Thailand vaccine trial edges closer to dengue vaccine

bangkok - Scientists have edged closer to a dengue vaccine following trials in Thailand, where dengue fever is endemic, that have shown a vaccine candidate to be safe and effective, although more evidence is needed to prove its effectiveness.

The results of the clinical phase II trial, showing the vaccine to be 30 per cent effective in protecting from dengue, were published in The Lancet last week (11 September). The vaccine CYD-TDV, which was developed by the drug company Sanofi Pasteur, has been tested on 4,000 children aged four to 11 from 57 schools in Thailand's Muang District.

Dengue fever is the world's most widespread mosquito-borne viral disease with around half of the global population at risk. There is no vaccine to protect against it, although there are several being developed.

It is difficult to develop an effective vaccine because dengue fever is caused by four different strains of virus — known as DENV 1, 2, 3 and 4. The challenge is to develop a vaccine that can protect against all types of dengue virus.

"The results of this trial show that the vaccine can protect against dengue fever caused by three virus types [DENV 1, 3 and 4]," said Pascal Barollier, a Sanofi Pasteur spokesperson. "The vaccine was well tolerated and safe, with no serious effects on those who received it."

But scientists not involved with the study say there is not enough data to prove the vaccine's effectiveness against severe dengue disease, and urged for further, larger trials.

Scott Halstead, a physician at the International Vaccine Institute in Seoul, Republic of Korea, said the result was both "surprising and disappointing", pointing out that the vaccine does not protect against DENV 2, "the most common type in Thailand".

He said it is too early to draw any conclusions about the vaccine's safety.

Sutee Yoksan, director of the Center for Vaccine Development at Mahidol University in Thailand, shared Halstead's concerns, and called for further investigations.

According to Barollier, phase III clinical studies involving 31,000 children and adolescents are ongoing in Latin America (Brazil, Columbia, Honduras, Mexico and Puerto Rico) and in five Asian countries (Indonesia, Malaysia, the Philippines, Thailand and Vietnam) where dengue is endemic.

These trial results are expected in 2014. If successful the vaccine could be available in 2015 in countries where dengue is a public health priority.


Health Ministry Wants Rp 1.8 Billion to Kill Cockroaches

The Health Ministry is under fire for allocating Rp 1.8 billion ($190,000) to kill cockroaches and flies in its own offices, with one lawmaker wondering aloud whether the ministry staff is aware of proper sanitary habits.

Poempida Hidayatullah, a member of House of Representatives Commission IX, overseeing financial affairs, said that he had no strident objections to the plan, but still found it curious that the Health Ministry would allocate funds for it.

He added that one obvious key to a pest-free environment was preventative cleaning.

"I'm not going to make a fuss about the program to extinguish flies and cockroaches," Poempida said on the sidelines of a meeting with the Health Ministry in Jakarta on Monday. "I see the benefit that it will make the Health Ministry office more hygienic. But is this because they are filthy?

"I'm just going to think positively. Maybe the cockroaches and the flies appeared because the health program failed."

But the $190,000 plan to kill insects wasn't the only Health Ministry budget item that raised eyebrows on Monday.

Poempida also voiced suspicions over a plan to spend Rp 80 billion for certification for 2,500 health lecturers.

That would mean a budget expenditure of over Rp 30 million per certification, an amount the lawmaker said was absurd.

"Rp 30 million for certification training doesn't make sense. It should only cost Rp 2 million to Rp 3 million. That amount just doesn't make any sense," Poempida said.

Rieke Diah Pitaloka, another member of Commission IX, added her own suspicions, singling out a vague budget request for an unnamed number of vehicles for the ministry.

"There was a budget request for a vehicle worth Rp 700 million per unit, which is still not clear yet," Rieke said.

She also harshly criticized the ministry's plan to allocate more money for bureaucracy than for public health services in next year's state budget.

