New England Journal of Medicine
http://content.nejm.org/current.shtml
Volume 362 — June 3, 2010 — Number 22

Perspective
The Public’s Response to the 2009 H1N1 Influenza Pandemic
G. K. SteelFisher, R. J. Blendon, M. M. Bekheit, and K. Lubell
[free full-text]

New England Journal of Medicine
http://content.nejm.org/current.shtml
Volume 362 — May 27, 2010 — Number 21

Perspective
Pandemic Vaccines — The Legal Landscape
W. E. Parmet
[free full-text]

The Pediatric Infectious Disease Journal
June 2010 – Volume 29 – Issue 6
http://journals.lww.com/pidj/pages/currenttoc.aspx

Original Studies
Reduction in Gastroenteritis in United States Children and Correlation With Early Rotavirus Vaccine Uptake From National Medical Claims Databases
Cortese, Margaret M.; Tate, Jacqueline E.; Simonsen, Lone; Edelman, Laurel; Parashar, Umesh D.

Abstract
Background: We sought to estimate rotavirus disease reduction among children in hospital and office settings in the 4 US regions following rotavirus vaccine introduction and to estimate vaccine uptake.

Methods: Two national third-party payer medical claims databases were used to examine the number of visits for gastroenteritis per annual nongastroenteritis visits among children aged <5 years during July 2003 to June 2008 in hospital and office settings. The gastroenteritis burden attributable to rotavirus was computed as the excess of all gastroenteritis visits during rotavirus seasons above the baseline of visits during nonrotavirus periods. Rotavirus vaccine uptake was estimated by comparing claims for rotavirus vaccine with those for diphtheria-tetanus-acellular pertussis vaccines.

Results: In the South, Northeast, and Midwest, the typical winter-spring gastroenteritis peak due to rotavirus was markedly dampened in 2007-2008. Compared with the mean for 3 prevaccine seasons, the excess gastroenteritis visits that occurred during the 2007-2008 rotavirus season was reduced by >90% among infants in all care settings in 3 regions and by >70% among children aged 1 to 4 years. In the West, disease reductions were lower (53%-63% reduction among hospitalized infants). At the onset of the 2007-2008 season, coverage with >=1 rotavirus vaccine dose was an estimated 57% among infants, 17% among children aged 1 year, and 0 among those aged 2 to 4 years.

Conclusions: The rotavirus burden in 2007-2008 was markedly reduced in all US regions and exceeded that explained by only direct protection of the youngest vaccinated children.

PLoS Medicine
(Accessed 7 June 2010)
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

Studies Needed to Address Public Health Challenges of the 2009 H1N1 Influenza Pandemic: Insights from Modeling
Maria D. Van Kerkhove, Tommi Asikainen, Niels G. Becker, Steven Bjorge, Jean-Claude Desenclos, Thais dos Santos, Christophe Fraser, Gabriel M. Leung, Marc Lipsitch, Ira M. Longini Jr, Emma S. McBryde, Cathy E. Roth, David K. Shay, Derek J. Smith, Jacco Wallinga, Peter J. White, Neil M. Ferguson, Steven Riley Policy Forum, published 01 Jun 2010

Summary Points
– As the global epidemiology of the pandemic (H1N1) 2009 influenza (H1N1pdm) virus strain unfolds into 2010, substantial policy challenges will continue to present themselves for the next 12 to 18 months.

– Here, we anticipate six public health challenges and identify data that are required for public health decision making: Measuring age-specific immunity to infection; accurately quantifying severity; improving treatment outcomes for severe cases; quantifying the effectiveness of interventions; capturing the full impact of the pandemic on mortality; and rapidly identifying and responding to antigenic variants.

– Representative serological surveys stand out as a critical source of data with which to reduce uncertainty around policy choices for both pharmaceutical and nonpharmaceutical interventions after the initial wave has passed.

– Continuing to monitor the time course of incidence of severe H1N1pdm cases will give a clear picture of variability in underlying transmissibility of the virus during population-wide changes in behavior such as school vacations and other nonpharmaceutical interventions.

