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Wednesday, May 5, 2021

Focused ultrasound enables precise noninvasive nerve therapy

 Carnegie Mellon University's He Lab is focusing on noninvasive neuroengineering solutions that not only provide diagnostic techniques, but also innovative treatment options. Their latest research has demonstrated that noninvasive neuromodulation via low-intensity ultrasound can have cell-type selectivity in manipulating neurons.

Parkinson's Disease, epilepsy and insomnia are just a few of the neurological disorders that use neuromodulation treatment techniques today. Neuromodulation delivers controlled physical energy to the nervous system to treat and improve patients' quality of life. Current neuromodulation approaches, while effective, bring both drawbacks and limitations.

"Deep brain stimulation, which is highly successful, but an invasive form of electric stimulation through implanted electrodes, is one example of how neuromodulation is being used in a clinical setting today," explained Bin He, professor of biomedical engineering at Carnegie Mellon University. "Medical professionals have also used noninvasive transcranial magnetic stimulation and transcranial current stimulation, both of which lack the ability to specifically focus on the neuro-circuit level. My group is interested in helping to develop a more effective and completely noninvasive alternative."

Low-intensity transcranial focused ultrasound, or tFUS, is an emerging and fully reversable neuromodulation technology. It is noninvasive, precise, and it does not require surgery. During tFUS neuromodulation, pulsed mechanical energy is transmitted through the skull, with high spatial resolution and selectivity, at highly-targeted brain regions, which can be steered to elicit activation or inhibition through parameter tuning.

In work recently published in Nature Communications, He's group demonstrated, for the first time, that specific cell types can be targeted through tFUS neuromodulation. Their study found that excitatory neurons showed high sensitivity to ultrasound pulse repetition frequency, while inhibitory neurons did not.

This finding is significant, because it demonstrates the first capability for a noninvasive neuromodulation technique to modulate a selected cell subpopulation, using a technique that can be directly translated for human use. With the demonstrated capability of tFUS to activate excitatory or inhibitory neurons, future applications may lead to precise targeting of brain circuits using focused ultrasound energy, and activate or inhibit selected sub-populations of neurons by tuning ultrasound parameters.

"As a result of our research, we obtained direct evidence that different neuron populations unequally respond to ultrasound stimulation in the brain," said Kai Yu, co-first author of the paper and a research scientist in He's lab at Carnegie Mellon University. "We identified a critical stimulation parameter that is able to tune the balance between excitatory and inhibitory neuronal activities, and we conducted thorough control experiments to support these valuable neuroscience findings."

The application of this research has broad implications; it's not just limited to one disease. For many people suffering from pain, depression and addition, He believes non-invasive tFUS neuromodulation could be used to facilitate treatment.

"If we can localize and target areas of the brain using acoustic, ultrasound energy, I believe we can potentially treat a myriad of neurological and psychiatric diseases and conditions," said He. "This type of treatment option has great potential to shift what doctors study in medical school and go on to practice. Of course, a noninvasive, precise, reversive treatment option also presents endless benefits for patients. My dream would be to make everything noninvasive."

He's next goal is to further develop the tFUS neuromodulation technology with increased spatial resolution and focality, and directly test the applicability of tFUS to treat brain conditions in humans.


Story Source:

Materials provided by College of Engineering, Carnegie Mellon University. Original written by Sara Vaccar. Note: Content may be edited for style and length.


Journal Reference:

  1. Kai Yu, Xiaodan Niu, Esther Krook-Magnuson, Bin He. Intrinsic functional neuron-type selectivity of transcranial focused ultrasound neuromodulationNature Communications, 2021; 12 (1) DOI: 10.1038/s41467-021-22743-7

Personalized sweat sensor reliably monitors blood glucose without finger pricks

 Many people with diabetes endure multiple, painful finger pricks each day to measure their blood glucose. Now, researchers reporting in ACS Sensors have developed a device that can measure glucose in sweat with the touch of a fingertip, and then a personalized algorithm provides an accurate estimate of blood glucose levels.

According to the American Diabetes Association, more than 34 million children and adults in the U.S. have diabetes. Although self-monitoring of blood glucose is a critical part of diabetes management, the pain and inconvenience caused by finger-stick blood sampling can keep people from testing as often as they should. Scientists have developed ways to measure glucose in sweat, but because levels of the sugar are much lower than in blood, they can vary with a person's sweat rate and skin properties. As a result, the glucose level in sweat usually doesn't accurately reflect the value in blood. To obtain a more reliable estimate of blood sugar from sweat, Joseph Wang and colleagues wanted to devise a system that could collect sweat from a fingertip, measure glucose and then correct for individual variability.

