Participatory Environmental Health Research

The field of environmental health is facing increasingly complex challenges that require innovative approaches to research and decision-making. One promising strategy is to expand the participation of the community, which has the potential to enhance the effectiveness and relevance of health sciences. Although this approach is relatively new in the field of environmental health, it has a long history of success in other scientific disciplines such as ornithology, where citizen science initiatives like bird counts have been taking place for over a century, and geography where land use surveys were carried out by school children in Britain in the 1930s and 1940s. 

Crowdsourcing could achieve in months what would take years through conventional research approaches. Passive Citizen science and digital citizen panels speed up research by increasing the numbers of participants and data points, making data collection more cost-effective and efficient, and by improving the engagement and participation of community members. “Extreme” citizen science and quantified-self approaches would go even further to involve the public in co-creation, co-design, data analysis, interpretation, and, ultimately, public health actions. Awareness to stay fit and healthy and the use of fitness trackers continues to rise, especially among a growing aging population with disposable income to burn, but this hasn't yet resulted in the rise of Collaboratory Health Research. 

Crowdsourced online information has been used for tracking the spread of biological contaminants and infectious diseases for several years now. While games like Flu-City, and Big Tech- or government-supported programs like HealthMap, FluTracking,  EPA maps, many other apps ceased to exist. Sickweather, launched in 2011 reached an audience of 10 million daily active users during the heights of the COVID-19 pandemic, filed for bankruptcy in 2022. Apparently their "NoPeek” privacy solution wasn't sufficient for gaining citizens’ trust and engagement. 

Despite the early promise of passive crowdsourcing, it often struggles with accuracy issues. For example, Google Flu Trends (launched in 2008 and used aggregated search query data, initially claiming 97% accuracy when compared to CDC data) was criticized for not being able to predict the 2009 H1N1 pandemic and overestimating influenza-like activity in the United States during the 2012–2013 flu season. Web-based crowdsourcing was used to digitize geospatial information on thousands of public drinking water service areas in California.

Controlled community-team-based studies (active crowdsourcing) also report larger numbers for disease incidence and side effects of drugs (adverse event preventing from daily activities). This, however, is not an overestimate - and it is in line with recent findings of circulating unbound spike protein after COVID-19 vaccination. 

Communities are better able to provide key ground-truthed information. People's perception of environmental health hazards may not be consistently associated with their health outcomes since their health vulnerabilities vary, depending on the age, gender and other variables. Citizen scientists can, however, operate sensors to collect more objective and accurate data - continuously and in real-time. In our community-based studies, these were gut microbiome, urine, blood, environmental and exhaled air samples. The development of portable air monitors, sensing platforms for detection of various inorganic, organic, and biological analytes and home urine labs has made it possible to track changes in environmental health on a global scale. While there are limitations to sensor technology in terms of sensitivity and selectivity, they continue to evolve along with participatory health approaches and have the potential to greatly enhance our understanding of the impact of the environment on human health.

REFERENCES

Jeanjean M, Dron J, Allen BL, Gramaglia C, Austruy A, Lees J, Ferrier Y, Periot M, Dotson MP, Chamaret P, Cohen AK. Participatory environmental health research: A tool to explore the socio-exposome in a major european industrial zone. Environmental Research. 2023 Feb 1;218:114865.

Gabashvili IS The Incidence and Effect of Adverse Events Due to COVID-19 Vaccines on Breakthrough Infections: Decentralized Observational Study With Underrepresented Groups JMIR Form Res 2022;6(11):e41914 doi: 10.2196/41914 PMID: 36309347 PMCID: 9640199

Gabashvili IS Cutaneous Bacteria in the Gut Microbiome as Biomarkers of Systemic Malodor and People Are Allergic to Me (PATM) Conditions: Insights From a Virtually Conducted Clinical Trial JMIR Dermatol 2020;3(1):e10508 doi: 10.2196/10508

Siira E, Wolf A. Are digital citizen panels an innovative, deliberative approach to cardiovascular research? Eur J Cardiovasc Nurs. 2022 Apr 9;21(3):287-291. doi: 10.1093/eurjcn/zvab132. PMID: 35030241.

