Archive for July, 2011

FC Barcelona & Bill Gates Foundation will help in the fight against polio

Friday, July 29th, 2011 (last updated)

FC Barcelona, la Fundació FC Barcelona and the Bill & Melinda Gates Foundation have announced a three year collaboration deal to help in the worldwide fight against polio.

Protect infants now! Ask CDC to recommend infant meningococcal vaccines

Friday, July 29th, 2011 (last updated)

Infants are the most vulnerable among us—they cannot stand up for themselves, and so it is our job to protect them. Every child deserves a healthy start. That’s why the Centers for Disease Control and Prevention (CDC) recommends that infants be vaccinated against many diseases that threaten their health and their lives. But one deadly disease continues to cause intense devastation among infants and their families: Meningococcal disease, one of the most common causes of meningitis and sepsis.

Right now, the US Centers for Disease Control and Prevention (CDC) is traveling around the country seeking public input on whether infants two years and younger should be immunized against meningitis — a leading cause of preventable infant death in the U.S. One out of 16 infants who contract the disease will not survive.  Among survivors, one in five will suffer seizures, blindness, amputation, paralysis or learning disabilities. Successful vaccination programs have eliminated small pox globally, and cases of polio, measles, diphtheria and Hib are at all time lows. The eradication of meningococcal meningitis is an achievable, pressing public health objective and vaccinating infants is an important step in that direction. One safe and effective meningitis vaccine has been approved by the Food & Drug Administration, and more are on the horizon. But it is up to CDC to recommend that pediatricians include them in their vaccination schedule. If you cannot attend a CDC regional meeting in Seattle, Chicago, or Denver this summer, this petition will give you a voice to let CDC know you support infant immunization against meningitis.  Sign the Meningitis Angels petition, today!

Sign the petition

Time to mandate influenza vaccination in health-care workers

Wednesday, July 27th, 2011 (last updated)

We are happy to promote Dr. Arthur’s Caplan’s recent Lancet article on the importance of mandating flu vaccines for health care workers.

As Dr. Caplan, chair of the Department of Medical Ethics at the University of Pennsylvania, notes, “Rates of influenza vaccination in health-care workers have averaged well under 50% for the past decade in many hospitals and long-term care facilities in the USA and in other nations.” This dismal rate is highly problematic, he explains, in large part because vaccination of doctors and nurses plays such a crucial role in protecting patients from infection, illness, and death, especially among children, the elderly, and those who are immuno-compromised.

Yet no amount of coaxing or reasoning has convinced the majority of health-care workers to get themselves vaccinated. All of which leads Dr. Caplan to ask an important question: “Given the failure of voluntary vaccination strategies and the dangers low vaccination rates present to vulnerable patients, shouldn’t all health-care workers be required to be vaccinated against influenza and other communicable diseases as a condition of their employment?”
The answer, of course, is yes — absolutely. “It is time,” says Dr. Caplan, “to make clear what the ethical reasons are for requiring vaccination and then to get a mandate in place in all health-care institutions and clinics.” And Dr. Caplan offers just such clarity in his op-ed, not the least of which are the following points:

[E]very code of ethics adopted by physicians, nurses, nurses aides, social workers, pharmacists, and other health-care professionals states very clearly, succinctly, and loftily that the interests of patients must come ahead of anyone else’s…Whatever one’s views about personal rights to choose, unless a valid medical reason exists to not vaccinate, the best interests of the patient trumps personal choice in the hierarchy of self-imposed professional values.

“Mandates do work,” Dr. Caplan writes. At the University of Pennsylvania’s health-care system, where vaccination is mandatory, he reports that vaccination rates are now greater than 98 percent. Underscoring the need for such a policy on a national level, he concludes: “It is time to acknowledge professional duty and make influenza vaccination of health-care workers a mandatory obligation.