Rieke, a former actress turned outspoken politician, said that the ministry allocated about 49 percent of their total budget, or Rp 15.3 trillion, for public health services, and almost 51 percent, or Rp 15.8 trillion, for bureaucracy.

Out of the 51 percent allocated for bureaucracy, the ministry is allocating 22.7 percent for office maintenance and supplies and 17 percent for monitoring and evaluation activities.

"What good does it do if the state budget is used for bureaucratic needs?" Rieke said. "We should focus more of the budget on public health services."

In response to the criticism, Health Minister Nafsiah Mboi argued that the bureaucratic expenditures included salaries for vital medical staff, such as paramedics.

"This doesn't mean that bureaucracy is more important, but this is for the paramedics. Who's going to serve the public if no paramedics are available? We need many paramedics."

Nafsiah claimed that she had reduced office costs and that most of the bureaucratic budget would be used to assist paramedics on a regional level.

"You must look at the details of the budget," she said. "In this meeting we are talking about the macro aspects. Please discuss the micro aspects with my staff from Echelon I," she said, referring to top-level ministry officials.

Also on Monday, the Indonesian Forum for Budget Transparency (Fitra) criticized the Rp 23 trillion allocated in next year's draft budget for official travel expenses for ministries and government institutions.

A Fitra spokesperson said the amount was too high and prone to graft.

Finance Minister Agus Martowardojo said he is continuing to evaluate the amount budgeted for official travel expenses.


Health Ministry: 175 1Malaysia clinics by end of the year

Kuala Lumpur - The Health Ministry plans to have 175 1Malaysia clinics by year-end due to the high demand, said Minister Datuk Seri Liow Tiong Lai.

"The clinics have benefited some five million patients so far. The response has been very encouraging.

"There are currently 119 1Malaysia clinics in operation nationwide while 56 more are in various stages of implementation," he said at the launch of the 1Malaysia clinic at the Danau Kota flats here yesterday.

Liow said they planned to expand the clinics' services to include healthcare for mothers and children beginning next year.

The 1Malaysia clinics, he said, would make it easier for patients to seek treatment as they were open from 10am to 10pm and located near residences.

Patients, he said, could seek treatment at the community-based clinics but needed to go to a hospital for serious ailments.

The clinics offer treatment for minor ailments such as cough, flu and fever, basic dressings, sugar and urine tests as well as health advice, among others.

Liow later attended the Hari Raya open house organised by Wangsa Maju MCA division chief Datuk Yew Teong Look's service centre. Yew was formerly the Wangsa Maju MP.


Health, education ministries launch online course for field epidemiologists

The Health Ministry has launched an online distance-learning course for field epidemiologists to help them improve their knowledge about epidemiological investigations, which might be useful when dealing with unexpected public health crises.

The 2012 Field Epidemiologist Training Program (PAEL) offers participants a unique online training methodology in which they can study from anywhere in the country.

"Many health workers have limited chances to attend training courses as they live in remote areas, precisely those places that are classified as areas with serious health problems," Sulistiono, the Health Ministry's human resources, learning and training center head, said on Friday.

Field epidemiologists have the responsibility of investigating unexpected health problems that need immediate intervention.

Some 140 epidemiology field assistants are currently attending the online PAEL pilot program in seven provinces: Central Java, East Java, Jakarta, North Sumatra, South Sulawesi, South Sumatra and West Java.

The program, developed by the ministry in collaboration with the Education and Culture Ministry's Information and Communications Technology Center (Pustekkom), began on Sept.11 and will run for the next 31 days.

Sulistiono hopes that such trainings would be developed further in the future. "The e-learning can be done from home, which means we can be more efficient in our spending," he said.


Study of U.S. Health Care System Finds Both Waste and Opportunity to Improve

WASHINGTON — The American medical system squanders 30 cents of every dollar spent on health care, according to new calculations by the respected Institute of Medicine. But in all that waste and misuse, policy experts and economists see a significant opportunity — a way to curb runaway health spending, to improve medical outcomes and even to put the economy on sounder footing.

