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Information for Persons Who Are Immunocompromised Regarding Prevention and Treatment of SARS-CoV-2 Infection in the Context of Currently Circulating Omicron Sublineages — United States, January 2023
BOX. Prevention measures against SARS-CoV-2 for persons who are immunocompromised, their household members, and close contacts in the context of currently circulating Omicron sublineages — United States, January 2023
Because Evusheld is not currently authorized for preexposure prophylaxis against SARS-CoV-2 infection in the United States, it is important that persons who are moderately to severely immunocompromised,* those who might have an inadequate immune response to COVID-19 vaccination, and those with contraindications to receipt of COVID-19 vaccines, exercise caution and recognize the need for additional preventive measures to protect themselves from SARS-CoV-2 infection. Persons with immunocompromise, their household members, and close contacts can use the following steps and precautions to help prevent SARS-CoV-2 infection and mitigate COVID-19 illness if they become infected.
COVID-19 vaccines, booster doses, and staying up to date*
- COVID-19 vaccines remain the best way to protect against severe COVID-19. COVID-19 vaccines help the body develop protection against SARS-CoV-2 infection. Although vaccinated persons sometimes get infected with SARS-CoV-2, staying up to date with COVID-19 vaccines significantly lowers the risk for severe illness, hospitalization, or death from COVID-19.
- CDC recommends that all persons who are eligible, especially those who are immunocompromised or have weakened immune systems,† get an updated (bivalent) booster dose and stay up to date with their COVID-19 vaccines.
Personal COVID-19 action plan§
- Persons should consider how to protect themselves and others around them should they become ill with COVID-19 or if the community COVID-19 transmission level changes. The plan should include:
- ways to protect oneself and others including considerations in case of illness, such as finding a room in which to isolate
- actions to take in case of exposure or symptom onset
- what to do in the event of receipt of a positive SARS-CoV-2 test result
- Persons should share their COVID-19 plan with their family, friends, and health care providers so they can support prevention and preparation steps. CDC suggests that persons consider how others can help them if they get ill. It is important to adhere to treatment plans, keep routine health care appointments, and ensure that prescriptions are filled. Persons should make alternative plans for work, child care, and other responsibilities that might cause stress if they become ill.
Masks or respirators¶
- Masks are made to contain droplets and particles that persons breathe, cough, or sneeze. A variety of masks are available. Some masks provide a higher level of protection than others. Wearing a mask with the best fit and comfort provides the best protection.**
- Respirators (e.g., N95 and NIOSH-approved KN95) provide higher protection than masks.†† Respirators are made to protect persons by fitting closely on their face to filter out particles, including SARS-CoV-2. They can also block droplets and particles that a person breathes, coughs, or sneezes out to limit transmission to others. NIOSH approves many types of filtering facepiece respirators. The most widely available are N95 respirators, but other types (N99, N100, P95, P99, P100, R95, R99, and R100) offer the same or better protection as an N95 respirator.
Physical distancing
- Small particles that persons breathe out can contain virus particles. The closer a person is to other persons, the higher the risk for exposure to SARS-CoV-2. Persons can minimize risk of exposure by avoiding indoor crowded areas or maintaining a ≥6 ft (1.8 m) distance from others. Such actions must be balanced against risks of avoiding such activities.
Ventilation§§
- Opening windows and doors to bring as much fresh air into the home as possible (weather permitting) can improve ventilation.
- Portable high-efficiency particulate air cleaners are useful if a home is not outfitted with an HVAC system.
- Exhaust fans and other fans can improve air flow.
- In homes where the HVAC fan operation can be controlled by a thermostat, the fan should be set to the “on” position instead of “auto” when others are visiting. This allows the fan to run continuously, even if heating or air conditioning is not on, to ensure the HVAC system provides continuous airflow and filtration.
Time outdoors
- Spending time outdoors, when possible, instead of indoors, can also help reduce transmission. Viral particles spread between persons more readily indoors than outdoors.
Handwashing
- Frequent handwashing with soap and water, preferably, or using a hand sanitizer that contains ≥60% alcohol can reduce risk for many illnesses, including COVID-19.
