We don’t yet know how effective COVID vaccines are for people with immune deficiencies. But we know they’re safe — and worthwhile


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Vanessa Bryant, Walter and Eliza Hall Institute and Charlotte Slade, Walter and Eliza Hall InstituteThe COVID vaccine rollout is underway in Australia, with people in phase 1b now eligible to be vaccinated.

So far, we have two vaccines available in Australia: the Pfizer/BioNTech vaccine, approved for people aged 16 and older, and the Oxford/AstraZeneca vaccine, approved for those over 18. Evidence has shown both vaccines are safe and offer near-complete protection against severe COVID-19, hospitalisation and, most importantly, COVID-related death.

Both vaccines are also safe and effective at generating immune responses in the elderly. But what about another vulnerable group — people with immunodeficiencies? Many people with immunodeficiencies are included in group 1b and will now be thinking about getting their vaccine.

Although we’re still gathering data to determine whether COVID vaccines will work as well in people with immunodeficiencies as they do in the general population, they’re likely to offer at least a reasonable degree of protection. And importantly, we know they’re safe.

What are immunodeficiencies?

Immunodeficiencies are conditions that weaken the body’s ability to fight infection. People’s immune system may be compromised for many reasons, and this can be transient or lifelong.

Primary immunodeficiencies occur when some or all of a person’s immune system is missing, defective or ineffective. These are rare and often genetic diseases that may be diagnosed early in life, but can occur at any age.

Examples of primary immunodeficiencies include severe combined immunodeficiency (SCID) and common variable immunodeficiency (CVID).




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What does it mean to be immunocompromised? And why does this increase your risk of coronavirus?


Secondary immunodeficiencies are acquired, and more common. They may occur as a result of other diseases (for example, via HIV infection), treatments and medications (such as chemotherapy or corticosteroids), or environmental exposure to toxins (for example, prolonged exposure to heavy metals or pesticides).

Sometimes the immune system in people with immunodeficiencies can react in exaggerated ways too, and cause autoimmune disease (such as rheumatoid arthritis or gut inflammation). So it sometimes makes more sense to describe the immune system as “dysregulated”, rather than “deficient”.

An illustration of SARS-CoV-2, the virus that causes COVID-19.
People with immunodeficiencies are more susceptible to being infected with viruses, such as SARS-CoV-2.
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Immunodeficiencies, COVID-19 and vaccines

People with secondary immunodeficiencies are generally at higher risk of becoming infected with SARS-CoV-2 and of developing severe disease. Surprisingly, although people with primary immunodeficiency may be at greater risk of getting infections, including COVID, most are no more susceptible to developing severe COVID compared with the overall population.

This may be because the most severe COVID-19 symptoms are usually not due to gaps in immunity, but to an overactive immune response to SARS-CoV-2.

In fact, immune-suppressing steroids may be an effective treatment for severe COVID. Clinical trials looking into this are underway.

However, as vaccines work by mobilising our immune systems, for people who have a weaker immune system to begin with, vaccines may not be as effective. They may generate an incomplete or short-lived response, so people with immunodeficiencies may need additional boosters to maintain protective immunity.




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Efficacy and safety

It’s difficult to assess COVID vaccine efficacy in people with immunodeficiencies, because people with primary immunodeficiencies or cancer weren’t included in clinical trials.

A very small number of people with HIV have been included in trials of a few of the vaccines, but limited data is publicly available. So it’s too early to draw any firm conclusions on whether the vaccines will be as effective in people with HIV as for the general population.

We also don’t yet know how long immunity to COVID-19 or COVID vaccines lasts. This will be particularly important for immunodeficient people. Research is underway to determine whether they’ll need booster jabs more frequently to maintain immunity.

A woman wearing a head scarf looks out the window.
Clinical trials of COVID vaccines haven’t generally included people with immunodeficiencies.
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We do know the vaccines are safe for this group.

Neither the AstraZeneca nor the Pfizer vaccines can cause an infection, so they won’t present a problem for people with immunodeficiencies (or for elderly people, who may also have weakened immune responses).

Usually, we avoid giving “live attenuated” vaccines (vaccines that contain weakened elements of the virus) to anyone with immunodeficiency. Because of their weakened immune systems and increased susceptibility to infection, there’s a chance they could develop a full-blown infection. An example of this is the chickenpox vaccine. But no live attenuated COVID vaccines have been approved anywhere in the world.

Preliminary evidence from vaccine rollouts around the world has shown COVID vaccines are safe for immunocompromised people with cancer. Although, if you’re going through cancer treatment, you should discuss the timing of your vaccination with your specialist.

There have been no unusual safety concerns to indicate any increased risk for HIV-positive people receiving any of the COVID vaccines either.

Get the jab

Vaccination is most definitely recommended for people with immunodeficiencies, and they’re included in priority groups for vaccine rollout in Australia. Group 1b includes people with underlying medical conditions which may place them at higher risk from COVID-19, including “immunocompromising conditions”.

If you have a diagnosed immunodeficiency or autoimmune disease, you can talk to your doctor or specialist for specific advice on the timing of your COVID vaccination and your condition. There’s generally no reason to change your normal medications or therapies before receiving the vaccine.

Organisations including the Australian Society of Clinical Immunology and Allergy and the Immune Deficiency Foundation of Australia have published resources which offer guidance for people with immunodeficiencies in relation to COVID vaccination.




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The Conversation


Vanessa Bryant, Laboratory Head, Immunology Division, Walter and Eliza Hall Institute and Charlotte Slade, Laboratory Head, Immunology Division, Walter and Eliza Hall Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

5 ways our immune responses to COVID vaccines are unique



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Paul Gill, Monash University and Menno van Zelm, Monash University

The Oxford vaccine trial at the centre of safety concerns this week highlights the idea that people’s immune systems respond to vaccines differently.

We don’t yet know whether reports of immune complications in one or two trial participants have been linked to the COVID-19 vaccine itself, or if they were given the placebo vaccine.

But it does highlight the importance of phase 3 clinical trials in many thousands of people, across continents. These not only tell us whether a vaccine is safe, but also whether it works for people of different ages or with particular health issues.

