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Minister of health in Thailand Witthaya Kaewparadai

Successful HIV Vaccine Study Will Lead to Further Research

Washington Medical researchers in Thailand have developed an approach to prevent HIV the same way it has been treated, by using a combination vaccine to successfully halt the spread of the disease.

Public health officials announced September 24 in Bangkok that they successfully used two previously unsuccessful HIV vaccines in combination in a large, six-year study to prevent people from getting HIV, which causes AIDS. The vaccines used in the study cannot cause HIV infection because they are not made from and do not contain the whole virus, active or dead, the medical researchers said.

The combination vaccine cut the risk in 16,402 Thai volunteers by 31.2 percent, Thai Health Minister Witthaya Kaewparadai reported at a briefing. The result of the study is a very important step for developing an AIDS vaccine. It's the first time in the world that we have found a vaccine that can prevent HIV infection, Kaewparadai told reporters.

Researchers say the results are not enough to go ahead immediately with widespread production of the combo vaccine using the prime-boost approach developed in Thailand. Normally, vaccine results have to exceed 50 percent before being accepted for general use, medical researchers say. Officials at the two pharmaceutical companies that manufactured the vaccines said it will take many years of testing and further research before the combo vaccine can be used widely.

Witthaya Kaewparadai minister of health in Thailand

STUDY BEGAN IN 2003

The study, which began in October 2003, was conducted by the Thai Ministry of Public Health with funding and support from the U.S. Army's Walter Reed Army Institute of Research and the U.S. National Institute of Allergy and Infectious Diseases (NIAID), which is part of the National Institutes of Health based in Washington. The principal investigator was Dr. Supachai Rerks-Ngarm of the Thai Ministry of Public Health's Department of Disease Control.

Thailand was selected for the $105 million study because U.S. Army medical researchers had conducted initial research when the HIV/AIDS epidemic first emerged there in the 1990s, identifying and isolating virus strains and providing the virus's genetic information to vaccine makers. The study was conducted with the full support of the Thai government because the country had an emerging problem with AIDS when the study began.

The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) began support work for this trial 18 years ago, in 1991, when Thailand was recommended as one of the WHO-sponsored countries in preparation for HIV vaccine trials. A study in 2006 by the HIV Vaccine Advisory Committee found that the trial was being conducted at the highest scientific and ethical standards and with active community participation.

The study, the largest in HIV vaccine history, was conducted in the Rayong and Chonburi provinces with 16,402 men and women ages 18 to 30 who were at various levels of risk for HIV infection, the NIAID said. These provinces were selected because the populations in both are generally stable. We thank the trial staff in Thailand and the United States for their years of effort in successfully conducting this study and the study participants and the people of Thailand for their long-standing support of HIV vaccine research, said NIAID Director Dr. Anthony Fauci. These new findings represent an important step forward in HIV vaccine research.

Thai men and women were given either a placebo or the prime-boost combination of the vaccine ALVAC, from Sanofi Pasteur SA, which is the vaccine division of French drug maker Sanofi-Aventis; and the vaccine AIDSVAX, originally developed by VaxGen Inc. and now held by Global Solutions for Infectious Diseases, a nonprofit organization created by former VaxGen employees. Half of the volunteers received four priming doses of ALVAC and two boost doses of AIDSVAX over a six-month period. The other half received dummy doses of a placebo. The volunteers were tested for HIV every six months for three years after the vaccinations ended.

NIAID said the vaccines are based on the B and E strains of HIV that commonly circulate in Thailand. Researchers readily acknowledge that they do not know why the combination works to prevent HIV infection, and that it is unlikely the combination would work in the United States, where only the B strain is most common, in Africa or elsewhere in the world.

In previous HIV vaccine trials, neither ALVAC nor AIDSVAX proved effective in preventing HIV infection when used alone, researchers said, but when used in a prime-boost approach they tend to work. The first vaccine, ALVAC, primes the body's immune system to attack HIV, and the second vaccine, AIDSVAX, strengthens the body's immune response, researchers said.

The volunteers were given thorough briefings on the potential risks associated with receiving the experimental vaccine before agreeing to participate. All were given condoms, counseling and treatment for any other sexually transmitted diseases. On each clinic visit, each volunteer was counseled on how to avoid becoming infected with HIV. Any volunteer who became infected with HIV was given free treatment with anti-retroviral therapy based on the guidelines of the Thai Ministry of Public Health.

For the first time, an investigational HIV vaccine has demonstrated some ability to prevent HIV infection among vaccinated individuals. Additional research is needed to better understand how this vaccine regimen reduced the risk of HIV infection, but certainly this is an encouraging advance for the HIV vaccine field, Fauci said.

NIAID and its partners are working with other scientific experts to determine the next steps, including additional research of the vaccine regimen and the need to consider the impact of these new findings on other HIV vaccine candidates, NIAID said.

