Genetic change increased bird flu severity during U.S. spread

Scientists at St. Jude Children’s Research Hospital have discovered H5N1 avian influenza viruses gained the ability to cause severe disease and target the brain in mammals as they spread across North America.

Peer-Reviewed Publication

ST. JUDE CHILDREN'S RESEARCH HOSPITAL

 

IMAGE: H5N1 AVIAN INFLUENZA SPREAD FROM EUROPE TO NORTH AMERICA, THEN THROUGHOUT THE CONTINENT VIA WILD BIRDS. INSET SHOWS CLUSTERS OF INFECTIONS DETECTED ON THE EAST COAST FROM 2021-APRIL 2023, ACCORDING TO THE FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS. view more 

CREDIT: COURTESY OF ST. JUDE CHILDREN'S RESEARCH HOSPITAL

(MEMPHIS, Tenn. – May 29, 2023) St. Jude Children’s Research Hospital scientists discovered how the current epizootic H5N1 avian influenza virus (bird flu) gained new genes and greater virulence as it spread west. Researchers showed that the avian virus could severely infect the brains of mammalian research models, a notable departure from previous related strains of the virus. The researchers genetically traced the virus’ expansion across the continent and its establishment in wild waterfowl populations to understand what makes it so different. The study was recently published in Nature Communications.

 

“We haven’t seen a virus quite like this one,” said corresponding author Richard Webby, Ph.D., St. Jude Department of Infectious Diseases. “In 24 years of tracing this particular H5N1 flu lineage, we haven’t seen this ability to cause disease but also be maintained in these wild bird populations.”

 

When the scientists tested the newer avian flu strains for their ability to cause disease in mammals by infecting a ferret model, they found an unexpectedly high amount of pathogenicity.

 

“Some of these are really nasty viruses,” Webby said. “There’s a huge amount of the virus in the brain of infected animals. That’s the hallmark of what we saw with these flu strains — increased pathogenicity associated with high virus load in the brain. That’s not the first time we’ve seen H5 viruses in the brain, but these are probably some of the most virulent we’ve looked at over 24 years of following these viruses.”

 

Previous influenza viruses that caused severe disease in North America “burned out” in their main host bird population, and the outbreaks ended quickly. This current strain was detected at high levels in sick chickens but has expanded into other species.

 

“This is not just a chicken virus now,” Webby said. “It’s also infecting other avian and mammal species in the U.S. It’s a higher exposure risk for humans and other mammals than we’ve ever had in North America. We’ve never really been exposed to this level of circulation of these highly pathogenic flu viruses.”

 

A low risk to humans (for now)

 

While the newer strains of this H5N1 influenza show a greater ability to cause disease in mammals than earlier viruses, the scientists found it to be low-risk to humans. This is because the virus appears well-adapted to transmit between birds rather than between mammals.

 

“Overall, their risk to humans is still low,” Webby said. “But that risk does seem to be changing, and these viruses are doing things that we haven’t seen H5s do before. They’ve come into the continent’s wild bird population, they’ve reassorted, and they’ve been maintained over time. There are now many different types out there, and they're very nasty.”

 

Even though the risk of spreading infection is low, the research suggests humans should be cautious interacting with wildlife.

 

“Someone would have to work pretty hard to infect themselves with this virus. But if they do happen to be infected, there’s a real chance of getting a severe disease from it,” Webby said. “People just need to be careful and remember that some of the wild animals out there potentially harbor these highly pathogenic viruses.”

 

Genetic change supercharges spread and severity

 

In the past, similar strains of influenza viruses have not caused similarly severe diseases, nor have they become far-flung in wild bird populations. Since the new strains have done so much more damage, the scientists looked for what was different. The group identified the direct ancestor to the current strains, which spread from Europe to the Americas after gaining a different version of the viral protein, neuraminidase. This new protein increased the virus’s ability to transmit between birds. Then it arrived on the East Coast of Canada and traveled to the United States.

 

As the researchers studied the virus further, they pinpointed which viruses — distinct from previous ones —caused the current outbreaks. They found that after reaching North America, the virus rapidly changed again to become more virulent. It mixed with flu viruses in North American wild birds, swapping several genes. This reassortment of genes had two effects. One, the virus seemed to become even more adapted to the bird population, infecting many different types of birds. This included atypical hosts, such as buzzards and eagles, which typically do not get the flu. Second, the virus gained its severe disease-causing properties.

 

“The surprising thing was that just a few reassortment events did change these viruses’ ability to cause disease in our models,” Webby said. “And those events generated many different genotypes from that mixing. Then those viruses spread and have now become established in the North American wild bird population.”

