This is the pdf document version compiling  individual posts below on this date.

Vaccines_The Week in Review_20 December 2010

The PATH Malaria Vaccine Initiative (MVI), Merck (MSD), and NYU Langone Medical Center announced that they are working together to evaluate an approach targeting the circumsporozoite protein (CSP), a major surface protein on the malaria parasite. The organizations said that researchers working on this project are focusing on a new approach that targets a region of CSP important to a critical function of the protein. By blocking this function, it is hoped that invasion of the parasite into the liver, an essential step in causing malaria disease, can be prevented. Dr. Elizabeth Nardin, professor in the Department of Medical Parasitology at NYU Langone Medical Center, said, “We think we can improve the way sub-unit vaccines are designed by strategically targeting this critical protein function. Other vaccine approaches targeting CSP have required extremely high levels of antibody, which are difficult to elicit and to maintain. This approach has the potential to address that problem.” Dr. Christian Loucq, director of MVI, said, “We are very pleased that one of the world’s largest pharmaceutical companies and a major academic medical center have committed to testing a promising new way to defend children against malaria.” More technical detail at:

http://www.businesswire.com/news/home/20101213006891/en/PATH-Malaria-Vaccine-Initiative-Merck-NYU-Langone

GAVI announced the rollout of pneumococcal conjugate vaccine in Nicaragua “paving the way to introductions in more than 40 developing countries.” GAVI said that Nicaraguan children will receive pneumococcal vaccines on a routine basis as part of a regular childhood immunisation package provided by the country’s Ministry of Health. To support the introduction of pneumococcal vaccine in Nicaragua, GAVI has already approved US$4,732,000 for 2010-2011, and expects to commit another US$10 million through to 2015.

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

The Global Fund to Fight AIDS, Tuberculosis and Malaria said its Board of Directors approved 79 grants with a two-year commitment of US$1.7 billion, representing “the tenth time the Global Fund Board approved new proposals to support programs fighting the three diseases. The total approved funding for these ten rounds is US$21.7 billion for 150 countries since it was created in 2002.” The Global Fund said the US$1.7 billion is made up of US$732 million for HIV and AIDS, US$574 for malaria and US$299 million for TB and US$128 million for health systems strengthening. The 79 proposals which were found to be of sufficient technical quality to be funded constitute a success rate of just over half of the submitted proposals. The announcement noted that the Board also “adopted a series of measures to enable future funding opportunities, including the launch of Round 11 on 15 August 2011, with a submission due date for applicants on 15 December 2011.”

http://www.theglobalfund.org/en/pressreleases/?pr=pr_101215

Dow Jones Indexes said it is launching the Dow Jones Global Fund 50 Index: a new index in collaboration with the Global Fund to Fight AIDS, Tuberculosis and Malaria, “which will help generate resources for the Global Fund’s work.” The new index measures the performance of the largest companies that support the mission of the Global Fund. A portion of revenues generated through the licensing of the index will go to the Global Fund. Dow Jones said the new index “is the flagship of a new index series, which will include indexes with overlaying strategies and additional themes.” The index has been licensed to db X-trackers, the leading ETF platform of Deutsche Bank, to serve as a basis for a financial product, the db x-trackers Global Fund Supporters ETF. The ETF is now trading on the Frankfurt stock exchange.

Dow Jones described the Fund as comprising the top 50 companies (based on float-adjusted market capitalization) that contribute to the mission of the Global Fund.  The index is quoted in U.S Dollars (USD). Float-market capitalization measures the amount of shares in a company that are readily available to be traded by investors. No more than 15 companies are selected from any individual country. The weight of individual countries is capped at 40% and single components are capped at 20%. The composition of the index is reviewed annually, in June. Float factors, shares and weights are updated quarterly. As of October 29, 2010, the year-to-date performance calculated in USD for the Dow Jones Global Fund 50 Index is -4.29%. Back-tested historical data has been calculated daily back to December 31, 2004, the date at which the index base value is set at 1000.

http://www.theglobalfund.org/en/pressreleases/?pr=pr_101213

WHO announced that its Commission on Information and Accountability for Women’s and Children’s Health “will propose a framework for global reporting, oversight and accountability on women’s and children’s health, and will “create a system to track whether donations for women’s and children’s health are made on time, resources are spent wisely and transparently, and whether the desired results are achieved.” WHO reported that the accountability framework proposed by the Commission will:

– track results and resource flows at global and country levels;

– identify a core set of indicators and measurement needs for women’s and children’s health;

– propose steps to improve health information and registration of vital events – births and deaths – in low-income countries;

– explore opportunities for innovation in information technology to improve access to reliable information on resources and outcomes. The Commission will report in May 2011.

http://www.who.int/topics/millennium_development_goals/accountability_commission/en/index.html

The MMWR for December 17, 2010 / Vol. 59 / No. 49 includes:

Announcement: 14th Annual Conference on Vaccine Research

December 17, 2010 / 59(49);1620

The 14th Annual Conference on Vaccine Research, the largest scientific forum devoted exclusively to the research and development of vaccines and related technologies for prevention and treatment of disease through immunization, will be held May 16–18, 2011, at the Baltimore Marriott Waterfront Hotel in Baltimore, Maryland. The conference brings together the diverse fields of human and veterinary vaccinology to encourage collaboration and multidisciplinary approaches among disease-specific and methodologic experts.

One Health initiatives, herpesvirus vaccines, the status of human immunodeficiency virus vaccines, genomics, special populations in immunology, and alternative animal models in vaccine discovery are among topics scheduled for discussion during the conference. New this year is a preconference workshop in academic vaccinology, Writing and Submitting a Vaccine Research Paper.

…The vaccine research conference is sponsored by the National Foundation for Infectious Diseases, in collaboration with CDC and 13 other national and international agencies and organizations. Additional information is available at http://www.nfid.org/conferences/vaccine11

JAMA
December 15, 2010, Vol 304, No. 23, pp 2559-2658
http://jama.ama-assn.org/current.dtl

Medical News & Perspectives
Mothers Take Physicians’ Advice on Vaccines
Bridget M. Kuehn
AMA. 2010;304(23):2577-2578.doi:10.1001/jama.2010.1785

Extract (per JAMA convention)
Women are more likely to get a pertussis vaccination for their infants or a prenatal flu shot for themselves if a physician has advised them to do so and provides them with information, according to a pair of studies presented at the Infectious Diseases Society of America (IDSA) meeting in October. The findings suggest a simple recommendation from a physician can have a powerful effect on vaccination rates.

