There is considerable research worldwide in attempts to develop an HIV vaccine to
prevent AIDS (Lancet
336 (1990), 1545-6). There has been some encouraging results from immunisation of
rhesus macaque monkeys (Lancet
336: 1538-40). M.Girard et al. (1991) "Immunization of chimpanzees confers protection
against challenge with human immunodeficiency virus", PNAS
88: 542-6; describe the results of trials involving the use of different proteins
from the HIV virus as potential vaccines. Their results are encouraging and suggest
that a vaccine should be possible. Montagnier, a codiscoverer of HIV's involvement
in AIDS is also calling for attention on possible cooperative affects of mycoplasmas in
the acceleration of AIDS: Science
251 (1991), 271.
Scientific discussion of the difficulties of developing a malaria vaccine because of the genetic heterogeneity continues (Nature 349 (1991), 199-200). The summary of a recent Symposium on Genetic Variation of Malaria Parasites is in Nature 349 (1991), 193. The genetic complexicity of Plasmodium falciparum which causes malaria is because of several reasons; allelic variation of many genes, mutation, variable expression of genes, and occasional absence of genes after deletion. Mutation allows resistance to the drugs used, and this arises very rapidly. For general discussions on the prevention of malaria see JAMA 265 (1991), 317, 361, 383, 398-9.
A genetically engineered vaccine against the parasitic disease Schistosomiasis is being tested on a few volunteers (scientists who made it): Science 251 (1991), 630-1. This disease infects 200 million people worldwide, and there is no alternative vaccine, and drug treatment is not very effective.
The dangers in the possible recombination of vaccines, and the development of such vaccines is discussed in Nature 349 (1991), 369, in response to a paper in Science 251 (1991), 195-8, discussing experiments using the lymphocytic choriomeningtis virus in mice.
The high and growing incidence of Hepatitis B in Italy has led to a parliamentary bill to introduce compulsory vaccination against hepatitis B virus, in addition to polio, ditheria, pertussis and tetanus: Lancet 337 (1991), 228.
The final labstocks of smallpox should be destroyed by the end of 1993, after US and Soviet researchers have completed determing the DNA sequence (Nature 348 (1990), 666). This will reduce the danger of it being used in any biological weapons in the future. A comment on the potential for biowarfare is in Biotechnology 9 (1991), 121.
The PCR has been used for many applications. There should be increasing use of it for disease diagnosis, and one such test is described by P.Shankar et al. (1991) "Rapid diagnosis of tuberculous meningitis by polymerase chain reaction", Lancet 337: 5-7. The PCR was more sensitive than the other methods used, and initial positives were retested to check for the presence of false positives. A recent book on general genetic detection methods for bacteria is A.J.L. Macario & E.C. de Macario, eds., Gene Probes for Bacteria (San Diego: Academic Press 1990), for a review see Cell 63 (1990), 1125-7. A recent review on the use of new diagnostic techniques such as the PCR is P.M.Lizardi & F.R.Kramer (1991) "Exponential amplification of nucleic acids: new diagnostics using DNA polymerases and RNA replicases", TIBTECH 9: 53-8. It discusses PCR and Q-beta amplification, and future prospects.
A review on the use and development of rabies vaccines is M.Ferguson (1991) "Progress towards rabies control", TIBTECH 9: 7-11.
A description of a malaria vaccine developed in Columbia that is undergoing continuing human trials in that country is in NS (16 March 1991), 14-5, 18; BMJ 302 (1991), 432-3. The vaccine contains four peptide regions and trials so far have protected about 85% of the people given the vaccine, but these results are controversial and the trials are planned to be repeated under more controlled conditions. There was a trial planned with UK collaborators but it has been stopped so new backers will be sort; NS (23 Feb 1991), 6. On a different tact researchers claim to have discovered genes that protect humans against malaria NS (23 Feb 1991), 18.
The succesful uses of vaccines in Africa are described by B.D.Schoub et al. (1991) "Integration of hepatitis B vaccination into rural African primary health care programmes", BMJ 302: 313-6; and by H.C.Whittle et al. (1991) "Vaccination against hepatitis B and protection against chronic viral carriage in The Gambia", Lancet 337: 747-50. The authors urge that Hepatitis vaccine be included in the WHO multivalent vaccine programme. Hepatitis B vaccine may be introduced to the US pediatric immunisation schedule; JAMA 265: 1502; at an estimated cost of about US$22 for three-shots.
