Journal of Infectious Diseases
Volume 204 Issue 5 September 1, 2011
http://jid.oxfordjournals.org/content/204/5.toc

Catherine Yen, Jesùs Reyna Figueroa, Edgar Sánchez Uribe, Luz del Carmen-Hernández, Jacqueline E. Tate, Umesh D. Parashar, Manish M. Patel, and Vesta Richardson López-Collado

Monovalent Rotavirus Vaccine Provides Protection Against an Emerging Fully Heterotypic G9P[4] Rotavirus Strain in Mexico
J Infect Dis. (2011) 204(5): 783-786 doi:10.1093/infdis/jir390

Abstract
After the introduction of monovalent rotavirus vaccine (RV1) in Mexico in 2006–2007, diarrhea mortality and morbidity declined substantially among Mexican children under 5 years of age. In January 2010, surveillance identified the emergence of a novel G9P[4] rotavirus strain nationwide. We conducted a case-control study to assess the field effectiveness of RV1 against severe rotavirus gastroenteritis caused by this unusual strain and to determine whether the G9P[4] emergence was related to vaccine failure or failure to vaccinate. RV1 was 94% effective (95% confidence interval, 16%–100%) against G9P[4] rotavirus–related hospitalization, indicating that its emergence was likely unrelated to vaccine pressure.

The Lancet  
Aug 13, 2011  Volume 378  Number 9793 p541 – 636
http://www.thelancet.com/journals/lancet/issue/current?tab=past

Comment
The last mile in global poliomyelitis eradication
Zulfiqar A Bhutta

The Lancet Infectious Disease
Sep 2011  Volume 11  Number 9  p651 – 720
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Treatment as prevention for HIV
The Lancet Infectious Diseases

Preview
June 5, 2011, was the 30th anniversary of the first reports of five patients with an immune disorder in the US Centers for Diseases Control and Prevention publication Morbidity and Mortality Weekly Report. In the past three decades, HIV/AIDS has become a global pandemic that has defined an age and has affected almost every group of people irrespective of socioeconomic background, race, geography, or personal history, killing more than 33 million people worldwide. Leaps and bounds made in our understanding of HIV and its progression to AIDS and how the virus and syndrome spread and develop have led to great progress in the ability to manage the disease, reflected by a 20% fall in annual incidence in the past 10 years.

New England Journal of Medicine
http://content.nejm.org/current.shtml
August 25, 2011  Vol. 365 No. 8

Correspondence
Childhood Diarrhea Deaths after Rotavirus Vaccination in Mexico
N Engl J Med 2011; 365:772-773
August 25, 2011

Extract
“…The sustained reduction in the rate of death from diarrhea for three seasons after the introduction of the rotavirus vaccine, with reductions progressively extending to other age groups as they become age-eligible for vaccination, provides evidence that some mortality reduction is likely attributable to vaccination. The cumulative reduction of some 2640 childhood deaths since the vaccination program was initiated in Mexico highlights the lifesaving promise of rotavirus vaccines and supports the WHO recommendation for immunization of all children worldwide against rotavirus.”

New England Journal of Medicine
http://content.nejm.org/current.shtml
August 11, 2011  Vol. 365 No. 6
http://www.nejm.org/toc/nejm/365/6

Editorial
Antiretroviral Treatment as Prevention
S.M. Hammer

Extract
“…Antiretroviral therapy is by no means perfect and is not the ultimate answer to controlling and ending the HIV epidemic. Adverse events, emergence of drug-resistant viral strains, maintenance of adherence, sustainability, and cost are just some of the concerns. However, this is precisely the wrong time to limit access to antiretroviral therapy in resource-limited settings, since we have the tools in hand to maintain or restore health in infected persons and reduce transmission to their sexual partners.

Aggressive programs to diagnose and treat HIV infection as part of a comprehensive care package and multiple approaches to the prevention of transmission that have been tested in well-designed clinical trials have the potential to preserve health and control the epidemic until a safe and effective HIV vaccine is a reality.”

Pharmacoeconomics
September 1, 2011 – Volume 29 – Issue 9  pp: 731-821
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

Editorial
Value-Based Pricing: Incentive for Innovation or Zero Net Benefit?
Hughes, Dyfrig A.
Pharmacoeconomics. 29(9):731-735, September 1, 2011

[No abstract available]

Pharmacoeconomics
September 1, 2011 – Volume 29 – Issue 9  pp: 731-821
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

Original Research Articles
Economic Evaluation of Policy Options for Prevention and Control of Cervical Cancer in Thailand
Praditsitthikorn, Naiyana; Teerawattananon, Yot; Tantivess, Sripen; Limwattananon, Supon; Riewpaiboon, Arthorn; Chichareon, Saibua; Ieumwananonthachai, Nantakan; Tangcharoensathien, Viroj
Pharmacoeconomics. 29(9):781-806, September 1, 2011.
doi: 10.2165/11586560-000000000-00000

Abstract
Background: The Thai healthcare setting has seen patients with cervical cancer experience an increasing burden of morbidity and mortality, a stagnation in the performance of cervical screening programmes and the introduction of a vaccine for the prevention of human papillomavirus (HPV) infection.

Objective: This study aims to identify the optimum mix of interventions that are cost effective, from societal and healthcare provider perspectives, for the prevention and control of cervical cancer.

Methods: A computer-based Markov model of the natural history of cervical cancer was used to simulate an age-stratified cohort of women in Thailand. The strategy comparators, including both control and prevention programmes, were (i) conventional cytology screening (Pap smears); (ii) screening by visual inspection with acetic acid (VIA); and (iii) HPV-16, -18 vaccination. Input parameters (e.g. age-specific incidence of HPV infection, progression and regression of the infection, test performance of screening methods and efficacy of vaccine) were synthesized from a systematic review and meta-analysis. Costs (year 2007 values) and outcomes were evaluated separately, and compared for each combination. The screening strategies were started from the age of 30–40 years and repeated at 5- and 10-year intervals. In addition, HPV vaccines were introduced at age 15–60 years.

Results: All of the screening strategies showed certain benefits due to a decreased number of women developing cervical cancer versus ‘no intervention’. Moreover, the most cost-effective strategy from the societal perspective was the combination of VIA and sequential Pap smear (i.e. VIA every 5 years for women aged 30–45 years, followed by Pap smear every 5 years for women aged 50–60 years). This strategy was dominant, with a QALY gain of 0.01 and a total cost saving of Baht (Bt)800, compared with doing nothing. From the societal perspective, universal HPV vaccination for girls aged 15 years without screening resulted in a QALY gain of 0.06 at an additional cost of Bt8800, based on the cost of Bt15 000 for a full immunization schedule. The incremental cost-effectiveness ratio, comparing HPV vaccinations for girls aged 15 years with the current national policy of Pap smears for women aged 35–60 years every 5 years, was approximately Bt181 000 per QALY gained. This figure was relatively high for the Thai setting.

Conclusions: The results suggest that controlling cervical cancer by increasing the numbers of women accepting the VIA and Pap smear screening as routine and by improving the performance of the existing screening programmes is the most cost-effective policy option in Thailand.

