How long does immunity last after COVID vaccination? Do we need booster shots? 2 immunology experts explain

Vasso Apostolopoulos, Victoria University and Jack Feehan, Victoria UniversityAn important factor in achieving herd immunity against SARS-CoV-2 (the virus that causes COVID-19) is is how long the vaccines protect you.

If a vaccine continues to work well over a long period, it becomes easier to have a significant proportion of the population optimally protected, and in turn suppress or eliminate the disease entirely.

As the rollout of COVID-19 vaccines continues, public attention is increasingly turning to booster shots, which aim to top up immunity if it wanes. But is a third dose needed? And if so, when?

Let’s take a look at what the data tell us so far about how long immunity from COVID-19 vaccines might last.

First, what about immunity following COVID-19 infection?

The presence of antibodies against SARS-CoV-2 is used as an indicator of immunity, with higher levels indicating greater protection. Once antibody levels drop below a particular threshold, or vanish completely, the person is at risk of reinfection.

Initially, scientists observed people’s antibody levels rapidly decreased shortly after recovery from COVID-19.

However, more recently, we’ve seen positive signs of long-lasting immunity, with antibody-producing cells in the bone marrow identified seven to eight months following infection with COVID-19. In addition, scientists have observed evidence of memory T cells (a type of immune cells) more than six months following infection.

A study of over 9,000 recovered COVID-19 patients in the United States up to November 2020 showed a reinfection rate of only 0.7%. These findings closely align with a slightly more recent study suggesting reinfection after COVID-19 is very uncommon, at least in the short term.

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While it seems likely there’s some level of lasting protection following COVID-19 infection, if you’ve had COVID, getting vaccinated is still worthwhile.

There’s some evidence vaccination after recovery leads to a stronger level of immunity compared to “natural” immunity from infection, or immunity from vaccination alone. People with so-called “hybrid immunity” appear to exhibit a more diverse range of antibodies.

How long does immunity from vaccines last?

The vaccines deployed against COVID-19 in Australia and most of the western world come from two classes.

Those produced by AstraZeneca and Johnson & Johnson are viral vector vaccines. They use an adenovirus (which causes the common cold) to prime the immune system to respond to SARS-CoV-2.

The vaccines developed by Pfizer and Moderna use mRNA-based technology. The messenger RNA gives your cells temporary instructions to make the coronavirus’ spike protein, teaching your immune system to protect you if you encounter the virus.

For the viral vector vaccines, despite ongoing trials, there’s little data available on the duration of the antibody response. The original studies showed efficacy for one to two months, however the duration of protection, and whether a booster will be needed, require further evaluation.

Notably, a vaccine similar to AstraZeneca against a related coronavirus (Middle East respiratory syndrome, or MERS) showed stable antibody levels over a 12-month follow-up period. This gives hope for lasting protection against similar coronaviruses.

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The Pfizer and Moderna COVID-19 vaccines are the first vaccines based on mRNA technology to be approved for human use. So there’s still significant research required to evaluate the nature and duration of immunity they induce.

Interestingly, “germinal centers” have been identified in the lymph nodes of people vaccinated with the Pfizer vaccine. These act as training sites for immune cells, teaching them to recognise SARS-CoV-2, indicating a potential for long-lasting protection.

Initial studies only evaluated short-term efficacy, however recent research has found strong antibody activity at six months.

What about Delta?

Variants such as Delta, which are more transmissible and potentially more dangerous, are likely to increase interest in booster programs.

All vaccines show modestly reduced efficacy against Delta, so any decrease in protection over time could be more problematic than with the original SARS-CoV-2 virus, or other variants.

A recent preprint (a study yet to undergo peer review) found protection against the Delta variant waned within three months with both the Pfizer and AstraZeneca vaccines.

This research from the United Kingdom showed the Pfizer vaccine was 92% effective at preventing people from developing a high viral load at 14 days after the second dose, but this dropped to 78% at 90 days. AstraZeneca was 69% effective against the same measure at 14 days, dropping to 61% after 90 days.

This study shows vaccinated people who become infected with Delta still carry high amounts of virus (viral load). Third booster doses will be important to reduce these breakthrough infections and subsequent transmission.

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Although the UK study looked at infections rather than hospitalisations or deaths, data from around the world continue to show the unvaccinated are making up the vast majority of patients who develop serious illness.

Nonetheless, scientists are continuing to investigate how waning immunity could affect protection against the more serious outcomes of COVID-19.

OK, so what now?

Pfizer has reported positive results from trials of a third dose to boost immunity, and the company is seeking formal approval for a booster from the United States Food and Drugs Administration.

The United States has announced it will begin distributing third doses next month to people who received an mRNA vaccine eight months ago or more.

Other countries, such as Israel, have already begun rolling out boosters. The move to offer third doses in some high-income countries has raised ethical concerns, with many people around the world still unable to access a first or second dose.

A number of countries have authorised booster doses for at-risk populations in response to the rise of the Delta variant.

This includes older adults and those with compromised immune systems, to combat the increased risk of severe disease and diminished vaccine protection in these people.

In Australia, there is likely to be a booster program in the future. But given the current issues surrounding supply, it’s unlikely to be for some months.

