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Hybrid immunity provides better protection from COVID-19 than prior infection or vaccination alone: Study by University of Toronto

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People who have recovered from COVID-19 and been vaccinated against the virus have the best and longest lasting protection against future infection, compared to people who have been only vaccinated or only previously infected, according to a new international study.

The findings are published in Lancet Infectious Diseases.

Niklas Bobrovitz

“These findings highlight the importance of vaccination, even for people who have already had a SARS-CoV-2 infection, and may also help inform planning and policies for future booster shot campaigns,” says researcher and lead author Niklas Bobrovitz, a student in the MD program at the University of Toronto’s Temerty Faculty of Medicine.

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The study looked at the effect of COVID-19 infection or vaccination versus the combination of infection and vaccination (known as hybrid immunity) against future COVID-19 infection, hospitalization and severe disease. The researchers also explored how long protection lasts after the most recent infection or vaccination.

The findings show that people with hybrid immunity that includes a full primary dose regimen, which varies by manufacturer, are well protected from hospitalization or severe disease for at least nine months, with lesser but still substantial protection against reinfection.

The team found that prior infection and hybrid immunity both provided more robust and longer-lasting protection against the Omicron variant than vaccination alone. And although protection from infection quickly wore off following infection or vaccination (60 per cent reduced chance of infection at six months), the protection against hospitalization or severe disease remained high (97 per cent reduced chance of hospitalization or severe disease at 12 months).

To reach their findings, the team did a systematic review of 11 studies that examined people who’d been previously infected as well as 15 studies that featured people with hybrid immunity.

The study, which is the most comprehensive study of hybrid immunity to date, is part of SeroTracker, a group that tracks population immunity around the world using serology test results that show COVID-19 antibodies in a person’s blood from either vaccination or infection. The platform was created by Canadian graduate and professional students and launched early in the pandemic.

Bobrovitz first became involved in SeroTracker at the invitation of his classmate Tingting Yan, one of the platform’s co-creators who, at the time, was in the second year of the MD program and completing a master of science degree in the Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health.

Having recently completed a PhD in clinical epidemiology at the University of Oxford, Bobrovitz wanted to use his research skills to help protect the public from the consequences of COVID-19.

SeroTracker caught the attention of the Public Health Agency of Canada and the World Health Organization (WHO), which used the platform to develop models of the spread of infection. The project set the stage for Bobrovitz to work with researchers from around the world including Maria Van Kerkhove, WHO’s top COVID-19 technical adviser, and members of the Canadian COVID-19 Task Force.

The team also included contributions from learners at universities in the United States and Canada, including Brianna Cheng and Christian Cao, who are both in their first year of Temerty Medicine’s MD program, and Xiaomeng Ma, a PhD student at the Dalla Lana’s School of Public Health.

Though the team’s findings suggest that hybrid immunity offers greater protective benefit than vaccination alone, Bobrovitz stresses the importance of avoiding infection.

“Despite how much scientists and physicians have learned about COVID-19, it’s still very difficult to predict how an infection will affect different people,” Bobrovitz says. “Deliberately getting infected could result in death, a need for mechanical ventilation in the ICU or a host of serious chronic health consequences. It’s not worth the risk.”

Bobrovitz says that in addition to providing lessons for managing COVID-19 in the future, the study’s results may also have implications for outbreaks of other infectious diseases.

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Good Dental Health Essential in Sickle Cell Anemia, Study Finds |… – Sickle Cell Anemia News

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Good oral health is essential in people with sickle cell anemia (SCA), according to a new study from Saudi Arabia that found that several disease-causing bacteria species — including Enterobacteriaceae — were significantly more abundant in a group of patients with poorer dental health than in those with better oral care.

“A healthy mouth has a balance of bacteria, but inadequate oral health narrows the range of bacteria, resulting in oral dysbiosis, a state in which beneficial bacteria decrease and potentially pathogenic [disease-causing] bacteria increase,” the researchers wrote.

The findings also indicated that patients with low levels of hemoglobin F — a type of hemoglobin normally produced during fetal development — had a significantly higher prevalence of harmful bacteria species than those who had higher levels of the protein.

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“Our data further emphasise the importance of routine oral hygiene visits for patients with SCA,” the team wrote, adding, “This is especially important for patients with SCA and low [hemoglobin F], who have a higher probability of hospitalisation and clinical complications compared to patients with SCA and high [hemoglobin F].”

The research’s findings were reported in “Oral microbiota analyses of Saudi sickle cell anemics with dental caries,” a study published in the International Dental Journal

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Examining good versus poor dental health in SCA

Sickle cell disease (SCD) is caused by mutations in the HBB gene that lead to the production of a faulty version of hemoglobin, the protein in red blood cells that is responsible for carrying oxygen through the body. This faulty version is called hemoglobin S.

People with sickle cell anemia or SCA, the most common and often the most severe form of SCD, have two faulty gene copies encoding hemoglobin S.

Complications of dental caries or tooth decay, including acute pain, are often observed in patients with SCA — and have been associated with poor quality of life.

