Trends in Molecular Medicine
Volume 18, Issue 9, Pages 503-574 (September 2012)
http://www.sciencedirect.com/science/journal/14714914

Recombinant viral vaccines for cancer
Review Article
Pages 564-574
Ryan Cawood, Thomas Hills, Suet Ling Wong, Aliaa A. Alamoudi, Storm Beadle, Kerry D. Fisher, Leonard W. Seymour

Abstract
Cancer arises from ‘self’ in a series of steps that are all subject to immunoediting. Therefore, therapeutic cancer vaccines must stimulate an immune response against tumour antigens that have already evaded the body’s immune defences. Vaccines presenting a tumour antigen in the context of obvious danger signals seem more likely to stimulate a response. This approach can be facilitated by genetic engineering using recombinant viral vectors expressing tumour antigens, cytokines, or both, from an immunogenic virus particle. We overview clinical attempts to use these agents for systemic immunisation and contrast the results with strategies employing direct intratumoural administration. We focus on the challenge of producing an effective response within the immune-suppressive tumour microenvironment, and discuss how the technology can overcome these obstacles

Trends in Molecular Medicine
Volume 18, Issue 9, Pages 503-574 (September 2012)
http://www.sciencedirect.com/science/journal/14714914

Articles in Press
Lipidated promiscuous peptides vaccine for tuberculosis-endemic regions
Review Article
In Press, Corrected Proof, Available online 30 August 2012
Uthaman Gowthaman, Pradeep K. Rai, Nargis Khan, David C. Jackson, Javed N. Agrewala

Abstract
Despite nine decades of Bacillus Calmette–Guérin (BCG) vaccination, tuberculosis continues to be a major global health challenge. Clinical trials worldwide have proved the inadequacy of the BCG vaccine in preventing the manifestation of pulmonary tuberculosis in adults. Ironically, the efficacy of BCG is poorest in tuberculosis endemic areas. Factors such as nontuberculous or environmental mycobacteria and helminth infestation have been suggested to limit the efficacy of BCG. Hence, in high TB-burden countries, radically novel strategies of vaccination are urgently required. Here we showcase the properties of lipidated promiscuous peptide vaccines that target and activate cells of the innate and adaptive immune systems by employing a Toll-like receptor-2 agonist, S-[2,3-bis(palmitoyloxy)propyl]cysteine (Pam2Cys). Such a strategy elicits robust protection and enduring memory responses by type 1 T helper cells (Th1). Consequently, lipidated peptides may yield a better vaccine than BCG.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 30, Issue 41 pp. 5901-6006 (7 September 2012)

Meeting Report
Report of the ad-hoc consultation on aging and immunization for a future WHO research agenda on life-course immunization
Pages 6007-6012
Judith Thomas-Crusells, Janet E. McElhaney, M. Teresa Aguado

Abstract
WHO convened a meeting of around 30 experts to address the topic of aging and immunization in March 2011 in Geneva. The purpose of the meeting was to develop a global research agenda to eventually inform WHO policy recommendations regarding immunization beyond childhood and into old age. This issue is becoming more critical, since the population aged 60 and above will reach two billion people – three-quarters of whom will be in developing countries – in the next 40 years. The meeting reviewed current knowledge and gaps in information about: (1) the epidemiology of infectious diseases in the elderly in developed and developing countries and their contribution to disability in old age; (2) the deterioration of the immune system with age (“immune senescence”) and possible ways to measure and counteract it; and (3) immunization approaches to maintain or improve health in older persons. These approaches include the concept of a “life-course vaccination” schedule to help sustain immunity to vaccine-preventable diseases beyond childhood and into old age; strategies to strengthen older persons’ responses to vaccines (e.g., by adding adjuvants to vaccines, increasing vaccine dosage, and intradermal vaccine administration); and the possible development of new vaccines targeted specifically for older adults. Participants proposed priority research topics as well as strategies to facilitate and coordinate the research, including the establishment of networks of collaborators, with WHO playing a key coordinating role.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 30, Issue 41 pp. 5901-6006 (7 September 2012)

Cost-effectiveness of hepatitis A vaccination for adults in Belgium
Original Research Article
Pages 6070-6080
Jeroen Luyten, Stefaan Van de Sande, Koen de Schrijver, Pierre Van Damme, Philippe Beut

Abstract
Hepatitis A vaccination targeting adults (or adult risk-groups like e.g. travellers, health care workers, soldiers or teachers) could be considered an alternative to a universal infant or adolescent vaccination program in low endemic countries. We estimated the current disease burden of hepatitis A in Belgium, and evaluated whether adult vaccination is cost-effective. We used a Markov cohort model to simulate the costs and effects of (1) vaccination of adults and (2) serological screening of adults and vaccination of susceptibles and compared these with the current situation. The results indicated that these expanded vaccination strategies are not cost-effective in the epidemiological circumstances of a typical low-endemic western country. In order to gain 1 quality-adjusted life year the health care payer would have to pay 185,000€ for vaccination and 223,000€ for screening and vaccination of seronegatives. For adult vaccination to be cost-effective, risk-groups would need to be exposed to a force of infection that is 3.5–4 times higher than currently estimated in the general population; or the total costs of vaccination would have to drop with approximately 75%.

Vaccine
Volume 30, Issue 41 pp. 5901-6006 (7 September 2012)

Brief Report
The financial impact of a state adopting a personal/philosophical belief exemption policy: Modeling the cost of pertussis disease in infants, children and adolescents
Pages 5901-5904
Katelyn B. Wells, Saad B. Omer

Abstract
State school immunization exemption policies help reduce the risk of individual and community disease. Assessing the costs of vaccine preventable disease associated with a state adding a philosophical/personal belief school exemption policy is useful for making future policy decisions. Two formulas were developed to estimate the infant, child and adolescent hospitalization and non-medical costs of pertussis disease that are associated with adding a philosophical/personal belief school exemption policy. The parameter estimates were obtained from peer reviewed literature and the Centers for Disease Control and Prevention. The state of Iowa was used as an example in order to demonstrate how the formulas can be applied. The annual projected impact of pertussis disease in Iowa is $273,365 without a philosophical/personal belief exemption policy and an average of $410,047 (range of $281,566–$582,267) with adding a personal belief exemption policy. We project that adding a philosophical/personal belief exemption will cost 50% more dollars annually.

Vaccine
Volume 30, Issue 41 pp. 5901-6006 (7 September 2012)

Reviews
Measles outbreak in Europe: Susceptibility of infants too young to be immunized
Review Article
Pages 5905-5913
E. Leuridan, M. Sabbe, P. Van Damme

Abstract
As women vaccinated against measles transfer low amounts of antibodies, an increasing number of infants lack early protection through maternal antibodies until being immunised themselves.

This paper reviews the literature on disease burden of measles in the population too young to be immunized according to the respective national recommendations during recent outbreaks in EU and EEA/EFTA countries. In addition, specific control strategies adopted to protect this young population are reviewed.

Pubmed, Unbound Medline, Web of Knowledge and the Eurosurveillance database were searched using MESH terms: measles and epidemiology, measles and infants, prevalence of measles, measles and outbreaks and measles and epidemic. Additionally, data from Euvac.net and ECDC were consulted. Databases were searched from January 2001 to September 2011.

Fifty-three papers were included in the analysis. The percentage of all measles cases during outbreaks affecting young infants ranged from 0.25% to 83.0%. Specific control strategies were adopted: e.g. administration of the first or second vaccine dose earlier than recommended.

Infants younger than 12 months are often involved in measles outbreaks, and advancing the first vaccine dose could reduce the burden of disease. However, immunization before 9 months of age is not systematically recommended because of dysmature humoral immune responses of infants. High coverage and timely administration of the recommended series of vaccines are the most important measures to decrease measles incidence and measles circulation and protect vulnerable infants from infection.