PERTUSSIS PREVENTION
In 2009, there were nearly 17 000 reported cases of pertussis, including 14 deaths, according to the US Centers for Disease Control and Prevention (CDC). Cases have been rising among US teens and infants since the 1980s, according to the agency, and some scientists have suggested that parents refusing to vaccinate themselves or their children may be driving the increase. Currently, the CDC recommends that infants and young children receive a 5-dose series of diphtheria, tetanus, and pertussis (DTaP) and that adults receive …

JAMA
December 15, 2010, Vol 304, No. 23, pp 2559-2658
http://jama.ama-assn.org/current.dtl

Commentaries
The Right to Health as the Unheralded Narrative of Health Care Reform
Eric A. Friedman,
Eli Y. Adashi

JAMA. 2010;304(23):2639-2640.doi:10.1001/jama.2010.1845

Extract (per JAMA convention)
In passing the Affordable Care Act, the United States took a giant, if partial, step toward joining other nations wherein the right to health constitutes an inalienable moral and legal right. Although not widely appreciated, the right of every person to enjoy the highest attainable standard of physical and mental health 1 (the right to health for short) is not merely an abstract moral imperative. Rather, it is an established international legal precept still to be fully embraced in the United States. Even though the right to health was overshadowed during the health care debate by other narratives, such as insurance reform, cost control, and care delivery, this right remains a central if unheralded narrative of the Affordable Care Act and its legacy. What is this right that engenders these bold claims? It is an assertion of the responsibility of governments to strive for “the highest attainable standard of physical …

The Lancet
Dec 18, 2010  Volume 376  Number 9758  Pages 2041 – 2116
http://www.thelancet.com/journals/lancet/issue/current

Comment
Artemisinin resistance—the clock is ticking
Nicholas J White

Preview
Artemisinin resistance in falciparum malaria has emerged in western Cambodia.1 Chloroquine resistance arose in exactly the same place 50 years ago, spread to Africa, and killed millions of children.2–4 Resistance to sulfadoxine-pyrimethamine (the antimalarial combination that followed chloroquine) in Africa can be traced to the same origin. The parallels are chilling. If artemisinin resistance spreads widely, it will derail current initiatives to control and eliminate malaria. The consequences will be disastrous.

Nature
Volume 468 Number 7326 pp867-996  16 December 2010
http://www.nature.com/nature/current_issue.html

World View
Drug development needs a new brand of science
We need to break with the past to develop new medicines, says Garret FitzGerald. An interdisciplinary NIH centre points the way.

Garret FitzGerald

Last week, the US National Institutes of Health (NIH) voted to launch a National Center for Advancing Translational Sciences, focusing on translational medicine and therapeutics (TMAT), the growing field that aims to speed therapies from the laboratory to the clinic. NIH director Francis Collins called the decision “momentous” — a “disruptive innovation on an institutional scale” — and I think he is right. Only a translational approach can address the fact that the current model of drug discovery and development is unsustainable. Paradoxically, as we have witnessed a successful revolution in drug discovery, a crisis has emerged in drug development. Targets, and the chemistry needed to probe them, can be selected more rationally than ever — yet more and more candidate drugs are proving expensive failures.

One reason is that too many steps are pursued in specialist isolation, in both academia and industry. Too few people can bridge the translational and interdisciplinary divides. This has led to crucial and expensive mistakes in phase II of drug development — when there is often a failure to see an impact on efficacy, a propensity to ignore risks, or a danger of making errors in dose selection for phase III.

“We must revise how we reward ideas and will need common standards of data protection.”

The new NIH centre promises to catalyse a much-needed restructuring of the drug-development process. The centre can foster training by absorbing the Clinical and Translational Science Awards (CTSAs) and their educational infrastructure. This will allow scientists to partner in a modular approach to drug development, in which expertise is drawn from distinct sectors and regions as needed to address particular therapeutic challenges. Furthermore, the broad CTSA-supported programmes and infrastructure — from preclinical science to community outreach — could be harvested to support a more efficient approach to drug development, approval and dissemination.

Why has the need for such a radical change emerged? Thirty years ago, the best clinical pharmacology units housed experts from a range of disciplines. Cell biologists worked side by side with colleagues studying model systems and those involved in mechanistic studies of physiology, disease and drug action in humans and pharmacokinetics. Others were trained in chemistry, statistics and toxicology. Blending these heterogeneous talents fostered what we would now call interdisciplinary science, and, in the context of drug development, T1 translational research.

However, as the economics of academic departments shifted, clinical pharmacology fell from favour. Even the term clinical pharmacology has lost its lustre, and now covers only some of what we need. To attract the best and brightest, we need a new brand, backed by funders, academics and industry. Potential students must perceive the field to be hot.

So what shall we call this interdisciplinary, translational endeavour? It is difficult to imagine anyone rushing to join something called ‘T1 translational research’. ‘TMAT’, on the other hand, captures the fashion for translation, places the discipline in the heart of medicine and indicates the focus on developing novel therapeutics. Adoption of this term by the NIH follows a training programme in TMAT funded by the UK Wellcome Trust. Now we need to realize the potential of this brand and push the idea more widely.

The NIH centre will signal, both to Congress and the biomedical research community, the intimate connection between fundamental science and the accelerated delivery of cures to the general public. This is not a zero-sum game: success of translation requires investment in basic science. By developing sustainable career structures in TMAT, the centre can reverse the flow of bright young scientists into specialist silos. Joint investments in training, infrastructure and programmes would ensure that the efforts of the new centre would improve, not compete with, the translational efforts of disease-focused institutes and centres within the NIH.

The new TMAT centre could also act as a visible point of contact for extramural partners, including industry, charitable foundations and the US Food and Drug Administration, to buy into the restructuring required to move to a more modular approach to drug discovery and development. A looser, more distributed model spanning pharma, biotech and academia could then draw on knowledge more easily, and apply it more efficiently.

It is a big challenge, and two particular obstacles come to mind. First, we must revise how we reward ideas. At present, defence of intellectual property relies on patents on the composition of matter, usually molecules, most of which never become approved drugs. To make sure that they do, many people with diverse skill sets have to work effectively together. Inside a company, it is easy to reward everybody involved. As companies fragment, we should consider new models of intellectual property. Perhaps the financial rewards of a patent should be postponed until a drug is a profitable success — and a formal mechanism found to distribute rewards among all those who helped to make it happen.

Second, we will need common standards of data protection and privacy, and shared infrastructure that allows secure and compliant sharing of diverse types of information, including clinical data, across countries and sectors. This is the foundation upon which a global TMAT enterprise can be established. In some ways, this is the greatest challenge of all, but it can be done. As T. S. Eliot said: “Only those who will risk going too far can

Garret FitzGerald is director of the Institute of Translational Medicine and Therapeutics at the University of Pennsylvania in Philadelphia. e-mail:garret@exchange.upenn.edu

Science
17 December 2010 vol 330, issue 6011, pages 1573-1716
http://www.sciencemag.org/current.dtl

Policy Forum: Intellectual Property
Turning Patent Swords into Shares
Geertrui Van Overwalle
Science 17 December 2010: 1630-1631.[DOI:10.1126/science.1189592]

Compulsory licenses and patent pools will assist modern patent law in fueling genetic test development.

