DiversityNursing Blog

U.S. health officials have hard numbers to back up their warnings that this season's flu shots are less than perfect: A new study finds the vaccine reduces your risk of needing medical care because of flu by only 23 percent.

Most years, flu vaccine effectiveness ranges from 10 percent to 60 percent, reported the U.S. Centers for Disease Control and Prevention.

Despite the reduced effectiveness of this season's flu shot, "vaccination is still important," said lead report author Brendan Flannery, an epidemiologist with the CDC.

"But there are ways of treating and preventing flu that are especially important this season," he added. 

These include early treatment with antiviral drugs and preventing the spread of flu by washing hands and covering coughs, he said. 

Twenty-three percent effectiveness means that there is some benefit -- a little less flu in the vaccinated group. Flu is usually more common among unvaccinated Americans, Flannery said, "but this year there is a lot of influenza both in people who are vaccinated and in people who are unvaccinated."

The findings are published in the Jan. 16 issue of the Morbidity and Mortality Weekly Report.

As of early January, the middle of flu season, flu was widespread in 46 states, and 26 children had died from complications of the infection, CDC figures show. 

The vaccine's reduced effectiveness highlights the need to treat serious flu quickly with antiviral drugs such as Tamiflu or Relenza, the CDC said. Ideally, treatment should start within 48 hours of symptoms appearing.

Spot shortages of these drugs have been reported, and the CDC said that people may have to contact several pharmacies to fill these prescriptions. However, it anticipates enough supply overall to meet the high demand. 

In flu seasons when the vaccine is well matched to the circulating H3N2 strains, effectiveness has been between 50 and 60 percent, the CDC said. This year, however, about 70 percent of the H3N2 virus seen has been different from the H3N2 strains in the vaccine, which explains its reduced effectiveness, Flannery said.

Flu viruses change constantly, and this new H3N2 virus did not appear until after the flu strains were chosen for inclusion in the current vaccine, he explained.

Vaccine effectiveness is also related to the health of those getting vaccinated. The vaccine works best in young, healthy people, and is less effective in those 65 and older, the report noted.

This year's shot is most effective -- 26 percent -- for children 6 months old through 17 years. Older people get less benefit -- just 12 percent for those 18 to 49 years and 14 percent for those 50 and older, the CDC said.

Although the vaccine is less reliable than in some years, the CDC still recommends that everyone 6 months and older get vaccinated. Vaccination can prevent some infections and reduce severe disease that can lead to hospitalization and death, the agency said. 

Also, the vaccine protects against three or four flu viruses, some of which may circulate later this season, Flannery said. 

Dr. Marc Siegel, a professor of medicine at NYU Langone Medical Center in New York City, agreed. As other flu strains included in the vaccine emerge later in the season, he predicted the vaccine's effectiveness will rise to about 40 percent. 

Flu activity so far this season has been similar to the 2012-2013 flu season, which was classified as a "moderately severe" flu, officials say. Siegel said that season "the vaccine's effectiveness was about 40 percent, so this is even worse." 

However, he agreed it's a good idea to get a flu shot. "Twenty-three percent is better than nothing, and there is no downside to getting the vaccine," Siegel said.

Source: www.nlm.nih.gov

By ALISON BRUZEK

The last thing on your mind while you're home from school for the holidays is avoiding a deadly disease.

But imagine catching a disease as a teenager — a disease so terrible that it takes not just months to recover, but requires sacrificing both your legs.

That's what happened to Amy Purdy at age 19, when she was diagnosed with bacterial meningitis. It affects only about 4,000 people a year in the United States, according to the Centers for Disease Control and Prevention, but more than 10 percent of those people die. Others, like Purdy, suffer devastating consequences, including hearing loss, brain damage, or the loss of limbs from bloodstream infection.

College students are especially vulnerable, because meningitis is spread by living in close quarters and sharing drinking and eating utensils, or kissing. (An outbreak at Princeton University in 2013 sped up approval a new vaccine for the meningitis B strain.)

That's why the CDC recommends meningitis vaccine for all teenagers, especially if they weren't vaccinated as preteens.

Purdy, now 35, went on to become a Paralympic snowboarding champion and contestant in Dancing with the Stars. She's got a new book, On My Own Two Feet: From Losing My Legs to Learning the Dance of Life, coming out Dec. 30. Shots spoke to her about her battle with the disease and people's misconceptions about meningitis. This is an edited version of the conversation.

Had you heard about meningitis before you became sick?

Of course I heard the name meningitis before. I recognized what it was, but I had no idea that I was at risk. And I have to say, my mom actually told me just about a year before I got sick about one of her friends' son's who battled this horrific disease that came out of nowhere. He ended up losing his legs and his kidneys. It was the exact same thing that I got a year later.

Do you know how you got meningitis?

We have no idea how I got it. I was at an age that's more at risk — I was 19 years old. However, I wasn't a college student. I didn't live in a college dorm. I really wasn't even around that environment. They do say that those who are in college dorms are slightly more at risk than the rest of the world. I don't know how I got it, I was incredibly healthy at the time, I was a massage therapist, I worked out every day, I really took care of myself. It's just this invisible killer that kind of comes out of nowhere.

How did you cope with this loss at such a young age?

For me, it was life-changing. I nearly died multiple times in the hospital. I lost my legs, I lost my spleen, I lost my kidney function. I lost the life that I knew. And going through so much in such a small amount of time and so quickly, for me it put my life into perspective. There were certain things I focused on — I focused on how grateful I was for the things I had versus things I lost. I got a second chance at life and I wanted to use it. I didn't want to waste it by dwelling on what happened or why it happened.