Vaccine
Volume 30, Issue 41 pp. 5901-6006 (7 September 2012)

Maternal knowledge, attitudes and beliefs regarding gastroenteritis and rotavirus vaccine before implementing vaccination program: Which key messages in light of a new immunization program?
Original Research Article
Pages 5921-5927
Alyssa Morin, Thomas Lemaître, Anne Farrands, Nathalie Carrier, Arnaud Gagneur

Abstract
In July 2010, the National Advisory Committee on Immunization (NACI) recommended the systematic administration of rotavirus vaccines for all infants in Canada. According to the Erickson and De Wals framework, multiple factors need to be evaluated before implementing such a decision, including the study of the acceptability of this vaccine by the general population.

A cross-sectional survey was conducted from February 10 to February 18, 2011, at the Sherbrooke University Hospital Center in the province of Quebec. A questionnaire, based upon the Health Belief Model (HBM) and theoretical planned action, was self-administered to pregnant or early post-partum women. The variables collected included socio-demographic data, past experience with gastroenteritis, cues to vaccination and HBM dimensions. The associations between questionnaire variables and vaccination intention were assessed using univariate and multivariate analyses.

Of the 343 respondents, only 29% had already heard about rotavirus vaccination and among these, the intention of vaccination was 74%. In multivariate analysis, having a perception of infant vulnerability to gastroenteritis (OR = 2.3, 95% CI 1.3–4.0) and having no other child at home (OR = 2.3, 95% CI 1.3–4.2) were factors positively associated with a higher intention of vaccination, contrary to having already heard about the rotavirus vaccine in the media (OR = 0.5, 95% CI 0.2–0.9). The three cues independently associated with intention of vaccination were the reimbursement of the vaccine (OR = 3.0, 95% CI 1.6–5.7), its recommendation by a doctor (OR = 21.2, 95% CI 5.8–75.9) and its protection against the most severe forms of gastroenteritis (OR = 4.4, 95% CI 1.4–13.6).

To improve the success of this new vaccination program, several key messages should be integrated in the information made available to the general population: (1) rotavirus gastroenteritis is a mandatory infection for every child <5 years; (2) the vaccine is reimbursed and included in the provincial vaccination program; and (3) the vaccine protects against the worst forms of gastroenteritis. Finally, support should be offered to physicians as they play a key role in public acceptance of new vaccines.

Vaccine
Volume 30, Issue 40 pp. 5801-5900 (31 August 2012)

Student nurses’ reasons behind the decision to receive or decline influenza vaccine: A cross-sectional survey
Original Research Article
Pages 5824-5829
Charlotte Hunt, Antony Arthur

Abstract
This cross-sectional questionnaire survey examined influenza vaccination among 430 student nurses. Only 12.2% (95% CI 9.1–15.3%) of student nurses received the seasonal vaccine regularly with 27.6% (95% CI 23.3–31.8%) ever having received seasonal or pandemic H1N1 vaccine. Intention to be vaccinated was associated with having previously been vaccinated (p < 0.001) but not whether the vaccine was perceived as beneficial (p = 0.36). Previous influenza illness was associated with having the influenza vaccine (p < 0.001). The most frequently reported reason for receiving the seasonal influenza vaccine was being deemed at risk (42.4%) and for H1N1 vaccine was because it was offered for free (32.6%). For both vaccines the most reported reason for not being vaccinated was a perception of it not being needed. Student nurses form a substantial and influential part of the future healthcare workforce but to translate the widely held acceptance that influenza vaccine is beneficial into actual uptake, a more targeted and persuasive message is needed.

Vaccine
Volume 30, Issue 40 pp. 5801-5900 (31 August 2012)

Vaccine trials in the developing world: Operational lessons learnt from a phase IV poliomyelitis vaccine trial in South Africa
Original Research Article
Pages 5839-5843
H. Geldenhuys, Z. Waggie, M. Jacks, M. Geldenhuys, L. Traut, M. Tameris, M. Hatherill, W.A. Hanekom, R. Sutter, G. Hussey, H. Mahomed

Abstract
Background
Conducting vaccine trials in developing nations is necessary but operationally complex. We describe operational lessons learnt from a phase IV poliomyelitis vaccine trial in a semi-rural region of South Africa.

Methods
We reviewed operational data collected over the duration of the trial with respect to staff recruitment and training, participant recruitment and retention, and cold chain maintenance.

Results-Lessons Learnt
The recruitment model we used that relied on the 24 h physical presence of a team member in the birthing unit was expensive and challenging to manage. Forecasting of enrolment rates was complicated by incomplete baseline data and by the linear nature of forecasts that do not take into account changing variables. We found that analyzing key operational data to monitor progress of the trial enabled us to identify problem areas timeously, and to facilitate a collegial problem-solving process by the extended trial team.

Pro-actively nurturing a working relationship with the public sector health care system and the community was critical to our success. Despite the wide geographical area and lack of fixed addresses, we maintained an excellent retention rate through community assistance and the use of descriptive residential information. Training needs of team members were ongoing and dynamic and we discovered that these needs that were best met by an in-house, targeted and systemized training programme. The use of vaccine refrigerators instead of standard frost-free refrigerators is cost-effective and necessary to maintain the cold-chain.

Conclusion
Operational challenges of a vaccine trial in developing world populations include inexperienced staff, the close liaison required between researchers and public health care services, impoverished participants that require complex recruitment and retention strategies, and challenges of distance and access. These challenges can be overcome by innovative strategies that allow for the unique characteristics of the setting, trial population, and trial team.

Book: Parasitic Helminths: Targets, Screens, Drugs and Vaccines
Chapter 23: Antifilarial Vaccine Development: Present and Future Approaches
Dr. Conor R. Caffrey, Sara Lustigman, David Abraham, Thomas R. Klei
Published Online: 23 AUG 2012
DOI: 10.1002/9783527652969.ch2

Summary
This chapter contains sections titled:

– General Aspects of Human Filarial Infection and Disease

– Natural Host-Parasite Systems for Onchocerciasis and Lymphatic Filariasis

– Current Status of Filarial Vaccine Development

– Multivalent Vaccines

– Discovery of New Vaccine Candidates

– Conclusions

– References

J Am Med Inform Assoc
doi:10.1136/amiajnl-2012-000881
Research and applications
Vaccine adverse event text mining system for extracting features from vaccine safety reports
Taxiarchis Botsis1,2, Thomas Buttolph1, Michael D Nguyen1, Scott Winiecki1, Emily Jane Woo1, Robert Ball1
+ Author Affiliations
1Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA), Rockville, Maryland, USA
2Department of Computer Science, University of Tromsø, Tromsø, Norway
Correspondence to Dr Taxiarchis Botsis, Office of Biostatistics and Epidemiology, CBER, FDA, Woodmont Office Complex 1, Room 306N, 1401 Rockville Pike, Rockville, MD 20852, USA;
Contributors TB developed the VaeTM tool, analyzed the data, drafted and revised the paper; ThB acted as the consensus annotator, collected the evaluation data and revised the paper; SW and EJW acted as the primary annotators and revised the paper; MN revised the draft paper; RB revised the draft paper, created the mapping table for the BC criteria and supervised the study. All authors participated in the design of the evaluation plan, the monitoring of the process and the VaeTM updates.
Received 3 February 2012
Accepted 28 July 2012
Published Online First 1 September 2012

Abstract
Objective  To develop and evaluate a text mining system for extracting key clinical features from vaccine adverse event reporting system (VAERS) narratives to aid in the automated review of adverse event reports.

Design  Based upon clinical significance to VAERS reviewing physicians, we defined the primary (diagnosis and cause of death) and secondary features (eg, symptoms) for extraction. We built a novel vaccine adverse event text mining (VaeTM) system based on a semantic text mining strategy. The performance of VaeTM was evaluated using a total of 300 VAERS reports in three sequential evaluations of 100 reports each. Moreover, we evaluated the VaeTM contribution to case classification; an information retrieval-based approach was used for the identification of anaphylaxis cases in a set of reports and was compared with two other methods: a dedicated text classifier and an online tool.

