Christine Navarro, Cindy Lau, Sarah A Buchan, Ann N Burchell, Sharifa Nasreen, Lindsay Friedman, Evaezi Okpokoro, Peter C Austin, Darrell H S Tan, Jonathan B Gubbay, Jeffrey C Kwong, Sharmistha Mishra
Objective To estimate the real world effectiveness of modified vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine against mpox infection. Design Emulation of a target trial. Setting Linked databases in Ontario, Canada. Participants 9803 men aged ≥18 years with a history of being tested for syphilis and a laboratory confirmed bacterial sexually transmitted infection (STI) in the previous year, or who filled a prescription for HIV pre-exposure prophylaxis in the previous year. On each day between 12 June 2022 and 27 October 2022, those who had been vaccinated 15 days previously were matched 1:1 with unvaccinated men by age, geographical region, past HIV diagnosis, number of bacterial STI diagnoses in the previous three years, and receipt of any non-MVA-BN vaccine in the previous year. Main outcome measure The main outcome measure was vaccine effectiveness ((1–hazard ratio)×100) of one dose of subcutaneously administered MVA-BN against laboratory confirmed mpox infection. A Cox proportional hazards model was used to estimate hazard ratios to compare the rate of laboratory confirmed mpox between the two groups. Results 3204 men who received the vaccine were matched to 3204 unvaccinated controls. A total of 71 mpox infections were diagnosed, with 0.09 per 1000 person days (95% confidence interval (CI) 0.05 to 0.13) in the vaccinated group and 0.20 per 1000 person days (0.15 to 0.27) in the unvaccinated group over the study period of 153 days. Estimated vaccine effectiveness of one dose of MVA-BN against mpox infection was 58% (95% CI 31% to 75%). Conclusion The findings of this study, conducted in the context of a targeted vaccination programme and evolving outbreak of mpox, suggest that one dose of MVA-BN is moderately effective in preventing mpox infection. The dataset from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (eg, healthcare organisations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at (email das@ices.on.ca). The full dataset creation plan and underlying analytical code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification. Correspondence and requests for materials should be addressed to JCK or SM.
{"title":"Effectiveness of modified vaccinia Ankara-Bavarian Nordic vaccine against mpox infection: emulation of a target trial","authors":"Christine Navarro, Cindy Lau, Sarah A Buchan, Ann N Burchell, Sharifa Nasreen, Lindsay Friedman, Evaezi Okpokoro, Peter C Austin, Darrell H S Tan, Jonathan B Gubbay, Jeffrey C Kwong, Sharmistha Mishra","doi":"10.1136/bmj-2023-078243","DOIUrl":"https://doi.org/10.1136/bmj-2023-078243","url":null,"abstract":"Objective To estimate the real world effectiveness of modified vaccinia Ankara-Bavarian Nordic (MVA-BN) vaccine against mpox infection. Design Emulation of a target trial. Setting Linked databases in Ontario, Canada. Participants 9803 men aged ≥18 years with a history of being tested for syphilis and a laboratory confirmed bacterial sexually transmitted infection (STI) in the previous year, or who filled a prescription for HIV pre-exposure prophylaxis in the previous year. On each day between 12 June 2022 and 27 October 2022, those who had been vaccinated 15 days previously were matched 1:1 with unvaccinated men by age, geographical region, past HIV diagnosis, number of bacterial STI diagnoses in the previous three years, and receipt of any non-MVA-BN vaccine in the previous year. Main outcome measure The main outcome measure was vaccine effectiveness ((1–hazard ratio)×100) of one dose of subcutaneously administered MVA-BN against laboratory confirmed mpox infection. A Cox proportional hazards model was used to estimate hazard ratios to compare the rate of laboratory confirmed mpox between the two groups. Results 3204 men who received the vaccine were matched to 3204 unvaccinated controls. A total of 71 mpox infections were diagnosed, with 0.09 per 1000 person days (95% confidence interval (CI) 0.05 to 0.13) in the vaccinated group and 0.20 per 1000 person days (0.15 to 0.27) in the unvaccinated group over the study period of 153 days. Estimated vaccine effectiveness of one dose of MVA-BN against mpox infection was 58% (95% CI 31% to 75%). Conclusion The findings of this study, conducted in the context of a targeted vaccination programme and evolving outbreak of mpox, suggest that one dose of MVA-BN is moderately effective in preventing mpox infection. The dataset from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (eg, healthcare organisations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at <https://www.ices.on.ca/DAS> (email das@ices.on.ca). The full dataset creation plan and underlying analytical code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification. Correspondence and requests for materials should be addressed to JCK or SM.","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tackling UK's long term sickness will improve NHS productivity, analysis finds.","authors":"Matthew Limb","doi":"10.1136/bmj.q1997","DOIUrl":"https://doi.org/10.1136/bmj.q1997","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Finn and colleagues highlight the potential unintended consequences of shortened medical degrees—particularly regarding access to medicine, degree attrition rates, and reduced global recognition of the UK medical degree.1 Of particular concern is “paradoxically rising unemployment.” Increasing medical student and foundation year doctor cohorts, without concomitant increases in senior posts, will exacerbate competition for specialty training and consultant posts at …
