The WHO continues to issue weekly updates on the H1N1 pandemic updates at http://www.who.int/csr/disease/swineflu/en/index.html

Pandemic (H1N1) 2009 – update 97
Weekly update
23 April 2010

As of 18 April 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17853 deaths…

Situation update:
Summary: Currently the most active areas of transmission of pandemic influenza are in parts of West and Central Africa but transmission is also still occurring in South East Asia, and Central America. Pandemic influenza activity remains low in much of the temperate zone of both the northern and southern hemispheres. Seasonal influenza type B viruses have been increasingly detected over a larger area and are now the predominant circulating influenza viruses across East Asia, Central Africa and Northern and Eastern Europe. Very small numbers of type B viruses have also recently been detected in Central America. Seasonal influenza H3N2 is still being detected in South and Southeast Asia (mainly Indonesia), as well as sporadically in several countries of West Africa, and Eastern Europe.

Full report at: http://www.who.int/csr/don/2010_04_23a/en/index.html

WHO said that Immunization Week campaigns have launched in 112 countries globally “with the goals of expanding immunization coverage and raising awareness of the importance of vaccines.”

http://www.who.int/mediacentre/news/notes/2010/immunization_20100423/en/index.html

Statement of B.F. (Lee) Hall, M.D., Ph.D., and Anthony S. Fauci, M.D. National Institute of Allergy and Infectious Diseases National Institutes of Health on World Malaria Day April 25, 2010

“This year, we commemorate World Malaria Day by celebrating recent advances in controlling malaria. At the same time, we acknowledge the urgency in meeting critical milestones if we are to eliminate and eventually eradicate the disease worldwide.

“Although significant strides have been made toward malaria control and the elimination of the disease from many regions, global eradication is a long-term goal that will require a sustained commitment. As we accomplish our goals, disease patterns may change and new problems will inevitably arise. It is important that we adapt to the changing circumstances that result from our successes and commit to a long-term effort.

“Today we enter the second year of the Global Malaria Action Plan, [http://www.rollbackmalaria.org/gmap/] developed by the Roll Back Malaria (RBM) Partnership, a global framework for coordinated action against malaria, [http://www.rollbackmalaria.org/], which set ambitious goals to control, eliminate and eradicate malaria. We continue to support the RBM campaign, Count Malaria Out, which strives to achieve the 2010 target of delivering effective and affordable protection and treatment to all people at risk of malaria and cutting the disease burden in half compared with 2000 levels. This target marks a critical milestone in achieving the Millennium Development Goal [http://www.un.org/millenniumgoals/] set by the United Nations to halt the spread of malaria by 2015…

“…According to the World Health Organization, there were about 243 million cases of clinical malaria and 863,000 deaths in 2008. Most of the deaths occurred among children less than 5 years of age living in sub-Saharan Africa. Reducing the number malaria deaths to 500,000 by the end of this year and to near zero by 2015 will require a concerted effort engaging all stakeholders….

“…global eradication of malaria and even regional elimination may not be possible without the development of a safe, affordable and highly effective malaria vaccine…”

http://www.nih.gov/news/health/apr2010/niaid-21.htm

The GAVI Alliance Board “agreed to pursue the implementation of a common Health System Funding Platform to make better use of new and existing funds for health systems and to leverage additional funding.” This builds on announcements made at the high level Task Force on Innovative Financing and Health, in September 2009, to commit an additional US$900 million for Health Systems Strengthening. This harmonised platform “will help countries access money more simply and spend it more effectively.”

GAVI noted that the performance and results-based platform, which is being developed together with the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Bank with facilitation from the World Health Organization (WHO), “aims to better deliver the Millennium Development Goals (MDGs) by strengthening health systems and removing bottlenecks in the delivery of health services in the world’s poorest countries.”

http://www.gavialliance.org/media_centre/statements/GAVI_statement_HSF_Platform_20_04_2010.php

The Bill & Melinda Gates Foundation announced that Ernest Loevinsohn will join the Foundation’s Global Health Program as Director of Policy and Advocacy. Gates said that Dr. Loevinsohn “will lead the foundation’s efforts to encourage political commitment and effective investment in global health in both donor and developing countries. He will also manage a grant program, oversee work to build evidence to support effective policy making, and help lead the foundation’s work on the Global Fund to Fight AIDS, Tuberculosis, and Malaria.”

http://www.gatesfoundation.org/press-releases/Pages/ernest-loevinsohn-director-of-global-health-policy-and-advocacy-100423.aspx

PATH provided an update on its joint HPV vaccine project in India. PATH said that over the past few months, a post-licensure observational study involving administration of HPV vaccine in India, conducted as part of PATH’s global HPV Vaccines: Evidence for Impact project, “has been the focus of allegations from various groups. Recently these have been covered in the press, mainly in India. As a precaution, the Government of India has decided to suspend all project HPV vaccination and to conduct an inquiry to respond to voiced concerns.” PATH said that the project is being implemented by the immunization departments of India’s Andhra Pradesh and Gujarat states and “was carried out only after receiving all required approvals in India and the United States. PATH is cooperating fully with the government inquiry to assist in allaying voiced concerns.” To date, 23,500 girls have been fully vaccinated by the Ministries of Health and Family Welfare in Andhra Pradesh and Gujarat utilizing HPV vaccines licensed for sale in India and donated by Merck and GlaxoSmithKline.

Dr. Christopher Elias, president and CEO of PATH, said, “The mission of PATH worldwide, and in India, is to improve the health of people by advancing technologies, strengthening systems, and encouraging healthy behaviors. The HPV Vaccines: Evidence for Impact project was designed to address all three of these areas. The post-licensure observational study is generating data about vaccine coverage, feasibility, acceptability, and implementation costs associated with different HPV vaccine delivery strategies. The project also assesses cervical precancer screening and treatment strategies. It was designed, in cooperation with government agencies, to assist India’s public health system in identifying the most effective and affordable strategies to help prevent cervical cancer, a disease that kills an estimated 143,000 Indian women every year.

