DECADES OF VACCINES Vaccine trials: some highs and lows INTERVENTION RESEARCH TO IMPROVE HEALTH IN DEVELOPING COUNTRIES: PROGRESS AND FUTURE CHALLENGES.

Slides:

Advertisements

Similar presentations

Vaccines related epidemiology Programme design and policy options First EpiTrain course in Advanced Epidemiology Jurmala Latvia Hanna Nohynek.

Advertisements

Rotavirus vaccines Contentious issues and the way forward.

A Proposal for a Collaboration with INDEPTH to Engage in Evaluations of Vaccine Safety Presented by Steven Black, MD on behalf of PREVENT (PRogram Enhancing.

DR SWATI PRASHANT MD Paediatrics Index Medical College,Indore,MP,India.

Burden of Rotavirus Disease & Impact of Rotavirus Vaccination Umesh D. Parashar, MBBS, MPH Lead, Viral Gastroenteritis Epidemiology Team Centers for Disease.

End TB strategy target setting

The Global Burden of Hepatitis C Dr Daniel Lavanchy World Health Organization (WHO) Geneva, Switzerland 3 rd Paris Hepatitis Conference.

Part 1 DESCRIPTIVE EPIDEMIOLOGY 1. Objectives Describe the components of descriptive epidemiology Describe the uses and importance of descriptive epidemiology.

NHS boards’ health protection role Aim: ‘through co-operation with its partners, to protect the local population from hazards which endanger their health.

Hepatitis B and Hepatitis B Vaccine Epidemiology and Prevention of Vaccine- Preventable Diseases National Center for Immunization and Respiratory Diseases.

Prevention Bacille Calmette Guerin (BCG) Vaccine Live attenuated strain of Mycobacterium bovis; 1921 Efficacy Clinical trials UK: protective effect of.

Prevention and control of Hepatitis B In Central and Eastern Europe and Newly Independent States WHO/EURO.

Pneumonia Sapna Bamrah, MD CDC

Pneumococcal Disease and Pneumococcal Vaccines Epidemiology and Prevention of Vaccine- Preventable Diseases National Immunization Program Centers for Disease.

Introduction of New vaccines Hib as an Example St. Petersburg Jun 2001.

Dr R.Reesaul Chest Physician Chest Clinic P. D`or Hospital

ACCP Evidence base: Implications for policy and practice R. Sankaranarayanan MD Head, Screening Group World Health Organization (WHO) International Agency.

Hepatitis B: Epidemiology

Designing Strategies for Neglected Disease Research: What Innovations Do We Need? Julia Walsh MD MSc UCB School of Public Health

Epidemiology and Control Programs for HBV Infection. Yousef Qari, MD, FRCP(C), ABIM Gastoenterologist King Abdulaziz University Hospital.

The Work of WHO in the South-East Asia Region The Work of WHO in the South-East Asia Region Biennial Report of the Regional Director 1 January

Tuberculosis in Children and Young Adults

Harvard University Initiative for Global Health Global Health Challenges Social Analysis 76: Lecture 20.

Impact evaluation Evaluate new tools Translate new knowledge into policy and implementation Knowledge gap Program implementation.

Ayaga Bawah, PhD Principal Research Associate INDEPTH Network Accra, Ghana Using Demographic Surveillance Systems to Monitor Progress in MDGs 4 and 5 Presented.

Departmental Perspectives on Viral Hepatitis

Global Immunization Performance Update through 2011.

Prevention of pneumococcal disease – What are the prospects? Allison McGeer, MSc, MD, FRCPC Mount Sinai Hospital University of Toronto Allison McGeer,

Did you know?. About 9.5 million people die each year due to global infectious diseases. Most of them are in third world countries.

GSK South Africa. “Our global quest is to improve the quality of human life by enabling people to do more, feel better and live longer” GlaxoSmithKline.

Potential Cost-Effectiveness of a Tuberculosis Vaccine: Implications for Clinical Trials Jared Ditkowsky Kevin Schwartzman MD, MPH Montreal Chest Institute,

Overview National Hepatitis B Data

WORLD HEPATITIS DAY 2013 Johannesburg, Gauteng 29 th July, 2013 WORLD HEPATITIS DAY 2013 Johannesburg, Gauteng 29 th July, 2013 HEPATITIS B: Post-Vaccination.

Isoniazid preventive therapy for people living with HIV: Public health challenges and implementation issues Peter Godfrey-Faussett UNAIDS (with thanks.

Prophylatic vaccine replacing conventional BCG Delphine Noël Vanessa Infante Surendra Karki.

1 Neonatal vitamin A supplementation interacts with routine immunizations in infancy - with consequences for mortality Christine Stabell Benn, MD, PhD.

