How Well Did California’s Interventions to Improve Vaccination Rates Work?

MedicalResearch.com Interview with:
Ms. Cassandra Pingali

Ms. Pingali worked on this paper while a a graduate student at Emory University, and completed it post-graduation.
She is currently an ORISE fellow at Centers for Disease Control and Prevention
Immunization Services Division

MedicalResearch.com: What is the background for this study?

Response: Despite high overall immunization coverage in the United States, we are currently experiencing the largest measles outbreak since measles was declared eliminated in 2000. In 2014, California grappled with a very large measles outbreak known as the “Disneyland” outbreak. Later investigation revealed that most of the affected children were unvaccinated against measles despite the availability of a safe and effective vaccine.

In order to prevent future outbreaks, California officials wanted to improve their declining childhood vaccination coverage. California passed two laws and implemented an educational program for school staff to increase vaccination rates in the state. We felt it was important to take a systematic look at these interventions and examine if public health initiatives such as these are working to improve vaccination rates.

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Does the HPV Vaccine Come With a Moral Hazard?

MedicalResearch.com Interview with:
“Syringe and Vaccine” by NIAID is licensed under CC BY 2.0
Ali Moghtaderi PhD MBA
Assistant Research Professor and
Avi Dor PhD
Professor of Health Policy and Economics
Milken Institute School of Public Health
George Washington University

MedicalResearch.com: What is the background for this study?

Response: In this study, we investigate the effect of Human Papillomavirus (HPV) vaccination on participation in Pap test, which is one of the most effective cancer screening interventions. Cervical cancers are causally linked to HPV infections. The Pap test is a diagnostic procedure for early detection of cervical cancer. HPV vaccination provides partial protection against cervical cancer, and the Pap test is strongly recommended for women 21 to 65 years of age even after vaccination. If vaccination leads to a reduction in testing participation, it could contribute to greater incidence and severity of cervical cancer. Note that we focus on relatively older women (age 22 or older) who were not vaccinated at younger ages.  Continue reading

Measles Vaccine in Early Childhood Associated with Long Term Health and Cognitive Benefits

MedicalResearch.com Interview with:

Arindam Nandi  PhD Center for Disease Dynamics, Economics & Policy

Dr. Nandi

Arindam Nandi  PhD
Center for Disease Dynamics, Economics & Policy 

MedicalResearch.com: What is the background for this study?  

Response: The motivation for this study comes from a small but growing body of evidence on the potential long-term benefits of vaccines. The recent resurgence of measles outbreaks in several countries which had previously eliminated the virus makes our study additionally relevant. There have been over 1,000 measles cases reported across 28 states in the US so far in 2019, which is the largest number of cases the country has seen in almost 3 decades. Similarly high number of cases have been reported in several European countries in recent years. This study reiterates the importance of vaccination and proves the long-term benefits of the measles vaccine in low- and middle-income countries, which account for a large proportion of global measles cases.

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Antibody Points Way Toward Norovirus Vaccine

MedicalResearch.com Interview with:

CDC Image Based on electron microscopic (EM) imagery, this three-dimensional (3D) illustration provides a graphical representation of a single norovirus virion, set against a white background. Though subtle, the different colors represent different regions of the organism’s outer protein shell, or capsid. Illustrator: Alissa Eckert, MS

CDC Image
Based on electron microscopic (EM) imagery, this three-dimensional (3D) illustration provides a graphical representation of a single norovirus virion, set against a white background. Though subtle, the different colors represent different regions of the organism’s outer protein shell, or capsid. Illustrator: Alissa Eckert, MS

Lisa Lindesmith, MS
Research specialist
Ralph S. Baric, PhD
Professor, Departments of Epidemiology, Microbiology and Immunology
Lineberger Comprehensive Cancer Center
Gillings School of Global Public Health
University of North Carolina

MedicalResearch.com: What is the background for this study? Would you briefly explain the types of outbreaks caused by Norovirus infections?

Response: Noroviruses cause about 20% of endemic and 50% of food-borne acute gastroenteritis, infecting all age groups, globally.  While may different strains of norovirus cause outbreaks primarily in community settings, since the mid-1990’s the GII.4 strains of norovirus have caused waves of pandemic disease every 2-7 years.  These pandemics are associated with emergence of a GII.4 strain that has changed key viral domains rendering the virus less susceptible to recognition by and protection from a person’s immune system.  For a vaccine to be efficacious against pandemic GII.4 strains, it must be able to train the immune system to focus on the part of the GII.4 virus that does not change over time.

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Mandates Improve With Influenza Vaccination Rates of Hospital Personnel

Megan C. Lindley, MPHDeputy Associate Director for ScienceImmunization Services DivisionCDC

Megan C. Lindley

MedicalResearch.com Interview with:
Megan C. Lindley, MPH

Deputy Associate Director for Science
Immunization Services Division
CDC

MedicalResearch.com: What is the background for this study?

Response: Despite longstanding recommendations from the Advisory Committee on Immunization Practices, healthcare personnel influenza vaccination coverage remains below the Healthy People 2020 target of 90%. Healthcare employers use a variety of strategies to promote influenza vaccination among healthcare personnel, including facility-level mandates for vaccination. Several U.S. states have also enacted laws related to healthcare personnel influenza vaccination, but the effect of these laws on vaccination uptake is unclear.

