Numbers increase for sixth edition of Singapore dental show

Mon, 06 Feb 2012 11:39:22 +0100

SINGAPORE: This year’s edition of the International Dental Exhibition and Meeting in Singapore will be welcoming a number of new corporate faces to Asia largest dental show. Several companies from around the globe have announced their first ever participation at the biennial event which will be held at the end of April.

Interview: “The red dot is an excellent marketing instrument”

Mon, 06 Feb 2012 07:49:20 +0100

With around 14,000 entries from more than 70 countries in 2011, the red dot design award is the world’s largest design competition. Every year, the latest creations, projects and design achievements in all industries compete, ranging from architecture, through furniture, sportswear and automotive products to dental equipment, such as Acteon’s WhiteFox CBCT system or Dürr Dental’s intra-oral camera VistaCam iX, which were both awarded the red dot. This year, more entries have been submitted than ever before in the history of the red dot design award. Dental Tribune Online spoke with Prof. Peter Zec, initiator and CEO of the red dot design award, about the origins of the award, the latest trends and the commercial value of the red dot logo.

Worker loses dentures in nuclear reactor

Mon, 06 Feb 2012 07:34:03 +0100

THURSO, UK: Every day, many people around the world lose their dentures. There have been reports about fake teeth being found on the motorway after a woman was sick out of a car window, and dentures being lost during a parachute jump and even during a holiday boat trip in Australia. This time, an engineer, who used to work in a nuclear reactor, has recounted a colleague’s loss of his dentures.

Quality of life remains low in cancer survivors

Fri, 03 Feb 2012 08:48:05 +0100

DES MOINES, Iowa, USA: According to a survey undertaken by the University of Iowa, head and neck cancer survivors face poor quality of life owing to health-related issues. Owing to reduced oral functioning, over 50 percent reported persistent eating problems and 28.3 percent suffered from depression.

One out of ten Germans scared of visiting the dentist

Fri, 03 Feb 2012 07:13:34 +0100

BERLIN, Germany: Even though the majority of Germans attend regular dental check-ups, 12 per cent suffer from extreme dental phobia, a survey has found. Every second patient reported being a little afraid of seeing a dentist, whereas one out of three is not afraid at all. The survey results are similar to those found in other countries, such as the USA and Australia.

Improving Childhood Vaccination Rates

Wed, 01 Feb 2012 22:00:18 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 391-393, February 2012.

Chemotherapy Alone for Early-Stage Hodgkin's Lymphoma

Wed, 01 Feb 2012 22:00:18 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 470-471, February 2012.

The Perpetual Challenge of Infectious Diseases

Wed, 01 Feb 2012 22:00:18 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 454-461, February 2012.

GAD65 Antigen Therapy in Recently Diagnosed Type 1 Diabetes Mellitus

Wed, 01 Feb 2012 22:00:17 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 433-442, February 2012.

Keeping Score under a Global Payment System

Wed, 01 Feb 2012 22:00:17 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 393-395, February 2012.

Glucocorticoids plus N-Acetylcysteine in Alcoholic Hepatitis

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 476-477, February 2012.

Worth a Second Look

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 463-468, February 2012.

Ultraviolet A and Photosensitivity during Vemurafenib Therapy

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 480-481, February 2012.

Delayed Puberty

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 443-453, February 2012.

Uterine Fibroids and Evidence-Based Medicine — Not an Oxymoron

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 471-473, February 2012.

Staphylococcus aureus Reactivation Osteomyelitis after 75 Years

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 481-482, February 2012.

Timing of Antiretroviral Therapy for HIV-1–Associated Tuberculosis

Wed, 01 Feb 2012 22:00:15 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 474-476, February 2012.

Post-Traumatic Herniated Cervical Disk

Wed, 01 Feb 2012 22:00:15 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 462, February 2012.

Assessing Supplement Safety — The FDA's Controversial Proposal

Wed, 01 Feb 2012 22:00:15 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 389-391, February 2012.

ABVD Alone versus Radiation-Based Therapy in Limited-Stage Hodgkin's Lymphoma

Wed, 01 Feb 2012 22:00:13 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 399-408, February 2012.

Opportunity in Austerity — A Common Agenda for Medicine and Public Health

Wed, 01 Feb 2012 22:00:13 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 395-397, February 2012.

Ulipristal Acetate versus Placebo for Fibroid Treatment before Surgery

Wed, 01 Feb 2012 22:00:13 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 409-420, February 2012.

Insulin-Induced Lipohypertrophy

Wed, 01 Feb 2012 22:00:06 +0100

New England Journal of Medicine, Volume 366, Issue 5, February 2012.