30th anniversary of starting EPI

Infectious Diseases Prof Keith Neal. Mortality One in eight of all deaths Mainly respiratory Pneumonia, influenza Cancers Stomach, head and neck, cervix,

Polio Eradication  Although the number of endemic countries is at an all-time low in 2002, the actual number of cases was approximately four times higher.

Global Health Assessment Strategies Ricardo Izurieta.

1 Journal Club Alcohol, Other Drugs, and Health: Current Evidence March–April 2012.

Tuberculosis The evolution of a bacterium. 2 World Health Organization (WH.O. declared TB a global health emergency in cases per 100,

VACCINATION ACTIVE IMMUNIZATION Jana Dáňová Third Faculty of Medicine Dept. of Epidemiology.

The changing vaccination landscape and the sources of vaccination data

Immunizations – Everyone Every Age Joan Bowe, RN, BSN Director, Personal Health Division Chair, AICCO.

Efficacy of immunization among HIV infected adults: An Observation R Bansal, N Gupta Crosslay AIDS & Wellness Centre Pushpanjali Crosslay Hospital Vaishali.

New Vaccines in Developing Countries: Evidence, Practice, Policy, and Challenges Global Vaccines 202X: Access, Equity, Ethics Philadelphia, USA 2 May 2011.

Expanded program of Immunization (EPI) Introduction The Expanded Program on Immunization (EPI) was established in 1974 depending on the success of the.

N Engl J Med 2010; 362: January 28, 2010 Presenters ; Dr Ngwenya/Dr Nchimba.

CHILD MORTALITY IN AFRICA.  In the year 2006, for the first time since mortality data have been gathered, annual dates among children under the age of.

The Medical Research Council Presentation to the Portfolio Committee on Science and Technology March 16, 2005

1 EPI services for migrant populations in Tak province.

Tuberculosis in Children and Young Adults

Update on Effectiveness and Safety of Rotavirus Vaccines Umesh D. Parashar Lead, Viral Gastroenteritis Team Centers for Disease Control Prevention Atlanta,

Position on HPV vaccinesAvailable from In July 2013, The Global Advisory Committee on Vaccine Safety (GACVS) of the WHO reconfirmed that there had been.

Pneumococcal Vaccine Use Around the World: Successes and Challenges Adam L. Cohen, MD MPH Respiratory Diseases Branch, Division of Bacterial Diseases Centers.

Active immunity and vaccination What is immunisation? The process by which a person develops immunity to a disease causing organism. i.e. the blood contains.

Post-discharge chemoprevention of malaria in transfused children; a randomized trial in Uganda & Kenya R Idro, R Opoka, A Dhabangi, F TerKuile, and K Phiri.

Prevention of Perinatal and Childhood Hepatitis B Virus Infections Background on Where We’ve Been Lisa Jacques-Carroll, MSW Immunization Services Division,

Universal Vaccination Program Mexico: Lessons Learned from National Registry System November 2014.

SAFETY AND EFFICACY OF MVA85A, A NEW TUBERCULOSIS VACCINE, IN INFANTS PREVIOUSLY VACCINATED WITH BCG: A RANDOMISED, PLACEBO-CONTROLLED PHASE 2B TRIAL Michele.

Impact of Rotavirus Vaccination in Latin America

Haemophilus influenzae type b Using vaccines to measure disease burden: A Tale of Two Studies Presentation to PABIO 550 Diseases of Public Health Importance.

The Medical Research Council

Progress and Challenges with achieving Universal Immunization Coverage

The State of Pneumococcal Disease Prevention

Epidemiological Modeling to Guide Efficacy Study Design Evaluating Vaccines to Prevent Emerging Diseases An Vandebosch, PhD Joint Statistical meetings,

Tuberculosis Global Epidemiology

Immunization Throughout the Life Course: What Is the Clinician's Role?

Presentation transcript:

DECADES OF VACCINES Vaccine trials: some highs and lows INTERVENTION RESEARCH TO IMPROVE HEALTH IN DEVELOPING COUNTRIES: PROGRESS AND FUTURE CHALLENGES Celebrating 40 years of the MRC Tropical Epidemiology Group March 2012 Peter Smith

DTP3 COVERAGE GAVI 2011

MRC TEG: INVOLVEMENT IN VACCINE TRIALS DENGUE HAEMOPHILUS INFLUENZA HEPATITIS B HIV HPV HOOKWORK HSV2 LEISHMANIASIS LEPROSY MALARIA PNEUMOCOCCAL DISEASE ROTAVIRUS SCHISTOSOMIASIS (BOVINE) TUBERCULOSIS

MRC TEG: INVOLVEMENT IN VACCINE TRIALS DENGUE HAEMOPHILUS INFLUENZA  HEPATITIS B HIV HPV HOOKWORK HSV2  LEISHMANIASIS  LEPROSY MALARIA  PNEUMOCOCCAL DISEASE ROTAVIRUS SCHISTOSOMIASIS (BOVINE) TUBERCULOSIS

