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The recombinant herpes zoster vaccine (RZV), approved as a 2-dose series in the United States in October 2017, has proven highly effective and generally safe. However, a small risk of Guillain-Barré syndrome after vaccination was identified after approval, and questions remain about other possible adverse events. This data-mining study assessed RZV safety in the United States using the self-controlled tree-temporal scan statistic, scanning data on thousands of diagnoses recorded during follow-up to detect any statistically unusual temporal clustering of cases within a large hierarchy of diagnoses. IBM MarketScan data on commercially insured persons at least 50 years of age receiving RZV between January 1, 2018, and May 5, 2020, were used, including 56 days of follow-up; 1,014,329 doses were included. Statistically significant clustering was found within a few days of vaccination for unspecified adverse effects, complications, or reactions to immunization or other medical substances/care; fever; unspecified allergy; syncope/collapse; cellulitis; myalgia; and dizziness/giddiness. These findings are consistent with the known safety profile of this and other injected vaccines. No cluster of Guillain-Barré syndrome was detected, possibly due to insufficient sample size. This signal-detection method has now been applied to 5 vaccines, with consistently plausible results, and seems a promising addition to vaccine-safety evaluation methods. [ABSTRACT FROM AUTHOR]

We measured sensitivity and timeliness of a syndromic surveillance system to detect bioterrorism events. A hypothetical anthrax release was modeled by using zip code population data, mall customer surveys, and [...]

Background. The authors evaluated the effect of 3 doses (0.25 mg/day, 0.5 mg/day, and 1 mg/day) of micronized 17 [beta]-estradiol ([E.sub.2]) on C-reactive protein (CRP), interleukin-6 (IL 6), and lipids, compared with placebo, in healthy older women participating in an osteoporosis study. Methods. This randomized, double-blind, placebo-controlled study was conducted in a University clinical research center. Participants were healthy, community-living women older than 65 years. The primary outcome measure of the study was bone metabolism as estimated by serum and urine markers of bone turnover. For this analysis, the authors measured serum markers of CRP, IL-6, lipids, intracellular adhesion molecule-l, and E-selectin at baseline, after 12 weeks of treatment, and after 12 weeks with no treatment. Results. A significant dose-response effect of estrogen occurred on CRP levels. After 12 weeks of treatment, CRP decreased 59% in the 0.25 mg/day [E.sub.2] group and increased 65% in the 1 mg/day E2 group, compared with placebo. The CRP level continued to be elevated (92%), compared with placebo, 12 weeks after treatment was discontinued in the 1 mg/ day [E.sub.2] group. High-density lipoprotein (HDL) and HD[L.sub.2] cholesterol increased and low-density lipoprotein (LDL) cholesterol decreased at 12 weeks in the 1 mg/day [E.sub.2] group, with a significant dose-response effect. E-selectin decreased significantly in the 1 mg/day [E.sub.2] group 12 weeks after discontinuation of treatment (-7%), and there was a significant dose-response effect at this time. The 2 lower doses did not affect any of these parameters. Total and HD[L.sub.3] cholesterol, triglycerides, lipoprotein (a), intracellular adhesion molecule-l, and IL-6 did not change with any dose of [E.sub.2]. Conclusions. C-reactive protein, an inflammation marker associated with increased risk for cardiovascular disease, decreased in women taking the lowest estrogen dose but increased in women assigned to the highest estrogen dose, suggesting decreased inflammation with lower dose [E.sub.2]. However, with 3 months of treatment, 0.25 or 0.5 mg/day [E.sub.2] did not have the same beneficial effects on HDL or LDL cholesterol as did 1 mg/day [E.sub.2]. These data suggest that estradiol doses have differential short-term effects on markers of cardiovascular disease. Low-dose [E.sub.2] decreased CRP, an important marker of inflammation but did not affect lipid parameters, whereas the highest dose increased CRP and had a beneficial effect on lipid parameters. The long-term consequences of these effects are unknown, but it is possible that estradiol dose should be considered when risk: benefit ratios are evaluated for individual women before estrogen replacement therapy is initiated.

The New York City Department of Health and Mental Hygiene has established a syndromic surveillance system that monitors emergency department visits to detect disease outbreaks early. Routinely collected chief complaint [...]

Very low doses of estrogen may strengthen bones in elderly women without causing serious side effects, according to a study of 167 women. Although hormone replacement therapy can prevent osteoporosis, recent studies have shown that it increases the risk of breast cancer, stroke, and heart disease. In this study, the women took 0.25 milligrams of estrogen every day for three years.

An early warning system for West Nile virus (WNV) outbreaks could provide a basis for targeted public education and surveillance activities as well as more timely larval and adult mosquito [...]