Ulipristal Acetate versus Leuprolide Acetate for Uterine Fibroids

Wed, 01 Feb 2012 22:00:06 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 421-432, February 2012.

Early Liver Transplantation for Severe Alcoholic Hepatitis

Wed, 01 Feb 2012 22:00:04 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 477-479, February 2012.

Penny Wise, Pound Foolish? Coverage Limits on Immunosuppression after Kidney Transplantation

Wed, 01 Feb 2012 22:00:02 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Why Now Is Not the Time for Premium Support

Wed, 25 Jan 2012 22:00:07 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

The Wyden–Ryan Proposal — A Foundation for Realistic Medicare Reform

Wed, 25 Jan 2012 22:00:05 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Preparing for Precision Medicine

Wed, 18 Jan 2012 22:00:01 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

All Heat, No Light — The States' Medicaid Claims before the Supreme Court

Wed, 11 Jan 2012 22:00:06 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Three Patients with Full Facial Transplantation

Wed, 28 Dec 2011 22:00:10 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Everolimus in Postmenopausal Hormone-Receptor–Positive Advanced Breast Cancer

Wed, 07 Dec 2011 23:30:05 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Improving Childhood Vaccination Rates

Wed, 01 Feb 2012 22:00:18 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 391-393, February 2012.

Chemotherapy Alone for Early-Stage Hodgkin's Lymphoma

Wed, 01 Feb 2012 22:00:18 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 470-471, February 2012.

The Perpetual Challenge of Infectious Diseases

Wed, 01 Feb 2012 22:00:18 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 454-461, February 2012.

GAD65 Antigen Therapy in Recently Diagnosed Type 1 Diabetes Mellitus

Wed, 01 Feb 2012 22:00:17 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 433-442, February 2012.

Keeping Score under a Global Payment System

Wed, 01 Feb 2012 22:00:17 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 393-395, February 2012.

Glucocorticoids plus N-Acetylcysteine in Alcoholic Hepatitis

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 476-477, February 2012.

Worth a Second Look

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 463-468, February 2012.

Ultraviolet A and Photosensitivity during Vemurafenib Therapy

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 480-481, February 2012.

Delayed Puberty

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 443-453, February 2012.

Uterine Fibroids and Evidence-Based Medicine — Not an Oxymoron

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 471-473, February 2012.

Staphylococcus aureus Reactivation Osteomyelitis after 75 Years

Wed, 01 Feb 2012 22:00:16 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 481-482, February 2012.

Timing of Antiretroviral Therapy for HIV-1–Associated Tuberculosis

Wed, 01 Feb 2012 22:00:15 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 474-476, February 2012.

Post-Traumatic Herniated Cervical Disk

Wed, 01 Feb 2012 22:00:15 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 462, February 2012.

Assessing Supplement Safety — The FDA's Controversial Proposal

Wed, 01 Feb 2012 22:00:15 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 389-391, February 2012.

ABVD Alone versus Radiation-Based Therapy in Limited-Stage Hodgkin's Lymphoma

Wed, 01 Feb 2012 22:00:13 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 399-408, February 2012.

Opportunity in Austerity — A Common Agenda for Medicine and Public Health

Wed, 01 Feb 2012 22:00:13 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 395-397, February 2012.

Ulipristal Acetate versus Placebo for Fibroid Treatment before Surgery

Wed, 01 Feb 2012 22:00:13 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 409-420, February 2012.

Insulin-Induced Lipohypertrophy

Wed, 01 Feb 2012 22:00:06 +0100

New England Journal of Medicine, Volume 366, Issue 5, February 2012.

Ulipristal Acetate versus Leuprolide Acetate for Uterine Fibroids

Wed, 01 Feb 2012 22:00:06 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 421-432, February 2012.

Early Liver Transplantation for Severe Alcoholic Hepatitis

Wed, 01 Feb 2012 22:00:04 +0100

New England Journal of Medicine, Volume 366, Issue 5, Page 477-479, February 2012.

Penny Wise, Pound Foolish? Coverage Limits on Immunosuppression after Kidney Transplantation

Wed, 01 Feb 2012 22:00:02 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Why Now Is Not the Time for Premium Support

Wed, 25 Jan 2012 22:00:07 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

The Wyden–Ryan Proposal — A Foundation for Realistic Medicare Reform

Wed, 25 Jan 2012 22:00:05 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Preparing for Precision Medicine

Wed, 18 Jan 2012 22:00:01 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

All Heat, No Light — The States' Medicaid Claims before the Supreme Court

Wed, 11 Jan 2012 22:00:06 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Three Patients with Full Facial Transplantation

Wed, 28 Dec 2011 22:00:10 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

Everolimus in Postmenopausal Hormone-Receptor–Positive Advanced Breast Cancer

Wed, 07 Dec 2011 23:30:05 +0100

New England Journal of Medicine, Volume 0, Issue 0, Ahead of Print.

