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Perspective
Measles in the 21st Century
Barely 20 years ago, such a high proportion of childhood deaths globally was attributable to measles that the going estimate of more than 1 million measles-related deaths per year was almost certainly an underestimate. Pediatric wards in the developing world were filled with patients with measles…
- May 10, 2012
- Mulholland E.K., Griffiths U.K., Biellik R.
- N Engl J Med 2012; 366:1755-1757
- Interactive/Multimedia
Between 2000 and 2008, measles control improved markedly worldwide, but with poorer countries focused on polio eradication and some richer countries falling prey to opposition to vaccination, the measles genie seems to have slipped out of the bottle in recent years.
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Original Article
Immune-Correlates Analysis of an HIV-1 Vaccine Efficacy Trial
In clinical trials that show the efficacy of a vaccine, the identification of immune responses that are predictive of trial outcomes generates hypotheses about which of those responses are responsible for protection.– The RV144 phase 3 trial in Thailand (ClinicalTrials.gov number, NCT00223080)…
- April 5, 2012
- Haynes B.F., Gilbert P.B., McElrath M.J., et al.
- N Engl J Med 2012; 366:1275-1286
This analysis of correlates of the risk of HIV-1 infection in the RV144 vaccine trial identifies hypotheses for improving efficacy. The data indicate key roles of V1V2 (variable regions 1 and 2) IgG antibodies and envelope protein (Env) IgA antibodies in modulating infection risk.
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Editorial
The Road to an Effective HIV Vaccine
During the 30 years since the discovery of HIV as the cause of AIDS, efforts to develop a vaccine have faced immense challenges. First, naturally acquired immunity to protect against infection that results in disease, found with virtually all other known infectious agents, may not exist for HIV.…
- April 5, 2012
- Baden L.R. and Dolin R.
- N Engl J Med 2012; 366:1343-1344
During the 30 years since the discovery of HIV as the cause of AIDS, efforts to develop a vaccine have faced immense challenges. First, naturally acquired immunity to protect against infection that results in disease, found with virtually all other known ...
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Perspective
Improving Childhood Vaccination Rates
Recently, the mother of a young child confessed to me that she didn't know any parents who were following the recommended immunization schedule for their children. She said that when she told her pediatrician she'd like to follow an alternative schedule, the physician had simply acquiesced, leading…
- February 2, 2012
- Diekema D.S.
- N Engl J Med 2012; 366:391-393
- Free Full Text
U.S. parents who decline or delay selected vaccinations or refuse to vaccinate their children are a diverse group. Vaccine coverage can be increased by focusing on parents who encounter barriers to obtaining vaccines or hesitate because of fears about safety.
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Original Article
Efficacy Results of a Trial of a Herpes Simplex Vaccine
Both herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) can cause primary infection of the genital tract, and HSV-1 infection has become an increasingly frequent cause of genital disease. The majority of HSV infections are asymptomatic, and only 10 to 25% of persons with HSV-2 antibodies have…
- January 5, 2012
- Belshe R.B., Leone P.A., Bernstein D.I., et al.
- N Engl J Med 2012; 366:34-43
- CME
There is no vaccine to prevent herpes simplex virus (HSV) infection. In this trial in 8323 women, a candidate HSV vaccine containing glycoprotein D was found to be ineffective in preventing HSV-2 infection.
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Original Article
Norovirus Vaccine against Experimental Human Norwalk Virus Illness
Noroviruses are a leading cause of epidemic acute gastroenteritis and are also an important cause of sporadic cases of acute gastroenteritis. Because human noroviruses have not been grown in cell culture and there are no convenient animal models in which to evaluate immunity and illness, much of…
- December 8, 2011
- Atmar R.L., Bernstein D.I., Harro C.D., et al.
- N Engl J Med 2011; 365:2178-2187
There are neither specific therapies for nor a vaccine to prevent norovirus infection, a common cause of gastroenteritis. This study showed that a candidate norovirus vaccine confers modest protection against an experimental homologous norovirus challenge.
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Correspondence
Intussusception after Rotavirus Vaccination — Spontaneous Reports
To the Editor: Patel et al. report an increased risk of intussusception after rotavirus vaccination. We conducted a case-series analysis of 151 spontaneous reports of intussusception worldwide after administration of the rotavirus vaccine RV1 (Rotarix, GlaxoSmithKline Biologicals). On the basis of…
- December 1, 2011
- N Engl J Med 2011; 365:2139
- Free Full Text
To the Editor: Patel et al. report an increased risk of intussusception after rotavirus vaccination.¹ We conducted a case-series analysis² of 151 spontaneous reports of intussusception worldwide after administration of the rotavirus vaccine RV1 (Rotarix, ...
