Organization Position Paper Research Articles

Expert recommendations on hepatitis A vaccination for adults

Hepatitis A is a significant global public health concern, with severe clinical symptoms in adult cases that can progress to acute hepatic failure. With the implementation of comprehensive prevention and control measures based on vaccination, the reported incidence of hepatitis A in children has notably decreased in China, while the incidence of hepatitis A in adults has gradually increased. Vaccination against hepatitis A in adults remains a crucial preventive measure. This recommendation is formulated based on the World Health Organization's position paper on hepatitis A vaccines (2022), incorporating the latest domestic and international research advancements and opinions from domestic experts. Its aim is to provide recommendations for hepatitis A vaccination among Chinese adults, offering evidence for public health and vaccination professionals to scientifically use hepatitis A vaccines and maximize their preventive efficacy, thereby enhancing hepatitis A prevention and control efforts.

Progress and prospect of clinical application of anti-rabies virus monoclonal antibody preparation

Rabies is a severe infectious disease caused by the rabies virus, which seriously damages the central nervous system. Once it occurs, the fatality rate is close to 100%. The World Health Organization's position paper on rabies vaccines recognizes that rabies immunoglobulin (RIG) should be used for post-exposure prophylaxis (PEP) in all category Ⅲ exposure for the first time, as well as in category Ⅱ exposure that suffer from severe immune deficiency, long-term massive use of immunosuppressants, and head and face exposure. The anti-rabies virus monoclonal antibody has high purity and specific activity, can be produced on a sustainable scale, and has no risk of blood source virus contamination. Preclinical pharmacodynamic studies and clinical trial results of the anti-rabies virus monoclonal antibody preparation have confirmed that the preparation has a broad-spectrum neutralization effect on the rabies virus. Additionally, its combined application with the vaccine has little impact on the active immunity of the vaccine. Therefore, the anti-rabies virus monoclonal antibody preparation shows great potential for clinical application in PEP.

Nursing Leaders as Visionaries and Enablers of Action

ObjectivesThe engagement of nursing leaders is critical for the future of the cancer nursing profession, quality cancer care, and the overall health care system. The field of cancer care is facing enormous challenges, requiring strong nursing leadership. Cancer nursing leadership is needed to overcome the challenges caused by workforce shortages, restricted resources, historic and ongoing under-recognition of nursing, unsafe working conditions, and unequal access to education. The aim of this article is to contribute to the discussion about how cancer nursing leaders can act as visionaries and support transformation of cancer nursing for the future. Data SourcesAuthor experience, journal articles and organizational position papers were used. ConclusionTo improve the state of cancer nursing and the working conditions of the cancer nursing workforce, nursing leadership practices need to be embraced on all governance levels in clinical practice and academia. When effective and high-quality nursing leadership is enacted, positive outcomes for people affected by cancer, nursing, and health care systems can be achieved. Cancer nursing leadership needs to be supported through nursing scholarship, influencing national and global policies and strategies and by active involvement in national and international health care management. Implications for Nursing PracticeNursing leadership and governance is critical to strengthening the cancer nursing workforce. Strong nursing leadership is required to realize the vision for transforming the health care systems and cancer care. Therefore, collaboration among multidisciplinary leadership, health care organizations, academic institutions, professional organizations, and policy-making structures is warranted.

Expert consensus on preventive management of post-traumatic tetanus and establishment of vaccination clinic practice standards

Post-traumatic tetanus is the most important type of tetanus that occurs outside of the neonatal period. Wound management and rational use of tetanus immunological preparations are critically important for prevention of post-traumatic tetanus and reduction of tetanus-related morbidity and mortality. The Chinese Preventive Medicine Association (CPMA) convened a panel of experts to develop consensus on preventive management of post-traumatic tetanus and establishment of vaccination clinic practice standards. Based on relevant laws and regulations in China, the 2017 World Health Organization position paper on tetanus vaccines, and the most recent domestic and foreign research, the CPMA consensus document describes procedures for prevention and management of post-traumatic tetanus, appropriate use of active and passive tetanus immunological preparations, and requirements for vaccination clinics to manage post-traumatic tetanus prevention.

