Vaccines_The Week in Review_29 November 2010

This is the pdf document version compiling  individual posts below on this date.

WHO: Cholera in Haiti – update 4

24 November 2010 — As of 20 November 2010, the Haitian Ministry of Public Health and Population (MSPP) reported 60,240 cumulative cholera cases including 1,415 deaths at the national level. The case fatality rate in hospitals at the national level is 2.3%, with 67% of the deaths occurring at health services level and 33% at community level…

WHO/PAHO and partners, including the GOARN (Global Outbreak Alert and Response Network) continue to support the Haitian MSPP in the response to the outbreak. Civil unrest since 15 November has slowed down several activities, including delivery of supplies for prevention and treatment of patients, particularly in the Northern city of Cap Haitian. Trainings on cholera treatment and initiatives to chlorinate water for 300,000 people had to be postponed…

Recommendation

WHO does not recommend restrictions to international travel or trade due to the cholera outbreak in Haiti.

http://www.who.int/csr/don/2010_11_24/en/index.html

The GAVI Alliance opened a new application round from developing countries “in anticipation of continuing strong support from its donors, which currently include, among others, 17 countries and the Bill & Melinda Gates Foundation.”

GAVI Interim CEO Helen Evans commented, “GAVI is determined to continue supporting countries with life-saving vaccines. Far too many children in developing countries continue to remain vulnerable to vaccine-preventable diseases. This new round of applications offers the opportunity for eligible countries to continue reaching more children and save more lives.” The GAVI announcement noted that “although GAVI is facing a major funding challenge, the Executive Committee of the GAVI Alliance Board felt confident that donors would recognise the importance of these cost-effective vaccines and provide the necessary support to ensure that countries which have applications approved will be able to deliver urgently-needed vaccines.” GAVI said that “to continue its mission to save lives and protect people’s health by increasing access to immunisation, (it) GAVI needs to raise approximately US$3.7 billion more within the next five years. GAVI estimates that a fully-funded programme would prevent approximately 4 million future deaths by 2015, and enable the introduction of new vaccines including importantly those that tackle major causes of the world’s two biggest killers of children, pneumonia and diarrhoea.”

GAVI said the deadline for applications is 15 May 2011, allowing approximately six months for countries to prepare proposals. The timely submission of new proposals “will provide donors with clear evidence of the level of country demand for new life-saving vaccines when they meet in June for the first GAVI pledging conference.”

http://www.gavialliance.org/media_centre/press_releases/new_applications.php

GAVI said the International Finance Facility for Immunisation (IFFIm) priced its inaugural Australian dollar benchmark. The AUD$400 million, five-year bonds “provide investors with a unique opportunity to help protect millions of children in the world’s poorest countries against preventable diseases.” This most recent offering from IFFIm “demonstrates institutional investors’ continued support for IFFIm and its humanitarian purpose. IFFIm raises funds that are used by the GAVI Alliance to save children’s lives and protect people’s health by increasing access to immunisation in developing countries.” Alan R. Gillespie, Chairman of IFFIm’s Board, said, “This new offering introduces IFFIm as a benchmark issuer in another market – the Australian Dollar market. It follows IFFIm’s debut in the USD benchmark market in 2006, its institutional GBP offering in 2009, and a series of bonds for institutional and retail investors in Japan and the UK. We are extremely pleased that the transaction was received with great enthusiasm by such a diverse group of investors that seized the opportunity to purchase IFFIm bonds, while enabling IFFIm to deliver cost-efficient financing for much needed immunisation programmes in the poorest countries through the GAVI Alliance.”

http://www.gavialliance.org/media_centre/press_releases/iffim_australia.php

The Weekly Epidemiological Record (WER) for 26 November 2010, vol. 85, 48 (pp 473–488) includes: Meeting of the national onchocerciasis task forces, September 2010; Maternal and neonatal tetanus elimination in Bali and Java, Indonesia, 2010

http://www.who.int/entity/wer/2010/wer8548.pdf

JAMA
Vol. 304 No. 20, pp. 2205-2314, November 24, 2010
http://jama.ama-assn.org/current.dtl

Commentaries
The Evolution of Population Science: Advent of the Mega Cohort
J. Michael Gaziano

Extract
As more attention and resources have been focused on the health of populations over the last 2 centuries, epidemiology has emerged as an essential tool for gaining knowledge about disease and reducing the associated burden. Driven by the discovery of biomarkers, the advent of DNA analysis, and high-powered statistical software, as well as numerous other technological advances, epidemiology has evolved to a point at which massive cohorts with hundreds of thousands of participants are needed. Each step in this evolution can be defined by an enabling technology that aided in a better understanding of exposure-disease relationships, and in many cases, to transformative changes in public health efforts related to health care delivery. This commentary describes this evolution, from early descriptive studies to the new mega cohorts of today.

The Lancet
Nov 27, 2010  Volume 376  Number 9755  Pages 1799 – 1872
http://www.thelancet.com/journals/lancet/issue/current

Comment
Childhood pneumonia: a neglected, climate-sensitive disease?
Stuart Paynter, Robert S Ware, Philip Weinstein, Gail Williams, Peter D Sly

Preview
Reports from WHO and the Intergovernmental Panel on Climate Change (IPCC) list undernutrition, diarrhoea, and vector-borne disease as the most important health effects of climate change.1,2 Although these disorders are of major importance, childhood pneumonia, which is responsible for 17% of childhood deaths worldwide,3 is rarely mentioned in the context of climate change. Respiratory infections follow seasonal patterns. In temperate settings, respiratory illness is most common in winter months.4 However, the epidemiology is quite different in tropical settings, where most childhood deaths due to pneumonia occur, with the incidence of lower respiratory-tract infection being generally increased during the rainy season.

The Lancet
Nov 27, 2010  Volume 376  Number 9755  Pages 1799 – 1872
http://www.thelancet.com/journals/lancet/issue/current

What do children die from in India today?
Emmanuela Gakidou, Alan D Lopez

Preview
In The Lancet, The Million Death Study Collaborators make an important contribution to a topic of great public health significance: the causes of child mortality in India and their distribution across sexes and geographical regions. As the deadline of 2015 for achieving the Millennium Development Goals (MDGs) looms, the urgency for scaling up interventions becomes more pressing—especially in India, where 29.3% of global neonatal deaths and 16.1% of global child deaths occur. This new study shows the first estimates of the leading causes of child mortality from direct measurement of 23,152 child deaths captured across the country.