“For approval of the post-licensure observational study, PATH and its Indian collaborators worked with two ethical review committees in India and one in the United States to design study protocols and informed consent materials. PATH is confident that these procedural safeguards informed and guided all aspects of study implementation and conduct.”

http://www.path.org/news/an100422-hpv-india.php

JAMA
Vol. 303 No. 15, pp. 1451-1556, April 21, 2010
http://jama.ama-assn.org/current.dtl

Original Contributions
Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States
Alicia M. Siston; Sonja A. Rasmussen; Margaret A. Honein; Alicia M. Fry; Katherine Seib; William M. Callaghan; Janice Louie; Timothy J. Doyle; Molly Crockett; Ruth Lynfield; Zack Moore; Caleb Wiedeman; Madhu Anand; Laura Tabony; Carrie F. Nielsen; Kirsten Waller; Shannon Page; Jeannie M. Thompson; Catherine Avery; Chasisity Brown Springs; Timothy Jones; Jennifer L. Williams; Kim Newsome; Lyn Finelli; Denise J. Jamieson; for the Pandemic H1N1 Influenza in Pregnancy Working Group

Context  Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death.

Objective  To describe the severity of 2009 influenza A(H1N1) illness and the association with early antiviral treatment among pregnant women in the United States.

Design, Setting, and Patients  Surveillance of 2009 influenza A(H1N1) in pregnant women reported to the Centers for Disease Control and Prevention (CDC) with symptom onset from April through December 2009.

Main Outcome Measures  Severity of illness (hospitalizations, intensive care unit [ICU] admissions, and deaths) due to 2009 influenza A(H1N1) among pregnant women, stratified by timing of antiviral treatment and pregnancy trimester at symptom onset.

Results  We received reports on 788 pregnant women in the United States with 2009 influenza A(H1N1) with symptom onset from April through August 2009. Among those, 30 died (5% of all reported 2009 influenza A[H1N1] influenza deaths in this period). Among 509 hospitalized women, 115 (22.6%) were admitted to an ICU. Pregnant women with treatment more than 4 days after symptom onset were more likely to be admitted to an ICU (56.9% vs 9.4%; relative risk [RR], 6.0; 95% confidence interval [CI], 3.5-10.6) than those treated within 2 days after symptom onset. Only 1 death occurred in a patient who received treatment within 2 days of symptom onset. Updating these data with the CDC’s continued surveillance of ICU admissions and deaths among pregnant women with symptom onset through December 31, 2009, identified an additional 165 women for a total of 280 women who were admitted to ICUs, 56 of whom died. Among the deaths, 4 occurred in the first trimester (7.1%), 15 in the second (26.8%), and 36 in the third (64.3%);

Conclusions  Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1). Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths.

The Lancet
Apr 24, 2010  Volume 375  Number 9724  Pages 1407 – 1494
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Malaria 2010: more ambition and accountability please
The Lancet

Preview
This year’s strapline for World Malaria Day on April 25 is Counting Malaria Out. It indicates the hope of universal access to malaria prevention and treatment by the end of this year, as requested by UN Secretary-General Ban Ki-moon in 2008. Additionally, the World Health Assembly and Roll Back Malaria Partnership had called for a reduction of malaria cases and deaths by at least 50% by the end of 2010 compared with rates in 2000. There are less than 9 months to go, yet a strange sense of misplaced optimism seems to be prevailing in many quarters.

The Lancet Infectious Disease
May 2010  Volume 10  Number 5  Pages 289 – 366
http://www.thelancet.com/journals/laninf/issue/current

Review
Progress towards development of an HIV vaccine: report of the AIDS Vaccine 2009 Conference
Anna Laura Ross, Andreas Bråve, Gabriella Scarlatti, Amapola Manrique, Luigi Buonaguro

Summary
The search for an HIV/AIDS vaccine is steadily moving ahead, generating and validating new concepts in terms of novel vectors for antigen delivery and presentation, new vaccine and adjuvant strategies, alternative approaches to design HIV-1 antigens for eliciting protective cross-neutralising antibodies, and identification of key mechanisms in HIV infection and modulation of the immune system. All these different perspectives are contributing to the unprecedented challenge of developing a protective HIV-1 vaccine. The high scientific value of this massive effort is its great impact on vaccinology as a whole, providing invaluable scientific information for the current and future development of new preventive vaccine as well as therapeutic knowledge-based infectious-disease and cancer vaccines.

New England Journal of Medicine
Volume 362 — April 22, 2010 — Number 16
http://content.nejm.org/current.shtml

Review Article
Current Concepts: Advances in the Development of Vaccines against Neisseria meningitidis
L. K. K. Tan, G. M. Carlone, and R. Borrow

Extract: First 100 words per NEJM convention
Although two centuries have passed since Vieusseux described epidemic meningococcal disease,1 Neisseria meningitidis remains a leading cause of meningitis and sepsis. Overwhelming meningococcal disease can develop rapidly and is associated with mortality rates exceeding 20%.2 Thus, efforts to control the disease have focused on vaccination. In the past, vaccines against meningococcal disease have failed to provide immunogenicity and long-term protection in infants, who are at greatest risk. Although recent vaccines have improved coverage for this age group, there is still no broadly effective vaccine against N. meningitidis group B (NMB), now the predominant disease-causing isolate in industrialized countries.

The WHO continues to issue weekly updates on the H1N1 pandemic updates at http://www.who.int/csr/disease/swineflu/en/index.html

Pandemic (H1N1) 2009 – update 96
Weekly update
16 April 2010

As of 11 April 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17798 deaths.

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of information.

Situation update:

The most active areas of pandemic influenza virus transmission currently are in parts of the tropical zones of the Americas, West Africa, Eastern Africa and South East Asia. Although pandemic influenza continues to be the predominant circulating influenza virus worldwide, seasonal influenza type B virus circulation continues to be predominant in East Asia, and is being detected across other parts of Asia, and Europe at low levels. Sporadic detections of seasonal influenza H3N2 viruses have been reported across Asia, Eastern Europe and Eastern Africa most notably in recent weeks in Indonesia and Tanzania. Few seasonal H1N1 viruses were reported in the Russian Federation and Northern China in the last week…

Full report at: http://www.who.int/csr/don/2010_04_16/en/index.html

The WHO hosted the first meeting of the Review Committee of the International Health Regulations in Geneva, Switzerland from 12 – 14 April 2010. The Review Committee was also charged with the assessment of WHO’s response to the H1N1 pandemic.

