News Scan for Jul 25, 2013

HPV vaccination plateau
FDA clears rapid TB test
Hepatitis E in refugee camp

CDC says progress in HPV vaccination has stalled

Progress in the uptake of human papillomavirus (HPV) vaccine in US teen girls has stalled, the Centers for Disease Control and Prevention (CDC) said today.

The number of girls 13 to 17 years old who received at least one HPV vaccine dose was 53.8% in 2012, about the same as in 2011 (53.0%) after rising steadily each year since 2007, when it was 25.2%. The rate for the recommended three doses of the vaccine was 33.4% in 2012, down from 34.8% in 2011 after it rose appreciably each year from a low of 5.9% in 2007.

The Healthy People 2020 goal is 80% three-dose vaccine coverage. The figures are in a Morbidity and Mortality Weekly Report (MMWR) article today.

"Progress increasing HPV vaccination has stalled, risking the health of the next generation," said CDC Director Tom Frieden, MD, MPH, in a press conference today. "Doctors need to step up their efforts by talking to parents about the importance of HPV vaccine just as they do other vaccines and ensure it's given at every opportunity."

The MMWR data show that not receiving a healthcare provider's recommendation for HPV vaccination was one of the five top reasons parents reported for not vaccinating daughters. Healthcare providers are urged to give a strong recommendation for HPV vaccination for boys and girls 11 or 12 years old, the CDC said.
Jul 26 MMWR report


FDA clears rapid test for TB, drug resistance

The US Food and Drug Administration (FDA) today cleared a new test that can speed the diagnosis of tuberculosis (TB) and also identify a marker for resistance to rifampin, a key antibiotic in the treatment of the disease, the agency said in a statement.

The Xpert MTB/RIF Assay, made by Cephid, based in Sunnydale, Calif., can detect TB bacteria and the sign of drug resistance in about 2 hours, compared with traditional methods for detecting drug-resistant TB that typically take 1 to 3 months, the FDA said.

Alberto Gutierrez, PhD, who directs the FDA's office of in vitro diagnostics, said in the statement that the new test can be used in more diverse settings and that early detection of rifampin resistance can help curb the spread of drug-resistant TB.
Jul 25 FDA statement

In a related development, South African researchers recently reported that the same rapid test can help clinicians more quickly diagnose TB in children, according to a press release yesterday from the National Institutes of Health (NIH), which supported the study.

The study found that the Xpert MTB/RIF Assay detects about two thirds of cases identified by the current culture test, with results ready in 24 hours rather than the average of more than 2 weeks. The study appeared in the August issue of The Lancet Global Health.
Jul 24 NIH press release
August Lancet Global Health abstract


CDC profiles big hepatitis E outbreak in South Sudan refugee camp

A hepatitis E virus (HEV) outbreak that began in July 2012 caused more than 5,000 illnesses in four neighboring refugee camps in South Sudan and dragged on for months, illustrating the difficulty of stopping outbreaks in such settings, the CDC reported today.

Cases were first identified in the Jamam refugee camp in Upper Nile State, which houses refugees from violence in Sudan, the CDC said in MMWR. By Jan 27, 2013, 5,080 acute jaundice syndrome (AJS) cases had been reported at Jamam and three other refugee camps in the same county.

Cases initially peaked in August and then declined after authorities and humanitarian groups worked to improve safe drinking water availability, sanitation, and hygiene. But a second peak followed several months later. The CDC says that HEV outbreaks in refugee camps, unlike single-source waterborne outbreaks, can have multiple peaks involving different modes of transmission.

The overall attack rate in the three most affected camps was 7.4%, and 576 patients (11.3%) of AJS patients in those camps had been hospitalized by late January. Of those, 101 died, for a hospital case-fatality rate of 17.5%.

The report says vaccination should be considered as a tool to help control HEV outbreaks in refugee camps. A three-dose HEV vaccine is available but has not yet been prequalified by the World Health Organization. It has been shown to be safe and effective in people aged 16 to 64 years, but research is needed on its safety in pregnant women and children.
Jul 26 MMWR article

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