Science
http://www.sciencemag.org/current.dtl
28 May 2010  Vol 328, Issue 5982, Pages 1061-119

News of the Week: Infectious Diseases
Fears of Lax Surveillance if CDC Program Cut
Jennifer Couzin-Frankel

A proposal to stop funneling dollars directly to U.S. surveillance and research for most mosquito and other vector-borne diseases such as West Nile virus and dengue has scientists wringing their hands. They are concerned that if the plan sticks, the country will be ill-prepared to handle new emerging diseases and manage existing ones. The proposal in President Barack Obama’s 2011 budget for the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, combined with a $15.7 million cut for infectious disease work generally, would virtually eliminate the vector-borne program. Currently, CDC funds mosquito testing for a variety of diseases and investigations into patterns of disease spread in the United States.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 27, Pages 4335-4438 (17 June 2010)

Regular Papers
Human papillomavirus and cervical cancer: Gardasil® vaccination status and knowledge amongst a nationally representative sample of Australian secondary school students
Pages 4416-4422
Paul A. Agius, Marian K. Pitts, Anthony M.A. Smith, Anne Mitchell

Abstract
The aim of this paper was to measure student knowledge of HPV and risks associated with cervical cancer, explore associated factors, correlate knowledge of HPV and cervical cancer with other domains of sexual health related knowledge and estimate student self-reported rates of HPV immunisation. Data were from a nationally representative cross-sectional stratified cluster sample of year 10 and 12 students in the Australian secondary school system. Contingency table, comparison of means, correlation and multiple OLS regression analyses of students answering HPV (n = 1927) and cervical cancer (n = 2680) knowledge questions was undertaken. Student HPV and cervical cancer knowledge was generally poor. Young women exhibited better knowledge than young men however the difference was, to some extent, accounted for by vaccination for HPV. Sexually active students and those having more sexual partners in the previous year did not report higher levels of HPV and cervical cancer knowledge. The large majority of young women surveyed reported a HPV vaccination as did a small proportion of young men. Students who reported being vaccinated had higher levels of knowledge about HPV and cervical cancer. Student knowledge of HPV and cervical cancer is considerably limited. There is some evidence that being vaccinated for HPV improves a person’s level of understanding of the disease and cervical cancer. The recent national public health campaign focussing on cervical cancer vaccination for young women may be partly responsible for a lack of understanding of HPV as a common STI.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 26, Pages 4229-4334 (11 June 2010)

Review
Factors underlying parental decisions about combination childhood vaccinations including MMR: A systematic review
Pages 4235-4248
Katrina F. Brown, J. Simon Kroll, Michael J. Hudson, Mary Ramsay, John Green, Susannah J. Long, Charles A. Vincent, Graham Fraser, Nick Sevdalis

Abstract
Suboptimal childhood vaccination uptake results in disease outbreaks, and in developed countries is largely attributable to parental choice. To inform evidence-based interventions, we conducted a systematic review of factors underlying parental vaccination decisions. Thirty-one studies were reviewed. Outcomes and methods are disparate, which limits synthesis; however parents are consistently shown to act in line with their attitudes to combination childhood vaccinations. Vaccine-declining parents believe that vaccines are unsafe and ineffective and that the diseases they are given to prevent are mild and uncommon; they mistrust their health professionals, Government and officially-endorsed vaccine research but trust media and non-official information sources and resent perceived pressure to risk their own child’s safety for public health benefit. Interventions should focus on detailed decision mechanisms including disease-related anticipated regret and perception of anecdotal information as statistically representative. Self-reported vaccine uptake, retrospective attitude assessment and unrepresentative samples limit the reliability of reviewed data – methodological improvements are required in this area.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 26, Pages 4229-4334 (11 June 2010)

Regular Papers
Knowledge, attitudes and beliefs regarding influenza vaccination among healthcare workers in a Saudi hospital
Pages 4283-4287
Rifat Rehmani, Javed I. Memon

Abstract
Background
Annual influenza vaccination is recommended for healthcare workers (HCWs) in order to reduce the morbidity associated with influenza in healthcare settings. The objectives of the study were to determine the rate of influenza vaccination, knowledge, attitudes and beliefs toward influenza immunization among healthcare workers at our hospital, and to identify reasons for electing or declining the immunization.

Methods
Between January and February 2009, we carried out a cross-sectional study of influenza vaccination coverage among HCWs at King Abdul-Aziz Hospital, Saudi Arabia. After receiving a brief description of the aim of the study, 512 of 902 HCWs self-completed an anonymous questionnaire.

Results
Influenza vaccination coverage was low at a rate of 34.4% in 2008–9. The knowledge of influenza disease and prevention was low, with a mean knowledge score of 5.8 ± 2.1. The most common reason for being vaccinated was self-protection from illness (95%), and the most common reason for not being vaccinated was a belief that vaccine is not effective in disease prevention (51%). We found that being female, awareness of effectiveness of vaccine in disease prevention, feeling at risk of influenza, self-protection, to protect the patients, previous influenza vaccination were statistically significant factors for influenza vaccination.

