SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesWomen who have the HPV vaccine may need only one smear test to help prevent cervical cancer in their lifetime, according to a leading scientist. Women are currently invited for screening every three to five years in the UK. Prof Peter Sasieni said the vaccine was leading to such dramatic reductions in cancer that the screening programme would need to change soon. Cancer Research UK urged people to still come for screening when invited. Nearly all cases of cervical cancer are caused by human papillomaviruses – known as HPV. They can damage DNA and start to transform healthy cells into cancerous ones if there is a prolonged infection. There are more than 100 types of human papillomavirus and they are so common that most people will get an infection at some point during their lives. So the NHS invites women, and people with a cervix, for regular screening. Swabs of the cervix are used to check for signs of abnormalities using a microscope (the traditional smear test) or more recently to test for the virus itself. Cervical screening in Wales to be every five years90% reductionHowever, a seismic shift in preventing cervical cancer started in the UK in 2008 with the introduction of the HPV vaccine. It is offered to girls (and boys since 2019) aged between 11 and 13.The viruses are spread by close skin-to-skin contact so the vaccine is given before school children become sexually active.Research published in December shows the vaccine is cutting cervical cancer by nearly 90% in those who choose to have the jab. “This is really exciting,” Prof Sasieni, the director of the clinical trials unit at King’s College London, told Inside Health on BBC Radio 4.His modelling suggests between one and three checks a lifetime would be appropriate for people who have been immunised. He told me: “Probably women could be screened at [age] 30 and 45, you might want to do it at 30, 40 and 55 so three times. “There’s a new vaccine which will be used in the UK from the next school year, which protects against even more types of the virus, and I think with that probably one screen would be enough, maybe two, over a lifetime.” What is the HPV vaccine and who can get it?Busting the myths around sex virus HPV ‘I had no cancer symptoms but a smear saved my life’That would mark a dramatic shift in cervical screening in the space of a generation with mums needing regular checks while their daughters would need to go only a handful of times.However, the UK National Screening Committee has not made a decision about the future of cervical screening. Prof Sasieni says the issue is becoming increasingly pressing as the first generation to be vaccinated are now being invited for screening. “We really want to make those changes over the next couple of years, it is a big change [but] the vaccine has been so successful this makes perfect sense,” said Prof Sasieni.’I told them to save me for my children’This video can not be playedTo play this video you need to enable JavaScript in your browser.Laura Flaherty was diagnosed with cervical cancer this year at the age of 29 after putting off a routine smear test.”The HPV vaccine hadn’t been rolled out when I was at school,” she says.”I was diagnosed after a routine smear test. I’d put it off for four months – and while it wouldn’t have made a difference to my diagnosis – it just shows how important it is to keep up to date with your smears.”I was told I had abnormal cells and tested positive for HPV and further investigation revealed I had stage one cervical cancer, which resulted in a hysterectomy. “I was sat in a room and told: ‘I’m really sorry, it’s cancer’. I had two small children and I said ‘I need you to save me, they need looking after’.”I went for my smear test in February this year and was given the all clear in August. I just always feel so lucky to be here.”There are uncertainties. It is not known how long the protection from HPV lasts or if a mid-life booster dose is needed. And regular screening will be needed for decades due to the generations that have not been immunised. Karis Betts, the health information manager at Cancer Research UK, said: “Although we don’t know exactly what cervical screening will look like in the future, we’re already seeing scientific advances shape the way it’s delivered in the UK. “The success of the HPV vaccination programme and the introduction of better tests mean people need fewer screenings, but are still just as protected against cervical cancer.”Regular screening plays an important role in preventing cancer, especially if you have not received your HPV jab.”The Department of Health and Social Care said one in three people do not come for screening when invited.A spokesperson added: “The NHS Cervical Screening programme remains an important way of protecting the population – including those who have not been vaccinated – from developing cervical cancer.”Follow James on Twitter More on this storyNew cervical screenings will save lives – doctor’Waxes don’t save your lives, smear tests do’Trans man says confusion caused cervix check delay

