Table of Contents

Volume 7, Issue 12

  December 2011

  Pages 1245 - 1394

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 Issue Catalogue (MARC XML)

EDITOR'S CORNER

Open Access Article

Letter from the Editor

Ronald W. Ellis and Eva M. Riedmann
Page 1245
http://dx.doi.org/10.4161/hv.7.12.18970
Full Text | PDF




NEWS, POLICY AND PROFILES

Open Access Article

News

Eva M. Riedmann
Pages 1246 - 1249
http://dx.doi.org/10.4161/hv.7.12.18969
Abstract | Full Text | PDF

Positive results for GSK malaria vaccine in Phase III trial
Viruses may be responsible for up to 40% of cancers
Phase III: Dynavax’ Heplisav stands the test in hypo-responsive populations
FDA advises against needleless flu vaccinations
CDC panel recommends HPV vaccine for boys
Obesity associated with impaired immune response to influenza vaccination
Aduro treats first patient in pancreas cancer vaccine Phase II trial
First Parkinson’s disease vaccine to enter the clinic





PORTRAIT OF A LEADING VACCINOLOGIST

Open Access Article

Fighting against infectious diseases in China

Weidong Yin
Pages 1250 - 1253
http://dx.doi.org/10.4161/hv.7.12.18971
Abstract | PDF

Dr. Yin started his research on infectious disease prevention in the 1980s. In 1985, Dr. Yin sucessfully isolated the hepatitis A virus, after which, in 2002, he developed the first proprietary inactivated hepatitis A vaccine in China and soon launched it into the China market. Led by Dr. Yin, Sinovac successfully developed the vaccine prducts against SARS, H5N1, H1N1, hepatitis A and B and infleunza. Currently, Sinovac is working on the R&D of EV71 vaccine against hand, foot and mouth disease, and pneumococcal conjugate vaccine. Sinovac aims to provide Chinese children with international quality vaccines, and provide children in the world with vaccines made in China.




REVIEWS

Open Access Article

The continuing role of Haemophilus influenzae type b carriage surveillance as a mechanism for early detection of invasive disease activity

Susan P Jacups
Pages 1254 - 1260
http://dx.doi.org/10.4161/hv.7.12.17979
Abstract | PDF

Prior to the introduction of Haemophilus influenzae type b (Hib) conjugate vaccines, Hib was the leading cause of bacterial meningitis in children under five years of age worldwide. In countries that have adopted Hib vaccination schedules, invasive disease has reduced markedly.  Oro-naso pharyngeal carriage is recognized as the most significant source of infection. Hib carriage is significantly associated with poverty, such as overcrowding, poor ventilation in houses, lack of running water, and high smoking rates. Additionally, many Indigenous minority groups report high rates of Hib carriage. A resurgence of Hib disease among Alaskan children in the 1990s, lead  to  a change in approach  to eliminate Hib disease and carriage in high-risk populations. This new approach identifies strategies for eliminating Hib disease focusing on the reservoirs of colonization within families and communities. Monitoring Hib carriage continues to offer an early warning system, whereby intervention could prevent invasive disease resurgence.

Open Access Article

Acceptance on the move: Public reaction to shifting vaccination realities

Baruch Velan
Pages 1261 - 1270
http://dx.doi.org/10.4161/hv.7.12.17980
Abstract | PDF

This review examines four events related to vaccination that have occurred in recent years: (a) the ongoing recovery from the MMR/Autism scare in the UK, (b) the upgrading of the Varicella vaccine to a universal childhood vaccine, (c) the major effort of authorities to provide a vaccine for A/H1N1 influenza and its rejection by the public, and, d) the current attempts to change the HPV vaccine target from girls only to boys and girls. All of these changes have been met with shifts in the public acceptance of the relevant vaccine. These shifts are characterized not only by the number of people willing to be vaccinated, but also by the attitudes and the motives related to acceptance. Examination of the interrelationship between changes in vaccination realities, and changes in acceptance patterns suggests that today, the public has a better understanding of vaccination, is acting in a more reflexive way, and is capable of changing attitudes and behavior. All together, changes in vaccination enhance debates and dialogues about vaccines, and lead to higher awareness and more conscious acceptance.


