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dr Firman Abdullah SpOG / OBGYN

dr Firman Abdullah SpOG / OBGYN

Monday, June 29, 2009

The impact of human papillomavirus vaccination on cervical cancer prevention efforts. Massad LS, Einstein M, Myers E, Wheeler CM, Wentzensen N, Solom

Division of Gynecologic Oncology, Washington University School of Medicine, St. Louis, MO, USA.

OBJECTIVES: To review concepts, information, obstacles, and approaches to cervical cancer screening and prevention as vaccination against human papillomavirus (HPV) types 16 and 18 is adopted.

METHODS: Expert forum, conducted September 12-13, 2008, hosted by the Society of Gynecologic Oncologists, including 56 experts in cervical cancer and titled Future Strategies of Cervical Cancer Prevention: What Do We Need to Do Now to Prepare? RESULTS: The current approach to cervical cancer screening in the U.S. is limited by its opportunistic nature. If given to women before exposure, a vaccine against HPV 16,18 can decrease cervical cancer risk by up to 70%. The impact on abnormal cytology and cervical intraepithelial neoplasia (CIN) will be less but still substantial. As the prevalence of high-grade CIN falls, fewer women with positive screening tests will have truly preinvasive disease. To minimize harm from false positive tests in women who are at low risk for cancer because of early vaccination, later initiation of and longer intervals between screenings are ideal. However, the vaccine is less effective when administered after first intercourse, and delivering and documenting HPV vaccination to girls at optimal ages may prove difficult.


CONCLUSIONS: Until population-based data on the performance of cytology, HPV testing, and alternate screening or triage interventions become available, modifying current screening guidelines is premature. Current recommendations to initiate screening as late as age 21 and to screen less often than annually are appropriate for young women known to have been vaccinated before first intercourse.

PMID: 19410282 [PubMed - as supplied by publisher]

Congenital Varicella Syndrome: Still a Problem? Auriti C, Piersigilli F, De Gasperis MR, Seganti G.

Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.


A woman contracted chickenpox in the 12th week of gestation. Her general practitioner and later the consultant obstetrician warned her about the small risk of giving birth to a disabled child. She decided to continue the pregnancy without undergoing invasive tests to diagnose fetal intrauterine infection. Symptoms of congenital varicella syndrome (CVS) were detected by ultrasound in the 29th and 34th weeks of gestation. On admission to hospital, the baby was not considered infectious and was not isolated because polymerase chain reaction analysis to detect varicella zoster virus (VZV) DNA in the blood, cerebrospinal fluid, saliva, skin scrapings and feces gave negative results. He was also not separated from his mother. The mother was without clinical complications. Varicella during pregnancy may result in VZV transmission to the fetus or newborn. Intrauterine VZV infection in the first 28 weeks of gestation may result in CVS with limb deformities, brain abnormalities and mental retardation. Usually the newborn is not infectious, and therapy and isolation are unnecessary. When the mother catches the infection in the second trimester, the newborn may manifest shingles in the first 2 years of life. A maternal rash erupting 5 days before to 2 days after delivery is frequently associated with clinically severe varicella in the newborn, leading to high mortality if untreated. Then the newborn is infectious and must be isolated. This case report underlines the need for expert medical counseling for women who contract chickenpox at any time during pregnancy. It also underlines the importance of immunizing susceptible women of childbearing age before they become pregnant.
Copyright © 2009 S. Karger AG, Basel.

PMID: 19478488 [PubMed - as supplied by publisher]

Cytomegalovirus and other herpes virus infections in systemic diseases.] [Article in French] Michaux C, Morlat P, Bonnet F.

Service de médecine interne et maladies infectieuses, Hôpital Saint-André, CHU de Bordeaux, F-33075 Bordeaux, France.


Reactivation of Herpesviridae is well known among transplant patients, but has not been sufficiently studied in patients who receive immunosuppressive treatment for systemic inflammatory diseases. CMV infection seems relatively rare; it is easily diagnosed by real-time PCR, a fast and reliable diagnostic tool. CMV disease is most often manifested in the form of lung disease, hepatitis, or colitis. The highest risks are associated with steroid or cyclophosphamide boluses and methotrexate. Prophylactic treatment cannot be recommended in clinical practice. The utility of monitoring viremia and of preemptive therapy must be evaluated. Herpes zoster is the most frequent viral infection in systemic diseases. Most immunosuppressive treatments, except methotrexate, promote its occurrence. Visceral involvement is quite rare, and outcome almost always favorable. Prophylactic treatment cannot be recommended.

PMID: 19446998 [PubMed - as supplied by publisher]

Severe Meningoencephalitis Due to Late Reactivation of Varicella-Zoster Virus in an Immunocompetent Child. Spiegel R, Miron D, Lumelsky D, Horovitz Y

Pediatric Department A, HaEmekMedical Center, Afula, and Rappaport School, of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.


Recurrent reactivation of latent Varicella-Zoster virus may cause various neurological complications including encephalitis, myelitis, stroke episodes, and meningitis. It occurs mainly in elderly or immunocompromised patients and is very rare in children. We report a 14-year girl who presented with meningoencephalitis due to reactivation of Varicella-Zoster virus 10 years after she had chickenpox and 4 years after she had zoster. Characteristic skin lesions of varicella were absent. Varicella-Zoster virus DNA was detected in cerebrospinal fluid and magnetic resonance imaging (MRI) findings were consistent with small vessel cerebral vasculitis. Treatment with acyclovir and high dose methylprednisolone resulted in near-complete neurological recovery. Although rare, Varicella-Zoster virus may reactivate to cause significant central nervous system disease even in immunocompetent children. Diagnosis depends on a high degree of suspicion because the typical rash may not associate the disease. Characteristic lesions on MRI and the presence of Varicella-Zoster virus DNA in cerebrospinal fluid are key findings for the correct diagnosis.

PMID: 19494359 [PubMed - as supplied by publisher]

Severe cytomegalovirus (CMV) community-acquired pneumonia (CAP) precipitating a systemic lupus erythematosus (SLE) flare. Cunha BA, Gouzhva O, Naushe

Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA.

Cytomegalovirus (CMV) is a virus that infects both normal and compromised hosts. In normal hosts, CMV presents most often as an "infectious mononucleosis-like" illness, but less commonly may present as community-acquired pneumonia (CAP), colitis, hepatitis, or fever of unknown origin. In compromised hosts, CMV often presents as CAP, encephalitis, retinitis, adrenalitis, hepatitis, or colitis. Not unlike parvovirus B19, CMV is an immunomodulatory virus that may cause or exacerbate rheumatic/inflammatory disorders, particularly systemic lupus erythematosus (SLE). Acute CMV infection may result in de novo SLE or more commonly may precipitate an SLE flare. In patients with SLE who are taking immunosuppressives, CMV increases the degree of immunosuppression of cell-mediated immunity. We present the case of a 40-year-old woman with SLE who presented with severe CMV CAP. CMV infection was suspected because of 2 nonspecific laboratory findings: increased serum transaminases and atypical lymphocytes in the peripheral smear. SLE is a multisystem autoimmune disorder that spares the liver. Therefore, in a patient with SLE who experiences an SLE flare, increased serum transaminases should suggest the possibility of CMV. In patients with SLE with flare, the likelihood of CMV is further increased if serum transaminases are elevated with atypical lymphocytes and should prompt specific testing for CMV. This patient's severe CMV CAP was treated successfully with oral valganciclovir, and she made a slow but complete recovery.

PMID: 19486795 [PubMed - in process]

Friday, June 26, 2009

And Now, the HPV Vaccine

By Arthur Allen
Posted Thursday, June 8, 2006, at 4:07 PM ET
Doctors were blown away a few years ago when the New England Journal of Medicine published the first results of Merck's trials for a vaccine that protects against the human papillomavirus. The vaccine had prevented all infections caused by two deadly strains of the virus responsible for most of the world's 270,000 annual cervical cancer deaths. This was an unheard-of result. But as safe and effective as it appears to be, the vaccine—which the Food and Drug Administration approved today—will probably take years to have an impact on cervical cancer.

If you've had sex, you've probably been infected with the human papillomavirus, the only cause of cervical cancer. Fortunately, HPV infections usually clear up on their own, only 15 percent of the viral strains are carcinogenic, and doctors can halt slow-growing precancerous growths through routine cervical exams. Most of the 14,000 cases of cervical cancer in 2004 in the United States occurred in women who hadn't had a pap smear in three years or more. If all women were screened regularly, we wouldn't need a vaccine.
RELATED IN SLATE
Nobody wants cervical cancer, but Amanda Schaffer advises overzealous women to lay off the pap smears. Arthur Allen balances the intended benefits of new vaccines against their potential risks. Brent Staples and James Fallows discuss Shots in the Dark, a new book on the search for an AIDS vaccine by Jon Cohen, who also chimes in. Jordan Ellenberg argues that virginity pledges make an insignificant difference.
In Merck's trials involving about 20,000 girls and young women, the HPV vaccine eliminated all major cervical infections caused by the two strains of the human papillomavirus that cause 70 percent of cervical cancers. Merck is using a version of a vaccine, developed at the National Cancer Institute, which was cloned in viruses grown in a caterpillar-cell culture. It also seems to prevent vaginal cancers caused by these highly carcinogenic viruses and prevents genital warts caused by HPV 11 and HPV 6, two other strains contained in the vaccine.