[Editorial] For sepsis, the drugs don't work

On Oct 25, 2011, Eli Lilly announced the voluntarily withdrawal from the market of drotrecogin alfa (activated), marketed as Xigris, a drug licensed for the treatment of severe sepsis. Drotrecogin alfa, a recombinant form of human activated protein C with anticoagulant and anti-inflammatory activity, was the only pharmaceutical available designed specifically to treat sepsis. Its withdrawal marks the end of another chapter in the inglorious history of the search for a specific treatment for sepsis.

[Comment] Dolutegravir—a promising antiretroviral in development

Combination antiretroviral therapy (cART) has transformed the lives of people living with HIV. Studies suggest that treatment with cART might lead to the normal to near-normal life expectancy. Over the past decade our understanding of the toxic effects of cART has improved and new, convenient, seemingly less toxic, and more tolerable antiretroviral drugs in old and new classes have become available. Once or twice daily regimens—in particular fixed-dose once-daily combinations of two or three drugs—have simplified cART and made lifelong prescription far more acceptable.

[Comment] Dampening the effect of drug resistance in HIV: a leap forward

Antiretroviral therapy (ART) inhibits viral replication, allows for recovery of normal immune function, and prevents progression to AIDS in millions of people with HIV. However, if inhibition of viral replication is incomplete, the residual antiviral pressure will select for drug-resistant virus Although drug regimens are designed to prevent these outcomes, some people initiating ART since 1998 have acquired extensively drug-resistant HIV since the treatment's introduction 14 years ago. are reported from the Pursuing Later Treatment Options II (PLATO II) collaboration; this group analyses data from European cohorts to assess outcomes in people with HIV infection with a history of failure of drugs from the three main classes.

[Comment] Inactivated polio vaccine and global polio eradication

2012 will mark the 24th year of WHO's Global Poliomyelitis Eradication Initiative. Eradication has proven more difficult than originally envisioned because of geopolitical events, such as war, social disruption, and political indifference; social and cultural issues, such as distrust of poliovirus vaccines and vaccinators; and the unanticipated emergence of virulent vaccine-derived polioviruses in many locations. Few of these obstacles have bewildered the scientific community as much as the low efficacy of the major weapon in the arsenal, trivalent oral polio vaccine (OPV) in regions with dense populations, high birthrates, and poor sanitation resulting from diarrhoea due to enteric pathogens, particularly rotaviruses, and perhaps nutritional deficiencies and other factors.

[Comment] Updating prevaccination rotavirus-associated mortality

In The Lancet Infectious Diseases, Jacqueline Tate and colleagues assess more than 40 reports published between 2008 and 2011 and recent data from WHO-coordinated Global Surveillance Networks, which established the rate of rotavirus-associated acute gastroenteritis in children younger than 5 years who were admitted to hospital in various parts of the world. From these rates and the actual numbers of childhood deaths in different countries related to all causes of diarrhoea, Tate and colleagues obtained estimates of deaths associated with rotavirus disease.

[Comment] Why doesn't hand hygiene work better?

The field of infection control is devoted to reducing the spread of pathogens. Over the years, this endeavour has developed along two distinct lines. In resource-limited communities, as shown by Curtis and colleagues in their recent Review, simple hygienic measures can have a remarkable effect on decreasing transmission, although their implementation may be inconsistent. By contrast, modern high-tech hospitals, which occupy the opposite end of the resource spectrum, are ceaselessly haunted by a different set of transmissible pathogens, those that cause health-care-associated infection (HAI).

[Comment] Adherence to antiretroviral therapy: supervision or support?

We are entering a new phase in the strategic use of antiretroviral drugs. In addition to dramatically reducing HIV/AIDS-related morbidity and mortality, these drugs have recently shown an important effect in reducing HIV incidence and transmission.

[Errata] Erratum

Jentes ES, Poumerol G, Gershman MD, et al. The revised global yellow fever risk map and recommendations for vaccination, 2010: consensus of the Informal WHO Working Group on Geographic Risk for Yellow Fever. Lancet Infect Dis 2011; 11: 622–32—On page 625 of this Review, the margin link to the yellow fever risk maps should have been “http://www.who.int/ith” and the margin link to the CDC's vaccination map should have been “http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/yellow-fever.

[Errata] Erratum

Heffron R, Donnell D, Rees H, et al. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infect Dis 2012; 12: 19–26—In table 5, the odds ratio (95% CI) and p value for detection of any genital HIV-1 RNA in HIV-1 positive women taking injectable contraceptives should have been 1·38 (1·05 to 1·81) and 0·05 and for those taking oral contraceptives 0·98 (0·63 to 1·52) and 0·43. This correction has been made to the online version as of Jan 23, 2012.

