MEASLES ENCEPHALITIS—A Successful Method of Treatment with Typhoid Vaccine

During a 12-year period 50 patients with measles encephalitis were treated with typhoid vaccine—45 of them not until they were in a vegetative state. There were no deaths in the treated cases. All except one were clinically normal after treatment was ended. Late in the series it became apparent that after the clinical normal is attained and the electroencephalogram becomes normal, treatment should still be continued until the cortex has been “challenged” repeatedly and the electroencephalogram shown to remain normal.The “shock” element in the treatment with typhoid vaccine was prevented by anticipating and circumventing the unfavorable reactions to the vaccine.It may take 20 to 50 treatments or more with typhoid vaccine to return a patient to normality. Each individual is different and responds in a different period of time.     

Psychological Antecedents to Conception Among Abortion Seekers

At a university hospital, 642 women seeking induced abortion for an unwanted pregnancy were surveyed before the procedure regarding their perception of what psychological and behavioral factors, if any, played a role in their becoming pregnant: 35 percent said they had had intercourse during what they believed was a “safe period”; 33 percent believed that they had experienced a contraceptive failure; 29 percent indicated fear of side effects influenced their use of a contraceptive method; 27 percent and 21 percent, respectively, indicated that they had thought pregnancy “couldn''t happen to me” or had “put the thought of pregnancy out of my mind.” The women''s responses indicated that a number of additional attitudes, beliefs, and behaviors were also important and that for any individual woman at least three or four factors had often combined in a dynamic sequence to greatly increase her risk of pregnancy. The implications of the findings for educational and counseling programs are discussed.     

Valued Outcomes in the Selection of a Contraceptive Method

The perceptions and values of a sample of 106 women towards four contraceptive methods (oral contraceptives, intrauterine device, diaphragm and foam-and-condoms) were evaluated in the light of 24 identified issues of concern. The choice of a contraceptive method appears to represent a trade-off among negatively valued outcomes—the “best” method being least likely to incur undesirable consequences.     

Estimating Causal Effects from Family Planning Health Communication Campaigns Using Panel Data: The “Your Health,Your Wealth” Campaign in Egypt

Background

Health communication campaigns – involving mass media and interpersonal communication - have long been utilized by national family planning programs to create awareness about contraceptive methods, to shift social norms related to fertility control, and to promote specific behaviors, such as the use of condoms, injectable methods or permanent sterilization. However, demonstrating the effectiveness of these campaigns is often complicated because the infeasibility of experimental designs generally yields statistically non-equivalent samples of campaign-exposed and unexposed individuals.

Methods

Using data from a panel survey of reproductive age women in Egypt, we estimate the effects of the multimedia health communication campaign “Your Health, Your Wealth” (“Sahatek Sarwetek”) on precursors to contraceptive use (e.g., spousal communication, birth spacing attitudes) and on modern contraceptive use. Difference-in-differences and fixed effects estimators that exploit the panel nature of the data are employed to control for both observed and unobserved heterogeneity in the sample of women who self-report recall of the messages, thereby potentially improving upon methods that make no such controls or that rely solely on cross-sectional data.

Findings

All of the estimators find positive effects of the “Your Health, Your Wealth” campaign on reproductive health outcomes, though the magnitudes of those effects diverge, often considerably. Difference-in-differences estimators find that exposure to the campaign increases the likelihood of spousal discussions by 14.4 percentage points (pp.) (SE = .039, p<0.001) but has no effect on contraceptive use. In contrast, the fixed effects, instrumental variables estimator, controlling for unobserved heterogeneity, finds a large, statistically significant effect on modern contraceptive use (27.4 pp., SE = 0.135, p = 0.043).

Conclusions

The difficulties of evaluating family planning communication programs may be surmountable using panel data and analytic methods that address both observed and unobserved heterogeneity in exposure. Not controlling for such effects may lead to substantial underestimates of the effectiveness of such campaigns.     

