What the latest COVID research says about breakthrough cases and transmission : Shots - Health News

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NPR 12 October, 2021 - 02:22pm 40 views

Conventional wisdom says that if you're vaccinated and you get a breakthrough infection with the coronavirus, you can transmit that infection to someone else and make that person sick.

But new evidence suggests that even though that may happen on occasion, breakthrough infections might not represent the threat to others that scientists originally thought.

Ross Kedl, an immunologist at the University of Colorado School of Medicine, will point out to anyone who cares to listen that basic immunology suggests the virus of a vaccinated person who gets infected will be different from the virus of an infected unvaccinated person.

That's because vaccinated people have already made antibodies to the coronavirus. Even if those antibodies don't prevent infection, they still "should be coating that virus with antibody and therefore helping prevent excessive downstream transmission," Kedl says. And a virus coated with antibodies won't be as infectious as a virus not coated in antibodies.

In Provincetown, Mass., this summer, a lot of vaccinated people got infected with the coronavirus, leading many to assume that this was an example of vaccinated people with breakthrough infections giving their infection to other vaccinated people.

"In all these cases where you have these big breakthrough infections, there's always unvaccinated people in the room," he says.

In a recent study from Israel of breakthrough infections among health care workers, the researchers report that in "all 37 case patients for whom data were available regarding the source of infection, the suspected source was an unvaccinated person."

"I have seen no one report actually trying to trace whether or not the people who were vaccinated who got infected are downstream — and certainly only could be downstream — of another vaccinated person," Kedl says.

There's new laboratory evidence supporting Kedl's supposition. Initially, most vaccine experts predicted that mRNA vaccines like the ones made by Pfizer and Moderna that are injected into someone's arm muscle would generate only the kinds of antibodies that circulate throughout the body.

But that might not be the whole story.

"I think what was the big surprise here is that the mRNA vaccines are going beyond that," says Michal Caspi Tal, until recently an instructor at Stanford University's Institute for Stem Cell Biology and Regenerative Medicine and now a visiting scientist at the Massachusetts Institute of Technology.

What Tal has found is that in addition to the circulating antibodies, there was a surprisingly large amount of antibodies in mucosal membranes in the nose and mouth, two of the primary entry points for the coronavirus.

Immunologist Jennifer Gommerman of the University of Toronto found this as well.

"This is the first example where we can show that a local mucosal immune response is made, even though the person got the vaccine in an intramuscular delivery," Gommerman says.

If there are antibodies in the mucosal membranes, they would likely be coating any virus that got into the nose or throat. So any virus that was exhaled by a sneeze or a cough would likely be less infectious.

Gommerman says that until now, it seemed likely that a vaccine that was delivered directly to the mucosal tissue was the only way to generate antibodies in the nose or throat.

"Obviously a mucosal vaccination would be great too. But at least we're not sitting ducks," Gommerman says. "Otherwise everyone would be getting breakthrough infection."

But there's other evidence that a vaccinated person's breakthrough infection may not transmit efficiently to others.

Marion Pepper, an immunologist at the University of Washington, says a recent study from the Netherlands looked at how well virus from vaccinated people could infect cells in the lab.

Pepper says the answer was not well.

"If you actually isolate virus from people who are getting a secondary infection after being vaccinated, that virus is less good at infecting cells," Pepper says. "It's not known why. Is it covered with an antibody? Maybe. Has it been hit by some other kind of immune mediators, cytokines, things like that? Maybe. Nobody really knows. But the virus does seem to be less viable coming from a vaccinated person."

More studies are emerging that suggest there's something different about the virus coming from a vaccinated person, something that may help prevent transmission.

Whatever it is, the University of Colorado's Kedl says it's one more reason that getting vaccinated is a good idea.

"Because you're going to be even more protected yourself. And you're going to be better off protecting other people."

Kedl says that's what you call a win-win situation.

Read full article at NPR

Organ transplant surgery canceled due to new Cleveland Clinic policy requiring COVID-19 vaccination

CBS Pittsburgh 11 October, 2021 - 10:56pm

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EASTLAKE, Ohio — Mike Ganim was five days away from life-saving kidney transplant surgery when his wife, Debi, got the devastating news.

Debi Ganim said they were informed on October 8 that Cleveland Clinic implemented a new safety policy that required both living donors and organ recipients to be vaccinated against COVID-19. 

Mike is fully vaccinated, but the donor is not.

"It made us feel like we were back to square one," said Debi. "I've been terrified. Sometimes I have my moments that I don't think about it, but it comes back, and I think, 'What's going to happen?'" she said, with her voice cracking with emotion.

Nearly two years ago, Mike learned that his polycystic kidney disease was so advanced, doctors declared that he needed a new kidney.

“’It’s transplant time. No dialysis. We need a transplant, and we need it as soon as possible,’” Debi recalled the doctors telling her. 

Hope for a donor began to wane, when doctors suggested that she make her story public. So Debi posted a request on her Facebook page, asking for anyone who might be willing, to be tested as a potential donor. The post got more than 100 shares, and she was humbled by the dozens of messages of support. Friends, relatives, even strangers offered to take the blood test to find out if they were an organ donation match with Mike.

Weeks later, Debi received a message on Facebook. “Oh my gosh. I cannot believe we are finally reading the words, ‘I am your match,’” Debi recalled.

The message was from a longtime acquaintance, Sue George, whose daughter is a former third grade student of Debi's, some 13 years ago, but they had kept in touch over the years.

“I am your stranger!” George told her with a laugh. “But I just didn’t want to tell you, because I didn’t want to disappoint you, but I’m trying. I’m trying,” she told Debi.

After months of pre-operation procedures and preparation, the crucial surgery was scheduled on October 13. But last Friday, the Ganims were informed that the surgery would not proceed.

"We were blindsided," said George, who said that doctors knew all along that she was not vaccinated, and no one said that it would be a problem. George said that getting the vaccine now is not an option. "I don't want to get the vaccine," she explained. "I've got reasons -- medical, religious, and also freedom."

Debi and Mike Ganim are still hoping that there will be a way to proceed with transplant surgery, if perhaps, George undergoes her portion of the surgery at another hospital in Cleveland or Columbus.

"It's just wrong in so many ways," said Debi, of the Clinic's decision to cancel Mike's surgery. "All because of a policy that was just decided."

3News reached out to the Cleveland Clinic to see if Ganim's surgery can be grandfathered into its new policy, and received the following statement:

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