Pregnant air travellers face a higher risk of blood clots, but they can reduce their risks by walking airplane aisles, drinking water and doing calf exercises, according to a new review.
For women with additional risk, doctors may recommend compression stockings and injectable blood thinners while traveling, the authors write in the Journal of Travel Medicine.
“Both pregnancy and air travel are risk factors for venous thromboembolism, or a blood clot in the legs or lungs,” said senior author Dr. Leslie Skeith of the University of Calgary, a member of the CanVECTOR Canadian thrombosis research network.
Blood clots affect about one to two per 1,000 non-pregnant people each year and are the third leading cause of vascular death after heart attacks and strokes, the authors note. With more than two billion passengers flying each year, about 150,000 cases of travel-related blood clots are diagnosed annually.
Long-distance flights tend to increase the risk by three-fold, yet travel-related studies either don’t include pregnant women or only include a small number and don’t directly investigate how pregnancy increases the risk.
“There is very little evidence to guide what pregnant and postpartum women should do to prevent blood clots while travelling,” Skeith told Reuters Health by email.
Skeith and her colleagues review the many factors that play into an individual’s risk for a blood clot, including height, weight, recent surgery, pregnancy, use of oral contraceptives, hormone replacement therapy and a family history of clots or diseases that promote clotting.
Why pregnancy heightens clot risk
With pregnancy in particular, they write, the risk is higher because of physiological changes, such as slower blood flow and blood vessel dilation. Pelvic blood vessels may also be compressed as the uterus grows. Starting in early pregnancy, the body starts to become hypercoagulable, or more likely to form blood clots. These risks remain higher until about 12 weeks after giving birth.
Although the average pregnant or postpartum air traveler faces an increased risk of clots, the absolute risk estimate is low at less than 1 per cent, the study found.
Pregnant women with other risk factors, such as inherited blood problems, obesity and recent surgery, may face a higher blood clot risk, however. Although the risk depends on individual factors, women with a history of blood clots tend to have a four per cent higher risk while pregnant, and those with hormonal-associated blood clots tend to have a six per cent higher risk while pregnant.
For most women with a history of blood clots, the risk during air travel still remains low at just over one per cent. At the same time, pregnant women who face these higher risks should consider using more extensive blood clot prevention measures while travelling, such as the injectable blood thinner low-molecular-weight heparin (LMWH).
Aspirin trial begins
“It is known that LMWH prophylaxis lowers the risk of recurrent thrombosis in women with previous venous thromboembolism,” said Dr. Ida Martinelli of the University of Milan, who wasn’t involved in the study.
However, some studies show that certain blood conditions and blood thinners can lead to complications during delivery, so it’s best to consult a doctor for individual recommendations.
Skeith and colleagues are now studying whether aspirin can prevent blood clots in postpartum women with risk factors for clots. The pilot randomized trial, called PARTUM, is expected to start in 2020.
“We desperately need more research to better prevent blood clots in pregnant and postpartum women,” Skeith said. “We recommend talking to your doctor about different options.”
Mass vaccination campaign against Monkeypox needed, experts say – Global News
As the World Health Organization calculates whether to declare monkeypox a global health emergency, infectious disease experts are urging health officials to be more proactive and start ramping up vaccinations and surveillance — especially in African nations where the virus is most prevalent.
The WHO convened its emergency committee Thursday to consider whether the spiralling outbreak of monkeypox should be declared a “public health emergency of international concern,” the WHO’s highest level of alert.
But the United Nations agency is facing criticism over its treatment of monkeypox — jumping into action only after the disease started to spread in rich western nations.
The viral disease that causes flu-like symptoms and skin lesions is endemic in parts of Africa, which means it is consistently present in certain regions. The continent has registered just over 1,500 suspected cases since the start of 2022, of which 70 have been fatal, according to the WHO.
By comparison, Canada has confirmed over 200 cases, the majority of which are in Quebec, and has had no deaths.
“There are more cases that occur in Africa on a yearly basis than have already been reported outside of Africa right now. And there are more deaths that have occurred in Africa from monkeypox than have occurred in the rest of the world,” said Dr. Sameer Elsayed, an infectious disease physician and professor of epidemiology and biostatistics at Western University.
That’s why he believes Africa should be getting the lion’s share of resources to deal with monkeypox — and that should include mass vaccinations, he says.
“I think Africa needs to be looked at with high, high priority,” he said.
“It needs to be a mass vaccination campaign for monkeypox with the newer vaccines for people in the African continent, especially in the high endemic areas.”
He’s not alone.
Dr. Monica Gandhi, a physician and infectious disease expert at the University of California, San Francisco, says she also believes more people living in regions where monkeypox is more prevalent should be vaccinated.
“That will actually stop it in endemic regions in this non-endemic outbreak.”
That the WHO is only now taking monkeypox seriously is “profoundly problematic,” Gandhi says, given that the disease has been spreading and killing people in Central and West Africa for years.
Monkeypox has about half of Canadians worried, but most confident with health response: poll
“It’s been circulating since 1958. There are increasing outbreaks — a severe one in Nigeria, for example in 2017 — and it’s only really essentially when this has affected high-income countries that the WHO is jumping on it.”
