Nov 4, 2004 (CIDRAP News) – Two studies just published by the New England Journal of Medicine (NEJM) suggest that injecting influenza vaccine just beneath the skin surface, instead of into muscle, may be a way to stretch flu vaccine supplies without sacrificing protection.In one study, young adults who received one fifth of the standard vaccine dose in an intradermal shot showed at least as strong an immune response as others who received full-dose intramuscular shots.In the second study, intradermal vaccination with 40% of a standard dose worked just as well as a standard intramuscular dose in adults aged 18 to 60. However, older adults showed a somewhat less vigorous response to the reduced intradermal dose.”In times of shortage such as the present, intradermal vaccination of healthy young persons with reduced-dose inactivated influenza vaccine could be considered in order to stretch vaccine supplies,” write Robert Belshe, MD, and colleagues, authors of the second study. NEJM published both studies online as early-release articles.Intradermal vaccination involves inserting a needle 1 to 2 mm into the skin, according to the two reports. The method has been used with some success for hepatitis B and rabies vaccinations, but it is not approved for flu vaccination in the United States.The study using young adults was conducted by a Gaithersburg, Md., company called Iomai, which is developing vaccine skin patches. Richard T. Kenney, MD, and colleagues recruited 100 healthy adults ranging from 18 to 40 years old and randomly assigned them to receive either a standard intramuscular dose of trivalent flu vaccine (15 micrograms [mcg] of hemagglutinin per strain) or a single intradermal dose at about 20% strength (3 mcg of hemagglutinin per strain).As measured by increases in hemagglutination-inhibition titers 21 days after vaccination, the immune response in the intradermal group was similar to or better than that in the intramuscular group, the report says. Those who received intradermal shots had more local reactions to the vaccine, but the reactions were mild and transient.The authors write that using reduced-dose intradmeral shots “is particularly appealing, because standard tuberculin syringes and needles can be used with multidose vials of influenza [vaccine] to increase the supply of influenza vaccine by a factor about five.” But they add that further studies are needed to show the “wide-ranging relevance” of the technique.In the other study, researchers from Saint Louis University, the University of Rochester, and GlaxoSmithKline assigned two groups of 119 people each to receive trivalent flu vaccine by intradermal or intramuscular injection. The intradermal shots contained 6 mcg of hemagglutinin for each strain, while the intramuscular shot contained the standard dose of 15 mcg for each strain. Each group was divided into younger and older subgroups—18 to 60 years and older than 60.In the younger people, the two injection methods both yielded serum antibody responses that were “vigorous” and not significantly different. The older subgroups also had a strong antibody response to both types of vaccination, but the response was somewhat better in those who received intramuscular shots. However, the difference was significant only for one of the three viral strains in the vaccine (H3N2).As in the other study, local reactions to the injections were more common among the intradermal group than the intramuscular group, but they were mostly mild.The authors suggest that the intradermal injections could be used for younger members of two of the groups assigned priority for flu vaccine in the current shortage: healthcare workers and close contacts of infants younger than 6 months. The researchers add that the intradermal technique is harder to learn than the standard technique, but vaccinators would be likely to use the method effectively after training.The two reports are hailed as significant in an accompanying editorial by the late John R. La Montagne, PhD, and Anthony S. Fauci, MD, of the National Institute of Allergy and Infectious Diseases (NIAID). “Both of the current studies clearly show that intradermal vaccination may have greater immunogenicity than intramuscular vaccination,” they write. (La Montagne, who was deputy director of the NIAID, died suddenly this week.)On the basis of the two new studies and previous reports on intradermal immunization, “It is becoming clear that use of the intradermal route may at least partially overcome the relatively poor influenza-specific immune responses seen in certain at-risk populations, particularly the elderly,” La Montagne and Fauci write. They call for clinical trials in “a broad range of populations” to pave the way for approval of intradermal vaccination for flu.Kenney RT, Frech SA, Muenza LR, et al. Dose sparing with intradermal injection of influenza vaccine. N Engl J Med 2004;351(22) (published online Nov 3) [Full text]Belshe RB, Newman FK, Cannon J, et al. Serum antibody responses after intradermal vaccination against influenza. N Engl J Med 2004;351(22) (published online Nov 3) [Full text]
