Vaccine
-
More than ever, clinicians need regularly updated reviews given the continuously increasing amount of new information regarding innovative cervical cancer prevention methods. ⋯ Sufficient evidence exists to recommend HPV testing in triage of women with atypical cytology and in surveillance after treatment of CIN lesions. In the United States, recently reviewed knowledge has resulted in the approval of combined cytology and HC2 primary screening in women older than 30 years. However, in Europe, cytology-based screening still remains the standard screening method. The European screening policy will be reviewed based on the longitudinal results of randomised population trials which are currently underway.
-
The main potential areas of bias in economic evaluation (EE) in health care can be categorised as follows: (1) choosing the study question and design, (2) estimating clinical effectiveness; (3) choosing cost data sources, and (4) reporting and dissemination of results. Each of these is discussed while focusing on vaccines. ⋯ This paper explores the differences between them in relation to the four areas of bias. Finally, remedies to avoid bias in research and publications are proposed and discussed.
-
Control measures to limit the spread of a cholera outbreak in Pohnpei Island (Micronesia), included mass vaccination with the single-dose live-attenuated oral cholera vaccine CVD 103-HgR as a potential adjunct measure. The outbreak provided a unique opportunity to evaluate the practicality of use and effectiveness of this vaccine. Under field conditions encountered in Pohnpei, crude vaccine efficacy was estimated at 79.2% (95% CI: 71.9-84.6%) in the target population. Retrospective analysis suggests that mass vaccination with oral cholera vaccines can be a useful adjunct tool for controlling outbreaks, particularly if implemented early in association with other standard control measures.
-
While a number of studies remain to be completed, evidence is mounting that there is no demonstrable risk for infants immunized with vaccines containing thiomersal. Epidemiological studies in the US have shown no developmental or other central nervous system abnormalities resulting from exposure to vaccines containing thiomersal. During the initial evaluation of thiomersal in vaccines during 1999, the toxicological profile of ethyl mercury was unknown and presumed to be the same as that of methyl mercury. ⋯ Until such time as the scientific evidence is to hand, thiomersal-free presentations of hepatitis B are to be preferred for the birth dose. Given the same levels of exposure, adults are at much lower levels of risk because of increased body mass. It is not possible to prove that thiomersal is completely safe-epidemiology can only quantify a risk, not prove its absence.
-
Media attention and consequent public concerns about vaccine safety followed publication of a small case-series of children who developed autism after receipt of the measles-mumps-rubella (MMR) vaccine. Many well-controlled studies performed subsequently found no evidence that MMR vaccine causes autism. However, despite these studies, some parents remain concerned that the MMR vaccine is not safe. We will discuss the origins of the hypothesis that the MMR vaccine causes autism, studies performed to test the hypothesis, how these studies have been communicated to the public, and some suggested strategies for how this communication can be improved.