Blood pressure and contraceptive use

In a survey of 461 women routinely attending family planning clinics those taking oral contraceptives had significantly higher mean systolic and diastolic blood pressures than those using non-hormonal contraception. There appeared to be a dose-response relation of blood pressure to the progestogen component of two oral contraceptives with an identical 30 μg ethinyloestradiol component. This supports the idea that the progestogen as well as the oestrogen component has an aetiological role in the rise in blood pressure. There was a significant correlation of blood pressure with duration of current use of oral contraceptive but not with total duration of use. There was also a significant negative correlation of blood pressure with time since oral contraceptives were last taken, and women who had stopped using oral contraceptives over a month previously had similar blood pressures to those who had never taken them. In women taking oral contraceptives those who had either a history of hypertension in pregnancy or a family history of hypertension had significantly higher mean blood pressures than those who did not. Both systolic and diastolic blood pressures correlated independently with weight and body mass index, but controlling for the effect of this and age did not affect the above relations. No significant differences in mean blood pressures were found between different ethnic groups, and there was no relation of blood pressure to reported marital state, social class, parity, smoking, or alcohol use.Any oral contraceptive that has a less adverse effect on blood pressure has implications for general prescribing policy; thus even small differences in the progestogen contents of low-dose oestrogen pills may be important.     

Breast-milk Jaundice and Oral Contraceptives

Among breast-fed infants in the normal lying-in wards of a maternity hospital a significantly higher incidence of “idiopathic” jaundice was found in infants of mothers who had been receiving the contraceptive pill before the present pregnancy than in the infants whose mothers never had the pill. The pill became widely used in society at about the same time as breast-milk jaundice was first reported.     

Clinical Evaluation of a New Sequential Oral Contraceptive Agent

One hundred and seventy-eight patients were placed on a new sequential oral contraceptive preparation (Ortho-Novum SQ) and observed through a total of 1785 months in an effort to determine the effectiveness of the agent and its acceptability to patients. Patients with varicose veins and/or previous thrombophlebitis were not excluded from the study. The most frequent side effect was “breakthrough bleeding” which occurred in 19 patients. One patient became pregnant while apparently taking the tablets as directed, and another was already pregnant when started on the drug. However, in spite of at least four weeks'' continued ingestion after conception, both gave birth to normal female infants. Chloasma, noted in four patients while on combination oral contraceptives, cleared on this medication. There was no aggravation of thrombophlebitis or varicose veins. The acceptance of this sequential preparation by patients was excellent.     

Incremental Benefits of Male HPV Vaccination: Accounting for Inequality in Population Uptake

Background

Vaccines against HPV16/18 are approved for use in females and males but most countries currently have female-only programs. Cultural and geographic factors associated with HPV vaccine uptake might also influence sexual partner choice; this might impact post-vaccination outcomes. Our aims were to examine the population-level impact of adding males to HPV vaccination programs if factors influencing vaccine uptake also influence partner choice, and additionally to quantify how this changes the post-vaccination distribution of disease between subgroups, using incident infections as the outcome measure.

Methods

A dynamic model simulated vaccination of pre-adolescents in two scenarios: 1) vaccine uptake was correlated with factors which also affect sexual partner choice (“correlated”); 2) vaccine uptake was unrelated to these factors (“unrelated”). Coverage and degree of heterogeneity in uptake were informed by observed data from Australia and the USA. Population impact was examined via the effect on incident HPV16 infections. The rate ratio for post-vaccination incident HPV16 in the lowest compared to the highest coverage subgroup (RR_L) was calculated to quantify between-group differences in outcomes.

Results

The population-level incremental impact of adding males was lower if vaccine uptake was “correlated”, however the difference in population-level impact was extremely small (<1%) in the Australia and USA scenarios, even under the conservative and extreme assumption that subgroups according to coverage did not mix at all sexually. At the subgroup level, “correlated” female-only vaccination resulted in RR_L = 1.9 (Australia) and 1.5 (USA) in females, and RR_L = 1.5 and 1.3 in males. “Correlated” both-sex vaccination increased RR_L to 4.2 and 2.1 in females and 3.9 and 2.0 in males in the Australia and USA scenarios respectively.

Conclusions

The population-level incremental impact of male vaccination is unlikely to be substantially impacted by feasible levels of heterogeneity in uptake. However, these findings emphasize the continuing importance of prioritizing high coverage across all groups in HPV vaccination programs in terms of achieving equality of outcomes.     

Male contraception: expanding reproductive choice

The development of steroid-based oral contraceptives had revolutionized the availability of contraceptive choice for women. In order to expand the contraceptive options for couples by developing an acceptable, safe and effective male contraceptive, scientists have been experimenting with various steroidal/non-steroidal regimens to suppress testicular sperm production. The non-availability of a long-acting androgen was a limiting factor in the development of a male contraceptive regimen since all currently tested anti-spermatogenic agents also concurrently decrease circulating testosterone levels. A combination regimen of long-acting progestogen and androgen would have advantage over an androgen-alone modality since the dose of androgen required would be much smaller in the combination regimen, thereby decreasing the adverse effects of high steroid load. The progestogen in the combination regimen would act as the primary anti-spermatogenic agent. Currently, a number of combination regimens using progestogen or GnRH analogues combined with androgen are undergoing trials. The side effects of long-term use of androgens and progestogens have also undergone evaluation in primate models and the results of these studies need to be kept in view, while considering steroidal regimens for contraceptive use in men. Efforts are also being made to popularize non-scalpel vasectomy and to develop condoms of greater acceptability. The development of contraceptive vaccines for men, using sperm surface epitopes not expressed in female reproductive tract as source, still requires considerable research efforts.     

