Parents with sick kids might be able to take a break from crushing adult Tylenol and mixing it with apple sauce if they hurry quickly to a local pharmacy.
In Israel’s COVID-19 wards, doctors are learning which vaccinated patients are most vulnerable to severe illness, amid growing concerns about instances in which the shots provide less protection against the worst forms of the disease.
Around half of the country’s 600 patients presently hospitalized with severe illness have received two doses of the Pfizer Inc shot, a rare occurrence out of 5.4 million fully vaccinated people.
The majority of these patients received two vaccine doses at least five months ago, are over the age of 60 and also have chronic illnesses known to exacerbate a coronavirus infection. They range from diabetes to heart disease and lung ailments, as well as cancers and inflammatory diseases that are treated with immune-system suppressing drugs, according to Reuters interviews with 11 doctors, health specialists and officials.
Such “breakthrough” cases have become central to a global debate over whether highly vaccinated countries should give booster doses of COVID-19 vaccines, and to which people.
Israel began offering booster doses to people age 60 and up in July, and has since expanded that eligibility.
The United States, citing data out of Israel and other findings, said on Wednesday it would make booster doses available to all Americans beginning in September.
Other countries, including France and Germany, have so far limited their booster plans to the elderly and people with weak immune systems.
“The vaccinated patients are older, unhealthy, often they were bedridden before infection, immobile and already requiring nursing care,” said Noa Eliakim-Raz, head of the coronavirus ward at Rabin Medical Centre in Petach Tikva.
In contrast, “the unvaccinated COVID patients we see are young, healthy, working people and their condition deteriorates rapidly,” she said. “Suddenly they’re being put on oxygen or on a respirator.”
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Israel’s Health Ministry raised new alarm this week with a report showing the effectiveness against severe disease of the Pfizer vaccine, developed with Germany’s BioNTech, appeared to have dropped from more than 90% to 55% in people age 65 and up who received their second jab in January.
Disease experts say it is not clear how representative the figures are, but agree it is concerning given evidence that overall vaccine protection against infection is waning.
They cannot say whether that is due to the amount of time that has passed since inoculation, the ability of the highly contagious Delta variant to evade protection, the age and underlying health of the people vaccinated, or a combination of all of these factors.
Health officials in the UK and United States, two other nations with high vaccination rates and a spike in Delta infections, have reported similar trends.
In the UK, about 35% of the people hospitalized with a Delta case in recent weeks had received two doses of a COVID-19 vaccine. Nearly three-quarters of U.S. breakthrough infections that led to hospitalization or death were among people age 65 or older, according to federal data.
COVID-19 breakthrough infections taken ‘seriously’ as vaccinations continue: Fauci
U.S. officials said their booster plan is based on concern that over time, the vaccines will provide less protection against severe disease, including among younger adults.
“We are watching other countries carefully and (are) concerned that we too will see what Israel is seeing, which is worsening infections over time” among vaccinated people, U.S. Centers for Disease Control and Prevention Director Rochelle Walensky said at a press conference on Wednesday.
The World Health Organization has repeatedly urged wealthy nations to refrain from providing boosters while much of the world has yet to access their first COVID vaccine doses.
Immune response may not have triggered at all in some
The Delta variant, first identified in India, has become the dominant version of the SARS-CoV-2 virus globally, accelerating a pandemic that has killed more than 4.4 million people.
In Israel, daily new cases have increased from the single digits in June to around 8,000 since the arrival of Delta. Approximately half of the cases – the majority of them mild to moderate – are in vaccinated people.
Those vaccinated first in Israel were at high-risk, including people age 60 and up. The immune response of some may have weakened by the time Delta hit Israel. But for others with underlying health conditions, the vaccine may have not kicked in at all.
“For some of them the vaccine did not trigger an immune response, they had no antibodies, because of the illness itself or because they are treated with medication that suppresses the immune system,” said Dror Mevorach, who heads the coronavirus ward at Hadassah hospital in Jerusalem. He cited examples such as chronic lymphocytic leukemia and lymphoma.