The IHR Review Committee is made up of approximately 29 members “who have been selected from the roster of experts under the IHR structure or other WHO expert committees. The committee members represent a broad mix of expertise, practical experience and backgrounds, and includes experts from developed and developing countries. The members are some of the leading experts in the world in their respective fields. They are not WHO staff, nor do they receive funding from WHO for their contributions to the review process. Names of the committee members were made public prior to the first meeting.”

The review has three key objectives:

– Assess the functioning of the International Health Regulations (2005);

– Assess the ongoing global response to the pandemic H1N1 (including the role of WHO); and

– Identify lessons learned important for strengthening preparedness and response for future pandemics and public health emergencies.

Based on the committee’s advice, the Director-General will provide an interim report to the World Health Assembly (WHA) in May 2010, and an expected second, final report to the WHA in May 2011.

http://www.who.int/csr/disease/swineflu/frequently_asked_questions/review_committee/en/index.html

WHO Director-General Dr Margaret Chan opened the IHR Committee’s work. Her remarks are excerpted below:
“…This has been the first influenza pandemic in four decades. This has been the first major test of the functioning of the revised International Health Regulations, which entered into force in 2007.

“The International Health Regulations have a provision that calls for a review of their functioning no later than five years after their entry into force. In 2008, the World Health Assembly decided that this first review should be undertaken by the Sixty-third World Health Assembly in May 2010.

“…I believe there is merit in assessing the performance of an international instrument, like the IHR, when put to an extreme test by a widespread and closely scrutinized infectious disease event.

“As I have said before, this has been the most closely watched and carefully scrutinized pandemic in history. This gives us a vast body of scientific, clinical, and epidemiological data to assess.

“Moreover, the pandemic’s spread was rapidly global. To date, laboratory confirmed cases of H1N1 pandemic influenza have been officially reported from 213 countries and overseas territories or communities. This gives us a vast and varied experience to assess.

“…I see potential advantages in assessing the performance of the Regulations with a particular focus on the influenza pandemic and how it was managed, especially at the international level by WHO. When the performance of the IHR is assessed under the challenging conditions of an influenza pandemic, specific strengths and weaknesses are likely to come to light.

“..We are seeking lessons, about how the IHR has functioned, about how WHO and the international community responded to the pandemic, that can aid the management of future public health emergencies of international concern. And I can assure you: there will be more.

“We want to know what worked well. We want to know what went wrong and, ideally, why. We want to know what can be done better and, ideally, how…

“…As I said, we want a frank, critical, transparent, credible and independent review of our performance, as well as that of the International Health Regulations. The Secretariat will do everything it can to facilitate such a process.”

http://www.who.int/dg/speeches/2010/ihr_20100412/en/index.html

Transcript of press briefing at the Palais des Nations, Geneva, Dr Harvey Fineberg, Chair, IHR Review Committee, 14 April 2010 http://www.who.int/mediacentre/multimedia/pc_transcript_14_april_10_fineberg.pdf

The MMWR Weekly for April 16, 2010 / 59(14);423-430 includes:

Update: Influenza Activity — United States, August 30, 2009–March 27, 2010, and Composition of the 2010–11 Influenza Vaccine

The emergence and spread of 2009 pandemic influenza A (H1N1) virus resulted in substantial influenza activity in the United States throughout the summer and fall months of 2009, with activity peaking in late October. Activity declined beginning in November 2009 (1) but continued at lower levels through March 2010. The 2009 H1N1 virus remained the dominant circulating influenza virus throughout the season; <1% of characterized viruses were seasonal influenza A (H1), A (H3), and influenza B viruses. This report summarizes U.S. influenza activity* from August 30, 2009, the start of the 2009–10 influenza season, through March 27, 2010, and also reports on the 2010–11 Northern Hemisphere influenza vaccine strain selection….

Full report at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5914a3.htm

Clinical Infectious Diseases
15 May 2010  Volume 50, Number 10
http://www.journals.uchicago.edu/toc/cid/current

Articles and Commentaries
Immunogenicity and Safety of Intradermal Influenza Vaccination in Healthy Older Adults
Ru-Chien Chi, Michael T. Rock, and Kathleen M. Neuzil

Reduced dose influenza vaccine by intradermal or intramuscular injection generated postvaccination antibody titers generally comparable to full‐dose intramuscular vaccination in elderly adults. Results support the use of a reduced dose of influenza vaccine by either route during vaccine shortages.

Emerging Infectious Diseases
Volume 16, Number 5–May 2010
http://www.cdc.gov/ncidod/EID/index.htm

Research
Capacity of Public Health Surveillance to Comply with Revised International Health Regulations, USA
K.E. Armstrong et al.

Abstract
Public health surveillance is essential for detecting and responding to infectious diseases and necessary for compliance with the revised International Health Regulations (IHR) 2005. To assess reporting capacities and compliance with IHR of all 50 states and Washington, DC, we sent a questionnaire to respective epidemiologists; 47 of 51 responded. Overall reporting capacity was high. Eighty-one percent of respondents reported being able to transmit notifications about unknown or unexpected events to the Centers for Disease Control and Prevention (CDC) daily. Additionally, 80% of respondents reported use of a risk assessment tool to determine whether CDC should be notified of possible public health emergencies. These findings suggest that most states have systems in place to ensure compliance with IHR. However, full state-level compliance will require additional efforts.

Emerging Infectious Diseases
Volume 16, Number 5–May 2010
http://www.cdc.gov/ncidod/EID/index.htm

Effects of Pneumococcal Conjugate Vaccine 2 Years after Its Introduction, the Netherlands
G.D. Rodenburg et al.

Abstract
In the Netherlands, the 7-valent pneumococcal conjugate vaccine (PCV-7) was implemented in a 3+1-dose schedule in the national immunization program for infants born after April 1, 2006. To assess the vaccine’s effectiveness, we compared disease incidence before and after vaccine implementation (June 2004–June 2006 and June 2006–June 2008, respectively). We serotyped 2,552 invasive pneumococcal isolates from throughout the Netherlands, covering 25% of the country’s population. Clinical characteristics were extracted from hospital records. After June 2006, vaccine-serotype invasive pneumococcal disease (IPD) decreased 90% (95% confidence interval [CI] 68%–97%) in children age eligible for PCV-7; simultaneously, however, non–vaccine-serotype IPD increased by 71% (not significant), resulting in a 44% total net IPD reduction (95% CI 7%–66%). IPD rates did not change for other age groups. In the Netherlands, PCV-7 offered high protection against vaccine-serotype IPD in vaccinated children, but increases of non–vaccine-serotype IPD reduced net vaccine benefits.