[Correspondence] Dissemination of NDM-1

We read Timothy Walsh and colleagues' Article about the dissemination of NDM-1-positive bacteria in New Delhi. The findings are very relevant to the situation in India at present and have created a lot of debate; however, we wish to raise a few concerns about the methods used by the investigators.

[Correspondence] Dissemination of NDM-1

In The Lancet Infectious Diseases, Karthikeyan Kumarasamy and colleagues reported that blaNDM-1-containing bacteria was isolated from a few patients in India, Pakistan, and Bangladesh. Subsequently, Timothy Walsh and colleagues identified blaNDM-1-carrying bacterial species from the Enterobacteriaceae, Aeromonadaceae, Vibrionaceae, and Pseudomonadaceae, and some other non-fermenters, in New Delhi water samples. The emergence and rapid environmental dissemination of NDM-1 in a densely populated country like India is a very worrying scenario.

[Correspondence] Dissemination of NDM-1

I read the Article by Timothy Walsh and colleagues regarding environmental dissemination of NDM-1 in New Delhi with interest. In the research in context panel of the Article, the researchers state that none of the studies of carbapenemases that they found had examined waste material or drinking water. However, Quinteira and Peixe reported isolation of blaVIM-2 from sewage (24 isolates), rivers (17 isolates), pig faeces (seven isolates), ambulatory patients (seven isolates), and a healthy person from Portugal, and emphasised the importance of surveying environmental strains that might act as a source or reservoir of resistance genes with clinical relevance.

[Correspondence] Dissemination of NDM-1 – Authors' reply

We thank the three correspondents for their responses to our Article. Badrul Hasan and colleagues identified extended-spectrum β-lactamases (ESBLs) in faecal samples from wild birds; although the samples were negative for blaNDM-1, the gene might have been missed because the forward NDM-1 primer at position 123 is in fact a reverse primer at position 691–673 and the reverse primer is a forward primer at position 533–549, resulting in a PCR product of only 150 base pairs.

[Correspondence] Direct faecal PCR for diagnosis of Shiga-toxin-producing Escherichia coli

Martina Bielaszewska and colleagues characterised the Shiga-toxin-producing Escherichia coli (STEC) O104:H4 outbreak strain, which has been reported to cause gastroenteritis and haemolytic uraemic syndrome. They used a diagnostic protocol recommended by the Robert Koch Institute. Broth enrichment of faecal samples was followed by Shiga-toxin immunoassay or PCR to detect the genes encoding Shiga toxin (Stx) and other virulence factors, and microbiological culture was used as the gold standard. In our laboratory, we processed 754 faecal samples from 481 patients that were sent from affiliated hospitals and private practices in Bremen and Lower Saxony during the outbreak from May 23, to June 10, 2011.

[Correspondence] Genital HPV types in Australia

We were intrigued by Edoardo Tartaglia and colleagues' use of a small sample of human papillomavirus (HPV) typing data of unknown representativeness to scrutinise the decline in genital warts reported in Australia after HPV vaccination. They suggest that the decline could be less than anticipated by international data because genital warts in Australia might be caused predominantly by non-HPV vaccine types, implying that the cause of genital warts in Australia could be different to that in every other country studied.

[Correspondence] Is Escherichia coli bacteraemia preventable?

In response to yearly increases in Escherichia coli bacteraemia, the UK Department of Health recently launched mandatory E coli bacteraemia surveillance. Before starting this programme, the Department of Health should have reviewed historical data and contacted units, such as the Barking, Havering & Redbridge University Hospitals NHS Trust (BHRUT), that undertake bacteraemia surveillance. We have, therefore, pre-empted the surveillance findings and estimated the proportion of preventable E coli bacteraemias.

[Newsdesk] Australia publishes hospital staphylococcus bacteraemia rates

As part of a drive to increase transparency across Australian hospitals, the Australian Federal Government, on October 27, 2011, announced rates of Staphylococcus aureus bacteraemia (SAB) to the public for the first time. Nicola Roxon, then Minister for Health and Ageing, said that “the publication of infection rates caused by these potentially deadly bacteria will drive improved hospital performance”. The announcement covered 450 hospitals, including all public hospitals and any private hospitals that elected to be included.

[Newsdesk] Drug donated for treatment of visceral leishmaniasis

In a deal struck with WHO, Gilead Sciences have agreed to donate 445 000 vials of liposomal amphotericin B—used to treat visceral leishmaniasis and marketed under the brand name AmBisome—over the next 5 years. The donation is expected to reach some 50 000 patients during this time. “This initiative will greatly enhance access to AmBisome”, commented WHO's Jorge Alvar.

