The Lancet
May 02, 2009  Volume 373  Number 9674  Pages 1495 – 1576
http://www.thelancet.com/journals/lancet/issue/current

Viewpoint
Rescuing the bottom billion through control of neglected tropical diseases
Peter J Hotez, Alan Fenwick, Lorenzo Savioli, David H Molyneux
People in the bottom billion are the poorest in the world; they are often subsistence farmers, who essentially live on no money and are stuck in a poverty trap of disease, conflict, and no education.1,2 One of the most potent reinforcements of the poverty trap is the neglected tropical diseases (panel 1).3 Almost everyone in the bottom billion has at least one of these diseases. Several diseases coexist in 56 of 58 countries that are home to the people in the bottom billion.3 Here we outline low-cost opportunities to control the neglected tropical diseases through preventive chemotherapy, and propose financial innovations to provide poor individuals with essential drugs.

Science
1 May 2009  Vol 324, Issue 5927, Pages 565-663
http://www.sciencemag.org/current.dtl

Origins:
On the Origin of The Immune System
John Travis

Summary
Did the immune system evolve to keep out harmful organisms, or is it like a bouncer at a nightclub, trained to allow the right microbes in and kick the less desirable ones out? In the fifth essay in Science’s series in honor of the Year of Darwin, John Travis explores the evolution of the immune system and how it became the centerpiece of the most dramatic confrontation so far between science educators and scientists determined to keep evolution in the classroom and advocates of the quasi-religious theory known as intelligent design.

Vaccine
Volume 27, Issue 23, Pages 3013-3126 (18 May 2009)
http://www.sciencedirect.com/science/journal/0264410X

Do they accept compulsory vaccination?: Awareness, attitudes and behaviour of hospital health care workers following a new vaccination directive
Pages 3022-3025
Holly Seale, Julie Leask, C. Raina MacIntyre
Abstract
Achieving high vaccination rates among health care workers (HCW) is an ongoing challenge. In 2007, the state of New South Wales, Australia instituted a policy directive with compulsory provisions for health care workers to be vaccinated. This study sought to identify staff awareness and attitudes in the early phase of implementation. It involved a self-completed paper-based or electronic survey of HCWs in two tertiary-referral teaching hospitals in Sydney, Australia in 2007. A total of 894/1200 completed the paper survey, whilst a further 185 completed it online. Of the 1079 respondents, 60% (646/1079) were aware of the policy directive but only 10% (63/646) described the specific requirements. Seventy-eight per cent supported the policy; 13% neither supported nor opposed it; and 4% opposed it. This survey provides an early, broad indication of the level of understanding and the attitudes of the HCWs towards the new directive.

Vaccine
Volume 27, Issue 23, Pages 3013-3126 (18 May 2009)
http://www.sciencedirect.com/science/journal/0264410X

Cost–benefit comparisons of investments in improved water supply and cholera vaccination programs
Pages 3109-3120
Marc Jeuland, Dale Whittington
Abstract
This paper presents the first cost–benefit comparison of improved water supply investments and cholera vaccination programs. Specifically, we compare two water supply interventions – deep wells with public hand pumps and biosand filters (an in-house, point-of-use water treatment technology) – with two types of cholera immunization programs with new-generation vaccines – general community-based and targeted and school-based programs. In addition to these four stand-alone investments, we also analyze five combinations of water and vaccine interventions: (1) borehole + hand pump and community-based cholera vaccination, (2) borehole + hand pump and school-based cholera vaccination, (3) biosand filter and community-based cholera vaccination, (4) biosand filter and school-based cholera vaccination, and (5) biosand filter and borehole + hand pump. Using recent data applicable to developing country locations for parameters such as disease incidence, the effectiveness of vaccine and water supply interventions against diarrheal diseases, and the value of a statistical life, we construct cost–benefit models for evaluating these interventions. We then employ probabilistic sensitivity analysis to estimate a frequency distribution of benefit–cost ratios for all four interventions, given a wide variety of possible parameter combinations.

Our results demonstrate that there are many plausible conditions in developing countries under which these interventions will be attractive, but that the two improved water supply interventions and the targeted cholera vaccination program are much more likely to yield attractive cost–benefit outcomes than a community-based vaccination program. We show that implementing community-based cholera vaccination programs after borehole + hand pump or biosand filters have already been installed will rarely be justified. This is especially true when the biosand filters are already in place, because these achieve substantial cholera risk reductions on their own. On the other hand, implementing school-based cholera vaccination programs after the installation of boreholes with hand pump is more likely to be economically attractive. Also, if policymakers were to first invest in cholera vaccinations, then subsequently investing in water interventions is still likely to yield positive economic outcomes. This is because point-of-use water treatment delivers health benefits other than reduced cholera, and deep boreholes + hand pumps often yield non-health benefits such as time savings.