Plant Virus Particles Carrying Tumour Antigen Activate TLR7 and Induce High Levels of Protective Antibody

Induction of potent antibody is the goal of many vaccines targeted against infections or cancer. Modern vaccine designs that use virus-like particles (VLP) have shown efficacy for prophylactic vaccination against virus-associated cancer in the clinic. Here we used plant viral particles (PVP), which are structurally analogous to VLP, coupled to a weak idiotypic (Id) tumour antigen, as a conjugate vaccine to induce antibody against a murine B-cell malignancy. The Id-PVP vaccine incorporates a natural adjuvant, the viral ssRNA, which acts via TLR7. It induced potent protective anti-Id antibody responses in an in vivo mouse model, superior to the “gold standard” Id vaccine, with prevalence of the IgG2a isotype. Combination with alum further increased antibody levels and maintained the IgG2a bias. Engagement of TLR7 in vivo was followed by secretion of IFN-α by plasmacytoid dendritic cells and by activation of splenic CD11c^hi conventional dendritic cells. The latter was apparent from up-regulation of co-stimulatory molecules and from secretion of a wide range of inflammatory cytokines and chemokines including the Th1-governing cytokine IL-12, in keeping with the IgG2a antibody isotype distribution. PVP conjugates are a novel cancer vaccine design, offering an attractive molecular form, similar to VLP, and providing T-cell help. In contrast to VLP, they also incorporate a safe “in-built” ssRNA adjuvant.     

A Controlled Study of Disturbances Recorded Following the Use of Oral Poliomyelitis Vaccine

A double-blind study of disturbances recorded following the administration of a live trivalent oral poliomyelitis vaccine and an identical-appearing placebo was undertaken. Seven hundred and forty-one persons, 81% of the entire population of a small town, constituted the trial group. The two feedings, with a varied feeding sequence, were eight days apart, and at the second feeding and again eight days later, the participants were investigated under controlled conditions. There were no statistically significant differences in the number, nature or timing of the disturbances reported following the administration of the two vaccines. With both vaccines, significantly fewer reactions were reported among males, among the under-5 year group, among Occupational Class I, and after the first feeding as compared with the second. The Salk vaccine immunization status of the participants made no significant difference. With both active vaccine and placebo “vaccine” 14 to 15% of the participants reported some “reaction”.     

Further studies on sister-chromatid exchange frequency in users of hormonal contraceptives

Women using an estrogen-progestogen combination contraceptive exhibited an increased frequency of sister-chromatid exchange (SCE), supporting our previous observation. These elevated SCE frequencies tended to decline 3 months after the discontinuation of the pill. Women using a progestogen injectable contraceptive, on the other hand, had unaltered SCE rates. The analysis, in vitro; of mitomycin-C-induced SCE frequencies in women using either the combination or the progestogen injectable contraceptives showed significantly higher rates of induced SCE.     

RESISTANT URINARY TRACT INFECTIONS—Combined Autogenous Vaccine and Drug Therapy

The “miracle” antibiotics and sulfa drugs have been found unsatisfactory in treating certain severe resistant urinary tract infections apparently due to lack of immunity factor in the patient. Of a series of 56 patients with resistant urinary tract infection who were treated with autogenous vaccine and then with sulfa drugs, 26 were completely cured.     

Human Papillomavirus Infection and Vaccination: Awareness and Knowledge of HPV and Acceptability of HPV Vaccine among Mothers of Teenage Daughters in Weihai,Shandong, China

