The importance of measles vaccination
A vaccination against the measles virus has been available since 1968 and is given to young children to protect them from this potentially deadly virus. This is a very good thing as measles can attack the central nervous system and cause severe damage - in unvaccinated countries it still accounts for hundreds of thousands of deaths and millions of infections.
The virus is highly infectious, spreading through the air and 9 out of 10 people who come into contact with the virus will get measles. It has been so effective that cases of measles in the UK, US and many other parts of the world are now rare. The graph below illustrates the startling effectiveness of the vaccine program in the US.
Measles hasn't gone away
Despite this success, the measles virus has not been eliminated worldwide. To be fully effective at stopping new infections arriving from overseas (where vaccinations are not the norm) and triggering a spread of cases, it is important that the majority of the people in a country are still vaccinated (herd immunity). In most countries, vaccination is not compulsory, so future success depends on parents opting their children into the vaccination.
Vaccination rate is falling
Unfortunately, vaccination rates have fallen over the last 10 - 20 years, partly triggered by erroneous suspicion that the vaccine might cause autism or other health problems in young children. This means that the number of cases per year is now rising in countries that had all but eliminated measles which is bad for those who are now vulnerable to infection but a recent research report suggests that the problems run deeper and can directly affect aspergillosis patients amongst many others.
Measles virus destroys antibodies
Researchers have discovered that the measles vaccine works in two ways. Firstly it provides protection against the measles virus - but it also protects the immune system of the immunised person against severe attack. Someone who has had measles (child or adult) can have severely reduced protection from other infections for years as the viral infection also results in a huge loss of antibodies that have been built up over the patient's lifetime as a consequence of various infections. We need our antibodies so that our immune system can 'remember' earlier infections by bacteria, viruses and fungi - it enables us to respond quickly to a new infection. Failure to do so means that we have to experience the infection all over again, with all the risks to our health that that involves.
Aspergillosis patients
Aspergillosis patients, as well as people with other respiratory diseases, have a strong tendency to get more lung infections, These infections exacerbate their asthma symptoms and can make breathing so difficult a hospital admission is needed to provide oxygen and long courses of antibiotics are often important. The National Aspergillosis Centre in Manchester, UK has learned that vaccinating patients against these infections, where possible, is helpful as it controls exacerbations of the condition, reduced admissions and improves patients quality of life,
It may now be the case that aspergillosis patients will need to be checked to ensure that they are not at risk of getting measles, as succumbing to the virus could leave them even more vulnerable to secondary respiratory infections.
Fireworks, bonfires and aspergillosis
From late October to new year it is common in the UK for fireworks to be lit. Traditional busy times of the year such as Bonfire Night are still the times of heaviest use but instead of all of the celebrations happening on one night, they can now spread over a week. New Year is also a time for fireworks in many parts of the world, though the actual day this is celebrated varies across the globe, with Chinese New Year celebrated at a completely different time of year compared with UK, US and much of the world outside of China.
Firework displays are enjoyed by many wherever and whenever they occur, but there is a downside for people with respiratory disease. Fireworks are made using lots of gunpowder and bonfires often contain lots of damp wood and other burnable materials. Asthma UK warns us that burning all that gunpowder and firewood causes the release of many irritants that we know can potentially cause asthmatic problems. The British Lung Foundation warns us that people with Chronic Obstructive Pulmonary Disease (COPD) are also at risk. Many people with aspergillosis also have asthma and COPD - aspergillosis often comes along with, sometimes as a consequence of other respiratory diseases.
Outside air pollution
If the outside air is very still the irritants can persist and build up in a wide area around large displays, and of course, there are often many smaller displays scattered throughout the neighbourhood. It is pretty common in urban areas for the smoke to build up into an obvious fog with a strong smell which acts as a clear warning that the air is unsafe to breathe for some. Sometimes that fog is still apparent the next morning! However irritant gasses like nitrogen dioxide gas (NO2) can build up and be completely invisible - the gas is colourless and odourless, so be aware and remain vigilant for telltale symptoms of worsening breathing (ie coughing, wheezing, tightness in the chest or shortness of breath).
Airway irritants
Irritants such as very fine particulates in the smoke and NO2 in the exhaust gasses are known to cause asthma attacks so Asthma UK advises avoiding the smoke if you can and to make sure that you have taken your preventer inhaler as prescribed, Bring your reliever inhaler with you if going out and ensure that people around you know what to do should your breathing be affected.