SharecloseShare pageCopy linkAbout sharingImage source, Asthma UKThe current aerosol asthma inhalers we use are cheap but, because of the gases they contain, are one of the NHS’s biggest contributions to climate change. Other countries think alternatives are superior – and some patients in the UK who have switched say they are controlling their asthma better. So, could millions of people be prescribed different inhalers?”It’s like there’s a vacuum cleaner in your lungs trying to pull your air out.” That’s what an asthma attack feels like for nine-year-old Sebastian. Some of his attacks have needed treatment in hospital. A recent cross-country race left him keeled over on the floor struggling to breathe through the inflammation in his lungs and his tightened airways. “I fell over and my lungs felt like the air can’t go in, it felt like there was nothing in me left,” he says. Image source, Caroline SousekAsthma runs in his family. His mum Caroline Sousek says the disease has “hugely dominated” her life since the age of three. It would start from the moment she woke up wheezing: “I would not go anywhere without an inhaler in my hand, it really affected what I was able to do and when I was able to do it.”Both mum and son say they have transformed control of their asthma by changing their inhalers to ones that are also much better for the planet. “I just can’t believe the impact it’s had… it has literally been life-changing,” says Caroline – speaking to me for BBC Radio 4’s Inside Health. She and Sebastian still have “preventer” medication to reduce the risk of an attack and “reliever” medication in case one happens. But the crucial change for them, is how those drugs get into their lungs. Image source, Caroline SousekBefore, they had been using aerosol spray inhalers – also known as puffers or pressurised metered-dose inhalers. “The aerosol sprays contain a powerful greenhouse gas which is used to propel the medicine out of the inhaler and into the airways,” says Dr Alex Wilkinson, an NHS consultant in Stevenage who specialises in lung diseases. The different gases – called hydrofluorocarbons – used in these inhalers are between 1,000 and 3,000 times more potent at warming the planet than carbon dioxide. Inside Health is broadcast on BBC Radio 4 on Tuesdays at 2100 GMT – and Wednesdays at 1530 GMT. It is also available as a podcast on BBC Sounds.Listen to Inside Health: Asthma inhalers and Covid antivirals You might not think that adds up to much, after all inhalers are small and just slip inside your coat pocket. But more than five million people are being treated for asthma in the UK and the overwhelming majority are prescribed aerosol spray inhalers. Overall, around 4% of the NHS’s entire carbon footprint comes from asthma drugs. The only other medicines to come close are the anaesthetic gases used in surgery.Now, Caroline and Sebastian have “greener” inhalers that contain no propellant. These are called dry powder inhalers and you have to do the work of sucking the medicine out. The case for using dry powder inhalers is clear if you only care about climate change, but are they a better choice for patients?In a GP surgery in Sheffield you’ll find one of the country’s first “net-zero” GPs. Dr Aarti Bansal’s aim is to simultaneously improve care for patients and cut carbon emissions.”As long as you can get the medication into the right place in your lungs, then one inhaler is not necessarily better than the other and the vast majority of patients can use a dry powdered inhaler,” she tells Inside Health.She says the aerosol spray inhalers are “actually quite tricky” to use and people often get the technique wrong. So instead of the medicine going into the lungs “it’s going to hit the back of your throat”.Aerosol spray inhalers require a slow steady breath as the inhaler is used. A dry powder inhaler needs a quick hard suck, which is how many people use inhalers instinctively. Image source, Getty ImagesAsthma UK: How to use your inhaler Caroline says she found it “really difficult” to coordinate her breathing and the aerosol inhaler, particularly when she was feeling wheezy. But the switch to dry powder inhalers has transformed her life and she can even do a 10km run now.”A year and a half ago it seemed like something I could never do, I could manage 3km and my chest would feel like it was imploding.”Since I started taking [a dry powder preventer], I haven’t needed to take my reliever inhaler.”Image source, Caroline SousekDr Bansal says Caroline’s experience