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There are new flu vaccines on offer for 2024. Should I get one? What do I need to know?

<a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Influenza is a common respiratory infection. Although most cases are relatively mild, flu can cause more severe illness in young children and older people. Influenza virtually <a href="https://pubmed.ncbi.nlm.nih.gov/33243355/">disappeared</a> from Australia during the first years of the COVID-19 pandemic when public health restrictions reduced contact between people. Since 2022, it has returned to a seasonal pattern, although the flu season has started and peaked a few months earlier than before 2020. It’s difficult to predict the intensity of the flu season at this point in the year, but we can sometimes get clues from the northern hemisphere. There, the season <a href="https://www.who.int/tools/flunet">started</a> <a href="https://gis.cdc.gov/grasp/fluview/flu_by_age_virus.html">earlier</a> than usual for the third year running (peaking in early January rather than late February/March), with a similar number of reported cases and hospitalisations to the previous year. Influenza vaccines are recommended annually, but there are now an increasing number of different vaccine types. Here’s what to know about this year’s shots, available from <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">this month</a>. <h2>What goes into a flu vaccine?</h2> Like other vaccines, influenza vaccines work by “training” the immune system on a harmless component of the influenza virus (known as an antigen), so it can respond appropriately when the body encounters the real virus. Influenza strains are constantly changing due to genetic mutation, with the pace of genetic change <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10421855">much higher</a> than for SARS-CoV-2 (the virus that causes COVID). The strains that go into the vaccine are <a href="https://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations">reviewed</a> twice each year by the World Health Organization (WHO), which selects vaccine strains to match the next season’s predicted circulating strains. All current influenza vaccines in <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2024">Australia</a> contain four different strains (known as quadrivalent vaccines). One of the strains appeared to <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2314801">disappear</a> during the COVID pandemic, and the WHO has recently <a href="https://cdn.who.int/media/docs/default-source/influenza/who-influenza-recommendations/vcm-southern-hemisphere-recommendation-2024/202309_qanda_recommendation.pdf?sfvrsn=7a6906d1_5">recommended</a> dropping this strain from the vaccine. It’s expected trivalent (three strain) vaccines will become available in the near future. <h2>What’s different about new flu vaccines?</h2> There are eight brands of flu vaccines <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">available</a> in Australia in 2024. These include egg-based vaccines (Vaxigrip Tetra, Fluarix Tetra, Afluria Quad, FluQuadri and Influvac Tetra), cell-based vaccines (Flucelvax Quad), adjuvanted vaccines (Fluad Quad) and high-dose vaccines (Fluzone High-Dose Quad). Until recently, the process of manufacturing flu vaccines has remained similar. Since the development of the influenza vaccine in the <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination">1940s</a>, influenza viruses were grown in chicken eggs, then extracted, inactivated, purified and processed to make up the egg-based vaccines that are still used widely. However, there have been several enhancements to influenza vaccines in recent years. Older people’s immune systems tend not to respond as strongly to vaccines. In some flu vaccines, adjuvants (components that stimulate the immune system) are included with the influenza antigens. For example, an adjuvant is used in the Fluad Quad vaccine, recommended for over 65s. Studies <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">suggest</a> adjuvanted influenza vaccines are slightly better than standard egg-based vaccines without adjuvant in older people. An alternative approach to improving the immune response is to use higher doses of the vaccine strains. An example is Fluzone High-Dose Quad – another option for older adults – which contains the equivalent of four doses of a standard influenza vaccine. Studies <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">suggest</a> the high dose vaccine is better than the standard dose vaccine (without an adjuvant) in preventing hospitalisation and complications in older people. Other manufacturers have updated the manufacturing process. Cell-based vaccines, such as Flucelvax Quad, use cells instead of eggs in the manufacturing process. Other vaccines that are <a href="https://www.cdc.gov/flu/prevent/advances.htm">not yet available</a> also use different technologies. In the past, <a href="https://pubmed.ncbi.nlm.nih.gov/31151913/">manufacturing issues</a> with egg-based vaccines have reduced their effectiveness. Using an alternative method of production provides some degree of insurance against this in the future. <h2>What should I do this year?</h2> Given indications this year’s flu season may be earlier than usual, it’s probably safest to get your vaccine early. This is particularly <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-seasonal-influenza-vaccines-in-2024?language=en">important</a> for those at highest risk of severe illness, including older adults (65 years and over), those with chronic medical conditions, young children (six months to five years) and Aboriginal and Torres Strait Islander people. Influenza vaccines are also recommended in pregnancy to protect both the mother and the baby for the first months of life. Influenza vaccines are widely available, including at GP clinics and pharmacies, while many workplaces have occupational programs. For high-risk groups, <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">four of the vaccines</a> are subsidised by the Australian government through the <a href="https://www.health.gov.au/our-work/national-immunisation-program">National Immunisation Program</a>. In older people, a number of vaccines are now recommended: <a href="https://www.health.gov.au/sites/default/files/2024-03/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024.pdf">COVID</a> and influenza, as well as one-off courses of <a href="https://www.health.gov.au/sites/default/files/documents/2020/06/national-immunisation-program-pneumococcal-vaccination-schedule-from-1-july-2020-clinical-advice-for-vaccination-providers.pdf">pneumococcal</a> and <a href="https://www.health.gov.au/topics/immunisation/vaccines/shingles-herpes-zoster-immunisation-service">shingles</a> vaccines. In general, most vaccines can be given in the same visit, but talk to your doctor about which ones you need. <h2>Are there side effects?</h2> All influenza vaccines can <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">cause</a> a sore arm and sometimes more generalised symptoms such as fever and tiredness. These are expected and reflect the immune system reacting appropriately to the vaccine, and are mostly mild and short-term. These side effects are slightly more common in <a href="https://ncirs.org.au/sites/default/files/2021-02/Adjuvanted%20influenza%20vaccine%20vs%20standard%20dose%20influenza%20vaccine%20SoF%20EP%20E2D%20tables_26%20Feb%202021_Final.pdf">adjuvanted</a> and <a href="https://ncirs.org.au/sites/default/files/2022-05/HD%20vs%20sIV%20SoF%20EP%20E2D_March%202022_Final.pdf">high dose</a> vaccines. As with all medications and vaccines, allergic reactions such as anaphylaxis can occur after the flu vaccine. All vaccine providers are trained to recognise and respond to anaphylaxis. People with egg allergies should discuss this with their doctor, but in general, <a href="https://www.allergy.org.au/patients/food-allergy/egg-allergy-flu-vaccine">studies suggest</a> they can safely receive any (including egg-based) influenza vaccines. Serious side effects from the influenza vaccine, such as Guillain-Barré syndrome, a neurological complication, are very rare (one case per million people vaccinated). They are <a href="https://pubmed.ncbi.nlm.nih.gov/23810252/">thought</a> to be less common after influenza vaccination than after infection with influenza.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226623/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor of Infectious Diseases, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/there-are-new-flu-vaccines-on-offer-for-2024-should-i-get-one-what-do-i-need-to-know-226623">original article</a>.

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Dad awarded compensation after developing heart issue from mandatory vaccine

An Adelaide father is set to receive hefty compensation after a mandatory Covid jab left him with a debilitating health condition. In 2021 at the height of the Covid pandemic in Australia, 44-year-old Daniel Shepherd was required to receive tow Covid vaccinations, due to his hands on role at an aged care facility. After having two Pfizer vaccines, he suffered some adverse effects, but dismissed his symptoms as nothing serious. In the months after, Shepherd was required to have a booster shot when he began a new job with the Department of Child Protection in October of the same year. In January 2022, the father was told if we wanted to keep his job as a health and childcare worker, he needed to have the jab. After eventually agreeing to the booster, Shepherd has his third dose of Pfizer in late February 2022, but began suffering from chest pains just hours later. "It felt like someone had their knee right on my chest," he told <a href="https://www.9news.com.au/national/adelaide-news-covid-vaccine-man-to-get-government-compensation-after-developing-heart-condition/55cc0fbf-4631-4cf0-b395-8c8b6c71a43f" target="_blank" rel="noreferrer noopener">9News.</a> The pain kept getting worse until he was rushed to hospital a few weeks later when he thought he was having a heart attack. There he was diagnosed with post-vaccine pericarditis: an inflammation of the membrane around the heart. His illness meant he was unable to work full time, and also meant he was unable to keep up with his young son. "Even today with just mild exertion [I get] chest pains and then it's followed by fatigue, like severe fatigue," Shepard said. "It's heartbreaking to have to say 'sorry buddy, daddy's tired'." Mr Shepherd decided to take legal action after he was unable to work, launching a workers compensation claim against the government. In a landmark ruling in mid-January, the South Australian Employment Tribunal agreed to pay weekly compensation and medical bills to Shepherd. Doctors were unanimous in his case that the vaccine was the cause of his inability to work, but the government argued emergency directions that were in place at the time trumped the laws around workplace injury. Pericarditis is meant to clear within a few months, but Shepherd's symptoms have plagued him for almost two years. Image credits: 9News

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Millions of high-risk Australians aren’t getting vaccinated. A policy reset could save lives

