Issue
Number 317
June 3, 2002
CONTENTS OF THIS ISSUE
- New England Journal
of Medicine article describes how to recognize
and manage smallpox
- WHO presents new
"Global Agenda on Influenza"
- IOM study finds no
link between hepatitis B vaccine and
demyelinating neurological disorders
- Download "The ABCs
of Childhood Vaccines" presentation from CDC's
website
- Rotary Foundation
receives 2002 Gates Award for Global Health
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June 3, 2002
NEW ENGLAND JOURNAL OF MEDICINE ARTICLE DESCRIBES HOW TO
RECOGNIZE AND MANAGE SMALLPOX
The New England Journal of Medicine (NEJM) featured
articles on smallpox in its April 25, 2002, issue (vol.
346, no. 17) in response to national concerns about a
possible release of smallpox (variola) virus by
terrorists. New research on the efficacy of and reactions
to diluted smallpox vaccine was presented.
Because smallpox was eradicated as a naturally occurring
disease over 20 years ago, few physicians know
how to diagnose it now for purposes of
treatment and post-exposure vaccination of known
contacts. For that reason, as noted
in the editorial statement to the issue, a review article
was included "to help medical
professionals recognize and treat [smallpox] if
and when it occurs."
"Current Concepts: Diagnosis and Management of Smallpox,"
written by Joel G. Breman, M.D., D.T.P.H.,
and D. A. Henderson, M.D., M.P.H., includes a
thorough discussion of the disease's pathogenesis,
transmission, clinical manifestations, and
diagnosis as well as vaccination. Figure 1 shows
clinical manifestations and immune response
along a timeline. Tables outline (1) other eruptive
illness that can be misdiagnosed as
smallpox and (2) important differences between
severe chickenpox and smallpox.
The section on Emergency Reporting reads in part as
follows (excluding footnotes):
*****************************
A possible case of smallpox is a public health emergency
and of utmost international concern. State health
officials should be contacted immediately, and the
diagnosis confirmed in a Biological Safety Level 4
laboratory where staff members have been vaccinated. The
state officials should contact the CDC at any
time of the day or night (telephone number,
770-488-7100). The CDC, in turn, will inform the
WHO [World Health Organization]
Department of Communicable Diseases Surveillance and
Response Unit in Geneva, Switzerland.
After the patient has been isolated, interviews should be
conducted to identify contacts. The contacts should
be vaccinated as soon as possible and not
more than two or three days after exposure.
Smallpox vaccination within
this period offers substantial protection, which is the
rationale, in part, for the current
policy of not launching a program of widespread
vaccination of health care personnel before an
outbreak has occurred.
*****************************
The "ring vaccination and containment strategy" of
managing a possible international release of smallpox is
also discussed, followed by information on current and
projected vaccine supply.
To obtain a camera-ready (PDF format) copy of "Diagnosis
and Management of Smallpox," go to:
http://content.nejm.org/cgi/reprint/346/17/1300.pdf
To see the contents of the entire issue of NEJM, go to:
http://content.nejm.org/content/vol346/issue17/index.shtml
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June 3, 2002
WHO PRESENTS NEW "GLOBAL AGENDA ON INFLUENZA"
On May 31, 2002, the World Health Organization (WHO)
published the full text of the "Global Agenda on
Influenza Surveillance and Control" in the
Weekly Epidemiological Record (WER; vol. 77, no.
22). The Global Agenda was
developed during 2001 and was finalized by the 65
participants of the WHO Consultation on
Global Priorities in Influenza that was held in
Geneva, Switzerland, on May 6 and 7 of this
year.
Major themes in the Global Agenda include: improvement in
influenza surveillance; improvement in
understanding the burden of influenza and the
benefits of epidemic and pandemic preparedness;
expansion of the use of existing vaccines,
particularly in developing countries and in
high-risk groups; and acceleration of introduction
of new vaccines.
