Pandemic 2009 H1N1 influenza among health care workers

American Journal of Infection Control
Vol 41 | No. 7 | July 2013 | Pages 575-666
http://www.ajicjournal.org/current

Pandemic 2009 H1N1 influenza among health care workers
Renata D. Lobo, RN, MS; Maura S. Oliveira, MD, MS; Cilmara P. Garcia, MD; Helio Hehl Caiaffa Filho, MS; Anna S. Levin, MD, PhD
published online 02 January 2013. http://www.ajicjournal.org/article/S0196-6553%2812%2901240-0/abstract

Abstract
To evaluate factors associated with pandemic influenza among health care workers (HCWs), a case-case-control study was conducted with 52 confirmed cases, 120 influenza-negative cases, and 102 controls. Comorbidities (odds ratio [OR], 19.05; 95% confidence interval [95% CI]: 4.75–76.41), male sex (OR, 5.11; 95% CI: 1.80–14.46), and being a physician (OR, 8.58; 95% CI: 2.52–29.27) were independent risk factors for pandemic influenza infection among HCWs. Contact with symptomatic coworker or social contact was protective (OR, 0.11; 95% CI: 0.04–0.29). To our knowledge, this is the first study of factors associated with acquiring influenza involving HCW in nonsevere cases.

Increasing girls’ knowledge about human papillomavirus vaccination with a pre-test and a national leaflet: a quasi-experimental study

BMC Public Health
(Accessed 29 June 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
Increasing girls’ knowledge about human papillomavirus vaccination with a pre-test and a national leaflet: a quasi-experimental study
Robine Hofman, Puck AWH Schiffers, Jan Hendrik Richardus, Hein Raat, Inge MCM de Kok, Marjolein van Ballegooijen, Ida J Korfage BMC Public Health 2013, 13:611 (26 June 2013)

Abstract (provisional)
Background
Adolescent girls are at an age to be involved in the decision about HPV vaccination uptake and therefore need adequate information about the vaccination. This study assesses to what extent reading an official information leaflet about HPV contributes to girls’ knowledge levels, and to what extent an increase in knowledge is boosted by a pre-test measurement.

Methods
Participants (girls aged 11–14 years) were systematically allocated to group A that completed a pre-test measurement (12 true/false statements) or to group B that did not complete it. Subsequently, both groups read the HPV leaflet and completed the post-test measurement.

Results
The response rate was 237/287 (83%). Pre-test scores in group A (M = 3.6, SD = 1.81, p < 0.001) were lower than post-test mean knowledge scores (0–10) in group B (M = 4.6, SD = 2.05). Post-test knowledge scores in group A were higher than those in group B [6.2 (SD = 2.06) versus 4.6 (SD = 2.05), p < 0.001]. In the post-test measurement, about a third of both groups knew that vaccinations do not give 100% protection against cervical cancer and that the duration of protection is unknown.

Conclusions
Reading the information leaflet had a positive effect on knowledge, even more so when boosted by a pre-test measurement. However, knowledge on the degree and duration of protection against cervical cancer remained limited. Focusing girls’ attention on important aspects before they start reading the leaflet (e.g. by including a quiz on the first page) may serve to raise their awareness of these aspects.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Hospital-based cluster randomised controlled trial to assess effects of a multi-faceted programme on influenza vaccine coverage among hospital healthcare workers

Eurosurveillance
Volume 18, Issue 26, 27 June 2013
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Research articles
Hospital-based cluster randomised controlled trial to assess effects of a multi-faceted programme on influenza vaccine coverage among hospital healthcare workers and nosocomial influenza in the Netherlands, 2009 to 2011
by J Riphagen-Dalhuisen, JG Burgerhof, G Frijstein, AD van der Geest-Blankert, MB Danhof-Pont, HJ de Jager, AA Bos, EE Smeets, MJ de Vries, PM Gallee, E Hak

Abstract
Nosocomial influenza is a large burden in hospitals. Despite recommendations from the World Health Organization to vaccinate healthcare workers against influenza, vaccine uptake remains low in most European countries. We performed a pragmatic cluster randomised controlled trial in order to assess the effects of implementing a multi-faceted influenza immunisation programme on vaccine coverage in hospital healthcare workers (HCWs) and on in-patient morbidity. We included hospital HCWs of three intervention and three control University Medical Centers (UMCs), and 3,367 patients. An implementation programme was offered to the intervention UMCs to assess the effects on both vaccine uptake among hospital staff and patient morbidity. In 2009/10, the coverage of seasonal, the first and second dose of pandemic influenza vaccine as well as seasonal vaccine in 2010/11 was higher in intervention UMCs than control UMCs (all p<0.05). At the internal medicine departments of the intervention group with higher vaccine coverage compared to the control group, nosocomial influenza and/or pneumonia was recorded in 3.9% and 9.7% of patients of intervention and control UMCs, respectively (p=0.015). Though potential bias could not be completely ruled out, an increase in vaccine coverage was associated with decreased patient in-hospital morbidity from influenza and/or pneumonia.