<a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/ingrid-burfurd-1295906">Ingrid Burfurd</a>, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Each year, vaccines prevent thousands of deaths and hospitalisations in Australia. But millions of high-risk older Australians <a href="https://grattan.edu.au/report/a-fair-shot-ensuring-all-australians-can-get-the-vaccines-they-need/">aren’t getting</a> recommended vaccinations against COVID, the flu, pneumococcal disease and shingles. Some people are more likely to miss out, such as migrant communities and those in rural areas and poorer suburbs. As our new <a href="https://grattan.edu.au/report/a-fair-shot-ensuring-all-australians-can-get-the-vaccines-they-need/">Grattan report shows</a>, a policy reset to encourage more Australians to get vaccinated could save lives and help ease the pressure on our struggling hospitals. <h2>Adult vaccines reduce the risk of serious illness</h2> Vaccines slash the risk of <a href="https://www.ncirs.org.au/sites/default/files/2021-03/Influenza-fact-sheet_31%20March%202021_Final.pdf">hospitalisation</a> and serious illness, <a href="https://ncirs.org.au/recent-covid-19-vaccination-highly-effective-against-death-caused-sars-cov-2-infection-older">often by more than half</a>. COVID has already caused more than <a href="https://www.abs.gov.au/statistics/health/causes-death/provisional-mortality-statistics/latest-release">3,000 deaths in Australia this year</a>. On average, the flu kills about <a href="https://www.doherty.edu.au/news-events/news/statement-on-the-doherty-institute-modelling">600 people a year</a>, although a bad flu season, like 2017, can mean <a href="https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0%7E2017%7EMain%20Features%7EAustralia's%20leading%20causes%20of%20death,%202017%7E2">several thousand deaths</a>. And pneumococcal disease may also kill <a href="https://www.aihw.gov.au/getmedia/49809836-8ead-4da5-81c4-352fa64df75b/aihw-phe-263.pdf?inline=true">hundreds</a> of people a year. Shingles is rarely fatal, but can be extremely painful and cause <a href="https://www.healthdirect.gov.au/shingles#complications">long-term nerve damage</a>. Even before COVID, vaccine-preventable diseases caused tens of thousands of potentially preventable hospitalisations each year – more than <a href="https://www.aihw.gov.au/reports/primary-health-care/disparities-in-potentially-preventable-hospitalisa/data">80,000 in 2018</a>. Vaccines offered in Australia have been tested for safety and efficacy and have been found to be <a href="https://www.health.gov.au/topics/immunisation/about-immunisation/vaccine-safety#:%7E:text=serious%20side%20effects.-,Vaccine%20safety%20monitoring,approved%20for%20use%20in%20Australia.">very safe</a> for people who are <a href="https://www.health.gov.au/topics/immunisation/when-to-get-vaccinated/national-immunisation-program-schedule">recommended to get them</a>. <h2>Too many high-risk people are missing out</h2> Our <a href="https://grattan.edu.au/report/roundabouts-overpasses-carparks-hauling-the-federal-government-back-to-its-proper-role-in-transport-projects">report</a> shows that before winter this year, only 60% of high-risk Australians were vaccinated against the flu. Only 38% had a COVID vaccination in the last six months. Compared to a year earlier, two million more high-risk people went into winter without a recent COVID vaccination. Vaccination rates have fallen further since. Just over one-quarter (<a href="https://www.health.gov.au/sites/default/files/2023-11/covid-19-vaccine-rollout-update-10-november-2023.pdf">27%</a>) of people over 75 have been vaccinated in the last six months. That leaves more than 1.3 million without a recent COVID vaccination. Uptake is also low for other vaccines. Among Australians in their 70s, <a href="https://ncirs.org.au/sites/default/files/2022-12/Coverage%20report%202021%20SUMMARY%20FINAL.pdf">less than half</a> are vaccinated against shingles and only one in five are vaccinated against pneumococcal disease. These vaccination rates aren’t just low – they’re also unfair. The likelihood that someone is vaccinated changes depending on where they live, where they were born, what language they speak at home, and how much they earn. For example, at the start of winter this year, the COVID vaccination rate for high-risk Aboriginal and Torres Strait Islander adults was only 25%. This makes them about one-third less likely to have been vaccinated against COVID in the previous six months, compared to the average high-risk Australian. For more than 750,000 high-risk adults who do not speak English at home, the COVID vaccination rate is below 20% – about half the level of the average high-risk adult. Within this group, 250,000 adults aren’t proficient in English. They were 58% less likely to be vaccinated for COVID in the previous six months, compared to the average high-risk person. High-risk adults who speak English at home have a flu vaccination rate of 62%. But for people from 29 other language groups, who aren’t proficient in English, the rate is less than 31%. These 39,000 people have half the vaccination rate of people who speak English at home. These vaccination gaps contribute to the differences in people’s health. Australians born overseas don’t just have much lower rates of COVID vaccination, they also have much higher rates of death from COVID. Where people live also affects vaccination rates. High-risk people living in remote and very remote areas are less likely to be vaccinated, and even within capital cities there are big differences between different areas. <h2>We need to set ambitious targets</h2> Australia needs a vaccination reset. A new National Vaccination Agreement between the federal and state governments should include ambitious but achievable targets for adult vaccines. This can build on the success of targets for childhood and adolescent vaccination, setting targets for overall uptake and for communities that are falling behind. The federal government should ask the Australian Technical Advisory Group on Immunisation (ATAGI) to advise on vaccination targets for COVID, flu, pneumococcal and shingles for all high-risk older adults. <h2>Different solutions for different barriers</h2> Barriers to vaccination range from the trivial to the profound. A new national vaccination strategy needs to dismantle high and low barriers alike. First, to increase overall uptake, vaccination should be easier, and easier to understand. The federal government should introduce vaccination “surges”, especially in the lead-up to winter, as <a href="https://www.who.int/europe/news/item/09-10-2023-vulnerable--vaccinate.-protecting-the-unprotected-from-covid-19-and-influenza">countries in Europe</a> do. During surges, high-risk people should be able to get vaccinated even if they have had a recent infection or injection. This will make the rules simpler and make vaccination in aged care easier. Surges should be reinforced with advertising explaining who should get vaccinated and why. High-risk people should get SMS reminders. Second, targeted policies are needed for the many people who are happy to use mainstream primary care services, but who don’t get vaccinated – for example, due to <a href="https://theconversation.com/how-can-governments-communicate-with-multicultural-australians-about-covid-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097">language barriers</a>, or living in <a href="https://theconversation.com/over-half-of-eligible-aged-care-residents-are-yet-to-receive-their-covid-booster-and-winter-is-coming-205403">aged care</a>. <a href="https://www.health.gov.au/our-work/phn/what-PHNs-are">Primary Health Networks</a> should get funding to coordinate initiatives such as vaccination events in aged care and disability care homes, workforce training to support culturally appropriate care, and provision of interpreters. Third, tailored programs are needed to reach <a href="https://www.aihw.gov.au/reports/australias-health/health-promotion">people who are not comfortable or able to access mainstream health care</a>, who have the most complex barriers to vaccination – for example, distrust of the health system or poverty. These communities are all very different, so one-size-fits-all programs don’t work. The pandemic showed that vaccination programs can succeed when they are designed and delivered with the communities they are trying to reach. Examples are “<a href="https://pubmed.ncbi.nlm.nih.gov/36366401/">community champions</a>” who challenge misinformation, or health services organising vaccination events where communities work, gather or <a href="https://www.theguardian.com/australia-news/2021/aug/11/hundreds-queue-for-hours-and-some-camp-overnight-at-pop-up-vaccine-clinic-in-sydneys-lakemba">worship</a>. These programs should get ongoing funding, but also be accountable for achieving results. Adult vaccines are the missing piece in Australia’s whole-of-life vaccination strategy. For the health and safety of the most vulnerable members of our community, we need to close the vaccination gap. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/217915/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-breadon-1348098">Peter Breadon</a>, Program Director, Health and Aged Care, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/ingrid-burfurd-1295906">Ingrid Burfurd</a>, Senior Associate, Health Program, Grattan Institute, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/millions-of-high-risk-australians-arent-getting-vaccinated-a-policy-reset-could-save-lives-217915">original article</a>.

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What are the new COVID booster vaccines? Can I get one? Do they work? Are they safe?

