Dr. Buttery's Public Health BLOG

From U. Rochester Medical Center In one approach taking place at Rochester and several other sites, 1,200 people are taking part in a study of the vaccine together with an adjuvant, a substance designed to enhance the response of the immune system. The vaccine will be given with alum, a vaccine additive that has been used in commercial vaccines for decades to make them more effective, in two studies involving 600 participants each. If alum is effective, researchers ultimately would be able to reduce the amount of vaccine given to each person, thus making the vaccine available to more people.
"These findings represent an important step forward in the nation’s efforts to prepare for the possible emergence of a human pandemic of H5N1 avian influenza," noted NIAID Director Anthony S. Fauci, M.D. "We are working hard to address the many challenges that remain with regard to the development of an H5N1 vaccine."

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From Rice Univsedrsity a new study on Dengue, A mosquito-born disease, which kills tens of thousands of people per year and sickens 100 million more. Known as “bone-break disease,� Dengue is characterized by excruciating pain and was “the most important mosquito-borne viral disease affecting humans� in 2005 according to the U.S. Centers for Disease Control.

The study, from bioengineers and physicists at Rice University, appears in the March 24 issue of the journal Vaccine. The study suggests that the multi-site vaccination strategy, termed polytopic vaccination, may be effective against other diseases as well, including HIV and cancer.

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In this week's issue of the Lancet is an article, Vol 357,Issue 9515:25 March 2006, Pages 966-968, on the current capability to eradicate another infectious disease, Fiariasis. If transmission can be stopped in one country, why not in all countries, if the will can be engendered.

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This book (Yale University Press ISBN 0 300 10864 8) by Paul Offit, an infectious disease physician traced the origins of today's "vaccine crisis" to an incident during the 1950s in which thousands of people received polio vaccine containing live polio virus. Offit describes the development of polio vaccine, from trials of early vaccines through to the appearance on the scene of Jonas Salk.
The vaccine was highly effective and safe. It was licensed the next day thanks to political pressure, and during the next two weeks, five companies distributed about five million doses. Thirteen days after the first doses were administered, there were reports of cases of polio in immunised children. All of these initial cases had received vaccine manufactured by one company—Cutter Laboratories (although vaccine made by Wyeth also caused some cases of polio). In the end, at least 220 000 people were infected with live polio virus in Cutter's vaccine (including 100 000 contacts of immunised children), 70 000 developed muscle weakness, 164 were severely paralysed, and 10 died.
We are used to the effectiveness and safety of current immunogens. Most of us have never been told, or read, about this incident and the subsequent lawsuits that finally lead to the 1986 Vaccine Injury Compensation Program.

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From the CDC, March 24, is a report on the low rate & number of new cases. CDC notes that TB among foreign born person is 8.7 times the rate of US born persons. While the rate is dropping the disparate rate among foreign born persons, as well as drug resistance are signifiant barriers to eliminating TB.

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However, when you go to a petting zoo where do you wash your hands? The advice is good, the practicality leaves much to be desired. Is there a role here for local health departments?

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A fascinating study reported in "Science" this week refers to the issue of introducing a 'Gall Fly' which lays eggs in flower heads of an invasive weed, reducing seeds and spread of the weed, Fine! Now the researchers find that the Deer Mouse which is a reservoir for a number of zoonsies inimical to humans has enhanced ability to live through winter by feeding on the gall fly grubs.

Posted by at 11:32 AM | Permalink | Comments (0)

From The Imperial College, London a team from Imperial College London reveals a model which predicts how different strategies for increasing access to ART might affect HIV infection rates.
"This model demonstrates that ongoing provision of prevention initiatives for stopping the spread of HIV is vital. Although ART may prove effective as part of an integrated treatment and prevention programme, including increased education and promotion of safe sex practices, it is unlikely to be effective alone.
"For a number of years, there has been significant debate about access to antiretroviral drugs, and how the high cost of these drugs has hindered many poorer countries attempts to combat HIV epidemics. While ART is undoubtedly effective at treating AIDS patients, particularly in richer countries, without public health interventions it will not prove effective in stopping the spread of HIV in poorer countries."