So what are some of the immune factors that determine whether any of the 180 or so COVID-19 vaccine candidates being developed around the world actually work?




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Our immune responses are all different

An effective vaccine should generate long-lasting protective immunity against SARS-CoV-2, the virus that causes COVID-19.

This can be by generating antibodies to neutralise the virus and likely also by helping the immune system memorise and quickly respond to infection.

How vaccines work with your immune system to protect against disease.

We know, from developing vaccines against other viruses, that people’s immune response to a vaccine can vary. There’s every reason to believe this will also be the case for a COVID-19 vaccine.

1. Vaccine type and how it’s delivered

Many COVID-19 vaccine candidates contain parts of the SARS-CoV-2 spike protein to stimulate protective immunity. However, there are many different ways of delivering these proteins to the body, and some may be more effective than others at stimulating your immune system.

For example, the Oxford vaccine combines the spike protein with another virus to mimic the actions of SARS-CoV-2.

Meanwhile, the candidate developed by the University of Queensland contains the spike protein packaged with another compound (an adjuvant) to stimulate the immune system.




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Some people will likely need a follow-up booster shot to ensure longer-lasting immunity.

We may also see some vaccines delivered as a nasal spray. This may elicit a more effective immune response to COVID-19 in the upper respiratory tract, including the nostrils, mouth and throat.

2. Our previous infections

Previous infections may prime our immune system to respond differently to vaccination.

For instance, the SARS-CoV-2 virus belongs to a large family of human coronaviruses, four of which are responsible for common colds.

Being exposed to these cold-causing coronaviruses, and developing immune memory cells against them, may mean a stronger or quicker response to a COVID-19 vaccine.

Young woman with a cold blowing her nose
The common cold can also be caused by coronaviruses, and your immune system may be primed to respond.
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Exposure to common colds might give some people a head start in fighting COVID-19


Some people have poor protective immune responses to COVID-19 vaccine candidates. These people may have existing immunity to the adenovirus used in some vaccines to deliver the SARS-CoV-2 spike protein.

In other words, their body mounts an immune response to the wrong part of the vaccine (the delivery mechanism) and not so much to the characteristic part of the virus (the spike protein).

3. Our genetics

Our genes play a large part in regulating our immune system.

Researchers have already seen sex differences, which are partly governed by genes, in the immune response to the flu vaccine. They have also seen sex differences in the immune response to COVID-19.

So larger clinical trials should help us understand whether men and women respond differently to a COVID-19 vaccine.

People with inherited immune deficiencies may also be unable to generate protective immunity in response to vaccination.




Read more:
What does it mean to be immunocompromised? And why does this increase your risk of coronavirus?


4. Our age

The composition of our immune system changes throughout the course of our lives, and this affects our ability to mount a protective immune response.

Infants’ and children’s immune systems are still developing. So their immune response may be different to adults’.

Some COVID-19 vaccines may be more effective for children, or recommended for them, as we see already with the flu vaccine.




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As we get older, changes in our immune system mean we cannot efficiently maintain long-lasting protective immunity; we are less able to make new antibodies in response to infection.

We already know older people are less likely to mount a protective immune response with the flu vaccine.

So we need the data from large trials to verify whether COVID-19 vaccines work in children and elderly people.

5. Lifestyle factors

Diet, exercise, stress and whether we smoke influence our immune response to vaccination. So we can look after our immune system with a healthy lifestyle where possible.

There is also an emerging hypothesis that our gut microbes may influence our immune response to vaccination. But more research is needed to confirm this could occur during COVID-19 vaccination.




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The Conversation


Paul Gill, Post-doctoral Researcher (Gastroenterology and Immunology), Monash University and Menno van Zelm, Associate Professor, Immunology, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

COVID-19 and pregnancy: what we know about what happens to your immune system



It’s possible that changes to the immune system during pregnancy protect parent and child from COVID-19.
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April Rees, Swansea University and Catherine Thornton, Swansea University

Any new infectious disease poses unique challenges to people who are pregnant during an outbreak. The effects of Sars, Zika and influenza in pregnancy highlight the potential immediate and longer term detrimental health outcomes a virus can have for both mother and baby. These risks include premature delivery of the baby with Sars, birth defects with Zika and greater risk of severe influenza.

Should we be as worried about pregnancy and COVID-19? There are a number of things we need to think about. These fall into two broad areas related to the effects on the foetus and the effects on the pregnant person themselves.

In both cases we need to think about the immediate effects during the pregnancy as well as the longer term health effects for both parent and child. The early evidence we have shows that changes to the immune system during pregnancy could be somewhat protective against the disease.

The parent

Early data from pregnant women with COVID-19 indicates that the disease is linked to premature birth and changes to the placenta that might reflect altered blood flow. This suggests that virus-associated disruptions do occur between parent and foetus.

However, these studies were of women with severe cases of the disease. We know very little about the effect of mild disease or asymptomatic infection in pregnancy. Understanding this is critical, as studies have highlighted that asymptomatic and mildly infected pregnant women far outnumber those requiring hospitalisation for COVID-19.

This indicates that pregnant people are not more susceptible to severe COVID-19, which was one of the greatest concerns at the beginning of the pandemic and led to them being categorised as vulnerable.

The apparent protective effect of pregnancy against severe disease might simply reflect the different immune responses to severe COVID-19 seen in men and women, and the fact that more men than women die from the disease in general. However, we do not see the same response in pregnancy with other viruses, such as influenza, suggesting something else is at play with SARS-CoV-2.

The foetus

So far, it seems that the foetus is very well protected from the passage of SARS-CoV-2 from mother to child (known as vertical transmission) and such passage, while possible, seems to be uncommon. This might be down to the natural features of the placenta, which produces molecules that stop the virus binding to placental cells. It could also be that the placental membranes limit infection by the virus.

Of course, it is very difficult to study the placenta prior to birth. Alternative measures, such as analysing cellular debris released from the placenta (known as extracellular vesicles) which can be found in a sample of the mother’s blood, are really needed to find out what features of the placenta might protect the foetus from infection and what effects the virus has on the placenta.

