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

Volume 28, Issue 23, Pages 3875-4012 (21 May 2010)

Conference Report
Report of the fourth meeting on ‘Influenza vaccines that induce broad spectrum and long-lasting immune responses’, World Health Organization and Wellcome Trust, London, United Kingdom, 9–10 November 2009
Iain Stephenson, Frederick Hayden, Albert Osterhaus, Wendy Howard, Yuri Pervikov, Laszlo Palkonyay, Marie-Paule Kieny

Abstract
Current influenza vaccines are limited by the need for annual immunisation, frequent antigenic updating to match the evolution of circulating influenza virus strains, and reduced efficacy in elderly persons. On 9–10 November 2009, the Initiative for Vaccine Research of the World Health Organization convened jointly with the Wellcome Trust in London, United Kingdom, the fourth meeting on ‘Influenza vaccines that induce broad spectrum and long-lasting immune responses’. Presentations were made by representatives from industry, academia, governmental and non-governmental organisations. The objectives of the meeting were to update the progress of research in the field of influenza vaccine strategies able to generate cross protection against divergent influenza virus strains. Improvements in existing strategies including live attenuated influenza vaccines and adjuvantation of inactivated vaccines were summarised. Developments in novel antigen production methods, new routes of vaccine delivery and administration, and vaccine approaches based on conserved virus antigens were explored. In addition, correlates of immune protection and regulatory issues for the evaluation and approval of future novel vaccine strategies were discussed.

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

Volume 28, Issue 23, Pages 3875-4012 (21 May 2010)

Regular Papers
Surveillance of invasive pneumococcal disease in 30 EU countries: Towards a European system?
Germaine Hanquet, Anne Perrocheau, Esther Kissling, Daniel Levy Bruhl, David Tarragó, James Stuart, Pawel Stefanoff, Sigrid Heuberger, Paula Kriz, Anne Vergison, Sabine C. de Greeff, Andrew Amato-Gauci, Lucia Pastore Celentano and the ECDC country experts for pneumococcal disease

Abstract
In this era of new pneumococcal conjugate vaccines (PCV), we described and compared surveillance of invasive pneumococcal disease (IPD) and PCV policies in 30 European countries to provide guidance for Europe-wide surveillance. We confirmed the heterogeneity of surveillance systems and case definitions across countries but identified elements common to all countries, such as the availability of serotyping and the surveillance of pneumococcal meningitis. PCV impact was monitored in 11/15 countries using it. We propose steps for the monitoring of incidence rates and serotype distribution at EU level, to assess the need to introduce PCV and monitor its impact once introduced.

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

Volume 28, Issue 22, Pages 3755-3874 (14 May 2010)
Short Communications

Central European Vaccination Advisory Group (CEVAG) guidance statement on recommendations for 2009 pandemic influenza A(H1N1) vaccination
Roman Chlibek, Ioana Anca, Francis André, Mustafa Bakir, Inga Ivaskeviciene, Atanas Mangarov, Zsófia Mészner, Penka Perenovska, Roman Prymula, Darko Richter, Nuran Salman, Pavol Šimurka, Eda Tamm, Nataša Toplak, Vytautas Usonis

Abstract
The 2009 influenza A(H1N1) pandemic is markedly different from seasonal influenza with the disease affecting the younger population and a larger than expected number of severe or fatal cases has been seen in pregnant women, obese people and in people who were otherwise healthy. In Europe, influenza activity caused by the 2009 influenza A(H1N1) virus has passed the winter peak with nearly all countries now reporting lower influenza activity. However, although the rate of 2009 pandemic influenza A(H1N1) is declining, fatal cases continue to be reported and the future is hard to predict. The most effective protection against influenza is vaccination and increasing vaccine coverage is the only way to eliminate uncertainties regarding possible future waves of 2009 pandemic influenza A(H1N1). Recommendations have been developed for several central European countries but there is no clear or uniform definition with respect to priority groups or age groups who should receive vaccination. This paper contains the Central European Vaccination Advisory Group (CEVAG) guidance statement on recommendations for the vaccination of adults and children against 2009 pandemic influenza A(H1N1). CEVAG recommends vaccination of all health-care workers, pregnant women, children ≥6 months and <2 years of age and people with chronic medical conditions as a first priority.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 22, Pages 3755-3874 (14 May 2010)

Reviews
The global introduction of inactivated polio vaccine can
Ellen Heinsbroek, E. Joost Ruitenberg

Abstract
This literature review identifies the factors that influence the decision to introduce inactivated polio vaccine (IPV) in developing countries as opposed to the policy of vaccine cessation. Attenuated viruses in the oral polio vaccine (OPV) can replicate, revert to neurovirulence and become transmissible circulating vaccine-derived polioviruses (cVDPVs), preventing use of the vaccine in the post-eradication era. This literature review identifies (1) risks of complete cessation of vaccination, (2) barriers and (3) solutions for the introduction of IPV in developing countries. The reviewed literature favours to circumvent the so-called “OPV paradox” by global introduction of IPV.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 22, Pages 3755-3874 (14 May 2010)

Regular Papers
Knowledge, attitudes, and communication around human papillomavirus (HPV) vaccination amongst urban Asian mothers and physicians
Song-Nan Chow, Ruey Soon, Jong Sup Park, Chitsanu Pancharoen, You Lin Qiao, Partha Basu, Hextan Yuen Sheung Ngan

Abstract
To determine why HPV vaccination uptake is low in Asia, we surveyed attitudes, knowledge and communication about cervical cancer and HPV vaccination amongst 480 physicians and 1617 randomly selected urban mothers who could afford HPV vaccines in Korea, Malaysia, Taiwan and Thailand. HPV vaccine rejection by mothers was linked with poor knowledge and low perceptions of self-relevance. Physicians’ likelihood of raising the subject and/or recommending vaccination was linked to how proactively they advocate preventive health, their attitude to the subject’s sensitivity and their knowledge levels. Because most Asian mothers seek doctors’ advice and prefer them to take the initiative, physicians should be more proactive in discussing and recommending HPV vaccination.

“The U.S. Food and Drug Administration today revised its recommendations for rotavirus vaccines for the prevention of the disease in infants and has determined that it is appropriate for clinicians and health care professionals to resume the use of Rotarix and to continue the use of RotaTeq.

“The agency reached its decision based on a careful evaluation of information from laboratory results from the manufacturers and the FDA’s own laboratories, a thorough review of the scientific literature, and input from scientific and public health experts, including members of the FDA’s Vaccines and Related Biological Products Advisory Committee that convened on May 7, 2010 to discuss these vaccines.

“The FDA also considered the following in its decision:

– Both vaccines have strong safety records, including clinical trials involving tens of thousands of patients as well as clinical experience with millions of vaccine recipients.

– The FDA has no evidence that PCV1 or PCV2 pose a safety risk in humans, and neither is known to cause infection or illness in humans.

– The benefits of the vaccines are substantial, and include prevention of death in some parts of the world and hospitalization for severe rotavirus disease in the United States. These benefits outweigh the risk, which is theoretical.

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm212149.htm

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

Pandemic (H1N1) 2009 – update 100
Weekly update
14 May 2010

As of 9 May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18036 deaths.