But the vaccine doesn't reverse existing infections and doesn't seem to protect against the strains that account for the remaining 30 percent of cervical cancer cases. Sexually active, vaccinated women will continue to get pap smears that show abnormalities and have to be investigated. "It is important not to set false expectations that the need for pap smears is ending," says Jessica Kahn, a University of Cincinnati pediatrician who worked on the vaccine's clinical trials. Because it can take decades for HPV infections to progress to cancer, it may take that long to measure the benefits of the vaccine.
The vaccine's cost also has raised some questions about its value. If every American girl gets one course of three shots, which is expected to cost $300 to $500 total, then the national health-care bill could be in the range of $1.5 billion, on top of the $5 billion already spent on cervical cancer prevention. Many existing vaccines cost roughly a tenth of that retail. And the government, which provides more than half of all childhood vaccines, buys them even cheaper. The Centers for Disease Control's plan is to vaccinate 10-to-12-year-old girls, who are already supposed to go to the pediatrician between those ages for a meningitis shot and a pertussis-diphtheria-tetanus booster. (It's vital that girls be vaccinated before they have sex for the first time, since each new sexual encounter brings a 15 percent chance of HPV infection.) The Merck vaccine produces a strong immune response, but will it last from girlhood through a woman's sexual life? No one knows.
Another problem is how to get the vaccine to the women and girls who need it most—poor, uneducated women and those in the developing world. "None of us are going to be happy if the only women who get the vaccine are the same women who are already getting regular screens for cervical cancer," John Schiller, one of the vaccine's inventors, told me at his National Institutes of Health laboratory. The Vaccines for Children program, a Clinton-era entitlement, will probably make the vaccine available for free to poor children in the United States. But social conservatives like Focus on the Family leader James Dobson have opposed making vaccination mandatory, believing vaccination might lower barriers to teen sex.
In a roundabout way, this prudery may keep the vaccine out of reach of poor girls. Research and experience have shown that only mandatory-vaccination laws—which typically increase vaccination rates by 10 to 15 percent—get even cheap vaccines to the poor. Given the politics, state legislatures and public health boards may shy from requiring HPV vaccine for middle-school entry. Even mainline medical ethicists like Richard Zimmerman of the University of Pittsburgh have argued that "it seems unreasonable to mandate that an adolescent or college student who plans lifelong abstinence for religious or other reasons be vaccinated."
The answer may be to require HPV vaccination for children while explicitly allowing parents with strong beliefs to exempt their kids. This would recognize that mandatory vaccination campaigns work not by dragging refuseniks kicking and screaming to the medical clinic, but by forcing the issue for people who have to take the bus or borrow a ride to get to the doctor. Most states already allow some kind of religious or philosophical exemption for those who oppose other vaccines for their children.
Eventually, boys—who are equally responsible for spreading HPV—will need to get the vaccine, too, though they suffer rarely from penile and anal cancers caused by it. The history of vaccination campaigns against rubella, a normally trivial virus that devastates first-trimester fetuses when it infects their mothers, showed that the best way to eliminate a virus is to kill it in both sexes. This will add to the cost. Along with Merck, however, GlaxoSmithKline hopes to license a human papilloma vaccine, with approval slated for January. Schiller hopes that eventually the two firms' competition will lower prices and that the companies will engage in a beneficial "arms race," adding protection from additional lethal strains of HPV as they battle for market share. At the same time, Schiller is helping two Indian companies make cheaper versions of the vaccine for developing countries.
In the end, the HPV vaccine should prove a worthy addition to the cause of fighting cancer. So, it will be worth it to suck up the cost—and be patient about seeing results.

Human Papilloma Virus Vaccine Effective In Women Aged 24-45 Not Previously Exposed

An article published Online First and in an upcoming edition of The Lancet reports that women aged between 24 and 45 can be protected by the human papilloma virus (HPV) vaccine, if they have not been already infected by the virus. The report is the work of Dr Nubia Muñoz, from the National Institute of Cancer, Bogotá, Colombia, and collaborators.

Over the last thirty years, sexual behavior has changed. The age of the first marriage is rising, divorce rates are augmenting. As a result, premarital intercourse and having a new sexual partner around middle-age are common behaviors. The HPV virus is transmitted through sexual intercourse and can lead to cervical cancer or other cervical disease. It could be beneficial for older women to receive vaccination against the HPV virus. The women who participated in the randomized trial did not have a history of cervical disease or cancer or genital warts, caused by HPV types 6, 11, 16 and 18. The first group of women received the quadrivalent HPV vaccine and the second group received placebo (at day 1 and months 2 and 6).

There were a total of 1911 women in the first group and 1908 in the second group. The first endpoint for assessment was infection for six months or more, and cervical and external genital disease due to HPV 6, 11, 16, 18. The second was the same but genital disease was due to HPV 16 and 18 only. The average of follow-up time was of 2.2 years. No further data was analyzed at the end of the four year trial. Among the women, specific populations were analyzed.

The per-protocol population of ideal participants included 1615 women who were given the vaccine and 1607 receiving placebo. From day 1 and up to month seven, they all tested negative for the appropriate vaccine HPV type. Within one year, they all had to receive three vaccine doses. They were required to have one or more follow-up visits after month seven. Research showed that there were four cases of infection or disease in the vaccine group compared to forty one in the placebo group. Researchers observed the vaccine proved to have 91 percent effectiveness against all four virus strains (the percent reduction in incidence rate in the vaccine group compared to the placebo group). In the evaluation of the HPV 16 and 18 only, four cases occurred in the vaccine group compared with 23 in the placebo group (vaccine efficiency of 83 percent). When women who had not been completely vaccinated and had already existing HPV infection were included in the analysis, vaccine efficacy against all four HPV types was lower (31 percent). Effectiveness was of 24 percent when it was specifically against types HPV 16 and 18.

The authors write: "Lower effectiveness (about 30%) detected in the mixed population (susceptible women and those who have already acquired HPV infection or HPV-associated disease) suggests that the public health effect of vaccinating women aged 25-45 years will be smaller than that recorded after vaccinating susceptible adolescents. This notion will be assessed in future cost-benefit analyses."

Although there were two target outcomes of the trial, the researchers observed that in general, the women reaching the endpoint had infections, rather than cervical or genital disease. As a result, the high vaccine efficacy in the intention-to-treat population was mostly as a result of efficacy against infection.

The authors explain: "Maximum effect from prophylactic HPV vaccination programmes will be achieved in women who are susceptible to infection and disease related to vaccine HPV types (those not previously exposed). Notably, most adult women enrolled in the current study remained susceptible to vaccine HPV types at entry. Almost all women enrolled were susceptible to three or four vaccine HPV types, and about a third were positive to HPV 6, 11, 16, or 18 at baseline by serological or DNA testing; therefore about two-thirds were susceptible to all four vaccine HPV types. Most women who were HPV positive were positive to only one HPV type, meaning that the quadrivalent HPV vaccine could still potentially benefit these women via protection against vaccine HPV types with which they are not infected with."

They write in conclusion: "The quadrivalent HPV vaccine is efficacious in women aged 24��"45 years not infected with the relevant HPV types at enrolment."

"Safety, immunogenicity, and efficacy of quadrivalent human papillomavirus (types 6, 11, 16, 18) recombinant vaccine in women aged 24-45 years: a randomised, double-blind trial"
Nubia Muñoz, Ricardo Manalastas Jr, Punee Pitisuttithum, Damrong Tresukosol, Joseph Monsonego, Kevin Ault, Christine Clavel, Joaquin Luna, Evan Myers, Sara Hood, Oliver Bautista, Janine Bryan, Frank J Taddeo, Mark T Esser, Scott Vuocolo, Richard M Haupt, Eliav Barr, Alfred Saah
DOI: 10.1016/S0140-6736(09)60691-7
thelancet

Written by Stephanie Brunner (B.A.)
Copyright: Medical News Today

Why Are HPV Vaccine Rates So Low?

For Kari Lange, getting the human papillomavirus vaccine for her daughters, Erika, 16, and Darcy, 13, was a no-brainer. After all, the new vaccine is considered one of the most effective methods for preventing cervical cancer and genital warts. And the Lincolnshire, Ill., mom knew firsthand that even if the virus, which is transmitted through sexual contact, never progresses to cervical cancer, it is no picnic. She and her sister both contracted it when they were younger. "To me it wasn't even about sex," says Lange about having her daughters vaccinated. "It was just healthy for the kids."

The Food and Drug Administration approved Merck's human papillomavirus (or HPV) vaccine, Gardasil, in June 2006 for girls and women between the ages of 9 and 26. The U.S. Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists all recommend it. But despite their efforts—and a national ad campaign by Merck urging viewers to be "one less" person with cervical cancer—only two out of every 10 women in the approved age group have gotten the vaccine so far.

Why isn't everyone rushing to get immunized? In interviews with NEWSWEEK, health-care providers cited a variety of issues that may explain the low numbers: the high cost and inconvenience of the required three shots, a lack of awareness about HPV, the low number of regular physician visits among that age group, and parents' unease over immunizing their kids against a disease contracted through sexual activity. If the United States wants to lower the number of women who get cervical cancer each year, health officials say they must overcome those barriers. But it won't be easy.


Part of the problem is that—despite Merck's multimillion-dollar ad campaign—many patients, and parents, are still not aware of the link between the virus and the cancer. More than one-quarter of American women between the ages of 14 and 59 are estimated to have HPV, according to a study published last year in the Journal of the American Medical Association. But one 2007 study found that only 40 percent of women in the United States had even heard of the virus. And only half of them knew that HPV is the primary cause of cervical cancer. A new survey from the National Association of Nurse Practitioners in Women's Health found that more than 60 percent of women are unaware of any health problems associated with HPV. (In addition to abnormal cell growth, the virus can cause genital warts.)

The HPV vaccine doesn't guarantee that a woman won't get cervical cancer or warts, but it protects against viral types 16 and 18, which cause 70 percent of cervical cancer worldwide, and against types 6 and 11, which cause 90 percent of warts in both men and women. It's still unknown when, or if, immunity will wane and whether women will need to get booster shots later in life. But levels of the antibody to HPV appear to stay high for at least five years. Even if another dose is needed, health officials feel confident that another dose of the HPV vaccine is safe. It's not "biologically possible" to get HPV from the vaccine, which contains no live or killed virus and no viruslike particles, says the University of Michigan's Dr. Amanda Dempsey. The most common side effect has been pain at the injection site, says John Iskander, acting director of the CDC's immunization safety office.

But the vaccine is expensive: it typically costs $360 for three shots taken over six months. "There is a little bit of a sticker shock when they learn the cost," says Dr. James C. Turner, executive director of the department of student health at the University of Virginia and chair of the American College Health Association's vaccine-preventable disease committee. More than 98 percent of privately insured Americans get at least some coverage for the HPV vaccine. But more than 46 million Americans are uninsured, including 27 percent of women ages 19 to 26 (who aren't covered by the CDC's Vaccines for Children program, since they're not under 18).

HPV Vaccine Information For Young Women

There is now a vaccine that prevents the types of genital human papillomavirus (HPV) that cause most cases of cervical cancer and genital warts. The vaccine, Gardasil®, is given in three shots over six-months. The vaccine is routinely recommended for 11 and 12 year old girls. It is also recommended for girls and women age 13 through 26 who have not yet been vaccinated or completed the vaccine series.

Why the HPV vaccine is important
Who should get the HPV vaccine
Effectiveness of the HPV vaccine
Safety of the HPV vaccine
Cost and paying for the HPV vaccine
What vaccinated girls/women need to know
Other ways to prevent HPV and Cervical Cancer

Why the HPV vaccine is important

Genital HPV is a common virus that is passed on through genital contact, most often during sex. Most sexually active people will get HPV at some time in their lives, though most will never even know it. It is most common in people in their late teens and early 20s.

