Journal of Infectious Diseases
15 November 2010   Volume 202, Number 10
http://www.journals.uchicago.edu/toc/jid/current

Major Article
A 2009 Varicella Outbreak in a Connecticut Residential Facility for Adults with Intellectual Disability
Jessica Leung, Kathy Kudish, Chengbin Wang, Latetia Moore, Paul Gacek, Kay Radford, Adriana Lopez, Lynn Sosa, D. Scott Schmid, Matthew Cartter, and Stephanie Bialek
[Free full text]

Abstract
We investigated a varicella outbreak in a residential facility for adults with intellectual disabilities. A case of varicella was defined as a generalized maculopapular rash that developed in a facility resident or employee. Immunoglobulin M testing was conducted on serologic samples, and polymerase chain reaction testing was performed on environmental and skin lesion samples. Eleven cases were identified among 70 residents and 2 among 145 staff. An unrecognized case of herpes zoster was the likely source. Case patients first entered any residential facility at a younger age than non‐case residents (9.5 vs 15.0 years; ). Varicella zoster virus DNA was detected 2 months after the outbreak in environmental samples obtained from case patients’ residences. This outbreak exemplifies the potential for at‐risk pockets of varicella‐susceptible adults, especially among those who have lived in residential facilities from a young age. Evidence of immunity should be verified for all adults and healthcare staff in similar residential settings.

Journal of Infectious Diseases
15 November 2010   Volume 202, Number 10
http://www.journals.uchicago.edu/toc/jid/current

Major Article
Measles in the United States during the Postelimination Era
Amy Parker Fiebelkorn, Susan B. Redd, Kathleen Gallagher, Paul A. Rota, Jennifer Rota,
William Bellini, and Jane Seward
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Abstract
Background.Measles affected entire birth cohorts in the prevaccine era but was declared eliminated in the United States in 2000 because of a successful measles vaccination program.

Methods.We reviewed US surveillance data on confirmed measles cases reported to the Centers for Disease Control and Prevention and data on national measles-mumps-rubella (MMR) vaccination coverage during postelimination years 2001−2008.

Results.During 2001−2008, a total of 557 confirmed cases of measles (annual median no. of cases, 56) and 38 outbreaks (annual median no. of outbreaks, 4) were reported in the United States; 232 (42%) of the cases were imported from 44 countries, including European countries. Among case-patients who were US residents, the highest incidences of measles were among infants 6–11 months of age and children 12–15 months of age (3.5 and 2.6 cases/1 million person-years, respectively). From 2001 through 2008, national 1-dose MMR vaccine coverage among children 19–35 months of age ranged from 91% to 93%. From 2001 through 2008, a total of 285 US-resident case-patients (65%) were considered to have preventable measles (ie, the patients were eligible for vaccination but unvaccinated). During 2004–2008, a total of 68% of vaccine-eligible US-resident case-patients claimed exemptions for personal beliefs.

Conclusions.The United States maintained measles elimination from 2001 through 2008 because of sustained high vaccination coverage. Challenges to maintaining elimination include large outbreaks of measles in highly traveled developed countries, frequent international travel, and clusters of US residents who remain unvaccinated because of personal belief exemptions.

The Lancet
Oct 23, 2010  Volume 376  Number 9750  Pages 1363 – 1436
http://www.thelancet.com/journals/lancet/issue/current

Comment
Global Health Metrics and Evaluation—a call for abstracts
GHME Conference Organizing Committee

The Institute for Health Metrics and Evaluation (Seattle, WA, USA), The Lancet, the London School of Hygiene & Tropical Medicine, the Harvard School of Public Health, and the University of Queensland School of Population Health invite submission of abstracts for oral or poster presentation at their conference called Global Health Metrics and Evaluation: Controversies, Innovation, Accountability, to be held on March 14–16, 2011 in Seattle, WA, USA.

The Lancet
Oct 23, 2010  Volume 376  Number 9750  Pages 1363 – 1436
http://www.thelancet.com/journals/lancet/issue/current

Article
Equity and adequacy of international donor assistance for global malaria control: an analysis of populations at risk and external funding commitments
Robert W Snow, Emelda A Okiro, Peter W Gething, Rifat Atun, Simon I Hay

Preview
Funding for malaria control worldwide is 60% lower than the US$4·9 billion needed for comprehensive control in 2010; this includes funding shortfalls for a wide range of countries with different numbers of people at risk and different levels of domestic income. More efficient targeting of financial resources against biological need and national income should create a more equitable investment portfolio that with increased commitments will guarantee sustained financing of control in countries most at risk and least able to support themselves.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 47 pp. 7453-7576 (3 November 2010)

Letters to the Editor
An update to “The cost-effectiveness of rotavirus vaccination: Comparative analyses for five European countries and transferability in Europe”
Pages 7457-7459
Mark Jit, Marie-Josée J. Mangen, Hugues Melliez, Yazdan Yazdanpanah, Joke Bilcke, Heini Salo, W. John Edmunds, Philippe Beutels

Abstract
A cost-effectiveness analysis of rotavirus vaccination in Belgium, England and Wales, Finland, France and the Netherlands published in 2009 was updated based on recent studies on rotavirus burden of disease and vaccine efficacy. All the qualitative conclusions in the previous study were found to remain valid. Vaccination remains cost-effective in Finland only when using plausible tender prices.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 47 pp. 7453-7576 (3 November 2010)

Regular Papers
Acceptability of HPV vaccination among young adults aged 18–30 years–a population based survey in Sweden

Original Research Article
Pages 7492-7500
Karin Sundström, Trung Nam Tran, Cecilia Lundholm, Cecilia Young, Pär Sparén, Lisen Arnheim Dahlström

Preview
Acceptability of human papillomavirus (HPV) vaccination seems to be high in the Western world but fewer data are available for men than for women. There are also concerns that HPV vaccination might lead young people to change their healthcare-related behaviours. We investigated these issues in a population-based survey performed in Sweden during January-May, 2007, just after HPV vaccination had been licensed. A total of 10 567 men and women aged 18 to 30 years participated. The intention to accept HPV vaccination among these young adults was relatively high but could likely be improved with higher awareness of HPV-related diseases as well as of the safety and efficacy of vaccines in general. Also, the cost of the vaccine needs to be affordable. Even though few young adults stated their healthcare-related behaviours would change after HPV vaccination, a significant number were uncertain, suggesting a need for continued educational efforts when HPV-vaccinating this group.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 47 pp. 7453-7576 (3 November 2010)

A measles and rubella (MR) catch-up vaccination campaign in an Egyptian University: Vaccine uptake and knowledge and attitudes of students

Original Research Article
Pages 7563-7568
Khaled M. Abd Elaziz, Sahar M. Sabbour, Sahar A. Dewedar

Abstract
Introduction
In 2008, following a rubella epidemic, the Egyptian Ministry of Health implemented a Measles Rubella (MR) catch-up campaign, based on WHO recommendations for supplementary immunization activities to eliminate measles by 2010. The age group targeted was 10–20 years. This campaign was unique in Egypt as it was the first national vaccination campaign which included university students.

