Discovery May Help Prevent Rotavirus Epidemics

New Vaccines Shift the Course of Childhood Diarrhea-Causing Disease and Could Have Big Global Impact

New vaccines have the potential to prevent or temper epidemics of the childhood diarrhea-causing disease rotavirus, protect the unvaccinated and raise the age at which the infection first appears in children, federal researchers reported in a study today.

The findings were based on changing patterns of rotavirus transmission in the United States, where the disease is rarely fatal, and they have implications for combating epidemics in other countries where the death toll is much higher.

The research, published in the July 17 issue of the journal Science, is based on mathematical modeling that takes into account regional birth rates and predicted vaccination levels and effectiveness. The model suggests that when 80 percent or more of children in a given population are vaccinated, annual epidemics may occur on a less regular basis and more unvaccinated children will be protected. Data from 2007-2008, when vaccination first reached appreciable coverage levels in the United States, validate the model′s predictions.

“Rotavirus vaccines have rapidly and dramatically reduced hospitalizations and emergency room visits for gastroenteritis in American children,” said investigator Umesh D. Parashar, M.B.B.S., M.P.H., of the Centers for Disease Control and Prevention′s National Center for Immunization and Respiratory Diseases. “This research not only explains the effects of the U.S. rotavirus vaccination program, but also lays the foundation for understanding the tremendous life-saving benefits of vaccination in the developing world, where more than half a million children die from rotavirus each year.”

The study showed for the first time that the timing of rotavirus epidemics is dependent on the birth rate in the population because they are driven by infants who have never been infected before. In the United States, winter outbreaks would typically occur sooner in the higher birth rate states of the Southwest and later in the Northeast, where birth rates tend to be lower.

But with the introduction of two vaccines, the first in 2006, rotavirus outbreaks may become less frequent and less pronounced. They also may make their first appearance in children when they are older than the previous norm of less than 5 years of age, according to the research.

In older children, later onset would likely mean fewer cases and less severity of diarrhea.

The modeling and analysis were done by a team of researchers from the Fogarty International Center of the National Institutes of Health, the CDC, the Agency for Healthcare Research and Quality, the Pennsylvania State University, Princeton University and the George Washington University.

“When you can observe the immediate effects of vaccination and compare them to what the model predicted, you have a head start on stopping this preventable disease in countries where rotavirus unnecessarily kills hundreds of thousands of children,” said Roger I. Glass, M.D., Ph.D., one of the study authors and director of the Fogarty Center.

Lead author Virginia Pitzer, Sc.D., of Penn State and the Fogarty Center, said, “Each population is going to have a different demographic makeup, and there may be conditions we cannot predict with certainty, but we believe introducing vaccination in the developing world will decrease the terrible burden of rotavirus.”

Source: CDC, July 16, 2009

Blacks Have Highest Obesity Rate, Says CDC

Blacks had 51 percent higher prevalence of obesity, and Hispanics had 21 percent higher obesity prevalence compared with whites, according to researchers with the Centers for Disease Control and Prevention.

Greater prevalences of obesity for blacks and whites were found in the South and Midwest than in the West and Northeast. Hispanics in the Northeast had lower obesity prevalence than Hispanics in the Midwest, South or West. The study, in CDC′s Morbidity and Mortality Weekly Report, examined data from 2006-2008.

“This study highlights that in the United States, blacks and Hispanics are disproportionately affected by obesity,” said Dr. William H. Dietz, Director of CDC′s Division of Nutrition, Physical Activity, and Obesity, “If we have any hope of stemming the rise in obesity, we must intensify our efforts to create an environment for healthy living in these communities.”

The study uses data from the Behavioral Risk Factor Surveillance System (BRFSS), of the Centers for Disease Control and Prevention. BRFSS is an ongoing, state-based, random-digit–dialed telephone survey of the U.S. civilian, noninstitutionalized population aged 18 years and older.

The study found that in 40 states, obesity prevalence among blacks was 30 percent or more. In five of those states, Alabama, Maine, Mississippi, Ohio, and Oregon, obesity prevalence among blacks was 40 percent or greater.

