Introduction

Chronic obstructive pulmonary disease (COPD) is a prevalent chronic respiratory condition that represents the third leading cause of death worldwide.1,2 According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 definition, COPD is a

Heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration, and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.2

People with HIV (PWH) are particularly vulnerable to the development and progression of COPD, with both higher rates of COPD and an earlier and more rapid decline in lung function than in the general population, even after accounting for cigarette smoking and other known risk factors, such as intravenous drug use.3–7 The exact mechanisms that underlie HIV-associated COPD are incompletely known, but environmental exposures, heightened immune activation and systemic inflammation, accelerated aging, a predilection for the development of pneumonia, and alterations in the lung microbiome likely play important roles (Figure 1).8–11 The purpose of this review is to describe what is currently understood about the epidemiology and pathobiology of COPD among PWH, to indicate selected areas of active investigation, and to outline screening, diagnostic, prevention, and treatment strategies.

Figure 1 Drivers of COPD in PWH.

Epidemiology

Prevalence

As survival among PWH has improved with the use of antiretroviral therapy (ART), COPD has become an increasingly important comorbidity. PWH develop an earlier and more rapid decline in lung function, even after adjustment for traditional risk factors.3,5–7,12–15 A recent retrospective study evaluating comorbidities in PWH based on hospital discharge data found that COPD was the most common comorbidity across the 10-year study period and that COPD prevalence was higher among PWH than among those without HIV (23.5% versus 14.0%).16 Prevalence estimates of COPD among PWH have ranged from 3.4% to over 40% in prior studies; notably, most of these have been conducted in Europe and North America.17,18 Part of this heterogeneity is due to differences in COPD classification methods, such as self-report, International Classification of Diseases (ICD) diagnostic codes, use of CT scans, and spirometry.17,19 For example, a systematic review and meta-analysis by Bigna et al evaluating the global prevalence of COPD among PWH found that the prevalence varied from 5.6% to 10.6% depending on the diagnostic criteria used, with a higher prevalence when using spirometric criteria instead of self-report or ICD diagnostic codes.4

Geography

COPD in PWH occurs anywhere PWH reside. However, the risk factors for the development of COPD in PWH vary regionally due to differences in age, rates and duration of tobacco smoking, exposure to biomass fuels, and prevalence of tuberculosis, all of which have been implicated in COPD development.2,20–22 While the majority of studies on COPD in PWH have been conducted in the US and Europe, most PWH live in sub-Saharan Africa, where there is a high prevalence of both tuberculosis (TB) and exposure to biomass fuels, and where patients are typically younger and less likely to smoke tobacco. While earlier studies suggested that ART itself may be a risk factor for worsening lung function,23,24 Kunisaki et al conducted a multinational randomized controlled trial (RCT) in the modern ART era and did not find a difference in lung function based on timing of ART initiation.25

Biologic Sex

Biologic sex may also contribute to differences in COPD trajectories among PWH. In one study of longitudinal lung function changes in PWH, female sex was associated with distinct lung function trajectories, including baseline low diffusing capacity for carbon monoxide (DLco).26 In a study by McNeil et al of virally suppressed adults with HIV and their seronegative counterparts in Uganda, women with HIV demonstrated an accelerated FEV1 decline as compared to women without HIV, a finding that was not seen among men with and without HIV.27 Interestingly, in a large US-based cross-sectional analysis comparing women with and without HIV, women with HIV had a lower DLco than women without HIV, but there were no differences in spirometric outcomes by HIV status.28,29 In another study including the same cohort of women, baseline COPD prevalence was similar among men with and without HIV and women with and without HIV, but COPD incidence was higher among men with HIV when compared to men without HIV.30 In contrast, Abelman et al found in a post-pneumonia Ugandan cohort that women with HIV had over three-fold higher odds of COPD on spirometry compared to men with HIV, a sex-based difference not found in women and men without HIV.31 Further work is currently underway to investigate whether these reported HIV-associated sex-specific differences in COPD rates are driven by immunologic, hormonal, or environmental factors.

Risk Factors for COPD in PWH

There are many risk factors for the development of COPD in PWH including HIV itself,5,32 cigarette smoking and other inhalational exposures, air pollution, opportunistic infections and pneumonia, microbiome alterations,33,34 accelerated aging,35–38 and socioeconomic factors.39 This section focuses on the major drivers, such as smoking, as well as potential risk factors under investigation, such as chronic cytomegalovirus (CMV) coinfection.

Smoking

Smoking is the key risk factor for COPD in PWH. Smoking is more prevalent among PWH compared to their seronegative counterparts.40–42 However, studies of co-exposure to HIV and tobacco smoke suggest that PWH who smoke may also be more susceptible to smoking-induced lung damage than HIV-uninfected people who smoke. For example, Diaz et al found emphysema to be more prevalent among smokers with HIV as compared to smokers without HIV.43 Further, in a longitudinal multi-center cohort of 13,687 veterans with and without HIV, Crothers et al found that the prevalence and incidence of both COPD and lung cancer were higher among those with HIV compared to those without HIV despite similar levels of smoking.5 Importantly, among PWH on ART, smoking may reduce life expectancy more than HIV itself.44–46 While the pathophysiologic mechanism driving this HIV-associated difference is incompletely known, recent work suggests that, among PWH, tobacco smoke suppresses alveolar macrophage production of T-cell recruiting chemokines. This impairs the migration of cytotoxic T cells from the airway mucosa into the alveolar space, leading to localized airway mucosa inflammation and tissue destruction.47

Air Pollution

Air pollution – the leading environmental cause of death globally48 – is now the greatest threat to human health,49 and COPD is a leading cause of the nearly 7 million annual deaths attributed to air pollution.48,50 Air pollution results from a variety of human-related activities and natural events that include emissions from vehicles, factories, and power plants; traffic-related products; biomass fuel burning (ie, charcoal, firewood, animal dung, crop residues) for cooking and heating; dust storms; forest fires; and volcanic eruptions. The dominant pollution sources vary by region. Traffic- and industry-related sources drive exposure in high-income countries and urban settings, while biomass-related sources drive exposure in low- and middle-income countries and rural settings.51 Air pollution causes acute and chronic lung dysfunction, structural lung abnormalities, submaximal lung growth in childhood and adolescence, and augments lung disease risk in vulnerable populations.52–63 Even small acute increases in fine particulate matter (PM2.5) exposure worsen mortality,64 and there is no “safe” level of exposure.65 Biomass-associated COPD, compared to tobacco-associated COPD, is characterized by more small airways disease and fibrosis, less emphysema, higher DLco, and less airflow obstruction – in effect, a more fibrotic and less emphysematous phenotype.66–69 Exposure to biomass fuel smoke has also been associated with defective bacterial phagocytosis.70 In addition, PM2.5 exposure may also potentiate TB risk,21,71,72 which by itself is a risk factor for COPD and an important consideration in TB-endemic regions.

Similar to the influence of tobacco smoke, PWH may be more susceptible to air pollution-associated lung damage. For example, among PWH living in San Francisco, exposure to higher levels of outdoor air pollution was associated with increased susceptibility to Pneumocystis infection.73–75 Using ambulatory carbon monoxide (CO) sensors to measure personal air pollution exposure among 260 adults with and without HIV in rural Uganda, North et al found that exposure to short-term CO levels that exceed WHO air quality guidelines was associated with self-reported respiratory symptoms among PWH but not among HIV-uninfected comparators.76 Characterizing air pollution exposure among PWH and exploring the potentially outsized influence of air pollution exposure on lung health in this population is an area of ongoing investigation. As global smoking prevalence continues to decline and rapid industrialization and urbanization progresses, air pollution is poised to replace tobacco as the leading cause of chronic lung disease,77–79 and a multifaceted approach that also focuses on this often overlooked risk factor for lung disease among PWH is critical.

Opportunistic Infections and Pneumonia

PWH have historically had higher rates of pneumonia, and while incidence of bacterial pneumonia has decreased with the advent of ART,80,81 it remains common in this population.82–84 In the current era, PWH have similar rates of acute respiratory infections as people without HIV, but PWH experience more severe disease.85 Pneumonia has been associated with higher rates of COPD and lung function abnormalities in PWH.86–89 For example, Drummond et al conducted a US-based multi-center study evaluating spirometry in adults with and without HIV and found that participants with airflow obstruction were more likely to have a history of bacterial pneumonia and Pneumocystis jirovecii (PJP) infection.90 Specifically, PJP, an opportunistic infection that occurs in PWH with CD4 counts <200 cells/mm,3 elevated HIV RNA, and colonization by Pneumocystis have each been associated with higher risk of COPD among PWH.88,91,92 There are numerous contributors to the increased risk of pneumonia in PWH, including alterations in immunity, which lead to persistently elevated markers of immune activation and inflammation, as well as environmental and behavioral risk factors, and a higher prevalence of COPD, which is both a consequence of and a risk factor for pneumonia.9,93–96

Globally, tuberculosis is the leading infectious cause of death among PWH;97 PWH are 19 times more likely to develop TB disease than their seronegative counterparts.98,99 Pulmonary TB has been found to cause permanent scarring, bronchiectasis, pleural fibrosis, damage to small and large airways, as well as lung parenchymal damage, all of which may contribute to permanent lung function impairment.20,100 Whereas during the treatment phase of TB this impairment is typically restrictive, there is increasing evidence of a relationship between prior pulmonary TB infection and the subsequent development of obstruction and COPD.20,87 Rates differ significantly by the population under study, but pulmonary TB has been found to lead to airway obstruction in 18.4–86% of people in the general population.100 HIV is now recognized as a risk factor for post-TB lung disease, although the extent of this relationship is currently under study.87,100–104 There is some evidence to suggest that HIV may be associated with reduced severity of post-TB lung disease, but this is an area that merits further evaluation.100,105,106

Chronic CMV Infection

CMV is an important and omnipresent coinfection in HIV that has been associated with cardiovascular and cerebrovascular disease, other non-AIDS events, and increased mortality.107–112 Given the high rates of CMV antibody seropositivity among PWH, CMV IgG titers are commonly used as markers of CMV activity and have been shown to correlate with adverse outcomes.112,113 However, studies of CMV’s effect on lung function and COPD in PWH are limited. While chronic CMV infection in children with perinatally acquired HIV on ART has been associated with an abnormal FEV1,114 CMV’s association with COPD and other chronic lung diseases in adults with HIV has not been evaluated. Emerging data from the general population, however, suggest that chronic CMV infection is associated with COPD,115 and that higher CMV IgG titers are associated with COPD-related mortality.113 CMV is also associated with abnormal DLco in solid organ transplant recipients, although this has not been studied in PWH.116–118

There are several proposed mechanisms for CMV-mediated systemic immune effects, including persistent immune activation, endothelial dysfunction, and alterations in the gut microbiome.17,119–121 Similar biomarker activation patterns are noted in PWH with CMV and those with COPD. For example, sCD163, sCD14, and IL-6 are increased in both CMV IgG-positive PWH122–124 and PWH with lung function abnormalities, including both abnormal spirometry and abnormal DLco.10,121 These data suggest that there may be a shared mechanistic pathway between chronic CMV infection and chronic lung disease in PWH, but further work is needed to understand and characterize this relationship.

HIV-Specific Influences on COPD Pathogenesis

Several HIV-specific mechanisms may contribute to the increased incidence and accelerated development of COPD in PWH. Chronic HIV infection and the direct effects of HIV-related proteins on lung cells, altered lung and systemic immune responses (both immunosuppressive and pro-inflammatory), altered airway and gut microbial communities, impaired response to pathogens, and toxicity from antiretroviral therapies may all contribute to COPD pathogenesis in this population.23,24,125–132

HIV Infection

As the lung acts as a reservoir for HIV even after viral suppression, chronic HIV infection may directly contribute to COPD pathogenesis in various ways.132–134 Newly replicated viral particles released slowly over time bind to and interact with many cell types within the lung, which can lead to direct injury, oxidative stress, low-level chronic inflammation, and impaired response to pathogens.128,135 Although other cell types in the lung may be infected, alveolar macrophages are the best studied reservoir of HIV in the lung.132 HIV infection impairs macrophage phagocytic activity, thus hindering response to pathogens.127,132 HIV also skews the macrophage phenotype towards a pro-inflammatory and protease-producing phenotype through the release of a host of cytokines, chemokines, oxidants, and proteases, all of which contribute to COPD pathology. Cytokine and chemokine signaling in HIV-infected macrophages trigger a pro-inflammatory response including neutrophil and lymphocyte infiltration. Kaner et al found that alveolar macrophage expression of proteases such as matrix metalloproteinases 9 and 12 (MMP-9, MMP-12) is higher in PWH who smoke with emphysema than their seronegative counterparts.131 In murine models, MMPs degrade the extracellular matrix, directly contributing to emphysematous tissue destruction.136

Altered Adaptive Immune Responses

COPD development is not only mediated by HIV direct effects, but also by the altered cell-mediated adaptive immune responses in PWH, in particular, altered CD4+ T-cell responses. Numerous studies have shown a relationship between low CD4+ T cell counts and COPD or accelerated lung function decline, although conflicting data also exists.23,125,126,137 T cell exhaustion is typically seen in response to chronic antigen stimulation, such as chronic viral infection, and results in decreased functionality. In PWH, CD4+ T cells show signs of exhaustion even in the presence of ART, with an increased expression of programmed cell death protein-1 (PD-1), as well as impaired proliferative capacity.130,138,139 Furthermore, in PWH with COPD, airway mucosal CD4+ T cell numbers are depleted and poorly responsive to pathogens.130 These findings suggest that dysfunctional CD4+ T cell responses may uniquely contribute to COPD pathogenesis in PWH.

Activated and dysfunctional CD8+ T cells also appear to contribute to the disordered adaptive immune response in chronic HIV infection, and thus could contribute to COPD pathogenesis.138,139 PWH show persistent expansion of CD8+ T cells in blood and alveolar compartments, and the decreased CD4+/CD8+ ratio is associated with lung abnormalities even in PWH on ART.140,141 These expanded CD8+ T cell populations also show dysfunction, which is typically indicative of an accelerated aging or “immunosenescent” response. Like CD4+ T cells, CD8+ T cells display exhaustion markers, including PD-1, and a low proliferative capacity.138,139 The expanded population skews towards memory T cell and terminally differentiated CD8+ T cell populations unable to respond to new insults. Despite their impaired function, these exhausted T-cells produce a low-grade inflammatory response at mucosal surfaces, which is considered central to COPD pathology.

Changes to the Airway Epithelium

Alterations to the airway epithelium, the main barrier protecting the lungs from outside insults, such as cigarette smoke, air pollution, and inhaled toxins, can also play a major role in COPD pathogenesis. HIV has both direct and indirect effects on the airway epithelium, contributing to disordered barrier function, decreased mucociliary clearance, and generation of pro-inflammatory mediators. For example, HIV enters epithelial cells and disrupts cell–cell adhesion.129 HIV-associated proteins released from other infected cells disrupt epithelial tight junctions and induce oxidative stress.142 HIV and cigarette smoke synergistically disrupt mucociliary clearance, additively suppressing CFTR expression to decrease mucus hydration in cell culture models and inducing goblet cell metaplasia/hyperplasia to increase mucus production in simian models.143,144 Finally, when HIV binds specifically to basal cells, epithelial progenitor cells release proteases such as MMP-9 and pro-inflammatory mediators that induce migration and proliferation of macrophages and neutrophils.145

Changes in the Lung and Gut Microbiome

Lastly, shifts in both the lung and the gut microbiome can also contribute to chronic inflammatory responses in the lung and, hence, COPD pathogenesis. Data are conflicting on whether lung microbial communities differ in PWH based on 16S sequencing.146–148 However, subtle differences in the microbiome at the species or strain level or at a functional level cannot be discerned via these sequencing methods. It is plausible that at least a subset of PWH experience pathologic microbial alterations in the airways because of a more hospitable environment for pathogen growth. If present in PWH, microbiome perturbations could contribute to chronic airway inflammation. Furthermore, microbial translocation from a compromised gut mucosa, stimulating a chronic systemic inflammatory response, may contribute to lung disease in PWH as has been seen in asthma and pulmonary infections.149

Diagnosis and Clinical Findings of COPD in PWH

Screening and Diagnosis

COPD remains both underdiagnosed and misdiagnosed in people with HIV.150,151 While currently the US Preventative Services Task Force does not recommend screening for COPD in the general population,152 higher COPD prevalence among PWH raises the question whether screening should be done in this subpopulation. Currently, there are no screening and diagnostic criteria specific to PWH. While several studies have evaluated different screening approaches, no conclusive recommendations can be made regarding COPD screening and diagnosis in PWH at this time.150,153–156 For example, a group in Canada offered screening spirometry to all patients in an HIV clinic;156 notably, less than a third of the invited participants agreed to participate, and only 11% had airflow obstruction.

Recruitment and retention throughout the screening-to-diagnosis cascade have been major challenges in all studies. For example, a group in Italy implemented a three-step case-finding program, involving a 5-question screening questionnaire (which included questions about age, smoking history, cough and sputum production, shortness of breath, and exercise limitation), portable spirometry, and diagnostic spirometry.150 They found that 282 participants (19.6%) had a positive screening questionnaire, defined as having a positive answer to at least three questions, but only 33 participants ultimately completed diagnostic spirometry, of whom 22 met criteria for COPD. High participant dropout at each step of the screening process has been similarly reported elsewhere,153–155 even when the authors bypassed the screening spirometry and had a shorter questionnaire.155 Even within these limitations, COPD prevalence based on the screening outcomes has been consistently higher than the known COPD prevalence in each respective clinic,154 further underscoring the underappreciated burden of chronic lung disease in this population. Additional challenges with screening this high-risk population include lack of a high-performing, validated screening questionnaire in PWH and poor correlation between respiratory symptoms and obstruction on pulmonary function tests (PFTs).155 To our knowledge, qualitative studies focused on identifying patient, provider, or systems-level issues contributing to high dropout rates in screening studies among PWH have not been conducted. Having diagnostic spirometry available at the time of a positive screening questionnaire may help reduce high dropout rates.

Any PWH suspected of having COPD should undergo diagnostic testing with, at a minimum, portable spirometry and, in our opinion, full PFTs with pre- and post-bronchodilator spirometry, total lung capacity and lung volumes if spirometry is abnormal, and DLco measurement. Chest radiography demonstrates classic findings (Figure 2) mostly in individuals with advanced disease but is useful in ruling out alternative etiologies that also present with respiratory symptoms similar to those of COPD. Occasionally, additional testing such as chest computed tomography (CT) scans may be warranted to characterize the observed PFT abnormalities, and certain CT findings such as the presence of large bulla (Figure 3) may lead to consideration of additional therapies (eg, bullectomy).

Figure 2 Chest radiograph from person with HIV and COPD demonstrating hyperinflation, flattened diaphragms, and bilateral bullous lung disease (Courtesy of Laurence Huang, MD).

Figure 3 Chest computed tomography from the same person with HIV and COPD demonstrating large, bilateral bullae. This individual eventually underwent bullectomy with dramatic improvement in his respiratory status (Courtesy of Laurence Huang, MD).

Longitudinal Lung Function Trajectories of COPD in PWH

While there is a paucity of data on the natural history of COPD in PWH, lung function declines faster in PWH compared to HIV-negative controls, even when HIV is well-controlled and smoking rates are comparable.6,7,157 Notably, findings from the Pittsburgh HIV Lung Cohort suggested that there may be distinct lung function trajectories among PWH, in which differences in the rate of decline are associated with specific symptoms and distinct profiles of elevated immune activation biomarkers.26 Importantly, this study did not exclusively enroll individuals with COPD. In the general population, COPD studies have shown that lung function decline accelerates as COPD severity increases,158 but whether similar trajectories are seen in PWH is an area currently under study. In a study evaluating factors associated with lung function decline among PWH by Li et al, the authors found that lung function decline occurred more rapidly in older individuals and those with GOLD stage 1 than those with GOLD stage 0 COPD.126 Taken together, these studies suggest that PWH with COPD may demonstrate distinct lung function trajectories when compared to their seronegative counterparts, although additional study is needed in this area.