The WHO posted: HEALTH CLUSTER BULLETIN: CHOLERA OUTBREAK IN HAITI –SATURDAY, DECEMBER 11, 2010 – #9

“The violence and instability in Haiti due to results of the November 28th election has had a detrimental effect on the fight against the cholera epidemic. The epidemiological data reported indicates that the disease has reached all 10 department of the island nation, and will continue to spread…

EPIDEMIOLOGY

“On December 10th, MSPP reported that the cumulative number of hospital visits and deaths due to cholera, as of December 6th, was 97,595 and 2,193 respectively, giving an overall Case Fatality Rate of 2.2%. Of this total, 46,749 of patients have been hospitalized due to cholera. The in-hospital case fatality rate for the whole country is 3.2%….”

More at: http://new.paho.org/disasters/index.php?option=com_docman&task=doc_download&gid=1608

The Global Fund to Fight AIDS, Tuberculosis and Malaria made two related announcements. The first involves suspension of funding of two malaria grants in Mali with immediate effect and termination of a third grant for tuberculosis (TB) after it found evidence of misappropriation and unjustified expenditure. Management of the two suspended grants will be transferred to a new Principal Recipient. The Global Fund noted that the government of Mali “has condemned the embezzlement of funds and is working with the Global Fund to solve problems and ensure that grant activities can resume as soon as possible.” In addition to the Mali grant suspension, the Global Fund said it is placing grants in five countries on an “Additional Safeguards Policy” list. Grants in countries on this list are subject to closer scrutiny of their grant activities by The Global Fund and have certain restrictions on cash movements. The five countries are Cote d’Ivoire, Djibouti, Mali, Mauritania and Papua New Guinea.

The Global Fund also said it is “putting in place a number of actions to prevent and detect possible misuse of money for training in grants across all the 144 countries that receive funding, as well as drug theft in grants in specific countries. Michel Kazatchkine, the Global Fund’s Executive Director, commented, “The Global Fund tolerates no fraud, and we take public action to stop it, recover lost money and establish new and trustworthy channels for resources so they can reach those in need. Suspensions are the Global Fund’s way of making this clear to all concerned. They are a structured way to work with a country so that together we can put problems behind us and focus on saving lives…”

http://www.theglobalfund.org/en/pressreleases/?pr=pr_101207

Separately, The Global Fund said it will “invite major international funders of drug supplies to developing countries, technical and law enforcement agencies and implementers of health programs to intensify joint efforts to prevent theft of medical drugs.” A preliminary meeting will be held in January to draw up a joint action plan. The Global Fund noted that “in past years, reports and allegations of large-scale theft of new, effective malaria drugs have received particular attention. The medicines, known as Artemisinin-based Combination Therapies (ACTs), are given out for free or very cheaply in public health centers and hospitals in a large number of countries but are sold over the counter in pharmacies and street stalls for US$8 or more per treatment. Typically, more than half of malaria drugs in African countries are not given out by doctors or nurses but are sold over the counter. “Theft of medicines is a problem that affects all institutions investing in health services, and we must clamp down on it,” said Michel Kazatchkine, the Global Fund’s Executive Director. “However, no single institution can act on its own. We can only solve this challenge if we all work together.”

http://www.theglobalfund.org/en/pressreleases/?pr=pr_101210

The WHO posted: Avian influenza – situation in Indonesia – update 5

9 December 2010 – The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 21-year-old female from Bandung City, West Java, Province developed symptoms on 14 November, was hospitalized on 22 November and is currently in hospital. Initial investigations indicate the case resided in an area close to a business where chickens were kept and the area was found to be lacking cleanliness with chicken droppings present. Additional investigations on the possible source of infections are being undertaken. Laboratory tests have confirmed infection with the H5N1 avian influenza virus. Of the 171 cases confirmed to date in Indonesia, 141 have been fatal.

http://www.who.int/csr/don/2010_12_09/en/index.html

The U.S. Food and Drug Administration (FDA) issued final guidance for people who wish to comment during the agency’s advisory committee meetings. The FDA “encourages participation from all stakeholders in its decision-making process. Every advisory committee meeting includes an open public hearing session, during which interested people may present relevant information or their oral and/or written views. The guidance finalizes information contained in the 2005 draft guidance titled The Open Public Hearing – FDA Advisory Committee Meetings – Draft Guidance.”

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm236245.htm

The Weekly Epidemiological Record (WER) for 10 December 2010, vol. 85, 50 (pp 497–508) includes: Progress towards eradicating poliomyelitis in India, January 2009 – October 2010; Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2010.

http://www.who.int/entity/wer/2010/wer8550.pdf

The MMWR for December 10, 2010 / Vol. 59 / No. 48 includes:

– Nonpolio Enterovirus and Human Parechovirus Surveillance — United States, 2006–2008

– Progress Toward Poliomyelitis Eradication — India, January 2009–October 2010

–  Update: Outbreak of Cholera — Haiti, 2010

http://www.cdc.gov/mmwr/PDF/wk/mm5948.pdf

JAMA
December 8, 2010, Vol 304, No. 22, pp 2441-2548
http://jama.ama-assn.org/current.dtl

Lab, Field, & Clinic
Scientists Turn to Immune “Fingerprints” to Understand Vaccines, Infections
Bridget M. Kuehn

Extract
Despite the success of vaccines in preventing millions of deaths and serious illnesses each year, many mysteries remain about how they interact with the immune system to produce immunity. Similarly, an understanding of how the immune system responds to infection is limited.

As a result, important questions persist. For example, why are older adults less likely to develop protective immunity after vaccination? Why are some individuals susceptible to a particular infectious disease and others are less susceptible?

A new initiative hopes to catalogue the “fingerprints” of human immune responses (such as the production of antibodies) to vaccines or infectious agents.

To help answer such questions, the National Institute of Allergy and Infectious Diseases (NIAID) has launched its human immune phenotyping initiative, a $100-million effort that will be carried out at 6 institutions across the country. The participating centers will document and compare changes that occur in the immune system of …

The Lancet
Dec 11, 2010  Volume 376 Number 9757  Pages 1959 – 2040
http://www.thelancet.com/journals/lancet/issue/current

Comment
Cholera’s western front
Jason B Harris, Regina C LaRocque, Richelle C Charles, Ramendra N Mazumder, Azharul I Khan, Pradip K Bardhan

Preview
The cholera epidemics of the 19th century forged the way for the revolution in sanitation and the provision of safe sources of public water, which are the hallmark of developed countries. Nevertheless, more than 1 billion people, including much of the Haitian population, have little access to safe sources of water, and hence remain vulnerable to cholera epidemics.

Nature Medicine
December 2010, Volume 16 No 12
http://www.nature.com/nm/index.html

Commentary
Induction of unnatural immunity: prospects for a broadly protective universal influenza vaccine
Gary J Nabel & Anthony S Fauci

Preview
The immune system normally responds to influenza virus by making neutralizing antibodies to regions of the viral spike, the hemagglutinin, that vary year to year. This natural response protects against circulating subtypes but necessitates production of new vaccines annually. Newer vaccine approaches have succeeded in eliciting broadly neutralizing antibodies to highly conserved yet vulnerable regions of the hemagglutinin and suggest potential pathways for the development of universal influenza vaccines.