Our study used influenza vaccination coverage data reported by over 4,000 U.S. hospitals to examine three kinds of laws:
(1) Assessment laws, which require hospitals to assess healthcare personnel influenza vaccination status;
(2) Offer laws, which require hospitals to offer the influenza vaccine to healthcare personnel; and
(3) Ensure laws, which require hospitals to require healthcare personnel to demonstrate proof of influenza vaccination. Continue reading

Lack of HPV Vaccination in Young Minority Men Is Not a Matter of Access

MedicalResearch.com Interview with:
Perry N Halkitis, PhD, MS, MPH
Dean and Professor
Department of Urban-Global Public Health
Rutgers Public Health 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The rate of human papillomavirus (HPV) infection is high among young minority gay, bisexual, and other men who have sex with men despite the availability of a vaccine that can prevent the infection, a Rutgers School of Public Health study found.

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Massive Reduction in Cervical Cancer Among Vaccinated Young Women

MedicalResearch.com Interview with:

Dr. Tim PalmerHonorary Senior LecturerDepartment of PathologyUniversity of EdinburghEdinburgh, UK

Dr. Palmer

Dr. Tim Palmer
Honorary Senior Lecturer
Department of Pathology
University of Edinburgh
Edinburgh, UK 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: High risk HPV infection is the obligate cause of between 70 and 90% of cervical cancers, depending upon the country. The development of vaccines against the commonest hr-HPV types has the potential to reduce the burden of cervical cancer, especially in low and middle income countries that cannot afford screening programmes. Cervical cancer affects predominantly women in their 30s and is a major public health issue even in countries with well-established screening programmes. Scotland has had a successful immunisation programme since 2008, and women immunised at age 12 to13 have been screened since 2015. We can therefore demonstrate the effect of hr-HPV immunisation on the pre-invasive stages of cervical cancer.

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Therapeutic HPV Vaccine Can Trigger Resolution of Virus and Cervical Cancer in Some CIN Patients

MedicalResearch.com Interview with:

Diane Harper, M.D., M.P.H., M.S.Professor of Family Medicine and Obstetrics and GynecologySenior Associate Director, Michigan Institute for Clinical and Health ResearchPhysician Director for Community Outreach, Engagement and Health Disparities,Rogel Cancer CenterMichigan Medicine

Dr. Harper

Diane Harper, M.D., M.P.H., M.S.
Professor of Family Medicine and Obstetrics and Gynecology
Senior Associate Director, Michigan Institute for Clinical and Health Research
Physician Director for Community Outreach, Engagement and Health Disparities,
Rogel Cancer Center
Michigan Medicine 

MedicalResearch.com: What is the background for this study?

Response: There is no current cure for women with HPV infection that has progressed to CIN 2/3 disease. The only treatment is for the diseased cervix, and does not eliminate the risk of another CIN 2/3 from the HPV infection 15-20 years later.

This vaccine is made from a live virus that has 3 genes inserted:  human cytokine IL-2, and modified forms of HPV 16 E6 and E7 proteins. When the vaccine is injected subcutaneously, the proteins for HPV 16/E6 and E7 and the cytokine LI-2 proteins are made. These proteins trigger the immune response.  This is very different form imiquimod which is topical and not specific for HPV.

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HPV Vaccination Rates Low Among Adults at High-Risk for HIV Infection

MedicalResearch.com Interview with:

Lisa T. Wigfall, PhD, MCHES(R)Assistant Professor, Health and KinesiologyTexas A&M

Dr. Wigfall

Lisa T. Wigfall, PhD, MCHES(R)
Assistant Professor, Health and Kinesiology
Texas A&M

MedicalResearch.com: What is the background for this study?

Response: Human papilloma virus (or HPV) is a very common sexually transmitted infection that can cause some types of cancer. These include anal, cervical, oral, penile, vaginal, and vulvar cancers. Some people such as people who are HIV-positive and men who have sex with men have a greater risk for developing HPV-associated cancers. The risk of developing anal cancer is significantly higher for men who have sex with men who are also HIV-positive.

Our study included adults who were at risk for becoming HIV-positive, which included having unprotected anal sex.

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Anti-Vaccine Groups Are Not Just Worried About Autism

MedicalResearch.com Interview with:

Beth Hoffman, B.Sc., graduate studentUniversity of Pittsburgh Graduate School of Public HealthResearch Assistant,University of Pittsburgh Center for Research on Media, Technology and Health

Beth Hoffman

Beth Hoffman, B.Sc., graduate student
University of Pittsburgh Graduate School of Public Health
Research Assistant,
University of Pittsburgh Center for Research on Media, Technology and Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Vaccine refusal is a public health crisis – low vaccination rates are leading to outbreaks of deadly vaccine-preventable diseases. In 2017, Kids Plus Pediatrics, a Pittsburgh-based pediatric practice, posted a video on its Facebook pagef eaturing its practitioners encouraging HPV vaccination to prevent cancer. Nearly a month after the video posted, it caught the attention of multiple anti-vaccination groups and, in an eight-day period, garnered thousands of anti-vaccination comments.

