Abstractbook

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Abstractbook

NORDIC
VACCINE
MEETING 2014
#FSHFO/PSXBZ
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NORDIC
VACCINE
MEETING 2014
Bergen, Norway
April 23–25
NORDIC VACCINE MEETING 2014
APRIL 23–25
BERGEN, NORWAY
Published by the Norwegian Institute of Public Health
April 2014
Design and lay-out: Per Kristian Svendsen
Coverphoto: Colourbox.com
Printed by: WJ.NO
Number printed: 250
ISBN: 978-82-8082-622-0 printed edition
ISBN: 978-82-8082-623-7 electronic edition
Welcome to the Nordic
Vaccine Meeting 2014
The Nordic Vaccine Meetings began as an arena for the Nordic countries to discuss polio–
myelitis. The original focus was on vaccine production and participation was limited. The
focus has developed over the years and the scope of the meetings has widened.
This year’s meeting coincides with European Immunisation Week, and their “Immunisation
for life” theme is one of the topics in the scientific programme.
We hope you will enjoy both the scientific and social aspects of the meeting and that you
will take an active part in the discussions. As this is such an important part of the Nordic
Vaccine Meeting, we have set aside more time for discussions than previously.
The Nordic Vaccine Meeting 2014 is arranged by the Norwegian Institute of Public Health.
This is the first time that the meeting has been held in Bergen and we wish you a pleasant
stay here.
Best wishes,
The Organising and Programme Committee
Organising and
Programme Committee
/PSXBZ
Jeanette Stålcrantz (head of organising committee)
Berit Feiring (head of programme committee)
Marianne A. Riise Bergsaker
Susanne G Dudman
Elmira Flem
Inger Lise Haugen
Jorunn Hill
Lisbeth Meyer Næss
Hanne Nøkleby
Per Kristian Svendsen
Berit Sofie Wiklund
Britt Wolden
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Ingrid Uhnoo
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Peter Andersen
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Hanna Nohynek
*TMBOE
Thorolfur Gudnason
CONTACT INFORMATION:
Our professional meeting organiser can be contacted
if you have any practical questions during the meeting:
VIA Egencia Meetings & Incentives
Anita H. Johansen
Phone: +47 55 54 36 19
For questions about the conference and the programme, please do not
hesitate to contact one of the members in the organising and programme committee.
Contents
Organising and Programme Committee _________________________________4
Venue, Reception and Conference Dinner ________________________________6
Programme _______________________________________________________8
Oral abstracts _____________________________________________________11
Poster abstracts ___________________________________________________41
Participants ______________________________________________________64
Venue, Reception
and Conference Dinner
Venue
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Bryggen 5, 5003 Bergen, Norway
http://www.radissonblu.com/royalhotel-bergen/
The Radisson Blu Royal Hotel,
Bergen is centrally located in
the historic Bryggen area,
a UNESCO World Heritage
Site. Bryggen, which means
«wharf», has been the nerve
centre of Bergen for centuries
and thrives as a lively part of
the city. Bryggen is a reminder
:
of the town’s importance
as part of the Hanseatic League’s trading empire from the 14th to the mid-16th century.
Many fires, the last in 1955, have ravaged the characteristic wooden houses of Bryggen.
Their renovation has followed traditional methods to preserve their
main structure, a relic of an ancient
wooden urban style once common
in Northern Europe. Today, 62 buildings remain.
FOTO RADISSON BLU
FOTO: RADISSON BLU
Welcome reception
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The Welcome reception will be held on Wednesday, April
23 at Fløien Folkerestaurant on top of the famous mount
Fløien, 320 metres above sea level. The Fløibanen funicular in
Bergen is one of Norway’s best-known attractions. Fløibanen
can be found in the heart of Bergen, 150 m from Fisketorget
– the fish market – and Bryggen wharf, and it takes just 5
minutes to walk to the lower station from the conference
venue. The journey up to Fløien takes 5–8 minutes. The journey is an experience in itself and at the top you can enjoy
fantastic views over Bergen.
Practical information: Food and drinks will be served. FOTO: COLOURBOX.COM
You will receive a ticket for the funicular along with your
nametag. This is a return ticket so please bring this with you
on the journey both up and
down. The reception starts at
19:30 and Fløibanen runs every
15 minutes. We therefore ask
you to meet at the station by
19:00 in order to catch the 19:00
or 19:15 departure.
Return departures after 19:00 are
on the hour and half-hour, and
the last departure is at 23:00.
Address: Fløibanen AS
Vetrlidsallmenningen 21
5014 Bergen
http://www.floibanen.com
View from Fløien
FOTO: COLOURBOX.COM
Conference dinner
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FOTO: COLOURBOX.COM
The Conference dinner will be held
at the historical Håkon’s Hall, located
5 minutes walk from the conference
venue. The hall is 750 years old and
was built by King Håkon Håkonsson
as a royal residence and banqueting
hall. When his son Magnus Håkonsson Lagabøte married the Danish
princess Ingeborg in 1261, about
2000 guests were invited. “The King
held court in the stone hall” say the
sagas.
At that time Bergen was Norway’s largest and most important town, and Håkon’s Hall was the
site of major national events, such as the drawing up of Norway’s first complete set of laws.
Inside the thick stone walls there are still echoes of the medieval court’s solemn ceremonies
and riotous feasts. As a national cultural monument, Håkon’s Hall is still used for both royal
dinners and other official occasions.
You will receive a ticket for the dinner
along with your nametag. Please bring
this with you to the conference dinner.
Dinner starts at 19:30 on Thursday,
April 24. Dress code is semi-formal.
Address:
Bergenhus Festning
5003 Bergen
FOTO: COLOURBOX.COM
Programme
23 April
13.00
Lunch
14.00 – 14.10
Welcome remarks
John-Arne Røttingen, Norwegian Institute of Public Health, Norway
Session 1 Immunity and age: A need for lifelong vaccination programme?
Chairs: Hanna Nohynek, Finland and Hanne Nøkleby, Norway
14.10 – 15.00
Vaccine immunity in adults of all ages
Richard Aspinall, University of Cranfield, UK
15.00 – 15.30
Resurgence of pertussis in countries with high vaccination coverage
Audun Aase, Norwegian Institute of Public Health, Norway
15.30 – 15.45
Pertussis seroepidemiological survey: A joint Sweden – Norway project
Hans Hallander, Public Health Agency of Sweden, Sweden
15.45 – 16.05
Shingles vaccination programme in England
Mary Ramsay, Public Health England , UK
16.05 – 16.35
Coffee break
16.35 – 16.55
Economic evaluation of varicella immunisation programme in Finland
Heini Salo, National Institute for Health and Welfare, Finland
16.55 – 18.00
Panel discussion: Vaccinating adults: Challenges and strategies – Need for a lifelong vaccination
programme?
Introduction by Hanne Nøkleby, Norwegian Institute of Public Health
Presenters and representatives from the Nordic countries:
Gunnar Nylén, The National Board for Health and Welfare, Sweden
Taneli Puumalainen, Finnish Ministry of Social Affairs and Health, Finland
Haraldur Briem, Directorate of Health, Iceland
Palle Valentiner-Branth, Statens Serum Institut, Denmark
Synne Sandbu, Norwegian Institute of Public Health, Norway
19.30
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24 April
Session 2 Influenza infection and vaccination: Implications for immunity over the life course?
Chairs: Gunnar Nylén, Sweden and Olav Hungnes, Norway
09.00 – 09.25
Immunity and vaccination against influenza in children
Guus Rimmelzwaan, Erasmus Medical Center, The Netherlands
09.25 – 09.40
Use of live attenuated influenza vaccine in children: A clinical trial measuring systemic and local immune
responses
Rebecca Cox, University of Bergen, Norway
09.40 – 10.00
Influenza vaccination in childhood: The Finnish experience
Terhi Kilpi, National Institute for Health and Welfare, Finland
10.00 – 10.20
Influenza vaccination in childhood: Basis for the influenza vaccination programme in England
Mary Ramsay, Public Health England, UK
10.20 – 10.40
Panel discussion: Use of influenza vaccines in children
Tyra Grove Krause, Statens Serum Institut, Denmark
Gunnar Nylén, The National Board for Health and Welfare, Sweden
Terhi Kilpi, National Institute for Health and Welfare, Finland
Marianne A. Riise Bergsaker, Norwegian Institute of Public Health, Norway
10.40 – 11.10
Coffee break
11.10 – 11.40
Universal influenza vaccines: Future prospects
Guus Rimmelzwaan, Erasmus Medical Center, The Netherlands
Session 3 The challenge of preventing meningococcal disease
Chairs: Hans Fredlund, Sweden and Lisbeth M. Næss, Norway
11.40 – 12.00
A new meningococcal B vaccine: Evidence and promise
Svein Rune Andersen, Norwegian Medicines Agency, Norway
12.00 – 12.30
New recommendations for use of meningococcal vaccines in Norway
Lisbeth M. Næss, Norwegian Institute of Public Health, Norway
12.30 – 13.00
Panel discussion: Use of meningococcal vaccines in the Nordic countries
Thorolfur Gudnason, Directorate of Health, Iceland
Hans Fredlund, Örebro University Hospital, Örebro, Sweden
Hanna Nohynek, National Institute for Health and Welfare Finland
Hanne Nøkleby, Norwegian Institute of Public Health, Norway
13.00 – 14.00
Lunch
Session 4 Rotavirus vaccination in the Nordic countries
Chairs: Arto Palmu, Finland and Synne Sandbu, Norway
14.00 – 14.30
Rotavirus infection and vaccination: Basic facts and update
Kari Johansen, European Centre for Disease Control and Prevention, Sweden
14.30 – 14.55
How to measure impact of rotavirus vaccination: Opportunities for synergies across Nordic countries?
Elmira Flem, Norwegian Institute of Public Health, Norway
14.55 – 15.50
Impact of rotavirus vaccination in Finland
Tujia Leino, National Institute for Health and Welfare, Finland
#SJFGTUBUVTGSPNPUIFS/PSEJDDPVOUSJFTt1BOFMEJTDVTTJPO
Peter Henrik Andersen, Statens Serum Institut, Denmark
Ann Lindstrand, Public Health Agency of Sweden, Sweden
Elmira Flem, Norwegian Institute of Public Health, Norway
15.50 – 16.20
Coffee break
Session 5 Immunisation registries: A gold mine for vaccinologists
Chairs: Peter Henrik Andersen, Denmark and Berit Feiring, Norway
16.20 – 16.50
Scope and limitations of register based research
Lill Trogstad, Norwegian Institute of Public Health, Norway
16.50 – 17.05
Utilization of an electronic immunisation registry in Iceland – pitfalls and opportunities
17.05 – 17.20
Register-based monitoring of the Swedish HPV vaccination programme
Ingrid Uhnoo, Public Health Agency of Sweden, Sweden
17.20 – 17.35
Finnish National Vaccine Register - ten years in the making
Jukka Jokinen, National Institute for Health and Welfare, Finland
17.35 – 17.50
The Danish Vaccination Register – a never-ending story
Tyra Grove Krause, Statens Serum Institut, Danmark
17.50 – 18.00
Discussion
19.30
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25 April
Session 6 Challenges and strategies to handle communication hurdles
Chairs: Robb Butler, WHO, Denmark and Marianne A. Riise Bergsaker, Norway
09.00 – 09.30
Vaccine Acceptance: The role of risk communication
Robb Butler, World Health Organization, Denmark
09.30 – 09.50
Blogger views on immunisation-related topics
Gunnar Tjomlid, Norway
09.50 – 10.10
How to handle communication about signals of unexpected adverse events and deal with rumours?
Henrik G. Jensen, Danish Health and Medicines Authorithy, Denmark
10.10 – 10.30
Tailoring Immunization Programmes: An example from Sweden
Ann Lindstrand, Public Health Agency of Sweden, Sweden
10.30 – 10.50
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10.50 – 11.50
Vaccine communication in the Nordic countries: Strategies and channels
All Nordic countries
Madeleine Danielsson, The National Board for Health and Welfare, Sweden
Hanna Nohynek, National Institute for Health and Welfare, Finland
Peter Henrik Andersen, Statens Serum Institut, Denmark,
Ellen Furuseth and Ingunn Johansen Brenne, Norwegian Institute of Public Health, Norway
Session 7 News from the Nordic countries
Chairs: Tyra Grove Krause, Denmark and Britt Wolden, Norway
11.50 – 12.50
Current keypoints and emphasis in the Icelandic National Vaccination Program
News from the Danish Childhood Vaccination Programme
PCV10 impact on non-laboratory-confirmed IPD
Arto Palmu, National Institute for Health and Welfare, Finland
New organization of Public Health in Sweden
Anders Tegnell, Public Health Agency of Sweden, Sweden
Vaccinations in the childhood immunisation programme in Norway: are we on time?
Øystein Riise, Norwegian Institute of Public Health, Norway
12.50 – 13.00
Concluding remarks
Hanne Nøkleby, Norwegian Institute of Public Health, Norway
13.00
Lunch
Oral abstracts
APRIL 23
SESSION 1
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Richard Aspinall
Cranfield University, UK
The protection from infectious diseases provided by vaccines developed since the beginning of the 20th
century has prevented the death and/or disability of millions of children across the world. The success
of vaccines and vaccination schemes in the eradication of disease has led to them being considered key
tools in the maintenance of public health.
One of the most important considerations is that the vaccine development strategy has mainly been
driven by the aim to eradicate communicable diseases in children and in vulnerable younger adults. But
in a few short years the number of children globally will soon be surpassed by the number of adults over
the age of 65. The active lifestyle of these older adults, the ease and ready availability of both national and
international travel and the degree of immune deficiency recognised within this older population may
lead to a change in the number and type of diseases affecting this population of older adults.
The protection of older individuals through vaccination schemes needs to take into account the age
related changes in immunity which can lead to poorer responses both to infection and to vaccination.
The challenge for those involved in primary healthcare is how to protect this population from communicable diseases and keep them healthy, autonomous and independent using vaccines which in the main
were developed for use on children and young adults.
APRIL 23
SESSION 1
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Audun Aase
Norwegian Institute of Public Health, Norway
Many countries experience a resurge of pertussis in spite of high vaccination coverage. There has been a
particular increase in the reported incidence of pertussis in adolescent and adults the last years and these
groups are a significant reservoir of infection. The increase is likely attributed to a number of different
factors, like: increased clinical awareness, improved diagnostics, suboptimal acellular pertussis vaccines,
that all may contribute. In addition, new pertussis variants have been identified that harbors mutations in
virulence factors, possibly as an adaptation to extensive vaccination. Several new pertussis isolates lacking vaccine antigens like pertactin or pertussis toxin, or displaying other vaccine-antigen related mutations, have shown up in many countries with long history of vaccination (vaccine escape mutants). New
B. pertussis variants that bear mutations in the pertussis-toxin promotor gene leading to higher pertussis
toxin production and thus becoming more virulent have also been identified. These variants have totally
substituted previous variants in countries with long vaccination history. In several European countries
pertactin-deficient strains range from 3-20% of the clinical isolates, and a Japanese study report 27% of
the strains lack pertactin. There has also been an increase in B.holmesii, which may cause pertussis-like
symptoms, against which the existing vaccines do not protect. The new emerging strains really challenge the effectiveness of the today’s acellular pertussis (aP) vaccines. Indeed, recent studies from USA
and Australia indicate that effective whole cell pertussis vaccine gives longer-lasting protection than the
aP vaccines, provided it is given as the first dose. Consequently, there is a need for improved pertussis
vaccines, e.g. using genetically modified pertussis toxin, using vaccines containing more diverse antigen
compositions, using detoxified whole cell vaccine, outer membrane vesicle vaccines, or by using live attenuated B. pertussis given intra-nasally. New vaccination strategies have also been given much attention
like vaccination of adolescents, pregnant woman, neonatal vaccination, and various cocooning strategies.
