February 2020 PIN Newsletter

A Comment from the Coordinator

 

Lots going on in the world of pneumonia.  January 29-31, 2020 stakeholders gathered at CosmoCaixa in Barcelona, Spain to attend the Global Forum on Childhood Pneumonia.  In addition to a declaration to reduce child pneumonia deaths to less than 3 per 1000 live births by 2030, outcomes from the meeting included important commitments from Indonesia (introduction of pneumococcal conjugate vaccine into routine immunization services), Nigeria (introduction of national pneumonia control strategy), and Spain (increased Official Development Assistance support).

 

In addition, this month in our Deep Breaths Blog, we will hear from PIN Member Michael Mina as he discusses why measles is the master childhood infection.

 

 

Announcements

 

Registration for the American Thoracic Society Conference May 15-20, 2020 in Philadelphia is now open.

 

PIN member Nasreen Mahomed reached out to share her work around chest radiography and artificial intelligence.

 

Coronavirus got you down?  Want to write about it? The PIN is looking to feature more member-generated content in our coming newsletters and on our website. Submit your interests for blog authorship, your member updates, and any suggestions or comments to This email address is being protected from spambots. You need JavaScript enabled to view it..

 

 

DEEP BREATHS: BLOGS FROM PIN MEMBERS

 

Why measles is the master childhood infection By Michael Mina

 

Until the introduction of the measles containing vaccine, measles infected nearly 100% of children. Today, over 7 million cases occur annually (~5% of the annual global birth cohort), but this reflects a ~95% reduction in expected measles incidence due to vaccines.

 

Physicians and public health experts have long recognized that measles can be dangerous, with mortality ranging from 1 in 50-5000 cases, depending on healthcare infrastructure. Recent research suggests that deaths may be much higher.

 

Measles increases risk of other infectious diseases for 2-3 years

 

In a report we published in 2015, we compared the amount of measles with the amount of non-measles infectious diseases deaths in numerous countries. We found that after measles epidemics, children were at increased risk for dying of non-measles infectious diseases for 2-3 years after infection – accounted for ~50% of all childhood infectious disease deaths.

 

In a different study, we followed 2200 measles cases in the UK, retrospectively, and found increased medical visits and antibiotic use for 3-5 years following measles.

 

But how could an acute viral infection cause a years-long increased risk of infection with other diseases?

 

Measles causes immunological amnesia

 

Measles is a virus that infects and kills lymphocytes - immune cells that store protective immune memories. By killing off immune memory cells, measles might be causing the immune system to lose acquired memory – an “immunological amnesia”.

 

To test for immune amnesia, we collected a sample of blood from 77 unvaccinated children (who refused vaccine on religious grounds) before and after a measles outbreak in the Netherlands. We used VirScan to measures thousands of antibodies against hundreds of different pathogens. We found that measles caused large losses (20%-70%) of antibodies that protect against other infectious diseases. Findings that replicated in measles infected macaques.

 

Because antibodies are produced by long-lived memory cells that do not return once lost, we believe that reacquisition of immune memory would require re-infections or revaccinations – which could take years - during which time children would be at risk for other infection.

 

Measles, therefore, might be viewed as a master childhood infection – orchestrating excess susceptibility to other diseases – and highlights measles elimination as a key public health priority. Measles vaccinations has been deemed a ‘best-buy’ in public health, our findings suggest also that by preventing measles, the vaccine would serve to preserve immunity to all other infectious diseases as well.

 

Author: Michael Mina is an Assistant Professor of Epidemiology and of Immunology & Infectious Diseases at the Harvard T.H. Chan School of Public Health and is an associate medical director in clinical pathology, focusing on infectious disease diagnostics, at the Brigham and Women’s Hospital / Harvard Medical School. His work aims to understand the interface of immunity and public health, particularly surrounding vaccines and childhood infectious diseases.

 

 

ARTICLES AND NEWS

Recent selected articles:

 

Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China

By Wang, Hu, Hu, Zhu, Liu, Zhang, Wang, Xiang, Cheng, Xiong, Zhao, Li, Wang, Peng. Published in JAMA. Feb 7, 2020.

In this single-center case series of 138 hospitalized patients with confirmed novel coronavirus (2019-nCoV)-infected pneumonia in Wuhan, China, the authors found that presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.

Access article here.

Epidemiologic and clinical characteristics of novel coronavirus infections involving 13 patients outside Wuhan, China

By Chang, Lin, Wei, Xie, Zhu, Dela Cruz, Sharma. Published in JAMA. Feb 7, 2020.

Access article here.

A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster

By Chan, Yuan, Kok, To, Chu, Yang, Xing, Liu, Yip, Poon, Tsoi, Lo, Chan, Poon, Chan, Ip, Cai, Cheng, Chen, Hui, Yuen. Published in Lancet. Jan 24, 2020.

The authors’ findings were consistent with person-to-person transmission of this novel coronavirus in hospital and family settings, and the reports of infected travellers in other geographical regions

Access article here.

 

Pneumonia-related ideations, care-seeking, and treatment behaviors among children under 2 years with pneumonia symptoms in northwestern Nigeria

By Anaba, Hutchinson, Abegunde, White Johansson. Published in Pediatr Pulmonol. Jan 28, 2020.

The authors found that among 350 under-twos with pneumonia symptoms, 33.8% were taken to formal medical care and 38.0% used antibiotics. Women who positively viewed treatment efficacy and those who positively viewed health services quality had 1.35 (95% CI: 1.00-1.82; P = .050) and 2.13 (95% CI: 1.35-3.35; P = .001) times higher likelihood of attending formal medical sources, while women viewing peers as mostly attending drug shops had 29% lower likelihood. Perceived treatment efficacy and illness susceptibility were also significant predictors for antibiotic use.

Access article here.

 

Community and caregivers’ perceptions of pneumonia and care-seeking experiences in Nigeria: A qualitative study

By Bakare, Graham, Agwai, Shittu, King, Colbourn, Iuliano, Aranda, McCollum, Isah, Bahiru, Valentine, Falade, Burgess, INSPIRING Project Consortium. Published in Pediatr Pulmonol. Jan 27, 2020.

The authors found that there is a need for community-based approaches to improve caregiver knowledge and care seeking for under-five children with pneumonia, and recommended that messaging attend to knowledge of symptoms, risk factors, family dynamics, and community responsibilities in healthcare service delivery and utilization.

 

Access article here.

 

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Sunday, 23 February 2020