One of the ironies is that those losses actually led to a lot of great things, like Dancing With the Stars and the Paralympics.

Definitely. The way I look at it is, we all have disabilities. We all have things that limit us and that challenge us. But really, our real limitations are the ones we believe. And I, from the beginning, believed that I could accomplish my goals and accomplish my dreams and I set out to do that. I'm very grateful that I've had the opportunities I've had.

A new vaccine for meningitis B was approved this fall, and you're now working with the manufacturer, Pfizer, to promote it. How did that happen?

Pfizer's actually teamed up with my nonprofit organization, which is called Adaptive Action Sports. I cofounded this organization in 2005 to help people with physical disabilities get involved in action sports, go snowboarding, skateboarding. Obviously, they want to get the word out there that there's protection against this bacteria.

I'm really proud to be a part of this campaign, though. You hear about rare diseases and weird things happening to people on Oprah and Dateline and you just never think it's going to happen to you. And then come to find out you actually could've protected yourself against it. To me it seems like a no-brainer.

What do you want parents to ask their teen's doctor about meningitis?

The number one question is, "Do you carry the meningococcal meningitis vaccination?" I feel like if parents could vaccinate their kids against car accidents, they would. This is one of those things where there are ways to help protect your kid against this.

Source: www.npr.org

By DENNIS THOMPSON

Chickenpox befell Angelina Jolie this week, preventing the actress-turned-director from attending the premiere of her new film.

Meanwhile, an outbreak of mumps has hit the National Hockey League, sidelining more than a dozen players and two referees.

These are considered kids' diseases. Most adults have vivid, fretful childhood memories of standing in line to get vaccinations that they expected to provide lifetime protection.

Why, then, are these prominent adults -- and scores of others -- coming down with these infections?

Mainly, it comes down to two factors, experts say.

Vaccination rates have declined among children in some parts of the United States, increasing everyone's risk of exposure to virulent diseases like chickenpox, measles, mumps and whooping cough, said Dr. Aaron Glatt, a spokesman for the Infectious Diseases Society of America.

"These vaccines are not perfect," said Glatt, who's also executive vice president of Mercy Medical Center in Rockville Centre, N.Y. "If you don't have a perfect vaccine and you couple that with a less-than-ideal number of people getting it, then if one person gets it then it's more likely to spread to others."

On top of that, even adults who got their shots as kids are at risk of contracting these diseases once exposed to them, because the protection provided by childhood vaccinations can fade over time.

"You can be vaccinated for something and have antibodies that wane over time or disappear entirely," said Dr. Len Horovitz, an internist and lung specialist at Lenox Hill Hospital in New York City. "You can have intermittent immunity, or no immunity."

America's public health defense against infectious diseases is built on a concept called "herd immunity," Glatt explained. If enough people are vaccinated against diseases like chickenpox, influenza, mumps and whooping cough, then even those who aren't vaccinated benefit because those who are immune can't spread the disease.

Skepticism over the effectiveness and safety of vaccines has caused vaccine rates to decline in some parts of the country, Horovitz and Glatt said. In those locations, adults with waning or imperfect immunity could fall prey to childhood infectious diseases, particularly if there's an outbreak.

"There is less vaccination going on than there was previously," Glatt said. "These childhood diseases have not gone away, and there is a strong anti-vaccine lobby that plays a role in people's decision to have their children vaccinated."

Since the early 1980s, there has been an overall increasing trend of whooping cough in the United States, said Angela Jiles, a spokeswoman for the federal Centers for Disease Control and Prevention.

Between Jan. 1 and Aug. 16 of this year, the CDC received reports of 17,325 cases of whooping cough, a 30 percent increase from the same time period in 2013 and the most cases seen in six decades, Jiles said.

California is experiencing its worst outbreak of whooping cough in seven decades.

There also have been more reported mumps cases in the United States this year, due to some larger outbreaks, according to the CDC. A reported 1,078 people have contracted mumps in 2014, compared with 438 the year before. In 2006 -- the worst year in recent history -- there were 6,584 cases of mumps, largely due to outbreaks on college campuses, according to the CDC.

No one has said how Jolie might have contracted chickenpox, but many of the NHL players appear to have gotten mumps from each other, despite efforts by the hockey league to get players vaccinated.

A single dose of mumps vaccine is about 80 percent effective, and two doses is about 90 percent effective, Amy Parker Fiebelkorn, an epidemiologist with the CDC's measles, mumps, rubella and polio team, told The New York Times.

"There is no vaccine that's 100 percent effective," Fiebelkorn said. "There is some margin for fully vaccinated individuals to still be infected with mumps if they're exposed to the virus."

Unfortunately, adults who contract these diseases are in for a rougher ride than children. They are more likely to develop serious complications, and are at higher risk of death, Glatt and Horovitz said.

These viruses also can increase a person's risk of future illness. For example, chickenpox patients like Jolie have a lifetime risk of shingles, a disease that can cause terrible rashes and intense nerve pain. The chickenpox virus hides in deep reservoirs inside the human body, and then emerges later in life to cause shingles.

Concerned adults can ask their doctor for a blood test that will check their antibodies and see if they remain immune to these infectious diseases, Horovitz said.

"It's something that could be done in the course of your annual exam. It takes no more than an extra tube or two of blood," the same as regular checks for blood sugar and cholesterol, he said. "It would be particularly important for people with chronic medical conditions or who do a lot of foreign travel where these diseases are running rampant."

People also can talk with their doctor about vaccinations that are recommended for adults. For example, the CDC recommends that adults get a booster shot every 10 years for tetanus, diphtheria and whooping cough, as well as an annual flu shot.