APRIL 23
SESSION 1
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Hans Hallander1, Audun Aase2, Tove Herstad2, Margaretha Ljungman1, Lena Wehlin1, Ilias Galanis1,
Sharon Kuhlmann-Berenzon1
1
The Public Health Agency of Sweden, 2 Norwegian Institute of Public Health
Norway showed an almost 30-fold higher incidence per 100 000 of reported pertussis disease in 2012
compared to Sweden. In Norway single serum diagnostic serology was used in 40% of the cases. Swedish
notifications are mainly based on PCR/culture. The vaccination programs are similar but in Sweden there
was a vaccination break during the period 1979-1996, while in Norway vaccination of adults is more
common.
The aim of this study was to use a harmonized seroprevalence study for comparison of antigen pressure
in Sweden and Norway, using IgG anti-PT as marker.
Anonymized leftover serum samples (in Sweden n= 3619 and in Norway n=3060) were collected at laboratories for clinical chemistry
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There was significantly higher prevalence of recent infection in a Norwegian cohort of 16-29 year-olds
than in the same Swedish age-group (p=<0.01) at both cut-off points, ≥100 IU/ml 8.2% vs 1.4%. This
Swedish age-group was not vaccinated but most probably infected with pertussis during childhood. By
contrast corresponding Norwegian age-group was vaccinated with a whole cell vaccine.
In the age group ≥34 years, that was least biased by vaccination effects, there was no significant difference in the last year (p-value=0.20). This indicates that the antigenic pressure from circulating B. pertussis
is similar in the two countries.
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A downward trend of recent infection up to 18-19 years of age in a Swedish unvaccinated cohort and an
upward trend in a Norwegian vaccinated cohort already at the age of 12-13 years indicates that natural
infection may provide protection for 15-20 years and vaccination immunity for 3-5 years.
APRIL 23
SESSION 1
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Mary Ramsay1, Iain Kennedy1, Philip Keel1, Albert Jan Van Hoek1, Kevin Brown2
1
Immunisation Department, Public Health England, 2Virus Reference Department, Public Health England
In September 2013, the UK introduced a shingles vaccination programme for 70 year olds. The incidence
of shingles increases with age with the highest rate of complications in those aged over 85 years, where
around 5% of those affected are admitted to hospital. The mortality in those over 85yrs is 4.3 per 100,000.
Given the poor response to vaccination in older age groups, however, the optimal age for the UK programme was selected with the aim of providing protection in those with the greatest ability to benefit
but prior to the highest risk for shingles. This was based on modelling and economic analysis, although
there was considerable uncertainty around age specific efficacy and duration of protection. A catch-up
programme for 71-79 year olds was also phased in, commencing with those aged 79 years.
The vaccine was supposed to be delivered in general practice alongside the seasonal influenza programme, but stock shortages during October and November curtailed initial uptake. Vaccine coverage is
being monitored by automated extracts from GP information systems. By the end of January 2014, however, over 45% of the target age groups had received vaccine. Enhanced surveillance is being conducted
via existing primary care research networks and in pain clinics.
APRIL 23
SESSION 1
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Heini Salo, Tuija Leino, Jukka Ollgren, Kari Auranen, Petri Tiihonen, Terhi Kilpi
National Institute for Health and Welfare, Finland
#BDLHSPVOEVaricella zoster virus infection causes varicella (primary infection) and herpes zoster
(reactivation of latent infection). Lack of natural exposure to varicella under large-scale vaccination with
the varicella vaccine may increase the incidence of zoster in the unvaccinated cohorts.
0CKFDUJWF To assess the cost-effectiveness of a two-dose varicella immunisation programme in Finland,
including potential catch-up of all 1.5–12-years-olds and taking into account the potential impact of
varicella vaccination on zoster.
.FUIPET A dynamic transmission model was used to predict the burden of varicella and zoster.1 Serological data on varicella infection, case-notification data on zoster, and data on close contacts were used.
We followed birth cohorts of 57000 infants for 100 years after the onset of vaccination. We estimated the
number of varicella and zoster cases with and without varicella vaccination programme by each year
since programme onset. Health care resource use was estimated from register data. The analysis was
conducted both from the payer and societal perspective.
3FTVMUTThere were annually 56300 cases of varicella and 9000 cases of zoster. Without vaccination the
estimated annual health care provider costs of varicella and zoster were 1.9 and 3.7 MEUR, respectively.
The vaccination programme would prevent almost all varicella cases within a few years, and during the
first 10 years the vaccination programme would annually save 1.8 MEUR in health care costs and 12 MEUR
in productivity costs. The varicella vaccination programme was projected to increase the incidence of
zoster for some 30 years. The cost per QALY was 10700 - 15500 EUR, when the price per dose ranged from
30 to 40 EUR.
$PODMVTJPOT A two-dose vaccination programme with catch-up, taking into account its potential impact
on zoster, was cost-effective from a payer’s perspective and cost saving from the societal perspective.
1
Karhunen M, Leino T, Salo H, Davidkin I, Kilpi T, Auranen K. Modelling the impact of varicella
vaccination on varicella and zoster. Epidemiol Infect. 2010;138(4):469-81.
APRIL 23
SESSION 1
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Hanne Nøkleby
Norwegian Institute of Public Health, Norway
Thanks to well performing vaccination programs several common diseases have almost disappeared.
But vaccine immunity in childhood may not be sufficient to keep them away. Population immunity must
be maintained throughout life. The most obvious example is pertussis, where we have already seen the
resurgence of disease in adults due to limited duration of vaccine protection. The immunity induced by
vaccines against measles and rubella lasts longer, but the fully vaccinated cohorts, who have not been exposed to natural boosting, have only recently reached adult age. Following these cohorts to see if protection really is life-long, as we believed when the programs were started, will be important.
Other diseases mostly affect older persons. As we all want to live long and stay healthy, vaccination
against such diseases will be important. Influenza and pneumococcal vaccines are recommended in
most countries. Herpes zoster vaccine is available. What about vaccines against infections older people
meet on their exotic travels, or antibiotic resistant microbes that thrive in health care settings? A life-long
vaccination program may become an important tool to keep the population healthy and the health care
expenses at an acceptable level in the years to come.
SESSION 2
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Guus F. Rimmelzwaan
Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
APRIL 24
For the induction of protective immunity against seasonal influenza, commonly inactivated vaccine preparations are used. These vaccines are highly efficacious provided that the vaccine strains antigenically
match the epidemic strains. The use of these inactivated seasonal influenza vaccines affords little or no
protection against antigenically distinct influenza viruses, including potentially pandemic influenza A viruses of novel subtypes. It has been demonstrated in animal models and humans that natural influenza A
virus infection induces a certain degree of protective immunity against antigenically distinct (pandemic)
influenza viruses, including those of other subtypes, so called heterosubtypic immunity1-3. Virus-specific
CD8+ T cells are highly cross-reactive4-6 and contribute to this type of immunity3,8,9. In theory, prevention
of infection of immunologically naïve subjects, e.g children10, by the use of inactivated vaccines could also
prevent the induction of virus specific CD8 + T cell and heterosubtypic immunity11. We tested this hypothesis in mice and man and concluded that indeed the use of inactivated influenza vaccine may hamper
the induction of heterosubtypic immunity, otherwise induced by natural infection with seasonal influenza viruses12-15. Ideally, influenza vaccines induce more broadly protective immunity against viruses of
various subtypes. Recent research aims at defining conserved viral proteins or conserved regions of viral
proteins as targets for cross-protective humoral and cellular immune responses to aid the development
of more broadly protective vaccines. Especially immunologically naïve individuals such as children <5
years of age may benefit from these vaccines the most.
References
1. Kreijtz et al. Primary influenza A virus infection induces cross-protective immunity against a lethal infection with a heterosubtypic virus strain
in mice. Vaccine. 2007 25(4):612-20.
2. Kreijtz et al. Infection of mice with a human influenza A/H3N2 virus induces protective immunity against lethal infection with influenza A/
H5N1 virus. Vaccine. 2009 27(36):4983-9.
3. Sridhar et al. Cellular immune correlates of protection against symptomatic pandemic influenza. Nat Med. 2013 19(10):1305-12.
4. Hillaire et al. Human T-cells directed to seasonal influenza A virus cross-react with 2009 pandemic influenza A (H1N1) and swine-origin triplereassortant H3N2 influenza viruses. J Gen Virol. 2013 94:583-92.
5. van de Sandt et al. Human cytotoxic T lymphocytes directed to seasonal influenza A viruses cross-react with the newly emerging H7N9 virus. J
Virol. 2014 88(3):1684-93.
6. Kreijtz et al. Cross-recognition of avian H5N1 influenza virus by human cytotoxic T-lymphocyte populations directed to human influenza A
virus. J Virol. 2008 82(11):5161-6.
7. Hillaire et al. Cross-protective immunity against influenza pH1N1 2009 viruses induced by seasonal influenza A (H3N2) virus is mediated by
virus-specific T-cells. J Gen Virol. 2011 92:2339-49.
8. Hillaire et al. Characterization of the human CD8 T cell response following infection with 2009 pandemic influenza H1N1 virus. J Virol. 2011
85(22):12057-61.
9. Hillaire et al. Induction of virus-specific cytotoxic T lymphocytes as a basis for the development of broadly protective influenza vaccines. J
Biomed Biotechnol. 2011;2011:939860.
10. Bodewes et al. Prevalence of antibodies against seasonal influenza A and B viruses in children in Netherlands. Clin Vaccine Immunol. 2011
18(3):469-76.
11. Bodewes et al. Yearly influenza vaccinations: a double-edged sword? Lancet Infect Dis. 2009 9(12):784-8.
12. Bodewes et al. Vaccination against human influenza A/H3N2 virus prevents the induction of heterosubtypic immunity against lethal infection
with avian influenza A/H5N1 virus. PLoS One. 2009;4(5):e5538.
13. Bodewes et al. Vaccination with whole inactivated virus vaccine affects the induction of heterosubtypic immunity against influenza virus A/
H5N1 and immunodominance of virus-specific CD8+ T-cell responses in mice. J Gen Virol.2010 91:1743-53.
14. Bodewes et al. Vaccination against seasonal influenza A/H3N2 virus reduces the induction of heterosubtypic immunity against influenza A/
H5N1 virus infection in ferrets. J Virol. 2011 85(6):2695-702.
15. Bodewes et al. Annual vaccination against influenza virus hampers development of virus-specific CD8Ά T cell immunity in children. J Virol.
2011 85(22):11995-2000.
SESSION 2
64&0'-*7&"55&/6"5&%*/'-6&/[ "7"$$*/&*/$)*-%3&/"$-*/*$"-53*"-
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K G-I Mohn1, G Bredholt1, H J Aarstad2, R Pathirana1, K Brokstad3, R J Cox1,4
1
The Influenza Centre, Department of Clinical Science, University of Bergen, Norway, 2Department of Clinical Medicine, Head and Neck surgery, Haukeland University hospital, Bergen, Norway, 3Broegelmann Research Laboratory,
Department of Clinical Science, University of Bergen, Norway, 4Department of Research and Development, Haukeland University Hospital, Bergen, Norway
APRIL 24
#BDLHSPVOEBOEPCKFDUJWFThe live attenuated influenza vaccine (LAIV) was approved for prophylaxis
in European children in 2012. LAIV is administered as a nasal spray and elicits protection of the upper respiratory tract where the tonsils are important in activating an influenza specific immune response. In this
clinical study, we have vaccinated children undergoing elective tonsillectomy to investigate the systemic
and local immune responses after vaccination.
.BUFSJBMTBOE.FUIPETFifty-eight children aged 2-17 years old, scheduled for elective tonsillectomy,
were recruited from the Ear-Nose-Throat clinic at Haukeland University Hospital in Bergen, Norway.
Thirty-nine children were immunised with seasonal LAIV at 3, 7 or 14 days prior to tonsillectomy, of whom
30 children received 2 doses of vaccine. Sixteen children were controls. Blood and saliva samples were
collected prior to, 28 and 56 days after vaccination and at the time of tonsillectomy. Lymphcoytes were
separated from the blood and tonsils for investigating the humoral and cellular immune response. The
serological response was measured by haemagglutinin inhibition assay.
3FTVMUTThe vaccine was generally well tolerated, with few side reactions, with 44% of children reported
no reactions. A significant increase in Th1 CD4+ T cells was observed after the second vaccine dose.
Young children who had not previously been naturally infected with influenza showed increased B cell
responses after vaccination.
$PODMVTJPOTThe LAIV nasal spray was well tolerated in children and induces a systemic and local
immune response against all three vaccine viruses. This vaccine may represent a good needle free alternative for immunisation of high-risk children against seasonal influenza in Europe.
SESSION 2
*/'-6&/[ "7"$$*/"5*0/*/$)*-%)00%5)&'*//*4)&Y 1&3*&/$&
Terhi Kilpi, Ulrike Baum, Jukka Jokinen, Mika Lahdenkari, Jonas Sundman, Tuija Leino, Heini Salo,
Hanna Nohynek
Department of Vaccination and Immune Protection, Division of Health Protection, National Institute for Health
and Welfare (THL), Helsinki, Finland
APRIL 24
Background
Trivalent influenza vaccine (TIV) for children from 6 to 35 months of age was introduced in the national
vaccination programme in Finland in 2007. Before introduction, we estimated that with 60% effectiveness, TIV programme would be cost-saving in children up to 14 years of age(1). This still holds true for a
vaccine price of about 3 €/dose. We have now evaluated the success of the programme in terms of vaccination coverage and effectiveness.
Methods
Until 2012, seasonal influenza vaccine coverage was calculated using aggregated reports or data retrieved retrospectively from the health care center (HCC) databases. Since 2012, coverage estimates have
been calculated using a newly established National Vaccination Register (NVR), which continuously collects vaccination records from HCC. The effectiveness estimates were produced by linking the individual
NVR data to the laboratory-confirmed cases of influenza notified to the National Infectious Disease Register from public and private primary health care settings and hospitals. Full NVR and the corresponding
influenza case data were available from approximately half of the population.
Results
Prior to the pandemic, TIV coverage ranged seasonally between 21.6% and 43.2% in children aged 6 to
35 months, but dropped to 20.5% in 2010-2011, 13.2% in 2011-2012, 13.7% in 2012-2013, and 15.9% in
2013-2014. The effectiveness estimates against all influenza were 74.9% (95% CI 46.8-88.2) and 70.0%
(41.4-84.6) for the seasons 2012-2013 and 2013-2014, respectively. The corresponding figures were 83.2%
(54.8-93.8) and 68.5% (38.6-83.9) for all influenza A, 100.0% (-900.0-100.0) and 100.0% (-900.0-100.0) for influenza A(H1N1), and 26.9% (-137.9-77.6) and 100.0% (-900.0-100.0) for influenza B.
Conclusions
In the postpandemic, postnarcoleptic era, seasonal influenza vaccine coverage has fallen in children, although vaccine effectiveness has been quite satisfactory. Continuous monitoring of vaccine effectiveness
and efficient communication of the findings are essential in motivating parents to have their children
vaccinated against influenza.
Reference
1. Salo H, Kilpi T, Sintonen H, Linna M, Peltola V, Heikkinen T. Cost-effectiveness of influenza vaccination of healthy children. Vaccine
2006;24:4934-41.
SESSION 2
*/'-6&/[ "7"$$*/"5*0/*/$)*-%)00%#"4*4'035)&*/'-6&/[ "7"$$*/"5*0/130
(3"..&*/&/(-"/%
Mary Ramsay1, Joanne Yarwood1, Louise Letley1, Tom Skrinar1, Marc Baguelin1, Richard Pebody2
1
Immunisation Department, Public Health England, UK, 2Respiratory Department, Public Health England, UK
APRIL 24
In 2000, the UK selective influenza vaccination programme was extended to include all people aged
65 years or over. Vaccine coverage among those has been close to 75% since 2005/6 whereas coverage
in high-risk individuals under 65 years has remained at around 50% since 2008/9. Virological, clinical,
epidemiological, and behavioural data were used to develop an age- and risk-stratified influenza transmission model of influenza over 14 seasons, having accounted for the vaccination uptake in the existing
programme. The model suggested that while the vaccination of the population at highest risk did significantly reduce mortality, it had little effect on transmission. The study found that targeting transmitters
by extending the programme to 5–16-yr old children would increase the cost-effectiveness of the total
programme, even with modest coverage (30%). Based on this and other evidence, JCVI therefore recommended a programme to vaccinate all 2-17 year olds using the live attenuated vaccine. The plan is to roll
the programme out over four to five years, allowing time to increase capacity. As healthy children under
5 years of age had the highest influenza attributable hospital admission rates, in 2013/14 the programme
commenced by vaccinating 2 and 3 year olds in primary care. Primary school children (aged 5-10 years)
were also targeted in seven pilot areas. Coverage rates approaching 40% were reached in primary care;
around 50% coverage was achieved in primary school. The nasal vaccine was highly accepted by parents
although concerns about porcine gelatine were expressed in areas with high Muslim populations. Longer
term plans for further roll out are being developed.
