Month: August 2021

Categories : Hospitals Lab Tests and ImagingTags :

Joint Statement Says Prior Radiation Should not Affect Decisions to Image

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Previous radiation exposure should not be considered when assessing the clinical benefit of radiological exams, according to a statement by three scientific groups representing medical physicists, radiologists, and health physicists.

Medical radiation exposure is a hot topic. People receive average annual background radiation levels of around 3 mSv; exposure from a chest X-ray is about 0.1 mSv, and exposure from a whole-body CT scan is about 10 mSv. The annual radiation limit for nuclear workers is 20mSv.

The American Association of Physicists in Medicine, along with the American College of Radiology and the Health Physics Society, issued a joint statement opposing cumulative radiation dose limits for patient imaging, saying that there could be negative impacts on patient care. The statement opposes the position taken by several organisations and recently published papers.

“It is the position of the American Association of Physicists in Medicine (AAPM), the American College of Radiology (ACR), and the Health Physics Society (HPS) that the decision to perform a medical imaging exam should be based on clinical grounds, including the information available from prior imaging results, and not on the dose from prior imaging-related radiation exposures,” the statement reads.

“AAPM has long advised, as recommended by the International Commission on Radiological Protection (ICRP), that justification of potential patient benefit and subsequent optimization of medical imaging exposures are the most appropriate actions to take to protect patients from unnecessary medical exposures. This is consistent with the foundational principles of radiation protection in medicine, namely that patient radiation dose limits are inappropriate for medical imaging exposures.

“Therefore, the AAPM recommends against using dose values, including effective dose, from a patient’s prior imaging exams for the purposes of medical decision-making. Using quantities such as cumulative effective dose may, unintentionally or by institutional or regulatory policy, negatively impact medical decisions and patient care.

“This position statement applies to the use of metrics to longitudinally track a patient’s dose from medical radiation exposures and infer potential stochastic risk from them. It does not apply to the use of organ-specific doses for purposes of evaluating the onset of deterministic effects (e.g., absorbed dose to the eye lens or skin) or performing epidemiological research.”

The Radiological Society of North America also endorses the position.

The AAPM emphasises the importance of patient safety in their position. Radiation usage must be both justified and optimised and benefits should outweigh the risks.

“This statement is an important reminder that patients may receive substantial clinical benefit from imaging exams,” said James Dobbins, AAPM President. “While we want to see prudent use of radiation in medical imaging, and many of our scientific members are working on means of reducing overall patient radiation dose, we believe it is an important matter of patient safety and clinical care that decisions on the use of imaging exams be made solely on the presenting clinical need and not on prior radiation dose.

“AAPM is pleased to partner with our fellow societies—the American College of Radiology and the Health Physics Society—to bring a broadly shared perspective on the important issue of whether previous patient radiation exposure should play a role in future medical decision making.”

The AAPM cites the International Commission on Radiological Protection, which stresses that setting radiation exposure limits to patients is not appropriate. This is partly due to a lack of standardised dose estimates.

The position only addresses stochastic risks from radiation exposure, which are chance effects whose risk for a given imaging exam, like cancer,is unrelated to the amount of prior radiation. Deterministic effects, incremental, direct exposure responses, such as skin damage, result from different biological mechanisms and are not included.

The AAPM compiled a list of answers to frequently asked questions on the topic of medical radiation safety along with references to research papers which support the organisation’s position.

Source: News-Medical.Net

Categories : Diseases, Syndromes and ConditionsTags :

Red Blood Cell Abnormalities May Trigger Lupus

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Credit: CC0

A new study revealed that lupus may be triggered by a defective process in the development of red blood cells (RBCs) which leaves mitochondria remnants. The study was published in Cell.

The researchers found that in a number of lupus patients, maturing red blood cells fail to get rid of their mitochondria, which are normally excluded from red blood cells. This abnormal retention of mitochondria can trigger the cascade of immune hyperactivity characteristic of this disease.