Lung Function Trajectories in People with Perinatally Acquired HIV

While this review is focused on COPD in adults with HIV, the growing number of individuals with perinatally acquired HIV and their lung function trajectory should also be considered. Children and adolescents with HIV have a higher risk of pulmonary infections, including TB, and even with early ART initiation they remain more vulnerable to small airways dysfunction and risk of obstructive lung disease and other pulmonary abnormalities on spirometry and imaging.159–166 Even children who were exposed to but not infected with HIV remain at risk for abnormal lung function.167 Further, lung function in children seems to be affected by the timing of maternal ART initiation (pre-pregnancy versus during pregnancy).167 In addition, lung development and the ability to reach maximal lung function is impaired by HIV, repeat infections, smoking, pollution, and poverty, which in turn increases the risk for the development of chronic lung disease in adulthood.168,169 As this vulnerable population ages, we are likely to see an increased burden of chronic obstructive disease earlier in life. As most of our understanding of lung function trajectories in PWH with COPD comes from adult PWH from higher income settings, focused efforts for early screening, diagnosis, and management of this condition are needed in areas with high prevalence of adolescents and adults with perinatally acquired HIV.

Diffusing Capacity for Carbon Monoxide

Abnormal diffusing capacity for carbon monoxide is the most prevalent finding on PFTs in PWH, even when spirometry is normal.29,170 DLco impairment is non-specific and can be attributed to emphysema, fibrosis, pulmonary hypertension, or anemia. In PWH, it is also often associated with prior respiratory infections such as PJP, TB, or bacterial pneumonia, and the DLco abnormality may persist long after clinical and radiographic resolution of infection.89,126 Other risk factors for abnormal DLco include HIV infection, CD4 < 200 cells/mm,3 intravenous drug use, and hepatitis C infection.29,101,170–172

DLco abnormalities can predict the development, symptoms, and outcomes of COPD. Among people who smoke, DLco can become abnormal before spirometric criteria for COPD are met; DLco may also be a marker of early emphysema prior to the development of spirometric obstruction, small airways disease, or early vascular abnormalities.173–175 While there are additional and unique risk factors for abnormal DLco in PWH compared to the general population, perhaps suggestive of an HIV-specific lung function abnormality,10,176 it is also plausible that isolated DLco abnormalities may serve as a marker for early COPD in some patients. Among PWH, abnormal DLco, like abnormal FEV1, is an independent predictor of worse respiratory symptoms (such as dyspnea, cough, and mucus production),170 as well as a worse 6-minute walk test.177,178 Finally, abnormal DLco is an independent predictor of mortality in PWH with COPD.179,180

Imaging Findings in PWH with COPD

New techniques for quantitative imaging assessment have allowed in-depth characterization of imaging abnormalities in people with COPD. As current GOLD criteria define COPD based on chronic respiratory symptoms,2 chest imaging findings such as emphysema describe the structural abnormalities that drive this clinical entity. In the general population of people who smoke, studies have found that evidence of small airways disease and air trapping on imaging could predict COPD development and faster spirometry decline.181,182 Importantly, multiple imaging findings such as early interstitial lung abnormalities,183 pulmonary artery to aorta ratio >1,184 pulmonary arterial vascular pruning,185 progression186 and homogeneity of emphysema,187 airway wall thickness,188,189 and air trapping have all been associated with disease severity and adverse outcomes in COPD.181

Studies in PWH have shown a high prevalence of emphysema even in individuals without overt respiratory disease.190 In addition, Leung et al found that people with low DLco and a combination of centrilobular and paraseptal emphysema were more likely to have progression of emphysema,191 and significant emphysema burden was associated with increased mortality.192 Elevated TNFα and IL-1β, soluble CD14, nadir CD4, and low CD4/CD8 ratio are also independently associated with emphysema in PWH,140,193,194 although reports of a direct association of HIV with emphysema are contradictory.194,195 While the exact mechanisms are an area of active investigation, HIV-mediated chronic inflammation and immune dysregulation likely play an important role in emphysema formation.

Symptoms, Exacerbations, and Mortality

Compared to HIV-negative individuals, PWH with COPD have a higher respiratory symptom burden, worse quality of life, and an increased risk for COPD exacerbations.24,196–202 For example, PWH with emphysema have a worse chronic cough, increased mucus production, and decreased 6-minute walk distance compared to HIV-negative controls.198 In PWH who inject drugs, obstructive lung disease has been associated with more severe dyspnea than in their seronegative counterparts.203 In addition, PWH perform worse on six-minute walk testing.178 While COPD is associated with increased frailty in individuals with and without HIV, physical limitation scores are worse among PWH.204,205 Finally, COPD in PWH is not only often comorbid with cardiovascular disease, but also a risk factor for myocardial infarction206 and has been associated with increased mortality.180,192

Management of COPD in PWH

PWH have historically been excluded from large randomized controlled trials of COPD treatments. Therefore, there are very few HIV-specific data on COPD management, and instead general COPD guidelines for both chronic disease management and COPD exacerbations are applied to PWH.207 These management strategies include guideline-driven inhaler therapy, pulmonary rehabilitation, routine vaccinations, surgical or bronchoscopic lung volume reduction in qualifying patients, and management of other medical comorbidities.2 Here, we will focus on a few HIV-specific considerations.

Smoking Cessation

Given the high smoking prevalence among PWH and the excess morbidity and mortality associated with smoking in this population, smoking cessation remains a fundamental aspect of COPD care in PWH. Unfortunately, prescribing rates for smoking cessation therapies have been low for PWH with tobacco use disorder for many reasons, including competing clinical priorities, lack of time, low rates of provider training in smoking cessation interventions, and limited knowledge of nicotine replacement therapies and varenicline.208,209 In addition, PWH face additional challenges on the path to sustained smoking cessation that are due to HIV-related stigma, high rates of comorbid substance use, anxiety and depression, financial instability, lack of insurance, low level of education, and racial biases.210–213 Tailoring smoking cessation therapies to this population is an active area of research.209,214–226 Increased awareness among HIV care providers of the importance of smoking cessation, financial support for smoking cessation initiatives, and intervention studies inclusive of PWH are needed to identify the best ways to support smokers with HIV on their path to quitting.

Choice of Inhalers

Special attention should be paid in the treatment of COPD to PWH who are taking ritonavir or other boosted ART regimens. Ritonavir and cobicistat block the CYP3A4 isozyme and can increase the concentration of most corticosteroids. As a result, use of inhaled corticosteroids (ICS) in patients on these medications has been reported to cause Cushing’s syndrome.227–230 Beclomethasone is the ICS drug with the best side effect profile and can be used in PWH treated with ritonavir or cobicistat.230 In PWH who are receiving ritonavir or cobicistat, an added consequence is the inability to use any combination medication for COPD that includes an ICS as fluticasone- and budesonide-containing combination inhaler therapies are contraindicated and beclomethasone is only available as a single, standalone inhaler. Given the already elevated risk of pulmonary tuberculosis and other pneumonias in this population, additional caution should be applied when using ICS, as they can increase the risk of lung infections in this already vulnerable population.231,232

Modulation of Chronic Inflammation

While no HIV-specific COPD therapies exist, there is an interest in the role of modulating chronic inflammation to improve lung function and clinical outcomes. For example, in a small double-blind pilot clinical RCT of rosuvastatin taken daily for the management of COPD in PWH, Morris et al showed that after 24 weeks of daily rosuvastatin therapy, FEV1 stabilized and DLco improved significantly.233 Another trial studied the role of weekly azithromycin in HIV-related chronic lung disease, defined as an irreversible obstructive defect with minimal radiographic abnormalities, in children and adolescents.234 While the authors found no improvement in lung function parameters after 72 weeks of treatment, they noted an increased time to and fewer total exacerbations. Furthermore, data in the general population have shown benefit of using angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs) in slowing down the progression of emphysema on chest CT in COPD, albeit with no effect on longitudinal lung function on spirometry.235 A randomized controlled trial by MacDonald et al measured pneumoprotein levels as a proxy for lung function decline in PWH with COPD randomized to placebo or losartan treatment, but did not see any significant changes in the pneumoprotein plasma concentrations after 12 months of follow-up.236 Finally, an NHLBI-funded multi-site randomized controlled trial evaluating the influence of twice daily doxycycline on change in DLco among PWH who smoke is currently underway.237 In sum, findings from prior studies suggest that targeting chronic inflammation has the potential to improve lung function of PWH with COPD, but currently there are no definitive data to support any single drug’s use.

Prevention of COPD in PWH

Smoking Cessation

Smoking is perhaps the single most important modifiable risk factor for COPD among PWH. Evidence suggests that PWH may metabolize nicotine more rapidly than HIV-uninfected smokers,238 which could have important implications for the effectiveness of smoking cessation interventions among this population. A growing body of literature is focused on identifying effective smoking cessation interventions among PWH; Table 1 summarizes the randomized controlled trials that have been conducted or have recently completed enrollment on smoking cessation in PWH.218,220,225,226,239–262 For example, O’Cleirigh et al found that among 41 PWH who smoke and reported motivation to quit, those who were randomized to receive cognitive behavioral therapy for smoking cessation and anxiety/depression treatment in addition to nicotine replacement therapy were more likely to quit smoking compared to those who received nicotine replacement therapy alone,225 highlighting the importance of focusing concomitantly on smoking cessation and mental health in this population. A Cochrane review summarizing 14 randomized controlled trials of smoking cessation interventions among PWH in the United States found that pairing behavioral interventions with medications may facilitate short-term abstinence in comparison to medications alone but did not appear to facilitate long-term abstinence.263 Further, a systematic review of smoking cessation interventions among PWH found that successful smoking cessation was most likely when the intervention included cellphone-based technology.264 Although long-term smoking cessation is the goal, any reduction in exposure to tobacco products is likely to have significant health impacts. Using a Monte Carlo microsimulation model, Reddy et al demonstrated that sustained smoking cessation among PWH could result in over 260,000 expected years of life gained.44 This per-person survival gain is more than the life expectancy gained with early ART initiation or improved ART adherence, and among the general population is more than the life expectancy gained by initiating statins for primary cardiovascular disease prevention or clopidogrel for secondary cardiovascular disease prevention. Therefore, encouraging and supporting smoking cessation must remain a priority in the care for PWH.

Table 1 Summary of Randomized Controlled Trials of Smoking Cessation in People with HIV

Air Pollution Mitigation

Interventions aimed at reducing personal air pollution exposure can be categorized into policy-level approaches (regional, national, international) and personal-level approaches. Overall, there is no level of air pollution exposure below which there are no negative health impacts. In fact, evidence suggests that the greatest gains in health per unit reduction in air pollution exposure may occur at the lowest end of the exposure spectrum.265 While attention is being paid to regional and national air quality guidelines, individuals with HIV can adopt behavioral changes that may reduce their personal exposure. Evidence to guide these decisions is still an area of active research. In 2019, Carlsten et al published a summary of 10 key approaches to reduce personal exposure to outdoor and indoor pollution sources, including: using close-fitting face masks when exposure is unavoidable; preferential use of active transport (walking or cycling) rather than motorized transport; choosing travel routes that minimize near-road air pollution exposure; optimizing driving style and vehicle settings when in polluted conditions; moderating outdoor physical activity when and where air pollution levels are high; monitoring air pollution levels to inform when individuals should act to minimize exposure; minimizing exposure to household air pollution by using clean fuels, optimizing household ventilation, and adopting efficient cookstoves where possible; and using portable indoor air cleaners.266 Unfortunately, the data supporting these strategies are not of high quality, which highlights the importance of future work focused on carefully designed studies leveraging implementation science methodology to characterize the feasibility, acceptability, and effectiveness of behavioral interventions focused on improving air pollution-associated lung disease.

Infection Prevention

As pulmonary infections, many of which are preventable, have been implicated in the development of COPD among PWH, infection prevention is important for mitigating COPD risk. First, early ART initiation is imperative, as many pulmonary infections such as PJP are opportunistic infections and develop in the setting of high HIV viral loads and low CD4 counts. Primary prophylaxis for PJP prevention is recommended in PWH with CD4 counts <200 cells/mm3 and considered in those with CD4% <14%.267 Given the high morbidity and mortality associated with pneumococcal infection in PWH, pneumococcal immunization has been recommended in all adults with HIV.268 Consistent with general population recommendations, PWH should also receive annual flu vaccination, as well as the full COVID-19 vaccination series. Given the increased risk of TB disease and its associated mortality among PWH, screening for TB is recommended for all PWH at the time of HIV diagnosis and once a CD4 count ≥200 cells/mm3.269 PWH should be tested annually only if they have a history of a negative test for latent TB infection and are at high-risk for repeated or ongoing exposure to people with active TB disease.269 Among PWH diagnosed with latent TB, TB preventive treatment reduces both mortality and progression to active TB and thus should be offered to all PWH with a positive TB screening test without evidence of active TB disease.269,270

Future Directions

Although progress has been made in understanding the underlying mechanisms of COPD among PWH, significant knowledge gaps remain. For example, there are many cross-sectional studies evaluating the prevalence of COPD among PWH but only limited data on the natural disease course of COPD in PWH and whether it differs from the general population. Additionally, while studies suggest that PWH demonstrate a higher risk of COPD and a higher symptom burden, there are no HIV-specific screening guidelines for COPD in PWH. Further research is also needed on the interplay between risk factors such as mode of HIV transmission, biologic sex, aging, CMV infection, air pollution, and TB, as well as a deeper understanding of the epidemiology, development, and progression of chronic lung disease in PWH. Management strategies designed specifically for PWH with COPD are also warranted. Lastly, while much progress has been made in understanding the mechanistic pathways that render PWH particularly vulnerable to developing COPD, we remain limited in our ability to counteract these pathways and prevent COPD development. These are only a few examples highlighting the multiple avenues for future research, all of which have the potential to substantially improve both our scientific understanding of COPD among PWH and our ability to effectively prevent and treat this deadly, irreversible condition.

Conclusions

COPD is highly prevalent among PWH. With an aging global population of PWH, high rates of cigarette smoking, and air pollution, COPD is a growing health challenge, and improved diagnosis and treatment of COPD in PWH will become increasingly important. Further research is needed to understand the underlying mechanisms driving COPD in PWH, as well as HIV-specific screening and treatment modalities.

Disclosure

Katerina L Byanova and Rebecca Abelman are co-first authors for this study. Dr. Byanova was supported by NIH F32 HL166065. Dr. Abelman was supported by NIH T32 AI060530 and K12 HL143961. Dr. North was supported by NIH K23 HL154863. Dr. Christenson was supported by NIH R01 HL143998, she also reports personal fees from AstraZeneca, Sanofi, Regeneron, GlaxoSmithKline, Amgen, MJH Holdings LLC: Physicians’ Education Resource, Glenmark Pharmaceuticals, and Axon Advisors, outside the submitted work. Dr. Huang was supported by NIH R01 HL128156, R01 HL128156-07S2, and R01 HL143998.

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There is nothing like a good nap after a good session of fetch. Having a puppy can be one of the happiest times in your life, but there may be times when it gets a bit scary when things happen that you don’t understand.

As a new dog parent, you might find yourself admiring your new, fluffy addition while they sleep. What if they’re breathing too fast? What could this mean?

Seeing your pup with an increased respiratory rate while sleeping can be alarming, but it typically isn’t anything to worry about. This is all just a part of getting to know your dog and the mannerisms that come along with them.

Noticing fast breathing while asleep may have you second-guessing yourself about your puppy’s normal, awake breathing rate. There are a couple of different reasons why your puppy is breathing differently and having the ability to identify them will help calm your worrying mind.

Causes of Fast Breathing During Sleep

Image credit: Tanya Gorelova

Puppies have one priority in their life during adolescence: play! With normal exercise, your dog’s heart rate will naturally increase and he will start to breathe faster to keep up with his bounding heart.

To have an elevated heart rate and respiratory rate after playing or exercise is completely normal and sometimes it will linger as your puppy drifts off into a nap.

Sometimes, he won’t be able to keep his sleepy little eyes open as his body works to bring his pulse and breathing back down to a resting rate- his body is still developing and is not yet used to vigorous exercise, hence the sudden need for a good nap.

Your puppy’s breathing can change as he drifts off into a dream. Yes, dogs dream, too! Interestingly enough, experts found that a sleeping puppy’s brain can reflect a brain that’s awake. It can be tempting to wake a pup from their sleep when their breathing quickens, but it is important to allow them to hold their sleep cycle to ensure they are getting quality rest.

As long as no signs of stress are seen along with barking or shaking, an increased respiratory rate is nothing to be concerned about. For all we know, your puppy could be dreaming about playing in a never-ending field or winning a race! Sounds exhausting!

While we understand that an increased respiratory rate is a natural response to play and exercise, it is also important to know what labored breathing looks like, especially if your family chooses to love a brachycephalic (wide and short snout) puppy.

Dogs that are classified in the brachycephalic category are predisposed to breathing difficulties due to their airway composition. As you are monitoring breathing, be diligent about observing any wheezing or extensive abdominal heaving.

These can be tell-tale signs of dyspnea, or labored breathing. If you ever believe that your dog is struggling to get breaths in or out, contact your vet immediately.

Thermal regulation can come into play when breathing is involved. Dogs cool themselves down by panting as their body regulates itself back down to a normal and comfortable temperature.

On hot days, make sure that your dog has a cool indoor space where they can relax with a cold bowl of water for proper hydration.

Understanding Your Puppy’s Sleep Cycle

Image credit: Javon Swaby

Growing up is tough stuff. Experts have found that puppies spend roughly 18-20 hours a day sleeping. This is vital for both physical and behavioral development. Just like humans, pups go through the stages of sleep: light, REM, and deep.

However, unlike humans, they can run through that cycle multiple times a night, causing them to stir and change their breathing patterns.

The REM sleep cycle is when you are likely to see rapid breathing in your little one. At this time, the body is working to pull in more oxygen, therefore the respiratory rate will increase. This could also mean that they’re drifting off into dreamland or just simply still trying to settle down after a day of adventure.

As any dog owner knows, bladder control is one of the hurdles you have to jump through during puppyhood. Because of this, your puppy may stir in the middle of the night, his respiratory rate increasing as he realizes he needs to use the bathroom, as soon as possible!

Creating a comfortable and calm sleeping environment can prevent your puppy from running through multiple sleep cycles a night, therefore keeping their respiratory rate even and relaxed.

Puppies need a safe place and a spot that is solely theirs, like a comfy kennel or plush dog bed. If they’re sleeping in a place that is safe for them, they are far more likely to relax and stay that way throughout the night.

A good night’s sleep will usually follow up a day full of activity and adventure, so you must be giving your new friend the enrichment he needs throughout the day. This can include multiple walks, stimulating playtime, and plenty of interaction with family members.

After a fulfilling day, your puppy should fall into a deep sleep, keeping their breathing nice and regulated- one less thing for you to worry about as a new puppy owner.

Learn to Count their Breaths per Minute

Image credit: Josh Sorenson

If you’re still feeling anxious and uneasy about your puppy’s faster breathing, learning to count their breathing rate is a surefire way to give you some peace of mind.

When worrisome breathing appears, remain calm and focus on their chest; an inhale and exhale is counted as one breath. When you are confident with the rhythm, use a timer or your phone to start a 30-second clock.

You will count the number of breaths within that allotted amount of time and then multiply it by two. This will give you the number of breaths they are taking in a 60-second, or one-minute, span.