Source: www.cbsnews.com

By Meera Senthilingam

Its name means "bending over in pain." It has no treatment or vaccine. Its symptoms resemble Dengue fever. And it has infected more than 1 million people -- 155 of them fatally -- since spreading to the Americas one year ago.

The mosquito-borne Chikungunya virus has long been diagnosed in travelers returning from countries in Asia and Africa, where the disease is widespread. But in December 2013, the first people infected by mosquitoes local to the region were reported on the Caribbean island of Saint Martin.

This was the first outbreak of the debilitating disease in the Western hemisphere, health officials said.

All countries in Central America have now reported local transmission of Chikungunya [pronounced chik-un-GOON-ya], and the United States had 11 confirmed cases of local infection this year as of December 12, all in the state of Florida. There also have been 1,900 imported cases across the U.S. in returning travelers.

"It wasn't until 2013 that unfortunately a traveler resulted in local transmission of Chikungunya," said Erin Staples of the U.S. Centers for Disease Control (CDC), referring to the people infected in Saint Martin.

Those infected carry the virus in their bloodstream; it can then be picked up by mosquitoes as they bite, making them carriers. The virus has since spread rapidly and shows no signs of leaving, as ecological conditions are perfect for the disease to flourish.

"We knew it would spread," said Staples, a medical epidemiologist.

The big question perplexing officials: Why now?

Two mosquito species primed to the temperatures of Central and South America carry Chikungunya. The species -- Aedes aegypti and Aedes albopictus -- also carry the virus behind Dengue fever.

"Given the level of Dengue in the region, we knew there could be the same levels of Chikungunya," Staples said. Both diseases can cause joint pain and inflammation, headaches, rashes and fever, and can lead to death in rare cases.

But this tropical disease with an exotic name (which originates from the African Makonde dialect) causes more intense joint pain and inflammation. For some people the pain can last for months or years, resulting in additional psychological strain.

The lack of immunity among people living in the Americas provided a blank canvas for Chikungunya to spread throughout the population this year. As of December 12, more than 1.03 million people have been infected, in addition to the 155 who died, according to the Pan-American Health Organisation (PAHO). Almost all of the fatalities occurred in the Caribbean island countries of Guadaloupe and Martinique.

"Where we saw the biggest jump was after it reached the Spanish-speaking countries in the region," said Staples, referring to the weakened infrastructures and health systems of countries such as the Dominican Republic, which has reported more than 520,000 cases -- more than half of the overall outbreak and 5% of the island country's population.

As South American countries approach their summer, numbers are expected to rise there as the mosquitoes flourish in the heat.

"Brazil, Peru, Paraguay are coming into their summer months and reporting their first local transmission," Staples said. Already, more than 2,000 people have been infected in Brazil.

Is there cause for concern?

Because infection with Chikungunya is rarely fatal, the issue of most concern to officials is the burden on health services and the impact of the debilitating symptoms on the economy.

"The high number of cases can overload health services," says Dr. Pilar Ramon-Pardo, regional adviser for PAHO, the regional office of the World Health Organization. Until recently, monitoring for Chikungunya was not part of routine surveillance in the region.

"Clinicians have to be ready to diagnose," she said

About 20% to 30% of cases are expected to become chronic, with symptoms such as arthritis and other rheumatic manifestations leading to physical disabilities, Ramon-Pardo said. Further long-term effects are psychological as people become more depressed and tired.

All of this can result in missed work and lower school attendance, she said, hurting local economies.

Is it here to stay?

The warm climate of the region offers potential for Chikungunya levels to be maintained for years to come, just like Dengue fever. But areas of most concern are the tropics.

"The areas which have year-round favorable climate for the mosquito are at the greatest risk," says Dr. Laith Yakob of the London School of Hygiene and Tropical Medicine, which is monitoring the spread of the outbreak.

While the climate and mosquitos have long been present, Ramon-Pardo said, "we don't know why this is happening now." She said globalization is likely to blame, with increased population movement from one country to another. This offers more opportunities for local mosquitos to bite infected humans.

The CDC's Staples said she is temporarily at ease regarding numbers in the U.S. "We're moving into fall and winter periods, which should see activity decrease," she said. Cold temperatures reduce mosquito survival rates.

The rapid spread of Chikungunya this year also could help minimize future infections. "Chikungunya will go through a region quite rapidly and create a level of population immunity which helps mitigate large outbreaks of the disease," Staples said. Unlike Dengue, infection with Chikungunya results in lifelong immunity.

Like many other infections, Chikungunya could, however, remain in the background through animals capable of carrying the virus in their bloodstream and acting as so-called reservoirs of the disease.

"In Asia and Africa there is a transmission cycle in small mammals and monkeys," Ramon-Pardo said, meaning these animals keep the virus present within the population. "In the Americas ... we don't know yet."

Those words -- "we don't know" -- resonate throughout the community of scientists and government officials trying to control the outbreak.

The future risk of spread, levels of future immunity, risk from animal reservoirs, why this is only happening now, and the total economic impact are all unknown.

"Mathematical models are under construction by numerous research groups around the world to improve confidence over projections of future spread," said Yakob, whose team is modeling the disease. As they work, control efforts continue.

Getting it under control

When it comes to controlling Chikungunya, there are two main strategies -- reduce the likelihood of bites and remove the ever-biting mosquito. Prevention is the priority.

Unlike the mosquitoes behind malaria, which bite at night, the species behind Chikungunya bite any time, day or night. Those living in affected areas are asked to use repellent, sleep under bed nets and wear long clothing to avoid getting bitten. The air conditioned and indoor environments of people living in the U.S. mean numbers are likely to stay low there.

