Vaccines: The Week in Review

2 May 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 Curry, Editor and
Executive Director of the Center, at
david.r.curry@centerforvaccineethicsandpolicy.org.

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_guyan
a_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

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 June 2010 Volume 50, Number 11
http://www.journals.uchicago.edu/toc/cid/current
Clinical Attack Rate and Presentation of Pandemic H1N1 Influenza
versus Seasonal Influenza A and B in a Pediatric Cohort in Nicaragua
Aubree Gordon, Saira Saborío, Elsa Videa, Roger López, Guillermina Kuan,
Angel Balmaseda, and Eva Harris
Abstract
Background. Little is known about the clinical presentation and
epidemiology of influenza A H1N1pdm in children in developing countries. We
assessed the severity of influenza A H1N1pdm in children in Nicaragua by
comparing H1N1pdm cases to seasonal influenza cases in an ongoing cohort
study.
Methods. The Nicaraguan Influenza Cohort Study was established in June
2007 to study the burden and seasonality of pediatric influenza in a tropical
developing country. During the period from June 2007 through November
2009, a total of 4391 children aged 2–14 years participated in the cohort. We
examined the attack rate of clinical influenza and assessed symptoms at first
presentation in febrile patients with H1N1pdm versus those with seasonal
influenza A or B.
Results. The estimated clinical attack rate of H1N1pdm in the cohort was
20.1%, compared to 11.7% and 15.1% for seasonal influenza A and 11.9%
and 24.2% for seasonal influenza A and B in 2007 and 2008, respectively.
Symptoms significantly associated with H1N1pdm cases versus seasonal
influenza A cases were sore throat (adjusted odds ratio [OR], 1.7; 95%
confidence interval [CI], 1.2–2.5), wheezing (OR, 5.1; 95% CI, 1.3–19.0),
rhonchi (OR, 4.6; 95% CI, 1.4–15.0), crepitations (OR, 16.2; 95% CI, 2.1–
128.7), pneumonia (OR, 8.0; 95% CI, 1.7–37.3), nausea (OR, 2.8; 95% CI, 1.5–
5.1), and loss of appetite (OR, 2.1; 95% CI, 1.4–3.1). In addition, 3 concurrent
influenza and dengue virus coinfections were identified.
Conclusions. Children with influenza A H1N1pdm presented with
significantly more symptoms of lower respiratory infection and
gastrointestinal symptoms than children with seasonal influenza. The clinical
influenza attack rate was high in both pandemic and seasonal years.
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.

Emerging Infectious Diseases

Volume 16, Number 5–May 2010
http://www.cdc.gov/ncidod/EID/index.htm
[Reviewed earlier]

Human Vaccines
Volume 6, Issue 4 April 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/3/
[Reviewed earlier]

JAMA
Vol. 303 No. 16, pp. 1569-1660, April 28, 2010
http://jama.ama-assn.org/current.dtl
[No relevant content]

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]

The Lancet
May 01, 2010 Volume 375 Number 9725 Pages 1495 - 1578
http://www.thelancet.com/journals/lancet/issue/current
[No relevant content]

The Lancet Infectious Disease

May 2010 Volume 10 Number 5 Pages 289 - 366
http://www.thelancet.com/journals/laninf/issue/current
[Reviewed last week]

Nature
Volume 464 Number 7293 pp1245-1398 29 April 2010
http://www.nature.com/nature/current_issue.html
[No relevant content]

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.
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.

PLoS Medicine
(Accessed 2 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=aac96924d41874935d8e1
c2a2501181c#results
[No relevant content]

Science
30 April 2010 Vol 328, Issue 5978, Pages 533-652
http://www.sciencemag.org/current.dtl
[No relevant content]

Science Translational Medicine

28 April 2010 vol 2, issue 29
http://stm.sciencemag.org/content/current
[No relevant content]

Vaccine
Volume 28, Issue 21, Pages 3627-3754 (7 May 2010)
http://www.sciencedirect.com/science/journal/0264410X
[No relevant content]