A call for the erradication of polio is in Science 251 (1991), 1020. Of general interest is a leader by P.T.Rudd (1991) "Childhood immunisation in the new decade", BMJ 302: 481-2, which calls for earlier immunisation schedules. A letter on the timing of measles vaccinations is in JAMA 265: 1527.
On the general subject of recombinant vaccines see Lancet 337: 824-5; Science 251: 195-8; EEIN 1: 18. A letter which points out that the safety of new vaccines should not be always judged adeqaute if they are similar to existing vaccines, is in Lancet 337: 913. Rather, we should be designing better vaccines. See also Lancet 337: 1034-6 for comment on the safety of vaccinia viruses. A recombinant vaccine developed for use against ticks in cattle is reported in NS (1 June 1991), 18.
On the use of BCG as a vaccine vector see two papers; C.K.Stover et al. "New use of BCG for recombinant vaccines", Nature 351: 457-60; A.Aldovini & R.A.Young, "Humoral and cell-mediated immune responses to live recombinant BCG-HIV vaccines", Nature 351: 479-82; also see p. 442-3.
The problem of Racoons spreading rabies to surburban New York is in BMJ 302: 1172.
A mouse vaccine has been developed which gives laboratory mice total protection against malaria; S.Khusmith et al., "Protection against malaria by vaccination with Sporozite protein 2 plus CS protein", Science 252: 715-8; Washington Post (3 May 1991), A3; NS (8 June 1991), 22. A dual action vaccine has been developed, targeting two proteins which may give a synergistic effect. However, it may still be several years before a human analogue is developed. An historical (the last decade) review on this subject is M.F.Good, "Toward the development of the ideal malaria vaccine", MJA 154: 284-8. Another review is S.L.Hoffman et al., "Progress toward malaria preerythrocytic vaccines", Science 252: 520-715, see also 715-8. A paper on the probable avian origins of the parasite Plasmodium falciparum is in PNAS 88: 3140-44.
The Gulf War increased the interest in developing vaccines and immunisations against nerve gases, and similar agents; SA (April 1991), 84-5. The work will involve attempts at engineering the enzyme acetylcholinesterase, or the development of scavenger antibodies to neutralise the nerve gases before they bind, or even when they have bound, to the enzyme. There is also work on detection methods using bioreactors, and on developing generally applicable techniques.
An extensive review on the Hepatitis B Virus, and methods being used to erradicate it are in SA (April 1991), 48-54. Hepatitis B virus is the second most important known carcinogen, after tobacco. Also on hepatitis B vaccination see JAMA 265: 2679-83 and Lancet 337: 1180-3.
Recommendations on the strategy to use for measles immunisation are in JAMA 265: 2111-2, 2095-6. The success of immunisation may be lower in children that are immunised while they suffer from a viral disease, but they should still be vaccinated then, and may benefit from a second vaccination at a later stage.
A recent attempt at poliomyelitis vaccination in Bulgaria is being hindered by public fears, especially among gypsies and Turks, that the vaccination is in fact a Nazi-style sterilisation campaign; Lancet 337: 1152. On the hopes for the incresed vaccination of Africans, from 50% currently to 90% by the year 2000, see BMJ 302: 1297.
Although not a vaccine, there is a plant extractable drug described that may be able to control the disease Schistosomiasis; JAMA 265: 2650-1. The extract endod, from the soapweed plant, kills the snails that are the vector in this disease. For a comment on the structure of cholera toxin, and the future design of vaccines see Nature 351: 351, 371-7.
For a general review on the use of vaccinia virus see B.Moss, "Vaccinia virus: a tool for research and vaccine development", Science 252: 1662-7. On the dangers of recombinant vaccines see Science 253: 210. On the use of antisense RNA to prevent the growth of retroviruses see SA (July 1991), 14.
WHO is expected to revise the international ethical research conduct guidelines; JAMA 266: 187. This would include the revision of protocols and approval by two ethical committees, one in the host country, and one in the sponsoring country. The problems of randomised clinical trials are discussed in NEJM 324: 1585-92.
Letters on recombinant vaccines appear in Lancet 337: 1542. The attempts for the development of malaria vaccines continues; D.C.Kaslow et al., "Induction of Plasmodium falciparum transmission-blocking antibodies by recombinant vaccinia virus", Science 252: 1310-3. See also SA (July 1991), 10-11. the US FDA is relaxing its bureaucratic standards for the sale of polio vaccines, to allow the US sale of WHO approved vaccines that have not passed US tests; Nature 351: 510.