New research progress of the safety of human papillomavirus vaccine

Human papillomavirus infection is the main pathogenic factor leading to cervical cancer. About 630 000 new cancers are caused by HPV infection every year, among which cervical cancer accounts for the highest proportion (83%). The burden of cervical cancer is serious in China. Research data shows that there were nearly 110 000 new cases and nearly 50 000 deaths of cervical cancer in China in 2018, accounting for about 20 percent and 16 percent of the global total of cases and deaths, respectively. The World Health Organization's position paper clearly states that HPV vaccination can effectively prevent the occurrence of HPV-related diseases. Across clinical studies and real world data from around the world, HPV vaccines have shown good efficacy and safety. As of October 2019, 98 countries and regions around the world have included HPV vaccine in their national immunization program. However, with the increase of vaccination coverage and indications, the safety of HPV vaccine has become a global public health issue of high concern. Since the launch of HPV vaccine in 2006, many authorities around the world and countries have conducted long-term monitoring of the safety of HPV vaccine after its launch, and accumulated a large number of safety data, which showed that the HPV vaccine was safe and supported the use of HPV vaccine. In this paper, the safety data related to HPV vaccine in the world and mainland China will be combed to provide reference for the HPV vaccination in China.

IgE allergy diagnostics and other relevant tests in allergy, a World Allergy Organization position paper

Currently, testing for immunoglobulin E (IgE) sensitization is the cornerstone of diagnostic evaluation in suspected allergic conditions. This review provides a thorough and updated critical appraisal of the most frequently used diagnostic tests, both in vivo and in vitro. It discusses skin tests, challenges, and serological and cellular in vitro tests, and provides an overview of indications, advantages and disadvantages of each in conditions such as respiratory, food, venom, drug, and occupational allergy. Skin prick testing remains the first line approach in most instances; the added value of serum specific IgE to whole allergen extracts or components, as well as the role of basophil activation tests, is evaluated. Unproven, non-validated, diagnostic tests are also discussed. Throughout the review, the reader must bear in mind the relevance of differentiating between sensitization and allergy; the latter entails not only allergic sensitization, but also clinically relevant symptoms triggered by the culprit allergen.

Expert consensus on immunological prevention of human papillomavirus-related diseases (abridged)

Human papillomavirus (HPV)-related diseases such as cervical cancer are public health problems that threaten human health. In response to an action plan for the elimination of cervical cancer, we review the etiology, clinical features, and epidemiology of HPV-related diseases and HPV vaccinology. Our consensus statement is based on the World Health Organization position paper on HPV vaccines (2017) and on recent advances in Chinese and international HPV research. Its purpose is to strengthen HPV-related disease prevention and control by providing systematic, comprehensive evidence to enable health professionals use of HPV vaccine in a scientifically-appropriate manner that maximizes impact on disease.

Expert consensus on immunoprophylaxis of human papillomavirus-related diseases (abridged)

Human papillomavirus (HPV)-related diseases such as cervical cancer are public health problems that threaten human health. In response to an action plan for the elimination of cervical cancer, we review the etiology, clinical features, and epidemiology of HPV-related diseases and HPV vaccinology. Our consensus statement is based on the World Health Organization position paper on HPV vaccines (2017) and on recent advances in Chinese and international HPV research. Its purpose is to strengthen HPV-related disease prevention and control by providing systematic, comprehensive evidence to enable health professionals use of HPV vaccine in a scientifically-appropriate manner that maximizes impact on disease.

Expert consensus on immunological prevention of human papillomavirus-related diseases

Human papillomavirus (HPV)-related diseases such as cervical cancer have become a public health problem that seriously threatens human health. In response to the action plan for the elimination of cervical cancer, this consensus, on the basis of the World Health Organization position paper on HPV vaccine (2017) and the latest advances in research at home and abroad, provides an overview of HPV pathogens and the clinical, epidemiological and vaccine aspects of HPV related diseases. Through a comprehensive and systematic introduction of HPV disease-related knowledge, we aim to improve the level of prevention and control of HPV related diseases, especially to provide systematic and comprehensive evidence-based basis for professionals to use HPV vaccine scientificly.

Expert consensus on rabies exposure prophylaxis

Rabies is a zoonotic infectious disease caused by lyssavirus and characterized by central nervous system symptoms. The fatality rate of rabies is almost 100%. About 59 000 cases die of rabies worldwide every year, mainly in Asia and Africa. China is an epidemic country of rabies. Grade II and III exposures are the main types of rabies exposures in China. Standardized post-exposure prophylaxis (PEP) can prevent rabies almost 100%. Human Rabies Vaccine Technical Working Group, National Immunization Advisory Committee and invited experts reached an expert consensus on PEP by referring to the World Health Organization's position paper on rabies vaccine in 2018 and related research progress in recent.

