Vaccines lead as Pharmaceutical Technology lists the top five terms tweeted on infectious diseases in Q4 2021, based on data from GlobalData’s Pharmaceuticals Influencer Platform.

The top trends are the most mentioned terms or concepts among Twitter discussions of more than 150 infectious diseases experts tracked by GlobalData’s Pharmaceuticals Influencer platform during the fourth quarter (Q4) of 2021.

1. Vaccines – 6,011 mentions

Pfizer and BioNTech’s announcement of their Covid-19 shot being 100% effective in adolescents after four months, vaccine hesitancy and misinformation resulting in a surge in Covid cases in the US, and less awareness about Omicron, were some of the popular discussions on vaccines in Q4.

Laurie Garrett, a science journalist and former senior fellow at the Council of Foreign Relations (CFR), shared an article on the Pfizer-BioNTech Covid-19 vaccine shot proving to be 100% effective in a study conducted among 2,228 children aged between 12 and 15 years. The study also found no serious side effects associated with the vaccine during a six-month follow-up after the second dose, indicating it to be a definite success in vaccinating adolescents, Garrett tweeted. The article further noted that the two companies will use the results of the study to pursue full approvals for the vaccine in the US and rest of the world.

Vaccines was also discussed by Prof Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine, who shared an article on the prospects of a winter surge in Covid-19 infections driven by the emergence of the Omicron variant. An analysis shared by Hotez further revealed that pro-Trump counties reported far higher coronavirus death rates ever since the vaccine rollouts. Experts claimed that political polarisation and misinformation around vaccines and the Covid-19 disease are causing a significant rise in deaths during the pandemic in the US.

In another tweet, Muge Cevik, science communicator at the University of St Andrews, tweeted on the lack of awareness about the new Omicron variant, and its impact on immunity and vaccines. Cevik stated that the new data emerging from the spread of the variant could be misinterpreted without context. She highlighted that the Omicron variant contains more than 30 mutations in the spike protein, which is the part that helps it to enter human cells and is the target for vaccines. The mutation profile of the variant, therefore, is different from other variants of concern (VOCs), she added.

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2. Covid-19 – 3,867 mentions

The comparison of global daily Covid-19 death estimates against actual deaths, Covid-19 taking a toll on mental health of children and adolescents, and the approval of first oral antiviral for treating Covid-19, were some of the popular discussions on Covid-19 in the fourth quarter.

Gregg Gonsalves, an epidemiologist and associate professor at the Yale School of Public Health, tweeted an article suggesting that the actual death toll from Covid-19 is 15.8 million against the official estimates of 4.8 million. The article highlighted that it is highly likely that the true value lies between 9.8 million and 18.5 million additional deaths. It added that Covid-19 may have led to a greater number of deaths than stated by official statistics. Gonsalves further noted that inequitable access to vaccines may prolong the pandemic leading to more deaths.

Covid-19 was also discussed by António Guterres, UN Secretary-General, on how the disease is taking a huge toll on the mental health of children and adolescents worldwide. He tweeted that more investments in health services were required, while the stigma associated with seeking help should be removed. The article noted that an estimated 13% of adolescents aged between ten and 19 years suffered from a mental disorder across the world. In addition, governments allocated just 2% of their health budgets to mental health globally, which is less than $1 per person in some of the poorest nations, the article highlighted.

In another tweet, Esin Davutoğlu Şenol, professor of medicine at the Gazi University Faculty of Medicine, shared an article on the first oral antiviral for Covid-19 Lagevrio (molnupiravir) being approved by the Medicines and Healthcare products Regulatory Agency (MHRA). The drug was approved as a safe and effective treatment for reducing hospitalisations and deaths in people suffering from mild to moderate Covid-19 symptoms but at a risk of developing severe disease, the article noted.

Developed by Ridgeback Biotherapeutics and Merck Sharp & Dohme (MSD), the drug works effectively by interfering with virus replication. It prevents the virus from multiplying, keeping the viral load low and thereby reducing the severity of the disease. The article further detailed that Lagevrio is most effective during the early stages of the disease, with the MHRA recommending its use as early as after being infected and within five days of symptoms onset.

3. HIV – 1,029 mentions

The unknown facts about the interaction between Covid-19 and HIV, the National Institute for Health and Care Excellence’s (NICE) announcement of an injectable treatment for HIV, and actions needed to end HIV transmissions in the UK were some of the popular discussions on HIV in Q4 2021.

Carlos del Rio, a distinguished professor of medicine at Emory University School of Medicine, shared insights on the unknown facts about the interaction between Covid-19 and HIV. Covid-19 led to the disruption in HIV prevention and treatment, but it is not yet known whether HIV has increased susceptibility to Covid-19 infection. Similarly, Covid-19 leads to worse outcomes in HIV patients, but there is no context on the mechanism and risk factors for worse outcomes. Furthermore, the increase in HIV and Covid-19 induced mortality in people with HIV may lead to interruption in healthcare services and interfere with prevention campaigns leading to increased HIV transmissions.