Testing for SARS-CoV-2¶¶
- Persons should get tested if they have COVID-19 symptoms. Viral tests are used for SARS-CoV-2 detection. There are two types of viral tests: rapid tests and laboratory tests. These tests might use nasal, throat, or saliva samples. Persons can take actions to reduce further transmission if they are aware of their SARS-CoV-2 infection.
- Free at-home tests*** are available. Persons should check with their health insurance, Medicaid, or Medicare plan to learn what tests are available.††† Persons with a disability can receive help from the Disability Information and Access Line§§§ to access a test or identify an accessible test location.
- Persons should be aware of free or low-cost testing locations¶¶¶ that are near their homes.
COVID-19 Treatment****
- Persons should contact their health care provider, health department, or community health center†††† to learn about treatment options. Treatment must be started within 5–7 days after symptoms develop to be effective.
- Community Test to Treat locations§§§§ can be accessed if or when persons cannot reach their health care provider or do not have one. These sites offer testing and prescriptions from a health care provider (either onsite or by telehealth) and dispense medications.
- Antiviral treatments are available for persons with mild to moderate COVID-19 symptoms who are at high risk for progression to severe disease, hospitalization, and death. Persons are at high risk of disease if they
- are aged ≥50 years
- have an underlying health condition,¶¶¶¶ especially moderate to severe immunosuppression
- are unvaccinated
- Persons who are immunocompromised should discuss a treatment plan with their doctor and identify which COVID-19 treatment would be best for them. Some persons with COVID-19 who are immunocompromised or receiving immunosuppressive treatment might benefit from a convalescent plasma treatment.*****
- CDC recommends that immunocompromised persons with COVID-19 isolate for ≥10 days and check with their health care provider before ending isolation.†††††
Abbreviations: HVAC = heating, ventilation, and air conditioning; NIOSH = National Institute for Occupational Safety and Health.
* https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html
† https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
§ https://www.cdc.gov/coronavirus/2019-ncov/downloads/needs-extra-precautions/FS_COVID_Plan_FINAL.pdf
¶ https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html
** Persons who are deaf or hard of hearing may request a clear mask to assist with lipreading or seeing facial expressions. Persons with sensory disorders or intellectual and developmental disabilities might be unable to wear masks and should consider face shields.
†† Persons with severe respiratory impairment (e.g., shortness of breath with minimal exertion or supplemental oxygen use) should consult with a health care provider regarding N95 respirator usage. Some N95 respirators might contain latex. Persons with natural rubber latex allergies should consult the manufacturer’s website for information about the specific model.
§§ https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/Improving-Ventilation-Home.html; https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html
¶¶ https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html
*** https://special.usps.com/testkits
††† https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free
§§§ https://acl.gov/DIAL
¶¶¶ https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html
**** https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html
†††† https://data.hrsa.gov/data/reports/datagrid?gridName=FQHCs
§§§§ https://covid-19-test-to-treat-locator-dhhs.hub.arcgis.com/
¶¶¶¶ https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/underlyingconditions.html
***** https://www.fda.gov/media/136798/download
††††† https://www.cdc.gov/coronavirus/2019-ncov/your-health/isolation.html
Flu vaccine appears to be a very good match to circulating strains, CDC says
This year’s flu shot appears to be “a very good match” to the circulating strains, U.S. Centers for Disease Control and Prevention Director Dr. Rochelle Walensky said at a news briefing Monday. (Kristin Murphy, Deseret News)
Estimated read time: 4-5 minutes
WASHINGTON — This year’s flu shot appears to be “a very good match” to the circulating strains, U.S. Centers for Disease Control and Prevention Director Dr. Rochelle Walensky said at a news briefing Monday. However, she noted that flu vaccinations are lagging behind the pace of previous years.
Through the end of October, CDC data shows that vaccinations for pregnant women, a group that is more vulnerable to severe illness from influenza, are down about 12% from the same point in 2021.
Vaccination rates for seniors, the age group most likely to be hospitalized with influenza, were down about three percentage points from October 2021.
Flu vaccinations for children are down about 5% compared with where they were before the COVID-19 pandemic, Walensky said.