English PB, Richardson MJ, Garzón-Galvis C. From crowdsourcing to extreme citizen science: participatory research for environmental health. Annual review of public health. 2018 Apr 1;39:335-50.

Liu Y, Kwan MP, Kan Z. Inconsistent Association between Perceived Air Quality and Self-Reported Respiratory Symptoms: A Pilot Study and Implications for Environmental Health Studies. International Journal of Environmental Research and Public Health. 2023 Jan 13;20(2):1491.

Gabashvili IS. Effects of diet, activities, environmental exposures and trimethylamine metabolism on alveolar breath compounds: protocol for a retrospective case-cohort observational study medRxiv 2021.01.25.21250101; doi: https://doi.org/10.1101/2021.01.25.21250101

Khizar S, Zine N, Jaffrezic-Renault N, Elaissari A, Errachid A. Prospective analytical role of sensors for environmental screening and monitoring. TrAC Trends in Analytical Chemistry. 2022 Aug 3:116751.

Who Benefits the Least from the COVID-19 Vaccines

Factors associated with inadequate vaccine responses in patients with breakthrough infections are still not fully understood. Studies show that genes, environment (such as air pollution), and gene-environmental interactions all influence Coronavirus disease. Less research has been done for the vaccines. 

An earlier study [Boyarsky et al, 2021]  found that 46% of transplant patients had no antibody response after two doses of messenger RNA (mRNA) vaccines. Several medical case reports about fatal breakthrough  infections listed chronic migraine, obesity, autoimmune conditions,  diabetes, atrial fibrillation, myeloma (with anti-BCMA CAR-T therapy), arterial hypertension and old age among pre-existing conditions.  Some fatal breakthroughs, however, had no apparent underlying causes. 

A new study used real-world data to evaluate risk factors of impaired antibody response to SARS-CoV-2 mRNA vaccines in individuals with chronic medical conditions evaluated in a respiratory specialty clinic. The percentage of patients without antibodies detected was as follows:

- 14% in asthma 

- 15% in COPD

- 19% in Sarcoidosis

- 36% in Interstitial lung diseases

- 37% in Rheumatic diseases

- 48% in Congestive Heart Failure (CHF). 

More than a fifth of patients with chronic medical conditions may still have insufficient levels of antibodies to fight COVID-19 even after a second mRNA vaccine dose. Interstitial lung disease and congestive heart failure are two independent risk factors for low antibody response to COVID vaccination. These patients tended to be older — between 65 and 95 years old with a median age of 80.5 — and had preexisting comorbidities, such as cardiovascular disease and Type 2 diabetes. A subset of patients was also on immunosuppressive drugs that may affect vaccine efficacy. 

Anther study that analyzed fatal breakthrough cases came with the following risk order: Overweight/Obesity; Chronic cardiac disease; Diabetes mellitus, Chronic neurologic disease; Chronic kidney disease; Chronic liver disease; Chronic pulmonary disease; Immunosupression.  Pregnancy was shown to double the risk of breakthrough infection. 

Note that the mean age of study population was 62 years and the individuals received two doses of mRNA vaccines. Newer study shows that advanced age is one of major risk factors of fatal breakthrough COVID-19 even after an additional booster dose. 

CDC data, sourced from more than two dozen states, shows that between April and June, a total of 77,000 breakthrough cases and 1,500 breakthrough deaths were recorded, compared to more than 1.74 million breakthrough cases and 15,000 deaths recorded between July and the first week of November. It is unclear exactly how many of these people had also been boosted. As of October 12, 2021, there have been at least 31,895 individuals with SARS-CoV-2 breakthrough infections who were hospitalized or died in the United States. 

REFERENCES

Boyarsky BJ, Werbel WA, Avery RK, Tobian AA, Massie AB, Segev DL, Garonzik-Wang JM. Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients. Jama. 2021 Jun 1;325(21):2204-6.

Juthani PV, Gupta A, Borges KA, Price CC, Lee AI, Won CH, Chun HJ. Hospitalisation among vaccine breakthrough COVID-19 infections. The Lancet Infectious Diseases. 2021 Nov 1;21(11):1485-6.