 

Webby’s group and others continue to monitor the ongoing avian flu pandemic globally to assess its continually evolving risk to both humans and birds.

 

Authors and funding

The study’s co-first authors are Ahmed Kandeil, Christopher Patton, Jeremy Jones, Trushar Jeevan and Walter Harrington, all of St. Jude. The other authors are Sanja Trifkovic, Jon Seiler, Thomas Fabrizio, Karlie Woodard, Jasmine Turner, Jeri-Carol Crumpton, Lance Miller, Adam Rubrum, Jennifer DeBeauchamp, Charles Russell, Elena Govorkova, Peter Vogel and Lisa Kercher, St. Jude; Mia Kim-Torchetti, National Veterinary Services Laboratories, Animal and Plant Health Inspection Service (APHIS), US Department of Agriculture (USDA); Yohannes Berhane, National Centre for Foreign Animal Disease and the University of Manitoba and David Stallknecht and Rebecca Poulson, The University of Georgia.

 

The study was supported by grants and contracts from the National Institute of Allergy and Infectious Diseases (HHSN272201400006C, 7 5N93021C00016 and R01AI150745), the National Science Foundation (1911955) and ALSAC, the fundraising and awareness organization of St. Jude.

 

St. Jude Media Relations Contacts

 

Michael Sheffield
Desk: (901) 595-0221
Cell: (901) 379-6072
michael.sheffield@stjude.org
media@stjude.org

 

St. Jude Children's Research Hospital

St. Jude Children's Research Hospital is leading the way the world understands, treats and cures childhood cancer, sickle cell disease and other life-threatening disorders. It is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. Treatments developed at St. Jude have helped push the overall childhood cancer survival rate from 20% to 80% since the hospital opened more than 60 years ago. St. Jude shares the breakthroughs it makes to help doctors and researchers at local hospitals and cancer centers around the world improve the quality of treatment and care for even more children. To learn more, visit stjude.org, read St. Jude Progress blog, and follow St. Jude on social media at @stjuderesearch. 

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JOURNAL

Nature Communications

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Rapid evolution of A(H5N1) influenza viruses after intercontinental spread to North America

ARTICLE PUBLICATION DATE

29-May-2023

Can phrases like ‘isn’t it?’ or ‘right?’ compromise classroom learning? New study answers

A researcher in Japan noted that the use of interrogative tags such as ‘isn’t it?’ and ‘right?’ by the teachers can limit student involvement and learning

Peer-Reviewed Publication

DOSHISHA UNIVERSITY

 

IMAGE: WHILE TEACHERS USE THE THIRD-TURN REPEAT STRATEGY TO ENCOURAGE STUDENT INCLUSION, IT MIGHT SILENCE CURIOSITY. view more 

CREDIT: MIKA ISHINO

Classroom education, in an ideal sense, must engage all students in a constructive discussion with the teacher, making it the latter’s responsibility to utilize different inclusive strategies. To bring the attention of distracted students back to the classroom discussion, teachers often have to use different methods to remind them that they are an equal and important part of this shared activity. This task can be tricky since most teachers attend to multiple students in a classroom. What strategies do teachers use to draw the attention of all the students to the common thread of a classroom discussion?

In a study that was recently published in Classroom Discourse, Dr. Mika Ishino of Doshisha University explored this question by analyzing the video recordings of classroom interactions between teachers and students in Japan. Dr. Ishino specifically examined how teachers employed the epistemic stance marker ‘ne’ during the classroom discussions, to make the interaction more inclusive with all the students. An epistemic stance marker is a word that modifies the tone of a sentence, to increase the interpersonal interaction between the speaker and the listener. “‘ne’ is roughly equivalent to English interrogative tags ‘you know’, ‘isn’t it’, and ‘right?’. It mainly marks the sharedness of the referent information between the speaker and the hearer,” explains Professor Ishino.

The study found that the epistemic stance marker ‘ne’ is commonly used in the third-turn during teacher-student interactions. In the first turn, the teacher asks a question to the class as a whole. In the second turn, one student usually answers the question. For the third-turn, the teacher then repeats the answer and adds ‘ne’ to open the interaction and include the rest of the students in this exchange.

“When the teachers produced their third-turn repeat in response to an individual student’s reply, they marked the repeated item with the Japanese epistemic stance marker, ‘ne’ or ‘na’, and shifted their gaze from the respondent individual to other students or ‘public space’ such as the blackboard”, Dr. Ishino observes. She further adds, “In doing so, the teachers treated the rest of the students as the party who also had access to the questioning item in the same manner as the respondent student.”

