The Bill & Melinda Gates Foundation announced 65 grants of US$100,000 each “to pursue bold ideas for transforming health in developing countries“ as part of its Grand Challenges Explorations program, a five-year, $100 million initiative to promote innovation in global health. The current grantees “were selected from more than 2,400 proposals. A wide range of disciplines are represented, including applicants from traditional life sciences, public health, engineering, math and computer sciences. They are based at universities, research institutes, hospitals, nonprofit organizations, and private companies around the world.” Funded projects in the vaccine area include:

– Michael Chan of the Ohio State Research Foundation will develop a safe strain of the Tuberculosis bacterium and use it to ferment beans used in the traditional Asian dish natto, which could then be eaten as an oral TB vaccine;

– Ali Salanti of the University of Copenhagen in Denmark will develop and test a vaccine combining a novel placental malaria vaccine candidate with the cervical cancer vaccine, with the potential of inducing a strong protective response against both diseases;

– Steven Meshnick and Carla Hand of the University of North Carolina will develop a biodegradable “synthetic lymph node” that could be placed under the skin to deliver more effective vaccines.

http://www.gatesfoundation.org/press-releases/Pages/gce-round-five-winners-101109.aspx

The IFPMA (International Federation of Pharmaceutical Manufacturers & Associations) published its 2010 “Status Report on Pharmaceutical Industry R&D for Diseases of the Developing World.” The report “highlights the increasing efforts of IFPMA member companies, working with partners or alone, to develop medicines and vaccines for the 10 diseases of the developing world (DDW) prioritized by the TDR tropical disease research and training organization.”  The 10 diseases are, in order of decreasing mortality: tuberculosis, malaria, human African trypanosomiasis (sleeping sickness), leishmaniasis, dengue, onchocerciasis (River blindness), American trypanosomiasis (Chagas disease), schistosomiasis, leprosy and lymphatic filariasis.

IFPMA said the number of DDW medicine and vaccine projects undertaken by IFPMA companies “has increased from 84 in 2009 to a total of 102 this year. The number of tuberculosis projects grew from 25 to 31 and malaria projects from 34 to 41, while projects for the remaining eight tropical diseases increased from 25 to 30.”
Mr. Haruo Naito, President of the IFPMA and President & CEO of Eisai Co., Ltd., speaking at the IFPMA Assembly in Washington DC, said, “This latest Developing World Disease R&D Status Report shows that our industry is serious about helping to address human diseases, including those which otherwise risk being neglected because they affect poor countries. In October, the Director General of the World Health Organization called on companies to help improve access to medicines for neglected tropical diseases – and IFPMA companies responded with significant new or expanded donation programs. Today, we see that our companies are also equally committed to help develop new medicines and vaccines for these diseases. The latest report also shows that industry is not alone in its R&D efforts, for nearly four out of five DDW research projects are undertaken in cooperation with non-industry partners…”  http://www.ifpma.org/News/NewsReleaseDetail.aspx?nID=13810

The Weekly Epidemiological Record (WER) for 12 November 2010, vol. 85, 46 (pp 453–460) includes: Meeting of the WHO working group on polymerase chain reaction protocols for detecting subtype influenza A viruses – Geneva, June 2010; Fourth meeting of National Influenza Centres in the WHO Western Pacific Region – May 2010.

http://www.who.int/entity/wer/2010/wer8546.pdf

The Lancet
Nov 13, 2010  Volume 376  Number 9753  Pages 1617 – 1710
http://www.thelancet.com/journals/lancet/issue/current

Research priorities for malaria elimination
Kevin Marsh

Preview
The Lancet’s four-paper Series examines the need for, and prospects of, malaria elimination. The papers make sobering reading. Elimination will be hard work, it will take a long time, and it will be expensive. Moreover, elimination requires that we first control malaria to the point where it is no longer a public health problem, and this is by far the most important, immediate target for increased and sustained international investment.1 Nonetheless, elimination (and eventually eradication) is still important as a long-term goal, both for countries that are currently or will shortly be in a position to consider it, and worldwide.

The Lancet
Nov 13, 2010  Volume 376  Number 9753  Pages 1617 – 1710
http://www.thelancet.com/journals/lancet/issue/current

World Report
Defrauding of the Global Fund gives Sweden cold feet
Ann Danaiya Usher

Sweden has withheld its pledge to the Global Fund because of concerns about the misuse of US$25 million in grants in four African countries. Ann Danaiya Usher reports. At the third pledging round of the Global Fund to Fight AIDS, Tuberculosis and Malaria in New York, Sweden’s AIDS Ambassador Anders Nordström surprised the gathering by announcing that Sweden would not be making a pledge. The decision is a response to findings by the Global Fund’s Office of the Inspector General, which has identified cases of misappropriated grant money in Cameroon, Mauritania, Mali, and Zambia.

The Lancet
Nov 13, 2010  Volume 376  Number 9753  Pages 1617 – 1710
http://www.thelancet.com/journals/lancet/issue/current

Comment
Poliomyelitis eradication: another step forward
Nigel W Crawford, Jim P Buttery

Preview
In The Lancet today, Roland Sutter and colleagues1 provide randomised data for a new combination bivalent type 1 and 3 oral poliovirus vaccine (bOPV) in India. This vaccine will be important for the poliomyelitis endgame, which formally began in 1988 when the World Health Assembly outlined plans for worldwide poliomyelitis eradication by 2000.2 With four endemic poliomyelitis countries remaining (India, Pakistan, Afghanistan, and Nigeria) and with intermittent epidemics worldwide, this goal remains elusive.

The Lancet
Nov 13, 2010  Volume 376  Number 9753  Pages 1617 – 1710
http://www.thelancet.com/journals/lancet/issue/current

Articles
Immunogenicity of bivalent types 1 and 3 oral poliovirus vaccine: a randomised, double-blind, controlled trial
Roland W Sutter, T Jacob John, Hemant Jain, Sharad Agarkhedkar, Padmasani Venkat Ramanan, Harish Verma, Jagadish Deshpande, Ajit Pal Singh, Meghana Sreevatsava, Pradeep Malankar, Anthony Burton, Arani Chatterjee, Hamid Jafari, R Bruce Aylward

Summary
Background
Poliovirus types 1 and 3 co-circulate in poliomyelitis-endemic countries. We aimed to assess the immunogenicity of a novel bivalent types 1 and 3 oral poliovirus vaccine (bOPV).

