Dr. Genova is associate director of the Center for Autism Research at Kessler Foundation. CREDIT Kessler Foundation
Kessler Foundation scientists conducted an online survey of parents of school-aged children to compare the effects of pandemic-related school closures on autistic vs neurotypical students. Their findings indicate that children on the autism spectrum are at greater risk for negative educational outcomes.
The article, “Effects of school closures resulting from COVID-19 in autistic and neurotypical children,” (doi: 10.3389/feduc.2021761485) was published open access on November 23, 2021, by Frontiers in Education. This open access article is available at:https://www.frontiersin.org/articles/10.3389/feduc.2021.761485/full The authors are Helen Genova, PhD, Aditi Arora, PhD, and Amanda Botticello, PhD, MPH, of Kessler Foundation.
Using the COVID-19 Adolescent Symptom and Psychological Questionnaire, survey data were collected from May 2020 to August 2020 from parents/guardians of school-aged children – autistic and neurotypical – aged 4 to 15 years. Final sample was N=250, including respondents with neurotypical children (65%), and those with autistic children (35%).
The survey revealed differences in the psychological impact of the pandemic on neurotypical and autistic children, as reported by their parents. Overall, parents of autistic children were more likely to report negative effects of the pandemic. For neurotypical children, being isolated from friends was the most negative experience; for autistic children, disruption of their routine schedule was the most negative.
While neurotypical children turned to virtual experiences to connect socially, autistic children were less likely to participate in virtual experiences. This finding has implications for the shift to online delivery of education, medical treatment, and therapy precipitated by the pandemic. “Children on the autism spectrum may benefit less from virtual services,” noted Dr. Genova. “While remote delivery of educational and therapy services may be a convenient way for schools and facilities to remain open when in-person attendance carries risks, the long-term negative effects for children on the autism spectrum may be significant. To help them continue to achieve their educational goals, autistic children may need alternative ways to keep pace with their peers.”
The study also revealed that parents of children on the autism spectrum had specific concerns related to their children’s diagnosis. “Addressing these concerns is important for the mental health of parents and children,” added Dr. Genova, “since stress levels of caregivers can influence stress levels of autistic children.”
Scripps Research scientists identified a site on SARS-CoV-2, the virus that causes COVID-19, that could be useful in developing a vaccine against a broad set of coronaviruses. CREDIT Scripps Research
The COVID-causing virus SARS-CoV-2 harbors a vulnerable site at the base of its spike protein that is found also on closely related coronaviruses, according to a new study from Scripps Research. The discovery, published Feb 8 in Science Translational Medicine, could inform the design of broad-acting vaccines and antibody therapies capable of stopping future coronavirus pandemics.
The scientists had previously isolated an antibody from a COVID-19 survivor that can neutralize not only SARS-CoV-2 but also several other members of the family of coronaviruses known as beta-coronaviruses. In the new work, they mapped at atomic scale the site, or “epitope,” to which the antibody binds on the SARS-Cov-2 spike protein. They showed that the same epitope exists on other beta coronaviruses, and demonstrated with animal models that the antibody is protective against the effects of SARS-CoV-2 infection.
“We’re hopeful that the identification of this epitope will help us develop vaccines and antibody therapies that work against all beta-coronaviruses, including coronaviruses that may jump from animals to humans in the future,” says study co-senior author Raiees Andrabi, PhD, an institute investigator in the Department of Immunology and Microbiology at Scripps Research.
Beta-coronaviruses have emerged recently as major, ongoing threats to public health. These coronaviruses include SARS-CoV-1, which killed about 800 people, mostly in Asia, in a series of outbreaks in 2002-04; MERS-CoV, which has killed about 900 people, mostly in the Middle East, since 2012; and, of course, SARS-CoV-2, which by now has killed over 5 million people worldwide in the COVID-19 pandemic. Two other beta coronaviruses, HCoV-HKU1 and HCoV-OC43, cause only common colds, but are suspected of having caused deadly pandemics centuries ago, when they first jumped from animals to humans. Researchers widely believe that future coronavirus pandemics initiated by animal-to-human spread are inevitable.
