For RV1, the two dose schedule was given at 10 and 14 weeks of ag

For RV1, the two dose schedule was given at 10 and 14 weeks of age. No efficacy data for RV1 with the recommended 6 and 10 week schedule is available, and it is possible that the efficacy may be lower than that observed with the 10 and 14 week schedule due to higher maternal antibody and potential interference by first oral polio vaccine dose. The efficacy

of three doses of RV5 administered at 6, 10, and 14 weeks of age in Africa (Ghana, Kenya, and Mali) was 64% (95% CI: 40–79%) and in Asia (Bangladesh and Vietnam) was 51% (95% CI: 13–73%) against severe rotavirus disease during the first year of life [21] and [22]. As seen for RV1, RV5 efficacy appeared to decline during the second year of life and was 20% (95% CI: −16 to 44%) in

Africa and 46% (95% CI: 1–71%) in Asia [21] and [22]. Despite lower efficacy in low NVP-BKM120 income countries, the significant disease burden in these settings results in a greater absolute number of rotavirus cases GSK1120212 ic50 prevented per 100 vaccinated children compared with higher income countries with lower disease burden. In clinical trials, RV1 efficacy during the first year of life in South Africa (77%) was higher than in Malawi (49%) but the vaccine prevented seven episodes of severe rotavirus gastroenteritis per 100 vaccinated infants in Malawi compared with four episodes prevented per Parvulin 100 vaccinated infants

in South Africa due to the higher disease burden in Malawi compared with South Africa [18]. Rotavirus vaccines have had a notable impact on mortality, hospitalizations and outpatient visits in countries that have introduced the vaccine into their national immunization programme, including some evidence suggesting that rotavirus vaccines may offer indirect protection to older, unvaccinated age groups. Perhaps the most exciting post-licensure data pertains to the effect of rotavirus vaccination in reducing deaths from childhood diarrhea in some countries in Latin America, as the mortality benefits of vaccination were not assessed in pre-licensure trials. In Mexico, following RV1 introduction into the national immunization programme in 2007, the diarrhea mortality rate declined to 35% (95% CI: 29–39%) in 2008 compared with the pre-vaccine baseline (2003–2006): the decline in mortality has been sustained for three years from 2008 to 2010 [23] and [24]. Brazil saw a similar decline of 22–41% in diarrhea mortality rates among children <5 years of age following the introduction of RV1 into the national immunization program in 2006 [25] and [26] (Fig. 2).

While MMPs are required for normal tissue homeostasis, there is a

While MMPs are required for normal tissue homeostasis, there is also evidence that they play a role in the pathogenesis

of a range of inflammatory-fibrotic Bcr-Abl inhibitor diseases [84], [85] and [86], disrupting the basement membrane and aiding the recruitment of inflammatory cells [87]. MMPs have wide-ranging effects on inflammatory and immune processes, such as modulating chemokine activity and activation of TGFβ, IL-1β and TNF [88]. They are known to be important in a number of ocular surface diseases, and inhibition of MMP activity has been shown to reduce conjunctival scarring after glaucoma surgery [89]. MMP9 is part of the neutrophil lysosome, and mediates epithelial dissolution through degradation of type IV collagen [82]. Children with active trachoma have increased amounts of conjunctival MMP9 (determined by immunohistochemistry, zymography and gene expression analysis) [46] and [90]. Scarring trachoma is associated with increased expression of MMP9 and a coding SNP that is adjacent to the active binding site of the MMP9 enzyme [46], [68] and [91], and with differential expression of MMPs 7, 9, 10 and 12 and tissue inhibitor of MMP (TIMP)-1; recurrence of trichiasis after surgery is associated with

an altered MMP1/TIMP1 transcript ratio [55], [67], [68] and [92]. Scar tissue in trachoma probably originates from activated fibroblasts which are stimulated to produce collagen by profibrogenic check details mediators (TGF-β, PDGF, CTGF and bFGF) [50], [93] and [94]. Chemokines have also been shown to act as fibrogenic mediators, in particular, the CC- and CXC-chemokine families, and various members of these families have been associated with scarring, including the pro-fibrogenic the CCL18 [50], [55], [69] and [87]. Since the pathology of Ct infection is similar in the eye and genital tract [4] and [16], and both are part of the common mucosal immune

