The WHO’s Initiative for Vaccine Research (IVR) released its Strategic Plan 2010-2020. The Executive Summary of the 34-page plan notes:

“Building on a decade of experience, IVR has formulated a long-term Strategic Plan that takes account of the evolving vaccine R&D landscape, and of the strong leadership role it can play as the WHO integrated vaccine research arm. The much welcomed new players in the vaccine R&D pipeline accentuate the need for increased global coordination and normative and technical support to countries, roles that are at the heart of IVR’s mandate.

“The Strategic Plan 2010–2020 has a matrix approach that uses four strategic functions and a set of priority areas to address public health priorities, and it is here that IVR has most significantly evolved since the previous strategy. The matrix is directly aligned with WHO’s corporate strategy and policies to stimulate innovation in health research, as well as with the global immunization agenda of the Organization. This harmonization will further strengthen synergies between research- and disease-focused programmes.

Strategic functions
The four strategic functions that will guide the core work of IVR over the next 10 years are:
i) identification of vaccine and vaccination research priorities;
ii) the development of research standards and guidelines;
iii) the strengthening of research and product development capacity;
iv) the translation of research results into policy and practice.

http://whqlibdoc.who.int/hq/2010/WHO_IVB_10.02_eng.pdf

The sixty-third World Health Assembly (17–21 May 2010; Geneva, Switzerland) closed after passing multiple resolutions. A WHO media summarized these actions from which we select those key to our monitoring of issues touching on vaccine ethics and policy:

…Public health, innovation and intellectual property: global strategy and plan for action
The issue of intellectual property is critical for 4.8 billion people who live in developing countries, more than 40% of them living on less than 2 US dollars a day. Poverty affects their access to health products to fight disease. The debate this year focused on financing issues, including the rational use of funds, and conducting research through regional networks. The global strategy proposes that WHO should play a strategic and central role in the relationship between public health and innovation and intellectual property within its mandate. The strategy was designed to promote new thinking in innovation and access to medicines, which would encourage needs-driven research rather than purely market-driven research. A new consultative working group will examine the way to take this work forward and is expected to report back to the 65th Health Assembly in 2012…

…Viral hepatitis
Member States accepted the report to the World Health Assembly and adopted a resolution including a World Hepatitis Day on 28 July. Viral hepatitis (i.e. hepatitis A, B, C, D and E) —a combination of diseases that are estimated to kill over 1 million people each year and an estimated 1 in 12 persons are currently infected and have to face a life with liver disease if unrecognized. This endorsement by Member States calls for WHO to develop a comprehensive approach to the prevention and control of these diseases…

…Monitoring of the achievement of the health-related Millennium Development Goals (MDGs)
The resolution expresses concern at the relatively slow progress in attaining the Millennium Development Goals, particularly in sub-Saharan Africa and at the fact that maternal, newborn and child health as well as universal access to reproductive health services remain constrained by health inequities.   Member States noted that MDGs 4 and 5 were lagging behind and agreed to strengthen national health systems as well as take into account health equity in all national policies. They also reaffirmed the value of primary health care and renewed their commitment to prevent and eliminate maternal, newborn and child mortality and morbidity…

…Global eradication of measles
Member States endorsed a series of interim targets set for 2015 as milestones towards the eventual global eradication of measles. Countries were encouraged by the efforts and progress made in controlling measles but also highlighted the challenges that need to be addressed to achieve the 2015 targets. These include competing public health priorities, weak immunization systems, sustaining high routine vaccination coverage, addressing the funding gap, vaccinating the hard-to-reach population and addressing an increasing number of measles outbreaks particularly in cross border areas. Success in achieving the measles 2015 targets is a key issue if the Millennium Development Goal 4 to reduce child mortality is to be reached…

…Treatment and prevention of pneumonia
WHO Member States adopted a resolution on the treatment and prevention of pneumonia — the number one killer of children under five years globally. The resolution makes it clear that intensified efforts to address pneumonia are imperative if the achievement of Millennium Development Goal 4 is to be achieved…

…Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits
Members States expressed strong support for the continuing efforts of the Open-Ended Working Group to further global pandemic influenza preparedness by strengthening the sharing of influenza viruses and of benefits such as vaccines. Member States spoke on the progress made at the recent intergovernmental meeting (held 10-12 May 2010) and characterized the interaction as transparent, substantive, collaborative and an important foundation for future negotiation in this area. The role of industry as a stakeholder in the process to increase global capacity for vaccine production, increased technology transfer to developing countries, and access to supplies of vaccine and medicines at affordable prices for resource-limited countries were among issues raised. A number of countries urged the collaboration to move forward to increase pandemic preparedness and protect global public health. Having considered the report of the Open-Ended Working Group (15 April 2010), a resolution was passed:
– to request the Director-General to continue to support the effort and undertake any technical consultations and studies as necessary; and
– to decide that the group will report through the Executive Board to the Sixty-fourth World Health Assembly ( May 2011) .

http://www.who.int/mediacentre/news/releases/2010/wha_closes_20100521/en/index.html

Complete World Health Assembly documentation available at: http://apps.who.int/gb/e/e_wha63.html

The GAVI Alliance said it welcomed the World Health Assembly resolution “that calls on the WHO and its 193 Member States to take concrete actions to tackle pneumonia, which kills more than 1.6 million children a year…”  GAVI CEO Julian Lob-Levyt commented, “We applaud this initiative and we call on governments to adhere to the commitment they made here today to protect the world’s most vulnerable citizens. The resolution was passed by consensus, underlining a new universal commitment to combating pneumonia…This is the first time that governments of the world have come together to make a unified, comprehensive commitment to tackle the most prevalent killer of young children in the world.” The resolution calls on governments to combat pneumonia “through implementation of three groups of effective interventions outlined in the WHO/UNICEF Global Action Plan for the prevention and control of Pneumonia (GAPP). The GAPP aims to:
– Protect children by providing a healthy environment where they are at low risk of pneumonia; steps include encouraging exclusive breastfeeding for six months, reducing indoor air pollution and promoting hand washing
– Prevent children becoming ill with pneumonia by vaccinating against its causes. Pneumococcus bacteria and Haemophilus influenzae type b (Hib) are the leading causes of the most severe cases of pneumonia and both are vaccine-preventable
– Treat children who become ill with pneumonia through effective case management in communities, health centres and hospitals.

http://www.gavialliance.org/media_centre/press_releases/2010_05_21_wha_pneumonia_resolution.php

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

Pandemic (H1N1) 2009 – update 101
Weekly update
21 May 2010

As of 16 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18097 deaths…

Situation update:
The current situation is largely unchanged since the last update. The most active areas of pandemic influenza virus transmission currently are in parts of the Caribbean and Southeast Asia. In the temperate zone of the northern and southern hemisphere, overall pandemic influenza activity remains low to sporadic. In central Africa, there has been increased transmission of seasonal influenza type B viruses, accounting for 85% of all influenza isolates in the region. Influenza B also continues to be detected at low levels across parts of Asia and Europe, and has now been reported in Central America…

