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]
The year-round Rijeka-Munich route is already operating, ie it has continued uninterruptedly after the summer season, they point out from Rijeka Airport, and currently Croatia Airlines can fly to Munich every Thursday and Sunday with a Dash 8 Q400 aircraft. “The current traffic on this line is not very satisfactory since the average occupancy of aircraft in the past winter months was only 25%. However, this occupancy should be taken with a large amount of reserve since it is only the first year of this line during the winter, and potential passengers are not yet sufficiently aware of its existence, ie with winter lines it is normal that the habit of traveling during the winter is formed only after 3-4 years of turnover. The same can be seen from our experience with the year-round line to Cologne, which was introduced last winter, and this year continued with a change of destination to Düsseldorf, but these two cities are only 40km away, so it can be said that they are the same market. ” stand out from Rijeka Airport. The opportunity is there, let’s use it. If the route is not profitable in 2-3 years, it will be canceled, which gives a clear signal to other airlines. Namely, last year the average occupancy of aircraft on the line Rijeka – Cologne was 40%, while this year the percentage has risen to 55%. These are funds that help establish the year-round Rijeka-Munich airline. Until now, Rijeka has been connected to Munich via Croatia Airlines on Thursdays and Sundays from October 28.10.2018, 30.3.2019. to March 2018, 2019, and in accordance with the new financial resources, the mentioned line continued during XNUMX as well as in XNUMX, so Kvarner is connected by a year-round line with Munich. Rijeka Airport The decision of the Tourist Board provided additional funds for the implementation of strategic marketing campaigns in emitting markets in 2019 for advertising in cooperation with Croatia Airlines and the Kvarner Tourist Board, which provides funds for this cooperation in the same amount as the CNTB. By the way, after last year’s record season in which 30% growth was achieved in passenger transport, four new lines were opened at Rijeka Airport in 2019, and new lines are being opened. “In 2019 For now, we have confirmed the arrival of 4 new airlines: TUI, Volote, Lufthansa and Air Serbia, which will fly to 3 new destinations: London Gatwick, Marseille and Belgrade, and the already existing Munich. Belgrade will be another year-round line that will continue to operate after the summer season. Negotiations are currently underway with some other companies, but so far we have not confirmed any other new lines. ” conclude from Rijeka Airport. What is the most difficult and most important is to open a direct flight with a destination, it is the first prerequisite for the growth of tourism, especially in the pre- and post-season. And having a direct year-round line with Cologne and Munich is a big plus for the whole of Kvarner. Now it is necessary to sit at the table, all tourism workers, and target the mentioned markets in order to create demand, and thus the profitability of the line. This is an opportunity not to be missed. Out of the tourist season, Kvarner can certainly build its opportunity through events, health, active and business tourism.
“We have come to realize that the handling of COVID-19 […] and the handling of the economy are inseparable. We’ve learned from the many countries that have put too much emphasis on health that the economic issues turn into another kind of [problem],” he explained.The regulation stipulates that the mandates of affected state agencies would be returned to the relevant ministries or taken over by the newly formed National Economic Recovery (PEN) task force or the national COVID-19 task force, both of which answer to Airlangga, who is the chairman of the national committee and its policymaking subcommittee.The Mangrove Management National Coordination Team, for example, was dissolved and its authorities were distributed to the Environment and Forestry Ministry and the Maritime Affairs and Fisheries Ministry. The Ease of Doing Business task force, which was established in 2017 under Jokowi, will have its duties taken over by the PEN task force.Absent from the list of dissolved agencies are three state bodies that Presidential Chief of Staff Moeldoko previously said were being considered for disbandment, namely the Peatland Restoration Agency (BRG), the National Sports Standardization and Accreditation Agency (BSANK) and the National Commission for the Elderly. When asked why some agencies previously named were not dissolved, Donny Gahral Adian, the lead expert at the Office of the Presidential Chief of Staff (KSP), hinted that there might be more to come.“So far, there are 18 agencies that were disbanded with the Perpres. But there are other agencies whose tasks can be integrated with the relevant ministries that are still under review,” he told the Post on Tuesday.Jokowi floated the idea of disbanding state agencies that were deemed ineffective or that had overlapping mandates early last week. He said he would like to see a leaner bureaucracy and that the measure would help the government rein in its spending.Since then, a handful of state officials have pointed out a number of state agencies for review.Administrative and Bureaucratic Reforms Minister Tjahjo Kumolo told kompas.com on Monday that the agencies disbanded in the new presidential regulation were not listed among the state bodies that his ministry submitted to the State Secretariat for consideration.