Friday, November 17, 2023

 

Evidence of climate change in the North Atlantic can be seen in the deep ocean, study finds


North Atlantic circulation reduced little Ice Age cooling

Peer-Reviewed Publication

WOODS HOLE OCEANOGRAPHIC INSTITUTION

Multicorer Recovery 

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THIS SHOWS THE MULTICORER BEING RECOVERED. THE SEDIMENT IN THE TUBES IS APPROXIMATELY HOW MUCH HAS ACCUMULATED IN THE PAST 1,000 YEARS. 

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CREDIT: PHOTO CREDIT: PROF. IAN HALL (CARDIFF UNIVERSITY.)




Woods Hole, Mass. (November 17, 2023) –Evidence of climate change in the North Atlantic during the last 1,000 years can be seen in the deep ocean, according to a newly published paper led by researchers from the Woods Hole Oceanographic Institution (WHOI) and University College London. 

The paper, “Surface climate signals transmitted rapidly to deep North Atlantic throughout last millennium,” published in Science, presents records from North Atlantic sediments that agree with observations of recent surface and deep ocean warming and freshening. 

The scientists’ data also show a connection between the surface and the deep ocean throughout the last 1,200 years. This time period includes climate oscillations such as the warm Medieval Climate Anomaly (around 850-1250 Common Era, CE) and the cold Little Ice Age spanning around 1400-1850 CE], as well as modern warming.

“Our data provide strong support for the idea that the overflows have consistently transferred surface climate changes to the deep ocean throughout the past 1,200 years,” said article lead author Wanyi Lu, a post-doctoral scientist at WHOI. 

The scientists used samples from 11 sediment cores taken from the sea south of Iceland, where overflows of cold, dense waters from the Nordic seas sink and fill the deep North Atlantic. These overflows are a part of the deep limb of the Atlantic Meridional Ocean Circulation, which acts like a conveyor belt in carrying warm surface water north from the equator and returning cool deep water south. 

The Earth’s surface has gotten warmer in the past hundred years. However, the ocean has slowed this warming by absorbing and storing more than 90% of the excess heat. 

“We provide evidence that the deep ocean cooled from the Medieval Climate Anomaly to the Little Ice Age. This means that the deep ocean gave heat back to the atmosphere, and therefore reduced Little Ice Age surface cooling. This is the same process –but acting in the opposite direction –that has caused the ocean to reduce modern surface warming,” said Lu.

From the sediment cores, the researchers removed the tiny fossil shells of foraminifera (single-celled organisms living in surface and deep water) and measured the chemistry of the shells. This gave the researchers information about the ocean’s environment when those foraminifera lived and formed their shells. 

A key finding of the study is that most of the surface and deep records show warming and freshening during the 20th century, whereas most surface and deep records show that the Little Ice Age was cooler than the Medieval Climate Anomaly.

“The 20th-century changes we see in our surface records agree with the fast warming and freshening of North Atlantic surface waters that we know from modern measurements. This gives us confidence that the older surface and deep ocean changes we see are reliable, and that the deep North Atlantic was cooling before the current warming,” said Lu. 

 

“Since we don't have a long record of deep ocean temperature from thermometers, these data fill an important gap” said co-author Jake Gebbie, a senior scientist and physical oceanographer at WHOI. “These observations promise to reduce our dependence on climate models to understand how Earth's climate varies.” 

The study also shows that local differences and short-term changes at the ocean surface are averaged by the deep ocean. This means that in locations with a strong surface to deep connection, climate reconstructions from the deep ocean could be a better monitor than individual surface records for the timing and size of surface climate changes that took place on decadal and longer time scales. 

“Many researchers focus on the upper ocean because that is where most of the excess heat is stored in the modern ocean. However, at the location where we sampled sediment cores – the overflow region where surface water from the Nordic seas flows over the Iceland-Scotland ridge and sinks to great depths – there is a pathway for heat and carbon to be transferred from the surface to the deep Atlantic,” said co-author Delia Oppo, a senior scientist and paleoceanographer at WHOI. 

