Jared Berberabe

Following a review of 2 new 2019 Federal Advisory Committee on Immunization Practices (ACIP) recommendations, the American Cancer Society (ACS) has updated its guidelines for human papillomavirus (HPV) vaccination.

Guidelines for use of the HPV vaccine were first issued in 2007; an update to those guidelines were published in 2016. The latest update addresses key concerns surrounding when routine vaccination should begin, the effectiveness of subsequent catch-up vaccinations, and whether to recommend shared clinical decision-making about vaccination. The ACS, in adapting these concerns, also provided several qualifying statements regarding their own interpretation of the new set of guidelines.

Both the ACIP and ACS recommend that girls and boys should receive 2 doses of the HPV vaccine when they are between the ages of 9 and 12.

In their qualifying statement, the ACS noted the presence of emerging evidence suggesting that series completion rates and vaccine acceptance tended to be higher when vaccination began as early as 9 instead of 11, which previous guidelines had recommended.

Parents also reported a greater sense of ease with administering vaccines early on, preferring to have fewer shots per visit. The ACS affirmed that the subsequent higher rates of completion and vaccine acceptance meant higher rates of cancer prevention, thereby increasing overall vaccine effectiveness.

The newest guidelines emphasize that children and young adults up to age 26, who have not received the vaccine, should be vaccinated, since vaccination of young adults will not prevent as many cancers as vaccination of children and teens.

The ACS qualified their statement by suggesting that providers inform individuals from the age range of 22-26 about the risk of lower efficacy. This updates the previous 2016 guidelines, which could not determine a harmonized age range between both men and women, and also reaffirms increased opportunity for college-aged individuals and those still under their parents’ household to gain access to vaccination.

The ACS does not recommend that individuals older than 26 receive the HPV vaccination.

Although the ACIP suggested that adults aged 27 to 45 years should receive the HPV vaccination, the ACS does not endorse this, due to the low effectiveness and low cancer prevention rate within this age group. The effectiveness of the HPV vaccine dramatically decreases by age 18 and minimal benefits are noted by age 20. The ACS also noted that although the vaccine is safe to receive for adults in the 27 to 45 age range, the benefits are severely limited.

Regarding the additional recommendation that the ACIP made about having shared clinical decision making for clinicians and adults, the ACS worries that such a discussion may interfere with efforts for vaccination at younger ages. Furthermore, the ACS noted that the recommendation may unintentionally suggest increased parental focus on their children’s future sexual behavior rather than on cancer prevention.

The HPV vaccination, since its 2006 unveiling, has successfully reduced the number of genital warts, recurrent respiratory papillomatosis, cervical precancers, and cervical cancers in the global population. Yet, lower rates of HPV vaccination in the United States have prompted a re-commitment to eliminating the disease as early as possible.

Combining HPV vaccination and cervical cancer screening could possibly prevent tens of thousands of cancer-related mortalities each year, the ACS concluded. Vaccination of adolescents ages 9 to 12 years will prevent almost 90% of cancers for which HPV is responsible. Given this, the ACS hopes that this will lead to the first elimination of a cancer in history.

Saslow D, Andrews KS, Manassaram-Baptiste D, Smith RA, Fontham ETH. Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation. 

ACS Updates HPV Vaccination Recommendations to Start at Age 9. News Release. American Cancer Society; July 8, 2020. Accessed July 8, 2020. https://www.cancer.org/latest-news/acs-updates-hpv-vaccination-recommendations-to-start-at-age-9.html

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The American Cancer Society has updated its guidelines regarding the administration of the HPV vaccine.

American Cancer Society Updates Guidelines for HPV Vaccination

Lack of fluctuations in the abundance of gut bacteria over a 24-hour time period can indicate that an individual has type 2 diabetes, according to a study published in the medical journal 

“When certain gut bacteria do not follow a day-night rhythm, so if their number and function does not change over the course of the day, this can be an indicator for a potential type 2 diabetes disease,” explained chronobiologist Silke Kiessling, co-contributor to the study. “Knowing this can improve diagnosis and outlook of type 2 diabetes.”

Alongside lifestyle, genetics, and obesity, the gut microbiome is an important risk factor for predicting metabolic disorders and nutrition-related diseases. Changes in the microbiome can correlate to changes in the metabolic health of an individual. Gut bacteria are evaluated by taking fecal samples for research purposes.

The study observed 2 population cohorts, 1 from a German population called KORA, and 1 from an independent population in England called FoCus. In the German population, 1976 individuals demonstrated a positive correlation between oscillations in the number of microbiota members and the abundance of type 2 diabetes among the population. In the independent population, 1363 confirmed positive correlations between microbial oscillations and type 2 diabetes prevalence. An additional 699 individuals from the German population were successfully predicted to be diagnosed with type 2 diabetes 5 years after the initial sampling.

In these cohorts, arrhythmic bacteria—those that do not change in the 24-hour cycle—are considered markers for potential disease, and the investigators refer to these markers as risk signatures. A change in the number therefore represents an increased possibility of contracting a nutrition-related disease.

The study placed special importance on registering the time of day that gut bacteria samples were taken, and posited that changes in the gut bacteria may affect other microbiome-associated diseases, such as Crohn disease or intestinal cancer. Further research is required to verify this, according to investigators.

The use of cohort studies also warranted future work, as the investigators offered the possibility of re-examining the individuals in the population over time. From these observations, investigators may then be able to ascertain typical signs that lead to future disease occurrences.

