journalists Air France-of this travel magazine which is distributed monthly in 420 thousand copies, and has 000 readers in Europe and 398.000 in France, visited Zadar in April to write a report on the Sea Organ. Estimated the value of the published report on Croatia and Zadar is as much as 390.000 euros. http://magazines.airfrance.com/fr/air-france-magazine/232-aout-2016/#88A group composed of 13 journalists from Germany, Austria and Switzerland during the three days of June she followed celebrating the 50th anniversary of the making of the film about Winnetou and visited numerous filming locations from Velebit, Paklenica and the Zrmanja canyon, but also Starigrad, Zadar, Pakostane, Kornati and Krka. The result of this study trip are numerous articles, mainly in print, but also in electronic media in German-speaking countries, and the value of the material published so far in Germany alone is more than 716.000 euros. https://www.mainpost.de/ueberregional/politik/zeitgeschehen/In-Kroatien-auf-den-Spuren-von-Winnetou;art16698,9273806Ellena Bianco and Marco Restelli, renowned Italian journalists who write for numerous publications (Confidenze, Donna Moderna, Elle, Sette, Dove…), visited Zadar County in June and on that occasion visited Zadar, the islands of Ugljan and Pašman, Dugi otok and Pag, and NP Paklenica and the canyon of the river Zrmanja.http://www.agendaviaggi.com/zara-melodia-adriatico/Dugi Otok, a natural paradise in CroatiaKevin John Rushby, a journalist for a well-known British newspaper The Guardian visited Zadar and Kornati in August, and published a report on the trip:https://www.theguardian.com/travel/2016/sep/04/croatia-kornati-islands-kayaking-road-tripAmerican journalist Margo Pfeiff which publishes its reports in San Francisco Chronicle-u i San Francisco Globe-You, you Los Angeles Times-s, visited Starigrad Paklenica, Velebit, Kornati, Zadar and the Zadar hinterland, and the first part of her report on continental Croatia has already been published, while a report on coastal Croatia, and thus Zadar, is expected by the end of the year. http://www.latimes.com/travel/la-tr-eastern-croatia-20160711-snap-story.html In the first nine months of 2016, the Zadar County Tourist Board continued its successful cooperation with the Croatian Tourist Board and organized 37 different study trips for representatives of foreign media, and on which it is 100 journalists and bloggers from 23 countries participated.Thus, in the mentioned period, in cooperation with local tourist boards, most journalists and bloggers from Germany (13), France and Luxembourg (10), and the Netherlands (7) were hosted. Zadar County was also visited by journalists from Great Britain, Belgium, Austria, Switzerland, Spain, Portugal, Italy, Slovenia, Hungary, the Czech Republic, Poland, Sweden, Denmark, Norway, as well as the USA, Australia, Japan, Korea and Colombia. . Also, in Zadar County, they filmed television stations from Norway, France, Hungary and the Czech Republic, and journalists mostly visited and got to know the city of Zadar, NP Paklenica, Nin, Biograd, Pag, Ugljan, Pašman, Dugi otok, PP Telašćica, canyon. Zrmanja, Vrana Lake as well as the Zadar hinterland.”Since its beginnings, the Zadar County Tourist Board has been paying special attention to cooperation with journalists and the organization of study trips for journalists. This communication tactic within public relations aims to permanently inform media representatives about the tourist offer of Zadar County and Croatia, ie to report in an affirmative manner. The value of published articles and broadcasts not only significantly exceeds the costs of the study trips themselves, but the invested funds are multiplied many times over.. “Point out the Zadar County Tourist Board, and as a confirmation of the thesis, the fact that the value of published articles on the topic of Winnetou in Germany alone exceeds 5 million kuna speaks for itself.See: Calculating the value of Winnetou media articlesIt is the greatest power of tourism that connects various industries vertically and horizontally, and every investment, ie investment in events, study trips, etc.… returns many times through an increased number of arrivals and overnight stays, and thus generating tourist spending that remains with the local community. returns again to the city and tourist boards. A perfect circle, isn’t it? This is the meaning of investing in quality content as well as new motives for the arrival of tourists. Thus, in this case as well, where the Tourist Board of the Zadar Parish, through investment in study trips, generated great media visibility that can be clearly measured as well as the reach of these media. Of course how it will all come back through an increase in arrivals and overnight stays.Also in the period January – September 2016, the Zadar County Tourist Board in cooperation with tour operators and travel agencies participated in the organization of the reception of 150 foreign agents, with the aim of getting to know the Zadar County and its tourist offer. The most numerous were agents from the USA, Germany, Japan, Belgium and Luxembourg, and among the major tour operators, the county was visited by representatives of TUI, Luxairtours and Jet2holidays. Agents from the United States, members of the famous Virtuoso group that connects hundreds of agencies and thousands of professionals in the elite tourism segment, visited Zadar County in September to learn about the possibilities of our region, and in the future improve sales of travel arrangements for Zadar County in the US market.The values of media announcements created as a result of the stay of study groups of journalists in the Zadar County are estimated at amounts that exceed many times the entire budget of the Zadar County Tourist Board. “Organization of study trips of journalists is one of the most important tools of the Zadar County Tourist Board, which continuously creates a positive image and recognizability of the tourist destination – Zadar County. „They conclude from the Zadar County Tourist Board.Among the most significant study trips from the Zadar County Tourist Board are:
According to the E-visitor tourist check-in and check-out system, Dubrovnik achieved record tourist results in the first five months of this year!From January 1 to May 31, 2017, 274 tourists stayed in Dubrovnik, which is as much as 080% more than in the same period in 18. There were 2016 overnight stays, or 830% more than last year. In the first five months, the most numerous tourists were from the United Kingdom, the United States, Croatia, France, Germany, Austria, South Korea, Spain, Bosnia and Herzegovina and Finland.This year’s May is the best tourist May in Dubrovnik! In May 2017 alone, there were 126 arrivals, which is 477% more than in the same month last year, and 15 overnight stays, which is 406% more than in 270. The first place was visited by tourists from the United Kingdom, followed by tourists from the USA, Germany, France, Finland, Sweden, Croatia, Canada, Australia and South Korea.In Dubrovnik-Neretva County, a growth of 15 percent In May 2017, there were 180.296 arrivals in the Dubrovnik-Neretva County, which is 15% more than in May 2016, and 634.327 overnight stays, which is 14% more than in May 2016.In the first five months of 2017, in the Dubrovnik-Neretva County, 371.149 arrivals were registered with 1.238.293 overnight stays. Compared to 2016, overnight stays increased by 23%. The largest number of overnight stays was realized by tourists from the United Kingdom, Croatia, Germany, the United States of America, France, Bosnia and Herzegovina and Austria.
