Should universal hepatitis B immunisation be introduced in the UK?

Anti-cancer vaccines - a one-hit wonder?

Immunization against common bacterial and viral diseases has helped prevent millions of deaths worldwide. More recently, the concept of vaccination has been developed into a potentially novel strategy to treat and prevent cancer formation, progression, and spread. Over the past few years, a handful of anti-cancer vaccines have been licensed and approved for use in clinical practice, thus providing a breakthrough in the field. However, the path has not always been easy, with many hurdles that have had to be overcome in order to reach this point. Nevertheless, with more anti-cancer vaccines currently in development, there is still hope that they can eventually become routine tools used in the treatment and prevention of cancer in the future. This review will discuss in detail both types of anti-cancer vaccine presently used in clinical practice - therapeutic and preventive - before considering some of the more promising anti-cancer vaccines that are currently in development. Finally, the issue of side effects and the debate surrounding the overall cost-effectiveness of anti-cancer vaccines will be examined.

Hepatitis B virus: Where do we stand and what is the next step for eradication?

Hepatitis B (HB) virus (HBV) infection, which causes liver cirrhosis and hepatocellular carcinoma, is endemic worldwide. Hepatitis B vaccines became commercially available in the 1980s. The World Health Organization recommended the integration of the HB vaccine into the national immunisation programs in all countries. HBV prevention strategies are classified into three groups: (1) universal vaccination alone; (2) universal vaccination with screening of pregnant women plus HB immune globulin (HBIG) at birth; and (3) selective vaccination with screening of pregnant women plus HBIG at birth. Most low-income countries have adopted universal vaccine programs without screening of pregnant women. However, HB vaccines are not widely used in low-income countries. The Global Alliance for Vaccine and Immunization was launched in 2000, and by 2012, the global coverage of a three-dose HB vaccine had increased to 79%. The next challenges are to further increase the coverage rate, close the gap between recommendations and routine practices, approach high-risk individuals, screen and treat chronically infected individuals, and prevent breakthrough infections. To eradicate HBV infections, strenuous efforts are required to overcome socioeconomic barriers to the HB vaccine; this task is expected to take several decades to complete.

Continuing impact of infectious diseases on childhood deaths in England and Wales, 2003-2005

BACKGROUND

Data on the contribution of specific infections to childhood deaths in developed countries are limited.

METHODS

Infection-related deaths in children aged 28 days to 14 years who died in England and Wales between 2003 and 2005 were identified from routine anonymized death certificate dataset provided by the Office for National Statistics to the Health Protection Agency, using predefined International Classification of Diseases codes for infection.

RESULTS

There were 1368 infection-related deaths documented, constituting 20% of all childhood deaths. An underlying medical condition was recorded in 50% (676 cases), the most common being prematurity in infants (322/660, 52%), cerebral palsy in 1 to 4 year olds (46/190, 24%), and malignancy (46/163, 28%) in 5 to 14 year olds. Of the 837 deaths where a pathogen was coded, 494 (59%) specified bacterial infection, 256 (31%) viral infection, and 69 (8%) fungal infection. Among deaths with recorded bacterial infections, a lower proportion of meningococcal and pneumococcal infections (14% [22/155] vs. 60% [205/339], P < 0.0001) and a higher proportion of Gram-negative enteric bacilli (78/155 cases [50%] vs. 17/339 cases [5%], P < 0.0001) were reported in children with and without documented underlying medical conditions, respectively.

CONCLUSIONS

Infections continue to make a major contribution to deaths in children, particularly among those with underlying conditions. Identification of the pathogens associated with childhood deaths should help prioritize the development of intervention strategies for reducing pediatric mortality. Linkage of death registrations to national infectious disease surveillance systems should be undertaken to strengthen monitoring of infectious deaths and evaluate the effect of interventions.

Gastroenterology in developing countries: issues and advances

Developing countries shoulder a considerable burden of gastroenterological disease. Infectious diseases in particular cause enormous morbidity and mortality. Diseases which afflict both western and developing countries are often seen in more florid forms in poorer countries. Innovative techniques continuously improve and update gastroenterological practice. However, advances in diagnosis and treatment which are commonplace in the West, have yet to reach many developing countries. Clinical guidelines, based on these advances and collated in resource-rich environments, lose their relevance outside these settings. In this two-part review, we first highlight the global burden of gastroenterological disease in three major areas: diarrhoeal diseases, hepatitis B, and Helicobacter pylori. Recent progress in their management is explored, with consideration of future solutions. The second part of the review focuses on the delivery of clinical services in developing countries. Inadequate numbers of healthcare workers hamper efforts to combat gastroenterological disease. Reasons for this shortage are examined, along with possibilities for increased specialist training. Endoscopy services, the mainstay of gastroenterology in the West, are in their infancy in many developing countries. The challenges faced by those setting up a service are illustrated by the example of a Nigerian endoscopy unit. Finally, we highlight the limited scope of many clinical guidelines produced in western countries. Guidelines which take account of resource limitations in the form of "cascades" are advocated in order to make these guidelines truly global. Recognition of the different working conditions facing practitioners worldwide is an important step towards narrowing the gap between gastroenterology in rich and poor countries.

Childhood immunisation: what is the future?

Improved immunisation programmes and the development of new vaccines provide unprecedented opportunities to improve and sustain the health of our children. There are major challenges ahead in communicating the benefits of immunisation to all populations and in delivering vaccines to those in greatest need. In this review on immunisation, I have asked international opinion leaders to comment on the present and the future of immunisation to provide signposts for the narrative.