Among 3 million vaccinated Israelis covered by Clalit, the country’s largest healthcare provider, 600 have suffered severe breakthrough cases since June. Around 75% of them were above the age of 70 and were at least 5 months after their second dose, according to Ran Balicer, Clalit’s chief innovation officer. Nearly all of them have chronic illnesses.
“We are hardly seeing young vaccinated people in severe condition,” said Balicer.
Israel reports drop in Pfizer COVID-19 vaccine’s effectiveness in preventing infection
In the UK, doctors described similar characteristics among vaccinated patients who fall severely ill.
“In those people who come in, because of their age, because of their co-morbidities, they might be people that you would expect that the vaccine is not quite so efficacious as other age groups,” said Tom Wingfield, a clinical lecturer at the Liverpool School of Tropical Medicine.
A new surge in U.S. coronavirus cases and deaths has been fueled by Delta, particularly in states where vaccination rates remain low. Among vaccinated patients who become infected, there is evidence of older people being hit harder.
In Texas, 92% of the vaccine breakthrough cases that resulted in death were in people over the age of 60 and 75% had a known underlying condition that put them at high risk from COVID-19, according to a public health department spokesperson.
Initial data in Israel suggests the booster shots administered in the last few weeks are reducing the risk of infection in older people compared with those who have received only two doses.
Pfizer medical director says COVID-19 vaccine highly effective against Delta variant
Even without boosters, Israeli doctors say that vaccinated patients tend to recover more quickly.
“The vaccinated patients I’ve treated usually left the ICU in about three days. The unvaccinated patients took a week or two until they stabilized,” said Yael Haviv-Yadid, head of the critical care ward at Sheba Medical Centre near Tel Aviv.
Even if the vaccine did not stop them getting ill, it may have mitigated their illness, said Alex Rozov, head of the coronavirus ward at Barzilai Medical Centre in Ashkelon.
“Our cautious impression is that the vaccinated patients suffer an easier course of illness – the treatment is more effective among those who have antibodies.”
(Additional reporting by Alistair Smout and Josephine Mason in London, Carl O’Donnell in New York; Editing by Michele Gershberg and Dan Grebler)
© 2021 Reuters
At least five B.C. children died from influenza last month, as mortalities spike
At least five children died last month in British Columbia from influenza as a rise of early season respiratory illnesses added strain to the beleaguered healthcare system.
The figure marks a departure from the average of two to three annual flu deaths among children in the province between 2015 and 2019, data from the BC Coroners Service shows.
“Public health is monitoring the situation closely and is reminding people of the steps they can take to protect themselves, their children and their loved ones against the flu,” the B.C. Centre for Disease Control said in a statement.
“It is important to know that death associated with influenza in previously healthy children continues to be rare.”
The centre said it is aware of a sixth reported flu death among children and youth under 19, but it was not immediately clear why the sixth wasn’t included in the coroners’ figures.
Provincial Health Officer Dr. Bonnie Henry said the children who died included one who was younger than five years old, three who were between five and nine, and two adolescents who were between 15 and 19.
“Early findings indicate some of the children experienced secondary bacterial infections contributing to severe illness, which can be a complication of influenza,” Henry said in a statement Thursday.
The deaths in British Columbia suggest figures could tick up across the country given the common challenges facing health systems this respiratory season. Alberta has also recorded the deaths of two children with influenza so far this season.
Before the COVID-19 pandemic, an average of five to six kids died per flu season across Canada, data collected from 12 hospitals across the country shows.
The national data was collected between 2010 and 2019 by IMPACT, a national surveillance network administered by the Canadian Paediatric Association. It was included in a research paper published in March in “The Lancet Regional Health — Americas” journal that also found no deaths from the flu among children in either 2020 or 2021.
No one from either IMPACT or the B.C. Centre for Disease Control was immediately available for an interview.
On Monday, Henry said that after two years of low flu rates, mostly due to COVID-19 pandemic restrictions, the province is seeing a “dramatic increase” in illness and it arrived sooner than normal.
She urged parents to get their children vaccinated against the flu.
On Thursday, British Columbia’s Health Ministry announced a “blitz” of walk-in flu clinics that will open across the province Friday through Sunday. Flu vaccines are free to all kids aged six months and older in B.C.
