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Dengue vaccine now available at select Watsons stores

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Dengvaxia, a vaccine against dengue, is now available over-the-counter nationwide at select stores of Watsons, the first retailer to offer the vaccine in the Philippines.

Watsons Dengue Vaccine KV 2

“We decided to offer dengue vaccination in our 108 selected stores nationwide as we recognize the importance of having vaccination accessible to Filipinos to protect them against dengue infection and make them healthier. It is our latest addition that we offer in our stores, aside from cervical cancer, flu and pneumonia vaccinations,” says Danilo Chiong, Watsons Trading Health Director.

Produced by pharmaceutical firm Sanofi Pasteur, Dengvaxia took over 20 years of extensive research and tests to develop. Studies on the vaccine were conducted on 41,000 people and were carried out in 15 countries including the Philippines. With test results fully reviewed by a committee of independent experts, the vaccine has been recommended by the World Health Organization (WHO).

In a WHO position paper published in July 29, 2016, it says that to prevent dengue infection, dengue vaccine should be a part of a comprehensive dengue control strategy, which include well-executed and sustained vector controls, evidence-based best practices for clinical care and strong dengue surveillance.

The vaccine has also been endorsed by the Philippine Society for Microbiology and infectious Diseases (PSMID) and Philippine College of Physicians (PCP). In February 2017, the vaccine got the approval to be administered in 14 countries, including the Philippines, where dengue is endemic.

In the Philippines, there were 211,106 reported dengue cases in 2016. The most number of cases was reported in Regions VI, VII, III, IV-A, and XII. All age groups were affected by dengue.

Age bracket and dosage

Since there is no specific treatment for dengue, Dr. Rontgene Solante, Past President at PSMID, said the dengue vaccine can protect individuals against the illness. It can be administered to individuals 9 to 45 years old living in endemic areas for prevention of dengue illness caused by dengue virus serotypes 1, 2, 3 and 4. It is to be taken in three doses of 0.5ml at six-month intervals to increase antibodies response, thereby protecting them from all four strains of the virus. The vaccine, when correctly administered in three doses, stays effective in four to five years.

The vaccine costs P4,000 per dose or P12,000 for all three doses, which is reasonable considering the high incidence of dengue and high cost of treatment in the Philippines.

“The vaccine is not just for kids but adults should also be vaccinated as this is safe and can modify infection. Don’t look at the price but in the long-term benefits it provides,” said Solante.

Solante, however, relayed the vaccine is not effective for children below nine years old. A study made on the vaccine and these children showed that the efficacy of the vaccine was below 50%. Likewise, the vaccine cannot be administered to persons over 45 years old as there was no study made yet about its effectiveness for these individuals.

Apart from these, other persons who have the following cannot take the vaccine: history of severe allergic reaction; congenital or acquired immune deficiency diseases; symptomatic HIV infection; and pregnant or breastfeeding women.

Solante, however, said that those were infected by dengue in the past can still avail of the vaccine.

Solante advised individuals to administer the vaccine correctly. “If a person who has taken the first dose fails to take the second dose on the scheduled (sixth) month, and instead take it, let’s say, on the eighth month, the vaccine is still effective. But, if he misses taking it for a couple of years, the vaccine became ineffective and has to start taking it all over again.”

The vaccine is injected in arms via the subcutaneous route over the deltoid region. How is it effective? In his presentation, Dr. Solante said the vaccine can result to 80.8% reduction in hospitalized dengue; 93.2% drop in severe dengue; and 65.6% decline in symptomatic dengue, which means that if a person is infected, symptoms are reduced.

The vaccine does not contain adjuvants or preservatives so the adverse effect or reaction is lower, according to Solante. Adverse reactions include headache, malaise, myalgia, pain, injection site reaction, and other mild to moderate reactions.

A study conducted by the University of the Philippines showed that the vaccine is expected to reduce dengue cases in the country by over 24% in a span of five years.

Meanwhile, Chiong said that they will have a doctor in over 100 selected Watsons stores to administer the vaccine during vaccination dates. The first scheduled dengue vaccination will be on April 30, 2017 (1st dose); October 29, 2017 (2nd dose) and April 29, 2018 (3rd dose). The second schedule vaccination will be on May 14, 2018 (1st dose); November 12, 2018 (2nd dose); and May 13, 2018 (3rd dose).

REYNALDO “Rey” R. VICENTE’s career experience involves mostly research in publishing companies. He previously held the position of Research and Events Director of Media G8way Corp., publisher of Computerworld Philippines (CWP), PC World Philippines, and IT Resource. He also handled events organized for CWP. Prior to this, he was a Research Head of a business publication. Now as co-publisher of Zest Magazine, Rey also serves as Managing Editor. Rey finished his bachelor’s degree majoring in Economics at the University of Santo Tomas.