Papers on immunisation programs include; W.H. Foege, "Preventive medicine and public health", JAMA 265: 3162-3; BMJ 302;1489-91. It is expected that poliomyelitis will soon be eradicated from the world, to follow the case of smallpox (last case in 1978). The third disease to be eradicated from the world is expected to be guinea worm disease, in 1996.
The 3-d structure of cholera toxin has been determined, see Science 253: 382-3. Other bacterial toxin shapes have also been recently determined, these should aid vaccine development. On a genetic engineered cholera vaccine that is in human trials in Chile see NS (24 Aug 1991), 10. On the transfer of prion, a viral protein that is thought to be responsible for scrapie, and is transmitted without any nucleic acid, see Nature 352: 679-83. A report on malaria is Science 253: 1562.
On immunization in the USA see JAMA 266: 1338-9 (hepatitis B); 1321-2 (low immunization rate in the USA). On the use of influenca vaccines in the Netherlands see BMJ 303: 508; and in Canada see CMAJ 145: 375, 465-72, 481-2l; also MJA 154: 692-5. On Haemophilus influenzae vaccine; JAMA 266: 1960-5. On the safety of measles vaccine; Lancet 338: 920.
An alternative method for protection from disease is intracellular immunisation with overexpression of viral proteins, see G. Natsoulis & J.D. Boeke, "New antiviral strategy using capsid-nuclease proteins", Nature 352: 632-5.
A live recombinant cholera vaccine is to be tested in Latin America, where there is
a major current epidemic. The vaccine has passed trials in Indonesia, and in some
North Americans and Swiss, and is a single dose oral vaccine; GEN
(Nov/Dec 1991), 1, 50. There is little environmental concern, despite the passing of
some vaccine in faeces. The WHO, US AID and the Swiss Serum Vaccine Institute are
expected to support the trials, and the ethical issues of clinical trials in an area
currently exposed to an epidemic, are being debated.
The liability of the government for polio vaccine injuries in the USA is discussed in Science 254: 1290. On protecting physicians from such liability see JAMA 266: 2951. Vaccine safety must be weighed against efficacy in mass immunisation trials; Lancet 338: 1309-12. Also on immunisation see JAMA 266: 2678-9.
A hepatitis A vaccine has been developed, and has been shown to be effective in humans; Science 254: 1581-2. A review on the production of recombinant whooping cough vaccines is TIBTECH 9: 232-8. A new method for rapid selection of virus antigens that may confer protection in a vaccine may speed up the production of vaccines; Nature 353: 792, 852-5. On poliovirus antigen chimeras see TIBTECH 9: 415-21.
There are continuing efforts to develop a vaccine and to control malaria; Science 254: 190; and a review in TIBTECH 9: 389-93. On human rabies in USA see JAMA 266: 2956-8. On pheumococcal vaccine see NEJM 325: 1506-7.
Environmental regulation of bacterial virulence has implications for attempts to make vaccines, see a review in TIBTECH 9: 309-15. The crucial viral determinants are only expressed under certain environmental circumstances. On viral proteases see Nature 354: 22-3.
Viruses' have many roles in human cancer, see a review in Science 254: 1167-73. Viruses may be the second most important environmental risk for cancer, after smoking. On cancer incidence and on the numerous possible risk factors being researched in Europe; Science 254: 1114-5. An example of these risks and the difficulty of establishing clear links is seen in the question whether gastric carcinoma is an environmental infection, because infection with Helicobacter pylori greatly increases our risk, see NEJM 325: 1132-6, 1127-31, 1170-1. The editors conclude that the infection is not a direct cause of this cancer.
On malaria vaccines and the production of antibodies in human volunteers see; L.F.
Fries et al., "Liposomal malaria vaccine in humans: A safe and potent adjuvant strategy",
89: 358-62. The mechanism of the drug chloroquine is described in Nature
355: 108-9, 167-9
The suggestion that unstable B chromosomes of fungi may be used to generate pathogenic variation is made following the finding that a fungal gene for antibiotic resistance is on a dispensable "B" chromosome: Science 254 (1991), 1773-6. On a drug resistant strain of tuberculosis bacteria, and the possible rise of TB in countries from which it had been thought to be eliminated is in Science 255: 148-150. Of general interest is a finding that antibodies appear to be able to destroy viruses inside cells; SA (Jan 1991), 15.
