RESEARCH UPDATES

28. COVID-19 Vaccines and Cancer (Aug.13/21)

The two-dose Pfizer-BioNTech COVID-19 vaccine provides an effective immune response and is safe in people undergoing treatment for certain types of cancer, according to a study published in the June 2021, JAMA Oncology. Compared to individuals without cancer however, people with breast, colon and lung cancers, appear to have a “lagging” immune response to the vaccine.

Israeli researchers compared antibody responses after vaccination with the Pfizer-BioNTech vaccine in 232 adults receiving chemotherapy or radiation treatment for cancer with those of 220 healthy adults. After the first dose, 29% of the cancer patients had detectable antibodies in their blood, compared with 84% of those without the disease and 86% had detectable levels in their blood after the second dose. 

Having cancer regardless of treatment status is a risk factor for worse outcome from infections including influenza and COVID-19. Thus, doctors are recommending vaccination to all cancer patients. For newly diagnosed cancer patients, it is best to vaccinate before treatment as the immune response to the vaccine may be impaired in patients receiving chemotherapy. The vaccine is optimally administered at least two weeks before chemotherapy starts. The question of how soon vaccination should occur after completion of chemotherapy or immunotherapy is still being investigated.

https://news.cancerconnect.com/treatment-care/covid-19-vaccines-and-cancer?utm_source=CancerConnect&utm_campaign=12a0cdbcee-EMAIL_CAMPAIGN_9_20_2018_13_9_COPY_01&utm_medium=email&utm_term=0_4403223c9e-12a0cdbcee-6283611

29. If You Received the Pfizer or Moderna Vaccines, Expect to Get a Booster Starting This Fall (Aug.22/21)

With the surging Delta variant battling whatever gains that months of vaccinations made against COVID-19, federal health officials are sending reinforcements in the form of booster shots. These should become available next month. 

“The first part that is already happening is a third dose of vaccine recommended for those who are immunocompromised,” Dr. Mark Sawyer, an infectious disease specialist at UC-San Diego and Rady Children’s Hospital in San Diego, told Healthline. “It’s not considered so much a booster, but another chance to respond to the whole vaccination series, since some people with immunocompromising conditions don’t respond,” he explained. “The next part we will see is a true booster dose for those who have already had either one dose of Johnson & Johnson, or two doses of one of the mRNA vaccines,” Sawyer said. “The purpose of this dose is to boost the immune levels that may have worn off. This is especially important for protection from the Delta variant. This is expected to start mid to late September.”

According to the Centers for Disease Control and Prevention (CDC) guidelines updated August 20, individuals will be eligible for a booster 8 months after their final dose, once authorized by the Food and Drug Administration (FDA). On August 20, the CDC said the most at-risk people will be first in line for boosters, including healthcare professionals, residents of long-term care facilities, and other older adults. People who received the one-shot Johnson & Johnson vaccine can expect to need a booster as well. However, because it became available later than the other two-shot vaccines, the CDC is still compiling the necessary data to move forward with details.

https://www.healthline.com/health-news/if-you-received-the-pfizer-or-moderna-vaccines-expect-to-get-a-booster-starting-this-fall#Likely-no-mixing-and-matching-of-boosters

30. English Study Finds Long COVID Affects Up To 1 in 7 Children Months After Infection (Sept.01/21)

The authors of an English study led by University College London and Public Health England, claim that as many as 1 in 7 children may have symptoms linked to the coronavirus months after testing positive for COVID-19.  Even though children infrequently become severely ill with Covid-19, they can suffer lingering symptoms. The study found that 11 to 17 year-olds who tested positive for the virus were twice as likely to report three or more symptoms 15 weeks later than those who had tested negative.