Unscramble to World Health Organization position paper on vaccines against HPV published in 2017

Unscramble to World Health Organization position paper on vaccines against HPV published in 2017

ALLERGEN IMMUNOTHERAPY: EFFICACY, PERSISTENCE, CONSISTENCY, AND COST EFFECTIVENESS

Although allergen immunotherapy (AIT) has been used for the treatment of allergic rhinitis (AR), allergic conjunctivitis, asthma, stinging insect hypersensitivity, and atopic dermatitis for over 100 years, it has been slow to gain universal acceptance. With the publication of the “World Health Organization Position Paper, Allergen Immunotherapy” in 1998 which summarized the scientific evidence for the efficacy and long-term benefit of this therapy, it has become an accepted and respected modality of treatment. In this review there are discussed following topics of allergen immunotherapy: the reasons for recommending AIT, mechanism of action, subcutaneous and sublingual methods of application, duration, adherence and cost effectiveness. It is necessary to support, not blame, the patient for nonadherence as it is the responsibility of the patient, the physician, and the health-care system to create an environment in which the patient can be adherent. Nonadherence is multifactorial in most every patient and the physician must address all of the factors if adherence is to be improved. The greatest challenge is taking the time to create an individualized patient-tailored strategy to improve adherence, as one size does not fit all. Adherence is dynamic and selecting the best time to start AIT and assuring that there is close follow-up through AIT years of treatment is essential. The patient who is persistent and consistent in year one of AIT may not continue to be so in year three without added encouragement and support. The health-care systems and professional organizations need to help train physicians and their staff both in efficient and accurate ways to assess nonadherence and in implementing interventions to optimize adherence. The multidisciplinary approach to treating this disease of nonadherence will require the involvement of all healthcare professionals, researchers, professional organizations, insurance companies, and policy-makers.

Inhalant Horse Allergens and Allergies: A Review of the Literature

A wealth of literature exists regarding common allergies to household pets such as cat or dog. Allergy to horse, however, is infrequently discussed in the medical literature despite significant sensitization rates among urban-dwelling subjects without direct exposure to horses. A literature search was conducted in PubMed and additional references were collected from surveying the references of the pulled articles. This review summarizes aspects of IgE-mediated horse allergy including the prevalence and mechanisms for sensitization, clinical presentation, molecular characterization of the major and minor horse allergens, and the role of allergen immunotherapy. There is currently only one horse immunotherapy study showing significant improvement in clinically sensitive patients. The 1997 World Health Organization Position Paper on Immunotherapy lists horse immunotherapy among the areas needing further clinical research. Inclusion of horse into the standard allergen panel for children and adults has been supported by several authors, although further identification and characterization of horse antigens is needed to provide the most efficacious extract. As clinicians, we need to be aware of the potential cross-reactivity among the common mammalian allergens and consider the possibility of known or occult exposure to horse as a possible source of symptom exacerbation in susceptible individuals.

Clinical Use of Probiotics in Pediatric Allergy (cuppa): A World Allergy Organization Position Paper

Background Probiotic administration has been proposed for the prevention and treatment of specific allergic manifestations such as eczema, rhinitis, gastrointestinal allergy, food allergy, and asthma. However, published statements and scientific opinions disagree about the clinical usefulness.Objective A World Allergy Organization Special Committee on Food Allergy and Nutrition review of the evidence regarding the use of probiotics for the prevention and treatment of allergy.Methods A qualitative and narrative review of the literature on probiotic treatment of allergic disease was carried out to address the diversity and variable quality of relevant studies. This variability precluded systematization, and an expert panel group discussion method was used to evaluate the literature. In the absence of systematic reviews of treatment, meta-analyses of prevention studies were used to provide data in support of probiotic applications.Results Despite the plethora of literature, probiotic research is still in its infancy. There is a need for basic microbiology research on the resident human microbiota. Mechanistic studies from biology, immunology, and genetics are needed before we can claim to harness the potential of immune modulatory effects of microbiota. Meanwhile, clinicians must take a step back and try to link disease state with alterations of the microbiota through well-controlled long-term studies to identify clinical indications.Conclusions Probiotics do not have an established role in the prevention or treatment of allergy. No single probiotic supplement or class of supplements has been demonstrated to efficiently influence the course of any allergic manifestation or long-term disease or to be sufficient to do so. Further epidemiologic, immunologic, microbiologic, genetic, and clinical studies are necessary to determine whether probiotic supplements will be useful in preventing allergy. Until then, supplementation with probiotics remains empirical in allergy medicine. In the future, basic research should focus on homoeostatic studies, and clinical research should focus on preventive medicine applications, not only in allergy. Collaborations between allergo-immunologists and microbiologists in basic research and a multidisciplinary approach in clinical research are likely to be the most fruitful.

