Study explores hepatitis C virus reinfection in Victoria, British Columbia

Victoria, BC - In the past eight years, potent antiviral drugs for the treatment of hepatitis C virus (HCV) infection have increasingly become available across Canada and other high-income countries. These drugs—called direct-acting antivirals (DAAs)—are highly effective with high rates of cure. In Canada and other high-income countries, new cases of HCV infection tend to be concentrated among people who share equipment for drug use. Studies across high-income countries have generally found low rates of HCV reinfection in people who were first cured of the virus. A team of researchers in Victoria, British Columbia, in alliance with HCV researchers in Sydney, Australia, have been studying the issue of HCV reinfection among people in Victoria. The researchers reviewed health-related information collected from people struggling with chronic mental health conditions, homelessness and, in some cases, chronic viral infections such as HCV and HIV. The researchers reviewed data collected between 2014 and late 2019. Among 482 people who took HCV treatment, 418 were cured. Over the course of the study, 22 out of 418 people (5%) became reinfected with HCV. The risk of reinfection was greatest in people who were injecting drugs at the time they first initiated HCV treatment and in some people with HIV. The study confirms the relatively low rate of reinfection. The researchers also found that 55 people died during or after HCV treatment. A total of 35% of these deaths were from overdoses. The study team stated that its findings underscore “the importance of integrating HCV care with strategies to address drug-related harms.” The study used data from the Cool Aid Health Centre in Victoria. The centre provides primary care and support to more than 5,000 vulnerable people in that city. It has a multidisciplinary care team and provides low-barrier access to HCV testing, treatment and post-treatment care as well as many other services, including supportive housing. Cool Aid Health Centre also has a nurse-led HCV programme that includes harm reduction approaches for its service users. The researchers found that the risk of reinfection was greatest in the following groups: people who were injecting drugs at the time they initiated their first round of HCV treatment people with HIV. The researchers stated that there were several possible explanations for HCV reinfection among people with HIV whose HCV was cured with treatment, including the following: Other studies suggest that some people with HIV and HCV co-infection may have “increased needle and syringe sharing compared to people with HCV alone.” In some people, the immune system can spontaneously clear HCV infection. However, HIV weakens the immune system, and a weakened immune system is less likely to clear HCV spontaneously compared to some people who do not have HIV. People with HIV require more ongoing medical and laboratory visits than people without HIV. As a result of more frequent interactions with the healthcare system, HCV reinfection may be more likely detected in people with HIV. A total of 55 people died over the course of the study. Two deaths occurred while people were getting their first round of HCV treatment and the other deaths occurred after treatment. According to the researchers, the major causes of death were due to “drug overdose, liver-related causes and other medical comorbidities.” The researchers stated that this study’s findings are important because they can be used to “inform clinical guidelines, clinical management and health policy, highlighting the critical need to ensure adequate access to harm-reduction programs, post-treatment monitoring for reinfection and integrated approaches to improve care for HCV and other areas of health for people who use drugs.” The researchers made the following relevant points after reviewing the study’s findings: “As HCV therapy is expanded to populations of people who inject drugs (PWID) with continued risk behaviours for re-exposure, acknowledgement that HCV reinfection will occur is crucial. While reinfection does occur, the incidence has been shown to be lower than reported rates of primary HCV infection. For clinicians at our clinic, we have had to reframe the perspective that an episode of HCV reinfection should not be characterized as an individual “treatment failure,” but as the inevitable consequence of large-scale treatment programs for highly marginalized PWID populations. Appropriate strategies must be in place to maximize prevention of reinfection and offer retreatment for reinfection. The potential to exacerbate stigma and discrimination in the context of HCV reinfection is real, and therefore a completely non-judgmental approach is essential.” “While the current rate of HCV treatment among HIV-HCV coinfected [people] is improving in Canada, this will be difficult to sustain, as the population that remains to be treated is marginalized and largely disengaged from care. Canadian providers recognize that poor access to harm-reduction services and mental health treatments are serious barriers to initiating HCV treatments for PWID. PWID may not seek to undergo DAA treatment for various reasons, including not knowing where to access treatment, having asymptomatic HCV infection, difficulty in accessing veins for blood work, prioritizing other pressing health and social issues and experiences of stigma and discrimination when accessing services. PWID voices have started to be heard as they respond to healthcare provider gatekeeping of DAAs by seeking out more person-centered, equity-oriented and harm reduction-focused HCV care.” “Peer-based outreach education and support services, including HCV point-of-care testing, can facilitate access to care, especially when peers are seen as trusted sources of knowledge who can vouch for the efficacy, few side effects and lowered barriers to eligibility that now exist in the current DAA era.”

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Hep C World News - Week of December 19, 2021

More investment needed to achieve HCV elimination
 

Baltimore, MD - Game-changing therapies have made the WHO goal of achieving hepatitis C elimination by 2030 possible, but many countries find themselves fighting an uphill battle, according to experts. “In 2019 to 2020, WHO estimated there were 50 million persons living with chronic HCV, of whom 1.4 million were persons who inject drugs and 2.3 million were coinfected with HIV. New infections were identified in more than 1.5 million people, with deaths in the range of 0.3 million,” Mark Sulkowski, MD, FAASLD, professor of medicine at Johns Hopkins University, said during a session on viral hepatitis elimination at The Liver Meeting Digital Experience. Unfortunately, unlike trends seen for malaria, HIV and tuberculosis, mortality due to HCV and hepatitis B have increased in recent years. “At the current pace, it’s anticipated that morbidity and mortality for HBV and HCV will continue to increase if we don’t begin to apply the tools we have developed for treatment and prevention,” Sulkowski said. The current estimates for the number of infections indicate that HCV remains a major global health challenge, but its negative effects extend beyond the disease itself, according to Margaret Hellard, AM, MBBS, FRACP, FAFPHM, PhD, deputy director at the Burnet Institute and head of hepatitis services in the infectious diseases unit at The Alfred Hospital in Australia. “As well as deaths, it’s important to think about the broader impact of HCV. It reduces health, well-being and quality of life in individuals and their families and causes liver cirrhosis, liver cancer and other comorbidities,” Hellard said during a presentation at The Liver Meeting Digital Experience. “As well, people with HCV have an internalized and enacted stigma, and there’s discrimination that impacts on their lives. They have reduced social and workforce participation, workforce productivity and personal financial security. It impacts on all aspects of their lives.” In 2016, the United Nations included combating communicable diseases, including viral hepatitis, among its sustainable development goals and WHO released its proposal for eliminating viral hepatitis as a public health threat by 2030, according to Hellard. “The organization envisioned a world where transmission is halted and people living with hepatitis had access to effective care and treatment services. In other words, the care continuum is vastly improved, and if we can do that, the anticipation is that we would reduce new infections by 90% and we would reduce mortality by 65%,” Sulkowski said. “This is certainly a very important goal and we have the tools; it is simply a matter of applying those, which of course can be very difficult.” In 2021, WHO also released the interim guidance for country validation of viral HCV elimination, which set targets for demonstration of elimination, according to Sulkowski. These include reducing incidence of HCV by 80% and mortality by 65% by 2030, as compared with 2015. The organization also set HCV-specific targets for absolute annual incidence (5 or less per 100,000) and annual mortality rate (2 or less per 100,000). Additionally, WHO set programmatic targets for testing and treatment, with the goal of having more than 90% of people with HCV diagnosed and, of those diagnosed, having more than 80% treated. Prevention targets included reducing unsafe injections, ensuring the blood supply is 100% safe and providing approximately 300 needles, syringes and injection kits to persons who inject drugs. Although the significant public health burden spurred WHO’s decision to set elimination targets, novel therapies are what made this goal possible, according to Hellard. “Why is HCV elimination achievable? Simply because direct-acting antivirals were game-changing. We have curative therapies available where people can take a single tablet daily for 8 to 12 weeks and be cured of their infection,” Hellard said. “However, despite the setting of targets and the game changers that make it possible to achieve elimination globally, we are not tracking well.” In terms of progress, only 15 countries are currently on track to achieve HCV elimination as a public health threat by 2030, according to 2020 data from the Polaris Observatory. “In my view, a major challenge is the massive lack of funding for the viral hepatitis response. Despite the high number of infections, rising deaths, WHO targets and actually having a cure, HCV does not receive major funding from any of the big global initiatives, such as Global Fund, Gates Foundation and the World Bank’s Global Financing Facility,” Hellard said. “There have been some important admirable exceptions in terms of Unitaid providing support and some ‘leftover’ global fund monies, but overall, very little has been done in terms of global investment in HCV.” This lack of investment is part of a “non-virtuous cycle,” according to Hellard. Global health funding priorities have been developed over time using a number of reports and programs, but the key driver is whether the disease in question is likely to have a significant economic and development impact on a country and its individuals. In addition to addressing the public health problem posed by hepatitis, Hellard noted that the U.N.’s 2030 sustainable development goals included universal health coverage. This aims to provide health care and financial protection to all people of a particular country or region by providing a specific package of benefits, with the end goal of providing risk protection, improved health services and broadly helping the country. However, diseases included in these specific health benefits packages are identified through a country’s disease control priorities as well as other more general priorities, according to Hellard. “Particularly in countries where HCV has a considerable impact, you need to show the extent of this impact of HCV on the country and its health so it is recognized as a priority disease,” Hellard said.
 

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Hep C World News - Week of December 12, 2021

Importance of HCV screening in pregnancy

Chicago, IL - The CDC, U.S. Preventive Services Task Force and other medical societies, including the American College of Gynecology and the Society for Maternal-Fetal Medicine, recommend HCV screening in every pregnancy, as they recognize that many new HCV infections occur in women of childbearing age, according to Reau, the Richard B. Capps Chair of Hepatology at Rush University in Chicago. In the study, researchers used a large database of women from Ontario, Canada, to analyze pregnancy outcomes as well as maternal-to-childhood transmission in women who were HCV-positive and HCV-negative. “The populations weren’t perfectly matched,” Reau said, noting that injection drug use and cirrhosis were more common in the HCV population. “We realize that those are going to contribute to outcome.” Among patients with HCV, the risk for preterm birth and maternal complications was slightly higher, but the majority of pregnancies were well tolerated in this population. HCV screening, though, was less common than one would hope, with minority of infants screened, according to Reau. The researchers also found that viral load was an important fact in the potential for maternal-to-childhood transmission. If viral load was low, then infants were highly unlikely to be infected, Reau noted. Reau also said it was interesting that the testing strategy for infants was different. HCV PCR was used in a minority of infants, but most still had HCV antibody testing around the 18-month mark, which is what guidelines recommend. “So, there was no treatment in this population during pregnancy, but it is nice to see that, for the most part, that maternal and childhood outcomes are good, with a slight signal in HCV-positive mothers,” Reau said. “[These data] kind of support that new screening strategy to identify mothers who are HCV-infected in that pregnancy, which offers an opportunity not necessarily to change pregnancy or decrease the rate of maternal-to-childhood transmission but to link them to curative therapy postpartum.”
 

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Hep C World News - Week of December 5, 2021

Rapid treatment model improves HCV care in injection drug users

New York, NY - A simplified, rapid treatment model for hepatitis C virus improved cure rates and the cascade of care among young people who inject drugs, according to a recent study. “Over the prior decade, a growing proportion of untreated HCV infection is in younger people, specifically young people who inject drugs (PWID), and young PWID seek and engage in HCV treatment at low rates,” Benjamin Eckhardt, MD, MS, assistant professor at NYU School of Medicine, said during a presentation at The Liver Meeting Digital Experience. “There is a growing body of research to support simplified hepatitis treatment strategies with fewer baseline laboratory tests, pan-genotypic direct-acting antiviral therapy and less on-treatment monitoring.” To evaluate outcomes of such an approach in PWID, Eckhardt and colleagues conducted the HCV-Seek, Test and Rapid Treatment (ST&RT) study — an open-label, randomized, controlled pilot study conducted at the Lower East Side Harm Reduction Center in New York City. They recruited young, active PWID aged 18 to 29 years who injected drugs in the last 30 days and were HCV-antibody positive and treatment-naïve. Enrollment occurred from October 2018 to March 2020, with 1-year follow-up continuing through March 2021. The primary endpoint was the percentage of patients achieving sustained virologic response at 12 weeks after treatment within 12 months of enrollment, with secondary endpoints looking at treatment cascade numbers. For the ST&RT study, participants underwent HCV RNA testing and were then randomly assigned to usual care or rapid treatment. In the usual care arm, participants received baseline HCV RNA test results within 2 to 7 days via in-person or telephone conversations. Those who were antibody-positive were then referred to an on-site care coordinator and, through the NYC Department of Health-funded Check Hep C Patient Navigation Program, were linked to community-based HCV providers and went through the typical cascade of care before initiation of therapy. In the rapid treatment arm, participants underwent additional lab tests and a medical evaluation in addition to HCV RNA testing at day 0. They were sent home with a 7-day starter pack of Epclusa (sofosbuvir/velpatasvir, Gilead Sciences) and were advised to initiate treatment when they received confirmatory test results via telephone or in-person 2 to 7 days later. In terms of follow-up, participants in the rapid treatment arm returned at day 7 to receive the remainder of their first month of medication, at day 28 for on-treatment monitoring labs and to receive the remainder of their 12 weeks of therapy and again at 12 weeks after treatment to test for cure. Eckhardt noted, however, that the researchers intentionally had “a very flexible, individualized” treatment plan. The researchers recruited 39 young, active PWID, of whom 19 were randomly assigned rapid treatment and 20 assigned usual care. Of those, 14 in the rapid treatment arm and nine in the usual care arm were HCV RNA-positive. The majority of patients were young, with a mean age of approximately 26 years, and male. A large percentage were very active in their injection drug use, with most injecting drugs more than half of the days in the last 30 days. Notably, Eckhardt said, a significant proportion had been previously diagnosed with HCV and approximately one-quarter had previously sought HCV care. All study participants however were treatment naïve. After treatment, nine of 14 participants in the rapid treatment arm achieved SVR at 12 weeks after treatment compared with one participant in the usual care arm (P < .01). Among those who did not achieve cure in the rapid treatment arm, two participants had continued viremia, including one with confirmed treatment failure and one who opted not to initiate therapy, and three participants had missing viral load testing, including one who was incarcerated for longer than 1 year within 7 days of initiation of therapy and two who were lost to follow-up after treatment during the first wave of the COVID-19 pandemic. Among those who did not achieve cure in the usual care arm, two had confirmed treatment failure and eight never initiated therapy. Results also showed that the cascade of care was significantly better in the rapid treatment arm vs. the usual care arm.

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Hep C World News - Week of November 28, 2021

Using Policy Tools to Combat the U.S. Opioid Crisis
 

Washington, DC - Policy has been critical to achieving major public health advances, including in tobacco control, maternal and child health, and injury prevention. Policy — which includes legislation, rulemaking, and public campaigns — offers a set of tools for improving health at the population level. The opioid crisis — which has claimed more than 500,000 American lives since 1999 and contributed to declining life expectancy — illustrates five general steps essential for using public policy to produce substantial gains in population health. These steps are relevant to myriad public health challenges, such as climate change, gun violence, and the obesity crisis.  A first step in addressing a major public health challenge through policy change is defining the problem. Problem definition dictates and constrains the types of policy solutions considered. For example, framing the opioid crisis as a criminal justice problem implies a law-enforcement response (e.g., stringent sentencing laws for drug possession), whereas framing it as a health problem implies a health services response (e.g., improved access to evidence-based treatments). Quantifying a problem’s impact in morbidity or mortality terms is often the starting point for understanding its scope. Alarming numbers alone, however, may have counterintuitive effects on people’s will to act. As the toll of a crisis increases, public empathy and willingness to help tend to decrease. Studies by Paul Slovic, a professor of psychology at the University of Oregon, illustrate this paradox: society often fails to respond to large-scale humanitarian crises while highly valuing a single life. Slovic’s studies underscore the challenge for human cognition of thinking about or connecting with millions of people. Although using storytelling to define societal problems can humanize them, it often backfires in public health. A child refugee may elicit empathy for people affected by a humanitarian crisis, but depictions of people who are obese, unemployed, or incarcerated or who sell sex or use drugs may not. Defining problems involves constructing narratives about who is to blame, emotional responses to the affected population, and moral judgments about deservingness, influencing perceptions about appropriate solutions. Narratives that fail to overcome the negative stereotypes can lead to support for punitive approaches (e.g., involving child protective services when a pregnant woman uses opioids rather than connecting her with effective treatment). Stigma against people who use drugs is further heightened when it intersects with race, given the deep-seated racial prejudices entangled with punitive attitudes toward drug use. Randomized experiments are being used to test which types of messages most effectively reduce stigma and shift attitudes toward public health–oriented policies and away from punitive, shaming policies. Once a societal problem has been defined, a second step involves elevating it on the agenda to capture and sustain the attention of the public and policymakers. In his classic study of the issue-attention cycle, Anthony Downs describes the common failure to recognize dire conditions that stem from major societal problems, such as racism, poverty, and malnutrition. He describes the cycle of a problem suddenly leaping into prominence, remaining salient briefly, and then fading from public view — often as the underlying conditions that precipitated it remain largely unaddressed. This pattern is reflected in the history of U.S. drug policy: a largely invisible heroin crisis in poor urban communities of color suddenly gained prominence (and resources) when primarily White, suburban, middle-class communities were affected.
 

