Journal of Health, Population and Nutrition, Vol. 25, No. 1, Mar, 2007, pp. 118-121
Satellite Symposium on Challenges to Enteric Vaccines
Salvador de Bahia, Brazil, 12 June 2005
A.D. Steele and M.P. Kieny
Initiative for Vaccine Research, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
Correspondence and reprint requests should be addressed to: Prof. Duncan Steele Initiative for Vaccine Research/RPD Department of Immunization, Vaccines and Biologicals World Health Organisation 20 Avenue Appia CH-1211 Geneva 27 Switzerland Tel: +41 22 791 3752, Fax: +41 22 791 4860 Email: firstname.lastname@example.org
Code Number: hn07017Background and rationale
In an effort to promote vaccine research and develop-ment of enteric vaccines, including cholera, typhoid fever, and rotavirus vaccines and to address the challenges for their future implementation, the WHO Initiative for Vaccine Research hosted a one-day Satellite Symposium dedicated to addressing the opportunities to use the licensed vaccines against cholera and typhoid fe-ver and to consider the challenges which remain for introduction of rotavirus vaccine, including clinical trials in developing-country settings. The Bill and Melinda Gates Foundation graciously provided US$ 50,000 to organize the Satellite Symposium.
The Symposium was followed by a three-day Global Vaccine Research Forum, which also included a session on the other two important enteric vaccines against en-terotoxigenic Escherichia coli and Shigella. The Forum brought together a world-wide selection of top researchers and scientists and served as a forum for the partners of GAVI (the Global Alliance for Vaccines and Immunization) to discuss vaccine research and development issues and to update research agenda. Moreover, both the meetings provided an opportunity for discussion of broader issues of vaccine policy and implementation.
Goals, objectives, and activities
Although diarrhoeal mortality, globally, is observed to be on the decrease, it is well-recognized that the vast bulk of morbidity and mortality of the estimated annual 1.9 million deaths is borne by infants and young children living in developing countries. The Symposium addressed the challenges and opportunities for the effective implementation of these vaccines in the regions where they are most needed.
Currently, two vaccines are licensed for cholera, but are not yet readily used in the areas considered endemic for cholera, nor in children who are largely affected by the disease. Two recent studies have demonstrated that (a) cholera vaccine can be administered in mass immunization campaigns in areas where cholera is endemic with good protective effects and (b) that there appears to be good herd protection in vaccinated populations and non-vaccinated individuals. The remaining challenges include identifying and overcoming the obstacles to im-plementation of the vaccines in these settings. Similarly, the typhoid fever vaccines are licensed and have been proven to be effective in preventing the disease and can be administered in school-age populations with good protection given.
The present state of development of rotavirus vac-cines indicates an urgent need to increase the global capacity to conduct multiple clinical trials in developing countries, particularly in Africa and Asia. These trials will need to evaluate safety, immunogenicity, and efficacy of the vaccine candidates in different populations and geographical areas which differ significantly in epi-demiology of the virus and viral strain diversity and in the social, health, and economical background of the population—all of which may have a significant impact on final efficacy results.
The agenda of the Symposium (attached) included different sessions focused on different enteric vaccines, which allowed for discussion of priority issues which have been identified as major obstacles for the imple-mentation of vaccines against cholera and typhoid fever and the introduction of rotavirus vaccines.
The participants of the Satellite Symposium were provided with an opportunity to attend all other sessions of the Forum to interact and share their experiences with experts working on other infectious diseases or areas. The linking of the Symposium with the Global Vaccine Research Forum has, thus, provided an ideal forum for cross-field interactions, exchange of information, and sharing of experiences between scientists against other priority infectious diseases, such as HIV, tuberculosis, malaria, and other infections, including enterotoxigenic E. coli and Shigella, with high-level participation from experts in the field of vaccines, including that from de-veloping countries.
Accomplishments and outcomes of the Symposium
The focus of the Symposium was typhoid fever and cholera (for which licensed vaccines have been available for a number of years), and rotavirus. The presentations addressed the question whether introduction plans for rotavirus, typhoid, and cholera vaccines are credible in-vestment cases for developing countries.
The main conclusions of the Symposium were as follows:
For enteric vaccines in general, the following few hur-dles should be overcome before wider use:
More specifically, for typhoid fever vaccines
More specifically, for rotavirus vaccines
More specifically, for cholera vaccines
Both Satellite Symposium and main Global Vaccine Re-search Forum were very well-attended with more than 50 and 150 participants respectively from all regions and representing all stakeholders of the fields of R&D of immunization and vaccine.
Extensive media coverage organized around both events allowed for effective advocacy and dissemination of key messages.
The report of the Symposium and Global Vaccine Research Forum has been completed and is being print-ed at WHO. It will be disseminated widely in the R&D of immunization and vaccine as hard copies and be posted on the Initiative for Vaccine Research website.Summary of the Symposium
The WHO Initiative for Vaccine Research and Depart-ment of Immunization, Vaccines and Biologicals plans to act on the conclusions and recommendations of the Symposium and notably in the following areas:
© 2007 ICDDR,B: Centre for Health and Population Research