Vaccine
Volume 28, Issue 29, Pages 4539-4686 (23 June 2010)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Measles in the United Kingdom 1990–2008 and the effectiveness of measles vaccines
Hershel Jick, Katrina Wilcox Hagberg

Abstract
We identified all children in the UK General Practice Research Database diagnosed with measles from 1990 to 2008 and calculated annual incidence according to age and geographic region by dividing the number of cases per year by the number of children who were active in the population. We evaluated the effectiveness of the measles vaccines by comparing the vaccination histories of children who were diagnosed with measles (cases) to children who were not (controls). The annual incidence of measles fell after the introduction of the MMR vaccine in late 1988. However, a modest outbreak of measles occurred in 1994, leading to large nationwide programs to immunize children. Since 1996, the incidence of measles has fallen by more than 80%. Prior measles vaccination is highly effective and has substantially reduced the risk of measles.

Vaccine
Volume 28, Issue 29, Pages 4539-4686 (23 June 2010)
http://www.sciencedirect.com/science/journal/0264410X

A cost–effectiveness analysis of Japanese encephalitis vaccine in Cambodia
Sok Touch, Chutima Suraratdecha, Chham Samnang, Seng Heng, Lauren Gazley, Chea Huch, Ly Sovann, Chab Seak Chhay, Sann Chan Soeung

Abstract
This study aimed to evaluate the cost and effectiveness of introducing a live, attenuated vaccine (SA 14-14-2) against Japanese encephalitis (JE) into the immunization program. The study demonstrated that SA 14-14-2 immunization is cost–effective in controlling JE in Cambodia compared to no vaccination. Averting one disability-adjusted life year, from a societal perspective, through the introduction of SA 14-14-2 through routine immunization, or a combination of routine immunization plus a campaign targeting children 1–5 or 1–10 years of age, costs US$22, US$34 and US$53, respectively. Sensitivity analyses confirmed that there was a high probability of SA 14-14-2 immunization being cost–effective under conditions of uncertainty.

Vaccine
Volume 28, Issue 29, Pages 4539-4686 (23 June 2010)
http://www.sciencedirect.com/science/journal/0264410X

Influenza vaccination of future healthcare workers: A cross-sectional study of uptake, knowledge and attitudes
Debra L. Blank, David M.S. Bodansky, Anna Forbes, Emma Garde, Fleur Story, Andrea K. Roalfe, Lynda Tait

Abstract
Promotional campaigns recommend immunisation against influenza in healthcare workers (HCWs) but the uptake in this group remains low. We conducted a survey study during the 2008–2009 influenza vaccination period amongst future HCWs to quantify uptake and identify barriers to immunisation. Overall uptake was 8.0% (95% CI 5.9–10.8%), which is lower than the uptake amongst current HCWs (13.4%) and short of current government targets (75%). Knowledge about influenza was good but insufficient to encourage HCWs to get vaccinated. Promotional campaigns are needed that emphasise the role of vaccination in personal and patient protection.

WHO released its Pandemic (H1N1) 2009 vaccine deployment update – 31 May 2010. The update, reflecting activity in the WHO “stockpile”, notes that:

– 99 countries have requested vaccine donations

– 86 countries have signed agreements with WHO

– National Deployment Plans: 67 are complete and final; 7 plans are being refined

– Through 31 May 2010, 49 countries have received 32,393, 600 doses of pandemic (H1N1) vaccine. The overall stockpile has received pledges of some 200 million doses, and commitments of 118 million doses. The report notes that the apparent gap is “not applicable since sufficient vaccines have been pledged to meet at least 10% population coverage of all countries that have requested vaccine.”

This one-page update available at:

http://www.who.int/csr/disease/swineflu/action/h1n1_vaccine_deployment_update20100531.pdf

The WHO continues to issue weekly updates on the H1N1 pandemic at http://www.who.int/csr/disease/swineflu/en/index.html
Pandemic (H1N1) 2009 – update 103
Weekly update
4 June 2010

As of 30 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18138 deaths…

Situation update:
Active but declining transmission of pandemic influenza virus continued to be detected in parts of the Caribbean and Southeast Asia. In the countries of temperate southern hemisphere there is no evidence yet to suggest that the winter influenza season has begun, however there has been limited localized pandemic influenza virus transmission in Chile. In the rest of the world, overall pandemic influenza virus transmission remains low. Seasonal influenza B viruses are currently the predominant type of influenza virus circulating globally, although at low levels. Of note, during the later part of May 2010, low but significant levels of predominantly seasonal influenza H3N2 viruses have been detected in several countries of East Africa.

More at: http://www.who.int/csr/don/2010_05_21/en/index.html

The MMWR Weekly for June 4, 2010 / 59(21);657-661, includes:

Preliminary Results: Surveillance for Guillain-Barré Syndrome After Receipt of Influenza A (H1N1) 2009 Monovalent Vaccine — United States, 2009–2010

On June 2, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr).

Guillain-Barré syndrome (GBS) is an uncommon peripheral neuropathy causing paralysis and in severe cases respiratory failure and death. GBS often follows an antecedent gastrointestinal or upper respiratory illness but, in rare cases, can follow vaccination. In 1976, vaccination against a novel swine-origin influenza A (H1N1) virus was associated with a statistically significant increased risk for GBS in the 42 days after vaccination (approximately 10 excess cases per 1 million vaccinations), a consideration in halting the vaccination program in the context of limited influenza virus transmission (1). To monitor influenza A (H1N1) 2009 monovalent vaccine safety, several federal surveillance systems, including CDC’s Emerging Infections Program (EIP), are being used. In October 2009, EIP began active surveillance to assess the risk for GBS after 2009 H1N1 vaccination. Preliminary results from an analysis in EIP comparing GBS patients hospitalized through March 31, 2010, who did and did not receive 2009 H1N1 vaccination showed an estimated age-adjusted rate ratio of 1.77 (GBS incidence of 1.92 per 100,000 person-years among vaccinated persons and 1.21 per 100,000 person-years among unvaccinated persons). If end-of-surveillance analysis confirms this finding, this would correspond to 0.8 excess cases of GBS per 1 million vaccinations, similar to that found in seasonal influenza vaccines (2,3). No other federal system to date has detected a statistically significant association between GBS and 2009 H1N1 vaccination. Surveillance and further analyses are ongoing.

The 2009 H1N1 vaccine safety profile is similar to that for seasonal influenza vaccines, which have an excellent safety record. Vaccination remains the most effective method to prevent serious illness and death from 2009 H1N1 influenza infection; illness from the 2009 H1N1 influenza virus has been associated with a hospitalization rate of 222 per 1 million and a death rate of 9.7 per 1 million population.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5921a3.htm

The MMWR Weekly for May 28, 2010 / Vol. 59 / No. 20 / Pg. 613 – 648, includes:

– FDA Licensure of Bivalent Human Papillomavirus Vaccine (HPV2, Cervarix) for Use in Females and Updated HPV Vaccination Recommendations from the Advisory Committee on Immunization Practices (ACIP)

– FDA Licensure of Quadrivalent Human Papillomavirus Vaccine (HPV4, Gardasil) for Use in Males and Guidance from the Advisory Committee on Immunization Practices (ACIP)

http://www.cdc.gov/mmwr/mmwr_wk/wk_cvol.html

The Weekly Epidemiological Record (WER) for 4 June 2010, vol. 85, 23 (pp 213–228) includes: Polio vaccines and polio immunization in the pre-eradication era: WHO position paper. http://www.who.int/wer/2010/wer8523.pdf

In a posting, WHO noted:

“A new position paper covering routine polio immunization in the pre-eradication era, particularly in developing country settings, was published today in the WHO Weekly Epidemiological Record. The position paper includes information on the types of polio vaccine available, and their safety, immunogenicity, field efficacy and cost-effectiveness. It concludes with policy recommendations.

