The International Finance Facility for Immunisation (IFFIm) announced the renewal of its Treasury Management Agreement with the World Bank for a five year period. Alan Gillespie, IFFIm Board Chair, said, “this has been an effective partnership that has positioned IFFIm exceptionally well in markets and contributed greatly to the GAVI Alliance’s role in vaccinating children in developing countries against serious, but preventable diseases.” Under the agreement, the World Bank manages IFFIm’s finances according to prudent policies and standards. This includes IFFIm’s funding strategy and its implementation in the capital markets, rating agency and investor outreach, hedging transactions and investment management. The World Bank also coordinates with IFFIm’s donors and manages their pledges and payments as well as IFFIm’s disbursements for immunisation and health programmes through the GAVI Alliance. IFFIm was set up in 2006, to help save millions of children’s’ lives by increasing funding for the purchase and delivery of vaccines and by strengthening health services in developing countries through the GAVI Alliance. IFFIm’s donors are the United Kingdom, France, Italy, Spain, Australia, the Netherlands, Sweden, Norway and South Africa. Brazil has also announced that it will become an IFFIm donor.

http://www.gavialliance.org/library/news/press-releases/2011/iffim-and-world-bank-renew-commitment-to-raise-funds-for-gavi-programmes/

WHO Meeting Announcement: World Conference on Social Determinants of Health

Place: Rio de Janeiro, Brazil
Date: 19–21 October 2011

This conference will bring together Member States and stakeholders to build support for the implementation of action on social determinants of health to reduce inequities. The conference is being organized in accordance with a 2009 World Health Assembly Resolution (WHA62.14) and will be hosted by the Government of Brazil.

The event will provide a global platform for dialogue on how the 2008 recommendations of the WHO Commission on Social Determinants of Health could be taken forward. Specifically, the conference will provide a process for the sharing of national experiences and technical knowledge on addressing social determinants of health.

The conference will aim to catalyse coordinated global action in five key areas:

governance to tackle the root causes of health inequities: implementing action on social determinants of health; the role of the health sector, including public health programmes, in reducing health inequities; promoting participation: community leadership for action on social determinants; global action on social determinants: aligning priorities and stakeholders; monitoring progress: measurement and analysis to inform policies on social determinants.

Member States are expected to endorse the Rio Declaration, thereby strengthening their political commitment to reducing health inequities

http://www.who.int/mediacentre/events/meetings/2011/social_determinants_health/en/index.html

The MMWR for October 14, 2011 / Vol. 60 / No. 40
– Progress Toward Implementation of Human Papillomavirus Vaccination — the Americas, 2006–2010

– Establishment of a Viral Hepatitis Surveillance System — Pakistan, 2009–2011

– Recommendation of the Advisory Committee on Immunization Practices (ACIP) for Use of Quadrivalent Meningococcal Conjugate Vaccine (MenACWY-D) Among Children Aged 9 Through 23 Months at Increased Risk for Invasive Meningococcal Disease

The Weekly Epidemiological Record (WER) for 14 October 2011, vol. 86, 42 (pp 457–468) includes: Recommended composition of influenza vaccines for use in the 2012 southern hemisphere influenza season

http://www.who.int/entity/wer/2011/wer8642.pdf

Twitter Watch
A selection of items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and by no means intended to be exhaustive.

GAVIAlliance GAVI Alliance
First child in Ethiopia receives pneumococcal vaccine…millions more to follow
11 hours ago

GAVIAlliance GAVI Alliance
Ethiopia is 1 of 10 pilots where #GAVI funds civil society organisations to help with immunisation- ht.ly/6Ywkd
15 Oct

pahowho PAHO/WHO
World Conference on Social Determinants of Health who.int/sdhconference/…
14 Oct

PublicHealth APHA
Cervical cancer kills 36,000+ women each yr in the Americas. HPV vaccination varies widely, says MMWR study: goo.gl/aTZZZ
14 Oct