The Lancet
Nov 27, 2010  Volume 376  Number 9755  Pages 1799 – 1872
http://www.thelancet.com/journals/lancet/issue/current

Viewpoint
Universal access to malaria medicines: innovation in financing and delivery
Olusoji Adeyi, Rifat Atun

Preview
In recent years, several constraints have impeded access to effective treatments for malaria due to Plasmodium falciparum. First, the parasite has become increasingly resistant to established cheap drugs, such as chloroquine and sulfadoxine-pyrimethamine. Second, development assistance has been routed largely through public channels, whereas affected individuals seek treatment mostly through the private sector. Finally, new artemisinin-based combination treatments (ACTs), recommended by WHO for uncomplicated falciparum malaria,1 are too expensive for many people who seek treatment in the private sector.

The Lancet Infectious Disease
Dec 2010  Volume 10 Number 12  Pages 813 – 892
http://www.thelancet.com/journals/laninf/issue/current

Reflection and Reaction
Can HPV vaccination help to prevent anal cancer?
Joel Palefsky

Preview
In The Lancet Infectious Diseases today, Jane Kim reports1 a cost-effectiveness analysis of vaccination with the quadrivalent human papillomavirus (HPV) vaccine (for HPV types 6, 11, 16, and 18) in men who have sex with men (MSM) to prevent anal intraepithelial neoplasia and cancer related to vaccine-type HPV. MSM, especially those with HIV infection, have one of the highest risks of anal cancer,2–4 and incidence of anal cancer is increasing every year in men and women in developed countries.5

The Lancet Infectious Disease
Dec 2010  Volume 10 Number 12  Pages 813 – 892
http://www.thelancet.com/journals/laninf/issue/current

The Lancet conference on mass gatherings medicine
John McConnell, Ziad Memish

Preview
What constitutes a mass gathering is challenging to define. Ensuring a safe environment and provision of health care during mass gatherings can be equally challenging. The event that formed the focus of The Lancet conference on mass gatherings medicine (Jeddah, Saudi Arabia, Oct 23–25, 2010) was the annual Hajj pilgrimage, which takes place in and around the city of Mecca, not far from the venue of the conference. The Hajj occurs over 5 days during the final month of the Islamic calendar (officially beginning this year on Nov 14 of the Gregorian calendar), attracts 2–3 million visitors, and is the largest annual mass gathering.

The Lancet Infectious Disease
Dec 2010  Volume 10 Number 12  Pages 813 – 892
http://www.thelancet.com/journals/laninf/issue/current

Articles
Targeted human papillomavirus vaccination of men who have sex with men in the USA: a cost-effectiveness modelling analysis
Jane J Kim

Summary
Background
A vaccine targeting human papillomavirus (HPV) types 16 and 18, which are associated with 80% of anal cancers, is efficacious in men. High-risk populations such as men who have sex with men (MSM) might especially benefit from vaccination. I aimed to estimate the cost-effectiveness of HPV vaccination of MSM in the USA.

Methods
I constructed decision-analytic models to estimate the direct health and economic outcomes of HPV vaccination (against types 6, 11, 16, and 18) for prevention of HPV-related anal cancer and genital warts. The model parameters that were varied were age at vaccination (12 years, 20 years, and 26 years), previous exposure to vaccine-targeted HPV types, and prevalence of HIV-1. I used the models to conduct sensitivity analyses, including duration of vaccine protection, vaccine cost, and burden of anal cancer and genital warts.

Findings
In a scenario of HPV vaccination of MSM at 12 years of age without previous exposure to HPV, compared with no vaccination, vaccination cost US$15 290 per quality-adjusted life-year gained. In scenarios where MSM are vaccinated at 20 years or 26 years of age, after exposure to HPV infections, the cost-effectiveness ratios worsened, but were less than $50 000 per quality-adjusted life-year under most scenarios. For example, HPV vaccination of MSM at 26 years cost $37 830 per quality-adjusted life-year when previous exposure to all vaccine-targeted HPV types was assumed to be 50%. Outcomes were most sensitive to variations in anal cancer incidence, duration of vaccine protection, and HIV prevalence in MSM.

Interpretation
HPV vaccination of MSM is likely to be a cost-effective intervention for the prevention of genital warts and anal cancer.

Funding
US National Cancer Institute.

The Lancet Infectious Disease
Dec 2010  Volume 10 Number 12  Pages 813 – 892
http://www.thelancet.com/journals/laninf/issue/current

Review
Priorities for tuberculosis research: a systematic review
Jamie Rylance, Madhukar Pai, Christian Lienhardt, Paul Garner

Reliable and relevant research can help to improve tuberculosis control worldwide. In recent years, various organisations have assessed research needs and proposed priorities for tuberculosis. We summarise existing priority statements and assess the rigour of the methods used to generate them. We found 33 documents that specifically outline priorities in tuberculosis research. The top priority areas were drug development (28 articles), diagnosis and diagnostic tests (27), epidemiology (20), health services research (16), basic research (13), and vaccine development and use (13).

NEJM Online First: November 24, 2010 (10.1056/NEJMp1012300) http://www.nejm.org/doi/full/10.1056/NEJMp1012300

Perspective
A National Cholera Vaccine Stockpile — A New Humanitarian and Diplomatic Resource
Matthew K. Waldor, M.D., Ph.D., Peter J. Hotez, M.D., Ph.D., and John D. Clemens, M.D.

The Pediatric Infectious Disease Journal
December 2010 – Volume 29 – Issue 12  pp: A9-A10,1067-1157,e80-e99
http://journals.lww.com/pidj/pa     ges/currenttoc.aspx

Original Studies
Estimating the Rotavirus Hospitalization Disease Burden and Trends, Using Capture-recapture Methods
Staat, Mary Allen; Rice, Marilyn A.; Donauer, Stephanie; Payne, Daniel C.; Bresee, Joseph S.; Mast, T. Christopher; Curns, Aaron T.; Cortese, Margaret M.; Connelly, Beverly; McNeal, Monica; Ward, Richard L.; Bernstein, David I.; Parashar, Umesh D.; Salisbury, Shelia
Pediatric Infectious Disease Journal. 29(12):1083-1087, December 2010.
doi: 10.1097/INF.0b013e3181fb8f7b

Abstract:
Background: Rotavirus surveillance is needed to provide estimates of disease burden and to evaluate the effect of vaccination programs. Our objective was to use capture-recapture methods to estimate rotavirus hospitalization rates and to examine trends over time.