The study observed 3,065 11 to 17 year-olds in England who tested positive in a PCR test between January and March of which 14% reported three or more symptoms such as unusual tiredness or headaches 15 weeks later, compared to 7% of the 3,739 who had tested negative over the same period.  The researchers saw that in spite of the findings suggesting as many as 32,000 teenagers might have multiple symptoms linked to COVID-19 after 15 weeks, the prevalence of long COVID in the age group was lower than some had feared in 2020.

https://www.reuters.com/business/healthcare-pharmaceuticals/english-study-finds-long-covid-affects-up-1-7-children-months-after-infection-2021-09-01/

31. WHO Monitoring New Coronavirus Variant Named Mu (Sept.01/21)

On August 30th  the World Health Organization added another version of coronavirus, the Mu variant (also known as B.1.621) to it’s list of “variants of interest” given the concerns that it may partially evade the immunity people have developed from past infection or vaccination. The Mu variant has been detected in 39 countries and according to the WHO “has a constellation of mutations that indicate potential properties of immune escape”.

In January 2021 the Mu variant was first identified in Colombia and since then sporadic cases and larger outbreaks have been recorded around the world including in the UK, Europe, the US and Hong Kong.  The variant maybe gaining ground in Colombia and Ecuador where it accounts for 39% and 13% of Covid cases respectively, while it makes up less than 0.1% of Covid infections globally.

Of interest to scientists and public health officials is whether the Mu variant is more transmissible, or causes more serious disease, than the Delta variant that is dominant in much of the world.  The WHO bulletin states ‘The epidemiology of the MU variant in South America, particularly with the co-circulation of the Delta variant, will be monitored for changes.’

In the UK,  at least 32 cases of the Mu variant have been detected most of which were in people in theirs 20s. The pattern of infection suggests it was brought in by travelers. Some positive results were found among those with one or two doses of Covid vaccine.

https://www.theguardian.com/world/2021/sep/01/who-monitoring-new-coronavirus-variant-named-mu

32. Biden Administration Likely to Approve Covid-19 Boosters at Six Months (Aug.26/21)

President Joe Biden’s administration is planning to issue updated guidance recommending a third dose of Pfizer or Moderna’s vaccine be given to Americans 6 months after their second dose instead of 8 months as most vaccinated Americans say they’re ready for the next shot.

The administration announced the long-anticipated plans for boosters last week, recommending a third dose be given at least 8 months after the second. But federal regulators are now likely to decide a 6 month waiting period is preferable after reviewing information from vaccine manufacturers and other countries. A final plan will need to be approved by the CDC’s vaccine advisory committee and the FDA. Thus, distribution of the booster shots is expected to begin Sept. 20, pending final signoff by the FDA clearance and CDC. The Biden administration and vaccine manufacturers have indicated that there should be enough doses for any fully vaccinated adult seeking a third dose. Approval for a plan, which is also expected to include information on a Johnson & Johnson booster shot, is expected by mid-September.

https://www.wsj.com/articles/biden-administration-plans-covid-19-vaccine-boosters-at-six-months-instead-of-eight-11629919356

https://www.healthline.com/health-news/everything-you-need-to-know-about-covid-19-booster-shots?slot_pos=article_3&utm_source=Sailthru%20Email&utm_medium=Email&utm_campaign=daily&utm_content=2021-09-07&apid=35071678&rvid=f0f57ada60cbcff8355009cb5e3a7d953ab89292aca3a379e264fc111d37cf3b

33. Moderna Makes Twice as Many Antibodies as Pfizer, Study Says (Aug.31/21)

A study showed that Moderna Inc.’s Covid vaccine generated more than double the antibodies of a similar shot made by Pfizer and BioNTech SE. The study compared the levels of antibodies produced by the two vaccines which are believed to be one of the important components of the immune response. It did not look at whether the difference in antibodies led to a difference in efficacy over time between the two shots, both of which were more than 90% effective in final-stage clinical trials.

The study was conducted among 1,600 workers at a major Belgium hospital system looking at the antibody levels against the coronavirus spike protein in blood samples 6 to 10 weeks after vaccination. The participants had not been infected with the coronavirus before getting vaccinated. Results showed that the antibody levels among those who got two doses of the Moderna vaccine averaged 2,881 units per milliliter, compared with 1,108 units per milliliter among those who received two Pfizer doses. Such results propose the differences might be due to the higher amount of active ingredient in the Moderna vaccine which has 100 micrograms versus 30 micrograms in the Pfizer-BioNTech or the slightly longer interval between the doses of the Moderna vaccine at 4 weeks, versus three weeks for the Pfizer-BioNTech. 