is far from unique and that she changes patients’ inhalers if they’re using the wrong technique. “I find if I switch them to a dry powder inhaler that often improves their control,” she says.Control is key for both patients and the planet. The less people need to rely on their reliever inhalers the better it is for both their quality of life and greenhouse gas emissions. The NHS says somebody has a potentially life-threatening asthma attack every 10 seconds in the UK. Dry powder inhalers are not radical or new. They used to be common in the UK and remain the preferred choice in other countries. In Norway, only one person in 10 with asthma has an aerosol spray inhaler. “Over the past two decades, we’ve had a dramatic switch [to aerosols] and it appears that’s been done to reduce drug costs,” says Dr Wilkinson. However, he says it is not clear if the aerosol inhalers really were cheaper overall – if poor technique meant people ended up having more attacks and needing more treatment.That momentum is now being reversed as the NHS attempts to cut its carbon emissions. The National Institute for Health and Care Excellence, which advises doctors on which medicines should be used, says dry powder inhalers will be suitable for many. Dr Bansal says aerosol inhalers have become the default choice: “It’s just become a prescribing habit really, it’s what we are used to.”Asthma carbon footprint ‘as big as eating meat’Use a ‘greener’ inhaler if you can, patients toldHowever, there are concerns that the drive towards “greener” inhalers could harm some patients. Those who have well-controlled asthma and are used to aerosol spray inhalers may be better off sticking with their current device. The very elderly and young children may not be able to perform the rapid intake of breath that’s needed with a dry powdered inhaler. But nine-year-old Sebastian is happy he’s on the right one. “They’re making me feel wonderful, like I barely even have asthma. I feel really happy for not just me, but all the animals of the world can be less endangered.”Follow James on Twitter

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesPeople catching Omicron are 50% to 70% less likely to need hospital care compared with previous variants, a major analysis says. The UK Health Security Agency says its early findings are “encouraging” but the variant could still lead to large numbers of people in hospital. It also shows the vaccine’s ability to stop you catching Omicron starts to wane 10 weeks after a booster dose.Protection against severe disease is likely to be far more robust. The report comes hot on the heels of data from South Africa, Denmark, England and Scotland which all pointed to reduced severity.The latest analysis is based on all cases of Omicron and Delta in the UK since the beginning of November, including 132 people admitted to hospital with the variant. There have also been 14 deaths in people within 28 days of catching Omicron. The report shows people catching Omicron are:31% to 45% less likely to go to A&E50% to 70% less likely to be admitted to hospital for treatmentHowever, a milder virus could still put pressure on hospitals. The issue remains that any benefit of a milder virus could be wiped out by large numbers of people catching Omicron. The UK has set another daily Covid record with 119,789 confirmed cases.There is also uncertainty about what will happen when Omicron reaches older age groups as most of those catching it and going into hospital so far are under the age of 40.Dr Jenny Harries, the chief executive of the UKHSA, said: “Our latest analysis shows an encouraging early signal that people who contract the Omicron variant may be at a relatively lower risk of hospitalisation than those who contract other variants. “Cases are currently very high in the UK, and even a relatively low proportion requiring hospitalisation could result in a significant number of people becoming seriously ill.”There are also signs that the effect of booster doses is waning. Two doses of a vaccine were shown to offer limited protection against catching Omicron, which was then restored with a booster dose. However, the report says this protection drops by between 15% and 25% after 10 weeks. This is still better than having no booster dose and the protection against severe disease or death is likely to be even greater. The health and social care secretary, Sajid Javid, said the early data was “promising” and government was monitoring the data “hour-by-hour”.But he warned: “Cases of the variant continue to rise at an extraordinary rate – already surpassing the record daily number in the pandemic. Hospital admissions are increasing, and we cannot risk the NHS being overwhelmed.”Follow James on TwitterUK Health Security AgencyThe BBC is not responsible for the content of external sites.