There are about 40 types of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause cervical cancer in women and other less common genital cancers— like cancers of the anus, vagina, and vulva (area around the opening of the vagina). Other types of HPV can cause warts in the genital areas of men and women, called genital warts. Genital warts are not a life-threatening disease. But they can cause emotional stress and their treatment can be very uncomfortable.

Every year, about 12,000 women are diagnosed with cervical cancer and almost 4,000 women die from this disease in the U.S.

About 1% of sexually active adults in the U.S. (or 1 million people) have visible genital warts at any point in time.

Who should get the HPV vaccine

The HPV vaccine is recommended for 11 and 12 year-old girls.1 It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series.

1 Note: The vaccine can also be given to girls 9 or 10 years of age.

Will sexually active females benefit from the vaccine?

Ideally females should get the vaccine before they become sexually active, when they may be exposed to HPV. Females who are sexually active may also benefit from the vaccine, but they may get less benefit from it. This is because they may have already gotten an HPV type targeted by the vaccine. Few sexually active young women are infected with all HPV types covered by the vaccine so they would still get protection from those types they have not yet gotten. Currently, there is no test available to tell if a girl/woman has had HPV in the past, or which types.

Can pregnant women get the vaccine?

The vaccine is not recommended for pregnant women. There has been limited research looking at vaccine safety for pregnant women and their unborn babies. So far, studies suggest that the vaccine does not cause health problems for pregnant women or their developing child. But more research is still needed. For now, pregnant women should wait until their pregnancy is over before getting the vaccine. If a woman finds out she is pregnant after she has started getting the vaccine series, she should wait until her pregnancy is over before finishing the three-dose series.

Should girls/women be screened for cervical cancer before getting vaccinated?

No. Girls/women do not need to get an HPV test or Pap test to find out if they should get the vaccine. Neither of these tests can tell the specific HPV type(s) that a woman has (or has had in the past), so there’s no way to know if she has already had the HPV types covered by the vaccine.

Why is the HPV vaccine only recommended for girls/women through age 26?

The vaccine has been widely tested in girls/women 9 through 26 years of age. New research is being done on the vaccine’s safety and efficacy in women older than 26 years of age. The FDA will consider licensing the vaccine for these women when there is enough research to show that it is safe and effective for them.

What about vaccinating boys and men?

We do not yet know if the vaccine is effective in boys or men. It is possible that vaccinating males will have health benefits for them by preventing genital warts and rare cancers, such as penile and anal cancer. It is also possible that vaccinating boys/men will have indirect health benefits for girls/women. Studies are now being done to find out if the vaccine works to prevent HPV infection and disease in males. When more information is available, this vaccine may be licensed and recommended for boys/men as well.

Effectiveness of the HPV Vaccine

This vaccine targets the types of HPV that most commonly cause cervical cancer and genital warts. The vaccine is highly effective in preventing those types of HPV and related diseases in young women.

The vaccine is less effective in preventing HPV-related disease in young women who have already been exposed to one or more HPV types. That is because the vaccine does not treat existing HPV infections or the diseases they may cause. It can only prevent HPV before a person gets it.

How long does vaccine protection last? Will a booster shot be needed?

Research suggests that vaccine protection will last a long time. More research is being done to find out if women will need a booster vaccine many years after getting vaccinated to boost protection.

What does the vaccine not protect against?

The vaccine does not protect against all types of HPV— so it will not prevent all cases of cervical cancer. About 30% of cervical cancers will not be prevented by the vaccine, so it will be important for women to continue getting screened for cervical cancer (regular Pap tests). Also, the vaccine does not prevent other sexually transmitted infections (STIs). So it will still be important for sexually active persons to lower their risk for other STIs.

Will girls/women be protected against HPV and related diseases, even if they don’t get all three doses?

It is not yet known how much protection girls/women would get from receiving only one or two doses of the vaccine. For this reason, it is very important that girls/women get all three doses of the vaccine.

Safety of the HPV vaccine

This vaccine has been licensed by the FDA and approved by CDC as safe and effective. It was studied in thousands of females (ages 9 through 26 years) around the world and its safety continues to be monitored by CDC and the FDA. Studies have found no serious side effects. The most common side effect is soreness in the arm (where the shot is given). There have recently been some reports of fainting in teens after they got the vaccine. For this reason, it is recommended that patients wait in their doctor’s office for 15 minutes after getting the vaccine.

Cost and Paying for the HPV vaccine

The retail price of the vaccine is about $125 per dose ($375 for full series).

Is the HPV vaccine covered by insurance plans?

While some insurance companies may cover the vaccine, others may not. Most large insurance plans usually cover the costs of recommended vaccines.

How can I get help paying for the vaccine?

Children age 18 and younger may be eligible to get vaccines, including the HPV vaccine, for free through the Vaccines for Children (VFC) program if they are: Medicaid eligible; uninsured; or American Indian or Alaska Native. Doctors may charge a small fee to give each shot. However VFC vaccines cannot be denied to an eligible child if the family cannot afford the fee.

Some states also provide free or low-cost vaccines at public health department clinics to people without health insurance coverage for vaccines. Contact your State Health Department to see if your state has such a program.

What vaccinated girls/women need to know

Will girls/women who have been vaccinated still need cervical cancer screening?

Yes, women will still need regular cervical cancer screening (Pap tests) because the vaccine will NOT protect against all HPV types that cause cervical cancer. Also, women who got the vaccine after becoming sexually active may not get the full benefit of the vaccine if they had already acquired HPV.

Other ways to prevent HPV and Cervical Cancer

Another HPV vaccine is now being considered for licensure by the FDA. This vaccine would protect against the types of HPV that cause most cervical cancers, but it would not protect against genital warts.

Are there other ways to prevent cervical cancer?

Regular cervical cancer screening and follow-up can prevent most cases of cervical cancer. The Pap test can detect cell changes in the cervix before they turn into cancer. Pap tests can also detect most, but not all, cervical cancers at an early, treatable stage. Most women diagnosed with cervical cancer in the U.S. have either never had a Pap test, or have not had a Pap test in the last 5 years. The HPV test can tell if a woman has HPV on her cervix. This test can be used with the Pap test to help your doctor determine next steps in cervical cancer screening.

Are there other ways to prevent HPV?

The only sure way to prevent HPV is to abstain from all sexual activity. For those who are sexually active, condoms may lower the chances of getting HPV, if used all the time and the right way. Condoms may also lower the risk of developing HPV-related diseases (genital warts and cervical cancer). But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV.

Sexually active adults can also lower their risk of HPV by being in a mutually faithful relationship with someone who has had no or few sex partners, or by limiting their number of sex partners. The fewer partners a person has had – the less likely he or she is to have HPV. But even persons with only one lifetime sex partner can get HPV, if their partner has had previous partners.

Sources

Food and Drug Administration (FDA). FDA News: FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus.

The FUTURE II Study Group. Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virological evidence of HPV infection. J Infect Dis. 2007; 196:1438-1446.

FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med. 2007; 356(19):1915-27.

Garland SM, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, et al. Females United to Unilaterally Reduce Endo/Ectocervical Disease (FUTURE) I Investigators. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med. 2007; 356(19):1928-43.

Harper DM, Franco EL, Wheeler C, et al; HPV Vaccine Study Group. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised controlled trial. Lancet. 2006; 367(9518): 1247-1255.

Ho GY, Bierman R, Beardsley L, et al. Natural history of cervicovaginal papillomavirus infection as measured by repeated DNA testing in adolescent and young women. N Engl J Med. 1998; 338(7):423-428.

Koutsky LA. Epidemiology of genital human papillomavirus infection. Am J Med. 1997; 102(5A):3-8.

National Institutes of Health (NIH). NIH Consensus Statement: Cervical Cancer. 1996; 14:1-38.

Paavonen J, Jenkins D, Bosch FX, Naud P, Salmeron J, Wheeler CM et al. Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet 2007;370(9596):1414.

United States Cancer Statistics, National Program of Cancer Registries (NPCR). U.S. Cancers by Type.

Weinstock H, Berman S, Cates W, Jr. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2004; 36(1):6-10.

Winer R, Hughes JP, Feng Q, et al. Consistent condom use from time of first vaginal intercourse and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006;354:2645–2654.

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Page last reviewed: June 26, 2008
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Cervical cancer vaccine

Can you explain about the cervical cancer vaccine?

This page is about the new vaccines to prevent cervical cancer. There is information about
What the human papilloma virus (HPV) is
HPV and cancer
Research into vaccines to prevent HPV
The HPV vaccination programme
Side effects of the vaccine
Do we still need cervical cancer screening?
What the human papilloma virus (HPV) is
There are over 100 different types of human papilloma virus (HPVs). It is sometimes called the ‘wart virus’ or ‘genital wart virus’ as some types of HPV cause genital warts. The virus is passed on from one person to another through sexual contact.

Many women will be infected with the HPV virus at some time during their lifetime. Often the virus causes no harm and goes away without treatment.

HPV and cancer
HPV can increase the risk of developing cervical cancer. Cervical cancer is cancer of the neck of the womb. About 3,000 women are diagnosed with this type of cancer every year in the UK. Most women infected with HPV don’t go on to develop cervical cancer. But for some, infection with HPV can go on to cause
Genital warts
Changes in the cervix, which may develop into a cancer
Changes in the vaginal tissues, which may develop into vaginal cancer
Of the different types of HPV, types 16 and 18 cause about 7 out of 10 (70%) cancers of the cervix. Most of the remaining 30% of cervical cancers are associated with other high risk HPV types. HPV types 6 and 11 cause genital warts but are less likely to cause cancer.

You can find out more about the risks and causes of cervical cancer in the cervical cancer section of CancerHelp UK.
HPV is also a risk factor for other types of cancer including vaginal cancer, vulval cancer, anal cancer and cancer of the penis.

Research into vaccines to prevent HPV
Several research trials have tested vaccines as a way of preventing infection with HPV. A trial testing Gardasil called FUTURE II reported its results in October 2005. This phase 3 trial involved over 12,000 women aged between 16 and 26. These women did not have HPV before the start of the trial. The women were divided into two groups. Half the women were given Gardasil and the other half had a dummy vaccine (placebo). Both groups of women had 3 injections of either the vaccine or placebo over six months. Over the following two years the women had regular checks to see if they had got HPV, or had any precancerous changes to the cells of the cervix, which could develop into a cancer. The group who had the vaccine showed no precancerous changes. Of the 5,258 women who had the placebo, 21 had precancerous changes, which is 0.4%. The researchers found that Gardasil protected against HPV types 6 and 11, as well as 16 and 18.

