mRNA vaccine for adults aged 60 and older.

Potential RSV vaccines from other companies are also in the works.

Vaccinating pregnant individuals could help protect infants, Papenburg said. That’s why pertussis (or whooping cough) vaccines are given in pregnancy, and the antibodies cross the placenta.

Earlier this month, Pfizer announced Phase 3 clinical trial results for its RSV vaccine candidate in a press release. The vaccine is given in pregnancy with the aim of protecting the infant.

Currently, those hospitalized for RSV receive supportive care for what brought them in, like dehydration or oxygen through a mask to ease their breathing.

Babies at high risk of RSV complications can be given monthly shots of a costly treatment called palivizumab during the regular RSV season. Some provinces and territories started rolling it out early this year.

Last week, drug makers Sanofi and AstraZeneca announced that the European Commission authorized a one-dose RSV drug called nirsevimab. It’s a laboratory-developed antibody designed to protect infants during their first exposure to RSV.

“You can give that one shot and the baby has protective levels of antibodies for the whole RSV season,” Papenburg said. “What the studies have shown is that it protects as well as palivizumab in terms of preventing hospitalizations” in both high-risk patients as well as otherwise healthy term infants.

The likely catch? Price.

“I think one of the big questions will be is, what will be the cost?” Papenburg said. “How much are we willing to pay to avert these hospitalizations due to RSV?”

Immunization advisory committees like NACI will likely be considering use of nirsevimab in all infants, said Papenburg, who reports potential conflicts of interest in the last 36 months from several drug makers, including AstraZeneca.

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Kevin Neil Friesen Obituary 2024 – Crossings Funeral Care

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It is with heavy hearts that we announce the peaceful passing of Kevin Neil Friesen age 53 on Thursday, March 28, 2024 at the Bethesda Regional Health Centre.

A funeral service will be held at 2:00 pm on Thursday, April 4, 2024 at the Bothwell Christian Fellowship Church, with viewing one hour prior to the service.

A longer notice to follow.  

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Spring allergies: Where is it worse in Canada? – CTV News

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The spring allergy season has started early in many parts of Canada, with high levels of pollen in some cities such as Toronto, Ottawa and Montreal.

Daniel Coates, director of Aerobiology Research Laboratories in Ottawa, expects the elevated amounts to continue next week for places, such as most of Ontario, if the temperature continues to rise. Aerobiology creates allergen forecasts based on data it collects from the air on various pollens and mould spores.

Pollens are fertilizing fine powder from certain plants such as trees, grass and weeds. They contain a protein that irritates allergy sufferers.

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Although pollen levels declined after a cold spell in some places, he said they are soaring again across parts of Canada.

“So the worst is definitely British Columbia right now, followed by Ontario and Quebec and then the Prairies and Atlantic Canada for the upcoming weeks,” said Coates in a video interview with CTVNews.ca. “We are seeing pollen pretty much everywhere, including the Maritimes.”

He said pollen has increased over the past 20 years largely due to longer periods of warm weather in Canada.

Meanwhile, the Maritimes is one of the best places to live in Canada if you have seasonal allergies, in part because of its rocky territory, Coates said.

With high levels of cedar and birch pollen, British Columbia is the worst place for allergy sufferers in Canada, he added.

“British Columbia is going strong,” Coates explained, noting the allergy season started “very early” in the province in late January. “It has been going strong since late January, early February and it’s progressing with high levels of pollen, mostly cedar, but birch as well, and birch is highly allergenic.”

Causes of high pollen levels

Coates expects a longer allergy season if the warm weather persists. He notes pollen is increasing in Canada and worldwide, adding that in some cases the allergy season is starting earlier and lasting longer than 15 years ago.

He says tree pollen produced last year is now being released into the air because of warmer weather.

“Mother nature acts like a business,” he said. “So you have cyclical periods where things go up and down. … So when it cooled down a little bit, we saw (pollen) reduce in its levels, but now it’s going to start spiking.”