For blacks, the prevalence of obesity ranged from 23 percent to 45.1 percent among all states and the District of Columbia; among Hispanics in 50 states and DC, the prevalence of obesity ranged from 21 percent to 36.7 percent, with 11 states having an obesity prevalence of 30 percent or higher. Among whites in 50 states and the District of Columbia, the prevalence of obesity ranged from 9 percent to 30.2 percent, with only West Virginia having a prevalence of 30 percent or more.

“We know that racial and ethnic differences in obesity prevalence are likely due to both individual behaviors, as well as differences in the physical and social environment,” said Liping Pan, M.D., M.P.H., lead author and epidemiologist. “We need a combination of policy and environmental changes that can create opportunities for healthier living.”

For this study analysis, CDC analyzed the 2006−2008 BRFSS data.

Source: CDC, July 16, 2009

Higher Levels of adiponectin Protein Associated with Lower Risk of Type 2 Diabetes

Persons with higher levels of adiponectin, a protein that is produced by fat cells and that has anti-inflammatory and insulin-sensitizing properties, have an associated lower risk of type 2 diabetes, according to an analysis of previous studies, reported in the July 8 issue of JAMA.

Some studies have suggested several mechanisms through which adiponectin may decrease the risk of type 2 diabetes, although the strength and consistency of the relation between plasma adiponectin and risk of type 2 diabetes has been unclear, according to background information in the article.

Shanshan Li, M.D., M.Sc., of the Harvard School of Public Health, Boston, and colleagues conducted a review and meta-analysis to assess the consistency of the association of adiponectin levels and risk of type 2 diabetes. The researchers identified thirteen studies with a total of 14,598 participants and 2,623 new cases of type 2 diabetes that met criteria for inclusion in the meta-analysis.

The authors found that higher adiponectin levels were associated with a lower risk of type 2 diabetes. This inverse association was consistently observed in whites, East Asians, Asian Indians, African Americans and Native Americans. The results did not differ substantially by method of diabetes ascertainment, study size, follow-up duration, body mass index or proportions of men and women.

“Although these epidemiologic studies cannot establish causality, the consistency of the association across diverse populations, the dose-response relationship, and the supportive findings in mechanistic studies indicate that adiponectin is a promising target for the reduction of risk of type 2 diabetes,” the authors write.

The researchers add that recent studies have shown that adiponectin levels can be increased through pharmaceutical and lifestyle interventions. “In addition, adiponectin levels may be useful for identifying persons likely to benefit most from interventions to treat ‘dysfunctional adipose tissue’ and its metabolic complications. Future studies should also evaluate whether adiponectin is useful for prediction of type 2 diabetes in addition to established risk factors using statistical techniques appropriate for prognostic analyses.”

Source: JAMA. 2009;302[2]:179-188

Reduced Dosage for Pneumococcal Vaccine in Infants Effect, Says Study

Infants who received two or three primary doses of the 7-valent pneumococcal conjugate vaccine (PCV-7) both had a decreased rate of carrying pneumococcal microorganisms that can cause pneumonia and other infections, compared to infants who were not vaccinated, according to a study in the July 8 issue of JAMA.

Crowded infant vaccine schedules and less favorable cost-effectiveness calculations have prompted exploration of reduced-dose vaccine schedules other than the currently recommended 3 + 1-dose schedule of PCV-7, which consists of 3 primary doses before age 6 months followed up by a booster vaccination in the second year of life, according to background information in the article. Difficulty in implementing the 3 + 1-dose schedule in developing countries is another reason for exploring reduced schedules. The effects of reduced-dose schedules of PCV-7 on pneumococcal carriage in children are largely unknown.

Elske J. M. van Gils, M.D., of the University Medical Center Utrecht, the Netherlands, and colleagues examined the effects of a 2-dose and 2 + 1-dose PCV-7 schedule on nasopharyngeal (upper part of the throat behind the nose) pneumococcal carriage in young children. The randomized trial included 1,003 healthy newborns and 1 of their parents in a general community in the Netherlands, with follow-up to age 24 months. Infants were randomly assigned to receive 2 doses of PCV-7 at 2 and 4 months; 2 + 1 doses of PCV-7 at 2, 4, and 11 months; or no dosage (control group).

