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Shingle vaccine very effective against post-herpetic neuralgia

 MD-FM Thursday April 18, 2013





Sarah :

MD FM — Medical News from around the the world with Peter Goodwin



PETER: Hello, and to begin with: the shingles vaccine is very effective at a population level, however, vaccination of the elderly is very low...

SARAH: Yes: In a study published in PLoS Medicine, which included more than 766,000 older individuals, researchers found that the vaccine was highly effective even in individuals with immunosuppression.

Bob-Langan-1: There was basically halving of incident zoster in people who were vaccinated, and it’s also highly effective against post-herpetic neuralgia, which is really where the main public health burden comes from shingles. And these findings are important because they’re actually very similar to what was shown in the randomized trials 

SARAH: That was the lead author of the study, Sinéad Langan, from the UK, whose team led the first cohort study to assess vaccine effectiveness in individuals from unselected general populations in the United States –not restricted by insurance, geographical region or immune status.

PETER: The vaccine hasn’t been introduced in Europe yet, has it?

SARAH: No, but in the US it’s recommended for everyone over 60 who is not immunosuppressed. However, the team found that that vaccine uptake was extremely low: only about 4% of the study population received vaccination. This was particularly the case among black people and those with evidence of low income.

Bob-Langan-2: First of all it’s an expensive vaccine --it costs about 200 dollars per shot and that doesn’t necessarily include administration costs. There are a lot of other issues because this is actually a vaccine that’s usually kept frozen, and a lot of physicians don’t have freezers in their offices. There’s a lot of confusion also about billing and reimbursement of the vaccine. So I think it’s cost and administrative issues that are really the key barriers to vaccination. So we need to target that and try to improve vaccine uptake, particularly in the subgroups that are really less likely to get vaccinated 

SARAH: Again that was Dr. Langan, from the UK.






PETER: Some babies’ colics could be early manifestations of migraines…

SARAH: Yes, a case control-study in JAMA, including 800 children, reports that children with migraine were more likely to have experienced infantile colic than those without migraine:  a surprizing 72 percent vs. 26 percent! The lead author, Luigi Titomanlio, suggested a hypothetic common mechanism at play:

Bob-Titomanlio-1: When we suffer from migraine attacks, you have an inflammation around the brain vessels --this leads to pain. We can imagine that children with colics suffer from a similar sensitization of the perivascular nerve terminals in the gut, and so this leads to abdominal pain, crying, fussing in the first month of life. 

SARAH: That was Dr. Titomanlio, from France, who added:

Bob-Titomanlio-2: It’s very interesting for colic because it’s a benign condition but it has a high impact in families, because it’s painful for the babies and it’s a source of stress for parents. There is currently no therapy for colic and so understanding why babies feel pain is important to provide a better care. 

SARAH: Dr. Titomanlio said is still too early to change the practice:

Bob-Titomanlio-3: Our results do not change the current approach to colic. It’s a proof of concept –so we understand now that colic and migraine are probably the same disease. Future studies should be planned to understand if we can treat colic infants with anti-migraine treatments, and we’ll see what will happen in the future. But now the current approach to colic infants is the same. 

SARAH: Dr. Titomanlio, from France.



PETER: A study in Jama Neurology suggests glucocerebrosidase gene mutations are risk a factor for dementia with lewy bodies : The researchers found a significant association between mutation carrier status and dementia, with an odds ratio of 8.28. The mean age at diagnosis of dementia was earlier in mutation carriers than in non-carriers (63 vs. 69 years) with higher disease severity scores.





PETER:  Researchers from the United States Center for Disease Control and Prevention are calling for an enhanced surveillance for infections by new influenza A virus called H7N9


SARAH: Yes, this is in reaction to a case report in the NEJM on 3 patients who are severely ill after having been infected by the virus in China. Because this strain had not been detected in humans or animals before, it raises serious concerns. Molecular diagnostic assays that can specifically detect H7N9 have been developed in China and are in development in other countries.

PETER: Are there signs of a possible pandemic?

SARAH: So far, Chinese officials report that human to-human transmission is not occurring. But efforts have to be deployed to further evaluate the virus’s transmission potential.

PETER: Where does the virus come from?

SARAH: The animal reservoir appears to be birds. The whole viral genome was made available extremely rapidly, and shows that the virus has a low pathogenic level among birds, which remain asymptomatic. This could potentially lead to a “silent” spread of the virus, which also appears to be better adapted than other avian influenza viruses at infecting mammals...

PETER: Any recommendation regarding treatment?

SARAH: Oral oseltamivir or inhaled zanamivir should be administered to patients with suspected or confirmed H7N9 virus infection as soon as possible. But more research is urgently needed on new antiviral agents and drugs with different mechanisms of action. 




PETER:  A study illustrates how weight changes at the population level can trigger great reductions in diabetes and cardiovascular mortality. Sarah?

SARAH: Yes, the team showed that the economic crisis that occurred in Cuba between 1991 and 1995, which caused extreme food and fuel shortages, was associated with a population-wide loss of 4-5 kg and accompanied by dramatic reductions in diabetes and cardiovascular mortality. To do so, the researchers, from Spain, Cuba and the United States, studied data on 1000 to 2000 individuals in Cuba.

Bob-Franco-1: This is a population that is very homogenous, that means that when changes in the population happen, those changes happen in the whole population. 

SARAH: That was Manual Franco, from Spain, lead author of the BMJ study. The team then showed that, as the crisis resolved, the population’s rebound in body weight was associated with a rise in diabetes incidence and mortality and a leveling off of the decline in cardiovascular mortality. Dr. Franco said these findings highlight the importance of implementing population-wide health policies at a more global scale, to reduce obesity:

Bob-Franco-2: We have to think about how the whole population can move from one risk level to the other. If everybody does more physical activity, everybody eats less, cardiovascular diseases and diabetes can be prevented, and this is one very important question for public health. Policies that directly relate to food distribution are the ones that will probably have more effect and then, on the side of physical activity, transportation policies are fundamental. 

SARAH: Dr. Franco, from Spain.



BREVE 1 Sur fond musical

PETER: Finally, in brief: Simple aspiration and drainage followed by intrapleural minocycline pleurodesis is a safe and more effective treatment option for primary spontaneous pneumothorax than is simple aspiration and drainage only—the current standard approach. These are the findings of a randomized trial published in The Lancet, which reported a recurrence rate of 29.2% at one year in the minocycline group vs. 49.1% in the standard approach group.


And …..



A randomized study in Jama Internal Medicine suggests a home-based intensive and long-term exercise program was beneficial for patients with Alzheimer’s disease, whose physical functioning appeared to deteriorate less rapidly than that of patients receiving usual community care. In addition, this approach apparently did not increase costs of health and social services or cause any significant adverse effects.

 That's all from MDFM for now. We'll be back next week


Previous editions


Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)

Best of Science in Nutrition 2013: Yogurt for a healthier diet (EB & IUNS 2013)
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