News Scan for Aug 27, 2015

India tetanus elimination
Global water sanitation
Food pathogen network
Pneumococcal vaccine protection

India eliminates maternal and neonatal tetanus ahead of schedule

The World Health Organization (WHO) today announced that all of India's 675 districts have eliminated maternal and neonatal tetanus.

Maternal and neonatal tetanus cases in India have been reduced to less than one case per 1,000 live births ahead of the elimination target date set for December 2015.

Elimination can be attributed to programs that directly addressed maternal vaccination and unhygienic obstetric care, especially among impoverished or isolated populations. India's Mission Indradhanush provided tetanus immunization campaigns directed at children and pregnant women, while the National Rural Health Mission and Janani Suraksha Yojana promoted in-facility perinatal and birthing care.

The WHO said that, given the prevalence of tetanus in the environment, vaccination and hygiene campaigns will require ongoing collaboration between government and community health entities in order to prevent future cases.
Aug 27 WHO press release


WHO announces global water sanitation plan to target tropical diseases

The WHO today announced a plan to integrate water sanitation programs with four public health interventions to reduce the global burden of neglected tropical diseases (NTDs) by 2020.

NTDs such as leprosy, trachoma, and schistosomiasis affect more than 1 million people and cause more than 500,000 deaths each year. The WHO plan proposes integrating improved water and sanitation programs with interventions that provide preventive NTD chemotherapy, innovative and intensified disease management, vector control, and veterinary public health.

The global strategy focuses on strengthening the evidence base for water and sanitation improvement in impoverished communities, improving collaborations between governments and local health workers, and addressing the role of poverty and inequality in access to water and risk of disease.

Given that 660 million people lack access to clean water sources and 2.5 billion do not have adequate sanitation, addressing contaminated water's role in disease is expected to lead toward significant progress in eliminating or eradicating 16 of 17 targeted NTDs.
Aug 27 WHO strategy


Companies asked to contribute samples to federal food pathogen network

A new approach to finding the source of foodborne disease outbreaks that involves a network of state and federal labs mapping out the entire DNA sequences of various strains of food pathogens and a public database housing the information is "radically transforming" investigations, and food companies are being asked to help, said a Reuters story yesterday. The system aims to considerably shorten the time it takes to get contaminated foods out of circulation and thus lessen the burden of foodborne diseases.

The network is being constructed by the US Food and Drug Administration (FDA); the database, known as GenomeTrakr and housed at the National Institutes of Health (NIH), not only stores the sequences of strains from patients ill with such diseases as Salmonella and Listeria but also contains pathogens identified during routine FDA inspections at food plants.

The FDA is asking food manufacturers to voluntarily contribute samples from their facilities to the database as well, although "convincing companies to offer up potentially incriminating evidence has been a hard sell," says the story.

Since GenomeTrakr's inception in 2012, 25,000 genomes have been added to the database. In 2013, the first year the system was used to experiment with Listeria sequences, 19 clusters of illness were identified and 4 outbreaks solved. This compares with identification of 14 clusters and solution of 1 outbreak the previous year using the older method of comparing pulsed-field gel electrophoresis (PFGE) results from ill patients.

David Acheson, MD, a former official at the FDA and the US Department of Agriculture (USDA), compared the two methods to witnessing a hit-and-run accident, saying "While PFGE might identify the vehicle as a brown Toyota Corolla, whole genome sequencing provides the license number and even the vehicle identification number," according to the story.

The Centers for Disease Control and Prevention and the USDA have "signed on" to the program.
Aug 27 Reuters story


Pediatric pneumococcal vaccination has protective effect on adults

Pneumococcal vaccine coverage in children protects adults from invasive pneumococcal disease (IPD) at a local level, according to a study yesterday in the Journal of Infectious Diseases.

Researchers from the Yale School of Public Health and the Connecticut Department of Public Health analyzed ZIP code–level data on pediatric immunization with at least three or four doses of pneumococcal conjugate vaccine 7 (PCV7) from Connecticut's state immunization registry. Data were compared with ZIP code–level incidence of IPD in Connecticut between 1998 and 2009 and US Census data on race, income level, and population density at the local level.

Between 1998 and 2009, Connecticut reported 5,838 cases of IPD, 2,313 of which were caused by PCV7 serotypes. People aged 40 to 64 years accounted for 1,947 of all IPD cases, and 2,375 cases occurred in people 65 years of age and older.

Connecticut's immunization registry contains data on 176,923 children. By 2009, 95% of them had received three doses of PCV7, and 88% had received four doses (three doses plus booster).

After PCV7 was introduced in 2000, IPD rates declined each year by an average of 63% in children under 5 years of age, 36% in adults 40 to 64, and 37% in people 65 and older. By 2008, fewer than 8% of IPD cases in adults 40 years and older were caused by the seven serotypes covered by the vaccine.

ZIP codes with a higher proportion of children who did not receive the fourth dose of PCV7 had a higher proportion of adult IPD cases caused by PCV7 serotypes. When a gap of ten percentage points was observed between children who received the third and fourth doses, the odds of an adult case of IPD caused by a PCV7 serotype increased by 54.3% (95% confidence interval, 20.2%-98.2%).

The ZIP codes with a lower pediatric uptake of the booster dose were also significantly more likely to have a higher population density and a higher proportion of Hispanic and/or Black residents and children under 5 years of age.

The investigators noted that their results may not translate to effects of the PCV13 vaccine, which the United States began using instead of PCV7 in 2010.
Aug 26 J Infect Dis study

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