Methods: Children <3 years of age residing in Hamilton County, Ohio hospitalized with acute gastroenteritis, and laboratory-confirmed rotavirus between 1997 and 2008 were identified through 2 independent surveillance systems: an active system with prospective enrollment of children admitted with acute gastroenteritis and a passive system of children identified by rotavirus testing as part of their usual medical care. Capture-recapture methods compared cases from both systems to estimate the number of missed cases from either system. Using census data for Hamilton County, rates per 10,000 with 95% confidence intervals (CI) for rotavirus hospitalizations were estimated.

Results: Overall, 486 cases were identified using active surveillance and 244 using passive surveillance, with 127 cases captured by both. Using capture-recapture methods, the overall rate in children <3 years old was 26.9/10,000; CI: 24.1, 30.6. Rates varied by year: highest in 1998 (48.1/10,000; CI: 32.4, 92.2) and lowest in 2008 (3.2/10,000; CI: 2.1, 6.1) after rotavirus vaccine introduction. Among children <5 years old, rates were highest in <3-month-old children (51.8/10,000; CI: 39.4, 75.1) and lowest in older age groups: 24 to 35 months (20.5/10,000; CI: 14.7, 30.3) and 36 to 59 months (4.1/10,000; CI: 2.9, 7.2). Rates from capture-recapture methods and adjusted active system were comparable.

Conclusions: Capture-recapture methods were a useful tool to estimate rotavirus disease burden and to monitor trends, especially in the era of rotavirus immunization.

PLoS Medicine
(Accessed 28 November 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

Which Path to Universal Health Coverage? Perspectives on the World Health Report 2010

Sara Bennett, Sachiko Ozawa, Krishna D. Rao
Perspective, published 22 Nov 2010    doi:10.1371/journal.pmed.1001001

Opening
From the US to China, South Africa to India, governments and citizens are engaged in an active debate about how best to protect people from catastrophic health care costs while ensuring access to health care of adequate quality. While it is widely known that in the US there are 50 million uninsured, it is perhaps less well known that across the world 100 million people are pushed into poverty each year because of health care expenditures. This is an avoidable tragedy.

With the financial crisis still looming over many countries, this year’s World Health Report: “Health Systems Financing: The path to universal coverage” could not be more timely in addressing the question of how to ensure that all people have access to health care services, without suffering financial hardship. In a hundred easy-to-read pages, the report synthesizes evidence concerning effective strategies to achieve universal coverage, drawing upon the now substantial body of published literature from around the world, as well as a number of background papers commissioned especially for the report…

Vaccine, In Press, Corrected Proof, Available online 26 October 2010
Economic analysis of the global polio eradication initiative

Original Research Article
Radboud J. Duintjer Tebbens, Mark A. Pallansch, Stephen L. Cochi, Steven G.F. Wassilak, Jennifer Linkins, Roland W. Sutter, R. Bruce Aylward, Kimberly M. Thompson

Abstract

The global polio eradication initiative (GPEI), which started in 1988, represents the single largest, internationally coordinated public health project to date. Completion remains within reach, with type 2 wild polioviruses apparently eradicated since 1999 and fewer than 2,000 annual paralytic poliomyelitis cases of wild types 1 and 3 reported since then. This economic analysis of the GPEI reflects the status of the program as of February 2010, including full consideration of post-eradication policies. For the GPEI intervention, we consider the actual pre-eradication experience to date followed by two distinct potential future post-eradication vaccination policies. We estimate GPEI costs based on actual and projected expenditures and poliomyelitis incidence using reported numbers corrected for underreporting and model projections. For the comparator, which assumes only routine vaccination for polio historically and into the future (i.e., no GPEI), we estimate poliomyelitis incidence using a dynamic infection transmission model and costs based on numbers of vaccinated children. Cost-effectiveness ratios for the GPEI vs. only routine vaccination qualify as highly cost-effective based on standard criteria. We estimate incremental net benefits of the GPEI between 1988 and 2035 of approximately 40–50 billion dollars (2008 US dollars; 1988 net present values).

Despite the high costs of achieving eradication in low-income countries, low-income countries account for approximately 85% of the total net benefits generated by the GPEI in the base case analysis. The total economic costs saved per prevented paralytic poliomyelitis case drive the incremental net benefits, which become positive even if we estimate the loss in productivity as a result of disability as below the recommended value of one year in average per-capita gross national income per disability-adjusted life year saved. Sensitivity analysis suggests that the finding of positive net benefits of the GPEI remains robust over a wide range of assumptions, and that consideration of the additional net benefits of externalities that occurred during polio campaigns to date, such as the mortality reduction associated with delivery of Vitamin A supplements, significantly increases the net benefits. This study finds a strong economic justification for the GPEI despite the rising costs of the initiative.

Vaccines_The Week in Review_22 November 2010

This is the pdf document version compiling  individual posts below on this date.

WHO: Cholera in Haiti – update 3

17 November 2010 — On 16 November, the Haitian Ministry of Public Health and Population (MSPP) reported that as of 14 November, 17,418 cumulative number of hospitalized admissions and 1,065 deaths were reported from seven Departments in the country. The departments reporting cases include Artibonite, Centre, Nord, Nord-Ouest, Nord Est, Ouest, and Sud. In metropolitan Port-au-Prince, communes reporting increases in cases include Carrefour, Cite Soleil, Delmas, Kenscoff, Petion Ville, and Tabarre. The rise in the number of cases in Cite Soleil is particularly concerning, due to its crowded living conditions, poor sanitation, and lack of access to potable water. On 16 November, Dominican Republic registered its first case of cholera in a 32-year-old male returning from Haiti…

Recommendation
WHO does not recommend restrictions to international travel or trade due to the cholera outbreak in Haiti. For further information, please refer to the “WHO statement relating to international travel and trade to and from countries experiencing outbreaks of cholera” below.

