February
2007
Compiled by
Wendy E Braund, MD, MPH, MSEd
Resident, Pfizer Practicum Rotation in Health Policy and
Preventive Medicine
DRAMATIC DROP IN HIV INFECTIONS
HALTS CIRCUMCISION TRIALS
According to two randomized control trials conducted in
Kenya and Uganda with NIH support, men who are
circumcised have approximately half the risk of
uncircumcised men of contracting HIV through vaginal
intercourse. The risk reduction was 48% in Uganda and
53% in Kenya, replicating results found in a similar,
previous study in
South Africa
that showed a 60% decreased risk of HIV by female to
(circumcised) male. All three trials enrolled adult
males desiring circumcision, and all participants
received education regarding condom use and safer sexual
practices.
Anthony
Fauci, director of NIAID at NIH called adult male
circumcision an “important addition to an HIV prevention
strategy for men.” The WHO has developed activities
regarding male circumcision and offers guidance and
training to countries that desire to make the procedure
a more prominent part of their HIV prevention
strategies.
Roehr,
B. Dramatic drop in HIV infections halts circumcision
trials. BMJ 2007 (January 6);334:11.
February 2007 Index
AN APPROACH TO PREVENTION OF
INFECTIOUS DISEASES DURING MILITARY DEPLOYMENTS
The
approach to prevention of infectious diseases utilized
by the US military during deployments has elements that
are applicable to disaster relief and humanitarian
missions in the civilian sector. The six part method
involves preparation, education, personal protective
measures, vaccines, chemoprophylaxis and surveillance.
Preparation
entails familiarity with the most likely infectious
etiologies in a location, preparation/supplies for
managing acute infections, and infection control
strategies that are appropriate for the location.
Education of those deploying and those responsible
for their medical is also critical – and is the basis
for good preparation. Utilization of standard
precautions against infection and injury plus avoidance
of vector exposure and contaminated water are
personal protective measures. The military regularly
administers routine and deployment-specific vaccines
and requires hepatitis B vaccination by all personnel.
Chemoprophylaxis regimens for malaria follow CDC
guidelines, and the military is exploring other agents,
as appropriate to specific settings. Surveillance
is critical to ongoing assessment of military infectious
disease prevention strategies; they utilize tracking
systems for key infectious diseases, and all personnel
undergo pre- and post-deployment medical evaluations.
The
authors describe ways in which this six-part approach
has applicability in civilian disaster response and
humanitarian missions.
Murray
CK, Horvath, LL. An approach to prevention of infectious
diseases during military deployments. Travel Medicine
2007(February 1);44:424-430.
February 2007 Index
PREVENTION OF
ROTAVIRUS DISEASE: GUIDELINES FOR USE OF ROTAVIRUS
VACCINE
The
American
Academy of Pediatrics is recommending oral
administration of the new rotavirus vaccine to infants
at 2, 4, and 6 months of age. The bovine-based
pentavalent vaccine was approved by the FDA on
February 3, 2006. The four-part rational for this recommendation is
described in their policy statement. First, similar
rates of rotavirus infection among children in developed
and developing nations indicate that clean water and
good hygiene have little impact on transmission. Then,
they note the on-going morbidity associated with
rotavirus in the
US,
despite other currently available therapies. Third,
studies of the natural progression of the disease
suggest that initial infection protects children against
future gastroenteritis. Finally, US vaccine trials have
demonstrated 98% efficacy for prevention of severe
illness from rotavirus and 74% efficacy for prevention
against viral diarrhea of any severity. Vaccine adverse
events, contraindications and precautions are also
discussed.
Committee on Infections Diseases. Policy statement:
prevention of rotavirus disease: guidelines for use of
rotavirus vaccine. Pediatrics January 2007
(January);119(1):171-181.