<a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> As the COVID virus continues to <a href="https://pubmed.ncbi.nlm.nih.gov/36680207/">evolve</a>, so does our vaccine response. From <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-covid-19-vaccines-available-to-target-current-variants?language=en">December 11</a>, Australians will have access to <a href="https://www.health.gov.au/news/atagi-recommendations-on-use-of-the-moderna-and-pfizer-monovalent-omicron-xbb15-covid-19-vaccines?language=en">new vaccines</a> that offer better protection. These “monovalent” booster vaccines are expected to be a <a href="https://theconversation.com/cdc-greenlights-two-updated-covid-19-vaccines-but-how-will-they-fare-against-the-latest-variants-5-questions-answered-213341">better match</a> for currently circulating strains of SARS-CoV-2, the virus that causes COVID. Pfizer’s monovalent vaccine will be <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/new-covid-19-vaccines-available-to-target-current-variants?language=en">available</a> to eligible people aged five years and older. The Moderna monovalent vaccine can be used for those aged 12 years and older. Who is eligible for these new boosters? How do they differ from earlier ones? Do they work? Are they safe? <h2>Who’s eligible for the new boosters?</h2> The federal government has accepted the Australian Technical Advisory Group (ATAGI) recommendation to use the new vaccines, after Australia’s regulator <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">approved their use last month</a>. However, vaccine eligibility has remained the same since September. ATAGI <a href="https://www.health.gov.au/news/atagi-recommendations-on-use-of-the-moderna-and-pfizer-monovalent-omicron-xbb15-covid-19-vaccines?language=en">recommends</a> Australians aged over 75 get vaccinated if it has been six months or more since their last dose. People aged 65 to 74 are recommended to have a 2023 booster if they haven’t already had one. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=315&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=315&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=315&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=396&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=396&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560533/original/file-20231120-21-4igdnx.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=396&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>For people without risk factors. <a class="source" href="https://www.health.gov.au/sites/default/files/2023-10/atagi-recommended-covid-19-vaccine-doses.pdf">Health.gov.au</a></figcaption></figure> Adults aged 18 to 64 with underlying risk factors that increase their risk of severe COVID are also recommended to have a 2023 booster if they haven’t had one yet. And if they’ve already had a 2023 booster, they can consider an additional dose. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=311&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=311&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=311&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=391&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=391&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560532/original/file-20231120-26-70jfyr.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=391&fit=crop&dpr=3 2262w" alt="" /></a><figcaption>Advice for people with risk factors. <a class="source" href="https://www.health.gov.au/sites/default/files/2023-10/atagi-recommended-covid-19-vaccine-doses.pdf">Health.gov.au</a></figcaption></figure> For adults aged 18 to 64 without underlying risk factors who have already received a 2023 booster, an additional dose isn’t recommended. But if you’re aged 18 to 64 and haven’t had a booster in 2023, you can consider an additional dose. Additional doses aren’t recommended for children without underlying conditions that increase their risk of severe COVID. A primary course is not recommended for children aged six months to five years without additional risk factors. <h2>Monovalent, bivalent? What’s the difference?</h2> From monovalent The initial COVID vaccines were “monovalent”. They had one target – the original viral strain. But as the virus mutated, we assigned new letters of the Greek alphabet to each variant. This brings us to Omicron. With this significant change, we saw “immune evasion”. The virus had changed so much the original vaccines didn’t provide sufficient immunity. To bivalent So vaccines were updated to target an early Omicron subvariant, BA.1, plus the original ancestral strain. With two targets, these were the first of the “bivalent” vaccines, which were approved in Australia <a href="https://theconversation.com/omicron-specific-vaccines-may-give-slightly-better-covid-protection-but-getting-boosted-promptly-is-the-best-bet-190736">in 2022</a>. Omicron continued to evolve, leading to more “immune escape”, contributing to repeated waves of transmission. The vaccines were updated again in <a href="https://theconversation.com/havent-had-covid-or-a-vaccine-dose-in-the-past-six-months-consider-getting-a-booster-199096">early 2023</a>. These newer bivalent vaccines target two strains – the ancestral strain plus the subvariants BA.4 and BA.5. Back to monovalent Further changes in the virus have meant our boosters needed to be updated again. This takes us to the recent announcement. This time the booster targets another subvariant of Omicron known as XBB.1.5 (sometimes known as <a href="https://theconversation.com/the-kraken-subvariant-xbb-1-5-sounds-scary-but-behind-the-headlines-are-clues-to-where-covids-heading-198158">Kraken</a>). This vaccine is monovalent once more, meaning it has only one target. The target against the original viral strain has been removed. According to advice given to the World Health Organization <a href="https://www.who.int/news/item/18-05-2023-statement-on-the-antigen-composition-of-covid-19-vaccines">in May</a>, this is largely because immunity to this original strain is no longer required (it’s no longer infecting humans). Raising immunity to the original strain may also hamper the immune response to the newer component, but we’re not sure if this is occurring or how important this is. The United States <a href="https://theconversation.com/cdc-greenlights-two-updated-covid-19-vaccines-but-how-will-they-fare-against-the-latest-variants-5-questions-answered-213341">approved</a> XBB.1.5-specific vaccines from Pfizer and Moderna in <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-action-updated-mrna-covid-19-vaccines-better-protect-against-currently-circulating">mid-September</a>. These updated vaccines have also been <a href="https://www.tga.gov.au/sites/default/files/2023-10/auspar-spikevax-xbb.1.5-231012.pdf">approved in</a> places including Europe, Canada, Japan and Singapore. In Australia, the Therapeutic Goods Administration (TGA) approved them <a href="https://www.tga.gov.au/products/covid-19/covid-19-vaccines/covid-19-vaccines-regulatory-status">in October</a>. <h2>Do these newer vaccines work?</h2> Evidence for the efficacy of these new monovalent vaccines comes from the results of research <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2023-PI-02409-1&d=20231117172310101">Pfizer</a> and <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">Moderna</a> submitted to the TGA. Evidence also comes from a <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">preprint</a> (preliminary research available online that has yet to be independently reviewed) and an update Pfizer <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2023-09-12/10-COVID-Modjarrad-508.pdf">presented</a> to the US Centers for Disease Control. Taken together, the available evidence shows the updated vaccines produce good levels of antibodies in <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">laboratory studies</a>, <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">in humans</a> and <a href="https://www.tga.gov.au/resources/auspar/auspar-spikevax-xbb15">mice</a> when compared to previous vaccines and when looking at multiple emerging variants, including EG.5 (sometimes known as <a href="https://theconversation.com/the-who-has-declared-eris-a-variant-of-interest-how-is-it-different-from-other-omicron-variants-211276">Eris</a>). This variant is the one causing high numbers of cases around the world currently, including in Australia. It is very similar to the XBB version contained in the updated booster. The updated vaccines should also cover <a href="https://theconversation.com/how-evasive-and-transmissible-is-the-newest-omicron-offshoot-ba-2-86-that-causes-covid-19-4-questions-answered-212453">BA.2.86 or Pirola</a>, according to <a href="https://www.tga.gov.au/sites/default/files/2023-10/auspar-spikevax-xbb.1.5-231012.pdf">early results</a> from clinical trials and the US <a href="https://www.cdc.gov/respiratory-viruses/whats-new/covid-19-variant.html">Centers for Disease Control</a>. This variant is responsible for a rapidly increasing proportion of cases, with case numbers growing <a href="https://twitter.com/BigBadDenis/status/1725310295596560662?s=19">in Australia</a>. It’s clear the virus is going to continue to evolve. So performance of these vaccines against new variants will continue to be closely monitored. <h2>Are they safe?</h2> The <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2023-PI-02409-1&d=20231117172310101">safety</a> of the updated vaccines has also been shown to be similar to previous versions. Studies <a href="https://www.medrxiv.org/content/10.1101/2023.08.22.23293434v2">comparing them</a> found no significant difference in terms of the adverse events reported. Given the availability of the updated vaccines, some countries have removed their approval for earlier versions. This is because newer versions are a closer match to currently circulating strains, rather than any safety issue with the older vaccines. <h2>What happens next?</h2> The availability of updated vaccines is a welcome development, however this is not the end of the story. We need to make sure eligible people get vaccinated. We also need to acknowledge that vaccination should form part of a comprehensive strategy to limit the impact of COVID from now on. That includes measures such as mask wearing, social distancing, focusing on ventilation and air quality, and to a lesser degree hand hygiene. Rapidly accessing antivirals if eligible is also still important, as is keeping away from others if you are infected.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/217804/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, Professor, Infectious Diseases and Microbiology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-the-new-covid-booster-vaccines-can-i-get-one-do-they-work-are-they-safe-217804">original article</a>.

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“Done with the vaccine”: Karl Stefanovic blasts fifth booster

Karl Stefanovic has once again sparked controversy after declaring he is “done with the vaccine.” Karl shocked viewers after expressing concerns that the jab could cause “heart issues” as the Australian Technical Advisory Group (ATAGI) updated its vaccine recommendations. According to the ATAGI, as of February 20, anyone aged 18 and over who has not had the COVID vaccine or has not contracted the virus in the past six months will be eligible to get another shot - opening up a fourth dose for Aussies aged 19-29 and a fifth dose for those 65 and over. “As you know, I am not a glowing ambassador for more than two shots,” Stefanovic said. The Today show host then questioned whether another dose would be able to fight new strains of the virus, stating he is aware of people “over the age of 60 who are still incredibly nervous about getting it." “The other thing that I am concerned about, if I have another dose, is that I may get complications,” he said. The host’s guest, medical expert Dr Nick Coatsway insisted Australians aged 60 and over “needn’t be” scared of the jab but added that the conceded boosters are only a temporary solution. “Let’s understand the science, if you get a fifth dose your protection is enhanced for around about 8-12 weeks and then it returns after the fourth dose or the third dose,” Dr Coatsworth said. The ATAGI has again emphasised the importance of Aussies who are already eligible, including people over 65, to get their booster in 2023 as they remain at high risk of severe disease and death from COVID. Currently, there is no additional booster available to those 18 and below, with the exception of children aged 5-17 who are at high risk of developing a severe illness. Image credit: Getty

Parents' grim warning after losing 3-year-old to flu

Doctors have issued a crucial warning for parents after a healthy and happy Perth toddler became the youngest person in Western Australia to die from the flu in 2023. Muhammed Saadiq Segaff is being remembered as a cheerful but cheeky boy after dying from a strain of the flu virus, influenza A. The three-year-old’s health rapidly declined at Fiona Stanley Hospital, located about 16km from the state's capital, where the toddler went from having difficulty breathing to cardiac arrest. As a result, he underwent open heart surgery before being transported to Perth’s Children's Hospital where doctors and nurses had to use a machine to keep Muhammed’s blood pumping during the transfer. Yet despite their best efforts, they couldn’t save his life, with his parents making the painful decision to turn off his life support on May 26 after his family flew in from Singapore to say their goodbyes. Although influenza is a common virus, it can be fatal in high risk groups as it attacks the lungs, nose and throat. Typical symptoms include chills, fever, fatigue, headaches and muscle aches, with most fit and healthy people able to recover without seeing a doctor. However, young children, senior adults, unhealthy adults and pregnant women have an increased chance of contracting more severe cases due to being immunocompromised. Doctors advise getting a flu shot annually, but statistics are showing that the uptake of flu vaccines in WA in 2023 is slower than usual. “We have a significant and effective prevention strategy for flu, it’s a flu vaccine,” Perth Children’s Hospital infectious diseases specialist Chris Blyth told 7News. Despite the chilling warning, less than 14 per cent of children under five have gotten the vaccination in WA, with a slimmer figure for those aged between five and 15 years old. Dr Blyth said about 10 per cent of children who are admitted to hospital with the flu require intensive care. Parents are advised to monitor children for unusual symptoms associated with the flu, such as breathlessness and fast breathing, which Dr Blyth warned could impact the heart. “Confusion or drowsiness is another important sign. Both of those things would make me want to seek medical advice,” he said. “In the middle of winter, our hospitals are full of people with respiratory illnesses but if parents think their child is much sicker than they normally are they should be seeking advice.” Muhammed’s parents hope that by sharing their son’s heartbreaking story, more parents will consider vaccinating their children against the flu annually. “No parents want this to happen to their own children,” Muhammed’s mother Shikin Hasnawi told 7News. “We just miss him so much,” his father Segaff Sinin said. The WA government has extended its free flu vaccine rollout to children and seniors until the end of June in an attempt to encourage further uptake of the shot. Image credit: 7 News Perth

Caring

I’m over 65 and worried about the flu. Which vaccine should I have?

