Wallis Wang

The medical sector is urging children, the elderly, the pregnant and chronically ill patients to get vaccinated against seasonal flu as soon as possible to prevent serious complications such as brain inflammation.

That came in a joint appeal by 15 medical groups, including the Hong Kong Paediatric Society, the Hong Kong Society for Infectious Diseases and the Hong Kong Geriatric Society, along with Legislative Council members David Lam Tzit-yuen and Rebecca Chan Hoi-yan.

They emphasized the “absolute necessity” of vaccinations for high-risk individuals in order to prevent severe illness, hospitalization and even death.

High-risk groups are said to be more susceptible to severe illness, hospitalization, admission to intensive care units and other complications when infected with the flu.

“Children, in particular, have frequent social contacts and engage in group activities at school, which can easily spread respiratory viruses, including influenza,” they said. “They can also bring viruses back home, putting high-risk individuals at risk.”

One of the severe complications that high-risk individuals may develop is acute necrotizing encephalitis, which is a serious neurological condition resulting from the invasion of the central nervous system by the virus and subsequent inflammation, they warned.

“This condition can lead to symptoms such as seizures, rapid deterioration of consciousness and, in some cases, coma and death. Even if patients are fortunate enough to recover, they may experience extensive multiple organ damage and lifelong neurological deficits, necessitating prolonged treatment and rehabilitation.”

The medical professionals stressed the importance of parents and caregivers taking high-risk individuals to get vaccinated against both seasonal flu and Covid-19 as soon as possible to safeguard their health.

These recommendations are particularly timely as they follow the unfortunate death of a four-year-old girl with no known health issues. The girl passed away on April 29 after being infected with influenza A, marking the third death of a child due to seasonal flu within a two-week period.

The girl had been experiencing a fever and sore throat since April 25 and was initially taken to St Paul’s Hospital. Due to worsening symptoms, she was transferred to the pediatric intensive care unit at Pamela Youde Nethersole Eastern Hospital, but unfortunately, her condition did not improve.

While many advances in clinical research have catalyzed psychiatry’s understanding of schizophrenia management, the practical application of those lessons learned have lagged behind.

In an interview with HCPLive during the American Psychiatric Association (APA) 2024 Annual Meeting in New York, NY, this weekend, John Kane, MD, co-director and professor at the Institute of Behavioral Science at Feinstein Institutes for Medical Research, discussed his planned presentation topic regarding the progression of antipsychotic therapies for schizophrenia.

As Kane explained, research and therapeutic development has been promising of late in schizophrenia—including the anticipated US Food and Drug Administration (FDA) decision for Karuna Therapeutics’ xanomeline-trospium (KarXT) for the treatment of adults with schizophrenia.¹ But he also perceives a difficulty in implementing new clinical evidence and drug indications into care strategies in a timely fashion.

A pair of examples that speak to that struggle, Kane said, is the implementation of proven long-acting injectables (LAIs) and clozapine.

“A substantial proportion of patients do not respond adequately to the first or second medication that they receive,” Kane said. “The long-acting injectable medications have been shown to facilitate adherence and reduce the risk of relapse and re-hospitalization, as well as discontinuation of medication. So, unfortunately, they are also underutilized particularly in early-phase patients.”

With the development of later-generation antipsychotics, Kane has observed a notable improvement in safety profiles—only clozapine stands out for particular treatment efficacy, being the lone FDA-approved therapy indicated for treatment-resistant depression. However, that trend may change with the development of up-and-coming antipsychotic medications: muscarinic agonists that differentiate from the common dopamine D2 receptor-targeting drugs that constitute the traditional early classes of schizophrenia drugs.²

“We will wait to see if those drugs are more effective, or more efficacious than the medicines that we currently have available,” Kane said. “But they do seem to work, and they do seem to be working via a different mechanism. So that’s very exciting.”