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Hep C World News - Week of November 21, 2021

Full COVID-19 vaccination decreased infection, death post-liver transplant
 

Miami, FL - Post-liver transplant recipients who were fully vaccinated against COVID-19 saw a decrease in COVID-19 infection or death, according to a presentation at The Liver Meeting Digital Experience. “Full vaccination with two doses of a COVID-19 mRNA vaccine is associated with a 64% decrease in COVID-19, a 58% reduction in symptomatic COVID-19 and 87% reduction in death among liver transplant recipients,” Binu V. John, MD, MPH, affiliate associate professor at the University of Miami Miller School of Medicine and chief of hepatology at the Bruce W. Carter VA Medical Center, said during the presentation. From Dec. 15, 2020, to April 30, 2021, John, also the chief of hepatology with the Miami VA Health System, and colleagues used ICD codes to identify 1,936 patients from a group of patients with cirrhosis who underwent liver transplantation between 2008 and 2020. Of these patients, 799 were fully vaccinated. Investigators considered patients fully vaccinated 7 days after receiving the second dose of either the Pfizer BNT162b2 mRNA or Moderna 1273 mRNA vaccines, or 28 days post-Janssen Ad.26.COV2.S vaccine. A positive COVID-19 PCR test or death served as the outcomes. Investigators propensity matched 753 vaccinated and 753 control patients with similar sex, age, race, location, smoking status, comorbidities (chronic obstructive pulmonary disease, hypertension and kidney transplantation) and immunosuppressive therapies (calcineurin inhibitor and anti-metabolite therapy). To control for immortal bias, vaccination date of each vaccinated patient was assigned to the matched control. A Cox regression model was used to estimate hazard ratios of COVID-19 infection or COVID-19 related death associated with vaccination. John and colleagues censored event-free patients at the end of the study period or after the controls got fully vaccinated. John and colleagues found patients who were fully vaccinated tended to be older, male, white, have COPD and hypertension, post-kidney transplant, be on a calcineurin inhibitor and anti-metabolite and less likely to be a smoker. There were two vaccinated patients and 15 patients in the control group who developed COVID-19 infection after the date of full vaccination. According to John, there were no deaths in the vaccinated group; two COVID-19 related deaths were noted in the control group. Full vaccination against COVID-19 correlated with a 75% reduction in COVID-19 infection or death (adjusted HR = 0.25; 95% CI, 0.07-0.87; P = .03), according to multivariable analysis results. “Reduction of SARs-CoV-2 infection and death appear to be greater than suggested by antibody response,” John said. “This raises the possible role of T cell-mediated response to vaccination. Similar observations have been noted with influenza vaccine in liver transplant recipients despite low antibody titers, vaccination associated with reduction in hospitalization and death.”

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Hep C World News - Week of November 7, 2021

Physicians should continue efforts to vaccinate patients with cirrhosis against COVID-19

Las Vegas, NV - No safety and efficacy concerns for COVID-19 messenger RNA vaccines were noted among patients with cirrhosis compared with the general population, according to a presentation at the ACG Annual Scientific Meeting.  “In a large cohort of patients who received the messenger RNA (mRNA) COVID-19 vaccines in the U.S., we found that the efficacy and safety of these vaccines in patients with cirrhosis is similar to the general population without cirrhosis,” Yousaf B. Hadi, MD, a gastroenterology fellow in the department of medicine at West Virginia University, Morgantown, told Healio Gastroenterology. “This is encouraging data and considering that patients with cirrhosis are at higher risk of adverse outcomes of COVID-19 disease, we need continued efforts to vaccinate as many of these patients as possible.” Hadi and colleagues performed a retrospective cohort using TriNetx to assess 402,202 patients who received an mRNA COVID-19 vaccine. Of these patients, 3,063 had cirrhosis. Outcomes from patients with cirrhosis were compared with those without it. Propensity-score matching was used to compare the groups. Investigators matched patients based on age, gender, ethnicity, BMI and comorbid conditions, including diabetes, chronic lower respiratory diseases, ischemic heart disease, heart failure, nicotine dependence and chronic kidney disease. Results from the propensity-score matched assessment showed that after COVID-19 vaccination, no significant difference was found between the cirrhosis and non-cirrhosis groups with regard to the incidence of adverse events of special interest (RR = 1.29; 95% CI, 0.9-1.86) and new diagnosis of COVID-19 (RR = 1.27; 95% CI, 0.58-2.8). Hadi said patients with cirrhosis had higher 30-day all-cause hospitalization after COVID-19 vaccination. Results from subgroup analysis showed that after COVID-19 vaccination, patients with decompensated cirrhosis (RR = 1.23; 95% CI, 0.74-2.05) or compensated cirrhosis (RR = 1.48; 95% CI, 0.88-2.5), compared with patients without cirrhosis, did not have different 30-day adverse events of special interest. After vaccination, fewer than 10 patients in the decompensated cirrhosis and compensated cirrhosis subgroups received a new diagnosis of COVID-19, Hadi said. “The next step in research is to analyze outcomes at a longer duration of follow-up to study if the efficacy decreases sooner in this cohort compared to the general population, or if booster doses can help in the cirrhosis cohort,” Hadi said.
 

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Hep C World News - Week of October 31, 2021

SAMHSA reports that 40 million in U.S. had a substance use disorder last year
 

Washington, DC - More than 40 million Americans were living with a substance use disorder in 2020, Capt. Michael King, PhD, MSW, of the Substance Abuse and Mental Health Services Administration (SAMHSA) said Monday. King was reporting on the results of the SAMHSA annual National Survey on Drug Use and Health for 2020. "Many longstanding behavioral health problems are still here and are possibly getting worse," King, who is acting director of SAMHSA's Center for Behavioral Health Statistics and Quality, said on a phone call with reporters. And although the 40 million figure represents a doubling from 2019's estimate of 20 million, King cautioned that "the difference is most likely due to one of the changes in how we conduct our survey and it was a planned change, long in coming -- a change in the diagnostic criteria manual from the DSM-4 to DSM-5. In addition, many of our other methodological changes impacted this number more than likely, so while the number appears much larger, there are many caveats to that." In terms of mental health, the survey found that 21% of adults -- almost 53 million people -- were classified as having any mental illness, and nearly 6% of the population, or 14 million, had a serious mental illness in the last year, King said. In terms of youth suicide -- the first year the report asked about this issue -- 12% of adolescents had serious thoughts of suicide, 5% had a plan, and 2% attempted suicide in the past year. SAMHSA continues to make special efforts to include race and ethnicity data in its findings, according to King. "For example, one of the findings that stands out is that among people reporting two or more races, 11%, or just over half a million people, had serious thoughts of suicide, 3% had a suicide plan, and about 1% attempted suicide in the past year," he said, while "among Hispanic or Latino adults, 4%, or nearly 2 million people, had serious thoughts of suicide, 1% had a plan, and about 0.5% had attempted suicide in the past year." "From a service perspective, our data clearly shows that treatment gaps remain for all of these people," he continued. "Consistent with the prevalence of substance use disorder (SUD), we found that 41 million people were classified as needing substance use treatment, and from a mental health perspective, less than half of the adults with any mental illness -- approximately 46% of them -- actually received any mental health services." And the situation was much worse for those with coexisting SUD and any mental illness: less than 6% of those people actually received services for both, King said. This survey was the first to ask about vaping; results showed that while most older nicotine users -- approximately 88% -- use only tobacco products like cigarettes, nearly two-thirds of adolescents who were vaping didn't use any other tobacco products, "which shows you what the impact of vaping is," he said. In 2020, 21.4% of people ages 12 or older (or 59.3 million people) used illicit drugs in the past year, including 17.9% (or 49.6 million people) who used marijuana. In terms of age, the percentage of people who used marijuana in the past year was highest among young adults ages 18 to 25 (34.5%) compared with 16.3% of those ages 26 or older and 10.1% of adolescents ages 12 to 17. Among people ages 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids in the past year. Among the 9.5 million people who misused opioids in the past year, 9.3 million people misused prescription pain relievers and 902,000 people used heroin. As far as new substance use was concerned, 1.3 million people in 2020 initiated cigarette smoking, 4.1 million initiated alcohol use, 2.8 million initiated marijuana use, and 1.2 million initiated prescription pain reliever misuse in the past year. The vast majority of people who were past-year initiates of cigarette smoking or alcohol use tried cigarettes or alcohol for the first time before age 26. The survey is usually based exclusively on data from in-person interviews of 70,000 randomly selected people ages 12 and over; however, due to the pandemic, surveyors were only able to collect data for half of the year -- specifically quarter 1 and quarter 4 -- so the number of interviews for 2020 is only about 35,000. In addition, "we had to add new web survey methods and new content to help assess the impact of the ongoing pandemic," King noted.

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Hep C World News - Week of October 24, 2021

More than half of COVID-19 survivors experience symptoms 6 months after recovery

Hershey, PA - More than half of COVID-19 survivors experience symptoms consistent with long COVID up to 6 months after recovery, data from a systematic review published in JAMA Network Open showed. Long COVID is defined by the CDC as “new, returning, or ongoing health problems” occurring 4 or more weeks after being initially infected with SARS-CoV-2. It has been linked to more than 200 symptoms. Researchers from the Penn State College of Medicine and two universities in Australia searched PubMed, Scopus, the WHO Global Literature on Coronavirus Disease, and CoronaCentral databases for studies published from December 2019 through March 2021. They identified 2,100 studies, including 57 studies with 250,351 survivors of COVID-19 who met trial inclusion criteria. The mean age of survivors was 54.4 years, 140,196 (56%) were male and 197,777 (79%) were hospitalized with acute COVID-19. The researchers classified symptoms as short term (occurring 1 month after COVID-19 diagnosis or discharge), intermediate (2 to 5 months) and long term (6 months). After 1 month, 54% of people experienced at least one long COVID symptom (interquartile range [IQR], 45%-69%), and the rate remained similar over the following months. Between 2 and 5 months, 55% experienced at least one symptom (IQR, 34.8%-65.5%). At 6 months, 54% were still experiencing at least one symptom (IQR, 31%-67%). “These findings confirm what many health care workers and COVID-19 survivors have been claiming, namely, that adverse health effects from COVID-19 can linger,” Vernon Chinchilli, PhD, co-lead study investigator and chair of the department of public health sciences at the Penn State College of Medicine, said in a news release. Researchers assessed 38 clinical manifestations in three categories — organ systems (neurologic, respiratory, digestive, etc.), constitutional symptoms and functional mobility. The most common neurocognitive symptoms were difficulty concentrating (median IQR, 23.8% [20.4%-25.9%]), memory deficits (median IQR, 18.6% [17.3%-22.9%]) and cognitive impairment (median IQR, 17.1% [14.1%-30.5%]). The most common mental health disorders were anxiety (median IQR, 29.6% [14%-44%]), sleep disorder (median IQR, 27% [19.2%-30.3%]), depression (median IQR, 20.4% [19.2%-21.5%]), and post-traumatic stress (median IQR, 13.3% [7.3%-25.1%]). “The burden of poor health in COVID-19 survivors is overwhelming,” Paddy Ssentongo, MD, an assistant research professor at the Penn State Center for Neural Engineering, said in the news release. “Among these are the mental health disorders. One's battle with COVID doesn’t end with recovery from the acute infection.” Other commonly reported symptoms included joint pain (median IQR, 10% [6.1%-19%]), fatigue or muscle weakness (median IQR, 37.5% [25.4%-54.5%]), and flu-like symptoms (median IQR, 10.3% [4.5%-19.2%]). “Our study was not designed to confirm COVID-19 as the sole cause of these symptoms. It is plausible that symptoms reported by patients in some of the studies examined were due to some other causes," Ssentongo said.

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Hep C World News - Week of October 17, 2021

Toronto to ask feds to decriminalize possession of illicit drugs for personal use
 

Toronto, ON - Toronto is preparing to ask the federal government to decriminalize the possession of illicit drugs for personal use in the city, saying the move is needed as drug-related deaths reach record highs. A public consultation on the matter wrapped up this week and the city’s top doctor said Toronto expects to send its request to Health Canada later this fall. “In Toronto, deaths involving all substances, including opioids, have increased to record highs,” Dr. Eileen de Villa said in a statement. “The situation remains urgent and more action is needed to respond.” Toronto Public Health said a total of 521 confirmed opioid overdose deaths were recorded in the city last year. That represented a 78 per cent increase from deaths recorded in 2019, it said. City data also indicates that in the first three months of this year, paramedics responded to 1,173 suspected opioid overdose calls, including 93 involving a death. That compared to 46 calls involving death in the first three months of 2020. The decriminalization request Toronto is preparing – which will ask Health Canada for an exemption under the Controlled Drugs and Substances Act for personal drug use in the city – would follow a similar one made by Vancouver in May. Leigh Chapman, a registered nurse and co-organizer with the Toronto Overdose Prevention Society, called Toronto’s planned federal request “a step in the right direction.” She lost her 43-year-old brother, Brad, to an opioid overdose in August 2015 — a few weeks after he was released from jail. His death led to a coroner’s inquest that yielded a series of recommendations to better safeguard vulnerable people living with addictions. One of the recommendations was that the federal government should consider decriminalizing the possession of all drugs for personal use and increase prevention, harm reduction and treatment services. Chapman said those measures could have saved her brother. m“Brad’s whole life would have been different if he hadn’t had ... literally a cycle of incarceration for probably over 20 years on and off,” she said. A 2016 study published in the journal PLOS ONE found that between 2006 and 2013 in Ontario, one in ten drug toxicity deaths in adults occurred within one year of release from provincial incarceration. “I think we need to reduce the harms from criminalization to be able to better meet people’s needs, meet them where they’re at and see how we can help them stay alive,” Chapman said. Councilor Joe Cressy, chair of the Toronto Board of Health, said city staff are “currently consulting on the details of what an exemption would look like” when it comes to decriminalizing drugs for personal use in Canada’s most populous city. “We are dealing with a public health crisis,” Cressy said. “And the way to address it is with a health response.” Decriminalization is a key element in a series of measures needed to tackle the overdose crisis, alongside treatments, increased harm reduction services and a safer supply, Cressy said. “It is a critical piece and I think that the chorus of experts, from law enforcement to healthcare, who are calling for such action nationally, is only growing because people continue to die from preventable deaths,” he said. Toronto’s Centre for Addiction and Mental Health recently released a statement on the issue, saying making criminals out of substance users has been ineffective and counterproductive. Cressy added that while Toronto’s request to the federal government would be specific to the city, national decriminalization was something the local board of health has called for every year since 2018. “A nationwide framework, something that CAMH has called for, that Toronto’s Board of Health has long called for, could and should be done immediately,” he said. Health Canada did not immediately respond to a request for comment. This report by The Canadian Press was published in a recent edition of The Toronto Star.
 