Measurements  The performance metrics of VaeTM were text mining metrics: recall, precision and F-measure. We also conducted a qualitative difference analysis and calculated sensitivity and specificity for classification of anaphylaxis cases based on the above three approaches.

Results  VaeTM performed best in extracting diagnosis, second level diagnosis, drug, vaccine, and lot number features (lenient F-measure in the third evaluation: 0.897, 0.817, 0.858, 0.874, and 0.914, respectively). In terms of case classification, high sensitivity was achieved (83.1%); this was equal and better compared to the text classifier (83.1%) and the online tool (40.7%), respectively.

Conclusion  Our VaeTM implementation of a semantic text mining strategy shows promise in providing accurate and efficient extraction of key features from VAERS narratives.

Clinical Investigation
August 2012, Vol. 2, No. 8, Pages 765-767 , DOI 10.4155/cli.12.69
(doi:10.4155/cli.12.69)

Conference Report: World Vaccine Trials Congress 2012
Jonathan K Fallon & James L Gulley
Gaylord National Convention Center, National Harbor, MD, USA, 11–12 April 2012

Summary
The successful design and implementation of vaccine clinical trials is a long and complicated process. Determining trial size, choosing an appropriate end point, managing diverse trial sites, and collecting detailed safety data are just some of the challenges faced along the way. At the World Vaccine Trials Congress 2012, presenters from academia, government agencies, industry and nonprofit organizations described their experiences dealing with these challenges. Also highlighted were newer issues related to the increasing globalization of infectious disease vaccine trials, the clinical development of promising cancer vaccines, and the emergence of electronic data-collection tools. The conference thus provided valuable insights into the present and future of the vaccine trial enterprise.

The Guardian
http://www.guardiannews.com/
Accessed 1 September 2012

Time is ripe for breakthrough on child mortality, says senior Unicef official
Unicef doctor says investment now could help meet millennium development goals on tackling child and maternal mortality
Mark Tran

Extract

An inense focus on countries with the highest levels of child mortality combined with the availability of cheaper vaccines and medicines can lead to a development breakthrough, according to a senior UN health expert.

Dr Mickey Chopra, chief health officer at Unicef, the UN children’s agency, said investment now would lead to massive strides in meeting the millennium development goals of reducing maternal deaths by three-quarters (MDG4) and the deaths of children under five by two-thirds (MDG5), both by 2015.

“If we make the kind of investment we need now, which is not huge, we could achieve a ‘man on the moon’ moment,” Chopra told the Guardian. “We have a clearer idea why and where children are dying. Twenty-four countries account for 80% of the deaths. We know where they are dying within those countries. Combined with effective interventions such as vaccines and breastfeeding, we have the potential to reach kids in the most cost-effective manner.”…

http://www.guardian.co.uk/global-development/2012/aug/28/breakthrough-child-mortality-unicef-official?newsfeed=true

Wall Street Journal
http://online.wsj.com/home-page
Updated August 31, 2012, 9:44 a.m. ET

Rabies vaccine test expanded after W.Va. success
Associated Press
Extract
LEWISBURG, W.Va. — The U.S. Department of Agriculture is expanding testing of a new rabies vaccine to Virginia, Ohio and the St. Lawrence Seaway region following initial success in West Virginia.

USDA wildlife biologist John Houber says trials of the ONRAB vaccine at the additional sites will allow the agency to confirm the results of initial testing in Greenbrier County in southeastern West Virginia. The USDA also plans a second year of trials in West Virginia.

The Register-Herald (http://bit.ly/NFHioB ) says Houber discussed the vaccine trials this week during a meeting of the Greenbrier County Commission.

About 80,000 baits laced with the vaccine were air-dropped in Greenbrier County last fall in the first field trial in the U.S.

Houber said the vaccine’s effectiveness rate was nearly 50 percent. The expected first-year effectiveness rate for a rabies vaccine is 15 percent…

http://online.wsj.com/article/APbe423f150e3b476899b989d42522d793.html?KEYWORDS=vaccine

Twitter Watch  [accessed 1 September 2012  15:08]
Items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and is by no means intended to be exhaustive.

UNICEF @UNICEF
In response to global increase in #cholera, we’ve developed a Cholera Toolkit with @WHO @Oxfam and @CDCgov http://uni.cf/PoAIJ5 
1:50 PM – 28 Aug 12

Gates Health @gateshealth
Hurry, this is the last week to nominate for the annual Gates Vaccine Innovation Award! Deadline is Friday, August 31.  http://cot.ag/NniHFv 
Retweeted by Gates Foundation
7:27 AM – 27 Aug 12

GAVI Alliance @GAVIAlliance
From applying 4 funding 2 co-financing cost of vaccines, GAVI emphasises country ownership of immunisation programmes. http://ht.ly/dlnxN 
6:33 AM – 30 Aug 12

Seth Berkley @GAVISeth
During Ramadan, Yemen hlth centres are packed w/ families getting their children vaccinated against rotavirus. Great! http://ear.li/55s 
Retweeted by GAVI Alliance
8:42 AM – 22 Aug 12

GAVI Alliance GAVIAlliance
In this video, vaccine inventor, Paul Offit, describes this deadly disease and the power of vaccines. http://ht.ly/d5gAh  #vaccineswork
Vaccine inventor and pediatrician, Paul Offit, describes pertussis.
1:52 AM – 20 Aug 12

Editor’s Notes:

– Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_25 August 2012

– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

– Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…

Meeting Report: WHO Technical Working Group on creation of an oral cholera vaccine stockpile
Geneva, 26–27 April 2012
Authors: WHO
Publication details: 15 pages; WHO reference number: WHO/HSE/PED/2012

Overview
The 64th World Health Assembly (2011) called for an integrated, comprehensive strategy of cholera prevention and control. The WHA Resolution 64.15 included consideration of the use of oral cholera vaccines (OCV) “where appropriate, in conjunction with other recommended prevention and control methods and not as a substitute for such methods”.

This consideration was taken forward at a September 2011 consultation, which noted that an OCV stockpile for outbreak control could be initiated in the near future.

This is the report of a Technical Working Group which was convened, in April 2012, to develop an OCV stockpile implementation framework. Participants advised on: the criteria for choice of stockpiled vaccine and its deployment; the appropriate size of an OCV stockpile; the managing partnership and evaluation processes required; the decision-making procedure and operational issues; and the financing mechanism.

http://www.who.int/iris/bitstream/10665/75240/1/WHO_HSE_PED_2012_2_eng.pdf

PAHO reported on a meeting of its Technical Advisory Group on Vaccine-Preventable Diseases (TAG) focused on cholera. The meeting was heldin Washington, D.C. on 16 August 2012. The group reported that elimination of cholera transmission on the Island of Hispaniola can be achieved by increasing and sustaining access to clean drinking water and adequate sanitation, and that “reaching the long-term goal will be greatly aided with complementary short-term actions such as the expanded use of oral cholera vaccine.” PAHO said the meeting of the Technical Advisory Group is “framed in the set of actions that governments of Haiti and Dominican Republic, PAHO/WHO, and other agencies and partners have been carrying out in the wake of the cholera outbreak in October 2010.” One example of this coordinated action is the launching last June of the Regional Coalition on Water and Sanitation for the Elimination of Cholera on the Island of Hispaniola, which helps governments to harmonize and streamline international assistance and investments in water and sanitation infrastructure on the island.  Dr. Jon Andrus, Deputy Director of PAHO, opened the meeting by tasking TAG with the provision of technical recommendations on cholera vaccination grounded in the best available science. “If the evidence indicates, especially with the recent experience of demonstration projects conducted in the field in Haiti, we should not fail to miss short-term opportunities to save more lives more quickly. However, such action must be balanced within the long-term vision of safe water and sanitation that will ultimately stop cholera transmission on the island.”