More at: http://www.who.int/csr/don/2010_11_17/en/index.html

WHO released the “Global report on antimalarial drug efficacy and drug resistance: 2000–2010,” and called on malaria-endemic countries “to be increasingly vigilant in monitoring antimalarial drug efficacy in order to allow for early detection of artemisinin resistance.” WHO said the report is based on 1,100 studies conducted by national malaria control programs and research institutes over the ten-year period. The report estimates that only 34% of malaria-endemic countries are complying with WHO recommendations to routinely monitor the efficacy of first- and second-line antimalarial medicines. Dr Pascal Ringwald of the Drug Resistance and Containment Unit, within WHO’s Global Malaria Programme and one of the report authors, said, “A greater political commitment to support and sustain national monitoring of the efficacy of antimalarial medicines is critical to prevent a wider emergence of artemisinin resistance.” Dr Robert Newman, Director of WHO’s Global Malaria Programme, commented, “The emergence of artemisinin resistance on the Cambodia-Thailand border has been a wake-up call to the world to prevent its spread, increase monitoring, and preserve ACTs as the only effective treatment we have for falciparum malaria.  Prompt action will be critical to sustain progress in malaria control and achieve the health-related Millennium Development Goals.”

http://www.who.int/mediacentre/news/releases/2010/malaria_20101118/en/index.html

WHO: Global report on antimalarial efficacy and drug resistance: 2000-2010

http://www.who.int/entity/malaria/publications/atoz/9789241500470/en/index.html

Merck announced that the U.S. Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee “has advised that the data presented support an indication for GARDASIL [Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant] for the prevention of anal cancer and anal intraepithelial neoplasia (AIN) in both males and females 9 through 26 years of age.” The Committee’s input will be considered by the FDA in its review of the supplemental Biologics License Application (sBLA) that Merck submitted for GARDASIL in early 2010. The FDA is not bound by the Committee’s guidance, but takes its advice into consideration when reviewing vaccines.

http://www.businesswire.com/news/home/20101117006740/en/FDA-Advisory-Committee-Supports-Approval-GARDASIL%C2%AE-Prevention

The GAVI Alliance announced a new, “unprecedented” Joint Financing Arrangement (JFA) today with the Government of Nepal to support the implementation of the Nepalese National Health Sector Programme. GAVI said the three year agreement, involving a US$14.5 million contribution from GAVI, “is aimed at providing more predictable funding to the Nepalese Government so that it can better plan health programmes. It is also expected that the JFA will help Nepal deliver health services more equitably and sustainably and to use resources more effectively and efficiently.” Under the JFA’s terms, Nepal’s leading aid donors – GAVI, DFID, AusAid, World Bank, USAID, UNFPA, WHO and UNICEF – “agree to channel their development assistance in support of the Government’s health programmes through one simplified management system that will sharply reduce the reporting that donors require from low-income countries such as Nepal.”  Carole Presern, Managing Director, GAVI Special Projects, commented, “We are shifting countries’ administrative burden to Platform development partners and are confident that a long term and fruitful partnership, as the one we have signed in Nepal, is the way forward for achieving better health outcomes – more services, more health workers, and functioning logistics systems.”

The Health Systems Funding Platform was “established in 2009 at the recommendation of the High Level Taskforce on Innovative International Financing for Health Systems. The initiative is being developed by the GAVI Alliance, the Global Fund to fight HIV/AIDS, TB and Malaria and the World Bank, facilitated by the World Health Organization, and in consultations with countries and other key stakeholders, including civil society and the private sector. The platform is part of a broad international effort to strengthen health systems and accelerate progress towards the Millennium Development Goals.”

http://www.gavialliance.org/media_centre/statements/nepal_hsfp.php

Niger national health authorities presented Dr. Marc LaForce, director of the Meningitis Vaccine Project (MVP), with the “Illustre Combattant de la Méningite.” MVP is a partnership between PATH and the World Health Organization that is funded by the Bill & Melinda Gates Foundation. The partnership fostered development of MenAfriVac, a vaccine against the epidemic meningitis that sweeps through sub-Saharan countries known as the meningitis belt during the dry season. Beginning in December, more than 20 million people in Niger, Mali, and Burkina Faso will receive MenAfriVac™ in the first nationwide vaccination campaigns using a meningitis vaccine developed specifically for Africa.

http://www.path.org/news/an101511-Niger-meningitis.php

The American Society of Tropical Medicine and Hygiene (ASTMH) announced that Sabin President Dr. Peter Hotez has assumed his role of president of the Society, “a worldwide organization of scientists, clinicians and program professionals whose mission is to promote global health through the prevention and control of infectious and other diseases that disproportionately afflict the global poor.”

http://sabin.org/news-resources/in-news/2010/11/08/sabin-president-dr-peter-hotez-named-president-american-society-tr

WHO released a newsletter which reports on its main achievements in immunization for 2008-09. WHO said it “covers a broad scope of activities, from global immunization policy; to research and development of vaccines and technologies; quality, safety and standards; access to immunization services; and communication, advocacy and media. It also describes the framework and priorities for the Strategic Plan 2010-2015 of the Department of Immunization, Vaccines and Biologicals.”

WHO/IVB/10.11: http://whqlibdoc.who.int/hq/2010/WHO_IVB_10.11_eng.pdf

The Weekly Epidemiological Record (WER) for 19 November 2010, vol. 85, 47 (pp 461–472) includes Turkmenistan certified malaria-free; WHO Quantitative Immunization and Vaccine-Related Research meeting, October 2010 – summary; Yellow fever surveillance and outbreak response: revision of case definitions, October 2010

http://www.who.int/entity/wer/2010/wer8547.pdf

The MMWR for November 19, 2010 / Vol. 59 / No. 45 includes:

– Update: Cholera Outbreak — Haiti, 2010
– Occupational Transmission of Neisseria meningitidis — California, 2009
– Announcements: Adult Vaccination Coverage Estimates Online
http://www.cdc.gov/mmwr/PDF/wk/mm5945.pdf

Clinical Infectious Diseases
15 December 2010  Volume 51, Number 12
http://www.journals.uchicago.edu/toc/cid/current

Editorial Commentary: How Did the 2008–2009 Seasonal Influenza Vaccine Affect the Pandemic?
W. Paul Glezen
[Free full-text]

VIEWPOINTS
Pandemic Influenza’s 500th Anniversary
David M. Morens, Jeffery K. Taubenberger, Gregory K. Folkers, and Anthony S. Fauci
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Abstract
It is impossible to know with certainty the first time that an influenza virus infected humans or when the first influenza pandemic occurred. However, many historians agree that the year 1510 a.d.—500 years ago—marks the first recognition of pandemic influenza. On this significant anniversary it is timely to ask: what were the circumstances surrounding the emergence of the 1510 pandemic, and what have we learned about this important disease over the subsequent five centuries? We conclude that in recent decades significant progress has been made in diagnosis, prevention, control, and treatment of influenza. It seems likely that, in the foreseeable future, we may be able to greatly reduce the burden of influenza pandemics with improved vaccines and other scientific and public health approaches.

