Science
30 October 2009  Vol 326, Issue 5953, Pages 639-737
http://www.sciencemag.org/current.dtl

Reports
The Transmissibility and Control of Pandemic Influenza A (H1N1) Virus

Yang Yang,1 Jonathan D. Sugimoto,1,2 M. Elizabeth Halloran,1,3 Nicole E. Basta,1,2 Dennis L. Chao,1 Laura Matrajt,4 Gail Potter,5 Eben Kenah,1,3,6 Ira M. Longini, Jr.1,3,*

Pandemic influenza A (H1N1) 2009 (pandemic H1N1) is spreading throughout the planet. It has become the dominant strain in the Southern Hemisphere, where the influenza season has now ended. Here, on the basis of reported case clusters in the United States, we estimated the household secondary attack rate for pandemic H1N1 to be 27.3% [95% confidence interval (CI) from 12.2% to 50.5%]. From a school outbreak, we estimated that a typical schoolchild infects 2.4 (95% CI from 1.8 to 3.2) other children within the school. We estimated the basic reproductive number, R0, to range from 1.3 to 1.7 and the generation interval to range from 2.6 to 3.2 days. We used a simulation model to evaluate the effectiveness of vaccination strategies in the United States for fall 2009. If a vaccine were available soon enough, vaccination of children, followed by adults, reaching 70% overall coverage, in addition to high-risk and essential workforce groups, could mitigate a severe epidemic.

1 Center for Statistics and Quantitative Infectious Diseases, Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA 98109, USA.
2 Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA.
3 Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA 98195, USA.
4 Department of Applied Mathematics, University of Washington, Seattle, WA 98195, USA.
5 Department of Statistics, University of Washington, Seattle, WA 98195, USA.
6 Department of Global Health, University of Washington, Seattle, WA 98195, USA.

* To whom correspondence should be addressed. E-mail: longini@scharp.org

Vaccine
Volume 27, Issue 50, Pages 6967-7138 (23 November 2009)
http://www.sciencedirect.com/science/journal/0264410X

Cost-effectiveness of a 3-dose pneumococcal conjugate vaccine program in the province of Quebec, Canada
Béatrice Poirier, Philippe De Wals, Geneviève Petit, Lonny J. Erickson, Jacques Pépin

Abstract
In the province of Quebec, Canada, the pneumococcal 7-valent conjugate vaccine (PCV-7) was licensed in 2001 and a publicly funded program was implemented in 2004, recommending 3 doses for healthy children. An economic analysis was performed both from a health care and societal perspective. Outcomes possibly prevented by PCV-7 and observed in 2006–2007 were compared to expected frequencies based on rates measured before PCV-7 use. Annual program costs were close to $21 M for the health system and $23 M for society. Approximately 20 000 infections were prevented annually and estimated economic benefits were $5 M for the health system and $23 M for society, using a 3% per annum discounting rate. The incremental cost-effectiveness ratio was $18 000 per QALY gained for the health system and the program was close to the break-even threshold in a societal perspective.

Vaccine
Volume 27, Issue 49, Pages 6807-6966 (16 November 2009)

How much will it hurt? HPV vaccine side effects and influence on completion of the three-dose regimen
Paul L. Reiter, Noel T. Brewer, Sami L. Gottlieb, Annie-Laurie McRee, Jennifer S. Smith

Abstract
We examined the prevalence of reported pain following human papillomavirus (HPV) vaccination and whether it differed from that for other adolescent vaccines or affected completion of the HPV vaccine regimen. In 2008, we conducted cross-sectional surveys with parents of adolescent girls aged 11–20 living in areas of North Carolina with elevated cervical cancer rates who had received at least one dose of HPV vaccine. Pain from HPV vaccination, while commonly reported by parents, was less frequent compared to other adolescent vaccines and did not appear to affect vaccine regimen completion. These findings may be important to increase HPV vaccination coverage.

Vaccine
Volume 27, Issue 48, Pages 6651-6806 (12 November 2009)

Collection of routine national seasonal influenza vaccine coverage data from GP practices in England using a web-based collection system
Peter Gates, Karen Noakes, Fateha Begum, Richard Pebody, David Salisbury

Abstract
This paper describes a web-based system developed to collect data on influenza (flu) vaccine uptake in near real time during the flu season in England. Data are collected from all GP practices providing the immunisation programme. Data are submitted either monthly or weekly on-line to a website using manual, automated and semi-automated methods. During the 2008/09 season, a final response rate of 96.2% was achieved (n = 7980/8293). This equates to 52,217,430 GP registered patients aged 6 months and over being included in the survey. The majority of reports (65.5%) were submitted via automated or semi-automated methods. We were also able to collect the data weekly from a sentinel group of GP practices (approximately 50%) that have fully automated data extraction facilities. This system successfully provides data locally and nationally to monitor the annual seasonal flu programme, with a large sample size, quickly and efficiently, with minimal burden on the NHS. At a time when the first influenza pandemic of the 21st century is occurring, the ability to measure influenza vaccine uptake coverage in near real time will be invaluable.

Vaccine
Volume 27, Issue 47, Pages 6481-6650 (5 November 2009)

Cost-effectiveness of pneumococcal conjugate vaccine: An update after 7 years of use in the United States
G. Thomas Ray, Stephen I. Pelton, Keith P. Klugman, David R. Strutton, Matthew R. Moore

Abstract
Seven-valent pneumococcal conjugate vaccine (PCV7) has been in routine use in the United States since 2000 and data have indicated direct and indirect effects of the vaccine. We simulated the effects of PCV7 on children vaccinated during 2000–2006, incorporating direct and indirect effects on incidence of invasive pneumococcal disease (IPD), hospitalized pneumonia and otitis media. Before accounting for indirect effects, PCV7 cost $201,000 per life-year saved. After incorporating indirect effects on IPD, cost per life-year saved was $10,400. The presence of modest additional indirect effects against hospitalized pneumonia and otitis media in children may have resulted in overall cost savings.

Vaccine
Volume 27, Issue 47, Pages 6481-6650 (5 November 2009)

Estimated research and development costs of rotavirus vaccines
Donald W. Light, Jon Kim Andrus, Rebecca N. Warburton

Abstract

Diseases like rotavirus afflict both upper- and lower-income countries, but most serious illnesses and deaths occur among the latter. It is a vital public health issue that vaccines for these types of global diseases can recover research and development (R&D) costs from high-priced markets quickly so that manufacturers can offer affordable prices to lower-income nations. Cost recovery depends on how high R&D costs are, and this study attempts to replace high, unverified estimates with lower, more verifiable estimates for two new vaccines, RotaTeq (Merck) and Rotarix (GlaxoSmithKline or GSK), based on detailed searches of public information and follow-up interviews with senior informants. We also offer a new perspective on “cost of capital” as a claim for recovery from public bodies. Our estimates suggest that companies can recover all fixed costs quickly from affluent markets and thus can offer these vaccines to lower-income countries at prices they can afford. Better vaccines are a shared project between companies and public health agencies; greater transparency and consistency in reporting of R&D costs is needed so that fair prices can be established.