[Newsdesk] Infectious disease surveillance update

Health officials in the Philippines have reported 128 confirmed and 200 suspected cases of leptospirosis. Many of the infections are likely to have arisen through contact with flood waters after heavy rains brought by tropical storm Washi in mid-December. The areas most affected by the leptospirosis outbreak, Iligan and Cagayan de Oro in the south of the country, were also the areas hardest hit by the floods. The outbreak has claimed the lives of four people so far.

[Newsdesk] Research brief

Vaccines based on human adenovirus 5 (Ad5) induce protective immune responses against several pathogens in animal models, but the neutralising antibodies to Ad5 that most people make are likely to impair the immunological potency of such vaccines. To circumvent this potential problem, researchers have isolated more than 1000 chimpanzee adenovirus strains. Vaccine vectors derived from some of these viruses induce potent cellular immunity in mice. Moreover, in a phase 1 clinical trial, a chimpanzee adenovirus-based vector expressing non-structural hepatitis C virus (HCV) proteins induced broad, sustained T-cell responses to HCV.

[Media Watch] Partnering to heal

We are introduced to a postsurgery ward in an American hospital, to which a healthy young female student has been admitted after an appendectomy. She acquires an intravenous-line-associated infection caused by meticillin-resistant Staphylococcus aureus (MRSA) and dies. The video then retraces the choices and actions of five individuals on the ward who collectively and unwittingly facilitated this outcome. These people include a family member of another patient with MRSA, the physician manager of the ward responsible for implementing and leading safety initiatives, the infection control practitioner providing support for the ward, a third-year medical student, and a registered nurse.

[Articles] Once daily dolutegravir (S/GSK1349572) in combination therapy in antiretroviral-naive adults with HIV: planned interim 48 week results from SPRING-1, a dose-ranging, randomised, phase 2b trial

Dolutegravir was effective when given once daily without a pharmacokinetic booster and was well tolerated at all assessed doses. Our findings support the assessment of once daily 50 mg dolutegravir in phase 3 trials.

[Articles] Trends in virological and clinical outcomes in individuals with HIV-1 infection and virological failure of drugs from three antiretroviral drug classes: a cohort study

A substantial improvement in viral load suppression and accompanying decrease in the rates of AIDS in people after extensive failure to drugs from the three original antiretroviral classes during 2000–09 was probably mainly driven by availability of newer drugs with better tolerability and ease of use and small cross-resistance profiles, suggesting the public health benefit of the introduction of new drugs.

[Articles] Immunogenicity of supplemental doses of poliovirus vaccine for children aged 6–9 months in Moradabad, India: a community-based, randomised controlled trial

Supplemental mOPV1 resulted in almost total seroprevalence against poliovirus type 1, which is consistent with recent absence of poliomyelitis cases; whereas seroprevalence against types 2 and 3 was expected for routine vaccination histories. The immunogenicity of IPV produced in India (Panacea) was similar to that of an internationally manufactured IPV (GSK). Intradermal IPV was less immunogenic.

[Articles] 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis

Introduction of effective and available rotavirus vaccines could substantially affect worldwide deaths attributable to diarrhoea. Our new estimates can be used to advocate for rotavirus vaccine introduction and to monitor the effect of vaccination on mortality once introduced.

[Series] Non-communicable health risks during mass gatherings

Mass gatherings (MGs) have been associated with high rates of morbidity and mortality from non-communicable diseases, accidents, and terrorist attacks, thus posing complex public health challenges. We assessed the health risks and public health responses to MGs to identify an evidence-based framework for public health interventions. Human stampedes and heat-related illnesses are the leading causes of mortality. Minor traumatic injuries and medical complaints are the main contributors to morbidity and, particularly, the need for onsite medical care.

[Series] Crowd and environmental management during mass gatherings

Crowds are a feature of large cities, occurring not only at mass gatherings but also at routine events such as the journey to work. To address extreme crowding, various computer models for crowd movement have been developed in the past decade, and we review these and show how they can be used to identify health and safety issues. State-of-the-art models that simulate the spread of epidemics operate on a population level, but the collection of fine-scale data might enable the development of models for epidemics that operate on a microscopic scale, similar to models for crowd movement.

[Grand Round] Surgical treatment of drug-resistant tuberculosis

The global emergence and spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis has led to the re-examination of surgery as a possible adjunctive treatment. We present the case of a 26-year-old HIV-seronegative patient with XDR pulmonary tuberculosis refractory to medical therapy. Surgical resection of the patient's solitary cavitary lesion was done as adjunctive treatment, and a successful outcome with a combination of surgery and drug therapy was achieved. We review the history of surgical therapy for tuberculosis and reports of its role in treatment of MDR and XDR tuberculosis.