“Our work suggests that the deep ocean is feeling the heat that human activities have been generating. Climate change is recorded in the deep ocean.” Lu said. 

Oppo added, “People should understand how important the ocean is to their climate. Without the ocean uptake of heat, global warming would be even worse than it is.” 

Funding for this research was provided by the National Science Foundation; WHOI’s Edna McConnell Clark Foundation Fund; and the WHOI Postdoctoral Scholar Program, with funding provided by the Weston Howland Jr. Postdoctoral Scholarship. 

Authors: Wanyi Lu1*, Delia Oppo1, Geoffrey Gebbie1, David Thornalley 1,2 

 

Affiliations: 

1Woods Hole Oceanographic Institution, Woods Hole, MA, USA 

2Department of Geography, University College London, London, UK 

*Corresponding author 

 

About Woods Hole Oceanographic Institution 

The Woods Hole Oceanographic Institution (WHOI) is a private, non-profit organization on Cape Cod, Massachusetts, dedicated to marine research, engineering, and higher education. Established in 1930, its primary mission is to understand the ocean and its interaction with the Earth as a whole, and to communicate an understanding of the ocean’s role in the changing global environment. WHOI’s pioneering discoveries stem from an ideal combination of science and engineering—one that has made it one of the most trusted and technically advanced leaders in basic and applied ocean research and exploration anywhere. WHOI is known for its multidisciplinary approach, superior ship operations, and unparalleled deep-sea robotics capabilities. We play a leading role in ocean observation and operate the most extensive suite of data-gathering platforms in the world. Top scientists, engineers, and students collaborate on more than 800 concurrent projects worldwide—both above and below the waves—pushing the boundaries of knowledge and possibility. For more information, please visit www.whoi.edu 

Key takeaways: 

• The study presents high-resolution records from North Atlantic sediments that agree with instrumental observations of 20th century surface and deep warming and freshening. 

• The results suggest that Earth's cooling climate from the Medieval Climate Anomaly to the Little Ice was transmitted to the deep North Atlantic by an active overflow. 

• The results imply that ocean circulation reduced the size of surface climate change that occurred between the warmest part of Medieval Climate Anomaly and the coldest part of the Little Ice Age. 

 


Biomedical engineers at Case Western Reserve University, University of Chicago to restore sense of feeling for breast cancer patients


CASE WESTERN RESERVE UNIVERSITY
GRANT AND AWARD ANNOUNCEMENT

 

U$A

State reporting requirements for involuntary holds, court-ordered guardianship, and the national firearm background check system

JAMA Health Forum

Peer-Reviewed Publication

JAMA NETWORK




About The Study: In this study of state laws, there was substantial heterogeneity in National Instant Criminal Background Check System (NICS) reporting requirements for mental health prohibitions for firearm possession and a lack of clarity around processes. This raises questions about the ability of NICS to be used to block firearm purchases or possession by individuals with court-identified high risk of perpetrating violence toward themselves or others. 

Authors: Marian E. Betz, M.D., M.P.H., of the University of Colorado Anschutz Medical Campus School of Medicine in Aurora, is the corresponding author.

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/

(doi:10.1001/jamahealthforum.2023.3945)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, conflict of interest and financial disclosures, and funding and support.

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About JAMA Health Forum: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health and health care. The journal publishes original research, evidence-based reports and opinion about national and global health policy; innovative approaches to health care delivery; and health care economics, access, quality, safety, equity and reform. Its distribution will be solely digital and all content will be freely available for anyone to read.

 

Benefits of adolescent fitness to future cardiovascular health possibly overestimated


Peer-Reviewed Publication

KAROLINSKA INSTITUTET





There is a well-known relationship between good physical fitness at a young age and a lower risk of cardiovascular disease later in life. However, when researchers adjusted for familial factors by means of sibling analysis, they found a weaker association, although the link between high body mass index (BMI) and cardiovascular disease remained strong. The study, which was conducted by researchers from Karolinska Institutet and other universities, is published in JAMA Network Open.