Vasso Apostolopoulos, Professor of Immunology and Associate Provost, Research Partnerships, Victoria University and Jack Feehan, Research Officer – Immunology and Translational Research, Victoria University

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

If I’ve already had COVID, do I need a vaccine? And how does the immune system respond? An expert explains

Andre Coelho/EPA/AAP

Sunit K. Singh, Banaras Hindu UniversityOver a year into the pandemic, questions around immune responses after COVID continue to confound.

One question many people are asking is whether the immunity you get from contracting COVID and recovering is enough to protect you in the future.

The answer is no, it’s not.

Here’s why.

Remind me, how does our immune response work?

Immune responses are innate or acquired. Innate, or short-term immunity, occurs when immune cells that are the body’s first line of defence are activated against a pathogen like a virus or bacteria.

If the pathogen is able to cross the first line of defence, T-cells and B-cells are triggered into action. B-cells fight through secreted proteins called antibodies, specific to each pathogen. T-cells can be categorised into helper T-cells and killer T-cells. Helper T-cells “help” B-cells in making antibodies. Killer T-cells directly kill infected cells.

Once the battle is over, B-cells and T-cells develop “memory” and can recognise the invading pathogen next time. This is known as acquired or adaptive immunity, which triggers long-term protection.

What happens when you get reinfected? Memory B-cells don’t just produce identical antibodies, they also produce antibody variants. These diverse set of antibodies form an elaborate security ring to fight SARS-CoV-2 variants.

Natural immunity is not enough

Getting COVID and recovering (known as “natural infection”) doesn’t appear to generate protection as robust as that generated after vaccination.

And the immune response generated post-infection and vaccination, known as hybrid immunity, is more potent than either natural infection or vaccination alone.

People who have had COVID and recovered and then been vaccinated against COVID have more diverse and high-quality memory B-cell responses than people who’ve just been vaccinated.

Studies indicate mRNA vaccines generate a more potent immune response with previous infection, at least against some variants including Alpha and Beta.

And studies have shown that antibody levels were higher among those who’d recovered from COVID and were subsequently vaccinated than those who’d only had the infection.

Memory B-cells against the coronavirus have been reported to be five to ten times higher in people vaccinated post-infection than natural infection or vaccination alone.

Is one dose enough after COVID?

Some reports have suggested people who’ve had COVID need only one dose of the vaccine. Clinical trials of approved vaccines didn’t generate relevant data because people who’d already had COVID were excluded from phase 3 trials.

One study from June showed people with previous exposure to SARS-CoV-2 tended to mount powerful immune responses to a single mRNA shot. They didn’t gain much benefit from a second jab.

A single dose of an mRNA vaccine after infection achieves similar levels of antibodies against the spike protein’s receptor binding domain (which allows the virus to attach to our cells) compared to double doses of vaccination in people never exposed to SARS-CoV-2.

We need more studies to fully understand how long memory B-cell and T-cell responses will last in both groups.

Also, a single dose strategy has only been studied for mRNA-based vaccines. More data is required to understand whether one jab post-infection would be effective for all the vaccines.

At this stage, it’s still good to have both doses of a COVID vaccine after recovering from COVID.

Does Delta change things?

The development of new vaccines must keep pace with the evolution of the coronavirus.

At least one variant seems to have evolved enough to overtake others, Delta, which is about 60% more transmissible than the Alpha variant. Delta is moderately resistant to vaccines, meaning it can reduce how well the vaccines work, particularly in people who’ve only had one dose.

There’s no data available yet about how effective a single jab is for people who were previously infected with Delta and recovered.

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The most important thing you can do to protect yourself from Delta is to get fully vaccinated.

According to a Public Health England report, one dose of Pfizer offered only about 33% protection against symptomatic disease with Delta, but two doses was 88% effective. Two doses was also 96% effective against hospitalisation from Delta. The AstraZeneca vaccine was 92% effective against hospitalisation from Delta after two doses.

A few vaccine manufacturers, including Pfizer, are now planning to use a potential third dose as a booster to combat the Delta variant.

Sunit K. Singh, Professor of Molecular Immunology and Virology, Institute of Medical Sciences, Banaras Hindu University

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

New research suggests immunity to COVID is better than we first thought

Nigel McMillan, Griffith University

Early in the pandemic, many researchers feared people who contracted COVID could be reinfected very quickly. This was because several early studies showed antibodies seemed to wane after the first few months post-infection.

It was also partly because normal human coronaviruses, which are one cause of common colds and are cousins of SARS-CoV-2, do not generate long-lasting immunity, so we can get reinfected with them after 12 months.

But new preliminary research suggests key parts of the immune system can remember SARS-CoV-2 for at least eight or nine months, and possibly for years.

Immune memory

When a country is invaded by an enemy, it rallies its forces, fights the war and hopefully repels the invaders. While the enemy has disappeared back to their own territory, a smart country sets up watchers to look for any signs of a new invasion. These lookouts know what the enemy looks like and are familiar with their uniform and how they travel.

Our immune system is exactly the same. Whenever we fight a bacterial or viral infection we leave behind certain cells that remember exactly what this invader looks like. These are called memory cells and their job, in the event of another “invasion”, is to warn our immune system early and ensure the right sort of response is mounted. It means we don’t have to start all over again to make a new response, and so reinfection is either eliminated or the time to recovery is much reduced.

