Commonly used alcohol-based mouthwash brand disrupts balance of oral microbiome, scientists say

The oral microbiome is the community of bacteria that live in the mouth, they help us digest our food and keep our mouth healthy. Changes to the composition of the oral microbiome have been linked to periodontal diseases and some cancers.

The research, published in Journal of Medical Microbiology is a follow-up to a larger study investigating the use of mouthwash as a method to reduce the transmission of sexually transmitted diseases in men who have sex with men. Researchers wanted to explore further and investigate whether the mouthwash used had an impact on the oral microbiome of the patients.

Researchers from the Institute of Tropical Medicine in Antwerp, Belgium found that two species of opportunistic bacteria were significantly more abundant in the mouth after three months of daily use of the alcohol-based mouthwash, Fusobacterium nucleatum and Streptococcus anginosus. These two bacteria have been previously linked to gum disease, oesophageal and colorectal cancers. Researchers also saw a decrease in a group of bacteria called Actinobacteria which are crucial contributors to the regulation of blood pressure.

Dr Jolein Laumen, first author of the study and researcher at ITM’s Unit of Sexually Transmitted Infections said:

“Alcohol-based mouthwashes are widely available. The public may use them daily to tackle bad breath or prevent periodontitis, but they should be aware of the potential implications. Ideally, long-term usage should be guided by healthcare professionals”.

Professor Chris Kenyon an author of the study and Head of the Unit of Sexually Transmitted Infections said:

“Up to half of men who have sex with men report using mouthwash for oral hygiene. This study adds to the literature that this is likely having an adverse effect on their oral microbiomes”.

While the results link the daily use of alcohol-based mouthwash to alterations of the oral microbiome, researchers are reluctant to draw substantial conclusions from the data. Information on dietary habits and smoking was not collected so researchers were unable to account for this in the analysis. As the small sample group was taken from the initial study, the results of this study may also not be representative of the population as a whole. Further research should examine how the detected changes affect clinical outcomes on larger and more representative sample groups.

Reference:

J.G.E. Laumen, C. Van Dijck, S.S. Manoharan-Basil​, T. de Block, S. Abdellati​, B.B. Xavier​, S. Malhotra-Kumar​ and C. Kenyon, The effect of daily usage of Listerine Cool Mint mouthwash on the oropharyngeal microbiome: a substudy of the PReGo trial, Journal of Medical Microbiology, https://doi.org/10.1099/jmm.0.001830

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New postpartum care recommentheions of AHA target CVD risk

Pregnancy-related deaths in the U.S. have risen 140% over the past three decades and cardiovascular disease is the leading cause. Despite existing medical guidance on pregnancy and cardiovascular health, current trends in health outcomes suggest a significant opportunity for an improved system of care, particularly in the postpartum period.

The American Heart Association, the world’s leading voluntary organization focused on heart and brain health and this year celebrating 100 years of lifesaving service, recently convened a group of champions with experience in maternal health, postpartum health and/or women’s health and cardiovascular disease to develop comprehensive recommendations for enhancing postpartum systems of care. The group also examined health professional education on cardiovascular risks related to pregnancy, with the aim of improving maternal health outcomes and reducing disparities.

“Pregnancy is a cardiopulmonary stress test that may unmask underlying cardiovascular disease or reveal a higher propensity to develop future cardiovascular disease as a result of adverse pregnancy events or outcomes,” said Rachel Bond, M.D., a volunteer member of the American Heart Association’s Postpartum System of Care Writing Group and women’s heart health and prevention specialist. “Heart disease during pregnancy leaves birthing people with a higher lifetime risk of cardiovascular disease after delivery and leads to an increased risk for their children.”