PLoS One
[Accessed 27 August 2011]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Assessing Google Flu Trends Performance in the United States during the 2009 Influenza Virus A (H1N1) Pandemic
Samantha Cook, Corrie Conrad, Ashley L. Fowlkes, Matthew H. Mohebbi and effectiveness of seasonal vaccination. Euro Surveill PLoS ONE: Research Article, published 19 Aug 2011 10.1371/journal.pone.0023610

Abstract
Background
Google Flu Trends (GFT) uses anonymized, aggregated internet search activity to provide near-real time estimates of influenza activity. GFT estimates have shown a strong correlation with official influenza surveillance data. The 2009 influenza virus A (H1N1) pandemic [pH1N1] provided the first opportunity to evaluate GFT during a non-seasonal influenza outbreak. In September 2009, an updated United States GFT model was developed using data from the beginning of pH1N1.

Methodology/Principal Findings
We evaluated the accuracy of each U.S. GFT model by comparing weekly estimates of ILI (influenza-like illness) activity with the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet). For each GFT model we calculated the correlation and RMSE (root mean square error) between model estimates and ILINet for four time periods: pre-H1N1, Summer H1N1, Winter H1N1, and H1N1 overall (Mar 2009–Dec 2009). We also compared the number of queries, query volume, and types of queries (e.g., influenza symptoms, influenza complications) in each model. Both models’ estimates were highly correlated with ILINet pre-H1N1 and over the entire surveillance period, although the original model underestimated the magnitude of ILI activity during pH1N1. The updated model was more correlated with ILINet than the original model during Summer H1N1 (r = 0.95 and 0.29, respectively). The updated model included more search query terms than the original model, with more queries directly related to influenza infection, whereas the original model contained more queries related to influenza complications.

Conclusions
Internet search behavior changed during pH1N1, particularly in the categories “influenza complications” and “term for influenza.” The complications associated with pH1N1, the fact that pH1N1 began in the summer rather than winter, and changes in health-seeking behavior each may have played a part. Both GFT models performed well prior to and during pH1N1, although the updated model performed better during pH1N1, especially during the summer months.

PLoS One
[Accessed 27 August 2011]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Predictive Mapping of Human Risk for West Nile Virus (WNV) Based on Environmental and Socioeconomic Factors
Ilia Rochlin, David Turbow, Frank Gomez, Dominick V. Ninivaggi, Scott R. Campbell vaccine, vector surveillance and control are the most PLoS ONE: Research Article, published 10 Aug 2011 10.1371/journal.pone.0023280

Abstract 
A West Nile virus (WNV) human risk map was developed for Suffolk County, New York utilizing a case-control approach to explore the association between the risk of vector-borne WNV and habitat, landscape, virus activity, and socioeconomic variables derived from publically available datasets. Results of logistic regression modeling for the time period between 2000 and 2004 revealed that higher proportion of population with college education, increased habitat fragmentation, and proximity to WNV positive mosquito pools were strongly associated with WNV human risk. Similar to previous investigations from north-central US, this study identified middle class suburban neighborhoods as the areas with the highest WNV human risk. These results contrast with similar studies from the southern and western US, where the highest WNV risk was associated with low income areas. This discrepancy may be due to regional differences in vector ecology, urban environment, or human behavior. Geographic Information Systems (GIS) analytical tools were used to integrate the risk factors in the 2000–2004 logistic regression model generating WNV human risk map. In 2005–2010, 41 out of 46 (89%) of WNV human cases occurred either inside of (30 cases) or in close proximity (11 cases) to the WNV high risk areas predicted by the 2000–2004 model. The novel approach employed by this study may be implemented by other municipal, local, or state public health agencies to improve geographic risk estimates for vector-borne diseases based on a small number of acute human cases.

PLoS Medicine
(Accessed 27 August 2011)
http://www.plosmedicine.org/article/browse.action?field=date

Building the Field of Health Policy and Systems Research: Social Science Matters

Lucy Gilson, Kara Hanson, Kabir Sheikh, Irene Akua Agyepong, Freddie Ssengooba, Sara Bennett Policy Forum, published 23 Aug 2011
doi:10.1371/journal.pmed.1001079

Summary Points
All researchers hold a knowledge paradigm that frames their understanding of reality and of the functions and nature of research. Some disciplines are dominated by a particular paradigm and some are spread across paradigms.

The criticisms that Health Policy and Systems Research (HPSR) is too context specific, does not offer clear lessons for policy makers, and is not rigorous are partly a reflection of differences in knowledge paradigms between those with predominantly clinical, biomedical, and epidemiological backgrounds, underpinned by a positivist paradigm, and those with social science backgrounds underpinned by a relativist paradigm.

Health policies and systems are complex social and political phenomena, constructed by human action rather than naturally occurring. Relativist social science perspectives are, therefore, of particular relevance to HPSR as they recognise that all phenomena are in essence constructed through human behaviour and interpretation.

Social science insights that can advance the science of HPSR include approaches to generalising from rich understanding of context; supporting policy learning; and enhancing research rigour and quality.

PLoS Medicine Series on HPSR
Following the First Global Symposium on Health Systems Research in Montreux in November 2010, PLoS Medicine commissioned three articles on the state-of-the-art in Health Policy and Systems Research (HPSR). Three Policy Forum articles, authored by a diverse group of global health academics, critically examine the current challenges to the field and lay out what is needed to build capacity in HPSR and support local policy development and health systems strengthening, especially in low- and middle-income countries.

– Paper 1. Kabir Sheikh and colleagues. Building the Field of Health Policy and Systems Research: Framing the Questions.

– Paper 2. Lucy Gilson and colleagues. Building the Field of Health Policy and Systems Research: Social Science Matters.

– Paper 3. Sara Bennett and colleagues. Building the Field of Health Policy and Systems Research: An Agenda for Action.

 Editor’s Note: Vaccines: The Week in Review will resume publication on 29 August 2011 following a vacation break. 

The pdf version of Vaccines: The Week in Review  8 August 2011 comprising the posts below for this date is available here: Vaccines_The Week in Review_8 Aug 2011

   Merck and Serum Institute of India announced an agreement “to work together to develop and commercialize a pneumococcal conjugate vaccine (PCV) for use in the emerging and developing world countries.” Merck and Serum said they will form a Product Advisory Committee to oversee the activities required to develop and seek approval for PCV and pursue World Health Organization (WHO) prequalification. Under the terms of the agreement, Merck, through an affiliate, will receive specific rights to market PCV in certain designated territories and Serum will receive specific rights in other territories. Both companies will contribute to the development and manufacture of PCV. Merck and Serum noted that the specific financial details of this agreement are confidential, and that the collaboration “does not impact the on-going vaccine development programs in both the organizations.”

