apec.org.uk/), Australian Action on Pre-eclampsia (AAPEC) www.aapec.org.au), New Zealand Action on Pre-eclampsia (NZ APEC) (www.nzapec.com/), and Association de Prevention et d’Actions contre la pre-eclampsie (APAPE) (www.eclampsie.moonfruit.fr/) [515]. The Preeclampsia Foundation advocates for: better patient (and health care provider) SP600125 solubility dmso education about the antenatal, early postnatal and long-term maternal implications of preeclampsia; an emphasis on early maternal signs

and symptoms of preeclampsia; better doctor–patient communication about preeclampsia; and evidence-based guidelines for pre-eclampsia screening, detection; and management [515]. There is growing evidence that women may experience post-traumatic stress disorder up to seven years postpartum [516], [517], [518], [519], [520], [521], [522], [523] and [524], the prevalence of symptoms being highly variable, ranging from the minority to the majority of women, and higher after: maternal hospitalization >7 days, HDP onset/delivery preterm, NICU admission, adverse neonatal outcomes, and uncertainty about the child’s long-term health [519]. Symptoms are not specific to the HDP, and follow preterm delivery for other indications FGFR inhibitor [520]. Although post-traumatic stress symptoms do not have an impact on infant cognitive or psychomotor development at one year of age, maternal symptoms are amenable

to clinical psychological therapy, and earlier referral may abbreviate treatment [523]. Women and their maternity care providers seem to view experiences of preeclampsia differently. For health-care professionals, preeclampsia represented the Farnesyltransferase care that must be delivered,

primarily responding to the biology of preeclampsia. For women, generally lacking knowledge and understanding about pre-eclampsia, preeclampsia represented fear and risk [525]. In a survey of women who had experienced preeclampsia, eclampsia and/or HELLP, preeclampsia was viewed as very important to all and traumatic to many respondents, women, their partners, close relatives, or friends. The provision of information and support was valued prior to, and at the time of, diagnosis as well as being revisited during ongoing care [526]. Women are not knowledgeable about the HDP, even with pre-existing hypertension, and are not satisfied with the medical information they receive, suggesting that clinicians should both place more value on informing women about their disease and its potential course, and check that women have understood the information [527] and [528]. Although limited health literacy may complicate risk communication, tools have been developed for such purposes [527] and [528]. Women enjoy participating in aspects of their care, be it receiving information as study participants [529], or participating in management of their BP [530]. They do not object to being randomized [380]. Women have expressed a preference for home or day care [531] and self (rather than 24-h ambulatory) BP monitoring [532].

The 3-dose tetravalent HPV-16/18/33/58 vaccine

adjuvanted with AS01 induced higher levels of cross-reacting antibodies to non-vaccine antigens selleck screening library (HPV-31, -45 and -52) one month after the last vaccine dose than vaccines adjuvanted with AS02 or AS04 (Supplementary Fig. 2). Cross-reacting antibody responses tended to be lower when the HPV-16/18/33/58 AS01 vaccine was administered on a 2-dose schedule than a 3-dose schedule. In TETRA-051 (Fig. 3A), all vaccines induced similar frequencies of HPV-16 and -18 specific memory B-cells one month after the last vaccine dose, but the frequencies of HPV-31 and -45 specific memory B-cells were higher in tetravalent HPV-16/18/31/45 vaccine groups than in the control group, regardless of VLP concentration (median HPV-31 specific B-cell counts per 106 B-cells [interquartile range] ranged from 2203 [1042–7567] to 5374 [2510–7642] for tetravalent formulations versus 263 [194–922] for control, and median HPV-45 specific B-cell counts ranged from 683 [437–2935] to 2246 PLX3397 [760–7538] for tetravalent formulations versus 198 [100–567] for control). In Study NG-001 (Fig. 3B), the median frequency of HPV-16 specific memory B-cells one month after the last vaccine dose was approximately 2-fold lower for the tetravalent

AS04 vaccine (729 [563–1484]) than control (1518 [865–2588]), whereas tetravalent vaccines adjuvanted with AS01 (4550 [2117–7031]) and AS02 (2950 [1384–5014]) induced higher median frequencies of HPV-16 specific B-cells than control. The median frequency of HPV-18 specific B-cells was approximately 1.6-fold lower for the tetravalent AS04 vaccine (512 [113–1312]) and