More at: http://www.who.int/csr/don/2010_05_21/en/index.html

The NIH said that new research “has found that an experimental Ebola vaccine developed by NIH researchers protects monkeys against not only the two most lethal Ebola virus species for which it was originally designed, both recognized in 1976, but also against a newer Ebola virus species that was identified in 2007.” Nancy J. Sullivan, Ph.D., of the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases (NIAID), NIH, led the study team. Currently, there are no specific treatments or vaccines available to control Ebola outbreaks. NIAID Director Anthony S. Fauci, M.D. commented, “The important work by Dr. Sullivan and her colleagues shows that it is possible to generate immunity to newly identified species of Ebola virus with a vaccine originally designed to protect against a different species,” says “This finding will guide future vaccine design and may open an avenue for developing a single vaccine that works against both known and emerging Ebola virus species.” The experimental Ebola vaccine being developed at NIAID has two components, a prime and a boost. The prime consists of a DNA vaccine containing a small piece of genetic material encoding surface proteins from Zaire ebolavirus and Sudan ebolavirus. The boost consists of a weakened cold virus that delivers the Zaire ebolavirus surface protein.

http://www.nih.gov/news/health/may2010/niaid-20.htm

The findings appear in the open-access journal PLoS Pathogens 20 May 2010: http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1000904

GAVI noted that “vaccine bonds” offered by the International Finance Facility for Immunisation (IFFIm) since 2008 “have proved remarkably popular with Japanese retail investors, particularly women who account for around half the buyers in recent transactions,” and have raised more than JPY 111 billion equivalent (US$ 1.2 billion). GAVI said this support has increased its grant giving capacity by 100 per cent. From http://www.gavialliance.org/media_centre/press_releases/2010_05_20_iffim_japan.php

The Weekly Epidemiological Record (WER) for 21 May 2010, vol. 85, 21 (pp 185–196) includes: Rift Valley fever, South Africa – update; Public health measures taken at international borders during early stages of pandemic influenza A (H1N1) 2009: preliminary results; Prevention and treatment of artemisinin-resistant falciparum malaria: update for international travellers

http://www.who.int/wer/2010/wer8521.pdf

Clinical Infectious Diseases
15 June 2010  Volume 50, Number 12
http://www.journals.uchicago.edu/toc/cid/current

Review Article
Guidance for Isolation Precautions for Mumps in the United States: A Review of the Scientific Basis for Policy Change

Preeta K. Kutty, Moe H. Kyaw, Gustavo H. Dayan, Michael T. Brady, Joseph A. Bocchini, Jr, Susan E. Reef, William J. Bellini, and Jane F. Seward

Abstract
The 2006 mumps resurgence in the United States raised questions about the appropriate isolation period for people with mumps. To determine the scientific basis for isolation recommendations, we conducted a literature review and considered isolation of virus and virus load in saliva and respiratory secretions as factors that were related to mumps transmission risk. Although mumps virus has been isolated from 7 days before through 8 days after parotitis onset, the highest percentage of positive isolations and the highest virus loads occur closest to parotitis onset and decrease rapidly thereafter. Most transmission likely occurs before and within 5 days of parotitis onset. Transmission can occur during the prodromal phase and with subclinical infections. Updated guidance, released in 2007–2008, changed the mumps isolation period from 9 to 5 days. It is now recommended that mumps patients be isolated and standard and droplet precautions be followed for 5 days after parotitis onset.

Clinical Infectious Diseases
15 June 2010  Volume 50, Number 12
http://www.journals.uchicago.edu/toc/cid/current

Invited Article
Emerging Infections: The Origin and Prevention of Pandemics

Brian L. Pike, Karen E. Saylors, Joseph N. Fair, Matthew LeBreton, Ubald Tamoufe, Cyrille F. Djoko, Anne W. Rimoin, and Nathan D. Wolfe

Abstract
Despite the fact that most emerging diseases stem from the transmission of pathogenic agents from animals to humans, the factors that mediate this process are still ill defined. What is known, however, is that the interface between humans and animals is of paramount importance in the process. This review will discuss the importance of the human-animal interface to the disease emergence process. We also provide an overview of factors that are believed to contribute to the origin and global spread of emerging infectious diseases and offer suggestions that may serve as future prevention strategies, such as social mobilization, public health education, behavioral change, and communication strategies. Because there exists no comprehensive global surveillance system to monitor zoonotic disease emergence, the intervention measures discussed herein may prove effective temporary alternatives.

Emerging Infectious Diseases
Volume 16, Number 6–June 2010
http://www.cdc.gov/ncidod/EID/index.htm

Commentary
Whence Feral Vaccinia?

Richard C. Condit
University of Florida, Gainesville, Florida, USA

[Full text]
When the World Health Organization declared smallpox eradicated in 1979, smallpox vaccination was discontinued worldwide. Although cessation of smallpox vaccination is well justified, given the risks associated with complications from the vaccine, lack of vaccination nevertheless creates a growing population of persons now susceptible to infection by a few poxviruses previously covered by the smallpox vaccine. These include the orthopoxviruses monkeypox; cowpox; and, ironically, vaccinia, the virus used for smallpox vaccination. Although few persons die from these infections, they are nevertheless a public health nuisance and expense. Thus, understanding the epidemiology of these viruses is in the interest of public health.

The most common vaccine-preventable poxvirus infections in humans are cowpox and monkeypox (1). Both are zoonoses; the natural host for each seems to be rodents, and transmission occurs through close contact. Monkeypox virus occurs in western and central Africa, causes a disseminated infection in humans, can be transmitted among humans at a low rate, and is associated with a 1%–10% (depending on the virus strain) case-fatality rate. Cowpox virus is relatively common in Europe and Asia, causes a limited exanthema, and does not often cause death of previously healthy persons.

Vaccinia, the virus used in the live smallpox vaccine, was originally isolated in the late 18th century from persons with illness that clinically resembled cowpox. However, modern genomics have shown that the vaccinia virus strains used for smallpox control in the 20th and 21st centuries are genetically distinct from cowpox viruses currently circulating. In fact, with 2 notable exceptions, vaccinia virus is not found in nature. However, vaccinia infection has been documented in India and Brazil (2). In India, some strains of buffalopox, transmitted to humans through buffaloes, appear to be vaccinia. Likewise, in Brazil, reports of a cowpox-like disease, caused by a vaccinia virus and transmitted from cattle to humans, have increased substantially since the first report in 2000. In both outbreaks (India and Brazil), evidence suggests that the original source of the virus was the smallpox vaccine virus that has been introduced into the wild—or feral vaccinia, as it has sometimes been called. The reservoirs for these viruses in the wild are not well understood.

In this issue of Emerging Infectious Diseases, Abrahão et al. (3) describe a serosurvey for orthopoxvirus among 344 wild animals from the Brazilian Amazonia ecosystem. The animals, 296 monkeys and a variety of other mammals, were captured by a fauna-rescue program during the construction of a hydroelectric plant in Tocantins State, Brazil, far removed from other human activity. Of these animals, 84 (24%), predominantly monkeys, were seropositive for orthopoxvirus. Furthermore, 18 serum samples were positive for orthopoxvirus DNA according to PCR. From these 18 positive samples, sequencing of 6 isolates revealed the vaccinia strain commonly associated with vaccinia outbreaks among cattle and humans in Brazil.

These finding suggest a remarkably high incidence of vaccinia infection in the Brazilian wilderness and in a host, namely monkeys, not normally considered as an active reservoir for orthopoxviruses. Although Abrahão et al. do not specifically identify monkeys as a primary reservoir for vaccinia virus and do not address the mode of transmission of the virus among these animals, the results suggest a substantial repository of vaccinia virus in the Brazilian wilderness. Especially given the broad host range of vaccinia, these findings warrant a substantial effort to characterize further the circulation of vaccinia virus in this region. If the results described in the article by Abrahão et al. (3) can be confirmed and expanded by other laboratories, they would have major implications for public health.