Aspergillosis
People who have aspergillosis might also consider that autumn is a time for many trees to drop their leaves and other plant material to die back. The presence of so much food for moulds means that there can be lots of the Aspergillus fungus on the ground and in the air at these times of the year. Try to avoid places where there is lots of leaf mould being disturbed, for example by people walking to a display and it can be a good idea to wear a facemask to minimise the number of dust and spore particles you are inhaling. If wearing a facemask makes you feel uncomfortable there are now companies making attractive scarves that contain air filtration layer so when they are wrapped over your mouth & nose they provide reasonable protection.
How people with aspergillosis can help look after their liver
What does our liver do?
Our livers are really important for us to live a healthy life. Tucked right underneath our ribcage it is a large soft organ that has a rich blood supply. It can recognise and break down or filter any toxic substances that it may find - consequently our blood is quickly cleaned of anything that is not meant to be in our bloodstream.
Toxic substances can get into our body when we eat them, drink them, inhale then or when our doctors inject substances directly into our bloodstream. They can even be part of the daily process that continually renews the tissues that make up our bodies, breaking down proteins and ridding us of any toxic by-products of this process. This is a hugely complex process that we are as yet unable to reproduce artificially - the only way we can replace a badly damaged liver is to replace it with a transplanted donated liver.
What happens if our liver stops working?
Not surprisingly if our livers become dysfunctional our bodies soon start to suffer and there is a long list of illnesses caused by a sick liver. One of the most well-known ways we can damage our livers is to take alcoholic drinks to excess regularly, but we should also be aware that obesity is also a risk to our livers.
Why is this important to aspergillosis patients?
In addition aspergillosis patients should be aware that the medications that they have to take can risk damaging their livers. Doctors closely monitor their patients especially when they first prescribe a mediation that may cause toxicity. They need to watch closely for signs of the liver starting to be distressed by monitoring the signs using blood tests referred to as liver function tests. The purpose of these tests is to detect the very early signs of liver distress so that the doctor can take action to prevent any long term damage.
We know that antifungal medication can cause liver damage in some people, sometimes because the dose of an antifungal is too high and a quick adjustment can prevent further problems, or sometimes the patient is switched to a different drug if dose reduction doesn't have the desired impact on the liver.
What can I do?
What can you, the patient do to help yourselves when taking an antifungal medication? Firstly, of course, it is very important to have a good working relationship with your medication team and report any new symptoms quickly to your doctor can assess if any action is needed.
You can also help by keeping your liver in the best condition it can be so that it can detoxify your blood quickly and keep you in the best health possible. You may be surprised by some of the things you should and shouldn't do!
- Smoking is bad. There are hundreds of toxins in cigarette smoke that your liver has to work on to keep you well while it should be working on other toxins
- Coffee is good! Take a few cups a day but ensure you are still taking plenty of water as well
- Alcoholic drinks - stick to medical advice. If you are taking antifungal drugs I am afraid the advice is no alcohol consumption (your liver will love you for it)
- Eat the rainbow - select fruit and veg of every colour to be part of your diet.
- Take care when using acetaminophen - often found in colds & flu remedies. No more than 4000 milligrams per day.
- Weight - keep your Body Mass Index between 18 and 25
- Infection control - wash your hands well after using the toilet and before preparing food
- Exercise as much as you can - see your specialist physio for advice
- Get vaccinated against hepatitis
- Practice safe sex - diseases transmitted by sex can hurt your liver
- Avoid 'liver detox' products eg milk thistle, turmeric. Tell your doctor what you are taking.
NOTE: Herbs and supplements cause 25% of the liver damage treated by doctors - especially borage, comfrey, groomwell, coltsfoot but also Atractylis gummifera, celandine, chaparral, germander and pennyroyal oil.
Good foods for your liver (all in moderation)
- Coffee
- Oatmeal
- Green tea
- Water
- Almonds
- Spinach
- Blueberries
- Herbs & spices
Foods you should limit
- Sugar
- Fatty foods
- Salt
- snack foods (usually rich in the above)
- Alcohol
- There are more details on diet here
- British Liver Trust
A step-change in computer power for aspergillosis genomics
Future research in aspergillosis genetics will be (and is being) done with huge computers as they analyse entire genomes and generate huge amounts of data from the information gleaned when sequencing robots read entire genomes of complex living organisms - Aspergillus or human. The human genome contains about 3 billion base pair letters that together form a complex collection of 20-25,000 genes.
Each of these genes may be switched on or off in an infinite array of gene expression that not only makes an organism what it is but also regulates the response of a human body to external events such as infection. It is likely that mistakes in how some of these genes are expressed or how they function contribute to the reason why some of us are vulnerable to fungal infections such as aspergillosis while most of us aren't.
