The pdf version of Vaccines: The Week in Review  25 July 2011 comprising the posts below for this date is available here: Vaccines_The Week in Review_25 July 2011

   WHO’s Global Advisory Committee on Vaccine Safety, following review of new data for the meningococcal A conjugate vaccine (MenAfriVac), “concluded that the experience from the first three countries to introduce this vaccine did not indicate any reasons for concern about the vaccine’s safety.” The data reviewed by the Advisory Committee ― at its meeting of 15-16 June 2011 ― were collected in Burkina Faso, Mali and Niger during the September and December 2010 vaccination campaigns and from the surveillance systems, WHO said. The Committee “recognized that it would not be practical to conduct active surveillance on a widespread basis during future immunization activities, (but) it highlighted the need for continuous surveillance as the vaccine is rolled out to ensure that further data on the safety profile of the vaccine can be obtained.” Other issues discussed by the Committee included a new approach for classifying serious adverse events following immunization, information sheets describing the safety profile of important vaccines and the development of a global strategy to enhance vaccine safety capacity in low- and middle-income countries.

Full report: Meeting of the Global Advisory Committee on Vaccine Safety, July 2011
pdf, 339kb

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

The FDA’s Vaccines and Related Biological Products Advisory Committee identified the strains selected for the 2011-2012 influenza season as:

– A/California/7/09 (H1N1)-like virus (pandemic (H1N1) 2009 influenza virus)

– A/Perth /16/2009 (H3N2)-like virus

– B/Brisbane/60/2008-like virus

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm263319.htm

    WHO issued a policy recommendation warning against the use of inaccurate blood tests for active tuberculosis, noting that “the use of currently available, commercial blood (serological) tests to diagnose active tuberculosis (TB) often leads to misdiagnosis, mistreatment and potential harm to public health.” WHO is urging countries “to ban the inaccurate and unapproved blood tests and instead rely on accurate microbiological or molecular tests, as recommended by WHO.” Dr Mario Raviglione, Director of WHO’s Stop TB Department, said, “In the best interests of patients and caregivers in the private and public health sectors, WHO is calling for an end to the use of these serological tests to diagnose tuberculosis. A blood test for diagnosing active TB disease is bad practice. Test results are inconsistent, imprecise and put patients’ lives in danger.”

Today’s policy recommendation applies to blood tests for active TB. Blood tests for inactive TB infection (also known as dormant or latent TB) are currently under review by WHO.

http://www.who.int/mediacentre/news/releases/2011/tb_20110720/en/index.html

The Weekly Epidemiological Record (WER) for 22 July 2011, vol. 86, 30 (pp 317–324) includes: Rotavirus vaccine and intussusception: report from an expert consultation; Meeting of the Global Advisory Committee on Vaccine Safety, June 2011

http://www.who.int/entity/wer/2011/wer8630.pdf

Twitter Watch
A selection of items of interest this week from a variety of twitter feeds. This capture is highly selective and by no means intended to be exhaustive.

CDCgov CDC.gov
@CDCgov keeps children #immunized against vaccine preventable diseases saving nearly $14 billion in direct costs go.usa.gov/BVM #CDC247

EndPolioNow EndPolioNow
Rotarians play key role in Pakistan’s strategy to end polio bit.ly/nNRdWl

GAVIAlliance GAVI Alliance
Great news today! A new human clinical trial of an #HIV #vaccine is showing incredible promise: http://ht.ly/5JYHV #globalhealth #AIDS

GAVIAlliance GAVI Alliance
7 days until World #HepatitisDay. Did you know there is a #hepatitis B #vaccine? http://ht.ly/5K6f7 /via @WHOnews #globalhealth

Annals of Internal Medicine
July 19, 2011; 155 (2)
http://www.annals.org/content/current

Reviews
Low Health Literacy and Health Outcomes: An Updated Systematic Review
Nancy D. Berkman, Stacey L. Sheridan, Katrina E. Donahue, David J. Halpern, and Karen Crotty
Ann Intern Med July 19, 2011 155:97-107;

Health literacy has been associated with health-related knowledge and patient comprehension. This systematic review updates a 2004 review and found 96 eligible studies that suggest that low health literacy is associated with less ability to understand and follow medical advice, poorer health outcomes, and differential use of some health care services. Policymakers, clinicians, and other stakeholders need to find ways to reduce the effects of low health literacy on health outcomes.

Editorials
Testing Rules of Thumb and the Science of Health Literacy
Cynthia Baur and Nancy Ostrove
Ann Intern Med July 19, 2011 155:129-130;

In this issue, the study by Woloshin and Schwartz suggests that lay people understand percents better than natural frequencies when considering information about drug therapies, and Berkman and colleagues’ findings address conventional wisdom about the associations between health literacy and some health-related outcomes. This editorial discusses these 2 articles in light of currently accepted ideas about health literacy. The editorialists assert that the findings reinforce a fundamental principle of health literacy: the need to pretest communication materials with the target audience.

Cost Effectiveness and Resource Allocation
(accessed 25 July 2011)
http://www.resource-allocation.com/

Review
A systematic review of economic evaluations of health and health-related interventions in Bangladesh
Hoque ME, Khan JAM, Hossain SSA, Gazi R, Rashid H, Koehlmoos TP and Walker DG Cost Effectiveness and Resource Allocation 2011, 9:12 (20 July 2011)

Abstract (provisional)
Background
Economic evaluation is used for effective resource allocation in health sector. Accumulated knowledge about economic evaluation of health programs in Bangladesh is not currently available. While a number of economic evaluation studies have been performed in Bangladesh, no systematic investigation of the studies has been done to our knowledge. The aim of this current study is to systematically review the published articles in peer-reviewed journals on economic evaluation of health and health-related interventions in Bangladesh.

Methods
Literature searches was carried out during November-December 2008 with a combination of key words, MeSH terms and other free text terms as suitable for the purpose. A comprehensive search strategy was developed to search Medline by the PubMed interface. The first specific interest was mapping the articles considering the areas of exploration by economic evaluation and the second interest was to scrutiny the methodological quality of studies. The methodological quality of economic evaluation of all articles has been scrutinized against the checklist developed by Evers Silvia and associates. Result: Of 1784 potential articles 12 were accepted for inclusion. Ten studies described the competing alternatives clearly and only two articles stated the perspective of their articles clearly. All studies included direct cost, incurred by the providers. Only one study included the cost of community donated resources and volunteer costs. Two studies calculated the incremental cost effectiveness ratio (ICER). Six of the studies applied some sort of sensitivity analysis. Two of the studies discussed financial affordability of expected implementers and four studies discussed the issue of generalizability for application in different context.

Conclusion
Very few economic evaluation studies in Bangladesh are found in different areas of health and health-related interventions, which does not provide a strong basis of knowledge in the area. The most frequently applied economic evaluation is cost-effectiveness analysis. The majority of the studies did not follow the scientific method of economic evaluation process, which consequently resulted into lack of robustness of the analyses. Capacity building on economic evaluation of health and health-related programs should be enhanced.

