WHO experts favor single-dose H1N1 vaccine regimen

first_imgOct 30, 2009 (CIDRAP News) – An expert committee that advises the World Health Organization (WHO) today updated its guidance on pandemic H1N1 vaccines, recommending a single dose for most age-groups and advising that any of the forms are safe for pregnant women.At a media briefing today, Dr Marie-Paule Kieny, director of the agency’s Initiative for Vaccine Research, said this week’s 3-day meeting of the Strategic Advisory Group of Experts (SAGE) on immunizations marked the group’s first discussion of the pandemic H1N1 vaccine since mid July, when it took up the vaccine priority question and addressed concerns about low yields with the first vaccine seed strains.”The level of evidence in October is much higher than July, and the recommendations are much more precise than July,” she said.After examining clinical trial data for all versions of the vaccine, the group recommended a single dose for everyone aged 10 and older, as long as such use in line with national regulatory authorities. Though the group said immunogenicity data are more limited for young children, it also recommended that countries that have children as a high-priority group administer one dose so that as many children can be vaccinated as possible.The United States has prioritized children to receive the pandemic vaccine has recommended that those under age 10 receive two doses. Also, Europe’s drug regulatory agency on Sep 23 announced it would stick to its initial recommendation that the three vaccines it approved be given in two doses, because data were insufficient to merit a one-dose recommendation. However, it added that one dose may be enough in adults.At a separate press briefing today, reporters asked Thomas Frieden, MD, director of the US Centers for Disease Control and Prevention (CDC), about the difference between the SAGE recommendation and the CDC’s guidance. He said preliminary vaccine data on children have not shown the desired immune response in children that would warrant a single-dose recommendation. Though the CDC is anticipating new data soon from the National Institutes of Health, “for the time being, we’re sticking with what the ACIP [Advisory Committee on Immunization Practices] has recommended,” Frieden said.Kieny said the WHO group advised that more studies are needed to guide a recommended vaccine dose for immunocompromised patients.Fourteen countries have now launched pandemic H1N1 vaccination programs, she said. In its review of early vaccine monitoring data for the pandemic, SAGE found no indication of unusual reactions, and it found that the events reported so far are well within the range of those seen with seasonal flu vaccines.Given concerns about vaccinating pregnant women, the WHO panel looked at animal studies of all forms of the vaccine and found no evidence of direct or indirect harm to fertility, pregnancy, embryonic or fetal development, birthing, or postnatal development. Given the high risk of flu complications in pregnant women, the group said any licensed vaccine can be used in pregnant women, unless specific contraindications have been outlined by national regulatory bodies.The United States is among countries where authorities have recommended that pregnant women not receive the intranasal, live attenuated H1N1 vaccine (LAIV). Public health officials were in a difficult position when the first pandemic vaccine doses were delivered, because nearly all of them were the LAIV version, though pregnant women are at the front of the line to be vaccinated. However, US officials have recently said the injectable version that pregnant women and other high-risk groups can receive makes up half of the increasing supply.The group also took up the issue of whether seasonal and pandemic H1N1 vaccines can be given at the same time. In a statement today, the WHO panel said clinical trials on coadministration of the vaccines are ongoing, but it endorsed the CDC recommendation that the intranasal versions of the seasonal and pandemic vaccines should not be given together. The group said the seasonal and pandemic vaccines can be given at the same time provided both are inactivated (injectable) or one is inactivated and the other is LAIV.Regarding options for the Southern Hemisphere’s 2009-2010 seasonal flu vaccine, SAGE weighed whether a trivalent vaccine (pandemic H1N1 plus seasonal H3N2 and B) or a bivalent vaccine (seasonal H3N2 and B) plus a separate pandemic H1N1 vaccine would be best. They concluded that both formulation options should be available, depending on national needs.See also:Oct 30 WHO statement on SAGE recommendationshttp://www.who.int/csr/disease/swineflu/notes/briefing_20091030/en/index.htmllast_img read more

