Resistance to common antibiotic rising among Indian patients

Agencies
October 22, 2019

Resistance to commonly-used antibiotic clarithromycin is rising among Indian patients and that too at quite a fast pace, health experts have warned.

Clarithromycin is used to treat a wide variety of bacterial infections. This medication can also be used in combination with anti-ulcer medications to treat certain types of stomach ulcers.

According to the World Health Organization (WHO), antibiotic resistance is one of the biggest threats to global health, food security and development today.

Sunil Sofat, Additional Director, Department of Interventional Cardiology (Adult) at Jaypee Hospital in Noida, said that every antibiotic medicine has its own mechanism to treat diseases.

"Yes, this is true that the resistance to clarithromycin is rising among the Indian patients and that too at quite a fast pace. There are multiple factors for the same but one of the major reasons behind it is self-medication," Sofat told IANS.

"In India, a huge population prefers to consume over-the-counter (OTC) drugs without even consulting a doctor. In the long run, this may make them resistant to most of the antibiotics including clarithromycin," Sofat added.

In a recent study presented at United European Gastroenterology (UEG) Week Barcelona 2019, researchers have found that resistance to clarithromycin, one of the most established antimicrobials used to eradicate Helicobacter pylori (H. pylori), had increased from 9.9 per cent in 1998 to 21.6 per cent last year, with increases in resistance also seen for levofloxacin and metronidazole.

The study, which analysed 1,232 patients from 18 countries across Europe, investigated resistance to antibiotics regularly taken for Helicobacter pylori infection, a harmful bacterium associated with gastric ulcers, lymphoma and gastric cancer.

According to Gaurav Jain, Senior Consultant, Internal Medicine at Dharamshila Narayana Superspeciality Hospital, New Delhi, antibiotic resistance is a major concern.

"In India the consumption of antibiotics without consulting a qualified physician is quite common which is leading to its resistance," Jain told IANS.

"There is increase in resistance to antibiotics including clarithromycin which is undoubtedly a worrisome situation in the country," Jain said.

However, Deepak Verma of Internal Medicine at Columbia Asia Hospital, Ghaziabad said: "Most of the cases that we see in India are connected to gram-negative bacteria such as e.coli that causes urinary tract infection (UTI)."

He added that the main causes for antibiotic resistance in India are its rampant misuse where people indulge in self-doctoring as well as taking medicines prescribed by unregistered medical practitioners, including quacks who suggest antibiotics quite indiscriminately.

"They primarily use antibiotics symptomatically which is not a correct method for all ailments -- without blood and urine culture. Antibiotics can force the pathogen to develop resistance," Verma explained.

"Since the clinical culture in India is different from that of the western countries, the lack of awareness of the right process to prescribe antibiotics increases the chances of people using antibiotics without questioning," he stressed.

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Agencies
September 17,2020

Vaccine candidates for COVID-19 should elicit a broad immune response that includes antibodies, and the body's helper and killer T cells, according to a study which says weak or uncoordinated immunity may lead to a poor disease outcome.

The research, published in the journal Cell, confirms that a multi-layered, virus-specific immune response is important for controlling the novel coronavirus during the acute phase of the infection and reducing COVID-19 disease severity.

"Our observations could also explain why older COVID-19 patients are much more vulnerable to the disease," said study senior author Shane Crotty from the La Jolla Institute for Immunology in the US.

"With increasing age, the reservoir of T cells that can be activated against a specific virus declines and the body's immune response becomes less coordinated, which looks to be one factor making older people drastically more susceptible to severe or fatal COVID-19," Crotty said.

In the research, the scientists collected blood samples from 50 COVID-19 patients, and analysed multiple branches of their immune system -- novel coronavirus specific antibodies, helper and killer T cells.

"It was particularly important to us to capture the whole range of disease manifestation from mild to critically ill so we could identify differentiating immunological factors," said study co-author and infectious disease specialist Sydney Ramirez.

The researchers found that all fully recovered individuals had measurable antibody, helper and killer T cell responses against the novel coronavirus SARS-CoV-2.

However, they said the response varied widely in acute COVID-19 patients, with some lacking neutralising antibodies, others helper or killer T cells or any combination thereof.

"When we looked at a combination of all of our data across all 111 measured parameters we found that in general, people who mounted a broader and well-coordinated adaptive response tended to do better," said Carolyn Moderbacher, another co-author of the study from La Jolla Institute for Immunology.

"A strong SARS-CoV-2 specific T cell response, in particular, was predictive of milder disease. Individuals whose immune response was less coordinated tended to have poorer outcomes," Moderbacher said.