The researchers made a touch-based sweat glucose sensor with a polyvinyl alcohol hydrogel on top of an electrochemical sensor, which was screen-printed onto a flexible plastic strip. When a volunteer placed their fingertip on the sensor surface for 1 minute, the hydrogel absorbed tiny amounts of sweat. Inside the sensor, glucose in the sweat underwent an enzymatic reaction that resulted in a small electrical current that was detected by a hand-held device. The researchers also measured the volunteers' blood sugar with a standard finger-prick test, and they developed a personalized algorithm that could translate each person's sweat glucose to their blood glucose levels. In tests, the algorithm was more than 95% accurate in predicting blood glucose levels before and after meals. To calibrate the device, a person with diabetes would need a finger prick only once or twice per month. But before the sweat diagnostic can be used to manage diabetes, a large-scale study must be conducted, the researchers say.


Story Source:

Materials provided by American Chemical SocietyNote: Content may be edited for style and length.


Journal Reference:

  1. Juliane R. Sempionatto, Jong-Min Moon, Joseph Wang. Touch-Based Fingertip Blood-Free Reliable Glucose Monitoring: Personalized Data Processing for Predicting Blood Glucose ConcentrationsACS Sensors, 2021; DOI: 10.1021/acssensors.1c00139

Risk for severe COVID-19 increases with BMI above 23

 The risk for severe COVID-19 leading to hospital admission and death is increased at a body mass index (BMI) of more than 23 kg/m2, according to a study published online April 28 in The Lancet Diabetes & Endocrinology.

Min Gao, from the University of Oxford in the United Kingdom, and colleagues conducted a community-based cohort study using deidentified patient-level data to examine the association of obesity with adverse outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Data were included for 6,910,695 eligible individuals (mean BMI, 26.78 kg/m2).

The researchers found that 0.20 percent of the eligible individuals were admitted to the hospital, 0.02 percent were admitted to an  (ICU), and 0.08 percent died after a positive SARS-CoV-2 test. A J-shaped association was identified between BMI and admission to the hospital for COVID-19 and death (adjusted hazard ratios per kg/m2 from the nadir at BMI of 23 kg/m2, 1.05 and 1.04, respectively); across the whole BMI range, there was a linear association with ICU admission (hazard ratio, 1.10). There was a significant interaction between BMI and age and ethnicity; above BMI 23 kg/m2, hazard ratios increased per kg/m2 for  (adjusted hazard ratio for , 1.09 versus 1.01 for those aged 20 to 39 versus 80 to 100 years) and for Blacks versus Whites (hazard ratios, 1.07 versus 1.04).

"We don't yet know that  specifically reduces the risk of severe COVID-19 outcomes, but it is highly plausible, and will certainly bring other health benefits," a coauthor said in a statement.


Explore further

Hyperglycemia, hypoglycemia linked to poor outcomes in COVID-19

More information: Abstract/Full Text
Editorial
https://medicalxpress.com/news/2021-05-severe-covid-bmi.html

New study traces progenitor genomes causing COVID-19 and geospatial spread

 In the field of molecular epidemiology, the worldwide scientific community has been steadily sleuthing to solve the riddle of the early history of SARS-CoV-2. Despite recent efforts by the World Health Organization, no one to date has identified the first case of human transmission, or 'patient zero' in the COVID-19 pandemic.

Finding the earliest possible case is needed to better understand how the virus may have jumped from its animal host first to infect humans as well as the history of how the SARS-CoV-2  has mutated over time and spread globally.

Since the first SARS-CoV-2 virus infection was detected in December 2019, well over a million genomes of SARS-CoV-2 have been sequenced worldwide, revealing that the coronavirus is mutating, albeit slowly, at a rate of 25 mutations per  per year. The sheer number of emerging variants, including the UK (B.1.1.1.7), South African (B.1.351), South American (P.1) and now, Indian (B.1.617) have not only come to replace prior dominant strains in their respective regions, but still threaten world health due to their potential to escape today's vaccines and therapeutics.