1.5-fold lower for the AS02 vaccine (533 [211–1139]) than control (818 [416–2134]), whereas the AS01 vaccine (919 [430–1493]) induced similar median frequencies of HPV-18 specific memory B-cells to control. The tetravalent formulations induced higher frequencies of HPV-33 and -58 specific B-cells, compared to cross-reacting HPV-33 and -58 specific B-cell responses induced by the control vaccine (HPV-33 specific B-cell counts ranged from 1453 [631–3044] to 5678 [2610–8551] for tetravalent formulations versus 124 [39–317] for control, and HPV-58 specific B-cell counts ranged Edoxaban from 1907 [910–2452] to 4006 [2117–5805] for tetravalent formulations versus 112 [34–385] for control). Comparing the tetravalent formulations, the highest median B-cell response for all four vaccine types was induced by the AS01 formulation, regardless of dose schedule; the AS02 formulation induced an intermediate response and the AS04 formulation induced a lower response. In TETRA-051 (Fig. 4A), the control vaccine induced strong CD4+ T-cell responses to both HPV-16 and -18 one month following last vaccination, and induced cross-reacting CD4+ T-cell responses to HPV-31 and -45. All tetravalent formulations also induced high levels of CD4+ T-cells to HPV-16, -18, -31 and -45, regardless of VLP content. In Study NG-001 (Fig.

The fact that all three IFN expression plasmids induced similar levels of ISG transcripts at the muscle injection site, suggests that similar amounts of IFNa1, IFNc and IFNb were produced by the muscle cells.

In contrast, only IFNb and IFNc plasmids induced antiviral genes in head kidney, liver and heart. The lack of induction of antiviral genes by IFNa1 plasmid injection is not due to lack of effect of IFNa1 on head kidney cells, since recombinant IFNa1 and IFNc induced similar levels of ISG transcripts in head kidney leucocytes. These results thus suggest that IFNc and IFNb are distributed through the circulation and induce antiviral genes systemically in the fish while IFNa is only active at the production site. During a virus infection, IFNa is thus probably mainly important at the virus infection site while IFNc and IFNb may be distributed systemically and trigger synthesis of antiviral proteins in cells throughout Fluorouracil mw the fish body. In this context IFNc appears to be a main player in innate antiviral responses of Atlantic salmon since GW-572016 it is produced by a variety of cell types, is induced by both viral dsRNA and ssRNA analogs and has equally strong antiviral activity as IFNa1 [8]. While IFNb is also distributed systemically, it has less antiviral activity than IFNa and IFNc,

is produced mainly by specialized leukocytes and was mainly induced by the ssRNA analog [8]. The difference in distribution properties of IFNa compared to IFNb and IFNc may have several explanations. The number of disulphide bridges might possibly influence the degradation rate of the IFNs. IFNa is a 2C-IFN, which contains one disulphide bridge, while IFNb and IFNc are 4C-IFNs, which contain two disulphide bridges [21]. However, the isoelectric points of IFNa1 (pI 9.2) and IFNb/IFNc (pI 6.9/pI 5.1) are also quite different and might influence their distribution Florfenicol and degradation properties. The time course study showed that IFNc plasmid induced up-regulation of not only antiviral genes (Mx, ISG15, Viperin, IFIT5), but also genes for receptors of virus RNA (RIG-I, TLR3 and TLR7) in head kidney throughout the 8 week experimental period. This suggests

that fish injected with IFNc plasmid indeed possess increased innate immunity to virus infection compared to fish injected with IFNa1 or control plasmid. Increased expression of Mx and ISG15 protein was confirmed both in liver and heart of IFNc plasmid injected fish 8 weeks after injection. It is thus highly likely that injected IFNc plasmid may continue to provide systemic expression of antiviral genes beyond the 8 weeks experimental period. This finding inspired us to investigate if injection of IFNc plasmid might in fact provide protection of Atlantic salmon against virus infection even at 8 weeks after plasmid injection. For this purpose we chose a high virulent strain of ISAV, which is an orthomyxovirus that causes high mortality in Atlantic salmon presmolts.