In a typical year, about 60% of American adults get vaccinated against influenza.
Flu hits the US hard
Flu season has gotten off to an early and severe start in the U.S., with hospitalization rates hitting levels that typically aren’t seen until December or January.
“We, of course, look in real time as to how well we think the influenza match is to what is circulating right now. The good news is that looks like it is a very good match,” Walensky said of the early start to the respiratory virus season.
She noted that the CDC would have more definitive data later in the season but that the data is encouraging.
Walensky said that even when the vaccine doesn’t closely match the circulating flu strains, “We see a 35% decrease in rates of hospitalization … which really just emphasizes, when we do have a good match, how much more effective it will be.”
CDC data shows that nearly 20,000 people in the United States were admitted to the hospital for flu during the week of Thanksgiving, almost double the number of admissions from the week before.
COVID-19 hospitalizations have ticked up as well, rising 27% in the week after Thanksgiving. But COVID-19 is no longer the only virus straining hospitals.
Just 5% of the U.S. population lives in an area considered to have a high COVID-19 community level.
Walensky said Monday that the CDC was “actively looking into” expanding its community levels beyond COVID-19 to include the effects of other viruses, such as the flu.
“In the meantime, what I do want to say is, one need not take wait for CDC action in order to put a mask,” she said.
People who are sick should stay home and away from others, use good hygiene like covering coughs and washing hands frequently, use a high-quality mask and improve the ventilation in indoor spaces, Walensky said.
Treatment is available
If you do get sick, it’s important to get tested, even if you’ve been vaccinated, said Dr. Sandra Fryhofer, board chair of the American Medical Association and an internal medicine physician in Atlanta.
If you have COVID-19 or the flu, there are antiviral medications for both. But flu antivirals don’t work against COVID-19, and vice versa.
“It is going to be a confusing respiratory infections season. Figuring out what’s making people sick is going to be a conundrum,” Fryhofer said.
In response to a question about shortages of key medications during this rough virus season, Walensky said that “CDC is aware of the reports of some of the shortages for both antivirals as well as antibiotics across the country. I know FDA is working … with manufacturers to try and explore what can be done to address this.”
She also urged doctors not to prescribe antibiotics for illnesses caused by viruses.
Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, said he and his colleagues have been astonished by the steep increase in flu cases this season. They have also wondered what could be causing it.
He says it’s likely that after two years without much flu activity in the U.S., we lost some of our immunity against that virus just as the country has returned to more normal travel and activity patterns.
It is going to be a confusing respiratory infections season. Figuring out what’s making people sick is going to be a conundrum.
–Sandra Fryhofer, American Medical Association
“Some of it has got to do with our behaviors in the past, having avoided flu and now opening up our lives to activities such as travel, religious services, getting together with families, going out to entertainment venues and doing all those things that take us into groups,” he said.
The flu vaccines are good at preventing severe outcomes, he said, but they don’t do much to stop the virus’ spread.
“It keeps you out of the emergency room, the hospital, the intensive care unit and the cemetery. It’s not very good at interrupting transmission, and it is not very good at preventing milder infection,” he said.
Schaffner says it’s likely that flu hospitalizations are going up because the virus is hitting the elderly, who, on the whole, tend to get less protection from vaccinations.
“The vaccine works least well among the population we most want to protect, namely older people, and that’s because they have immune systems that are much less robust than the immune systems of younger people.”
Schaffner noted that there are high-dose vaccines for seniors, which are preferred for this age group to help increase their protection.
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Flu vaccine appears to be a very good match to circulating strains, CDC says
CNN
—
This year’s flu shot appears to be “a very good match” to the circulating strains, US Centers for Disease Control and Prevention Director Dr. Rochelle Walensky said at a news briefing Monday. However, she noted that flu vaccinations are lagging behind the pace of previous years.
Through the end of October, CDC data shows that vaccinations for pregnant women, a group that is more vulnerable to severe illness from influenza, are down about 12% from the same point in 2021.
Vaccination rates for seniors, the age group most likely to be hospitalized with influenza, were down about 3 percentage points from October 2021.
