Shot in the arm. H1N1 vaccine is headed to state health departments to ward off pandemic's spread, but experts worry about delay

While the federal government has been praised for its response to the H1N1 virus, HHS Secretary Kathleen Sebelius was in the hot seat last week when senators quized herabout delays in vaccination production. For providers in Chicago, "The limitation right now is the vaccine supply. When they get it, they will use it as best they can", says Julie Morita, left, who is with the city health department's immunization program.

Molecular epidemiology of adenovirus type 4 infections in US military recruits in the postvaccination era (1997-2003)

BACKGROUND

Military recruits are at a higher risk of respiratory infection than their civilian counterparts. Continuous outbreaks of adenovirus (Ad)-associated acute respiratory disease were documented among US trainees before the implementation of serotype 4 (Ad4) and serotype 7 vaccines in 1971. The discontinuation of Ad vaccination programs in 1999 precipitated the reemergence of Ad in training sites, with Ad4 accounting for 98% of all diagnosed cases.

METHODS

A total of 724 Ad4 strains isolated from recruits presenting with febrile respiratory illness at 8 training sites nationwide between 1997 and 2003 were genome typed by restriction enzyme analysis.

RESULTS

Seven genome types were identified, all of which were distinct from the prototype Ad4p and the vaccine type 4p1. Results showed very different, and often stable, genome type distributions at different geographic sites, despite the homogeneity of the recruit source population.

CONCLUSIONS

The data support the hypothesis that reservoirs for Ad outbreaks are within recruit training sites or in their immediate environments, not in the incoming recruit population. Molecular characterization beyond serotype is critical to understanding the transmission dynamics of Ad infection in these unique susceptible populations and to the implementation of effective prevention approaches.

Antigen and vaccine banks: technical requirements and the role of the european antigen bank in emergency foot and mouth disease vaccination

Antigen and vaccine banks are stocks of immunogenic materials ready to be formulated into vaccines (bulk antigens) or ready to use (vaccines) in case of need by one or more of the parties of the bank. These stocks were primarily developed by foot and mouth disease [FMD] free European countries to control unexpected severe FMD episodes after the cessation of routine vaccination in the 1990s. For various reasons, including the lack of suitable antigens or of discriminatory tests to be used following emergency vaccination, such banks have so far not been developed to control other transboundary diseases, although over the last few years stocks of vaccines have been collected by the European Community to support control measures for bluetongue or classical swine fever. The FMD virus antigens in the banks are stored at ultra-low temperatures (usually -130 degrees C) to guarantee a shelf life of at least five years compared to a shelf-life of one to two years for vaccines stored at +4 degrees C. When concentrated, a 50 I volume of antigens can contain up to 15 million cattle doses as per the standard potency specifications in the OIE Manual of Diagnostic Tests and Vaccines for Terrestrial Animals. Selecting antigen/vaccine strains for storage in a bank and selecting the appropriate strain(s) to be used in the case of emergency vaccination is the responsibility of FMD disease experts. The paper discusses the role of serological testing for the detection of infected animals in a vaccinated population, which is necessary for the recognition of FMD status. Technical advantages and disadvantages of antigen and vaccine banks in general are also outlined in this article. Finally, the experience of the European Community in organising, renewing, and controlling a sizeable FMD antigen bank since 1993 is discussed, and the use of the European Union (EU) antigen bank for international actions outside the EU is presented.

[International health at home: bringing the experiences back home with you]

International Health research conducted under extreme conditions in low-income countries may lead to a better understanding of epidemics in high-income countries, by questioning assumptions which are important in these countries. Examples are given of how observations in Guinea-Bissau have led to reinterpretation of the decline in measles mortality, of the polio model, and of the impact of stopping vaccinations after eradication in the industrialised countries.

Varicella zoster virus vaccination policies and surveillance strategies in Europe

The incorporation of varicella zoster virus (ZVV) vaccination in childhood immunisation schedules is becoming an increasingly common option in Europe. The current study forms part of the European Sero-Epidemiology Network 2 (ESEN2) organisational analysis for VZV and describes current passive immunisation policies, as well as current and proposed active immunisation strategies, and existing surveillance systems for diseases caused by the varicella zoster virus in ESEN countries. A questionnaire was compiled and distributed to 23 participating countries. A VZV vaccine is currently licensed in 14 of the 20 participating ESEN countries. Germany is the only country to have incorporated VZV vaccination into its routine childhood immunisation programme. Three further countries currently recommend vaccination of children against VZV and five countries are also considering introducing routine immunisation against VZV for children. However, of the eight countries with or considering introducing childhood VZV immunisation, only six have case-based mandatory notification of varicella, and only two countries have primary care surveillance data available for herpes zoster.