Click here for full article

Anti-vaccine fears spreading to the developing world

Monday, July 25th, 2011 (last updated)

The public health community has gotten markedly better at distributing effective vaccines to the children who need them. But researchers are noticing an increase in mistrust of vaccines around the world, and they’re concerned that unfounded suspicions could derail immunization programs essential to saving lives.

Anti-vaccine groups in the U.S. and Europe have for years questioned the safety of vaccines like measles-mumps-rubella, or MMR; one highly publicized claim — that the vaccine causes autism — has been debunked over and over. But according to Heidi Larson, a researcher and lecturer at the London School of Hygiene and Tropical Medicine, anti-vaccine groups exist in developing countries as well and are getting better networked and organized.

In a paper published online last month in The Lancet, Larson and her co-authors write that “current antivaccination groups have new levels of global reach and influence, empowered by the internet and social networking capacities allowing like minds to rapidly self-organise transnationally, whether for or against vaccines.”

Fears and suspicions around vaccine safety have already contributed to a slight decline in vaccination rates in the U.S. And public health experts say recent whooping cough and measles outbreaks in several countries have been connected to people who refused the vaccines. In the Ukraine, a 2008 measles and rubella vaccination campaign was suspended due to public mistrust of the vaccine. The campaign, which was targeting 7.5 million people, ended up only reaching 116,000 people.

Vaccine distrust in the developing world can evolve out of cultural, religious, or sometimes economic or political reasons, says Larson. In the case of a polio vaccination boycott in northern Nigeria in 2003, “marginalised communities asserted their voice by refusing or challenging government-driven initiatives.”

Whatever the reason for the distrust, Larson and her colleagues would like to learn about suspicions early on. They’ve developed an alert system for early detection of distrust, using reports from local media and “informants,” including local health workers. The pilot initiative is in Kenya, a country that recently introduced the pneumococcal vaccine. “We are monitoring acceptance and looking for any issues that may come up,” says Larson. If they hear anything, they’ll let partners rolling out the vaccine know they need to do more to assure people they’re trustworthy.

Larson says these days, the vaccine questioners and refusers are usually in clusters, which can threaten herd immunity from disease. “It would be better if scattered individuals were the questioners, because when they start clustering, it becomes a bigger problem,” Larson tells Shots

Polio is one disease where mistrust of the vaccine could really set back progress towards eradication, Larson says. The CIA’s attempt to collect DNA from bin Laden’s family in Pakistan under the guise of a Hepatitis B vaccination drive didn’t help, as Humanosphere blogger Tom Paulson has pointed out. Pakistan has the highest incidence of polio in the world, but suspicions around vaccination efforts have been rising.

A great TED-presentation of Bruce Aylward: How we’ll stop polio for good

Monday, July 25th, 2011 (last updated)

Polio is almost completely eradicated. But as Bruce Aylward – Epidemiologist who heads the Polio Eradication program at WHO, The Global Polio Eradication Initiative (GPEI) – says: Almost isn’t good enough with a disease this terrifying.

Aylward lays out the plan to continue the scientific miracle that ended polio in most of the world and to snuff it out everywhere, forever.

Scripps Research scientists create vaccine against heroin high

Thursday, July 21st, 2011 (last updated)

Researchers at The Scripps Research Institute have developed a highly successful vaccine against a heroin high and have proven its therapeutic potential in animal models.

The new study, published recently online ahead of print by the American Chemical Society’s Journal of Medicinal Chemistry, demonstrates how a novel vaccine produces antibodies (a kind of immune molecule) that stop not only heroin but also other psychoactive compounds metabolized from heroin from reaching the brain to produce euphoric effects.

“In my 25 years of making drug-of-abuse vaccines, I haven’t seen such a strong immune response as I have with what we term a dynamic anti-heroin vaccine,” said the study’s principal investigator, Kim D. Janda, the Ely R. Callaway, Jr. Chair in Chemistry and a member of The Skaggs Institute for Chemical Biology at Scripps Research. “It is just extremely effective. The hope is that such a protective vaccine will be an effective therapeutic option for those trying to break their addiction to heroin.”