Share Pinterest Share on Twitter Optogenetics involves inserting a gene for a light-sensitive protein into the neurons, using a modified virus. These neurons then become activated when light is focused on them through the thin optical fibers. Yizhar and his team established a method that allows them to zoom in on a particular part of the brain’s network: the “communications cables” that link up the entire brain. These “cables” are the axons – thin extensions of the nerve cells that carry electric pulses from the cells’ centers. Some axons are relatively short and linked to nearby neurons, but others can be lengthy, reaching out to distant regions of the brain.In the new study, which was published in Nature Neuroscience, the team, led by PhD student Mathias Mahn, showed that optogenetic techniques can be used to temporarily silence these long-range axons, effectively leading to a reversible “disconnect” between two distant brain nodes. By observing what happens when crucial connections are disabled, the researchers were able to begin to filling in the picture of the axons’ role in the brain’s internal conversation. Since mental and neurological diseases are often thought to result from changes in long-range brain connectivity, these studies could contribute to a better understanding of the mechanisms behind health and disease in the brain.“The research led us to a deeper understanding of the unique properties of the axons and synapses that form the connections between neurons,” says Yizhar. “We were able to uncover the responses of axons to various optogenetic manipulations. Understanding these differences will be crucial to unraveling the mechanisms for long-distance communication in the brain.” Share on Facebook Email Will we ever be able to understand the cacophonous chatter taking place between the 80 million neurons in our brains? Dr. Ofer Yizhar and his group in the Weizmann Institute of Science’s Neurobiology Department have taken a large step in this direction with a new research method that can provide scientists with targeted control over vital parts of the brain’s communications.Yizhar works in the relatively new field of optogenetics, in which scientists use genetic engineering and laser light in thin optical fibers to investigate the living brain. With these tools, scientists can modulate and control the activities of nerve circuits in the brain, and thus begin to unravel the networks of links and nodes in the brain’s communications systems.Yizhar is particularly interested in the long-distance communications between nerve cells in different areas of the brain. “The coordination between different brain systems is vital to the normal functioning of the brain. If we can understand the extended lines of communication between cells that are in the different regions of the brain – some of them quite far from one another,” says Yizhar, “we might be able, in the future, to understand the changes that take place in the brain in diseases such as depression, anxiety and schizophrenia. Because we do not have an understanding of these diseases on a functional level, we are sorely lacking good ways to treat them.” LinkedIn
Share on Twitter Reflecting rapidly changing cultural attitudes in the United States toward sexuality, a new study finds that the percentage of adults who have had sex with people from their same gender has doubled since the 1990s. The study also found that acceptance of same-sex sexuality has increased among all generations, with Millennials the most accepting.Jean Twenge, professor of psychology at San Diego State University and author of Generation Me, along with colleagues Ryne Sherman of Florida Atlantic University and Brooke Wells of Widener University, analyzed data from the General Social Survey, a nationally representative survey of more than 30,000 adults that has queried Americans about their attitudes toward same-sex sexual behavior since 1973 and about sexual partners since 1989.Between 1990 and 2014 the percentage of men who reported having had sex with at least one man increased from 4.5 percent to 8.2 percent, and the number of women reporting having had sex with at least one woman increased from 3.6 percent to 8.7 percent. The percentage of adults reporting having had sex with both men and women rose from 3.1 percent to 7.7 percent. LinkedIn Share on Facebook Share Pinterest Email Among Millennials–adults between the ages of 18 and 29 during the 2010s–7.5 percent of men and 12.2 percent of women reported having had a same-sex experience.Lesbian sexual experiences are more likely to occur when women are young, the researchers found, while youth doesn’t appear to be a factor for male gay sexual experience.The survey also collected data on respondents’ attitudes toward same-sex relations. Between 1973 and 1990, the percentage of adults who believed “sexual relations between two adults of the same sex [was] not wrong at all” hardly budged, rising from 11 percent to 13 percent. Since then, however, such acceptance has risen to 49 percent of all adults and 63 percent of Millennials in 2014. The researchers published their findings today in the journal Archives of Sexual Behavior.“These large shifts in both attitudes and behavior occurred over just 25 years, suggesting rapid cultural change,” Twenge said.What’s driving this change? Several social and media factors are at play, Twenge said, but broadly, Americans appear to care less about social norms and more about their own wants.“These trends are another piece of evidence that American culture has become more individualistic and more focused on the self and on equality,” she said. “Without the strict social rules common in the past, Americans now feel more free to have sexual experiences they desire.”