system, it is likely that similar processes lead to resolution of infection and/or the development of scarring sequelae at each site. The few studies that have been conducted on the immunological correlates of protective immunity and immunopathology in human genital Ct infection have reached broadly similar conclusions to those of studies in the eye [10], [95], [96] and [97]. Local, endocervical IgA antibodies appear to be protective [95], and stronger Th-1 type cell-mediated immune responses to Ct antigens are seen in the peripheral blood of subjects who do not have sequelae [96] and [97]. An important difference between ocular and genital infection is that in the eye, the damaging sequelae occur at the site of the initial infection, the conjunctival epithelium. By contrast, in the female genital tract the major sequelae develop in the fallopian tubes and not at the cervix, which is the site of inoculation. Impairment of immunological barriers to ascending infection may explain the association between HIV infection and chlamydial PID [98]; no association has been reported between HIV and trachoma.

We have previously demonstrated in human and mouse systems

We have previously demonstrated in human and mouse systems

that ex vivo transduction of DC precursors with LVs for production of granulocyte macrophage colony stimulating factor (GM-CSF), interleukin-4 (IL-4) and tumor antigens induced self-differentiation of potent anti-cancer therapeutic DC vaccines (“self-differentiated myeloid derived antigen presenting cell reactive against tumors – SmartDCs”) [5] and [6]. Recently, we have developed a 28-h method compatible with good manufacturing practices (GMP) for production of cryopreserved SmartDCs in sufficient amounts for clinical cancer immunotherapy studies [7]. Another explored use of iDCs is to accelerate the immune regeneration of patients receiving CD34+ hematopoietic SCT by ameliorating the homeostatic reconstitution and enhancing antigen presentation in lymphopenic SCR7 recipients. After HSCT, patients show slow DC recovery, requiring approximately 60 days in order to reach pre-transplant levels [8]. We

have recently established a proof-of-concept animal model using NOD/Rag1(−/−)/IL-2rγ(−/−) (NRG) immune deficient mice which lack T, B and NK cells and can be repopulated with cells from the human peripheral blood [9]. We showed that human SmartDCs expressing the HCMV pp65 (65 kDa lower matrix phosphoprotein) antigen dramatically enhanced the engraftment, in vivo expansion and functionality of autologous human T cells reactive against pp65 in NRG mice [10]. Quantitative pp65 selleck kinase inhibitor CTL responses produced in the mice could be directly measured by tetramer assay and ELISPOT. We observed a significantly faster expansion of human CD4+ and CD8+ T cells in the spleen and peripheral blood and a massive recruitment of lymphocytes to the SmartDC/pp65 injection site [10]. Thus, this model confirmed our hypothesis that preconditioning

the host with iDCs producing homeostatic (mediated through expression of human cytokines) and antigen-specific (mediated through expression of pp65) stimuli accelerated human T cell responses in a lymphopenic host. A major limitation in the use of LVs for vaccine development is their intrinsic potential to integrate in the genome of the infected cells which, at least theoretically, could below cause insertional mutagenesis or “genotoxicity” [11] and [12]. Lentiviral gene transfer into hematopoietic stem cells with lentiviral vectors has recently reached the clinics for gene therapy replacement and was shown to be safe [13]. On the other hand, the use of LVs for immunization approaches is also an expanding field [6], but so far only pre-clinical, since following a risk/benefit calculation, integrating viruses are usually perceived as non-safe for vaccine development. It is known that non-integrated lentiviral DNA can support transcription, and, for growth-arrested cells, “episomal” LV can produce steady high-level transgene expression [14], [15], [16] and [17].

However, only a small group of participants (19%) felt that the s

However, only a small group of participants (19%) felt that the social support they experienced also positively influenced their physical activity level.