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Down on Vitamin D? It could be the cause of chronic inflammation

Lead researcher, UniSA’s Dr Ang Zhou, says the findings suggest that boosting vitamin D in people with a deficiency may reduce chronic inflammation.

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Photo by Michele Blackwell from Unsplash.com

Inflammation is an essential part of the body’s healing process. But when it persists, it can contribute to a wide range of complex diseases including type 2 diabetes, heart disease, and autoimmune diseases.

Now, world-first genetic research from the University of South Australia shows a direct link between low levels of vitamin D and high levels of inflammation, providing an important biomarker to identify people at higher risk of or severity of chronic illnesses with an inflammatory component.

The study examined the genetic data of 294 ,970 participants in the UK Biobank, using Mendelian randomization to show the association between vitamin D and C-reactive protein levels, an indicator of inflammation.

Lead researcher, UniSA’s Dr Ang Zhou, says the findings suggest that boosting vitamin D in people with a deficiency may reduce chronic inflammation.

“Inflammation is your body’s way of protecting your tissues if you’ve been injured or have an infection,” Dr Zhou says. “High levels of C-reactive protein are generated by the liver in response to inflammation, so when your body is experiencing chronic inflammation, it also shows higher levels of C-reactive protein. This study examined vitamin D and C-reactive proteins and found a one-way relationship between low levels of vitamin D and high levels of C-reactive protein, expressed as inflammation. Boosting vitamin D in people with deficiencies may reduce chronic inflammation, helping them avoid a number of related diseases.”

Supported by the National Health and Medical Research Council and published in the International Journal of Epidemiology the study also raises the possibility that having adequate vitamin D concentrations may mitigate complications arising from obesity and reduce the risk or severity of chronic illnesses with an inflammatory component, such as CVDs, diabetes, and autoimmune diseases.

Senior investigator and Director of UniSA’s Australian Centre for Precision Health, Professor Elina Hyppönen, says these results are important and provide an explanation for some of the controversies in reported associations with vitamin D.

“We have repeatedly seen evidence for health benefits for increasing vitamin D concentrations in individuals with very low levels, while for others, there appears to be little to no benefit.” Prof Hyppönen says.  “These findings highlight the importance of avoiding clinical vitamin D deficiency, and provide further evidence for the wide-ranging effects of hormonal vitamin D.”

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Fatigue, headache among top lingering symptoms months after COVID

Fatigue and headache were the most common symptoms reported by individuals an average of more than four months out from having COVID-19, investigators report.

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Photo by @cottonbro from Pexels.com

Fatigue and headache were the most common symptoms reported by individuals an average of more than four months out from having COVID-19, investigators report.

Muscle aches, cough, changes in smell and taste, fever, chills and nasal congestion were next in the long line of lingering symptoms.

“Our results support the growing evidence that there are chronic neuropsychiatric symptoms following COVID-19 infections,” Medical College of Georgia investigators write in the journal ScienceDirect

“There are a lot of symptoms that we did not know early on in the pandemic what to make of them, but now it’s clear there is a long COVID syndrome and that a lot of people are affected,” says Dr. Elizabeth Rutkowski, MCG neurologist and the study’s corresponding author.

The published study reports on preliminary findings from the first visit of the first 200 patients enrolled in the COVID-19 Neurological and Molecular Prospective Cohort Study in Georgia, or CONGA, who were recruited on average about 125 days after testing positive for the COVID-19 virus.

CONGA was established at MCG early in the pandemic in 2020 to examine the severity and longevity of neurological problems and began enrolling participants in March 2020 with the ultimate goal of recruiting 500 over five years.

Eighty percent of the first 200 participants reported neurological symptoms with fatigue, the most common symptom, reported by 68.5%, and headache close behind at 66.5%. Just over half reported changes in smell (54.5%) and taste (54%) and nearly half the participants (47%) met the criteria for mild cognitive impairment, with 30% demonstrating impaired vocabulary and 32% having impaired working memory.

Twenty-one percent reported confusion, and hypertension was the most common medical condition reported by participants in addition to their bout with COVID-19.

No participants reported having a stroke, weakness or inability to control muscles involved with speaking, and coordination problems were some of the less frequently reported symptoms.

Twenty-five percent met the criteria for depression, and diabetes, obesity, sleep apnea and a history of depression were associated with those who met the criteria. Anemia and a history of depression were associated with the 18% who met the objective criteria for anxiety.

