The comparative efficacy and safety of herpes zoster vaccines: A network meta-analysis

BackgroundWe estimated the relative efficacy and safety of vaccines for prevention of herpes zoster (HZ) using network meta-analysis (NMA) based on evidence from randomized controlled trials.MethodsA systematic literature review evaluated two different HZ vaccines: adjuvanted recombinant zoster vaccine (RZV) and zoster vaccine live (ZVL), with different formulations assessed. Detailed feasibility assessment indicated that a NMA was feasible for efficacy (incidence of HZ and postherpetic neuralgia [PHN]) and safety (serious adverse events [SAE] and reactogenicity [injection-site reactions, systemic reaction]) outcomes. Primary analyses included frequentist NMAs with fixed effects for efficacy outcomes, due to limited data availability, and both fixed and random effects for safety and reactogenicity outcomes. As age is a known effect modifier of vaccine efficacy (VE), VE analyses were stratified by age.ResultsRZV demonstrated significantly higher HZ efficacy than ZVL in adults ≥60 years of age (YOA) (VE_RZV = 0.92 (95% confidence interval [95%CI]: 0.88, 0.94), VE_ZVL = 0.51 (95%CI: 0.44, 0.57)) and adults ≥70 YOA (VE_RZV = 0.91 (95%CI: 0.87, 0.94), VE_ZVL = 0.37 (95%CI: 0.25, 0.48)). Similarly, RZV demonstrated significantly higher PHN efficacy than ZVL in adults ≥60 YOA (VE_RZV = 0.89 (95%CI: 0.70, 0.96), VE_ZVL = 0.66 (95%CI: 0.48, 0.78)) and adults ≥70 YOA (VE_RZV = 0.89 (95%CI: 0.69, 0.96), VE_ZVL = 0.67 (95%CI: 0.44, 0.80)). RZV was associated with significantly more injection-site and systemic reactions compared to most formulations of ZVL and placebo, however definitions and data collection procedures differed across the included studies. There were no statistically significant differences found between RZV and any formulation of ZVL or placebo for SAEs.ConclusionRZV is significantly more effective in reducing HZ and PHN incidence in adults ≥60 YOA, compared with ZVL. As anticipated with an adjuvanted vaccine, RZV results in more reactogenicity following immunization. No differences in SAEs were found between RZV and ZVL.     

Risk assessment: Foodhandling practices and food-contact surfaces of hawkers in Malaysia

Risk assessment, as a supplement to epidemiological data, provides invaluable food safety assurance information to help prevent foodborne illnesses. A study of foodhandling practices (FHP) and food-contact surfaces (FCS) by methods of risk assessments was carried out in spring 1998. Aimed at determining the extent of risk concerns in FHP and FCS, 36 samples of three ethnic origins (Malay, Chinese and Indian) and in three designated hawker sites in Kuala Lumpur were pre-defined. The FHP were assessed based on 13 main constructs in three distinct areas of cleaning and cleanliness, personal hygiene and training and time/temperature control and cross-contamination. The FCS were assessed based on the contamination levels of work surfaces (WS), chopping boards (CB) and dishcloths (DC). The findings showed high concerns for FHP in general. FCS findings for the ethnic hawker foods showed high concern for Nasi Lemak , and moderate to high concerns for Char Koay Teow and Roti Canai . The FCS results were used in an attempt to validate the findings of the FHP. Pearson bivariate correlations, however, showed no association between FHP and FCS scores. Findings of this study provide: (1) useful risk indicators for three popular and traditionally ethnic hawker foods; (2) a yardstick for monitoring the hawkers using standardised risk assessment; and (3) useful feedback for the government/control authority on the need for intervention in the surveillance of hawkers and hawker foods.     

Missed hepatitis B birth dose vaccine is a risk factor for incomplete vaccination at 18 and 24 months

1. Download high-res image (163KB)
2. Download full-size image

     

Vaccines for Health Care Personnel

Medical Center Occupational Health (MCOH) programs must protect health care personnel (HCP) against the occupational risk of vaccine-preventable diseases. This thematic review outlines the rationale for the use of recommended vaccines in HCP; summarizes the available evidence regarding vaccine effectiveness, administration, and assessment of immunity; and provides guidance for MCOH programs navigating challenging situations.     

Knowledge,Attitudes, and Behavior of the Parents of Asthmatic Children in Maputo

Asthma is increasing in frequency worldwide. The education of affected children and their parents is fundamental for the management of the disease. The aim of our study was to describe the knowledge, attitudes, and behavior of the parents of asthmatic children. We studied 152 adults accompanying asthmatic children to consultations in the pediatrics department of Maputo Central Hospital (Mozambique). In general, knowledge about asthma was poor: 11% of the adults thought that asthma was contagious and transmitted from person to person, and 4% thought that it was transmitted by contaminated food. More than half the parents thought that the child could not lead a normal life even during the periods between attacks. A large proportion of the parents thought that asthma could be cured by medical treatment in 7% of cases and by alternative treatment in 43% of cases. The precipitating factors were well identified by the adults, but they had an inaccurate perception of the symptoms of an asthma attack. The actions of the various classes of drugs used were poorly understood. Education programs for both the children and their parents should be developed to improve the management of asthmatic children. Surveys of this type facilitate the targeting of such programs.     