The B.C. Centre for Disease Control said getting the shot is particularly important for those at risk of severe outcomes, including those with chronic medical conditions like heart, lung, kidney or liver disorders and diseases, those with conditions that cause difficulty breathing or swallowing, those who need to take Aspirin for long periods of time and those who are very obese.
The BC Coroners Service said its data is preliminary and subject to change while investigations are completed.
The cases include those where influenza was identified as an immediate, pre-existing or underlying cause of death, or as a significant condition.
Henry said updates on pediatric influenza-related deaths will be posted weekly as part of the respiratory surveillance summaries on the B.C. Centre for Disease Control website.
This report by The Canadian Press was first published Dec. 8, 2022.
Cough and cold medication shortage to end next year, pharmacists association says
A Shopper’s Drug Mart pharmacist The Daily Press spoke with on Tuesday wouldn’t say how much they’d received but advised to hurry while quantities last. A Rexall pharmacist is only selling children’s Tylenol to parents with sick kids, not to those just preparing for a rainy day.
Adam Chappell, owner and pharmacist at Parma Right in The 101 Mall, told The Daily Press he was expecting nine retail-sized bottles of children’s Tylenol last Wednesday, which he also planned to keep behind the counter and limit to one bottle per customer.
The shortage makes it difficult for parents to control fevers in their children, leading to more doctor visits, he said.
“We had more public health measures in place with COVID, so we had 1½ to two years where we really didn’t see much influenza or common cold,” said Chappell, whose independent pharmacy opened in November.
“So now we’re seeing everything all at once because we’re now socializing more. It’s that time of year, so we’re starting to see more influenza, cough and colds and COVID is still circulating. I think it’s a combination of higher use and some lingering logistical issues.”
A children’s drug shortage began in the spring and worsened in the summer when an early onset of flu and respiratory syncytial virus was made worse by COVID-19, which presents as a cold. Parents began stocking up.
When local manufacturers could not keep up with demand, Health Canada arranged to import supply from the United States and Australia, whose first shipment in early November went straight to hospitals, in part because the labels were not bilingual, Postmedia reported.
Health Canada has authorized 500,000 bottles of imported children’s acetaminophen for retail to arrive in December, and domestic supply is starting to recover, Jen Belcher with the Ontario Pharmacists Association told The Daily Press in a telephone interview.
That organization asserts pandemic lockdowns in China are blocking exports of the raw ingredients used for medications, Postmedia reported Nov. 16.
If lockdowns in China continue, however, she conceded it could interrupt the ingredient supply in the long-term. There is also a global reliance on India for the raw ingredients used in over-the-counter medication.
Canadian manufacturers can tap various international suppliers if approved by Health Canada, Belcher said.
Adult Tylenol and Advil remain plentiful.
Chappell recommends that parents speak to their pharmacist to determine a dosage of adult pills based on the child’s weight and symptoms. They can be crushed and added to yogurt, apple sauce or chocolate syrup.
If parents can wait a few days for the package to arrive, they can order a supply for their child from a compounding pharmacist, who is qualified to make custom medications including liquid formulations. There are several compounding pharmacists in Sudbury, but none in Timmins.
“When it comes to cough and cold medication for both adults and children, we’re not seeing an imported supply of those. Those are short and have been for quite some time due to this high level of demand, small amounts have been trickling through the supply chain but it hasn’t been enough to keep up with demand,” said Belcher.
She expects the adult cough and cold medication shortage to end sometime between January and March, 2023, just in time for the end of flu season.
A quick check of the adult cough and cold section of four downtown pharmacies on Tuesday showed partially empty shelves, but there was still a variety of medication to choose from.
Belcher said pharmacists have lots of experience finding alternatives for patients, if necessary.
“While the over-the-counter medications in short supply are the most visible representation of the challenges to our supply chain, pharmacy teams have been managing very high levels of drug shortages, some critical, where there are really few or no alternative options,” she said, adding that up to 20 per cent of the team’s day is spent managing shortages.
