New This Week

February 2018 Invasive Serotype 35B Pneumococci Including an Expanding Serotype Switch Lineage “Our conclusion that both clonal expansion and diversification had occurred in the post-PCV13 era is validated by the results of Chochua et al. During 2015–2016, we observed no further increase in serotype 35B. We agree with Chochua et al. that the emergence of serotype 35B is of concern and the development of a new generation pneumococcal vaccine is necessary.
February 2018 Pneumococcal conjugate vaccine 13 delivered as one primary and one booster dose (1 + 1) compared with two primary doses and a booster (2 + 1) in UK infants: a multicentre, parallel group randomised controlled trial “The Gavi Alliance currently supplies vaccines and vaccine support for the world’s poorest countries and projects a spend on pneumococcal vaccines between 2011 and 2020 of US$4·7 billion (2016 pneumococcal AMC annual report28). Most countries receiving Gavi Alliance support use a 3 + 0 schedule. An eventual shift to a 1 + 1 therefore has very significant financial implications with a reduction of approximately one third in vaccine costs. This cost reduction is particularly relevant for those lower middle income countries who are soon to graduate from Gavi Alliance eligibility and will thus be required to fund their own PCV programmes.” …
February 2018 The dengue vaccine dilemma “The vaccine was not approved in younger children because of less favourable efficacy and safety; in particular, an increase in hospital admissions due to dengue among those aged 2–5 years. This finding, which might have been an effect of age or because of more dengue-unexposed (ie, seronegative) individuals in the younger age group, could not then be explained since serostatus before immunisation was unknown for most trial participants. However, some experts warned in 2016 that the increased risk of hospital admission was a serious safety concern, including Maíra Aguiar and colleagues in this journal, a point emphasised by Aguiar and Nico Stollenwerk in their Correspondence published online on Dec 21, 2017.”

January 29, 2018
Immunogenicity of a two-dose investigational hepatitis B vaccine, HBsAg-1018, using a toll-like receptor 9 agonist adjuvant compared with a licensed hepatitis B vaccine in adults (full text) “Alum-adjuvanted vaccines approved for the prevention of hepatitis B infection are highly effective in children but less so in adults. Vaccinating adults at risk for hepatitis B remains a challenge. For example, in 2010, an estimated 77.2% of 14 million individuals with diabetes 59 years of age and younger (10.8 million individuals) had not been vaccinated. Little progress has been made; in 2015, an estimated 75.6% of such persons had not been vaccinated. Even when the alum-adjuvanted vaccines are administered, they have several limitations. Such limitations will make it difficult to achieve the recent call by the World Health Assembly and by the US National Academies of Sciences, Engineering, and Medicine for eliminating viral hepatitis as a public health problem by 2030.”
January 25, 2018 Rapid increase in non-vaccine serotypes causing invasive pneumococcal disease in England and Wales, 2000–17: a prospective national observational cohort study “Invasive pneumococcal disease incidence due to non-PCV13 serotypes doubled (7·97 per 100 000; 1·97, 1·86–2·09) since the introduction of PCV7, and accelerated since 2013/14—especially serotypes 8, 12F, and 9N, which were responsible for more than 40% of invasive pneumococcal disease cases by 2016/17. Invasive pneumococcal disease incidence in children younger than 5 years remained stable since 2013/14, with nearly all replacement disease occurring in adults. … Interpretation: Both PCV7 and PCV13 have had a major effect in reducing the burden of invasive pneumococcal disease in England and Wales; however, rapid increases in some non-PCV13 serotypes are compromising the benefits of the programme.”
January 23, 2018 Humoral and cell-mediated immune responses to H5N1 plant-made virus-like particle vaccine are differentially impacted by alum and GLA-SE adjuvants in a Phase 2 clinical trial (full text) “The H5VLP influenza was generally well tolerated in all tested conditions after the 1st and the 2nd dose. Statistical comparisons for solicited symptoms showed overall significantly higher incidences in H5VLP recipient (Suppl. Figure 1). The safety profiles of alum-adjuvanted and GLA-adjuvanted groups were similar with the exception of swelling and muscle ache after the first dose. However, the majority of solicited symptoms reported in this study were mild or moderate or ≤Grade 2 intensity for all dosage regimens (data not shown). …  Data availability Clinical data that support the findings of this study are available from Medicago Inc. but restrictions apply to the availability of these data.”