New England Journal of Medicine
December 9, 2010  Vol. 363 No. 24
http://content.nejm.org/current.shtml

Perspective
A National Cholera Vaccine Stockpile — A New Humanitarian and Diplomatic Resource
M.K. Waldor, P.J. Hotez, J.D. Clemens

Free full-text: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1001593

PLoS Medicine
(Accessed 12 December 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

Participatory Epidemiology: Use of Mobile Phones for Community-Based Health Reporting
Clark C. Freifeld, Rumi Chunara, Sumiko R. Mekaru, Emily H. Chan, Taha Kass-Hout, Anahi Ayala Iacucci, John S. Brownstein

Science
10 December 2010 vol 330, issue 6010, pages 1441-1572
http://www.sciencemag.org/current.dtl

News of the Week
Infectious Diseases
Australia to Test ‘Mosquito Vaccine’ Against Human Disease
Martin Enserink

Science 10 December 2010: 1460-1461.[DOI:10.1126/science.330.6010.1460]

In January, entomologists will start deploying a strange bacterium called Wolbachia pipientis in an attempt to halt disease transmission by mosquitoes.

Science Translational Medicine
8 December 2010 vol 2, issue 61
http://stm.sciencemag.org/content/current

Editorial
Vaccine Policy: Summun Bonum
Caroline Ash

Scientists and policy-makers must help to achieve a public consensus about the value of vaccination to individuals and society.

Science Translational Medicine
8 December 2010 vol 2, issue 61
http://stm.sciencemag.org/content/current

Meeting Reports: Vaccines
A Crisis of Public Confidence in Vaccines
Steven Black and Rino Rappuoli

Abstract
A meeting was held in Siena, Italy, in July 2010 to review the evidence for a decrease in public confidence in vaccines, to discuss possible reasons for this phenomenon, and to develop possible strategies to improve public confidence in vaccines. Prevention of morbidity and mortality by vaccination is one of the major public health accomplishments of the last century. Nevertheless, despite the improved safety and effectiveness of vaccines, public confidence in vaccination is decreasing. Improved methods of vaccine safety assessment have not improved public confidence. In addition, dissemination of false information on the Internet has undermined public confidence globally. Reductions in vaccine uptake or use of available vaccines can and have resulted in increased morbidity and mortality due to infectious diseases. The lack of public confidence in vaccines risks undermining the political will necessary to rapidly respond to a more severe influenza pandemic in the future. To improve the current situation, we must define both the risks and the benefits of individual vaccines so that the public can understand the rationale for vaccine recommendations. Key to regaining public trust in vaccines is a credible, consistent, and unified message developed from the private and public sectors that directly addresses public concerns. Unless an active effort is made to improve public confidence and trust in vaccination, there is a risk that gains made in combating the morbidity and mortality of infectious diseases through the use of vaccines will be lost. Loss of political will resulting from this loss of public confidence may also result in inappropriate decisions regarding the development and use of pandemic influenza vaccines for use in future pandemics, thus compromising public health.

Vaccines_The Week in Review_6 December 2010

This is the pdf document version compiling  individual posts below on this date.

The November issue of GIN was released with the lead story: NEW CONJUGATE VACCINE TO PROTECT AGAINST MENINGITIS A TO BE LAUNCHED

[30/11/2010 from Maya van den Ent (UNICEF) & Carol Tevi Benissan (WHO)]

[Initial paragraphs]

A new conjugate vaccine, to protect against meningococcal group A disease, was successfully used during pilot vaccination campaigns in Burkina Faso, Mali and Niger in September 2010. The campaigns vaccinated over 1 million people aged 1 – 29 years. Group A meningococcus is the main cause of meningitis epidemics and accounts for an estimated 80-85% of all cases in the 25 countries of the African meningitis belt. The new vaccine is expected to provide protection for at least 10 years, as compared to the polysaccharide vaccines currently in use, that protects for only three years.

Burkina Faso will conduct a nationwide campaign with the new vaccine targeting over 12 million people from 6 December 2010. Mali and Niger will roll out the vaccination in December and continue into 2011. The vaccine, called MenAfriVac and manufactured by the Serum Institute of India Ltd, is available at less than US$ 0.50 per dose. Its development in less than a decade has been possible through a unique public-private partnership. The Meningitis Vaccine Project, which has coordinated development, is a collaboration between WHO and PATH, made possible through a grant from the Bill & Melinda Gates Foundation. The introduction in Burkina Faso, Mali and Niger is being funded by the governments of the introducing countries, the GAVI Alliance and other partners. UNICEF and WHO are playing a vital role in supporting countries to prepare for the mass campaigns. However, an additional US$ 475 million must be mobilized in

order for the vaccine to be introduced in the remaining 22 countries of the meningitis belt. http://www.who.int/entity/immunization/GIN_November_2010.pdf

The World Health Organization, UNICEF, the National Institute of Allergy and Infectious Diseases (NIAID) and the Bill & Melinda Gates Foundation announced a collaboration “to increase coordination across the international vaccine community and create a Global Vaccine Action Plan.” The plan “will build on the successes of current work to achieve key milestones in the discovery, development and delivery of lifesaving vaccines to the most vulnerable populations in the poorest countries over the next decade.” The organizations said the collaboration follows the January 2010 call by Bill and Melinda Gates for the next ten years to be the Decade of Vaccines.  The Global Vaccine Action Plan “will enable greater coordination across all stakeholder groups – national governments, multilateral organizations, civil society, the private sector and philanthropic organizations — and will identify critical policy, resource, and other gaps that must be addressed to realize the life-saving potential of vaccines.”

The announced described the structure of the Decade of Vaccines Collaboration as including a Leadership Council to provide oversight for the planning effort, a Steering Committee that holds the primary responsibility for developing the action plan, an International Advisory Committee to assist the Leadership Council in evaluating the action plan, and a Secretariat for administrative support. Prof. Pedro Alonso, Director for the Institute for Global Health of Barcelona and Dr. Christopher Elias, President and CEO of PATH, have been appointed co-chairs of the Steering Committee and the Secretariat.

