MenB planned for inclusion in vaccination programme 
 
Following independent advice from the Joint Committee on Vaccination and Immunisation (JCVI), the DH is planning to introduce the meningococcal B (MenB) vaccine into the childhood vaccination programme. 
 
The move follows a review of evidence showing that the Bexsero® vaccine, which was licensed by the European Medicines Agency in January last year, is effective in preventing MenB in infants. According the JCVI, the vaccine will be rolled out subject to successful negotiations with the manufacturer, Novartis, to agree a “cost- effective” price. 
 
The JCVI has recommended adding the vaccination to the primary childhood programme, meaning that, if plans progress, infants will be immunised starting at two months of age. 
 
Deputy Chief Medical Officer, Professor John Watson said: “Infants under one year of age are most at risk of MenB and the number of cases peak at around five or six months of age. With early diagnosis and antibiotic treatment, most make a full recovery. But it is fatal in about one in ten cases and can lead to long-term health problems such as amputation, deafness, epilepsy and learning difficulties.” 
 
If the roll-out goes ahead as planned, the UK will be the first country to introduce a national MenB immunisation programme.

Public Health England along with the Department of Health and NHS England have published the Annual ’Flu Plan, which includes details about the extension of the ’flu vaccination programme to children in 2014 and 2015. 
 
Due to the scale of the extension nationally, it is being implemented gradually, with geographical piloting in the early years that will provide learning to inform subsequent roll-out
SSRI use during pregnancy linked to developmental disorders
 
A study of nearly 1000 mother-child pairs has found that prenatal exposure to selective serotonin reuptake inhibitors (SSRIs), frequently prescribed for depression, anxiety and other disorders, was associated with autism spectrum disorder (ASD) and developmental delays (DD) in boys. 
 
The findings, published in the online edition of Pediatrics, were drawn from an analysis of data carried out by researchers from the Johns Hopkins Bloomberg School of Public Health from large samples of ASD and DD cases in children aged two to five years. 
 
“While the study included girls, the substantially stronger effect in boys alone suggests possible gender difference in the effect of prenatal SSRI exposure,” said study investigator and psychiatric epidemiologist Li-Ching Lee. 
 
“This study provides further evidence that in some children, prenatal exposure to SSRIs may influence their risk for developing an autism spectrum disorder. This research also highlights the challenge for women and their physicians to balance the risks versus the benefits of taking these medications, given that a mother’s underlying mental health conditions also may pose a risk, both to herself and her child.”
DH fast-tracks access to innovative medicines
 
In a new move by the DH, severely ill patients with life-threatening and seriously debilitating conditions will be offered the opportunity to trial promising new medicines years before they would normally be available to prescribers. 
 
The Early Access to Medicines scheme will see doctors working with patients to make innovative drugs available as soon the Medicines and Healthcare Products Regulatory Agency (MHRA) has signalled that the benefits outweigh the risks following an initial scientific assessment. 
 
This so-called Early Access to Medicines Scientific Opinion will support the prescriber in deciding with the patient whether to use the medicine before its licence is approved. Medicines made available through the scheme will typically be commissioned by NHS England through its specialised commissioning arrangements, delivering a single national approach to commissioning. 
 
The scheme will mean that drug companies will be able to gain early experience of their medicines being used in the NHS and work closely with regulators to look at the value of the drugs.
Study points to aspirin benefit in cancer risk
 
Data from two long-term studies have suggested the already multi-faceted aspirin may be effective in lowering risk of colon cancer risk among people with high levels of a specific type of gene. 
 
The finding, published in Science Translational Medicine, comes from an analysis of the studies, which involved nearly 128,000 participants. Investigators found that individuals whose colons have high levels of 15-hydroxyprostaglandin dehydrogenase (15-PGDH) RNA significantly reduced their risk of developing colorectal cancer by taking aspirin. About half of the population possesses high levels of 15-PGDH, the researchers point out. 
 
While previous trials and prospective studies have indicated that aspirin could reduce colorectal cancer risk, this retrospective study provides the first evidence to help explain why aspirin benefits some people, but not others.
NHS England calls for improved awareness of kidney injury
 
NHS England has brought together a group of patients and professionals in a bid to improve the care of patients with acute kidney injury. The aim is to help professionals and the public understand the key aspects of kidney injury and to gauge the impact of acute kidney injury on individuals and the population. 
 