Cyrus Poonawalla, CMD, Chairman, Serum Institute, commented, “Serum Institute is committed to improving access to and affordability of vaccines for children throughout the world. In working closely with Merck in the development of this collaboration it became clear that we share parallel public health goals and that our passion for getting vaccines to everyone who needs them is made even stronger by working together.” Julie L. Gerberding, president, Merck Vaccines, said, “Working side by side with Serum gives us the best chance of developing and bringing a product to the market that will help to protect more babies and children. Expanding vaccine access to emerging and developing markets is a top priority and we feel strongly that this collaboration will be a giant step toward impacting the devastation of pneumococcal disease.”

http://www.businesswire.com/news/home/20110803005528/en/Merck-Serum-Institute-Announce-Collaboration-Develop-Expand

The International Vaccine Institute (IVI) and Inviragen, Inc. announced the signing of a memorandum of understanding “with the ultimate objective of making a dengue vaccine widely accessible to people in countries where this disease is endemic.” The IVI, through the Dengue Vaccine Initiative (DVI), “is developing strategies to raise awareness of the need to invest in research and development of a dengue vaccine, and to finance the development and distribution of vaccines, goals which will be furthered through this collaboration with Inviragen.” As part of the collaboration, IVI and Inviragen “also aim to strengthen the regulatory and policy environments to accelerate dengue vaccine development and introduction, and to raise funding to assist low- and middle-income countries with procuring available vaccine candidates.”  The announcement noted that “no specific treatment or reliable prevention method exists for the infection whose reach, already endemic in more than 120 countries, continues to grow. A safe, effective and affordable dengue vaccine would represent a powerful tool against this major public health threat, which is the world’s most important vector borne viral disease.”  Earlier this year, IVI announced the launch of the DVI, in collaboration with the Sabin Vaccine Institute, the Johns Hopkins University, and the World Health Organization. The DVI “aims to increase the global priority given to dengue vaccines through evidence-based research to inform policy.” http://www.businesswire.com/news/home/20110802007473/en/CORRECTING-REPLACING-International-Vaccine-Institute-Inviragen-Announce

   The Measles Initiative announced that it “has helped vaccinate one billion children in more than 60 developing countries since 2001, making significant gains in the global effort to stop measles,” noting that the child who received the history-making measles vaccination was one of 3.5 million immunized in Mozambique this May. The immunization campaign was sponsored by the Measles Initiative’s five founding partners – the American Red Cross, United Nations Foundation, U.S. Centers for Disease Control and Prevention (CDC), UNICEF, and World Health Organization (WHO).

The announcement noted that since 2009, widespread outbreaks affecting 30 countries in sub-Saharan Africa, including the Democratic Republic of the Congo and Ethiopia, have resulted in more than 320,000 new measles cases and more than 2,400 measles-related deaths. In the past year, several European nations have faced their worst measles outbreaks in more than 10 years, with more than 30 000 estimated cases across the region. The U.S. is also experiencing its largest measles outbreak since 1996, with more than 150 reported cases, the announcement said. “The steady march toward a measles-free world is now facing a setback,” said Dr Brent Burkholder, director of the CDC’s global immunization division. “Outbreaks in Africa, a high number of deaths in India and global funding gaps threaten the gains made in the last ten years and will hinder efforts to eradicate measles and achieve MDG4.” http://www.who.int/immunization/newsroom/press/measles_initiative_vaccinates_billion_4august2011/en/index.html

The Weekly Epidemiological Record (WER) for 5 August 2011, vol. 86, 32 (pp 341–352) includes Meeting of the International Task Force for Disease Eradication, April 2011 http://www.who.int/entity/wer/2011/wer8632.pdf

Twitter Watch
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.

pahowho PAHO/WHO
Costa Rica Hosts Regional Consultation on Social Determinants of Health bit.ly/rqCTgW

gatesfoundation Gates Foundation
RT @gatespolio “Our greatest responsibility is to be good ancestors.” Jonas Salk, #polio vaccine developer

EndPolioNow EndPolioNow
Famine in #HornofAfrica makes children more susceptible polio. RI polio partner, #UNICEF, increases immunizations. http://cot.ag/p3KXkF

GAVIAlliance GAVI Alliance
Milestone: The #Measles Initiative has helped vaccinate 1 billion children in 60+ countries since ’01! http://ht.ly/5V9aF h/t @UNFoundation

gatesfoundation Gates Foundation
Progress & Partnerships | Our 2010 Annual Report: http://gates.ly/pwFBGx

GAVISeth Seth Berkley
Excited to be heading to Geneva tonight to start as CEO of GAVI. Such an exciting time in vaccines with so much to do!

Medic Medic Mobile
by MalariaVaccine
Breakthrough: New #malaria vaccine found to be safe, well tolerated in Tanzanian children http://bit.ly/q6tCMt #globalhealth #hcsm

British Medical Journal
6 August 2011 Volume 343, Issue 7818
http://www.bmj.com/content/current

Editor’s Choice
Don’t forget tuberculosis
Fiona Godlee, editor, BMJ

Extract
Not so long ago tuberculosis was seen as an “old” disease, one that had been conquered in large parts of the world and might even be eliminated. No longer. HIV/AIDS, poverty, travel, and migration have seen tuberculosis re-emerge as a global pandemic. It now affects a third of the world’s population, and although there is optimism about reaching the millennium development goal target—that global incidence should be falling by 2015, no country or region has elimination realistically in its sights.

Analysis
Tuberculosis in the UK—time to regain control
Ibrahim Abubakar, Marc Lipman, Charlotte Anderson, Peter Davies, Alimuddin Zumla
BMJ 2011;343:doi:10.1136/bmj.d4281 (Published 31 July 2011)

Health Affairs
August 2011; Volume 30, Issue 8
New Perspectives On Substance Abuse
http://content.healthaffairs.org/content/current

Global Health Financing
Economic Perspectives On The Advance Market Commitment For Pneumococcal Vaccines
Christopher M. Snyder, Wills Begor, and Ernst R. Berndt
Health Aff August 2011 30:1508-1517; doi:10.1377/hlthaff.2011.0403

Abstract
Pharmaceutical companies have long been reluctant to invest in producing new vaccines for the developing world because they have little prospect of earning an attractive return. One way to stimulate such investment is the use of an advance market commitment, an innovative financing program that guarantees manufacturers a long-term market. Under this arrangement, international donors pay a premium for initial doses sold to developing countries. In exchange, companies agree to continue supplying the vaccine over the longer term at more sustainable prices. This article provides a preliminary economic analysis of a pilot advance market commitment program for pneumococcal vaccines, explaining the principles behind the program’s design and assessing its early performance. Spurred by the advance market commitment—and other contemporaneous initiatives that also increased resources to vaccine suppliers—new, second-generation pneumococcal vaccines have experienced a much more rapid rollout in developing countries than older first-generation vaccines.

Health Affairs
August 2011; Volume 30, Issue 8
New Perspectives On Substance Abuse
http://content.healthaffairs.org/content/current

Global Pharmaceutical Pricing
Setting Cost-Effectiveness Thresholds As A Means To Achieve Appropriate Drug Prices In Rich And Poor Countries
Patricia M. Danzon, Adrian Towse, and Andrew W. Mulcahy
Health Aff August 2011 30:1529-1538; doi:10.1377/hlthaff.2010.0902

Abstract
Finding better mechanisms to enable differential pricing that reflects different degrees of willingness to pay across countries with different income levels is an important challenge for drug manufacturers and policy makers. Drug prices must be high enough to meet manufacturers’ needs—covering costs and ensuring adequate investment in research and development, as well as producing a profit—but low enough to allow consumers access to medicines that they need. Examining drug pricing, we found that in rich countries, insurance coverage can make consumers insensitive to price, which means that manufacturers’ prices are largely unrestrained unless payers intervene. In middle- and low-income countries, where most consumers pay for drugs out of pocket, we found that the poorest countries face the highest prices, relative to their mean per capita income. We recommend that countries and payers set their own cost-effectiveness thresholds to reflect how much they are willing to pay for “health gain”—in other words, for a measured improvement in the health of a person or a population. Adopting this approach broadly should lead to appropriate price differences across and within countries, benefiting consumers and manufacturers alike.