[Editorial] For sepsis, the drugs don't work

On Oct 25, 2011, Eli Lilly announced the voluntarily withdrawal from the market of drotrecogin alfa (activated), marketed as Xigris, a drug licensed for the treatment of severe sepsis. Drotrecogin alfa, a recombinant form of human activated protein C with anticoagulant and anti-inflammatory activity, was the only pharmaceutical available designed specifically to treat sepsis. Its withdrawal marks the end of another chapter in the inglorious history of the search for a specific treatment for sepsis.

[Comment] Dolutegravir—a promising antiretroviral in development

Combination antiretroviral therapy (cART) has transformed the lives of people living with HIV. Studies suggest that treatment with cART might lead to the normal to near-normal life expectancy. Over the past decade our understanding of the toxic effects of cART has improved and new, convenient, seemingly less toxic, and more tolerable antiretroviral drugs in old and new classes have become available. Once or twice daily regimens—in particular fixed-dose once-daily combinations of two or three drugs—have simplified cART and made lifelong prescription far more acceptable.

[Comment] Dampening the effect of drug resistance in HIV: a leap forward

Antiretroviral therapy (ART) inhibits viral replication, allows for recovery of normal immune function, and prevents progression to AIDS in millions of people with HIV. However, if inhibition of viral replication is incomplete, the residual antiviral pressure will select for drug-resistant virus Although drug regimens are designed to prevent these outcomes, some people initiating ART since 1998 have acquired extensively drug-resistant HIV since the treatment's introduction 14 years ago. are reported from the Pursuing Later Treatment Options II (PLATO II) collaboration; this group analyses data from European cohorts to assess outcomes in people with HIV infection with a history of failure of drugs from the three main classes.

[Comment] Inactivated polio vaccine and global polio eradication

2012 will mark the 24th year of WHO's Global Poliomyelitis Eradication Initiative. Eradication has proven more difficult than originally envisioned because of geopolitical events, such as war, social disruption, and political indifference; social and cultural issues, such as distrust of poliovirus vaccines and vaccinators; and the unanticipated emergence of virulent vaccine-derived polioviruses in many locations. Few of these obstacles have bewildered the scientific community as much as the low efficacy of the major weapon in the arsenal, trivalent oral polio vaccine (OPV) in regions with dense populations, high birthrates, and poor sanitation resulting from diarrhoea due to enteric pathogens, particularly rotaviruses, and perhaps nutritional deficiencies and other factors.

[Comment] Updating prevaccination rotavirus-associated mortality

In The Lancet Infectious Diseases, Jacqueline Tate and colleagues assess more than 40 reports published between 2008 and 2011 and recent data from WHO-coordinated Global Surveillance Networks, which established the rate of rotavirus-associated acute gastroenteritis in children younger than 5 years who were admitted to hospital in various parts of the world. From these rates and the actual numbers of childhood deaths in different countries related to all causes of diarrhoea, Tate and colleagues obtained estimates of deaths associated with rotavirus disease.

[Comment] Why doesn't hand hygiene work better?

The field of infection control is devoted to reducing the spread of pathogens. Over the years, this endeavour has developed along two distinct lines. In resource-limited communities, as shown by Curtis and colleagues in their recent Review, simple hygienic measures can have a remarkable effect on decreasing transmission, although their implementation may be inconsistent. By contrast, modern high-tech hospitals, which occupy the opposite end of the resource spectrum, are ceaselessly haunted by a different set of transmissible pathogens, those that cause health-care-associated infection (HAI).

[Comment] Adherence to antiretroviral therapy: supervision or support?

We are entering a new phase in the strategic use of antiretroviral drugs. In addition to dramatically reducing HIV/AIDS-related morbidity and mortality, these drugs have recently shown an important effect in reducing HIV incidence and transmission.

[Errata] Erratum

Jentes ES, Poumerol G, Gershman MD, et al. The revised global yellow fever risk map and recommendations for vaccination, 2010: consensus of the Informal WHO Working Group on Geographic Risk for Yellow Fever. Lancet Infect Dis 2011; 11: 622–32—On page 625 of this Review, the margin link to the yellow fever risk maps should have been “http://www.who.int/ith” and the margin link to the CDC's vaccination map should have been “http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/yellow-fever.

[Errata] Erratum

Heffron R, Donnell D, Rees H, et al. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infect Dis 2012; 12: 19–26—In table 5, the odds ratio (95% CI) and p value for detection of any genital HIV-1 RNA in HIV-1 positive women taking injectable contraceptives should have been 1·38 (1·05 to 1·81) and 0·05 and for those taking oral contraceptives 0·98 (0·63 to 1·52) and 0·43. This correction has been made to the online version as of Jan 23, 2012.