Aim
o report uptake of MR vaccine and reasons for declining the vaccine among medical and non-medical students in the campaign and to assess the knowledge about the vaccine and the diseases.

Methods
The study was conducted in two stages. In the first stage during the vaccination sessions, medical and other students (N = 310) were given a questionnaire to assess their knowledge of the campaign and the vaccine. The second stage (N = 341) was carried out when the campaign was completed to assess vaccine uptake among medical students.

Results
Posters displayed inside the university were reported to be the main source of information about the campaign. Students were generally poorly informed about both vaccine adverse effects, and contraindications although medical students tended to be better informed than other students. Overall 64.8% medical students accepted the vaccine with higher uptake among females than males (85.9 and 58.3% respectively). Non-compliant students had a significantly higher mean age. Almost half of students who did not accept the vaccine gave their reason as having little information about the vaccine (43.3%).

Conclusion
The MR campaign in Ain Shams University may have been more successful with better use of health education messages.

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

Volume 28, Issue 47 pp. 7453-7576 (3 November 2010)

Knowledge of vaccination of allergic children among Italian primary care pediatricians, hospital pediatricians and pediatric residents

Original Research Article
Pages 7569-7575
Susanna Esposito, Chiara Azzari, Giorgio Bartolozzi, Gaetano Maria Fara, Franco Giovanetti, Milena Lo Giudice, Carlotta Galeone, Marta Ciofi degli Atti and for the Italian Society of Pediatric Allergy and Immunology

Abstract
A cross-sectional survey of Italian pediatricians and pediatric residents was carried out between 15 September and 18 October 2008 in order to evaluate their knowledge concerning the administration of vaccines to children with suspected or proved allergies. Of the 750 physicians who accepted to participate (620 pediatricians and 130 residents), 630 (84.0%; 407 females; mean age 43.5 ± 11.2 years) returned completed questionnaires: 268 primary care pediatricians (42.5%), 244 hospital pediatricians (38.8%), and 118 pediatric residents (18.7%). Knowledge concerning the vaccination of children with suspected or proved allergies was far from optimal, with the poorest knowledge being shown by the pediatric residents and no difference between the primary care and hospital pediatricians. Since pediatricians are the main parents’ advisors regarding vaccinations, these results indicate an urgent need for educational programmes (especially for residents) and evidence-based guidelines concerning vaccinations in children with suspected or proved allergies.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 46 pp. 7345-7452 (28 October 2010)

Vaccine preventable diseases in returned international travelers: Results from the GeoSentinel Surveillance Network

Original Research Article
Pages 7389-7395
Andrea K. Boggild, Francesco Castelli, Philippe Gautret, Joseph Torresi, Frank von Sonnenburg, Elizabeth D. Barnett, Christina A. Greenaway, Poh-Lian Lim, Eli Schwartz, Annelies Wilder-Smith, Mary E. Wilson and for the GeoSentinel Surveillance Network

Abstract
Vaccine preventable diseases (VPDs) threaten international travelers, but little is known about their epidemiology in this group. We analyzed records of 37,542 ill returned travelers entered into the GeoSentinel Surveillance Network database. Among 580 (1.5%) with VPDs, common diagnoses included enteric fever (n = 276), acute viral hepatitis (n = 148), and influenza (n = 70). Factors associated with S. typhi included VFR travel (p < 0.016) to South Central Asia (p < 0.001). Business travel was associated with influenza (p < 0.001), and longer travel with hepatitis A virus (p = 0.02). 29% of those with VPDs had pre-travel consultations. At least 55% of those with VPDs were managed as inpatients, compared to 9.5% of those with non-VPDs. Three deaths occurred; one each due to pneumococcal meningitis, S. typhi, and rabies. VPDs are significant contributors to morbidity and potential mortality in travelers. High rates of hospitalization make them an attractive target for pre-travel intervention.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 46 pp. 7345-7452 (28 October 2010)

Healthy young and middle age adults: What will it take to vaccinate them for influenza?

Original Research Article
Pages 7420-7422
Lori Uscher-Pines, Jurgen Maurer, Arthur Kellerman, Katherine M. Harris

Abstract
Starting in 2010, healthy adults age 19–49 will be recommended for annual influenza vaccination. Because they were not previously targeted, little is known about their vaccine-related attitudes and behaviors. Using nationally representative survey data from 2009 to 2010, we found that adults newly recommended for influenza vaccination (as compared to previously recommended groups) are less likely to believe flu vaccines are safe (44% vs. 63%), to have ever been vaccinated (36% vs. 64%), to be vaccinated following a healthcare provider recommendation (44% vs. 52%), and to visit a doctor’s office during vaccination season (41% vs. 69%). To boost rates of influenza vaccination in this population, new and untraditional strategies aimed at encouraging first-time vaccination are needed.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 46 pp. 7345-7452 (28 October 2010)

Racial disparities in diarrhea-associated hospitalizations among children in five US States, before and after introduction of rotavirus vaccine

Original Research Article
Pages 7423-7426
Catherine Yen, Claudia A. Steiner, Marguerite Barrett, Aaron T. Curns, Katherine Hunter, Emily Wilson, Umesh D. Parashar

Abstract
Racial differences in diarrheal disease have not been systematically examined, and the impact of rotavirus vaccine on these differences has not been assessed. We compared diarrhea-associated hospitalizations by race/ethnicity among children <5 years pre- (2000–2006) and post- (2007 and 2008) rotavirus vaccine introduction in five US states. Pre-vaccine hospitalization rates were greater among whites versus blacks and Hispanics. However, black (versus non-black) infants <6 months and white (versus non-white) children ≥1 year had higher rates. In 2008, racial disparities for children 12–35 months resolved, but higher hospitalization rates among black infants <6 months persisted, highlighting the need for timely vaccination.