Open Access Article

Approaches to improved targeting of DNA vaccines

Gang Wang, Li Pan and Yongguang Zhang
Pages 1271 - 1281
http://dx.doi.org/10.4161/hv.7.12.17983
Abstract | PDF

Proper targeting of DNA vaccines has been identified as a crucial factor in improving the efficacy of DNA vaccines. In general, targeting measures affect either directly the DNA or the protein(s) expressed by DNA vaccines towards antigen-presenting cells (APC) to enable efficacious antigen presentation via MHC class I and II pathways. Improved targeting of the delivery of antigen can significantly increase the protective effects and reduce vaccination doses and toxicity. In this review, we summarize the targeting approaches reported in the scientific literature to improve DNA vaccine efficacy.

Open Access Article

Rotavirus vaccines: Update on global impact and future priorities

Catherine Yen, Jacqueline E. Tate, Manish M. Patel, Margaret M. Cortese, Benjamin Lopman, Jessica Fleming, Kristen Lewis, Baoming Jiang, Jon Gentsch, Duncan Steele and Umesh D. Parashar
Pages 1282 - 1290
http://dx.doi.org/10.4161/hv.7.12.18321
Abstract | PDF

Early rotavirus vaccine adopter countries in the Americas, Europe, and in Australia have documented substantial declines in rotavirus disease burden following the introduction of vaccination.  However, the full public health impact of rotavirus vaccines has not been realized as they have not been introduced into routine immunization programs in countries of Africa and Asia with the highest rotavirus disease morbidity and mortality burden.  In this article, we review the epidemiology of rotavirus disease, the development and current status of rotavirus vaccines including newly available vaccine impact data from early-introducer countries, and future priorities for implementation and monitoring of rotavirus vaccination programs in developing countries.




SHORT REPORT

Open Access Article

Pandemic influenza vaccination coverage in children with type 1 diabetes: Analysis from seven Italian centers

Ivana Rabbone, Andrea E. Scaramuzza, Dario Iafusco, Riccardo Bonfanti, Fortunato Lombardo, Valentino Cherubini, Sonia Toni, Franco Cerutti and Gian Vincenzo Zuccotti
Pages 1291 - 1292
http://dx.doi.org/10.4161/hv.7.12.18335
Abstract | PDF

The pandemic influenza vaccination coverage  in  children with type 1 diabetes has been analysed. 1461 charts have been reviewed (788 M and 673 F, ages 13.0±4.1 yrs, disease duration 6.0±4.8 yrs, HbA1c 7.9±1.2%). Among them, 428 patients (29.3%) underwent A/H1N1 vaccination. A special effort is required to implement an increased immunization rate. 





RESEARCH PAPERS

Open Access Article

Immune response to influenza vaccination in children treated with methotrexate or/and tumor necrosis factor-α inhibitors

Andreas Woerner, Marie-Josèphe Sauvain, Christoph Aebi, Margrit Otth and Isabel B. Bolt
Pages 1293 - 1298
http://dx.doi.org/10.4161/hv.7.12.17981
Abstract | PDF

In children treated with immunosuppressive medication such as methotrexate and tumor necrosis factor-alpha (TNF-α) inhibitors, additional immunizations are recommended because of increased susceptibility to infections. However, it is unclear if adequate antibody response to vaccinations can be established in children receiving methotrexate and/or TNF-α inhibitors. In a prospective open label study, we assessed seroprotection and seroconversion following influenza vaccination during 2 seasons (6 strains) in 36 children with autoimmune disease treated either with methotrexate (n=18), TNF-α inhibitors (n=10) or both (n=8) and a control group of 16 immunocompetent children. Influenza antibody titers were determined by hemagglutinin inhibition assay, before and 4-8 weeks after vaccination. Post-vaccination seroprotection (defined as a titer ³1:40) did not significantly differ between immunosuppressed and immunocompetent subjects. Seroconversion, defined as the change from a nonprotective (<1:40) to a protective titer (³1:40) with at least a 4-fold titer increase, was less likely to occur in immunosuppressed patients, although no significant difference from the control group was established. Safety evaluation of vaccination showed no serious adverse events. Children receiving methotrexate and/or TNF-α inhibitors can be safely and effectively immunized against influenza, with a seroprotection after vaccination comparable to immunocompetent children.