For more information: https://tinyurl.com/vrpxfdu5

Hep C World News - Week of October 3, 2021

People with HIV do not respond as well to COVID-19 vaccines, study finds

San Francisco, CA - People with HIV have a less robust response to COVID-19 vaccination than those without HIV, data presented at IDWeek suggest. Matthew Spinelli, MD, MAS, assistant professor of medicine at the University of California, San Francisco, and colleagues matched 100 people with HIV with 100 adult patients without HIV who were receiving care at a San Francisco clinic for chronic medical conditions at least 10 days after receiving the second dose of a COVID-19 messenger RNA vaccine.   In both groups, 25 participants received Moderna’s vaccine and the other 75 participants received Pfizer’s vaccine. Each group had 13 women. The median age of all participants was 59 years. The median time between vaccine doses was 35 days (interquartile range [IQR], 20-63). Those with HIV had a median CD4+ T-cell count of 511 (IQR, 351-796), and five people had an HIV RNA greater than 200. According to the researchers, the odds of pseudovirus neutralizing antibody nonresponse was a 2.4-fold greater among people with HIV compared with those without HIV (95% CI, 1.1-5.4). Additionally, continuous anti-RBD IgG concentrations were 43% lower in those with HIV (95% CI, 0.36-0.88). “The factors that predicted a less robust response were a lower CD4 count, non-suppressed viral load and getting the Pfizer, rather than the Moderna, vaccine,” Monica Gandhi, MD, MPH, professor of medicine and associate chief of the division of HIV, infectious diseases and global medicine at the University of California, San Francisco, and coauthor of the study, told Healio. Following an adjustment for age, sex and days after vaccination, each 100-cell increase in CD4+T-cell count was associated with a 22% increase in neutralizing antibody titers, among those living with HIV Additionally, unsuppressed HIV RNA greater than 200 was associated with 89% lower neutralizing antibody titers. The authors reported that receipt of the Pfizer vaccine was associated with 77% lower neutralizing titers compared with the Moderna vaccine. “Plans to provide boosters to people living with HIV, with the data currently available, seem reasonable, particularly to those with lower CD4+ counts or unsuppressed viral loads, although effective antiretroviral therapy is also very important for these patients,” Spinelli told Healio. “Next steps include examining T cell responses, as well as immune responses to booster vaccination, which has already started locally among people living with HIV.” The FDA has authorized booster doses of Pfizer’s COVID-19 vaccine for people who are immunocompromised, aged 65 years or older, or who are at risk for severe infection. The FDA plans to meet on Oct. 14 and 15 to discuss booster doses of the Moderna and Johnson & Johnson COVID-19 vaccine. The NIH in March recommended that people with HIV be prioritized for COVID-19 vaccination as a high-risk group based on some research that has shown they are at an increase risk for death or poorer outcomes.

For more information: https://tinyurl.com/hrc8kc23

Hep C World News - Week of September 26, 2021

Study looks at the risk for HCC after direct-acting antiviral treatment for Hep C
 

Bologna, Italy - Hepatocellular carcinoma (HCC) has become a major issue in coinfected HIV/HCV patients with liver cirrhosis. We aimed to determine the rate of HCC occurrence after a direct-acting antiviral (DAA) treatment and to evaluate the factors associated with the risk of HCC in this population. They conducted a retrospective multicenter observational study including cirrhotic HIV/HCV-coinfected patients treated with DAAs, between October 2014 and January 2017. The researchers collected demographics characteristics, data regarding HIV and HCV infections and treatment with DAAs. We investigated the rate and the time of occurrence of HCC. Statistical analysis explored the factors associated to development of liver cancer. During a median follow-up of 55 months, 24 out of 232 patients developed HCC, after a median of 22.5 months from starting DAAs. Factors associated with HCC were a higher Child--Pugh Turcotte (CPT) score (P = 0.002), HCV genotype 3 (P = 0.04), previous HCC (P < 0.001) and CD4+ cell count nadir greater than 350 cells/μl (P = 0.001), whereas antiretroviral therapy (ART) was associated to a lower rate of cancer (P = 0.02). At multivariable analysis CPT score and a history of HCC remained independently associated with HCC after DAAs (P = 0.003 and P < 0.001, respectively), and ART administration maintained its protective role (P = 0.047), regardless of HIV RNA at baseline. Their study highlights the importance of a long-lasting follow-up for HCC after HCV eradication, mostly in those patients with advanced cirrhosis and history of HCC. Furthermore, our data showed a potential role of ART itself (and not of undetectable HIV RNA) in reducing the risk for HCC development. The study was led by Guardigni Violaa, of the RECHIV study group.

For more information: https://tinyurl.com/dxhd3665

Hep C World News - Week of September 19, 2021

Meth and cocaine overdose deaths increased 180% among U.S. adults

Atlanta, GA - A large study finds a rising and devastating trends in meth use. The number of overdose deaths involving psychostimulants besides cocaine -- primarily methamphetamine -- increased by 180% in recent years, a cross-sectional study from the National Institute on Drug Abuse (NIDA) found. Using data from both the National Surveys on Drug Use and Health (NSDUH) and the National Vital Statistics System Multiple Cause of Death, overdose deaths increased from 5,526 in 2015 to 15,489 in 2019 (P<0.001 for trend), reported Beth Han, MD, PhD, MPH, and colleagues. Past-year methamphetamine use increased by a weighted 43% over the 4-year period -- from 1.4 million (95% CI 1.2-1.6 million) to 2.0 million (95% CI 1.7-2.3 million, P=0.002), as described in JAMA Psychiatry. The number of people who self-identified as frequent methamphetamine users also increased by 66% -- from 615,000 in 2015 (95% CI 512,000-717,000) to 1,021,000 in 2019 (95% CI 860,000-1,183,000; P=0.002). Analyses of the NSDUH data -- which included 195,711 respondents ages 18 to 64 -- found that the combined use of methamphetamine and cocaine increased by 60% -- from 402,000 (95% CI 306,000-499,000) to 645,000 (95% CI 477,000-813,000; P=0.001). This trend, the team said, mirrors similar drug use patterns shown in previous research about the rise of users of both methamphetamine and opioids. "Expansion of community-based interventions to reduce injection drug use-associated harms and overdoses, such as comprehensive Syringe Services Programs, could help mitigate overdose risks and the additional spread of infectious diseases," Han and co-authors wrote. They noted that since 2017, individuals who reported past-year methamphetamine use also reported associated high-risk behaviors such as having methamphetamine use disorder (MUD) and use through injection -- more frequently than they did lower-risk use patterns. This suggests an evolving pattern of riskier methamphetamine use behaviors among U.S. adults, the team suggested. "What makes these data even more devastating is that currently, there are no approved medications to treat methamphetamine use disorder," said co-author Emily Einstein, PhD, chief of NIDA's Science Policy Branch, in a press release. "NIDA is working to develop new treatment approaches, including safe and effective medications urgently needed to slow the increase in methamphetamine use, overdoses, and related deaths." The demographics of those who reported using methamphetamine shifted from 2015 to 2019, the analysis showed. MUD without the use of injection increased 10-fold for Black Americans (0.06% to 0.64%, P<0.001), tripled among white individuals (0.28% to 0.78%, P<0.001), and more than doubled for those who identified as Hispanic (0.39% to 0.82%, P<0.001). Similar upward trends were found among sexual orientation subgroups, the researchers said: The prevalence of MUD without injection more than tripled among heterosexual women (0.24% to 0.74%, P<0.001) and among gay or bisexual women (0.21% to 0.71%, P <0.001), and more than doubled among straight men (0.29% to 0.79%, P<0.001) and gay or bisexual men (0.29% to 0.80%, P=0.007). The direction of the findings, coupled with other research showing a growth of methamphetamine use during the pandemic, indicates a potential for the trend to accelerate in the years since 2019, Han and co-authors said. Overall, 104,408 of the NSDUH respondents identified as women (coming to a weighted percentage of 50.9%), 114,248 were white (60.6%), 25,389 were Black (12.6%), and 35,686 were Hispanic (18%). Study limitations, the researchers said, included the cross-sectional nature of the NSDUH data, which precluded drawing causal inferences; the self-report survey style, which is subject to recall and "social desirability" bias; and the likelihood that the prevalence of methamphetamine use may have been underestimated, since NSDUH does not include homeless, incarcerated, or institutionalized individuals.

For more information: https://tinyurl.com/f7424wjr

Hep C World News - Week of September 12, 2021

More than 1,000 overdose deaths in B.C. year-to-date

Vancouver, BC - More than 1,000 people have died of illicit drug overdose so far in 2021, the latest numbers show. Data from the B.C. Coroners Service released Tuesday showed at least 1,011 deaths are suspected to have been caused by illicit drug toxicity in the first half of the year. Most of those people were men. Most were alone when they died. The latest data includes deaths that occurred between January and the end of June, B.C.'s ninth consecutive month in which at least 150 people died of toxic drug overdose, and the 16th month in a row with more than 100 deaths. The province's chief coroner described the toll as a "tragic reminder" that the supply remains a threat to public health and safety across B.C. In a statement including the latest data, Lisa Lapointe said drug toxicity is now the leading cause of death for British Columbians between the ages of 19 and 39. In the first six months of the year, the highest number of deaths have been in B.C.'s Lower Mainland. The regions with the highest rates of death were the Vancouver Coastal and Northern health authorities. B.C.'s death toll, a number which Lapointe said will grow as additional investigative results are received, is a number that Lapointe says keeps her up at night. On International Overdose Awareness Day, the chief coroner spoke to CTV Morning Live in Vancouver ahead of an announcement on substance-related harms in the province. "It's tremendously sad. As coroners, we speak directly with the families of those who have died," she said. Part of the reason these deaths are so devastating is that they're "completely preventable," Lapointe said, and they often come after a lengthy struggle from the deceased's families to find support and help. Lapointe was joined by B.C. Emergency Health Services advanced care paramedic Brian Twaites and co-founder of Moms Stop the Harm Leslie McBain for a news conference later in the day, during which she discussed her mid-year report. The province has been in a public health emergency for more than five years. The total number of lives lost since the emergency was declared is now at 7,760. Speaking to CTV News before the live event Tuesday, Lapointe said she's hopeful that change will come. "We are in a very, very sad trajectory right now." Projections for 2021, based on the first few months, suggest there may be as many as 2,000 or more deaths by the time the year is out. Lapointe said it's expected to be another record year.

For more information: https://tinyurl.com/2vm4x38z

Hep C World News - Week of September 5, 2021

Surge in smoking among young adults during lockdown

London, UK - The number of 18 – 34 year-olds who smoke increased by 25% in England during the first lockdown, according to a new study led by UCL researchers. This means that over 652,000 more young adults smoke, compared to before the pandemic. The study, published today in the journal Addiction and funded by Cancer Research UK, found that over 4.5 million more adults would be classed as high-risk drinkers during the same period as the number rose by 40%. But this trend was particularly worrying in women (up 55%) as well as people from lower socioeconomic groups (up 64%). Though existing heavy drinkers did make attempts to cut down, this was only observed in adults from higher socioeconomic groups, suggesting that if trends continue, health inequalities linked to alcohol could worsen. There were increases in the number of existing smokers quitting successfully, and overall levels of smoking in adults remains stable. However, the increased number of young adults who smoke means that, for the Government to deliver its goal for England to become smoke-free by 2030, smokers would need to quit at a rate of around 40% faster than predicted. While the study doesn't explain why these changes occurred, the researchers noted that people from lower income backgrounds, younger adults, and women are among those who have been disproportionately affected by the pandemic. Given that many people mistakenly believe that smoking and drinking help relieve stress, they suggest it's possible that some may have taken up these up for the first time or relapsed to help them cope. Smoking is the biggest preventable cause of cancer—it is known to cause at least 15 different cancer types—while drinking even small amounts of alcohol increases the risk of seven different types of cancer. Lead author Dr. Sarah Jackson (UCL Institute of Epidemiology & Health) said: "The first lockdown was unprecedented in the way it changed people's day-to-day lives. We found that many smokers took this opportunity to stop smoking, which is fantastic. However, the first lockdown was also a period of great stress for many people, and we saw rates of smoking and risky drinking increase among groups hardest hit by the pandemic. "It will be important to keep a close eye on how these increases in smoking and drinking develop over time to ensure appropriate support is made accessible for anyone who needs it." Michelle Mitchell, Cancer Research UK's chief executive, said: "There's no 'safe' level of smoking or drinking, and stopping smoking or cutting down drinking will help to reduce your risk of cancer. "Public health campaigns and prevention services have a vital role to play in helping people to quit and also maintaining the motivation of those who have already made positive changes. The upcoming tobacco control plan for England is a key opportunity for the Government to reduce smoking rates, but this can only be achieved with sufficient investment. "A Smokefree Fund—using tobacco industry funds, but without industry interference—could pay for the comprehensive measures needed to prevent people from starting to smoke and helping those who do, to quit." The Addiction study also involved researchers from the University of Sheffield. Cancer Research UK extrapolations comparing smoking prevalence of in 18–34 year olds in England 21.5% before lockdown (August 2019–February 2020) to 26.8% during the first lockdown (April 2020–July 2020) and using ONS mid-year population estimates for 2020 to estimate the number of people this represents. This includes those taking up smoking for the first time and those who have relapsed after not smoking for at least a year. Cancer Research UK estimates that around 3,300,000 18–34 year olds in England were classed as smokers during the first lockdown in April 2020–July 2020. Comparing high-risk drinking prevalence of all adults in England of 25.8% August 2019–February 2020 to 36% in April 2020–July 2020 and using ONS mid-year population estimates for 2020 to estimate the number of people this represents.

For more information: https://tinyurl.com/5frvkjma

Hep C World News - Week of August 29, 2021

Israel planning to administer forth Covid vaccine shot

Tel Aviv, Israel - The country's national coronavirus czar says people should expect to receive a new vaccination against the virus more frequently - 'every five to six months'. Israel expected to give out vaccines that have been specially adapted to cope with different variants of the coronavirus by late 2021 or early 2022, he says. Israel is set to begin preparations to administer fourth doses of the coronavirus vaccines as the country deals with soaring cases despite its trail-blazing roll-out of jabs. The country's national coronavirus czar Salman Zarka said the country needs to prepare for a fourth injection, which could be modified to better protect against new variants of the virus.      'Given that that the virus is here and will continue to be here, we also need to prepare for a fourth injection,' he told Kan public radio.  'This is our life from now on, in waves.' Last month, he told The Times of Israel that people should expect to receive more vaccines to deal with new variants.     'It seems that if we learn the lessons from the fourth wave, we must consider the [possibility of subsequent] waves with the new variants, such as the new one from South America,' he said at the time.  'Thinking about this and the waning of the vaccines and the antibodies, it seems every few months — it could be once a year or five or six months — we'll need another shot.' He added that he expects Israel to be given out vaccines that had been specially adapted to cope with different variants of the virus by late 2021 or early 2022.  While Israel is seeing record case numbers in its fourth wave, the jabs are still protecting against severe illness with Covid deaths running at about half of the level of its second wave.Stats compiled by Oxford University-backed research team Our World in Data shows there were a record 1,892 Covid cases per million people in Israel on Wednesday — nearly 0.2 per cent of the entire population in a single day. That was significantly higher than second worst-hit Mongolia, where the rate was 1,119 per million, and double the figures for Kosovo (980), Georgia (976) and Montenegro (909), which rounded out the top five.  Israel has become the Covid capital of the world just months after leading the charge on vaccines, according to data that shows jab protection is waning.
 

For more information: https://tinyurl.com/2nkk4bzs

Hep C World News - Week of August 22, 2021

Concurrent HCV, opioid agonist treatment improves quality of life for injection drug users

Clemson, SC - People who inject drugs experienced sustained increases in health-related quality of life when they were successfully treated for hepatitis C during opioid agonist treatment, according to a study published in Clinical Infectious Diseases. Assessing how HCV treatment impacts health-related quality of life for people who inject drugs (PWID) “is necessary to better understand the relationship between curing HCV and improving patient-centered health outcomes for a population whose stigmatization often creates barriers to accessing treatment,” said Alain Litwin, MD, a professor at Clemson University and executive director of the Prisma Health Addiction Research Center. People who inject drugs successfully treated for hepatitis C during opioid agonist treatment had sustained increases in health-related quality of life following SVR. Source: Adobe Stock. “There is little previous research investigating the relationship between HCV treatment with direct-acting antiviral agents and health-related quality of life among PWID,” Litwin told Healio. Litwin and colleagues studied 141 PWID who achieved SVR following HCV treatment at three opioid agonist treatment (OAT) clinics in Bronx, New York. According to the study, they assessed five health dimensions mobility, self-care, usual activities, pain/discomfort and anxiety/depression producing an index of health-related quality of life (HRQOL) ranging from 0 to 1 referred to as EQ-5D-3L. These were measures at baseline, 4 weeks, 8 weeks and 12 weeks during treatment and 12 and 24 weeks after treatment. Overall, the study demonstrated a mean EQ-5D-3L at baseline of 0.66. At this time, more than half of the study population reported no baseline problems with self-care (85.1%), usual activities (56%) or mobility (52.5%), and at least two-thirds reported problems with pain/discomfort (78%) and anxiety/depression (66%), with 22% and 21.3% reporting extreme problems for pain/discomfort and anxiety/depression, respectively, Litwin and colleague reported. At 24 weeks after treatment, the study demonstrated that the proportion of participants reporting pain/discomfort and anxiety/depression decreased by 25.7% and 24%, respectively. According to the researchers, this means the mean EQ-5D-3L significantly improved during treatment and was sustained at 0.77 12-weeks after SVR following treatment completion. Mirinda Ann Gormley, PhD, MSPH, a postdoctoral fellow at the Clemson University College of Behavioral, Social and Health Sciences, said that although the increases were sustained following HCV treatment, the overall HRQOL was still lower than the HRQOL of the general U.S. population. “Our results show that successful HCV treatment can increase the health-related quality of life of PWID on OAT, which should encourage future efforts to implement treatment for HCV during OAT,” Gormley and Litwin told Healio. “Additionally, although health-related quality of life increased following successful HCV treatment, these results show that additional actions may be necessary to raise the health-related quality of life of this population.”
 