Methods
We did a randomised, double-blind, controlled trial to assess the superiority of monovalent type 2 OPV (mOPV2), mOPV3, or bOPV over trivalent OPV (tOPV), and the non-inferiority of bivalent vaccine compared with mOPV1 and mOPV3. The study was done at three centres in India between Aug 6, 2008, and Dec 26, 2008. Random allocation was done by permuted blocks of ten. The primary outcome was seroconversion after one monovalent or bivalent vaccine dose compared with a dose of trivalent vaccine at birth. The secondary endpoints were seroconversion after two vaccine doses compared with after two trivalent vaccine doses and cumulative two-dose seroconversion. Parents or guardians and study investigators were masked to treatment allocation. Because of multiple comparisons, we defined p≤0·01 as statistically significant. This trial is registered with Current Controlled Trials, ISRCTN 64725429.

Results
900 newborn babies were randomly assigned to one of five vaccine groups (about 180 patients per group); of these 70 (8%) discontinued, leaving 830 (92%) for analysis. After the first dose, seroconversion to poliovirus type 1 was 20% for both mOPV1 (33 of 168) and bOPV (32 of 159) compared with 15% for tOPV (25 of 168; p>0·01), to poliovirus type 2 was 21% (35 of 170) for mOPV2 compared with 25% (42 of 168) for tOPV (p>0·01), and to poliovirus type 3 was 12% (20 of 165) for mOPV3 and 7% (11 of 159) for bOPV compared with 4% (7 of 168) for tOPV (mOPV3 vs tOPV p=0·01; bOPV vs tOPV; p>0·01). Cumulative two-dose seroconversion to poliovirus type 1 was 90% (151 of 168) for mOPV1 and 86% (136 of 159) for bOPV compared with 63% (106 of 168) for tOPV (p<0·0001), to poliovirus type 2 was 90% (153 of 170) for mOPV2 compared with 91% (153 of 168) for tOPV (p>0·01), and to poliovirus type 3 was 84% (138 of 165) for mOPV3 and 74% (117 of 159) for bOPV compared with 52% (87 of 168) for tOPV (p<0·0001). The vaccines were well tolerated. 19 serious adverse events occurred, including one death; however, these events were not attributed to the trial interventions.

Interpretation
The findings show the superiority of bOPV compared with tOPV, and the non-inferiority of bOPV compared with mOPV1 and mOPV3.

Funding: GAVI Alliance, World Health Organization, and Panacea Biotec.

Nature
Volume 468 Number 7321 pp133-340  11 November 2010
http://www.nature.com/nature/current_issue.html

News
Vaccine offers meningitis hope
First affordable and effective weapon against killer meningococcal meningitis A rolled out in Africa.
Declan Butler

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 49 pp. 7713-7824 (16 November 2010)

Regular Papers
Forecasting the economic value of an Enterovirus 71 (EV71) vaccine
Original Research Article
Pages 7731-7736
Bruce Y. Lee, Angela R. Wateska, Rachel R. Bailey, Julie H.Y. Tai, Kristina M. Bacon, Kenneth J. Smith

Abstract

Enterovirus 71 (EV71) is a growing public health concern, especially in Asia. A surge of EV71 cases in 2008 prompted authorities in China to go on national alert. While there is currently no treatment for EV71 infections, vaccines are under development. We developed a computer simulation model to determine the potential economic value of an EV71 vaccine for children (<5 years old) in China. Our results suggest that routine vaccination in China (EV71 infection incidence ≈0.04%) may be cost-effective when vaccine cost is $25 and efficacy ≥70% or cost is $10 and efficacy ≥50%. For populations with higher infection risk (≥0.4%), a $50 or $75 vaccine would be highly cost-effective even when vaccine efficacy is as low as 50%.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 49 pp. 7713-7824 (16 November 2010)

Regular Papers
Public vaccination programmes against hepatitis B in The Netherlands: Assessing whether a targeted or a universal approach is appropriate
Original Research Article
Pages 7723-7730
Hans Houweling, Christiaan F.W. Wittevrongel, Marcel Verweij, E. Joost Ruitenberg and on behalf of the National Immunisation Programme Review Committee of the Health Council of the Netherlands

Abstract
To date, the policy to control hepatitis B in the Netherlands is to vaccinate specific risk groups, rather than all children. Low incidence of the disease has fueled debate whether such a targeted vaccination strategy or rather a universal strategy, as recommended by the World Health Organization, is appropriate. The standard framework for assessing whether a particular vaccination should be included in a public programme, as recently proposed by the Health Council of the Netherlands (HCN), was applied to the various options for hepatitis B vaccination. This framework includes seven selection criteria, grouped under five thematic headings: seriousness and extent of the disease burden, effectiveness and safety of the vaccination, acceptability of the vaccination, efficiency of the vaccination, and priority of the vaccination. From about 1990 the disease burden has stayed more or less the same over time and careful assessment has made it clear that the targeted approach has failed to reach a significant part of the risk groups. Models suggest that the public health benefits obtained through targeted programmes could be augmented considerably by universal vaccination. Based on the assessment that universal vaccination means better protection for high-risk groups as well as the whole population, the HCN calls for universal immunisation, even though hepatitis B to a large extent is limited to specific high-risk groups. Should the Netherlands adopt universal vaccination, several immunisation programmes targeted to high-risk groups will, however, remain of crucial importance for years to come.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 49 pp. 7713-7824 (16 November 2010)

Peruvian FSWs: Understanding HPV and barriers to vaccination

Original Research Article
Pages 7743-7747
Brandon Brown, Cesar Carcamo, Magaly M. Blas, Maria Valderrama, Neal Halsey

Abstract
Vaccine acceptability and vaccine-related knowledge data were collected from female sex workers (FSWs) in Lima, Peru to determine their awareness of HPV and barriers to the potential acceptability of HPV vaccine. FSWs were found to have low knowledge of HPV, HPV vaccine, and cervical cancer. Due to high reported sexual exposure, FSWs are likely at increased risk of cervical cancer, and should have access to HPV vaccine. FSWs should be targeted for HPV education campaigns and barriers to vaccination should be addressed. Future studies should assess HPV prevalence in this population and examine retention issues for vaccine dose completion.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 48 pp. 7577-7712 (10 November 2010)

Editorial
World Pneumonia Day: Fighting pneumonia with safe and affordable vaccines
Pages 7577-7578
Ron Dagan, Gregory Poland

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 48 pp. 7577-7712 (10 November 2010)

Meeting Report
Report of the international forum on pandemic influenza 2010: Qingdao, China, 24–25 July 2010
Pages 7579-7582
Andre Varella

The 2009 H1N1 influenza pandemic is the first pandemic to hit the world in the 21st century. According to World Health Organization (WHO) reports, as of 18 July 2010, more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, and over 18,336 people have died as a result of the disease [1]. In an effort to facilitate the exchange of strategic and operational experience in the fight against the pandemic, the Chinese Center for Disease Control and Prevention (China CDC), supported by the China Ministry of Health, in collaboration with WHO, the World Bank, the U.S. CDC, and co-organised with the Elsevier Publishing Group, hosted the International Forum on Pandemic Influenza 2010 in July. The two-day meeting, attended by over 600 international delegates, saw human health and animal health professionals discuss the current situation of the pandemic, the global response and vaccination strategies, pandemic surveillance and preparedness, and the animal–human interface in influenza and other emerging infectious diseases. A summary of the discussions is presented here.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 48 pp. 7577-7712 (10 November 2010)

