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It’s never too late to get the vaccine for HPV, the virus that can lead to cervical and other cancers – The Globe and Mail

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The question: A few of my married female friends have been told by their doctors to get the Gardasil 9 vaccine to prevent cervical cancer. We’ve all heard about the benefits of teens getting vaccinated, but it’s news to me that older people might need it. Should I get it, too?

The Answer: It’s certainly true that there’s been a big push to inoculate adolescents before they become sexually active. But the vaccine isn’t only for teens.

Here’s what you need to know: Gardasil 9, the most widely used brand of the vaccine, guards against nine different types of the human papillomavirus (HPV), which is spread through vaginal, anal and oral sex.

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An infection can cause cellular changes that may lead to cervical cancer and other tumours affecting both females and males.

There are actually dozens of different types of HPV. The vaccine provides protection from the forms of HPV that are responsible for about 90 per cent of cervical cancers and a high percentage of throat, oral, penis, anal, vaginal and vulva cancers, as well as genital warts.

However, for maximum effectiveness, you need to be inoculated before exposure to the virus. That’s why the provinces offer free HPV shots to youth, starting around the age of 11 or 12.

Although eligibility for a publicly funded shot is limited to young people, “it’s never too late to vaccinate for HPV,” says Nancy Durand, a gynaecologist at Sunnybrook Health Sciences Centre in Toronto.

The vaccine is typically delivered in three separate injections over a period of six months (those under 14 get two shots). Each shot costs about $200. Many private insurance plans will cover the bill.

Durand says that Canada’s National Advisory Committee on Immunization “places no upper age limit on this vaccine, regardless of whether you have had a past history of exposure.”

About 75 per cent of Canadians will be infected with at least one type of HPV at some point in their lives. But it’s extremely unlikely that someone will have been exposed to all types of the virus covered by Gardasil 9. That means the vaccine can still provide protection against the types of HPV that an individual has not yet encountered.

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Even so, why would older people in long-term monogamous relationships need the vaccine? After all, you might think, they are not being exposed to new types of HPV.

Unfortunately, that might be wishful thinking, Durand says. “You may be monogamous as far as you know. But you don’t always know what your partner is doing. New HPV exposures may be happening without your knowledge.”

Yet even if you are monogamous now, one sobering statistic tells us that more than 50 per cent of marriages end in divorce. The death of a spouse will also leave a person single.

So there are various reasons why people seek new partners later in life and may encounter certain types of HPV for the first time.

Of course, not all HPV infections result in a cancer or persistent genital warts. The immune system has the ability to inactivate the virus or eradicate it entirely from the body. “The clearance rate for this infection is close to 80 per cent in patients under the age of 30,” Durand says.

But as we grow older, the immune system becomes less effective at keeping the virus in check. It’s possible that an inactive infection can become active again, leading to abnormal cells that may progress to cancer.

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For reasons that are not fully understood, women seem to have a better ability than men to clear HPV from their bodies, Durand says.

Aside from shielding us from new HPV exposures, continuing research suggests the vaccine may also provide some help against existing infections, says Marc Steben, chair of the Canadian Network on HPV Prevention.

In particular, several studies have looked at women who have been treated for abnormal or “pre-cancerous” cells discovered through cervical-cancer screening – known as the pap test.

The women who received HPV vaccination during their care were less likely to have the abnormal cells reappear and to require further treatment, compared with those who didn’t get a shot.

This suggests the vaccine “should be part of the treatment plan to prevent recurrence of infection,” Steben says.

Despite the potential benefits of the HPV vaccine, many doctors don’t recommend it to their patients. They often assume their patients are either monogamous or will balk at the price.

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Durand believes patients should at least be informed of the option so they can decide for themselves.

Paul Taylor is a Patient Navigation Advisor at Sunnybrook Health Sciences Centre. He is a former Health Editor of The Globe and Mail. Find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

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2nd COVID-19 case of unknown origin reported in California – Global News

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California health officials on Friday confirmed the second case of novel coronavirus in the United States believed to have been transmitted to a person who didn’t travel internationally or come in close contact with anyone who had it.

Health officials in San Jose said the patient was an older adult woman with chronic health conditions who does not have a travel history or any known contact with a traveler or infected person. It comes a day after state officials said a woman hospitalized at UC Davis Medical Center in Sacramento had contracted the illness after no known contact.

“This new case indicates that there is evidence of community transmission, but the extent is still not clear,” said Dr. Sara Cody, health officer for Santa Clara County and director of the County of Santa Clara Public Health Department.