The GAVI Alliance released a summary of actions and next steps from its meeting of donors and partners in early October, including a plan for its first pledging conference in June 2011 “to ensure that the global health partnership has the necessary funding to introduce new vaccines against the two biggest killers of children – pneumonia and diarrhoea.” Mary Robinson, Chair of the GAVI Alliance Board, commented, “The right to health is a basic human right and the inequity that exists between those children who are lucky enough to be vaccinated and those who are not is shocking. Every one of us shares a collective responsibility to make a difference. Despite the financial crisis, let’s surprise everyone next June by ensuring that GAVI gets the funding it needs. GAVI’s mission is too important to fail.”

http://www.gavialliance.org/media_centre/statements/call_for_action.php

The Global Fund to Fight AIDS, Tuberculosis and Malaria held the Second Meeting of the Third Voluntary Replenishment (2011-2013) in New York, 4-5 October 2010. Donors announced funding of US$11.7 billion for the years 2011-2013, representing “the largest ever financial pledge for the collective, international effort to fight the three pandemics.” The new funding compares with US$9.7 billion committed to the Global Fund in Berlin in September 2007 for the period 2008-2010. The meeting reviewed “follow up work undertaken in response to a range of issues raised by participants in The Hague, and discussed the current reform program being implemented by the Global Fund Secretariat, and considered future resource projections for the next three years.” With sufficient funding for the Replenishment the Global Fund, (the Fund) said it “could be in a position to: eradicate malaria as a public health concern in most malaria endemic countries; virtually eliminate the transmission of HIV from mother to child; contain the threat of multi-drug resistant tuberculosis; prevent millions of avoidable deaths from AIDS; and contribute to significant reductions in maternal and child mortality.”

http://www.theglobalfund.org/en/replenishment/newyork/

The Stop TB Partnership announced its GLOBAL PLAN TO STOP TB 2011-2015 which it said “for the first time identifies all the research gaps that need to be filled to bring rapid TB tests, faster treatment regimens and a fully effective vaccine to market. It also shows public health programmes how to drive universal access to TB care, including how to modernize diagnostic laboratories and adopt revolutionary TB tests that have recently become available.” The organization said that twenty-two countries, including South Africa, bear 80% of the burden of TB worldwide. Some 9 million people become ill with active TB and nearly 2 million die each year. The new Global Plan sets out to provide diagnosis and treatment approaches recommended by the World Health Organization (WHO) for 32 million people over the next five years.

The Global Plan calls for US$37 billion for implementation of TB care between 2011 and 2015, leaving a funding gap of about US$14 billion, or approximately US$2.8 billion per year, which “needs to be filled by international donors.” The plan “includes a separate calculation of the funding required to meet targets for research and development: a total of US$ 10 billion, or US$ 2 billion per year. High-income countries and those with growing economies will need to increase their investment in research and development to fill an estimated gap of about US$ 7 billion, or US$ 1.4 billion per year.” Dr Margaret Chan, Director-General of WHO, which hosts the Stop TB Partnership, said, “There is an urgent need to scale up action against TB – 10 million people, including 4 million women and children, will lose their lives unnecessarily between now and 2015 if we fail. TB control works, with global incidence of the disease declining since 2004, although much too slowly.”

http://www.who.int/mediacentre/news/releases/2010/tb_20101013/en/index.html

Plan documentation at http://www.stoptb.org/global/plan/

The WHO issued Working to overcome the global impact of neglected tropical diseases – its first report on neglected tropical diseases. The report “presents evidence to demonstrate that activities undertaken to prevent and control neglected tropical diseases are producing results – and that achievements are being recognized…Neglected tropical diseases blight the lives of a billion people worldwide and threaten the health of millions more. These close companions of poverty weaken impoverished populations, frustrate the achievement of health in the Millennium Development Goals and impede global public health outcomes.”
http://www.who.int/neglected_diseases/2010report/en/index.html

WHO report at: http://www.who.int/entity/neglected_diseases/2010report/NTD_2010report_embargoed.pdf

The U.S. Supreme Court heard opening arguments in Bruesewitz v. Wyeth, Inc., Docket No. 09-152 involving the National Childhood Vaccine Injury Act of 1986 and vaccine manufacturer liability. The case was brought by the family of Hannah Bruesewitz, a Pennsylvania teen whose seizure disorder surfaced after she received a diphtheria, tetanus, and pertussis vaccine made by Wyeth.

Links to the docket and various briefs are presented below. The Questions Presented summary is presented in full text here:

“Section 22(b)(1) of the National Childhood Vaccine Injury Act of 1986 [“the Act”] expressly preempts certain design defect claims against vaccine manufacturers “if the injury or death resulted from side effects that were unavoidable even though the vaccine was properly prepared and was accompanied by proper directions and warnings.” 42 U.S.C. § 300aa-22(b)(1). A-104.
“The Question Presented is:
Whether the Third Circuit erred in holding that, contrary to its plain text and the decisions of this Court and others, Section 22(b)(1) preempts all vaccine design defect claims, whether the vaccine’s side effects were unavoidable or not?”

http://www.abanet.org/publiced/preview/briefs/oct2010.shtml#09152

Merit briefs

– Brief for Petitioners Russell Bruesewitz and Robalee Bruesewitz, Parents and Natural Guardians of Hannah Bruesewitz, a minor child, and In Their Own Right

– Brief for Respondent Wyeth, Inc. F/K/A Wyeth Laboratories, Wyeth-Ayerst Laboratories, Wyeth Lederle, Wyeth Lederle Vaccines and Lederle Laboratories,

– Reply Brief for Petitioners Russell Bruesewitz and Robalee Bruesewitz, Parents and Natural Guardians of Hannah Bruesewitz, a minor child, and In Their Own Right

Amicus briefs

– Brief for the National Vaccine Information Center, Its Co-Founders, and 24 Other Organizations in Support of Petitioners

– Brief for Marguerite Willner in Support of Petitioner

– Brief for Mark A. Geistfeld in Support of Petitioner

– Brief for the American Association for Justice, Public Justice and Public Citizen in Support of Petitioner