WHO_Europe WHO/Europe
by Eurovaccine
Investment in building relations with media, parent communities, and other stakeholders helps in #vaccine safety events bit.ly/reIO2q
13 Oct

JAMA   
October 12, 2011, Vol 306, No. 14, pp 1513-1614
http://jama.ama-assn.org/current.dtl

Commentaries
A Model for Dissemination and Independent Analysis of Industry Data
Harlan M. Krumholz, Joseph S. Ross
JAMA. 2011;306(14):1593-1594.doi:10.1001/jama.2011.1459

Extract
Each day, patients and their physicians make treatment decisions with access to only a fraction of the relevant clinical research data. Many clinical studies, including randomized clinical trials, are never published in the biomedical literature. 1, 2 Among those that are published, key information is often not presented, such as data on specific outcomes and safety end points. 3, 4 Moreover, patient-level data from clinical trials are rarely publicly available, leaving investigators to conduct meta-analyses of summary-level data, an approach with limitations. 5

Current clinical research standards lack sufficiently strong requirements for transparency and availability. There are no uniform international standards requiring that study protocols, statistical analysis plans, and study results be made available, and there are no requirements that completed clinical trial data be publicly available or posted for independent analysis. Even data submitted to the US Food and Drug Administration are not made publicly available

Pharmacoeconomics
November 1, 2011 – Volume 29 – Issue 11  pp: 913-1009
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

The Importance of the Comparator in Economic Evaluations: Working on the Efficiency Frontier
Neyt, Mattias; Van Brabandt, Hans
Pharmacoeconomics. 29(11):913-916, November 1, 2011.
doi: 10.2165/11595260-000000000-00000

[No abstract]

Pharmacoeconomics
November 1, 2011 – Volume 29 – Issue 11  pp: 913-1009
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

Rotavirus Vaccine RIX4414 (Rotarix™): A Pharmacoeconomic Review of its Use in the Prevention of Rotavirus Gastroenteritis in Developing Countries
Plosker, Greg L.
Pharmacoeconomics. 29(11):989-1009, November 1, 2011.
doi: 10.2165/11207210-000000000-00000

Abstract:
This article provides an overview of the clinical profile of rotavirus vaccine RIX4414 (Rotarix™) in the prevention of rotavirus gastroenteritis (RVGE) in developing countries, followed by a comprehensive review of pharmacoeconomic analyses with the vaccine in low- and middle-income countries.

RVGE is associated with significant morbidity and mortality among children <5 years of age in developing countries. The protective efficacy of a two-dose oral series of rotavirus vaccine RIX4414 has been demonstrated in several well designed clinical trials conducted in developing countries, and the ‘real-world’ effectiveness of the vaccine has also been shown in naturalistic and case-control trials after the introduction of universal vaccination programmes with RIX4414 in Latin American countries. The WHO recommends universal rotavirus vaccination programmes for all countries.

Numerous modelled cost-effectiveness analyses have been conducted with rotavirus vaccine RIX4414 across a wide range of low- and middle-income countries. Although data sources and assumptions varied across studies, results of the analyses consistently showed that the introduction of the vaccine as part of a national vaccination programme would be very (or highly) cost effective compared with no rotavirus vaccination programme, according to widely used cost-effectiveness thresholds for developing countries. Vaccine price was not known at the time the analyses were conducted and had to be estimated. In sensitivity analyses, rotavirus vaccine RIX4414 generally remained cost effective at the highest of a range of possible vaccine prices considered.    Despite these favourable results, decisions regarding the implementation of universal vaccination programmes with RIX4414 may also be contingent on budgetary and other factors, underscoring the importance of subsidized vaccination programmes for poor countries through the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunization).

