Mr. Reginald Arthur-Mensah¹, Mr. Paa Kofi Tawiah Adu-Gyamfi¹ & Dr. Abigail Kyei¹.

¹Department of Nursing and Midwifery, 51����.

The control of COVID-19 has seen vaccine development move at record speed with more than 170 different vaccines in trials. But how are these vaccines prepared and how will they protect us against the disease? Before we delve into that, let us understand what vaccines and their related procedures are.

Vaccines

Vaccines are products that help the immune system combat invading disease-causing microorganisms of the body (Coelho, 2020). They are scientifically prepared biological formulations that provide protection to the body from certain diseases (Tortora, Funke & Case, 2019).

Vaccines can be administered via;

• Oral route – administered through the mouth
• Intranasal route – administered through the nose
• Subcutaneous route – Injected into an area just beneath the skin
• Intramuscular route – injected into the muscles
• Intradermal route – injected into layers of the skin (CDC, 2021).

Vaccination

Vaccination is the act of receiving a vaccine as protection against contracting certain particular diseases (WHO, 2021).

The principle of vaccines and vaccination

Vaccines contain suspensions of weakened, killed, fragmented, toxins of microorganisms or antibodies to certain microorganisms (Brunson, 2020). Vaccines train the immune system to detect and fight diseases-causing microorganisms. Vaccines and vaccination teach the immune system to “destroy” and “remember” diseases-causing microorganisms (see Figure 1). This act begins the process of immunization/immunity to that particular disease or diseases (CDC, 2021).

Vaccination is the safest, simple and effective method of protecting people from certain harmful diseases before they come into contact with them. Unlike most medicines, which treat and/or cure diseases, vaccines prevent diseases.

Figure 1: How vaccines work

Source: Brunson, (2020).

The four major types of COVID-19 vaccines

There are more vaccine candidates simultaneously in the pipeline for COVID-19 than ever before for an infectious disease. All of them are trying to achieve the same thing; immunity to the virus. They do so by stimulating an immune response to an antigen, a molecule found on the virus. In the case of COVID-19, the antigen is typically the characteristic spike protein (S protein) found on the surface of the virus, which it normally uses to help it invade human cells (see Figure 2).

There are four categories of COVID-19 vaccines in clinical trials. They include; whole virus, protein subunit, nucleic acid (RNA and DNA) and viral vector (Gavi, 2021).

Figure 2: SARS CoV 2 (Causative agent of COVID-19)

Source: Coelho, 2020.

Whole virus

Whole virus vaccines use a weakened (attenuated) or deactivated form of the virus that causes a disease to trigger protective immunity to it. There are two types of whole virus vaccines. Live attenuated vaccines use a weakened form of the virus, which can still grow and replicate, but does not cause illness. Inactivated vaccines contain viruses whose genetic material has been destroyed by heat, chemicals or radiation so that they cannot infect cells and replicate, but can still trigger an immune response.

Protein subunits (fragments of microbes)

Rather than injecting a whole virus to trigger an immune response, subunit vaccines (sometimes called acellular vaccines) contain purified pieces of it, which have been specially selected for their ability to stimulate immune cells. Because these fragments are incapable of causing disease, subunit vaccines are considered very safe. There are several types: protein subunit vaccines contain specific isolated proteins from viral or bacterial pathogens; polysaccharide vaccines contain chains of sugar molecules (polysaccharides) found in the cell walls of some bacteria; conjugate subunit vaccines bind a polysaccharide chain to a carrier protein to try and boost the immune response. However, the immune response might be weak.

Nucleic acids

Nucleic acid vaccines use genetic material from a disease-causing virus or bacterium to stimulate an immune response against it. Depending on the vaccine, the genetic material could be DNA or RNA; in both cases it provides the instructions for making a specific protein from the pathogen, which the immune system will recognise as foreign (an antigen). Once injected into host cells, this genetic material is read by the cell’s own protein-making machinery and used to manufacture antigens, which then trigger an immune response. Since the antigens are produced using the body’s own cells and in large quantities, the immune reaction is strong.