Two other phase 3 trials have tested the vaccine Cervarix. The first was for women under 26. It involved over 18,000 women from all over the world, including the UK. This study was called ‘PATRICIA’ (PApilloma TRIal to prevent Cervical cancer In young Adults). The second was for women of 26 and over. The trials found that Cervarix was useful in preventing HPV infection. Cervarix was licensed in the UK in 2007 for the prevention of precancerous changes in the cervix in girls and women between the age of 10 and 25.

The HPV vaccination programme
In the UK, girls in year 8 at school (aged 12 to 13) are offered the HPV vaccine. The vaccine the Government has chosen to use is Cervarix. Girls have three injections over 6 months given by a nurse. A letter about the vaccine and a consent form is sent to the parents of the girl before she has the vaccine. It is up to her whether she has the vaccine. A 2 year 'catch up' programme also started in Autumn 2008, to vaccinate girls aged between 13 and 18. The NHS immunisation website has more information about the vaccination programme and when girls in the catch up programme will be offered the vaccine.

It is also possible to have the vaccination privately. The cost for private treatment varies from doctor to doctor. We are hearing reports of about £500 being charged for a course of 3 injections.

This research means that if girls take up the vaccination the programme will prevent at least 7 out of 10 cancers of the cervix and possibly even more in the future. But it takes between 10 and 20 years for a cancer to develop after HPV infection. So any benefits in reducing cervical cancer won’t be seen for quite a long time. But the number of cases of pre-cancerous changes in the cervix (CIN) will fall quite rapidly.

It is not certain how long the vaccination gives protection for. So far the trials have followed people up for 6 years so we know that it lasts at least this long. It is expected that the vaccines should last for life but more research is needed to find out if this is the case. It may be that women will need a booster dose at some time.

Side effects of the vaccine
The side effects are usually mild and include
Headache
Aching muscles
Redness and soreness around the site of the injection
Fever
Feeling and being sick
Stomach pain
Diarrhoea
Itching, rash
Dizziness
Do we still need cervical cancer screening?
Yes – We will definitely still need the cervical screening programme in the UK, even after the vaccines become widely available. The vaccines don't prevent infection with all types of HPV. Also from the research so far, we don't think the vaccines will help prevent cervical cancer in women already infected with HPV. And it takes about 10 to 20 years after HPV infection for a cervical cancer to develop.

So it’s very important to remember that women will still need cervical cancer screening (smear tests) for many years to come. There is more information about cervical cancer screening in the cervical cancer section of CancerHelp UK.

A UK trial is planned to look at a vaccine to treat women already infected with HPV. You can find out more about the latest research into cervical cancer in the cervical cancer section of CancerHelp UK.

Cervical cancer vaccine benefits older women

WASHINGTON - Older women can benefit just as much as younger women from Merck's Gardasil vaccine against cervical cancer, researchers in Colombia reported on Monday.

They found that women ages 24 to 45 who had no history of cancer-causing genital warts or cervical disease were much less likely to become infected with the wart virus if they got the vaccine than women who got placebo jabs.

The study, published in the Lancet medical journal, points to a potentially lucrative new market for the vaccine against the human papilloma virus or HPV.

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Merck, which paid for the Colombian study, has also shown that Gardasil is 90 percent effective in preventing sexually transmitted warts in men.

GlaxoSmithKline's rival vaccine Cervarix protects against two HPV strains and is used in Europe.

Dr. Nubia Munoz of the National Institute of Cancer in Bogota and colleagues tested 1,900 women who got the recommended series of three Gardasil shots and 1,900 who got sham injections.

After two years, four women who got the vaccine developed an HPV infection or cervical disease, compared to 41 in the placebo group, they wrote — which translates to an efficacy of more than 90 percent.

HPV is the most common sexually transmitted disease in the world. About 20 million Americans are infected with it, according to the U.S. Centers for Disease Control and Prevention.

It is the main cause of cervical cancer, which kills 3,870 women a year in the United States and 300,000 globally.

It can also cause other types of cancer, including anal and penis cancer, as well as mouth and neck cancer. The CDC estimates that HPV caused 25,000 cases of cancer a year in the United States between 1998 and 2003.

Many women in industrialized countries get regular exams of the cervix, called a Pap smear, to check for precancerous changes caused by the virus.

Gardasil is designed to protect against HPV types 16 and 18, which are known to cause about 70 percent of all cases of cervical cancer. It also is designed to protect against HPV strains 6 and 11, which cause genital warts.

Gardasil is approved in the United States for use in girls and women ages 9 to 26, but Merck is seeking to expand its use to older women. The vaccine does not protect anyone who has already been infected with one of the strains of HPV.

Not approved by FDA
Vaccinating women over age 26 has not been approved by the U.S. Food and Drug Administration and is not included in U.S. CDC guidelines.

Munoz's team noted that older women may, however, be at risk.

"Changes in sexual behavior during the past 30 years, characterized by rising age at first marriage and an increase in divorce rates, have led to more widespread premarital sexual intercourse and acquisition of new sexual partners around middle age, respectively," they wrote.


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"Published work suggests that in the U.S.A., nearly 40 percent of men and women have married and divorced by 55 years of age, and that more than 25 percent of these people have remarried at least once," they added.

"As the potential for HPV infection and disease exists in women in their third, fourth, and fifth decades of life, these women could benefit from prophylactic HPV vaccination."

A mathematical model published in October showed that vaccinating older women against cervical cancer could cut rates in half for women through age 45.

Copyright 2009 Reuters. Click for restrictions.

Benefit To Women Not Enough To Sway Men To Get HPV Vaccine

Informing men that a new vaccine to prevent human papillomavirus (HPV) would also help protect their female partners against developing cervical cancer from the sexually transmitted infection did not increase their interest in getting the vaccine, according to a new Florida State University study.

Mary Gerend, assistant professor of medical humanities and social sciences at the FSU College of Medicine, and Jessica Barley, a 2008 Florida State psychology graduate who based her honors thesis on the study, found that men are no more likely to want the vaccination just because they can help protect their female sexual partners. An HPV vaccine for women has been available since 2006, and a vaccine for men is likely to be approved in the near future.

"You can probably interpret this finding in a number of ways," Gerend said. "Thinking about the benefit to their own health -- protection again rare genital cancers and genital warts -- is all men really need to know; telling them all that extra stuff really isn't going to push them one way or another."

For maximum benefit to public health, both men and women should be vaccinated but little was known about men's interest in the vaccine before Gerend's study, which was published in the journal Sexually Transmitted Diseases. Gerend presented the findings recently at the annual meeting of the Society of Behavioral Medicine in Montreal.

HPV is the most common sexually transmitted infection, according to the Centers for Disease Control and Prevention (CDC), which estimates that approximately 20 million Americans are currently infected with HPV and that another 6.2 million people become newly infected each year. HPV-related cancers are very rare in men, but last year the American Cancer Society estimated that nearly 20,000 women would be diagnosed with cervical and other cancers caused by HPV in 2008.

Gerend's research team randomly divided 356 male college students into groups and gave one group a self-protection message that focused on the benefits of HPV vaccination for men and the other a partner-protection message that focused on the benefits of HPV vaccination for men and their female partners.

Men were asked to rate, on a scale of 1 to 6, the likelihood that they would get the vaccine, with 1 equaling "very unlikely" and 6 equaling "very likely." There was little difference between the groups, with both expressing only moderate interest in getting the vaccine. Those who received the self-protection message had a mean response of 3.9 on the 6-point scale, while the mean response from the group who got the partner-protection message was 3.8.

Moreover, men who identified themselves as being in a committed relationship also did not indicate a higher degree of interest in the vaccination.

"Now, we have to remember that these were 18-, 19-, 20-year-old male college students, so we have to keep that in mind when considering their idea of a committed relationship," Gerend said. "And if we did this study again, I'd really want to make sure we drilled home the message of the seriousness of HPV for women. I think they got that message, but it might not have been strong enough."

The key point in encouraging women to receive the vaccine is the message about how it reduces their risk of developing cervical cancer. The results of Gerend's study have important implications for how the vaccine for men will be marketed for public acceptance when it becomes available. Efficacy trials in men are ongoing, and the Food and Drug Administration is expected to approve it for use in men as early as this year.

In the meantime, Gerend is working on another study funded by the National Cancer Institute to gauge the best message for encouraging young women to receive the HPV vaccination. The most recent estimates from the CDC, based on 2007 data, suggest that acceptance rates for the HPV vaccine remain low -- about 1 in 4 for girls ages 13 to 17 and about 1 in 10 for women in the 18 to 26 age group.

Source:
Doug Carlson
Florida State University

Monday, June 15, 2009

A controlled clinical trial of light and retinopathy of prematurity

A controlled clinical trial of light and retinopathy of prematurity.




Seiberth V, Linderkamp O, Knorz MC, Liesenhoff H

Am J Ophthalmol 1994; 118:492-5.

Abstract
Bright continuous light has been implicated in the pathogenesis of retinopathy of prematurity. To investigate the influence of light on the incidence and severity of retinopathy of prematurity, we enrolled 127 preterm infants (birth weight < or = 1,500 g; gestational age < or = 32 weeks) in a controlled clinical study. Randomization was done separately for three birth-weight groups (< 1,000 g; 1,000 to 1,249 g; 1,250 to 1,500 g). The babies' eyes were patched all day and night from birth to a gestational age of 35 weeks. The infants in the control group were exposed to cycled lighting conditions (that is, reduced light level during the night). Of 62 infants with patched eyes, 26 (42%) developed retinopathy of prematurity. In the control group, 25 of 65 infants (39%) showed retinopathy of prematurity (P = .596). There were also no statistically significant differences in the incidences of retinopathy of prematurity in the birth-weight subgroups or in the severity of retinopathy of prematurity. Thus, patching of the eyes from birth to 35 weeks of postconceptional age does not decrease the risk of retinopathy of prematurity in preterm infants when compared to a control group exposed to cycled lighting conditions.

MeSH
Female; Gestational Age; Humans; Incidence; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Light; Male; Prospective Studies; Retinopathy of Prematurity; Sensory Deprivation

Author Address
University Eye Clinic, Klinikum Mannheim, Faculty for Clinical Medicine, University of Heidelberg, Germany.