International Journal of Infectious Diseases
http://www.sciencedirect.com/science/journal/12019712

[In Press]
Europe’s neglected infections of poverty
In Press, Corrected Proof, Available online 16 July 2011
Peter J. Hotez, Meredith Gurwith

Summary
Objectives
To review the prevalence, incidence, and geographic distribution of the major neglected infections of poverty in Europe as a basis for future policy recommendations.

Methods
We reviewed the literature from 1999 to 2010 for neglected tropical diseases listed by PLoS Neglected Tropical Diseases (http://www.plosntds.org/static/scope.action) and the geographic regions and countries of (continental) Europe. Reference lists of identified articles and reviews were also hand searched, as were World Health Organization databases.

Results
In Eastern Europe, the soil-transmitted helminth infections (especially ascariasis, trichuriasis, and toxocariasis), giardiasis, and toxoplasmosis remain endemic. High incidence rates of selected food-borne helminthiases including trichinellosis, opisthorchiasis, taeniasis, and echinococcosis also occur, while brucellosis and leptospirosis represent important bacterial zoonoses. Turmoil and economic collapse following the war in the Balkans, the fall of Communism, and Europe’s recent recession have helped to promote their high prevalence and incidence rates. In Southern Europe, vector-borne zoonoses have emerged, including leishmaniasis and Chagas disease, and key arboviral infections. Additional vulnerable populations include the Roma, orphans destined for international adoption, and some immigrant groups.

Conclusions
Among the policy recommendations are increased efforts to determine the prevalence, incidence, and geographic distribution of Europe’s neglected infections, epidemiological studies to understand the ecology and mechanisms of disease transmission, and research and development for new control tools.

The Lancet  
Jul 23, 2011  Volume 378  Number 9788  p289 – 372
http://www.thelancet.com/journals/lancet/issue/current

Comment
The vaccine paradox
Richard Horton, Pamela Das

Preview
The next decade will likely bring astonishing successes in vaccine biology, discovery, and delivery. Justifiable confidence in this proposition led the Bill & Melinda Gates Foundation last year to pledge US$10 billion to a new Decade of Vaccines. For the world’s largest and most influential health foundation, vaccines are the number one priority. The foundation estimates that if vaccine coverage could be scaled up to 90%, the lives of 7·6 million children younger than 5 years could be saved between 2010 and 2019.

The Lancet  
Jul 23, 2011  Volume 378  Number 9788  p289 – 372
http://www.thelancet.com/journals/lancet/issue/current

Comment
A call to action for the new decade of vaccines
E Richard Moxon, Pamela Das, Brian Greenwood, David L Heymann, Richard Horton, Orin S Levine, Stanley Plotkin, Gus Nossal

Preview
No medical intervention has such an unambiguous track record of preventing morbidity and mortality from infectious diseases than that of vaccines.1 The type of vaccine-preventable diseases ranges from the acute (eg, measles or meningitis) to the chronic (eg, liver and cervical cancers). Further reduction of deaths and disability from infections remains a major challenge. Few would deny that there is a moral imperative to make vaccines widely available on an equitable basis, but governments are frustratingly slow to grasp a different and compelling argument: vaccines create wealth.

The Lancet  
Jul 23, 2011  Volume 378  Number 9788  p289 – 372
http://www.thelancet.com/journals/lancet/issue/current

Perspectives
Time to mandate influenza vaccination in health-care workers
Arthur Caplan

Preview
Earlier this year, I had the opportunity to chat with David Salisbury, National Director for Immunisation at the UK’s Department of Health. He told me how proud he was of the success that had been achieved in getting people living in the UK to get their influenza shots. I mentioned that one group that had proven very tough to vaccinate in the USA was health-care workers. He rolled his eyes and confided that doctors in the UK were a hard lot to get vaccinated as well…

The Lancet  
Jul 23, 2011  Volume 378  Number 9788  p289 – 372
http://www.thelancet.com/journals/lancet/issue/current

Series
The next decade of vaccines: societal and scientific challenges
E Richard Moxon, Claire-Anne Siegrist

Summary
Vaccines against microbial diseases have improved the health of millions of people. In the next decade and beyond, many conceptual and technological scientific advances offer extraordinary opportunities to expand the portfolio of immunisations against viral and bacterial diseases and to pioneer the first vaccines against human parasitic and fungal diseases. Scientists in the public and private sectors are motivated as never before to bring about these innovations in immunisation. Many societal factors threaten to compromise realisation of the public health gains that immunisation can achieve in the next decade and beyond—understanding these factors is imperative. Vaccines are typically given to healthy individuals and safety issues loom high on the list of public concerns. The public needs to regain confidence in immunisation and trust the organisations responsible for the research, development, and implementation of vaccines. In the past, by use of a judicious amalgam of knowledge and empiricism, successful vaccines were largely developed by microbiologists who identified antigens that induced immune responses to conserved pathogen components. In the future, vaccines need to be developed against deadly diseases for which this strategy is often not feasible because of the extensive antigenic variability of relevant pathogens. High microbial diversity means that immunity after natural infection is often ineffective for prevention of disease on subsequent exposure, for example in HIV infection and malaria. Additionally, vaccines need to be generated to protect the people who are most vulnerable because of age or underlying diseases. Thus, in the future, a much deeper understanding of the immunological challenges—including the diversifying role of host genetics and environmental factors, leading perhaps to more personalised approaches—will be the touchstone for rational design and development of adjuvants that result in novel safe and effective vaccines.

The Lancet  
Jul 23, 2011  Volume 378  Number 9788  p289 – 372
http://www.thelancet.com/journals/lancet/issue/current

Series
Vaccine discovery and translation of new vaccine technology
Rino Rappuoli, Steven Black, Paul Henri Lambert

Summary
An unprecedented increase in new vaccine development has occurred over the past three decades. This activity has resulted in vaccines that protect against an increased range of vaccine-preventable diseases, vaccines that reduce the number of required injections, and vaccines with improved safety and purity. New methods of discovery, such as reverse vaccinology, structural biology, and systems biology, promise new vaccines for different diseases and efficient development pathways for these vaccines.    We expect development of vaccines not only for infectious diseases in children but also for healthy adults, pregnant women, and elderly people, and for new indications such as autoimmune disease and cancer. We have witnessed a concomitant development of new technology for assessment of vaccine safety to rapidly identify potential safety issues. Success of these new approaches will depend on effective implementation of vaccination programmes, creative thinking on the part of manufacturers and regulators as to how best to ensure that safe and effective vaccines are available in a timely manner, and improvement of public awareness about the benefits and risks of new vaccines in a way that encourages confidence in vaccines.

The Pediatric Infectious Disease Journal
August 2011 – Volume 30 – Issue 8  pp: A9-A10,633-728,e130-e154
http://journals.lww.com/pidj/pages/currenttoc.aspx

Original Studies
Risk Factors for Measles in Young Infants in an Urban African Area With High Measles Vaccination Coverage
Balé, Carlito; Garly, May-Lill; Martins, Cesario; Nielsen, Jens; Whittle, Hilton; Aaby, Peter
Pediatric Infectious Disease Journal. 30(8):689-693, August 2011.
doi: 10.1097/INF.0b013e31821786a4

Abstract:
Background: We examined risk factors for measles infection before measles vaccination at 9 months of age in Guinea-Bissau.