"The SARS-CoV-2 virus has already infected more than 145 million people and caused 3 million deaths across the world," said Sudhir Kumar, director of the Institute for Genomics and Evolutionary Medicine, Temple University. "We set out to find the genetic common ancestor of all these infections, which we call the progenitor genome."

This progenitor genome (proCoV2) is the mother of all SARS-CoV-2 coronaviruses that has infected and continue to infect people today.

In the absence of patient zero, Kumar and his research team now may have found the next best thing to aid the worldwide molecular epidemiology detective work. "We reconstructed the genome of the progenitor and its early pedigree by using a big dataset of coronavirus genomes obtained from infected individuals since December 2019," said Kumar, the lead author of a new study, appearing in advanced online edition of the journal Molecular Biology and Evolution.

They found that the progenitor gave rise to a family of coronavirus strains, whose members included the strains found in Wuhan, China, in December 2019. "In essence, the events in December in Wuhan, China, represented the first superspreader event of a virus that had all the tools necessary to cause a worldwide pandemic right out of the box." said Kumar.

Kumar's group estimates that the SARS-CoV-2 progenitor was already circulating with an earlier timeline—at least 6 to 8 weeks prior to the first genome sequenced in China, known as Wuhan-1. "This timeline puts the presence of proCoV2 in late October 2019, which is consistent with the report of a fragment of spike protein identical to Wuhan-1 in early December in Italy, among other evidence," said Sayaka Miura, a senior author of the study.

"We have found progenitor genetic fingerprint in January 2020 and later in multiple coronavirus infections in China and the USA. The progenitor was spreading worldwide months before and after the first reported cases of COVID-19 in China," said Pond.

Besides their findings on SARS-CoV-2's early history, Kumar's group also has developed intuitive mutational fingerprints and Greek symbol classification (ν, α, β, γ, δ, and ε) to simplify the categorization of the major strains, sub-strains and variants infecting an individual or colonizing a global region. This may help scientists better trace and provide context for the order of emergence of new variants.

"Overall, our mutational fingerprinting and nomenclature provide a simple way to glean the ancestry of new variants as compared to phylogenetic designations, e.g., B.1.351 and B.1.1.7," said Kumar.

For example, an α fingerprint refers to genomes that one or more of the α variants and no other subsequent major variants, and αβ fingerprint refers to genomes that contain all α, at least one β variant, and no other major variants.

"With our tools, we observed the spread and replacement of prevailing strains in Europe (αβε with αβζ) and Asia (α with αβε), the preponderance of the same strain for most of the pandemic in North America (αβ?δ), and the continued presence of multiple high-frequency strains in Asia and North America," said Pond.

Getting to the root of the problem

To identify the progenitor genome, they used a approach not applied to SARS-CoV-2 previously, called mutation order analysis. The technique, which is used extensively in cancer research, relies on a clonal analysis of mutant strains and the frequency in which pairs of mutations appear together to find the root of the virus.

Many previous attempts in analyzing such large datasets were not successful because of "the focus on building an evolutionary tree of SARS-CoV-2," says Kumar. "This coronavirus evolves too slow, the number of genomes to analyze is too large, and the data quality of genomes is highly variable. I immediately saw parallels between the properties of these genetic data from coronavirus with the genetic data from the clonal spread of another nefarious disease, cancer."

Kumar and Miura have developed and investigated many techniques for analyzing genetic data from tumors in cancer patients. They adapted and innovated these techniques to build a trail of mutations that traced back to the progenitor genetic fingerprint. "The mutation tracking approach produced the progenitor and the family history of its major mutation. It is a great example of how big data coupled with biologically-informed data mining reveals important patterns," said Kumar.

An earlier timeline emerges"This progenitor genome had a sequence very different from what some folks are calling the reference sequence, which is what was observed first in China and deposited into the GISAID SARS-CoV-2 database," said Kumar.

The closest match was to eight genomes sampled 26 to 80 days after the earliest sampled virus from 24 December 2019. Multiple close matches were found in all sampled continents and detected as late as June 2020 (pandemic day 181) in South America. Overall, 140 genomes Kumar's group analyzed all contained only synonymous differences from proCoV2. That is, all their proteins were identical to the corresponding proCoV2 proteins in the amino acid sequence. A majority (93 genomes) of these protein-level matches were from coronaviruses sampled in China and other Asian countries.

