Vaccines_The Week in Review_1 November 2010

WHO announced that 15 countries across Africa launched a synchronized mass polio immunization campaign to reach 72 million children. WHO said that “some 290,000 vaccinators have been mobilized to go door-to-door to deliver two drops of oral polio vaccine (OPV) to every child under five in areas considered at ‘highest risk’ of polio transmission.”  This is part of a series of synchronized immunization activities which began in 2009 and continued in March and April, 2010, following the spread of polio from Nigeria to 24 countries across west and central Africa and in the Horn of Africa.

“We are on the cusp of an exciting possibility here,” said Dr Gianfranco Rotigliano, UNICEF’s Regional Director for West and Central Africa. “Political leaders across Africa answered the challenge posed by this dreadful disease and the results are before us. It shows what can be done when there is leadership and dynamic partnership with donor support around such an important health issue. We need to continue efforts to vaccinate and to put the needs of children in Africa first.” The 15-country synchronized activities will cost approximately US$42.6 million, and are funded by the Bill & Melinda Gates Foundation, the US Centers for Disease Control and Prevention (CDC), USAID, Rotary International, UNICEF and the Governments of Germany and Japan.

http://www.who.int/mediacentre/news/releases/2010/polio_20101026/en/index.html

WHO released a revised WHO-UNICEF Joint Statement on Vaccine Donations WHO/IVB/10.09 which “updates previous WHO statements on vaccine donations (WHO/VSQ/97.05; WHO/V&B/00.25) and clarifies situations which were not covered by the previous policy statement, such as donations for research projects and donations in the case of emergency, epidemic or pandemic situations.”

[Full text]

“…Exceptional Situations

There may be exceptional situations when it is not possible to meet the minimum requirements outlined above. These commonly include:

– Donations to research projects:

The use of vaccine donated for research purposes must be guided by the International Ethical Guidelines for Biomedical Research Involving Human Subjects issued by the Council for International Organizations of Medical Sciences (CIOMS) in collaboration with the World Health Organization ( http:\\www.cioms.ch\frame_guidelines_nov_2002.htm), the Declaration of Helsinki, and supplemented by other internationally and nationally accepted statements of ethical guidance adopted by the recipient country.

Such projects must also comply with other national regulations and requirements related to medical research involving human subjects. New vaccines or devices that have not received regulatory approval in the country should not be used on human subjects without the appropriate approval being obtained from the National Drug Regulatory Agency for their use under the conditions of the study. Under these circumstances, it is especially important to ensure the suitability of the product, its presentation, and its schedule, as it may not be yet licensed in the recipient country nor WHO prequalified.

– Vaccines donated for emergency, epidemic or pandemic situations when it may not be possible to apply all the minimum specifications above:

In some instances the vaccine specifications and presentation may vary from what is in routine use, the remaining shelf life may be limited, and sustainability is not an issue. In such cases the most important considerations are that the vaccine is suitable to the country’s needs from the public health perspective and that the responsible officials in the recipient country are in full agreement with shipping the vaccine, and are able to respond to quality and storage aspects of the donation. In addition, as with any other donation, the vaccine is subject to prescribed licensing and/or other control procedures set up by the recipient government. In such cases it is also useful for recipient countries to have an immunization plan…”

http://www.who.int/immunization/documents/WHO_IVB_10.09/en/

The GAVI Alliance announced that Luxembourg made a multi-year pledge of € 4.1 million (US$5.7 million) to support GAVI programs between 2011 and 2015

http://www.gavialliance.org/media_centre/press_releases/luxembourg.php

The Global Fund to Fight AIDS, Tuberculosis and Malaria announced that Luxembourg’s will commit EUR 7.5 million to the Global Fund for the period 2011-2013, “making it one of the top per capita donors.” Luxembourg has been a donor to the Global Fund since its inception in 2002. The Grand Duchy’s contributions to the Global Fund “have been increasing since then and by the end of 2013 they will have reached EUR 26 million.”

http://www.theglobalfund.org/en/pressreleases/?pr=pr_101027

The APHA Governing Council will be considering approval of a position statement on “Annual Influenza Vaccination of Health Workers” at its annual meeting next week in Denver. The proposed position statement “provides an up-to-date influenza-specific context for APHA’s longstanding policy recommending vaccination requirements for healthcare and laboratory workers and students for all vaccine-preventable diseases. APHA said public debate open to all conference attendees will take place Sunday afternoon (7 November 2010); the Governing Council will vote on the position statement on Tuesday (8 November 2010). The draft position statement is available at:   http://www.apha.org/NR/rdonlyres/FAD4A159-875C-4186-8B46-5B300DA1E37A/0/D1Resubmission.pdf.  Please see Event Watch below for information on the APHA meeting.

The Bill & Melinda Gates Foundation announced the next stage of Grand Challenges Explorations, with “nine outstanding Grand Challenges Explorations grantees have received new funding of up to $1 million each to support continued research on their innovative work.” The Foundation said these projects “have shown success during their initial grant period and align with the foundation’s strategic global health priorities, including vaccines, family health, and infectious disease. The grantees come from diverse disciplines and are at various stages in their careers, but share a common goal—to make breakthrough advances that lead to new solutions to improve health worldwide.”

http://www.gatesfoundation.org/press-releases/Pages/gce-next-stage-winners-announced-101027.aspx

The Weekly Epidemiological Record (WER) for 29 October 2010, vol. 85, 44 (pp 437–444) includes: Outbreak news: Cholera, Haiti; Cholera, Pakistan; Crimean-Congo haemorrhagic fever (CCHF) and dengue fever, Pakistan; Global vaccination update, 2009 http://www.who.int/entity/wer/2010/wer8544.pdf

The MMWR for October 29, 2010 / Vol. 59 / No. 42 includes:
– Global Routine Vaccination Coverage, 2009

– Rapid Diagnostic Tests for Malaria — Haiti, 2010

http://www.cdc.gov/mmwr/PDF/wk/mm5942.pdf

The Lancet
Oct 30, 2010  Volume 376  Number 9751 Pages 1437 – 1512
http://www.thelancet.com/journals/lancet/issue/current

Editorial
GAVI’s challenges: funding and leadership

Original Text

The Lancet

Since its launch in 2000, the mission of the GAVI Alliance has been to fund vaccination programmes in low-income countries with an annual domestic gross product below US$1000 per head. The Alliance so far has provided access to immunisation for more than 250 million children worldwide, contributed to an estimated 5·4 million saved lives, and protected many more against disabilities.

