Vaccination Programmes Might Be Threatened As Mercury Ban Proposal Is Ongoing

Mercury, also known as hydrargyrum, is a chemical element with the symbol Hg and atomic number 80. It is a heavy silvery element and the only metal that is liquid at standard conditions for temperature and pressure. This chemical element can produce many adverse human health effects, such as permanent damage to nervous system. It can also be transferred from a mother to her unborn child.

The World Health Organization (WHO) stated that mercury is highly toxic and one of the top 10 chemicals of public health concern. It can be found in small amounts in many products such as thermometers, batteries and in vaccines, for a small amount. WHO suggests products that contain mercury, except vaccines, should be phased out; for example switch from mercury thermometers to digital thermometers.

In February 2009, the Governing Council of United Nations Environment Program (UNEP) started to work on a legally binding global treaty on mercury. The work of the intergovernmental negotiating committee (INC) will be carried out over five sessions, started from June 2010 until early 2013. The first INC was held in Stockholm, the second was in Chiba (Japan), and the third meeting was held in Nairobi on 31 October to 4 November 2011.

The problem is that a proposed ban might include thiomersal (thimerosal), a mercury compound that commonly used to prevent contamination and can extend the shelf life of vaccines. Thiomersal is used in about 300 million vaccines worldwide for fighting diseases such as diphtheria, flu, hepatitis B, meningitis, polio, tetanus, etc. Many experts, including WHO vaccines expert David Wood, said that not being able to use mercury is not a viable option and might threaten vaccination programmes.

Thiomersal was suspected as a cause of autism in children who received vaccines. A medical study in 1998 linked a common childhood vaccine injection to autism. But then many studies found no sign the mercury compound is risky.

At the moment, there is not a viable alternative to thiomersal and if it were banned, the pharmaceutical companies would likely to switch to preservative-free vaccines. This condition will complicate the supply chain and vaccination campaigns in poor countries because the vaccines will have a much shorter shelf life. It can also affect the cost of production since pharmaceutical company would need to reconfigure their factories.

Tim Kasten, head of the chemicals branch at UNEP, said “The document is still a draft, so some of these proposals have to be taken with a grain of salt”. He also said that there could be provisions to allow mercury for certain uses, for instance in vaccines, because the amount of mercury in vaccines is very small and does not threaten the environment. But, the annex of the draft document stated that there is no allowable use exemption for mercury products in pharmaceutical products, including vaccines.

Some experts, such as Paul Offit (University of Pennsylvania) and Andrew Nelson (University of Leeds), disagreed with the idea of banning mercury completely. Offit said that it would be a tragic example for not being able to explain to the public where the real risk lies. While Nelson said that if we knew the risks and handled it properly then there is not a problem. Besides, an absolute ban for mercury is ridiculous since the health of millions of children benefit from vaccines.

In the United States of America, Canada, Norway and Sweden, pharmaceutical companies have been encouraged to produce thiomersal-free vaccines and no other mercury products can be used as medical preservative.

Reference:

• CBC News
• UNEP
• WebMD
• WHO
• Wikipedia

GAVI Board Opened a Funding Window for HPV and Rubella Vaccines

The Global Alliance for Vaccines and Immunisation (GAVI) Board opened a funding window for human papilloma virus (HPV) and rubella vaccines. They also encouraged the 57 countries eligible for support from GAVI Alliance to apply for funding for introduction of both vaccines. GAVI Alliance’s funds can only be used for vaccines prequalified by World Health Organization (WHO) which recommends on inclusion of HPV and rubella vaccines in national immunisation programmes.

WHO will continue to collaborate with national immunisation programmes planning to introduce both vaccines, providing technical support in logistics management, reaching age groups beyond infancy, and setting up effective systems for monitoring of adverse events following immunisation. The WHO Assistant Director-General, Dr. Flavio Bustreo, said that WHO supports the GAVI Board’s decision in opening funding window for both vaccines.

"The decision by the GAVI Board to invite countries to apply for funding for introduction of human papilloma virus and rubella vaccines is great news for developing countries. The protection afforded by the HPV vaccine will save many more women from the pain and suffering caused by cervical cancer. Availability of funding for rubella vaccine will prevent the severe birth defects that result from rubella infection in early pregnancy and give a much-needed boost to countries' efforts to eliminate both measles and rubella."

Dr Flavia Bustreo, WHO Assistant Director-General, Family, Women's and Children's Health

HPV were known widely as the cause of cervical cancer which responsible for more than 250 million deaths and over 500,000 new cases in each year. HPV is the leading causes of cancer among women and 85% of them were from developing countries. Mainly the cases occur in women aged over 40.

Routine vaccination for young adolescent girls to protect them against HPV has been recommended by the WHO. Yet, there only two vaccines available in the market throughout the world and both are highly efficacious in preventing infection with virus types 16 and 18, which cause around 70% of cervical cancer cases globally.

WHO recommends all countries that have not yet introduced rubella vaccine to consider introducing it and put it in routine immunisation. Rubella is airborne droplets transmitted disease and generally a mild illness. But, if a pregnant woman infected (contracted) by rubella during her first trimester, it can cause miscarriages, still births and infants born with Congenital Rubella Syndrome (CRS). CRS is a congenital defect caused by rubella which commonly in form of heart problems, deafness or cataracts (blindness). It is estimated 112,000 cases occurred globally.

During the last decade, large-scale rubella vaccination has enabled elimination of rubella and CRS in Western Hemisphere and several European countries. But, in Africa, South-East Asia and Western Pacific regions, the burden of CRS is still high.