“Our findings support that red blood cells can play a really important role in driving inflammation in a subgroup of lupus patients. So this adds a new piece to the lupus puzzle, and could now open the door to new possibilities for therapeutic interventions,” said the study’s senior author, Dr Virginia Pascual, the Drukier Director of the Gale and Ira Drukier Institute for Children’s Health and the Ronay Menschel Professor of Pediatrics at Weill Cornell Medicine

Lupus is a chronic disorder with no cure that features intermittent and sometimes debilitating attacks by the immune system on the body’s own healthy tissues, including skin, joints, hair follicles, heart and kidneys. A common underlying factor in lupus is the abnormally elevated production of immune-activating proteins called type I interferons. Treatments aim to suppress immune activity, including interferon-driven inflammation.

Previous research found defective mitochondria in the immune cells of lupus patients. In the current study, the researchers focussed on red blood cells, which should lack mitochondria. Many lupus patients had red blood cells with detectable levels of mitochondria, and more common in patients with worse symptoms. By contrast, healthy controls had no mitochondria-containing red blood cells.

Lead author of the study, Dr. Simone Caielli, assistant professor of immunology research at the Drukier Institute and the Department of Pediatrics at Weill Cornell Medicine, then studied how human red blood cells normally get rid of mitochondria as they mature, as prior studies had mainly examined this in mice, and why this process could be defective in lupus patients.

Subsequent experiments showed these abnormal red blood cells cause inflammation. Normally, when red blood cells age or display signs of damage they are removed by macrophages, with binding antibodies helping removal. When the macrophages ingest them, the mitochondrial DNA in the red blood cells triggers a powerful inflammatory pathway called the cGAS/STING pathway, in turn driving type I interferon production. These findings show that “those lupus patients with mitochondria-containing red blood cells and evidence of circulating anti-RBC antibodies had higher interferon signatures compared to those who didn’t,” Dr Caielli said.

The researchers are now investigating how the mitochondria is retained in these cells. Identifying lupus patients with these cells could help predict when they are likely to undergo lupus flares and to develop therapies.

Source: Weill Cornell Medicine

Categories : COVIDTags :

Are There Different Symptoms for the Delta Variant?

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Photo by Brittany Colette on Unsplash

MedPage Today investigates whether, according to some reports, there is in fact a difference in Delta symptoms compared to earlier variants.

Though hard data are lacking, ZOE study leader Tim Spector, MB, MSc, MD, of King’s College London, said his app’s data suggests the disease is “acting different now. It’s more like a bad cold in this younger population.”

Headache, followed by sore throat, runny nose, and fever were now the most common reported symptoms.

“All those are not the old classic symptoms,” Dr Spector said, adding that cough dropped to fifth place, and “we don’t even see loss of smell coming into the top 10 anymore. This variant seems to be working slightly differently.”

Dr Spector’s data however is only preliminary and comes from self-reports, and has not even been peer reviewed or published. However, other experts also have noticed a change in reported COVID symptoms.

One of those who has heard reports but is cautious about their interpretation is David Kimberlin, MD, a paediatric infectious diseases expert at the University of Alabama at Birmingham.

“I don’t think with what we know right now that we can conclude [Delta] is much different in terms of symptoms,” Dr Kimberlin told MedPage Today. “There have been some reports that it causes more cold-like illness, but so did the original COVID. I think we’ll know more over the next couple of months as we have the opportunity to realise the data.”

Purvi Parikh, MD, of NYU Langone in New York City and a spokesperson for the American College of Allergy, Asthma & Immunology, has also heard of COVID being mistaken for allergies, but allergies do not come with high fever, nausea, vomiting, or diarrhoea.

Other symptoms unlikely in allergy include myalgia and chills, said Alan Goldsobel, MD, of Allergy & Asthma Associates of Northern California, who is also a professor at Stanford University. Allergy indicators include the time of year (for those with seasonal allergy), as well as itching, he added.

Distinguishing COVID from common cold symptoms could be harder, Drs Parikh and Goldsobel noted.

“If you aren’t sure, I do recommend COVID testing,” Dr Parikh said.

