Vaccine
Volume 34, Issue 20, Pages 2291-2402 (29 April 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/20

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Editorial
Another emerging arbovirus, another emerging vaccine: Targeting Zika virus
Pages 2291-2293
Ricardo Palacios, Gregory A. Poland, Jorge Kalil
Excerpt
…There are three main current strategies to control further outbreaks of ZIKV: vector control, supportive treatment of affected patients, and protection through immunization. None of them is a fully effective stand-alone strategy; rather, they are combined options to address a broad public health issue with the current tools available. While vector control is the ideal option as it simultaneously impacts other mosquito-borne transmission of several diseases, sustainable and durable measures to do so are not widely available. In that regard, one of the next challenges is to measure the efficacy of mosquito control measures using the reduction of human cases, rather than only entomological parameters, as the appropriate metric. Of immediate need is the development of a vaccine, as well as other therapeutic and prophylactic products, to address this public health emergency.
What is clear is that significantly enhanced research efforts are urgently needed. We suggest a research agenda that includes the following:
.1 Better understand ZIKV as a zoonotic disease in humans, the molecular evolution of ZIKV, and its adaptation to humans and specific geographic regions.
.2 Better understand the immunology and pathophysiology of human ZIKV infection.
.3 Determine whether ZIKV infection is causative of CMRM and of GBS in humans.
.4 Better understand the pathophysiology of ZIKV infection in pregnant women and the effect of the developing fetus.
.5 Better understand the pathophysiology of ZIKV infection in relation to GBS.
.6 Develop an animal model of human ZIKV infection that recapitulates the important elements of immunology and pathophysiology in humans. Such a model is useful in better understanding the disease and its consequences, and in the development of diagnostic kits, mmunotherapeutics and vaccines.
.7 Fund research to develop novel ZIKV vaccine candidates and bring promising candidates through the development process to licensure.
.8 Fund research to develop antivirals and immunotherapeutics for treatment of ZIKV infections.
Much of the above could be accelerated by the establishment of a global research fund to address emerging and rapidly pandemic viruses such as ZIKV and others, particularly in regard to the above items and the development of antivirals and vaccines…

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Commentary
Every rabies death is a veterinary and health system failure until proven otherwise
Pages 2294-2295
David N. Durrheim
No abstract

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Estimating the public health importance of the CYD-tetravalent dengue vaccine: Vaccine preventable disease incidence and numbers needed to vaccinate
Original Research Article
Pages 2397-2401
Bradford D. Gessner, Annelies Wilder-Smith
Abstract
Background
To evaluate the potential public health impact of the live attenuated tetravalent Sanofi Pasteur dengue vaccine (CYD-TDV) we analyzed data from the reported clinical trials to calculate vaccine preventable disease incidence (VPDI) and number needed to vaccinate (NNV) based on the licensure indication for persons age 9 years and above.
Methods
VPDI is defined as incidence in an unvaccinated population X vaccine efficacy (VE), and thus incorporates both VE and the underlying burden of disease. NNV was calculated as 100,000 divided by VPDI divided by 2-year length of study. We compared these values to data for three newer vaccines that are currently integrated into some national immunization programs in Asia and Latin America, namely pneumococcal conjugate, Haemophilus influenzae type b, and rotavirus vaccines.
Results
In the Asian-Pacific trial, in the first 25 months after the first dose of the dengue vaccine, CYD-TDV prevented annually 2639 cases of virologically confirmed dengue for every 100,000 persons vaccinated, for an NNV of 18. In the Latin American trial, given the overall lower annual dengue incidence compared to Asia, VPDI was 1707, and NNV 28. For the Asian-Pacific and Latin American studies, the VPDIs for hospitalized virologically confirmed disease at the trials’ end were 638 and 239 per 100,000 population per year, respectively, with NNVs of 75 and 201. VPDI for confirmed dengue hospitalization was higher than that for Hib vaccine against Hib meningitis or all cause severe pneumonia while lower than that for rotavirus vaccine against severe rotavirus gastroenteritis.
Conclusions
Our analysis found that the CYD-TDV dengue vaccine had favorable VPDI and NNV, also when compared to existing vaccines used in Latin America and Asia. VPDI and NNV varied by serotype distribution, extent of prior dengue exposure (baseline seroprevalence) and country. These findings will help policy-makers decide where and how to introduce this vaccine post-licensure.