Working out which of this huge number of genes is responsible for allowing fungal infection is clearly a massive task, but it is more complicated than that. If we were to sequence the genome of one person we would only get very limited information about which of their genes are fungal infection susceptibility genes. Perhaps there is more than one gene involved? As a consequence, we need to sequence the genomes of many more people who have aspergillosis in order to get a more accurate impression of the number of genes involved, and which genes are involved in permitting a fungal infection.
We also have to sequence the genomes of people who haven't got aspergillosis so that we have something to compare the test subjects with. All in all, we will need to sequence dozens of individuals in order to arrive at reliable conclusions. This takes many months to achieve.
Computer power
Even with our most powerful computers at the University of Manchester this still takes a lot of time. Investment in Edinburgh genomic computing resources uses state of the art computer power that is 5 x faster than its predecessor, but this is just a linear progression rather than a dramatic step-change in performance likely to radically speed up the genomics work.
Additionally, however fast these computers already are, the rate of advance in computing speed will be forced to slow down as current technology will soon reach its fundamental limits - for example current computers work with 'bits' that represent two states - I and O so we have lots and lots of power but only the ability to work with 'yes' or 'no'. This isn't enough to process the forthcoming mass of incoming data - we need a complete step-change in how computers work to achieve fundamental accelerations in speed.
Google and quantum bits
Google, apart from being a huge company that provided services to you and I, is also a computer research company. It has been working on this fundamental limit to computer speed for some time and has just announced the successful construction of a computer that uses quantum particles rather than 'bits'. Quantum bits can work with many more states compared with 'bits' so you can imagine how that might speed things up a little. Instead of 'yes' or 'no', each particle can also store 'maybe', 'yes and no' and many more - each of these new states would have taken many current bits to achieve the same end.
We can only really appreciate the huge improvement in speed this offers by setting this new computer a really difficult problem to solve - one we know will take a computer using current technology a long time to finish. Google claims that when they set a current computer a particular test problem it would take 10,000 years for it to solve it - I presume that they haven't actually tested that using a realtime run!
Quantum supremacy
How long did the computer using quantum bits take to work out the same problem? It would be really amazing if it could do it in 100 years, incredible if it could do it in 10 years. In fact, Google claims it took just 200 seconds - truly a step-change in computer power for aspergillosis genomics.
If we are able to use that kind of computer power for genomics work in the future we would have results in fractions of a second, speeding up work on aspergillosis genomics 1000's of times, making it theoretically possible we could be doing complete genome checks in a single visit to the clinic in the future.
https://www.bbc.co.uk/news/science-environment-50154993
Advice for people with respiratory conditions in winter
Many patients with respiratory conditions like aspergillosis report increased frequency of chest infections during the winter months, and this is mentioned repeatedly in our Facebook support groups (Public, Private). The cold weather brings problems of many kinds, but respiratory infection is one of the most serious. Infections by bacteria or virus have a major impact on their quality of life as their breathing becomes restricted and often they quickly become too exhausted to carry on with tasks of daily living.
Why does the winter cause increased vulnerability to respiratory infections? Is it because of the cold weather making us weaker and unable to fight off infection? In part - yes it is! Cold air cannot hold moisture as well as warmer air and thus cold air, is drier air. Inhaling dry air tends to dry out our airways and this can make us vulnerable to infection. This has two impacts - it irritates the lining of our airways and makes us cough, which itself increases our risk of infection, but it also dries out the mucous lining our airways and makes it more difficult to move - so we end up coughing much more than normal as we try to cough up this thickened substance.
People with chronic respiratory disease such as COPD, asthma, aspergillosis are particularly vulnerable to dry air as their airways are very sensitive to irritation.
Winter holds all kinds of pressures for the NHS and one of the biggest is a huge increase in people with respiratory conditions whose condition has become worse as a result of the cold weather. This video includes some advice on how to make sure the cold doesn't affect your condition to prevent you from needing hospital treatment.
Reproduced with thanks, produced by NHS Blackpool CCG 2019
We Are Undefeatable
We Are Undefeatable is a campaign which aims to help those with chronic health conditions exercise. Both the conditions and forms of exercise vary widely - the goal is to find out what works best for you!
Visit the website to discover how exercise has helped other people with chronic conditions, and what the campaign can do for you : We Are Undefeatable
For more information on exercises specific to aspergillosis and chronic lung conditions:
- How do I exercise in a bed or chair?
- Your lungs and exercise
- BLF: Keeping active with a lung condition
Aspirin may reduce harmful effects of air pollution on lungs
A recent study by Dr Xu Gao and colleagues has looked at the relationship between lung function and the use of non-steroidal anti-inflammatory drugs (which include aspirin) in 2,280 veterans. The researchers then compared this with air pollution data from the previous month in their hometown of greater Boston. Other factors, including whether or not the participant was a smoker were also taken into consideration.