Situation update:
The most active areas of pandemic influenza virus transmission currently are in parts of the Caribbean and Central America, and to a lesser extent in West Africa and South and Southeast Asia. In the temperate zone* of the northern and southern hemisphere, overall pandemic influenza activity remains sporadic. Seasonal influenza virus type B continues to be detected at low levels across parts of Asia, Africa, and Europe…

More at: http://www.who.int/csr/don/2010_05_14/en/index.html

The Bill & Melinda Gates Foundation announced 78 grants of US$100,000 each in the latest round of Grand Challenges Explorations. Grand Challenges Explorations is a five-year, $100 million initiative to promote innovation in global health. It is part of the Grand Challenges in Global Health initiative which is supported by the Gates Foundation to achieve major breakthroughs in global health.

Gates said that projects winning grants around more effective vaccines include:

– Sweat-triggered vaccine delivery: Carlos Alberto Guzman of the Helmholtz Centre for Infection Research in Germany with Claus-Michael Lehr and Steffi Hansen of the Helmholtz-Institute for Pharmaceutical Research will develop nanoparticles that penetrate the skin through hair follicles and burst upon contact with human sweat to release vaccines.

– A “seek-and-destroy” laser vaccine: Owain Millington and Gail McConnell of University of Strathclyde in the United Kingdom will use existing imaging systems to identify and destroy Leishmania parasites with a targeted laser;

– Treating worm infections to improve vaccine effectiveness: Susanne Nylén Spoormaker of the Karolinska Institute in Sweden will research whether treating patients for worm infections prior to vaccinations can improve the ability of the immune system to respond effectively to vaccines.

Applications for the next round of Grand Challenges Explorations are being accepted through May 19, 2010. Topics for Round 5 are:

– Create Low-Cost Cell Phone-Based Applications for Priority Global Health Conditions

– Create New Technologies to Improve the Health of Mothers and Newborns

– Create New Ways to Protect Against Infectious Disease

– Create New Technologies for Contraception

– Grant application instructions, including the list of topic areas in which proposals are currently being accepted, are available at the Grand Challenges Explorations website: www.grandchallenges.org.

http://www.gatesfoundation.org/press-releases/Pages/grand-challenges-explorations-round-four-winners-100509.aspx

National HIV Vaccine Awareness Day, May 18, 2010

Statement of Anthony S. Fauci, M.D., Margaret I. Johnston, Ph.D., and Gary J. Nabel, M.D., Ph.D., National Institute of Allergy and Infectious Diseases, National Institutes of Health

“More people today have access to life-saving antiretroviral therapy for HIV/AIDS than ever before. Yet for every person who begins treatment for HIV infection, two to three others become newly infected. Treatment alone will not curtail the HIV/AIDS pandemic. To control and ultimately end this pandemic, we need a powerful array of proven HIV prevention tools that are widely accessible to all who would benefit from them.

Vaccines historically have been the most effective means to prevent and even eradicate infectious diseases. They safely and cost-effectively prevent illness, disability and death. We at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, have been working for more than two decades with our colleagues worldwide to develop an HIV vaccine, and this research continues to rank among our top priorities.

National HIV Vaccine Awareness Day marks an opportunity to reflect on our progress, renew our commitment to finding an HIV vaccine, and personally thank the scientists, community educators, health care workers, and especially the many study volunteers who have dedicated their time and energy to this important endeavor. Only with the continued commitment of volunteers may we more effectively confront the global scourge of HIV/AIDS and pursue the goal of an HIV vaccine.

We have witnessed significant progress in HIV vaccine research during the past year. Notably, a major clinical trial in Thailand gave us the first indication that an experimental vaccine can protect some humans against HIV infection (http://www.niaid.nih.gov/news/newsreleases/2009/Pages/ThaiVaxStudy.aspx). With the participation of more than 16,000 volunteers, investigators found the vaccine to be 31 percent effective at preventing HIV infection. Although this level of protection is modest, it gives us hope that a safe and effective HIV vaccine is possible. The priority now is to try to understand how the vaccine induced protection against HIV infection in some individuals, and to build on those results.

The Thai trial demonstrated the power of large-scale clinical trials to advance HIV vaccine development and to answer fundamental scientific questions. Such trials are possible only through strategic partnerships among federal collaborators, nongovernmental organizations and the private sector. NIAID continues to pursue focused clinical HIV vaccine research through such partnerships.

At the same time, we are bolstering our commitment to the basic laboratory research that provides a foundation for future vaccine development. In the past year, scientists at NIAID and elsewhere discovered several new antibodies able to neutralize diverse HIV strains that circulate worldwide. These antibodies disable HIV by latching onto vulnerable sites on the virus. Some of these sites previously were unknown, so their discovery widens the field of targets that a vaccine could exploit. Current and future studies will determine whether scientists can develop HIV vaccines based on protein replicas of these targets, and whether the immune response to these vaccines might protect people from HIV infection. Many other studies also are under way to explore basic questions about HIV and its interaction with the immune system.

As we recognize recent progress in HIV vaccine research and hope for continued advances, we must remember that a vaccine alone will not end the HIV/AIDS pandemic. If an HIV vaccine is developed, it will need to be used in concert with multiple other scientifically proven HIV prevention tools. NIAID continues to support research into an array of investigational HIV prevention methods, including pre-exposure prophylaxis with antiretroviral drugs, microbicides, and expanded HIV testing and treatment with linkage to care. (http://www.niaid.nih.gov/topics/hivaids/research/prevention/Pages/default.aspx).

http://www.nih.gov/news/health/may2010/niaid-11.htm

WHO announced EVIPNet Africa’s first series of policy briefs on malaria treatment, noting that “six countries in sub-Saharan have developed their own set of policy briefs on how to improve access to malaria treatment working with EVIPNet (Evidence-informed policy network).” EVIPNet was set up in response to a 2005 World Health Assembly resolution calling for WHO to establish or strengthen “mechanisms to transfer knowledge in support of evidence-based public health and health care delivery systems and evidence-based related policies”  WHO said that development of the policy briefs are “a significant achievement because it represents the first time that policy-makers, researchers, and members of civil society in Burkina Faso, Cameroon, Central African Republic, Ethiopia, Mozambique and Uganda have collaborated with each other to better use scientific evidence to produce health policies.” The EVIPNet tools are now being applied to different problems in Africa, Asia and Latin America and the Caribbean. These include: maternal and child mortality; the integration of noncommunicable diseases programmes at community level; effective financing of primary health care; and outbreak response.

