Immunogenicity and Safety of the AS04-adjuvanted Human Papillomavirus-16/18 Cervical Cancer Vaccine in Malaysian Women Aged 18-35 years: A Randomized Controlled Trial.

INTRODUCTION: Cervical cancer is the third most common cancer in women worldwide. The HPV-16/18 AS04- adjuvanted vaccine (Cervarix©) has previously been shown to be highly immunogenic with a clinically acceptable safety profile. This phase IIIb, double-blind, randomized (1:1) and placebo controlled trial (NCT00345878) was designed to evaluate the vaccine immunogenicity against HPV-16 and HPV-18 as well as its safety and reactogenicity in Malaysian women. METHODS: Healthy women aged 18-35 years received intramuscularly three doses of either the vaccine (HPV group) or aluminium hydroxide (ALU group) at 0, 1, and 6 months. Antibody titers were measured by an enzyme-linked immunosorbent assay (ELISA). RESULTS: A total of 271 eligible subjects were enrolled and 266 subjects completed the study. Initially seronegative subjects in the HPV group showed 100% seroconversion one month post-dose-3 for anti HPV-16 and anti-HPV-18 antibodies with geometric mean titers of 11107.5 (95% CI: 9727.3-12683.4) EL.U/mL and 4273.5 (95% CI: 3771.8-4841.9) EL.U/mL, respectively. Over 96% of subjects in both groups received all three vaccine doses. Solicited local (pain) and general symptoms (myalgia, fatigue, arthralgia and headache) were commonly reported in both HPV and ALU groups. Eight serious adverse events were reported throughout the study (five in the HPV group; three in the ALU group), all considered by investigators to be unrelated to vaccination. CONCLUSION: The HPV-16/18 AS04-adjuvanted vaccine was immunogenic and generally well tolerated in Malaysian women aged 18-35 years.

Influenza and seasonal influenza vaccination among diabetics in Singapore: knowledge, attitudes and practices.

INTRODUCTION: Seasonal influenza vaccination is recommended for diabetics; however, the vaccination uptake rate among diabetics remains low. This study explored the knowledge, attitudes and practices among diabetics in Singapore with regard to influenza and influenza vaccination. METHODS: A survey was conducted among type 1 and 2 diabetes mellitus patients who attended three management centres of the Diabetic Society of Singapore in January 2007. The pilot-tested questionnaire covered influenza and influenza vaccination in terms of the patient demographics, medical history and knowledge, attitudes and practices. RESULTS: A total of 307 diabetics participated in the study. Of these, 139 (45.3 percent) claimed to know the difference between influenza and the common cold, while 98 (31.9 percent) and 18 (5.9 percent) participants thought that influenza vaccines protected against all influenza strains and provided lifelong immunity, respectively. 247 (80.4 percent) participants were aware that they were at a moderate or higher risk for influenza-related complications, while 181 (58.9 percent) considered vaccination to be effective in preventing influenza and its complications. Only 94 (30.6 percent) participants were previously vaccinated. Among those unvaccinated, 117 (54.9 percent) did not think vaccination was necessary, while 104 (48.8 percent) had never considered it. As observed from the multivariate analysis, income was a key predictor of influenza vaccination. While 241 (78.5 percent) participants cited healthcare professional advice as the main guiding factor for getting vaccinated, 199 (64.8 percent) had never been advised on influenza vaccination. Of the 108 (35.1 percent) participants who had received previous advice on influenza vaccination, the majority had received it from their healthcare professionals. CONCLUSION: Uptake of influenza vaccination among diabetics in Singapore is low, and the key predictor is income. Perception and knowledge are the main barriers, and hence, healthcare professionals should educate and encourage vaccination among diabetics.

Safety and efficacy of human rotavirus vaccine during the first 2 years of life in Asian infants: randomised, double-blind, controlled study.

This study evaluates the safety and efficacy against severe rotavirus gastroenteritis of the oral live attenuated human rotavirus vaccine RIX4414 (Rotarix) during the first 2 years of life in Asian infants from high-income countries. Healthy infants were enrolled to receive 2 doses of RIX4414 (N=5,359) or placebo (N=5,349). From 2 weeks post-dose 2 to 2 years of age, vaccine efficacy was 96.1% (95%CI:85.1%; 99.5%) against severe rotavirus gastroenteritis, 100% (95%CI:80.8%; 100%) against wild-type G1P[8] and 93.6% (95%CI:74.7%; 99.3%) against circulating non-G1 rotavirus types. No intussusception cases were reported within 31 days post-vaccination. RIX4414 shows a good safety profile and offers high protection during the first 2 years of life with potentially significant public health impact in this population.

A nationwide outbreak of coconut-associated paratyphoid A fever in Singapore.

A large outbreak of 167 cases of paratyphoid A was reported in Singapore during the period 15 February to 4 May 1996. Cases were distributed all over the country and no specific food establishment was implicated. The attack rate was highest among the Indian ethnic group between the ages of 25 and 34 years. A case-control study showed that consumption of a variety of food items in which imported deshelled coconut was used as an ingredient was statistically significantly associated with the illness (P < 0.001). As soon as the vehicle of transmission was suspected, the import of deshelled coconut was banned. No further cases were reported four weeks after the ban. The outbreak highlighted the need to maintain a high degree of vigilance against the introduction of infectious diseases through imported food.