While the findings to date are not surprising and are consistent with what other investigators are finding, Rutkowski says the fact that symptoms reported by participants often didn’t match what objective testing indicated, was surprising. And, it was bidirectional.

For example, the majority of participants reported taste and smell changes, but objective testing of both these senses did not always line up with what they reported. In fact, a higher percentage of those who did not report the changes actually had evidence of impaired function based on objective measures, the investigators write. While the reasons are not certain, part of the discrepancy may be a change in the quality of their taste and smell rather than pure impaired ability, Rutkowski says.

“They eat a chicken sandwich and it tastes like smoke or candles or some weird other thing but our taste strips are trying to depict specific tastes like salty and sweet,” Rutkowski says. Others, for example, may rely on these senses more, even when they are preparing the food, and may be apt to notice even a slight change, she says.

Either way, their data and others suggest a persistent loss of taste and smell following COVID-19, Rutkowski and her colleagues write.

Many earlier reports have been based on these kinds of self-reports, and the discrepancies they are finding indicate that approach may not reflect objective dysfunction, the investigators write.

On the other hand, cognitive testing may overestimate impairment in disadvantaged populations, they report.

The first enrollees were largely female, 35.5% were male. They were an average of 44.6 years old, nearly 40% were Black and 7% had been hospitalized because of COVID-19. Black participants were generally disproportionately affected, the investigators say.

Seventy-five percent of Black participants and 23.4% of white participants met criteria for mild cognitive impairment. The findings likely indicate that cognitive tests assess different ethnic groups differently. And, socioeconomic, psychosocial (issues like family problems, depression and sexual abuse) and physical health factors generally may disproportionately affect Black individuals, the investigators write. It also could mean that cognitive testing may overestimate clinical impairment in disadvantaged populations, they write.

Black and Hispanic individuals are considered twice as likely to be hospitalized by COVID-19 and ethnic and racial minorities are more likely to live in areas with higher rates of infection. Genetics also is a likely factor for their increased risk for increased impact from COVID, much like being at higher risk for hypertension and heart disease early and more severely in life.

A focus of CONGA is to try to better understand how increased risk and effects from COVID-19 impact Blacks, who comprise about 33% of the state’s population.

A reason fatigue appears to be such a major factor among those who had COVID-19 is potentially because of levels of inflammation, the body’s natural response to an infection, remain elevated in some individuals. For example, blood samples taken at the initial visit and again on follow up showed some inflammatory markers were up and stayed up in some individuals.

These findings and others indicate that even though the antibodies to the virus itself may wain, persistent inflammation is contributing to some of the symptoms like fatigue, she says. She notes patients with conditions like multiple sclerosis and rheumatoid arthritis, both considered autoimmune conditions that consequently also have high levels of inflammation, also include fatigue as a top symptom.

“They have body fatigue where they feel short of breath, they go to get the dishes done and they are feeling palpitations, they immediately have to sit down and they feel muscle soreness like they just ran a mile or more,” Rutkowski says.

“There is probably some degree of neurologic fatigue as well because patients also have brain fog, they say it hurts to think, to read even a single email and that their brain is just wiped out,” she says. Some studies have even shown shrinkage of brain volume as a result of even mild to moderate disease. 

These multisystem, ongoing concerns are why some health care facilities have established long COVID clinics where physicians with expertise in the myriad of problems they are experiencing gather to see each patient.

CONGA participants who reported more symptoms and problems tended to have depression and anxiety. Problems like these as well as mild cognitive impairment and even impaired vocabulary may also reflect the long-term isolation COVID-19 produced for many individuals, Rutkowski says.

“You are not doing what you would normally do, like hanging out with your friends, the things that bring most people joy,” Rutkowski says. “On top of that, you may be dealing with physical ailments, lost friends and family members and loss of your job.”

For CONGA, participants self-report symptoms and answer questions about their general state of health like whether they smoked, drank alcohol, exercised, and any known preexisting medical conditions. But they also receive an extensive neurological exam that looks at fundamentals like mental status, reflexes and motor function. They also take established tests to assess cognitive function with results being age adjusted. They also do at-home extensive testing where they are asked to identify odors and the ability to taste sweet, sour, bitter, salty, brothy or no taste. They also have blood analysis done to look for indicators of lingering infection like those inflammatory markers and oxidative stress.

Neuropsychiatric symptoms are observed in the acute phase of infection, but there is a need for accurate characterization of how symptoms evolve over time, the investigators write.

And particularly for some individuals, symptoms definitely linger. Even some previously high-functioning individuals, who normally worked 80 hours a week and exercised daily, may find themselves only able to function about an hour a day and be in the bed the remainder, Rutkowski says.