But mosquito control is at the heart of it all. Mass spraying of insecticides and removal of any sources of shallow water in which mosquitoes can breed are taking place across the continents. According to the CDC's Staples, Florida has been highly aggressive with its approach to control. "We're only at 11 (cases) due to such proactive measures," Staples said. For now, prevention is all they have as officials wait and see how the outbreak pans out.

"There is no vaccine currently and no good antivirals, so we are trying to control the spread of the disease," Staples said. "There are a lot of questions and only time will tell what we'll see for Chikungunya in the future."

Source: www.cnn.com

By Barry Hoffman

Paul Alexander's most impressive accomplishment is something most people never think about.

He taught himself how to breathe.

Alexander, 67, is a victim of the worst that polio had to offer children in the late 1940s and early 1950s. At the age of 6, he was completely paralyzed by the disease, his lungs stopped working, and he was literally thrown into an iron lung.

Alexander has been in that iron lung for 61 years because he remains almost totally paralyzed, able to move only his head, neck and mouth. He is one of an estimated seven people in the United States who are still living in an iron lung, and yet he has had a long and successful career as a lawyer. 

"Over the years, I've been able to escape this machine for a few hours at a time by teaching myself voluntary breathing," Alexander said recently as he lay in the iron lung at his home in Dallas, Texas. "I have to consciously push air into my lungs, something that's done involuntarily by just about everyone else. It's hard work, but it allows me to escape this infernal device, if only for a little while."

Alexander "escapes" the machine most often when he is litigating a case -- his specialty is family law -- or gives a speech.

While he sometimes condemns the contraption that keeps him alive, Alexander is most grateful for his iron lung, whose machinery is essentially unchanged from the first ones that were put in use in the late 1930s. His machine, in fact, is the same one he entered 61 years ago.

"It is my cage, but it's also my cocoon," he said, as the iron lung issued a noticeable whishing sound, an almost uncanny replication of normal breathing.

But we're getting ahead of the story.

This year marks the 60th anniversary of the nation's first mass polio vaccine inoculations, a time when hundreds of thousands of grade school students -- many of them throughout the South -- lined up in school gymnasiums, stuck out their arm and gritted their teeth as a nurse gave them Dr. Jonas Salk's experimental vaccine.

The shot was literally a game-changer. Most of these children had seen at least one or two classmates come to school on crutches, paralyzed by the ravages of polio. More than a few knew other students and friends who had died from the disease. 

So 1954 signified their liberation during the summer -- they could return to public swimming pools and play in the rain and eat in restaurants and not be afraid that they would wake up the next day with a fever and terrible leg pains, which could rapidly lead to paralysis.

That's what happened to 6-year-old Paul Alexander in 1952, two years too early for the Salk vaccine.

"I remember it was really hot and raining, something that is sort of rare for Dallas in August," he recalled, "and my brother and I had been outside playing, running around and getting wet when the rain started.

"Our mother called for us to come in for dinner, and I remember her taking one look at me -- hot and wet and feverish -- and she cried out, 'Oh my God!' She ripped my clothes off and threw me onto her and my dad's bed and called the doctor.

"She knew right away that I had polio. I don't know how she knew, but she knew. I remember feeling hot and feverish, and for the next few days, I stayed in the bed and didn't move. I remember I had this coloring book, and I felt this compulsion to color as much as I could, sort of like maybe I wouldn't be able to do it in the future."

Why didn't Alexander's parents take him to the hospital? "Our family doctor said that all the kids with polio were at Parkland (Dallas' big municipal hospital), and he didn't want me there with the other kids because maybe I had a better chance to recover at home," Alexander said.

But all of that became moot about six days later when he could no longer move and found it difficult to breathe: "I remember having terrible pains in my legs, and breathing became really laborious. So they finally took me to Parkland."

And that's when the most horrifying event occurred before Alexander's long battle with polio could even begin: "I had become immobile; I don't think I could even talk, so the hospital staff put me on a gurney in a long hallway with all the other hopeless polio kids. Most of them were dead."

That would have been Alexander's fate, too, if not for Dr. Milton Davis, a well-known pediatric cardiologist who was examining all of the children in the hallway. "He took one look at me, gathered me up in his arms, and I think he performed a tracheotomy on me almost immediately so I could breathe," Alexander said. "And the next thing I remember, I was inside an iron lung."

And then he blacked out.

Alexander woke up weeks later still in the iron lung: "The pain was still there, although it seemed much less to me, and the iron lung pumped hot steam through a thick plastic water pump into my chest. This kept the mucuous loose enough so I could breathe." 

He couldn't see through the steam at first, and he couldn't talk. But Alexander said he found some sort of determination within himself as strong as the iron in the device that was keeping him alive. "I decided I was going to fight this," he said. "I was going to have a life."

Eighteen months later, his parents brought him home. They stayed with him in shifts, fed him, helped him with school work (he was still enrolled in elementary school) and encouraged him to keep up his curiosity and enthusiasm for learning.

"My mother lobbied the school district for home-school learning, something very rare in the 1950s," he said. His dad fashioned a writing implement for him, similar to a T-square, which Alexander would put in his mouth and move around with his neck muscles in order to write.

Through their efforts and his own fierce determination, Alexander graduated high school as the class salutatorian. "I would have been valedictorian but the biology teacher gave me a B because I couldn't take lab," he joked.