Our team analyzed the profiles of a randomly selected sample of 197 commenters in the hopes that this crisis may be stemmed if we can better understand and communicate with vaccine-hesitant parents.

We determined that, although Kids Plus Pediatrics is an independent practice caring for patients in the Pittsburgh region, the commenters in the sample were spread across 36 states and eight countries.

By delving into the messages that each commenter had publicly posted in the previous two years, we also found that they clustered into four distinct subgroups:

  • “trust,” which emphasized suspicion of the scientific community and concerns about personal liberty;
  • “alternatives,” which focused on chemicals in vaccines and the use of homeopathic remedies instead of vaccination;
  • “safety,” which focused on perceived risks and concerns about vaccination being immoral; and
  • “conspiracy,” which suggested that the government and other entities hide information that this subgroup believes to be facts, including that the polio virus does not exist. 

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Chikungunya Vaccine Candidate: Valneva Reports Positive Phase 1 Interim Results

MedicalResearch.com Interview with:
ValnevaThomas Lingelbach
President & CEO of Valneva

MedicalResearch.com: What is the background for this study? Would you briefly explain the significance of Chikungunya disease?

Response: Chikungunya is a mosquito-borne viral disease caused by the Chikungunya virus (CHIKV), a Togaviridae virus, transmitted by Aedes mosquitoes. The chikungunya virus causes clinical illness in 72-92% of infected humans around four to seven days after an infected mosquito bite. People infected with chikungunya may suffer from acute onset of fever, debilitating joint and muscle pain, headache, nausea and rash, potentially developing into long-term, serious health impairments such as visual, neurological, heart and gastrointestinal manifestations that in some extreme cases can lead to fatalities.

This photograph depicts a female Aedes albopictus mosquito as she was feeding on a human host. You can see the red, needle-like proboscis that had penetrated the skin, and was filled with the host’s blood, which had filled her abdomen. Ae. albopictus is known to be a vector for a number of arboviral diseases, including yellow fever, dengue fever, and Chikungunya fever. CDC/ James Gathany

This photograph depicts a female Aedes albopictus mosquito as she was feeding on a human host. You can see the red, needle-like proboscis that had penetrated the skin, and was filled with the host’s blood, which had filled her abdomen. Ae. albopictus is known to be a vector for a number of arboviral diseases, including yellow fever, dengue fever, and Chikungunya fever.
CDC/ James Gathany

Chikungunya outbreaks have been reported in Asia, Africa, the Americas and Europe. As of 2017, there have been more than one million reported cases in the Americas. The medical burden is expected to grow as the CHIKV primary mosquito vectors continue to further spread geographically.

Currently there are no preventive vaccines against Chikungunya making it a major threat to public health.

We set out to develop VLA1553, a live-attenuated vaccine candidate, as a potential solution to the growing unmet need chikungunya poses. Our hope is that having a preventative vaccine for chikungunya will allow people living in endemic areas to have peace of mind while enjoying the outdoors.

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Type 1 Diabetes Cases Drop After Rotavirus Vaccine Introduced

MedicalResearch.com Interview with:

Dr Kirsten Perrett MBBS FRACP PhD Team Leader / Clinician-Scientist Fellow, Population Allergy, Murdoch Children's Research Institute Consultant Paediatrician, Department of Allergy and Immunology and General Medicine The Royal Children's Hospital Fellow, School of Population and Global Health, The University of Melbourne Murdoch Children's Research Institute Parkville, Victoria  Australia

Dr. Kirsten Perrett

Dr Kirsten Perrett MBBS FRACP PhD
Team Leader / Clinician-Scientist Fellow, Population Allergy, Murdoch Children’s Research Institute
Consultant Paediatrician, Department of Allergy and Immunology and General Medicine
The Royal Children’s Hospital
Fellow, School of Population and Global Health
The University of Melbourne
Parkville, Victoria  Australia

MedicalResearch.com: What is the background for this study?

Response: Before rotavirus vaccines were available, rotavirus infection was the most common cause of severe gastroenteritis in infants and young children. Because it is so contagious, infection in childhood is thought to be universal in unvaccinated children.

Previous studies indicated that rotavirus infection of infants might be an environmental promoter of type 1 diabetes. Therefore, we anticipated that the introduction of the rotavirus vaccine might alter the disease incidence in young children. 

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College Students at Increased Risk of Meningitis

MedicalResearch.com Interview with:

Sarah Anne Mbaeyi MD MPH Division of Bacterial Diseases CDC 

Dr. Mbaeyi

Sarah Anne Mbaeyi MD MPH
Division of Bacterial Diseases
CDC 

MedicalResearch.com: What is the background for this study?

Response: College freshman living in residence halls, though not college students overall, have previously been identified as being at increased risk for meningococcal disease. However, these evaluations were conducted in the 1990s when rates of disease were higher, serogroup C was the predominant cause of disease, and before the availability of quadrivalent meningococcal conjugate (MenACWY) or serogroup B meningococcal (MenB) vaccines.