By using the third-turn repeat ‘ne’, teachers modify the nature of the interaction such that all students in the class, including the distracted, are given equal status in the discussion. Once this happens, the teacher moves on to the next question. However, Dr. Ishino found that this practice can have a negative impact on student involvement and learning. When the teachers use the third-turn repeat as a consistent strategy without checking if all the students are in sync, they potentially curtail the chance of any follow-up questions that the students can ask. “If there is a possibility that some students were not on the same page with the respondent student or did not know the answer to the questioning items, the inclusive third-turn repeat is designed to limit the students’ responses to a silent agreement,” Dr. Ishino concludes.

The study reveals that in an interaction with multiple students, it is crucial for teachers to ensure that no student is more privileged than others. Furthermore, the use of third-term repeats like ‘ne’ may be a helpful way to encourage inclusive learnings during classroom discussions. However, it can have serious negative consequences on student involvement and learning in the long term.

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About Dr. Mika Ishino from Doshisha University, Japan
Dr. Mika Ishino is an associate professor in the Faculty of Global and Regional Studies, Department of Global and Regional Studies at Doshisha University. Her academic interests include applied linguistics, language teacher education, and conversation analysis. She has previously worked at public high schools in Japan as an English teacher. Her research interest mainly lies in how teachers accomplish the pedagogical goals in their classroom institutional settings. She has also been the recipient of the ‘Best Paper Award’ by the Japan Society of Educational Sociology.

Funding information
The Japan Society supported this work for the Promotion of Science under Grant number: 19K13305.

Media contact:
Organization for Research Initiatives & Development
Doshisha University
Kyotanabe, Kyoto 610-0394, JAPAN
E-mail：jt-ura@mail.doshisha.ac.jp

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JOURNAL

Classroom Discourse

DOI

10.1080/19463014.2023.2190033 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Inclusive Third-Turn Repeats: Managing or Constraining Students’ Epistemic Status?

ARTICLE PUBLICATION DATE

29-May-2023

WAIT, WHAT?!

Reduced emissions during the pandemic led to increased climate warming

Peer-Reviewed Publication

STOCKHOLM UNIVERSITY

 

IMAGE: ÖRJAN GUSTAFSSON IN THE TOWER AT HANIMAADHOO MEASURING STATION. view more 

CREDIT: PHOTO: JOAKIM ROMSON

The Covid pandemic shutdowns in South Asia greatly reduced the concentration of short-lived cooling particles in the air, while the concentration of long-lived greenhouse gases was barely affected. Researchers were thus able to see how reduced emissions of air pollution leads to cleaner air but also stronger climate warming.

It is well known that emissions of sulfur and nitrogen oxides and other air pollutants lead to the formation of aerosols (particles) in the air that can offset, or mask, the full climate warming caused by greenhouse gases such as carbon dioxide and methane. But there has been a lack of knowledge about this ‘masking effect’. In order to determine the size, large-scale experiments involving huge regions would be required – this is infeasible.

The Covid pandemic became such a ‘natural’ experiment. In the spring of 2020, the activity of many industries and transportation worldwide decreased due to pandemic restrictions. This created a unique opportunity to study what happens to the climate if emissions of gases and aerosols are rapidly reduced.

Measuring station in the northernmost Maldives
At Hanimaadhoo, a measuring station in the northernmost Maldives off the coast of India, researchers have been measuring  the atmospheric composition and radiation for soon two decades. (Measurements reveal the impact of air pollution on climate and health in southern Asia) The measuring station is strategically placed to capture air masses from the Asian subcontinent and located in an area with few regional emission sources. When emissions suddenly decreased during the pandemic in South Asia (mainly Pakistan, India and Bangladesh), an opportunity was created to see what impact this had on the climate.

Short-lived air particles decreased but not greenhouse gases
A new article in the scientific journal NPJ Climate and Atmospheric Science shows that the concentrations of polluting short-lived air particles decreased significantly, while the concentrations of longer-lived greenhouse gases were barely affected in the air mass over South Asia. The cooling effect of the aerosols comes from the fact that they reflect incoming solar radiation back into space. With a lower aerosol content, there is less cooling, and thus less ‘masking’ of the warming effect of the significantly longer-lived climate gases. Measurements taken at the same time over the northern Indian Ocean revealed a seven percent increase in solar radiation reaching the Earth’s surface, thus increasing temperatures.

“Through this large-scale geophysical experiment, we were able to demonstrate that while the sky became bluer and the air cleaner, climate warming increased when these cooling air particles were removed,” says Professor Örjan Gustafsson at Stockholm University, who is responsible for the measurements in the Maldives and who led the study.