“Prior to polio eradication, national immunization schedules should include either oral polio vaccine, inactivated polio vaccine, or a combination of both. Vaccine decisions should be based on assessments of the potential for importation of wild poliovirus (WPV) and subsequent transmission. High immunization coverage is essential to ensure adequate population immunity. As long as WPV transmission has not been interrupted everywhere, all polio-free countries and areas remain at risk of re-importation, particularly from the remaining polio-endemic countries.

http://www.who.int/immunization/newsroom/news_routine_polio_immunization_position_paper_2010/en/index.html

iBio, Inc. and the Fraunhofer USA Center for Molecular Biotechnology (CMB) announced an agreement which provides a license of iBio’s proprietary technology to CMB for the development and manufacture of Global Health Vaccines for, and financed by, the Bill & Melinda Gates Foundation. The announcement noted that “…a principal focus of the Bill & Melinda Gates Foundation is to provide access to vaccines for the neediest people in the developing countries in the world (Global Alliance for Vaccines & Immunization (GAVI) Eligible Countries), representing vast numbers of people currently unable to afford preventive and therapeutic medical care (Global Access Objectives). Global Health Vaccines, subject to this agreement, are vaccines for human or veterinary use for the prevention of malaria, tuberculosis, rotavirus, trypanosomiasis, hookworm and rabies.”

The announcement continues: “Under the terms of the Agreement, CMB will use iBio’s technology under a non-exclusive, non-royalty bearing grant to develop and test new Global Health Vaccines funded by the Bill & Melinda Gates Foundation. The Agreement establishes iBio as the preferred manufacturer of Global Health Vaccines and provides a right of first refusal to iBio to provide technology transfer and vaccine manufacturing services to achieve Global Access Objectives on a commercially reasonable, competitive and sustainable cost basis. In accordance with prior agreements, iBio will own commercial rights to new technology and improvements arising during the course of the programs. Additional terms of the Agreement provide for mutual cooperation with respect to the sharing of clinical data and regulatory filings related to the program.”

Robert Kay, Chairman and CEO of iBio, said, “The attributes of our technology – including rapid response to pandemic disease threats, surge capacity, and scalable manufacturing facilities with much lower capital and operating costs – should enable the Foundation to achieve its objective to provide vaccines to vast populations that have been neglected until now. In this symbiotic relationship, as we help the Foundation achieve its Foundation-funded Global Access Objectives, iBio is helped to optimize and broaden its technology platform for commercial purposes and expand its commercial manufacturing and tech transfer programs.”

Dr. Vidadi Yusibov, Executive Director of CMB and Chief Scientific Officer of iBio, commented, “The Bill & Melinda Gates Foundation and iBio, along with the Defense Advanced Research Projects Agency (DARPA), are key stakeholders in the success of our technology development. Their support was critical for establishing this technology and demonstrating its potential for development of vaccines against viral, bacterial and parasitic diseases. I am confident this cooperation will provide great benefit for all parties.”

iBio describes itself as “a biopharmaceutical company commercializing its proprietary technology, the iBioLaunch™ platform, for the production of biologics including vaccines and therapeutic proteins. The iBioLaunch platform uses transient gene expression in green plants for superior efficiency in protein production. Advantages include significantly lower capital and process costs, and the technology is ideally suited to infectious disease applications where speed, scalability, and surge capacity are important. iBio’s strategy is to utilize its technology for development and manufacture of its own product candidates and work with both corporate and government clients to reduce their costs during product development and meet their needs for low cost, high quality biologics manufacturing systems. iBio owns technology developed at the Fraunhofer USA Center for Molecular Biotechnology, and continues to sponsor development and refinement of the technology for broad applications in human healthcare.”

http://www.businesswire.com/portal/site/home/permalink/?ndmViewId=news_view&newsId=20100603005415&newsLang=en

GAVI said the International Finance Facility for Immunisation (IFFIm), in collaboration with GAVI Alliance, the World Bank and HSBC Securities (Japan) Limited, would begin offering another in a series of vaccine investment bonds, also known as “vaccine bonds”, to Japanese retail investors starting 7 June 2010. The multi-tranche transaction includes the first IFFIm bond denominated in Brazilian real (BRL) and settled in JPY. The triple-A rated IFFIm is offering investors the three investment options. http://www.gavialliance.org/media_centre/press_releases/2010_06_04_iffim_japanese_bonds.php

WHO posted The Smallpox Eradication Programme – SEP (1966-1980), an archive and photo gallery marking the 30th anniversary of the eradication of smallpox. Smallpox was officially declared eradicated in 1980 and is the first disease to have been fought on a global scale. This extraordinary achievement was accomplished through the collaboration of countries around the world.

At the end of the 1960s, smallpox was still endemic in Africa and Asia. Vaccination campaigns, surveillance and prevention measures aimed to contain epidemic hotspots and to better inform affected populations. All these strategies were used to combat the disease.

The photographs presented in the galleries below illustrate the various activities carried out to eradicate smallpox around the world. They show how the same eradication methods and strategies were repeated in very different countries around the globe.

http://www.who.int/features/2010/smallpox/en/index.html

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

MAJOR ARTICLE
Treatment Outcomes among Patients with Extensively Drug-Resistant Tuberculosis: Systematic Review and Meta-Analysis
Karen R. Jacobson,1; Dylan B. Tierney,1; Christie Y. Jeon,2; Carole D. Mitnick,3,4, and Megan B. Murray1,2,4

1Division of Infectious Disease, Massachusetts General Hospital, 2Department of Epidemiology, Harvard School of Public Health, 3Department of Global Health and Social Medicine, Harvard Medical School, and 4Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts

Background.There is debate surrounding the effectiveness of the 23‐valent pneumococcal polysaccharide vaccine (PPV). We determined whether PPV was associated with reduced mortality or additional hospitalization for vaccine‐preventable infections in patients previously hospitalized for community‐acquired pneumonia (CAP).

Methods.From 2000 through 2002, adults with CAP admitted to the hospital in Edmonton, Alberta, Canada, were enrolled in a population‐based cohort. Postdischarge outcomes during 5 years were ascertained using administrative databases. The primary outcome was the composite of all‐cause mortality or additional hospitalization for vaccine-preventable infections. Proportional hazards analysis was used to determine the association between PPV use and outcomes.

Results.A total of 2950 patients were followed up for a median of 3.8 years. The mean patient age was 68 years; 52% were male. One-third (n=956) received PPV: 667 (70%) before and 289 (30%) during hospitalization. After discharge, 1404 patients (48%) died, 504 (17%) were admitted with vaccine-preventable infections, and 1626 (55%) reached the composite outcome of death or infection. PPV was not associated with reduced risk of the composite outcome (589 [62%] vs 1037 [52%] for those unvaccinated; adjusted hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.79–1.04). Results were not altered in sensitivity analyses using propensity scores (adjusted HR, 0.91; 95% CI, 0.79–1.04), restricting the sample to patients 65 years or older (adjusted HR, 0.90; 95% CI, 0.77–1.04), or considering only those who received PPV at discharge (adjusted HR, 0.84; 95% CI, 0.71–1.00).

Conclusions.One-half of patients discharged from the hospital after pneumonia die or are subsequently hospitalized with a vaccine-preventable infection within 5 years. PPV was not associated with a reduced risk of death or hospitalization. Better pneumococcal vaccination strategies are urgently needed.

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

News
Malaria Vectored Vaccines Consortium (MVVC)
Sharmila Bakshi and Egeruan Babatunde Imoukhuede

The European Vaccine Initiative (EVI) is coordinating the Malaria Vectored Vaccines Consortium (MVVC), a four year project set-up with the aim of integrating capacity-building and networking in the design and conduct of Phase I and II clinical trials of viral vectored candidate malaria vaccines in East and West African adults, children, and infants. The overall objective of the project is to develop a safe, non-reactogenic, effective, and affordable malaria vaccine for use by the malaria endemic populations of the world.

The MVVC Consortium consists of eight partners; European Vaccine Initiative (EVI); UniversitätsKlinikum Heidelberg, Germany; The University of Oxford (UOXF), United Kingdom (UK); Vienna School of Clinical Research (VSCR), Austria; Okairos s.r.l, Italy; Centre National de Recherche et Formation sur le Paludisme (CNRFP), Burkina Faso; Kenya Medical Research Institute (KEMRI ), Kenya; Medical Research Council Gambia (MRC Gambia), The Gambia; and Université Cheikh Anta Diop (UCAD), Senegal.

