Jenina Pellegren

The CDC Foundation recently announced that the Pfizer Foundation granted them a $1million donation, aimed at advancing efforts to combat the spread of the Zika virus. In addition, the CDC Foundation has also received, “donations of up to 170,000 doses of injectable reversible contraceptive product from Pfizer…for the Zika Contraception Access Network (Z-CAN) in Puerto Rico,” according to a 

The Pfizer Foundation funds will go towards Zika virus outbreak emergency response, as well as Z-CAN. Judith A. Monroe, MD, president and CEO of the CDC Foundation commented, “The generous support of Pfizer and the Pfizer Foundation is vitally important to help combat the devastating effects of the Zika outbreak. We can do so much more working together to help prevent Zika from affecting more families.”

Women infected with Zika during pregnancy are likely to pass the infection to their developing fetuses, in turn, causing congenital microcephaly— a lifelong disability caused by severe brain defects. Microcephaly can cause eye defects, hearing loss, and impaired growth. In Puerto Rico, for those who are choosing to delay or avoid pregnancy due to the Zika virus outbreak, Z-CAN has been offering a variety of free contraceptive options. Z-CAN comes after an April 2016 

 found that, according to a 2008 survey conducted in a Puerto Rico hospital, 65.5% of pregnancies were unplanned. The report also mentioned that 1 in 5 women between the ages of 15 and 44 do not desire to become pregnant. However, at the time, “access to contraception [was] constrained by limited availability, especially of highly effective long-acting reversible contraceptives, high cost, incomplete insurance coverage, and lack of trained providers.”

 and threaten the wellbeing of those at highest risk of developing Zika-related complications. Currently, there are 180 locally-acquired cases of Zika virus infections in Florida, and a total of 3,879 travel-associated cases in the United States.

In addition to the Zika virus funding granted to the CDC Foundation, Pfizer Foundation has granted an additional $1 million to the 

 (DOH) to assist in Zika response efforts. According to the DOH, the funds will be used to advance education efforts among Florida residents, aid in the state’s ongoing Zika virus investigations, and fund necessary supplies and lab equipment. In addition, the DOH also announced that it will be “using these funds to purchase Zika prevention kits to distribute in Miami-Dade County,” Florida’s current active zone of transmission.

Commenting on the increasing threat of the Zika virus, Sally Susman, executive vice president of corporate affairs at Pfizer Inc, stated, “A challenge like Zika requires every organization to bring forward their resources and expertise to manage health risks that exist for people in affected areas of the country. We welcome the opportunity to partner with the CDC Foundation and healthcare professionals to address today's health needs while work continues to identify longer-term solutions.”

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The CDC Foundation and the Florida Department of Health have announced that the the Pfizer Foundation has donated millions to improve Zika response efforts.

Pfizer Foundation Donates Millions to Help Combat Zika

Human Immunodeficiency Virus (HIV) remains a major health issue around the world. Sub-Saharan Africa is the most affected region, accounting for two-thirds of new global HIV infections in 

. During the 2016 HIV Research and Prevention (HIVR4P) meeting in Chicago, researchers conducting trials to assess the safety and efficacy of the dapivirine vaginal ring announced several key findings and insights of the ASPIRE study, known as MTN-020.

NIAID Director Anthony S. Fauci, MD said, “Women need an HIV prevention modality that offers safe, effective protection and is practical for use in their daily lives. Women enrolled in the MTN-020/ASPIRE study reported that the experimental vaginal ring generally did not interfere with sexual intercourse, which is an encouraging sign that this product could appeal to a larger group of women at risk for HIV infection.”

 sponsored by the International Partnership for Microbicides, and funded by the National Institute of Health (NIH), evaluated 2,629 women 18-45 living in Malawi, South Africa, Uganda, and Zimbabwe. The research revealed that the participants’ risk of acquiring HIV infection fell by 27%. HIV risk was reduced by approximately 56% among women who used the ring with greater frequency. For those participants who used it consistently, risk was reduced by up to 75%.

According to the analysis, led by Nicole Laborde, PhD, MPH, of RTI International in Research Triangle Park, located in North Carolina, “Some women reported greater sexual satisfaction partially due to perceived protection provided by the ring.” However, some women said they become anxious over whether their partners would notice the ring during sex and this reduced sexual pleasure. Other participants ceased engaging in certain sexual activities that they felt would alert their partners to the ring. Most women, however, found the ring did not negatively affect sexual encounters at all.