Source: MedPage Today

Categories : COVIDTags :

Attaining Herd Immunity for COVID Now Unlikely

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In an article published in the South African Medical Journal, Shabir Madhi, Professor of Vaccinology at Wits, argues that COVID variants have made the initial goal of attaining herd immunity no longer feasible, even for well-resourced countries. However, vaccine protection against severe COVID seems a more realistic path to normalcy.

In low and middle income countries (LMICs), the official COVID case estimates are likely grossly underestimated, Prof Madhi writes, due to a lack of testing coverage. Even in South Africa, the true number of COVID cases is likely in the region of 10 times the 2.39 million recorded through testing. The true number of COVID-related deaths in India is also estimated as 3.4–3.9 million, again 10 times the official count, and in South Africa it is likely three times the official  figure of 70 388 in July 2021.

While New Zealand researchers have suggested that COVID eradication is feasible, it is likely a very long term goal if at all attainable. The herd immunity goal can be considered with the equation (p1 = 1 – 1/R0), where p1 is the proportion of immune individuals who will also no longer transmit the virus, and R0 is the reproduction rate, ie the number of susceptible individuals a single infected person can further infect. However, this ignores key aspects of the virus.

The problem is that the proportion of people that would need to be immunised to achieve herd immunity was initially calculated at 67%, based on an assumed R0 of 3, derived from the Wuhan strain’s R0 of 2.5 to 4. However, the Delta variant has an R0 of 6, meaning that to reach herd immunity, 84% of the population would need to be vaccinated. In South Africa, this would be 100% of the population aged over 12.

The emergence of SARS-CoV-2 variants, especially the Beta variant with the E484K mutation, showed that existing vaccine protection, including the Pfizer variant, can be degraded to an extent.

Studies have strongly suggested that neutralising and antibody titers are associated with mild to moderate COVID protection, while protection from severe COVID may be mediated by T-cell immunity.

Real world data showed that in Israel, with a world best immunisation of 61.6% using the Pfizer vaccine which produces the greatest antibody response, herd immunity appeared to be successful until an outbreak of the more transmissible Delta variant combined with waning vaccine effectiveness. 

However, in the UK, excess death data showed that, even with a resurgence of cases caused by the Delta variant, there was a significant decoupling of deaths from cases. This points to the effectiveness of vaccines in preventing severe illness, as opposed to reaching herd immunity.

Vaccine rollouts have therefore not interrupted COVID transmission. Prof Madhi concludes that, based on an estimated R0 of 6 for the Delta variant, “it is unlikely that any country could have a sustainable strategy for durable high level of protection against infection by the delta variant. Mutations of the SARS-CoV-2 genome are likely to continue resulting in enhanced transmissibility, infectiousness and resistance to neutralising activity.”

He observes that the “UK approach seemingly concedes that the goal of herd immunity, even in a highly resourced setting, is unattainable.”

He adds that aspiring to reach herd immunity by wealthy countries comes at the cost of exacerbating vaccine inequality, which he says “is immoral.”
Antibody dynamics modelling suggests that a booster would be required every 2–3 years to protect against severe COVID, and every 6–9 months to protect against moderate disease. This is a challenging goal, and likely unattainable for most LMICs, especially given the slow rate of vaccination in those settings.

Source: South African Medical Journal

Categories : Medical Industry Mental HealthTags :

Mistreatment at Med School Leads to Later Exhaustion, Regret

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Medical students who experienced mistreatment during medical school were more likely to become exhausted or disengaged, have less empathy, and have career regret, a new study has revealed.

Among a large national sample of trainees, the 22.9% of respondents who reported mistreatment on the Association of American Medical Colleges’ Medical School Year 2 Questionnaire (Y2Q) had higher exhaustion and disengagement scores on the Graduation Questionnaire (GQ) 2 years later, reported Liselotte Dyrbye, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues writing in JAMA Network Open.

Furthermore, of those who had experienced mistreatment, 18.8% reported career regret on the GQ.

