Clinical Infectious Diseases
1 June 2010   Volume 50, Number 11
http://www.journals.uchicago.edu/toc/cid/current

The Changing Epidemiology of Invasive Pneumococcal Disease in Aboriginal and Non–Aboriginal Western Australians from 1997 through 2007 and Emergence of Nonvaccine Serotypes

Deborah Lehmann, Judith Willis, Hannah C. Moore, Carolien Giele, Denise Murphy, Anthony D. Keil, Catherine Harrison, Kathy Bayley, Michael Watson, and Peter Richmond, on behalf of the Vaccine Impact Surveillance Network

Abstract
After introduction of a 3-dose childhood schedule of pneumococcal conjugate vaccine, rates of invasive disease decreased among children and non‐Aboriginal adults but increased markedly among young Aboriginal adults, which has resulted in an increasing disparity, in recent years, between Aboriginal and non-Aboriginal people, with respect to disease rates.

Journal of Infectious Diseases
1 June 2010  Volume 201, Number 11
http://www.journals.uchicago.edu/toc/jid/current

Editorial Commentaries
Vaccine Epidemiology: Efficacy, Effectiveness, and the Translational Research Roadmap
Geoffrey A. Weinberg and Peter G. Szilagyi

Despite the rather short history of vaccination, compared with the millennia of various human plagues and pestilences, more than a dozen major infectious diseases (most notably, smallpox, poliomyelitis, rabies, diphtheria, tetanus, pertussis, Haemophilus influenzae type b disease, measles, mumps, and rubella) have been controlled in many parts of the world [1]. The recently licensed rotavirus vaccines show great promise in this new century for controlling an infection which leads to 25,000–50,000 hospitalizations, nearly 400,000 emergency room visits, and 400,000 medical care visits of children in the United States annually, while at the same time leading to nearly 600,000 deaths worldwide [2–5].

As each new vaccine is considered for licensure, the most basic of questions is perhaps the most complex to answer: “How well does the candidate vaccine prevent the disease for which it was developed?” In this issue of the Journal, Curns et al [6] estimate that pentavalent rotavirus vaccine use has decreased hospitalization rates for acute gastroenteritis among children in the United States aged <5 years by 45%, including those who were either too young or too old to be eligible for vaccination. A monovalent rotavirus vaccine is also licensed for use in the United States [2, 3] but was not available during the study period.

The Curns et al [6] study is timely and important and also highlights the distinction between the epidemiologic concepts of vaccine efficacy and vaccine effectiveness [7–12]. These often confused terms fit well into the new paradigm of translational research discussed below…[Free Full text at link above]

New England Journal of Medicine
Volume 362 — April 29, 2010 — Number 17
http://content.nejm.org/current.shtml

To the Editor: Madhi and colleagues (Jan. 28 issue)1 describe the effectiveness of a live, oral rotavirus vaccine against rotavirus gastroenteritis among infants in South Africa and Malawi. The vaccine had 64.1% efficacy against G1 rotavirus strains and 59.7% efficacy against non-G1 strains. However, we need to consider the prevalence of various strains before introducing the vaccine extensively in the community. A study in Bangladesh from 2001 through 2005 showed that the G1P[8] strain was the most prevalent (36.4%), followed by G9P[8] (27.7%), G2P[4] (15.4%), and G12P[6] (3.1%), but in 2005–2006, G2P[4] appeared as the most prevalent strain (43.2%), and G12P[6] increased in prevalence (11.1%).2 The recently licensed Rotarix vaccine includes only P[8] specificity, with less efficacy against heterotypic non-P[8] strains. The study by Kafulafula et al. showed that breast-feeding influences the rate of gastroenteritis in infants during the first year of life,3 although the authors did not report these results. The currently available Rotarix vaccine might provide good coverage against rotavirus strains that are prevalent in wealthier countries, but for developing countries like Malawi, we might need a vaccine containing different rotavirus strains.

Dewan S. Billal, Ph.D.
University of Laval
Quebec, QC, Canada
dsbh2000@yahoo.com

The Pediatric Infectious Disease Journal
May 2010 – Volume 29 – Issue 5
http://journals.lww.com/pidj/pages/currenttoc.aspx

Opinion and Analysis

Randomized Trials to Study the Nonspecific Effects of Vaccines in Children in Low-Income Countries
Shann, Frank; Nohynek, Hanna; Scott, J. Anthony; Hesseling, Anneke; Flanagan, Katie L.; on behalf of the Working Group on The Nonspecific Effects of Vaccines
The Pediatric Infectious Disease Journal. 29(5):457-461, May 2010.

