News Scan for Oct 09, 2013

News brief

Study: Statin failed to help patients with ventilator-related pneumonia

In a randomized controlled trial in France, a statin drug failed to improve survival rates in patients with ventilator-associated pneumonia (VAP), according to a report published online today by the Journal of the American Medical Association (JAMA).

Statins, used to lower cholesterol, have anti-inflammatory and immunomodulating effects, and some observational studies have suggested that they improve outcomes in various infections, the report notes. Some experts have suggested that the drugs could be used to treat seriously ill patients in an influenza pandemic.

The French study was conducted in 26 intensive care units (ICUs) from January 2010 to March 2013. In a double-blind design, patients were assigned to receive either simvastatin or a placebo, started on the same day as antibiotic treatment and continuing until ICU discharge, death, or day 28. The primary outcome measure was mortality on day 28.

The study was stopped at the first interim analysis, after enrollment of 300 patients, because no benefit was seen. Day-28 mortality was 21.2% (95% confidence interval [CI], 15.4%-28.6%) in the simvastatin group, versus 15.2% (95% CI, 10.2%-22.1%) in the placebo group; the difference was not significant (P=.10). All but 7% of the simvastatin group and 11% of the placebo group were naive to statin therapy, and the results in the statin-naive patients were similar to those in the overall groups.

The authors concluded that their findings do not support the use of statins to improve outcomes in VAP patients.
Oct 9 JAMA report

 

Japanese encephalitis vaccine from China endorsed by WHO

A Japanese encephalitis vaccine manufactured in China has been prequalified by the World Health Organization (WHO), which should make it easier to protect children in developing countries , the agency announced today. This is the first time a Chinese vaccine has reached this status and opens the way for United Nations procuring agencies to source the vaccine.

The newly available vaccine is given in just one dose, it can be used in infants, and it is less expensive than other Japanese encephalitis vaccines, the WHO said.

Prequalification of a vaccine by WHO involves a rigorous review process to assure it meets international standards of quality, safety, and efficacy. Other Chinese manufacturers are expected to apply for prequalification of their vaccines on the heels of this approval, says the release.

Japanese encephalitis is a serious flavivirus-caused infection transmitted by mosquitoes that can cause inflammation of the brain. It is endemic in parts of China, the southeastern parts of the Russian Federation, and South and Southeast Asia. There is no specific treatment, but vaccines are available for prevention.

Said WHO Director-General Margaret Chan of the new vaccine, "This is a welcome development both in the fight to protect children in developing countries from Japanese encephalitis and in the future availability of vaccines more generally, as China is now producing vaccines up to WHO standards."
Oct 9 WHO news release

 

Localizing polio battle without fanfare called key to defeating disease

Working to achieve stronger health systems, bottom-up community engagement, and support for current health workers, particularly women, in the three countries where polio remains endemic rather than focusing on highly publicized international efforts and deadlines may be the key to eradication of the disease, say two independent articles published yesterday in PLoS Medicine.

One article, "The Final Push for Polio Eradication," authored by experts from Afghanistan, Pakistan, and Nigeria, stresses that the locals there need to embrace polio eradication as a social problem rather than a foreign agenda and take ownership of it. "Polio eradication will only be achieved with stronger health systems and bottom-up community engagement, which is likely to require more time and more investment than is currently available" because of political fragility in the countries, state the authors. Immunization efforts need to continue "without the fanfare," they say.

They offer specific strategies and tactics tailored to the realities of their experience in the three countries. Polio, they say, has been portrayed as new battleground between Western forces and terrorist groups. By supporting national and subnational governments in strengthening their routine immunization and other primary healthcare services, the "Western link" of the Global Polio Eradication Initiative (GPEI) and its deadlines would have a lower profile.

Another article focuses on "Lady Health Workers (LHWs)" in Pakistan. These women along with other ground-level staff are the key to polio eradication in that country, say the authors. They interviewed  60 frontline Pakistani LHWs in 2011.

The 106,000 LHWs in Pakistan are part of teams that go door to door in urban slum and rural households providing basic primary care including immunizations. These government health staff need three things, says the article: a living wage (they earn less than US $5 per day), better security, and opportunities for career development and advancement. A shift from "leader-centric" models to support and advocacy of these grassroots health workers "could be at once far-reaching and low-profile," say the authors.
Oct 8 PLoS Med press release
Oct 8 PLoS Med "Final Push" article
Oct 8 PLoS Med article on LHWs

Flu Scan for Oct 09, 2013

News brief

Tests find H7N9 replicates well in human lung tissue

A German research team that analyzed and compared H7N9 influenza virus from a diseased human and H7 viruses from birds found that the human strain replicated as well as seasonal flu in lab culture designed to mimic human lung tissue, but the avian H7 strain grew poorly. They reported their findings yesterday in the latest edition of mBio.

The team also found that the H7N9 strain showed low induction of antiviral beta-interferon, which they said is due to efficient suppression of the interferon by the viral NS1 protein.

All of the viruses tested were found mainly in type 2 pneumocytes, which the team wrote is a clue that the H7N9 virus doesn't differ in tissue tropism compared with other human and avian flu subtypes.

The team said the findings add more evidence that the H7N9 virus infecting people in China is adapted to efficient growth in human lung tissue. They also noted that their experimental lung tissue findings complement other studies using animal models and that the approach may be useful for gauging the zoonotic potential of avian flu viruses.
Oct 8 mBio abstract

 

Study finds low levels of hypersensitivity reactions to H1N1 vaccine

A review of hypersensitivity reactions in people who received the monovalent 2009 H1N1 vaccine found that the rate of events was low, similar to other vaccines, but that levels in women were increased.

The study is based on incidents reported to the federal government's Vaccine Adverse Event Reporting System (VAERS). Researchers are from the Hypersensitivity Working Group of the Clinical Immunization Safety Assessment Network, which includes officials from the US Centers for Disease Control and Prevention (CDC). The team published its findings yesterday in Vaccine.

Experts including seven allergists identified 1,984 possible hypersensitivity events and, based on a review of patient records, verified 1,286 as hypersensitivity disorders. The most common diagnosis was hives/urticaria, followed by anaphylaxis and anxiety.

The overall rate of reported hypersensitivity reactions was 10.7 per million vaccine doses distributed, with a twofold higher rate for live vaccine, the report says.

Though coverage rates for the vaccine were slightly higher in men, women heavily outnumbered men among 20- to 59-year-olds who had a hypersensitivity diagnosis. Women aged 30 to 39 were the hardest-hit group. The gender balance was about even in patients under age 10.

The most common treatment for all conditions was diphenhydramine, and only 51% of 102 anaphylaxis patients with available information received epinephrine, the recommended treatment for severe reactions.

Researchers doubted that the higher reported rate in women could be related to selective reporting, because rates were nearly equal in children and leveled off in older women. They suggested that the difference in adult women could be associated with reproductive hormones or that these women may be at higher risk for certain allergies. More study is needed to explore the suspected hypersensitivity associations, they noted.
Oct 8 Vaccine abstract

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