Conclusion
Despite the recommendations, influenza vaccination coverage is low among HCWs at our hospital. Misconceptions about influenza vaccination were prevalent among the healthcare workers. Specific continuous educational and vaccination programs for different targets should be organized to reduce morbidity and mortality in high-risk patients.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 26, Pages 4229-4334 (11 June 2010)

Regular Papers
Optimal vaccine stockpile design for an eradicated disease: Application to polio
Pages 4312-4327
Radboud J. Duintjer Tebbens, Mark A. Pallansch, James P. Alexander, Kimberly M. Thompson

Abstract
Eradication of a disease promises significant health and financial benefits. Preserving those benefits, hopefully in perpetuity, requires preparing for the possibility that the causal agent could re-emerge (unintentionally or intentionally). In the case of a vaccine-preventable disease, creation and planning for the use of a vaccine stockpile becomes a primary concern. Doing so requires consideration of the dynamics at different levels, including the stockpile supply chain and transmission of the causal agent. This paper develops a mathematical framework for determining the optimal management of a vaccine stockpile over time. We apply the framework to the polio vaccine stockpile for the post-eradication era and present examples of solutions to one possible framing of the optimization problem. We use the framework to discuss issues relevant to the development and use of the polio vaccine stockpile, including capacity constraints, production and filling delays, risks associated with the stockpile, dynamics and uncertainty of vaccine needs, issues of funding, location, and serotype dependent behavior, and the implications of likely changes over time that might occur. This framework serves as a helpful context for discussions and analyses related to the process of designing and maintaining a stockpile for an eradicated disease.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 25, Pages 4119-4228 (7 June 2010)

Regular Papers
Rotavirus vaccination in northeast Brazil: A laudable intervention, but can it lead to cost-savings?
Pages 4162-4168
Chiara Centenari, Ricardo Q. Gurgel, Anna Klara Bohland, Débora M.P. Oliveira, Brian Faragher, Luis E. Cuevas

Abstract
This study assessed the family and heath system’s costs due to diarrhoea in children <2 years old, before/after the introduction of a rotavirus vaccine in Brazil in 2006. Information on diarrhoea health care costs and morbidity were obtained from the primary health care system, the National Public Health database (2004–2008) and care-givers. Diarrhoea ambulatory consultations and hospitalizations had a declining trend during the entire period, with additional steeper reductions after vaccine introduction. The vaccine thus is associated with reduced diarrhoea consultations and hospitalization costs and families’ out-of-pocket expenses. Despite these gains, the overall health system’s costs have increased.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 25, Pages 4119-4228 (7 June 2010)

Regular Papers
Omission bias and vaccine rejection by parents of healthy children: Implications for the influenza A/H1N1 vaccination programme
Pages 4181-4185
Katrina F. Brown, J. Simon Kroll, Michael J. Hudson, Mary Ramsay, John Green, Charles A. Vincent, Graham Fraser, Nick Sevdalis

Abstract
2009 H1N1 influenza A (“swine flu”) vaccine has been offered to healthy UK children aged 6 months–5 years since December 2009, though around 50% of parents plan to reject the vaccine. This study examined whether such parents exhibit omission bias (preference for errors arising from inaction over errors arising from action). One-hundred and forty-two parents completed an online questionnaire in which they rated (a) probability of occurrence, (b) symptoms and (c) duration of a hypothetical disease and a hypothetical vaccine adverse event (VAE). Almost all attributes were rated significantly less favourably when relating to VAE than to disease (p < 0.01 for 17 of 22 outcomes), despite the attributes being objectively identical. These data suggest that any vaccine is at a disadvantage in many parents’ consciousness in comparison with the infection itself, and that minor safety concerns could have disproportionately detrimental effects on vaccine uptake. Behavioural science offers strategies to ameliorate the impact of this bias and these should be explored further.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 25, Pages 4119-4228 (7 June 2010)

Regular Papers
Factors influencing HPV vaccination status in a Latino population; and parental attitudes towards vaccine mandates
Pages 4186-4191
Nava Yeganeh, Donna Curtis, Alice Kuo

Abstract
We performed a retrospective cohort study in a largely Latino population in Los Angeles, surveying 95 parents of 11–17 year old girls between May and June 2008 to examine factors associated with [1] parental consent for Human Papillomavirus (HPV) immunization one year after vaccine implementation and [2] parental support of an HPV vaccine mandate for adolescents prior to middle school entry. 73% of participants had heard of the HPV vaccine and 37% of daughters had already received the vaccine. Variables associated with vaccination included Latino ethnicity, the belief that vaccines are safe, and that HPV vaccine prevents cervical cancer. The most frequent reasons for refusing vaccination included parental request for more information and missed opportunities in clinic. Variables associated with parents agreeing with a law mandating HPV vaccination included: belief in vaccine safety, recent maternal Pap Smear, HPV vaccination of participant’s daughter prior to survey, and Latino ethnicity. Our survey supports the work of previous studies recommending continued educational campaigns emphasizing the safety of HPV vaccine, and its efficacy in reducing cervical cancer.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 25, Pages 4119-4228 (7 June 2010)

