Research | Anaphylactic shock after vaccination ‘extremely rare’
BMJ-British Medical Journal | 23 Jan 2012
A sudden, serious allergic reaction—known anaphylaxis or anaphylactic shock— following vaccination, is “extremely rare,” concludes research published online in the Archives of Disease in Childhood.
Anaphylaxis can be fatal and can be triggered by several factors, including specific foods, airborne allergens, stings and bites, and drugs/vaccines.
But because anaphylaxis is rare, it is usually very difficult to pick this up as a potential side effect of a new treatment during clinical trials. Manufacturers have to rely on data collected after the product has come to market.
The authors base their findings on children under the age of 16 in the UK and Ireland, who were suspected of having experienced anaphylaxis after being vaccinated between 2008 and 2009.
All the cases came from specialists, who were asked to report on any child they treated with suspected or actual anaphylaxis following a vaccination during this period to the British Paediatric Surveillance Unit.
During this time, 15 cases were reported following vaccination with the single measles jab; the HPV jab which is used to protect against cervical cancer; two types of vaccine for meningitis; a hepatitis A vaccine; typhoid vaccine; and a school leaver’s booster jab (probably tetanus/polio).
Only seven of these cases were confirmed as anaphylaxis. Six children required an injection of adrenaline and intravenous fluids. All made a full recovery; one child recovered without treatment.
Three of these children already carried injectable adrenaline, which is used to treat severe allergic reactions.
Two of the cases were associated with the single component measles vaccine. As more than 16,000 doses were imported over the study period, this gives an incidence of 12 cases of anaphylaxis for every 100,000 doses, say the authors.
Three of the cases were associated with the HPV vaccine. More than two million doses of this vaccine were administered during the study period, giving an incidence of 1.4 cases per million doses.
None of the cases were associated with the normal pre-school or infant immunisation schedule, including the triple MMR jab.
And around 5.5 million children would have received routine vaccinations during this period without any reported cases of anaphylaxis, say the authors.
“This is extremely reassuring data for the general public and healthcare workers alike,” they conclude. “Despite its limitations, the small numbers of cases reported are likely to be a true estimate of anaphylaxis [following immunisation] rates.”
Research | What type of helmet is best for winter play?
Children’s Hospital of Eastern Ontario Research Institute | 20 Jan 2012
It’s not winter in Canada if children don’t spend time speeding down the slopes! Canadian tobogganing is a tradition handed down from generation to generation. For a long time, it’s been considered one of the safest winter activities.
Unfortunately, the arrival of winter is followed by an increase in visits to hospital emergency departments by young people presenting with head injuries resulting from winter activities, including tobogganing. Fortunately, helmets are known to reduce the risk of head injury; but with so many helmet options available today, which is the best one? Dr. Michael Vassilyadi from the Children’s Hospital of Eastern Ontario (CHEO) Research Institute, together with a research team at the University of Ottawa, put this question to the test. The results are published today in the Journal of Neurosurgery: Pediatrics.
“In activities such as tobogganing or skiing, children are able to attain very high velocities,” explained Dr. Vassilyadi, Associate Professor in the Department of Surgery, Division of Neurosurgery at CHEO and co-author of this study. “This creates a disproportionate amount of risk considering their underdeveloped skills necessary to protect themselves during unexpected events, such as falling or running into objects or other people.”
Currently, there is no certified winter recreational helmet available, so parents use what is available or no head protection at all. This study compared the protective characteristics of three types of helmets that are currently used by children ages 7 and under. Ice hockey, alpine ski, and bicycling helmets were impacted at 2.0, 4.0, 6.0 and 8.0 metres/second at the front and side impact locations using a monorail drop rig in a lab setting. The impact surface and velocities were chosen to simulate an impact similar to that expected for a child during tobogganing.
“We defined helmet safety performance by the ability of a helmet to reduce acceleration of the head during the impact,” said Dr. Blaine Hoshizaki, director of the Neurotrauma Impact Laboratory at the University of Ottawa, and co-author of this study. “Helmets are designed and tested to mitigate the risk of an injury; they are not designed to eliminate head injuries. Parents must be vigilant and educate their children about ways to be safe and have fun outdoors.”