That prospect has spurred efforts towards the development of a pan-beta-coronaviral vaccine or antibody therapy. Scripps researchers took an initial step in that direction in 2020 when they identified an antibody, in a blood sample from a COVID-19 survivor, that could neutralize both SARS-CoV-2 and SARS-CoV-1. Although neutralizing tests weren’t available for all other beta-coronaviruses, they found that the antibody at least bound to most of these viruses.
In the new study, the team used X-ray crystallography and other techniques to precisely map the antibody’s binding site on the SARS-CoV-2 spike protein. They showed that the same site is found on most other beta coronaviruses—which helps explain the antibody’s broad effect on these viruses.
“The site is on the stem of the viral spike protein and is part of the ‘machinery’ the virus uses to fuse with cell membranes in its human or animal hosts after the virus has initially bound to a cell-surface receptor,” says study co-senior author Dennis Burton, PhD, Chair of the Department of Immunology and Microbiology at Scripps Research. “Fusion allows the viral genetic material to enter and take over host cells, and the crucial role of this machinery explains why the site is consistently present across beta-coronaviruses.”
By contrast, the receptor binding site at the top of the viral spike protein mutates relatively rapidly and thus tends to vary greatly from one beta-coronavirus to the next—making it a poor target for broad beta-coronavirus vaccines or antibody therapies.
The researchers now are following up with efforts to find other, perhaps even more broadly effective antibodies, in their search for optimal antibodies and vaccines against coronaviruses.
Patients under immunosuppressive therapy, who do not respond to primary COVID-19 vaccination, have an increased risk for severe COVID-19 disease courses. Until now, it was not clear whether those patients at risk can benefit from an additional booster vaccination. Recent research findings from MedUni Vienna show that a third vaccination is safe and effective in those patients who were initially unable to produce antibodies after vaccination. The study was recently published in the acclaimed journal Annals of the Rheumatic Diseases.
Even after two vaccinations, patients receiving immunosuppressive treatment for autoimmune diseases often fail to develop an adequate immune response after vaccination to protect them against COVID-19. In particular patients treated with the B-cell depleting drug rituximab, e.g. for rheumatoid arthritis, are considered to be particularly at risk for severe disease courses. Up until now, it had not been established whether these patients can benefit from a third vaccination and whether they should be vaccinated with the same vaccine or a different vaccination strategy.
Booster vaccination essential This question has now been answered by a recently published study conducted by an interdisciplinary research group from MedUni Vienna, coordinated by the Division of Rheumatology of the Department of Medicine III. First author Michael Bonelli and his study team were able to show that even patients under rituximab treatment who did not respond to primary vaccination are able to develop an immune response following a booster vaccination. “Since patients under certain immunosuppressive therapy are at high risk for an insufficient vaccination response and therefore a severe COVID-19 disease, an early booster vaccination should be considered” explains Michael Bonelli.
Included in vaccination recommendations “Our study is the first randomised, blinded trial to show the efficacy and safety of a booster vaccination in patients without an immune response after two vaccinations because of an rituximab treatment. In addition, ongoing studies investigate the efficacy of a forth vaccination in our patients at risk.” points out Daniel Aletaha, Head of the Division of Rheumatology at MedUni Vienna. The results obtained with the chosen study design are considered particularly reliable within the scientific community. Daniel Aletaha says: “Accordingly, our study, which also compared the efficacy and safety of different vaccination strategies, has already been included in the World Health Organization (WHO) and Australian Technical Advisory Group on Immunization (ATAGI) Covid-19 vaccination recommendations for immunosuppressed patients.”
Treatments used to help people with multiple sclerosis (MS) manage their condition can reduce the effectiveness of Covid-19 vaccines, according to research from Cardiff University and Queen Mary University of London.
