April 29, 2016

Gone viral

The story

Good riddance to the Ebola outbreak headlines of 2014. Now a new wave of vaccine research is trickling in to take their place.

The hybrid

Mix a vesicular stomatitis virus with an Ebola glycoprotein and out comes rVSV-ZEBOV, a promising live-attenuated vaccine for Ebola. The virus got an 'A' on it's final Phase I report card after it was shown to be safe and immunogenic. Well, actually an 'A-', since some participants suffered from fever and arthritis.

The context

We've seen preliminary reports on this data before, so think of this week's news as a polished version of a rough draft. The vaccine is undergoing Phase 2 and 3 testing in the PREVAIL trial in Liberia and the STRIVE trial in Sierra Leone. Interim results from Phase 3 trials in Guinea found rVSV-ZEBOV to be 100% effective when given to cluster contacts of infected persons. Whoa.

The vaccines

rVSV-ZEBOV may be the most well-studied of the vaccines, but there are other candidates in the pipeline. In the event of a renewed outbreak, a range of manufacturing plants and suppliers would prove useful. 

The takeaway

Outbreaks in West Africa were a worldwide public health emergency. Vaccines offer hope for a less frightening Round 2.  

Say it on rounds

When your main form of exercise is sprinting to arrests

You may be on to something. Researchers placed participants on exercise bikes and looked at interval-based short bursts (20 second sprints x 3 cycles over 10 mins) vs. longer but less intense workouts (45 mins at a moderate pace). The interval group saw the same benefits as the paced group – increased peak oxygen uptake, insulin sensitivity, and skeletal muscle mitochondrial content – in a fraction of the time.
PLoS One

When you find your patient smoking by the fire escape

Hopefully you're not on the Crohn's unit. A multicenter prospective cohort study of 500 patients with Crohn's Disease found that smokers relapsed more frequently and at earlier timepoints than non-smokers, regardless of disease therapy. 
Am J Gastroenterol

Did we mention smoking?

So did England's Royal College of Physicians, who issued a statement advocating for e-cigarettes as an alternative to other tobacco products. The group says e-cigs are more popular than nicotine replacement therapy and contain less harmful chemicals than traditional tobacco. The CDC has taken a different approach and says there is no evidence to support e-cigarette use in smoking cessation.

Brush up


Pre-exposure prophylaxis (PrEP) pills prevent HIV transmission. Current CDC guidelines recommend daily use to prevent HIV transmission for anybody with HIV-positive partners, men who have sex with men (MSM), inconsistent condom users, those with multiple sexual partners or recent bacterial STDs, and IV drug users. Emtricitabine-tenofovir (Truvada) is currently the only PrEP med approved by the FDA. 

What's the evidence

For on-demand PrEP use? Daily use is known to prevent HIV, but some patients don't comply. 2015's IPERGAY showed that high risk MSM who took Truvada before sex had an 86% reduction in new HIV infections, but the trial suffered from low participant adherence. On-demand use has not yet gained FDA approval or been incorporated into formal HIV guidelines.

Procedure price geography

Forget delegate maps – there's a United States of medical costs. And, as it stands, a knee replacement is $17,000 less in Miami, FL, than 180 miles north in Palm Bay.

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