Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 48 pp. 7577-7712 (10 November 2010)

Editorial
World Pneumonia Day: Fighting pneumonia with safe and affordable vaccines
Pages 7577-7578
Ron Dagan, Gregory Poland

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 48 pp. 7577-7712 (10 November 2010)

Meeting Report
Report of the international forum on pandemic influenza 2010: Qingdao, China, 24–25 July 2010
Pages 7579-7582
Andre Varella

The 2009 H1N1 influenza pandemic is the first pandemic to hit the world in the 21st century. According to World Health Organization (WHO) reports, as of 18 July 2010, more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, and over 18,336 people have died as a result of the disease [1]. In an effort to facilitate the exchange of strategic and operational experience in the fight against the pandemic, the Chinese Center for Disease Control and Prevention (China CDC), supported by the China Ministry of Health, in collaboration with WHO, the World Bank, the U.S. CDC, and co-organised with the Elsevier Publishing Group, hosted the International Forum on Pandemic Influenza 2010 in July. The two-day meeting, attended by over 600 international delegates, saw human health and animal health professionals discuss the current situation of the pandemic, the global response and vaccination strategies, pandemic surveillance and preparedness, and the animal–human interface in influenza and other emerging infectious diseases. A summary of the discussions is presented here.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 48 pp. 7577-7712 (10 November 2010)

Review
Summary of invasive pneumococcal disease burden among children in the Asia-Pacific region

Review Article
Pages 7589-7605
Tzou-Yien Lin, Nitin K. Shah, Dennis Brooks, Carmen S. Garcia

Abstract
Invasive pneumococcal disease (IPD) burden is significant in the Asia-Pacific region. This review describes the epidemiology and Streptococcus pneumoniae (SP) serotype distribution of IPD in children in the Asia-Pacific region from studies published from 1999 to 2010. IPD incidence varies widely in Asia-Pacific countries depending on the method of surveillance, the population studied, and the time period. Incidences are highest for younger children, with rates near 100–200 cases per 100,000 children aged <1 or 2 years. Incidences of preventable disease are estimated to be 6–200 cases per 100,000. Heptavalent pneumococcal conjugate vaccine (PCV7) serotype coverage shows a very wide range over the Asia-Pacific region. Ten countries have high vaccine serotype coverage (>70%), and six countries have low vaccine serotype coverage (<50%). The majority of SP serotypes in children with IPD in most countries in the Asia-Pacific region are susceptible to penicillin (intermediate and resistant <50%); a few countries have SP serotypes with high level resistance to penicillin (intermediate and resistant >50%). Japan, Taiwan, and Thailand have high PCV7 serotype coverage. Countries with low pneumococcal resistance to antimicrobials have shown increasingly higher nonsusceptibility with time. National vaccination programmes that include PCV7, 10-valent pneumococcal conjugate vaccine (PCV), or 13-valent PCV would significantly affect IPD burden in children aged <5 years in the Asia-Pacific region, as well as the burden of penicillin-nonsusceptible IPD.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 28, Issue 48 pp. 7577-7712 (10 November 2010)

Regular Papers
Cost-effectiveness of dual influenza and pneumococcal vaccination in 50-year-olds

Original Research Article
Pages 7620-7625
Kenneth J. Smith, Bruce Y. Lee, Mary Patricia Nowalk, Mahlon Raymund, Richard K. Zimmerman

Abstract
Influenza vaccination is now recommended for all ages; CDC pneumococcal polysaccharide vaccination (PPV) recommendations are comorbidity-based in nonelderly patients. We constructed a Markov model to estimate the cost-effectiveness of dual influenza and pneumococcal vaccination in 50-year-olds. Patients were followed for 10 years, with differing time horizons examined in sensitivity analyses. With 100% vaccine uptake, dual vaccination cost $37,700/QALY gained compared to a CDC recommendation strategy; with observed vaccine uptake, dual vaccination cost $5,300/QALY. Results were sensitive to shorter time horizons, favoring CDC recommendations. We found dual vaccination of all 50-year-olds economically reasonable. Shorter duration models may not fully account for PPV effectiveness.