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

Research Paper
Knowledge and attitudes towards vaccines and immunization among adolescents in South Africa
Simona Zipursky, Charles Shey Wiysonge and Gregory Hussey

Despite evidence showing their benefits, routine adolescent immunization programmes are still lacking across Africa. In 2008 we conducted a qualitative study of adolescents’ knowledge and attitudes towards immunization in a peri-urban community in South Africa. Results show that while vaccination as a concept is acceptable amongst adolescents, low levels of knowledge about vaccines, the process of being vaccinated, as well as unfamiliarity with the concept of preventative medicine in general will likely hinder achieving high and equitable routine adolescent immunization coverage. Effective educational programs and integrated adolescent healthcare strategies will be critical to delivering successful immunization services to this group.

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

Research Paper
Acceptability of prophylactic human papillomavirus vaccination among adult men
Brenda Y Hernandez, Lynne Wilkens, Pamela Thompson, Yurii Shvetso, Marc Goodman, Lily Ning and Lana Kaopua

Objectives: HPV vaccine acceptability was examined as part of a cohort study of HPV infection among adult males.

Methods: Between July 2004 and June 2007, 445 adult males aged ≥18 years were enrolled primarily from a university-based population. A structured questionnaire addressed HPV vaccine awareness, attitudes, and intention to be vaccinated.

Results: Overall, 69% of men reported that they were likely or very likely to be vaccinated against HPV if a prophylactic vaccine were available. Men most frequently cited side effects (69%), efficacy (65%), and safety (63%) as the major factors that would influence their decision to be vaccinated against HPV. Issues of vaccine costs and efficacy were important considerations for men of vaccine-eligible ages (18-26 years). Men who cited cost as a major factor in their HPV vaccine decisions and those indicating cost as a potential barrier had greater intention to be vaccinated. Heterosexual men had less intention to be vaccinated compared to men who have sex with men.

Conclusion. Acceptability of HPV vaccination among males is generally high. Costs and sexual history may influence vaccine utilization.

The Lancet
http://www.thelancet.com/journals/lancet/issue/current
Jun 05, 2010  Volume 375 Number 9730 Pages 1939 – 2050

Review
Countdown to 2015 decade report (2000–10): taking stock of maternal, newborn, and child survival
Zulfiqar A Bhutta, Mickey Chopra, Henrik Axelson, Peter Berman, Ties Boerma, Jennifer Bryce, Flavia Bustreo, Eleonora Cavagnero, Giorgio Cometto, Bernadette Daelmans, Andres de Francisco, Helga Fogstad, Neeru Gupta, Laura Laski, Joy Lawn, Blerta Maliqi, Elizabeth Mason, Catherine Pitt, Jennifer Requejo, Ann Starrs, Cesar G Victora, Tessa Wardlaw

Summary
The Countdown to 2015 for Maternal, Newborn, and Child Survival monitors coverage of priority interventions to achieve the Millennium Development Goals (MDGs) for child mortality and maternal health. We reviewed progress between 1990 and 2010 in coverage of 26 key interventions in 68 Countdown priority countries accounting for more than 90% of maternal and child deaths worldwide. 19 countries studied were on track to meet MDG 4, in 47 we noted acceleration in the yearly rate of reduction in mortality of children younger than 5 years, and in 12 countries progress had decelerated since 2000. Progress towards reduction of neonatal deaths has been slow, and maternal mortality remains high in most Countdown countries, with little evidence of progress. Wide and persistent disparities exist in the coverage of interventions between and within countries, but some regions have successfully reduced longstanding inequities. Coverage of interventions delivered directly in the community on scheduled occasions was higher than for interventions relying on functional health systems. Although overseas development assistance for maternal, newborn, and child health has increased, funding for this sector accounted for only 31% of all development assistance for health in 2007. We provide evidence from several countries showing that rapid progress is possible and that focused and targeted interventions can reduce inequities related to socioeconomic status and sex. However, much more can and should be done to address maternal and newborn health and improve coverage of interventions related to family planning, care around childbirth, and case management of childhood illnesses.

The Lancet
http://www.thelancet.com/journals/lancet/issue/current
May 29, 2010  Volume 375 Number 9729 Pages 1845 – 1938

Series
The HIV-associated tuberculosis epidemic—when will we act?
Anthony D Harries, Rony Zachariah, Elizabeth L Corbett, Stephen D Lawn, Ezio T Santos-Filho, Rhehab Chimzizi, Mark Harrington, Dermot Maher, Brian G Williams, Kevin M De Cock

Preview
Despite policies, strategies, and guidelines, the epidemic of HIV-associated tuberculosis continues to rage, particularly in southern Africa. We focus our attention on the regions with the greatest burden of disease, especially sub-Saharan Africa, and concentrate on prevention of tuberculosis in people with HIV infection, a challenge that has been greatly neglected. We argue for a much more aggressive approach to early diagnosis and treatment of HIV infection in affected communities, and propose urgent assessment of frequent testing for HIV and early start of antiretroviral treatment (ART).

The Lancet Infectious Disease
Jun 2010  Volume 10 Number 6  Pages 367 – 440
http://www.thelancet.com/journals/laninf/issue/current

Leading Edge
Polio—a pathogen on a precipice
The Lancet Infectious Diseases

Original Text
30 years ago, on May 8, 1980, the World Health Assembly formally recognised the global eradication of smallpox. For thousands of years the disease had claimed many millions of lives (an estimated 300 million to 500 million in the 20th century alone). The culmination of 200 years of public health efforts from Edward Jenner’s discovery of the cowpox vaccine, the achievement was a milestone in global health and gave hope that other diseases might too be consigned to the history books. But despite efforts before and since the eradication of smallpox, no other infectious disease has been successfully eradicated, and to some people the demise of smallpox seems like a fluke.

Efforts to eradicate yellow fever, yaws, and malaria have all fallen by the wayside; or, if not completely forgotten, their realisation seems a long way off—in the 1950s and 1960s people talked of malaria eradication in decades, now we talk of it optimistically in terms of the next century. Programmes for perhaps the two most promising candidates, polio and dracunculiasis, have seen eradication come tantalisingly within reach, but both diseases cling on in a few endemic countries from which outbreaks in non-endemic countries emanate—such as the polio outbreak in Tajikistan this year.

Polio, like dracunculiasis and smallpox, has no non-human reservoir and has known preventive interventions, in this case highly effective vaccines, and therefore is an attractive target. And the prominence of the disease in high-income countries charged early control efforts. In the USA, for example, President Franklin D Roosevelt, who was paralysed by the disease, initiated the huge charitable fundraising efforts known as The March of Dimes, which was instrumental in funding the development of both Salk and Sabin polio vaccines. Resulting immunisation programmes in the USA and Europe staring in the 1950s saw rapid and early success. The incidence of polio in the USA and Europe declined rapidly, and in 1960 Czechoslovakia became the first country to declare polio eradicated. In 1985 the Pan American Health Organization launched an initiative to eradicate polio from the Americas, and in the same year, the Rotary Organisation pledged to raise US$120 million to immunise all children worldwide. With such positive initial gains WHO, UNICEF, the Rotary Organisation, and the US Centres for Disease Control and Prevention launched the Global Polio Eradication Initiative in 1988.

Within the first 5 years of the initiative, global incidence of the disease declined from an estimated 350 000 to 100 000. Since then, enormous gains have been made freeing much of the world from the crippling viral disease, which is now endemic in just a handful of regions in four countries: Afghanistan, India, Nigeria, and Pakistan.

Nonetheless, despite 22 years of gains, in the past 5 years the disease and its would-be eradicators have reached something of a stalemate. Each year 1000—2000 people have been affected by the disease, with outbreaks in both endemic and non-endemic countries. The impasse has led some to question the goal of eradication. Given the low incidence of the disease, are the benefits of achieving eradication worth the ongoing expense? But this question misses the point—the incidence is so low only because of eradication efforts; were surveillance to be relaxed and were mass immunisation campaigns to give way to routine vaccination alone, numbers of cases would surely rise again, and the disease spread to regions from which it has been eliminated.

Clearly, new approaches are needed to achieve eradication in the last strongholds. In a new strategic plan launched in April, the Global Polio Eradication Initiative highlights that, in addition to the old tools of government accountability, mass immunisation, and public engagement, new diplomacy, education, and accountability on ever more local levels are needed to reach the specific populations affected. In India, for example, the disease is not a national problem, but associated with populations in Uttar Pradesh and Bihar in the northwest, so targeting these regions and migrants from them will be essential in preventing the spread of disease.

