June 2007, Volume 20, Issue 3,pp.237-344 Editorial introductions vii Editorial introductions. Paediatric and neonatal infections 237 Adverse events following immunization: perception and evidence. Jan Bonhoeffer; Ulrich Heininger 247 Managing congenital syphilis again? The more things change [horizontal ellipsis]. Rana Chakraborty; Suzanne Luck 253 Rotavirus vaccines in developed countries. Jim P Buttery; Carl Kirkwood 259 The burden of influenza in children. Mary Iskander; Robert Booy; Stephen Lambert 264 T cell-based diagnosis of childhood tuberculosis infection. Ajit Lalvani; Kerry A Millington 272 Aseptic meningitis. Bonita E Lee; H Dele Davies Pathogenesis and immune response 278 Herpesviral-bacterial synergy in the pathogenesis of human periodontitis. Jørgen Slots 284 Leptospirosis: pathogenesis, immunity, and diagnosis. Raghavan UM Palaniappan; Subbupoongothai Ramanujam; Yung-Fu Chang 293 Experimental infections with West Nile virus. Richard A Bowen; Nicole M Nemeth 298 The role of superantigens of group A Streptococcus and Staphylococcus aureus in Kawasaki disease. Kousaku Matsubara; Takashi Fukaya 304 Distinction between bacterial and viral infections. Jari Nuutila; Esa-Matti Lilius 311 New concepts in vaccine development in malaria. Bernard N Kanoi; Thomas G Egwang Current World Literature Bibliography 317 Current World Literature. Editorial introductions Current Opinion in Infectious Diseases was launched in 1988. Utah, Dr Stevens com- It is part of a successful series of review journals whose pleted an Infectious Dis- unique format is designed to provide a systematic and ease Fellowship at Brooke critical assessment of the literature as presented in the Army Medical Center in many primary journals. The field of infectious diseases is San Antonio, Texas, and divided into 12 sections that are reviewed once a year. has been Chief of Infectious Each section is assigned a Section Editor, a leading Diseases at the Veterans authority in the area, who identifies the most important Affairs Medical Center in topics at that time. Here we are pleased to introduce the Boise, Idaho since 1979. Journal’s Section Editors for this issue. Dr Stevens is Professor of Medicine at the University of Washington School of Section Editors Medicine; his major clinical interests have been in sta- Paul T. Heath phylococcal and streptococcal toxic shock syndromes, and in skin and soft tissue infections including necrotiz- Paul Heath a is Senior Lec- ing fasciitis and gas gangrene. Dr Stevens’ research turer and Honorary Consult- interests are centered on gram-positive bacteria and ant in Paediatric Infectious the role of extracellular toxins in the pathogenesis Diseases at St George’s of severe soft tissue infection caused by Streptococcus Hospital and St George’s pyogenes, Clostridium perfringens and methicillin-resistant Vaccine Institute, Univer- Staphylococcus aureus. His current research investigates sity of London. He trained the mechanisms of toxin-induced shock and organ dys- in paediatrics and infectious function, and the effects of toxins on endothelial cells, diseases at the Royal Chil- granulocytes and platelets. Dr Stevens is also studying dren’s Hospital, Melbourne, the importance of the mechanisms of action of antibiotics the John Radcliffe Hospital, in treating gram-positive infections. Oxford and St George’s Hos- pital, London. Dr Heath’s Dr Stevens has published over 150 original research particular research interests papers, 60 book chapters, 110 abstracts and two books, are in the epidemiology of vaccine-preventable diseases, Streptococcal Infections: Clinical Aspects, Microbiology and clinical vaccine trials – particularly in at-risk groups – and Molecular Pathogenesis (co-authored with Dr Edward perinatal infections. Kaplan) and An Atlas of Infectious Diseases: Skin and Soft Tissue, Bone and Joint Infections. He has coordinated national surveillance studies on Haemophilus influenzae and Group B streptococcal infec- Dr Stevens is a member of the American Society of tions in British children. He sits on national committees Microbiology, a Fellow in the American College of concerned with meningitis, Group B streptococcus Physicians, a Fellow in the Infectious Disease Society prevention, Pneumococcal and Hib infections, hospital- of America and a member of the Association of American acquired infections, and on vaccination of the immuno- Physicians. In 2000, Dr Stevens received the Infectious compromised host. Disease Society of America’s Society Citation Award, and The William Altemier Award from the Surgical Dennis L. Stevens Infectious Disease Society in 2001. He has served as a consultant for the CDC Working Group on Invasive Group Dr Stevens received his PhD in Microbiology from A streptococcal infections, and for the WHO and NIH on Montana State University and his MD from the similar matters. Dr Stevens is currently Chairman of University of Utah College of Medicine. Following the Infectious Disease Society of America’s Guidelines a residency in internal medicine at the University of Committee on Skin and Soft Tissue Infections. Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Adverse events following immunization: perception and evidence Jan Bonhoeffer and Ulrich Heininger Purpose of review Introduction The aim of this article is to highlight the evidence on new Immunization safety is a real concern because all vaccines and ongoing vaccine safety concerns in the light of several may cause side effects. Both healthcare workers and vaccines recently licensed and others made available and patients need reminding that immunization is an recommended more widely. induced, controlled stimulus to the immune system, so Recent findings some adverse reactions can be expected. Most reactions, There is increasingly convincing epidemiologic and however, are transient and mild. Immunization safety laboratory evidence against a causal relation of several concerns have existed since the day of the first available alleged adverse events following immunization. The vaccine. Since the introduction of Jenner’s cowpox scientific framework to detect and investigate adverse vaccine, however, the benefits of saving children from events following immunization is increasingly robust. tragic outcomes of common diseases outweighed the risks Summary of perceived adverse events following immunization Currently available vaccines are safe in immunocompetent (AEFIs). individuals and there is no evidence to deviate from current immunization schedules. Immunization safety concerns are different from con- cerns about other medical interventions, because they Keywords are administered to generally healthy individuals and the adverse events, immunization, safety tolerance of AEFIs is substantially lower compared to adverse events following medication for an existing ill- Curr Opin Infect Dis 20:237–246. ß 2007 Lippincott Williams & Wilkins. ness. As successful vaccination programs span several generations over time, no doctor, nurse or parent may University Children’s Hospital, Basel, Switzerland have ever seen the prevented diseases. It will be an Correspondence to Dr med Jan Bonhoeffer, Pediatric Infectious Diseases and increasing challenge to communicate the benefits of Vaccines, University Children’s Hospital, Postfach, 4005 Basel, Switzerland E-mail: [email protected] immunization in the apparent absence of disease and the presence of AEFIs, even if mild. Current Opinion in Infectious Diseases 2007, 20:237–246 Abbreviations Also, safety concerns are increasing as the success of AEFI adverse event following immunization immunization systems increases. With a decreasing inci- DTP diphtheria, tetanus, pertussis GBS Guillain-Barre´ syndrome dence of disease, public attention shifts towards AEFIs. ITP idiopathic thrombocytopenia It is then only a matter of time until a concern will be MCV4 tetravalent conjugated meningococcal vaccine MMR measles, mumps and rubella raised and publicized, public confidence might be lost, MS multiple sclerosis immunization rates will then decrease and a resurgence ORS oculo-respiratory syndrome SIDS sudden infant death syndrome of disease is likely to follow. Therefore, maintaining the SMR standard mortality rate success of immunization programs critically relies on public confidence, which is based on public perception. ß 2007 Lippincott Williams & Wilkins Public perception depends on the quality of information 0951-7375 provided. Information about the safety of immunizations needs to be placed on the most rigorous scientific basis possible, because concerns may lead to withdrawal of the product from the market, modification of the pertinent recommendations, or loss of public confidence. Immunization safety concerns often follow a recognizable pattern: the alleged AEFI is a prevalent medical entity of increasing prevalence or unknown cause; the AEFI is suggested to be caused by immunization by some inves- tigators; the methodology of the ‘index study’ (and sub- sequent studies by the same study group) is inadequate (typically poorly or not controlled case series); public communication is made prematurely, resonating with 237 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. 238 Paediatric and neonatal infections individuals suffering from the medical entity, but under- Table 1 Adverse events following immunization for which estimating the potential of harming those who could current scientific evidence does not support the hypothesis