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesThe wave of Omicron appears to be milder according to preliminary studies published in the UK and South Africa.Early evidence suggests fewer people are needing hospital treatment than with other variants – with estimates ranging from a 30% to a 70% reduction.But the concern remains that even if Omicron is milder, the sheer number of cases could overwhelm hospitals. More than 100,000 cases have been reported in the UK in a single day for the first time.A deeper understanding of the severity of Omicron will help countries decide how to respond to the virus.Daily UK Covid cases top 100,000 for first timeVulnerable five to 11-year-olds should get the jabThe study in Scotland has been tracking coronavirus and the number of people ending up in hospital. It said that if Omicron behaved the same as Delta, they would expect around 47 people to have been admitted to hospital already. At the moment there are only 15.The researchers said they were seeing a roughly two-thirds reduction in the number needing hospital care, but there were very few cases and few at-risk elderly people in the study. Dr Jim McMenamin, the national Covid-19 incident director at Public Health Scotland, described it as a “qualified good news story”.He said the data was “filling in a blank” about protection against hospitalisation, but cautioned it was “important we don’t get ahead of ourselves”.The Omicron variant is spreading incredibly quickly and a high number of cases could wipe out any benefit of it being milder.Prof Mark Woolhouse, from the University of Edinburgh, said: “An individual infection could be relatively mild for the vast majority of people, but the potential for all these infections to come at once and put serious strain on the NHS remains.”Meanwhile, another study in South Africa also points to the Omicron wave being milder. It showed people were 70-80% less likely to need hospital treatment, depending on whether Omicron is compared to previous waves, or other variants currently circulating. However, it suggested there was no difference in outcomes for the few patients that ended up in hospital with Omicron. “Compellingly, together our data really suggest a positive story of a reduced severity of Omicron compared to other variants,” said Prof Cheryl Cohen of the National Institute for Communicable Diseases, in South Africa.Why milder?The reduction in severity is thought to be a combination of the fundamental properties of the Omicron variant as well as high levels of immunity from vaccinations and previous infections. An analysis of Omicron by Imperial College London suggests Omicron’s mutations have made it a milder virus than Delta. The researchers said the chances of turning up at A&E would be 11% lower with Omicron than Delta if you had no prior immunity. However, that now applies to relatively few people due to high levels of vaccination and infection. The same analysis said that accounting for immunity in the population meant a 25% to 30% lower risk of visiting A&E with Omicron and around a 40% reduction in needing to stay in hospital for more than a day. Prof Neil Ferguson, one of the researchers, said: “It is clearly good news, to a degree.”However, he warned the reduction is “not sufficient to dramatically change the modelling” and the speed that Omicron is spreading meant “there’s the potential of still getting hospitalisations in numbers that could put the NHS in a difficult position”. Laboratories studies have suggested potential reasons Omicron could be milder.The University of Hong Kong found Omicron was better at infecting the airways, but worse at getting into the deep tissues of the lungs, where it can do more damage.The University of Cambridge found the variant was not as good at fusing lung cells together, which happens in the lungs of people who become severely ill.The UK Health Security Agency is expected to publish early real-world data on Omicron soon, which could give further indications of the variant’s severity.Follow James on Twitter

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesTwo doses of a Covid vaccine are not enough to stop you catching the Omicron variant, UK scientists have warned. Early analysis of UK Omicron and Delta cases showed the vaccines were less effective at stopping the new variant. However, a third booster prevents around 75% of people getting any Covid symptom. The UK Health Security Agency said vaccines were still likely to offer good protection against severe Covid that needed hospital treatment. Omicron: How worried should we be?The latest lab science on Omicron’s threatThe concern since the heavily mutated Omicron variant first emerged was that it would make vaccines less effective. Scientists analysed data from 581 Omicron cases and thousands of Delta cases to calculate how effective the vaccines were against the new variant.The analysis is based on limited data, but showed a dramatic drop in effectiveness for the Oxford-AstraZeneca vaccine and a significant drop off for two doses of Pfizer. The 75% protection against Covid symptoms after a booster is not as high as against previous variants.So far around 22 million people have received