Vaccines: The Week in Review

13 September 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

The WHO reported that Angola and the Democratic Republic of

Congo (DR Congo) are experiencing outbreaks of wild poliovirus type
1 (WPV1). In Angola, the outbreak, which began in April 2007, has this year
spread to re-infect previously polio-free areas in Angola (the provinces of Bie,
Bengo, Huambo, Lunda Norte, Lunda Sul and Uige), as well as to
neighbouring DR Congo, re-infecting Kasai Occidental province which borders
Angola. This outbreak is classified as 're-established' transmission, as it has
persisted for a period greater than 12 months.
The report notes that, “given the recent progress achieved in Nigeria (99%
reduction in cases this year compared to the same period in 2009), west
Africa (no cases since 1 May 2010) and the Horn of Africa (no cases in more
than 12 months), central Africa is now considered to be the greatest risk to
Africa's polio eradication efforts. Angola's outbreak is currently the only
geographically expanding outbreak in Africa. This situation increases the risk
to achieving the next global milestone of the new Global Polio Eradication
Initiative (GPEI) Strategic Plan 2010-2012, the cessation of all re-established
WPV transmission by end-2010.”
WHO said that there is currently a high risk of international spread of WPV
from Angola and DR Congo, given the limited impact to date of control
measures and the historical cross-border spread from both countries. In
2010, outbreak response in both countries has been inadequate to stop
transmission of the imported viruses. Independent monitoring of
supplementary immunization activities (SIAs) indicate as many as 25% of
children are regularly missed during SIAs in key areas of Angola (including
Luanda, Lunda Norte and Lunda Sul). In DR Congo, no response activities
have been conducted in the east of the country since November 2009.
WHO stressed that the outbreaks require urgent action to reach a higher
proportion of children with oral polio vaccine (OPV) across Angola and DR
Congo and improve surveillance across Angola and DR Congo. Due to sub-
national surveillance gaps, further undetected circulation of WPV1 cannot be
ruled out. Given the increasingly widespread transmission of WPV1 in Angola
and documented spread to DR Congo, the World Health Organization (WHO)
considers the risk of further international spread as high. Given persistent
undetected transmission of WPV1 in eastern DR Congo, and historical
evidence of international spread, WHO considers the risk of further
international spread as high.
http://www.who.int/csr/don/2010_09_08/en/index.html

The Pharmaceutical Research and Manufacturers of America

(PhRMA) released a new report – Medicines in Development for
Infectious Diseases 2010 – which highlights that “critical challenges
remain in the centuries-old battles against infectious diseases, particularly as
bacteria and viruses mutate and as the threat of bioterrorism grows.
Responding to this need, America’s biopharmaceutical research companies
this year have 395 new medicines and vaccines in the pipeline to fight
infectious diseases. All 395 are in later stages of development, meaning in
clinical trials or under Food and Drug Administration (FDA) review.”
The report also notes that “a total of 145 vaccines are in development to
prevent a variety of infections, including a number of forms of influenza.
Additionally, 88 antibiotics and 96 antivirals are in development. Treatments
for HIV infection are not included in the most recent report, but a 2009
survey identified 97 medicines and vaccines in testing for HIV/AIDS.”
The full report is available at:
http://www.phrma.org/sites/phrma.org/files/attachments/Infectious_Diseases_
2010.pdf

The MMWR for September 10, 2010 / Vol. 59 / No. 35 includes:

- Parental Attitudes and Experiences During School Dismissals Related to
2009 Influenza A (H1N1) --- United States, 2009
http://www.cdc.gov/mmwr/mmwr_wk.html

The Weekly Epidemiological Record (WER) for 10 September 2010,

vol. 85, 37 (pp 357–364) includes: Evaluation of elimination of neonatal
tetanus in Madagascar, 2009; Performance of acute flaccid paralysis (AFP)
surveillance and incidence of poliomyelitis, 2010
Download full text [pdf 241kb]
Events/Conference Watch
[Editor’s Note]
Vaccines: The Week in Review is now monitoring key events and conferences
and will include summaries of key announcements and other content. Event
Watch is not intended to be exhaustive, but indicative of themes and
issues the Center is actively tracking. If you would like to suggest events
and conferences for coverage, please write to David Curry at
david.r.curry@centerforvaccineethicsandpolicy.org