JAMA
Vol. 303 No. 14, pp. 1339-1440, April 14, 2010
http://jama.ama-assn.org/current.dtl

News & Analysis
Progress in Immunization Information Systems—United States, 2008
JAMA. 2010;303(14):1361-1362.

[First 150 words per JAMA convention]
Immunization information systems (IISs) are confidential, computerized information systems that collect and consolidate vaccination data from multiple health-care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographic area.1 A CDC program goal for 2010 is to achieve >95% participation in an IIS (defined as having two or more recorded vaccinations) among children aged <6 years. To monitor progress toward this goal, CDC annually surveys immunization grantees in 50 states, five cities, and the District of Columbia, using the Immunization Information Systems Annual Report (IISAR). All 56 grantees were asked to complete the IISAR; 52 did so for 2008. This report highlights results from the 2008 IISAR, which indicated that 75% of all U.S. children aged <6 years (approximately 18 million children) participated in an IIS in 2008, an increase from 65% in 2006.1 The majority of grantees (82%) . . .

Journal of Infectious Diseases
15 May 2010  Volume 201, Number 10
http://www.journals.uchicago.edu/toc/jid/current

Editorial Commentaries
Adult Male Circumcision: Will It Reduce Disease Caused by Human Papillomavirus?
Raphael P. Viscidi and Keerti V. Shah

Journal of Infectious Diseases
15 May 2010  Volume 201, Number 10
http://www.journals.uchicago.edu/toc/jid/current

Asymptomatic Wild–Type Poliovirus Infection in India among Children with Previous Oral Poliovirus Vaccination
Nicholas C. Grassly, Hamid Jafari, Sunil Bahl, Sunita Durrani, Jay Wenger, Roland W. Sutter, and R. Bruce Aylward

Background.Mucosal immunity induced by oral poliovirus vaccine (OPV) is imperfect and potentially allows immunized individuals to participate in asymptomatic wild‐type poliovirus transmission in settings with efficient fecal‐oral transmission of infection.

Methods.We examined the extent of asymptomatic wild‐type poliovirus transmission in India by measuring the prevalence of virus in stool samples obtained from 14,005 healthy children who were in contact with 2761 individuals with suspected poliomyelitis reported during the period 2003–2008.

Results.Wild‐type poliovirus serotypes 1 and 3 were isolated from the stool samples of 103 (0.74%) and 104 (0.74%) healthy contacts, respectively. Among contacts of individuals with laboratory-confirmed poliomyelitis, 27 (12.7%) of 213 and 29 (13.9%) of 209 had serotypes 1 and 3, respectively, isolated from their stool samples. The odds ratio of excreting serotype 1 wild‐type poliovirus was 0.13 (95% confidence interval, 0.02–0.87) among healthy children reporting 6 doses of OPV, compared with children reporting 0–2 doses. However, two‐thirds of healthy children who excreted this virus reported 6 doses, and the prevalence of this virus did not decrease with age over the sampled range.

Conclusions.Although OPV is protective against infection with poliovirus, the majority of healthy contacts who excreted wild-type poliovirus were well vaccinated. This is consistent with a potential role for OPV-vaccinated children in continued wild-type poliovirus transmission and requires further study.

The Lancet
Apr 10, 2010  Volume 375  Number 9722  Pages 1225 – 1318
http://www.thelancet.com/journals/lancet/issue/current

Perspectives
Is there an ethical obligation to complete polio eradication?
Claudia I Emerson, Peter A Singer

Preview
May, 2010, the World Health Assembly (WHA) is expected to endorse the aggressive new strategy of the Global Polio Eradication Initiative (GPEI) to stop polio transmission. Earlier this year, the Executive Board of the WHA expressed strong support for finishing the job of polio eradication. They were encouraged by the Independent Evaluation of Major Barriers to Interrupting Poliovirus Transmission which concluded in November, 2009, that “if the managerial, security, and technical issues can be addressed, polio eradication can be achieved”.

The Lancet
Apr 10, 2010  Volume 375  Number 9722  Pages 1225 – 1318
http://www.thelancet.com/journals/lancet/issue/current

Public financing of health in developing countries: a cross-national systematic analysis
Chunling Lu, Matthew T Schneider, Paul Gubbins, Katherine Leach-Kemon, Dean Jamison, Christopher JL Murray

Summary
Background
Government spending on health from domestic sources is an important indicator of a government’s commitment to the health of its people, and is essential for the sustainability of health programmes. We aimed to systematically analyse all data sources available for government spending on health in developing countries; describe trends in public financing of health; and test the extent to which they were related to changes in gross domestic product (GDP), government size, HIV prevalence, debt relief, and development assistance for health (DAH) to governmental and non-governmental sectors.

Methods
We did a systematic analysis of all data sources available for government expenditures on health as agent (GHE-A) in developing countries, including government reports and databases from WHO and the International Monetary Fund (IMF). GHE-A consists of domestically and externally financed public health expenditures. We assessed the quality of these sources and used multiple imputation to generate a complete sequence of GHE-A. With these data and those for DAH to governments, we estimated government spending on health from domestic sources. We used panel-regression methods to estimate the association between government domestic spending on health and GDP, government size, HIV prevalence, debt relief, and DAH disbursed to governmental and non-governmental sectors. We tested the robustness of our conclusions using various models and subsets of countries.

Findings
In all developing countries, public financing of health in constant US$ from domestic sources increased by nearly 100% (IMF 120%; WHO 88%) from 1995 to 2006. Overall, this increase was the product of rising GDP, slight decreases in the share of GDP spent by government, and increases in the share of government spending on health. At the country level, while shares of government expenditures to health increased in many regions, they decreased in many sub-Saharan African countries. The statistical analysis showed that DAH to government had a negative and significant effect on domestic government spending on health such that for every US$1 of DAH to government, government health expenditures from domestic resources were reduced by $0·43 (p=0) to $1·14 (p=0). However, DAH to the non-governmental sector had a positive and significant effect on domestic government health spending. Both results were robust to multiple specifications and subset analyses. Other factors, such as debt relief, had no detectable effect on domestic government health spending.