PLoS One
[Accessed 16 October 2011]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

7-Valent Pneumococcal Conjugate Vaccination in England and Wales: Is It Still Beneficial Despite High Levels of Serotype Replacement?
Yoon Hong Choi, Mark Jit, Nigel Gay, Nick Andrews, Pauline A. Waight, Alessia Melegaro, Robert George, Elizabeth Miller
PLoS ONE: Research Article, published 14 Oct 2011 10.1371/journal.pone.0026190

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 46 pp. 8175-8470 (26 October 2011)

Regular Papers
Reasons related to non-vaccination and under-vaccination of children in low and middle income countries: Findings from a systematic review of the published literature, 1999–2009
Pages 8215-8221
Jeanette J. Rainey, Margaret Watkins, Tove K. Ryman, Paramjit Sandhu, Anne Bo, Kaushik Banerjee

Abstract
Objective
Despite increases in routine vaccination coverage during the past three decades, the percent of children completing the recommended vaccination schedule remains below expected targets in many low and middle income countries. In 2008, the World Health Organization Strategic Advisory Group of Experts on Immunization requested more information on the reasons that children were under-vaccinated (receiving at least one but not all recommended vaccinations) or not vaccinated in order to develop effective strategies and interventions to reach these children.

Methods
A systematic review of the peer-reviewed literature published from 1999 to 2009 was conducted to aggregate information on reasons and factors related to the under-vaccination and non-vaccination of children. A standardized form was used to abstract information from relevant articles identified from eight different medical, behavioural and social science literature databases.

Findings
Among 202 relevant articles, we abstracted 838 reasons associated with under-vaccination; 379 (45%) were related to immunization systems, 220 (26%) to family characteristics, 181 (22%) to parental attitudes and knowledge, and 58 (7%) to limitations in immunization-related communication and information. Of the 19 reasons abstracted from 11 identified articles describing the non-vaccinated child, 6 (32%) were related to immunization systems, 8 (42%) to parental attitudes and knowledge, 4 (21%) to family characteristics, and 1 (5%) to communication and information.

Conclusions
Multiple reasons for under-vaccination and non-vaccination were identified, indicating that a multi-faceted approach is needed to reach under-vaccinated and unvaccinated children. Immunization system issues can be addressed through improving outreach services, vaccine supply, and health worker training; however, under-vaccination and non-vaccination linked to parental attitudes and knowledge are more difficult to address and likely require local interventions.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 46 pp. 8175-8470 (26 October 2011)

Regular Papers
Attitudes and perceptions of private pediatricians regarding polio immunization in India
Pages 8317-8322
Panna Choudhury, Naveen Thacker, Lisa M. Gargano, Paul S. Weiss, Vipin M. Vashishtha, Tanmay Amladi, Karen Pazol, Walter A. Orenstein, Saad B. Omer, James M. Hughes

Abstract
Background
India has faced considerable challenges in eradicating polio. Uttar Pradesh (UP) and Bihar are the two states in India where transmission of polio has never been interrupted. Private pediatricians are important stakeholders for vaccine delivery and maintaining public confidence in vaccines. The purpose of this study was to investigate the attitudes and perceptions of pediatricians in India regarding polio immunization and their opinions about various strategies regarding polio eradication in the country.

Methods
A random sample of 785 pediatricians belonging to the Indian Academy of Pediatrics (IAP) were selected for the survey with over sampling of members located in Bihar and UP. Potential participants were either contacted by phone or sent a self-administered anonymous questionnaire by mail. For this analysis both sets of responses were combined. Surveys were conducted from June 2009 to June 2010.

Results
A total of 398 surveys were completed (51%). Nearly all respondents indicated that polio eradication is still an important priority (99.7%). Ninety-six percent of pediatricians believed that strengthening routine immunization efforts remains the best way to eradicate polio in endemic areas. Other measures thought to be important in eradicating polio are mass campaigns with IPV (73%) and mass campaigns with bivalent OPV (59%). Pediatricians also identified several barriers to polio eradication which included parents’ lack of awareness of the importance of polio vaccination (88.8%), parents’ lack of confidence in polio vaccine (64.0%), religious beliefs (59.2%), fear of side effects (59.2%), lack of time or priority (56.6%), superstition (50.3%) and cultural beliefs (46.4%).