One avenue by which schizophrenia care has improved in practice, Kane noted, is the addition of multidisciplinary care team members earlier into a patient’s diagnosis. Facets of disease management—including psychosocial care, family-based education, supportive employment and education—have become better embedded into the initiation of schizophrenia treatment at institutions like his own.

“And we believe that the combination of these modalities and these professionals is really necessary to bring about the best chance of recovery for someone in the early phase of schizophrenia, and we’ve seen the growth of programs across the US and around the world that are delivering this type of treatment,” Kane said. “I think we still have a long way to go. But that’s been a very positive development, as well.“

References

1. ^{Armstrong A. After long journey, Karuna’s schizophrenia drug gets FDA decision date. Fierce Biotech. Published November 29, 2023. https://www.fiercebiotech.com/biotech/after-long-journey-karunas-schizophrenia-drug-gets-fda-decision-date}
2. ^{Foster DJ, Bryant ZK, Conn PJ. Targeting muscarinic receptors to treat schizophrenia. Behav Brain Res. 2021;405:113201. doi:10.1016/j.bbr.2021.113201}

While pollution often evokes images of plastics or oil spills, a more insidious threat lurks in the Baltic Sea. Thallium, a highly toxic heavy metal, is increasing, and human activities are the prime suspect. A recent study by the Woods Hole Oceanographic Institution (WHOI) reveals the extent of this contamination, raising serious ecological concerns.

Thallium: The underestimated pollutant

Thallium, despite being less widely recognized than heavy metal hazards like lead and mercury, possesses a potent toxicity that demands attention.

Historically, thallium found employment in various industries, including the production of rodenticides and electronic components. As awareness of the severe health risks associated with thallium exposure grew, its use in industrial settings has significantly diminished.

Nonetheless, the legacy of past practices, combined with ongoing releases from certain industries, continues to pose a threat to both human health and the delicate balance of ecosystems. Even trace amounts of thallium can have far-reaching and damaging consequences, making it a persistent environmental concern.

Baltic Sea and thallium

The Baltic Sea possesses several unique characteristics that make it acutely susceptible to the damaging effects of pollution. As a semi-enclosed body of water, its limited exchange with the open ocean leads to slower dilution of contaminants, allowing them to linger and accumulate for extended periods. This stagnation exacerbates the impact of pollutants on the sea’s delicate ecosystem.

The Baltic Sea is already under significant environmental stress due to human activities. Oxygen depletion, known as hypoxia, poses a major threat with widespread consequences for marine life and the health of the overall ecosystem.

The introduction of thallium pollution compounds this existing crisis. Thallium’s toxic properties and potential for bioaccumulation add a new dimension of danger to the Baltic’s already compromised state.

A disturbing timeline

The WHOI study exposes a deeply concerning reality: human activity plays a dominant role in the rising levels of toxic thallium entering the Baltic Sea ecosystem. This pollution trend is both alarming and undeniable.

Study lead author Chadlin Ostrander conducted the study as a postdoctoral investigator in WHOI’s Department of Marine Chemistry and Geochemistry.

“Humans are releasing a lot of thallium into the Baltic Sea, and people should be made aware of that. If this continues – or if we further change the chemistry of the Baltic Sea in the future or if it naturally changes – then more thallium could accumulate. That would be of concern because of its toxicity,” said Ostrander.

The research explicitly links the significant release of toxic thallium with human actions. The evidence shows that our activities directly impact the health of the Baltic Sea. Moreover, the study pinpoints a sharp increase in thallium entering the Baltic Sea, starting around 1947. This surge highlights the environmental consequences of the rapid industrial expansion that followed World War II.

Significant thallium pollution in Baltic Sea

The research data strongly suggests that industries such as cement production and coal combustion play a significant role in thallium pollution. This underscores the environmental burden accompanying industrial activities.

The study’s most concerning revelation is that 20-60% of thallium buildup in the Baltic Sea ecosystem can be attributed to human activity. This massive contribution highlights the urgent need to understand the potential repercussions of this contamination. These findings paint a sobering picture of our impact on the Baltic Sea.

