Twitter Watch: Week to 11 July 2011

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.

globalfundnews The Global Fund
Making AIDS History – Ending the epidemic. Capitol Hill Summit, 26 July in Washington #amfAR via @scispeaksblog…

Eurovaccine ECDC Eurovaccine
WHO Action Plan increasing supply and use of influenza vaccine launches into 2nd 5 years #influenza #pandemic #vaccine

pahowho PAHO/WHO
ProVac Project to Support Countries on Introduction of New Vaccines Presented by Jon Andrus via @AddThis

KaiserFamFound Kaiser Family Found
Global Health Policy Report: UN Report Shows Significant Progress Toward Reaching MDGs, But Mixed Results In Some Areas

PublicHealth APHA
Among its experiments, the #STS135 shuttle crew will be exploring vaccine development. Public health in space!

GAVISeth Seth Berkley
Delighted Margie McGlynn, former Pres Merck Vaccines chosen as CEO @AIDSVaccine just 4 days after my departure. Known her for years! Great!

AIDSvaccine IAVI
IAVI (@AIDSvaccine) pleased to announce appointment of Margaret McGlynn as President & CEO: #HIV #vaccine #globalhealth

gatesfoundation Gates Foundation
After 20+ years, @Rotary and partners are “this close” to ending polio: #endpolio #vaccines

GAVIAlliance GAVI Alliance
RT @gaviseth: Reborn as GAVISeth. It feels strange, only 1 letter & still passionate about vaccines! From the doc formerly known as IAVISeth

UNDP UN Development
Millennium Development Goals Report 2011: World is still on track to achieve the #MDGs @un #globaldev #poverty

NCDs and the UN summit

British Medical Journal
9 July 2011 Volume 343, Issue 7814

Editor’s Choice
NCDs and the UN summit
Fiona Godlee, editor, BMJ

In September the United Nations will hold its first ever high level summit on non-communicable diseases. Richard Smith has been keeping BMJ readers up to speed on developments via his blog ( ) and it’s clear that the build up to this important meeting is gaining pace. Since the summit was announced last year, questions about who and what should be included have been hotly debated. The need to prioritise against a huge potential list of conditions has led to a focus on four main disease groups that share causative factors: cardiovascular disease, diabetes, chronic obstructive pulmonary disease, and common cancers. The summit won’t address mental health, as some …

Global response to non-communicable disease
UnitedHealth, National Heart, Lung, and Blood Institute Centers of Excellence
BMJ 2011;342:doi:10.1136/bmj.d3823 (Published 30 June 2011)

The forthcoming UN meeting on non-communicable diseases is an important opportunity for promoting global action on conditions that have been neglected. A network of researchers from low and middle income countries describes what is needed

Despite causing 63% of global deaths, with 80% occurring in the developing world, 1 non-communicable diseases did not feature in the millennium development goals and account for less than 3% of global health aid. 2 The huge global burden from non-communicable diseases is expected to increase substantially over the next few years, and urgent action is needed (box 1). 1 3 In September the United Nations will hold a high level summit on non-communicable diseases. The only previous UN meeting on health, in 2001, led to the Global Fund to Fight AIDs, Tuberculosis, and Malaria, which has saved millions of lives. We, a group of researchers mostly from low and middle income countries, describe how the UN meeting provides an opportunity to mount a major global response to non-communicable diseases, how its success can be made more likely, and what outcomes we would like to see. ..

Box 1: Burden of non-communicable disease13

– 36 million deaths a year, 63% of global deaths

– 80% of deaths from cardiovascular and diabetes and almost 90% of deaths from chronic obstructive pulmonary disease occur in low and middle income countries

– 29% of deaths from non-communicable diseases in low and middle income countries occur in people under 60 compared with 13% in high income countries

– Deaths are projected to increase by 15% between 2010 and 2020 with increases of 20% in Africa, the Middle East, and South East Asia

– Almost 6 million people a year die from tobacco use, 3.2 million from physical inactivity, 2.3 million from the harmful use of alcohol, 7.8 million from raised blood pressure, and 2.8 million from being overweight or obese..

Research Aims to Boost Pertussis Control

July 6, 2011, Vol 306, No. 1, pp 11-114

Medical News & Perspectives
Research Aims to Boost Pertussis Control
M. J. Friedrich
JAMA. 2011;306(1):27-29.doi:10.1001/jama.2011.888

[First 150 words…]
Before the availability of the pertussis vaccine, more than 270 000 cases and 10 000 deaths were reported annually in the United States. Mass immunization programs begun around the world in the 1940s almost eradicated childhood cases of the disease by the 1970s.

Yet in the last 2 decades, the number of cases of pertussis, or whooping cough, has been increasing in countries with high vaccination rates, particularly among 10- to 19-year-olds and infants younger than 5 months. Pertussis cases peak every 3 to 5 years, and the United States and other countries are in the midst of another upswing.       According to the US Centers for Disease Control and Prevention (CDC), more than 21 000 cases were reported in 2010, the highest number since the 1950s.

