Public health news: February 2006

Vietnam success against tetanus

28 February 2006

Vietnam has effectively eradicated tetanus in mothers and the newborn through immunization.  In the 1980s 20,000 neonates died each year from tetanus.  Tetanus toxoid vaccine has been given routinely to pregnant women in Vietnam since 1991.

Viet Nam eliminates maternal and neonatal tetanus  (WHO, February 2006)
Health protection  (Internal link)

British teenagers petition for more sex education

28 February 2006

CosmoGirl magazine has collected 2000 signatures from teenagers in the UK demanding better sex and relationships education (SRE) in schools.

Teenage girls call for compulsory sex education (Guardian, February 2006)
'Just say know' petition  (Cosmo Girl, February 2006)
Health promotion  (Internal link)

Chikungunya epidemic attracts aid package

27 February 2006

The French colony of Reunion has been promised €36m (US$42.8m) in aid by Paris to help combat a widespread epidemic of the mosquito-borne flaviviral chikungunya disease. It is estimated that 20 per cent of the population of the island have so far contracted the disease.

French pledge for disease island  (BBC News, February 2006)
Promed update  (Promed, February 2006)
Viral hemorrhagic fevers  (eMedicine.com, September 2005)
Reunion country profile  (CIA Factbook, January 2006)
Health protection  (Internal link)

UK Government orders H5N1 vaccine

24 February 2006

The Government has placed orders for 3.5m doses of a vaccine against H5N1, to be ready by October 2006.  It is important to distinguish between this potential vaccine - which will hopefully protect against the current strain of avian influenza currently causing a very small clinical attack rate but high mortality - and a vaccine for pandemic influenza which, with current technology can only be developed once a pandemic strain emerges.

UK to buy bird flu vaccine stock  (BBC News, February 2006)
Influenza pandemic planning  (Internal link, regularly updated)

Malnutrition screening recommended

22 February 2006

The National Institute for Health and Clinical Excellence (NICE) has issued guidance advising all NHS hospital inpatients, and patients attending their first outpatient appointment, should be screened for malnutrition.

Malnutrition test 'must be norm'  (BBC News, February 2006)
Nutrition support in adults (CG32)  (NICE, February 2006)

H5N1 in France, India and Egypt

19 February 2006

This weekend avian influenza has been confirmed in birds in France, India and Egypt.  It is probably now just a matter of time before birds in the UK are found with the virus.  The risk to the public will still remain extremely low, however, since the virus does not pass easily between birds and humans, and as yet has shown no sign of being transmitted between humans.  It is feared that over time the virus may mutate allowing more efficient human to human transmission, starting a worldwide influenza pandemic. Such a pandemic strain would be likely to have a much lower mortality than the current H5N1 strain.

No panic over bird flu threat  (BBC News, February 2006)
Influenza pandemic planning  (Internal link, updated regularly)

PCT Herceptinâ„¢ decision upheld

16 February 2006

A woman lost her High Court battle yesterday to force her PCT to pay for trastuzumab for early stage breast cancer.  Although the correct decision - the drug is not yet licensed for early stage breast cancer in the UK nor been appraised by the National Institute for Clinical Health and Excellence (NICE) - it does highlight some problems with the system.  Firstly, promising but costly new treatments, especially for diseases where the window of opportunity is short (such as some cancers), should be appraised as quickly as possible.  Secondly, patients should not be misled about the efficacy of new treatments when only limited data are available: the medical profession needs to present clear, balanced, information early on to the lay press to prevent patients from being given false hope.  Finally, the correct pathways for bringing drugs to market still need to be adhered to (even if they could be more efficient); politicians should not interfere with this process.

Woman loses Herceptin court bid  (BBC News, February 2006)
Cancer patient loses legal battle for Herceptin  (Guardian, February 2006)
Health secretary vs NICE  (Internal link, below)

Full smoking ban agreed by MPs

15 February 2006

Members of Parliament last night agreed - finally - to a comprehensive smoking ban in all public spaces in England, including bars and clubs, from summer 2007.  Wales, Scotland and N Ireland are all bringing in similar legislation. 

Campaigners welcome smoking ban  (BBC News, February 2006)
Health promotion (Internal link)

European avian flu spread continues

15 February 2006

Wild birds in Austria and Germany are now suspected of harbouring avian flu.  Although the diagnosis awaits confirmation, it is highly likely, as is eventual spread throughout the rest of Europe, and to other continents as yet unaffected.

Bird flu spreading across Europe  (BBC News, February 2006)
Flu pandemic planning  (Internal link)

STI home-testing kits being considered

14 February 2006

Free home-test kits for sexually transmitted infections such as chlamydia are apparently being considered by the Government.  The huge rise in STIs in the last decade, especially amongst teenagers and people in their early 20s, has left GUM clinics over-burdened.  Home test kits would potentially make testing more convenient, and less embarrassing, thereby improving uptake.

Free home test to combat rise in sexual infections (Times Online, February 2006)
Free sex test devices in pipeline  (BBC News, February 2006)
Mapping the Issues - HIV and other STIs in the UK (HPA, November 2005)

Avian influenza in EU

13 February 2006

Fairly predictably, avian influenza has now been found in birds in Europe.  Over the weekend, confirmed or suspected H5N1 was reported in birds in Italy, Greece, Bulgaria and Slovenia.  The fear is that the larger the pool of avian influenza, the more chance the virus has of mutating to a form which spreads easily between humans, resulting in a pandemic strain.