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Original Article
First Results of Phase 3 Trial of RTS,S/AS01 Malaria Vaccine in African Children
Each year, malaria occurs in approximately 225 million persons worldwide, and 781,000 persons, mostly African children, die from the disease. During the past decade, the scale-up of malaria-control interventions has resulted in considerable reductions in morbidity and mortality associated with…
- November 17, 2011
- The RTS,S Clinical Trials Partnership
- N Engl J Med 2011; 365:1863-1875
- Free Full Text
Each year, about 225 million persons have malaria, with some 781,000 associated deaths. In a preliminary report of a phase 3 trial in African children, the RTS,S/AS01 malaria vaccine had about 50% efficacy against incident malaria and 34% efficacy against severe disease.
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Editorial
A Vaccine for Malaria
It's been a long time coming, and indeed we are still not there yet, but it is becoming increasingly clear that we really do have the first effective vaccine against a parasitic disease in humans. If there are no unforeseen disasters, the RTS,S/AS01 Plasmodium falciparum malaria vaccine should…
- November 17, 2011
- White N.J.
- N Engl J Med 2011; 365:1926-1927
- Free Full Text
It's been a long time coming, and indeed we are still not there yet, but it is becoming increasingly clear that we really do have the first effective vaccine against a parasitic disease in humans. If there are no unforeseen disasters, the RTS,S/AS01 ...
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Perspective
The Role of Cost-Effectiveness in U.S. Vaccination Policy
Vaccination policy is driven by several factors, including vaccine safety and efficacy, avertable disease burden, acceptability, and societal value. One measure of value is an intervention's cost-effectiveness, defined as the additional cost required per additional unit of health benefit produced…
- November 10, 2011
- Kim J.J.
- N Engl J Med 2011; 365:1760-1761
- Free Full Text
One of the factors driving vaccination policy is societal value, one measure of which is cost-effectiveness. Unlike most U.S. public health institutions, the Advisory Committee on Immunization Practices explicitly considers cost-effectiveness in making recommendations.
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Original Article
HPV Vaccine against Anal HPV Infection and Anal Intraepithelial Neoplasia
Anal cancer is biologically similar to cervical cancer, including having a causal relationship with human papillomavirus (HPV) infection. Although HPV type 6 (HPV-6) or HPV type 11 (HPV-11) alone is rarely causal, the proportion of anal cancers associated with infection with HPV type 16 (HPV-16) or…
- October 27, 2011
- Palefsky J.M., Giuliano A.R., Goldstone S., et al.
- N Engl J Med 2011; 365:1576-1585
- Free Full Text
- CME
Infection with human papillomavirus (HPV) serotypes 16 and 18 in men who have sex with men is a cause of considerable morbidity associated with anal intraepithelial neoplasia. This study shows that the HPV vaccine decreases the risk of HPV-associated anal disease.
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Clinical Implications of Basic Research
Stalking Influenza Diversity with a Universal Antibody
The back-and-forth battle between influenza viruses and humans is defined by diversity. We fight previously unseen pathogens with a diverse repertoire of antibodies, and influenza viruses evade our immune system by presenting us with diverse surface-protein sequences. Corti and colleagues have…
- October 20, 2011
- Russell C.J.
- N Engl J Med 2011; 365:1541-1542
The genetic shifts and drifts of the influenza virus pose an obstacle to designing antiviral agents and vaccines that are effective over the long term. However, a recent study suggests that this goal is attainable.
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Original Article
Oil-in-Water Emulsion Adjuvant with Influenza Vaccine in Young Children
Children have the highest rates of seasonal influenza infection and illness, with amplification of community viral transmission. Thus, numerous countries recommend routine seasonal vaccination to protect children directly and the entire population indirectly.– Parenteral trivalent inactivated…
- October 13, 2011
- Vesikari T., Knuf M., Wutzler P., et al.
- N Engl J Med 2011; 365:1406-1416
- Free Full Text
Over two influenza seasons, 4707 children were randomly assigned to either control (noninfluenza) vaccines or trivalent influenza vaccines with or without adjuvant MF59. The vaccine with MF59 proved efficacious in this vulnerable population.
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Original Article
Rotavirus Vaccine and Health Care Utilization for Diarrhea in U.S. Children
Before February 2006, when routine vaccination of infants in the United States with pentavalent rotavirus vaccine (RV5) was recommended, rotavirus diarrhea caused an estimated 400,000 visits to physician's offices, 200,000 emergency department visits, 55,000 hospitalizations, and 20 to 60 deaths…
- September 22, 2011
- Cortes J.E., Curns A.T., Tate J.E., et al.