Along with warmer weather, another factor in higher pollen levels is people planting more male trees in urban areas because they don’t produce flowers and fruits and are less messy as a result, he said. But male trees produce pollen while female ones mostly do not.

Moulds

Coates said moulds aren’t as much of a problem.

“They’ve been mainly at lower levels so far this season,” he explained. “Moulds aren’t as bad in many areas of Canada, but they’re really, really bad in British Columbia.”

In B.C., moulds are worse because of its wet climate and many forested areas, he said.

Coping with allergies

Dr. Blossom Bitting, a naturopathic doctor and herbal medicine expert who works for St. Francis Herb Farm, says a healthy immune system is important to deal with seasonal allergies.

“More from a holistic point of view, we want to keep our immune system strong,” she said in a video interview with CTVNews.ca from Shediac, N.B. “Some would argue allergies are an overactive immune system.”

Bitting said ways to balance and strengthen the immune system include managing stress levels and getting seven to nine hours of restful sleep. “There is some research that shows that higher amounts of emotional stress can also contribute to how much your allergies react to the pollen triggers,” Bitting said.

Eating well by eating more whole foods and less processed foods along with exercising are also important, she added. She recommends foods high in Omega-3 Fatty Acids such as flaxseeds, flaxseed oil, walnuts and fish. Fermented foods with probiotics such as yogurt, kimchi and miso, rather than pasteurized ones, can keep the gut healthy, she added. Plant medicines or herbs such as astragalus, reishi mushrooms, stinging nettle and schisandra can help bodies adapt to stressors, help balance immune systems or stabilize allergic reactions, she said.

To cope with allergies, she recommends doing the following to reduce exposure to pollen:

  • Wear sunglasses to get less pollen into the eyes;
  • Wash outdoor clothes frequently, use outer layers for outside and remove them when you go inside the house;
  • Use air purifiers such as with HEPA (high efficiency particulate air) filters;
  • Wash pets and children after they go outside;
  • Keep the window closed on days with high pollen counts.

Mariam Hanna, a pediatric allergist, clinical immunologist and associate professor with McMaster University in Hamilton, Ont., says immunotherapy can help patients retrain their bodies by working with an allergist so they become more tolerant to pollens and have fewer symptoms.

“Some patients will need medications like over-the-counter antihistamines or speaking with their doctor about the right types of medications to help with symptom control,” she said in a video interview with CTVNews.ca.

Coates recommends people check pollen forecasts and decrease their exposure to pollen since no cure exists for allergies. “The best is knowing what’s in the air so that you can adjust your schedules, or whatever you’re doing, around the pollen levels.”

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Do you need a spring COVID-19 vaccine? Research backs extra round for high-risk groups

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Recent studies suggest staying up-to-date on COVID shots helps protect high-risk groups from severe illness

New guidelines suggest certain high-risk groups could benefit from having another dose of a COVID-19 vaccine this spring — and more frequent shots in general — while the broader population could be entering once-a-year territory, much like an annual flu shot.

Medical experts told CBC News that falling behind on the latest shots can come with health risks, particularly for individuals who are older or immunocompromised.

Even when the risk of infection starts to increase, the vaccines still do a really good job at decreasing risk of severe disease, said McMaster University researcher and immunologist Matthew Miller.

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Who needs another COVID shot?

Back in January, Canada’s national vaccine advisory body set the stage for another round of spring vaccinations. In a statement (new window), the National Advisory Committee on Immunization (NACI) stated that starting in spring 2024, individuals at an increased risk of severe COVID may get an extra dose of the latest XBB.1.5-based vaccines, which better protect against circulating virus variants.

That means:

  • Adults aged 65 and up.
  • Adult residents of long-term care homes and other congregate living settings for seniors.
  • Anyone six months of age or older who is moderately to severely immunocompromised.

The various spring recommendations don’t focus on pregnancy, despite research (new window) showing clear links between a COVID infection while pregnant, and increased health risks. However, federal guidance does note that getting vaccinated during pregnancy can protect against serious outcomes.