Journal of Infectious Diseases
15 December 2010   Volume 202, Number 12
http://www.journals.uchicago.edu/toc/jid/current

Major Articles/Brief Reports
Cervical Human Papillomavirus Prevalence in 5 Continents: Meta-Analysis of 1 Million Women with Normal Cytological Findings
Laia Bruni, Mireia Diaz, Xavier Castellsagué, Elena Ferrer, F. Xavier Bosch, and Silvia de Sanjosé

Abstract
Background.Baseline information on human papillomavirus (HPV) prevalence and type distribution is highly desirable to evaluate the impact of prophylactic HPV vaccines in the near future.

Methods.A meta-analysis was performed of studies published between 1995 and 2009 that used polymerase chain reaction or Hybrid Capture 2 for HPV detection in women with normal cytological findings.

Results.The analysis included 194 studies comprising 1,016,719 women with normal cytological findings. The estimated global HPV prevalence was 11.7% (95% confidence interval, 11.6%–11.7%). Sub-Saharan Africa (24.0%), Eastern Europe (21.4%), and Latin America (16.1%) showed the highest prevalences. Age-specific HPV distribution presented with a first peak at younger ages (<25 years) and, in the Americas and Africa, a rebound at older ages (45 years). Among the women with type-specific HPV data ( ), the 5 most common types worldwide were HPV-16 (3.2%), HPV-18 (1.4%), HPV-52 (0.9%), HPV-31 (0.8%), and HPV-58 (0.7%).

Conclusions.Although the prevalence of HPV in women with normal cytological findings is high and variable across world regions, HPV types 16, 18, 31, 52, and 58 are consistently found among the 10 most common types in all of them. These results represent the most comprehensive assessment of HPV burden among women with normal cytological findings in the pre–HPV vaccination era worldwide.

The Lancet
Nov 20, 2010  Volume 376 Number 9754  Pages 1711 – 1798
http://www.thelancet.com/journals/lancet/issue/current

Comment
Measles eradication: past is prologue
David L Heymann, Paul E Fine, Ulla K Griffiths, Andrew J Hall, Sandra Mounier-Jack

Preview
In 1969, David Morley emphasised the high mortality rates from measles in west Africa and other countries. He predicted an increase in speculation about the possibility of measles eradication, and concluded that eradication programmes were likely to be successful only if built on a foundation of effective child-care services that are available to the whole community.1,2 Speculation about measles eradication has continued, most recently at a WHO meeting on measles in which a concluding statement encouraged a 2020 target for measles eradication.

The Lancet
Nov 20, 2010  Volume 376 Number 9754  Pages 1711 – 1798
http://www.thelancet.com/journals/lancet/issue/current

Articles
Adult and child malaria mortality in India: a nationally representative mortality survey
Neeraj Dhingra, Prabhat Jha, Vinod P Sharma, Alan A Cohen, Raju M Jotkar, Peter S Rodriguez, Diego G Bassani, Wilson Suraweera, Ramanan Laxminarayan, Richard Peto, for the Million Death Study Collaborators

Summary
Background
National malaria death rates are difficult to assess because reliably diagnosed malaria is likely to be cured, and deaths in the community from undiagnosed malaria could be misattributed in retrospective enquiries to other febrile causes of death, or vice-versa. We aimed to estimate plausible ranges of malaria mortality in India, the most populous country where the disease remains common.

Methods
Full-time non-medical field workers interviewed families or other respondents about each of 122 000 deaths during 2001—03 in 6671 randomly selected areas of India, obtaining a half-page narrative plus answers to specific questions about the severity and course of any fevers. Each field report was sent to two of 130 trained physicians, who independently coded underlying causes, with discrepancies resolved either via anonymous reconciliation or adjudication.

Findings
Of all coded deaths at ages 1 month to 70 years, 2681 (3·6%) of 75 342 were attributed to malaria. Of these, 2419 (90%) were in rural areas and 2311 (86%) were not in any health-care facility. Death rates attributed to malaria correlated geographically with local malaria transmission ratesderived independently from the Indian malaria control programme. The adjudicated results show 205 000 malaria deaths per year in India before age 70 years (55 000 in early childhood, 30 000 at ages 5—14 years, 120 000 at ages 15—69 years); 1·8% cumulative probability of death from malaria before age 70 years. Plausible lower and upper bounds (on the basis of only the initial coding) were 125 000—277 000. Malaria accounted for a substantial minority of about 1·3 million unattended rural fever deaths attributed to infectious diseases in people younger than 70 years.

Interpretation
Despite uncertainty as to which unattended febrile deaths are from malaria, even the lower bound greatly exceeds the WHO estimate of only 15 000 malaria deaths per year in India (5000 early childhood, 10 000 thereafter). This low estimate should be reconsidered, as should the low WHO estimate of adult malaria deaths worldwide.

New England Journal of Medicine
November 18, 2010  Vol. 363 No. 21
http://content.nejm.org/current.shtml

Review Article
Current Concepts: Influenza Vaccines for the Future
L.C. Lambert, A.S. Fauci
[Free full text]

…Conclusions
Although the past decade has witnessed considerable improvements in our approach to the development of influenza vaccines, much still needs to be done. Although converting from egg-based to cell-based systems and adding adjuvants to enhance protective immune responses are important steps in the right direction, it is the new vaccine technologies that hold the promise of revolutionizing influenza vaccinology. Over the next decade, advances are anticipated that will substantially decrease vaccine production time, provide enhanced protection (especially in populations at greatest risk), and end mismatches between vaccine strains and circulating viruses. To fully reap the benefits as progress is made in developing new vaccines, we will need both clear regulatory guidance on pathways for their approval and a robust and agile infrastructure to ensure their timely production and equitable distribution.

Vaccine
Volume 28, Issue 50 pp. 7825-8048 (23 November 2010)
http://www.sciencedirect.com/science/journal/0264410X

Regular papers
Dynamic model of rotavirus transmission and the impact of rotavirus vaccination in Kyrgyzstan Original Research Article
Pages 7923-7932
Birgitte Freiesleben de Blasio, Kaliya Kasymbekova, Elmira Flem

Abstract
New rotavirus vaccines show promise to reduce the burden of severe diarrhea among children in developing countries. We present an age-specific dynamic rotavirus model to assess the effect of rotavirus vaccination in Kyrgyzstan, a country in Central Asia that is eligible for funds from the GAVI Alliance. A routine rotavirus vaccination program at 95% coverage and 54% effectiveness against severe infection is estimated to lead to a 56% reduction in rotavirus-associated deaths and a 50% reduction in hospital admissions, while outpatient visits and homecare episodes would decrease by 52% compared to baseline levels after 5 years of intervention. A 10% reduction in vaccine efficacy due to incomplete 3-dose regimen is estimated to increase the numbers of severe cases by 6–8%. Herd immunity was found to account for 1% or less of averted cases of severe gastroenteritis, while an extra 7–8% of all rotavirus infections would be avoided due to reduced transmission. Conclusion: Rotavirus vaccines would reduce the burden of rotavirus disease substantially, but the results are sensitive to delay in age-appropriate vaccination.