ADDITIONAL STUDIES NEEDED

A conference is being held in New York during the week of September 28-October 2 with dozens of researchers, vaccine makers, major research donors and HIV/AIDS groups to determine where to go next. At the conference will be medical researchers from Thailand, the U.S. Army, NIAID and independent researchers.

U.S. Army Colonel Jerome Kim, an infectious disease expert and the Army HIV vaccine product manager at the Walter Reed Army Institute of Research's Division of Retrovirology, said researchers now will try to understand why the vaccine worked in some people and how the combo vaccine blocks infections.

Additional studies are clearly needed to better understand how this vaccine regimen reduced the risk of HIV infection, Kim said. The Thai study demonstrates why the HIV vaccine field must take a balanced approach to conducting both the basic research needed to discover and design new HIV vaccines and, when appropriate, testing candidate vaccines in people, said Margaret Johnston, director of NIAID's Vaccine Research Program within the Division of AIDS. Both avenues provide critical information that will continue to help us better understand what is needed to develop a fully protective HIV vaccine.

Lieutenant General Eric Schoomaker, the Army surgeon general and commander of the U.S. Army Medical Command, said the Thai study results are important, but modest. I'm pleased and proud to announce the results of the trial, which for the first time ever have shown that it is possible for a vaccine to reduce the risk of HIV infection in humans, Schoomaker said September 24 in Washington. Although the level of protection is modest, at 31 percent efficacy, the study represents a major scientific achievement.

Military medicine is interested in research that improves global health and makes the world safer for everyone, he added. WHO and UNAIDS said in a joint statement that the study results, representing a significant scientific advance, are the first demonstration that a vaccine can prevent HIV infection in a general adult population, and characterized the results as modestly protective.

However, these results have instilled new hope in the HIV vaccine research field and promise that a safe and highly effective HIV vaccine may become available for populations throughout the world who are most in need of such a vaccine, the statement said.

The board of the National Health Security Office (NHSO) has revealed that 14 hospitals affiliated with the private-run Bangkok Hospital Group have begun providing treatment for patients with high-cost and urgent diseases under the universal health care scheme. Under the new cooperation between the NHSO and the Bangkok Hospital, patients with diseases including heart disease, coronary artery disease, and stroke (cerobrovascular disease) should be able to receive prompt and proper treatment, says the board. The NHSO will be responsible for managing the overall system of transferring patients to the 14 hospitals of the Bangkok Hospital and the costs of treatment will be covered by the newly endorsed per capita budget of 2,400 baht. The NHSO-Bangkok Hospital cooperation was considered and approved by the NHSOs board on April 21, 2009. Public Health Minister Witthaya Kaewparadai in his capacity as president of the National Health Security Committee chaired the meeting. The Universal Coverage has taken care of 47 million Thais, from general health care to treatment of high-cost diseases such as heart disease and stroke, says Mr Witthaya. All state hospitals and certain private medical institutions provide services under this scheme. The higher the number of private hospitals joining the scheme, the more effective its services will be, says the minister, adding that it is good news that the 14 hospitals of Bangkok Hospital will become a part of the universal coverage system. Unnecessary deaths or disabilities could be avoided with these hospitals promptly providing high-cost and urgently needed treatment, for instance, open-heart surgery, says Mr Witthaya. The hospitals, meanwhile, will be given a reasonable financial compensation to pay the bill for treatment they provide under the universal health care scheme.
Mr Witthaya says the Cabinet meeting on April 21, 2009 endorsed the proposal to increase the Universal Coverage budget to 2,400 baht per head in fiscal year 2010 from currently 2,202 baht per head. The 198-baht rise in the per capita budget was based on the number of in- and out-patients receiving health care under the scheme in fiscal year 2009 and an additional financial burden caused by the kidney dialysis programme for the last-stage patients. Furthermore, he says, health promotion activities are also needed to be done more extensively in order to cope with the rising number of aging population. The ultimate goal of this effort is to make Thai people age healthily. Four out of 14 hospitals, namely Bangkok Hospital Medical Center, Samitivej Srinakarin Hospital, Bangkok-Ratchasima Hospital, Bangkok-Phuket Hospital, will be providing open-heart surgery to about a hundred patients per year, says Dr Vinai Swasdivorn, secretary-general of the NHSO. As for treatment for coronary artery disease, Bangkok Hospital Medical Center; Bangkok-Pattaya Hospital; Bangkok-Ratchasima Hospital; and Bangkok-Phuket Hospital will be providing services to an unlimited number of patients under the universal health care scheme. Moreover, all 14 hospitals located in all parts of the country will be providing care for an unlimited number of patients with a disease of blood vessels supplying the brain under an agreement that the NHSO will pay for the service at an agreed rate. In principle, the agreement between the NHSO and the Bangkok Hospital Group will initially last one year.

