Twitter Watch: Week to 27 June 2011

A selection of items of interest this week from a variety of twitter feeds. This capture is highly selective and by no means intended to be exhaustive.

AIDSvaccine IAVI
Want to know more about @AIDSvaccine is & what we do? Watch our short video: bit.ly/kWA5AE #HIV #AIDS #vaccine #research #globalhealth

CDCgov CDC.gov
2.5mil deaths prevented in children under 5 due to measles, polio & diphtheria-tetanus-pertussis vaccines go.usa.gov/Wtv #PH10

sabinvaccine Sabin Vaccine Inst.
Major Funding Announced to Continue Development of #Vaccine for Human Hookworm Infection: bit.ly/lpGxF1

GAVIAlliance GAVI Alliance
WATCH: the Center for Strategic & International Studies has posted a video about the June 13 conference and GAVI’s future http://ht.ly/5nOpf

GAVIAlliance GAVI Alliance
The Economist- A shot in the arm: The world’s market for vaccines is being turned upside down http://ht.ly/5mG64 #4mlives

Editorial: Measles outbreak in Europe

British Medical Journal
25 June 2011 Volume 342, Issue 7812
http://www.bmj.com/content/current

Editorials
Measles outbreak in Europe
Simon Cottrell, Richard John Roberts
BMJ 2011;342:doi:10.1136/bmj.d3724 (Published 15 June 2011)

Extract
Despite the current threat in Europe rates of infection are declining globally

Current outbreaks of measles in Europe are a reminder of the important risks of death and serious morbidity associated with measles. Between 2009 and 2010, cases of measles increased dramatically in Europe, with notifications increasing from 7175 to 30 367. 1 In 2010 most reported cases were in Bulgaria (22 005), but there were also 5019 in France, 861 in Italy, 787 in Germany, 406 in Ireland, 397 in the United Kingdom, and 302 in Spain. Of these, 21 877 people were admitted to hospital and 21 died (case fatality 0.69 deaths/1000 reported cases); 71% of people infected were aged under 20 years and 85% were unvaccinated. The World Health Organization has reported outbreaks in 24 European countries already this year. 2 There is little sign of a decrease in cases in 2011, and travel has facilitated transmission between countries. From January to March 2011, 9349 cases were reported, and 18 of 32 reporting countries found that the incidence of measles was higher than during the same period in 2010. 3

Currently the French outbreak is the largest in Europe and it has not yet peaked. Since it began in 2008, France …

Influenza Vaccination of Schoolchildren and School Outbreaks

Clinical Infectious Diseases
Volume 53 Issue 2 July 15, 2011
http://www.journals.uchicago.edu/toc/cid/current

Major Articles
Shioko Kawai, Seiichiro Nanri, Eiko Ban, Mikako Inokuchi, Tetsuya Tanaka, Mitsuaki Tokumura, Keiko Kimura, and Norio Sugaya
Influenza Vaccination of Schoolchildren and Influenza Outbreaks in a School
Clin Infect Dis. (2011) 53(2): 130-136 doi:10.1093/cid/cir336

Abstract
Background. The objective of this retrospective descriptive study was to determine whether the universal influenza vaccination for schoolchildren was effective in controlling influenza outbreaks in a school. A universal vaccination program for schoolchildren was started in Japan in the 1960s, but the government abandoned the program in 1994 because of lack of evidence that the program was effective in preventing influenza in schoolchildren.

Methods. Influenza vaccine coverage rates, total numbers of class cancellation days, and absentee rates were reviewed in a single elementary school during the 24-year period during 1984–2007.