1:47
World Health Organization raises COVID-19 risk to highest level


World Health Organization raises COVID-19 risk to highest level

Officials were able to get quick confirmation because the test was done by the Santa Clara County Public Health Laboratory with test kits received from the federal Centers for Disease Control and Prevention. Officials submitted the woman’s specimens for testing Thursday and received the results Thursday night.

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The California Department of Public Health said Friday that the state will receive enough kits from the CDC to test up to 1,200 people, a day after Gov. Gavin Newsom complained to federal health officials that the state had already exhausted its initial 200 test kits.

State official also said the federal government decided it will not need to use the Fairview Developmental Center in Orange County to isolate passengers from the Diamond Princess cruise ship. That’s because of the imminent end of the isolation period for those passengers and the relatively small number of persons who ended up testing positive, officials said.


READ MORE:
California monitoring more than 8,400 flight arrivals for COVID-19 symptoms

The CDC had originally estimated that as many as half the passengers would test positive. But the state said the actual number has been “substantially lower.” A federal judge had granted officials in Costa Mesa a temporary restraining order blocking the transfers during the time when state officials said the facility had been “critically needed.”

Cody said the newly confirmed case in Santa Clara County is not linked to two previous cases in that county, nor to others in the state.

The Santa Clara County resident was treated at a local hospital and is not known to have traveled to Solano County, where public health officials have identified dozens of people — but less than 100 — who had close contact with the case announced Thursday. They are quarantined in their homes. and a few who have shown symptoms are in isolation, officials said.

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1:59
COVID-19: CDC reports first case in U.S. with unknown connection


COVID-19: CDC reports first case in U.S. with unknown connection

At UC Davis Medical Center, at least 124 registered nurses and other health care workers were sent home for “self-quarantine” after the woman with the virus was admitted, National Nurses United, a nationwide union representing RNs, said Friday.

“Despite University of California medical facilities being generally better prepared and equipped to treat challenging medical cases, the … case highlights the vulnerability of the nation’s hospitals to this virus,” the union said.

The case of the infected women marks an escalation of the worldwide outbreak in the U.S. because it means the virus could spread beyond the reach of preventative measures like quarantines, though state health officials said that was inevitable and that the risk of widespread transmission remains low.

California public health officials on Friday said more than 9,380 people are self-monitoring after arriving on commercial flights from China through Los Angeles and San Francisco. That’s up from the 8,400 that Newsom cited on Thursday, though officials said the number increases daily as more flights arrive.


READ MORE:
First COVID-19 case in U.S. with unknown connection reported in California

Officials are not too worried, for now, about casual contact, because federal officials think the coronavirus is spread only through “close contact, being within six feet of somebody for what they’re calling a prolonged period of time,” said Dr. James Watt, interim state epidemiologist at the California Department of Public Health.

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The virus can cause fever, coughing, wheezing and pneumonia. Health officials think it spreads mainly from droplets when an infected person coughs or sneezes, similar to how the flu spreads.

As infectious disease experts fanned out in the Solano County city of Vacaville, some residents in the city between San Francisco and Sacramento stocked up on supplies amid fears things could get worse despite official reassurances, while others took the news in stride.

The woman in the community who has coronavirus first sought treatment at NorthBay VacaValley Hospital in Vacaville, before her condition worsened and she was transferred to the medical center in Sacramento.






3:04
Trump says U.S. mulling over COVID-19 travel ban extension


Trump says U.S. mulling over COVID-19 travel ban extension

Sacramento County’s top health official told The Sacramento Bee on Friday that he expects several medical workers to test positive themselves in the next few days. Numerous workers at both hospitals have been tested, but the tests were sent to labs approved by the CDC and generally take three to four days to complete.

Peter Beilenson, Sacramento County’s health services director, said he expects even those who test positive to become only mildly ill.

Confusion over how quickly the woman was tested for coronavirus concerned McKinsey Paz, who works at a private security firm in Vacaville. The company has already stockpiled 450 face masks and is scrambling for more “since they’re hard to come by.” The company’s owner bought enough cleaning and disinfectant supplies to both scrub down the office and send home with employees.

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But they appeared to be at the extreme for preparations.


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Countries take dramatic steps to contain new virus that ‘doesn’t respect borders’

Eugenia Kendall was wearing a face mask, but in fear of anything including the common cold. Her immune system is impaired because she is undergoing chemotherapy, and she has long been taking such precautions.

“We’re not paranoid. We’re just trying to be practical,” said her husband of 31 years, Ivan Kendall. “We wipe the shopping carts if they have them, and when I get back in the car I wipe my hands — and just hope for the best.”