It is estimated that 10%-15% of emergency admissions have acute kidney injury, in addition to the underlying medical problem that brings them to hospital. The presence of acute kidney injury on top of the medical emergency is an important marker of illness severity, significantly increasing mortality risk and delaying recovery. 
 
“It is not as simple as making sure everyone has enough fluids, although that is important,” Dr Richard Fluck, National Clinical Director for Renal Disease for, explains. “But the needs are simple. We need to identify people who are at risk, monitor them appropriately, diagnose the problem early and provide reliable and consistent treatment to everyone.” 
 
As part of the Keeping Kidneys Healthy project, to be introduced this summer, NHS England will introduce a national system of measurement across the country, aimed at improving early diagnosis of acute kidney damage. The project will also allow NHS England and other organisations to assess how much acute kidney injury is occurring and support the drive to reduce the avoidable harm the condition causes.
Bowel cancer screening programme well ahead of target
 
The roll-out target for screening centres offering tests for bowel cancer has been exceeded, according to figures from Public Health England (PHE).
 
The data, released at the end of March, show that nearly 37% of bowel scope screening centres in England are operational, thus easily surpassing the 30% target set by the Department of Health in its 2011 Strategy for Cancer. 
 
The one-off bowel scope screening test – or flexible sigmoidoscopy – is currently offered to men and women at the age of 55, alongside the faecal occult blood (FOB) home test kit, which is sent to all men and women between the ages of 60 and 74 years. Both screening procedures are provided as part of the NHS Bowel Cancer Screening Programme. 
 
Director of the programme, Professor Julietta Patnick, commented: “Offering this form of screening to men and women at the age of 55 will play a significant role in identifying any abnormalities, at an early stage that could develop into bowel cancer if not detected.” 
 
There are over 40,000 new cases of bowel cancer diagnosed each year in the UK, with some 16,000 deaths from the disease. The lifetime risk of bowel cancer is one in 14 men and one in 19 women. 
 
The risk of bowel cancer increases markedly with age, with over 80% of bowel cancers arising in people who are 60 or over. Flexible sigmoidoscopy examines the part of the bowel where most cancers are identified. 
 
In April this year, the NHS Bowel Cancer Screening Programme began piloting the faecal immunochemical test (FIT), which can quantify the amount of blood found in a stool sample and is potentially more accurate than the current FOB screen.
Study highlights shortfalls in psoriasis management 
 
GPs need better training to help them to manage patients with psoriasis, according to research findings from The University of Manchester. 
 
The inflammatory condition, which affects 1.8 million people in the UK and is associated with heart disease, depression and other inflammatory conditions such as Crohn’s disease and arthritis, can often be elusive, the researchers point out. 
 
But their studies, funded by the National Institute for Health Research (NIHR), have shown that even GPs specialising in dermatology receive very little training about how to manage psoriasis as a long-term condition. 
 
The Manchester study programme, known as IMPACT (Identification and Management of Psoriasis Associated ComorbidiTy), has helped prompt the launch this May of a new training programme for practitioners. 
 
Dr Christine Bundy, one of the study leads, said: “We have reports that most clinicians, even those with a special interest in psoriasis, do not feel skilled or confident in supporting patients to change their lifestyle behaviour to help manage their condition better. Yet we know evidence-based methods to manage mood and behaviour can improve quality of life and help people recover from psoriasis flares quicker. 
 
“Not identifying these additional factors which are often associated with psoriasis is not only bad news for the patients; it also has financial implications for the future health spend in the NHS.” 
 
Professor Chris Griffiths, consultant dermatologist at Salford Royal NHS Foundation Trust and IMPACT Principal Investigator, added: “A large part of our training will focus on how to have the conversations that can make a difference to people’s lives, such as noticing whether their psoriasis is affecting other areas of their life, for example drinking too much, over-eating, being inactive or feeling low and depressed. 
 
For more information contact the training programme manager alison.j.littlewood@manchester.ac.uk
GUIDELINES ROUND-UP 
 
New recommendations focus on Longer-term CVD risk
 
Measures to prevent cardiovascular disease (CVD) should be extended to people with low short-term risk but high lifetime risk of cardiovascular events, according to new recommendations by the Joint British Societies (JBS). 
 
