News Scan for Aug 30, 2016

Vaccine exemptions
Meningitis B vaccine recs
Antibiotic resistance and childbirth

AAP: No non-medical vaccine exemptions

For the first time in its history, the American Academy of Pediatrics (AAP) issued a policy paper recommending against all non-medical vaccine expeditions for school-age children. While medical exemptions are still valid, the AAP is asking states to eliminate non-medical exemptions—including for religious or personal beliefs.

The AAP, writing in Pediatrics yesterday, said that allowing non-medical vaccinations threatens "herd" immunity, or the 90% to 95% vaccine coverage needed to protect a population against outbreaks of infectious disease. Although most public school districts require proof of immunization before enrollment, there are also laws that allow for non-medical immunization exemptions.

"States that offer personal-belief exemptions have had steady increases in the number of exemptions over time. Religious exemptions have increased for states that do not offer personal-belief/philosophical exemptions but have, through regulatory language, broadly defined religion for the purposes of obtaining vaccine exemption,” the AAP explained in the paper. "The ease of requirements to obtain nonmedical exemptions, especially those of personal belief, can have a significant impact on the rate of exemptions and immunizations."

Often, the AAP said, like-minded people who eschew vaccination for personal-belief or philosophical reasons live near each other, creating "cluster" communities of unvaccinated children that can threaten public health. Requiring immunization upon school entry is a good way to mitigate the risk of infectious disease outbreaks, the AAP said.
Aug 29 Pediatrics policy statement
Aug 29 AAP News story


AAP releases meningitis B vaccine recommendations

The AAP yesterday unveiled its recommendations for serogroup B meningococcal vaccine in people age 10 and older, which are in line with those that have been made by the Advisory Committee on Immunization Practices (ACIP), an expert group that advises the US Centers for Disease Control and Prevention (CDC).

The AAP published its policy statement from its committee on infectious diseases in Pediatrics. The recommendations pertain to two newly licensed vaccines approved for those ages 10 through 25 years old: Trumenba, made by a subsidiary of Pfizer, and Bexsero, produced by Novartis. Trumenba is given as a two- or three-dose series, and Bexsoso is approved only for the two-dose series.

The AAP recommends either vaccine for those at increased risk for meningococcal serogroup B disease, such as those with certain underlying health conditions or people in outbreak settings. It also said that, based on the latest epidemiology and persistence data, the vaccine can be given to healthy adolescents and young adults ages 16 through 23—though the preferred age is 16 through 18—for short-term protection against most serogroup B strains.

The protein antigens used for each vaccine vary, so the AAP emphasized that neither vaccine protects against all serogroup B strains. It added that all doses in the series be of the same vaccine.
Aug 29 Pediatrics report
Aug 29 AAP News story
Aug 29 AAP News Q and A


UN experts warn antibiotic resistance will put mothers, infants at risk

Every year, more than 30,000 women and 400,000 newborns die from infections that occur shortly after a woman has given birth. And those numbers will likely grow as rising drug resistance renders antibiotics less effective.

That's the central message in a commentary yesterday by Anthony Costello, MD, World Health Organization (WHO) director of maternal, newborn, child, and adolescent health, and Stefan S. Peterson, MD, PhD, MPH, UNICEF chief of health. The global health experts write that overuse of antibiotics in humans, along with "needless use" in animals, has created a "recipe for disaster" by accelerating the process in which exposed microbes build resistance.

Antibiotic resistance, they say, will have a major impact on newborns, who lack fully developed immune systems and are therefore more susceptible to infections they might pick up from their mother or from the hospital. Even more at risk will be children born in low-income countries, where healthcare facilities often lack basic sanitary conditions and lifesaving antibiotics are scarce.

"More children in Africa die from a lack of access to antibiotics than from antibiotic-resistant infections," Costello and Peterson write. "Indeed, many still die from infections, such as bacterial pneumonia, that should be easily treatable."

To solve this problem of "access and excess" and save the lives of infants and mothers, Costello and Peterson write, healthcare providers need to begin by stopping the spread of infection and negating the need for antibiotics. This means that all healthcare facilities must have running water and basic sanitation, and that staff must follow good hygiene practices. They also recommend implementing policies to discharge mothers and newborns from the hospital sooner, in order to reduce exposure to infectious microbes.

And lastly, healthcare providers should use antibiotics only when they can confirm that they are absolutely needed. "Simply put, those who need lifesaving antibiotics must get them, and those who do not must not," they write.
Aug 29 WHO commentary

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