- N Engl J Med 2011; 365:1108-1117
- Free Full Text
Routine U.S. infant vaccination for rotavirus began in 2006. CDC investigators found that rates of diarrhea-associated hospitalization, outpatient visits, and ER visits declined in 2007–2009 as compared with 2001–2006 among children under 5. The benefit was greater for vaccinated children.
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Clinical Implications of Basic Research
Eliciting Mucosal Immunity
Sometimes simple things are hard to handle. This is true of infectious diarrhea, which remains one of the leading causes of death in children worldwide and a major factor in long-term morbidity. Some gut infections rapidly become systemic, with deadly effects even in adults, as evidenced by the…
- September 22, 2011
- Lencer W.I. and von Andrian U.H.
- N Engl J Med 2011; 365:1151-1153
Eliciting mucosal immunity through vaccination has been problematic. Two recent studies suggest a strategy to achieve this goal.
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Original Article
A Field Trial to Assess a Blood-Stage Malaria Vaccine
An effective malaria vaccine would improve the prospects for eradicating malaria. Vaccines that interrupt the transmission of malaria are emphasized in discussions of eradication, but the ideal malaria vaccine would provide a direct clinical benefit. Vaccines targeting the blood stages of malaria…
- September 15, 2011
- Thera M.A., Doumbo O.K., Coulibaly D., et al.
- N Engl J Med 2011; 365:1004-1013
- Free Full Text
In this study of 400 children in Mali, an adjuvanted vaccine based on an apical membrane antigen 1 from the 3D7 strain of Plasmodium falciparum (a blood-stage antigen) showed some strain-specific activity in preventing clinical malaria.
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Correspondence
Protection against Malaria by MSP3 Candidate Vaccine
To the Editor: In 2007, we conducted a double-blind, randomized, phase 1b clinical trial (ClinicalTrials.gov number, NCT00452088) using the merozoite surface protein 3 (MSP3) vaccine in a malaria-endemic area. A total of 45 children who were 12 to 24 months of age were randomly assigned in a 1:1:1…
- September 15, 2011
- N Engl J Med 2011; 365:1062-1064
- Free Full Text
Malaria is a leading cause of illness and death in the developing world. Thus, the need for an effective vaccine is great. In this phase 1 trial in Burkina Faso, a merozoite surface protein–based vaccine showed some evidence of protection against clinical malaria.
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Perspective
HIV Vaccine Development — Improving on Natural Immunity
Although a number of methods of preventing infection with the human immunodeficiency virus (HIV) have proven effective to varying degrees, it is generally agreed that a safe and effective vaccine against HIV infection would be a critical component of a highly effective prevention toolkit for…
- September 8, 2011
- Johnston M.I. and Fauci A.S.
- N Engl J Med 2011; 365:873-875
- Free Full Text
Since our natural immune response to HIV infection is ineffective, a key goal for an HIV vaccine is to induce a response different from that induced by natural infection — an “unnatural immunity,” involving production of broadly neutralizing antibodies.
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Correspondence
Childhood Diarrhea Deaths after Rotavirus Vaccination in Mexico
To the Editor: The World Health Organization (WHO) recommends the use of rotavirus vaccines for all children worldwide to control severe rotavirus disease, which causes 527,000 childhood deaths annually. After the phased national introduction of rotavirus vaccine in Mexico in 2006 and 2007, we…
- August 25, 2011
- N Engl J Med 2011; 365:772-773
- Free Full Text
Rotavirus is associated with substantial global mortality and morbidity. The use of the rotavirus vaccine is associated with a sustained decrease in the rate of death related to childhood diarrhea in Mexico.
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Perspective
Incomplete Care — On the Trail of Flaws in the System
It was no one's fault, but it was everyone's fault. The 53-year-old woman had presented with pneumococcal sepsis with disseminated intravascular coagulation and had barely survived but had lost multiple digits. Ten years earlier, she had undergone splenectomy after a motor vehicle accident. There…
- August 11, 2011
- Gandhi T.K., Zuccotti G., Lee T.H.
- N Engl J Med 2011; 365:486-488
- Free Full Text
A patient-safety investigation motivated by a lawsuit over pneumococcal sepsis in a patient who had undergone splenectomy but never received pneumococcal vaccination demonstrates the complexity of redesigning systems and care processes to prevent common errors.
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Medical Meetings Pediatrics Conferences and Meetings

2012 Certifying Examinations of the American Board of Pediatrics

The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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