Conclusion
There is still strong support for polio eradication efforts among IAP members. Pediatricians in India strongly believe that improving the coverage of routine immunization remains the best way to eradicate polio. There is an urgent need to improve awareness, build confidence in the program, and remove barriers among parents.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 46 pp. 8175-8470 (26 October 2011)

Regular Papers
The cost-effectiveness of male HPV vaccination in the United States
Pages 8443-8450
Harrell W. Chesson, Donatus U. Ekwueme, Mona Saraiya, Eileen F. Dunne, Lauri E. Markowitz

Abstract
Introduction
The objective of this study was to estimate the cost-effectiveness of adding human papillomavirus (HPV) vaccination of 12-year-old males to a female-only vaccination program for ages 12–26 years in the United States.

Methods
We used a simplified model of HPV transmission to estimate the reduction in the health and economic burden of HPV-associated diseases in males and females as a result of HPV vaccination. Estimates of the incidence, cost-per-case, and quality-of-life impact of HPV-associated health outcomes were based on the literature. The HPV-associated outcomes included were: cervical intraepithelial neoplasia (CIN); genital warts; juvenile-onset recurrent respiratory papillomatosis (RRP); and cervical, vaginal, vulvar, anal, oropharyngeal, and penile cancers.

Results
The cost-effectiveness of male vaccination depended on vaccine coverage of females. When including all HPV-associated outcomes in the analysis, the incremental cost per quality-adjusted life year (QALY) gained by adding male vaccination to a female-only vaccination program was $23,600 in the lower female coverage scenario (20% coverage at age 12 years) and $184,300 in the higher female coverage scenario (75% coverage at age 12 years). The cost-effectiveness of male vaccination appeared less favorable when compared to a strategy of increased female vaccination coverage. For example, we found that increasing coverage of 12-year-old girls would be more cost-effective than adding male vaccination even if the increased female vaccination strategy incurred program costs of $350 per additional girl vaccinated.

Conclusions
HPV vaccination of 12-year-old males might potentially be cost-effective, particularly if female HPV vaccination coverage is low and if all potential health benefits of HPV vaccination are included in the analysis. However, increasing female coverage could be a more efficient strategy than male vaccination for reducing the overall health burden of HPV in the population.

The pdf version of Vaccines: The Week in Revoew  10 October 2011, comprising the posts below for this date, is available here: Vaccines_The Week in Review_10 Oct 2011

 WHO reported on measles outbreak in Member States in the European and African regions, with several reported outbreaks in the Americas linked to Europe or Africa.

[full text]
Europe: As of 20 September 2011, 40 of 53 Member States in the WHO European Region have reported 26,025 confirmed measles cases for the period January – July 2011 to the WHO European Regional Office through routine surveillance and outbreak reports. The highest number of cases was reported from France with 14,025 cases for the first six months of the year. In addition, eleven of all cases in the Region were lethal (6 in France and one in each of Germany, Kyrgyzstan, Romania, the Former Yugoslav Republic of Macedonia and the United Kingdom). The predominant genotype currently circulating in the European Region is D4, the same endemic genotype from the United Kingdom in 2008. The most recent outbreak was reported from Israel in September, with 12 cases. Member States have responded to the outbreak by modifying the vaccination schedule, like France, or by offering vaccination free of charge or in schools, to increase accessibility to and availability of vaccines.

Africa: The Regional Office reports that as of September 2011 large measles outbreaks are being reported by the Democratic Republic of the Congo, with over 103,000 cases, Nigeria, with 17,428 cases, and Zambia, with 5,397 cases, and Ethiopia, with 2 902 cases. Even though deaths are not routinely reported to the Regional Office, the WHO Country Office in the Democratic Republic of the Congo reports over 1100 measles-associated deaths in the country during 2011.