In preparation for the introduction of human papillomavirus (HPV) vaccine, we investigated awareness and knowledge of HPV/HPV vaccine and potential acceptability to HPV vaccine among mothers with a teenage daughter in Weihai, Shandong, China. A cross-sectional survey was conducted in 2013 with a sample of 1850 mothers who had a daughter (aged 9–17 years) attending primary, junior and senior high schools. In the final sample (N = 1578, response rate 85.30%), awareness of HPV was reported by 305 (19.32%) mothers. Awareness varied significantly by daughter’s age (P<0.01), mother’s education level (P<0.01), mother’s occupation (P<0.01), household income (P<0.01) and residence type (P<0.01). Knowledge about HPV/HPV vaccine was poor with a mean total score of 3.56 (SD = 2.40) out of a possible score of 13. Mothers with a higher education level reported higher levels of knowledge (P = 0.02). Slightly more than one-fourth (26.49%) of mothers expressed their potential acceptability of HPV vaccine for their daughters. Acceptability increased along with increased daughters’ age (P<0.01), household income (P<0.01) and knowledge level (P<0.01). House wives and unemployed mothers had the highest acceptability (P<0.01). The most common reasons for not accepting HPV vaccination were “My daughter is too young to have risk of cervical cancer (30.95%)”, “The vaccine has not been widely used, and the decision will be made after it is widely used (24.91%)”, “Worry about the safety of the vaccine (22.85%)”. Awareness and knowledge of HPV/HPV vaccines are poor and HPV vaccine acceptability is low among these Chinese mothers. These results may help inform appropriate health education programs in this population.     

Clinical and Laboratory Findings in a Trial of Norgestrel,a Low-dose Progestogen-only Contraceptive

Norgestrel, a progestogen-only oral contraceptive, was given continually at a dose of 75 μg/day to 144 women of proved fertility. It was an efficient contraceptive with a failure rate of 2·1% (assessed by the “life-table” method) within the first 12 cycles and 3·6% within the first 30 cycles (or 2·0 conceptions per 100 woman-years when assessed by the Pearl index). The overall conception rate for the entire trial period was 2·1% and 1·3 pregnancies per 100 woman-years respectively. Norgestrel caused a high proportion of irregular and generally short bleeding intervals, about one-fifth of the cycles lasting less than 17 days. This irregularity appeared to be due to individual variance in cycle length between women rather than that between their successive cycles. No confirmed instances of thromboembolism were observed. Norgestrel apparently exerts its contraceptive action by several mechanisms: reduction in the sperm penetrability of the cervical mucus and an impairment of luteal function appear important. The serum concentrations of cholesterol and globulin were significantly reduced in women taking norgestrel. Preliminary observations suggest that on discontinuing the medication fertility is promptly restored. Of the 144 women originally enrolled 57 (40%) withdrew for reasons connected with the method before completing 30 months on trial, over half of them because of the irregular menstrual pattern. Nonetheless, in view of its main clinical and laboratory characteristics and simple mode of administration, norgestrel appears to be a useful alternative to the combined type of pill for women unsuitable for, or unable to tolerate, oestrogen-containing preparations.     

Assessment of Incremental Dosage Regimen of Combined Oestrogen-Progestogen Oral Contraceptive

Eighty-six women of proved fertility used an incremental dosage regimen of a combined oral contraceptive for a total of 570 cycles over one year. A daily tablet containing 50 μg of ethinyloestradiol and 50 μg D-norgestrel was taken for 11 days and a daily tablet containing 50 μg ethinyloestradiol and 125 μg D-norgestrel for the next 10 days. Withdrawal bleeding occurred during the tabletfree interval of seven days. The new preparation proved to be an efficient contraceptive, well tolerated, and with few side effects. Women who had gained weight while taking other oral contraceptives lost weight when they changed to the new preparation. The regimen allowed a significant reduction in the cycle dose of progestogen, and these results suggest that a further reduction in the cycle dose of both oestrogen and progestogen may be possible without losing contraceptive efficiency.     

A Vaccine Encoding Conserved Promiscuous HIV CD4 Epitopes Induces Broad T Cell Responses in Mice Transgenic to Multiple Common HLA Class II Molecules

Current HIV vaccine approaches are focused on immunogens encoding whole HIV antigenic proteins that mainly elicit cytotoxic CD8+ responses. Mounting evidence points toward a critical role for CD4+ T cells in the control of immunodeficiency virus replication, probably due to cognate help. Vaccine-induced CD4+ T cell responses might, therefore, have a protective effect in HIV replication. In addition, successful vaccines may have to elicit responses to multiple epitopes in a high proportion of vaccinees, to match the highly variable circulating strains of HIV. Using rational vaccine design, we developed a DNA vaccine encoding 18 algorithm-selected conserved, “promiscuous” (multiple HLA-DR-binding) B-subtype HIV CD4 epitopes - previously found to be frequently recognized by HIV-infected patients. We assessed the ability of the vaccine to induce broad T cell responses in the context of multiple HLA class II molecules using different strains of HLA class II- transgenic mice (-DR2, -DR4, -DQ6 and -DQ8). Mice displayed CD4+ and CD8+ T cell responses of significant breadth and magnitude, and 16 out of the 18 encoded epitopes were recognized. By virtue of inducing broad responses against conserved CD4+ T cell epitopes that can be recognized in the context of widely diverse, common HLA class II alleles, this vaccine concept may cope both with HIV genetic variability and increased population coverage. The vaccine may thus be a source of cognate help for HIV-specific CD8+ T cells elicited by conventional immunogens, in a wide proportion of vaccinees.     