Human Vaccines
Volume 7, Issue 8    August 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/7/

Reviews
Meningococcal disease: The advances and challenges of meningococcal disease prevention
Ram Yogev and Tina Tan

Abstract
Vaccination as a means to prevent meningococcal disease caused by Neisseria meningitidis is critical given the abrupt onset and rapid progression of this disease. Five serogroups-A, B, C, W-135, and Y-are responsible for the majority of cases. In developed countries, infants have the greatest risk of disease, with a smaller secondary peak observed in late adolescence. Vaccines utilizing the polysaccharide capsule are poorly immunogenic in young children but can reduce the incidence of meningococcal carriage in high risk groups. In contrast, protein conjugate vaccines to polysaccharide capsules A, C, W-135, and Y have broadened the population protection from disease but their effect on meningococcal carriage and transmission is yet unknown except for monovalent meningococcal C conjugate that has been shown to reduce carriage. Challenges remain in providing direct protection to infants and protection against meningococcal B disease. To date, outer membrane vesicle vaccines have been used to control meningococcal B disease in epidemic settings and vaccine candidates against subcapsular antigens are in development, but a vaccine that confers long-lasting protection is unavailable.

Human Vaccines
Volume 7, Issue 8    August 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/7/

Reviews
Factors associated with increased vaccination in 2009 H1N1 school-located influenza vaccination programs
Open Access Article
Christopher S. Ambrose and Frangiscos Sifakis

Abstract
In the United States, school-located influenza vaccination (SLIV) programs have increased significantly in recent years. In June 2010, the Office of Inspector General issued a report regarding 38 elementary school H1N1 SLIV programs conducted in 6 localities in November/December 2009. By locality, there was a mean of 14 to 46 first doses of vaccine administered per 100 students. The locality that conducted programs in early November had a higher uptake rate than localities with later programs (46 vs 21 per 100 students; P<.01). Among localities with programs in mid- to late-November, the locality with programs after school hours had a lower uptake rate than the two localities with programs during school hours (16 vs 28, P=.05, and 16 vs 30, P<.01, respectively). These data suggest that future SLIV programs may achieve higher uptake rates if conducted during school hours with advance parental consent and when parental demand is highest.

Human Vaccines
Volume 7, Issue 8    August 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/7/

Commentary
Should Chickenpox vaccine be included in the National immunization schedule in India?
Ramesh Verma, Mohan Bairwa, Suraj Chawla, Shankar Prinja and Meena Rajput

Abstract
Varicella (chickenpox) is an acute, highly contagious viral disease with worldwide distribution. The highest prevalence occurs in the 4 – 10 year age group but tends to be more severe in adults. It may be fatal in neonates, immunocompromised persons, and normal adults, especially smokers. Varicella is usually a benign childhood disease, and rarely rated as an important public health problem, but this can be severe and even fatal in otherwise healthy children (<1 out of every 10,000 cases). Chickenpox can cause pneumonia (23 out of every 10,000 cases), and is an important risk factor for developing severe invasive “strep” (group A streptococcal disease). Complications of varicella include bacterial infections (up to 5% of cases), decreased platelets, arthritis, hepatitis, pneumonia (more commonly in adults) or encephalitis (1 in 10,000 cases), which may cause a failure of muscular coordination, sometimes resulting in persistent sequelae or death. Varicella is the leading cause of vaccine-preventable death in children. Universal vaccination can cause a dramatic reduction in the incidence of varicella, associated complications, hospitalizations and fatality rates. In India, due to the high cost of the vaccine, it would be difficult to vaccinate a large percentage of the children. The government of India should consider the inclusion of varicella vaccine in the National Immunization Schedule with the help of International agencies.

Human Vaccines
Volume 7, Issue 8    August 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/7/

Commentary
New generation typhoid vaccines: An effective preventive strategy to control typhoid fever in developing countries
Ramesh Verma, Mohan Bairwa, Suraj Chawla, Shankar Prinja and Meena Rajput

Abstract
Typhoid fever is a serious systemic infection, caused by the enteric pathogen Salmonella enterica serovar Typhi, a highly virulent and invasive enteric bacterium. This disease occurs in all parts of world where water supplies and sanitation are substandard. These pathogens then travel to food, drinks and water through house-flies and other vectors. Globally, an estimated 12 – 33 million cases of enteric fever occur with 216,000 – 600,000 deaths per year, almost exclusively in the developing countries. Health surveys conducted by the Health Ministry of India in the community development areas indicated a morbidity rate varying from 102-2219/100,000 population in different parts of the country. A limited study in an urban slum showed 1% of children up to 17 years of age suffer from typhoid fever annually. The continued high burden of typhoid fever and the alarming spread of antibiotic resistant strains led the World Health Organization (WHO), almost ten years ago, to recommend immunization using the two new-generation vaccines in school- aged children in areas where typhoid fever posed a significant problem and where antibiotic resistant strains were prevalent. Morbidity and mortality due to high incidence of typhoid fever favors the introduction of typhoid vaccine in routine immunization in India. This vaccine should be given at the age of 2 years with Vi antigen vaccine and at least one more dose be given at 5 years of age.

International Journal of Infectious Diseases
Volume 15, Issue 8 pp. e509-e582 (August 2011)
http://www.sciencedirect.com/science/journal/12019712

Perspectives
Super-spreaders in infectious diseases
Pages e510-e513
Richard A. Stein

Summary
Early studies that explored host–pathogen interactions assumed that infected individuals within a population have equal chances of transmitting the infection to others. Subsequently, in what became known as the 20/80 rule, a small percentage of individuals within any population was observed to control most transmission events. This empirical rule was shown to govern inter-individual transmission dynamics for many pathogens in several species, and individuals who infect disproportionately more secondary contacts, as compared to most others, became known as super-spreaders. Studies conducted in the wake of the severe acute respiratory syndrome (SARS) pandemic revealed that, in the absence of super-spreading events, most individuals infect few, if any, secondary contacts. The analysis of SARS transmission, and reports from other outbreaks, unveil a complex scenario in which super-spreading events are shaped by multiple factors, including co-infection with another pathogen, immune suppression, changes in airflow dynamics, delayed hospital admission, misdiagnosis, and inter-hospital transfers. Predicting and identifying super-spreaders open significant medical and public health challenges, and represent important facets of infectious disease management and pandemic preparedness plans.

The Lancet  
Aug 06, 2011  Volume 378  Number 9790  p457 – 540
http://www.thelancet.com/journals/lancet/issue/current

Comment
What is the future of epidemiology?
Raj Bhopal, Gary J Macfarlane, William Cairns Smith, Robert West, on behalf of the Management Executive Committee for the XIX World Congress of Epidemiology

Preview
Epidemiology is thriving. The striking features of contemporary epidemiology are diversity, change, and global reach: from society to the molecule, responding to technical advances and changing patterns of disease. The two main challenges are: translating epidemiology into evidence, practice, and ultimately better health; and strengthening epidemiology research capacity, particularly in low-income and middle-income countries.