A resurgence of pertussis in countries with high vaccination rates, particularly among infants younger than 5 months and 10- to 19-year-olds, is not well understood…

Publicly-funded HPV Vax Programs: Population Effectiveness, Not Efficacy Should Decide

Journal of Infectious Diseases
Volume 204 Issue 3 August 1, 2011

Philip E. Castle and Fang-Hui Zhao
Editor’s Choice: Population Effectiveness, Not Efficacy, Should Decide Who Gets Vaccinated Against Human Papillomavirus via Publicly Funded Programs
J Infect Dis. (2011) 204(3): 335-337 doi:10.1093/infdis/jir287

No abstract; Final paragraph
“…From a comparative and cost-effectiveness perspective, based on current information, it is probably a better health care investment of public or insurer dollars to maximize vaccination coverage in young women rather than widely targeting both men and women. As shown in Australia, men benefit soon after implementation of a high-coverage, female-only HPV vaccination program [16]. Because MSM may not benefit from the “herd immunity” of vaccinating women, targeted vaccination of MSM for the prevention of genital warts and anal cancer may be appropriate and desirable [17], as well as cost-effective, provided that enough men self-identify as MSM at an age when HPV vaccination will provide substantial benefit. Thus, for publicly financed programs or insurers, the most rational, cost-effective vaccination strategy is comprehensive coverage in HPV-naive girls (ages 11–12) and targeted vaccination in selected male subpopulations, rather than widespread vaccination of both sexes. Other potential recipients who are willing to pay out of pocket should make a decision informed by the potential benefits and costs. As more data become available to address the uncertainties regarding the benefits of HPV vaccination and/or costs decrease, the most cost-effective use of HPV vaccines may need to be revisited.

Incremental Impact of Adding Boys to Current HPV Vaccination Programs: Herd Immunity

Journal of Infectious Diseases
Volume 204 Issue 3 August 1, 2011

Marc Brisson, Nicolas van de Velde, Eduardo L. Franco, Mélanie Drolet, and Marie-Claude Boily
Editor’s Choice: Incremental Impact of Adding Boys to Current Human Papillomavirus Vaccination Programs: Role of Herd Immunity
J Infect Dis. (2011) 204(3): 372-376 doi:10.1093/infdis/jir285

(See the editorial commentary by Castle and Zhao, on pages 335–7.)

Our aim was to examine the potential incremental impact of vaccinating boys against human papillomavirus (HPV) on vaccine-type infection in females and males, using an individual-based HPV transmission-dynamic model. Under base assumptions (vaccine efficacy = 99%, duration of protection = 20 years, coverage = 70%), vaccinating 12-year-old boys, in addition to girls, resulted in an incremental reduction in HPV-16/18 (HPV-6/11) incidence over 70 years of 16% (3%) in females and 23% (4%) in males. The benefit of vaccinating boys decreased with improved vaccination coverage in girls. Given the important predicted herd immunity impact of vaccinating girls under moderate to high vaccine coverage, the potential incremental gains of vaccinating boys are limited.

Female HPV Vaccination and Age: Cost-effectiveness Analyses

Journal of Infectious Diseases
Volume 204 Issue 3 August 1, 2011

Tjalke A. Westra, Mark H. Rozenbaum, Raina M. Rogoza, Hans W. Nijman, Toos Daemen, Maarten J. Postma, and Jan C. Wilschut
Until Which Age Should Women Be Vaccinated Against HPV Infection? Recommendation Based on Cost-effectiveness Analyses
J Infect Dis. (2011) 204(3): 377-384 doi:10.1093/infdis/jir281

Introduction. Cervical cancer is caused by infection with human papillomavirus (HPV). Several countries have implemented vaccination programs against HPV for teenage girls before sexual debut. However, recent clinical trials have demonstrated that vaccination of older women is highly effective as well. Accordingly, it has been suggested that these older women should also be offered vaccination. Here, the cost-effectiveness of HPV vaccination for older women was assessed.

Methods. A Markov model was used to estimate age-specific health benefits and cost savings of HPV vaccination for women 12–50 years of age, in the Netherlands. Sensitivity analyses were performed to test the robustness of the outcomes. State-of-the-art health-economic methods were used, and international health-economic guidelines were followed.

Results. HPV vaccination is highly cost-effective for girls aged 12–16 years. Remarkably, cost-effectiveness only slowly declines with increasing age of the vaccinees up to 25 years. Indeed, substantial health benefits can be obtained by vaccinating women in this age group at acceptable costs. Beyond this age, cost-effectiveness of HPV-vaccination rapidly declines.

Conclusions. Not only HPV vaccination of girls before sexual debut is a highly effective and cost-effective strategy for prevention of  cervical cancer, but also vaccination of women until the age of 25 years is generally cost-effective.

Paediatric Economic Evaluation: Are QALYs Contraindicated?

August 1, 2011 – Volume 29 – Issue 8  pp: 637-730

Current Opinion
Challenges in Health State Valuation in Paediatric Economic Evaluation: Are QALYs Contraindicated?
Ungar, Wendy J.
Pharmacoeconomics. 29(8):641-652, August 1, 2011.

With the growth in the use of health economic evaluation to inform healthcare resource allocation decisions, the challenges in applying standard methods to child health have become apparent. A unique limitation is the paucity of child-specific preference-based measures. A single, valid, preference-based measure of utility that can be used in children of all ages does not exist. Thus, the ability to derive a QALY for use in cost-utility analysis (CUA) is compromised. This paper presents and discusses existing and novel options for deriving utilities for paediatric health states for use in CUAs.

While a direct elicitation may be preferred, a child’s ability to complete a standard gamble or time trade-off task is hampered by cognitive and age limitations. The abstract notions contained in indirect instruments such as the EQ-5D and Health Utilities Index may also pose challenges for young children. Novel approaches to overcome these challenges include the development of age-appropriate instruments such as the EQ-5D-Y, the development of new child-specific utility instruments such as the Child Health Utility-9D and the re-calibration of existing adult instruments to derive preference weights for health states from children themselves. For children aged <6 years, researchers have little choice but to use a proxy reporter such as parents. While parents may be reliable reporters for physical activity limitations and externally manifest symptoms, their ability to accurately report on subjective outcomes such as emotion is questionable. Catalogues of utility weights for a range of conditions are increasingly becoming available but retain many of the same limitations as valuing health states from children or from proxies.