The Alliance’s accomplishment has been the result of a unique public—private partnership that has pioneered and supported innovative and performance-based financing and programming-based approaches to global health. By bringing together developing countries, donor governments, research and technical institutes, civil society organisations, vaccine producers, and private philanthropists, the dynamics of the global vaccine market have changed through sustainable supply, research, competition, and price reduction.

The current 5-year goal of GAVI is to expand by 2015 its vaccination programmes to include combined vaccine against diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type B, together with pneumococcal and rotavirus vaccines. This initiative needs $7 billion in funding. So far, only $2.7 billion has been secured. The funding shortfall of $4.3 billion must be solved by June, 2011, during GAVI’s pledging conference if more than 4 million child deaths are to be prevented.

The Alliance’s future will depend on its soon to be appointed new leader, who must be an excellent fundraiser. GAVI depends too heavily on one foundation and the changing priorities of core donor countries. The new leader must be a strong global advocate to endorse vaccination as one of the most cost-effective health and developmental interventions, and one that is crucial for achieving the Millennium Development Goals.     The individual must also be a passionate campaigner in promoting children’s immunisation as a global public good and a shared responsibility of the world community—by being the voice of millions of children threatened by a preventable illness. Immunisation is far overdue to become a right rather than a privilege.

The Lancet Infectious Disease
Nov 2010  Volume 10  Number 11  Pages 737 – 812
http://www.thelancet.com/journals/laninf/issue/current

Leading Edge
Slow progress towards universal access
The Lancet Infectious Diseases

Preview
At the 2006 UN General Assembly high-level meeting on AIDS in New York, world leaders set the ambitious goal of providing universal access to HIV prevention, treatment, and care by 2010. The main target of this initiative was to provide 80% of people in need of antiretroviral therapy with access to appropriate treatment. Progress towards achieving this universal access target is documented in the Towards Universal Access report by UNAIDS, UNICEF, and WHO, released on Sept 28, 2010. With statistics available until the end of 2009, the report shows that, despite many successes, the goal of universal access will not be met.

The Lancet Infectious Disease
Nov 2010  Volume 10  Number 11  Pages 737 – 812
http://www.thelancet.com/journals/laninf/issue/current

Articles
Hepatitis B immune memory in children primed with hexavalent vaccines and given monovalent booster vaccines: an open-label, randomised, controlled, multicentre study
Alessandro Remo Zanetti, Luisa Romanò, Cristina Giambi, Anna Pavan, Vito Carnelli, Guglielmino Baitelli, Giancarlo Malchiodi, Edgardo Valerio, Antonella Barale, Maria Anna Marchisio, Domenico Montù, Alberto Eugenio Tozzi, Fortunato D’Ancona, for the study group

Preview
5 years after immunisation with hexavalent vaccines, immunological memory seems to persist in children with anti-HBs concentrations lower than 10 mIU/mL, suggesting that booster doses are not needed. Additional follow-up is needed.

The IDSA (Infectious Disease Society of America) held its 48th Annual Meeting in Vancouver, BC, Canada from 21 – 24 October 2010. A video archive of media conferences with ISDA panels on a range of topics including HIV Global Health Influenza Pediatrics Emerging infections and more is available at:

http://www.idmeeting.org/omk.php?sid=S20101019100441ZY45HT&pid=1697

WHO: Avian influenza – situation in Indonesia – update 4

18 October 2010 — The Ministry of Health of Indonesia has announced two new cases of human infection of H5N1 avian influenza. A 35-year-old male from West Jakarta, Jakarta Province developed symptoms on 16 August, was hospitalized on 20 August and died on 27 August. Initial investigations into the source of his infection suggest a number of sudden chicken deaths occurred around the case’s house a week before onset. The second case, a 40-year-old female from Kota Depok, West Java Province developed symptoms on 9 September, was hospitalized on 12 September and died on 17 September. Initial investigations into the source of her infection suggest exposure at a live bird market.

For both cases laboratory tests have confirmed infection with the H5N1 avian influenza virus. Of the 170 cases confirmed to date in Indonesia, 141 have been fatal. http://www.who.int/csr/don/2010_10_18/en/index.html

The Weekly Epidemiological Record (WER) for 22 October 2010, vol. 85, 43 (pp 425–436) includes: Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj); Elimination of maternal and neonatal tetanus in Myanmar, 2010; Changing epidemiology of pneumococcal serotypes after introduction of conjugate vaccine: July 2010 report.

http://www.who.int/entity/wer/2010/wer8543.pdf

Clinical Infectious Diseases
15 November 2010  Volume 51, Number 10
http://www.journals.uchicago.edu/toc/cid/current

Major Article
The Infection Attack Rate and Severity of 2009 Pandemic H1N1 Influenza in Hong Kong
Joseph T. Wu, Edward S. K. Ma, Cheuk Kwong Lee, Daniel K. W. Chu, Po-Lai Ho, Angela L. Shen, Andrew Ho, Ivan F. N. Hung, Steven Riley, Lai Ming Ho, Che Kit Lin, Thomas Tsang, Su-Vui Lo, Yu-Lung Lau, Gabriel M. Leung, Benjamin J. Cowling, and J. S. Malik Peiris
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Abstract
Background.Serial cross-sectional data on antibody levels to the 2009 pandemic H1N1 influenza A virus from a population can be used to estimate the infection attack rates and immunity against future infection in the community.

Methods.From April through December 2009, we obtained 12,217 serum specimens from blood donors (aged 16–59 years), 2520 specimens from hospital outpatients (aged 5–59 years), and 917 specimens from subjects involved in a community pediatric cohort study (aged 5–14 years). We estimated infection attack rates by comparing the proportions of specimens with antibody titers 1:40 by viral microneutralization before and after the first wave of the pandemic. Estimates were validated using paired serum samples from 324 individuals that spanned the first wave. Combining these estimates with epidemiologic surveillance data, we calculated the proportion of infections that led to hospitalization, admission to the intensive care unit (ICU), and death.