{"title":"The many costs of condensed medical degrees","authors":"Harriet E Haswell, Matthew J Taylor","doi":"10.1136/bmj.q1970","DOIUrl":"https://doi.org/10.1136/bmj.q1970","url":null,"abstract":"Finn and colleagues highlight the potential unintended consequences of shortened medical degrees—particularly regarding access to medicine, degree attrition rates, and reduced global recognition of the UK medical degree.1 Of particular concern is “paradoxically rising unemployment.” Increasing medical student and foundation year doctor cohorts, without concomitant increases in senior posts, will exacerbate competition for specialty training and consultant posts at …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142160637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
When people consult their GP they often arrive with a clearly defined medical problem—a pain, a lump, breathlessness, a rash—and what they’re asking for is a diagnosis, treatment, and, if necessary, a referral. However, the solution to a problem isn’t always obvious or simple: a patient may present with back pain and insomnia, but further discussion may reveal relationship problems, stresses at work, or self-medication with alcohol in an attempt to deal with isolation and low mood. When patients come asking for help because they can no longer cope alone, it’s not easy to disentangle …
{"title":"Helen Salisbury: Resisting the temptation to offer advice","authors":"Helen Salisbury","doi":"10.1136/bmj.q1953","DOIUrl":"https://doi.org/10.1136/bmj.q1953","url":null,"abstract":"When people consult their GP they often arrive with a clearly defined medical problem—a pain, a lump, breathlessness, a rash—and what they’re asking for is a diagnosis, treatment, and, if necessary, a referral. However, the solution to a problem isn’t always obvious or simple: a patient may present with back pain and insomnia, but further discussion may reveal relationship problems, stresses at work, or self-medication with alcohol in an attempt to deal with isolation and low mood. When patients come asking for help because they can no longer cope alone, it’s not easy to disentangle …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142166346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joanna McLaughlin, Carlos Sillero Rejon, Mike Bell, Bjoern Schwander, Karen Coulman, Hugh McLeod
Reducing the prevalence of obesity requires multifaceted intervention, and system-wide modelling would support a move away from current piecemeal policy making towards an equitable and cost effective strategy, argue Joanna McLaughlin and colleagues Despite longstanding government rhetoric of a commitment to tackling obesity, UK policies have not provided an adequate and coherent response. A 2021 analysis of 14 key obesity policy documents since 1992 identified repeated inadequacies in policy design, implementation, and evaluation.1 The 2023 Institute for Government report on tackling obesity concluded that the government had no serious plan to meet the aim of tackling obesity and called for learning from past mistakes.2 Obesity is one of the biggest health challenges of our age; prevalence in England continues to rise and reached 26% in 2021 (32% of those aged 55-74), one of the highest rates worldwide, and shows stark inequalities by deprivation.3 It is well established that population obesity is not going to be solved through treatment or simplistic encouragement for individuals to eat less and move more.2 As a report from the UK Government Office for Science concluded in 2007, obesity is a system level problem that requires simultaneous action on multiple fronts.4 The World Health Organization’s 2022 plan for obesity further highlights the range of settings and approaches where action must be taken, including fiscal, regulatory, and lived environment interventions.5 Nevertheless, UK obesity policy includes minimal population level interventions and continues to rely on short term, individual level, treatment focused approaches12 that only a small percentage of the eligible population can access.6 The problems in policy making on obesity are symptomatic of inadequacies across many public health policy areas,78 but obesity provides a good example of the problematic influence of “nanny statism” political concerns.1 Current …
{"title":"Holistic modelling as a catalyst for effective obesity policy","authors":"Joanna McLaughlin, Carlos Sillero Rejon, Mike Bell, Bjoern Schwander, Karen Coulman, Hugh McLeod","doi":"10.1136/bmj-2023-077139","DOIUrl":"https://doi.org/10.1136/bmj-2023-077139","url":null,"abstract":"Reducing the prevalence of obesity requires multifaceted intervention, and system-wide modelling would support a move away from current piecemeal policy making towards an equitable and cost effective strategy, argue Joanna McLaughlin and colleagues Despite longstanding government rhetoric of a commitment to tackling obesity, UK policies have not provided an adequate and coherent response. A 2021 analysis of 14 key obesity policy documents since 1992 identified repeated inadequacies in policy design, implementation, and evaluation.1 The 2023 Institute for Government report on tackling obesity concluded that the government had no serious plan to meet the aim of tackling obesity and called for learning from past mistakes.2 Obesity is one of the biggest health challenges of our age; prevalence in England continues to rise and reached 26% in 2021 (32% of those aged 55-74), one of the highest rates worldwide, and shows stark inequalities by deprivation.3 It is well established that population obesity is not going to be solved through treatment or simplistic encouragement for individuals to eat less and move more.2 As a report from the UK Government Office for Science concluded in 2007, obesity