<a href="https://theconversation.com/profiles/magdalena-plebanski-1063786">Magdalena Plebanski</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/jennifer-boer-1210047">Jennifer Boer</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/katie-louise-flanagan-1066858">Katie Louise Flanagan</a>, <a href="https://theconversation.com/institutions/university-of-tasmania-888">University of Tasmania</a>, and <a href="https://theconversation.com/profiles/kirsty-wilson-1103649">Kirsty Wilson</a>, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Influenza, or the flu, is a virus transmitted by respiratory droplets from coughing and sneezing. It can cause the sudden onset of a fever, cough, runny nose, sore throat, headache, muscle and joint pain. In Australia, the flu is responsible for <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4004f.htm">more than 5,000 hospitalisation and 100 deaths</a> a year. The highest rates are among those over 65, whose immune systems aren’t as effective as they used to be, and children under five, whose immune systems are yet to mature. To combat the decline in immunity as we age, specific vaccines are available for people aged 65 and over. So how do they work, and why exactly are they needed? <h2>Remind me, how does the immune system work?</h2> The immune system uses multiple mechanisms to fight viral infections, which can be divided into two major arms of the immune system, called innate and adaptive immunity. Innate immunity involves multiple inflammatory cells and chemicals that are triggered immediately, or within hours of encountering an infection. They activate the immune system to clear the infection. Adaptive immunity takes a little longer (weeks) to work and involves memory T cells and antibody-producing B cells, which can be reactivated when the body encounters a virus or other pathogen. The combined innate and adaptive immune response determines how well we respond to an invading virus like influenza. <h2>Why are older people more at risk from the flu?</h2> Generally, as we age past 65, the innate cells become less effective at their job of clearing infections. They also start <a href="https://www.annualreviews.org/doi/full/10.1146/annurev-cellbio-100616-060718">producing more inflammation</a>. New T and B cell numbers also decrease with increasing age and hence the adaptive immune response is also not as effective as when we are younger. This immune system decline is called immunosenescence, which leads to increased susceptibility, hospitalisation and death from influenza.Certain medical conditions, such as cancer and heart and lung conditions, increase susceptibility to severe influenza, with older people being more likely to have additional medical conditions than younger people. <h2>What flu vaccines are available?</h2> <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">Annual flu vaccines</a> are recommended to protect against the common circulating strains of influenza, which can differ from year to year. The standard flu vaccines offered to adults aged under 65 consist of surface proteins of the virus or inactivated (killed) virus from four influenza strains: two A strains (H1N1 and H3N2) and two B strains. When you’re vaccinated, your immune system makes antibodies from B cells which protect you if you become exposed to these strains of the virus. However, the standard influenza vaccine is less effective in older people. Two stronger or augmented vaccines have been made targeting this age group. They contain the same components as the standard vaccine, but one vaccine – called <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2020-CMI-01074-1&d=20230529172310101">Fluad</a> – uses a strong adjuvant (an agent used to increase the immune response to vaccination) called MF59 to stimulate better immunity. The other augmented vaccine, called <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2020-CMI-02062-1">Fluzone</a>, uses a four-fold higher dose of each influenza strain to increase immunity. <h2>How do they compare?</h2> <a href="https://academic.oup.com/cid/article/73/11/e4251/5992287?login=false">Studies comparing Fluad and Fluzone</a> show both vaccines stimulate stronger immunity against influenza than the standard flu vaccine and are therefore likely to provide better protection. Studies directly testing for improved clinical outcomes with vaccines for over-65s show a small benefit of receiving either of the vaccines over the standard vaccine, including a modest decrease in lab-confirmed influenza, <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30235-7/fulltext">hospitalisations</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563546/">emergency department visits</a> compared to the standard influenza vaccine. They are however yet to show and impact on flu-related deaths. <figure class="align-right "> </figure> In the few studies comparing <a href="https://academic.oup.com/cid/article/73/11/e4251/5992287?login=false">Fluad and Fluzone directly</a>, there is little evidence of a difference between them in reducing influenza and serious flu outcomes. <a href="https://www.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2023">The Australian Technical Advisory Group on Immunisation therefore recommends</a> using either Fluad or Fluzone. While both have been Therapeutic Goods Administration (TGA) approved since 2020, only Fluad is available for free on the National Immunisation Program for people aged 65 and over. Fluzone is only available with a private prescription if you’re 60 years and over, at a cost of around A$65-70. If neither augmented vaccine is available, a standard influenza vaccine is also acceptable for older people, since any influenza vaccine is preferable to receiving none. Flu vaccines can also be given at the same time as COVID vaccines. <h2>How else can we protect against the flu?</h2> While influenza vaccination is the single most effective way of preventing influenza, other measures such as social distancing and wearing a mask or N95 respirator can also provide some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779801/">community protection</a>. Wearing a mask or N95 respirator significantly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779801/">reduces the risk</a> of infecting others when infected. The evidence for protecting oneself against infection is less conclusive, mainly because it’s linked to early, consistent and, importantly, the <a href="https://cdn.who.int/media/docs/default-source/influenza/advice-on-the-use-of-masks-in-the-community-setting-in-influenza-a-(h1n1)-outbreaks.pdf?sfvrsn=24a45a95_1&download=true">correct use of masks</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/204810/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/magdalena-plebanski-1063786">Magdalena Plebanski</a>, Professor of Immunology, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/jennifer-boer-1210047">Jennifer Boer</a>, Postdoctoral Research Fellow, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a>; <a href="https://theconversation.com/profiles/katie-louise-flanagan-1066858">Katie Louise Flanagan</a>, Infectious Diseases Specialist and Clinical Professor, <a href="https://theconversation.com/institutions/university-of-tasmania-888">University of Tasmania</a>, and <a href="https://theconversation.com/profiles/kirsty-wilson-1103649">Kirsty Wilson</a>, Postdoctoral Research Fellow, <a href="https://theconversation.com/institutions/rmit-university-1063">RMIT University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/im-over-65-and-worried-about-the-flu-which-vaccine-should-i-have-204810">original article</a>.

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Should I get a flu vaccine this year? Here’s what you need to know

<a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> After having low rates of influenza (flu) transmission in recent years thanks to our COVID control strategies, case numbers are now rising. So far this year, Australia has had <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">more than 32,000</a> lab-confirmed cases of the flu and 32 deaths. Getting a flu vaccine is the best way to protect against getting the flu. These are reformulated each year to protect against the most widely circulating strains – if our predictions are right. Below you’ll find everything you need to know about the 2023 flu vaccine. But first, some flu basics. <h2>What are the different types of flu?</h2> There are two main types of influenza: influenza A and influenza B. On the surface of the influenza virus there are two main proteins, the hemagglutinin (HA or H) and neuraminidase (NA or N). Different strains are named after their versions of the H and N proteins, as in H1N1 or “swine flu”. <figure class="align-center "><img src="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525044/original/file-20230509-15-c78c12.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" alt="" /><figcaption>HA is the yellow spike, while the NA is the green oval. <a class="source" href="https://www.shutterstock.com/image-vector/structure-influenza-virus-infographics-vector-illustration-542924464?src=ixiW0w-59I3I17RpN4L3wQ-1-12">Shutterstock</a></figcaption></figure> Minor changes in the proteins (HA and NA) on the surface are common because the enzyme the virus uses to make copies of itself is prone to errors. Sometimes the influenza virus can change more abruptly when it mixes up components from different influenza viruses – including influenza viruses that typically infect birds, pigs or bats – to create a virus that’s basically new. The regular change in the virus is the reason the vaccine is updated every year. The <a href="https://www.tga.gov.au/about-tga/advisory-bodies-and-committees/australian-influenza-vaccine-committee-aivc">Australian Influenza Vaccine Committee</a> meets late in the year to plan what should be included in the vaccine for the following season, after considering what happened in our last flu season and in the Northern hemisphere winter. <h2>What strains does this year’s flu shot protect against?</h2> Modern flu vaccines typically protect against four strains. For this year’s vaccine, the committee <a href="https://www.tga.gov.au/resources/publication/meeting-statements/aivc-recommendations-composition-influenza-vaccines-australia-2023">has recommended</a> it includes: <ul> <li> an A/Sydney/5/2021 (H1N1)pdm09-like virus </li> <li> an A/Darwin/9/2021 (H3N2)-like virus </li> <li> a B/Austria/1359417/2021 (B/Victoria lineage)-like virus </li> <li> a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus. </li> </ul> The naming of the viral components can sometimes be confusing. The name is <a href="https://www.cdc.gov/flu/about/viruses/types.htm">derived from</a> the virus type (A or B)/the place it was first isolated/strain number/year isolated (virus subtype). This year’s vaccine therefore includes an influenza A virus similar to the 2009 pandemic-causing H1N1 isolated from Sydney in 2021 and a second influenza A virus (H3N2) isolated in Darwin in 2021. Influenza B viruses are classified into 2 lineages: Victoria and Yamagata. This year’s vaccine includes an influenza B isolated from Austria in 2021 (Victoria lineage) and an influenza B isolated in Phuket in 2013 (Yamagata lineage). <h2>Who should get a flu shot?</h2> Health authorities <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommend</a> everyone aged six months of age or over should get the flu vaccine every year. <a href="https://www.health.gov.au/news/2023-national-immunisation-program-influenza-vaccination-early-advice-for-vaccination-providers">Some groups</a> are at greater risk of significant disease from the flu and can access the flu vaccine for free. This includes: <ul> <li> Aboriginal and Torres Strait Islander people aged six months and over </li> <li> children aged six months to five years </li> <li> pregnant women at any stage of pregnancy </li> <li> people aged 65 years or over </li> <li> people aged five years to 65 years who have certain underlying health conditions affecting the heart, lungs, kidneys or immune system, and those with diabetes. </li> </ul> <h2>How can I get it?</h2> You can get a flu shot from your local general practice or pharmacy. Or you may have an opportunity to get vaccinated at your workplace if your employer supplies it. While the vaccine is free for those in the <a href="https://www.health.gov.au/sites/default/files/2023-02/fighting-flu-starts-with-you-consumer-fact-sheet.pdf">above groups</a>, there can be a consultation or administration fee, depending on where you get your vaccine. If you aren’t eligible for a free vaccine, it usually costs around A$20-$30. <h2>Are there different options?</h2> For over 65s, whose immune systems may not work as well as when they were younger, a <a href="https://www.health.gov.au/sites/default/files/2023-03/atagi-advice-on-seasonal-influenza-vaccines-in-2023.pdf">specific vaccine</a> is available that includes an adjuvant which boosts the immune response. This is free for over-65s under the national immunisation program. A high-dose vaccine is also available for people aged 60 and over. However this isn’t currently funded and costs around $70 on a private prescription. People with egg allergies can safely get the egg-based flu vaccine. However there is also a cell-based immunisation for people who don’t want a vaccine made in eggs. When vaccines are grown in eggs, sometimes the virus can change and this might affect the level of protection. Cell-based vaccines aim to address this issue. The cell-based vaccine isn’t funded so patients will pay around $40 for a private prescription. <h2>How well do they work?</h2> The vaccine’s effectiveness depends on how well the strains in the vaccine match those circulating. It generally <a href="https://www.health.gov.au/resources/publications/aisr-2022-national-influenza-season-summary">reduces</a> the chance of being admitted to hospital with influenza by <a href="https://www.health.gov.au/sites/default/files/documents/2022/08/influenza-vaccine-efficacy-effectiveness-and-impact-explained.docx">30-60%</a>. <h2>What are the side effects?</h2> You can’t get the flu from the vaccine as there’s no live virus in it. When people get a flu-like illness after the vaccine, it can be due to mild effects we sometimes see after vaccination, such as headaches, tiredness or some aches and pains. These usually go away <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#possible-side-effects-of-influenza-vaccination">within a day or two</a>. Alternatively, symptoms after getting a flu shot may be due to another respiratory virus such as respiratory syncytial virus (RSV) that circulates in winter. <h2>When’s the best time to get your flu shot?</h2> The vaccine provides <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu#vaccine-information">peak protection</a> around three to four months <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine#when-to-get-the-influenza-vaccine">after</a> you get it. The <a href="https://www.immunisationcoalition.org.au/news-data/influenza-statistics/">peak of the flu season</a> is usually between June and September, however this changes every year and can vary in different parts of the country. Given this, the best time to get the vaccine is usually around late April or early May. So if you haven’t already, now would be a good time to get it.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/203406/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/paul-griffin-1129798">Paul Griffin</a>, Associate Professor, Infectious Diseases and Microbiology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">original article</a>.