Review
Summary of invasive pneumococcal disease burden among children in the Asia-Pacific region

Review Article
Pages 7589-7605
Tzou-Yien Lin, Nitin K. Shah, Dennis Brooks, Carmen S. Garcia

Abstract
Invasive pneumococcal disease (IPD) burden is significant in the Asia-Pacific region. This review describes the epidemiology and Streptococcus pneumoniae (SP) serotype distribution of IPD in children in the Asia-Pacific region from studies published from 1999 to 2010. IPD incidence varies widely in Asia-Pacific countries depending on the method of surveillance, the population studied, and the time period. Incidences are highest for younger children, with rates near 100–200 cases per 100,000 children aged <1 or 2 years. Incidences of preventable disease are estimated to be 6–200 cases per 100,000. Heptavalent pneumococcal conjugate vaccine (PCV7) serotype coverage shows a very wide range over the Asia-Pacific region. Ten countries have high vaccine serotype coverage (>70%), and six countries have low vaccine serotype coverage (<50%). The majority of SP serotypes in children with IPD in most countries in the Asia-Pacific region are susceptible to penicillin (intermediate and resistant <50%); a few countries have SP serotypes with high level resistance to penicillin (intermediate and resistant >50%). Japan, Taiwan, and Thailand have high PCV7 serotype coverage. Countries with low pneumococcal resistance to antimicrobials have shown increasingly higher nonsusceptibility with time. National vaccination programmes that include PCV7, 10-valent pneumococcal conjugate vaccine (PCV), or 13-valent PCV would significantly affect IPD burden in children aged <5 years in the Asia-Pacific region, as well as the burden of penicillin-nonsusceptible IPD.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 48 pp. 7577-7712 (10 November 2010)

Regular Papers
Cost-effectiveness of dual influenza and pneumococcal vaccination in 50-year-olds

Original Research Article
Pages 7620-7625
Kenneth J. Smith, Bruce Y. Lee, Mary Patricia Nowalk, Mahlon Raymund, Richard K. Zimmerman

Abstract
Influenza vaccination is now recommended for all ages; CDC pneumococcal polysaccharide vaccination (PPV) recommendations are comorbidity-based in nonelderly patients. We constructed a Markov model to estimate the cost-effectiveness of dual influenza and pneumococcal vaccination in 50-year-olds. Patients were followed for 10 years, with differing time horizons examined in sensitivity analyses. With 100% vaccine uptake, dual vaccination cost $37,700/QALY gained compared to a CDC recommendation strategy; with observed vaccine uptake, dual vaccination cost $5,300/QALY. Results were sensitive to shorter time horizons, favoring CDC recommendations. We found dual vaccination of all 50-year-olds economically reasonable. Shorter duration models may not fully account for PPV effectiveness.

Vaccine
Volume 28, Issue 48 pp. 7577-7712 (10 November 2010)

Public health and economic impact of the 13-valent pneumococcal conjugate vaccine (PCV13) in the United States

Original Research Article
Pages 7634-7643
Jaime L. Rubin, Lisa J. McGarry, David R. Strutton, Keith P. Klugman, Stephen I. Pelton, Kristen E. Gilmore, Milton C. Weinstein

Abstract
The 7-valent pneumococcal conjugate vaccine (PCV7) has dramatically decreased pneumococcal disease incidence, and the 13-valent vaccine (PCV13) protects against 6 additional Streptococcus pneumoniae serotypes. A decision-analytic model was constructed to evaluate the impact of infant vaccination with PCV13 versus PCV7 on pneumococcal disease incidence and mortality as well as the incremental benefit of a serotype catch-up program. PCV13 effectiveness was extrapolated from observed PCV7 data, using assumptions regarding serotype prevalence and PCV13 protection against additional serotypes. The model predicts that PCV13 is more effective and cost saving compared with PCV7, preventing 106,000 invasive pneumococcal disease (IPD) cases and 2.9 million pneumonia cases, and saving $11.6 billion over a 10-year period. The serotype catch-up program would prevent an additional 12,600 IPD cases and 404,000 pneumonia cases, and save an additional $737 million compared with no catch-up program.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X

Importance of vaccination habit and vaccine choice on influenza vaccination among healthy working adults

Original Research Article
Pages 7706-7712
Chyongchiou J. Lin, Mary Patricia Nowalk, Seth L. Toback, Matthew D. Rousculp, Mahlon Raymund, Christopher S. Ambrose, Richard K. Zimmerman

Abstract
This randomized cluster trial was designed to improve workplace influenza vaccination rates using enhanced advertising, choice of vaccine type (intranasal or injectable) and an incentive. Workers aged 18–49 years were surveyed immediately following vaccination to determine factors associated with vaccination behavior and choice. The questionnaire assessed attitudes, beliefs and social support for influenza vaccine, demographics, and historical, current, and intentional vaccination behavior. Of the 2389 vaccinees, 83.3% received injectable vaccine and 16.7% received intranasal vaccine. Factors associated with previous influenza vaccination were older age, female sex, higher education and greater support for injectable vaccine (all P < .02). Current influenza vaccination with intranasal vaccine vs. injectable vaccine was associated with higher education, the study interventions, greater support for the intranasal vaccine and nasal sprays, less support of injectable vaccine, more negative attitudes about influenza vaccine, and a greater likelihood of reporting that the individual would not have been vaccinated had only injectable vaccine been offered (all P < .01). Intentional vaccine choice was most highly associated with previous vaccination behavior (P < .001). A key to long term improvements in workplace vaccination is to encourage first time influenza vaccination through interventions that include incentives, publicity and vaccine choice.

Vaccines_The Week in Review_8 November 2010

THis is the pdf version compiling  individual posts for this date.

The WHO reported that “an acute outbreak of poliomyelitis is occurring in the Republic of Congo, with 120 cases of acute flaccid paralysis and 58 deaths. Half the cases have been reported in the past ten days, with the first case occurring in early October. Two cases have been confirmed to have been caused by wild poliovirus type 1 and laboratory testing continues.” The report notes that most cases are in young adults: among those cases for which age data is available (43) at this time, 33 are between the ages of 15-25 years. Only one is under five years old, three are between 7 and 13 and five are between 26 and 58.