Any antibodies that a mother infected with SARS-CoV-2 makes will pass to the foetus across the placenta (known as passive immunity). This provides short-term protection from many infectious agents for the last months of pregnancy and for some months after the baby is born. These antibodies will also continue to be provided in breast milk if the baby is breast fed.

A mother breastfeeds her baby
Babies can acquire antibodies against viruses via breastfeeding.
SeventyFour/Shutterstock

Early studies from China have shown that antibodies that protect against COVID-19 are present in newborns of women who had such antibodies. This confirms that passive immunity, where a baby essentially inherits antibodies from a parent, occurs with SARS-CoV-2. We now need some larger studies to investigate whether anti-SARS-CoV-2 antibodies are present in human milk to better understand the role of these antibodies in neutralising the virus and protecting the baby.

Molecules other than antibodies can also pass from parent to foetus. Pregnant women with severe COVID-19 have many of the hallmarks of an inflammatory response that we see in other people with similar symptoms. This includes elevated levels of molecules such as interleukin-6 (IL-6), which indicates that the immune response has been activated.

There are a number of studies showing that maternal immune activation can have detrimental effects on the developing foetus. Such activation is associated with increased risk of respiratory, cardiovascular, neurodevelopmental and other disorders in the offspring. Whether SARS-CoV-2 will have such long-term effects on the health of these children remains to be seen.

The role of the immune system

In a previous article, we discussed how the immune system changes during pregnancy, and it might be that unique features of this and other dynamic adaptations that occur with pregnancy provide protection from severe COVID-19.

Other examples of possible protective mechanisms include differences in the receptor molecules used by SARS-CoV-2 to invade human cells. Angiotensin-converting enzyme 2 (ACE2) is the best known of these viral entry receptors but CD147, CD26 and others also have this role.

All of these receptors undergo changes during pregnancy, which might contribute to resilience. These receptors also occur as soluble forms that can be measured in blood and breast milk and might act as decoy receptors, stopping the virus from binding to cells.

What next?

Elaborating on why both the pregnant person and their child seem to be relatively resilient to severe forms of COVID-19 might help us understand other disease processes and identify ways to combat the disease.

Work from the UK Obstetric Surveillance System has shown that, as with the wider population, Asian and Black pregnant women are more likely to be admitted to hospital with SARS-CoV-2 infection. Therefore, we really need to consider the effects of ethnicity and other risk factors in our studies of COVID-19 in pregnancy.

This is especially important as these studies will support efforts towards the use of any vaccine in pregnancy.The Conversation

April Rees, PhD Researcher in Immunology, Swansea University and Catherine Thornton, Professor of Human Immunology, Swansea University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

No, the extra hygiene precautions we’re taking for COVID-19 won’t weaken our immune systems



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Vasso Apostolopoulos, Victoria University; Maja Husaric, Victoria University, and Maximilian de Courten, Victoria University

During the COVID-19 pandemic we’re constantly being reminded to practise good hygiene by frequently washing our hands and regularly cleaning the spaces where we live and work.

These practices aim to remove or kill the coronavirus that causes COVID-19, and thereby minimise our risk of infection.

But there have been some suggestions using hand sanitiser and practising other hygiene measures too often could weaken our immune system, by reducing our body’s exposure to germs and with it the chance to “train” our immune defences.

The good news is, there’s no evidence to suggest this will be the case.




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The ‘hygiene hypothesis’

For healthy immune function, it’s important we’re exposed to a diverse range of bugs in the environment, known as microbes. Most of these don’t make us sick.

The belief that a high level of cleaning and personal hygiene weakens our immune system is a common interpretation of what’s called the “hygiene hypothesis”.

The hygiene hypothesis is a theory that suggests a young child’s environment can be “too clean”, and they won’t be exposed to enough of these microbes to effectively stimulate their immune system as it develops.

The argument is that this results in increased allergies, asthma and certain autoimmune disorders. But scientists have refuted this hypothesis in recent years, as research has shown there are multiple other reasons for the increased incidence of these conditions.

Importantly, being too dirty doesn’t help our immune system either. It generally makes inflammation worse.

A young girl plays in the mud.
The ‘hygiene hypothesis’ has been controversial.
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What is the immune system?

The immune system works to protect our bodies against things that threaten to make us sick — from harmful chemicals, to bacteria and viruses, to cancer cells.

It’s made up of two lines of defence. The first is the “innate” immune system, which responds rapidly to a range of pathogens to fight infection and prevent tissue damage.

Next is the “adaptive” immune system, made up of immune cells that develop a more targeted or specific response to fight off harsher germs such as viruses. Adaptive immune cells work by recognising small parts of the virus on the outside of the infected cell (for example, lung cells), and destroying them.

These cells then become what we call “memory cells”. The next time they encounter the same virus, they can eliminate it straight away.

This development of the immune system starts after birth and declines in old age.




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What can weaken our immune system?

Some aspects of our modern lifestyle can weaken our immune system. These include:

Woman holds healthy breakfast bowl with blueberries, guava and cereal.
A healthy diet is one way to support immune function.
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But there’s no scientific evidence to support the notion that extra hygiene precautions will weaken our immune system or leave us more susceptible to infection by bacteria or viruses.

Microbes are everywhere: in the air, on food, and in plants, animals, soil and water. They can be found on just about every surface, including inside and outside your body.

The hygiene measures recommended during COVID-19 will help curb the spread of the coronavirus and greatly reduce our risk of infection — but won’t eliminate all microbes from our lives.




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Keep it clean

Cleaning refers to the removal of microbes, dirt and impurities from surfaces. It doesn’t kill microbes, but by removing them, it lowers their numbers and therefore reduces the risk of spreading infection.

In contrast, disinfecting refers to using chemicals, known as disinfectants, to kill microbes on surfaces.

A combination of cleaning and disinfecting is the most effective way to get rid of microbes such as coronavirus.

A colourful bucket of cleaning products, with a woman mopping in the background.
Cleaning removes microbes and lowers the risk an infection will spread.
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Extra hand hygiene is of course one of the most important infection control measures.

We’ve been advised to clean our hands with soap and water for at least 20 seconds. If this is not possible, use hand sanitiser with at least 60% ethanol or 70% isopropanol.