Viral vectors

Viral vector-based vaccines differ from most conventional vaccines in that they don’t actually contain antigens, but rather use the body’s own cells to produce them. They do this by using a modified virus (the vector) to deliver genetic code for antigen, in the case of COVID-19, spike proteins found on the surface of the virus, into human cells. By infecting cells and instructing them to make large amounts of antigen, which then trigger an immune response, the vaccine mimics what happens during natural infection with certain pathogens, especially viruses. This has the advantage of triggering a strong cellular immune response by T cells as well the production of antibodies by B cells.

Vaccines are the new tool in the fight against COVID-19 and it is hugely encouraging to see so many vaccines proving successful and going into development. Working as quickly as they can, scientists from across the world are collaborating and innovating to bring us treatments and vaccines that will collectively save lives and end this pandemic.

However, but for the foreseeable future we must continue wearing face protection, practicing hand hygiene, practicing respiratory hygiene and ensuring physical distancing and all the other specific COVID-19 safety protocols. Being vaccinated does not mean that we can throw caution to the wind and put ourselves and others at risk, we must continue to live safe.

References

Brunson, E., K. (2020). Vaccines. Encyclopaedia Britannica. (Accessed March 20, 2021).

CDC, (2021). Vaccines: The Basics. Retrieved from . (Accessed March 18, 2021).

Coelho, S., (2020). What is a vaccine? Types, stages for approval. Retrieved from . (Accessed March 20, 2021).

Gavi (2021). The four types of COVID-19 vaccines. Retrieved from . (Accessed March 17, 2021).

Tortora, G., J., Funke, B., R., & Case, C., L., (2019). Microbiology: An introduction. Pearson Education Inc, Boston, USA.

WHO, (2021). Vaccines and Immunization: What is vaccination? Retrieved from . (Accessed March 19, 2021).

Click to download PDF: Vaccines, Vaccination and the four types of COVID-19 Vaccines (1)

Dr Mrs Abigail Kyei (Department of Nursing and Midwifery, 51����)

Introduction

A new strain of the SARS-COV2, the virus causing the ongoing COVID-19 pandemic, of the coronavirus family, threatens to further overburden the already overwhelmed health care facilities and systems across the globe. The new strain is the SARS-COV2 VUI 202012/01 or B.1.1.7. The strain was first detected in September 2020, in southeastern England and has since accounted for about 60% of cases in the country.

Features of the new strain of the virus

The new strain has several genetic mutations especially on its “spike proteins” on the viral cell surface which it uses to attach to the human host cells (see Figure 1 and 2). Thus, this makes the new strain attach to the human host cells more readily and efficiently making it easier for the virus to enter into the host cells to cause disease. It is estimated that these mutations can make the virus up to 70% more transmissible. However, there is no evidence that it is linked to a higher risk of hospital admissions or deaths. At least, 17 mutations in the spike proteins have been identified but mutation G614 is of urgent concern. (see Figure 2).

Countries the new stain has been detected

The new strain has been detected in about 33 countries including; Australia, Belgium, Brazil, Canada, Chile, China, Denmark, Finland, France, Germany, Iceland, India, Ireland, Israel, Italy, Japan, Jordan, Lebanon, Malta, The Netherlands, Norway, Pakistan, Portugal, Singapore, South Korea, Spain, Sweden, Switzerland, Taiwan, Turkey, the United Arab Emirates, the United Kingdom and the United States of America.

In Africa, South Africa also identified a strain similar to the B.1.1.7 in October. The strain is B.1.351. It appears to spread more easily and quickly but it is not more severe. Another variant has recently been detected in Nigeria, but there is no evidence of easy transmissibility and higher virulence.

The new strain and the COVID-19 vaccines

Current evidence suggests that most mutations of the new strain are on the viral spike proteins as earlier mentioned. It is these spike proteins the COVID-19 vaccines target. The vaccines are expected to elicit antibody reactions against many parts of the viral spike proteins; hence, it is unlikely that a single new mutation in the virus will make the vaccine less effective.