These spatiotemporal patterns suggested that proCoV2 already possessed the full repertoire of protein sequences needed to infect, spread and persist in the global human population.

They found the proCoV2 virus and its initial descendants arose in China, based on the earliest mutations of proCoV2 and their locations. Furthermore, they also demonstrated that a population of strains with at least three mutational differences from proCoV2 existed at the time of the first detection of COVID-19 cases in China. With estimates of SARS-CoV-2 acquiring 25 mutations per year, this meant that the virus must already have been infecting people several weeks before the December 2019 cases.

Mutational signatures

Because there was strong evidence of many mutations before the ones found in the reference genome, Kumar's group had to come up with a new nomenclature of mutational signatures to classify SARS-CoV-2 and account for these by introducing a series of Greek letter symbols to represent each one.

For example, they found that the emergence of α SARS-CoV-2 genome variants came before the first reports of COVID-19. This strongly implies the existence of some sequence diversity in the ancestral SARS-CoV-2 populations. All 17 of the genomes sampled from China in December 2019, including the designated SARS-CoV-2 reference genome, carry all three α variants. But, 1,756 genomes without α variants were sampled across the world until July 2020. Therefore, the earliest sampled genomes (including the designated reference) were not the progenitor strains.

It also predicts the progenitor genome had offspring that were spreading worldwide during the earliest phases of COVID-19. It was ready to infect right from the start.

"The progenitor had all the ability it needed to spread," said Pond. "There is an overabundance of non-synonymous changes in the population. What happened between bats and humans remains unclear, but proCoV2 could already infect at pandemic scales."

A global spread

Altogether, they have identified seven major evolutionary lineages and the episodic nature of their global spread. The proCoV2 genome gave rise to many major offspring lineages, some of which arose in Europe and North America after the likely genesis of the ancestral lineages in China.

"Asian strains founded the whole pandemic," said Kumar. "But over time, many variants that evolved elsewhere are now infecting Asia much more."

Their mutational-based analyses also established that North American coronaviruses harbor very different genome signatures than those prevalent in Europe and Asia.

"This is a dynamic process," said Kumar. "Clearly, there are very different pictures of spread that are painted by the emergence of new mutations, the three εs, γ&delta, which we found to occur after the spike protein change (a β mutation). Scientists are still figuring out if any functional properties of these mutations have sped up the pandemic."

Remarkably, the mutational signature of αβ?δ has remained the dominant lineage in North America since April 2020, in contrast to the turn-over seen in Europe and Asia. More recently, novel fast-spreading variants including an S protein variant (N501Y) from South Africa and the UK (B.1.1.17) have rapidly increased. Coronaviruses with N501Y variant in South Africa carry the αβγδ genetic fingerprint, whereas those in the UK carry the αβε genetic fingerprint, according to their classification scheme. "Therefore, αβ ancestor continues to give rise rise to many major offshoots of this coronavirus." Said Kumar.

Real-time updates

The MBE study relied on three snapshots were retrieved from GISAID on July 7, 2020, (a dataset of 60,332 genomes), October 12, 2020, (contained 133,741 genomes), and finally, an expanded dataset of 172,480 genomes sampled on December 30, 2020.

Moving forward, they will continue to refine their results as new data becomes available.

"More than a million SARS-CoV-2 genomes are sequenced now," said Pond. "The power of this approach is that the more data you have, the more easily you can tell the precise frequency of individual mutations and mutation pairs. These variants that are produced, the single nucleotide variants, or SNVs, their frequency, and history can be told very well with more data. Therefore, our analyses infer a credible root for the SARS-CoV-2 phylogeny."

The MBE study is part of their effort to maintain a continuous, live real-time monitoring of SARS-CoV-2 genomes, which has now grown to include more than 350,000 genomes.

"We have set up a live dashboard showing regularly updated results because the processes of data analysis, manuscript preparation, and peer-review of scientific articles are much slower than the pace of expansion of SARS-CoV-2 genome collection," said Pond. "We also provide a simple 'in-the-browser' tool to classify any SARS-CoV-2 genome based on key mutations derived by the MOA analysis.

"These findings and our intuitive mutational fingerprints and barcodes of SARS-CoV-2 strains have overcome daunting challenges to develop a retrospective on how, when and why COVID-19 has emerged and spread, which is a prerequisite to creating remedies to overcome this pandemic through the efforts of science, technology, public policy and medicine," said Kumar.