After the presentation of scientific evidence and the results of two demonstration projects, the Technical Advisory Group, chaired by Dr. Ciro de Quadros, recommended introduction of the oral cholera vaccine. This recommendation was supported by data presented by Partners in Health and GHESKIO, two nongovernmental health organizations with a long history of work in Haiti. Acting on PAHO’s suggestion, both had recently conducted projects which achieved high vaccination coverage of up to 90% for two doses of the oral cholera vaccine.

Given that current global supplies of the vaccine are limited, TAG experts also recommended prioritizing vaccination in densely populated urban areas with limited access to sanitation and drinking water, and in rural areas where access to health services is most challenging. As manufacturers ramp up production in the near future, the experts unanimously recommended moving toward universal vaccination. However, they noted that doing so will require urgent attention to mobilizing and sustaining the flow of financial resources, strengthening operational capacity, and insuring that vaccination efforts are well-integrated into the long-term vision of safe water and sanitation to stop cholera’s transmission. The Technical Advisory Group also highlighted the importance of finding solutions to the global scarcity of the cholera vaccine, as well as the need to strengthen epidemiological surveillance processes, which are critical in securing cholera prevention and control. TAG members additionally stressed the need to conduct research to close current knowledge gaps on the vaccine.

Members of PAHO’s Technical Advisory Group for Vaccine-Preventable Disease include Dr. Ciro de Quadros (Chairperson and Executive Vice- President of the Sabin Vaccine Institute), Dr. Peter Figueroa (Rapporteur and Acting Chief Medical Officer at the Ministry of Health of Jamaica), Dr. Roger Glass (Fogarty International Center, U.S. National Institutes of Health), Dr. Anne Schuchat (National Center for immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention), Dr. Jeannette Vega (Center for Epidemiology and Health Policy, Chile), Dr. Akira Homma (Policy and Strategy Council, Bio-Manguinhos Institute, Fiocruz, Brazil), Dr. Arlene King (Ministry of Health and Long-term Care, Canada), Dr. Ramiro Guerrero-Carvajal (PROESA, Colombia), Dr. José Ignacio Santos (Department of Experimental Medicine, National Autonomous University of Mexico) and Cuahtémoc Ruiz (PAHO).

The U.S. Global Health Initiative (GHI) published interim reports on its “aspirational goals in eight broad health areas.” The reports focus on progress against GHI targets through links provided on the program graphic here:

http://www.ghi.gov/about/goals/index.htm

The Global Fund said it signed two grant agreements with Nigeria worth a total of US$225 million to support programs that will prevent and treat malaria. The grant agreements “expand a partnership with the Global Fund that has yielded remarkable progress in recent years, such as undertaking the largest distribution of bed nets done anywhere – more than 45 million to date.”  Included is an additional US$50 million for bed nets, “approved in an unusual move by the Global Fund Board that was linked to additional commitments by the Government of Nigeria.” During a transformation of the Global Fund’s grant management structure this year, Nigeria was identified as one of 20 ‘high impact’ countries now under a special designation.

http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-08-24_Nigeria_and_the_Global_Fund_Sign_Grant_Agreements_worth_USD_225_Million_to_Fight_Malaria/

   NIAID said it awarded 14 grants totaling US$7.8 million in first-year funding for “basic research to identify new approaches for designing a safe and effective HIV vaccine.” The grants were awarded under the Innovation for HIV Vaccine Discovery (IHVD) initiative, which is expected to receive up to $34.8 million over the next four years. NIAID Director Anthony S. Fauci, M.D. commented, “Recent discoveries about the basic biology of HIV and how the virus adapts to its host have provided useful information and new opportunities to guide vaccine development. These grants are designed to build on that information and stimulate discovery of new ways to design a robust vaccine that prevents acquisition and establishment of latent infection.” The 14 IHVD grant recipient organizations include:

– Altravax Inc. (Sunnyvale, Calif.)

– Catholic University of America (Washington, D.C.)

– Dartmouth College (Hanover, N.H.)

– Duke University (Durham, N.C.)

– Harvard Medical School (Boston)

– Massachusetts General Hospital (Boston)

– NYU Langone Medical Center (New York City)

– University of California (Irvine)

– University of Maryland (Baltimore)

– University of Medicine and Dentistry of New Jersey (Newark)

– University of Minnesota (Minneapolis)

– University of North Carolina (Chapel Hill)

– University of Rochester (Rochester, N.Y.)

– University of Texas at El Paso

http://www.nih.gov/news/health/aug2012/niaid-21.htm

Post: A Global Partnership for Vaccine Design
USID – IMPACT blog
Posted by Guest blogger Margaret McGlynn, IAVI President and CEO on Monday, August 13th 2012

When you’re dealing with a global public health crisis, having an international presence isn’t just advisable – it is imperative. This applies as much to the development of new tools to prevent disease as it does to treatment. An AIDS vaccine candidate, for example, must be tested in the people who will eventually use it and against the strains of HIV it is devised to protect them from.

That’s why the International AIDS Vaccine Initiative (IAVI), in partnership with USAID, has worked diligently over the past several years to establish itself as a truly global non-profit partner. Using donor funds, IAVI has created an enviable network of research centers in sub-Saharan Africa dedicated to assessing novel AIDS vaccine candidates in clinical trials and conducting supporting epidemiological studies on HIV. These partnerships have made meaningful contributions to the research capacity of many developing countries—a capability that is now helping local researchers tackle other diseases.

IAVI and its partners are now applying that same model to support the design of a new generation of AIDS vaccine candidates. Today, IAVI and the Translational Health Sciences and Technology Institute (THSTI), an autonomous institute of the Indian government’s Department of Biotechnology (DBT), launched an HIV Vaccine Design Programme near New Delhi. The Programme is dedicated to the large-scale generation and preclinical evaluation of immunogens, the active ingredients of vaccines. It will focus on devising immunogens capable of eliciting antibodies that can prevent infection by a broad range of the circulating genetic variants of HIV.

That challenge, known to researchers as the neutralizing antibody problem, has long stymied progress toward an AIDS vaccine. But recent discoveries of antibodies capable of blocking a number of HIV variants have provided researchers with clues to the design of potentially powerful new vaccine candidates. The HIV Vaccine Design Programme will use these insights to develop new methods to generate large numbers of potential HIV immunogens and rapidly assess their potential for use in candidate vaccines. Much of the work will take place in a laboratory housed within THSTI that is being built and staffed with support from IAVI, DBT and THSTI.

The Programme’s location is no accident. Over the past decade, IAVI has enjoyed a productive partnership for the clinical evaluation of candidate AIDS vaccines with key medical research institutions of the Indian government. Indian scientists have also actively participated in an international consortium of HIV laboratories supported by IAVI to advance HIV vaccine research. The government of India, meanwhile, is in the early phase of its “Decade of Innovation”, a policy that seeks to harness a growing roster of home-grown biotechs, the nation’s deep pool of scientific talent and global research partnerships to boost innovation in a variety of high-tech fields.