Results.We found that 3.3% and 14% of persons aged 5–59 years had antibody titers 1:40 before and after the first wave, respectively. The overall attack rate was 10.7%, with age stratification as follows: 43.4% in persons aged 5–14 years, 15.8% in persons aged 15–19 years, 11.8% in persons aged 20–29 years, and 4%–4.6% in persons aged 30–59 years. Case-hospitalization rates were 0.47%–0.87% among persons aged 5–59 years. Case-ICU rates were 7.9 cases per 100,000 infections in persons aged 5–14 years and 75 cases per 100,000 infections in persons aged 50–59 years, respectively. Case-fatality rates were 0.4 cases per 100,000 infections in persons aged 5–14 years and 26.5 cases per 100,000 infections in persons aged 50–59 years, respectively.

Conclusions.Almost half of all school-aged children in Hong Kong were infected during the first wave. Compared with school children aged 5–14 years, older adults aged 50–59 years had 9.5 and 66 times higher risks of ICU admission and death if infected, respectively.

Clinical Infectious Diseases
15 November 2010  Volume 51, Number 10
http://www.journals.uchicago.edu/toc/cid/current

Review Article
Transfusion-Transmitted Malaria in Countries Where Malaria Is Endemic: A Review of the Literature from Sub-Saharan Africa
Alex K. Owusu-Ofori, Christopher Parry, and Imelda Bates

Abstract
Although international policies recommend that blood for transfusion should be screened for transfusion-transmitted infections, malaria screening is not performed in most malaria-endemic countries in sub‐Saharan Africa. Our literature review identified 17 relevant studies from the period 1980–2009 and indicated that the median prevalence of malaria among 33,029 blood donors was 10.2% (range, 0.7% in Kenya to 55.0% in Nigeria). Malaria screening methods, including microscopy (used in 16 of 17 studies), are either insensitive or impractical for donor screening in resource-poor countries. Even if a suitable screening method were available, rejection of malaria-positive donors would jeopardize the blood supply. Only 1 study established the prevalence of parasitemia among transfusion recipients. This review highlights the need for more evidence about the clinical impact of transfusion-transmitted malaria to justify the policy of screening for blood for malaria in areas of endemicity and for a critical analysis of the feasibility of implementing such a policy and its effect on blood supply.

Editorial Commentary: Malaria and Transfusion: A Neglected Subject Coming Back to the Forefront
Jean-Pierre Allain

Emerging Infectious Diseases
Volume 16, Number 11–November 2010
http://www.cdc.gov/ncidod/EID/index.htm

Research
Outbreaks of Pandemic (H1N1) 2009 and Seasonal Influenza A (H3N2) on Cruise Ship
Kate A. Ward, Paul Armstrong, Jeremy M. McAnulty, Jenna M. Iwasenko, and Dominic E. Dwyer
Author affiliations: New South Wales Health, Sydney, New South Wales, Australia (K.A. Ward, J.M. McAnulty); Western Australian Department of Health, Perth, Western Australia, Australia (P. Armstrong); South Eastern Area Laboratory Services, Sydney (J.M. Iwasenko); and Institute of Clinical Pathology and Medical Research, Sydney (D.E. Dwyer)

Abstract
To determine the extent and pattern of influenza transmission and effectiveness of containment measures, we investigated dual outbreaks of pandemic (H1N1) 2009 and influenza A (H3N2) that had occurred on a cruise ship in May 2009. Of 1,970 passengers and 734 crew members, 82 (3.0%) were infected with pandemic (H1N1) 2009 virus, 98 (3.6%) with influenza A (H3N2) virus, and 2 (0.1%) with both. Among 45 children who visited the ship’s childcare center, infection rate for pandemic (H1N1) 2009 was higher than that for influenza A (H3N2) viruses. Disembarked passengers reported a high level of compliance with isolation and quarantine recommendations. We found 4 subsequent cases epidemiologically linked to passengers but no evidence of sustained transmission to the community or passengers on the next cruise. Among this population of generally healthy passengers, children seemed more susceptible to pandemic (H1N1) 2009 than to influenza (H3N2) viruses. Intensive disease control measures successfully contained these outbreaks.

Emerging Infectious Diseases
Volume 16, Number 11–November 2010
http://www.cdc.gov/ncidod/EID/index.htm

Conference Summary
International Conference on Emerging Infectious Diseases, 2010
Nina Marano, Theresa L. Smith, Rana A. Hajjeh, Marian McDonald, Carolyn B. Bridges, Sharon A. Martin, and Terence Chorba
Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

“The seventh International Conference on Emerging Infectious Diseases (ICEID) was held in Atlanta, Georgia, USA, July 11–14, 2010. The conference goal was to bring together public health professionals to encourage exchange of scientific and public health information on global emerging infectious disease issues. The conference was organized by the Centers for Disease Control and Prevention (CDC), American Society for Microbiology, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories, and the World Health Organization; additional support was provided by 40 other multidisciplinary public health partners.

“The conference schedule was built around 20 plenary speakers, 31 panel sessions, 110 scientific oral presentations, and 445 posters from 6 continents. Topics included relevant infectious diseases issues from the past 2 years and updates on a variety of new findings and approaches, including social determinants of health, lessons learned from the recent pandemic (H1N1) 2009, zoonotic diseases, viral hepatitis, prevention challenges of respiratory diseases, travelers’ health, new developments in vaccines, and vaccine-preventable diseases. Rima Khabbaz, Deputy Director for Infectious Diseases at CDC, and Center directors Kevin Fenton, Thomas Hearn, and Anne Schuchat conducted tours of outstanding posters that addressed emergence, prevention, and control of infectious diseases in the international and domestic arenas…” The full agenda and list of speakers can be found at the conference website (www.iceid.org).