‘Pull the brake’: Unease as more than half of COVID-19 beds in Jakarta in use

first_imgAnies previously said in July that the administration had prepared 4,556 isolation beds and 659 ICU beds for COVID-19 patients, higher than the figures mentioned in the release.However, city officials also noted that the number of available ICU beds have shown a significant decrease due in part to reallocation to non-COVID-19 patients – entire ICU wards can be redesignated under such circumstances.National COVID-19 task force spokesperson Wiku Adisasmito said during a press briefing on Tuesday that the bed occupancy rate, which he referred to as bed utilization per month, stood at 66 percent in the capital.”There is still some buffer before we reach 80 percent; this is the [safe] bed occupancy rate that usually applies at hospitals, so they can carefully and promptly treat patients,” Wiku told reporters. As of Wednesday, the city recorded 27,863 confirmed cases, with 9,044 active cases and 981 deaths. Among the active cases, 2,714 patients are currently hospitalized. The hospitalized patients also include 1,221 suspected cases of COVID-19 and two probable cases.Jakarta Health Agency head Widyastuti said during a webinar on Aug. 6 that the capital was, at the moment, in a “very critical condition”, as more than half of the bed capacity was used on a daily basis.Read also: Jakarta still struggles with virus despite improved health facilities”We have to be alert. If we don’t improve our bed capacity – daily testing capacity can reach 5,000 specimens from the ones we conduct free of charge, in addition to the ones carried out by private labs – then [hospitals] can collapse, because there simply is not enough capacity,” she said.Data provided by Widyastuti during the webinar show that, from Aug. 1 to 4, the isolation bed occupancy rate stood at 58 percent and the ICU bed occupancy rate at 61 percent.On July 24, Anies said the isolation bed occupancy rate was at 44 percent and ICU bed occupancy rate at 32 percent. This meant ICU utilization almost doubled within less than two weeks.Widyastuti said the city had been improving its bed capacity to match its testing capacity as well as tracing efforts by community health centers.Jakarta had eight referral hospitals at the beginning of the pandemic and now had 67, she said, adding that the administration had further resorted to experts’ estimations to predict the number of cases it would see and the number of hospital beds as well as human resources it would need to prepare.As the city began to gradually reopen its economy since early June, the administration has ramped up testing capacity, reaching four times the benchmark set by the World Health Organization (WHO) of 1 test per 1,000 people per week.Officials have largely attributed the city’s soaring case number to this fact, in addition to its aggressive contact-tracing, although the positivity rate remained higher than the WHO suggestion of 5 percent, reaching 8.7 percent in the past week.Jakarta Health Agency data show that daily isolation bed occupancy rates in the city’s 67 referral hospitals began to gradually increase to around 50 percent after July 20.Before then, the rate had been fluctuating at around 25 percent since the beginning of May, with the ICU occupancy rate consistently higher than the isolation bed occupancy rate, although it mostly stayed below 50 percent.Read also: ‘It was too crowded’: Patients find it hard to get COVID-19 tests, treatmentIn March, peak occupancy across both bed categories reached 200 percent on some days. By May, peak occupancy had come down to 71 percent for isolation beds and 121 percent for ICU beds.The bed occupancy rate and length of stay in hospitals stood at 83.99 percent and 2.57 days, respectively, in March; 112 percent and 6.33 days in April; 43.06 percent and 7.68 days in May; 40.58 percent and 7.69 days in June and 45.20 percent and 7.06 days in July.The Jakarta administration decided on Thursday to once again extend its transition from large-scale social restrictions (PSBB) for another two weeks beginning on Friday. The city started the transition on July 5.Governor Anies in mid-July hinted at the possibility of the administration pulling “the emergency brake”, which would restore the stricter PSBB if cases continued to soar amid concerns of rising positivity rates. During PSBB, the city allowed only eight essential sectors to operate.University of Indonesia epidemiologist Tri Yunis Miko urged the administration to pull the brake now, before cases soared beyond the health care system’s capacity.Increasing the number of beds, while necessary to anticipate further spikes, was not the solution, he said, insisting that eliminating sources of transmission was key.”How many more beds do we need to add? Do we know how many cases we’ll see in the future? Testing is increasing, but we can’t guess the number of cases and how many of these cases will be severe. We can’t be sure of it, because it depends on the population,” he said on Thursday.He said that extending the transition phase was “like doing nothing”, with a tightening and easing of restrictions being done at the same time.Read also: Our health system’s capacity vs demand from large-scale social distancingReimposing the PSBB in full, however, was not an option, given the economic concerns of the government, Miko acknowledged. Even so, he suggested that the city reimpose stricter restrictions at lower levels of administration, such as districts and subdistricts.While doing this, the administration must also ensure that companies let employees work from home and distribute aid to those who may potentially lose their income, he said.Editor’s Note: Updated to include disclaimer by the Jakarta administration that reallocation of ICU wards for non-COVID-19 patients have also contributed to the sharp decline in available ICU beds in the capital. Jakarta is reaching a critical point in its fight against COVID-19 as it sees rising hospitalization of COVID-19 patients, prompting concerns that it would have to increase its healthcare capacity and reimpose stricter curbs.Jakarta Governor Anies Baswedan said in a press release late on Thursday that 65 percent of 4,456 isolation beds and 67 percent of 483 intensive care unit (ICU) beds designated for COVID-19 patients were now occupied.”In the past two weeks, there has been a trend of increasing isolation and ICU room [occupation] in Jakarta. […] The [occupancy rates] have varied over a month, ranging from 40 to 50 percent in July,” Anies said.center_img Topics :last_img read more