Given the dynamic relationship in quality of life (QOL) between family members when a child is ill, it seems appropriate to consider a ‘family perspective’ rather than an individual perspective in child health state valuation. In a collective approach, health state utilities derived from multiple family members may be combined mathematically. Alternatively, in a unitary approach, a single utility estimate may be determined to represent the family’s perspective. This may include deriving utilities through parent-child dyad estimation or by using a household model that combines the utility weights of the patient and family members, incorporating reciprocal QOL effects.

While these various approaches to child health state valuation represent novel research developments, the measurement challenges and threats to validity persist. Given the importance of non-health benefits to child health, especially in the domains of education and public policy, it may be worthwhile to consider an approach that allows incorporation of externalities to produce a cost-benefit analysis. The use of discrete-choice methods to assess willingness to pay for novel child health interventions holds promise as a means to produce meaningful economic evidence.

Regardless of the approach taken, the highest degree of methodological rigour is essential. The increasing attention being paid by health economic researchers to the measurement challenges of paediatric health state valuation can only increase the value of child health economic evidence for decision making.

Cost-of-Illness Studies: A Guide to Critical Evaluation

August 1, 2011 – Volume 29 – Issue 8  pp: 637-730

Practical Application
Cost-of-Illness Studies: A Guide to Critical Evaluation
Larg, Allison; Moss, John R.
Pharmacoeconomics. 29(8):653-671, August 1, 2011.
doi: 10.2165/11588380-000000000-00000

Cost-of-illness (COI) studies aim to assess the economic burden of health problems on the population overall, and they are conducted for an ever widening range of health conditions and geographical settings. While they attract much interest from public health advocates and healthcare policy makers, inconsistencies in the way in which they are conducted and a lack of transparency in reporting have made interpretation difficult, and have ostensibly limited their usefulness. Yet there is surprisingly little in the literature to assist the non-expert in critically evaluating these studies. This article aims to provide non-expert readers with a straightforward guide to understanding and evaluating traditional COI studies. The intention is to equip a general audience with an understanding of the most important issues that influence the validity of a COI study, and the ability to recognize the most common limitations in such work.

Cost-Effective Strategies for Mitigating a Future Influenza Pandemic

PLoS One
[Accessed 11 July 2011];jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Cost-Effective Strategies for Mitigating a Future Influenza Pandemic with H1N1 2009 Characteristics
Nilimesh Halder, Joel K. Kelso, George J. Milne
Research Article, published 08 Jul 2011

We performed an analysis of the cost-effectiveness of pandemic intervention strategies using a detailed, individual-based simulation model of a community in Australia together with health outcome data of infected individuals gathered during 2009–2010. The aim was to examine the cost-effectiveness of a range of interventions to determine the most cost-effective strategies suitable for a future pandemic with H1N1 2009 characteristics.

Methodology/Principal Findings
Using transmissibility, age-stratified attack rates and health outcomes determined from H1N1 2009 data, we determined that the most cost-effective strategies involved treatment and household prophylaxis using antiviral drugs combined with limited duration school closure, with costs ranging from $632 to $777 per case prevented. When school closure was used as a sole intervention we found the use of limited duration school closure to be significantly more cost-effective compared to continuous school closure, a result with applicability to countries with limited access to antiviral drugs. Other social distancing strategies, such as reduced workplace attendance, were found to be costly due to productivity losses.

The mild severity (low hospitalisation and case fatality rates) and low transmissibility of H1N1 2009 meant that health treatment costs were dominated by the higher productivity losses arising from workplace absence due to illness and childcare requirements following school closure. Further analysis for higher transmissibility but with the same, mild severity had no effect on the overall findings.

Risk Factors for Severe Outcomes: 2009 Influenza A (H1N1)

PLoS Medicine
(Accessed 11 July 2011)

Risk Factors for Severe Outcomes following 2009 Influenza A (H1N1) Infection: A Global Pooled Analysis
Maria D. Van Kerkhove, Katelijn A. H. Vandemaele, Vivek Shinde, Giovanna Jaramillo-Gutierrez, Artemis Koukounari, Christl A. Donnelly, Luis O. Carlino, Rhonda Owen, Beverly Paterson, Louise Pelletier, Julie Vachon, Claudia Gonzalez, Yu Hongjie, Feng Zijian, Shuk Kwan Chuang, Albert Au, Silke Buda, Gerard Krause, Walter Haas, Isabelle Bonmarin, Kiyosu Taniguichi, Kensuke Nakajima, Tokuaki Shobayashi, Yoshihiro Takayama, Tomi Sunagawa, Jean Michel Heraud, Arnaud Orelle, Ethel Palacios, Marianne A. B. van der Sande, C. C. H. Lieke Wielders, Darren Hunt, Jeffrey Cutter, Vernon J. Lee, Juno Thomas, Patricia Santa-Olalla, Maria J. Sierra-Moros, Wanna Hanshaoworakul, Kumnuan Ungchusak, Richard Pebody, Seema Jain, Anthony W. Mounts, on behalf of the WHO Working Group for Risk Factors for Severe H1N1pdm Infection Research Article, published 05 Jul 2011

Development of Newborn and Infant Vaccines

Science Translational Medicine
6 July 2011 vol 3, issue 90

Perspective – Pediatric Vaccines
Development of Newborn and Infant Vaccines
Guzman Sanchez-Schmitz and Ofer Levy
6 July 2011: 90ps27

Vaccines for early-life immunization are a crucial biomedical intervention to reduce global morbidity and mortality, yet their developmental path has been largely ad hoc, empiric, and inconsistent. Immune responses of human newborns and infants are distinct and cannot be predicted from those of human adults or animal models. Therefore, understanding and modeling age-specific human immune responses will be vital to the rational design and development of safe and effective vaccines for newborns and infants.