Vaccine
Volume 28, Issue 48 pp. 7577-7712 (10 November 2010)

Public health and economic impact of the 13-valent pneumococcal conjugate vaccine (PCV13) in the United States

Original Research Article
Pages 7634-7643
Jaime L. Rubin, Lisa J. McGarry, David R. Strutton, Keith P. Klugman, Stephen I. Pelton, Kristen E. Gilmore, Milton C. Weinstein

Abstract
The 7-valent pneumococcal conjugate vaccine (PCV7) has dramatically decreased pneumococcal disease incidence, and the 13-valent vaccine (PCV13) protects against 6 additional Streptococcus pneumoniae serotypes. A decision-analytic model was constructed to evaluate the impact of infant vaccination with PCV13 versus PCV7 on pneumococcal disease incidence and mortality as well as the incremental benefit of a serotype catch-up program. PCV13 effectiveness was extrapolated from observed PCV7 data, using assumptions regarding serotype prevalence and PCV13 protection against additional serotypes. The model predicts that PCV13 is more effective and cost saving compared with PCV7, preventing 106,000 invasive pneumococcal disease (IPD) cases and 2.9 million pneumonia cases, and saving $11.6 billion over a 10-year period. The serotype catch-up program would prevent an additional 12,600 IPD cases and 404,000 pneumonia cases, and save an additional $737 million compared with no catch-up program.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X

Importance of vaccination habit and vaccine choice on influenza vaccination among healthy working adults

Original Research Article
Pages 7706-7712
Chyongchiou J. Lin, Mary Patricia Nowalk, Seth L. Toback, Matthew D. Rousculp, Mahlon Raymund, Christopher S. Ambrose, Richard K. Zimmerman

Abstract
This randomized cluster trial was designed to improve workplace influenza vaccination rates using enhanced advertising, choice of vaccine type (intranasal or injectable) and an incentive. Workers aged 18–49 years were surveyed immediately following vaccination to determine factors associated with vaccination behavior and choice. The questionnaire assessed attitudes, beliefs and social support for influenza vaccine, demographics, and historical, current, and intentional vaccination behavior. Of the 2389 vaccinees, 83.3% received injectable vaccine and 16.7% received intranasal vaccine. Factors associated with previous influenza vaccination were older age, female sex, higher education and greater support for injectable vaccine (all P < .02). Current influenza vaccination with intranasal vaccine vs. injectable vaccine was associated with higher education, the study interventions, greater support for the intranasal vaccine and nasal sprays, less support of injectable vaccine, more negative attitudes about influenza vaccine, and a greater likelihood of reporting that the individual would not have been vaccinated had only injectable vaccine been offered (all P < .01). Intentional vaccine choice was most highly associated with previous vaccination behavior (P < .001). A key to long term improvements in workplace vaccination is to encourage first time influenza vaccination through interventions that include incentives, publicity and vaccine choice.

Vaccines_The Week in Review_8 November 2010

THis is the pdf version compiling  individual posts for this date.

The WHO reported that “an acute outbreak of poliomyelitis is occurring in the Republic of Congo, with 120 cases of acute flaccid paralysis and 58 deaths. Half the cases have been reported in the past ten days, with the first case occurring in early October. Two cases have been confirmed to have been caused by wild poliovirus type 1 and laboratory testing continues.” The report notes that most cases are in young adults: among those cases for which age data is available (43) at this time, 33 are between the ages of 15-25 years. Only one is under five years old, three are between 7 and 13 and five are between 26 and 58.