They further emphasize the need for proactive strategies to mitigate thallium release, alongside research to better understand the long-term consequences of this toxic heavy metal’s presence in a fragile marine environment.

Thallium in the Baltic Sea leads to sulfide paradox

The story of thallium in the Baltic Sea takes an unexpected turn when we consider the sea’s widespread hypoxic zones, areas with extremely low oxygen levels. These oxygen-depleted regions create a unique situation.

When oxygen is scarce, chemical compounds called sulfides become more prevalent in the water. These sulfides have a strong affinity for thallium, acting like a natural trap. Thallium readily binds with sulfides, effectively getting locked away in the seafloor sediments.

This natural process of thallium sequestration by sulfides offers a temporary reprieve. However, researchers caution that disturbing this delicate balance could have dire consequences.

Efforts to improve the Baltic Sea’s health by addressing hypoxia, while well-intentioned, might inadvertently trigger the release of trapped thallium. If the oxygen levels in the water were to rise significantly, the chemical bond between thallium and sulfides could weaken, potentially causing a surge of thallium back into the water column.

Such a scenario could lead to a significant increase in the amount of freely circulating thallium in the Baltic Sea. This, in turn, would pose a much greater threat to marine life as thallium becomes more bioavailable, meaning it can more easily enter the food chain and accumulate in organisms.

This complex interplay between hypoxia and thallium contamination highlights the need for a nuanced approach to environmental remediation in the Baltic Sea. Addressing one issue must be done with careful consideration of potential secondary effects on other environmental factors.

Thallium’s path through the food web

One of the most insidious aspects of thallium contamination is its potential to bioaccumulate. This means that organisms absorb thallium from their environment, but their bodies have limited ability to excrete it. As a result, the toxic metal builds up within their tissues over time.

The food chain amplifies the threat of thallium:

• Tiny organisms like algae and plankton can absorb thallium directly from the water. These primary producers form the base of the Baltic Sea food web.
• Small fish consume algae and plankton, ingesting the accumulated thallium. Due to bioaccumulation, the concentration of thallium within the fish’s tissues increases as they feed throughout their lives.
• Predatory fish higher in the food chain then eat these smaller fish, leading to an even greater concentration of thallium in their bodies. Humans, as potential consumers of these fish, face the risk of ingesting significant levels of this toxic metal.

The bioaccumulative nature of thallium poses a multi-faceted threat. High thallium levels in fish can cause illness or death, disrupting marine populations and destabilizing the intricate web of predator and prey relationships.

Consumption of contaminated seafood can have significant and potentially long-term health consequences for humans, as thallium’s toxicity can lead to a range of neurological and developmental problems.

The increase in thallium in the Baltic Sea necessitates vigilant monitoring and careful assessment of its potential effects on the ecosystem and its implications for human health.

Global warning

“We predict, based on activities in the region, that the source of the thallium pollution is historic cement production in the region. As cement production continues to rise globally, this research could serve to caution manufacturers about the need to mitigate potential downstream effects of cement kiln dust on surrounding aquatic and marine ecosystems,” said study co-author Colleen Hansel, a senior scientist in WHOI’s Department of Marine Chemistry and Geochemistry.

The Baltic Sea is not unique. Thallium contamination could be happening in other coastal regions near industrial activities. This study highlights the urgent need for stricter environmental monitoring and proactive pollution control, particularly in the context of growing industries like cement manufacturing.

The increase in thallium levels in the Baltic Sea is a stark reminder of humanity’s footprint on the environment. It demonstrates how a legacy of past practices and ongoing industrial activities can have unforeseen, long-term consequences for delicate ecosystems.

Further research is crucial for identifying mitigation strategies, protecting the Baltic Sea, and raising awareness of the underappreciated threat of thallium pollution worldwide.

The study is published in the journal Environmental Science & Technology.

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