No significant differences in vaccine serotype (a strain of microorganisms having a set of antigens in common), nonvaccine serotype, and overall pneumococcal carriage were observed at 6 months in both vaccine groups compared with the control group. At 12 months, vaccine serotype carriage rates were significantly lower in both vaccine groups compared with the control group, with 25 percent in the 2-dose schedule group, 20 percent in the 2 + 1-dose schedule group, and 38 percent in the control group. A further decrease of vaccine serotype carriage was found at 18 months after 2 + 1-dose schedule and at 24 months after 2 primary doses compared with the control group.

In analysis comparing the 2-dose and 2 + 1-dose schedules, the researchers observed a significant difference in vaccine serotype carriage at 18 months with 24 percent vaccine serotype carriage in the 2-dose schedule group compared with 16 percent in the 2 + 1-dose schedule group. At 24 months, the estimates for vaccine serotype carriage in both vaccine groups were at the same level with 15 percent in the 2-dose schedule group and 14 percent in the 2 + 1-dose schedule group, compared with 36 percent in the control group.

“In conclusion, both 2-dose and 2 + 1-dose schedules of PCV-7 significantly reduce vaccine serotype pneumococcal carriage in children. This study supports future implementation of reduced-dose PCV-7 schedules,” the authors write.

Source: JAMA. 2009;302[2]:159-167

Protection Your Skin from the Sun in Summer Months

According to the American Cancer Society, most of the more than 1 million cases of non-melanoma skin cancer diagnosed yearly in the United States are considered to be sun-related. Melanoma, the most serious type of skin cancer, accounts for about 8,110 of the 10,850 deaths due to skin cancer each year. Medical experts believe that too much exposure to the sun in childhood or adolescence is a major cause of skin cancer and premature skin aging later in life.

Marty Visscher, Ph.D., Director, Skin Sciences Institute at Cincinnati Children’s Hospital Medical Center, explains that some people do not understand the dangers of prolonged sun exposure. “During the summer months, it is critical that people use sunscreen and sun-protective clothing to reduce their risk of sun damage,” Dr. Visscher said. She said the best sunscreen protection will have an SPF number of at least 15 or higher and it should be applied liberally to the skin at least once every hour for maximum protection. “People can never be too careful about putting on sunscreen,” said Dr. Visscher. There are many products which higher SPF levels. You will get a little more protection from an SPF 30 than from SPF 15, but not twice the protection.

According to the federal trade commission (FTC), some of the dangerous effects of sun exposure on the skin include sunburn, photosensitive reactions (rashes), and cell and tissue damage. However, Dr. Visscher explains that there are several precautionary methods that people can take to make sure they don’t harm their skin from too much sun exposure.

Dr. Visscher, along with the FTC, advises the following ways for people to protect themselves from the sun:

  • Use water-resistant sunscreens that help protect skin from both UVA and UVB rays and that have SPF numbers of at least 15. Dr. Visscher wants people to remember that that sunscreen will wash off in water and it should be reapplied frequently at a minimum of every hour and more often if a person is drying off and removing the sunscreen with the towel. Dr. Visscher also reminds people that the sun exposure is actually higher when they are around water, due to the reflection effects of the water.
  • Apply the sunscreen 20-30 minutes before going out into the sun.
  • The nose and lips get high exposure and often require use of sun blocks, containing zinc oxide or titanium oxide, so look for these ingredients on the label.
  • Parents speak with camp counselors to make sure they apply and reapply their sunscreen on their child (or at least supervise the child when he or she is applying the sunscreen.
  • Keep babies younger than six months out of the sun. Sunscreens may irritate baby skin, and an infant’s developing eyes are especially vulnerable to sunlight.
  • Wear sun-protective clothing that lists the garment’s Ultraviolet Protection Factor (UPF) (the level of protection the garment provides from the sun’s harmful ultraviolet (UV) rays).
  • Parents need to limit their child’s playtime during the hours when the sun is at its strongest peak, which is between 10 am and 3 pm, in the summer months. If a person is outside during these peak hours, he or she needs to remember to take breaks in the shade.

Source: Cincinnati Children’s Hospital Medical Center, July 7, 2009

Addiction to Prescription Pain Killers Among Patients and Physicians

Chemical dependency and recovery in patients and physicians are closely examined in a series of articles and editorials in the July 2009 issue of Mayo Clinic Proceedings. The subject is especially timely. As the immense challenges, including potential tragedies, of prescription chemical addiction and abuse are being discussed, these articles offer crucial overview, direction and optimism.

