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European Health Psychologist – Bulletin of the European Health Psychology Society
Vol 16, No 6 (2014)
http://www.ehps.net/ehp/index.php/contents/issue/view/21/showToc

Experiences of Child Vaccine Providers With the National Immunization Programme and Their Dialogue With Parents
I.A. Harmsen , R. A.C. Ruiter , G. Kok , T.G.W. Paulussen , H.E. de Melker , L. Mollema
Abstract
Background:
Child Vaccine Providers (CVP) work at Child Welfare Centers (CWC), administer vaccines and communicate with parents about the National Immunization Programme (NIP). We performed this quantitative study to get more insight in CVPs attitude, their need for information and education, and their experience with educating (critical) parents who visit the CWC.
Methods:
We conducted a cross-sectional on-line self-report questionnaire. In total, 1427 CVPs received, and 432 CVPs completed the questionnaire (response rate = 30.3%). Findings: Half of the CVPs (52.2%) indicated that they sometimes avoid discussion with parents. CVPs give 1-2 minutes education during a consult about the NIP to parents, but prefer 2-5 minutes, while 11.8% of the CVPs do not give education at all.
Discussion:
CVPs indicated not having enough time to fulfill the information need of parents, we think that CWCs should schedule an extra consult, or information meeting when parents have many questions. CVPs have a need for education in how to communicate with parents, therefore Public Health Institutes should develop training for CVPs about how to communicate with parents.

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New England Journal of Medicine
This article was published on January 28, 2015, at NEJM.org.
DOI: 10.1056/NEJMoa1411627

[PDF] A Monovalent Chimpanzee Adenovirus Ebola Vaccine—Preliminary Report
Tommy Rampling, M.R.C.P., Katie Ewer, Ph.D., Georgina Bowyer, B.A., Danny Wright, M.Sc., Egeruan B. Imoukhuede, M.D., Ruth Payne, M.R.C.P., Felicity Hartnell, M.B., B.S., Malick Gibani, M.R.C.P., Carly Bliss, B.A., Alice Minhinnick, M.B., Ch.B., Morven Wilkie, M.R.C.P., Navin Venkatraman, M.R.C.P., Ian Poulton, Dip.H.E., Natalie Lella, B.A., Rachel Roberts, M.Sc., Kailan Sierra-Davidson, B.A., Verena Kr.hling, Ph.D., Eleanor Berrie, Ph.D., Francois Roman, M.D., Iris De Ryck, Ph.D., Alfredo Nicosia, Ph.D., Nancy J. Sullivan, Ph.D., Daphne A. Stanley, M.S., Julie E. Ledgerwood, D.O., Richard M. Schwartz, Ph.D., Loredana Siani, Ph.D., Stefano Colloca, Ph.D., Antonella Folgori, Ph.D., Stefania Di Marco, Ph.D., Riccardo Cortese, M.D., Stephan Becker, Ph.D., Barney S. Graham, M.D., Richard A. Koup, M.D., Myron M. Levine, M.D., Vasee Moorthy, D.Phil., Andrew J. Pollard, Ph.D., Simon J. Draper, D.Phil., W. Ripley Ballou, M.D., Alison Lawrie, Ph.D., Sarah C. Gilbert, Ph.D., and Adrian V.S. Hill, D.M.
Abstract
Background
The West African outbreak of Ebola virus disease has caused more than 8500 deaths. A vaccine could contribute to outbreak control in the region. We assessed a monovalent formulation of a chimpanzee adenovirus 3 (ChAd3)–vectored vaccine encoding the surface glycoprotein of Zaire ebolavirus (EBOV), matched to the outbreak strain.
Methods
After expedited regulatory and ethics approvals, 60 healthy adult volunteers in Oxford, United Kingdom, received a single dose of the ChAd3 vaccine at one of three dose levels: 1×1010 viral particles, 2.5×1010 viral particles, and 5×1010 viral particles (with 20 participants per group). Safety was assessed over the next 4 weeks. Antibodies were measured on enzyme-linked immunosorbent assay (ELISA) and T-cell responses on enzyme-linked immunospot (ELISpot) and flow-cytometry assays.
Results
No safety concerns were identified at any of the dose levels studied. Fever developed in 2 of the 59 participants who were evaluated. Prolonged activated partial-thromboplastin times and transient hyperbilirubinemia were observed in 4 and 8 participants, respectively. Geometric mean antibody responses on ELISA were highest (469 units; range, 58 to 4051; 68% response rate) at 4 weeks in the high-dose group, which had a 100% response rate for T cells on ELISpot, peaking at day 14 (median, 693 spot-forming cells per million peripheral-blood mononuclear cells). Flow cytometry revealed more CD4+ than CD8+ T-cell responses. At the vaccine doses tested, both antibody and T-cell responses were detected but at levels lower than
those induced in macaques protected by the same vaccine.
Conclusions
The ChAd3 monovalent vaccine against EBOV was immunogenic at the doses tested.
(Funded by the Wellcome Trust and others; ClinicalTrials.gov number, NCT02240875.)