There are several comments and discussion on the role of the WHO in world health; JAMA 267: 15-23, 24. It includes the discussion of immunisation strategies which are still a basic need. An article on one of the health goals is P.F. Wright et al., "Strategies for the global eradication of poliomyelitis by the year 2000", NEJM 325 (1991), 1774-9. The goal is achievable even with current vaccines, it requires investment but is not only a just goal of medicine but is also economically feasible even with the limited international aid that is given now.
A summary of a recent report of the US Institute of Medicine is "Adverse events following pertussis and rubella vaccines", JAMA 267: 392-6. See also; Lancet 339: 239.
Discussion of research on
vaccines is included in the section on AIDS. The French researcher Zagury has been
cleared of the medical complaints made against his AIDS vaccine trials in the USA
as in France; Science
255: 680; EEIN
Trials of a putative leprosy vaccine using Mycobacterium leprae /BCG in India continue (among 50,000 people), though data from Venezuelan trials question whether it is effective; Lancet 339: 446-50; Nature 356; 373. The mildly successful results of a leprosy vaccine trial involving only BCG (50% protection) are in J.M. Ponnighaus et al., "Efficacy of BCG vaccine against leprosy and tuberculosis in northern Malawi", Lancet 339: 636-9. Malaria vaccine trials are debated in; BMJ 304: 451; Science 255: 1063-4; NS (22 Feb 1991), 3, 6.
Vaccination is one technology that has already a history of use, and has been well established. Genetically engineered vaccines may aid the array of vaccines, though they may not always be as cost effective as older vaccines. Another way costs of new vaccines can be greater is if they are injectable, versus older oral vaccines, as in the case of a Polio vaccine case debated in India; Nature 356: 94.
Some papers on immunisation schedules and the extent of vaccine coverage are; in the UK, BMJ 304: 682-4; to include Haemophilus influencae type B conjugate vaccines in current immunisation schemes, Lancet 339: 802-3; Lancet 339: 507-10; JAMA 267: 628-9. Adding additional vaccines to immunisation schemes may interfere with immunisation from existing vaccines; JAMA 267: 673-8. On the WHO vaccine project, Children's Vaccine Initiative, and ways to encourage industry to invest in vaccine production, see Science 255: 1201.
On AIDS vaccines also see the section on AIDS. A review of paths to an AIDS vaccine
is in TIBS
17: 191-6. The question of whether liability concerns are delaying the development
of an AIDS vaccine see Science
256: 168-70. It is suggested that the government step in to limit liability on approved
products, to encourage faster research progress. Another attempt to encourage companies
to research vaccines is by US-AID which says that vaccines make good public relations; Science
256: 431. The politics of a vaccination program in the Camaroon is discussed in
339: 1222. The WHO is now going to diversify its approaches to malaria prevention,
rather than focusing mainy on vaccine development. If the research money had been
spend in a diversified manner, such as money on vector control through civil engineering, and netting, there would be less malaria in the world today.
A clinical trial of inactivated hepatitis A vaccine is in BMJ 304: 1272-6, and such vaccines may be approved in the USA; JAMA 267: 2007-8; Lancet 339: 1198-9. The monitorring of US preschool immunization program is in JAMA 267: 1952-5, and several problems are raised such as missed immunisation in urban areas which leads to measles epidemics. The current efficacy of whole-cell pertussis vaccine in the USA is discussed in JAAM 267: 2745-9. It makes the important point that any new vaccines should be measured for efficacy and cost against older and existing vaccination routines.
A discussion of malaria, and tools to eradicate it is in Science
257: 36-8. A prevention method is discussed in A. Bermejo & H. Veeken, "Insecticide-impregnated
bed nets for malaria control: a review of field trials", Bulletin of WHO
70: 293-6. The results in areas of medium and low transmission were good, but not
in high risk areas. A book review about malaria research is in SA
(June 1992), 93.
Research aimed at developing a vaccine for Lyme disease is reported in Science 256: 1623. Using Salmonella as a vaccine, see S.N. Chatfield et al., "Use of the nirB promoter to direct the stable expression of heterologous antigens in Salmonella oral vaccine strains: development of a single-dose oral tetanus vaccine"", Biotechnology 10: 888-92. The canarypox virus may be another vaccine vector; Lancet 339: 1448-9. On Haemophilus influenzae immunisation in Australia see MJA 156: 518-20. A discussion on whether experimental vaccines should be used to contain the cholera epidemic in America is in Lancet 340: 231-2. Leprosy is discussed in BMJ 305: 206-7, with the comment that multidrug treatment is insufficient. On a positive note, the target of polio eradication by the year 2000 may be possible, if sufficient funding is given; BMJ 305: 69-70; and on polio programs in the Phillipines; Weekly Epidemiological Record 28 (10 July 1992), 205-7. On biotechnology vaccines see a book review in Science 257: 561-2.