The workshops were broken into Dasatinib chemical structure morning and afternoon sessions. The morning sessions began with a welcome, the identification of specific goals for each day (e.g. complete final tables for peer review; write an outline of a results section), and didactic sessions on key topics/learning objectives (e.g. an introduction to tables and figures; how the analysis section fits into

a paper). The afternoon sessions were primarily devoted to independent one-on-one work with rotating faculty to prepare the awardees for review by academic faculty occurring every afternoon. The workshop concluded each day with status updates and goal setting from each awardee, followed by a group evaluation of the day’s activities. Tribal awardees attended the morning sessions with all participants, but the afternoon sessions were modified for them in several ways. The tribal awardees had their own workroom and the Native faculty member provided technical assistance almost exclusively for tribal awardees for the duration of the click here workshops, while other faculty members (e.g. statisticians, subject matter experts) rotated between all of the awardees. The afternoon sessions began with a debriefing — a general discussion

about the lessons and the identification of specific questions. This process occurred within the large group of all of the tribal awardees so as to facilitate dialog and co-learning. The tribal participants had essentially never been exposed to the process of writing a scientific manuscript before and thus had many questions about not only the structure of a manuscript but also how the writing might be interpreted by Native American lay readers. The de-briefing process Fossariinae gave the tribal members the opportunity to put all of their questions and concerns on the table, which then informed much of the technical assistance provided

to them in the afternoon sessions. The afternoon sessions primarily involved the translation of what the tribal participants reported as academic language (e.g. “sample size”) into public health practice or implementation language (e.g. “total number of community members who participated”) with a specific focus on implementation within the tribal community context. For example, after a morning training on the development of the single overarching communication objective or “SOCO” statement, tribal participants worked in small groups to find the story of their community’s intervention, in a clear and concise “SOCO” way, while not overly narrowing the story in a way that would fail to recognize the significant time and effort the families who had participated in the intervention had invested.

philoxeroides seedlings in response to Cr exposure are also shown in ( Fig. 9). Since the soluble protein content in the leaf tissues were slightly higher in Cr treated plants than in control plants in the 12 day of the experiment; it is likely that Cr induced stress over the course of the treatment and that antioxidative enzymes activities were consequently same. It is reported that heavy metal stress

has been shown to induce a variety of proteins resulting in an overall increase in protein content. 19 However the additional experiment buy PFI-2 is necessary to confirm the tolerance of these plants to heavy metal stress. The results of the present study indicated that A. philoxeroides accumulates high amounts of Cr in roots than shoots. A. philoxeroides is a fast growing plant and has the ability to tolerate high Cr (150 mg/l Cr) concentrations. Thus it can be used for phytoremediation. All authors have none to declare. “
“Mycophenolate mofetil (MMF) is an immunosuppressant and prodrug of mycophenolic acid, used extensively in transplant medicine. It is a reversible inhibitor of inosine monophosphate dehydrogenase1 in purine biosynthesis, more specifically guanine synthesis. MMF is also

used in the treatment of autoimmune diseases, such as Behcet’s see more disease, pemphigus vulgaris and systemic lupus erythematosus. The chemical name for MMF is 2-morpholinoethyl (E)-6-(1,3-dihydro-4-hydroxy-6-methoxy-7-methyl-3-oxo-5-isobenzofuranyl)-4-methyl-4-hexenoate. The empirical formula and molecular weight of the drug are C23H31NO7 and 433.50 g respectively. The chemical structure of MMF is presented in Fig. 1. An extensive literature surrey is carried out and found a few HPLC2, 3, 4, 5, 6 and 7 methods have been reported for the determination of MMF present in biological fluids or biological matrixes. Very few reverse phase-HPLC

methods8 and 9 are reported for the determination of the drug in dosage forms. But no LC/MS method is reported to determine the quantity of MMF in pharmaceutical formulations; Histone demethylase therefore the authors are interested in developing a new LC/MS method for the assay of MMF in pharmaceutical formulations. The scope of the present investigation is to apply this method to determine the amount of MMF and to study the stability of MMF under forced degradation. This manuscript gives the first report for the application of proposed LC/MS method in stability testing and assay of pharmaceutical dosage forms with less-time consuming analysis. HPLC grade methanol (sd Fine-Chem Limited, Mumbai, India), acetonitrile (Qualigens Fine Chemicals, Mumbai, India) and ammonium acetate (Qualigens Fine Chemicals, Mumbai, India); AR grade glacial acetic acid (Loba Chemie Pvt. Ltd., Mumbai, India), hydrochloric acid, sodium hydroxide, methanol and hydrogen peroxide (Qualigens Fine Chemicals, Mumbai, India) and Milli-Q water (RANKEM Laboratories, Mumbai, India) were used for the present investigation.

