Vaccines: The Week in Review

30 August 2010
Center for Vaccine Ethics & Policy
http://centerforvaccineethicsandpolicy.wordpress.com/
A program of
- Center for Bioethics, University of Pennsylvania
http://www.bioethics.upenn.edu/
- The Wistar Institute Vaccine Center
http://www.wistar.org/vaccinecenter/default.html
- Children’s Hospital of Philadelphia, Vaccine Education Center
http://www.chop.edu/consumer/jsp/microsite/microsite.jsp

This weekly summary targets news and events in the global vaccines field gathered
from key governmental, NGO and company announcements, key journals and
events. This summary provides support for ongoing initiatives of the Center for
Vaccine Ethics & Policy, and is not intended to be exhaustive in its coverage.
Vaccines: The Week in Review is now also posted in a blog format at
http://centerforvaccineethicsandpolicy.wordpress.com/. Each item is treated as an individual
post on the blog, allowing for more effective retrospective searching. Given email
system conventions and formats, you may find this alternative more effective. This
blog also allows for RSS feeds, etc.
Comments and suggestions should be directed to
David R. Curry, MS
Editor and
Executive Director
Center for Vaccine Ethics & Policy
david.r.curry@centerforvaccineethicsandpolicy.org

[Editor’s Note: Vaccines: The Week in Review resumes publication

today covering news, announcements, conferences and key journal
activity since early August.]

Sabin Vaccine Institute, Fogarty International Center of the U.S.

National Institutes of Health, and Fundação Oswaldo Cruz convened
Smallpox Eradication after 30 Years: Lessons, Legacies and
Innovations” in Rio de Janeiro, Brazil on 24 August 2010. The meeting
involved “global health dignitaries from 33 countries to share global health
lessons, legacies and innovations post smallpox eradication.” 2010 marks the
30th anniversary of the Global Commission for the Certification of Smallpox
Eradication officially reporting the elimination of smallpox disease. Smallpox
remains the only disease to ever have been eradicated.
Dr. Mirta Roses, Director of the Pan American Health Organization,
commented, “The eradication of smallpox has rightly been called one of
mankind’s greatest achievements. Not only was it an important public health
milestone, but it also gave rise to the founding of the Expanded Program on
Immunization, which has been instrumental in saving the lives of millions of
children around the world. As we have advanced with polio eradication in the
Americas, now a global goal, and the elimination of measles and rubella, the
Americas are forging a new future in control of vaccine-preventable diseases
that sets examples for the rest of the world. We honor the heroes of smallpox
eradication and the millions of health workers who toil selflessly every day to
bring life-saving vaccines to the remotest corners of the earth, and we urge
continued government, NGO, and private sector support for the goals of
universal immunization.”
http://www.sabin.org/pressroom/releases/2010/08/24/sabin-vaccine-institute-
fogarty-international-center-us-national-insti

Statement from the International Symposium on Smallpox

Eradication
After 30 Years: Lessons, Legacies and Innovations
We, the 260 scientists, public health workers, historians and other
professionals from 34 countries who participated in the August 24‐27, 2010
Smallpox Eradication Symposium at the Oswaldo Cruz Foundation in Rio de
Janeiro, offer the following observations on smallpox eradication:
- First, smallpox eradication removed from the human population a virus that
killed an estimated 300 million people in the twentieth century.
- Second, after 1980 smallpox vaccination was stopped saving the great costs
of vaccination programs and eliminating the sometimes severe complications
of smallpox vaccination.
- Third, the smallpox eradication program inspired a generation of public
health practitioners and several major programs such as:
A wider program of vaccination (The Expanded Program on Immunizations)
that has helped achieve high levels of immunization around the world
preventing large numbers of deaths of children and adults.
Wide
 -spread use of epidemiological surveillance as a key tool in disease
control.
Programs that have made great progress toward the global eradication of
polio and Guinea Worm and the elimination of measles and rubella from the
Americas.
- Fourth, it demonstrated that international cooperation and solidarity can
contribute to major public health improvements around the world.
- Finally, since the end of smallpox vaccination an increasing proportion of
the population of the world is susceptible to smallpox. Given the current
limited supplies of smallpox vaccine, release of smallpox into the
environment could cause a catastrophic global epidemic. Further, smallpox
virus is known to be held by only two laboratories in the world as authorized
by WHO. Although these two laboratories maintain extensive precautions
against release of the virus, no containment system is risk-free. In addition, it
cannot be ascertained that there are no unauthorized stores of smallpox
virus.
More than 15 years have elapsed since the World Health Assembly agreed
to postpone the destruction of the smallpox virus. Therefore, in the interest of
global security, consideration should now be given to early destruction of
existing laboratory stocks of smallpox virus when on-going WHO-sanctioned
research is completed on improved vaccines and diagnostics, effective anti-
virals, and reliable animal model.
Finally, possession or deployment of the smallpox virus outside the WHO-
sanctioned facilities should be designated a crime against humanity.
http://sabin.org/files/uploads/pdfs/Statement%20from%20the
%20International%20Symposium%20on%20Smallpox%20Eradication
%20After%2030%20Years-%20Lessons%2C%20Legacies%20and
%20Innovations.pdf