In Japan , a Hepatitis A vaccine has recently been announced, after the results of clinical trials; Yomuiri Shimbun (28 Aug 1992), 30; NEJM 327: 488-90. A successful newborn immunization program for Hepatitis B is reported from Tonga in Weekly Epidemiological Record 28 (10 July 1992), 207-9.
The question of whether an AIDS vaccine is possible is asked in Biotechnology 10: 768-71. (see also the later section on AIDS)
A general review on making vaccines by biotechnology is in Biotechnology 10: 763-6. It includes a list of current vaccine development projects under clinical testing or development in the USA. An alternative to immunisation is generation of antibodies in vitro (or in vivo) by genetic techniques, see J.D. Marks et al., "By-passing immunization: building high affinity human antibodies by chain shuffling", Biotechnology 10: 779-83. On the transfering of whole immune cells to fight viruses see Science 257: 166. The use of autoimmunity as therapy is reviewed in Biotechnology 10: 641-5.
The mechanism of drug resistant tuberculosis has been found to be due to the loss of an isoniazid antibiotic resistance gene from earlier TB strains; Nature 358: 538-9, 591-3. An article on the overuse of antibiotics and disease-resistant bacteria is in Time (31 Aug 1992), 38-9.
The success of the American polio immunization schemes may not be matched by Asian programs for some time, due to shortages of vaccine; Science 257: 1467. The first case of polio in Holland for 14 years has lead to renewed immunisation campaigns there; NS (3 Oct 1992), 9. BCG immunisation practise in the UK is surveyed in BMJ 305: 495-8. Swedish tests of a new pertussis vaccine appear good; JAMA 268: 958-9; while a Japanese vaccine is being used in the USA; FDA Consumer (Sept 1992), 22-5. Calls for large scale immunization against Haemophilus influenzae b are made in BMJ 305: 485-6. Rabies vaccines and wild dogs is discussed in Nature 359: 277; BMJ 305: 725-6. A new publication on rabies is WHO Expert Committee on Rabies, eighth report (WHO 1992, 83pp.). The variability of viruses is discussed in a conference report in Nature 359: 107-8. Drug treatment for chickenpox is discussed in Lancet 340: 639-40.
The prospects for HIV vaccines and AIDS vaccines appears to be retreating, according to a report reviewing some commercial companies development programs in Science 257: 1472-3. Comments on whether vaccination for HIV should be tested are in Nature 359: 522. On vaccine development and safety assessment procedures for new vaccines by the FDA are in Biotechnology 10: 936-7.
A book review of interest to malaria research is in Nature 359: 114-5; and the function of the malaria circumsporoite protein's function has at last been identified; Nature 359: 361-2; Cell 70: 1020-33. The protein binds as a ligand to a receptor on hepatocytes, of the liver. A Colombian-developed malaria vaccine begun safety trials among volunteers from the US Army in October; NS (26 Sept 1992), 6. WHO has announced a new policy for malaria research, emphasising a more flexible local approach.
Several review papers on drug-resistant microorganisms and diseases are in Science 257: 1021, 1036-8; M.L. Cohen, "Epidemiology of drug-resistance: implications for a post-antimicrobial era", Science 257: 1050-5; B.R. Bloom & C.J.L. Murray, "Tuberculosis: commentary on a reemergent killer", p. 1055-64; H.C. Neu, "The crisis in antibiotic resistance", p. 1064-73; R.M. Krause, "The origin of plagues: old and new", p. 1073-78. They point out that the current overuse of antibiotics is resulting in drug-resistant pathogens which is costing people lives. The rise of tuberculosis is attributed to collapsing public health schemes and increased poverty in an article in NS (10 Oct 1992), 30-37. On how Columbus's discovery of America introduced and spread disease in the New World (America) see NS (10 Oct 1992), 38-41; and on how microbes move today, seeAJPH 82: 1326-7, 1407-13.