a booster dose, but even if everyone was boosted the lower vaccine effectiveness would still leave millions of people susceptible. The real world data backs up laboratory studies that showed a 40-fold reduction in the ability of antibodies from double-vaccinated people to take out the virus. There is optimism that vaccines will still keep many people out of hospital even if more do get Covid. Data on severity could be published next week.However, an Omicron wave could be problematic even if it was milder. A large and sudden wave could lead to everyone who is still vulnerable needing hospital care at the same time. The rapid surge in Omicron cases was already hinting that the variant was getting around some of the protection given by vaccine. It is estimated that the number of Omicron cases is doubling every two-to-three days. The UKHSA estimates that more than half of all cases in the country will be Omicron by the mid-December and that if growth continues unabated there will be more 100,000 cases a day by the end of the month. Dr Mary Ramsay, the head of immunisation at the UKHSA, said: “These early estimates should be treated with caution but they indicate that a few months after the second jab, there is a greater risk of catching the Omicron variant compared to Delta strain.””We expect the vaccines to show higher protection against the serious complications of COVID-19, so if you haven’t yet had your first two doses please book an appointment straight away.”The research comes amid concern about the growing numbers of Omicron cases in the UK. Scotland’s First Minister, Nicola Sturgeon, has warned of a “tsunami” of cases as she tightened Covid isolation rules and encouraged people to cancel Christmas party plans.The Levelling Up Secretary Michael Gove warned “we face a deeply concerning situation” after chairing a Cobra meeting with the first ministers of the devolved administrations this afternoon. He said measures taken so far were “proportionate” but said they “absolutely” needed to keep everything under review.”Action is absolutely required and as new data comes in we will consider what action we do require to take in the face of that data,” he said.A further 58,194 Covid cases have been reported in the UK, according to the latest government statistics. This is mostly still the Delta variant, but is the highest figure since 9 January this year. Follow James on TwitterUKHSAThe BBC is not responsible for the content of external sites.

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesScientists believe they have found “the trigger” that leads to extremely rare blood clots after the Oxford-AstraZeneca Covid vaccine. The team – in Cardiff and the US – have shown in exquisite detail how a protein in the blood is attracted to a key component of the vaccine. They think this kicks off a chain reaction, involving the immune system, that can culminate in dangerous clots.The vaccine is thought to have saved about a million lives from Covid. However, concerns about rare blood clots shaped how the vaccine has been used around the world including an alternative being offered to the under-40s in the UK. It also started a scientific detective hunt to figure out what was going on and if it could be prevented. The Cardiff team were given emergency government funding to find the answers.AstraZeneca’s own scientists also joined the research project after earlier results from the team were published.A spokeswoman for AstraZeneca stressed that clots were more likely to occur because of a Covid infection than the vaccine, and that the complete explanation for why they occur had not yet been established. “Although the research is not definitive, it offers interesting insights and AstraZeneca is exploring ways to leverage these findings as part of our efforts to remove this extremely rare side effect,” she added.There were two initial clues for the researchers investigating the rare blood clots:The greater risk of clots was seen only with some of the vaccine technologies People with clots had unusual antibodies that were attacking a protein in their blood called platelet factor fourThe vaccines used in the UK all try to deliver a snippet of the Covid-virus’s genetic code into the body to train the immune system. Some package that code up inside spheres of fat, while the AstraZeneca one used an adenovirus (specifically a common cold virus from chimpanzees) as its microscopic postman. The researchers thought the adenovirus might be linked to the rare clots occurring in some people. So they used a technique called cryo-electron microscopy to take images of the adenovirus in molecular-level detail. Nobel prize awarded for imaging moleculesTheir study, published in the journal Science Advances, reveals the outer surface of the adenovirus attracts the platelet factor four protein to it like a magnet. Prof Alan Parker, one of the researchers at Cardiff University, told BBC News: “The adenovirus has an extremely negative surface, and platelet factor four is extremely positive and the two things fit together quite well.” He added: “We’ve been able to prove the link between the key smoking guns of adenoviruses and platelet factor four. “What we have is the