This long-lived memory response can last a lifetime for some viruses such as measles.

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But how long for COVID?

We have two main parts of our adaptive immune response: B cells and T cells. Both of these cells can generate “memory”.

We’ll talk about B cells first. They make antibodies, which latch onto and destroy disease-causing agents such as viruses and bacteria.

A team of researchers from Australia, led by Menno van Zelm at Monash University, published a preliminary study last week showing the body can generate memory B cells specific to SARS-CoV-2. The research showed these cells last at least eight months, and likely even longer. This means these memory B cells could still rapidly produce antibodies against SARS-CoV-2 eight months post-infection, if the person were to be exposed to the virus again (although this work has not yet been peer-reviewed so should be treated with caution).

Other researchers from the United States showed memory B cells lasted at least six months, in a preliminary study also released last week.

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While the researchers from Australia saw a drop in circulating antibodies against the virus after two months in the blood of the 25 patients they looked at, they found memory B cells against two important parts of the virus: the spike protein (what most vaccines are designed to target) and the “nucleocapsid”, another structural protein of the virus.

They say this should give long-lasting immunity.

But we can’t directly prove this, because that would involve reinfecting patients, which would be unethical. So to study this further, we have to rely on natural reinfections.

There have been just 26 confirmed cases of reinfection reported worldwide so far, according to a COVID reinfection tracker by Dutch news agency BNO News (although the true tally is likely higher). With 60 million people infected globally so far, reinfection therefore seems to be a very rare event.

Illustration of an antibody-producing B cell. New research suggests our immune system can remember how to produce antibodies against SARS-CoV-2 at least eight months after infection, and probably even longer.
Shutterstock

What about T cells? These are cells that bind directly to infected human cells within the body and destroy them. All infected cells smuggle out bits of the invading pathogen onto their surface, as a kind of “SOS” signal that allows T cells to find the hidden enemy.

Researchers from the University of Oxford published a study in September showing memory T cell responses to SARS-CoV-2. This means certain T cells could remember how to respond to virus-infected cells, long after the initial infection was cleared —although there was no data on how long this may last.

A more recent study, published as a preliminary report last week from researchers in China and Germany, answers this question.

They studied patients from Wuhan, where the first reported COVID cases occurred, and who therefore have the oldest immune responses. They showed T cell memory responses were still present nine months after infection.

So what does this all mean going forward?

It would seem SARS-CoV-2 is not like its normal common cold coronavirus cousins. People’s immune responses to common cold coronaviruses typically don’t last very long, meaning we typically get reinfected by 12 months.

But it’s clear people’s immune systems can “remember” and respond to SARS-CoV-2. Interestingly, more severe coronavirus infections SARS and MERS appear to elicit longer-lasting responses up to three years.

So, people who’ve been naturally infected with SARS-CoV-2 can expect reinfection to be rare. If it does occur it will probably result in very mild disease, but otherwise they should be fully protected for at least eight or nine months after their first infection.

But we still don’t know what would happen if someone was re-exposed after this timeline — only time will tell.

Nigel McMillan, Program Director, Infectious Diseases and Immunology, Menzies Health Institute, Griffith University

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

Immunity to COVID-19 may not last. This threatens a vaccine and herd immunity

Nigel McMillan, Griffith University

How is the world going to go back to the days when we could grab a coffee, see a movie, or attend a concert or footy game with anyone?

Opinion suggests there are two options: an effective vaccine, or herd immunity via at least 60-80% of people becoming infected. Either one of these options requires that people become immune to SARS-CoV-2, the coronavirus that causes COVID-19.

An important new study released online this week could have a large bearing on how our future looks in 2021 and beyond.

It suggests our immunity to SARS-CoV-2 does not last very long at all — as little as two months for some people. If this is the case, it means a potential vaccine might require regular boosters, and herd immunity might not be viable at all.

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Immunity dwindles quickly

Antibodies are an important part of our immune system that mainly work by physically binding to virus particles and stopping them infecting cells. They can attach to infected cells to induce cell death in some cases.

We also have T cells, another part of the immune system that is much better at recognising and killing virus-infected cells. But for COVID-19, antibodies are important in the lungs because T cells aren’t good at getting to airways where the virus first invades.

Antibodies attach on to viruses and prevent them from infecting our cells.
Shutterstock

The newly released research, from Katie Doores and her team at Kings College London, looked at how long the antibody response lasted in people who had COVID-19. It has been submitted to a journal but hasn’t been peer-reviewed, so it must be treated with some caution.

Of the 65 patients studied, 63 produced antibody responses. The important measurements in the study relate to how good the response is. This is measured in the lab by putting patients’ blood serum together with infectious SARS-CoV-2 virus and seeing whether the virus can infect cells in a lab dish. This is called a “neutralisation assay”, and here the results were good.

Around 60% of people produced a very potent neutralisation response that stopped virus growing in the lab cells.

Finally, the researchers measured how long the antibody response lasted. This is the most important data. Unfortunately, antibodies levels began falling after day 20 and only 17% of patients retained a potent level at day 57. Some patients completely lost their antibodies after two months.