For more information: https://tinyurl.com/eyxmzabj

Hep C World News - Week of August 15, 2021

Toronto reports highest-ever daily opioid overdose count during August long weekend

Toronto, ON - Officials in Toronto say the region is seeing a stark increase in emergency calls for overdoses in part due to the emergence of new, highly potent drugs. (CBC) There were almost 200 opioid-related overdose calls Toronto over the August long weekend, with 51 calls to 911 on July 30 alone — marking the highest number of emergency calls for overdoses on a single day since local paramedics began monitoring data in 2017. Paramedics report there were no fatal calls for suspected opioid overdoses during those five days. Officials say they believe the stark increase in calls is due to a range of substances found within the unregulated drug supply. The city's drug checking service has reported finding unexpected, highly potent drugs in samples collected in recent months. Those include opioids like carfentanil, etonitazene, isotonitazene, and etizolam. These substances, which are being found mixed with more common opioids like fentanyl, are likely to contribute to higher incidents of overdoses, according to the news release. Toronto paramedics say if someone is overdosing, the opioid antidote naloxone should be administered to reverse the effects and 911 should be called. While naloxone remains effective in countering overdoses, those who work in harm reduction programs — either independently or through the city — say more is needed to tackle the crisis. Rhiannon Thomas is the program coordinator for CounterFIT Women's Harm Reduction at the South Riverdale Community Health Centre. She says the opioid crisis is an epidemic in the country, and while harm reduction programs continue to help clients, systemic change is needed to find a lasting solution. Thomas says that she doesn't believe people who use drugs are valued in society, given societal response to the issue. "I see a lack of political will and interest to invest resources and time into the lives of people who use drugs," Thomas said. "If we don't do things to change policy and practice very soon, those numbers are going to continue to climb."
 

For more information: https://tinyurl.com/2b4w8fhu
 

Hep C World News - Week of August 8, 2021

Virtual medical care is here to stay post-pandemic

Vancouver, BC - Seeing a health-care professional via video or telephone has improved patient care access in British Columbia and will continue after the threat of COVID-19 subsides, says the leader of the organization that represents thousands of physicians across the province. Dr. Ramneek Dosanjh, president-elect of Doctors of B.C., said virtual appointments increased fourfold during the pandemic — and the option of seeing a doctor remotely is here to stay. "I think that we will not go back to the pre-pandemic virtual care levels," Dosanjh told CBC's The Early Edition recently. "The future is here and the goal is now to just navigate the road ahead." Dosanjh says it is important to have in-person appointments with your doctor as some medical concerns should be physically examined. She said virtual appointments can be efficient and effective for follow-up care, prescription refills and mental health check-ins. Virtual appointments can also greatly benefit British Columbians with mobility issues or those who live in rural communities where accessing the doctor's office is a challenge. "It's enabled them to access care in a way that they previously weren't able to," said Dosanjh. But Dosanjh does have some concerns about the increasing use of phone and video appointments — one being that patients may not know if they have a situation requiring urgent care. She said it's also important that increased virtual appointments do not result in "fragmented care" for British Columbians who could end up "jumping from doctor to doctor" rather than receiving continuous care from their family physician or specialist. A Canadian Medical Association (CMA) survey released last June suggested 47 per cent of Canadians used virtual care such as calls, email, texts or video during the pandemic. Of these, 91 per cent said they were very satisfied with the experience.

For more information: https://tinyurl.com/5kxp46u7

Hep C World News - Week of August 1, 2021

Canadians would support use of vaccine passports, Angus Reid survey finds

Arnprior, ON - The idea of providing proof of vaccination is one Canadians would be on board with if it meant a return to the things they enjoy during the pandemic. In a recent survey by the Angus Reid Institute, 79 per cent of Canadians polled said they would carry a vaccine passport to travel internationally, while 76 per cent said they would carry one to cross the border to the United States. At home, 55 per cent of people said they would provide proof at public places such as restaurants, malls, movie theatres, and even workplaces. "If it meant I didn’t have to wear a mask anymore and we could open everything up and put everything back to normal, I’ll carry whatever they ask me to carry," said Shawn Lewis, who was out picking up groceries at the Metro location in Arnprior. "It would definitely make a lot of sense because you know everybody around you is vaccinated." In Renfrew County, more than 50 per cent of the population has received at least one dose of the COVID-19 vaccine. Medical Officer of Health Dr. Robert Cushman is anticipating that number to reach 70 per cent before vaccine hesitancy becomes prominent. "Renfrew County tends to be very pro-vaccine, which is great," says Dr. Cushman. "I think most people want their own private vaccine passport because they realize that it will help them in certain places." But there are some who say they don’t like the idea of a digital passport being scanned on their phone. "Personally, myself no," says Bob Lachance, who was also out running errands in Arnprior. "If we need a passport, maybe present it if you want to go somewhere. But personally I don’t think it’s necessary."

For more information: https://tinyurl.com/58ndce5b

Hep C World News - Week of July 25, 2021

Mortality increases among transplantation recipients with COVID-19

Milan, Italy - Liver transplant candidates with decompensated cirrhosis who were infected with COVID-19 had increased mortality during the first and second waves of the pandemic, according to data published in Gut. “Increased mortality in [liver transplantation (LT)] candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of [15 or greater] was observed with no significant difference between first and second waves of the pandemic,” Luca Saverio Belli, from the department of hepatology and gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy, and colleagues wrote. “Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventive measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).” Liver transplant recipients with decompensated  cirrhosis who were infected with COVID-19 had increased mortality during the first and second waves of the pandemic. Source: Adobe Stock Belli and colleagues collected data from adult liver transplantation recipients with COVID-19 from February 21 to November 20, 2020. Investigators identified 136 adult cases of laboratory-confirmed SARS-CoV-2 infection from 33 centers in 11 European countries; 113 of these adults had COVID-19. After a median 18 days, 37 patients died and respiratory failure was the most common cause (89.2%). Belli and colleagues noted the 60-day mortality risk was not significantly altered between first (35.3%; 95% CI, 23.9% to 50%) and second (26%; 95% CI, 16.2% to 40.2%) waves. Clinical presentation and course also were not significantly changed between the two waves of the COVID-19 pandemic. Multivariable cox regression analysis revealed two important negative independent factors for mortality. The first was a Lab-MELD of 15 or greater (MELD score 15-19 HR = 5.46; 95% CI, 1.18-16.5; MELD score 20 HR = 5.24; 95% CI, 1.77-15.55). The other was dyspnea on presentation (HR = 3.89; 95% CI, 2.02-7.51). According to researchers, after a median time of 78.5 days, 26 patients underwent a liver transplantation. Twenty-five patients were alive after a median follow-up of 118 days, Belli and colleagues reported. After liver transplantation, short-term survival was 96%. There were no cases of SARS-CoV-2 reinfection reported.

For more information: https://tinyurl.com/38by9hxs

Hep C World News - Week of July 18, 2021

FDA says children aged as young as 3 years can take Epclusa for hepatitis C

Washington, DC - Under an FDA-approved expansion of the pediatric indication, children aged as young as 3 years are now able to receive Epclusa for the treatment of chronic hepatitis C virus regardless of HCV genotype or severity. The FDA originally approved Epclusa (sofosbuvir/velpatasvir, Gilead Sciences) for adults in 2016 and for children aged 6 years or older in March 2020. Gilead said the FDA has approved two strengths of an oral pellet — sofosbuvir 200 mg/velpatasvir 50 mg and sofosbuvir 150 mg/velpatasvir 37.5 mg — that were developed for younger children who cannot swallow tablets. The recommended dose in the younger age group is based on the weight of the child, the drug maker said. A 12-week treatment course is approved for children without cirrhosis or with compensated cirrhosis (Child-Pugh class A), and in combination with ribavirin for patients with decompensated cirrhosis (Child-Pugh class B or C), Gilead said. It is the only protease inhibitor-free, pangenotypic HCV regimen approved for patients aged as young as 3 years, according to Gilead. The decision “represents important progress toward that goal by expanding more cure options for children living with HCV,” Gilead Chief Medical Officer Merdad Parsey, MD, PhD, said in a news release. “This approval adds to the robust clinical evidence supporting the safety and ecacy of Epclusa across a broad set of patients, including those with end-stage renal disease and all stages of fibrosis." According to Gilead, as of 2018, there were up to 60,500 children in the United States living with HCV, and incidence rates are on the rise. Mother-to-child transmission, which is the most common cause of HCV in children, increased 161% from 2009 to 2017, the company said. IV drug use has been the primary driver of HCV among women of childbearing age. The expanded approval is based on data from a phase 2, open-label clinical trial conducted among 41 children aged 3 to younger than 6 years who were treated with sofosbuvir/velpatasvir for 12 weeks

For more information: https://tinyurl.com/nrm8d6xr

Hep C World News - Week of July 11, 2021

WHO releases recommendations and guidance on Hep C virus self-testing

Geneva, Switzerland - New guidelines from WHO strongly recommend offering self-testing for hepatitis C virus (HCV) as an additional approach to HCV testing services. WHO releases the new guidelines – its first on HCV self-testing – during the International AIDS Society Conference 2021.  WHO set a goal to eliminate HCV as a public health problem by 2030 in its Global health sector strategy on viral hepatitis (2016–2021), with targets to diagnose 90% of those with HCV and to treat 80% of those diagnosed. However, as of 2019 only an estimated 21% of the 58 million people with chronic HCV infection globally were diagnosed. And, despite recent advances in highly effective and affordable direct-acting antiviral (DAA) treatment, only 9.4 million (62% of those diagnosed) were treated with DAAs between 2015 and 2019. In many settings people from key populations, particularly men who have sex with men and people who inject drugs, have high rates of HCV infection but do not benefit from testing and treatment. WHO’s guidance on HCV self-testing is meant to support the efforts of national programmes to reach people who may not otherwise test.  The new guidelines highlight key considerations for policy-makers, national programmes, providers and implementers of HCV testing services. These considerations for HCV self-testing include designing appropriate and context-specific messages, service delivery models and support tools through engagement with communities; setting up efficient pathways for people who self-test to obtain confirmatory testing and treatment or prevention services; training providers; creating a supportive and enabling policy environment; and using quality-assured products. To help assure quality, WHO has published technical specifications for prequalification of HCV self-testing products. HCV self-testing kits are likely to be available soon.  Evidence of impact and experience with HIV self-testing was an impetus to consider self-testing for HCV. Development of the HCV self-testing guidelines also drew on compelling evidence of the acceptability and usability of HCV self-testing for both users and providers in almost a dozen countries from different regions and confirmation that the great majority of lay users are able to perform HCV self-testing.  “HIV self-testing has been an effective tool in accelerating progress towards achieving global goals, and many country programmes have benefited from the availability of HIV self-testing to support continuity of essential services in the COVID-19 context,” said Dr Meg Doherty, Director of the WHO Global HIV, Hepatitis and STI Programmes. “We encourage countries and national programmes to start planning for introduction of HCV self-testing as well, especially for priority populations and regions with the greatest gaps in testing coverage.” Unitaid funding supported the development and evidence generation for the new HCV self-testing guidelines. “Unitaid played a critical role in expanding access to HIV self-testing in countries and is pleased to advance efforts supporting HCV self-testing,” said Philippe Duneton, Executive Director of Unitaid. “Creating simplified and more accessible pathways to diagnosis for the 58 million people with HCV worldwide is essential to making real progress against this virus. The COVID-19 pandemic has further underscored the importance of simple, at-home tests in ensuring that people can access care. We welcome these new guidelines from WHO as an important step towards meeting HCV elimination targets.” WHO expresses thanks to the experts who developed and reviewed these guidelines. As WHO celebrates the global Self-Care Month, culminating in Self-Care Day, 24 July, the recommendation for HCV self-testing is timely and an important addition to growing self-care options.

For detailed information: https://www.who.int/publications/i/item/9789240031128

Hep C World News - Week of July 4, 2021

The lambda COVID-19 variant is now spreading in Canada

Ottawa, ON – The CBC reported recently that multiple variants of the virus behind COVID-19 are circulating in Canada, and lambda has now joined their ranks. While only a small number of cases have been reported countrywide so far, public health officials are keeping a close eye on this variant of interest first identified in South America. Lambda, or C.37, is one of the latest variants of the virus behind COVID-19, and it's now being reported in Canada. The first samples were found in Peru back in August 2020, but it was only deemed a variant of interest by the World Health Organization (WHO) in mid-June. "Lambda has been associated with substantive rates of community transmission in multiple countries, with rising prevalence over time concurrent with increased COVID-19 incidence," reads an epidemiological update from the WHO released on June 15. In Canada, 11 cases of the variant have been reported as of July 5, the Public Health Agency of Canada (PHAC) told CBC News in a statement.  PHAC is "monitoring carefully" for more cases and research tied to the variant's transmissibility and vaccines' effectiveness against it, said spokesperson Anne Génier. Two recently discovered cases were in Alberta and both are tied to travel, health officials there said on Wednesday. According to the WHO, lambda has also been reported in dozens of other countries. So far, it's hitting South America the hardest. The variant has been on the rise in countries beyond Peru such as Ecuador, Argentina and Chile — and in the latter, it recently accounted for more than a third of all the country's sequenced cases. Lambda carries a "number of mutations," according to the WHO, which may make it more transmissible or resistant to neutralizing antibodies. "There are mutations on the spike protein portion of the virus, which as we know is one of the important pieces of the virus, and the mutations are slightly different than some of the previous mutations we've seen," said Dr. Lucas Castellani, an infectious diseases specialist at the Sault Area Hospital in Sault Ste. Marie, Ont.  "That said, what we don't know is what all of this means." So far, there's "limited evidence" on the impact of the changes to the spike protein, the WHO notes, but public health teams around the world are hoping to learn more about how the variant operates. Dr. Anthony Chow, professor emeritus at the University of British Columbia's division of infectious diseases, also cautioned that the strain has the potential to turn into a variant of concern. "It is highly transmissible, and that it has been a hallmark of variants of concern — the way they spread," said Chow. Sault Ste. Marie, Ont.-based infectious disease specialist Dr. Lucas Castellani explains what we know, and don't know, about the lambda variant and how it operates. Despite its multiple mutations, there's early evidence that yes, vaccines likely protect you from getting infected by lambda. A recent U.S. lab-based study — which was published online, but has not yet been peer-reviewed — suggests that the "vaccines in current use will remain protective against the lambda variant and that monoclonal antibody therapy will remain effective." But the WHO stressed that further studies are still needed to "validate the continued effectiveness of vaccines." Chow stressed the need for Canadians to keep getting vaccinated to protect themselves as best as possible. "Those who hesitate about getting their vaccines, they're still starting to have doubts or worrying about side effects," he said, "but the real harm from infection by the virus is so much greater than any possible side effects." Most Canadians shouldn't be too worried about lambda, experts told CBC News — at least not yet. "If you're vaccinated, I think it's not too concerning," said Castellani. "We're changing this virus from one that causes severe illness, death, and debilitation to patients to one that's manageable." But as the country keeps loosening restrictions, he warned some Canadians will bear the brunt of the variant's spread. "We'll probably see more cases as more people are travelling," he continued. "Also, we've reduced restrictions at the border to some degree … it's almost impossible to prevent future transmission events from happening." Jeffrey Joy, an assistant professor in the division of infectious diseases with the University of British Columbia's department of medicine, agreed there's no cause for alarm just yet — but he also stressed the need to keep monitoring for this, and other, virus variants. "What we really need to do in Canada is set up a good system of molecular surveillance, so that we can act on the hotspots of new variants as they arise in Canada before they spread widely in the population," he said.
 

For more information: https://tinyurl.com/2bkxf98x

Hep C World News - Week of June 27, 2021

Interim guidance for country validation of viral hepatitis elimination

Geneva, Switzerland - In 2016, the World Health Assembly adopted the Global Health Sector Strategy (GHSS) on viral hepatitis. The GHSS called for elimination of viral hepatitis B and C infection as a public health problem (defined as a 90% reduction in incidence [95% for HBV and 80% for HCV] and 65% reduction in mortality by 2030, compared with the 2015 baseline). A broad range of countries have now developed national viral hepatitis plans, and several countries also requested guidance from the World Health Organization (WHO) on the establishment of global criteria for measuring elimination of viral hepatitis and a standardized process for validation of elimination. WHO has developed this interim guidance for countries and other stakeholders seeking validation of elimination of viral hepatitis as a public health problem, with a specific focus on hepatitis B virus (HBV) and hepatitis C virus (HCV). It provides a global framework for the processes and standards for validation of elimination, and overall proposes the use of absolute impact targets to validate elimination at the national level (instead of, although equivalent to, the relative reduction targets originally defined in the 2016 GHSS) in combination with a set of programmatic targets.