[Correspondence] Dissemination of NDM-1

We read Timothy Walsh and colleagues' Article about the dissemination of NDM-1-positive bacteria in New Delhi. The findings are very relevant to the situation in India at present and have created a lot of debate; however, we wish to raise a few concerns about the methods used by the investigators.

[Correspondence] Dissemination of NDM-1

In The Lancet Infectious Diseases, Karthikeyan Kumarasamy and colleagues reported that blaNDM-1-containing bacteria was isolated from a few patients in India, Pakistan, and Bangladesh. Subsequently, Timothy Walsh and colleagues identified blaNDM-1-carrying bacterial species from the Enterobacteriaceae, Aeromonadaceae, Vibrionaceae, and Pseudomonadaceae, and some other non-fermenters, in New Delhi water samples. The emergence and rapid environmental dissemination of NDM-1 in a densely populated country like India is a very worrying scenario.

[Correspondence] Dissemination of NDM-1

I read the Article by Timothy Walsh and colleagues regarding environmental dissemination of NDM-1 in New Delhi with interest. In the research in context panel of the Article, the researchers state that none of the studies of carbapenemases that they found had examined waste material or drinking water. However, Quinteira and Peixe reported isolation of blaVIM-2 from sewage (24 isolates), rivers (17 isolates), pig faeces (seven isolates), ambulatory patients (seven isolates), and a healthy person from Portugal, and emphasised the importance of surveying environmental strains that might act as a source or reservoir of resistance genes with clinical relevance.

[Correspondence] Dissemination of NDM-1 – Authors' reply

We thank the three correspondents for their responses to our Article. Badrul Hasan and colleagues identified extended-spectrum β-lactamases (ESBLs) in faecal samples from wild birds; although the samples were negative for blaNDM-1, the gene might have been missed because the forward NDM-1 primer at position 123 is in fact a reverse primer at position 691–673 and the reverse primer is a forward primer at position 533–549, resulting in a PCR product of only 150 base pairs.

[Correspondence] Direct faecal PCR for diagnosis of Shiga-toxin-producing Escherichia coli

Martina Bielaszewska and colleagues characterised the Shiga-toxin-producing Escherichia coli (STEC) O104:H4 outbreak strain, which has been reported to cause gastroenteritis and haemolytic uraemic syndrome. They used a diagnostic protocol recommended by the Robert Koch Institute. Broth enrichment of faecal samples was followed by Shiga-toxin immunoassay or PCR to detect the genes encoding Shiga toxin (Stx) and other virulence factors, and microbiological culture was used as the gold standard. In our laboratory, we processed 754 faecal samples from 481 patients that were sent from affiliated hospitals and private practices in Bremen and Lower Saxony during the outbreak from May 23, to June 10, 2011.

[Correspondence] Genital HPV types in Australia

We were intrigued by Edoardo Tartaglia and colleagues' use of a small sample of human papillomavirus (HPV) typing data of unknown representativeness to scrutinise the decline in genital warts reported in Australia after HPV vaccination. They suggest that the decline could be less than anticipated by international data because genital warts in Australia might be caused predominantly by non-HPV vaccine types, implying that the cause of genital warts in Australia could be different to that in every other country studied.

[Correspondence] Is Escherichia coli bacteraemia preventable?

In response to yearly increases in Escherichia coli bacteraemia, the UK Department of Health recently launched mandatory E coli bacteraemia surveillance. Before starting this programme, the Department of Health should have reviewed historical data and contacted units, such as the Barking, Havering & Redbridge University Hospitals NHS Trust (BHRUT), that undertake bacteraemia surveillance. We have, therefore, pre-empted the surveillance findings and estimated the proportion of preventable E coli bacteraemias.

[Newsdesk] Australia publishes hospital staphylococcus bacteraemia rates

As part of a drive to increase transparency across Australian hospitals, the Australian Federal Government, on October 27, 2011, announced rates of Staphylococcus aureus bacteraemia (SAB) to the public for the first time. Nicola Roxon, then Minister for Health and Ageing, said that “the publication of infection rates caused by these potentially deadly bacteria will drive improved hospital performance”. The announcement covered 450 hospitals, including all public hospitals and any private hospitals that elected to be included.

[Newsdesk] Drug donated for treatment of visceral leishmaniasis

In a deal struck with WHO, Gilead Sciences have agreed to donate 445 000 vials of liposomal amphotericin B—used to treat visceral leishmaniasis and marketed under the brand name AmBisome—over the next 5 years. The donation is expected to reach some 50 000 patients during this time. “This initiative will greatly enhance access to AmBisome”, commented WHO's Jorge Alvar.