The Lancet  
Aug 06, 2011  Volume 378  Number 9790  p457 – 540
http://www.thelancet.com/journals/lancet/issue/current

Comment

Is immunisation child protection?
Adam Finn, Julian Savulesc

Preview
The Lancet’s Series entitled new decade of vaccines shows the great opportunities for, and many challenges that face, successful development and implementation of vaccines in the coming decades. The Series emphasises recent advances in biomedical sciences, particularly molecular microbiology, immunology, and genetics. But the biggest hurdle to realisation of this potential could instead relate to failure of parental acceptance of safe and effective vaccination.

The Lancet  
Aug 06, 2011  Volume 378  Number 9790  p457 – 540
http://www.thelancet.com/journals/lancet/issue/current

Review
Mathematical models in the evaluation of health programmes
Geoffrey P Garnett, Simon Cousens, Timothy B Hallett, Richard Steketee, Neff Walker

Preview
Modelling is valuable in the planning and evaluation of interventions, especially when a controlled trial is ethically or logistically impossible. Models are often used to calculate the expected course of events in the absence of more formal assessments. They are also used to derive estimates of rare or future events from recorded intermediate points. When developing models, decisions are needed about the appropriate level of complexity to be represented and about model structure and assumptions.

Nature Medicine
August 2011, Volume 17 No 8
http://www.nature.com/nm/index.html

Editorial
Difficult decisions
doi:10.1038/nm0811-901

Conditional approval aims to speed the delivery of drugs to patients in need. But when full approval is denied, complications arise for patients, companies and regulatory agencies alike.

New England Journal of Medicine
August 4, 2011  Vol. 365 No. 5
http://content.nejm.org/current.shtml

Perspectives
Developing the Nation’s Biosimilars Program
S. Kozlowski, J. Woodcock, K. Midthun, and R. Behrman Sherman
Free full text

Extract
Biologic products developed over the past three decades and approved by the Food and Drug Administration (FDA) now provide important therapeutic options for a variety of serious clinical conditions (see graph Numbers of FDA-Approved Biologic Products of Various Types Available for Treating or Preventing Various Conditions.). Therapeutic biologics such as genetically engineered recombinant proteins and monoclonal antibodies represent a large portion of newly approved therapies for conditions such as chronic inflammatory diseases and cancer. Biologic enzyme-replacement therapies provide clinical benefits in previously untreatable genetic disorders. Although typically more structurally complex than the small-molecule drugs more prevalent in today’s market, biologics vary in complexity from cellular therapies to small, highly purified proteins. Unfortunately, access to such products may be limited, not infrequently because of their cost….

Pediatrics
August 2011, VOLUME 128 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml

Articles
Near Elimination of Varicella Deaths in the US After Implementation of the Vaccination Program
Mona Marin, John X. Zhang, and Jane F. Seward
Pediatrics 2011; 128:214-220

Abstract
OBJECTIVE: Varicella has been preventable by vaccination in the United States since 1995. Previous studies reported a 66% decline in mortality rate during the first 6 years of the program. Since then, vaccination coverage has increased substantially. We updated the analysis of US varicella mortality for 2002–2007 and assessed the impact of the first 12 years of the US varicella vaccination program on varicella deaths.

METHODS: National data on deaths for which varicella was listed as an underlying or contributing cause were obtained from the Mortality Multiple Cause-of-Death records from the US National Center for Health Statistics. We calculated the age-adjusted and age-specific mortality rates for 2002–2007 and trends since the prevaccine years.

RESULTS: During the 12 years of the mostly 1-dose US varicella vaccination program, the annual average mortality rate for varicella listed as the underlying cause declined 88%, from 0.41 per million population in 1990–1994 to 0.05 per million population in 2005–2007. The decline occurred in all age groups, and there was an extremely high reduction among children and adolescents younger than 20 years (97%) and among subjects younger than 50 years overall (96%). In the last 6 years analyzed (2002–2007), a total of 3 deaths per age range were reported among children aged 1 to 4 and 5 to 9 years, compared with an annual average of 13 and 16 deaths, respectively, during the prevaccine years.

CONCLUSIONS: The impressive decline in varicella deaths can be directly attributed to successful implementation of the 1-dose vaccination program. With the current 2-dose program, there is potential that these most severe outcomes of a vaccine-preventable disease could be eliminated.

Pediatrics
August 2011, VOLUME 128 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml

Articles
Effectiveness of Pentavalent Rotavirus Vaccine Against Severe Disease
Mary Allen Staat, Daniel C. Payne, Stephanie Donauer, Geoffrey A. Weinberg, Kathryn M. Edwards, Peter G. Szilagyi, Marie R. Griffin, Caroline B. Hall, Aaron T. Curns, Jon R. Gentsch, Shelia Salisbury, Gerry Fairbrother, Umesh D. Parashar, and the New Vaccine Surveillance Network (NVSN)
Pediatrics 2011; 128:e267-e275

Abstract
OBJECTIVE: To determine the vaccine effectiveness (VE) of complete and partial vaccination with the pentavalent rotavirus vaccine (RV5) in the prevention of rotavirus acute gastroenteritis (AGE) hospitalizations and emergency department visits during the first 3 rotavirus seasons after vaccine introduction.

METHODS: Active, prospective population-based surveillance for AGE and acute respiratory infection (ARIs) in inpatient and emergency department settings provided subjects for a case-control evaluation of VE in 3 US counties from January 2006 through June 2009. Children with laboratory-confirmed rotavirus AGE (cases) were matched according to date of birth and onset of illness to 2 sets of controls: children with rotavirus-negative AGE and children with ARI. The main outcome measure was VE with complete (3 doses) or partial (1 or 2 doses) RV5 vaccination.

RESULTS: Of age-eligible children enrolled, 18% of cases, 54% of AGE controls, and 54% of ARI controls received ≥1 dose of RV5. The VE of RV5 for 1, 2, and 3 doses against all rotavirus genotypes with the use of rotavirus-negative AGE controls was 74% (95% confidence interval [CI]: 37%–90%), 88% (95% CI: 66%–96%), and 87% (95% CI: 71%–94%), respectively, and with the use of ARI controls was 73% (95% CI: 43%–88%), 88% (95% CI: 68%–95%), and 85% (95% CI: 72%–91%), respectively. The overall VE estimates were comparable during the first and second years of life and against AGE caused by different rotavirus strains.

CONCLUSION: RV5 was highly effective in preventing severe rotavirus disease, even after a partial series, with protection persisting throughout the second year of life.

Science Translational Medicine
3 August 2011 vol 3, issue 94
http://stm.sciencemag.org/content/current

Perspective
Hepatitis C Virus
Progress Toward Development of a Hepatitis C Vaccine with Broad Shoulders
Ranjit Ray

Abstract
Hepatitis C virus (HCV) infection in humans can cause progressive and end-stage liver disease. As such, preventive measures against HCV, including vaccine development, are a priority among researchers in the field. The report from Garrone et al. describes the development of a vaccine platform to generate HCV-neutralizing antibodies that are based on retrovirus-derived virus-like particles (VLPs) pseudotyped with heterologous viral envelope proteins. Immunization with these VLPs induced neutralizing antibodies in mouse and macaque models. These results, when considered in the context of an earlier clinical trial that used recombinant HCV E1/E2 purified protein as a subunit vaccine and additional findings from the VLP strategy, may lead to a new HCV vaccine that induces a neutralizing antibody response.