WHO said the outbreak is due to imported poliovirus. Congo had recorded its last case of indigenous polio in 2000. Investigations are ongoing to determine definitively the origins of the virus. The Government of Congo has alerted the public to the outbreak and launched an emergency response plan, with support from key partners, including WHO, UNICEF and the US CDC. At least three nationwide vaccination campaigns are expected, using monovalent oral polio vaccine and targeting the entire population. The number, geographic extent and target age groups of further campaigns will be determined by the Government based on the evolving epidemiology. It is anticipated that a multi-country campaign will be required to cover bordering at-risk areas. New cases continue to be reported every day.

http://www.who.int/csr/don/2010_11_04a/en/index.html

World Pneumonia Day — November 12, 2010

MMWR Weekly Announcement: November 5, 2010 / 59(43);1413

Pneumonia kills more children than any other illness; among approximately 9 million children aged <5 years who die each year worldwide, 1.6 million die from pneumonia (1). Through the Global Action Plan for Prevention and Control of Pneumonia, the World Health Organization and international partners recommend that the global health burden of pneumonia be reduced by 1) using vaccines against organisms that cause pneumonia, 2) providing appropriate care and treatment for persons who contract pneumonia, and 3) promoting preventive measures such as exclusive breastfeeding of infants during their first 6 months of life (2).

Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib) account for approximately 60% of pneumonia deaths worldwide of children aged 1 month–5 years in countries that do not use pneumococcal or Hib conjugate vaccines (3,4). In the United States, pneumococcal and Hib conjugate vaccines are recommended for infants and children aged <2 years as part of the routine infant immunization schedule and have reduced morbidity and mortality from pneumococcal disease by 76% and from Hib disease by >99% among children aged <5 years (5,6). In 2010, a 13-valent pneumococcal conjugate vaccine was licensed and recommended in the United States. Collaborative international efforts are expanding use of these vaccines in developing countries (7).

Respiratory viruses, such as respiratory syncytial virus (RSV), influenza, and measles, also are major causes of pneumonia globally. In 2005, an estimated 33.8 million episodes of RSV-associated acute lower respiratory infection occurred in children aged <5 years worldwide (8). Recent studies suggest that 6%–10% of childhood pneumonia is associated with influenza (9,10). Use of influenza and measles vaccines, antiviral medications, and supportive health care can reduce the burden of pneumonia caused by these viruses.

To raise awareness of the effects of pneumonia globally, the second annual World Pneumonia Day, November 12, 2010, is being promoted by a coalition of more than 100 major health, humanitarian relief, advocacy, faith-based, government, and other organizations; CDC and UNICEF are providing technical assistance. Events are scheduled at CDC and elsewhere in the United States and other countries. Additional information is available at http://worldpneumoniaday.org

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5943a6.htm?s_cid=mm5943a6_w

The Weekly Epidemiological Record (WER) for 5 November 2010, vol. 85, 45 (pp 445–452) includes: Outbreaks following importations of wild poliovirus into countries of the WHO African, European and South-East Asian Regions: January 2009 – September 2010

http://www.who.int/entity/wer/2010/wer8545.pdf

The MMWR for November 5, 2010 / Vol. 59 / No. 43 includes:

– Outbreaks Following Wild Poliovirus Importations — Europe, Africa, and Asia, January 2009–September 2010

– Cholera Outbreak — Haiti, October 2010

– Notes from the Field: Malaria Imported from West Africa by Flight Crews — Florida and Pennsylvania, 2010

– Announcement: World Pneumonia Day — November 12, 2010
http://www.cdc.gov/mmwr/PDF/wk/mm5943.pdf

Human Vaccines
Volume 6, Issue 11  November 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/10/

Meeting Report
The global pertussis initiative: Meeting report from the regional Latin America meeting, Costa Rica, 5-6 December, 2008
Rolando Ulloa-Gutierrez, Daniela Hozbor, Maria L. Avila-Aguero, Jaime Caro, Carl-Heinz Wirsing von König, Tina Tan and Stanley Plotkin