This suggests our immune response to SARS-CoV-2 may be lost much faster than we might have hoped, and people might thereafter be susceptible to reinfection with the virus.

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One vaccine might not be enough

It therefore follows that COVID-19 vaccines may not be as effective as we hope. The fact antibody levels reduce over time is normal, but this typically happens much more slowly. Antibody responses against the mumps, measles and chickenpox viruses last for more than 50 years. A tetanus vaccination wanes more quickly but still lasts 5-10 years before a booster is needed.

So why is this happening? It comes down to the nature of the SARS-CoV-2 coronavirus itself. The four normal strains of coronaviruses that cause common colds in humans also fail to prompt a long-lasting immune response, with most people losing antibodies completely after 6-12 months. Coronaviruses in general seems to be particularly good at not being well recognised by our immune system. Indeed, a feature of common cold coronaviruses is that people get reinfected by them all the time.

SARS, another coronavirus which caused a pandemic in 2003, seems to produce a slightly longer antibody response, lasting up to three years. It’s still a long way short of a lifetime, but it perhaps helps explain why the virus disappeared in 2003.

Herd immunity might be in trouble

So herd immunity may not be the solution some think. This is because if immunity is short-lived, we will be in an ongoing cycle of endless reinfection. For herd immunity to be effective we need a high percentage (perhaps more than 60%) of people to be immune at any one time to disrupt chains of transmission. This can’t happen if a lot of reinfection is occurring.

The hope is vaccines will give much stronger and longer lasting immune responses to the virus than getting and recovering from COVID-19 itself. Indeed, the first vaccine candidates from Pfizer and Moderna, reported in early July, show very strong immune responses.

However, these studies only reported out to 14 and 57 days, respectively, after vaccinations were completed. They don’t tell us whether there is a long-lived response that we would need for a vaccine to be truly protective. Phase 3 trials designed to measure this are due to report in December 2020, so watch this space.

While we wait, we should reflect on the fact that although the results of the Kings College study are in one sense disappointing news, this knowledge adds to the truly remarkable scientific progress we have made in understanding a virus that only emerged in December 2019.

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

Nigel McMillan, Program Director, Infectious Diseases and Immunology, Menzies Health Institute, Griffith 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

Shutterstock

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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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.

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.

Eat your vegetables – studies show plant-based diets are good for immunity

We’ve been told there are many benefits of eating our veggies. Could they improve our immune system too?
From shutterstock.com

Yasmine Probst, University of Wollongong and Joel Craddock, University of Wollongong

The number of people in Australia who follow vegetarian or plant-based diets is growing rapidly. People might choose to be vegetarian for ethical, cultural or health-related reasons.

While not all vegetarians are necessarily following a healthy diet, research shows vegetarianism can have many benefits for health. One we’re learning more about is its potential to strengthen our immune systems.

We’re still working out what aspects of a vegetarian diet may be responsible for this – whether it’s the lack of meat or the emphasis on plant-based foods.

But we think the higher volume of foods including fruits, vegetables and legumes seen in vegetarian diets is likely to have a lot to do with any associated health benefits.

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What do vegetarians eat?

Vegetarian diets are comprised of combinations of fruit, vegetables, whole grains, nuts and seeds, legumes and, for some, dairy and eggs.

There are many types of vegetarian eating patterns, from vegan (no animal products) through to lacto-ovo (some animal products such as eggs and dairy). But each avoids eating meat.

There are also a few semi-vegetarian approaches which include eating small amounts of some meats. People who primarily follow a vegetarian diet but include fish are referred to as pescetarian, while those who occasionally eat other forms of meat are considered flexitarian.

Importantly, not all vegetarians follow a healthy and balanced diet. Many won’t eat the recommended daily servings of fruit and vegetables, and will consume too much junk food.

But studies show that balanced vegetarian eating patterns could be good for our immune system and the related response of the body.

Defending from attack

Our bodies are faced with daily challenges such as getting rid of toxic chemicals and defending against nasty viruses. The immune system is “switched on” in response to these attacks.

Having a healthy immune system is important, as it prevents us from becoming sick. A healthy immune system can be supported by a number of lifestyle factors including adequate sleep, healthy body weight and regular physical activity. It can also be substantially affected by the foods we eat and drink.

Some research has found following a vegetarian diet could improve our immune systems.
From shutterstock.com

People following vegetarian diets tend to have lowered levels of white blood cells, our natural defender cells. This is the case for vegetarian diets including vegan, lacto-vegetarian and lacto-ovo vegetarian.

Having very low levels of these cells is not ideal as it can affect the body’s ability to fight infection. However, having just the right number of white cells within a healthy range may reduce your chances of getting sick.

An added shield of protection

As well as helping the immune system, vegetarian diets may also help our body with a related process called inflammation. Vegetarian diets have been shown to prevent inflammation due to the antioxidant components within the foods.

Inflammation occurs when the body releases cells to attack unwanted pathogens or respond to injury. It may result in redness to an area of the body or the release of certain chemicals inside our bodies. Inflammation is a protective measure that the body uses to stay as healthy as it can.

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People who follow vegetarian diets have lower levels of some of these chemicals (called C-reactive protein and fibrinogen) compared to people following a non-vegetarian diet.