– Brief for Vaccine Injured Petitioners Bar Association, The George Washington University Law School Vaccine Injury Clinic, and Zenoria Phillips Deloatch, As Personal Representative of The Estate of Moshella F. Roberts in Support of Petitioner

– Brief for Glaxosmithkline LLC, Merck Sharp & Dohme Corp. (Formerly Known As Merck & Co., Inc.), And Sanofi Pasteur Inc. in Support of Respondent

– Brief for Washington Legal Foundation in Support of Respondent

– Brief for United States of America in Support of Respondent

– Brief for the American Academy of Pediatrics and 21 Other Physician and Public Health Organizations in Support of Respondent

– Brief for Patricia A. Buffler, Diego T. Buriot, Jose Cordero, Ronald E. Gots, Ronald Hart, Steven H. Lamm, Angus Nicoll, Onora O’Neill, Samuel Osher, James D. Watson and Richard Wilson in Support of Respondent

– Brief for the Chamber of Commerce of the United States of America in Support of Respondent

– Brief for Kenneth W. Starr and Erwin Chemerinsky in Support of Petitioners Urging Reversal

The Weekly Epidemiological Record (WER) for 15 October 2010, vol. 85, 42 (pp 413–424) includes: Controlling rubella and preventing congenital rubella syndrome – global progress, 2009; Antigenic and genetic characteristics of influenza A(H5N1) and influenza A(H9N2) viruses and candidate vaccine viruses developed for potential use in human vaccines. http://www.who.int/entity/wer/2010/wer8542.pdf

The MMWR for October 15, 2010 / Vol. 59 / No. 40, includes:

–  Estimated Lifetime Risk for Diagnosis of HIV Infection Among Hispanics/Latinos — 37 States and Puerto Rico, 2007

–  Tetanus and Pertussis Vaccination Coverage Among Adults Aged ≥18 Years — United States, 1999 and 2008

–  Progress Toward Control of Rubella and Prevention of Congenital Rubella Syndrome — Worldwide, 2009

–  Announcements: Final 2009–10 Influenza Season Vaccination Coverage Estimates

–  Announcements: Conference on Mobile Technologies Use for Public Health and Medical Information — November 8–10, 2010

http://www.cdc.gov/mmwr/PDF/wk/mm5940.pdf

The UN’s Food and Agriculture Organization (FAO) announced that “an ambitious global effort that has brought rinderpest, a deadly cattle plague, to the brink of extinction, is ending all field activities, paving the way for official eradication of the disease.” FOA made the announcement at a Global Rinderpest Eradication Symposium held in Rome, 13-14 October 2010. The eradication, achieved through mass immunization with vaccines, “…would be the first time in history that humankind has succeeded in wiping out an animal disease in the wild, and only the second time, after smallpox in 1980, that a disease has been eliminated thanks to human efforts.” Rinderpest does not affect humans directly, but its ability to cause swift, massive losses of cattle and other hoofed animals has led to devastating effects on agriculture for millennia, leaving famine and economic devastation in its wake, FOA said. A joint FAO/OIE announcement of global rinderpest eradication is expected in mid-2011, pending a review of final official disease status reports from a handful of countries to the World Organisation for Animal Health (OIE).

The Lancet
Oct 16, 2010  Volume 376 Number 9749 Pages 1273 – 1362
http://www.thelancet.com/journals/lancet/issue/current

Editorial
The Global Fund: a bleak future ahead
The Lancet

Extract
On Oct 5, at the third replenishment conference for the Global Fund to Fight AIDS, Tuberculosis and Malaria, donors pledged US$11.7 billion for 2011–13—a sum that falls badly short of what is needed. The world is backsliding on its commitments, made recently at the Millennium Development Goal Summit in New York, to expand access for millions of people to life-saving interventions.

The Lancet
Oct 16, 2010  Volume 376 Number 9749 Pages 1273 – 1362
http://www.thelancet.com/journals/lancet/issue/current

Comment
Time for a bold new vision at the Stop TB Partnership
Salmaan Keshavjee, Francoise Girard, Mark Harrington, Paul E Farmer

New England Journal of Medicine
October 14, 2010  Vol. 363 No. 16
http://content.nejm.org/current.shtml

Perspectives
Legislating against Use of Cost-Effectiveness Information
P.J. Neumann, M.C. Weinstein [free full-text]

Science
15 October 2010  Vol 330, Issue 6002, Pages 281-412
http://www.sciencemag.org/current.dtl

News of the Week
Immunology:
Painful Failure of Promising Genital Herpes Vaccine
Jon Cohen

A vaccine designed to ward off genital herpes has failed in a large clinical trial, abruptly ending the product’s seemingly promising future. After 8 years of study in more than 8000 women in the United States and Canada, there was not even a hint of a positive result against the sexually transmitted disease caused by herpes simplex virus-2.

Science Translational Medicine
13 October 2010 vol 2, issue 53
http://stm.sciencemag.org/content/current

Research Articles
Vaccines
A Defined Tuberculosis Vaccine Candidate Boosts BCG and Protects Against Multidrug-Resistant Mycobacterium tuberculosis
Sylvie Bertholet, Gregory C. Ireton, Diane J. Ordway, Hillarie Plessner Windish, Samuel O. Pine, Maria Kahn, Tony Phan, Ian M. Orme, Thomas S. Vedvick, Susan L. Baldwin, Rhea N. Coler, and Steven G. Reed
13 October 2010: 53ra74

A vaccine with a four-protein fusion peptide from Mycobacterium tuberculosis effectively boosts the current childhood TB vaccine and protects against drug-resistant TB.

Science Translational Medicine
13 October 2010 vol 2, issue 53
http://stm.sciencemag.org/content/current

Editor’s Choice
Human Papillomavirus
To Vaccinate or Not: Parents Decide
Donna E. Hansel
13 October 2010: 53ec160

Although prophylactic human papillomavirus vaccines now are available, fewer than 20% of girls 9 to 26 years of age have completed the three-dose series.

The GAVI Alliance held its “first replenishment meeting” in New York last week “to agree on how to fund programmes to avert an estimated 4.2 million future deaths through immunisation.” GAVI said the meeting was intended to “…set the stage for a pledging conference in 2011” in the context of efforts to raise US$4.3 billion to scale-up its immunisation programmes in developing countries between 2010 and 2015.”  GAVI did not release a summary of meeting actions but issued media releases on a commitment by Canada of $50 million over five years, and a new pledge by Australia of A$60 million (US$58 million) over three years, doubling the country’s previous commitment.