Testing of a
vaccine developed by Manuel Patarroyo of Columbia has begun in volunteers in the
258: 34-5. The vaccine is based on a polymer, and the FDA issued approval for a
phase 1 safety and antibody response trial. The vaccine has already been tested
on thousands in South American trials but their are many skeptics of the reported
effectiveness. The same vaccine should begin trials in January in Tanzania in a double blind
trail sponsored by the WHO; Science
258: 207. A review of the critical book, Malarial Capers
by R.S. Desowitz is in NEJM
327: 1324-5. The use of plant extracts and iron chelators in malaria treatment is
reviewed in NEJM
327: 1519-21. A report from the world summit on malaria is in NS
(24 Oct 1992), 10; (7 Nov 1992), 4. A review is NS
(31 Oct 1992), 37-41.
The French company Institut Marieux has been persuaded to modify a polio plant in India , rather than withdraw from the project; Nature 360: 3. The Indian government decided to use a cheaper oral vaccine instead of the planned injectable polio vaccine that the original plant would make, and the company said it would abandon it. Now the plant will be converted and will make other vaccines.
WHO trials of a measles vaccine have been stopped, following unexplained mortality; Science 258: 546-7. Children are protected from measles, but have higher risk of some other diseases. Measles is the number one infectious killer disease, so it is still planned to give the vaccine to children older than 9 months who do not suffer from the apparent immune suppression that the vaccine causes when used at earlier ages. Protection against serogroup B meningo-coccal disease in older children or adults has been found using a Cuban made vaccine in Brazilian trials; Lancet 340: 1074-8. Hepatitis B vaccination trials are reported in CMAJ 147: 1023-8, 1029-43.
The politics and lobbying behind an AIDS vaccine trial in the USA is discussed in Science 258: 211, 536-9, 883-4; Lancet 340: 1216; NS (24 Oct 1992), 8; (14 Nov 1992), 11. The problem was that Congress specified a US$20 million grant for a particular vaccine made by a company MicroGeneSys, while it should be medical experts who decide which vaccine trial is most appropriate. It follows lobbying by the company, and could escalate into companies lobbying for research funds from government. However, the money will be spent on trials, including that vaccine; Nature 360: 94; Science 258: 1079-80. Another AIDS vaccine trial may also begin in the near future on women and fetuses; Science 258: 298.
A recent editorial in Nature (359: 657-8) reports on a new US Institute of Medicine report, Emerging Infections: Microbial Threats to Health in the United States, which calls for renewed research on infectious diseases warning of the dangers of further plagues in any country; Science 258: 540. A report on drug-resistant microbes and tuberculosis is in SA (Nov 1992), 12-3. A general method for construction of chimeric vaccinia vaccines by direct insertion of foreign DNA in packaging is reported in PNAS 89: 9977-81.
A letter on the effectiveness of rabies vaccine trials in Europe, showing their extent, is in Nature 360: 115-6.
The results of a
in which fewer episodes of malaria were reported than a placebo group is good news,
M.V. Valero et al., "Vaccination with SPf66, a chemically synthesised vaccine, against
malaria in Columbia", Lancet
341: 705-10; Nature
362: 410; NS
(27 March 1992), 7; Science
259: 1689-90. The protective efficacy in 1-4 year olds was 77%, and 22% in 15-44
year olds. The subjects were mainly of African origin, suggesting that the vaccine
should now be tried in Africa. The trial had earlier been criticised, but the positive
results suggest it is useful. A trial from Tanzania is expected to give results in
mid-1994. A symposium report on ethical dilemmas in malaria drug and vaccine trials
is in JME
18 (1992), 189-92. A general review on tropical diseases is in NS
(20 Feb 1993), Supplement 1-4. The mapping of the malarial parasite's genome is discussed
(March 1992), 98-101. There are at least four species of malaria parasites, and they
show much genotypic variation; Lancet
341: 793. A book review on Malaria: Obstacles and Opportunities
, is in NEJM
Next year trials of a vaccine engineered to protect against virally caused cancer are expected to commence; Science 259: 758; Nature 362: 695; SA (April 1993), 84-5. An example of a fusion vaccine is M.H. Tao & R. Levy, "Idiotype/granulocyte-macrophage colony-stimulating factor fusion protein as a vaccine for B-cell lymphoma", Nature 362: 755-8. The Epstein Barr virus is carried by 90% of the world's people, and is usually harmless. Letters on human prion dementia are in Lancet 341: 626-8. A new way to look for disease causing genes is to insert the bacteria into an animal and watch for the expressed genes; M.J. Mahan et al., "Selection of bacterial virulence genes that are specifically induced in host tissues", Science 259: 686-8, 595. A review is P.W. Ewald, "The evolution of virulence", SA (April 1993), 56-62.
