Experts describe types of rashes associated with MIS-C

CHOP experts describe types of rashes associated with MIS-C

In April 2020, pediatricians began recognizing a puzzling syndrome in children involving hyperinflammation that results in an array of symptoms, including fever, gastrointestinal distress and rash. The syndrome, thought to be a post-infectious complication of SARS-CoV-2 infection, was given the name Multisystem Inflammatory Syndrome Children, or MIS-C. However, diagnosing the condition has posed challenges, as many of its symptoms, including rash, are common in many other pediatric infections.

In a study published in Open Forum Infectious Diseases, researchers at Children’s Hospital of Philadelphia (CHOP) describe the array of rashes seen in MIS-C patients at their hospital through late July 2020, providing photos and information that could help doctors diagnose future cases.

“We hope the information provided in this research letter will help general pediatricians and emergency department physicians who may wonder if a patient with a fever requires a more extensive examination,” said Audrey Odom John, MD, Ph.D., Chief of the Division of Pediatric Infectious Diseases at CHOP and senior author of the paper. “Given that some rashes associated with MIS-C are distinctive, we also imagine these images could help many parents who are looking for signs that their child needs prompt evaluation.”

The research team analyzed the MIS-C-associated rashes of seven patients seen at CHOP. Although the researchers did not observe a single, defining rash associated with COVID-19, there were several types of rashes that were common in these patients, both in appearance and location.

In terms of rash location, all patients in the study developed a rash on their lower body, and five of the seven patients had a rash on their inner thighs. Rashes on the chest and upper extremities were also common, occurring in four out of seven patients.

More than half of the patients presented with small-to-medium annular plaques, which look like dime-size circles, on their chest and back. More than half of the patients in the study also developed purpura, tiny red spots, often in the center of the dime-like annular plaques.

While some patients did develop a cherry-red rash on the bottoms of their feet and palms of their hands, this sort of rash was seen in less than half of the patients in the study. Rashes on the face were uncommon, and the rashes rarely itched.

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Cell-type mapping used to identify cellular substrates that underlie two types of thirst

A team of researchers from the California Institute of Technology, Nankai University and the University of California, Berkeley, has found that the cellular substrates that underlie two types of thirst could be identified using a certain kind of cell-type mapping. In their paper published in the journal Nature, the group outlines their study of thirst and the way it is processed by the brain.

Prior research has shown that our brains process at least two main kinds of thirst: Osmotic and hypovolaemic. Osmotic thirst is what we feel when we need more water. Hypovolaemic thirst is what we feel when we need minerals and water to replenish blood supplies. The researchers note that this can be easily observed—when people are just thirsty, they will be satisfied with a glass of water. But when they have been working out, they need water with added minerals. This is because we lose minerals through sweat. In this new effort, the researchers wanted to learn more about how the brain processes both types of thirst.

Prior research has shown that circumventricular organs located in the lamina terminalis are the parts of the brain that process the two kinds of thirst, but how they do so has not been clear. To find out, the researchers used stimulus-to-cell type mapping which involved the use of single-cell RNA sequencing. The goal was to figure out which of the cellular components were involved with processing thirst types. They then forced test mice to experience either of the two types of thirst. That allowed them to see which cells were responding to which type of thirst. They also used optogenetics, in which the cells were engineered to respond to a light source. Shining a light on the cells then produced one kind of thirst or the other depending on how they had been engineered as evidenced by the water source the mice chose to use—one that was just water, or one that contained minerals, salt and sugar.

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The three types of vaccine hesitancy authorities need to combat

There are high hopes that one or, with any luck, several of the COVID-19 vaccines in development will bring an end to the pandemic. The most promising are often invoked in government briefings and by the media, with their progress closely followed. Optimism is tempered by uncertainties regarding how effective any vaccine will be.

However, recent polls show that even if an effective vaccine is produced, uptake will not be universal. Reports suggest that between one-sixth and half of the UK population would refuse a COVID vaccine, and there is considerable vaccine skepticism elsewhere too, particularly in high-income countries. This poses a serious challenge to achieving herd immunity.

Politicians rarely engage with vaccine skepticism—and when they do, often don’t understand the complexity of people’s feelings. In the case of COVID, they and public health experts need to pay attention to the different sources of skepticism that will affect uptake, and engage with people who hesitate or refuse to be vaccinated.