Methods: Among 1524 children enrolled in a trial of early measles vaccination at 4.5 months of age, we assessed the relative risk (RR) of measles before enrollment and the incidence rate ratio between 4.5 and 9 months of age for different groups.

Results: The incidence was high, with 4% having measles before 4.5 months and 10% having measles between 4.5 and 9 months of age. The main risk factor was the age of the mother; children of young mothers (age, 15–24 years) had lower antibody titers and higher risk of measles than children of older mothers both before 4.5 months (RR = 1.74 [1.02–2.96]) and between 4.5 and 9 months of age (incidence rate ratio = 1.59 [1.05–2.41]). Having no Bacillus Calmette-Gué;rin scar was associated with a higher risk of measles before 4.5 months of age (RR = 2.61 [1.54–4.45]). Children who were not breast-fed and had fever or respiratory infection at enrollment had a 2- to 4-fold higher risk of measles between 4.5 and 9 months of age.

Interpretation: Young mothers transmit lower titers of antibodies to their children and an increasing proportion of infants become susceptible to measles before the age of measles vaccination.

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

Volume 29, Supplement 2  pp. B1-B70 (22 July 2011)
Historical Influenza Pandemics

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

Volume 29, Supplement 1 pp. A1-A50 (1 July 2011)
Transfer of Technology for Pandemic Influenza Vaccine Production in Developing Countries

Vaccine
Volume 29, Issue 34 pp. 5575-5820 (5 August 2011)

Short Communications
Midwife attitudes: An important determinant of maternal postpartum pertussis booster vaccination
Pages 5591-5594
Spring Chenoa Cooper Robbins, Julie Leask, Elizabeth Helen Hayles, John K.H. Sinn

Background
The study was designed to determine the feasibility of implementing routine dTpa vaccination in the maternity ward to new mothers and to assess midwives’ attitudes toward pertussis booster vaccination, their perceived susceptibility and severity of pertussis in their patients’ communities, the perceived barriers and benefits of their patients’ vaccinations, and their cues to action and self-efficacy in delivering the vaccine.

Method
A self-completed questionnaire was developed to evaluate constructs of the Health Belief Model as well as to measure midwife demographic information. Questionnaires were completed by midwives during in-services at both a public hospital and a private hospital in New South Wales, Australia.

Results
Midwives who perceived ease in integrating booster vaccination into their workload were more likely to have high self-efficacy in delivering booster vaccination, measured through perceived importance of the role as part of their job (r = .449, p < .01), perceived confidence in delivering vaccination as part of their role (r = .608, p < .01), and perceived sufficient level of skills to deliver booster vaccination (r = .528, p < .01).

Conclusions
These results suggest that, of the factors measured, the most important to midwives in terms of providing pertussis booster vaccination to mothers was their own perceived self-efficacy of providing the vaccination. To increase midwives’ desire and confidence to provide pertussis booster to mothers, educational materials and skills workshops could be offered.

Vaccine
Volume 29, Issue 34 pp. 5575-5820 (5 August 2011)

Regular Papers
HPV vaccine and adolescent males
Pages 5595-5602
Paul L. Reiter, Annie-Laurie McRee, Jessica A. Kadis, Noel T. Brewer

Abstract
In 2009, the United States approved quadrivalent HPV vaccine for males 9–26 years old, but data on vaccine uptake are lacking. We determined HPV vaccine uptake among adolescent males, as well as stage of adoption and vaccine acceptability to parents and their sons. A national sample of parents of adolescent males ages 11–17 years (n = 547) and their sons (n = 421) completed online surveys during August and September 2010. Analyses used multivariate linear regression. Few sons (2%) had received any doses of HPV vaccine, and most parents and sons were unaware the vaccine can be given to males. Parents with unvaccinated sons were moderately willing to get their sons free HPV vaccine (mean = 3.37, SD = 1.21, possible range 1–5). Parents were more willing to get their sons vaccinated if they perceived higher levels of HPV vaccine effectiveness (β = 0.20) or if they anticipated higher regret about their sons not getting vaccinated and later developing an HPV infection (β = 0.32). Vaccine acceptability was also modest among unvaccinated sons (mean = 2.98, SD = 1.13, possible range 1–5). Sons were more willing to get vaccinated if they perceived higher peer acceptance of HPV vaccine (β = 0.39) or anticipated higher regret about not getting vaccinated and later developing an HPV infection (β = 0.22). HPV vaccine uptake was nearly nonexistent a year after permissive national recommendations were first issued for males. Vaccine acceptability was moderate among both parents and sons. Efforts to increase vaccine uptake among adolescent males should consider the important role of peer acceptance and anticipated regret.

Vaccine
Volume 29, Issue 33 pp. 5331-5574 (26 July 2011)

Costs and impact of meningitis epidemics for the public health system in Burkina Faso
Pages 5474-5480
Anaïs Colombini, Ousmane Badolo, Bradford D. Gessner, Philippe Jaillard, Emmanuel Seini, Alfred Da Silva

Abstract
Background
Epidemic meningococcal meningitis remains a serious health threat in the African meningitis belt. New meningococcal conjugate vaccines are relatively costly and their efficiency will depend on cost savings realized from no longer having to respond to epidemics.

Methods
We evaluated the cost and impacts to the public health system of the 2007 epidemic bacterial meningitis season in Burkina Faso through a survey at the different level of the health system. A micro-economic approach was used to evaluate direct medical and non medical costs for both the public health system and households, as well as indirect costs for households.

Results
The total national cost was 9.4 million US$ (0.69 US$ per capita). Health system costs were 7.1 million US$ (1.97% of annual national health spending), with 85.6% for reactive vaccination campaigns. The remaining 2.3 million US$ was borne by households of meningitis cases. The mean cost per person vaccinated was 1.45 US$; the mean cost of case management per meningitis case was 116.3 US$ when including household costs and 26.4 US$ when including only health sector costs. Meningitis epidemics disrupted all health services from national to operational levels with the main contributor being a large increase in medical consultations.

Conclusions
Preventive meningococcal conjugate vaccines should contribute to more efficient use of funds dedicated to meningitis epidemics and limit the disruption of routine health services.

Vaccine
Volume 29, Issue 33 pp. 5331-5574 (26 July 2011)

“Wait and see” vaccinating behaviour during a pandemic: A game theoretic analysis
Pages 5519-5525
Samit Bhattacharyya, Chris T. Bauch

Abstract
During the 2009 H1N1 pandemic, many individuals did not seek vaccination immediately but rather decided to “wait and see” until further information was available on vaccination costs. This behaviour implies two sources of strategic interaction: as more individuals become vaccinated, both the perceived vaccination cost and the probability that susceptible individuals become infected decline. Here we analyze the outcome of these two strategic interactions by combining game theory with a disease transmission model during an outbreak of a novel influenza strain. The model exhibits a “wait and see” Nash equilibrium strategy, with vaccine delayers relying on herd immunity and vaccine safety information generated by early vaccinators. This strategic behaviour causes the timing of the epidemic peak to be strongly conserved across a broad range of plausible transmission rates, in contrast to models without such adaptive behaviour. The model exhibits not only feedback mechanisms but also a feed-forward mechanism: a high initial perceived vaccination cost perpetuates high perceived vaccine costs (and lower vaccine coverage) throughout the remainder of the outbreak. This suggests that any effect of risk communication at the start of a pandemic outbreak will be amplified compared to the same amount of risk communication effort distributed throughout the outbreak.

