This pdf version includes al the posts from this date as a single, integrated document:

Vaccines_The Week in Review_31 January 2011

GAVI announced that His Highness Sheikh Mohamed bin Zayed Al Nahyan, the Crown Prince of Abu Dhabi and Deputy Supreme Commander of the UAE Armed Forces, and the Bill & Melinda Gates Foundation entered into a partnership in which each committed US$50 million for immunisation programmes in Afghanistan and Pakistan. Of the total US$ 100 million, GAVI will receive US$66 million to buy and deliver additional supplies of the five-in-one pentavalent vaccine and to support the introduction of new pneumococcal vaccines in Afghanistan. http://www.gavialliance.org/media_centre/press_releases/partnership_for_immunisation.php

British Prime Minister David Cameron said that the United Kingdom would double its current contribution to polio eradication, and called on other donors to back the Global Polio Eradication Initiative. Prime Minister Cameron said: “I passionately believe that we have a once-in-a-lifetime opportunity to rid the world of the evil of polio. We have the vaccines and the tools to do it. All that’s missing is real and sustained political will to see this effort through to the end. That’s why I’m announcing today that the UK is prepared to fully vaccinate an additional 45 million children against polio, through a doubling of our support to the Global Polio Eradication Initiative over the next two years. In return for that commitment, we ask other donors to do their bit, and affected countries to strengthen their routine immunisation programmes. We have come so far in eradicating polio. We are so close to delivering a polio-free world for all our children. Let’s finish the job. And let’s eradicate polio once-and-for-all.”

Bill Gates, speaking at the World Economic Forum in Davos, Switzerland, announced that the Bill & Melinda Gates Foundation has committed an additional $102 million to support efforts to stamp out the disease. “Eliminating the last one percent of polio requires the kind of political leadership shown by the UK government and Prime Minister Cameron today,” Gates said. “Eradicating polio requires innovative thinking and political will, as well as funding from a range of donors, to support an aggressive program that will get the job done.”

The U.K. said its commitment is subject to two conditions which will apply only to the additional £20m each year:

– first, that this additional support is underpinned by increased commitment to strengthen routine immunisation. Routine, country based immunisation programmes are vital to ensuring that polio eradication can be maintained in the future. Countries need to make national health systems capacity a priority now if we expect to maintain eradication in the future.

– second, that our support has the additional effect of leveraging more effort from others in order to broaden and deepen funding through a matching fund basis.

How will the matching basis work? For every $5 pledged by others from 1 January 2011 to 31 December 2012, the UK will increase its support by $1 up to a maximum of the additional £40m announced.

The UK’s challenge aims to help GPEI expand the donor base and strengthen sustainable funding options going into the future and creates an opportunity for others to get involved.

http://www.gatesfoundation.org/press-releases/Pages/uk-government-polio-partnership-110128.aspx

Bill Gates, co-chair of the Bill & Melinda Gates Foundation, commented on polio eradication in Pakistan, said, “We commend the government of Pakistan on its commitment to stop the transmission of the polio virus in Pakistan. In just a year’s time, I have seen the tremendous progress that can take place and I’m confident that with this plan, and the will to carry it out, Pakistan will be able to eliminate polio. This effort is essential to eradicating polio globally.  My colleagues and I are deeply committed to working closely with you to ensure success. The lives and health of children in Pakistan and throughout the world are at stake. We call on the government of Pakistan to hold a special polio summit to assess progress in six months and we stand by Pakistan as its partner in this important cause to rid the world of polio once and for all.”

The Gates Foundation noted that it has pledged more than US$1 billion to the global polio program in the last decade, including more than US$85 million for the eradication program in Pakistan.

http://www.gatesfoundation.org/press-releases/Pages/pakistan-polio-emergency-plan-110124.aspx

WHO said that a Commission on Information and Accountability for Women’s and Children’s Health “will propose a framework for global reporting, oversight and accountability on women’s and children’s health” and “will create a system to track whether donations for women’s and children’s health are made on time, resources are spent wisely and transparently, and whether the desired results are achieved.”  WHO said the accountability framework proposed by the Commission will:

– track results and resource flows at global and country levels;

– identify a core set of indicators and measurement needs for women’s and children’s health;

– propose steps to improve health information and registration of vital events – births and deaths – in low-income countries, and

– explore opportunities for innovation in information technology to improve access to reliable information on resources and outcomes.

The Commission will report in May 2011. http://www.who.int/topics/millennium_development_goals/accountability_commission/en/index.html

The Malaria Eradication Research Agenda (malERA) initiative announced publication in a supplement to PLoS Medicine, 25 January 2011, of a collection of 12 reviews, comprising three reflective pieces and nine research and development agendas. Pedro L. Alonso, chair of the malERA Steering Committee, commented, “I am delighted to see published this R&D agenda for malaria eradication, after an intense and perhaps unprecedented consultative process that lasted two years and involved more than 250 of the leading scientists in the malaria field and beyond”.

http://www.who.int/malaria/elimination/malera/en/index.html

See PLoS Medicine in Journal Watch below.

The Weekly Epidemiological Record (WER) for 28 January 2011, vol. 86, 5 (pp 37–44) includes: Outbreak news – Yellow fever, Côte d’Ivoire; – Yellow fever, Uganda;

Meeting of the Global Advisory Committee on Vaccine Safety, December 2010; WHO Strategic Advisory Group of Experts (SAGE) on immunization: Request for nominations

http://www.who.int/entity/wer/2011/wer8605.pdf

The MMWR for January 28, 2011 / Vol. 60 / No. 3, includes:
– Updated Recommendations for Use of Meningococcal Conjugate Vaccines — Advisory Committee on Immunization Practices (ACIP), 2010

http://www.cdc.gov/mmwr/pdf/wk/mm6003.pdf

Twitter Watch
A selection of items of interest this week from a variety of twitter feeds from NGOs and other sources.

gatesfoundation Gates Foundation
Blog: Bill Gates on his upcoming annual letter and a new video about #vaccines and #polio: http://bit.ly/ffC4qH

Reuters Reuters Top News
by sabinvaccine
Polio can be all but stopped in 3 years: Bill Gates http://reut.rs/dMryCo

malariacentre LSHTM Malaria Centre
Clinical testing of new molecular method for diagnosis of malaria infections is underway at LSHTM:http://bit.ly/e039aL

whonews WHO News
cy #vaccination campaign against yellow fever outbreak in Cote d’Ivoire http://tinyurl.com/687rjsh #globalhealth #yellowfever

British Medical Journal
29 January 2011 Volume 342, Issue 7791
http://www.bmj.com/content/current

News
Vaccination programme to protect children against pneumonia and diarrhoea needs more funds
Kate Womersley

Extract
Up to one million children’s lives could be saved every year if new vaccines to tackle the causes of pneumonia and diarrhoea were widely available in the developing world, says a report from Save the Children published on 21 January.

Pneumonia and diarrhoea kill more under 5s globally than any other illnesses, accounting for three times more deaths than malaria and HIV combined. The report says that the death toll could be cut by up to one quarter if children were routinely vaccinated against these diseases.

The report charts progress towards achieving the United Nations’ millennium development goals. Its authors found “extraordinary progress” in some countries, with some of the world’s poorest—including Malawi, Nepal, Bolivia, and Bangladesh—being on track to achieve the goal of reducing child mortality by two thirds by 2015.