Interpretation
To address the negative effect of DAH on domestic government health spending, we recommend strong standardised monitoring of government health expenditures and government spending in other health-related sectors; establishment of collaborative targets to maintain or increase the share of government expenditures going to health; investment in the capacity of developing countries to effectively receive and use DAH; careful assessment of the risks and benefits of expanded DAH to non-governmental sectors; and investigation of the use of global price subsidies or product transfers as mechanisms for DAH.

Funding
Bill & Melinda Gates Foundation.

PLoS Medicine
(Accessed 18 April 2010)
http://medicine.plosjournals.org/perlserv/?request=browse&issn=1549-1676&method=pubdate&search_fulltext=1&order=online_date&row_start=1&limit=10&document_count=1533&ct=1&SESSID=aac96924d41874935d8e1c2a2501181c#results

Mortality Measurement Matters: Improving Data Collection and Estimation Methods for Child and Adult Mortality
Colin Mathers, Ties Boerma

Abstract
The accurate measurement and estimation of mortality levels, trends, causes, and differentials are a cornerstone of public health. Child and adult mortality rates, often summarized in a life expectancy measure, are key indicators of levels of health and development. The preferred source of mortality data is prospective measurement through continuous registration of deaths, as is done in civil registration systems. But in many countries, especially those with poorly developed statistical systems and higher levels of mortality, retrospective measurement in households and surveys is the principal vehicle for data collection. All methods of data collection suffer from two generic problems: omission of events and dating errors. During the past few decades, demographers have developed and used a range of methods to improve data collection, assess levels of bias, and correct for such biases [1]–[3]. In three papers published in this issue of PLoS Medicine [4]–[6], Murray, Rajaratnam and colleagues revisit these analytical methods and techniques and present improved methods for the analysis of mortality data collected through death registration, censuses, or household surveys.

Science
16 April 2010  Vol 328, Issue 5976, Pages 271-392
http://www.sciencemag.org/current.dtl

News of the Week
U.S. Science Policy: Obama Picks Pragmatists for New Bioethics Panel
Constance Holden

President Barack Obama named the members of his bioethics commission—headed by two university presidents—last week. The 12-member group, selected more for practical advice than for philosophizing, as the last one was prone to, will hold its first meeting in Washington, D.C., in July.

Science
16 April 2010  Vol 328, Issue 5976, Pages 271-392
http://www.sciencemag.org/current.dtl

Reports
Structural Basis of Preexisting Immunity to the 2009 H1N1 Pandemic Influenza Virus
Rui Xu, Damian C. Ekiert, Jens C. Krause, Rong Hai, James E. Crowe, Jr., and Ian A. Wilson
Abstract

The 2009 H1N1 swine flu is the first influenza pandemic in decades. The crystal structure of the hemagglutinin from the A/California/04/2009 H1N1 virus shows that its antigenic structure, particularly within the Sa antigenic site, is extremely similar to those of human H1N1 viruses circulating early in the 20th century. The cocrystal structure of the 1918 hemagglutinin with 2D1, an antibody from a survivor of the 1918 Spanish flu that neutralizes both 1918 and 2009 H1N1 viruses, reveals an epitope that is conserved in both pandemic viruses. Thus, antigenic similarity between the 2009 and 1918-like viruses provides an explanation for the age-related immunity to the current influenza pandemic.

Vaccine
Volume 28, Issue 20, Pages 3509-3626 (30 April 2010)
http://www.sciencedirect.com/science/journal/0264410X

Editorial
Vaccinomics and bioinformatics: Accelerants for the next golden age of vaccinology
Gregory A. Poland, Ann L. Oberg

[No abstract]

Vaccine
Volume 28, Issue 20, Pages 3509-3626 (30 April 2010)
http://www.sciencedirect.com/science/journal/0264410X

Review
EV71: An emerging infectious disease vaccine target in the Far East?
Juan Xu, Yuan Qian, Shixia Wang, Jill M. Grimes Serrano, Wei Li, Zuhu Huang, Shan Lu

Abstract
Hand, foot, and mouth disease (HFMD) is a common viral illness in infants and children caused by viruses that belong to the enterovirus genus of the picornavirus family. Although most HFMD do not result in serious complications, outbreaks of HFMD caused by enterovirus 71 (EV71) can present with a high rate of neurological complications, including meningoencephalitis, pulmonary complications, and possibly death. HFMD caused by EV71 has become a major emerging infectious disease in Asia and the highly pathogenic potential of EV71 clearly requires the attention of world medical community. Although vaccine development for EV71 is active and ongoing in Asian countries, a greater joint effort is needed for vaccine researchers and developers in both developed and developing countries to produce a safe and effective EV71 vaccine.

The WHO continues to issue weekly updates on the H1N1 pandemic updates at http://www.who.int/csr/disease/swineflu/en/index.html

Pandemic (H1N1) 2009 – update 95
Weekly update
9 April 2010

As of 4 April 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17700 deaths…

Situation update:
The current situation is largely unchanged since the last update. The most active areas of pandemic influenza virus transmission continue to be in parts of Southeast Asia, West Africa, and in the tropical zone of the Americas. In Chile, a country of the southern hemisphere temperate zone, there is evidence of early localized pandemic influenza virus transmission in advance of the usual start of the southern hemisphere winter influenza season. Seasonal influenza type B viruses continue to actively circulate in East Asia, but are also being detected at low levels across other parts of Asia and Europe. More at: http://www.who.int/csr/don/2010_04_09/en/index.htmlhttp://www.who.int/csr/don/2010_04_09/en/index.html

PLoS Medicine
(Accessed 11 April 2010)
http://medicine.plosjournals.org/perlserv/?request=browse&issn=1549-1676&method=pubdate&search_fulltext=1&order=online_date&row_start=1&limit=10&document_count=1533&ct=1&SESSID=aac96924d41874935d8e1c2a2501181c#results

Economic Appraisal of Ontario’s Universal Influenza Immunization Program: A Cost-Utility Analysis
Beate Sander, Jeffrey C. Kwong, Chris T. Bauch, Andreas Maetzel, Allison McGeer, Janet M. Raboud, Murray Krahn Research Article, published 06 Apr 2010

Abstract

Background
In July 2000, the province of Ontario, Canada, initiated a universal influenza immunization program (UIIP) to provide free seasonal influenza vaccines for the entire population. This is the first large-scale program of its kind worldwide. The objective of this study was to conduct an economic appraisal of Ontario’s UIIP compared to a targeted influenza immunization program (TIIP).