Flu vaccinations for children are down about 5% compared with where they were before the Covid-19 pandemic, Walensky said.
In a typical year, about 60% of American adults get vaccinated against influenza.
Flu season has gotten off to an early and severe start in the US, with hospitalization rates hitting levels that typically aren’t seen until December or January.
“We, of course, look in real time as to how well we think the influenza match is to what is circulating right now. The good news is that looks like it is a very good match,” Walensky said of the early start to the respiratory virus season.
She noted that the CDC would have more definitive data later in the season but that the data is encouraging.
Walensky said that even when the vaccine doesn’t closely match the circulating flu strains, “We see a 35% decrease in rates of hospitalization … which really just emphasizes, when we do have a good match, how much more effective it will be.”
CDC data shows that nearly 20,000 people in the United States were admitted to the hospital for flu during the week of Thanksgiving, almost double the number of admissions from the week before.
Covid-19 hospitalizations have ticked up as well, rising 27% in the week after Thanksgiving. But Covid-19 is no longer the only virus straining hospitals.
Just 5% of the US population lives in an area considered to have a high Covid-19 community level.
Walensky said Monday that the CDC was “actively looking into” expanding its community levels beyond Covid-19 to include the effects of other viruses, such as the flu.
“In the meantime, what I do want to say is, one need not take wait for CDC action in order to put a mask,” she said.
People who are sick should stay home and away from others, use good hygiene like covering coughs and washing hands frequently, use a high-quality mask and improve the ventilation in indoor spaces, Walensky said.
If you do get sick, it’s important to get tested, even if you’ve been vaccinated, said Dr. Sandra Fryhofer, board chair of the American Medical Association and an internal medicine physician in Atlanta.
If you have Covid-19 or the flu, there are antiviral medications for both. But flu antivirals don’t work against Covid-19, and vice versa.
“It is going to be a confusing respiratory infections season. Figuring out what’s making people sick is going to be a conundrum,” Fryhofer said.
In response to a question about shortages of key medications during this rough virus season, Walensky said that “CDC is aware of the reports of some of the shortages for both antivirals as well as antibiotics across the country. I know FDA is working…with manufacturers to try and explore what can be done to address this.”
She also urged doctors not to prescribe antibiotics for illnesses caused by viruses.
Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, said he and his colleagues have been astonished by the steep increase in flu cases this season. They have also wondered what could be causing it.
He says it’s likely that after two years without much flu activity in the US, we lost some of our immunity against that virus just as the country has returned to more normal travel and activity patterns.
“Some of it has got to do with our behaviors in the past, having avoided flu and now opening up our lives to activities such as travel, religious services, getting together with families, going out to entertainment venues and doing all those things that take us into groups,” he said.
The flu vaccines are good at preventing severe outcomes, he said, but they don’t do much to stop the virus’ spread.
“It keeps you out of the emergency room, the hospital, the intensive care unit and the cemetery. It’s not very good at interrupting transmission, and it is not very good at preventing milder infection,” he said.
Schaffner says it’s likely that flu hospitalizations are going up because the virus is hitting the elderly, who, on the whole, tend to get less protection from vaccinations.
“The vaccine works least well among the population we most want to protect, namely older people, and that’s because they have immune systems that are much less robust than the immune systems of younger people.”
Schaffner noted that there are high-dose vaccines for seniors, which are preferred for this age group to help increase their protection.
Polio detected in NYC’s sewage, suggesting virus circulating
NEW YORK (AP) — The virus that causes polio has been found in New York City’s wastewater in another sign that the disease, which hadn’t been seen in the U.S. in a decade, is quietly spreading among unvaccinated people, health officials said Friday.
The presence of the poliovirus in the city’s wastewater suggests likely local circulation of the virus, health authorities from the city, New York state and the federal government said.
The authorities urged parents to get their children vaccinated against the potentially deadly disease.
“The risk to New Yorkers is real but the defense is so simple — get vaccinated against polio,” New York City Health Commissioner Dr. Ashwin Vasan said. “With polio circulating in our communities there is simply nothing more essential than vaccinating our children to protect them from this virus, and if you’re an unvaccinated or incompletely vaccinated adult, please choose now to get the vaccine. Polio is entirely preventable and its reappearance should be a call to action for all of us.”