The results show that a complete phasing out of fossil fuel combustion in favor of renewable energy sources with zero emissions could result in rapid ‘unmasking’ of aerosols, while greenhouse gases linger.

“During a couple of decades, emission reductions risk leading to net climate warming due to the ‘masking’ effect of air particles, before the temperature reduction from reduced greenhouse gas emissions takes over. But despite an initial climate warming effect, we obviously still urgently need a powerful emission reduction,” says Örjan Gustafsson.

Hanimaadhoo measuring station in the northernmost Maldives.

CREDIT

Photo: Joakim Romson

Contact:
Örjan Gustafsson, professor of biogeochemistry at Stockholm University
E-mail: orjan.gustafsson@aces.su.se Phone: 0046703247317

Read article in NPJ Climate and Atmospheric Science.

Additional reading: Measurements reveal the impact of air pollution on climate and health in southern Asia

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JOURNAL

npj Climate and Atmospheric Science

ARTICLE TITLE

Aerosol demasking enhances climate warming over South Asia

1 in 5 teachers feel carrying gun to class would make schools safer; More than half think armed teachers would make students less safe

Reports and Proceedings

RAND CORPORATION

U.S. teachers are divided on whether arming themselves would make schools safer, with one in five saying they would be interested in carrying a gun to school, according to a nationally representative survey conducted by the RAND Corporation.

The survey found that 54% of teachers believe teachers carrying firearms would make schools less safe, 20% believe teacher-carry would make schools safer, and 26% feel it would make schools neither more nor less safe.

Yet even more concerning to teachers than guns is bullying, which teachers listed as their top safety concern.

The survey, conducted in October and November 2022, focused on how K-12 teachers view safety in their schools.

“Even with the unfortunate regularity of gun violence in U.S. schools, which often drives the policy debate around school safety, only 5% of teachers overall selected gun violence as their largest safety concern,” said Heather L. Schwartz, a report author and senior policy researcher at RAND, a nonprofit, nonpartisan research organization. “Despite the prevalence of anti-bullying programs, everyday school violence is a concern for teachers. Bullying, not active shooters, was teachers’ most common top safety concern, followed by fights and drugs.”

Teachers’ beliefs about whether teacher-carry policies would make schools safer varied both by their own race and ethnicity as well as by the racial and ethnic composition of the student population in their school. White teachers were more likely than Black teachers to feel that teachers carrying firearms would make schools safer, and male teachers in rural schools were most likely to say they would personally carry a firearm at school if allowed.

Important to school safety is a system of threat reporting and intervention, as well as a climate that encourages adults to prevent violence before it occurs. Most teachers surveyed were confident that threats would get reported.

Visible school safety measures, beyond armed staff, were also viewed as affecting school climate positively. The most common physical safety measures – which 80% or more of teachers said their school had in place – were visitor systems, exterior and interior locks, and staff IDs.

Based on the survey results, the researchers suggest several areas for further research. One is developing better approaches for school safety and security planning that might balance the frequent, lower-level forms of school violence such as bullying with lower-probability, extreme forms of school violence like shootings.

Other authors of the report, “Teachers’ Views on School Safety: Consensus on Many Security Measures, But Stark Division About Arming Teachers,” are Brian A. Jackson, Melissa Kay Diliberti and Pauline Moore.

This research was undertaken by the RAND Homeland Security Research Division and RAND Education and Labor.

Four ways to advance equity and justice goals in climate action planning

Peer-Reviewed Publication

UNIVERSITY OF WATERLOO

Municipal climate action plans often identify equity and justice as goals, but engagement with these concepts is mostly rhetorical. A new study from the University of Waterloo details how planners can bridge the gap and challenge the current state of climate change and social inequity.   

The study asserts that developing participatory approaches to public consultation and community engagement that actively and intentionally involve vulnerable populations who are most affected by climate change is critical. Expanding the sphere of knowledge we consider when talking about climate change reshapes the questions that are asked and the possible solutions and alternatives that are up for discussion. 

“The urban governance community is not as explicit as it should be about the need to prioritize vulnerable residents during decision-making processes about climate change,” said Kayleigh Swanson, PhD candidate in Waterloo’s School of Planning. “Consequently, the voices of people experiencing various forms of oppression are largely excluded from so-called participatory climate action planning processes.”  

In pursuing participatory methods, the study advises practitioners to keep four actions top of mind: consistently modifying strategies, designing collaborative spaces that recognize various ways of knowing, addressing the gap between what is said and what is done, and attending to the underlying social processes that drive vulnerability to climate change.  