JAMA
January 26, 2011, Vol 305, No. 4, pp 329-423
http://jama.ama-assn.org/current.dtl

Commentaries
The Promise of Comparative Effectiveness Research
Paul Sullivan, Don Goldmann
JAMA. 2011;305(4):400-401.doi:10.1001/jama.2011.12

[Initial language per JAMA convention]

The American Recovery and Reinvestment Act will provide an unprecedented stimulus for translational and health services research. A $1.1 billion investment in comparative effectiveness research (CER) 1 should produce a torrent of new information about the effectiveness of drugs, technologies, and interventions. For this to result in better, more cost-effective health care, better evidence is needed to address the translational gap between clinical studies and everyday practice. 2 In essence, this is CER for implementation strategies (a type of CER seriously underrepresented in current discourse, but necessary to deliver on the Institute of Medicine’s goals for improved health care quality).

Credit is due to the US Department of Health and Human Services for recognizing this need. Evaluation of the implementation and dissemination strategies for mainstream CER is embedded within several programs funded by the American Recovery and Reinvestment Act that share the broad objective of spreading CER findings widely…

The Lancet
Jan 29, 2011  Volume 377 Number 9763 Pages 353 – 438
http://www.thelancet.com/journals/lancet/issue/current

Comment
Health in southeast Asia
William Summerskill, Richard Horton

Preview
Neglect of human rights that compromises health outcomes, the combination of high population density and domestic livestock that encourages zoonoses, claims over viral sovereignty, and an emphasis on health tourism that creates dual standards of care: too often health in southeast Asia is in the news for the wrong reasons. Today’s Lancet reports good news from the region as well as disappointments, and provides opportunities to improve care locally by analysing how a variety of health systems in different settings within the region are responding to rapid socioeconomic change and shifting threats to health.

The Lancet
Jan 29, 2011  Volume 377 Number 9763 Pages 353 – 438
http://www.thelancet.com/journals/lancet/issue/current

Dengue vaccine prospects: a step forward
Bruno Guy, Jeffrey Almond, Jean Lang

Preview
The worldwide expansion of dengue fever is a growing health problem. Crucial issues surround this global expansion and some of them present some challenges for vaccine development. Nevertheless, several promising approaches are being investigated in both academic and industrial laboratories.1 Vaccine candidates include live, attenuated vaccines obtained via cell passages or by recombinant DNA technology (such as those being developed by the US National Institutes of Allergy and Infectious Diseases, InViragen, Walter Reed Army Institute of Research/GlaxoSmithKline, and Sanofi Pasteur), and subunit vaccines (such as those developed by Merck/Hawaii Biotech).

The Lancet
Jan 29, 2011  Volume 377 Number 9763 Pages 353 – 438
http://www.thelancet.com/journals/lancet/issue/current

Series
Health and health-care systems in southeast Asia: diversity and transitions
Virasakdi Chongsuvivatwong, Kai Hong Phua, Mui Teng Yap, Nicola S Pocock, Jamal H Hashim, Rethy Chhem, Siswanto Agus Wilopo, Alan D Lopez

Southeast Asia is a region of enormous social, economic, and political diversity, both across and within countries, shaped by its history, geography, and position as a major crossroad of trade and the movement of goods and services. These factors have not only contributed to the disparate health status of the region’s diverse populations, but also to the diverse nature of its health systems, which are at varying stages of evolution. Rapid but inequitable socioeconomic development, coupled with differing rates of demographic and epidemiological transitions, have accentuated health disparities and posed great public health challenges for national health systems, particularly the control of emerging infectious diseases and the rise of non-communicable diseases within ageing populations.

The Lancet Infectious Disease
Feb 2011  Volume 11 Number 2  Pages 73 – 152
http://www.thelancet.com/journals/laninf/issue/current

Editorial
A new market to save lives from pneumococcal disease
The Lancet Infectious Diseases

Pneumonia is the world’s leading killer of children younger than 5 years, and is one of the foremost vaccine-preventable killers of children today. Every year, pneumococcal disease kills about 1 million children worldwide. Children younger than 5 years in low-income countries are 89 times more likely to die from pneumococcal disease than are children in high-income countries. In Nicaragua, 20% of children who get pneumococcal disease die, compared with a global average of 18%. Through introduction of an innovative financing mechanism called advance market commitment (AMC), developed by the GAVI Alliance, Nicaragua became the first developing country to introduce a new 13-valent pneumococcal vaccine in December last year, just months after the vaccine was made available in the USA.

The Lancet Infectious Disease
Feb 2011  Volume 11 Number 2  Pages 73 – 152
http://www.thelancet.com/journals/laninf/issue/current

Comment
Immunological correlates of protection for the RTS,S candidate malaria vaccine
Brian Greenwood

Evidence continues to accumulate that the candidate malaria vaccine RTS,S provides substantial, although not complete, protection against malaria in African children. In The Lancet Infectious Diseases today, Olutu and colleagues1 add to this body of evidence, reporting persistence of protection for at least 15 months after vaccination of Kenyan and Tanzanian infants with the RTS,S candidate malaria vaccine formulated with the AS01 adjuvant. There was no evidence for a reduction in efficacy from that reported during the first 8 months of follow-up of this trial (around 50% efficacy).

The Lancet Infectious Disease
Feb 2011  Volume 11 Number 2  Pages 73 – 152
http://www.thelancet.com/journals/laninf/issue/current

Efficacy of RTS,S/AS01E malaria vaccine and exploratory analysis on anti-circumsporozoite antibody titres and protection in children aged 5–17 months in Kenya and Tanzania: a randomised controlled trial

Ally Olotu, John Lusingu, Amanda Leach, Marc Lievens, Johan Vekemans, Salum Msham, Trudie Lang, Jayne Gould, Marie-Claude Dubois, Erik Jongert, Preeti Vansadia, Terrell Carter, Patricia Njuguna, Ken O Awuondo, Anangisye Malabeja, Omar Abdul, Samwel Gesase, Neema Mturi, Chris J Drakeley, Barbara Savarese, Tonya Villafana, Didier Lapierre, W Ripley Ballou, Joe Cohen, Martha M Lemnge, Norbert Peshu, Kevin Marsh, Eleanor M Riley, Lorenz von Seidlein, Philip Bejon

Summary

Background

RTS,S/AS01E is the lead candidate malaria vaccine. We recently showed efficacy against clinical falciparum malaria in 5—17 month old children, during an average of 8 months follow-up. We aimed to assess the efficacy of RTS,S/AS01E during 15 months of follow-up.

Methods

Between March, 2007, and October, 2008, we enrolled healthy children aged 5—17 months in Kilifi, Kenya, and Korogwe, Tanzania. Computer-generated block randomisation was used to randomly assign participants (1:1) to receive three doses (at month 0, 1, and 2) of either RTS,S/AS01E or human diploid-cell rabies vaccine. The primary endpoint was time to first clinical malaria episode, defined as the presence of fever (temperature ≥37·5°C) and a Plasmodium falciparum density of 2500/μL or more. Follow-up was 12 months for children from Korogwe and 15 months for children from Kilifi. Primary analysis was per protocol. In a post-hoc modelling analysis we characterised the associations between anti-circumsporozoite antibodies and protection against clinical malaria episodes. This study is registered with ClinicalTrials.gov, number NCT00380393.