Cornil and Chandon also show that unlike health warnings, this multisensory imagery does not reduce expected eating enjoyment or willingness to pay for the food. In fact, “focusing on the pleasure of eating, rather than value for money, health, or hunger, makes people happier to pay more for less food,” said Chandon.Cornil and Chandon conducted five different experiments using different groups such as French schoolchildren, adult Americans and young Parisian women. In the first study, 42 French schoolchildren were asked to imagine – incorporating their five senses – the pleasure of eating familiar desserts and were then asked to choose portions of brownies. They naturally chose portions of brownies that were two sizes smaller than the portions chosen by children in a control condition.In another experiment, Cornil and Chandon imitated high end restaurants by describing a regular chocolate cake as smelling of “roasted coffee” with “aromas of honey and vanilla” with an “aftertaste of blackberry”. This vivid description made 190 adult Americans choose a smaller portion compared to a control condition where the cake was simply described as “chocolate cake”. The study also had a third condition, in which people were told about the calorie and fat content of each cake portion. This nutrition information also led people to choose a smaller portion, but at a cost: It reduced the amount that people were willing to pay for the cake by about $1 compared to the multisensory condition.A third study showed that people underestimated how much they will enjoy eating small portions of chocolate brownies. They expected to enjoy small portions less than larger ones, when actually both were enjoyed equally. This mistake was eliminated by multisensory imagery, which made people better forecasters of their own future eating enjoyment.“Having more descriptive menus or product labels that encourage customers to use their senses can lead to positive outcomes for consumer satisfaction and health, but also for profits,” said Cornil. “This could make for a more sustainable food industry, which struggles to grow in the face of today’s obesity epidemic.”The study was based on Cornil’s PhD dissertation which was conducted at INSEAD under the mentorship of Chandon who is also the director of the INSEAD Sorbonne University Behavioural Lab. This article has implications for health authorities and a wide range of food providers, from food manufacturers and restaurants to catering companies for schools and hospitals. Pinterest LinkedIn The rapid rise in portion sizes has gone hand in hand with rising rates of obesity. To curb supersizing, governments and public health institutions have advocated portion size limits and health warnings, but they have had limited success. Consumers feel they are being infantilized and food marketers feel they’re being squeezed as they typically extract higher profits from bigger portions.But new research has found that people can be encouraged to choose smaller, healthier portions, without compromising on enjoyment. In their article, published in the October 2016 issue of the Journal of Marketing Research, Pierre Chandon, the L’Oréal Chaired Professor of Marketing, Innovation and Creativity at INSEAD and Yann Cornil, Assistant Professor of the Sauder School of Business, University of British Columbia, find that people will choose smaller portions of chocolate cake when they are asked to vividly imagine the multisensory pleasure (taste, smell, texture) of similar desserts.How can focusing on the pleasure of food make people want smaller portions? When it comes to eating, pleasure is inversely related to size. It is at its maximum in the first few bites of the food. Each additional bite becomes then less enjoyable and it is the last bite which determines the overall impression of how much we enjoyed the food. When people choose portions based on value for money, or the fear of being hungry, they end up choosing one of today’s supersized portions which are just not that enjoyable to eat toward the end. Share on Twitter Email Share on Facebook Share
Share on Twitter Pinterest Share Email New research sheds light on the type of sacrifices people are willing to make to protect their moral reputations.“Tania Reynolds, Bo Winegard, and I were all graduate students in Roy Baumeister’s lab. (I left to begin my postdoc at the University of North Carolina after I received my Ph.D. in the summer of 2016.) Our common scholarly interest in the idea that the human self evolved for and serves social purposes was what brought us to choose this particular topic,” said Andrew J. Vonasch, the study’s corresponding author.“My research in particular examines the relationship between morality and rationality. A lot of economic models of human behavior assume that people are only rational when they narrowly pursue their own self-interest, but history shows us that people are also tremendously concerned with being and appearing moral. We wanted to scientifically test how far people would go to protect their reputations, as this would speak to the social nature of the self.” LinkedIn Share on Facebook Vonasch and his colleagues analyzed data from more than 150,000 participants in 100 countries who completed the World Values Survey. They found that individuals from around the world thought avoiding doing anything people would view as immoral was more important than any non-moral value besides physical security.In another set of surveys, the researchers found that a little over half of participants said they would rather die that have a lifetime reputation as a child molester. Seventy percent said they would rather have their hand amputated than be labeled a Neo-Nazi, while 30 percent said they would rather spend a year in jail but be forgiven than avoid jail but forever be labeled a criminal.However, chopping off a limb is easier said than done. So the research devised two experiments to further test the sacrifices people would make to protect their reputations. They uncovered that many people preferred enduring pain or touching disgusting live worms to having their reputation damaged with an e-mail that described them as racist.About 30% of college students submerged their hands in a pile worms and 63% submerged their hands in a nearly-freezing cold pressor to prevent the e-mail from being sent to their entire university. But the researchers believe it is likely that this finding is an underestimate. Many participants (correctly) expressed skepticism that the researchers would actually disseminate the damaging e-mail.