The new recommendations call for:

access to comprehensive health coverage through the first 12 months following birth for all postpartum patients;

standardized education for all health care professionals who may encounter a pregnant or postpartum patient;

​patient-centered holistic care, as well as collaboration and respect for all members of the maternity team, including midwives, doulas, mental health practitioners, community health workers and others; and

risk-factor monitoring during routine pre-conception and interconception care, including screening for cardiovascular risk factors such as blood pressure, fasting lipid panel, weight and glucose intolerance/diabetes and other lesser-known biomarkers. ​

This is the latest development from the American Heart Association’s comprehensive Advancing Maternal Health Through Quality Improvement and Professional Education initiative, launched in July 2022 with funding support from Merck for Mothers, Merck’s global maternal health effort to help create a world where no one has to die while giving birth.

“We proudly support the American Heart Association in its relentless work to build longer, healthier lives,” said Jacquelyn Caglia, director of learning, communications and U.S. programs for Merck for Mothers. “These new recommendations would greatly expand access to high-quality maternal care for all women across the country and are especially critical for underrepresented groups, whom we know are more likely to be impacted by life-threatening risk factors, such as cardiovascular disease.”

In an earlier phase of the Advancing Maternal Health initiative, the Association launched a course on its Professional Education Hub™ on the role of cardiovascular health in maternal health. In the course, interdisciplinary experts identify and explain the increased cardiovascular risk and contributing comorbidities that affect pregnant and recently pregnant individuals with cardiovascular conditions.

The next phase of this important work includes convening maternal health leaders and clinicians who can determine ways to integrate the recommendations as appropriate and monitor the process of inclusion as well as outcomes from adoption. ​

Additional Resources:

Spanish News Release (To be added when available)

Opportunities in the Postpartum Period to Reduce Cardiovascular Disease Risk After Adverse Pregnancy Outcomes – Professional Heart Daily

Heart disease risk factors in women highlight need for increased awareness, prevention | American Heart Association

Optimizing the Approach to Adverse Pregnancy Outcomes and Long-Term Cardiovascular Risk: Missed Opportunities and Future Directions – Professional Heart Daily

Pregnancy and Maternal Health Resources and Tools | Go Red for Women

Call to Action: Maternal Health and Saving Mothers: A Policy Statement From the American Heart Association

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Cumulative dose of corticosteroid injections not associated with risk of subsequent fracture including in patients with preexisting osteoporosis: JAMA

Cumulative dose of Injection corticosteroids not associated with risk of subsequent fracture including in patients with preexisting osteoporosis suggests a new study published in the JAMA.

Corticosteroid injections (CSIs) are an important tool for pain relief in many musculoskeletal conditions, but the longitudinal effects of these treatments on bone health and fracture risk are unknown. A study was done to determine whether cumulative doses of corticosteroid injections are associated with higher risk of subsequent osteoporotic and nonosteoporotic fractures. This cohort study included adult patients receiving any CSI from May 1, 2018, through July 1, 2022. Eligible patients resided in Olmsted County, Minnesota, and were empanelled to receive primary care within the Mayo Clinic. Cox proportional hazards regression models were used to evaluate risk of fracture based on cumulative injected corticosteroid dose. The primary outcome was risk of fracture by total triamcinolone equivalents received.

Secondary outcomes consisted of risks of fracture based on triamcinolone equivalents received in subgroups of patients not at high risk for fracture and patients with osteoporosis. Results A total of 7197 patients were included in the study (mean [SD] age, 64.4 [14.6] years; 4435 [61.6%] women; 183 [2.5%] Black and 6667 [92.6%] White), and 346 (4.8%) had a new fracture during the study period. Of these fractures, 149 (43.1%) were considered osteoporotic. In the adjusted Cox proportional hazards regression model, there was no association of higher fracture risk based on cumulative CSI dose (adjusted hazard ratio [HR], 1.04 [95% CI, 0.96-1.11]). There was also no associated higher risk of fracture in the non–high-risk (adjusted HR, 1.11 [95% CI, 0.98-1.26]) or osteoporosis (adjusted HR, 1.01 [95% CI, 0.90-1.11]) subgroups. Age, Charleson Comorbidity Index, and previous fracture were the only factors that were associated with higher fracture risk. In this cohort study of cumulative injected corticosteroid dose and risk of subsequent fracture, no association was observed, including in patients with a preexisting diagnosis of osteoporosis. Treatment of painful conditions with CSI should not be withheld or delayed owing to concern about fracture risk.