Study explores the risk of new-onset diabetes mellitus following SARS-CoV-2 infections
In a recent study posted to the medRxiv* preprint server, researchers evaluated individuals who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and were diagnosed with diabetes mellitus within six months of the onset of coronavirus disease 2019 (COVID-19) to understand the temporal relationship between SARS-CoV-2 infections and diabetes mellitus.
Recent research indicates a potential increase in the new-onset diabetes mellitus diagnoses after SARS-CoV-2 infections. While the causative mechanisms are not clearly understood, various hypotheses suggest the roles of stress-induced hyperglycemia during SARS-CoV-2 infections, changes in the innate immune system, virus-induced damage or changes to the beta cells or vasculature of the pancreas, as well as the side effects of the treatment in the increased incidence of diabetes mellitus diagnoses.
Furthermore, the drastic lifestyle changes brought about by the COVID-19 pandemic have decreased physical activity and increased obesity. The stress induced by the pandemic has also increased endogenous cortisol levels, a known risk factor for diabetes mellitus. Examining the temporal relationship between SARS-CoV-2 infections and new-onset cases of diabetes mellitus will help develop effective screening and therapeutic strategies.
About the study
In the present study, the team conducted a nationwide analysis using electronic health records aggregated in the National COVID Cohort Collaborative (N3C) database in the United States (U.S.). They analyzed all individuals with SARS-CoV-2 infections and type 2 diabetes mellitus between March 2020 and February 2022. Data from the health records for the six months preceding and following the SARS-CoV-2 infections were included to avoid selection and ascertainment bias.
SARS-CoV-2 infections were confirmed based on the International Classification of Diseases, Tenth Revision (ICD-10) code, or laboratory test results. New-onset diabetes mellitus cases were defined as those that did not have an ICD code for diabetes mellitus in their electronic health records before September 2019. The incidence of diabetes mellitus was then analyzed concerning SARS-CoV-2 infections.
The results reported a sharp increase in new-onset diabetes mellitus diagnoses in the 30 days following SARS-CoV-2 infections, with the incidence of new diagnoses decreasing in the post-acute stage up to approximately a year after the infection. Surprisingly, the number of new-onset diabetes mellitus cases in the months following SARS-CoV-2 infections is lower than in the months preceding the infection.
The authors believe that the increase in healthcare interactions brought about due to the COVID-19 pandemic might explain the notable increase in diabetes mellitus diagnoses in the time surrounding SARS-CoV-2 infections. New patients might have been tested for hemoglobin A1C or glucose levels during their first interaction with the healthcare system, the results of which might have then been used to diagnose diabetes mellitus.
Additionally, SARS-CoV-2 infection-induced physiological stress could have triggered diabetes mellitus in high-risk individuals who might have developed the disease later in life without COVID-19.
According to the authors, the overall risk of developing diabetes mellitus has increased, irrespective of SARS-CoV-2 infections, due to the drastic decrease in physical activity, weight gain, and the stress induced by the COVID-19 pandemic. Furthermore, a longer follow-up period might report an increased incidence in new-onset diabetes mellitus cases, with the SARS-CoV-2 infection precipitating disease development in individuals who might not have otherwise developed diabetes.
To summarize, the researchers conducted a cross-sectional, nationwide analysis of individuals in the U.S. to understand the temporal relationship between diagnoses of new-onset diabetes mellitus and SARS-CoV-2 infections. The results reported a spike in diabetes mellitus diagnoses in the one month following SARS-CoV-2 infections, followed by a marked decrease in the number of diagnoses for up to a year after the infection.
The authors believe that the sudden increase in diabetes diagnoses could be due to increased healthcare interactions brought about by the COVID-19 pandemic. The new-onset diabetes mellitus cases could also be a reaction to the physiological stress induced by SARS-CoV-2 infections.
Furthermore, the drastic lifestyle changes brought about by the COVID-19 pandemic might be responsible for the high incidence of diabetes mellitus, irrespective of SARS-CoV-2 infections. However, extensive research is required to understand the epidemiology and mechanisms connecting SARS-CoV-2 infections with new-onset diabetes mellitus.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
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