Tropical Medicine & International Health
September 2011  Volume 16, Issue 9  Pages 1043–1189
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue

Child Health
Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology (pages 1044–1053)
Claire Glenton, Inger B. Scheel, Simon Lewin and George H. Swingler
Article first published online: 28 JUN 2011 | DOI: 10.1111/j.1365-3156.2011.02813.x
Free full-text

Summary
Objectives Lay health workers (LHWs) are used in many settings to increase immunisation uptake among children. However, little is known about the effectiveness of these interventions. The objective of this review was to assess the effects of LHW interventions on childhood immunisation uptake.

Methods We searched Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, British Nursing Index and Archive, AMED, POPLINE and WHOLIS, reference lists of included papers and relevant reviews, and contacted the authors of relevant papers. We selected randomised and non-randomised controlled trials, controlled before–after studies, and interrupted time series of any intervention delivered by LHWs and designed to increase childhood immunisation uptake. Two authors independently extracted data using a standard form and assessed risk of bias and evidence quality.

Findings We identified twelve studies, ten of which were randomised controlled trials. Seven studies were conducted among economically disadvantaged populations in high-income countries. Five studies were from low- and middle-income countries. In ten studies, LHWs promoted childhood immunisation. In two studies, LHWs vaccinated children themselves. In most of the studies, the control group populations received no intervention or standard care. Most of the studies showed that LHWs increased immunisation coverage. However, study settings were diverse, allowing us to carry out only one meta-analysis including four studies.

Conclusion LHWs could make an important contribution to achieving the Millennium Development Goal for child health. However, more high-quality studies are needed, particularly from LMICs. More studies are also needed to assess the effects of using LHWs to vaccinate children themselves.

Tropical Medicine & International Health
September 2011  Volume 16, Issue 9  Pages 1043–1189
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue

Child Health
Impact of rotavirus vaccination on diarrhoea mortality and hospital admissions in Brazil (pages 1180–1184)
Ricardo Q. Gurgel, Chinenye Ilozue, Jailson B. Correia, Chiara Centenari, Sandala M. T. Oliveira and Luis E. Cuevas
Article first published online: 12 JUL 2011 | DOI: 10.1111/j.1365-3156.2011.02844.x

Summary
Objective To analyse the data reported by the national surveillance system of Brazil, including data on diarrhoea mortality and hospital admissions before and after rotavirus vaccine introduction, and evaluate the impact of its widespread use under operational conditions.

Method Retrospective analysis of routinely collected data was reported by several surveillance systems of Brazil, comprising an 8-year period of all diarrhoea-related hospitalisations and deaths in children <5 years old (2002–2009). Linear regressions were used to compare trends of diarrhoea hospitalisations and deaths before and after vaccine introduction (2002–2005 vs. 2006–2009).

Results There was a long-term reduction in hospitalisations that preceded the introduction of the vaccine. This reduction was more marked in <1-year-old than in 1– to 4-year-old children. All-cause diarrhoea hospitalisations decreased further after vaccine introduction and the decrease was larger in <1-year-old (−35.6%) than in 1– to 4-year-old children (−12.3%). The number of deaths was decreasing before vaccine introduction, and the decrease also accelerated after vaccine introduction, with deaths halving in <1-year-old and decreasing by 32.9% in 1- to 4-year-old children. The linear relationships between hospitalisations and deaths were statistically different before and after vaccine introduction.

Conclusions The data demonstrate a decreasing trend in all-cause diarrhoea-related hospitalisations and deaths in children <5 years of age. These reductions were steeper between 2006 and 2009, highlighting the potential beneficial effect of the rotavirus vaccine associated with all-cause diarrhoeal disease.

Tropical Medicine & International Health
September 2011  Volume 16, Issue 9  Pages 1043–1189
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue

Health policy
Political will for better health, a bottom-up process (pages 1185–1189)
Wim De Ceukelaire, Pol De Vos and Bart Criel
Article first published online: 24 JUN 2011 | DOI: 10.1111/j.1365-3156.2011.02817
Free full-text

Summary
Lately, different voices in the global public health community have drawn attention to the interaction between the State and civil society in the context of reducing health inequities. A rights-based approach empowers people not only to claim their rights but also to demand accountability from the State. Lessons from history show that economic growth does not automatically have positive implications for population health. It may even be disruptive in the absence of strong stewardship and regulation by national and local public health authorities. The field research in which we have been involved over the past 20 years in the Philippines, Palestine, Cuba, and Europe confirms that organized communities and people’s organizations can effectively pressure the state into action towards realizing the right to health. Class analysis, influencing power relations, and giving the State a central role have been identified as three key strategies of relevant social movements and NGOs. More interaction between academia and civil society organizations could contribute to enhance and safeguard the societal relevance of public health researches. Our own experience made us discover that social movements and public health researchers have a lot to learn from one another.

The pdf version of Vaccines: The Week in Revew  1 August 2011 comprising the posts below for this date is available here: Vaccines_The Week in Review_1 Aug 2011

UNICEF, the Kenya Ministry of Health and WHO launched a vaccination campaign for children living in the host communities around Dadaab refugee camp in Northern Kenya. The campaign will target 202,665 children under five, with measles and polio vaccines, together with Vitamin A and de-worming tablets. The action was described as part of a regional push to ensure all children in drought affected areas are vaccinated against a killer disease like measles which can be deadly for malnourished children, and be protected from polio.

http://www.unicef.org/media/media_59359.html

    WHO and public health organizations globally recognized the first official WHO World Hepatitis Day, 28 July 2011 “to increase the awareness and understanding of viral hepatitis and the diseases that it causes. It provides an opportunity to focus on specific actions such as: strengthening prevention, screening and control of viral hepatitis and its related diseases; increasing hepatitis B vaccine coverage and integration into national immunization programmes; and coordinating a global response to hepatitis.”

A range of published and video content is available at:

http://www.who.int/csr/disease/hepatitis/world_hepatitis_day/en/index.html

WHO Europe reported on efforts to improve cross-regional collaboration in protecting polio-free areas through a meeting held 21 to 22 July 2011 in Urumqi, Xinjiang, China, involving more than 40 international public health specialists, senior officials and experts engaged in the field of polio eradication. The two-day workshop was co-hosted by WHO and the Chinese Centre for Disease Control and Prevention, with experts from China, India, Myanmar, Vietnam, Pakistan, Nepal, Tajikistan, the Russian Federation, Kazakhstan, Kyrgyzstan, Mongolia and Uzbekistan, as well as WHO headquarters, the WHO European Region, South East Asia Region, Western Pacific Region and WHO partner agencies. Meeting participants summarized five major lessons learned in 2010:

– Importations occur all the time and will continue until polio eradication is achieved.

– The most vulnerable populations will be affected the most. Reported immunization coverage may not always represent true childhood population immunity. Even when accurate, subnational variation is what matters most, i.e. “the weakest link”.

– Rapid response is vital; delays mean any outbreak could be catastrophic in size and fatal. It requires sensitive surveillance at all critical subnational levels. Every step in acute flaccid paralysis (AFP) surveillance needs to be timely. Early notification of suspicion is best.