The Leadership Council is comprised of:

– Dr. Margaret Chan, Director General of WHO;

– Dr. Anthony S. Fauci, Director of NIAID, part of the National Institutes of Health;

– Mr. Anthony Lake, Executive Director for UNICEF;

– Ms. Joy Phumaphi, Chair of the International Advisory Committee and Executive Secretary, African Leaders Malaria Alliance

– Dr. Tachi Yamada, President of Global Health at the Bill & Melinda Gates Foundation;

The Steering Committee includes globally recognized experts in vaccine delivery, advocacy, research and development, and access:

– Dr. Nicole Bates, Senior Program Officer, Global Health Policy and Advocacy, Bill & Melinda Gates Foundation

– Dr. Seth Berkley, President & CEO, International AIDS Vaccine Initiative (IAVI)

– Dr. Zulfiqar Bhutta, Founding Chair, Division of Women and Child Health, Aga Khan University

– Dr. Lola Dare, CEO, Center for Health Sciences Training, Research and Development International

– Ms. Helen Evans, Acting CEO, GAVI Alliance

– Dr. Lee Hall, Chief, Parasitology and International Programs Branch, Division of Microbiology and Infectious Diseases, NIAID

– Dr. T. Jacob John, Professor and Head, Departments of Clinical Microbiology and Virology, Christian Medical College, Vellore, India (Retired)

– Dr. Orin Levine, Executive Director, International Vaccine Access Center (IVAC)

– Dr. Jean-Marie Okwo-Bele, Director, WHO Department of Immunization, Vaccines and Biologicals

– Dr. Ciro de Quadros, Executive Vice President, Sabin Vaccine Institute

– Dr. David Salisbury, Director of Immunization, UK Department of Health

– Dr. Anne Schuchat, Director, National Center for Immunization and Respiratory Diseases, CDC

– Dr. Peter A. Singer, Director, McLaughlin-Rotman Centre for Global Health, University of Toronto

– Dr. Lucky Slamet, Deputy for Therapeutic Products, Narcotic, Psychotropic and Addictive Substance Control, National Agency of Drug and Food Control, Indonesia

– Dr. Gina Tambini, Area Manager, Family and Community Health, PAHO

– Dr. Jos Vandelaer, Chief, Immunization, Programme Division, UNICEF

– Ms. Sandy Wrobel, CEO and Managing Director, Applied Strategies

The Decade of Vaccines Collaboration said it expects to complete its work by mid-2012.  At that time, “all vaccine stakeholder groups will be responsible for implementing the action plan.”

http://www.gatesfoundation.org/press-releases/Pages/decade-of-vaccines-collaboration.aspx

The GAVI Alliance Board, meeting in Kigali, Rwanda, approved a five-year business plan from 2011-2015 “setting ambitious but achievable targets expected to cost US$6.8 billion” and unanimously elected Former Norwegian Minister of Health and current member of parliament Dagfinn Høybråten as its new Chair. GAVI said that representatives from Norway and Sweden announced new commitments to GAVI totalling US$55 million, the United Kingdom offered to co-host the pledging conference in London next June, and France and the Bill & Melinda Gates Foundation “offered to work with the UK to mobilise support for the conference.” Concluding her last GAVI board meeting as Chair, Mary Robinson said, “GAVI offers donors an unbeatable deal in terms of value for money and an opportunity to invest in saving the lives of millions of children – children who will grow up free of disease, attend school and become healthy productive adults.” Mr Høybråten, who is also leader of Norway’s Christian Democratic Party, has been a member of the GAVI Board since 2006.

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

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

WHO Director-General Dr. Margaret Chan released a statement on 30 November 2010 on “Human rights – a central concern for the global HIV response.” An excerpt is presented below:

“…HIV-related stigma and discrimination continue to undermine HIV responses. The fear of being shunned by their families and friends, marginalized in their communities or denied employment and other services is often the reason why people do not present for HIV testing or attend HIV services. All too often it is the negative attitudes and behaviours of health workers that make health services inaccessible and unacceptable to those people at greatest risk of HIV infection and in greatest need of prevention, treatment and care services. People living with HIV, drug users, sex workers and men who have sex with men should be able to attend health services where they feel safe and are ensured the best possible and non-judgmental care.

The failure to promote and protect human rights increases vulnerability and can drive HIV epidemics. In sub-Saharan Africa, women and girls are particularly vulnerable to HIV; 80% of all women living with HIV are in this region. In Eastern Europe, over 50% of HIV cases are among people who inject drugs. In France, Netherlands and Spain, between 1/3 and 3/4 of new HIV infections are concentrated among migrants.

On the eve of a new decade, we need to address laws, policies, and regulations that increase HIV vulnerability and risk, impede access to health services or infringe on human rights, particularly for vulnerable and most-at-risk populations. In nearly 80 countries, same-sex sexual relations are criminalized, with 6 countries applying the death penalty. In over 50 countries and territories, there are restrictions on travel and residence for people living with HIV. In many countries drug users are sent to prison or compulsory rehabilitation programmes rather than being provided with effective treatment. The health sector has a critical role to play in promoting public health approaches and arguments when laws are made and strategies developed by other sectors.

Today, I call on all sectors to protect human rights, including the right to health, and to combat discrimination. Working with people living with HIV is critical for an effective HIV response and Member States need to be mindful of the commitments made in the 2006 Political Declaration on HIV/AIDS to promote better legal and social environments for people to access HIV testing, prevention and treatment.

WHO is firmly committed to the goal of achieving universal access to key HIV services. However, this will not be possible unless we make sure that the human rights of everyone, everywhere, are protected and promoted.”

http://www.who.int/mediacentre/news/statements/2010/AIDS_Day_20101130/en/index.html

Statement from the U.S. National Institutes of Health on Worlds AIDS Day 2010 Excerpt:

“…We have come a long way in the fight against HIV/AIDS, but we still have much to do, especially in our efforts to cure existing infections and prevent new ones,” said National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony S. Fauci, M.D.

“Although progress has been made in reducing the number of new HIV infections globally, the onslaught of new infections is still unacceptably high — 2.6 million in 2009 alone,” Dr. Fauci added. “Unless we stem this tide of new infections, and hopefully cure a substantial proportion of those already infected, it will be nearly impossible to control or end the HIV/AIDS pandemic.”

During the past year, NIH-supported researchers reported a number of important advances related to HIV prevention strategies — advances that build on the foundation of knowledge generated in part by NIH’s investment in HIV/AIDS research. These strategies include vaccines, topical gels (microbicides) with anti-HIV activity, pre-exposure prophylaxis with antiretroviral drugs, and behavioral and social science interventions.

An effective vaccine is a critical goal in HIV prevention. A large study conducted in Thailand provided the first signs that a vaccine actually could prevent HIV infection, albeit in a relatively small percentage of those vaccinated. Those findings were by no means the final answer, and more research is now underway to understand how this vaccine regimen works and how its efficacy might be increased. In another major step toward development of an effective vaccine, NIH-sponsored researchers discovered several potent human antibodies that can stop most known HIV strains from infecting human cells in the laboratory. These antibodies could be used to design HIV vaccines, or could be further developed to treat HIV infection. The novel techniques used in this research may accelerate HIV vaccine research as well as the development of vaccines for other infectious diseases.

Another significant milestone for HIV prevention came in July 2010, when the Centre for the AIDS Programme of Research in South Africa (CAPRISA) reported that a vaginal gel containing the antiretroviral drug tenofovir reduced the risk of male-to-female sexual transmission of HIV by approximately 40 percent. NIH funding provided the training and research infrastructure for this study.