Experts in both communities are interviewing immediate family members and expanding their net to include more distant family members who may have been in contact, social gatherings like church that the patient may have attended and any possible time spent at work or events like a concert.






0:38
COVID-19: U.N. official says ‘window of opportunity’ for virus containment is narrowing


COVID-19: U.N. official says ‘window of opportunity’ for virus containment is narrowing

Besides the woman, all the other cases in the U.S. have been for people who traveled abroad or had close contact with others who traveled.

Earlier U.S. cases included 14 in people who returned from outbreak areas in China, or their spouses; three people who were evacuated from the central China city of Wuhan; and 42 American passengers on the Diamond Princess cruise ship.

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The number of people sickened by the virus hovered Friday around 83,000, and there were more than 2,800 deaths, most of them in China.

© 2020 The Canadian Press

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Ontario confirms new case of coronavirus in Toronto – Toronto Star

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Coronavirus Live Updates: New Unexplained Cases Reported in the U.S. – The New York Times

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Credit…Max Whittaker for The New York Times

Troubling new signs of how the coronavirus is spreading in the United States emerged on Friday, as cases not explained by overseas travel or contact with a person known to be infected were reported in California, Oregon and Washington State.

Officials from the three states announced that their testing had found new cases: a high school student from Washington State; an employee of a school in Oregon, near Portland; and a woman in Santa Clara County, Calif., in the heart of Silicon Valley.

Sixty-five cases of the virus have been reported in the United States, but until this week, all of them could be explained by overseas travel or contact with someone who had been ill. The three new cases on Friday, and a case earlier in the week, in California, were the first in the United States in which the cause was mysterious and unknown — a sign, experts warned, that the virus might now be spreading in this country.

“If we were worried yesterday, we are even more worried today,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. “Now we have to ask: How widely, really widely, is this virus out there?”

As word emerged of the unexplained cases, local officials scrambled to trace everyone who had come in contact with those who were ill. California health officials said they were increasing testing. And in Washington State, officials suggested that people needed to prepare for the possibility of schools closing and businesses keeping workers home.

“We’re going to be increasingly recommending that people try and avoid crowds and close contact with other people,” Dr. Jeff Duchin, health officer for Public Health Seattle & King County, said. “We may get to a point where we want to recommend canceling large public gatherings — social events, sporting events, entertainment — until we get over a hump of what might be a large outbreak.”

Stocks tumbled for a seventh consecutive day on Friday, recording the market’s worst week since the 2008 financial crisis.

The S&P 500 index fell about 0.8 percent, and the Dow Jones industrial average fell more than 1 percent. The S&P index lost more than 11 percent in the week, and almost 13 percent since its peak on Feb. 19.

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The Coronavirus Outbreak

  • Answers to your most common questions:

    Updated Feb. 26, 2020

    • What is a coronavirus?
      It is a novel virus named for the crownlike spikes that protrude from its surface. The coronavirus can infect both animals and people and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS.
    • How do I keep myself and others safe?
      Washing your hands frequently is the most important thing you can do, along with staying at home when you’re sick.
    • What if I’m traveling?
      The C.D.C. haswarned older and at-risk travelers to avoid Japan, Italy and Iran. The agency also has advised against all nonessential travel to South Korea and China.
    • Where has the virus spread?
      The virus, which originated in Wuhan, China, has sickened more than 80,000 people in at least 33 countries, including Italy, Iran and South Korea.
    • How contagious is the virus?
      According to preliminary research, it seems moderately infectious, similar to SARS, and is probably transmitted through sneezes, coughs and contaminated surfaces. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
    • Who is working to contain the virus?
      World Health Organization officials have been working with officials in China, where growth has slowed. But this week, as confirmed cases spiked on two continents, experts warned that the world was not ready for a major outbreak.

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The sell-off was fueled mostly by worry that measures to contain the coronavirus would hamper corporate profits and economic growth, and fears that the outbreak could get worse. The selling has in a matter of days dragged stock benchmarks around the world into a correction — a drop of 10 percent or more that is taken as a measure of extreme pessimism.

In Europe, the Britain’s FTSE 100 fell more than 3 percent and the Dax in Germany fell more than 4 percent. In Asia, the Nikkei 225 in Japan closed down 3.7 percent, the KOSPI in South Korea dropped 3.3 percent and the Shanghai Composite in China dropped 3.7 percent.

South Korea, which has the largest coronavirus outbreak outside China, reported 594 new cases on Saturday morning, bringing its total to 2,931. In North Korea, Kim Jong-un ordered all-out efforts to fight the virus at a high-level meeting, state media reported.