From these, the weights were computed using the inverse variance method to calculate the heterogeneity statistic Q = 96.23, p < 0.0001, df = 9 ( Egger et al 2001). Because homogeneity was rejected, the DerSimonian and

Laird random effects model was estimated yielding a tau squared equal to 0.19. The corresponding weights and pooled OR of 2.17 (95% CI 1.61 to 2.91) are presented in Figure 2 (see also Figure 3 on the eAddenda for a detailed forest plot.) The 95% CIs of all but one of the studies, as well as that of the pooled result, lie to the right of 1.00, indicating significantly greater risk of absence from usual work among participants whose early expectations about their recovery were poor. For the sensitivity analysis, the standard error of the estimated

ORs of the 5 studies with low risk of bias was computed from the 95% CIs. From these, the weights were computed using the inverse MK-8776 clinical trial variance method to calculate the heterogeneity statistic Q = 43.83, p < 0.0001, df = 4 ( Egger et al 2001). Because homogeneity was again rejected, the DerSimonian and Laird random effects model was estimated yielding a tau squared equal to 0.34. The corresponding weights and pooled OR of 2.52 (95% CI 1.47 to 4.31) are presented in Figure 4 (see also Figure 5 on the eAddenda for a detailed forest plot.) The confidence intervals of the five studies with low risk of bias as well as that of our pooled result all lie to the right of 1.00, again indicating significantly greater risk of absence from usual work MDV3100 in vivo among participants Edoxaban whose early expectations about their recovery were poor. In order to detect whether publication bias might be affecting the cohort of studies we included in the review, a regression analysis was performed using precision as a predictor for standard normal deviates (Egger et al 1997). The standard normal deviates were computed by dividing the ORs with their corresponding standard error and the precision was computed as the inverse of the standard error. A marginal t-test of the constant

(t = −0.770) yielded a p value of 0.46 indicating no publication bias, which is in line with the observation that there is no clear asymmetry in the scatterplot ( Figure 6.) This review confirmed that the recovery expectations of patients with acute or subacute non-specific low back pain are a statistically significant predictor of absence from usual work due to progression to chronic low back pain. The odds of remaining absent from work at a given time point beyond 12 weeks after the onset of the pain were two times higher among those with negative expectations about their recovery. This pooled result (OR = 2.17, 95% CI 1.61 to 2.91) indicates a strong predictive value. In addition, our analysis yielded consistent evidence of this prognostic role of patients’ expectations.

Out of the 50 eyes check details with retinal hemorrhages, only 1 (2%) lacked either a subdural or intrascleral hemorrhage. Within these, 33 (66%) had both subdural and intrascleral hemorrhages, while 15 (30%) had a subdural without intrascleral hemorrhage, and 1 (2%) had an intrascleral without subdural hemorrhage. Subdural hemorrhage was present in 58 eyes (97%), of which 33 (57%) also had retinal and intrascleral hemorrhages. Only 6 of these eyes

(10%) positive for subdural hemorrhage had neither retinal nor intrascleral hemorrhages, while 15 (26%) had retinal hemorrhage of any kind without intrascleral hemorrhage, and 4 (6.9%) had intrascleral hemorrhage without retinal hemorrhage. Therefore, 10 eyes (17%) had subdural hemorrhage without retinal hemorrhage, of which 6 had unilateral retinal hemorrhages and 4 lacked retinal hemorrhages bilaterally. Intrascleral hemorrhage was present in 38 eyes (63%): click here 33 of those eyes (87%) also had subdural and retinal hemorrhages, 4 (11%) had subdural without retinal hemorrhages, and 1 (2.6%) had retinal without subdural hemorrhage. Intrascleral hemorrhage always accompanied a retinal or subdural hemorrhage. Vitreoretinal interface abnormalities were seen in 51 abusive head trauma eyes (85%) (Figure 1, Right panel). ILM tear in isolation was the most common observation in 22 eyes (37%). The incidence of ILM tear with a perimacular ridge and cherry hemorrhage

was 20 (33%), while incidence of only ILM tear and a perimacular ridge was 5 (8%) and of only cherry hemorrhage with ILM tear was 4 (6.7%). Every eye with a perimacular ridge or cherry hemorrhage had a torn ILM. In eyes with ILM tear, 20 (39%) also had a cherry hemorrhage and a perimacular ridge, 5 (10%) had a perimacular ridge without a cherry hemorrhage, 4 (7.8%) had a cherry hemorrhage without a perimacular ridge, and 22 (43%) did not have an accompanying perimacular ridge