Major Challenges in Providing an Effective and Timely Pandemic Vaccine for Influenza A(H7N9)

JAMA   
June 26, 2013, Vol 309, No. 24
http://jama.ama-assn.org/current.dtl

Viewpoint | ONLINE FIRST
Major Challenges in Providing an Effective and Timely Pandemic Vaccine for Influenza A(H7N9)
Michael T. Osterholm, PhD, MPH; Katie S. Ballering, PhD; Nicholas S. Kelley, PhD
JAMA. 2013;309(24):2557-2558. doi:10.1001/jama.2013.6589.
Published online May 9, 2013  http://jama.jamanetwork.com/article.aspx?articleid=1686871

Opening language (no abstract)
The emergence of avian influenza A(H7N9) virus in humans has public health authorities around the world on high alert for the potential development of a human influenza pandemic.1 As of May 8, 2013, authorities had identified 131 confirmed cases and 32 deaths among residents of 8 provinces and 2 municipalities in China.2

Three primary scenarios exist for how this A(H7N9) virus outbreak will unfold. First, the virus could disappear in the animal reservoir, ending new human cases. Second, the virus could persist in the animal reservoir, resulting in sporadic human infections. Third, the virus could, through mutation or reassortment, become readily transmissible between humans, resulting in a global pandemic…

Ukraine at risk of polio outbreak; Standardised case definitions for adverse events following immunisation

The Lancet  
Jun 29, 2013  Volume 381  Number 9885  p2223 – 2298
http://www.thelancet.com/journals/lancet/issue/current

World report
Ukraine at risk of polio outbreak
Ed Holt
Preview |
A combination of public mistrust in vaccinations, poor vaccine supply, and corruption in the health system has left Ukraine with worryingly low rates of immunisation. Ed Holt reports.

Correspondence
Standardised case definitions for adverse events following immunisation
Ulrich Heininger
Preview |
Comparability of data obtained in different vaccine trials is of interest for those who want to assess reactogenicity and safety profiles of specific vaccines. In this regard, the Brighton Collaboration (founded in 2000) has set internationally recognised standards by creating case definitions for many adverse events following immunisation (AEFI), and by developing standards for the collection and reporting of safety data in clinical trials.1

Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission

The Lancet  
Jun 29, 2013  Volume 381  Number 9885  p2223 – 2298
http://www.thelancet.com/journals/lancet/issue/current

Clinical features and viral diagnosis of two cases of infection with Middle East Respiratory Syndrome coronavirus: a report of nosocomial transmission
Benoit Guery, Julien Poissy, Loubna el Mansouf, Caroline Séjourné, Nicolas Ettahar, Xavier Lemaire, Fanny Vuotto, Anne Goffard, Sylvie Behillil, Vincent Enouf, Valérie Caro, Alexandra Mailles, Didier Che, Jean-Claude Manuguerra, Daniel Mathieu, Arnaud Fontanet, Sylvie van der Werf, the MERS-CoV study group
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2960982-4/abstract

Summary
Background
Human infection with a novel coronavirus named Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first identified in Saudi Arabia and the Middle East in September, 2012, with 44 laboratory-confirmed cases as of May 23, 2013. We report detailed clinical and virological data for two related cases of MERS-CoV disease, after nosocomial transmission of the virus from one patient to another in a French hospital.

Methods
Patient 1 visited Dubai in April, 2013; patient 2 lives in France and did not travel abroad. Both patients had underlying immunosuppressive disorders. We tested specimens from the upper (nasopharyngeal swabs) or the lower (bronchoalveolar lavage, sputum) respiratory tract and whole blood, plasma, and serum specimens for MERS-CoV by real-time RT-PCR targeting the upE and Orf1A genes of MERS-CoV.

Findings
Initial clinical presentation included fever, chills, and myalgia in both patients, and for patient 1, diarrhoea. Respiratory symptoms rapidly became predominant with acute respiratory failure leading to mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Both patients developed acute renal failure. MERS-CoV was detected in lower respiratory tract specimens with high viral load (eg, cycle threshold [Ct] values of 22·9 for upE and 24 for Orf1a for a bronchoalveolar lavage sample from patient 1; Ct values of 22·5 for upE and 23·9 for Orf1a for an induced sputum sample from patient 2), whereas nasopharyngeal specimens were weakly positive or inconclusive. The two patients shared the same room for 3 days. The incubation period was estimated at 9—12 days for the second case. No secondary transmission was documented in hospital staff despite the absence of specific protective measures before the diagnosis of MERS-CoV was suspected. Patient 1 died on May 28, due to refractory multiple organ failure.

Interpretation
Patients with respiratory symptoms returning from the Middle East or exposed to a confirmed case should be isolated and investigated for MERS-CoV with lower respiratory tract sample analysis and an assumed incubation period of 12 days. Immunosuppression should also be taken into account as a risk factor.

Funding
French Institute for Public Health Surveillance, ANR grant Labex Integrative Biology of Emerging Infectious Diseases, and the European Community’s Seventh Framework Programme projects EMPERIE and PREDEMICS.

Comment: Malaria eradication: is it possible? Is it worth it? Should we do i?

The Lancet Global Health
July 2013  Volume 1  Number 1  e1 – 54
http://www.thelancet.com/journals/langlo/issue/current

Comment
Malaria eradication: is it possible? Is it worth it? Should we do it?
Jenny Liu, Sepideh Modrek, Roly D Gosling, Richard GA Feachem

Preview |
The malaria map is rapidly shrinking. In 1900, endemic malaria was present in almost every country. Nowadays, the disease has been eliminated in 111 countries and 34 countries are advancing towards elimination.1 Elimination is defined as the absence of transmission in a defined geography—typically a country.2 Successful malaria control programmes in the remaining 64 countries with ongoing transmission have helped to reduce global incidence by 17% and mortality by 26% since 2000.3 For the 34 eliminating countries, the reductions were 85% in incidence and 87% in mortality.