Americas: The last case of endemic measles was reported from the region in 2002. In 2011 the Region has received reports of several outbreaks linked to importation of measles virus from other regions. The largest, in Quebec, Canada, involves 742 reported cases, 89 requiring hospitalization, but no measles-associated deaths. Other outbreaks have been reported from the United States (213 cases), Ecuador (41 cases), Brazil (18 cases), Columbia (7 cases), Mexico (3 cases), and Chile (6 cases). Most of these outbreaks are linked to importations from Europe, except for outbreaks in the United States and Chile linked to cases from Malaysia and the outbreak in Ecuador, linked to Kenya.

Measles is a highly infectious disease that causes complications and deaths, even in previously-healthy individuals, but is fully preventable by vaccination. Countries need to ensure that they reach 95% coverage with two doses of measles vaccine across all age groups up to 15 years of age. Otherwise the country will experience measles outbreaks with large numbers of cases, associated hospitalizations and deaths. The recent outbreaks in countries with high volumes of international travellers can lead to measles exportation to regions previously free of measles, such as the Region of the Americas or certain African countries. These exportations can lead to large outbreaks and associated deaths.

These outbreaks should remind travellers that they should ensure that they have had two doses of measles-containing vaccine before their trip.

http://www.who.int/csr/don/2011_10_07/en/index.html

   The Nobel Prize in Physiology or Medicine 2011 was awarded jointly to Bruce A. Beutler and Jules A. Hoffmann “for their discoveries concerning the activation of innate immunity” and to Ralph M. Steinman (posthumously) “for his discovery of the dendritic cell and its role in adaptive immunity”.

Extract from press release:

Jules Hoffmann made his pioneering discovery in 1996, when he and his co-workers investigated how fruit flies combat infections. They had access to flies with mutations in several different genes including Toll, a gene previously found to be involved in embryonal development by Christiane Nüsslein-Volhard (Nobel Prize 1995). When Hoffmann infected his fruit flies with bacteria or fungi, he discovered that Toll mutants died because they could not mount an effective defense. He was also able to conclude that the product of the Toll gene was involved in sensing pathogenic microorganisms and Toll activation was needed for successful defense against them.

Bruce Beutler was searching for a receptor that could bind the bacterial product, lipopolysaccharide (LPS), which can cause septic shock, a life threatening condition that involves overstimulation of the immune system. In 1998, Beutler and his colleagues discovered that mice resistant to LPS had a mutation in a gene that was quite similar to the Toll gene of the fruit fly. This Toll-like receptor (TLR) turned out to be the elusive LPS receptor. When it binds LPS, signals are activated that cause inflammation and, when LPS doses are excessive, septic shock. These findings showed that mammals and fruit flies use similar molecules to activate innate immunity when encountering pathogenic microorganisms. The sensors of innate immunity had finally been discovered.

The discoveries of Hoffmann and Beutler triggered an explosion of research in innate immunity. Around a dozen different TLRs have now been identified in humans and mice. Each one of them recognizes certain types of molecules common in microorganisms. Individuals with certain mutations in these receptors carry an increased risk of infections while other genetic variants of TLR are associated with an increased risk for chronic inflammatory diseases…

Ralph Steinman discovered, in 1973, a new cell type that he called the dendritic cell. He speculated that it could be important in the immune system and went on to test whether dendritic cells could activate T cells, a cell type that has a key role in adaptive immunity and develops an immunologic memory against many different substances. In cell culture experiments, he showed that the presence of dendritic cells resulted in vivid responses of T cells to such substances. These findings were initially met with skepticism but subsequent work by Steinman demonstrated that dendritic cells have a unique capacity to activate T cells.

Further studies by Steinman and other scientists went on to address the question of how the adaptive immune system decides whether or not it should be activated when encountering various substances. Signals arising from the innate immune response and sensed by dendritic cells were shown to control T cell activation. This makes it possible for the immune system to react towards pathogenic microorganisms while avoiding an attack on the body’s own endogenous molecules.