This means people maintaining a vegetarian diet long-term are at a lower risk of getting type 2 diabetes, heart disease or even some cancers. Each of these chronic diseases is associated with increased inflammation in the body. This is shown in blood tests by increased levels of C-reactive protein, as this is a signal of systemic inflammation.

The reason why vegetarians have lowered levels of inflammation remains to be fully understood.

We suspect the high amount of fruits, vegetables, whole grains, nuts and seeds are helping. These foods are full of important nutrients including fibres, vitamins, minerals and compounds called phytochemicals.

All of these nutrients have been shown to improve levels of inflammation in the long term and may influence the body’s immune response as an added bonus.

Should I switch to a vegetarian diet?

Going vegetarian may not be for everyone.

And it’s unwise to start a new eating pattern without understanding the potential impacts it can have on your health.

Vegetarian diets that are inappropriately balanced can lead to an increased risk of iron, zinc and vitamin B12 deficiencies. This can be detrimental to overall health, particularly if followed for extended periods of time.

The risks may be greater for certain groups of people who have added nutrient needs due to life stage, gender or for another health-related reason.

So vegetarian eating should always be undertaken carefully and under professional guidance, preferably that of a dietitian, to minimise these risks.

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But importantly, only 5.1% of the Australian population eat the recommended amount of fruit and vegetables – five serves of vegetables and two serves of fruit each day.

So whether you’re vegetarian or not, focusing on incorporating more plant-based foods into your diet is worthwhile. We’re constantly learning more ways this is good for your health.

Yasmine Probst, Senior lecturer, School of Medicine, University of Wollongong and Joel Craddock, PhD Candidate, University of Wollongong

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

SAUDI ARABIA: AUTHORITIES RELEASE CHRISTIAN BLOGGER

Kingdom silences convert, prohibits him from leaving country.

LOS ANGELES, April 16 (Compass Direct News) – In a surprise move, a Saudi Christian arrested in January for describing his conversion from Islam and criticizing the kingdom’s judiciary on his blog site was released on March 28 with the stipulation that he not travel outside of Saudi Arabia or appear on media.

Hamoud Saleh Al-Amri (previously reported as Hamoud Bin Saleh), 28, reportedly attributed his release to advocacy efforts by the Arab Network for Human Rights Information (ANHRI). The Cairo-based organization had campaigned for his release along with other rights groups, reported Christian advocacy organization Middle East Concern (MEC).

Gamal Eid, director of ANHRI, told Compass by telephone that he believed his organization had nothing to do with Al-Amri’s release. Rather, he said he believed officials were loath to keep a person of questionable mental stability in prison.

“He is mentally not stable, because he had the courage to say in his blog that he is a Christian,” Eid said. “Anyone in his right mind in Saudi Arabia wouldn’t do that.”

The country’s penalty for “apostasy,” or leaving Islam, is death, although in recent years there have been no known cases of kingdom citizens formally convicted and sentenced with capital punishment for the offense.

This was not the first imprisonment for Al-Amri. He was detained in 2004 for nine months and in 2008 for one month before he was re-arrested on Jan. 13 of this year, and Eid said the young blogger was tortured during the first two incarcerations.

Al-Amri’s treatment during this latest imprisonment is unknown. After his previous releases he had contacted Eid’s office, but the ANHRI director said he has not done so since being released from Riyadh’s Eleisha prison, known for its human rights abuses.

“He was mistreated the first two times he was imprisoned, but this time I don’t know, because he hasn’t contacted me,” said Eid. “In the past he was mistreated with sleep deprivation, prolonged solitary confinement and a continuous barrage of physical torture and insults.”

The advocate added that it is likely Al-Amri was mistreated during his recent imprisonment.

“I consider anyone who declares his religion to be anything than Islam to be extremely brave and courageous, but this extreme courage bordering on carelessness is madness, because he knows what could happen in Saudi,” Eid said. “I’m not a doctor, but I find this extreme.”

Al-Amri has become isolated from his family and lives alone, Eid said, but he said he was unable to comment on the convert’s current situation.

 

Blog Blocked

Following Al-Amri’s latest arrest, MEC reported, Saudi authorities blocked access to his blog inside Saudi Arabia. Google then locked it, claiming there was a technical violation of terms of service. On Feb. 5 it was reportedly restored due to public pressure – after his March 28 release, Al-Amri had credited his release to ANHRI’s efforts on his blog, www.christforsaudi.blogspot.com – but yesterday Compass found the site did not work.

Eid said he was not surprised the blog was blocked.

“That’s what I expected,” he said. “But he will probably start another blog – it’s not difficult.”

Saudi Arabia’s ruling monarchy restricts media and other forms of public expression, though authorities have shown some tolerance for criticism and debate since King Abdullah bin Abdul Aziz Al Saud officially ascended to the throne in 2005, according to the U.S. Department of State.

“Arabic countries are the worst on the list of censoring the Internet and are at the top of the list of antagonizing the freedom of the Internet,” said Eid. “But the Internet is still a good venue, because people are still able to express their views despite the government’s effort to curtail their efforts.”

In his blog prior to his arrest, Al-Amri had criticized the government for quashing individual rights.

