News Scan for Aug 30, 2016

News brief

AAP: No non-medical vaccine exemptions

For the first time in its history, the American Academy of Pediatrics (AAP) issued a policy paper recommending against all non-medical vaccine expeditions for school-age children. While medical exemptions are still valid, the AAP is asking states to eliminate non-medical exemptions—including for religious or personal beliefs.

The AAP, writing in Pediatrics yesterday, said that allowing non-medical vaccinations threatens "herd" immunity, or the 90% to 95% vaccine coverage needed to protect a population against outbreaks of infectious disease. Although most public school districts require proof of immunization before enrollment, there are also laws that allow for non-medical immunization exemptions.

"States that offer personal-belief exemptions have had steady increases in the number of exemptions over time. Religious exemptions have increased for states that do not offer personal-belief/philosophical exemptions but have, through regulatory language, broadly defined religion for the purposes of obtaining vaccine exemption,” the AAP explained in the paper. "The ease of requirements to obtain nonmedical exemptions, especially those of personal belief, can have a significant impact on the rate of exemptions and immunizations."

Often, the AAP said, like-minded people who eschew vaccination for personal-belief or philosophical reasons live near each other, creating "cluster" communities of unvaccinated children that can threaten public health. Requiring immunization upon school entry is a good way to mitigate the risk of infectious disease outbreaks, the AAP said.
Aug 29 Pediatrics policy statement
Aug 29 AAP News story

AAP releases meningitis B vaccine recommendations

The AAP yesterday unveiled its recommendations for serogroup B meningococcal vaccine in people age 10 and older, which are in line with those that have been made by the Advisory Committee on Immunization Practices (ACIP), an expert group that advises the US Centers for Disease Control and Prevention (CDC).

The AAP published its policy statement from its committee on infectious diseases in Pediatrics. The recommendations pertain to two newly licensed vaccines approved for those ages 10 through 25 years old: Trumenba, made by a subsidiary of Pfizer, and Bexsero, produced by Novartis. Trumenba is given as a two- or three-dose series, and Bexsoso is approved only for the two-dose series.

The AAP recommends either vaccine for those at increased risk for meningococcal serogroup B disease, such as those with certain underlying health conditions or people in outbreak settings. It also said that, based on the latest epidemiology and persistence data, the vaccine can be given to healthy adolescents and young adults ages 16 through 23—though the preferred age is 16 through 18—for short-term protection against most serogroup B strains.

The protein antigens used for each vaccine vary, so the AAP emphasized that neither vaccine protects against all serogroup B strains. It added that all doses in the series be of the same vaccine.
Aug 29 Pediatrics report
Aug 29 AAP News story
Aug 29 AAP News Q and A

UN experts warn antibiotic resistance will put mothers, infants at risk

Every year, more than 30,000 women and 400,000 newborns die from infections that occur shortly after a woman has given birth. And those numbers will likely grow as rising drug resistance renders antibiotics less effective.

That's the central message in a commentary yesterday by Anthony Costello, MD, World Health Organization (WHO) director of maternal, newborn, child, and adolescent health, and Stefan S. Peterson, MD, PhD, MPH, UNICEF chief of health. The global health experts write that overuse of antibiotics in humans, along with "needless use" in animals, has created a "recipe for disaster" by accelerating the process in which exposed microbes build resistance.

Antibiotic resistance, they say, will have a major impact on newborns, who lack fully developed immune systems and are therefore more susceptible to infections they might pick up from their mother or from the hospital. Even more at risk will be children born in low-income countries, where healthcare facilities often lack basic sanitary conditions and lifesaving antibiotics are scarce.

"More children in Africa die from a lack of access to antibiotics than from antibiotic-resistant infections," Costello and Peterson write. "Indeed, many still die from infections, such as bacterial pneumonia, that should be easily treatable."

To solve this problem of "access and excess" and save the lives of infants and mothers, Costello and Peterson write, healthcare providers need to begin by stopping the spread of infection and negating the need for antibiotics. This means that all healthcare facilities must have running water and basic sanitation, and that staff must follow good hygiene practices. They also recommend implementing policies to discharge mothers and newborns from the hospital sooner, in order to reduce exposure to infectious microbes.

And lastly, healthcare providers should use antibiotics only when they can confirm that they are absolutely needed. "Simply put, those who need lifesaving antibiotics must get them, and those who do not must not," they write.
Aug 29 WHO commentary

Ebola Scan for Aug 30, 2016

News brief

Convalescent serum fails to protect monkeys from Ebola virus

Blood serum from rhesus monkeys that had survived Ebola virus (EBOV) infection offered little protection to other rhesus monkeys that were treated with the serum several days after exposure to the virus, according to an Aug 28 report in the Journal of Infectious Diseases.

During West Africa's recent Ebola epidemic, the World Health Organization recommended studying the use of Ebola convalescent serum to treat Ebola patients, with the expectation that antibodies in the serum would be protective. But results from studies so far have been inconclusive.

In the study, nine monkeys were infected with Zaire Ebola virus (ZEBOV). Three days later, 4 of the monkeys were treated with serum from rhesus monkeys that had previously survived ZEBOV infection, 3 received serum from monkeys that had survived Sudan EBOV (SEBOV) disease, and 2 received no treatment. The monkeys that survived long enough received more treatments on days 6 and 9.

All 4 monkeys treated with the ZEBOV convalescent serum died on days 8 and 9, and 2 of the 3 monkeys that received SEBOV serum died on days 7 and 9. The 2 control animals succumbed on day 9.

To further assess the effects of the SEBOV convalescent serum, the researchers did a follow-up study in which three more monkeys were exposed to ZEBOV and then treated with the serum. All the animals died on days 7 and 9 after exposure, which suggests that the survivor in the initial study may not have been protected by the product, the authors said.

They commented that all the monkeys had EBOV in their blood at the time of treatment, which sets a "high bar" for any candidate treatment to clear.

"We conclude that convalescent sera treatment initiated in [monkeys] at the onset of viremia is not an effective therapeutic, particularly when compared to the recent successes of the small interfering RNA and ZMapp therapeutics at advanced stages of disease," the authors concluded.
Aug 28 J Infect Dis abstract
Jan 6 CIDRAP News story on trial of convalescent plasma in Guinea

Report describes simple method for inactivating Ebola in human samples

Researchers reported this week that a protocol involving a little detergent and mild heat can be used in the field to inactivate EBOV in human serum samples while preserving their diagnostic value, thus protecting healthcare workers who handle them.

Writing in the Journal of Infectious Diseases, the authors said the deactivation method consists of treating samples with a 0.5% solution of Tween-20 and heating them to 56°C (133°F) for 1 hour. When this method was used in lab conditions on samples spiked with high levels of EBOV, no surviving virus was found in the samples.

When the protocol was used on 240 samples during Sierra Leone's recent Ebola epidemic, 120 samples tested positive for immunoglobulin G (IgG) and/or IgM antibodies to EBOV. "This demonstrates that the inactivation protocol allows for the safe detection of seropositive samples," the authors wrote.

"Use of this simple inactivation procedure will help strengthen the safety measures in the ﬁeld or in a healthcare setting and conﬁdence of healthcare workers who are performing these diagnostic assays," the researchers said.
Aug 28 J Infect Dis abstract