Findings

894 children were assigned, 447 in each treatment group. In the per-protocol analysis, 82 of 415 children in the RTS,S/AS01E group and 125 of 420 in the rabies vaccine group had first or only clinical malaria episode by 12 months, vaccine efficacy 39·2% (95% CI 19·5—54·1, p=0·0005). At 15 months follow-up, 58 of 209 children in the RTS,S/AS01E group and 85 of 206 in the rabies vaccine group had first or only clinical malaria episode, vaccine efficacy 45·8% (24·1—61·3, p=0·0004). At 12 months after the third dose, anti-circumsporozoite antibody titre data were available for 390 children in the RTS,S/AS01E group and 391 in the rabies group. A mean of 15 months (range 12—18 months) data were available for 172 children in the RTS,S/AS01E group and 155 in the rabies group. These titres at 1 month after the third dose were not associated with protection, but titres at 6·5 months were. The level of protection increased abruptly over a narrow range of antibody concentrations. The most common adverse events were pneumonia, febrile convulsion, gastroenteritis, and P falciparum malaria.

Interpretation

RTS,S/AS01E confers sustained efficacy for at least 15 months and shows promise as a potential public health intervention against childhood malaria in malaria endemic countries.

Funding

PATH Malaria Vaccine Initiative (MVI), GlaxoSmithKline.

PLoS Medicine
(Accessed 30 January 2011)
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

A Research Agenda for Malaria Eradication: Diagnoses and Diagnostics
Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000396

A Research Agenda for Malaria Eradication: Health Systems and Operational Research
Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000397

A Research Agenda for Malaria Eradication: Vaccines
Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000398

A Research Agenda for Malaria Eradication: Basic Science and Enabling Technologies
Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000399

A Research Agenda for Malaria Eradication: Monitoring, Evaluation, and Surveillance
Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000400

A Research Agenda for Malaria Eradication: Vector Control
Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000401

A Research Agenda for Malaria Eradication: Drugs
Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000402

A Research Agenda for Malaria Eradication: Modeling
Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000403

A Research Agenda for Malaria Eradication: Cross-Cutting Issues for Eradication

Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000404

The Role of Research in Viral Disease Eradication and Elimination Programs: Lessons for Malaria Eradication

Joel G. Breman, Ciro A. de Quadros, Walter R. Dowdle, William H. Foege, Donald A. Henderson, T. Jacob John, Myron M. Levine Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000405

A Research Agenda to Underpin Malaria Eradication

Pedro L. Alonso, Graham Brown, Myriam Arevalo-Herrera, Fred Binka, Chetan Chitnis, Frank Collins, Ogobara K. Doumbo, Brian Greenwood, B. Fenton Hall, Myron M. Levine, Kamini Mendis, Robert D. Newman, Christopher V. Plowe, Mario Henry Rodríguez, Robert Sinden, Laurence Slutsker, Marcel Tanner Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000406

Some Lessons for the Future from the Global Malaria Eradication Programme (1955–1969)

José A. Nájera, Matiana González-Silva, Pedro L. Alonso Review, published 25 Jan 2011
doi:10.1371/journal.pmed.1000412

Science
28 January 2011 vol 331, issue 6016, pages 365-496
http://www.sciencemag.org/current.dtl

Research Articles
Rapid Pneumococcal Evolution in Response to Clinical Interventions

Nicholas J. Croucher, Simon R. Harris, Christophe Fraser, Michael A. Quail, John Burton, Mark van der Linden, Lesley McGee, Anne von Gottberg, Jae Hoon Song, Kwan Soo Ko, Bruno Pichon, Stephen Baker, Christopher M. Parry, Lotte M. Lambertsen, Dea Shahinas, Dylan R. Pillai, Timothy J. Mitchell, Gordon Dougan, Alexander Tomasz, Keith P. Klugman, Julian Parkhill, William P. Hanage, and Stephen D. Bentley
Science 28 January 2011: 430-434.[DO

Abstract
Epidemiological studies of the naturally transformable bacterial pathogen Streptococcus pneumoniae have previously been confounded by high rates of recombination. Sequencing 240 isolates of the PMEN1 (Spain23F-1) multidrug-resistant lineage enabled base substitutions to be distinguished from polymorphisms arising through horizontal sequence transfer. More than 700 recombinations were detected, with genes encoding major antigens frequently affected. Among these were 10 capsule-switching events, one of which accompanied a population shift as vaccine-escape serotype 19A isolates emerged in the USA after the introduction of the conjugate polysaccharide vaccine. The evolution of resistance to fluoroquinolones, rifampicin, and macrolides was observed to occur on multiple occasions. This study details how genomic plasticity within lineages of recombinogenic bacteria can permit adaptation to clinical interventions over remarkably short time scales.

Science
28 January 2011 vol 331, issue 6016, pages 365-496
http://www.sciencemag.org/current.dtl

News & Analysis
Epidemiology
Despite Sensitivities, Scientists Seek to Solve Haiti’s Cholera Riddle
Martin Enserink

Summary
Several cholera experts have told Science that nailing the source of the recent cholera outbreak in Haiti could potentially embarrass the United Nations, distract from the day-to-day fight to control the outbreak, and even lead to violence. So their passion for traditional shoe-leather epidemiology has been tempered by diplomatic and strategic concerns. Indeed, prominent cholera scientists declined to discuss the issue with Science or would only speak off the record. The U.S. Centers for Disease Control and Prevention is investigating the source, but a spokesperson referred questions about it to a panel charged by the U.N. secretary-general with investigating the outbreak.

Science Translational Medicine
26 January 2011 vol 3, issue 67
http://stm.sciencemag.org/content/current

Commentary
Pharmaceutical research –
Between Confidentiality and Scientific Exchange: The Place of Publication in Drug Discovery and Pharmaceutical Research
Martine Clozel
26 January 2011: 67cm2

Abstract
To continue to improve life expectancy and quality of life, the discovery of innovative therapies should be among the prime goals of the life sciences. The large majority of the drugs that are discovered and successfully developed to the point of being used by patients come from the drug industry, but publications from this sector are rare among life sciences research publications. Publications in the field of pharmaceutical drug discovery should take into account the confidentiality inherent to the protection of the intellectual property rights of a discovery, but they are fundamentally important because they can enhance scientific knowledge, improve the care and safety of patients, provide information for prescribers, and educate the public about the pharmaceutical industry.

Vaccine
Volume 29, Issue 7 pp. 1355-1526 (4 February 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Articles
Vaccination against the 2009 pandemic influenza A (H1N1) among healthcare workers in the major teaching hospital of Sicily (Italy) Original Research Article
Pages 1408-1412
Emanuele Amodio, Giovanna Anastasi, Maria Grazia Laura Marsala, Maria Valeria Torregrossa, Nino Romano, Alberto Firenze

Abstract
The aim of the study was to investigate factors involved in vaccination acceptance among healthcare workers (HCWs) and adverse reactions rates associated with pandemic influenza vaccination. The study was carried out in the major teaching hospital of Sicily from November 2009 to February 2010 on 2267 HCWs. A total of 407 (18%) HCWs were vaccinated against the 2009 pandemic influenza A (H1N1). A logistic regression analysis indicates an increased risk of non-vaccination against pandemic influenza in females (OR = 1.6; 95% CI = 1.3–2.1) compared to males, in nurses/technicians/administrative workers (OR = 1.7; 95% CI = 1.3–2.2) compared to doctors/biologists, and in HCWs who were non-vaccinated against seasonal influenza in 2008–2009 (OR = 4.9; 95% CI = 3.7–6.5) compared to vaccinated HCWs. Overall, 302 (74.2%) out of 407 questionnaires distributed to vaccinated HCWs were returned within the observation period. One hundred fifty-two workers (50.3%) experienced at least one adverse reaction (30.1%, local reactions; 6.6% systemic reactions and 13.6% both of them). The most frequent side effect of vaccination was pain at the injection site (43.4%). Twelve (3.9%) out of 302 HCWs stated they experienced influenza-like illness episodes during the follow-up period. The use of an adjuvanted vaccine against pandemic influenza A (H1N1) appears to be an effective and safe preventive strategy, showing a prevalence of both local and systemic adverse reactions not very different from that seen after vaccination with non-adjuvanted seasonal influenza vaccine. Despite this finding, vaccination coverage among HCWs remains very low, suggesting the need to implement educational campaigns directed to groups with lower coverage rates.