“This does not mean that fitness is irrelevant,” says the study’s last author Viktor Ahlqvist, doctoral student at the Department of Global Public Health, Karolinska Institutet. “We could still see an association, although it was weaker after taking into account factors shared by full siblings. We also think that adolescence is an important time in life for establishing good habits such as exercising and having a healthy diet.”

Challenging to prove causal associations

Many observational studies have previously demonstrated links between various risk factors at a young age and cardiovascular disease in adulthood. However, whether the associations are causal is challenging to prove because of the potential influence of unaccounted genetic and environmental factors. A collaborative team including researchers from Karolinska Institutet in Sweden has therefore tried to examine if a large proportion of cardiovascular diseases in adulthood could indeed be prevented with a lower BMI, lower blood pressure, improved physical fitness or improved muscle strength in adolescence.

Sourcing data from the Swedish Military Conscription Register and other Swedish registries, the researchers identified over a million 18-year-old males and followed them for 60 years. Almost half of them were full brothers.

“The strength of our study, which makes it more reliable than many other conventional observational studies, is that we have used sibling analyses,” says the study’s first author Marcel Ballin, researcher at Uppsala University and analyst at Region Stockholm’s Centre for Epidemiology and Community Medicine. “By doing so we could examine how the relationship changes when controlling for all shared sibling factors. This includes environmental factors such as childhood environment and half of the genetics.”

High BMI is a strong risk factor

The results show that a high BMI in late adolescence was strongly associated with future cardiovascular disease, even after the researchers had controlled for shared familial factors. However, the association between physical fitness and cardiovascular disease was considerably weaker in the sibling analysis, suggesting that many previous observational studies might have overestimated the relevance of adolescent fitness to cardiovascular health later in life.

“Our conclusion is that of the risk factors studied, high BMI is the strongest individual risk factor for cardiovascular disease, and that efforts to tackle the obesity epidemic should continue to be given high priority,” says co-author Daniel Berglind, docent at the Department of Global Public Health, Karolinska Institutet. “A good level of fitness and muscle strength in adolescence doesn’t seem as crucial, but physical activity still remains important for public health, as it can bring other health benefits.”

Several limitations

The study examined the association between risk factors at a young age and future cardiovascular disease; other disease outcomes were not investigated. The researchers had no data on whether the participants’ risk factors varied later in life, and they only studied men, which makes it difficult to extend their findings to women. The Military Conscription Register also lacks details on certain risk factors for future cardiovascular disease, such as diet, alcohol consumption, smoking, blood lipids and blood glucose.

The researchers received no specific grant for this study. Co-author Martin Neovius is on the advisory panels for Ethicon, Johnson & Johnson and Itrim and has been a consultant for the Swedish armed forces outside the scope of this study. No other conflicts of interest have been reported.

Publication: “Genetic and environmental factors and cardiovascular disease risk in adolescents”, Marcel Ballin, Martin Neovius, Francisco B. Ortega, Pontus Henriksson, Anna Nordström, Daniel Berglind, Peter Nordström, Viktor H. Ahlqvist, JAMA Network Open, online 17 November 2023, doi: 10.1001/jamanetworkopen.2023.43947.

 

U$A

Research spotlight: prescribing of benzodiazepines in a homeless veteran population


Peer-Reviewed Publication

MASSACHUSETTS GENERAL HOSPITAL

Prescribing of Benzodiazepines in a Homeless Veteran Population 

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INFOGRAPHIC DETAILING KEY FINDINGS OF THE STUDY.

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CREDIT: MASS GENERAL RESEARCH INSTITUTE



What Question Were You Investigating?

Despite elevated risk for substance use disorder and overdose death in the homeless population, benzodiazepine prescribing for this population has not been examined.

Our team therefore set out to answer the questions:

  • What is the rate of benzodiazepine prescribing to homeless vs. non-homeless veterans with mental illness in the VA system?
  • Are homeless veterans more likely to receive risky and potentially inappropriate prescriptions?
     

What Methods Did You Use?

We used logistic regression to compare likelihood of benzodiazepine prescribing and t tests to compare indicators of risky and potentially inappropriate benzodiazepine prescribing patterns for homeless veterans with mental illness and their housed counterparts.