David Benkeser, a biostatistician at Emory University advised “I would urge caution in making the conclusion that because Moderna demonstrated a slightly higher peak on average that its efficacy will be slower to wane.”  “Such a conclusion requires a host of assumptions that have not yet been evaluated.” He also noted both vaccines produce high levels of antibodies and other studies have shown even relatively low levels of antibodies are protective.

https://www.bloomberg.com/news/articles/2021-08-31/moderna-jab-spurs-double-pfizer-covid-antibody-levels-in-study

34. COVID-19 Updates: U.K. to Offer Booster Shots for Everyone Over 50 (Sept.14/21)

The United Kingdom will start giving COVID-19 booster shots to everyone over age 50, according to The Associated Press. The AP reported that a U.K. medical panel on vaccinations and immunizations advised that people over age 50 be allowed to get COVID-19 booster shots, as immunity may wane over the winter months. Healthcare workers and people who are immunocompromised will also be able to get COVID-19 vaccine boosters.

As more people return to the workplace after months working remotely, vaccination status is becoming a condition of employment, according to CNBC. Job postings requiring vaccination have spiked since the Food and Drug Administration (FDA) granted full approval to the Pfizer-BioNTech COVID-19 vaccine, according to jobs site Indeed, showing increasing numbers of employers requiring candidates be vaccinated, reported CNBC.

https://www.healthline.com/health-news/covid-19-updates#9/14/21-3:49-p.m.-PDT-U.K.-to-offer-COVID-19-vaccine-boosters-for-everyone-over-age-50

Image Source: https://www.health.com/condition/infectious-diseases/coronavirus/covid-19-booster-shot-side-effects 

35. Risk Factors and Disease Profile of Post-Vaccination SARS-CoV-2 Infection in UK Users of the COVID Symptom Study App (Sept.01/21)

This study aimed to identify risk factors for post-vaccination SARS-CoV-2 infection and describe the characteristics of post-vaccination illness. Findings showed that frailty was associated with post-vaccination infection in older adults (≥60 years) after their first vaccine dose, and individuals living in highly deprived areas had increased odds of post-vaccination infection following their first vaccine dose. Individuals without obesity (BMI <30 kg/m2) had lower odds of infection following their first vaccine dose. Vaccination (compared with no vaccination) was associated with reduced odds of hospitalization or having more than five symptoms in the first week of illness following the first or second dose, and long-duration (≥28 days) symptoms following the second dose. Almost all symptoms were reported less frequently in infected vaccinated individuals than in infected unvaccinated individuals, and vaccinated participants were more likely to be completely asymptomatic, especially if they were 60 years or older.

To minimize SARS-CoV-2 infection, at-risk populations must be targeted in efforts to boost vaccine effectiveness and infection control measures. The study findings might support caution around relaxing physical distancing and other personal protective measures in the post-vaccination era, particularly around frail older adults and individuals living in more deprived areas, even if these individuals are vaccinated, and might have implications for strategies such as booster vaccinations.

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00460-6/fulltext

36. Reopening and Vaccination Policies (Sept.09/21)

Canada is now firmly in the midst of a fourth wave of the COVID-19 pandemic. This is primarily due to the highly contagious delta variant, which now makes up nearly 90% of all reported cases of COVID-19 across the country. While these challenges are not new, a key difference in this wave is the role of vaccinations. According to the COVID-19 Vaccination Tracker, 78% of the eligible population – Canadians age 12+ – are fully vaccinated, while 85% of those eligible have received at least one dose. This translates to 68% of the overall Canadian population having received both doses of a vaccination and 74% having one. Additionally, there remains a large swath of the population – those age under 12 years of age – who are not yet eligible to receive a vaccine, and likely will remain ineligible until early next year.

A key, evolving conversation is the role of vaccination passports. In early August, the federal Liberal government committed to a national vaccine passport. However, timelines around this continue to be fluid and will likely continue to be, particularly in light of the current federal election. At the time of the announcement the federal government called on other jurisdictions to implement similar systems or use the emerging federal system. In the weeks since, provinces have taken a range of approaches. For instance, Quebec, B.C., Ontario, Newfoundland and Labrador are all in varying stages of introducing their own proof of vaccination systems – notably all are being referred to as vaccination cards, not passports. Additionally, these jurisdictions are implementing associated policies that articulate when and where proof of vaccination is required ie: for accessing restaurants, clubs, ticketed sporting events and organized social gatherings such as weddings.