Disease-modifying therapies (DMTs) are a group of treatments for people with MS and affect the immune system. As vaccines work by triggering the body to produce an immune response, it was suspected that some DMTs could reduce the effectiveness of Covid-19 vaccines. The study, published in the journal Annals of Neurology, provides the largest peer-reviewed, published evidence of the effect of DMTs on immune responses to Covid-19 vaccines.
It is hoped this new information will better equip clinicians to provide guidance to people with MS on treatment options.
The research team studied almost 500 people with MS and used a technique known as dried blood spot sampling to investigate the effects of DMTs on Covid-19 vaccine effectiveness. This approach reduced study costs as well as the need for potentially vulnerable patients to attend the clinic during the pandemic.
The findings show that people with MS taking either of two specific DMTs, fingolimod and ocrelizumab, were less likely to produce antibodies in response to AstraZeneca and Pfizer Covid-19 vaccines than people with MS not taking any DMT. If they did produce antibodies, the levels were lower than those found in people taking other DMTs, or not taking any DMT at all. However, the researchers found that other DMTs, including some that are highly effective for MS treatment, had no detrimental effect on Covid-19 vaccine response.
Immune cells, such as T-cells, are also an important part of our immune response to vaccines or viruses. The researchers studied T-cell responses in a small group of study participants who failed to mount an adequate antibody response to Covid-19 vaccination. They found that overall, 40 per cent of this group were able to produce a strong T-cell response, despite having a poor antibody response.
“People with MS have faced uncertainty during the Covid-19 pandemic as a direct result of their condition and the treatments they take to manage it,” says Dr Ruth Dobson, Clinical Senior Lecturer in Neurology at Queen Mary.
“Our study provides high-quality evidence that will support clinicians to advise people with MS on treatment options considering the Covid-19 pandemic. However, further trials are essential to help us understand how best to balance the risks of potentially suspending or delaying MS treatment with the need to effectively vaccinate people with MS against Covid-19.”
Dr Emma Tallantyre, Clinical Senior Lecturer in Neurology at Cardiff University, adds: “Questions about the Covid vaccine are among the most common we are currently facing from people with MS in our clinics. Highlighting groups who have mounted an inadequate Covid vaccine response has already been helpful in guiding who should receive additional doses of the vaccine, and who may need to continue to take additional infection-prevention precautions over the winter. We hope further work will allow us to individualise our management, to protect people with MS from Covid, while keeping their MS under control.”
Jo Welton, 38 was diagnosed with relapsing MS in 2009. She is a medical writer from South Wales. Day-to-day Jo mainly experiences fatigue, weakness, and pain in her left leg. She has been on disease modifying treatment (DMT) Gilenya for nearly eight years. She joined the study after being told about it by her MS team. Since, despite having two AstraZeneca vaccinations she has been told she has reduced immunity to COVID-19 and is waiting to find out if her booster vaccination has worked.
Jo says: “I have a scientific background so was interested in the study as soon as I heard about it. It was also important for me to know how much immunity I had as this impacts my day-to-day living. I’ve followed the guidelines about DMTs and MS right from the start, so this has meant I’ve been shielding for over 20 months. It’s been so difficult seeing everyone getting back to some sort of normality and not feeling like I was able to. I feel vulnerable and, although it’s not deliberate, left behind.
“Ignorance is bliss for some people, but it’s not a risk I want to take. I lost my Grandma to the virus earlier this year – this has made it even more important for me to take the necessary steps to mitigate the risk. Knowing I don’t have immunity means I can continue working remotely, socially distance, and ask friends and family to get their booster vaccine and do lateral flow tests when we meet. Having MS is hard enough without getting COVID-19 as well.”
Dr Clare Walton, Head of Research at the MS Society, says: “This is the largest published study looking at the relationship between certain high intensity disease modifying treatments (DMTs) and the AstraZeneca and Pfizer Covid-19 vaccines. It found some people with MS on these DMTs had a significantly reduced immune response to the vaccine compared to people not taking any.