Methods and Findings
A cost-utility analysis using Ontario health administrative data was performed. The study was informed by a companion ecological study comparing physician visits, emergency department visits, hospitalizations, and deaths between 1997 and 2004 in Ontario and nine other Canadian provinces offering targeted immunization programs. The relative change estimates from pre-2000 to post-2000 as observed in other provinces were applied to pre-UIIP Ontario event rates to calculate the expected number of events had Ontario continued to offer targeted immunization. Main outcome measures were quality-adjusted life years (QALYs), costs in 2006 Canadian dollars, and incremental cost-utility ratios (incremental cost per QALY gained). Program and other costs were drawn from Ontario sources. Utility weights were obtained from the literature. The incremental cost of the program per QALY gained was calculated from the health care payer perspective. Ontario’s UIIP costs approximately twice as much as a targeted program but reduces influenza cases by 61% and mortality by 28%, saving an estimated 1,134 QALYs per season overall. Reducing influenza cases decreases health care services cost by 52%. Most cost savings can be attributed to hospitalizations avoided. The incremental cost-effectiveness ratio is Can$10,797/QALY gained. Results are most sensitive to immunization cost and number of deaths averted.

Conclusions
Universal immunization against seasonal influenza was estimated to be an economically attractive intervention.

Vaccine
Volume 28, Issue 19, Pages 3265-3508 (26 April 2010)
http://www.sciencedirect.com/science/journal/0264410X

Conference Report
Report of the sixth AREB meeting, Manila, The Philippines, 10–12 November 2009
Pages 3265-3268
B. Dodet and for the Asian Rabies Expert Bureau (AREB)

Abstract
During their sixth annual meeting held in Manila (Philippines), the Asian Rabies Expert Bureau (AREB) reviewed the implementation of programs for rabies prevention, control, and elimination in Asia. AREB members strongly support a “one health” approach for controlling rabies, combining increased public awareness, community involvement, pre-exposure prophylaxis (PrEP) programs for children living in endemic areas, improved dog bite management and improved access to post-exposure prophylaxis (PEP) for exposed persons, as well as extended dog vaccination. They called for stronger PrEP recommendations for children living at risk of rabies exposure and clear, simplified PEP regimens utilizing modern WHO pre-qualified vaccines and, in case of category III exposures, appropriate administration of rabies immunoglobulin (RIG) or, hopefully, monoclonal antibody combinations in the future. They renewed their support for World Rabies Day, one of the best opportunities to increase advocacy for rabies control.

Vaccine
Volume 28, Issue 19, Pages 3265-3508 (26 April 2010)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
The Immunisation Beliefs and Intentions Measure (IBIM): Predicting parents’ intentions to immunise preschool children
Pages 3350-3362
Sarah Tickner, Patrick J. Leman, Alison Woodcock

Abstract
In England, uptake of the second dose of MMR (against measles, mumps, rubella), and dTaP/IPV or DTaP/IPV booster (against diphtheria, tetanus, pertussis, polio), is lower than that of the primary course. The Immunisation Beliefs and Intentions Measure (IBIM), based on the theory of planned behaviour (TPB) and qualitative interviews, was used to predict parents’ intentions to take preschoolers for these recommended vaccinations. Parents from 43 child groups in southern England were randomised to receiving questions about either MMR (N = 193) or dTaP/IPV (N = 159). Overall, 255 parents fully completed TPB-based items. Regression analyses revealed that parental attitudes about the protective benefits of immunising and perceived behavioural control were strong, reliable predictors of intention to immunise with MMR. For dTaP/IPV, perceived protective benefits and number of children reliably predicted intention to immunise. Differences between parents with ‘maximum immunisation intentions’ and those with ‘less than maximum intentions’ are described. The IBIM appears to be a useful measure for predicting parents’ intentions to immunise preschoolers. Implications for improving uptake are discussed.

Vaccine
Volume 28, Issue 19, Pages 3265-3508 (26 April 2010)
http://www.sciencedirect.com/science/journal/0264410X

Characterizing the acceptability of a vaccine for West Nile virus by public health practitioners
Pages 3423-3427
Tasha Epp, Shannon Waldner, Judith Wright, Phil Curry, Hugh G. Townsend, Andrew Potte

Abstract
This study examines health care personnel’s knowledge of West Nile virus (WNv) and attitudes towards a proposed chimeric yellow fever/WNv vaccine within the province of Saskatchewan. Telephone and in-person interviews with medical health officers and public health nurses provided information with which to assess the acceptability of implementing vaccination as a component for prevention of WNv within the province with the highest number of WNv cases to date in western Canada. The majority of health care professionals felt confident in the potential efficacy of vaccination for prevention of WNv but suggested that targeted vaccination programs could be most effective.

The WHO continues to issue weekly updates on the H1N1 pandemic updates at http://www.who.int/csr/disease/swineflu/en/index.html

Pandemic (H1N1) 2009 – update 94
Weekly update
1 April 2010

As of 28 March 2010, worldwide more than 213 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17483 deaths.

WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of information.

Situation update:
The most active areas of pandemic influenza virus transmission currently are in parts of the tropical zones of Asia, the Americas, and Africa. Pandemic influenza activity remains low in much of the temperate areas of both the northern and southern hemispheres. Although pandemic influenza virus continues to be the predominant influenza virus circulating worldwide, seasonal influenza type B viruses are predominant in much of East Asia, and have been increasingly detected at low levels across southeast and western Asia, East Africa, and in parts of eastern and northern Europe. Seasonal influenza A (H3N2) is still being detected in very small numbers in parts of Asia and Australia…  More at: http://www.who.int/csr/don/2010_04_01/en/index.html

WHO reported that from 4 January to 28 March 2010, the Ministry of Health of Chad reported 1531 suspected cases of meningococcal disease including 151 deaths (case-fatality rate: 10%). So far, seven districts have crossed the epidemic threshold (Bébidja, Bédjondo, Béré, Doba, Dono-Manga, Goundi and Laï) while five others crossed the alert threshold (Bénoye, Laokassi and Sarh). The International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control has provided 157,000 doses of trivalent ACW vaccine for a mass vaccination campaign in affected areas of Dono-Manga and Goundi as well as 282,000 doses of bivalent vaccine for mass vaccination in Doba and Bebidja. Vaccines are being provided with the support of the Global Alliance for Vaccines and Immunization (GAVI). Vaccination campaigns have been completed or are being conducted in Bébidja and Doba district, while others will take place shortly in Dono-Manga and Goundi districts. WHO, UNICEF, Médecins sans Frontières and the International Federation of Red Cross (IFRC) are working with the Ministry of Health, Chad to implement the vaccination campaigns as well as other emergency control measures, including case management and surveillance in neighbouring districts.