The HIV Vaccine Design Programme provides an opportunity to engage an emerging economy in the global quest to develop a vaccine against HIV. For India, it creates an opportunity to address a crisis of significant relevance to Indians.  As importantly, it seeds the kinds of collaborations that often foster scientific and technical innovation and generate ideas that might be applied to address other diseases that have long hampered development.

http://blog.usaid.gov/2012/08/a-global-partnership-for-vaccine-design/

PATH’s Malaria Vaccine Initiative (MVI) announced a new collaboration with the International AIDS Vaccine Initiative (IAVI) and Imperial College London “to measure the capacity of different vaccine candidates in human clinical testing to elicit an immune response aimed at protecting against deadly malaria parasites.” David C. Kaslow, M.D., director of MVI, said, “Until now, malaria vaccine scientists have struggled to directly compare the cellular immune response elicited in humans by one vaccine to that of another, and this has hampered the ability to prioritize a portfolio of vaccine candidates. We are fortunate to have in IAVI and Imperial College London partners with a track record of developing validated human immunological assays. Through this new collaboration, we look forward to being able to make better informed decisions about if and how various malaria vaccines elicit immune responses at the cellular level in humans.” MVI said the tests will help “prioritize investments and allow scientists to refine vaccine strategies by showing whether a particular formulation, delivery approach, or vaccine adjuvant elicits a superior cell-mediated immune response.” More at: http://www.malariavaccine.org/pr2012Aug20-referencelab.php

MVI said it recently named “some of the world’s most eminent malaria scientists and vaccinologists to its Vaccine Science Portfolio Advisory Council (VSPAC) — “a group of external experts tasked with providing strategic input and advice on the MVI’s scientific portfolio and overall research and development (R&D) program.” The new members of the VSPAC are: Dr. Norman Baylor, President and CEO of Biologics Consulting Group, Inc. and former Director of the Office of Vaccines Research and Review (OVRR) in the FDA’s Center for Biologics Evaluation and Research; Dr. Kamini Mendis, an independent consultant on malaria and tropical medicine, formerly the Coordinator of Malaria Treatment and Malaria Elimination at WHO; Dr. Rafick-Pierre Sékaly, Co-Director and Chief Scientific Officer of VGTI Florida; and Dr. Fidel Zavala, Professor at the Department of Molecular Microbiology and Immunology at the Bloomberg School of Public Health, Johns Hopkins University. Dr. David C. Kaslow, director of MVI and former chair of the VSPAC, said, “We’re fortunate to have some of the world’s most distinguished scientists advising us on MVI’s malaria vaccine research and development strategy. The expertise of the VSPAC members is a critical resource to realizing our near-term strategic goal of supporting development of a first-generation malaria vaccine that could protect millions against disease and death, as well as our long-term goals of developing more highly effective second-generation vaccines, including vaccines to support future elimination and eradication efforts.”

http://www.path.org/news/pr120814-mvi-vspac.php

The FDA (U.S.) said it approved the 2012-2013 influenza (flu) vaccine formulation for all six manufacturers licensed to produce and distribute the vaccines in the United States. Based on that information and the recommendations of the FDA’s Vaccines and Related Biological Products Advisory Committee, the strains selected for inclusion in the 2012-2013 flu vaccines are:

– A/California/7/2009 (H1N1)-like virus
– A/Victoria/361/2011 (H3N2)-like virus
– B/Wisconsin/1/2010-like virus.

The FDA noted that while the H1N1 virus is the same as what was included in the 2011-2012 influenza vaccines, this year’s influenza H3N2 and B viruses differ from those in the 2011-2012 influenza vaccines. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm315365.htm

The MMWR Weekly for August 24, 2012 / Vol. 61 / No. 33 includes:
Vaccination Coverage Among Children in Kindergarten — United States, 2011–12 School Year

The Weekly Epidemiological Record (WER):

– 24 August 2012, vol. 87, 34 (pp. 317–328) includes: Global leprosy situation, 2012
http://www.who.int/entity/wer/2012/wer8734.pdf

– 17 August 2012, vol. 87, 33 (pp. 305–316) includes: Meeting of the International Task Force for Disease Eradication, April 2012; Progress towards eliminating onchocerciasis in the WHO Region of the Americas in 2011: interruption of transmission in Guatemala and Mexico; Monthly report on dracunculiasis cases, January–May 2012
http://www.who.int/entity/wer/2012/wer8733.pdf

WHO Fact Sheet: Pneumonia
Fact sheet N°331
August 2012

Key Facts
– Pneumonia is the leading cause of death in children worldwide.

– Pneumonia kills an estimated 1.4 million children under the age of five years every year – more than AIDS, malaria and tuberculosis combined.

– Pneumonia can be caused by viruses, bacteria or fungi.

– Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors.

– Pneumonia can be treated with antibiotics, but around 30% of children with pneumonia receive the antibiotics they need.

Full Fact Sheet: http://www.who.int/mediacentre/factsheets/fs331/en/index.html

UNICEF said it launched the Innovate for Children website to “draw attention to health and education challenges faced by children in developing countries – and the potential for innovative product design and inventive use of technology to find solutions.” The website “welcomes comments and ideas, and invites online submissions on projects designed to accelerate reduction of child mortality. UNICEF’s methodology in innovation work “emphasizes the importance of understanding the needs of users and the geographic, social and economic barriers that limit access to life-saving supplies and services.”

Website: http://www.unicefinnovation.org/
http://www.unicef.org/media/media_65582.html

Proceedings: Progress Toward Rubella Elimination and CRS Prevention in Europe

This meeting was held 8-10 February, 2012 in Rome, Italy. Over 150 people from 47 countries came together to review the latest developments in the fight against rubella and CRS in Europe. A special session on measles was also convened to review the numerous overlaps in these two areas. Proceedings are now available for download.

Progress Toward Rubella Elimination and CRS Prevention in Europe_finalweb.pdf(3.26mb pdf)

Workshop Summary: Accelerating the Development of New Drugs and Diagnostics: Maximizing the Impact of the Cures Acceleration Network
August 22, 2012

Summary
Advances in technologies and knowledge are creating new avenues for research and opportunities for the discovery and clinical development of innovative therapies and diagnostics. However, despite these opportunities, only a small fraction of investigational products are successfully developed into cures and therapies that can be accessed by patients. One response to the ever-widening gap between the number and promise of basic scientific discoveries and the translation of those discoveries into therapies is a renewed emphasis on collaborative approaches among federal agencies, academia, and industry, all directed at the advancement of the drug development enterprise.

The newly developed Cures Acceleration Network (CAN) — a part of the National Center for Advancing Translational Sciences (NCATS) within the National Institutes of Health (NIH) — has the potential to catalyze widespread changes in NCATS, NIH, and the drug development ecosystem in general.

On June 4–5, 2012, the IOM Forum on Drug Discovery, Development, and Translation held, at the request of NCATS, a workshop — bringing together members of federal government agencies, the private sector, academia, and advocacy groups — to explore options and opportunities in the implementation of CAN. This document summarizes the workshop.

http://iom.edu/Reports/2012/Accelerating-the-Development-of-New-Drugs-and-Diagnostics.aspx?utm_medium=etmail&utm_source=Institute%20of%20Medicine&utm_campaign=08.22.12+Report+-+Cures+Acceleration+Network&utm_content=New%20Reports&utm_term=Academic

Emerging Infectious Diseases
Volume 18, Number 9—September 2012
http://www.cdc.gov/ncidod/EID/index.htm

Perspective
Hepatitis E, a Vaccine-Preventable Cause of Maternal Deaths
A. B. Labrique et al.

Abstract
Hepatitis E virus (HEV) is a major cause of illness and of death in the developing world and disproportionate cause of deaths among pregnant women. Although HEV vaccine trials, including trials conducted in populations in southern Asia, have shown candidate vaccines to be effective and well-tolerated, these vaccines have not yet been produced or made available to susceptible populations. Surveillance data collected during 2001–2007 from >110,000 pregnancies in a population of ≈650,000 women in rural Bangladesh suggest that acute hepatitis, most of it likely hepatitis E, is responsible for ≈9.8% of pregnancy-associated deaths. If these numbers are representative of southern Asia, as many as 10,500 maternal deaths each year in this region alone may be attributable to hepatitis E and could be prevented by using existing vaccines.