Frequent hand-washing, especially if a sanitiser is used, can disrupt the natural skin biome, which can lead to increased skin infections. This can be managed with the use of moisturisers.

But the extra hygiene measures during COVID-19 won’t weaken our immune systems. On the contrary, they are vital in controlling the pandemic.

If you’re worried about your immune system, don’t stop washing your hands or keeping your house clean. Importantly, follow a healthy balanced diet, do regular exercise and look after your mental health.




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The Conversation


Vasso Apostolopoulos, Pro Vice-Chancellor, Research Partnerships, Victoria University; Maja Husaric, Lecturer; MD, Victoria University, and Maximilian de Courten, Health Policy Lead and Professor in Global Public Health at the Mitchell Institute, Victoria University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Miss hugs? Touch forms bonds and boosts immune systems. Here’s how to cope without it during coronavirus



Claudio Furlan/Lapresse/Sipa USA

Michaela Pascoe, Victoria University; Alexandra Parker, Victoria University; Glen Hosking, Victoria University, and Sarah Dash, Victoria University

Don’t shake hands, don’t high-five, and definitely don’t hug.

We’ve been bombarded with these messages during the pandemic as a way to slow the spread of COVID-19, meaning we may not have hugged our friends and family in months.

This might be really hard for a lot of us, particularly if we live alone. This is because positive physical touch can make us feel good. It boosts levels of hormones and neurotransmitters that promote mental well-being, is involved in bonding, and can help reduce stress.

So how can we cope with a lack of touch?


Wes Mountain/The Conversation, CC BY-ND

Touch helps us bond

In humans, the hormone oxytocin is released during hugging, touching, and orgasm. Oxytocin also acts as a neuropeptide, which are small molecules used in brain communication.

It is involved in social recognition and bonding, such as between parents and children. It may also be involved in generosity and the formation of trust between people.

Touch also helps reduce anxiety. When premature babies are held by their mothers, both infants and mothers show a decrease in cortisol, a hormone involved in the stress response.

Positive touch can release oxytocin, which is involved in human bonding.
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Touch promotes mental well-being

In adults with advanced cancer, massages or simple touch can reduce pain and improve mood. Massage therapy has been shown to increase levels of dopamine, a neurotransmitter (one of the body’s chemical messengers) involved in satisfaction, motivation, and pleasure. Dopamine is even released when we anticipate pleasurable activities such as eating and sex.




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Disruptions to normal dopamine levels are linked to a range of mental illnesses, including schizophrenia, depression and addiction.

Serotonin is another neurotransmitter that promotes feelings of well-being and happiness. Positive touch boosts the release of serotonin, which corresponds with reductions in cortisol.

Serotonin is also important for immune system function, and touch has been found to improve our immune system response.

Symptoms of depression and suicidal behaviour are associated with disruptions in normal serotonin levels.

But what about a lack of touch?

Due to social distancing measures during the COVID-19 pandemic, we should be vigilant about the possible effects of a lack of physical touch, on mental health.

It is not ethical to experimentally deprive people of touch. Several studies have explored the impacts of naturally occurring reduced physical touch.

For example, living in institutional care and receiving reduced positive touch from caregivers is associated with cognitive and developmental delays in children. These delays can persist for many years after adoption.




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Less physical touch has also been linked with a higher likelihood of aggressive behaviour. One study observed preschool children in playgrounds with their parents and peers, in both the US and France, and found that parents from the US touched their children less than French parents. It also found the children from the US displayed more aggressive behaviour towards their parents and peers, compared to preschoolers in France.

Another study observed adolescents from the US and France interacting with their peers. The American kids showed more aggressive verbal and physical behaviour than French adolescents, who engaged in more physical touch, although there may also be other factors that contribute to different levels of aggression in young people from different cultures.

Maintain touch where we can

We can maintain touch with the people we live with even if we are not getting our usual level of physical contact elsewhere. Making time for a hug with family members can even help with promoting positive mood during conflict. Hugging is associated with smaller decreases in positive emotions and can lessen the impact of negative emotions in times of conflict.

In children, positive touch is correlated with more self-control, happiness, and pro-social skills, which are behaviours intended to benefit others. People who received more affection in childhood behave more pro-socially in adulthood and also have more secure attachments, meaning they display more positive views of themselves, others, and relationships.

Pets can help

Petting animals can increase levels of oxytocin and decrease cortisol, so you can still get your fill of touch by interacting with your pets. Pets can reduce stress, anxiety, depression
and improve overall health.

In paediatric hospital settings, pet therapy results in improvements in mood. In adults, companion animals can decrease mental distress in people experiencing social exclusion.

Cuddling with pets is therapeutic and may help ease the mental health effects of social distancing.
Shutterstock



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Are people with pets less likely to die if they catch the coronavirus?


What if I live alone?

If you live alone, and you don’t have any pets, don’t despair. There are many ways to promote mental health and well-being even in the absence of a good hug.

The American College of Lifestyle Medicine highlights six areas for us to invest in to promote or improve our mental health: sleep, nutrition, social connectedness, exercise, stress management, and avoiding risky substance use. Stress management techniques that use breathing or relaxation may be a way to nurture your body when touch and hugs aren’t available.

Staying in touch with friends and loved ones can increase oxytocin and reduce stress by providing the social support we all need during physical distancing.


This article is supported by the Judith Neilson Institute for Journalism and Ideas.The Conversation

Michaela Pascoe, Postdoctoral Research Fellow in Mental Health, Victoria University; Alexandra Parker, Professor of Physical Activity and Mental Health, Victoria University; Glen Hosking, Senior Lecturer in Psychology, Victoria University, and Sarah Dash, Postdoctoral research fellow, Victoria University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

While we wait for a coronavirus vaccine, eating well, exercising and managing stress can boost your immune system



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Julia J Rucklidge, University of Canterbury and Grant Schofield, Auckland University of Technology

Social distancing may remain necessary during the 18 months or more we’ll have to wait for a coronavirus vaccine.

This can feel like we have little control, but there are several evidence-based protective measures we can take in the interim to ensure we are as healthy as possible to fight off infection and prevent mental health problems that escalate with uncertainty and stress.