Depending on the impact velocity, the type of helmet significantly affected the risk of brain injury. The ice hockey helmet was the most protective at the lower-velocity impacts (2-6 metres/second), and the bicycle helmet was the most protective at the high-velocity impact (8 metres/second). Alpine helmets had limited effectiveness at both the low and high velocity impacts. This research provides insights regarding the limitations of the helmets, but confirms that all helmets are protective.
“This research study does not take a stand about the ‘best’ helmet,” continued Dr. Vassilyadi. “A hockey helmet is likely the best for younger children when tobogganing as presented in this study. I think this is a great outcome because hockey helmets offer multi-impact protection by design; they can be worn with a toque; and a facial shield or cage can be easily added. The bottom line is that all helmets are protective – and young children should be wearing helmets during winter activities.”
This research was funded by ThinkFirst Canada, a national non-profit organization dedicated to the prevention of brain and spinal cord injuries.
Research | Scientists make progress in assessing tornado seasons
Columbia University | Earth Institute | 19 Jan 2012
Research | In 2011, Japan and NZ were hardest hit by earthquakes
Helmholtz Association of German Research Centres | 19 Jan 2012
Last year, earthquakes and their consequences, such as tsunamis, landslides, and ground settlements, caused a damage of 365 billion US dollars. Hence, 2011 was the year with the so far highest economic losses due to earthquakes. This is the result of an analysis submitted by James Daniell from the Center for Disaster Management and Risk Reduction Technology (CEDIM) of Karlsruhe Institute of Technology (KIT). According to this analysis, 20,500 people died, about a million people lost their homes.
Japan and New Zealand were hit hardest by the catastrophes. “With losses in the amount of 335 billion US dollars alone, the Tohuku earthquake is the most expensive earthquake so far,” says James Daniell. The earthquake with a magnitude of 9 and the following tsunami hit northern Japan on March 11: 19,300 people died, 450,000 lost their homes. The earthquake near Christchurch, New Zealand, in February caused 20 billion dollars of losses. Above all, buildings were destroyed. Large economic losses also resulted from the earthquakes in the Turkish region of Van, in the region of India-Nepal-Tibet, in the Chinese provinces of Yunnan and Xinjiang, and in the U.S. state of Virginia.
Worldwide, at least 133 earthquakes occurred in 2011, during which people died, were injured or lost their homes or which caused immense damage to property. Most often, i.e. 27 times, earthquakes took place in Japan. These were mostly aftershocks of the Tohoku earthquake. China was affected 20 times, Turkey 18 times. Including the aftershock near Christchurch, New Zealand was hit by 17 earthquakes.
20,500 people died as a result of earthquakes, tsunamis, or other consequences. Statistically speaking, this is below the average of the past years. More than 1 million people lost their homes. For comparison: The devastating earthquake on Haiti in 2010 caused about 137,000 casualties, between one and two million people lost their homes. In 2011, the earthquakes and their side effects destroyed or damaged more than 1.7 million buildings, of these, more than one million in Japan alone.
James Daniell published the 43-paged report in cooperation with Armand Vervaeck from the Belgian foundation of SOS Earth-quakes. The report is based on the CATDAT database that has been set up systematically by him since 2003. It contains information from online archives, reports of institutions, publications, and from other data collections worldwide. Daniell’s work is financed by the Australian Sir John Monash Foundation.
Complete report in the English language: http://www.cedim.de/download/CATDATDamagingEarthquakesDatabase2011AnnualReview.pdf
Karlsruhe Institute of Technology (KIT) is a public corporation according to the legislation of the state of Baden-Württemberg. It fulfills the mission of a university and the mission of a national research center of the Helmholtz Association. KIT focuses on a knowledge triangle that links the tasks of research, teaching, and innovation.