“Challenging the status quo is not an easy task, but the evidence shows that climate actions are more effective if they are designed and implemented with engagement by local actors,” said Dr. Mark Seasons, professor in Waterloo’s School of Planning. “Urban governance actors can influence the conditions that determine whether people can participate effectively and help to frame important issues being considered by decision-makers.”  

Building inclusionary planning processes is a considerable challenge for urban governance actors, but these processes are necessary to realize equitable distributive outcomes. Exclusion runs the risk of creating a triple injustice whereby those who contribute to climate change the least are positioned to suffer the most from its effects and are disproportionately affected by climate action policies that exacerbate the social, economic, and environmental challenges the groups already face.  

The study, Centering Equity and Justice in Participatory Climate Action Planning: Guidance for Urban Governance Actors, appears in the journal Planning Theory & Practice. 

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JOURNAL

Planning Theory & Practice

Actively reducing noise by ionizing air

Peer-Reviewed Publication

ECOLE POLYTECHNIQUE FÉDÉRALE DE LAUSANNE

 

IMAGE: PLASMA VALVES DARK view more 

CREDIT: © STANISLAV SERGEEV & MATHIAS DELAHAYE

Did you know that wires can be used to ionize air to make a loudspeaker? Simply put, it’s possible to generate sound by creating an electric field in a set of parallel wires, aka a plasma transducer, strong enough to ionize the air particles. The charged ions are then accelerated along the magnetic field lines, pushing the residual non-ionized air in a way to produce sound.

If a loudspeaker can generate sound, it can also absorb it.

While this plasma loudspeaker concept is not new, EPFL scientists went ahead and built a demonstration of the plasma transducer, with the aim to study noise reduction. They came up with a new concept, what they call the active “plasmacoustic metalayer” that can be controlled to cancel out noise. Their results are published in Nature Communications.

The scientists were intrigued by the idea of using plasma to reduce noise, since it gets rid of one of the most important aspects of conventional loudspeakers: the membrane.  Loudspeakers equipped with membranes, like the ones in your car or at home, are some of the most studied solution for active noise reduction. It’s active because the membrane can be controlled to cancel out different sounds, as opposed to a wall that does the job passively.

The problem with using the conventional loudspeaker as a sound absorber is that its membrane limits the frequency range of operation. For sound absorption, the membrane behaves mechanically, vibrating to cancel out the sound waves in the air. The fact that the membrane is relatively heavy, i.e. the inertia of the membrane, limits its ability to interact efficiently with fast changing sounds or at high frequencies.

“We wanted to reduce the effect of the membrane as much as possible, since it’s heavy. But what can be as light as air? The air itself,”explains Stanislav Sergeev, postdoc at EPFL’s Acoustic Group and first author. “We first ionize the thin layer of air between the electrodes that we call a plasmacoustic metalayer. The same air particles, now electrically charged, can instantaneously respond to external electrical field commands and effectively interact with sound vibrations in the air around the device to cancel them out.”

Sergeev continues, “As expected, the communication between the electrical control system of the plasma and the acoustic environment is much faster than with a membrane.”

Not only is the plasma efficient at high frequencies, but it is also versatile since it can be tuned to work at low frequencies as well. Indeed, the scientists show that the dynamics of thin layers of air plasma can be controlled to interact with sound over deep-subwavelength distances, to actively respond to noise and cancel it out over a broad bandwidth. The fact that their device is active is key, since passive noise reduction technologies are limited in the band of frequencies that can be controlled.

The plasma absorber is also more compact that most conventional solutions. Exploiting the unique physics of plasmacoustic metalayers, the scientists experimentally demonstrate perfect sound absorption: “100% of the incoming sound intensity is absorbed by the metalayer and nothing is reflected back,” says EPFL’s Acoustic Group’s senior scientist Hervé Lissek. They also show tunable acoustic reflection from several Hz to the kHz range, with transparent plasma layers of thicknesses down to only a thousandth of a given wavelength, much smaller than conventional noise reduction solutions. 

To give an idea of how much more compact the plasma absorber is, consider a low, audible sound frequency of 20 Hz, where the sonic wavelength is 17m meters long. The plasma layer would only need to be 17 mm thick to absorb the noise, whereas most conventional noise reduction solutions, like absorbing walls, would need to be at least 4 m thick which often limits its feasibility.

“The most fantastic aspect in this concept is that, unlike conventional sound absorbers relying on porous bulk materials or resonant structures, our concept is somehow ethereal. We have unveiled a completely new mechanism of sound absorption, that can be made as thin and light as possible, opening new frontiers in terms of noise control where space and weight matter, especially at low frequencies” says Hervé Lissek.