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“Putrid cookers”: Anti-vaxxers slammed for spreading lies about Jock Zonfrillo’s death

Just hours after MasterChef judge Jock Zonfrillo’s sudden death, heartless anti-vaxxers took to social media to spread disinformation. Zonfrillo died in Melbourne on May 1. While the cause of death has not been publicly announced, police said that his death was not being treated as suspicious, and a report was made for the coroner. The anti-vaxxers took this as a chance to spread disinformation online, implying that his death was linked to the Covid vaccine. “Did Jock Zonfrillo get the Pfizer or Moderna RNA vaccine?” one person tweeted the day after his death. Another commented on the way that his death was described as “sudden” with no confirmed cause- completely ignoring the fact that Zonfrillo’s family have not released that information. “The mainstream media has been reporting countless such ‘sudden deaths’ with ‘no cause of death given’,” wrote the anti-vaxxer on Facebook on May 2. “Since when are death reports being provided with no cause given? “I know since when: since they rolled out those experimental Covid vaccines, which are dropping people faster than they can clue in that it is murdering them. The mainstream media and medical establishment will never admit it – they omit the REAL reason someone died by saying ‘no immediate cause of death was given’,” wrote another. The ill-informed comments have attracted significant backlash from Aussies who slammed the “cookers” for taking advantage of the tragedy to spread disinformation. “Of course the putrid cookers have already come out, saying it was the Covid vaccine that killed Jock Zonfrillo. They really are opportunistic scum. RIP Jock,” one person tweeted in response to the lies. <blockquote class="twitter-tweet"> Of course the putrid cookers have already come out, saying it was the covid vaccine that killed Jock Zonfrillo. They really are opportunistic scum. RIP Jock. <a href="https://t.co/t7jxe9QX1P">pic.twitter.com/t7jxe9QX1P</a> — JayJay (@JayJay91341991) <a href="https://twitter.com/JayJay91341991/status/1653215630768865281?ref_src=twsrc%5Etfw">May 2, 2023</a></blockquote> “I’m always unsurprised at the amount of cookers that come out of the woodwork when a celebrity dies. Shame on anyone who is using Jock Zonfrillo’s death to push their anti-vax vile rhetoric,” tweeted another. <blockquote class="twitter-tweet"> I’m always unsurprised at the amount of cookers that come out of the woodwork when a celebrity dies. Shame on anyone who is using Jock Zonfrillo’s death to push their anti-vax vile rhetoric. — MrDreeps (@MrDreepy) <a href="https://twitter.com/MrDreepy/status/1652947746419281921?ref_src=twsrc%5Etfw">May 1, 2023</a></blockquote> “Distance yourself from people who impulsively attribute the death of a celebrity to the Covid-19 Vaccine. “It demonstrates extreme congruence bias, and a profound lack of empathy. #jockzonfrillo,” wrote a third. <blockquote class="twitter-tweet"> Distance yourself from people who impulsively attribute the death of a celebrity to the Covid-19 Vaccine. It demonstrates extreme congruence bias, and a profound lack of empathy. <a href="https://twitter.com/hashtag/jockzonfrillo?src=hash&ref_src=twsrc%5Etfw">#jockzonfrillo</a> — Nick Holt (@realnickholt) <a href="https://twitter.com/realnickholt/status/1652919969926254592?ref_src=twsrc%5Etfw">May 1, 2023</a></blockquote> Images: Instagram

News

Fran Drescher calls for an end to “bull***t” vaccine mandates

Fran Drescher has divided audiences after using her platform to go on a tirade about bringing an end to “bull***t” vaccine mandates. The former star of The Nanny took to the stage at the 2023 Screen Actors Guild (SAG) Awards on Sunday, and used the opportunity to voice her controversial opinions about Covid-19 restrictions. “As the nation declares an end to the Covid emergency this May, I hope we will see everyone return to work in equal opportunity,” Drescher, 65, said in her speech during the telecast, <a href="https://nypost.com/2023/02/27/fran-drescher-calls-for-end-to-vaccine-mandate-in-sag-speech/?utm_campaign=SocialFlow&utm_medium=SocialFlow&utm_source=NYPTwitter">Page Six</a> reports. The entertainment industry’s pandemic protocols were originally set to end on January 31st, but have been extended until April 1st. Meanwhile, more than 20 US states still enforce vaccine mandates to varying degrees. “Our industry brings billions of production dollars to states across the nation, but if they want our business, let’s wield our financial influence to make governors act in the best interest of freedom, diversity, inclusion and democracy,” Drescher said. “As my character Bobbi Flekman said in This Is Spinal Tap – money talks and bulls**t walks!” Her divisive comments were met with a mixed reaction online, with many viewers claiming it was “irresponsible” for Drescher to use her platform in such a way. <blockquote class="twitter-tweet"> Fran Drescher’s comments on the <a href="https://twitter.com/hashtag/CovidVaccine?src=hash&ref_src=twsrc%5Etfw">#CovidVaccine</a> were irresponsible. Using her logic, people wouldn’t be universally vaccinated against diseases like measles and tetanus. Public health is PUBLIC because it takes collective work. — 🇺🇦мег 🇺🇦 (@sassybibrarian) <a href="https://twitter.com/sassybibrarian/status/1630038810095648768?ref_src=twsrc%5Etfw">February 27, 2023</a></blockquote> <blockquote class="twitter-tweet"> God I love Fran Drescher, but her speech at the SAG awards could have been an email. — Francis (@Fusterduster) <a href="https://twitter.com/Fusterduster/status/1630022506668249088?ref_src=twsrc%5Etfw">February 27, 2023</a></blockquote> <blockquote class="twitter-tweet"> Woody Harrelson and now Fran Drescher. Big weekend for anti-vaxxers. — 𝐓𝐨𝐦𝐚𝐬 ⁽ʷʰᵒ ⁱˢ ᵍᵃʸ⁾ (@cinema_gay) <a href="https://twitter.com/cinema_gay/status/1630021950293655554?ref_src=twsrc%5Etfw">February 27, 2023</a></blockquote> Elsewhere in her speech, Drescher also discussed her efforts to help make Hollywood more environmentally friendly by joining with Green Council with a goal to eliminate single-use plastic both on camera and behind the scenes. She also applauded IMDb for “taking a stand against ageism, stereotyping and gender rigidity by allowing our members to define themselves their way on their profile page – for free.” Image credits: Getty Images

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Six-month-old children to receive COVID-19 vaccine in new recommendations

The US Centers for Disease Control and Prevention (CDC)’s Advisory Committee on Immunization Practices (ACIP) has updated its 2023 immunisation schedule for children and individuals under the age of 18. COVID-19 vaccinations were included in the new recommendations for routine children inoculations in the United States, but it remains to be seen whether or not Australia will take the same measure into consideration - one leading infectious diseases physician is doubtful. For children in the United States, the schedule comes only as a recommendation and not as a mandate. The COVID-19 vaccinations will now feature alongside the likes of other common vaccinations for the measles, MMR, mumps, polio, chickenpox, and the flu. It was last year in 2022 that the CDC first recommended COVID-19 vaccination for children of six months and up, but it has only now been formalised. <blockquote class="twitter-tweet"> US vaccine schedule kids 0-6 years <a href="https://t.co/n3X0vQEGUm">pic.twitter.com/n3X0vQEGUm</a> — Irene Tosetti, MD MBA MPH (@itosettiMD_MBA) <a href="https://twitter.com/itosettiMD_MBA/status/1624741715134357506?ref_src=twsrc%5Etfw">February 12, 2023</a></blockquote> Professor Robert Booy from the University of Sydney’s Infectious Diseases Institute spoke to SBS News about the United State’s approach to their vaccination recommendations, suggesting they may be “a bit gung-ho”. “They're recommending vaccinations even for children who are at mild risk," he said, “they're recommending vaccinations to all children." Professor Booy went on to add that he does not believe Australia will follow in the US’ footsteps, and that the vaccination is unlikely to be recommended for babies here. "We're taking the approach that vaccination is for children who are vulnerable - children who are at high risk and who have multiple medical problems or disability,” he explained. On the subject of Australia’s childhood vaccinations, he stated that the country is “not standing out”, as the United Kingdom is “more conservative” and equally unlikely to adopt the new US recommendations. “We're just doing similar to other countries,” he said. “The US is standing out by being a bit 'gung-ho' in recommending vaccination to all children under five." Dr Deepti Gurdasani, a clinical epidemiologist and statistical geneticist from the United Kingdom, took to Twitter to share her belief that the UK and Australia were unlikely to follow. <blockquote class="twitter-tweet"> The US has added COVID vaccines to their routine childhood immunisation schedule from 6 months onwards. Will other countries follow? Feel little hope that this will happen in the UK or perhaps even Australia. <a href="https://t.co/NvFB8gK2I7">https://t.co/NvFB8gK2I7</a> — Dr. Deepti Gurdasani (@dgurdasani1) <a href="https://twitter.com/dgurdasani1/status/1624758319188692993?ref_src=twsrc%5Etfw">February 12, 2023</a></blockquote> At this stage, Australians aged five and up are recommended to receive a COVID-19 vaccination. However, the vaccinations are still recommended for children from six months to five years who are immunocompromised, have a disability, or have health conditions that increase their risk of severe COVID-19 symptoms. Images: Getty

