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An affordable, highly immunogenic Neisseria meningitidis serogroup A meningococcal conjugate vaccine (PsA-TT) was licensed for use in sub-Saharan Africa in 2009. In 2010, Burkina Faso became the first country to implement a national prevention campaign, vaccinating 11·4 million people aged 1-29 years. We analysed national surveillance data around PsA-TT introduction to investigate the early effect of the vaccine on meningitis incidence and epidemics.We examined national population-based meningitis surveillance data from Burkina Faso using two sources, one with cases and deaths aggregated at the district level from 1997 to 2011, and the other enhanced with results of cerebrospinal fluid examination and laboratory testing from 2007 to 2011. We compared mortality rates and incidence of suspected meningitis, probable meningococcal meningitis by age, and serogroup-specific meningococcal disease before and during the first year after PsA-TT implementation. We assessed the risk of meningitis disease and death between years.During the 14 year period before PsA-TT introduction, Burkina Faso had 148 603 cases of suspected meningitis with 17 965 deaths, and 174 district-level epidemics. After vaccine introduction, there was a 71% decline in risk of meningitis (hazard ratio 0·29, 95% CI 0·28-0·30, p0·0001) and a 64% decline in risk of fatal meningitis (0·36, 0·33-0·40, p0·0001). We identified a statistically significant decline in risk of probable meningococcal meningitis across the age group targeted for vaccination (62%, cumulative incidence ratio [CIR] 0·38, 95% CI 0·31-0·45, p0·0001), and among children aged less than 1 year (54%, 0·46, 0·24-0·86, p=0·02) and people aged 30 years and older (55%, 0·45, 0·22-0·91, p=0·003) who were ineligible for vaccination. No cases of serogroup A meningococcal meningitis occurred among vaccinated individuals, and epidemics were eliminated. The incidence of laboratory-confirmed serogroup A N meningitidis dropped significantly to 0·01 per 100 000 individuals per year, representing a 99·8% reduction in the risk of meningococcal A meningitis (CIR 0·002, 95% CI 0·0004-0·02, p0·0001).Early evidence suggests the conjugate vaccine has substantially reduced the rate of meningitis in people in the target age group, and in the general population because of high coverage and herd immunity. These data suggest that fully implementing the PsA-TT vaccine could end epidemic meningitis of serogroup A in sub-Saharan Africa.None.

Background After the Department of Defense implemented a mandatory anthrax vaccination program in 1998 concerns were raised about potential long-term safety effects of the current anthrax vaccine. The CDC multicenter, randomized, double-blind, placebo-controlled Anthrax Vaccine Adsorbed (AVA) Human Clinical Trial to evaluate route change and dose reduction collected data on participants’ quality of life. Our objective is to assess the association between receipt of AVA and changes in health-related quality of life, as measured by the SF-36 health survey (Medical Outcomes Trust, Boston, MA), over 42 months after vaccination. Methods 1562 trial participants completed SF-36v2 health surveys at 0, 12, 18, 30 and 42 months. Physical and mental summary scores were obtained from the survey results. We used Generalized Estimating Equations (GEE) analyses to assess the association between physical and mental score difference from baseline and seven study groups receiving either AVA at each dose, saline placebo at each dose, or a reduced AVA schedule substituting saline placebo for some doses. Results Overall, mean physical and mental scores tended to decrease after baseline. However, we found no evidence that the score difference from baseline changed significantly differently between the seven study groups. Conclusions These results do not favor an association between receipt of AVA and an altered health-related quality of life over a 42-month period.