or a cherry hemorrhage. In total, 24 (40%) eyes had a cherry hemorrhage: 20 (83%) also had ILM tears and a perimacular ridge, while Rolziracetam 4 (17%) had an ILM tear without a perimacular ridge. There were 25 (42%) eyes out of 60 with perimacular ridges: 20 (80%) also had both cherry hemorrhages and ILM tears, while 5 (20%) had a torn ILM without a cherry hemorrhage. Subdural hemorrhage at the optic nerve has a bluish hue externally. In cross-section, the blood is visible inside the dura (Figure 2, Left). Microscopically, intrascleral hemorrhage is found surrounding ruptured intrascleral vessels at the junction of the optic nerve and sclera (Figure 2, Right). Intrascleral bleeding is often continuous with the subdural space. Typical perimacular ridges are elevated, circular retinal folds with a canopy of ILM above, torn away from retina, with fibrin-hemorrhage debris below. Often a portion of the perimacular ridge can be seen clinically, surrounding hemorrhage at the macula (Figure 3, Top left).

This could support the hypothesis that similar Compound Library in vivo protection could be obtained from SIgA antibody in breast milk to GBS in a highly breastfed population. However, maternal SIgA does not appear to enter the neonatal circulation, [61] except in preterm infants, where ingestion of milk rich in IgA to respiratory syncytial virus (RSV) resulted in increased serum IgA levels during the perinatal period [62], so its effectiveness is limited to the mucosal surface. SIgA is more resistant to proteolysis than other immunoglobulins and is therefore able to function in the gastrointestinal tract [46]. This could account for the finding that the faeces of breast fed infants contains

IgA by the second day of life, compared to 30% of formula-fed infants, where IgA is only found in faeces by one month of age [63]. Breast milk contains SIgA antibodies against bacterial-adhesion-site-like pili [46] and [64]. SIgA antibody in milk blocks adherence of S. pneumoniae and

Haemophilus influenza to human retropharyngeal cells [64] and casein in vitro [65]. The neutralizing capacity Vismodegib of milk anti-poliovirus antibodies has also been reported [66] and [67]. The effect of third trimester maternal immunization with a single dose of licensed quadrivalent meningococcal vaccine on the potential protection of infants, including by breast milk demonstrated elevated N. meningitidis-specific IgA antibodies in breast milk up to six months post partum in vaccinated infants [68]. Similarly, in mothers

who received pneumococcal polysaccharide vaccine (PSV) during the third trimester, the geometric mean concentration of IgA in breast milk was significantly higher two months postpartum than in women who received conjugate H. influenzae vaccine in the third trimester and remained higher at seven months post partum. [69] As described above, high levels of breast milk SIgA could offer protection to neonates via interference of antibody with the carbohydrate-mediated attachment Rolziracetam of GBS to nasopharyngeal epithelial cells. Through this mechanism, colonizing organism load may be reduced with a consequent reduction in morbidity and mortality caused by GBS in the neonatal period [70]. In transition milk, low or moderate IgA antibodies to CPS type III GBS, were detected in approximately 63% of a cohort of 70 Swedish women [71]. In a study of IgG antibody concentration in transition milk in 46 women from the USA, Weisman and Dobson [70] found concentrations of IgG to types Ia, II or III which were approximately 10% of those in maternal serum. Edwards et al. measured IgG and IgA in breast milk to type III GBS in 18 women with high and low antibody titers and found measurable levels of antibody in both groups up to 2 months post-delivery [72]. Detectable levels of CPS serotype III antibody in breast milk in women correlated with concurrently high levels in their serum.