Our approach was unique in that it is the first study to attempt to investigate this question. We were able to do so in a large, national VA database, the country's largest provider of homeless services.
 

What Did You Find?

We found that although homeless veterans were less likely than their housed peers to receive a benzodiazepine prescription, they were more likely to receive risky and potentially in appropriate prescriptions, including multiple concurrent benzodiazepine prescriptions and concurrent prescriptions for benzodiazepines and opioids or sedatives.
 

What Are the Implications?

To our knowledge this was the first study to examine prescribing patterns for benzodiazepines as treatments for a homeless population, providing novel evidence about a vulnerable and understudied population at high risk for substance use disorder, overdose, and death. These findings of high rates of concurrent prescribing with other sedating medications are of substantial clinical concern, given that drug overdose death in the homeless population is a leading cause of death, at rates up to 30-fold higher than for the U.S. general population. Our results highlight the need for heightened attention to safe benzodiazepine prescribing practices for homeless veterans.


What are the next steps?

Our hope is that paper can inform clinicians about the importance of prudent prescribing of benzodiazepines to homeless patients and encourage providers to talk with patients about whether and how they combine substances when considering whether to prescribe benzodiazepines.
 

Paper Cited:

Koh, K. A., Szymkowiak, D., & Tsai, J. (2023). Benzodiazepine Prescriptions for Homeless Veterans Affairs Service Users With Mental Illness. Psychiatric services (Washington, D.C.), appips20220472. Advance online publication. https://doi.org/10.1176/appi.ps.20220472

 

 

Crime-free housing policies increase evictions among minorities, but do not cut crime


Report recommends cities reconsider polices

Reports and Proceedings

RAND CORPORATION



Policies that encourage landlords to evict tenants who have involvement with the criminal justice system do not appear to reduce crime, while increasing evictions among Black residents and people with lower incomes, according to a new RAND Corporation report.

Studying “crime-free housing policies” adopted by cities in California over a decade-long period, researchers found no meaningful statistical evidence that the policies reduce crime.

The study also found that crime-free housing policies significantly increased evictions in the areas of cities where more Black residents lived and where residents tended to have lower  incomes.

“These policies do not appear to create any meaningful benefits to communities, but they do likely lead to increased harm for predominantly low-income minority groups,” said Max G. Griswold, the study’s lead author and an assistant policy researcher at RAND, a nonprofit research organization.

Beginning in 1992, some cities across the nation began adopting crime-free housing policies that either encourage or mandate owners of multi-unit housing complexes to evict tenants who have involvement with the criminal justice system. The policies are generally seen as a part of the war on drugs and were part of a movement to encourage landlords to aid in efforts to lower crime.

Individual city policies may apply to all multi-unit housing in a city or only some targeted units. The programs also typically include efforts to increase physical security such as improving fencing and outdoor lighting, and instruct landlords about how to assess the criminal backgrounds of potential tenants.

While the policies are criticized by opponents as targeting lower-income tenants and people from minority racial groups, proponents claimed that the policies reduce crime and calls for assistance from police.

Criticism about the policies’ negative effects prompted California lawmakers this year to pass a law barring cities from enforcing their crime-free housing policies. The U.S. Department of Justice has also sued one California city alleging its crime-free housing policy violated residents’ civil rights. However, about 2,000 cities nationally have crime-free housing programs.

RAND researchers evaluated the effects of crime-free housing policies by examining 34 cities in California with such policies and comparing trends in crime rates to other cities in the state that did not adopt such policies. The study period spanned from 2009 to 2019.

Researchers found that crime trends during the study period were similar across all of the municipalities examined. Investigating all crimes, violent crimes, and burglaries, researchers were unable to detect a statistically significant effect of crime-free housing policies on crime rates.

The analysis found that crime-free housing policies did have a significant effect on evictions.

For example, the number of evictions in average municipal-block groups that contain rental units covered by crime-free housing programs increased by about by 21% in 2019.

The study found that crime-free housing policies are disproportionately implemented in cities and municipal blocks that have larger Black populations. In addition, neighborhood blocks that are subject to crime-free housing policies have lower median incomes than municipal blocks without CFHPs.