References:

• Global Alliance for Vaccines and Immunisation (GAVI)
• Wikipedia
• World Health Organization (WHO)

GSK’s Pandemrix is Not Recommended for Children and Adolescents

Pandemrix, a flu vaccine developed by GlaxoSmithKline (GSK) and patented in September 2006, were investigated due to its potential risk of narcolepsy in children and adolescents. The investigation began in August 2010 conducted by the Swedish Medical Products Agency (MPA) and the Finnish National Institute for Health and Welfare (THL). The report stated that around 6.6 times increased risk among children and adolescents, or about 3.6 additional cases of narcolepsy per 100,000 vaccinated subjects.

The European Union (EU) was suggesting restriction of using the flu vaccine because of the potential risk. Other entity, the European Medicines Agency (EMEA), said that the vaccine should only be used in people under 20 years in the absence of seasonal trivalent influenza vaccines, which has very rare cases of narcolepsy in youth.

During the outbreak of swine flu (H1N1 virus) in 2009-2010, Pandemrix was widely used along with other flu vaccines from Novartis and Baxter. More than 31 million doses of Pandemrix have been given to people in 47 countries, except United States of America. There were 335 cases of narcolepsy in those vaccinated and about two-thirds of the cases were in Finland and Sweden. The researchers from both countries were the first to raise concerns about the possibility of narcolepsy link to Pandemrix after noting cases in children after given the vaccine shot. They also suggested children that given the vaccine shot were nine times more likely to suffer narcolepsy.

GSK, the biggest pharmaceutical company in UK, stated that they committed to conduct research regarding the potential association between Pandemrix and narcolepsy.

References:

• EMEA (European Medicines Agency)
• GSK (GlaxoSmithKline)
• Medscape
• Wikipedia

Taking Anti-psychotics Drug in Elder With Diabetes Could Increased Risk of Hyperglycemia

A new research, issued by Archives of Internal Medicine, found that elder patients with diabetes has an increased risk for hyperglycemia when they are prescribed an anti-psychotic medication, specially in the first 2 weeks after starting the medication. The risk was 50% higher than their counterparts who did not take anti-psychotic medication for at least 6 months.

Lorraine L. Lipscombe, MD, from the University of Toronto, Canada, suggest that physicians should be vigilant in monitoring the glycemic levels in elderly patients with diabetes who begin anti-psychotic therapy. Because, diabetes in older patients is generally not as well controlled as in younger ones and elder patients may be less likely to report early on their symptoms of increased urination or thirst or dehydration.

The research included 13,817 patients aged 66 years or older with diabetes who began taking an anti-psychotic drug between 1 April 2002 and 31 March 2006, and were followed up for an average of 2 years. The anti-psychotic drugs that used in the reasearch were atypical agents group, such as olanzapine, quetiapine, and risperidone, and older traditional agents group. The research subjects were divided into 3 groups, those treated with insulin (14.4%), those taking oral hypoglycemic agents (45.5%), and those not taking any diabetes treatment (40.2%).

During the follow-up, 11% of the patients were hospitalized for hyperglycemia and 24.1% of them were on insulin, 13.1% were taking oral hypoglycemic agents and 3.8% were not taking any diabetes medications.

Dr. Lipscombe found that all anti-psychotic agents are equal when it comes to the risk of hyperglycemia. The increased risk was similar for both typical and atypical agents. A previous study suggested that anti-psychotics may affect insulin secretion, while the other suggested that anti-psychotics' effect on dopamine levels, plays a role in regulating blood glucose levels.

Reference:

• Medscape

Depression often Misdiagnosed

Physicians around the world seem to have difficulty telling who is depressed and who is not, as reported by Alex J. Mitchell, MRCPsych. from Leicester General Hospital, UK, in his meta-analysis study. The report also shows that general practitioners (GPs) correctly identify depression in 47.3% of cases.

The GPs in urban practice encounter 20 true cases of depression in 100 patients. They correctly diagnosed 10 cases, missed 10 cases and incorrectly diagnose 15 non-depressed patients with depression (false-positive rate about 20%).

In rural practice, the GPs encounter 10 true cases of depression in 100 patients, they correctly diagnosed 5 cases and misdiagnosed 17 non-depressed patients with depression (false-positive rate about 17%).

Dr. Mitchell also reports that the Netherlands and Italy's GPs have the most diagnostic accuracy compared to the UK and US's GPs.

Reference:

• Medscape

CDC Recommendations about H1N1 Vaccination

Centers for Disease Control and Prevention (CDC) suggest priority distribution of H1N1 influenza vaccine in 5 groups.

The director of National Center for Immunization & Respiratory Diseases with the CDC, Anne Schuchat, MD, announced that there are 5 recommendation groups to receive the vaccine:

1. Pregnant women,
2. household contacts of children younger than 6 months of age,
3. healthcare workers & emergency medical services personnel,
4. children and young people between 6 months and 24 years of age,
5. non-elderly adults with underlying risk conditions or medical conditions that increase their risk for complications from influenza.

The Advisory Committee of Immunization Practices also proposed a priority group that should be vaccinated in the event of a shortage. These include:

1. Pregnant women,
2. household contacts of children younger than 6 months of age,
3. healthcare workers & emergency services personnel who have direct contact with patient or infectious substances,
4. children between 6 months and 4 years of age,
5. children between 5 to 18 years of age who have underlying risk factors that put them at greater risk for complications of influenza.

Reference:

• Medscape