Research | Many high-risk Americans don’t get Hep B vax
Brown University | 24 Jan 2012
Although there is an effective vaccine for hepatitis B and public health officials have a strong sense of who is at highest risk for the infectious liver disease, tens of thousands of people in the United States contract the virus every year. According to a new study by researchers at Brown University, missed opportunities to administer the vaccine continue to be a reason why infections persist.
“This is a really simple thing that we could do and if somebody ends up getting the disease because we didn’t make the effort then I think that’s really a shame,” said Brian Montague, assistant professor of medicine in the Warren Alpert Medical School of Brown University and a physician at The Miriam Hospital.
Yet in an analysis published Jan. 12, 2012, in advance online in the journal Infection, senior author Montague and lead author Farah Ladak found that in a nationally representative sample of high-risk adults, 51.4 percent said they were unvaccinated. More than half of them had the potential to receive the vaccine based on their reported contact with health care providers.
The study is based on responses by more than 15,000 adults to the 2007 Behavioral Risk Factor Surveillance Survey, which gathers health information from more than 430,000 people across the United States. The respondents in the study’s analysis acknowledged engaging in risk behaviors such as certain sexual practices or needle drug use and could definitively report their hepatitis B status. Previous research has found that more than 95 percent new infections in adults occur among people with such behavioral risk factors.
Montague, Ladak, and their co-authors sought to figure out who among this highly vulnerable population was going unvaccinated and whether and where they could have received the three required shots.
They found that vaccinations were relatively infrequent among adults older than 33 (vaccinations have increased markedly in children since the 1990s), among people with less access to health insurance, and among people who have also not been vaccinated against other diseases such as the flu.
But even among people with access to health care, including people who reported specific contact with health care providers, thousands of people went unvaccinated, Ladak said. The study identifies places where improved vaccine delivery would make a substantial difference — for instance when people are tested for HIV, such as at the doctor’s office, in a hospital or clinic, and especially in jail.
For those infected as adults, hepatitis B does not always result in persistent infection and chronic liver disease, but it is especially likely to do so among people infected with HIV. Such co-infections are common because many of the risk factors for contracting either virus are the same.
“In persons visiting [HIV-testing] locations there was a high prevalence of people who had not received the vaccine,” said Ladak, a Brown public health graduate. “One of the areas that really stuck out was jails and prisons. Given that many states have mandates to vaccinate incarcerated individuals, you wonder why in so many of these prisons people have not received vaccinations.”
Ladak noted that the new study’s figures from 2007 closely mirror similar research published in 2000, suggesting that despite widespread awareness among public health officials that vaccinations have been lacking among adults, there has not been clear progress.
Calls to do better
The study lends additional support to the urging of the Institute of Medicine, which in a 2010 report emphasized the importance of seizing opportunities to vaccinate people for hepatitis B and C. The report suggested that officials have not devoted enough resources to vaccination programs, perhaps because the infections sometimes don’t present any symptoms, as a reason for the continued prevalence of the diseases.
Montague said some programs are also structured to ensure missed opportunities. For example, funding for HIV care programs allows testing and vaccination of those who are HIV positive. Funding is often not available, though, for combined screening for hepatitis B together with HIV.
“Given that the risks for HIV, hepatitis B and hepatitis C overlap, what we need is integrated testing and prevention programs and strategies that link those cases identified with effective treatment in the community,” Montague said.
In addition to Montague and Ladak, other authors were Annie Gjelsvik, Edward Feller and Samantha Rosenthal.
Research | Despite the risks, mephedrone users in the UK are ready to try the next legal high
University College London | 18 Jan 2012
Since mephedrone was made illegal in the UK in 2010, the street price of the drug has risen while the quality has degraded, which in turn may have reduced use of the drug. New research published online today reveals that young people who continued to use mephedrone after it became illegal would switch to a new legal high if it were pure and rated highly by their friends or on the Internet. They would be less deterred by a lack of scientific research on the new drug.
