POST 00987E : MATERIAL OF INTEREST

POST 00987E : MATERIAL OF INTEREST 9 October 2006 ___________________________________________ This posting is sending you various material of interest reproduced from Tech Updates. Thanks to Bob Davis and Evelyn Chege. It starts with one message from Bob Davis. The full text of the two articles are available only on a pay-per-view basis, but the résumés below will give you the critical information. The first is about prolonged excretion of poliovirus. A related article on this same topic was published in 2004 in the Bulletin of the World Health Organization (Link provided in the message below : go to the bottom of the list on the webpage, under January). The second article, also in résumé, is about the effectiveness of the Hib vaccine in Kenya. And finally a quite interesting issue of the Lancet with main articles on the MDG countdown to 2015. In this same issue, there is also a "Comment" on "Pneumonia : the leading killer of children". This issue of the Lancet can be downloaded from : http://www.technet21.org/pdf_file/MDG-4_Lancet_special_issue.pdf Please note that it will be hosted temporarily on our site. It is rather heavy at 1.4 MB before encoding. ____________________________________________ PROLONGED EXCRETION OF WPV IN DEVELOPING COUNTRIES Skepticism of polio eradicability -- shrinking after publication of Nigeria's most recent incidence data -- is based partially on the belief that the prolonged excretion of wild poliovirus may lead to long term persistence of the virus in the environment. Does long term excretion occur often enough to justify such skepticism? This hypothesis receives no support from recent studies in Ethiopia, Pakistan and Guatemala just published in Biologicals. Khan and colleagues conclude that "persistent poliovirus excretion among persons 2 years of age and older with residual paralytic poliomyelitis is uncommon in developing countries." Full text of this reference is available from Elsevier only on a pay per view basis, but see related 2004 reference from the Bulletin of the World Health Organization, at http://www.who.int/bulletin/downloads/en/index2.html -------------------------- No evidence for prolonged excretion of polioviruses in persons with residual paralytic poliomyelitis in Ethiopia, Pakistan and Guatemala. By Khan AJ, Gebreselassie H, Asturias EJ, Agboatwalla M, Teklehaimanot R, Luby SP, Bayene B, Chezzi C, Asghar H, Moatter T, Torres OR, Kew O, Winkelstein J, Halsey NA. Department of International Health, Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W5041, Baltimore, MD 21205, USA. Persons who have developed acute flaccid paralysis following infection with wild-type polioviruses or vaccine-associated paralytic poliomyelitis usually excrete polioviruses for only a few weeks. However, some patients with paralytic poliomyelitis have had prolonged excretion of polioviruses for periods of up to 10 years after onset of disease. Most prolonged excretors have been identified in industrialized countries. We studied 348 patients 2-28 years old in Ethiopia, Pakistan and Guatemala with residual paralytic poliomyelitis to determine if they had IgA or IgG deficiency or persistent poliomyelitis excretion at least 1 year after onset of disease. None of the 348 affected individuals had IgG deficiency or persistent poliovirus excretion. One child had borderline low serum IgA concentration. Since we did not study children under 2 years of age, persons born with IgG deficiency disorders may have died in developing countries where replacement immunoglobulin therapy is not readily available. Nevertheless, persistent poliovirus excretion among persons 2 years of age and older with residual paralytic poliomyelitis is uncommon in developing countries. PMID: 16682222 [PubMed - indexed for MEDLINE] ----------------------------- Effectiveness of Haemophilus influenzae type b Conjugate vaccine introduction into routine childhood immunization in Kenya. By Cowgill KD, Ndiritu M, Nyiro J, Slack MP, Chiphatsi S, Ismail A, Kamau T, Mwangi I, English M, Newton CR, Feikin DR, Scott JA. Epidemic Intelligence Service, Epidemiology Program Office, Division of Applied Public Health Training, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga, USA. CONTEXT: Haemophilus influenzae type b (Hib) conjugate vaccine is not perceived as a public health priority in Africa because data on Hib disease burden and vaccine effectiveness are scarce. Hib immunization was introduced in Kenyan infants in 2001. OBJECTIVE: To define invasive Hib disease incidence and Hib vaccine program effectiveness in Kenya. DESIGN, SETTING, AND PATIENTS: Culture-based surveillance for invasive Hib disease at Kilifi District Hospital from 2000 through 2005 was linked to demographic surveillance of 38,000 children younger than 5 years in Kilifi District, Kenya. Human immunodeficiency virus (HIV) infection and Hib vaccination status were determined for children with Hib disease admitted 2002-2005. INTERVENTIONS: Introduction of conjugate Hib vaccine within the routine childhood immunization program at ages 6, 10, and 14 weeks beginning November 2001. MAIN OUTCOME MEASURES: Incidence of culture-proven Hib invasive disease before and after vaccine introduction and vaccine program effectiveness. RESULTS: Prior to vaccine introduction, the median age of children with Hib was 8 months; case fatality was 23%. Among children younger than 5 years, the annual incidence of invasive Hib disease 1 year before and 1 and 3 years after vaccine introduction was 66, 47, and 7.6 per 100,000, respectively. For children younger than 2 years, incidence was 119, 82, and 16 per 100,000, respectively. In 2004-2005, vaccine effectiveness was 88% (95% confidence interval, 73%-96%) among children younger than 5 years and 87% (95% confidence interval, 66%-96%) among children younger than 2 years. Of 53 children with Hib admitted during 2002-2005, 29 (55%) were age-ineligible to have received vaccine, 12 (23%) had not been vaccinated despite being eligible, and 12 (23%) had received 2 or more doses of vaccine (2 were HIV positive). CONCLUSIONS: In Kenya, introduction of Hib vaccine into the routine childhood immunization program reduced Hib disease incidence among children younger than 5 years to 12% of its baseline level. This impact was not observed until the third year after vaccine introduction. PMID: 16896110 [PubMed - indexed for MEDLINE] ______________________________________________________________________________ All members of the TechNet21 e-Forum are invited to send comments on any posting or to use the forum to raise a new discussion or request technical information in relation to immunization services. 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