What to expect

The virus that causes COVID-19 will keep changing. That is what simply happens to microorganisms as they continue their infectivity in human populations. The scientific community continues to sample positive cases for new strains of the virus. However, it is unlikely to predict how the viral mutations might affect the pathophysiology of the disease until large data are analyzed.

Preventive measures against the new strain

The preventive measures against this new strain follow the precautionary and preventive measures against the original strain. They include;

1. The regular washing of hands with soap under running water.
2. The intermittent sanitizing of the hands with an alcohol-based hand rub.
3. Avoidance of touching the T zone of the face as well as the eyes, nose and mouth.
4. Wearing of face protection e.g., nose masks, face shields at all times.
5. Practising physical distancing and staying away from crowds and large groups of people.
6. Refraining from smoking and other activities that weaken the lungs.
7. Staying home if one feels unwell.

This new strain may be more infective, but it still relies on humans to spread it. Let us stop the spread of the virus by adhering to all the precautionary measures stated above. Let us all endeavour to stay safe. As of January 3, 2021, over 85 million people have been infected with the virus, 48 million people have recovered from the disease with about 1.8 million deaths worldwide (WHO, COVID-19, 2021)

References

Strains of Coronavirus. Retrieved from . (Accessed January 2, 2021).

WHO Coronavirus Disease (COVID-19) Dashboard. Retrieved from . (Accessed January 3, 2021).

Download pdf: The Pink Month The Pink Man (1)

Introduction

Everyone, irrespective of gender, is born with some amount of breast tissue. The breast tissue consists of the milk-producing glands (called the lobules) and the ducts that carry the milk produced to the nipples (see Figure 1). During puberty, females begin to develop more breast tissue than males. Additionally, the female breast cells are constantly exposed to the growth-promoting effects of the female hormones, oestrogen and progesterone. Apropos, the males eventually do not develop milk-producing breasts. This is what likely predisposes females to develop breast cancer than males. However, because males also have some amount of breast tissue, they can also develop breast cancer.

Recently, the Ashanti Regional Directorate of the Ghana Health Service expressed concern with the increasing cases of breast cancer especially among men in the Ashanti region of Ghana. It was indicated that, out of a population of 40 men in the region, up to three men suffer from the disease (Kasapafmonline.com).

This calls for the creation of awareness coupled with continuous education on the subject of breast cancer, especially amongst men today.

Figure 1: The breast tissue

Source: American Cancer Society, 2020

Causes of male breast cancer

Theoretically, male breast cancer occurs when some cells of the breast begin to divide more rapidly than the normal cell division of the breast. The rapidly dividing cells form a tumour that may spread to nearby tissues such as the lymph nodes or to other parts of the body (see Figure 2).

Figure 2: Tumour size chart of breast cancer

Source: Medical News, 2020.

General types of male breast cancer

• Lobular carcinoma (cancer that begins in the milk-producing glands)
• Ductal carcinoma (cancer that begins in the milk ducts)

Risk factors of male breast cancer

Factors that increase the risk of male breast cancer include;

• Older age
• Exposure to oestrogen such as taking oestrogen related drugs e.g. drugs used for hormone therapy for prostate cancer
• Family history of breast cancer
• Klinefelter’s syndrome (A genetic disorder where males are born with more than one copy of the X chromosome. As a result, such males produce lower levels of certain male hormones and more female hormones)
• Liver disease
• Obesity
• Testicle diseases or surgery

Symptoms and signs of male breast cancer

• A painless lump that does not move around within the breast or thickening in your breast tissue
• Changes to the skin covering your breast, such as dimpling (a slight depression of the skin around the breast), puckering (irregular folding in the skin around the breast), redness around the skin covering your breast
• Changes to your nipple, such as redness around the skin covering your breast, a rash around the nipple, a nipple that begins to turn inward and pain in the nipple area
• Discharge from your nipple which may be stained with blood (see Figure 3).

Figure 3: Symptoms and signs of male breast cancer

Source: AABCA, 2020.