The 9th International Rotavirus Symposium, held at Johannesburg,

South Africa released the following Call to Action:
We the Participants of the 9th International Rotavirus Symposium
Considering that:
- Diarrhea is the second greatest killer of children under five worldwide,
killing 1.33 million children under five each year;
- Rotavirus is the leading cause of severe diarrheal disease;
- Rotavirus-related diarrheal disease takes the lives of more than 500,000
children under five every year and is responsible for the hospitalization of
millions more around the world;
- 85% of rotavirus deaths occur in low income countries in sub-Saharan Africa
and Asia;
- A growing body of evidence attests to the safety, efficacy, effectiveness and
lifesaving potential of rotavirus vaccines;
- In light of the demonstrated burden of rotavirus disease and the evidence
supporting the use of vaccines to reduce that burden, there is a need to
increase access to affordable rotavirus vaccines in the developing world;
- In 2009 WHO recommended that rotavirus vaccines be included in every
nation’s immunization program;
- Adding rotavirus vaccination in national immunization programs and
combining it with appropriate diarrhea control interventions as part of a
package of strategies to prevent diarrheal diseases-related deaths would be
critical to achieving Millennium Development Goal 4 (MDG 4);
- Prevention and control of diarrheal disease requires collaborative action by
national governments, industry, civil society organizations, and international
health agencies.
Therefore, We Agree to:
- Continue to support immunization as a common public good worldwide, an
economic necessity and a vital political priority;
- Encourage increased vaccine research and expanded surveillance for
vaccine preventable diseases;
- Encourage the joint collaboration of national governments, health
professionals, bilateral and multilateral agencies, the GAVI Alliance, and the
manufacturers of vaccines to facilitate and accelerate the introduction of
affordable rotavirus vaccines worldwide;
- Advocate for and raise awareness among public and policy makers of the
burden of rotavirus-related diarrheal disease and the value of vaccination;
- Call upon political leaders and decision-makers from developing countries to
increase financial support to their national immunization programs;
- Call upon political leaders and decision-makers from developed countries
and global - immunization partners to scale-up financial support to the GAVI
Alliance.
http://www.sabin.org/pressroom/sabin_news/2010/08/09/9th-international-
rotavirus-symposium-call-action
Call to Action PDF: here
 WHO Director General Dr. Margaret Chan announced the end of the
Phase 6 of the Influenza pandemic alert:
H1N1 in post-pandemic period
The world is no longer in phase 6 of influenza pandemic alert. We are now
moving into the post-pandemic period. The new H1N1 virus has largely run its
course…
As we enter the post-pandemic period, this does not mean that the H1N1
virus has gone away. Based on experience with past pandemics, we expect
the H1N1 virus to take on the behaviour of a seasonal influenza virus and
continue to circulate for some years to come.
In the post-pandemic period, localized outbreaks of different magnitude
may show significant levels of H1N1 transmission. This is the situation we are
observing right now in New Zealand, and may see elsewhere.
In fact, the actions of health authorities in New Zealand, and also in India,
in terms of vigilance, quick detection and treatment, and recommended
vaccination, provide a model of how other countries may need to respond in
the immediate post-pandemic period.
Globally, the levels and patterns of H1N1 transmission now being seen
differ significantly from what was observed during the pandemic. Out-of-
season outbreaks are no longer being reported in either the northern or
southern hemisphere. Influenza outbreaks, including those primarily caused
by the H1N1 virus, show an intensity similar to that seen during seasonal
epidemics.
During the pandemic, the H1N1 virus crowded out other influenza viruses
to become the dominant virus. This is no longer the case. Many countries are
reporting a mix of influenza viruses, again as is typically seen during seasonal
epidemics.
Recently published studies indicate that 20–40% of populations in some
areas have been infected by the H1N1 virus and thus have some level of
protective immunity. Many countries report good vaccination coverage,
especially in high-risk groups, and this coverage further increases
community-wide immunity.
Pandemics, like the viruses that cause them, are unpredictable. So is the
immediate post-pandemic period. There will be many questions, and we will
have clear answers for only some. Continued vigilance is extremely
important, and WHO has issued advice on recommended surveillance,
vaccination, and clinical management during the post-pandemic period.
Based on available evidence and experience from past pandemics, it is
likely that the virus will continue to cause serious disease in younger age
groups, at least in the immediate post-pandemic period. Groups identified
during the pandemic as at higher risk of severe or fatal illness will probably
remain at heightened risk, though hopefully the number of such cases will
diminish.
In addition, a small proportion of people infected during the pandemic,
including young and healthy people, developed a severe form of primary viral
pneumonia that is not typically seen during seasonal epidemics and is
especially difficult and demanding to treat. It is not known whether this
pattern will change during the post-pandemic period, further emphasizing the
need for vigilance.
As I said, pandemics are unpredictable and prone to deliver surprises. No
two pandemics are ever alike. This pandemic has turned out to be much
more fortunate than what we feared a little over a year ago.
This time around, we have been aided by pure good luck. The virus did not
mutate during the pandemic to a more lethal form. Widespread resistance to
oseltamivir did not develop. The vaccine proved to be a good match with
circulating viruses and showed an excellent safety profile.
Thanks to extensive preparedness and support from the international
community, even countries with very weak health systems were able to
detect cases and report them promptly.
Had things gone wrong in any of these areas, we would be in a very
different situation today….
http://www.who.int/mediacentre/news/statements/2010/h1n1_vpc_20100810/
en/index.html
:: Read the report from the Emergency Committee meeting
:: WHO recommendations for the post-pandemic period
:: Press briefing - audio and video files
:: Surveillance recommendations in the post-pandemic period