Caring

Former MP reveals "devastating" Covid vaccine side effects

Former federal MP Dr Kerryn Phelps has revealed both she and her wife have suffered continual health issues after receiving the Covid vaccine, while implying the true rate of adverse effects is higher than reported. In an explosive submission to Parliament’s Long Covid inquiry, the former Australian Medical Association (AMA) president has broken her silence about the "devastating" experience. “This is an issue that I have witnessed first-hand with my wife who suffered a severe neurological reaction to her first Pfizer vaccine within minutes, including burning face and gums, paraesethesiae, and numb hands and feet, while under observation by myself, another doctor and a registered nurse at the time of immunisation,” the 65-year-old said. “I continue to observe the devastating effects a year-and-a-half later with the addition of fatigue and additional neurological symptoms including nerve pains, altered sense of smell, visual disturbance and musculoskeletal inflammation. The diagnosis and causation has been confirmed by several specialists who have told me that they have seen ‘a lot’ of patients in a similar situation.” “Jackie [Kerryn's wife] asked me to include her story to raise awareness for others,” she said. “We did a lot of homework before having the vaccine, particularly about choice of vaccine at the time. In asking about adverse side effects, we were told that ‘the worst thing that could happen would be anaphylaxis’ and that severe reactions such as myocarditis and pericarditis were ‘rare’.” Dr Phelps revealed she was also diagnosed with a <a href="https://www.news.com.au/finance/economy/federal-budget/covid-vaccine-injury-payouts-explode-to-77-million-budget-reveals/news-story/df39fcf430c6cadb487a9914df7a3422" target="_self" data-tgev="event119" data-tgev-container="bodylink" data-tgev-order="df39fcf430c6cadb487a9914df7a3422" data-tgev-label="finance" data-tgev-metric="ev">vaccine injury</a> from her second dose of Pfizer in July 2021, “with the diagnosis and causation confirmed by specialist colleagues”. Dr Phelps said both reactions were reported to the Therapeutic Goods Administration (TGA) “but never followed up”. She revealed she had spoken with other doctors “who have themselves experienced a serious and persistent adverse event” but that “vaccine injury is a subject that few in the medical profession have wanted to talk about”. “Regulators of the medical profession have censored public discussion about adverse events following immunisation, with threats to doctors not to make any public statements about anything that ‘might undermine the government’s vaccine rollout’ or risk suspension or loss of their registration,” she said. “There has been a delay in recognition of vaccine injury, partly because of under-reporting, concerns about vaccine hesitancy in the context of managing a global pandemic, and needing to find the balance between risks and benefits on a population level.” According to the TGA’s most recent <a href="https://www.tga.gov.au/news/covid-19-vaccine-safety-reports/covid-19-vaccine-safety-report-15-12-2022" target="_self">safety update</a>, there have been a total of 137,141 adverse event reports from nearly 64.4 million doses — a rate of 0.2 per cent. There have been 819 reports “assessed as likely to be myocarditis” from 49.8 million doses of Pfizer and Moderna. Fourteen deaths have officially been linked to vaccination — 13 after AstraZeneca and one after Pfizer. Image credits: Getty Images

News

Thousands of Tasmanian devils are dying from cancer – but a new vaccine approach could help us save them

Tasmanian devils are tough little creatures with a ferocious reputation. Tragically, each year thousands of Tasmanian devils suffer and die from contagious cancers – devil facial tumours. We have discovered that a modified virus, like the attenuated adenovirus used in the AstraZeneca COVID-19 vaccine, can make devil facial tumour cells more visible to the devil immune system. We have also found key immune targets on devil facial tumour cells. These combined advances allow us to move forward with a vaccine that helps the devil immune system find and fight the cancer. And we have a clever way to deliver this vaccine, too – with edible baits. A puzzling cancer Tasmanian devils mainly suffer from the original devil facial tumour, or DFT1. A second type of devil facial tumour (DFT2) has begun emerging in southern Tasmania that further threatens the already endangered devil population. DFT1 and DFT2 are <a href="https://www.tcg.vet.cam.ac.uk/about/DFTD">transmissible cancers</a> – they spread living cancer cells when the devils bite each other. This has presented a puzzle: a cancer cell that comes from another animal should be detected by the immune system as an invader, because it is “genetically mismatched”. For example, in human medicine, tissue transplants need to be genetically matched between the donor and recipient to avoid the immune system rejecting the transplant. Somehow, DFT1 and DFT2 seem to evade the immune system, and devils die from tumours spreading throughout their body or from malnutrition due to the facial tumours disrupting their ability to eat. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/495558/original/file-20221116-12-jv29a8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/495558/original/file-20221116-12-jv29a8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/495558/original/file-20221116-12-jv29a8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495558/original/file-20221116-12-jv29a8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495558/original/file-20221116-12-jv29a8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495558/original/file-20221116-12-jv29a8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495558/original/file-20221116-12-jv29a8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495558/original/file-20221116-12-jv29a8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" alt="Close-up of a Tasmanian devil held by human hands, with a tumour on its lower jaw" /></a><figcaption>A Tasmanian devil with DFT1. Andrew S. Flies @WildImmunity</figcaption></figure> On the bright side, the immune systems of a few wild devils have been able to overcome DFT1. Furthermore, <a href="https://www.nature.com/articles/srep43827">previous vaccine and immunotherapy trials</a> showed the devil immune system can be activated to kill DFT1 cells and clear away sizeable tumours. This good news from both the field and the laboratory has allowed our team to zoom in on key DFT protein targets that the devil immune system can attack. This helps us in our quest to develop a more effective and scalable vaccine. How can we vaccinate wild animals? Even if we succeed in producing a <a href="https://doi.org/10.1080/14760584.2020.1711058">protective DFT vaccine</a>, we can’t trap and inject every devil. Luckily, clever researchers in Europe in the 1970s figured out that <a href="https://doi.org/10.1371/journal.pntd.0003953">vaccines can be incorporated into edible food baits</a> to vaccinate wildlife across diverse landscapes and ecosystems. In 2019, we hypothesised an oral bait vaccine could be made to protect devils from DFT1 and DFT2. Fast forward to November 2022 and the pieces of this ambitious project are falling into place. First, using samples from <a href="https://doi.org/10.1007/s00432-021-03601-x">devils with strong anti-tumour responses</a>, we have found that the main immune targets are <a href="https://doi.org/10.1098/rsob.220208">major histocompatibility proteins</a>. These are usually the main targets in transplant rejection. This tells us what to put into the vaccine. Second, we tested a virus-based delivery system for the vaccine. We used a weakened adenovirus most of the human population has already been exposed to, and found that in the lab this virus can enter devil facial tumour cells. Importantly, the weakened adenovirus can be modified to produce proteins that can <a href="https://doi.org/10.1099/jgv.0.001812">stimulate the devil immune system</a>. This means it forces the devil facial tumour cells to show the major histocompatibility proteins they normally hide, making the cells “visible” to cancer-killing immune cells. This vaccine approach is much like the AstraZeneca COVID-19 vaccine that uses a weakened chimpanzee adenovirus to deliver cargo to our immune system, getting it to recognise SARS-CoV-2. <a href="https://www.aphis.usda.gov/wildlife_damage/nepa/states/US/us-2019-onrab-ea.pdf">Adenoviral vaccines have also been widely used</a> in oral bait vaccines to protect raccoons from the rabies virus. Edible protection But there were additional challenges to overcome. Our collaborators in the USA who research and develop other wildlife vaccines suggested that developing an effective bait for devils might be as challenging as making the vaccine itself. Our first studies of placebo baits in the wild confirmed this. Contrary to previous studies which showed devils eating most of the baits, we found the baits were also readily consumed by other species, including eastern quolls, brushtail possums, and Tasmanian pademelons. This led us to test an automatic bait dispenser supplied by our collaborators at the US Department of Agriculture National Wildlife Research Center. The <a href="https://www.publish.csiro.au/WR/justaccepted/WR22070">dispensers proved quite effective</a> at reducing the amount of “off target” bait consumption and showed devils could successfully retrieve the baits with their dexterous paws. <figure><iframe src="https://www.youtube.com/embed/5BEBfFqOY8k?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Tasmanian devil retrieving a placebo bait from an automatic bait dispenser.</figcaption></figure> Encouragingly, a recent mathematical modelling study suggests an <a href="https://lettersinbiomath.journals.publicknowledgeproject.org/index.php/lib/article/view/555">oral bait vaccine could eliminate DFT1</a> from Tasmania. Successful delivery of the vaccine would be a demanding and long-term commitment. But with it, we could prevent the suffering and deaths of thousands of individual devils, along with helping to reestablish a healthy wild devil population. Can’t stop now A bit of additional good news fell into place in late 2022 with the announcement that our international team was awarded an Australian Research Council Linkage Project grant to develop better baits and ways to monitor wildlife health in the field. These oral bait vaccine techniques that eliminate the need to catch and jab animals could be applied to future wildlife and livestock diseases, not just Tassie devils. Building on this momentum, we are planning to start new vaccine trials in 2023. We don’t know yet if this new experimental vaccine can prevent devils from getting devil facial tumours. However, the leap we have made in the past three years and new technology gives us momentum and hope that we might be able to stop DFT2 before it spreads across the state. Perhaps, we can even eliminate DFT1.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/194536/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> Writen by Andrew S. Flies, Chrissie Ong and Ruth Pye. Republished with permission from <a href="https://theconversation.com/thousands-of-tasmanian-devils-are-dying-from-cancer-but-a-new-vaccine-approach-could-help-us-save-them-194536" target="_blank" rel="noopener">The Conversation</a>. Image: Getty Images

Family & Pets

WHO reveals new “imminent threat in every region of the world”

<div> <div> <div> <div> <div> Two major public health bodies have now declared measles as an “imminent threat” to the global community. The Centres for Disease Control and Prevention (CDC) and the World Health Organisation (WHO) feared that a record decline of measles vaccination rates and persistent outbreaks mean that the respiratory virus is an “imminent threat in every region of the world”. WHO Director-General Dr Tedros Adhanom Ghebreyesus said it was “absolutely critical” that immunisation programs were bought back on track to avoid what he said is a “preventable disease”. “The paradox of the pandemic is that while vaccines against Covid-19 were developed in record time and deployed in the largest vaccination campaign in history, routine immunisation programs were badly disrupted, and millions of kids missed out on lifesaving vaccinations against deadly diseases like measles,” said Dr Ghebreyesus. Measles is one of the most contagious viruses, being transmitted through water droplets released in sneezes and coughs coming from infected people. In fact, the CDC states that nine out of 10 people who are not vaccinated against the disease will become infected in the advent of exposure. Common symptoms include fever, cold-symptoms, conjunctivitis and red and blotchy rashes that first appear around the face and hairline before spreading around the body. The measles, mumps and rubella-containing vaccines administered through childhood are considered the best defence against the disease and significantly reduce outbreaks. According to the WHO, India, Somalia and Yemen are the three countries with the largest measles outbreak. As always, consult your doctor if you’re concerned about measles or vaccination updates. Image: Getty </div> </div> </div> </div> </div>

