Measles Aerosol Vaccine Project

AbstractAerosol delivery of measles vaccine to the respiratory mucosa, mimicking the natural route of transmission for measles virus, is the most promising non-injectable method of measles vaccination studied so far. A phase II/III study is underway in India to confirm that its efficacy is equivalent to that of existing routes of administration. Studies suggest aerosolized measles vaccine appears to be equally or more immunogenic than subcutaneous vaccine in children 9 months and older. Aerosol delivery devices are available or being developed, and could be used by lay people with limited training, and would avoid issues of injection safety. Measles vaccine is not licensed for respiratory administration. Administration of the current measles vaccine via the respiratory route is being comprehensively studied to achieve licensure for international use under the auspices of the WHO's Measles Aerosol Project. The most suitable aerosol administration device for use in low resource environments is being evaluated in such studies

COVID-19 vaccine trials should seek worthwhile efficacy.

No Abstrac

Role of parental practices in the promotion of physical activity in early childhood in the city of Cali

Objetivo: Caracterizar las prácticas parentales para promover hábitos de actividad física en sus hijos de uno a cinco años de edad. El estudio fue realizado durante el año 2014 en la ciudad de Cali, Colombia. Materiales y métodos: El estudio tuvo un diseño mixto con dos fases: una fase cualitativa con diseño fenomenológico (con 20 padres) y una fase cuantitativa con diseño transversal correlacional (con 91 padres de diferentes niveles socioeconómicos). Se utilizaron entrevistas en profundidad y el cuestionario "Prácticas de crianza para promover hábitos de salud en la primera infancia". Resultados: En las entrevistas, la mayoría de padres refieren prácticas de promoción de actividad física como la realización conjunta de actividades, la proposición de actividades que impliquen esfuerzo, la explicación de beneficios, el acompañamiento a espacios para realizar ejercicio, el modelamiento y la enseñanza de algún deporte. Los datos cuantitativos señalan que la mayoría de los padres refirió el uso de prácticas responsivas como el monitoreo, la explicación de beneficios y el acompañamiento. Se encontraron diferencias en función del nivel socioeconómico en prácticas como facilitar el acceso a espacios apropiados para realizar actividad física. Conclusiones: Los resultados del estudio señalan la importancia de involucrar a los padres en la promoción de la actividad física y muestran algunos aspectos a considerar en las intervenciones de este tipo.Objective: To characterize parental practices to promote physical activity habits in children from one to five years of age. The study was conducted in 2014 in the city of Cali, Colombia. Methods: The study had a mixed-method design in two phases: a qualitative phase with phenomenological design (with 20 parents) and a quantitative phase with correlational cross-sectional design (with 91 parents from different socioeconomic level). In-depth interviews and the "Raising practices to promote healthy habits in early childhood" questionnaire were used as assessment tools. Results: In the interviews, most parents reported physical activity promotion practices such as the joint performance of activities, the proposal of activities that imply effort, the explanation of benefits, the accompaniment to sport places, the modeling and teaching of any sport. Quantitative data showed that most of the parents use responsive practices such as monitoring, explanation of benefits and accompaniment. Differences were found depending on socioeconomic level in practices such as facilitating access to appropriate spaces for physical activity. Conclusions: The results of the study point out the importance of involving parents in the promotion of physical activity and show some aspects to be considered in this kind of interventions

Postexposure prophylaxis with rVSV-ZEBOV following exposure to a patient with Ebola virus disease relapse in the United Kingdom: an operational, safety, and immunogenicity report

Background: In October 2015, 65 people came into direct contact with a healthcare worker presenting with a late reactivation of Ebola virus disease (EVD) in the UK. Vaccination was offered to 45 individuals with an initial assessment of high exposure risk. Methods: Approval for rapid expanded access to the recombinant vesicular stomatitis virus–Zaire Ebola virus vaccine (rVSV-ZEBOV) as an unlicensed emergency medicine was obtained from the relevant authorities. An observational follow-up study was carried out for 1 year following vaccination. Results: 26/45 individuals elected to receive vaccination between October 10th and 11th 2015 following written informed consent. By day 14, 39% had seroconverted, rising to 87% by day 28 and 100% by 3 months, although these responses were not always sustained. Neutralising antibody responses were detectable in 36% by day 14 and 73% at 12 months. Common side effects included fatigue, myalgia, headache, arthralgia and fever. These were positively associated with glycoprotein (GP)-specific T-cell but not IgM or IgG antibody responses. No severe vaccine-related adverse events were reported. No-one exposed to the virus became infected. Conclusions: This paper reports the use of the rVSV-ZEBOV vaccine given as an emergency intervention to individuals exposed to a patient presenting with a late reactivation of EVD. The vaccine was relatively well tolerated but a high percentage developed a fever ≥37.5oC necessitating urgent screening for Ebola virus and a small number developed persistent arthralgia

An online decision tree for vaccine efficacy trial design during infectious disease epidemics: The InterVax-Tool.

