1. Fractional-dose vaccination offers long lasting protection against yellow fever
Abstract: http://annals.org/aim/article/doi/10.7326/M18-1529
URLs go live when the embargo lifts
A one-fifth dose of yellow fever vaccine protects against yellow fever for 10 years and does not require a booster. Findings from a follow-up study of a randomized controlled, non-inferiority trial are published in Annals of Internal Medicine.
Yellow fever is an acute viral hemorrhagic disease that is spread by infected mosquitoes. In a recent outbreak of urban yellow fever in Angola and the Democratic Republic of Congo, 4,347 suspected cases and 377 deaths were reported from December 2015 to October 2016. Since there is no cure, vector control and vaccination are essential for prevention. Outbreaks of yellow fever and a frequently depleted vaccine stock increase demand for a dose-sparing strategy. A fractional dose of 17D yellow fever virus (17D-YFV) vaccine has been shown to be non-inferior to the standard dose for inducing a protective immune response, but whether this dose provides long-term protection is not known.
Researchers from Leiden University Medical Center, Leiden, the Netherlands, studied 10 year follow-up data on a subgroup of patients from the trial to evaluate whether fractional-dose vaccination conferred long-term immunity. They found that 97 percent of participants had protective levels of yellow-fever neutralizing antibodies more than 10 years after receiving fractional dose of 17D-YFV vaccine compared with 34 of 35 who received the standard dose. According to the researchers, this is one of the first studies to document long-term protection after fractional-dose yellow fever vaccination. These findings reinforce the policy of using fractional doses in preventive mass vaccination campaigns before an impeding outbreak and also show that a booster dose is not necessary.
Media Contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Anna H.E. Roukens, MD, PhD, please contact her directly at A.H.E.Roukens@lumc.nl.
2. New evidence must be considered when prescribing aspirin for primary prevention
Abstract: http://annals.org/aim/article/doi/10.7326/M18-2637
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Recently published trials provide more evidence to help guide decision-making about prescribing aspirin for primary prevention. An analysis of key findings from these trials is published in Annals of Internal Medicine.
Aspirin is known to have important benefits, including preventing cardiovascular events and possibly reducing the incidence and mortality of some types of cancer. However, it is not without harms. Aspirin use can increase the risk for gastrointestinal bleeding and intracerebral hemorrhage. Despite a large number of trials, questions remain about aspirin's net benefit because the benefits and risks are so closely balanced.
Michael Pignone, MD, MPH from Dell Medical School at the University of Texas, Austin, says that new evidence should be considered when making decisions about prescribing aspirin for primary prevention. The ASPREE (Aspirin in Reducing Events in the Elderly) trial showed a greater harm than benefit for initiating aspirin treatment in older adults, but did not inform treatment for those who were receiving aspirin before age 70. The ASCEND (A Study of Cardiovascular Events in Diabetes) trial found that aspirin use was associated with a modest reduction in cardiovascular events and major bleeding risk increased modestly. No effect was seen on cancer and findings were inconclusive for all-cause mortality.
According to Dr. Pignone, these new data suggest that aspirin therapy should not be initiated for primary prevention in most adults older than 70 with or without diabetes. Evidence is not clear whether to withdraw aspirin use after age 70. For those under 70, aspirin may still provide net benefit in those at high cardiovascular risk after use of other preventive medications like statins. Although recent evidence tilts away from aspirin use at this time, additional follow up from these trials looking at aspirin's effect on cancer over a longer time period could change the recommendation.
Media Contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview someone from ACP, please contact Shahreen Abedin at shahreen.abedin@austin.utexas.edu.
3. ACP releases principles to guide patient partnership in health care
New ACP position paper details how patient-centered care can improve outcomes
Abstract: http://annals.org/aim/article/doi/10.7326/M18-0018 Editorial: http://annals.org/aim/article/doi/10.7326/M18-2947
URLs go live when the embargo lifts
The American College of Physicians (ACP) has released a set of four principles that aims to solidify the role of patients and families in their care plans. ACP's position paper, "Principles for Patient and Family Partnership in Care," is published in Annals of Internal Medicine.
Increasing evidence shows that patient and family partnership in care can improve health outcomes, practice efficiency, and patient and professional satisfaction. Patient- and family-centered strategies have been shown to lower utilization of health care resources, result in fewer referrals and diagnostic testing, and reduce health care costs.
Active partnership with patients and families in their care and at the system level can improve safety and reduce harm. One study found that patients who actively participated in care were more likely to report problems with filling prescriptions, drug effectiveness, and medication-related symptoms. ACP's High Value Care initiative aims to improve health, avoid harms, and eliminate wasteful practices.
ACP's principles for patient and family partnership in care, based on a comprehensive literature review and a multi-stakeholder vetting process, are:
- Patients and families should be treated with dignity and respect.
- Patients and families should be active partners in all aspects of their care.
- Patients and families should contribute to the development and improvement of health care systems.
- Patients and families should be partners in the education of health care professionals.
Media Contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview someone from ACP, please contact Steve Majewski, SMajewski@mail.acponline.org or 215-351-2514.
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Also in this issue: The Burden of Candidate Pathogenic Variants for Kidney and Genitourinary Disorders Emerging From Exome Sequencing
Hila Milo Rasouly, PhD; Emily E. Groopman, BA; Reuben Heyman-Kantor, BA; David A. Fasel, BS; Adele Mitrotti, MD; Rik Westland, MD, PhD; Louise Bier, MSc; Chunhua Weng, PhD; Zhong Ren, BS; Brett Copeland, BS; Priya Krithivasan, MSc; Wendy K. Chung, MD, PhD; Simone Sanna-Cherchi, MD; David B. Goldstein, PhD†; and Ali G. Gharavi, MD
Original Research
Abstract: http://annals.org/aim/article/doi/10.7326/M18-1241
Editorial: http://annals.org/aim/article/doi/10.7326/M18-3090
Journal
Annals of Internal Medicine