“Public space has emerged as a critical lifeline for cities and their residents,” she told the Thomson Reuters Foundation.The city of Braga in northern Portugal has opened public squares, sidewalks, parks and more throughout the city to restaurants and local businesses seeking to reopen to customers while maintaining social distancing.”This is almost a ‘must-do’,” said Mayor Ricardo Rio, noting that the move can be an “accelerator” to the economic recovery and that a few hundred businesses have already taken advantage of the opportunity.Research from a University of Massachusetts professor has found that outdoor activities are far less likely to transmit the coronavirus than indoor ones, a sense that is driving both policymakers and consumers. Public and outdoor space has been at a premium during the coronavirus pandemic: bike sales have leapt, park use is way up, and even pavement chalk drawing appears to be having a moment.Now as many cities start to reopen, some are looking at their sidewalks, squares, parking lots and even streets as a hidden asset in boosting their economies.”The COVID-19 pandemic has drastically changed our relationship with our streets, open public spaces and public facilities,” said Laura Petrella, chief of planning, finance and economy at UN-Habitat. In Tampa, Florida, for instance, Jeff Gigante’s Forbici Modern Italian restaurant had to weather seven weeks of relying solely on sales of takeout food.Even when he was allowed to reopen in early May, he could only do so at 25% capacity, including his staff — hardly a solution, Gigante said, until the Tampa mayor announced emergency policies allowing the new use of public space.That meant the street in front of Forbici was closed down, and Gigante was allowed to put up a tent that can seat 72 at well-spaced tables.”This really gave us our life back,” he said in a phone interview.While the restaurant screens both staff and diners for symptoms of COVID-19, Gigante said the establishment is bustling again: “It feels very similar to pre-COVID. People are very appreciative, grateful that we’re open.”Underutilised spaceThroughout the world, public space is playing a quiet but key new role amid coronavirus upheavals, said Petrella.In Kisumu, Kenya, she said, local authorities have converted public spaces into open-air markets — similar to Kalaw, Myanmar, where streets have been closed to allow for social distancing at vegetable markets.And many cities worldwide are expanding options for walking, running and bicycle riding, she noted.Indeed, the need for recreation and new transit options has dominated much of the discussion around public space, said Phil Myrick, head of the Project for Public Spaces, a Philadelphia-based NGO.But, he said, the potential for use of public space is far greater.”As we think about ways to reopen during this pandemic, it’s staring us in the face: Sidewalks and street spaces are right there outside of every business, restaurant, hairdresser, dry cleaner,” Myrick said.Particularly in the developed world, these spaces have long been underutilized, and are far more equitably distributed across cities, he said.With traffic levels far lower than normal, “we can create more space for those businesses to start to move outside”.That is the idea in Vilnius, the capital of Lithuania.The city had encouraged residents to use parks and forests for recreation purposes throughout the pandemic, but something was missing, said the city’s mayor, Remigijus Simasius.”The feeling of city life — people were hungry for this,” he said by phone.So officials allowed businesses to expand into the city’s historic squares, parks and sidewalks, and closed some streets to allow businesses to use these, as well.About 400 businesses have done so thus far, Simasius said, and as competitions arose, the city even had to come up with metrics for deciding which establishment would have access to which piece of public space.The difference in the city was instantly noticeable, he said: “There was unimaginable enthusiasm on the first day.”That is part of a broader strategy, the mayor said, aimed at drawing in young families and new talent: “This is an important factor of economic recovery, but we were thinking even more about the spirit of the city.”Permanent changesWhile many new policies were developed under emergency circumstances, some cities are already seeking to make these changes permanent.For instance, Simasius said that while aspects of how the city permits outdoor use will go back to normal next year, the general aim of allowing more outdoor space and street closures will remain.Mayor Rio of Braga agreed, although he noted restaurants and other shops would probably have to start paying to occupy this public space.And in Tampa, discussions are already underway to maintain the current policies indefinitely in the area around Gigante’s restaurant, according to city spokeswoman Ashley Bauman.In the past, opening outdoor space for bars and restaurants has been complicated, said Travis G. Hill, chief executive at the Virginia Alcoholic Beverage Control Authority, the state regulator that is overseeing the approvals process