“A nation which lives in this system cannot guarantee the safety of its individuals,” he wrote. “Preserving their rights from violation will always be a matter of concern, as the rights of a citizen, his dignity and humanity will always be subject to abuse and violation by those few who have absolute immunity provided to them by the regime.”

Eid of ANHRI described lack of civil law in Saudi Arabia as “extreme.” Citizens can be tortured endlessly, he said, adding that Saudis who openly state Christian faith face severe danger.

Although there have been recent moves towards reform, Saudi Arabia restricts political expression and allows only a strict version of Sunni Islam to be publicly practiced, according to MEC.

Political critic Fouad Ahmad al-Farhan became the first Saudi to be arrested for Web site postings on Dec. 10, 2007; he was released in April 2008.

Eid said he believes the lenient action of the Saudi authorities is a welcome move in a country where “there is no such thing as religious freedom.” In fact the move could encourage people of other faiths to speak up.

“This will open the door to whoever wants to express his belief, whether Christian, Hindu or other,” he said.

Saudis who choose a faith other than Islam and express it may face extra-judicial killings. In August 2008, a 26-year-old woman was killed for disclosing her faith on a Web site. Fatima Al-Mutairi reportedly had revealed on Web postings that she had left Islam to become a Christian.

Gulfnews.com reported on Aug. 12, 2008 that her father, a member of the religious police or Commission for Promotion of Virtue and Prevention of Vice, cut out her tongue and burned her to death “following a heated debate on religion.” Al-Mutairi had written about hostilities from family members after they discovered she was a Christian, including insults from her brother after he saw her Web postings about her faith. Some reports indicated that her brother was the one who killed her.

She had reportedly written an article about her faith on a blog of which she was a member under the nickname “Rania” a few days before her murder.

Report from Compass News Direct

TURKEY: MALATYA MURDER CASE AIDS PROBE OF ‘DEEP STATE’ CRIMINALS

Video testimony, reenactment of crime scene hints at hearts of killers, martyrs.

ISTANBUL, November 25 (Compass Direct News) – Last week’s court hearing on the bloody murder of three Christians in Turkey’s southeastern city of Malatya paved the way for further investigations into the connection between the five defendants and shadowy elements of the Turkish state linked to criminal activities.

The 13th hearing at Malatya’s Third Criminal Court on Friday (Nov. 21) in the murders of Turkish Christians Necati Aydin and Ugur Yuksel and German Christian Tilmann Geske presented little new evidence. No witnesses were called to testify.

The court prosecutor and plaintiff lawyers, however, are pursuing proof that there are links between the murderers and Ergenekon, an ultranationalist cabal of retired generals, politicians, journalists and mafia members under investigation for conspiracy in recent murders.

A separate criminal investigation has linked the cabal to high-profile attacks, murders and plans to engineer domestic chaos and ultimately overthrow the government. Evidence in the Malatya case indicates that a local journalist, Varol Bulent Aral, acted as a bridge between the five murder suspects and Ergenekon.

Plaintiff attorneys also believe that Aral incited the suspected ringleader of the attack, Emre Gunaydin, to murder by convincing him foreign missionaries were connected to the Kurdistan Worker’s Party, a domestic outlawed terrorist organization.

According to a Nov. 14 statement, Gunaydin testified that Aral promised him state immunity for the planned attacks. In court last week, however, he refuted the claim and said he hadn’t met with Aral.

On April 18, 2007 the three Christians were tied up, stabbed and tortured for several hours before their throats were slit in what Turkish media have dubbed “the Malatya massacre” at the Zirve Publishing Co. office in Malatya.

Gunaydin along with Salih Gurler, Cuma Ozdemir, Hamit Ceker and Abuzer Yildirim, who have been in jail for the past 19 months, are accused of the murder. They are all between 19 and 21 years old.

Per their request, plaintiff attorneys have received the Ergenekon file from the 13th High Criminal Court of Istanbul and have reviewed it for connections with the Malatya murders. It is now under investigation by the court prosecutors and judges.

“We are talking about a room with five guys and three men,” said Orhan Kemal Cengiz, who leads the team of plaintiff lawyers. “There is no doubt this is first degree murder; a barbaric act. These things will increase their term of punishment to three counts of murder and three life imprisonment terms each, as well as other crimes such as preventing freedom, stealing and others. We don’t have a question about this.”

The question that remains, according to the plaintiff attorneys, is the identity of the real powers behind the bloody attack. Cengiz said he and the court now have no doubt there were greater forces behind the Malatya murders.

“I am 100 percent sure – it is the impression of the prosecutor and no one has doubts – there are sources behind these young men, but we can’t identify them,” Cengiz told Compass.

The plaintiff team hopes to bring up to 21 witnesses to the stand in subsequent hearings in order to make connections between Ergenekon and the Malatya murders clear.

“We believe all of them are somehow connected and have relevant information to this case,” he said.

If the list is accepted, he said the trial may go on for another year. “But if nothing comes out last minute, it may be over in three or four months,” he said.

 

Missionary Activities on Trial, Again

At Friday’s hearing, defense lawyers reiterated their position that the five young men acted in response to missionary efforts, suggesting that such activities were sufficiently nefarious to incite the violent murders.