http://www.who.int/rpc/evipnet/policybriefs/en/index.html

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) launched its Ten Principles on Counterfeit Medicines, “to re-focus attention on this issue and underline the R&D-based pharmaceutical industry’s stance in the global fight against counterfeit medicines.” Mr Haruo Naito, President of the IFPMA, and President and CEO of Eisai, commented: “Counterfeit medicines are a crime, and our industry is serious about tackling this problem head on. These criminals pose a threat to global public health: deliberately and deceitfully they attempt to pass off their dangerous products as legitimate medicines, and risk patients’ lives in order to make illegal profits. This is not about commercial interest; this is about protecting patients, and we stand ready to be an active partner in WHO-led efforts, including IMPACT.”
Speaking in support of the IFPMA Principles, Mr. Thomas T. Kubic, CEO of PSI, said: “Based on our research, the number of counterfeit medicine incidents worldwide rose almost seven percent last year, to 1,693. Of particular concern has been the growth in counterfeit anti-infectives. In 2009, incidents involving counterfeit anti-infectives increased by almost 50% over the previous year. Anti-infectives, which include anti-malarials, are the therapeutic category most affected by counterfeiting incidents in Africa. Moreover, criminal gangs engaged in the manufacture, distribution and sale of counterfeit medicines are now copying other life-saving treatments including cancer therapies and heart disease medicines.” Eduardo Pisani, Director General of the IFPMA, commented: “We hope that the Ten Principles will highlight the full scope of the problem and demonstrate that the fight against counterfeit medicines is simply about protecting patients’ health. The IFPMA calls on all stakeholders, including governments, health care providers, patients, the private sector and the WHO, to take collaborative action and create a global policy environment that recognizes, prioritizes and effectively addresses this major threat to global health.”

http://www.ifpma.org/News/NewsReleaseDetail.aspx?nID=13800

Ten Principles (one page summary): http://www.ifpma.org/documents/NR13800/IFPMA_Ten_Principles_on_Counterfeit_Medicines_12May2010.pdf

The MMWR for May 14, 2010 / Vol. 59 / No. 18  includes:

Progress Toward Interruption of Wild Poliovirus Transmission — Worldwide, 2009
In 1988, an estimated 350,000 cases of poliomyelitis were occurring annually worldwide. By 2005, because of global vaccination efforts, indigenous transmission of wild poliovirus (WPV) types 1 and 3 (WPV1 and WPV3) had been eliminated from all but four countries (Afghanistan, India, Nigeria, and Pakistan). No cases of WPV type 2 have been reported since 1999. This report describes progress toward global WPV eradication during 2009 and updates previous reports (1—6). During 2009 a total of 1,606 cases of WPV infection were reported, compared with 1,651 in 2008. WPV3 incidence increased 67%, to 1,124 cases, compared with 675 in 2008. However, WPV1 incidence decreased 51%, to 482 cases in 2009, compared with 976 cases in 2008. In India, nearly all polio cases in 2009 were reported in high-risk districts in western Uttar Pradesh and central Bihar. In Afghanistan and Pakistan, WPV circulation in high-risk districts continued because of difficulties vaccinating children in conflict-affected areas and operational limitations in parts of Pakistan (5). In Nigeria, cases decreased by 51%, to 388 cases in 2009, compared with 798 in 2008. During 2009, outbreaks from importation of WPV affected 19 previously polio-free African countries (2). Two key steps are needed to make further progress in polio eradication: 1) addressing local barriers to interrupting transmission, and 2) using bivalent oral poliovirus vaccine (bOPV) broadly for WPV 1 and 3 in supplemental immunization activities (SIAs)…
a href=”http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5918a1.htm”>http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5918a1.htm

The Weekly Epidemiological Record (WER) for 14 May 2010, vol. 85, 20 (pp 177–184) includes Outbreak news – Rift Valley fever, South Africa; Progress in interrupting wild poliovirus transmission worldwide, 2009
http://www.who.int/wer/2010/wer8520.pdf

The Lancet
May 15, 2010  Volume 375 Number 9727  Pages 1665 – 1752
http://www.thelancet.com/journals/lancet/issue/current

Correspondence
GAVI’s funding challenge
Julian Lob-Levyt

Thanks to The Lancet for highlighting the funding challenge that the GAVI Alliance faces as we embark on our next decade of work (March 6, p 791).1 It is important to clarify that all of GAVI’s currently approved programmes are funded up to and including 2015. Such funding includes the existing support for pentavalent vaccine, which has already been introduced in 57 countries.

An important GAVI principle is to add value through long-term funding. Since the founding of the alliance in 2000, GAVI partners have increased immunisation rates to nearly 80% in developing countries, averted over 5 million deaths, and built a solid delivery platform that can now be used to introduce new life-saving vaccines against two of the world’s biggest childhood killers: pneumonia and diarrhoea. Herein lies our funding challenge. Only with increased donor support will we be able to expand further the effect on child mortality by immunising every poor child against these diseases.

Our donors share our ambition, as illustrated by the Gates Foundation’s dedication of US$10 billion to a “decade of vaccines”.2 As Swedish Development Minister Gunilla Carlsson herself said in a press conference at the World Economic Forum in Davos, Switzerland, “Sweden has been with GAVI from the beginning…I hope that other donors also see the good work that GAVI is doing.”3

1 Usher AD. GAVI enters its second decade with massive funding gap. Lancet 2010; 375: 791. Full Text | PDF(43KB) | CrossRef | PubMed

2 Bill & Melinda Gates Foundation. Bill and Melinda Gates pledge $10 billion in call for decade of vaccines. http://www.gatesfoundation.org/press-releases/Pages/decade-of-vaccines-wec-announcement-100129.aspx. (accessed April 7, 2010).

3 Davos 2010 Press Conference. Bill & Melinda Gates Foundation pledges new commitment to vaccines. http://www.livestream.com/worldeconomicforum03/video?clipId=pla_0a5ad43d-be31-42e8-b924-79b5fd46885e. (accessed April 22, 2010).

Nature
Volume 465 Number 7295 pp135-260  13 May 2010
http://www.nature.com/nature/current_issue.html

Opinion
Vaccinate before the next pandemic?
Klaus Stöhr of Novartis argues that pre-pandemic immunization with a cocktail of likely strains could be a cheap, practical and equitable way to protect people against influenza.

PLoS Medicine
(Accessed 16 May 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

Can Foreign Policy Make a Difference to Health?
Sigrun Møgedal, Benedikte Louise Alveberg Perspective, published 11 May 2010
New Complexities and

Approaches to Global Health Diplomacy: View from the U.S. Department of State
Kerri-Ann Jones Perspective, published 11 May 2010

Science
14 May 2010  Vol 328, Issue 5980, Pages 777-936
http://www.sciencemag.org/current.dtl

Special Issue: Tuberculosis & Malaria

Landscapes of Infection
Stella Hurtley, Caroline Ash, and Leslie Roberts

Redrawing Africa’s Malaria Map
Martin Enserink
Smaller countries on the hardest-hit continent have shown how aggressive malaria control can slash cases and deaths. Can the big ones follow?

As Challenges Change, So Does Science
Martin Enserink
Although nobody believes that it is possible in the next 10, 20, or even 30 years, the call to eradicate malaria, combined with the plummeting disease burden, are already reshaping the scientific agenda. |

Malaria’s Drug Miracle in Danger
Martin Enserink
Like many others before it, the latest generation of malaria drugs is losing its punch. This time, can global disaster be averted?

If Artemisinin Drugs Fail, What’s Plan B?
Martin Enserink
If the current generation of artemisinin-based combination therapies should fail, does the world have a solid backup plan? The short answer: No.

The ‘Do Unto Others’ Malaria Vaccine
Gretchen Vogel
Once neglected, research on transmission-blocking vaccines for malaria is gaining new prominence.

Shrinking the Malaria Map From the Outside In
Leslie Roberts
A debate is brewing over how best to fight malaria: Go for the quick wins, or the worst places first, or both?