Dr. José R. Romero, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, said, “This is sobering; we know polio spreads silently, and it’s likely that there are many people infected with polio and shedding the virus in these communities. This is also an urgent and living reminder of the importance of vaccination.”
New York City is being forced to confront polio as city health officials are struggling to vaccinate vulnerable populations against monkeypox and adjusting to changing COVID-19 guidelines.
“We are dealing with a trifecta,” Mayor Eric Adams said Friday on CNN. “COVID is still very much here. Polio, we have identified polio in our sewage, and we’re still dealing with the monkeypox crisis. But the team is there. And we’re coordinating and we’re addressing the threats as they come before us, and we’re prepared to deal with them with the assistance of Washington, D.C.”
The announcement about the discovery of the polio virus in New York City comes shortly after British health authorities reported finding evidence the virus has spread in London but found no cases in people. Children ages 1-9 in London were made eligible for booster doses of a polio vaccine Wednesday.
In New York, one person suffered paralysis weeks ago because of a polio infection in Rockland County, north of the city. Wastewater samples collected in June in both Rockland and adjacent Orange County were found to contain the virus.
CDC officials said the virus identified in wastewater samples collected in New York City did not contain enough genetic material to determine if they were linked to the Rockland County patient.
Most people infected with polio have no symptoms but can still give the virus to others for days or weeks. Vaccination offers strong protection, and authorities urged people who haven’t gotten the shots to seek one immediately.
Based on past outbreaks, it is possible that hundreds of people in the state have gotten polio and don’t know it, officials said.
Polio was once one of the nation’s most feared diseases, with annual outbreaks causing thousands of cases of paralysis. The disease mostly affects children.
Vaccines became available starting in 1955, and a national vaccination campaign cut the annual number of U.S. cases to less than 100 in the 1960s and fewer than 10 in the 1970s, according to the Centers for Disease Control and Prevention.
A small percentage of people who contract polio suffer paralysis. The disease is fatal for 5-10% of those paralyzed.
All schoolchildren in New York are required to have a polio vaccine, but Rockland and Orange counties are both known as centers of vaccine resistance.
According to the CDC’s most recent childhood vaccination data, about 93% of 2-year-olds had received at least three doses of polio vaccine. But the rate is only 80% in New York state, and is far lower in the area around where the polio case was reported — just 60% in Rockland County and 59% in Orange County, according to state data.
Breast Cancer Spreads More Aggressively at Night, Startling New Study Finds
When people with metastatic breast cancer close their eyes at night, their cancer awakes and starts to spread.
That’s the striking finding from a paper published in Nature this week that overturns the assumption that breast cancer metastasis happens at the same rate around the clock.
The result may change the way that doctors collect blood samples from people with cancer in the future, the researchers say.
“In our view, these findings may indicate the need for healthcare professionals to systematically record the time at which they perform biopsies,” says senior author Nicola Aceto, a professor of molecular oncology at ETH Zurich.
“It may help to make the data truly comparable.”
Researchers first stumbled across this topic when they noticed an unexplained difference in the number of circulating tumor cells in samples analyzed at different times of the day.
“Some of my colleagues work early in the morning or late in the evening; sometimes they’ll also analyze blood at unusual hours,” Aceto says.
Mice that seemed to have a much higher number of circulating cancer cells than humans provided another clue: Mice sleep during the day when blood samples are most often taken.
To investigate what was going on, the Swiss researchers studied 30 women with breast cancer (21 patients with early breast cancer that had not metastasized and nine patients with stage IV metastatic disease).
They found “a striking and unexpected pattern”: Most circulating tumor cells (78.3 percent) were found in blood samples that were taken at nighttime while a much lower amount was found in daytime samples.
When the researchers injected mice with breast cancer cells and took blood samples during the day, they found the same result. Circulating tumor cells were much higher when the mouse was at rest.