The prosecution team rebutted the statement, saying that according to constitutional Articles 9 and 24, people have the right to share their faith, and no person or authority can follow and record those activities. They pointed out that the five defendants had been collecting data and planning the murders at least eight months before they carried them out.

Defense lawyers also requested that the prison where the defendants are held conduct a psychological exam of the defendants – especially Gurler – because they were all under stress due to suspected ringleader Gunaydin’s threats.

 

Revisiting Crime Scene

Those present in the courtroom on Friday viewed year-old video footage of defendants Ozdemir, Ceker and Gunaydin each walking through the crime scene shortly after their arrest, describing how they attacked, stabbed and sliced the throats of Aydin, Geske and finally Yuksel.

A sobering silence prevailed in the courtroom as judges, lawyers, local press, Turkish Protestant observers and others watched Ozdemir and later Ceker walk through the Zirve publishing house and re-enact the murders over the dried blood pools of the three martyrs. In their accounts, they implicated Gunaydin and Salih as the main aggressors, although all accuse the others of participating in the murders.

During the video presentation, judges and lawyers noticed suspect Gurler laughing at the witnesses’ testimonies at the crime scene. In the video, Ozdemir and Ceker testified that they had told Gurler and Gunaydin they couldn’t take the violence.

In the video testimony, Ozdemir said he told Gurler while he was stabbing Aydin, the first to be killed, “That’s enough, I can’t do this.” Ozdemir looked down during his video testimony, forlorn and unable to watch.

Gurler later told angry judges that he was laughing because all the witnesses’ statements in the video were false.

“They’re lying against me,” he said.

In his video account of the murder scene, Ceker described how the five young men and the three Zirve staff members talked “a lot” about religion before the suspects attacked Aydin, tying him and lying him on the floor face down.

Gunaydin confronted Aydin about his missionary activities and asked him why he was acting “against Turks” before Gurler sliced his throat, according to Ceker’s original statement.

In Gunaydin’s video testimony, profusely sweating, he described the repeated stabbings of the victims, re-enacting his arm movements and describing how Ozdemir held a gun at the victims, threatening them.

“I didn’t look,” Gunaydin said after describing one of the violent stabbing scenes. “I’m weak about these things … I can’t even cut chicken.”

He described how while Yildirim and Gurler were repeatedly stabbing Geske, the victim lifted his hands up in a gesture of prayer. Gunaydin also described how Yuksel, injured by the stabbing while tied and on the floor, cried out in Turkish, “Mesih, Mesih [Messiah],” between moans before they stuffed a towel in his mouth to silence him.

After the court showed his video testimony, Gunaydin stood up and told the court he had just gotten out of the hospital at that time, and that that account was not how he now remembered the events of April 18, 2007.

In their video testimony, the young men described how the phone and doorbell were ringing while they were torturing the Christians. Before coming out the door with their hands in the air, they showed police interviewing them in the video how they had disposed of their guns and bloodied knives in the Zirve office.

Gunaydin escaped through a window, fell and was severely injured. On Friday plaintiff lawyers requested from the court an investigation into who entered the crime scene while Gunaydin was in the hospital.

When the defendants were asked whether they knew of Aral’s alleged offer of state protection to Gunaydin or a monetary award for the murders, they claimed to have no information.

“I never saw a check in the course of these events, nor did I hear anything about it,” said Gurler. “I only knew that Emre had a bank statement.”

Yildirim also claimed ignorance: “I don’t remember anything about a check. If Emre had one, it would have stayed in his pocket; he wouldn’t have showed it to us.”

When asked about meetings between Gunaydin and Aral, the defendants said they hadn’t witnessed any between the two. They did admit to having spoken to Aral at a sports complex about a different matter, but they knew him as “Mehmet.”

 

Foreign Press, Organizations Negligent

Twelve of the nearly 20 private and human rights lawyers from around Turkey that compose the plaintiff team attended the court hearing last week. Cengiz said the primary purpose of the plaintiff lawyers, who are working pro bono, was to create a legal “common eye” that is watching all related cases such as Ergenekon and the murder of Hrant Dink, editor of Armenian newspaper Agos, who was murdered months before the three Christians in Malatya.

But the plaintiff lawyers pointed out that very few international bodies and foreign press members are actively monitoring the case, even though in their estimation the Malatya murders are directly linked to uncovering deep elements of Turkish corruption.

“This case has tremendous implications for democracy and deep-state elements in Turkey,” said Cengiz, who has received numerous threats since the beginning of the trial and lives under 24-hour protection.

“What we have here is a concrete act of the Ergenekon gang and it’s interesting.”  

Report from Compass Direct News

TURKEY: SUSPECT IN MALATYA MURDERS EXPECTED STATE SUPPORT

Journalist allegedly told ringleader officials would not prosecute him for killing Christians.

MALATYA, Turkey, October 21 (Compass Direct News) – Lawyers and judges in the case of three Christians murdered here in April 2007 are continuing to investigate whether the attack was masterminded by troubled youths or shadowy elements of the Turkish state.

Plaintiff attorneys believe the first witness at the hearing on Thursday (Oct. 16), local journalist Varol Bulent Aral, incited the suspected ringleader of the attacks to murder by convincing him foreign missionaries were connected to the Kurdistan Worker’s Party (PKK), a domestic outlawed terrorist organization. The suspected ringleader, Emre Gunaydin, testified that Aral promised him state immunity for the planned attacks.