The eradication of polio seems imminent, but with so few cases, there is a temptation to think an acceptable level of infection has been achieved. Not so. To stop short of eradication would not only be a snub to the hundreds of thousands of health workers and community members involved in the effort so far, but also would risk resurgence of a disease that for many is now a distant memory. The new levels of engagement in the last strongholds of polio will sever its grip from the precipice to which it clings. We look forward to 30 years or so from now, when we can reflect on the polio eradication programme and its legacy in global health.

New England Journal of Medicine
http://content.nejm.org/current.shtml
Volume 362 — June 3, 2010 — Number 22

Perspective
The Public’s Response to the 2009 H1N1 Influenza Pandemic
G. K. SteelFisher, R. J. Blendon, M. M. Bekheit, and K. Lubell
[free full-text]

New England Journal of Medicine
http://content.nejm.org/current.shtml
Volume 362 — May 27, 2010 — Number 21

Perspective
Pandemic Vaccines — The Legal Landscape
W. E. Parmet
[free full-text]

The Pediatric Infectious Disease Journal
June 2010 – Volume 29 – Issue 6
http://journals.lww.com/pidj/pages/currenttoc.aspx

Original Studies
Reduction in Gastroenteritis in United States Children and Correlation With Early Rotavirus Vaccine Uptake From National Medical Claims Databases
Cortese, Margaret M.; Tate, Jacqueline E.; Simonsen, Lone; Edelman, Laurel; Parashar, Umesh D.

Abstract
Background: We sought to estimate rotavirus disease reduction among children in hospital and office settings in the 4 US regions following rotavirus vaccine introduction and to estimate vaccine uptake.

Methods: Two national third-party payer medical claims databases were used to examine the number of visits for gastroenteritis per annual nongastroenteritis visits among children aged <5 years during July 2003 to June 2008 in hospital and office settings. The gastroenteritis burden attributable to rotavirus was computed as the excess of all gastroenteritis visits during rotavirus seasons above the baseline of visits during nonrotavirus periods. Rotavirus vaccine uptake was estimated by comparing claims for rotavirus vaccine with those for diphtheria-tetanus-acellular pertussis vaccines.

Results: In the South, Northeast, and Midwest, the typical winter-spring gastroenteritis peak due to rotavirus was markedly dampened in 2007-2008. Compared with the mean for 3 prevaccine seasons, the excess gastroenteritis visits that occurred during the 2007-2008 rotavirus season was reduced by >90% among infants in all care settings in 3 regions and by >70% among children aged 1 to 4 years. In the West, disease reductions were lower (53%-63% reduction among hospitalized infants). At the onset of the 2007-2008 season, coverage with >=1 rotavirus vaccine dose was an estimated 57% among infants, 17% among children aged 1 year, and 0 among those aged 2 to 4 years.

Conclusions: The rotavirus burden in 2007-2008 was markedly reduced in all US regions and exceeded that explained by only direct protection of the youngest vaccinated children.

PLoS Medicine
(Accessed 7 June 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

Studies Needed to Address Public Health Challenges of the 2009 H1N1 Influenza Pandemic: Insights from Modeling
Maria D. Van Kerkhove, Tommi Asikainen, Niels G. Becker, Steven Bjorge, Jean-Claude Desenclos, Thais dos Santos, Christophe Fraser, Gabriel M. Leung, Marc Lipsitch, Ira M. Longini Jr, Emma S. McBryde, Cathy E. Roth, David K. Shay, Derek J. Smith, Jacco Wallinga, Peter J. White, Neil M. Ferguson, Steven Riley Policy Forum, published 01 Jun 2010

Summary Points
– As the global epidemiology of the pandemic (H1N1) 2009 influenza (H1N1pdm) virus strain unfolds into 2010, substantial policy challenges will continue to present themselves for the next 12 to 18 months.

– Here, we anticipate six public health challenges and identify data that are required for public health decision making: Measuring age-specific immunity to infection; accurately quantifying severity; improving treatment outcomes for severe cases; quantifying the effectiveness of interventions; capturing the full impact of the pandemic on mortality; and rapidly identifying and responding to antigenic variants.

– Representative serological surveys stand out as a critical source of data with which to reduce uncertainty around policy choices for both pharmaceutical and nonpharmaceutical interventions after the initial wave has passed.

– Continuing to monitor the time course of incidence of severe H1N1pdm cases will give a clear picture of variability in underlying transmissibility of the virus during population-wide changes in behavior such as school vacations and other nonpharmaceutical interventions.

Science
http://www.sciencemag.org/current.dtl
28 May 2010  Vol 328, Issue 5982, Pages 1061-119

News of the Week: Infectious Diseases
Fears of Lax Surveillance if CDC Program Cut
Jennifer Couzin-Frankel

A proposal to stop funneling dollars directly to U.S. surveillance and research for most mosquito and other vector-borne diseases such as West Nile virus and dengue has scientists wringing their hands. They are concerned that if the plan sticks, the country will be ill-prepared to handle new emerging diseases and manage existing ones. The proposal in President Barack Obama’s 2011 budget for the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, combined with a $15.7 million cut for infectious disease work generally, would virtually eliminate the vector-borne program. Currently, CDC funds mosquito testing for a variety of diseases and investigations into patterns of disease spread in the United States.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 27, Pages 4335-4438 (17 June 2010)

Regular Papers
Human papillomavirus and cervical cancer: Gardasil® vaccination status and knowledge amongst a nationally representative sample of Australian secondary school students
Pages 4416-4422
Paul A. Agius, Marian K. Pitts, Anthony M.A. Smith, Anne Mitchell

Abstract
The aim of this paper was to measure student knowledge of HPV and risks associated with cervical cancer, explore associated factors, correlate knowledge of HPV and cervical cancer with other domains of sexual health related knowledge and estimate student self-reported rates of HPV immunisation. Data were from a nationally representative cross-sectional stratified cluster sample of year 10 and 12 students in the Australian secondary school system. Contingency table, comparison of means, correlation and multiple OLS regression analyses of students answering HPV (n = 1927) and cervical cancer (n = 2680) knowledge questions was undertaken. Student HPV and cervical cancer knowledge was generally poor. Young women exhibited better knowledge than young men however the difference was, to some extent, accounted for by vaccination for HPV. Sexually active students and those having more sexual partners in the previous year did not report higher levels of HPV and cervical cancer knowledge. The large majority of young women surveyed reported a HPV vaccination as did a small proportion of young men. Students who reported being vaccinated had higher levels of knowledge about HPV and cervical cancer. Student knowledge of HPV and cervical cancer is considerably limited. There is some evidence that being vaccinated for HPV improves a person’s level of understanding of the disease and cervical cancer. The recent national public health campaign focussing on cervical cancer vaccination for young women may be partly responsible for a lack of understanding of HPV as a common STI.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 26, Pages 4229-4334 (11 June 2010)

Review
Factors underlying parental decisions about combination childhood vaccinations including MMR: A systematic review
Pages 4235-4248
Katrina F. Brown, J. Simon Kroll, Michael J. Hudson, Mary Ramsay, John Green, Susannah J. Long, Charles A. Vincent, Graham Fraser, Nick Sevdalis

Abstract
Suboptimal childhood vaccination uptake results in disease outbreaks, and in developed countries is largely attributable to parental choice. To inform evidence-based interventions, we conducted a systematic review of factors underlying parental vaccination decisions. Thirty-one studies were reviewed. Outcomes and methods are disparate, which limits synthesis; however parents are consistently shown to act in line with their attitudes to combination childhood vaccinations. Vaccine-declining parents believe that vaccines are unsafe and ineffective and that the diseases they are given to prevent are mild and uncommon; they mistrust their health professionals, Government and officially-endorsed vaccine research but trust media and non-official information sources and resent perceived pressure to risk their own child’s safety for public health benefit. Interventions should focus on detailed decision mechanisms including disease-related anticipated regret and perception of anecdotal information as statistically representative. Self-reported vaccine uptake, retrospective attitude assessment and unrepresentative samples limit the reliability of reviewed data – methodological improvements are required in this area.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 26, Pages 4229-4334 (11 June 2010)

Regular Papers
Knowledge, attitudes and beliefs regarding influenza vaccination among healthcare workers in a Saudi hospital
Pages 4283-4287
Rifat Rehmani, Javed I. Memon

Abstract
Background
Annual influenza vaccination is recommended for healthcare workers (HCWs) in order to reduce the morbidity associated with influenza in healthcare settings. The objectives of the study were to determine the rate of influenza vaccination, knowledge, attitudes and beliefs toward influenza immunization among healthcare workers at our hospital, and to identify reasons for electing or declining the immunization.