Vaccine
Volume 29, Issue 7 pp. 1355-1526 (4 February 2011)
http://www.sciencedirect.com/science/journal/0264410X

The changing epidemiology of varicella incidence after implementation of the one-dose varicella vaccination policy Original Research Article
Pages 1448-1454
Ie-Bin Lian, Yu-Zen Chien, Pi-Shan Hsu, Day-Yu Chao

Abstract
The varicella vaccine has been available in the Taiwan market since July 1997. Beginning 1998–1999, Taipei City and Taichung City/County as the early launch areas included the varicella vaccine in their free pediatric vaccination programs. By contrast, the national free vaccination program was not implemented until 2004. We aim to investigate the changing epidemiology of varicella incidence through an analysis of age–period–cohort effects. With the greatest decrease in varicella incidence occurring in children aged below 6, the incidence of varicella shifted to older age groups as reflected in different birth cohorts. The current study provides important implications for the current vaccination policy.

The pdf version of Vaccines: The Week in Review for 24 January 2011 is below and includes all posts for this date which follow:

Vaccines_The Week in Review_24 January 2011

WHO said that WHA Member States, meeting at the 128th session of the Executive Board, “rallied their support for the WHO/UNICEF Global Immunization Vision and Strategy (GIVS Strategy 2006-2015) and its impact in guiding national immunization strategies to reach the child survival goals.” Mindful of the challenges ahead, WHO said Member States “mentioned the need to:

(1) ensure that introducing newer vaccines is not done at the expense of basic immunization;

(2) expand the use of rubella vaccines;

(3) maintain high measles vaccination coverage and not drop our guard against the disease, particularly in Africa where large scale measles outbreaks have occurred;

(4) strengthen linkages between polio eradication efforts and routine immunization;

(5) facilitate vaccine technology transfer to developing countries and promote other strategies to bring down the prices of life-saving vaccines and replicating the success of MenAfrVac; and

(6) strengthen surveillance for vaccine-preventable diseases.”

Also, the Executive Board “commends WHO’s leadership on the Decade of Vaccines, a vision for using the next 10 years to achieve immunization goals and reach important milestones in vaccine research, development and financing.” More details on the Decade of Vaccines strategic framework will be presented for discussion at the 64th World Health Assembly in May 2011.

http://www.who.int/immunization/newsroom/newsstory_givs_eb_jan2011/en/index.html

WHO released WHO/IVB/2010 – WHO vaccine-preventable diseases: monitoring system – 2010 global summary, covering disease incidence of diphtheria, measles, mumps, pertussis, polio, rubella and CRS, neonatal and total tetanus, and yellow fever, as well as vaccination coverage for BCG, DTP, hepatitis B, Hib, measles, polio, pneumococcal conjugate, rotavirus, tetanus toxoid and yellow fever. The publication also includes the latest reported recommended immunization schedule. This data is reported on annual basis to the WHO regional offices by 193 member states, and is presented both by member states and in regional summary.

http://www.who.int/immunization/documents/who_ivb_2010/en/index.html

The Bill & Melinda Gates Foundation and UNICEF announce a visit by Mr. Anthony Lake, UNICEF Executive Director, and Dr. Tachi Yamada, president of the Global Health Program of the Gates Foundation to boost the Government of Angola’s efforts to stop transmission of polio in the country by increasing vital immunization coverage. The organizations noted that Angola “has faced several challenges following the aftermath of the war, including massive rural migration to the urban areas which strained health and sanitation services and harbored conditions for the spread of polio.

In 2010, 32 people contracted polio in Angola, a disappointing turnaround from 2004, when Angola celebrated three consecutive years free from the virus and the country stood ready to be declared polio-free.  But by May of 2005, the disease returned and quickly spread to Namibia (2006), DR Congo (2006, 2008 and 2010), and the Republic of Congo (2010). This sequence of events shows that children remain at risk everywhere as long as polio transmission is not interrupted globally.” Mr. Lake and Dr. Yamada “will meet with senior government officials and partners in the fight against polio to urge an increased commitment of all levels of society. They will also discuss how to support national, provincial and municipal efforts in Angola to interrupt transmission.  As part of the mission, they will visit families, volunteers and health services in peri-urban areas of Luanda, visiting the frontline in the fight against the virus and observing what action communities are taking.”

http://www.gatesfoundation.org/press-releases/Pages/eradicating-polio-in-angola-110121.aspx

Twitter Watch
A selection of items of interest this week from a variety of twitter feeds from NGOs and other sources.

MalariaVaccine PATH MVI
Washington Post op-ed: “Global vaccine efforts offer hope to millions” http://wapo.st/f0aDNK ##

ArthurCaplan Arthur Caplan
destroying smallpox? http://www.thetakeaway.org/2011/jan/18/smallpox/

StateDept StateDept
by USAID
U.S. helps to vaccinate seven million Pakistani children against #measles and #polio: http://go.usa.gov/Y3L #Pakistan @USAID

The Lancet
Jan 22, 2011  Volume 377  Number 9762  Pages 271 – 352
http://www.thelancet.com/journals/lancet/issue/current

Series
Reproductive health, and child health and nutrition in India: meeting the challenge
Vinod Kumar Paul, Harshpal Singh Sachdev, Dileep Mavalankar, Prema Ramachandran, Mari Jeeva Sankar, Nita Bhandari, Vishnubhatla Sreenivas, Thiagarajan Sundararaman, Dipti Govil, David Osrin, Betty Kirkwood

Summary
India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and consequences of urbanisation and demographic transition. In 2005, India embarked on the National Rural Health Mission, an extraordinary effort to strengthen the health systems. However, coverage of priority interventions remains insufficient, and the content and quality of existing interventions are suboptimum. Substantial unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate. Increases in the numbers of deliveries in institutions have not been matched by improvements in the quality of intrapartum and neonatal care. Infants and young children do not get the health care they need; access to effective treatment for neonatal illness, diarrhoea, and pneumonia shows little improvement; and the coverage of nutrition programmes is inadequate. Absence of well functioning health systems is indicated by the inadequacies related to planning, financing, human resources, infrastructure, supply systems, governance, information, and monitoring. We provide a case for transformation of health systems through effective stewardship, decentralised planning in districts, a reasoned approach to financing that affects demand for health care, a campaign to create awareness and change health and nutrition behaviour, and revision of programmes for child nutrition on the basis of evidence. This agenda needs political commitment of the highest order and the development of a people’s movement.

Nature
Volume 469 Number 7330 pp265-438  20 January 2011
http://www.nature.com/nature/current_issue.html

Nature | Editorial
Smallpox should be saved
doi:10.1038/469265a
Published online
19 January 2011

For much of the world’s population, smallpox is a disease of history. The variola virus that causes it last swept through humans in a natural outbreak in Somalia in 1977, and the world was declared free of smallpox in 1980. The disease that killed Queen Mary II of England, Tsar Peter II of Russia, King Louis XV of France and hundreds of millions more during the past century alone is gone — but not forgotten. Smallpox lives on in the memories of those who witnessed its awful impact first hand. It is a terrifying spectre for those who warn that terrorists may seek to spread disease. And it survives in two laboratories, where research continues on live virus.