Vaccine
Volume 29, Issue 32 pp. 5087-5330 (18 July 2011)

Short Communications
HPV vaccine information-seeking behaviors among US physicians: Government, media, or colleagues?
Pages 5090-5093
Shalanda A. Bynum, Teri L. Malo, Ji-Hyun Lee, Anna R. Guiliano, Susan T. Vadaparampil

Abstract
The multiple information sources available may pose a challenge to physicians in providing accurate human papillomavirus (HPV) vaccine information to patients. The purpose of this study was to describe physicians’ HPV vaccine information-seeking behaviors and assess if these behaviors differ by physician specialty and sociodemographic characteristics. In 2009, 1008 Family Physicians (FPs), Pediatricians (Peds), and Obstetricians/Gynecologists (OBGYNs) completed a survey to assess their HPV vaccine information-seeking behaviors and vaccination practices. The largest proportion obtained HPV vaccine information from professional organizations (50.0%), followed by the Advisory Council on Immunization Practices (ACIP) (36.0%), and medical conferences (33.1%). Peds and FPs were more likely to obtain vaccine information from the ACIP (p-values < 0.05). OBGYNs, non-White/Caucasian physicians, and those aged 40–49 were more likely to obtain vaccine information from internet websites (p-values < 0.05). There is a need for targeted HPV vaccine communication approaches based on sociodemographic and physician specialty characteristics.

Vaccine
Volume 29, Issue 32 pp. 5087-5330 (18 July 2011)

Regular Papers
Difficulties in the prevention of cervical cancer: Adults’ attitudes towards HPV vaccination 3 years after introducing the vaccine in Hungary
Pages 5122-5129
Erika Marek, Timea Dergez, Antal Kricskovics, Krisztina Kovacs, Gabor Rebek-Nagy, Katalin Gocze, Istvan Kiss, Istvan Ember, Peter Gocze

Abstract
Cervical cancer is one of the most prevalent gynaecological malignancies worldwide. The Hungarian incidence and mortality of this disease take the 4th–5th places within the European Union. A survey including 785 male and female adults was conducted to assess the knowledge and attitudes concerning HPV vaccination. We focused on the difficulties of the primary and secondary prevention of cervical cancer and examined some potential sociodemographic predictors of HPV vaccine acceptability.

Our findings have identified some important issues like: incomplete knowledge, intense distrust and financial concerns. Almost half of the college students (45.6%) are unaware of HPV infections. We confirmed previous findings that older age and female gender correlates with better knowledge on STDs, including HPV. We found that greater exposure to health information comes with better knowledge and more positive attitudes towards vaccination.

One quarter of survey respondents do not believe that cervical cancer may be prevented by vaccination. More than half of the adults do not trust national health care system and the preparedness of Hungarian doctors. General attitudes towards vaccination are broadly positive, 80% of survey participants had expressed desire towards HPV vaccination, however if there was a need to pay for the vaccination the willingness would decrease by half.

Primary prevention through HPV-focused educational programs, clear communication and financial support would be important for public health to reduce the high incidence and mortality of cervical cancer in Hungary in the future.

 Vaccine
Volume 29, Issue 32 pp. 5087-5330 (18 July 2011)

Regular Papers
HPV vaccination among a community sample of young adult women
Pages 5238-5244
Lisa E. Manhart, Albert J. Burgess-Hull, Charles B. Fleming, Jennifer A. Bailey, Kevin P. Haggerty, Richard F. Catalano

Abstract
Objectives
Despite the high efficacy of the human papillomavirus (HPV) vaccine, uptake has been slow and little data on psychosocial barriers to vaccination exist.

Methods
A community sample of 428 women enrolled in a longitudinal study of social development in the Seattle WA metropolitan area were interviewed about HPV vaccine status, attitudes, and barriers to HPV vaccination in spring 2008 or 2009 at age 22.

Results
Nineteen percent of women had initiated vaccination, 10% had completed the series, and 40% of unvaccinated women intended to get vaccinated. Peer approval was associated with vaccine initiation (adjusted prevalence ratio (APR) 2.1; 95% confidence interval 1.4–3.2) and intention to vaccinate (APR 1.4; 1.1–1.9). Belief the vaccine is <75% effective was associated with less initiation (APR 0.6; 0.4–0.9) or intention to vaccinate (APR 0.5; 0.4–0.7). Vaccine initiation was also less likely among cigarette smokers and illegal drug users, whereas intention to vaccinate was more common among women currently attending school or with >5 lifetime sex partners, but less common among women perceiving low susceptibility to HPV (APR 0.6; 0.5–0.9).

Conclusions
HPV vaccination uptake was low in this community sample of young adult women. Increasing awareness of susceptibility to HPV and the high efficacy of the vaccine, along with peer interventions to increase acceptability, may be most effective.

Vaccine
Volume 29, Issue 32 pp. 5087-5330 (18 July 2011)

Regular Papers
Economic burden of HPV-related cancers in France
Pages 5245-5249
I. Borget, L. Abramowitz, P. Mathevet

Abstract
Human papillomavirus (HPV) infection is associated with a range of diseases and cancers at different anatomical sites. In addition to its role as a necessary cause of cervical cancer, HPV is also associated with cancers of the vulva, vagina, anus, penis, head and neck. With the exception of cervical cancer, however, very few data are available on the economic burden of HPV-associated cancers. We assessed the annual costs associated with management of HPV-related cancers in France from the healthcare payers’ perspective. We used data from studies that employed similar methodologies to estimate the costs during 2006 for cervical cancer, vulvar and vaginal cancers, anal cancer, and penile cancer, and during 2007 for head and neck cancers. Data on hospital-management costs for cancer were derived from the French national hospital database. The costs of outpatient care and daily allowance costs were estimated using data from the French National Institute of Cancer report for 2007. The costs for HPV-related cancers were estimated according to the percentage of each cancer type attributable to HPV infection. The estimated total costs associated with HPV-related cancers in France were €239.7 million. The overall costs in men were €107.2 million, driven mainly by head and neck cancers (€94.6 million). The total costs in women were €132.5 million, due mainly to invasive cervical cancer (€83.9 million). The costs associated with HPV-related cancers are important to consider when evaluating the overall benefits of HPV vaccination in males and females.