Methods
Between January and February 2009, we carried out a cross-sectional study of influenza vaccination coverage among HCWs at King Abdul-Aziz Hospital, Saudi Arabia. After receiving a brief description of the aim of the study, 512 of 902 HCWs self-completed an anonymous questionnaire.

Results
Influenza vaccination coverage was low at a rate of 34.4% in 2008–9. The knowledge of influenza disease and prevention was low, with a mean knowledge score of 5.8 ± 2.1. The most common reason for being vaccinated was self-protection from illness (95%), and the most common reason for not being vaccinated was a belief that vaccine is not effective in disease prevention (51%). We found that being female, awareness of effectiveness of vaccine in disease prevention, feeling at risk of influenza, self-protection, to protect the patients, previous influenza vaccination were statistically significant factors for influenza vaccination.

Conclusion
Despite the recommendations, influenza vaccination coverage is low among HCWs at our hospital. Misconceptions about influenza vaccination were prevalent among the healthcare workers. Specific continuous educational and vaccination programs for different targets should be organized to reduce morbidity and mortality in high-risk patients.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 26, Pages 4229-4334 (11 June 2010)

Regular Papers
Optimal vaccine stockpile design for an eradicated disease: Application to polio
Pages 4312-4327
Radboud J. Duintjer Tebbens, Mark A. Pallansch, James P. Alexander, Kimberly M. Thompson

Abstract
Eradication of a disease promises significant health and financial benefits. Preserving those benefits, hopefully in perpetuity, requires preparing for the possibility that the causal agent could re-emerge (unintentionally or intentionally). In the case of a vaccine-preventable disease, creation and planning for the use of a vaccine stockpile becomes a primary concern. Doing so requires consideration of the dynamics at different levels, including the stockpile supply chain and transmission of the causal agent. This paper develops a mathematical framework for determining the optimal management of a vaccine stockpile over time. We apply the framework to the polio vaccine stockpile for the post-eradication era and present examples of solutions to one possible framing of the optimization problem. We use the framework to discuss issues relevant to the development and use of the polio vaccine stockpile, including capacity constraints, production and filling delays, risks associated with the stockpile, dynamics and uncertainty of vaccine needs, issues of funding, location, and serotype dependent behavior, and the implications of likely changes over time that might occur. This framework serves as a helpful context for discussions and analyses related to the process of designing and maintaining a stockpile for an eradicated disease.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 25, Pages 4119-4228 (7 June 2010)

Regular Papers
Rotavirus vaccination in northeast Brazil: A laudable intervention, but can it lead to cost-savings?
Pages 4162-4168
Chiara Centenari, Ricardo Q. Gurgel, Anna Klara Bohland, Débora M.P. Oliveira, Brian Faragher, Luis E. Cuevas

Abstract
This study assessed the family and heath system’s costs due to diarrhoea in children <2 years old, before/after the introduction of a rotavirus vaccine in Brazil in 2006. Information on diarrhoea health care costs and morbidity were obtained from the primary health care system, the National Public Health database (2004–2008) and care-givers. Diarrhoea ambulatory consultations and hospitalizations had a declining trend during the entire period, with additional steeper reductions after vaccine introduction. The vaccine thus is associated with reduced diarrhoea consultations and hospitalization costs and families’ out-of-pocket expenses. Despite these gains, the overall health system’s costs have increased.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 25, Pages 4119-4228 (7 June 2010)

Regular Papers
Omission bias and vaccine rejection by parents of healthy children: Implications for the influenza A/H1N1 vaccination programme
Pages 4181-4185
Katrina F. Brown, J. Simon Kroll, Michael J. Hudson, Mary Ramsay, John Green, Charles A. Vincent, Graham Fraser, Nick Sevdalis

Abstract
2009 H1N1 influenza A (“swine flu”) vaccine has been offered to healthy UK children aged 6 months–5 years since December 2009, though around 50% of parents plan to reject the vaccine. This study examined whether such parents exhibit omission bias (preference for errors arising from inaction over errors arising from action). One-hundred and forty-two parents completed an online questionnaire in which they rated (a) probability of occurrence, (b) symptoms and (c) duration of a hypothetical disease and a hypothetical vaccine adverse event (VAE). Almost all attributes were rated significantly less favourably when relating to VAE than to disease (p < 0.01 for 17 of 22 outcomes), despite the attributes being objectively identical. These data suggest that any vaccine is at a disadvantage in many parents’ consciousness in comparison with the infection itself, and that minor safety concerns could have disproportionately detrimental effects on vaccine uptake. Behavioural science offers strategies to ameliorate the impact of this bias and these should be explored further.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 25, Pages 4119-4228 (7 June 2010)

Regular Papers
Factors influencing HPV vaccination status in a Latino population; and parental attitudes towards vaccine mandates
Pages 4186-4191
Nava Yeganeh, Donna Curtis, Alice Kuo

Abstract
We performed a retrospective cohort study in a largely Latino population in Los Angeles, surveying 95 parents of 11–17 year old girls between May and June 2008 to examine factors associated with [1] parental consent for Human Papillomavirus (HPV) immunization one year after vaccine implementation and [2] parental support of an HPV vaccine mandate for adolescents prior to middle school entry. 73% of participants had heard of the HPV vaccine and 37% of daughters had already received the vaccine. Variables associated with vaccination included Latino ethnicity, the belief that vaccines are safe, and that HPV vaccine prevents cervical cancer. The most frequent reasons for refusing vaccination included parental request for more information and missed opportunities in clinic. Variables associated with parents agreeing with a law mandating HPV vaccination included: belief in vaccine safety, recent maternal Pap Smear, HPV vaccination of participant’s daughter prior to survey, and Latino ethnicity. Our survey supports the work of previous studies recommending continued educational campaigns emphasizing the safety of HPV vaccine, and its efficacy in reducing cervical cancer.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 25, Pages 4119-4228 (7 June 2010)

Regular Papers
Survey of girls’ recall of a film providing information on human papillomavirus and cervical cancer 6 months after an offer of vaccination
Pages 4210-4214
Loretta Brabin, Rebecca Stretch, Stephen A. Roberts, Peter Elton, David Baxter, Rosemary McCan

Abstract
Pre-adolescent girls who have been successfully immunised against human papillomavirus (HPV) may have relatively little knowledge about cervical cancer. A questionnaire was sent to 1084 girls approximately 6 months after they had been offered vaccination to assess whether an educational film had influenced their vaccine decision and what information they recalled. Girls who viewed the film were more likely to have wanted the vaccine than non-viewers (p = 0.015), but only 42% of them could recall details of the film 6 months later. Fear of cervical cancer may motivate young adolescents for vaccination but false assumptions might undermine later preventive actions by both the vaccinated and unvaccinated groups.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 25, Pages 4119-4228 (7 June 2010)

Regular Papers
Health beliefs of Taiwanese women seeking HPV vaccination
Pages 4224-4228
Yu-Yun Hsu, Keng-Fu Hsu, Ya-Min Cheng, Susan Jane Fetzer, Cheng-Yang Chou

Abstract
In Taiwan, human papillomavirus (HPV) vaccine is recommended for women aged 9–26 years. The purpose of this study was to examine health beliefs and reasons for HPV vaccination among young adult women (aged 18–26 years), and adult women (aged over 26 years). Women who initiated HPV vaccination were recruited from three hospitals in southern Taiwan. One hundred and eighty-nine subjects completed a questionnaire on health beliefs and reasons for HPV vaccinations. 38% (n = 72) of the women who initiated vaccination were over the age of 26. Health beliefs regarding HPV vaccination differ between young adult women and adult women. Recommendations from others (family, health care providers, etc.) are among the main reasons for young adult women to initiate HPV vaccination; while self-awareness of the risk for HPV infection and personal gynecologic diseases are main reasons for adult women to initiate HPV vaccination. Furthermore, women aged 18–26 are more likely than women aged over 26 to consider the cost and availability of vaccination. Media also plays an important role in a woman’s decision to seek HPV vaccination.

