Just when we thought that morbidities and mortalities from COVID-19 are declining across the world, some other viral infections are posing a threat to humanity. This situation may also be compounded by the possible emergence of more transmissible and mode deadly SARS-CoV-2 variants. Amidst these grim prospects, we also have happy news. India has just approved her first indigenously developed vaccine for cervical cancer, a malicious cancer that kills around 75,000 women every year in India alone. In today’s column let’s deliberate upon these developments.
About 100 cases of a new viral infection named “Tomato Flu” have been reported in India (The Hindu, Sep 2, 2022). According to a Lancet Respiratory Medicine report, the first case was logged in Kollam district of Kerala on May 6, 2022 (Scroll, August 31, 2022). Tomato flu is still in an endemic state and is confined to children below the age of 9.
What triggered this viral infection is still unknown. Experts have warned that, if left unchecked, the virus could spread to adults. The causative agent is a virus called Coxsackievirus A16 (a non-polio enteric virus). So far, there have been no fatalities and the infection resolved by itself in a short time. The infection can spread from person to person through body fluids and feco-oral route. Infected individuals must be isolated for at least 5 days to prevent the spread from body secretions, fluids from skin blisters or other means.
The main symptoms include high fever, joint pains, red blisters and sores in hand, foot, and mouth; some of which may grow to the size of a tomato. That’s why the malady has been named tomato flu (tomato fever); some people also call it hand, foot, and mouth disease (HFMD). The symptoms are similar to that of chikungunya and dengue. Possible treatments include isolation, rest, administration of plenty of fluids and hot water sponges to alleviate the pain.
Paracetamol and other symptomatic treatments can also be used to take care of the fever and pain.
As yet, no specific drugs or vaccines are available for tomato flu.
A new variant of the monkeypox virus has been detected in the UK (India TV News, Sep. 2, 2022). It was found in a person who recently travelled to West Africa. Though contact tracing is underway, no other linked cases have been reported so far. Genital lesions and sores on the mouth or anus have been included as symptoms of monkeypox by an international group of experts. Sexual contact is the most likely cause of the spread of this virus; gay and bisexual men are predominantly affected by the spread of this viral infection. Monkeypox may also be spread by contact with body fluids and contaminated clothing of sick individuals.
Meanwhile, the WHO has introduced a naming system for monkeypox variants that precludes stigmatizing the countries of origin. The original Congo strain has been placed in Clade I and the West African one as Clade II. Clade II has further been classified into two sub-groups: Clade IIa and Clade IIb (WHO, Aug. 12, 2022).
Indigenous Cervical Cancer Vaccine
An India-made vaccine for cervical cancer has been released recently (The Hindu, Sep 1, 2022). Over 1.25 lakh women in India are hit by cervical cancer every year. About 75,000 women in India die from this malicious cancer annually. This cancer is mainly caused by infection with a virus called Human Papilloma Virus (HPV). The virus comes in a variety of variants. Majority of women are infected by one or another type of HPV; but, less than 1% of infected individuals have infections that lead to development of cervical cancer. Though HPV infections can cause skin or genital warts in males, the largest fatality is in females from cervical cancer due to HPV infections.
Cervical cancer is the 4th most common cancer in women globally. In 2020 alone, there were 604,000 new cases and 340,00 deaths globally. Two vaccines have already been developed elsewhere.
Gardasil is a vaccine developed by Merck company and is a quadrivalent vaccine i.e., it can target four variants of HPV. Cervarix is another vaccine which was developed by GlaxoSmithKline (GSK) and is a bivalent vaccine. India’s vaccine, developed by Serum Institute of India (SII), is a quadrivalent vaccine and it has been named Cervivac. These vaccines produce virus-like particles (VLPs) inside the body that elicit an antibody response against HPV thus protecting women against the deadly cervical cancer.
The major problem of existing vaccines by Merck and GSK is that they are nor affordable by most women in poor countries including India. Cervivac has been priced at just Rs. 200-400 per shot. It is priced about 10 times lower than foreign vaccines.
Cervivac comes as a lifesaver for tens of thousands of Indian women who would have been susceptible to the deadly cervical cancer caused by HPV.
Cervical cancer is most frequently diagnosed in women from age 35 to 44. The average age at diagnosis is usually 50. This cancer rarely strikes women below the age of 20.
Emerging COVID Variants
The WHO has recently warned that new COVID variants that are more transmissible and more deadly may emerge in the near future (The Mint, Sep. 1, 2022). Therefore, all countries must abide by protocols to prevent infections as well as to prevent infections from leading to serious disease.
On the other hand, scientists have warned that Omicron variants, especially BA.5 can re-infect you very efficiently even if you have had Omicron infections earlier (The Daily Pioneer, July 24, 2022). Reinfections may occur within weeks of a prior infection. In a way, you may be re-infected by a lineage of BA.5 almost every month. BA.5 seems to be a stealthy invader; it can break through vaccine defenses and our immune system finds it difficult to recognize it as an enemy and mount an immune response against it, according to Prof. David Altmann, Dept. of Immunology and Inflammation, Imperial College of London (ICL).
Updated COVID vaccines specific against Omicron, besides the original Wuhan strain, have recently been approved in the UK and USA (Nature, Sep 1, 2022). These new editions of vaccines are bivalent, i.e., targeting both Wuhan and Omicron variants. However, they were not more effective in preventing Omicron infections than the currently used vaccines. Therefore, all of us must remain watchful about SARS-CoV-2 and its variants. Meanwhile, we need to enhance the rates of vaccinations for all eligible populations. In addition, all eligible people must get their booster shots as soon as feasible.
COVID-19 seems far from over. As our immunity fades over time, there is the likelihood of the emergence of new sub-variants. Therefore, we all must strictly follow the Covid-appropriate behavior. We also must be watchful about the possibility of the monkeypox virus spreading across the country.
We also must ensure that the adult population in India is fully vaccinated at the earliest. The possibility of vaccinating children below the age of 12 must also be looked into. And, immunocompromised people and those above 60 years of age must be given the 2nd booster doses at the earliest, if feasible. And, we must beware of new viral infections such as tomato flu and the possible rise of superbugs.
(The views expressed are personal)