Media Releases at: http://www.gavialliance.org/media_centre/press_releases/index.php

Novartis announced a collaboration with Synthetic Genomics Vaccines Inc. to “combine synthetic biology and genome sequencing capabilities with leading edge vaccine technology to create more flexible processes to generate influenza seed viruses, with the aim to speed up influenza vaccine production.” The three-year agreement is supported by a BARDA award. The anno8uncement noted that “currently Novartis and other vaccines companies rely on the WHO to identify and distribute live reference viruses to create seasonal or pandemic vaccines. Under this collaboration, Novartis and SGVI will work to develop a “bank” of synthetically constructed seed viruses ready to go into production as soon as WHO identifies the flu strains. The technology could reduce the vaccine production time by up to two months, which is particularly critical in the event of a pandemic.”

Rino Rappuoli, Head of Research for Novartis Vaccines and Diagnostics, said, “Our research strategy has always been to apply new vaccine technologies and innovation to deliver better prevention methods and meet patient needs. We are pleased to work in collaboration with Craig Venter and SGVI to study and develop this promising and important new synthetic genomics technology. It has the potential to safely reduce the time needed to develop new vaccines and improve pre-pandemic preparedness.”

Novartis said it “plans to test vaccines that could potentially result from this new approach in large-scale clinical trials. Review and approval from country health authorities will be obtained before any commercial use.”

http://www.novartis.com/newsroom/media-releases/en/2010/1449685.shtml

Johnson & Johnson and Crucell announced an agreement whereby Johnson & Johnson will acquire all outstanding equity of Crucell that it does not already own for approximately € 1.75 billion in a recommended cash tender offer. Johnson & Johnson currently owns 17.9% of Crucell’s outstanding shares. J&J said it “expects to maintain Crucell’s existing facilities, to retain Crucell’s senior management and, generally, to maintain current employment levels. Johnson & Johnson also intends to keep Crucell as the center for vaccines within the Johnson & Johnson pharmaceutical group, and to maintain Crucell’s headquarters in Leiden.  Paul Stoffels, Global Head, Pharmaceutical Research and Development, Johnson & Johnson, commented, “Johnson & Johnson and Crucell share a commitment to improving the lives of people worldwide. This potential combination would provide us with a new platform for growth and advances our goal to deliver integrated health care solutions, with particular emphasis on prevention. Operational excellence in manufacturing and supply chain has made Crucell an established and reliable supplier of vaccines, in particular to emerging markets. We hope to build on those capabilities, and the expertise and talent of Crucell’s employees to continue making a difference in the lives of people worldwide.”
http://www.jnj.com/connect/news/corporate/Johnson-and-Johnson-and-Crucell-Reach-Agreement-on-Intended-Public-Offer-of-Ordinary%20Share-of-Crucell

NIH announced “three new contracts to fund research on vaccines to protect against emerging infectious diseases and biological threats that could be used in a terror attack.”  Total funding for the three awards could reach US$68 million depending on the successful completion of defined project milestones. NIAID Director Anthony S. Fauci, M.D. commented, “These new contracts build on NIAID’s commitment to support the advanced development of products that are important to the public health but often unattractive to investors in private industry, by bridging the funding gap with contracts intended to address specific health needs.” The three studies will focus on a dengue vaccine delivered by a needle-free device, an anthrax vaccine delivered orally, and an anthrax vaccine delivered in conjunction with an adjuvant. Clinical trials of all three vaccine products should begin within three years, FDA noted

http://www.nih.gov/news/health/oct2010/niaid-07.htm

The FDA awarded US$904,000 to Pan American Health Organization (PAHO) “to research and develop an information hub for medical products and related regulatory processes and systems in the Americas Region.” FDA said the “hub” will collect and produce data and map structures and processes in the areas of medical products, including drugs, biologics, vaccines, medical devices and other medical products, and related regulatory processes and systems. The award “will help FDA, and all PAHO member states, to better understand other countries’ regulatory systems, support capacity to use harmonized standards and guidelines across countries, and prevent, and if necessary respond more quickly to, problems in the medical product supply chain.” The FDA noted that “regulatory agencies in the Americas Region have different legal and regulatory frameworks, different institutional and administrative structures, different standards and guidelines, and different ways of collecting and analyzing information. Better collaboration among these agencies will build confidence and knowledge among the participants, stakeholders, and ultimately benefit patients and consumers throughout the region.”

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm228423.htm

PAHO: http://new.paho.org/hq/index.php

BARDA (Biomedical Advanced Research and Development Authority) announced a three-year, US$57 million contract to Sanofi Pasteur to “secure a continued year-round supply of eggs and other essential supplies for pandemic influenza vaccine as part of pandemic preparedness.” BARDA Director Dr. Robin Robinson commented, “This contract ensures that progress continues in creating a solid base for manufacturing pandemic influenza vaccine in the United States. While BARDA is currently investing in the development of new vaccine technologies, we must also ensure a robust supply of vaccine for Americans with technologies currently available.”

http://www.businesswire.com/news/home/20101008005977/en/BARDA-Funds-Year-Round-Egg-Supply-Pandemic-Flu

The Weekly Epidemiological Record (WER) for 8 October 2010, vol. 85, 41 (pp 401–412) includes: Outbreak news – Yellow fever, Senegal; Recommended viruses of influenza vaccines for use in the 2011 influenza season (southern hemisphere)

http://www.who.int/entity/wer/2010/wer8541.pdf

The MMWR for October 8, 2010 / Vol. 59 / No. 39, includes:

– Seasonal Influenza Vaccination Coverage Among Children Aged 6 Months–18 Years — Eight Immunization Information System Sentinel Sites, United States, 2009–10 Influenza Season

– Influenza Activity — United States and Worldwide, June 13–September 25, 2010

– Announcement: Application Deadline for The CDC Experience Applied Epidemiology Fellowship — December 3, 2010

http://www.cdc.gov/mmwr/PDF/wk/mm5939.pdf

Clinical Infectious Diseases
1 November 2010  Volume 51, Number 9
http://www.journals.uchicago.edu/toc/cid/current

Editorial Commentary:
Cell Culture–Derived Influenza Vaccines: Has Their Time Come?
David I. Bernstein

Articles and Commentaries
Clinical Efficacy of Cell Culture–Derived and Egg‐Derived Inactivated Subunit Influenza Vaccines in Healthy Adults
Sharon Frey, Timo Vesikari, Agnieszka Szymczakiewicz-Multanowska, Maria Lattanzi, Allen Izu, Nicola Groth, and Sandra Holmes

This trial evaluated the efficacy of cell culture– and egg‐derived influenza vaccines versus placebo. The high overall vaccine efficacies, 83.8% and 78.4% against vaccine-like and 69.5% and 63.0% against all circulating influenza virus strains, support use of both vaccines for seasonal influenza vaccination.