Regular Papers
Survey of girls’ recall of a film providing information on human papillomavirus and cervical cancer 6 months after an offer of vaccination
Pages 4210-4214
Loretta Brabin, Rebecca Stretch, Stephen A. Roberts, Peter Elton, David Baxter, Rosemary McCan

Abstract
Pre-adolescent girls who have been successfully immunised against human papillomavirus (HPV) may have relatively little knowledge about cervical cancer. A questionnaire was sent to 1084 girls approximately 6 months after they had been offered vaccination to assess whether an educational film had influenced their vaccine decision and what information they recalled. Girls who viewed the film were more likely to have wanted the vaccine than non-viewers (p = 0.015), but only 42% of them could recall details of the film 6 months later. Fear of cervical cancer may motivate young adolescents for vaccination but false assumptions might undermine later preventive actions by both the vaccinated and unvaccinated groups.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 25, Pages 4119-4228 (7 June 2010)

Regular Papers
Health beliefs of Taiwanese women seeking HPV vaccination
Pages 4224-4228
Yu-Yun Hsu, Keng-Fu Hsu, Ya-Min Cheng, Susan Jane Fetzer, Cheng-Yang Chou

Abstract
In Taiwan, human papillomavirus (HPV) vaccine is recommended for women aged 9–26 years. The purpose of this study was to examine health beliefs and reasons for HPV vaccination among young adult women (aged 18–26 years), and adult women (aged over 26 years). Women who initiated HPV vaccination were recruited from three hospitals in southern Taiwan. One hundred and eighty-nine subjects completed a questionnaire on health beliefs and reasons for HPV vaccinations. 38% (n = 72) of the women who initiated vaccination were over the age of 26. Health beliefs regarding HPV vaccination differ between young adult women and adult women. Recommendations from others (family, health care providers, etc.) are among the main reasons for young adult women to initiate HPV vaccination; while self-awareness of the risk for HPV infection and personal gynecologic diseases are main reasons for adult women to initiate HPV vaccination. Furthermore, women aged 18–26 are more likely than women aged over 26 to consider the cost and availability of vaccination. Media also plays an important role in a woman’s decision to seek HPV vaccination.

Vaccine
Volume 28, Issue 24, Pages 4013-4118 (28 May 2010)
http://www.sciencedirect.com/science/journal/0264410X

Editorial
Thirty years after smallpox: Celebration and sobering thoughts
Pages 4013-4014
Gregory A. Poland, Donald Henderson
[No abstract published]

Vaccine
Volume 28, Issue 24, Pages 4013-4118 (28 May 2010)
http://www.sciencedirect.com/science/journal/0264410X

Review
A systematic review of measures used in studies of human papillomavirus (HPV) vaccine acceptability
Pages 4027-4037
Jennifer D. Allen, Gloria D. Coronado, Rebecca S. Williams, Beth Glenn, Cam Escoffery, Maria Fernandez, Raegan A. Tuff, Katherine M. Wilson, Patricia Dolan Mullen

Abstract
Background
The recent proliferation of studies describing factors associated with HPV vaccine acceptability could inform health care providers in improving vaccine coverage and support future research. This review examined measures of HPV and HPV-vaccine knowledge, attitudes, beliefs and acceptability, described psychometric characteristics, and provided recommendations about their use.

Methods
A systematic search of Medline, CINAHL, PsychoInfo, and ERIC through May 2008 for English language reports of quantitative data from parents, young adults or adolescents yielded 79 studies.

Results
The majority of studies were cross-sectional surveys (87%), self-administered (67%), conducted before prophylactic vaccines were publicly available (67%) and utilized convenience samples (65%). Most measured knowledge (80%), general attitudes about HPV vaccination (40%), and willingness to vaccinate one’s daughter (26%). Two-thirds did not report reliability or validity of measures. The majority did not specify a theoretical framework.

Conclusions
Use of a theoretical framework, consistent labeling of constructs, more rigorous validation of measures, and testing of measures in more diverse samples are needed to yield measurement instruments that will produce findings to guide practitioners in developing successful community and clinical interventions.