Immuno-enhancement effects of Shenqi Fuzheng Injection on cyclophosphamide-induced immunosuppression in Balb/c mice

Ethnopharmacological relevance

Radix Codonopsis and Radix Astragali, of which Shenqi Fuzheng Injection (SFI) is composed, are commonly used in traditional Chinese medicine to improve immune function against chronic diseases.

Aim of the study

The present study was thus designed to systematically elucidate the in vivo immuno-enhancement effects of SFI in immunosuppressed mice induced by cyclophosphamide (Cy) treatment.

Materials and methods

Balb/c mice were injected intraperitoneally (i.p.) once daily with low-dose (2.5 g raw materials/kg), intermediate-dose (5 g raw materials/kg), high-dose (10 g raw materials/kg) of SFI for 10 consecutive days, respectively, accompanied by i.p. injection of Cy (80 mg/kg) on Days 4-6.

Results

Compared with vehicle group, low-, intermediate- and high-dose SFI treatment accelerated recovery dose-dependently of spleen index, peripheral white blood cell and bone marrow cell counts, enhanced T cell and B cell proliferation responses, as well as splenic nature killer cell activity and peritoneal macrophage phagocytosis, and restored the level of interleukin-2 in the serum. Furthermore, SFI treatment promoted recovery of the amount of peripheral white blood cells on Day 6, rather than recombinant human Granulocyte Colony-Stimulating Factor (rhG-CSF) did.

Conclusions

These results demonstrate, for the first time, that chronic treatment with SFI results in accelerating recovery of immunosuppression in Cy-treated mice, which is competent in taking into consideration for both precautions and remedy. Our findings provide experimental evidences for further researches and clinical application in cancer patients undergoing chemotherapy.     

肌沟穴药物封闭、穴位点压、一次性手法松解术分期治疗肩关节周围炎400例临床观察

[目的]观察肌沟穴药物封闭、穴位点压、一次性手法松解术分期治疗肩关节周围炎疗效。[方法]将400例住院患者(Ⅰ期94例、Ⅱ期204例、Ⅲ期102例),根据肩关节周围炎分期特点,分别采用肌沟穴药物封闭(Ⅰ期)、穴位点压(Ⅱ期)、一次性手法松解术(Ⅲ期),观察临床症状、肩关节及上肢活动。根据患者不同分期,选择相应方法治疗,随访30d,判定疗效。[结果]Ⅰ期94例均痊愈;Ⅱ期204例痊愈184例,好转20例,Ⅲ期102例均痊愈。总痊愈率95.00%(380/400)。[结论]肌沟穴药物封闭、穴位点压、一次性手法松解术治疗肩关节周围炎疗效满意。     

手法配合中药热罨包治疗腰椎间盘突出症105例

自2009年～2010年,采用中医正骨手法配合中药热罨包治疗腰椎间盘突出症105例均获得了很好的疗效,症状改善率提高,复发率降低,治疗时间缩短。最终提高了生活质量,提高了劳动能力,社会效益显著,从而降低病人的总体医疗费用,提高经济效益。因此,具有很高的临床应用和推广价值。     

Prevalent cord-stump care practices among mothers of infants: Against the backdrop of chlorhexidine digluconate gel scale-up

Within the context of Chlorhexidine scale-up, this cross-sectional study explores umbilical cord-stump care practices of mothers of infants in Enugu-North, and their perspectives on specific issues fueling unhygienic cord-stump care practices. Quantitative data were collected from 397 participants using a structured questionnaire. Cumulatively, 29.2% of the respondents resorted to unhygienic substances for cord-stump-care, and 11.3% of them used Chlorhexidine for care. Compared to mothers within the ‘22-26-year-old’ category, mothers within the ‘17-21-year-old’ category were more likely to desire a short time-to-cord-separation (OR = 2.1; 95% CI = 1.0–4.5). First-time mothers (OR = 5.9; 95% CI = 3.5–10.2) and younger mothers (OR = 152.8; 95% CI = 36.2–891.1) were more likely to yield to gatekeepers' opinions on newborn-care compared to non-first-time mothers and older mothers (32-40-year-old category), respectively. This study identifies putative predictors of newborn-care decisions within the context of Chlorhexidine scale-up. Further, the prevalence of Chlorhexidine use was low, and the use of unhygienic substances was significant.