Past Issues

Treatment For Mumps Focuses On Easing Symptoms

Recently, several child health experts have reported a rising number of children reporting to hospitals with mumps. The most affected districts include Kampala, Wakiso, Mukono, Masaka, Kyenjojo, Lira, Soroti, Serere, Mbale, Agago, Adjumani, Gulu, Kiryadongo, Jinja, Kabarole, Busia and Mbarara.By December last year, mumps had been reported in 20 districts and according to Dr Richard Idro, the associate professor of paediatrics and child health, Makerere University and a consultant at Mulago National Referral Hospital, the perception is that initial cases were reported in July 2022 and these later spread countrywide.What are mumps?Mumps is best known for puffy cheeks as well as the tender, painful jaw it causes. Mumps is a contagious illness caused by a virus and mostly affects children. The affected person may develop fever and pain in the throat as well as in the glands that produce saliva (parotid) on each side of the face near the ear. The swollen glands may be tender or painful. However, some people do not develop any signs.According to Dr Charity Asaba, a general physician at St Catherine's Hospital in Kampala, mumps spreads five days after the swelling starts. It is, therefore, important that you consult a qualified health worker for proper diagnosis if you or your child experiences symptoms such as swelling of one or both of the parotid glands found below the ears, headache, muscle aches or pain, tiredness, pain or tenderness around the swelling, fever of 103 F (39 C) or greater, trouble eating or drinking, confusion or disorientation, stomach pain and pain and swelling of the testicles.Mode of transmissionMumps is a contagious viral infection and children can stay with the virus for between one to seven days before symptoms appear. When someone has mumps, the virus is contained in one's saliva. Therefore, coughing or sneezing can release tiny droplets with the virus into the air.You can get the virus by breathing in tiny droplets, touching a surface where droplets have landed and then touching your face or through direct contact such as kissing or sharing a water bottle.The virus can stay on surfaces such as doorknobs, utensils and cups, causing infection to anyone who gets in contact with respiratory droplets and saliva from an infected person."Since the infection is contagious, it is important an infected person stays at home until they are well enough," he says.Treatment, prevention"Mumps is one of the viral illnesses against which you should develop immunity. So, if you never suffered from mumps as a child and you do not develop immunity as an adult, when you are exposed, you can develop mumps," Dr Idro says.He adds that there is no customised treatment for mumps. Instead, health workers will help treat its symptoms such as pain, swelling and fever. The patient should be able to recover in one or two weeks.A number of countries immunise against mumps under the Measles Mumps Rubella vaccine (MMR) as a preventive measure. Unfortunately, in Uganda, mumps vaccination is not part of the routine vaccination programme although, according to Dr Asaba, some private health facilities carry out the vaccination at a fee.Management at homeDr Idro says when a child has mumps, they must be taken to a health worker who will prescribe paracetamol, depending on their age and weight to help manage the fever. The child must also get enough rest to aid the healing process.At home, they should drink plenty of sweet fluids to keep them hydrated. The foods they eat should also be soft since the infection also causes difficulty chewing.Avoid giving a child with mumps foods or liquids that are bitter because they stimulate the already inflamed salivary glands to produce more saliva, which becomes more painful. Also, soothe the swollen parotid glands with a cool compress to help reduce the swelling.ComplicationsA person with a strong immunity will heal from mumps without any complications. However, those with weak immunity are likely to develop other complications, which can occur even without one suffering from swollen salivary glands.Experts note that in rare cases, serious complications can occur from suffering from mumps. Since the infection is viral, it easily gets into the blood stream and then moves to any part of the body. Complications happen when the virus reaches other body tissues.Dr Idro says, "Mumps may lead to meningitis (swelling of the membranes around the brain and spinal cord) or encephalitis (inflammation of the brain causing head, fever and neck stiffness). Fortunately, meningitis related to mumps rarely causes long-term problems."Encephalitis can also cause changes in consciousness, seizures and loss of muscle control.Mumps may also inflame and damage the pancreas leading to pancreatitis and damage of the insulin producing cells which is a long term risk of the child developing diabetes."The infection can also cause inflammation of the heart muscles, the kidneys. Also, poorly managed mumps can cause hearing loss and this complication can happen suddenly or over time. Hearing usually gets better after the illness,"Dr Asaba says.ReproductionA mumps infection after puberty can cause orchitis (swelling of the testes) and swollen testicles may lead to a decrease in the size of the testicle and a decline in fertility.Girls who after puberty suffer from mumps can develop swelling of the ovaries, a complication that causes pain, upset stomach, vomiting and fever. This condition, however, does not seem to affect fertility.When a woman gets mumps during the first 12 weeks of pregnancy, it may increase the risk of a miscarriage. Provided by SyndiGate Media Inc. (Syndigate.Info).