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5 ways nutrition could help your immune system fight off the coronavirus


Coronavirus and underlying medical conditions

There is recent evidence that some younger people suffer strokes after contracting the virus, but the majority of people who end up hospitalised, in intensive care or dying from COVID-19 have an underlying medical condition. One study showed 89% of those hospitalised in the US had at least one.

These underlying medical conditions include high blood pressure, high blood sugar (especially type 2 diabetes), excessive weight and lung conditions. An analysis of data from the UK National Health Service shows that of the first 2,204 COVID-19 patients admitted to intensive care units, 72.7% were either overweight or obese.

All of these health issues have been associated with our lifestyle including poor diet, lack of exercise, smoking, excessive alcohol and high stress.

It’s obvious we have created a society where being active, eating healthily, drinking less and keeping our stress under control is difficult. Perhaps it’s time to push back. This may be important for major conditions like heart disease and diabetes as well as the added threat we face from emerging infectious diseases.

One study shows only 12% of Americans are in optimal metabolic health, which means their blood pressure, blood glucose, weight and cholesterol are within a healthy range. This rate is likely similar in many Western countries.

There is now a body of evidence linking our unhealthy lifestyle with viral, especially respiratory diseases. High blood sugar reduces and impairs immune function. Excessive body fat is known to disrupt immune regulation and lead to chronic inflammation. Insulin resistance and pre-diabetes can delay and weaken the immune response to respiratory viruses.




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Improving immunity through lifestyle choices

If we are going to restrict and change our lifestyles for 12 to 18 months while we wait for a vaccine, and if we want to protect ourselves better now and in the future, we could address these lifestyle factors. They not only affect our recovery from viruses and respiratory infections, but are also the biggest cost to the quality of life in most countries.

Optimising the health of the nation must be at the forefront. And this is long overdue. There has been a substantial under-investment by most developed countries in preventive medicine to reduce chronic diseases and improve both longevity and quality of life through healthy lifestyles.

Healthy organisms are naturally resistant to infections. This is true in plants, animals and people. Maintaining optimal health is our best defences against a pandemic until a vaccine is available.

We identify three modifiable risk factors:

1. Diet

Research shows better nourished people are less likely to develop both mental and physical problems. Certain nutrients, such as vitamins C and D and zinc have been identified as essential for improving immunity across the lifespan. A better diet is associated with a lower chance of developing mental health problems in both children and adults. Low levels of specific nutrients, such as vitamin D, have been recognised as risk factors for COVID-19. These nutrients are easy (and cheap) to replenish.

What does it mean to be better nourished? Eating real whole foods – fruits and vegetables, nuts, legumes, fish and healthy fats and reducing the intake of ultra-processed foods.

2. Exercise

Being physically fit adds years to your life – and quality of life. High cardiorespiratory (lung and heart) fitness is also associated with less respiratory illness, and better survival from such illnesses.

How do you get fit? Set aside time and prioritise walking at a minimum, and more vigorous activity if possible, every day. Ideally, you would get outside and be with important others. The more the better, as long as you are not overdoing it for your individual fitness level.

3. Stress

Stress impairs our immunity. It disrupts the regulation of the cortisol response which can suppress immune function. Chronic stress can decrease the body’s lymphocytes (white blood cells that help fight off infection). The lower your lymphocyte count, the more at risk you are of catching a virus.

How do we lower stress? Meditation, yoga, mindfulness, cognitive-behaviour therapy, optimising sleep and eating well can all help in mitigating the negative impact of stress on our lives. Taking additional nutrients, such as the B vitamins, and the full breadth of minerals like magnesium, iron and zinc, during times of stress has a positive impact on overall stress levels.




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Modifying lifestyle factors won’t eliminate COVID-19 but it can reduce the risk of death and help people to recover. And these factors can be in our control if we and our governments take the initiative.The Conversation

Julia J Rucklidge, Professor of Psychology, University of Canterbury and Grant Schofield, Professor of Public Health and Director of the Human Potential Centre, Auckland University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

5 ways nutrition could help your immune system fight off the coronavirus



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Clare Collins, University of Newcastle

The coronavirus presents many uncertainties, and none of us can completely eliminate our risk of getting COVID-19. But one thing we can do is eat as healthily as possible.

If we do catch COVID-19, our immune system is responsible for fighting it. Research shows improving nutrition helps support optimal immune function.

Micronutrients essential to fight infection include vitamins A, B, C, D, and E, and the minerals iron, selenium, and zinc.

Here’s what we know about how these nutrients support our immune system and the foods we can eat to get them.




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1. Vitamin A

Vitamin A maintains the structure of the cells in the skin, respiratory tract and gut. This forms a barrier and is your body’s first line of defence. If fighting infection was like a football game, vitamin A would be your forward line.

We also need vitamin A to help make antibodies which neutralise the pathogens that cause infection. This is like assigning more of your team to target an opposition player who has the ball, to prevent them scoring.

Vitamin A is found in oily fish, egg yolks, cheese, tofu, nuts, seeds, whole grains and legumes.

Further, vegetables contain beta-carotene, which your body can convert into vitamin A. Beta-carotene is found in leafy green vegetables and yellow and orange vegetables like pumpkin and carrots.

2. B vitamins

B vitamins, particularly B6, B9 and B12, contribute to your body’s first response once it has recognised a pathogen.

They do this by influencing the production and activity of “natural killer” cells. Natural killer cells work by causing infected cells to “implode”, a process called apoptosis.

At a football match, this role would be like security guards intercepting wayward spectators trying to run onto the field and disrupt play.

Fish is a good source of vitamin B6.
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B6 is found in cereals, legumes, green leafy vegetables, fruit, nuts, fish, chicken and meat.

B9 (folate) is abundant in green leafy vegetables, legumes, nuts and seeds and is added to commercial bread-making flour.

B12 (cyanocobalamin) is found in animal products, including eggs, meat and dairy, and also in fortified soy milk (check the nutrition information panel).

3. Vitamins C and E

When your body is fighting an infection, it experiences what’s called oxidative stress. Oxidative stress leads to the production of free radicals which can pierce cell walls, causing the contents to leak into tissues and exacerbating inflammation.