MenACWY vaccine is routinely recommended for all adolescents at age 11 years and 16 years, as well as unvaccinated or undervaccinated college freshmen living in residence halls. MenB vaccine is not routinely recommended for all adolescents or college students, but may be administered to persons aged 16-23 years, with the preferred age of 16-18 years, based on clinical decision-making. Meningococcal vaccines are also recommended during an outbreak, and in recent years MenB vaccines have been used during multiple outbreaks on college campuses.

In this evaluation, we aimed to describe the current epidemiology of meningococcal disease among college-aged young adults in the United States.

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Vaccine Preventable Infections Common After Pediatric Organ Transplantation

MedicalResearch.com Interview with:

Amy G. Feldman, MD, MSCS Assistant Professor, Pediatrics-Gastroenterology, Hepatology and Nutrition Program Director, Liver Transplant Fellowship Children's Hospital Colorado  University of Colorado Medicine

Dr. Feldman

Amy G. Feldman, MD, MSCS
Assistant Professor, Pediatrics-Gastroenterology, Hepatology and Nutrition
Program Director, Liver Transplant Fellowship
Children’s Hospital Colorado
University of Colorado Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pediatric solid organ transplant recipients are at increased risk for vaccine preventable infections due to life-long immunosuppressive medications.  The objectives of this study were to 1) evaluate in pediatric    solid organ transplant recipients the number of hospitalizations for vaccine-preventable infections in the first five years post-transplantation and 2) determine the associated morbidity, mortality and costs.

In this multicenter cohort study of 6980 children who underwent solid organ transplantation from January 1, 2004, to December 31, 2011, at a center participating in Pediatric Health Information System (PHIS), 15% of individuals had at least 1 hospitalization for a vaccine-preventable infection in the first 5 years after transplant.  Children who received transplants when they were younger than 2 years and recipients of lung, intestine, heart, and multi-visceral organs were at increased risk for hospitalization with a vaccine-preventable infection.  Transplant hospitalizations complicated by a vaccine-preventable infection were $120,498 more expensive (median cost) and were on average 39 days longer than transplant hospitalizations not complicated by vaccine-preventable infections Continue reading

All Travelers to Pakistan At Risk of Getting Drug Resistant Typhoid Fever

MedicalResearch.com Interview with:

Kevin Chatham-Stephens, MD, MPH, FAAP CDR U.S. Public Health Service

Dr. Chatham-Stephens

Kevin Chatham-Stephens, MD, MPH, FAAP
CDR U.S. Public Health Service

MedicalResearch.com: What is the background for this study?

Response: Typhoid fever is a life-threatening disease caused by Salmonella Typhi bacteria. It spreads when someone consumes food or water that has been contaminated with feces (poop) from someone carrying the bacteria. About 12–27 million cases of typhoid fever occur worldwide every year.

About 350 culture-confirmed cases of typhoid fever in the United States are reported to CDC each year. Most of these cases occur among international travelers.

Symptoms of typhoid fever often include high fever, weakness, stomach pain, cough, and loss of appetite. Some people have diarrhea or constipation. Typhoid fever can be prevented through vaccination and safe food and water practices. Typhoid fever is treated with antibiotics, although most infections diagnosed in the United States cannot be successfully treated with the class of antibiotics called fluoroquinolones.

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Mother’s Milk and Microbiome Affect Babies’ Reaction to Diarrhea Disease from Rotavirus

MedicalResearch.com Interview with:

3D graphical representation of a number of Rotavirus virions: CDC image

3D graphical representation of a number of Rotavirus virions: CDC image

Sasirekha Ramani, PhD
Assistant Professor
Molecular Virology and Microbiology
Baylor College of Medicine
Houston, TX

MedicalResearch.com: What is the background for this study?

Response: This work pertains to Rotavirus, a leading cause of diarrhea and vomiting in children under the age of 5 years. In this paper, we described our work with a rotavirus strain that almost exclusively causes neonatal infections. For many years, we have been trying to understand why this strain primarily infects newborns and why infection in some babies is associated with gastrointestinal symptoms while others are asymptomatic. A few years ago, we showed that this particular virus binds to developmentally-regulated glycans (sugars) in the gut as receptors. As the baby grows, these sugars get modified, and that potentially explains why infection with this virus is primarily restricted to neonates. However, we didn’t really have to answer to why there are differences in association with clinical presentations.

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CDC Identifies Most Serious Norovirus Strains

MedicalResearch.com Interview with:
"Day 19: Norovirus (stomach flu) visits our home." by Loren Kerns is licensed under CC BY 2.0Rachel M. Burke, PhD, MPH
Epidemiologist, Viral Gastroenteritis Branch
Centers for Disease Control and Prevention
Atlanta, GA 30329

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Noroviruses are the leading cause of vomiting and diarrhea from acute gastroenteritis (inflammation of the stomach or intestines) among people of all ages in the United States. Each year in the United States, norovirus illness is responsible for an estimated 19 to 21 million cases of acute gastroenteritis, and contributes to 56,000 to 71,000 hospitalizations and 570 to 800 deaths, mostly among children and the elderly.

CDC linked information from two different surveillance systems to analyze 3,747 norovirus outbreaks reported by health departments from 2009 to 2016. Our study provides a comprehensive description of norovirus outbreaks from the epidemiology and laboratory perspectives, using the National Outbreak Reporting System (NORS) and CaliciNet, respectively. 