In the USA there is a relatively low rate of vaccination considering its economic status. Plans are being discussed to freely distribute vaccines in the USA; Science 259: 1528-9; JAMA 269: 1480-1. This is no doubt good for children in the USA, and worth the US$300 million cost. The interesting thing ethically is that there is reluctance to do it. The reason cited against it is that it may slow down R&D into new vaccines. Standards for pediatric vaccines are in JAMA 269: 1817-22, 1844-5.
The use of DNA as an influenca vaccine is reported in J.B. Ulmer et al., "Heterologous protection against influenca by injection of DNA encoding a viral protein", Science 259: 1745-9, 1691-2.
New York city has powers to allow for one year detention of tuberculosis patients who do not complete treatment on their own; Lancet 341: 751. Letters on the re-emergence of tuberculosis are in BMJ 306: 514-5. The WHO has declared on 22 April that tuberculosis is the world's worst disease.
A controversy in
has erupted over the high incidence (1 in 400) of side effects from a
(mumps, measles, rubella) vaccine made and used in Japan. It was withdrawn after
the media released unpublicised government risk data. At the time of writing no
MMR vaccine is being offered to children because the government refuses to use the
US vaccine, which has a 20 year history of safe use with almost no side effects. The scandal
reveals that the Japanese Ministry of Health and Welfare has been attempting to encourage
Japanese industry by not using a foreign vaccine, while risking public health with a vaccine with 100-200 times more side effects. If children want to be vaccinated
now they must pay about Y10,000 for a vaccine that was previously free.
In India there have been claims that expired and old vaccines have been used which have caused a higher death rate; Lancet 341: 1402; BMJ 306: 1499. In the USA the plans for all children to receive immunization funded by the government (EEIN 3: 31) are being implemened; JAMA 269: 2062-3, 2616; AJDC 147: 536-7. The WHO policy on vaccines is discussed in NEJM 328: 1420-2; Lancet 341: 1142-3.
The reactions of US pediatricians to a US Centers for Diseases Control Recommendation that all infants be vaccinated aghainst hepatitis B was not positive, with only 32% thinking it was warranted, Pediatrics 91: 699-702. The results of a trial of hepatitis B vaccine in Gambia has found it 84% effective in preventing children from being infected; Lancet 341: 1129-31.
A review on the subject of immunization of adults and a list of vaccines used is in NEJM 328: 1252-8. A report from a March conference on vaccine development in the USA is in GEN (15 April 1993), 1, 3, 12. A hepatitis C vaccine that works in chimpanazees has been reported in the USA. The use of genetically engineered tumour cells as vaccines against cancer is entering some trials; PNAS 90: 3539-43. In China an anticancer vaccine against Epstein-Barr virus (found in 95% of all adults in the world, and linked to cancer) has suggested that it may work, NS (1 May 1993), 16. Vaccines against hepatitits, HIV, malignant melanoma, cervical cancer, prostrate cancer, and glycoconjugates are discussed. In the USA two new vaccines have been approved by the FDA, a new Haemophilus b conjugate vaccine and a combined Diptheria-Tetanus-Pertussis and Haemophilus b conjugate vaccine; JAMA 269: 2359.
Synthetic peptides which block the binding of malaria -infected cells to endothelial cells in monkeys have been developed; GEN (1 Jun), 27. This may allow a therapy which keeps blood flow through vital organs despite infection. In the world at least 267 million people carry the malaria parasite. A general review on malaria is Time (31 May 1993), 34-40.
Flu virus has long resisted efforts for therapy, as most of us face every few years. Drug design to make sialidase-based inhibitors of the virus are described in Nature 363: 418-23. Researchers at the Whitehead Institute in Cambridge, MA, USA, have identified a spring mechanism by which the virus fuses with cell membranes; GEN (1 Jun), 10. It is a further target for attempts at a cure for the cold (see also above).
In Ireland a man who suffered brain damage after a pertusis vaccine, almost 24 years ago, has been given 2.75 million in damages from the Welcome Foundation; BMJ 306: 1365; Lancet 341: 1338-9. This is a very large sum and the first legal case in the UK to result in payement following vaccine-induced damage.
Many papers on the reemergence of tuberculosis (TB) are signs of the growing importance placed on this WHO priority disease; AJPH 83: 639-41, 647-8; Lancet 341: 1142, 1145; BMJ 306: 1147; Newsweek (17 May 1993), 22-7. A new screening test for TB is reported in Science 260: 750, 819-22. A paper showing that increased time in a New York City jail increases your chance of TB makes the prison sentence in New York even more serious; JAMA 269: 2228-31. Also on TB control in New York see AJPH 83: 758-66, 766-8. A history of the attempts to control communicable disease in England is in BMJ 306: 1461-4.