Experts who have worked on monkeypox in places like the Democratic Republic of Congo have long taken note of rising cases while population immunity to pox viruses has been decreasing, due to lack of vaccination. This is why the world shouldn’t be surprised at the current outbreaks, said Anne Rimoin, an epidemiology professor at UCLA in California, who has studied monkeypox for two decades.
The COVID-19 pandemic has demonstrated how quickly a deadly virus can spread across the globe when the right conditions are present, so health officials ought to learn from this and start being more proactive, she said.
“When it comes to infectious diseases, in particular those viruses that have the potential for global spread, it’s much easier to stay out of trouble than it is to have to get out of trouble.”
In addition to providing vaccines, health officials should also be ramping up resources to study this disease and do more surveillance to get a better understanding of monkeypox and learn why it is spreading in new and unusual ways, Rimoin said.
“We’ve given this virus a lot of runway to be able to spread. We have not been looking for it as vigilantly as we should be,” she said.
“I think we have to learn the lessons that we’ve learned with COVID-19 and that it is much better to invest ahead of time to get in front of these viruses, to do the kind of surveillance it’s necessary to be regularly updating our knowledge about viruses.”
Good disease surveillance is just as important in poorer countries as it is in “high-resource settings,” she added.
Like many countries around the world, Canada and the United States stopped vaccinating the general population against smallpox by around 1972, which means many on this continent are highly susceptible to pox viruses like monkeypox.
Given that scientists expect to see more emerging infectious diseases due to factors such as climate change, deforestation and globalization, the world should start getting better prepared for new outbreaks, Elsayed said.
This is why, in addition to calling for vaccinations and more resources to fight monkeypox in Africa, Elsayed believes governments in developed nations should also consider more options to protect citizens from pox viruses, including possibly re-introducing mass smallpox vaccinations.
“I believe that these vaccines should come on board again for the general population … but not (just) for monkeypox, but also to protect the world against perhaps a smallpox pandemic that can happen in the future, or even another virus that’s closely related to monkeypox but hasn’t reached humans,” Elsayed said.
He stressed this should only be considered after addressing the more pressing needs in Africa first.
WHO looks into reports of traces of monkeypox found in semen
Rimoin noted that when the world stopped vaccinating against smallpox, it opened a “gap of immunity” for populations to once again be vulnerable to it. And with the emergence of a number of new pox viruses in different parts of the globe, including mousepox, cowpox and camelpox, the world is not immune to new outbreaks, she said.
“We now have to really think about, How important is it for us to be able to keep pox viruses out of the population?” she said. “What are the stakes of allowing this virus to spread? And then acting accordingly.”
-With files from Global News reporter Reggie Checcini and Reuters.
© 2022 Global News, a division of Corus Entertainment Inc.
New Brunswick prepares for COVID-19 vaccine rollout for children under 5 – CBC.ca
New Brunswick will be ready to roll out COVID-19 vaccines to children under five as soon as they’re approved and available, according to the chief medical officer of health.
The province is also working on an early flu vaccination campaign in anticipation of “a higher than normal” influenza season this year, said Dr. Jennifer Russell.
In the U.S., immunization of infants and preschoolers against COVID-19 began this week after the Food and Drug Administration (FDA) authorized emergency use of the Moderna and Pfizer-BioNTech vaccines in children as young as six months old last Friday, and the Centers for Disease Control and Prevention (CDC) recommended use of the vaccines in this age group the following day.
No COVID-19 vaccine has been approved for children under five in Canada yet. Health Canada is reviewing an application from Moderna.
“We are waiting for Health Canada as well as NACI [National Advisory Committee on Immunization] to come forth with their recommendations,” said Russell.
The province is “watching very closely,” she said, and is “ready to act on those when they come through.”
Russell could not estimate when that might be.
“But we are preparing ahead of time for that inevitability.”
No details yet
Planning for the rollout is underway, said Department of Health spokesperson Michelle Guenard.
The department is working with its primary care partners, including the regional health authorities, community pharmacies and the New Brunswick Medical Society, she said.
No other details, such as where the shots will be available or who will administer them, are available yet.
“Final decisions will be made after Health Canada has given approval to the vaccine,” Guenard said in an emailed statement. “This includes reviewing a statement from NACI and local considerations.”
“Guidance will be provided to those identified to be immunizers for the under-five vaccinations,” she added. “This includes sharing information from Health Canada, the vaccine supplier, NACI and guidance from New Brunswick Public Health.”
Russell called the U.S. approval “very encouraging.”
“I think whatever protections we can provide to the population as a whole is very important,” she said. “This is one of the last pieces, really, that we’ve been waiting for.”
The under-five age group is the only one in the province that doesn’t currently have COVID-19 vaccines available to them.
Children aged five to 11 have been able to get a shot since November.
“As we have seen with older age groups, we expect that the vaccines for younger children will provide protection from the most severe outcomes of COVID-19, such as hospitalization and death,” FDA commissioner Dr. Robert M. Califf said in a statement.