Interestingly, the cancer cells collected during the rest period were “highly prone to metastasize, whereas circulating tumor cells generated during the active phase are devoid of metastatic ability”, the researchers said.
Genetic analysis revealed that tumor cells taken from mice and humans at rest had upregulated their expression of mitotic genes. This makes them better at metastasizing as mitotic genes control cell division.
The researchers ran experiments where they gave some mice jet lag by changing the light-dark routine. Messing with the circadian rhythm led to a massive decrease in the concentration of circulating tumor cells in mice.
In another experiment, the researchers tested whether giving the mice hormones that were similar to those found in the body when mice are awake would affect the number of circulating tumor cells when the mouse was at rest.
They injected mice with testosterone, insulin (a hormone that makes it possible to turn sugar into energy), and dexamethasone (a synthetic chemical that acts like cortisol, the stress hormone).
The researchers found a “marked reduction” in the number of circulating tumor cells in a blood sample taken during the rest period (when the tumor would normally be most aggressive).
“Our research shows that the escape of circulating cancer cells from the original tumor is controlled by hormones such as melatonin, which determine our rhythms of day and night,” says Zoi Diamantopoulou, the study’s first author and a molecular oncology researcher at ETH Zurich.
This paper was published in Nature.
Monkeypox cases are being detected in Australia. It could have been circulating ‘under the radar’ across the world for years
The monkeypox virus, now diagnosed in hundreds of people in 26 countries, may have been quietly circulating for years before its sudden emergence worldwide, scientists have theorised.
Infectious disease experts and scientists at genetic labs are urgently looking for clues to explain why a virus that has been found in West Africa for half a century and typically doesn’t spread readily from person to person made such a dramatic and troubling appearance in the past month.
Learn more about monkeypox in the video player above
Watch the latest News on Channel 7 or stream for free on 7plus >>
“There may have been undetected transmission for a while,” said Rosamund Lewis, the World Health Organisation’s technical lead for monkeypox during a briefing last week.
“What we don’t know is how long that may have been. We don’t know if it’s weeks, months or possibly a couple of years.”
At the University of Leuven in Belgium, virology professor Marc Van Ranst said his laboratory’s sequencing revealed genetic mutations of the virus that were “limited” and “none of them are smoking guns”.
“Everybody is interested in more complete genomes to get an idea about quite an important question: How long have these viruses been circulation, under the radar?” Van Ranst said.
“I think nobody believes this jumped out of Africa a couple of weeks ago.”
University of Edinburgh scientists recently sequenced samples from the outbreak and posted their findings on May 30.
The samples they investigated descended from a version of monkeypox that was identified in Singapore, Israel, Nigeria and the United Kingdom between 2017 and 2019.
While the investigators did identify an “unexpectedly large number” of changes to the virus’s genetic code since that time, some experts do not believe such shifts necessarily explain the breadth of the current outbreak.
In Africa, most human cases of monkeypox have historically occurred through exposure to infected animals such as rodents and not through person-to-person transmission.
“What’s likely happened is an endemic infectious disease from Africa found its way into a social and sexual network and then was greatly aided by major amplification events like raves in Belgium to disseminate around the world,” Amesh Adalja, a senior scholar at the Johns Hopkins Centre for Health Security, said.
“Because it’s being transmitted through close contact in sexual encounters, many of the lesions are getting mistaken for other sexually transmitted infections, which may be delaying diagnosis.”
Increased vigilance by public health authorities, health care providers and individuals worldwide have dramatically improved detection in recent weeks.
Stealthy circulation
“Whenever you start looking for a disease that’s new in a population, you find many, many more cases,” David Heymann, a professor at the London School of Hygiene and Tropical Medicine who formerly led the WHO’s Program on Emerging and other Communicable Diseases, told NBC News.
Heymann supported the theory that the disease may have been present in some populations for several years outside the 11 Central and West Africa countries where the virus has become endemic.
Cases may be circulating stealthily among people outside the global gay community, he suggested.
“The concern is looking in only one population rather than looking more broadly,” he said.