News Quote: "BANGKOK, July 30 2009 (TNA) The Ministry of Public Health is set to begin distributing 800,000 anti-viral Oseltamivir capsules to clinics nationwide on August 3, according to Minister Witthaya Kaewparadai."

People warned of 6 diseases during winter BANGKOK, 8 November 2009 (NNT) The Ministry of Public Health has warned people of six diseases coming with the winter. They are influenza, pneumonia, measles, German measles, chicken pox and diarrhoea as viruses can spread easily in cold climates.

Public Health Minister, Witthaya Kaewparadai, cautioned that people were prone to the diseases if their body could not adjust to the season changes, especially children and elderly people. The Minister has instructed the Disease Control Department to make the announcement in order for provincial public health offices to educate people on ways to protect themselves against the diseases.

Director-General of the Disease Control Department, MD Manit Teeratantikanont, elaborated that winter diarrhoea is often found in infants aged less than two years old who drink water or eat food containing the virus. Initial symptoms include flu-like fever, followed by diarrhoea. Generally, the condition is not serious but it can develop in children. If it does not improve the patient must be hospitalized.

To prevent diarrhea among infants, MD Manit suggested mothers to breastfeed their children. Other measures include hygienic food preparation and cooking, drinking boiled water and ensuring a high sanitary standard of toilets. Regarding other five diseases, he said most of them could be transmitted via coughing and sneezing.

According to Permanent Secretary for Public Health, MD Paijit Warachit, 545,980 patients were infected with the six mentioned diseases in winter last year. Diarrhoea accounted for 83% or 455,010 cases, killing 32 patients. Pneumonia accounted for 43,247 cases, killing 321 patients. Other four diseases had no fatalities reported.

map of Thailand regions

Thailand is divided into 75 provinces (changwat), which are gathered into 5 groups of provinces by location. There are also 2 special governed districts: the capital Bangkok (Krung Thep Maha Nakhon) and Pattaya, of which Bangkok is at provincial level and thus often counted as a 76th province.

Each province is divided into districts and the districts are further divided into sub-districts (tambons). As of 2006 there are 877 districts (amphoe) and the 50 districts of Bangkok (khet). Some parts of the provinces bordering Bangkok are also referred to as Greater Bangkok (pari monthon). These provinces include Nonthaburi, Pathum Thani, Samut Prakan, Nakhon Pathom and Samut Sakhon. The name of each province's capital city (mueang) is the same as that of the province. For example, the capital of Chiang Mai province (changwat Chiang Mai) is Mueang Chiang Mai or Chiang Mai. The 76 provinces are as follows:
Map of Thailand
Wat Arun, in Bangkok
Central

1. Ang Thong
2. Bangkok (Krung Thep Maha Nakhon), Special Governed District of
3. Chai Nat
4. Kanchanaburi
5. Lopburi
6. Nakhon Nayok
7. Nakhon Pathom
8. Nonthaburi
9. Pathum Thani
10. Phetchaburi
11. Phra Nakhon Si Ayutthaya
12. Prachuap Khiri Khan
13. Ratchaburi
14. Samut Prakan
15. Samut Sakhon
16. Samut Songkhram
17. Saraburi
18. Sing Buri
19. Suphan Buri

East

1. Chachoengsao
2. Chanthaburi
3. Chonburi
4. Prachinburi
5. Rayong
6. Sa Kaeo
7. Trat

North

1. Chiang Mai
2. Chiang Rai
3. Kamphaeng Phet
4. Lampang
5. Lamphun
6. Mae Hong Son
7. Nakhon Sawan
8. Nan
9. Phayao
10. Phetchabun
11. Phichit
12. Phitsanulok
13. Phrae
14. Sukhothai
15. Tak
16. Uthai Thani
17. Uttaradit

Northeast (Isan)

1. Amnat Charoen
2. Buri Ram
3. Chaiyaphum
4. Kalasin
5. Khon Kaen
6. Loei
7. Maha Sarakham
8. Mukdahan
9. Nakhon Phanom
10. Nakhon Ratchasima
11. Nong Bua Lamphu
12. Nong Khai
13. Roi Et
14. Sakon Nakhon
15. Si Sa Ket
16. Surin
17. Ubon Ratchathani
Phra Borommathat Nakhon Si Thammarat Thailand
18. Udon Thani
19. Yasothon

South

1. Chumphon
2. Krabi
3. Nakhon Si Thammarat
4. Narathiwat
5. Pattani
6. Phang Nga
7. Phatthalung
8. Phuket
9. Ranong
10. Satun
11. Songkhla
12. Surat Thani
13. Trang
14. Yala

Last updated: 17 July 2010
Page created: 08 June 2010
   
     
   
     
 
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