Additionally, researchers investigated the connection between program adherence and intimate partner violence. In a similar trial of the once-daily antiretroviral drug, Truvada, women who faced intimate partner violence were less likely to adhere to the program. According to the ASPIRE study’s authors, participants who experienced intimate partner violence or other types of social harm “were nearly 1.5 times more likely to report low adherence to the ring.” This data suggests exposure to intimate or social violence can increase risk of HIV infection. A 

 published by the World Health Organization (WHO) in 2013 serve to back this statistic. Authors of the report write, “the mechanisms underpinning a women’s increased vulnerability to HIV or STIs include direct infection from forced sexual intercourse.”

In South Africa, approximately 42,596 cases of rape were 

 in 2015-2016, which suggests women are likely to experience violence at the hands of their sexual partners. This information, along with data from other HIV prevention studies, suggests the importance of undetectable HIV protection.

The reported experiences of the women who participated in the study revealed a variety of sexual dynamics. Dr. Palanee-Phillips, director of network trials at the Wits Reproductive Health and HIV Institute in Johannesburg, South Africa and the protocol co-chair on the ASPIRE study commented, “we are learning more about how these diverse behaviors and circumstances influence the use of the ring. While we have found that most women do disclose ring use to their primary partners, it is reassuring that adherence is not affected for the significant minority of women who choose to use it more discreetly.”

Research and data collection on the ring will continue through the HOPE (HIV Open-Label Prevention Extension) study. All participants will continue to receive HIV services whether or not they continue using the ring; this will include condoms, partner testing, and counseling. Investigators believe, “this approach will shed light on the critical questions of whether participants like using the ring, and why.”

Feature Picture Source: NIAID / flickr / 

During the 2016 HIV Research and Prevention (HIVR4P) meeting in Chicago, researchers conducting trials to assess the safety and efficacy of the dapivirine vaginal ring announced several key findings and insights of the ASPIRE study, known as MTN-020.

ASPIRE HIV Prevention Study Reveals Several Key Findings

 2015 Sexually Transmitted Disease Surveillance report from the Centers for Disease Control and Prevention (CDC), sexually transmitted diseases (STDs) are on the rise and systems of prevention have eroded. Currently, there are 20 million new STDs in the United States every year; approximately half of these infections are found in young people between the ages of 15 and 24 years. There are more than 110 million new and existing infections across the US at any given time. Many cases continue to go undiagnosed.

, Jonathan Mermin, MD, MPH, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, said, “We have reached a decisive moment for the nation. We must mobilize, rebuild and expand services -- or the human and economic burden will continue to grow.”

There were an estimated 1.5 million case of chlamydia in 2015, an increase, according the surveillance report, of almost 6% since 2014. Meanwhile, cases of syphilis, both primary and secondary, increased by 19%, and cases of Gonorrhea increased by approximately 13% since 2014. Contributing to this was a rise in infections among men “across all diseases,” the report said.  However, the data only captures a small part of the burden STDs have had in the United States. To date, infections from human papillomavirus, herpes simplex virus, and trichomoniasis go unreported to the CDC.

Young individuals as well as gay and bisexual men face the greatest risk of contracting STDs. There have also been “troubling increases” in rates of syphilis among newborns. Through a CDC media 

, Gail Bolan, MD, director of the CDC’s Division of STD Prevention said, “The health outcomes of syphilis — miscarriage, stillbirth, blindness or stroke – can be devastating.” He continued, “The resurgence of congenital syphilis and the increasing impact of syphilis among gay and bisexual men makes it clear that many Americans are not getting the preventive services they need. Every pregnant woman should be tested for syphilis, and sexually active gay and bisexual men should be tested for syphilis at least once a year.”

However, as Dr. Mermin pointed out, prevention resources specifically targeting STD rates across the United States are being “stretched thin”. Both state and local STD programs have had their budgets cut, causing closures of more than 20 STD clinics in 2015 alone. This means people are losing access to preventative services and slipping through the cracks of the public health system. The CDC recommends state and local health departments direct resources to those most affected by this recent epidemic. They are also asking providers to make STD screening a standard part of patient care, especially among pregnant women.

 testing and treatment guidelines so healthcare professionals can provide individuals with effective care. Parents and the public at large need to speak openly about STD transmission and testing. The CDC recommends parents and providers, “Offer young people safe, effective ways to access needed information and services.” It is critical that public and private healthcare providers, along with local leaders, promote STD prevention education in their communities.