Pre-exposure prophylaxis or PreP involves giving uninfected people antiretroviral drugs as a possible means of preventing HIV infection. Just last week, the published results of the NIH-sponsored iPrEx study indicated that a daily dose of an oral antiretroviral drug cut the risk of HIV infection by more than 40 percent among men who have sex with men (http://www.niaid.nih.gov/news/newsreleases/2010/Pages/iPrEx.aspx). The study found even higher rates of effectiveness, up to 73 percent, among those participants who adhered most closely to the PrEP regimen. Ongoing research will determine whether PrEP can work in other at-risk populations, including women and heterosexual men…”

http://www.nih.gov/news/health/nov2010/od-30.htm

PhRMA released a new report – Biopharmaceutical Researchers Testing 100 Medicines and Vaccines for HIV Infection and Related Conditions. The overview notes that:

“…treatment alone is not enough to combat HIV/AIDS. For every two patients who begin receiving HIV treatment, five people become infected. A preventative vaccine is crucial to the fight against AIDS. “A safe and effective HIV vaccine is critical to the control of HIV globally,” says Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID). According to the International AIDS Vaccine

Initiative (IAVI), without a significant improvement in prevention efforts, including an HIV vaccine, infections could double from about 5 million a year in 2005 to 10 million a year by 2030. IAVI estimates that the potential positive impact of AIDS vaccines would be enormous, especially in the developing world.

Conservatively, a vaccine that is 50 percent effective and given to only 30 percent of the population could reduce new HIV infections by 34 percent over 15 years, according

to IAVI. Currently, 33 vaccines are in development. In addition to the vaccines, there are 56 antivirals, two cancer treatments, four immunomodulators, three gene therapies, and two other medicines now in human clinical trials or before the Food and Drug Administration awaiting approval.

http://www.phrma.org/sites/phrma.org/files/AIDS_2010_0.pdf

The Weekly Epidemiological Record (WER) for 3 December 2010, vol. 85, 49 (pp 489–496) includes: Outbreak news – Cholera, Haiti – update; Monitoring progress towards measles elimination; Monthly report on dracunculiasis cases, January–September 2010.

http://www.who.int/entity/wer/2010/wer8549/en/index.html

The MMWR for December 3, 2010 / Vol. 59 / No. 47 includes:

– Seasonal Influenza and 2009 H1N1 Influenza Vaccination Coverage Among Pregnant Women — 10 States, 2009–10 Influenza Season

– Vital Signs: HIV Testing and Diagnosis Among Adults — United States, 2001–2009

– Announcement: National Influenza Vaccination Week — December 5–11, 2010

http://www.cdc.gov/mmwr/PDF/wk/mm5947.pdf

Human Vaccines
Volume 6, Issue 12  December 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/11/

Meeting Reports
A key for successful development of flu vaccines: Public-private collaboration – the Barcelona vaccine forum, Phacilitate, the Fira Palace Barcelona Spain, 21-23 June, 2010, the meeting report
Cristina Niculescu and Jean-Marc Balloul

Abstract
At the Barcelona Vaccine Forum, Phacilitate 2010 numerous plenary sessions, round table discussions, and workshops were dedicated to discussions surrounding one major topic, i.e. ensuring flu vaccine availability in a pandemic situation. High level speakers and participants coming from different horizons (WHO, US-FDA, EU-EMA, vaccine industry, etc ) shared their experience encountered during the influenza pandemic from 2009, the strategies and actions undertook for accelerating pandemic flu vaccines development and approval, the cooperation and coordination activities deployed to overcome the shortage for such vaccine, encountered especially in developing countries. During other sessions, the speakers highlighted the role of innovative partnering, business models or funding opportunities in enabling vaccine market development on a global scale. Finally, novel approaches and technologies for vaccines production that respond better to the growing worldwide demand for influenza vaccine and the achievements with the development of an “universal” vaccine that could guard against all seasonal and pandemic influenza strains were presented during the Barcelona Forum.

Human Vaccines
Volume 6, Issue 12  December 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/11/

Reviews
Could the United States experience rubella outbreaks as a result of vaccine refusal and disease importation?
Brynn E. Berger and Saad B. Omer

Prenatal rubella infection early in gestation is likely to damage the fetus, leading to miscarriage, stillbirth, neonatal death, or congenital rubella syndrome (CRS). CRS is a devastating syndrome that encompasses a wide variety of disorders, including (but certainly not limited to) cataracts, congenital heart defects, deafness, and mental retardation. Elimination of rubella was declared in the United States in 2004; however, the US faces the risk of rubella outbreaks. In this article, we discuss the possibility of rubella outbreaks in the US due to refusal of measles-mumps-rubella (MMR) vaccination and importation of the disease from regions where vaccination coverage is suboptimal. To avoid the severe health consequences associated with prenatal rubella infection, continued attention should be given to the maintenance of high MMR coverage.

Human Vaccines
Volume 6, Issue 12  December 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/11/

Short Reports
A policy framework for accelerating adoption of new vaccines
Open Access Article
Orin S. Levine, Rana Hajjeh, John Wecker, Thomas Cherian, Katherine L. O’Brien, Maria Deloria Knoll, Lois Privor-Dumm, Hans Kvist, Angeline Nanni, Allyson P. Bear and Mathuram Santosham

Rapid uptake of new vaccines can improve health and wealth and contribute to meeting Millennium Development Goals. In the past, however, the introduction and use of new vaccines has been characterized by delayed uptake in the countries where the need is greatest. Based on experience with accelerating the adoption of Hib, pneumococcal and rotavirus vaccines, we propose here a framework for new vaccine adoption that may be useful for future efforts. The framework organizes the major steps in the process into a continuum from evidence to policy, implementation and finally access. It highlights the important roles of different actors at various times in the process and may allow new vaccine initiatives to save time and improve their efficiency by anticipating key steps and actions.

Human Vaccines
Volume 6, Issue 12  December 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/11/

Commentaries
The threat of vaccine associated poliomyelitis in India: Medicolegal issues involved
Meena Rajput and Luv Sharma

India is among the world’s large reservoirs of wild poliovirus (WPV) with 559 confirmed cases of poliomyelitis (wild virus) being reported in 2008. The World Health Organization’s program for the eradication of poliomyelitis in third world countries like India is associated with major ethical and medico-legal implications. Two vaccines are available in India for poliomyelitis i.e. oral polio vaccine (OPV) and inactivated polio vaccine (IPV), of which OPV is used in the eradication campaign, the case count for 2009 being 36 out of a total of 384 reported cases globally, the case count for mid 2010 being 19 cases out of 84 reported globally. There are widespread reports of vaccine derived poliomyelitis as well as vaccine associated poliomyelitis (VAP) from different parts of the country, which can be linked to resurgence of polio in several states or to the failure of the polio drive (Polio Sundays). Though an extended comprehensive polio campaign is on and both money and manpower are being dumped for achieving the goal of polio eradication, the ground reality is entirely different. The argument that wild polio strains have surfaced to hamper the drive cannot account for all post vaccination cases. The Indian Academy of Paediatrics has forcefully suggested replacement of OPV by IPV, as the effectiveness of IPV far exceeds the cost benefit of OPV. IPV has by and large replaced OPV in many parts of the world. The second issue is the threat of litigation on the health department once the post vaccination cases rise even further. There are certain other socio-ethical issues discussed in this paper on a subject which has an important bearing on the health statistics of this country.