“Many people, if not most, are willing to make great sacrifices to protect their reputations,” Vonasch explained to PsyPost. “Luckily, we usually organize our lives so we don’t have to make major sacrifices–but our research strongly suggests that many people would if they had to.”“People rated moral reputation as one of their most important values,” he continued. “They stated that, hypothetically, they would go to great lengths to protect their reputations. And when we had people in the lab think they might lose their reputations, they chose to put their hands in worms, or put themselves in pain, rather than suffer reputational damage. (Of course, being ethical scientists, we wouldn’t have actually damaged anyone’s reputation in our studies).”The findings suggest that many ordinary people are willing to make sacrifices to maintain their status as a morally good person. But it is possible that people are also willing to make sacrifices to maintain other types of reputations.“These studies focused on what people would do to not appear immoral,” Vonasch said. “We predicted that a reputation of being moral would be especially important to most people, because people are generally wary of immoral people who might cheat or swindle them. However, there are many other kinds of reputation that people care about–how they look, whether people think they are intelligent or rich or brave, etc. Our future research will investigate which types of reputation are most important to people in what circumstances.”The study, “Death Before Dishonor: Incurring Costs to Protect Moral Reputation“, was published July 21, 2017 in the journal Social Psychological and Personality Science.
Nov 16, 2009Study profiles Aussie hospital casesAustralian researchers who studied hospitalized H1N1 flu patients in seven Melbourne hospitals from May to mid July report that 30 of 112 patients (27%) required intensive care and 3 died. Patients who had multifocal changes on chest x-rays were hospitalized longer and were more likely to need intensive care, according to the Medical Journal of Australia. Twenty-four patients had no known risk factors. Fifteen patients—a quarter of the women—were pregnant or in the postpartum period.http://tinyurl.com/amj111609h1n1Nov 16 Med J Aust reportDisparity between H1N1 and seasonal flu deaths exploredA Canadian Press report probed the wide difference between the numbers of H1N1 flu deaths reported so far and the estimated toll from seasonal flu. Canada, with 4,000 to 8,000 flu-related deaths yearly, has 161 confirmed H1N1 deaths. Experts note that those numbers count different things, because only a small fraction of all seasonal flu–related deaths are directly attributed to flu. In most cases, flu contributes to death from such direct causes as bacterial pneumonia or heart attack.http://chealth.canoe.ca/channel_health_news_details.asp?channel_id=1020&relation_id=71452&news_channel_id=1020&news_id=29487Nov 15 Canadian Press storyPublic buy-in crucial in H1N1 responseMistrust in government and economic fears are two factors that would make it difficult to maintain social distancing during a pandemic, according to findings published today in the American Journal of Bioethics. The study was based on the results of focus groups in four Michigan cities. The authors said more intense efforts are needed to engage the public in pandemic planning.http://www.informaworld.com/openurl?genre=article&issn=1526-5161&volume=9&issue=11&spage=4November Am J Bioeth articleWHO notes pandemic-related TB challengesBecause many H1N1-related deaths have involved people with chronic respiratory conditions, the World Health Organization (WHO) recently issued a statement to alert tuberculosis (TB) program managers to possible “challenges and synergies” in the effort to control the two diseases. The statement stresses the importance of maintaining TB treatment during a pandemic and notes that lab services developed for TB control can be useful for pandemic H1N1 diagnostics and surveillance.http://www.who.int/tb/features_archive/h1n1/en/index.htmlNov 12 WHO statementDelays faulted in Ukraine’s severe casesFactors such as delays in seeking medical care and getting antiviral medication to outbreak areas contributed to a sudden spike in severe flu-related pneumonia cases in the Ukraine, the New York Times reported. The late-October surge in flu-like illnesses prompted a WHO probe, which found the patterns in line with other countries. Doctors blame the news media and politicians for spreading misinformation, while others say a weak healthcare system played a role.http://www.nytimes.com/2009/11/14/world/europe/14flu.htmlNov 13 New York Times storySwitzerland, France OK H1N1 vaccinesNovartis announced that Swiss regulators approved its adjuvanted cell-culture pandemic H1N1 vaccine, which was previously licensed by Germany. In clinical trials a single dose containing 3.75 mcg of antigen and 0.125 mcg of MF59 adjuvant provoked a strong immune response. The vaccine is cleared for use in people ages 3 years and older. Also, Sanofi said French regulators approved its unadjuvanted H1N1 vaccine.http://www.novartis.com/newsroom/media-releases/en/2009/1355007.shtmlNov 13 Novartis press releasePandemic flu detected in North KoreaIn what may be the first pandemic H1N1 virus detection in North Korea, a man from South Korea got sick with the flu while working across the border at an industrial complex, the Korea Times reported today. The man was diagnosed in South Korea, where the country’s unification ministry announced the case today. South Korea reported the case to North Korea and advised it to check all North Korean workers at the industrial complex.http://www.koreatimes.co.kr/www/news/nation/2009/11/113_55592.htmlNov 16 Korea Times story
