A new study has revealed that the presence of Clostridium difficile is widespread in non-healthcare settings around the world. This research from the University of Houston was present at Infectious Disease Society of America IDWeek.
Clostridium difficile, or C diff, is a gram-positive bacterium that causes inflammation of the colon and is the most implicated in antibiotic-associated diarrhoea. The organism is commonly found in water, air, human and animal faeces, hospital surfaces, and soil. Responsible for for almost half a million infections and 15 000 deaths in the US each year, the presence of C diff in community settings has been mostly overlooked. Over 2014 to 2017, researchers gathered samples from public areas, health care settings, and shoe soles in the US and 11 other countries. They compared the rates of C diff positivity between settings, including shoe soles, which were investigated for their potential role in environmental transmission.
In samples taken from around the world, 26% of environmental samples from health care and non-health care sites tested positive for C diff strains. Shoe soles had the highest positivity rates, with 45% of samples testing positive for the bacteria.
“C diff infection was known historically as a hospital-associated infection, and efforts to reduce the infection and control its spread have been focused on hospitals and long-term care facilities,” said presenting author Jinhee Jo, a postdoctoral infectious disease fellow at the University of Houston. “Recently, cases of community-acquired C diff have been increasing, which suggests the need for broader community stewardship.”
“The results of this study shift our understanding of C diff, including where it is found, how it is transmitted, and who it affects,” said Kevin W. Garey, professor of pharmacy practice at the UH College of Pharmacy. “We can no longer think of C diff as only existing in health care settings, and the population at risk is no longer just the very sick patient in the hospital. Identifying that person at risk anywhere in the world should become a priority regardless of whether the person is in a hospital or the community.”
A recent study showed that people with substance use disorders (SUDs) face higher risks for developing COVID and for experiencing serious problems associated with the infection. The study, published in World Psychiatry, examined these risks in fully vaccinated individuals with SUDs.
The study included 579 372 people in the US, of whom 30 183 had a diagnosis of SUD and 549 189 without such a diagnosis) who were fully vaccinated between December 2020 and August 2021 and had not contracted COVID before their vaccinations.
The risk for breakthrough COVID infection in vaccinated people with SUDs ranged from 6.8% for tobacco use disorder to 7.8% for cannabis use disorder, all significantly higher than the 3.6% in the vaccinated non-SUD population. After controlling for demographics (age, gender, ethnicity) and vaccine types (Pfizer, Moderna, Johnson & Johnson), patients with SUDs – with the exception of those with tobacco use disorder – still had higher risks for breakthrough COVID-19 compared with matched individuals without SUDs, with the highest risks for those with cocaine use disorder and cannabis use disorder.
The higher risk for people with SUDs was found to be largely due to their higher prevalence of comorbidities and adverse socioeconomic determinants of health (such as problems related to education, employment, and housing). However, those with cannabis use disorder, who were younger and had less comorbidities, still had a higher risk for breakthrough infection even matching for these. This could indicate that other variables, such as behavioural factors or adverse effects of cannabis on pulmonary and immune function, could explain some of their higher risk for breakthrough infection.
“In our study, the overall risk of COVID infection among vaccinated SUD patients was low, highlighting the effectiveness and the need for full vaccination in this population,” the authors wrote. “However, our findings document that this group remains a vulnerable one even after vaccination, confirming the importance for vaccinated patients with SUD to continue to take protective preventive measures against the infection.”
While massage has been used to treat muscle pain and injury for thousands of years, it is only now that a study has scientifically confirmed that it improves recovery and strength gains. Intriguingly, the mechanism behind this is mechanically clearing out of immune cells from the injury site after they have done their job.
Using a custom-designed robotic system massage system for mice, the team found that this mechanical loading (ML) rapidly clears immune cells called neutrophils out of severely injured muscle tissue. This process also removed inflammatory cytokines released by neutrophils from the muscles, enhancing the process of muscle fiber regeneration. The research is published in Science Translational Medicine.
“Lots of people have been trying to study the beneficial effects of massage and other mechanotherapies on the body, but up to this point it hadn’t been done in a systematic, reproducible way. Our work shows a very clear connection between mechanical stimulation and immune function. This has promise for regenerating a wide variety of tissues including bone, tendon, hair, and skin, and can also be used in patients with diseases that prevent the use of drug-based interventions,” said first author Bo Ri Seo, PhD.
Dr Seo and her colleagues previously found in mouse studies that mechanical massage of injured muscles doubled the rate of muscle regeneration and reduced tissue scarring over the course of two weeks. With a new device inspired by soft robotics, the researchers sought to confirm these results. They found that the greater the force applied, the stronger the injured muscles became.