New variants are poised to keep Covid-19 circulating at high levels throughout the summer
The next influx of infections will probably come from the newer Omicron subvariants BA.4 and BA.5, two closely related viruses that were first characterized in South Africa and that landed in the United States around late March, according to the gene sequence sharing site GISAID.
These variants are gaining ground against BA.2, particularly in the central part of the country. Recent research suggests that they escape immunity created by vaccines and past infections.
According to the most recent updates from the US Centers for Disease Control and Prevention and the genomics company Helix, BA.4 and BA.5 together accounted for an estimated 6% to 7% of new infections in the US in late May.
“It’s a serious threat,” Dr. David Ho, a professor of microbiology and immunology at Columbia University in New York City, wrote in an email. “Only a month ago, it was .02 percent.”
BA.4 has been detected in at least 30 countries, and BA.5 has been sampled in 32 countries, according to the website Outbreak.info, which is maintained by the Scripps Research Institute.
Ho and his co-authors recently tested antibodies from the blood of vaccinated and boosted people, as well as the antibodies of people who’d recovered from breakthrough Covid-19 infections, against engineered BA.4 and BA.5 viruses in the lab. In each case, they found a drop in potency against BA.4 and BA.5.
They found that that BA.4 and BA.5 viruses are more than four times as likely to escape antibodies in people who’ve been vaccinated and boosted compared with BA.2 viruses.
More breakthrough infections
All of this means BA.4 and BA.5 are more likely to lead to breakthrough infections, even in people who’ve had Covid-19 before.
Without upgraded vaccines or boosters, Ho expects that a lot of Americans will get sick in the coming weeks to months. “I think we will see lots of infections but not necessarily more severe disease or deaths,” he said.
Ho’s research is posted as a preprint, which means it has not been scrutinized by outside experts or published in a medical journal.
South Africa, which is ahead of the US in its BA.4/BA.5 cycle, has seen infections rise but has not seen a corresponding increase in deaths, said Shishi Luo, associate director of bioinformatics and infectious disease at Helix.
“So I think if we extrapolate from South Africa, what we’ll see in the US is that BA.4 and BA.5 will increase, because it has some competitive advantages compared to existing strains, but fingers crossed, it is not going to lead to more severe outcomes,” Luo said.
One question variant hunters have asked is whether BA.4 and BA.5 can outcompete BA.2.12.1, the highly contagious strain that’s currently the main cause of Covid-19 infections in the US.
These branches of the Omicron family tree rose to prominence about the same time; BA.2.12.1 quickly took over the US while BA.4 and BA.5 were establishing themselves in South Africa.
They share some similarities, including changes at location 452 of their genome, a genetic address known for helping variants escape our immunity.
Viruses square off
“It’s like boxing,” said Dr. Alex Greninger, assistant director of the University of Washington’s clinical virology laboratory. “It’s like the national champion from South Africa going against the national champion in the United States.
“You don’t know how to rank them if they haven’t ever fought,” he says.
But BA.4 and BA.5 have gone up against BA.2.12.1 in other parts of the world, like the UK. There, scientists found that the time it took the number of infections caused by a variant to double was about 5½ days for BA.2.12.1 and about a day less for BA.4 and BA.5, indicating that those viruses are spreading faster. The doubling times were included in a recent technical report from the UK Health Security Agency.
“The betting favorite now suggests that BA.4 and BA.5 would be able to take out BA.2.12.1,” Greninger said.
Ho and his team think they may have figured out what’s giving BA.4 and BA.5 an extra edge.
In addition to all the changes in other Omicron variants that help them shrug off our vaccines, these viruses pulled off a F486V mutation. That’s a big change that helps disguise them from our immune system. In the past, it came with a downside: It made the virus’ spike less likely to be able to bind to our cells, so they were less competitive. But BA.4 and BA.5 have an additional mutation, called R493Q, that restores their ability to bind to cells, restoring their ability to infect us.
Though BA.4 and BA.5 seem capable of overpowering BA.2.12.1, they haven’t squared off in the US, and the fitness of these strains depends a lot on the playing field. The variants aren’t following a rulebook.
But for the next few months, experts say, there’s just going to be a lot of Covid-19 around us.