Troost-Ekong lifts Nigeria past South Africa in quarter-finals

first_imgSouth Africa’s Percy Tau in action with Nigeria’s William Troost-EkongCairo, Egypt | AFP |  William Troost-Ekong’s late winner sent Nigeria through to the semi-finals of the Africa Cup of Nations on Wednesday after a tense 2-1 victory over South Africa in Cairo.Samuel Chukwueze fired the Super Eagles ahead in the first half in front of a healthy, largely pro-Nigerian crowd at the 75,000-capacity Cairo International Stadium.But Bongani Zungu’s looping header brought South Africa level on 70 minutes, the goal awarded with the aid of VAR — introduced for the first time at the tournament from the quarter-final stage onwards — after it was initially ruled out for offside.Centre-back Troost-Ekong then turned home at a corner a minute from time to set three-time champions Nigeria up with a clash against Algeria or Ivory Coast for a spot in the July 19 final.“We were lucky in the end to score this second goal because in the second half South Africa played much better,” said Nigeria coach Gernot Rohr.“We’re happy, we have to recover well because the next game, either Algeria or Ivory Coast will be very difficult also.”South Africa boss Stuart Baxter admitted the nature of the defeat was tough to digest.“It’s difficult when you’ve lost a game in the dying minutes, it’s difficult to find positives. I’m sure in one week’s time I will find some positives, but at this moment I’m finding it very difficult,” he said.Left-back Jamilu Collins made his first appearance in Egypt after shaking off a pre-tournament injury while Villarreal forward Chukwueze came in for Moses Simon in the Nigerian attack. Baxter stuck with the same side that shocked hosts Egypt in the last round, as match-winner Thembinkosi Lorch retained his place despite Themba Zwane’s return from suspension.– VAR makes its mark –Rohr had suggested South Africa were favourites in the build-up following their defeat of the record seven-time champions, a tag Baxter promptly rejected with Bafana Bafana’s lone competitive win over Nigeria coming in qualifying for these finals.Odion Ighalo’s goals have been the driving force behind Nigeria’s run here but it was emerging young forward Chukwueze, coming off a solid debut season in Spain’s top flight, who struck just before the half-hour to end the impasse.Alex Iwobi skipped past a couple of defenders down the left before pulling back for Chukwueze, who swept into the corner as the ball trickled back his way after a first shot was blocked.Following a stodgy first half Nigeria appeared the far sharper after the break, Peter Etebo rattling the crossbar with a superb 25-yard free-kick destined for the top corner but for the fingertips of Ronwen Williams.A number of promising attacks fizzled out for Nigeria and their lack of precision came back to haunt them when Zungu hauled South Africa level, nodding back across goal after a Percy Tau set-piece was shown upon a video review to have been flicked on by Ighalo.But after their stunning elimination of Mohamed Salah’s Egypt there was to be no follow-up act from South Africa as Williams flapped at an inswinging corner and Troost-Ekong forced over the line with his knee to clinch victory for NigeriaShare on: WhatsApplast_img read more