Book reviews on the introduction of diseases into the Americas by Europeans are in Science 260: 1179-81. Disease transmission by insects, a new book is reviewed in Nature 363: 506-7. Gene studies have shown that flu migrates via migratory birds.
A review of bacterial endotoxins is in SA (Medicine), 156-63. The emergence of E. coli infection in foods in the USA is examined in JAMA 2264: 2217-20, 2264-6. In Indian reservations in the South Western USA people are dying due to a mystery respiratory illness, Nature 363: 479-80. In one old person's home in Chiba, Japan, there have been 12 patients out of 80 infected with MRSA in the last year; Yomiuri Shinbun (11 June 1993), 30.
A US Institute of Medicine calls viruses the most cost-effective disease prevention
tools made, but the cost of development can be US$200 million to bring one to market;
261: 156; Biotechnology
11: 867. They call for a national vaccine authority in the USA. The March-April
issue of World Health
focuses on The Children's Vaccine Initiative. The question of whether to destroy
the final stocks of smallpox virus is to be taken at the World Medical Assembly next
year, it is still being debated; NS (21 Aug 1993), 3.
The finding of poliovirus in members of a religious community that object to vaccination in Holland and Canada is reported in JAMA 270: 3104. As efforts continue to erradicate poliovirus , and this is the first case of it in North America for a couple of years, we must ask the ethical question can individual's objection to vaccination continue to endanger the health of others, by harbouring the virus. Factors affecting uptake of vaccination in the UK are reported in BMJ 307: 168-71. A study of the cost-effectiveness of prenatal screening and vaccination against hepatitis is SSM 37: 173-81; see also BMJ 307: 276-7. The September issue of Scientific American features many papers on Life, Death and the Immune System.
On tuberculosis research, Science 261: 159; NEJM 329: 134-8; JAMA 270: 694. The use of satellites to trace human disease, e.g. by looking at mosquito breeding grounds, in Africa is reported in Science 261: 31-2. The question of where new diseases come from is asked in Science 261: 680-1; JRSM 86: 373-7; JAMA 270: 384-5. Resurgent diseases in Russia are reported in Science 261: 415; a special issue on women and tropical diseases is in SSM 37 (4), 441-520. The debate on leprosy vaccine in India is in Lancet 342: 233.
A genetic map of the malaria vector X chromosome of 2 centi-morgan resolution is reported in Science 261: 605-8. A review of genetic research against malarial vectors is Science 261: 546-8. A short review of global malaria control is Bulletin of WHO 71: 281-4; and on vector control, MJA 158: 681-90; JAMA 270: 685-6.
is revising plans to obtain the goals of its
vaccine programme; Science
261: 1511; Lancet
342: 856. The targets that
has for immunisation are summarised in Lancet
342: 855. The
has revised the vaccine laws to provide free vaccines to many poor children, and
it is expected to simplify the procedures, Lancet
342: 607. The cost of vaccination is US$250 out of US$448 per child in the immunisation
schedule in the private sector. But how much is the real cost? The FDA is helping
Russia improve its vaccination program, FDA Consumer
(Sept 1993), 26-30. In
there is also denial of old vaccines being used, and an explanation of the childhood
immunisation policy is given, Lancet
The UK MRC has approved a malaria vaccine trial in very young children, Science 261: 1392. A special issue of Social Science and Medicine 37 (9), 1091-1180 is on malaria. A review of a book on hepatitis B vaccines is Lancet 342: 603-4.
Prion diseases are discussed in Nature 365: 93, 98, 386; Lancet 342: 680, 790-2. There is much public anxiety in the UK about the danger of bovine spongiform encephalitis (mad cow disease) becoming the human disease Creutzfeldt-Jakob disease (see section on recombinant products).
A paper on tracing the route of tuberculosis infection is A. Genewein et al., "Molecular approach to identifying route of transmission of tuberculosis in the community", Lancet 342: 841-4. The study showed transmission is happening in similar places in Europe and the UK, including some in the general population. On the role of poverty in the spread, BMJ 307: 759-61. See also JAMA 270: 1363; and on TB mechanism, Science 261: 1390. A reverse PCR test for detecting murine retroviruses is reported in Biotechnology 11: 1042-6.