“While this doesn’t mean these patients are necessarily at higher risk of severe illness if they catch COVID-19, it will be worrying for some. It’s vital that people with weakened immune systems are better supported to protect themselves from the virus, including a right to work from home and feeling assured that the general public are doing everything they can to help keep them safe. We also advise people with MS on these DMTs not to alter their treatment without speaking to someone from their MS healthcare team.”
New research presented this week at ACR Convergence, the American College of Rheumatology’s annual meeting, shows that in Alabama, one in 10 racial or ethnic minority patients with a rheumatic disease in a large rheumatology clinic said they were unlikely to get vaccinated against COVID-19 (Abstract #0617). COVID-19 is the disease caused by the novel SARS-CoV-2 coronavirus.
Research presented at ACR Convergence 2020 showed that people of color with rheumatic disease have worse health outcomes from COVID-19 infection, are more likely to be hospitalized to treat their coronavirus infection and are more likely to require invasive ventilator treatment. While COVID-19 vaccines are now available in the U.S., hesitancy to receive them persists. Alabama lags behind other U.S. states in COVID-19 vaccine uptake. According to researchers, people in racial and ethnic minority groups also face disparities in access to the vaccines.
In addition, many in Alabama’s large Black population mistrust the medical establishment due to past abuses like the Tuskegee Syphilis study. Researchers at the University of Alabama at Birmingham (UAB) launched this new study to find out more about vaccine hesitancy and uptake among racial and ethnic minority patients at a large academic center’s rheumatology clinic. “Many patients seen in rheumatology clinics are immunosuppressed or have comorbidities that put them at risk for higher morbidity and mortality due to COVID-19,” says Maria I. Danila, MD, MSc, MSPH, Associate Professor of Medicine, Division of Clinical Immunology and Rheumatology at UAB and the study’s corresponding author. “Early during the rollout of the COVID-19 vaccination program in our region, it became apparent that vaccination among some minority communities was lagging. We conducted this study to take ‘the pulse’ of vaccine uptake in our area and to understand the top reasons why some patients had not been vaccinated. Our goal was to inform the development of communication strategies to ensure equitable access to vaccination among our patients.”
Between April 19 and May 6, 2021, researchers invited patients from racial and ethnic minority communities in Alabama to complete a survey during their in-person visits to the rheumatology clinic. They assessed patients’ vaccination confidence using a standard psychological scale. They analyzed patients’ attitudes and beliefs about COVID-19 vaccines and determined the potential factors associated with getting a vaccine: such as age, sex, education level, vaccine confidence, safety concerns about the vaccine, medical mistrust and receipt of a flu vaccine in the past. There were 150 patients who agreed to complete the survey. They had a mean age of 54, 86.9% were women, 94% identified as Black or African American, 69% had some college, and 22% said they believed that they would get better medical care if they belonged to a different racial or ethnic group. Although 81% of people who completed the survey had received the flu vaccine in the past, only two-thirds said they had received a COVID-19 vaccine. Of 50 people who remained unvaccinated, only half said they had been offered a COVID-19 shot. One third said they did not plan to be vaccinated.
The participants who did not plan on receiving a vaccine listed several reasons why. More than half said they had concerns about vaccine side effects, 53% feared a rheumatic disease flare, 32% said they knew someone who had a bad experience with the vaccine, 21% said they worried about getting COVID-19 from the vaccine, and 18% were concerned that the vaccine would “modify my DNA.” Unvaccinated patients also expressed their desire to have more information about the safety and efficacy of the vaccine in people with a rheumatic disease. After multivariable adjustment, researchers found that patients of an older age, not having safety concerns about the new vaccine, having gotten a flu shot in the past, and having higher vaccine confidence overall were associated with receipt of a COVID-19 vaccine. There was no association between reporting medical mistrust and vaccine receipt.
“Our findings suggest that a one-size-fits-all approach is not a viable solution to help inform COVID-19 vaccine decisions among people with rheumatic disease,” says Dr. Danila. “To build trust, it is important to listen to understand why people may be reluctant to become vaccinated, and to address their specific concerns in an empathic and non-judgmental.
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