  • Competing interests: B.J.W. has been a principal investigator of vaccine trials for several manufacturers, including Medicago Inc., for which his institution obtained research contracts.
  • Since 2010, B.J.W. served as Medical Officer for Medicago Inc. In addition, B.J.W. has held and continued to hold peer-reviewed support from Canadian Institutes of Health Research and other sources for collaborative, basic science work with Medicago Inc.
  • B.J.W. has received honoraria from several vaccine manufacturers for participation on Scientific Advisory Boards (including Medicago Inc).
  • N.L., S.T., S.P. and É.A. are employees of Medicago Inc.
  • J.M. is a full-time employee and shareholder of Immune Design.

January 18, 2018 Epidemiological Data on the Effectiveness of Influenza Vaccine—Another Piece of the PuzzleThe lack of suitable vaccine candidates, combined with the potential for vaccine strains to antigenically change in the egg adaptation process, have now been shown to result in impaired protection against this subtype. Similarly, problems with the live attenuated influenza vaccine have surfaced in recent years. This has led to a downgrading in recommendations for this formulation in the United States, from a preferred status for younger children, to a neutral recommendation, and a nonpreferred status, compared with the inactivated vaccine. The reasons for the apparent downward drift in effectiveness over time and the conflicting estimates in other regions are not yet clear but may be related to the effect of revaccination over several seasons.”
January 16, 2018 – Effect of Age at Vaccination on Rotavirus Vaccine Effectiveness in Bolivian Infants “Rotavirus vaccines are less effective in developing countries versus developed countries. One hypothesis for this difference in performance is that higher levels of maternal antibodies in developing countries may interfere with vaccine response, suggesting that delayed dosing could be beneficial. … Conclusions: Our results indicate that early administration may improve VE and support the current WHO recommendations for the RV1 schedule. Comment: Rotavirus is a live oral vaccine which can  cause Intussusception. When a portion of the intestine folds inside another part causing blockage.

January 15, 2018
Five years of monitoring for the emergence of oseltamivir resistance in patients with influenza A infections in the Influenza Resistance Information Study “Compared with other studies that have analysed the susceptibility of influenza viruses at treatment onset, it provides detailed data on the risk of emergence of resistance in immunocompetent patients, with some hints regarding the possible emergence of resistance in viruses that display a genetic background favouring this emergence and its sustainability. This study also confirms the lack of correlation between decreases in viral load and clinical outcome, especially when a resistant virus emerges.”
January 15, 2018How Can We Best Protect Infants from Pertussis? (full text) “The development of a new monovalent PT alone vaccine, even if the PT component is included in an existing licensed vaccine, would require a major financial commitment, particularly if it were to achieve licensure in a country with a rigorous regulatory authority. It is also unlikely that countries that have successful maternal Tdap programs would be eager to support research to replace Tdap with a monovalent PT vaccine. The most expedient solution to the production of such a vaccine could include collaboration between funding sources such as the Gates Foundation, one or more manufacturers currently producing PT as part of their Tdap vaccine, and one or more relevant national regulatory authorities in countries that would benefit. In summary, the major findings from this report are that the baboon-model provides evidence that transplacental antibody to PT alone is sufficient for newborn protection and that the avoidance of the other antigens in Tdap would ameliorate issues related to suppression of infant responses to routine vaccination.
January 11, 2018 A Physician’s Recommendation for HPV Vaccination: What Makes African American Mothers Compliant? “A physician’s recommendation should advise AA mothers on the risk of HPV and the importance of HPV vaccination at an early age to reduce cervical cancer risk. It should further address mothers’ perceived disadvantages of HPV vaccination (e.g., side effects). Comment: The disadvantages are not perceived. Visit the Vaccine Research Library to see for yourself
January 2018 Child Mortality In The US And 19 OECD Comparator Nations: A 50-Year Time-Trend Analysis “”While child mortality progressively declined across all countries, mortality in the US has been higher than in peer nations since the 1980s. From 2001 to 2010 the risk of death in the US was 76 percent greater for infants and 57 percent greater for children ages 1-19. During this decade, children ages 15-19 were eighty-two times more likely to die from gun homicide in the US. Over the fifty-year study period, the lagging US performance amounted to over 600,000 excess deaths.”

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