EPFL has partnered with Sonexos SA, a Swiss-based audio technology company, to develop cutting-edge active sound absorbers that use the plasmacoustic metalayer concept. Together, they aim to provide novel and efficient solutions for reducing noise in a wide range of applications, including the automotive, consumer, commercial, and industrial sectors.

“This strategic collaboration leverages EPFL's expertise in material science and acoustics, as well as Sonexos' proven track record in delivering high-performance audio solutions,” explains Mark Donaldson, CEO and Founder of Sonexos. 

EPFL scientists show that a thin layer of plasma, created by ionizing air, could be promising as an active sound absorber, with applications in noise control and room acoustics.

CREDIT

© Alain Herzog / EPFL

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JOURNAL

Nature Communications

DOI

10.1038/s41467-023-38522-5 

ARTICLE TITLE

Ultrabroadband sound control with deep- subwavelength plasmacoustic metalayers

Heart health is sub-optimal among American Indian/Alaska Native women, supports needed

AI/AN women have more risk factors for poor heart health, such as high rates of Type 2 diabetes, obesity and smoking, and increased exposure to trauma and violence, according to a new American Heart Association scientific statement

Peer-Reviewed Publication

AMERICAN HEART ASSOCIATION

Statement Highlights:

• In its first scientific statement addressing cardiovascular health in American Indian/Alaska Native (AI/AN) women of childbearing age, the American Heart Association reports that more than 60% of AI/AN women already have suboptimal heart health when they enter pregnancy, which is strongly related to the development of heart disease later in life.

• In addition, more than 4 in 5 AI/AN women reported they have experienced violence, and they are disproportionately likely to have also experienced a high number of adverse childhood experiences, which contribute to higher heart disease risk.

• Type 2 diabetes is the predominant, traditional cardiovascular disease (CVD) risk factor in AI/AN women, with a prevalence of up to 72% among women in some AI/AN communities.

• Addressing heart disease risks in AI/AN women requires attention to traditional CVD risk factors and social determinants of health, as well as understanding how the legacy of colonization, exploitation, racism and discrimination shape the health of AI/AN individuals.

DALLAS, May 31, 2023 — Heart health risks emerge early in life in American Indian/Alaska Native (AI/AN) women and are increased by social factors — like high levels of experiencing violence and traumatic life events — and disproportionately high rates of Type 2 diabetes, smoking and obesity, according to a new scientific statement published today in Circulation: Cardiovascular Quality and Outcomes, a peer-reviewed American Heart Association journal.

Cardiovascular disease is the leading cause of pregnancy-related death in the U.S. and the second leading cause of death in AI/AN women in the U.S. Overall, AI/AN individuals are 50% more likely to be diagnosed with premature cardiovascular (CVD) disease than their white counterparts. According to the statement, more than 60% of AI/AN women have suboptimal heart health when they become pregnant, which is strongly related to the development of heart disease later in life.

“Cardiovascular disease rates are particularly high in AI/AN women of reproductive age, for whom early detection and management of CVD remain paramount for improving cardiovascular health and reducing premature death,” said Garima Sharma, M.D., FAHA, chair of the writing committee for this scientific statement. “We hope to bring to the forefront the disproportionate burden of CVD, adverse pregnancy outcomes and poor maternal health in American Indian and Alaska Native women as maternal mortality in the United States continues to increase.”

Sharma is the director of women’s cardiovascular health and cardio-obstetrics at Inova Health System in Falls Church, VA, and adjunct associate professor at the Ciccarone Center for the Prevention of Cardiovascular Disease at Johns Hopkins University School of Medicine in Baltimore.

This is the first time maternal cardiovascular health in AI/AN individuals has been addressed in an American Heart Association scientific statement. The writing group reported on cardiovascular health status among AI/AN women based on the Association’s optimal heart health metrics called Life’s Essential 8. The statement also highlights underrecognized risks and social determinants of health that disproportionately affect AI/AN individuals. These environmental risk factors include food insecurity, inadequate access to care, psychological health factors (anxiety, depression), posttraumatic stress disorder, substance abuse, intimate partner violence, institutional and structural racism, and the historical context of colonization, dominance and exploitation of AI/AN people and lands.

Social determinants of health

The statement stresses the impact of social determinants of health on mental health and substance use disorders in AI/AN women. Despite their geographic and cultural differences, AI/AN women often share common experiences of racism and discrimination, which contribute to an overall environment of mistreatment and toxic stress, according to the statement.