JAMA   
August 15, 2012, Vol 308, No. 7
http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=24772&direction=P

Viewpoint
The State of the World’s Refugees: Adapting Health Responses to Urban Environments
António Guterres, MEng; Paul Spiegel, MD, MPH

Extract [Free full text]
The forced displacement of populations, across borders and within their own countries, is one of the most visible and enduring manifestations of persecution and conflict. At the end of 2011, more than 42 million people had been forcibly displaced from their homes by conflict, including 15 million refugees and 26 million internally displaced people (IDPs).1 In 2011, more than 4.3 million people were newly uprooted, with some 800 000 fleeing to neighboring countries in humanitarian crises stretching from Côte d’Ivoire, Libya, Syria, the border between Sudan and South Sudan, to the Horn of Africa1 and more recently due to conflict in Mali.2

These new emergencies unfolded alongside unresolved crises that have resulted in millions of people living in situations of protracted displacement, often for decades. Millions of refugees and IDPs from countries such as Somalia, Afghanistan, Eritrea, Colombia, the Democratic Republic of Congo, and Iraq remain unable to return to their homes after extended periods in exile. The vast majority of refugees—approximately 80%—are hosted in the developing world, primarily in neighboring countries…

JAMA   
August 15, 2012, Vol 308, No. 7
http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=24772&direction=P

Viewpoint
A Framework for Catastrophic Disaster Response
Dan Hanfling, MD; Bruce M. Altevogt, PhD; Lawrence O. Gostin, JD

Extract
The Japanese tsunami, Haitian earthquake, and Gulf Coast hurricane offered stark reminders of how vulnerable organized societies are to catastrophic events. They also show how public health emergencies—whether naturally occurring (eg, a pandemic outbreak of novel influenza) or deliberate (eg, a terrorist attack using an improvised nuclear device)—will stress the health system beyond its current capacity. This will require a health and medical response that is fundamentally different from the status quo.

The Lancet Infectious Disease
Sep 2012  Volume 12  Number 9  p647 – 736
http://www.thelancet.com/journals/laninf/issue/current

Comment
Global mortality of 2009 pandemic influenza A H1N1
Cécile Viboud, Lone Simonsen

Preview
More than 3 years after the emergence of the 2009 pandemic influenza A H1N1 virus, the associated global mortality remains unclear. Of 18 500 laboratory-confirmed pandemic-associated deaths identified during April, 2009, to April, 2010, worldwide, less than 12% were reported from Africa and southeast Asia, although these regions are home to more than 38% of the world’s population. Laboratory-confirmed deaths are gross underestimates of influenza-related mortality because of the lack of routine laboratory tests and difficulties in identification of influenza-related deaths triggered by bacterial superinfections or exacerbation of chronic illnesses.

Research
Estimated global mortality associated with the first 12 months of 2009 pandemic influenza A H1N1 virus circulation: a modelling study
Fatimah S Dawood, A Danielle Iuliano, Carrie Reed, Martin I Meltzer, David K Shay, Po-Yung Cheng, Don Bandaranayake, Robert F Breiman, W Abdullah Brooks, Philippe Buchy, Daniel R Feikin, Karen B Fowler, Aubree Gordon, Nguyen Tran Hien, Peter Horby, Q Sue Huang, Mark A Katz, Anand Krishnan, Renu Lal, Joel M Montgomery, Kåre Mølbak, Richard Pebody, Anne M Presanis, Hugo Razuri, Anneke Steens, Yeny O Tinoco, Jacco Wallinga, Hongjie Yu, Sirenda Vong, Joseph Bresee, Marc-Alain Widdowson

Summary
Background
18 500 laboratory-confirmed deaths caused by the 2009 pandemic influenza A H1N1 were reported worldwide for the period April, 2009, to August, 2010. This number is likely to be only a fraction of the true number of the deaths associated with 2009 pandemic influenza A H1N1. We aimed to estimate the global number of deaths during the first 12 months of virus circulation in each country.

Methods
We calculated crude respiratory mortality rates associated with the 2009 pandemic influenza A H1N1 strain by age (0—17 years, 18—64 years, and >64 years) using the cumulative (12 months) virus-associated symptomatic attack rates from 12 countries and symptomatic case fatality ratios (sCFR) from five high-income countries. To adjust crude mortality rates for differences between countries in risk of death from influenza, we developed a respiratory mortality multiplier equal to the ratio of the median lower respiratory tract infection mortality rate in each WHO region mortality stratum to the median in countries with very low mortality. We calculated cardiovascular disease mortality rates associated with 2009 pandemic influenza A H1N1 infection with the ratio of excess deaths from cardiovascular and respiratory diseases during the pandemic in five countries and multiplied these values by the crude respiratory disease mortality rate associated with the virus. Respiratory and cardiovascular mortality rates associated with 2009 pandemic influenza A H1N1 were multiplied by age to calculate the number of associated deaths.

Findings
We estimate that globally there were 201 200 respiratory deaths (range 105 700—395 600) with an additional 83 300 cardiovascular deaths (46 000—179 900) associated with 2009 pandemic influenza A H1N1. 80% of the respiratory and cardiovascular deaths were in people younger than 65 years and 51% occurred in southeast Asia and Africa.

Interpretation
Our estimate of respiratory and cardiovascular mortality associated with the 2009 pandemic influenza A H1N1 was 15 times higher than reported laboratory-confirmed deaths. Although no estimates of sCFRs were available from Africa and southeast Asia, a disproportionate number of estimated pandemic deaths might have occurred in these regions. Therefore, efforts to prevent influenza need to effectively target these regions in future pandemics.

Funding
None.

The Lancet Infectious Disease
Sep 2012  Volume 12  Number 9  p647 – 736
http://www.thelancet.com/journals/laninf/issue/current

Comment
Effectiveness of H1N1 vaccination in Scotland, UK
John S Oxford
Preview
The inherent scientific strength of the UK National Health Service (NHS) is exemplified in The Lancet Infectious Diseases by the report by Colin Simpson and colleagues.1 Few countries have nationally linked primary care, hospital records, death certificates, and virological swab data. The numbers in the study are large, with nearly 24 million person-days of observation during the two waves of the H1N1 2009 influenza pandemic in the early summer and the autumn, with the numbers vaccinated and outcomes ranging from hospital admission to death.

Research
Effectiveness of H1N1 vaccine for the prevention of pandemic influenza in Scotland, UK: a retrospective observational cohort study
Colin R Simpson, Lewis D Ritchie, Chris Robertson, Aziz Sheikh, Jim McMenamin
Summary
Background
A targeted vaccination programme for pandemic H1N1 2009 influenza was introduced in Scotland, UK, in October, 2009. We sought to assess the effectiveness of this vaccine in a sample of the Scottish population during the 2009—10 pandemic.

Methods
We assessed the effectiveness of the Scottish pandemic H1N1 2009 influenza vaccination with a retrospective cohort design. We linked data of patient-level primary care, hospital records, death certification, and virological swabs to construct our cohort. We estimated vaccine effectiveness in a nationally representative sample of the Scottish population by establishing the risk of hospital admission and death (adjusted for potential confounders) resulting from influenza-related morbidity in vaccinated and unvaccinated patients and laboratory-confirmed cases of influenza H1N1 2009 in a subset of patients.

Findings
Pandemic H1N1 2009 influenza vaccination began in week 43 of 2009 (Oct 21, 2009) and was given to 38 296 (15·5%, 95% CI 15·4—15·6) of 247 178 people by the end of the study period (Jan 31, 2010). 208 882 (85%) people were unvaccinated. There were 5207 emergency hospital admissions and 579 deaths in the unvaccinated population and 924 hospital admissions and 71 deaths in the vaccinated population during 23 893 359 person-days of observation. The effectiveness of H1N1 vaccination for prevention of emergency hospital admissions from influenza-related disorders was 19·5% (95% CI 0·8—34·7). The vaccine’s effectiveness in preventing laboratory-confirmed influenza was 77·0% (95% CI 2·0—95·0).

Interpretation
Pandemic H1N1 2009 influenza vaccination was associated with protection against pandemic influenza and a reduction in hospital admissions from influenza-related disorders in Scotland during the 2009—10 pandemic.