SESSION 3
"/&8.&/*/(0$0$$"-#7"$$*/&&7*%&/$&"/%130.*4&
Svein Rune Andersen
Norwegian Medicines Agency, Norway
APRIL 24
Vaccines against group A, C W-135 and Y based on the capsular polysaccharides have been available since
the late 60-ies, either as polysaccharide vaccines or conjugate vaccines. The fact that the group B capsular
polysaccharide is not immunogenic has led to the search for alternative sub-capsular vaccine antigens.
Vaccines against group B based on outer membrane vesicles (OMV) have previously been found to be
efficacious (Norway, Cuba, New Zealand, & Normandy, France) in clonal outbreak situations. However, due
to the high variability in the antigens in the outer membrane of the meningococci it has been challenging to develop vaccines which offer broader protection.
Bexsero is the first broad protective vaccine against group B meningococcal disease. It was granted marketing authorisation in EU/EEA in 2013.The vaccine contains three relatively conserved outer membrane
proteins: factor H binding protein (fHbp, 936-741), Neisseria adhesin (NadA, 961c), Neisserial Heparin
binding protein (NHBA, 287-953). Bexsero also contains outer membrane vesicles (OMV) derived from the
New Zealand epidemic strain (NZ 898/254). The conserved proteins were identified by applying the socalled reversed vaccinology technology, which involves decoding of the genetic make-up to identify the
conserved outer membrane proteins which successively were tested for capacity to induce a protective
antibody response in animal models.
Protection against meningococcal disease is primarily based on complement mediated bacteriolysis induced by serum antibodies binding to bacterial surface components. As clinical protection trials were not
considered a feasible option, serum bactericidal activity has been accepted by the regulatory authorities
as a valid surrogate for predicting the clinical efficacy of serogroup B meningococcal vaccines.
Assessment of the clinical performance of Bexsero is complicated by the fact that the protective capacity
is dependent of the frequency of circulating strains expressing one or more of the targeted surface proteins. An assay (MATS) has been developed to help monitoring the frequency and expression level of the
vaccine antigens among circulating strains. Currently available information indicates Bexsero could offer
protection against approximately 80% of the European strains. However, a more exact beneficial effect of
Bexsero will not be possible to conclude on until post-marketing efficacy studies are available.
The current knowledge on immunogenicity and adverse reactions, as well as currently unanswered questions related to Bexsero will be discussed.
SESSION 3
/038&(*"/3&$0..&/%"5*0/4'0364&0'.&/*/(0$0$$"-4&30(3061#7"$$*/&
"/%5&53"7"-&/5"$:8$0/K 6("5&7"$$*/&4
Lisbeth M. Næss, Hans Blystad, Dominique A. Caugant, Elmira Flem, Inger Lise Haugen, Hanne Nøkleby, Synne
Sandbu, Ingeborg S. Aaberge, Jann Storsæter.
Division of Infectious Disease Control, Norwegian Institute of Public Health (NIPH), Oslo, Norway
APRIL 24
Meningococcal disease is a life-threatening disease caused by the bacterium Neisseria meningitidis. Case
fatality rate is about 10% and 10-20% of survivors are left with permanent sequelae, such as loss of limbs
and neurological disorders. There are 12 serotypes, with six, A, B, C, Y, W and X causing the majority of
disease. The incidence of meningococcal disease in the Nordic countries is low. In Norway the incidence
was 0.5 per 100, 000 in 2012 with the majority of cases being in children < 5 years of age and in teenagers
aged 15-17 years.
Norway experienced a serious serogroup B epidemic in the 1980s and B has been the dominating serogroup for decades, but in recent years there has been a relative increase in serogroup C, Y and W cases
warranting a new vaccination strategy.
Recently, tetravalent conjugate vaccines against serogroup A, C, Y and W meningococcal disease, providing improved immunogenicity, have replaced plain polysaccharide vaccines. In addition, Bexsero, the first
meningococcal vaccine showing broad protection against serogroup B disease was approved in Europe
in 2013.
The availability of tetravalent conjugate vaccines and the new B vaccine led to the need for a revision of
guidelines for use of meningococcal vaccines in Norway. An expert group was appointed at NIPH in 2013
to evaluate the documentation of efficacy/effectiveness for the new meningococcal vaccines, to define
risk groups and to develop new recommendations for use of these vaccines. The new recommendations
will be presented.
SESSION 4
305"7*364*/'&$5*0/"/%7"$$*/"5*0/#"4*$'"$54"/%61%"5&
Kari Johansen
European Centre for Disease Prevention and Control, Sweden
Rotaviruses may cause severe febrile acute gastroenteritis leading to dehydration in need of acute
rehydration.
APRIL 24
In a 1-year prospective cohort study conducted in Sweden (n=604) a minimum incidence of hospitalisation of 388 per 100,000 was observed, with significant variability between study regions ranging from
280 to 542 per 100,000. Median age of hospitalised children was 14 months and mean total duration of
diarrhoea was 6.9 days. For 68% of hospitalised children a temperature of >38.5 ºC was reported. Complications occurred in >10% of the children, with hypertonic dehydration (32/604) and generalised seizures
(10/604) occurring most frequently. Overall G1[P8] was most prevalent in all study regions (77%), while
the most varied pattern was observed in the western region with G1[P8] observed in 61%, G4[P8] in
13%,G9[P8] in 10%, G2[P4] in 8%, and G3[P8] in 8% of the children. Presence of rotavirus RNA (NSP3) in
serum was observed in >95% of investigated children; geometric mean concentration of rotavirus RNA of
1,999 genome equivalents/mL (95%CI 1585; 2520). At least one additional family member in ~50% of
investigated households of hospitalized children excreted rotavirus. Care providers were absent from
work on average 5 days per hospitalised child, 4 days due to rotavirus-induced gastroenteritis in the child
and one day due to gastroenteritis in care provider.
Two oral vaccines (RV1 and RV5) are authorised and available in the EU/EEA since 2006. Post-authorisation
effectiveness studies suggest promising vaccine effectiveness against severe disease ranging from 70% to
almost 100%. Post-authorisation safety studies conducted in non-EU countries (Australia, Brazil, Mexico,
and the US) indicate a small age-dependant increased risk of intussusception during the first 7 days
following dose 1 for both vaccines, ranging between 1 per 14,000 to 1 per 199,000 vaccinated infants.
An increasing number of EU/EEA countries are now introducing rotavirus vaccines into their routine
immunization programmes. Surveillance for intussusception is strongly recommended to exclude a
higher incidence following vaccination in the EU/EEA.
SESSION 4
)0850.&"463&*.1"$50'305"7*3647"$$*/"5*0/0110356/*5*&4'034:/&3(*&4
"$3044/03%*$$06/53*&4
Elmira Flem
Department of Vaccines, Norwegian Institute of Public Health, Norway
APRIL 24
Several European countries have recently introduced rotavirus vaccination in childhood immunization
programs. Among Nordic countries, Finland, Norway, and Sweden are those where rotavirus vaccines
are either already included or will be included in the immunization programs in the nearest future. This
represents an opportunity to measure public health impact of rotavirus vaccination both at the national
and regional levels. The goals of such evaluation are to 1) document short- and long-term impact of the
vaccination program on the burden of disease, 2) assess indirect population effects of vaccination such as
herd protection, and 3) identify potential risk factors for primary vaccine failure or predictors of reduced
vaccine performance. Using Norway as an example, several approaches to measure the impact and effectiveness of rotavirus vaccination will be presented, and opportunities for synergies across the Nordic
countries will be explored.
SESSION 4
*.1"$50'305"7*3647"$$*/"5*0/*/'*/-"/%
Tuija Leino1, Jukka Ollgren1, Heini Salo1, Markku Kuusi2, Ulpu Elonsalo1 and Merja Roivainen2
1
Department of Vaccination and Immune Protection, 2 Department of Infectious disease surveillance and control,
Division of Health Protection, National Institute for Health and Welfare (THL), Helsinki, Finland
APRIL 24
Background
Rotavirus (RV) vaccine was included into the national immunisation programme in September 2009. This
study estimates the impact of RV immunisation programme on number of cases registered to National
Infectious Disease Register (NIDR), on the total hospital treated acute gastroenteritis (AGE) burden, as well
as, on severe RV disease burden in Finland during the first years after immunisation programme introduction. The safety of RV vaccine is studied also.
Methods
The RV related disease outcomes as well as diagnoses related to safety (e.g. Kawasaki sdr, Intussusception) were based on data registered in the National Hospital Discharge Register using ICD 10 codes.
Incidences of hospitalised and hospital outpatient cases of AGE and RVGE as well as diagnoses related to
safety were compared prior (1999–2005) and after (2010-12) the start of the programme among children
under 5 years of age. ICD 10 codes utilised in effectiveness study were A00-A09, R11 and K52. Incidence of
RV cases registered to NIDR were compared before and after programme introduction.
Results
The reductions in disease burden, when the post-introduction years were compared to pre-vaccine era,
were 87% (95% CI 85–90) in hospital inpatient RVGE among toddlers at 1 year of age and 67%
(95% CI 65–69) when the total inpatient AGE burden was considered. For the corresponding hospital
outpatient cases the reductions were 82% (95% CI 68–91) and 22% (18–25). The reported incidence of RV
based on NIDR among children < 5years of age was 44/100 000 i.e. 1/10 of the burden prior immunization
(460/100 000).
Discussion
During the first post-vaccination years, RV immunisation programme clearly managed to control the
severe, hospital treated, forms of RVGE. The total disease burden is a more valuable end point than mere
diagnosed cases as laboratory confirmation practices change after vaccine introduction1.
Reference
1. Tuija Leino; Jukka Ollgren; Heini Salo; Petri Tiihonen; Terhi Kilpi. First year experience of rotavirus immunisation programme in Finland. Vaccine
2012;31(1):176-82.
SESSION 5
65*-*[ "5*0/0'"/&-&$530/*$*..6/*[ "5*0/3&(*453:*/*$&-"/%
1*5'"--4"/%0110356/*5*&4
Thorolfur Gudnason
Directorate of Health, Iceland
Central registry of vaccinations has been available in Iceland since 2007 and contains information on all
childhood vaccinations as well as information on most adult and travellers vaccinations from 2002. Before
2007, information on vaccinations was only obtainable at the sites where they were carried out.
APRIL 24
The electronic immunization registry is an electronic real time interactive central database which contains
information on personal identifiers of the vaccinees, the date and site of vaccination, the ATC/HL7 number and brand names of the vaccines and individual refusal of vaccinations.
The immunization registry is currently being used to measure vaccination coverage, evaluate programs
at different sites and to obtain lists of un- and partially vaccinated children. The potential utilization of the
registry includes estimation of vaccine efficacy, monitoring adverse effects, refusal of vaccinations and
cost, and opportunities for individuals to check their own immunization status on-line.
Central electronic immunization registries are costly and need continous monitoring for technical and
human errors (quality control). Individual privacy issues may also be of concern which may conflict with
official legal obligations.
Central immunization registries provide the optimal tool to improve vaccination coverage and eliminate
vaccine preventable diseases.
SESSION 5
3&(*45&3#"4&%.0/*503*/(0'5)&48&%*4))177"$$*/"5*0/130(3"..&
Ingrid Uhnoo1, Eva Netterlid1, Joakim Dillner2, Lisen Arnheim-Dahlström3, Pär Sparén3
1
The Public Health Agency of Sweden, Stockholm, 2Departments of Laboratory Medicine, Medical Epidemiology and
Biostatistics, Karolinska Institute, Stockholm, Sweden, 3Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
APRIL 24
Background: Prior to the approval of the first HPV vaccine in 2006, a OBUJPOBM)17JNNVOJ[BUJPOTZTUFN
4WFWBD
was established in Sweden. Informed consent was required for registration of vaccinations. In
January 2013 UIF4XFEJTI/BUJPOBM7BDDJOBUJPO3FHJTUFS with mandatory registration of vaccinations
was started. During 2007-2011 Sweden had a partially subsided opportunistic HPV vaccination program
for girls 13-17 years. In 2012 the national vaccination program targeting girls 10-12 years was launched
including a catch-up program up to 18 years of age.
Methods: A national HPV vaccination monitoring program was developed in 2012 in a collaboration between the Public Health Agency and the Karolinska Institute. A prequisite for estimating the impact of the
HPV program was the establishment of the HPV vaccination register including consent for linkage with
health data registries and biobanks. A major component of the monitoring program is register linkages of
the HPV vaccination register with patient registries, pharmaceutical registries and The Swedish National
Quality Register on Cervical Cancer Prevention.
Results: Several register-based national cohort studies assessing the impact of the opportunistic HPV
vaccination program have been performed. The studies have shown that the incidence of genital warts
among young women has decreased significantly, that the effectiveness of qHPV vaccine was 93 %
in girls vaccinated before 14 years of age and that 3 vaccine doses was more effective than 2 doses in
reducing the condyloma risk. In a large safety study in Sweden and Denmark no association of the qHPV
vaccine with autoimmune and neurological adverse events was found in adolescent girls. Other ongoing
register-based studies include assessment of vaccine effectiveness against cervical lesions and participation of HPV vaccinated women in a national cervical screening program.
Conclusions: The experience of the Swedish HPV vaccination surveillance system has by extensive use of
register linkages provided early and important data to support the safety and effectiveness of the vaccination program.
SESSION 5
'*//*4)/"5*0/"-7"$$*/"5*0/3&(*45&35&/:&"34*/5)&.",*/(
Jukka Jokinen, Jonas Sundman, Ulrike Baum, Susanna Jääskeläinen, Esa Ruokokoski, Tuija Leino,
Hanna Nohynek, Terhi Kilpi
Department of Vaccination and Immune Protection, National Institute for Health and Welfare (THL), Finland
APRIL 24
Background
The importance of National Vaccination Register (NVR) in Finland has been identified for over a decade.
However, due to regional management of health-care services in Finland, and variety of patient-recording
systems, compiling vaccination records on a nation-wide level has proven to be particularly difficult. In
addition, appropriately standardised recording conventions for vaccinations have been lacking.
Methods
In order to avoid double-entry of vaccination records, the method of collecting records is implemented so
that vaccinations are included into data-content of relevant national registers. These include e.g. hospitaldischarge register, birth register, and most recently, outpatient care register. Further standardisation of
coding, as well as interactions with the patient-recording system providers and health-care providers,
have been initiated.
Results
The number of primary health-care providers linking into the online data collection has been steadily increasing: At the turn of 2013-2014, approximately 90% of more than 150 Finnish health-care centers were
part of NVR. Two health-care center specific reports have already been published on THL public webpages, one for childhood vaccinations (Oct2013) and one for HPV vaccinations (Apr2014). At the same
time, data from NVR is already utilised for impact evaluation of the national vaccination programme.
However, few problems in the completeness of the records have been identified which are either related
to data-collection or recording conventions. In order to improve the quality of NVR, ways to correct these
deficiencies are currently being implemented.
Conclusions
With the complexity and wide variety of patient-recording systems and -conventions, establishment of
NVR requires a lot of multidisciplinary effort. In addition, improving or even maintaining the quality of
NVR calls for continuous interaction with the relevant stakeholders. However, even during the implementation stage of NVR, it has already proven to be invaluable data source for evaluating the impact of
vaccinations. Continuous nurturing of NVR is therefore imperative.
