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Monitoring chronic coronavirus infections may help forecast new variant threats, study suggests – CBC News

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This is an excerpt from Second Opinion, a weekly health and medical science newsletter. If you haven’t subscribed yet, you can do that by clicking here.


As Omicron began its swift spread around the world, theories about its origins sprang up as well.

Did the heavily mutated coronavirus variant evolve within an animal host before spilling back into humans or in a COVID-19 patient being treated with a drug capable of spurring viral mutations?

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Or, many scientists wondered, did the latest variant of concern develop during a protracted battle against the virus inside the body of someone with a compromised immune system?

While there are no clear answers just yet to the questions around Omicron’s emergence, that third theory — tied to viral evolution inside immunocompromised hosts — is an area that’s getting attention from researchers, with one new study suggesting that monitoring chronic infections may be a means to predict future variants that could pose a threat.

In early findings, published online as a preprint paper and not yet peer-reviewed, a team of Israeli researchers affiliated with Tel Aviv University looked at 27 chronically infected coronavirus patients.

All of those individuals had suppressed immune systems for various reasons, including certain cancers, high-dosage steroid treatment or low levels of T-cells from conditions such as AIDS.

“Presumably, these immune system disorders prevent clearance of the virus as compared to patients with an intact immune system, and thus the virus thrives for lengthy periods of time,” the researchers wrote.

Mutations ‘mirror’ those in variants of concern

Typically during SARS-CoV-2 infections, viral shedding lasts anywhere from a few days to a few weeks.

But documented cases of chronic infections, such as those studied by the team, can last far longer, with replicating viruses detectable for lengthy periods of time. (That’s notably different from long COVID, the researchers noted, in which the initial infection is shorter but symptoms persist.)

After analyzing the set of patients with chronic infections, the team concluded that the overall patterns of mutations observed in those cases “closely mirror” the patterns observed in variants of concern.

There were instances of viral rebound, for example, where the virus dropped to undetectable levels but then appeared to replicate throughout the body again — which may suggest mutations capable of evading antibodies, the researchers wrote, offering a possible signal that scientists can use to identify future variants.

Nurse Ashley De Lumen attends to a COVID-19 patient on a ventilator in the intensive care unit of Humber River Hospital, in Toronto in January. (Evan Mitsui/CBC)

But in their small sample of patients, the team didn’t find instances of certain mutations that could drive virus transmission, prompting researchers to suggest that any variants emerging in chronically infected patients might lack that key capability. That’s a potential trade-off, they argued, between the virus becoming more transmissible or more immune evasive.

“Overall, we suggest that extensive monitoring of chronic infections can be used for forecasting the set of mutations in future [variants of concern],” the team concluded.

‘Critically important’ studies

Jason Kindrachuk, an assistant professor in medical microbiology and infectious diseases at the University of Manitoba in Winnipeg, said these kinds of studies are proving “critically important,” but he stressed that a small subset of patients isn’t necessarily representative of what’s happening more broadly with chronic infections.

Kindrachuk said he wasn’t surprised that there were instances of immune evasion within the 27 patients studied, but noted that it will be crucial to understand why there weren’t also mutations linked to increased transmissibility, which have helped multiple variants spread like wildfire.

“Whether those types of shifts in the virus are more random or related to a subset of chronic infections, that’ll be important to say,” he said.

WATCH | Virologist on Omicron’s origins and what’s next for pandemic: 

Famed virologist Angela Rasmussen on Omicron’s origins, what’s next for the pandemic

2 months ago

Duration 6:57

Famed virologist Angela Rasmussen talks to Adrienne Arsenault about the origins of Omicron, what’s next for the COVID-19 pandemic and the death threats she’s received since taking over a top lab in Saskatoon. 6:57

Virologist Angela Rasmussen, who works with the University of Saskatchewan’s Vaccine and Infectious Disease Organization in Saskatoon, questioned that element, noting it’s hard to suggest that any trade-off is happening more broadly based on a sample of this size.

Omicron, she noted, may have arisen within an immunocompromised host and possesses a variety of mutations, making it both highly contagious and immune evasive, which throws a wrench in the Israeli team’s conclusions.

“But otherwise, I think it’s a very interesting study,” Rasmussen said. “And it certainly adds a lot to our body of knowledge.”