Paul A. Offit, MD wins 2011 Biotech Humanitarian Award

 The Biotechnology Industry Organization (BIO) announced that it honored  Paul A. Offit, MD, with the 2011 Biotech Humanitarian Award. Dr. Offit is Chief of the Division of Infectious Diseases and the Director of the Vaccine Education Center at The Children’s Hospital of Philadelphia. Jim Greenwood, president and CEO of BIO, said, “BIO is honored to present Paul Offit with the 2011 Biotech Humanitarian Award. His personal endeavors in developing one of only two rotavirus vaccines available today, his dedication to bringing awareness to the benefits of vaccinating children and his work at The Children’s Hospital of Philadelphia, can be credited with saving countless lives every day. Through his innovative science, exceptional work as an advocate and ability to communicate complicated concepts in a direct and easy-to-understand manner, Dr. Offit epitomizes what we look for in a biotech humanitarian.”

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Central African Republic, Benin and Cameroon to introduce pneumococcal vaccines

   GAVI announced that the governments of Central African Republic, Benin and Cameroon will introduce GAVI-funded pneumococcal vaccines in the coming weeks. In the past seven months, Nicaragua, Guyana, Yemen, Kenya, Sierra Leone, Mali, DR Congo and Honduras have introduced the pneumococcal vaccines.

Lutheran Malaria Initiative launched

The Global Fund announced that Lutheran World Relief and The Lutheran Church—Missouri Synod forged “a unique partnership to mobilize Lutherans in the United States in the fight against malaria in Africa.” The new Lutheran Malaria Initiative “aims to raise a total of US$45 million towards the global goal of eliminating malaria deaths in Africa by 2015, with up to US$12 million of the amounts raised through the campaign to flow through the Global Fund to support malaria programs in Africa.  Professor Michel Kazatchkine, Executive Director of the Global Fund, commented, “Faith-based organizations are already critical providers of rural health care in many parts of the developing world. We are pleased to partner with the Lutheran Malaria Initiative and are looking forward to jointly continue the fight against malaria.” The Global Fund noted that the Lutheran initiative comes in addition to the United Methodist Church pledge of US$28 million to the Global Fund last September 2010, with both partnerships initiated with the support of the United Nations Foundation.$45_Million_to_Fight_Malaria_in_Africa/

WHO: Global Meeting on Implementing New and Under-utilized Vaccines


[30/06/2011 from Hemanthi Dassanayake-Nicolas, WHO HQ; GIN, June 2011]

The fifth WHO Global Meeting on Implementing New and Under-utilized Vaccines was organized by WHO/HQ and held in Montreux, Switzerland from 22-24 June 2011 with over 125 participants including representatives from Ministries of Health from 18 countries, WHO, UNICEF (HQ, Regional and Country offices), partner agencies including AMP, The Bill and Melinda Gates Foundation, CDC, Clinton Health Access Initiative, GAVI Secretariat, JSI (MCHIP), NORAD, PATH, Sabin Institute, SIVAC, and USAID, as well

as participants from universities, NGOs, manufacturers, and independent consultants.

The overall theme of the NUVI meeting was “Sustaining the gains of new vaccine introduction” with the objectives to review and discuss key issues in new and under-utilized vaccine introduction among immunization partners, regions and countries. The meeting had plenary sessions to discuss the progress with the Global NUVI Plan of Action, updates from GAVI on NUVI Financing, and lessons learned from new vaccines introduction to date The meeting also hosted six workshops on the following areas: Prioritization of vaccines at the country level; Communication for NUVI; Vaccine Supply & Pricing; Delivery Strategies for Typhoid, JE, Rubella and HPV vaccines; Immunization Schedules; and Human Resources for Immunization. The main priorities to be undertaken by the different partner institutions in the coming year were identified, the main ones being to continue to support fully informed decision making on the introduction of new vaccines, and the theme conclusion being to further work towards

government ownership of the national immunization programme, to engage in strengthening routine immunization, to work on demand creation and community engagement, to maintain the momentum with donors and focus on critical messages that “we can deliver”, and that further support be provided to vaccine introduction in lower middle-income countries.

WHO IVB 11.03 – standards for vaccines

    WHO released WHO IVB 11.03: manual for the establishment of national and other secondary standards for vaccines. “Aimed primarily at staff of national control laboratories and vaccine manufacturers, this document contains guidance on the principles of the preparation of national or other secondary biological standards, and details the issues which should be considered in the preparation and calibration of such standards.

Twitter Watch: Week to 4 July 2011

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.

whadvocacy WorldHealth Advocacy
by GlobalHealth
@WHOBulletin #globalhealth projections: by 2060 #NCDs will account for more deaths than CDs by more than 5:1

GAVISeth Seth Berkley
Thank you all for the wonderful comments and support in my transition from @IAVI and IAVISeth to @GAVIAlliance and @GAVISeth

GAVIAlliance GAVI Alliance
Exciting news! 3 more African countries have introduced #vaccines to combat pneumonia, w/ #GAVI‘s support: #GlobalHealth

HarvardHSPH HarvardPublicHealth
Global cost of chronic disease could hit as high as $35 trillion if left unchecked now #publichealth

RT @CDC_eHealth New web graphics available to support CDC Vaccines for Preteens & Teens campaign. Add to your site.