Consequently, there is a continuing need to design and develop a new generation of broadly protective and safe vaccines, especially for this age category. The anionic adjuvant Endocine™ was developed specifically to formulate intranasal vaccines. Endocine™ is

composed check details of endogenous lipids found ubiquitously in the human body and has been tested successfully in clinical trials with diphtheria, influenza and HIV [19], [20] and [21] (and unpublished data). The results of these trials showed that Endocine™ is safe and tolerable in humans, and in the influenza trial the Endocine™ adjuvanted whole virus vaccine fulfilled the EMA/CHMP HAI criteria for a seasonal influenza vaccine. Moreover, influenza-specific IgA was measured in nasal swabs and it was shown that the Endocine™ adjuvanted vaccine induced a significantly higher fold-increase in nasal IgA compared to the mock vaccine with Endocine™ alone [19]. In line with these observations, no adverse effects of the administration of Endocine™ were noted in pre-clinical toxicology or efficacy studies (unpublished

data). The two components of Endocine™, monoolein (monoglyceride) and oleic acid (fatty acid), are metabolites generated in mammalians when lipids (triglycerides) are mobilized and energy needed. Monoolein is composed of glycerol and oleic acid and is a nontoxic, biodegradable and biocompatible material which is included in the FDA Inactive Ingredients Guide and in nonparenteral

selleck chemicals medicines licensed in the United Kingdom [53]. Oleic acid has been described as being the most abundant fatty acid in human adipose tissue and it is abundantly present in mammalian tissues including tissues from rat, chicken, pig and cow [54] and [55]. Both oleic acid and monoolein and are classified as GRAS (generally recognized as safe) by the FDA, US. A study in mice showed that Endocine™ mixed with a commercially available trivalent split influenza vaccine (Vaxigrip) significantly (p < 0.003–0.05) improved the humoral (HI, VN) and see more cellular (IFNγ and IL-2 secreting cells) immunity upon nasal administration [21]. Furthermore, intranasal immunization with the Endocine™ formulated vaccine significantly increased the H1N1-specific IgA levels both in serum and nasal washings [21]. In the present study, we have shown that Endocine™ formulated inactivated pH1N1/09 influenza vaccines administered as nasal drops induced a protective systemic immune response in influenza naïve ferrets. Serum HI antibody titers of ≥40 (GMT) were already measured after one immunization, even at the lowest antigen dose of 5 μg HA split antigen. All animals in this study received three nasal immunizations, but optimal serological responses were already measured after two immunizations and the third immunization proved to be redundant for antibody induction.

3). In the next phase of analyses we

attempted to identify if different scientific, economic, societal and ethical perspectives led the discussants to arrive at dissimilar conclusions from available evidence base. This required referring to the original articles that the discussants used in building their arguments. Part of this exploration included identifying if same evidence was interpreted differently by different discussants. learn more We also took recent and emerging evidence into account. Of the 177 articles resulting from the data screening process (Fig. 2), 117 were from the domain of ‘epidemiology’, 39 from ‘vaccine’ and 21 from ‘debate’. Articles retrieved under ‘debate’ comprised efficacy, adverse events and immunization performance related discussion, perceptions of pediatricians toward immunization against

rotavirus, as well as policy matters. ‘Vaccine’ articles encompassed clinical trials, mechanisms of action, and inhibitory factors related to oral live vaccines, vaccine uptake by general population in urban and rural settings, as well as economic issues. Most of the articles in ‘epidemiology’ were on hospital based studies, and only 14 out of 117 articles (12%) selleck screening library described community based investigations. While 10 community based studies were carried out over the last decade, the rest were from an earlier time. Apart from articles referring to rotavirus group A, group B rotavirus studies (occurring rarely and mostly in adults) also featured in our search. Nine articles dealing with infrequent rotavirus genotypes of group A and five about group

B were not included during detailed analysis and thus a total of 163 articles (103 from ‘epidemiology’, Ergoloid 39 from ‘vaccine’ and 21 from ‘debate’) were analyzed in-depth. Original research and review articles were used in the citation for the present write-up, as deemed appropriate. The earliest article documenting rotavirus in children in India appeared from Vellore in Tamilnadu [15] within a year of its first detection in Australia [16]. We noticed that articles on rotavirus diarrhea subsequently started appearing from various parts of the country, including north-eastern states [17], [18] and [19], all of which appeared under ‘epidemiology’. Cognitive contents in articles used for detailed analyses were arranged into themes as shown in Fig. 3 for synthesizing arguments. The six emerging themes were – (a) disease burden, (b) host factors (mother and child), (c) macro-social environment, (d) the agent (rotavirus) and the vaccine, (e) immunization program issues, and (f) economic issues. Disease burden is presented here under two major headings, (a) morbidity and (b) mortality due to rotavirus diarrhea in India. Most of the information under this topic came from facility based studies [20], and we identified scarcity of data on morbidity and mortality in communities.