JAMA
December 1, 2010, Vol 304, No. 21, pp 2323-2430
http://jama.ama-assn.org/current.dtl

Medical News & Perspectives
As Trials Advance for a Malaria Vaccine, Policy Makers Urged to Plan for Its Use
JAMA. 2010;304(21):2348. doi: 10.1001/jama.304.21.2348
Rebecca Voelker

[First 150 words per JAMA convention]
As the first promising malaria vaccine makes its way through phase 3 clinical trials in sub-Saharan Africa, stakeholders’ greatest fears go beyond the possibility that the vaccine may fail to meet safety and efficacy goals. They worry that even if the vaccine is licensed, inadequate planning for its distribution could leave it to languish in warehouses. “After decades of research and tens of millions of dollars invested  . . .  it would be scandalous if this vaccine just sits on the shelf,” said Yvette Collymore, MA, of the nonprofit PATH Malaria Vaccine Initiative (MVI), during a recent Washington, DC, conference. MVI and the vaccine’s creator, GlaxoSmithKline (GSK) Biologicals, partnered in 2001 to develop the vaccine for infants and young children in sub-Saharan Africa. But the origins …

JAMA
December 1, 2010, Vol 304, No. 21, pp 2323-2430
http://jama.ama-assn.org/current.dtl

Lab Reports
Tuberculosis Vaccine
JAMA. 2010;304(21):2350. doi: 10.1001/jama.2010.1715
Tracy Hampton, PhD

[First 150 words per JAMA convention]
A new tuberculosis vaccine boosts protectiveness of the current bacille-Calmette-Guérin (BCG) vaccine, which becomes less effective over time, suggest preclinical findings from scientists at the Infectious Disease Research Institute in Seattle and Colorado State University in Fort Collins (Bertholet S et al. Sci Transl Med. 2010;2[53]:53ra74).

The new vaccine consists of a single recombinant fusion protein produced from 4 Mycobacterium tuberculosis (Mtb) antigens from Mtb protein families associated with virulence or latency.

The vaccine induced CD4 T helper type 1 cell responses and led to a reduction in the number of bacteria in the lungs of vaccinated mice that were challenged with virulent or multidrug-resistant Mtb strains, prevented the death of guinea pigs that were vaccinated and subsequently challenged with virulent Mtb, and elicited CD4 and CD8 T cell responses in human peripheral blood mononuclear cells from BCG-vaccinated or Mtb -exposed individuals.

The results support testing the vaccine …

The Lancet
Dec 04, 2010  Volume 376 Number 9756 Pages 1873 – 1958
http://www.thelancet.com/journals/lancet/issue/current

Comment
Eliminating malaria—all of them
J Kevin Baird

Preview
In 1952, Lowell Coggeshall1 wrote “The greatest misconceptions about the treatment of malaria, especially in the past, have arisen from the fact that too many considered it a single disease. Malaria is not a disease—it is a variety of diseases.” In The Lancet’s Series, four papers detail the lofty goal of elimination for the broad spectrum of clinical manifestations, species, and stages of plasmodia that are responsible for these many diseases (table). Do we have the tools to manage them all?

The Lancet
Dec 04, 2010  Volume 376 Number 9756 Pages 1873 – 1958
http://www.thelancet.com/journals/lancet/issue/current

Correspondence
Rotavirus vaccine efficacy in African and Asian countries
Stephen Obaro

Preview
The report by George Armah and colleagues (Aug 21, p 606)1 on the efficacy of a pentavalent rotavirus vaccine in sub-Saharan Africa is encouraging news for the control of rotavirus gastroenteritis in African children. Interestingly, the same vaccine is about 50% less efficacious than reported in some developed countries.2 Although the absolute proportion of severe diarrhoeal disease prevented is still much higher in the African setting, the relative poor performance of enteric vaccines in these populations deserves further mechanistic study.

Rotavirus vaccine efficacy in African and Asian countries
Giorgio Tamburlini, Adriano Cattaneo, Lorenzo Monasta
Preview
The design of the studies by George Armah and colleagues1 and K Zaman and colleagues2 on the efficacy of pentavalent rotavirus vaccine against severe rotavirus gastroenteritis in African and Asian countries neglects a crucial factor: breastfeeding.

Rotavirus vaccine efficacy in African and Asian countries – Authors’ reply
Robert F Breiman, George Armah, K Zaman, Samba Sow, Dang Duc Anh, Max Ciarlet, Kathleen M Neuzil
Preview
The pentavalent rotavirus vaccine offers an opportunity to affect child health positively, particularly in regions of the world with high diarrhoea morbidity and mortality. Although our study focused on the prevention of severe gastroenteritis, we agree with Stephen Obaro that the vaccine might be effective against less common outcomes, including mortality. In fact, such an effect has been shown in postmarketing studies, most notably in Mexico, where introduction of a rotavirus vaccine into the national immunisation programme correlated with a significant reduction in all-cause diarrhoea mortality.

Nature
Volume 468 Number 7324 pp599-720  2 December 2010
http://www.nature.com/nature/current_issue.html

Reviews
Impacts of biodiversity on the emergence and transmission of infectious diseases
Felicia Keesing, Lisa K. Belden, Peter Daszak, Andrew Dobson, C. Drew Harvell, Robert D. Holt, Peter Hudson, Anna Jolles, Kate E. Jones, Charles E. Mitchell, Samuel S. Myers, Tiffany Bogich & Richard S. Ostfeld + et al

Abstract
Current unprecedented declines in biodiversity reduce the ability of ecological communities to provide many fundamental ecosystem services. Here we evaluate evidence that reduced biodiversity affects the transmission of infectious diseases of humans, other animals and plants. In principle, loss of biodiversity could either increase or decrease disease transmission. However, mounting evidence indicates that biodiversity loss frequently increases disease transmission. In contrast, areas of naturally high biodiversity may serve as a source pool for new pathogens. Overall, despite many remaining questions, current evidence indicates that preserving intact ecosystems and their endemic biodiversity should generally reduce the prevalence of infectious diseases.

New England Journal of Medicine
December 2, 2010  Vol. 363 No. 23
http://content.nejm.org/current.shtml

Perspective
Influenza Vaccine — Safe, Effective, and Mistrusted
K.M. Harris, J. Maurer, A.L. Kellermann

[This article has no abstract; the first 100 words appear below]

On August 10, 2010, the World Health Organization (WHO) declared an end to the 2009 influenza A (H1N1) pandemic. It is fortunate that the virus that had spread worldwide so quickly turned out to be less severe than was first feared. It is worth remembering, though, that an earlier strain of H1N1 influenza — the one that emerged in 1918 — sparked the worst closely observed and recorded pandemic in history, killing an estimated 20 million to 40 million people worldwide.