Reference:

Sytsma TT, Thomas S, Fischer KM, Greenlund LS. Corticosteroid Injections and Risk of Fracture. JAMA Netw Open. 2024;7(5):e2414316. doi:10.1001/jamanetworkopen.2024.14316

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Donidalorsen Therapy Effective Against Hereditary Angioedema: NEJM

A recent phase published in the New England Journal of Medicine 3 trial demonstrated that donidalorsen, an antisense oligonucleotide, significantly reduces the frequency of hereditary angioedema (HAE) attacks. This rare disorder is characterized by episodic and potentially life-threatening swelling due to kallikrein–kinin dysregulation and may soon have a more effective long-term prophylactic option.

The double-blind, randomized trial inluded a total of 90 patients with hereditary angioedema who were assigned to receive either donidalorsen or a placebo. Donidalorsen was administered subcutaneously at a dose of 80 mg every 4 weeks (45 patients) or every 8 weeks (23 patients), while 22 patients received a placebo. The primary endpoint of the study was the time-normalized number of investigator-confirmed HAE attacks per 4 weeks, measured from week 1 to week 25.

The results of this trial found that patients receiving donidalorsen every 4 weeks underwent a least-squares mean attack rate of 0.44 attacks per 4 weeks, while the individuals on an 8-week schedule had a rate of 1.02 and the placebo group had an attack rate of 2.26. This translates to an 81% reduction in the attack rate for the 4-week group when compared to the placebo, with a median reduction of 90% from baseline. For the 8-week group, the reduction was 55% with a median decrease of 83%. During the period from weeks 5 to 25, the 4-week group saw an 87% reduction in attack rates when compared to placebo, while the 8-week group underwent a 60% reduction. These figures illuminate the potential of donidalorsen as a highly effective prophylactic treatment.

Despite reducing attack rates, donidalorsen also significantly improved the quality of life for patients. At week 25, the least-squares mean total score on the Angioedema Quality-of-Life Questionnaire improved by 18.6 points more in the 4-week group when compared to the placebo group. This improvement highlights the substantial impact donidalorsen can have on daily living for the individuals with HAE. Safety data from the trial indicated that donidalorsen was generally well-tolerated. The most common adverse events included erythema at the injection site, headache and nasopharyngitis with 98% of these events being mild or moderate in severity.

The findings from this phase 3 trial suggest that donidalorsen as a promising candidate for the long-term prophylactic treatment of hereditary angioedema. Donidalorsen could offer new hope for the individuals with HAE by significantly reducing attack rates and improving the quality of life of patients.

Reference:

Riedl, M. A., Tachdjian, R., Lumry, W. R., Craig, T., Karakaya, G., Gelincik, A., Stobiecki, M., Jacobs, J. S., Gokmen, N. M., Reshef, A., Gompels, M. M., Manning, M. E., Bordone, L., Newman, K. B., Treadwell, S., Wang, S., Yarlas, A., & Cohn, D. M. (2024). Efficacy and Safety of Donidalorsen for Hereditary Angioedema. In New England Journal of Medicine. Massachusetts Medical Society. https://doi.org/10.1056/nejmoa2402478

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Metformin may be as safe as insulin during pregnancy, 11-year data shows

Metformin is safe to use during pregnancy to manage diabetes, with no long-term adverse effects on the children born and their mothers for at least 11 years after childbirth, according to research presented Sunday at ENDO 2024, the Endocrine Society’s annual meeting in Boston, Mass. This is the first study to look at longer term effects of metformin use during pregnancy.