Addiction to and abuse of prescription opioid drugs are prevalent, and they exact an immense toll on patients, physicians and society, according to Steven Passik, Ph.D., Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, in “Issues in Long-Term Opioid Therapy: Unmet Needs, Risks, and Solutions.”

Opioid drugs have been used by humans for thousands of years and are the longest continuously used class of medications, explains William Lanier, M.D., editor-in-chief of Mayo Clinic Proceedings. Dr. Lanier and Evan Kharasch, M.D., Ph.D., Department of Anesthesiology, Washington University in St. Louis, authored the editorial “Contemporary Clinical Opioid Use: Opportunities and Challenges.” It summarizes the recent increased interest in this drug category.

Opioid medications are chemicals that work by binding to specific receptors, particularly in the nervous system and gastrointestinal tract; decrease perception of pain and reaction to pain; and increase pain tolerance. Side effects include sedation, respiratory depression and constipation. When opioid consumption is ongoing, physical dependence can and will develop. This, in turn, can lead to problematic withdrawal upon abrupt discontinuation of medication. Dependence, coupled with the feeling of euphoria these drugs can produce, leads to abuse.

According to Dr. Lanier, the recent growing interest in opioids stems from five sources: advances in the design of these drugs; expansion and innovation in methods of drug delivery; increased public awareness of pain management options and the appropriateness of aggressively treating pain as the “fifth vital sign” and pain relief as a fundamental human right; growing recognition of the serious consequences of opioid misuse, misadventure and addiction; and medicolegal aspects of practitioners’ prescribing practices and legal consequences for under- or overprescribing.

In addition to individuals who have chronic pain, both cancer and non-cancer related, anesthesiologists have the greatest risk of opioid dependence and abuse among health care providers. Also in the high-risk group for health care providers are nurse anesthetists and sedation nurses. Challenges specific to these groups are discussed by Michael Oreskovich, M.D., Washington Physicians Health Program in Seattle, and Ryan Caldeiro, M.D., Department of Psychiatry and Behavioral Sciences at the University of Washington, Seattle, in “Anesthesiologists Recovering From Chemical Dependency: Can They Safely Return to the Operating Room?”

Severe chronic pain includes that produced by cancer and such non-cancer conditions as back injury and surgery. Opioids are a cornerstone of pain management for individuals in these categories, according to Howard Smith, M.D., Department of Anesthesiology, Albany Medical College, N.Y. In “Opioid Metabolism,” he writes that approximately 10 percent to 20 percent of physicians will develop a substance abuse problem during their career, a rate similar to or exceeding the general population. For anesthesiologists, according to Drs. Oreskovich and Caldeiro, the increased risk is cited as an occupational hazard because of the highly addictive medications they administer to patients daily.

Health care professionals helping patients with chronic pain must balance aggressive treatment with the need to minimize the risks of misuse and abuse, according to Dr. Passik. In “A Comparison of Long- and Short-Acting Opioids for the Treatment of Chronic Noncancer Pain,” Charles Argoff, M.D., and Daniel Silvershein, M.D., both from the Department of Neurology, Albany Medical College, N.Y., write that management of chronic non-cancer pain, for example, requires comprehensive assessment of each patient; the establishment of a structured treatment regimen or program; ongoing reassessment of the pain condition and the response to therapy; and a continual appraisal of the patient’s adherence to the treatment. Their colleague, Dr. Smith, stresses the importance of understanding the metabolism of opioids in individual patients.

Keen awareness by family and friends of potential addiction is crucial for physicians and other health care providers, not to mention the general public, who might be at risk, according to “Chemical Dependency and the Physician” by Keith Berge, M.D., Department of Anesthesiology, Mayo Clinic; Marvin Seppala, M.D., Hazelden Foundation, Center City, Minn.; and Agnes Schipper, J.D., Mayo Clinic Legal Department. Especially important is that family, friends and co-workers of health care providers confront any suspected addiction and abuse because of the potential harm that might befall the individual and his or her patients. Health care facilities should have written policies and procedures in place to assist when these highly emotionally charged situations involving health care providers occur, Dr. Berge and his colleagues write. Long-term recovery and sobriety can be achieved with appropriate treatment, aftercare and monitoring, they add.