If you’re uncomfortable with multiplying, then just count the number of breaths for one minute straight. A young dog will likely take anywhere from 20-45 breaths per minute, whereas a large or older dog will land around 12-30 breaths per minute.

Remember, smaller dogs may have a higher breath count whereas larger dogs may be lower. It is best practice to keep a note or journal of the pet’s respiratory rate so you can find patterns and understand what their normal breathing may look like.

Disorders that Hinder Puppy Respiration

If your veterinarian determines that your puppy is breathing fast because of an underlying issue, be prepared to be well-versed in the following areas so that you can understand how to best help your pup.

Tracheal collapse

The trachea is a large tube that sits close to the esophagus and is responsible for transporting oxygen into the body. In cases where the trachea collapses on itself, the cartilage breaks down, creating an area that is too small for air to flow through.

When the dog is breathing fast, their respiratory effort can become labored. This disorder is typically only seen in older dogs, not puppies.

Diaphragmatic hernia

Typically a congenital effect in young puppies due to lack of development, the organs in the diaphragm can push up against the lungs, causing a deficit in breathing. This defect can only be corrected with surgical intervention.

Dehydration

Canine dehydration can be identified when the dog’s pant is heavy and fast with shorter breaths. Paired with a high heart rate, dull mentation, and the refusal to be active, dehydration can leave a dog feeling pretty awful at an alarming rate.

If you suspect that your dog is dehydrated, they may also have a dry nose, mouth, and dry gums. A dog suffering from advanced dehydration may need hospitalization and to receive intravenous fluids.

Laryngeal paralysis

The laryngeal folds are located in the back of the throat and can adapt to breathing, eating, and drinking. Sometimes, the folds have nerve issues which result in closing and opening at the wrong times.

The paralysis of the laryngeal folds can greatly hinder the airflow of oxygen into the lungs of the puppy. A tell-tale sign of laryngeal paralysis is a wheezing or honking noise when the dog attempts to breathe rapidly. In most cases, this disorder is caused by trauma but can develop in dogs as they age.

Heart disease

The heart’s main role in the body is to pump healthy, oxygenated blood in circulation. A disturbance in this system results in heart disease, to rope all the potential conditions under one term.

Some more specific terms can include dilated cardiomyopathy, hypertrophic cardiomyopathy, pericardial effusion, and valve disease. Without oxygen flowing appropriately due to an issue with the heart, your puppy may begin to breathe heavier or more rapidly to compensate.

Respiratory disease

Sometimes, bacteria, fungi, and viruses attack the lungs and make it difficult for the puppy to breathe as the body works hard to clear the foreign infection. If the infection clings to the lung tissue, it can make it increasingly difficult for your dog to get the correct amount of oxygen.

Vaccines are available to prevent contagious illnesses, such as kennel cough. It can inflame the trachea and produce a dry and painful cough that originates in the lungs. This problem is common when a large number of dogs are kept together, such as in a boarding facility or kennel. However, experts have learned that the most common respiratory disease is pneumonia and requires hospitalization.

Pain

Even as humans, when we feel pain our breathing rate can drastically change. Pain can come in many different forms and dogs will use their breathing pattern to regulate their nervous system. This breathing pattern may look quicker or they will take bigger breaths with more depth.

Overheating

The most extreme form of overheating can lead to heatstroke. When a dog is trying to cool itself down, their breathing will be rapid to aid in dropping their internal temperature. Dogs cannot sweat like humans do, so their cooling system is directly correlated to their breathing.

Experts tell us that it is not safe to keep pets outdoors above the temperature of 90 degrees Fahrenheit. If you live in a hot climate, it is best practice to ensure that your dog has a cool, safe place to regulate their body temperature.

Do not let becoming familiar with the systemic diseases that can affect your pet’s respiratory effort and rate intimidate you. If you still feel that you need further support and guidance, do not hesitate to set up a meeting with a veterinary professional.

When to Contact Your Vet

Your veterinarian is always going to be willing to address any concerns you have as a new puppy owner. Your pup will go through a series of vaccines that have to be bolstered early in on their lives. This is an ideal opportunity for you to regularly observe their breathing and address your concerns with your vet.

Familiarize yourself with emergent situations when it comes to your puppy’s breathing so you can assess the situation if the puppy is breathing fast or too slow. Contact your vet if you notice that their gums are bright red, white, or blue, if they have a decreased appetite, if they are exercise intolerant, or if their mouth is gaping open while breathing. A veterinarian will be able to perform further diagnostics to get to the bottom of any underlying health issue that may be a cause for concern.


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Several states, including Rajasthan, Gujarat, Uttarakhand, Karnataka, Haryana, and Tamil Nadu, have put their healthcare infrastructure on alert after the Centre’s directive to review preparedness in view of a surge in respiratory illnesses, especially among children, in China.

The Karnataka Health Department also issued an advisory for citizens to be aware of the seasonal flu in regard to the illnesses. According to it, seasonal flu is an infectious disease that typically lasts five to seven days and is known for its low morbidity and mortality rates.

However, it poses a higher risk to infants, the elderly, pregnant women, the immunocompromised, and those on long-term medications such as steroids, who may require hospitalisation. The symptoms include fever, chills, malaise, loss of appetite, myalgia, nausea, sneezing, and a dry cough that can last up to three weeks in high-risk groups.

Rajasthan's medical and health department advised its staff to stay vigilant and form rapid response teams. In its advisory, the state's health department asked officials concerned to prepare an action plan for the prevention and treatment of the disease.

Additional Chief Secretary of the Rajasthan Health Department, Shubhra Singh, while addressing officials through video conference, said the situation is "not worrisome at present" but the medical staff should work with full vigilance for surveillance and prevention of infectious diseases across the state, a statement said. Singh directed officials to prepare an action plan in three days for the prevention and treatment of this disease. She asked them to appoint a nodal officer at the district and medical college levels and to form rapid response teams at the division and district levels.

Uttarakhand Health Secretary Dr R Rajesh Kumar has issued guidelines in this regard. He asked medical teams to monitor symptoms of pneumonia and influenza in children. Three districts of Uttarakhand — Chamoli, Uttarkashi and Pithoragarh — share borders with China.

The Gujarat government also issued a circular, in which all hospitals were ordered to remain on alert. Doctor Rakesh Joshi, Superintendent of Ahmedabad Civil Hospital, said state-run hospitals have once again started preparations, keeping in mind the mysterious virus spreading in China.

Tamil Nadu Director of Public Health and Preventive Medicine has alerted the health department to step up surveillance for respiratory illnesses in the state. In addition to enhancing disease surveillance, the health department has also been asked to strengthen the facilities to manage the patients.

The Haryana health department has put out a directive, stressing that any “clustering of unusual respiratory illness” in public or private hospitals must be reported immediately.

Medical colleges and hospitals, including private facilities, have been requested to report cases of severe acute respiratory illness, acute respiratory illness or influenza-like illness in the IDSP-IHIP portal.

Directorate of Health and Family Welfare Services in Puducherry has also advised everyone to strictly follow the practice of wearing a face mask in public places. According to the Puducherry health department, as per the current situation and available data, there is no abnormal increase in respiratory diseases

People with chronic diseases are also advised to approach the nearest health facility if they suffer from symptoms such as fever, runny nose, cough and difficulty breathing.

The developments come after the Centre issued an advisory to states and Union territories urging them to immediately review public health and hospital preparedness measures.

The Union Health Ministry in its advisory on Sunday said that currently, the situation is not that alarming, adding that it is closely monitoring the same.

"In view of the recent reports indicating a surge in respiratory illness in children in northern China in recent weeks, the Union Health Ministry has proactively decided to review the preparedness measures against respiratory illnesses, as a matter of abundant caution. This is noted to be important in view of the ongoing influenza and winter season that results in an increase in respiratory illness cases. The government of India is closely monitoring the situation and indicated that there is no need for any alarm," the ministry said.

Union Health Secretary has also written a letter to the states and UTs advising them to immediately review public health and hospital preparedness measures.

"All States and Union Territories have been advised to implement 'Operational Guidelines for Revised Surveillance Strategy in the context of Covid', shared earlier this year, which provides for integrated surveillance of respiratory pathogens presenting as cases of influenza-like illness (ILI) and severe acute respiratory illness (SARI)," the Union Health Ministry's letter said.

(With inputs from Shilpa Nair and Sagay Raj)

Published By:

Poulami Kundu

Published On:

Nov 29, 2023

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CALQUENCE six-year follow-up data reinforce long-term benefit in chronic
lymphocytic leukemia, and data across multiple hematology assets showcase breadth of promising early pipeline

New, longer-term data from ALPHA Phase III trial will further show potential of
danicopan to address clinically significant extravascular hemolysis and maintain
disease control, allowing paroxysmal nocturnal hemoglobinuria patients to continue
standard-of-care treatment with ULTOMIRIS or SOLIRIS

AstraZeneca will present new clinical and real-world data in multiple hematological conditions at the 65th American Society of Hematology (ASH) Annual Meeting and Exposition, December 9 to 12, 2023 in San Diego, CA.

A total of 63 abstracts will feature 14 approved and potential new medicines across the Company’s portfolio and pipeline including from Alexion, AstraZeneca’s Rare Disease group, in chronic lymphocytic leukemia (CLL) and several types of lymphoma, paroxysmal nocturnal hemoglobinuria (PNH), atypical hemolytic uremic syndrome (aHUS) and amyloid light-chain (AL) amyloidosis.

Anas Younes, Senior Vice President, Hematology R&D, AstraZeneca, said: “Our data at ASH will exemplify how we are advancing a range of innovative modalities including antibody drug conjugates, next-generation immunotherapies and T-cell engagers in hematology. Updated clinical data for AZD0486, our CD19/CD3 T-cell engager, reinforce our belief in this approach as a potential new treatment for lymphoma, and new CALQUENCE data continue to demonstrate long-term efficacy and safety in chronic lymphocytic leukemia with further follow up.”

Gianluca Pirozzi, Senior Vice President, Head of Development, Regulatory and Safety, Alexion, said: “Alexion has transformed the treatment landscape and redefined care for the paroxysmal nocturnal hemoglobinuria patient community over the past two decades. At the ASH Annual Meeting, new results from our pivotal ALPHA trial will demonstrate the promise of Factor D inhibition to advance care for the small subset of patients with paroxysmal nocturnal hemoglobinuria who experience clinically significant extravascular hemolysis. We are proud to further our leadership in rare disease by sharing data from our robust hematology pipeline, reflecting our commitment to innovation and improving outcomes for the patients and families we serve.”

CALQUENCE® (acalabrutinib) continues to demonstrate long-term benefits in CLL

Six-year follow-up data from the pivotal ELEVATE-TN Phase III trial will further support the continued efficacy, safety and tolerability of CALQUENCE for long-term use in patients with treatment-naïve CLL.1

Data from a Phase II trial will show the safety and efficacy of CALQUENCE and rituximab followed by chemotherapy and autologous stem cell transplantation in fit patients with treatment-naïve mantle cell lymphoma (MCL).2

An analysis of five prospective CALQUENCE trials, including three randomized, controlled Phase III trials and two non-randomized trials, will show acceptable safety outcomes based on rates of nonfatal and fatal ventricular arrhythmias and sudden death in patients with CLL.3

Novel early assets show potential to improve outcomes for blood cancer patients

Data from our early portfolio will demonstrate how the Company is advancing multiple modalities across several scientific platforms, including Immuno-Oncology, Immune-Engagers, Antibody Drug Conjugates (ADCs) and Epigenetics as part of its strategy to attack cancer from multiple angles.

Updated Phase I data for AstraZeneca’s CD19/CD3 T-cell engager, AZD0486, will further demonstrate the acceptable safety profile and high response rate of this treatment in relapsed/refractory (R/R) B-cell non-Hodgkin lymphoma (NHL).4 We will also present the first clinical data on sabestomig, a PD-1/TIM-3 targeting bispecific antibody, in R/R Hodgkin lymphoma, showing encouraging early signals of activity.5

The first preclinical data for AZD9829, a novel CD123-targeting ADC, using AstraZeneca’s proprietary linker technology to deliver a topoisomerase I inhibitor warhead, will demonstrate promising anti-tumor activity in acute myeloid leukemia.6 In addition, preclinical data will demonstrate anti-tumor activity of AstraZeneca’s novel PRMT5 inhibitor in MTAP silenced Hodgkin lymphoma models.7

Showcasing advances to bolster our leadership in PNH with new data on Factor D inhibition and impact of C5 inhibition in long-term disease control

New results from the 24-week and long-term extension period from the pivotal ALPHA Phase III trial will reinforce the potential for danicopan add-on therapy to address clinically significant extravascular hemolysis (EVH) in the small subset of PNH patients who experience this condition while treated with C5 inhibitor therapy, allowing them to maintain control of intravascular hemolysis (IVH) through standard-of-care treatment with ULTOMIRIS® (ravulizumab-cwvz) or SOLIRIS® (eculizumab).8

Further, patient-reported outcomes from the ALPHA trial will suggest danicopan as an add-on to ULTOMIRIS or SOLIRIS improved quality of life compared to C5 inhibitor therapy alone in patients with PNH who experience clinically significant EVH.9

Additionally, Alexion will present an analysis of six-year outcomes from the Phase III clinical trial evaluating the safety and efficacy of ULTOMIRIS in patients with PNH who did not have previous treatment with a C5 inhibitor.10 The analysis compared survival against untreated patients in the International PNH Registry, the largest global real-world database of patients with PNH. Results will suggest ULTOMIRIS improved survival and maintained effective long-term control of IVH, the most significant contributor to morbidity and premature mortality in PNH.10

Improving diagnosis and management of life-threatening rare diseases, including amyloidosis

24-month results of a Phase II trial will demonstrate the safety and tolerability of CAEL-101 in combination with cyclophosphamide-bortezomib-dexamethasone with or without daratumumab for the treatment of AL amyloidosis.11

Real-world analyses across AL amyloidosis, aHUS and hematopoietic stem cell transplant-associated thrombotic microangiopathy (HSCT-TMA) will also be presented, advancing the scientific understanding of these rare, hematological conditions.12-16

Key presentations during the 65th ASH Annual Meeting and Exposition

Lead author

Abstract title

Presentation details

CALQUENCE (acalabrutinib)

 

Sharman, JP

Acalabrutinib ± Obinutuzumab vs Obinutuzumab + Chlorambucil in Treatment-naive Chronic Lymphocytic Leukemia: 6-year Follow-up of ELEVATE-TN

 

 

Abstract # 636
Oral Session: 642. Chronic Lymphocytic Leukemia: Clinical and Epidemiological: Frontline Treatment with Targeted Agents in Patients with Chronic Lymphocytic Leukemia
December 10, 2023
17:45 PST
Location: Seaport Ballroom ABCD (Manchester Grand Hyatt San Diego)

Westin, J

Smart Stop: Lenalidomide, Tafasitamab, Rituximab and Acalabrutinib Alone and with Combination Chemotherapy for the Treatment of Newly Diagnosed Diffuse Large B-cell Lymphoma

 

Abstract # 856Ora
l Session: 626. Aggressive Lymphomas: Prospective Therapeutic Trials: Initial Treatment Strategies in Aggressive B-Cell Lymphomas
December 11, 2023
15:30 PST
Location: Seaport Ballroom ABCD (Manchester Grand Hyatt San Diego)

Hawkes, EA

A Window Study of Acalabrutinib and Rituximab, Followed by Chemotherapy and Autograft (ASCT) in Fit Patients with Treatment-naïve Mantle Cell Lymphoma (MCL): First Report of the Investigator-initiated Australasian Leukemia and Lymphoma Group NHL33 ‘WAMM’ Trial

 

Abstract # 735
Oral Session: 623. Mantle Cell, Follicular and Other Indolent B-Cell Lymphomas: Clinical and Epidemiological: Prospective Clinical Trials in Mantle Cell Lymphoma Incorporating Novel Agents
December 11, 2023
11:00 PST
Location: Grand Hall B (Manchester Grand Hyatt San Diego)

Hawkes, EA

TrAVeRse: A Phase 2, Open-Label, Randomized Study of Acalabrutinib in Combination with Venetoclax and Rituximab in Patients with Treatment- naïve Mantle Cell Lymphoma

 

Abstract # 3054
Poster Session: 623. Mantle Cell, Follicular, and Other Indolent B-Cell Lymphomas: Clinical and Epidemiological: Poster II
December 10, 2023
18:00 - 20:00 PST
Location: Halls G-H (San Diego Convention Center)

Sharman, J

Analysis of Ventricular Arrhythmias and Sudden Death with Acalabrutinib From 5 Prospective Clinical Trials

 

 

Abstract # 4643
Poster Session: 642. Chronic Lymphocytic Leukemia: Clinical and Epidemiological: Poster III
December 11, 2023
18:00 - 20:00 PST
Location: Halls G-H (San Diego Convention Center)

Ferrajoli, A

Cumulative Review of Hypertension in Patients with Chronic Lymphocytic Leukemia (CLL) and Other Hematologic Malignancies Treated with Acalabrutinib: Data from Clinical Trials

 

 

Abstract # 1917
Poster Session: 642. Chronic Lymphocytic Leukemia: Clinical and Epidemiological: Poster I
December 9, 2023
17:30 - 19:30 PST
Location: Halls G-H (San Diego Convention Center)

Sun, C

Extended Follow-Up and Resistance Mutations in CLL Patients Treated with Acalabrutinib

Abstract # 1891
Poster Session: 641. Chronic Lymphocytic Leukemias: Basic and Translational: Poster I
December 9, 2023
17:30 - 19:30 PST
Location: Halls G-H (San Diego Convention Center)

Jain, P

Acalabrutinib with Rituximab as First-line Therapy for Older Patients with Mantle Cell Lymphoma – A Phase II Clinical Trial

Abstract # 3036
Poster Session: 623. Mantle Cell, Follicular, and Other Indolent B-Cell Lymphomas: Clinical and Epidemiological: Poster II
December 10, 2023
18:00 - 20:00 PST
Location: Halls G-H (San Diego Convention Center)

Perini, G

ACRUE: A Phase 2, Open-label Study of Acalabrutinib in Combination with Rituximab in Elderly and/or Frail Patients with Treatment-naïve Diffuse Large B-Cell Lymphoma

e-Publication
Online Only

AZD0486

 

Gaballa, S

Double Step-Up Dosing (2SUD) Regimen Mitigates Severe ICANS and CRS While Maintaining a High Efficacy in Subjects with Relapsed/Refractory (R/R) B-cell Non-Hodgkin Lymphoma (NHL) Treated with AZD0486, a Novel CD19xCD3 T-cell Engager (TCE): Updated Safety and Efficacy Data from the Ongoing First-in-Human (FIH) Phase I Trial

Abstract # 1662
Poster Session: 623. Mantle Cell, Follicular, and Other Indolent B-Cell Lymphomas: Clinical and Epidemiological: Poster I
December 9, 2023
17:30 - 19:30 PST
Location: Halls G-H (San Diego Convention Center)

AZD9829

Dutta, D

First Disclosure of AZD9829, a TOP1i-ADC Targeting CD123: Promising Preclinical Activity in AML Models with Minimal Effect on Healthy Progenitors

e-Publication
Online Only

 

AZD7789

Mei, M

Safety and Preliminary Efficacy of Sabestomig (AZD7789), an Anti-PD-1 and Anti-TIM-3 Bispecific Antibody, in Patients with Relapsed or Refractory Classical Hodgkin Lymphoma Previously Treated with Anti-PD-(L)1 Therapy

 

Abstract # 4433
Poster Session: 624. Hodgkin Lymphomas and T/NK cell Lymphomas: Clinical and Epidemiological: Poster III
December 11, 2023
18:00 - 20:00 PST
Location: Halls G-H (San Diego Convention Center)

PRMT5 inhibitor

Urosevic, J

Epigenetic Silencing of MTAP in Hodgkin’s Lymphoma Renders it Sensitive to a 2nd Generation PRMT5 Inhibitor