WHO said the outbreak is due to imported poliovirus. Congo had recorded its last case of indigenous polio in 2000. Investigations are ongoing to determine definitively the origins of the virus. The Government of Congo has alerted the public to the outbreak and launched an emergency response plan, with support from key partners, including WHO, UNICEF and the US CDC. At least three nationwide vaccination campaigns are expected, using monovalent oral polio vaccine and targeting the entire population. The number, geographic extent and target age groups of further campaigns will be determined by the Government based on the evolving epidemiology. It is anticipated that a multi-country campaign will be required to cover bordering at-risk areas. New cases continue to be reported every day.

http://www.who.int/csr/don/2010_11_04a/en/index.html

World Pneumonia Day — November 12, 2010

MMWR Weekly Announcement: November 5, 2010 / 59(43);1413

Pneumonia kills more children than any other illness; among approximately 9 million children aged <5 years who die each year worldwide, 1.6 million die from pneumonia (1). Through the Global Action Plan for Prevention and Control of Pneumonia, the World Health Organization and international partners recommend that the global health burden of pneumonia be reduced by 1) using vaccines against organisms that cause pneumonia, 2) providing appropriate care and treatment for persons who contract pneumonia, and 3) promoting preventive measures such as exclusive breastfeeding of infants during their first 6 months of life (2).

Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib) account for approximately 60% of pneumonia deaths worldwide of children aged 1 month–5 years in countries that do not use pneumococcal or Hib conjugate vaccines (3,4). In the United States, pneumococcal and Hib conjugate vaccines are recommended for infants and children aged <2 years as part of the routine infant immunization schedule and have reduced morbidity and mortality from pneumococcal disease by 76% and from Hib disease by >99% among children aged <5 years (5,6). In 2010, a 13-valent pneumococcal conjugate vaccine was licensed and recommended in the United States. Collaborative international efforts are expanding use of these vaccines in developing countries (7).

Respiratory viruses, such as respiratory syncytial virus (RSV), influenza, and measles, also are major causes of pneumonia globally. In 2005, an estimated 33.8 million episodes of RSV-associated acute lower respiratory infection occurred in children aged <5 years worldwide (8). Recent studies suggest that 6%–10% of childhood pneumonia is associated with influenza (9,10). Use of influenza and measles vaccines, antiviral medications, and supportive health care can reduce the burden of pneumonia caused by these viruses.

To raise awareness of the effects of pneumonia globally, the second annual World Pneumonia Day, November 12, 2010, is being promoted by a coalition of more than 100 major health, humanitarian relief, advocacy, faith-based, government, and other organizations; CDC and UNICEF are providing technical assistance. Events are scheduled at CDC and elsewhere in the United States and other countries. Additional information is available at http://worldpneumoniaday.org

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5943a6.htm?s_cid=mm5943a6_w

The Weekly Epidemiological Record (WER) for 5 November 2010, vol. 85, 45 (pp 445–452) includes: Outbreaks following importations of wild poliovirus into countries of the WHO African, European and South-East Asian Regions: January 2009 – September 2010

http://www.who.int/entity/wer/2010/wer8545.pdf

The MMWR for November 5, 2010 / Vol. 59 / No. 43 includes:

– Outbreaks Following Wild Poliovirus Importations — Europe, Africa, and Asia, January 2009–September 2010

– Cholera Outbreak — Haiti, October 2010

– Notes from the Field: Malaria Imported from West Africa by Flight Crews — Florida and Pennsylvania, 2010

– Announcement: World Pneumonia Day — November 12, 2010
http://www.cdc.gov/mmwr/PDF/wk/mm5943.pdf

Human Vaccines
Volume 6, Issue 11  November 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/10/

Meeting Report
The global pertussis initiative: Meeting report from the regional Latin America meeting, Costa Rica, 5-6 December, 2008
Rolando Ulloa-Gutierrez, Daniela Hozbor, Maria L. Avila-Aguero, Jaime Caro, Carl-Heinz Wirsing von König, Tina Tan and Stanley Plotkin

Abstract
Pertussis remains endemic across the world, with an estimated 279,000 deaths in 2002, the majority in infants under 1 year of age. Worldwide epidemiologic data indicates increasing infection rates in older children and adults, which act as a source of infection to young infants. The Global Pertussis Initiative (GPI) is an expert scientific forum, which has published consensus recommendations for the monitoring, prevention, and treatment of the disease. This paper reports the proceedings of a regional meeting, held in Costa Rica in December 2008. The meeting gathered information on regional epidemiological, diagnostic capabilities and the ability to introduce GPI recommended vaccine strategies in Latin America. The capacity of Latin American countries to conduct vaccination programs is high and there is considerable government support. Whole-cell pertussis vaccines are used across Latin America, which appear to be quite effective. A 4-dose schedule is typically used (2, 4, 6, and 18 months), and a booster given at 4 to 6 years of age, with coverage often above 90%, but with regions of low coverage due to political and geographical difficulties. Adequate surveillance is lacking in many countries, giving insufficient data to guide vaccination policy. Improvements are being made, with countries such as Costa Rica, Panama, and Argentina introducing polymerase chain reaction (PCR) diagnosis. Those countries that do not currently use a preschool booster should launch one. Implementing vaccination programs in adolescents and/or adults to reduce exposure to infants would be beneficial and possible in most countries, given their current infrastructure.

Human Vaccines
Volume 6, Issue 11  November 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/10/

Commentaries
Assessment of HPV vaccines: From the burden of disease to the Health Technology Assessment approach
Giuseppe La Torre

Human Vaccines
Volume 6, Issue 11  November 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/10/

Why it is still important that countries know the burden of pneumococcal disease

Rosa Prato, Silvio Tafuri, Francesca Fortunato and Domenico Martinelli

Pneumococcal diseases are a major public health problem worldwide. WHO estimates about 1.6 million of annual deaths, mostly in infants, elderly and immunocompromised individuals. Data on the burden of pneumococcal diseases are still limited but information on serotypes circulation and epidemiological pattern of diseases are essential to assess the impact of old and new vaccines. The 23-valent pneumococcal polysaccharide vaccine is recommended in the elderly in many industrialized countries. The 7-valent polysaccharide-protein conjugate vaccine is introduced into routine infant immunization programs of several countries; it is modifying the epidemiology of invasive pneumococcal diseases (IPD) in the population, including adults of all ages. The 10-valent pneumococcal conjugate vaccine is licensed for active immunization of infants and children from 6 weeks up to 2 years of age but it does not contain the emergent 19A serotype. The 13-valent pneumococcal conjugate vaccine is an evolution of the 7-valent and currently addresses the overall need for a broader serotypes coverage. Vaccine manufacturers must continue to further develop pneumococcal vaccines covering the majority of the circulating serotypes in all age groups. Vaccination appears to be the only public health action that could reduce the impact of IPD.