South Korean officials have warned that confirmed cases would rise sharply as they aggressively tested thousands of people, particularly in the southeastern city of Daegu. More than 86 percent of patients have been in Daegu and nearby towns; many have been associated with a church called Shincheonji, which has a strong presence in Daegu.

The United States military, which has more than 28,000 personnel in South Korea, said on Saturday that the spouse of an American soldier infected with the virus had also tested positive for it. She had been in self-quarantine since Wednesday, following her husband’s diagnosis, and was being transported to a military hospital, the military said.

Also on Saturday, Mr. Kim, North Korea’s leader, convened the Politburo of his ruling party to order an all-out campaign to prevent an outbreak, state media reported. The North has not reported any coronavirus cases, but there has been concern that the secretive, totalitarian country could be hiding an outbreak.

“In case the infectious disease spreading beyond control finds its way into our country, it will entail serious consequences,” the North’s official Korean Central News Agency quoted Mr. Kim as saying. It said that officials had discussed “measures to deter the influx and spread of the infectious disease in a scientific, preemptive and lockdown way.”

North Korea has already closed its 930-mile border with China, where the coronavirus emerged, and its border with Russia. But the Chinese border has long been porous for smugglers, who ferry goods across the shallow river that separates the countries. The North has also suspended all flights and trains to and from China and asked all foreign diplomats not to leave their compounds.

The state media report Saturday also said that Mr. Kim had fired one of his top aides, Ri Man-gon, and another official for corruption, but it was unclear whether the dismissals were connected to the antivirus campaign.

As the coronavirus outbreak spreads, the world’s biggest companies have begun painting a bleak picture of broken supply chains, disrupted manufacturing, empty stores and flagging demand for their wares.

The announcements by businesses like Mastercard, Microsoft, Apple and United Airlines offer a look at how the virus is affecting consumer behavior and business sentiment. These corporate bulletins — and what executives do in response — could determine how much economic damage the outbreak inflicts.

Some companies have expressed optimism that governments will curb new infections and that consumer spending in Europe and North America will be largely unscathed. But if executives see a threat beyond the first three months of the year, they may pare planned investments and even lay off workers.

The stock-market plunge this week, the steepest since the financial crisis, suggests that investors are bracing for a bad news.

“Everything is slowing down even more — and that has not been fully appreciated,” said Michael O’Rourke, chief market strategist at JonesTrading.

Many times in many countries, political leaders have tried to censor health officials and play down the risks of infection just as epidemics approached. This strategy has almost never worked, historians and former health officials said.

And if there are more deaths than leaders predict, stonewalling destroys the reputations of the leaders themselves.

This week’s efforts to reorganize the Trump administration’s chaotic response to the coronavirus outbreak risk falling into that pattern. The White House will coordinate all messaging, the public was told, and scientists in the government will not be popping up on television talk shows, saying what they think.

That may not be a winning strategy, experts warned. The stock market reacts to rumors, and the Federal Reserve Bank may succumb to political pressure. But pathogens, like hurricanes and tsunamis, are immune to spin.

“It’s crucially important that experts tell the public what they know and when they know it,” said Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention. “That’s the only way to earn and maintain the public trust that is essential to work together as a society and fight an epidemic.”

When the coronavirus emerged in Wuhan, China, residents in a nearby suburb thought they were safe. Zuoling New Town, a bustling community of retired farmers, factory workers and white-collar professionals, was 22 miles from the market where the outbreak appeared to have started.

But as the virus spread, Zuoling emerged as a stubborn hot spot of infections, and a somber lesson in how the state’s effort to contain the virus left some communities vulnerable. The leadership’s top-down campaign relied on grass-roots mobilization, and the very newness and isolation of Zuoling proved to be a weakness, depriving residents of food supplies, medical care and labor.

Residents crammed into the only large supermarket to stock up. Those worried about fevers crowded the local clinic, and many were sent back to their high-rise homes, sometimes spreading the virus. The nearest public hospital assigned to take patients was 10 miles away, making it difficult to get treatment without a car.

“I never imagined that this would hit our home,” said Zhang Jin, a 47-year-old resident. His mother, Yan Yinzhen, who was living with him, contracted what doctors believed was the coronavirus, possibly from a neighbor. Mr. Zhang, his wife and father all fell ill.

“We’ve lost confidence,” said Mr. Zhang, a school bus driver. “Nobody in the neighborhood took charge.”

Reporting was contributed by Peter Eavis, Donald G. McNeil Jr., Choe Sang-Hun, Thomas Fuller, Sheri Fink, Nicholas Bogel-Burroughs, Amy Qin and Sui-Lee Wee.

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