http://www.who.int/csr/don/2010_04_01a/en/index.html

The MMWR for April 2, 2010 / Vol. 59 / No. 12 includes:
Interim Results: Influenza A (H1N1) 2009 Monovalent and Seasonal Influenza Vaccination Coverage Among Health-Care Personnel — United States, August 2009–January 2010

Abstract

Since 1986, the Healthcare Infection Control Practices Advisory Committee and the Advisory Committee on Immunization Practices (ACIP) have recommended all health-care personnel (HCP) be vaccinated annually for influenza. Since 1989, estimated overall influenza vaccination coverage among HCP has never exceeded 49%. This report summarizes results of a population-based survey administered via the Internet in January 2010 to 1,417 HCP to assess vaccination coverage. By mid-January 2010, estimated vaccination coverage among HCP was 37.1% for 2009 pandemic influenza A (H1N1) and 61.9% for seasonal influenza. Overall, 64.3% received either of these influenza vaccines, but only 34.7% reported receiving both vaccines.

From report:

“…Seasonal influenza vaccination coverage was substantially higher among HCP working in hospitals (71.7%) than those working in long-term care facilities (54.0%) or other settings (48.4%) (p = 0.003 and p = 0.001, respectively). 2009 H1N1 vaccination coverage also was higher among HCP working in hospitals (50.6%) than those working in outpatient clinics (39.2%), long-term care facilities (20.1%), or other settings (33.4%) (p = 0.003, p<0.001, and p = 0.015, respectively). For both vaccine types, physicians, physician assistants, dentists, and nurses had similar vaccination levels, which were slightly higher than those for allied health professionals and nonclinical staff; however, differences between these professional groups were not statistically significant…”

The MMWR for April 2, 2010 / Vol. 59 / No. 12 includes:

March 19, 2010 / Vol. 59 / No. RR–2
Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies — Recommendations of the Advisory Committee on Immunization Practices
Abstract

This report summarizes new recommendation and updates previous recommendations of the Advisory Committee on Immunization Practices (ACIP) for postexposure prophylaxis (PEP) to prevent human rabies. Previously, ACIP recommended a 5-dose rabies vaccination regimen with human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV). These new recommendations reduce the number of vaccine doses to four. ACIP recommendations for the use of rabies immune globulin (RIG) remain unchanged. For persons who previously received a complete vaccination series (pre- or postexposure prophylaxis) with a cell-culture vaccine or who previously had a documented adequate rabies virus-neutralizing antibody titer following vaccination with noncell-culture vaccine, the recommendation for a 2-dose PEP vaccination series has not changed. Similarly, the number of doses recommended for persons with altered immunocompetence has not changed; for such persons, PEP should continue to comprise a 5-dose vaccination regimen with 1 dose of RIG. Recommendations for preexposure prophylaxis also remain unchanged, with 3 doses of vaccine administered on days 0, 7, and 21 or 28. Prompt rabies PEP combining wound care, infiltration of RIG into and around the wound, and multiple doses of rabies cell culture vaccine continue to be highly effective in preventing human rabies.

Clinical Infectious Diseases
1 May 2010  Volume 50, Number 9
http://www.journals.uchicago.edu/toc/cid/current

Invited Article
Surfing The Web: Infectious Diseases Resources for the iPhone
Richard L. Oehler, Kevin Smith, and John F. Toney

Abstract
Modern technology has revolutionized the clinician’s ability to have vast information resources available literally at one’s fingertips. The advent of the smartphone—an integration of the mobile phone with an ultraportable computer, web browser, multimedia player, and camera, has given clinicians the capability to merge their information and communication resources into one compact handheld instrument. Apple’s iPhone, and its sister device, the iPod touch, with a combined customer base of more than 50 million users and more than 100,000 downloadable applications, are now the leading handheld platforms for medical personnel to access personal information, medical reference, clinical data, and medically oriented “apps” on the go. The purpose of this article is to provide an overview of some of the diverse infectious diseases‐oriented resources available to the iPhone/iPod touch user.

Human Vaccines
Volume 6, Issue 4  April 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/3/

Special Focus Reviews
Tuberculosis vaccine development :The development of novel (preclinical) DNA vaccine
Masaji Okada and Yoko Kita

Abstract
A third of the world’s population is infected with Mycobacterium tuberculosis, and 2 million people die from tuberculosis every year. The only tuberculosis vaccine currently available is an attenuated strain of Mycobacterium bovis BCG, although its efficacy against adult tuberculosis disease remains controversial. Furthermore multi-drug resistant tuberculosis is becoming big problems [a big problem] in the world. Therefore, the development of novel therapeutic vaccine as well as novel prophylactic vaccine against tuberculosis is required. This review provides a summary of novel vaccines (especially DNA vaccines) in preclinical stage using mouse, guinea pig and monkey models. In several promising novel vaccines, the studies were extended to a cynomolgus monkey model, which is currently the best animal model of human tuberculosis. The review also provides recent advances of the precise studies of induction of immunity including CD8 positive cytotoxic T cells and effector molecules such as granulysin by these vaccines, against multi-drug resistant tuberculosis and extremely drug resistant tuberculosis.

Towards new tuberculosis vaccine
Open Access Article
Stefan Svenson, Gunilla Källenius, Andrzej Pawlowski and Beston Hamasur

Abstract
According to WHO, about one third of the world’s population is infected with bacteria of the Mycobacterium tuberculosis complex. Currently there is globally 9.15 million recorded cases of overt tuberculosis (TB) annually and due to lack of adequate diagnostics presumably a large but unknown number of non-recorded cases. TB is estimated to cause 1.65 million deaths per annum which accounts for one-fifth of all deaths by infectious diseases of adults in low-income countries. During recent years a rapid spread of multi-drug resistant bacteria causing about 0.5 million TB cases per year has worsened the problem. The live attenuated Bacillus Calmette-Guérin (BCG) vaccine which is the only currently available TB vaccine does not confer any significant protection against the most common and contagious form of TB – adult pulmonary TB.