Vaccine
Volume 28, Issue 24, Pages 4013-4118 (28 May 2010)
http://www.sciencedirect.com/science/journal/0264410X

Editorial
Thirty years after smallpox: Celebration and sobering thoughts
Pages 4013-4014
Gregory A. Poland, Donald Henderson
[No abstract published]

Vaccine
Volume 28, Issue 24, Pages 4013-4118 (28 May 2010)
http://www.sciencedirect.com/science/journal/0264410X

Review
A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability
Pages 4027-4037
Jennifer D. Allen, Gloria D. Coronado, Rebecca S. Williams, Beth Glenn, Cam Escoffery, Maria Fernandez, Raegan A. Tuff, Katherine M. Wilson, Patricia Dolan Mullen

Abstract
Background
The recent proliferation of studies describing factors associated with HPV vaccine acceptability could inform health care providers in improving vaccine coverage and support future research. This review examined measures of HPV and HPV-vaccine knowledge, attitudes, beliefs and acceptability, described psychometric characteristics, and provided recommendations about their use.

Methods
A systematic search of Medline, CINAHL, PsychoInfo, and ERIC through May 2008 for English language reports of quantitative data from parents, young adults or adolescents yielded 79 studies.

Results
The majority of studies were cross-sectional surveys (87%), self-administered (67%), conducted before prophylactic vaccines were publicly available (67%) and utilized convenience samples (65%). Most measured knowledge (80%), general attitudes about HPV vaccination (40%), and willingness to vaccinate one’s daughter (26%). Two-thirds did not report reliability or validity of measures. The majority did not specify a theoretical framework.

Conclusions
Use of a theoretical framework, consistent labeling of constructs, more rigorous validation of measures, and testing of measures in more diverse samples are needed to yield measurement instruments that will produce findings to guide practitioners in developing successful community and clinical interventions.

The WHO’s Initiative for Vaccine Research (IVR) released its Strategic Plan 2010-2020. The Executive Summary of the 34-page plan notes:

“Building on a decade of experience, IVR has formulated a long-term Strategic Plan that takes account of the evolving vaccine R&D landscape, and of the strong leadership role it can play as the WHO integrated vaccine research arm. The much welcomed new players in the vaccine R&D pipeline accentuate the need for increased global coordination and normative and technical support to countries, roles that are at the heart of IVR’s mandate.

“The Strategic Plan 2010–2020 has a matrix approach that uses four strategic functions and a set of priority areas to address public health priorities, and it is here that IVR has most significantly evolved since the previous strategy. The matrix is directly aligned with WHO’s corporate strategy and policies to stimulate innovation in health research, as well as with the global immunization agenda of the Organization. This harmonization will further strengthen synergies between research- and disease-focused programmes.

Strategic functions
The four strategic functions that will guide the core work of IVR over the next 10 years are:
i) identification of vaccine and vaccination research priorities;
ii) the development of research standards and guidelines;
iii) the strengthening of research and product development capacity;
iv) the translation of research results into policy and practice.

http://whqlibdoc.who.int/hq/2010/WHO_IVB_10.02_eng.pdf

The sixty-third World Health Assembly (17–21 May 2010; Geneva, Switzerland) closed after passing multiple resolutions. A WHO media summarized these actions from which we select those key to our monitoring of issues touching on vaccine ethics and policy:

…Public health, innovation and intellectual property: global strategy and plan for action
The issue of intellectual property is critical for 4.8 billion people who live in developing countries, more than 40% of them living on less than 2 US dollars a day. Poverty affects their access to health products to fight disease. The debate this year focused on financing issues, including the rational use of funds, and conducting research through regional networks. The global strategy proposes that WHO should play a strategic and central role in the relationship between public health and innovation and intellectual property within its mandate. The strategy was designed to promote new thinking in innovation and access to medicines, which would encourage needs-driven research rather than purely market-driven research. A new consultative working group will examine the way to take this work forward and is expected to report back to the 65th Health Assembly in 2012…

…Viral hepatitis
Member States accepted the report to the World Health Assembly and adopted a resolution including a World Hepatitis Day on 28 July. Viral hepatitis (i.e. hepatitis A, B, C, D and E) —a combination of diseases that are estimated to kill over 1 million people each year and an estimated 1 in 12 persons are currently infected and have to face a life with liver disease if unrecognized. This endorsement by Member States calls for WHO to develop a comprehensive approach to the prevention and control of these diseases…

…Monitoring of the achievement of the health-related Millennium Development Goals (MDGs)
The resolution expresses concern at the relatively slow progress in attaining the Millennium Development Goals, particularly in sub-Saharan Africa and at the fact that maternal, newborn and child health as well as universal access to reproductive health services remain constrained by health inequities.   Member States noted that MDGs 4 and 5 were lagging behind and agreed to strengthen national health systems as well as take into account health equity in all national policies. They also reaffirmed the value of primary health care and renewed their commitment to prevent and eliminate maternal, newborn and child mortality and morbidity…

…Global eradication of measles
Member States endorsed a series of interim targets set for 2015 as milestones towards the eventual global eradication of measles. Countries were encouraged by the efforts and progress made in controlling measles but also highlighted the challenges that need to be addressed to achieve the 2015 targets. These include competing public health priorities, weak immunization systems, sustaining high routine vaccination coverage, addressing the funding gap, vaccinating the hard-to-reach population and addressing an increasing number of measles outbreaks particularly in cross border areas. Success in achieving the measles 2015 targets is a key issue if the Millennium Development Goal 4 to reduce child mortality is to be reached…

…Treatment and prevention of pneumonia
WHO Member States adopted a resolution on the treatment and prevention of pneumonia — the number one killer of children under five years globally. The resolution makes it clear that intensified efforts to address pneumonia are imperative if the achievement of Millennium Development Goal 4 is to be achieved…

…Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits
Members States expressed strong support for the continuing efforts of the Open-Ended Working Group to further global pandemic influenza preparedness by strengthening the sharing of influenza viruses and of benefits such as vaccines. Member States spoke on the progress made at the recent intergovernmental meeting (held 10-12 May 2010) and characterized the interaction as transparent, substantive, collaborative and an important foundation for future negotiation in this area. The role of industry as a stakeholder in the process to increase global capacity for vaccine production, increased technology transfer to developing countries, and access to supplies of vaccine and medicines at affordable prices for resource-limited countries were among issues raised. A number of countries urged the collaboration to move forward to increase pandemic preparedness and protect global public health. Having considered the report of the Open-Ended Working Group (15 April 2010), a resolution was passed:
– to request the Director-General to continue to support the effort and undertake any technical consultations and studies as necessary; and
– to decide that the group will report through the Executive Board to the Sixty-fourth World Health Assembly ( May 2011) .

http://www.who.int/mediacentre/news/releases/2010/wha_closes_20100521/en/index.html

Complete World Health Assembly documentation available at: http://apps.who.int/gb/e/e_wha63.html

The GAVI Alliance said it welcomed the World Health Assembly resolution “that calls on the WHO and its 193 Member States to take concrete actions to tackle pneumonia, which kills more than 1.6 million children a year…”  GAVI CEO Julian Lob-Levyt commented, “We applaud this initiative and we call on governments to adhere to the commitment they made here today to protect the world’s most vulnerable citizens. The resolution was passed by consensus, underlining a new universal commitment to combating pneumonia…This is the first time that governments of the world have come together to make a unified, comprehensive commitment to tackle the most prevalent killer of young children in the world.” The resolution calls on governments to combat pneumonia “through implementation of three groups of effective interventions outlined in the WHO/UNICEF Global Action Plan for the prevention and control of Pneumonia (GAPP). The GAPP aims to:
– Protect children by providing a healthy environment where they are at low risk of pneumonia; steps include encouraging exclusive breastfeeding for six months, reducing indoor air pollution and promoting hand washing
– Prevent children becoming ill with pneumonia by vaccinating against its causes. Pneumococcus bacteria and Haemophilus influenzae type b (Hib) are the leading causes of the most severe cases of pneumonia and both are vaccine-preventable
– Treat children who become ill with pneumonia through effective case management in communities, health centres and hospitals.