From fundamental research to medical use

The discoveries that are awarded the 2011 Nobel Prize have provided novel insights into the activation and regulation of our immune system. They have made possible the development of new methods for preventing and treating disease, for instance with improved vaccines against infections and in attempts to stimulate the immune system to attack tumors. These discoveries also help us understand why the immune system can attack our own tissues, thus providing clues for novel treatment of inflammatory diseases…

http://www.nobelprize.org/nobel_prizes/medicine/laureates/2011/press.html

     The GAVI Alliance “praised ‘la Caixa’ Foundation’s leadership and generosity in donating € 4 million (US$5.7 million) to GAVI’s new Matching Fund.” GAVI described the matching programme as ” a major new effort with the private sector to raise US$260 million for immunisation by the end of 2015. Under the programme, the Gates Foundation has pledged US$50 million to match contributions to GAVI from primarily private sector companies, their customers and employees. In addition, pledges to the Matching Fund by UK companies and their customers and employees are being matched by the £ 50 million pledge from the UK Department for International Development (DFID).”  The “la Caixa” pledge – € 2 million in 2011 and € 2 million in 2012 — specifically goes toward the purchase of pneumococcal vaccine for GAVI-supported countries in Latin America.   http://www.gavialliance.org/library/news/press-releases/2011/la-caixa-donation-matching-fund/

   The Bill & Melinda Gates Foundation announced a new initiative for Nigeria’s Executive Governors “challenging them to deliver a dramatic improvement in polio and routine immunization by the end of 2012.” The program “will recognize those Executive Governors whose states pass a pre-defined threshold to improve routine immunization coverage and end polio. The states that meet the threshold criteria will be awarded a $500,000 grant from the Bill & Melinda Gates Foundation to support their top health priorities.” The award will support winning governors’ priority initiatives in public health, such as malaria and tuberculosis, improving immunization, HIV prevention and treatment, or safe drinking water and hygiene promotion. In addition to the grant, “those governors who achieve the goals will receive special recognition from Mr. Gates for their contribution to the elimination of polio. Winning governors will be highlighted in foundation communications, such as Mr. Gates’ annual letter or the foundation’s annual report, social media materials and Mr. Gates’ public engagements globally.” In addition, “if Governors choose, they also may contribute $250,000 to their chosen health project and the foundation will match that contribution, meaning a potential total $1 million towards improving health in their state.”

http://www.gatesfoundation.org/press-releases/Pages/governors-immunization-leadership-challenge-111004.aspx

The Gates Foundation announced that it is accepting nominations for the first Gates Vaccine Innovation Award “to recognize, celebrate, and spur transformative ideas for achieving impact through the delivery of vaccines.” Nominations will be accepted through 17 November 2011. The Gates Vaccine Innovation Award “seeks to reward those who have achieved significant improvements in the prevention, control, or elimination of vaccine preventable disease through imaginative and pioneering approaches,” and is “unique in that it complements other awards already focused on scientific research and development. The winning person or team will receive $250,000 and earn special recognition by foundation leadership for their contribution.” The Gates Vaccine Innovation Award application process is open to any individual or team from any discipline – academic institutions, governments, health care facilities, research institutions, non-profit organizations and for-profit companies. Nominations are being accepted online now at: www.gatesfoundation.org/gates-vaccine-innovation-award.

http://www.gatesfoundation.org/press-releases/Pages/gates-vaccine-innovation-award-111006.aspx

The Weekly Epidemiological Record (WER) for 7 October 2011, vol. 86, 41 (pp 445–456) includes: Hepatitis C; Monkeypox; Nipah virus;
http://www.who.int/entity/wer/2011/wer8641.pdf

Twitter Watch
A selection of items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and by no means intended to be exhaustive.