Elimination Meets Reality in Hispaniola
Leslie Roberts
Hispaniola’s fledging program to eliminate malaria, now sidetracked by the earthquake, illustrates the difficulties that arise when ambitious goals collide with reality.

Reviews
Tuberculosis: What We Don’t Know Can, and Does, Hurt Us
David G. Russell, Clifton E. Barry, 3rd, and JoAnne L. Flynn

The Population Dynamics and Control of Tuberculosis
Christopher Dye and Brian G. Williams

That Was Then But This Is Now: Malaria Research in the Time of an Eradication Agenda
Stefan H. I. Kappe, Ashley M. Vaughan, Justin A. Boddey, and Alan F. Cowman

The Selection Landscape of Malaria Parasites
M. J. Mackinnon and K. Marsh

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

Pandemic (H1N1) 2009 – update 99
Weekly update
7 May 2010
As of 2nd May, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18001 deaths…

Situation update:
The most active areas of pandemic influenza virus transmission currently are in parts of West Africa, the Caribbean, and Southeast Asia. In the temperate zone of the northern and southern hemisphere, overall pandemic influenza activity remains sporadic. Seasonal influenza virus type B continues to be detected sporadically across Asia, Africa, Europe, and the Americas, however, low levels of late season virus circulation have primarily detected in East and Central Asia, southern Europe, and central Africa…

Full report at: http://www.who.int/csr/don/2010_05_07/en/index.html

The WHO released Pandemic (H1N1) 2009 vaccine deployment update – 3 May 2010. This one-page summary reports on the status of the H1N1 pandemic vaccine stockpile.

Current situation
– WHO has received pledges of approximately 200 million doses of vaccine, 70 million syringes and US$ 48 million for operations.

– 99 countries have requested vaccine donations

– 84 countries have signed agreements with WHO

– Progress of National Deployment Plans: 58 are complete and final; 5 plans are being refined.

– Completed Vaccine Deliveries (1 January – 3 May): 39 Countries / 20,930,900 doses

– Planned Vaccine Deliveries (May): 22 Countries / 16,798,200 doses

http://www.who.int/csr/disease/swineflu/action/h1n1_vaccine_deployment_update20100503.pdf

The Weekly Epidemiological Record (WER) for 7 May 2010, vol. 85, 19 (pp 165–176) includes: Poliomyelitis in Tajikistan– update; Dracunculiasis eradication – global surveillance summary, 2009; WHO Strategic Advisory Group of Experts (SAGE) on immunization: request for nominations

http://www.who.int/wer/2010/wer8519.pdf

The MMWR for May 7, 2010 / 59(17);514-516 includes:

The Adult Hepatitis Vaccine Project — California, 2007–2008

Since hepatitis B vaccine was first released in 1981, a public health goal has been to vaccinate adults at risk for infection because of risky sexual behaviors and needle-sharing practices (1,2). However, vaccination coverage for this group has remained low (3). During 2007, in the United States, among the estimated 43,000 persons newly infected with hepatitis B virus (HBV), the highest rate was reported among persons aged 25–44 years, and the majority of these infections were among at-risk adults (1). Surveillance data were similar in California (4). In 2006, when the Advisory Committee on Immunization Practices (ACIP) recommended that hepatitis B vaccination be offered to all adults as part of routine prevention services in settings where a high proportion of those served are at increased risk (2,5), CDC launched a national initiative encouraging states to use existing federal funds to purchase adult hepatitis B–containing (HepB) vaccine. In response, the California Department of Public Health (CDPH) established the Adult Hepatitis Vaccine Project (AHVP) to expand hepatitis B vaccination in sites serving at-risk adults. This report summarizes results for 2007–2008, which indicated that 28,824 doses of HepB vaccine were administered at 29 participating sites in the first 19 months of AHVP; 13 sites administered HepB vaccine for the first time. Federal provision of vaccine resulted in vaccination of many adults who otherwise might not have been vaccinated against HBV. Increased capacity to vaccinate all adults at risk is needed for the elimination of HBV transmission in the United States…

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5917a2.htm

The MMWR for May 7, 2010 / 59(17);514-516 includes:

Rotavirus Vaccination Coverage Among Infants Aged 5 Months — Immunization Information System Sentinel Sites, United States, June 2006–June 2009

In February 2006, the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination of all U.S. infants with 3 doses of a pentavalent rotavirus vaccine administered at ages 2, 4, and 6 months (1). In June 2008, ACIP updated its recommendations to include use of a second rotavirus vaccine, a 2-dose monovalent vaccine, administered at ages 2 and 4 months (1). The maximum age for the first dose of either rotavirus vaccine (RV) is 14 weeks and 6 days. CDC recently analyzed data from Immunization Information System (IIS) sentinel sites 1) to assess trends in coverage with ≥1 dose of RV during June 2006–June 2009 among infants aged 5 months and 2) to compare RV coverage in the second quarter of 2009 with that of two other routinely-recommended vaccines for U.S. infants: diphtheria, tetanus, and acellular pertussis (DTaP) vaccine, and 7-valent pneumococcal conjugate vaccine (PCV7). RV coverage increased following vaccine introduction and, in June 2009, averaged 72% at the eight currently participating IIS sentinel sites. However, ≥1 dose RV coverage among infants aged 5 months was 13% lower than the average coverage with ≥1 dose of DTaP and PCV7 at these same sites. Lower RV coverage could reflect typical new-vaccine coverage dynamics, the presence of RV-specific barriers (2,3), or both. Identifying and reducing barriers to vaccination and educating parents and providers about the health benefits of rotavirus vaccination should increase coverage and help prevent severe rotavirus disease.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5917a4.htm

Human Vaccines
Volume 6, Issue 5  May 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/3/

Commentary
Rotavirus vaccines for global use: What are the remaining issues and challenges?
Baoming Jiang, Manish Patel and Umesh Parashar, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

JAMA
Vol. 303 No. 17, pp. 1669-1771, May 5, 2010
http://jama.ama-assn.org/current.dtl

Original Contributions
Pneumococcal Vaccination and Risk of Acute Myocardial Infarction and Stroke in Men
Hung Fu Tseng; Jeffrey M. Slezak; Virginia P. Quinn; Lina S. Sy; Stephen K. Van Den Eeden; Steven J. Jacobsen

Context
Multiple studies have shown that preventing influenza by vaccination reduces the risk of vascular events. However, the effect of pneumococcal polysaccharide vaccine on vascular events remains controversial.

Objective
To examine the association between pneumococcal vaccination and risk of acute myocardial infarction (MI) and stroke among men.

Design, Setting, and Participants
A prospective cohort study of Kaiser Permanente Northern and Southern California health plans with 84 170 participants aged 45 to 69 years from the California Men’s Health Study who were recruited between January 2002 and December 2003, and followed up until December 31, 2007. The cohort was similar to the population of health plan members and men who responded to a general health survey in California on important demographic and clinical characteristics. Demographic and detailed lifestyle characteristics were collected from surveys. Vaccination records were obtained from the Kaiser Immunization Tracking System.

Main Outcome Measure
Incidence of acute MI and stroke during the follow-up period in men who had no history of such conditions.