International Symposium on Hepatitis E

Organized by the International Vaccine Institute (IVI) with sponsorship of the
Centers for Disease Control (CDC) and in collaboration with the World Health
Organization (WHO) Seoul, Korea
September 15-16, 2010
http://www.ivi.org/popup/hepE_symposium/default.asp

UN Inter-Agency Support Group on Indigenous Peoples' Issues (IASG)

Place: Geneva, Switzerland
Date: 16–17 September 2010
WHO is hosting the annual meeting of the UN Inter-Agency Support Group
on Indigenous Peoples' Issues (IASG). This year's meeting will focus on the
health of indigenous people. The meeting will discuss work carried out in this
area to date, with a view to sharing best practices and fostering collaboration
between UN organizations and other IASG members.
The IASG was established in 2002 to support and promote the UN
Permanent Forum on Indigenous Issues (UNPFII), which focuses on indigenous
issues related to economic and social development, culture, the environment,
education, health and human rights. It constitutes an important arena for
international cooperation and dialogue on indigenous peoples' issues.
There are an estimated 370 million indigenous peoples living in more than
70 countries worldwide. They represent a rich diversity of cultures, religions,
traditions, languages and histories; yet continue to be among the world's
most marginalized population groups. The health status of indigenous
peoples varies significantly from that of non-indigenous population groups in
countries all over the world.
http://www.who.int/mediacentre/events/meetings/2010/iasg/en/index.html
United Nations Permanent Forum on Indigenous Issues
http://www.un.org/esa/socdev/unpfii/

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

1 October 2010 Volume 51, Number 7
http://www.journals.uchicago.edu/toc/cid/current
[Reviewed last week]

Emerging Infectious Diseases

Volume 16, Number 9–September 2010
http://www.cdc.gov/ncidod/EID/index.htm
[Reviewed earlier]

Human Vaccines
Volume 6, Issue 9 September 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/9/
[Reviewed last week]

JAMA
Vol. 304 No. 10, pp. 1041-1140, September 8, 2010
http://jama.ama-assn.org/current.dtl
Commentaries
Public Reporting of Hospital Hand Hygiene Compliance—Helpful or
Harmful?
Matthew P. Muller; Allan S. Detsky
[First 150 words per JAMA convention; we include this commentary as it
relates to public reporting strategies associated with HCW influenza
immunization uptake]
Public reporting of hospital performance has been proposed as a means of
improving quality of care while ensuring both transparency and
accountability.1 Organizations feel pressure to perform well, deriving from
their desire to protect market share and defend reputations. This pressure, if
effectively harnessed, can lead to an increase in quality improvement
activities and better patient outcomes, although the evidence supporting the
latter claim is mixed.1
In 2002, it was estimated that approximately 1.7 million hospital-acquired
infections (HAIs) and 99 000 HAI-related deaths occurred in the United States
each year.2 Hand hygiene is considered the most important strategy to
prevent HAIs.3 Since 2002, an increasing number of US states have
mandated public reporting of quality indicators related to HAI prevention; to
date, none have included reports of hand hygiene compliance in their
mandates. This Commentary suggests the need for caution…
Do IRBs Protect Human Research Participants?
Christine Grady
[First 150 words per JAMA convention]
Institutional review boards (IRBs) are the core of the well-established US
system for the protection of human research participants. Institutional review
boards were initially created to provide independent review of research
conducted by researchers at their own institutions, impartial assessment of
the ethical acceptability of proposed research, and a check on investigators'
interests.1 Subsequently, advances in knowledge, technology, and resources
have changed the face of research. Pharmaceutical industry research
spending exceeds the National Institutes of Health (NIH) budget, which
increased from approximately $1 billion in 1970 to $30 billion in 2010.2
Multisite research, expansion into international and community settings,
novel scientific opportunities, freezers of stored samples, expanded
categories of researchers, and entities including contract research
organizations, data and safety monitoring committees, clinical trial
coordinating centers, and commercial IRBs have transformed the clinical
research enterprise.
Concurrently, the number of, investment in, and responsibilities of IRBs
have increased. . . .
Editorial
A Theme Issue on Infectious Disease and Immunology—Call for
Papers
Gianna Zuccotti; Phil B. Fontanarosa
[First 150 words per JAMA convention]
Infectious diseases and immunologic disorders are common reasons patients
seek medical care, can be associated with considerable morbidity, and
account for substantial health care expenditures. Each year, there are
millions of outpatient visits for a variety of infectious disorders, such as upper
respiratory tract infections, acute otitis media, skin infections, community-
acquired pneumonia, hepatitis, and sexually transmitted infections. In
addition, infectious processes may represent life-threatening conditions for
hospitalized patients, ranging from severe sepsis and ventilator-acquired
pneumonia to nosocomial infection with resistant organisms and surgical site
infections.
Despite control of some infectious processes, novel pathogens continue to
emerge and cause severe and widespread illness, such as pandemic 2009
influenza A(H1N1) and outbreaks with multidrug-resistant organisms. At the
same time, the pipeline for new antibiotics is limited since many
pharmaceutical companies have curtailed antimicrobial research and
development because of concerns about high costs, low . . .