Vaccine
Volume 28, Issue 50 pp. 7825-8048 (23 November 2010)
http://www.sciencedirect.com/science/journal/0264410X

Regular papers
Serologic testing to verify the immune status of internationally adopted children against vaccine preventable diseases Original Research Article
Pages 7947-7955
Mary Allen Staat, Laura Patricia Stadler, Stephanie Donauer, Indi Trehan, Marilyn Rice, Shelia SalisburyAbstract

Abstract
Definitive immunization guidelines for internationally adopted children are lacking. We examined whether these children had serologic evidence of protection against vaccine-preventable diseases. For children with ≥3 vaccine doses, overall protection was high for diphtheria (85%), tetanus (95%), polio (93%), hepatitis B (77%), and Hib (67%). For children ≥12 months of age with ≥1 dose of measles, mumps, or rubella vaccines, 95%, 72%, and 94% were immune, respectively. Children without immunization documentation had lower immunity. Serologic testing was useful in verifying the immunization status in internationally adopted children with and without documentation of immunizations.

Vaccine
Volume 28, Issue 50 pp. 7825-8048 (23 November 2010)
http://www.sciencedirect.com/science/journal/0264410X

Regular papers
The impact of indirect benefits of vaccination on postlicensure vaccine effectiveness estimates: A scenario analysis Original Research Article
Pages 7987-7992
Manish M. Patel, Jacqueline Tate, Margaret Cortese, Daniel C. Payne, Greg Armstrong, Umesh D. Parashar, Ben Lopman

Abstract
Vaccine efficacy is measured in randomized, prelicensure clinical trials where vaccination typically affords only direct protection to the vaccinated individual. Vaccine effectiveness is measured in postlicensure observational studies where vaccination might provide indirect benefits to a population as a whole in addition to directly protecting the vaccinated individual. The potential discrepancy in effectiveness and efficacy estimates would depend on the postlicensure study design. We developed a mathematical model to assess the impact of indirect benefits on vaccine effectiveness as measured by the common cohort study design under scenarios of homogenous and heterogenous vaccine allocation. We found that under the cohort design, effectiveness estimates equaled efficacy if either the indirect effects were assumed to be negligible or vaccine allocation in the community was homogenous. However, in presence of indirect benefits, effectiveness estimates would be biased upward compared with vaccine efficacy if one of the two sub-populations in the same study had a higher rate of vaccination. Because of indirect effects of vaccination, even in studies where other biases can be eliminated, the presence of distinct sub-populations with varying rates of vaccination can lead to discrepancies between effectiveness and efficacy estimates.

Vaccine
Volume 28, Issue 50 pp. 7825-8048 (23 November 2010)
http://www.sciencedirect.com/science/journal/0264410X

Regular papers
Examining attitudes and knowledge about HPV and cervical cancer risk among female clinic attendees in Johannesburg, South Africa Original Research Article  Pages 8026-8032
Shelley A. Francis, Jennifer Nelson, Joan Liverpool, Soji Soogun, Nokuthula Mofammere, Roland J. Thorpe Jr.

Abstract
Developing countries account for 85% of the nearly 500,000 yearly cases of cervical cancer worldwide with approximately 250,000 deaths occurring in Sub-Saharan Africa, South Asia, and Latin America. In South Africa, cervical cancer is the 3rd leading cause of death among women. Although cervical cancer can be screened for with regular Pap tests, access to preventive screenings may be nearly non-existent in resource poor settings that have limited public health infrastructure and where women may lack basic health education. Therefore, it is important to understand women’s attitudes, knowledge, and beliefs about HPV, cervical cancer, and the HPV vaccine, and assess their access to preventive screening in order to mitigate their risk for developing the disease.

Eighty-six women, ages 18–44 with at least one child who presented at an antenatal clinic in a township in Johannesburg were recruited to complete a brief questionnaire. Using both descriptive and multivariate statistics, we assessed knowledge of cervical cancer, HPV, and the vaccine; assessed maternal-child communication about sex and STDs, assessed willingness to vaccinate child; and identified barriers to assessing medical care and the vaccine.

The majority of participants were unfamiliar with HPV and cervical cancer, were concerned about their child’s and their own risk for HPV and cervical cancer, faced numerous barriers to accessing screening, and were willing to vaccinate their child. Our findings indicate that women in developing countries need increased access to screening and education about HPV and cervical cancer prevention.

Vaccines_The Week in Review_15 November 2010

This is the pdf document version compiling  individual posts below on this date.

American Public Health Association (APHA) Annual Conference attendees voted 82% to 18% in support of the APHA position statement titled “Annual Influenza Vaccination Requirements for Health Workers.” According to an APHA officer, the vote indicates “broad support across the organization and its state affiliates beyond the explicit endorsement by 11 of 27 Sections.”  The position statement calls for “institutional, employer, and public health policy to require influenza vaccination of all health workers as a precondition of employment and thereafter on an annual basis, unless a medical contraindication recognized in national guidelines is documented in the worker’s health record.”

WHO reported that “risk of further international spread of the ongoing polio outbreak in Central Asia and the North Caucasus Federal Region in Russia continues to be high.” In Central Asia, genetic sequencing of the poliovirus isolated from a child paralyzed in Kazakhstan on 12 August 2010 has confirmed ongoing circulation of the virus which caused the Tajikistan outbreak and subsequently spread to the Russian Federation, Turkmenistan and possibly Uzbekistan. In the Russian Federation, the detection of an additional case of polio with onset on 25 September in the Republic of Dagestan confirms ongoing poliovirus transmission in the North Caucasus Federal Region.