Abstract
Pertussis remains endemic across the world, with an estimated 279,000 deaths in 2002, the majority in infants under 1 year of age. Worldwide epidemiologic data indicates increasing infection rates in older children and adults, which act as a source of infection to young infants. The Global Pertussis Initiative (GPI) is an expert scientific forum, which has published consensus recommendations for the monitoring, prevention, and treatment of the disease. This paper reports the proceedings of a regional meeting, held in Costa Rica in December 2008. The meeting gathered information on regional epidemiological, diagnostic capabilities and the ability to introduce GPI recommended vaccine strategies in Latin America. The capacity of Latin American countries to conduct vaccination programs is high and there is considerable government support. Whole-cell pertussis vaccines are used across Latin America, which appear to be quite effective. A 4-dose schedule is typically used (2, 4, 6, and 18 months), and a booster given at 4 to 6 years of age, with coverage often above 90%, but with regions of low coverage due to political and geographical difficulties. Adequate surveillance is lacking in many countries, giving insufficient data to guide vaccination policy. Improvements are being made, with countries such as Costa Rica, Panama, and Argentina introducing polymerase chain reaction (PCR) diagnosis. Those countries that do not currently use a preschool booster should launch one. Implementing vaccination programs in adolescents and/or adults to reduce exposure to infants would be beneficial and possible in most countries, given their current infrastructure.

Human Vaccines
Volume 6, Issue 11  November 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/10/

Commentaries
Assessment of HPV vaccines: From the burden of disease to the Health Technology Assessment approach
Giuseppe La Torre

Human Vaccines
Volume 6, Issue 11  November 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/10/

Why it is still important that countries know the burden of pneumococcal disease

Rosa Prato, Silvio Tafuri, Francesca Fortunato and Domenico Martinelli

Pneumococcal diseases are a major public health problem worldwide. WHO estimates about 1.6 million of annual deaths, mostly in infants, elderly and immunocompromised individuals. Data on the burden of pneumococcal diseases are still limited but information on serotypes circulation and epidemiological pattern of diseases are essential to assess the impact of old and new vaccines. The 23-valent pneumococcal polysaccharide vaccine is recommended in the elderly in many industrialized countries. The 7-valent polysaccharide-protein conjugate vaccine is introduced into routine infant immunization programs of several countries; it is modifying the epidemiology of invasive pneumococcal diseases (IPD) in the population, including adults of all ages. The 10-valent pneumococcal conjugate vaccine is licensed for active immunization of infants and children from 6 weeks up to 2 years of age but it does not contain the emergent 19A serotype. The 13-valent pneumococcal conjugate vaccine is an evolution of the 7-valent and currently addresses the overall need for a broader serotypes coverage. Vaccine manufacturers must continue to further develop pneumococcal vaccines covering the majority of the circulating serotypes in all age groups. Vaccination appears to be the only public health action that could reduce the impact of IPD.

Human Vaccines
Volume 6, Issue 11  November 2010
http://www.landesbioscience.com/journals/vaccines/toc/volume/6/issue/10/

Marking Nov 12, 2010 – World Pneumonia Day: Where are we, where are vaccines?
Ron Dagan, Ciro A. de Quadros, Javier Garau, Keith P. Klugman, Najwa Khuri-Bulos, Orin Levine, Samba Sow and Yonghong Yang

Infectious diseases such as smallpox, pneumonia, rotavirus, malaria and measles have inflicted untold pain, suffering and death on the human population. The fingerprints of these deadly diseases can be found across the pages of history. The harrowing effects of pneumonia on the human body were described by Hippocrates as early as 460 B.C.;1 smallpox scarring can be found on Egyptian mummies dating back more than 3,000 years ago;2 and the Persian philosopher and physician Rhazes detailed the devastation of measles in the 10 century A.D.3 Without the benefits of modern medical interventions, our ancestors had little to no defense against infectious disease, and mortality rates were staggering. In 1531, for example, measles was responsible for the death of half the population of Honduras.4 Furthermore, some historical estimates indicate case fatality rates as high as 90 percent during smallpox epidemics among Native American populations in the early part of the 15th century.5

