McCracken, George H. M.D.; Nelson, John D. M.D.
NEARING POLIO ERADICATION The Global Polio Eradication Initiative was launched in 1988 and might have achieved its goal years ago were there not three stubborn pockets of persisting wild poliovirus (WPV) activity. The surveillance data for January 2011 through March 2013 are available (MMWR 2013; 62: 335). The number of WPV cases globally decreased from 650 in 2011 to 223 in 2012. Circulation of WPV continues in only 3 countries: Afghanistan, Nigeria and Pakistan, but there have been imported cases from those countries to previously poliofree countries: 309 imported cases in 12 countries in 2011 and, quite remarkably, only 6 imported cases in 2 countries in 2012. The end of WPV on earth is not an unreachable goal in spite of the attacks on health care workers in Nigeria and Pakistan in recent months. Security measures have been bolstered to protect the persons distributing polio vaccine and the eradication initiative goes forth. In a subsequent MMWR (June 14, 2013) we learned of new cases of WPV type 1 infection in Somalia and Kenya. These are the fi rst confi rmed polio cases in Somalia since March 2007 and in Kenya since July 2011. This highlights the risk of international travel to Africa until the focus in Nigeria is eradicated.
DISPOSITION OF MANUSCRIPTS In 2012 The Pediatric Infectious Disease Journal received 1124 manuscripts for consideration of publication. Of these, 184 (16.8%) were immediately rejected because they were not considered by the Chief Editors to have high enough priority for publication and this rapid decision would allow the authors to submit their work elsewhere in a timely fashion. Of the total submissions, 712 (63%) were categorized as Original Studies or Brief Reports, 91 were HIV Reports and 68 were Vaccine Reports. We received 90 Letters. The average time from submission until the fi rst disposition letter was sent to the authors was 30 days and, always surprising to us, it took an additional 40 days to receive the revised manuscripts back from the authors. The time from fi nal acceptance to publication was approximately 5 to 6 months. The journal accepted one-third of the Original Studies and Brief Reports that were submitted and, by design, a higher percentage for the HIV Reports (44%) and Vaccine Reports (69%). We received manuscripts from 80 countries, of which approximately one-quarter were submitted from the United States and 3-5% each were received from India, Spain, Italy, China, Japan, United Kingdom, France, Turkey and Canada. These statistics for 2012 are similar to those in 2011.
INFLUENZA VACCINE During the 2012–13 influenza season in the United States influenza A (H3N2) viruses predominated overall, but influenza B viruses and, to a lesser extent, influenza A (H1N1)pdm09 (pH1N1) viruses also were reported. The season was moderately severe, with a higher percentage of outpatient visits for influenza-like illness (ILI), higher rates of hospitalization, and more reported deaths attributed to pneumonia and influenza compared with recent years (MMWR 2013; 62(23): 473). There were 149 laboratory-confirmed influenza-associated pediatric deaths reported from 38 states; the largest number occurred in Texas (18 cases), followed by New York (14) and Florida (8). Seventy-nine deaths were associated with influenza B viruses. For 2013–14 three quadravalent influ-enza vaccines, comprising two influenza A and two influenza B strains, will be available for pediatrics. In 6 of the past 12 influenza seasons, the dominating circulating influenza B strain was different from the strain selected for inclusion in the trivalent vaccine. For this coming season only Fluzone Quadrivalent (Sanofi Pasteur) vaccine has been approved for infants and children as young as 6 months whereas the others vaccines are approved for 2 or 3 years of age and older.
FROZEN BERRIES When fresh berries are not available, for many years one of us has eaten frozen berry mix with yogurt daily for lunch, seemingly with no obvious adverse effect. To our surprise as of June 14, 2013 there have been 97 cases of hepatitis A infection resulting from eating contaminated frozen berry and pomegranate mix from at least one manufacturer. The Centers for Disease Control and Prevention reported that molecular analyses of several strains suggested that the origin of the virus was North Africa or the Middle East region and the pomegranate seeds were sourced from Turkey. Similar outbreaks of hepatitis A have occurred in Europe this year and in British Columbia in 2012 where the berry lover among us is currently vacationing.
XENOINTOXICATION OF BEDBUGS Bedbug bites do not cause any infectious diseases that we are aware of, so we should not be concerned about them. Right? Wrong! They drive people nuts with itching and the very idea of bedbugs grosses people out. They are the bane of the hotel industry. Ivermectin (Stromectol) is most familiar to us as the Heartgard medicine we give to protect our dogs against heartworm, but it kills many parasites, worms and insects. Ivermectin is the main weapon in the worldwide campaigns to eradicate filariasis and river blindness. Johnathan Steele, an emergency medicine physician at Eastern Virginia Medical School, had the idea that if humans took ivermectin, the bedbugs who feasted on their blood might ingest enough ivermectin to kill them (NY Times January 1, 2013). The process is called xenointoxication (poisoning the guest). He tried the idea first on mice given the drug and found that 86% of the bedbugs who bit the mice died. He then tried the process on 4 medical students who volunteered to take one dose of ivermectin and submit themselves to multiple bedbug bites. More than 60% of the bed-bugs died, which is presumably more than would have died of natural causes after a blood meal. This may sound like a crazy idea, but there would be great satisfaction in knowing that the critter who bit you is going to die. Perhaps Dr. Steele can think of a clever, more direct way of getting bedbugs to ingest ivermectin.
INTESTINAL BACTERIA AND HEART DISEASE In the June 2013 Newsletter we told you about a possible relationship between intestinal bacteria and obesity. We now learn of a link between the food we eat, intestinal bacteria and heart disease (New Eng J Med 2013; 368:1575). Lecithin is present in large amounts in egg yolks. When we eat egg yolks, lecithin is broken down into choline among other things. Intestinal bacteria metabolize choline to a substance that the liver converts to trimethylamine N-oxide (TMAO). TMAO concentrations in blood of humans are related directly to increased risk of heart attacks and strokes. The investigators did a clever experiment. Volunteers who ate 2 hard-boiled eggs developed increased TMAO in their blood, but those treated with antibiotics to wipe out intestinal bacteria did not develop increased TMAO after eating the eggs. Previous studies with carnatine, which is abundant in red meat and which is chemically related to lecithin, reported similar increases in choline that can be acted on by intestinal bacteria. Should we stop eating red meat and eggs? Not until there is further information about this complex subject. The role of intestinal bacteria in our health or disease becomes ever more fascinating.
EFFECTIVENESS OF HPV VACCINE In 2006 the human papillomavirus (HPV) vaccine was introduced into the routine immunization schedule for girls 11-12 years of age with catch-up vaccination for those 13-26 years. Markowitz and her colleagues from the Centers for Disease Control and Prevention, Atlanta, GA (J Infect Dis 2013: doi: 10.1093/infdis/jit192) analyzed the prevalence of HPV in 2007-2010 and compared results with those in the pre-vaccine period of 2003-2006. The prevalence of vaccine-type viruses (types 6, 11, 16 and 18) decreased from 11.5% to 5.1%, an impressive 56%. The calculated vaccine effectiveness for at least one dose was 82%. It is unfortunate that only approximately one-third of eligible girls received the vaccine.