Results. The mean number of class cancellation days and the mean absentee rate in the compulsory vaccination period (1984–1987; mean vaccine coverage rate, 96.5%) were 1.3 days and 2.5%, respectively, and they increased to 8.3 days and 3.2% during the quasi-compulsory vaccination period (1988–1994; vaccine coverage, 66.4%). In the no-vaccination period (1995–1999; vaccine coverage, 2.4%), they were 20.5 days and 4.3%, respectively, and in the voluntary vaccination period (2000–2007; vaccine coverage, 38.9–78.6%), they were 7.0–9.3 days and 3.8%–3.9%. When minor epidemics were excluded, there was a significant inverse correlation between the vaccine coverage rates and both the number of class cancellation days and absentee rates.

Conclusions. The universal influenza vaccination for schoolchildren was effective in reducing the number of class cancellation days and absenteeism in the school.

Health Advocacy Organizations and Evidence-Based Medicine

JAMA   
June 22/29, 2011, Vol 305, No. 24, pp 2493-2592
http://jama.ama-assn.org/current.dtl

Commentaries
Health Advocacy Organizations and Evidence-Based Medicine
Sheila M. Rothman
JAMA. 2011;305(24):2569-2570.doi:10.1001/jama.2011.866

[No abstract: first 150 words per JAMA convention]
Strong and independent not-for-profit advocacy organizations are vital to a democratic society. At their best, they stand apart from the interests of the marketplace and the government, helping to promote diverse public concerns. The scope of their activities is extensive. Some not-for-profit advocacy organizations spearhead campaigns to eliminate discriminatory legislation and improve the life chances of vulnerable groups. Others challenge economic interests to better protect the environment. Still others work to advance civil and human rights.

Health advocacy organizations are part of this sector. They speak for targeted populations affected by a variety of diseases such as epilepsy, breast cancer, mental illness, and autism. They effectively communicate their priorities to legislators, regulators, private and public funders, and the media. Their initiatives often highlight needs that might otherwise be overlooked. However, some health advocacy organizations, as shall be illustrated, are so committed to securing diagnostic and treatment interventions for their targeted …

Editorial: Measles once again

The Lancet Infectious Disease
Jul 2011  Volume 11  Number 7  Pages 489 – 578
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Measles once again
The Lancet Infectious Diseases
An effective vaccine against measles has been available for the past 40 years. Before its introduction in 1963 there were almost 135 million cases of measles and over 6 million measles-related deaths per year. Globally, thanks to this vaccine the number of measles deaths worldwide fell by 78% between 2000 and 2008, from an estimated 733 000 to 164 000.

However, despite these efforts, it is hard to believe that in the 21st century measles remains a leading vaccine-preventable cause of deaths in children younger than 5 years old. The disease is still endemic in many parts of Europe. In the past 2 years, Austria, France, Germany, Ireland, Italy, the Netherlands, Spain, and the UK have all seen outbreaks. In 2010, more than 27 795 cases of measles were reported in Europe, and 21 853 were reported during the 2009—10 outbreak in Bulgaria where 25 people died.

In USA during the 1980s, the number of measles cases was low but a big increase occurred in 1989 with almost 18 000 cases reported. Lack of a second dose of measles, mumps, and rubella (MMR) vaccine could have decreased the level of immunity among the school-age population, among whom most of the cases were reported. Subsequently, two rounds of vaccination were recommended. At the end of 2000, thanks to vaccination, the ongoing transmission of endemic measles was declared eliminated in the USA. However, this year from January 1 to May 20, 118 cases were reported in the USA. 46% of the cases were imported, most from countries in the WHO European region.

Before the era of vaccination, immunity against measles was acquired by natural infection or by protection given by antibodies transmitted from the mother to the fetus during gestation. Measles transmission requires contact between a susceptible person and the infectious secretions of a person with measles. The incidence of measles varies cyclically. Incidence rises as susceptible individuals enter the population. Acquisition of immunity through exposure to the virus or vaccination decreases the number of susceptible individual in the population and measles incidence falls. The interval between epidemic peaks is proportional to the number of susceptible individuals that accumulate over time. In the presence of vaccination, the interval between peaks of disease can be 10 years; without vaccination, the interval can be 3—4 years. A decline in the uptake of immunisation in the past decade has increased the susceptible population and measles has resurged.