The fate of these known virus stocks, held in secure laboratories in the United States and Russia, is once again the subject of debate. In May 2011, the World Health Assembly — the decision-making body of the World Health Organization — will vote on whether to set a date by which these collections should be destroyed. They should not be eliminated, at least not completely.

This journal has previously argued that, because the possibility cannot be ruled out that other, secret stocks of smallpox are being held elsewhere, the benefits of continued access to live virus stocks for research outweigh the risks of maintaining them. In 1999 (Nature 398, 733; 1999), we wrote: “Rightly, public-health advocates bemoan the prospect of any measure that increases the risk of a re-emergence of this scourge. But, given the impossibility of knowing who now possesses the virus, and from where it might appear, it is better to have a number of arrows in the quiver than to destroy the stock and cross our collective fingers.” The world has changed much since then, and the US terrorist attacks of September 2001 and the subsequent focus on prospects for bioterrorism have increased the stakes further. Smallpox would be an effective weapon — it spreads easily and kills almost one-third of the people it infects. Furthermore, the triumph of smallpox eradication after widespread vaccination in the 1960s and 1970s means that some 40% of the world’s population has no immunity.

“Smallpox is a disease of history, but it cannot be consigned to the past.”

In an essay published online earlier this month in the journal Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, security expert Jonathan Tucker argues that many of the stated goals of the World Health Organization’s smallpox research programme have been achieved — such as antiviral drugs and diagnostic tools — and that there is a diminished need for live virus to be retained (J. B. Tucker Biosecur. Bioterror. doi:10.1089/bsp.2010.0065; 2011). This may be true, but further study of the virus could still reveal a huge amount, both on the specifics of what makes it such a formidable foe and on human immunology and viral pathogenesis in general.

The scientific case for retaining live variola virus to improve public health is strong. The risk of doing so is largely political. The threat of an accidental release or theft from the biosecure repositories at which it is held — at the Centers for Disease Control and Prevention in Atlanta, Georgia, and the State Research Center of Virology and Biotechnology (‘Vector’) near Novosibirsk — seems remote. Destruction of the stocks would be a largely symbolic step.

Countries in Africa and Asia endured the havoc of smallpox most recently, and fear of a repeat outbreak — as well as mistrust of those who control the stocks — has produced strong calls from these nations for its destruction. There is equally strong insistence in countries such as the United States and Russia that it should be retained for defensive research. In a recent article in The New York Times, former US government heavy-hitters Kenneth Bernard and Richard Danzig call elimination of the virus stocks a “bad idea”. They say: “We have an obligation to ensure that our children’s children never have to worry about seeing this ancient scourge kill yet again. Destroying the remaining research specimens of smallpox at this time will prevent us from fulfilling this obligation.”

Tucker warns that the result of this political stand-off, further complicated by the rare involvement of security and defence officials in a public-health matter, could be a “diplomatic train wreck” — particularly given that the World Health Assembly will seek a consensus decision. As part of a compromise solution, he suggests that the United States and Russia should agree to destroy part of their collections, such as hybrid viruses that are scientifically redundant. A handful of strains would continue to be held at each site, for research in the short term and reference afterwards. That seems a sensible approach. True, the world will be denied a final victory in the heroic effort to defeat smallpox, but uncertainty over undeclared surviving stocks would make that a hollow accomplishment anyway. So, too, would development of molecular-biology techniques that could see the smallpox virus reconstructed. Smallpox is a disease of history, but it cannot be consigned to the past.

Nature
Volume 469 Number 7330 pp265-438  20 January 2011
http://www.nature.com/nature/current_issue.html

Perspectives
Systemic risk in banking ecosystems
Andrew G. Haldane &Robert M. May

Abstract
In the run-up to the recent financial crisis, an increasingly elaborate set of financial instruments emerged, intended to optimize returns to individual institutions with seemingly minimal risk. Essentially no attention was given to their possible effects on the stability of the system as a whole. Drawing analogies with the dynamics of ecological food webs and with networks within which infectious diseases spread, we explore the interplay between complexity and stability in deliberately simplified models of financial networks. We suggest some policy lessons that can be drawn from such models, with the explicit aim of minimizing systemic risk.

The Pediatric Infectious Disease Journal
February 2011 – Volume 30 – Issue 2
http://journals.lww.com/pidj/pa     ges/currenttoc.aspx

Original Studies
Timing of the Availability and Administration of Influenza Vaccine Through the Vaccines for Children Program
Bhatt, Praful; Block, Stan L.; Toback, Seth L.; Ambrose, Christopher S.
Pediatric Infectious Disease Journal. 30(2):100-106, February 2011.
doi: 10.1097/INF.0b013e3181efff54

Abstract:
Background: Influenza vaccine must be distributed and administered each year during a limited time interval. To our knowledge, no previous studies have simultaneously evaluated the delivery and administration of privately purchased vaccines and influenza vaccines acquired through the Vaccines for Children (VFC) program.

Methods: A prospective, observational study was conducted in US outpatient pediatric offices, tracking all influenza vaccinations during the season by age group, first or second vaccination, the child’s need for 1 or 2 doses, type of vaccine, and VFC status.

Results: A total of 42 and 84 practices completed the study in 2007 to 2008 and 2008 to 2009, respectively. In both seasons, initial shipments of VFC influenza vaccine generally arrived 4 to 5 weeks later than non-VFC shipments; VFC vaccine administration also started 1 month later than administration of privately purchased vaccine. Vaccine administration peaked in early November and late October in years 1 and 2, respectively, and declined rapidly thereafter. Overall, approximately one-half of all children who required 2 doses of vaccine were estimated to have received 2 doses. In both years, 2-dose compliance rates in the VFC population were 17% to 19% lower than those in the non-VFC population, possibly resulting from the VFC population’s shorter time interval for second dose receipt.

Conclusions: The VFC program is critical to ensuring financially vulnerable children have access to vaccination. Manufacturers, distributors, and public health officials should deliver VFC influenza vaccine to providers as quickly as possible. Pediatric healthcare providers should increase efforts to vaccinate all populations, especially the VFC population, in later months.

Pediatric Infectious Disease Journal
Volume 30, January 2011, Supplement, Real World Impact of Rotavirus Vaccination 1, pp. S1-S66

Real-world Impact of Rotavirus Vaccination
Patel, Manish M.; Steele, Duncan; Gentsch, Jon R.; Wecker, John; Glass, Roger I.; Parashar, Umesh D.
Pediatric Infectious Disease Journal. 30(1):S1-S5, January 2011.
doi: 10.1097/INF.0b013e3181fefa1f

Worldwide, diarrhea is the second most common cause of fatal childhood disease, estimated to cause approximately 1.34 million deaths among children aged <5 years.1 Rotavirus is the leading cause of severe diarrhea in young children and is responsible for approximately one-third of all diarrheal deaths.2 Two effective rotavirus vaccines, a single-strain attenuated human rotavirus vaccine (Rotarix, GlaxoSmithKline Biologicals) and a multistrain bovine-human reassortant vaccine (RotaTeq, Merck and Company), are now available and recommended for routine immunization of all infants by the World Health Organization (WHO).3 Efficacy of these vaccines has ranged from 80% to 98% in industrialized countries,4–7 including Latin America, and 39% to 77% in developing countries, such as Africa and Asia.8–10 On the basis of efficacy data from Europe and America, the WHO initially approved use of the vaccines in these regions in 2006 and within 2 years several countries added rotavirus vaccination into their routine immunization programs. Subsequently, after proof of efficacy in Asia and Africa, the WHO recommendation was expanded to all infants worldwide in 2009.3

As rotavirus vaccines are implemented within national childhood immunization programs, evaluation of their effect is important for several reasons.11,12 First, routine immunization occurs in real-world conditions different from ideal clinical trial settings. Thus, monitoring postlicensure impact on rotavirus disease is crucial for ensuring that appropriate gains in terms of expected vaccination benefits are attained. Second, changes in the epidemiology of rotavirus disease might occur in the postlicensure era, such as shifts in average age at infection, seasonality of disease, and serotype distribution after vaccination or appearance of unusual genetic variants. Third, ensuring that protection is conferred through the first and second years of life when most severe disease and mortality from rotavirus occur will be crucial for the success of a rotavirus vaccination program. Finally, assessing whether vaccination has an affect on rotavirus transmission in the community, thus providing benefits to unvaccinated groups, is important. Monitoring impact with focus on these public health considerations will not only allow assessment of the effectiveness of rotavirus vaccines in routine use, but also generate the necessary evidence to inform public health policy decision-making and continued investment in rotavirus vaccines.