http://www.gavialliance.org/media_centre/press_releases/2010_05_21_wha_pneumonia_resolution.php

The WHO continues to issue weekly updates on the H1N1 pandemic at http://www.who.int/csr/disease/swineflu/en/index.html

Pandemic (H1N1) 2009 – update 101
Weekly update
21 May 2010

As of 16 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18097 deaths…

Situation update:
The current situation is largely unchanged since the last update. The most active areas of pandemic influenza virus transmission currently are in parts of the Caribbean and Southeast Asia. In the temperate zone of the northern and southern hemisphere, overall pandemic influenza activity remains low to sporadic. In central Africa, there has been increased transmission of seasonal influenza type B viruses, accounting for 85% of all influenza isolates in the region. Influenza B also continues to be detected at low levels across parts of Asia and Europe, and has now been reported in Central America…

More at: http://www.who.int/csr/don/2010_05_21/en/index.html

The NIH said that new research “has found that an experimental Ebola vaccine developed by NIH researchers protects monkeys against not only the two most lethal Ebola virus species for which it was originally designed, both recognized in 1976, but also against a newer Ebola virus species that was identified in 2007.” Nancy J. Sullivan, Ph.D., of the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases (NIAID), NIH, led the study team. Currently, there are no specific treatments or vaccines available to control Ebola outbreaks. NIAID Director Anthony S. Fauci, M.D. commented, “The important work by Dr. Sullivan and her colleagues shows that it is possible to generate immunity to newly identified species of Ebola virus with a vaccine originally designed to protect against a different species,” says “This finding will guide future vaccine design and may open an avenue for developing a single vaccine that works against both known and emerging Ebola virus species.” The experimental Ebola vaccine being developed at NIAID has two components, a prime and a boost. The prime consists of a DNA vaccine containing a small piece of genetic material encoding surface proteins from Zaire ebolavirus and Sudan ebolavirus. The boost consists of a weakened cold virus that delivers the Zaire ebolavirus surface protein.

http://www.nih.gov/news/health/may2010/niaid-20.htm

The findings appear in the open-access journal PLoS Pathogens 20 May 2010: http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1000904

GAVI noted that “vaccine bonds” offered by the International Finance Facility for Immunisation (IFFIm) since 2008 “have proved remarkably popular with Japanese retail investors, particularly women who account for around half the buyers in recent transactions,” and have raised more than JPY 111 billion equivalent (US$ 1.2 billion). GAVI said this support has increased its grant giving capacity by 100 per cent. From http://www.gavialliance.org/media_centre/press_releases/2010_05_20_iffim_japan.php

The Weekly Epidemiological Record (WER) for 21 May 2010, vol. 85, 21 (pp 185–196) includes: Rift Valley fever, South Africa – update; Public health measures taken at international borders during early stages of pandemic influenza A (H1N1) 2009: preliminary results; Prevention and treatment of artemisinin-resistant falciparum malaria: update for international travellers

http://www.who.int/wer/2010/wer8521.pdf

Clinical Infectious Diseases
15 June 2010  Volume 50, Number 12
http://www.journals.uchicago.edu/toc/cid/current

Review Article
Guidance for Isolation Precautions for Mumps in the United States: A Review of the Scientific Basis for Policy Change

Preeta K. Kutty, Moe H. Kyaw, Gustavo H. Dayan, Michael T. Brady, Joseph A. Bocchini, Jr, Susan E. Reef, William J. Bellini, and Jane F. Seward

Abstract
The 2006 mumps resurgence in the United States raised questions about the appropriate isolation period for people with mumps. To determine the scientific basis for isolation recommendations, we conducted a literature review and considered isolation of virus and virus load in saliva and respiratory secretions as factors that were related to mumps transmission risk. Although mumps virus has been isolated from 7 days before through 8 days after parotitis onset, the highest percentage of positive isolations and the highest virus loads occur closest to parotitis onset and decrease rapidly thereafter. Most transmission likely occurs before and within 5 days of parotitis onset. Transmission can occur during the prodromal phase and with subclinical infections. Updated guidance, released in 2007–2008, changed the mumps isolation period from 9 to 5 days. It is now recommended that mumps patients be isolated and standard and droplet precautions be followed for 5 days after parotitis onset.

Clinical Infectious Diseases
15 June 2010  Volume 50, Number 12
http://www.journals.uchicago.edu/toc/cid/current

Invited Article
Emerging Infections: The Origin and Prevention of Pandemics

Brian L. Pike, Karen E. Saylors, Joseph N. Fair, Matthew LeBreton, Ubald Tamoufe, Cyrille F. Djoko, Anne W. Rimoin, and Nathan D. Wolfe

Abstract
Despite the fact that most emerging diseases stem from the transmission of pathogenic agents from animals to humans, the factors that mediate this process are still ill defined. What is known, however, is that the interface between humans and animals is of paramount importance in the process. This review will discuss the importance of the human-animal interface to the disease emergence process. We also provide an overview of factors that are believed to contribute to the origin and global spread of emerging infectious diseases and offer suggestions that may serve as future prevention strategies, such as social mobilization, public health education, behavioral change, and communication strategies. Because there exists no comprehensive global surveillance system to monitor zoonotic disease emergence, the intervention measures discussed herein may prove effective temporary alternatives.

Emerging Infectious Diseases
Volume 16, Number 6–June 2010
http://www.cdc.gov/ncidod/EID/index.htm

Commentary
Whence Feral Vaccinia?

Richard C. Condit
University of Florida, Gainesville, Florida, USA

[Full text]
When the World Health Organization declared smallpox eradicated in 1979, smallpox vaccination was discontinued worldwide. Although cessation of smallpox vaccination is well justified, given the risks associated with complications from the vaccine, lack of vaccination nevertheless creates a growing population of persons now susceptible to infection by a few poxviruses previously covered by the smallpox vaccine. These include the orthopoxviruses monkeypox; cowpox; and, ironically, vaccinia, the virus used for smallpox vaccination. Although few persons die from these infections, they are nevertheless a public health nuisance and expense. Thus, understanding the epidemiology of these viruses is in the interest of public health.

The most common vaccine-preventable poxvirus infections in humans are cowpox and monkeypox (1). Both are zoonoses; the natural host for each seems to be rodents, and transmission occurs through close contact. Monkeypox virus occurs in western and central Africa, causes a disseminated infection in humans, can be transmitted among humans at a low rate, and is associated with a 1%–10% (depending on the virus strain) case-fatality rate. Cowpox virus is relatively common in Europe and Asia, causes a limited exanthema, and does not often cause death of previously healthy persons.

Vaccinia, the virus used in the live smallpox vaccine, was originally isolated in the late 18th century from persons with illness that clinically resembled cowpox. However, modern genomics have shown that the vaccinia virus strains used for smallpox control in the 20th and 21st centuries are genetically distinct from cowpox viruses currently circulating. In fact, with 2 notable exceptions, vaccinia virus is not found in nature. However, vaccinia infection has been documented in India and Brazil (2). In India, some strains of buffalopox, transmitted to humans through buffaloes, appear to be vaccinia. Likewise, in Brazil, reports of a cowpox-like disease, caused by a vaccinia virus and transmitted from cattle to humans, have increased substantially since the first report in 2000. In both outbreaks (India and Brazil), evidence suggests that the original source of the virus was the smallpox vaccine virus that has been introduced into the wild—or feral vaccinia, as it has sometimes been called. The reservoirs for these viruses in the wild are not well understood.

In this issue of Emerging Infectious Diseases, Abrahão et al. (3) describe a serosurvey for orthopoxvirus among 344 wild animals from the Brazilian Amazonia ecosystem. The animals, 296 monkeys and a variety of other mammals, were captured by a fauna-rescue program during the construction of a hydroelectric plant in Tocantins State, Brazil, far removed from other human activity. Of these animals, 84 (24%), predominantly monkeys, were seropositive for orthopoxvirus. Furthermore, 18 serum samples were positive for orthopoxvirus DNA according to PCR. From these 18 positive samples, sequencing of 6 isolates revealed the vaccinia strain commonly associated with vaccinia outbreaks among cattle and humans in Brazil.

