News Scan for Dec 18, 2017

'America First' biothreats
Dengue vaccine probe
Vaccine education and exemptions
OTC sore throat treatment

'America First' strategy outlines measured against biothreats

President Donald Trump today released a new foreign strategy called the "America First" document, outlining his administration's geopolitical goals. In addition to naming Russia and China as America's "rivals," the president dedicates less than 1 page of the 68-page document to the threats posed by biological weapons.

In a section called, "Combat Biothreats and Pandemics," Trump says that early detection, emergency response, and dedication to medical innovation are necessary to fight both biological weapons and natural outbreaks such as SARS (severe acute respiratory syndreom) and Ebola. Supporting innovation through "strengthening the intellectual property" is labeled as a "priority action."

Elsewhere in the strategy, the president names both North Korea and Syria as states where rogue governments have harnessed biological weapons that could bring global destruction if employed. He also cites the use of chemical and bioweapons in the Middle East by the terrorist group ISIS as an example of weapons of mass destruction that must be stopped.
Dec 18 White House strategy


Dengvaxia fallout continues with legal probe

Major news agencies reported over the weekend and today that the fallout from Sanofi Pasteur's decision to limit the use of the Dengvaxia vaccine is continuing in the Philippines, where lawmakers are continuing to investigate both the Filipino government and the vaccine's manufacturer, Sanofi Pasteur.

Many are questioning the motive of former president Benigno Aquino III's decision to orchestrate a massive vaccination of school-age children in the spring of 2016. Others are wondering if Sanofi dismissed vital information concerning the vaccine's potential to cause severe dengue infections in dengue-naive recipients.

In a story published in the New York Times, reporters quoted parents who are concerned their children are now more vulnerable to severe dengue infections. They also highlighted the biggest conundrum facing countries licensed to use Dengvaxia: If the vaccine is only supposed to be administered to those who had previously contracted dengue, but there's no rapid test that can be performed to determine that, what are clinicians, parents, and lawmakers supposed to do?

Both the Philippines and Brazil initiated government-sponsored vaccination campaigns in 2016, but so far the Philippines are the only country to begin a legal examination of the vaccine.
Dec 18 Wall Street Journal story
Dec 17 New York Times story


Mandatory vaccine education reduces number of exemptions

A study published today in the journal Pediatrics describes the results of a Washington law that mandated counseling before parents were allowed to claim a vaccine exemption for their child. Forty percent less parents sought exemptions after receiving counseling from a health care provider, researchers found.

Washington state implemented senate bill 5005 (SB5005) on July 22, 2011 as a way to address pockets of vaccine hesitancy and exemptions in certain communities. SB5005 required parents to submit a Certificate of Exemption (COE) signed by a Washington-licensed health care provider documenting that they discussed "the benefits and risks of immunizations" with the provider.

To study the impact of the bill, researchers compared kindergarten vaccine data from 1997 to 1998 through 2013 to 2014. Like all other states, Washington requires proof of vaccination or exemption before children begin kindergarten.

After SB5005 was implemented, there was a relative reduction of exemption by 40.2%, and a significant absolute reduction of 2.9 percentage points (95% confidence interval, −4.2% to −1.7%) in the rates of immunization exemptions at the state level.  

"Our findings highlight the importance of evidence-informed legislation to reduce the risk of vaccine preventable diseases," the authors concluded. "States in the United States and jurisdictions in other countries should consider adding parental counseling as a requirement for obtaining exemptions to vaccination requirements."
Dec 18 Pediatr study


Study: Probiotics, chewing gum offer no benefit for sore throats

Probiotics and xylitol chewing gum, two over-the-counter antibiotic alternatives used to treat sore throat symptoms, have no significant effect, according to a 4-year randomized controlled trial that took place in the United Kingdom. The team reported their findings today in the latest edition of CMAJ (Canadian Medical Association Journal).

Probiotics and xylitol, a type of birch sugar that prevents bacterial growth, have been shown to prevent recurrence of respiratory infections. Clinicians have eyed them as a possible over-the-counter treatment that might help manage bacterial and viral infections, which could potentially help curb antibiotic use. However, their role in treating pharyngitis has been unclear.

The study included 934 people ages 3 and older from a primary care setting between 2010 and 2014, of which 698 provided complete data. Participants used a symptoms diary to record the number of probiotic capsules and sticks of chewing gum they used each day, along with their sort throat severity symptoms. Researchers considered participants "compliant" if they took 75% of their treatment.

No significant effect was found for probiotics or xylitol gum, and there were no differences between groups for both of the treatments, which investigators said suggests that neither intervention helped control acute symptoms.

"There is no reason for clinicians to advise patients to use either of these treatments for the symptomatic management of pharyngitis," they wrote.
Dec 18 CMAJ abstract
Dec 18 CMAJ press release

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