Italy fights to contain bird flu  (BBC News, February 2006)
Flu pandemic planning  (Internal link)

International PH network set up

10 February 2006

The International Association of National Public Health Institutes (IANPHI) was set up last week at a conference in Brazil.  Its first aims are to co-ordinate and support member institutes' pandemic planning, disaster preparedness and chronic disease systems.

HPA CEO at IANPHI launch (HPA, February 2006)
Global conference to address needs of developing PH institutes (ASPH, February 2006)

Meningitis associated with multiple kissing partners

10 February 2006

A case-control study in the UK involving 144 case-control pairs has found an association between multiple (tongue) kissing partners in the fortnight prior to illness and risk of developing meningitis (OR 2.1, 95% CI 1.2-3.7).  Although this is an interesting outcome, it does not confirm causality and may be the result of confounding (e.g. individuals who are more sociable and come into contact with more people may also be more likely to have multiple kissing partners). 

Tully et al, BMJ (Epub ahead of print, BMJ, February 2006 DOI [?]: 10.1136/bmj.38725.728472.BE, not yet live)
Kissing many 'risks meningitis'  (BBC News, February 2006)

Male circumcision may cut HIV transmission risk too

9 February 2006

Findings from research carried out in Uganda by Quinn et al suggest that male circumcision may not only reduce the risk of HIV infection in men (as previously reported by Auvert et al) but also the chance of passing on HIV to female partners.  Details were presented at the Conference on Retroviruses and Opportunistic Infections in Denver.  If confirmed in further trials these results could have a large impact on HIV strategies around the world, especially in Africa.

Male circumcision protects women from AIDS: study  (Reuters, February 2006)
CROI 2006 (CROI, February 2006)
Auvert et al, PLoS Medicine (PLoS, October 2005)

Bird flu marches on to another continent

8 February 2006

This time it's Africa.  The H5N1 strain of avian influenza has been found in poultry in Nigeria.  There were fears that infection in Africa was a matter of if, not when, and predictions that the disease will have a huge impact on local economies and livelihoods.  Some of the predictions of the spread of the virus were made based on the migratory patterns of wild birds thought to be carrying the disease.  If large numbers of birds become infected on the continent, human cases of avian influenza are virtually inevitable.

Deadly bird flu found in Africa  (BBC News, February 2006)
Avian influenza situation (birds) in Nigeria (WHO, February 2006)
Avian influenza and pandemic threat in Africa  (WHO, October 2005)
Flu pandemic planning  (Internal link)

Changes to UK imms schedule

8 February 2006

The Chief Medical Officer has announced the addition of the pneumococcal vaccine to the routine schedule for all children and some alterations to the immunisation schedules for meningococcal C (MenC) and haemophilus (Hib) vaccinations.

My summary of new immunisation schedule (pdf, 41kb)
Children to be given new vaccine (BBC News, February 2006)
NHS Immunisations website (DH, February 2006)
Health protection (Internal link)

Low fat diet benefits questioned

8 February 2006

The role of dietary fat reduction in the prevention of heart disease, stroke, breast cancer and colorectal cancer may not be as striking as previously thought.  Results from the large Women's Health Initiative in the US have found no difference in rates of disease between women who were prospectively placed on a low-fat diet vs those on a normal diet at 8 years' follow-up.  However, the reduction in dietary fat content was less than anticipated in the intervention group so these negative finding may not be conclusive.

WHI - Breast, JAMA (2006) 295: 629-642 (JAMA, February 2006)
WHI - Colorectal cancer, JAMA (2006) 295: 643-655 (JAMA, February 2006)
WHI - Heart disease & stroke, JAMA (2006) 295:655-666  (JAMA, February 2006)
Women's Health Initiative (NHLBI, February 2006)

Health Secretary vs NICE

6 February 2006

The High Court begins hearing a case today between a patient with early HER2-positive breast cancer and Swindon Primary Care Trust (PCT). The patient is requesting NHS funding for trastuzumab (Herceptinâ„¢) treatment, which the PCT has so far refused.

The HERA trial (jointly funded by Roche, makers of Herceptinâ„¢) does give some interesting initial evidence for the efficacy of trastuzumab in preventing recurrence of early-stage breast cancer.  However early results have not shown an overall reduction in mortality (at 2 year follow-up), and there seems to be a small but significant risk of cardiotoxicity from the agent.

Although the case is ostensibly between the patient and the PCT, it is likely to have wider repercussions. In particular, it may be interpreted as a show-down between the Secretary of State for Health, Patricia Hewitt, and the National Institute for Clinical Health and Excellence (NICE).  Although NICE was set up by the Government to independently investigate the cost-effectiveness and efficacy of new treatments - such as trastuzumab - before their introduction, in this instance the Health Secretary announced the drug would be made available on the NHS before NICE has made its appraisal and before it has been licensed.

Woman begins Herceptin court bid  (BBC News, February 2006)
HERA Trial Study Team, NEJM (2005) 353:1659-72  (NEJM, October 2005)
National Institute for Clinical Health & Excellence (NICE, February 2006)
Breast cancer drug test for all (BBC News, October 2005)
Roche UK press release (Roche, May 2005)

Weather may help predict malaria epidemics

3 February 2006

A new modelling system based on long-term weather forecasting may be able to predict malaria epidemics up to 5 months in advance.

Malaria and weather come under same umbrella (Nature, February 2006)
Thomson et al, Nature (2006) 439:576-9  (Nature, February 2006)