Figure 2 shows that there is great variability in physical activity preferences. Approximately one-third of the participants preferred going to a health club or performing a sporting activity, while 25% of the participants preferred lifestyle activities, like walking or gardening. Over 40% preferred a combination of both types of physical activity. Quisinostat supplier Additionally, 40% of the participants preferred being physically active with others, 30% alone, and 30% preferred a combination of both. The participants who preferred sports or the health club tended to also prefer being physically active with others, whereas the participants who preferred lifestyle activities tended to also prefer being physically active alone. Table 2 shows the results of the cluster analysis, which generated two clusters. Although all categories of the interview were entered in the cluster analysis, Table 2 shows only the categories that

were significantly different between the clusters that were formed by the cluster analysis. The clusters could be characterised as one cluster with a high physical RG7204 activity level and one cluster with a low physical activity level. A high physical activity level was related to being physically active because of enjoyment and high self-efficacy for physical activity. A low physical activity level was related to being sedentary because of poor weather influencing health, financial constraints, health problems, and being ashamed to be physically active. We also investigated if the clusters

differed in lung function, exercise capacity, dyspnoea severity, gender, or age. The cluster with a high physical activity level was characterised by higher lung function and exercise capacity and less severe dyspnoea than the cluster with low physical activity level. Gender and age did not differ significantly between clusters. The identification of personal perspectives about physical activity is important because it increases our knowledge of the facilitators 3-mercaptopyruvate sulfurtransferase of and barriers to physical activity in people with COPD. Our results show that the most frequently reported reason to be physically active was health benefits, followed by enjoyment, continuous active lifestyle in the past, and functional reasons. The most frequently reported reason to be sedentary was poor weather, followed by health problems, and lack of intrinsic motivation. Additionally, we could identify several factors that were related to the actual measured physical activity level. A high physical activity level was related to the following two facilitators: enjoyment and self-efficacy for physical activity. A low physical activity level was related to the following four barriers: weather influencing health, financial constraints, health problems, and shame. An identified facilitator of physical activity was enjoyment.

Fifteen days after the third inoculation, the mice were challenge

Fifteen days after the third inoculation, the mice were challenged intracerebrally with a dose of 100LD50 (previously determined), prepared

from a DENV-4-infected suckling mouse brain (mouse-adapted H241 strain). Mouse mortality was monitored daily for 21 days. The statistical analysis (Long-Rank test, Mantel-Cox) was performed with GraphPad Prism 5.0 (GraphPad Software Inc., San Diego, CA). DENV-4-DNAv transfected cells Rucaparib showed positive fluorescence where DENV-4-specific MIAF was used, which indicates the expression of the DENV-4 prM and E proteins. In the cells transfected with pCI no fluorescence was seen. As positive control we used cells infected with dengue-4 virus, these cells were incubated with primary antibodies (DENV-4 MIAF) and secondary antibody (anti-mouse IgG) and analyzed in optical microscopy (Fig. 1). The band corresponding to prM and E protein, of approximately 53–54 kDa, was clearly visible in the lanes containing DENV-4-DNAv transfected cell lysates. This band corresponds to the expected molecular weight of the E protein and was detected in cell lysates by

immunoprecipitation followed by western blot from culture infected with dengue-4 virus and transfected with recombinant plasmid but not in cultures transfected with empty pCI (Fig. 2). Neutralizing antibodies is the goal of dengue vaccination; to evaluate the induction capacity of our construction we performed a PRNT assay, comparing the results with SKI-606 nmr virus immunization that is associated with induction of high levels

of neutralizing antibodies. As expected, animals immunized with the pCI plasmid did not produce neutralizing antibodies against dengue-4 virus. On the other hand, the animals immunized with DENV-4-DNAv unless produced rising levels, after each vaccine inoculation, of specific neutralizing antibodies against dengue-4 virus. The neutralizing antibody titers of DENV-4-DNAv immunized group were only one dilution lower than those titers observed in DENV-4-immnunized mice (Table 2). Once we detected satisfactory neutralizing antibodies levels after vaccination, we decided to evaluate the vaccine protection after challenge with a lethal infection. The spleen cells of DENV-4-DNAv-immunized animals produced high levels of IL-2, IL-10, IFN-γ in the presence of ConA and DENV-4 compared to non-stimulated cells. Cell supernatants of DENV-4-DNAv-immunized animals showed much higher concentrations of IL-10 and IL-2 than IFN-γ. The same profile was seen in the cell supernatants of mice immunized with DENV-4. IL-4 was not detected in any group of immunized mice independent of the time of supernatant collection (Fig. 3). To address if T cells obtained from DENV-4-DNAv immunized mice could respond to specific antigen stimulus, BALB/c mice were inoculated with 100 μg of DENV-4-DNAv in the quadriceps muscle as described in Section 2.