The articles in this supplement elegantly describe the experience of early-introducer countries in Europe, America, and Australia, and address these relevant postlicensure topics (Table 1). The effect of rotavirus vaccines on burden of severe childhood diarrhea in these early introducer countries has been rapid, easily measured, and substantial, demonstrating the health value of rotavirus vaccination. Two of the most interesting and unanticipated findings in the early rotavirus vaccine era have included indirect protection and changes in rotavirus seasonality.13,14 The lessons learned to-date will be valuable for other countries, considering the introduction of rotavirus vaccines into their childhood immunization programs.

Science
21 January 2011 vol 331, issue 6015, pages 249-364
http://www.sciencemag.org/current.dtl

Review
Animal Migration and Infectious Disease Risk
Sonia Altizer, Rebecca Bartel, and Barbara A. Han
Science 21 January 2011: 296-302.[D

Abstract
Animal migrations are often spectacular, and migratory species harbor zoonotic pathogens of importance to humans. Animal migrations are expected to enhance the global spread of pathogens and facilitate cross-species transmission. This does happen, but new research has also shown that migration allows hosts to escape from infected habitats, reduces disease levels when infected animals do not migrate successfully, and may lead to the evolution of less-virulent pathogens. Migratory demands can also reduce immune function, with consequences for host susceptibility and mortality. Studies of pathogen dynamics in migratory species and how these will respond to global change are urgently needed to predict future disease risks for wildlife and humans alike.

Science Translational Medicine
19 January 2011 vol 3, issue 66
http://stm.sciencemag.org/content/current

Commentary
Policy
“Creating Hope” and Other Incentives for Drug Development for Children
Edward Connor and Pablo Cure
19 January 2011: 66cm1

Abstract
Enhancing drug development for pediatric disease is a priority and a public responsibility. The Creating Hope Act of 2010 is important new proposed legislation that adds drugs and biologics for treating rare diseases in children to those for neglected tropical diseases as eligible for a priority review voucher from the U.S. Food and Drug Administration. The Act enhances existing incentive programs through specific financial benefits to companies who seek a pediatric indication for a new drug to treat an orphan disease that occurs specifically in children.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 6 – pp. 1115-1354 (1 February 2011)

Meeting Report

The Global Pertussis Initiative: Report from a Round Table Meeting to discuss the epidemiology and detection of pertussis, Paris, France, 11–12 January 2010
Pages 1115-1121
Nicole Guiso, Carl-Heinz Wirsing von König, Kevin Forsyth, Tina Tan, Stanley A. Plotkin

Abstract
Pertussis remains endemic worldwide and is an important public health problem, even in countries with sustained high vaccination coverage. Resurgence of pertussis in the post-vaccination era has been reported in many areas of the world. The Global Pertussis Initiative (GPI) was established in 2001 to evaluate the ongoing problem of pertussis worldwide and to recommend appropriate pertussis control strategies. In addition to primary vaccinations, the GPI currently recommends a pertussis booster vaccination to pre-school children, adolescents and those adults at risk of transmitting Bordetella pertussis infection to infants. At a meeting in Paris, France, in January 2010, GPI members discussed pertussis surveillance and testing then prepared recommendations on the implementation and utilisation of these activities. Issues and projects discussed included: national surveillance systems and their suitability for other countries; seroprevalence studies; ideal surveillance methodologies; ongoing efforts in obtaining biological samples; standardisation of sample treatment; culture; real-time polymerase chain reaction (PCR); and likely future advances such as antibody detection in saliva. Previous regional meetings of the GPI have confirmed that many countries have limited laboratory facilities for the detection of pertussis. The GPI hopes that the future introduction of increased laboratory capabilities and greater harmonisation of clinical definitions and detection methods will lead to enhanced surveillance and a better estimate of the burden of pertussis infection worldwide. This article provides a current guide on the appropriate use of laboratory diagnostics and optimal surveillance methodologies to assist countries in the control of pertussis disease.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 6 – pp. 1115-1354 (1 February 2011)

Lessons from pandemic influenza A(H1N1): The research-based vaccine industry’s perspective Review Article
Pages 1135-1138
Atika Abelin, Tony Colegate, Stephen Gardner, Norbert Hehme, Abraham Palache

Abstract
As A(H1N1) influenza enters the post-pandemic phase, health authorities around the world are reviewing the response to the pandemic. To ensure this process enhances future preparations, it is essential that perspectives are included from all relevant stakeholders, including vaccine manufacturers. This paper outlines the contribution of R&D-based influenza vaccine producers to the pandemic response, and explores lessons that can be learned to improve future preparedness.

The emergence of 2009 A(H1N1) influenza led to unprecedented collaboration between global health authorities, scientists and manufacturers, resulting in the most comprehensive pandemic response ever undertaken, with a number of vaccines approved for use three months after the pandemic declaration. This response was only possible because of the extensive preparations undertaken during the last decade.

During this period, manufacturers greatly increased influenza vaccine production capacity, and estimates suggest a further doubling of capacity by 2014. Producers also introduced cell-culture technology, while adjuvant and whole virion technologies significantly reduced pandemic vaccine antigen content. This substantially increased pandemic vaccine production capacity, which in July 2009 WHO estimated reached 4.9 billion doses per annum. Manufacturers also worked with health authorities to establish risk management plans for robust vaccine surveillance during the pandemic. Individual producers pledged significant donations of vaccine doses and tiered-pricing approaches for developing country supply.

Based on the pandemic experience, a number of improvements would strengthen future preparedness. Technical improvements to rapidly select optimal vaccine viruses, and processes to speed up vaccine standardization, could accelerate and extend vaccine availability. Establishing vaccine supply agreements beforehand would avoid the need for complex discussions during a period of intense time pressure.