“Metformin has been extensively used for managing raised blood glucose values in pregnancy for many decades now. It is the only blood glucose-lowering oral medication approved for use in pregnancy,” said Deep Dutta, M.D., D.M., Director of Endocrinology at CEDAR Superspeciality Healthcare in Dwarka, New Delhi, India.

The researchers cited that data are only available up to roughly five years after childbirth in most studies they found in their analysis. They sought to understand the longer-term effects on mothers with diabetes and their children beyond previously published data.

In their literature review, the researchers analyzed data from 10,117 children-mother pairs taken from seven different study cohorts.

Nine-year-old children born to mothers who took metformin during pregnancy showed similar BMI, waist circumference, dual-energy X-ray absorptiometry (DXA) total body fat, DXA-total body fat percent, DXA-total body fat-free mass, MRI visceral adipose tissue and magnetic-resonance spectroscopy liver fat percentage as children born to mothers who used insulin during pregnancy.

Ultimately, they concluded that taking metformin during pregnancy is as safe as using insulin for lowering blood glucose during pregnancy. Obesity and diabetes in mothers who took metformin during pregnancy were also similar during the 11-year postpartum follow-up period.

Dutta said that the rate of obesity, diabetes or motor development issues in these two groups of children was also similar until 11 years after childbirth.

“Our study provides us with reassuring data on the long-term safety of metformin use in pregnancy on the children and their mothers,” Dutta said.

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Do epilepsy medications taken during pregnancy affect a child’s creativity?

While older drugs for epilepsy, taken while pregnant, have been shown in previous research to affect the creative thinking of children, a new study finds no effects on creativity for children born to those taking newer epilepsy drugs. This study is published in the May 29, 2024, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Overall, the study found no effects on the children’s creative abilities or their executive function, which is a person’s ability to plan, focus, and manage multiple tasks. However, when researchers looked only at children with higher concentrations of these medications in the mother’s blood during the third trimester, the study found an association with poorer performance in tests of children’s executive function, but no effect on their creative abilities.

“Our findings highlight that even for epilepsy medications that are generally considered to be safe in pregnancy, dose adjustments should be made with a goal of reaching an optimal balance between controlling seizures and the minimizing negative effects on the developing child,” said study author Kimford Meador, MD, PhD, of Stanford University in Palo Alto, California and a Fellow of the American Academy of Neurology.

The study involved 251 children of female participants with epilepsy and 73 children of female participants without the disease.

Of those with epilepsy, most were taking just one epilepsy medication. Of this group, 81 people were on lamotrigine and 68 people were on levetiracetam.

The children were evaluated at age four and a half with a test of creative thinking where they were provided with a shape or figure and responded by completing or adding their own illustrations. This test assesses fluency, flexibility and originality abilities.

After adjusting for mothers’ IQ and education, researchers found no differences in the creativity scores between the children born to mothers with epilepsy and those born to mothers without the disease.

In addition, they found no differences in creativity between the children of mothers with epilepsy that could be linked to different levels of antiseizure medications found in mothers’ blood samples during the third trimester.

However, researchers found higher third trimester blood concentrations of these medications were associated with poorer performance on tests of executive skills. This link was mainly associated with exposure to levetiracetam.

“There is still so much to learn about the impact of a mother’s epilepsy medications on their child’s creative development,” said Meador. “More studies are needed, especially in older children, to assess the full effect of these medications on childhood development.”

A limitation of the study was that cognitive tests at age four and a half are not as accurate at predicting creativity and thinking skills in the teenage and adult years as tests taken at older ages.

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Hot flashes in menopausal women may signal increased risk for heart and metabolic issues, reveals study

Women experiencing moderate-to-severe vasomotor symptoms face a three times greater risk for metabolic-dysfunction-associated steatotic liver disease (MASLD) compared to those with mild symptom severity, according to research being presented Monday at ENDO 2024, the Endocrine Society’s annual meeting in Boston, Mass.