Scholarships to Southern Methodist University in Dallas and the University of Texas in Austin allowed Alexander, with the help of a paid health aide, to get an undergraduate degree and then a law degree. He returned to the Dallas area and became associated with an Arlington law firm for a while, but eventually established a private practice that still handles everything from family law to financial cases.

"With help from a medical aide or one of my friends, I can get out of the lung and attend functions in a wheelchair or argue a case for a few hours," he said. "But I always have to remember to tell myself to inhale, exhale, inhale."

Alexander came to the attention this year of the leaders of the Dallas area's Rotary clubs through one of his doctors, Alexander Peralta, Jr., who is a Rotarian from Duncanville, Texas. 

Rotary International has been working with the Bill and Melinda Gates Foundation to eliminate polio worldwide, just as smallpox has been eradicated.

"One of our clubs, which is well-versed in modern technology (the Dallas e-Club) went to Paul's house and made a four-minute video with him," said Bill Dendy, District Governor of District 5810, which has 65 local Rotary clubs in the north Texas area.

"What none of us realized at first is what a compelling story this is, not only Paul's triumphs under difficult circumstances, but also what a terrifying experience it can be, just sitting in the presence of that machine that keeps him alive. The iron lung personalizes the horror all those thousands of kids went through a little more than half a century ago," Dendy said. The video they made has been submitted to the local PBS station in Dallas. 

Since making contact with Alexander, various district Rotary clubs have volunteered to make improvements to his house -- an old ramp leading to the front door was replaced -- and to be available to take him to his appointments. Throughout his life, Alexander has had a combination of help from health aides provided through the government and friends who pitch in.

Alexander said his iron lung is no longer supported by any company on an ongoing basis. The last company to service his machine, Philips Respironics, no longer does so. "So now, we have to strip spare parts from other discarded iron lungs to keep us going," he said. So far, it hasn't been a problem, he added: "There are only seven iron lung users left, so I don't think this is going to be a big problem of supply and demand."

How did he accomplish so much -- and keep his sense of humor -- while being virtually immobile for more than 60 years?

"It all starts with love," Alexander said. "My parents raised me in love. They taught me never to give up. They taught me the importance of relationships. They were always there for me.

"So, naturally, I had to reciprocate. And you know what? They were right. Anything is possible."

Source: www.medicinenet.com

By Meera Senthilingam

"It only takes one virus to get through for a person to be infected," explained Dr. John Mascola. This is true of any viral infection, but in this instance, Mascola is referring to HIV and his ongoing efforts to develop a vaccine against the virus. "It's been so difficult to make an HIV/AIDS vaccine."

Those were the words of many working in HIV vaccine development until the results of a 2009 trial in Thailand surprised everyone. "The field is energized," said Mascola, director of the Vaccine Research Center at the U.S. National Institute of Allergy and Infectious Diseases, describing the change in atmosphere in the vaccine community.

The trial included over 16,000 volunteers and was the largest clinical trial ever conducted for a vaccine against HIV. It was also the first to show any protection at all against infection.

Two previously developed vaccines, known as ALVAC-HIV and AIDSVAX, were used in combination, with the first priming an immune response against HIV and the second used as a booster once the immunity waned. The duo reduced the risk of contracting HIV by 31.2% -- a modest reduction, but it was a start.

To date, only four vaccines have made it as far as testing for efficacy to identify their levels of protection against HIV. Only this one showed any protection.

"That trial was pivotal," Mascola said. "Prior to that, it wasn't known whether a vaccine could be possible."

In recent years, there have been parallel findings of an equally pivotal nature in the field of HIV prevention, including the discovery that people regularly taking their antiretroviral treatment reduce their chances of spreading HIV by 96% and that men who are circumcised reduce their risk of becoming infected heterosexually by approximately 60%.

Both improved access to antiretrovirals and campaigns to increase male circumcision in high-risk populations have taken place since the discoveries, and although numbers of new infections are falling, they're not falling fast enough.

In 2013, there were 35 million people estimated to be living with HIV globally. There were still 2.1 million new infections in 2013, and for every person who began treatment for HIV last year, 1.3 people were newly infected with the lifelong virus, according to UNAIDS. A vaccine remains essential to control the epidemic.

A complex beast

Scientists like Mascola have dedicated their careers to finding a vaccine, and their road has been tough due to the inherently complicated nature of the virus, its aptitude for mutating and changing constantly to evade immune attack, and its ability attack the very immune cells that should block it.

There are nine subtypes of HIV circulating in different populations around the world, according to the World Health Organization, and once inside the body, the virus can change continuously.

"Within an individual, you have millions of variants," explained Dr. Wayne Koff, chief scientific officer for the International AIDS Vaccine Alliance.

HIV invades the body by attaching to, and killing, CD4 cells in the immune system. These cells are needed to send signals for other cells to generate antibodies against viruses such as HIV, and destroying those enables HIV to cause chronic lifelong infections in those affected.

Measles, polio, tetanus, whooping cough -- to name a few -- all have vaccines readily available to protect from their potentially fatal infections. But their biology is seemingly simple in comparison with HIV.

"For the older ones, you identify the virus, either inactivate it or weaken it, and inject it," Koff said. "You trick the body into thinking it is infected with the actual virus, and when you're exposed, you mount a robust immune response."

This is the premise of all vaccines, but the changeability of HIV means the target is constantly changing. A new route is needed, and the true biology of the virus needs to be understood. "In the case of HIV, the old empirical approach isn't going to work," Koff said.

Scientists have identified conserved regions of the virus that don't change as readily, making them prime targets for attack by antibodies. When the success of the Thai trial was studied deep down at the molecular level, the protection seemed to come down to attacking some of these conserved regions. Now it's time to step it up.