Enhancing international regulatory co-operation and mutual recognition of approvals could accelerate vaccine supply, while maintaining safety standards. Strengthening communications with the public and healthcare workers using new approaches and new channels could help improve vaccine uptake. Finally, increasing seasonal vaccine coverage will be particularly important to extend and sustain pandemic vaccine production capacity.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 6 – pp. 1115-1354 (1 February 2011)

Major motives in non-acceptance of A/H1N1 flu vaccination: The weight of rational assessment Original Research Article
Pages 1173-1179
Baruch Velan, Giora Kaplan, Arnona Ziv, Valentina Boyko, Liat Lerner-Geva

Abstract
Recent efforts of health authorities to promote vaccination against influenza A/H1N1 were met with low compliance rates in most industrialized countries. Here we analyzed the attitudes of the Israeli public towards A/H1N1 vaccination based on a telephone survey conducted several months after the peak of the outbreak. The findings attest to the low uptake of the A/H1N1 vaccine (17%) in Israel, and identify the socio-demographic characteristics associated with non-compliance. In addition, the survey reveals passiveness, fear and distrust as motives leading to non-compliance. Most importantly, the study identified the substantial weight of reflective assessment in the attitude of lay individuals towards the A/H1N1 vaccine. As many as 30% of the non-vaccinated responders provided reasoned arguments for rejecting the vaccine, based mainly on assessment of threat versus actual risk. These observations highlight the need to consider the opinion of the lay public when implementing new vaccination programs.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 6 – pp. 1115-1354 (1 February 2011)

The potential economic value of a hookworm vaccine

Original Research Article
Pages 1201-1210
Bruce Y. Lee, Kristina M. Bacon, Rachel Bailey, Ann E. Wiringa, Kenneth J. Smith

Abstract
Hookworm infection is a significant problem worldwide. As development of hookworm vaccine proceeds, it is essential for vaccine developers and manufacturers, policy makers, and other public health officials to understand the potential costs and benefits of such a vaccine. We developed a decision analytic model to evaluate the cost-effectiveness of introducing a hookworm vaccine into two populations in Brazil: school-age children and non-pregnant women of reproductive age. Results suggest that a vaccine would provide not only cost savings, but potential health benefits to both populations. In fact, the most cost-effective intervention strategy may be to combine vaccine with current drug treatment strategies.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 5 – pp. 865-1114 (29 January 2011)

Approaches to monitoring biological outcomes for HPV vaccination: Challenges of early adopter countries Review Article
Pages 878-885
Charlene A. Wong, Mona Saraiya, Susan Hariri, Linda Eckert, Roberta I. Howlett, Lauri E. Markowitz, Julia M.L. Brotherton, Katy Sinka, Olga G. Martinez-Montañez, Susanne K. Kjaer, Eileen F. Dunne

Abstract
In this review, we describe plans to monitor the impact of human papillomavirus (HPV) vaccine on biologic outcomes in selected international areas (Australia, Canada, Mexico, the Nordic countries, Scotland, and the United States) that have adopted this vaccine. This summary of monitoring plans provides a background for discussing the challenges of vaccine monitoring in settings where resources and capacity may vary. A variety of approaches that depend on existing infrastructure and resources are planned or underway for monitoring HPV vaccine impact. Monitoring HPV vaccine impact on biologic outcomes is a complex and challenging task, but also plays an important role in documenting the benefit of vaccination, monitoring the progress of vaccination programs, and providing data to inform vaccination and disease prevention policies.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 5 – pp. 865-1114 (29 January 2011)
Regular Papers
Predictors of HPV vaccine uptake among women aged 19–26: Importance of a physician’s recommendation Original Research Article
Pages 890-895
S.L. Rosenthal, T.W. Weiss, G.D. Zimet, L. Ma, M.B. Good, M.D. Vichnin

Abstract
Among insured women, aged 19–26 years, those who discussed the HPV vaccine with their physician and received a recommendation were overwhelmingly more likely to be vaccinated. Student status and perception of the personal importance of vaccination were also predictive of vaccination. The strength of the physician’s recommendation played a significant role in the decision to be vaccinated, resulting in a 4-fold greater likelihood of vaccination when women received a strong recommendation versus one that was not strong. Health care providers should be well-informed about HPV vaccination and recognize that the strength of their recommendation to patients will foster appropriate uptake.

Vaccine
a href=”http://www.sciencedirect.com/science/journal/0264410X”>http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 5 – pp. 865-1114 (29 January 2011)
Incremental costs of introducing jet injection technology for delivery of routine childhood vaccinations: Comparative analysis from Brazil, India, and South Africa

Original Research Article
Pages 969-975
Ulla K. Griffiths, Andreia C. Santos, Neeti Nundy, Erica Jacoby, Dipika Matthias

Abstract
Background
Disposable-syringe jet injectors (DSJIs) have the potential to deliver vaccines safely and affordably to millions of children around the world. We estimated the incremental costs of transitioning from needles and syringes to delivering childhood vaccines with DSJIs in Brazil, India, and South Africa.

Methods
Two scenarios were assessed: (1) DSJI delivery of all vaccines at current dose and depth; (2) a change to intradermal (ID) delivery with DSJIs for hepatitis B and yellow fever vaccines, while the other vaccines are delivered by DSJIs at current dose and depth. The main advantage of ID delivery is that only a small fraction of the standard dose may be needed to obtain an immune response similar to that of subcutaneous or intramuscular injection. Cost categories included were vaccines, injection equipment, waste management, and vaccine transport. Some delivery cost items, such as training and personnel were excluded as were treatment cost savings caused by a reduction in diseases transmitted due to unsafe injections.

Results
In the standard dose and depth scenario, the incremental costs of introducing DSJIs per fully vaccinated child amount to US$ 0.57 in Brazil, US$ 0.65 in India and US$ 1.24 in South Africa. In the ID scenario, there are cost savings of US$ 0.11 per child in Brazil, and added costs of US$ 0.45 and US$ 0.76 per child in India and South Africa, respectively. The most important incremental cost item is jet injector disposable syringes.

Conclusion
The incremental costs should be evaluated against other vaccine delivery technologies that can deliver the same benefits to patients, health care workers, and the community. DSJIs deserve consideration by global and national decision-makers as a means to expand access to ID delivery and to enhance safety at marginal additional cost.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 5 – pp. 865-1114 (29 January 2011)
Parental decline of pneumococcal vaccination and risk of pneumococcal related disease in children Original Research Article
Pages 994-999
Jason M. Glanz, David L. McClure, Sean T. O’Leary, Komal J. Narwaney, David J. Magid, Matthew F. Daley, Simon J. Hambidge

Abstract
Background
An increasing number of parents are choosing to decline immunizations for their children. This study examined the association between the parental decision to decline pneumococcal conjugate (PCV7) vaccinations and the risk of hospitalization due to pneumococcal disease or lobar pneumonia in children.

Methods
We conducted a case–control study nested within a cohort of children enrolled in the Kaiser Permanente Colorado (KPCO) health plan between 2004 and 2009. Each child hospitalized with pneumococcal disease or lobar pneumonia (n = 106) was matched to 4 randomly selected controls (n = 401). Cases were matched to controls by age, sex, high-risk status, calendar time, and length of enrollment in KPCO. Disease status and parental vaccination decisions were validated with medical record review. Cases and controls were classified as vaccine decliners or vaccine acceptors.

Results
Among 106 cases, there were 6 (6%) PCV7 vaccine decliners; among 401 controls, there were 4 (1%) vaccine decliners. Children of parents who declined PCV7 immunization were 6.5 times (OR = 6.5; 95% CI = 1.7, 24.5) more likely to be hospitalized for invasive pneumococcal disease or lobar pneumonia than vaccinated children.

Conclusions
Parental decline of pneumococcal vaccination apparently increases the risk for hospitalization due to pneumococcal disease or lobar pneumonia in children. Providers can use this information when helping parents weigh the benefits and risks of immunizing their children.

The is the pdf version of the Week in Review and integrates the posts below on this date into single summary:

Vaccines_The Week in Review_17 January 2011

Director-General of the World Health Organization Dr Margaret Chan, at the launch of the Global Plan for Artemisinin Resistance Containment in Geneva, Switzerland, 12 January 2011, issued the following statement:

Protecting our best weapon in treating malaria

The report we are launching today sets out a high-level plan to protect our most potent weapon in treating malaria, the artemisinins. These medicines are the key ingredient of artemisinin-based combination therapy, or ACTs.