Open Access Article

Social and cultural determinants of anticipated acceptance of an oral cholera vaccine prior to a mass vaccination campaign in Zanzibar

Christian Schaetti, Claire-Lise Chaignat, Raymond Hutubessy, Ahmed M. Khatib, Said M. Ali, Christian Schindler and Mitchell G. Weiss
Pages 1299 - 1308
http://dx.doi.org/10.4161/hv.7.12.18012
Abstract | PDF

Despite improvements in sanitation and water supply, cholera remains a serious public health burden. Vaccination is included among recommendations for cholera control. Cultural concepts of illness are likely to affect vaccine acceptance. This study examined social and cultural determinants of anticipated acceptance of an oral cholera vaccine (OCV) prior to a mass vaccination campaign in Zanzibar. Using a cultural epidemiological approach, 356 unaffected adult residents were studied with vignette-based semi-structured interviews. Anticipated acceptance was high for a free OCV (94%), but declined with increasing price. Logistic regression models examined social and cultural determinants of anticipated acceptance at low (USD 0.9), medium (USD 4.5) and high (USD 9) price. Models including somatic symptoms (low and high price), social impact (low and medium) and perceived causes (medium and high) explained anticipated OCV acceptance better than models containing only socio-demographic characteristics. Identifying thirst with cholera was positively associated with anticipated acceptance of the low-priced OCV, but acknowledging the value of home-based rehydration was negatively associated. Concern about spreading the infection to others was positively associated at low price among rural respondents. Confidence in the health system response to cholera outbreaks was negatively associated at medium price among peri-urban respondents. Identifying witchcraft as cause of cholera was negatively associated at medium and high price. Anticipated acceptance of free OCVs is nearly universal in cholera-endemic areas of Zanzibar; pre-intervention assessments of community demand for OCV should not only consider the social epidemiology, but also examine local socio-cultural features of cholera-like illness that explain vaccine acceptance.

Open Access Article

Pooled analysis of safety data from pediatric Phase II RTS,S/AS malaria candidate vaccine trials

Johan Vekemans, Yolanda Guerra, Marc Lievens, Sarah Benns, Didier Lapierre, Amanda Leach and Thomas Verstraeten
Pages 1309 - 1316
http://dx.doi.org/10.4161/hv.7.12.18046
Abstract | PDF

Prior to progression to Clinical Development Phase III, GlaxoSmithKline Biologicals performed a pooled analysis of phase two safety data following administration of 8860 doses of RTS,S/AS to 2981 children under 5 years old. RTS,S/AS was associated with increased rates of non-serious URTI, rash and diaper dermatitis graded mild or moderate. There was no significant increased rate of overall or single SAEs. Two episodes of simple febrile seizure were estimated to be related to vaccination. Significant decreased relative risks of death, any SAE, any SAE excluding malaria and pneumonia were observed. The results suggest a favourable risk-benefit balance which is to be confirmed in the ongoing Phase III trials.

Open Access Article

Determinants of tetanus and seasonal influenza vaccine uptake in adults living in Germany

Merle M. Böhmer, Dietmar Walter, Gérard Krause, Stephan Müters, Antje Gößwald and Ole Wichmann
Pages 1317 - 1325
http://dx.doi.org/10.4161/hv.7.12.18130
Abstract | PDF