In January, the mild success in Thailand will be applied in South Africa, where over 19% of the adult population is living with HIV. The country is second only to bordering Swaziland for having the highest rates of HIV in the world.

"The Thai vaccine was made for strains (of HIV) circulating in Thailand," said Dr. Larry Corey, principal investigator for the HIV Vaccine Trials Network, which is leading the next trial in South Africa. The strain, or subtype, in this case was subtype B. "For South Africa, we've formed a strain with common features to (that) circulating in the population." This region of the world has subtype C.

An additional component, known as an adjuvant, is being added to the mix to stimulate a stronger and hopefully longer-lasting level of immunity. "We know durability in the Thai trial waned," Corey said. If safety trials go well in 2015, larger trials for the protective effect will take place the following year. An ideal vaccine would provide lifelong protection, or at least for a decade, as with the yellow fever vaccine.

A broad attack

The excitement now reinvigorating researchers stems not only from a modestly successful trial but from recent successes in the lab and even from HIV patients themselves.

Some people with HIV naturally produce antibodies that are effective in attacking the HIV virus in many of its forms. Given the great variability of HIV, any means of attacking these conserved parts of the virus will be treasured and the new found gold comes in the form of these antibodies -- known as "broadly neutralizing antibodies." Scientists including Koff set out to identify these antibodies and discover whether they bind to the outer coat of the virus.

The outer envelope, or protein coat, of HIV is what the virus uses to attach to, and enter, cells inside the body. These same coat proteins are what vaccine developers would like our antibodies to attack, in order to prevent the virus from entering our cells. "Broadly neutralizing antibodies" could hold the key because, as their name suggests, they have a broad remit and can attack many subtypes of HIV. "We will have found the Achilles heel of HIV," Koff said.

Out of 1,800 people infected with HIV, Koff and his team found that 10% formed any of these antibodies and just 1% had extremely broad and potent antibodies against HIV. "We called them the elite neutralizers," he said of the latter group. The problem, however, is that these antibodies form too late, when people are already infected. In fact, they usually only form a while after infection. The goal for vaccine teams is to get the body making these ahead of infection.

"We want the antibodies in advance of exposure to HIV," explained Koff. The way to do this goes back to basics: tricking the body into thinking it is infected.

"We can start to make vaccines that are very close mimics of the virus itself," Mascola said.

Teams at his research center have gained detailed insight into the structure of HIV in recent years, particularly the outer coat, where all the action takes place. Synthesizing just the outer coat of a virus in the lab and injecting this into humans as a vaccine could "cause enough of an immune response against a range of types of HIV," Mascola said.

The vaccine would not contain the virus itself, or any of its genetic material, meaning those receiving it have no risk of contracting HIV. But for now, this new area remains just that: new. "We need results in humans," Mascola said.

Rounds of development, safety testing and then formal testing in high-risk populations are needed, but if it goes well, "in 10 years, there could be a first-generation vaccine." If improved protection is seen in South Africa, a first-generation vaccine could be with us sooner.

Making an Impact

When creating vaccines, the desired level of protection is usually 80% to 90%. But the high burden of HIV and potentially beneficial impact of lower levels of protection warrant licensing at a lower percentage.

"Over 50% is worth licensing from a public health perspective," Koff said, meaning that despite less shielding from any contact with the HIV virus, even a partially effective vaccine would save many lives over time.

The next generations will incorporate further advancements, such as inducing neutralizing antibodies, to try to increase protection up to the 80% or 90% desired.

"That's the history of vaccine research; you develop it over time," Corey said. He has worked in the field for over 25 years and has felt the struggle. "I didn't think it would be this long or this hard ... but it's been interesting," he ponders.

But there is light at the end of tunnel. Just.

"There has been no virus controlled without a vaccine," he concluded when explaining why, despite antiretrovirals, circumcision and increased awareness, the need for a one-off intervention like a vaccine remains strong.

"Most people that transmit it don't even know they have it," he said. "To get that epidemic, to say you've controlled it, requires vaccination."

Source: www.cnn.com

The current measles vaccine - administered by an injection - is effective and safe, but experts say coverage could be made better by a vaccine that is easier to administer and transport. Now, a measles vaccine consisting of dry powder that is delivered with a puff of air has proven safe in early human trials and effective in previous animal trials.

Though many people living in the US consider measlesto be a thing of the past - thanks, in large part, to widespread vaccination efforts - the disease has made a comeback in recent years. 

In fact, 2014 has so far seen a record number of measles cases in the US, with 603 confirmed cases reported to the Centers for Disease Control and Prevention's (CDC) National Center for Immunization and Respiratory Diseases (NCIRD) between January 1st and October 31st.

The organization says this is the highest number of cases since measles elimination was confirmed in the US in 2000.

Measles is spread by droplets or direct contact with the nose or throat secretions of people who are infected, but it can also be spread through the air or by objects containing nose and throat secretions.

According to the World Health Organization (WHO), measles is "one of the most readily transmitted communicable diseases and probably the best known and most deadly of all childhood rash/fever illnesses."

In 2013, the disease killed 145,700 people worldwide - most of whom were children - despite an already existing effective injectable vaccine.

"Delivering vaccines in the conventional way, with needle injections, poses some serious challenges, especially in resource-poor parts of the world," says Prof. Robert Sievers, author of the latest study from the University of Colorado Boulder's Department of Chemistry and Biochemistry.

New vaccine safe, with evidence of positive immune response

To improve the delivery of the vaccine, Prof. Sievers and his colleagues created a dry delivery technique - that involves an inhalable, dry powder - in order to circumvent the need for injections and liquid storage, and to avoid risk of vaccine contamination.