ACTs are the gold standard. They are the most effective treatment for falciparum malaria, the most deadly form of malaria.

Combination therapy is a deliberate strategy to delay the development of drug resistance, which inevitably happens when any antimalarial drug is widely, and especially, unwisely used.

ACTs deliver a two-punch attack on the malaria parasite. By combining drugs with different mechanisms of action and different time spans of activity, ACTs increase the likelihood that any parasites not killed by one drug will be killed by the second one.

The usefulness of these therapies is now under threat.

Evidence of resistance to artemisinins was suspected on the Cambodia-Thailand border in 2008 and confirmed in 2009. Other suspected foci have been identified in the Greater Mekong subregion, but are not yet confirmed.

This part of the world is the historical epicentre for the emergence of drug-resistant malaria parasites. History tells us what to expect…..

…We are launching a global plan at the start of 2011, but this does not mean that aggressive action has not already taken place. On the contrary.

Containment efforts began immediately on the Cambodia-Thailand border at the end of 2008, even before resistance was confirmed. Household coverage with treated bednets is nearly 100%.

Health facilities have been set up to diagnose and treat malaria. Services are open 24 hours a day, free of charge, and stocked with quality-assured ACTs. Intensive monitoring of therapeutic efficacy continues.

What the global plan aims to do is add another safeguard by extending vigilance and preventive measures to all endemic countries.

The emergence of artemisinin resistance has been a wake-up call. It gives us another compelling reason to step up existing control measures with the greatest sense of urgency.

The global plan spells out clearly what needs to be done. It is my sincere wish that the international community will seize this unprecedented opportunity.

Full statement at: http://www.who.int/dg/speeches/2011/malaria_plan_20110112/en/index.html

The Global Fund to Fight AIDS, Tuberculosis and Malaria said its board re-appointed Professor Michel Kazatchkine as Executive Director for a further three-year-term. Dr Tedros Adhanom Ghebreyesus, chair of the Board of the Global Fund and the Minister of Health of Ethiopia, commented, “I congratulate Professor Kazatchkine on his reappointment as Executive Director. He has led the Global Fund through a period of rapid growth that has enabled many countries to make major progress towards achieving the health-related Millennium Development Goals. The Board looks forward to working with him in the coming years as we continue our global effort to fight these major epidemics.” The Global Fund noted that since its creation in 2002 it “has become a leading force in the fight against the three diseases. With approved funding of US$21.7 billion for 140 countries, it is the main international financier for the three diseases, supporting more than half of those on antiretroviral treatment globally and providing around two-thirds of international funding for tuberculosis and malaria.”

http://www.theglobalfund.org/en/pressreleases/?pr=pr_110111

WHO said that new evidence published in Lancet Infectious Diseases about a Kesho Bora study (“A better future”, Swahili) found that “giving HIV positive mothers a combination of 3 antiretroviral drugs (ARVs) during pregnancy, delivery and breastfeeding cuts HIV infections in infants by 43% by the age of 1 year and reduces transmissions during breastfeeding by 54% compared with the previously recommended ARV drug regimen stopped at delivery.” The balance of risks and benefits of continuing ARVs during breastfeeding was not known prior to this study which was conducted in five sites in Burkina Faso, Kenya, and South Africa and coordinated by WHO’s Department of Reproductive Health and Research.  WHO said this approach “offers new hope for mothers with HIV infection who cannot safely feed their babies with infant formula. It will improve the chances of infants remaining healthy and free of HIV infection as breast milk provides optimal nutrition and protects against other fatal childhood diseases such as pneumonia and diarrhoea.”

Number of pages: 4
Publication date: 14 January 2011
Languages: English
WHO reference number: WHO/RHR/11.01

http://whqlibdoc.who.int/hq/2011/WHO_RHR_11.01_eng.pdf

The MMWR for January 14, 2011 / Vol. 60 / No. 1, includes:
– Local Health Department Costs Associated with Response to a School-Based Pertussis Outbreak — Omaha, Nebraska, September–November 2008

– Progress in Immunization Information Systems — United States, 2009

– Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis (Tdap) Vaccine from the Advisory Committee on Immunization Practices, 2010

– Notices to Readers: Changes to the National Notifiable Infectious Disease List and Data Presentation — January 2011

http://www.cdc.gov/mmwr/pdf/wk/mm6001.pdf

Emerging Infectious Diseases
Volume 17, Number 1–January 2011
http://www.cdc.gov/ncidod/EID/index.htm

Expedited posting
Mann P, O’Connell E, Zhang G, Llau A, Rico E, Lequen FC.
Alert system to detect possible school-based outbreaks of influenza-like illness.
Emerg Infect Dis. 2011 Feb; [Epub ahead of print]

Abstract
To evaluate the usefulness of school absentee data in identifying outbreaks as part of syndromic surveillance, we examined data collected from public schools in Miami-Dade County, Florida, USA. An innovative automated alert system captured information about school-specific absenteeism to detect and provide real-time notification of possible outbreaks of influenza-like illness.

JAMA
January 12, 2011, Vol 305, No. 2, pp 123-212
http://jama.ama-assn.org/current.dtl

Original Contributions
Herpes Zoster Vaccine in Older Adults and the Risk of Subsequent Herpes Zoster Disease
Hung Fu Tseng, Ning Smith, Rafael Harpaz, Stephanie R. Bialek, Lina S. Sy, Steven J. Jacobsen

Abstract
Context Approximately 1 million episodes of herpes zoster occur annually in the United States. Although prelicensure data provided evidence that herpes zoster vaccine works in a select study population under idealized circumstances, the vaccine needs to be evaluated in field conditions.

Objective To evaluate risk of herpes zoster after receipt of herpes zoster vaccine among individuals in general practice settings.

Design, Setting, and Participants A retrospective cohort study from January 1, 2007, through December 31, 2009, of individuals enrolled in the Kaiser Permanente Southern California health plan. Participants were immunocompetent community-dwelling adults aged 60 years or older. The 75 761 members in the vaccinated cohort were age matched (1:3) to 227 283 unvaccinated members.

Main Outcome Measure Incidence of herpes zoster.

Results Herpes zoster vaccine recipients were more likely to be white, women, with more outpatient visits, and fewer chronic diseases. The number of herpes zoster cases among vaccinated individuals was 828 in 130 415 person-years (6.4 per 1000 person-years; 95% confidence interval [CI], 5.9-6.8), and for unvaccinated individuals it was 4606 in 355 659 person-years (13.0 per 1000 person-years; 95% CI, 12.6-13.3). In adjusted analysis, vaccination was associated with a reduced risk of herpes zoster (hazard ratio [HR], 0.45; 95% CI, 0.42-0.48); this reduction occurred in all age strata and among individuals with chronic diseases. Risk of herpes zoster differed by vaccination status to a greater magnitude than the risk of unrelated acute medical conditions, suggesting results for herpes zoster were not due to bias. Ophthalmic herpes zoster (HR, 0.37; 95% CI, 0.23-0.61) and hospitalizations coded as herpes zoster (HR, 0.35; 95% CI, 0.24-0.51) were less likely among vaccine recipients.

Conclusions Among immunocompetent community-dwelling adults aged 60 years or older, receipt of the herpes zoster vaccine was associated with a lower incidence of herpes zoster. The risk was reduced among all age strata and among individuals with chronic diseases.