Diagnosis of male breast cancer

• Routine physical exams (breast self-examinations)
• Mammography (using X rays)
• Biopsies (examining samples of breast tissue under the microscope)

Treatment of male breast cancer

Generally, male breast cancer detected early have a high probability for treatment success. Treatment options include;

• Surgery to remove the breast tissue
• Chemotherapy
• Radiation therapy
• Hormone therapy
• Targeted therapy

Prevention of male breast cancer

The following measures are recommended as guidelines to help prevent breast cancer in men. They include;

• Avoidance of smoking
• Regular exercise
• Eating a healthy diet, with an emphasis on plant-based foods
• Limiting the consumption of red meats and processed meats
• Maintaining a healthy weight
• Limiting or avoidance of alcohol consumption altogether

The month of October is designated by the WHO as the Breast Cancer Awareness month. It is observed to increase attention and support for the awareness, early detection, treatment as well as palliative care for the disease.

We, therefore, leave you with these thoughts and reminders;

• Breast cancer is not limited to women alone
• Breast cancer in men is real
• Breast cancer in men is avoidable
• Practice regular breast self-examinations and breast cancer screening test.

Let us all stay safe and healthy by adhering to the above preventive measures.

References:

American Cancer Society, (2020). What is breast cancer in men? (Accessed October 2, 2020).

A/R: Breast Cancer among men on the rise; voluntary screening crucial. kasapafmonline.com (Accessed October 1, 2020).

African American Breast Cancer Alliance (AABCA) (2020). Breast Cancer 411. Retrieved from aabcainc.org (Accessed October 2, 2020).

Medical News Today, 2020. How does tumour size relate to breast cancer stage? Your breast cancer diagnosis. Retrieved . (Accessed October 3, 2020).

Mr Reginald Arthur-Mensah Jnr (Department of Nursing and Midwifery, 51����).

Dr Mrs Abigail Agartha Kyei (Department of Nursing and Midwifery, 51����).

Download PDF: Microbiology of SARS CoV2 amid school reopening

Reginald Arthur-Mensah Jnr (Department of Nursing and Midwifery, 51����).

Abigail Agartha Kyei (Department of Nursing and Midwifery, 51����).

Introduction

The World Health Organization (WHO) declared a global health emergency of international concern on January 30, 2020, due to the novel coronavirus disease which is caused by the SARS CoV2 virus. On February 11, 2020, WHO announced a name for the new coronavirus disease as COVID-19. On March 12, 2020, the disease was declared a pandemic¹. To curb the spread of the disease in Ghana, on March 15, 2020, the government announced a series of comprehensive measures, including the closure of all schools; Basic, Junior High, Senior High and Universities. This move negatively affected some 9.2 million basic school students (kindergarten, primary and junior high schools) and 1 million tertiary education students². Ongoing terms/semesters/trimester were interrupted and upcoming terms/semesters/trimester cannot begin until they are adapted to the new reality.

As of 6th May 2020, UNESCO estimated that 192 countries have temporarily closed schools worldwide, impacting over 1.6 billion learners globally². The scale and speed of school closures were unprecedented worldwide. Never before had so many students been out of school at the same time, disrupting learning and upsetting visions of the youth. School closures were based on evidence and suggestions from the previous influenza outbreaks that they reduce physical contacts between persons and therefore interrupt transmission of infections³.

There is an urgent need to identify how countries can safely return students to school and parents to work once the number of COVID-19 cases begins to fall. The decision to reopen schools for in-person educational instruction is among the greatest challenges of many governments. Around the world, this has become a contentious issue, with students, their families, and educators expressing strong opinions about what is best for them. There has never been a more important time for open discussion and collaboration with the goal of reaching a consensus on the reopening of schools while protecting the health and well-being of students and educators during the COVID-19 pandemic.

The best way to avert and slow down transmission in the midst of school reopening is to be well informed about the characterization of the COVID-19 virus, how it spreads from one source to another, the pathogenesis of the disease, the pathophysiology of the disease and how it can be prevented. Be that as it may, the pandemic is expected to have significant long-term effects on education.