The report suggests that municipal policymakers should reconsider maintaining or adopting crime-free housing policies because they do not serve their main purpose of reducing crime. If crime-free policies are maintained, they should be required to inform people why they are being evicted, which is not necessary under the existing policies.

Support for the project was provided by the Lowy Family Group through its funding of the RAND Center on Housing and Homelessness.

The study, “An Evaluation of Crime-Free Housing Policies,” is available at www.rand.org.  Other authors of the report are Stephanie Brooks Holliday, Alex Sizemore, Cheng Ren, Lawrence Baker, Khadesia Howell, Osonde A. Osoba, Jhacova Williams, Jason M. Ward and Sarah B. Hunter.

The RAND Social and Economic Well-Being division seeks to actively improve the health, and social and economic well-being of populations and communities throughout the world.

 

Consumption of antibiotics in the community back to pre-pandemic levels in the European Union and European Economic Area



Community consumption rebounded in the EU, increasing by 18.8% between 2021 and 2022


Peer-Reviewed Publication

EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL (ECDC)

Community consumption of antibacterials for systemic use (ATC group J01) by ATC group, population-weighted mean of 26 EU/EEA countries, 2019–2022 

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THE AUTHORS OBSERVED A HIGH VARIABILITY IN THE EU/EEA POPULATION-WEIGHTED MEAN COMMUNITY ANTIBIOTIC CONSUMPTION BETWEEN 2019 AND 2022.

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CREDIT: EURSOSURVEILLANCE





This year’s European Antibiotic Awareness Day (EAAD) focuses on the targets outlined in the 2023 Council Recommendation to step up efforts in the European Union (EU) against antimicrobial resistance in a One Health approach. [1] Those recommendations formulate the 2023 goal to reduce total antibiotic consumption (community and hospital sectors combined) by 20%, using consumption data from 2019 as baseline.

Consumption of antibiotics in the community accounts for around 90% of the total use. This means, that a substantial and consistent decline in the use of antibiotics in this sector will be key on the way towards reaching the set goals for 2030 which aim at preventing and reducing antimicrobial resistance overall.

During the first year of the COVID-19 pandemic, data from the European Union (EU)/European Economic Area (EEA) showed an unprecedented 18.5% decrease in community consumption of antibiotics in 2020 compared with the 2019 baseline. This drop has been related to the use of non-pharmaceutical interventions (e.g. physical distancing or wearing of face masks) which reduced overall spread of pathogens, and to the fact that prescriptions of antibiotics were affected by the disrupted access to healthcare services during the first year of the pandemic.

Unusual fluctuation between 2019 and 2022
In their rapid communication published in Eurosurveillance on occasion of EAAD and World AMR Awareness Week, Ventura-Gabarró et al. present most recent data reported to the European Surveillance of Antimicrobial Consumption Network. [2] They show that the observed decrease from 2020 did not last.

Instead, along with the gradual lifting of interventions across the EU/EEA, mean community consumption went up again and increased by 18.8% between 2021 and 2022 with no significant difference from the pre-pandemic level in 2019. This rebound in consumption of antibacterials for systemic use in the community sector moved antibiotic consumption rates back towards the 2019 baseline value.

The data presented by Ventura-Gabarró et al. show different patterns of antibiotic consumption across the EU/EEA countries. In 13 of 27 countries, community antibiotic consumption was higher in 2022 than in 2019, with an average increase of 8.4% among these 13 countries (range: 0.6–26.9).

From 2020 to 2021, the EU/EEA overall, as in 15 individual countries (Austria, Denmark, Estonia, Iceland, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Portugal, Romania, Slovenia, Spain and Sweden), observed no or just a marginal (less than +/−3%) change in antibiotic consumption in the community. Between 2021 and 2022 pre-pandemic levels of 2019 were reached again with an average increase of 20.5%.