Background In 2002 CDC initiated the Anthrax Vaccination Program (AVP) to provide voluntary pre-exposure vaccination with Anthrax Vaccine Adsorbed (AVA) for persons at high risk of exposure to Bacillus anthracis spores. There has been concern that AVA could be associated with long term impairment of physical and/or mental health. Objectives To ascertain whether physical and mental functional status, as measured by the SF-36v2 health survey (Medical Outcomes Trust, Boston, MA), of AVA recipients and controls changed differently over time. Methods We enrolled 437 exposed (received AVA) and 139 control subjects. The exposed group received AVA under then-current Advisory Committee on Immunization Practices (ACIP) recommendations. SF-36v2 surveys were completed at 0, 12, and 30 months. SF-36v2 physical and mental scores both range from 0 to 100 with an estimated national average of 50 points. Results For physical scores, the average change from baseline was −0.53 for exposed vs. −0.67 for controls at 12 months ( p = 0.80) and −1.09 for exposed vs. −1.97 for controls at 30 months ( p = 0.23). For mental scores, the average change from baseline was −1.50 for exposed vs. −1.64 for controls at 12 months ( p = 0.86) and −2.11 for exposed vs. −0.24 for controls at 30 months ( p = 0.06). In multivariable analysis, the difference in mental score change between exposed vs. controls at 30 months was less pronounced ( p = 0.37) but other findings were similar to univariate analyses. Conclusions These results do not favor an association between receipt of AVA and an altered health related quality of life over a 30-month period.

When people choose a particular occupation, they presumably make an implicit judgment that they will perform well on a job at some point in the future, typically after extensive education and/or on-the-job experience. Research on learning and skill acquisition has pointed to a power law of practice, where large gains in performance come early in practice, with diminishing returns with greater experience. However, it is not clear whether young adults understand the nature of job learning and performance over time. In the current study, 153 university students were provided with job descriptions and video clips for 20 different jobs. They were asked to estimate the shape of their learning curves for each job, and to provide judgments of their performance levels from the first day on the job to a point after six months of job experience. We investigated the patterns of expected learning/performance curves, and explored the role of personality, interests, self-concept, self-estimates of abilities, entity/incremental theories of intelligence, and gender in prediction of the patterns of expected curves. Participants generally expected a power function or a linear function of improvement across the jobs, with notable differences in anticipated performance depending on job characteristics of gender dominance, ability demands, and interest themes. Traits and job engagement variables provided significant predictive power for accounting for individual differences in expected job performance over time. Implications for implicit theories of intelligence and occupational choice are discussed.

This study describes the serotype distribution and antibiotic resistance patterns among 397 S. pneumoniae meningitis case isolates recovered in Salvador, Brazil, during the period of 2000–2007, before introduction of the 10-valent pneumococcal conjugate vaccine. The active hospital-based surveillance showed a decline in the annual incidence rates of pneumococcal meningitis during the period of study, from 1.12 cases to 0.83 cases/100,000 persons for all age groups (P

Background Routine childhood immunization with pneumococcal conjugate vaccines (PCV7s) began in 2000 in the United States. Despite vaccine shortages, reductions in invasive pneumococcal disease occurred rapidly during 2000–2002. Age-appropriate PCV7 coverage was estimated and characteristics associated with undervaccination were identified for children in the 1998–2002 birth cohorts. Methods Data were analyzed for 85,135 children aged 19–35 months in the 2001–2004 National Immunization Surveys. To obtain PCV7 coverage estimates by birth cohorts, a pooled analysis was conducted by combining individual survey years that sampled children with appropriate birth dates. Logistic regression models were used to identify factors associated with age-appropriate vaccination. Results The proportion of children receiving the primary 3-dose PCV7 series by age 12 months increased from 45.5% (±0.6) among children born in 2000 to 62.1% (±0.7) among those born in 2002. By age 24 months, an estimated 30.7% (±0.6), 38.0% (±0.6), and 49.0% (±1.1) of children born in 2000, 2001 and 2002, respectively, had received all four PCV7 doses; however, only 15.0% (±0.4), 16.1% (±0.4) and 24.4% (±0.6) of children were age-appropriately immunized. Among children born in 1998 and 1999, 10.1% ±0.5) and 37.6% (±0.7), respectively, received one or more catch-up doses during their second year of life. Lower age-appropriate PCV7 coverage was independently associated with black race, Hispanic ethnicity, receiving vaccinations from public health providers, and low household income. Conclusions The dramatic reductions in pneumococcal-related diseases from direct and indirect vaccine effects occurred when few children had received the recommended complete vaccine schedule, and there were substantial racial and socioeconomic disparities in coverage.