Dr Condit is a professor in the Department of Molecular Genetics and Microbiology at the University of Florida. His research interests are the fundamental mechanisms of poxvirus transcription and assembly.

References

Damon IK. Poxviruses. In: Knipe DM , Howley PM, editors, Fields virology. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 2947–75.

Moussatché N, Damaso CR, McFadden G. When good vaccines go wild: feral Orthopoxvirus in developing countries and beyond. Journal of Infections in Developing Countries. 2008;2:156–73.

Abrahão JS, Silva-Fernandes AT, Lima LS, Campos RK, Guedes MIMC, Cota MMG, et al. Vaccinia virus infection in monkeys, Brazilian Amazon. Emerg Infect Dis. 2010;16:976–9.

The Lancet
May 22, 2010  Volume 375  Number 9728  Pages 1753 – 1844
http://www.thelancet.com/journals/lancet/issue/current

[This issue includes a number of Comment and Perspectives pieces on TB]

Series
Tuberculosis control and elimination 2010–50: cure, care, and social development
Knut Lönnroth, Kenneth G Castro, Jeremiah Muhwa Chakaya, Lakhbir Singh Chauhan, Katherine Floyd, Philippe Glaziou, Mario C Raviglione

Preview
Rapid expansion of the standardised approach to tuberculosis diagnosis and treatment that is recommended by WHO allowed more than 36 million people to be cured between 1995 and 2008, averting up to 6 million deaths. Yet tuberculosis remains a severe global public health threat. There are more than 9 million new cases every year worldwide, and the incidence rate is falling at less than 1% per year. Although the overall target related to the Millennium Development Goals of halting and beginning to reverse the epidemic might have already been reached in 2004, the more important long-term elimination target set for 2050 will not be met with present strategies and instruments.

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

Leading Edge
Coordination essential in malaria battle
The Lancet Infectious Diseases

April 24 marked World Malaria Day, 2010. A particularly important year in the fight against the disease, since December is the target date for the ambitious goal set out by the World Health Assembly and Roll Back Malaria in 2008 to provide universal access to prevention and treatment, with the aim of halving the number of cases of and deaths from the disease relative to 2000. Furthermore, this year is two-thirds of the way along the path to the target date for the Millennium Development Goals (MDGs), several of which are intrinsically linked to malaria, and dependent on successes in its control.

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.

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

The Xs and Y of immune responses to viral vaccines
Sabra L Klein, Anne Jedlicka, Andrew Pekosz

Preview
The biological differences associated with the sex of an individual are a major source of variation, affecting immune responses to vaccination. Compelling clinical data illustrate that men and women differ in their innate, humoral, and cell-mediated responses to viral vaccines. Sex affects the frequency and severity of adverse effects of vaccination, including fever, pain, and inflammation. Pregnancy can also substantially alter immune responses to vaccines. Data from clinical trials and animal models of vaccine efficacy lay the groundwork for future studies aimed at identifying the biological mechanisms that underlie sex-specific responses to vaccines, including genetic and hormonal factors.

Nature
Volume 465 Number 7296 pp267-390  20 May 2010
http://www.nature.com/nature/current_issue.html

Thousands of chemical starting points for antimalarial lead identification
Francisco-Javier Gamo, Laura M. Sanz, Jaume Vidal, Cristina de Cozar, Emilio Alvarez, Jose-Luis Lavandera, Dana E. Vanderwall, Darren V. S. Green, Vinod Kumar, Samiul Hasan, James R. Brown, Catherine E. Peishoff, Lon R. Cardon & Jose F. Garcia-Bustos

Abstract
Malaria is a devastating infection caused by protozoa of the genus Plasmodium. Drug resistance is widespread, no new chemical class of antimalarials has been introduced into clinical practice since 1996 and there is a recent rise of parasite strains with reduced sensitivity to the newest drugs. We screened nearly 2 million compounds in GlaxoSmithKline’s chemical library for inhibitors of P. falciparum, of which 13,533 were confirmed to inhibit parasite growth by at least 80% at 2 µM concentration. More than 8,000 also showed potent activity against the multidrug resistant strain Dd2. Most (82%) compounds originate from internal company projects and are new to the malaria community. Analyses using historic assay data suggest several novel mechanisms of antimalarial action, such as inhibition of protein kinases and host–pathogen interaction related targets. Chemical structures and associated data are hereby made public to encourage additional drug lead identification efforts and further research into this disease.

Chemical genetics of Plasmodium falciparum
W. Armand Guiguemde, Anang A. Shelat, David Bouck, Sandra Duffy, Gregory J. Crowther, Paul H. Davis, David C. Smithson, Michele Connelly, Julie Clark, Fangyi Zhu, María B. Jiménez-Díaz, María S. Martinez, Emily B. Wilson, Abhai K. Tripathi, Jiri Gut, Elizabeth R. Sharlow, Ian Bathurst, Farah El Mazouni, Joseph W. Fowble, Isaac Forquer, Paula L. McGinley, Steve Castro, Iñigo Angulo-Barturen, Santiago Ferrer, Philip J. Rosenthal, Joseph L. DeRisi, David J. Sullivan, John S. Lazo, David S. Roos, Michael K. Riscoe, Margaret A. Phillips, Pradipsinh K. Rathod, Wesley C. Van Voorhis, Vicky M. Avery & R. Kiplin Guy

Here, a library of more than 300,000 chemicals was screened for activity against Plasmodium falciparum growing in red blood cells. Of these chemicals, 172 representative candidates were profiled in detail; one exemplar compound showed efficacy in a mouse model of malaria. The findings provide the scientific community with new starting points for drug discovery.

Nature
Volume 465 Number 7296 pp267-390  20 May 2010
http://www.nature.com/nature/current_issue.html

Letter
Climate change and the global malaria recession
Peter W. Gething, David L. Smith, Anand P. Patil, Andrew J. Tatem, Robert W. Snow & Simon I. Hay

Rising global temperatures resulting from climate change have been predicted to increase the future incidence of infectious diseases, including malaria. However, it is known that the range of malaria has contracted through a century of economic development and disease control. This contraction has now been quantified, and compared with the predicted effects of climate on malaria incidence. It is suggested that the impact of rising temperature is likely to be minor.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X

Volume 28, Issue 23, Pages 3875-4012 (21 May 2010)

Conference Report
Report of the fourth meeting on ‘Influenza vaccines that induce broad spectrum and long-lasting immune responses’, World Health Organization and Wellcome Trust, London, United Kingdom, 9–10 November 2009
Iain Stephenson, Frederick Hayden, Albert Osterhaus, Wendy Howard, Yuri Pervikov, Laszlo Palkonyay, Marie-Paule Kieny

Abstract
Current influenza vaccines are limited by the need for annual immunisation, frequent antigenic updating to match the evolution of circulating influenza virus strains, and reduced efficacy in elderly persons. On 9–10 November 2009, the Initiative for Vaccine Research of the World Health Organization convened jointly with the Wellcome Trust in London, United Kingdom, the fourth meeting on ‘Influenza vaccines that induce broad spectrum and long-lasting immune responses’. Presentations were made by representatives from industry, academia, governmental and non-governmental organisations. The objectives of the meeting were to update the progress of research in the field of influenza vaccine strategies able to generate cross protection against divergent influenza virus strains. Improvements in existing strategies including live attenuated influenza vaccines and adjuvantation of inactivated vaccines were summarised. Developments in novel antigen production methods, new routes of vaccine delivery and administration, and vaccine approaches based on conserved virus antigens were explored. In addition, correlates of immune protection and regulatory issues for the evaluation and approval of future novel vaccine strategies were discussed.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X