Results
During follow-up, there were 1211 first MIs in 112 837 vaccinated person-years (10.73 per 1000 person-years) compared with 1494 first MI events in 246 170 unvaccinated person-years (6.07 per 1000 person-years). For stroke, there were 651 events in 122 821 vaccinated person-years (5.30 per 1000 person-years) compared with 483 events in 254 541 unvaccinated person-years (1.90 per 1000 person-years). With propensity score adjustment, we found no evidence for an association between pneumococcal vaccination and reduced risk of acute MI (adjusted hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.98-1.21) or stroke (adjusted HR, 1.14; 95% CI, 1.00-1.31). An inverse association was also not found in men of different age and risk groups. The results appeared to be consistent, because using more specific International Classification of Diseases, Ninth Revision codes for the outcome definition did not change the estimations.

Conclusion
Among a cohort of men aged 45 years or older, receipt of pneumococcal vaccine was not associated with subsequent reduced risk of acute MI and stroke.

Editorials
Preventing Myocardial Infarction With Vaccination: Myths and Realities
Mohammad Madjid; Daniel M. Musher

Extract
Many clinical studies supported by basic experiments suggest that infections may trigger an acute coronary syndrome. The role of respiratory infections, especially influenza and pneumococcal pneumonia, in acute coronary syndrome in high-risk patients has been well documented.1-3 Such infections can cause an exaggerated inflammatory response in a high-risk atherosclerotic plaque, which may be followed by destabilization of the plaque, activation of the coagulation cascade, vascular thrombosis, and subsequent myocardial infarction (MI). Given the high prevalence of coronary heart disease and its risk factors in the population and the frequency of influenza and pneumonia, it is likely that each year thousands of patients might develop cardiovascular events after having such infections. This potentially causal effect has immense clinical implications, because it offers a potential method for preventing cardiovascular events by preventing or treating these infections.4 In this issue of JAMA, Tseng and…

The Lancet
May 08, 2010  Volume 375  Number 9726  Pages 1579 – 1664
http://www.thelancet.com/journals/lancet/issue/current

World Report
Tide turns for drug manufacturing in Africa
Tatum Anderson

Preview
With several efforts underway to increase the local production of drugs in developing countries, Tatum Anderson assesses the pros and cons of manufacturing medicines in Africa.A drugs producer in Uganda has become the first in a least developed country (LDC)—a category reserved for the world’s poorest nations—to achieve a world-class seal of quality for its manufacturing standards.

New England Journal of Medicine
Volume 362 — May 6, 2010 — Number 18
http://content.nejm.org/current.shtml

Review Article [Free Full-text]
Medical Progress: Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection
Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza

New England Journal of Medicine
Volume 362 — May 6, 2010 — Number 18
http://content.nejm.org/current.shtml

Special Report
Information Technology and Global Surveillance of Cases of 2009 H1N1 Influenza
J. S. Brownstein and Others

The widespread adoption of increasingly sophisticated forms of information technology has paralleled the increase in rapid and far-reaching international travel. The emergence and global spread of the 2009 pandemic influenza A (H1N1) virus illustrated not only the hazards of an interconnected world, but also the powerful role of new methods for detecting, tracking, and responding to infectious diseases. Although formal reporting, surveillance, and response structures remain essential to protecting public health, a new generation of freely accessible, online, and real-time informatics tools for disease tracking are expanding the ability of public health professionals to detect weak signals across borders and to raise earlier warnings of emerging disease threats.

The HealthMap H1N1 System
HealthMap (http://healthmap.org) is an example of a new effort in transparent, global, public health surveillance. The HealthMap system combines automated, around-the-clock data collection and processing with expert review and analysis to aggregate reports according to type of disease and geographic location. HealthMap sifts through large volumes of information on events, obtained from a broad range of online sources in multiple languages, to provide a comprehensive view of ongoing global disease activity through a freely available Web site…

PLoS Medicine
(Accessed 9 May 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

Negotiating Equitable Access to Influenza Vaccines: Global Health Diplomacy and the Controversies Surrounding Avian Influenza H5N1 and Pandemic Influenza H1N1
David P. Fidler Policy Forum, published 04 May 2010
doi:10.1371/journal.pmed.1000247

PLoS Medicine
(Accessed 9 May 2010)

A Population-Based Evaluation of a Publicly Funded, School-Based HPV Vaccine Program in British Columbia, Canada: Parental Factors Associated with HPV Vaccine Receipt
Gina Ogilvie, Maureen Anderson, Fawziah Marra, Shelly McNeil, Karen Pielak, Meena Dawar, Marilyn McIvor, Thomas Ehlen, Simon Dobson, Deborah Money, David M. Patrick, Monika Naus Research Article, published 04 May 2010
doi:10.1371/journal.pmed.1000270

Science Translational Medicine
5 May 2010 vol 2, issue 30
http://stm.sciencemag.org/content/current

Policy
Institutional Review Boards, Professionalism, and the Internet
Robert Martensen

Abstract
Even as the Internet generates pressures that erode professional authorities of all kinds, it also provides opportunities for researchers and their institutional review boards to bolster their status as trusted sources. To this end, we must work to improve clinical protocol design and approval procedures and maintain the integrity of the study participant recruitment process in clinical trials.

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

Pandemic (H1N1) 2009 – update 98
Weekly update
30 April 2010

As of 25th of April, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17919 deaths…

Situation update:
The current situation is largely unchanged since the last update. The most active areas of transmission of pandemic influenza H1N1 virus continue to be parts of West and Central Africa with some focal areas of activity in South and Southeast Asia. Pandemic influenza activity H1N1 remains low in much of the temperate areas of both the northern and southern hemispheres. Seasonal influenza type B virus is the predominant influenza virus, though also at low levels of circulation, across East Asia, Northern and Eastern Europe. Influenza type B viruses have also been detected in Central Africa and this week in West Africa. Seasonal influenza H3N2 viruses have continued to be detected in South and Southeast Asia, as well as sporadically in some countries of West and Central Africa, and Eastern Europe.

Full report at: http://www.who.int/csr/don/2010_04_30a/en/index.html

UNICEF and the World Health Organization released SOURCES AND PRICES OF SELECTED MEDICINES FOR CHILDREN, a new online publication that “lists medicines formulated for children…to help doctors and organizations obtain some of the 240 essential medicines that can save the lives of children.” Hans Hogerzeil, Director Essential Medicines and Pharmaceutical Policies at WHO, said, “An estimated 9 million children die each year from preventable and treatable causes. Improved availability and access to safe child-specific medicines is still far from reality for many children in poor countries. This one-of-its-kind publication will be useful for organizations and personnel involved in procurement to identify where medicines may be found and what they cost.”