More than 84% of AI/AN women experience violence in their lifetime, which may be reflected in the high prevalence of mood disorders, anxiety, and substance and alcohol use disorders in this population.

AI/AN women are also disproportionately more likely to have experienced a high number of adverse childhood experiences, such as neglect, abuse or having a parent in prison, which increase the likelihood of high-risk behaviors (cigarette smoking, substance use, etc.) and chronic disease in adulthood.

“AI/AN women’s mental and behavioral health disparities reflect the toxic stress and trauma of violence,” said Sharma. “Maternal care for AI/AN women must address traditional as well as social and cultural determinants of health. Common CVD risk factors such as Type 2 diabetes, obesity, smoking and premature atherosclerosis are aggravated in AI/AN individuals by chronic stress, intergenerational trauma, violence, adverse childhood experiences and food insecurity.”

Traditional risk factors

Life’s Essential 8 metrics for optimal cardiovascular health include blood pressure, cholesterol, blood glucose/Type 2 diabetes, weight, diet, physical activity, nicotine exposure and sleep duration. While rates of high blood pressure and cholesterol disorders are similar among AI/AN women compared to women of other races, and most report leisure or work-related physical activity, other factors have a significant impact on their heart health:

• Type 2 diabetes is the predominant CVD risk factor in AI/AN women, with an age-adjusted prevalence three times higher than among white women. Type 2 diabetes has a prevalence of up to 72% in some AI/AN communities. Women with Type 2 diabetes are also more likely to have additional CVD risk factors.
• Obesity affects almost half of AI/AN women, also beginning in childhood, and contributes to other CVD risk factors such as high blood pressure, Type 2 diabetes and sleep problems.
• While only 10% of the U.S. population in general meets the American Heart Association’s dietary recommendations, it’s more difficult for AI/AN women because of barriers such as limited access to healthy food and lack of reliable transportation.
• About one-third of AI/AN women smoke cigarettes, more than twice the percentage of women who smoke in the United States population overall; this includes 7.2% who smoked during pregnancy.

Risks surrounding pregnancy

The statement highlights pregnancy risks related to cardiovascular health in AI/AN women:

• The pregnancy-related death rate is 26.5% among non-Hispanic AI/AN women — lower than among non-Hispanic Black women, who have the highest rate at 41.4%, yet much higher than the national average of 17.3% among all adults. Of those giving birth between ages 35 to 40, AI/AN women are five times as likely to die compared to white women.
• Peripartum cardiomyopathy, a form of heart failure during and immediately after pregnancy, is responsible for more deaths (14.5%) among AI/AN women than women of any other race or ethnicity.
• AI/AN women also experience significantly higher rates of other pregnancy complications in comparison to white women, such as infection, postpartum hemorrhage or gestational diabetes. Pregnancy complications are associated with increased cardiovascular risk among all women.
• When present, high blood pressure is a strong predictor of CVD. Pregnant people with obesity, which is prevalent among AI/AN women, are at greater risk for developing preeclampsia. Hypertensive disorders of pregnancy, such as gestational high blood pressure and preeclampsia, contribute to maternal death among AI/AN women.
• Only 60.4% of AI/AN women sought prenatal care in the first trimester compared with 81.6% of non-Hispanic white women. This disparity is driven by AI/AN women often living in rural communities — 40% live on tribal lands or reservations, rural or frontier communities with limited access to health care.

Addressing maternal health in AI/AN women

The statement makes several recommendations about ways to address cardiovascular risks among AI/AN women, including:

• Addressing adverse childhood experiences at the community and individual level, bolstering existing family connections and improving family functioning through referrals to child and adult mental health services, parenting programs and social services to counter the effects of past trauma and reduce additional family stressors.
• Establishing a framework free of stigma and judgment to address AI/AN women’s mental health and substance use within the context of structural racism and the long history of mistreatment of AI/AN individuals.
• Recognizing the personal stories of AI/AN women living with heart disease as a rich resource for health care professionals and researchers who are developing prevention and treatment programs. These women may also help reach others in the community as ambassadors.
• Providing appropriate screening and transfer of high-risk pregnancies to multi-disciplinary, team-based care, including preventive cardiology, maternal-fetal medicine, cardio-obstetrics and psychiatry.
• Developing an accessible workforce that provides culturally sensitive care, incorporating prenatal care, mental health care, birth workers and other health care professionals, including those from the tribal community.

“Health systems and community-based organizations that identify trauma and teach and celebrate resilience are essential to address mental and behavioral health needs and to promote healing of AI/AN women, families and communities,” the statement says.