Vasomotor symptoms include hot flashes or night sweats-symptoms that have become synonymous with menopause.

“This research is significant as it contributes to understanding the link between vasomotor symptoms and cardiometabolic risk factors,” said Eleni Armeni, M.D., M.Sc., Ph.D., a research fellow at the Second Department of Obstetrics and Gynecology, at Aretaieio Hospital National and Kapodistrian University of Athens, in Athens, Greece. “It is crucial for the general public because it emphasizes how hot flashes and night sweats can signal an increased risk for heart and metabolic issues.”

MASLD is also known as non-alcoholic fatty liver disease (NAFLD). In this cross-sectional study, researchers sought to analyze the likelihood of someone developing MASLD related to menopause and the potential link with vasomotor symptoms.

“Women experiencing these symptoms should consult a health care professional to address the symptoms and assess their cardiovascular health,” Armeni said. “Previously, vasomotor symptoms were primarily seen as indicators of estrogen deficiency, but this study suggests broader implications for cardiovascular health related to this hormonal imbalance.”

Armeni and colleagues evaluated 106 peri- and postmenopausal women treated in an outpatient menopause clinic. They estimated steatotic liver disease (SLD) to determine the risk of the fatty liver index. The researchers accounted for age, exercise, alcohol, smoking, a history of menstrual irregularity, and hormone replacement therapy use.

The results showed that 42 women with moderate-to-severe vasomotor symptoms had a three times higher risk for MASLD compared with 64 women who had mild symptom severity. That risk was 9.3 times higher when they limited the sample to those who experienced symptoms within five years after the menopausal transition.

“We hope these findings will encourage health care providers to offer comprehensive care to peri- and postmenopausal women, going beyond discussions solely focused on hormone replacement therapy,” Armeni said.

Reference:

Hot flashes in menopausal women may signal increased risk for heart and metabolic issues, The Endocrine Society, Meeting: ENDO 2024.

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Early Oral Antivirals Reduce Risk of Post-COVID Condition, Study Finds

Researchers have found that the early use of oral antiviral drugs during the acute phase of COVID-19 significantly reduces the risk of developing post-COVID condition (PCC). A recent study was published in the Journal of Infection by Juan Jiang and colleagues. The study highlights the potential of these medications, particularly nirmatrelvir-ritonavir, in mitigating long-term COVID-19 symptoms.

Post-COVID condition (PCC), also known as long COVID, encompasses a range of persistent symptoms following an acute COVID-19 infection. The chronic effects can be debilitating, affecting quality of life and placing additional burdens on healthcare systems. Given the urgency of finding effective treatments to prevent PCC, this study aimed to determine the efficacy of early oral antiviral interventions.

The primary objective of the study was to investigate the association between early administration of oral antiviral drugs, specifically nirmatrelvir-ritonavir and molnupiravir, and the risk of developing PCC. Additionally, the study aimed to compare the efficacy of these two antiviral drugs in reducing PCC risk.

A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Embase, Cochrane, MedRxiv, and Psycinfo, from their inception until November 1, 2023. Studies that assessed the impact of oral antiviral drugs on PCC incidence were included. Pairwise and network meta-analyses were performed using a random-effects model to calculate risk ratios (RRs) and confidence intervals (CIs).

  • The meta-analysis included nine observational studies with a total of 866,066 patients.

  • Nirmatrelvir-ritonavir was evaluated in eight studies, and molnupiravir in two, with one study assessing both drugs.

  • The pairwise meta-analysis demonstrated that early use of oral antiviral drugs significantly reduced the risk of PCC, with a risk ratio of 0.77 (95% CI 0.68–0.88).

  • The network meta-analysis revealed that nirmatrelvir-ritonavir was potentially more effective than molnupiravir in reducing PCC risk, with a surface under the cumulative ranking curve (SUCRA) of 95.5% compared to 28.8% for molnupiravir.