Funding
National Institute for Health Research Health Technology Assessment Programme (UK).

Nature Reviews Immunology
September 2012 Vol 12 No 9
http://www.nature.com/nri/journal/v12/n8/index.html

The impact of differential antiviral immunity in children and adults
Andrew J. Prendergast, Paul Klenerman & Philip J. R. Goulder
p636 | doi:10.1038/nri3277

Abstract
The course of immune maturation has evolved to favour survival at each stage of development in early life. Fetal and neonatal immune adaptations facilitate intrauterine survival and provide early postnatal protection against extracellular pathogens, but they leave infants susceptible to intracellular pathogens such as viruses that are acquired perinatally. This Review focuses on three such pathogens — HIV, hepatitis B virus and cytomegalovirus — and relates the differential impact of these infections in infants and adults to the antiviral immunity that is generated at different ages. A better understanding of age-specific antiviral immunity may inform the development of integrated prevention, treatment and vaccine strategies to minimize the global disease burden resulting from these infections.

The Pediatric Infectious Disease Journal
September 2012 – Volume 31 – Issue 9  pp: A7-A8,889-1002,e141-e175
http://journals.lww.com/pidj/pages/currenttoc.aspx

Eradication of Invasive Pneumococcal Disease due to the Seven-valent Pneumococcal Conjugate Vaccine Serotypes in Calgary, Alberta
Leal, Jenine; Vanderkooi, Otto G.; Church, Deirdre L.; MacDonald, Judy; Tyrrell, Gregory J.; Kellner, James D.
Pediatric Infectious Disease Journal. 31(9):e169-e175, September 2012.
doi: 10.1097/INF.0b013e3182624a40

Abstract:
Background: The seven-valent pneumococcal conjugate vaccine (PCV7) was licensed in Canada in 2001. Routine infant vaccination programs in Alberta began in 2002. Several years after PCV7 introduction, the routine use of PCV7 in infants and high-risk children has led to near elimination of invasive pneumococcal disease (IPD) caused by vaccine serotypes.

Methods: Prospective, population-based surveillance of all IPD cases was conducted from January 1998 to December 2010. Demographic, clinical and microbiologic data were collected.

Results: There were 1462 IPD cases over 13 years. Comparing PCV7 serotype IPD incidence in the prevaccine period (1998–2001) to the late postvaccine period (2007–2010), there were declines in children 0–5 months (100%), 6–23 months (98%), 2–4 years (97%), 5–15 years (100%) as well as in adults 16–64 years (73%), 65–84 years (90%) and ≥85 years of age (100%). From 2008 to 2010, there were no cases of PCV7 serotype IPD in children under 2 years of age. There have been increases in non-PCV7 serotype IPD; notably, serotypes 5 and 19A have increased significantly in adults and 19A in children.

Conclusions: PCV7 serotype IPD has been eliminated in vaccine-eligible young children and nearly eliminated in all other age groups. Serotype 19A increased significantly at all ages before the introduction of an expanded valency pneumococcal conjugate vaccine

PLoS One
[Accessed 25 August 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

The Effectiveness of U.S. Public Health Surveillance Systems for Situational Awareness during the 2009 H1N1 Pandemic: A Retrospective Analysis
Michael A. Stoto
PLoS ONE: Research Article, published 22 Aug 2012 10.1371/journal.pone.0040984

Abstract 
Background
The 2009 H1N1 outbreak provides an opportunity to learn about the strengths and weaknesses of current U.S. public health surveillance systems and to identify implications for measuring public health emergency preparedness.

Methodology/Principal Findings
We adopted a “triangulation” approach in which multiple contemporary data sources, each with different expected biases, are compared to identify time patterns that are likely to reflect biases versus those that are more likely to be indicative of actual infection rates. This approach is grounded in the understanding that surveillance data are the result of a series of decisions made by patients, health care providers, and public health professionals about seeking and providing health care and about reporting cases to health authorities. Although limited by the lack of a gold standard, this analysis suggests that children and young adults are over-represented in many pH1N1 surveillance systems, especially in the spring wave. In addition, the nearly two-month delay between the Northeast and the South in the Fall peak in some surveillance data seems to at least partially reflect regional differences in concerns about pH1N1rather than real differences in pH1N1 infection rates.

Conclusions/Significance
Although the extent of the biases suggested by this analysis cannot be known precisely, the analysis identifies underlying problems with surveillance systems – in particular their dependence on patient and provider behavior, which is influenced by a changing information environment – that could limit situational awareness in future public health emergencies. To improve situational awareness in future health emergencies, population-based surveillance systems such as telephone surveys of representative population samples and seroprevalence surveys in well-defined population cohorts are needed.

PLoS Medicine
(Accessed 25 August 2012)
http://www.plosmedicine.org/article/browse.action?field=date
Why We Need Urban Health Equity Indicators: Integrating Science, Policy, and Community
Jason Corburn, Alison K. Cohen
Policy Forum, published 14 Aug 2012
doi:10.1371/journal.pmed.1001285

Summary Points
– As the urban population of the planet increases and puts new stressors on infrastructure and institutions and exacerbates economic and social inequalities, public health and other disciplines must find new ways to address urban health equity.

– Urban indicator processes focused on health equity can promote new modes of healthy urban governance, where the formal functions of government combine with science and social movements to define a healthy community and direct policy action.

– An inter-related set of urban health equity indicators that capture the social determinants of health, including community assets, and track policy decisions, can help inform efforts to promote greater urban health equity.

– Adaptive management, a strategy used globally by scientists, policy makers, and civil society groups to manage complex ecological resources, is a potential model for developing and implementing urban health equity indicators.

– Urban health equity indicators are lacking and needed within cities of both the global north and south, but universal sets of indicators may be less useful than context-specific measures accountable to local needs.

Science        
17 August 2012 vol 337, issue 6096, pages 769-876
http://www.sciencemag.org/content/337/6096.toc
News & Analysis
Public Health
Policy Shifts on Emergency Use of Cholera Vaccines
Martin Enserink

Summary
Many experts have argued that in outbreak situations—especially in the poor, messy places where cholera often strikes—existing vaccines are too expensive, not effective enough, and too impractical to roll out; they might even make matters worse, some fear, because they distract health workers from treating patients or improving water and sanitation, the cornerstones of cholera control. But now, the tide appears to have turned. This week, a technical working group at the World Health Organization is set to publish a report advocating for the creation of a global stockpile of cholera vaccines that would be rushed to countries when an outbreak begins.

Science Translational Medicine
22 August 2012 vol 4, issue 148
http://stm.sciencemag.org/content/current

Review
IMMUNOENGINEERING
Engineering Approaches to Immunotherapy
Melody A. Swartz, Sachiko Hirosue, and Jeffrey A. Hubbell
22 August 2012: 148rv9

Abstract
As the science of immunology grows increasingly mechanistic, motivation for developing quantitative, design-based engineering approaches has also evolved, both for therapeutic interventions and for elucidating immunological pathways in human disease. This has seeded the nascent field of “immunoengineering,” which seeks to apply engineering analyses and design approaches to problems in translational immunology. For example, cell engineers are creating ways to tailor and use immune cells as living therapeutics; protein engineers are devising new methods of rapid antibody discovery; biomaterials scientists are guiding vaccine delivery and immune-cell activation with novel constructs; and systems immunologists are deciphering the evolution and maintenance of T and B cell receptor repertoires, which could help guide vaccine design. The field is multidisciplinary and collaborative, with engineers and immunologists working together to better understand and treat disease. We discuss the scientific progress in this young, yet rapidly evolving research area, which has yielded numerous start-up companies that are betting on impact in clinical and commercial translation in the near future.