In vitro experiments suggested that neutrophil-secreted factors stimulate the growth of muscle cells, but the prolonged presence of those factors impairs the production of new muscle fibres. In vivo testing showed that stronger muscle fibre types predominated in treated, injured muscle types. Depleting neutrophils in mice after the third day resulted in greater strength recovery, indicating that they are important in the initial recovery period but removing them from the injury site early leads to improved muscle regeneration.
“The idea that mechanics influence cell and tissue function was ridiculed until the last few decades, and while scientists have made great strides in establishing acceptance of this fact, we still know very little about how that process actually works at the organ level. This research has revealed a previously unknown type of interplay between mechanobiology and immunology that is critical for muscle tissue healing, in addition to describing a new form of mechanotherapy that potentially could be as potent as chemical or gene therapies, but much simpler and less invasive,” said Don Ingber, MD, PhD, founding director of the Wyss Institute for Biologically Inspired Engineering at Harvard.
On Thursday, the UK government announced that South Africa has come of the COVID red list, which has been cut from 54 to just seven.
Brazil and Mexico also come off the red list, which requires travellers to quarantine in an approved hotelat their cost for 10 full days – at a cost of £2285 for one person. The seven countries remaining on the red list are Panama, Colombia, Venezuela, Peru, Ecuador, Haiti and the Dominican Republic. Vaccinated travellers from South Africa will be treated the same as returning fully-vaccinated UK residents so long as they have not visited a red-list country in the 10 days before arriving in England. All incoming travellers will still complete a passenger locator form.
UK Transport Secretary Grant Shapps said the changes begin on Monday and “mark the next step” in opening travel.
The UK’s travel rues have recently been simplified, with the amber list removed entirely, and advice against holidays changed for 32 countries. Arrivals from 37 more destinations will have their vaccination status certificates recognised, meaning they can avoid more expensive post-arrival testing requirements.
Speaking to the BBC, British expats Matt and Hannah Pirnie, who have lived in South Africa for a decade, said the separation has been difficult.
“It’s been a long pandemic for us. Not seeing family, not being allowed to go back, but more importantly grandparents not being able to come here and see their grandkids. It’s been a long two years,” Matt said.
“First of all when all the aeroplanes stopped initially – that was quite anxiety provoking – and then to be put on the red list for so long has just been quite hard to wrap your head around why,” Hannah adds.
Announcing the latest changes, Mr Shapps said the government was “making it easier for families and loved ones to reunite”. He said that with fewer restrictions “and more people travelling, we can all continue to move safely forward together along our pathway to recovery”.
In addition to the much-abbreviated red list, the government said passengers would soon be able to use a photograph of a lateral flow test as a minimum requirement to verify a negative result, and the more expensive ‘day two’ PCR test was to be replaced with a lateral flow test.
Bhekisisawrites that although there are a great number of people who are hesitant but not completely unwilling to take vaccines, there are a number of proven methods to help convince them to get their vaccinations. They offer six helpful tips to improve communication.
Early on during COVID vaccine trials, surveys showed that more than two thirds of adults globally said they would be willing to get on board when a vaccine became available. This was promising, but willingness to get vaccinated doesn’t necessarily translate into actual uptake.
In South Africa at least one poll showed similar results, yet so far just over 32% have actually followed through with getting at least one vaccine dose. There is some good news, though, as there is evidence showing that many people simply need the right approach.
Here are six things to take into account when encouraging hesitant people to get vaccinated.
1. Know the audience To persuade people to get vaccinated, messages have to be tailored for the intended audience. For example, UK study showed that people seeking to be vaccinated may be receptive to messages public health benefits of vaccination, while those who are vaccine hesitant appear to be more interested about benefits for themselves.
2. Get the word out ASAP A study in Nature found that the right timing of vaccine messages can increase appointments and subsequent vaccinations. Participants in the US received a text message inviting them to make a vaccination appointment either one day after becoming eligible or eight days after. The earlier text got 1.5 times as many people to make appointments than the later one.
In addition, making the booking also increased uptake, as almost 90% of participants who made a booking after receiving the text kept their appointments – and nearly everyone receiving their first dose got the second.
3. Allay people’s fears The speed of the COVID vaccine rollout led some to question its safety. Studies from around the world show that fears about ingredients, safety and what many perceive as rushed approval processes deter people from getting vaccinated. This can be compounded by a lack of transparency around vaccine trials and ‘big pharma’ procurement deals can compound doubt and hesitancy.
Though vaccines have abundant evidence on their safety and efficacy, acknowledging that people’s fears are valid is important, as is showing empathy to make hesitant people more open to balanced, evidenced-based messages. At the same time, it is best to be honest about minor side effects, and contextualise how rare the severe side effects are.