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Global deaths due to measles fell by 48%, from 871 000 in 1999 to an estimated 454 000 in 2004, thanks to major national immunization activities and better access to routine childhood immunization, the agencies said. These measles mortality data, calculated by WHO, are the latest available.
"Measles remains a major killer of children in the developing world, but it doesn't have to be," UNICEF Executive Director Ann M. Veneman said. "Just two doses of an inexpensive, safe, and available measles vaccine can prevent most, if not all, measles deaths."
WHO and UNICEF have concentrated measles mortality reduction activities in 47 countries that account for about 98% of global measles deaths, working primarily to improve routine immunization as well as providing treatment to children with measles and strengthening disease surveillance. Supplementary immunization activities (SIAs) have also proven to be especially effective: from 1999 to 2004, nearly 500 million children were immunized against measles.

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While we worry about AIDS we tend to forget the toll of TB and Malaria in developing countries. A news extra in the BMJ today referrences data from the Feb 28 Issue of the International Journal of Epidemiology noting that:
Between 700 000 and 900 000 children in sub-Saharan Africa aged under 5 years died of the disease in 2000, accounting for 16% to 20% of deaths in that age group, the report estimates. The authors said the results suggest that malaria mortality increased during the 1980s and 1990s, and they cited previous studies that blame the increase on growing resistance to the commonly used antimalarial drug chloroquine. Malaria is directly accountable for around 18% of deaths among children in sub-Saharan Africa

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From this month's Health Affairs (Health Affairs, 25, no. 2 (2006): 348-356) we learn that "VACCINES ARE AMONG THE MOST EFFECTIVE and cost-effective interventions to improve child survival in low- and middle-income countries. Nevertheless, millions of children fail to receive the routine traditional six vaccines against diphtheria, pertussis, and tetanus (DPT); polio; bacillus Calmette-Guérin (BCG); and measles. The World Health Organization (WHO) estimates that in 2003 there were 528,400 cases of measles, 106,135 cases of pertussis, 13,831 cases of tetanus, and 6,654 cases of diphtheria

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News of a study from the NIH that finds a Potential Marker To Identify Sickle Cell Patients at High Risk of Complications .
Researchers say the enzyme lactate dehydrogenase (LDH) appears to hold promise in patients with sickle cell disease as a marker for risk of pulmonary hypertension and other complications, including early death. Pulmonary hypertension — abnormally high blood pressure in the lungs — is common in sickle cell disease.

“Our findings suggest that patients with sickle cell disease and high LDH levels should have especially careful monitoring for pulmonary hypertension, a life-threatening complication,� says Gregory Kato, M.D., the lead author of the study. Kato is a clinician in the NIH Clinical Center Department of Critical Care Medicine and director of the Sickle Cell Vascular Disease Unit in the NHLBI Vascular Medicine Branch.

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If this research is confirmed it may be one more way to reduce ear infections in children.
These results confirm that using the H influenzae-derived protein D as a carrier protein for pneumococcal polysaccharides not only allowed protection against pneumococcal otitis, but also against acute otitis media due to non-typable H influenzae. Whether this approach would also allow improved protection against lower respiratory tract infections warrants further investigation.
Ref: The Lancet: Volume 367, Issue 9512 , 4 March 2006-10 March 2006, Pages 740-748

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The March 6 issue of Lancet-Infectious Diseases refers to the WHO Stop TB Goals and should be read by all interested in public health, as well as the WHO Stop TB strategy

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From the Proceedinhgs of the NAS this week, quoted in 'Science', is an article on the genetic study of people with TB. The study showed that specific strains of TB transmitted most effectively within genetically similar population groups, and that the effectiveness of BCG is more apparent among genetically linked populations. A fascinating study which may lead to changes in the future treatment and prevention of TB.
Ref: Proc. Natl. Acad. Sci. U.S.A. 103, 2869 (2006).

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One more report about the lack of health effects from Mobile phones and radio masts, from University of Ulster. The news media just cannot avoid preaching news & doom, despite evidence to the contrary.
Health fears about mobile phones and masts are not based on sound science, according to a scientific expert who has studied effects of radiowaves for many years.
Professor Anthony Barker, delivering a lecture at University’s Coleraine campus, said that no robust scientific basis exists for controversies over the construction and siting of base stations (masts) or for worries that handsets may give off dangerous radiation.
People should not be concerned about having masts at the end of their road, he said, speaking about ‘Mobile Phones and Health’ in the latest of the University’s Science in Society lectures.

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In a news release from Duke University today we find out that both nature and nurture -- genetic makeup and the environment experienced through life -- combine to influence health and well-being, Duke University Medical Center researchers and their colleagues have determined in four new studies. The researchers showed that people's genes play a key role in how they respond both biologically and psychologically to stress in their environment.
It is probably time that more emphasis in, and knowledge of, genetics was provided to public health policy makers.

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