In previous work, he and his team showed that their vaccine protected rhesus macaques and cotton rats from measles infection, and they also demonstrated that their dry vaccines can be safely stored for 6 months to 4 years at room temperature or in refrigerators kept at 36-46° F (2-8°C).

But their latest study heralds the success of the first phase 1 clinical trial for their vaccine in humans. "Out of an abundance of caution," says Prof. Sievers, "we test first in people who have already had the disease, or been injected earlier by needles with liquid vaccines."

As such, they enrolled 60 adult males aged 18-45 years who were already seropositive for the measles antibody. In the clinical trial, the researchers tested delivery of the powder using two devices and compared those two groups with a group that received the typical injection.

Results showed that the men from all three groups responded similarly and displayed no clinically relevant side effects. What is more, there was also evidence of a positive immune response to vaccination from the powder.

Any adverse events were recorded with diary cards for 28 days after the vaccination, and researchers followed the participants for 180 days post-vaccination to watch for any long-term adverse events. Additionally, the team measured measles antibodies 7 days before vaccination and 21 and 77 days after vaccination.

Commenting on their new dry vaccine, Prof. Sievers says:

"You don't need to worry about needles; you don't need to worry about reconstituting vaccines with clean water; you don't need to worry about disposal of sharps waste or other vaccine wastage issues; and dry delivery is cheaper."

Vaccine trials in humans are ongoing

Though their trial demonstrated that their powder vaccine is safe, because the men were already immune to measles, it could not compare effectiveness of the vaccines.

"It is very good news that we encountered no problems," says Prof. Sievers, "and now we can move on."

He and his team plan to continue their research through phase 2 and 3 trials in people who are not yet immune to measles, including women and children.

The research was funded by a $20 million grant from the Foundation for the National Institutes of Health, with support from the Bill and Melinda Gates Foundation. It should be noted that the authors of the paper include researchers from the Serum Institute of India, Ltd. - the largest manufacturer of childhood vaccines used in developing countries.

Additionally, Prof. Sievers is president and CEO of Aktiv-Dry, LLC, a Colorado-based company that provides dry powder solutions for the vaccine, pharmaceutical and biotechnology industries.

By Sara Cheshire

Can we predict the future of medicine? Although designer babies and a disease-free world may or may not come to pass, you can get a glimpse of the most promising and upcoming medical innovations each year, via the Cleveland Clinic.

The clinic's Top 10 Medical Innovations list, which has been an annual undertaking since 2007, contains treatments and technologies that are expected to significantly change patient care and save lives.

To be considered, each innovation must have a good chance of being available to the public in the upcoming year, says Dr. Michael Roizen, chief wellness officer at the Cleveland Clinic and chairman of the committee that decides the list. The committee must also expect it to have a significant impact on a large part of the population.

The process starts with a panel of Cleveland Clinic physicians and scientists who submit their ideas. These suggestions, which Roizen said totaled about 700 for the 2015 list, are then narrowed down and voted on by 40 physicians in a variety of health fields.

Here's what they selected for 2015:

1. Mobile stroke unit

Videoconferencing has made its way into ambulances, specifically for treating stroke victims on the go. Hospital stroke neurologists can interpret symptoms via a broadband video link and instruct an onboard paramedic, critical care nurse and CT technologist on treatment. This new technology should improve the speed of medical care, which is important as strokes quickly damage and kill brain cells.

2. Dengue fever vaccine

The World Health Organization reports that about half of the world's population is now at risk for dengue fever, which up until now was preventable only by avoiding mosquito bites. The disease is a leading cause of death and illness in children in some countries. A new vaccine has been developed and tested, and is expected to be available in 2015.

3. Painless blood testing

For those who hate large needles, a nearly painless way to sample blood will be a welcome relief. Plus, it will be cheaper and provide faster results than today's blood test. The new technology takes blood from your fingertip, and the Cleveland Clinic reports that over 100 tests can be performed on just one drop of blood.

4. New way to lower cholesterol

New self-injectable drugs called PCSK9 inhibitors have shown to be very effective in lowering cholesterol. These drugs may prove to be helpful for people with high LDL cholesterol who don't have good results with statins. The FDA is expected to approve the first PCSK9 in 2015.

5 ways to lower cholesterol

5. Cancer drug that doesn't harm healthy tissue

Although chemotherapy can save lives, it can be hard on the body and attack healthy cells as well as cancerous ones. A welcome breakthrough in the world of cancer treatment, antibody-drug conjugates can deliver targeted treatment without damaging healthy tissue.

6. Immune booster for cancer patients

Immune checkpoint inhibitors have been shown to prevent cancer cells from "hiding" from the immune system, allowing the body to more effectively fight these abnormal cells. Combined with chemotherapy and radiation treatment, the drugs have shown significant, long-term cancer remissions for patients with metastatic melanoma, one of the most deadly forms of cancer.

7. Wireless cardiac pacemaker

Until this point, wires have been a necessary component in pacemakers. A new wireless pacemaker about the size of a vitamin can now be implanted in the heart without surgery. Its lithium-ion battery is estimated to last about seven years.

8. New medications for idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis is a life-threatening disease that causes scarring in the lungs, leading to breathing difficulties and a shortage of oxygen in the brain and other organs. Life expectancy is only three to five years after diagnosis, but those numbers may change now that the FDA has approved two experimental drugs that slow the disease: pirfenidone and nintedanib.