Journal of Infectious Diseases

1 October 2010 Volume 202, Number 7
http://www.journals.uchicago.edu/toc/jid/current
[Reviewed last week]

The Lancet
Sep 11, 2010 Volume 376 Number 9744 Pages 845 - 928
http://www.thelancet.com/journals/lancet/issue/current
Editorial
Hepatitis E vaccine: why wait?
The Lancet
In The Lancet today, Buddha Basnyat asks why are hepatitis E and the
conjugate typhoid vaccines not available, despite their proven efficacy and
safety. In 2007, Mrigendra Prasad Shrestha and colleagues assessed the
safety and efficacy of a recombinant protein hepatitis E virus (HEV) vaccine
that was produced in insect cells by the US Army working with
GlaxoSmithKline. This vaccine showed 95·5% efficacy after administration of
three doses (20 μg per dose) at months 0, 1, and 6 in a phase 2 randomised
controlled trial of 2000 healthy, mostly young men in Nepal. Although
GlaxoSmithKline retains the intellectual property rights to this vaccine, it
reportedly has no plans for development. The results of Feng-Cai Zhu and
colleagues' phase 3 trial, reported in The Lancet today, using a recombinant
HEV vaccine (HEV 239), which was produced in bacterial cells, lend support to
the efficacy and safety of such a vaccine. HEV 239 was assessed in a general
population of healthy men and women (aged 16—65 years) living in Jiangsu
province, China. Three doses (30 μg of purified recombinant hepatitis E
antigen per dose) of HEV 239 administered at months 0, 1, and 6 resulted in
100% efficacy in 48 693 individuals, whereas 15 of 48 663 people given the
placebo (hepatitis B vaccine) developed hepatitis E.
HEV is a single-strand, positive-sense RNA virus that was first recognised in
India in the 1980s. This virus is transmitted enterically from individual to
individual through contaminated water and uncooked food, resulting in
hepatitis epidemics or sporadic cases. The highest incidence of sporadic
cases in developing countries is in the age group 15—35 years; in developed
countries, individuals older than 45 years have the highest incidence. A third
of the world's population, mostly in developing countries, is infected with
HEV. Genotypes 1, 2, and 4 are prevalent in developing countries, whereas
genotype 3 is prevalent in Europe and the USA. At least 50% of acute viral
hepatitis in endemic countries is caused by HEV. Because HEV infection is
self-limiting, the hepatitis is usually acute. Hepatitis E cannot be clinically
distinguished from the other acute viral hepatides; therefore, diagnosis is by
use of enzyme immunoassay for the detection of specific IgM or viral RNA
with reverse transcriptase polymerase chain reaction.
HEV vaccines should also be assessed in pregnant women (particularly those
in the second and third trimesters), immunosuppressed individuals, and
infants (<2 years). Efficacy and safety should first be assessed in pregnant
women with HEV infection, in whom fulminant hepatitis can arise. The
mortality rate is 5—25% in pregnant women compared with 1% in the
general population infected with the virus—eg, in one hospital in Kathmandu,
Nepal, 20—30% of pregnant women with hepatitis E die. HEV can be
vertically transmitted during pregnancy, and increases the risk of abortions,
stillbirths, deaths in newborn babies, and neonatal hypoglycaemia and liver
injury.
HEV infection in people with chronic liver disease can increase the mortality
rate—eg, 1-year mortality in Indian individuals with these comorbidities was
70%. Hence, individuals with underlying chronic hepatic disease might
benefit most from an HEV vaccine. The period of protection afforded with
vaccination against HEV should also be established.
 Precautions for prevention of the spread of HEV include improvements in
sanitation, education about handwashing, and storage, handling, and
preparation of uncooked pork. Because no treatment exists for HEV infection,