The 2009 H1N1 virus did give us one gift of inestimable value: it provided a full-scale test of the…

Pediatrics
December 2010 / VOLUME 126 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Pentavalent Rotavirus Vaccine in Developing Countries: Safety and Health Care Resource Utilization
Celia D. C. Christie, Newton D. Duncan, Kirk A. Thame, Matthew T. Onorato, Hyacinth D. Smith, Lavern G. Malcolm, Robbin F. Itzler, Mark J. DiNubile, and Penny M. Heaton
Pediatrics 2010; 126: e1499-e1506.

Abstract
OBJECTIVE In the international, placebo-controlled, Rotavirus Efficacy and Safety Trial, the pentavalent rotavirus vaccine reduced the rate of rotavirus-attributable hospitalizations and emergency department visits by 95%. This study investigated the effect in Jamaica.

METHODS The vaccine effect on rates of hospitalizations and emergency department visits in Jamaica was evaluated in both modified intention-to-treat and per-protocol analyses. Rates of serious adverse events, including intussusception, also were compared between groups.

RESULTS A total of 1804 Jamaican infants, 6 to 12 weeks of age at entry and primarily from low/middle-income families of African heritage, received 1 dose. During the first year after dose 1, there were 2 and 11 hospitalizations or emergency department visits attributable to rotavirus gastroenteritis involving any serotype among 831 evaluable vaccine recipients and 809 evaluable placebo recipients, respectively (rate reduction: 82.2% [95% confidence interval: 15.1%–98.0%]). In the per-protocol analysis, all 8 G1 to G4 rotavirus-attributable events that occurred 2 weeks after dose 3 were in the placebo group (rate reduction: 100% [95% confidence interval: 40.9%–100%]). Of the 1802 subjects included in the safety analyses, intussusception was confirmed for 1 vaccine recipient (115 days after the third dose) and 3 placebo recipients. One vaccine recipient and 3 placebo recipients died during the follow-up period, but none of the deaths was considered to be vaccine-related.

CONCLUSIONS In this posthoc subgroup analysis, the vaccine reduced health care resource utilization attributable to rotavirus gastroenteritis, without increased risk of intussusception or other serious adverse events, among infants in a resource-limited country.

PLoS Medicine
(Accessed 5 December 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

WHO and Global Health Monitoring: The Way Forward
J. Ties Boerma, Colin Mathers, Carla Abou-Zahr Essay, published 30 Nov 2010
doi:10.1371/journal.pmed.1000373

Can We Count on Global Health Estimates?
Editorial, published 30 Nov 2010
doi:10.1371/journal.pmed.1001002

A Call for Responsible Estimation of Global Health
Wendy J. Graham, Sam Adjei Essay, published 30 Nov 2010
doi:10.1371/journal.pmed.1001003

Production and Analysis of Health Indicators: The Role of Academia
Christopher J. L. Murray, Alan D. Lopez Essay, published 30 Nov 2010
doi:10.1371/journal.pmed.1001004

Global Health Estimates: Stronger Collaboration Needed with Low- and Middle-Income Countries
Osman Sankoh Essay, published 30 Nov 2010
doi:10.1371/journal.pmed.1001005

The Imperfect World of Global Health Estimates
Peter Byass Essay, published 30 Nov 2010
doi:10.1371/journal.pmed.1001006

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 2 (16 December 2010)

Regular Papers
Knowledge differences between male and female university students about human papillomavirus (HPV) and cervical cancer: Implications for health strategies and vaccination Original Research Article
Pages 153-160
Rui Medeiros, Diana Ramada

Abstract
Knowledge about HPV and cervical cancer (CC) depends on several factors such as gender and education, which brings implications for health strategies and vaccination. A survey was conducted in Portugal with a representative sample of 1706 university students. Only 55.4% (n = 945) had already heard of HPV, although 88.3% (n = 834) from that know that is a risk factor for CC. 89% students (n = 841) wants to be vaccinated against it, but only 13.8% stated as main reason to be vaccinated “prevention of the disease”. Mean scores of knowledge were calculated. Statistical differences were found, regarding “CC knowledge”, in gender (p < 0.001) and between health sciences schools and non-health sciences schools (p < 0.001). Differences regarding the study area in “knowledge and beliefs of HPV” (p < 0.001) and in “relation between HPV and CC” (p < 0.001) were found. Therefore, these differences may help to develop effective strategies that lead to decline CC incidence and mortality.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 2 (16 December 2010)

Regular Papers

Economic analysis of the global polio eradication initiative
Original Research Article
Pages 334-343
Radboud J. Duintjer Tebbens, Mark A. Pallansch, Stephen L. Cochi, Steven G.F. Wassilak, Jennifer Linkins, Roland W. Sutter, R. Bruce Aylward, Kimberly M. Thompson

Abstract
The global polio eradication initiative (GPEI), which started in 1988, represents the single largest, internationally coordinated public health project to date. Completion remains within reach, with type 2 wild polioviruses apparently eradicated since 1999 and fewer than 2000 annual paralytic poliomyelitis cases of wild types 1 and 3 reported since then. This economic analysis of the GPEI reflects the status of the program as of February 2010, including full consideration of post-eradication policies. For the GPEI intervention, we consider the actual pre-eradication experience to date followed by two distinct potential future post-eradication vaccination policies. We estimate GPEI costs based on actual and projected expenditures and poliomyelitis incidence using reported numbers corrected for underreporting and model projections. For the comparator, which assumes only routine vaccination for polio historically and into the future (i.e., no GPEI), we estimate poliomyelitis incidence using a dynamic infection transmission model and costs based on numbers of vaccinated children. Cost-effectiveness ratios for the GPEI vs. only routine vaccination qualify as highly cost-effective based on standard criteria. We estimate incremental net benefits of the GPEI between 1988 and 2035 of approximately 40–50 billion dollars (2008 US dollars; 1988 net present values). Despite the high costs of achieving eradication in low-income countries, low-income countries account for approximately 85% of the total net benefits generated by the GPEI in the base case analysis. The total economic costs saved per prevented paralytic poliomyelitis case drive the incremental net benefits, which become positive even if we estimate the loss in productivity as a result of disability as below the recommended value of one year in average per-capita gross national income per disability-adjusted life year saved. Sensitivity analysis suggests that the finding of positive net benefits of the GPEI remains robust over a wide range of assumptions, and that consideration of the additional net benefits of externalities that occurred during polio campaigns to date, such as the mortality reduction associated with delivery of Vitamin A supplements, significantly increases the net benefits. This study finds a strong economic justification for the GPEI despite the rising costs of the initiative.