Explore further

Data analysis identifies the 'mother' of all SARS-CoV-2 genomes

More information: Sudhir Kumar et al, An evolutionary portrait of the progenitor SARS-CoV-2 and its dominant offshoots in COVID-19 pandemic, Molecular Biology and Evolution (2021). DOI: 10.1093/molbev/msab118
https://phys.org/news/2021-05-progenitor-genomes-covid-geospatial.html

After the Pandemic: Has Medical Research Been Changed Forever?

 For MedPage Today's "After the Pandemic" series, we asked our editorial board members to discuss what significant and lasting effects the COVID-19 pandemic will have on medicine and the delivery of healthcare.

Here, we interview Harlan Krumholz, MD, SM, cardiologist and researcher at Yale University in New Haven, Connecticut, and co-founder of the preprint server medRxiv.

Can you share an anecdote about a patient you saw in your practice and how the pandemic influenced their situation? What was the outcome?

Krumholz: I will say globally that I have had the opportunity to talk with very many people suffering from long COVID, and the impact can be devastating and debilitating.

Someone who was previously healthy -- and now suffering from long COVID -- recently conveyed how the lingering symptoms have caused her to lose her job and wander from doctor to doctor in search of answers. She is disabled by intermittent symptoms that affect her thinking, her energy, her bowel function, and more. The costs of care are threatening her financial well-being -- and she does not know where to turn.

The problem for doctors is that we have little evidence-based information to provide and we are chasing symptoms without understanding their cause -- or what might resolve them. There is a feeling of great inadequacy -- and a determination to work hard to find some solutions. At this point, we are so limited in what we know and how we can help. This has to be a top priority.

What was the role of medRxiv during the pandemic?

Krumholz: medRxiv has been a terrific help to the scientific community during the pandemic. It has sped the communication of science and fostered interactions among scientists around the world. It is an open and rapid way to share pre-peer reviewed studies. For the most part, people seemed to have quickly realized that this is science in progress, and not to take it as truth -- but as work open for comment. It has embedded the preprint culture in a way that I hope will be sustained and spread.

I am not aware of any harm that has accrued and I am aware that many good interactions have resulted from the sharing of the information. And it is certainly better than science by press release alone. Also, importantly, our screening process is intended to protect the public's interest -- safeguarding privacy, promoting registration, requiring ethics approval, and ensuring that dangerous claims are avoided.

What will be medRxiv's impact going forward? How can medRxiv and traditional journals coexist in the future?

Krumholz: They serve different functions. The traditional journals produce a peer-reviewed product of record -- and the preprint server is enabling the rapid dissemination of science in progress.

The purpose of the preprint is to engender engagement and to stimulate constructive comments that enable the work to be put in perspective. The preprint server is for rapid communication of work that is yet to be peer-reviewed -- we know peer review publication can take years -- and could benefit others with an interest in the topic. I know I depend on preprints to learn what others are doing and finding -- and it sparks collaborations.

Anyone interested in science -- and eager to learn what others are doing -- will benefit from greater adoption of preprints.

You might have depended on scientific meetings for that in the past. The preprint server is doing a scientific meeting in real time, with more content than a usual poster, and with an archived copy that can be cited and will always be available.

What changes to the scientific establishment are needed beyond preprints?

Krumholz: We need more open science and more collaboration and more engagement of people as participants and teammates in studies, and more use of digital data and technologies. And just the spirit that we need to work together, without regard for credit, to relieve suffering.

https://www.medpagetoday.com/special-reports/after-the-pandemic/92432

Are Immunosuppressed Responding to 2 Vax Doses?

 Back in March, we published in JAMA and reported here in MedPage Today that only 17% of immunosuppressed transplant patients -- in stark contrast to 100% of immunocompetent people -- mounted detectable antibodies to SARS-CoV-2 after the first dose of mRNA vaccine. Our report was among the top five most read articles in JAMA, and generated substantial -- and understandable -- concern among communities of immunosuppressed people. As a transplant surgeon, I was frustrated and frightened for my patients, and my Johns Hopkins colleagues and I eagerly awaited the results looking at antibody response after full two-dose vaccination.

