Friday, August 25, 2023
The Highly Mutated BA.2.86, the Detecting Lab and Immunity Questions
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Yesterday, TrialSite reported that the Centers for Disease Control and Prevention (CDC) picked up on a new SARS-CoV-2 variant, one highly mutated, termed BA.2.86. In the United States, the mutated variant was sequenced in Michigan thanks to the ongoing surveillance occurring at the University of Michigan Clinical Microbiology Laboratory.
The University of Michigan Clinical Microbiology Laboratory in the report is termed the originating lab, while the submitting lab was the Lauring Lab, University of Michigan, Department of Microbiology and Immunology. This lab is led by Adam Lauring, M.D., Ph.D., a Professor of Internal Medicine, Infectious Disease and Microbiology & Immunology.
The Clinical Microbiology Lab is led by Michael Bachman, M.D., Ph.D., and Paul R. Lephart, Ph.D., D(ABMM), both Associate Directors of the prominent Midwestern lab—one staffed by 55 medical technologists and clinical laboratory scientists. The laboratories provide service 365 days a year to meet the medical needs of Michigan Medicine and the clients of the “M-Labs” program.
The Clinical Microbiology Laboratory has close ties with Adult and Pediatric Infectious Diseases, the Infection Control Program, the Department of Pharmacy, and the School of Public Health. Close collaboration is key among the various functional areas, thus providing the ongoing analysis of interactions between organisms and antimicrobial agents that allow for dynamic reporting to clinicians on the floors and foster productive research collaborations that directly result in improving the quality of care provided to patients.
The Clinical Microbiology Laboratories are accredited by the College of American Pathologists (CAP) and active in the CAP Laboratory Accreditation and Proficiency Testing programs
More on the variant
CBS News coverage of the latest variant discovered revealed some useful information. Kathleen Conley, a CDC spokesperson told the network news, “Today we are more prepared than ever to detect and respond to changes in the COVID-19 virus.” Conley empathized that “Scientists are working now to understand more about the newly identified lineage in these four cases and we will share more information as it becomes available.”
Alexander Tin covered the story for CBS News HealthWatch.
Is BA.2.86 a more threatening or dangerous variant of SARS-CoV-2? Will it lead to more severe COVID-19? While the World Health Organization went on the record that the variant includes dozens of genetic changes, for comparison it’s a similar situation in some ways to how Omicron emerged as a materially different stain than, say, delta.
But public health agencies and academic research centers need more data to determine the risk levels associated with BA.2.86. TrialSite reported that this newly detected strain has been detected in Israel and Denmark as well.
The concern, among other things, is that the mutations could aid the pathogen in its ability to evade immunity, both of the natural (previous infection) as well as vaccine-induced type. There is no real threat at this point given the pathogen has only been detected in a few places. Also, it may well be the case that the human body’s current immune responses help fight off the mutant. Or for that matter, the mutant may not be able to compete with existing highly infectious strains.
CBS News obtained a presentation from a Fred Hutch Cancer Center evolutionary biologist, Jesse Bloom, Ph.D., conveying what could be considered potentially disturbing information about the latest variant. “Deep mutational scanning indicates BA.2.86 variant will have equal or greater escape than XBB.1.5 from antibodies elicited by pre-omicron and first-generation Omicron variants.”
Some of the mutations exist in parts of the virus that could help it evade immunity provided by prior vaccination or infection.
But Bloom also suggested the collective immunity may well be ready to take on BA.2.86, “[T]here are also broader mechanisms of immunity elicited by vaccination and infection that provide some protection against severe disease even for very heavily mutated variants.”
What are the implications for the latest vaccine that will likely be approved by FDA, and recommended by CDC for the fall season?
A monovalent mRNA vaccine produced by both Pfizer-BioNTech and Moderna are under clinical study. TrialSite reported on a trial site looking to enroll adolescents in Cincinnati Ohio for the Moderna clinical trial.
The FDA recommended that the vaccine makers tailor this COVID-19 season’s vaccine to XBB.1.5, an Omicron variant. As TrialSite has reported recently, while this strain predominated circulating Omicron variants across America just a few months ago it is now at 10.3% or lower. TrialSite estimates that by October XBB.1.5 will be under 5% of all circulating SARS-CoV-2 variants, if not less.
What does this mean for COVID-19 vaccine effectiveness? And what about the emerging predominant variants? For example, EG.5 at over 17% of SARS-CoV-2 cases according to the CDC now is the pathogen to watch. The good news for vaccination and natural immunity supporters---EG.5 is an XBB descendent so perhaps the vaccine’s effectiveness will be better than expected. Or perhaps Moderna pointed out, according to CBS News, that its shot provides "a significant boost in neutralizing antibodies" for EG.5.
