News Scan for Oct 29, 2015

Health plans and HPV vaccination
EU gain-of-function report
Fungal meningitis follow-up

Health plans fare poorly in lifting HPV vaccine levels in girls

Health plans in general are doing a poor job at raising human papillomavirus (HPV) vaccination levels in adolescent girls, according to researchers from the US Centers for Disease Control and Prevention (CDC) and their collaborators at Princeton University. The team published its findings in Morbidity and Mortality Weekly Report (MMWR).

They looked at 2013 data from 367 commercial plans and 153 Medicaid plans to determine whether girls received the recommended three HPV vaccine doses by age 13.

Median coverage levels in 2013 were 12% for commercial plans and 19% for Medicaid plans. However, the group found a wide range among the two plans: 0% to 34% for the commercial ones, and 5% to 52% for Medicaid plans.

The study doesn't hint at why HPV vaccine coverage by age 13 is low, but the investigators noted that other studies have found clinicians less likely to strongly recommend immunization for girls ages 11 and 12 compared with older adolescents.

The authors noted that improved vaccine coverage rates and a better understanding of how the highest-performing health plans support HPV vaccination are needed and that more knowledge of barriers to vaccination may help in devising incentives that encourage plans to boost immunization levels.
Oct 30 MMWR report


EU council addresses gain-of-function issues

A European scientific council has published a report to help its member states navigate controversial gain-of-function research issues, highlighting what procedures and regulations are currently in place, outlining areas of consensus, and identifying areas that still need to be settled. The 36-page report is published by the European Academies Scientific Advisory Council (EASAC), which includes national science academies of member states.

Topics covered in the report include risk-benefit assessment, scientific responsibility and self-governance, research review and management, advisory body roles, and the publication of sensitive information.

One of the report's main focuses is biosafety, and the group recommends a layered approach that integrates responsibilities and actions at researcher, institution, funder, and national levels.

Two of the report's main conclusions are the need for more public engagement that includes researchers explaining the objectives of their work and the fact that the issues have global relevance and require ongoing discussion.

Some of the other themes of the report include the need to share best practices and the belief that self-regulation requires checks and balances in the scientific community and awareness-raising that includes education and training.

Experts noted that biosafety issues should be addressed at every stage, including during grant applications, and that risk-benefit evaluations aren't a one-time process but rather an evolving activity. The group found no need for a new advisory body at the EU level.

Regarding publication of potentially sensitive scientific information, the EASAC report said that journals should continue to seek expert advice when needed and that export control laws are an inappropriate tool for blocking publication.

Further consideration should be given to an international forum to keep the dialogue going between scientists and policymakers on gain-of-function issues, according to the report.
Oct 29 EASAC gain-of-function report
Oct 29 Nature

Relapse seen in small number of fungal meningitis outbreak cases

Ongoing monitoring by the CDC of patients infected in a 2012-13 fungal meningitis outbreak linked to contaminated corticosteroid injections has identified 2 more illnesses, bringing the total to 753, and 8 patients have suffered relapses, representing 1% of the total. Researchers posted their update today in a note from the field in the latest issue of MMWR.

According to initial findings, most patients received antifungal treatment for at least 6 months after diagnosis; by 1 year after diagnosis, 42% of 455 patients being followed were considered cured, 41% had finished treatment but were still not considered cured, 7% were still being treated, 8% had died, and follow-up was incomplete for 2%.

One of the relapses occurred 21 months after therapy stopped, highlighting the need for ongoing health provider vigilance.

Researchers said it's unclear if resuming steroid injections poses a risk to patients, but they noted some of the patients have had surgery with no complications related to their earlier fungal infection.
Oct 30 MMWR note from the field

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