Two Turkish Christians, Necati Aydin and Ugur Yuksel, and a German, Tilmann Geske, were brutally tortured and killed at a publishing house in this southeastern city on April 18, 2007.

Gunaydin, along with Salih Gürler, Cuma Ozdemir, Hamit Ceker and Abuzer Yildirim, who have been in jail for the past 18 months, are accused of the murder. They are all between 19 and 21 years old.

The court subpoenaed Aral for the last four hearings, but he failed to show at each one. The 32-year-old testified at Thursday’s hearing at Malatya Third Criminal Court under police custody since he was arrested on Oct. 2 for carrying a false ID.

Gunaydin said during the hearing that Aral had promised him state protection for the murders.

“He had promised me state support,” he said. “[Aral] should explain this to the court.”

But when the judge asked whether Aral had convinced him to commit the murders, Gunaydin claimed his right to remain silent.

Aral, however, denied promising clemency to Gunaydin for murdering the three Christians. He claimed to only have discussed only the PKK with Gunaydin, not Christian missionary activity.

In Gunaydin’s testimony at an August hearing, however, he described Aral as telling him that he saw a connection between missionaries and the PKK. The goal of Christian missionary work in Turkey, Aral reportedly said, was “to destroy the motherland.”

Recent high-level political events in Turkey, however, show that the plausibility of his alleged promise for state protection to Gunaydin and the other four youths may not be unfounded.

In January police uncovered and started arresting members of Ergenekon, an ultranationalist cabal of retired generals, politicians, journalists and mafia members under investigation for conspiracy in recent murders. The indictment has accused 86 suspects, 70 of which are in custody.

A separate criminal investigation has linked the cabal to high-profile attacks, murders and plans to engineer domestic chaos and ultimately overthrow the government. Evidence in the Malatya case indicates that Aral acted as a bridge between the five murder suspects and Ergenekon.

In January Malatya police found Aral’s diary, which mentioned multiple people indicted in Ergenekon and contact information for Kemal Kerincsiz, an ultranationalist lawyer who had charged two Turkish Christians for “insulting Islam.” The court case of Hakan Tastan and Turan Topal has been underway for two years.

In his diary Aral mentioned the duty to “protect the state’s honor.” His frequent comments to media have also raised eyebrows, such as his recent statement that, “I can’t stand that patriots like Veli Kucuk are in prison.”

Kucuk is a retired major general arrested in the Ergenekon case. He has been indicted for threatening Hrant Dink, a Turkish-Armenian journalist who was assassinated in January 2007, and is believed to be a key player in the network, according to Turkish national daily Today’s Zaman.

When Judge Eray Gurtekin asked Aral why his diary mentioned these people, Aral claimed he “received information” and wrote their names down to think about them later. He claimed to be merely compiling information in order to write a book about Ergenekon.

The witness was more elusive when he was asked if he knew Orhan Kemal Cengiz, who leads the team of plaintiff lawyers.

Aral merely said he didn’t know Cengiz. But for the last few months Aral has talked to many journalists in the country’s major cities, trying to prove that Cengiz was the leader of a secret resistance group established by the government responsible for the murders of Hrant Dink, Father Andrea Santoro (a Catholic priest who was killed in 2006), and the Malatya murders.

Judge Gurtekin then asked Aral if he had worked as a police informant for either the police or gendarmerie. He answered, “I have many police and military officers among my friends. We drink tea and talk with each other.”

 

Dark Connections

Plaintiff attorneys have seen some progress in the Malatya trial, which has continued for nearly a year. But they believe it will take time to get to the root of the crime, which they say runs very deep.

“It has become very clear for everyone that there is this very dark, complex, sophisticated web of relations behind the scenes, but we can’t pick them out or prove them beyond reasonable doubt for the time being,” said Cengiz. “We are stuck. Everyone sees that some of the witnesses are not witnesses at all – they are either aiding and abetting or a member of the gang. Some people like Bulent Aral are there to create a cloak of confusion that you can’t get past.”

Aral was arrested last year while in possession of a Kalashnikov assault rifle, which he claims he had confiscated from a 10-year-old, and was arrested while en route to a police station to hand over the gun. A week before the three Christians were killed in 2007, Gunaydin visited Aral in prison.

Plaintiff attorneys said that as defendant Abuzer Yildirim and Aral were leaving the courtroom after the court’s adjournment, they noticed Aral tell Yildirim face-to-face, “Look around carefully. This may be the last time you see these things before you die.”

The plaintiff attorneys said that Aral may not have been threatening him with this statement, but instead warning him about other threats or possible dangers stemming from the case, according to Haberturk news Website.

Following the last testimony, five knives, two guns and blood-stained clothes of the suspects found at the crime scene were shown to the court.

The plaintiff attorneys requested the Ergenekon file from the 13th High Criminal Court of Istanbul on Aug. 12. They have not yet received the file, but hope to find a relationship between the Malatya and Ergenekon investigations and possibly combine them.

The next hearing is scheduled in Malatya for Nov. 21.  

Report from Compass Direct News