Examining Perceptions about Mandatory Influenza Vaccination of Healthcare Workers through Online Comments on News Stories

Background

The aim of this study was to understand online public perceptions of the debate surrounding the choice of annual influenza vaccinations or wearing masks as a condition of employment for healthcare workers, such as the one enacted in British Columbia in August 2012.

Methods

Four national and 82 local (British Columbia) Canadian online news sites were searched for articles posted between August 2012 and May 2013 containing the words “healthcare workers” and “mandatory influenza vaccinations/immunizations” or “mandatory flu shots and healthcare workers.” We included articles from sources that predominantly concerned our topic of interest and that generated reader comments. Two researchers coded the unedited comments using thematic analysis, categorizing codes to allow themes to emerge. In addition to themes, the comments were categorized by: 1) sentiment towards influenza vaccines; 2) support for mandatory vaccination policies; 3) citing of reference materials or statistics; 4) self-identified health-care worker status; and 5) sharing of a personal story.

Results

1163 comments made by 648 commenters responding to 36 articles were analyzed. Popular themes included concerns about freedom of choice, vaccine effectiveness, patient safety, and distrust in government, public health, and the pharmaceutical industry. Almost half (48%) of commenters expressed a negative sentiment toward the influenza vaccine, 28% were positive, 20% were neutral, and 4% expressed mixed sentiment. Of those who commented on the policy, 75% did not support the condition to work policy, while 25% were in favour. Of the commenters, 11% self-identified as healthcare workers, 13% shared personal stories, and 18% cited a reference or statistic.

Interpretation

The perception of the influenza vaccine in the comment sections of online news sites is fairly poor. Public health agencies should consider including online forums, comment sections, and social media sites as part of their communication channels to correct misinformation regarding the benefits of HCW influenza immunization and the effectiveness of the vaccine.     

Fatigue and Fear with Shifting Polio Eradication Strategies in India: A Study of Social Resistance to Vaccination

Shifting polio eradication strategies may have generated fear and “resistance” to the eradication program in Aligarh, India during the summer of 2009. Participant observation and formal interviews with 107 people from May to August 2009 indicated that the intensified frequency of vaccination was correlated with patients'' doubt in the efficacy of the vaccine. This doubt was exacerbated in a few cases as families were uninformed of the use of monovalent mOPV1, while P3 cases continued to occur. Many families had also come to believe that their children had been adversely affected by OPV after being told the vaccine carried no risk. Though polio is now largely eradicated in India, with only a single case in 2011, greater transparency about changes with vaccination policy may need to be considered to build trust with the public in future eradication programs.     

Focus: Vaccines: COVID-19 Vaccine Hesitancy in Israel Immediately Before the Vaccine Operation

The development of a vaccine for COVID-19 presented hope for a way out of the global crisis caused by the virus. However, a potential barrier may be vaccine hesitancy, and identifying the factors that affect it is critical, especially concerning a new vaccine technology. The purpose of this research is to identify the factors that effects vaccine hesitancy by using a holistic view. The data were collected from 504 people in December 2020, 3 days before the vaccine operation started in Israel. The analysis included three categories of determinants: (1) contextual influences; (2) health records; and (3) perceived health attitudes. The results indicate that different sets of variables affect willingness to accept the vaccine among the whole spectrum of the vaccine-hesitant and the undecided subsample. In the full sample, gender, age, income, influenza vaccine, perceived trust, perceived susceptibility, perceived benefits, and perceived barriers affected vaccine acceptance. The perceived level of suffering from COVID-19 was associated with willingness to vaccinate, and when religious beliefs increased, the intention to vaccinate decreased. For the undecided subsample, the factors included gender, influenza vaccine, trust in the vaccine company, and perceived vaccine benefits and barriers. The results suggest that efforts of governments and health institutions should focus on women and highlight the vaccine as an opportunity to “go back to normal” without worries. Those results will help implement vaccine strategy in the following cases: if infant vaccination is pursued and if emergency vaccines or new vaccine technologies emerge for another pandemic as well.