Norovirus outbreaks caused by GII.4 strains occurred more often in healthcare settings, affected older adults, and caused more severe illness, leading to hospitalization or death.

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Why Aren’t More Teens Vaccinated Against Cancer Causing HPV?

MedicalResearch.com Interview with:

Anna Beavis, MD, MPH Assistant Professor The Kelly Gynecologic Oncology Service Department of Gynecology and Obstetrics Johns Hopkins Medicine Baltimore, MD 21287-128

Dr. Beavis

Anna Beavis, MD, MPH
Assistant Professor
The Kelly Gynecologic Oncology Service
Department of Gynecology and Obstetrics
Johns Hopkins Medicine
Baltimore, MD 21287-128

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We wanted to look at reasons parents don’t vaccinate their children against HPV, including how those reasons have changed over time from 2010-2016 and how those reasons are different between boys and girls in the most recent data from 2016. We used a nationwide dataset which is publically available from the CDC (Centers for Disease Control) – the National Immunization Survey-Teen, or NIS-Teen – which surveys parents of teens ages 13-17 years old every year to determine rates of all recommended vaccinations. In parents who report that they don’t intend to vaccinate their child against HPV , the survey asks parents why.

We found that from 2010 to 2016, the percentage of parents reporting concerns about their child not being sexually active yet went down significantly for both boys and girls. Also, in boys specifically, parents reported male gender as a less common reason for not vaccinating. For both boys and girls, we found that concerns about safety and side effects, necessity, and lack of knowledge about the vaccine were common reasons for not planning to vaccinate.  Also, 10% of parents of girls vs. 20% of parents of boys reporting never having a provider recommendation for the vaccine as their primary reason for not vaccinating.

These results may reflect the growing public understanding of the HPV vaccine as a vaccine which is best given before exposure, so before initiation of sexual activity between the ages of 11 and 12, and that it is recommended for both boys and girls. Also, over 80% of people will have an HPV infection in their lifetime, so everyone should get vaccinated regardless of anticipated sexual activity.

Additionally, providers should focus their counseling and recommendation on improving knowledge about the HPV vaccine, including its decade-long track record of safety and necessity.    Continue reading

Program Can Help Parents Manage Kids’ Pain from Vaccines

MedicalResearch.com Interview with:

Dr. Anna Taddio BScPhm PhD Professor at the Leslie Dan Faculty of Pharmacy University of Toronto and Senior Associate Scientis The Hospital for Sick Children 

Dr. Taddio

Dr. Anna Taddio BScPhm PhD
Professor at the Leslie Dan Faculty of Pharmacy
University of Toronto and Senior Associate Scientis
The Hospital for Sick Children 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In our prior research, parents have reported they are not educated about how to soothe their infants during painful procedures like vaccinations and that they want to know how they can help. Parents also reported that concerns about their infant’s pain affects their decision-making around vaccination. We therefore set out to target parents for education about how to soothe their infants.

We picked the hospital setting because almost all parents are in the hospital for some period of time following the birth of an infant and already routinely receive education about healthy baby topics. Providing information about pain management was easy to add. We found that about 1 out of 10 parents that were given this information acted on it. 

MedicalResearch.com: What should readers take away from your report?

Response: No parent wants to see their child in pain and a parents’ desire to reduce pain is supported when we provide them with evidence-based strategies to use. These strategies are easy to use, and not only decrease unnecessary infant suffering, they also help parents. Parents are less anxious about their children getting vaccinations. Attending to infant distress is also important for healthy infant development. Targeting parents at the time of birth also ensures that parents will use and advocate for better pain care for their children across different  medical settings and throughout the lifespan.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We need to find ways to reach more parents so that they can use this information to help their children. We also need to follow parents over time and teach them about the strategies that are helpful for children of different ages. Finally, we need to study how better pain management practices impacts on vaccination rates.

Citation:

Effectiveness of a hospital-based postnatal parent education intervention about pain management during infant vaccination: a randomized controlled trial Anna Taddio BScPhm PhD, Vibhuti Shah MD, Lucie Bucci MA, Noni E. MacDonald MD, Horace Wong MSc, Derek Stephens MSc

CMAJ 2018 October 22;190:E1245-52. doi: 10.1503/cmaj.180175

[last-modified]

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Vaccines Prevent Disease and Death – Why Are Some US Children Not Vaccinated?

MedicalResearch.com Interview with:
"Vacuna influenza / Flu vaccine" by El Alvi is licensed under CC BY 2.0Kathryn M. Edwards, M.D.
Sarah H. Sell and Cornelius Vanderbilt Chair in Pediatrics
Professor of Pediatrics
Vanderbilt University School of Medicine

Dr. Edwards discusses the statement from the Infectious Diseases Society of America (IDSA) regarding the Centers for Disease Control and Prevention’s new data on child vaccine rates across the United States.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: To monitor the uptake of vaccines the CDC conducts a National Immunization Survey each year.  This survey is conducted by random-digit dialing (cell phones or landlines) of parents and guardians of children 19-35 months of age.  The interviewers ask the families who provides the vaccines for their children and if these providers can be contacted to inquire about the immunizations received.  The overall response rate to the telephone survey was 26% and immunization records were provided on 54% of the children where permission was granted.  Overall 15, 333 children had their immunization records reviewed.