Volume 28, Issue 23, Pages 3875-4012 (21 May 2010)

Regular Papers
Surveillance of invasive pneumococcal disease in 30 EU countries: Towards a European system?
Germaine Hanquet, Anne Perrocheau, Esther Kissling, Daniel Levy Bruhl, David Tarragó, James Stuart, Pawel Stefanoff, Sigrid Heuberger, Paula Kriz, Anne Vergison, Sabine C. de Greeff, Andrew Amato-Gauci, Lucia Pastore Celentano and the ECDC country experts for pneumococcal disease

Abstract
In this era of new pneumococcal conjugate vaccines (PCV), we described and compared surveillance of invasive pneumococcal disease (IPD) and PCV policies in 30 European countries to provide guidance for Europe-wide surveillance. We confirmed the heterogeneity of surveillance systems and case definitions across countries but identified elements common to all countries, such as the availability of serotyping and the surveillance of pneumococcal meningitis. PCV impact was monitored in 11/15 countries using it. We propose steps for the monitoring of incidence rates and serotype distribution at EU level, to assess the need to introduce PCV and monitor its impact once introduced.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X

Volume 28, Issue 22, Pages 3755-3874 (14 May 2010)
Short Communications

Central European Vaccination Advisory Group (CEVAG) guidance statement on recommendations for 2009 pandemic influenza A(H1N1) vaccination
Roman Chlibek, Ioana Anca, Francis André, Mustafa Bakir, Inga Ivaskeviciene, Atanas Mangarov, Zsófia Mészner, Penka Perenovska, Roman Prymula, Darko Richter, Nuran Salman, Pavol Šimurka, Eda Tamm, Nataša Toplak, Vytautas Usonis

Abstract
The 2009 influenza A(H1N1) pandemic is markedly different from seasonal influenza with the disease affecting the younger population and a larger than expected number of severe or fatal cases has been seen in pregnant women, obese people and in people who were otherwise healthy. In Europe, influenza activity caused by the 2009 influenza A(H1N1) virus has passed the winter peak with nearly all countries now reporting lower influenza activity. However, although the rate of 2009 pandemic influenza A(H1N1) is declining, fatal cases continue to be reported and the future is hard to predict. The most effective protection against influenza is vaccination and increasing vaccine coverage is the only way to eliminate uncertainties regarding possible future waves of 2009 pandemic influenza A(H1N1). Recommendations have been developed for several central European countries but there is no clear or uniform definition with respect to priority groups or age groups who should receive vaccination. This paper contains the Central European Vaccination Advisory Group (CEVAG) guidance statement on recommendations for the vaccination of adults and children against 2009 pandemic influenza A(H1N1). CEVAG recommends vaccination of all health-care workers, pregnant women, children ≥6 months and <2 years of age and people with chronic medical conditions as a first priority.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 22, Pages 3755-3874 (14 May 2010)

Reviews
The global introduction of inactivated polio vaccine can
Ellen Heinsbroek, E. Joost Ruitenberg

Abstract
This literature review identifies the factors that influence the decision to introduce inactivated polio vaccine (IPV) in developing countries as opposed to the policy of vaccine cessation. Attenuated viruses in the oral polio vaccine (OPV) can replicate, revert to neurovirulence and become transmissible circulating vaccine-derived polioviruses (cVDPVs), preventing use of the vaccine in the post-eradication era. This literature review identifies (1) risks of complete cessation of vaccination, (2) barriers and (3) solutions for the introduction of IPV in developing countries. The reviewed literature favours to circumvent the so-called “OPV paradox” by global introduction of IPV.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 22, Pages 3755-3874 (14 May 2010)

Regular Papers
Knowledge, attitudes, and communication around human papillomavirus (HPV) vaccination amongst urban Asian mothers and physicians
Song-Nan Chow, Ruey Soon, Jong Sup Park, Chitsanu Pancharoen, You Lin Qiao, Partha Basu, Hextan Yuen Sheung Ngan

Abstract
To determine why HPV vaccination uptake is low in Asia, we surveyed attitudes, knowledge and communication about cervical cancer and HPV vaccination amongst 480 physicians and 1617 randomly selected urban mothers who could afford HPV vaccines in Korea, Malaysia, Taiwan and Thailand. HPV vaccine rejection by mothers was linked with poor knowledge and low perceptions of self-relevance. Physicians’ likelihood of raising the subject and/or recommending vaccination was linked to how proactively they advocate preventive health, their attitude to the subject’s sensitivity and their knowledge levels. Because most Asian mothers seek doctors’ advice and prefer them to take the initiative, physicians should be more proactive in discussing and recommending HPV vaccination.

“The U.S. Food and Drug Administration today revised its recommendations for rotavirus vaccines for the prevention of the disease in infants and has determined that it is appropriate for clinicians and health care professionals to resume the use of Rotarix and to continue the use of RotaTeq.

“The agency reached its decision based on a careful evaluation of information from laboratory results from the manufacturers and the FDA’s own laboratories, a thorough review of the scientific literature, and input from scientific and public health experts, including members of the FDA’s Vaccines and Related Biological Products Advisory Committee that convened on May 7, 2010 to discuss these vaccines.

“The FDA also considered the following in its decision:

– Both vaccines have strong safety records, including clinical trials involving tens of thousands of patients as well as clinical experience with millions of vaccine recipients.

– The FDA has no evidence that PCV1 or PCV2 pose a safety risk in humans, and neither is known to cause infection or illness in humans.

– The benefits of the vaccines are substantial, and include prevention of death in some parts of the world and hospitalization for severe rotavirus disease in the United States. These benefits outweigh the risk, which is theoretical.

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm212149.htm

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 100
Weekly update
14 May 2010

As of 9 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18036 deaths.

Situation update:
The most active areas of pandemic influenza virus transmission currently are in parts of the Caribbean and Central America, and to a lesser extent in West Africa and South and Southeast Asia. In the temperate zone* of the northern and southern hemisphere, overall pandemic influenza activity remains sporadic. Seasonal influenza virus type B continues to be detected at low levels across parts of Asia, Africa, and Europe…

More at: http://www.who.int/csr/don/2010_05_14/en/index.html

The Bill & Melinda Gates Foundation announced 78 grants of US$100,000 each in the latest round of Grand Challenges Explorations. Grand Challenges Explorations is a five-year, $100 million initiative to promote innovation in global health. It is part of the Grand Challenges in Global Health initiative which is supported by the Gates Foundation to achieve major breakthroughs in global health.

Gates said that projects winning grants around more effective vaccines include:

– Sweat-triggered vaccine delivery: Carlos Alberto Guzman of the Helmholtz Centre for Infection Research in Germany with Claus-Michael Lehr and Steffi Hansen of the Helmholtz-Institute for Pharmaceutical Research will develop nanoparticles that penetrate the skin through hair follicles and burst upon contact with human sweat to release vaccines.