Pediatrics
April 2010 / VOLUME 125 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Parental Vaccine Safety Concerns in 2009
Gary L. Freed, MD, MPHa,b,c, Sarah J. Clark, MPHa,b, Amy T. Butchart, MPHa,b, Dianne C. Singer, MPHa,b, Matthew M. Davis, MD, MAPPa,b,d,e
a Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, and
d Division of General Internal Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan; and
b Child Health Evaluation and Research Unit,
c Department of Health Management and Policy, School of Public Health, and
e Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan

OBJECTIVE Vaccine safety concerns can diminish parents’ willingness to vaccinate their children. The objective of this study was to characterize the current prevalence of parental vaccine refusal and specific vaccine safety concerns and to determine whether such concerns were more common in specific population groups.

METHODS In January 2009, as part of a larger study of parents and nonparents, 2521 online surveys were sent to a nationally representative sample of parents of children who were aged 17 years. The main outcome measures were parental opinions on vaccine safety and whether the parent had ever refused a vaccine that a doctor recommended for his or her child.

RESULTS The response rate was 62%. Most parents agreed that vaccines protect their child(ren) from diseases; however, more than half of the respondents also expressed concerns regarding serious adverse effects. Overall, 11.5% of the parents had refused at least 1 recommended vaccine. Women were more likely to be concerned about serious adverse effects, to believe that some vaccines cause autism, and to have ever refused a vaccine for their child(ren). Hispanic parents were more likely than white or black parents to report that they generally follow their doctor’s recommendations about vaccines for their children and less likely to have ever refused a vaccine. Hispanic parents were also more likely to be concerned about serious adverse effects of vaccines and to believe that some vaccines cause autism.

CONCLUSIONS Although parents overwhelmingly share the belief that vaccines are a good way to protect their children from disease, these same parents express concerns regarding the potential adverse effects and especially seem to question the safety of newer vaccines. Although information is available to address many vaccine safety concerns, such information is not reaching many parents in an effective or convincing manner.

Pediatrics
April 2010 / VOLUME 125 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Measles Outbreak in a Highly Vaccinated Population, San Diego, 2008: Role of the Intentionally Undervaccinated

David E. Sugerman, MD, MPHa, Albert E. Barskey, MPHb, Maryann G. Delea, MPHc, Ismael R. Ortega-Sanchez, PhDb, Daoling Bi, MSb, Kimberly J. Ralston, MPHd, Paul A. Rota, PhDb, Karen Waters-Montijo, MPHd, Charles W. LeBaron, MDb

a Epidemic Intelligence Service, Office of Workforce and Career Development, and
b Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
c Council of State and Territorial Epidemiologists, Atlanta, Georgia; and
d Immunizations Branch, County of San Diego Health and Human Services Agency, San Diego, California

OBJECTIVE In January 2008, an intentionally unvaccinated 7-year-old boy who was unknowingly infected with measles returned from Switzerland, resulting in the largest outbreak in San Diego, California, since 1991. We investigated the outbreak with the objective of understanding the effect of intentional undervaccination on measles transmission and its potential threat to measles elimination.

METHODS We mapped vaccination-refusal rates according to school and school district, analyzed measles-transmission patterns, used discussion groups and network surveys to examine beliefs of parents who decline vaccination, and evaluated containment costs.

RESULTS The importation resulted in 839 exposed persons, 11 additional cases (all in unvaccinated children), and the hospitalization of an infant too young to be vaccinated. Two-dose vaccination coverage of 95%, absence of vaccine failure, and a vigorous outbreak response halted spread beyond the third generation, at a net public-sector cost of $10 376 per case. Although 75% of the cases were of persons who were intentionally unvaccinated, 48 children too young to be vaccinated were quarantined, at an average family cost of $775 per child. Substantial rates of intentional undervaccination occurred in public charter and private schools, as well as public schools in upper-socioeconomic areas. Vaccine refusal clustered geographically and the overall rate seemed to be rising. In discussion groups and survey responses, the majority of parents who declined vaccination for their children were concerned with vaccine adverse events.

CONCLUSIONS Despite high community vaccination coverage, measles outbreaks can occur among clusters of intentionally undervaccinated children, at major cost to public health agencies, medical systems, and families. Rising rates of intentional undervaccination can undermine measles elimination.

Pediatrics
April 2010 / VOLUME 125 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Clinical Report—Guidelines for the Ethical Conduct of Studies to Evaluate Drugs in Pediatric Populations
Robert E. Shaddy, MD, Scott C. Denne, MD,

The Committee on Drugs and Committee on Pediatric Research
The proper ethical conduct of studies to evaluate drugs in children is of paramount importance to all those involved in these types of studies. This report is an updated revision to the previously published guidelines from the American Academy of Pediatrics in 1995. Since the previous publication, there have been great strides made in the science and ethics of studying drugs in children. There have also been numerous legislative and regulatory advancements that have promoted the study of drugs in children while simultaneously allowing for the protection of this particularly vulnerable group. This report summarizes these changes and advances and provides a framework from which to guide and monitor the ethical conduct of studies to evaluate drugs in children.

Free pdf of article: http://pediatrics.aappublications.org/cgi/reprint/125/4/850

Science
2 April 2010  Vol 328, Issue 5974, Pages 1-122
http://www.sciencemag.org/current.dtl

Perspectives
Virology:
A Vaccine Monkey Wrench?

Hartmut Hengel1 and Ulrich H. Koszinowski2
Cytomegalovirus (CMV) is an enveloped DNA virus that, like other herpes viruses, establishes life-long latency in its host after infection. Reactivation of latent virus or secondary infection by the same (or similar) virus frequently occurs, confounding the host’s ability to establish immune protection. In industrialized countries, primary, recurrent, and secondary infection during pregnancy is the greatest cause of many congenital diseases such as childhood deafness, and neurological handicaps, including mental retardation. Hence, development of a vaccine against human CMV is a high priority (1). On page 102 of this issue, Hansen et al. (2) elucidate how CMV reinfects its human host despite the immune system’s capacity to control primary infection.

1 Institute for Virology, Heinrich-Heine-University, Düsseldorf, Germany.
2 Max von Pettenkofer-Institute, Ludwig-Maximilians-University, Munich, Germany.