Conversely, medical students who experienced a better environment more likely to:

Have lower exhaustion scores: for each 1-point increase on the Y2Q, there was a 0.05 reduction in exhaustion score
Report lower disengagement scores on the GQ: for each 1-point increase on the Y2Q, there was a 0.04 reduction in disengagement score
Further, reports of having positive interactions with faculty on the Y2Q were associated with higher empathy scores on the GQ. For each 1-point increase, there was a rise of 0.02 in empathy score. Positive student-to-student interactions were linked to having lower odds of career regret during the last year of medical school.

“The potential protective effect of positive experiences within the learning environment may provide insight into strengths that organizations can amplify to mitigate burnout, decline in empathy, and career choice regret among their students,” wrote Dyrbye and colleagues.

The team noted the opportunity for potential interventions. “Although the most effective approaches to addressing mistreatment of learners remain elusive, the frequency of mistreatment varies between educational programs, suggesting there are likely to be levers within the control of the organisation that adequate commitment, leadership, infrastructure, resources, and accountability can lead to a meaningful reduction in mistreatment.”

Average age of the respondents was 28 years, 52% were women, 72.8% were single, and 91% reported having no dependents. The study also found that older medical students reported higher disengagement scores, and that women reported lower exhaustion (by 0.27 points) and disengagement (by 0.47 points) scores on the GQ.

However, women and older medical students had higher empathy scores compared with their male peers (0.74 points and 0.05 points, respectively).

The researchers observed that conflicting findings on burnout among women in medicine have been reported. For example, a longitudinal cohort study of resident physicians across specialties in the US found that female residents were “more likely to develop burnout and have worsening in the severity of their emotional exhaustion between the second and third year of training compared with male residents, even after controlling for various forms of mistreatment.”

Limitations of their own study, the researchers noted, included unestablished differences between the exhaustion, disengagement, and empathy scale measures that were used in the questionnaires; and the varying response rates between questionnaires: 55.5% for the Y2Q and 81.5% for the GQ.

Source: MedPage Today

Categories : COVID UncategorizedTags :

COVID Eradication is Tough but not Impossible, Study Shows

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Image by Ivan Diaz on Unsplash
Image by Ivan Diaz on Unsplash

A new analysis shows that the global eradication of COVID is tough but theoretically more feasible than for polio and less so than it was for smallpox.

The article in BMJ Global Health ranked the feasibility of eradicating the three diseases based on technical, socio-political and economic factors.

Smallpox, which was declared eradicated in 1980, had the highest average score for eradication feasibility. It had an average score of 2.7 on a three-point scale across 17 variables.  COVID had an average score of 1.6 which was close to polio’s average score of 1.5.

Professor Nick Wilson from the University of Otago said that their analysis shows COVID’s eradication is feasible.

Vaccination programmes, public health measures and the global interest in combating the disease together contribute to making eradication possible.

“Elimination of COVID-19 at the country level has been achieved and sustained for long periods in various parts of the Asia Pacific region, which suggests that global eradication is possible.”

Vaccination programmes eradicated smallpox and two of the three serotypes of poliovirus, while other diseases are close to eradication. China recently became the 40th country to be certified malaria-free.

In ranking the feasibility of eradication for the three diseases, the researchers incorporated factors including the availability of safe and effective vaccines, the possibility of lifelong immunity, the impact of public health measures, effective infection control messaging by governments, political and public concern about the infection and public acceptance of infection control measures.

While there has been a focus on the need to reach herd immunity to overcome COVID, population immunity may not be essential to combat the disease, as smallpox was eradicated through ring-vaccination programmes which target the contacts of those infected.

The challenges of eradicating COVID relative to smallpox and polio include poor vaccine acceptance in some countries and the emergence of variants of the pandemic virus that may be more transmissible or able to evade the protection from vaccines.

But Professor Wilson said eventually the virus will be reach the limit of more infectious mutations, and so new vaccines will likely be formulated to deal with evolving strains of the disease.

Other obstacles includedthe cost of global vaccination and upgrading health systems, and achieving international cooperation in the face of aggressive anti-science movements and vaccine nationalism.