The primary objective of this study was to assess determinants of vaccine uptake in adults living in Germany exemplified by one standard vaccination (tetanus) and one vaccination targeting specific risk-groups (seasonal influenza). Data from 21,262 telephone household-interviews representative of the adult population in Germany were collected in 2009 and analysed. A total 73.1% of the adult population had a sufficient tetanus vaccination status according to national recommendations (i.e. last tetanus shot ≤10 years ago). Influenza vaccination coverage in the target population (i.e. persons ≥60 years, chronically ill, healthcare workers) was 44.1%. Persons who received professional vaccination advice within the past five years were more frequently vaccinated against tetanus and influenza than persons without (p<0.001). Private physicians were identified as the most important source for vaccination advice. Having a statutory health insurance, last physician contact <1 year ago, and living in the eastern part of Germany were independently associated with higher tetanus and influenza vaccine uptake. Low socio-economic status, two-sided migration background, and the feeling of being insufficiently informed on the benefits of vaccination were independently associated with low uptake of tetanus but not influenza vaccines. Our results show that tetanus vaccination coverage in the general adult population and influenza vaccination coverage in the target population are unsatisfactorily low in Germany. Since physicians’ advice has a major impact on the vaccination decision, physician reminder systems could provide a method to increase vaccination coverage in adults. For tetanus, information activities should target population groups with an increased risk of being undervaccinated.

Open Access Article

Peripheral immunization induces functional intrahepatic Hepatitis C specific immunity following selective retention of vaccine-specific CD8 T cells by the liver

Krystle A. Lang Kuhs, Roberta Toporovski, Arielle A. Ginsberg, Abby L. Olsen, Devon J. Shedlock, Matthew P. Morrow, Jian Yan, Rebecca G. Wells and David B. Weiner
Pages 1326 - 1335
http://dx.doi.org/10.4161/hv.7.12.18279
Abstract | PDF

It is believed that an effective HCV vaccine must induce strong HCV-specific cytotoxic IFN-γ+ CD8+ T cells able to migrate into and become fully activated within the liver, an organ known to suppress T cell responses and induce tolerance. Given the importance of intrahepatic HCV-specific T cells in the clearance of acute infection, the goal of this present study was to determine if peripheral immunization was able to induce functional intrahepatic HCV-specific T cell based immunity both in the presence and absence of HCV antigen expression within the liver. Using a novel HCV NS3/NS4A DNA vaccine, we show that peripheral immunization of C57BL/6 mice results in the formation of a large pool of fully functional HCV-specific cytotoxic IFN-γ+ CD8+ T cells within the liver and that these cells were highly enriched within the liver as compared to the spleen. Following hepatic expression of cognate HCV antigen using a previously described liver transfection method, we show that this pool of vaccine-induced HCV-specific CD8+ T cells retained its ability to become highly activated as shown by the upregulation of IFN-γ and CCR5 expression, as well as by the clearance of HCV NS3 expressing hepatocytes. Taken together, these findings suggest that T cell effector function is preserved within the liver and that selective recruitment of antigen-specific T cells to the liver may play a previously unappreciated role in the process of immune surveillance, which may be exploited for future T cell based HCV vaccines.

Open Access Article

Safety and immunogenicity of a modified process hepatitis B vaccine in healthy adults ≥ 50 years

Christopher L. Gilbert, Stephanie O. Klopfer, Jason C. Martin, Florian P. Schödel and Prakash K. Bhuyan
Pages 1336 - 1342
http://dx.doi.org/10.4161/hv.7.12.18333
Abstract | PDF