SESSION 5
5)&%"/*4)7"$$*/"5*0/3&(*45&3o"/&7&3&/%*/(4503:
Tyra Grove Krause
Department of Infectious Disease Epidemiology,Statens Serum Institut, Denmark
APRIL 24
Since the year 2000 Denmark has had a national childhood vaccination database (CVD) with person
identifiable information on all vaccinations administered to children below the age of 18 years as part of
the national childhood vaccination programme. The CVD has been a valuable data source for research
studies and has contributed immensely to the knowledge on effectiveness and safety of childhood vaccinations. Furthermore, it has been used for providing precise estimates of vaccination coverage of childhood vaccinations by birth cohort and region. The CVD did not include information on product name or
batch number of the vaccine, and it was neither timely updated nor accessible for health care personnel
and citizens.
In 2008, the Danish government decided that a national immunization information system including
data on all administered vaccinations should be established and in 2013 The Danish Vaccination Register
(DDV) went live. From 2015 it will be mandatory for doctors to report all given administered vaccinations,
including those outside of standard programmes such as travel vaccines and vaccines for risk groups
including information on product name and batch number. DDV also captures information on vaccinations from existing electronic data sources such as the CVD and the prescription database. Citizens
have access to information on their own and their childrens´ vaccinations and they can register previous
vaccinations from their paper vaccination card.
The main challenge the coming years is to get DDV integrated with the many different electronic patient
record systems used by doctors at clinics and hospitals to avoid double-entry.
From 2014 data from DDV will be used to identify parents of children with at least one missing vaccination at 2, 6½ and 14 years in order to send them written reminders.
The DDV already serves as a useful tool for health care personnel and citizens. Data from DDV will be used
to generate reminders and also contribute to studies which increase knowledge on risks and benefits of
vaccines.
SESSION 6
7"$$*/&"$$&15"/$&5)&30-&0'3*4,$0..6/*$"5*0/
Robb Butler
World Health Organization, Denmark
Despite relatively high immunization coverage rates in the European Region, challenges to ensure herd
immunity and protect individuals against vaccine-preventable diseases persist. Demand side barriers
to immunization in the European region are multi-factoral and include issues of complacency, convenience and/ or confidence in vaccine(s) or immunization programs. Any of these factors may contribute to
the acceptance, delay or refusal of one, some or all vaccines. Vaccine hesitancy by some parents, and a
significant minority of health workers in the European Region, threatens the individual and societal ability
to protect infants and children, and to prevent the negative health impacts of these diseases.
APRIL 25
Protecting the bottom-line public health gains made by immunization programmes, and improving
programme impact, are dependent on individuals: understanding the benefits and risks of immunization
and the diseases they prevent; making evidence-informed choices; being encouraged to seek immunization services; taking responsibility to protect children, adolescents and adults, throughout the life course;
and being sufficiently engaged and empowered to influence health service provision and overcome
barriers to vaccination. Risk communication provides a tool through which we can generate and maintain demand for immunization services by: leveraging both traditional and social media communication
platforms; optimizing the role of the frontline health care workers; identifying and mobilizing immunization champions and agents of change; tailoring immunization programme advocacy and communication
to meet the needs of susceptible populations, including mobile, marginalized and migrant populations;
conveying the benefits of immunization and the risks presented by vaccine-preventable diseases.
This talk looks at the different determinants that influence vaccination behaviour, it considers the importance of strong risk communication capacity and behavioural communications research, and the need for
tailoring messages, channels and campaigns to particular audiences. NORDIC VACCINE MEETING 2014
SESSION 6
#-0((&37*&840/*..6/*[ "5*0/3&-"5&%501*$4
Gunnar Roland Tjomlid, Norway
The Internet is flooded with bad information about vaccines. «The MMR vaccine causes autism.» «Most
vaccines don’t work.» «The polio vaccine can give you cancer.» «The HPV-vaccines kill young girls.» There
is a small, but very loud, anti vaccine movement using the internet and social media to turn parents away
from vaccinating their children. Their arguments are usually based on manipulative statistics, pseudoscience and plain lies, but as long as is sounds «sciency», many people buy into the misinformation.
This is a problem, and in recent years we have seen the results of this anti-vaccine campaign in epidemics
of vaccine-preventable diseases in the Western world. Internationally the Wakefield-scandal was a primary driver for the vaccine-fear, but in Norway the narcolepsy-tragedy in the wake of the 2009-pandemic
mass vaccination also fuelled the mistrust of vaccines.
APRIL 25
How can we combat all the misinformation out there? The health authorities are not doing a good
enough job. People want and need good information about science and health presented in a way that
can be easily understood; served when and where it is needed. As a blogger without an academic background I have tried to understand and promote science-based medicine and debunk myths regarding
vaccines. This has brought me a lot of enemies from the anti-vaccine movement who have used the most
vile tactics to attack and discredit me.
In my presentation I will give the audience an insight into the world of the Norwegian anti-vaccine movement, what methods and arguments they use, how they attack science and science-promoters, and what
I think is the most effective way to promote science-based medicine.
SESSION 6
)0850$0..6/*$"5&"#0654*(/"-40'6/&Y 1&$5&%"%7&34&&7&/54"/%%&"-
8*5)36.0634
Henrik G. Jensen
Danish Health and Medicines Authority, Denmark
Generally speaking, a proportional risk in connection with drug treatment is accepted. The acceptance
level usually increases in proportion to the severity of the disease.
Risk acceptance in connection with vaccination is generally low. Mainly because vaccination is administered to healthy people, and the disease vaccinated against is generally perceived by the vaccinated to
be absent. In mass vaccination, all the side effects listed in the SPC can be expected. In addition, some
side effects are not detected during clinical trials, but are first identified when the vaccine is introduced to
large populations – several millions.
Many diseases can emerge at the same time as a vaccination is administered without having any causal
relationship to the vaccine.
APRIL 25
When parents find out that their child have developed autism, a mental illness or simply does not meet
the school’s expectations, we seek explanations. Adverse reactions after vaccination are often an obvious
thesis, but most frequently a causal scientific link cannot be established.
Openness and transparency form the scientific basis for the management of unexpected side effects or
rumours. All data must be presented.
Written communication must not be underestimated – so the media should be updated at all times on
the occurrence, the frequencies and not least the authorities’ assessment. International cooperation and
communication from international organisations like WHO, EMA and FDA are of utmost importance.
We work on a scientific basis. And this will form the background for our communication. We will post any
potential side effect but at the same time give information about the disease we are preventing and the
number of people who have received the vaccine.
The population consists of many audiences and everyone has the right to information and answers.
Vaccine opponents are also entitled to dialogue and scientifically valid answers.
SESSION 7
$633&/5,&:10*/54"/%&.1)"4*4*/5)&*$&-"/%*$/"5*0/"-7"$$*/"5*0/130(3".
Thorolfur Gudnason
Directorate of Health, Iceland
In 2014, the main keypoints and emphasis in the National Icelandic Vaccination Program are:
1. Utilization of the information obtained by the electronic immunization registry in identifying groups
of children sub-optimally vaccinated.
2. Analyze the results of a survey on the attitude of the public towards vaccinations.
3. Explore the feasibility of introducing varicella vaccination in the National Vaccination Program.
4. Evaluate the possibility of introducing 2-dose vaccination schedule vaccine instead of the 3-dose
schedule of the bivalent HPV vaccine.
APRIL 25
5. Evaluate the impact of the general pneumococcal vaccination program (10-valent conjugated vaccine)
on invasive pneumococcal disease, otitis media, antibiotic usage, pneumococcal antibiotic resistance
and respiratory infections among children.
SESSION 7
/&84'30.5)&%"/*4)$)*-%)00%7"$$*/"5*0/130(3"..&
Palle Valentiner-Branth
Statens Serum Institut, Denmark
5FNQPSBSZDIBOHFPGWBDDJOFTVTFEJOUIF%BOJTI$IJMEIPE7BDDJOBUJPO1SPHSBNNF
Statens Serum Institut has experienced technical production issues relating to the polio vaccine that
forms part of two of the vaccines under the Danish childhood vaccination programme, the DiTeKiPolHib
vaccine to be given at 3, 5 and 12 months and the DiTeKiPol Booster at 5 years of age. After putting out
a tender, it has been established that no other producers were able to provide the needed quantity of
equivalent vaccines.
As from 15 January 2014, children who initiate vaccination under the childhood vaccination programme
were to receive a hexavalent vaccine which protects against hepatitis B in addition to providing protection against diphtheria, tetanus, pertussis, polio and Haemophilus influenzae B-infection. Instead of the
SSI’s normal booster vaccine, two vaccines for separate injection; a dTap vaccine produced by the SSI, SSI
and a polio vaccine will be used.
25 APRIL
It is anticipated that Statens Serum Institut will start providing the two vaccines again as from the autumn
of 2014.
5IF%BOJTI(PWFSONFOUIBTEFDJEFEUPTFMMUIFWBDDJOFQSPEVDUJPOGBDJMJUJFTBU4UBUFOT4FSVN
*OTUJUVU
According to an investigation, national vaccine production is not profitable and it is no longer necessary.
The sale will include the entire vaccine production which employs around 400 people and SSI diagnostica
with 90 people. The sales procedure will be initiated in April 2014 and the production will continue at
normal level so that SSI can continue the supply to customers in Denmark and abroad.
3FNJOEFSMFUUFSTUPCFTFOEUPDIJMESFOXIPBSFOPUGVMMZWBDDJOBUFEBDDPSEJOHUPUIFJSBHF
Based on information from the Danish Vaccination Registry reminder letters will be send out to children
at 2, 6½ and 14 years of age who are not fully vaccinated starting from May 2014. This will serve as a
reminder to unvaccinated children and as an opportunity for the parents or their doctors to make corrections in the Danish Vaccination Registry if the information is incorrect. This program is planned to continue for the next four years.
$IBOHFTJOUIF$IJMEIPPE7BDDJOBUJPO1SPHSBNNF
On 1 January 2014, the age limitation was changed on the existing offer of free HPV (human papilloma
virus) vaccination under the Danish childhood vaccination programme. As previously, the HPV vaccination is offered to all girls when they turn 12 years old, but the offer has now been broadened so that the
vaccination may be given until the young women turn 18 years old (as opposed to the previous 15-year
age limitation).
Furthermore, a temporary free HPV vaccination offer has been passed covering women from the 19931997 birth cohorts. The offer is available until the end of 2015. The vaccine is identical to the vaccine
given to 12-year-old girls under the Danish childhood vaccination programme and thus protects against
cervical cancer as well as genital warts (condyloma), EPI-NEWS 35/08.
Depending on a positive opinion from the European Medicine Agency, a two dose HPV schedule as opposed to the current three dose schedule will be considered for girls 9-13 years of age.
SESSION 7
1$7*.1"$50//0/-"#03"503:$0/'*3.&%*1%
Arto A. Palmu
Background: Vaccine effectiveness (VE) of pneumococcal conjugate vaccines (PCV) against cultureconfirmed Invasive Pneumococcal Disease (IPD) has been well documented. Now, we have evaluated the
impact of PCV10 against suspected non-laboratory-confirmed IPD using hospital discharge diagnoses in
the Finnish Invasive Pneumococcal disease (FinIP) trial and the National Vaccination Programme (NVP).
APRIL 25
Methods: The FinIP trial was a phase III/IV cluster-randomized, double-blind trial in children <19 months
who received PCV10 in 52 clusters or hepatitis B/A vaccine as control in 26 clusters according to 3+1 or
2+1 schedules (infants <7 months) or catch-up schedules (children 7-18 months) in 2009-10 with followup until 2012. Hospitals’ in/outpatient discharge reports with ICD-10 diagnoses compatible with IPD
(ICD-10 codes A40.3, B95.3, G00.1 or M00.1) and unspecified sepsis (ICD-10 codes A40.9, A41.9, A49.9,
G00, G00.9, I30.1, M00, M00.9, or B95.5) were collected from national Care Register and subsequently
verified using patient files. The main objective was to estimate VE against suspected IPD (excluding those
detected by culture or DNA/RNA detection) in infants aged <7 months at enrolment. Blinded followup lasted from the date of the first vaccination (trial enrolment from Feb-2009 through Oct-2010) to
December 31, 2011.
Results. Together with parallel AOM trial, >47,000 children were enrolled. Altogether 102 episodes of
suspected non-laboratory-confirmed IPD were found. The VE was 71% (95%CI 52-83) in infant 3+1/2+1
schedules combined and 69% (95%CI 32-86) in catch-up groups. The Vaccine Attributable Reduction was
142 per 100,000 person-years in infants and 111 in catch-up groups.
Conclusions. This is the first report showing the impact of PCV on suspected non-confirmed IPD. The
absolute rate reduction was markedly higher compared to laboratory-confirmed IPD, which implies low
sensitivity of the laboratory-based case definition and subsequently higher public health impact of PCVs
against IPD than previously estimated.
SESSION 7
/&803("/*[ "5*0/0'16#-*$)&"-5)*/48&%&/
Anders Tegnell1, Ingrid Uhnoo1, Ann Lindstrand1
1
The Public Health Agency of Sweden, Stockholm
January 1, 2014 the Public Health Agency (PHA) in Sweden started its operation. The agency was formed
by merging the Public Health Institute (Folkhälsoinstitutet, FHI), the Swedish Institute for Infectious
Disease Control (Smittskyddsinstitutet, SMI) and a part of the National Board of Health and Welfare
(NBHW). From SMI and FHI the complete responsibilities was moved into PHA and from the NHBW the
responsibilities to develop the national reports on public health and the majority of the activities related
to environmental health was transferred. The PHA now has a wide mandate in the area of Public Health in
Sweden including also relevant international collaborations.
APRIL 25
Relating to the national vaccination programs, the PHA has inherited the activities from the SMI and is as
a result responsible for the surveillance of vaccine-preventable diseases (VPDs), implementation of the
Swedish National Vaccination Register and providing evidence-based knowledge, documentation and
expert advice to other agencies involved in vaccinations. In 2012 the government assigned the involved
agencies to review the surveillance systems used for monitoring the impact and safety of the national
vaccination programs and in particular with respect to the vaccination coverage and vaccine safety.
This review has further clarified the important and complex activities involved and in addition identified
some gaps that need to be filled. The merger of agencies has provided PHA with larger and wider expertise in evaluation and monitoring of VPDs, which will be needed as new vaccines are considered for the
programs.
SESSION 7
5)&/038&(*"/7"$$*/"5*0/4$)&%6-&"3&8&0/5*.& Øystein Riise, Ida Laake, Inger Lise Haugen, Hanne Nøkleby, Marianne Bergsaker and Jann Storsæter
Div. of Infectious Disease Control, Norwegian Institute of Public Health, Norway
High vaccination coverage is essential in prevention of childhood infections. However, coverage at age
2 years does not reflect if children are appropriately vaccinated at all times. The immunization schedule
specifies age and doses hence delay may increase risk of e.g. pertussis, pneumococcal disease and measles in young and vulnerable children.
Considerable delay is found in countries with high vaccination coverage. Delay of ≥ 6 months has been
described in 1/3 of children in the U.S. In Australia ¼ was delayed for diphtheria-tetanus-pertussis vaccination suggesting that timeliness should be the new benchmark if coverage is high.
Cross- country comparison of vaccination delays is challenging due to different: schedules (e.g. 3+1 vs.
2+1), age recommendations, and definitions of delay, vaccines, vaccination providers, socioeconomic
diversities and methods of accessing national vaccination data.
APRIL 25
The Norwegian immunisation registry, SYSVAK, is a national electronic immunisation registry that became nationwide in 1995. Vaccination is voluntary, but notification to SYSVAK is mandatory, based on
personal identification numbers. We analyzed vaccination data for 63382 children less than two years
of age and born in 2010. Coverage for individual vaccines were 93 % or above. Specifically we analyzed
delayed vaccination compared to Norwegian recommendations, delay on sub-national level, missing
vaccinations, splitting of combination vaccines, coverage vs. delay, impact of summer holiday and timeliness for vaccines in migrant families.
