Compulsory childhood vaccination

The Lancet Infectious Disease
Jul 2009  Volume 9  Number 7   Pages 393 – 454

Leading Edge
Compulsory childhood vaccination
The Lancet Infectious Diseases

The UK faces an outbreak of measles virus infection on a scale not seen since vaccination became available. Figures released in February for England and Wales show a 36% rise in confirmed cases of measles, from 990 in 2007 to 1348 in 2008, the highest number since monitoring was introduced in 1995. A further 382 cases were reported in the first 3 months of this year. According to the Health Protection Agency, most cases are among children who have not been fully vaccinated with the combined measles, mumps, and rubella (MMR) vaccine.

Protecting children with HIV against pneumococcal disease

The Lancet Infectious Disease
Jul 2009  Volume 9  Number 7   Pages 393 – 454

Protecting children with HIV against pneumococcal disease
Andrea Meehan, Grant Mackenzie, Delane Shingadia, Robert Booy

Rwanda has become the first developing nation to introduce pneumococcal conjugate vaccine. The aim is to vaccinate nearly all Rwandan infants by the end of 2009. However, equally at risk older children with HIV are unfortunately not yet on the agenda.1 WHO estimates that disease due to Streptococcus pneumoniae claims the lives of up to 1 million children every year.2 These deaths are disproportionately represented in the developing world, particularly in children infected with HIV3 of whom there are about 2 million in sub-Saharan Africa alone.

Emergence and pandemic potential of swine-origin H1N1 influenza virus

Volume 459 Number 7249 pp889-1026

Emergence and pandemic potential of swine-origin H1N1 influenza virus

Gabriele Neumann1, Takeshi Noda2 & Yoshihiro Kawaoka1,2,3,4

Influenza viruses cause annual epidemics and occasional pandemics that have claimed the lives of millions. The emergence of new strains will continue to pose challenges to public health and the scientific communities. A prime example is the recent emergence of swine-origin H1N1 viruses that have transmitted to and spread among humans, resulting in outbreaks internationally. Efforts to control these outbreaks and real-time monitoring of the evolution of this virus should provide us with invaluable information to direct infectious disease control programmes and to improve understanding of the factors that determine viral pathogenicity and/or transmissibility.

Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA
International Research Center for Infectious Diseases,
Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
ERATO Infection-Induced Host Responses Project, Japan Science and Technology Agency, Saitama 332-0012, Japan

Correspondence to: Yoshihiro Kawaoka1,2,3,4 Correspondence should be addressed to Y.K. (Email:

Signature Features of Influenza Pandemics — Implications for Policy

New England Journal of Medicine
Volume 360 — June 18, 2009 — Number 25

The Signature Features of Influenza Pandemics — Implications for Policy
M. A. Miller, C. Viboud, M. Balinska, and L. Simonsen

[Initial text per NEJM convention]
Vast amounts of time and resources are being invested in planning for the next influenza pandemic, and one may indeed have already begun. Data from past pandemics can provide useful insights for current and future planning. Having conducted archeo-epidemiologic research, we can clarify certain “signature features” of three previous influenza pandemics — A/H1N1 from 1918 through 1919, A/H2N2 from 1957 through 1963, and A/H3N2 from 1968 through 1970 — that should inform both national plans for pandemic preparedness and required international collaborations.

Past pandemics were characterized by a shift in the virus subtype, shifts of the highest death rates to…

Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans

New England Journal of Medicine
Volume 360 — June 18, 2009 — Number 25

Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans
Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team

Background On April 15 and April 17, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in specimens obtained from two epidemiologically unlinked patients in the United States. The same strain of the virus was identified in Mexico, Canada, and elsewhere. We describe 642 confirmed cases of human S-OIV infection identified from the rapidly evolving U.S. outbreak.

Methods Enhanced surveillance was implemented in the United States for human infection with influenza A viruses that could not be subtyped. Specimens were sent to the Centers for Disease Control and Prevention for real-time reverse-transcriptase–polymerase-chain-reaction confirmatory testing for S-OIV.

Results From April 15 through May 5, a total of 642 confirmed cases of S-OIV infection were identified in 41 states. The ages of patients ranged from 3 months to 81 years; 60% of patients were 18 years of age or younger. Of patients with available data, 18% had recently traveled to Mexico, and 16% were identified from school outbreaks of S-OIV infection. The most common presenting symptoms were fever (94% of patients), cough (92%), and sore throat (66%); 25% of patients had diarrhea, and 25% had vomiting. Of the 399 patients for whom hospitalization status was known, 36 (9%) required hospitalization. Of 22 hospitalized patients with available data, 12 had characteristics that conferred an increased risk of severe seasonal influenza, 11 had pneumonia, 8 required admission to an intensive care unit, 4 had respiratory failure, and 2 died. The S-OIV was determined to have a unique genome composition that had not been identified previously.