Journal of Infectious Diseases
15 November 2010   Volume 202, Number 10
http://www.journals.uchicago.edu/toc/jid/current

Major Article
A 2009 Varicella Outbreak in a Connecticut Residential Facility for Adults with Intellectual Disability
Jessica Leung, Kathy Kudish, Chengbin Wang, Latetia Moore, Paul Gacek, Kay Radford, Adriana Lopez, Lynn Sosa, D. Scott Schmid, Matthew Cartter, and Stephanie Bialek
[Free full text]

Abstract
We investigated a varicella outbreak in a residential facility for adults with intellectual disabilities. A case of varicella was defined as a generalized maculopapular rash that developed in a facility resident or employee. Immunoglobulin M testing was conducted on serologic samples, and polymerase chain reaction testing was performed on environmental and skin lesion samples. Eleven cases were identified among 70 residents and 2 among 145 staff. An unrecognized case of herpes zoster was the likely source. Case patients first entered any residential facility at a younger age than non‐case residents (9.5 vs 15.0 years; ). Varicella zoster virus DNA was detected 2 months after the outbreak in environmental samples obtained from case patients’ residences. This outbreak exemplifies the potential for at‐risk pockets of varicella‐susceptible adults, especially among those who have lived in residential facilities from a young age. Evidence of immunity should be verified for all adults and healthcare staff in similar residential settings.

Journal of Infectious Diseases
15 November 2010   Volume 202, Number 10
http://www.journals.uchicago.edu/toc/jid/current

Major Article
Measles in the United States during the Postelimination Era
Amy Parker Fiebelkorn, Susan B. Redd, Kathleen Gallagher, Paul A. Rota, Jennifer Rota,
William Bellini, and Jane Seward
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Abstract
Background.Measles affected entire birth cohorts in the prevaccine era but was declared eliminated in the United States in 2000 because of a successful measles vaccination program.

Methods.We reviewed US surveillance data on confirmed measles cases reported to the Centers for Disease Control and Prevention and data on national measles-mumps-rubella (MMR) vaccination coverage during postelimination years 2001−2008.

Results.During 2001−2008, a total of 557 confirmed cases of measles (annual median no. of cases, 56) and 38 outbreaks (annual median no. of outbreaks, 4) were reported in the United States; 232 (42%) of the cases were imported from 44 countries, including European countries. Among case-patients who were US residents, the highest incidences of measles were among infants 6–11 months of age and children 12–15 months of age (3.5 and 2.6 cases/1 million person-years, respectively). From 2001 through 2008, national 1-dose MMR vaccine coverage among children 19–35 months of age ranged from 91% to 93%. From 2001 through 2008, a total of 285 US-resident case-patients (65%) were considered to have preventable measles (ie, the patients were eligible for vaccination but unvaccinated). During 2004–2008, a total of 68% of vaccine-eligible US-resident case-patients claimed exemptions for personal beliefs.

Conclusions.The United States maintained measles elimination from 2001 through 2008 because of sustained high vaccination coverage. Challenges to maintaining elimination include large outbreaks of measles in highly traveled developed countries, frequent international travel, and clusters of US residents who remain unvaccinated because of personal belief exemptions.

The Lancet
Oct 23, 2010  Volume 376  Number 9750  Pages 1363 – 1436
http://www.thelancet.com/journals/lancet/issue/current

Comment
Global Health Metrics and Evaluation—a call for abstracts
GHME Conference Organizing Committee

The Institute for Health Metrics and Evaluation (Seattle, WA, USA), The Lancet, the London School of Hygiene & Tropical Medicine, the Harvard School of Public Health, and the University of Queensland School of Population Health invite submission of abstracts for oral or poster presentation at their conference called Global Health Metrics and Evaluation: Controversies, Innovation, Accountability, to be held on March 14–16, 2011 in Seattle, WA, USA.

The Lancet
Oct 23, 2010  Volume 376  Number 9750  Pages 1363 – 1436
http://www.thelancet.com/journals/lancet/issue/current

Article
Equity and adequacy of international donor assistance for global malaria control: an analysis of populations at risk and external funding commitments
Robert W Snow, Emelda A Okiro, Peter W Gething, Rifat Atun, Simon I Hay

Preview
Funding for malaria control worldwide is 60% lower than the US$4·9 billion needed for comprehensive control in 2010; this includes funding shortfalls for a wide range of countries with different numbers of people at risk and different levels of domestic income. More efficient targeting of financial resources against biological need and national income should create a more equitable investment portfolio that with increased commitments will guarantee sustained financing of control in countries most at risk and least able to support themselves.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 47 pp. 7453-7576 (3 November 2010)

Letters to the Editor
An update to “The cost-effectiveness of rotavirus vaccination: Comparative analyses for five European countries and transferability in Europe”
Pages 7457-7459
Mark Jit, Marie-Josée J. Mangen, Hugues Melliez, Yazdan Yazdanpanah, Joke Bilcke, Heini Salo, W. John Edmunds, Philippe Beutels

Abstract
A cost-effectiveness analysis of rotavirus vaccination in Belgium, England and Wales, Finland, France and the Netherlands published in 2009 was updated based on recent studies on rotavirus burden of disease and vaccine efficacy. All the qualitative conclusions in the previous study were found to remain valid. Vaccination remains cost-effective in Finland only when using plausible tender prices.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 47 pp. 7453-7576 (3 November 2010)

Regular Papers
Acceptability of HPV vaccination among young adults aged 18–30 years–a population based survey in Sweden

Original Research Article
Pages 7492-7500
Karin Sundström, Trung Nam Tran, Cecilia Lundholm, Cecilia Young, Pär Sparén, Lisen Arnheim Dahlström

Preview
Acceptability of human papillomavirus (HPV) vaccination seems to be high in the Western world but fewer data are available for men than for women. There are also concerns that HPV vaccination might lead young people to change their healthcare-related behaviours. We investigated these issues in a population-based survey performed in Sweden during January-May, 2007, just after HPV vaccination had been licensed. A total of 10 567 men and women aged 18 to 30 years participated. The intention to accept HPV vaccination among these young adults was relatively high but could likely be improved with higher awareness of HPV-related diseases as well as of the safety and efficacy of vaccines in general. Also, the cost of the vaccine needs to be affordable. Even though few young adults stated their healthcare-related behaviours would change after HPV vaccination, a significant number were uncertain, suggesting a need for continued educational efforts when HPV-vaccinating this group.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 47 pp. 7453-7576 (3 November 2010)