MEDLINE record details

Arthritis related to rubella: a complication of natural rubella and rubella immunization

Arthritis related to rubella: a complication of natural rubella and rubella immunization.




Bayer AS

Postgrad Med 1980; 67:131-4.

Abstract
The success of the childhood rubella immunization program has caused an upward shift in age of those susceptible to rubella. An associated increase has taken place in the incidence of rubella-related arthritis, which occurs more often in the post-pubertal population. Fortunately, however, the arthralgia-arthritis syndromes of naturally acquired rubella and those associated with vaccination are usually transient and mild.

MeSH
Adolescent; Adult; Arthritis, Infectious; Child; Child, Preschool; Female; Humans; Infant; Rubella; Rubella Vaccine; Vaccination

CAS Registry Number (Substance Name)
0 (Rubella Vaccine)

MEDLINE record details

Congenital ocular blindness in children, 1945 to 1984

Congenital ocular blindness in children, 1945 to 1984.




Robinson GC, Jan JE, Kinnis C

Am J Dis Child 1987; 141:1321-4.

Abstract
A total of 676 children born in British Columbia with congenital ocular blindness during the years 1945 through 1984 were studied. The birth prevalence rate of congenital blindness has decreased from eight per 10,000 live births in the late 1940s to three per 10,000 live births. Retinopathy of prematurity was replaced by genetic ocular disorders as the leading cause of congenital blindness, although the former is reemerging. The rate of congenital rubella infection also declined. There has been a significant increase in the rate of births with optic nerve lesions during the past 15 years, while the rate of births with lesions of the lens fell, reflecting the decline in the rate of maternal rubella infection. There are fewer children with congenital ocular legal blindness who have no light perception today, and they also have fewer associated handicaps.

MeSH
Blindness; British Columbia; Female; Humans; Infant, Newborn; Male

Author Address
Department of Pediatrics, Faculty of Medicine, B.C. Children's Hospital, Vancouver, Canada.

MEDLINE record details

Congenital rubella infection after previous immunity of the mother

Congenital rubella infection after previous immunity of the mother.




Saule H, Enders G, Zeller J, Bernsau U

Eur J Pediatr 1988; 147:195-6.

Abstract
A newborn boy was admitted with a congenital rubella infection. Seven years previously his mother had been vaccinated against rubella; 3 years previously rubella immunity had been confirmed. Therefore, intrauterine transmission must have occurred after maternal reinfection during pregnancy. Prenatal diagnosis of rubella embryopathy with serological methods after subclinical maternal reinfection is nearly impossible.

MeSH
Adult; Female; Humans; Infant, Newborn; Male; Pregnancy; Pregnancy Complications, Infectious; Prenatal Diagnosis; Rubella; Rubella Syndrome, Congenital; Rubella Vaccine

CAS Registry Number (Substance Name)
0 (Rubella Vaccine)

Author Address
II. Kinderklinik im Krankenhauszweckverband, Augsburg, Federal Republic of Germany.

MEDLINE record details

Congenital rubella retinopathy--a progressive disease

Congenital rubella retinopathy--a progressive disease]





Menne K

Klin Monatsbl Augenheilkd 1986; 189:326-9.

Abstract
Congenital rubella retinopathy is characterized by disseminated dusty or mottled pigmentation with greatest density in the macula. Visual fields, dark adaptation, the electroretinogram and the electrooculogram are normal or close to normal. The intensity of the pigmentation increases over a number of years; as a rare complication it can lead to subretinal neovascularization. This complication is due to atrophy and necrosis of the pigment epithelium, both being induced by the rubella virus. After scarred healing the subretinal neovascularization leads to disciform maculopathy. This rare complication of rubella retinopathy is illustrated by two case reports of girls aged 14 and 16 years.

MeSH
Adolescent; Adult; Atrophy; Child; Female; Humans; Male; Necrosis; Neovascularization, Pathologic; Pigment Epithelium of Eye; Retinal Diseases; Retinal Vessels; Rubella; Visual Acuity

MEDLINE record details

Current understanding and management of retinopathy of prematurity

Current understanding and management of retinopathy of prematurity.



Quiram PA, Capone A

Curr Opin Ophthalmol 2007; 18:228-34.

Abstract
PURPOSE OF REVIEW: Retinopathy of prematurity is the leading cause of childhood blindness in industrialized countries and is the fifth leading cause of bilateral childhood blindness worldwide. There have been new insights into understanding the factors involved in the pathogenesis of retinopathy of prematurity and related retinal detachment. This review outlines the current recommendations for initiation, frequency, and duration of screening examinations and describes the infants at the highest risk for developing complications from retinopathy of prematurity. The rationale and timing of treatment are also discussed. RECENT FINDINGS: Infants who undergo early screening and treatment for retinopathy of prematurity have improved long-term functional and structural outcomes compared with those who receive conventional screening and treatment. Patients undergoing surgical repair of retinopathy of prematurity-related detachments (stage 4A, 4B and 5) can have favorable anatomical and functional outcomes. The increased survival of lower birth weight infants has increased the prevalence of aggressive, posterior retinopathy of prematurity that may be unresponsive to conventional treatment. SUMMARY: While full understanding of the mechanisms that underlie the formation of retinopathy of prematurity and related detachments is not complete, progress has been made in identifying risk factors, screening of high-risk patients, and optimizing the timing of surgical interventions to improve structural and functional outcomes.

Author Address
Associated Retinal Consultants, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. pollyquiram@yahoo.com

MEDLINE record details


Publication Type:
Journal Article


ISSN:
1040-8738


Country:
United States


Language:
eng


Date of Entry:
20070416

Elimination of rubella and congenital rubella syndrome--United States, 1969-2004

Elimination of rubella and congenital rubella syndrome--United States, 1969-2004.







MMWR Morb Mortal Wkly Rep 2005; 54:279-82.

Abstract
In October 2004, CDC convened an independent panel of internationally recognized authorities on public health, infectious disease, and immunization to assess progress toward elimination of rubella and congenital rubella syndrome (CRS) in the United States, a national health objective for 2010. Since rubella vaccine licensure in 1969, substantial declines in rubella and CRS have occurred, and the absence of endemic transmission in the United States is supported by recent data: 1) fewer than 25 reported rubella cases each year since 2001, 2) at least 95% vaccination coverage among school-aged children, 3) estimated 91% population immunity, 4) adequate surveillance to detect rubella outbreaks, and 5) a pattern of virus genotypes consistent with virus originating in other parts of the world. Given the available data, panel members concluded unanimously that rubella is no longer endemic in the United States. This report summarizes the history and accomplishments of the rubella vaccination program in the United States and the Western Hemisphere and the challenges posed by rubella for the future.

MeSH
Humans; Rubella; Rubella Syndrome, Congenital; Rubella Vaccine; United States; Vaccination; World Health

CAS Registry Number (Substance Name)
0 (Rubella Vaccine)

MEDLINE record details

Epidemiology of rubella in Finland

Epidemiology of rubella in Finland.





Davidkin I, Peltola H, Leinikki P

Euro Surveill 2004; 9:13-4.

Abstract
Before rubella vaccination programmes began, rubella infection was prevalent in Finnish children. The disease occurred as epidemics at intervals of a few years. Rubella infection was most often contracted between the ages of 2 and 12 years. Vaccinations specifically aimed at eradicating rubella were begun with monocomponent vaccine in the mid-1970s, and the measles, mumps and rubella (MMR) vaccination programme with two injections got underway in 1982. A clear reduction in rubella cases was evident a few years after the launch of the MMR programme. Owing to a sufficiently high vaccination coverage (>95% since 1987), circulation of the indigenous rubella virus in the Finnish population ceased in the late 1990s. Some rubella cases have been imported to Finland since elimination, but they have not caused any secondary cases. This shows unambiguously that protection against rubella continues to be effective, although our cohort studies imply that the vaccine induced antibody levels do decrease with time. The MMR programme has also eliminated congenital rubella syndrome (CRS) from the country. The last CRS case was recorded in 1986. As a result of the high coverage two dose MMR vaccination programme, rubella was successfully eliminated from Finland. How long the acquired protection will last remains to be seen.

MeSH
Adolescent; Adult; Child; Female; Finland; Humans; Male; Rubella

Author Address
National Public Health Institute (KTL), Helsinki, Finland.

MEDLINE record details

In situ detection of rubella RNA and antigens in cultured cells

In situ detection of rubella RNA and antigens in cultured cells.




Filipenko D, Hobman T, MacDonald I, Gillam S

J Virol Methods 1988; 22:109-18.

Abstract
We developed in situ hybridization and immunofluorescent procedures to detect rubella RNA and antigens in tissue-cultured cells infected with rubella virus. cDNA fragments of the rubella virus E1 structural gene were used as probes for in situ hybridization to detect rubella RNA sequences in Vero cells infected with rubella virus. Using antibodies against rubella proteins, indirect immunofluorescence detected rubella virus structural proteins in Vero cells infected with rubella virus. The immunofluorescence method has also been applied to study the expression of rubella polypeptide E1 in transfected COS cells and may be applied to the detection and study of persistent rubella virus infection in human tissues.

MeSH
Animals; Antibodies, Viral; Antigens, Viral; DNA Probes; Fluorescent Antibody Technique; Nucleic Acid Hybridization; RNA, Viral; Rubella virus; Vero Cells

CAS Registry Number (Substance Name)
0 (Antibodies, Viral), 0 (Antigens, Viral), 0 (DNA Probes), 0 (RNA, Viral), 0 (rubella antibodies)

Author Address
Department of Pathology, Faculty of Medicine, University of British Columbia Research Centre, Vancouver, Canada.

MEDLINE record details

Retinopathy of prematurity in multiple-gestation pregnancies

Retinopathy of prematurity in multiple-gestation pregnancies.




Blumenfeld LC, Siatkowski RM, Johnson RA, Feuer WJ, Flynn JT

Am J Ophthalmol 1998; 125:197-203.