Yet as science advanced, humanity developed defenses against infectious disease in the form of lifesaving interventions, including vaccines, medical products (e.g., bed nets), therapeutics, and behavioral interventions.6 Across the developed world, these interventions quickly turned the tide against infectious disease. In the United States, infectious disease mortality declined 95 percent during the first 8 decades of the 20th century, from 797 deaths per 100,000 in 1900 to 36 deaths per 100,000 in 1980.7 The success of vaccination programs in the United States and Europe ushered in the 20th-century the concept of “disease eradication”—the idea that a specific disease could be eliminated from the planet. In 1977, after a decade-long campaign involving 33 nations, smallpox was eradicated worldwide—approximately ten years after it had been eradicated from the United States and the rest of the Western Hemisphere.8 But for millions living in the world’s poor and developing countries, it is as if these live-saving interventions were never developed.

The World Bank defines developing countries as those making less than US $11,905 gross national income per capita per year. People living in developing countries make up more than 80 percent of the world’s population.9 A child born in a developing country faces many of the same risks her ancestors did 1,000 years ago. She is 237 times more likely to die of Hib disease than a child born to parents living in a high-income country.10 She’s also 118 times more likely to die from rotavirus diarrhea,11 89 times more likely to die from pneumococcal disease,10 57 times more likely to die from HIV/AIDS,12 and 29 times more likely to die from tuberculosis.12 For such children, life-saving medical interventions are few and far between. That is why child mortality rates in the developing world remain as high as 60 times those in developed countries,13 and life expectancies are shorter by almost a quarter century.14

Journal of Infectious Diseases
1 December 2010  Volume 202, Number 11
http://www.journals.uchicago.edu/toc/jid/current

Editorial Commentaries
A Paradigm for the Control of Influenza [free full-text]
Edward B. Lewin

The Lancet
Nov 06, 2010  Volume 376  Number 9752  Pages 1513 – 1616
http://www.thelancet.com/journals/lancet/issue/current

Comment
Malaria elimination: worthy, challenging, and just possible
Pam Das, Richard Horton
Preview
“I have been astonished by colleagues who have suggested that smallpox eradication must have been easy…some with more grandiose dreams have argued that a whole new vista for public health has opened—the eradication of many diseases…At this time, I don’t believe we have either the technology or the commitment to pursue another eradication goal.”D A Henderson, 20091

Call to action: priorities for malaria elimination
Richard GA Feachem, Allison A Phillips, Geoffrey A Targett, Robert W Snow
Preview
The Lancet’s four-part Series on malaria elimination summarises the remarkable progress achieved over the past 100 years and discusses the substantial technical, operational, and financial challenges that confront malaria-eliminating countries.1–4 The Series comes at a time when there are increased resources to combat malaria worldwide. A three-part strategy to achieve malaria eradication has been developed and is widely endorsed: aggressive control in high-burden regions; progressive elimination from endemic margins to shrink the malaria map; and research and development, to develop new tools and techniques.

Series
Shrinking the malaria map: progress and prospects
Richard GA Feachem, Allison A Phillips, Jimee Hwang, Chris Cotter, Benjamin Wielgosz, Brian M Greenwood, Oliver Sabot, Mario Henry Rodriguez, Rabindra R Abeyasinghe, Tedros Adhanom Ghebreyesus, Robert W Snow

Ranking of elimination feasibility between malaria-endemic countries
Andrew J Tatem, David L Smith, Peter W Gething, Caroline W Kabaria, Robert W Snow, Simon I Hay

Operational strategies to achieve and maintain malaria elimination
Bruno Moonen, Justin M Cohen, Robert W Snow, Laurence Slutsker, Chris Drakeley, David L Smith, Rabindra R Abeyasinghe, Mario Henry Rodriguez, Rajendra Maharaj, Marcel Tanner, Geoffrey Targett

Costs and financial feasibility of malaria elimination
Oliver Sabot, Justin M Cohen, Michelle S Hsiang, James G Kahn, Suprotik Basu, Linhua Tang, Bin Zheng, Qi Gao, Linda Zou, Allison Tatarsky, Shahina Aboobakar, Jennifer Usas, Scott Barrett, Jessica L Cohen, Dean T Jamison, Richard GA Feachem

