News Scan for Mar 03, 2015

Another MERS case
HPV vaccine benefits

Saudis report another MERS case, raising March total to 12

Saudi Arabia reported another MERS case today, raising the count for the first 3 days of March to a dozen, 11 of which occurred in Riyadh.

The case involves a 70-year-old Saudi woman in Riyadh who has a preexisting disease and is in critical condition, the Ministry of Health (MOH) reported. She is not a healthcare worker and has no history of recent exposure to other MERS-CoV (Middle East respiratory syndrome coronavirus) cases, but possible animal exposure is under investigation.

The new case increased the MOH's cumulative MERS tally to 932 cases, including 400 deaths, 503 recoveries, and 29 patients still under treatment. The latter figure includes two patients on home isolation.

The 12 cases reported so far this month follow 75 cases reported in Saudi Arabia in February, but just 20 cases in January.

February marked the third most active month of the past 11 months for MERS in Saudi Arabia, according to an analysis posted today on ProMED-mail, the reporting service of the International Society for Infectious Diseases.

ProMED Deputy Editor Marjorie P. Pollack wrote that data on the MOH site show that 209 cases were reported in May 2014, during a springtime MERS surge, and that partial data for April 2014 show 177 cases. In October there were 36 cases, but all other months since last spring were marked by fewer than 30 cases, according to Pollack.

She noted that 22 of the 86 cases reported from Feb 1 through Mar 2 involved contact with MERS in a healthcare setting, pointing to ongoing transmission in hospitals and clinics. In addition, 10 of the 86 patients were exposed to camels or camel products in the 2 weeks before their illness.
Mar 3 MOH statement on new case
Mar 3
ProMED-mail post on MERS cases


Study: HPV vaccination programs cut infections, anogenital warts

The long-term population-level effects of widespread female vaccination programs for human papillomavirus (HPV), begun in 2007, are promising, cutting infection rates by up to 68% and anogenital warts up to 61%, but continued surveillance for waning efficacy remains important, according to a meta-analysis published yesterday in The Lancet Infectious Diseases.

The international group of authors, from Quebec and elsewhere, searched for HPV articles published between Jan 1, 2007, and Feb 28, 2014, that analyzed changes in incidence or prevalence of HPV before and after HPV vaccination programs were implemented.

The analysis included 20 studies from nine high-income countries that use the quadrivalent vaccine targeting HPV types 16 and 18, which are associated with 70% to 80% of cervical cancers, and types 6 and 11, associated with 85% to 95% of anogenital warts. The studies involved 16,600 women.

In countries with female vaccination coverage of at least 50%, the overall prevalence of HPV types 16 and 18 infections in girls aged 13 to 19 years decreased significantly (68%) from pre- to post-vaccination years (relative risk [RR], 0.32; 95% confidence interval [CI], 0.19-0.52), and the incidence of anogenital warts dropped by 61% (RR, 0.39; 95% CI, 0.22-0.71).

Significant reductions were likewise seen for HPV types 31, 33, and 45 in the same age-group (RR, 0.72; 95% CI, 0.54-0.96), suggesting cross-protection, according to the authors.

The incidence of anogenital warts in boys younger than 20 years was significantly reduced (RR, 0.66; 95% CI, 0.47-0.91), as it was in women 20 to 39 years (RR, 0.68; 95% CI, 0.51-0.89), providing strong evidence of both cross-protection and herd immunity.

Countries with HPV vaccine coverage rates below 50% also saw significant reductions in the rates of HPV types 16 and 18 infection in girls younger than 20 (RR, 0.50, 95% CI, 0.34-0.74) as well as in the incidence of anogenital warts (RR, 0.86; 95% CI, 0.79-0.94), but with no evidence of cross-protection or herd protection.

The authors of an accompanying commentary find it "striking" that the greatest effect of HPV vaccine was apparent in countries with school-based vaccination programs (Australia, New Zealand, and the United Kingdom), a finding corroborated in other studies.
Mar 3 Lancet Infect Dis study abstract
Accompanying commentary


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