The Lancet
Nov 28, 2009  Volume 374  Number 9704  Pages 1793 – 1866
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Can malaria be eliminated?
The Lancet

Preview: At the UK Academy of Medical Sciences’ annual international health lecture last week, Nicholas White asked whether malaria elimination was feasible or futile. By elimination, he means the interruption of malaria transmission, creating zero incidence of locally contracted cases. White reviewed past attempts to control, eliminate, and even eradicate malaria—and their disappointments. But now, he argued, there was a new opportunity to defeat malaria, an opportunity that should be grasped firmly before the fashions of global health divert attention elsewhere.

The Lancet
Nov 28, 2009  Volume 374  Number 9704  Pages 1793 – 1866
http://www.thelancet.com/journals/lancet/issue/current

Correspondence
Scarcity of pneumococcal vaccine where it is needed most
Original Text
Julian Lob-Levyt

In your Sept 12 issue, two studies that estimate the global and country-level burden of childhood disease caused by Streptococcus pneumoniae (pneumococcus)1 and Haemophilus influenzae type b (Hib)2 show concrete evidence of a troubling disparity. A disproportionate toll of these diseases, particularly pneumococcal disease, is levied on African and Asian children. An article from Kenya3 has further shown that African children with sickle-cell disease are particularly vulnerable to bacterial infections such as pneumococcal disease.

Yet, these are precisely the children and the places that lack access to life-saving vaccines. Although Hib vaccine—thanks to a concerted multiyear collaborative effort—has or is planned to arrive in nearly every country in the world by next year, none of the ten countries with the highest pneumococcal disease burden routinely provides the pneumococcal conjugate vaccine.

This chasm between the places where the most children lose their lives to pneumococcal disease and where life-saving vaccines are available can be closed. The GAVI Alliance provides assistance to eligible countries to introduce the pneumococcal vaccine sustainably through innovative donor-led financing mechanisms such as the Advance Market Commitment for as little as US$0·15 per dose. Our hope is to introduce the vaccine in 42 countries by 2015.

Strong evidence is an essential component of successful child health interventions. Armed with robust new studies such as these, now is the time to act by maintaining our commitment to provide financial assistance to resource-poor countries and supporting policy makers to prioritise prevention.

References

1 O’Brien KL, Wolfson LJ, Watt JP, et alfor the Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet 2009; 374: 893-902. Summary | Full Text | PDF(540KB) | CrossRef | PubMed

2 Watt JP, Wolfson LJ, O’Brien KL, et alfor the Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. Lancet 2009; 374: 903-911. Summary | Full Text | PDF(529KB) | CrossRef | PubMed

3 Williams TN, Uyoga S, Ndila C, et al. Bacteraemia in Kenyan children with sickle-cell anaemia: a retrospective cohort and case—control study. Lancet 2009; 374: 1364-1370. Summary | Full Text | PDF(116KB) | CrossRef | PubMed

Pediatrics
December 2009 / VOLUME 124 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Spatial Accessibility to Providers and Vaccination Compliance Among Children With Medicaid
Linda Y. Fu, MD, MSa,b, Nuala Cowan, MAc, Rosie McLaren, MSd, Ryan Engstrom, PhDc and Stephen J. Teach, MD, MPHb
a Goldberg Center for Community Pediatric Health
b Center for Clinical and Community Research, Children’s National Medical Center, Washington, DC
c Department of Geography, George Washington University, Washington, DC
d National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

OBJECTIVE: We examined the relationship between spatial accessibility to pediatric immunization providers and vaccination compliance in a low-income, urban population of children.

METHODS: In 2007, we accessed the Washington, DC, Immunization Information System (IIS) to collect data on the immunization statuses and residential addresses of children who were aged 19 to 35 months and had Medicaid insurance. In addition, we calculated each child’s spatial accessibility to pediatric vaccination providers by assessing the provider-to-population ratio at each residential address. Spatial accessibility was divided into tertiles (low, medium, and high) of access. The relationship between spatial accessibility to providers and vaccination compliance was examined by using logistic regression analysis adjusting for age, type of vaccination provider, and enrollment in child care status.

RESULTS: Overall for our cohort of 4195 children, 80.5% of the children were up-to-date with vaccinations. Vaccination coverage ranged from 61.6% to 100% (median: 79.2%) among different neighborhoods. Having the highest level of access to pediatric vaccination providers was associated with 36% higher odds of being up-to-date as compared with having the lowest level of access. The middle tertile of access was associated with 25% higher odds of being up-to-date.

CONCLUSIONS: Within our low-income, urban population, children with higher spatial accessibility to pediatric vaccination providers were more likely to be up-to-date with vaccinations. This association may guide future studies and efforts to ensure adequate immunization coverage for children regardless of where they live.

Pediatrics
December 2009 / VOLUME 124 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Booster Vaccinations: Can Immunologic Memory Outpace Disease Pathogenesis?
Michael E. Pichichero, MD
Rochester General Research Institute, Rochester General Hospital, Rochester, New York

Almost all current vaccines work by the induction of antibodies in serum or on the mucosa to block adherence of pathogens to epithelial cells or interfere with microbial invasion of the bloodstream. However, antibody levels usually decline after vaccination to undetectable amounts if further vaccination does not occur. Persistence of vaccine-induced antibodies usually goes well beyond the time when they should have decayed to undetectable levels because of ongoing “natural” boosting or other immunologic mechanisms. The production of memory B and T cells is of clear importance, but the likelihood that a memory response will be fast enough in the absence of a protective circulating antibody level likely depends on the pace of pathogenesis of a specific organism. This concept is discussed with regard to Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis; hepatitis A and B; diphtheria, tetanus, and pertussis; polio, measles, mumps, rubella, and varicella; rotavirus; and human papilloma virus. With infectious diseases for which the pace of pathogenesis is less rapid, some individuals will contract infection before the memory response is fully activated and implemented. With infectious diseases for which the pace of pathogenesis is slow, immune memory should be sufficient to prevent disease.