Conclusions A novel swine-origin influenza A virus was identified as the cause of outbreaks of febrile respiratory infection ranging from self-limited to severe illness. It is likely that the number of confirmed cases underestimates the number of cases that have occurred.

Pandemic Potential of a Strain of Influenza A (H1N1): Early Findings

19 June 2009   Vol 324, Issue 5934, Pages 1477-1602

Pandemic Potential of a Strain of Influenza A (H1N1): Early Findings

Christophe Fraser,1,* Christl A. Donnelly,1,* Simon Cauchemez,1 William P. Hanage,1 Maria D. Van Kerkhove,1 T. Déirdre Hollingsworth,1 Jamie Griffin,1 Rebecca F. Baggaley,1 Helen E. Jenkins,1 Emily J. Lyons,1 Thibaut Jombart,1 Wes R. Hinsley,1 Nicholas C. Grassly,1 Francois Balloux,1 Azra C. Ghani,1 Neil M. Ferguson,1, Andrew Rambaut,2 Oliver G. Pybus,3 Hugo Lopez-Gatell,4 Celia M. Alpuche-Aranda,5 Ietza Bojorquez Chapela,4 Ethel Palacios Zavala,4 Dulce Ma. Espejo Guevara,6 Francesco Checchi,7 Erika Garcia,7 Stephane Hugonnet,7 Cathy Roth,7 The WHO Rapid Pandemic Assessment Collaboration

A novel influenza A (H1N1) virus has spread rapidly across the globe. Judging its pandemic potential is difficult with limited data, but nevertheless essential to inform appropriate health responses. By analyzing the outbreak in Mexico, early data on international spread, and viral genetic diversity, we make an early assessment of transmissibility and severity. Our estimates suggest that 23,000 (range 6000 to 32,000) individuals had been infected in Mexico by late April, giving an estimated case fatality ratio (CFR) of 0.4% (range: 0.3 to 1.8%) based on confirmed and suspected deaths reported to that time. In a community outbreak in the small community of La Gloria, Veracruz, no deaths were attributed to infection, giving an upper 95% bound on CFR of 0.6%. Thus, although substantial uncertainty remains, clinical severity appears less than that seen in the 1918 influenza pandemic but comparable with that seen in the 1957 pandemic. Clinical attack rates in children in La Gloria were twice that in adults (<15 years of age: 61%; 15 years: 29%). Three different epidemiological analyses gave basic reproduction number (R0) estimates in the range of 1.4 to 1.6, whereas a genetic analysis gave a central estimate of 1.2. This range of values is consistent with 14 to 73 generations of human-to-human transmission having occurred in Mexico to late April. Transmissibility is therefore substantially higher than that of seasonal flu, and comparable with lower estimates of R0 obtained from previous influenza pandemics.

1 MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, Faculty of Medicine, Norfolk Place, London W2 1PG, UK.
2 Institute of Evolutionary Biology, University of Edinburgh, Ashworth Laboratories, Edinburgh EH9 3JT, UK.
3 Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, UK.
4 Directorate General of Epidemiology, FCO. De P. Miranda, 177 5th Floor, Mexico City, 01480, Mexico.
5 National Institute of Epidemiological Diagnosis and Reference, Prolongación Carpio No. 470 (3° piso), Col Santo Tomás, México City, C.P. 11340, Mexico.
6 Secretaría de Salud – Servicios de Salud de Veracruz Soconusco No. 36, Colonia Aguacatal, C.P. 910 Xalapa, Veracruz, México State.
7 World Health Organization.

* These authors contributed equally to this work.
All authors are members of this collaboration.
To whom correspondence should be addressed. E-mail:

Pneumococcal vaccination in developing countries

Volume 27, Issue 32, Pages 4247-4380 (9 July 2009)

Pneumococcal vaccination in developing countries: Where does science end and commerce begin?
Pages 4247-4251
Joseph L. Mathew
Recently Pneumococcal vaccines have generated considerable interest in developing countries as an intervention for protecting children from pneumonia and thereby reducing childhood mortality. Many convincing scientific arguments have been put forward, although they are often based either on extension of information from developed countries, or estimation plus extrapolation of limited local data. In addition, there is also significant commercial pressure to prescribe/recommend Pneumococcal vaccine(s). Against such a background, it is important for developing countries to critically appraise the issues involved in order to make a rational choice. This brief paper explores these issues, showing that the current Pneumococcal vaccines have limited effectiveness in developing countries and the hype surrounding them is more commercial than scientific.