These finding suggest a remarkably high incidence of vaccinia infection in the Brazilian wilderness and in a host, namely monkeys, not normally considered as an active reservoir for orthopoxviruses. Although Abrahão et al. do not specifically identify monkeys as a primary reservoir for vaccinia virus and do not address the mode of transmission of the virus among these animals, the results suggest a substantial repository of vaccinia virus in the Brazilian wilderness. Especially given the broad host range of vaccinia, these findings warrant a substantial effort to characterize further the circulation of vaccinia virus in this region. If the results described in the article by Abrahão et al. (3) can be confirmed and expanded by other laboratories, they would have major implications for public health.

Dr Condit is a professor in the Department of Molecular Genetics and Microbiology at the University of Florida. His research interests are the fundamental mechanisms of poxvirus transcription and assembly.

References

Damon IK. Poxviruses. In: Knipe DM , Howley PM, editors, Fields virology. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 2947–75.

Moussatché N, Damaso CR, McFadden G. When good vaccines go wild: feral Orthopoxvirus in developing countries and beyond. Journal of Infections in Developing Countries. 2008;2:156–73.

Abrahão JS, Silva-Fernandes AT, Lima LS, Campos RK, Guedes MIMC, Cota MMG, et al. Vaccinia virus infection in monkeys, Brazilian Amazon. Emerg Infect Dis. 2010;16:976–9.

The Lancet
May 22, 2010  Volume 375  Number 9728  Pages 1753 – 1844
http://www.thelancet.com/journals/lancet/issue/current

[This issue includes a number of Comment and Perspectives pieces on TB]

Series
Tuberculosis control and elimination 2010–50: cure, care, and social development
Knut Lönnroth, Kenneth G Castro, Jeremiah Muhwa Chakaya, Lakhbir Singh Chauhan, Katherine Floyd, Philippe Glaziou, Mario C Raviglione

Preview
Rapid expansion of the standardised approach to tuberculosis diagnosis and treatment that is recommended by WHO allowed more than 36 million people to be cured between 1995 and 2008, averting up to 6 million deaths. Yet tuberculosis remains a severe global public health threat. There are more than 9 million new cases every year worldwide, and the incidence rate is falling at less than 1% per year. Although the overall target related to the Millennium Development Goals of halting and beginning to reverse the epidemic might have already been reached in 2004, the more important long-term elimination target set for 2050 will not be met with present strategies and instruments.

The Lancet Infectious Disease
May 2010  Volume 10  Number 5  Pages 289 – 366
http://www.thelancet.com/journals/laninf/issue/current

Leading Edge
Coordination essential in malaria battle
The Lancet Infectious Diseases

April 24 marked World Malaria Day, 2010. A particularly important year in the fight against the disease, since December is the target date for the ambitious goal set out by the World Health Assembly and Roll Back Malaria in 2008 to provide universal access to prevention and treatment, with the aim of halving the number of cases of and deaths from the disease relative to 2000. Furthermore, this year is two-thirds of the way along the path to the target date for the Millennium Development Goals (MDGs), several of which are intrinsically linked to malaria, and dependent on successes in its control.

The Lancet Infectious Disease
May 2010  Volume 10  Number 5  Pages 289 – 366
http://www.thelancet.com/journals/laninf/issue/current

Review
Progress towards development of an HIV vaccine: report of the AIDS Vaccine 2009 Conference

Anna Laura Ross, Andreas Bråve, Gabriella Scarlatti, Amapola Manrique, Luigi Buonaguro

Summary
The search for an HIV/AIDS vaccine is steadily moving ahead, generating and validating new concepts in terms of novel vectors for antigen delivery and presentation, new vaccine and adjuvant strategies, alternative approaches to design HIV-1 antigens for eliciting protective cross-neutralising antibodies, and identification of key mechanisms in HIV infection and modulation of the immune system. All these different perspectives are contributing to the unprecedented challenge of developing a protective HIV-1 vaccine. The high scientific value of this massive effort is its great impact on vaccinology as a whole, providing invaluable scientific information for the current and future development of new preventive vaccine as well as therapeutic knowledge-based infectious-disease and cancer vaccines.

The Lancet Infectious Disease
May 2010  Volume 10  Number 5  Pages 289 – 366
http://www.thelancet.com/journals/laninf/issue/current

The Xs and Y of immune responses to viral vaccines
Sabra L Klein, Anne Jedlicka, Andrew Pekosz

Preview
The biological differences associated with the sex of an individual are a major source of variation, affecting immune responses to vaccination. Compelling clinical data illustrate that men and women differ in their innate, humoral, and cell-mediated responses to viral vaccines. Sex affects the frequency and severity of adverse effects of vaccination, including fever, pain, and inflammation. Pregnancy can also substantially alter immune responses to vaccines. Data from clinical trials and animal models of vaccine efficacy lay the groundwork for future studies aimed at identifying the biological mechanisms that underlie sex-specific responses to vaccines, including genetic and hormonal factors.

Nature
Volume 465 Number 7296 pp267-390  20 May 2010
http://www.nature.com/nature/current_issue.html

Thousands of chemical starting points for antimalarial lead identification
Francisco-Javier Gamo, Laura M. Sanz, Jaume Vidal, Cristina de Cozar, Emilio Alvarez, Jose-Luis Lavandera, Dana E. Vanderwall, Darren V. S. Green, Vinod Kumar, Samiul Hasan, James R. Brown, Catherine E. Peishoff, Lon R. Cardon & Jose F. Garcia-Bustos

Abstract
Malaria is a devastating infection caused by protozoa of the genus Plasmodium. Drug resistance is widespread, no new chemical class of antimalarials has been introduced into clinical practice since 1996 and there is a recent rise of parasite strains with reduced sensitivity to the newest drugs. We screened nearly 2 million compounds in GlaxoSmithKline’s chemical library for inhibitors of P. falciparum, of which 13,533 were confirmed to inhibit parasite growth by at least 80% at 2 µM concentration. More than 8,000 also showed potent activity against the multidrug resistant strain Dd2. Most (82%) compounds originate from internal company projects and are new to the malaria community. Analyses using historic assay data suggest several novel mechanisms of antimalarial action, such as inhibition of protein kinases and host–pathogen interaction related targets. Chemical structures and associated data are hereby made public to encourage additional drug lead identification efforts and further research into this disease.

Chemical genetics of Plasmodium falciparum
W. Armand Guiguemde, Anang A. Shelat, David Bouck, Sandra Duffy, Gregory J. Crowther, Paul H. Davis, David C. Smithson, Michele Connelly, Julie Clark, Fangyi Zhu, María B. Jiménez-Díaz, María S. Martinez, Emily B. Wilson, Abhai K. Tripathi, Jiri Gut, Elizabeth R. Sharlow, Ian Bathurst, Farah El Mazouni, Joseph W. Fowble, Isaac Forquer, Paula L. McGinley, Steve Castro, Iñigo Angulo-Barturen, Santiago Ferrer, Philip J. Rosenthal, Joseph L. DeRisi, David J. Sullivan, John S. Lazo, David S. Roos, Michael K. Riscoe, Margaret A. Phillips, Pradipsinh K. Rathod, Wesley C. Van Voorhis, Vicky M. Avery & R. Kiplin Guy

Here, a library of more than 300,000 chemicals was screened for activity against Plasmodium falciparum growing in red blood cells. Of these chemicals, 172 representative candidates were profiled in detail; one exemplar compound showed efficacy in a mouse model of malaria. The findings provide the scientific community with new starting points for drug discovery.

Nature
Volume 465 Number 7296 pp267-390  20 May 2010
http://www.nature.com/nature/current_issue.html

Letter
Climate change and the global malaria recession
Peter W. Gething, David L. Smith, Anand P. Patil, Andrew J. Tatem, Robert W. Snow & Simon I. Hay

Rising global temperatures resulting from climate change have been predicted to increase the future incidence of infectious diseases, including malaria. However, it is known that the range of malaria has contracted through a century of economic development and disease control. This contraction has now been quantified, and compared with the predicted effects of climate on malaria incidence. It is suggested that the impact of rising temperature is likely to be minor.