To download the report: https://www.who.int/publications/i/item/9789240028395

Hep C World News - Week of June 20, 2021

Fully vaccinated people should continue wearing masks as delta variant spreads
 

Geneva, Switzerland – World Health Organization (WHO) officials stressed Friday the need for fully vaccinated people to “continue to be appropriately cautious” and keep up with social distancing measures like mask wearing as the highly infectious Delta variant of the coronavirus becomes increasingly dominant in the U.S. and spurs new Covid-19 surges around the world—including in highly vaccinated countries. The Delta variant, which was first identified in India and is more infectious than previous coronavirus strains, is now responsible for approximately 10% of coronavirus infections in the U.S. as of June 5 and has caused new Covid-19 outbreaks in such countries as the United Kingdom, Australia and Israel. The variant’s spread means people should follow public health measures like mask wearing, frequent sanitizing and social distancing “with much more care,” Dr. Michael Ryan, executive director of the WHO’s World Emergencies Programme, said at a press briefing Friday, saying the Delta strain should make the world “more cautious, more diligent, and more dedicated to” following those protocols.

For more information: https://tinyurl.com/8zcf2nb7

Hep C World News - Week of June 13, 2021

Combination ravidasvir, sofosbuvir effectively treats chronic hepatitis C

Geneva, Switzerland - Ravidasvir in addition to sofosbuvir was safe and effective in the treatment of patients with chronic hepatitis C virus, according to research published in The Lancet Gastroenterology and Hepatology. “The WHO Global Health Sector Strategy on Viral Hepatitis 2016–21 aims to eliminate viral hepatitis as a public health threat, test 90% of people with HCV and treat 80% of people with HCV worldwide by 2030. However, by March 2021, only 12 countries were on course to HCV elimination by 2030,” Isabelle Andrieux-Meyer, MD, of the Drugs for Neglected Diseases Initiative in Geneva, Switzerland, and colleagues wrote. “Therefore, there is a need for an affordable, pan-genotypic, potent and safe HCV treatment regimen to complement other regimens, which has low risk of drug–drug interactions and that is simple and suitable for use in decentralized public health settings.” In a two-stage, open-label, phase 2/3 clinical trial, researchers analyzed 301 patients (median age 47 years, 52% genotype 3 infection) with HCV, regardless of genotype, to assess the safety and efficacy of ravidasvir plus sofosbuvir. Patients without cirrhosis received ravidasvir 200 mg and sofosbuvir 400 mg once daily for 12-weeks; patients with cirrhosis received the same regimen for 24-weeks. The primary endpoint was sustained virological response 12-weeks post-treatment. According to study results, 97% of patients (95% CI, 94-99) achieved sustained virological response at week 12. Further sustained response was reported in 96% of patients with cirrhosis and 97% of patients with genotype 3 HCV infection. Researchers noted no difference in response rates by HIV co-infection or in patients previously treated with interferon. “This ravidasvir plus sofosbuvir combination appears suitable for use in diverse populations, including individuals with HIV and multiple other comorbidities, and it could provide an additional affordable public health solution with some key advantages for countries that do not have, or have not overcome, sofosbuvir patent barriers,” Andrieux-Meyer and colleagues concluded. “This regimen might be useful in decentralized public health settings in countries, such as Thailand and Malaysia, in which a high proportion of the population are estimated to have a chronic HCV infection.”
 

For more information: https://tinyurl.com/8axbxp8w

Hep C World News - Week of June 6, 2021

New study finds number of smokers has reached all-time high of 1.1 billion

London, UK - Smoking killed almost 8 million people in 2019 and the number of smokers rose as the habit was picked up by young people around the world, according to new research. A study published in the Lancet on Thursday said efforts to curb the habit had been outstripped by population growth with 150 million more people smoking in the nine years from 1990, reaching an all-time high of 1.1 billion. The study’s authors said governments need to focus on reducing the uptake of smoking among young people, as 89% of new smokers were addicted by the age of 25 but beyond that age were unlikely to start. “Young people are particularly vulnerable to addiction, and with high rates of cessation remaining elusive worldwide, the tobacco epidemic will continue for years to come unless countries can dramatically reduce the number of new smokers starting each year,” said the study’s lead author Marissa Reitsma, a researcher at the Institute for Health Metrics and Evaluation. Though the prevalence of smoking has reduced globally over the past three decades, it increased for men in 20 countries and for women in 12. Just 10 countries made up two-thirds of the world’s smoking population: China, India, Indonesia, the US, Russia, Bangladesh, Japan, Turkey, Vietnam and the Philippines. One in three tobacco smokers (341 million) live in China. In 2019, smoking was associated with 1.7 million deaths from ischemic heart disease, 1.6 million deaths from chronic obstructive pulmonary disease, 1.3 million deaths from tracheal, bronchus and lung cancer, and nearly 1 million deaths from stroke. Previous studies have shown that at least half of long-term smokers will die from causes directly linked to smoking, and that smokers have an average life expectancy 10 years lower than those who have never smoked. The research examined trends in 204 countries and was produced as part of the Global Burden of Disease consortium of researchers, which studies health issues that lead to death and disability. According to the study, half of all the countries had made no progress in stopping uptake among 15- to 24-year-olds and the average age for someone to start was 19, when it is legal in most places. Reitsma said the evidence suggested that if young people faced delays in picking up the habit, they would be less likely to end up becoming smokers at all. “Ensuring that young people remain smoke-free through their mid-20s will result in radical reductions in smoking rates for the next generation,” said Reitsma. Despite 182 countries signing a 2005 convention on tobacco control, enforcing policies to reduce smoking had been varied. Researchers said taxation was the most effective policy but there was a significant discrepancy between the high cost of a packet of cigarettes in developed countries and a significantly lower costs in low- and middle-income countries. The study’s co-author, Vin Gupta, said there needed to be stronger commitment to tackling smoking, as well as products such as flavoured cigarettes and e-cigarettes that could be enticing young people. “Despite progress in some countries, tobacco industry interference and waning political commitment have resulted in a large and persistent gap between knowledge and action on global tobacco control,” said Gupta. “Bans on advertising, promotion and sponsorship must extend to internet-based media, but only one in four countries have comprehensively banned all forms of direct and indirect advertising.”
 

For more information: https://tinyurl.com/ub5bauns

Hep C World News - Week of May 30, 2021

Crystal methamphetamine use in British Columbia

Vancouver, BC - A cross-sectional study of people who access harm reduction services was recently published, which noted that an increased use of crystal methamphetamine (“crystal meth”) has been observed across North America and international jurisdictions, including a notable increase in the presence of methamphetamines in illicit drug toxicity deaths in British Columbia. The researchers used data from a cross-sectional survey and urine toxicology screening to report the prevalence, correlates, and validity of self-reported crystal meth use among clients of harm reduction sites in BC. Survey data were collected from 1,107 participants across 25 communities in BC, through the 2018 and 2019 Harm Reduction Client Survey. They described reported substance use and used a multivariate logistic regression model to characterize crystal meth use. Urine samples provided by a subset of participants were used to derive validity of self-reported three-day crystal meth use compared to urine toxicology screening. They found that, excluding tobacco, crystal meth was the most frequently reported substance used in the past three days in 2018 and 2019 (59.7% and 71.7%, respectively). Smoking was the dominant route of administration for crystal meth, crack, heroin, and fentanyl. Multivariate analysis determined significantly higher odds of crystal meth use among those who used opioids (Adjusted Odds Ratio [AOR] = 3.13), cannabis (AOR = 2.10), and alcohol (1.41), and among those who were not regularly housed (AOR = 2.08) and unemployed (AOR = 1.75). Age ≥50 was inversely associated with crystal meth use (AOR = 0.63). Sensitivity of self-reported crystal meth use was 86%, specificity was 86%, positive predictive value was 96%, and negative predictive value was 65%. The researchers concluded that crystal meth was the most commonly used substance among clients of harm reduction sites in BC in 2018 and 2019, was frequently used concurrently with opioids. Comparison to urine samples demonstrated high validity of self-reported crystal meth use. They stated that understanding evolving patterns of substance use will be imperative in tailoring harm reduction and substance use services for individuals that use crystal meth.

For more information: https://tinyurl.com/55vhfem8

Hep C World News - Week of May 23, 2021

NACI recommends same shot vaccine when it comes to 2nd doses

Ottawa, ON - The National Advisory Committee on Immunization has updated its guidance on second shots, recommending that patients receive the same vaccine in round two as they did at their first appointment. But if that vaccine is unavailable, NACI suggests taking Johnson & Johnson in place of Oxford-AstraZeneca, and taking Moderna in place of Pfizer-BioNTech – both are mRNA vaccines – or vice-versa. When it comes to the viral vector vaccines AstraZeneca and J&J, however, the question is moot for the time being. Plans to distribute the initial 300,000-dose shipment of Johnson & Johnson remain on hold after Health Canada learned parts of the batch were manufactured at a Maryland facility mired in quality-control problems. An mRNA vaccine in place of a second AstraZeneca shot may be an option, but NACI is waiting on more data. A Spanish study released initial results last week showing a second dose of Pfizer for AstraZeneca recipients produced a stronger immune response, but more information is pending. A U.K. study earlier this month found that the same sequence produced some stronger initial side effects, but that they were temporary and mixing the vaccines was deemed safe. Further data on whether the blend yields similar or better results than two doses of the same vaccine is expected in a few weeks. Matthew Tunis, executive secretary to NACI, told a parliamentary health committee Friday that AstraZeneca recipients should wait 12 weeks to get a second dose in order to elicit a stronger immune response. NACI has previously said that up to 16 weeks will suffice.
 

For more information: https://tinyurl.com/5mcsbb4p

Hep C World News - Week of May 16, 2021

COVID-19 pandemic led to decreases in hepatitis C testing and treatment

Secaucus, NJ - The COVID-19 pandemic caused major decreases in hepatitis C virus testing and treatment, hindering efforts to meet WHO goals for 2030, according to a study in the American Journal of Preventive Medicine. “As much as we think about 2020 as the year of the pandemic and hopefully, we're sort of in that downward flow at the moment it’s also going to be the year that we're going to remember hepatitis C,” Harvey W. Kaufman, MD, senior medical director at Quest Diagnostics and head of Quest Diagnostics health trends research, told Healio. “It’s the year that the Nobel Prize was awarded to Harvey J. Alter, MD, Michael Houghton, PhD, DSc Hon, and Charles M. Rice, PhD, for the discovery of hepatitis C,” he continued. “It was the year that the U.S. Preventive Services Task Force and the CDC revised their guidelines for hepatitis C, recommending that all adults be tested. It was the year that both the U.S. Preventive Services Task Force and the CDC recommended that women who are pregnant get tested for each pregnancy. It was a great year in terms of what we sort of hoped for in terms of recognition and awareness of hepatitis C.” Kaufman said the pandemic “got in the way of what can be, and will be, a great medical advance, which is the elimination of hepatitis C. So, this study is timely, it's big, and that's why we did it.” To assess the impact of the COVID-19 pandemic on hepatitis C, Kaufman and colleagues evaluated data from a large national reference clinical laboratory and national estimates of dispensed prescriptions for HCV treatment. According to the study, the researchers estimated the average number of HCV antibody tests, HCV antibody-positive test results, and HCV RNA positive test results by month, from January to July for 2018 and 2019, and compared these data with the same months in 2020. The study demonstrated that, when compared with 2018 and 2019, HCV antibody testing volume decreased 59% during April 2020 and rebounded to a 6% reduction in July. Additionally, they found that the number of HCV RNA-positive results fell by 62% in March 2020 and remained 39% below the baseline by July 2020. The study showed that prescriptions for HCV treatments also decreased 43% in May, 37% in June and 38% July, relative to the corresponding months in 2018 and 2019. “There's a gap in care due to the pandemic. We need outreach, we need to involve engaged people to get tested, and then follow up with treatment. We need to extend testing to more adults to capture the 2.4 million Americans who were estimated to have hepatitis C as soon as possible because many of these people will develop chronic hepatitis and will develop the sequelae which includes liver failure, liver cancer and death, and they can also spread hepatitis C to other individuals unknowingly,” Kaufman said. “I'm not sure if we're going to hit the WHO target of 2030 because of the setback, but hopefully, we won't get too far behind and can accelerate our efforts and get back on track.”
 

For more information: https://tinyurl.com/27zkhsah

Hep C World News - Week of May 9, 2021

Infective endocarditis from IV drug use tied to hemorrhagic stroke

Columbus, Ohio - One consequence of the ongoing opioid epidemic in the United States may be an increase in the number of hemorrhagic strokes caused by infective endocarditis, research suggests. Intravenous drug use (IVDU) can cause this bacterial infection of the heart. In a single-center study, infective endocarditis was associated with an increase in the risk for hemorrhagic stroke as well as an increase in healthcare use and costs. "Patients who are known IV drug users who have endocarditis should be more carefully screened for symptoms of cardiovascular disease," Shahid M. Nimjee, MD, PhD, associate professor of neurosurgery and surgical director of the Comprehensive Stroke Center at the Ohio State University Wexner Medical Center, Columbus, Ohio, said in a press release. The findings were presented at the International Stroke Conference (ISC) 2021. In the United States, 47,000 patients are treated in the hospital for endocarditis each year. Endocarditis increases the risk for stroke, which can entail significant morbidity and mortality, the authors note. IVDU is a risk factor for endocarditis. In the context of the opioid epidemic, Nimjee and colleagues sought to compare the risk for stroke among patients with endocarditis from IVDU with the risk among patients with endocarditis from other causes. They retrospectively studied patients who had undergone treatment for infective endocarditis at Wexner Medical Center between January 1, 2014, and July 1, 2018. They examined patients' concomitant IV drug abuse and evaluated demographics, risk factors, and associated costs. Dramatic Increase In all, 351 patients met the study's inclusion criteria, and 170 (48%) had a history of IVDU-associated endocarditis. The incidence of patients with IVDU-associated endocarditis increased 630% from 2014 to 2018. The prevalence of overall intracranial hemorrhage was increased among patients with IVDU, compared with those without (25.9% vs 13.9%; P = .005). This increase in prevalence included increases in intraparenchymal hemorrhage (12.4% vs 5.1%; P = .012), subarachnoid hemorrhage (17.6% vs 4.4%; P = .0001), and cerebral microbleeds (14.1% vs 7.2%; P = .022). IVDU also was associated with an increase in prevalence of infectious intracranial aneurysm (10.6% vs 1.8%; P = .0001) and brain abscess (4.7% vs 1.1%; P = .025). Compared to patients with endocarditis from other causes, significantly higher numbers of patients with IVDU-associated endocarditis were homeless (5.9% vs 1.1%; P = .014), uninsured (10.0% vs 2.8%; P = .005), and unemployed (75.9% vs 31.7%; P = .0001). Medical costs were more than twice as high among patients with endocarditis from IVDU than among those with endocarditis from other causes. The difference in healthcare costs during admission per patient was more than $100,000. "The wider societal impact of the opioid epidemic is not well understood," Nimjee said in the press release. "Our research suggests that the impact of the opioid epidemic is far-reaching and contributes to increased costs in the criminal justice, health care systems, and the workplace. The increased costs can be particularly substantial for stroke care."

For more information: https://tinyurl.com/mb2pzm68

Hep C World News - Week of May 2, 2021

US reports record number of STDs for 6th straight year
 

Atlanta, GA - The United States reported more than 2.5 million cases of chlamydia, gonorrhea and syphilis in 2019, setting a record for STDs for a sixth consecutive year, the CDC said.“Less than 20 years ago, gonorrhea rates in the U.S. were at historic lows, syphilis was close to elimination and advances in chlamydia diagnostics made it easier to detect infections,” Raul Romaguera, DMD, MPH, acting director of the CDC’s Division of STD Prevention, said in a press release. “That progress has since unraveled, and our STD defenses are down. We must prioritize and focus our efforts to regain this lost ground and control the spread of STDs.” The newly released 2019 STD Surveillance Report, which was delayed because of the COVID-19 pandemic, showed that the U.S. experienced another increase from the 2.4 million STD cases reported in 2018. The sharpest increase was observed in congenital syphilis, the incidence of which has nearly quadrupled since 2015, according to the CDC. According to the report, data showed that STD rates were five to eight times higher among African American or Black people than among non-Hispanic white people, and rates among American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander people were three to five times higher than rates among non-Hispanic white people. Hispanic or Latino people were one to two times more likely to experience an STD than non-Hispanic white people. Additionally, gay and bisexual men and younger people also faced an increased burden. According to the report, gay and bisexual men made up nearly half of all 2019 primary and secondary syphilis cases and had gonorrhea rates that were 42 times higher than heterosexual men in some areas, whereas people aged 15 to 24 years accounted for 61% of chlamydia cases and 42% of gonorrhea cases. “Focusing on hard-hit populations is critical to reducing disparities,” Jo Valentine, MSW, associate director of the Office of Health Equity in CDC’s Division of STD Prevention, said in the press release. “To effectively reduce these disparities, the social, cultural, and economic conditions that make it more difficult for some populations to stay healthy must be addressed. These include poverty, unstable housing, drug use, lack of medical insurance or regular medical provider, and high burden of STDs in some communities.” According to the CDC, preliminary data from 2020 suggest that many of the trends continued into 2020, when much of the country experienced major disruptions to STD testing and treatment services because of the COVID-19 pandemic. “STDs will not wait for the pandemic to end, so we must rise to the challenge now,” Romaguera said. “These new data should create a sense of urgency and mobilize the resources needed, so that future reports can tell a different story.”
 