is a system level problem that requires simultaneous action on multiple fronts.4 The World Health Organization’s 2022 plan for obesity further highlights the range of settings and approaches where action must be taken, including fiscal, regulatory, and lived environment interventions.5 Nevertheless, UK obesity policy includes minimal population level interventions and continues to rely on short term, individual level, treatment focused approaches12 that only a small percentage of the eligible population can access.6 The problems in policy making on obesity are symptomatic of inadequacies across many public health policy areas,78 but obesity provides a good example of the problematic influence of “nanny statism” political concerns.1 Current …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142160639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Susan Bewley, Kath Checkland, Paul Garner, Riittakerttu Kaltiala, Margaret McCartney, Carl Heneghan, Hannah Ryan
The Cass review of the care of children and adolescents with gender dysphoria was a wake up call.1 Having commissioned several peer reviewed, systematic reviews of evidence, paediatrician Hilary Cass’s team drew on four years’ comprehensive engagement with service users, parents, clinicians, researchers, and advocacy groups, finding that most children’s gender dysphoria in historical cohorts resolves through puberty; suicidality is equivalent to children with diagnosed mental health …
{"title":"Legal clarity allows the use of GnRH analogues in research","authors":"Susan Bewley, Kath Checkland, Paul Garner, Riittakerttu Kaltiala, Margaret McCartney, Carl Heneghan, Hannah Ryan","doi":"10.1136/bmj.q1961","DOIUrl":"https://doi.org/10.1136/bmj.q1961","url":null,"abstract":"The Cass review of the care of children and adolescents with gender dysphoria was a wake up call.1 Having commissioned several peer reviewed, systematic reviews of evidence, paediatrician Hilary Cass’s team drew on four years’ comprehensive engagement with service users, parents, clinicians, researchers, and advocacy groups, finding that most children’s gender dysphoria in historical cohorts resolves through puberty; suicidality is equivalent to children with diagnosed mental health …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142160635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Great Ormond Street Hospital reviews over 700 children treated by former surgeon.","authors":"Clare Dyer","doi":"10.1136/bmj.q1977","DOIUrl":"https://doi.org/10.1136/bmj.q1977","url":null,"abstract":"","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lightning is responsible for over a third of deaths by natural disasters in India. And it disproportionately affects the poorest people, write Majid Alam and Rishabh Jain On the morning of 6 July, 48 year old Leela Devi went to harvest moong beans near her house in Bihar, northeast India. She was struck unconscious by a powerful thunderbolt and despite being rushed by relatives to the nearby government hospital she was declared dead on arrival. Leela’s death is not an isolated incident. On the same day, 10 people were killed in lightning strikes across Bihar,1 with the overall number of deaths in the state for the year so far estimated to exceed 40. According to data from the National Crime Record Bureau (NCRB) 26 924 people across India died from lightning strikes between 2009 and 2019.2 Lightning strikes are also likely to be responsible for several deaths linked to other natural disasters like floods or cyclones. According to NCRB data on accidental deaths, 35.8% of the 8060 deaths from natural forces between 2021 and 2022 were caused by lightning—this is far more than for heatstroke (9.1%) or cold weather conditions (8.9%).3 The changing climate makes tackling lightning strikes more urgent. Sanjay Srivastava, founder of the Climate Resilient Observing Systems Promotion Council (CROPC), a non-profit advocacy group working in the field of disaster management, says that whenever …
{"title":"Lightning strikes the health of low income workers in India","authors":"Majid Alam, Rishabh Jain","doi":"10.1136/bmj.q1718","DOIUrl":"https://doi.org/10.1136/bmj.q1718","url":null,"abstract":"Lightning is responsible for over a third of deaths by natural disasters in India. And it disproportionately affects the poorest people, write Majid Alam and Rishabh Jain On the morning of 6 July, 48 year old Leela Devi went to harvest moong beans near her house in Bihar, northeast India. She was struck unconscious by a powerful thunderbolt and despite being rushed by relatives to the nearby government hospital she was declared dead on arrival. Leela’s death is not an isolated incident. On the same day, 10 people were killed in lightning strikes across Bihar,1 with the overall number of deaths in the state for the year so far estimated to exceed 40. According to data from the National Crime Record Bureau (NCRB) 26 924 people across India died from lightning strikes between 2009 and 2019.2 Lightning strikes are also likely to be responsible for several deaths linked to other natural disasters like floods or cyclones. According to NCRB data on accidental deaths, 35.8% of the 8060 deaths from natural forces between 2021 and 2022 were caused by lightning—this is far more than for heatstroke (9.1%) or cold weather conditions (8.9%).3 The changing climate makes tackling lightning strikes more urgent. Sanjay Srivastava, founder of the Climate Resilient Observing Systems Promotion Council (CROPC), a non-profit advocacy group working in the field of disaster management, says that whenever …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142160638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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