Nov 4, 2011 (CIDRAP News) – For many years, public health personnel have cited the estimate of 70% to 90% when talking about the level of protection afforded by seasonal influenza vaccines. But last week’s meta-analysis of flu vaccine studies in The Lancet Infectious Diseases—along with several other studies in recent years—has raised the question of whether it’s time to change the message about flu vaccines.The meta-analysis produced little or no evidence of 70% to 90% efficacy for most population groups. The investigators used strict criteria to focus on the most reliable studies, selecting only those that used laboratory-confirmed or lab-excluded influenza as outcomes, among other stringent requirements.The authors found that evidence from high-quality randomized controlled trials (RCTs) indicates that flu vaccines have an efficacy of about 59% in adults younger than 65. They did find good RCT evidence that the nasal-spray vaccine (live attenuated influenza vaccine, or LAIV) works well in children 6 months to 7 years old, but RCT evidence of the vaccine’s efficacy in older children and adults was lacking. And the investigators found very limited evidence of the vaccine’s effectiveness in older people, for whom, owing to ethical concerns, vaccine efficacy has not been tested in RCTs.The report stressed that existing vaccines are the best flu prevention weapon available and should continue to be used, but called for increased efforts to develop better vaccines.Public health and immunization officials interviewed by CIDRAP News offered a range of views on whether public communications about flu vaccination should be revised in light of the Lancet ID report—and on whether vaccine benefits have been overstated up until now. One official who thinks the study signals a need for changes is Kristen Ehresmann, RN, MPH, director of the Infectious Disease Epidemiology, Prevention and Control Division at the Minnesota Department of Health in St. Paul.”I definitely think the messages need to change to make sure we’re being very clear with the public about what the truth is and what we know,” she told CIDRAP News. “It certainly won’t help public health if we gloss over the new data.”Others, however, suggest that it’s not helpful or necessary to focus on the vaccine effectiveness numbers, with all their nuances and qualifiers. Instead, they advocate simply emphasizing that vaccines provide some protection and are the best flu defense available. They don’t necessarily buy the notion that the benefits of vaccination have been overstated.”I think that the message should continue to be to get vaccinated,” said Claire Hannan, MPH, executive director of the Association of Immunization Managers, based in Rockville, Md. To talk about efficacy numbers is not helpful, in her view: “I think it just creates confusion.”Changes in CDC informationAs it happens, the Centers for Disease Control and Prevention (CDC) actually changed some of its online education materials dealing with flu vaccine effectiveness less than 2 weeks before the Lancet ID report was published on Oct 25. (CDC officials were aware of the Lancet ID report in advance, as they had heard a preview of the research at the National Influenza Vaccine Summit Meeting in May.)The changes in the online materials were carefully noted by the risk-communication consulting team of Peter Sandman and Jody Lanard. They took the occasion of the Lancet ID report’s release to criticize the CDC over how long it took to change the online guidance and for making the changes without any public announcement.A CDC online Q&A article for health professionals, updated Oct 12, says that RCTs conducted in 2009 and 2010 suggest that inactivated flu vaccines are 50% to 70% efficacious in adults younger than 65 when the influenza A strains in the vaccine and those in circulation are well matched. The statement does not mention the previously cited estimate of 70% to 90%In an analysis sent to CIDRAP News, Sandman and Lanard said the CDC should have changed the number sooner, because two of the three cited studies were published in 2009 and one in early 2010. They added, “The October 12 update does not mention that the 50%-70% estimate is a departure from what the CDC has been saying for years. No CDC news release accompanied the update and heralded this significant change.”The CDC also has an online Q&A article for the general public on flu vaccine effectiveness, which was updated Oct 13. The 70%-90% estimate was dropped from this document in February and replaced by a statement that the CDC was reviewing the latest studies on vaccine effectiveness, according to Sandman and Lanard.The latest version does not mention the 50%-70% estimate for efficacy in nonelderly adults. Instead, it says the flu vaccine in the 2010-11 season was estimated to be about 60% effective overall and mentions a pre-licensing trial of LAIV that showed the vaccine worked in up to 9 out of 10 children. It also says that a 2009 study by Arnold Monto and colleagues revealed that trivalent inactivated vaccine (TIV) “protected 7 out of 10 people” from flu. Sandman and Lanard branded this last statement misleading, because the Monto study covered adults 18 to 49, not all ages.Sandman and Lanard note that the Lancet ID study has raised some concern that the reduced estimates of efficacy may hurt flu vaccine uptake. “But the more frightening issue, it seems to us, is whether people who learn that the flu vaccination establishment has been systematically hyping flu vaccine effectiveness might lose some of their confidence in the flu vaccine, in other vaccines, and in public health more generally,” they wrote.Numbers not emphasizedIn responding to the Sandman-Lanard critique, CDC spokesman Glen Nowak said the agency has generally avoided focusing on vaccine effectiveness numbers in its influenza educational materials, because vaccine effectiveness varies so much and is so unpredictable in any given season. He also said the revisions of the Q&A articles were in the works for a long time and acknowledged that an earlier update might have been appropriate.”I would caution you about using those specific Web pages as indicators of the full scale of our public and provider educational efforts on flu,” Nowak said. “When you look at the full breadth, very few of those actually provide any specific information on flu vaccine effectiveness. We haven’t done that in many years.””While those [numbers] certainly have some use, you can’t really tell someone in October or November how well the vaccine is going to protect them,” he said. He added that vaccine effectiveness varies by age-group and is affected by a host of factors.In addition, Nowak said the CDC has found that stressing specific numbers is not very helpful in inducing people to get vaccinated, especially given the impossibility of predicting vaccine effectiveness in any flu season. “When doing communication and messaging, you have to consider, ‘What is my communication goal?’ For people who are skeptical, I’m not sure that giving them information that plays to their skepticism will increase the chance of getting the flu vaccine,” he said.As for the timing of updating the online Q&A materials, Nowak said the process of reviewing relevant Web pages was under way for more than a year, amid “dynamic and changing” data about flu vaccine effectiveness. Referring to Sandman and Lanard’s point that the information should have been updated sooner, he commented, “To recognize that there were other results in published studies that should’ve been factored in, that made sense.”At the same time, he insisted that the previous 70%-90% estimate for vaccine effectiveness was supported by studies and, in the earlier CDC materials, was “adequately caveated.” An archived earlier version of the Q&A for the general public, noted by Sandman and Lanard, says vaccination can reduce the risk of flu by 70%-90% for healthy adults when the vaccine matches well with circulating strains but may be less effective in the elderly and young children. Nowak also said the recent changes in the online Q&A materials are “consistent with” the Lancet ID analysis.Embracing the dataWhile some assert that talking about flu vaccine effectiveness details just confuses the public, Ehresmann, who is a member of the Advisory Committee on Immunization Practices (ACIP), takes a different view. Her job includes overseeing immunization programs at the Minnesota Department of Health.”I definitely think we have to embrace the data to maintain our credibility—and this is important not just for flu but for all our messages,” she said. “I think we need to say this is new information that we have, and we need to respond to the science and the data. This is what we can say about flu vaccine now. It’s not perfect, but it’s still an important tool.”Ehresmann said the findings didn’t come as a surprise to her because she had been briefed on them previously, and some other experts have said the findings should come as no surprise to those who follow flu vaccine research. But Ehresmann said the report has surprised many in public health: “I think for other folks in public health it was pretty shocking in the sense that it was very much a departure from that 70% to 90% that had been so often quoted that it had taken on a life of its own. So it’s taking public health folks a while to get their head around it.”She said she intends to cite the 59% efficacy estimate in public communications and acknowledge that 70%-90% is too high. “By touching on the 59%, you’re not overselling it . . . and you’re not trying to hide anything. If you just say it’s not perfect and it’s the best we have, people don’t know that you really saw the data and are acknowledging the data.””In Minnesota we’re taking this sort of ’embrace the data’ approach—this is the reality,” she said, adding that she’s unsure what approach other states will take.Anti-vaccine sentiments are among the factors that counsel frankness as the best approach, she commented. “We’re working with folks who are opposed to vaccination. They call you on everything if you’re not straight. So it’s best to just be straight about it up front.”Ehresmann’s views are in harmony with those expressed earlier by Paul Etkind, senior director of infectious diseases at the National Association of County and City Health Officials (NACCHO). As reported previously, he said that if public health officials go into the specifics of flu vaccine efficacy, they should acknowledge that the numbers are lower than those generally cited previously.Staying on courseIn contrast, Hannan, of the Association of Immunization Managers, doesn’t see the Lancet ID report as a reason to change the main messages about flu vaccines. She is more in the don’t-focus-on-the-numbers camp.”I don’t think the message should change,” she said. “We need to support research and push manufacturers to make improvements in the vaccine, but I think the overall message to get vaccinated should continue.”On whether the benefits of flu vaccination have been oversold, Hannan said, “That’s a tough question. I don’t know. I’ve looked at the report, and I’ve heard people a lot smarter than me go back and forth on the topic. It’s hard to study influenza vaccines. It’s variable; there are a number of different outcomes depending on what you’re looking for.”As for citing efficacy or effectiveness percentages, she said, “I think some of that is lost on the public. Seventy to 90 percent—what does that really mean?” To make a point of telling the public that those numbers are too high would just create confusion, in her view.On the other hand, she agrees with one particular implication of the Lancet ID study: that the intranasal vaccine should be recommended over the TIV for young children, given the higher efficacy shown in a number of RCTs. “I do think that the ACIP should consider that,” she said. “It’s up to the committee to really look at that. But I think they should.”Hannan said her sense is that the findings didn’t come as much of a surprise to members of her organization, who are mainly immunization directors in state health departments. “I don’t think people really saw them as something new,” she said. “There has always been an understanding that this vaccine is variable and it’s not perfect. I don’t think it changed anyone’s message.”However, she also said it seems the report is motivating immunization officials to work harder to promote vaccination. “I think it put them a little more on the promotional side,” she said.A more complex viewChristopher J. Harrison, MD, chair of the Vaccine Advocacy Committee of the Pediatric Infectious Diseases Society, offers a more complicated view of the Lancet ID report and its implications for what the public should know about flu vaccines. Harrison is director of the Pediatric Vaccine Treatment and Evaluation Unit at Children’s Mercy Hospital and Clinics and a professor of pediatrics at the University of Missouri in Kansas City.”I think what the meta-analysis showed is what we can prove to be true, not necessarily what is true,” Harrison said. Vaccination “is still one of the best weapons, and the numbers used by the different public health groups may be looking at the best case, whereas the meta-analysis looks at