Slightly more boys were lost to follow-up, those lost to follow u

Slightly more boys were lost to follow-up, those lost to follow up had lower Protein Tyrosine Kinase inhibitor SES, higher BMI z-score at 11 years and higher parental obesity than those followed up (see Table 2), though differences were small. Prevalence of healthy weight (BMI < 85th centile), overweight (BMI 85th–94th centile) and obesity (BMI at or above 95th centile) are described in Table 3 for the CiF sample and Table 4 for the entire

cohort. Prevalence of overweight and obesity was similar between the CIF sample and the entire ALSPAC cohort and between boys and girls. There was some differential loss to follow up from 3 to 7 years and 11 to 15 years. Children who were obese at 3 years were slightly more likely to be lost to follow-up at 7 years [25.3% (21/83)] than those overweight at 3 years [23.0% (28/122)] or healthy weight at 3 years [19.5% (165/846)]. Children who were obese at 11 years were slightly more likely to be lost to follow up at 15 years [35.2% (50/142)] SB431542 supplier than children overweight [31.2% (39/125)] or healthy weight [28.5% (170/597)]. From 7 to 11 years, loss to follow up was similar in each group (~ 18%). The incidence of overweight and obesity in the CiF sample from 3 to 7, 7 to 11, and 11 to 15 years is shown in Table 5A. Incidence of overweight and obesity was higher

from 7 to 11 years [overweight 11.8% (76/646); obese 6.7% (43/646)] than 3 to 7 years [overweight 5.3% (36/681); obese 5.1% (35/681)] and 11 to 15 years [overweight 5.6% (24/427); obese 1.6% (7/427)]. There was some differential loss to follow up from 7 to 11 years and 11 to 15 years. Children obese at 7 years were slightly more likely to be lost to follow up at 11 years [28.3% (184/651)] than those overweight at 7 [23.4% (167/714)] or healthy weight at 7 [23.4% (1499/6394)]. Children obese at 11 years were slightly more likely to be lost to follow up at 15 [35.3% (376/1066)] than children who were overweight [32.1% (291/907)] or healthy weight [29.7% (1417/4778)]. Incidence of overweight [11.4% (558/4895)] and obesity [5.0% (243/4895)] from 7 to 11 years in the entire cohort was higher than the incidence

from 11 to 15 years [overweight 6.5% (220/3361); obese 1.4% (47/3361)], see Table 5B. In addition, the incidence of found overweight was slightly higher than the incidence of obesity at each time period. Furthermore, incidence of overweight and obesity from 7 to 11 years and from 11 to 15 years was similar between boys and girls and to the entire ALSPAC cohort (for full results see Supplementary Web Figs. 1 and 2 in Appendix A). In the CiF sample, 47.3% (52/110) of children who were overweight and obese at 3 years were overweight and obese at 15 years compared to 20% (93/465) of children who were healthy weight at 3 years; 70% (77/110) of children who were overweight and obese at 7 years were overweight and obese at 15 years compared to 15.3% (75/491) of children who were healthy weight at 7 years; 67.

The 43 autoimmune events were equally distributed across arms (22

The 43 autoimmune events were equally distributed across arms (22 in HPV arm; 21 in control arm) and were due to goiter CX-5461 clinical trial (8 in HPV arm; 9 in control arm), rheumatoid arthritis (4 in HPV arm; 6 in control arm), inflammatory bowel disease (3 in HPV arm including 1 Crohn’s disease; 2 in control arm), systemic lupus erythematosus (2 in HPV arm; 1 in control arm), insulin-dependent diabetes mellitus (1 in HPV arm; 1 in control arm) and other conditions (4 in HPV arm; 2 in control arm). The 15 deaths observed were equally distributed across arms (8 in HPV arm; 7 in control arm) and were due to suicides (4 in control arm), automobile

accidents (1 in HPV arm; 2 in control arm), physical assault (2 in HPV arm), cancer (1 in HPV arm; 1 in control arm), Crohn’s

disease (1 in HPV arm), systemic lupus erythematosus (1 in HPV arm), HIV-associated conditions (1 in HPV arm), and acute myocardial infarction (1 in HPV arm). Immunogenicity results are summarized in Fig. 3a–d. GMTs peaked at one month following last dose, declined thereafter selleck products and remained relatively stable beyond 12–24 months post-vaccination. By ELISA, we observed that 100% of vaccinated participants were seropositive against HPV-16 and HPV-18 after three doses and remained seropositive at the end of the 4-year follow-up period. By EIA, we observed that 100% and 99.5% of vaccinated participants were seropositive against HPV-16(V5) and HPV-18(J4), respectively, after three doses. At the end of the 4-year follow-up period, 92.3% and 45.8% of vaccinated participants remained seropositive against HPV-16(V5) and HPV-18(J4), respectively. This report