“Those trusted with the care of children can have confidence in the safety and effectiveness of these COVID-19 vaccines and can be assured that the agency was thorough in its evaluation of the data,” he said.
The FDA found the known and potential benefits of the Moderna and Pfizer-BioNTech COVID-19 vaccines “outweigh the known and potential risks in the pediatric populations.”
According to the clinical trial data, the most commonly reported side effects in children aged six months to five years old included pain, redness and swelling at the injection site, fever and underarm (or groin) swelling/tenderness of lymph nodes in the same arm (or thigh) as the injection.
Spike in flu cases
A total of 52.7 per cent of eligible New Brunswickers have received a COVID-19 booster shot, as of this week’s COVIDWatch report, 88.1 per cent have received two doses and 93.3 per cent have received one dose.
The province wants to have as many people protected as possible going into the fall, said Russell.
The “pattern of the pandemic” has been that the risks tend to decrease in the summer when people are outside more, physically distancing, and increase in the fall and winter, she said.
“I think that correlation is holding true at the moment but you know we try to be prepared for whatever comes our way with COVID because there aren’t any guarantees.
“We are aware that we’re expecting a higher than normal flu season this year and so we will be pushing our vaccination campaigns early.”
New Brunswick is dealing with an unusually late flu season, due in part to the lifting of COVID-19 protective measures in March, such as masking.
Normally, the flu season really starts to “take off” in January and “peters out” once the warmer weather begins, the province’s acting deputy chief medical officer of health Dr. Yves Léger has said.
But nearly a quarter of this season’s cases occurred in one week this month.
Seventy-three positive influenza cases were reported in week 23, which ended June 11, the most recent statistics available from Public Health show. Six of the cases required hospitalization.
Two new influenza outbreaks were reported in nursing homes and one new influenza-like illness outbreak was reported in a school, the influenza surveillance report shows.
A total of 302 cases have been reported so far this season, which began Aug. 29, 2021 and continues until Aug. 27. That’s up from 40 just a month ago.
There have been 60 hospitalizations and four deaths.
If the risks for COVID-19 transmission increase in the fall at the same time the risks for the flu are expected to rise, “then we’ve got, you know, a double kind of risk happening,” said Russell.
“So we want to address that early and making sure that everybody who’s eligible for flu vaccination gets vaccinated as well.”
The province is also “really keen” to have people who fell behind with their routine vaccinations to get caught up on those, she said.
“We wouldn’t want to see a resurgence of vaccine-preventable diseases.”
COVID-19 vaccines saved 20M lives in 1st year, scientists say – CTV News
Nearly 20 million lives were saved by COVID-19 vaccines during their first year, but even more deaths could have been prevented if international targets for the shots had been reached, researchers reported Thursday.
On Dec. 8, 2020, a retired shop clerk in England received the first shot in what would become a global vaccination campaign. Over the next 12 months, more than 4.3 billion people around the world lined up for the vaccines.
The effort, though marred by persisting inequities, prevented deaths on an unimaginable scale, said Oliver Watson of Imperial College London, who led the new modelling study.
“Catastrophic would be the first word that comes to mind,” Watson said of the outcome if vaccines hadn’t been available to fight the coronavirus. The findings “quantify just how much worse the pandemic could have been if we did not have these vaccines.”
The researchers used data from 185 countries to estimate that vaccines prevented 4.2 million COVID-19 deaths in India, 1.9 million in the United States, 1 million in Brazil, 631,000 in France and 507,000 in the United Kingdom.
An additional 600,000 deaths would have been prevented if the World Health Organization target of 40% vaccination coverage by the end of 2021 had been met, according to the study published Thursday in the journal Lancet Infectious Diseases.
The main finding — 19.8 million COVID-19 deaths were prevented — is based on estimates of how many more deaths than usual occurred during the time period. Using only reported COVID-19 deaths, the same model yielded 14.4 million deaths averted by vaccines.
The London scientists excluded China because of uncertainty around the pandemic’s effect on deaths there and its huge population.
The study has other limitations. The researchers did not include how the virus might have mutated differently in the absence of vaccines. And they did not factor in how lockdowns or mask wearing might have changed if vaccines weren’t available.
Another modelling group used a different approach to estimate that 16.3 million COVID-19 deaths were averted by vaccines. That work, by the Institute for Health Metrics and Evaluation in Seattle, has not been published.
In the real world, people wear masks more often when cases are surging, said the institute’s Ali Mokdad, and 2021’s Delta wave without vaccines would have prompted a major policy response.
“We may disagree on the number as scientists, but we all agree that COVID vaccines saved lots of lives,” Mokdad said.
The findings underscore both the achievements and the shortcomings of the vaccination campaign, said Adam Finn of Bristol Medical School in England, who like Mokdad was not involved in the study.
“Although we did pretty well this time — we saved millions and millions of lives — we could have done better and we should do better in the future,” Finn said.
Funding came from several groups including the WHO; the U.K. Medical Research Council; Gavi, the Vaccine Alliance; and the Bill and Melinda Gates Foundation.
AP health and science reporter Havovi Todd contributed
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content
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