GAVI announced that Julian Lob-Levyt will step down as CEO of

the GAVI Alliance in October “to take up a major role in the private
sector after leading the public-private global health partnership through
nearly six years of growth and innovation.” Dr Lob-Levyt will continue as CEO
until October to oversee GAVI’s first Resource Mobilisation Meeting on 6
October at which “existing and potential donors will be asked to pledge
additional funds to enable new vaccines against pneumococcal disease and
rotavirus diarrhoea to be added to immunisation programmes.” In November,
Dr Lob-Levyt, will become Managing Director of DAI Europe and Senior Vice
President of DAI, based in London. DAI “has worked in 150 developing and
transition countries, providing comprehensive development solutions in areas
including HIV/AIDS and avian influenza control, crisis mitigation and stability
operations, agriculture and agribusiness, democratic governance and public
sector management, private sector development and financial services,
economics and trade, water and natural resources management, and energy
and climate change.”
Geneva, 11 August 2010: More at:
http://www.gavialliance.org/media_centre/press_releases/ceo.php

The Bill & Melinda Gates Foundation today announced the opening
of Round 6 of Grand Challenges Explorations, described as a US$100
million grant initiative to encourage bold and unconventional global health
solutions. Proposals are being accepted until November 2, 2010. Grand
Challenges Explorations “offers researchers the chance to win US$100,000
grants to foster innovative projects that could transform health in developing
countries. The initiative focuses on areas where creative, unorthodox thinking
is most urgently needed. For this round, applicants are asked to focus their
proposals on these five topic areas:
- Design New Approaches to Cure HIV Infection;
- Create the Next Generation of Sanitation Technologies;
- Create Low-Cost Cell Phone-Based Applications for Priority Global Health
Conditions;
- Create New Technologies for the Health of Mothers and Newborns;
- The Poliovirus Endgame: Create Ways to Accelerate, Sustain and Monitor
Eradication.
http://www.gatesfoundation.org/press-releases/Pages/grand-challenges-
explorations-round-six-100819.aspx

NIH launched a new nationwide research initiative “to define

changes in the human immune system, using human and not animal
studies, in response to infection or to vaccination.” Six U. S.-based
Human Immune Phenotyping Centers will receive a total of US$100 million
over five years to conduct this research. NIAID Director Anthony S. Fauci,
M.D. commented, "Recognizing the differences in immune system activity
before, during and after exposure to an infectious agent or vaccine will help
in the development of safer, more effective therapeutics and vaccines. This
research effort also will contribute to the ongoing evolution in our ability to
study the immune system.”
Investigators will analyze samples from well-characterized groups, including
children, the elderly and people with autoimmune diseases such as lupus.
These groups represent diverse populations with respect to age, genetics,
gender and ethnicity. The research teams will examine immune system
elements of these populations before and after exposure to naturally
acquired infections or to vaccines or vaccine components. The profile that will
emerge of the body’s response to vaccination will be based on the most
sophisticated and comprehensive assays currently available. This will enable
new approaches to examining vaccine safety, not just of individual vaccines
but of the processes of immunization in general.
The following six core institutions and principal investigators will participate
in the inaugural program:
Baylor Research Institute, Dallas – Jacques Banchereau, Ph.D.
Dana-Farber Cancer Institute, Boston – Ellis Reinherz, M.D.
Emory University, Atlanta – Bali Pulendran, Ph.D.
Mayo Clinic, Rochester, Minn. – Gregory Poland, M.D.
Stanford University, Calif. – Mark Davis, Ph.D.
Yale University, New Haven, Conn. – David Hafler, M.D., and Erol Fikrig, M.D.
http://www.nih.gov/news/health/aug2010/niaid-11.htm

The Institute of Medicine (IOM) released a letter report outlining “a

conceptual framework to help the U.S. Food and Drug Administration
evaluate the ethical issues involved in determining whether
companies should start or continue clinical trials on approved drugs
and in ensuring that these studies are ethically conducted.” The
proposed framework “underscores the importance of FDA's decision-making
processes and study design considerations,” and notes that FDA “should
ensure that any randomized, controlled trial to evaluate the efficacy and
safety of an approved drug that is suspected of causing serious adverse
events is conducted only when the existing evidence and any evidence from
new observational studies would be insufficient to enable the agency to make
responsible policy decisions. The agency should determine that questions
about a drug's possible risks or risk-benefit balance rise to the level of
requiring a policy decision, such as whether to revise the product's label…”
Te framework also notes that “…FDA should make sure that trials are
appropriately designed to resolve uncertainties about efficacy and safety and
to minimize risks to participants. Risks should be judged acceptable by
appropriate oversight bodies, and participants and studies should be
continuously monitored to assure that the risks continue to be
acceptable. The process of informed consent should continue over the course
of the trials, and participants should be promptly advised of substantial
changes in clinical practice or professional standards and new research
findings that could affect their willingness to accept the risks associated with
a trial. FDA should apply principles and practices of regulatory science to
ensure that its policy decisions reflect the best available scientific evidence
and analytic techniques and that they are made in a transparent way to
ensure public accountability.”
The report responds to one of several questions FDA asked IOM to explore
in a review of ethical and scientific issues related to studying the safety of
drugs on the market.
http://www8.nationalacademies.org/onpinews/newsitem.aspx?
RecordID=12948
The report is available at: http://www.nap.edu/catalog.php?record_id=12948