The moment many transplant patients and physicians have been waiting for has finally arrived, but unfortunately the news is not great. We have now published in JAMA second-dose data from our national study of vaccine immune responses in immunosuppressed solid organ transplant recipients. Among 658 COVID-19-naïve participants who received the full two-dose series of mRNA vaccines, 46% (compared to 83% after just one dose) still had no detectable antibodies, and even among those with detectable antibodies, the levels were still somewhat low. The situation is worse among those taking anti-metabolites: for this group, 57% had no antibodies after full vaccination, compared to 32% with no antibodies among those not taking anti-metabolites.

Unfortunately, this blunted antibody response seems to correlate with diminished protective immunity. We are seeing in our own patients, and hearing from around the country, many cases of transplant patients receiving a full vaccine series, thinking they are immune, believing that the CDC guidelines for vaccinated people apply to them, relaxing the masking and distancing behaviors that have protected them for over a year, and sadly finding themselves hospitalized with a new COVID-19 infection. Some have even died. This is highly problematic. We need more effort and action to spread the word that vaccination does not necessarily mean immunity in this vulnerable population.

So, what should our transplant patients do in light of these findings? First and foremost, they should continue to practice all the protective behaviors they have thus far practiced. While the rest of the world is celebrating the new freedoms that come with vaccination, unfortunately the time is not yet right for transplant patients to do so. Eventually we will understand the immune response to vaccines in our patients enough to relax these restrictions, but right now we only know the impact on antibody response (with very little understanding of memory B cell and T cell response, which are both important), and what we know is not encouraging. Transplant patients should also make sure that everyone around them gets vaccinated, so at least their environments are safer. And, of course, this is yet another reason that everyone should want to get vaccinated -- to protect the vulnerable who cannot achieve immunity for themselves, and ultimately help reach herd immunity.

So, what is next? Will other platforms perform better? If someone had no, or limited, immune response to two doses, will a third dose help? Should the third dose be of the sample platform or a different platform? Is it reasonable for some patients to reduce immunosuppression, risking rejection, just to achieve an immune response? How do B cell and T cell responses look in immunosuppressed people? In the meantime, should people with no vaccine response receive pre-exposure exogenous antibody preparations for interim protection? We continue to strive to answer these questions, and enrollment in our study remains open and ongoing.

Dorry Segev, MD, PhD, is a professor of surgery and epidemiology and associate vice chair of surgery at Johns Hopkins University School of Medicine and Bloomberg School of Public Health.

https://www.medpagetoday.com/infectiousdisease/covid19vaccine/92439

Novavax Vaccine Shows 43% Efficacy Against South African Variant

 Novavax Inc's COVID-19 vaccine had efficacy of 43% against infections caused by the South African variant in a group that included people with and without HIV, and 51% in people who were HIV negative, according to a new analysis published on Wednesday.

The post-hoc analysis was published in the New England Journal of Medicine along with full data from the company's trial in South Africa, which included nearly 2,700 volunteers who had not been previously infected with the coronavirus.

Results announced in January showed efficacy of 49.4% against symptomatic COVID-19 in the South African trial looking at a mixture of the original virus and the South African variant, and 60.1% among those who were HIV-negative.

The study also showed that prior infection with an earlier version of the virus did not reduce the risk of COVID-19 caused by the South African variant among people who got placebo shots.

The average age of trial volunteers was 32. Most cases were mild-to-moderate.

The study did not provide data on efficacy of the Novavax vaccine in preventing severe disease or hospitalization, "one of the most important factors in determining the usefulness of a vaccine," said Dr Peter English, a retired consultant in communicable disease control and former chair of the British Medical Association’s Public Health Medicine Committee.

"Most vaccines are less effective at preventing mild disease than they are at preventing severe disease; so this vaccine could turn out to be much more effective at preventing hospital admissions and deaths – we simply don’t know, yet," said English, who was not involved in the study.

The trial's main goals were to test how the vaccine performed in people who were HIV negative, as well as those who were HIV positive and medically stable. The study excluded other volunteers taking drugs to suppress the immune system or those with auto-immune diseases, which could reduce vaccine efficacy. Among those evaluated, 94% were HIV negative and 6% were HIV positive.

Novavax has said it is making new versions of its vaccine to protect against emerging virus variants. The company is expected to report data from its ongoing late-stage study in the United States and Mexico in the second quarter.

https://www.usnews.com/news/top-news/articles/2021-05-05/novavax-vaccine-shows-43-efficacy-against-south-african-variant-study-finds