[Newsdesk] Infectious disease surveillance update

Health officials in the Philippines have reported 128 confirmed and 200 suspected cases of leptospirosis. Many of the infections are likely to have arisen through contact with flood waters after heavy rains brought by tropical storm Washi in mid-December. The areas most affected by the leptospirosis outbreak, Iligan and Cagayan de Oro in the south of the country, were also the areas hardest hit by the floods. The outbreak has claimed the lives of four people so far.

[Newsdesk] Research brief

Vaccines based on human adenovirus 5 (Ad5) induce protective immune responses against several pathogens in animal models, but the neutralising antibodies to Ad5 that most people make are likely to impair the immunological potency of such vaccines. To circumvent this potential problem, researchers have isolated more than 1000 chimpanzee adenovirus strains. Vaccine vectors derived from some of these viruses induce potent cellular immunity in mice. Moreover, in a phase 1 clinical trial, a chimpanzee adenovirus-based vector expressing non-structural hepatitis C virus (HCV) proteins induced broad, sustained T-cell responses to HCV.

[Media Watch] Partnering to heal

We are introduced to a postsurgery ward in an American hospital, to which a healthy young female student has been admitted after an appendectomy. She acquires an intravenous-line-associated infection caused by meticillin-resistant Staphylococcus aureus (MRSA) and dies. The video then retraces the choices and actions of five individuals on the ward who collectively and unwittingly facilitated this outcome. These people include a family member of another patient with MRSA, the physician manager of the ward responsible for implementing and leading safety initiatives, the infection control practitioner providing support for the ward, a third-year medical student, and a registered nurse.

[Articles] Once daily dolutegravir (S/GSK1349572) in combination therapy in antiretroviral-naive adults with HIV: planned interim 48 week results from SPRING-1, a dose-ranging, randomised, phase 2b trial

Dolutegravir was effective when given once daily without a pharmacokinetic booster and was well tolerated at all assessed doses. Our findings support the assessment of once daily 50 mg dolutegravir in phase 3 trials.

[Articles] Trends in virological and clinical outcomes in individuals with HIV-1 infection and virological failure of drugs from three antiretroviral drug classes: a cohort study

A substantial improvement in viral load suppression and accompanying decrease in the rates of AIDS in people after extensive failure to drugs from the three original antiretroviral classes during 2000–09 was probably mainly driven by availability of newer drugs with better tolerability and ease of use and small cross-resistance profiles, suggesting the public health benefit of the introduction of new drugs.

[Articles] Immunogenicity of supplemental doses of poliovirus vaccine for children aged 6–9 months in Moradabad, India: a community-based, randomised controlled trial

Supplemental mOPV1 resulted in almost total seroprevalence against poliovirus type 1, which is consistent with recent absence of poliomyelitis cases; whereas seroprevalence against types 2 and 3 was expected for routine vaccination histories. The immunogenicity of IPV produced in India (Panacea) was similar to that of an internationally manufactured IPV (GSK). Intradermal IPV was less immunogenic.

[Articles] 2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis

Introduction of effective and available rotavirus vaccines could substantially affect worldwide deaths attributable to diarrhoea. Our new estimates can be used to advocate for rotavirus vaccine introduction and to monitor the effect of vaccination on mortality once introduced.

[Series] Non-communicable health risks during mass gatherings

Mass gatherings (MGs) have been associated with high rates of morbidity and mortality from non-communicable diseases, accidents, and terrorist attacks, thus posing complex public health challenges. We assessed the health risks and public health responses to MGs to identify an evidence-based framework for public health interventions. Human stampedes and heat-related illnesses are the leading causes of mortality. Minor traumatic injuries and medical complaints are the main contributors to morbidity and, particularly, the need for onsite medical care.

[Series] Crowd and environmental management during mass gatherings

Crowds are a feature of large cities, occurring not only at mass gatherings but also at routine events such as the journey to work. To address extreme crowding, various computer models for crowd movement have been developed in the past decade, and we review these and show how they can be used to identify health and safety issues. State-of-the-art models that simulate the spread of epidemics operate on a population level, but the collection of fine-scale data might enable the development of models for epidemics that operate on a microscopic scale, similar to models for crowd movement.

[Grand Round] Surgical treatment of drug-resistant tuberculosis

The global emergence and spread of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis has led to the re-examination of surgery as a possible adjunctive treatment. We present the case of a 26-year-old HIV-seronegative patient with XDR pulmonary tuberculosis refractory to medical therapy. Surgical resection of the patient's solitary cavitary lesion was done as adjunctive treatment, and a successful outcome with a combination of surgery and drug therapy was achieved. We review the history of surgical therapy for tuberculosis and reports of its role in treatment of MDR and XDR tuberculosis.