JAMA
Vol. 304 No. 13, pp. 1413-1514, October 6, 2010
http://jama.ama-assn.org/current.dtl

Special Communications
Evaluating the Risks of Clinical Research
Annette Rid; Ezekiel J. Emanuel; David Wendle

Abstract
The ethical appropriateness of clinical research depends on protecting participants from excessive risks. Yet no systematic framework has been developed to assess research risks, and as a result, investigators, funders, and review boards rely only on their intuitive judgments. Because intuitive judgments of risk are subject to well-documented cognitive biases, this approach raises concern that research participants are not being adequately protected. To address this situation, we delineate a method called the systematic evaluation of research risks (SERR), which evaluates the risks of research interventions by comparing these interventions with the risks of comparator activities that have been deemed acceptable. This method involves a 4-step process: (1) identify the potential harms posed by the proposed research intervention; (2) categorize the magnitude of the potential harms into 1 of 7 harm levels on a harm scale; (3) quantify or estimate the likelihood of each potential harm; and (4) compare the likelihood of each potential harm from the research intervention with the likelihood of harms of the same magnitude occurring as a result of an appropriate comparator activity. By explicitly delineating, quantifying, and comparing the risks of research interventions with the risks posed by appropriate comparator activities, SERR offers a way to minimize the influence of cognitive biases on the evaluation of research risks and thereby better protect research participants from excessive risks.

The Lancet
Oct 09, 2010  Volume 376  Number 9748  Pages 1195 – 1272
http://www.thelancet.com/journals/lancet/issue/current

Comment
Academic medicine must take its global role: the M8 Alliance of Academic Health Centers and Medical Universities
Mazda Adli, Sabine Kleinert, Stephen K Smith, Detlev Ganten

Preview
At the inaugural World Health Summit in 2009, the M8 Alliance of Academic Health Centers and Medical Universities was formed to lead intensified international debate about research and education in global health challenges. The idea was to create an international forum that seeks discussions with governmental representatives, policy makers, non-governmental organisations, civil society, and the health-related industry to initiate cross-sectoral solutions for the most pressing global health challenges.

The Lancet
Oct 09, 2010  Volume 376  Number 9748  Pages 1195 – 1272
http://www.thelancet.com/journals/lancet/issue/current

Global health governance—the response to infectious diseases
Rose Gana Fomban Leke

Preview
The burden of disease that affects the developing world has grown from a high prevalence of communicable infectious diseases1 to new additions of emerging infections plus an increasing problem of non-communicable diseases.2,3 Most infectious diseases are largely specific to the world’s poorest regions, and sub-Saharan Africa bears a great burden of these diseases.4 Bilateral and multilateral institutions, followed by organisations and many new initiatives including advocates for health, make up the multiple actors that are responding to the increasing threats of such a crisis in infectious disease.

The Lancet
Oct 09, 2010  Volume 376  Number 9748  Pages 1195 – 1272
http://www.thelancet.com/journals/lancet/issue/current

Review
Financing of HIV/AIDS programme scale-up in low-income and middle-income countries, 2009–31
Robert Hecht, John Stover, Lori Bollinger, Farzana Muhib, Kelsey Case, David de Ferranti

Summary
As the global HIV/AIDS pandemic nears the end of its third decade, the challenges of efficient mobilisation of funds and management of resources are increasingly prominent. The aids2031 project modelled long-term funding needs for HIV/AIDS in developing countries with a range of scenarios and substantial variation in costs: ranging from US$397 to $722 billion globally between 2009 and 2031, depending on policy choices adopted by governments and donors. We examine what these figures mean for individual developing countries, and estimate the proportion of HIV/AIDS funding that they and donors will provide. Scenarios for expanded HIV/AIDS prevention, treatment, and mitigation were analysed for 15 representative countries. We suggest that countries will move in increasingly divergent directions over the next 20 years; middle-income countries with a low burden of HIV/AIDS will gradually be able to take on the modest costs of their HIV/AIDS response, whereas low-income countries with a high burden of disease will remain reliant upon external support for their rapidly expanding costs. A small but important group of middle-income countries with a high prevalence of HIV/AIDS (eg, South Africa) form a third category, in which rapid scale-up in the short term, matched by outside funds, could be phased down within 10 years assuming strategic investments are made for prevention and efficiency gains are made in treatment.

Pediatrics
October 2010 / VOLUME 126 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Articles
Prenatal and Infant Exposure to Thimerosal From Vaccines and Immunoglobulins and Risk of Autism
Cristofer S. Price, William W. Thompson, Barbara Goodson, Eric S. Weintraub, Lisa A. Croen, Virginia L. Hinrichsen, Michael Marcy, Anne Robertson, Eileen Eriksen, Edwin Lewis, Pilar Bernal, David Shay, Robert L. Davis, and Frank DeStefano

OBJECTIVE Exposure to thimerosal, a mercury-containing preservative that is used in vaccines and immunoglobulin preparations, has been hypothesized to be associated with increased risk of autism spectrum disorder (ASD). This study was designed to examine relationships between prenatal and infant ethylmercury exposure from thimerosal-containing vaccines and/or immunoglobulin preparations and ASD and 2 ASD subcategories: autistic disorder (AD) and ASD with regression.

METHODS A case-control study was conducted in 3 managed care organizations (MCOs) of 256 children with ASD and 752 controls matched by birth year, gender, and MCO. ASD diagnoses were validated through standardized in-person evaluations. Exposure to thimerosal in vaccines and immunoglobulin preparations was determined from electronic immunization registries, medical charts, and parent interviews. Information on potential confounding factors was obtained from the interviews and medical charts. We used conditional logistic regression to assess associations between ASD, AD, and ASD with regression and exposure to ethylmercury during prenatal, birth-to-1 month, birth-to-7-month, and birth-to-20-month periods.

