News Scan for Apr 28, 2015

US flu season review
Antibiotic use in chickens
Shingles vaccine
Early HPV vaccination
Princeton meningitis recap
IOM name change

CDC says tough 2014-15 flu season is finally ending

Two straight weeks of low influenza activity signal that the long 2014-15 flu season, marked by its heavy impact on seniors and poor vaccine performance, is drawing to an end, the Centers for Disease Control and Prevention (CDC) said in a short review of the season yesterday.

Flu activity stayed elevated for 20 weeks, making the season considerably longer than the average of 13 weeks over the past 13 seasons. H3N2 viruses were the dominant strain, and H3N2-dominated seasons are usually more severe.

As the CDC has noted previously, this season brought record hospitalization rates in those 65 and older, who accounted for 60% of flu hospitalizations. From Sep 28, 2014, through Apr 18, an estimated 313.8 of every 100,000 seniors were hospitalized for flu. The next-highest rate was 182.3 per 100,000 in 2012-13. Hospitalization rates in younger age-groups were similar to or lower than in previous seasons.

Flu-related deaths this season were within expected boundaries for an H3N2-dominant season, the CDC said. The share of deaths attributed to pneumonia and flu peaked in mid-January at 9.3%, which was comparable to the peaks in past severe seasons, such as 2003-04 (10.4%) and 2012-13 (9.9%).

A total of 128 flu-related deaths in children have been reported this season, but the toll is likely to climb further, since reporting can be delayed, the agency said. Since 2004, the flu-related pediatric death toll has ranged from 37 to 171 per season, aside from the 2009-10 pandemic year, when it was 358.

The CDC also noted that most circulating H3N2 viruses differed from the H3N2 strain in the vaccine, which probably explains why the estimated vaccine effectiveness (VE) against H3N2 was only 18%. VE against influenza B was estimated at 45%, and overall VE was 19%.

"VE results this season underscore the importance of having flu vaccines that are well-matched to circulating flu viruses, as well as just how challenging this can be to achieve with a virus that is constantly changing," the CDC said. "This season's disappointing VE also underscores the importance of ongoing efforts to improve influenza vaccine technology."
Apr 27 CDC


Tyson Foods aims to stop using human antibiotics in chickens

Tyson Foods Inc., one of the world's largest meat and poultry producers, announced today a goal of eliminating the use of human antibiotics in broiler chickens by the end of September 2017, with the aim of limiting the spread of antibiotic resistance.

"Antibiotic resistant infections are a global health concern,” Donnie Smith, Tyson president and CEO, said in a statement. "We're confident our meat and poultry products are safe, but want to do our part to responsibly reduce human antibiotics on the farm so these medicines can continue working when they're needed to treat illness."

"Given the progress we've already made reducing antibiotics in our broilers, we believe it's realistic to shoot for zero by the end of our 2017 fiscal year," Smith said. "But we won't jeopardize animal well-being just to get there. We'll use the best available treatments to keep our chickens healthy, under veterinary supervision."

The company pledged to report annually on its progress. The firm has already stopped using antibiotics in its 35 broiler hatcheries, requires a veterinary prescription for antibiotics used on broiler farms, and has reduced the use of human antibiotics to treat broiler chickens by more than 80% since 2011, the statement said.

Tyson said it is also forming working groups with independent farmers and others in its beef, pork, and turkey supply chains to discuss how to reduce the use of human antibiotics on cattle, hog, and turkey farms. Those groups will begin meeting this summer.

The company said its international business is committed to taking similar measures on antibiotic use in its global chicken operations but has not set a timeframe. Other plans call for providing funding to increase research on disease prevention and antibiotic alternatives on farms.
Apr 28 Tyson statement


Phase 3 trial of shingles vaccine demonstrates 97% efficacy in older adults

The subunit candidate vaccine HZ/su significantly reduced the risk of herpes zoster (shingles) in adults older than 50, maintaining its efficacy even in those over 70, groups that are at the highest risk for the disease, according to the findings of a phase 3 trial published today in the New England Journal of Medicine.

The study population comprised 15,411people from 18 countries who were 50 years of age or older and who had no history of shingles and had not been vaccinated previously for shingles or varicella (chicken pox). They were randomized to receive two injections 2 months apart of either HZ/su or placebo and followed for at least 30 months beginning 1 month after the second dose. The vast majority (14,759, 95.8%) received both doses.