Mumps Can Cause Infertility In Men, Scientists Warn

Health experts have warned that mumps infection can affect the fertility of men by reducing the number of sperms and their ability to swim.Mumps is a viral disease which manifests with fever, puffy cheeks and swollen jaw. The outbreak of the disease which majorly affects children, was confirmed in Kampala, Wakiso and Mukono by the Health Ministry on May 3, 2023. Dr Esther Babirekere, a paediatrician at Mulago Hospital said in an interview last week that they have also seen increases in the number of children presenting with mumps at the facility.

"Some of that virus may go into private parts of the men and it affects the testis and those men may be infertile. We encourage people to vaccinate against this," Dr Babirekere said.According to the Ministry of Health, up to 75 percent of infertility in the country is caused by treatable infectious diseases. Between 10 and 15 percent of couples in the country cannot have children because of infertility, according to studies by the ministry officials.

Different research studies also indicate that between 35 percent and 50 percent of the reasons for infertility in families are contributed by men, contrary to the social construct which majorly blames women.A report by Dr Sahar Mohammed Zaki from Iraq which was published in the International Journal of Advanced Research, confirms the link between mumps and male infertility. But Dr Zaki states that age matters."Mumps can cause infertility in males if they are infected after puberty due to the rupture of the testis blood barrier and can affect the sperms either by decreasing the count or motility so it can lead to oligozoospermia (low sperm count) or asthenozoospermia (reduced sperm motility)," the 2016 report reads.The researcher also explained that mumps also can lead to the production of antibodies against sperm.

"[This] can be detected either in blood or seminal fluid and these antibodies mostly affect the motility of sperm in the seminal fluid or the movement of sperm in the female reproductive canal and this results in infertility," the report indicates.Dr Allan Muruta, the Commissioner for Public Health Emergencies at the Health Ministry, however, said mumps is not one of the priority diseases that they focus on because it is self-limiting."We don't have the vaccine in government. It is not because of the cost, but maybe because the disease is not very dangerous. It is possible that parents have become more aware and active in what is happening to their children. Most of us got the infection when we were still young," he said.

Dr Babirekere of Mulago Hospital said the vaccine is in private facilities. Our quick survey found that one can access it at around 80,000 from private players.However, some health experts and researchers believe that the risk of infertility due to mumps is very low and may only be temporary. According to information from the National Health Service (NHS) of England, under half of all males who get mumps-related orchitis (inflammation of testicles) notice some shrinkage of their testicles."…an estimated 1 in 10 men experience a drop in their sperm count (the amount of healthy sperm their body can produce). However, this is very rarely large enough to cause infertility," the information from NHS reads.

Trained Immunity: Its Role In COVID-19 And Potential In Preparing For Future Infectious Outbreaks

In a recent review published in Cell Host & Microbe, researchers reported on the contribution of trained immune responses to protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and future pandemics.

Study: The role of trained immunity in COVID-19: Lessons for the next pandemic. Image Credit: Corona Borealis Studio/Shutterstock.Com Background

Trained immunity refers to a long-term enhancement in the cellular responsiveness of the innate immunological system induced by particular vaccines and infections. During the three years of the coronavirus disease 2019 (COVID-19) pandemic, vaccines that can induce trained immunological responses have been investigated for their immunological induction capabilities to enhance protection against COVID-19.

About the review

In the present review, researchers reviewed existing data on the potential widening of the therapeutic landscape of COVID-19 by vaccines that induce trained immunological responses.

Trained immune responses generated by non-COVID-19 vaccines

Methods that boost innate immunological responses during the initial days of SARS-CoV-2 infection before activating antigen-targeted B and T lymphocyte responses would improve COVID-19 outcomes by inhibiting SARS-CoV-2 replication and halting disease progression. Studies have reported that specific vaccines, particularly those comprising live but attenuated microorganisms, can confer immune protection against non-target organisms.