RESULTS There were no findings of increased risk for any of the 3 ASD outcomes. The adjusted odds ratios (95% confidence intervals) for ASD associated with a 2-SD increase in ethylmercury exposure were 1.12 (0.83–1.51) for prenatal exposure, 0.88 (0.62–1.26) for exposure from birth to 1 month, 0.60 (0.36–0.99) for exposure from birth to 7 months, and 0.60 (0.32–0.97) for exposure from birth to 20 months.

CONCLUSIONS In our study of MCO members, prenatal and early-life exposure to ethylmercury from thimerosal-containing vaccines and immunoglobulin preparations was not related to increased risk of ASDs.

PLoS Medicine
(Accessed 10 October 2010)
http://medicine.plosjournals.org/perlserv/?request=browse&issn=1549-1676&method=pubdate&search_fulltext=1&order=online_date&row_start=1&limit=10&document_count=1533&ct=1&SESSID=aac96924d41874935d8e1c2a2501181c#results

Reflections on Pandemic (H1N1) 2009 and the International Response
Gabriel M. Leung, Angus Nicoll

Summary Points
– Many of the initial responses to the 2009 H1N1 pandemic went well but there are many lessons to learn for future pandemic planning.

– Clear communication of public health messages is crucial, and should not confuse what could happen (and should be prepared for) with what is most likely to happen.

– Decisions regarding pandemic response during the exigencies of a public health emergency must be judged according to the best evidence available at the time.

– Revising pandemic plans—to be more flexible and more detailed—should wait for WHO leadership if national plans are not to diverge. Surveillance beyond influenza should be stepped up, and contingencies drawn up for the emergence or re-emergence of other novel and known pathogens.

– Data collection and sharing are paramount, and include epidemiological and immunological data. Clinical management of severe influenza disease should not be limited to the current antiviral regimen, and include the development of other therapeutics (e.g., novel antivirals and immunotherapy).

– Greater and more timely access to antivirals and influenza vaccines worldwide remains an ongoing challenge.

Vaccine
Volume 28, Issue 44 pp. 7137-7240 (18 October 2010)

Editorial
A global prescription for adult immunization: Time is catching up with us
Pages 7137-7139
Gregory A. Poland, Joël Belmin, Joanne Langley, Jean-pierre Michel, Pierre Van Damme, Sabine Wicker

Vaccine
Volume 28, Issue 44 pp. 7137-7240 (18 October 2010)

Regular Articles
Design of a robust infrastructure to monitor the safety of the pandemic A(H1N1) 2009 vaccination program in Taiwan
Original Research Article
Pages 7161-7166
Wan-Ting Huang, Wen-Wen Chen, Hsu-Wen Yang, Wan-Chin Chen, Yen-Nan Chao, Yu-Wen Huang, Jen-Hsiang Chuang, Hsu-Sung Kuo

Abstract
On November 1, 2009, Taiwan began a nationwide pandemic A(H1N1) 2009 vaccine (“H1N1 vaccine”) program to control the influenza pandemic. Timely assessment of immunization safety during this mass vaccination campaign was a public health priority. Therefore, the government developed a national postlicensure safety surveillance strategy to identify and evaluate new, unexpected, or prioritized adverse events in recipients of H1N1 vaccine in near real-time. We describe the design and methodology of this new safety assessment infrastructure, address challenges encountered, and its potential future use for routine vaccine pharmacovigilance in Taiwan.

Vaccine
Volume 28, Issue 44 pp. 7137-7240 (18 October 2010)

Middle- and high-school health education regarding adolescent vaccines and human papillomavirus
Original Research Article
Pages 7179-7183
Amanda F. Dempsey, Sarah Schaffer

Abstract
We performed a mail-based survey of health education teachers in 6 states with diverse health education environments to better understand health education curricula in secondary schools related to adolescent vaccination and human papillomavirus (HPV) infection. Of the 198 respondents (response rate 68%), 66% and 71% reported teaching adolescents about recommended vaccines and HPV, respectively. Middle schools were significantly less likely to include these topics in their health curriculum than high schools even though middle schools are generally the school type attended by 11–12 year olds, the preferred target age for adolescent vaccination and HPV prevention activities.

Vaccine
Volume 28, Issue 44 pp. 7137-7240 (18 October 2010)

Knowledge and attitudes regarding influenza vaccination among nurses: A research review

Original Research Article
Pages 7207-7214
Jing Zhang, Alison E. While, Ian J. Norman

Abstract
Introduction
Influenza vaccination rates among nurses remain suboptimal despite health authority recommendations in many countries and several vaccination campaign programmes to encourage nurses to be vaccinated in many institutions. We reviewed published studies investigating nurses’ knowledge and attitudes towards influenza vaccination to establish what is known about the determinants of nurses’ influenza vaccination practices.

Methods
Relevant articles published up to July 2010 were identified through multiple databases (CINAHL, MEDLINE, PubMed, EMBASE, BNI, HMIC, PsycINFO, CMAC, and CNJ) using predetermined search strategies. Review of the titles and abstracts revealed 182 of 254 references were not relevant. Of 45 full papers reviewed, 32 did not report nurse data separately and one was a duplicate report of a study.

Results
We included 12 research studies which had investigated the relationship between knowledge and attitudes towards influenza vaccination and nurses’ vaccination practices published between 2003 and 2010. All the studies were descriptive and relied upon self-report data. The findings of this review indicate a relationship between knowledge, attitudes and vaccination practices of nurses. There were three main findings: first, there was a strong association between nurses’ knowledge of influenza and vaccination and their vaccination status; second, the surveys showed a positive relationship between perceptions of influenza as a serious illness and vaccination as effective and safe and a positive vaccination status; and third, there was a relationship between nurses’ vaccination status and their reported promotion of vaccination to their patients.

Conclusion
This review indicates that higher knowledge and positive attitudes towards influenza vaccination have a significantly positive association with vaccination coverage among nurses. Further studies are needed to identify influences on nurses’ attitudes and practices regarding influenza vaccination and the personal, organizational, and situational factors that influence the uptake of influenza vaccine by nurses.