Elimination of measles, defined as the interruption of indigenous transmission, is difficult because the disease is very contagious and transmissible before an infected person shows signs of illness. Ideally, two doses of MMR vaccine given to 95% of children are required to halt the spread of the virus. By 2009 only 60% of countries worldwide had achieved 90% coverage with at least one vaccine dose. Difficulty accessing services, religious beliefs, and vaccine scepticism are only part of the reasons for low coverage. Better organisation of the vaccination systems is required—for example, 10% of children receive one dose of vaccine but then miss the second shot. Lack of reminders and difficulty tracking moving families are among the weaknesses of the vaccine system.

However, elimination is not impossible. Measles was eliminated from the Americas in 2000, but progress towards elimination in the European region has faltered. By 2010, 30 of the 53 European countries had reached the target of a measles incidence of fewer than one case per million population. The WHO Europe strategic plan for measles 2010—15 sets targets of 90% measles vaccination coverage, and reductions in the number of cases to fewer than five per million and in mortality by 95% compared with 2000 levels.

Additional effort and resources from European states are needed to reach the above targets. Vaccine acceptability could be improved through better communication with the public. Thought needs to be given to targeted messaging campaigns and perhaps the recruitment of public figures as advocates for vaccination. Catch-up vaccination campaigns outside the routine system are needed to cover susceptible populations. Commitment from governments, donors, and parents is needed to make measles a disease of the past. Despite recent outbreaks, elimination in Europe in the in the next 4 years should be achievable, and would inspire efforts in developing regions, which still have the highest burden of the disease: global eradication of the disease in this generation would spare future generations from this preventable disease.

Safety and efficacy of the HVTN 503 (HIV)

The Lancet Infectious Disease
Jul 2011  Volume 11  Number 7  Pages 489 – 578
http://www.thelancet.com/journals/laninf/issue/current

Articles
Safety and efficacy of the HVTN 503/Phambili Study of a clade-B-based HIV-1 vaccine in South Africa: a double-blind, randomised, placebo-controlled test-of-concept phase 2b study
Glenda E Gray, Mary Allen, Zoe Moodie, Gavin Churchyard, Linda-Gail Bekker, Maphoshane Nchabeleng, Koleka Mlisana, Barbara Metch, Guy de Bruyn, Mary H Latka, Surita Roux, Matsontso Mathebula, Nivashnee Naicker, Constance Ducar, Donald K Carter, Adrien Puren, Niles Eaton, M Julie McElrath, Michael Robertson, Lawrence Corey, James G Kublin, on behalf of the HVTN 503/Phambili study team

Preview
The MRKAd5 HIV-1 vaccine did not prevent HIV-1 infection or lower viral-load setpoint; however, stopping our trial early probably compromised our ability to draw conclusions. The high incidence rates noted in South Africa highlight the crucial need for intensified efforts to develop an efficacious vaccine.

Pertussis booster vaccination throughout life in Europe

The Lancet Infectious Disease
Jul 2011  Volume 11  Number 7  Pages 489 – 578
http://www.thelancet.com/journals/laninf/issue/current

Review
Rationale for pertussis booster vaccination throughout life in Europe
Fred Zepp, Ulrich Heininger, Jussi Mertsola, Ewa Bernatowska, Nicole Guiso, John Roord, Alberto E Tozzi, Pierre Van Damme

Preview
Although the introduction of universal pertussis immunisation in infants has greatly reduced the number of reported cases in infants and young children, disease incidence has been increasing in adolescents and adults in recent years. This changing epidemiological pattern is probably largely attributable to waning immunity after natural infection or vaccination. Furthermore, improved diagnostic testing, active surveillance, changes in disease susceptibility, vaccine characteristics, and increased awareness of the disease might also be contributing factors.