MalariaVaccine PATH MVI
We’re live-tweeting the malaria R&D funding study report launch happening now in London. More about the report:

Transmission of Influenza on International Flights, May 2009

Emerging Infectious Diseases
Volume 17, Number 7–July 2011

Transmission of Influenza on International Flights, May 2009
A.R. Foxwell et al.
Air travel is one of the fastest ways to spread infectious diseases around the globe; the rapid spread of pandemic flu in 2009 was a prime example. Preventing the spread of infection among air passengers involves contacting those who sat near symptomatic passengers. However, the definition of “near” varies according to how infectious the virus is and how much the passengers and crew move around. It also depends on the length of the flight and how good the air circulation is. A study of flights to Australia found that for flu, the risk zone is smaller than previously thought. On long flights, risk was higher for those sitting in a smaller square zone around a symptomatic passenger (2 seats to either side and 2 seats in front and behind) than in the larger linear zone previously used (2 rows on either side). Narrowing the zone, and thus the number of potentially exposed passengers, may speed the contact process so exposed passengers can get preventive health care sooner.

Cholera Epidemic, Haiti

Emerging Infectious Diseases
Volume 17, Number 7–July 2011

Understanding the Cholera Epidemic, Haiti
R. Piarroux et al.
After onset of a cholera epidemic in Haiti in mid-October 2010, a team of researchers from France and Haiti implemented field investigations and built a database of daily cases to facilitate identification of communes most affected. Several models were used to identify spatiotemporal clusters, assess relative risk associated with the epidemic’s spread, and investigate causes of its rapid expansion in Artibonite Department. Spatiotemporal analyses highlighted 5 significant clusters (p<0.001): 1 near Mirebalais (October 16–19) next to a United Nations camp with deficient sanitation, 1 along the Artibonite River (October 20–28), and 3 caused by the centrifugal epidemic spread during November. The regression model indicated that cholera more severely affected communes in the coastal plain (risk ratio 4.91) along the Artibonite River downstream of Mirebalais (risk ratio 4.60). Our findings strongly suggest that contamination of the Artibonite and 1 of its tributaries downstream from a military camp triggered the epidemic.

Implications of the Introduction of Cholera to Haiti
Scott F. Dowell and Christopher R. Braden
Author affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA

Meeting Report: Next generation vaccines

Human Vaccines
Volume 7, Issue 7  July 2011

Meeting Report
Next generation vaccines
Volume 7, Issue 7   July 2011
Eva M. Riedmann

In February this year, about 100 delegates gathered for three days in Vienna (Austria) for the Next Generation Vaccines conference. The meeting held in the Vienna Hilton Hotel from 23rd–25th February 2011 had a strong focus on biotech and industry. The conference organizer Jacob Fleming managed to put together a versatile program ranging from the future generation of vaccines to manufacturing, vaccine distribution and delivery, to regulatory and public health issues. Carefully selected top industry experts presented first-hand experience and shared solutions for overcoming the latest challenges in the field of vaccinology. The program also included several case study presentations on novel vaccine candidates in different stages of development. An interactive pre-conference workshop as well as interactive panel discussions during the meeting allowed all delegates to gain new knowledge and become involved in lively discussions on timely, interesting and sometimes controversial topics related to vaccines.

Informed consent in vaccination in India: Medicolegal aspects

Human Vaccines
Volume 7, Issue 7  July 2011

Informed consent in vaccination in India: Medicolegal aspects
Volume 7, Issue 7   July 2011
Meena Rajput and Luv Sharma

The doctrine of informed consent forms an integral part of any doctor-patient relationship. It serves both ways as it develops trust and confidence in the patient for the doctor after being told about all that is to be done; conversely the doctor can carry out planned medical interventions in a more serene manner, being confident of being protected by this doctrine if anything untoward occurs. Informed consent gives a blanket shield against compensation and criminal negligence charges filed by patients if the doctor has not deviated from standard practices of treatment or intervention or if no evidence of mal intention is forthcoming. Informed consent is applicable in most of the treatment modalities in which any intervention/invasive procedure is to be done or if any risk of complication is well known or documented. Surprisingly, even when serious life threatening complications are not only reported but on a steady rise due to vaccines, informed consent in vaccination is neither in vogue nor practice. Even in the United States, there is no federal requirement for informed consent before vaccination1, even though National Childhood Vaccine Injury Act and the Vaccine Compensation Amendments are in place2. This paper attempts to present an overall comment on the necessity of informed consent before any vaccination especially in the Indian context in the backdrop of the beginning of vaccine compensation claims and litigation against the complications of vaccination in India.

Economic evaluation: herpes zoster vaccine

Human Vaccines
Volume 7, Issue 7  July 2011

Short Report
Economic evaluation of a vaccine for the prevention of herpes zoster and post-herpetic neuralgia in older adults in Switzerland
Volume 7, Issue 7   July 2011
Thomas D. Szucs, Reto W. Kressig, Manto Papageorgiou, Werner Kempf, Jean-Pierre Michel, Anton Fendl and Xavier Bresse

Background: A life-attenuated vaccine aimed at preventing herpes zoster (HZ) and its main complication, post-herpetic neuralgia (PHN), will soon be available in Europe. The study’s objective was to assess the clinical and economic impact of a vaccination program for adults aged 70-79 years in Switzerland. Results: A vaccination strategy compared to a no-vaccination resulted in lifetime incremental cost-effectiveness ratios (ICERs) of 25,538 CHF (23,646 USD) per QALY gained, 6,625 CHF (6,134 USD) per HZ case avoided, and 15,487 CHF (14,340 USD) per PHN3 case avoided under the third-party payer perspective. Sensitivity analyses showed that the model was most sensitive to the discount rates, HZ epidemiological data and vaccine price used. Methods: A Markov model, simulating the natural history of HZ and PHN and the lifetime effects of vaccination, previously developed for the UK was adapted to the Swiss context. The model includes several health states including good health, HZ, PHN, and death. HZ and PHN states reflected pain severity. Conclusion: The model predicts clinical and economic benefits of vaccination in the form of fewer HZ and PHN cases and reductions in healthcare resource use. ICERs were within the commonly accepted thresholds in Switzerland, indicating that a HZ vaccination program would be considered a cost-effective strategy in the Swiss setting.