– Response to threat requires full political support. Cross-border coordination and cooperation is critical.

– Outbreaks are much less expensive to prevent than to control and interrupt. Risk assessment should be undertaken by countries and provinces and should lead to risk reduction. Funding prevention requires local mobilization.

http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/news/news/2011/07/securing-the-gains-cross-regional-collaboration-in-protecting-polio-free-areas

 The Bill & Melinda Gates Foundation and Fútbol Club (FC) Barcelona/FC Barcelona Foundation “kicked off a three-year partnership to energize the global fight to end polio and draw attention to the promise of life-saving vaccines.” The first year of the partnership will focus on polio eradication. The announcement noted that “FC Barcelona – with 18 million Facebook fans and multiple Twitter channels with millions of followers – will engage its followers through social media. In-stadium advertisements and announcements during matches will highlight the tremendous opportunity the world has to end polio and save millions of lives through childhood vaccination. Fans will be encouraged to join the team in the effort to eradicate only the second disease in history. The partnership will use the tagline “More than a Goal. End Polio,” a play on FC Barcelona’s tagline, ‘More than a Club.’”

http://www.gatesfoundation.org/press-releases/Pages/fc-barcelona-and-foundation-team-up-110728.aspx\

The Weekly Epidemiological Record (WER) for 29 July 2011, vol. 86, 31 (pp 325–340) includes: Cholera, 2010; Monthly report on dracunculiasis cases, January– May 2011

http://www.who.int/entity/wer/2011/wer8631.pdf

Twitter Watch
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.

GAVIAlliance GAVI Alliance
Our @UNICEF & @WHOnews partners on the ground are working hard to protect children in the #HornofAfrica from measles: http://ht.ly/5QIXk

CDCgov CDC.gov
Find out what’s planned for the Public Health Informatics conference. Please visit: go.usa.gov/KiZ

pahowho PAHO/WHO
PAHO, Seventh-day Adventists Partner to Strengthen Health Efforts in the Americas bit.ly/n8cFaa @adventistchurch #adventist #PAHOWHO

GAVIAlliance GAVI Alliance
Today is World #HepatitisDay. Since 2000, 267 million infants have been immunised against hepatitis B w/ #GAVI support! gavialliance.org/library/news/s…

TheLancet The Lancet
10 million injecting drug users worldwide have hepatitis C and 1.3 million have hepatitis B bit.ly/nmyF1b #hepatitisday

TheLancet The Lancet
Hepatitis affects half a billion people globally. World Health Assembly declares today World Hepatitis Day bit.ly/oJNA6x #hepatitisday

GAVIAlliance GAVI Alliance

The @UNICEF site shows supplies of life-saving #vaccines for @GAVIAlliance countries: http://bit.ly/pCeyDE /via @orinlevine

NPRHealth NPR Health News
by GlobalHealth
Vaccine Mistrust Spreading To The Developing World http://n.pr/pGeg3A

Emerging Infectious Diseases
Volume 17, Number 8–August 2011
http://www.cdc.gov/ncidod/EID/index.htm

Research
Spread of Measles Virus D4-Hamburg, Europe, 2008–2011
A. Mankertz et al.

Abstract
A new strain of measles virus, D4-Hamburg, was imported from London to Hamburg in December 2008 and subsequently spread to Bulgaria, where an outbreak of >24,300 cases was observed. We analyzed spread of the virus to demonstrate the importance of addressing hard-to-reach communities within the World Health Organization European Region regarding access to medical care and vaccination campaigns. The D4-Hamburg strain appeared during 2009–2011 in Poland, Ireland, Northern Ireland, Austria, Greece, Romania, Turkey, Macedonia, Serbia, Switzerland, and Belgium and was repeatedly reimported to Germany. The strain was present in Europe for >27 months and led to >25,000 cases in 12 countries. Spread of the virus was prevalently but not exclusively associated with travel by persons in the Roma ethnic group; because this travel extends beyond the borders of any European country, measures to prevent the spread of measles should be implemented by the region as a whole.

Emerging Infectious Diseases
Volume 17, Number 8–August 2011
http://www.cdc.gov/ncidod/EID/index.htm

Research
Cost-effectiveness of Sick Leave Policies for Health Care Workers with Influenza-like Illness, Brazil, 2009
N.V.V.P. Mota et al.

Abstract
We describe the effect of influenza-like illness (ILI) during the outbreak of pandemic (H1N1) 2009 on health care worker (HCW) absenteeism and compare the effectiveness and cost of 2 sick leave policies for HCWs with suspected influenza. We assessed initial 2-day sick leaves plus reassessment until the HCW was asymptomatic (2-day + reassessment policy), and initial 7-day sick leaves (7-day policy). Sick leaves peaked in August 2009: 3% of the workforce received leave for ILI. Costs during May–October reached R$798,051.87 (≈US $443,362). The 7-day policy led to a higher monthly rate of sick leave days per 100 HCWs than did the 2-day + reassessment policy (8.72 vs. 3.47 days/100 HCWs; p<0.0001) and resulted in higher costs (US $609 vs. US $1,128 per HCW on leave). ILI affected HCW absenteeism. The 7-day policy was more costly and not more effective in preventing transmission to patients than the 2-day + reassessment policy.

Journal of Infectious Diseases
Volume 204 Issue 4 August 15, 2011
http://www.journals.uchicago.edu/toc/jid/current

PERSPECTIVE
David M. Morens, Edward C. Holmes, A. Sally Davis, and Jeffery K. Taubenberger
Global Rinderpest Eradication: Lessons Learned and Why Humans Should Celebrate Too
J Infect Dis. (2011) 204(4): 502-505 doi:10.1093/infdis/jir327

Extract
After more than a decade of effort by the Global Rinderpest Eradication Programme (GREP) of the UN Food and Agricultural Organization (FAO), the Organisation mondiale de la santé (Office international des épizooties [OIE]), and the International Atomic Energy Agency (IAEA), among others [ 3– 5], the veterinary disease rinderpest ( Figure 1 ) was declared eradicated on 25 May 2011 [ 6]. Since rinderpest virus does not cause human disease, why is this achievement important to humans?

Since at least the Roman era, rinderpest (German for “cattle plague”) has been indirectly responsible for countless human deaths resulting from agricultural losses that led to famine and disease. The Ethiopian poem cited above refers to an African rinderpest panzootic that caused rapid loss of virtually all of the cattle, buffaloes, elands, and wild swine, as well as many sheep, goats, and wildlife species, such as antelopes, gazelles, giraffes, hartebeest, and wildebeest (the “Great Ethiopian Famine” of 1887–1892 [ 2, 7– 11]). Rinderpest virus (RPV) not only infects cattle but also infects >40 other domestic and wild artiodactyl species. It has been credited with decimation of native African wildlife species and even the decline of the European bison.