LEPROSY VACCINE TRIALS Vaccine trials Venezuela Malawi South India Nine-banded armadillo

STUDY YEAR Latitude 0 Relative risk 1 RR (95% CI) STUDIES OF THE PROTECTIVE EFFECT OF BCG VACCINATION AGAINST LEPROSY Merle, Cunha & Rodrigues, 2010

TRIAL OF LEPROSY VACCINE IN VENEZUELA Conducted in 29,000 close contacts of leprosy cases in 3 States of Venezuela Individually randomised to BCG or BCG+M.leprae (double-blind) Followed for 5 years post-vaccination, with yearly examination for disease 150,000 person-years-at-risk – 59 post vaccination cases by July 1991 BCG aloneBCG + M. leprae Cases of leprosy 3128 Cases with onset >1 y post vaccination and M. leprae soluble antigen skin test negative 119 Convit et al 1992

RISK OF LEPROSY ACCORDING TO NUMBER OF BCG SCARS AT ENTRY TO THE TRIAL No. of BCG scarsNo. of contactsCases of leprosyCases/1000Relative risk Convit et al 1992

TRIAL OF LEPROSY VACCINE IN MALAWI Conducted in 121,000 residents of Karonga District, Malawi Individually randomised to BCG or BCG+M.leprae or Placebo (depending on BCG status) Followed for 5 -9 years post-vaccination, with enhanced passive case detection of cases of leprosy and tuberculosis BCG Scar +veBCG Scar -veBCG Scar –ve and +ve Randomised group No. of persons BCG 23,456 Placebo 23,307 RRBCG+ KML 38,251 BCG 27,904 RRBCG+ KML (Hi dose) 30,262 BCG 31,971 RR Cases of leprosy * Karonga Prevention Trial Group 1996

TRIAL OF LEPROSY VACCINE IN MALAWI Conducted in 121,000 residents of Karonga District, Malawi Individually randomised to BCG or BCG+M.leprae or Placebo (depending on BCG status) Followed for 5 -9 years post-vaccination, with enhanced passive case detection of cases of leprosy and tuberculosis BCG Scar +veBCG Scar -veBCG Scar –ve and +ve Randomised group No. of persons BCG 23,456 Placebo 23,307 RRBCG+ KML 38,251 BCG 27,904 RRBCG+ KML (Hi dose) 30,262 BCG 31,971 RR Cases of leprosy * Cases of TB Karonga Prevention Trial Group 1996

TRIAL OF LEPROSY VACCINES IN SOUTH INDIA Conducted in 171,000 residents of Chingleput District, Tamilnadu Individually randomised to BCG or BCG+KML or ICRC or Myco.W or Placebo (5-arm trial) Initially followed for 5-6 years post-vaccination with two surveys for leprosy cases Incidence of leprosy in trial much lower than expected Protective efficacy in 2 nd resurvey – 5-6 years post vaccination Gupte et al 1998

Trial of single dose of autoclave-killed Leishmania major + BCG against cutaneous leishmaniasis in Bam, Iran 3600 school children (6- 15y), LST-ve, randomised to BCG or BCG+ALM Followed for lesions 2y post-vaccination BCGBCG+ALM Cases of leishmaniasis 6353

Efficacy of killed whole parasite vaccines against leishmaniasis Noazin et al, 2009 Iran

GLOBAL BURDEN OF PNEUMOCOCCAL DISEASE

Cutts et al, 2005 Endpoint Vaccine (n=8189)Placebo (n=8151) Vaccine efficacy (95%CI) NumberRate/1000 yearsNumberRate/1000 years Radiographic pneumonia (25 – 48) Deaths (3 – 28) Hospital admissions (7 – 21) Clinical pneumonia (1 – 12)

Vaccination team 123 Time since start of programme (years) Usual EPI vaccines given plus HBV Usual EPI vaccines given 45 Introduction of Hepatitis B vaccine in The Gambia (Stepped-wedge design)

Introduction of Hepatitis B vaccine in The Gambia (Stepped-wedge design) : 60,000 infants received EPI vaccines, 60,000 received EPI vaccines + HBV vaccine Long term aim (40 years+) is to compare incidence of liver cancer and liver diseases in the two groups Sample of study population examined at age 15 years to assess long-term protective effect of vaccination against HB carrier state.

Protective effect of infant HBV vaccination against HBV chronic carriage at age 15 years UnvaccinatedFully vaccinatedPartially vaccinated Chronic carriers/ No. examined 51/4202/4921/84 Vaccine efficacy (95%CI) 96.6% ( )90.1% (69.9 – 99.9) Van de Sande et al, 2007

Thank you