Science Translational Medicine
22 August 2012 vol 4, issue 148
http://stm.sciencemag.org/content/current

Health Care
Measuring the Benefits of HPV Vaccination
Ruanne V. Barnabas
22 August 2012: 148ec149
[No abstract] Costs of HPV disease in the United States could be offset by vaccination.
15 August 2012 vol 4, issue 147
http://stm.sciencemag.org/content/4/147.toc

Vaccine: Development and Therapy
(Accessed 25 August 2012)
http://www.dovepress.com/vaccine-development-and-therapy-journal

Reasons for not having received influenza vaccination and its predictors in Canadians
Original Research
Authors: Chen Y, Wu J, Yi QL, Laroche J, Wong T
Published Date August 2012 Volume 2012:2 Pages 23 – 33
DOI: http://dx.doi.org/10.2147/VDT.S32618
Yue Chen,1 Jun Wu,2 Qi-long Yi,1 Julie Laroche,3 Thomas Wong2
1Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, 2Professional Guidelines and Public Health Practice Division, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, 3Immunization Assessment and Information, Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada

Background: Influenza vaccination is the most effective way to prevent influenza. However, only about one-third of Canadians receive an annual seasonal influenza vaccination.
Methods: The reasons for not having received influenza vaccination were examined among 131,061 Canadians ≥ 12 years of age who participated in a national survey in 2007–2008. Among them, 127,297 subjects responded to the questions concerning their flu shot history and were grouped into three categories: never (n = 51,767), 1+ year ago (n = 29,310), last year (n = 46,220). Subjects who reported not having had a flu shot during the past year were asked the reasons for not having it. The log binomial regression model was used to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for the associations of various reasons for not having received influenza vaccination and their predictors.
Results: When weighted to the Canadian population, 44.0% had never previously received influenza vaccine and 24.5% had received the vaccine > 12 months ago. The most common reasons for not having received influenza vaccination in the past 12 months were “Respondent did not think it necessary” (71.3%) and “Have not gotten around to it” (17.6%). Log binomial regression analysis shows that females were less likely to report these two reasons compared to males with PRs of 0.98 (0.97, 0.99) and 0.84 (0.81, 0.87), respectively. Younger participants were more likely to report, “Have not gotten around to it.” For those who had an influenza vaccination previously, the primary reason for not having an influenza vaccination in the last year was “Have not gotten around to it.”
Conclusions: More than two-thirds of Canadians 12+ years of age did not receive an influenza vaccination in the past year, and “Respondent did not think it necessary” and “Have not gotten around to it” were the main reasons.

Thesis: Evaluation of the impact of access to free influenza vaccine on immunization rates for children with cystic fibrosis
By Jones, Katie, M.P.H., THE UNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH, 2012, 47 pages; 1511823

Abstract:
Children with cystic fibrosis are at increased risk of seasonal influenza associated complications, which makes them a judicious target of interventions designed to increase influenza vaccination rates. The Baylor College of Medicine/Texas Children’s Hospital Pediatric Cystic Fibrosis (BCM/TCH CF) Care Center implemented an enhanced multi-component initiative designed to increase influenza vaccination rates in its patient population during the 2011-2012 influenza season. We evaluated the impact of specific components of this intervention on vaccination rates among the clinic’s patient population via a historical medical chart review and examined the relationship between vaccination status and the number of pulmonary exacerbations requiring hospital admission during the influenza season. The multi-component intervention was comprised of providing influenza free of charge in the CF Care Center, reminders via phone call and letters, and drive through influenza vaccine clinics on nights and weekends. The intervention to increase influenza vaccination rates led to overall improved vaccination rates among the patients at the BCM/TCH CF Care Center, increasing from 90% adherence observed during the 2010-2011 season to 94% adherence during the 2011-2012 season. The availability of free influenza vaccine in the CF Care Center, combined with reminders about being vaccinated early in the season proved to be the most effective practices for improving the vaccination rate in the CF Care Center.
http://gradworks.umi.com/15/11/1511823.html

CURRENT OPINION – Advances in hepatitis immunization (A, B, E): public health policy and novel vaccine delivery
G Hendrickx, A Vorsters, P Van Damme – Curr Opin Infect Dis, 2012

Summary
Follow-up of vaccinated individuals confirms the long-term protection offered by
the hepatitis A as well as hepatitis B vaccines. Data confirm the safety and immunogenicity profile of both vaccines, also when used in patient groups. The first data on the hepatitis E…

CURRENT OPINION – Meningococcal disease in travelers: update on vaccine options
JP Cramer, A Wilder-Smith – Curr Opin Infect Dis, 2012

Summary
The vaccine of choice for travelers at risk of invasive meningococcal disease is a
tetravalent conjugate meningococcal vaccine. Data on the need for re-vaccination
schedules are still lacking, and so are data on immunogenicity in very young children and …

Analysis of indexes used to evaluate immunization coverage rate of first dose of measles containing vaccine.
Beijing Da Xue Xue Bao. 2012 Aug 18;44(4):617-21.
http://www.ncbi.nlm.nih.gov/pubmed/22898859
[Article in Chinese]

Rui LP, Zhang L, Tang N, Wang T.

Source
Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China.

Abstract
OBJECTIVE:
To obtain an objective index of evaluating the immunization coverage rate of first dose of measles containing vaccine (MCV1)by comparison of the indexes in Guizhou Province.

METHODS:
Multistage random sampling method was applied to draw subjects from healthy children who had no measles history and aged from 8 months to 6 years of age. The investigated immunization coverage rate (IIR) and the estimated immunization coverage rate (EIR) were evaluated according to the positive rate of measles antibody as a gold standard, and the data of incidence cases as a reference.

RESULTS:
The IIR was 86.0% for the group aged from 8 months to 1 year, 90.1% for the group aged from 2 to 3 years and 90.2% for the group aged from 4 to 6 years. The adjusted estimated immunization coverage rate (AIIR) was 89.8%, 94.8% and 95.3%, respectively. Given the vaccine efficacy (VE) was 82.9%, the EIR1 was 59.8%, 71.6% and 77.9%, respectively and the AEIR1 was 68.2%, 79.7% and 86.8%, respectively; given the VE was 95%, the EIR1 was 84.3%, 90.1% and 92.7%, respectively, and the AEIR1 was 88.6%, 93.4% and 96.0%, respectively. The EIR2 was 97.9%, 94.5% and 91.4%, respectively. The relative difference was from 0 to 2.4% when compared with the estimated positive rate of AIIR and AEIR1 given the VE was 95% with the actual positive rate of measles antibody, the difference had no statistical significance(P>0.05). The relative error was low for the estimate positive rates of AIIR and EIR2 and AEIR1 (given the VE was 95%) for the children that had not suffered from measles, the relative error varied from 7.0% to 15.8%.

CONCLUSION:
The investigated immunization coverage rate after adjustment and the AEIR1 (VE 95%) were in line with the actual positive rate of measles antibody, which suggests that we should set an integral evaluation system for the immunization coverage rate based on AIIR and AEIR1.

PMID: 22898859
[PubMed – in process]
Free full text

New York Times
http://www.nytimes.com/
Accessed 25 August 2012
August 24, 2012, 7:03 am
Opinion
Tropical Diseases: The New Plague of Poverty
By PETER J. HOTEZ
Published: August 18, 2012

Extract
Houston
In the United States, 2.8 million children are living in households with incomes of less than $2 per person per day, a benchmark more often applied to developing countries. An additional 20 million Americans live in extreme poverty. In the Gulf Coast states of Louisiana, Mississippi and Alabama, poverty rates are near 20 percent. In some of the poorer counties of Texas, where I live, rates often approach 30 percent. In these places, the Gini coefficient, a measure of inequality, ranks as high as in some sub-Saharan African countries.

Poverty takes many tolls, but in the United States, one of the most tragic has been its tight link with a group of infections known as the neglected tropical diseases, which we ordinarily think of as confined to developing countries…

http://www.nytimes.com/2012/08/19/opinion/sunday/tropical-diseases-the-new-plague-of-poverty.html?_r=2