The authors highlight that “although the resurgence of both viral and bacterial respiratory tract infections during the latter part of our study period might partly explain this rebound in antibiotic consumption, the increase could also reflect a missed opportunity to strengthen and reinforce prudent antibiotic use.” They conclude that “the COVID-19-pandemic had a substantial impact on community antibiotic consumption in the EU/EEA between 2020 and 2022. Countries exhibited different patterns of antibiotic consumption, underlining the importance of understanding each country in its own context. Further examination into local prescribing and consumption behaviours for specific antibiotic groups can inform effective stewardship interventions and bring the EU/EEA closer to its antibiotic consumption targets for 2030.”

 

----Ends----

References/notes to editors:
[1] European Antibiotic Awareness Day (EAAD) is a European health initiative coordinated by ECDC. It provides a platform and support for national campaigns on the prudent use of antibiotics in the EU/EEA and take place each year across Europe on 18 November. EAAD is organised in partnership with the World AMR Awareness Week, organised annually by the World Health Organization from 18 to 24 November. See more: https://www.ecdc.europa.eu/en/news-events/european-antibiotic-awareness-day-eaad-2023

[2] Ventura-Gabarró Cèlia, Leung Vivian H, Vlahović-Palčevski Vera, Machowska Anna, Monnet Dominique L, Högberg Liselotte Diaz, ESAC-Net study group. Rebound in community antibiotic consumption after the observed decrease during the COVID-19 pandemic, EU/EEA, 2022. Euro Surveill. 2023;28(46):pii=2300604. https://doi.org/10.2807/1560-7917.ES.2023.28.46.2300604

The authors analysed community sector consumption of antibacterials for systemic use group (anatomical therapeutic chemical (ATC) group J01), quantified as defined daily doses (DDD) per 1,000 inhabitants per day (ATC/DDD index for 2023), and as reported to the European Surveillance of Antimicrobial Consumption Network (ESAC-Net)

[3] Antibiotics, also known as antimicrobial drugs, are medicines that can kill or inhibit the growth of bacteria to cure infections in people, animals and sometimes plants. Bacteria have antibiotic resistance when specific antibiotics have lost their ability to kill or stop the growth of the bacteria. Some bacteria are naturally resistant to certain antibiotics (intrinsic or inherent resistance). A more worrying problem is when some bacteria, that are normally susceptible to antibiotics, become resistant as a result of genetic changes (acquired resistance). Resistant bacteria survive in the presence of the antibiotic and continue to multiply causing longer illness or even death. Infections caused by resistant bacteria may require more care as well as alternative and more expensive antibiotics, which may have more severe side effects. Responsible use of antibiotics can help stop resistant bacteria from developing and help keep antibiotics effective for the use of future generations. See also: https://www.ecdc.europa.eu/en/antimicrobial-resistance/facts/factsheets/general-public

 MENINGITIS

Significant "post-COVID" resurgence in invasive meningococcal disease


Peer-Reviewed Publication

INSTITUT PASTEUR

Neisseria meningitidis bacteria (in red) binding to the surface of an epithelial cell (nucleus in blue) infected with influenza virus (viral neuraminidase in green). Influenza infection facilitates diplococci binding to the cell surface. 

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NEISSERIA MENINGITIDIS BACTERIA (IN RED) BINDING TO THE SURFACE OF AN EPITHELIAL CELL (NUCLEUS IN BLUE) INFECTED WITH INFLUENZA VIRUS (VIRAL NEURAMINIDASE IN GREEN). INFLUENZA INFECTION FACILITATES DIPLOCOCCI BINDING TO THE CELL SURFACE. FLUORESCENCE MICROSCOPY.
© INSTITUT PASTEUR/ MUHAMED-KHEIR TAHA INVASIVE BACTERIAL INFECTIONS UNIT

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CREDIT: © INSTITUT PASTEUR/ MUHAMED-KHEIR TAHA INVASIVE BACTERIAL INFECTIONS UNIT





A team of scientists from the Institut Pasteur has used the database of the National Reference Center for Meningococci to trace the evolution of invasive meningococcal disease cases in France between 2015 and 2022, revealing an unprecedented resurgence in the disease after the easing of control measures imposed during the COVID-19 epidemic. Recently reported cases have mainly been caused by meningococcal serogroups that were less frequent before the pandemic, and there has been a particular uptick in cases among people aged 16 to 24. The results, published in the Journal of Infection and Public Health on October 12, 2023, should help guide adaptation of the vaccine strategy for this fatal disease.