Vitamin C and vitamin E help protect cells from oxidative stress.




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Vitamin C also helps clean up this cellular mess by producing specialised cells to mount an immune response, including neutrophils, lymphocytes and phagocytes.

So the role of vitamin C here is a bit like cleaning up the football ground after the game.

Good sources of vitamin C include oranges, lemons, limes, berries, kiwifruit, broccoli, tomatoes and capsicum.

Vitamin E is found in nuts, green leafy vegetables and vegetables oils.

4. Vitamin D

Some immune cells need vitamin D to help destroy pathogens that cause infection.

Although sun exposure allows the body to produce vitamin D, food sources including eggs, fish and some milks and margarine brands may be fortified with Vitamin D (meaning extra has been added).

Most people need just a few minutes outdoors most days.

People with vitamin D deficiency may need supplements. A review of 25 studies found vitamin D supplements can help protect against acute respiratory infections, particularly among people who are deficient.

5. Iron, zinc, selenium

We need iron, zinc and selenium for immune cell growth, among other functions.

Iron helps kill pathogens by increasing the number of free radicals that can destroy them. It also regulates enzyme reactions essential for immune cells to recognise and target pathogens.

Whole grain foods contain a variety of important nutrients.
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Zinc helps maintain the integrity of the skin and mucous membranes. Zinc and selenium also act as an antioxidant, helping mop up some of the damage caused by oxidative stress.

Iron is found in meat, chicken and fish. Vegetarian sources include legumes, whole grains and iron-fortified breakfast cereals.

Zinc is found in oysters and other seafood, meat, chicken, dried beans and nuts.

Nuts (especially Brazil nuts), meat, cereals and mushrooms are good food sources of selenium.




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Putting it all together

It’s true some supermarkets are out of certain products at the moment. But as much as possible, focus on eating a variety of foods within each of the basic food groups to boost your intake of vitamins and minerals.

While vitamin and mineral supplements are not recommended for the general population, there are some exceptions.

Pregnant women, some people with chronic health conditions, and people with conditions that mean they can’t eat properly or are on very restrictive diets, may need specific supplements. Talk to your doctor, Accredited Practising Dietitian or pharmacist.




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And beyond diet, there are other measures you can take to stay as healthy as possible in the face of coronavirus.

Stop smoking to improve your lung’s ability to fight infection, perform moderate intensity exercise like brisk walking, get enough sleep, practise social distancing and wash your hands with soap regularly.The Conversation

Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Five life lessons from your immune system



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Are you exhausted? Your immune cells might be too.
from www.shutterstock.com

Joanna Groom, Walter and Eliza Hall Institute

This article is part of our occasional long read series Zoom Out, where authors explore key ideas in science and technology in the broader context of society and humanity.


Scientists love analogies. We use them continually to communicate our scientific approaches and discoveries.

As an immunologist, it strikes me that many of our recurring analogies for a healthy, functioning immune system promote excellent behaviour traits. In this regard, we should all aim to be a little more like the cells of our immune system and emulate these characteristics in our lives and workplaces.

Here are five life lessons from your immune system.




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The bugs we carry and how our immune system fights them


1. Build diverse and collaborative teams

Our adaptive immune system works in a very specific way to detect and eradicate infections and cancer. To function, it relies on effective team work.

At the centre of this immune system team sits dendritic cells. These are the sentinels and leaders of the immune system – akin to coaches, CEOs and directors.

They have usually travelled widely and have a lot of “life experience”. For a dendritic cell, this means they have detected a pathogen in the organs of the body. Perhaps they’ve come into contact with influenza virus in the lung, or encountered dengue fever virus in the skin following a mosquito bite.

Dendritic cells form a surveillance network – shown here as reddish stained cells in skin.
Ed Uthman (Houston, TX, USA) via Wikimedia Commons, CC BY

After such an experience, dendritic cells make their way to their local lymph nodes – organs structured to facilitate immune cell collaboration and teamwork.

Here, like the best leaders, dendritic cells share their life experiences and provide vision and direction for their team (multiple other cell types). This gets the immune cell team activated and working together towards a shared goal – the eradication of the pathogen in question.

The most important aspect of the dendritic cell strategy is knowing the strength of combined diverse expertise. It is essential that immune team members come from diverse backgrounds to get the best results.

To do this, dendritic cells secrete small molecules known as chemokines. Chemokines facilitate good conversations between different types of immune cells, helping dendritic cells discuss their plans with the team. In immunology, we call this “recruitment”.

This 3D image of a lymph node shows the cells that produce chemokines in red and blue.
Joanna Groom/WEHI, Author provided

Much like our workplaces, diversity is key here. It’s fair to say, if dendritic cells only recruited more dendritic cells, our immune system would completely fail its job. Dendritic cells instead hire T cells (among others) and share the critical knowledge and strategy to steer effective action of immune cells.

T cells can then pass these plans down the line – either preparing themselves to act directly on the pathogen, or working alongside other cell types, such as B cells that make protective antibodies.

In this way, dendritic cells establish a rich and diverse team that works together to clear infections or cancer.

2. Learn through positive and negative feedback

Immune cells are excellent students.

During development, T cells mature in a way that depends on both positive and negative feedback. This occurs in the thymus, an organ found in the front of your chest and whose function was first discovered by Australian scientist Jacques Miller (awarded the 2018 Japan Prize for his discoveries).




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As they mature, T cells are exposed to a process of trial and error, and take on board criticism and advice in equal measure, to ensure they are “trained” to respond appropriately to what they “see” (for example, molecules from your own body, or from a foreign pathogen) when they leave the thymus.

Importantly, this process is balanced, and T cells must receive both positive and negative feedback to mature appropriately – too much of either on its own is not enough.

In the diverse team of the immune system, cells can be both the student and the teacher. This occurs during immune responses with intense cross-talk between dendritic cells, T cells and B cells.

In this supportive environment, multiple rounds of feedback allow B cells to gain a tighter grip on infections, tailoring antibodies specifically towards each pathogen.

The result of this feedback is so powerful, it can divert cells away from acting against your own body, instead converting them into active participants of the immune system team.

Developing avenues that promote constructive feedback offers potential to correct autoimmune disorders.