 

Abstract # 4185
Poster Session: 605. Molecular Pharmacology and Drug Resistance: Lymphoid Neoplasms: Poster III
December 11, 2023
18:00 - 20:00 PST
Location: Halls G-H (San Diego Convention Center)

Danicopan

Kulasekararaj, A

Danicopan as Add-On Therapy to Ravulizumab or Eculizumab Versus Placebo in Patients with Paroxysmal Nocturnal Hemoglobinuria and Clinically Significant Extravascular Hemolysis: Phase 3 Long-term Data

Abstract # 576
Oral Session: 508. Bone Marrow Failure: Acquired: Unraveling the Future of PNH Therapy from Clinical Trials
December 10, 2023
17:45 PST
Location: Room 7 (San Diego Convention Center)

Piatek, C

Patient-reported Outcomes: Danicopan as Add-On Therapy to Ravulizumab or Eculizumab Versus Placebo in Patients with Paroxysmal Nocturnal Hemoglobinuria and Clinically Significant Extravascular Hemolysis

Abstract # 1346
Poster Session: 508. Bone Marrow Failure: Acquired: Poster I
December 9, 2023
17:30 - 19:30 PST
Location: Halls G-H (San Diego Convention Center)

ULTOMIRIS (ravulizumab-cwvz)

Kulasekararaj, A

Ravulizumab Provides Durable Control of Intravascular Hemolysis and Improves Survival in Patients with Paroxysmal Nocturnal Hemoglobinuria: Long-Term Follow-Up of Study 301 and Comparisons with Patients of the International PNH Registry

Abstract # 2714
Poster Session: 508. Bone Marrow Failure: Acquired: Poster II
December 10, 2023
18:00 - 20:00 PST
Location: Halls G-H (San Diego Convention Center)

Röth, A

Ravulizumab Effectiveness in the Real-world: Evidence from the International PNH Registry

Abstract # 2722
Poster Session: 508. Bone Marrow Failure: Acquired: Poster II
December 10, 2023
18:00 - 20:00 PST
Location: Halls G-H (San Diego Convention Center)

Piatek, C

Efficacy and Safety of Subcutaneous Ravulizumab in Patients with Paroxysmal Nocturnal Hemoglobinuria Who Received Prior Intravenous Eculizumab: 2-Year Follow-Up

Abstract # 2713
Poster Session: 508. Bone Marrow Failure: Acquired: Poster II
December 10, 2023
18:00 - 20:00 PST
Location: Halls G-H (San Diego Convention Center)

CAEL-101

Valent, J

Safety and Tolerability of CAEL-101, an Anti-Amyloid Monoclonal Antibody, Combined with Anti-Plasma Cell Dyscrasia Therapy in Patients with Light-Chain Amyloidosis: 24-Month Results of a Phase 2 Study

Abstract # 540
Oral Session: 654. MGUS, Amyloidosis and Other Non-Myeloma Plasma Cell Dyscrasias: Clinical and Epidemiological: From Light Chain to Fibril–Novel Diagnostics to Treatments for Amyloidosis
December 10, 2023
13:15 PST
Location: Seaport Ballroom EFGH (Manchester Grand Hyatt San Diego)

Costello, M

CAEL-101 Enhances the Clearance of Light Chain Fibrils and Intermediate Aggregates by Phagocytosis

Abstract # 3307
Poster Session: 651. Multiple Myeloma and Plasma Cell Dyscrasias: Basic and Translational: Poster II
December 10, 2023
18:00 - 20:00 PST
Location: Halls G-H (San Diego Convention Center)

AL Amyloidosis

Lyons, G

Treatment Patterns and Outcomes for Patients with Light Chain (AL) Amyloidosis: Analysis of a Large US Claims Database

e-Publication
Online Only

Thompson, J

Real-world Treatment Patterns Following Update to National Comprehensive Cancer Network Guidelines for Light-Chain Amyloidosis: Results from a US Administrative Claims Database

e-Publication
Online Only

Laires, P

Prevalence, Incidence, and Characterization of Light Chain Amyloidosis in the USA: A Real-world Analysis Utilizing Electronic Health Records (EHR)

e-Publication
Online Only

aHUS

Wang, Y

Patient Characteristics and Diagnostic Journey of Thrombotic Microangiopathy Associated with a Trigger: A Real-world, Retrospective, Multi-national Study

e-Publication
Online Only

HSCT-TMA

Wang, Y

Real-World Analysis of the Underdiagnosis, Clinical Outcomes and Associated Burden of Hematopoietic Stem Cell Transplantation-Associated Thrombotic Microangiopathy (HSCT-TMA) in the United States of America

Abstract # 491
Oral Session: 904. Outcomes Research – Non-Malignant Conditions: What to Know: Management Costs and Outcomes in Various Non-Malignant Disorders
December 10, 2023
10:30 PST
Location: Pacific Ballroom Salons 15-17 (Marriott Marquis San Diego Marina)

PNH

Wagner-Ballon, O

Neutrophil PNH Type II Cells Are Associated with Thrombosis and Bone Marrow Failure Without Hemolysis: Evidence from Analysis of the 5-year French Nation-Wide Multicenter Observational Study

Abstract # 4083
Poster Session: 508. Bone Marrow Failure: Acquired: Poster III
December 11, 2023
18:00 - 20:00 PST
Location: Halls G-H (San Diego Convention Center)

INDICATIONS AND USAGE

CALQUENCE is a Bruton tyrosine kinase (BTK) inhibitor indicated for the treatment of adult patients with mantle cell lymphoma (MCL) who have received at least one prior therapy.

This indication is approved under accelerated approval based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

CALQUENCE is also indicated for the treatment of adult patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL).

IMPORTANT SAFETY INFORMATION ABOUT CALQUENCE® (acalabrutinib) tablets

Serious and Opportunistic Infections

Fatal and serious infections, including opportunistic infections, have occurred in patients with hematologic malignancies treated with CALQUENCE.

Serious or Grade 3 or higher infections (bacterial, viral, or fungal) occurred in 19% of 1029 patients exposed to CALQUENCE in clinical trials, most often due to respiratory tract infections (11% of all patients, including pneumonia in 6%). These infections predominantly occurred in the absence of Grade 3 or 4 neutropenia, with neutropenic infection reported in 1.9% of all patients. Opportunistic infections in recipients of CALQUENCE have included, but are not limited to, hepatitis B virus reactivation, fungal pneumonia, Pneumocystis jirovecii pneumonia, Epstein-Barr virus reactivation, cytomegalovirus, and progressive multifocal leukoencephalopathy (PML). Consider prophylaxis in patients who are at increased risk for opportunistic infections. Monitor patients for signs and symptoms of infection and treat promptly.

Hemorrhage

Fatal and serious hemorrhagic events have occurred in patients with hematologic malignancies treated with CALQUENCE. Major hemorrhage (serious or Grade 3 or higher bleeding or any central nervous system bleeding) occurred in 3.0% of patients, with fatal hemorrhage occurring in 0.1% of 1029 patients exposed to CALQUENCE in clinical trials. Bleeding events of any grade, excluding bruising and petechiae, occurred in 22% of patients.

Use of antithrombotic agents concomitantly with CALQUENCE may further increase the risk of hemorrhage. In clinical trials, major hemorrhage occurred in 2.7% of patients taking CALQUENCE without antithrombotic agents and 3.6% of patients taking CALQUENCE with antithrombotic agents. Consider the risks and benefits of antithrombotic agents when co-administered with CALQUENCE. Monitor patients for signs of bleeding.

Consider the benefit-risk of withholding CALQUENCE for 3-7 days pre- and post-surgery depending upon the type of surgery and the risk of bleeding.

Cytopenias

Grade 3 or 4 cytopenias, including neutropenia (23%), anemia (8%), thrombocytopenia (7%), and lymphopenia (7%), developed in patients with hematologic malignancies treated with CALQUENCE. Grade 4 neutropenia developed in 12% of patients. Monitor complete blood counts regularly during treatment. Interrupt treatment, reduce the dose, or discontinue treatment as warranted.

Second Primary Malignancies

Second primary malignancies, including skin cancers and other solid tumors, occurred in 12% of 1029 patients exposed to CALQUENCE in clinical trials. The most frequent second primary malignancy was skin cancer, reported in 6% of patients.  Monitor patients for skin cancers and advise protection from sun exposure.

Atrial Fibrillation and Flutter

Grade 3 atrial fibrillation or flutter occurred in 1.1% of 1029 patients treated with CALQUENCE, with all grades of atrial fibrillation or flutter reported in 4.1% of all patients. The risk may be increased in patients with cardiac risk factors, hypertension, previous arrhythmias, and acute infection. Monitor for symptoms of arrhythmia (eg, palpitations, dizziness, syncope, dyspnea) and manage as appropriate.

ADVERSE REACTIONS

The most common adverse reactions (≥20%) of any grade in patients with relapsed or refractory MCL were anemia,* thrombocytopenia,* headache (39%), neutropenia,* diarrhea (31%), fatigue (28%), myalgia (21%), and bruising (21%). The most common Grade ≥3 non-hematological adverse reaction (reported in at least 2% of patients) was diarrhea (3.2%).

*Treatment-emergent decreases (all grades) of hemoglobin (46%), platelets (44%), and neutrophils (36%) were based on laboratory measurements and adverse reactions.

Dose reductions or discontinuations due to any adverse reaction were reported in 1.6% and 6.5% of patients, respectively. Increases in creatinine to 1.5 to 3 times the upper limit of normal (ULN) occurred in 4.8% of patients.

The most common adverse reactions (≥30%) of any grade in patients with CLL were anemia,* neutropenia,* thrombocytopenia,* headache, upper respiratory tract infection, and diarrhea.

*Treatment-emergent decreases (all grades) of hemoglobin, platelets, and neutrophils were based on laboratory measurements and adverse reactions.

In patients with previously untreated CLL exposed to CALQUENCE, fatal adverse reactions that occurred in the absence of disease progression and with onset within 30 days of the last study treatment were reported in 2% for each treatment arm, most often from infection. Serious adverse reactions were reported in 39% of patients in the CALQUENCE plus obinutuzumab arm and 32% in the CALQUENCE monotherapy arm, most often due to events of pneumonia (7% and 2.8%, respectively).

Adverse reactions led to CALQUENCE dose reduction in 7% and 4% of patients in the CALQUENCE plus obinutuzumab arm (N=178) and CALQUENCE monotherapy arm (N=179), respectively. Adverse events led to discontinuation in 11% and 10% of patients, respectively. Increases in creatinine to 1.5 to 3 times ULN occurred in 3.9% and 2.8% of patients in the CALQUENCE combination arm and monotherapy arm, respectively.

In patients with relapsed/refractory CLL exposed to CALQUENCE, serious adverse reactions occurred in 29% of patients. Serious adverse reactions in >5% of patients who received CALQUENCE included lower respiratory tract infection (6%). Fatal adverse reactions within 30 days of the last dose of CALQUENCE occurred in 2.6% of patients, including from second primary malignancies and infection.

Adverse reactions led to CALQUENCE dose reduction in 3.9% of patients (N=154), dose interruptions in 34% of patients, most often due to respiratory tract infections followed by neutropenia, and discontinuation in 10% of patients, most frequently due to second primary malignancies followed by infection. Increases in creatinine to 1.5 to 3 times ULN occurred in 1.3% of patients who received CALQUENCE.

DRUG INTERACTIONS

Strong CYP3A Inhibitors: Avoid co-administration of CALQUENCE with a strong CYP3A inhibitor. If these inhibitors will be used short-term, interrupt CALQUENCE. After discontinuation of strong CYP3A inhibitor for at least 24 hours, resume previous dosage of CALQUENCE.

Moderate CYP3A Inhibitors: Reduce the dosage of CALQUENCE to 100 mg once daily when co-administered with a moderate CYP3A inhibitor.

Strong CYP3A Inducers: Avoid co-administration of CALQUENCE with a strong CYP3A inducer. If co-administration is unavoidable, increase the dosage of CALQUENCE to 200 mg approximately every 12 hours.

SPECIFIC POPULATIONS

Based on findings in animals, CALQUENCE may cause fetal harm and dystocia when administered to a pregnant woman. There are no available data in pregnant women to inform the drug-associated risk. Advise pregnant women of the potential risk to a fetus.

Pregnancy testing is recommended for females of reproductive potential prior to initiating CALQUENCE therapy. Advise female patients of reproductive potential to use effective contraception during treatment with CALQUENCE and for 1 week following the last dose of CALQUENCE.

It is not known if CALQUENCE is present in human milk. Advise lactating women not to breastfeed while taking CALQUENCE and for 2 weeks after the last dose.

Avoid use of CALQUENCE in patients with severe hepatic impairment (Child-Pugh class C). No dosage adjustment of CALQUENCE is recommended in patients with mild (Child-Pugh class A) or moderate (Child-Pugh class B) hepatic impairment.

Please see full Prescribing Information, including Patient Information.

INDICATION(S) & IMPORTANT SAFETY INFORMATION for ULTOMIRIS® (ravulizumab-cwvz)

What is ULTOMIRIS?

ULTOMIRIS is a prescription medicine used to treat:

  • adults and children 1 month of age and older with a disease called Paroxysmal Nocturnal Hemoglobinuria (PNH).
  • adults and children 1 month of age and older with a disease called atypical Hemolytic Uremic Syndrome (aHUS). ULTOMIRIS is not used in treating people with Shiga toxin E. coli related hemolytic uremic syndrome (STEC-HUS).
  • adults with a disease called generalized Myasthenia Gravis (gMG) who are anti-acetylcholine receptor (AChR) antibody positive.
  • adults with PNH or aHUS when administered subcutaneously (under your skin).

It is not known if ULTOMIRIS is safe and effective in children younger than 1 month of age.

It is not known if ULTOMIRIS is safe and effective for the treatment of gMG in children.

Subcutaneous administration of ULTOMIRIS has not been evaluated and is not approved for use in children.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about ULTOMIRIS?

ULTOMIRIS is a medicine that affects your immune system and can lower the ability of your immune system to fight infections.

  • ULTOMIRIS increases your chance of getting serious and life-threatening meningococcal infections that may quickly become life-threatening and cause death if not recognized and treated early.

1.     You must receive meningococcal vaccines at least 2 weeks before your first dose of ULTOMIRIS if you are not vaccinated.

2.     If your healthcare provider decided that urgent treatment with ULTOMIRIS is needed, you should receive meningococcal vaccination as soon as possible.

3.     If you have not been vaccinated and ULTOMIRIS therapy must be initiated immediately, you should also receive 2 weeks of antibiotics with your vaccinations.

4.     If you had a meningococcal vaccine in the past, you might need additional vaccination. Your healthcare provider will decide if you need additional vaccination.

5.     Meningococcal vaccines reduce but do not prevent all meningococcal infections. Call your healthcare provider or get emergency medical care right away if you get any of these signs and symptoms of a meningococcal infection: headache with nausea or vomiting, headache and fever, headache with a stiff neck or stiff back, fever, fever and a rash, confusion, muscle aches with flu-like symptoms and eyes sensitive to light.

Your healthcare provider will give you a Patient Safety Card about the risk of meningococcal infection. Carry it with you at all times during treatment and for 8 months after your last ULTOMIRIS dose. It is important to show this card to any healthcare provider or nurse to help them diagnose and treat you quickly.

ULTOMIRIS is only available through a program called the ULTOMIRIS REMS. Before you can receive ULTOMIRIS, your healthcare provider must: enroll in the ULTOMIRIS REMS program; counsel you about the risk of meningococcal infection; give you information and a Patient Safety Card about the symptoms and your risk of meningococcal infection (as discussed above); and make sure that you are vaccinated with a meningococcal vaccine, and if needed, get revaccinated with the meningococcal vaccine. Ask your healthcare provider if you are not sure if you need to be revaccinated.

ULTOMIRIS may also increase the risk of other types of serious infections. Make sure your child receives vaccinations against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) if treated with ULTOMIRIS. Call your healthcare provider right away if you have any new signs or symptoms of infection.

Who should not receive ULTOMIRIS?

Do not receive ULTOMIRIS if you have a meningococcal infection or have not been vaccinated against meningococcal infection unless your healthcare provider decides that urgent treatment with ULTOMIRIS is needed.

Before you receive ULTOMIRIS, tell your healthcare provider about all of your medical conditions, including if you: have an infection or fever, are pregnant or plan to become pregnant, and are breastfeeding or plan to breastfeed. It is not known if ULTOMIRIS will harm your unborn baby or if it passes into your breast milk. You should not breastfeed during treatment and for 8 months after your final dose of ULTOMIRIS.

Tell your healthcare provider about all the vaccines you receive and medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements which could affect your treatment.

If you have PNH and you stop receiving ULTOMIRIS, your healthcare provider will need to monitor you closely for at least 16 weeks after you stop ULTOMIRIS. Stopping ULTOMIRIS may cause breakdown of your red blood cells due to PNH. Symptoms or problems that can happen due to red blood cell breakdown include: drop in your red blood cell count, tiredness, blood in your urine, stomach-area (abdomen) pain, shortness of breath, blood clots, trouble swallowing, and erectile dysfunction (ED) in males.

If you have aHUS, your healthcare provider will need to monitor you closely for at least 12 months after stopping treatment for signs of worsening aHUS or problems related to a type of abnormal clotting and breakdown of your red blood cells called thrombotic microangiopathy (TMA). Symptoms or problems that can happen with TMA may include: confusion or loss of consciousness, seizures, chest pain (angina), difficulty breathing and blood clots or stroke.

ULTOMIRIS can cause serious side effects including allergic reactions to acrylic adhesive. Allergic reactions to the acrylic adhesive may happen with your subcutaneous ULTOMIRIS treatment. If you have an allergic reaction during the delivery of subcutaneous ULTOMIRIS, remove the on-body injector and get medical help right away. Your healthcare provider may treat you with medicines to help prevent or treat allergic reaction symptoms as needed.

What are the possible side effects of ULTOMIRIS?

ULTOMIRIS can cause serious side effects including infusion-related reactions. Symptoms of an infusion-related reaction with ULTOMIRIS may include lower back pain, tiredness, feeling faint, discomfort in your arms or legs, bad taste, or drowsiness. Stop treatment of ULTOMIRIS and tell your healthcare provider or nurse right away if you develop these symptoms, or any other symptoms during your ULTOMIRIS infusion that may mean you are having a serious infusion reaction, including: chest pain, trouble breathing or shortness of breath, swelling of your face, tongue, or throat, and feel faint or pass out.

The most common side effects of ULTOMIRIS in people treated for PNH are upper respiratory tract infection and headache.

The most common side effects of ULTOMIRIS in people treated for aHUS are upper respiratory tract infection, diarrhea, nausea, vomiting, headache, high blood pressure and fever.

The most common side effects of ULTOMIRIS in people with gMG are diarrhea and upper respiratory tract infections.

The most common side effects of subcutaneous administration of ULTOMIRIS in adults treated for PNH and aHUS are local injection site reactions.

Tell your healthcare provider about any side effect that bothers you or that does not go away. These are not all the possible side effects of ULTOMIRIS. For more information, ask your healthcare provider or pharmacist. Call your healthcare provider right away if you miss an ULTOMIRIS infusion or for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Read the Instructions for Use that comes with subcutaneous ULTOMIRIS for instructions about the right way to prepare and give your subcutaneous ULTOMIRIS injections through an on-body injector.

Please see the accompanying full Prescribing Information and Medication Guide for ULTOMIRIS, including Boxed WARNING regarding serious and life-threatening meningococcal infections/sepsis. Please see the accompanying Instructions for Use for the ULTOMIRIS On Body Delivery System.