The 2009 National Immunization Survey-Teen (NIS-Teen)

estimates that coverage for adolescent vaccination at the national,
state and selected local area levels show continued nationwide
improvement – as much as 15 percent – for vaccines specifically
recommended for pre-teens. The survey of more than 20,000 teens aged
13-17 found that in 2009 there were increases in the percentage of teens in
this age group who had received vaccines routinely recommended for 11-
and 12-year-olds. Specifically:
- For one dose of the tetanus-diphtheria-acellular pertussis vaccine (Tdap),
coverage went up about 15 points to about 56 percent;
- For one dose of meningococcal conjugate vaccine, coverage went up about
12 points to about 54 percent;
- For girls who received at least one dose of human papillomavirus (HPV)
vaccine, coverage increased 7 points to about 44 percent. However, for girls
who received the recommended three doses of HPV vaccine, coverage was
only about 27 percent (a 9 percent increase);
- For one dose of HPV vaccine, no differences were observed between
racial/ethnic groups. However, coverage was higher among teens living in
poverty compared with those living at or above the poverty level.
- For the recommended three doses of HPV vaccine, differences were
observed between racial/ethnic groups, including significantly lower coverage
for blacks and Hispanics compared to whites;
- There were no significant differences in coverage by racial/ethnic group or
by poverty status for Tdap or meningococcal conjugate vaccine; and
As in 2008, there was wide variation in adolescent vaccination coverage
among state and local areas.
Anne Schuchat, M.D., director of CDC's National Center for Immunization
and Respiratory Diseases, commented, "This year's data are mixed. We can
see that more parents of adolescents are electing to protect their children
from serious diseases such as pertussis, meningitis, and cervical cancer, but
there is clear room for improvement in our system's ability to reach this age
group."
http://www.cdc.gov/media/pressrel/2010/r100819b.htm

Journal Watch
[Editor’s Note]
Vaccines: The Week in Review continues its weekly scanning of key journals
to identify and cite articles, commentary and editorials, books reviews and
other content supporting our focus on vaccine ethics and policy. Journal
Watch is not intended to be exhaustive, but indicative of themes and
issues the Center is actively tracking. We selectively provide full text of
some editorial and comment articles that are specifically relevant to our
work. Successful access to some of the links provided may require
subscription or other access arrangement unique to the publisher. Our initial
scan list includes the journals below. If you would like to suggest other titles,
please write to David Curry at
david.r.curry@centerforvaccineethicsandpolicy.org

Clinical Infectious Diseases

15 September 2010 Volume 51, Number 6
http://www.journals.uchicago.edu/toc/cid/current
Editorial Commentary: The Present and Future Control of Pertussis
James D. Cherry

Emerging Infectious Diseases

Volume 16, Number 9–September 2010
http://www.cdc.gov/ncidod/EID/index.htm
Letters
Mobile Messaging as Surveillance Tool during Pandemic (H1N1)
2009, Mexico
M. Lajous et al.
To the Editor: Pandemic (H1N1) 2009 highlighted challenges faced by
disease surveillance systems. New approaches to complement traditional
surveillance are needed, and new technologies provide new opportunities.
We evaluated cell phone technology for surveillance of influenza outbreaks
during the outbreak of pandemic (H1N1) 2009 in Mexico.
On May 12, 2009, at 2:20 pm, a random sample of 982,708 telephones
from an 18 million nationwide network of mostly prepaid cell phones (1)
received a text message invitation to a Ministry of Health survey. Influenza-
like illness (ILI) in April, date of fever onset, severity, number of household
members with ILI, age, influenza vaccination, household size, and number of
children in each household were assessed (online Technical Appendix Figure
1). ILI was defined as fever and cough or sore throat, and severe ILI was
defined as inability to work, study, or maintain family care. Unstructured
supplementary service data, an interactive platform available on most cell
phones, was used. We obtained daily counts of suspected and confirmed
cases of pandemic (H1N1) 2009 from the nationwide clinic-based surveillance
system Sistema Nacional de Vigilancia Epidemiológica (SINAVE) (2,3).
Of 70,856 responses received, 56,551 (78.1%) were unique mobile
numbers (5.8% response rate; only the first response was used). Within 3
hours, 53% of responses were received and by 24 hours, 89% were received.
Mean (SD) age of respondents was 25.2 (10.4) years (online Technical
Appendix Table). A total of 9,333 persons reported ILI and 49.3% had severe
symptoms. Mean number of other persons with ILI in the household was 1.6
among respondents reporting severe disease and 0.3 among those with
nonsevere disease (p<0.0001, by t test)…

Human Vaccines
Volume 6, Issue 8 August 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/8/
[Reviewed earlier]

JAMA
http://jama.ama-assn.org/current.dtl
Vol. 304 No. 8, pp. 829-922, August 25, 2010
[No relevant content]
Vol. 304 No. 7, pp. 715-814, August 18, 2010
[No relevant content]
Vol. 304 No. 6, pp. 607-704, August 11, 2010
[No relevant content]