Specific immunotherapy, one century later

Specific immunotherapy, one century later

A brief introduction to World Allergy Organization position paper

特异性免疫治疗（specific immunotherapy，SIT）被认为是一种有可能从根本上调节变态反应发病机制的“对因疗法”，是目前治疗变应性鼻炎（AR）的重要手段之一。变应原SIT的传统方法是皮下免疫治疗（subcutaneous immunotherapy，SCIT），至今已有100年的历史。研究证实，SCIT能够有效地改善AR的症状，具有长期持续的疗效，并能预防新的致敏形成和阻止AR发展成为哮喘，

Insertion and Placement of Central Catheters in the Oncology Patient

To review the current up-to-date recommendations for insertion and placement of central venous access devices and discuss the prevention of complications during and post-placement of central catheters. Journal articles, electronic articles, organizational position papers, personal experience. There are numerous types of vascular access catheters that play an important role in the management of complex treatments for the oncology patient. Cancer patients with a catheter have a higher rate of thrombosis and infection as part of their disease process and treatment; hence, nursing care can eliminate or minimize complications. Nurses must be educated on the correct procedures and rationale for insertion and placement as well as for the care and maintenance of each specific device.

Specific Immunotherapy in a Pollen-Allergic Patient With Human Immunodeficiency Virus Infection

Background According to the World Health Organization position paper, immunodeficiency such as human immunodeficiency virus (HIV) infection is a relative contraindication for specific immunotherapy (SIT). Since the introduction of highly active antiretroviral therapy, a significant reconstitution of immune competence in individuals with HIV is possible.Case Report In a 52-year-old man, HIV infection was diagnosed in 1987. Antiretroviral therapy was started in 1998. He presented himself in July 2001 because of an increasingly severe seasonal rhinoconjunctivitis. Symptoms were not sufficiently alleviated by various antiallergic drugs.Results The investigations showed a relevant sensitization to tree pollens. Specific immunotherapy with a tree pollen mix (hazel, birch, ash, and alder, 25% each) was started in November 2001. Viral load at this time was less than 50 copies/mL, the CD4+ cell count was 307/μL. Therapy was given in monthly intervals until mid-April 2005 without any side effects. Viral load and CD4+ cell counts did not change during SIT. Clinically, rhinoconjunctivitis was experienced only intermittently and symptom relief was almost 90%.Conclusions This report indicates that in patients with well-controlled HIV infection on highly active antiretroviral therapy, SIT with pollen extracts is a potential and successful therapeutic option.

Policy Perspectives in Environmental Health

The nursing community has become increasingly active in the environmental health policy arena by exerting its influence at the local, state, and national environmental health policy levels; on media-specific issues; and in the work-related venues where they have influence. Nurses are valued and trusted by policy makers, and should be active in policy efforts to increase access to public health information such as potentially hazardous chemicals in the air, water, food, soil, and land. Given the global nature of environmental contamination, it is critical that nursing's international organization becomes active in environmental health policies. Promotion of healthy environments should be translated to organizational position papers and practice recommendations within nursing and nursing specialty organizations.

Local reactions during allergen immunotherapy do not require dose adjustment

Background: The recent World Health Organization position paper on allergen immunotherapy states that local reactions to immunotherapy are not predictive of subsequent systemic reactions. Nevertheless, in clinical practice dose adjustment after local reactions continues to be recommended, presumably in an effort to prevent future systemic reactions. Objective: We sought to determine whether dose adjustment versus no adjustment for local reactions during allergen immunotherapy influences the occurrence of subsequent systemic reactions. Methods: In a single-site allergy clinic before October 1, 1997, local reactions after allergen vaccine injection resulted in adjustment of the subsequent dose. After October 1, 1997, no dose adjustments were made for immediate and late local reactions. For the same 9-month period before and after the change in local reaction dose-adjustment policy, systemic reaction rates were compared retrospectively. For individuals experiencing a systemic reaction, local reaction rates and local reactions immediately preceding a systemic reaction were also compared before and after the policy change. Results: Comparing the 9-month period (October 1996-June 1997) preceding the policy change and the 9 months (October 1997-June 1998) after the change in policy, the systemic reaction rates (0.80% and 1.01%, respectively) were not statistically different (P = .24). Among those experiencing a systemic reaction, the rate of local reactions was unchanged (7.3% and 4.7%, respectively; P = .07), and the rate of local reactions immediately preceding a systemic reaction did not increase (18.8% and 10.5%, respectively; P = .37). The sensitivity of a local reaction predicting a systemic reaction at the next immunotherapy dose was 15%. Conclusions: A local reaction is a very insensitive predictor for a subsequent systemic reaction at the next allergen vaccine dose. Dose adjustment for most local reactions is unnecessary and may delay therapy, increase costs, and put the patient at increased risk of dose administration errors. (J Allergy Clin Immunol 2000;106:840-3.)