Professor Wilson says while the virus may infect animal populations, they will note likely hamper eradication.

“Wild animal infections with SARS-CoV-2 appear to be fairly rare to date and when companion animals become infected, they don’t appear to reinfect humans.”

A co-author of the article, Professor Michael Baker from the University’s Department of Public Health, says global concern about the pandemic could be tapped.

“The massive scale of the health, social and economic impacts of COVID-19 in most of the world has generated unprecedented global interest in disease control and massive investment in vaccination programmes.

“Unlike smallpox and polio, control of COVID-19 also benefits from the added impact of public health measures, such as border controls, social distancing, contact tracing and mask wearing, which can be very effective if well deployed.”

Professor Baker says upgrading health systems to target COVID-19 could also help to control other diseases, and could even aid in eradicating measles.

“When all factors are taken into account, it could be that the benefits of eradicating COVID-19 outweigh the costs, even if eradication takes many years and has a significant risk of failure.”

This work is preliminary, the researchers cautioned.

“The World Health Organization or a coalition of national agencies working collaboratively needs to formally review the feasibility and desirability of attempting COVID-19 eradication on a global basis,” Professor Baker says.

The researchers noted it is important to distinguish between eradication of infection, ie the permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts; and elimination, ie the reduction to zero of the incidence of infection caused by a specific agent in a defined geographical area as a result of deliberate efforts.

COVID elimination has been reached and sustained for long periods in a number of jurisdictions in the Asia-Pacific region (notably China, Hong Kong, Taiwan, Australia and New Zealand), demonstrating that global eradication is technically possible.

Source: EurekAlert!

Categories : COVIDTags :

Single COVID Vaccine Dose Enough For Previously Infected

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Infected cell covered with SARS-CoV-2 viruses. Source: NIAID

In a small study, people with previous COVID infection were observed to have higher antibody levels after a single dose of Pfizer vaccine compared with uninfected people after two doses.

Furthermore, there was no increase in IgG levels after the second dose among those previously infected, possibly indicating that one dose of vaccine may be sufficient for this population, reported James Moy, MD, of Rush University Medical Center in Chicago, and colleagues  in a JAMA Network Open research letter.

“This study highlights the potential for recommending a single dose for previously infected individuals and may be useful for discussions surrounding vaccination strategy,” the authors wrote.

Whether to offer only a single dose of vaccine to those previously infected with COVID is a hot topic, with some experts conceding that previously infected individuals likely only need one dose, but would be challenging to implement.

Indeed, Dr Moy’s group urged performing “baseline serological testing” for previously infected individuals, but CDC and the agency’s Advisory Committee on Immunization Practices (ACIP) argued that this would be next to impossible to do for the entire country.

At a meeting in March, ACIP Chair José Romero, MD, voiced concern that the one-dose strategy would only work if individuals had sufficiently high antibody titers. If people had no or low antibodies, they may not have “enough memory B-cells to boost to levels that will be protective,” he said.

The researchers recruited adult participants at the team’s academic medical center, sorting them according toinfection status. Prior infection was established by a positive RT-PCR test and/or a positive SARS-CoV-2 antibody result. Overall, 30 participants had no evidence of infection, while 29 did.

The authors measured SARS-CoV-2 spike IgG levels at baseline and then after the first and second doses of the Pfizer vaccine among all participants.

There were no significant IgG differences between the first and second dose in previously infected individuals. Interestingly, four participants reported a previous positive COVID test via RT-PCR, but had no evidence of antibodies.

“Vaccine responses in these four participants resembled infection-naive individuals,” Moy’s group noted, adding that because this group did not develop S-protein antibodies, baseline testing should be required before forgoing a second dose.

The researchers said study limitations included the small sample size and lack of diversity of participants, as well as lack of neutralisation studies and T-cell response studies.