Vaccine
Volume 29, Issue 32 pp. 5087-5330 (18 July 2011)

Regular Papers
Human papillomavirus (HPV) vaccination: Perception and practice among French general practitioners in the year since licensing
Pages 5322-5328
D. Lutringer-Magnin, J. Kalecinski, G. Barone, Y. Leocmach, V. Regnier, A.C. Jacquard, B. Soubeyrand, P. Vanhems, F. Chauvin, C. Lasset

Abstract
Acceptance of the Human Papillomavirus (HPV) vaccine by targeted populations will depend to a large extent on its acceptability among physicians. We examined the perceptions, attitudes and practices of general practitioners (GPs) in relation to HPV vaccination.

From November 2007 to April 2008, a cross-sectional survey was carried out among a representative 5% sample of GPs in the large Rhône-Alpes region of France. Both quantitative (self-administered questionnaire) and qualitative (interview) approaches were used.

During the month preceding the survey, 75.6% of the 279 GPs who responded had given at least one HPV vaccination and 47.6% had given a vaccination at the routine target age of 14 years. Overall, 80.8% of GPs reported a favourable opinion about HPV vaccination, 17.4% were uncertain and 1.8% were opposed. The main justification for a favourable opinion related to the public health benefits of the HPV vaccination (cited by 60% of those favouring vaccination). The main justification for an “opposed or uncertain” opinion was the too recent introduction of the vaccine (cited by 43.4%). The major difficulties in providing HPV vaccination were patients’ concerns about potential side effects (cited by 37% of the respondents) and the target age of 14 years (28.9%).   Interviews suggested that the concern about age may relate to the need, as perceived by GPs, to discuss sexually transmitted infections with adolescent patients. A favourable opinion about HPV vaccination was associated with seeing more female patients per week, younger age, and GPs’ intention to recommend hepatitis B vaccination.

This representative survey of GPs in a major region of France finds a favourable opinion about the HPV vaccine and widespread use of it, despite some concerns that the recent introduction of the vaccine means that we do not yet fully understand the potential for side effects and about the recommended target age of recipients.

The pdf version of Vaccines: The Week in Review  18 July 2011 comprising the all the posts below for this date is available here: Vaccines_The Week in Review_18 July 2011

    The Global Fund said it welcomed the decision by the Netherlands to commit a further €163.5 million for the period 2011-13. The Netherlands made the significant new funding pledge “despite a reduction in the country’s overall official development assistance (ODA) budget. The Global Fund noted. The Netherlands is “the tenth largest donor to the Global Fund and has been among the most generous in terms of its contributions as a percentage of gross national income. It has pledged more than €648 million, including this latest pledge, to the Global Fund since its creation in 2002.”

http://www.theglobalfund.org/en/mediacenter/pressreleases/2001-07-15_Global_Fund_welcomes_the_Netherlands_decision_to_commit_%E2%82%AC163_5_million/

    PAHO said a regional consultation will be held with the countries of the Hemisphere from November to December 2011 to discuss the plan of action for the Decade of Vaccines. The announcement was part of a meeting arranged by the Pan American Health Organization/World Health Organization (PAHO/WHO) with representatives of the Decade of Vaccines Collaboration and eight countries of the Hemisphere in Buenos Aires during the XIX Meeting of the Technical Advisory Group on Vaccine-preventable Diseases. The objective of this meeting, held on 8 July, was “to share ideas to ensure that the strategies and lines of action for the Decade of Vaccines respond to the challenges facing national immunization programs in the Americas.” In the consultation programmed for late 2011, the goal will be to “include the heads of immunization programs, the people in charge of epidemiological surveillance, and the chairs and members of national immunization advisory committees.” Christopher Elias, Co-Chair of the Steering Committee of the Decade of Vaccines Collaboration, “highlighted the efforts and achievements of immunization programs in the Americas, making special reference to the PAHO/WHO Revolving Fund, a group procurement mechanism for the purchase of vaccines, syringes, and related supplies for the Organization’s Member States.

http://new.paho.org/hq/index.php?option=com_content&task=view&id=5697&Itemid=1926

The MMWR Weekly for July 15, 2011 / Vol. 60 / No. 2 includes:

Dengue Virus Infections Among Travelers Returning from Haiti — Georgia and Nebraska, October 2010

The Weekly Epidemiological Record (WER) for 15 July 2011, vol. 86, 29 (pp 301–316) includes: Rubella vaccines: WHO position Paper

“In an updated position paper…WHO recommends that countries use the opportunity of accelerated measles control and elimination activities to introduce rubella-containing vaccine. All countries that have not yet introduced rubella vaccine, and are providing two doses of measles vaccine using routine immunization and/or supplementary immunization activities should consider the inclusion of rubella-containing vaccine in their immunization programme.

http://www.who.int/entity/wer/2011/wer8629.pdf

Twitter Watch
A selection of items of interest this week from a variety of twitter feeds. This capture is highly selective and by no means intended to be exhaustive.

unpublications UN Publications
Check out the yearly assessment of global progress towards the MDGs, in the #MDG Report 2011 at bit.ly/pdFX83

PublicHealth APHA
Public health returns to the big screen: Trailer released for Contagion, upcoming movie on airborne virus outbreak: http://goo.gl/CuhC9

PIH Partners In Health
VIDEO: @PIH‘s Paul Farmer interviewed about his new book & humanitarian aid to #Haiti http://ow.ly/5Eysl via @priTheWorld

GAVIAlliance GAVI Alliance
“Will CEOs also agree to join GAVI in this fight?” – @billroedy‘s challenge to CEOs, as #GAVI‘s envoy: http://ht.ly/5DPVx #globalhealth

wellcometrust Wellcome Trust
#Globalhealth – the biggest #bioethics challenge of all? http://wellc.me/p56s84 « @nuffbioethics guest post (& video) on our blog.

MalariaVaccine PATH MVI
Have you seen the @gatesfoundation‘s We Can End Malaria infographic? http://bit.ly/k0Sgef

British Medical Journal
16 July 2011 Volume 343, Issue 7815
http://www.bmj.com/content/current

Editorials
Safety of adjuvanted pandemic influenza A (H1N1) 2009 vaccines
Frank DeStefano, Claudia Vellozzi, Lawrence B Schonberger, Robert T Chen
BMJ 2011;343:doi:10.1136/bmj.d4159 (Published 12 July 2011)

Extract
Risk of Guillain-Barré syndrome, if any, is smaller than for 1976 swine flu vaccines

Guillain-Barré syndrome has been a focus of safety monitoring since the report in 1976 of an increased risk of almost one extra case per 100 000 influenza vaccinations of swine origin. 1 Subsequent studies have shown either no increased risk or a slightly increased risk (1-2 per million vaccinees) after vaccination for seasonal flu. 2 The spread of the 2009 pandemic influenza A (H1N1) virus, which contained genes of swine origin, resulted in the development and widespread use of influenza A (H1N1) monovalent vaccines (2009 H1N1 vaccines). 3 These included formulations containing oil in water adjuvants that had not previously been widely used in flu vaccines in Europe. Although available evidence suggested that the adjuvanted vaccines had acceptable safety profiles, 3 data on the risk of rare adverse events, such as Guillain-Barré syndrome, were limited.

