News in brief - June 12, 2006

WHO director-general dies - Meningococcal vaccine in short supply - Antidepressant warning issued - Plan to boost flu vaccination rates

WHO director-general dies

Dr. Jong-Wook Lee, World Health Organization director-general, died May 22. He was 61.

"The loss of Dr. Lee carries profound repercussions for the international public health community," said Georges C. Benjamin, MD, executive director of the American Public Health Assn.

The South Korean native died in Geneva after emergency surgery for a blood clot in the brain. He started his career with WHO in 1983 as a consultant on Hansen's disease in the South Pacific. He had been director-general for two years.

During his tenure, WHO achieved the ratification of the Framework Convention on Tobacco Control, the first international public health treaty, and led the health response to avian influenza, the Asian tsunami and the Pakistan earthquake.

"Dr. Lee has been the positive force needed to draw the attention of the world and its leaders to emerging threats," said Elias A. Zerhouni, MD, director of the National Institutes of Health.

Meningococcal vaccine in short supply

The Centers for Disease Control and Prevention wants physicians to hold off administering meningococcal conjugate vaccine to 11- to 12-year-olds because Sanofi Pasteur can't manufacture enough to meet demand. Doctors should keep giving the shot to teens entering high school who did not get it already, college freshmen in dorms and others at high risk. The vaccine's polysaccharide version also is an option for people traveling to areas where the disease is epidemic, although this version is also in short supply.

The agency is asking doctors to call back those who did not receive the shot when supply problems are resolved later this year.

The vaccine was approved in January 2005.

Antidepressant warning issued

A Dear Healthcare Professional letter was sent last month by the manufacturer of the antidepressant Paxil, or paroxetine hydrochloride, and Paxil CR, its controlled-release version, urging physicians to monitor adult patients using the drugs for worsening of depression and signs of suicide. The medication already had carried warnings to monitor closely teens and young adults ages 18 to 24.

A recent meta analysis of the drug by its manufacturer, GlaxoSmithKline, found that patients using Paxil had a higher frequency of suicidal behavior than did those on placebo. The finding resulted in a label change expanding the warning to closely monitor adult patients, particularly those up to age 30.

"It is important that all patients, especially young adults and those who are improving, receive careful monitoring during paroxetine therapy regardless of the condition being treated," said the Food and Drug Administration in a May 12 posting on its MedWatch Internet site.

But the data should be interpreted with caution, the agency said, because although the number of suicide attempts was statistically significant among those who took the drug, the number of events was small -- 11 out of 3,455.

GlaxoSmithKline, which made the labeling changes voluntarily, said it was difficult to conclude that there is a causal relationship between the drug and suicide attempts because there were so few events and that the events themselves are symptoms of depression and other psychiatric illnesses that the drug is intended to treat.

Plan to boost flu vaccination rates

With about three-quarters of the nation's population already on the priority list to receive an annual flu shot, it might not be long before the recommendation applies to everyone. If more people do heed the call to get vaccinated, they might be more successful this year. If all goes according to plan, there should be more vaccine to go around.

Of course, as production and distribution problems have plagued flu shots over the past few years, more than a few physicians are skeptical that this year will be any better.

But because there could be as many as 120 million doses of vaccine available this season, compared with 80 million doses last season, attention is shifting to how to use those additional doses, said Nicole Smith, PhD, MPH, a member of the Centers for Disease Control and Prevention's Influenza Branch. She spoke at a May 18 briefing on the upcoming flu season that was sponsored by the National Foundation for Infectious Diseases in collaboration with several federal agencies and the AMA.

The CDC's Advisory Committee on Immunization Practices is planning to discuss this topic at its June 29-30 meeting, Dr. Smith said.

AMA Trustee Ardis D. Hoven, MD, also speaking at the briefing, noted that the immunization rate among health care workers, long a priority group for vaccination, is particularly in need of a boost. Only about 40% of physicians said they had been vaccinated the previous season.

She also urged physicians and others to continue to offer immunizations throughout the flu season. Often vaccination rates drop dramatically after Thanksgiving, she said, although flu generally doesn't peak until February.

One way to avoid the entire problem of an annual vaccine would be to develop a universal influenza vaccine that could be administered just once and provide immunity to the unchanging features of the virus, said George Curlin, MD, MPH, the medical officer for the Office of the Director at the National Institute of Allergy and Infectious Diseases. Dr. Curlin oversees vaccine clinical trials.

"If we had a universal vaccine, there wouldn't be this race against time every year," he said.