WHO says global childhood vaccinations closer to prepandemic levels
Childhood vaccinations worldwide are rising to coverage levels close to those seen before the COVID-19 pandemic, according to new data from WHO and UNICEF.
The agencies estimate that 4 million more children received full vaccination in 2022 compared with the previous year, but recovery is not keeping pace in low-income countries. Approximately 20.5 million children globally still missed at least one vaccine constituting a part of routine immunization in 2022, although that is better than the 24.4 million children who missed at least one dose in 2021.
The data also concluded that 14.5 million children did not receive a single dose of diphtheria, tetanus, and pertussis (DTP) vaccine, which is used as the marker of overall immunization coverage, compared with 18 million who received no DTP doses in 2021.
The new coverage levels remain below those prior to the COVID-19 pandemic when 18.4 million children missed out on at least one vaccination. They are also far short of the United Nations’ target to slash the global number of “zero-dose children” by 50% by 2030.
According to the report, the only vaccine to gain ground was the HPV vaccine. The UN hopes to see HPV vaccine rates rise to 90% of girls worldwide by 2030. ■
Weekly insulin found safe, effective for T2D
Research published June 24, 2023, in JAMA shows that once-weekly insulin icodec is safe for people with T2D. It also showed that individuals with T2D who used insulin icodec maintained healthier blood glucose levels compared with people who received daily injections of insulin degludec.
The Phase III ONWARDS 3 trial included 564 insulin-naïve patients with T2D from 11 countries. Participants were randomized to receive injected icodec once a week and a placebo daily or injected degludec daily and a placebo once a week.
After 26 weeks of treatment plus 5 weeks of follow-up, participants who received a weekly icodec injection had much greater improvements in their blood glucose levels compared with those who received daily injected degludec.
Rates of adverse events in both groups were very low. The new findings add to other ONWARDS trials assessing how icodec works in various clinical scenarios.
Experts believe the once-weekly version of the drug could minimize the stigma associated with daily insulin treatment.
Novo Nordisk funded the trials. ■
Daily statin reduces heart disease risk among adults living with HIV
A study published July 23, 2023, in NEJM found that cholesterol-lowering statin drugs helped curb the risk of significant CVD in people living with HIV by more than one-third, potentially preventing one in five major CV events or premature deaths in this population.
Individuals living with HIV are at a much higher risk of CVD.
For the Phase III trial, REPRIEVE study researchers randomized patients in either a treatment group that administered a daily statin (pitavastatin calcium) or a control group that provided a placebo.
The researchers followed participants for about 5 years. However, the trial ended early after investigators found the treatment benefits outweighed possible risks.
Researchers found that participants who took daily pitavastatin had 35% fewer major CV events compared with placebo recipients. Patients in the treatment group were also 21% less likely than those in the placebo group to experience such CV events, and pitavastatin recipients had a 30% reduction in their LDL cholesterol levels.
“Lowering LDL cholesterol levels reduces risks for CV events, like having a heart attack and stroke, but these findings suggest there may be additional effects of statin therapy that explain these reduced risks among people living with HIV,” said study chair Steven K. Grinspoon, MD, in a news release. “Ongoing research about how statin therapy may affect inflammation and increase immune activation among people with HIV may help us better understand the additional benefits we’re seeing with this treatment approach.” ■
AHA: Vaping harms heart and lungs
In a recent scientific statement, the American Heart Association (AHA) is urging more research about the detrimental effects of vaping on the heart and lungs.
“E-cigarettes deliver numerous substances into the body that are potentially harmful, including chemicals and other compounds that are likely not known to or understood by the user. There is research indicating that nicotine-containing e-cigarettes are associated with acute changes in several hemodynamic measures, including increases in blood pressure and heart rate,” said an AHA news statement.
AHA also noted a “significant association” between e-cigarette use and the development of incident respiratory disease over 2 years, including asthma, emphysema, chronic obstructive pulmonary disease, and chronic bronchitis.
“Negative effects of e-cigarettes have been shown through in vitro studies and in studies of individuals exposed to chemicals in commercially available products,” said the news release.
Vitamin E acetate is the ingredient that is likely causing e-cigarette, or vaping, product use–associated lung injury hospitalizations.
The statement noted that additional research is needed to gauge the health effects of vaping on heart attacks and strokes.
The statement also pointed out that e-cigarettes are the most commonly used tobacco product among high school and middle school–age students.
“Because e-cigarettes and other vaping systems have only been in the U.S. for about 15 years, we do not yet have enough information on their long-term health effects, so we must rely on shorter-term studies, molecular experiments, and research in animals to try to assess the true risk of using e-cigarettes,” the statement said. “It is necessary for us to expand this type of research since the adoption of e-cigarettes has grown exponentially, especially in young people, many of whom may have never used combustible cigarettes.” ■
State of hepatitis C cure is dismal for patients
According to a recent CDC report, only one-third of individuals with a documented hepatitis C diagnosis were cured over the past decade. Based on data that spanned from 2013 to 2022, the report also found that for patients without health insurance under the age of 40 years, only 1 in 6 have been cured.
In 2013, curative treatments known as direct-acting antiviral agents were introduced to combat hepatitis C, offering cure rates of near 100% with minimal adverse effects. The treatment is costly, however, and arduous prior authorization requirements are usually necessary.
“This alarming assessment of HCV cures in the modern treatment era underscores a stark reality: The benefits of pharmaceutical advances will only come to fruition through concerted action to rectify glaring gaps in our health care financing and delivery systems,” said a press statement from the Center for Health Law & Policy Innovation of Harvard Law School and the National Viral Hepatitis Roundtable, in response to the report.
According to CDC, hepatitis C affects approximately 2.4 million Americans and is the deadliest bloodborne infectious disease in the United States. ■
Is cytisinicline effective for smoking cessation?
Researchers have found that cytisinicline effectively and safely assisted people with smoking cessation when dosed at a higher concentration than typically used in Europe. Cytisinicline is used in some European countries to aid smoking cessation, but its traditional dosing regimen and treatment duration may not be optimal.
Participants in the ORCA-2 trial received cytisinicline as a 3-mg tablet taken orally 3 times per day for 6 weeks. According to findings published in JAMA on July 11, 2023, this was associated with higher continuous abstinence rates for smoking during weeks 3 to 6 and weeks 3 to 24,
compared to the use of a placebo.
Patients who took cytisinicline for 12 weeks demonstrated continuous abstinence rates of 32.6% versus 7.0% in the placebo group for weeks 9 to 24. All three sections of the ORCA-2 trial reported high percentages of behavioral support compliance, with 92.8% of sessions completed in the 12-week group, 89.5% in the 6-week group, and 86.8% in the placebo cohort.
“Cytisinicline reduced nicotine craving and was well tolerated by participants who adhered to the treatment schedule at a high rate, even though the trial was conducted during the early phases of the U.S. COVID-19 pandemic,” wrote the study authors.
Adverse effects such as insomnia, nausea, and strange dreams occurred in less than 10% of each group but caused 2.9% of cytisinicline recipients and 1.5% of patients in the placebo group to withdraw from the trial. Serious adverse events were seen in 3.3% and 1.1% of patients, respectively, but were deemed to be unrelated to the treatment.
These results are expected to help support a request for an FDA approval for cytisinicline, which is already available as an OTC smoking cessation product in Eastern and Central Europe. ■