Human Vaccines
Volume 6, Issue 11  November 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/10/

Marking Nov 12, 2010 – World Pneumonia Day: Where are we, where are vaccines?
Ron Dagan, Ciro A. de Quadros, Javier Garau, Keith P. Klugman, Najwa Khuri-Bulos, Orin Levine, Samba Sow and Yonghong Yang

Infectious diseases such as smallpox, pneumonia, rotavirus, malaria and measles have inflicted untold pain, suffering and death on the human population. The fingerprints of these deadly diseases can be found across the pages of history. The harrowing effects of pneumonia on the human body were described by Hippocrates as early as 460 B.C.;1 smallpox scarring can be found on Egyptian mummies dating back more than 3,000 years ago;2 and the Persian philosopher and physician Rhazes detailed the devastation of measles in the 10 century A.D.3 Without the benefits of modern medical interventions, our ancestors had little to no defense against infectious disease, and mortality rates were staggering. In 1531, for example, measles was responsible for the death of half the population of Honduras.4 Furthermore, some historical estimates indicate case fatality rates as high as 90 percent during smallpox epidemics among Native American populations in the early part of the 15th century.5

Yet as science advanced, humanity developed defenses against infectious disease in the form of lifesaving interventions, including vaccines, medical products (e.g., bed nets), therapeutics, and behavioral interventions.6 Across the developed world, these interventions quickly turned the tide against infectious disease. In the United States, infectious disease mortality declined 95 percent during the first 8 decades of the 20th century, from 797 deaths per 100,000 in 1900 to 36 deaths per 100,000 in 1980.7 The success of vaccination programs in the United States and Europe ushered in the 20th-century the concept of “disease eradication”—the idea that a specific disease could be eliminated from the planet. In 1977, after a decade-long campaign involving 33 nations, smallpox was eradicated worldwide—approximately ten years after it had been eradicated from the United States and the rest of the Western Hemisphere.8 But for millions living in the world’s poor and developing countries, it is as if these live-saving interventions were never developed.

The World Bank defines developing countries as those making less than US $11,905 gross national income per capita per year. People living in developing countries make up more than 80 percent of the world’s population.9 A child born in a developing country faces many of the same risks her ancestors did 1,000 years ago. She is 237 times more likely to die of Hib disease than a child born to parents living in a high-income country.10 She’s also 118 times more likely to die from rotavirus diarrhea,11 89 times more likely to die from pneumococcal disease,10 57 times more likely to die from HIV/AIDS,12 and 29 times more likely to die from tuberculosis.12 For such children, life-saving medical interventions are few and far between. That is why child mortality rates in the developing world remain as high as 60 times those in developed countries,13 and life expectancies are shorter by almost a quarter century.14

Journal of Infectious Diseases
1 December 2010  Volume 202, Number 11
http://www.journals.uchicago.edu/toc/jid/current

Editorial Commentaries
A Paradigm for the Control of Influenza [free full-text]
Edward B. Lewin

The Lancet
Nov 06, 2010  Volume 376  Number 9752  Pages 1513 – 1616
http://www.thelancet.com/journals/lancet/issue/current

Comment
Malaria elimination: worthy, challenging, and just possible
Pam Das, Richard Horton
Preview
“I have been astonished by colleagues who have suggested that smallpox eradication must have been easy…some with more grandiose dreams have argued that a whole new vista for public health has opened—the eradication of many diseases…At this time, I don’t believe we have either the technology or the commitment to pursue another eradication goal.”D A Henderson, 20091

Call to action: priorities for malaria elimination
Richard GA Feachem, Allison A Phillips, Geoffrey A Targett, Robert W Snow
Preview
The Lancet’s four-part Series on malaria elimination summarises the remarkable progress achieved over the past 100 years and discusses the substantial technical, operational, and financial challenges that confront malaria-eliminating countries.1–4 The Series comes at a time when there are increased resources to combat malaria worldwide. A three-part strategy to achieve malaria eradication has been developed and is widely endorsed: aggressive control in high-burden regions; progressive elimination from endemic margins to shrink the malaria map; and research and development, to develop new tools and techniques.

Series
Shrinking the malaria map: progress and prospects
Richard GA Feachem, Allison A Phillips, Jimee Hwang, Chris Cotter, Benjamin Wielgosz, Brian M Greenwood, Oliver Sabot, Mario Henry Rodriguez, Rabindra R Abeyasinghe, Tedros Adhanom Ghebreyesus, Robert W Snow

Ranking of elimination feasibility between malaria-endemic countries
Andrew J Tatem, David L Smith, Peter W Gething, Caroline W Kabaria, Robert W Snow, Simon I Hay

Operational strategies to achieve and maintain malaria elimination
Bruno Moonen, Justin M Cohen, Robert W Snow, Laurence Slutsker, Chris Drakeley, David L Smith, Rabindra R Abeyasinghe, Mario Henry Rodriguez, Rajendra Maharaj, Marcel Tanner, Geoffrey Targett

Costs and financial feasibility of malaria elimination
Oliver Sabot, Justin M Cohen, Michelle S Hsiang, James G Kahn, Suprotik Basu, Linhua Tang, Bin Zheng, Qi Gao, Linda Zou, Allison Tatarsky, Shahina Aboobakar, Jennifer Usas, Scott Barrett, Jessica L Cohen, Dean T Jamison, Richard GA Feachem

Nature Medicine
November 2010, Volume 16 No 11
http://www.nature.com/nm/index.html

News
The new age of global health governance holds promise
Tikki Pang, Nils Daulaire, Gerald Keusch, Rose Leke, Peter Piot, Srinath Reddy, Andrzej Rys & Nicole Szlezak

The recognition that many diseases present worldwide challenges has spurred nations and institutions to participate in the development of what is known as ‘global health governance’. But this new form of governance will only succeed with strengthened country commitment, collaborations across disparate sectors and improved accountability.

New England Journal of Medicine
November 4, 2010  Vol. 363 No. 19
http://content.nejm.org/current.shtml

Correspondence
Poliovirus Vaccine and Vaccine-Derived Polioviruses

To the Editor:
The Perspective article by Modlin1 and the articles on polio immunization by Mohammed et al.2 and Jenkins et al.3 (June 24 issue) reflect the dilemma of eradication: it cannot be accomplished without discontinuing the use of the oral vaccine that has brought us close to eradication. Oral poliovirus vaccine (OPV) strains inexorably revert to virulence. It has been obvious for years that inactivated poliovirus vaccine (IPV) prevents paralysis caused by the passage of poliovirus through the blood to the central nervous system. The article by Mohammed et al. shows that IPV also could be used economically. The article also shows that the serum antibody titer has an inverse effect on the intestinal excretion of poliovirus; this would have been even clearer had the investigators obtained samples later than 1 week after challenge. The authors advocate the development of an IPV based on Sabin strains, although it is likely to be more expensive because of the need for higher antigen content. Also, if the strains used to make IPV escape from the production facility, they would almost certainly revert to virulence. Another solution is to use combination vaccines containing diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, and IPV components in developing countries.