The term was also tweeted by Laura Waters, an HIV consultant, with respect to the approval of the first long-acting injectable HIV-1 treatment by NICE. The injectable form of cabotegravir with rilpivirine was found to be as effective as oral antiretrovirals in keeping viral loads low in clinical trials. Waters tweeted that it was important to spread the news to people approaching their clinics that the treatment would be available in a few months.

In another discussion, Matthew Hodson, executive director of NAM aidsmap, a UK-based charity sharing information on HIV and AIDS, tweeted on the ignorance around HIV and AIDS and the actions needed to be taken to end HIV transmissions in the UK. The prime minister of the UK Boris Johnson was criticised for confusing between HIV and AIDS while speaking about vaccines development and research. Hodson tweeted that ignorance leads to fear and stigma, which further creates challenges for HIV testing and treatment that ultimately contributes to spreading of the disease. The UK government needs to take further steps to improve understanding about HIV through public awareness campaigns to reach its goal of ending HIV transmissions by 2030, the article added.

4. Immunity – 377 mentions

Vaccine-induced immunity being better than infection and recovery, UK risk assessment of the Omicron variant, and cancer vaccines that can launch tumour-fighting immunity were among the popular discussions on immunity in Q4.

Prof Peter Hotez shared a research on more evidence being published by the Morbidity and Mortality Weekly Report (MMWR), an epidemiological digest of the US Centers for Disease Control and Prevention (CDC), on vaccine-induced immunity. The report highlighted that vaccine-induced immunity is better than the immunity achieved after infection and recovery or natural immunity. The report stated that vaccination benefits when compared with infection without vaccination appeared to be higher for those administered with the Moderna vaccine rather than the Pfizer-BioNTech vaccine. It also noted that vaccines had higher protective effect among adults aged 65 years and older, than for those aged between 18 and 64 years.

Immunity was also mentioned by Kai Kupferschmidt, a molecular biologist, in a tweet about a new risk assessment by the UK Health Security Agency for Omicron stating that the risk of immune escape from vaccines and antibody treatments to be high. The assessment found mutations to reduce antibody binding and lead to changes in all four neutralising antibody binding sites in the receptor-binding domain (RBD). The analysis also found no epidemiological data on vaccine effectiveness, and the mutations present to reduce the binding of most available therapeutic monoclonal antibodies, based on structural modelling.

In another tweet, Lawrence A. Tabak, acting director of the National Institutes of Health (NIH), US, shared a study on devising cancer vaccines that work better on launching tumour-fighting immunity by spotting and killing the distinct proteins on cancer cells. The idea is based on how the Moderna and Pfizer mRNA vaccines programme human cells to interpret the injected synthetic messenger RNA into the coronavirus spike protein. Many of the cancer vaccines are still in the experimental stage, but researchers continue to make new discoveries such as the NIH-funded study in mice that helps to improve the selection of protein targets on tumours to boost the immune response. Researchers first discovered a solution to the existing challenge in developing precision cancer vaccines that is T cell exhaustion.

A study conducted on mice with lung tumours found that the immune system initially responded as usual producing lots of T cells that attack many different cancer-specific proteins, the article detailed. The different subsets of T cells, however, interfered with each other leading to the emergence of a dominant T cell type that kept the remaining T cells out of the tumour from attacking the neoantigens in the cancer. Researchers are now working on vaccines in combination with immunotherapy drugs that can target the immune system against cancer in other ways, the article highlighted.

5. Antibiotic – 373 mentions

Researchers finding a possible treatment strategy without antibiotics for meningitis, and the changes in antibiotic use in 2020 during the Covid-19 pandemic were some of the discussions on antibiotic in the fourth quarter.

Dr Saskia Popescu, an infectious disease epidemiologist and senior infection preventionist, shared an article on researchers from the University of Copenhagen and Lund University being able to utilise rats’ own immune cells to kill the bacterial meningitis infection. The article noted that immune cells entering the brain’s membrane or the meninges developed a net-like structure that traps bacteria. It also blocks the movement of cerebrospinal fluid, which helps in clearing waste products prepared by the active brain cells.

Researchers discovered that if the nets were dissolved, it would allow the cerebrospinal fluid to pass through the brain freely. The nets consist mainly of DNA, so the researchers applied drugs for cutting up DNA, called the DNase. Rats infected with pneumococcus bacteria, which causes bacterial meningitis, were given the DNase. The treatment was reported to reduce brain swelling and also helped in removing metabolic waste production from the infected brain. In comparison, antibiotic treatment did not have an effect on brain swelling or waste clearance, the article detailed.

Andrew Seaton, an antibiotic stewardship lead at NHS Greater Glasgow and Clyde, mentioned the term in a tweet about The Scottish One Health Antimicrobial Use and Antimicrobial Resistance in 2020 report, which stated that 7.8% of antibiotics in Scotland were prescribed by nurses in 2020. The report also found that the total use of antibiotics in humans across all settings was 19.2 defined daily doses (DDDs) per 1,000 population per day (DDDs/1,000/day), a 4% year-on-year decrease since 2016, with an overall reduction of 17.1% between 2016 and 2020 and a 11.8% reduction from 2019 to 2020. The decline may have been due to the impact of Covid-19 on antibiotic use across settings, according to the report.