WHO said that countries at risk of poliovirus importation from Central Asia or the North Caucasus Federal Region of the Russian Federation “should continue to strengthen surveillance for AFP cases, ensure processing of all specimens at a WHO-accredited poliovirus laboratory, maintain high routine immunization coverage against polio, and conduct supplementary OPV immunization activities as needed to close gaps in population immunity.” As per recommendations in the WHO’s International Travel and Health guidelines, travelers to and from polio-affected countries should be fully protected by vaccination. Travelers who have in the past received three or more doses of OPV should be offered another dose of polio vaccine before departure. Any unimmunized individuals intending to travel to a polio-infected area should have a complete course of polio vaccination. Travelers from polio-affected areas should have a full course of vaccination against polio before leaving, with a minimum one dose of OPV before departure.

http://www.who.int/csr/don/2010_11_13/en/index.html

The Bill & Melinda Gates Foundation announced 65 grants of US$100,000 each “to pursue bold ideas for transforming health in developing countries“ as part of its Grand Challenges Explorations program, a five-year, $100 million initiative to promote innovation in global health. The current grantees “were selected from more than 2,400 proposals. A wide range of disciplines are represented, including applicants from traditional life sciences, public health, engineering, math and computer sciences. They are based at universities, research institutes, hospitals, nonprofit organizations, and private companies around the world.” Funded projects in the vaccine area include:

– Michael Chan of the Ohio State Research Foundation will develop a safe strain of the Tuberculosis bacterium and use it to ferment beans used in the traditional Asian dish natto, which could then be eaten as an oral TB vaccine;

– Ali Salanti of the University of Copenhagen in Denmark will develop and test a vaccine combining a novel placental malaria vaccine candidate with the cervical cancer vaccine, with the potential of inducing a strong protective response against both diseases;

– Steven Meshnick and Carla Hand of the University of North Carolina will develop a biodegradable “synthetic lymph node” that could be placed under the skin to deliver more effective vaccines.

http://www.gatesfoundation.org/press-releases/Pages/gce-round-five-winners-101109.aspx

The IFPMA (International Federation of Pharmaceutical Manufacturers & Associations) published its 2010 “Status Report on Pharmaceutical Industry R&D for Diseases of the Developing World.” The report “highlights the increasing efforts of IFPMA member companies, working with partners or alone, to develop medicines and vaccines for the 10 diseases of the developing world (DDW) prioritized by the TDR tropical disease research and training organization.”  The 10 diseases are, in order of decreasing mortality: tuberculosis, malaria, human African trypanosomiasis (sleeping sickness), leishmaniasis, dengue, onchocerciasis (River blindness), American trypanosomiasis (Chagas disease), schistosomiasis, leprosy and lymphatic filariasis.

IFPMA said the number of DDW medicine and vaccine projects undertaken by IFPMA companies “has increased from 84 in 2009 to a total of 102 this year. The number of tuberculosis projects grew from 25 to 31 and malaria projects from 34 to 41, while projects for the remaining eight tropical diseases increased from 25 to 30.”
Mr. Haruo Naito, President of the IFPMA and President & CEO of Eisai Co., Ltd., speaking at the IFPMA Assembly in Washington DC, said, “This latest Developing World Disease R&D Status Report shows that our industry is serious about helping to address human diseases, including those which otherwise risk being neglected because they affect poor countries. In October, the Director General of the World Health Organization called on companies to help improve access to medicines for neglected tropical diseases – and IFPMA companies responded with significant new or expanded donation programs. Today, we see that our companies are also equally committed to help develop new medicines and vaccines for these diseases. The latest report also shows that industry is not alone in its R&D efforts, for nearly four out of five DDW research projects are undertaken in cooperation with non-industry partners…”  http://www.ifpma.org/News/NewsReleaseDetail.aspx?nID=13810

The Weekly Epidemiological Record (WER) for 12 November 2010, vol. 85, 46 (pp 453–460) includes: Meeting of the WHO working group on polymerase chain reaction protocols for detecting subtype influenza A viruses – Geneva, June 2010; Fourth meeting of National Influenza Centres in the WHO Western Pacific Region – May 2010.

http://www.who.int/entity/wer/2010/wer8546.pdf

The Lancet
Nov 13, 2010  Volume 376  Number 9753  Pages 1617 – 1710
http://www.thelancet.com/journals/lancet/issue/current

Research priorities for malaria elimination
Kevin Marsh

Preview
The Lancet’s four-paper Series examines the need for, and prospects of, malaria elimination. The papers make sobering reading. Elimination will be hard work, it will take a long time, and it will be expensive. Moreover, elimination requires that we first control malaria to the point where it is no longer a public health problem, and this is by far the most important, immediate target for increased and sustained international investment.1 Nonetheless, elimination (and eventually eradication) is still important as a long-term goal, both for countries that are currently or will shortly be in a position to consider it, and worldwide.

The Lancet
Nov 13, 2010  Volume 376  Number 9753  Pages 1617 – 1710
http://www.thelancet.com/journals/lancet/issue/current

World Report
Defrauding of the Global Fund gives Sweden cold feet
Ann Danaiya Usher

Sweden has withheld its pledge to the Global Fund because of concerns about the misuse of US$25 million in grants in four African countries. Ann Danaiya Usher reports. At the third pledging round of the Global Fund to Fight AIDS, Tuberculosis and Malaria in New York, Sweden’s AIDS Ambassador Anders Nordström surprised the gathering by announcing that Sweden would not be making a pledge. The decision is a response to findings by the Global Fund’s Office of the Inspector General, which has identified cases of misappropriated grant money in Cameroon, Mauritania, Mali, and Zambia.

The Lancet
Nov 13, 2010  Volume 376  Number 9753  Pages 1617 – 1710
http://www.thelancet.com/journals/lancet/issue/current

Comment
Poliomyelitis eradication: another step forward
Nigel W Crawford, Jim P Buttery

Preview
In The Lancet today, Roland Sutter and colleagues1 provide randomised data for a new combination bivalent type 1 and 3 oral poliovirus vaccine (bOPV) in India. This vaccine will be important for the poliomyelitis endgame, which formally began in 1988 when the World Health Assembly outlined plans for worldwide poliomyelitis eradication by 2000.2 With four endemic poliomyelitis countries remaining (India, Pakistan, Afghanistan, and Nigeria) and with intermittent epidemics worldwide, this goal remains elusive.

The Lancet
Nov 13, 2010  Volume 376  Number 9753  Pages 1617 – 1710
http://www.thelancet.com/journals/lancet/issue/current

Articles
Immunogenicity of bivalent types 1 and 3 oral poliovirus vaccine: a randomised, double-blind, controlled trial
Roland W Sutter, T Jacob John, Hemant Jain, Sharad Agarkhedkar, Padmasani Venkat Ramanan, Harish Verma, Jagadish Deshpande, Ajit Pal Singh, Meghana Sreevatsava, Pradeep Malankar, Anthony Burton, Arani Chatterjee, Hamid Jafari, R Bruce Aylward

Summary
Background
Poliovirus types 1 and 3 co-circulate in poliomyelitis-endemic countries. We aimed to assess the immunogenicity of a novel bivalent types 1 and 3 oral poliovirus vaccine (bOPV).