development of a vaccine is the best way forward in developing and
developed countries. However, developing countries are unlikely to have the
resources needed to develop and test vaccines. So why have companies
invested their resources in creating vaccines such as those for HEV that are
safe and seem effective, and then not developed them when they are
urgently needed?
The answer might be that pharmaceutical companies do not think an HEV
vaccine is commercially viable. Hopefully, this situation will change after the
International Symposium on Hepatitis E in Seoul, South Korea, on Sept 15—
16. This symposium has been organised by the International Vaccine Institute
in collaboration with WHO. Experts from around the world will gather to share
data about hepatitis E epidemiology, disease burden, diagnostic methods,
and vaccines. One of the planned outcomes of this symposium is the
generation of strategies for the rapid development and delivery of HEV
vaccines, which is not a moment too soon.
Article
Efficacy and safety of a recombinant hepatitis E vaccine in healthy
adults: a large-scale, randomised, double-blind placebo-controlled,
phase 3 trial
Feng-Cai Zhu, Jun Zhang, Xue-Feng Zhang, Cheng Zhou, Zhong-Ze Wang,
Shou-Jie Huang, Hua Wang, Chang-Lin Yang, Han-Min Jiang, Jia-Ping Cai, Yi-Jun
Wang, Xing Ai, Yue-Mei Hu, Quan Tang, Xin Yao, Qiang Yan, Yang-Ling Xian,
Ting Wu, Yi-Min Li, Ji Miao, Mun-Hon Ng, James Wai-Kuo Shih, Ning-Shao Xia
Summary
Background
Seroprevalence data suggest that a third of the world's population has been
infected with the hepatitis E virus. Our aim was to assess efficacy and safety
of a recombinant hepatitis E vaccine, HEV 239 (Hecolin; Xiamen Innovax
Biotech, Xiamen, China) in a randomised, double-blind, placebo-controlled,
phase 3 trial.
Methods
Healthy adults aged 16—65 years in, Jiangsu Province, China were randomly
assigned in a 1:1 ratio to receive three doses of HEV 239 (30 μg of purified
recombinant hepatitis E antigen adsorbed to 0·8 mg aluminium hydroxide
suspended in 0·5 mL buffered saline) or placebo (hepatitis B vaccine) given
intramuscularly at 0, 1, and 6 months. Randomisation was done by computer-
generated permuted blocks and stratified by age and sex. Participants were
followed up for 19 months. The primary endpoint was prevention of hepatitis
E during 12 months from the 31st day after the third dose. Analysis was
based on participants who received all three doses per protocol. Study
participants, care givers, and investigators were all masked to group and
vaccine assignments. This trial is registered with ClinicalTrials.gov, number
NCT01014845.
Findings
11 165 of the trial participants were tested for hepatitis E virus IgG, of which
5285 (47%) were seropositive for hepatitis E virus. Participants were
randomly assigned to vaccine (n=56 302) or placebo (n=56 302). 48 693
(86%) participants in the vaccine group and 48 663 participants (86%) in the
placebo group received three vaccine doses and were included in the primary
efficacy analysis. During the 12 months after 30 days from receipt of the
third dose 15 per-protocol participants in the placebo group developed
hepatitis E compared with none in the vaccine group. Vaccine efficacy after
three doses was 100·0% (95% CI 72·1—100·0). Adverse effects attributable
to the vaccine were few and mild. No vaccination-related serious adverse
event was noted.
Interpretation
HEV 239 is well tolerated and effective in the prevention of hepatitis E in the
general population in China, including both men and women age 16—65
years.
Funding
Chinese National High-tech R&D Programme (863 programme), Chinese
National Key Technologies R&D Programme, Chinese National Science Fund
for Distinguished Young Scholars, Fujian Provincial Department of Sciences
and Technology, Xiamen Science and Technology Bureau, and Fujian
Provincial Science Fund for Distinguished Young Scholars.