New opioid formulas designed to minimize abuse are now in late-stage development and could help, Dr. Passik says. These drugs are chemically designed to diminish euphoric effects, thus possibly reducing problematic use. For now, responsibility coupled with expertise, insight, diligence and compassion are among the components that can meet the challenges of opioid use in pain management, the authors agree.

Source: Mayo Clinic, July 7, 2009

Total Laparoscopic Aortic Surgery Is Feasible, Shows Satisfactory Results

Recently the use of laparoscopy for vascular procedures has been limited by difficulties in aortic exposure and anastomosis techniques, as well as the concurrent competitive progress of endovascular surgery. For aortic repair, best results (in terms of long-term patency) have been obtained by conventional surgery which has been associated short-term morbidity and mortality.

Endovascular techniques (which are noninvasive but have less reliable long-term results) as well as video-endoscopic aortic surgery are alternatives to conventional surgery. Minimally invasive surgery benefits include reduced time in intensive care and a shorter hospital stay; a quicker resumption of intestinal transit; less abdominal wall complications; and reduced requirements for anelgesics.

“The goal of total laparoscopic aortic repair is to achieve the same outcome as open repair without invasive laparotomy,” said Jérôme Cau, MD, professor at Poitiers University Hospital in Poitiers, France. “However, specialized training is required to master the procedure and get acquainted with coelioscopic practice necessary for laparoscopic suture.”

Dr. Cau said he and fellow researchers performed a study that completed a retrospective analysis of laparoscopic techniques for vascular procedures in a series of 219 patients, to determine its feasibility for treatment and outcomes with respect to aortic occlusive disease (AOD), abdominal aortic aneurysms (AAA) and aorto-renal bypass in the endovascular era. These findings were presented today at the 63rd Annual Meeting of the Society for Vascular Surgery.

One hundred and twenty-seven AODs; 80 AAAs and 12 aorto-renal bypasses were studied from the hospital; this series did not include 110 aortic bypass patients operated on in others centers by this team. The mean patient age was 61 years and the gender ratio was three men to one woman. The mean operative time of procedures for AOD was 223 (±50) minutes, with a mean clamp time of 56 (±21) minutes. A total of 3.6 percent of AOD procedures had to be converted to open surgeries.

For laparoscopic AAA procedures, the mean operative time was 262 (±57) minutes and the mean “clamp time was 103 (±15) minutes. Eight AAAs had to be converted to an open procedure. The 30-day mortality rate was 0.9 percent. Overall mortality rate was 13.4 percent during a mean follow-up time of 16.2 months. The primary assisted patency rate for AAAs and occlusive disease was 100 percent.

Dr. Cau added that as any in any relatively new technique, laparoscopy’s place in vascular surgery remains to be defined. He noted that for aortoiliac occlusive diseases, this technique has shown excellent results and should compete with open repair for the treatment of TASC C & D occlusive diseases.

“Aneurysm repair in laparoscopy has been demonstrated to be feasible and reliable, and in our experience showed promising and satisfactory results,” noted Dr. Cau. “In the aneurysmal pathology we can predict that the competition with endovascular aortic repair (which is becoming the standard) will make laparoscopy more difficult to ‘find its place’ and make room for hybrid techniques. Specific training remains particularly important to reach technical success in laparoscopy and needs to be presented to the young generation of vascular surgeons in university pilot center.”

“Precise indications for this kind of surgery, compared to endovascular and open surgery, remain to be determined by randomized studies,” added Dr. Cau. “Nevertheless, it is a difficult technique. Further development will rely on effective training, advances in technique and instrumentation.”

Source: Society for Vascular Surgery, June 12, 2009

Tuberculosis Vaccine Effectiveness Study

In a study funded by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, Saint Louis University’s Center for Vaccine Development is investigating whether the standard vaccine used in foreign countries against tuberculosis offers better protection as a shot, drink or combination of both.

“The fight against tuberculosis is important because a third of the world is thought to be infected and there are significant problems with drug-resistant TB organisms,” said Daniel Hoft, M.D., Ph.D., principal investigator and director of the division of immunobiology at Saint Louis University School of Medicine.

The “standard” tuberculosis vaccine, bacillus Calmette-Guérin (BCG), is given to infants in foreign countries, and is not currently recommended for use in the U.S.