The Centers for Disease Control and Prevention reported a rise in STDs and a dent in preventive services in their 2015 Sexually Transmitted Disease Surveillance report.

CDC Reports STDs are on the Rise in the US

 is responsible for bubonic, septicemic, and pneumonic plague. Without prompt treatment, infections are 100% fatal. Humans can become infected by handling an infected animal or by being bitten by fleas carrying the bacteria. It is responsible for killing millions of people in Europe during the Middle Ages but, human plague infections still occur today.

The World Health Organization (WHO) has classified 

 as a re-emerging pathogen because of an increase in human infections globally. The Centers for Disease Control and Prevention (CDC) has classified 

 as a tier-1 select agent—materials that have been identified by the federal government as agents that can be used as bioweapons. Antibiotic resistant strains of the bacteria can be isolated from patients with plague and used in biological terrorism.

However, a potential vaccine may have been 

 by researchers from the University of Texas Medical Branch at Galveston (UTMB) that provides animals with long-term protection from the plague. In a 

 from UTMB, Ashok Chopra, UTMB professor of microbiology and immunology said, “The optimal strategy for protecting people and animals against this deadly disease would be through vaccination, but there are no FDA-licensed plague vaccines available in the US. We've been working to develop a vaccine that will generate long-term immunity and protection against the plague."

, the researchers constructed new versions of the 

 bacteria, by deleting and modifying certain genes. This “mutant bacteria” was designed to provide immunity from the plague without making the animals in the study ill. The researchers also tested the longevity of the immune response after vaccination and found the animals were protected for up to five months.

Chopra emphasized, “In addition to how well a vaccine works to protect against disease, safety is another important aspect for vaccine development. We have shown that our mutants (versions of the bacteria) are safe vaccine candidates as our detailed analyses showed no sign of damage to bodily tissues in the vaccinated animals.”

The study authors plan to request the CDC exclude their “mutants” from the select agent list in order to be able to safely produce and test the potential vaccines. Further research will continue to evaluate the safety and efficacy in non-human primates.

A mutated version of Yersinia pestis may hold the key to vaccines for the plague.

Mutant Y. pestis May Hold the Key to Potential Vaccine for Plague

To assess factors associated with the likelihood that healthcare providers (HCP) will accept seasonal influenza vaccine policy changes, Nova Scotia researchers 

 the roles that their knowledge and attitude play in the matter.  

Between September and October 2010, researchers circulated a self-report survey to a sample of HCPs in a pediatric care facility that provides primary and consultative services. The survey was designed to collect information pertaining to the knowledge, attitudes, and beliefs HCPs have regarding seasonal influenza vaccinations. The researchers wanted to know what factors were associated with their willingness to accept policy change. The outcome was measured by evaluating the impact that knowledge had on individual attitudes.

In the United States, more than 300 facilities require immunizations in order to maintain employment. In response to this change, vaccine compliance rates have exceeded 99%. Policies that require annual influenza vaccinations as a condition for employment are 

 by The Society for Healthcare Epidemiology of America (SHEA). Still, overall HCP vaccination rates remain well below the recommended target of 90%.

Failures to increase vaccination uptake among HCP have pushed jurisdictions in Canada to increase seasonal influenza vaccine uptake through policy changes, which include: mandatory masking programs, declarations, and the consideration of legislative changes.

In 2012, British Columbia became the first jurisdiction in Canada to put into place a province-wide policy that required designated HCPs to either receive a seasonal influenza vaccine or wear a mask. Following the implementation of this policy, immunizations increased from 40% to 74%.

Results from the study were mixed when evaluating the impact that knowledge had on actual willingness to accept vaccine policy changes, suggesting that knowledge was only a significant predictor at the organizational and legislative levels.

 According to the study’s authors, “Even with a 'mandatory' vaccine program, there are pitfalls associated with attitudinal barriers to vaccine acceptance amongst HCPs.” The study results suggest that although knowledge is a critical factor in willingness to accept policy change at local and legislative levels, it is an insufficient predictor.  

The researchers concluded, “attitudes toward behavior reflect the judgement and perceptions of that knowledge (ie, information) and thus play a key role in the willingness to accept policy change. Knowledge is a proximal predictor of attitudes, implying that it must be an important consideration when attempting to impact attitudes.”