Abstract
PURPOSE: To determine differences in incidence of retinopathy of prematurity between neonates of multiple-gestation and single-gestation pregnancies and to analyze differences in severity of retinopathy of prematurity among siblings of multiple-gestation pregnancies. METHODS: We reviewed the records of 149 neonates of multiple-gestation pregnancies and 691 single-gestation neonates screened for retinopathy of prematurity at one hospital from January 1, 1992, through December 31, 1995. The peak stage of retinopathy of prematurity was recorded for all infants. The multiple-gestation infants were then separated into concordant and discordant retinopathy of prematurity groups, with discordance defined as a difference of at least 2 stages of retinopathy of prematurity between siblings. Between siblings with discordant retinopathy of prematurity, multiple factors were compared. RESULTS: Retinopathy of prematurity was present in 69 (46%) of the multiple-gestation neonates. Retinopathy of prematurity was present in 312 (45%) of single-birth neonates. The percentage of multiple-gestation neonates with stages 1, 2, or 3 (prethreshold) or threshold retinopathy of prematurity was similar to that of single-gestation neonates. Stage 4 or 5 retinopathy of prematurity did not occur in either group. CONCLUSIONS: There was no significant difference in stage of retinopathy of prematurity between infants of single-gestation pregnancies vs those of multiple-gestation pregnancies. The majority (84%) of infants of multiple-gestation pregnancies had concordant retinopathy of prematurity. In those infants with discordant disease, zygosity and postgestational factors other than lowest serum glucose were not related to severity of retinopathy of prematurity.

MeSH
Adult; Birth Weight; Female; Florida; Gestational Age; Humans; Incidence; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Retinopathy of Prematurity; Severity of Illness Index

Author Address
Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, FL 33101, USA.

MEDLINE record details

The outcome of pregnancies complicated by rubella, 1990-1997

The outcome of pregnancies complicated by rubella, 1990-1997]





Figueroa-Damián R, Ortiz-Ibarra FJ, Arredondo-García JL, Ahued-Ahued JR

Salud Publica Mex ; 41:271-7.

Abstract
OBJECTIVE: To describe the experience of management of pregnant women complicated with rubella and to evaluate the perinatal outcome. MATERIAL AND METHODS: A total of 67 pregnant women with positive IgM test for rubella were studied in the period from January 1st, 1990 to October 31st, 1997. Sixty-six of these women were followed until the end of gestation, in 4 patients an elective abortion was performed and 1 patient had a molar pregnancy. The effects of rubella on gestation and on the product were evaluated in sixty-one of the patients. Anti-rubella IgM was determined at birth and positive infants were subjected to evaluation by echocardiogram, brainstem auditory evoked potentials (BAEP) and ophthalmological study. RESULTS: Mean age of the patients was 24.7 +/- 5.5 years; 28 patients were primigravidae. Pregnancies were normal showing no complications due to the rubella episode. In 35 cases (52.2%), the viral infection occurred during the first trimester of pregnancy, in 23 cases (34.5%) during the second and in 9 (13.3%) during the third. Seventy-one percent of infants born to mothers infected during the first trimester of pregnancy were also infected, and 51.6% developed congenital rubella syndrome. The most frequent manifestations of CRS were: prematurity, low birth weight and alterations of the BAEP. CONCLUSIONS: In Mexico, rubella is still a cause of fetal damage, which shows the need for preventive strategies, such as universal vaccination, to avoid rubella infection during pregnancy.

MeSH
Adolescent; Adult; Female; Gestational Age; Humans; Incidence; Infant, Newborn; Mexico; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Rubella

Author Address
Departamento de Infectología, Instituto Nacional de Perinatología (INPer), México.

MEDLINE record details

Neovascular maculopathy associated with rubella retinopathy

[Neovascular maculopathy associated with rubella retinopathy]




Hirano K, Tanikawa A, Miyake Y

Nippon Ganka Gakkai Zasshi 2000; 104:431-6.

Abstract
BACKGROUND: We report three eyes of two patients with rubella retinopathy which were associated with choroidal neovascularization in the macula. CASES: A 7-year-old girl (case 1) and a 12-year-old girl (case 2) whose mothers had suffered rubella during their pregnancy revealed typical rubella retinopathy in both eyes and neovascular maculopathy in one eye at their initial visit to our clinic. Neovascular maculopathy developed in another eye of case 1 after a follow-up of 10 months. RESULTS: The clinical characteristics indicated that 1. sudden visual loss occurs in children, 2. there is no external trigger such as eye injury, and 3. the visual prognosis appears relatively good. CONCLUSION: Although neovascular maculopathy is rare in pediatric disease, the rubella retinopathy may have the potential to cause neovascular maculopathy.
MeSH
Child; Female; Humans; Macula Lutea; Macular Degeneration; Pregnancy; Pregnancy Complications, Infectious; Prenatal Exposure Delayed Effects; Retinal Diseases; Retinal Neovascularization; Rubella

Author Address
Department of Ophthalmology, Nagoya University School of Medicine, Japan.

MEDLINE record details

Optical coherence tomography in the management of acute retinopathy of prematurity

Optical coherence tomography in the management of acute retinopathy of prematurity.




Patel CK

Am J Ophthalmol 2006; 141:582-4.

Abstract
PURPOSE: To demonstrate the microscopic changes, in vivo, accompanying stage 4 retinopathy of prematurity. DESIGN: Interventional case study. METHODS: Optical coherence tomography (OCT) of the macula was performed in a baby with presumed stage 4a retinopathy of prematurity (retinopathy of prematurity). The findings were correlated with clinical staging and video indirect ophthalmoscopy. RESULTS: OCT changed the staging of retinopathy of prematurity from 4a to 4b, demonstrated intraretinal edema, and objectively confirmed the clinical impression of disease progression. CONCLUSIONS: OCT could be valuable as a new strategy in the staging and surgical management of retinopathy of prematurity.

MeSH
Acute Disease; Disease Progression; Female; Gestational Age; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Laser Surgery; Ophthalmoscopy; Retina; Retinopathy of Prematurity; Tomography, Optical Coherence

Author Address
Oxford Eye Hospital, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, United Kingdom. ckpatel@btinternet.com

MEDLINE record details

Perinatal factors associated with retinopathy of prematurity

Perinatal factors associated with retinopathy of prematurity.




Gallo JE, Jacobson L, Broberger U

Acta Paediatr 1993; 82:829-34.

Abstract
The etiology of retinopathy of prematurity appears to be multifactorial. Introduction of new treatments in neonatal care may add new risk factors. We have analyzed the relationship between 42 perinatal factors and the development of retinopathy of prematurity in 78 infants with a birth weight < 1501 g and/or gestational age < 33 weeks. We have also applied a chronological analysis of the maximum and minimum pO2 and pCO2 values. Retinopathy of prematurity was seen in 37 of 78 infants (47.4%). Nineteen factors were found to be related to the development of retinopathy of prematurity. However, when step-wise logistic regression analysis was used, only birth weight, number of days of oxygen therapy and use of beta-blocking agents by the mother before birth were found to be associated with the development of retinopathy of prematurity. The results suggest that medication with beta blockers immediately before birth should be used cautiously.

MeSH
Blood Gas Analysis; Humans; Infant, Newborn; Infant, Premature; Prospective Studies; Retinopathy of Prematurity; Risk Factors

Author Address
Department of Ophthalmology, Huddinge University Hospital, Stockholm, Sweden.

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Persistent rubella infection and rubella-associated arthritis

Persistent rubella infection and rubella-associated arthritis.

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Chantler JK, Ford DK, Tingle AJ

Lancet 1982; 1:1323-5.

Abstract
Rubella virus has been isolated from peripheral blood lymphocytes in six out of seven women with rubella-associated arthritis. The arthritis occurred after natural infection (one case) or immunisation with HPV 77 DES vaccine (six cases) and had been present for up to 6 years. The identification of rubella virus was confirmed by plaque/microfocus reduction in the presence of anti-rubella antiserum, and by immunoprecipitation of rubella virus antigens and their analysis on polyacrylamide gels. These women with rubella virus in their lymphocytes did not have abnormal serum antibody levels, but a standard lymphoproliferative assay showed that they had strong cell-mediated immune responses to rubella virus antigens.

MeSH
Adult; Antibodies, Viral; Antigens, Viral; Arthritis, Infectious; Chronic Disease; Female; Humans; Immunity, Cellular; Lymphocytes; Rubella; Rubella Vaccine; Rubella virus; Time Factors; Vaccines, Attenuated

CAS Registry Number (Substance Name)
0 (Antibodies, Viral), 0 (Antigens, Viral), 0 (Rubella Vaccine), 0 (Vaccines, Attenuated)

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Prevalence of retinopathy of prematurity in premature babies examined during the period 1992-1999, Joinville (SC)

Prevalence of retinopathy of prematurity in premature babies examined during the period 1992-1999, Joinville (SC): evaluation of associated risks--screening.]





Bonotto LB, Moreira AT, Carvalho DS

Arq Bras Oftalmol ; 70:55-61.

Abstract
PURPOSES: To evaluate the prevalence of retinopathy of prematurity in premature babies examined at the "Hospital de Olhos Sadalla Amin Ghanem", coming from the "Maternidade Darcy Vargas" during the period from June 1992 to June 1999. To describe the risk factors that cause a predisposition to develop retinopathy of prematurity in the "Maternidade Darcy Vargas" and criteria to improve screening. METHODS: 286 premature babies were selected in accordance with the predetermined criteria (gestation period less than 37 weeks, first examination at 4-12 week of age, minimum of 3 ophthalmic examinations before being 180 days old and registration at the "Hospital de Olhos Sadalla Amin"). An analysis of the total group of premature babies was carried out, being classified into Group 1 (without retinopathy of prematurity) and Group 2 (with retinopathy of prematurity) and the factors related to presence or not of retinopathy of prematurity in the premature babies were described. In order to evaluate the frequency of retinopathy of prematurity and factors associated with its occurrence, the Chi-Squared or the Fisher Exact tests were used. Margin of error 5%. RESULTS: 228 premature babies did not present sings of retinopathy of prematurity (group 1) and 58 presented signs (group 2). The prevalence of retinopathy of prematurity was 20%, 9% being in stage 1; 7% in stage 2; 4% in stage 3 and 1% in stage 4a. The most involved factors were: birth weight (p<0.0001), oxygen therapy (p<0.0000), birth age (p=0.0006), lung disease (p=0.0041), blood transfusion (p=0.0002), central nervous system alterations (p=0.0259), serious infections (p=0.0278) and Apgar less than 7 in the first minute (p=0.0442). The premature babies that most needed treatment weighed less than 1,399 g and were 33 weeks old. CONCLUSION: According to the data the prevalence of retinopathy of prematurity was 20%. The premature babies' risks of retinopathy of prematurity were concentrated on weight below 1,400 g and age of 33 weeks. Bigger premature babies should be observed when one or more of the following factors are present: oxygen therapy, blood transfusion, lung disease, central nervous system alterations, serious infections and Apgar less than 7 in the first minute.