The Joint British Societies’ Consensus Recommendations for the Prevention of Cardiovascular Disease (JBS3), published in Heart, place particular emphasis on lifetime risk and feature an online tool designed to aid risk assessment and decision-making. 
 
Current management strategies focus on 10-year CVD risk, levels of which are used to trigger the introduction of statins, antihypertensives and other preventive drug therapies. But these guidelines, as well as the standard CVD risk calculators that accompanied them, have attracted criticism for their emphasis on short-term risk and older subjects. 
 
There is concern, for instance, that the ACC/AHA cholesterol guidelines may lead to an excess of patients being started on statins merely because of their advanced age, while younger people whose risk factors or family history warrant more aggressive interventions, go untreated. 
 
The JBS3 guidelines recognise that there is a continuum of CVD risk in the population and that most cardiovascular events occur in individuals who are at “intermediate risk”. Since cardioprotective drugs are now know to be largely safe and efficacious over the longer term, and have become cheaper, their use may be extended beyond the current 10-year CVD risk threshold. 
 
The new JBS3 recommendations state that drug therapy should be considered in individuals with high lifetime CVD risk estimated from “heart age and other JBS3 metrics”, which can be determined using an online JBS3 calculator. The tool can then also be used to estimate what benefits specific interventions, including lifestyle changes, would have on modifying lifetime risk.
Devices for asthma diagnosis get green light
 
NICE has issued final guidance recommending the use of devices to measure the levels of exhaled nitric oxide as an option for diagnosing asthma. 
 
The recommended devices, NIOX MINO, NIOX VERO and NObreath, have been shown to be effective in diagnosing suspected asthma, but NICE emphasises that other tests, as recommended by the British Guideline on the Management of Asthma, are still needed to confirm the diagnosis. 
 
Nitric oxide testing is also recommended as an option to support the management of asthma in people who still have symptoms despite being treated with inhaled corticosteroids. 
 
Asthma is the most common long-term medical condition, with some 5.4 million British people, including 1.1 million children, affected – the third highest prevalence in the world. 
 
In people already diagnosed with asthma, measuring nitric oxide levels to guide their asthma management can reduce attacks. The measurements can also help gauge levels of adherence to prescribed medication; research suggests that as many as 30% of people do not take their medication to control their asthma.
New quality standards for conduct disorder
 
NICE has issued a new quality standard on the recognition and management of antisocial behaviour and conduct disorders in children and young people. 
 
Conduct disorder is a serious mental health condition seen frequently in general practice. It affects around one in 20 children aged between five and 16 years and is the most common mental and behavioural problems in children and young people (see BJFM Vol 1;2(Sept/ Oct) 2013:33-35). Children with conduct disorders often have other mental health disorders, most commonly attention deficit hyperactivity disorder (ADHD). 
 
The new standard highlights very specific areas where improvements are most needed, including:  
  • Children and young people with a suspected conduct disorder and any significant complicating factors should have a comprehensive assessment, as should the parents or carers.  
  • Children with a conduct disorder who have been referred for treatment should have a key worker to oversee their care and facilitate engagement with services.  
  • Parents or carers of children aged 3 to 11 years with a conduct disorder should be offered a referral for group or individual parent or carer training. 
 
Dr Moira Doolan, a consultant psychotherapist at the South London and Maudsley Child and Adolescent Mental Health Services (CAMHS), said: “The new quality standard reiterates the importance of supporting the child’s parents or guardians... Parent training programmes provide them with strategies for dealing with difficult children and how to better support them.”
TECHNOLOGY APPRAISAL
 
NICE supports new wound management device
 
New NICE medical technology guidance published in March has approved a device that aims to help improve the treatment of wounds. Known as Debrisoft monofilament debridement pad, it is now recommended as part of the management of acute or chronic wounds in community settings. 
 
Debrisoft is a single-use polyester fibre pad, which is wiped across the wound with gentle pressure. The dead cells, wound debris and pus are removed by sticking to the pad’s monofilament fibres. Using this device, debridement takes two to four minutes per wound, and is performed without need for analgesia. 
 
The benefits that the Debrisoft pad is likely to provide, compared with other debridement methods, include enabling faster debridement with reduced frequency and number of episodes of care, particularly nurse visits, good tolerance by patients and convenience and ease of use.