"Everybody from Paul Krugman to Paul Ryan agrees it is essential to restrain costs," said Dr. Mark D. Smith, the president of the California HealthCare Foundation and the chairman of the committee that wrote the report, referring to the liberal economist and Op-Ed columnist for The New York Times, and the conservative Wisconsin congressman who is Mitt Romney's vice-presidential running mate. "The health care industry agrees, too."

The Institute of Medicine report — its research led by 18 best-of-class clinicians, policy experts and business leaders — details how the American medical system wastes an estimated $750 billion a year while failing to deliver reliable, top-notch care. That is roughly equivalent to the annual cost of health coverage for 150 million workers, or the budget of the Defense Department, or the 2008 bank bailout.

The institute's analysis of 2009 data shows $210 billion spent on unnecessary services, like repeated tests, and $130 billion spent on inefficiently delivered services, like a scan performed in a hospital rather than an outpatient center.

It also shows the health care system wasting $75 billion a year on fraud, $55 billion on missed prevention opportunities and a whopping $190 billion on paperwork and unnecessary administrative costs. The Institute of Medicine is an independent adviser to the government and the public, and part of the National Academy of Sciences.

The report depicts a system that saves lives in miraculous fashion, but is also expensive and outmoded and in some cases downright Kafkaesque.

"If banking were like health care, automated teller machine transactions would take not seconds but perhaps days or longer as a result of unavailable or misplaced records," the report said. "If home building were like health care, carpenters, electricians and plumbers each would work with different blueprints, with very little coordination."

Along with the squandered money there is a human toll, the report said, as medical errors and inefficiencies mean that doctors fail to deliver the best and most timely care to patients.

"If the care in every state were of the quality delivered by the highest-performing state, an estimated 75,000 fewer deaths would have occurred across the country in 2005," the report said.

But the report — and independent health care experts and economists analyzing it — identified an opportunity in that $750 billion of wasted health spending. If hospitals, doctors and insurers could wring even a fraction of that money out, it would help to bend the so-called cost curve of runaway health inflation while improving patient outcomes.

The point of the report is that "Americans should expect to get and should demand to get better value for their health care dollar," Dr. Smith said.

"That money is not only not buying anything," said David Cutler, the Harvard health economist. "It is actually a sign of poor care. A lot of cost reductions, if we do them the right way, would mean improved health, not worse health."

Professor Cutler gave as an example rules to make sure that doctors do not perform inductions for otherwise healthy pregnant women before 39 weeks of gestation. It would both save money and improve health outcomes by reducing the rate of Caesarean sections, he said.

The report gives recommendations intended to reduce spending and improve care: ensuring doctors work in teams and share information; making prices and costs transparent to consumers; rewarding doctors for outcomes, not procedures; ensuring all doctors use the best-tested practices, and identifying and correcting errors among them.

The report also detailed instances of health care providers offering such smarter care: hospitals preventing re-hospitalizations, upgrading their records systems and cutting out ineffective therapies, for example.

Some health economists and policy experts believe that political changes and financial pressure have already spurred insurers and health care providers to start squeezing out costs, contributing to the slowdown in health spending growth seen in the past few years.

"We're starting to see some very early results," said Wendy Everett, the president of NEHI, a health care research group based in Cambridge, Mass.

She said she expected to see more and more adoption of best practices in the next few years, spurred by President Obama's Affordable Care Act, other changes to Medicare and Medicaid and a recognition among doctors and insurers that the current trajectory of health care spending is unsustainable.

"This train's coming much faster than we thought," Ms. Everett said. She guessed that within a decade providers being paid for the quality, not quantity, of care would be "the norm."


Dengue vaccine – still a long way off says World Health Organization (WHO)

New York, NY, United States (IRIN) – Dengue fever is classed by the World Health Organization (WHO) as a "major international public health concern". WHO estimates that it infects 50-100 million people a year; it is a leading cause of death among children in Asia and Latin America, and it is now spreading outside its traditional heartlands to Africa and the Middle East.