Source: MedPage Today

Categories : Medical Research & TechnologyTags :

Doctor’s Presence During BP Measurement Triggers Flight-or-fight Response

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Photo by Thirdman from Pexels
Photo by Thirdman from Pexels

A small study has shown that a doctor’s presence during a blood pressure measurement skews the results, according to researchers who studied the effect by measuring nerve activity.

The phenomenon known as ‘white coat hypertension‘ is where the mere presence of a medical professional can raise blood pressure. Known about for decades, it occurs in about a third of patients.

In a small study published in the journal Hypertension, researchers probed the effect by measuring blood pressure, heart rate and nerve traffic in the skin and muscles with and without a doctor present.

The researchers found a “drastic reduction” in the body’s alarm response when a doctor was not present, said co-lead author Dr Guido Grassi, professor of internal medicine at the University of Milano-Bicocca.

Blood pressure and heart rate increases in response to a perceived threat, said Dr Meena Madhur, associate professor of medicine in the divisions of clinical pharmacology and cardiology at Vanderbilt University.

“If you’re out in the wild and a bear was charging after you, you’d want your blood vessels in your skin, for example, to constrict and the blood vessels in your muscles to dilate to provide more blood flow to those organs so that you can run really fast,” said Prof Madhur, who was not involved in the new research.

The study included 18 people, 14 of them men, with untreated mild to moderate hypertension. Each participant was examined in a lab, where an electrode measured nerve activity in the skin and muscles. Readings were taken twice in the presence of a doctor and twice without.

Both blood pressure and heart rate rose when the doctor was present, with nerve traffic patterns to the skin and skeletal muscle suggesting a classic fight or flight reaction.

Without the doctor’s presence, cardiovascular and neural responses were “strikingly different,” the researchers wrote. Fight or flight response indications were “entirely absent”.

Peak systolic blood pressure was an average of 14 points lower when the participant was alone than when a doctor was present, and peak heart rate was lowered by nearly 11 beats per minute.

This was the first study to actually measure sympathetic nervous system responses to doctors supervising a blood pressure measurement, the researchers wrote.

The study’s findings illustrated the complexity of blood pressure measurement and how it is affected by involuntary nervous system reactions, Grassi said. “Measurements without the doctor’s presence may better reflect true blood pressure values.”

White coat hypertension is not a new concept, Prof Madhur said, “this just drives home the fact that we should be more conscious of how the blood pressure is taken in the clinic.”

Last year, the American Medical Association and AHA issued a joint report endorsing more blood pressure measurement at home.

Limitations included the small study size due to the complexity of the measurements, the researchers said. Subsequent research would need to examine blood pressure medication as they could affect the fight or flight response, said Orof Madhur.

The work needs to be repeated with more women to examine possible sex differences. And she’d be interested in seeing whether people have the same response to nurses and other medical professionals as they did to doctors in this study.

Previous work shows that when nurses take blood pressure measurements, the white coat effect is reduced.

This latest research emphasises the need for people to handle blood pressure measurements with care, Prof Madhur said.

“I always tell my patients that we really can’t rely on a single office blood pressure measurement, because that’s just a random point in time,” she said.

Prof Madhur said that to take an accurate reading at home, a patient should sit still, with their back straight and supported and feet on the floor, waiting at least a few minutes before recording blood pressure. They should take multiple readings at the same time of day over the course of a week, and bring that log to their doctor’s appointment. Those at-home readings should be the ones used for planning treatment, she said.

“But,” Prof Madhur added, “if we are going to do an office blood pressure reading, it should be taken with the doctor not in the room.”

Source: American Heart Association

Categories : Metabolic DisordersTags :

A Specific Type of Fat Cell Responds to Insulin

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Source: Pixabay

While it was known that fat cells can influence insulin sensitivity, researchers have recently discovered that there are three different subtypes of mature fat cells in white adipose tissue and that it is only one of these, called AdipoPLIN, that responds to insulin. The findings, which were published in Cell Metabolism, may have implications for the treatment of metabolic diseases such as Type 2 diabetes. 

