Happy Halloween!

Maggie and Alicia

 

Nothing better than infection prevention related Halloween costumes.  I'm still trying to imagine Mike dressed as a flu vaccine, but its a bit difficult.  Anyway, here in Iowa City Maggie dressed as a collection of hospital pathogens clinging to Alicia, a contaminated textile.  Good times.

Science Friday: Influenza Vaccine Debate

Mike Osterholm, PhD MPH

Earlier this week, Mike posted his thoughts on the recent Lancet ID review of influenza vaccine efficacy.  This week's Science Friday featured a "debate" between Mike Osterholm, one of the authors, and Bill Schaffner. The discussion covers several important topics including the utility of influenza vaccine in seniors.

Click here to listen to the mp3 audio (full hour, but the vaccine discussion is first up)

Source: Science Friday (NPR, Talk of the Nation)

Needle-free flu vaccine? Not so fast!

On second thought. Maybe the hypospray did hurt?

Bummer.  We were getting so close to the Star Trek reality we always dreamed about.  We can now talk to our communicator-like, Siri-enabled iPhones and until this week, we could get a flu vaccine using a hypospray-like needle-less jet injector. Unfortunately, for your deltoids, FDA now recommends against the use of the intramuscular-labeled vaccine using jet injectors.  Only one vaccine, the MMR, is approved for use with the jet injector and the FDA hasn't received the safety and effectiveness data to approve other vaccines using this technology.

Note: This does not apply to the intradermal vaccine, which is supplied in its own pre-filled syringe.

Source: FDA Updated Communication on Use of Jet Injectors 10/26/2011 

It's a vaccine, not a miracle

There apparently was a recent rumor causing quite a stir in some segments of the infectious diseases community that a paper was about to be published that would show that influenza vaccine doesn't work. Well, the paper was published yesterday and the results don't quite match the rumor. Osterholm and colleagues have published a systematic review and meta-analysis on the efficacy and effectiveness of influenza vaccine in Lancet Infectious Diseases. The major finding was that the pooled efficacy of the vaccine is 59%. This is somewhat lower than that found by the Cochrane group (73% in years when the vaccine and circulating strains were well matched); however, there were some differences in methodology that are well outlined in an editorial that accompanies the paper.

Shocking? I don't think so. I have never thought that influenza vaccine was a great vaccine. It's a good vaccine; certainly good enough to widely recommend its use. But clearly not so good as to fire healthcare workers who refuse to take it.

Two years ago I blogged about the interview in the Atlantic with Tom Jefferson, the head of the Cochrane influenza group. Here's the money quote from that interview:

"For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents. That's not a vaccine, that's a miracle."

Headline of the day

This is my favorite headline about the demise of drotrecogin alpha (a.k.a. activated protein C, Xigris), which was withdrawn from the market yesterday after the PROWESS-SHOCK study results revealed it to be no better than placebo in the treatment of severe sepsis. The headline, of course, implies that Xigris once was effective, it just isn’t any more…and from the quotes in this story, it appears that Lilly is arguing that improvements in sepsis management have now made it impossible to detect the incremental benefit that Xigris provided (you know, back when we were super-terrible at treating sepsis).

Fair enough, but that explanation ignores the controversial history of this drug and the role of Eli Lilly in the surviving sepsis campaign. It also ignores one of the most important lessons we should learn from this debacle: the perils of the subgroup analysis. Eli, our in-house methodologist, may wish to chime in, but you can start here with a nice review that points out why subgroup analyses of clinical trials should be treated with extreme caution, and used only to generate hypotheses, not for clinical decision making (or drug approval!).

1 week to 7 billion

(AP Photo/Pavel Rahman): Bangladesh

7 billion people. Seven billion. Unimaginable. The UN Population Fund estimates by October 31, 2011, the world's population will be 7 billion. Only 200 years ago, there were 1 billion people on the planet and it took 150 years to get to 3 billion. The UN projects that it could grow to 15 billion by the year 2100.  I wonder if it will even be possible to control the emergence of resistant pathogens like NDM-1 if we don't first address the population crisis.

Atlantic Monthly has a wonderful series of photographs that highlight the population explosion and the secondary environmental impact.

My favorite comment below the photo series is "7 bil peeps can fit in an area 34x34 miles. Shoulder to shoulder back to front."  I don't know if this is true, but perhaps they can test it out on MythBusters.

h/t JJ Furuno

Encouraging antibiotic development: a grassroots effort

Dear Readers,

I have just received this call to action from Dr. Timothy Walsh, Professor at Cardiff University, who I mentioned last week in regards to the NDM-1 crisis in India. Below is an online petition from the British Society for Antimicrobial Chemotherapy (BSAC), that I would urge you to sign. The petition will be presented to 10 Downing street (British Government) on the 9th of November followed by a garden reception to further articulate the crisis we currently face.

Antibiotic Action

Securing the future of antibiotic development …. determined to make a difference

www.antibiotic-action.com


New antibiotics are urgently needed for use now and in the future

No antibiotics – no chemotherapy | No antibiotics – no transplant surgery | No antibiotics – no hip/knee replacements | No antibiotics – no treatment for infectious diseases| No antibiotics – no heart surgery | No antibiotics – no cystic fibrosis treatment | No antibiotics – no kidney transplants

NO ANTIBIOTICS – NO CURE – NO CHANCE

The simple truth

Please join this global initiative - sign the petition on the website above.

Thank you.