During the COVID-19 epidemic, health and hygiene measures like wearing masks and social distancing had a positive impact on respiratory infections. This was the case for invasive meningococcal disease (IMD), with the number of infections falling by more than 75% in 2020 and 2021. But what would happen at the end of the pandemic, when the protective measures were eased? "During the COVID-19 pandemic, two theories emerged," explains Muhamed-Kheir Taha, co-lead author of the study, Head of the Invasive Bacterial Infections Unit and Director of the National Reference Center for Meningococci at the Institut Pasteur. "The first was that this positive effect would last and that meningococci would stop circulating over the long term. The second was that there would be a rapid resurgence in bacterial activity among a naive population which had not come into contact with the bacteria for a long time." A team of scientists from the Institut Pasteur therefore decided to conduct a detailed study of the evolution of the disease between 2015 and 2022, and they confirmed the second hypothesis.

Using samples from the National Reference Center for Meningococci, which has recorded all cases of IMD in France since 1980, the scientists were able to look back over the pandemic period. The first observation was clear. "There was an unprecedented resurgence in invasive meningococcal disease in autumn 2022, and now, in autumn 2023, the number of cases is higher than in the pre-COVID-19 period," outlines Samy Taha, first author of the study and a scientist in the Institut Pasteur's Invasive Bacterial Infections Unit. Compared with a total of 298 cases recorded between January and September 2019, 421 cases have already been recorded between January and September 2023 – a rise of 36%, even though the winter peak has not yet arrived. The figure for the same period in 2021 was 53 cases. There are two main explanations for this: general immunity was weaker because strains were circulating less, but there was also a decrease in vaccination, with meningitis C vaccination falling by 20% during the first lockdown, for example. So the population has become naive when faced with bacteria that are constantly evolving – the bacterial genome is highly variable.

"Since the pandemic, there has been a particular resurgence in meningococcal serogroups W and Y compared with the other serogroups," continues Ala-Eddine Deghmane, co-lead author of the study and Deputy Director of the National Reference Center for Meningococci at the Institut Pasteur. "And although all age groups are concerned, we found that those most affected by this new wave of meningitis are young people aged 16 to 24." In other words, the meningococcal bacterial strains responsible for IMD today are different from those that were circulating before the pandemic, and they target different age groups. "It is almost as if the COVID-19 epidemic has reset the entire system," says Samy Taha.

This resurgence in meningitis could gather momentum in the coming months with the effect of seasonal influenza. The influenza virus creates a favorable context for the development of meningococcal bacteria. All mass gatherings can be a risk factor for infection in general, and especially for IMD.

In France, only meningitis C vaccination is mandatory; vaccination for meningitis B is merely recommended in infants. But there are not yet any recommendations in the general population for serogroups Y and W. The scientists are therefore in contact with the French National Authority for Health to help adapt the future vaccine strategy. "If the quadrivalent meningococcal vaccine for serogroups A, C, Y and W were to be recommended for adolescents, it would provide direct protection for them and also indirect protection for other categories of the population," explains Ala-Eddine Deghmane. Adolescents are the main healthy carriers of meningococci. "We must remember that without treatment, the mortality rate for bacterial meningitis is virtually 100%. Even with proper treatment, there is still a 10% mortality rate. So vaccine prevention is crucial," concludes Muhamed-Kheir Taha.

 

Source

The rapid rebound of invasive meningococcal disease in France at the end of 2022, Journal of Infection and Public Health12 octobre 2023
Samy Taha, Eva Hong, Mélanie Denizon, Michael Falguières, Aude Terrade, Ala-Eddine Deghmane, Muhamed-Kheir Taha

Invasive Bacterial Infections Unit and National Reference Center for Meningococci and Haemophilus influnezae, Institut Pasteur, Université Paris Cité, France

https://doi.org/10.1016/j.jiph.2023.10.001