A measles and rubella (MR) catch-up vaccination campaign in an Egyptian University: Vaccine uptake and knowledge and attitudes of students

Original Research Article
Pages 7563-7568
Khaled M. Abd Elaziz, Sahar M. Sabbour, Sahar A. Dewedar

Abstract
Introduction
In 2008, following a rubella epidemic, the Egyptian Ministry of Health implemented a Measles Rubella (MR) catch-up campaign, based on WHO recommendations for supplementary immunization activities to eliminate measles by 2010. The age group targeted was 10–20 years. This campaign was unique in Egypt as it was the first national vaccination campaign which included university students.

Aim
o report uptake of MR vaccine and reasons for declining the vaccine among medical and non-medical students in the campaign and to assess the knowledge about the vaccine and the diseases.

Methods
The study was conducted in two stages. In the first stage during the vaccination sessions, medical and other students (N = 310) were given a questionnaire to assess their knowledge of the campaign and the vaccine. The second stage (N = 341) was carried out when the campaign was completed to assess vaccine uptake among medical students.

Results
Posters displayed inside the university were reported to be the main source of information about the campaign. Students were generally poorly informed about both vaccine adverse effects, and contraindications although medical students tended to be better informed than other students. Overall 64.8% medical students accepted the vaccine with higher uptake among females than males (85.9 and 58.3% respectively). Non-compliant students had a significantly higher mean age. Almost half of students who did not accept the vaccine gave their reason as having little information about the vaccine (43.3%).

Conclusion
The MR campaign in Ain Shams University may have been more successful with better use of health education messages.

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

Volume 28, Issue 47 pp. 7453-7576 (3 November 2010)

Knowledge of vaccination of allergic children among Italian primary care pediatricians, hospital pediatricians and pediatric residents

Original Research Article
Pages 7569-7575
Susanna Esposito, Chiara Azzari, Giorgio Bartolozzi, Gaetano Maria Fara, Franco Giovanetti, Milena Lo Giudice, Carlotta Galeone, Marta Ciofi degli Atti and for the Italian Society of Pediatric Allergy and Immunology

Abstract
A cross-sectional survey of Italian pediatricians and pediatric residents was carried out between 15 September and 18 October 2008 in order to evaluate their knowledge concerning the administration of vaccines to children with suspected or proved allergies. Of the 750 physicians who accepted to participate (620 pediatricians and 130 residents), 630 (84.0%; 407 females; mean age 43.5 ± 11.2 years) returned completed questionnaires: 268 primary care pediatricians (42.5%), 244 hospital pediatricians (38.8%), and 118 pediatric residents (18.7%). Knowledge concerning the vaccination of children with suspected or proved allergies was far from optimal, with the poorest knowledge being shown by the pediatric residents and no difference between the primary care and hospital pediatricians. Since pediatricians are the main parents’ advisors regarding vaccinations, these results indicate an urgent need for educational programmes (especially for residents) and evidence-based guidelines concerning vaccinations in children with suspected or proved allergies.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 46 pp. 7345-7452 (28 October 2010)

Vaccine preventable diseases in returned international travelers: Results from the GeoSentinel Surveillance Network

Original Research Article
Pages 7389-7395
Andrea K. Boggild, Francesco Castelli, Philippe Gautret, Joseph Torresi, Frank von Sonnenburg, Elizabeth D. Barnett, Christina A. Greenaway, Poh-Lian Lim, Eli Schwartz, Annelies Wilder-Smith, Mary E. Wilson and for the GeoSentinel Surveillance Network

Abstract
Vaccine preventable diseases (VPDs) threaten international travelers, but little is known about their epidemiology in this group. We analyzed records of 37,542 ill returned travelers entered into the GeoSentinel Surveillance Network database. Among 580 (1.5%) with VPDs, common diagnoses included enteric fever (n = 276), acute viral hepatitis (n = 148), and influenza (n = 70). Factors associated with S. typhi included VFR travel (p < 0.016) to South Central Asia (p < 0.001). Business travel was associated with influenza (p < 0.001), and longer travel with hepatitis A virus (p = 0.02). 29% of those with VPDs had pre-travel consultations. At least 55% of those with VPDs were managed as inpatients, compared to 9.5% of those with non-VPDs. Three deaths occurred; one each due to pneumococcal meningitis, S. typhi, and rabies. VPDs are significant contributors to morbidity and potential mortality in travelers. High rates of hospitalization make them an attractive target for pre-travel intervention.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 46 pp. 7345-7452 (28 October 2010)

Healthy young and middle age adults: What will it take to vaccinate them for influenza?

Original Research Article
Pages 7420-7422
Lori Uscher-Pines, Jurgen Maurer, Arthur Kellerman, Katherine M. Harris

Abstract
Starting in 2010, healthy adults age 19–49 will be recommended for annual influenza vaccination. Because they were not previously targeted, little is known about their vaccine-related attitudes and behaviors. Using nationally representative survey data from 2009 to 2010, we found that adults newly recommended for influenza vaccination (as compared to previously recommended groups) are less likely to believe flu vaccines are safe (44% vs. 63%), to have ever been vaccinated (36% vs. 64%), to be vaccinated following a healthcare provider recommendation (44% vs. 52%), and to visit a doctor’s office during vaccination season (41% vs. 69%). To boost rates of influenza vaccination in this population, new and untraditional strategies aimed at encouraging first-time vaccination are needed.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 46 pp. 7345-7452 (28 October 2010)

Racial disparities in diarrhea-associated hospitalizations among children in five US States, before and after introduction of rotavirus vaccine

Original Research Article
Pages 7423-7426
Catherine Yen, Claudia A. Steiner, Marguerite Barrett, Aaron T. Curns, Katherine Hunter, Emily Wilson, Umesh D. Parashar

Abstract
Racial differences in diarrheal disease have not been systematically examined, and the impact of rotavirus vaccine on these differences has not been assessed. We compared diarrhea-associated hospitalizations by race/ethnicity among children <5 years pre- (2000–2006) and post- (2007 and 2008) rotavirus vaccine introduction in five US states. Pre-vaccine hospitalization rates were greater among whites versus blacks and Hispanics. However, black (versus non-black) infants <6 months and white (versus non-white) children ≥1 year had higher rates. In 2008, racial disparities for children 12–35 months resolved, but higher hospitalization rates among black infants <6 months persisted, highlighting the need for timely vaccination.