For more information: https://tinyurl.com/zaprkfvf

Hep C World News - Week of April 25, 2021

Unregulated, weed-like drug dubbed ‘CBD on crack’ has spiked in popularity

Chicago, IL - Chicago businesses are exploiting an apparent loophole in federal law that allows the unfettered sale of a trendy hemp byproduct called Delta-8-THC, which has commonly been described as “marijuana-lite” or “diet weed.” There’s a new high in town. A growing number of Chicago businesses are now exploiting a loophole in federal law that appears to allow the unfettered sale of a trendy hemp byproduct called Delta-8-THC, which has commonly been described as “marijuana-lite” or “diet weed.” Retailers across the city have started selling a variety of Delta-8 products in settings that resemble licensed cannabis dispensaries but aren’t subject to the same stiff regulations. Many sell everything from edibles to vaping cartridges, as well as smokable hemp flower sprayed with Delta-8 extract. Some places are even dosing food and drinks with Delta-8 and allowing customers to consume it on site. That flies in the face of a hard-fought provision in the state’s marijuana legalization law that tightly regulates public consumption, which isn’t allowed in Chicago yet.“People travel to Chicago because it’s Chicago and they make it a point to stop here because of the vibe,” said Adryan Delgado, the manager of Wake-N-Bakery, a coffee shop in Lake View that sells drinks and pastries infused with Delta-8 and CBD. Those spots have become extremely popular — with lines stretching down the block. Waits can be 30 minutes to get inside, Delgado said. Adryan Delgado manages Wake-N-Bakery, a coffee shop and bakery that sells CBD- and Delta 8-THC-infused products in Lake View. Pat Nabong/Sun-Times Delta-8 is similar to Delta-9-THC, the psychoactive compound in weed that gets users high, though it’s extracted from hemp and not marijuana. Those selling Delta-8 claim it has all the upsides of pot and none of the buzz-killing side effects, like anxiety and paranoia. Entrepreneurs seized on Delta-8 after the federal Farm Bill of 2018 made legal the distribution and sale of hemp and its byproducts. That law explicitly excluded Delta-9, but there’s no mention of its mellower relative. As Delta-8’s popularity has grown, the influential trade group that represents Illinois’ licensed pot businesses has started lobbying state and federal lawmakers for stricter regulations while raising concerns about its safety. State Rep. Bob Morgan, a pro-pot Democrat from Deerfield, has already introduced legislation that would require products containing Delta-8, CBD and other unchecked cannabinoids to be tested and labeled. “Many of these products are unsafe, untested, and it’s only a matter of time before someone gets hurt,” Morgan said on Twitter Monday, noting the bill is slated for a House vote this week. Though Delta-8 is currently sold at some dispensaries in the state, the Cannabis Business Association of Illinois is also pushing to completely prohibit its sale outside those controlled environments. Pam Althoff, a former state senator who now serves as the trade group’s executive director, said Delta-8 sellers are increasingly cropping up in “cannabis deserts,” where licensed pot shops haven’t opened. She described Delta-8 as a potentially dangerous “substitute” for legal weed — and one that’s being sold at lower prices. “Delta-8 is creating a competitive market without being subject to the same standards and regulations and rules that the cannabis industry is,” noted Althoff, who likened the Delta-8 dilemma to the deadly vaping and synthetic marijuana crises that previously roiled the nationwide cannabis industry. That stark warning was echoed by the owner of a cannabis testing lab who noticed multiple “red flags” when he tested Delta-8 products bought off store shelves in Chicago. The tester, who asked to remain anonymous, said he was most concerned that one brand of vaping cartridges had high levels of residual solvents and heavy metals, namely lead and chromium. “They’re not testing for that. … Heavy metals were directly attributed to the ‘Vapegate,’” said the tester, who shared the results with the Sun-Times.On top of that, he also found that some Delta-8 products have illegal levels of Delta-9 — meaning some stores are essentially selling weed.

For more information: https://tinyurl.com/rhjpuk

Hep C World News - Week of April 18, 2021

'Breakthrough' COVID Infection Rates as Expected

New York, NY - While federal data on breakthrough COVID-19 infections following vaccination only recently became available, a handful of states and independent health systems have put forward their own analyses, and the findings are reassuring -- the rate of breakthrough infections are as expected. Michigan was among the first states to report numbers last week: 246 people who were fully vaccinated (more than 2 weeks out from their second dose) came down with COVID from January to March. Three of those people died. That was out of a total of 1.8 million people in the state who were fully vaccinated at that time, according to the Detroit Free Press. State health department spokesperson Lynn Sutfin told the Free Press that some of those cases may still be excluded after they're fully adjudicated against other CDC criteria, such as not having a positive COVID test less than 45 days prior to their post-vaccination positive. Data from other states suggest similar low rates of breakthrough infection. Oregon, for instance, reported 168 cases of breakthrough infection among more than 700,000 fully vaccinated people as of April 2, with 19 hospitalizations and three deaths. Minnesota reported 89 cases among 800,000 fully vaccinated people as of March 22, with no deaths. Other states that have reported breakthrough cases include Washington (102 cases, eight hospitalizations, two deaths among one million fully vaccinated); South Carolina (155 cases among more than 560,000 fully vaccinated); and Nevada (58 cases among more than 500,000 fully vaccinated). On April 8th, the CDC reported national data, finding 5,800 breakthrough infections, with 396 requiring hospitalization and 74 deaths. The agency has a team that has been monitoring these infections since February, according to the Washington Post. During a White House press briefing last Friday, NIAID Director Anthony Fauci, MD, said he didn't have any concerns about breakthrough infections after vaccination. More than 74 million people in the U.S. have been fully vaccinated as of April 13, according to the CDC's vaccination tracker. "That number of individuals who were breakthrough infections is not at all incompatible with a 90-plus percent vaccine efficacy," Fauci said. "I don't think that there needs to be concern about any shift or change in the efficacy of the vaccine." "There's nothing there yet that's a red flag," Fauci said. "We're obviously going to keep an eye on that very, very carefully." Evidence from health systems also supports low rates of vaccine breakthrough. According to a letter published March 23 in the New England Journal of Medicine, the majority of post-vaccination infections among healthcare workers at the University of California San Diego and the University of California Los Angeles occurred before workers were fully vaccinated. Only seven infections among 36,659 fully vaccinated healthcare workers occurred more than 2 weeks after the second dose, researchers reported. David Perlin, PhD, chief science officer for Hackensack Meridian Health in New Jersey, told MedPage Today that among about 25,000 healthcare workers, only about 100 have tested positive for COVID-19 after vaccination, and most infections were mild. Few were hospitalized and none had severe illness, he said. "It's about the level we expected," Perlin said, adding that there hasn't been any clear pattern as to whether breakthrough infection is being driven by a particular variant -- notably, the B.1.351 or "South African" variant, which has been shown to evade vaccine immunity to some extent. "Among the vaccinated individuals who were virus-positive, we see the occasional E484K mutation, but there's no correlation" with breakthrough infection, Perlin said. "We were concerned about that at first, but with the analysis we've done so far, that does not seem to be the case." Perlin noted that as with the rest of the country, the B.1.1.7 variant is now dominant in New Jersey, and appears to be outcompeting other variants. "N501Y [the key mutation in B.1.1.7] seems very robust and may well outcompete E484K, which has immune escape but is facing selection pressure," Perlin said. But that doesn't mean we should rest easy, he warned. "Once N501Y gets a foothold, it seems to move quickly, but as long as we have infection, and people mount an immune response that's somewhat weak, there will be selection pressure" that can drive further mutation, he said. "That's another reason that, more than ever, we need to vaccinate as quickly as possible."

For more information: https://tinyurl.com/3p6r6n9k

Hep C World News - Week of April 11, 2021

The world's poorest countries are at India's mercy for vaccines

Cape Town, South Africa – Opinion: This is what happens when a third of humanity depends on one manufacturer for Covid jabs. We need to waive patents now As the UK’s vaccination programme was “knocked off course” due to a delay in receiving five million doses of the AstraZeneca vaccine from India, a far more chilling reality was unfolding: about a third of all humanity, living in the poorest countries, found out that they will get almost no coronavirus vaccines in the near future because of India’s urgent need to vaccinate its own massive population. It’s somewhat rich for figures in Britain to accuse India of vaccine nationalism. That the UK, which has vaccinated nearly 50% of its adults with at least one dose, should demand vaccines from India, which has only vaccinated 3% of its people so far, is immoral. That the UK has already received several million doses from India, alongside other rich countries such as Saudi Arabia and Canada, is a travesty. The billions of AstraZeneca doses being produced by the Serum Institute in India are not for rich countries – and, in fact, not even for India alone: they are for all 92 of the poorest countries in the world. Except they’re now being treated as the sovereign property of the Indian government. How did we get here? Exactly one year ago, researchers at Oxford University’s Jenner Institute, frontrunners in the race to develop a coronavirus vaccine, stated that they intended to allow any manufacturer, anywhere, the rights to their jab. One of the early licences they signed was with the Serum Institute, the world’s largest vaccine manufacturer. One month later, acting on advice from the Gates Foundation, Oxford changed course and signed over exclusive rights to AstraZeneca, a UK-based multinational pharmaceutical group. AstraZeneca and Serum signed a new deal. Serum would produce vaccines for all poor countries eligible for assistance by Gavi, the Vaccines Alliance – an organisation backed by rich countries’ governments and the Gates Foundation. These 92 nations together counted for half the world – or nearly four billion people. India’s fair share of these vaccines, by population, should have been 35%. However there was an unwritten arrangement that Serum would earmark 50% of its supply for domestic use and 50% for export. The deal included a clause that allowed AstraZeneca to approve exports to countries not listed in the agreement. Some countries which asked for emergency vaccine shipments from Serum, including South Africa and Brazil, were justified: they had nothing else. Rich countries like the UK and Canada, however, which had bought up more doses than required to vaccinate their people, to the detriment of everyone else, had no moral right to dip into a pool of vaccines designated for poor countries. Paradoxically, when South Africa and India asked the World Trade Organization to temporarily waive patents and other pharmaceutical monopolies so that vaccines could be manufactured more widely to prevent shortfalls in supply, among the first countries to object were the UK, Canada and Brazil. They were the very governments that would later be asking India to solve their own shortfalls in supply. The deal did not include restrictions on what price Serum could charge, despite AstraZeneca’s pledge to sell its vaccine for no profit “during the pandemic”, which led to Uganda, which is among the poorest countries on Earth, paying three times more than Europe for the same vaccine. (An AstraZeneca spokesperson told Politico that the “price of the vaccine will differ due to a number of factors, including the cost of manufacturing – which varies depending on the geographic region – and volumes requested by the countries”.) As it became clear that the western pharmaceutical industry could barely supply the west, let alone anywhere else, many countries turned to Chinese and Russian vaccines. Meanwhile, the Covax Facility – the Gavi-backed outfit that actually procures vaccines for poor countries – stuck to its guns and made deals exclusively with western vaccine manufacturers. From those deals, the AstraZeneca vaccine is now the only viable candidate it has. The bulk of the supply of this vaccine comes from Serum, and a smaller quantity from SK Bioscience in South Korea. As a result, a third of all humanity is now largely dependent on supplies of one vaccine from one company in India. Cue the Indian government’s involvement. Unlike western governments, which poured billions into the research and development of vaccines, there is no evidence that the Indian government has provided a cent in research and development funding to the Serum Institute. (This did not stop it turning every overseas vaccine delivery into a photo-op.) The government then commandeered approval of every single Covax shipment sent out from Serum – even, according to one well-placed source within the institute, directing how many doses would be sent and when. The Indian government has not publicly commented on its involvement in the vaccine shipments and has refused requests for comment. Last month, faced with a surge in infections, the Indian government announced an expansion of its domestic vaccination programme to include 345 million people, and halted all exports of vaccines. About 60m vaccine doses have already been dispensed, and the government needs another 630m to cover everyone in this phase alone. One other vaccine is approved for use – Bharat Biotech’s Covaxin – but it is being produced and utilised in smaller quantities. As more vaccines are approved, the pressure on Serum might decrease. For now, however, the bulk of India’s vaccination goals will be met by just one supplier, which faces the impossible choice of either letting down the other 91 countries depending on it, or offending its own government. The consequences are devastating. To date, 28m Covax Facility doses have been produced by Serum for the developing world – 10m of which went to India. The second largest shipment went to Nigeria, which received 4m doses, or enough to cover only 1% of its population. Given the new Indian government order of 100m doses, further supplies to countries like Nigeria may be delayed until July. And given the Indian government’s need of 500m more vaccine doses in the short run, that date could surely be pushed out even further. This colossal mess was entirely predictable, and could have been avoided at every turn. Rich countries such as the UK, the US, and those of the EU, and rich organisations such as Covax should have used their funding of western pharmaceutical companies to nip vaccine monopolies in the bud. Oxford University should have stuck to its plans of allowing anyone, anywhere, to make its vaccine. AstraZeneca and Covax should have licensed as many manufacturers in as many countries as they could to make enough vaccines for the world. The Indian government should have never been effectively put in charge of the wellbeing of every poor country on the planet. For years, India has been called “the pharmacy of the developing world”. It’s time to rethink that title. We will need many more pharmacies in many more countries to survive this pandemic.
 

Opinion by: Achal Prabhala and Leena Menghaney. Achal is the coordinator of the AccessIBSA project, which campaigns for access to medicines in India, Brazil and South Africa; Leena is an Indian lawyer who has worked for two decades on pharmaceutical law and policy.
 

For more information: https://tinyurl.com/3knsm7tr

Hep C World News - Week of April 4, 2021

People with long-COVID at high risk of depression and PTSD

London, UK - People living with long-COVID are at significant risk of experiencing depression and post-traumatic stress disorder (PTSD), according to research published in the European Respiratory Journal. The research is one of the first long-term follow-up studies of people who presented at hospital with COVID-19. Researchers found that a significant proportion of patients who attended hospital, whether admitted or discharged from the emergency department and regardless of disease severity, experienced an ongoing mental health burden – 14% showed signs of depression and 11% experienced PTSD. The researchers say that COVID-19 patients should be routinely monitored for psychological distress in post-COVID care to ensure that they recover both physically and mentally. Dr Swapna Mandal, Consultant Respiratory Physician at the Royal Free London NHS Foundation Trust, UK, was a lead researcher on the study. She said: “Whilst caring for COVID patients we could see the mental health effects; patients were terrified by what was happening to them and what they were seeing around them. Many people who have had COVID-19 report adverse mental health after the infection has cleared, but up to now, there have been very few long-term studies focused on this issue. “Based on these concerns, when we set up our post-COVID follow-up clinics we sought to monitor the psychological consequences among patients. We screened for depression and PTSD so that we could support our patients to get the right help and to gain insight in to how prevalent these long-term effects are.” Researchers conducted virtual follow-up care with 760 patients who presented at the Royal Free London NHS Foundation Trust, UK, with COVID-19 including those who were treated in the emergency department (112 patients), inpatient wards (558) and intensive care unit (90). The respondents’ average age was 60 years and the cohort comprised 60% male and 48% of black or minority ethnic background. Patients were followed-up at nine weeks and screened for psychological distress using the Patient Health Questionnaire 2-item scale, which assesses depression by asking about the frequency of depressed mood in the past two weeks, as well as the Trauma Screening Questionnaire, another self-report tool that is designed to identify those experiencing PTSD. The questionnaire data showed that at approximately nine weeks after discharge, a significant proportion of patients who had attended the hospital experienced varying levels of ongoing mental health burden. Around 105 patients (14%) of those receiving follow-up care showed signs of depression and 80 patients (11%) experienced symptoms of PTSD. The data also showed that patients who experienced depression or PTSD were more likely to have ongoing physical symptoms, such as breathlessness and muscle pain, and they were less likely to have returned to work at nine weeks’ follow-up. Dr Mandal said: “Our results show very clearly that among those who we provided post-COVID care for, many have experienced some level of poor mental health during their recovery. All health professionals who are involved in the care of those with long-COVID must be aware of this and should actively screen patients for symptoms, even in those with pre-existing mental health issues. It is vital that multidisciplinary clinics are established to manage all aspects of long-COVID symptoms in a holistic manner, so that patients are able to fully recover.” When the researchers accounted for others factors that can impact mental health – such as the patients’ age, sex, socioeconomic status, and ethnicity; whether they had any existing illness and related symptoms; or if they presented with worse COVID-19 symptoms – they found that the increased prevalence of depression or PTSD among long-COVID patients remained. Dr Mandal explained: “Interestingly, our data suggests there were no significant differences in the levels of depression or PTSD between ethnic groups, nor among those admitted to the ICU when compared with patients admitted to inpatient wards or those who presented at the emergency department, suggesting that disease severity does not impact the likelihood of experiencing ongoing mental health issues. “However, as our respondents included only those who had attended the emergency department or stayed in the hospital, the analysis of the relationship between mental health and disease severity is somewhat limited. Future studies should investigate this further by looking at patients who were treated in primary care settings, such as GP clinics and those who self-treated at home following doctors’ or official advice.” Professor Anita Simonds, President of the European Respiratory Society and Consultant in Respiratory and Sleep Medicine at Royal Brompton Hospital, UK, was not involved in the research. She said: “The results of this long-term study support that individuals who have had COVID-19 are at-risk of worsening mental health. Research on other long-term lung conditions like asthma and COPD suggests that addressing patients’ anxiety or mental ill health can improve their quality of life and ability to keep physically active, which may help with symptom management and recovery in the long run. Health professionals who are caring for those with long-COVID should monitor mental health and ensure patients can access local psychological services alongside respiratory rehabilitation. “Long-COVID treatment is likely to become a large burden on health systems around the world, so is it vitally important that clinics equally address the physical and mental health symptoms of long-COVID and that policymakers ensure clinics have the resources to offer this multidisciplinary care.” The researchers say they were not able to screen patients for depression or PTSD on admission to hospital, so it is not clear if some patients had pre-existing mental health issues or were undiagnosed.