Shu-Yi Liao et al, Impaired SARS-CoV-2 mRNA vaccine antibody response in chronic medical conditions: a real-world analysis, Chest (2022). DOI: 10.1016/j.chest.2021.12.654

A Fresh Air Look at Ventilation

Environmental factors contribute to the spread of microorganisms causing diseases. Sunlight can kill viruses in minutes, while increased air pollution could be one of the risk factors of more severe outcomes. Humidity is also thought to be important. A team of scientists from Northeast US analyzed COVID-19 cases from 2669 counties and found that cold and dry weather and low levels of ultraviolet radiation are moderately associated with increased SARS-CoV-2 transmissibility, with humidity playing the largest role. 17.5% of the virus’ reproductive number was attributable to meteorological factors, with temperature accounted for 3.73%, humidity accounted for 9.35%, and UV radiation for 4.44%. This is in line with earlier findings about SARS-CoV-2 being less stable at higher humidity and warmer temperatures in human nasal mucus and sputum. Like in previous environmental studies, however, these fractions were not the same everywhere and were higher in northern counties. 

20 years ago, American scientists Wells and Riley developed a model of the airborne transmission of infectious diseases such as tuberculosis and measles. A novel modified version of this model was used to estimate the impact of relative humidity on the removal of respiratory droplets containing infectious virus particles. The results showed that this impact depended on the ventilation rate and the size range of virus-laden droplets.  It was concluded that increasing the ventilation rate is more beneficial, while installing and running humidifiers may not be an efficient solution to reduce the risk of COVID-19 disease in indoor spaces. 

A popular metric for airflow is Air Changes per Hour (ACH, also called Air Change Rate).  It tells how many times the air within a space can be replaced with fresh air each hour. Increasing the ventilation rate from 0.5 ACH to 6 ACH was predicted to decrease the infection risk by half. Studies of US houses and apartments found typical ACH values between 0.5 and 2.0 (with open windows). 4.0 ACH is the minimum air exchange rate acceptable for commercial buildings, but 1.5 ACH is the reality for most schools. Opening a car window raises ACH to 6.  Natural ventilation combined with novel technologies could help to increase fresh air intake with minimal energy cost.

Virus clouds can, indeed, be dispersed with some fresh, clean air. But fresh air isn’t going to stop the spread of microorganisms in high-density crowds. Effective ventilation is only one of basic infection control strategies along with hand/environmental hygiene, social distancing, case surveillance and other evidence-based measures. 

REFERENCES

Aganovic A, Bi Y, Cao G, Drangsholt F, Kurnitski J, Wargocki P. Estimating the impact of indoor relative humidity on SARS-CoV-2 airborne transmission risk using a new modification of the Wells-Riley model. Building and environment. 2021 Aug 23:108278.

Ma Y, Pei S, Shaman J, Dubrow R, Chen K. Role of meteorological factors in the transmission of SARS-CoV-2 in the United States. Nature Communications. 2021 Jun 14;12(1):1-9.

Anaphylaxis to COVID-19 vaccinies

Anaphylaxis  - severe, potentially life-threatening allergic reaction - can occur within seconds or minutes of exposure to allergens. Multiple cases of anaphylaxis have been described for COVID-19 vaccines. 

For the Pfizer/BioNTech vaccine, twenty-one anaphylaxis cases (a rate of 11.1 per million doses administered, later updated as 4.7/million from 28-million-datapoints), were documented in the US after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine during December 14–23, 2020. 17 of those had a documented history of allergies or allergic reactions, seven of whom had a history of anaphylaxis. 71% of them occurred within 15 min following the first dose of BioNTech vaccine. 

Anaphylactic shock to Pfizer vaccine happened in those with history of anaphylaxis to other vaccines (rabies and influenza A(H1N1) vaccine), drugs (prochlorperazine, antibiotics, sulfa drugs), venom (jellyfish sting) or nuts. Out of 21, 4 were allergic to sulfa drugs, 2 were allergic to nuts.