The GAVI Alliance released a summary of actions and next steps from its meeting of donors and partners in early October, including a plan for its first pledging conference in June 2011 “to ensure that the global health partnership has the necessary funding to introduce new vaccines against the two biggest killers of children – pneumonia and diarrhoea.” Mary Robinson, Chair of the GAVI Alliance Board, commented, “The right to health is a basic human right and the inequity that exists between those children who are lucky enough to be vaccinated and those who are not is shocking. Every one of us shares a collective responsibility to make a difference. Despite the financial crisis, let’s surprise everyone next June by ensuring that GAVI gets the funding it needs. GAVI’s mission is too important to fail.”

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

The Global Fund to Fight AIDS, Tuberculosis and Malaria held the Second Meeting of the Third Voluntary Replenishment (2011-2013) in New York, 4-5 October 2010. Donors announced funding of US$11.7 billion for the years 2011-2013, representing “the largest ever financial pledge for the collective, international effort to fight the three pandemics.” The new funding compares with US$9.7 billion committed to the Global Fund in Berlin in September 2007 for the period 2008-2010. The meeting reviewed “follow up work undertaken in response to a range of issues raised by participants in The Hague, and discussed the current reform program being implemented by the Global Fund Secretariat, and considered future resource projections for the next three years.” With sufficient funding for the Replenishment the Global Fund, (the Fund) said it “could be in a position to: eradicate malaria as a public health concern in most malaria endemic countries; virtually eliminate the transmission of HIV from mother to child; contain the threat of multi-drug resistant tuberculosis; prevent millions of avoidable deaths from AIDS; and contribute to significant reductions in maternal and child mortality.”

http://www.theglobalfund.org/en/replenishment/newyork/

The Stop TB Partnership announced its GLOBAL PLAN TO STOP TB 2011-2015 which it said “for the first time identifies all the research gaps that need to be filled to bring rapid TB tests, faster treatment regimens and a fully effective vaccine to market. It also shows public health programmes how to drive universal access to TB care, including how to modernize diagnostic laboratories and adopt revolutionary TB tests that have recently become available.” The organization said that twenty-two countries, including South Africa, bear 80% of the burden of TB worldwide. Some 9 million people become ill with active TB and nearly 2 million die each year. The new Global Plan sets out to provide diagnosis and treatment approaches recommended by the World Health Organization (WHO) for 32 million people over the next five years.

The Global Plan calls for US$37 billion for implementation of TB care between 2011 and 2015, leaving a funding gap of about US$14 billion, or approximately US$2.8 billion per year, which “needs to be filled by international donors.” The plan “includes a separate calculation of the funding required to meet targets for research and development: a total of US$ 10 billion, or US$ 2 billion per year. High-income countries and those with growing economies will need to increase their investment in research and development to fill an estimated gap of about US$ 7 billion, or US$ 1.4 billion per year.” Dr Margaret Chan, Director-General of WHO, which hosts the Stop TB Partnership, said, “There is an urgent need to scale up action against TB – 10 million people, including 4 million women and children, will lose their lives unnecessarily between now and 2015 if we fail. TB control works, with global incidence of the disease declining since 2004, although much too slowly.”

http://www.who.int/mediacentre/news/releases/2010/tb_20101013/en/index.html

Plan documentation at http://www.stoptb.org/global/plan/

The WHO issued Working to overcome the global impact of neglected tropical diseases – its first report on neglected tropical diseases. The report “presents evidence to demonstrate that activities undertaken to prevent and control neglected tropical diseases are producing results – and that achievements are being recognized…Neglected tropical diseases blight the lives of a billion people worldwide and threaten the health of millions more. These close companions of poverty weaken impoverished populations, frustrate the achievement of health in the Millennium Development Goals and impede global public health outcomes.”
http://www.who.int/neglected_diseases/2010report/en/index.html

WHO report at: http://www.who.int/entity/neglected_diseases/2010report/NTD_2010report_embargoed.pdf

The U.S. Supreme Court heard opening arguments in Bruesewitz v. Wyeth, Inc., Docket No. 09-152 involving the National Childhood Vaccine Injury Act of 1986 and vaccine manufacturer liability. The case was brought by the family of Hannah Bruesewitz, a Pennsylvania teen whose seizure disorder surfaced after she received a diphtheria, tetanus, and pertussis vaccine made by Wyeth.

Links to the docket and various briefs are presented below. The Questions Presented summary is presented in full text here:

“Section 22(b)(1) of the National Childhood Vaccine Injury Act of 1986 [“the Act”] expressly preempts certain design defect claims against vaccine manufacturers “if the injury or death resulted from side effects that were unavoidable even though the vaccine was properly prepared and was accompanied by proper directions and warnings.” 42 U.S.C. § 300aa-22(b)(1). A-104.
“The Question Presented is:
Whether the Third Circuit erred in holding that, contrary to its plain text and the decisions of this Court and others, Section 22(b)(1) preempts all vaccine design defect claims, whether the vaccine’s side effects were unavoidable or not?”

http://www.abanet.org/publiced/preview/briefs/oct2010.shtml#09152

Merit briefs

– Brief for Petitioners Russell Bruesewitz and Robalee Bruesewitz, Parents and Natural Guardians of Hannah Bruesewitz, a minor child, and In Their Own Right

– Brief for Respondent Wyeth, Inc. F/K/A Wyeth Laboratories, Wyeth-Ayerst Laboratories, Wyeth Lederle, Wyeth Lederle Vaccines and Lederle Laboratories,