Nature Medicine
November 2010, Volume 16 No 11
http://www.nature.com/nm/index.html

News
The new age of global health governance holds promise
Tikki Pang, Nils Daulaire, Gerald Keusch, Rose Leke, Peter Piot, Srinath Reddy, Andrzej Rys & Nicole Szlezak

The recognition that many diseases present worldwide challenges has spurred nations and institutions to participate in the development of what is known as ‘global health governance’. But this new form of governance will only succeed with strengthened country commitment, collaborations across disparate sectors and improved accountability.

New England Journal of Medicine
November 4, 2010  Vol. 363 No. 19
http://content.nejm.org/current.shtml

Correspondence
Poliovirus Vaccine and Vaccine-Derived Polioviruses

To the Editor:
The Perspective article by Modlin1 and the articles on polio immunization by Mohammed et al.2 and Jenkins et al.3 (June 24 issue) reflect the dilemma of eradication: it cannot be accomplished without discontinuing the use of the oral vaccine that has brought us close to eradication. Oral poliovirus vaccine (OPV) strains inexorably revert to virulence. It has been obvious for years that inactivated poliovirus vaccine (IPV) prevents paralysis caused by the passage of poliovirus through the blood to the central nervous system. The article by Mohammed et al. shows that IPV also could be used economically. The article also shows that the serum antibody titer has an inverse effect on the intestinal excretion of poliovirus; this would have been even clearer had the investigators obtained samples later than 1 week after challenge. The authors advocate the development of an IPV based on Sabin strains, although it is likely to be more expensive because of the need for higher antigen content. Also, if the strains used to make IPV escape from the production facility, they would almost certainly revert to virulence. Another solution is to use combination vaccines containing diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, and IPV components in developing countries.

Stanley A. Plotkin, M.D.
University of Pennsylvania, Philadelphia, PA

Pediatrics
November 2010 / VOLUME 126 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

Articles
Association Between Medicaid Reimbursement and Child Influenza Vaccination Rates
Byung-Kwang Yoo, MD, PhDa, Andrea Berry, MSa, Megumi Kasajima, BSa, Peter G. Szilagyi, MD, MPHb
Departments of a Community and Preventive Medicine and
b Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York

OBJECTIVE We examined associations between influenza vaccination rates and Medicaid reimbursement rates for vaccine administration among poor children who were eligible for Medicaid (<100% of the federal poverty level in all states).

METHODS We analyzed 3 consecutive National Immunization Surveys (NISs) to assess influenza vaccination rates among nationally representative children 6 to 23 months of age during the 2005–2006 (unweighted N = 12 885), 2006–2007 (unweighted N = 9238), and 2007–2008 (unweighted N = 11 785) influenza seasons (weighted N = 3.3–4.0 million per season). We categorized children into 3 income levels (poor, near-poor, or nonpoor). We performed analyses with full influenza vaccination as the dependent variable and state Medicaid reimbursement rates (continuous covariate ranging from $2 to $17.86 per vaccination) and terms with income levels as key covariates.

RESULTS In total, 21.0%, 21.3%, and 28.9% of all US children and 11.7%, 11.6%, and 18.8% of poor children were fully vaccinated in the 2006, 2007, and 2008 NISs, respectively. Multivariate analyses of all 3 seasons found positive significant (all P < .05) associations between state-level Medicaid reimbursement and influenza vaccination rates among poor children. A $10 increase, from $8 per influenza vaccination (the US average) to $18 (the highest state reimbursement), in the Medicaid reimbursement rate was associated with 6.0-, 9.2-, and 6.4-percentage point increases in full vaccination rates among poor children in the 2006, 2007, and 2008 NIS analyses, respectively.

CONCLUSION Medicaid reimbursement rates are strongly associated with influenza vaccination rates.