INDICATIONS & IMPORTANT SAFETY INFORMATION FOR SOLIRIS® (eculizumab) [injection for intravenous use 300mg/30mL vial]

What is SOLIRIS?

SOLIRIS is a prescription medicine used to treat:

  • patients with a disease called Paroxysmal Nocturnal Hemoglobinuria (PNH).
  • adults and children with a disease called atypical Hemolytic Uremic Syndrome (aHUS). SOLIRIS is not for use in treating people with Shiga toxin E. coli related hemolytic uremic syndrome (STEC-HUS).
  • adults with a disease called generalized myasthenia gravis (gMG) who are anti-acetylcholine receptor (AChR) antibody positive.
  • adults with a disease called neuromyelitis optica spectrum disorder (NMOSD) who are anti-aquaporin-4 (AQP4) antibody positive.

It is not known if SOLIRIS is safe and effective in children with PNH, gMG, or NMOSD.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about SOLIRIS?

SOLIRIS is a medicine that affects your immune system and can lower the ability of your immune system to fight infections.

  • SOLIRIS increases your chance of getting serious and life-threatening meningococcal infections that may quickly become life-threatening and cause death if not recognized and treated early.
  • You must receive meningococcal vaccines at least 2 weeks before your first dose of SOLIRIS if you are not vaccinated.
  • If your doctor decided that urgent treatment with SOLIRIS is needed, you should receive meningococcal vaccination as soon as possible.
  • If you have not been vaccinated and SOLIRIS therapy must be initiated immediately, you should also receive 2 weeks of antibiotics with your vaccinations.
  • If you had a meningococcal vaccine in the past, you might need additional vaccination. Your doctor will decide if you need additional vaccination.
  • Meningococcal vaccines reduce but do not prevent all meningococcal infections. Call your doctor or get emergency medical care right away if you get any of these signs and symptoms of a meningococcal infection: headache with nausea or vomiting, headache and fever, headache with a stiff neck or stiff back, fever, fever and a rash, confusion, muscle aches with flu-like symptoms, and eyes sensitive to light.

Your doctor will give you a Patient Safety Card about the risk of meningococcal infection. Carry it with you at all times during treatment and for 3 months after your last SOLIRIS dose. It is important to show this card to any doctor or nurse to help them diagnose and treat you quickly.

SOLIRIS is only available through a program called the SOLIRIS REMS. Before you can receive SOLIRIS, your doctor must enroll in the SOLIRIS REMS program; counsel you about the risk of meningococcal infection; give you information and a Patient Safety Card about the symptoms and your risk of meningococcal infection (as discussed above); and make sure that you are vaccinated with the meningococcal vaccine and, if needed, get revaccinated with the meningococcal vaccine. Ask your doctor if you are not sure if you need to be revaccinated.

SOLIRIS may also increase the risk of other types of serious infections. Make sure your child receives vaccinations against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) if treated with SOLIRIS. Certain people may be at risk of serious infections with gonorrhea. Certain fungal infections (Aspergillus) may occur if you take SOLIRIS and have a weak immune system or a low white blood cell count.

Who should not receive SOLIRIS?

Do not receive SOLIRIS if you have a meningococcal infection or have not been vaccinated against meningitis infection unless your doctor decides that urgent treatment with SOLIRIS is needed.

Before you receive SOLIRIS, tell your doctor about all of your medical conditions, including if you: have an infection or fever, are pregnant or plan to become pregnant, and are breastfeeding or plan to breastfeed. It is not known if SOLIRIS will harm your unborn baby or if it passes into your breast milk.

Tell your doctor about all the vaccines you receive and medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements which could affect your treatment. It is important that you have all recommended vaccinations before you start SOLIRIS, receive 2 weeks of antibiotics if you immediately start SOLIRIS, and stay up-to-date with all recommended vaccinations during treatment with SOLIRIS.

If you have PNH, your doctor will need to monitor you closely for at least 8 weeks after stopping SOLIRIS. Stopping treatment with SOLIRIS may cause breakdown of your red blood cells due to PNH. Symptoms or problems that can happen due to red blood cell breakdown include: drop in the number of your red blood cell count, drop in your platelet count, confusion, kidney problems, blood clots, difficulty breathing, and chest pain.

If you have aHUS, your doctor will need to monitor you closely during and for at least 12 weeks after stopping treatment for signs of worsening aHUS symptoms or problems related to abnormal clotting (thrombotic microangiopathy). Symptoms or problems that can happen with abnormal clotting may include: stroke, confusion, seizure, chest pain (angina), difficulty breathing, kidney problems, swelling in arms or legs, and a drop in your platelet count.

What are the possible side effects of SOLIRIS?

SOLIRIS can cause serious side effects including serious infusion-related reactions. Tell your doctor or nurse right away if you get any of these symptoms during your SOLIRIS infusion: chest pain; trouble breathing or shortness of breath; swelling of your face, tongue, or throat; and feel faint or pass out. If you have an infusion-related reaction to SOLIRIS, your doctor may need to infuse SOLIRIS more slowly, or stop SOLIRIS.

The most common side effects in people with PNH treated with SOLIRIS include: headache, pain or swelling of your nose or throat (nasopharyngitis), back pain, and nausea.

The most common side effects in people with aHUS treated with SOLIRIS include: headache, diarrhea, high blood pressure (hypertension), common cold (upper respiratory infection), stomach-area (abdominal) pain, vomiting, pain or swelling of your nose or throat (nasopharyngitis), low red blood cell count (anemia), cough, swelling of legs or feet (peripheral edema), nausea, urinary tract infections, and fever.

The most common side effects in people with gMG treated with SOLIRIS include: muscle and joint (musculoskeletal) pain.

The most common side effects in people with NMOSD treated with SOLIRIS include: common cold (upper respiratory infection); pain or swelling of your nose or throat (nasopharyngitis); diarrhea; back pain; dizziness; flu-like symptoms (influenza), including fever, headache, tiredness, cough, sore throat, and body aches; joint pain (arthralgia); throat irritation (pharyngitis); and bruising (contusion).

Tell your doctor about any side effect that bothers you or that does not go away. These are not all the possible side effects of SOLIRIS. For more information, ask your doctor or pharmacist. Call your doctor for medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch, or call 1-800-FDA-1088.

Please see the full Prescribing Information and Medication Guide for SOLIRIS, including Boxed WARNING regarding serious and life-threatening meningococcal infections.

CALQUENCE® (acalabrutinib)

CALQUENCE® (acalabrutinib) is a next-generation, selective inhibitor of Bruton’s tyrosine kinase (BTK). CALQUENCE binds covalently to BTK, thereby inhibiting its activity.17,18 In B cells, BTK signaling results in activation of pathways necessary for B-cell proliferation, trafficking, chemotaxis and adhesion.

CALQUENCE has been used to treat 50,000 patients worldwide and is approved in the US for the treatment of CLL and SLL and for the treatment of adult patients with MCL who have received at least one prior therapy.17 CALQUENCE is approved for CLL in the EU and many other countries worldwide and approved in Japan for relapsed or refractory CLL and SLL.

As part of an extensive clinical development program, AstraZeneca is currently evaluating CALQUENCE in more than 20 company-sponsored clinical trials. CALQUENCE is being evaluated for the treatment of multiple B-cell blood cancers, including CLL, MCL, diffuse large B-cell lymphoma, Waldenström’s macroglobulinemia, marginal zone lymphoma and other hematologic malignancies.

ULTOMIRIS® (ravulizumab-cwvz)

ULTOMIRIS® (ravulizumab-cwvz), the first and only long-acting C5 complement inhibitor, provides immediate, complete and sustained complement inhibition. The medication works by inhibiting the C5 protein in the terminal complement cascade, a part of the body’s immune system. When activated in an uncontrolled manner, the complement cascade over-responds, leading the body to attack its own healthy cells. ULTOMIRIS is administered intravenously every eight weeks in adult patients, following a loading dose.

ULTOMIRIS is approved in the US, EU and Japan for the treatment of certain adults with generalized myasthenia gravis (gMG).

ULTOMIRIS is also approved in the US, EU and Japan for the treatment of certain adults with PNH and for certain children with PNH in the US and EU.

Additionally, ULTOMIRIS is approved in the US, EU and Japan for certain adults and children with aHUS to inhibit complement-mediated thrombotic microangiopathy.

Further, ULTOMIRIS is approved in the EU and Japan for the treatment of certain adults with neuromyelitis optica spectrum disorder (NMOSD).

As part of a broad development program, ULTOMIRIS is being assessed for the treatment of additional hematology and neurology indications.

SOLIRIS® (eculizumab)

SOLIRIS® (eculizumab) is a first-in-class C5 complement inhibitor. The medication works by inhibiting the C5 protein in the terminal complement cascade, a part of the body’s immune system. When activated in an uncontrolled manner, the terminal complement cascade over-responds, leading the body to attack its own healthy cells. SOLIRIS is administered intravenously every two weeks, following an introductory dosing period.

SOLIRIS is approved in the US, EU, Japan and China for the treatment of patients with PNH and aHUS.

Additionally, SOLIRIS is approved in Japan and the EU for the treatment of certain adult and pediatric patients with gMG and in the US and China for certain adults with gMG.

Further, SOLIRIS is approved in the US, EU, Japan and China for the treatment of certain adults with NMOSD.

SOLIRIS is not indicated for the treatment of patients with Shiga-toxin E. coli-related hemolytic uremic syndrome.

AstraZeneca in hematology
AstraZeneca is pushing the boundaries of science to redefine care in hematology. We have expanded our commitment to patients with hematologic conditions, not only in oncology but also in rare diseases with the acquisition of Alexion, allowing us to reach more patients with high unmet needs. By applying our deep understanding of blood cancers, leveraging our strength in solid tumor oncology and delivering on Alexion’s pioneering legacy in complement science to provide innovative medicines for rare diseases, we are pursuing the end-to-end development of novel therapies designed to target underlying drivers of disease.

By targeting hematologic conditions with high unmet medical needs, we aim to deliver innovative medicines and approaches to improve patient outcomes. Our goal is to help transform the lives of patients living with malignant, rare and other related hematologic diseases, shaped by insights from patients, caregivers and physicians to have the most meaningful impact.

AstraZeneca in oncology
AstraZeneca is leading a revolution in oncology with the ambition to provide cures for cancer in every form, following the science to understand cancer and all its complexities to discover, develop and deliver life-changing medicines to patients.

The Company’s focus is on some of the most challenging cancers. It is through persistent innovation that AstraZeneca has built one of the most diverse portfolios and pipelines in the industry, with the potential to catalyze changes in the practice of medicine and transform the patient experience.

AstraZeneca has the vision to redefine cancer care and, one day, eliminate cancer as a cause of death.

Alexion
Alexion, AstraZeneca Rare Disease, is the group within AstraZeneca focused on rare diseases, created following the 2021 acquisition of Alexion Pharmaceuticals, Inc. As a leader in rare diseases for more than 30 years, Alexion is focused on serving patients and families affected by rare diseases and devastating conditions through the discovery, development and commercialization of life-changing medicines. Alexion focuses its research efforts on novel molecules and targets in the complement cascade and its development efforts on hematology, nephrology, neurology, metabolic disorders, cardiology and ophthalmology. Headquartered in Boston, Massachusetts, Alexion has offices around the globe and serves patients in more than 50 countries.

AstraZeneca
AstraZeneca (LSE/STO/Nasdaq: AZN) is a global, science-led biopharmaceutical company that focuses on the discovery, development, and commercialization of prescription medicines in Oncology, Rare Diseases and BioPharmaceuticals, including Cardiovascular, Renal & Metabolism, and Respiratory & Immunology. Based in Cambridge, UK, AstraZeneca operates in over 100 countries and its innovative medicines are used by millions of patients worldwide. Please visit www.astrazeneca-us.com and follow the Company on social media @AstraZeneca.

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References

1.     Sharman JP, Egyed M, Jurczak J, et al. Acalabrutinib ± Obinutuzumab vs Obinutuzumab + Chlorambucil in Treatment-naive Chronic Lymphocytic Leukemia: 6-year Follow-up of ELEVATE-TN. Presented at: American Society of Hematology (ASH) Annual Meeting and Exposition 2023; December 9-12, 2023; San Diego, CA. Abs 636.

2.     Hawkes EA, Lee ST, Churilov L, et al. A Window Study of Acalabrutinib, Rituximab, Followed by Chemotherapy and Autograft (ASCT) in Fit Patients with Treatment-naïve Mantle Cell Lymphoma (MCL): The Investigator-led Australasian Leukemia and Lymphoma Group NHL33 ‘WAMM’ Trial. Presented at: American Society of Hematology (ASH) Annual Meeting and Exposition 2023; December 9-12, 2023; San Diego, CA. Abs 735.

3.     Sharman JP, Ghia P, Miranda P, et al. Analysis of Ventricular Arrhythmias and Sudden Death with Acalabrutinib From 5 Prospective Clinical Trials. Presented at: American Society of Hematology (ASH) Annual Meeting and Exposition 2023; December 9-12, 2023; San Diego, CA. Abs 4643.

4.     Gaballa S, Nair R, Jacobs R, et al. Double step-up dosing (2SUD) regimen mitigates severe ICANS and CRS while maintaining high efficacy in subjects with relapsed/refractory (R/R) B-cell Non-Hodgkin Lymphoma (NHL) Treated with AZD0486, a Novel CD19xCD3 T-cell Engager (TCE): Updated Safety and Efficacy data from the Ongoing First-in-human (FIH) Phase 1 trial. Presented at: American Society of Hematology (ASH) Annual Meeting and Exposition 2023; December 9-12, 2023; San Diego, CA. Abs 1662.

5.     Mei M, Corazzelli G, Morschhauser F, et al. Safety and Preliminary Efficacy of Sabestomig (AZD7789), an Anti-PD-1 and Anti-TIM-3 Bispecific Antibody, in Patients with Relapsed or Refractory Classical Hodgkin Lymphoma Previously Treated with Anti-PD-(L)1 Therapy. Presented at: American Society of Hematology (ASH) Annual Meeting and Exposition 2023; December 9-12, 2023; San Diego, CA. Abs 4433.

6.     Dutta D, Pan P, Fleming R, et al. First Disclosure of AZD9829, a TOP1i-ADC Targeting CD123: Promising Preclinical Activity in AML Models with Minimal Effect on Healthy Progenitors. Presented at American Society of Hematology (ASH) Annual Meeting and Exposition 2023; December 9-12, 2023; San Diego, California. e-Publication.

7.     Urosevic J, Lynch JT, Meyer S, et al. Epigenetic Silencing of MTAP in Hodgkin’s Lymphoma Renders it Sensitive to a 2nd Generation PRMT5 Inhibitor. Presented at: American Society of Hematology (ASH) Annual Meeting and Exposition 2023; December 9-12, 2023; San Diego, CA. Abs 4185.

8.     Kulasekararaj A, Griffin M, Piatek CI, et al. Danicopan as Add-on Therapy to Ravulizumab or Eculizumab Versus Placebo in Patients with Paroxysmal Nocturnal Hemoglobinuria and Clinically Significant Extravascular Hemolysis: Phase 3 Long-term Data. Presented at: American Society of Hematology (ASH) Congress; December 9-12, 2023; San Diego, CA. Abs 576.

9.     Piatek C, et al. Patient-Reported Outcomes: Danicopan as Add-On Therapy to Ravulizumab or Eculizumab Versus Placebo in Patients with Paroxysmal Nocturnal Hemoglobinuria and Clinically Significant Extravascular Hemolysis. Presented at: American Society of Hematology (ASH) Congress; December 9-12, 2023; San Diego, CA. Abs 1346.

10.  Kulasekararaj A, Schrezenmeier H, Usuki K, et al. Ravulizumab Provides Durable Control of Intravascular Hemolysis and Improves Survival in Patients with Paroxysmal Nocturnal Hemoglobinuria: Long-term Follow-up of Study 301 and Comparisons with Patients of the International PNH Registry. Presented at: American Society of Hematology (ASH) Congress; December 9-12, 2023; San Diego, CA. Abs 2714.

11.  Valent J, Liedtke M, Zonder JA, et al. Safety and Tolerability of CAEL-101, an Anti-Amyloid Monoclonal Antibody, Combined with Anti-Plasma Cell Dyscrasia Therapy in Patients with Light-Chain Amyloidosis: 24-Month Results of a Phase 2 Study. Presented at: American Society of Hematology (ASH) Congress; December 9-12, 2023; San Diego, CA. Abs 540.

12.  Lyons G, et al. Treatment Patterns and Outcomes for Patients with Light Chain (AL) Amyloidosis: Analysis of a Large US Claims Database. Presented at: American Society of Hematology (ASH) Congress; December 9-12, 2023; San Diego, CA.

13.  Thompson J, et al. Real-world Treatment Patterns Following Update to National Comprehensive Cancer Network Guidelines for Light-Chain Amyloidosis: Results from a US Administrative Claims Database. Presented at: American Society of Hematology (ASH) Congress; December 9-12, 2023; San Diego, CA.

14.  Laires P, et al. Prevalence, Incidence, and Characterization of Light Chain Amyloidosis in the USA: A Real-world Analysis Utilizing Electronic Health Records (EHR). Presented at: American Society of Hematology (ASH) Congress; December 9-12, 2023; San Diego, CA.

15.  Wang Y, et al. Patient Characteristics and Diagnostic Journey of Thrombotic Microangiopathy Associated with a Trigger: A Real-world, Retrospective, Multi-National Study. Presented at: American Society of Hematology (ASH) Congress; December 9-12, 2023; San Diego, CA.

16.  Wang Y, Rava A, Smuzynski M, et al. Real-world Analysis of the Underdiagnosis, Clinical Outcomes and Associated Burden of Hematopoietic Stem Cell Transplantation-associated Thrombotic Microangiopathy (HSCT-TMA) in the United States of America. Presented at: American Society of Hematology (ASH) Congress; December 9-12, 2023; San Diego, CA. Abs 491.

17.  CALQUENCE® (acalabrutinib) [prescribing information]. Wilmington, DE; AstraZeneca Pharmaceuticals LP; 2022.

18.  Wu J, Zhang M, Liu D. Acalabrutinib (ACP-196): a selective second-generation BTK inhibitor. J Hematol Oncol. 2016;9(21).

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In a recent article published in Scientific Reportsresearchers explored the applicability of machine learning (ML) approaches and using digital traces from social media to develop and test an early alert indicator and trend forecasting model for pandemic situations in Germany.

Study: Development of an early alert model for pandemic situations in Germany. Image Credit: Corona Borealis Studio/Shutterstock.comStudy: Development of an early alert model for pandemic situations in Germany. Image Credit: Corona Borealis Studio/Shutterstock.com

Background

In early 2020, when the first severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) outbreak occurred in China, healthcare systems of several countries were not ready to handle the ensuing pandemic. 

Delayed measures to prevent its onward spread were either not taken or taken too late due to the lack of an early warning system (EWS), which resulted in three million positive cases of coronavirus disease 2019 (COVID-19) worldwide. The unprecedented COVID-19 pandemic raised the urgent need to increase the preparedness of global healthcare systems.

Responding to this, the Artificial Intelligence Tools for Outbreak Detection and Response (AIOLOS), a French-German collaboration, tested several ML modeling approaches to support the development of an EWS utilizing Google Trends and Twitter data on COVID-19 symptoms to forecast up-trends in conventional surveillance data, such as reports from healthcare facilities or public health agencies.

The challenge with such systems is the lack of fully automated and digital data recorded in real-time for analysis and prompt countermeasures during a pandemic. 

About the study

Thus, in the present study, researchers used social media data, particularly from Google Trends and Twitter, as a source of COVID-19-associated information where information spreads faster than traditional channels (e.g., newspapers). 

They used ontology, text mining, and statistical analysis to create a COVID-19 symptom corpus. Next, they used a log-linear regression model to examine the relationship between digital traces and surveillance data and developed pandemic trend-forecasting Random Forest and LSTM models. 

