Public Health

On Wednesday, January 11, 2012, Peter J. Hotez, MD, PhD, gave the Maurice Hilleman Pediatric Grand Rounds lecture at The Children’s Hospital of Philadelphia/University of Pennsylvania. Hotez is an internationally recognized expert on tropical diseases and vaccine development and holds the following positions: Professor of Pediatrics and Molecular Virology & Microbiology and Chief of the Section of Pediatric Tropical Medicine at Baylor College of Medicine; Endowed Chair of Tropical Pediatrics at Texas Children’s Hospital; and President, Sabin Vaccine Institute. More

A Novartis Vaccines and Diagnostics, Inc., manufacturing facility in North Carolina has geared up to produce pandemic influenza vaccine made from mammalian cell lines, rather than from the traditional hen egg-based methods that have been used for more than 50 years. The plant, open since November 2009, was dedicated in a December 12 ceremony after Novartis submitted a Biological License Application for the vaccine to the U.S. Food and Drug Administration. The cell-based system and production methods are similar to those that have been licensed and used for seasonal influenza vaccine in Europe since 2007. More

Nearly a year ago, the History of Vaccines blog covered the introduction of MenAfriVac (PsA-TT) to the African meningitis belt, an area stretching from Senegal to Ethiopia, where epidemic waves of meningitis occur and can last up to three years. In the largest of these epidemic waves in history, meningitis killed more than 25,000 people from 1996 to 1997. MenAfriVac, a vaccine against the Group A type of meningococci bacteria that causes 80 to 85% of meningitis cases in the African epidemics, was the result of a collaboration between the World Health Organization (WHO) and PATH. The first vaccine developed specifically for use in Africa, it was introduced last year in Burkina Faso, Mali, and Niger, with almost 20 million people aged 1 to 29 (the age range most at risk) being vaccinated.

In June, the History of Vaccines blog reported that all three countries were reporting record lows in confirmed Group A meningitis cases during an epidemic season. Now the vaccine is being introduced to three more African countries: Cameroon, Chad, and Nigeria. More

The human papillomavirus (HPV) vaccine has been recommended as part of the routine vaccination schedule for girls aged 11-12 since 2006 for the prevention of cervical cancer. In 2009, the FDA licensed the vaccine for use in males aged 9-26 years for the prevention of genital warts caused by two types of HPV, but the vaccine was not yet recommended for boys as part of the routine immunization schedule.

Meeting today at the Centers for Disease Control and Prevention in Atlanta, the Advisory Committee on Immunization Practices voted to recommend routine immunization against HPV for boys at age 11-12. ACIP members, experts selected by the Secretary of the United States Department of Health and Human Services, develop the recommendations that are used in the U.S. Recommended Childhood, Adolescent and Adult Immunization Schedules. More

On October 12, the Philadelphia Neurological Society held one of its regular meetings at The College of Physicians of Philadelphia and invited Paul A. Offit, MD, to speak to the membership. Offit, chief of infectious diseases at The Children’s Hospital of Philadelphia (CHOP), vaccine developer, and advisor to The History of Vaccines, greeted the membership with his first slide and title of his talk: “Why are neurologists scared of vaccines?”  Though Offit’s title was tongue-in-cheek, it spoke to a tension he has perceived between neurology and vaccinology. More

In honor of World Rabies Day, we’d like to draw attention to two rabies vaccines recently found in the collection of the Mütter Museum of The College of Physicians of Philadelphia. Museum curator Anna Dhody recently alerted us to a box of vaccines and other medical supplies she found in a little-visited storage area in the museum basement. The box belonged to a collection of medical equipment donated by James G. Kitchen II, MD (d. 1998), who was a Pocono Lake, Pennsylvania, physician and fellow of The College of Physicians of Philadelphia. Dr. Kitchen stocked the vaccine in his office supplies to address what was probably a fairly uncommon need in his practice: post-exposure rabies prophylaxis in humans. More

Going to the movies is a time-honored way of getting away from the vagaries of work and home life and inhabiting a different and exotic place. I don’t know if car mechanics can really enjoy chase movies or cowboys can appreciate Westerns, but as a specialist in Infectious Diseases, I rarely get a chance to see someone plying my trade inside the multiplex. There are spoilers ahead, so read on cautiously if you have not yet seen Contagion and plan to go.

The new Steven Soderbergh movie, Contagion, is a fairly realistic guesstimate of what might happen if a highly contagious, new infectious agent started moving around the world and destroying people willy nilly like a marauding tornado. While there has never been an infection quite like “MEV-1” as depicted in Contagion, the question of how we would respond as a medical community and as a society is a worthy one to address. Whether the answer is right or wrong – well, let’s hope we never find out.

From an Infectious Diseases angle, the infection in Contagion is crafted to be highly transmissible and fatal. This would be like a hybrid of the 1918-1919 pandemic flu, Nipah virus and SARS. The end of the movie shows the mechanism via which MEV-1 began to infect humans, and it is highly reminiscent of Nipah and SARS. Thus has some built-in credibility as it builds on diseases that we already understand. It is also eerily reminiscent of the most recent big flu outbreak (A/California/2009 H1N1) where the virus contained elements that came from birds, pigs and people. The rapidity of spread lends the movie much of its terror, but is not far off the rapidity of spread of influenza. Similarly, the incubation period and time to death is also reminiscent of the 1918-1919 pandemic flu. So the film-makers have done their homework and created a plausible disaster scenario. More

The so-called Spanish influenza pandemic of 1918 was one of the worst natural disasters in history. Estimates of total death counts vary, but it is commonly stated that the virus infected about one-third of the world’s population and killed about 50 million – possibly as many as 100 million. Researchers have long been interested in learning more about the virus and what made it so deadly, and genetic analysis has been a large part of that effort. In 2005 the full genome sequence of the virus was published, and research has continued from that point.

The virus behind the 1918 pandemic was an H1N1 strain; in fact, it was the only H1N1 strain to cause a pandemic in the 20th century. (Pandemics that began in China in 1956 and Hong Kong in 1968 were caused by H2N2 and H3N2 strains, respectively.) It was unusually severe, and in an unexpected result for an influenza virus, tended to kill healthy young adults rather than the typical flu victims – the very old and the very young. This contributed to the initial fear when novel H1N1 appeared in 2009, particularly since the number of deaths per age group early in the outbreak skewed heavily toward young adults. More

Two important vaccine meetings were held September 11 and 12 at The College of Physicians of Philadelphia. The September 12 meeting entitled Research Integrity Challenges in Vaccine Development and Distribution for Public Health Emergencies was sponsored by the Department of Health and Human Services, the Office of Research Integrity, Drexel University, University of Pennsylvania Center for Bioethics, and The College of Physicians of Philadelphia. Speakers focused on vaccine development and distribution for biological threats and how the emergency preparedness experiences with A/H1N1 provided lessons that might inform future preparation for similar public health emergencies. More

Human papillomavirus (HPV) is primarily known for its role in causing cervical cancer. Two strains of the virus – strains 16 and 18 – are estimated to be responsible for 70% of cervical cancer cases, leading to about 500,000 new cases and 270,000 deaths worldwide each year.

Both of the HPV vaccines available in the United States have been shown to be effective in preventing cervical infection with strains 16 and 18. The Gardasil quadrivalent vaccine also offers protection against two strains that cause genital warts. But HPV’s role in cancer is not limited to cervical cancer; the virus can also cause oral, anal, and penile cancer. More