– A “seek-and-destroy” laser vaccine: Owain Millington and Gail McConnell of University of Strathclyde in the United Kingdom will use existing imaging systems to identify and destroy Leishmania parasites with a targeted laser;

– Treating worm infections to improve vaccine effectiveness: Susanne Nylén Spoormaker of the Karolinska Institute in Sweden will research whether treating patients for worm infections prior to vaccinations can improve the ability of the immune system to respond effectively to vaccines.

Applications for the next round of Grand Challenges Explorations are being accepted through May 19, 2010. Topics for Round 5 are:

– Create Low-Cost Cell Phone-Based Applications for Priority Global Health Conditions

– Create New Technologies to Improve the Health of Mothers and Newborns

– Create New Ways to Protect Against Infectious Disease

– Create New Technologies for Contraception

– Grant application instructions, including the list of topic areas in which proposals are currently being accepted, are available at the Grand Challenges Explorations website: www.grandchallenges.org.

http://www.gatesfoundation.org/press-releases/Pages/grand-challenges-explorations-round-four-winners-100509.aspx

National HIV Vaccine Awareness Day, May 18, 2010

Statement of Anthony S. Fauci, M.D., Margaret I. Johnston, Ph.D., and Gary J. Nabel, M.D., Ph.D., National Institute of Allergy and Infectious Diseases, National Institutes of Health

“More people today have access to life-saving antiretroviral therapy for HIV/AIDS than ever before. Yet for every person who begins treatment for HIV infection, two to three others become newly infected. Treatment alone will not curtail the HIV/AIDS pandemic. To control and ultimately end this pandemic, we need a powerful array of proven HIV prevention tools that are widely accessible to all who would benefit from them.

Vaccines historically have been the most effective means to prevent and even eradicate infectious diseases. They safely and cost-effectively prevent illness, disability and death. We at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, have been working for more than two decades with our colleagues worldwide to develop an HIV vaccine, and this research continues to rank among our top priorities.

National HIV Vaccine Awareness Day marks an opportunity to reflect on our progress, renew our commitment to finding an HIV vaccine, and personally thank the scientists, community educators, health care workers, and especially the many study volunteers who have dedicated their time and energy to this important endeavor. Only with the continued commitment of volunteers may we more effectively confront the global scourge of HIV/AIDS and pursue the goal of an HIV vaccine.

We have witnessed significant progress in HIV vaccine research during the past year. Notably, a major clinical trial in Thailand gave us the first indication that an experimental vaccine can protect some humans against HIV infection (http://www.niaid.nih.gov/news/newsreleases/2009/Pages/ThaiVaxStudy.aspx). With the participation of more than 16,000 volunteers, investigators found the vaccine to be 31 percent effective at preventing HIV infection. Although this level of protection is modest, it gives us hope that a safe and effective HIV vaccine is possible. The priority now is to try to understand how the vaccine induced protection against HIV infection in some individuals, and to build on those results.

The Thai trial demonstrated the power of large-scale clinical trials to advance HIV vaccine development and to answer fundamental scientific questions. Such trials are possible only through strategic partnerships among federal collaborators, nongovernmental organizations and the private sector. NIAID continues to pursue focused clinical HIV vaccine research through such partnerships.

At the same time, we are bolstering our commitment to the basic laboratory research that provides a foundation for future vaccine development. In the past year, scientists at NIAID and elsewhere discovered several new antibodies able to neutralize diverse HIV strains that circulate worldwide. These antibodies disable HIV by latching onto vulnerable sites on the virus. Some of these sites previously were unknown, so their discovery widens the field of targets that a vaccine could exploit. Current and future studies will determine whether scientists can develop HIV vaccines based on protein replicas of these targets, and whether the immune response to these vaccines might protect people from HIV infection. Many other studies also are under way to explore basic questions about HIV and its interaction with the immune system.

As we recognize recent progress in HIV vaccine research and hope for continued advances, we must remember that a vaccine alone will not end the HIV/AIDS pandemic. If an HIV vaccine is developed, it will need to be used in concert with multiple other scientifically proven HIV prevention tools. NIAID continues to support research into an array of investigational HIV prevention methods, including pre-exposure prophylaxis with antiretroviral drugs, microbicides, and expanded HIV testing and treatment with linkage to care. (http://www.niaid.nih.gov/topics/hivaids/research/prevention/Pages/default.aspx).

http://www.nih.gov/news/health/may2010/niaid-11.htm

WHO announced EVIPNet Africa’s first series of policy briefs on malaria treatment, noting that “six countries in sub-Saharan have developed their own set of policy briefs on how to improve access to malaria treatment working with EVIPNet (Evidence-informed policy network).” EVIPNet was set up in response to a 2005 World Health Assembly resolution calling for WHO to establish or strengthen “mechanisms to transfer knowledge in support of evidence-based public health and health care delivery systems and evidence-based related policies”  WHO said that development of the policy briefs are “a significant achievement because it represents the first time that policy-makers, researchers, and members of civil society in Burkina Faso, Cameroon, Central African Republic, Ethiopia, Mozambique and Uganda have collaborated with each other to better use scientific evidence to produce health policies.” The EVIPNet tools are now being applied to different problems in Africa, Asia and Latin America and the Caribbean. These include: maternal and child mortality; the integration of noncommunicable diseases programmes at community level; effective financing of primary health care; and outbreak response.

http://www.who.int/rpc/evipnet/policybriefs/en/index.html

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) launched its Ten Principles on Counterfeit Medicines, “to re-focus attention on this issue and underline the R&D-based pharmaceutical industry’s stance in the global fight against counterfeit medicines.” Mr Haruo Naito, President of the IFPMA, and President and CEO of Eisai, commented: “Counterfeit medicines are a crime, and our industry is serious about tackling this problem head on. These criminals pose a threat to global public health: deliberately and deceitfully they attempt to pass off their dangerous products as legitimate medicines, and risk patients’ lives in order to make illegal profits. This is not about commercial interest; this is about protecting patients, and we stand ready to be an active partner in WHO-led efforts, including IMPACT.”
Speaking in support of the IFPMA Principles, Mr. Thomas T. Kubic, CEO of PSI, said: “Based on our research, the number of counterfeit medicine incidents worldwide rose almost seven percent last year, to 1,693. Of particular concern has been the growth in counterfeit anti-infectives. In 2009, incidents involving counterfeit anti-infectives increased by almost 50% over the previous year. Anti-infectives, which include anti-malarials, are the therapeutic category most affected by counterfeiting incidents in Africa. Moreover, criminal gangs engaged in the manufacture, distribution and sale of counterfeit medicines are now copying other life-saving treatments including cancer therapies and heart disease medicines.” Eduardo Pisani, Director General of the IFPMA, commented: “We hope that the Ten Principles will highlight the full scope of the problem and demonstrate that the fight against counterfeit medicines is simply about protecting patients’ health. The IFPMA calls on all stakeholders, including governments, health care providers, patients, the private sector and the WHO, to take collaborative action and create a global policy environment that recognizes, prioritizes and effectively addresses this major threat to global health.”

http://www.ifpma.org/News/NewsReleaseDetail.aspx?nID=13800

Ten Principles (one page summary): http://www.ifpma.org/documents/NR13800/IFPMA_Ten_Principles_on_Counterfeit_Medicines_12May2010.pdf

The MMWR for May 14, 2010 / Vol. 59 / No. 18  includes:

Progress Toward Interruption of Wild Poliovirus Transmission — Worldwide, 2009
In 1988, an estimated 350,000 cases of poliomyelitis were occurring annually worldwide. By 2005, because of global vaccination efforts, indigenous transmission of wild poliovirus (WPV) types 1 and 3 (WPV1 and WPV3) had been eliminated from all but four countries (Afghanistan, India, Nigeria, and Pakistan). No cases of WPV type 2 have been reported since 1999. This report describes progress toward global WPV eradication during 2009 and updates previous reports (1—6). During 2009 a total of 1,606 cases of WPV infection were reported, compared with 1,651 in 2008. WPV3 incidence increased 67%, to 1,124 cases, compared with 675 in 2008. However, WPV1 incidence decreased 51%, to 482 cases in 2009, compared with 976 cases in 2008. In India, nearly all polio cases in 2009 were reported in high-risk districts in western Uttar Pradesh and central Bihar. In Afghanistan and Pakistan, WPV circulation in high-risk districts continued because of difficulties vaccinating children in conflict-affected areas and operational limitations in parts of Pakistan (5). In Nigeria, cases decreased by 51%, to 388 cases in 2009, compared with 798 in 2008. During 2009, outbreaks from importation of WPV affected 19 previously polio-free African countries (2). Two key steps are needed to make further progress in polio eradication: 1) addressing local barriers to interrupting transmission, and 2) using bivalent oral poliovirus vaccine (bOPV) broadly for WPV 1 and 3 in supplemental immunization activities (SIAs)…
a href=”http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5918a1.htm”>http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5918a1.htm

The Weekly Epidemiological Record (WER) for 14 May 2010, vol. 85, 20 (pp 177–184) includes Outbreak news – Rift Valley fever, South Africa; Progress in interrupting wild poliovirus transmission worldwide, 2009
http://www.who.int/wer/2010/wer8520.pdf

The Lancet
May 15, 2010  Volume 375 Number 9727  Pages 1665 – 1752
http://www.thelancet.com/journals/lancet/issue/current

Correspondence
GAVI’s funding challenge
Julian Lob-Levyt

Thanks to The Lancet for highlighting the funding challenge that the GAVI Alliance faces as we embark on our next decade of work (March 6, p 791).1 It is important to clarify that all of GAVI’s currently approved programmes are funded up to and including 2015. Such funding includes the existing support for pentavalent vaccine, which has already been introduced in 57 countries.

An important GAVI principle is to add value through long-term funding. Since the founding of the alliance in 2000, GAVI partners have increased immunisation rates to nearly 80% in developing countries, averted over 5 million deaths, and built a solid delivery platform that can now be used to introduce new life-saving vaccines against two of the world’s biggest childhood killers: pneumonia and diarrhoea. Herein lies our funding challenge. Only with increased donor support will we be able to expand further the effect on child mortality by immunising every poor child against these diseases.

Our donors share our ambition, as illustrated by the Gates Foundation’s dedication of US$10 billion to a “decade of vaccines”.2 As Swedish Development Minister Gunilla Carlsson herself said in a press conference at the World Economic Forum in Davos, Switzerland, “Sweden has been with GAVI from the beginning…I hope that other donors also see the good work that GAVI is doing.”3

1 Usher AD. GAVI enters its second decade with massive funding gap. Lancet 2010; 375: 791. Full Text | PDF(43KB) | CrossRef | PubMed

2 Bill & Melinda Gates Foundation. Bill and Melinda Gates pledge $10 billion in call for decade of vaccines. http://www.gatesfoundation.org/press-releases/Pages/decade-of-vaccines-wec-announcement-100129.aspx. (accessed April 7, 2010).

3 Davos 2010 Press Conference. Bill & Melinda Gates Foundation pledges new commitment to vaccines. http://www.livestream.com/worldeconomicforum03/video?clipId=pla_0a5ad43d-be31-42e8-b924-79b5fd46885e. (accessed April 22, 2010).

Nature
Volume 465 Number 7295 pp135-260  13 May 2010
http://www.nature.com/nature/current_issue.html

Opinion
Vaccinate before the next pandemic?
Klaus Stöhr of Novartis argues that pre-pandemic immunization with a cocktail of likely strains could be a cheap, practical and equitable way to protect people against influenza.

PLoS Medicine
(Accessed 16 May 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

Can Foreign Policy Make a Difference to Health?
Sigrun Møgedal, Benedikte Louise Alveberg Perspective, published 11 May 2010
New Complexities and

Approaches to Global Health Diplomacy: View from the U.S. Department of State
Kerri-Ann Jones Perspective, published 11 May 2010

Science
14 May 2010  Vol 328, Issue 5980, Pages 777-936
http://www.sciencemag.org/current.dtl

Special Issue: Tuberculosis & Malaria

Landscapes of Infection
Stella Hurtley, Caroline Ash, and Leslie Roberts

Redrawing Africa’s Malaria Map
Martin Enserink
Smaller countries on the hardest-hit continent have shown how aggressive malaria control can slash cases and deaths. Can the big ones follow?

As Challenges Change, So Does Science
Martin Enserink
Although nobody believes that it is possible in the next 10, 20, or even 30 years, the call to eradicate malaria, combined with the plummeting disease burden, are already reshaping the scientific agenda. |

Malaria’s Drug Miracle in Danger
Martin Enserink
Like many others before it, the latest generation of malaria drugs is losing its punch. This time, can global disaster be averted?

If Artemisinin Drugs Fail, What’s Plan B?
Martin Enserink
If the current generation of artemisinin-based combination therapies should fail, does the world have a solid backup plan? The short answer: No.

The ‘Do Unto Others’ Malaria Vaccine
Gretchen Vogel
Once neglected, research on transmission-blocking vaccines for malaria is gaining new prominence.

Shrinking the Malaria Map From the Outside In
Leslie Roberts
A debate is brewing over how best to fight malaria: Go for the quick wins, or the worst places first, or both?

Elimination Meets Reality in Hispaniola
Leslie Roberts
Hispaniola’s fledging program to eliminate malaria, now sidetracked by the earthquake, illustrates the difficulties that arise when ambitious goals collide with reality.

Reviews
Tuberculosis: What We Don’t Know Can, and Does, Hurt Us
David G. Russell, Clifton E. Barry, 3rd, and JoAnne L. Flynn

The Population Dynamics and Control of Tuberculosis
Christopher Dye and Brian G. Williams

That Was Then But This Is Now: Malaria Research in the Time of an Eradication Agenda
Stefan H. I. Kappe, Ashley M. Vaughan, Justin A. Boddey, and Alan F. Cowman

The Selection Landscape of Malaria Parasites
M. J. Mackinnon and K. Marsh

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 99
Weekly update
7 May 2010
As of 2nd May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18001 deaths…

Situation update:
The most active areas of pandemic influenza virus transmission currently are in parts of West Africa, the Caribbean, and Southeast Asia. In the temperate zone of the northern and southern hemisphere, overall pandemic influenza activity remains sporadic. Seasonal influenza virus type B continues to be detected sporadically across Asia, Africa, Europe, and the Americas, however, low levels of late season virus circulation have primarily detected in East and Central Asia, southern Europe, and central Africa…

Full report at: http://www.who.int/csr/don/2010_05_07/en/index.html

The WHO released Pandemic (H1N1) 2009 vaccine deployment update – 3 May 2010. This one-page summary reports on the status of the H1N1 pandemic vaccine stockpile.