February 2007 Index
A COMPREHENSIVE
IMMUNIZATION STRATEGY TO ELIMINATE TRANSMISSION OF
HEPATITIS B VIRUS INFECTION IN THE UNITED STATES
ACIP
has published updated recommendations to increase
hepatitis B vaccination of adults at risk for HVB
infection. The primary changes from previous
recommendations include: universal hepatitis B
vaccination for all adults in setting in which a large
proportion of the population are likely to be at risk
for HBV infection; implementation in of standing orders
in medical settings to identify and vaccinate adults
recommended for vaccination; provision of information
describing the health benefits, risk factors, and
suggested groups of vaccine recipients, risk assessment
to inform appropriateness of vaccination on a
patient-specific basis and vaccination to all adults who
report risks for HBV infection or request vaccination to
ensure vaccination of adults at risk who have not
completed the vaccination series. The MMWR report also
describes HBV infection, populations at risk for
infection, vaccine schedules, and safety of the
hepatitis B vaccine.
Advisory Committee on Immunization Practices (ACIP). A
comprehensive immunization strategy to eliminate
transmission of hepatitis B virus infection in the
United States, Recommendations of the Advisory
Committee on Immunization Practices (ACIP) Part II:
Immunization of Adults. MMWR 2006 (December
8);55(RR16):1-25.
February 2007 Index
SUNSAFE IN THE MIDDLE SCHOOL
YEARS: A COMMUNITY-WIDE INTERVENTION TO CHANGE
EARLY-ADOLESCENT SUN PROTECTION
Rates
of skin cancer associated with early-life sun exposure
are rising, and sun protection rapidly declines during
the adolescent years. The SunSafe in the Middle School
Years program is a multi-component model to improve
adolescent sun protection behaviors. Annual educational
sessions for adults (clinicians, school personnel,
athletic coaches and pool/beach staff) and staff and
peer-led activities for middle school students were
complemented by sun protection promotion materials
distributed in the community (bookmarks, posters). Sun
behaviors were observed and the proportion of the
individual adolescents’ body surface protected from the
sun was measured. The randomized controlled trial
conducted in ten communities demonstrated a significant
intervention effect after two years. This ecological
approach appears to be an effective way to positively
impact adolescent sun behaviors and potentially reduce
their risk of skin cancer.
Olsen
AL, Gaffney C, Starr P, Gibson JJ, Cole BF, Dietrich AJ.
Sunsafe in the middle school years: a community-wide
intervention to change early-adolescent sun protection.
Pediatrics 2007 (January);119 (1):e247-2256.
February 2007 Index
OFFICE-BASED COUNSELING FOR
UNINTENTIONAL INJURY PREVENTION
A
recent report provides guidance to pediatricians
regarding injury-prevention counseling at various
developmental stages. Parents of infants should be
counseled about traffic safety, burn, fall, choking and
drowning prevention, creating a safe sleep environment
and CPR. Parents of preschool aged children should be
advised regarding traffic safety, burn, fall, poison and
drowning prevention, and firearm safety. Counseling of
parents and their school-aged children should
concentrate on traffic, water, sports, and firearm
safety. Adolescents should receive guidance on traffic,
water, sports and firearm safety. Specific
recommendations and suggestions for implementation are
included in the report.
Gardner
HG and the Committee on Injury, Violence, and Poison
Prevention. Office-based counseling for unintentional
injury prevention. Pediatrics 2007;119:202-206
February 2007 Index
BRIEF INTERVENTION FOR
ALCOHOL USE BY PREGNANT WOMEN
Brief
intervention is an effective method to help pregnant
women abstain from alcohol. A study in which hundred
fifty-five pregnant women who reported using alcohol
received either assessment-only or brief intervention
demonstrated that women in the intervention group were
five times more likely to report abstinence than women
in the assessment-only group. In addition, newborns of
mothers in the intervention group had higher birth
lengths and birth weights, and their fetal mortality
rate was three times lower than newborns of women who
received assessment-only. The brief intervention was
provided by nonmedical professionals (WIC nutritionists)
at WIC centers, demonstrating that non-physician
providers and community-based organizations can play a
critical role in reducing alcohol consumption during
pregnancy and improving newborn outcomes.
O’Connor MJ, Whaley SE. Brief intervention for alcohol
use by pregnant women. Am J Pub Health
2007(February);97(2):252-258.
February 2007 Index