“These findings increase our knowledge about the function of fat tissue,” said co-corresponding author Niklas Mejhert, researcher at the Department of Medicine, Huddinge, at Karolinska Institutet. “They show that the overall capacity of fat tissue to respond to insulin is determined by the proportion and function of a specific fat cell subtype. This could have implications for diseases such as obesity, insulin resistance and Type 2 diabetes.”

The researchers identified 18 classes of cells that form clusters in white adipose tissue in humans. Of these, three constituted mature fat cells with distinct phenotypes.

To determine if a specific function was linked to the fat cell subtypes, the researchers measured how these subtypes in four people reacted to short-term increases in insulin levels. They found that insulin activated the gene expression in the AdipoPLIN subtype but did not affect the other two subtypes. The response to insulin stimulation was also proportional to the individual’s whole-body insulin sensitivity.

A challenge to the prevailing view
“Our findings challenge the current view of insulin resistance as a generally reduced response to insulin in the fat cells,” said co-corresponding author Mikael Rydén, professor in the same department. “Instead, our study suggests that insulin resistance, and possibly type 2 diabetes, could be due to changes in a specific subtype of fat cells. This shows that fat tissue is a much more complex tissue than previously thought. Like muscle tissue, people have several types of fat cells with different functions, which opens up for future interventions targeted at different fat cell types.”

The researchers employed spatial transcriptomics, which generates information about tissue organisation via microscopy and gene expression via RNA sequencing.

”This study is unique in that it is the first time we’ve applied spatial transcriptomics to fat tissue, which has a special set of characteristics and composition,” said third corresponding author Patrik Ståhl. “We are very happy that the technology continues to contribute to solving biologically complex questions in an increasing number of research areas.”

Source: Karolinska Institute

Categories : Diseases, Syndromes and ConditionsTags : 1 Comment

Marburg Virus Detected in Guinea

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Colourised scanning electron micrograph of Marburg virus particles (blue) both budding and attached to the surface of infected VERO E6 cells (orange). Credit: NIAID

Guinea’s health authority announced the first detection of the Marburg virus in the country, which is also the first case in West Africa.

Marburg, a haemorrhagic fever-causing virus related to Ebola, killed more than 200 people in Angola in 2005, the deadliest recorded outbreak. Laboratory tests of samples taken from a now-deceased patient turned out positive for the Marburg virus.

The patient had sought treatment at a local clinic in the southern prefecture of Gueckedou, and a medical team had been sent to investigate the case.  Cases of the 2021 Ebola outbreak in Guinea occurred in Gueckedou, as well as the 2014–2016 West Africa outbreak were initially detected.

“We applaud the alertness and the quick investigative action by Guinea’s health workers. The potential for the Marburg virus to spread far and wide means we need to stop it in its tracks,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “We are working with the health authorities to implement a swift response that builds on Guinea’s past experience and expertise in managing Ebola, which is transmitted in a similar way.”

Contact tracing efforts are underway, and health authorities are launching education and awareness programmes on the disease. 

Four high-risk contacts, including a healthcare worker, have been identified, as well as 146 others who could be at risk, according to expert Dr Krutika Kuppalli, who spoke to the BBC. A team of WHO experts is on the ground helping to investigate the case and aiding the national health authority’s emergency response.

Cross-border surveillance is also being enhanced to quickly detect any cases, with neighbouring countries on alert. The Ebola control systems in place in Guinea and in neighbouring countries are proving crucial to the emergency response to the Marburg virus.

Marburg is transmitted to people from fruit bats and spreads among humans through direct contact of body fluids.

Illness begins abruptly, with high fever, severe headache and malaise. Within seven days, severe haemorrhagic signs appear in many patients. Case fatality rates are high, ranging from 24% to 88% in past outbreaks depending on virus strain and case management.

With no direct treatments for the virus, supportive care, including rehydration with oral or intravenous fluids, and treatment of specific symptoms, improves survival. There are evaluations underway for potential treatments, including blood products, immune therapies and drug therapies.

One experimental antiviral compound being tested works by preventing viral particles from ‘budding off’ of infected cells.

Source: WHO