They defined the true-positive rates (TPR), false-positive rates (FPR), and false-negative rates (FNR) of the up-trends in surveillance data in agreement with a previous study by Kogan et al., who used a Bayesian model for anticipating COVID-19 infection up-trends in the United States of America (USA) a week ahead.

For the evaluation of trend decomposition, the researchers used Seasonal and Trend decomposition using the Loess (STL) method, where the "STL forecast" function allowed them to extend the time series data from a given interval to a future time point. 

Applying this to the training data, which covered a specific period, helped to extrapolate the data to predict the trend component for a future period. They focused on the top 20 symptoms and conducted the STL decomposition on the extrapolated data for each symptom.

Further, they used correlation analysis to compare the extrapolated trend with the trend component extracted from the entire dataset.

Further, the researchers examined whether there were increases in the frequency of certain COVID-19 symptoms in digital sources such as Google Trends and Twitter before similar increases in established surveillance data.

To this end, they examined 168 symptoms from Google Trends and 204 from Twitter and calculated their respective sensitivity, precision, and F1 scores.

Sensitivity measures the proportion of true positives, precision measures the proportion of true positives among all positive predictions, and F1 score is a combined measure of sensitivity and precision.

The researchers used the hypergeometric test to identify the 20 most significant terms related to the disease on Google Trends and Twitter between February 2020 and February 2022.

In this way, they investigated if combining multiple symptoms using the harmonic mean P-value (HMP) method could improve the accuracy of detecting increases in disease surveillance data.

Furthermore, the researchers used a sliding window approach involving data analysis within a specific time frame to build an ML classifier to predict future trends in confirmed COVID-19 cases and hospitalizations.

They set the forecast horizon to 14 days ahead. They used a nine-fold time series cross-validation scheme to tune the hyperparameters of the Random Forest and LSTM models during the training procedure. 

Finally, the team used the Shapley Additive Explanations (SHAP) method to understand the influence of individual Google search and Twitter terms on the LSTM's predictions of up-trends. The analysis involved calculating the mean absolute SHAP values for different predictive symptoms.

They created bar plots where the symptoms ranked in descending order of their mean absolute SHAP values.

The symptoms with higher SHAP values were considered more influential in predicting up-trends in confirmed COVID-19 cases and hospitalization. Examples are hypoxemia, headache, muscle pain, dry cough, and nausea. 

Results

The researchers identified 162 symptoms related to COVID-19 and their 249 synonyms. Any symptoms with adjusted P values below a 5% significance level were considered significant in statistical analysis.

They ranked the symptom terms based on the frequency of their occurrence, which led to the top five symptom terms in the COVID-19-related literature. 

These were "pneumonia," "fever, pyrexia," "cough," "inflammation," and "shortness of breath, dyspnea, breathing difficulty, difficulty breathing, breathlessness, labored respiration." Furthermore, the top 20 symptoms account for 61.4% of the total co-occurrences of all identified symptoms.

The researchers found that the STL decomposition algorithm was robust and showed high correlations, nearly equal to one.

High F1 scores for symptoms, stuffy nose, joint pain, malaise, runny nose, and skin rash indicated their strong correlations with increases in confirmed cases. Symptoms with low F1 scores were multiple organ failure, rubor, and vomiting. Some symptoms, such as delirium, lethargy, and poor feeding, indicated the severity of COVID-19, including hospitalization and deaths.

Since different symptoms had high F1 scores in Google Trends and Twitter, it becomes important to consider multiple digital sources when analyzing symptom-level trends.

Overall, certain symptoms observed in digital traces can serve as early warning indicators for COVID-19 and detect the onset of pandemics ahead of classical surveillance data.

The researchers found that Google Trends had an F1 score of 0.5, while Twitter had an F1 score of 0.47 when tracking confirmed cases. These were lower for hospitalization and death, ~0.38 or even lower.

They noted that digital traces were unreliable for predicting deaths, but combining them was a promising way of detecting incident cases and hospitalization.

The LSTM model, using the combination of Google Trends and Twitter, showed better prediction performance, achieving an F1 score of 0.98 and 0.97 for up-trend forecasting of confirmed COVID-19 cases and hospitalizations, respectively, in Germany, with a larger forecast horizon of 14 days. It also predicted down-trends, with F1 scores of 0.91 and 0.96 for confirmed cases and hospitalizations, respectively. 

Conclusion

Early alert indicator and trend forecasting models for COVID-19 have been developed previously in other countries. However, since each country's socio-economic and cultural backgrounds vary, researchers developed an EWS specific to Germany.

The study demonstrated that combining Google Trends and Twitter data enabled accurate forecasting of COVID-19 trends two weeks (14 days) ahead of standard surveillance systems.

In the future, similar systematic tracking of digital traces could complement established surveillance data assessment, data, and text mining of news articles to promptly react to future pandemic situations that may arise in Germany.

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A cluster of undiagnosed pneumonia in children was reported in northern China by the media and ProMED on 21 November. Chinese authorities have previously reported an increase in respiratory infections, but it is unclear whether these are related, according to WHO.

WHO, in a statement released on November 23, 2023, disclosed China's National Health Commission's (NHC) update on the increase in respiratory disease incidences addressed at a press conference on 13 November 2023. This increase was attributed to the lifting of restrictions on COVID-19 and the circulation of known pathogens like influenza, mycoplasma pneumoniae (a bacterial infection usually seen in children under the age of five), respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19). The health system needs to be strengthened to handle patients and enhance disease surveillance in healthcare facilities and communities.

WHO's Initiative

Through the International Health Regulations mechanism, WHO requested additional epidemiologic and clinical information, as well as laboratory results from these reported clusters among children, as per WHO's official website.

Acting director of the WHO's Department of Epidemic and Pandemic Preparedness and Prevention Maria Van Kerkhove, on November 28, said the increase was likely driven by a rise in children contracting pathogens that they had avoided during two years of COVID restrictions, as per a Reuters report.

"We asked about comparisons prior to the pandemic. And the waves that they’re seeing now, the peak is not as high as what they saw in 2018-2019," Van Kerkhove told health news outlet STAT in an interview, as quoted by Reuters.

"This is not an indication of a novel pathogen. This is expected. This is what most countries dealt with a year or two ago," she added, as quoted in the report.

What is Walking Pneumonia caused by Mycoplasma Pneumoniae?

Mycoplasma pneumoniae bacteria commonly cause mild infections of the respiratory system (the parts of the body involved in breathing). Sometimes, these bacteria can cause more serious lung infections that require hospital care, according to the official website of the Centers for Disease Control and Prevention (CDC).

In contrast to a severe form of pneumonia, walking pneumonia is mild. In pneumonia, the air sacs in your lungs fill with mucus and other fluids, your airways swell, and you cough up mucus.

"Walking pneumonia is a non-medical term for a mild case of pneumonia. A more medically correct term would be atypical pneumonia, and can be caused by certain molds, viruses or bacteria, often a common bacterium called Mycoplasma pneumonia," according to Lung.org.

“Walking pneumonia" is the common term for atypical pneumonia.

How does it spread?

Small respiratory droplets containing bacteria are usually formed when an infected person coughs or sneezes. If a healthy person breathes in those droplets, that person will end up getting infected, too.

It is uncommon for people to get infected when they spend a short period of time with someone who is sick with M. pneumoniae do not get infected. However, the bacteria is more likely to spread among the people living together as they spend more time together.

What are the common symptoms?

The symptoms of Mycoplasma pneumoniae infection in children younger than 5 years of age may differ from those in older children and adults. In contrast, they may experience the following cold-like symptoms, according to CDC include sneezing, stuffy or runny nose, sore throat, watery eyes, wheezing, vomiting, and diarrhea.

Who is prone to infection?

Children, the elderly, and those with weakened lungs are especially susceptible to pneumonia caused by the bacteria. If someone is coughing, feverish, or having difficulty breathing, they should go to the doctor immediately. In the early stages, recovery is easier and takes less time. The infection is more likely to develop in a severe form in vulnerable groups who already have respiratory problems.

How to prevent?

WHO recommended people in China to follow measures to lower the risk of respiratory illness, which included vaccination, keeping adistance from people who are ill, staying home when ill, getting tested and medical care as needed, wearing masks as appropriate, ensuring good ventilation, and regular hand-washing.

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Pneumonia Outbreak In China: Health departments of several states including Rajasthan, Gujarat, Karnataka, Tamil Nadu and Uttarakhand have put alerts in sight of rising pneumonia cases in China. China is grappling with a surge in respiratory illnesses, including pneumonia, especially in children. The World Health Organization (WHO) sought information on the laboratory results, data on recent trends, and the spread of pneumonia last week.

According to WHO, “On 21 November, media and ProMED reported clusters of undiagnosed pneumonia in children in northern China. It is unclear if these are associated with the overall increase in respiratory infections previously reported by Chinese authorities or separate events.” WHO also reported that since mid-October, China has experienced an increase in cases of influenza-like illness compared to the same period in the previous three years.

Watch the video below about best foods for lung health: 

Important Things About Pneumonia

1. It Can Be A Bacterial, Viral, Or Fungal Infection

According to Harvard Medical School, bacterial pneumonia can also complicate a viral illness like the flu. Many viruses can cause pneumonia. Most cases of viral pneumonia are relatively mild, but some can cause severe symptoms, such as severe acute respiratory system (SARS) coronavirus and the more recent SARS-CoV-2 (COVID-19). The most common cause of bacterial pneumonia is Strep pneumonia (often called pneumococcal pneumonia).

ALSO READ: Mysterious Pneumonia Outbreak In China: WHO Seeks Details For Respiratory Illnesses In Children | Precautions You Should Take

2. Both Young And Old At Risk

Age is one of the biggest risk factors for pneumonia and young children and adults (over the age of 65) are at the highest risk of pneumonia. While majorly, children under 2 years of age are likely to be at high risk of getting diagnosed with this respiratory illness. But it can be treated with proper medication and care.

3. How It Spreads

Pneumonia is a contagious disease that can spread from one person to another (Image Credits: Canva)

Pneumonia is a contagious respiratory disease that spreads from person to person when one coughs or sneezes. The droplets from the infected person’s mouth or nostrils are released into the air, making the other person breathe the same germ-infected air.

4. Symptoms

Some common symptoms of pneumonia to watch out for include high fever (up to 105 F or 40.55 C), cough with yellow, green or bloody mucus, tiredness (fatigue), rapid breathing, shortness of breath, rapid heart rate, sweating or chills, chest pain and/or abdominal pain, especially with coughing or deep breathing, loss of appetite, bluish skin, lips or nails (cyanosis) and confusion or altered mental state.

ALSO READ: World Pneumonia Day 2023: Doctor Explains How Cigarette Smoking Can Be The Strongest Risk Factor For Pneumonia

5. Treatment

According to the Cleveland Clinic, treatment for pneumonia depends on the cause, bacterial, viral or fungal and how serious the case is. In many cases, the cause can’t be determined and treatment is focused on managing symptoms and making sure the condition doesn’t get worse.

 

(Disclaimer: This article is for informational purposes only. It is not a substitute for professional advice, diagnosis or treatment.)

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ROME – Just hours after a Vatican news conference confirming Pope Francis’s trip to Dubai this weekend for a United Nations climate summit, the Vatican announced Tuesday that it has been cancelled upon medical advice due to an ongoing infection causing lung inflammation.

A Vatican spokesman announced, however, that Pope Francis will lead his Wednesday General Audience, though it wasn’t immediately clear whether he would do so from St. Peter’s Square as usual or via livestream from indoors as he conducted last Sunday’s Angelus address.

In a Nov. 28 statement, Vatican spokesman Matteo Bruni said that “even though the general clinical framework of the Holy Father in relation to the state of influenza and inflammation of the respiratory tract has improved, doctors have asked the Pope not to make the trip planned for the coming days to Dubai.”

Bruni, who hours earlier had briefed reporters on the papal trip and confirmed the pope’s plans to travel to Dubai, said Pope Francis accepted the doctor’s advice “with great regret, and the trip is therefore cancelled.”

“As the pope and the Holy See remain willing to be part of the discussions taking place in the coming days, the ways in which this can be implemented will be defined as soon as possible,” Bruni said, without offering further specifics.

Concern over the pontiff’s health arose Saturday when the Vatican issued a brief statement saying Francis had cancelled all of the day’s audiences due to a “mild flu.”

A second statement published later Saturday said Francis had gone to Rome’s Gemelli Hospital for a CAT-scan to rule out “pulmonary complications,” and that the scan “was negative.”

In a statement Monday, Bruni confirmed that the pope’s CT scan Saturday “ruled out pneumonia but showed pulmonary inflammation that caused some breathing difficulties.”

“For a greater effectiveness of the therapy, a cannula needle was positioned for an infusion of intravenous antibiotic therapy,” he said, saying the pope’s conditions are currently “good and stable, he does not have a fever, and his respiratory situation is clearly improving.”

In order to help facilitate the pope’s recovery, Bruni said some “important commitments” in coming days have been postponed so that Francis “can dedicate the desired time and energy to them.”

Other commitments “of an institutional character or which are easier to support given his current health conditions,” are still on the schedule, however, it remains unclear whether Pope Francis will preside over his Wednesday general audience this week as expected.

Concern over any form of respiratory disease for Pope Francis, who is missing part of one lung, spiked earlier this year when he was hospitalized with bronchitis, saying afterwards that it had been a close call.

In late March he was rushed to the Gemelli Hospital following his weekly general audience when he experienced breathing difficulties. He was diagnosed with bronchitis and was administered intravenous antibiotics before being released three days later.

Respiratory diseases are particularly alarming for Francis, as he had part of one lung removed as a young Jesuit due to a serious bout of pneumonia.

Following April’s hospital stay, the pope was admitted to the Gemelli Hospital again in June for surgery on an abdominal hernia and he continues to suffer from other milder maladies, such as ongoing sciatica and knee troubles.

This is not the first time Pope Francis has cancelled a scheduled trip. He postponed a July 2022 trip to the Democratic Republic of Congo and South Sudan, which was later rescheduled for January of this year.

Follow Elise Ann Allen on X: @eliseannallen



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By Philip Pullella

VATICAN CITY (Reuters) - Pope Francis has cancelled his planned trip to the COP28 climate meeting in Dubai because of the effects of influenza and lung inflammation, the Vatican said on Tuesday, adding to concerns about his health.

The pope, who is 86, was due to begin a three-day visit to Dubai on Friday and the Vatican had said earlier on Tuesday that he was going ahead with the trip.

"Although the Holy Father's general clinical condition has improved with regard to the flu and inflammation of the respiratory tract, doctors have asked the pope not to make the trip planned for the coming days to Dubai," the Vatican said.

The pope had agreed not to travel "with great regret," it added, saying that it would look into ways that the leader of the world's Roman Catholics could contribute to the discussions remotely.

In a briefing earlier on Tuesday, Vatican spokesperson Matteo Bruni had said Francis would deliver one of the keynote speeches in Dubai on Saturday and have bilateral meetings the same day with about 30 people, including about 20 heads of state.

The pope had also met with Spanish bishops visiting the Vatican on Tuesday.

CONCERN FOR THE ENVIRONMENT

The pope has made protection of the environment one of the cornerstones of his pontificate.

In a document issued in October, Francis had appealed to climate change deniers and foot-dragging politicians to have a change of heart, saying they cannot gloss over its human causes or deride scientific facts while the planet "may be nearing the breaking point".

Francis also said the transition to clean, renewable energy and the abandonment of fossil fuels was not going fast enough.

The Vatican had announced on Monday the pope would limit his activities this week in order to conserve his strength after contracting the flu.

A CT scan done at a Rome hospital on Saturday excluded pneumonia but detected inflammation in the pope's lungs that caused breathing difficulties. He was receiving antibiotics intravenously, the Vatican said on Monday.

As a young man in his native Argentina, Francis had part of a lung removed.

(Reporting by Philip Pullella and Alvise Armellini; additional reporting by Gavin Jones and Keith Weir; Editing by Bernadette Baum, Chris Reese and Lisa Shumaker)

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New cases don't respond to standard treatments and some can progress to pneumonia.

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Veterinarians, including those in Florida, are reporting an increased number of dogs suffering from a potentially deadly and contagious respiratory illness.

The infections are not responding to commonly prescribed antibiotics, according to the University of Florida's College of Veterinary Medicine.

What isn't clear so far is whether the disease is caused by something new or from Canine Infectious Respiratory Disease Complex, known commonly as “kennel cough.” 

The mysterious illness began in Oregon during the summer and now has been reported in 14 states, according to the American Veterinary Medical Association.

What states have seen cases of the mysterious respiratory dog disease?

As of Monday, the illness had been reported in the following states:

  • California
  • Colorado
  • Florida
  • Georgia
  • Idaho
  • Illinois
  • Indiana
  • Maryland
  • Massachusetts
  • New Hampshire
  • Oregon
  • Rhode Island
  • Vermont
  • Washington

No central reporting system exists to confirm spike in respiratory cases

"The lack of a centralized reporting system means it’s not even possible to confirm that there is a spike in CIRDC — Canine Infectious Respiratory Disease Complex — incidence or severity," UF reported.

"The intense media coverage of a 'mystery disease' may be raising awareness and discussion about CIRDC cases that would otherwise be managed as usual. It’s also possible that localized clusters are occurring due to one or more known pathogens due to some predisposing factor, such as an asymptomatically infected dog visiting a dog park, day care, dog show, or boarding kennel, etc."

Kennel cough in dogs is a highly contagious respiratory disease in dogs, according to the American Kennel Club.

Is this a new pathogen that's affecting dogs?

Researchers are looking into the possibility of emerging or increasingly virulent pathogens, UF said.

Many of the cases suspected to have “atypical CIRDC” have not been confirmed with diagnostic testing.

While some dogs were tested, that was done weeks later, which is "too late to detect some of the most likely culprits, such as influenza virus, pneumovirus, and respiratory coronavirus."

Adding to the difficulties in detecting the culprit, many tests were done at a large diagnostic lab that does not include pneumovirus, UF said.

Dogs 101: How much food should I feed my dog? Here's what to know from puppy to adulthood.

Symptoms of mystery respiratory dog disease:

According to the University of Florida's College of Veterinary Medicine, symptoms of the mystery respiratory illness in dogs include:

  • Acute cough, sneezing, nasal discharge, eye discharge, fever, anorexia, lethargy.
  • Severe cases can progress to life-threatening pneumonia requiring oxygen and ventilator support.
  • Cough may persist for weeks to months.

The American Association of Veterinary Medicine added these symptoms:

  • Chronic mild to moderate inflammation of the trachea lasting six to eight weeks or longer, which is minimally or not responsive to antibiotics.
  • Chronic pneumonia that is minimally or not responsive to antibiotics.
  • Acute pneumonia that rapidly becomes severe and often leads to poor outcomes in as little as 24 to 36 hours
  • Difficulty or rapid breathing, wheezing, dehydration, fever, nasal or eye discharge, weight loss, loss of appetite and lethargy.

Understanding your dog: Why does my dog tilt its head? Trying to understand your pet's nonverbal communication.

The disease is highly contagious and spreads rapidly among dogs in contact with other dogs.

  • Dogs that visit with other dogs, such as boarding, day care, dog shows, dog parks
  • So far, animal shelters seem to be less frequently affected by unknown pathogens, although historic levels of crowding present risks for outbreaks
  • People and other species have not been reported to be at risk

Treatments of mysterious dog illness

Unlike more common infections associated with kennel cough, new cases do not respond to "standard medical therapy and can have a prolonged illness that can progress to pneumonia," according to the University of Illinois School of Veterinary Medicine.

Currently the treatment that dogs receive is symptomatic and supportiveDr. Marta Vidal-Abarca, with Petkeen.com told USA TODAY.