Methods
We did a randomised, double-blind, controlled trial to assess the superiority of monovalent type 2 OPV (mOPV2), mOPV3, or bOPV over trivalent OPV (tOPV), and the non-inferiority of bivalent vaccine compared with mOPV1 and mOPV3. The study was done at three centres in India between Aug 6, 2008, and Dec 26, 2008. Random allocation was done by permuted blocks of ten. The primary outcome was seroconversion after one monovalent or bivalent vaccine dose compared with a dose of trivalent vaccine at birth. The secondary endpoints were seroconversion after two vaccine doses compared with after two trivalent vaccine doses and cumulative two-dose seroconversion. Parents or guardians and study investigators were masked to treatment allocation. Because of multiple comparisons, we defined p≤0·01 as statistically significant. This trial is registered with Current Controlled Trials, ISRCTN 64725429.

Results
900 newborn babies were randomly assigned to one of five vaccine groups (about 180 patients per group); of these 70 (8%) discontinued, leaving 830 (92%) for analysis. After the first dose, seroconversion to poliovirus type 1 was 20% for both mOPV1 (33 of 168) and bOPV (32 of 159) compared with 15% for tOPV (25 of 168; p>0·01), to poliovirus type 2 was 21% (35 of 170) for mOPV2 compared with 25% (42 of 168) for tOPV (p>0·01), and to poliovirus type 3 was 12% (20 of 165) for mOPV3 and 7% (11 of 159) for bOPV compared with 4% (7 of 168) for tOPV (mOPV3 vs tOPV p=0·01; bOPV vs tOPV; p>0·01). Cumulative two-dose seroconversion to poliovirus type 1 was 90% (151 of 168) for mOPV1 and 86% (136 of 159) for bOPV compared with 63% (106 of 168) for tOPV (p<0·0001), to poliovirus type 2 was 90% (153 of 170) for mOPV2 compared with 91% (153 of 168) for tOPV (p>0·01), and to poliovirus type 3 was 84% (138 of 165) for mOPV3 and 74% (117 of 159) for bOPV compared with 52% (87 of 168) for tOPV (p<0·0001). The vaccines were well tolerated. 19 serious adverse events occurred, including one death; however, these events were not attributed to the trial interventions.

Interpretation
The findings show the superiority of bOPV compared with tOPV, and the non-inferiority of bOPV compared with mOPV1 and mOPV3.

Funding: GAVI Alliance, World Health Organization, and Panacea Biotec.

Nature
Volume 468 Number 7321 pp133-340  11 November 2010
http://www.nature.com/nature/current_issue.html

News
Vaccine offers meningitis hope
First affordable and effective weapon against killer meningococcal meningitis A rolled out in Africa.
Declan Butler

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 49 pp. 7713-7824 (16 November 2010)

Regular Papers
Forecasting the economic value of an Enterovirus 71 (EV71) vaccine
Original Research Article
Pages 7731-7736
Bruce Y. Lee, Angela R. Wateska, Rachel R. Bailey, Julie H.Y. Tai, Kristina M. Bacon, Kenneth J. Smith

Abstract

Enterovirus 71 (EV71) is a growing public health concern, especially in Asia. A surge of EV71 cases in 2008 prompted authorities in China to go on national alert. While there is currently no treatment for EV71 infections, vaccines are under development. We developed a computer simulation model to determine the potential economic value of an EV71 vaccine for children (<5 years old) in China. Our results suggest that routine vaccination in China (EV71 infection incidence ≈0.04%) may be cost-effective when vaccine cost is $25 and efficacy ≥70% or cost is $10 and efficacy ≥50%. For populations with higher infection risk (≥0.4%), a $50 or $75 vaccine would be highly cost-effective even when vaccine efficacy is as low as 50%.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 49 pp. 7713-7824 (16 November 2010)

Regular Papers
Public vaccination programmes against hepatitis B in The Netherlands: Assessing whether a targeted or a universal approach is appropriate
Original Research Article
Pages 7723-7730
Hans Houweling, Christiaan F.W. Wittevrongel, Marcel Verweij, E. Joost Ruitenberg and on behalf of the National Immunisation Programme Review Committee of the Health Council of the Netherlands

Abstract
To date, the policy to control hepatitis B in the Netherlands is to vaccinate specific risk groups, rather than all children. Low incidence of the disease has fueled debate whether such a targeted vaccination strategy or rather a universal strategy, as recommended by the World Health Organization, is appropriate. The standard framework for assessing whether a particular vaccination should be included in a public programme, as recently proposed by the Health Council of the Netherlands (HCN), was applied to the various options for hepatitis B vaccination. This framework includes seven selection criteria, grouped under five thematic headings: seriousness and extent of the disease burden, effectiveness and safety of the vaccination, acceptability of the vaccination, efficiency of the vaccination, and priority of the vaccination. From about 1990 the disease burden has stayed more or less the same over time and careful assessment has made it clear that the targeted approach has failed to reach a significant part of the risk groups. Models suggest that the public health benefits obtained through targeted programmes could be augmented considerably by universal vaccination. Based on the assessment that universal vaccination means better protection for high-risk groups as well as the whole population, the HCN calls for universal immunisation, even though hepatitis B to a large extent is limited to specific high-risk groups. Should the Netherlands adopt universal vaccination, several immunisation programmes targeted to high-risk groups will, however, remain of crucial importance for years to come.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 49 pp. 7713-7824 (16 November 2010)

Peruvian FSWs: Understanding HPV and barriers to vaccination

Original Research Article
Pages 7743-7747
Brandon Brown, Cesar Carcamo, Magaly M. Blas, Maria Valderrama, Neal Halsey

Abstract
Vaccine acceptability and vaccine-related knowledge data were collected from female sex workers (FSWs) in Lima, Peru to determine their awareness of HPV and barriers to the potential acceptability of HPV vaccine. FSWs were found to have low knowledge of HPV, HPV vaccine, and cervical cancer. Due to high reported sexual exposure, FSWs are likely at increased risk of cervical cancer, and should have access to HPV vaccine. FSWs should be targeted for HPV education campaigns and barriers to vaccination should be addressed. Future studies should assess HPV prevalence in this population and examine retention issues for vaccine dose completion.