trigger, but there’s a lot of steps that have to happen next.”Image source, ASUThe researchers think the next stage is “misplaced immunity”, but this needs to be confirmed in further research.It is thought the body starts to attack platelet factor four after confusing it for part of the foreign adenovirus to which it is stuck. So antibodies are released into the blood, which clump together with platelet factor four and trigger the formation of dangerous blood clots. However, this requires a series of unlucky events, which could explain why the clots are so rare. These clots, known as vaccine-induced immune thrombotic thrombocytopenia, have been linked to 73 deaths out of nearly 50 million doses of AstraZeneca given in the UK. “You could never have predicted it would have happened and the chances are vanishingly small, so we need to remember the bigger picture of the number of lives this vaccine has saved,” said Prof Parker.AstraZeneca said the vaccine is thought to have saved more than a million lives around the world and prevented 50 million cases of Covid. The University of Oxford declined to comment on the research. Dr Will Lester, a consultant haematologist at University Hospitals Birmingham NHS Trust, praised the “very detailed” research saying it helps explain the “most likely initial step” in clotting. He added: “Many questions still remain unanswered, including whether some people may be more susceptible than others and why the thrombosis (clotting) is most commonly in the veins of the brain and liver, but this may come with time and further research.”The Cardiff team hope their findings can be used to improve adenovirus-based vaccines in the future to reduce the risk of these rare events. Follow James on Twitter

SharecloseShare pageCopy linkAbout sharingAll over 40s should be offered a third dose of a Covid vaccine, according to the UK government’s vaccine advisors. The move would top up protection and help limit the spread of the virus over winter. Evidence suggests the chance of testing positive for Covid falls by more than 80% two weeks after a booster.The Joint Committee on Vaccination and Immunisation also said 16 and 17 year olds, who were initially offered only a single dose, should now get a second. So far, 12.6 million people have had a booster dose. They have been given to the over 50s, front-line medical staff and people with health conditions that put them at greater risk. Is my Covid vaccine wearing off?People aged 40-49 years old will be topped up with either Pfizer or a half dose of the Moderna jab. This should be offered six months after the second dose. The UK’s drug safety regulator – the Medicines and Healthcare products Regulatory Agency (MHRA) – said the booster doses were safe and side-effects were either a sore arm or flu-like symptoms.Dr June Raine, regulator’s chief executive, said: “We welcome today’s announcement by the JCVI, on the extension of the booster campaign to 40-49 year olds. This further strengthens our ability to ensure people are protected against COVID-19 and saves lives.”Our proactive monitoring of the safety of booster doses does not raise any new concerns.”The amount of protective given by the vaccines does fall after the second the dose. Prof Neil Ferguson said there was “no reason” not to give boosters to younger age groups and it “could make quite a big difference to driving down transmission to low levels”. Children – aged 16 and 17 – have only been offered one dose of a Covid vaccine so far. They will now get a second dose – at least 12 weeks after their first.Follow James on Twitter

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesUnderstanding how some people naturally resist Covid infection, despite clearly being exposed to the virus, could lead to better vaccines, say researchers. A team at University College London said some people had a degree of Covid-immunity before the pandemic started.This likely came from the body learning how to fight viruses that are related to the one which has swept the world. Upgrading vaccines to copy this protection, could make the jabs even more effective, the team said. The scientists were closely monitoring hospital staff during the first wave of the pandemic – including by taking regular blood samples. Despite being in a high-risk environment, not everyone in the study came down with Covid. The results, published in the journal Nature, showed some people just managed to avoid the virus.But around one-in-10 had signs of being exposed, but never had symptoms, never tested positive and never developed Covid-fighting antibodies in their blood. Part of their immune system was able to get on top of the virus before it managed to take hold – what’s known as an “abortive infection”.Image source, Getty ImagesBlood samples showed these people already had (as in before the pandemic) protective T-cells, which recognise and kill cells infected with Covid. Dr Leo Swadling, one of the researchers, said their immune systems were already “poised” to fight the new disease. These T-cells were able to spot a different part of the virus than the bit most of the current vaccines train the immune system to find. Vaccines are largely aimed at the spike protein, which