Author Address
Setor de Ciências da Saúde, Universidade Federal do Paraná, Curitiba, PR, Brazil. ligia@oftalmopediatria.com.br

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Retinopathy following measles, mumps, and rubella vaccination in an immuno-incompetent girl

Retinopathy following measles, mumps, and rubella vaccination in an immuno-incompetent girl.

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Schuil J, van de Putte EM, Zwaan CM, Koole FD, Meire FM

Int Ophthalmol 1998; 22:345-7.

Abstract
We describe a 4-year-old girl with subnormal visual acuity due to a bilateral retinopathy. The child had a history of encephalitis following MMR vaccination. Temporary retinopathy associated with measles, mumps, and rubella (MMR) vaccination has been described. Recently an idiopathic CD4+ T lymphocytopenia in the child was diagnosed. This cellular immunodeficiency supports our hypothesis of measles retinopathy after vaccination of an immuno-deficient child.

MeSH
CD4-Positive T-Lymphocytes; Child, Preschool; Diagnosis, Differential; Female; Humans; Immunoglobulin G; Measles; Measles Vaccine; Measles-Mumps-Rubella Vaccine; Mumps; Mumps Vaccine; Retinal Diseases; Rubella; Rubella Vaccine; T-Lymphocytopenia, Idiopathic CD4-Positive; Vaccines, Combined; Visual Acuity

CAS Registry Number (Substance Name)
0 (Immunoglobulin G), 0 (Measles Vaccine), 0 (Measles-Mumps-Rubella Vaccine), 0 (Mumps Vaccine), 0 (Rubella Vaccine), 0 (Vaccines, Combined)

Author Address
Bartiméus Institute of Visually Impaired Children, Zeist, The Netherlands.

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Retinopathy of prematurity: the life of a lifetime disease.

Retinopathy of prematurity: the life of a lifetime disease.

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Tasman W, Patz A, McNamara JA, Kaiser RS, Trese MT, Smith BT

Am J Ophthalmol 2006; 141:167-74.

Abstract
PURPOSE: To provide information on retrolental fibroplasias (RLF), later known as retinopathy of prematurity. DESIGN: Review of the literature on the subject and a first-person account of what was then RLF by one of the authors (A.P.) who was involved in the earliest days in research regarding RLF. METHODS: MEDLINE search on the topics of RLF and retinopathy of prematurity plus a first-person historic review of original work that dealt with RLF. RESULTS: In 1942, elevated levels of oxygen were thought to play a major role in the development of the disease; at that time, no treatment was available. During the lifetime of this disease, other possible causes have been investigated. These include vitamin E as a prophylaxis against retinopathy of prematurity and the efficacy of light reduction to prevent retinopathy of prematurity. It has been shown that the light reduction does not play a role in reducing the progression of retinopathy of prematurity. Vitamin E studies were inconclusive; some studies show a positive effect and others do not. A major advance occurred with the development of the International Classification of Ophthalmology in 1984, which laid the groundwork for collaborative studies to determine whether cryotherapy of the avascular zone of retina would reduce the incidence of blindness in newborn infants, when compared with control subjects. The study showed that cryotherapy was effective; this was followed by laser photocoagulation when lasers became portable enough to take to the neonatal intensive care unit. At the same time, improved surgical techniques moved from scleral buckling for retinal detachment to vitrectomies (some lens sparing) for more desperate cases that had progressed to stage 4 and stage 5 retinopathy of prematurity. Late changes in adults who were born before any treatment and are now baby boomers ran the gamut from the dragging of the retina in the posterior pole to retinal detachment, cataract, and myopia. CONCLUSION: Retinopathy of prematurity is a lifetime disease for which preventive and better treatment modalities continue to evolve.

MeSH
Animals; Disease Models, Animal; Humans; Hyperoxia; Infant, Newborn; Oxygen; Retinopathy of Prematurity

CAS Registry Number (Substance Name)
7782-44-7 (Oxygen)

Author Address
Department of Ophthalmology, Jefferson Medical College, and Wills Eye Hospital, 840 Walnut Street, Suite 1510, Philadelphia, PA 19107, USA. wst1@ureach.com

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Retinopathy of prematurity in multiple-gestation pregnancies

Retinopathy of prematurity in multiple-gestation pregnancies.




Blumenfeld LC, Siatkowski RM, Johnson RA, Feuer WJ, Flynn JT

Am J Ophthalmol 1998; 125:197-203.

Abstract
PURPOSE: To determine differences in incidence of retinopathy of prematurity between neonates of multiple-gestation and single-gestation pregnancies and to analyze differences in severity of retinopathy of prematurity among siblings of multiple-gestation pregnancies. METHODS: We reviewed the records of 149 neonates of multiple-gestation pregnancies and 691 single-gestation neonates screened for retinopathy of prematurity at one hospital from January 1, 1992, through December 31, 1995. The peak stage of retinopathy of prematurity was recorded for all infants. The multiple-gestation infants were then separated into concordant and discordant retinopathy of prematurity groups, with discordance defined as a difference of at least 2 stages of retinopathy of prematurity between siblings. Between siblings with discordant retinopathy of prematurity, multiple factors were compared. RESULTS: Retinopathy of prematurity was present in 69 (46%) of the multiple-gestation neonates. Retinopathy of prematurity was present in 312 (45%) of single-birth neonates. The percentage of multiple-gestation neonates with stages 1, 2, or 3 (prethreshold) or threshold retinopathy of prematurity was similar to that of single-gestation neonates. Stage 4 or 5 retinopathy of prematurity did not occur in either group. CONCLUSIONS: There was no significant difference in stage of retinopathy of prematurity between infants of single-gestation pregnancies vs those of multiple-gestation pregnancies. The majority (84%) of infants of multiple-gestation pregnancies had concordant retinopathy of prematurity. In those infants with discordant disease, zygosity and postgestational factors other than lowest serum glucose were not related to severity of retinopathy of prematurity.

MeSH
Adult; Birth Weight; Female; Florida; Gestational Age; Humans; Incidence; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Retinopathy of Prematurity; Severity of Illness Index

Author Address
Bascom Palmer Eye Institute, Department of Ophthalmology, Miami, FL 33101, USA.

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Rubella-associated arthritis. I. Comparative study of joint manifestations associated with natural rubella infection and RA 27/3 rubella immunisation

Rubella-associated arthritis. I. Comparative study of joint manifestations associated with natural rubella infection and RA 27/3 rubella immunisation.





Tingle AJ, Allen M, Petty RE, Kettyls GD, Chantler JK

Ann Rheum Dis 1986; 45:110-4.

Abstract
Joint manifestations observed during the course of a prospective RA 27/3 rubella immunisation trial were compared with those observed during an intercurrent wild rubella epidemic in an outlying community. Among 44 rubella haemagglutination inhibition (HAI) negative females ranging in age from 17 to 33 years who received rubella vaccine, six (13.6%) developed acute polyarticular arthritis within two to four weeks postvaccine and two (4.5%) had continuing or recurrent arthropathy lasting longer than 18 months. In contrast, among 23 females ranging in age from 11 to 39 years undergoing wild rubella infection, 12 (52.2%) developed acute polyarticular arthritis and seven (30.4%) had recurrent arthropathy 18 months postinfection. Among 23 males ranging in age from 13 to 54 years undergoing wild rubella infection, only two (8.7%) developed acute arthritis and both individuals had continuing joint manifestations 18 months postinfection. Wild rubella infection in adult populations is associated with a higher incidence, increased severity, and more prolonged duration of joint manifestations than is seen after RA 27/3 rubella immunisation.

MeSH
Adolescent; Adult; Arthritis, Infectious; Female; Humans; Joints; Rubella; Rubella Vaccine; Time Factors

CAS Registry Number (Substance Name)
0 (Rubella Vaccine)

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Significance of congenital mixed viral infection in the pathogenesis of retinopathy of prematurity

Significance of congenital mixed viral infection in the pathogenesis of retinopathy of prematurity]



Lozovskaia LS, Okhotnikova IM, Parameĭ OV, Sidorenko EI

Vestn Oftalmol ; 117:15-8.

Abstract
Forty-three infants aged 1-5 months with somatic and neurological diseases, including congenital, 18 of these with retrolental fibroplasia (RF) and 25 without RF were examined. Control group consisted of 36 age-matched infants. Based on identification of viral antigens in urine precipitate cells, mixed viral infection was diagnosed in 100% patients and 16.6% healthy babies. Ophthalmotropic ECHO 11 and 19 viruses were detected in 100% patients with RF, 28% patients without RF, and 10% healthy babies, while rubella virus was identified in 83.3, 60, and 8.3%, respectively. The viruses were detected only in association with other enteroviruses: Coxsakie A, B, and entero 69-71. These viruses detected in infants with RF were as a rule present in their mothers. Maternal anamnesis was in all cases aggravated by high risk indicators of vertical transfer of toxigenic enteroviruses to the fetus. The results indicate that congenital mixed viral infection (association of ophthalmotropic ECHO and rubella viruses with toxigenic Coxsakie and entero 69-71 viruses) is involved in the pathogenesis of RF.

MeSH
Adult; Age Factors; Coxsackievirus Infections; Disease Transmission, Vertical; Enterovirus B, Human; Enterovirus Infections; Female; Humans; Infant; Infant, Newborn; Male; Pregnancy; Pregnancy Complications, Infectious; Retinopathy of Prematurity; Rubella; Virus Diseases

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The prevalence of retinopathy of prematurity in very low birth weight newborn infants

The prevalence of retinopathy of prematurity in very low birth weight newborn infants.





Lermann VL, Fortes Filho JB, Procianoy RS

J Pediatr (Rio J) ; 82:27-32.

Abstract
OBJECTIVE: To evaluate the prevalence of retinopathy of prematurity and the risk factors affecting very low birth weight infants at a neonatal intensive care unit. METHODS: A cross-sectional study investigating all newborn infants with birth weights < or = 1,500 g and/or gestational ages < or = 32 weeks, admitted to the Neonatal ICU at the Hospital de Clínicas de Porto Alegre, from October 2002 to March 2004. Patients underwent indirect binocular ophthalmoscopy of the fundus at six weeks postpartum. Infants who progressed to threshold disease were given laser therapy. RESULTS: One hundred and fourteen newborn infants were studied. Eighty-three patients were not diagnosed with retinopathy of prematurity, 18 had stage I retinopathy of prematurity, seven stage II retinopathy of prematurity and six patients had threshold retinopathy of prematurity. The prevalence of retinopathy of prematurity was 27.2% (95% CI: 19.28-36.32) affecting 31 newborn infants, and the prevalence of retinopathy of prematurity progressing to threshold disease was 5.26% (95% CI: 1.96-11.10), affecting six patients. Retinopathy of prematurity was confirmed in 50% of the patients with weights below 1,000 g and 71.5% of newborn infants born at gestational ages of less than 28 weeks. Gestational age and birth weight were significantly lower among patients with retinopathy of prematurity than among those without. CONCLUSIONS: Although the results of this study demonstrate that the observed prevalence was similar to that described in literature, this ROP frequency remains elevated among very low birth weight infants. The development of retinopathy of prematurity was inversely proportional to weight and gestational age at birth.