9. Single-dose radiation therapy for breast cancer

The National Cancer Institute estimates that 40,000 women in the United States will die from breast cancer in 2014. The Cleveland Clinic cites multiple chemotherapy appointments, sometimes requiring the patient to travel long distances, as a hindrance to successful treatment. Intraoperative radiation therapy is a new solution. It treats a breast cancer tumor during surgery in a single dose, reducing time and cost spent on treatment.

10. New drug for heart failure

About 5.1 million people in the United States suffer from heart failure, according to the National Heart, Lung and Blood Institute. It is managed with a combination of drugs, but a new drug, angiotensin-receptor neprilysin inhibitor, has been granted fast-track status by the FDA because of its ability to cut the risk of dying from heart failure more effectively than current treatments.

For more information on the annual medical innovations list, including descriptions and videos, download the "Innovations" app or visit the website. A "where is it now" feature also includes updates on innovations that made the top 10 list in prior years.

"We look in past to see what we voted on to improve the process," Roizen said. "With one exception, we've been pretty good."

Source: www.cnn.com

By Caleb Hellerman

Earlier this week, Brian Shepherd sat down in a small doctor's office in Bethesda, Maryland. A technician swabbed his arm and gave him a quick jab with a needle.

With that, Shepherd became subject No. 13 in the experiment testing a potential Ebola vaccine.

The trial was launched on an emergency basis earlier this month by the National Institute on Allergy and Infectious Disease. It's the first to test this kind of Ebola vaccine in humans.

"It's not just for the money," Shepherd wrote in a Reddit AMA. "I'm very interested in translational research and experiencing it from the guinea pig side is very rewarding. But yeah, the money helps. This one study will fund most of my grad school application costs, though not in time for application season."

The vaccine doesn't use live virus and can't infect volunteers with Ebola. Instead it uses specific Ebola proteins to trigger an immune response. They're delivered through the body on a modified version of an adenovirus, a type of cold virus.

In the initial phase, 10 healthy volunteers were given a low dose of vaccine. They were monitored for side effects and tested to see if their bodies are producing antibodies. In the second phase, of which Brian is a part, an additional 10 volunteers are being given a higher dose.

All participants will be followed for nearly a year and tested at regular intervals.

Shepherd, who has volunteered for several prior research studies at NIH, spoke with CNN about his experience.

The following is a condensed version of that conversation:

CNN: How did you come to join the study?

Brian Shepherd: I actually work at NIH; I'm a post-doc researcher in a developmental biology lab. Most trials I learn about from reading a ListServ (email list).

I heard about the vaccine study from going to preliminary meetings for a different study.

CNN: When was this?

Shepherd: Less than a month ago. I had my first appointment on August 26. It was just a sit-down, to talk about the trial, go through paperwork and consent forms, explaining what the trial was for. Then they did an initial run-through of my health history.

CNN: What was next?

Shepherd: The next week I had my second appointment. They did a full physical, blood work, health history, breathing checks. A lot of poking and prodding. My third visit was Wednesday. They drew blood, then gave me a shot. Now, my next appointment is Sunday.

CNN: What was it like? You wrote that pulling off the Band-aid was the worst of the pain.

Shepherd: I'm supposed to keep a daily diary for the first seven days, logging my temperature and any symptoms. The next morning, I woke up with a slight fever, 100.5. I took some Tylenol and it went away.

Other than that I feel fine. In fact, I ran a half-mile in a relay race at lunchtime with some people from work.

CNN: You wrote that for each of these regular visits, you're paid $175. How many times have you been a human guinea pig?

Shepherd: This is my second drug trial. Before that, I did mostly MRI studies.

The first one I did, I was in the MRI machine and had three tasks. They gave me two buttons and showed pictures. If it was Spiderman, I'd hit one button; if it was the Green Goblin, I'd hit the other. So I spent 15 minutes playing Spiderman vs. Green Goblin.

CNN: Did you have any reservation at all, taking part in this Ebola vaccine trial?

Shepherd: None at all.

Source: http://www.cnn.com

By KAREN KAPLAN

Another influenza season is in the books, and overall it caused less sickness and death than flu seasons in the recent past, according to a new report from the Centers for Disease Control and Prevention.

Between Sept. 29, 2013, and May 17, 2014, a total of 53,471 specimens sent to U.S. labs tested positive for a flu virus. Among them, 87% were influenza A viruses, and the most common of these were versions of the H1N1 virus that prompted the swine flu epidemic in 2009. The other 13% of the confirmed specimens were influenza B viruses.

The CDC findings, which were published Thursday in the Morbidity and Mortality Weekly Report, did not estimate a total number of flu deaths for the 2013-14 flu season. But based on records kept by doctors and hospitals, researchers concluded that flu activity in the last year resulted in “lower levels of outpatient illness and mortality” compared with years when the predominant strains were versions of the H3N2 virus.

At least 96 children died of the flu in the last year, laboratory tests confirmed. Those deaths were reported in 30 states, New York City and Chicago. In about half of these cases, the patients had at least one preexisting condition, such as a neurologic disorder or a pulmonary disease, that may have made them more vulnerable to the flu.

The most striking statistic in the report is the rate of hospitalization among people between the ages of 50 and 64. Over the course of the entire flu season, the cumulative hospitalization rate for these adults was 54.3 per 100,000 people. In the previous four years, that figure has been as low as 8.1 and it never topped 40.6.

The report noted one human case of a H3N2 virus that was first spotted in pigs in 2010 and was identified in a dozen people the following year. The new case was a child from Iowa who had direct contact with pigs. The patient fully recovered, apparently without spreading it to relatives or anyone else, according to the CDC.

The vaccine for the 2014-15 flu season will be based on the same four viruses, the CDC said.

Source: latimes.com