The findings suggest that early intervention with oral antiviral drugs during the acute phase of COVID-19 can play a crucial role in preventing long-term complications associated with PCC. Nirmatrelvir-ritonavir, in particular, showed superior efficacy compared to molnupiravir, indicating it may be the preferred choice for reducing the risk of PCC.

The study supports the standardized administration of oral antiviral drugs in non-hospitalized COVID-19 patients according to current guidelines. This approach could significantly decrease the incidence of PCC, improving patient outcomes and reducing the strain on healthcare systems dealing with long COVID cases.

The early administration of oral antiviral drugs, particularly nirmatrelvir-ritonavir, during the acute phase of COVID-19 is effective in reducing the risk of developing post-COVID conditions. These findings underscore the importance of timely antiviral treatment to prevent long-term COVID-19 sequelae and advocate for adherence to current treatment guidelines.

Reference:

Jiang, J., Li, Y., Jiang, Q., Jiang, Y., Qin, H., & Li, Y. (2024). Early use of oral antiviral drugs and the risk of post COVID-19 syndrome: a systematic review and network meta-analysis. The Journal of Infection, 106190, 106190. https://doi.org/10.1016/j.jinf.2024.106190

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Metabolic and Bariatric Surgery Shows Promising Impact on Apo B100 Levels in High BMI Individuals: Multi-Centric Study

Iran: In a groundbreaking multi-centric prospective cohort study, researchers have shed light on the transformative impact of metabolic and bariatric surgery (MBS) on Apo B100 levels in individuals with high body mass index (BMI). The study, conducted across several medical institutions, unveils compelling evidence suggesting a significant correlation between MBS procedures and the reduction of Apo B100 levels, indicating potential improvements in cardiovascular health among obese patients.

The study, published in Obesity Surgery, found that bariatric surgery significantly reduced Apo-B100 levels and improved lipid profiles and liver enzymes, indicating a positive impact on dyslipidemia and cardiovascular risk in individuals with high body mass index.

Apo B100, a protein found in low-density lipoproteins (LDL), plays a crucial role in cholesterol metabolism and is widely recognized as a key biomarker for cardiovascular risk assessment. High levels of Apo B100 are often associated with an increased risk of atherosclerosis and coronary artery disease, particularly in individuals with elevated BMI.

MBS leads to significant weight loss and improvements in obesity-related comorbidities. However, there is no clarity on the impact of MBS on Apolipoprotein B100 (Apo-B100) regulation. Apo-B100 is essential for the assembly and secretion of serum lipoprotein particles. Increased levels of these factors can accelerate atherosclerotic plaque development in blood vessels. Considering this, Foolad Eghbali, Iran University of Medical Sciences, Tehran, Iran, and colleagues aimed to evaluate changes in Apo-B100 levels following metabolic and bariatric surgery.

For this purpose, 121 participants from the Iranian National Obesity and Metabolic Surgery Database (INOSD) underwent One-Anastomosis Gastric Bypass (OAGB) (n = 70), Laparoscopic Sleeve Gastrectomy (LSG) (n = 43), or Roux-en-Y Gastric Bypass (RYGB) (n = 8). Serum Apo-B100, liver enzymes, lipid profiles, and fasting glucose were measured preoperatively and six months postoperatively.

The study led to the following findings:

· Apo-B100 levels significantly decreased from 94.63 ± 14.35 mg/dL preoperatively to 62.97 ± 19.97 mg/dL after six months, alongside reductions in total cholesterol, triglycerides, LDL, VLDL, AST, and ALT.

· Greater Apo-B100 reductions occurred in non-diabetics versus people with diabetes and correlated strongly with baseline Apo-B100 (r = 0.455) and LDL levels (r = 0.413).

· Surgery type did not impact Apo-B100 changes in multivariate analysis.

“The findings showed that in patients with high BMI undergoing metabolic & bariatric surgery procedures, there was a significant reduction in Apolipoprotein B100 (Apo-B100) levels six months post-surgery (from 94.63 ± 14.35 mg/dL to 62.97 ± 19.97 mg/dL),” the researchers wrote.