Mephedrone is a synthetic stimulant — a ‘designer drug’ — that became widely used in the UK from 2008 to 2010. Its rise in popularity may have been caused by its legality and ready availability (typically sold online as ‘plant food’), and also to the reduced purity of street cocaine and ecstasy during the same period. In 2010, because of its similarity to amphetamines and frenzied media reporting of the harmful effects of the drug, mephedrone was made illegal in the UK and scheduled as a Class B drug. The drug is still available through street dealers and online.
Research published online today in the journal Addiction shows that after taking mephedrone, users showed impaired working memory as well as the typical stimulant drug effects of euphoria, self confidence and buzzing.
While intoxicated, they also experienced marked craving for mephedrone and typically binged on the drug, taking it repeatedly for an average of eight hours. When drug-free, this group showed higher levels of depression and poorer long term memory compared to controls using drugs other than mephedrone.
When asked what factors might influence them to try a new legal high, the same users said they would be drawn to a new drug that was pure and had few short-term or long-term harms. While they would be attracted by positive reports from friends and on the Internet, lack of scientific research on the drug and its legal status were less important factors.
Mephedrone has been the most publicized ‘legal high’ in recent years, but there are many new compounds currently emerging on Internet markets. In 2010, 41 new substances were detected in the EU, compared with 24 in 2009 and 13 in 2008. Of those 41 new substances, 15 are synthetic stimulants, just like mephedrone. One of these may become the new ‘legal high’ that current mephedrone users want.
Says lead researcher Tom Freeman of University College London, “Drug users today are attracted to new substances that are pure and have few adverse effects. Lack of scientific research on the effects and risks of new legal highs might explain why young people rely on subjective reports from friends or the Internet when deciding whether to try a new substance. Internet reports may be biased and offer an opportunity for drug vendors to promote their products. As well as encouraging new research, an important harm reduction strategy is for the media and advice websites such as FRANK to provide balanced and up-to-date information on these drugs.”
Research | Black Saturday provides bushfire answers
The Australian National University | 18 Jan 2012
Clearing vegetation close to houses is the best way to reduce impacts of severe bushfires, according to a team of scientists from Australia and the USA who examined house loss after as a result of Black Saturday, when a series of fires raged across the Australian state of Victoria, killing 173 and injuring 414.
The research involving 12,000 measurements at 500 houses affected by the Black Saturday fires was only made possible by the sheer size of the devastation of February 7, 2009.
“More than any other major wildfire in Australia, Black Saturday provided an unprecedented opportunity to learn about the effects of land management on house loss,” said senior author Dr Philip Gibbons from The Australian National University.
The research team found that fuel reduction close to houses afforded the greatest protection.
“Clearing trees and shrubs within 40 meters of houses was the most effective form of fuel reduction on Black Saturday,” said Dr Gibbons.
“However, there was less risk to houses from vegetation in planted gardens compared with vegetation in remnant native bushland.”
Houses close to public forest were at greater risk, but concerns raised after Black Saturday about national parks were not reflected in the results.
“On Black Saturday, houses were at similar risk whether they were adjacent to National Park or State Forest,” said Professor David Lindenmayer from ANU, a co-author of the research.
Logging native forests did not reduce the chance of house loss.
“We found no significant relationship between house loss and the amount of logging in the landscape,” said Professor Ross Bradstock from The University of Wollongong who was an expert witness in the Bushfires Royal Commission.
A key issue after Black Saturday was prescribed burning. However, the researchers found that protection afforded to houses by prescribed burning on Black Saturday was only modest, despite the team examining landscapes that had been burnt considerably before Black Saturday.
“Clearing vegetation within 40 meters of houses was twice as effective as prescribed burning,” said Dr Geoff Cary from ANU.
All forms of fuel reduction examined in the study, including prescribed burning, were most effective if undertaken closer to houses, .
Bbut the research team cautions that reducing fuel close to houses is not always an appropriate strategy.
“Intensive fuel reduction close to houses can be expensive, can have significant environmental and aesthetic impacts and can be risky in some circumstances,” said Dr Gibbons.
“Many of these issues can be avoided if new housing is not permitted adjacent to forests.”