When comparing immunization rates for 2017 and 2016, the last two years of the study, several new findings were discovered.

First the overall coverage rate for 3 doses of polio vaccine, one dose of MMR, 3 doses of Hepatitis b, and 1 dose of chickenpox vaccine was 90%, a high rate of coverage.  Children were less likely to be up to date on the hepatitis A vaccine (70%) and rotavirus vaccine (73%). Coverage was lower for children living in rural areas when compared with urban areas and children living in rural areas had higher percentages of no vaccine receipt at all (1.9%) compared with those living in urban areas (1%).

There were more uninsured children in 2017 at 2.8% and these children had lower immunization rates.  In fact 7.1% of the children with no insurance were totally unimmunized when compared with 0.8% unimmunized in those with private insurance. Vaccine coverage varies by state and by vaccine. Continue reading

Increase In Measles in Italy Linked to Austerity Measures

MedicalResearch.com Interview with:

Measles

Veronica Toffolutti PhD
Research Fellow in Health Economics
Bocconi University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Austerity has been linked to several health damaging effects such as suicides, increase in unmet needs, disease outbreaks that affect vulnerable peoples such as malaria in Greece, HIV in Greece and Romania during the current economic crises or in the earlier economic crisis cuts in public health expenditure have been linked with diphtheria and TB.

Europe is experiencing declining vaccination rates and resurgences in measles incidence rates. Italy appears to be particularly affected reporting the second largest number, second to Romania, of infection in Europe in 2017. Starting from the point that the primary reason for the outbreak in the decline in the measles vaccination we test the hypothesis that large budget reductions in public health spending were also a contributing factor.

Using data on 20 Italian regions for the period 2000-2014 we found that each 1% reduction in the real per capita public health expenditure was associated with a decrease of 0.5 percentage points (95% CI: 0.36-0.65 percentage points) in MMR coverage, after adjusting for time and regional-specific time-trends.  Continue reading

Can the HPV Vaccine Be Used To Treat Some Skin Cancers?

MedicalResearch.com Interview with:

Jeffrey Rapaport

Dr. Rapaport

Dr. Jeffrey Rapaport MD, PA
Emeritus head of Dermatology
Teaneck’s Holy Name Hospital.

Dr. Rapaport discusess a case recently reported in JAMA: In 2016:

A 97-year-old female patient was suffering from multiple squamous cell carcinomas varying from small to incredibly large in size on both of her legs. She was injected with the HPV vaccine commonly known as Gardasil, which is also used to treat warts and oral papilloma. She was first injected in her arm, and then after a period of six weeks, the vaccine was directly injected into her tumors. It was observed that this treatment eventually killed off almost all the tumors on her legs. According to recent press coverage, she is now looking forward to celebrating her 100th birthday in fall 2018.

MedicalResearch.com: What is the background for this study?Is HPV thought be a trigger for some cutaneous squamous cell carcinomas?

Response: The link between skin cancers and HPV vaccinations has normally been investigated in patients who have received organ transplants. Due to the immune-suppressant drugs these patients must take, it is incredibly common to find cases of skin cancer in patients who have undergone transplants. The relaxed immune system, which would normally eliminate cancers caused by the HPV virus, would open the floodgates for multiple skin tumors to emerge. In this case of the 97 year old, I would assume her immune system was healthy. There is, however, growing evidence that receiving multiple vaccines for the HPV virus is necessary even in patients with healthy immune systems. So, regardless of immune health, I believe we need to expand the frequency of the HPV vaccine, even beyond the current three-tiered system for women below 26 and men below 21.

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Vaccines Against Rotavirus Gastroenteritis Decreased Infections Even in Unvaccinated Kids

MedicalResearch.com Interview with:

Chuanxi Fu, MD.PhD. Professor of Epidemiology, School of Public Health Zhejiang Chinese Medical University Associate editor, Human Vaccines & Immunotherapeutics

Dr. Chuanxi Fu

Chuanxi Fu, MD.PhD.
Professor of Epidemiology, School of Public Health
Zhejiang Chinese Medical University
Associate editor, Human Vaccines & Immunotherapeutics 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Since 2000, the Lanzhou lamb rotavirus vaccine has been exclusively licensed in China for voluntary rotavirus gastroenteritis prevention, however, the effects of the vaccination on population health, including any indirect impact to unvaccinated individuals have not been evaluated.

In the study enrolled 33 407 patients with rotavirus gastroenteritis from 2007 to 2015 seasons in southern China shows vaccination effects in which the median age at onset increased by 4 months, and onset, peak, and cessation of incidence were delayed. The incidence rate ratio among children younger than 4 years and among children ineligible for vaccination decreased as citywide vaccination coverage increased, and the adjusted odds ratio for rotavirus gastroenteritis among unvaccinated infants decreased in areas with higher vaccination coverage.  Continue reading

Kids May One Day Be Vaccinated Against Acne Toxins

MedicalResearch.com Interview with:

Eric Huang, PhD Professor, Department of Dermatology University of California, San Diego

Dr. Huang

Eric Huang, PhD
Professor, Department of Dermatology
University of California, San Diego

MedicalResearch.com: What is the background for this study? To whom would the vaccine be targeted?  Affected individuals?  Patients with strong family history? Resistant acne cases?