For more information: https://tinyurl.com/2buzwypw

Hep C World News - Week of March 28, 2021

Pfizer begins early-stage study of oral COVID-19 drug

New York, NY - Pfizer Inc has started an early-stage U.S. trial of an oral COVID-19 antiviral therapy that could be prescribed to patients at the first sign of infection, the company said recently. The drugmaker, which developed the first authorized COVID-19 vaccine in the U.S. with Germany's BioNTech SA, said the antiviral candidate showed potent activity against SARS-CoV-2, the virus that causes COVID-19, in lab studies. Pfizer's candidate, named PF-07321332, is a protease inhibitor that prevents the virus from replicating in cells. Protease inhibitors have been effective at treating other viral pathogens such as HIV and hepatitis C virus, both on their own and in combination with other antivirals, the company said. Pfizer believes this class of molecules may provide well-tolerated treatments against COVID-19, as currently marketed therapeutics that work on the same lines have not reported safety concerns. The company is also studying an intravenously administered antiviral candidate in an early-stage trial in hospitalized COVID-19 patients. "Together, the two (oral and intravenous candidates) have the potential to create an end-to-end treatment paradigm that complements vaccination in cases where disease still occurs," Pfizer's Chief Medical Officer Mikael Dolsten said in a statement.Pfizer's candidate is behind two other oral antiviral therapies, which are in mid-stage trials – the first being developed by rival Merck & Co with Ridgeback Bio, and a second from Roche Holding and Atea Pharmaceuticals. Gilead Sciences' remdesivir is currently the only U.S. Food and Drug Administration-approved drug for the treatment of COVID-19. The FDA has granted an emergency authorization to intravenous therapies from Eli Lilly - bamlanivimab alone and in combination with etesevimab, and a combination therapy from Regeneron.
 

For more information: https://tinyurl.com/wfk8z6sw

Hep C World News - Week of March 21, 2021

Thrombosis Canada issues statement on AstraZeneca vaccine and blood clots

Toronto, ON – Thrombosis Canada has reviewed recent reports from the United Kingdom and Europe relating to the SARS-CoV-2 (COVID-19) vaccine made by AstraZeneca and the development of a very rare type of thrombosis (blood clots) that is associated with thrombocytopenia (low blood platelets). It is the view of Thrombosis Canada that, based on all available evidence, people who receive the AstraZeneca vaccine are not at increased risk of developing blood clots when compared with the general population. However, the AstraZeneca vaccine may be associated with extremely rare cases of blood clots that occur in the brain (called cerebral sinus vein thrombosis) and are associated with low blood platelets. These blood clots were found to occur in 1 in 250,000 to 1 in 500,000 people who received the vaccine. By comparison, people who have COVID-19 are at much higher risk of developing blood clots, which occur in about 1 in 20 people who are in hospital with COVID-19 and in about 1 in 100 people who have COVID-19 but are not in hospital. “Thrombosis Canada strongly recommends that people receive vaccinations for COVID-19, including the vaccine made by AstraZeneca” says Thrombosis Canada President, Jim Douketis, “that’s what we are telling the many patients who have been asking us because of the reports from Europe. The benefits of preventing blood clots and other disease caused by COVID-19 far outweigh any possible risks, which we consider very low.” Thrombosis Canada further strongly recommends that the following groups of people receive vaccinations for COVID-19:

1)            people who have had a previous blood clot

2)            people with a family member who has developed a blood clot

3)            people with a hereditary clotting tendency (e.g., factor V Leiden mutation)

4)            people who are receiving blood thinner medications

For more information: https://thrombosiscanada.ca/resourcepage/patient-family-information/

Hep C World News - Week of March 14, 2021

COVID-19 test authorized for home use
 

San Diego, CA - One year into the pandemic, the FDA has authorized its first molecular COVID-19 diagnostic that can be performed completely at home and purchased without a prescription. Cue Health’s cartridge-based nasal swab test can be used solo or for children as young as two with adult supervision, regardless of whether a person is showing symptoms or suspects that they’ve been exposed directly to the coronavirus. The kit includes a single-use test and sample collecting wand as well as a battery-powered cartridge reader that connects to a smartphone app. Results are expected within 20 minutes. “For the first time, consumers can access laboratory-grade testing at home,” said Ayub Khattak, co-founder and CEO of Cue Health, which was recently named one of Fierce Medtech's 2020 Fierce 15. “With this FDA authorization, we are one step closer to achieving our mission of making molecular diagnostic testing available to anyone, anywhere, at any time through a connected healthcare delivery ecosystem,” Khattak said. In studies, Cue Health’s home test had a false-negative rate of 4% with zero false-positive results. And after raising more than $100 million in funding last year—plus a $481 million U.S. government contract to expand its manufacturing—the company said it expects to be able to produce more than 100,000 tests per day by this summer. To date, the FDA has authorized more than 330 different COVID-19 tests and sample collection kits, including molecular, antigen and antibody tests for the home, the lab and anywhere in between. The agency has also prioritized the review of diagnostics designed for the point of care as well as those that could help relieve the burden on centralized testing facilities.  The FDA also authorized Adaptive Biotechnologies’ DNA-sequencing blood test that identifies T-cell immune responses to the coronavirus to indicate a recent or prior infection—similar to an antibody test with high accuracy. This can determine whether the body’s white blood cells “remember” a previous exposure to the virus and potentially protect against a future infection.
 

For more information: https://www.cuehealth.com/what-is-cue/how-cue-detects-covid-19/

Hep C World News - Week of March 7, 2021

Health Canada approves Johnson & Johnson's COVID-19 vaccine

Ottawa, ON - Canada's national campaign to inoculate people against the novel coronavirus got good news on two fronts today: one vaccine maker now plans to accelerate its deliveries and federal regulators have cleared a fourth COVID-19 vaccine for use in this country. Prime Minister Justin Trudeau said today that, after negotiations with the federal government, vaccine manufacturer Pfizer has agreed to move up delivery of 3.5 million doses of its COVID-19 vaccine — originally scheduled to arrive in the summer — to the next three months. The company will deliver an additional 1.5 million doses in March, one million more doses in April and another million in May, Trudeau said, bringing the total number of doses of all approved vaccines expected to arrive by the end of this month to 8 million. The announcement came just hours after Health Canada approved the use of Johnson & Johnson's COVID-19 vaccine in Canada, providing provinces and territories with another vaccine in addition to those previously approved from Pfizer-BioNTech, Moderna and AstraZeneca-Oxford. second version of the AstraZeneca-Oxford vaccine that is biologically identical but manufactured under different conditions by the Serum Institute of India under the brand name "Covishield" has also been authorized. Prime Minister Justin Trudeau says Pfizer will be delivering an additional 1.5 million doses to Canada in March. The Johnson & Johnson vaccine, produced by the U.S. health care giant's pharmaceutical subsidiary, Janssen Inc., is widely seen as one of the easiest to distribute because it requires only one dose and can be stored for long periods of time at regular refrigerator temperatures of 2 C to 8 C. "As long as it takes, we'll be there with what people need to get through this pandemic. That means we're sending more and more vaccines to the provinces and territories in the coming weeks and months," Trudeau told a press conference today. The new Pfizer delivery schedule and the Johnson & Johnson approval are expected to accelerate Canada's vaccine rollout, which has so far lagged behind dozens of other countries that have vaccinated more people per capita.  Dr. Dan Barouch, director, Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, says the Johnson & Johnson vaccine he helped to create is highly effective against COVID-19 and new variants of concern. In approving the Johnson & Johnson vaccine, Health Canada's chief medical adviser said a review of data from a clinical trial involving more than 44,000 participants found the shot is safe and effective. "As with all COVID-19 vaccines, Health Canada authorized the Janssen one after an independent and thorough scientific review for safety, efficacy and quality," said Dr. Supriya Sharma. "After assessing all the data, we concluded there was strong evidence that showed the benefits of this vaccine outweigh the potential risks."
 

For more information: https://tinyurl.com/wxa822pm

Hep C World News - Week of February 28, 2021

EU told to back vaccine passports or Google or Apple may step in

Brussels, Belgium - European Union leaders inched toward establishing bloc-wide vaccine certificates to enable countries to reopen to travel as Commission President Ursula von der Leyen warned that unless they hurry Apple Inc. and Google will step into the vacuum.   During a five-hour video call, the EU’s 27 leaders focused on how to haul their nations back to a form of normalcy after a pandemic that’s claimed more than 500,000 lives and shut down large parts of their economies. While there was broad support for certificates of some sort, leaders didn’t agree on the type of privileges they would grant. “We have all agreed that we need vaccine certificates,” German Chancellor Angela Merkel told reporters after the talks on Thursday. “In the future, it will certainly be good to have such a certificate but that will not mean that only those who have such a passport will be able to travel; about that, no political decisions have been made yet.” Europe’s leaders have been anxious to find a response after facing criticism for a vaccination program that lagged behind the U.S. and U.K. There’s also the prospect of a third wave of infections leading again to stricter lockdowns. It was the first such meeting as prime minister of Italy for Mario Draghi, the former European Central Bank president. He asked leaders to adopt a more resolute and pragmatic approach to speed up vaccinations and told them the program has to move much faster, according to an official with knowledge of the call. Draghi also called for a tougher approach against companies that don’t respect delivery commitments, suggesting that their exports from the EU could be blocked not only during the period they don’t respect accords, but also for a certain period afterward. The growing support for a digital certificate with common criteria such as vaccination, negative testing or immunity was helped by Merkel seeming to soften her stance on the matter, backing work on such a document, according to two people familiar with her remarks. But von der Leyen urged the group to move faster before U.S. tech companies fill the void. “It is important to have a European solution because otherwise others will go into this vacuum,” she said at a press briefing. “Google and Apple are already offering solutions to the World Health Organization. And this is sensitive information so we want to be very clear here that we offer a European solution.” A spokesperson from the WHO said the organization has taken a software-neutral approach to the development of a vaccination certification and “neither Google nor Apple are involved in this process.”  A person familiar with Apple’s position on the matter suggested that von der Leyen had misunderstood the situation. Apple has never discussed a possible vaccine application with the WHO or the EU, the person said on condition of anonymity. “If we as European Union don’t provide a solution, somebody else will, whether it’s going to be the U.S. big tech companies or somebody else, the solution will be provided,” Alex Patelis, chief economic adviser to Greek Prime Minister Kyriakos Mitsotakis, told Bloomberg. “Let’s get the infrastructure ready.” Countries including Germany and Belgium have come under fire from the EU commission for closing frontiers with other European nations to keep the virus under control. While they said that non-essential travel should be restricted, their summit communique included no new commitments, merely reiterating that shutting borders should be proportionate and non-discriminatory.
 

For more information: https://tinyurl.com/vjzyr2nd

Hep C World News - Week of February 21, 2021

COVID-19 leads to challenges ‘at every single step’ of HCVcare
 

Birmingham, Atlanta - The COVID-19 pandemic has had “a tremendously negative impact” on efforts to eliminate hepatitis C, according to Ricardo Franco, MD. “Curative HCV treatment is the last step in the HCV care cascade that starts with robust screening and linkage to care — and that doesn’t change, regardless of the status of the pandemic,” Franco, an associate professor of medicine (infectious diseases) at the University of Alabama at Birmingham and an associate scientist at the UAB Center for AIDS Research, told Healio. Franco outlined earlier steps in the HCV care cascade, including a physical evaluation and “a lot of attention” to competing priorities that may affect patients, such as other medical conditions that may not be well controlled, psychological barriers, limited transportation, unstable housing and food insecurity. These factors do not change because of the pandemic; in fact, they may become more significant, according to Franco. Implementation approaches enable providers to shorten the care cascade in HCV, he continued. One step in this process is the ability to test patients for HCV, treat them and cure the disease, but those strategies “can only flourish in ideal situations that the pandemic does not allow.” The pandemic “creates an extra layer of challenges at every single step of the HCV care cascade because it shifts public health priorities away from HCV work,” Franco said. These challenges include financial hardship, job insecurity, interruptions to family and social interactions, uncertainty and anxiety, all of which have “a tremendously negative impact” on patients, clinicians, health care systems and public health experts working to coordinate a concerted response to HCV, with the ultimate goal of eliminating the disease. According to Franco, modeling studies from the United Kingdom and Italy that examined the impact of postponing HCV treatment because of the pandemic demonstrated a negative effect on disease elimination goals. “Some of these models propose coordinated prioritization of patients with advanced fibrosis and cirrhosis to continue moving the care cascade,” he said. “Otherwise, we could even see an increase in HCV-related mortality as a delayed consequence of the problems we’re having now. The more you look at it, the more concerning it becomes.” Further, patients with HCV are vulnerable, according to Franco; they may be hard to reach and experiencing stigma. COVID-19 only increases these challenges.
 

For more information: https://tinyurl.com/bck83zaq

Hep C World News - Week of February 14, 2021

Vaccine manufacturer 'extremely committed' to meeting delivery targets

Montreal, PQ - The head of Pfizer Canada says the pharmaceutical giant is entirely focused on meeting its upcoming delivery targets and that it's possible the company could continue to accelerate shipments of its COVID-19 vaccine to the country. "Pfizer is extremely committed to meeting its contractual obligations, and we have every intention of meeting the four million commitment by the end of March that the prime minister has been talking about," Pfizer president Cole Pinnow said Sunday on Rosemary Barton Live. "As long as we're honouring our contract, we don't really feel that it's value added to talk about hypotheticals," Pinnow said, when asked by CBC Chief Political Correspondent Rosemary Barton about potential penalties for missed deadlines. The early months of Canada's COVID-19 inoculation campaign have been beset by disruptions to the delivery schedule. But on Friday, Prime Minister Justin Trudeau announced the country's vaccine supply would see a boost in the months ahead. Pfizer is now set to deliver 2.8 million more shots between April and June than originally planned. Deliveries previously earmarked for later in the year have also been moved up, meaning Canada will receive 6.2 million more doses than expected between July and August. Four million extra doses of the Moderna vaccine are also expected to arrive this summer. Most at risk, first in line: Public health experts say racialized Canadians should be prioritized for vaccines As far as the Pfizer-BioNTech product is concerned, Pinnow said it's not outside the realm of possibility that the company's deliveries to Canada could be shifted forward again. "We're going to continue to look for opportunities to accelerate delivery. We recognize that we want to bring back as much vaccine to Canadians as soon as possible." Pfizer's shipments to Canada dropped in recent weeks as the company's manufacturing plant in Puurs, Belgium, underwent upgrades to increase the production of its vaccine.  The company told the Globe and Mail last November that Canada would be sent doses from Pfizer's plant in Kalamazoo, Mich., but the company backtracked on that statement earlier this year. "We were working to accelerate the delivery to Canada of [the vaccine], based upon the accelerated review process that Health Canada had put in place," Pinnow told Barton. "So as part of that, we re-evaluated what our supply chain plan was going to be." A driver pulls his truck out of the Pfizer plant in Puurs, Belgium, on Dec. 21, 2020. Work to scale up manufacturing operations at the facility is now complete. (Valentin Bianchi/The Associated Press) When he was U.S. president, Donald Trump signed an executive order late last year aimed at ensuring Americans are given priority for receiving vaccines developed or procured by the United States government. "There was some uncertainty with the prior administration, and so we wanted to have confidence in where we were sourcing the product, and we felt that Belgium really provided us with more certainty at the time," Pinnow said. Canada is projected to receive 40 million doses of the Pfizer-BioNTech vaccine by September — the federal government's target month to vaccinate all Canadians seeking a jab. But under the agreement the country has signed with the pharmaceutical company, Canada can receive up to 76 million doses in total. "We're always open to talking about incremental demand or incremental supply," Pinnow said.
 