To read the Global Agenda in WER, go to:
http://www.who.int/wer
To read the Global Agenda and learn about its background,
go to:
http://www.who.int/emc/diseases/flu/index.html
To read WHO's Influenza Fact Sheet, go to:
http://www.who.int/inf-fs/en/fact211.html
If you have questions about the Global Agenda, contact WHO
by email at
globalagenda@who.int
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June 3, 2002
IOM STUDY FINDS NO LINK BETWEEN HEPATITIS B VACCINE AND
CERTAIN DEMYELINATING NEUROLOGICAL
DISORDERS
On May 30, 2002, the Institute of Medicine (IOM) released
the latest report of the Immunization Safety
Review Committee. "Hepatitis B Vaccine and
Demyelinating Neurological Disorders" examines the
hypothesis that hepatitis B vaccine could
cause multiple sclerosis (MS), Guillain-Barre
syndrome, and four other diseases that
damage or destroy the myelin that surrounds the body's
nerve fibers. The committee
determined that hepatitis B vaccine does not lead
to MS in adults and that existing evidence is
insufficient for the other diseases.
The abstract to the Executive Summary states: "[T]he
committee found that the epidemiological evidence
(i.e., from studies of vaccine-exposed
populations and their control groups or of
patients with these diseases and
their control groups) favors rejection of a causal
relationship between the hepatitis B vaccine
in adults and multiple sclerosis. The
evidence was inadequate to accept or reject a
causal relationship between the
hepatitis B vaccine and all other demyelinating
conditions."
The report will soon be published by the National Academy
Press (NAP) in book form. The approximately
95-page book will cost $18.00 (14.40 if purchased
on the NAP website). Prepublication proofs are not
available for general purchase for
this title.
A camera-ready (PDF format) version of the report's Executive
Summary is available at:
http://www.iom.edu/iom/iomhome.nsf/WFiles/HepatitisB_ExecSummary/$file/HepatitisB_ExecSummary.PDF
To read all or part of the report online, go to:
http://www.nap.edu/books/0309084695/html/index.html
For more information, call the National Academy Press at
(800) 624-6242.
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June 3, 2002
DOWNLOAD "THE ABCs OF CHILDHOOD VACCINES" PRESENTATION
FROM CDC'S WEBSITE
The Centers for Disease Control and Prevention (CDC) now
offers an "ABCs of Childhood Vaccines"
PowerPoint slide series for parents and
others who have a special interest in childhood
vaccines. All ready to be downloaded from
the CDC website, the five parts of the presentation can
be used together or independently.
The five parts of the colorful presentation are:
Vaccine Safety, Risks of Not Vaccinating, How Vaccines
Work, Natural Immunity, and Primary Vaccinations.
Easy downloading instructions accompany the description
of the presentation on the main page. Also
offered are instructions for printing slides in
black and white, text-only files, and a flyer to
promote the presentation
as a teaching tool.
To access the "ABCs of Childhood Vaccines" main page, go
to:
http://www.cdc.gov/nip/vaccine/ABCs/default.htm
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June 3, 2002
ROTARY FOUNDATION RECEIVES 2002 GATES AWARD FOR GLOBAL
HEALTH
In recognition of its contributions toward polio
eradication and other public health issues, the Rotary
Foundation of Rotary International has been granted the
2002 Gates Award for Global Health. The
Global Health Council, which administers the
award, chose from a large field of nominated
organizations. Bill Gates, Sr., was
scheduled to present the award to Rotary Foundation
Trustee Chairman Luis Vicente Giay at a May
30 dinner as part of the Global Health Council's
29th annual conference.
According to the Global Health Council, "Rotary has
contributed over US$462 million toward polio
eradication, and has mobilized over one
million Rotary members to help immunize more than
2 billion children in 122 countries."
Other Rotary activities include a revolving loan program
for women in Uganda to break the link
between AIDS and chronic poverty and a project in
the Philippines to provide
free tuberculosis screening and treatment for
children of pre-school or elementary age.
To learn more about Rotary International, go to:
http://www.rotary.org
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