summarizes results from the final ATP analysis of the NCI-sponsored CVT under GlaxoSmithKline Biologicals’ FDA-BB-IND-7920. Our results confirm the high efficacy of VLP-based vaccines against incident CIN2+ associated with HPV-16/18 [4], [5], [6], [7], [8], [9] and [10]. It is reassuring that high efficacy against infections and lesions associated with the HPV types in the vaccine Tolmetin formulation has now been reported for VLP-based vaccines from multiple trials conducted in different populations, despite differences in study methodology [4], [5], [6], [7], [8], [9], [10], [26] and [27] (Table 4). Furthermore, our report is consistent with previous results suggesting that vaccination with the HPV-16/18 vaccine might confer partial protection against some oncogenic HPV types not included in the vaccine formulation [28]. We observed 60% efficacy against CIN2+ associated with incident oncogenic HPV infections with types other than HPV-16/18, an effect that increased to near 80% when we considered evidence of HPV persistence preceding referral to colposcopy.

Ultimately, understanding the energyrequirements of everyday acti

Ultimately, understanding the energyrequirements of everyday activities after stroke will determine whether stroke survivors are at risk of recurrent cardiovascular events. Ethics approval:

The University of Sydney Human Research Ethics Committee approved this study. All participants gave written informed consent before data collection began. Support: This research was conducted as part of a larger study Improving community ambulation which is funded by a Heart Foundation (Australia) grant (G06S2556). MA is the recipient of a scholarship provided by the University of Dammam, Kingdom of Saudi Arabia. None declared. “
“Summary of: Austin MA, et al (2010) Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised Rucaparib molecular weight controlled trial. BMJ 341: c5462.

doi: 10.1136/bmj.c5462 [Prepared by Kylie Hill, CAP Editor.] LY2109761 mouse Question: In patients with a suspected acute exacerbation of COPD, does titrated oxygen in the pre-hospital setting change mortality, length of hospital stay and blood gas measurements? Design: Cluster randomised controlled trial in which paramedics were allocated to deliver titrated or high flow oxygen. Randomisation sequence was concealed prior to allocation. Setting: Ambulance service and emergency department in Hobart, Australia. Participants: People who were: transported by ambulance to the emergency department, aged ≥35 years, breathless, and were thought to have COPD based on their acute symptoms, a patient-stated history of COPD, or a smoking history of > 10 pack-years. Randomisation

of 64 paramedics allocated 32 to the titrated oxygen unless group and 30 to the high flow oxygen group. Over the study duration, 179 and 226 patients were allocated to the titrated and high flow oxygen groups, respectively. Interventions: Patients in both groups received basic support, nebulised bronchodilators, intravenous dexamethasone and, if necessary, intravenous or intramuscular salbutamol. In addition, the intervention group received titrated oxygen via nasal prongs, with the aim of maintaining arterial oxygen saturation, measured via a pulse oximeter (SpO2) between 88% and 92%. Nebulised therapy was delivered by compressed air. The control group received high flow oxygen (8 to 10 L/min) via a non-rebreather face mask. Nebulised therapy was delivered by compressed oxygen at 6 to 8 L/min. Outcome measures: The primary outcome was pre-and in-hospital mortality. Secondary outcomes were length of hospital stay and blood gas measurements. Results: The primary outcome was captured for all enrolled patients. According to the intention to treat (ITT) analysis, mortality in the intervention and control groups was 4% (n = 7) and 9% (n = 21), respectively. The relative risk was 0.42 (95% CI 0.20 to 0.89).