“Experts believe it provides some protection against TB disease, particularly in children where severe manifestations of TB are averted,” Hoft said. “However, despite widespread use of BCG, TB remains a major cause of death worldwide. The main purpose of this study is to find out if BCG can be used in a more effective way.

“We hope to learn whether a BCG vaccine drink or a combination of a drink and an injection could increase immune responses against tuberculosis lung infection and affect the progression of the disease as it spreads throughout the body.”

The study also will look at whether it is better to give one or two doses of the BCG vaccine.

A total of 70 healthy volunteers who are 18 to 40 years old are needed for the research. The study will last about two years and requires up to 21 scheduled visits. Each visit takes between 30 minutes and three hours, depending upon the procedures being performed. Study participants will be compensated for their time and travel after each completed visit.

Tuberculosis is a deadly disease that strikes developing nations hardest. Each year, nearly 8 million new cases of TB develop, and 2 million persons die from the infectious disease.

Source: Saint Louis University Medical Center, June 12, 2009

Nurse Researchers Help Fight Spread of Infectious Disease

Fighting infectious disease, the very heart of public health and the genesis of contemporary nursing, is about more than hand washing and immunizations. It’s about screening and early detection, identifying risk and protective factors, and educating clinicians, facilities and the public. But it all begins with research

Infectious disease rates, stable since the 1918 influenza pandemic, have been on the rise since the mid-1980s. The battle against these illnesses—from HIV/AIDS to MRSA and from STDs to resurgent tuberculosis (TB), and others—has been escalating, and long before the recent emergence of the H1N1 influenza virus earlier this year.

For Johns Hopkins University School of Nursing (JHUSON) nurse researchers, the communities around the corner and around the world are their infectious disease laboratories.

JHUSON faculty research, for example, is shedding light on curbing sexually transmitted infections and their physical and emotional repercussions on college campuses. It also is exploring best practices to curtail the spread of resurgent diseases like tuberculosis and reducing the impact of treatment resistant infections like MRSA both within and beyond the hospital setting.

The community-based inquiry not only is yielding new knowledge but also, when coupled with its translation into clinical education and practice, is helping to save lives today and to be better prepared to save them in an uncertain future.

Infection Detective at Work in High-Risk Environments: JHUSON researcher, Assistant Professor and self-professed “infection control preventionist” Jason Farley, PhD, MPH, ARNP, is working to give nurse colleagues and other health care professionals the research-based tools they need to identify, prevent, and destroy drug-resistant infections in hospitals and in communities from Maryland to South Africa.

Growing rates of drug-resistant infections like tuberculosis and methicillin-resistant staphylococcus aureus (MRSA), coupled with recent H1N1 pandemic concerns, make his work most timely. His MRSA-related research not only has documented its evolution from a hospital problem into a community and public health concern, but also has given health providers.

Farley’s work is as much about transmitting knowledge as it is about curbing infection transmission. In new work supported by the JHU’s Center on Global Health, he is evaluating current tuberculosis infection control practices and strategies in TB hospitals throughout South Africa. With highly drug-resistant TB adding to the significant toll taken by HIV/AIDS in that country, the need to improve infection control is marked. Yet, Farley has found considerable inattention to such issues as segregated care for TB-infected patients, lack of evaluation and testing of health care workers for the disease, and limited use of respirators to combat the spread of this airborne disease.

Farley notes, “Infection control needs to be paramount in our thoughts about patient safety and also in how we avoid infection in health care workers.” His work in South Africa seeks to determine if a trained infection control nurse can help reduce or eliminate these and other gaps in infection control. From a public health perspective, Farley says, “No one knows about infection control better than nurses. It’s where our profession’s evidence-based roots began; nurses will continue to be on the front lines of infection prevention and public education tomorrow.”

Breaking through the Sound of Silence: When the Infection is Sexual—Most sexually transmitted diseases (STDs) can be readily treated and cured; all can be prevented. Yet, in the U.S. alone, as many as 19 million new cases of a sexually transmitted disease (STD) are diagnosed each year, almost half of which are among sexually active teens and young adults.