Journal of Infectious Diseases

15 September 2010 Volume 202, Number 6
http://www.journals.uchicago.edu/toc/jid/current
Major Articles and Brief Reports: Viruses
School Opening Dates Predict Pandemic Influenza A(H1N1)
Outbreaks in the United States [Free full text]
Dennis L. Chao, M. Elizabeth Halloran, and Ira M. Longini, Jr
Abstract
The opening of schools in the late summer of 2009 may have triggered the
fall wave of pandemic influenza A(H1N1) in the United States. We found that
an elevated percentage of outpatient visits for influenza‐like illness occurred
an average of 14 days after schools opened in the fall of 2009. The timing of
these events was highly correlated (Spearman correlation coefficient, 0.62;
). This result provides evidence that transmission in schools catalyzes
community‐wide transmission. School opening dates can be useful for future
pandemic planning, and influenza mitigation strategies should be targeted at
school populations before the influenza season.

The Lancet
http://www.thelancet.com/journals/lancet/issue/current
Aug 28, 2010 Volume 376 Number 9742 Pages 657 - 742
[No relevant content]
Aug 21, 2010 Volume 376 Number 9741 Pages 565-656
Editorial
Pandemic influenza—(some) reasons to be cheerful?
The Lancet
Comment
Rotavirus: realising the potential of a promising vaccine
E Anthony S Nelson, Roger I Glass
Preview
In 2006, two studies that described the efficacy and safety of two new oral
rotavirus vaccines were joint winners of The Lancet's Paper of the Year.1–3
These trials had been done in infants in high-income and middle-income
countries in the Americas and Europe, but no efficacy data were available for
infants in low-income populations in Africa and Asia where 85% of the more
than 500 000 deaths from rotavirus occur.4 Unlike parenteral vaccines, live
oral vaccines have behaved differently in high-income and low-income
populations because of various immunological factors such as higher titres of
transplacental or breast-milk antibodies, host problems related to
micronutrient malnutrition, interfering gut flora (tropical enteropathy),
intercurrent infections, or an altered distribution of circulating strains.
The India HPV-vaccine suspension
Heidi J Larson, Pauline Brocard, Geoffrey Garnett
Preview
In response to demands from advocacy groups, the Indian Government has
suspended demonstration projects for HPV vaccination in Andhra Pradesh and
Gujarat.1,2 The episode provides salutary lessons about how a lack of public
confidence can amplify if not quickly addressed.
Articles
Efficacy of pentavalent rotavirus vaccine against severe rotavirus
gastroenteritis in infants in developing countries in sub-Saharan
Africa: a randomised, double-blind, placebo-controlled trial
George E Armah, Samba O Sow, Robert F Breiman, Michael J Dallas, Milagritos
D Tapia, Daniel R Feikin, Fred N Binka, A Duncan Steele, Kayla F Laserson,
Nana A Ansah, Myron M Levine, Kristen Lewis, Michele L Coia, Margaret Attah-
Poku, Joel Ojwando, Stephen B Rivers, John C Victor, Geoffrey Nyambane,
Abraham Hodgson, Florian Schödel, Max Ciarlet, Kathleen M Neuzil
Preview
Pentavalent rotavirus vaccine is effective against severe rotavirus
gastroenteritis in the first 2 years of life in African countries with high
mortality in infants younger than 5 years. We support WHO's
recommendation for adoption of rotavirus vaccine into national expanded
programmes on immunisation in Africa.
Aug 14, 2010 Volume 376 Number 9740 Pages 487 - 564
[No relevant content]

The Lancet Infectious Disease

Sep 2010 Volume 10 Number 9 Pages 577 - 652
http://www.thelancet.com/journals/laninf/issue/current
Review
Guillain-Barré syndrome after exposure to influenza virus
Helmar C Lehmann, Hans-Peter Hartung, Bernd C Kieseier, Richard AC
Hughes
Preview
Guillain-Barré syndrome (GBS) is an acute, acquired, monophasic
autoimmune disorder of peripheral nerves that develops in susceptible
individuals after infection and, in rare cases, after immunisation. Exposure to
influenza via infection or vaccination has been associated with GBS. We
review the relation between GBS and these routes of exposure.
Epidemiological studies have shown that, except for the 1976 US national
immunisation programme against swine-origin influenza A H1N1 subtype
A/NJ/76, influenza vaccine has probably not caused GBS or, if it has, rates
have been extremely low (less than one case per million vaccine recipients).
By contrast, influenza-like illnesses seem to be relevant triggering events for
GBS. The concerns about the risk of inducing GBS in mass immunisation
programmes against H1N1 2009 do not, therefore, seem justified by the
available epidemiological data. However, the experiences from the 1976
swine flu vaccination programme emphasise the importance for active and
passive surveillance to monitor vaccine safety.