POSTERS
Poster abstracts
1 1&35644*4*/%&/."3,3&$&/5$)"/(&4*/"(&%*453*#65*0/
Tine Dalby 1*, Peter H. Andersen 2, Steen Hoffmann 1
1
Microbiology & Infection Control, Statens Serum Institut, Copenhagen, Denmark, 2 Infectious Disease Epidemiology,
Statens Serum Institut, Copenhagen, Denmark
#BDLHSPVOE
Infant pertussis vaccination was introduced in Denmark in 1961. In 1997 the whole-cell vaccine was
replaced by an acellular, monocomponent vaccine and in 2003 a pre-school booster was introduced.
There are no official recommendations for adolescent or adult vaccination. The latest pertussis-epidemic
in Denmark was in 2002 with an incidence of 36 per 100,000. In non-epidemic years the level is 7-10
per 100,000. In the period 1995 to 2013 six infant deaths from pertussis were recorded. Notification of
laboratory-confirmed pertussis in Denmark has been mandatory since 2007 while in previous years data
were submitted to Statens Serum Institut by the laboratories on a voluntary basis. Pertussis in Denmark is
nowadays mainly confirmed by PCR or serology. The use of culture has diminished through the years and
it is now rarely used. PCR was introduced in 1998 and serology in 2010.
.FUIPET
Using the national database of laboratory-confirmed pertussis, the distribution of age-groups was examined.
3FTVMUT
In 1995, pertussis was primarily confirmed in children and 80% of the cases were found among children
younger than 10 years of age. In 2013, however, 44% of all diagnosed cases were adults aged 20 years and
older. The median age in 1995 was 5.1 years and in 2013 the median age was 15.7 years. This change in
age-group specific incidence has occurred gradually over the 1995-2013 period and in particular since
2003. Before the introduction of the pre-school booster, the main peak among older children was at 3-5
years of age. This peak has gradually moved and is now among 12-14-year-olds.
POSTERS
$PODMVTJPO
The age-distribution of confirmed pertussis in Denmark has changed during the last ten years. An increasing number and proportion of adult cases are found and this is primarily thought to be due to improved diagnostic methods and enhanced knowledge about pertussis not being an infection restricted
to childhood. The peak among older children is believed to have changed as a result of introducing the
pre-school booster.
1 %&5&3.*/*/($06/53:41&$*'*$7"$$*/&%&$*4*0/.",*/('3".&803,4*/$-6%*/(
'6/%*/(*.1-&.&/5"5*0/"/%$0..6/*$"5*0/
Lamb IF1, Gottvall M2, Young C3, Ploner A1, Sparén P1 and Arnheim Dahlström L1
1
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, 2 Department of
Public Health and Caring Sciences, Uppsala University, Sweden, 3 Sanofi Pasteur, Solna, Sweden
0CKFDUJWFT
Organised vaccination programmes in Europe have reduced vaccine preventable diseases and deaths,
however the level of success varies between countries. The association between H1N1 vaccination and
narcolepsy is an example where public trust in vaccines was tested. Although vaccines undergo rigorous
testing before approval from European authorities and inclusion into vaccination programmes, there is
little publicly available information about who is involved in the decision-making process. The aims of this
study are to shed light on and provide information on roles and influences of stakeholders and associated
advisory parties in the vaccine decision-making process and to provide a better understanding of the
vaccine implementation process and methods of communication between stakeholders and healthcare
providers in the Nordic countries.
.FUIPET
Two comprehensive web-based questionnaires have been developed from the literature regarding
national vaccination programmes and recommendations. The first questionnaire has been sent to public
health authorities and key experts in the field in Denmark, Finland, Iceland, Norway and Sweden and aims
to gather detailed information on how decision-making, implementation, funding and communication
are carried out and assess the level of adherence to the EU recommended guidelines currently in place.
The second questionnaire will be sent to healthcare providers who administer vaccinations with the aim
of investigating how the decision-making process is communicated to and upheld by healthcare professionals who are responsible for the public vaccination programs.
POSTERS
'VUVSFJNQMJDBUJPOT
Information on the organisational structures in each country and the processes involved in vaccine
decision-making and implementation will be important for developing tools to improve and sustain the
vaccination coverage in public programs. Information from healthcare providers will help us to better
understand how information is conferred from authorities and communicated to the public, ensuring
that the importance of vaccination is conferred, resulting in optimal vaccine uptake in the population.
1 4&"40/"-*/'-6&/4"7"$$*/&&''&$5*7/&44"/%"1016-"5*0/
$0)035"/"-:4*4'30..*--*0/*/%*7*%6"-4*/450$,)0-.$06/5:
Amy Leval1 2 *, Maria Pia Hergens1 2 *, Karin Persson1, Åke Örtqvist1,2
1Department of Communicable Disease Control and Prevention, Stockholm County, 2Department of Medicine Solna,
Infectious Disease Unit, Karolinska Institutet, Sweden
*Contributed equally
#BDLHSPVOE: In Stockholm County, seasonal influenza vaccination is recommended and available at no
individual out-of-pocket costs to those over age 65, or to younger individuals with certain underlying risk
profiles. Estimates of seasonal influenza vaccine effectiveness (VE) are important for determining future
vaccination policies and programs, preferably from several seasons since the effectiveness varies substantially between years. In addition, analysis during a specific influenza season may permit early detection of
vaccine failure due to a poor virus-vaccine match.
Method: All individuals living in Stockholm County as of October 1st of the 2011-2012 and 2012-2013
season were included. Vaccination status was obtained from Stockholm’s vaccine register. Main influenza
outcome variables (ICD-10 codes J09-J11) and comorbidities were obtained from in-patient, out-patient
and primary care databases. VE was assessed with seasonal vaccination as a time-varying exposure using
Cox multivariate analyses adjusting for age, sex, comorbidity status and previous flu vaccinations including the pandemic influenza A (H1N1) pdm09 vaccine (Pandemrix®).
Results: For those vaccinated for the 2011-2012 season, hazard ratio (HR) for influenza inpatient and
outpatient care was 0.86 (95% CI 0.74-1.01) compared to unvaccinated. For those vaccinated for the 20122013 season, hazard ratios (HR) were 0.56 (95% CI 0.41-0.77) for influenza inpatient and outpatient care
compared to unvaccinated.
POSTERS
Conclusion: In 2012-2013, seasonal influenza vaccination provided substantial protective effects on
hospitalization for influenza and outpatient care whereas significant VE were not found in the 2011-2012
season.
1 3&%6$&%)041*5"-*[ "5*0/%6&504*/64*5*4"/%1/&6.0/*""'5&3*/530%6$5*0/
0'1$7
Ann Lindstrand1,2,3, Rutger Bennet4, Illias Galanis1, Margareta Blennow3,6, Lina Schollin Ask3, Sofia Hultman Dennison7, Malin Ryd Rinder3, Margareta Eriksson4, Birgitta Henriques-Normark1,5,8, Åke Örtqvist9*, Tobias Alfvén2,3 *
1
Swedish Institute for Communicable Disease Control, 171 82 Solna, Sweden, 2 Department of Public Health Sciences, Division of Global Health, Karolinska Institutet, 171 77 Stockholm, Sweden, 3 Sachs´ Children´s Hospital, South
General Hospital, Stockholm, Sweden, 4 Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Solna,
Sweden, 5 Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 77 Stockholm, Sweden ,
6
Karolinska Institutet, Department of Clinical Sciences and Education, Stockholm, Sweden, 7 Otorhinopharyngeal
department, Karolinska University Hospital, Sweden, 8 Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Solna, Sweden, 9 Department of Communicable Disease Control and Prevention, Stockholm County Council, Sweden, and Karolinska Institutet, Department of Medicine, Karolinska Solna, Unit
of Infectious Diseases, Sweden
* Equal contribution
#BDLHSPVOE Streptococcus pneumoniae is the major cause of bacterial pneumonia and sinusitis. Pneumonia kills about 1.3 million children <5 years annually and sinusitis is a feared paediatric disease due
to orbital and intracranial complications. Although effective against invasive pneumococcal disease, the
effectiveness of pneumococcal conjugate vaccine (PCV) against pneumonia is less consistent and its
effect on sinusitis is not known. Here, we compared hospitalizations rates due to sinusitis and pneumonia
4 years before and after introduction of PCV.
.FUIPE Retrospective study of hospital registry data on hospitalizations due to sinusitis and pneumonia
in all children 0-<18 years. Trend analysis, incidence rates and relative risks were calculated comparing
July 2003-June 2007 to July 2008-June 2012, excluding the year of PCV7 introduction.
3FTVMUTSinusitis hospitalizations decreased significantly in children 0-<2 years from 70 cases/100 000/
year before the introduction of PCV7 to 25 cases/100 000/year (RR=0.35, P<0.001) after the introduction.
Pneumonia hospitalizations decreased significantly in children 0-<2 years (RR 0.81, P<0,001) and 2-<5
years (RR=0.85, P=0.002) during the same period.
POSTERS
$PODMVTJPOTIntroduction of PCV led to a decreased risk of hospitalization due to sinusitis (65% decreased risk) and to pneumonia (19% decreased risk) in children 0-< 2 years.
'JHVSF Incidence of hospitalization by discharge diagnosis /100 000/year/age group in Stockholm
County, Sweden, 2003-2012
4JOVTJUJT 1OFVNPOJBFYDMVEJOHWJSBMQOFVNPOJB
1 .0%&-&45*."5&40'"(&41&$*'*$*/'-6&/[ "3&-"5&%0651"5*&/57*4*54"/%.03
5"-*5:*/5)&6,*/3&$&/5:&"34
Gonçalo Matias1, Robert J. Taylor2, François Haguinet1, Cynthia Schuck-Paim2, John Logie3,
Roger L. Lustig2, Douglas M. Fleming4
1
GlaxoSmithKline Vaccines, Wavre, Belgium, 2Sage Analytica, Bethesda, Maryland, United States, 3GlaxoSmithKline
Pharmaceuticals, Harlow, United Kingdom, 4Independent consultant, Birmingham, United Kingdom
#BDLHSPVOE
Accurate assessment of the overall burden of influenza and attributable mortality is challenging. However, statistical methods using virus guided regression modelling techniques allow estimation of these
parameters while controlling for the potential influence of other circulating respiratory pathogens. We
used similar methods to update the burden of outpatient visits and mortality related to influenza types
by age groups in England and Wales between 1996 and 2008.
.FUIPET
We generated weekly time series for multiple influenza-related health outcomes and respiratory deaths
for age groups <5, 5–17, 18–49, 50–64, and ≥65 years using data from General Practice Research Database
(GPRD) and UK national vital statistics data, respectively. A multiple linear regression model was applied
to each age stratum to statistically associate general practitioner (GP) office visits and attribute respiratory deaths to influenza A or B while controlling for RSV.
3FTVMUT
The average number of seasonal influenza-attributable GP office visits during the study period was
857,996; more than 1/3 visits occurred in children <18 years. The relative proportions of GP office visits
related to influenza A and B were 76% and 24%, respectively. The highest influenza A and B burdens were
observed in children <5 years (2436 visits/100,000 persons) and 5–17 years (996 visits/100,000 persons),
respectively. Further, average number of seasonal all-age influenza associated deaths for study period
was projected to be 11,868; 90% occurred in elderly ≥65 years, whereas children <5 years accounted for
an annual average of 19 deaths.
POSTERS
$PODMVTJPO
Detailed estimates of the total burden of influenza and mortality using the methods described here
should be considered for updating the current understanding of the burden of disease and optimizing
the decisions on public health and vaccination policies.
'VOEJOH GlaxoSmithKline Biologicals SA
1 &7*%&/$&0'&"3-:)&3%1305&$5*0/"'5&3*/'"/57"$$*/"5*0/8*5)5)&7"-&/5
1/&6.0$0$$"-/0/5:1&"#-&HAEMOPHILUS INFLUENZAE1305&*/%$0/K 6("5&
7"$$*/&1)*%$7
"3&7*&8
Tomas Mrkvan, William P. Hausdorff, Marta Moreira, Dorota Borys
GlaxoSmithKline Vaccines, Wavre, Belgium
#BDLHSPVOEBOEBJNTPHiD-CV (GlaxoSmithKline Vaccines) has demonstrated robust protection against
invasive pneumococcal disease (IPD) in vaccinated children, but its ability to elicit herd protection is
unclear. Herd protection is believed to be mediated by reduction in vaccine-type nasopharyngeal colonization (VT-NPC) in vaccinated subjects, resulting in reduced transmission to non-vaccinated individuals. Clinical trials and post-marketing studies showed reduced VT-NPC and overall pneumococcal NPC in
PHiD-CV-vaccinated children.1 VT-NPC was also lower in older, unvaccinated siblings of PHiD-CV-immunized children in the cluster-randomized Finnish IPD trial (FinIP/NCT00861380).2
.FUIPET To assess if PHiD-CV provides herd protection against IPD, we reviewed data from FinIP and
post-marketing studies in the first years following PHiD-CV introduction.
3FTVMUT In FinIP in unvaccinated ≥5-year-olds, in 2011 (first year after enrolment completion), hospitaldiagnosed suspected non-confirmed IPD decreased by 29% (95%CI:-6; 35) in PHiD-CV versus control
clusters,3 while no consistent effect on culture-confirmed VT-IPD was observed.4 In 2012 (second year
after enrolment completion), culture-confirmed VT-IPD decreased by 32% (95%CI:11; 47).4
2-3 years after PHiD-CV implementation in immunization programs in Finland and Brazil, reductions in
VT-IPD5,6 and in overall pneumococcal meningitis (Brazil)7 were observed in vaccine-ineligible populations. Moreover, 2-3 years post-PHiD-CV implementation in Kilifi, Kenya, no VT-IPD was detected in
<5-year-olds despite incomplete vaccination coverage.8
$PODMVTJPOT Increasing evidence from low- and high-transmission settings suggests that PHiD-CV
confers early herd protection against VT-IPD in infants too young to be vaccinated, older children, and
adults.
POSTERS
'VOEJOH: GlaxoSmithKline Biologicals AS
1 3&7*&80':&"31045-*$&/463&&Y 1&3*&/$&8*5)5)&7"-&/51/&6.0$0$$"-
/0/5:1&"#-&HAEMOPHILUS INFLUENZAE1305&*/%$0/K 6("5&7"$$*/&1)*%$7
Tomas Mrkvan, Marta Moreira, Javier Ruiz-Guiñazú, Dorota Borys
GlaxoSmithKline Vaccines’ pneumococcal conjugate vaccine, PHiD-CV, was licensed in 2008-2009 and has
since been registered in >125 countries and introduced in national infant immunization programs of >40
countries worldwide. A considerable body of evidence has accumulated since its licensure, supporting
PHiD-CV efficacy/effectiveness against invasive pneumococcal disease (IPD), pneumonia and acute otitis
media (AOM).
*1%: Two double-blind, randomized, controlled trials, the Finnish IPD study (FinIP/NCT00861380) and
the Latin American Clinical Otitis Media and PneumoniA Study (COMPAS/NCT00466947) showed 100%
effectiveness/efficacy (95% CIs: 83-100% and 77-100%, respectively) against vaccine-type IPD (3+1 infant
schedules, intent-to-treat analyses [ITT]). Case-control studies in vaccine-eligible children in Finland,
Brazil and Canada (Quebec) 2-3 years after PHiD-CV introduction also showed high effectiveness against
vaccine-type IPD (98% [72-100%] in Finland [2+1]; 84% [66-92%] in Brazil [3+1/catch-up]; 99% [89-100%]
in Quebec [2+1]) and against 19A IPD (82% [11-96%] in Brazil; 67% [8-88%] in Quebec). Surveillance data
up to 3 years after PHiD-CV implementation in several countries support these results.
1OFVNPOJB: PHiD-CV showed 23%(9-36%) efficacy against WHO-defined consolidated communityacquired pneumonia in COMPAS, and 25% (3-43%) effectiveness against hospital-diagnosed pneumonia
in FinIP (3+1, ITT). A time-series analysis in 2-24-month-olds in Brazil estimated up to 29% reductions in
pneumonia hospitalizations 1 year after PHiD-CV introduction. Another time-series analysis estimated a
17% decrease in pneumonia mortality rates in 2-23-month-olds 3 years after PHiD-CV implementation in
Brazil.