Crucial not to ‘ostracize’ patients

This latest research, as well as earlier findings on viral evolution within people chronically ill with COVID-19, suggests a need to monitor those kinds of patients, the experts who spoke to CBC News agreed.

“I do think that it is really important to start building networks like this to try to start understanding which mutations are going to be more likely to emerge in the case of persistent infection,” Rasmussen said.

But doing so is easier said than done, Kindrachuk said, since much of Canada is loosening restrictions and limiting testing access, all while other countries are dealing with uncontrolled transmission.

“How do we manage patients with chronic infections? Not every person who has a chronic infection will have a variant of concern … so what do you do?” he asked.

Monitoring those patients is crucial, given the need to both spot variants and stop their spread, Kindrachuk said.

“If it remains in that individual — even if it has all mutations it needs to be a better, fitter version of SARS-CoV-2 — if it stays out of someone else, it’ll resolve over time,” he continued.

But Kindrachuk said there’s a razor-thin line between keeping an eye on those patients and further marginalizing people who may already have stigmatized conditions such as HIV/AIDS.

“We don’t want to ostracize people,” he said.

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Measles case reported locally turns out to be negative: health unit

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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On March 26, the Simcoe Muskoka District Health Unit (SMDHU) was notified by Public Health Ontario’s (PHO) laboratory that due to laboratory error, the case of measles that had been lab-confirmed positive on March 12, based on symptoms and a positive urine measles laboratory result by PHO’s laboratory, is in fact negative for the measles virus.

“With this new information of the negative lab result, we believe that that individual was not infected with measles and that there has not been any public exposure to measles resulting from this individual’s illness,” said Dr. Charles Gardner, medical officer of health. “We recognize that notifying the public of what we believed to be a positive measles case in our area created worry, anxiety and disruption for some, and we regret this.

“We do know that, despite best efforts, on rare occasions laboratory errors can occur. We are working closely with the PHO’s laboratory to do all that we can to ensure that such an incident does not occur again.”

Measles is a highly contagious viral infection that spreads very easily through airborne transmission. The measles virus can live in the air or on surfaces for up to two hours.

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Symptoms of measles begin seven to 21 days after exposure and include fever, runny nose, cough, drowsiness, and red eyes. Small white spots appear on the inside of the mouth and throat but are not always present. Three to seven days after symptoms begin, a red, blotchy rash appears on the face and then progresses down the body.

The risk of transmission to those vaccinated with two doses is low, and when it does occur tends to show a reduction in the severity of these symptoms.

“Although we are relieved for the individual involved, and for all Simcoe-Muskoka residents, that this case has now been confirmed as negative, we know that measles is still active in Ontario at this time and the potential remains for new cases to arise, especially given the increase in Ontarians travelling to areas in the world that have higher numbers of measles cases,” said Dr. Gardner. “This is why we continue to advise individuals to keep up to date with their routine immunizations, including measles, mumps and rubella (MMR) vaccination.”

The risk of measles is low for people who have been fully immunized with two doses of measles vaccine or those born before 1970; however, many children have been delayed in receiving their routine childhood immunizations and people who have not had two doses of measles vaccine are at higher risk of contracting the disease.

People who do get sick usually recover without treatment, but measles can be more severe for infants, pregnant women, and those with compromised immune systems. Possible complications include middle-ear infections, pneumonia, diarrhea, or encephalitis (swelling of the brain) and occasionally death in the very young. Even individuals who are up to date with the measles vaccine should watch for symptoms of measles for 21 days after exposure.

For more information about measles, please visit smdhu.org or call Health Connection at 705-721-7520 or 1-877-721-7520, Monday to Friday between 8:30 a.m. and 4:30 p.m. to speak with a public health professional.

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Kate Middleton Not Alone. Cancer On Rise For People Under 50, Say Experts

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Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery

London:

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When Catherine, Princess of Wales, revealed she was being treated for cancer last week, part of the shock was that an otherwise healthy 42-year-old has a disease that mostly plagues older people.

However, researchers have been increasingly sounding the alarm that more and more people under 50 are getting cancer — and no one knows why.

Across the world, the rate of under-50s diagnosed with 29 common cancers surged by nearly 80 percent between 1990 and 2019, a large study in BMJ Oncology found last year.

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The researchers predicted the number of new cancer cases among younger adults will rise another 30 percent by the end of this decade, with wealthy countries particularly affected.