Nature
http://www.nature.com/nature/current_issue.html
Volume 466 Number 7310 pp1023-1148 26 August 2010
[No relevant content]
Volume 466 Number 7309 pp903-1014 19 August 2010
Editorial
After the pandemic
Despite some mistakes, the World Health Organization handled the flu
outbreak well.
Volume 466 Number 7308 pp797-896 12 August 2010
[No relevant content]

Nature Medicine
August 2010, Volume 16 No 8
http://www.nature.com/nm/index.html
[Reviewed earlier]

New England Journal of Medicine

http://content.nejm.org/current.shtml
August 26, 2010 Vol. 363 No. 9
[No relevant content]
August 19, 2010 Vol. 363 No. 8
Special Report
HPV Vaccination Mandates — Lawmaking amid Political and
Scientific Controversy
J. Colgrove, S. Abiola, M.M. Mello [Free full-text]
August 12, 2010 Vol. 363 No. 7
[No relevant content]

The Pediatric Infectious Disease Journal

September 2010 - Volume 29 - Issue 9
http://journals.lww.com/pidj/pages/currenttoc.aspx
Original Studies
Measles Outbreak Associated With an International Youth Sporting
Event in the United States, 2007
Chen, Tai-Ho; Kutty, Preeta; Lowe, Luis E.; Hunt, Elizabeth A.; Blostein, Joel;
Espinoza, Rita; Dykewicz, Clare A.; Redd, Susan; Rota, Jennifer S.; Rota, Paul
A.; Lute, James R.; Lurie, Perrianne; Nguyen, Michael D.; Moll, Mària; Reef,
Susan E.; Sinclair, Julie R.; Bellini, William J.; Seward, Jane F.; Ostroff, Stephen
M.
doi: 10.1097/INF.0b013e3181dbaacf
Abstract:
Background: Despite elimination of endemic measles in the United States
(US), outbreaks associated with imported measles continue to occur. In 2007,
the initiation of a multistate measles outbreak was associated with an
imported case occurring in a participant at an international youth sporting
event held in Pennsylvania.
Methods: Case finding and contact tracing were conducted. Control
measures included isolating ill persons and administering postexposure
prophylaxis to exposed persons without documented measles immunity.
Laboratory evaluation of suspected cases and contacts included measles
serologic testing, viral culture, detection of viral RNA by reverse-transcription
polymerase chain reaction, and viral genotyping.
Results: The index case occurred in a child from Japan aged 12 years.
Contact tracing among 1250 persons in 8 states identified 7 measles cases; 5
(71%) cases occurred among persons without documented measles
vaccination. Epidemiologic and laboratory investigation supported a single
chain of transmission, linking the outbreak to contemporaneous measles
virus genotype D5 transmission in Japan. Of the 471 event participants, 193
(41%) lacked documentation of presumed measles immunity, 94 (49%) of
193 were US-resident adults, 19 (10%) were non-US-resident adults (aged
>18 years), and 80 (41%) were non-US-resident children.
 Discussion: Measles outbreaks associated with imported disease are likely
to continue in the US. Participants in international events, international
travelers, and persons with routine exposure to such travelers might be at
greater risk of measles. To reduce the impact of imported cases, high
measles, mumps, and rubella vaccine coverage rates should be maintained
throughout the US, and support should continue for global measles control
and elimination.

Pediatrics
http://pediatrics.aappublications.org/current.shtml
August 2010 / VOLUME 126 / ISSUE 2
[Reviewed earlier; No relevant content]

PLoS Medicine
(Accessed 29 August 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=aac96924d41874935d8e1
c2a2501181c#results
[No relevant content]

Science
http://www.sciencemag.org/current.dtl
27 August 2010 Vol 329, Issue 5995, Pages 985-1112
Reports
Induction of Broadly Neutralizing H1N1 Influenza Antibodies by
Vaccination
Chih-Jen Wei, Jeffrey C. Boyington, Patrick M. McTamney, Wing-Pui Kong,
Melissa B. Pearce, Ling Xu, Hanne Andersen, Srinivas Rao, Terrence M.
Tumpey, Zhi-Yong Yang, and Gary J. Nabel
Abstract
The rapid dissemination of the 2009 pandemic influenza virus underscores
the need for universal influenza vaccines that elicit protective immunity to
diverse viral strains. Here, we show that vaccination with plasmid DNA
encoding H1N1 influenza hemagglutinin (HA) and boosting with seasonal
vaccine or replication-defective adenovirus 5 vector encoding HA stimulated
the production of broadly neutralizing influenza antibodies. This prime/boost
combination increased the neutralization of diverse H1N1 strains dating from
1934 to 2007 as compared to either component alone and conferred
protection against divergent H1N1 viruses in mice and ferrets. These
antibodies were directed to the conserved stem region of HA and were also
elicited in nonhuman primates. Cross-neutralization of H1N1 subtypes elicited
by this approach provides a basis for the development of a universal
influenza vaccine for humans.

20 August 2010 Vol 329, Issue 5994, Pages 877-984

[No relevant content]
13 August 2010 Vol 329, Issue 5993, Pages 713-876
Perspectives
AIDS/HIV: A Boost for HIV Vaccine Design
Dennis R. Burton1,2 and Robin A. Weiss3
A major roadblock to the development of an effective vaccine against the
human immunodeficiency virus (HIV-1) is the lack of an immunogen that
elicits broadly protective antibodies (1). Passive transfer studies in animal
models have associated protection with neutralizing antibodies and,
encouragingly, serum studies show that a subset of HIV-infected individuals
produces potent broadly neutralizing antibodies (2). Understanding the viral
targets of such antibodies and how they achieve potent and broad
neutralization has become a key endeavor in HIV vaccine research. On page
856 of this issue, Wu et al. (3) describe the isolation of particularly potent
monoclonal broadly neutralizing antibodies using a novel selection strategy,
and on page 811, Zhou et al. (4) solve the crystal structure of the most
effective of these antibodies in complex with its target gp120, a viral
envelope glycoprotein. These studies further invigorate the currently active
field of discovering broadly neutralizing antibodies against HIV (2, 5–7) and
provide valuable molecular information for rational vaccine design.