Shingles was confirmed during follow-up in 216 participants who received both vaccine doses, 6 in the vaccine group and 210 in the placebo group, for an overall VE of 97.2% (95% confidence interval [CI], 93.7 to 99.0; P < 0.001). The rate was not significantly different in participants aged 50 to 59 years than in those 60 to 69 or 70 and over.

Injection-site or systemic symptoms within 7 days after vaccination were reported by 84.4% of those in the vaccine group and 37.8% of controls; most were mild to moderate and transient, with pain at the injection site and muscle soreness the most common.

The currently licensed vaccine for shingles, Zostavax, which is a live vaccine, has been reported to have about 70% efficacy in adults 50 to 59 years of age and less than 40% in those 70 and older. It is contraindicated for immunosuppressed individuals. HZ/su contains 50 micrograms of recombinant varicella-zoster virus glycoprotein E, making it safer than live vaccine for immunocompromised people, plus an adjuvant system called AS01B.
Apr 28 N Engl J Medabstract


Study findings provide strong evidence in favor of early HPV vaccination

Quadrivalent (four-strain) human papillomavirus (qHPV) vaccine significantly reduced the incidence of cervical dysplasia in adolescent girls and also brought decreases in the incidence of anogenital warts, offering further justification for vaccination programs that are being widely promoted, say results of a Canadian study published yesterday in Pediatrics.

The authors retrospectively examined the records of two cohorts of adolescent girls in Ontario: those in 8th/9th grades before introduction of a publicly funded, largely school-based qHPV vaccination program (ie, school years 2005-06 and 2006-07) and those in the same grades after the program's implementation (ie, school years 2007-08 and 2008-09). The former group was termed the ineligible group and the latter, the eligible group. The subjects' records in grades 10 to 12 were examined again to determine outcomes.

The ineligible group comprised 131,781 girls and the eligible group 128,712 (total 260,493). Dysplasia was identified in 2,436 cases and anogenital warts in 400. Vaccination was associated with a significant reduction in the incidence of dysplasia of 5.70 cases per 1,000 girls (95% CI, –9.91 to –1.50), for a relative reduction of 44% (relative risk 0.56; 95% CI, 0.36 to 0.87).

At least one dose of the three-dose regimen was received by 75,848 girls, with 88% of those completing the entire series. Program eligibility had "a major impact on vaccine exposure," say the authors: 50.6% of eligible girls received vaccine, compared with less than 1% of ineligible girls. Anogenital warts were present in 400 cases, with reductions in risk "attributable to program eligibility and vaccination" but not reaching significance.

The authors say that "All results speak to the value of offering qHPV vaccination to young girls through a population-based program."
Apr 27 Pediatrics abstract


Final Princeton meningitis case involved unvaccinated contact

Although no cases occurred among students who received at least one dose of meningococcal serogroup B (MenB) vaccine in response to a meningitis outbreak at Princeton University in 2013-14, the ninth and final case occurred in an unvaccinated contact after a vaccination campaign, indicating that vaccinees could still carry serogroup B Neisseria meningitidis.

The results of the outbreak and immunization investigation, conducted by researchers at Princeton and the Centers for Disease Control and Prevention, were published yesterday in Pediatrics.

The campaign involved immunization clinics in December 2013 and February 2014 and targeted a student population of about 5,800. About 95% of students received one MenB dose, and 89% received two doses. No additional cases of serogroup B meningococcal disease occurred in students, but an unvaccinated close contact of Princeton students became the ninth person infected, in March 2014.

(Inexplicably, the report does not mention Princeton by name, instead calling it "a New Jersey university" and "University A." But no other university would meet the outbreak description.)

The authors conclude, "The outbreak investigation and highly successful vaccination campaign described here can serve as a model for how to approach similar outbreaks in the future."
Apr 27 Pediatricsabstract


IOM to change name to National Academy of Medicine

The membership of the National Academy of Sciences (NAS) voted today at its 152nd annual meeting to change the name of the Institute of Medicine (IOM) to the National Academy of Medicine.

The change will take effect Jul 1, the IOM said in a press release. "The change is part of a broader internal reorganization to more effectively integrate the work of the National Academies of Sciences, Engineering, and Medicine," according to the release. "Reports and studies on health and medicine will continue uninterrupted as activities of the Institute of Medicine, which will become one of the six program units operating under the direction of the integrated academies."

"The establishment of the National Academy of Medicine is a significant milestone in our history," said NAS President Ralph J. Cicerone, PhD. "It will also better align us to take a more integrated, multidisciplinary approach to our work, reflecting how science is best done today."
Apr 28 IOM press release

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