Demand and supply of dengue vaccine in Brazil

Human Vaccines
Volume 7, Issue 7  July 2011

Research Paper
Estimating potential demand and supply of dengue vaccine in Brazil
Volume 7, Issue 7   July 2011
Ananda Amarasinghe and Richard T. Mahoney

Dengue is endemic in Brazil. Several dengue vaccine candidates, including one at the Butantan Institute in Sao Paulo, are being evaluated in clinical trials and may be licensed in several years. This study estimates the potential doses of dengue vaccine needed in Brazil under different scenarios in the first 5 years after vaccine introduction. Estimates were based on 2015-2022 country population projections. An estimated country population of 200-209 million with an annual 3.3-3.5 million cohort in the 12 to 23 month age group was included in the analysis. Computations were made for vaccines requiring one, two and three doses. A total of 7.8-62.9 million doses would be needed for only routine vaccination of 12-23 months cohort in first five years with different vaccination schedules. A combination of country-wide routine 12-23 month-old vaccination plus catch-up vaccination of individuals up to 40 years age is an appropriate strategy to control dengue. For this combination strategy, 129-425 million doses would be needed in the first five years after introduction. If vaccination is not provided to areas with low incidence of dengue, an estimated 108-360 million doses would be needed. This study provides a range of vaccine uptake estimates under different scenarios based on disease epidemiology. Actual demand and uptake will depend on the country vaccine introduction policy and strategies, vaccine supply capacity, cost, and vaccine profile. We consider one option based on the availability of vaccine from different sources. A more advanced vaccine uptake model based on estimates of vaccine impact under various scenarios should be developed.

Future and application of computational vaccinology

Human Vaccines
Volume 7, Issue 7  July 2011

Beyond epitopes: Future and application of computational vaccinology
Volume 7, Issue 7   July 2011
Johannes Söllner

Vaccine research has significantly changed face within the last decade. Newly developed vaccines usually comprise defined subunits and often next generation adjuvants. On the downside, as in many areas ultimately of interest to clinical development, basic research does only slowly translate to bedside therapy. Part of the reason can be found in regulatory processes. On the other hand new technologies such as NGS (Next Generation Sequencing), Systems Biology, recently unimagined computing and storage power and suitable information technologies allow new perspectives and approaches to the field, enlarging the gap between possible and approved even more. Computational vaccinology is an aid to vaccine developers to help bridge this gap, but naturally only if it is accepted as tool and made use of. The aim of this commentary is to point out recent developments and trends and show how this can invigorate vaccine development. It is felt necessary to make a case for rational vaccine design augmented by computational vaccinology for the community to harness the full potential of emerging and already burgeoning technologies and concepts such as Next Generation Sequencing and Systems Biology.

Global Progress Toward Measles Eradication

Journal of Infectious Diseases

Global Progress Toward Measles Eradication and Prevention of Rubella and Congenital Rubella Syndrome
Volume 204 suppl 1 July 1, 2011

The extensive supplement is organized into the following sections:

Group B streptococcal vaccine: resource-poor countries

The Lancet  
Jul 02, 2011  Volume 378  Number 9785  Pages 1 – 98

Group B streptococcal vaccine for resource-poor countries
Stephanie J Schrag, for the Global Group B Streptococcal Vaccine Working Group

Neonatal deaths, which occur mostly in resource-poor countries during the first week of life, constitute 41% of the 8·8 million deaths in children aged less than 5 years worldwide.1 Sepsis and pneumonia cause about a third of neonatal deaths. Maternal immunisation—the prevention cornerstone of neonatal tetanus and influenza programmes—has untapped potential to protect neonates from other infectious diseases. Group B streptococcal vaccines are uniquely suited to maternal immunisation in view of the substantial perinatal morbidity and mortality, particularly in the first 48 h of life.

Global tuberculosis control: Lancet Editorial and Seminar

The Lancet  
Jul 02, 2011  Volume 378  Number 9785  Pages 1 – 98

A new era for global tuberculosis control?
The Lancet
In this week’s Lancet we publish a Seminar on tuberculosis, a disease that remains a major cause of death worldwide. Although tuberculosis is curable and preventable, long treatment durations, multidrug-resistant strains, a deadly association with HIV, and an inextricable link with poverty all mean that the disease presents an enormous challenge for countries to tackle. Although there has been commendable progress in case detection and aversion of deaths by treatment, in recent years the rates of decline in tuberculosis incidence have not been falling fast enough to meet global targets.

Stephen D Lawn, Alimuddin I Zumla
Tuberculosis results in an estimated 1·7 million deaths each year and the worldwide number of new cases (more than 9 million) is higher than at any other time in history. 22 low-income and middle-income countries account for more than 80% of the active cases in the world. Due to the devastating effect of HIV on susceptibility to tuberculosis, sub-Saharan Africa has been disproportionately affected and accounts for four of every five cases of HIV-associated tuberculosis. In many regions highly endemic for tuberculosis, diagnosis continues to rely on century-old sputum microscopy; there is no vaccine with adequate effectiveness and tuberculosis treatment regimens are protracted and have a risk of toxic effects.