Body

New Covid vaccine now available

A new vaccine touted to target the Omicron strain of COVID-19 has been introduced in Australia, making it the first vaccine containing both the original and Omicron strain to enter the country. A spokesperson for the Department of Health and Aged Care confirmed that the Moderna Spikevax bivalent (or combination) vaccine would join the national vaccine rollout from Monday, October 10, and be available to Australian adults as a booster dose. "The Moderna bivalent vaccine will be integrated into the existing COVID-19 booster program and all sites participating in the COVID-19 vaccine roll-out program will have access to this vaccine in coming weeks," the spokesman said. "People who are due for a COVID-19 dose are encouraged not to wait and to book an appointment as soon as possible, using whichever vaccine is available to them." It comes after the TGA (Therapeutic Goods Administration) <a href="https://www.tga.gov.au/news/media-releases/tga-provisionally-approves-moderna-bivalent-covid-19-vaccine-use-booster-dose-adults" target="_blank" rel="noopener">provisionally approved the vaccine</a> as a booster for adults over the age of 18 on August 29. ATAGI (Australian Technical Advisory Group on Immunisation) recommends that the new vaccine is administered three months after your last vaccine or COVID-19 infection - but that you only need it if you’re not up-to-date with your boosters. For most people, four doses of a Covid vaccine are recommended, while immunocompromised people are recommended to get five. How is it different from vaccines we already have? Like current vaccines, the Moderna bivalent vaccine is an mRNA vaccine that contains genetic blueprints for spike proteins found in the original strain of COVID-19. When we get a Covid jab, the vaccine prompts our body to build replicas of the protein that alert our immune system to respond by producing antibodies - creating an immune “memory” that can then neutralise the real virus if we are infected with Covid. But, this new Moderna vaccine differs in that it also includes the blueprints for spike protein of the Omicron BA.1 subvariant which was circulating earlier this year. Associate Professor Paul Griffin, an infectious disease physician at the University of Queensland, told <a href="https://www.sbs.com.au/news/article/moderna-spikevax-bivalent-vaccine-explained/puz90l4oj" target="_blank" rel="noopener">SBS News</a> that the term “bivalent” refers to the vaccine’s ability to target two virus variants instead of one. Though the vaccine only targets the BA.1 variant, Professor Griffin said it appears to provide extra protection against subvariants BA.4 and BA.5, which are circulating in Australia currently. "[It] has been shown to give better protection against Omicron, including later Omicron subvariants BA.4 and BA.5 that have caused the recent waves in Australia," Professor Griffin explained. In the Omicron variant - which includes the BA.1, BA.2, BA.3, BA.4, and BA.5 subvariants - the spike protein has <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/rmv.2381" target="_blank" rel="noopener">at least 30 mutations</a> that have changed the shape of the protein slightly in comparison to the original virus. As a result, original Covid vaccines are less effective at neutralising infections caused by these subvariants, since the antibodies these vaccines created are less likely to recognise the Omicron spike protein. How effective is it? ATAGI have said that Moderna’s bivalent vaccine showed a small benefit over original vaccines for fighting Omicron variants, while a study published in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2208343" target="_blank" rel="noopener">New England Journal of Medicine</a> found that those who received the new jab had a greater antibody response to BA.1, BA.4 and BA.5. However, it is still unknown how these levels of antibodies translate to preventing infection, hospitalisation and death, or how long the antibodies last. Where can I get it? If you still need a booster shot, you can find your nearest clinic using the health department’s clinic finder which can be accessed <a href="https://www.health.gov.au/resources/apps-and-tools/covid-19-vaccine-clinic-finder" target="_blank" rel="noopener">here</a>. Image: Getty Images

Body

Viral infections including COVID are among the important causes of dementia – one more reason to consider vaccination

With more of us living into old age than at any other time, dementia is increasing steadily worldwide, with major individual, family, societal and economic consequences. Treatment remains largely ineffective and aspects of the underlying pathophysiology are still unclear. But there is good evidence that neurodegenerative diseases – and their manifestation as dementia – are not an inevitable consequence of ageing. Many <a href="https://blogs.otago.ac.nz/pubhealthexpert/dementia-update-on-causes-and-prevention-including-the-role-of-covid-19/" target="_blank" rel="noopener">causes of dementia</a>, including viral infections, are preventable. COVID and other viral infections are centrally involved in insults to the brain and subsequent neurodegeneration. COVID-positive outpatients have a more than three-fold higher risk of Alzheimer’s and more than two-fold <a href="https://www.frontiersin.org/articles/10.3389/fneur.2022.904796/full" target="_blank" rel="noopener">higher risk of Parkinson’s disease</a>. A study of almost three million found risks of psychiatric disorders following COVID infection returned to baseline after one to two months. But other disorders, including “<a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(22)00260-7/fulltext" target="_blank" rel="noopener">brain fog</a>” and dementia, were still higher than among controls two years later. <blockquote class="twitter-tweet"> 🚨I wrote about “brain fog”—one of the most common & disabling symptoms of long COVID (and many other pre-pandemic conditions), and one of the most misunderstood. Here’s what brain fog actually is, and what it’s like to live with it. 1/ <a href="https://t.co/Gq8iylgfBr">https://t.co/Gq8iylgfBr</a> — Ed Yong is on sabbatical (@edyong209) <a href="https://twitter.com/edyong209/status/1569302974811308032?ref_src=twsrc%5Etfw">September 12, 2022</a></blockquote> Among more than six million adults older than 65, individuals with COVID were at a <a href="https://content.iospress.com/articles/journal-of-alzheimers-disease/jad220717" target="_blank" rel="noopener">70% higher risk than the uninfected</a> for a new diagnosis of Alzheimer’s disease within a year of testing positive for COVID. More than 150,000 people with COVID and 11 million controls have been involved in a <a href="https://www.nature.com/articles/s41591-022-02001-z" target="_blank" rel="noopener">study</a> of long-term consequences of acute COVID infection. A year after infection, there was an overall 40% higher risk (an additional 71 cases per 1000 people) of neurologic disorders, including memory problems (80% higher risk) and Alzheimer’s disease (two-fold higher risk). These risks were elevated even among those not hospitalised for acute COVID. SARS-CoV-2, the virus that causes COVID, can <a href="https://rupress.org/jem/article/218/3/e20202135/211674/Neuroinvasion-of-SARS-CoV-2-in-human-and-mouse" target="_blank" rel="noopener">invade brain tissue</a>. Other viruses can also cause direct damage to the brain. A study of almost two million people showed the <a href="https://pubmed.ncbi.nlm.nih.gov/35723106/" target="_blank" rel="noopener">risk of Alzheimer’s was markedly lower</a> in those who had been vaccinated against influenza. The cost of dementia Dementia is characterised by <a href="https://www.who.int/en/news-room/fact-sheets/detail/dementia" target="_blank" rel="noopener">progressively deteriorating cognitive function</a>. This involves memory, thinking, orientation, comprehension, language and judgement, often accompanied by changes in mood and emotional control. It is one of the major causes of disability among older people. Worldwide prevalence exceeds 55 million and there are almost ten million new cases annually. It is the seventh leading cause of death. In 2019, the estimated global cost of dementia was US$1.3 trillion and rising. The best known form of dementia – Alzheimer’s – was <a href="https://pubmed.ncbi.nlm.nih.gov/8713166/" target="_blank" rel="noopener">first described in 1907</a>. Dementia is generally described as developing in three stages: <ul> <li> impairment of memory, losing track of time and becoming lost in familiar places </li> <li> further deterioration of memory with forgetfulness of names and recent events, becoming confused at home, losing communication skills and personal care habits, repeated questioning, wandering </li> <li> increased difficulty walking, progressing to inactivity, marked memory loss, involving failure to recognise relatives and friends, disorientation in time and place, changes in behaviour, including lack of personal care and emergence of aggression. </li> </ul> Treatments largely unsuccessful There are no cures and no resounding treatment successes. Management involves support for patients and carers to optimise physical activity, stimulate memory and treat accompanying physical or mental illness. Dementia has a <a href="https://www.who.int/en/news-room/fact-sheets/detail/dementia" target="_blank" rel="noopener">disproportionate impact on women</a>, who account for 65% of dementia deaths and provide 70% of carer hours. We may know less about the pathology of dementia than we imagined: some key data are under scrutiny for <a href="https://www.science.org/content/article/potential-fabrication-research-images-threatens-key-theory-alzheimers-disease" target="_blank" rel="noopener">possible inappropriate manipulation</a>. But we do know about many of the causes of dementia and therefore about prevention. In addition to viral infections, there are at least four other contributing causes: <a href="https://pubmed.ncbi.nlm.nih.gov/19782001/" target="_blank" rel="noopener">cardiovascular disease</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/30833374/" target="_blank" rel="noopener">type 2 diabetes</a> (especially if untreated), <a href="https://pubmed.ncbi.nlm.nih.gov/29653873/" target="_blank" rel="noopener">traumatic brain injury</a> and <a href="https://www.bmj.com/content/357/bmj.j2353" target="_blank" rel="noopener">alcohol</a>. The brain has its own immune system – cells called microglia. These play a role in brain development, <a href="https://www.nature.com/articles/s41588-022-01149-1" target="_blank" rel="noopener">account for 5-10% of brain mass</a> and become activated by damage and loss of function. They are also <a href="https://pubmed.ncbi.nlm.nih.gov/23622250/" target="_blank" rel="noopener">implicated in Alzheimer’s</a> and their inflammation has been shown to be <a href="https://pubmed.ncbi.nlm.nih.gov/23254930/" target="_blank" rel="noopener">central to its pathology</a>. Dementia is preventable In the absence of effective treatment, prevention is an important goal. The association with viral infections means we should pay careful attention to vaccine availability and uptake (for influenza, COVID and any future variants) and place greater emphasis on combatting misinformation regarding vaccines. The association with atherosclerosis and stroke, as well as diabetes, supports primary prevention that involves healthier diets (plant-based diets low in salt and saturated fats), physical activity and weight control. Alcohol consumption is a major problem globally. We have allowed high intake to be normalised and talk about no more than two glasses per day as though that is innocuous. Despite the myth of some beneficial aspects of alcohol, the <a href="https://www.thelancet.com/article/S0140-6736(18)31310-2/fulltext" target="_blank" rel="noopener">safest intake is zero drinks per week</a>. <blockquote class="twitter-tweet"> My article speaks about a study that showed that people who chronically consume alcohol and become unconscious because of it, their chances of having dementia increase 10 fold. <a href="https://t.co/0DOFf9X5Zx">https://t.co/0DOFf9X5Zx</a> <a href="https://twitter.com/mrcopsych?ref_src=twsrc%5Etfw">@mrcopsych</a> — Hannah (@Hannah46221416) <a href="https://twitter.com/Hannah46221416/status/1575274580788355074?ref_src=twsrc%5Etfw">September 29, 2022</a></blockquote> This requires a complete <a href="https://pubmed.ncbi.nlm.nih.gov/19560606/" target="_blank" rel="noopener">national rethink</a> around the availability and acceptability of alcohol as well as assistance with alcohol addiction and treatment of alcohol-related disorders. Traumatic brain injury is associated with sport and, more importantly, falls and car crashes. It is recognised as a global priority and there is increasing awareness of the preventability of falls among older people. The management of head injuries is being ramped up in contact sports. However, data on the impact of best management of the initial injury on subsequent risk of dementia are lacking and <a href="https://pubmed.ncbi.nlm.nih.gov/29381704/" target="_blank" rel="noopener">risk remains elevated</a> even 30 years after the initial trauma. The evidence that dementia has preventable causes, including viral infection, should better inform policy and our own behaviour.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/190962/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/john-donne-potter-1275983" target="_blank" rel="noopener">John Donne Potter</a>, Professor, Research Centre for Hauora and Health, <a href="https://theconversation.com/institutions/massey-university-806" target="_blank" rel="noopener">Massey University</a> This article is republished from <a href="https://theconversation.com" target="_blank" rel="noopener">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/viral-infections-including-covid-are-among-the-important-causes-of-dementia-one-more-reason-to-consider-vaccination-190962" target="_blank" rel="noopener">original article</a>. Image: Getty Images