the worst case,” he added. “There are a number of other studies that are notably robust and point to better numbers.”He didn’t mention specifically which studies should have been included. The Lancet ID authors excluded studies that relied on serology (antibody levels) as indicators of influenza infection, because of difficulty in interpreting the findings in vaccinated persons. They also used only those RCTs in which the comparison group received a placebo or a non-flu vaccine, and they excluded flu vaccine challenge studies—those involving intentional exposure to flu—because such cases can differ from natural infection. Also excluded were observational studies that relied on nonspecific outcomes such as mortality and flu-like illness.Harrison welcomed the report’s conclusion that the LAIV works well in young children: “Savvy pediatricians have come to grips with that in their own practices. So we’re going to favor that in our practices even though it’s not recommended [over the TIV] at the CDC level.”For him, the essential message about flu vaccines should be, “If you’re eligible as a child to get the vaccine, get the intranasal one. If you’re a young, healthy person, you probably have about two thirds protection [with vaccination]. But the best thing of all is to get enough of us immunized so we have a modest level of herd immunity.”He suggested that vaccination of about 80% of the population would be enough to begin to achieve herd immunity, which would have the effect of improving vaccine effectiveness because people would have fewer exposures to flu viruses.Harrison also commented, “Don’t avoid the vaccine because of the new study. It isn’t breaking new ground; it’s reminding us of stuff we need to do better. We need to work together and get better vaccines.”Inside baseball?Another official who sees no need for major changes in what the public health community tells the public about flu vaccine benefits is Jeff Levi, PhD, executive director of the Trust for America’s Health (TFAH), a nonprofit advocacy group based in Washington, DC.”I don’t get the sense that anyone oversold flu vaccines,” said Levi. “There are always concerns about the right match [between the vaccine and circulating strains], but the bottom line is it’s [vaccination] still a good thing to do. I don’t think the study challenges that in any way.”Levi also defended the CDC’s communication approach on flu vaccination. “My sense of the way the CDC has spoken to the public about it is that it’s important protection to have and the response will vary depending on the individual and the match. And I think that’s the message people have heard.”And as for what numerical estimates of efficacy should be communicated, Levi commented, “This is a very inside-public-health conversation that has no relevance to the larger community. . . . We can get very technical about the numbers we use, or we can say this is protective and it’s a lot better than going without it.”See also: Oct 25 CIDRAP News story “Strict meta-analysis raises questions about flu vaccine efficacy”Oct 25 CIDRAP News story “Public health groups say flu vaccine is best tool, despite limitations”CDC Q&A for health professionals on flu vaccine effectivenessCDC Q&A for the general public on flu vaccine effectivenessEarlier version of CDC Q&A for the public
Feb 24, 2012 (CIDRAP News) – Just why the US influenza season has been so tame thus far is uncertain, but the possible reasons include mild weather, vaccination, and high population immunity owing to a fairly stable set of circulating viruses, a Centers for Disease Control and Prevention (CDC) official said today.The CDC announced 2 weeks ago that the flu season had officially begun, as measured by the percentage of positive tests on respiratory specimens. But today’s CDC weekly flu update shows that US flu activity is still low as measured by the number of outpatient medical visits for influenza-like illness (ILI), and only one state reported high ILI activity last week.”This is the latest start to the season in 29 years,” said Joseph Bresee, MD, at a CDC press briefing today. He said all three flu subtypes are circulating in the United States, but H3N2 viruses have made up more than 70% of the isolates identified, and type B viruses have been very few.Bresee said a combination of factors probably explains why the season has been late, mild, and dominated by H3N2.”The timing of influenza and how severe it is each year is highly variable and hard to predict,” he said. “One factor is that the viruses circulating this year are quite similar to the viruses last year, so possibly there is high immunity to the viruses in the population.”Also, he said. “We’ve seen vaccine coverage rates continue to trend upward, which should lead to less disease over time.”Another possible factor is that the population has high levels of antibodies to the 2009 pandemic H1N1 virus, thanks to widespread exposure during the pandemic, Bresee said.In response to a question, he said the unusually mild winter may also be a factor: “We do know that in cold, less humid times, flu viruses remain more viable for longer, and in cold weather people tend to cluster inside more,” where they can share infections.Today’s CDC update said 14.4% (614 of 4,269) respiratory specimens tested last week were positive for flu. Bresee said this is the third week in a row that the proportion has topped 10%, a level seen as a sign that the flu season is under way.No flu-related deaths in children were reported last week, and the proportion of deaths attributed to pneumonia and influenza remained below the epidemic threshold. Only 1.9% of outpatient medical visits were ascribed to ILI, which is below the national baseline of 2.4%.Missouri was the only state to report high ILI activity last week, while Alabama and South Dakota cited moderate activity, the CDC said. Six states reported low ILI activity, and the remaining 41 had “minimal” cases.The geographic spread of actual flu cases presents a slightly different picture, according to the CDC. From that perspective, Colorado and California had widespread flu activity, 13 other states had regional activity, and 20 states had local activity.”While most [flu] indicators are low, we expect them to increase in coming weeks,” Bresee commented. He called this season’s pattern “unusual but not unprecedented.”In the past 35 years, the flu season has peaked