This reduction correlated with liver enzyme and lipid profile improvements, specifically in non-diabetics. The researchers note that the type of surgery did not majorly impact Apo-B100 changes.

Reference:

Jaliliyan, A., Madankan, A., Mosavari, H. et al. The Impact of Metabolic and Bariatric Surgery on Apo B100 Levels in Individuals with high BMI: A Multi-Centric Prospective Cohort Study. OBES SURG (2024). https://doi.org/10.1007/s11695-024-07258-6

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Birth by C-section more than doubles odds of measles vaccine failure, claims study

A study by the University of Cambridge, UK, and Fudan University, China, has found that a single dose of the measles jab is up to 2.6 times more likely to be completely ineffective in children born by C-section, compared to those born naturally.

Failure of the vaccine means that the child’s immune system does not produce antibodies to fight against measles infection, so they remain susceptible to the disease.

A second measles jab was found to induce a robust immunity against measles in C-section children.

Measles is a highly infectious disease, and even low vaccine failure rates can significantly increase the risk of an outbreak.

A potential reason for this effect is linked to the development of the infant’s gut microbiome-the vast collection of microbes that naturally live inside the gut. Other studies have shown that vaginal birth transfers a greater variety of microbes from mother to baby, which can boost the immune system.

“We’ve discovered that the way we’re born — either by C-section or natural birth — has long-term consequences on our immunity to diseases as we grow up,” said Professor Henrik Salje in the University of Cambridge?’s Department of Genetics, joint senior author of the report.

He added: “We know that a lot of children don’t end up having their second measles jab, which is dangerous for them as individuals and for the wider population.

“Infants born by C-section are the ones we really want to be following up to make sure they get their second measles jab, because their first jab is much more likely to fail.”

The results are published today in the journal Nature Microbiology.

At least 95% of the population needs to be fully vaccinated to keep measles under control but the UK is well below this, despite the Measles, Mumps and Rubella (MMR) vaccine being available through the NHS Routine Childhood Immunisation Programme.

An increasing number of women around the world are choosing to give birth by caesarean section: in the UK a third of all births are by C-section, in Brazil and Turkey over half of all children are born this way.

“With a C-section birth, children aren’t exposed to the mother’s microbiome in the same way as with a vaginal birth. We think this means they take longer to catch up in developing their gut microbiome, and with it, the ability of the immune system to be primed by vaccines against diseases including measles,” said Salje.

To get their results, the researchers used data from previous studies of over 1,500 children in Hunan, China, which included blood samples taken every few weeks from birth to the age of 12. This allowed them to see how levels of measles antibodies in the blood change over the first few years of life, including following vaccination.

They found that 12% of children born via caesarean section had no immune response to their first measles vaccination, as compared to 5% of children born by vaginal delivery. This means that many of the children born by C-section did still mount an immune response following their first vaccination.

Two doses of the measles jab are needed for the body to mount a long-lasting immune response and protect against measles. According to the World Health Organisation,in 2022 only 83% of the world’s children had received one dose of measles vaccine by their first birthday-the lowest since 2008.

Salje said: “Vaccine hesitancy is really problematic, and measles is top of the list of diseases we’re worried about because it’s so infectious.”

Measles is one of the world’s most contagious diseases, spread by coughs and sneezes. It starts with cold-like symptoms and a rash, and can lead to serious complications including blindness, seizures, and death.

Before the measles vaccine was introduced in 1963, there were major measles epidemics every few years causing an estimated 2.6 million deaths each year.

Reference:

Wei Wang, Megan O’Driscoll, Qianli Wang, Sihong Zhao, Henrik Salje, Hongjie Yu. Dynamics of measles immunity from birth and following vaccination. Nature Microbiology, 2024; DOI: 10.1038/s41564-024-01694-x.

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