Background: Generating protective immune responses in older adults (particularly ≥65 years) remains challenging for vaccines in general.  This study examined the immune response engendered in older adults by RECOMBIVAX HB™ manufactured using a modified adjuvant (modified-process hepatitis B vaccine; mpHBV), RECOMBIVAX-HB™, and ENGERIX-B™. 
Methods: Randomized, double-blind, multicenter study enrolled healthy, seronegative subjects (N=538) to receive mpHBV (10 µg hepatitis B surface antigen [HBsAg]), RECOMBIVAX-HB™ (10 µg HBsAg), or ENGERIX-B™ (20 µg HBsAg) at Day 1, Month 1, and Month 6.  Prespecified analysis of subpopulations 50-64 years and ≥65 years was conducted.  Serum antibody to HBsAg (anti-HBs) was measured Predose 1 and 1 month Postdose 3. 
Results: For subjects ≥50 years, seroprotection rates (SPR, anti-HBs titer ≥10 mIU/mL) were 75.7% (95% CI: 68.0,82.2) for mpHBV, 68.0% (95% CI: 59.8,75.5) for RECOMBIVAX HB™, and 84.0% (95% CI: 77.0,89.6) for ENGERIX-B™.  For subjects 50-64 years, SPRs were 82.1% (95% CI: 73.8,88.7) for mpHBV, 77.4% (95% CI: 68.7,84.7) for RECOMBIVAX-HB™, and 88.5% (95% CI: 81.1,93.7) for ENGERIX-B™.  For subjects ≥65 years, SPRs were 57.5% (95% CI: 40.9,73.0) for mpHBV, 34.4% (95% CI: 18.6,53.2) for RECOMBIVAX-HB™, and 67.7% (95% CI: 48.6,83.3) for ENGERIX-B™.  There were 6 non-vaccine related serious adverse events reported.
Conclusions: The majority of subjects ≥50 years old achieved seroprotection.  The sub-population ≥65 years had lower vaccination responses than the 50-64 years sub-population.  For subjects ≥65 years, mpHBV and ENGERIX-B™ groups achieved higher seroprotection rates than the RECOMBIVAX-HB group.  The safety profile of mpHBV was consistent with the other groups. 

Open Access Article

Comparative immunogenicity and safety of human papillomavirus (HPV)-16/18 vaccine and HPV-6/11/16/18 vaccine: Follow-up from Months 12–24 in a Phase III randomized study of healthy women aged 18–45 years

Mark H. Einstein, Mira Baron, Myron J. Levin, Archana Chatterjee, Bradley Fox, Sofia Scholar, Jeffrey Rosen, Nahida Chakhtoura, Dorothée Meric, Francis J. Dessy, Sanjoy Kumar Datta, Dominique Descamps and Gary Dubin
Pages 1343 - 1358
http://dx.doi.org/10.4161/hv.7.12.18281
Abstract | PDF

In this observer-blind study (NCT00423046), women (N=1,106), stratified by age (18–26, 27–35, 36–45 years), were randomized (1:1) to receive the HPV-16/18 vaccine (Cervarix®, GlaxoSmithKline Biologicals, Months 0,1,6) or the HPV-6/11/16/18 vaccine (Gardasil® Merck & Co., Inc., Months 0,2,6). Month 7 results were previously reported; we now report Month 24 results. In the according-to-protocol cohort for immunogenicity (seronegative and DNA-negative at baseline for HPV type analyzed), seropositivity rates of neutralizing antibodies (nAbs) [pseudovirion-based neutralization assay] were, across all age strata, 100% (HPV-16/18 vaccine) and 97.5–100% (HPV-6/11/16/18 vaccine) for HPV-16, and 99.0–100% (HPV-16/18 vaccine) and 72.3–84.4% (HPV-6/11/16/18 vaccine) for HPV-18. Corresponding geometric mean titers (GMTs) were 2.4–5.8-fold higher for HPV-16 and 7.7–9.4-fold higher for HPV-18 with the HPV-16/18 vaccine versus the HPV-6/11/16/18 vaccine; HPV-16 and HPV-18 GMTs were significantly higher with the HPV-16/18 vaccine than the HPV-6/11/16/18 vaccine (p<0.0001) in the total vaccinated cohort (received ≥1 vaccine dose, irrespective of baseline sero/DNA-status). Similar results were obtained using enzyme-linked immunosorbent assay (ELISA). Positivity rates and GMTs of antigen-specific IgG antibodies in cervicovaginal secretions (ELISA) were not significantly different between vaccines. At Month 24, CD4+ T-cell responses for HPV-16 and HPV-18 were higher with the HPV-16/18 vaccine; memory B-cell response was higher for HPV-18 with the HPV-16/18 vaccine and similar between vaccines for HPV-16. Both vaccines were generally well tolerated. Although an immunological correlate of protection has not been defined, differences in the magnitude of immune response between vaccines may represent determinants of duration of protection.