Stanley A. Plotkin, M.D.
University of Pennsylvania, Philadelphia, PA

Pediatrics
November 2010 / VOLUME 126 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

Articles
Association Between Medicaid Reimbursement and Child Influenza Vaccination Rates
Byung-Kwang Yoo, MD, PhDa, Andrea Berry, MSa, Megumi Kasajima, BSa, Peter G. Szilagyi, MD, MPHb
Departments of a Community and Preventive Medicine and
b Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York

OBJECTIVE We examined associations between influenza vaccination rates and Medicaid reimbursement rates for vaccine administration among poor children who were eligible for Medicaid (<100% of the federal poverty level in all states).

METHODS We analyzed 3 consecutive National Immunization Surveys (NISs) to assess influenza vaccination rates among nationally representative children 6 to 23 months of age during the 2005–2006 (unweighted N = 12 885), 2006–2007 (unweighted N = 9238), and 2007–2008 (unweighted N = 11 785) influenza seasons (weighted N = 3.3–4.0 million per season). We categorized children into 3 income levels (poor, near-poor, or nonpoor). We performed analyses with full influenza vaccination as the dependent variable and state Medicaid reimbursement rates (continuous covariate ranging from $2 to $17.86 per vaccination) and terms with income levels as key covariates.

RESULTS In total, 21.0%, 21.3%, and 28.9% of all US children and 11.7%, 11.6%, and 18.8% of poor children were fully vaccinated in the 2006, 2007, and 2008 NISs, respectively. Multivariate analyses of all 3 seasons found positive significant (all P < .05) associations between state-level Medicaid reimbursement and influenza vaccination rates among poor children. A $10 increase, from $8 per influenza vaccination (the US average) to $18 (the highest state reimbursement), in the Medicaid reimbursement rate was associated with 6.0-, 9.2-, and 6.4-percentage point increases in full vaccination rates among poor children in the 2006, 2007, and 2008 NIS analyses, respectively.

CONCLUSION Medicaid reimbursement rates are strongly associated with influenza vaccination rates.

Vaccines_The Week in Review_1 November 2010

WHO announced that 15 countries across Africa launched a synchronized mass polio immunization campaign to reach 72 million children. WHO said that “some 290,000 vaccinators have been mobilized to go door-to-door to deliver two drops of oral polio vaccine (OPV) to every child under five in areas considered at ‘highest risk’ of polio transmission.”  This is part of a series of synchronized immunization activities which began in 2009 and continued in March and April, 2010, following the spread of polio from Nigeria to 24 countries across west and central Africa and in the Horn of Africa.

“We are on the cusp of an exciting possibility here,” said Dr Gianfranco Rotigliano, UNICEF’s Regional Director for West and Central Africa. “Political leaders across Africa answered the challenge posed by this dreadful disease and the results are before us. It shows what can be done when there is leadership and dynamic partnership with donor support around such an important health issue. We need to continue efforts to vaccinate and to put the needs of children in Africa first.” The 15-country synchronized activities will cost approximately US$42.6 million, and are funded by the Bill & Melinda Gates Foundation, the US Centers for Disease Control and Prevention (CDC), USAID, Rotary International, UNICEF and the Governments of Germany and Japan.

http://www.who.int/mediacentre/news/releases/2010/polio_20101026/en/index.html

WHO released a revised WHO-UNICEF Joint Statement on Vaccine Donations WHO/IVB/10.09 which “updates previous WHO statements on vaccine donations (WHO/VSQ/97.05; WHO/V&B/00.25) and clarifies situations which were not covered by the previous policy statement, such as donations for research projects and donations in the case of emergency, epidemic or pandemic situations.”

[Full text]

“…Exceptional Situations

There may be exceptional situations when it is not possible to meet the minimum requirements outlined above. These commonly include:

– Donations to research projects:

The use of vaccine donated for research purposes must be guided by the International Ethical Guidelines for Biomedical Research Involving Human Subjects issued by the Council for International Organizations of Medical Sciences (CIOMS) in collaboration with the World Health Organization ( http:\\www.cioms.ch\frame_guidelines_nov_2002.htm), the Declaration of Helsinki, and supplemented by other internationally and nationally accepted statements of ethical guidance adopted by the recipient country.

Such projects must also comply with other national regulations and requirements related to medical research involving human subjects. New vaccines or devices that have not received regulatory approval in the country should not be used on human subjects without the appropriate approval being obtained from the National Drug Regulatory Agency for their use under the conditions of the study. Under these circumstances, it is especially important to ensure the suitability of the product, its presentation, and its schedule, as it may not be yet licensed in the recipient country nor WHO prequalified.

– Vaccines donated for emergency, epidemic or pandemic situations when it may not be possible to apply all the minimum specifications above:

In some instances the vaccine specifications and presentation may vary from what is in routine use, the remaining shelf life may be limited, and sustainability is not an issue. In such cases the most important considerations are that the vaccine is suitable to the country’s needs from the public health perspective and that the responsible officials in the recipient country are in full agreement with shipping the vaccine, and are able to respond to quality and storage aspects of the donation. In addition, as with any other donation, the vaccine is subject to prescribed licensing and/or other control procedures set up by the recipient government. In such cases it is also useful for recipient countries to have an immunization plan…”

http://www.who.int/immunization/documents/WHO_IVB_10.09/en/

The GAVI Alliance announced that Luxembourg made a multi-year pledge of € 4.1 million (US$5.7 million) to support GAVI programs between 2011 and 2015

http://www.gavialliance.org/media_centre/press_releases/luxembourg.php

The Global Fund to Fight AIDS, Tuberculosis and Malaria announced that Luxembourg’s will commit EUR 7.5 million to the Global Fund for the period 2011-2013, “making it one of the top per capita donors.” Luxembourg has been a donor to the Global Fund since its inception in 2002. The Grand Duchy’s contributions to the Global Fund “have been increasing since then and by the end of 2013 they will have reached EUR 26 million.”

http://www.theglobalfund.org/en/pressreleases/?pr=pr_101027

The APHA Governing Council will be considering approval of a position statement on “Annual Influenza Vaccination of Health Workers” at its annual meeting next week in Denver. The proposed position statement “provides an up-to-date influenza-specific context for APHA’s longstanding policy recommending vaccination requirements for healthcare and laboratory workers and students for all vaccine-preventable diseases. APHA said public debate open to all conference attendees will take place Sunday afternoon (7 November 2010); the Governing Council will vote on the position statement on Tuesday (8 November 2010). The draft position statement is available at:   http://www.apha.org/NR/rdonlyres/FAD4A159-875C-4186-8B46-5B300DA1E37A/0/D1Resubmission.pdf.  Please see Event Watch below for information on the APHA meeting.