Underimmunization in Ohio’s Amish

July 2011, VOLUME 128 / ISSUE 1

Underimmunization in Ohio’s Amish: Parental Fears Are a Greater Obstacle Than Access to Care
Olivia K. Wenger, Mark D. McManus, John R. Bower, and Diane L. Langkamp
Pediatrics 2011; 128:79-85

OBJECTIVE: Holmes County, Ohio, one of the largest Amish communities in the world, has persistently low immunization rates. Studies of other Amish communities have revealed that parents do not immunize their children because of lack of access to immunizations. Our study explored reasons that Amish parents in the previously uninvestigated Holmes County population exempt themselves from immunizations.

METHODS: In January 2007, questionnaires for assessing attitudes regarding immunizations were mailed to a random sampling of 1000 Amish parents in Holmes County.

RESULTS: Thirty-seven percent of the parents responded. Among the 359 respondents, 68% stated that all of their children had received at least 1 immunization, and 17% reported that some of their children had received at least 1 immunization. Only 14% of the parents reported that none of their children had received immunizations. Eighty-six percent of the parents who completely exempted their children from vaccines stated that the main reason they do not vaccinate their children is concern over adverse effects. Many parents indicated that they allow their children to receive only some vaccines because of concern about the way certain vaccines are produced.

CONCLUSIONS: The reasons that Amish parents resist immunizations mirror reasons that non-Amish parents resist immunizations. Even in America’s closed religious communities, the major barrier to vaccination is concern over adverse effects of vaccinations. If 85% of Amish parents surveyed accept some immunizations, they are a dynamic group that may be influenced to accept preventative care. Underimmunization in the Amish population must be approached with emphasis on changing parental perceptions of vaccines in addition to ensuring access to vaccines.

Large-Scale Spatial Epidemic Spreading

PLoS One
[Accessed 4 July 2011];jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Evolution of Scaling Emergence in Large-Scale Spatial Epidemic Spreading
Lin Wang, Xiang Li, Yi-Qing Zhang, Yan Zhang, Kan Zhang Research Article, published 01 Jul 2011

Zipf’s law and Heaps’ law are two representatives of the scaling concepts, which play a significant role in the study of complexity science. The coexistence of the Zipf’s law and the Heaps’ law motivates different understandings on the dependence between these two scalings, which has still hardly been clarified.

Methodology/Principal Findings
In this article, we observe an evolution process of the scalings: the Zipf’s law and the Heaps’ law are naturally shaped to coexist at the initial time, while the crossover comes with the emergence of their inconsistency at the larger time before reaching a stable state, where the Heaps’ law still exists with the disappearance of strict Zipf’s law. Such findings are illustrated with a scenario of large-scale spatial epidemic spreading, and the empirical results of pandemic disease support a universal analysis of the relation between the two laws regardless of the biological details of disease. Employing the United States domestic air transportation and demographic data to construct a metapopulation model for simulating the pandemic spread at the U.S. country level, we uncover that the broad heterogeneity of the infrastructure plays a key role in the evolution of scaling emergence.

The analyses of large-scale spatial epidemic spreading help understand the temporal evolution of scalings, indicating the coexistence of the Zipf’s law and the Heaps’ law depends on the collective dynamics of epidemic processes, and the heterogeneity of epidemic spread indicates the significance of performing targeted containment strategies at the early time of a pandemic disease.

Scaling Up Global Health Interventions

PLoS Medicine
(Accessed 26 June 2011: database unavailable)

Scaling Up Global Health Interventions: A Proposed Framework for Success
Gavin Yamey Essay, published 28 Jun 2011

Summary Points
– The rise in international aid to fund large-scale global health programs over the last decade has catalyzed interest in improving the science of scale-up.
– This Essay draws upon key themes in the emerging science of large-scale change in global health to propose a framework for explaining successful scale-up.
– Success factors for scaling up were identified from interviews with implementation experts and from the published literature.
– These factors include the following: choosing a simple intervention widely agreed to be valuable, strong leadership and governance, active engagement of a range of implementers and of the target community, tailoring the scale-up approach to the local situation, and incorporating research into implementation.

AIDS and Public Policy

1 July 2011 vol 333, issue 6038, pages 1-124

AIDS: Let Science Inform Policy
Anthony S. Fauci
Science 1 July 2011: 13.

Thirty years have passed since the first cases of acquired immune deficiency syndrome (AIDS) were reported by the U.S. Centers for Disease Control and Prevention. How does this anniversary compare to the 20th or the 10th? The differences are considerable, because we now have an unprecedented opportunity, based on solid scientific data, to control and ultimately end the AIDS pandemic.

Policy Forum
Turning the Tide Against HIV
Robin J. Shattock, Mitchell Warren, Sheena McCormack, and Catherine A. Hankins
Science 1 July 2011: 42-43.

Although the annual number of new HIV infections (incidence) declined from a peak of 3.5 million in 1996 to 2.6 million in 2009, the total number living with HIV continues to rise as more people live longer. While 6.6 million people with HIV are now on antiretroviral treatment (ART), 9 million are waiting to receive it, with two people newly infected for every person starting ART (1). Twenty million more people are predicted to acquire HIV by 2031, which will increase treatment costs up to $35 billion a year (2). This raises issues of sustainability. Thus, reducing HIV incidence is critical to keeping alive the promise of universal access to HIV prevention, treatment, care, and support.

Science Translational Medicine: Innovation

Science Translational Medicine
29 June 2011 vol 3, issue 89

The Fiber of Modern Society
Elazer R. Edelman and Martin B. Leon
29 June 2011: 89cm14
In a series of articles, diverse professionals engage in a critical dialogue on innovation.

Repaving the Road to Biomedical Innovation Through Academia
Andrew R. Marks
29 June 2011: 89cm15
New funding models that support high-risk research in academia will spur innovation.

How to Revive Breakthrough Innovation in the Pharmaceutical Industry
Bernard H. Munos and William W. Chin
29 June 2011: 89cm16
Pharmaceutical firms must reengage in high-risk discovery research and only take genuine breakthroughs to the clinic.