[Editor’s Note: In an earlier edition, we inadvertently did not include the

following important article from The Lancet, Volume 376, Issue 9741,
Pages 615 - 623, 21 August 2010]
Efficacy of pentavalent rotavirus vaccine against severe rotavirus
gastroenteritis in infants in developing countries in Asia: a
randomised, double-blind, placebo-controlled trial
K Zaman, Dang Duc Anh, John C Victor, Sunheang Shin, Md Yunus, Michael J
Dallas, Goutam Podder, Vu Dinh Thiem, Le Thi Phuong Mai, Stephen P Luby,
Le Huu Tho, Michele L Coia, Kristen Lewis, Stephen B Rivers, David A Sack,
Florian Schödel, A Duncan Steele, Kathleen M Neuzil, Max Ciarlet
Summary
Background
Rotavirus vaccine has proved effective for prevention of severe rotavirus
gastroenteritis in infants in developed countries, but no efficacy studies have
been done in developing countries in Asia. We assessed the clinical efficacy
of live oral pentavalent rotavirus vaccine for prevention of severe rotavirus
gastroenteritis in infants in Bangladesh and Vietnam.
Methods
In this multicentre, double-blind, placebo-controlled trial, undertaken in rural
Matlab, Bangladesh, and urban and periurban Nha Trang, Vietnam, infants
aged 4—12 weeks without symptoms of gastrointestinal disorders were
randomly assigned (1:1) to receive three oral doses of pentavalent rotavirus
vaccine 2 mL or placebo at around 6 weeks, 10 weeks, and 14 weeks of age,
in conjunction with routine infant vaccines including oral poliovirus vaccine.
Randomisation was done by computer-generated randomisation sequence in
blocks of six. Episodes of gastroenteritis in infants who presented to study
medical facilities were reported by clinical staff and from parent recollection.
The primary endpoint was severe rotavirus gastroenteritis (Vesikari score
≥11) arising 14 days or more after the third dose of placebo or vaccine to
end of study (March 31, 2009; around 21 months of age). Analysis was per
protocol; infants who received scheduled doses of vaccine or placebo without
intervening laboratory-confirmed naturally occurring rotavirus disease earlier
than 14 days after the third dose and had complete clinical and laboratory
results were included in the analysis. This study is registered with
ClinicalTrials.gov, number NCT00362648.
Findings
2036 infants were randomly assigned to receive pentavalent rotavirus
vaccine (n=1018) or placebo (n=1018). 991 infants assigned to pentavalent
rotavirus vaccine and 978 assigned to placebo were included in the per-
protocol analysis. Median follow up from 14 days after the third dose of
placebo or vaccine until final disposition was 498 days (IQR 480—575). 38
cases of severe rotavirus gastroenteritis (Vesikari score ≥11) were reported
during more than 1197 person-years of follow up in the vaccine group,
compared with 71 cases in more than 1156 person years in the placebo
group, resulting in a vaccine efficacy of 48·3% (95% CI 22·3—66·1) against
severe disease (p=0·0005 for efficacy >0%) during nearly 2 years of follow-
up. 25 (2·5%) of 1017 infants assigned to receive vaccine and 20 (2·0%) of
1018 assigned to receive placebo had a serious adverse event within 14 days
of any dose. The most frequent serious adverse event was pneumonia
(vaccine 12 [1·2%]; placebo 15 [1·5%]).
Interpretation
In infants in developing countries in Asia, pentavalent rotavirus vaccine is
safe and efficacious against severe rotavirus gastroenteritis, and our results
support expanded WHO recommendations to promote its global use.
Funding
PATH (GAVI Alliance grant) and Merck