The Bill & Melinda Gates Foundation announced the next stage of Grand Challenges Explorations, with “nine outstanding Grand Challenges Explorations grantees have received new funding of up to $1 million each to support continued research on their innovative work.” The Foundation said these projects “have shown success during their initial grant period and align with the foundation’s strategic global health priorities, including vaccines, family health, and infectious disease. The grantees come from diverse disciplines and are at various stages in their careers, but share a common goal—to make breakthrough advances that lead to new solutions to improve health worldwide.”

http://www.gatesfoundation.org/press-releases/Pages/gce-next-stage-winners-announced-101027.aspx

The Weekly Epidemiological Record (WER) for 29 October 2010, vol. 85, 44 (pp 437–444) includes: Outbreak news: Cholera, Haiti; Cholera, Pakistan; Crimean-Congo haemorrhagic fever (CCHF) and dengue fever, Pakistan; Global vaccination update, 2009 http://www.who.int/entity/wer/2010/wer8544.pdf

The MMWR for October 29, 2010 / Vol. 59 / No. 42 includes:
– Global Routine Vaccination Coverage, 2009

– Rapid Diagnostic Tests for Malaria — Haiti, 2010

http://www.cdc.gov/mmwr/PDF/wk/mm5942.pdf

The Lancet
Oct 30, 2010  Volume 376  Number 9751 Pages 1437 – 1512
http://www.thelancet.com/journals/lancet/issue/current

Editorial
GAVI’s challenges: funding and leadership

Original Text

The Lancet

Since its launch in 2000, the mission of the GAVI Alliance has been to fund vaccination programmes in low-income countries with an annual domestic gross product below US$1000 per head. The Alliance so far has provided access to immunisation for more than 250 million children worldwide, contributed to an estimated 5·4 million saved lives, and protected many more against disabilities.

The Alliance’s accomplishment has been the result of a unique public—private partnership that has pioneered and supported innovative and performance-based financing and programming-based approaches to global health. By bringing together developing countries, donor governments, research and technical institutes, civil society organisations, vaccine producers, and private philanthropists, the dynamics of the global vaccine market have changed through sustainable supply, research, competition, and price reduction.

The current 5-year goal of GAVI is to expand by 2015 its vaccination programmes to include combined vaccine against diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type B, together with pneumococcal and rotavirus vaccines. This initiative needs $7 billion in funding. So far, only $2.7 billion has been secured. The funding shortfall of $4.3 billion must be solved by June, 2011, during GAVI’s pledging conference if more than 4 million child deaths are to be prevented.

The Alliance’s future will depend on its soon to be appointed new leader, who must be an excellent fundraiser. GAVI depends too heavily on one foundation and the changing priorities of core donor countries. The new leader must be a strong global advocate to endorse vaccination as one of the most cost-effective health and developmental interventions, and one that is crucial for achieving the Millennium Development Goals.     The individual must also be a passionate campaigner in promoting children’s immunisation as a global public good and a shared responsibility of the world community—by being the voice of millions of children threatened by a preventable illness. Immunisation is far overdue to become a right rather than a privilege.

The Lancet Infectious Disease
Nov 2010  Volume 10  Number 11  Pages 737 – 812
http://www.thelancet.com/journals/laninf/issue/current

Leading Edge
Slow progress towards universal access
The Lancet Infectious Diseases

Preview
At the 2006 UN General Assembly high-level meeting on AIDS in New York, world leaders set the ambitious goal of providing universal access to HIV prevention, treatment, and care by 2010. The main target of this initiative was to provide 80% of people in need of antiretroviral therapy with access to appropriate treatment. Progress towards achieving this universal access target is documented in the Towards Universal Access report by UNAIDS, UNICEF, and WHO, released on Sept 28, 2010. With statistics available until the end of 2009, the report shows that, despite many successes, the goal of universal access will not be met.

The Lancet Infectious Disease
Nov 2010  Volume 10  Number 11  Pages 737 – 812
http://www.thelancet.com/journals/laninf/issue/current

Articles
Hepatitis B immune memory in children primed with hexavalent vaccines and given monovalent booster vaccines: an open-label, randomised, controlled, multicentre study
Alessandro Remo Zanetti, Luisa Romanò, Cristina Giambi, Anna Pavan, Vito Carnelli, Guglielmino Baitelli, Giancarlo Malchiodi, Edgardo Valerio, Antonella Barale, Maria Anna Marchisio, Domenico Montù, Alberto Eugenio Tozzi, Fortunato D’Ancona, for the study group

Preview
5 years after immunisation with hexavalent vaccines, immunological memory seems to persist in children with anti-HBs concentrations lower than 10 mIU/mL, suggesting that booster doses are not needed. Additional follow-up is needed.

The IDSA (Infectious Disease Society of America) held its 48th Annual Meeting in Vancouver, BC, Canada from 21 – 24 October 2010. A video archive of media conferences with ISDA panels on a range of topics including HIV Global Health Influenza Pediatrics Emerging infections and more is available at:

http://www.idmeeting.org/omk.php?sid=S20101019100441ZY45HT&pid=1697

WHO: Avian influenza – situation in Indonesia – update 4

18 October 2010 — The Ministry of Health of Indonesia has announced two new cases of human infection of H5N1 avian influenza. A 35-year-old male from West Jakarta, Jakarta Province developed symptoms on 16 August, was hospitalized on 20 August and died on 27 August. Initial investigations into the source of his infection suggest a number of sudden chicken deaths occurred around the case’s house a week before onset. The second case, a 40-year-old female from Kota Depok, West Java Province developed symptoms on 9 September, was hospitalized on 12 September and died on 17 September. Initial investigations into the source of her infection suggest exposure at a live bird market.

For both cases laboratory tests have confirmed infection with the H5N1 avian influenza virus. Of the 170 cases confirmed to date in Indonesia, 141 have been fatal. http://www.who.int/csr/don/2010_10_18/en/index.html

The Weekly Epidemiological Record (WER) for 22 October 2010, vol. 85, 43 (pp 425–436) includes: Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj); Elimination of maternal and neonatal tetanus in Myanmar, 2010; Changing epidemiology of pneumococcal serotypes after introduction of conjugate vaccine: July 2010 report.

http://www.who.int/entity/wer/2010/wer8543.pdf

Clinical Infectious Diseases
15 November 2010  Volume 51, Number 10
http://www.journals.uchicago.edu/toc/cid/current

Major Article
The Infection Attack Rate and Severity of 2009 Pandemic H1N1 Influenza in Hong Kong
Joseph T. Wu, Edward S. K. Ma, Cheuk Kwong Lee, Daniel K. W. Chu, Po-Lai Ho, Angela L. Shen, Andrew Ho, Ivan F. N. Hung, Steven Riley, Lai Ming Ho, Che Kit Lin, Thomas Tsang, Su-Vui Lo, Yu-Lung Lau, Gabriel M. Leung, Benjamin J. Cowling, and J. S. Malik Peiris
[Free full text]

Abstract
Background.Serial cross-sectional data on antibody levels to the 2009 pandemic H1N1 influenza A virus from a population can be used to estimate the infection attack rates and immunity against future infection in the community.