But dengue is difficult to deal with. There is no cure, only treatment for the symptoms. And although there are effective vaccines against related viruses, like yellow fever and Japanese encephalitis, no one has yet succeeded in making a safe, effective vaccine against dengue.

Now a team of researchers working with the French drug company Sanofi Pasteur has carried out a randomized trial of a possible vaccine, involving more than 4,000 schoolchildren in northern Thailand, and have produced some interesting results. Their vaccine was only partly effective but the team's findings – reported in the British medical journal, the Lancet – suggest that the development of a useful vaccine is getting closer.

Derek Wallace of Sanofi-Pasteur, one of the authors of the report, hailed their results as an important step. "Our study constitutes the first ever demonstration that a safe and effective dengue vaccine is possible," he says. "Further trials [of the vaccine] are currently under way in a number of different countries, and we hope that the positive results of this trial will be confirmed by these larger studies."

The trial took place in Thailand's Muang District, based at Ratchaburi Regional Hospital, and involved researchers from Bangkok's Mahidol University. Children aged 4-11 from 35 local schools were enrolled in the trials. Two-thirds of them were given three doses of the vaccine, known as CYD-TDV (a recombinant, live, attenuated tetravalent vaccine, based on yellow fever 17D vaccine strain, produced in Vero cells). The control group received either rabies vaccine or a placebo.

The children were vaccinated three times, at six-monthly intervals, and the researchers looked at the presence of dengue antibodies in their blood, as well as checking all cases of fever, mild or serious, and recording which were due to dengue.

The results were mixed. While the vaccine appears to be safe and well tolerated, it had only a limited effect. It gave useful protection against three strains of the disease, those known as DENV 1, 3 and 4. But although the vaccinated children produced antibodies to DENV 2, they still caught the disease just as often as the children in the control group. And unfortunately DENV 2 is the most common strain of dengue fever in northern Thailand.


Scott Halstead of the International Vaccine Institute in Seoul, points out that even these results were made less useful by the fact that they did not test the vaccine on teenagers, who are more likely to get the severe form of the disease. He said: "Results from this vaccine trial provide hard evidence of protection against DENV 1, 3 and 4 mild disease but insufficient data to calculate vaccine efficacy rates for severe disease. Future dengue vaccine trials should provide robust evidence of efficacy against severe disease by selecting populations weighted to assure inclusion of sufficient numbers of at risk children."

Bill Messer, clinical assistant professor at the Division of Infectious Diseases in the University of North Carolina School of Medicine, is blunter, pointing out that Sanofi Pasteur has been trying to refine the vaccine for the past decade (it started presenting papers on it in about 2001) but that the vaccine still cannot produce a "robust" response.

"This [study] is an encouraging first step, but far from where we need to be. It did not show the vaccine can prevent severe cases. That is an important endpoint [for a dengue vaccine]. You need to show recipient populations protection against severe dengue in order to encourage [vaccination]," he said.

While most dengue patients do not have symptoms or only mild pain and a rash, up to 10 percent develop a lethal "severe" form of the disease (previously known as dengue haemorrhagic fever). Only five children in the study had severe dengue, too few to analyse, a limitation the authors noted was being corrected in ongoing studies with 30,000 adults and children in dengue-endemic countries.

Messer also said the number of people tested thus far in Thailand is insufficient to prove the vaccine will not cause severe dengue. Health experts have expressed concern that complications from a dengue vaccine may result in infection rather than confer protection.

Despite some positive results from the trials, it seems that a dengue vaccine is still a long way off.


Asia fails to take up rotavirus vaccine

Bangkok, Thailand (IRIN) – Most countries in Asia have yet to make the rotavirus vaccine part of their national immunization programme (NIP), despite a World Health Organization (WHO) recommendation to do so.