Skeptics aren’t all the same

There are three types of vaccine hesitancy that governments and health authorities need to be aware of.

The first reluctant group are those with concerns about safety testing. Many people will hesitate to have a newly developed vaccine even after it has passed the safety and efficacy tests of the main regulatory agencies. This is because it will still be too soon to know what long-term effects it may have.

These concerns are likely to become more prominent if a vaccine is rolled out to the public before it has been licensed – that is, before the regulatory authorities give it their seal of approval, having conducted a final review of all the testing data—and therefore without the usual legal framework governing liability and accountability should anything go wrong.

The UK government is considering temporarily authorizing an unlicensed vaccine if it feels its quality and safety is sufficiently clear and the need for it is high.

The second set of skeptics are notoriously unmoved by science: these are the anti-vaxxer groups. Too often, any vaccine resistors are tarred with this brush and are portrayed as people for whom opinion is more important than fact, swayed by outlandish conspiracy theories about hidden interests rather than by evidence.

Nevertheless, plenty of people hold these beliefs. Opposing sides are sharply demarcated, often accompanied by claims that reason is on the side of science and unreason prevails everywhere else. In this way, the discussion becomes increasingly polarized.

The third reluctant group has received little attention so far. It comprises people motivated by animal welfare and environmental concerns. The number of vegans and vegetarians is increasing rapidly, with many in recent years spurred by environmental concerns. Vegans don’t automatically refuse vaccination on animal welfare grounds; however, there’s a cocktail of environmental and animal welfare concerns around COVID vaccines that may drive some to reject vaccination.

A case in point is a petition currently circulating on social media, which shows a specific concern that some people have. It claims that a number of COVID vaccines in development use squalene as an adjuvant—that is, as a helper ingredient—and that the squalene is sourced from sharks.

It’s not yet clear whether any of the vaccines in development do actually contain shark squalene, but it is used in other vaccines. If used in ones for COVID, conservationists warn this will vastly increase the number of sharks that will be killed.

With a growing number of consumers shunning products that are not sustainable, and influential voices claiming that the pandemic itself resulted from human-induced damage to natural environments, these sorts of environmental arguments against vaccines are likely to become more common.

Each of these sources of skepticism may then be compounded by worries that vaccination will be mandatory, depending on the policy each country chooses to adopt. This adds fuel to the fire of those who argue that vaccines should be refused on the grounds that they’re an infringement of civil liberties.

How to respond

These three very different kinds of concerns need to be taken seriously. Rather than a blanket response to vaccine resistors, politicians and public health leaders need to acknowledge the different concerns, values and beliefs people have.

One-way science communication, expecting the public to passively accept what they are told by politicians and scientists, will be a serious mistake. To combat each form of skepticism, transparency about any forthcoming vaccine is a minimal requirement. Beyond this, there needs to be a meaningful engagement with people’s concerns.

For those with safety concerns, this means being open about the safety testing of the vaccine and each of its ingredients. Authorities should participate in discussions with these people about benefits and risks, who will be most affected by both, and how to balance them.

For those with environmental concerns, there needs to transparency about the way that all ingredients are sourced and their potential environmental impacts. There should be an openness to seek and use alternatives where possible. In the case of squalene, for instance, there are potential natural sources other than sharks.

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Types of flu people encounter in childhood may affect susceptibility to different flu strains later in life

A team of researchers from the University of Pennsylvania, the University of Pittsburgh, Centro Nacional de Diagnóstico y Referencia, Nicaragua, and the University of Michigan has found that the strains of influenza virus that infect people when they are young may influence their susceptibility to other influenza strains later in life. In their paper published in Proceedings of the National Academy of Sciences, the group describes their study of influenza strains in ferrets and human blood samples and what they found.

As the researchers note, most people are first infected with an influenza virus at age five, when they first go to school. Thereafter, most people are exposed to and are infected by several influenza viruses throughout their lifetimes. Prior research has shown that the antibody response by an individual person to a specific influenza virus can be boosted by infections by other strains. In this new effort, the researchers sought to find out if the strain of influenza that infects a person early in their life might affect their ability to fight off other strains later in life. To find out, they conducted tests with two well-known strains of influenza, lab ferrets and human blood.

The experiments involved infecting ferrets or blood samples with one strain of an influenza virus and then attempting to infect them again with another strain—and also attempting to infect blood samples from people who had already had one or the other types of infection earlier in their life.

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