Many are symptom-free, don’t even know they have an STD, and, as a result, don’t get treated. Others whose STD symptoms are evident, may lack access to care or may be too ashamed, afraid or upset to discuss the illness, much less get treatment for it. In either case, continuing infection and ongoing transmission are likely. Whether well-known STDs like gonorrhea, syphilis and HIV/AIDS or less familiar ones like chlamydia and herpes, the physical repercussions of untreated STDs can be significant, ranging from pelvic disease to infertility, cervical cancer, even death, with attendant health care costs and lost productivity.

The emotional toll can be equally or even more devastating, particularly since so many affected and infected are between the ages of 15 and 24. JHUSON Assistant Professor, Hayley D. Mark, PhD, MPH, RN doesn’t think that’s good for the public health and has been working to change the situation through research.

Drawn to the field of STD research because it “affects the human condition as a whole – health, psychology and social environment,” she noted that certain STDs tend to be passed around within specific closed communities, such as a college campus, the nightclub scene or the correctional facility.

While it is well know that screening reduces the likelihood of transmitting HIV and bacterial STDs, Mark wondered whether wide-scale, voluntary screening also could help reduce the incidence of the transmission of genital herpes, HSV-2, a viral, often silent STD. that puts people at greater risk for HIV infection.

She began her inquiry on a college campus, assessing how to motivate student participation in STD screening and the performance characteristics of the HSV test in college students , reported in the Journal of American College Health and Sexually Transmitted Disease, respectively. Results suggested that to be successful, information about the availability of screening for HSV-2 should be neutral in tone and informative, transmitted broadly by a trusted source such as a student health center. Further, Mark’s finding that a diagnosis of HVS-2 often causes significant emotional and social difficulty (social break-ups, depression, and anxiety) led her to recommend the value of both immediate and follow-up counseling to address both the medical and psychological aspects of infection.

Mark believes nurses are ideally poised to break through the silence that so often surrounds STDs. She notes, “Because we are trained to help people feel comfortable in an uncomfortable medical environment, we can help open the door to STD prevention as well as to screening and treatment. Part of what we do is help people talk about difficult health topics by providing a nonjudgmental environment in which knowledge can be shared. It’s a great model of how nurses work to promote the public health.”

Source: Johns Hopkins University School of Nursing, June 12, 2009

Research May Lead to Improved Immune System in Newborn Babies

Newborn babies have immature immune systems, making them highly vulnerable to severe infections and unable to mount an effective immune response to most vaccines, thereby frustrating efforts to protect them.

The World Health Organization estimates that more than 2 million newborns and infants less than 6 months of age die each year due to infection. Researchers at Children’s Hospital Boston believe they have found a way to enhance the immune system at birth and boost newborns’ vaccine responses, making infections like respiratory syncytial virus, pneumococcus and rotavirus much less of a threat.

Ofer Levy, MD, PhD and colleagues in Children’s Division of Infectious Diseases have shown that the newborn immune system functions differently than that of adults, but that one portion of the immune response is fully functional and can be harnessed to boost innate immunity in these tiny infants.

For more than a decade it’s been known that people’s first line of defense against infection is a group of receptors known as Toll-like receptors (TLRs) on the surface of certain white blood cells. Functioning like an early radar system, TLRs detect the presence of invading bacteria and viruses and signal other immune cells to mount a defense. People have 10 different kinds of TLRs, and Levy’s team found that when most of them were stimulated, newborns’ immune responses are very impaired — with one important exception.

One TLR, known as TLR8, triggered a robust immune response in antigen-presenting cells, which are crucial for vaccine responses, suggesting that agents that stimulate TLR8 could be used to enhance immune responses in newborns, perhaps as adjuvants given along with vaccines. With the help of a $100,000 pilot grant from the Bill & Melinda Gates Foundation, Levy’s team is now validating their work in human cells and in animal models, and eventually want to test TLR8 stimulators – some of which are already available — in human babies.

Levy’s team is uncovering other differences in the newborn immune system that could lead to additional targets for drugs or vaccines. “As we better understand the molecular pathways that account for newborns’ susceptibility to infections, we can leverage them to enhance their immune defenses,” Levy says.

The ability to vaccinate newborns — rather than wait until they reach 2 months of age — would provide important global health benefits, adds Levy, whose lab is one of the few in the world to specifically focus on vaccination in newborns. “Birth is a point of contact with healthcare systems,” he says. “If you could give a vaccine at birth, a much higher percentage of the population can be covered.”

Source: Children’s Hospital Boston, June 12, 2009