Hence solutions should be used within 24 h or stored in light

Hence solutions should be used within 24 h or stored in light resistant containers. Compatibility studies of HCQ sulphate in different vehicle reveals that HCQ was compatible with both sodium chloride and dextrose when stored at temperature below 4 °C. Hence both reagents dextrose as well as sodium chloride can be used as osmotic pressure adjusters while developing parenteral dosage form (Table 6). From Solubility analysis data of AS, it was found that addition of 10% ethanol dramatically increased the solubility of drug. So it can be

used as a cosolvent during formulation of injection for AS (Fig. 1). Stability results show that AS was found to be unstable under conditions of humidity. Storage in refrigerated temperature is

recommended. In solution state stability as the pH decreased i.e. acidity increased, the degradation of AS increased.22 The drug was most stable at pH 8 at both temperatures Proteases inhibitor of storage temperature i.e. 2–8 °C and 25 °C. HCQ was found to be soluble in many pharmaceutical solvents and buffers and does not possess any solubility problem. As per stability it is advisable to store the drug in cold, protected it from light and temperature; as light related degradation was found during the stability studies of drug. Hence unformulated APIs can be stored either separately or together provided humidity is controlled (Fig. 2). Based on these observations, to develop combined dosage form of AS and HCQ, dry powder is considered as a best form to avoid instability or the formulation can be constituted before use. Drug should be stored in light resistant containers in refrigerated condition. Hence it would be advisable to prepare the formulation in controlled humidity atmosphere. The stability of fixed-dose co-formulations

should be tested when manufactured under humidity-controlled conditions and packaged in moisture resistant containers. Compatibility studies of drugs suggest the use of sodium chloride and dextrose as formulation adjuvants. All authors have none to declare. “
“Liver diseases are still a worldwide health problem. Use of medicinal plants and their formulations are common for the treatment Thalidomide of liver diseases.1 Lever is known to be a unique organ with self-regenerative ability and serves a dual purpose of secretory and excretory functions.2 The central role of liver in detoxification of endogenous and exogenous compounds, and consequently, its continuous exposure to various xenobiotics, therapeutic agents and pollution contributes toward compromised health of this vital organ.3 Acetaminophen (Paracetamol) is one of the safe and reliable antipyretic and analgesic drugs when used at recommended therapeutic doses.4 Overdose of acetaminophen may lead to hepatotoxic and nephrotoxic effects with serious consequences.5 Due to paucity of reliable hepatoprotective drugs in modern medicine, herbal drugs are being recommended for the treatment of liver diseases.

These strategies included: (1) screening all pregnant women for c

These strategies included: (1) screening all pregnant women for chronic hepatitis B infection; Once the sub-committee compiles and reviews the epidemiological, vaccine, and economic data and hears from KCDC and external experts, members try to reach a consensus on recommendations

concerning control measures for the disease in question, including immunization; target groups for vaccination; route of administration; and other key considerations. If the sub-committee cannot reach a consensus, it is the prerogative of the Chairperson to decide what recommendations to give to the KACIP. A senior officer from Selleck I BET151 the KCDC summarizes the data, opinions and recommendations coming from the sub-committee and includes this information in a bound document prepared for KACIP members for each meeting. This document also includes information and views from KCDC and other (non-industry) experts,

as well as the meeting agenda, recommendations from the previous meeting, and the terms of reference of the Committee. During the meetings of the KACIP, experts, including ex-officio members, officials from the KFDA or the KCDC or members of the relevant sub-committee, give presentations or are asked to express their views. Members then discuss each issue in depth and develop recommendations, usually by consensus. An officer of the KCDC records the recommendations or other results of the meeting, which the KACIP Chairperson submits

to the Director of the KCDC, who in turn transmits the recommendations to the MoH. Selleckchem Y 27632 The minutes of the KACIP meetings are given to the KCDC Director and other staff, but are not made public. While most decisions made by the Committee are approved by the MoH and thus implemented, KACIP recommendations are not legally binding, and there have been times where recommendations were not implemented for some time due to a lack of funding or the need to revise laws in order to enact the policy change. For example, the program recommended by the KACIP to subsidize MycoClean Mycoplasma Removal Kit part of the costs of EPI vaccines administered at private health facilities (described above) required that the Prevention of Contagious Diseases Act be revised, before it could be implemented. If a recommendation is approved by the MoH, officials of the KCDC then develop a budget to cover the costs of the new policy change (e.g., the introduction of a new vaccine), and plan the steps necessary to implement the recommendation, working with both public and private health facilities and organizations. The Public Relations Department of the KCDC then prepares public education materials, such as brochures, posters, and vaccine information statements or factsheets to alert the public and medical community of the new recommendations.