Response: The background for this study is to develop vaccines to replace the antibiotics which may induce resistant bacteria.

Preventive acne vaccines will be used for injection into elementary students to prevent the acne development when they become teenagers. Therapeutic acne vaccines using monoclonal antibodies will be used for those patients who already have acne vulgaris.

Both patients with strong family history and resistant acne cases are highly recommended to use when the acne vaccines are available.  

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No Premature Menopause Found in Adolescents Who Receive HPV Vaccine

MedicalResearch.com Interview with:

Allison L. Naleway, PhD Senior Investigator Associate Director, Science Programs Center for Health Research Kaiser Permanente

Dr. Naleway

Allison L. Naleway, PhD
Senior Investigator
Associate Director, Science Programs
Center for Health Research
Kaiser Permanente

MedicalResearch.com: What is the background for this study?

Response: Reports of premature menopause after human papillomavirus (HPV) vaccination have received a lot of media attention, including on social media, but these reports were based on a small number of isolated cases. Large studies have demonstrated the safety of HPV vaccination, but parental safety concerns—including potential impact on future fertility—are often cited as one reason for lower HPV coverage.

Rates of HPV vaccination have lagged behind coverage rates for other recommended adolescent vaccinations, such as tetanus-diphtheria-acellular pertussis and meningococcal conjugate. (Based on national coverage estimates from 2016, 65% of 13–17 year-old females received at least one HPV vaccination and only 49.5% were up to date with the series, compared to about 88% of adolescents who received Tdap.)

We conducted a study of nearly 200,000 young women to determine whether there was any elevated risk of primary ovarian insufficiency (POI) after HPV or other recommended vaccinations.  Continue reading

New HIV Vaccine Advances in Phase 2 Studies

MedicalResearch.com Interview with:

Dan Barouch, M.D., Ph.D. Professor of Medicine Harvard Medical School Ragon Institute of MGH, MIT, and Harvard Director, Center for Virology and Vaccine Research Beth Israel Deaconess Medical Center Boston, MA 02215

Dr. Barouch

Dan Barouch, M.D., Ph.D.
Professor of Medicine
Harvard Medical School
Ragon Institute of MGH, MIT, and Harvard
Director, Center for Virology and Vaccine Research
Beth Israel Deaconess Medical Center
Boston, MA 02215

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study demonstrates that the mosaic Ad26/Env HIV vaccine candidate induced robust and comparable immune responses in humans and monkeys.

Moreover, the vaccine provided 67% protection against viral challenge in monkeys.   

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Recombinant Polio Vaccine Improved Survival Rate Among Some With Aggressive Recurrent Brain Tumor

MedicalResearch.com Interview with:

Dr. Annick Desjardins, Assistant Professor of Medicine, photographed on October 2, 2013.

Dr. Desjardins

Annick Desjardins, M.D., F.R.C.P.C.
Associate Professor of Neurology
Associate Professor of Neurosurgery
Director of Clinical Research
The Preston Robert Tisch Brain Tumor Center at Duke
Duke University School of Medicine
Durham, NC 27710

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The poliovirus receptor (CD155) is an onco-fetal cell adhesion molecule with widespread expression in all solid tumors and particularly in primary CNS tumors (adult and pediatric).

Recombinant nonpathogenic polio–rhinovirus chimera (PVSRIPO) was generated by replacing a critical piece of the genetic information from the Sabin type 1 polio vaccine, making PVSRIPO incapable of harming or killing normal brain cells, but toxic/lethal in cancer cells. In preclinical models, it has been demonstrated that the infection of tumor cells, leads to the release of danger signals, which triggers a recruitment of dendritic/CD4/CD8 T cells and a destruction of tumor cells by anti-tumor T cells.

The manuscript reports the results of the phase 1 trial of PVSRSIPO in recurrent WHO grade IV malignant glioma patients. Adult patients with recurrence of a single glioblastoma lesion, 1-5.5cm in dimension, in a non-eloquent area of the brain, were enrolled on study. PVSRIPO is injected slowly over 6.5 hours directly into the tumor via a small catheter inserted via a small bur hole. Once intratumoral injection is completed, the catheter is removed and patients are observed for localized tumor inflammation, followed by tumor contraction. A total of 61 patients were treated on study, 9 patients in a dose escalation phase and 52 in a dose expansion phase. Side effects observed were in relation to the localized inflammation of the tumor and depending on the cerebral functions in close proximity to the tumor: headaches, visual field changes, hemiparesis, etc.

One patient experienced a brain hemorrhage at the time of catheter removal, which triggered right sided weakness and aphasia. The patient remained alive 57.5 months after PVSRIPO infusion at data cutoff of March 20th, 2018. Two on-study death were observed, a patient died from cerebral edema and seizures, which was later found to be due to tumor progression, and one patient died from the complications of an intracranial hemorrhage while receiving anticoagulation and bevacizumab.

The median overall survival among all 61 patients who received PVSRIPO was 12.5 months (95% CI, 9.9 to 15.2), comparatively to 11.3 months (95% CI, 9.8 to 12.5) in a historical control group of patients treated at Duke and who would have met eligibility on trial, would have the trial been available to them.