This second edition offers current details on 612 different paediatric formulations of 240 medicines selected from the ‘WHO Model List of Essential Medicines for Children’, as well as therapeutic food, and vitamin and mineral supplements, to treat major childhood illnesses and diseases.

http://www.who.int/medicines/publicatio ns/essentialmedicines/Sources_Prices2010.pdf

The GAVI Alliance said that Guyana became the fourth GAVI-eligible country to introduce rotavirus vaccine. Guyana’ Minister of Health Dr Leslie Ramsammy commented, “Introducing rotavirus vaccines into our immunisation programme is a crucial step in saving our children’s lives. We are committed to doing all that we can for our children to make sure they grow up to be healthy and productive adults. In 1994, the government of Guyana decided that all proven, life-saving vaccines should be available to all of our children. We made this commitment and we will continue to grow our vaccination programme.”

http://www.gavialliance.org/media_centre/press_releases/2010_04_30_guyana_tackles_2nd_biggest_killer.php

The MMWR for April 30, 2010 / Vol. 59 / No. 16 includes:

Interim Results: State-Specific Seasonal Influenza Vaccination Coverage — United States, August 2009–January 2010

[From CDC Media Release}

More Americans were vaccinated against seasonal flu during the 2009-10 season (40 percent of eligible population) than during the previous flu season (33 percent of eligible population), according to a report by the Centers for Disease Control and Prevention. The greatest gain in vaccination rates was in children 6 months to 17 years. About 40 percent of children were vaccinated for seasonal flu last season, representing a 16 percentage point jump from the 2008-09 season.

There also was an increase in the percentage of healthy adults (people without a chronic health condition such as asthma or diabetes), aged 18–49 years old who were vaccinated against seasonal flu. Coverage in this group increased from approximately 22 percent in 2008-09 to approximately 28 percent for the 2009-10 season. Coverage remained stable among adults 18-49 years of age with chronic health conditions, all adults 50-64 years, and those 65 years and older.

“These results are encouraging,” said Dr. Anne Schuchat, director of CDC’s National Center for Immunization and Respiratory Diseases. “It’s now important that we build on this success next fall and winter. We want people, especially parents, to make getting a flu vaccination each year a regular habit”

Licensure of a High-Dose Inactivated Influenza Vaccine for Persons Aged ≥65 Years (Fluzone High-Dose) and Guidance for Use — United States, 2010

The Weekly Epidemiological Record (WER) for 30 April 2010, vol. 85, 18 (pp 156–164) includes: Poliomyelitis in Tajikistan: first importation since Europe certified polio-free; Schistosomiasis

http://www.who.int/wer/2010/wer8518.pdf

Clinical Infectious Diseases
1 June 2010   Volume 50, Number 11
http://www.journals.uchicago.edu/toc/cid/current

The Changing Epidemiology of Invasive Pneumococcal Disease in Aboriginal and Non–Aboriginal Western Australians from 1997 through 2007 and Emergence of Nonvaccine Serotypes

Deborah Lehmann, Judith Willis, Hannah C. Moore, Carolien Giele, Denise Murphy, Anthony D. Keil, Catherine Harrison, Kathy Bayley, Michael Watson, and Peter Richmond, on behalf of the Vaccine Impact Surveillance Network

Abstract
After introduction of a 3-dose childhood schedule of pneumococcal conjugate vaccine, rates of invasive disease decreased among children and non‐Aboriginal adults but increased markedly among young Aboriginal adults, which has resulted in an increasing disparity, in recent years, between Aboriginal and non-Aboriginal people, with respect to disease rates.

Journal of Infectious Diseases
1 June 2010  Volume 201, Number 11
http://www.journals.uchicago.edu/toc/jid/current

Editorial Commentaries
Vaccine Epidemiology: Efficacy, Effectiveness, and the Translational Research Roadmap
Geoffrey A. Weinberg and Peter G. Szilagyi

Despite the rather short history of vaccination, compared with the millennia of various human plagues and pestilences, more than a dozen major infectious diseases (most notably, smallpox, poliomyelitis, rabies, diphtheria, tetanus, pertussis, Haemophilus influenzae type b disease, measles, mumps, and rubella) have been controlled in many parts of the world [1]. The recently licensed rotavirus vaccines show great promise in this new century for controlling an infection which leads to 25,000–50,000 hospitalizations, nearly 400,000 emergency room visits, and 400,000 medical care visits of children in the United States annually, while at the same time leading to nearly 600,000 deaths worldwide [2–5].

As each new vaccine is considered for licensure, the most basic of questions is perhaps the most complex to answer: “How well does the candidate vaccine prevent the disease for which it was developed?” In this issue of the Journal, Curns et al [6] estimate that pentavalent rotavirus vaccine use has decreased hospitalization rates for acute gastroenteritis among children in the United States aged <5 years by 45%, including those who were either too young or too old to be eligible for vaccination. A monovalent rotavirus vaccine is also licensed for use in the United States [2, 3] but was not available during the study period.

The Curns et al [6] study is timely and important and also highlights the distinction between the epidemiologic concepts of vaccine efficacy and vaccine effectiveness [7–12]. These often confused terms fit well into the new paradigm of translational research discussed below…[Free Full text at link above]

New England Journal of Medicine
Volume 362 — April 29, 2010 — Number 17
http://content.nejm.org/current.shtml

To the Editor: Madhi and colleagues (Jan. 28 issue)1 describe the effectiveness of a live, oral rotavirus vaccine against rotavirus gastroenteritis among infants in South Africa and Malawi. The vaccine had 64.1% efficacy against G1 rotavirus strains and 59.7% efficacy against non-G1 strains. However, we need to consider the prevalence of various strains before introducing the vaccine extensively in the community. A study in Bangladesh from 2001 through 2005 showed that the G1P[8] strain was the most prevalent (36.4%), followed by G9P[8] (27.7%), G2P[4] (15.4%), and G12P[6] (3.1%), but in 2005–2006, G2P[4] appeared as the most prevalent strain (43.2%), and G12P[6] increased in prevalence (11.1%).2 The recently licensed Rotarix vaccine includes only P[8] specificity, with less efficacy against heterotypic non-P[8] strains. The study by Kafulafula et al. showed that breast-feeding influences the rate of gastroenteritis in infants during the first year of life,3 although the authors did not report these results. The currently available Rotarix vaccine might provide good coverage against rotavirus strains that are prevalent in wealthier countries, but for developing countries like Malawi, we might need a vaccine containing different rotavirus strains.

Dewan S. Billal, Ph.D.
University of Laval
Quebec, QC, Canada
dsbh2000@yahoo.com

The Pediatric Infectious Disease Journal
May 2010 – Volume 29 – Issue 5
http://journals.lww.com/pidj/pages/currenttoc.aspx

Opinion and Analysis

Randomized Trials to Study the Nonspecific Effects of Vaccines in Children in Low-Income Countries
Shann, Frank; Nohynek, Hanna; Scott, J. Anthony; Hesseling, Anneke; Flanagan, Katie L.; on behalf of the Working Group on The Nonspecific Effects of Vaccines
The Pediatric Infectious Disease Journal. 29(5):457-461, May 2010.

Abstract:
The Expanded Program on Immunization (EPI) has led to large reductions in morbidity and mortality among children in low-income countries. However, the basic EPI schedule may no longer be optimal because of changes in vaccines, programs, and epidemiologic circumstances. In addition, evidence has accumulated that some EPI vaccines may have nonspecific effects that increase or decrease mortality from subsequent infections with other unrelated organisms. There is therefore a need for randomized trials to evaluate the effects of alternative EPI schedules on all-cause mortality, as well as vaccine efficacy against the target diseases. We have reviewed the available literature on the nonspecific effects of vaccines on mortality, and compiled a list of potential trials that might address this issue. We have then ranked the trials based on the potential importance of the results and the ethical and practical considerations. Trials of early BCG vaccination in low-birth-weight babies, early measles vaccination, and altered timing of DTP vaccination all have a high priority.

