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REVIEW ON AEROSOL MEASLES VACCINES/ FEASIBILITY OF GLOBAL MEASLES ERADICATION

Friday, 9th of May 2008

Dear All,
 
 CHILD SURVIVAL UPDATE 20/2008: TWO ON MEASLES/BOOK REVIEW/READER
 FEEDBACK (2)
 
 1) AEROSOL MEASLES VACCINE
 
 In this abstract, available in full to Vaccine subscribers, Low and
 colleagues report on the most recent work with aerosolized measles vaccine.
 The next step, say the authors, is large randomized trials to establish
 safety and efficacy of this new delivery technology.
 
 All previous introductions of new EPI technologies, such as vaccine vial
 monitors and autodisabled needles and syringes, have followed field trials
 to ascertain how health workers accept and use the innovation.
 
 Vaccine. 2008 Jan 17;26(3):383-98. Epub 2007 Nov 26.);
 
 Immunogenicity and safety of aerosolized measles vaccine: systematic
 review and meta-analysis.

 Low N, Kraemer S, Schneider M, Restrepo AM.
 
 
 Insititute of Social and Preventive Medicine, University of Bern,
 Bern, Switzerland. low@ispm.unibe.ch
 
 
 Aerosols are the most promising non-injectable method of measles
 vaccination studied so far and their efficacy is thought to be
 comparable to injected vaccine. We conducted a systematic review up
 to May 2006 to examine the immunogenicity and safety of aerosolized
 measles vaccine (Edmonston-Zagreb or Schwarz strains) 1 month or more
 after vaccination. Where possible we estimated pooled serological
 response rates and odds ratios (with 95% confidence intervals, CI)
 comparing aerosolized and subcutaneous vaccines in children in three
 age groups and adults. We included seven randomized trials, four
 non-randomized trials and six uncontrolled studies providing
 serological outcome data on 2887 individuals. In children below 10
 months, the studies were heterogeneous. In four comparative studies,
 seroconversion rates were lower with aerosolized than with
 subcutaneous vaccine and in two of these the difference was unlikely
 to be due to chance. In children 10-36 months, the pooled
 seroconversion rate with aerosolized vaccine was 93.5% (89.4-97.7%)
 and 97.1% (92.4-100%) with subcutaneous vaccine (odds ratio 0.27,
 0.04-1.62). In 5-15-year olds the studies were heterogeneous. In all
 comparative studies aerosolized vaccine was more immunogenic than
 subcutaneous. Reported side effects were mild. Aerosolized measles
 vaccine appears to be equally or more immunogenic than subcutaneous
 vaccine in children aged 10 months and older. Large randomized trials
 are needed to establish the efficacy and safety of aerosolized
 measles vaccine as primary and booster doses.
 
 
 2) FEASIBILITY OF GLOBAL MEASLES ERADICATION
 
 
 The case against measles eradication grows daily weaker. This abstract is
 available in full to journal subscribers.
 
 
 Expert Rev Vaccines. 2008 Apr;7(3):355-62.
 
 Feasibility of global measles eradication after interruption of
 transmission in the Americas.
 de Quadros CA, Andrus JK, Danovaro-Holliday MC, Castillo-Solórzano C.
 
 Sabin Vaccine Institute, Washington, DC 20006, USA.
 ciro.dequadros@sabin.org
 
 Measles is one of the most infectious diseases. Before the
 introduction of the measles vaccine, nearly all children contracted
 measles. By the end of the 1980s, most countries of the world had
 incorporated the measles vaccine into their routine vaccination
 programs. Globally, some 345,000 deaths due to measles still occur
 every year. Eradication of measles would play an important role in
 improving child survival. The goal to eradicate measles from the
 Americas was set by the Pan-American Sanitary Conference in 1994.
 Progress to date has been remarkable. Measles is no longer an endemic
 disease in the Americas and interruption of transmission has been
 documented in most countries. As of December 2007, 5 years have
 elapsed since the detection of the last endemic case in Venezuela in
 November 2002. This experience demonstrates that interruption of
 measles transmission can be achieved and sustained over a long period
 of time. Global eradication should be feasible if the appropriate
 strategies are implemented. Even in a new paradigm in which
 eradication is not followed by the discontinuation of vaccination,
 eradication of measles should be a good investment to avoid expensive
 epidemics and save those children that would potentially die due to
 infection with the measles virus. It is not only a dream to think
 that we will see a world free of measles by the year 2015.
 