At 24 months, the survival plateaued in patients treated with PVSRIPO with an overall survival rate of 21% (95% CI, 11 to 33) at 24 months and 36 months in PVSRIPO treated patients, while overall survival in the historical control group continued to decline, with an overall survival rates of 14% (95% CI, 8 to 21) at 24 months and 4% (95% CI, 1 to 9) at 36 months in the historical control group.  Continue reading

TDAP Vaccine During Pregnancy Protects Infants Against Whooping Cough

MedicalResearch.com Interview with:

Sylvia Becker-Dreps, MD MPH Associate Professor, Department of Family Medicine Associate Director, Office of International Activities (Latin America Focus) Director, UNC Program in Nicaragua University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7595

Dr. Becker-Dreps

Sylvia Becker-Dreps, MD MPH
Associate Professor, Department of Family Medicine
Associate Director, Office of International Activities (Latin America Focus)
Director, UNC Program in Nicaragua
University of North Carolina at Chapel Hill
Chapel Hill, NC 27599-7595

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: Pertussis (or whooping cough) is a respiratory infection caused by bacteria. It has been becoming more common in the US over the past two decades. Infants are more likely to be hospitalized and die of the disease. They are especially vulnerable in the first months of life because they have not yet had time to complete the DTaP vaccine series themselves. (Currently, infants receive 3 doses of DTaP at 2,4, and 6 months of age.) Immunizing mothers allows the mothers to pass antibodies against pertussis through the placenta and provide passive immunity to infants early in life. In early 2013, the CDC recommended that pregnant women receive a Tdap vaccine in every pregnancy. That recommendation was based on studies of the immune response to the vaccine, not real cases of pertussis.

Our study examined clinical cases of pertussis in over 675,000 infants throughout the US. We found that in the first six months of life, infants of vaccinated mothers (those that received Tdap during pregnancy) had 75% less pertussis hospitalizations and 50% less pertussis cases overall.  Continue reading

15 Metropolitan Areas Have Large Numbers of Unvaccinated Kindergarten Students

MedicalResearch.com Interview with:
“Syringe and Vaccine” by NIAID is licensed under CC BY 2.0Melissa S Nolan, PhD, MPH
Assistant Professor of Epidemiology
Department of Epidemiology and Biostats
Arnold School of Public Health
University of South Carolina
Columbia, SC 2920

MedicalResearch.com: What is the background for this study?

Response: As the CDC says, “vaccines are one of the greatest success stories in public health”. In the US, fifteen different vaccines are currently available and recommendations are based on age group and medical indication. Estimates suggest that the US childhood vaccination program has prevented 381 million infections and avoided 855,000 deaths. Despite these astounding public health successes, a movement opposing childhood vaccinations has been growing. Medical contraindications do exist, and these children rely on others to be fully vaccinated to provide herd immunity for children that cannot get vaccinations for medical reasons. In contrast to this important vulnerable clinical population, other reasons for non-vaccination include religious and philosophical beliefs.

A major reason for philosophical belief-exemptions is based on the erroneous belief that vaccines cause autism. With philosophical-belief based non-vaccinated populations on the rise, our current study aimed to better understand why some parents seek exemptions for their children.

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FDA Fast Tracks Development of PaxVax Vaccine for Chikungunya

MedicalResearch.com Interview with:

Lisa Danzig, MD Chief Medical Office PaxVax

Dr. Danzig

Lisa Danzig, MD
Chief Medical Office
PaxVax

MedicalResearch.com: Would you briefly explain what is meant by Chikungunya infection?  Whom does it primarily affect?  How is it transmitted and what the  complications?

Response: Chikungunya is caused by the chikungunya virus (CHIKV), an arthropod-borne virus (arbovirus) spread by infected mosquitos.

Infection with chikungunya virus results in severe, often debilitating joint pain in infected patients, known as arthralgia. Symptoms can include intense discomfort in joints, such as the wrists, fingers, ankles, and feet, in the knees and in the hips or shoulders. Those affected can also frequently suffer from headaches, fever, and severe muscle pain, rashes on the torso and limbs and swelling in one or more cervical lymph nodes. Individuals who are at a higher risk for contracting chikungunya include infants, elderly and those with chronic conditions.

The virus is a small, spherical, enveloped, positive-strand RNA virus. The virus is transmitted by the Aedes aegypti and Aedes albopictus mosquito, which originated in Africa, first spreading to Asia and recently expanding to the western hemisphere.  Outbreaks are rapid and widespread.  In February 2005 a major outbreak of chikungunya occurred in the islands of the Indian Ocean after which over 1.9 million cases have been reported in India, Indonesia, Maldives, Myanmar and Thailand.

Chikungunya spread has been identified in 45 countries in the Americas alone with more than 1.7 million suspected cases reported to the Pan American Health Organization since 2015, increasing the incidence of the disease and risk to U.S. travelers. In 2016 there were approximately 60,000 cases of chikungunya across India. Beyond the Indian subcontinent, the Caribbean, Central America and South America, inhabitants and travelers visiting sub-Saharan Africa and Southeast Asia are also at risk.

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