Pediatrics
May 2010 / VOLUME 125 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

Knowledge of Interim Recommendations and Use of Hib Vaccine During Vaccine Shortages
Allison Kempe, Christine Babbel, Gregory S. Wallace, Shannon Stokley, Matthew F. Daley, Lori A. Crane, Brenda Beaty, Sandra R. Black, Jennifer Barrow, and L. Miriam Dickinson

Abstract
OBJECTIVES The goals were to determine among pediatricians and family physicians (1) knowledge of interim recommendations regarding Haemophilus influenzae type b (Hib) vaccine administration, (2) current practices, and (3) factors associated with nonadherence.

METHODS An Internet-based survey was conducted in April 2008 among national samples.

RESULTS Response rates were 68% (220 of 325 physicians) among pediatricians and 51% (153 of 302 physicians) among family physicians. Seventy-three percent of pediatricians and 45% of family medicine physicians reported insufficient Hib vaccine supplies, and 22% to 24% reported having to defer doses for infants 2 to 6 months of age 10% of the time. Ninety-eight percent of pediatricians and 81% of family physicians were aware of the interim recommendations (P .0001), and virtually all knew that the booster dose should be deferred; however, 22% of pediatricians and 33% of family medicine physicians reported not deferring this dose. Physicians in both specialties were less likely to adhere to recommendations to defer in this age group if they thought that their practice had sufficient vaccine supplies (pediatricians, odds ratio: 0.01 [95% confidence interval: 0.003–0.03]; family medicine physicians, odds ratio: 0.10 [95% confidence interval: 0.03–0.33]). Family medicine physicians were less likely to adhere to recommendations if they had not heard about the interim recommendations (odds ratio: 0.04 [95% confidence interval: 0.01–0.21]).

CONCLUSIONS Most primary care physicians experienced Hib vaccine shortages, and many have had to defer doses for 2- to 6-month-old children. Most are knowledgeable regarding interim recommendations, but one-fifth to one-third reported nonadherence.

Pediatrics
May 2010 / VOLUME 125 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

Mother-Daughter Communication and Human Papillomavirus Vaccine Uptake by College Students
Megan E. Roberts, Meg Gerrard, Rachel Reimer, and Frederick X. Gibbons

Abstract

OBJECTIVES Although a human papillomavirus(HPV) vaccine has been available for more than 3 years, little research has documented the uptake and predictors of vaccination among older adolescents and young adult women. The purpose of this cross-sectional study was to examine the prevalence of HPV vaccination among college women across time and to explore the effect of mother-daughter communication on vaccination.

METHODS During the period of fall 2007 through fall 2009, a convenience sample of 972 female undergraduate students (aged 18–25) at a large Midwestern state university (89% white) completed a paper-and-pencil or online anonymous questionnaire that assessed their sexual-risk behavior, knowledge of HPV, perceptions of HPV risk, communication from their mothers about sex-related topics (including HPV), and their current vaccination status.

RESULTS Sixty-five percent of the women reported being sexually active, and 49% reported having received at least the first of the 3-shot vaccine series. The mother’s approval of HPV vaccination, mother-daughter communication about sex, and daughter’s perceptions of vulnerability to HPV were positively associated with vaccination status. Among the women who had not received any of the HPV shots, the mother’s approval of HPV vaccination, perceived vulnerability to HPV, and risky sexual behavior were predictive of interest in receiving the vaccine. Mother-daughter communication about values related to sex was negatively associated with interest.

CONCLUSIONS Although many of these young women were old enough to receive the vaccine without their parents’ consent, perception of their mother’s approval and mother-daughter communication about sex were important predictors of vaccination.

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

Pandemic (H1N1) 2009 – update 97
Weekly update
23 April 2010

As of 18 April 2010, worldwide more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 17853 deaths…

Situation update:
Summary: Currently the most active areas of transmission of pandemic influenza are in parts of West and Central Africa but transmission is also still occurring in South East Asia, and Central America. Pandemic influenza activity remains low in much of the temperate zone of both the northern and southern hemispheres. Seasonal influenza type B viruses have been increasingly detected over a larger area and are now the predominant circulating influenza viruses across East Asia, Central Africa and Northern and Eastern Europe. Very small numbers of type B viruses have also recently been detected in Central America. Seasonal influenza H3N2 is still being detected in South and Southeast Asia (mainly Indonesia), as well as sporadically in several countries of West Africa, and Eastern Europe.

Full report at: http://www.who.int/csr/don/2010_04_23a/en/index.html

WHO said that Immunization Week campaigns have launched in 112 countries globally “with the goals of expanding immunization coverage and raising awareness of the importance of vaccines.”

http://www.who.int/mediacentre/news/notes/2010/immunization_20100423/en/index.html

Statement of B.F. (Lee) Hall, M.D., Ph.D., and Anthony S. Fauci, M.D. National Institute of Allergy and Infectious Diseases National Institutes of Health on World Malaria Day April 25, 2010

“This year, we commemorate World Malaria Day by celebrating recent advances in controlling malaria. At the same time, we acknowledge the urgency in meeting critical milestones if we are to eliminate and eventually eradicate the disease worldwide.

“Although significant strides have been made toward malaria control and the elimination of the disease from many regions, global eradication is a long-term goal that will require a sustained commitment. As we accomplish our goals, disease patterns may change and new problems will inevitably arise. It is important that we adapt to the changing circumstances that result from our successes and commit to a long-term effort.

“Today we enter the second year of the Global Malaria Action Plan, [http://www.rollbackmalaria.org/gmap/] developed by the Roll Back Malaria (RBM) Partnership, a global framework for coordinated action against malaria, [http://www.rollbackmalaria.org/], which set ambitious goals to control, eliminate and eradicate malaria. We continue to support the RBM campaign, Count Malaria Out, which strives to achieve the 2010 target of delivering effective and affordable protection and treatment to all people at risk of malaria and cutting the disease burden in half compared with 2000 levels. This target marks a critical milestone in achieving the Millennium Development Goal [http://www.un.org/millenniumgoals/] set by the United Nations to halt the spread of malaria by 2015…

“…According to the World Health Organization, there were about 243 million cases of clinical malaria and 863,000 deaths in 2008. Most of the deaths occurred among children less than 5 years of age living in sub-Saharan Africa. Reducing the number malaria deaths to 500,000 by the end of this year and to near zero by 2015 will require a concerted effort engaging all stakeholders….

“…global eradication of malaria and even regional elimination may not be possible without the development of a safe, affordable and highly effective malaria vaccine…”

http://www.nih.gov/news/health/apr2010/niaid-21.htm

The GAVI Alliance Board “agreed to pursue the implementation of a common Health System Funding Platform to make better use of new and existing funds for health systems and to leverage additional funding.” This builds on announcements made at the high level Task Force on Innovative Financing and Health, in September 2009, to commit an additional US$900 million for Health Systems Strengthening. This harmonised platform “will help countries access money more simply and spend it more effectively.”