covers the outer surface of the Covid virus. However, these rare T-cells were able to look inside the virus and find the proteins that are necessary for it to replicate. “The healthcare workers that were able to control the virus before it was detectable were more likely to have these T-cells that recognise the internal machinery before the start of the pandemic,” Dr Swadline added. These internal proteins are very similar in all related species of coronavirus, including the ones that are widespread and cause common cold symptoms. It means targeting these proteins with a vaccine could give some protection against all coronaviruses and new Covid variants. The team said the current vaccines were doing an excellent job of preventing people from becoming severely ill, but were not as good at stopping them catching Covid.Prof Mala Maini told me: “I think we could all see that they could do better.”What we’re hoping, by including these T-cells, is that they might be able to protect against infection as well as disease, and we hope they would be better at recognising new variants that arise.”While nearly everyone will have caught these common cold coronaviruses, not everyone will have developed the right kind of protective T-cells. It may be that healthcare workers are more regularly exposed to the viruses through their work and that is why some of them had protection. Dr Alexander Edwards, from the University of Reading, said: “Insights from this study could be critical in the design of a different type of vaccine. “Hopefully this study will lead to further advances in vaccine development, as we need all the types of vaccine we can get.”Follow James on Twitter

SharecloseShare pageCopy linkAbout sharingAn innovative type of medicine – called gene silencing – is set to be used on the NHS for people who live in crippling pain. The drug treats acute intermittent porphyria, which runs in families and can leave people unable to work or have a normal life. Clinical trials have shown severe symptoms were cut by 74% with the drug.While porphyria is rare, experts say the field of gene silencing has the potential to revolutionise medicine.Listen: Inside Health Gene Silencing Special Listen: The Silence of the GenesSisters Liz Gill and Sue Burrell have both had their lives turned around by gene silencing. Before treatment, Liz remembers the trauma of living in “total pain” and, at its worst, she spent two years paralysed in hospital. Younger sister Sue says she “lost it all overnight” when she was suddenly in and out of hospital, made redundant and did know whether her partner would stick with her (he did).”It was scary,” she tells me.Both became used to taking potent opioid painkillers on a daily basis. But even morphine could not block the pain during a severe attack that needed hospital treatment.Silence of the genesGene silencing gets to the root-cause of the sisters’ disease rather than just managing their symptoms. Their porphyria leads to a build-up of toxic proteins in the body, that cause the physical pain. Gene silencing “mutes” a set of genetic instructions to block that protein production. Both had been taking the therapy as part of a clinical trial and are still getting monthly injections. “The difference is astronomical, we’re not in pain anymore,” Liz said.”You’re not dependent on opiate-based pain relief and that leads to things like being able to succeed in a job and being able to buy your own home.” Image source, Sue BurrellSue said the therapy had transformed her life: “[You’re] able to do things that you couldn’t do before, being able to be a mother better, being able to be a wife better… to just live life.”Clinical trials showed the gene silencing therapy, called givosiran, cut the number of severe attacks by 74%.The National Institute for Health and Clinical Excellence (NICE), which approves drugs for use in England, said the therapy “would improve people’s quality of life” and was “value for money”.Image source, Getty ImagesProf David Rees, the director of the King’s College Hospital National Acute Porphyria Service, told the BBC: “To find a drug that really does transform people’s lives is extraordinary.”However, acute intermittent porphyria is rare. Only around 17 people are diagnosed in the UK each year. “[But] if we can control genes and switch them on and off when we want to, then almost anything is possible in terms of treating diseases including Alzheimer’s and cancer and everything else,” Prof Rees said.Gene-silencing has already proven effective in other rare genetic diseases such as amyloidosis. Its ability to tweak how DNA works in the human body, without permanently altering it, has already seen it used as a twice-a-year cholesterol busting jab.Tara Moore, a professor of personalised medicine at the University of Ulster, said gene silencing had the potential to be as big as antibiotics. She told BBC Radio 4’s Inside Health: “It will be, it’s a very powerful tool, it is so specific, it’s really phenomenal.”There’s really nothing to stop us targeting so many different diseases from cancer to cardiovascular disease to cholesterol problems.” Follow James on Twitter