The Ethiopian tragedy exemplifies the importance of animal disease to humans. Without cattle to plow fields and fertilize crops with dung, the once-fertile Ethiopian lands became a graveyard. Planting and harvesting ceased; vast destruction of the native fauna …

Journal of Infectious Diseases
Volume 204 Issue 4 August 15, 2011
http://www.journals.uchicago.edu/toc/jid/current

Eileen F. Dunne, Maya Sternberg, Lauri E. Markowitz, Geraldine McQuillan, David Swan, Sonya Patel, and Elizabeth R. Unger
Human Papillomavirus (HPV) 6, 11, 16, and 18 Prevalence Among Females in the United States—National Health and Nutrition Examination Survey, 2003–2006: Opportunity to Measure HPV Vaccine Impact?
J Infect Dis. (2011) 204(4): 562-565 doi:10.1093/infdis/jir342

Abstract
The 2003–2006 National Health and Nutrition Examination Surveys were used to assess human papillomavirus (HPV) types 6, 11, 16, and 18 DNA detection from females aged 14–59 years who self-collected cervicovaginal swab specimens. Prevalence was 8.8% (95% confidence interval [CI], 7.8%–10.0%) and was highest among women aged 20–24 years (18.5%; 95% CI, 14.9%–22.8%). Age group, education, marital status, and sexual behavior were associated with detection. These data provide baseline information before HPV vaccine introduction. Early impact of vaccine in the United States may be determined by a reduction in the prevalence of HPV 6, 11, 16, and 18 infection among young women.

Susan Hariri, Elizabeth R. Unger, Maya Sternberg, Eileen F. Dunne, David Swan, Sonya Patel, and Lauri E. Markowitz
Prevalence of Genital Human Papillomavirus Among Females in the United States, the National Health and Nutrition Examination Survey, 2003–2006
J Infect Dis. (2011) 204(4): 566-573 doi:10.1093/infdis/jir341

Abstract
Background. Genital human papillomaviruses (HPV) include  >40 sexually transmitted viruses. Most HPV infections do not progress to disease, but infection with certain types of HPV can cause cervical and other anogenital and oropharyngeal cancer, and other types of HPV are associated with anogenital warts. HPV vaccines prevent infection with HPV 16 and 18, which account for 70% of cases of cervical cancer, and HPV 6 and 11, which cause 90% of the cases of anogenital warts.

Methods. Using  data and self-collected cervicovaginal specimens from 4150 females, 14–59 years of age, from consecutive National Health and Nutrition Examination Surveys (2003–2006), we estimated the prevalence of type-specific HPV DNA and examined sociodemographic and sexual determinants.

Results. The  overall prevalence of HPV was 42.5% in females 14–59 years of age and varied significantly by age, race or ethnicity, and number of sex partners. Individual type prevalence was less than 7%, ranging from <0.5% through 6.5%. The most common type was nononcogenic HPV 62 (found in 6.5% of subjects), followed by HPV 53 and HPV 16 (4.7%), both of which are oncogenic types. The most prevalent species was nononcogenic α3.

Conclusions. HPV infection is common among US females, with the highest burden of  infection found in young females 20–24 years of age. Monitoring trends in HPV type distribution will contribute to our understanding of the early impact of HPV vaccines.

The Lancet Infectious Disease
Aug 2011  Volume 11  Number 8  p579 – 650
http://www.thelancet.com/journals/laninf/issue/current

Review

The revised global yellow fever risk map and recommendations for vaccination, 2010: consensus of the Informal WHO Working Group on Geographic Risk for Yellow Fever

Emily S Jentes, Gilles Poumerol, Mark D Gershman, David R Hill, Johan Lemarchand, Rosamund F Lewis, J Erin Staples, Oyewale Tomori, Annelies Wilder-Smith, Thomas P Monath, for the Informal WHO Working Group on Geographic Risk for Yellow Fever

Preview

The changing epidemiology of yellow fever and continued reports of rare but serious adverse events associated with yellow fever vaccine have drawn attention to the need to revisit criteria for the designation of areas with risk for yellow fever virus activity, and to revise the vaccine recommendations for international travel. WHO convened a working group of international experts to review factors important for the transmission of yellow fever virus and country-specific yellow fever information, to establish criteria for additions to or removal from the list of countries with risk for yellow fever virus transmission, to update yellow fever risk maps, and to revise the recommendations for vaccination for international travel.
Emily S Jentes, Gilles Poumerol, Mark D Gershman, David R Hill, Johan Lemarchand, Rosamund F Lewis, J Erin Staples, Oyewale Tomori, Annelies Wilder-Smith, Thomas P Monath, for the Informal WHO Working Group on Geographic Risk for Yellow Fever

Preview
The changing epidemiology of yellow fever and continued reports of rare but serious adverse events associated with yellow fever vaccine have drawn attention to the need to revisit criteria for the designation of areas with risk for yellow fever virus activity, and to revise the vaccine recommendations for international travel. WHO convened a working group of international experts to review factors important for the transmission of yellow fever virus and country-specific yellow fever information, to establish criteria for additions to or removal from the list of countries with risk for yellow fever virus transmission, to update yellow fever risk maps, and to revise the recommendations for vaccination for international travel.

The Lancet Infectious Disease
Aug 2011  Volume 11  Number 8  p579 – 650
http://www.thelancet.com/journals/laninf/issue/current

Fact and fiction in tuberculosis vaccine research: 10 years later
Stefan HE Kaufmann

Preview
Tuberculosis is one of the most deadly infectious diseases. The situation is worsening because of co-infection with HIV and increased occurrence of drug resistance. Although the BCG vaccine has been in use for 90 years, protection is insufficient; new vaccine candidates are therefore needed. 12 potential vaccines have gone into clinical trials. Ten are aimed at prevention of tuberculosis and, of these, seven are subunit vaccines either as adjuvanted or viral-vectored antigens. These vaccines would be boosters of BCG-prime vaccination.

New England Journal of Medicine
July 28, 2011  Vol. 365 No. 4
http://content.nejm.org/current.shtml

Original Articles
Protective Effect of Natural Rotavirus Infection in an Indian Birth Cohort
B.P. Gladstone and Others

Background
More than 500,000 deaths are attributed to rotavirus gastroenteritis annually worldwide, with the highest mortality in India. Two successive, naturally occurring rotavirus infections have been shown to confer complete protection against moderate or severe gastroenteritis during subsequent infections in a birth cohort in Mexico. We studied the protective effect of rotavirus infection on subsequent infection and disease in a birth cohort in India (where the efficacy of oral vaccines in general has been lower than expected).

Methods
We recruited children at birth in urban slums in Vellore; they were followed for 3 years after birth, with home visits twice weekly. Stool samples were collected every 2 weeks, as well as on alternate days during diarrheal episodes, and were tested by means of enzyme-linked immunosorbent assay and polymerase-chain-reaction assay. Serum samples were obtained every 6 months and evaluated for seroconversion, defined as an increase in the IgG antibody level by a factor of 4 or in the IgA antibody level by a factor of 3.

Results
Of 452 recruited children, 373 completed 3 years of follow-up. Rotavirus infection generally occurred early in life, with 56% of children infected by 6 months of age. Levels of reinfection were high, with only approximately 30% of all infections identified being primary. Protection against moderate or severe disease increased with the order of infection but was only 79% after three infections. With G1P[8], the most common viral strain, there was no evidence of homotypic protection.

Conclusions
Early infection and frequent reinfection in a locale with high viral diversity resulted in lower protection than has been reported elsewhere, providing a possible explanation why rotavirus vaccines have had lower-than-expected efficacy in Asia and Africa. (Funded by the Wellcome Trust.)

Supported by the Wellcome Trust.