For more information: https://tinyurl.com/g6otr4sy

Hep C World News - Week of February 7, 2021

GSK and CureVac to develop next generation mRNA COVID-19 vaccines

Brentford, UK - GlaxoSmithKline plc (LSE/NYSE: GSK) and CureVac N.V. (Nasdaq: CVAC) announced a new €150m collaboration, building on their existing relationship, to jointly develop next generation mRNA vaccines for COVID-19 with the potential for a multi-valent approach to address multiple emerging variants in one vaccine. GSK will also support the manufacture of up to 100 million doses of CureVac’s first generation COVID-19 vaccine candidate CVnCoV in 2021. Through this new exclusive co-development agreement, GSK and CureVac will contribute resources and expertise to research, develop, and manufacture a number of novel mRNA vaccine candidates, including multi-valent and monovalent approaches. The aim of this work is to offer broader protection against a variety of different SARS-CoV2 variants, and to enable a quick response to new variants potentially emerging in the future. The development programme will begin immediately, with the target of introducing the vaccine in 2022, subject to regulatory approval. The increase in emerging variants with the potential to reduce the efficacy of first generation COVID-19 vaccines requires acceleration of efforts to develop vaccines against new variants to keep one step ahead of the pandemic. These next generation COVID-19 vaccines may either be used to protect people who have not been vaccinated before, or to serve as boosters in the event that COVID-19 immunity gained from an initial vaccination reduces over time. In addition, the collaboration will assess the development of novel mRNA vaccines to protect against multiple respiratory viruses, including COVID-19. This collaboration will build on CureVac's first generation COVID-19 vaccine candidate CVnCoV, which is currently in Phase 2b/3 clinical trial and on CureVac's ability to optimise mRNA for a strong immune response, manufacturability, and stability at standard 2-8°C cold chain conditions for vaccines. CureVac's platform is uniquely adapted to designing multi-valent vaccines with a balanced immune response and a low dose of mRNA. Emma Walmsley, Chief Executive Officer, GSK, said: "We believe that next generation vaccines will be crucial in the continued fight against COVID-19. This new collaboration builds on our existing relationship with CureVac and means that together, we will combine our scientific expertise in mRNA and vaccine development to advance and accelerate the development of new COVID-19 vaccine candidates. At the same time, we will also support the production of CureVac’s first generation vaccines with the manufacture of 100 million doses in 2021." Franz-Werner Haas, Chief Executive Officer of CureVac, said: "We are very pleased to build on our existing relationship with GSK with a new agreement to jointly develop next generation mRNA-based vaccines, in addition to our current candidate CVnCoV. With the help of GSK’s proven vaccine expertise, we are equipping ourselves to tackle future health challenges with novel vaccines." As part of the new collaboration, GSK will also support manufacture of CureVac’s first-generation COVID-19 vaccine candidate CVnCoV which is currently in Phase 2b/3 trials. Using its established manufacturing network in Belgium, GSK aims to support manufacturing of up to 100 million doses of the vaccine in 2021. Under the terms of the new collaboration agreement, GSK will be the marketing authorisation holder for the next generation vaccine, except in Switzerland, and will have exclusive rights to develop, manufacture, and commercialise the next generation COVID-19 vaccine in all countries with the exception of Germany, Austria and Switzerland. GSK will make an upfront payment of €75m and a further milestone payment of €75m, conditional on the achievement of specific milestones.
 

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Hep C World News - Week of January 31, 2021
 

‘Multilayered approach’ to COVID-19 still needed as vaccine rollout continues

Boston, MA - It is still important for people who have been vaccinated against COVID-19 to wear masks and practice social distancing, experts said. “It remains important to practice well-established, evidence-based prevention measures,” Joshua Barocas, MD, an assistant professor of medicine at Boston University School of Medicine and infectious diseases physician at Boston Medical Center, said during an Infectious Diseases Society of America press briefing. IDSA experts encouraged continued mask wearing as vaccines continue to be distributed. According to the CDC, more than 27 million people in the United States have received at least one dose of COVID-19 vaccine, and more than 6.4 people have received the full two doses. The vaccine rollout, plus emerging real-world clinical trial data on vaccine effectiveness, has created “an encouraging period of time,” Barocas said, although he stressed that inequities in vaccine distribution will need to be worked out. “Vaccines do offer true risk reduction, and that is the good news, but it is important to remember that only a very small portion of the population has actually been vaccinated,” Barocas said. “People with the greatest need for protection have not been at the front of the line, and we know that there are existing and growing inequities in who has been vaccinated. Black and Latinx people, who are at the highest risk of infection currently, have been and are still the least likely to be vaccinated.” Barocas likened mask wearing to armor in a jousting match, noting that although it may not guarantee protection, it is still safer than to not wear it. He said that a “multilayered approach,” including mask wearing, social distancing and other proven mitigation efforts, will be needed even as vaccination continues. Ricardo Franco, MD, an assistant professor of medicine at the University of Alabama at Birmingham and an associate scientist at the University of Alabama at Birmingham’s Center for AIDS Research, said during the briefing that emerging SARS-CoV-2 variants demonstrate the need for mitigation efforts, even among those who are vaccinated. “The emergence of these variants only brings greater urgency. Once production of vaccines and provisions of supplies reach ideal capacity, we will only have optimal vaccine distribution when we inject greater resources to local health departments and we find creative ways to leverage retail stores and pharmacies to administer these vaccines,” he said. “It is also very important to quickly report the number of vaccine shots given back to the CDC, so we know in real time which locales are in need of allocation of additional vaccine vials in a timely manner.” The percentage of the population that needs to be vaccinated to achieve herd immunity is unclear, Franco said, and is a “moving target” driven by the population being studied, the vaccines being used and how a given population is prioritized for distribution. He also noted that vaccine hesitancy is a “concerning element” of distribution that may further increase the amount of time that mask wearing and social distancing will be necessary. “We need to remain committed to using all the tools we have,” Franco said.

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Hep C World News - Week of January 24, 2021

The pandemic has exposed a crisis in Canada’s care homes

Toronto, ON - In late December the Tendercare Living Centre in Toronto became the site of an angry demonstration. Forty-eight of the home’s 200-odd residents had died from covid-19. Survivors’ relatives gathered to demand that it employ more staff. A doctor said the home had mixed infected with uninfected residents and had too little oxygen to treat the sick. She described it as a war zone. A hospital took over its management. By mid-January, 74 residents had died. The toll at Tendercare Living was an extreme example of a widespread problem. Deaths in Canada from covid-19 are about half those in the European Union as a share of population. Nearly three-quarters of the 14,000 Canadian deaths to mid-December took place in care homes. A study by the Canadian Institute for Health Information found that deaths in Canadian long-term care homes by late May were 25% higher than the average among 17 members of the OECD, a rich-country club, as a share of their populations. On December 31st The Toronto Star, Canada’s largest-circulation newspaper, published an editorial that took up the full front page decrying needless death in the long-term care system. It is “as if we have allowed [old people] to be put into coffins and buried alive before our very eyes”, the newspaper wrote. The crisis may soon subside. In Ontario, the most populous province (of which Toronto is the capital), all long-term care residents are due to be vaccinated by mid-February. But the problems highlighted by the pandemic will not disappear quickly. Canada consigns too many old people to institutions, one reason why such a high proportion of covid-19 deaths has taken place in them. They are poorly regulated, and many are badly designed. The problems will grow more pressing as the population ages. The share of Canadians older than 65 is expected to rise from a sixth to a quarter by 2041. In its treatment of old people Canada is an “international outlier”, says a recent report by Queen’s University’s School of Policy Studies. Canada spends less than most rich countries on long-term care: 1.3% of GDP (including the cost of compulsory insurance) compared with 1.7% on average by members of the OECD. That money is skewed towards institutions such as Tendercare Living rather than towards helping people remain in their own houses. In Canada 42% of people over 80 who need constant care are in institutions, compared with an OECD average of 30%. Denmark, which passed a law in 1987 that effectively barred construction of collective facilities, spends less on institutions than on home care, which is much cheaper. Canada, by contrast, spends six times more on institutional care. “We don’t do [home care] well. We default to institutional care,” says Fred Horne, a former health minister of the western province of Alberta.

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Hep C World News - Week of January 17, 2021

Guelph student creates Covid-19 vaccination calculator

Guelph, ON - Jasmine Mah, a University of Guelph graduate, and Steven Wooding, a U.K. physicist, paired up and created an online tool that projects a date range for when a Canadian could expect to receive their double dose. The estimated timeline is based on factors such as your age, or whether you work in health care or with seniors in long-term care or live in an Indigenous community, all groups prioritized for Stage One of the federal rollout. Mah said she created the calculator Vaccine Queue Calculator for Canada (omnicalculator.com) after hearing people talk about the pandemic being over because of the availability of vaccines. “I think people might be a little too over optimistic,” said Mah. “Yes, vaccines have been approved but we still have a ways to go. I don’t want people to let their guard down too early. We still have to be careful,” said the 28-year-old, who lives in Los Angeles with her husband, a Canadian doing post-doctoral work at a university there as well as in the U.K.  “Because I’m Canadian this topic was really important for me,” said Mah, who graduated from Guelph in 2018 with a masters in science. “I wanted to be a part of this and help people figure out when they are going to get their vaccine.” Mah has collaborated on calculators before, including one that estimated how much hand sanitizer a person would need to buy based on their usage. The vaccine calculator is based on an earlier one done by Wooding for the U.K., which began delivering the vaccine about a week before Canada. The pair used the federal government’s vaccine rollout plan, which includes broad estimates of how many doses will be delivered in three-month timelines in 2021, as well as population and employment data from Statistics Canada. In some cases, studies were used to determine, for instance, how many people in Canada live in long-term-care homes. And wherever possible, Mah said they tried to reduce the amount of double-counting in the priority categories so for instance, if someone was 80 years or older and lived in a long-term-care home, they aren’t counted twice.
 

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Hep C World News - Week of January 10, 2021

Canada's vaccine rollout is slower than other countries

Regina, SK – Canada is falling behind in its initial rollout of COVID-19 vaccines at a critical time in the pandemic, and experts say our most vulnerable populations are being left at risk. Despite having months to prepare for the deployment of the initial shipment of vaccines to those most threatened by COVID-19 in long-term care facilities, a consistent rollout plan has yet to fully materialize on the ground. "It just seems to be chaos right now," said Alyson Kelvin, an assistant professor at Dalhousie University and a virologist at the Canadian Centre for Vaccinology evaluating Canadian vaccines with the VIDO-InterVac lab in Saskatoon.  "We know who is a vulnerable population, so we need a strategy of actually vaccinating them." Long-term care residents were largely left out of Canada's initial rollout of the Pfizer-BioNTech vaccine, which requires storage temperatures of –80 to –60 C, in favour of waiting for the more easily transportable Moderna vaccine and vaccinating health-care workers first. But once thawed, the Pfizer-BioNTech vaccine can be used for up to five days at basic refrigeration temperatures — meaning it could be taken out of distribution hubs across the country and brought into long-term care facilities directly during that window of time.  A registered pharmacy technician prepares COVID-19 vaccines in Toronto on Dec. 15. (Evan Mitsui/CBC) "We treated the Pfizer vaccine with as much care and respect as possible and that really created all these hub sites," said Dr. Zain Chagla, an infectious diseases physician at St. Joseph's Healthcare Hamilton and an associate professor at McMaster University. "And I think that did hinder some of the innovation and the ability to do things elsewhere." The federal government has deployed almost 500,000 doses of both the Pfizer-BioNTech and Moderna vaccines to distribution sites across the country since mid-December, but the actual rollout of vaccinations is up to the individual provinces and territories.  Quebec took the bold step of actually putting its vaccine distribution centres inside long-term care facilities, making it easier to inoculate residents as quickly as possible.   British Columbia made the decision to move the Pfizer-BioNTech vaccine from its distribution sites almost immediately into long-term care homes to inoculate residents and staff upon receiving its first doses. Andy Yoon, 77, of Abbotsford, B.C., became the first long-term care resident in the Fraser Health region to receive the COVID-19 vaccine on Dec. 24. (Submitted by Fraser Health) Yet Ontario decided against bringing the Pfizer-BioNTech vaccine directly into long-term care homes initially, despite other provinces doing so, and is only now doing so more than three weeks after receiving its first shipment.  Dr. Vera Etches, Ottawa's medical officer of health, announced Tuesday the city would be transporting the Pfizer-BioNTech vaccine out of its distribution hub at the Ottawa Hospital and directly into long-term care residences, after vaccine-handling criteria from Pfizer were changed. Despite receiving 53,000 doses of the Moderna vaccine last week, which is much easier to bring into long-term care residences, only 3,000 doses have actually been administered in Ontario as of Tuesday. Ontario has pledged to vaccinate all residents, health-care workers and essential caregivers at long-term care homes in the hardest hit regions of Toronto, Peel, York and Windsor-Essex by Jan. 21, but has not set a deadline for the rest of the province.  To date, fewer than 1,000 long-term care residents have been vaccinated in Ontario. "The provincial health-care systems aren't experts in newly emerging viruses, brand new speedy vaccine platforms and pandemics," said Kelvin. For that reason, ongoing communication from the federal government to the provinces and territories and local level is essential, she said. "To leave each province and territory to have to come up with their own plan, when they're not experts in this, I think is a failure."  Kelvin said putting experts with relevant backgrounds in long-term care at the helm of vaccine rollouts across the country could have mitigated some of the missteps made so far. "We need somebody who's knowledgeable about long-term care facilities in Canada and their current functioning states," she said.
 

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Hep C World News - Week of January 3, 2021

Trench fever observed among homeless individuals in Canada

Winnipeg, MB - Bartonella quintana, the agent that caused trench fever among soldiers during World War I, has been observed among homeless populations in Canada, according to a small study of cases published in the Canadian Medical Association Journal. The results also suggest B. quintana may cause culture-negative endocarditis and can be fatal in the absence of antimicrobial and surgical treatment. Carl Boodman, MDCM, FRCPC, an R5 Chief Medical Resident of infectious diseases and medical microbiology at the University of Manitoba in Winnipeg, Manitoba, Canada, told Healio that the study is the largest description of Canadian B. quintana cases to date, and that the endocarditis cases occurred over the span of just a few months. “This suggests that B. quintana, the etiology of trench fever, is likely underdiagnosed in Canada,” Boodman said. “Because B. quintana is transmitted by body lice, it is a disease of poverty, a disease typically associated with war and displacement. These cases demonstrate that much more needs to be done to improve the conditions of people experiencing homelessness in Canada.” Boodman and colleagues examined a 48-year-old man admitted to an ED in Manitoba with chest pain and shortness of breath. The patient had sought care for body lice infestation and chest pain during the 18 months before his admission. After the man’s admission, three more patients diagnosed with B. quintana were discovered during a 6-month period. All three patients had accessed resources at a single homeless shelter. “Bartonella quintana should be on the differential diagnosis when caring for patients who are experiencing homelessness or who have had evidence of body lice infestation and present unwell,” Boodman said. “If diagnosed and treated early, we can prevent fatal endovascular complications such as endocarditis and mycotic aneurysms.” According to the researchers, three of the four patients were admitted to the ED 3 months before hospital admission, and two of the four had links to the rural community. Additionally, two of the patients made a full recovery; one had mild neurologic deficits, including mild aphasia; and one had severe neurologic deficits including severe aphasia and paralysis. Boodman said the study’s small sample size was one of its limitations and that further research is warranted. “Larger seroprevalence studies and ectoparasite surveillance studies are needed to understand the true burden of this disease among underhoused people in Canada,” Boodman said.

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