Vaccine Safety Datalink: pandemic influenza

Volume 29, Issue 31 pp. 4875-5086 (12 July 2011)

Regular Papers
Monitoring vaccine safety using the Vaccine Safety Datalink: Utilizing immunization registries for pandemic influenza
Pages 4891-4896
Natalie L. McCarthy, Julianne Gee, Eric Weintraub, James G. Donahue, James D. Nordin, Matthew F. Daley, Allison Naleway, Michelle Henninger, Roger Baxter, Bradley Crane, Laurie Aukes, Nicole Wagner, Sarah Fisher, Steven J. Jacobsen, Lina Sy, James Baggs

Mass vaccination campaigns during which new vaccines may be administered to many millions of people in a short period of time call for timely and accurate post-licensure surveillance to monitor vaccine safety. To address the need for timely H1N1 influenza vaccine safety information during the 2009–2010 H1N1 influenza pandemic, the Vaccine Safety Datalink (VSD) project assessed the feasibility and potential mechanisms for utilizing data from state and local immunization registries to capture vaccinations that would not otherwise be captured by the data systems of the participating VSD managed care organizations (MCOs). Three of the eight VSD sites were able to capture H1N1 immunization data electronically from the state and local registries, and one site was able to capture the immunizations through a paper-based system; however, the remaining four sites encountered various obstacles that prevented capture of such data. Additional work will be required at these sites to overcome the barriers, which included privacy and confidentiality laws, time constraints brought on by the pandemic, as well as data quality concerns.

Cost-effectiveness: 10- and 13-valent pneumococcal vaccines – Argentina

Volume 29, Issue 31 pp. 4875-5086 (12 July 2011)

Regular Papers
Cost-effectiveness analysis of the 10- and 13-valent pneumococcal conjugate vaccines in Argentina
Pages 4963-4972
Analía Urueña, Tomás Pippo, María Sol Betelu, Federico Virgilio, Norberto Giglio, Angela Gentile, Salvador García Jimenez, Bárbara Jáuregui, Andrew D. Clark, Máximo Diosque, Carla Vizzotti

Since the 10-valent pneumococcal conjugate vaccine (PCV-10) and 13-valent pneumococcal conjugate vaccine (PCV-13) were recently licensed for use in Argentina, both vaccines were evaluated to estimate the costs, health benefits and cost-effectiveness of adding a PCV to the routine child immunization schedule.

The integrated TRIVAC vaccine cost-effectiveness model from Pan American Health Organization’s ProVac Initiative (Version 1.0.65) was used to assess the health outcomes of 20 successive cohorts from birth to 5 years of age. PCV-10 and PCV-13 were each compared to a scenario assuming no PCV vaccination. A 3 + 1 (three doses + booster) schedule and a vaccination price of US$ 20.75 per dose was assumed in the base case for both vaccines.

Introduction of PCV-13 rather than PCV-10 would increase the number of life years gained (LYG) by at least 10%. The number of LYG (and LYG after adjustment for DALY morbidity weights) was 56,882 (64,252) for PCV-10 compared to 65,038 (71,628) for PCV-13. From the health system perspective, the cost per DALY averted was US$ 8973 and US$ 10,948 for PCV-10 and PCV-13 respectively, and US$ 8546 and US$ 10,510 respectively, after incorporating costs saved by households. When PCV13 was compared to PCV10 directly, the additional benefits of PCV-13 was conferred at a cost of US$ 28,147 per DALY averted. Cost-effectiveness was influenced mainly by vaccine price, serotype replacement, pneumonia mortality and discount rate.

Routine vaccination against S. pneumoniae in Argentina would be cost-effective with either PCV-10 or PCV-13. PCV-13, with higher coverage of local serotypes, would prevent more cases of pneumonia, invasive pneumococcal disease, sequelae and deaths with a higher number of LYG and DALYs averted, but PCV-10, due its higher impact in the prevention of AOM, would save more costs to the healthcare system.

Pneumococcus vaccination as countermeasure against pandemic influenza

Volume 29, Issue 31 pp. 4875-5086 (12 July 2011)

Regular Papers
A model to evaluate mass vaccination against pneumococcus as a countermeasure against pandemic influenza
Pages 5065-5077
Sonya Crowe, Martin Utley, Guy Walker, Peter Grove, Christina Pagel

A mathematical model has been developed for the purpose of evaluating vaccination against pneumococcus as a countermeasure against pandemic influenza. As the characteristics of a future pandemic cannot be known in advance, three distinct pandemic scenarios were considered, corresponding to a 1918-like pandemic, a 1957/1968-like pandemic and a 2009-like pandemic.

Model estimates for each of these pandemic scenarios are presented for two options of vaccination programme; universal vaccination of the entire UK population and vaccination only of those people considered to be at heightened risk of developing influenza complications. We find that the benefits of each option (in terms of estimated number of deaths and hospital admissions avoided and the courses of antibiotics saved) are high in a 1918-like pandemic and very small in a 2009-like pandemic. Given that the decision regarding deployment of the counter measure would occur prior to knowledge of the flu-strain characteristics being available, we also present the weighted average of the outcomes from the three pandemic scenarios. Based on the historical occurrence of pandemics over the last 100 years, the weighted average of outcomes is an estimated 1400 deaths prevented by the universal vaccination option and 400 deaths saved by the targeted vaccination option (at a cost of approximately 400 million and 50 million courses of vaccine respectively).

Finally, the longer term implications of using PPV as a countermeasure against pandemic influenza have been considered by estimating the expected number of courses of vaccine bought and the expected number of deaths and hospital admissions prevented over time under each policy.