Evidence used in developing the statement is limited by the small numbers of AI/AN women in clinical trials and the lack of health registries with data separated for the AN/AI population.

“We need to understand the health status of AI/AN populations and work collaboratively to improve cultural competency among our clinicians and partner with policymakers, health care professionals, local communities and tribal leadership to design better studies and include the voices of these patients in providing appropriate care,” said Sharma.

This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Cardiovascular Disease and Stroke in Women and Underrepresented Populations Committee of the Council on Clinical Cardiology; the Council on Hypertension; the Council on Cardiovascular and Stroke Nursing; the Council on Arteriosclerosis, Thrombosis and Vascular Biology; and the Council on Quality of Care and Outcomes Research. American Heart Association scientific statements promote greater awareness about cardiovascular disease and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

Co-authors are Vice Chair Allison Kelliher, M.D.; Jason Deen, M.D.; Tassy Parker, Ph.D., R.N.; Tracy Hagerty, M.D.; Eunjung Esther Choi, M.D.; Ersilia M. DeFilippis, M.D.; Kimberly Harn, M.Ed., R.T. (R), (M.R.); Robert Dempsey, M.D., FAHA; and Donald M. Lloyd-Jones, M.D., Sc.M., FAHA. Authors’ disclosures are listed in the manuscript.

The Association receives funding primarily from individuals. Foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers, and the Association’s overall financial information are available here.

Additional Resources:

• Available multimedia is on the right column of news release link https://newsroom.heart.org/news/heart-health-is-sub-optimal-among-american-indianalaska-native-women-supports-needed?preview=cf8231495df9dc804b775bffc3466452
• After May 31, view the manuscript online. 
• AHA news release: Rural residents, American Indians travel farthest for certified stroke care (June 2021)
• AHA News story: Plaque-lined arteries put future health of young American Indians at risk (Nov. 2021)
• Follow AHA/ASA news on Twitter @HeartNews

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

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JOURNAL

Circulation Cardiovascular Quality and Outcomes

DOI

10.1161/HCQ.0000000000000117 

ARTICLE TITLE

Status of Maternal Cardiovascular Health in American Indian and Alaska Native Individuals: A Scientific Statement From the American Heart Association

COVID-19 vaccine builds powerful immune response in First Nations peoples, study finds

Peer-Reviewed Publication

THE PETER DOHERTY INSTITUTE FOR INFECTION AND IMMUNITY

Published in Nature Immunology and Nature Briefing, the research is the first of its kind to decisively map immune responses produced by a COVID-19 vaccination in any First Nations populations.

In partnership with Menzies School of Health Research, researchers at the Peter Doherty Institute for Infection and Immunity (Doherty Institute) evaluated immune responses in Aboriginal and Torres Strait Islander peoples and non-Indigenous individuals after receiving the mRNA COVID-19 vaccine.

Lead author of the study and PhD candidate at the Doherty Institute, University of Melbourne’s Wuji Zhang, said the research provides strong evidence that COVID-19 vaccination triggers effective immune responses against the virus in First Nations peoples.

“We found excellent antibody and T cell responses against SARS-CoV-2 in Australian First Nations peoples following COVID-19 vaccination. We saw high levels of antibodies binding to the virus following two vaccine doses,” Mr Zhang said.

“T cells against the spike protein, which often recognise small sections of the virus and are similar across different variants, were also seen in higher numbers and showed ‘memory signatures’ following vaccination.”

University of Melbourne Professor Katherine Kedzierska, a Laboratory Head at the Doherty Institute, said the findings are the first to report excellent immune responses to COVID-19 vaccination in First Nations peoples.

“Like other studies on non-Indigenous cohorts, antibody responses against the COVID variants Delta and Omicron were lower compared to the ancestral strain, but were substantially increased following the booster vaccine dose.

Media release - Page 1

“While the results of the study are encouraging, it also showed that antibody responses are highly affected by comorbidities in Indigenous populations, especially diabetes and renal disease,” Professor Kedzierska said.

Associate Professor Jane Davies of Menzies School of Health Research said the results confirm the effectiveness of vaccination.

“Our research should further encourage First Nations communities around the world to get vaccinated and boosted,” Associate Professor Davies said.

“This work also highlights the crucial importance of being up-to-date with COVID vaccination for individuals with comorbidities, especially diabetes and renal disease.”

- ENDS

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JOURNAL

Nature Immunology

DOI

10.1038/s41590-023-01508-y 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

COVID-19 vaccine builds powerful immune response in First Nations peoples, study finds

ARTICLE PUBLICATION DATE

30-May-2023