POSTERS
"0.: In COMPAS, clinical AOM was reduced by 19% (4-31%) in PHiD-CV-vaccinated children (ITT). Reductions were observed in all-cause otitis outpatient visits in Brazil and in AOM-related hospital visits/admissions in Iceland after PHiD-CV introduction. Consistent with an effect on AOM, an 8% (-1-15%) reduction
in antimicrobial purchases was observed in PHiD-CV-vaccinated children in FinIP (3+1, ITT).
$PODMVTJPO: PHiD-CV vaccination in infants and young children proved effective against pneumococcal
infections, highlighting PHiD-CV’s public health value.
'VOEJOH: GlaxoSmithKline Biologicals AS
1 #6%(&5015*.*[ "5*0/.0%&-'031/&6.0$0$$"-7"$$*/"5*0/*/*/'"/54"/%
&
-%&3-:5)&$"4&0'41"*/"/%5)&/&5)&3-"/%4
Emmanuelle Delgleize1, Tomas Mrkvan1, Bernard Hoet1, Baudouin Standaert1.
1
#BDLHSPVOEBOEBJNTRecommending bodies today may have to consider routine immunization with
pneumococcal conjugate vaccines (PCV) in two groups (infants and elderly). This analysis aimed to identify an optimal PCV strategy within a constrained budget from the health-care payer perspective. Two
countries, Spain and The Netherlands with different baseline pediatric PCV uptake (70% and 90%, respectively), pediatric schedules and age indication in elderly are considered in this analysis.
.FUIPET: An optimization model linked to a prevalence-based disease management sub-model was
developed. This program allows to find an optimal solution given an objective function (either minimize
cases, minimize quality-adjusted life-years lost or minimize life-years lost) under budget constraints. In
case of a fixed budget increase, the model calculates the optimal vaccine uptake in both groups. The
minimal vaccine efficacy against overall community-acquired pneumonia (irrespective of the etiology)
(VE-CAP) in elderly justifying an investment in elderly vaccination is also estimated. Herd protection resulting from infant vaccination is included and varies with VE and uptake.
3FTVMUT: In Spain, though pneumonia disease burden is high in the elderly, the model estimates that
additional budget should be first allocated to increase uptake amongst infants, irrespective of VE-CAP
in elderly. In The Netherlands, the VE-CAP in the elderly would have to at least be 70% i.e. about 3 times
higher than that of infants to prioritize elderly vaccination.
POSTERS
$PODMVTJPOT: VE-CAP in the elderly would have to be very high to prioritize elderly vaccination. Increasing uptake for infant immunization with PCV is identified as the optimal strategy to reduce the impact on
invasive and non-invasive pneumococcal disease in the whole population, in both countries.
1 "1305&*/#"4&%7"$$*/&"("*/45.&/*/(0$0$$"-%*4&"4&'035)&"'3*$"/
.&/*/(*5*4#&-5
Lisbeth M. Næss1, Gunnstein Norheim1, Gro Tunheim1, Marianne Arnemo1, Åse-Karine Fjeldheim1,
Karin Bolstad1, Audun Aase1, Aleida Mandiarote2, Domingo Gonzalez2, Daniel Cardoso2, Luis Garcia2,
Einar Rosenqvist1
1
Division of Infectious Disease Control, Norwegian Institute of Public Health (NIPH), Oslo, Norway, 2Finlay Institute (FI),
Havana, Cuba
0CKFDUJWFMeningococci of serogroups A, W, and more recently X, are the main causes of meningococcal disease in sub-Saharan Africa. Norway and Cuba have previously experienced epidemics caused by
serogroup B meningococci, and each developed safe and effective vaccines based on outer membrane
vesicles (OMVs) against epidemic serogroup B meningococcal disease. A partnership between NIPH and
FI has been established to develop an affordable OMV vaccine for African countries targeting A and W
meningococci.
.FUIPET The vaccine was produced by fermentor growth of representative epidemic serogroup A and
W meningococcal strains from Africa, followed by detergent extraction and purification of OMV by gel
filtration. Toxicology studies of the vaccine were performed in rats. The immunogenicity of the A+W OMV
vaccine in mice was compared with commercially available meningococcal conjugate and polysaccharide
vaccines. In addition, formulations of the vaccine including OMVs from a serogroup X strain has been
studied. Protective antibody responses were measured by serum bactericidal activity (SBA) and opsonic
activity (OPA) assays.
3FTVMUT The A+W OMV vaccine induced higher bactericidal titers (SBA) in mice against both serogroup A
and W strains than observed with conjugate and polysaccharide vaccines. Similar results were observed
in OPA. Addition of X-OMV also induced high SBA responses against serogroup X meningococci. Following acceptable results in toxicological studies, the vaccine was approved by the Cuban medicinal agency
(CECMED) for use in humans and a phase I clinical trial was performed in Cuba in December 2013 showing a good safety profile of the vaccine.
POSTERS
$PODMVTJPO The novel A+W OMV vaccine induced comparable or higher levels of protective antibodies
in mice than existing meningococcal vaccines. X OMV could successfully be included to the A+W vaccine
to make a trivalent AWX vaccine. This indicates that the vaccine has the potential to become an affordable
and effective vaccine for prevention of meningococcal disease in Africa.
1 *.1"$50'5&/7"-&/51/&6.0$0$$"-$0/K 6("5&7"$$*/&1$7
"("*/45
$-*/*$"-*/7"4*7&1/&6.0$0$$"-%*4&"4&*1%
".0/(7"$$*/&&-*(*#-&$)*-%3&/
*/'*/-"/%
Arto A. Palmu, Terhi M. Kilpi, Hanna Rinta-Kokko, Hanna Nohynek, Esa Ruokokoski, Pekka Nuorti, Jukka Jokinen
Background: PCV10 was introduced into the Finnish National Vaccination Programme (NVP) in September
2010 using a 2+1 schedule (at 3, 5, and 12 months). The impact of PCVs against culture-confirmed IPD
has been well documented. Now, we evaluated the impact of PCV10 against clinical IPD among vaccineeligible children during the first two years after the NVP-introduction using routine hospital discharge
report register.
Methods: The target cohort eligible for NVP (children born from 06/2010-09/2012) was compared with
two calendar-time and age-matched (3-30 months) cohorts before NVP introduction in 2004 to 2008.
Period 01/200908/2010 was excluded because of PCV10-trial conducted in Finland. Hospitals’ in/outpatient discharge reports with ICD-10 diagnoses compatible with IPD (A40.3/B95.3/G00.1/M00.1) were
collected from national Care Register and used for calculation of clinical IPD rates before and after NVP
implementation. Episode duration of 90 days was used. The vaccination coverage is estimated to be
around 95%.
Results. The rate of all clinical IPD episodes was 138 in the combined control cohorts and 52/100,000
person-years in the target cohort. The relative rate reduction was 62% (95%CI 51 to 68) and the absolute
rate reduction 86/100,000 person-years in the target cohort compared with control cohorts combined.
POSTERS
Conclusions. Higher disease burden of IPD was detected using the discharge register data compared to
the laboratory-based register data for culture-confirmed IPD. Despite lower point estimate for relative
rate reduction compared to that reported for culture-confirmed IPD (80%), the absolute reduction was
almost two-fold.
1 */%*3&$5&''&$5*7&/&440'5&/7"-&/51/&6.0$0$$"-)"&.01)*-64*/'-6&/[ "&
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1)"3:/(&"-$"33*"(&o'*/*1*/%*3&$5$"33*"(&456%:
Jukka Jokinen1, Terhi M. Kilpi1, Tarja Kaijalainen2, Ritva Syrjänen3, Esa Ruokokoski1, M. Van Dyke4, Arto A. Palmu3
1
Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, 2Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Oulu, 3Department of
Vaccination and Immune Protection, National Institute for Health and Welfare, Tampere, 4GlaxoSmithKline Vaccines,
Wavre, Belgium
#BDLHSPVOEFinIP trial was designed to evaluate effectiveness of PHiD-CV10 (GlaxoSmithKline) against
diseases associated with S.pneumoniae and H.influenzae. We conducted a satellite study in older siblings
of the FinIP-vaccinated children to evaluate indirect effectiveness against carriage. Previously presented
results based on nasopharyngeal samples demonstrated 29% reduction in vaccine-type carriage. Here we
report results based on both nasopharyngeal (NPS) and orophragyngeal (OPS) samples.
.FUIPETFinIP was a cluster-randomised, double-blind trial, where 29126 children <7 months were
recruited from Feb’09 to Oct’10. Children received PHiD-CV10 in 2/3 and control vaccine in 1/3 of 72 clusters according to 3+1 or 2+1 schedules. For our indirect carriage study, we sampled separately the NPS
and the OPS of 1423 unvaccinated 3 to 7-year-old siblings of FinIP participants from Apr’11 to Nov’11.
Generalized linear mixed model was used to estimate indirect effectiveness against carriage due to
S.pneumoniae (Pnc), H.influenzae, M.catarrhalis and S.aureus.
POSTERS
3FTVMUTPositive in either NPS or OPS increased the pneumococcal yield by 25% compared to NPS-alone.
Table reports indirect vaccine effectiveness (VE) of PHiD-CV10 against NPS-alone / NPS or OPS carriage
(1-odds ratios) in unvaccinated siblings of the FinIP-vaccinated children.
$PODMVTJPOTImpact against vaccine-type carriage was identical for NPS-alone and with the
addition of OPS. Addition of OPS increases sensitivity of detection of pneumococcus and their
combination may therefore give a more accurate estimate of carriage prevalence.
1 */7"4*7&1/&6.0$0$$"-%*4&"4&*/*/'"/54:06/(&35)"/%":4#&'03&"/%
"'5&3*/530%6$5*0/0'5)&1$7*/%&/."3,
Hans-Christian Slotved*, Tine Dalby, Steen Hoffmann.
Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark.
#BDLHSPVOE: The seven-valent pneumococcal conjugate vaccine (PCV-7) was introduced into the Danish
childhood immunization program (at 3, 5 and 12 months of age) in 2007, and was replaced with PCV-13
in 2010. After the introduction of these vaccines the number of cases of invasive pneumococcal disease
(IPD) due to vaccine types (VTs) declined markedly in children younger than two years of age. We present
data on IPD in infants from a 14 year period.
.FUIPET The study included all infants (younger than 90 days) born 01.01.1999 until 31.12.2013, who
had not been PCV vaccinated and from whom a pneumococcus isolate from blood or cerebrospinal fluid
had been submitted to the national reference laboratory as part of the mandatory surveillance. All isolates were serotyped using pneumotest latex and Quellung reaction.
3FTVMUT A total of 60 IPD cases were identified (39 from 1999-2007, and 21 from 2008 and onwards). IPD
cases due to PCV-7 serotypes were not observed later than 2009. The incidence (number of IPD cases per
100,000 live births) varied from 4.47 to 9.29 in the period 1999 – 2007 and from 1.73 to 9.22 in the period
2008 - 2013.
POSTERS
$PODMVTJPO In Danish infants IPD due to PCV-7 serotypes has decreased, and has not been observed
since 2009. The total number of IPD cases in Danish infants younger than 90 days seems to be unchanged.
1 .:7"$$*/&4o"/0/-*/&4&37*$&'30.5)&/038&(*"/*/45*565&0'16#-*$)&"-5)
Maria Hagerup-Jenssen1, Inger Lise Haugen1, Gro Ung1
1
Division of Infectious Disease Control, Norwegian Institute of Public Health (NIPH), Oslo, Norway
People vaccinated in Norway have secure online access to their vaccination status if it is recorded in the
Norwegian Immunisation Registry (SYSVAK). Using this service, you will find an overview of the vaccines
given and registered for you and your children if they are less than 16 years old.
Vaccination certificates can be printed in Norwegian or English when travelling or applying to study or
work abroad.
My Vaccines is linked to the Norwegian Immunisation Registry. The registry is nationwide and childhood
vaccinations have been registered since 1995. Other vaccines have been registered since 2011.
You can access My Vaccines using a personal login for which you will need an electronic ID.
The service is part of the Ministry of Health and Care Service’s “My Health” initiative to make health information available online.
POSTERS
Since the launch of this service in 2011, there have been 42 000 downloads.
1 4*.6-5"/&0647"$$*/"5*0/48*5)..3"/%%5"1*17)*#"/%3"5&0')041*5"-
"%.*44*0/48*5)"/:*/'&$5*0/4"/"5*0/8*%&3&(*45&3#"4&%456%:
Signe Sørup1, Christine Stabell Benn1, 2,3, Anja Poulsen4, Tyra G. Krause5, Peter Aaby1, 3, and Henrik Ravn1, 3
1
Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark,
2
Institute of Clinical Research, University of Southern Denmark and Odense University Hospital, Denmark,
3
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau, 4 The Child & Adolescent Clinic, Rigshospitalet,
Copenhagen, Denmark, 5 Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen,
Denmark
#BDLHSPVOE We have recently found that the live vaccine against measles, mumps, and rubella (MMR) is associated with nonspecific protection against infectious disease hospitalizations
in Denmark. The recommended vaccination schedule includes three doses of the inactivated
vaccine against diphtheria, tetanus, pertussis, polio, and Haemophilus influenzae type b (DTaPIPV-Hib) at 3, 5, and 12 months of age and MMR at 15 months of age. However, some children
received MMR and DTaP-IPV-Hib simultaneously. In low-income countries simultaneous administration of live measles vaccine and inactivated diphtheria-tetanus-pertussis vaccine may
neutralize the beneficial nonspecific effects of measles vaccine. We examined whether MMR and
DTaP-IPV-Hib administered simultaneously was associated with increased incidence of infectious
disease admissions in Denmark compared with MMR alone.
.FUIPET 558,221 children born in Denmark 1997-2006 were followed from 15 months to 4
years of age using nationwide registers of vaccinations and hospital admission. We used Cox
regression to estimate incidence rate ratios (IRRs) of infectious disease admissions, adjusted for
background factors including exact age.
POSTERS
3FTVMUT The incidence rate of infectious disease admissions was 6.5 per 100 person-years
(77,268 admissions/1,194,022 person-years). Simultaneous administration of MMR and DTaPIPV-Hib was associated with an increased rate of infectious disease admissions (adjusted IRR,
1.09; 95% confidence interval (CI), 1.02-1.17) compared with MMR alone. The increased rate was
confined to admissions due to lower respiratory infections (adjusted IRR, 1.29; 95% CI, 1.15-1.44).
$PODMVTJPOT Simultaneous administration of MMR and DTaP-IPV-Hib compared with MMR
alone may increase the rate of hospital admissions related to lower respiratory infections in a
high-income setting.
1 $"--'03$0--"#03"5*0/456%*&40/(&/&3"-.03#*%*5:1"55&3/43&-"5&%50
7"$$*/"5*0/4$)&%6-&4*/5)&/03%*$$06/53*&4
Signe Sørup1, Christine Stabell Benn1, 2,3, Henrik Ravn1, 3, and Peter Aaby1, 3
1
Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
2
Institute of Clinical Research, University of Southern Denmark and Odense University Hospital, Denmark
3
Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
Vaccines are recommended based on their effects on the targeted diseases. However, studies from lowincome countries with high infectious disease pressure have shown that vaccines may also have nontargeted effects on other infectious diseases. In Denmark, we have recently shown that MMR vaccination
is associated with 14% lower rate of hospital admission with any type of infection. As this was done in a
context of herd immunity against measles, mumps, and rubella, it indicates that vaccines may also have
non-specific effects in high-income settings.
Vaccine schedules are designed to optimise the balance between early target disease protection on one
hand and high antibody responses on the other hand; non-specific effects of vaccines are not considered.
Potentially the currently available vaccines could provide greater morbidity reduction than today if the
vaccination schedules were designed to also optimise non-specific effects of vaccines.