The Lancet Infectious Disease

Sep 2010 Volume 10 Number 9 Pages 577 - 652
http://www.thelancet.com/journals/laninf/issue/current
[Reviewed earlier]

Nature
Volume 467 Number 7312 pp133-244
http://www.nature.com/nature/current_issue.html
[No relevant content]

Nature Medicine
September 2010, Volume 16 No 9
http://www.nature.com/nm/index.html
News
Amidst growing vaccine concerns, NIH sets up engine for answers -
p940
Roxanne Palmer
Commentary
The 2010 scientific strategic plan of the Global HIV Vaccine
Enterprise
The Council of the Global HIV Vaccine Enterprise: Seth Berkley, Kenneth
Bertram,
Jean-François Delfraissy, Ruxandra Draghia-Akli, Anthony Fauci, Cynthia
Hallenbeck,
Madame Jeannette Kagame, Peter Kim, Daisy Mafubelu, Malegapuru W
Makgoba,
Peter Piot, Mark Walport, Mitchell Warren & Tadataka Yamada; for Members
of the Enterprise: José Esparza, Catherine Hankins, Margaret I Johnston, Yves
Lévy
& Manuel Romaris; for Alternate members: Rafi Ahmed & Alan Bernstein
[Selected excerpts from the full Commentary]
The 2010 Plan's two scientific priorities
Recognizing the importance of pursuing a diverse range of vaccine
concepts and approaches, the 2010 Plan prioritizes two main drivers key to
the next phase of HIV vaccine research and development that specifically
require global collaboration.
First, the Plan recognizes that clinical trials and human clinical investigation
present an unequalled opportunity to obtain important information about the
human immune system and its response to vaccine candidates and that they
are pivotal to advancing both vaccine discovery and vaccine development.
Human efficacy trials are essential to defining the ability of vaccines to
prevent infection or disease and for the discovery of vaccine-induced
correlates and signatures of protection, which would ultimately accelerate the
development or improvement of HIV vaccines for future licensure and public
health use. This scientific imperative—made possible by major advances in
laboratory and computational techniques that have opened up complex
biological systems, including the human immune system, to rigorous and
rapid scientific analysis—underpins the importance of clinical efficacy trials to
advancing vaccine discovery and development.
Second, the Plan recognizes that trials must be linked to and build upon the
tools and concepts of basic biomedical science, including genomics and
computational biology, immunology, virology and model systems, to optimize
both vaccine design and information on vaccine biology in humans. A
strengthened clinical trials effort must therefore be accompanied by
sustained, strong support for fundamental vaccine discovery research. In
pursuing an increasingly science-driven clinical trials effort, the field will
advance promising candidates toward vaccine licensure and, at the same
time, contribute fundamental scientific insights that will improve future
vaccine design, product development and clinical trials.
The 2010 Plan is therefore predicated on a multidisciplinary approach that
bridges the lab and the clinic, entrenching human research as intrinsic to the
discovery process, and mobilizing the collaborative efforts of basic, preclinical
and clinical scientists in highly iterative vaccine design and testing…
Conclusion and next steps
The creation of the Global HIV Vaccine Enterprise and its emphasis on a
shared Scientific Strategic Plan represents an unprecedented response by the
international scientific community to the scientific, public health and
humanitarian challenges posed by HIV/AIDS. Enterprise stakeholders have a
shared commitment to fulfill three essential functions: conducting regular
assessments of scientific priorities and updating them to reflect lessons
learned, new opportunities and the influence of new scientific findings and
new technologies, establishing global processes to address priority areas and
establishing a culture of mutual accountability for effective implementation of
the Plan by funders and investigators. These commitments remain imperative
to the fulfillment of the 2010 Plan in driving progress in the field.
Over the past 18 months, major scientific advances have signaled the
beginning of an important new phase in HIV vaccine research. At the same
time, there is increasing evidence that the epidemic is in danger of spinning
out of control. It is our collective responsibility to ensure that this moment is
not lost. Continued progress in the field urgently requires that funders, aid
agencies, researchers, industry, regulatory agencies, advocates and civil
society commit to working together as an open and collaborative global
community. Until a deployable, efficacious vaccine is developed, that
objective will be the only and ultimate goal of the Global HIV Vaccine
Enterprise.