SharecloseShare pageCopy linkAbout sharingImage source, CRISTINA ALDEHUELAChildren across much of Africa are to be vaccinated against malaria in a historic moment in the fight against the deadly disease.Malaria has been one of the biggest scourges on humanity for millennia and mostly kills babies and infants. Having a vaccine – after more than a century of trying – is among medicine’s greatest achievements.The vaccine – called RTS,S – was proven effective six years ago.Now, after the success of pilot immunisation programmes in Ghana, Kenya and Malawi, the World Health Organization says the vaccine should be rolled out across sub-Saharan Africa and in other regions with moderate to high malaria transmission. Dr Tedros Adhanom Ghebreyesus, director-general of the WHO, said it was “a historic moment”. “The long-awaited malaria vaccine for children is a breakthrough for science, child health and malaria control,” he said. “[It] could save tens of thousands of young lives each year.”Deadly parasiteMalaria is a parasite that invades and destroys our blood cells in order to reproduce, and it’s spread by the bite of blood-sucking mosquitoes.Drugs to kill the parasite, bed-nets to prevent bites and insecticides to kill the mosquito have all helped reduce malaria.But the greatest burden of the disease is felt in Africa, where more than 260,000 children died from the disease in 2019. It takes years of being repeatedly infected to build up immunity and even this only reduces the chances of becoming severely ill.Dr Kwame Amponsa-Achiano piloted the vaccine in Ghana to assess whether mass vaccination was feasible and effective.”It is quite an exciting moment for us, with large scale vaccination I believe the malaria toll will be reduced to the barest minimum,” he said.Constantly catching malaria as a child inspired Dr Amponsa-Achiano to become a doctor in Ghana.”It was distressing, almost every week you were out of school, malaria has taken a toll on us for a long time,” he told me.Saving children’s livesThere are more than 100 types of malaria parasite. The RTS,S vaccine targets the one that is most deadly and most common in Africa: Plasmodium falciparum.Trials, reported in 2015, showed the vaccine could prevent around four in 10 cases of malaria, three in 10 severe cases and lead to the number of children needing blood transfusions falling by a third. However, there were doubts the vaccine would work in the real world as it requires four doses to be effective. The first three are given a month apart at five, six and seven months old, and a final booster is needed at around 18 months.Image source, BRIAN ONGOROThe findings of the pilots were discussed by two expert advisory groups at the WHO on Wednesday.The results, from more than 2.3 million doses, showed:the vaccine was safe and still led to a 30% reduction in severe malariait reached more than two-thirds of children who don’t have a bed-net to sleep underthere was no negative impact on other routine vaccines or other measures to prevent malariathe vaccine was cost-effective”From a scientific perspective, this is a massive breakthrough, from a public health perspective this is a historical feat,” said Dr Pedro Alonso, the director of the WHO Global Malaria Programme.”We’ve been looking for a malaria vaccine for over 100 years now, it will save lives and prevent disease in African children.”Why is malaria so hard to beat?Having just seen the world develop Covid vaccines in record time, you might be wondering why it has taken so long with malaria?Malaria is caused by a parasite which is far more insidious and sophisticated than the virus that causes Covid. Comparing them is like comparing a person and a cabbage.The malaria parasite has evolved to evade our immune system. That’s why you have to catch malaria time and time again before starting to get even limited protection. It has a complicated life cycle across two species (humans and mosquitoes), and even inside our body it morphs between different forms as it infects liver cells and red blood cells.Developing a malaria vaccine is like nailing jelly to a wall and RTS,S is only able to target the sporozoite form of the parasite (this is the stage between being bitten by a mosquito and the parasite getting to the liver).It is why the vaccine is ‘only’ 40% effective. However, this is still a remarkable success and paves the way for the development of yet more potent vaccines.The vaccine, developed by the pharmaceutical giant GSK, is not going to replace all the other measures for controlling malaria such as insecticide-treated bed nets. It will be used alongside them to get closer to the goal of zero deaths from malaria.And it won’t be used outside of Africa where different forms of malaria, which the vaccine can’t protect against, are more prevalent.Dr Ashley Birkett, from the Path malaria vaccine initiative, said rolling out the vaccine was a “historic event” that would “take away fear” from families.He told me: “Imagine your young child could be healthy one day and full of potential and then after the bite of an infected mosquito, while playing with friends or sleeping in a bed, they could be dead in a couple of weeks.”Malaria is a huge problem, it’s frightening and scary.”Follow James on Twitter