“[The agencies] that the Administrative and Bureaucratic Reforms Ministry recommended to be disbanded were not included in the Perpres,” Tjahjo said on Monday. He did not respond to queries for further details on Tuesday.Following Airlangga’s announcement on Monday, Tjahjo told the Post that his ministry had submitted a shortlist of state agencies to be disbanded. This list was made after evaluating state agencies’ performance and scrutinizing potentially overlapping authority.“The State Secretariat will deliberate further [whether the agencies should be disbanded]. Hopefully a decision will be reached in July,” Tjahjo said.The state agencies dissolved on Monday and those that may still be under consideration were established both by presidential or government regulations and by laws. Tjahjo has said, however, that state bodies with a mandate established by law can only be disbanded after the approval of the House of Representatives through an amendment to the law.Jokowi is no stranger to disbanding non-performing government agencies and advocating for a leaner and more agile bureaucracy.Shortly after his inauguration in 2014, Jokowi disbanded 10 agencies through Perpres No. 176/2014. He also dissolved an agency that was tasked with reducing greenhouse gas emissions and deforestation as well as the National Climate Change Council and returned their respective mandates to the Environment and Forestry Ministry in 2015.Jokowi went on to disband another 10 agencies in 2016, and another agency, the Sidoarjo Mudflow Mitigation Agency, in 2017.But critics have decried what they say is the President’s propensity to turn a blind eye to overlapping authority in the agencies that surround him.Zaenur Rohman, a researcher at Gadjah Mada University’s Center for Anti-Corruption Studies (Pukat UGM), has noted that the State Secretariat, the Cabinet Secretariat and the KSP all have similar tasks.“In addition to reviewing other institutions, the State Palace itself needs to be reviewed, regarding how its agencies carry out their duties,” Zaenur said.While he expressed appreciation for efforts to control state spending, the researcher said the government would do well to review a number of its spending decisions. Some Rp 4.1 trillion (US$ 276.78 million) has been earmarked for state travel expenditures in a purported effort to support the economies of tourist destinations throughout the country.“That budget could be channeled directly to the businesses in the form of a stimulus or to sections of the public that were hit hardest by the [sluggish] economy resulting from COVID-19,” he said.Topics : President Joko “Jokowi” Widodo disbanded 18 state agencies on Monday, but this may only be the beginning of a renewed drive to trim down the Indonesian bureaucracy, officials have hinted.Jokowi has signed Presidential Regulation (Perpres) No. 82/2020 on the COVID-19 response and the National Economic Recovery Committee, announced Coordinating Economic Minister Airlangga Hartarto at the State Palace on Monday.The regulation disbanded 18 state agencies in a bid to free up more resources so that the government could respond more effectively to the COVID-19 crisis, Cabinet Secretary Pramono Anung said on Tuesday.
The funding allocations include nearly $8 million in Community Development Block Grant funds and nearly $4 million in Emergency Solutions Grant funds derived from the federal 2020 Coronavirus Aid, Relief and Economic Security Act. The legislation, sponsored by Commissioner Levine Cava, authorizes the County to use federal CARES Act dollars to provide direct assistance to local businesses and families. A small business assistance program will provide forgivable loans to businesses with 25 or fewer employees. The loans will be available for the payment of business expenses, including employee payroll costs. Businesses receiving the loans will be required to document job creation and/or retention, with the majority of jobs to be held by individuals with low to moderate income – those less than 80 percent of area median income. MIAMI-DADE – The Miami-Dade Board of County Commissioners today (May 19) approved legislation to provide stimulus funding to local small businesses and direct assistance to families affected by the COVID-19 pandemic. In addition, the legislation provides substantial food and housing assistance for individuals with low to moderate income. Nutritional assistance funds will be available for an estimated 10,000 individuals in public housing that are income eligible and have not already received pandemic relief assistance for groceries. These are likely residents that lost their service sector jobs when COVID-19 caused the shutdown of the tourism and hospitality industry. Funds will also go towards homeless prevention and rapid re-housing activities. “It is critical that the County be able to act quickly to get needed funding into the community to assist our small businesses – the backbone of our economy – and our most vulnerable populations that have been hit hardest by the pandemic crisis,” said Commissioner Levine Cava. “This legislation will enable the County to continue working with its community development partners to better meet the needs of our small business owners and our residents whose safety nets have been damaged.”