In order to impact HCPs' willingness to accept policy change pertaining to seasonal influenza vaccination, new, comprehensive, and novel approaches should be taken. According to research, peer vaccine champions, opinion leaders, and participation from labor management, have all been proven to be effective in other 

. Early involvement and communication by union officials proved to be an effective approach to helping HCPs accept “vaccinate or mask” policy changes.

Human resistance may be the greatest challenge when introducing any policy changes. To successfully implement changes, early engagement and collaboration with labor unions and safety bodies is an avenue worth exploring. For healthcare organizations attempting large-scale change in their seasonal influenza programs, the researchers advise removing as many barriers as possible and considering options that will protect patient populations most effectively.

To assess factors associated with the likelihood that healthcare providers will accept seasonal influenza vaccine policy changes, Nova Scotia researchers examined the roles that their knowledge and attitude play in the matter. 

Healthcare Provider Attitudes Toward Seasonal Influenza Vaccine Policies

In the United States, pharmacists trained to provide immunization delivery has grown from 40,000 in 2007, to more than 260,000 in 2015. According to the Centers for Disease Control and Prevention (

), “by 2016, all accredited schools of pharmacy in the US will be required to include immunization training of student pharmacists as part of their core curricula.”

Pharmacists are critical to expanding access to pandemic vaccination. However, little is known about the relationships and planning activities between public health programs and pharmacies. A recent 

 analyzed data from the CDC to assess those jurisdictions that received immunization and emergency preparedness funding between 2012 to 2015.

In total, out of the 53 jurisdictions that were assessed, 47 (88.7%) reported they included pharmacies in pandemic vaccine distribution. In addition, approximately 45% had plans to recruit pharmacists to vaccinate and 30.8% had begun to establish formal relationships with pharmacists. The researchers found, “While most jurisdictions plan to include pharmacies as pandemic vaccine providers, work is needed to establish formalized agreements between public health departments and pharmacies to improve pandemic preparedness coordination and ensure that vaccinating pharmacists are fully utilized during a pandemic.”

Pharmacists have expanded their authority throughout the United States to vaccinate, particularly against influenza. As a result, pharmacists in every state, as well as those in the District of Columbia and Puerto Rico, are becoming increasingly familiar with vaccine management and delivery. Currently, one in four adults receive their seasonal “flu-shot” in a pharmacy or other retail 

Despite the progress being made, overall vaccination rates for adults in the United States remains low and racial and ethnic disparities in coverage persist. To address these challenges, the CDC encouraged pharmacists to support “immunization neighborhood,” and implement National Vaccine Advisory Committee Standards for Adult Immunization Practice.

In order for pharmacies to become ready to provide vaccinations, specifically influenza, in the event of a severe pandemic, they must understand the logistical differences between planning for both seasonal and pandemic influenza. Typically, pharmacists prepare for seasonal influenza by ordering vaccinations through their vendor. However, providers who wish to administer vaccinations during a pandemic must coordinate and enroll with their local public health program. Allocation depends upon patient population size and demographics, as well as storage and handling capabilities; this means that pharmacists must coordinate with public health officials well in advance.

 According to the public health data collected, most programs view pharmacies and pharmacists as valuable public health partners and have plans to include pharmacists as vaccinators, though there have been some identifiable gaps that remain.

Most often, there is incomplete information regarding the community population. A lack of clarity pertaining to enrollment and outreach as well as limited storage and handling capacity also make rapid vaccine allocation decisions challenging. Additionally, issues regarding uninsured patients have not been clarified. The authors of the report concluded, “perhaps the biggest pandemic vaccine program planning gap is that most public health programs appear to be underestimating the value and potential vaccination capacity pharmacies and pharmacists might have in rapidly vaccinating the public during a pandemic.”

 25% of seasonal influenza vaccine to adults during flu season. The researchers believe including pharmacies during pandemic influenza vaccine campaigns, despite high levels of participation from other vaccinators, can reduce the time it takes to vaccinate 80% of US adults with a single dose, from 18 weeks to 11 weeks.

As of September 2016, a pilot program has begun in three states to solidify partnerships between pharmacists and public health programs. The CDC and Association of State and Territorial Health Officials, are working with their immunization and preparedness partners to disseminate and raise awareness of available preparedness tools.

Pharmacists are critical to expanding access to pandemic vaccination. However, little is known about the relationships and planning activities between public health programs and pharmacies.

Jenina Pellegren

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