"This means that, since the agent causing the infection has not been identified, the treatment is not aimed at killing any pathogen in particular," Vidal-Abarca said.

"Instead, the treatment is aimed at mitigating clinical signs and facilitating the dog’s recovery."

Dog illness spreading across US: Mysterious and fatal dog respiratory illness now reported in 14 states

Treatment, Vidal-Abarca said, includes:

  • Oxygen therapy.
  • Use of a nebulizer to get medicine into the dog's lungs.
  • Antibiotics to treat secondary infection.
  • Measures to ensure the dog has "adequate nutrition" and hydration, including IVs.

How can you best protect your dog from the mystery respiratory illness?

Although researchers are not yet sure what causes the illness, here are tips from the AVMA and others to help keep your pet as safe as possible:

  • Make sure your dog has been fully vaccinated, especially for kennel cough.
  • Avoid dog parks, pet stores and grooming facilities.
  • Be mindful of boarding, unless absolutely necessary.
  • If your dog shows any signs of respiratory issues, contact your vet and keep your pet isolated.

Canine influenza virus affecting dogs in Florida

H3N2 is circulating along the eastern and western coasts as documented in show dogs and shelters, UF said.

H3N2 is an influenza A virus that is specific for dogs. The virus is currently circulating in dogs in different communities in the country, including Florida and Georgia. Most dogs have no immunity to this virus and will be infected upon exposure. The virus can also infect cats. There is no evidence it infects people.

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The government has ramped up preparedness to tackle any unusual spike in respiratory diseases following reports about a recent outbreak of childhood respiratory illnesses and pneumonia in northern China.

A press release from the Directorate of Health and Family Welfare Services said the Union Health Ministry was closely monitoring the respiratory diseases situation after the World Health Organisation (WHO) recently released a report on the matter.

On reviewing the situation and assessing preparedness in Puducherry region, the Directorate of Health said that available data suggested that there was no abnormal increase in respiratory diseases, accounting for the low incidence of seasonal flu as of now.

As a precautionary measure though, the directorate has made all the facilities to treat those who come with such symptoms in the district hospitals and all the Primary Health Centres. Adequate beds have been allocated to admit and treat such patients at the Government General Hospital, TB Sanatorium (designated Respiratory Care Hospital) in Gorimedu and Indira Gandhi Government Medical College Hospital and Research Institute (IGMCRI).

Testing is underway at the IGMCRI as part of measures to handle seasonal respiratory infections.

The Health Directorate pointed out that seasonal influenza was a mild respiratory illness, usually with or without fever. People with chronic diseases are advised to approach the nearest health facility if they suffer from symptoms such as fever, runny nose, cough and difficulty breathing. Everyone is advised to strictly follow the practice of wearing a face mask as there is a habit of sneezing and coughing in crowded places. Avoiding crowded places can help prevent the flu. Proper hand washing and personal hygiene will help prevent infection, the advisory said.

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A long line of parents and their children at a hospital reception.

Parents with children who are suffering from respiratory diseases are lining up at a children's hospital in Chongqing, China, on November 23, 2023.Getty Images

  • Parts of northern China have seen a surge in children with respiratory illnesses.

  • The WHO requested more information from Chinese health officials, who said common bugs are the cause.

  • Experts do not believe this is the start of a new pandemic.

Cases of respiratory illness among children in northern China have surged in recent weeks, but it's unlikely this is the start of a new pandemic, according to the World Health Organization.

The WHO has been monitoring an increase in respiratory illness among children in northern China since mid-October. At a press conference on November 13, Chinese health authorities pinned a nationwide rise in respiratory disease, mostly in children, to the lifting of COVID-19 restrictions — which mostly ended in December 2022 — and the circulation of known pathogens such as flu, mycoplasma pneumoniae, respiratory syncytial virus (RSV), and SARS-CoV-2. The WHO said on Wednesday it's unclear if these are separate events.

Fears that this could be a new pandemic were sparked on November 21, when ProMED, an infectious disease alert system, flagged up "reported clusters of undiagnosed pneumonia in children" in parts of China and hospitals becoming overwhelmed.

However, after requesting detailed information from Chinese authorities, the WHO said that no unusual or novel pathogens had been detected.

Maria Van Kerkhove, acting director of the WHO's department of epidemic and pandemic preparedness and prevention, told STAT in an interview on Friday that the spike reflects an increased wave of cases, not discrete clusters that would be more indicative of a new virus.

"You hear 'undiagnosed.' People think, well, that means they must have ruled everything else out, and therefore it's probably new. You hear 'clusters,' which means there's some people linked in space and time. 'Children' — which is always alarming — 'with pneumonia,' which indicates a level of severity. And you hear 'China.' So I think a lot of people were immediately drawn back to the beginning of the Covid pandemic and thought: Oh God. Not again."

She gave two reasons why this outbreak is not the new COVID.

1) China is likely experiencing an immunity gap

In a conference call with the WHO on Thursday, Chinese health officials presented evidence suggesting the outbreak is partly caused by what's known as an immunity gap, STAT reported.

An immunity gap is the idea that lockdowns to prevent the spread of COVID also dramatically reduced the transmission of other common viruses and bacteria, such as flu and RSV. During this time, kids who had never been exposed to these bugs developed few immunological defenses against them, so when things went back to normal, and they were able to circulate again, more children were at risk of getting sick.

Van Kerkhove told the outlet that she backs this theory. "This is expected. This is what most countries dealt with a year or two ago," she said.

François Balloux, director of the UCL Genetics Institute, expressed the same view. "China is likely experiencing a major wave of childhood respiratory infections now as this is the first winter after their lengthy lockdown, which must have drastically reduced the circulation of respiratory bugs, and hence decreased immunity to endemic bugs," he said.

Insider health correspondent Hilary Brueck reported last year amid a spike in US children getting sick with viruses that the immunity gap or "debt" does not mean children's immune systems were damaged by lockdowns and other measures to prevent the spread of COVID, as some claimed.

2) The illnesses are not caused by a new virus

Chinese health officials said that the outbreak of respiratory illness is caused by known pathogens.

Van Kerkhove said that they provided the WHO with percentages of how many cases have been caused by influenza, rhinovirus, adenovirus, and mycoplasma pneumoniae, respectively.

She said that they had not seen patients who were not diagnosable, nor a clustering of undiagnosed pneumonias.

The health authorities also told the WHO that they had not detected any new variants or subtypes of the known pathogens. "This is not an indication of a novel pathogen," she said.

Her view is shared by other public health experts too. A group of biosecurity experts from UNSW Sydney, Australia, wrote in The Conversation on Monday: "There is no indication that the current situation in China is a new pandemic, but we should always identify and pay attention to undiagnosed pneumonia clusters. Early warning systems give us the best chance of preventing the next pandemic."

Read the original article on Business Insider

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Pope Francis has canceled his planned trip to the COP28 climate meeting in Dubai because of the effects of influenza and lung inflammation, the Vatican said Tuesday.

The pope, who is 86, was due to begin a three-day visit to Dubai on Friday and the Vatican had said earlier on Tuesday that he was going ahead with the trip.

"Although the Holy Father's general clinical condition has improved with regard to the flu and inflammation of the respiratory tract, doctors have asked the pope not to make the trip planned for the coming days to Dubai," the Vatican said.

The pope had agreed not to travel "with great regret," it added.

Francis, as a young man in his native Argentina, had part of a lung removed.

The Vatican announced on Monday the pope would limit his activities this week in order to conserve his strength.

A CT scan done at a Rome hospital on Saturday excluded pneumonia but detected inflammation in the pope's lungs that caused breathing difficulties. He was receiving antibiotics intravenously, the Vatican said on Monday.

The pope met with Spanish bishops visiting the Vatican on Tuesday.


© 2023 Thomson/Reuters. All rights reserved.

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Since mid-October 2023, the World Health Organization (WHO) has been monitoring data from Chinese surveillance systems that have been showing an increase in respiratory illness in children in northern China.

Chinese authorities attributed this increase to lifting of COVID-19 restrictions and the arrival of the cold season, and due to circulating known pathogens such as influenza, Mycoplasma pneumoniae, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Mycoplasma pneumonia and RSV are known to affect children more than adults.

Pneumonia

Pneumonia is a form of acute respiratory infection that is most commonly caused by viruses or bacteria. It can cause mild to life-threatening illness in people of all ages; however, it is the single largest infectious cause of death in children worldwide.

Pneumonia killed more than 808 000 children under the age of 5 in 2017, accounting for 15% of all deaths of children under 5 years. People at-risk for pneumonia also include adults over the age of 65 and people with preexisting health problems.

When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake. These infections are generally spread by direct contact with infected people. Vaccines can help prevent pneumonia.

Influenza

Influenza (Flu) is a common cause of pneumonia, especially among younger children, the elderly, pregnant women, or those with certain chronic health conditions or who live in a nursing home.

Influenza is a highly contagious viral infection that is one of the most severe illnesses of the winter season. Influenza is spread easily from person to person, usually when an infected person coughs or sneezes.

Pneumonia is a serious infection or inflammation of the lungs. The air sacs fill with pus and other liquid, blocking oxygen from reaching the bloodstream. If there is too little oxygen in the blood, the body's cells cannot work properly, which can lead to death.

As flu strains change each year, it is necessary to get a flu vaccination each season to make sure you are protected against the most current strains. Pneumonia vaccinations are usually only necessary once, although a booster vaccination may be recommended for some individuals.

Walking Pneumonia

In recent days, there has been a surge in cases of infection by the bacterium mycoplasma pneumoniae Mycoplasma pneumonia reported in multiple hospitals across China, with children being the most affected. This year, the infection has occurred earlier than usual and has shown a trend toward affecting younger children, leading pediatricians to warn that this year could see a widespread outbreak of Mycoplasma pneumonia.

The Mycoplasma pneumoniae bacterium is one of the most recognized of all human pathogens, and there are different known species. These bacteria can cause many symptoms, including dry cough, fever, and mild shortness of breath on exertion. Mycoplasma pneumonia can spread easily among children.

Most people with respiratory infections caused by Mycoplasma pneumoniae don’t develop pneumonia. For this reason, Mycoplasma pneumonia is known as atypical pneumonia and is sometimes called walking pneumonia.

Mycoplasma pneumonia spreads quickly through contact with respiratory fluids in crowded areas, like schools, college campuses, and nursing homes. When someone coughs or sneezes, moisture containing the bacteria is released into the air, and others around them can easily breathe the bacteria in.

About 7 to 20 percent of cases of community-acquired (outside of a hospital) pneumonia happen as a result of infection by atypical bacterial microorganisms. Of these, Mycoplasma pneumoniae causes the most infections, though only about 10% of people infected will actually develop pneumonia.

Mycoplasma pneumonia symptoms are different from those of typical pneumonia caused by common bacteria, like Streptococcus and Haemophilus. Patients usually do not have severe shortness of breath, high fever, and a productive cough with Mycoplasma pneumonia. Instead, they have a low-grade fever, dry cough, mild shortness of breath, and fatigue.

Mycoplasma pneumonia may mimic an upper respiratory infection or common cold rather than a lower respiratory infection or pneumonia. A dry cough is the most common sign of infection.

In some cases, Mycoplasma pneumonia infection can become dangerous. If you have asthma, Mycoplasma pneumonia can make your symptoms worse. Mycoplasma pneumonia can also develop into a more severe case of pneumonia. In rare cases, untreated Mycoplasma pneumonia can be fatal.

Respiratory Syncytial Virus

Respiratory syncytial virus (RSV) causes mild illness in most children and adults. However, pneumonia can be serious, requiring treatment and sometimes hospitalization. Rarely, for people at high risk, pneumonia can be fatal.

For some infants, older adults, and people with certain health conditions, an RSV infection can become severe and lead to other health conditions, like bronchiolitis and pneumonia.

RSV typically stays confined to the upper airways. In certain situations, though, it can move into the lungs. While rare, this is when RSV-related pneumonia may develop. RSV is the leading cause of pneumonia in children under age 1.

Symptoms of RSV may be as mild as a runny nose and sore throat. When pneumonia develops, you may notice symptoms that happen slowly or suddenly. Symptoms may include cough with yellow, green, or bloody sputum, fever, chills, shallow or rapid breathing patterns, rapid pulse rate, chest pain with deep breaths or coughing, fatigue, and low appetite.

Don't Press Pandemic Panic Button

Scientists have cautioned against concerns of a potential new pandemic following the World Health Organization's request for more information from China regarding an increase in respiratory illnesses and pneumonia clusters among children.

While some worry that this surge might signal the emergence of another dangerous pathogen capable of triggering a pandemic, scientists believe, based on current information, it's more likely an increase in common respiratory infections like the flu. Similar rises in respiratory infections were observed globally after COVID-19 lockdowns were lifted, potentially including a resurgence of COVID itself.

Prevention Tips

Based on the available information, WHO recommends that people in China follow measures to reduce the risk of respiratory illness, which include recommended vaccines against influenza, COVID-19 and other respiratory pathogens as appropriate; keeping distance from people who are ill; staying home when ill; getting tested and medical care as needed; wearing masks as appropriate; ensuring good ventilation; and practicing regular handwashing.

WHO does not recommend any specific measures for travellers to China. In general, persons should avoid travel while experiencing symptoms suggestive of respiratory illness, if possible; in case of symptoms during or after travel, travellers are encouraged to seek medical attention and share travel history with their health care provider.

WHO advises against the application of any travel or trade restrictions based on the current information available on this event.

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Toronto emergency room doctors say the winter surge of COVID-19, flu and respiratory syncytial virus (RSV) infections is underway, with hospitals seeing a wave of visits across the GTA.

In the last week, nearly 250 Ontarians have been admitted to hospital, and Public Health Ontario (PHO) reports the COVID-19 wastewater signal is at its highest level in more than a year.

Toronto ER physician Dr. Kashif Pirzada took to social media this week to share he and his colleagues are doing far more resuscitations, crash intubations and seeing far more patients in cramped and packed emergency rooms.

“We are admitting adults again on the ward even younger people in their 30s and 40s,’ said Dr. Pirzada. “It means we have to do life-saving maneuvers so we have to put people on ventilators and we have to put people on machines to help them breathe …that’s very serious. That’s when [the] mortality rate is very high as well.”

“I had a healthy woman with no medical problems in her 40s, who was just fighting a cold for a few weeks and then developed severe pneumonia and had to end up in our ICU. So we saw that before COVID but now it’s much more common now.”

With the virus season revving up a little sooner than normal, these Toronto doctors say hospitals are not yet in crisis mode like they were last year when emergency departments were completely overwhelmed and children were sometimes waiting days for an ICU bed.

Dr. Pirzada said staffing levels are still not great.

“We’re just lucky that it’s not as overwhelming as last year but if it does get stressed and I’m worried about the holiday season, especially with the early inkling that we’re getting now that we won’t be able to handle it the way things are going. I’m really worried about what’s going to happen in the next month or so.”

When someone should be heading to an ER

“If you cross the line where you have a fever of more than five days, that makes us worried. If you have severe chest pain or trouble breathing, that’s a bad thing, you need to get checked out,” said Dr. Pirzada.

“[If] you are not eating or drinking anything, that’s also a bad sign, if you are so tired you can’t get up and do anything also a bad sign, especially in a kid, that’s also a sign to get checked.”

Doctors say now is the time to protect yourself, and if you’re sick, stay home and wear a mask.

“I went into a packed subway car the other day and I wear a mask in there because I was face to face with people. I think use your common sense like you don’t want to get more sick than you need to be. So in super crowded areas, I think it’s a good idea to wear [masks]. They’re annoying, they’re inconvenient, but I think they might save you a lot of grief this holiday season.”

Dr. Pirzada adds getting a COVID-19 booster would also help. The advice comes as just 24 per cent of the population has completed a primary COVID-19 vaccine series and two or more booster doses.



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By Dr. Greg Zerovnik

Contributing Writer

11/28/2023 at 12:49 PM

SAN BERNARDINO, CALIF. – A new monoclonal antibody and new anti-viral vaccines are coming for the first time to provide protection against RSV, Respiratory Syncytial (sin-SISH-uhl) Virus. LaSalle Medical Associates clinics will be providing these breakthroughs to patients this fall.

“RSV is a cold-like virus that is usually mild but can put some people in the hospital,” says Dr. Cheryl Emoto, Medical Director of LaSalle Medical Associates. “For the first time this fall, young infants and seniors (those with the highest risk for severe disease) now have a way to prevent it.”

The Centers for Disease Control and Prevention notes that “Most people recover in a week or two, but RSV can be serious. Infants and older adults are more likely to develop severe RSV and need hospitalization. Vaccines are available to protect older adults from severe RSV. Monoclonal antibodies are available to protect infants.”

The CDC goes on to note that RSV is “one of the most common causes of childhood illness and is the most common cause of hospitalization among infants [emphasis ours].” It usually starts in the fall and peaks in the winter, but this can vary.

Monoclonal antibodies and vaccines may now prevent RSV. A monoclonal antibody is a clone of a unique white blood cell (white blood cells are the body’s own infection fighters) given to augment and reinforce the body’s natural defenses. It’s the option available for infants who are entering their first RSV season. They are not used when someone already has RSV.

Up until now, almost all children have contracted RSV by the time they reach 24 months, so the new prevention regimen has the potential to prevent illness and potential complications such as bronchitis and pneumonia, making life easier for both infants and their parents or caretakers.

For older adults, the CDC estimates that between 60 to 100 thousand are hospitalized every year. resulting in 6,000 to 10,000 deaths. The most at-risk cohorts are older adults, adults with chronic heart or lung disease, those with weakened immune systems or certain underlying medical conditions and residents in nursing homes or long-term care facilities.

Complications may include asthma, chronic obstructive pulmonary disease (COPD, a chronic disease of the lungs that makes it hard to breathe), and congestive heart failure—when the heart can’t pump enough blood and oxygen through the body.

Additionally, this year, there is now a regimen for pregnant women that keeps the developing fetus safe from infection. Now is the time to contact your healthcare provider to schedule an appointment for preventive care, especially if you are pregnant, have an infant under 8 months of age or are 60 years of age or older.

LaSalle Medical Associates serves more than 350,000 patients in their clinics and statewide Independent Physicians Association Group (IPA) who are covered by Medi-Cal, Medicare, and Covered California, as well as those covered by Blue Cross, Blue Shield, Brand New Day, Molina, Care 1st, Health Net and Inland Empire Health Plan (IEHP).

LaSalle staff also help people who come into a clinic without any insurance to become enrolled for a variety of state and federal health coverage.

For more information call (909) 890-0407 or go online to LaSalleMedical.com.

Tags: (IEHP)and clinicsand Covered Californiaas well as those covered by Blue CrossasthmaBlue ShieldBrand New DayCare 1stCDCchronic obstructive pulmonary diseaseCOPDdelivering high-quality patient caredoctorsFresnoHealth NethospitalsInland Empire Health PlanKingsLos AngelesMaderamedi-calmedicareMolinaRespiratory Syncytial VirusriversideRSVSan BernardinoSan Bernardino and Tulare counties.

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 The Winter season is wonderful in terms of food and drink, but the risk of some diseases caused by bacteria increases in this season.

Winter Health

The winter season has started. people like the winter season but from a health point of view this season brings with it many risks. health experts say that the risk of certain diseases increases during the winter season. In such a situation, people should be cautious about their health. Let us know which diseases increase the risk in the winter season and which people need to be especially cautious in this cold season.

 

winter season diseases

Many types of viruses and bacteria become active during the winter season. These bacteria enter the body through breathing and make the body sick. Due to this, respiratory infections spread very quickly and widely. In such a situation, the risk of lung infection along with cold increases. Apart from this, people who have weak immunity have an increased risk of getting pneumonia in this season. 