The media scare over blood clots in the J&J and AstraZeneca vaccine generated the impression that they were far more frequent than they truly were: which were only one in a million for J&J and 4 to 6 million for AstraZeneca.
4. Name-dropping Socially influential people can greatly increase vaccine uptake when they encourage others to do so and get one themselves. In 1956, during low uptake of the polio vaccine, Elvis Presley was shown getting his polio shot on TV. This spurred US teenagers to recruit their friends, resulting in a surge of vaccinations. Studies show that even encouragement within peer groups can motivate members to get vaccinated.
5. Ignore holdouts and focus on fence-sitters A small percentage of people will not take the vaccine under any circumstances, and research shows that it’s virtually impossible to change their minds. About one in eight people are holdouts, while in South Africa the rate is roughly one in 15. While those who are merely hesitant may be persuaded over time, changing the minds of stubbornly resistant individuals is simply a waste of time and money.
6. Understand people’s realities Historically, vaccination campaigns focused on busting myths and providing evidence-based information about vaccine safety and benefits. Yet opposition to COVID-19 vaccines (and also non-pharmaceutical interventions such as wearing masks and social distancing) seems more strongly rooted in people’s lack of institutional trust, and even a mistrust of government in general when faced with a large-scale epidemic.
There is also a distrust of vaccine arising from historical injustice, such as racism and government experimentation on unknowing individuals. A more recent example is American intelligence services using a vaccination in Pakistan to track down Osama bin Laden, which became something the Taliban used to discredit subsequent vaccination drives.
The World Health Organization (WHO) is recommending widespread use of a new malaria vaccine among children in sub-Saharan Africa and in other regions with moderate to high P. falciparum malaria transmission. The vaccine, known as the RTS,S/AS01 (RTS,S or Mosquirix), has been trialled in three countries in a pilot programme involving 800 000 children.
Though the vaccine only offers moderate protection against malaria, with 36% protection against malaria cases among children. One study estimated that even with realistic vaccine coverage, at a constraint of 30 million doses, 5.3 million cases and 24 000 deaths could be prevented among children under five, .
“This is a historic moment. The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Using this vaccine on top of existing tools to prevent malaria could save tens of thousands of young lives each year.”
This comes amid stagnation in progress in recent years against the deadly disease. In sub-Saharan Africa, malaria remains a primary cause of childhood illness and death. More than 260 000 African children under the age of five die from malaria annually.
“For centuries, malaria has stalked sub-Saharan Africa, causing immense personal suffering,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “We have long hoped for an effective malaria vaccine and now for the first time ever, we have such a vaccine recommended for widespread use. Today’s recommendation offers a glimmer of hope for the continent which shoulders the heaviest burden of the disease and we expect many more African children to be protected from malaria and grow into healthy adults.”
The WHO recommends that in the context of comprehensive malaria control the RTS,S malaria vaccine be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by the WHO. This vaccine should be provided in a schedule of 4 doses in children from 5 months of age for the reduction of malaria disease and burden.
The outcome of the pilots informed the recommendation based on data and insights generated from two years of vaccination in child health clinics in Ghana, Kenya and Malawi. Findings include:
Vaccine introduction is feasible, improves health and saves lives, with good and equitable coverage of RTS,S seen through routine immunization systems. This occurred even in the context of the COVID pandemic.
RTS,S enhances equity in access to malaria prevention.
Data from the pilot programme showed that more than two-thirds of children in the 3 countries who are not sleeping under a bednet are benefitting from the RTS,S vaccine.
Layering of tools results in over 90% of children benefitting from at least one preventive intervention (insecticide treated bednets or the malaria vaccine).
Strong safety profile: To date, more than 2.3 million doses of the vaccine have been administered in 3 African countries – the vaccine has a favorable safety profile.
No negative impact on uptake of bednets, other childhood vaccinations, or health seeking behavior for febrile illness. In areas where the vaccine has been introduced, there has been no decrease in the use of insecticide-treated nets, uptake of other childhood vaccinations or health seeking behavior for febrile illness.
High impact in real-life childhood vaccination settings: Significant reduction (30%) in deadly severe malaria, even when introduced in areas where insecticide-treated nets are widely used and there is good access to diagnosis and treatment.
Highly cost-effective: Modelling estimates that the vaccine is cost effective in areas of moderate to high malaria transmission.
Next steps for the WHO-recommended malaria vaccine will include funding decisions from the global health community for broader rollout, and country decision-making on whether to adopt the vaccine as part of national malaria control strategies.
The pilot programme was financed through collaboration between Gavi, the Vaccine Alliance; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Unitaid.