Multiple immunological mechanisms regulate the effects, including cross-protective T lymphocyte response induction and a long-term enhancement in innate immune cell functioning. Of note, trained immunity does not depend on the causative antigen and can confer broad and cross-reactive immune protection.

The molecular substrates are denoted by metabolic and epigenetic cellular rewiring, resulting in improved chromatin availability and transcription of genes critical for defense. Vaccines that can induce trained immunological responses include Bacillus Calmette-Guerin (BCG), oral polio vaccine (OPV), measles-mumps-rubella (MMR), and influenza vaccines.

The vaccines produce functional and transcriptional programs of trained immunity. BCG vaccines activate myelopoiesis and functionally enhance myeloid cells, whereas influenza vaccines comprising the ASO3 adjuvant induce more robust interferon (IFN)-mediated responses against SARS-CoV-2. Intravenous BCG vaccinations enhance B and T lymphocyte responses following SARS-CoV-2 exposure and improve serological immune responses to anti-SARS-CoV-2 vaccines.

Studies using K18-human angiotensin-converting enzyme 2 (hACE2) mice have reported that BCG vaccines lower viral load, pathological damage to tissues, recruitment of inflammatory cells, and production of pro-inflammatory cytokines. BCG vaccines generated cross-reactive anti-SARS-CoV-2 antibodies and induced trained immunological responses such as the differentiation of myeloid cells and the activation of glycolytic pathways in the murine animals.

Animal studies indicated that BCG vaccines rapidly induce monocyte and T cell activation against SARS-CoV-2, likely due to direct bone marrow involvement. Epidemiological studies showed that BCG vaccinations during childhood prevent COVID-19 incidence and lower its severity in particular geographic locations such as South America and Africa, and BCG vaccines were more effective among older, immunocompromised individuals than young healthcare workers and following repeated doses than a single dose. BCG vaccines could amplify the immunogenicity of messenger ribonucleic acid (mRNA)- and adenovirus-based SARS-CoV-2 vaccines and their durability of protection.

Trained immunity produced by SARS-CoV-2 infections and lessons learned from the pandemic

Immunological defects in COVID-19 vary according to the strength of host defenses. In the case of effective immunological responses in the initial stage of COVID-19, SARS-CoV-2 replication is inhibited, leading to low levels of generalized inflammation and viremia and improved survival. In the case of defective host responses in the initial asymptomatic phase of COVID-19, SARS-CoV-2 multiplies rapidly in the host, resulting in a hyperinflammatory state and a worsened COVID-19 prognosis.

Infections by SARS-CoV-2 induce strong, trained immunological responses, which might contribute to prolonged inflammatory complications of infections by SARS-CoV-2. Indeed, post-COVID-19 syndrome (PCC) patients have demonstrated transcriptional dysregulations in their innate immunological system, with elevated IFN-I and III levels persisting beyond six months of acute COVID-19.

Trained immune responses following SARS-CoV-2 infections comprise increased interleukin-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) chemokine levels. Trained immunity-inducing vaccines authorized for use can become efficient tools for bridge vaccinations to mitigate the healthcare burden and economic consequences of pandemics. The trained responses may also enhance the COVID-19 vaccines' effectiveness.

Conclusions

Based on the review findings, experimental animal studies have shown that intravenously administered BCG vaccines can protect against COVID-19 by inducing trained immunological responses. Vaccines that can train the immune system, i.E., Shingrix, MMR, and BCG, can lower COVID-19 severity and associated mortality.

BCG vaccinations also improve humoral and cellular immune responses to various COVID-19 vaccine types, including adenovirus- and mRNA-based ones, and novel SARS-CoV-2 vaccines can confer long-term trained immune protection. However, vaccines that train the immune system cannot lower the total COVID-19 case counts, except for influenza, OPV, and multiple doses of BCG vaccines.

Infections by SARS-CoV-2 can also induce strong trained immunological responses in a few individuals, contributing to inflammatory complications in the long run. The review findings could inform vaccine development to harness the immunological potential of trained immunity and improve global preparedness for future pandemics. However, further research, including large-scale randomized controlled trials, is required for definitive inferences from the review findings.

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