Vaccinated people can also pass antibodies to their baby through the placenta and through breastmilk, that guidance states (new window).

What do the provinces now recommend?

Multiple provinces have started rolling out their own regional guidance based on those early recommendations — with a focus on allowing similar high-risk groups to get another round of vaccinations.

B.C. is set to announce guidance on spring COVID vaccines in early April, officials told CBC News, and those recommendations are expected to align with NACI’s guidance.

In Manitoba (new window), high-risk individuals are already eligible for another dose, provided it’s been at least three months since their latest COVID vaccine.

Meanwhile Ontario’s latest guidance (new window), released on March 21, stresses that high-risk individuals may get an extra dose during a vaccine campaign set to run between April and June. Eligibility will involve waiting six months after someone’s last dose or COVID infection.

Having a spring dose is particularly important for individuals at increased risk of severe illness from COVID-19 who did not receive a dose during the Fall 2023 program, the guidance notes.

And in Nova Scotia (new window), the spring campaign will run from March 25 to May 31, also allowing high-risk individuals to get another dose.

Specific eligibility criteria vary slightly from province-to-province, so Canadians should check with their primary care provider, pharmacist or local public health team for exact guidelines in each area.

WATCH: Age still best determines when to get next COVID vaccine dose, research suggests:

 

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Age still best determines when to get COVID vaccines, new research suggests

It’s been four years since COVID-19 was declared a pandemic, and new research suggests your age may determine how often you should get a booster shot.

Why do the guidelines focus so much on age?

The rationale behind the latest spring guidelines, Miller said, is that someone’s age remains one of the greatest risk factors associated with severe COVID outcomes, including hospitalization, intensive care admission and death.

So that risk starts to shoot up at about 50, but really takes off in individuals over the age of 75, he noted.

Canadian data (new window) suggests the overwhelming majority of COVID deaths have been among older adults, with nearly 60 per cent of deaths among those aged 80 or older, and roughly 20 per cent among those aged 70 to 79.

People with compromised immune systems or serious medical conditions are also more vulnerable, Miller added.

Will people always need regular COVID shots?

While the general population may not require shots as frequently as higher-risk groups, Miller said it’s unlikely there will be recommendations any time soon to have a COVID shot less than once a year, given ongoing uncertainty about COVID’s trajectory.

Going forward, I suspect for pragmatic reasons, [COVID vaccinations] will dovetail with seasonal flu vaccine campaigns, just because it makes the implementation much more straightforward, Miller said.

And although we haven’t seen really strong seasonal trends with SARS-CoV-2 now, I suspect we’ll get to a place where it’s more seasonal than it has been.

In the meantime, the guidance around COVID shots remains simple at its core: Whenever you’re eligible to get another dose — whether that’s once or twice a year — you might as well do it.

What does research say?

One analysis, published in early March in the medical journal Lancet Infectious Diseases (new window), studied more than 27,000 U.S. patients who tested positive for SARS-CoV-2, the virus behind COVID, between September and December 2023.

The team found individuals who had an updated vaccine reduced their risk of severe illness by close to a third — and the difference was more noticeable in older and immunocompromised individuals.

Another American research team from Stanford University recently shared the results from a modelling simulation looking at the ideal frequency for COVID vaccines.

The study in Nature Communications (new window) suggests that for individuals aged 75 and up, having an annual COVID shot could reduce severe infections from an estimated 1,400 cases per 100,000 people to around 1,200 cases — while bumping to twice a year could cut those cases even further, down to 1,000.

For younger, healthier populations, however, the benefit of regular shots against severe illness was more modest.

The outcome wasn’t a surprise to Stanford researcher Dr. Nathan Lo, an infectious diseases specialist, since old age has consistently been a risk factor for severe COVID.

It’s almost the same pattern that’s been present the entire pandemic, he said. And I think that’s quite striking.

More frequent vaccination won’t prevent all serious infections, he added, or perhaps even a majority of those infections, which highlights the need for ongoing mitigation efforts.

Lauren Pelley (new window) · CBC News

 

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