The researchers conclude that fuel reduction close to houses is only a partial solution to bushfires.
“No amount of fuel reduction will guarantee that a house is safe on extreme weather days like Black Saturday, so it is critical that other measures, such as early evacuation, safer places and architectural solutions are considered by every resident in fire-prone areas in addition to, or instead of, fuel reduction,” said Dr Gibbons.
“These are findings that are probably important internationally,” said Dr Max Moritz from the University of California at Berkeley who was a co-author of the research.
“Housing density in many bushfire-prone regions is increasing, so the next major bushfire will be even more devastating unless we continue to learn from Black Saturday,” added Dr Gibbons.
Research | Nursing home residents with dementia: Antidepressants are associated with increased risk of falling
Erasmus University Medical Center, Rotterdam, The Netherlands | 18 Jan 2012
Nursing home residents with dementia who use average doses of selective serotonin reuptake inhibitors (SSRIs) are three times more likely to have an injurious fall than similar people who don’t use these drugs. The association can be seen in people who use low doses of SSRIs and the risk increases as people take higher doses. The results are published in the British Journal of Clinical Pharmacology.
Many nursing home residents with dementia suffer from depression, and are therefore treated with antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are generally considered the treatment of choice. “Our study also discovered that the risk of an injurious fall increased even more if the residents were also given hypnotic or sedative drugs as sleeping pills,” said lead author Carolyn Shanty Sterke, who works in the Section of Geriatric Medicine at Erasmus University Medical Center, Rotterdam, The Netherlands.
Falls are a major health problem in nursing home residents with dementia. In nursing homes one-third of all falls result in an injury. “Physicians should be cautious in prescribing SSRIs to older people with dementia, even at low doses,” says Sterke.
Sterke carried out this research by recording the daily drug use and daily falls in 248 nursing home residents with dementia from 1 January 2006 until 1 January 2008. Data about the residents’ day-by day drug use came from a prescription database, and information on falls and subsequent injuries came from a standardised incident report system. In total, she had collected a dataset of 85,074 person-days.
The mean age of the participants was 82 years, and the prescription records showed that antidepressants had been used on 13,729 (16.1%) days, with SSRIs being used on 11,105 of these days.
The incident reports showed that 152 of the 248 residents (61.5%) sustained 683 falls. This corresponds to a fall incidence of 2.9 falls per person-year. Thirty-eight residents had a single fall, but 114 fell frequently. Two hundred twenty falls resulted in injury or death. Of these 10 were hip fractures, 11 were other fractures and 198 were injuries such as grazes, open wounds, sprains, bruises, and swellings. One person died after falling.
The risk of having an injurious fall increased threefold for residents taking SSRIs, from an absolute daily risk of 0.09% for a female aged 80 not taking an SSRI, to 0.28% for a female aged 80 taking one defined daily dose of SSRIs. Similar increases in absolute daily risk were found for both men and women, for different ages.
“Staff in residential homes are always concerned about reducing the chance of people falling and I think we should consider developing new treatment protocols that take into account the increased risk of falling that occurs when you give people SSRIs,” says Sterke.
This study is published in the British Journal of Clinical Pharmacology.
Full citation: Dose-response relationship between Selective Serotonin Reuptake Inhibitors and Injurious falls: A study in Nursing Home Residents with Dementia. Carolyn S Sterke, Gijsbertus Ziere, Ed F. van Beeck, Caspar W. N. Looman & Tischa J. M. van der Cammen. BJCP (2012); DOI: 10.1111/j.1365-2125.2011.04124.x
Research | Choking game prevalent among teens in Texas
Sam Houston State University | 18 Jan 2012
Nearly one out of seven college students surveyed at a Texas university has participated in the Choking Game, a dangerous behavior where blood flow is deliberately cut off to the brain in order to achieve a high, according to a study by The Crime Victims’ Institute at Sam Houston State University.
The Choking Game, also known as the Fainting Game, Pass Out, or Space Monkey, is played individually or in groups and involves manually choking oneself or others, applying a ligature around the neck or a plastic bag over the head, placing heavy objects on the chest, or hyperventilating to attain a euphoric feeling. This practice has led to several suffocation deaths in Texas and across the country.