for expanding outdoor use.”The outdoor space comes into conflict because people say it’s too loud, or it’s interfering with my use,” Hill said.But the pandemic has upended some of those regulatory assumptions, he said: “Local jurisdictions may see that people are more accepting of using these spaces with proper guidelines. It will be interesting to see what changes may remain.”In Seattle, officials have already announced that at least 23 miles of residential road closures will be made permanent.The closures, which allow local residents access but discourage through-traffic, were initially announced as a way to relieve crowding in local parks and to equitably spread out recreation opportunities, said city transportation director Sam Zimbabwe.Now, he said, the city is anticipating the prospect of changed transportation demands for the foreseeable future.”This is an example of the variety of approaches we think we can use over the next year of moving into recovery, and to think about how the city recovers stronger than before,” he said.Some residents say they look forward to the closures being made permanent.”It’s quite pleasant — we’ve definitely been enjoying walking and riding our bikes,” said Michal Waldfogel, 35, who lives with partner Ezra Cooper just off one of the Seattle streets affected by the new policy.”You definitely see more people out walking,” said Cooper, 42, noting the closure has brought a new energy to what had been a “sleepy” residential street.”I enjoy seeing people moving around,” he said. “I like the street to feel lively.” Topics :
Denmark’s PenSam has picked Amundi to manage more than half of its €4.8bn global listed equities portfolio, months after the pension fund announced the entire portfolio would be re-weighted and measured against the MSCI All Country World Index (ACWI) Climate index rather than the original ACWI.Amundi said that under the new mandate from the Danish labour-market pension fund, it will manage over €2.6bn of the fund’s global equities in a separate account, tracking the climate-tilted index while incorporating “client specific customisations”.Claus Jørgensen, PenSam’s CIO, said: “The partnership was a natural fit for PenSam as we see Amundi as a leader within ESG indexing.“The mandate will be key to achieving our key goals of strong returns, integration of climate objectives and low cost,” he added. Asked by IPE about the management of the remaining half of the global equities portfolio, PenSam said this would continue to be handled by Nordea, with the external manager having “more or less” kept its mandate and allocation.PenSam senior portfolio manager Henrik Lorin Rasmussen told IPE that Amundi had taken over the assets from a number of other external managers, but added that it was the pension fund’s policy not to disclose names of firms it had chosen not to use anymore.“We are currently not looking to use other managers than Amundi and Nordea – as we are quite happy with both,” he said, referring to the pension fund’s listed global equities allocation.For its part, Amundi said it was selected for the task based on its expertise in indexing, combined with its “commitment and track record within ESG and climate investing,” adding in the joint announcement that it had been managing tracking strategies and co-developing ESG-focused indices for many years.Fannie Wurtz, head of Amundi ETF, indexing and smart beta, said: “As a pioneer in index managed climate solutions since 2014, Amundi’s size and scale positions us perfectly to deliver best-in-class index management.”The €20bn Danish pension fund announced four months ago that it had switched weightings in its passively-managed listed global equities portfolio to take account of climate factors, by adopting the MSCI climate index for the whole €4.8bn allocation.This article was updated on 8 July to add more information and comment from PenSam on its choice of external managers.Looking for IPE’s latest magazine? Read the digital edition here.
This Pembroke Pines couple has started a petition to make pigs pets A Pembroke Pines woman has started a petition to stop the city from enforcing a code violation that would force her to get rid of two miniature pet pigs or face a $250 daily fine.Her petition has gathered over 64,819 signatures towards her goal of 65,000.The city gave Theresa Shaia until April 18 to get rid of her beloved pets, named Beetlejuice and Frankenstein, but she’s now fighting the violation in court. She is hoping to have a hearing in July.The whole thing started when a neighbor claimed the pigs smelled and called in a complaint.The city has a “nuisance” ordinance that states “no farm animals,” and Pembroke Pines law law states that “chickens or other farm animals, and four or more dogs over the age of four months old” are prohibited (section 155.013).Shaia and her partner, Michael Owens, started the Care2 petition to ask the city to change its ordinance to allow for miniature pigs, and to stop enforcing the potential code violation.Shaia says she recently experienced the loss of a close friend, and that losing her pets would just add to the devastation.