Yet according to the Fred Hutch evolutionary biologist Jesse Bloom, all bets are off if BA.2.86 is able to outcompete and overcome other fast-moving, mutating Omicron variants. That scenario could represent trouble for our collective immunity. BA.2.86 heavily mutated would be a “fairly poor match” for the current vaccines under clinical development which again target XBB.
A reminder tempering the concern. With each progressive mutation under the Omicron umbrella of variants, COVID-19 becomes ever milder all things considered. And there are treatments available. Yes, it still can turn severe and even deadly but the case fatality rate now ranks with influenza, if not even less dangerous for healthy people.
Even during the Delta variant surge TrialSite always reminded that 90-95% of the COVID-19 cases were mild to moderate, but that persons in high-risk categories (e.g., elderly, persons with comorbidities, immunocompromised) faced considerably higher threat. TrialSite emphasized with national and state public health agencies that face a U.S. population with a staggering reality—about 70% of the adult population is either overweight or obese as reported by Harvard T.H. Chan School of Public Health. During the pandemic, there was little time to risk stratify, and obesity itself was/and is a risk factor. Meaning a good half, of the country’s adults likely fell in the higher risk category. This remains so, although the case fatality rate is under 1%. But generally, the Omicron variants are more infectious, meaning they spread faster, yet overall lead to milder outcomes.
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Murdoch Children’s Bombshell: Medicinal Value of COVID-19 Vaccines Now Questionable Among Healthy Children
According to researchers at Australia’s Murdoch Children’s Research Institute, COVID-19 vaccines have demonstrated efficacy against severe incidence of SARS-CoV-2 in children and adolescents, but their value proposition as a mass medical tool becomes questionable considering the unfolding dynamics of today: high pre-existing infection and low risk when infected.
Researchers led by John Hart from the academic medical center for young people Down Under acknowledge that most children now have been infected by SARS-CoV-2, meaning they have built up immunity, and the vaccine’s benefit in healthy children is minimal. They argue any energies and attention placed on COVID-19 vaccination campaigns should be used to advocate for vaccines known to offer higher medical value, such as the measles vaccine. The ramifications of this recent set of findings are substantial.
Published in the BMJ Pediatrics Open, the international review was led by medical researchers from the Australian medical institute. They explored the challenges and considerations of COVID-19 vaccination, especially in low-and middle-income countries with high levels of community transmission and infection-derived immunity.
The team’s review, led by Hart, a medical epidemiologist, suggests that any COVID-19 vaccination scheme moving forward, especially in low-and middle-income countries should be coupled with routine childhood vaccination program that the researchers acknowledge “have greater impact on illness and death, including for measles, pneumonia and diarrheal disease.”
Mild for most
The Australian team found that about two-thirds of all young people that had COVIS-19 and were hospitalized in the first two years of the COVID-19 pandemic did not require medical intervention. Deaths, the investigators reported, “were extremely rare in children.”
Closing in on child herd immunity?
The researchers also point out that the vast majority of children have been infected with SARS-CoV-2. As immunity has increased over time, the disease continues to evolve. Prior research led by Murdoch Children’s found that croup, triggered by the novel coronavirus, declined in 2022 despite the rise of new variants.
Also, data from the Pediatric Active Enhanced Disease Surveillance (PAEDS) network in America found that rates of pediatric multisystem inflammatory syndrome (PIMS-TS), what was a major driver for childhood vaccination, were “Substantially lower during the Omicron COVID-19 variant period.” TrialSite reported on similar findings in the UK.
Net takeaway
While there are still cases where COVID-19 vaccination is recommended, the Australian researchers are clear—they value of these vaccines for children has markedly diminished. In fact, they use the COVID-19 vaccination push as a primary means of promoting more substantive medical vaccination, such as measles. Reading between the lines, and on the face of the piece, the investigators are more concerned about standard vaccination rates, especially in low-and moderate-income countries.
One takeaway called out by this independent media, children achieved herd immunity against SARS-CoV-2 by infection, not vaccination.
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Also see my other blogs. Main ones below:
http://edwatch.blogspot.com (EDUCATION WATCH)
http://antigreen.blogspot.com (GREENIE WATCH)
http://pcwatch.blogspot.com (POLITICAL CORRECTNESS WATCH)
http://australian-politics.blogspot.com (AUSTRALIAN POLITICS)
http://snorphty.blogspot.com (TONGUE-TIED)
https://immigwatch.blogspot.com (IMMIGRATION WATCH)
https://awesternheart.blogspot.com (THE PSYCHOLOGIST)
http://jonjayray.com/blogall.html More blogs
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