Open Access Article

Comparison of the immunogenicity of the human papillomavirus (HPV)-16/18 vaccine and the HPV-6/11/16/18 vaccine for oncogenic non-vaccine types HPV-31 and HPV-45 in healthy women aged 18–45 years

Mark H. Einstein, Mira Baron, Myron J Levin, Archana Chatterjee, Bradley Fox, Sofia Scholar, Jeffrey Rosen, Nahida Chakhtoura, Marie Lebacq, Robbert van der Most, Philippe Moris, Sandra L. Giannini, Anne Schuind, Sanjoy Kumar Datta and Dominique Descamps
Pages 1359 - 1373
http://dx.doi.org/10.4161/hv.7.12.18282
Abstract | PDF

Protection against oncogenic non-vaccine types (cross-protection) offered by human papillomavirus (HPV) vaccines may provide a significant medical benefit. Available clinical efficacy data suggest the two licensed vaccines (HPV-16/18 vaccine, GlaxoSmithKline Biologicals [GSK], and HPV-6/11/16/18 vaccine, Merck & Co., Inc.) differ in terms of protection against oncogenic non-vaccine HPV types -31/45. The immune responses induced by the two vaccines against these two non-vaccine HPV types (cross-reactivity) was compared in an observer-blind study up to Month 24 (18 months post-vaccination), in women HPV DNA-negative and seronegative prior to vaccination for the HPV type analyzed (HPV-010 [NCT00423046]). Geometric mean antibody titers (GMTs) measured by pseudovirion-based neutralization assay (PBNA) and enzyme-linked immunosorbent assay (ELISA) were similar between vaccines for HPV-31/45. Seropositivity rates for HPV-31 were also similar between vaccines; however, there was a trend for higher seropositivity with the HPV-16/18 vaccine (13.0–16.7%) versus the HPV-6/11/16/18 vaccine (0.0–5.0%) for HPV-45 with PBNA, but not ELISA. HPV-31/45 cross-reactive memory B-cell responses were comparable between vaccines. Circulating antigen-specific CD4+ T-cell frequencies were higher for the HPV-16/18 vaccine than the HPV-6/11/16/18 vaccine (HPV-31 [geometric mean ratio [GMR] =2.0; p=0.0002] and HPV-45 [GMR=2.6; p=0.0092]), as were the proportion of T-cell responders (HPV-31, p=0.0009; HPV-45, p=0.0793). In conclusion, immune response to oncogenic non-vaccine HPV types -31/45 was generally similar for both vaccines with the exception of T-cell response which was higher with the HPV-16/18 vaccine. Considering the differences in cross-protective efficacy between the two vaccines, the results might provide insights into the underlying mechanism(s) of protection.

Open Access Article

Immunogenicity and safety of the HPV-16/18 AS04-adjuvanted vaccine administered as a 2-dose schedule compared to the licensed 3-dose schedule: Results from a randomized study

Barbara Romanowski, Tino F. Schwarz, Linda M. Ferguson, Klaus Peters, Marc Dionne, Karin Schulze, Brian Ramjattan, Peter Hillemanns, Grégory Catteau, Kurt Dobbelaere, Anne Schuind and Dominique Descamps
Pages 1374 - 1386
http://dx.doi.org/10.4161/hv.7.12.18322
Abstract | PDF

The immunogenicity of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine (Cervarix®, GlaxoSmithKline Biologicals) administered according to its licensed vaccination schedule (3-dose, 3D) and formulation (20 μg of each HPV antigen; 20/20F) has previously been demonstrated. This partially-blind, controlled, randomized trial (NCT00541970) evaluated 2-dose (2D) schedules using the licensed 20/20F or an alternative formulation containing 40 μg of each antigen (40/40F), compared with the licensed 3D schedule. Healthy females stratified by age (9-14, 15-19, 20-25 years) were randomized to receive 2 doses of 20/20F at Months (M) 0,6 (n=240), 40/40F at M0,6 (n=241) or 40/40F at M0,2 (n=240), or 3 doses of 20/20F at M0,1,6 (licensed schedule/formulation, n=239). One month after the last dose, the 3D schedule was not immunologically superior to 2D schedules except in the 40/40F M0,2 group for HPV-16 (lower limit of 95% CI geometric mean antibody titer (GMT) ratio [2D/3D] <0.5). For both HPV-16 and HPV-18, the 2D schedules in girls 9-14 years were immunologically non-inferior to the 3D schedule in women 15-25 years (the age group in which efficacy has been demonstrated) (upper limit of 95% CI for GMT ratio [3D/2D] <2) one month after the last dose. At Month 24, non-inferiority was maintained for the 2D M0,6 schedules in girls 9-14 years versus the 3D schedule in women 15-25 years. All formulations had acceptable reactogenicity and safety profiles. These results indicate that the HPV-16/18 vaccine on a 2D M0,6 schedule is immunogenic and generally well tolerated in girls 9-14 years and that the 2D schedule is likely adequate for younger females.