"Timely vaccination with one of the two effective rotavirus vaccines [Rotarix and Rotateq] can prevent many cases of [rotavirus] illness and hospitalizations," WHO's Manila office said in an email to IRIN on 7 September. "WHO recommends the inclusion of rotavirus vaccine in the national immunization schedules of all countries."

According to WHO, rotavirus is the most common cause of severe diarrhoeal disease in young children, with more than 500,000 children under the age of five dying worldwide each year. Highly contagious, the virus causes vomiting and severe diarrhoea that can lead to dehydration and potential death.

Children aged six months to two years are particularly vulnerable to infection. Worldwide, rotavirus accounts for 37 percent of all diarrhoea deaths in children under five with 95 percent of those deaths occurring in developing countries.

While the virus is treatable by providing fluids and salts, health experts note that it has a devastating and deadly impact in areas where people cannot access medical care. There are no antibiotics or any other drug to fight the infection and since 2009 WHO has recommended the global use of the rotavirus vaccine.

"For rotavirus vaccine the main aim is to prevent or reduce the severity of the first one or two infections in young children," Tony Nelson, professor of paediatrics at the Chinese University of Hong Kong and member of the Rotavirus Organization of Technical Allies (ROTA council), told IRIN. "It is these first infections that are the most severe and most likely to cause life-threatening dehydration."

The international health NGO PATH reports that in Asia 42 percent of all hospital admissions of children under five with diarrhoea are the result of rotavirus, while 188,000 children under five die each year.

"As many of these deaths and admissions could be prevented by vaccination, it is sad that very few countries in Asia have announced plans to include rotavirus vaccines in their NIPs," Nelson said.

As of September 2012, 41 countries worldwide have introduced rotavirus vaccines in their NIPs. Four African countries – Botswana, Ghana, Rwanda and Sudan – have fully introduced the oral vaccine in their NIPs, while South Africa and Zambia introduced rotavirus vaccination on a regional basis.

However, only two countries in Asia – Philippines and Thailand – are vaccinating (or are about to) children against rotavirus: "Price continues to be an important barrier to introducing rotavirus vaccine," WHO explained.

In July, Philippines started vaccinating an estimated 700,000 children each year aged 1.5-3.5 months from the poorest communities.

In the same month Thailand announced it will vaccinate regionally, but has yet to provide an actual launch date. (

SEA health ministers agree better policies on the elderly

Health ministers from the 11 member states of the World Health Organization Southeast Asia Regional Office (WHO SEARO) agreed on Tuesday to adopt the Yogyakarta Declaration on Aging and Health, and committed to improving national responses to the health of aging populations.

The declaration comes at an important juncture in history as 142 million people or 8 percent of the population of the region are above the age of 60. The figure is estimated to double by 2025 and treble by 2050.

"The WHO follows a life-course approach to promoting healthy, active aging. People who get the right start in life, follow healthy lifestyles and take good care of their health can expect to remain active during their eighth, ninth and even 10th decades of life," WHO director general Margaret Chan said.

The adoption was made during the 30th health ministers meeting and the 65th session of the WHO regional committee for Southeast Asia in Yogyakarta, opened by Indonesian Vice President Boediono on Tuesday.

WHO SEARO groups together Bangladesh, Bhutan, South Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor Leste.

The declaration underscores concern that the economic effects of aging will impact on health care and social support systems and will require the attention of policy makers, NGOs and the private sector.

The ministers also recognized that healthy aging should optimize opportunities for the physical, social and mental health of older persons to enable them to take an active part in society and to enjoy an independent life without discrimination.

Health Minister Nafsiah Mboi said in her remarks at the meeting that the declaration "will force governments of [Southeast Asia region] member states to commit on building partnerships among various stakeholders to strengthen health qualities and services for aging populations."

Providing an example, Nafsiah said that Singapore had implemented a policy that prioritized housing facilities for families who were willing live together with their respective aged parents.

"In this case, each of the states has to look for the right policy for its respective country," she said. (