Vaccine
Volume 28, Issue 43  pp. 6943-7136 (8 October 2010)

Meeting Report
Polio vaccines and polio immunization in the pre-eradication era: WHO position paper—Recommendations
Pages 6943-6944
World Health Organization Department of Immunization Vaccines and Biologicals 20, Avenue Appia 1211 Geneva 27 Switzerland WHO Publication

Abstract
This article presents the WHO recommendations on the use of polio vaccines excerpted from the recently published Polio vaccines and polio immunization in the pre-eradication era: WHO position paper. This document replaces the WHO position paper entitled Introduction of inactivated poliovirus vaccine into oral poliovirus vaccine-using countries published in the Weekly Epidemiological Record in July 2003. Footnotes to this paper provide a limited number of core references; their abstracts as well as a more comprehensive list of references may be found at http://www.who.int/immunization/documents/positionpapers/en/index.html. Grading tables which assess the quality of scientific evidence for key conclusions are also available through this link and are referenced in the position paper.

Vaccine
Volume 28, Issue 43  pp. 6943-7136 (8 October 2010)

Global use of Haemophilus influenzae type b conjugate vaccine

Original Research Article
Pages 7117-7122
Linda R. Ojo, Rosalyn E. O’Loughlin, Adam L. Cohen, Jennifer D. Loo, Karen M. Edmond, Sharmila S. Shetty, Allyson P. Bear, Lois Privor-Dumm, Ulla K. Griffiths, Rana Hajjeh

Abstract
Haemophilus influenzae type b (Hib) conjugate vaccines have been underutilized globally. We report progress in global use of Hib vaccines included in national immunization schedules. The number of countries using Hib vaccine increased from 89/193 (46%) in 2004 to 158/193 (82%) by the end of 2009. The increase was greatest among low-income countries eligible for financial support from the GAVI Alliance [13/75 (17%) in 2004, 60/72 (83%) by the end of 2009], and can be attributed to various factors. Additional efforts are still needed to increase vaccine adoption in lower middle income countries [20/31 (65%) by the end of 2009].

Vaccine
Volume 28, Issue 43  pp. 6943-7136 (8 October 2010)

Supporting new vaccine introduction decisions: Lessons learned from the Hib Initiative experience

Original Research Article
Pages 7123-7129
R.A. Hajjeh, L. Privor-Dumm, K. Edmond, R. O’Loughlin, S. Shetty, U.K. Griffiths, A.P. Bear, A.L. Cohen, A. Chandran, A. Schuchat, E.K. Mulholland, M. Santosham

Abstract
The introduction of Haemophilus influenzae type b (Hib) vaccine in developing countries has suffered from a long delay. Between 2005 and 2009, a surge in Hib vaccine adoption took place, particularly among GAVI-eligible countries. Several factors contributed to the increase in Hib vaccine adoption, including support provided by the Hib Initiative, a project funded by the GAVI Alliance in 2005 to accelerate evidence-informed decisions for use of Hib vaccine. This paper reviews the strategy adopted by the Hib Initiative and the lessons learned in the process, which provide a useful model to accelerate uptake of other new vaccines.

United States and Norway will co-host a meeting of GAVI Alliance donors and partners on 6 October 2010. The high-level meeting of GAVI Alliance donors, potential donors and partners in New York on 6 October “to build on GAVI’s cost-effective success in preventing 5.4 million deaths in its first 10 years.” GAVI Alliance partners “will agree on action to avert an estimated 4.2 million future deaths through immunisation. The meeting will also set the outline for a pledging meeting in 2011. GAVI needs to raise US$4.3 billion to scale-up immunisation programmes between 2010 and 2015.”

http://www.gavialliance.org/about/resource_event/index.php\

WHO released a revised position paper on Pertussis vaccination in the Weekly Epidemiological Record, reaffirming “that high coverage of infants with 3 doses of quality pertussis vaccine remains the most important element of pertussis vaccination programmes.” WHO recommends a 3-dose primary series with the first dose administered at 6 weeks of age, and subsequent doses given 4-8 weeks apart, at 10-14 and 14-18 weeks of age. The last dose of the recommended primary series should be completed by the age of 6 months, with a booster dose, given at least 6 months after the last primary dose, recommended for children 1- 6 years of age, preferably during the second year of life. The position paper includes information on the relative merits, in terms of efficacy, safety and cost-effectiveness, of the whole-cell and acellular pertussis vaccines, and detailed information on the administration and schedules for pertussis vaccines.

http://www.who.int/wer/2010/wer8540.pdf

BARDA (Biomedical Advanced Research and Development Authority/HHS) said it is providing three sets of grants totaling $10.4 million “to help the World Health Organization (WHO) strengthen the ability of developing countries to produce flu vaccine, potentially reducing the global threat from influenza.” The grants will be used to assist developing countries with pandemic influenza vaccine manufacturing infrastructure, training on influenza vaccine manufacturing, and development and distribution of certain technologies for pandemic influenza vaccines. Robin Robinson, BARDA director, commented, “While we continue to build vaccine manufacturing capacity in the United States, and develop new, faster technologies for producing vaccine domestically, we can increase pandemic preparedness worldwide by helping other countries take advantage of technology.” Through this WHO initiative over the past five years, $40 million in U.S. funding has been used to develop vaccine manufacturing infrastructure in 10 countries: Egypt, India, Indonesia, Vietnam, Brazil, Mexico, Russia, Romania, Serbia, and Thailand.

“The second set of grants supports training on cutting-edge manufacturing techniques for WHO grantees. North Carolina State University’s Biotechnology and Education Center received $861,000, and Utah State’s Center for Integrated Biosystems received $322,000, to train selected personnel from manufacturers in developing countries. Trainees will receive hands-on instruction in the latest U.S. Food and Drug Administration good manufacturing practices in vaccine production technology. These practices can be taken back and implemented by manufacturers in their native countries.

“The third set of grants supports development of adjuvant and the transfer of technology to produce adjuvant. The use of adjuvants has been shown to reduce the amount of protein needed for flu vaccine to be effective, so the adjuvanted vaccine made in these countries could serve a greater number of people. The Infectious Disease Research Institute in Seattle received $790,000, and the University of Lausanne in Switzerland received $1.8 million, to develop adjuvants and other technologies that can be transferred without the restriction of intellectual property rights.”

http://www.businesswire.com/news/home/20100930007040/en/BARDA-Grants-Build-Global-Flu-Vaccine-Manufacturing