COMMENTARIES

Open Access Article

Hepatitis B Vaccine in national immunization schedule: A preventive step in India

Ramesh Verma, Pardeep Khanna, Shankar Prinja, Meena Rajput, Suraj Chawla and Mohan Bairwa
Pages 1387 - 1388
http://dx.doi.org/10.4161/hv.7.12.17878
Abstract | PDF

Hepatitis B is a disease of the liver caused by Hepatitis B virus (HBV) infection. HBV is transmitted through contact with infected blood or body fluids, unprotected sexual intercourse and the perinatal route but not through casual contact. About two billion people worldwide have been infected with the virus, an estimated 360 million live with chronic infection, and at least 600,000 people die annually from acute or chronic consequences of Hepatitis B, such that Hepatitis B is a major public health problem worldwide. HBV is 50 to 100 times more infectious than HIV. It has been estimated that, of the 25 million infants born every year in India, over one million run the lifetime risk of developing chronic HBV infection. Every year over 100,000 Indians die due to illnesses related to HBV infection. Following the launch of the Global Alliance for Vaccines and Immunization (GAVI) to intensify National Immunization Programs (NIPs) in developing countries worldwide. World Health Organization (WHO) recommends that Hepatitis B vaccine should be given to all infants. Several cost-effectiveness analyses of inclusion of Hepatitis B vaccine in India’s NIP have been performed. These indicate that universal childhood Hepatitis B immunization in India will be highly cost-effective. The Government of India is also supporting planned state programs for introducing new vaccines as part of routine immunization. The current immunization schedule for hepatitis B vaccine includes a dose given as early as possible after birth, preferably within 24 hours for all institutional deliveries because the birth dose of Hepatitis B vaccine is effective in preventing perinatal transmission of Hepatitis B. Irrespective of the birth dose, 3 doses are to be given at 6, 10, 14 weeks at the same time as DPT and OPV.

Open Access Article

Preventing mumps outbreaks in confined settings: Comprehensive ring vaccination as a containment strategy

Hagai Levine, Shmuel Rishpon, Michael Huerta-Hartal and Nadav Davidovitch
Pages 1389 - 1393
http://dx.doi.org/10.4161/hv.7.12.18111
Abstract | PDF

Even among vaccinated cohorts, prevention and control of mumps outbreaks remain a challenge, owing to sub-optimal population immunity. This is especially true in confined settings, where a single case could be the index for an imminent outbreak. Efficacy of post-exposure prophylaxis has not been demonstrated, while early identification of mumps and comprehensive vaccination of populations in confined settings during outbreaks may enable containment of mumps and disrupt further spread. However, we are not aware of official international guidelines concerning vaccination of exposed individuals during an outbreak, especially in a confined setting.
In this article we present our experience with mumps containment during outbreaks through vaccination campaigns in the Israeli civilian and military populations and discuss lessons for containment efforts in other settings.  Our analysis shows that a comprehensive ring vaccination should be considered in any case of mumps in confined settings.




LETTER

Open Access Article

Prospective human trials with Dengue virus vaccines and the NS1 antigen production among vaccine recipients

Subhash C. Arya and Nirmala Agarwal
Page 1394
http://dx.doi.org/10.4161/hv.7.12.17958
PDF