The scientists found that the effect was magnified when they broke down the dataset by age.

"People over the age of 65 were much more likely to have poor T cell responses, and a poorly coordinated immune response, and thus have much more severe or fatal COVID-19," Crotty said.

The scientists explained that as people age, the immune system's supply of deployable immature T cells dwindles, with fewer cells available to be activated to respond to a new virus.

"This could either lead to a delayed adaptive immune response that is unable to control a virus until it is too late to limit disease severity or the magnitude of the response is insufficient," Moderbacher said.

The scientists believe T cells, and helper T cells in particular, are associated with better protective immune responses.

"This was perplexing to many people, but controlling a primary infection is not the same as vaccine-induced immunity, where the adaptive immune system is ready to pounce at time zero," Crotty said.

"Thus, these findings indicate it is plausible T cells are more important in natural SARS-CoV-2 infection, and antibodies more important in a COVID-19 vaccine," he said.

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Agencies
September 30,2020

A new research adds to the growing body of evidence that airborne transmission of COVID-19 spreads more quickly in enclosed spaces.

Researchers were able to link a community outbreak of COVID-19 in China to a source patient who likely spread the virus to fellow bus riders through the bus's air conditioning system.

"Our study provided epidemiologic evidence of transmission over long distances, which was likely airborne," said study lead author Ye Shen from University of Georgia in the US.

According to the study, published in the journal JAMA Internal Medicine, it was largely believed that close contact through droplets is a major route of transmission for COVID-19.

"However, the widely adopted social distancing and hand washing did not effectively prevent the transmission globally. Instead, the number of new COVID-19 cases increased steadily," said Shen.

The research team worked with epidemiologists from two regional Centers for Disease Control and Prevention in China to trace infections following a large outdoor worship event in Zhejiang province.

Some of the attendees, it turns out, took two buses to the event creating a unique natural experiment for the researchers.

Both buses had closed windows and had air conditioning running, said Changwei Li, study co-author, but one bus carried a patient infected with the virus, and the other did not.

Of the passengers who later got sick, the majority of them rode on the same bus as the source patient.

Even though the two groups later mixed in with the larger crowd at the worship event, the number of new cases attributed to the event were much lower, suggesting that the bus was the major point of transmission.

Further, some of the bus passengers who later showed symptoms of COVID-19, the authors found, were not sitting close to the infected passenger.

These findings highlight scenarios where COVID-19 could be spread through fine aerosol particles being circulated in an enclosed space.

"Understanding the transmission routes of COVID-19 is critical to contain the pandemic, so that effective prevention strategies can be developed targeting all potential transmission routes," said Shen.

"Our findings provide solid support for wearing face covering in enclosed environments with poor ventilation," the study author wrote.

Recently, another study published in the journal Proceedings of the National Academy of Sciences, found that ordinary conversation creates a conical 'jet-like' airflow that quickly carries a spray of tiny droplets from a speaker's mouth across metres of interior space.

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Agencies
September 17,2020

covid.jpg

New Delhi, Sept 17: Union Health Minister Harsh Vardhan on Thursday said that the coronavirus vaccine will be made available in the country by the start of next year. The remarks come at a time when India is recording more than 50 lakh cases and people are awaiting the vaccine with bated breath.

"Just like other countries, India is also making efforts. Three vaccines candidates are in different phases. Under Prime Minister's guidance, an expert group is looking at it and there is advanced planning in place. We are hopeful that by the start of next year a vaccine will be available in India," Harsh Vardhan said in Rajya Sabha.

Two indigenous vaccines by Zydus Cadila and Bharat Biotech have completed phase 1. Serum Institute of India (SII) has again commenced the trials after getting clearance from the Drug Controller General of India.

India is the manufacturing partner of the vaccine candidate named Covishield, developed jointly by the University of Oxford's Jenner Institute's and AstraZeneca. The Pune-based firm, SII, is looking after the trials at 17 trial sites across India.

Besides this, the Russian Direct Investment Fund (RDIF) and Dr. Reddy's Laboratories Limited, a global pharmaceutical company headquartered out of India, have agreed to cooperate on clinical trials and distribution of Sputnik V vaccine in India.

Sputnik V, an adenovirus vector-based vaccine, was developed by the Gamaleya Scientific Research Institute of Epidemiology and Microbiology, along with the Russian Direct Investment Fund and registered on August 11.

"On regulatory approval in India, RDIF shall supply to Dr. Reddy's 100 million doses of the vaccine. The Sputnik V vaccine, which is based on well-studied human adenoviral vector platform with proven safety, is undergoing clinical trials for the coronavirus pandemic," said a statement from the fund.

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