Methods.From April through December 2009, we obtained 12,217 serum specimens from blood donors (aged 16–59 years), 2520 specimens from hospital outpatients (aged 5–59 years), and 917 specimens from subjects involved in a community pediatric cohort study (aged 5–14 years). We estimated infection attack rates by comparing the proportions of specimens with antibody titers 1:40 by viral microneutralization before and after the first wave of the pandemic. Estimates were validated using paired serum samples from 324 individuals that spanned the first wave. Combining these estimates with epidemiologic surveillance data, we calculated the proportion of infections that led to hospitalization, admission to the intensive care unit (ICU), and death.

Results.We found that 3.3% and 14% of persons aged 5–59 years had antibody titers 1:40 before and after the first wave, respectively. The overall attack rate was 10.7%, with age stratification as follows: 43.4% in persons aged 5–14 years, 15.8% in persons aged 15–19 years, 11.8% in persons aged 20–29 years, and 4%–4.6% in persons aged 30–59 years. Case-hospitalization rates were 0.47%–0.87% among persons aged 5–59 years. Case-ICU rates were 7.9 cases per 100,000 infections in persons aged 5–14 years and 75 cases per 100,000 infections in persons aged 50–59 years, respectively. Case-fatality rates were 0.4 cases per 100,000 infections in persons aged 5–14 years and 26.5 cases per 100,000 infections in persons aged 50–59 years, respectively.

Conclusions.Almost half of all school-aged children in Hong Kong were infected during the first wave. Compared with school children aged 5–14 years, older adults aged 50–59 years had 9.5 and 66 times higher risks of ICU admission and death if infected, respectively.

Clinical Infectious Diseases
15 November 2010  Volume 51, Number 10
http://www.journals.uchicago.edu/toc/cid/current

Review Article
Transfusion-Transmitted Malaria in Countries Where Malaria Is Endemic: A Review of the Literature from Sub-Saharan Africa
Alex K. Owusu-Ofori, Christopher Parry, and Imelda Bates

Abstract
Although international policies recommend that blood for transfusion should be screened for transfusion-transmitted infections, malaria screening is not performed in most malaria-endemic countries in sub‐Saharan Africa. Our literature review identified 17 relevant studies from the period 1980–2009 and indicated that the median prevalence of malaria among 33,029 blood donors was 10.2% (range, 0.7% in Kenya to 55.0% in Nigeria). Malaria screening methods, including microscopy (used in 16 of 17 studies), are either insensitive or impractical for donor screening in resource-poor countries. Even if a suitable screening method were available, rejection of malaria-positive donors would jeopardize the blood supply. Only 1 study established the prevalence of parasitemia among transfusion recipients. This review highlights the need for more evidence about the clinical impact of transfusion-transmitted malaria to justify the policy of screening for blood for malaria in areas of endemicity and for a critical analysis of the feasibility of implementing such a policy and its effect on blood supply.

Editorial Commentary: Malaria and Transfusion: A Neglected Subject Coming Back to the Forefront
Jean-Pierre Allain

Emerging Infectious Diseases
Volume 16, Number 11–November 2010
http://www.cdc.gov/ncidod/EID/index.htm

Research
Outbreaks of Pandemic (H1N1) 2009 and Seasonal Influenza A (H3N2) on Cruise Ship
Kate A. Ward, Paul Armstrong, Jeremy M. McAnulty, Jenna M. Iwasenko, and Dominic E. Dwyer
Author affiliations: New South Wales Health, Sydney, New South Wales, Australia (K.A. Ward, J.M. McAnulty); Western Australian Department of Health, Perth, Western Australia, Australia (P. Armstrong); South Eastern Area Laboratory Services, Sydney (J.M. Iwasenko); and Institute of Clinical Pathology and Medical Research, Sydney (D.E. Dwyer)

Abstract
To determine the extent and pattern of influenza transmission and effectiveness of containment measures, we investigated dual outbreaks of pandemic (H1N1) 2009 and influenza A (H3N2) that had occurred on a cruise ship in May 2009. Of 1,970 passengers and 734 crew members, 82 (3.0%) were infected with pandemic (H1N1) 2009 virus, 98 (3.6%) with influenza A (H3N2) virus, and 2 (0.1%) with both. Among 45 children who visited the ship’s childcare center, infection rate for pandemic (H1N1) 2009 was higher than that for influenza A (H3N2) viruses. Disembarked passengers reported a high level of compliance with isolation and quarantine recommendations. We found 4 subsequent cases epidemiologically linked to passengers but no evidence of sustained transmission to the community or passengers on the next cruise. Among this population of generally healthy passengers, children seemed more susceptible to pandemic (H1N1) 2009 than to influenza (H3N2) viruses. Intensive disease control measures successfully contained these outbreaks.

Emerging Infectious Diseases
Volume 16, Number 11–November 2010
http://www.cdc.gov/ncidod/EID/index.htm

Conference Summary
International Conference on Emerging Infectious Diseases, 2010
Nina Marano, Theresa L. Smith, Rana A. Hajjeh, Marian McDonald, Carolyn B. Bridges, Sharon A. Martin, and Terence Chorba
Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

“The seventh International Conference on Emerging Infectious Diseases (ICEID) was held in Atlanta, Georgia, USA, July 11–14, 2010. The conference goal was to bring together public health professionals to encourage exchange of scientific and public health information on global emerging infectious disease issues. The conference was organized by the Centers for Disease Control and Prevention (CDC), American Society for Microbiology, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories, and the World Health Organization; additional support was provided by 40 other multidisciplinary public health partners.

“The conference schedule was built around 20 plenary speakers, 31 panel sessions, 110 scientific oral presentations, and 445 posters from 6 continents. Topics included relevant infectious diseases issues from the past 2 years and updates on a variety of new findings and approaches, including social determinants of health, lessons learned from the recent pandemic (H1N1) 2009, zoonotic diseases, viral hepatitis, prevention challenges of respiratory diseases, travelers’ health, new developments in vaccines, and vaccine-preventable diseases. Rima Khabbaz, Deputy Director for Infectious Diseases at CDC, and Center directors Kevin Fenton, Thomas Hearn, and Anne Schuchat conducted tours of outstanding posters that addressed emergence, prevention, and control of infectious diseases in the international and domestic arenas…” The full agenda and list of speakers can be found at the conference website (www.iceid.org).