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Blood
December 6, 2014; Blood: 124 (21)

Turning a Tumor into a Vaccine Factory: In Situ Vaccination for Low-Grade Lymphoma
Thomas Marron, MD PhD1, Nina Bhardwaj, MD PhD*,1, Elizabeth Crowley*,2, Tibor Keler, PhD*,3, Thomas A. Davis, MD3, and Joshua Brody, MD*,1
Abstract
BACKGROUND:
Lymphomas are the 5th most common cancer in the U.S. and most are incurable with standard therapy. Previously, we completed three trials of ‘in situ vaccination’ – combining low-dose radiotherapy (XRT) with intratumoral administration of TLR9 agonist (CpG). We demonstrated induction of anti-tumor CD8 T cell responses and clinical remissions of patients’ non-irradiated sites of disease, lasting up to 4+ years. One limitation may have been the paucity of intratumoral dendritic cells (DC). DC are uniquely able to endocytose dying (e.g. irradiated) tumor cells for cross-presentation to anti-tumor CD8 T cells.
METHODS:
Flt3L– the predominant DC differentiation factor– induces tumor leukocyte infiltration and regression of lymphoma tumors pre-clinically and a new formulation of this cytokine -CDX-301- was shown to mobilize BDCA-1 and BDCA-3 DC subsets in an early phase trial. These DC subsets respond to several TLR agonists and cross-present antigens more effectively than plasmacytoid DC (the CpG-responsive DC subset). We initiated a phase I/II study of a new iteration of the in situ vaccine, adding Flt3L-priming and replacing the prior TLR9 agonist with the TLR3 agonist poly-ICLC (Fig 1A).
The vaccine consists of:
– intratumoral Flt3L administration to increase DC within the tumor
– low-dose XRT to induce immunogenic tumor cell death and release tumor-associated antigens, and
– intratumoral poly-ICLC administration to activate tumor antigen-loaded DC.
RESULTS:
Six patients have been enrolled, two patients have completed therapy. Treated patients had 2-200-fold increases in BDCA1 and BDCA3 intratumoral DC after Flt3L administration and marked DC activation after XRT and poly-ICLC. Both treated patients have had partial remissions of untreated sites per Cheson criteria, persisting or improving for >6 months after vaccination. These include regressions of bulky lymph nodes (Fig 1B), as well as peripheral blood (Fig1C) and bone marrow disease. A patient with significant peripheral blood tumor burden experienced >10-fold decrease in malignant B cells with concurrent increase in non-tumor B cells, suggesting a degree of cell specificity in the tumor-killing mechanism. Adverse effects have been mild.
CONCLUSIONS:
Preliminary results suggest that the Flt3L-primed in situ vaccine is feasible, safe and immunologically and clinically effective, warranting further study.