The use of antigen and vaccine banks in case of emergency vaccination in the European community

The Community control measures for foot-and-mouth disease (FMD) have been reviewed and are currently laid down in Directive 2003/85/EC of 29 September 2003. The Community is free of FMD and infection without practising vaccination. Legal provisions are in place to resort to emergency vaccination where required by the epidemiological situation and reserves of suitable antigens of the FMD virus for express formulation into vaccines have been established.

Extending the foot-and-mouth disease module to the control of other diseases

During the recent devastating epidemics of foot-and-mouth disease (FMD), bluetongue (BT), the highly pathogenic avian influenza (HPAI) and New Castle disease, more than 115 million animals were culled. The mass slaughter of animals raised serious ethical questions. These epidemics showed that the use of emergency vaccination is an essential element in disease control. During the last decade the FMD antigen banks have proved to be effective and this module should be extended. An international vaccine stock should be considered for classical swine fever and HPAI. Agreements with vaccine producers should be made easily available, with instant access to a vaccine reserve for rinderpest, peste des petits ruminants, BT, African horse sickness and Rift valley fever. These vaccines should meet international standards and should allow distinction between vaccinated and infected animals. Information should be gathered proactively on the use of vaccines for lumpy skin disease, sheep and goat pox and contagious bovine pleuropneumonia.

Australian contingency plans for emergency animal disease control: the role of antigen/vaccine banks

Vaccination is an important element of contingency plans for many animal diseases. The decision whether or not to use vaccine is complex, and must consider epidemiological, economic and social issues. Vaccines are rarely available in a country for emergency animal diseases unless a low pathogenicity strain of the agent is present or it is localised in carrier hosts. High quality commercial vaccine from overseas is often the preferred source of vaccine in an emergency, although less reliable sources may be used with additional safeguards. Alternatively, master seeds may be imported or developed for production within the country For contingency planning, diseases may be ranked according to the expected role of vaccine in the disease eradication strategy, with diseases for which vaccine is part of the initial response strategy receiving highest priority for action. A range of preparedness options is available, ranging from identifying producers of vaccine, obtaining permits for import and use from regulatory authorities, to establishing vaccine or antigen banks. Countries need to consider their individual situations and develop strategies to address the diseases of significance to them.

A global virtual network for foot-and-mouth disease in case of emergency

The use of emergency vaccination is considered in different contingency national plans as part of a foot-and-mouth disease (FMD) control strategy in countries whether vaccination is practised or not. The development of the inter-governmental and national FMD vaccine and antigen banks and some technical and operational problems that could affect their efficiency are analysed. The possibility of improving and implementing a more rational use of the antigen and vaccine banks through the creation of a Global Virtual Network of Vaccine and Antigen Banks is discussed.

[Preventive vaccines against papillomavirus and cervix cancer will soon enter clinical practice]

A vaccine may protect against cancers caused by high-risk human papillomaviruses (HPVs). Sexually transmitted high-risk HPV types are almost always found in cervical cancer. Incidents of HPV type 16 and cervical cancer has more than doubled after the 1980's in Finland. HPV L1 capsid protein can be produced in the yeast, after which it assembles into virus-like-particles (VLP) and can be readily used for vaccine production. HPV VLP vaccine is well tolerated and induces ten-fold higher serum antibody levels as compared to natural infection. HPV16 VLP vaccine has shown to be 91% protective effect against HPV16 infections in the first phase III study. Neutralizing HPV antibodies, induced by HPV VLP vaccination, effectively reduce the viral load even though total elimination of the virus may not be needed. It is not known for how long the vaccine induced protection will last. Recruitment of adolescents into population-based phase III vaccination studies should be large to allow reliable cancer registry based evaluation of protective effect against grave dysplasia and cervical cancer.