Characteristics in Coronaviruses

Coronaviruses (CoVs) are enveloped, positive-sense, single-stranded RNA viruses that belong to the subfamily Coronavirinae, family Coronaviridiae, order Nidovirales. There are four genera of CoVs, namely, Alphacoronavirus (α��dz�), Betacoronavirus (β��dz�), Deltacoronavirus (δCoV), and Gammacoronavirus (γ��dz�)⁴. Evolutionary analyses have shown that bats and rodents are the gene sources of most αCoVs and βCoVs, while avian species are the gene sources of most δCoVs and γCoVs⁴. CoVs have repeatedly crossed species barriers and some have emerged as important human pathogens. The best-known examples include severe acute respiratory syndrome CoV (SARS-CoV) which emerged in China in 2002–2003 to cause a large-scale epidemic with about 8000 infections and 800 deaths, and Middle East respiratory syndrome CoV (MERS-CoV) which has caused a persistent epidemic in the Arabian Peninsula since 2012⁵.

Prior to December 2019, 6 CoVs were known to infect human, including 2 αCoV (HCoV-229E and HKU-NL63) and 4 βCoV (HCoV-OC43 [lineage A], HCoV-HKU1 [lineage A], SARS-CoV [lineage B] and MERS-CoV [lineage C]). The βCoV lineage A HCoV-OC43 and HCoV-HKU1 usually cause self-limiting upper respiratory infections in immunocompetent hosts and occasionally lower respiratory tract infections in immunocompromised hosts and the elderly⁵. In contrast, SARS-CoV (lineage B βCoV) and MERS-CoV (lineage C βCoV) may cause severe lower respiratory tract infections with acute respiratory distress syndrome and extrapulmonary manifestations, such as diarrhoea, lymphopenia, deranged liver and renal function tests, and multiorgan dysfunction syndrome, among both immunocompetent and immunocompromised hosts with mortality rates of ∼10% and ∼35%, respectively⁶

SARS-CoV2 has a diameter of 60 nm to 140 nm and distinctive spikes, ranging from 9 nm to 12 nm, giving the virions the appearance of a solar corona (see Figure 1). Bats are thought to be a natural reservoir for SARS-CoV2, but it has been suggested that humans became infected with SARS-CoV2 via an intermediate host, such as the pangolin⁷.

Generally, coronaviruses cause respiratory, gastrointestinal and neurological disease⁸.

Transmission of SARS-CoV2

Human respiratory droplets expelled during face-to-face exposure during talking, coughing, or sneezing is the most common mode of transmission. Prolonged exposure to an infected person i.e. being within 6 feet for at least 15 minutes and briefer exposures to individuals who are symptomatic (e.g., coughing) are associated with a higher risk for transmission, while brief exposures to asymptomatic contacts are less likely to result in transmission⁹. Contact surface spread i.e. touching a surface with SARS CoV2 on it is another possible mode of transmission⁸. Transmission may also occur via aerosols i.e. smaller respiratory droplets that remain suspended in air, but it is unclear if this is a significant source of infection in humans, however, it is associated with the low-risk transmission of the virus¹⁰.

Pathogenesis of SARS-CoV2

Upon contact with the virus from an infected source through any of the routes of transmission, the virus enters the human host cell. To be successful, the virus targets human host cells, such as nasal cells (relating to the cells that line the nose), bronchial epithelial cells (relating to cells that line the bronchus) and pneumocytes (relating to the cells that line the alveoli)⁸. They attach to these cells through the viral structural spike, (S) protein (see Figure 1) that binds to the angiotensin-converting enzyme 2 (ACE2) receptor. After binding, the type 2 transmembrane serine protease (TMPRSS2), present in the human host cell promotes viral uptake into the cells by cleaving ACE2 and activating the SARS-CoV2 S protein (see Figure 2A). Activation of the S protein mediates the virus to enter the host cells through endocytosis. Endocytosis is the process by which the cell membranes of a cell folds inwards to ingest the material. This mechanism is possible through the receptor-binding domain (RBD) between SARS-CoV2 S proteins and ACE2 and TMPRSS2 human host target cells. These human host receptors are particularly expressed in alveolar epithelial type II cells (cells of the tiny air sacs of the lungs)¹¹.