“We saw a very robust and specific response from this heroin vaccine,” said George F. Koob, chair of the Scripps Research Committee on the Neurobiology of Addictive Disorders and a co-author of the new study. “I think a humanized version could be of real help to those who need and want it.”

“Heroin is lipophilic and is rapidly degraded to 6-acetylmorphine (6AM),” said G. Neil Stowe, a research associate in Janda’s laboratory who is first author of the new study. “Both readily cross the blood-brain barrier and gain access to the opioid receptors in the brain.”

The researchers linked a heroin-like hapten (a small molecule that elicits an immune response) to a generic carrier protein called keyhole limpet hemocyanin or KLH, and mixed it with Alum, an adjuvant (vaccine additive), to create a vaccine “cocktail.” This mixture slowly degraded in the body, exposing the immune system to different psychoactive metabolites of heroin such as 6AM and morphine.

“Critically, the vaccine produces antibodies to a constantly changing drug target,” said Stowe. “Such an approach has never before been engaged with drug-of-abuse vaccines.”

The results showed that the rats rapidly generated robust polyclonal antibodies in response to the dynamic heroin vaccine.

In addition, the study found that addicted rats were less likely to “self-administer” heroin by pressing on a lever after several booster shots of the vaccine. Only three of the seven rats that received the heroin vaccine self-administered heroin. In contrast, all of the control rats, including those given the morphine vaccine, self-administered the drug.

The team also found that the heroin vaccine was highly specific, meaning that it only produced an antibody response to heroin and 6AM, and not to the other opioid-related drugs tested, such as oxycodone as well as drugs used for opioid dependence—methadone, naltrexone, and naloxone. “The importance of this,” said Janda, “is that it indicates these vaccines could be used in combination with other heroin rehabilitation therapies.”

Researchers believe they may be a step closer to HIV vaccine

Wednesday, July 20th, 2011 (last updated)

Researchers are hoping they are one step closer to a HIV vaccine – using HIV. At the 6th International AIDS Society Conference on HIV Pathogens, Treatment, and Prevention in Rome, researchers with the Maryland-based VirxSys Corporation announced the findings of their VRX1273 vaccine.

The vaccine is a genetically altered version of SIV, the version of HIV found in non-human primates. Over the course of six months, five infected monkeys were injected with the vaccine three times, while five others were given a placebo vaccine. After 18 months, it was found that 40% of the vaccinated monkeys had very low to undetectable amounts of virus in their bodies.

“We are well on the path to a functional cure, at least in monkeys,” says  Laurent Humeau, VirxSys vice president of  research and development.

“Although this pre-clinical study is modest in terms of size, it is highly unusual to see near non-detectable levels of the virus not only circulating in the blood, but also in the reservoirs where HIV is known to replicate,” said Joep Lange, M.D., Ph.D., professor of medicine at the Academic Medical Center, University of Amsterdam, and head of the Amsterdam Institute of Global Health and Development.

In the monkeys, the vaccine’s effect was sustained two years after the initial vaccination, without the need for any booster shots.

Other researchers have created similar type therapeutic vaccines. In May, Dr. Louis Picker of the Oregon Health and Science University’s Vaccine and Gene Therapy Institute announced a vaccine successful in preventing monkeys from acquiring SIV. Like the VirxSys vaccine, this was a genetically altered virus. In this case, the altered virus was  CMV, from the herpes family.

But making the leap from monkeys to humans is a big step. Therapeutic vaccines “have looked really good in monkeys – but monkeys are not people and SIV is not HIV,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease. “Really good concepts in primates have been duds in people.”

Unlike many antiretroviral drugs on the market,  a therapeutic vaccine such as VRX1273 has the potential to be  a  cost effective way of dealing with HIV. Unlike drugs that are taken for the entire course of a patient’s  lifetime, this vaccine has the potential to administered just several times, possibly only once, over the course of a patient’s life.