In the linked study (doi: 10.1136/bmj.d3908 ), Dieleman and colleagues report the first data on adjuvanted 2009 H1N1 vaccines and the risk of Guillain-Barré syndrome from a …

Guillain-Barré syndrome and adjuvanted pandemic influenza A (H1N1) 2009 vaccine: multinational case-control study in Europe
Jeanne Dieleman, Silvana Romio, Kari Johansen, Daniel Weibel, Jan Bonhoeffer, Miriam Sturkenboom, and the VAESCO-GBS Case-Control Study Group
BMJ 2011;343:doi:10.1136/bmj.d3908 (Published 12 July 2011)
[Free full text]

Abstract
Objective  To assess the association between pandemic influenza A (H1N1) 2009 vaccine and Guillain-Barré syndrome.

Design  Case-control study.

Setting  Five European countries.

Participants 104 patients with Guillain-Barré syndrome and its variant Miller-Fisher syndrome matched to one or more controls. Case status was classified according to the Brighton Collaboration definition. Controls were matched to cases on age, sex, index date, and country.

Main outcome measures   Relative risk estimate for Guillain-Barré syndrome after pandemic influenza vaccine.

Results   Case recruitment and vaccine coverage varied considerably between countries; the most common vaccines used were adjuvanted (Pandemrix and Focetria). The unadjusted pooled risk estimate for all countries was 2.8 (95% confidence interval 1.3 to 6.0). After adjustment for influenza-like illness/upper respiratory tract infection and seasonal influenza vaccination, receipt of pandemic influenza vaccine was not associated with an increased risk of Guillain-Barré syndrome (adjusted odds ratio 1.0, 0.3 to 2.7). The 95% confidence interval shows that the absolute effect of vaccination could range from one avoided case of Guillain-Barré syndrome up to three excess cases within six weeks after vaccination in one million people.

Conclusions   The risk of occurrence of Guillain-Barré syndrome is not increased after pandemic influenza vaccine, although the upper limit does not exclude a potential increase in risk up to 2.7-fold or three excess cases per one million vaccinated people. When assessing the association between pandemic influenza vaccines and Guillain-Barré syndrome it is important to account for the effects of influenza-like illness/upper respiratory tract infection, seasonal influenza vaccination, and calendar time.

Clinical Infectious Diseases
Volume 53 Issue 3 August 1, 2011
http://www.journals.uchicago.edu/toc/cid/current

ARTICLES AND COMMENTARIES
Daniel C. Payne, Mary Allen Staat, Kathryn M. Edwards, Peter G. Szilagyi, Geoffrey A. Weinberg, Caroline B. Hall, James Chappell, Aaron T. Curns, Mary Wikswo, Jacqueline E. Tate, Benjamin A. Lopman, Umesh D. Parashar, and the New Vaccine Surveillance Network (NVSN)
Direct and Indirect Effects of Rotavirus Vaccination Upon Childhood Hospitalizations in 3 US Counties, 2006–2009
Clin Infect Dis. (2011) 53(3): 245-253 doi:10.1093/cid/cir307

Active, population-based surveillance from 2006-2009 observed dramatic decreases in rotavirus hospitalization rates among children in 3 US counties. In 2008, reductions were prominent among both vaccine eligible age groups and older, largely unvaccinated children; the latter likely resulting from indirect protection.

Clinical Infectious Diseases
Volume 53 Issue 3 August 1, 2011
http://www.journals.uchicago.edu/toc/cid/current

Brief Reports
Wing-Hong Seto, Benjamin J. Cowling, Hung-Suet Lam, Patricia T. Y. Ching, Mei-Lam To, and Didier Pittet
Clinical and Nonclinical Health Care Workers Faced a Similar Risk of Acquiring 2009 Pandemic H1N1 Infection
Clin Infect Dis. (2011) 53(3): 280-283 doi:10.1093/cid/cir375

Abstract
(See the editorial commentary by Drumright and Holmes, on pages 284–286.)

Reporting of confirmed pandemic influenza A virus (pH1N1) 2009 infection was mandatory among health care workers in Hong Kong. Among 1158 confirmed infections, there was no significant difference in incidence among clinical versus nonclinical staff (relative risk, 0.98; 95% confidence interval, 0.78–1.20). Reported community exposure to pH1N1 was common and was similar in both groups.

Lydia N. Drumright and Alison H. Holmes
Editorial Commentary: Monitoring Major Illness in Health Care Workers and Hospital Staff
Clin Infect Dis. (2011) 53(3): 284-286 doi:10.1093/cid/cir384

Extract
During the past 3 decades, our understanding of both the biology and epidemiology of infectious diseases has vastly improved because of methodological and technological developments. However, researchers have yet to take full advantage of the tools available to them, particularly in health care settings. Most studies of nosocomial influenza and other infections focus primarily on patients, but health care workers (HCWs) [ 1– 3] and hospitals [ 4] are likely to be central to disease transmission, prevention, and risk. Unfortunately, most studies of disease transmission within hospitals treat HCWs as “fixtures” rather than dynamic members of a disease transmission network, and there has been inadequate investment in the study of disease transmission among HCWs. This is a missed opportunity to develop a critical understanding of disease epidemiology, thereby increasing patient safety and supporting and protecting HCWs as one of society’s most important and valued resources.

The study in this month’s Clinical Infectious Diseases by Seto and colleagues highlights the importance of detailed surveillance and research of infectious diseases among HCWs in understanding the roles of HCWs and patients in nosocomial transmission. It demonstrates the value of an organizational ability to adopt and integrate innovative methods into hospital procedures, and also some missed opportunities to gain a more complete understand the observations.

SURVEILLANCE OF ILLNESS IN HEALTH CARE WORKERS POPULATIONS

An area in need of urgent attention is surveillance of infectious diseases among HCWs, which was magnified by the severe acute respiratory syndrome epidemic [ 5]. Although the dearth of surveillance in this population persists, recognition of the utility and value of collecting such data is beginning to emerge. Seto et al report on an impressive system of monitoring and surveillance of all hospital and clinic staff in 38 hospitals and 74 outpatient …

JAMA   
July 13, 2011, Vol 306, No. 2, pp 127-226
http://jama.ama-assn.org/current.dtl

Commentaries
The WHO Pandemic Influenza Preparedness Framework: A Milestone in Global Governance for Health
David P. Fidler, Lawrence O. Gostin
JAMA. 2011;306(2):200-201.doi:10.1001/jama.2011.960

[First 150 words]
After years of negotiations, the World Health Organization (WHO) reached agreement on a pandemic influenza preparedness (PIP) framework for the sharing of influenza viruses and access to vaccines and other benefits in April 2011. 1 The framework addresses a troubling controversy—should low- and middle-income countries share influenza virus specimens with WHO without assurances that benefits derived from sharing will be equitably distributed?