The increase in cases — and soaring global population — means that the number of deaths among under 50s from cancer has risen by nearly 28 percent over the last 30 years.

This occurred even as the odds of people of all ages surviving cancer have roughly doubled over the last half century.

Shivan Sivakumar, a cancer researcher at the UK’s University of Birmingham, called it an “epidemic” of young adult cancer.

Since Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery earlier this year, Sivakumar and other doctors have spoken out about the uptick in younger cancer patients they have been seeing at their clinics.

While breast cancer remains the most common for people under 50, the researchers expressed particular concern about the rise of gastrointestinal cancers — such as of the colon, pancreas, liver and oesophagus — in younger adults.

Colon cancer is now the leading cause of cancer deaths in men under 50 in the United States, according to the American Cancer Society. For women, it is number two — behind only breast cancer.

One high profile case of colorectal cancer was “Black Panther” actor Chadwick Boseman, who died at the age of 43 in 2020.

Why is this happening?

“We just don’t have the evidence yet” to say exactly what is causing this rise, Sivakumar told AFP, adding it was likely a combination of factors.

Helen Coleman, a cancer epidemiology professor at Queen’s University Belfast who has studied early onset cancer in Northern Ireland, told AFP there were two potential explanations.

One is that people in their 40s were exposed to factors known to cause cancer — such tobacco smoke, alcohol or being obese — at an earlier age than previous generations.

She pointed out that the “obesity epidemic” did not start until the 1980s.

Sivakumar felt that at least part of the puzzle could be explained by obesity.

However, there is “another wave” of under-50 patients who are neither obese nor genetically predisposed still getting cancer, he emphasised, adding that this could not be put down to “statistical chance”.

The other theory, Coleman said, is that “something different” has been going on with her generation.

Fingers have been pointed out a range of possible culprits — including chemicals, new drugs and microplastics — but none have been proven.

Some have suggested that so-called ultra-processed foods could be to blame. “But there’s very little data to back any of that up,” Coleman said.

Another theory is that the food we eat could be changing our gut microbiome.

While there is nothing conclusive yet, Coleman said her own research suggested that cancer causes changes to the microbiome, not the other way around.

Anti-vaxx conspiracy theorists have even tried to blame Covid-19 vaccines.

This is easily disproven, because the rise in young adult cancer has taken place over decades, but the vaccines have only been around for a few years.

What can be done?

To address the rise in younger colorectal cancer, in 2021 the US lowered the recommended age for screening to 45. Other countries have yet to follow suit.

But the researchers hoped that Catherine’s experience would remind people at home that they should consult their doctor if they sense anything is wrong.

“People know their bodies really well,” Sivakumar said.

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“If you really feel that something isn’t right, don’t delay — just get yourself checked out.”

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Almost 3,000 students suspended in Waterloo Region over immunization issues

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Close to 3,000 children attending elementary school across Waterloo Region were suspended from school on Wednesday morning for not having up-to-date immunization records.

The region says Waterloo Public Health suspended 2,969 students under the Immunization of School Pupils Act (ISPA).

For several months, the region has been campaigning for people to get their children’s vaccinations up to date, including sending letters home to parents on a couple of occasions, warning that students’ records needed to be up to date or they would be suspended.

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It announced in January that 32,000 students did not have up-to-date records: 22,000 elementary students and 10,000 high school students.


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“We have made remarkable progress from the original 27,567 immunization notices we sent to parents in November and December 2023,” Dr. Hsiu-Li Wang, medical officer of health, stated.

“Since that time, we have resolved more than 24,500 outdated vaccination records, providing students with valuable protection against these serious and preventable diseases.”

The high school students still have a few weeks to get their records up to date or else face suspension.

The ISPA requires students to have proof-of-vaccination records for diphtheria, polio, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox) and meningitis, which must be on file with public health.

Public health says caregivers whose children are suspended will need to book an appointment at regionofwaterloo.ca/vaccines for clinics, which will be held in Cambridge and Waterloo on weekdays.

“Given the high number of suspensions, it may take several days before you can be seen at an appointment and return your child to school,” a release from the region warns.

“Record submission and questions must be done in person to ensure immediate resolution.”

The last time suspensions over immunizations were issued was in 2019, when 1,032 students were suspended.

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