Humeau believes that he and his team are headed in the right direction and hope to start clinical trials in humans as soon as 18 months with approval from the U.S.  Food and Drug Administration.

The world is not on track to wipe out polio by 2012

Wednesday, July 20th, 2011 (last updated)

The report of the 30 June-1 July meeting of the Independent Monitoring Board (IMB) affirms that polio eradication can be achieved in the near-term, but that ‘this will not happen if things continue as they are.’

In particular, the IMB expresses concern at the situations in DR Congo, Chad and Angola, and the continuing increase in cases in Pakistan.

The IMB underscores ‘7 important positive signs’ which – if achieved by end 2011 – would affirm that the programme is back on track to interrupt all polio transmission by end-2012:

  1. no recurrence of cases in India  by end-2011;
  2. interruption of transmission in Kano and the surrounding north-west areas of Nigeria by end-2011;
  3. interruption of type 3 poliovirus globally by end-2011;
  4. a major expansion in capacity and expertise in Chad and DR Congo, with independent monitoring, surveillance data and case numbers clearly reflecting;
  5. the impact of this expansion by end-October 2011;
  6. a clear decline in the number of cases in Pakistan in the second half of 2011, compared to the equivalent period in 2010, with particular evidence that the National Emergency Action Plan is working in Sindh province;
  7. no more ‘surprises’ with re-emergence of the disease in polio-free countries; and, a decline in field reports suggesting poor or variable quality of vaccination campaigns and surveillance, and/or inadequate local leadership.

The IMB also expresses serious concern at the ongoing global funding gap, calling it ‘deadly serious’, and highlighting that – although the GPEI has long standing support from a core group of partners – it is neither right nor sustainable that the burden of financing should rest disproportionately on a narrow funding base. The Board concludes that there are a number of richer countries that have called for polio eradication, but have barely supported it financially.

The GPEI welcomes the findings and recommendations of the IMB. The heads of the spearheading partner agencies – the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF – and the Bill & Melinda Gates Foundation, will over the coming weeks discuss the report and its implications, and commit to specific actions to further support countries’ eradication efforts.

The IMB was established in 2010 at the request of the Executive Board of WHO and the World Health Assembly, to monitor progress against the milestones of the GPEI Strategic Plan 2010-2012.

Why are internet anti-vaccine messages dangerous

Tuesday, July 19th, 2011 (last updated)

Evidence has long shown routine vaccines to be safe and effective, but a growing community of critics still claims that they pose more danger than the diseases they prevent. A Google search of “vaccine,” for example, produces links to government and science-based vaccine websites on the same screen as official-sounding anti-vaccination links.

Given the success of vaccines in preventing a long list of diseases, why is opposition to vaccination gaining hold? Decision-making expert Valerie Reyna contends that it’s because anti-vaccination messages tell a compelling story compared to official sources, and they meet people’s need to understand rare adverse outcomes.

“In the era of Web 2.0, the contagion of ideas, transmitted rapidly through social media, is as concerning as the contagion of diseases because of their power to reduce vaccination rates, leaving populations vulnerable to preventable death and disability,” said Reyna, professor of human development in the College of Human Ecology and a co-director of the Center for Behavioral Economics and Decision Research.

This spring, the Centers for Disease Control reported that the United States is experiencing the highest number of measles cases in more than a decade. According to the alert, measles was declared eliminated in the United States in 2000 due to a high vaccination rate. This could change should vaccination rates decline.

Reyna presented her model of vaccine decisions at the University of Erfurt, Germany, in May to an international meeting of scientists examining the implications of the Internet and social media such as Twitter on public health messages about vaccination.

Being informed about vaccines involves more than having the facts. According Reyna’s research, people primarily rely on the meaning or “gist” of a situation rather than details to make judgments and decisions.

“Gist is simple, but not simple-minded,” Reyna said. “It involves connecting the dots — building on background knowledge, life experience and values. When people lack background knowledge, they tend to rely on anecdotes, personal experience and the little information that is widely available.”