– Reply Brief for Petitioners Russell Bruesewitz and Robalee Bruesewitz, Parents and Natural Guardians of Hannah Bruesewitz, a minor child, and In Their Own Right

Amicus briefs

– Brief for the National Vaccine Information Center, Its Co-Founders, and 24 Other Organizations in Support of Petitioners

– Brief for Marguerite Willner in Support of Petitioner

– Brief for Mark A. Geistfeld in Support of Petitioner

– Brief for the American Association for Justice, Public Justice and Public Citizen in Support of Petitioner

– Brief for Vaccine Injured Petitioners Bar Association, The George Washington University Law School Vaccine Injury Clinic, and Zenoria Phillips Deloatch, As Personal Representative of The Estate of Moshella F. Roberts in Support of Petitioner

– Brief for Glaxosmithkline LLC, Merck Sharp & Dohme Corp. (Formerly Known As Merck & Co., Inc.), And Sanofi Pasteur Inc. in Support of Respondent

– Brief for Washington Legal Foundation in Support of Respondent

– Brief for United States of America in Support of Respondent

– Brief for the American Academy of Pediatrics and 21 Other Physician and Public Health Organizations in Support of Respondent

– Brief for Patricia A. Buffler, Diego T. Buriot, Jose Cordero, Ronald E. Gots, Ronald Hart, Steven H. Lamm, Angus Nicoll, Onora O’Neill, Samuel Osher, James D. Watson and Richard Wilson in Support of Respondent

– Brief for the Chamber of Commerce of the United States of America in Support of Respondent

– Brief for Kenneth W. Starr and Erwin Chemerinsky in Support of Petitioners Urging Reversal

The Weekly Epidemiological Record (WER) for 15 October 2010, vol. 85, 42 (pp 413–424) includes: Controlling rubella and preventing congenital rubella syndrome – global progress, 2009; Antigenic and genetic characteristics of influenza A(H5N1) and influenza A(H9N2) viruses and candidate vaccine viruses developed for potential use in human vaccines. http://www.who.int/entity/wer/2010/wer8542.pdf

The MMWR for October 15, 2010 / Vol. 59 / No. 40, includes:

–  Estimated Lifetime Risk for Diagnosis of HIV Infection Among Hispanics/Latinos — 37 States and Puerto Rico, 2007

–  Tetanus and Pertussis Vaccination Coverage Among Adults Aged ≥18 Years — United States, 1999 and 2008

–  Progress Toward Control of Rubella and Prevention of Congenital Rubella Syndrome — Worldwide, 2009

–  Announcements: Final 2009–10 Influenza Season Vaccination Coverage Estimates

–  Announcements: Conference on Mobile Technologies Use for Public Health and Medical Information — November 8–10, 2010

http://www.cdc.gov/mmwr/PDF/wk/mm5940.pdf

The UN’s Food and Agriculture Organization (FAO) announced that “an ambitious global effort that has brought rinderpest, a deadly cattle plague, to the brink of extinction, is ending all field activities, paving the way for official eradication of the disease.” FOA made the announcement at a Global Rinderpest Eradication Symposium held in Rome, 13-14 October 2010. The eradication, achieved through mass immunization with vaccines, “…would be the first time in history that humankind has succeeded in wiping out an animal disease in the wild, and only the second time, after smallpox in 1980, that a disease has been eliminated thanks to human efforts.” Rinderpest does not affect humans directly, but its ability to cause swift, massive losses of cattle and other hoofed animals has led to devastating effects on agriculture for millennia, leaving famine and economic devastation in its wake, FOA said. A joint FAO/OIE announcement of global rinderpest eradication is expected in mid-2011, pending a review of final official disease status reports from a handful of countries to the World Organisation for Animal Health (OIE).

The Lancet
Oct 16, 2010  Volume 376 Number 9749 Pages 1273 – 1362
http://www.thelancet.com/journals/lancet/issue/current

Editorial
The Global Fund: a bleak future ahead
The Lancet

Extract
On Oct 5, at the third replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria, donors pledged US$11.7 billion for 2011–13—a sum that falls badly short of what is needed. The world is backsliding on its commitments, made recently at the Millennium Development Goal Summit in New York, to expand access for millions of people to life-saving interventions.

The Lancet
Oct 16, 2010  Volume 376 Number 9749 Pages 1273 – 1362
http://www.thelancet.com/journals/lancet/issue/current

Comment
Time for a bold new vision at the Stop TB Partnership
Salmaan Keshavjee, Francoise Girard, Mark Harrington, Paul E Farmer

New England Journal of Medicine
October 14, 2010  Vol. 363 No. 16
http://content.nejm.org/current.shtml

Perspectives
Legislating against Use of Cost-Effectiveness Information
P.J. Neumann, M.C. Weinstein [free full-text]

Science
15 October 2010  Vol 330, Issue 6002, Pages 281-412
http://www.sciencemag.org/current.dtl

News of the Week
Immunology:
Painful Failure of Promising Genital Herpes Vaccine
Jon Cohen

A vaccine designed to ward off genital herpes has failed in a large clinical trial, abruptly ending the product’s seemingly promising future. After 8 years of study in more than 8000 women in the United States and Canada, there was not even a hint of a positive result against the sexually transmitted disease caused by herpes simplex virus-2.

Science Translational Medicine
13 October 2010 vol 2, issue 53
http://stm.sciencemag.org/content/current

Research Articles
Vaccines
A Defined Tuberculosis Vaccine Candidate Boosts BCG and Protects Against Multidrug-Resistant Mycobacterium tuberculosis
Sylvie Bertholet, Gregory C. Ireton, Diane J. Ordway, Hillarie Plessner Windish, Samuel O. Pine, Maria Kahn, Tony Phan, Ian M. Orme, Thomas S. Vedvick, Susan L. Baldwin, Rhea N. Coler, and Steven G. Reed
13 October 2010: 53ra74

A vaccine with a four-protein fusion peptide from Mycobacterium tuberculosis effectively boosts the current childhood TB vaccine and protects against drug-resistant TB.