 
 

 Is global measles eradication feasible? [Curr Top Microbiol
 Immunol. 2006]

 Can measles be eradicated globally? [Bull World Health Organ.
 2004]

 Measles eradication: recommendations from a meeting cosponsored
 by the World Health Organization, the Pan American Health
 Organization, and CDC. [MMWR Recomm Rep. 1997]

 Measles eradication in the Americas: progress to date. [J
 Infect Dis. 2004]

 Western hemisphere leading the way in disease eradication. [EPI
 Newsl. 1997]
 
 
 3) Book Review
 
 EID Journal Home.  Volume 13, Number 12–December 2007
 
 Volume 13, Number 12–December 2007
 
 Silent Victories: The History and Practice of Public Health in
 Twentieth-Century America
 
 John W. Ward and Christian Warren, editors
 Oxford University Press, New York, USA, 2007
 ISBN: 9780195150698
 Pages: 484; Price: US $49.95
 
 
 The 20th century witnessed some notable public health triumphs in America:
 improvements in the water supply, further control of several infectious
 diseases through vaccines and antimicrobial drugs, and increases in life
 expectancy with enormous improvements in survival rates of mothers and
 their infants. What made these improvements possible? For anyone who has
 ever wondered, this book is an excellent place to start looking for
 answers.
 
 
 The stated purpose of the book is not to provide a comprehensive history of
 public health in America but to discuss 10 key public health advances of
 the 20th century. This is a broad objective in itself, which this volume
 richly achieves. The advances, originally chosen for MMWR (Morbidity and
 Mortality Weekly Report) in 1999, are each expanded into a section of the
 book: Control of Infectious Diseases, Control of Disease through
 Vaccination, Maternal and Infant Health, Nutrition, Occupational Health,
 Family Planning, Fluoridation, Vehicular Safety, Cardiovascular Disease,
 and Tobacco and Disease Prevention.
 
 
 The facts and figures are all there, of course, and they are generally very
 well presented and referenced. Infectious diseases are well represented;
 their respective chapters are excellent and informative. But it would be a
 pity if the reader stopped there. A unique strength of the book is the
 pairing of these expository chapters with essays by social scientists and
 historians who explore aspects of the social or political context. This
 combination makes it a book to savor. Experienced practitioners having a
 hard day may be encouraged to learn that many public health triumphs we
 take for granted today (the apt title Silent Victories is from a 1923
 lecture by C.-E.A. Winslow) were made possible only by heroic and sustained
 effort.
 
 
 One theme that emerges is the importance of coalitions, often including not
 only the medical community and health departments (and sometimes industry),
 but also activists, reformers, and even ordinary citizens who became
 passionate about a cause. Getting recognition and consensus within the
 medical community was essential, and not always easy, as in the development
 of occupational health, or even pasteurization at first. Wolf's article,
 for example, notes that ensuring clean pasteurized milk required 30 years
 of effort, during which time many infants died. In traffic safety,
 discussed by Albert, the activists were often the ones who pushed
 government into taking action. With regard to the more recent efforts
 toward tobacco cessation, Brandt argues that the 1964 Surgeon General's
 Report was a watershed comparable to John Snow's work on cholera, as it
 developed the foundations not only for tobacco cessation but also for
 chronic disease epidemiology.
 
 
 But, of course, public health cannot rest on these laurels. As Koplan and
 Thacker note in the Epilogue, public health in the coming century will face
 many challenges. Some are a continuation of 20th-century trends, such as
 emerging infectious diseases, healthy lifestyle choices, and ensuring that
 basic public health measures are available globally. Others will be new,
 including the aging of large segments of the population. As this book
 demonstrates, one of the best ways to meet the new challenges may well be
 to fully appreciate how these past successes were achieved.
 
 
 Reviewer: Stephen S. Morse* (Embedded image moved to file: pic10600.gif)
 Comments to Author
 *Columbia University, New York, New York, USA
 
 
 Good reading.
 
 
 Bob D.
 
 
 READER FEEDBACK:
 
 
 Thanks for these three updates on Hib vaccine. I am including the link to
 the actually MMWR rather than the draft you attached.
 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5706a3.htm This was published
 simultaneously in WHO's Weekly Epidemiological Review. In fact the MMWR
 edited the draft so that they only reported on data up to 2007 but the WER
 kept the original format with 2008 data.
 
 Regards,
 Ros O'Loughlin
 CDC & Hib Initiative
 
 ---------------------------------------------------------------------------------------------------
 Hi, Good update. I send you another article on Hib published by PAHO last
 week:
 http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1
 371%2Fjournal.pmed.0050087 . Another discussion article on Hib and pneumo
 was published in the same PLoS issue:
 http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1
 371%2Fjournal.pmed.0050086
 
 Best regards,
 
 Carolina Danovaro
 Panamerican Health Organization