GAVI noted that the performance and results-based platform, which is being developed together with the Global Fund to Fight AIDS, Tuberculosis and Malaria and the World Bank with facilitation from the World Health Organization (WHO), “aims to better deliver the Millennium Development Goals (MDGs) by strengthening health systems and removing bottlenecks in the delivery of health services in the world’s poorest countries.”

http://www.gavialliance.org/media_centre/statements/GAVI_statement_HSF_Platform_20_04_2010.php

The Bill & Melinda Gates Foundation announced that Ernest Loevinsohn will join the Foundation’s Global Health Program as Director of Policy and Advocacy. Gates said that Dr. Loevinsohn “will lead the foundation’s efforts to encourage political commitment and effective investment in global health in both donor and developing countries. He will also manage a grant program, oversee work to build evidence to support effective policy making, and help lead the foundation’s work on the Global Fund to Fight AIDS, Tuberculosis, and Malaria.”

http://www.gatesfoundation.org/press-releases/Pages/ernest-loevinsohn-director-of-global-health-policy-and-advocacy-100423.aspx

PATH provided an update on its joint HPV vaccine project in India. PATH said that over the past few months, a post-licensure observational study involving administration of HPV vaccine in India, conducted as part of PATH’s global HPV Vaccines: Evidence for Impact project, “has been the focus of allegations from various groups. Recently these have been covered in the press, mainly in India. As a precaution, the Government of India has decided to suspend all project HPV vaccination and to conduct an inquiry to respond to voiced concerns.” PATH said that the project is being implemented by the immunization departments of India’s Andhra Pradesh and Gujarat states and “was carried out only after receiving all required approvals in India and the United States. PATH is cooperating fully with the government inquiry to assist in allaying voiced concerns.” To date, 23,500 girls have been fully vaccinated by the Ministries of Health and Family Welfare in Andhra Pradesh and Gujarat utilizing HPV vaccines licensed for sale in India and donated by Merck and GlaxoSmithKline.

Dr. Christopher Elias, president and CEO of PATH, said, “The mission of PATH worldwide, and in India, is to improve the health of people by advancing technologies, strengthening systems, and encouraging healthy behaviors. The HPV Vaccines: Evidence for Impact project was designed to address all three of these areas. The post-licensure observational study is generating data about vaccine coverage, feasibility, acceptability, and implementation costs associated with different HPV vaccine delivery strategies. The project also assesses cervical precancer screening and treatment strategies. It was designed, in cooperation with government agencies, to assist India’s public health system in identifying the most effective and affordable strategies to help prevent cervical cancer, a disease that kills an estimated 143,000 Indian women every year.

“For approval of the post-licensure observational study, PATH and its Indian collaborators worked with two ethical review committees in India and one in the United States to design study protocols and informed consent materials. PATH is confident that these procedural safeguards informed and guided all aspects of study implementation and conduct.”

http://www.path.org/news/an100422-hpv-india.php

JAMA
Vol. 303 No. 15, pp. 1451-1556, April 21, 2010
http://jama.ama-assn.org/current.dtl

Original Contributions
Pandemic 2009 Influenza A(H1N1) Virus Illness Among Pregnant Women in the United States
Alicia M. Siston; Sonja A. Rasmussen; Margaret A. Honein; Alicia M. Fry; Katherine Seib; William M. Callaghan; Janice Louie; Timothy J. Doyle; Molly Crockett; Ruth Lynfield; Zack Moore; Caleb Wiedeman; Madhu Anand; Laura Tabony; Carrie F. Nielsen; Kirsten Waller; Shannon Page; Jeannie M. Thompson; Catherine Avery; Chasisity Brown Springs; Timothy Jones; Jennifer L. Williams; Kim Newsome; Lyn Finelli; Denise J. Jamieson; for the Pandemic H1N1 Influenza in Pregnancy Working Group

Context  Early data on pandemic 2009 influenza A(H1N1) suggest pregnant women are at increased risk of hospitalization and death.

Objective  To describe the severity of 2009 influenza A(H1N1) illness and the association with early antiviral treatment among pregnant women in the United States.

Design, Setting, and Patients  Surveillance of 2009 influenza A(H1N1) in pregnant women reported to the Centers for Disease Control and Prevention (CDC) with symptom onset from April through December 2009.

Main Outcome Measures  Severity of illness (hospitalizations, intensive care unit [ICU] admissions, and deaths) due to 2009 influenza A(H1N1) among pregnant women, stratified by timing of antiviral treatment and pregnancy trimester at symptom onset.

Results  We received reports on 788 pregnant women in the United States with 2009 influenza A(H1N1) with symptom onset from April through August 2009. Among those, 30 died (5% of all reported 2009 influenza A[H1N1] influenza deaths in this period). Among 509 hospitalized women, 115 (22.6%) were admitted to an ICU. Pregnant women with treatment more than 4 days after symptom onset were more likely to be admitted to an ICU (56.9% vs 9.4%; relative risk [RR], 6.0; 95% confidence interval [CI], 3.5-10.6) than those treated within 2 days after symptom onset. Only 1 death occurred in a patient who received treatment within 2 days of symptom onset. Updating these data with the CDC’s continued surveillance of ICU admissions and deaths among pregnant women with symptom onset through December 31, 2009, identified an additional 165 women for a total of 280 women who were admitted to ICUs, 56 of whom died. Among the deaths, 4 occurred in the first trimester (7.1%), 15 in the second (26.8%), and 36 in the third (64.3%);

Conclusions  Pregnant women had a disproportionately high risk of mortality due to 2009 influenza A(H1N1). Among pregnant women with 2009 influenza A(H1N1) influenza reported to the CDC, early antiviral treatment appeared to be associated with fewer admissions to an ICU and fewer deaths.

The Lancet
Apr 24, 2010  Volume 375  Number 9724  Pages 1407 – 1494
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Malaria 2010: more ambition and accountability please
The Lancet

Preview
This year’s strapline for World Malaria Day on April 25 is Counting Malaria Out. It indicates the hope of universal access to malaria prevention and treatment by the end of this year, as requested by UN Secretary-General Ban Ki-moon in 2008. Additionally, the World Health Assembly and Roll Back Malaria Partnership had called for a reduction of malaria cases and deaths by at least 50% by the end of 2010 compared with rates in 2000. There are less than 9 months to go, yet a strange sense of misplaced optimism seems to be prevailing in many quarters.

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.

New England Journal of Medicine
Volume 362 — April 22, 2010 — Number 16
http://content.nejm.org/current.shtml

Review Article
Current Concepts: Advances in the Development of Vaccines against Neisseria meningitidis
L. K. K. Tan, G. M. Carlone, and R. Borrow

Extract: First 100 words per NEJM convention
Although two centuries have passed since Vieusseux described epidemic meningococcal disease,1 Neisseria meningitidis remains a leading cause of meningitis and sepsis. Overwhelming meningococcal disease can develop rapidly and is associated with mortality rates exceeding 20%.2 Thus, efforts to control the disease have focused on vaccination. In the past, vaccines against meningococcal disease have failed to provide immunogenicity and long-term protection in infants, who are at greatest risk. Although recent vaccines have improved coverage for this age group, there is still no broadly effective vaccine against N. meningitidis group B (NMB), now the predominant disease-causing isolate in industrialized countries.