New England Journal of Medicine

September 9, 2010 Vol. 363 No. 11
http://content.nejm.org/current.shtml
[No relevant content]

The Pediatric Infectious Disease Journal

September 2010 - Volume 29 - Issue 9
http://journals.lww.com/pidj/pages/currenttoc.aspx
[Reviewed earlier; No relevant content]

Pediatrics
September 2010 / VOLUME 126 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml
[Reviewed earlier]

PLoS Medicine
(Accessed 12 September 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
10 September 2010 Vol 329, Issue 5997, Pages 1241-1426
http://www.sciencemag.org/current.dtl
[No relevant content]
Science Translational Medicine
8 September 2010 vol 2, issue 48
http://stm.sciencemag.org/content/current
[No relevant content]

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

Volume 28, Issue 41 pp. 6653-6808 (24 September 2010)

Original Research Article
Girls’ preferences for HPV vaccination: A discrete choice
experiment
Pages 6692-6697
Esther W. de Bekker-Grob, Robine Hofman, Bas Donkers, Marjolein van
Ballegooijen, Theo J.M. Helmerhorst, Hein Raat, Ida J. Korfag
Abstract
A discrete choice experiment was developed to investigate if girls aged 12–16
years make trade-offs between various aspects of human papillomavirus
(HPV) vaccination, and to elicit the relative weight that girls’ place on these
characteristics. Degree of protection against cervical cancer, protection
duration, risk of side-effects, and age of vaccination, all proved to influence
girls’ preferences for HPV vaccination. We found that girls were willing to
trade-off 38% protection against cervical cancer to obtain a lifetime
protection instead of a protection duration of 6 years, or 17% to obtain an
HPV vaccination with a 1 per 750,000 instead of 1 per 150,000 risk of serious
side-effects. We conclude that girls indeed made a trade-off between degree
of protection and other vaccine characteristics, and that uptake of HPV
vaccination may change considerably if girls are supplied with new evidence-
based information about the degree of protection against cervical cancer, the
protection duration, and the risk of serious side-effects.
Original Research Article
Factors affecting compliance with measles vaccination in Lao PDR
Pages 6723-6729
Maniphet Phimmasane, Somthana Douangmala, Paulin Koffi, Daniel Reinharz,
Yves Buisson
Abstract
In line with WHO objectives, the Lao Government is committed to eliminate
measles by 2012. Yet from 1992 to 2007, the annual incidence of measles
remained high while the vaccination coverage showed a wide diversity across
provinces. A descriptive study was performed to determine factors affecting
compliance with vaccination against measles, which included qualitative and
quantitative components. The qualitative study used a convenience sample
of 13 persons in charge of the vaccination program, consisting of officials
from different levels of the health care structure and members of vaccination
teams. The quantitative study performed on the target population consisted
of a matched, case-control survey conducted on a stratified random sample
of parents of children aged 9–23 months. Overall, 584 individuals (292 cases
and 292 controls) were interviewed in the three provinces selected because
of low vaccination coverage. On the provision of services side (supply), the
main problems identified were a lack of vaccine supply and diluent, a
difficulty in maintaining the cold chain, a lack of availability and competence
among health workers, a lack of coordination and a limited capacity to assess
needs and make coherent decisions. In the side of the consumer (demand),
major obstacles identified were poor knowledge about measles immunization
and difficulties in accessing vaccination centers because of distance and cost.
In multivariate analysis, a low education level of the father was a factor of
non-immunization while the factors of good compliance were high incomes,
spacing of pregnancies, a feeling that children must be vaccinated,
knowledge about immunization age, presenting oneself to the hospital rather
than expecting the mobile vaccination teams and last, immunization of other
family members or friends’ children. The main factors affecting the
compliance with vaccination against measles in Laos involve both the supply
side and the demand side. Obtaining an effective coverage requires
upgrading and training the Expanded Programme on Immunization (EPI) staff
and a reinforcement of health education for target populations in all
provinces.
Original Research Article
Seasonal influenza vaccine supply and target vaccinated population
in China, 2004–2009
Pages 6778-6782
Luzhao Feng, Anthony Wayne Mounts, Yunxia Feng, Yuan Luo, Peng Yang,
Zijian Feng, Weizhong Yang, Hongjie Yu
Abstract
To better understand the gap between limited influenza vaccine supply and
the target population for vaccination in China, we conducted a retrospective
survey to quantify the production capacity, supply and sale of seasonal
trivalent inactive vaccine (TIV) from the 2004–2005 through the 2008–2009
season, and estimated the target population who should receive annual
influenza vaccine. The maximum domestic capacity to produce TIV was 126
million doses in 2009. A total of 32.5 million doses of TIV were supplied in
2008–2009, with an average annual increase rate of 18% from 16.9 million in
2004–2005. This represents an amount sufficient to vaccinate 1.9% of
Chinese population. The average number of doses of TIV for sale by province
ranged from <5 to 108 per 1000 people. The differences are explained in part
by level of economic development but also influenced by local
reimbursement policies in some provinces. Based on national
recommendations, we estimated a target population of 570.6 million or 43%
of the total population. Supply and domestic production capacity for influenza
vaccine is currently insufficient to vaccinate the estimated target population
in China. The Government of China should consider measures to improve
domestic production capacity of influenza vaccine, expand successful
promotional campaigns, and add cost subsidies in high risk groups to further
encourage influenza vaccine usage.