The colours in this magnified slice through a lymph node show different cell types interacting as part of an immune response.
Joanna Groom/WEHI, Author provided



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3. A unique response for each situation

Our immune system knows that context is important – it doesn’t rely on a “one-size–fits-all” approach to resolve all infections.

This allows the cells of our immune system to perfectly respond to different types of pathogens: such as viruses, fungi, bacteria and helminths (worms).

In these different scenarios, even though the team members contributing to the response are the same (or similar), our immune system displays emotional intelligence and utilises different tools and strategies depending on the different situations, or pathogens, it encounters.

Importantly, our immune system needs to carefully control attack responses to get rid of danger. Being too heavy handed leaves us with collateral tissue damage, such as is seen allergy and asthma. Conversely, weak responses lead to immunodeficiencies, chronic infection or cancer.

A major research aim for people working in immunology is to learn how to harness balanced and tailored immune responses for therapeutic benefit.




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4. Focus on work/life balance

When we are overworked and poorly rested, we don’t function at our peak. The same is true for our immune cells.

An overworked immune cell is commonly referred to as being “chronically exhausted”. In this state, T cells are no longer effective at attacking tumour or virus-infected cells. They are lethargic and inefficient, much like us when we overdo it.

For T cells, this switch to exhaustion helps ensure a balanced response and avoids collateral damage. However, viruses and cancers exploit this weakness in immune responses by deliberately promoting exhaustion.

The rapidly advancing field of immunotherapy has tackled this limitation in our immune system head-on to create new cancer therapeutics. These therapies release cells of their exhaustion, refresh them, so they become effective once more.

This therapeutic avenue (called “immune checkpoint inhibition”) is like a self-care day spa for your T cells. It revives them, renewing their determination and efficiency.

This has revolutionised the way cancer is treated, leading to the award of the 2018 Nobel prize in Medicine to two of its pioneers, James P. Allison and Tasuku Honjo.




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5. Learn from life experiences

The cornerstone of our adaptive immune system is the ability to remember our past infections. In doing so, it can respond faster and in a more targeted manner when we encounter the same pathogen multiple times.

Quite literally, if it doesn’t kill you, it makes your immune system stronger.

Vaccines exploit this modus operandi, providing immune cells with the memories without the risk of infection.

Work still remains to identify the pathways that optimise formation of memory cells that drive this response. Researchers aim to discover which memories are the most efficient, and how to make them target particularly recalcitrant infections, such as malaria, HIV-AIDS and seasonal influenza.

While life might not have the shortcuts provided by vaccines, certainly taking time to reflect and learn after challenges can allow us to find better, faster solutions to future problems.




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The Conversation


Joanna Groom, Laboratory Head, Walter and Eliza Hall Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A strong immune system helps ward off colds and flus, but it’s not the only factor



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Winter bugs are impossible to escape.
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Hui-Fern Koay, University of Melbourne and Jesseka Chadderton, University of Melbourne

It’s peak flu season. You’re cold, rugged up and squashed on public transport or in the lift at work. You hear a hacking cough, or feel the droplets of a sneeze land on your neck. Will this turn into your third cold this year?

No matter how much we try to minimise our exposure to respiratory viruses, it’s far more difficult in winter when we spend so much time in close proximity to other people.

On top of this, viruses tend to be more stable in colder and drier conditions, which means they stick around longer.




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The common cold is caused by more than 200 different viruses, the most common of which are rhinoviruses (rhino meaning nose). Rhinovirus infections tend to be mild; you might get a sore throat and a head cold lasting just a few days.

Influenza, or the flu, is generally caused by type A or B influenza viruses. The flu is far more aggressive and often includes a fever, fatigue and body aches, in addition to all the classic cold symptoms.

The flu tends to be more severe than the common cold.
healthdirect

When it comes to getting sick, there’s always an element of bad luck involved. And some people, particularly those with young children or public transport commuters, are likely to come into contact with more viruses.

But you may have noticed that illness often strikes when you’re stressed at work, not sleeping properly, or you’ve been out partying a little too much. The health of our immune system plays an important role in determining how we can defend against invading cold and flu viruses.

How the immune system fights viruses

Your skin and saliva are key barriers to infection and form part of your immune system, along with cells in every tissue of your body, including your blood and your brain.

Some of these cells migrate around to fight infection at specific sites, such as a wound graze. Other cells reside in one tissue and regulate your body’s natural state of health by monitoring and helping with the healing process.

The cells that make up your immune system need energy too, and when you’re low on juice, they’ll be on low-battery mode. This is when our natural immune defences are weakened and normally innocuous bugs can begin to cause strife.

Our immune system requires a lot of energy to defend our bodies. Feeling tired and achy, overheating, and glands swelling are all signs that our immune system is busy fighting something.




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Boosting our natural defence system

Our immune system has evolved to naturally detect and eliminate viral infections. And we can actively strengthen our immunity and natural defences by looking after ourselves. This means:

  • getting adequate sleep. Sleep deprivation increases the hormone cortisol, which suppresses immune function when its levels are elevated

  • exercising, which helps the lymphatic system, where our immune cells circulate, and lowers levels of stress hormones

  • eating well and drinking enough water. Your immune system needs energy and nutrients obtainable from food. And staying well hydrated helps the body to flush out toxins

Good food feeds your immune system.
Anna Pelzer
  • not smoking. Smoking, or even secondary smoke, damages our lungs and increases the vulnerability of our respiratory system to infection.



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Educating our immune system

Natural defences aren’t always enough to keep us safe and we need the help of flu vaccinations.

Vaccines are designed to educate an army of B and T cells which make up your adaptive immune system. This arm of your immune system learns by exposure and provides long-term immunity.

These T and B cells need a bit of time from the initial influenza exposure before they can be activated. This activation lag time is when you feel the brunt of the flu infection: lethargy, body aches, extreme fatigue and unable to get off the couch for a day or two.

To overcome this delay and protect people before they are exposed to potentially harmful flu strains, flu vaccination introduces fragments of the influenza virus into the body, which acts like prior exposure to the bug (without actual infection).