Science Translational Medicine

http://stm.sciencemag.org/content/current
25 August 2010 vol 2, issue 46
[No relevant content]
18 August 2010 vol 2, issue 45
Ethics
360 Degrees of Human Subjects Protections in Community-Engaged
Research
Lainie Friedman Ross
Abstract
With the introduction of the new National Institutes of Health Roadmap in
2003, there has been a growing emphasis on translational research.
Translational research challenges current human subjects protections
guidelines that were written in the 1970s and were focused on the protection
of the individual participant in a clinical drug trial. Community engagement
requires a critical examination of the range of risks that may arise when
communities are both participants and partners in research, in order to
promote appropriate and effective protection of human subjects as
individuals and members of communities. Given that the principal
investigator has ultimate responsibility for ensuring the ethical integrity of
the research, researchers should be aware of the human subjects protections
delineated in the federal regulations that must be fulfilled and the other
entities that can help ensure human subjects protections.
11 August 2010 vol 2, issue 44
[No relevant content]

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 38 pp. 6123-6402 (31 August 2010)
Letter to the Editor
Community-level incentives to increase the use of vaccination
services in developing countries: An idea whose time has come?
Pages 6123-6124
Ajay S. Behl, Maya Vijayaraghavan, James D. Nordin, Michael V. Maciosek,
Peter M. Strebel
Methodology and measurement of the effectiveness of Haemophilus
influenzae type b vaccine: Systematic review Review Article
Pages 6128-6136
Rosalyn E. O’Loughlin, Karen Edmond, Punam Mangtani, Adam L. Cohen,
Sharmila Shetty, Rana Hajjeh, Kim Mulholland
Abstract
The use of the highly effective Haemophilus influenzae type b (Hib) conjugate
vaccine has increased globally. We review the benefits and limitations of
studies measuring Hib vaccine effectiveness (VE). We critically examine the
case–control approach by assessing the similarities and differences in
methodology and findings and discuss the need for future Hib VE studies. In
the absence of good surveillance data, vaccine effectiveness studies can play
an important role, particularly with the increasing use of pneumococcal
vaccine that has not been well tested under field conditions in less developed
countries. However, the effectiveness of Hib vaccine has been well
documented so the need for future VE Hib studies is minimal.
High vaccination rates for seasonal and pandemic (A/H1N1) influenza
among healthcare workers in Dutch general practice Original
Research Article
Pages 6164-6168
Wim Opstelten, Gerrit A. van Essen, Marie-Louise Heijnen, Mireille J.P.
Ballieux, Alexander N. Goudswaard
Abstract
In previous years, the influenza vaccination rate among Dutch general
practitioners (GPs) was low (36% during the 2007/2008 season). Since 2008,
yearly influenza vaccination has been actively recommended for GPs in The
Netherlands. Moreover, in 2009 the Dutch government urged healthcare
workers to receive additional vaccination against the pandemic influenza
(A/H1N1). The effects of these recommendations are unknown. In February
2010, a questionnaire was mailed to random samples of GPs (n = 810) and
GP-trainees (n = 300). Vaccination rates were determined and motives and
barriers for vaccination were assessed. The response rates for GPs and GP-
trainees were 83% and 90%, respectively. In total, 63% of the GPs were
vaccinated against seasonal influenza and 85% against pandemic (A/H1N1)
influenza. For GP-trainees, these percentages were 47% and 77%,
respectively. With regard to the medical staff working in the respondents’
practices, 60% received the seasonal and 76% the pandemic (A/H1N1)
influenza vaccine. Reducing the risk of transmitting the virus to vulnerable
patients and the individual's personal protection were the most frequently
reported motives for vaccination. Having no medical indication for influenza
vaccination and the conviction of being protected against influenza because
of frequent professional exposure to the virus were the most frequently
mentioned reasons for not being vaccinated. In conclusion, the seasonal
influenza vaccination rate among Dutch GPs has risen considerably since the
previous survey and the vaccination rate against pandemic (A/H1N1)
influenza was very high. Moreover, Dutch GPs were convinced that influenza
vaccination will reduce the risk of transmitting the virus to their patients.
Acceptability of Internet adverse event self-reporting for pandemic
and seasonal influenza immunization among health care
workers Original Research Article
Pages 6199-6202
Keswadee Lapphra, Simon Dobson, Julie A. Bettinger
Abstract
This study assessed the acceptability and feasibility of Internet self-reporting
for adverse events following pandemic and seasonal influenza immunization
among 270 health care workers at a tertiary care children's and women's
hospital in fall 2009. Participants responded to an online questionnaire 72 h
after vaccine receipt. Non-responders were sent a reminder email 8–10 days
after vaccine receipt, followed by a telephone call for those who did not
respond online. The overall online response rate was high (88%). Participants
rated the online self-report easy to use and would be willing to use it again.
The high response rate and acceptability of the online report method suggest
that web-based self-reporting for adverse event following immunization
(AEFI) has the potential for rapid assessments of AEFI in mass or new
immunization programs.
Is a mass immunization program for pandemic (H1N1) 2009 good
value for money? Evidence from the Canadian Experience Original
Research Article
Pages 6210-6220
Beate Sander, Chris T. Bauch, David Fisman, Robert A. Fowler, Jeffrey C.
Kwong, Andreas Maetzel, Allison McGeer, Janet Raboud, Damon C. Scales,
Marija Zivkovic Gojovic, Murray Krahn
Abstract
In response to the pandemic H1N1 influenza 2009 outbreak, many
jurisdictions undertook mass immunization programs that were among the
largest in recent history. The objective of this study was to determine the
cost-effectiveness of the mass H1N1 immunization program in Ontario,
Canada's most populous province (population 13,000,000). This analysis
suggests that a mass immunization program as carried out in Ontario and
many other high-income health care systems in response to H1N1 2009 was
effective in preventing influenza cases and health care resource use and was
also highly cost-effective despite the substantial program cost.
Modeling the national pediatric vaccine stockpile: Supply shortages,
health impacts and cost consequences Original Research Article
Pages 6318-6332
Sundar S. Shrestha, Gregory S. Wallace, Martin I. Meltzer
Abstract
Pediatric vaccine stockpiles have been in place in the U.S. since 1983 to
address the potential disruption in supply of routine pediatric vaccines.
Increases in the number of vaccines recommended for pediatric and
adolescent patients have increased the cost of stocking and maintaining the
stockpile. Based on a spreadsheet-based model (VacStockpile) we developed,
we estimated potential supply shortages of 14 stockpiled vaccines as of
August 1, 2008 and its health and financial impacts under various shortage
and stockpile scenarios. To illustrate the implications of policy options, we
compared “high” to “low” stockpile scenarios. The high stockpile scenario
ensures a 6-month vaccine supply to vaccinate all children according to
recommended schedules. The low scenario comprised of 50% of the high
scenario or existing stocks, whichever is smaller. For each vaccine, we used a
weighted average of five shortage scenarios ranging from 0% to 100%, in
25% increments. Demand for each vaccine was based on current distribution
or birth cohort size. The probabilities of shortages were based on number of
manufacturers, market stability, history of manufacturing problems, and
production complexity. CDC contract prices were used to estimate costs.
Expert opinion and literature provided estimates of health impacts due to
shortages. Applying the probabilities of shortages to all vaccines in a single
year, the “low” scenario could cost $600 million, with 376,000 vaccine-
preventable cases occurring and 1774 deaths. The “high” scenario could cost
$2 billion, with an additional $1.6 billion initial stocking, and result in 7100
vaccine-preventable cases occurring and 508 deaths. Based on the
assumptions in the model, there is the potential for large differences in
outcomes between the scenarios although some outcomes could potentially
be averted with measures such as catch-up campaigns after shortages. Using
the VacStockpile policy makers can readily evaluate the implications of
assumptions and decide which set of assumptions they wish to use in
planning.