POSTERS
The Nordic countries have a long tradition of register-based research which can be expanded to also
include studies of non-specific effects of vaccines. There are several differences between the vaccination
schedules of the Nordic countries. For instance MMR vaccination is recommended at 12 months of age in
Finland, at 15 months of age in Norway and Denmark, and at 18 months of age in Sweden and Iceland.
Such variation in vaccination schedules could be used to study morbidity patterns between the Nordic
countries in relation to the differences in recommended vaccination schedules.
1 1&3*/"5"-065$0.&4"/%$)*-%3&/4)&"-5)"'5&313&/"5"-&Y 10463&50
*/'-6&/[ ""/%*/'-6&/[ "7"$$*/"5*0/
L Trogstad1, S Mjaaland1,T Molden1, I Laake1,M Savic1, J Dembinski1, G Tunheim, I Borren, S Schjølberg1, K
Tambs1, A.-S Øyen1,2, A Robertson, GE Korsvold, I Bokn, S Valand, O Hungnes1, F Oftung1, KK Lie1, L Næss1, R
Cox3, P Magnus1, SE Håberg1
1
Norwegian Institute of Public Health, Oslo, Norway, 2Nic Waals Institute, Lovisenberg Hospital, Oslo, Norway,
3
The Influenza Centre at the University of Bergen, Bergen, Norway
#BDLHSPVOE
In Norway, a cohort of pregnant women and their children, the Norwegian Influenza Pregnancy Cohort
(NorFlu), was established during the influenza A H1N1pdm09 pandemic. The cohort comprises about
3200 mother and child pairs, 2600 with biological samples from mother (serum and peripheral blood
cells) and cord blood. Information on immunization, health and diseases is available from questionnaire
data and national health registries.
These resources enable us to study
tQFSJOBUBMPVUDPNFTBOEDIJMESFOTNFOUBMBOEDPHOJUJWFEFWFMPQNFOU
tSJTLGBDUPSTGPSTFWFSFJOøVFO[BJOQSFHOBODZBOEFòFDUPODIJMESFOTJNNVOFSFTQPOTF
following prenatal exposure to influenza A H1N1pdm09 virus infection or influenza immunization.
.BUFSJBMTBOENFUIPET
NorFlu questionnaires cover exposure to vaccination, influenza infection and anti-viral medication as well
as maternal and child development and health. Follow-up questionnaires at 6, 18 and 36 months have so
far been collected, and long term follow-up is planned.
Cohort data are linked to national health registries for selected outcomes and exposures: the Medical
Birth Registry of Norway on perinatal health, the Norwegian Patient Registry on childhood developmental disorders and maternal health outcomes, the Norwegian Immunisation Register for vaccination data
and the Surveillance System for Infectious Diseases for data on confirmed maternal influenza infection.
POSTERS
Clinical assessment of a sample of 3-year old children (N=600) focusing on developmental health and
immune status is ongoing, and will be completed spring 2015.
Elaborate information on prenatal exposure to immunization and infection will be established through
immunological analyses of maternal- and cord blood at birth, maternal and child blood after 3-5 years, as
well as questionnaire- and register data. Outcomes will be studied according to four maternal exposure
groups: 1) vaccinated and infected, 2) only vaccinated, 3) only infected and 4) neither vaccinated nor
infected. The possibility of using cellular immune responses as biomarkers for infection and vaccination
status will be explored.
1SFMJNJOBSZSFTVMUT
tPGUIFXPNFOIBEJOøVFO[BEVSJOHQSFHOBODZ
tPGUIFNPUIFSTXFSFIPTQJUBMJ[FEEVFUPJOøVFO[B
According to self report:
tXFSFiQSFUUZTJDLwPSiWFSZTJDLw
tXFSFTJDLGPSNPSFUIBOUISFFEBZTBWFSBHFEBZT
tXFSFWBDDJOBUFEBHBJOTUJOøVFO[B1BOEFNSJY
XFSFVTFEJOøVFO[BNFEJDBUJPO
tPGUIFCMPPETBNQMFTGSPNUIFNPUIFSIBEQSPUFDUJWF)*UJUFST
t8IFODPNQBSJOHWBDDJOBUFEWFSTVTOPOWBDDJOBUFEOPEJòFSFODFTJOMFOHUIPGHFTUBUJPOBOECJSUI
weight were found
$PODMVTJPOT
Short and long-term consequences of exposure to influenza in utero clearly need to be clarified, as do the
potential modifying effects of vaccination or anti-viral treatment. The relative importance of antibody-mediated as compared to cell mediated immunity in the protection against influenza, is unclear. Furthermore,
the impact of the specific immunological challenges in pregnancy on women’s immunological response
to influenza infection is largely unknown. Providing unique data including maternal and fetal biological
samples, NorFlu has the potential to contribute significantly in increasing our knowledge in all these fields.
1 )6."/1"1*--0."7*36413&7"-&/$&"/%(&/05:1&%*453*#65*0/*/63*/&4".1-&4
'30./0/7"$$*/"5&%$0)03540'"/%:&"30-%(*3-480.&/*//038":
Mona Hansen1, Ellen Myrvang1, Irene K. Christiansen1, Tor F. Molden2, Alexander Eieland1, Roger Meisal1, Berit
Feiring2, Truls Leegaard1, Jeanette Stålcrantz2 Ole H. Ambur1, Christine Jonassen1* and Lill Trogstad2.
1
Dept. Microbiology and Infection Control, Akershus University Hospital, Norway; 2Norwegian Institute of Public
Health, Norway; *Current address: Center for Laboratory Medicine, Østfold Trust Hospital, Fredrikstad, Norway
#BDLHSPVOE As part of a national surveillance programme of the HPV-vaccination, HPV testing in urine
was implemented as a surrogate sample for cervical infection in pre-screening age cohorts to monitor
vaccine effectiveness.
0CKFDUJWF To monitor HPV prevalence and genotype distribution in non-vaccinated cohorts of 17 and 21
year old (yo) girls/women in Norway to follow-up of the national child immunization program.
4UVEZEFTJHO Two near complete birth cohorts of 17 yo girls (n=~56.000) and one partial birth cohort
of 21 yo women (n=~10.000) were invited by mail to participate in the study. A total of ~13.000 urine
samples were so far collected and investigated for the presence and genotype of HPV using a modified
GP5+/6+ PCR protocol followed by DNA-DNA hybridization technology (Luminex).
3FTVMUTHPV infection was found highly prevalent in Norwegian cohorts of 17 and 21 yo girls/women.
The overall prevalence of HPV in the 17 yo cohorts will be presented, as well as HPV genotype distributions of both cohorts.
POSTERS
$PODMVTJPOTVaccine targeted HPV types are among the most prevalent types providing means for a
solid comparison to the HPV genotypes distributions in the currently enrolling vaccinated cohorts.
1 $'4.&*4"440$*"5&%8*5)5)&1"/%&.*$)/*/'-6&/[ "7*364#65/058*5))/
7"$$*/"5*0/
Magnus P1, Bakken IJ1, Gunnes N1, Ghaderi S1, Tveito K2, Trogstad L1, Håberg SE1.
1
The Norwegian Institute of Public Health, Oslo, Norway, 2The Journal of the Norwegian Medical Association, Oslo,
Norway
0CKFDUJWF: To estimate the association between exposure to H1N1 influenza infection and/
or H1N1 vaccination during the 2009 pandemic and later development of chronic fatigue
syndrome/myalgic encephalomyelitis (CFS/ME) in the Norwegian population.
.FUIPET: Norway has nation-wide registries for infectious diseases, vaccination as well as
attendance to health care. We used regression methods to estimate the relative risk of CFS/ME
in the years 2010-2012 according to exposure to influenza and/or vaccination with Pandemrix in
the last months of 2009.
3FTVMUT: During 2010-2012, 3645 new cases of CFS/ME were registered in the specialized health
care system. We estimated yearly incidence rates of CFS/ME for the period 2008-2012, and
calculated the proportion of patients with CFS/ME, diagnosed in 2008 and the first 9 months
of 2009 who received the vaccine compared to non-patients. Crude and adjusted hazard ratios
for developing CFE/ME during the years 2010-2012 were estimated according to influenza
infection and vaccination, using Cox regression. Subjects with a recognized influenza infection
had a significantly increased risk of developing CFS/ME compared to subjects without infection.
Vaccination carried no risk.
POSTERS
$PODMVTJPO: These preliminary results suggest that infection with the pandemic influenza virus
(H1N1) increases the risk of CFS/ME. Vaccination does not appear to influence the risk.
1 580"(&1&",4*/5)&13&7"-&/$&0'$'4.&*//038":"3&(*453:456%:
Bakken IJ1, Trogstad L1, Håberg SE1, Ghaderi S1, Gunnes N1, Tveito K2, Magnus P1.
1
The Norwegian Institute of Public Health, Oslo, Norway, 2The Journal of the Norwegian Medical Association, Oslo,
Norway
0CKFDUJWF: To estimate the prevalence of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME)
in the Norwegian population according to sex and age.
.FUIPET: Diagnoses for all patients who are hospitalized or attend outpatient clinics in Norwegian
specialized health services are reported to the Norwegian Patient Registry. We estimated sex- and agespecific prevalences by using the whole population (sized about 5 million) as denominator and registry
cases with CFS/ME (ICD-10 code: G93.3) as numerator. We had access to registry data for the years 2008
through 2012.
3FTVMUT: During these years, 5775 individual patients were registered with a diagnosis of CFS/ME as
outpatients or inpatients in Norwegian hospitals. The overall prevalence was 0.133 % (95 % confidence
interval (CI): 0.130-0.137). The female-male prevalence ratio was 3.0 (95 % CI: 2.8-3.2). The highest prevalence (0.416 %) was observed among women aged 15 to 19 years. A second peak (0.348 %) was found
among women aged 35-39 years.
POSTERS
$PODMVTJPO: The estimates are most likely biased by forces of selection and variable use of the G93.3
diagnosis in clinical practice. However, the sex ratio and the two age peaks point to biological regularities
that demand explanation.
1 3&4063$&4$0/4&26&/$&"/"-:4*40'48*5$)*/('30."50%04&)17
7"$$*/"5*0/4$)&%6-&*/'*/-"/%
Van Kriekinge, G.1; Mihalyi, A.1, Posiuniene, I.2
1
GlaxoSmithKline Vaccines, Wavre, Belgium; 2 GlaxoSmithKline Finland&Baltics, Vilnius, Lithuania
0CKFDUJWFT
The AS04-adjuvanted HPV-16/18 vaccine (AS04-adjuvanted) has been approved for use as a 2-dose (2D)
after the initial 3-dose (3D) schedule in girls aged 9-14 in the European Union. We explored the number
of cervical cancer (CC) cases and CC deaths that could be additionally prevented when switching from a
3-dose (3D) to a 2D- schedule (2D) under the same budget with the AS04-adjuvanted vaccine in Finland.
.FUIPE
A steady state population static model was developed to assess cervical cancer (CC) cases and deaths
potentially prevented by vaccination and the associated number of vaccine doses needed in Finland
for the AS04- adjuvanted vaccine administered to girls age 12 (N=28,355). Vaccine effectiveness of 93%
(95%CI: 78.9% – 98.7%) irrespective of HPV type was used, wherewith the reported vaccine efficacy of
the AS04-adjuvanted vaccine against CIN3+ was used as a proxy for effectiveness protecting against CC
and CC death. Vaccination coverage ranged from 0 to 100%. Pre-vaccination CC data were extracted from
the Globocan 2012. Sensitivity analyses using lower bound (LB) and upper bound (UB) of vaccine efficacy
were performed.
3FTVMUTBOE$PODMVTJPOT
With 60% vaccination coverage the potential annual number of CC cases and deaths prevented was 80
(LB: 68, UB: 85) and 29 (LB: 25, UB: 31), respectively. Number of doses needed for 3D was 51,039 vs. 34,026
doses for 2D. Allocating the number of doses liberated with the 2D vs. the 3D would allow increasing
coverage with the 2D to 90% resulting in 120 (LB: 102, UB: 127) CC cases (+40 vs. 3D) and 44 (LB: 38; UB:
47) CC deaths (+15 vs. 3D) avoided.
POSTERS
Under the same budget, the doses saved when switching from a 3D to 2D in Finland could be redistributed to increase vaccination coverage resulting in further reduction of CC burden or be invested in other
prevention initiatives.
1 *.1"$50'-*7&03"-#07*/&)6."/3&"44035"/5305"7*3647"$$*/&305"5&2¥
41.4%
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("4530&/5&3*5*4:&"34"'5&3*/530%6$5*0/*/50'*//*4)/"5*0/"-
*..6/*[ "5*0/130(3"..&/*1
Timo Vesikari1, Matti Uhari2, Marjo Renko2, Maria Hemming1, Marjo T Salminen1, Laurence Torcel-Pagnon3, Francois Simondon3, Hélène Bricout3
1
University of Tampere, Vaccine Research Center, Tampere, Finland; 2University of Oulu, Department of Pediatrics,
Oulu, Finland; and 3Epidemiology Department, Sanofi Pasteur MSD, Lyon, France
#BDLHSPVOERotavirus (RV) vaccination (RotaTeq® ) was introduced into Finnish NIP in September 2009
following a schedule of 2, 3 and 5 months. The coverage soon reached that of other childhood immunizations in Finland (>95%). In the preceding 2–3 years rotavirus vaccine had been given in the private sector
with 26% and 34% coverage for the years 2007 and 2008, respectively.
.FUIPETHospital discharge registers using ICD-10 codes for all-cause acute gastroenteritis (AGE) (ICD10 A00-A09) and RV AGE (ICD-10 A08.0), and laboratory databases of RV ELISA results were retrieved from
the University Hospitals of Tampere and Oulu from September 2001 to August 2013. Incidences of RV
AGE and all cause AGE hospitalizations were estimated among children under 16 years before vaccination from 2001 to 2006, during the transition from 2006 to 2009 , and post-NIP period, from 2009 to 2013,
respectively. ).
3FTVMUTIn the post NIP vs. pre-vaccination period, the reduction of the incidence of RV AGE hospitalizations in the target age group 6–47 months was 86,5 % (95% CI 82.2–89.7) and of all-cause AGE 71.3 %
(95%CI 68.5–73.8). In the age group 4–15 years, not eligible for NIP, there was no significant reduction
in hospitalizations for RV AGE. The vaccine impact for RV AGE was greater in Tampere, 94,3% (89.6–96.9)
than in Oulu, with a thinly populated but large coverage area, 79.8% (72.3–85.2).
POSTERS
$PODMVTJPOTRotaTeq® in NIP has had a strong impact in reducing hospitalizations for RV AGE and allcause AGE in the vaccine eligible age group. We did not observe indirect protection of older children who
were not eligible for the RV NIP. A higher post-NIP RV activity was seen in the 4th year of study, particularly
in Oulu area and in older children, suggesting local differences in the circulation of RV.
1 3&"--*'&&''&$5*7&/&440'-*7&03"-#07*/&)6."/3&"44035"/5305"7*364
7"$$*/&305"5&2¥41.4%
"'5&3*/530%6$5*0/*/50'*//*4)/"5*0/"-
*..6/*[ "5*0/130(3"..&/*1
"4%&5&3.*/&%*/"'063:&"3)041*5"-#"4&%
13041&$5*7&4637&*--"/$&
Timo Vesikari1, Matti Uhari2, Marjo Renko2, Maria Hemming1, Marjo T Salminen1, Laurence Torcel-Pagnon3, Francois Simondon3, Hélène Bricout3
1
University of Tampere, Vaccine Research Center, Tampere, Finland; 2University of Oulu, Department of Pediatrics,
Oulu, Finland; and 3Epidemiology Department, Sanofi Pasteur MSD, Lyon, France
#BDLHSPVOERotavirus (RV) vaccination (RotaTeq®) was introduced into Finnish NIP in September 2009
following a schedule of 2, 3 and 5 months. The coverage soon reached that of other childhood immunizations in Finland (>95%).