MeSH
Apgar Score; Brazil; Epidemiologic Methods; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Male; Ophthalmoscopy; Retinopathy of Prematurity

Author Address
Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

Significance of congenital mixed viral infection in the pathogenesis of retinopathy of prematurity]

[Significance of congenital mixed viral infection in the pathogenesis of retinopathy of prematurity][Article in Russian]


Lozovskaia LS, Okhotnikova IM, Parameĭ OV, Sidorenko EI.
Forty-three infants aged 1-5 months with somatic and neurological diseases, including congenital, 18 of these with retrolental fibroplasia (RF) and 25 without RF were examined. Control group consisted of 36 age-matched infants. Based on identification of viral antigens in urine precipitate cells, mixed viral infection was diagnosed in 100% patients and 16.6% healthy babies. pOphthalmotropic ECHO 11 and 19 viruses were detected in 100% atients with RF, 28% patients without RF, and 10% healthy babies, while rubella virus was identified in 83.3, 60, and 8.3%, respectively. The viruses were detected only in association with other enteroviruses: Coxsakie A, B, and entero 69-71. These viruses detected in infants with RF were as a rule present in their mothers. Maternal anamnesis was in all cases aggravated by high risk indicators of vertical transfer of toxigenic enteroviruses to the fetus. The results indicate that congenital mixed viral infection (association of ophthalmotropic ECHO and rubella viruses with toxigenic Coxsakie and entero 69-71 viruses) is involved in the pathogenesis of RF.

PMID: 11569172 [PubMed - indexed for MEDLINE]

Congenital Rubella: Retinopathy

Congenital Rubella: Retinopathy



"Salt-and-pepper" retinopathy

This fine speckling of the retina is the commonest ocular manifestation of congenital rubella.
It is called "salt-and-pepper" because there are tiny flecks of dark pigment mixed with fine areas of whitish depigmentation. Usually the pigment alteration is diffuse, but it may be most prominent either around the macula or in the retinal periphery.

These signs reflect diffuse damage to the retinal pigment epithelium (RPE). The good news is that the RPE is never damaged enough to interfere with vision or to cause major abnormalities in the electroretinogram (ERG), the standard objective test used to evaluate outer retinal function. The preservation of vision and a relatively or completely normal ERG allows you to differentiate rubella retinopathy from the hereditary retinal degenerations called retinitis pigmentosa.

Other causes of "salt-and-pepper" retinopathy are congenital syphilis, and toxicities of systemically administered thioridazine, choroquine, and deferoxamine.

Other ophthalmic complications include microphthalmia (small eye), cataract, glaucoma, corneal opacification, and uveitis. Vision is usually quite poor from these problems.

Congenital rubella is a multisystem disorder resulting from exposure of the fetus to maternal rubella during the first trimester of pregnancy. Ophthalmic complications are present in over 70% of patients.

The Global Initiative Vison 2020: The Right to Sight Childhood Blindness

The Global Initiative Vison 2020: The Right to Sight Childhood Blindness
David Yorston, FRCS FRCOphth
David Yorston, Eye Unit of Kikuyu Hospital, PO Box 45, Kikuyu, Kenya;
Top
Blindness in Children Worldwide
The Global Initiative and Childhood Blindness
Corneal Scarring
Congenital Cataract
RETINOPATHY OF PREMATURITY
Conclusion Blindness in Children WorldwideApart from cataract, trachoma and onchocerciasis, which are specific diseases, the Global Initiative has also targeted childhood blindness—blindness from any cause occurring in a person aged 15 or less. Why is this relatively uncommon problem such a high priority?
Childhood blindness is the second largest cause of blind-person years, following cataract. Globally, about 70 million blind person years are caused by childhood blindness. There are about 1.5 million blind children worldwide, and this number appears to be growing. Approximately 500,000 children become blind every year—one every minute—and about half of them die within one or two years of becoming blind. Approximately one third of the total economic cost of blindness is thought to be due to childhood blindness.
A child's eye is not merely a smaller version of an adult eye, and childhood blindness is different compared with adult blindness. Strategies that are effective against adult blindness need to be modified to combat childhood blindness.
Children are the most precious resource of families in developing countries. A blind child is a tragedy for these families. A child whose blindness could have been prevented or cured is an even greater disaster. Approximately 40% of childhood blindness is avoidable.
Corneal scarring after vitamin A deficiency

The different causes of avoidable blindness in children vary with geographical location, and with time. For example, the avoidable causes of childhood blindness in western Europe are very different to the avoidable causes in sub-Saharan Africa. However, even in the very poor countries in Africa, improvements in nutrition and primary health care have meant that blindness from vitamin A deficiency is less common than it was 25 years ago. It must also be expected that severe economic recession, or the destruction of health care systems by war or natural disaster, could lead to the re-emergence of conditions that had previously been controlled.
Top The Global Initiative and Childhood BlindnessThe goal of the Global Initiative is to reduce childhood blindness from its present level of 0.75/1,000 children to 0.4/1,000 children by 2020. To achieve this, three conditions must be controlled. They are:
corneal scarring in children
congenital cataract
RETINOPATHY OF PREMATURITY

Top
Blindness in Children Worldwide
The Global Initiative and Childhood Blindness
Corneal Scarring
Congenital Cataract
Retinopathy of Prematurity
Conclusion Corneal ScarringGreat improvements have already taken place in the prevention of corneal scarring. Primary health care programmes are distributing vitamin A, and immunising against measles. Traditional healers have been trained to avoid harmful practices. The greater availability of primary eye care has enabled children with corneal ulcers to be treated sooner and more effectively. However, despite these changes thousands of children become blind from corneal scarring every year, and many of them die. Goals for 2020 may include the total elimination of measles, and vitamin A deficiency, both of which are achievable targets.
Much of the work that has been done to prevent corneal scarring in children has been carried out by primary health care (PHC) programmes. PHC workers are often unaware of the great impact their services have. In future, prevention of childhood blindness should be a particular and recognised part of PHC.
Healthy eyes in Jamaica

Some children, particularly those with corneal dystrophies such as keratoconus, may benefit from corneal transplants. The role of penetrating keratoplasty in prevention of childhood blindness is unclear, and more research is required.
Top
Blindness in Children Worldwide
The Global Initiative and Childhood Blindness
Corneal Scarring
Congenital Cataract
Retinopathy of Prematurity
Conclusion Congenital CataractThis remains a major cause of blindness in low- and middle-income countries. Some congenital cataract may be preventable. For example, it is estimated that 50,000 children every year are born with cataracts caused by congenital rubella syndrome, which could be prevented by a programme of rubella immunisation. Several high- and middle-income countries have set a goal of eliminating new cases of congenital rubella syndrome by the year 2000. This goal should be extended to cover the rest of the world by 2020.
The results of cataract surgery in children with congenital cataract are frequently poor. The treatment and post-operative care of these patients requires special skills and experience, and expensive equipment. It is likely that outcomes would be improved if all congenital cataracts were operated on in tertiary centres—‘children's eye centres’. Approximately ten million people require one such centre. The centre requires at least one ophthalmologist with a special interest in childhood eye disease; and two low vision therapists, able to monitor visual acuity in young children, treat amblyopia, and manage any residual visual impairment.
There is uncertainty over the best way to manage congenital cataract. The role of intraocular lenses in children under two years of age remains very controversial. Removal of the posterior capsule at the time of initial surgery is the best way of guaranteeing a clear visual axis. However, there is a need for more research to clarify these issues.
Top
Blindness in Children Worldwide
The Global Initiative and Childhood Blindness
Corneal Scarring
Congenital Cataract
Retinopathy of Prematurity
Conclusion Retinopathy of PrematurityRetinopathy of prematurity (ROP) remains an important cause of blindness in children in high- and middle-income countries. In high-income countries, it is known that neonates under 1500g are at risk of ROP. In middle-income countries, the risk factors are much less clearly defined, and ROP may affect babies weighing more than 2000g at birth.
ROP may be partially preventable through improved obstetric and neonatal care and a reduction in the number of premature babies. Babies at risk of ROP must be examined by a trained ophthalmologist. Those with ‘threshold’ ROP disease require peripheral retinal ablation, either with cryotherapy or laser. The treatment of these children is best carried out in specialist children's eye centres, by appropriately trained, and adequately equipped, ophthalmologists.
More research is needed to clarify which babies are at risk of ROP in middle-income countries, in order to develop a clear screening regimen.
Top ConclusionThe goal of reducing childhood blindness by 2020 is achievable. It will require an emphasis on eliminating the causes of childhood blindness at the primary level, and the development of specialist centres for treating congenital cataract, glaucoma, and ROP at the tertiary level. To facilitate the planning of childhood blindness programmes, a table of the estimated needs of a population of ten million people, in different situations, is shown below.
Table
Estimated Needs for a Total Population of Ten Million

Congenital cataract

FootnotesFootnote: Figures included in David Yorston's article on Childhood Blindness have still to be officially ratified by the World Health Organization, but we are advised by WHO that a review and compilation of data presented is underway.
Editor.


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ACHMAD MOCHTAR GENERAL HOSPITAL BUKITTINGGI

ACHMAD MOCHTAR GENERAL HOSPITAL BUKITTINGGI
RUMAH SAKIT ACHMAD MOCHTAR BUKITTINGGI

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drFirman Abdullah SpOG / ObGyn

drFirman Abdullah SpOG / ObGyn

KELUARGA BESAR TNI-AD

Dr Firman Abdullah SpOG/ OBGYN, Bukittinggi, Sumatera Barat ,Indonesia

Dr Firman Abdullah SpOG/ OBGYN,                              Bukittinggi, Sumatera Barat ,Indonesia

Bukittinggi , Sumatera Barat , Indonesia

Bukittinggi , Sumatera Barat  , Indonesia
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dr Firman Abdullah SpOG / OBGYN

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dr Firman Abdullah SpOG/ObGyn

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