“For the summer, going into the winter, I expect these viruses to be out there at relatively high levels,” Greninger said. “Just the number of cases, the sheer disruptions of the work force — It’s just a very high, high burden of disease.”
Study reveals deadly new tick-borne virus is circulating in Georgia – WSB-TV Channel 2
ATLANTA — A potentially deadly new virus is circulating among ticks in Georgia, according to scientists at Emory University.
The Heartland virus was first identified in Missouri in 2009 and made two people severely ill.
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A new study published Wednesday in the academic journal Emerging Infectious Diseases found the virus circulating among Georgia’s most common tick, known as the lone star tick.
More than 50 cases of the virus have been identified in 11 states in the Midwest and Southeast since 2019.
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According to the study, most cases of the virus were found in people who had pre-existing conditions and their illnesses were “predominately severe or fatal.”
The symptoms of Heartland virus are fever, weakness, headaches, muscle pain, loss of appetite, nausea, diarrhea, weight loss, joint pain, low white blood cell count and easy bruising due to a low platelet count.
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The study revealed that a retroactive analysis confirmed that the Heartland virus, which hadn’t been identified yet, killed a Baldwin County resident in 2005.
“We’re trying to get ahead of this virus by learning everything that we can about it before it potentially becomes a bigger problem,” the study’s senior author, Gonzalo Vazquez-Prokopec said.
The study focused on ticks in the central part of the state and was conducted from 2018 to 2019. The warm, humid climate and abundant foliage in the Southeast make the are a prime breeding ground for ticks.
“Ticks are everywhere in Georgia,” Vazquez-Prokopec said.
Vazquez-Prokopec said that the purpose of the research is not to alarm people but to raise awareness of ticks’ potential threat to human health.
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Researchers discover HIV variant that’s more contagious and more severe circulating in the Netherlands
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Researchers have identified a variant of HIV that progresses to AIDS twice as quickly as past versions.
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People infected with the VB variant also have higher viral loads, making them more likely to transmit to others.
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Existing antiretroviral treatments for HIV still work against the newfound variant.
A highly aggressive and contagious variant of the human immunodeficiency virus (HIV) has been silently spreading in the Netherlands for decades, and researchers have finally identified it.
Like the coronavirus, the virus that causes AIDS (acquired immunodeficiency syndrome) has mutated into a slew of variants — some more dangerous than others. The newfound variant, called VB, appears to progress about twice as quickly as closely related strains.
Individuals infected with the VB variant are likely to develop AIDS within two to three years after diagnosis if they don’t receive treatment, rather than the typical six- to seven-year progression, researchers wrote in the journal Science.
This striking example of viral evolution has implications for the COVID-19 pandemic, wrote Joel Wertheim, associate professor of medicine at the University of California, San Diego, in a perspective published alongside the findings on Thursday.
“We should never underestimate the potential for viral evolution,” Wertheim, who was not involved in the study, told NPR. “Let this study stand in stark contrast to the claim that all viruses will inevitably evolve to be benign.”
Doubly aggressive and extra contagious
All variants of HIV attack the immune system in a similar fashion. The virus latches onto CD4 cells (also known as T cells), a type of white blood cell that leads the charge against infection, and causes them to swell and burst.
Researchers found that the VB variant explodes those cells twice as quickly, leading to a swifter decline in immune function. Once the CD4 count dips below a certain level, that person is considered immunocompromised with AIDS and is therefore prone to life-threatening infections.
While working on the BEEHIVE project — an initiative to understand how HIV has and continues to evolve — researchers noticed that 17 individuals had especially high viral loads early in infection. Fifteen of those individuals were from the Netherlands, and the other two were from Switzerland and Belgium.
After studying another 92 people infected with the VB variant, researchers determined that the viral load tends to be three or four times higher than typical HIV infections. More virus in the body means the host is more contagious to others, lead author Chris Wymant told NPR.
Fortunately, the standard antiretroviral drugs used to treat HIV still work to stop the transmission and progression of the VB variant, he said. If taken consistently, the medication can lower the viral load to an undetectable level, so many people with HIV can live normal and healthy lives.
Read the original article on Business Insider