CHILD SURVIVAL UPDATE 20/2008: TWO ON MEASLES/BOOK REVIEW/READER
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. firstname.lastname@example.org
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.
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
Can measles be eradicated globally? [Bull World Health Organ.
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
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
John W. Ward and Christian Warren, editors
Oxford University Press, New York, USA, 2007
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
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
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
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.
CDC & Hib Initiative
Hi, Good update. I send you another article on Hib published by PAHO last
371%2Fjournal.pmed.0050087 . Another discussion article on Hib and pneumo
was published in the same PLoS issue:
Panamerican Health Organization