In the winter season, cold and dry air causes diseases like asthma and bronchitis. Migraine pain also triggers more rapidly during the winter season. people who already suffer from headaches or migraine are at risk of migraine attacks in this season. Apart from this, people who have blood pressure problems, their bp may increase more in this season. Due to low temperatures in the winter season, the blood vessels become temporarily thin, due to which the bp increases and there is difficulty in the proper flow of blood in the blood veins.

 Which people should take special care?

During the winter season, special care should be taken by those people whose immune system is weak. people who are suffering from high bp should also take special care at this time. Small children and infants get pneumonia easily in this season, hence special care should be taken of them. people who suffer from asthma, bronchitis, or respiratory diseases should also be cautious about their health during this season.



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The eyes of the world are once again locked on China as it suffers another mysterious respiratory outbreak that is 'overwhelming' some hospitals.

Chaotic scenes of mask-wearing crowds in hospitals in Beijing have eerie echoes of the early days of the Covid outbreak four years ago that also began with an 'undiagnosed pneumonia.'

Chinese authorities insist they are simply dealing with a rebound in severe flu and respiratory illnesses that were suppressed by lockdowns, rather than a novel virus like the one that caused the Covid-19 pandemic.

China had the world's longest and harshest lockdown measures and is only now experiencing its first winter in years without them. The curbs are believed to have suppressed the population's immunity and left them vulnerable to seasonal illnesses.

While Chinese officials said they have no evidence of 'unusual or novel' pathogens, Obama's ex-White House Chief of Staff Rahm Emanuel has said Beijing's history of cover ups is a cause for skepticism. 

BEIJING, 2023: An image shows a crowded children's hospital in Beijing on October 30 amid a surge in respiratory illnesses in some areas of China

BEIJING, 2023: An image shows a crowded children's hospital in Beijing on October 30 amid a surge in respiratory illnesses in some areas of China

WUHAN, 2019: The above shows the scene in Wuhan in January 2020 amid growing concern about the mysterious pneumonia in the city

WUHAN, 2019: The above shows the scene in Wuhan in January 2020 amid growing concern about the mysterious pneumonia in the city

China has not revealed how many people have been hospitalized or died in the outbreak, but it appears to be mainly affecting children.

Doctors on the ground say they are seeing children with high fever and lung inflammation, but without a cough or pulmonary nodules — lumps on the lungs that are usually the result of a past infection.

There have been reports of overwhelmed pediatric hospitals in several Chinese cities including Beijing and 500 miles away in the north-east province of Liaoning.

The alarm was first raised over the outbreak internationally on November 21, when the disease surveillance system ProMED issued a notification about reports of an 'undiagnosed pneumonia' in China.

The system — which was also the first to raise the alarm in December 2019 over the emergence of Covid — works to detect unusual health events related to emerging infections.

It relies on a global network of healthcare experts who are on the look out for health notices and tips, social media discussions, health department announcements and reports from local media.

The alert it issued last week cited a local media report from FTV News, a Taiwanese media outlet, which described sick children crowding into hospitals in two Chinese cities suffering from symptoms associated with pneumonia.

When the alert was issued last week, there were immediate comparisons to the 2019 Covid outbreak.  

Like in 2019, it was left to independent health authorities rather than China itself to report the outbreak. 

The alert six days ago prompted the World Health Organization (WHO) to send an official request two days later to Chinese authorities asking for official data and information on the outbreak. 

The WHO, responding quickly and putting the pressure on China, is still reeling from criticism that it protected Beijing and parroted the country's official line that Covid could not spread between people despite no evidence supporting the claim.

Chinese officials have insisted no new pathogen is to blame and instead have blamed a surge in common winter bugs as the country faces its first full winter without anti-Covid measures

Chinese officials have insisted no new pathogen is to blame and instead have blamed a surge in common winter bugs as the country faces its first full winter without anti-Covid measures 

Rahm Emanuel, who was previously President Barack Obama's White House chief of staff, said recently there were still 'serious questions' about the recent pneumonia outbreak in China

Rahm Emanuel, who was previously President Barack Obama's White House chief of staff, said recently there were still 'serious questions' about the recent pneumonia outbreak in China

People were first made aware of the current viral outbreak on November 21, when the public disease surveillance system ProMED issued a notification about reports of 'undiagnosed pneumonia.'

People were first made aware of the current viral outbreak on November 21, when the public disease surveillance system ProMED issued a notification about reports of 'undiagnosed pneumonia.'

ProMED, a world health surveillance system run by health experts, first raised the alarm over the emergence of another 'undiagnosed pneumonia' in Wuhan, which later turned into the Covid-19 pandemic

ProMED, a world health surveillance system run by health experts, first raised the alarm over the emergence of another 'undiagnosed pneumonia' in Wuhan, which later turned into the Covid-19 pandemic

Chinese authorities arranged a teleconference with WHO on Thursday to provide the data requested. 

The agency said the information provided indicated the clusters of cases were from known pathogens.

The data showed China has been experiencing an increased number of children sick with mycoplasma pneumoniae – bacteria that causes mild infections of the respiratory system - since May.

Pediatric cases of RSV, adenovirus, influenza and COVID-19 have also been surging since the fall, according to the data seen by the WHO.

Chinese and world health officials say the surge is not completely unprecedented and China would not be the first country to suffer the ripple effects of pandemic-era lockdowns. 

Increasingly, studies have shown that children's immunity was damaged during Covid due to the lack of exposure to common germs that strengthen the immune system against infections. 

The UK experienced a rise in other illnesses following lockdowns and in spring of 2022, rates of some respiratory illnesses in the country were 20 times greater than after 2020's first shutdown. 

Data from April 2022 showed flu cases were up four times compared to July 2020, when social distancing restrictions were still in place in much of the world. 

The US also faced a surge in pediatric illnesses last winter as respiratory viruses spread in the absence of restrictions.

Doctors said at the time the spike in hospitalizations among children was 'worse than any other' — as seasonal bugs returned with a vengeance and cases of flu and RSV hit their highest level in more than a decade.

China had a much harsher and longer lockdown than other nations, under its 'zero Covid' policies, which were only officially lifted in January, with pandemic-era measures ended this summer. The harsh restrictions prompted mass protests that saw people calling on Xi Jinping to step down

Many experts expected China to face a major 'exit wave' after its harsh restrictions were lifted and there were reports shortly after restrictions were eased of hospitals in some areas being swamped.

DailyMail.com has analyzed the percentage of people testing positive for flu, rhinovirus, parainfluenza, RSV, hMPV and adenovirus in England during the pandemic. Rates for all of the viruses except rhinovirus were higher in April 2022 than the same time the previous year, when people were only allowed to meet in groups of six, working from home was in place and hugging was still discouraged

DailyMail.com has analyzed the percentage of people testing positive for flu, rhinovirus, parainfluenza, RSV, hMPV and adenovirus in England during the pandemic. Rates for all of the viruses except rhinovirus were higher in April 2022 than the same time the previous year, when people were only allowed to meet in groups of six, working from home was in place and hugging was still discouraged

The delay in reporting and lack of information concerning the number of cases and deaths once again worried officials of China's history of a lack of transparency when it comes to public health events. 

Local outlets said last week the outbreak seems to be affecting mostly children and has caused some schools to cancel classes due to the large number of absences caused by the illness. 

But because of the delay in reporting, what the world is coming to learn could be skewed. While China says the virus mostly affects children, the ambiguity is eerily similar to initial claims that Covid-19 did spread among people.

A WHO official said on November 23 the spike in respiratory illnesses that China is currently going through is not as high as before the Covid-19 pandemic. 

The official also reiterated that no new or unusual pathogens had been found in the recent cases, instead being linked to the flu, Covid and RSV. They said no new pathogens had been identified. 

Maria Van Kerkhove, acting director of the WHO's department of epidemic and pandemic preparedness and prevention, said this weekend the increase appeared to be driven by a rise in the number of children contracting pathogens that two years of Covid restrictions have kept them away from.

'We asked about comparisons prior to the pandemic. And the waves that they are seeing now, the peak is not as high as what they saw in 2018-2019,' Van Kerkhove told STAT.

She added: 'This is not an indication of a novel pathogen. This is expected. This is what most countries dealt with a year or two ago.'

China's National Health Commission spokesperson Mi Feng echoed these sentiments on Sunday and said the surge in acute respiratory illnesses was linked to the simultaneous circulation of several kinds of pathogens, most prominently influenza.

He said with the coming of winter and rise in cases, Chinese health agencies are continuing to monitor cases, encourage vaccinations, disperse medical resources and ensure people are receiving necessary treatment.  

He also advised people to wear masks and called on local authorities and treatment areas to extend service hours and increase the supply of medicines.

Images coming out of China show overwhelmed hospital waiting rooms crammed with parents and children.

But this may be reassuring compared to early in the Covid pandemic, when pictures coming out of Wuhan showed bodies piling up and overcrowded funeral homes.

Medical staff have also not been photographed wearing the full hazmat suits that were being seen in Wuhan in January 2020 as Covid took hold.

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COVID deaths and ICU admissions are low while flu and RSV are rising. Some experts are predicting a 'more intense' virus season than normal

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It’s difficult to know how any respiratory virus season is going to shake out, “but if I had to bet the house,” Matthew Miller sees a somewhat more intense season than what we’re used to, pre-pandemic.

The situation now isn’t what it was a year ago, when lineups at children’s emergency departments snaked out the doors and parents resorted to furtive cross-border trips to stock up on children’s Tylenol during a months-long shortage of kids’ fever relievers.

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Last year’s RSV (respiratory syncytial virus) season peaked unusually early, with infections shooting up beginning in September, after a near total disappearance during the earlier days of the pandemic, when measures in place to curb COVID’s spread also led to relatively little circulating RSV activity.

RSV is currently on the “high end of normal,” said Miller, and, despite an earlier spike last year, “those lines are starting to meet now.”

“It wouldn’t be crazy to think that we’re going to have a more intense respiratory season than usual,” said Miller, director of McMaster University’s Michael G. DeGroote Institute for Infectious Disease Research.

To get a sense of what winter might bring in the form of any viral onslaught, experts look to the southern hemisphere, which experiences their respiratory seasons over our summers. Australia has some of the best data for monitoring the “triple-demic” of RSV, influenzas, and COVID-19.

Australia saw an earlier-than-normal start to its flu season, and higher than pre-pandemic levels of infection, Miller said, as well as above seasonal norms for RSV.

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One recent study suggested COVID-19 infections may have been a driving force for the 2022 surge in RSV infections among children five and under, possibly because of the effects of SARS-CoV-2 on a child’s immune and respiratory systems.

In Canada, flu is increasing, but is within expected levels for this time of year, according to the Public Health Agency of Canada’s latest respiratory disease surveillance report.

Nationally, the COVID-19 per cent positivity — of those tested, the proportion that test positive — has remained stable over the past five surveillance weeks. There are signs weekly COVID-19 deaths are decreasing, and the number in ICU remained low for the week ending Nov. 21.

“We’re not getting a lot of serious, life-threatening cases that need admission to hospital or are overrunning ICUs like we were,” said Dr. Mike Howlett, president of the Canadian Association of Emergency Physicians.

Influenza looks like it’s on a “pre-pandemic trajectory,” and is just beginning to rise, said McMaster University immunologist Dawn Bowdish. Flu season usually peaks between December and February.

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“We’re not in the same absolute disaster as we were last year’s cold and flu season,” Bowdish said. “But we’re still experiencing so much health-care strain that even fewer hospitalizations are still really problematic,” Bowdish said.

Emergency departments are still overcrowded. People who need to be admitted are being “boarded” in hallways on stretchers. “I know some hospitals where the waiting time for admission has gone up from 20, 30 hours on average to 50, 60 hours on average,” Fowlet said.

In many ways, hospital crowding is worse now than previous years because underlying conditions haven’t been addressed, Fowlet said, including hiring enough emergency physicians and nurses to manage caseloads. As the National Post has reported, Canadian hospital capacity has been limping along for decades while governments and policy makers, Howlet said, have been “playing around the edges.”

“There’s not a health system in Canada that isn’t understaffed and struggling to deal with emergency admissions as it is,” Bowdish said.

The concern is post-Christmas, when viruses traditionally spread from kids to parents and grandparents, and adult hospitalizations become a problem, she said.

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Doctors are seeing some increase in childhood pneumonias. RSV is a common cause of pneumonia and bronchiolitis in young kids, “and I’m seeing more RSV than COVID right now,” said Howlett, who was recovering from what he suspected was an RSV infection he caught from his six-month-old grandchild.

Symptoms of RSV are broad, including common cold-like ones — runny nose, cough, sore throat, muscle aches and pains, and nausea, vomiting or occasional bit of diarrhea sometimes.

The more worrisome symptoms are a worsening cough and shortness of breath. The airways in the lungs of babies and infants are narrower. If a virus gets into the lungs, and secretions start to accumulate in the airways, they can run into difficulty with breathing.

It’s the younger ones, children between three months and 18 months of age, who tend to run into trouble. “They can start having significant wheezing, shortness of breath, rapid breathing,” Howlett said. “Their ribs are sucking in between their chest and under their chest, there’s some tugging around their neck from the muscles because they’re trying to get the air in.” Some need to be admitted to hospital for extra oxygen.

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Nationally, COVID activity has stabilized, though trends vary across the country. “Weekly deaths and the number in ICU remain low,” according to the federal government’s update for the week ending Nov. 21.

The COVID test positivity rate is around 19 per cent. “There’s no doubt that it’s circulating,” said Dr. Catherine Hankins, former co-chair of the Canadian Immunity Task Force.

“People have a certain amount of immunity. But it’s not like measles where you get the infection and you get the vaccination and you’re pretty much protected for life,” Hankins said.

Most of what’s circulating now are the XBB lineages, which the updated boosters were tailored to target.

“I think we’re at a point with COVID where we’re sort of equilibrating,” Miller said. There are going to be year-to-year variations, he said. “I know it’s felt like an eternity, but really, it’s only been four-ish years since COVID’s been around. It’s not yet clear what the average level will be.”

For COVID, the high-risk groups haven’t changed. Older adults and those with underlying medical conditions are at highest risk of severe infections.

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“There are some pieces of good news, though,” Miller said. This year’s flu vaccines appear a good match for viruses expected to circulate this winter. “If people get vaccinated now, they’ll generate immunity over the next two weeks” when cases are expected to begin rising, he said.

In August, Health Canada approved an RSV vaccine for adults aged 60 and older. However, the shots, which cost about $230 per dose, are not publicly covered by most provinces, even though RSV is one of the “big, underappreciated health burdens in older adults,” Miller said.

Human behavior can shape the spread of seasonal viruses, said Hankins, a professor in the School of Population and Global Health at McGill University.

“How many people get their flu vaccine? Get their COVID booster?”

Governments should make the RSV vaccine free to people 60 and older, she said.

She visited a Christmas market twice this weekend. “I saw one other person wearing a mask — these are tents where the air is kind of steamy and it’s packed with people.”

“We’re not going back to the old lockdown mentality,” Hankins said. “We have to go back to figuring out what is your risk tolerance, and how much risk are you prepared to take for yourself and the people around you.”

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  • A mystery dog illness is spreading across the country.
  • Dogs are developing serious symptoms, including respiratory distress, and the condition isn’t responding to usual treatments.
  • Veterinarians recommend prevention methods to protect your dog.

A mystery dog illness continues to spread across the country, leaving a growing number of dog owners concerned. The illness, which does not currently have a name, is raising a lot of questions among veterinarian agencies, with the American Veterinary Medical Association (AVMA) noting that its cause “remains a mystery,” despite hundreds of dogs contracting it. Though it doesn’t have an official name, there are a number of symptoms to be aware of, (like respiratory distress) and ways to prevent serious illness in your pup.

According to reports, the illness doesn’t respond well to usual treatments, making it even more concerning. “We’re letting people know that it’s something to be on the lookout for,” says Brian Collins, D.V.M., an extension veterinarian for the Cornell Margaret and Richard P. Riney Canine Health Center.

Meet the experts: Brian Collins, D.V.M., an extension veterinarian for the Cornell Margaret and Richard P. Riney Canine Health Center; Colleen Lambo, D.V.M., of The Vets; Victoria Hopson, D.V.M., an associate veterinarian at The Vets of Raleigh; Jeanette O’Quin, D.V.M., associate professor-clinical in the College of Veterinary Medicine at The Ohio State University.

So, what is the mystery dog illness and how can you protect your dog? Here’s what we know right now.

What are the symptoms of the mystery dog illness?

According to the Oregon Veterinary Medical Association (OVMA), which was one of the first organizations to flag the illness, symptoms may include:

  • Chronic cough
  • Fever
  • Discharge from eye and/or nose
  • Chronic pneumonia that doesn’t respond to antibiotics
  • Acute pneumonia that quickly becomes severe and may lead to “poor outcomes” in as little as 24 to 36 hours

Dogs with this illness may not be eating and drinking well, according to Collins. While Collins says that dogs can develop coughs, the cough from this illness “persists longer than normal,” meaning it lasts for weeks.

The illness is “resistant to standard treatments” and doesn’t cause a positive test for common respiratory illnesses in dogs, according to the New Hampshire Veterinary Diagnostic Laboratory.

“It’s likely a bacteria, it seems, but it’s not responding to antibiotics,” says Colleen Lambo, D.V.M., of The Vets.

How does the mystery dog illness spread?

It’s not entirely known how the mystery dog illness spreads. “We don’t know what the cause is but we’re thinking about it the way we do other forms of canine respiratory disease,” Collins says. “Those are all spread dog to dog.”

That can include dogs licking each other, playing together, breathing next to each other, and coughing and sneezing on each other, he says. Inanimate objects like a shared water or food bowl may spread the illness, too, Collins says. Even humans may spread the illness by petting an infected dog and then another canine, he says.

Where has the mystery dog illness been spotted?

Cases were first detected in Oregon, which has had more than 200 case reports, the AVMA says. However, other potential cases have been reported in California, Colorado, Georgia, and Florida, among other places.

But Collins notes that it’s difficult to say if these are the same illness or different conditions. “Since we don’t really know what the cause of this is, we can’t necessarily say that all of the outbreaks around the country are from the same organism,” he says.

How can I prevent my dog from getting sick?

The OVMA recommends doing the following to protect your dog from respiratory illnesses in general:

  • Reduce your dog’s contact with large numbers of dogs you don’t know
  • Try to keep your dog away from dogs that look sick (i.e. they have a cough, runny nose, and runny eyes)
  • Avoid communal water bowls
  • Make sure your dog is up to date on vaccinations, including canine influenza, Bordetella, and parainfluenza

“Avoid doggy daycare, boarding,—if possible—and dog parks,” says Victoria Hopson, D.V.M., an associate veterinarian at The Vets of Raleigh.

If you suspect that your dog is sick, Hopson also recommends calling a mobile vet, if possible, to lower the risk that you’ll spread illness at your local veterinarian’s office. (You can also call your regular vet’s office to ask about the next steps and if they want you to bring your dog into the clinic.)

Can the mystery dog illness spread to humans?

That’s also not clear at this time. “We don’t know what it is,” Collins says. “We can’t say definitively one way or the other if it infects people.”

“So far no human cases have been reported associated with sick dogs believed to be part of this outbreak,” says Jeanette O’Quin, D.V.M., associate professor-clinical in the College of Veterinary Medicine at The Ohio State University. “The overwhelming majority of canine infectious agents are not transmissible to people.”

If your dog appears to be sick, Collins recommends calling your vet. They can advise you on the next steps from there.

Headshot of Korin Miller

Korin Miller is a freelance writer specializing in general wellness, sexual health and relationships, and lifestyle trends, with work appearing in Men’s Health, Women’s Health, Self, Glamour, and more. She has a master’s degree from American University, lives by the beach, and hopes to own a teacup pig and taco truck one day.

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