Reitmeier S, Kiessling S, Clavel T, et al. Arrhythmic Gut Microbiome Signatures Predict Risk of Type 2 Diabetes. 

https://doi.org/10.1016/j.chom.2020.06.004

Gut bacteria improve type 2 diabetes risk prediction. News Release. Technical University of Munich; July 6, 2020. Accessed July 7, 2020. https://www.tum.de/nc/en/about-tum/news/press-releases/details/36118/

Type 2 diabetes risk prediction is improved by observing changes in gut bacteria, a study finds.


Gut Bacteria Contribute to Improved Prediction of Type 2 Diabetes

the Journal of the American Heart Association

 discovered that women living with HIV (WLWH) who have persistent levels of depression may exhibit a greater risk of heart disease.

The goal of the study was to identify reasons for why women with HIV tend to have increased atherosclerotic risk, the risk of plaque building up in arteries, which is a key contributor to heart attacks and strokes.

The study consisted of data collected from a sample of 700 women from a sub-study of the Women’s Interagency HIV study. Participants were divided into 2 latent classes for determining their psychosocial risk: high and low. Of the 700 women, 163 were identified as having high psychosocial risk, and 637 as having low psychosocial risk. The prevalence of depression, high stress, and probably post-traumatic stress disorder was also evaluated.

Compared with HIV-negative women, who respectively held 9% for plaque prevalence for both high and low psychosocial risk classes, WLWH had a plaque prevalence of 23% and 11% in their high and low psychosocial risk classes. The prevalence of plaque continued to build as symptoms of depression persisted.

Matthew Levy, lead investigator of the study and a research scientist in the epidemiological department at the Milken Institute School of Public Health at George Washington University in Washington, DC, said that previous studies had already found that women and men with HIV were at higher risk for heart disease, regardless of whether they exhibited high levels of depression or stress. “What our results show is that mental health factors may be further contributing to this risk,” he said.

Levy also suggested that HIV care providers screen patients for symptoms of depression and stress.

Dr Matthew Feinstein, a cardiologist and assistant professor of medicine at Northwestern University’s Feinberg School of Medicine in Chicago, concurred. “What this study tells us to do is consider the whole patient, consider the broader social context in which the patient exists. We have to ensure patients get all the support that they need, not just medically.”

The study concluded that while the psychosocial factors chosen were independent atherosclerotic risk factors among WLWH, they still supported furthering research into developing interventions for depression and stress in order to potentially mitigate and treat the increased risk.

Levy ME, Anastos K, Levine SR, et al. Depression and psychosocial stress are associated with subclinical carotid atherosclerosis among women living with HIV. 

Journal of the American Heart Association.

American Heart Association News. Persistent Depression might increase heart disease risk for women with HIV. News Release. American Heart Association; June 22, 2020. Accessed June 30, 2020. 

https://www.heart.org/en/news/2020/06/22/persistent-depression-might-increase-heart-disease-risk-for-women-with-hiv

A new study found increased plaque buildup levels in women with HIV who also suffered from persistent depression and stress. 

Women With HIV and Persistent Depression May Experience Greater Risk for Heart Disease

A nationally representative sample study found that women were more likely to receive opioid prescriptions compared with men; however, the findings pointed to the main factors that may be driving this discrepancy. 

Increased rates of opioid-related death have prompted an examination of present prescription opioid safety. Previous studies had determined that women were prescribed more opioid analgesics than men, but whether this disproportion related in any way to women-centric factors such as adverse socioeconomic and health conditions, greater contact with the health system, or women’s higher rates of being diagnosed with painful and depressive disorders, was largely unknown.

The team of investigators wanted to examine potential factors associated with this increased rate of opioid prescription among women. Investigators examined data from the 2005-2015 Medical Expenditure Panel Survey, which included all adults 18 years and older with prescription and health service utilization data.

According to the study, adults who received opioid prescriptions were more likely to be white, older, earn a lower income, live in the Midwest and South, and have public insurance, as well as more likely to have poorer health and higher rates of smoking and cancer.

Consistent with prior surveillance data, the team found that women did receive significantly higher rates of opioid prescriptions: 9287 women (16.2% of the sample) received opioid prescriptions, whereas 5679 men (11.7%) received them. Yet, after adjusting for the higher rates of nonopioid prescriptions, the study results found little discrepancy in the rates between men and women. According to the investigators, this suggested that the main factors driving this discrepancy were general sex-related differences in sociodemographics, health status, and overall health care utilization.

The findings also could not determine if the number of women who received opioid prescriptions was influenced by how they treated pain. The findings were also limited by the fact that the team was unable to examine any risks associated with the high opioid prescription rate, as well as unable to examine the doses and duration of these prescriptions. Finally, the team’s decision to base their analysis only on completed survey answers may also have limited the information they were able to receive.

Future research is needed to better understand the relationships that may drive increased risk for higher rates of opioid prescriptions in women, and prevention efforts should target these contributing factors, the study concluded.

Agnoli A, Jerant A, Franks P. Prescription Opioids and Patient Sex: A National Cross-Sectional Study. Journal of Women’s Health; (2020). 

Research has found that women receive higher rates of opioid prescriptions than men; a new study identifies why that may be.  

Author | Jared Berberabe

Articles

American Cancer Society Updates Guidelines for HPV Vaccination

Gut Bacteria Contribute to Improved Prediction of Type 2 Diabetes

Women With HIV and Persistent Depression May Experience Greater Risk for Heart Disease

Study Identifies Factors Driving Higher Opioid Prescription Rates in Women