Abstract:
The Expanded Program on Immunization (EPI) has led to large reductions in morbidity and mortality among children in low-income countries. However, the basic EPI schedule may no longer be optimal because of changes in vaccines, programs, and epidemiologic circumstances. In addition, evidence has accumulated that some EPI vaccines may have nonspecific effects that increase or decrease mortality from subsequent infections with other unrelated organisms. There is therefore a need for randomized trials to evaluate the effects of alternative EPI schedules on all-cause mortality, as well as vaccine efficacy against the target diseases. We have reviewed the available literature on the nonspecific effects of vaccines on mortality, and compiled a list of potential trials that might address this issue. We have then ranked the trials based on the potential importance of the results and the ethical and practical considerations. Trials of early BCG vaccination in low-birth-weight babies, early measles vaccination, and altered timing of DTP vaccination all have a high priority.

Pediatrics
May 2010 / VOLUME 125 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

Knowledge of Interim Recommendations and Use of Hib Vaccine During Vaccine Shortages
Allison Kempe, Christine Babbel, Gregory S. Wallace, Shannon Stokley, Matthew F. Daley, Lori A. Crane, Brenda Beaty, Sandra R. Black, Jennifer Barrow, and L. Miriam Dickinson

Abstract
OBJECTIVES The goals were to determine among pediatricians and family physicians (1) knowledge of interim recommendations regarding Haemophilus influenzae type b (Hib) vaccine administration, (2) current practices, and (3) factors associated with nonadherence.

METHODS An Internet-based survey was conducted in April 2008 among national samples.

RESULTS Response rates were 68% (220 of 325 physicians) among pediatricians and 51% (153 of 302 physicians) among family physicians. Seventy-three percent of pediatricians and 45% of family medicine physicians reported insufficient Hib vaccine supplies, and 22% to 24% reported having to defer doses for infants 2 to 6 months of age 10% of the time. Ninety-eight percent of pediatricians and 81% of family physicians were aware of the interim recommendations (P .0001), and virtually all knew that the booster dose should be deferred; however, 22% of pediatricians and 33% of family medicine physicians reported not deferring this dose. Physicians in both specialties were less likely to adhere to recommendations to defer in this age group if they thought that their practice had sufficient vaccine supplies (pediatricians, odds ratio: 0.01 [95% confidence interval: 0.003–0.03]; family medicine physicians, odds ratio: 0.10 [95% confidence interval: 0.03–0.33]). Family medicine physicians were less likely to adhere to recommendations if they had not heard about the interim recommendations (odds ratio: 0.04 [95% confidence interval: 0.01–0.21]).

CONCLUSIONS Most primary care physicians experienced Hib vaccine shortages, and many have had to defer doses for 2- to 6-month-old children. Most are knowledgeable regarding interim recommendations, but one-fifth to one-third reported nonadherence.

Pediatrics
May 2010 / VOLUME 125 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

Mother-Daughter Communication and Human Papillomavirus Vaccine Uptake by College Students
Megan E. Roberts, Meg Gerrard, Rachel Reimer, and Frederick X. Gibbons

Abstract

OBJECTIVES Although a human papillomavirus(HPV) vaccine has been available for more than 3 years, little research has documented the uptake and predictors of vaccination among older adolescents and young adult women. The purpose of this cross-sectional study was to examine the prevalence of HPV vaccination among college women across time and to explore the effect of mother-daughter communication on vaccination.

METHODS During the period of fall 2007 through fall 2009, a convenience sample of 972 female undergraduate students (aged 18–25) at a large Midwestern state university (89% white) completed a paper-and-pencil or online anonymous questionnaire that assessed their sexual-risk behavior, knowledge of HPV, perceptions of HPV risk, communication from their mothers about sex-related topics (including HPV), and their current vaccination status.

RESULTS Sixty-five percent of the women reported being sexually active, and 49% reported having received at least the first of the 3-shot vaccine series. The mother’s approval of HPV vaccination, mother-daughter communication about sex, and daughter’s perceptions of vulnerability to HPV were positively associated with vaccination status. Among the women who had not received any of the HPV shots, the mother’s approval of HPV vaccination, perceived vulnerability to HPV, and risky sexual behavior were predictive of interest in receiving the vaccine. Mother-daughter communication about values related to sex was negatively associated with interest.

CONCLUSIONS Although many of these young women were old enough to receive the vaccine without their parents’ consent, perception of their mother’s approval and mother-daughter communication about sex were important predictors of vaccination.