News Scan for Oct 09, 2013

Statins for ICU pneumonia patients
Japanese encephalitis vaccine
Community engagement in polio fight

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

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