Mind

Another booster recommended to Aussies

A fourth Covid vaccine will be made available to more Australians as infections continue to soar across the country. The Australian Technical Advisory Group on Immunisation (ATAGI) met with health officials agreeing to expand the booster program to those aged over 50 as well as some eligibility for those in their 30s. Health Minister Mark Butler is expected to make the announcement on Friday and is urging Aussies to pull up their sleeves. “I’m very confident that, if there’s an expansion of the fourth doses by ATAGI over the next couple of days, we’ve got more than enough vaccine in the warehouses and more than enough capacity in our pharmacies in our GP surgeries to deliver that as soon as people want it,” he said. “The real challenge is to get people lining up to get it. There’s more than five million people who are overdue their third dose, so it’s more than six months since they had their second dose. “They’re still overdue their third dose and I encourage them to go out and get it.” The fourth shot is currently only available for vulnerable people and Aussies aged 65 and over. Australia is on average recording 33,000 Covid-19 cases every day. Image: Shutterstock

Body

Vaccine status no longer required

International travellers to Australia will no longer be required to submit their covid vaccine status. Chief Medical Officer Paul Kelly amended the Biosecurity Act 2015 which will come into effect from July 6. “The Australian Government makes decisions on COVID related issues after considering the latest medical advice,” Health Minister Mark Butler said. “The Chief Medical Officer has advised it is no longer necessary for travellers to declare their vaccine status as part of our management of COVID. “Unvaccinated Australians, as well as certain groups of visa holders, have been able to travel to Australia for some time. “We will continue to act on the medical advice as needed.” Travellers however must still comply with the Covid-19 rules of airlines, including states and territories, and other countries. This currently includes wearing masks on inbound international flights. State and territory orders mandating masks on domestic flights also remain in place. Image: Shutterstock

International Travel

Why can you still get influenza if you’ve had a flu shot?

Restrictions have eased, international borders are open and influenza is back in Australia after a two-year absence. Suddenly, major <a href="https://www.abc.net.au/news/2022-06-08/medical-evacuations-as-flu-arrives-early-in-nt/101132294" target="_blank" rel="noopener">flu outbreaks</a> are occurring across the country, catching many off guard. Flu vaccinations aim to protect against four influenza viruses that cause disease in humans (two subtypes from influenza A and two from influenza B). But vaccine-mediated protection varies each year depending on how well the vaccine matches the disease-causing influenza viruses that are circulating at a given time. Vaccine effectiveness – a real-world measure based on the proportion of vaccinated people who still develop the flu – <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm" target="_blank" rel="noopener">ranges</a> from <a href="https://www.clinicaltrialsarena.com/comment/us-flu-vaccine-efficacy/" target="_blank" rel="noopener">16%</a> to <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/%24File/Vacc-efficacy-effect-impact-Oct18.pdf" target="_blank" rel="noopener">60%</a>. However, it’s still important to get your flu shot. If you’ve been vaccinated and still get the flu, you’re <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm" target="_blank" rel="noopener">less likely</a> to get as sick. <h2>Why it’s difficult to predict which subtypes will dominate</h2> Of the four types of influenza viruses that exist in nature, two cause significant disease in humans: influenza A and influenza B. The 2022 influenza vaccine is quadrivalent (targets four distinct viruses): two influenza A viruses (subtypes H3N2 and H1N1) and two influenza B viruses from distinct lineages. Within each flu A subtype further genetic variation can arise, with mutations (known as genetic drift) generating many viral variants that are classified into “clades” and sub-clades. H3N2 is particularly good at generating lots of diversity in this way. So predicting exactly which H3N2 virus to target in the vaccine is especially difficult. A key challenge for flu vaccines is the decision for which virus to target has to be made months ahead of time. The the H3N2 virus in the Australian flu vaccine (A/Darwin/9/2021) was chosen in September 2021 to enable the vaccine to be manufactured and distributed in time for the 2022 winter. There is no guarantee a different H3N2 virus that isn’t so well targeted by the vaccine won’t arrive in the country in the months leading into winter and start causing disease. Another factor that has made predicting which H3N2 virus to target in the vaccine uniquely difficult for 2022 is the lack of data on which viruses were dominant in the preceding flu seasons, both in Australia and on the other side of the Equator. With travel restrictions easing towards the end of 2021, flu cases did start to reappear during the northern hemisphere 2021-22 winter. But the lack of flu cases during the preceding seasons (due to COVID) meant the data used to predict which viruses to target was inadequate. The US Centers for Disease Control (CDC) analysed data from more than 3,000 children and <a href="https://www.clinicaltrialsarena.com/comment/us-flu-vaccine-efficacy/" target="_blank" rel="noopener">found</a> a vaccine effectiveness of just 16% protection from mild to moderate disease from H3N2. Protection from more severe disease was just 14%. <h2>We don’t know which subtypes will circulate in Australia</h2> Data about flu vaccine effectiveness in the southern hemisphere 2022 winter isn’t yet available, and it’s unclear how protective the current vaccine is against the currently circulating disease-causing subtypes. While H3N2 viruses appears to be <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/%24File/flu-05-2022.pdf" target="_blank" rel="noopener">driving some disease now</a>, other flu viruses may become more prevalent later in the season. The flu vaccine is a quadrivalent vaccine, so in addition to influenza A H3N2, it will protect against another influenza A subtype (H1N1) and two distinct lineages of influenza B virus. These viruses don’t change as rapidly as H3N2, so it’s more likely the vaccine will give better protection against these other influenza viruses. Even if vaccine protection against H3N2 is lower than usual this year, the vaccine <a href="https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm" target="_blank" rel="noopener">could make the difference</a> between recovering at home versus ending up in hospital. <h2>So who should get a flu shot and when?</h2> The flu vaccine offers the highest level of protection in the first three to four months months after vaccination. The season <a href="https://www.health.gov.au/health-topics/immunisation/vaccines/influenza-flu-vaccine" target="_blank" rel="noopener">generally peaks</a> between June and September – although this year we have seen a much earlier than usual start to the flu season. It’s unclear whether this early start will mean a longer flu season or an early finish. So it’s not too late to get vaccinated. Flu vaccines <a href="https://www.health.gov.au/health-topics/immunisation/vaccines/influenza-flu-vaccine" target="_blank" rel="noopener">are recommended</a> for everyone aged six months and over, but are particularly important for people who are more at risk of complications from influenza, including: <ul> <li>Aboriginal and Torres Strait Islander people aged six months and over</li> <li>children aged six months to five years</li> <li>pregnant women</li> <li>people aged 65 years or over</li> <li>people aged six months or over who have medical conditions that mean they have a higher risk of getting serious disease.</li> </ul> <h2>What if you still get the flu?</h2> If you develop flu symptoms, isolate and <a href="https://www.health.gov.au/health-topics/flu-influenza#diagnosis" target="_blank" rel="noopener">see your GP</a> for an influenza PCR test to determine whether you are indeed infected with influenza, particularly if you’re in the higher-risk groups. Specific antivirals for influenza <a href="https://www.health.gov.au/health-topics/flu-influenza#treatment" target="_blank" rel="noopener">can help</a>, if given early. To ensure rapid access to particularly vulnerable aged-care residents, aged-care facilities are being <a href="https://www1.racgp.org.au/newsgp/clinical/plans-ramp-up-for-tamiflu-deployment-in-aged-care" target="_blank" rel="noopener">stocked</a> with the flu antiviral drug Tamiflu. In New South Wales, free <a href="https://www.newsofthearea.com.au/4cyte-drive-through-covid-19-testing-centres-to-conduct-conduct-influenza-and-rsv-testing-94671" target="_blank" rel="noopener">drive-through clinics</a> now offer testing for influenza, respiratory syncytial virus (RSV) and SARS-CoV-2, the virus that causes COVID. Other states and territories may follow. This article originally appeared on <a href="https://theconversation.com/why-can-you-still-get-influenza-if-youve-had-a-flu-shot-184327" target="_blank" rel="noopener">The Conversation</a>. Image: Shutterstock

Body

Controversy over unvaccinated teachers still on leave with full pay

Hundreds of unvaccinated teachers remain on full time salaries as they ride out their “gardening leave”, with news on whether they will be allowed back in the classroom yet to be confirmed. Currently, there are a large number of educators on forced leave, causing widespread anger and frustration all across the teaching community as the strain on understaffed public schools reaches an all-time high. Whether teachers who failed to comply with vaccination mandates should be permitted back into schools at all has remained a matter of contention, with the vaccine mandate end date having passed in May 2022. The Education Department has retained the rule that requires all teachers to have at least two vaccines, but this could change next month following the completion of a “risk assessment”. The outcome of the risk assessment was not set to take effect until the beginning of Term 3 in mid-July, an anonymous teacher has shared. In the meantime, more than 330 teachers who chose not to comply with the vaccine mandate are being paid their full salary to complete “alternative duties” from home. Pay backdated to May the 13th has been funnelled into the stood-down teachers’ pockets, despite them not being “expected to undertake work during this time” – a directive included in an email. An anonymous teacher said he had been told to stay at home and take care of himself until the risk assessment, undertaken by the Education Department, was finalised. Just over 330 teachers had been subject to a Professional and Ethical Standards (PES) investigation for not complying with Covid-19 directives. The investigation had been halted however, while the Department carried out its assessment. Image: Getty

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There are new flu vaccines on offer for 2024. Should I get one? What do I need to know?

Dad awarded compensation after developing heart issue from mandatory vaccine

Millions of high-risk Australians aren’t getting vaccinated. A policy reset could save lives

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