JAMA – January 6, 2015, Vol 313, No. 1

January 6, 2015, Vol 313, No. 1

Viewpoint | January 6, 2015
The President’s National Security Agenda – Curtailing Ebola, Safeguarding the Future
Lawrence O. Gostin, JD1; Henry A. Waxman, JD2; William Foege, MD, MPH3
[+] Author Affiliations
JAMA. 2015;313(1):27-28. doi:10.1001/jama.2014.16572.
The Ebola epidemic is projected to affect tens of thousands in Sierra Leone, Liberia, and Guinea, with immense economic and social costs. Even in the United States, where only 1 patient with Ebola virus disease has died, the disease has spurred public fear, tested the readiness of the public health system, and led to measures such as enhanced border screening and state quarantines. The lesson of Ebola is clear: strong, resilient health systems are needed in Africa to curtail the outbreak at its source and in the United States to ameliorate risks and reassure the public.

The United States has led the global response to Ebola, devoting significant financial and human resources, deploying military troops, and sponsoring a groundbreaking United Nations Security Council resolution. Although there is some evidence that the spread of the disease is slowing in Liberia, the response of the United States is still not complete. Health systems in West Africa have been overwhelmed, and the US domestic public health system was not initially prepared, with inadequate training of and protection for health workers and inconsistent exercise of public health powers. This should not be a surprise given the severe budget cuts of recent years, including a 10% reduction in the Centers for Disease Control and Prevention’s 2013 budget1 and the loss of more than 50 000 state public health professionals.2

President Obama is trying to address these challenges. On November 5, 2014, he submitted a $6.2 billion emergency supplemental funding request to Congress to improve domestic and global health capacities in 3 critical areas: a surge of resources for containment and treatment in West Africa; enhanced prevention and detection of, and response to, Ebola entering the United States; and, perhaps most important, buttressing health systems to respond rapidly and flexibly to all hazards in the future.3 Epidemics will occur in the future. It is urgent that Congress support his request…
Original Investigation | January 6, 2015
Quadrivalent HPV Vaccination and Risk of Multiple Sclerosis and Other Demyelinating Diseases of the Central Nervous System
Nikolai Madrid Scheller, MB1; Henrik Svanström, MSc1; Björn Pasternak, MD, PhD1; Lisen Arnheim-Dahlström, PhD2; Karin Sundström, MD, PhD3; Katharina Fink, MD, DrMed4,5; Anders Hviid, DrMedSci1
[+] Author Affiliations
JAMA. 2015;313(1):54-61. doi:10.1001/jama.2014.16946.
Case reports have suggested a link between human papillomavirus (HPV) vaccination and development of multiple sclerosis and other demyelinating diseases.
To investigate if quadrivalent HPV (qHPV) vaccination is associated with an increased risk of multiple sclerosis and other demyelinating diseases.
Design, Setting, and Participants
Using nationwide registers we identified a cohort of all females aged 10 years to 44 years in Denmark and Sweden, followed up from 2006 to 2013, information on qHPV vaccination, and data on incident diagnoses of multiple sclerosis and other demyelinating diseases. The primary analysis used a cohort design including vaccinated and unvaccinated study participants. A secondary analysis used a self-controlled case-series design including only cases. Both analyses used a 2-year risk period following vaccination.
Information on qHPV vaccination was obtained through the national vaccination and prescription registers.
Main Outcomes and Measures
The primary outcomes were multiple sclerosis and a composite end point of other demyelinating diseases. Incidence rate ratios were estimated using Poisson regression, comparing rates of events in the 2-year risk periods following vaccination and in unvaccinated time periods.
The study included 3 983 824 females, among whom 789 082 received a total of 1 927 581 qHPV vaccine doses. During follow-up, 4322 multiple sclerosis cases and 3300 cases of other demyelinating diseases were identified, of which 73 and 90, respectively, occurred within the risk period. In the cohort analysis, there was no increased risk of multiple sclerosis (crude incidence rates, 6.12 events/100 000 person-years [95% CI, 4.86-7.69] and 21.54 events/100 000 person-years [95% CI, 20.90-22.20] for the vaccinated and unvaccinated periods; adjusted rate ratio, 0.90 [95% CI, 0.70-1.15]) or other demyelinating diseases (crude incidence rates, 7.54 events/100 000 person-years [95% CI, 6.13-9.27] and 16.14 events/100 000 person-years [95% CI, 15.58-16.71]; adjusted rate ratio, 1.00 [95% CI, 0.80-1.26]) associated with qHPV vaccination. Similarly, no increased risk was found using the self-controlled case-series design (multiple sclerosis: incidence ratio, 1.05 [95% CI, 0.79-1.38]; other demyelinating diseases: incidence ratio, 1.14 [95% CI, 0.88-1.47]).
Conclusions and Relevance
In this study with nationwide coverage of 2 Scandinavian countries, qHPV vaccination was not associated with the development of multiple sclerosis or other demyelinating diseases. These findings do not support concerns about a causal relationship between qHPV vaccination and demyelinating diseases.