Since most people don’t understand how vaccines work, the Internet, which facilitates users across the globe to sharing personal experiences and ideas about health care, fills the vacuum.

According to Reyna, anti-vaccination messages are expected when people don’t understand how vaccination works and when adverse events that are difficult to explain appear to be connected. Autism, for example, is diagnosed in children during the same time period that children receive a battery of vaccinations. Despite research to the contrary, anti-vaccination messages have claimed vaccines are to blame. Official sites, on the other hand, tend not to provide a convincing narrative story line that helps people connect the dots.

Under these circumstances, how do people approach the decision to vaccinate? In Reyna’s model, the decision to get a flu shot, for example, could be a seen as a decision between feeling OK (by not getting the vaccine) or taking a chance on not feeling OK (due to a vaccine side effect). Without better information, most people would choose not to get a vaccine.

“Public health messages need to be designed so that the correct ‘gist’ pops out,” Reyna said, “because the drive to extract meaning, combined with widespread lack of background knowledge about how vaccination works, is fertile ground for misleading explanations to take root.”

Why the CIA’s vaccine trick is a setback for global health

Monday, July 18th, 2011 (last updated)

Guardian broke the news that in the run-up to the raid on Osama bin Laden’s compound, the CIA used a vaccination campaign as a ruse to get DNA evidence from the al-Qaeda leader’s kids.  With help from a Pakistani doctor, Shakil Afridi, they set up clinics in two neighborhoods, delivering doses of the Hepatitis B vaccine to local children. The revelation drew a quick and angry response from health experts. Medecins Sans Frontieres called the operation “a dangerous abuse of medical care.”  In the Washington Post, Orin Levine and Laurie Garrett warned that the CIA’s “reckless tactics could have catastrophic consequences.”

Emily Rauhala (writer-reporter at TIME) gives us three reasons why this is bad news for public health:

1. Broken Trust

When people don’t trust medical personnel, they’re less likely to participate in legitimate public health campaigns. Eight years ago, rumors spread that an anti-polio campaign in Nigeria was an American plot to sterilize Muslim girls, causing many families to refuse the vaccine. The subsequent outbreak spread to eight countries. In Pakistan, the CIA’s operation may hurt efforts to eradicate polio, argue Levine and Garrett:

Many Pakistani communities suffer from preventable infections, including ones that have been brought under control or eradicated elsewhere. Pakistan is the last place on Earth where wild polio still spreads in local outbreaks. Only a handful of places elsewhere in the world have sporadic cases, and vaccine campaigns are vigorous in those areas. But if the Rotary Club, the Bill and Melinda Gates Foundation, governments and others working to eradicate polio realize their aspirations, Pakistan is where victory will be pronounced.

Complicating matters is the fact that Pakistan recently dissolved its Ministry of Health, which has left international programs to negotiate directly with local leaders. Many such leaders may be inclined to distrust doctors or to believe that vaccination programs are CIA ploys designed to hurt their communities.

2. Compromised Security

The CIA’s vaccine ruse bolsters the belief that humanitarian workers are government agents, which may heighten the risk of violence against them. Chris Albon a Ph.D. candidate and the founder of conflicthealth.com, reports that there is a recent history of violence attacks on humanitarian workers in Pakistan and Afghanistan. In 2007, a doctor who spoke out against anti-vaccine propaganda was killed in Bajaur agency. The same year, he notes, Taliban fighters kidnapped a public health worker and held him captive until he promised to stop vaccinating children.  Last August, Taliban gunmen captured and killed ten aid workers in Afghanistan, claiming they were spies. Such incidents keep health workers out of high-need conflict zones, often the very areas that are in need of care.

3. Conspiracy Theories, Galore

Humanitarian organizations have spent years trying to convince people that international aid workers are not, in fact, spies, or agents of doom. In Abbottabad and elsewhere, that’s going to be an increasingly tough sell.