During the avian influenza A(H5N1) outbreaks in late 2006, Indonesia refused to share virus specimens with WHO, claiming it was unfair to give pharmaceutical companies access. Industry would use viruses to patent vaccines and antiviral medications that Indonesia could not afford. Indonesia asserted sovereignty over viruses isolated within its territory, grounded on the Convention on Biological Diversity. Indonesia also argued that the 2005 International Health Regulations did not require states to share H5N1 viruses. 2 The international community feared that Indonesia’s refusal to share would impede surveillance and …

Medical Decision Making (MDM)
July/August 2011; 31 (4)
http://mdm.sagepub.com/content/current

Editorials
Using Models to Make Policy: An Inflection Point?
Med Decis Making July/August 2011 31: 527-529, doi:10.1177/0272989X11412079

Extract
The use of models in guidelines making may be reaching a kind of inflection point, based on the evolution of 2 separate—but coincidentally converging—lines of work in the fields of guidelines making and model building. The result will be improved transparency about the differences among guidelines and the reasons for differences. Transparency is particularly important in an age when guidelines for the same problem, made by different organizations, may vary substantially and when the “trustworthiness” or quality of guidelines has been questioned because of weaknesses in the steps by which guidelines are made. Users of guidelines— clinicians, patients, and policy makers—need transparency to make informed choices among guidelines.

Transparency is challenging because of the detail, complexity, and kinds of expertise involved at each of the 3 steps in guidelines making:
– Evidence is gathered systematically, evaluated for quality, and selected on the basis of strength for use in quantitative analysis.
– Analysis of the evidence is conducted quantitatively, often through modeling, to show the likely outcomes of different intervention strategies.
– Using the results of steps 1 and 2, guidelines groups then decide among different strategies, based on the decision makers’ values and decision thresholds.

In 2011, it is increasingly clear what kinds of expertise should be involved in each step and which methods will help ensure trustworthiness. Steps 1 and 2 may in some instances be done by “neutral” groups, expert in clinical research methodology and modeling, whereas groups that actually create guidelines may focus on step 3.

To understand and improve the overall process, the Institute of Medicine (IOM) of the US National Academy of Sciences recently released 2 reports. One, titled “Finding What Works in Health Care: Standards for Systematic Reviews,” is concerned with the quality of step 1, the process used to gather, review, and “weigh” evidence. 1 The …

PLoS Medicine
(Accessed 17 July 2011)
http://www.plosmedicine.org/article/browse.action?field=date

Individualized Cost-Effectiveness Analysis
John P. A. Ioannidis, Alan M. Garber Essay, published 12 Jul 2011
doi:10.1371/journal.pmed.1001058

Summary Points
– Cost-effectiveness analyses typically express their principal results as incremental cost-effectiveness ratios (ICERs).
– ICERs are useful in making decisions for allocation of resources at a population level, but typical ICER measures have shortcomings when used for individual decisions.
– For the same ICER, the cost-effectiveness may vary among individuals because not everyone assigns the same priorities to specific outcomes, shares the same attitudes toward risk, or faces the same distribution of expected outcomes.
– ICER information can be enhanced by providing additional metrics that individualize cost-effectiveness analyses.
– These metrics include the per person net benefit and cost, subgroup ICER estimates for observed measured sources of heterogeneity, and distributions of outcomes and costs for unknown or unmeasured sources of heterogeneity.

Science Translational Medicine
13 July 2011 vol 3, issue 91
http://stm.sciencemag.org/content/current

Perspectives: Vaccine Design
Vaccine Design Reaches the Atomic Level
Peter D. Kwong and Lawrence Shapiro
13 July 2011: 91ps29

Abstract
The genetic diversity of pathogens presents a challenge to the development of broadly effective vaccines. In this issue, Scarselli et al. combine atomic-level structural information with genomics and classical vaccinology to design a single immunogen that elicits protective immunity against more than 300 natural variants of the bacterial pathogen meningococcus B. This accomplishment provides a glimpse of the power of structure-based vaccine design to create immunogens capable of eliciting protective responses against genetically diverse pathogens.

Science Translational Medicine
13 July 2011 vol 3, issue 91
http://stm.sciencemag.org/content/current

Research Articles
Vaccine Design
Rational Design of a Meningococcal Antigen Inducing Broad Protective Immunity
Maria Scarselli, Beatrice Aricò, Brunella Brunelli, Silvana Savino, Federica Di Marcello, Emmanuelle Palumbo, Daniele Veggi, Laura Ciucchi, Elena Cartocci, Matthew James Bottomley, Enrico Malito, Paola Lo Surdo, Maurizio Comanducci, Marzia Monica Giuliani, Francesca Cantini, Sara Dragonetti, Annalisa Colaprico, Francesco Doro, Patrizia Giannetti, Michele Pallaoro, Barbara Brogioni, Marta Tontini, Markus Hilleringmann, Vincenzo Nardi-Dei, Lucia Banci, Mariagrazia Pizza, and Rino Rappuoli
13 July 2011: 91ra62
Abstract

The sequence variability of protective antigens is a major challenge to the development of vaccines. For Neisseria meningitidis, the bacterial pathogen that causes meningitis, the amino acid sequence of the protective antigen factor H binding protein (fHBP) has more than 300 variations. These sequence differences can be classified into three distinct groups of antigenic variants that do not induce cross-protective immunity. Our goal was to generate a single antigen that would induce immunity against all known sequence variants of N. meningitidis. To achieve this, we rationally designed, expressed, and purified 54 different mutants of fHBP and tested them in mice for the induction of protective immunity. We identified and determined the crystal structure of a lead chimeric antigen that was able to induce high levels of cross-protective antibodies in mice against all variant strains tested. The new fHBP antigen had a conserved backbone that carried an engineered surface containing specificities for all three variant groups. We demonstrate that the structure-based design of multiple immunodominant antigenic surfaces on a single protein scaffold is possible and represents an effective way to create broadly protective vaccines.

Podcast
Vaccine Design
Science Translational Medicine Podcast: 13 July 2011
Rino Rappuoli and Orla Smith
13 July 2011: 91pc8
http://podcasts.aaas.org/science_transl_med/ScienceTranslMed_110713.mp3

Tropical Medicine & International Health
August 2011  Volume 16, Issue 8  Pages 905–1041
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue

Implementation research
Communities of practice: the missing link for knowledge management on implementation issues in low-income countries? (pages 1007–1014)
Bruno Meessen, Seni Kouanda, Laurent Musango, Fabienne Richard, Valéry Ridde and Agnès Soucat
Article first published online: 12 MAY 2011 | DOI: 10.1111/j.1365-3156.2011.02794.x

Summary
The implementation of policies remains a huge challenge in many low-income countries. Several factors play a role in this, but improper management of existing knowledge is no doubt a major issue. In this article, we argue that new platforms should be created that gather all stakeholders who hold pieces of relevant knowledge for successful policies. To build our case, we capitalize on our experience in our domain of practice, health care financing in sub-Saharan Africa. We recently adopted a community of practice strategy in the region. More in general, we consider these platforms as the way forward for knowledge management of implementation issues.