Current situation
– WHO has received pledges of approximately 200 million doses of vaccine, 70 million syringes and US$ 48 million for operations.

– 99 countries have requested vaccine donations

– 84 countries have signed agreements with WHO

– Progress of National Deployment Plans: 58 are complete and final; 5 plans are being refined.

– Completed Vaccine Deliveries (1 January – 3 May): 39 Countries / 20,930,900 doses

– Planned Vaccine Deliveries (May): 22 Countries / 16,798,200 doses

http://www.who.int/csr/disease/swineflu/action/h1n1_vaccine_deployment_update20100503.pdf

The Weekly Epidemiological Record (WER) for 7 May 2010, vol. 85, 19 (pp 165–176) includes: Poliomyelitis in Tajikistan– update; Dracunculiasis eradication – global surveillance summary, 2009; WHO Strategic Advisory Group of Experts (SAGE) on immunization: request for nominations

http://www.who.int/wer/2010/wer8519.pdf

The MMWR for May 7, 2010 / 59(17);514-516 includes:

The Adult Hepatitis Vaccine Project — California, 2007–2008

Since hepatitis B vaccine was first released in 1981, a public health goal has been to vaccinate adults at risk for infection because of risky sexual behaviors and needle-sharing practices (1,2). However, vaccination coverage for this group has remained low (3). During 2007, in the United States, among the estimated 43,000 persons newly infected with hepatitis B virus (HBV), the highest rate was reported among persons aged 25–44 years, and the majority of these infections were among at-risk adults (1). Surveillance data were similar in California (4). In 2006, when the Advisory Committee on Immunization Practices (ACIP) recommended that hepatitis B vaccination be offered to all adults as part of routine prevention services in settings where a high proportion of those served are at increased risk (2,5), CDC launched a national initiative encouraging states to use existing federal funds to purchase adult hepatitis B–containing (HepB) vaccine. In response, the California Department of Public Health (CDPH) established the Adult Hepatitis Vaccine Project (AHVP) to expand hepatitis B vaccination in sites serving at-risk adults. This report summarizes results for 2007–2008, which indicated that 28,824 doses of HepB vaccine were administered at 29 participating sites in the first 19 months of AHVP; 13 sites administered HepB vaccine for the first time. Federal provision of vaccine resulted in vaccination of many adults who otherwise might not have been vaccinated against HBV. Increased capacity to vaccinate all adults at risk is needed for the elimination of HBV transmission in the United States…

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5917a2.htm

The MMWR for May 7, 2010 / 59(17);514-516 includes:

Rotavirus Vaccination Coverage Among Infants Aged 5 Months — Immunization Information System Sentinel Sites, United States, June 2006–June 2009

In February 2006, the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination of all U.S. infants with 3 doses of a pentavalent rotavirus vaccine administered at ages 2, 4, and 6 months (1). In June 2008, ACIP updated its recommendations to include use of a second rotavirus vaccine, a 2-dose monovalent vaccine, administered at ages 2 and 4 months (1). The maximum age for the first dose of either rotavirus vaccine (RV) is 14 weeks and 6 days. CDC recently analyzed data from Immunization Information System (IIS) sentinel sites 1) to assess trends in coverage with ≥1 dose of RV during June 2006–June 2009 among infants aged 5 months and 2) to compare RV coverage in the second quarter of 2009 with that of two other routinely-recommended vaccines for U.S. infants: diphtheria, tetanus, and acellular pertussis (DTaP) vaccine, and 7-valent pneumococcal conjugate vaccine (PCV7). RV coverage increased following vaccine introduction and, in June 2009, averaged 72% at the eight currently participating IIS sentinel sites. However, ≥1 dose RV coverage among infants aged 5 months was 13% lower than the average coverage with ≥1 dose of DTaP and PCV7 at these same sites. Lower RV coverage could reflect typical new-vaccine coverage dynamics, the presence of RV-specific barriers (2,3), or both. Identifying and reducing barriers to vaccination and educating parents and providers about the health benefits of rotavirus vaccination should increase coverage and help prevent severe rotavirus disease.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5917a4.htm

Human Vaccines
Volume 6, Issue 5  May 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/3/

Commentary
Rotavirus vaccines for global use: What are the remaining issues and challenges?
Baoming Jiang, Manish Patel and Umesh Parashar, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

JAMA
Vol. 303 No. 17, pp. 1669-1771, May 5, 2010
http://jama.ama-assn.org/current.dtl

Original Contributions
Pneumococcal Vaccination and Risk of Acute Myocardial Infarction and Stroke in Men
Hung Fu Tseng; Jeffrey M. Slezak; Virginia P. Quinn; Lina S. Sy; Stephen K. Van Den Eeden; Steven J. Jacobsen

Context
Multiple studies have shown that preventing influenza by vaccination reduces the risk of vascular events. However, the effect of pneumococcal polysaccharide vaccine on vascular events remains controversial.

Objective
To examine the association between pneumococcal vaccination and risk of acute myocardial infarction (MI) and stroke among men.

Design, Setting, and Participants
A prospective cohort study of Kaiser Permanente Northern and Southern California health plans with 84 170 participants aged 45 to 69 years from the California Men’s Health Study who were recruited between January 2002 and December 2003, and followed up until December 31, 2007. The cohort was similar to the population of health plan members and men who responded to a general health survey in California on important demographic and clinical characteristics. Demographic and detailed lifestyle characteristics were collected from surveys. Vaccination records were obtained from the Kaiser Immunization Tracking System.

Main Outcome Measure
Incidence of acute MI and stroke during the follow-up period in men who had no history of such conditions.

Results
During follow-up, there were 1211 first MIs in 112 837 vaccinated person-years (10.73 per 1000 person-years) compared with 1494 first MI events in 246 170 unvaccinated person-years (6.07 per 1000 person-years). For stroke, there were 651 events in 122 821 vaccinated person-years (5.30 per 1000 person-years) compared with 483 events in 254 541 unvaccinated person-years (1.90 per 1000 person-years). With propensity score adjustment, we found no evidence for an association between pneumococcal vaccination and reduced risk of acute MI (adjusted hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.98-1.21) or stroke (adjusted HR, 1.14; 95% CI, 1.00-1.31). An inverse association was also not found in men of different age and risk groups. The results appeared to be consistent, because using more specific International Classification of Diseases, Ninth Revision codes for the outcome definition did not change the estimations.

Conclusion
Among a cohort of men aged 45 years or older, receipt of pneumococcal vaccine was not associated with subsequent reduced risk of acute MI and stroke.

Editorials
Preventing Myocardial Infarction With Vaccination: Myths and Realities
Mohammad Madjid; Daniel M. Musher

Extract
Many clinical studies supported by basic experiments suggest that infections may trigger an acute coronary syndrome. The role of respiratory infections, especially influenza and pneumococcal pneumonia, in acute coronary syndrome in high-risk patients has been well documented.1-3 Such infections can cause an exaggerated inflammatory response in a high-risk atherosclerotic plaque, which may be followed by destabilization of the plaque, activation of the coagulation cascade, vascular thrombosis, and subsequent myocardial infarction (MI). Given the high prevalence of coronary heart disease and its risk factors in the population and the frequency of influenza and pneumonia, it is likely that each year thousands of patients might develop cardiovascular events after having such infections. This potentially causal effect has immense clinical implications, because it offers a potential method for preventing cardiovascular events by preventing or treating these infections.4 In this issue of JAMA, Tseng and…

The Lancet
May 08, 2010  Volume 375  Number 9726  Pages 1579 – 1664
http://www.thelancet.com/journals/lancet/issue/current

World Report
Tide turns for drug manufacturing in Africa
Tatum Anderson

Preview
With several efforts underway to increase the local production of drugs in developing countries, Tatum Anderson assesses the pros and cons of manufacturing medicines in Africa.A drugs producer in Uganda has become the first in a least developed country (LDC)—a category reserved for the world’s poorest nations—to achieve a world-class seal of quality for its manufacturing standards.