BACKGROUND: Licensed vaccines are urgently needed for emerging infectious diseases, but the nature of these epidemics causes challenges for the design of phase III trials to evaluate vaccine efficacy. Designing and executing rigorous, fast, and ethical, vaccine efficacy trials is difficult, and the decisions and limitations in the design of these trials encompass epidemiological, logistical, regulatory, statistical, and ethical dimensions. RESULTS: Trial design decisions are complex and interrelated, but current guidance documents do not lend themselves to efficient decision-making. We created InterVax-Tool (http://vaxeval.com), an online, interactive decision-support tool, to help diverse stakeholders navigate the decisions in the design of phase III vaccine trials. InterVax-Tool offers high-level visual and interactive assistance through a set of four decision trees, guiding users through selection of the: (1) Primary Endpoint, (2) Target Population, (3) Randomization Scheme, and, (4) Comparator. We provide guidance on how key considerations - grouped as Epidemiological, Vaccine-related, Infrastructural, or Sociocultural - inform each decision in the trial design process. CONCLUSIONS: InterVax-Tool facilitates structured, transparent, and collaborative discussion of trial design, while recording the decision-making process. Users can save and share their decisions, which is useful both for comparing proposed trial designs, and for justifying particular design choices. Here, we describe the goals and features of InterVax-Tool as well as its application to the design of a Zika vaccine efficacy trial

Ring vaccination with rVSV-ZEBOV under expanded access in response to an outbreak of Ebola virus disease in Guinea, 2016: an operational and vaccine safety report.

BACKGROUND: In March, 2016, a flare-up of Ebola virus disease was reported in Guinea, and in response ring vaccination with the unlicensed rVSV-ZEBOV vaccine was introduced under expanded access, the first time that an Ebola vaccine has been used in an outbreak setting outside a clinical trial. Here we describe the safety of rVSV-ZEBOV candidate vaccine and operational feasibility of ring vaccination as a reactive strategy in a resource-limited rural setting. METHODS: Approval for expanded access and compassionate use was rapidly sought and obtained from relevant authorities. Vaccination teams and frozen vaccine were flown to the outbreak settings. Rings of contacts and contacts of contacts were defined and eligible individuals, who had given informed consent, were vaccinated and followed up for 21 days under good clinical practice conditions. FINDINGS: Between March 17 and April 21, 2016, 1510 individuals were vaccinated in four rings in Guinea, including 303 individuals aged between 6 years and 17 years and 307 front-line workers. It took 10 days to vaccinate the first participant following the confirmation of the first case of Ebola virus disease. No secondary cases of Ebola virus disease occurred among the vaccinees. Adverse events following vaccination were reported in 47 (17%) 6-17 year olds (all mild) and 412 (36%) adults (individuals older than 18 years; 98% were mild). Children reported fewer arthralgia events than adults (one [<1%] of 303 children vs 81 [7%] of 1207 adults). No severe vaccine-related adverse events were reported. INTERPRETATION: The results show that a ring vaccination strategy can be rapidly and safely implemented at scale in response to Ebola virus disease outbreaks in rural settings. FUNDING: WHO, Gavi, and the World Food Programme

Case based measles surveillance in Pune: Evidence to guide current and future measles control and elimination efforts in India

Background: According to WHO estimates, 35% of global measles deaths in 2011 occurred in India. In 2013, India committed to a goal of measles elimination by 2020. Laboratory supported case based measles surveillance is an essential component of measles elimination strategies. Results from a case-based measles surveillance system in Pune district (November 2009 through December 2011) are reported here with wider implications for measles elimination efforts in India.Methods: Standard protocols were followed for case identification, investigation and classification. Suspected measles cases were confirmed through serology (IgM) or epidemiological linkage or clinical presentation. Data regarding age, sex, vaccination status were collected and annualized incidence rates for measles and rubella cases calculated.Results: Of the 1011 suspected measles cases reported to the surveillance system, 76% were confirmed measles, 6% were confirmed rubella, and 17% were non-measles, non-rubella cases. Of the confirmed measles cases, 95% were less than 15 years of age. Annual measles incidence rate was more than 250 per million persons and nearly half were associated with outbreaks. Thirty-nine per cent of the confirmed measles cases were vaccinated with one dose of measles vaccine (MCV1).Conclusion: Surveillance demonstrated high measles incidence and frequent outbreaks in Pune where MCV1 coverage in infants was above 90%. Results indicate that even high coverage with a single dose of measles vaccine was insufficient to provide population protection and prevent measles outbreaks. An effective measles and rubella surveillance system provides essential information to plan, implement and evaluate measles immunization strategies and monitor progress towards measles elimination

Quantifying the value of viral genomics when inferring who infected whom in the 2014–16 Ebola virus outbreak in Guinea

Transmission trees can be established through detailed contact histories, statistical or phylogenetic inference, or a combination of methods. Each approach has its limitations, and the extent to which they succeed in revealing a 'true' transmission history remains unclear. In this study, we compared the transmission trees obtained through contact tracing investigations and various inference methods to identify the contribution and value of each approach. We studied eighty-six sequenced cases reported in Guinea between March and November 2015. Contact tracing investigations classified these cases into eight independent transmission chains. We inferred the transmission history from the genetic sequences of the cases (phylogenetic approach), their onset date (epidemiological approach), and a combination of both (combined approach). The inferred transmission trees were then compared to those from the contact tracing investigations. Inference methods using individual data sources (i.e. the phylogenetic analysis and the epidemiological approach) were insufficiently informative to accurately reconstruct the transmission trees and the direction of transmission. The combined approach was able to identify a reduced pool of infectors for each case and highlight likely connections among chains classified as independent by the contact tracing investigations. Overall, the transmissions identified by the contact tracing investigations agreed with the evolutionary history of the viral genomes, even though some cases appeared to be misclassified. Therefore, collecting genetic sequences during outbreak is key to supplement the information contained in contact tracing investigations. Although none of the methods we used could identify one unique infector per case, the combined approach highlighted the added value of mixing epidemiological and genetic information to reconstruct who infected whom

SARS-CoV-2 Variants and Vaccines.

Viral variants of concern may emerge with dangerous resistance to the immunity generated by the current vaccines to prevent coronavirus disease 2019 (Covid-19). Moreover, if some variants of concern have increased transmissibility or virulence, the importance of efficient public health measures and vaccination programs will increase. The global response must be both timely and science based