You can still get the flu if you’ve been vaccinated but you might not get as sick.
VGstockstudio/Shutterstock

Seasonal vaccines are designed to match currently circulating strains and target those strains before you’re infected.

You can still catch the influenza virus if you are vaccinated. But because of this pre-education, the symptoms will likely be milder. The immune system has been trained and the army of B and T cells can move into action quicker.

Already have a cold or the flu?

If you’ve been sniffling and sneezing your way through winter, be comforted by the fact that these bugs are strengthening your immune system. Our body remembers the particular strain of rhinovirus or influenza we get, so it can recognise and mount a stronger defence if we encounter it again.


The Conversation


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Hui-Fern Koay, Research Fellow in Immunology, University of Melbourne and Jesseka Chadderton, PhD Candidate, University of Melbourne

This article was originally published on The Conversation. Read the original article.

The bugs we carry and how our immune system fights them



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The immune system has to establish which cells belong to us and which are foreign, no mean feat.
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Peter C. Doherty, The Peter Doherty Institute for Infection and Immunity

This article is part of a three-part package exploring immunity and infectious diseases around the world. Read the other articles here.


Human beings are large, complex, multicellular, multi-organ systems. We reproduce slowly and rely on a breadth of mechanisms that allow us to control the myriad of rapidly replicating, simple life forms that have evolved to live in or on us.

The system of defence is referred to collectively as immunity.

The word itself comes from the Latin immunis, describing the status of returned soldiers (Genio immunium) in the Roman state who were, for a time, exempt from paying taxes.

Our immunity protects us from many illnesses, including some forms of cancer. New cancer therapeutics, called immunotherapies, work by boosting our immune cells to fight cancer cells that have found ways to evade them.

The immune system is divided into two interactive spheres, the much older “innate” sphere, and the more recently evolved “adaptive” sphere. A primary challenge for the very specifically targeted cells that form the basis of adaptive immunity is to distinguish “self” (our own body cells and tissues) from “non-self” – the foreign invaders. When that goes wrong, we can develop autoimmune diseases such as multiple sclerosis or rheumatoid arthritis.




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The organisms we carry around with us

The human body is host to many organisms over a lifetime. Some are dangerous to health (pathogens), some are benign, and some are necessary for proper functioning.

Most of the genetic material we carry around with us is “non-self”: principally harmless bacteria (called “commensals”) that live in the gastrointestinal tract.

Traditionally, studies focused on the “bad bugs” in our gut that cause diarrhoea and dysentery. But more recently, we’re learning there are also good guys. And there’s a general consensus we need to know more about the “microbiome”, the mass of bacteria in any “clinically normal” gut.

Gut bacteria provide essential vitamin B12 and when they die, release myriad proteins that will be broken down into amino acids, which the body needs. About 30% of our poo is comprised of dead bacteria.

Apart from our microbiome, normal human beings also have a substantial “virome”. Viruses differ from bacteria (which are cells in their own right) in that they are much simpler and can only replicate in living cells.

The greatest number of viruses we carry around are the “bacteriophages”, which infect the commensal bacteria in our gut. Not all “phages” are, however, benign. For example, the toxin that causes human diphtheria is encoded in the genome of a bacteriophage.

There’s also a spectrum of viruses that persistently infect our body tissues. The most familiar are herpes viruses, like those that cause cold sores (H. simplex) and shingles (H. zoster). Both viruses hide out in the nervous system and are normally under immune control. They re-emerge to cause problems as a consequence of tissue stress (such as a sunburnt lip) or as immunity declines with age (shingles). This is why a booster shingles vaccine is recommended for the elderly.




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Our innate and adaptive immune systems

The innate system ranges from processes as basic as phagocytosis (ingestion of bacteria), to molecules like the interferons produced by any virus-infected cell that can limit replication. Such innate systems are found right across the evolutionary spectrum and don’t target specific pathogens.

The much younger adaptive immune system is what we stimulate with vaccines. A property of small white blood cells called lymphocytes, it divides broadly into two lineages: the B cells and T cells. These bear the extraordinarily diverse and very specific immunoglobulin (Ig) and T cell receptor (TCR) recognition molecules that detect invading pathogens (bacteria, virus, fungi and so on).

The immunoglobulins bind to “non-self” (foreign) proteins called “antigens”, while the T cell receptors are specifically targeted to “self” transplantation molecules.

The assassins of the immune system are then switched on; the killer T cells that eliminate virus-infected (or cancer) cells. Also activated are the “helper” T cells that secrete various molecules to “help” both the B cells and killer T cells differentiate and do their work.




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How does our immune system learn and remember?

All lymphocyte responses work by massive cell division in the lymph nodes (the “glands” in our neck that swell when we get a sore throat). This process is started by small numbers of “naive” B and T cells that haven’t encountered the invader before, and only stops when the foreign invader is eliminated.

The B cells differentiate into large protein-secreting cells called plasma cells, which produce the protective antibodies (immunoglobulins) that circulate for years in our blood.

Most of the T cells die off after they’ve done their job, but some survive so they can remember how to target specific invaders. They can be rapidly recalled to their “killer” or “helper” function.

Prior infection or the administration of non-living or “attenuated” (to cause a very mild infection) vaccines sets up the memory so protective antibodies are immediately available to bind (and neutralise) pathogens like the polio or measles virus. While immune T cells are rapidly recalled to “assassin” status and eliminate pathogen-infected cells.

As you may have gathered from this very brief and far too simplified account, the immune system is extraordinarily complex. And it’s also very finely balanced with, for example, cross reactive responses to bacterial proteins sometimes setting us up for autoimmune diseases.




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Another example of autoimmunity is rheumatoid arthritis, which can be triggered by blood-borne chemicals from tobacco smoke that modify “self” transplantation molecules in the joints.

The ConversationAnd when we talk about the possible effects of the microbiome, or the “too clean” hypothesis, we’re discussing how exposure to bacteria and viruses can modify that immune balance in ways that directly affect our wellbeing. This is a very active area of research which, given the underlying complexity, presents scientists with big challenges as we seek to reach verifiable conclusions.

Peter C. Doherty, Laureate Professor, The Peter Doherty Institute for Infection and Immunity

This article was originally published on The Conversation. Read the original article.