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
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
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
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]
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]
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]
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.
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.