“This study was undertaken to determine who is playing the game, in what context, and how they learned about it,” said Dr. Glen Kercher, director of the Crime Victims’ Institute. “It is our hope that these findings will inform efforts by parents, schools, and community agencies to warn young people about the dangers of participating in the Choking Game.”
The study was based on a survey completed by 837 students at a Texas university. Among the findings were:
- 16% percent of students reported having played the game; 72% reportedly played the game more than once
- Males were more likely to have played than females
- The average age when students first played the game was 14
- 90% of those who played the game first heard about it from peers
- Most students reported that others were present when they first played the game
- Curiosity about the effects of the Choking Game was a primary motivation for playing the game
- Learning about the potential dangers in engaging in this activity served as a deterrent for the majority of non-participants.
“Even though awareness of the Choking Game is growing, it should be noted that encouragement for parents to discuss this activity with their children should still be stressed,” said Brittany Longino Smith, who co-authored the study “The Choking Game” with Dr. Kercher and Dr. Leana Bouffard, an Associate Professor at SHSU.
A similar study on the Choking Game found that 90 percent of parents would support incorporating information on the behavior in health and drug prevention classes.
While preventative programs have increased to help warn adolescents of the use of illegal substances, the Choking Game is another method of achieving similar effects that has been introduced to this age group. “This ‘game,’ as it is often called, does not require obtaining any drugs or alcohol, is free, and can go undetected by many parents, teachers, physicians, and other authority figures. Most importantly, many of those who engage in this activity, do not understand that the practice can be just as deadly as the illegal substances youth have been warned against,” the study found.
Created by the Texas Legislature, the Crime Victims’ Institute has been charged with studying the impact of crime on victims, survivors, family members and the community in Texas.
Research | Does the La Niña weather pattern lead to flu pandemics?
Columbia University’s Mailman School of Public Health | 17 Jan 2012
Worldwide pandemics of influenza caused widespread death and illness in 1918, 1957, 1968 and 2009. A new study examining weather patterns around the time of these pandemics finds that each of them was preceded by La Niña conditions in the equatorial Pacific.
The study’s authors–Jeffrey Shaman of Columbia University’s Mailman School of Public Health and Marc Lipsitch of the Harvard School of Public Health—note that the La Niña pattern is known to alter the migratory patterns of birds, which are thought to be a primary reservoir of human influenza. The scientists theorize that altered migration patterns promote the development of dangerous new strains of influenza.
The study findings are currently published online in PNAS.
To examine the relationship between weather patterns and influenza pandemics, the researchers studied records of ocean temperatures in the equatorial Pacific in the fall and winter before the four most recent flu pandemics emerged. They found that all four pandemics were preceded by below-normal sea surface temperatures—consistent with the La Niña phase of the El Niño-Southern Oscillation. This La Niña pattern develops in the tropical Pacific Ocean every two and seven years approximately.
The authors cite other research showing that the La Niña pattern alters the migration, stopover time, fitness and interspecies mixing of migratory birds. These conditions could favor the kind of gene swapping—or genetic reassortment—that creates novel and therefore potentially more variations of the influenza virus.
“We know that pandemics arise from dramatic changes in the influenza genome. Our hypothesis is that La Niña sets the stage for these changes by reshuffling the mixing patterns of migratory birds, which are a major reservoir for influenza,” says Jeffrey Shaman, PhD, Mailman School assistant professor of Environmental Health Sciences and co-author of the study.
Changes in migration not only alter the pattern of contact among bird species, they could also change the ways that birds come into contact with domestic animals like pigs. Gene-swapping between avian and pig influenza viruses was a factor in the 2009 swine flu pandemic.
While a recent paper posited a link between influenza pandemics and strong El Niño events, authors of the current paper note that this 2011 analysis was based on flawed data. They propose to test the La Niña-influenza theory by studying influenza genetics, avian migration patterns and climate data.