Original Research Article

Control of hepatitis A by universal vaccination of children and
adolescents: An achieved goal or a deferred appointment?
Pages 6783-6788
Domenico Martinelli, Isabella Bitetto, Silvio Tafuri, Pietro L. Lopalco, Rosa
Maria Mininni, Rosa Prato
Abstract
Temporal trends of Hepatitis A cases and vaccination coverage data against
Hepatitis A Virus have been investigated to analyse the impact of the
universal routine vaccination strategy more than 10 years from its
introduction in Puglia (region of Southern Italy). The basic reproductive
number (R0) before vaccination introduction and the effective reproductive
number (Re) after introduction have been calculated. A progressive decrease
in incidence has been recorded in Puglia during last 10 years. Vaccination
coverage is actually 64.8% (95% CI: 52.7–76.9%) for children aged 12–24
months and of 67.6% (95% CI: 58.4–76.8%) for 12-year-old adolescents. R0
estimated in 1996 was 2.01; actually Re is 0.651. Theoretical age at infection
is 31.82 years. Universal routine vaccination aimed at the control of direct
transmission remains the milestone in the strategy for the containment of the
disease in settings at an intermediate level of endemicity.

Volume 28, Issue 40 pp. 6549-6652 (14 September 2010)

[No relevant content]

Volume 28, Issue 39 pp. 6403-6548 (7 September 2010)

Short Communications
Implementing a birth dose of hepatitis B vaccine for home deliveries
in Africa—Too soon?
Pages 6408-6410
Anna Kramvis, C. John Clements
Abstract
Despite the recommendation of the World Health Organization (WHO) to
provide the first hepatitis B vaccine dose at birth (within 24 h), there are
epidemiological, economic and logistical reasons why this may not be the
best approach for home births in Africa. The WHO policy presupposes that the
epidemiology of hepatitis B infection in Africa is similar to the rest of the
world and that the organizational, infrastructural and financial support is
adequate. While babies born in health facilities may be relatively easy to
immunize at birth, health systems and infrastructures in many resource-poor
countries in Africa would be severely challenged, if required to reach home
deliveries within 24 h of birth.
Original Research Article
Predictors of universal influenza vaccination uptake in grades 1 and
2 Toronto school children: Effective vaccination strategies should
not end with at risk children
Richard G. Foty, Astrid Guttmann, Jeffrey C. Kwong, Sarah Maaten, Doug
Manuel, David M. Stieb, Sharon D. Dell