.FUIPETA prospective study was conducted in the pediatric wards of University Hospitals of Tampere
and Oulu from September 2009 to August 2013. Children hospitalized for acute gastroenteritis (GE) with
parental consent were included and stool samples were taken. A test negative case-control analysis was
performed to estimate RotaTeq® VE. Definition for a case was RV acute gastroenteritis (RV AGE) with an
EIA+ and RT-PCR+ stool specimen; the controls were gastroenteritis cases negative for RV.
3FTVMUTWe identified 143 RV AGE cases in children under 16 years over the 4-year period. Of those cases,
17 occurred in vaccine eligible children: 8 fully vaccinated, 1 partially vaccinated and 8 unvaccinated. The
control group included 117 RV negative AGE cases. RotaTeq® vaccine effectiveness for fully vaccinated
children was 94.4% (CI 79.8-98.4), p≤0.001. RV AGE cases remained at a low level throughout the study,
but in the 4th year there was some resurgence of RV activity, particularly in Oulu. During the first three
years, the most common RV genotypes were G1P[8] and G4P[8], whereas G3P[8] became predominant in
the 4th season. A shift towards older age groups was observed during the study with peak age at 48–53
months in the fourth season.
POSTERS
$PODMVTJPORotaTeq® showed high and sustained effectiveness throughout the 4-year surveillance to
prevent hospitalizations for RV AGE in eligible children. It appears that over the years remaining RV AGE
cases may occur in unvaccinated older children who are initially protected from RV infection through
herd protection.
Participants
Aabakken, Per Harald
Sanofi Pasteur MSD
Norway
[email protected]
Bergsaker, Marianne R.
Norwegian Institute of Public Health
Norway
[email protected]
Aase, Audun
Norway
[email protected]
Blennow, Margareta
Sachsska barn- och ungdomssjukhuset, Södersjukhuset
Sweden
[email protected]
Agboton, Christian
Glaxosmithkline Biologicals - Medical Affairs
Belgium
[email protected]
Brenne, Ingunn Johansen
Dept. of Communication
Norway
[email protected]
Alheim, Katarina
Sanofi Pasteur MSD, PV Nordic department
Sweden
[email protected]
Andersen, Peter Henrik
Statens Serum Institut,
Department of Infectious Disease Epidemiology
Denmark
[email protected]
Briem, Haraldur
Directorate of Health
Iceland
[email protected]
Brorson, Ida
Sanofi Pasteur MSD Denmark
Denmark
[email protected]
Andersen, Svein Rune
Norwegian Medicines Agency
Norway
[email protected]
Bruun, Tone
Norway
[email protected]
Arnheim Dahlström, Lisen
Karolinska Institutet, Dept. Medical Epidemiology
and biostatistics
Sweden
[email protected]
Butler, Robb
World Health Organization
Denmark
[email protected]
Aronsson, Bernice
Södersjukhuset
Sweden
[email protected]
Aspinall, Richard
University of Cranfield
United Kingdom
[email protected]
Bakke, Hilde
GlaxoSmithKline. Regulatory
Norway
[email protected]
Bergquist, Charlotta
Medical Products Agency, Efficacy and Safety 2
Sweden
[email protected]
Bäckman, Margarete
Umea University Pediatrics
Sweden
[email protected]
Carlsson, Rolf
Sanofi Pasteur MSD
Sweden
[email protected]
Cavefors, Ann Sofie
Central Barnhälsovård, Göteborg/Södra Bohuslän
Sweden
[email protected]
Chandler, Rebecca
Swedish Medical Products Agency
Sweden
[email protected]
Chavoshi, Tina
Swedish National Board of Health and Welfare /
Socialstyrelsen
Sweden
[email protected]
Elonsalo, Ulpu
National Institute for Health and Welfare,
Dept. of Vaccination and Immune Protection
Finland
[email protected]
Coucheron, Berit
Janssen-Cilag AS
Norway
[email protected]
Englund, Hélène
Folkhälsomyndigheten, Enheten för vaccin och register
Sweden
[email protected]
Cox, Rebecca
University of Bergen
Norway
[email protected]
Feiring, Berit
Norway
[email protected]
Cronqvist, Ellinor
Swedish National Board of Health and Welfare,
Department of Knowledge-Based Policy and Guidance
Sweden
[email protected]
Fjällryd, Laila
Department of Children`s Health
Sweden
[email protected]
Dalby, Tine
Statens Serum Institut, Dept. of Microbiology & Infection
Control
Denmark
[email protected]
Damkjær, Mads
Sanofi Pasteur MSD Danmark
Denmark
[email protected]
Danielsson, Madelene Persson
National Board of Health and Welfare, Sweden
Sweden
[email protected]
Dao, Phuong
Norway
[email protected]
De Graaf, Truus
Head Programmes and Vaccine Supply
Netherlands
[email protected]
Doherty, T. Mark
GSK, Medical Affairs
Denmark
[email protected]
Flem, Elmira
Norway
[email protected]
Forslund, Carina
Umea University, Pediatrics
Sweden
[email protected]
Foss, Grethe
Pfizer
Norway
[email protected]
Fredlund, Hans
Dept Laboratory medicine/mikrobiology,
Örebro University hospital
Sweden
[email protected]
Furuseth, Ellen
Norway
[email protected]
Germod, Gitte Lykke
Statens Serum Institut, Sales & Business Development
Denmark
[email protected]
Ege, Maren Stapnes
Norway
[email protected]
Gil Cuesta, Julita
Denmark
[email protected]
Ellingsen, Espen Alme
Norway
[email protected]
Glismann, Steffen
GlaxoSmithKline Vaccine
Belgium
[email protected]
Glode Kristoffersen, Ida
Denmark
[email protected]
Hanttu, Anna
GSK, Medical
Finland
[email protected]
Gothefors, Leif
Umea University Pediatrics
Sweden
[email protected]
Hartvig Christiansen, Annette
Denmark
[email protected]
Greve-Isdahl, Margrethe
Norway
[email protected]
Haugen, Inger Lise
Norway
[email protected]
Grove Krause, Tyra
Statens Serum Institut, Department of Infectious Disease
Epidemiology
Denmark
[email protected]
Helander, Kicki
Allergy centre University hospital Linköping
Sweden
[email protected]
Gudmudsdottir, Thorbjörg
Iceland
[email protected]
Gudnason, Thorolfur
Iceland
[email protected]
Henningsson, Christina
Central barnhälsovård, Skaraborg, Sverige
Sweden
[email protected]
Hill, Jorunn
Norway
[email protected]
Gullichsen, Anna-Kaarina
Janssen, vaccines
Finland
[email protected]
Hiul Suppli, Camilla
Denmark
[email protected]
Gylling, Annette
Sanofi Pasteur MSD, Medical Affairs
Finland
[email protected]
Hungnes, Olav
Norwegian Inst of Public Health, Dept of Virology
Norway
[email protected]
Hagen, Hege Kristin
Sanofi Pasteur MSD
Norway
[email protected]
Høeg-Jensen, Lisbeth
Danish Health and Medicines Authority
Denmark
[email protected]
Hagerup-Jenssen, Maria E
Norway
[email protected]
Isoniemelä, Viivi
National Institute for Health and Welfare
Finland
[email protected]
Hallander, Hans
Public Health Agency of sweden
Sweden
[email protected]
Jacobsen, Malene
Janssen-Cilag
Denmark
[email protected]
Hallén, Ingemar
Smittskydd Värmland
(Dep of prevention and control of communicable
diseases, County Värmland)
Sweden
[email protected]
Janzén, Björn
AstraZeneca
Sweden
[email protected]
Janzon, Lars
Sanofi Pasteur MSD, Medical Affairs
Sweden
[email protected]
Jensen, Henrik G.
Danish Health and Medicines Authority
Denmark
[email protected]
Johansen, Kari
European Centre for Disease Prevention and Control
Sweden
[email protected]
Johansson, Ulla
Dpt.of Vaccination and Immune Protection
Finland
[email protected]
Johnsen, Jostein
Norway
[email protected]
Jokinen, Jukka
Finland
[email protected]
Kilpi, Terhi
Finland
[email protected]
Klüwer-Trotter, Birgitte
Norway
[email protected]
Kok, Sjirk
RIVM Department for Vaccine Supply and Prevention
Programmes
Netherlands
[email protected]
Krause Knudsen, Lisbet
Denmark
[email protected]
Lamb, Favelle
Karolinska Institutet,
Medical Epidemiology and Biostatistics
Sweden
[email protected]
Lange, Charlotte
Pfizer Denmark
Denmark
[email protected]
Lankinen, Kari S.
Finnish Medicines Agency Fimea
Finland
[email protected]
Leino, Tuija
Finland
[email protected]
Lenerius, Mathias
Pfizer AB, Vaccines
Sweden
[email protected]
Lepp, Tiia
The Public Health Agency of Sweden,
Vaccine and Register Unit
Sweden
[email protected]
Leval, Amy
Vaccine Expert Group Stockholm County
Sweden
[email protected]
Lie, Kristian
GSK
Norway
[email protected]
Liliedahl, Marie
Janssen Vacciner
Sweden
[email protected]
Lindberg, Anders
Anders Lindberg SMITTSKYDD
Sweden
[email protected]
Laake, Ida
Norway
[email protected]
Lindkvist, Rose-Marie
Health and Value
Denmark
[email protected]
Laitinen, Heli
Pfizer Oy, Vaccines
Finland
[email protected]
Lindstrand, Ann
Folkhälsomyndigheten Sverige
Sweden
[email protected]
Ljungman, Margaretha
Folkhälsomyndigheten
Sweden
[email protected]
Nylén, Gunnar
National Board of Health and Welfare, Sweden
Sweden
[email protected]
Lobosco, Hanna
Socialstyrelsen / Smittskydd
Sweden
[email protected]
Næss, Lisbeth Meyer
Norway,
[email protected]
Lundgren, Anna-Lena
Janssen Cilag AB Sweden
Sweden
[email protected]
Nøkleby, Hanne
Norway
[email protected]
Mjaaland, Siri
Norway
[email protected]
Olberg, Henning
Norway
[email protected]
Molden, Tor Egil F.
Norway
[email protected]
Olcén, Per
Örebro University
Sweden
[email protected]
Mrkvan, Tomas
Global Medical Affairs
Belgium
[email protected]
Oldin, Carin
Child public health unit, Landstinget Jönköping county
Sweden
[email protected]
Mörner, Andreas
Folkhälsomyndigheten, Avdelningen för mikrobiologi
Sweden
[email protected]
Olsen, David
Sanofi Pasteur MSD
Norway
[email protected]
Neale, Birgit
Statens Serum Institut, Sales & Business Development
Denmark
[email protected]
Olsen, Jan Ussing
Sanofi Pasteur MSD Denmark
Denmark
[email protected]
Netterlid, Eva
The Public Health Agency of Sweden,
Unit for Vaccine and Register (EU-VR)
Sweden
[email protected]
Palmborg, Andreas
Janssen-Cilag AB
Sweden
[email protected]
Nohynek, Hanna
Finland
[email protected]
Norberg, Erica
Pfizer AB, Vaccines
Sweden
[email protected]
Nordin, Lotta
GSK vaccines
Sweden
[email protected]
Palmu, Arto
National Institute for Health and Welfare, Department of
Vaccination and Immune Protection
Finland
[email protected]
Petersen, Jesper Westphal
Statens Serum Institut
Denmark
[email protected]
Pitkänen, Saila
Finland
[email protected]
Poelaert, Dirk
GSK Medical Affairs Europe
Belgium
[email protected]
Rydland, Kjersti
Norway
[email protected]
Posiuniene, Inga
GlaxoSmithKline, Medical department
Lithuania
[email protected]
Räsänen, Jukka
Sanofi Pasteur MSD
Finland
[email protected]
Puumalainen, Taneli
Ministry of Social Affairs and Health of Finland /
Department for Promotion of Welfare and Health
Finland
[email protected]
Rønne, Tove
Danish Health an Medicines Authority, Denmark
Denmark
[email protected]
Ramsay, Mary
Public Health England
United Kingdom
[email protected]
Remorie, Rolf
GlaxoSmithKline Global Vaccines
Belgium
[email protected]
Riise, Øystein R
Norway
[email protected]
Rønning, Karin
Norway
[email protected]
Røttingen, Jon-Arne
Norway
[email protected]
Salminen, Marjo
University of Tampere, Vaccine Research Center
Finland
[email protected]
Rimmelzwan, Guus
Erasmus Medical Center
Netherland
[email protected]
Salo, Heini
Finland
[email protected]
Ristun, Steffen
Pfizer
Norway
[email protected]
Sandbu, Synne
Norway
[email protected]
Robertson, Anna H
Norway
[email protected]
Saravuo, Essi
GSK oy, Vaccines business unit
Finland
[email protected]
Rombo, Lars
Karolinska Institutet Stockholm
Sweden
[email protected]
Schmidt-Ott, Ruprecht
GlaxoSmithKline Vaccine
Germany
[email protected]
Rubin, Johanna
Vaccine Expert Group Stockholm County
Sweden
[email protected]
Seterelv, Siri Schøyen
Norway
[email protected]
Ruokonen, Sini
GSK Finland and Baltics
Finland
[email protected]
Sjöblom, Ann-Christine
Vaccine Expert Group, Stockholm County
Sweden
[email protected]
Sjöblom, Kerstin
Pfizer AB, Vaccines
Sweden
[email protected]
Slotved, Hans-Christian
Statens Serum Institut
Denmark
[email protected]
Sommevåg, Johan
Janssen Cilag
Sweden
[email protected]
Sormunen, Pertti
Finland
[email protected]
Stenver, Doris Irene
Danish Health and Medicines Authority,
Drug Safety Surveillance Unit
Denmark
[email protected]
Stridh, Lisbeth Gustafsson
PFIZER AB. Vaccines
Sweden
[email protected]
Strömberg, Nina
Finland
[email protected]
Stålcrantz, Jeanette
Norway
[email protected]
Szirmai, Maria
Läkemedelsverket (MPA),
Dept. External relations and Innovation support
Sweden
[email protected]
Sørup, Signe
Bandim Health Project, Statens Serum Institut
Denmark
[email protected]
Tegnell, Anders
Folkhälsomyndigheten,
Avd. för övervakning och uppföljning
Sweden
[email protected]
Thoms, Graham
Novartis Vaccines UK
United Kingdom
[email protected]
Tiainen, Jenni
Finland
[email protected]
Tikkanen, Hillevi
Finland
[email protected]
Tillgren Moreau, Mia
Pfizer AB, Vaccines
Sweden
[email protected]
Tjomlid, Gunnar
Norway
[email protected]
Sundström, Åsa
Umea university, Pediatrics
Sweden
[email protected]
Torén, Björn
Sahlgrenska Universitetssjukhuset, Läkemedelsenheten
Sweden
[email protected]
Svendsen, Per Kristian
Norwegian Institute of Public Health,
Dept. of Communication
Norway
[email protected]
Trogstad, Lill Iren
Norway
[email protected]
Svensson, Lena
GSK
Sweden
[email protected]
Tveteraas, Ingun H.
Norway
[email protected]
Tønnessen, Ragnhild
Norway
[email protected]
Uhnoo, Ingrid
Public Health Agency of Sweden
Sweden
[email protected]
Wallmyr, Daniel
Childrens Public Health, Västra Götaland
Sweden
[email protected]
Ung, Gro
Norway
[email protected]
Wehlin, Lena
The public health agency of Sweden,
Department of Microbiology
Sweden
[email protected]
Ungerstedt, Martin
AstraZeneca Medical Affairs
Sweden
[email protected]
Vainio, Kirsti
Norway
[email protected]
Valentiner-Branth, Palle
Denmark
[email protected]
Wiklund, Berit Sofie
Norway
[email protected]
Wolden, Britt
Norway
[email protected]
Ylitalo, Tero
Pfizer, Vaccines
Finland
[email protected]
Vuola, Jenni
Sanofi Pasteur MSD, Finland
Finland
[email protected]
Zandbergen, Danielle
GlaxoSmithKline, Vaccines department
Netherlands
[email protected]
Wachowska, Martyna
AstraZeneca, GPPS
United Kingdom
[email protected]
Åhman, Heidi
Pfizer Vaccines
Finland
[email protected]

Abstractbook

Transcription

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