New England Journal of Medicine
Volume 362 — May 6, 2010 — Number 18
http://content.nejm.org/current.shtml

Review Article [Free Full-text]
Medical Progress: Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection
Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza

New England Journal of Medicine
Volume 362 — May 6, 2010 — Number 18
http://content.nejm.org/current.shtml

Special Report
Information Technology and Global Surveillance of Cases of 2009 H1N1 Influenza
J. S. Brownstein and Others

The widespread adoption of increasingly sophisticated forms of information technology has paralleled the increase in rapid and far-reaching international travel. The emergence and global spread of the 2009 pandemic influenza A (H1N1) virus illustrated not only the hazards of an interconnected world, but also the powerful role of new methods for detecting, tracking, and responding to infectious diseases. Although formal reporting, surveillance, and response structures remain essential to protecting public health, a new generation of freely accessible, online, and real-time informatics tools for disease tracking are expanding the ability of public health professionals to detect weak signals across borders and to raise earlier warnings of emerging disease threats.

The HealthMap H1N1 System
HealthMap (http://healthmap.org) is an example of a new effort in transparent, global, public health surveillance. The HealthMap system combines automated, around-the-clock data collection and processing with expert review and analysis to aggregate reports according to type of disease and geographic location. HealthMap sifts through large volumes of information on events, obtained from a broad range of online sources in multiple languages, to provide a comprehensive view of ongoing global disease activity through a freely available Web site…

PLoS Medicine
(Accessed 9 May 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

Negotiating Equitable Access to Influenza Vaccines: Global Health Diplomacy and the Controversies Surrounding Avian Influenza H5N1 and Pandemic Influenza H1N1
David P. Fidler Policy Forum, published 04 May 2010
doi:10.1371/journal.pmed.1000247

PLoS Medicine
(Accessed 9 May 2010)

A Population-Based Evaluation of a Publicly Funded, School-Based HPV Vaccine Program in British Columbia, Canada: Parental Factors Associated with HPV Vaccine Receipt
Gina Ogilvie, Maureen Anderson, Fawziah Marra, Shelly McNeil, Karen Pielak, Meena Dawar, Marilyn McIvor, Thomas Ehlen, Simon Dobson, Deborah Money, David M. Patrick, Monika Naus Research Article, published 04 May 2010
doi:10.1371/journal.pmed.1000270

Science Translational Medicine
5 May 2010 vol 2, issue 30
http://stm.sciencemag.org/content/current

Policy
Institutional Review Boards, Professionalism, and the Internet
Robert Martensen

Abstract
Even as the Internet generates pressures that erode professional authorities of all kinds, it also provides opportunities for researchers and their institutional review boards to bolster their status as trusted sources. To this end, we must work to improve clinical protocol design and approval procedures and maintain the integrity of the study participant recruitment process in clinical trials.

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 98
Weekly update
30 April 2010

As of 25th of April, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17919 deaths…

Situation update:
The current situation is largely unchanged since the last update. The most active areas of transmission of pandemic influenza H1N1 virus continue to be parts of West and Central Africa with some focal areas of activity in South and Southeast Asia. Pandemic influenza activity H1N1 remains low in much of the temperate areas of both the northern and southern hemispheres. Seasonal influenza type B virus is the predominant influenza virus, though also at low levels of circulation, across East Asia, Northern and Eastern Europe. Influenza type B viruses have also been detected in Central Africa and this week in West Africa. Seasonal influenza H3N2 viruses have continued to be detected in South and Southeast Asia, as well as sporadically in some countries of West and Central Africa, and Eastern Europe.

Full report at: http://www.who.int/csr/don/2010_04_30a/en/index.html

UNICEF and the World Health Organization released SOURCES AND PRICES OF SELECTED MEDICINES FOR CHILDREN, a new online publication that “lists medicines formulated for children…to help doctors and organizations obtain some of the 240 essential medicines that can save the lives of children.” Hans Hogerzeil, Director Essential Medicines and Pharmaceutical Policies at WHO, said, “An estimated 9 million children die each year from preventable and treatable causes. Improved availability and access to safe child-specific medicines is still far from reality for many children in poor countries. This one-of-its-kind publication will be useful for organizations and personnel involved in procurement to identify where medicines may be found and what they cost.”

This second edition offers current details on 612 different paediatric formulations of 240 medicines selected from the ‘WHO Model List of Essential Medicines for Children’, as well as therapeutic food, and vitamin and mineral supplements, to treat major childhood illnesses and diseases.

http://www.who.int/medicines/publicatio ns/essentialmedicines/Sources_Prices2010.pdf

The GAVI Alliance said that Guyana became the fourth GAVI-eligible country to introduce rotavirus vaccine. Guyana’ Minister of Health Dr Leslie Ramsammy commented, “Introducing rotavirus vaccines into our immunisation programme is a crucial step in saving our children’s lives. We are committed to doing all that we can for our children to make sure they grow up to be healthy and productive adults. In 1994, the government of Guyana decided that all proven, life-saving vaccines should be available to all of our children. We made this commitment and we will continue to grow our vaccination programme.”

http://www.gavialliance.org/media_centre/press_releases/2010_04_30_guyana_tackles_2nd_biggest_killer.php

The MMWR for April 30, 2010 / Vol. 59 / No. 16 includes:

Interim Results: State-Specific Seasonal Influenza Vaccination Coverage — United States, August 2009–January 2010

[From CDC Media Release}

More Americans were vaccinated against seasonal flu during the 2009-10 season (40 percent of eligible population) than during the previous flu season (33 percent of eligible population), according to a report by the Centers for Disease Control and Prevention. The greatest gain in vaccination rates was in children 6 months to 17 years. About 40 percent of children were vaccinated for seasonal flu last season, representing a 16 percentage point jump from the 2008-09 season.

There also was an increase in the percentage of healthy adults (people without a chronic health condition such as asthma or diabetes), aged 18–49 years old who were vaccinated against seasonal flu. Coverage in this group increased from approximately 22 percent in 2008-09 to approximately 28 percent for the 2009-10 season. Coverage remained stable among adults 18-49 years of age with chronic health conditions, all adults 50-64 years, and those 65 years and older.

“These results are encouraging,” said Dr. Anne Schuchat, director of CDC’s National Center for Immunization and Respiratory Diseases. “It’s now important that we build on this success next fall and winter. We want people, especially parents, to make getting a flu vaccination each year a regular habit”

Licensure of a High-Dose Inactivated Influenza Vaccine for Persons Aged ≥65 Years (Fluzone High-Dose) and Guidance for Use — United States, 2010

The Weekly Epidemiological Record (WER) for 30 April 2010, vol. 85, 18 (pp 156–164) includes: Poliomyelitis in Tajikistan: first importation since Europe certified polio-free; Schistosomiasis

http://www.who.int/wer/2010/wer8518.pdf