Science Translational Medicine
13 October 2010 vol 2, issue 53
http://stm.sciencemag.org/content/current

Editor’s Choice
Human Papillomavirus
To Vaccinate or Not: Parents Decide
Donna E. Hansel
13 October 2010: 53ec160

Although prophylactic human papillomavirus vaccines now are available, fewer than 20% of girls 9 to 26 years of age have completed the three-dose series.

The GAVI Alliance held its “first replenishment meeting” in New York last week “to agree on how to fund programmes to avert an estimated 4.2 million future deaths through immunisation.” GAVI said the meeting was intended to “…set the stage for a pledging conference in 2011” in the context of efforts to raise US$4.3 billion to scale-up its immunisation programmes in developing countries between 2010 and 2015.”  GAVI did not release a summary of meeting actions but issued media releases on a commitment by Canada of $50 million over five years, and a new pledge by Australia of A$60 million (US$58 million) over three years, doubling the country’s previous commitment.

Media Releases at: http://www.gavialliance.org/media_centre/press_releases/index.php

Novartis announced a collaboration with Synthetic Genomics Vaccines Inc. to “combine synthetic biology and genome sequencing capabilities with leading edge vaccine technology to create more flexible processes to generate influenza seed viruses, with the aim to speed up influenza vaccine production.” The three-year agreement is supported by a BARDA award. The anno8uncement noted that “currently Novartis and other vaccines companies rely on the WHO to identify and distribute live reference viruses to create seasonal or pandemic vaccines. Under this collaboration, Novartis and SGVI will work to develop a “bank” of synthetically constructed seed viruses ready to go into production as soon as WHO identifies the flu strains. The technology could reduce the vaccine production time by up to two months, which is particularly critical in the event of a pandemic.”

Rino Rappuoli, Head of Research for Novartis Vaccines and Diagnostics, said, “Our research strategy has always been to apply new vaccine technologies and innovation to deliver better prevention methods and meet patient needs. We are pleased to work in collaboration with Craig Venter and SGVI to study and develop this promising and important new synthetic genomics technology. It has the potential to safely reduce the time needed to develop new vaccines and improve pre-pandemic preparedness.”

Novartis said it “plans to test vaccines that could potentially result from this new approach in large-scale clinical trials. Review and approval from country health authorities will be obtained before any commercial use.”

http://www.novartis.com/newsroom/media-releases/en/2010/1449685.shtml

Johnson & Johnson and Crucell announced an agreement whereby Johnson & Johnson will acquire all outstanding equity of Crucell that it does not already own for approximately € 1.75 billion in a recommended cash tender offer. Johnson & Johnson currently owns 17.9% of Crucell’s outstanding shares. J&J said it “expects to maintain Crucell’s existing facilities, to retain Crucell’s senior management and, generally, to maintain current employment levels. Johnson & Johnson also intends to keep Crucell as the center for vaccines within the Johnson & Johnson pharmaceutical group, and to maintain Crucell’s headquarters in Leiden.  Paul Stoffels, Global Head, Pharmaceutical Research and Development, Johnson & Johnson, commented, “Johnson & Johnson and Crucell share a commitment to improving the lives of people worldwide. This potential combination would provide us with a new platform for growth and advances our goal to deliver integrated health care solutions, with particular emphasis on prevention. Operational excellence in manufacturing and supply chain has made Crucell an established and reliable supplier of vaccines, in particular to emerging markets. We hope to build on those capabilities, and the expertise and talent of Crucell’s employees to continue making a difference in the lives of people worldwide.”
http://www.jnj.com/connect/news/corporate/Johnson-and-Johnson-and-Crucell-Reach-Agreement-on-Intended-Public-Offer-of-Ordinary%20Share-of-Crucell

NIH announced “three new contracts to fund research on vaccines to protect against emerging infectious diseases and biological threats that could be used in a terror attack.”  Total funding for the three awards could reach US$68 million depending on the successful completion of defined project milestones. NIAID Director Anthony S. Fauci, M.D. commented, “These new contracts build on NIAID’s commitment to support the advanced development of products that are important to the public health but often unattractive to investors in private industry, by bridging the funding gap with contracts intended to address specific health needs.” The three studies will focus on a dengue vaccine delivered by a needle-free device, an anthrax vaccine delivered orally, and an anthrax vaccine delivered in conjunction with an adjuvant. Clinical trials of all three vaccine products should begin within three years, FDA noted

http://www.nih.gov/news/health/oct2010/niaid-07.htm

The FDA awarded US$904,000 to Pan American Health Organization (PAHO) “to research and develop an information hub for medical products and related regulatory processes and systems in the Americas Region.” FDA said the “hub” will collect and produce data and map structures and processes in the areas of medical products, including drugs, biologics, vaccines, medical devices and other medical products, and related regulatory processes and systems. The award “will help FDA, and all PAHO member states, to better understand other countries’ regulatory systems, support capacity to use harmonized standards and guidelines across countries, and prevent, and if necessary respond more quickly to, problems in the medical product supply chain.” The FDA noted that “regulatory agencies in the Americas Region have different legal and regulatory frameworks, different institutional and administrative structures, different standards and guidelines, and different ways of collecting and analyzing information. Better collaboration among these agencies will build confidence and knowledge among the participants, stakeholders, and ultimately benefit patients and consumers throughout the region.”

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm228423.htm

PAHO: http://new.paho.org/hq/index.php

BARDA (Biomedical Advanced Research and Development Authority) announced a three-year, US$57 million contract to Sanofi Pasteur to “secure a continued year-round supply of eggs and other essential supplies for pandemic influenza vaccine as part of pandemic preparedness.” BARDA Director Dr. Robin Robinson commented, “This contract ensures that progress continues in creating a solid base for manufacturing pandemic influenza vaccine in the United States. While BARDA is currently investing in the development of new vaccine technologies, we must also ensure a robust supply of vaccine for Americans with technologies currently available.”

http://www.businesswire.com/news/home/20101008005977/en/BARDA-Funds-Year-Round-Egg-Supply-Pandemic-Flu