Figure 1: Structural details of SARS CoV2¹²

Pathophysiology of SARS-CoV2

On entry, viral replication begins. The viral inflammatory response, consisting of both the innate and the adaptive immune response i.e. comprising the humoral and cell-mediated immunity, impairs lymphopoiesis i.e. the formation of lymphocytes in the bone marrow, lymph nodes, thymus and spleen and increases lymphocyte apoptosis i.e. a type of cell death in which the cell uses specialized cellular machinery to kill itself. As such, profound lymphopenia i.e. an abnormally small number of lymphocytes in the circulating blood may occur. This allows the virus to infect and kill T lymphocyte cells of the host⁸ (see Figure 2B).

As viral replication, transcription and translation accelerate and infection continues, the epithelial-endothelial barrier integrity of the alveolar is compromised (see Figure 2C). In addition to the epithelial cells, the virus infects pulmonary capillary endothelial cells, heightening the inflammatory response and triggering an influx of monocytes and neutrophils into the alveolar. Interstitial mononuclear inflammatory infiltrates and edema i.e. swelling from excessive accumulation of watery fluid in cells, tissues, or serous cavities, develop and appear as ground-glass opacities on computed tomographic (CT) imaging. Pulmonary edema filling the alveolar spaces with hyaline membrane formation follows, compatible with early-phase acute respiratory distress syndrome (ARDS). Bradykinin-dependent lung angioedema may also contribute to the disease¹³. Collectively, endothelial barrier disruption, dysfunctional alveolar-capillary oxygen transmission, and impaired oxygen diffusion capacity are characteristic features of COVID-19⁸.

Further, fulminant (sudden and severe) activation of coagulation and consumption of clotting factors occur leading to diffuse intravascular coagulation. Inflamed lung tissues and pulmonary endothelial cells may result in the microthrombi formation and contribute to the high incidence of thrombotic complications, such as deep venous thrombosis, pulmonary embolism and thrombotic arterial complications such as limb ischemia, ischemic stroke, myocardial infarction in critically ill patients. The development of viral sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection may further contribute to multiorgan failure including the heart, brain, lung, liver, kidney and the coagulation system¹⁴.

Figure 2: Pathogenesis and pathophysiology of SARS CoV2⁸

Symptoms of COVID-19

COVID-19 affects different people in different ways. Averagely, it takes 5 – 6 days from when someone is infected with the virus for symptoms to show, however it can take up to 14 days. Most infected people will develop mild to moderate illness and recover without hospitalization. Some may also develop severe complications of the disease or other comorbidities and death may result. Currently, the most serious symptoms include difficulty breathing or shortness of breath, chest pain or pressure and loss of speech or movement. Most common symptoms include fever, dry cough and general fatigue. The fewer common symptoms are aches and pains, sore throat, diarrhoea, conjunctivitis, headache, loss of taste or smell, a rash on skin and discolouration of fingers or toes¹⁵.

School reopening

As students prepare to come to school, it is cardinal for both educators and students to adhere to the following precautionary and preventive measures against the ongoing pandemic.

1. The regular washing of hands with soap under running water before and after lectures
2. The intermittent sanitizing of the hands with an alcohol-based hand rub during a lecture
3. Avoidance of touching the T zone of the face as well as the eyes, nose and mouth
4. Wearing of face protection e.g. nose masks, face shields at all times on return to campus
5. Practising physical distancing in the classrooms, social gatherings and staying away from crowds and large groups of people.
6. Refraining from smoking and other activities that weaken the lungs.
7. Staying home if one feels unwell.

Moreover, general school infection prevention and control practices should be enforced more effectively at this time.

Education is one of the strongest predictors of the health and the wealth of a country. Giving schools the support they need to confront COVID-19 could result in safe, healthy, and thriving environments for students and ultimately recognize education as a critical determinant of development in countries.