Moderna COVID-19 vaccine caused much fewer anaphylactic episodes (2.5 anaphylaxis cases per million doses administered for 27 million datapoints), but there were similarities with Pfizer cases. Out of 10 cases described in MMWR, 4 had Penicillin allergy (like 1 Pfizer case). Also, in common were allergies to sulfa drugs and azithromycin.   A Kansas woman who died 2nd day after experiencing anaphylactic reaction to her first Moderna shot, previously had an allergic reaction to Albuterol, a drug used to treat wheezing and shortness of breath.

The Pfizer-BioNTech vaccine contains lipid nanoparticles one of which is “pegylated” (Polyethylene glycol, molecular weight 2000 Da, abbreviated to PEG2000). The Moderna mRNA vaccine also includes a different pegylated lipid (also a PEG2000). Polyethylene glycols, also known as macrogols, could be causing serious allergic reactions ins some people.

One of the culprits of anaphylaxis in Astrazeneca could be polysorbate 80, used in the formulation of protein-based biopharmaceuticals, cosmetics, skin-care products, chewing gum and foods (ice creams and puddings). 41 reports of possible anaphylaxis were seen among around 5 million vaccinations in the United Kingdom. Four cases of people potentially experiencing anaphylactic reactions within 30 minutes of receiving the AstraZeneca vaccine have been reported in Queensland and one case with fatal outcome happened in Georgia. 

Polysorbate 80 is also an ingredient in Johnson and Johnson vaccine. For this vaccine, no cases of anaphylaxis were reported in ~22,000 participants of phase 3 clinical trial who received it. Five patients reported developing hives within a week. There was one case of what was considered severe “a hypersensitivity reaction,” but it was reportedly not related to anaphylaxis. Last month, however, one individual in South Africa developed anaphylaxis. No details have been published yet. 

According to the CDC, polysorbate 80 is an inactive ingredient in many viral vector vaccines for influenza (Fluarid, Fluax, etc), rotavirus, shingles, Hepatitis A, Hepatitis B, HPV, and meningococcus. Polysorbate 80 is also an ingredient in COVID-19 Sputnik V vaccine from Gamaleya Research Institute.

REFERENCES

Turner PJ, Ansotegui IJ, Campbell DE, Cardona V, Ebisawa M, Yehia EG, Fineman S, Geller M, Gonzalez-Estrada A, Greenberger PA, Leung AS. COVID-19 vaccine-associated anaphylaxis: A statement of the World Allergy Organization Anaphylaxis Committee. World Allergy Organization Journal. 2021 Feb 3:100517.

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020. MMWR Morb Mortal Wkly Rep 2021;70:46–51. DOI: http://dx.doi.org/10.15585/mmwr.mm7002e1external icon.

CDC COVID-19 Response Team; Food and Drug Administration. Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine - United States, December 21, 2020-January 10, 2021. MMWR Morb Mortal Wkly Rep. 2021 Jan 29;70(4):125-129. doi: 10.15585/mmwr.mm7004e1. PMID: 33507892; PMCID: PMC7842812.

Kounis NG, Koniari I, de Gregorio C, Velissaris D, Petalas K, Brinia A, Assimakopoulos SF, Gogos C, Kouni SN, Kounis GN, Calogiuri G. Allergic Reactions to Current Available COVID-19 Vaccinations: Pathophysiology, Causality, and Therapeutic Considerations. Vaccines. 2021 Mar;9(3):221.

Public Health England. COVID-19: the green book, chapter 14a.

Moghimi SM. Allergic Reactions and Anaphylaxis to LNP-Based COVID-19 Vaccines. Molecular Therapy. 2021 Mar 3;29(3):898-900.

Genes and Proteins of COVID-19

A pneumonia of unknown cause detected in Wuhan, China was first reported to the WHO Country Office in China on 31 December 2019.  The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020 and declared a pandemic on March 11. By that time the disease was known as COVID-19 and the name of the new virus was SARS-CoV-2

#China has reported to WHO a cluster of #pneumonia cases —with no deaths— in Wuhan, Hubei Province 🇨🇳 . Investigations are underway to identify the cause of this illness.

— World Health Organization (WHO) (@WHO) January 4, 2020

Scientists worked at speed to make this virus's gene and protein information available at record time. 

READ MORE