In a healthy mouth, different bacteria species co-exist in a balanced ratio. However, in cases of inadequate oral health, the number of beneficial bacteria decreases, while that of potentially harmful ones increases. This can lead to dental caries, which often result in cavities and other oral health problems.

“Although ample evidence indicates a causative correlation between the disruption of the oral [bacteria] and dental caries, the effect in SCA has not been investigated,” the researchers wrote.

Now, a team from the Netherlands and Saudi Arabia conducted a study to examine oral bacteria composition in people with SCA. Their aim was to compare bacteria species in patients with a high decayed, missing, and filled permanent teeth (DMTF) index — a measure of dental health — compared with others who had a low index.

In addition, they evaluated the effect of hemoglobin F levels on bacterial composition by comparing the profiles of patients with low and high levels of the protein. Fetal hemoglobin or hemoglobin F is considered a major modulator of disease severity in SCA.

This type of hemoglobin normally is found in fetuses and newborn babies, but is typically replaced by another hemoglobin variant after birth. However, hemoglobin F is more effective at transporting oxygen than its adult counterpart, and may, therefore, help to counteract the harmful effects of hemoglobin S on blood flow and oxygen transport.

In some individuals, the levels of hemoglobin F remain relatively high during childhood, and only start to decline later on in life, rather than immediately after birth.

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hygiene, self-care

High levels of Enterobacteriaceae bacteria found

This new study was conducted in the Eastern Province of Saudi Arabia, where the disease is highly prevalent. It included 100 patients, ages 5–12, from whom saliva was collected.

Among the patients, 27 had high dental caries — reflected by a high DMTF index of five points or more — and 73 had low dental caries, indicated by a low DMTF index of four points or fewer.

The research team identified 416 bacteria species in the patients’ samples. When analyzing their prevalence, seven were found to be significantly more abundant in patients with a high DMTF index than in those with a low index.

In addition, eight bacteria species were found to be significantly more prevalent in patients with low hemoglobin F levels compared with those with high levels of the protein.

In particular, the Enterobacteriaceae bacteria species, which have been associated with severe infections and high rates of antibiotic resistance, were found in great abundance in both patient groups, being the most significantly abundant bacteria species among those with low levels of hemoglobin F. 

“It has been suggested that the presence of the Enterobacteriaceae species in the oral cavity is favoured when an individual’s immunity is compromised,” the researchers wrote, adding that “patients with SCA are immunocompromised.”

Overall, these findings indicate that Saudi SCA patients with poorer dental health and low levels of hemoglobin F have a higher predominance of harmful bacteria in their mouth.

Our data further emphasise the importance of routine oral hygiene visits for patients with SCA.

“Our results provide a valuable addition to the global microbiome reference data set in an underexamined community,” the researchers wrote, adding, “These efforts are essential and warranted given the scarcity of [bacteria composition] data in Middle Eastern populations.”

Nevertheless, a study with a large sample size evaluating how oral bacterial species can relate to dental caries in SCA patients is required, the team noted.

The researchers said their findings indicate the important of good dental health in people with sickle cell anemia, given that the bacteria species otherwise found “are thought to drive the development and progression of dental caries.”

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Good Oral Health Crucial in People with Sickle Cell Anemia, Study Finds – Oral Health

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A new study from Saudi Arabia found that good dental health is vital for people with sickle cell anemia (SCA). The findings observed that multiple disease-causing bacteria were seen much more in the patients with poorer oral health than those with better oral health.

Patricia Valerio, PhD, noted, “The findings also indicated that patients with low levels of hemoglobin F – a type of hemoglobin normally produced during fetal development – had a significantly higher prevalence of harmful bacteria species than those who had higher levels of the protein.”

This research shows how important good oral hygiene is for patients with SCA and low hemoglobin F.

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Read more about this study from Sickle Cell Disease News.


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Respiratory viruses on decline: Province – Brandon Sun – The Brandon Sun

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Hospitalizations due to influenza, COVID-19 and respiratory syncytial virus (RSV) have all decreased in Manitoba, according to the province’s latest epidemiological respiratory virus surveillance report.

Data for the week of Jan. 15 to Jan. 21 indicates this respiratory virus season may finally be nearing its end, after it began earlier than usual and caused surges of severe illness and hospitalizations, particularly among babies and toddlers.

There were two flu-related hospital admissions that week, none requiring intensive care, while the Influenza A test positivity rate fell to 0.8 per cent, compared with 1.9 per cent the previous week. No cases of Influenza B have been detected provincially yet this season.

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There were 105 detected cases of RSV, with a weekly RSV test positivity rate of 8.3 per cent. The previous week, the test positivity rate for RSV was 8.7 per cent.

There were seven patients with COVID-19 in hospital, as well as three in intensive care. No new COVID deaths were reported, but the province retroactively updated its COVID-19 death toll. There were 15 deaths added to the total count last week, for an overall number of 316 Manitobans who lost their lives to COVID since this fall.

» Winnipeg Free Press

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