PLoS Medicine
(Accessed 30 November 2009)
http://medicine.plosjournals.org/perlserv/?request=browse&issn=1549-1676&method=pubdate&search_fulltext=1&order=online_date&row_start=1&limit=10&document_count=1533&ct=1&SESSID=aac96924d41874935d8e1c2a2501181c#results

Editorial
Time for a “Third Wave” of Malaria Activism to Tackle the Drug Stock-out Crisis
PLoS

PLoS Medicine
(Accessed 30 November 2009)
http://medicine.plosjournals.org/perlserv/?request=browse&issn=1549-1676&method=pubdate&search_fulltext=1&order=online_date&row_start=1&limit=10&document_count=1533&ct=1&SESSID=aac96924d41874935d8e1c2a2501181c#results

The Unequal World of Health Data
Peter Byass

Summary Points
– Health data, poverty, and inequality exist in a complex global co-dependency, therefore making meaningful comparisons of health across widely different settings challenging.
– Less data exist on the health of the poor than of the rich, which in turn raises important questions as to how representative available data are in relation to populations that go uncounted.
– Alternative strategies are needed to fill in inequitable gaps in data.

Poverty either in physical terms or in data does not justify the use of impoverished research methods or ethical standards. Reasonable, realistic, and contextually appropriate approaches to research are needed.

Science
7 November 2009  Vol 326, Issue 5957, Pages 1149-1304
http://www.sciencemag.org/current.dtl

Editorial
On Incentives for Innovation

Bruce Alberts
For science to thrive, it is crucial that the scientific community encourage the bold ambitions and innovative spirit of young researchers. In my own area of science, the United States could do much more to support this important goal. U.S. biomedical science is a large and important research enterprise that currently includes over 100,000 graduate students and postdoctoral fellows. Of these, only a select few will go on to become independent research scientists in academia. Assuming that the system supporting this career path works well, these will be the individuals with the most talent and interest in such an endeavor: young people well positioned to make the scientific breakthroughs that societies need to survive and thrive. But the current system squanders the creativity and energy of these exceptionally gifted young people through a funding process that forces them to avoid risk-taking and innovation.

Bruce Alberts is Editor-in-Chief of Science.

Vaccine
Volume 27, Issue 51, Pages 7139-7218 (27 November 2009)
http://www.sciencedirect.com/science/journal/0264410X

Optimal vaccination choice, vaccination games, and rational exemption: An appraisal
Pages 98-109
Piero Manfredi, Pompeo Della Posta, Alberto d’Onofrio, Ernesto Salinelli, Francesca Centrone, Claudia Meo, Piero Poletti

Abstract
A threat for vaccination policies might be the onset of “rational” exemption, i.e. the family’s decision not to vaccinate children after a seemingly rational comparison between the perceived risk of infection and the perceived risk of vaccine side effects. We study the implications of rational exemption by models of vaccination choice. By a simple model of individual choice we first prove the “elimination impossible” result in presence of informed families, i.e. aware of herd immunity, and suggest that limited information might explain patterns of universal vaccination. Next, we investigate vaccination choice in a game-theoretic framework for communities stratified into two groups, “pro” and “anti” vaccinators, having widely different perceived costs of infection and of vaccine side effects. We show that under informed families neither a Nash nor a Stackelberg behaviour (characterized, respectively, by players acting simultaneously and by an asymmetric situation with a “leader” and a “follower) allow elimination, unless “pro-vaccinators” assign no costs to vaccine side effects. Elimination turns out to be possible when cooperation is encouraged by a social planner, provided, however, he incorporates in the “social loss function” the preferences of anti-vaccinators only. This allows an interpretation of the current Italian vaccination policy.

Vaccine
Volume 27, Issue 51, Pages 7139-7218 (27 November 2009)
http://www.sciencedirect.com/science/journal/0264410X

Which factors are important in adults’ uptake of a (pre)pandemic influenza vaccine?
Pages 207-227
E.A.M. Zijtregtop, J. Wilschut, N. Koelma, J.J.M. Van Delden, R.P. Stolk, J. Van Steenbergen, J. Broer, B. Wolters, M.J. Postma, E. Hak

Abstract
Since 2008, (pre)pandemic vaccines against H5N1 influenza have been available and pandemic vaccines against new influenza H1N1 are currently produced. In The Netherlands, the vaccination call for seasonal influenza among the recommended groups approximates 70%. These statistics raise the question if adults in Western societies are willing to get a (pre)pandemic influenza vaccination, for example, against avian H5N1 or swine-like H1N1 virus. A questionnaire was performed to determine the predictors of a negative intention to be immunized against pandemic influenza among adults. Demographical, behavioural and organisational determinants were studied. Thirty-four and five percent of the respondents were negatively intended to get a pandemic influenza vaccination in a pre-pandemic or pandemic phase, respectively. On the basis of six behavioural determinants negative intention to get a pandemic influenza vaccination can be predicted correctly in almost 80% of the target group. These determinants should be targeted in pandemic preparedness plans.