Volume 28, Issue 37 pp. 5931-6122 (23 August 2010)

Short Communications
Attitudes towards vaccination against seasonal influenza of health-
care workers in primary health-care settings in Greece
Pages 5931-5933
Xanthi Dedoukou, Georgios Nikolopoulos, Antonios Maragos, Sophia
Giannoulidou, Helena C. Maltezou
Abstract
Vaccination of health-care workers (HCWs) against seasonal influenza has
been consistently recommended worldwide in order to prevent nosocomial
transmission and ensure delivery of health-care services during outbreaks.
We describe the effects of a nationwide campaign to promote influenza
vaccination among HCWs working in primary health-care centers in Greece.
During 2008–2009 the mean vaccination rate among HCWs in primary health-
care centers was 22.8% (range: 0–100%), with a considerable variability
among Health Districts (range: 12.66–54.68%). Logistic regression showed
that history of previous influenza vaccination, influenza vaccination the
previous season, being a physician and a larger number of employees were
associated with increased vaccination rates. Main reason for vaccination was
self-protection (75.90%), while main reasons for refusing vaccination were
belief that they are not at risk for contracting influenza (44.5%), doubts about
vaccine effectiveness (20.79%), and fear of vaccine adverse effects (20.33%).
Economics of employer-sponsored workplace vaccination to prevent
pandemic and seasonal influenza Original Research Article
Pages 5952-5959
Bruce Y. Lee, Rachel R. Bailey, Ann E. Wiringa, Abena Afriyie, Angela R.
Wateska, Kenneth J. Smith, Richard K. Zimmerman
Abstract
Employers may be loath to fund vaccination programs without understanding
the economic consequences. We developed a decision analytic computational
simulation model including dynamic transmission elements that estimated
the cost–benefit of employer-sponsored workplace vaccination from the
employer's perspective. Implementing such programs was relatively
inexpensive (<$35/vaccinated employee) and, in many cases, cost saving
across diverse occupational groups in all seasonal influenza scenarios. Such
programs were cost-saving for a 20% serologic attack rate pandemic scenario
(range: −$15 to −$995) per vaccinated employee) and a 30% serologic
attack rate pandemic scenario (range: −$39 to −$1,494 per vaccinated
employee) across all age and major occupational groups.

Volume 28, Issue 36 pp. 5757-5930 (16 August 2010)

Editorial
Mandating influenza vaccination for health care workers: Putting
patients and professional ethics over personal preference
Pages 5757-5759
Gregory A. Poland