in March four times and in April twice, “so we can’t predict the timing of activity nor when the season will end,” he said. He added that those who haven’t received a flu shot should still get one.Bresee noted that the World Health Organization (WHO) announced this week that two of the three flu strains (H3N2 and B) in the Northern Hemisphere’s flu vaccine should be changed for the 2012-13 season, a recommendation based on the viruses currently circulating globally.Despite this, most of the viruses characterized in the United States this season have been well matched to the vaccine, he said. “Slightly below 50% of the B viruses identified in the United States this season have been similar to the component in the vaccine,” but very few B viruses have circulated, he reported.He also noted that the WHO mentioned the option of including two B strains in next season’s vaccine, given the perennial difficulty of predicting which of the two B lineages—Victoria and Yamagata—will be more common. The WHO’s main recommendation was to switch to a Yamagata-lineage vaccine for next season (B/Wisconsin/1/2010-like).But the WHO said that if countries want to use a Victoria-lineage virus in a trivalent vaccine or cover both B lineages in a quadrivalent (four-strain) vaccine, they should use the same B strain as in this season’s formula.See also:CDC weekly flu updateCDC questions and answers on vaccine selectionFeb 23 CIDRAP News story “WHO picks two new strains for next season’s flu vaccine”
Apr 20, 2012 (CIDRAP News) – The US National Institutes of Health (NIH) has endorsed the recommendations of its biosecurity advisory committee to publish the full versions of two studies describing lab-modified, mammalian-transmissible H5N1 flu viruses, NIH officials announced today.The step signals an end to formal US government opposition to full publication of the two papers authored by Yoshiro Kawaoka, DVM, of the University of Wisconsin and Ron Fouchier, PhD, of Erasmus Medical Center in the Netherlands. But the Dutch government has been using export-control laws to stop Fouchier from submitting his revised manuscript to Science. Kawaoka’s study is expected to be published in Nature.In a statement today, NIH Director Francis Collins, MD, PhD, announced his endorsement of the recent recommendations by the National Science Advisory Board for Biosecurity (NSABB) that the two studies be published in full. The NSABB made the recommendations on Mar 30, reversing its December recommendation that the journals should withhold details of the studies, out of concern that malefactors or irresponsible scientists might misuse them and endanger public health.”The HHS Secretary [Health and Human Services Secretary Kathleen Sebelius] and I concur with the NSABB’s recommendation that the information in the two manuscripts should be communicated fully and we have conveyed our concurrence to the journals considering publication of the manuscripts,” Collins said. “This information has clear value to national and international public health preparedness efforts and must be shared with those who are poised to realize the benefits of this research.”The Secretary’s decision takes account of relevant US law, international obligations, and a rigorous analysis of the benefits and risks of publication,” he said. “The work in the Netherlands by Ron Fouchier is subject also to laws and regulations of the Netherlands, and the Dutch government is conducting its own review of Dr. Fouchier’s work. We respect that process and value the dialogue we have with Dutch authorities toward our common goals of encouraging scientific inquiry, advancing global health, and protecting the safety and security of our populations and the wider global community.”Collins’s statement noted that the NSABB met to reconsider the two manuscripts after the authors revised them to clarify some points. The board voted unanimously to endorse publication of Kawaoka’s full manuscript, but the members split 12-6 in favor of full publication of Fouchier’s paper.Collins stated, “The recommendation to communicate the research was based on the observation that the information in the revised manuscripts has direct applicability to ongoing and future influenza surveillance efforts and does not appear to enable direct misuse of the research in ways that would endanger public health or national security.”But the fate of Fouchier’s manuscript remains uncertain. He is scheduled to meet with Dutch government officials, journal editors, and international health officials Apr 23 and 24 to discuss the risks and benefits of publishing his research.Dutch officials have said Fouchier must apply for an export permit to publish his paper in Science and that the government plans to decide after next week’s meeting whether to grant an export license. But earlier this week Fouchier said he would submit his revised manuscript to Science without applying for an export permit.In other developments today, the NIH released a short statement in response to criticism from one NSABB member about the handling of the Mar 29-30 meeting at which the board voted to recommend publication of the two research reports.In a letter to the NIH and NSABB that was leaked last week, Michael T. Osterholm, PhD, MPH, asserted that NIH officials fashioned a biased agenda and set of speakers to induce the board to reverse its earlier recommendation. Osterholm is director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News.Osterholm, who said he spoke only for himself, charged that the board “kicked the can down the road” regarding the science policy issues at stake. He was one of the six members who voted against publishing the Fouchier paper.In a statement released to CIDRAP News today, the NIH said, “The NSABB agenda was developed through a careful deliberation with the aim of having the most scientifically rigorous review of the revised manuscripts and new data, discussion by influenza public health experts about the implications of the data for human health, and an in-depth briefing on the latest security information relevant to influenza research.”See also: Apr 20 statement by Francis CollinsApr 17 CIDRAP News story “Fouchier plans to flout Dutch export law, publish H5N1 study”Apr 16 CIDRAP News story “NSABB wants clarifications in Fouchier’s H5N1 manuscript”Apr 13 CIDRAP News story “NSABB member says officials stacked deck for board’s H5N1 decision”