Measles Concerns Over Missed Vaccinations

Peter Russell

April 29, 2019

More than half a million children in the UK missed out on a first dose of measles vaccine between 2010 and 2017, according to figures released last week by UNICEF.

It came as Simon Stevens, chief executive of NHS England, warned that public vaccine rejection was "a serious and growing public health time bomb".

Worldwide, an estimated 169 million children missed out on the first dose of the measles vaccine during the 7-year period, UNICEF said.

Executive Director Henrietta Fore said: "The ground for the global measles outbreaks we are witnessing today was laid years ago. The measles virus will always find unvaccinated children. If we are serious about averting the spread of this dangerous but preventable disease, we need to vaccinate every child, in rich and poor countries alike."

In the first 3 months of 2019, more than 110,000 measles cases were reported globally, up nearly 300% from the same period last year. The figures showed that an estimated 110,000 people, most of them children, died from measles in 2017, a 22% increase from the year before.

The US topped the list of high-income countries with the most children not receiving the first dose of the vaccine between 2010 and 2017, according to UNICEF. It said the UK was in third place, after France, with 527,000 children missing out on their first measles vaccine dose in the same period.

Mary Ramsay, head of immunisations at Public Health England, said: "These numbers highlight the importance of not only routine vaccination but also making sure anyone who missed a dose is caught up to minimise the risk of outbreaks."

NHS England expressed concern that many parents were being put off having their children vaccinated because of unfounded opposition to vaccination. "With measles cases almost quadrupling in England in just one year, it is grossly irresponsible for anybody to spread scare stories about vaccines, and social media firms should have a zero tolerance approach towards this dangerous content," Mr Stevens said on Wednesday.

End of Life Care

Among announcements this week from the National Institute for Health and Care Excellence (NICE) was draft guidance to cover organising and delivering care to adults approaching the end of their life.

A patient's care should be regularly reviewed by a lead healthcare professional, the guideline recommended, while good communication should be maintained between the patient, carer, and practitioner to ensure a shared understanding of needs.

An assessment of the needs of carers was among new recommendations. The guideline said it was important to consider the age of carers, as the needs of younger and older carers could differ.

Evidence showed that when supported, carers could help maintain a better quality of life for the person dying, according to the guideline. It said practitioners should therefore be encouraged to listen to the needs of carers, to consider the physical and emotional strain they might experience, and to look at how their needs could be met as well as the needs of those they care for.

The draft guideline, intended to be used alongside the NICE guideline on care of dying adults in the last days of life, was put out for consultation until 7th June, with final publication expected in October 2019.

T-cell Lymphoma Treatment Go-ahead

Brentuximab vedotin (Adcetris, Takeda) was recommended as an option for treating CD30-positive cutaneous T-cell lymphoma (CTCL) in adults after at least one systemic therapy.

NICE said that clinical trial evidence suggested that the antibody-drug conjugate was more effective than methotrexate or bexarotene (Targretin, Eisai) in terms of response rates and extending how long people lived without their disease getting worse.

In final guidance, it said patients would be eligible if they had mycosis fungoides stage IIB or over, primary cutaneous anaplastic large cell lymphoma, or Sézary syndrome.

The recommendation was dependent on the manufacturer supplying brentuximab vedotin at an agreed discount.

Helping to Prevent Suicides

A consultation has begun on a draft quality standard for suicide prevention.

NICE said it set out ways to reduce suicide and help people bereaved or affected by suicides whether in the community or in custody.

Interested parties have until the 23rd May to comment ahead of a final document expected in September 2019.

Rectal Cancer Treatment 'Lacks Good Evidence'

An assessment of low-energy contact X-ray brachytherapy (the Papillon technique) for locally advanced rectal cancer has found that current evidence on safety and efficacy was inadequate in quantity and quality.

NICE has begun a consultation on its draft guidance that recommends the procedure should only be used for research purposes.

In draft guidance, it called for further research to include randomised controlled trials comparing the procedure with standard care.

The consultation will end on 23rd May, and final guidance is expected in August 2019.

NICE 'Not Minded' to Recommend Type 1 Diabetes Treatment

An appraisal consultation was announced after NICE said it did not intend to recommend dapagliflozin (Forxiga, AstraZeneca) with insulin as an option for treating type 1 diabetes in adults with a BMI of at least 27 kg/m2, when insulin alone did not provide adequate glycaemic control despite optimal insulin therapy.

In draft guidance, an appraisal committee said clinical evidence suggested that compared with placebo, there were small improvements in blood glucose (HbA1c levels) and weight loss, and very small improvements in quality of life, from the treatment. However, it said there was no clinical evidence to show how long patients lived after treatment with dapagliflozin.

The consultation will last until 17th May 2019.

Type 2 Diabetes Treatment

In draft guidance, NICE recommended ertugliflozin (Steglatro, Merck Sharp & Dohme) with metformin and a dipeptidyl peptidase-4 (DPP-4) inhibitor as an option for treating type 2 diabetes in adults when diet and exercise alone do not provide adequate glycaemic control.

Patients would be eligible only if the disease was uncontrolled with metformin and a DPP-4 inhibitor, and a sulfonylurea or pioglitazone (Actos, Takeda, and others) was not appropriate.

Treating Hyperkalaemia

Sodium zirconium cyclosilicate (Lokelma, AstraZeneca) was recommended as an option for treating hyperkalaemia in adults, NICE said in draft guidance.

Patients would be eligible only if treatment was needed in an emergency care setting, and the drug was stopped after 28 days of maintenance treatment, or earlier if the hyperkalaemia resolved.

However, sodium zirconium cyclosilicate was not recommended for outpatients as it was considered too costly.

A consultation on the draft guideline closes on 20th May 2019.

Bioprosthetic Plug for Anal Fistula

Current evidence on the safety and efficacy of bioprosthetic plug insertion for anal fistula was adequate to support use of the procedure, NICE said in draft guidance.

It said treatment could be carried out provided that standard arrangements were in place for clinical governance, consent, and audit – and when undertaken by a surgeon experienced in managing anal fistulas.

A consultation on the guidance will close on 23rd May, with final guidance expected in September 2019.

Intracranial Aneurysm Procedure

NICE announced it was consulting on draft guidance on endovascular insertion of an intrasaccular wire-mesh blood-flow disruption device for intracranial aneurysm.

It said current evidence on the safety and efficacy of the procedure was adequate to support its use provided that standard arrangements were in place for clinical governance, consent, and audit.

The consultation period will run until 23rd May, with final guidance expected in August 2019.

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