The study found that NSAIDs nearly halved the effect of particulate matter (all solid and liquid particles suspended in air) on lung function. The mechanism by which this protection happens is unknown, but may be due to NSAIDS reducing inflammation in the lung caused by pollution. As most of the participants in the study were taking aspirin, this effect was deemed to be predominantly due to aspirin, but the effect of other NSAIDs would be useful to study.
These results show that aspirin may be useful in the short-term protection of lungs against air pollution. However, air pollution contributes to a number of other harmful bodily effects so it is still important to minimise overall exposure.
To check air pollution in your area, click here
References:
- Aspirin may halve air pollution harms
- Nonsteroidal Anti-Inflammatory Drugs Modify the Effect of Short-Term Air Pollution on Lung Function
Fungal biofilm structure and its indications in invasive aspergillosis
Microorganisms can group together on a surface to form collections of cells called biofilms; one example of this is dental plaque. Grouping together as a community protects these cells from environments which they may not be able to survive alone, such as the wrong pH or a lack of water or oxygen. Biofilms may be made up of many different species of microorganism and these species may be varied further by strain. In a recent paper, Caitlin Kowalski and colleagues at the Geisel School of Medicine at Dartmouth, USA, studied the ability of Aspergillus fumigatus biofilms to grow in low oxygen environments and cause invasive aspergillosis in mice.
Kowalski and colleagues exposed A. fumigatus to low levels of oxygen, which reflect the levels found in the lesions where the fungus grows in the lung, in order to identify genes and mechanisms involved in allowing the pathogen to grow under these conditions. They then discovered a specific mutation which allowed the strain to both grow better in low oxygen, but also cause disease better under these conditions. It remains to be discovered how this particular mutation allows the strain to grow more successfully and be more virulent in low oxygen. However in other fungal biofilms, for example the yeast Candida albicans, the colony can form wrinkles which improve oxygen penetration. Understanding how the structure of biofilm colony growth reflects advantages in the ability of the fungus to cause disease may allow clinicians and scientists to better predict the progression of disease and improve patient care.
Find out more:
- Fungal biofilm morphology impacts hypoxia fitness and disease progression.
- How fungal biofilm structure impacts lung disease
“Aspergillus and me” by Los Trensplantados
“Aspergillus and me” is a song written by Alessandro Pasqualotto, a medical mycologist from Brazil, and two transplant patients, Jimi Joe (kidney), and King Jim (liver).
The initiative started when King was hospitalized due to a chronic cough. King is known for being asthmatic and he has some mild bronchiectasis, in addition to being a liver transplant recipient. A bronchoalveolar lavage (BAL) was performed, and Pseudomonas aeruginosa was recovered in culture, in addition to Aspergillus fumigatus (galactomannan testing was not performed). At that time, Alessandro Pasqualotto visited King in the hospital primarily as a fan, not as a physician. After collecting several autographs in vinyl albums from the 80’s (King was part of the famous rock band Garotos da Rua), Pasqualotto and King started a discussion on the relevance of A. fumigatus in his BAL exam. Despite being treated with voriconazole by order of the medical team in charge, Pasqualotto thought the musician was only colonized by the fungus. The dilemma surrounding the relevance of Aspergillus in this context motivated both Pasqualotto and King to write a song about that.
After being discharged from the hospital, King collected a group of experienced musicians to record Pasqualotto’s song. This included Jimi Joe, a kidney transplant recipient who together with King formed the band “Los Tresplantados”, a group of three transplant musicians that approaches the importance of organ donation, as well as opportunistic infections. Los Tresplantados, however, have never written a song about fungal infections, so this was a great opportunity to increase people’s awareness of such important diseases.
So this is what “Aspergillus and me” are all about. Alternatively, musicians also refer to this song as “When Black Sabbath meets Neil Young”. We hope you enjoy the song!
Contacts: Alessandro C. Pasqualotto (acpasqualotto@gmail.com)
WhatsUp number: +55 51 999951614
Interview link (Portuguese only): https://www.youtube.com/watch?v=ZyywH0LtS50
Sunflower lanyards: support for travelling with invisible illnesses
Travelling through airports with an invisible illness can be difficult, as it may not be obvious to others that you need extra time or assistance. The experience can be stressful and anxious for some, and it may be hard to explain your hidden symptoms. This is why several airports in the UK have implemented a scheme, so that those with invisible illnesses can order a sunflower lanyard to wear through the airport. These lanyards make the wearer more visible so that they can travel independently, but access help quickly if needed. Some supermarkets are also trialing this scheme.
To find out more about sunflower lanyards, click here