The investigators are searching for answers to why and how, and while Rutkowski says she cannot yet answer all their questions, she can tell them with certainty that they are not alone or “crazy.”  

One of the best things everyone can do moving forward is to remain diligent about avoiding infection, including getting vaccinated or boosted to help protect your brain and body from long COVID symptoms and help protect others from infection, Rutkowski says. There is evidence that the more times you are infected, the higher the risk of ongoing problems.

Rutkowski notes that their study findings may be somewhat biased toward high percentages of ongoing symptoms because the study likely is attracting a high percentage of individuals with concerns about ongoing problems.

SARS-CoV-2 is thought to have first infected people in late 2019 and is a member of the larger group of coronaviruses, which have been a source of upper respiratory tract infections, like the common cold, in people for years.

At least part of the reason SARS-CoV-2 is believed to have such a wide-ranging impact is that the virus is known to attach to angiotensin-converting enzyme-2, or ACE2, which is pervasive in the body. ACE2 has a key role in functions like regulating blood pressure and inflammation. It’s found on neurons, cells lining the nose, mouth, lungs and blood vessels, as well as the heart, kidneys and gastrointestinal tract. The virus attaches directly to the ACE2 receptor on the surface of cells, which functions much like a door to let the virus inside.

Experience and study since COVID-19 started both indicate immediate neurological impact can include loss of taste and smell, brain infection, headaches and, less commonly, seizures, stroke and damage or death of nerves. As time has passed, there is increasing evidence that problems like loss of taste and smell, can become chronic, as well as problems like brain fog, extreme fatigue, depression, anxiety and insomnia, the investigators write. Persistent conditions including these and others are now referenced as “long Covid.”

The research was supported by funding from the National Institute of Neurological Disorders and Stroke and philanthropic support from the TR Reddy Family Fund.

Read the full study.

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Vitamin B6 supplements could reduce anxiety and depression

The study showed that Vitamin B12 had little effect compared to placebo over the trial period, but Vitamin B6 made a statistically reliable difference.

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Taking high-dose Vitamin B6 tablets has been shown to reduce feelings of anxiety and depression by new research.

Scientists at the University of Reading measured the impact of high doses of Vitamin B6 on young adults and found that they reported feeling less anxious and depressed after taking the supplements every day for a month.

The study, published in the journal Human Psychopharmacology: Clinical and Experimental, provides valuable evidence to support the use of supplements thought to modify levels of activity in the brain for preventing or treating mood disorders.

Dr David Field, lead author from the School of Psychology and Clinical Language Sciences at the University of Reading, said: “The functioning of the brain relies on a delicate balance between the excitatory neurons that carry information around and inhibitory ones, which prevent runaway activity.

“Recent theories have connected mood disorders and some other neuropsychiatric conditions with a disturbance of this balance, often in the direction of raised levels of brain activity.

“Vitamin B6 helps the body produce a specific chemical messenger that inhibits impulses in the brain, and our study links this calming effect with reduced anxiety among the participants.”

While previous studies have produced evidence that multivitamins or marmite can reduce stress levels, few studies have been carried out into which particular vitamins contained within them drive this effect.

The new study focused on the potential role of Vitamins B6, which is known to increase the body’s production of GABA (Gamma-Aminobutyric Acid), a chemical that blocks impulses between nerve cells in the brain.

In the current trial, more than 300 participants were randomly assigned either Vitamin B6 or B12 supplements far above the recommended daily intake (approximately 50 times the recommended daily allowance) or a placebo, and took one a day with food for a month.

The study showed that Vitamin B12 had little effect compared to placebo over the trial period, but Vitamin B6 made a statistically reliable difference.

Raised levels of GABA among participants who had taken Vitamin B6 supplements were confirmed by visual tests carried out at the end of the trial, supporting the hypothesis that B6 was responsible for the reduction in anxiety. Subtle but harmless changes in visual performance were detected, consistent with controlled levels of brain activity.

Dr Field said: “Many foods, including tuna, chickpeas and many fruits and vegetables, contain Vitamin B6. However, the high doses used in this trial suggest that supplements would be necessary to have a positive effect on mood.

“It is important to acknowledge that this research is at an early stage and the effect of Vitamin B6 on anxiety in our study was quite small compared to what you would expect from medication. However, nutrition-based interventions produce far fewer unpleasant side effects than drugs, and so in the future people might prefer them as an intervention.

“To make this a realistic choice, further research is needed to identify other nutrition-based interventions that benefit mental wellbeing, allowing different dietary interventions to be combined in future to provide greater results.

“One potential option would be to combine Vitamin B6 supplements with talking therapies such as Cognitive Behavioural Therapy to boost their effect.”

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