A pdf version of Vaccines: The Week in Review  11 July 2011 comprising the posts below for this date is available here: Vaccines_The Week in Review_11 July 2011

WHO: Global Alert and Response (GAR): Poliomyelitis in Pakistan
[Initial text; bolding by editor]  7 July 2011

Pakistan has reported wild poliovirus type 3 (WPV3) isolated from a 16-month old child with onset of paralysis on 9 June 2011, from a conflict-affected, inaccessible area of Khyber Agency, Federally Administered Tribal Areas (FATA). This is the only case of WPV3 detected in Asia in 2011. WPV3 transmission in Asia is on the verge of elimination, with the last case occurring more than six months ago, on 18 November 2010 (also from Khyber Agency, FATA).

Confirmation of continuation of WPV3 transmission in tribal areas of Pakistan has significant implications for the global effort to eradicate WPV3, particularly as Asia is on the verge of eliminating circulation of this strain. The detection of WPV3 in Pakistan represents the risk that it may spread from this transmission focus to other WPV3-free areas of Asia and beyond. Globally, WPV3 transmission is at historically low levels in 2011, with other circulation of this strain restricted to parts of west Africa (17 cases in Côte d’Ivoire, Guinea, Mali and Niger), Nigeria (five cases) and Chad (three cases). The risk of onward spread of WPV3 is deemed as high by the World Health Organization (WHO), particularly given large-scale population movements within Pakistan, between Pakistan and Afghanistan, and expected large-scale population movements associated with Umrah and the upcoming Hajj (pilgrimage to Mecca, Kingdom of Saudi Arabia) in the coming few months.

In 2011, supplementary immunization activities (SIAs) in Pakistan have been inadequate in quality in key high-risk areas and a significant proportion of children remained inaccessible in conflict affected tribal areas. In FATA, particularly in Khyber agency, nearly 50% of children have been regularly missed during SIAs for the last two years. In addition to challenges relating to reaching children in insecure areas of Khyber Pakhtunkhwa and FATA, significant operational challenges continue to mar the quality of SIAs in accessible areas of Khyber and in other key transmission areas of the country, notably in the provinces of Balochistan and Sindh. In addition to confirmation of the only WPV3 case in Asia in 2011, Pakistan is affected by country-wide geographical transmission of wild poliovirus type 1 (WPV1), with 57 confirmed WPV1 cases in 2011 (as at 5 July 2011), compared with 14 WPV1 cases for the same period in 2010…

http://www.who.int/csr/don/2011_07_07/en/index.html

The International AIDS Vaccine Initiative (IAVI) announced the appointment of Margaret (Margie) McGlynn as President and CEO. She had been a member of the IAVI Board of Directors since July 2010, and replaces Seth Berkley, IAVI’s Founding President and CEO.  IAVI said that in this role Ms. McGlynn “will be responsible for fostering an environment within IAVI that promotes innovation and flexibility and encourages collaboration with partners, while maintaining a strong commitment to engaging researchers, governments and communities in those countries hardest hit by the pandemic. As President and CEO, McGlynn will serve as an ex-officio member of IAVI’s Board of Directors.”

Ms. McGlynn, who had a 26-year career at Merck and led Merck’s vaccines and infectious diseases business, commented, “I have long been passionate about ensuring that people in the developing world can access life-saving medicines and vaccines, and I am delighted that, in my new role as CEO of IAVI, I will be able to contribute to advancing the search for an effective AIDS vaccine that one day will be available to all of those who need it. I am excited to lead IAVI and work with our partners to build upon the current renaissance in AIDS vaccine research. I look forward to working closely with the Board and senior leadership team to guide IAVI on its mission.” IAVI Founder Seth Berkley, now CEO of the GAVI Alliance, said, “Margie has the right combination of passion, experience and technical understanding to lead IAVI into its next phase. I am confident that IAVI will continue to make a major impact as it pursues its goal of ensuring the development of an AIDS vaccine, and I am secure in the knowledge that I am handing over the reins to an individual as capable and experienced as Margie. I look forward to seeing great things happen at IAVI in the coming years.”

http://www.businesswire.com/news/home/20110707006677/en/IAVI-Appoints-Margaret-McGlynn-President-Chief-Executive

Kiwanis International said it “is mobilizing its Kiwanis members across the globe to provide a much needed push to eliminate maternal and neonatal tetanus (MNT).” Kiwanis International announced a pledge to raise US$110 million by 2015 for the project, described as the largest single pledge for global MNT elimination efforts. The funds “will ultimately protect at least 61 million women and their future babies who are at risk of this deadly disease.” The Eliminate Project will involve “…the vast network of dedicated Kiwanians (who) will provide the funds necessary for UNICEF and its partners to get tetanus vaccines to millions of women,” said President and CEO of the U.S. Fund for UNICEF Caryl Stern. “We are deeply honored by their commitment to saving so many lives around the world.”  www.TheEliminateProject.org.

GENEVA, July 7, 2011 /PRNewswire-USNewswire/

http://www.prnewswire.com/news-releases/kiwanis-international-pledges-to-raise-us110-million-to-eliminate-maternal-and-neonatal-tetanus-125143034.html

GAVI said it welcomed the Australian Government-commissioned Independent Review of Aid Effectiveness and “commends the Australian Government on clearly and transparently setting out the strategic directions for Australia’s aid programme through to 2015.”  The review “commends GAVI’s critical work in providing life saving vaccines to children in the poorest countries in the world and for offering Australia a ‘proven, respected and innovative multilateral mechanism for further developing its interest in supporting countries in Africa, while at the same time minimizing the risk of aid fragmentation’ ”.

http://www.gavialliance.org/media_centre/statements/australian_review_aid_effectivness_20110706.php

The U.S. Food and Drug Administration approved Boostrix vaccine to prevent tetanus, diphtheria, and pertussis (whooping cough) in people ages 65 and older. Currently, there are vaccines approved for the prevention of tetanus and diphtheria that can be used in adults 65 and older. Boostrix, which is given as a single-dose booster shot, is the first vaccine approved to prevent all three diseases in older people.

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm262390.htm

WHO released WHO/IVB/11.06: Report on the WHO Quantitative Immunization and Vaccines Related Research (QUIVER) advisory meeting. Geneva, 5-7 October 2010. The document reports on the fourth annual meeting of the WHO Quantitative Immunization and Vaccine-Related Research (QUIVER) advisory committee held in October 2010 in Geneva.

http://whqlibdoc.who.int/hq/2011/WHO_IVB_11.06_eng.pdf

WHO issued a call for experts to serve on a new WHO SAGE Working Group on Yellow Fever Vaccines and “solicits proposals for experts to serve on this working group for which the terms of reference and needed expertise appear in the attached document.” Proposals for nominations should be sent by email to SAGE Executive Secretary at sageexecsec@who.int with curriculum vitae and indication of expertise no later than 24 July 2011.

Terms of reference and required expertise for SAGE Working Group on Vaccination in Yellow Fever Vaccines pdf, 47kb

http://www.who.int/immunization/sage/working_mechanisms/en/index.html

The Weekly Epidemiological Record (WER) for 8 July 2011, vol. 86, 28 (pp 289–300) includes: Validation of neonatal tetanus elimination in Burundi and the Comoros by a lot quality-assurance cluster sampling survey, 1 October 2008–30 September 2009

http://www.who.int/entity/wer/2011/wer8628.pdf