To help make sense of the continually fluid landscape as it relates to the COVID-19 pandemic, Global Public Affairs is re-instating our COVID-19 tracking tools. Below you will find an overview of the current pandemic landscape across the country. Attached are an updated set of documents that provide highlights on where Canadian jurisdictions fall on key policy conversations, how they are evolving across governments and across the private sector, and steps each jurisdiction is taking in light of the evolving COVID pandemic.

National COVID-19 Guidelines

Re-entry and Vaccination Status Policies

37. Pandemic Lockdown Tied to Worse Outcomes in mCRC (Sept.08/21)

One of the most pressing questions during the coronavirus pandemic has been its impact on cancer detection, diagnosis, and treatment. During the first Covid-19 surge, swamped health-care systems suspended cancer screenings and some in-person care while some people stayed away for fear of Covid-19 infection. A small new study from France is one of the first to show how diagnostic delays could lead to worse outcomes.

The paper, published Wednesday in JAMA Network Open, compared people newly diagnosed with metastatic colorectal cancer (mCRC) before and after the country’s 55-day pandemic lockdown in 2020. It found that 40 people diagnosed with mCRC after the lockdown had a tumor burden nearly 7x higher than 40 people diagnosed before the pandemic. For people with a higher tumor burden, their median survival decreased from 20 months to just under 15 months.

The researchers didn’t set out to study the pandemic’s impact on cancer. They were working on a large clinical trial using blood tests that measure circulating DNA to see if patients with metastatic colorectal cancer had certain genetic mutations that might respond to a targeted therapy. The researchers, led by Alain Thierry, director of research at INSERM and Institut de Recherche en Cancérologie de Montpellier, noticed significantly higher levels of circulating tumor DNA in most of the patients diagnosed after screening resumed on May 11, 2020, compared to 228 patients diagnosed before lockdown began on March 9, 2020. In their previous work, circulating DNA analysis had shown strong prognostic value.

Thierry said CRC should be a major target for any intervention to minimize Covid-related diagnostic delays. “Our data points first, to the crucial importance of early detection; second, to [the need] to maintain screening programs and diagnostic services during a pandemic; and third, to the need … to minimize patient’s fears by ensuring [better] communication,” he said.

https://www.statnews.com/2021/09/08/pandemic-lockdown-tied-to-worse-outcomes-metastatic-colorectal-cancer-study/ 

https://www.clinicaloncology.com/Solid-Tumors/Article/09-21/COVID-19-Delays-Breast-Colorectal-Cancer-Diagnoses/64692

Image Source: https://www.endsreport.com/article/1711151/pandemic-lockdown-slashed-carbon-emissions 

38. Can Intranasal COVID Vaccines Help Stop the Spread? (Sept.05/21)

High on the list for reducing viral load and reducing the chance of people spreading the virus should be intranasal vaccines, which would stimulate nasal tissue immune factors (mucosal immunity) including local mucosal IgA.

Daniel Oran, MA, and Eric Topol, MD, from the Scripps Institute published an opinion piece in Scientific American in March highlighting reasons for pursuing intranasal vaccines and for providing financial incentives. As they discuss, these vaccines offer ease of administration and eliminate the issue of “needle phobia.” But these vaccines still need to demonstrate efficacy and safety in clinical trials. For some, there is concern about using an attenuated, live COVID-19 virus and the theoretical risk that the vaccine itself can cause the infection. However, this wouldn’t be the first vaccine of its kind. 

Unfortunately, just a few intranasal vaccines are in necessary clinical trials with one recently being withdrawn (Altimmune’s AdCOVID, due to insufficient immune response).The leading contender among clinical trials is Bharat Biotech in India that has started phase II/III trials using a chimpanzee adenovirus which encodes the COVID-19 spike protein. 

https://www.medpagetoday.com/opinion/second-opinions/94366?xid=nl_secondopinion_2021-09-07&eun=g169463d0r