NEWS SCAN: Polio in Nepal, severe H1N1 indicators, malaria screening, global childhood vaccines

Sep 22, 2010

Nepal focuses polio vaccine efforts after recording 5 cases
After registering no polio cases last year, Nepal has confirmed five cases that occurred in Rautahat and Mohattari districts from February to June 2010, according to a report in The Himalayan today. In response, Nepal's Department of Health Services has begun vaccination campaigns in eight "highly vulnerable" districts, all of which border India in the southeastern part of the country. The targeted districts, in addition to Rautahat and Mohattari, are Bara, Parsa, Siraha, Sarlahi, Dhanusa, and Saptari.
Sep 22 Himalayan story

Study: Pneumonia test, nasopharyngeal swab not good indicators of severe H1N1
Australian researchers who studied 70 hospitalized patients who had 2009 pandemic H1N1 influenza found that neither a common test for pneumonia severity nor a nasopharyngeal swab was a good predictor of severe disease. Writing in PLoS ONE, they reported that the CURB-65 community-acquired pneumonia (CAP) severity index did not predict CAP severity or the need for intensive care unit (ICU) admission—only 2 of 11 patients admitted to ICU had CURB-65 scores of 2 or 3 on the 5-point scale, with 5 being most severe. On polymerase chain-reaction testing, nasopharyngeal specimens were only 63% sensitive in CAP patients, compared with 98% for lower respiratory tract specimens. The authors conclude, "Lower respiratory tract specimens should be collected when pandemic (H1N1) 2009 influenza CAP is suspected."
Sep 21 PLoS ONE study

Researchers say screening could limit overuse of malaria drugs in Africa
Malaria drugs are being overused to treat sick children in Zambia, a problem that could be addressed at the community level, according to a study by researchers from the Boston University School of Public Health. The study, published by PLoS Medicine, focused on the widespread practice of routinely treating most febrile children at community health posts with malaria drugs and referring those with suspected pneumonia to health facilities. (The two diseases are the leading causes of death for children under age 5 in sub-Saharan Africa.) In the year-long study, community health posts were randomly assigned to two groups. The intervention group first screened children with a rapid test for malaria and treated those who tested positive with artemisinin-based combination therapy (ACT), while treating those who had signs of nonsevere pneumonia with amoxicillin. The control group treated febrile children with ACT and referred those with signs of pneumonia to a health facility, in line with government policy. In the intervention group, 27.5% of children received ACT, versus 99.1% in the control group. For children with pneumonia, 68.2% in the intervention arm and 13.3% in the control arm received early and appropriate treatment. The authors say their approach might reduce overuse of malaria drugs and the accompanying risk of resistance while providing early and appropriate treatment for pneumonia.
Sep 21 PLoS Medicine study
Sep 21 Boston University press release

Global health leaders push for use of pneumococcal, rotavirus vaccines
International health and development officials at a meeting in New York City this week called for expanding the use of childhood vaccines, especially pneumococcal and rotavirus vaccines, as an essential strategy for saving children's lives. Health ministers, donors, and United Nations officials said the two vaccines can prevent deaths due to pneumonia and diarrhea, the two biggest killers of children under age 5, according to a news release from GAVI (the Global Alliance for Vaccines and Immunization), which hosted the event along with UNICEF and the Republic of Kenya. Dr. Guillermo Gonzalez, former Nicaraguan health minister, said his country has seen a 35% to 40% drop in child mortality since introduction of the rotavirus vaccine 3 years ago. GAVI said an estimated 8 million children died of pneumococcal diseases (pneumonia and meningitis) and 5 million children died of rotavirus infections in the past decade. The group said experts believe that use of the two vaccines can save 1 million lives per year. To introduce the two vaccines and maintain high rates of immunization in poor countries, GAVI said it needs $4.3 billion in new funding.
Sep 20 GAVI press release

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