GAVIAlliance GAVI Alliance
President Johnson Sirleaf is a tireless advocate for the right of all people to health and immunisation.”-@GAVISeth http://ht.ly/6RKYR
21 hours ago

gatesfoundation Gates Foundation
Are we drawing closer to the end of #polio? @BillGates and @JeffRaikes meet with Nigeria’s leaders: gates.ly/oYKDqL
8 Oct

ShotAtLife Shot@Life
by GAVIAlliance
Committed to #vaccines: Ppl in Sierra Leone strap coolboxes of vaccines on backs & bike 2 remote villages @gavialliance bit.ly/p8fjO6
7 Oct

GAVIAlliance GAVI Alliance
Campaign to eradicate polio likely to fail unless combined w/vaccines that combat other deadly diseases such as measles http://ht.ly/6QjKX
7 Oct

GAVISeth Seth Berkley
#DavidCameron tells Conservative Party about the importance of vaccinating the world’s children: http://ow.ly/6QcEE @Number10gov

ShotAtLife Shot@Life
by GAVIAlliance
In 10 years, @MeaslesInit has protected 1 billion children from #measles with #vaccines. Read the story: bit.ly/n6yKO5
6 Oct

MeaslesInit Measles Initiative
by Eurovaccine
New research on a measles outbreak in Japan shows vaccination much more cost-effective than containment and treatment bit.ly/pqs5Hh
7 Oct

gatesfoundation Gates Foundation
Introducing the Gates Vaccine Innovation Award–Honoring revolutionary leaders in saving child lives: bit.ly/oISLRF #vaccines
6 Oct

PATHtweets PATH
START-UP project: Seeking to make prevention of cervical cancer available to all women, no matter where they live. http://ow.ly/6FkO2
6 Oct

sabinvaccine Sabin Vaccine Inst.
On this day in 1956 Dr. Albert Sabin introduced his live-virus oral #polio #vaccine, read more @wired bit.ly/r01vxA
6 Oct

DofVC DoV Collaboration
RT: @ISGLOBALorg “Access to safe and effective vaccines is a human right not currently enjoyed by everyone” @DofVC #ECTMIH bit.ly/q1hQ0q
4 Oct

British Medical Journal
8 October 2011 Volume 343, Issue 7826
http://www.bmj.com/content/current

Practice
Quality Improvement Report: Improving MMR vaccination rates: herd immunity is a realistic goal
Philippa Cockman, Luise Dawson, Rohini Mathur, Sally Hull
BMJ 2011;343:doi:10.1136/bmj.d5703 (Published 4 October 2011)

Abstract
Problem  As measles is a highly infectious disease, the United Kingdom recommendation is for at least 95% of children to receive a first vaccination with the measles, mumps, and rubella (MMR) vaccine before age 2 years and a booster before age 5 years to achieve herd immunity and prevent outbreaks. Reported vaccination rates for England have improved since a low level in 2003-4. Coverage for London is consistently lower than for England, however, and concerns have been expressed that there could be an epidemic of measles in the capital.

Design  Observational time series study.

Setting  London Borough of Tower Hamlets.

Key measurements for improvement Uptake rates for childhood vaccinations. The key target was to reach 95% coverage for the first MMR vaccine before age 2 years.

Strategies for change Financial support for the development of geographically based networks of general practices. Commissioning of care packages, incentivising delivery of high quality integrated care with network level vaccination targets of 95%. Innovative use of information technology to enable robust call and recall processes, active follow-up of defaulters, and increased knowledge about the demography of the children most difficult to reach.

Effects of change  The development of networks of practices facilitated collaborative working among primary care clinicians and other stakeholders; peer review of achievements; and an element of healthy competition. Uptake improved for all childhood vaccinations, and to herd immunity levels for most. Uptake of the first MMR vaccine before age 2 years rose from 80% in September 2009 to 94% in March 2011.

Lessons learnt Achieving herd immunity for childhood vaccinations is an achievable target in an ethnically mixed, socially deprived inner city borough. The ability to identify characteristics of the difficult to reach groups, including significant differences in uptake across different ethnicities, will allow targeted interventions that may further improve overall coverage.

Health Affairs
October 2011; Volume 30, Issue 10

Agenda For Fighting Disparities
http://content.healthaffairs.org/content/current

From The Editor-in-Chief
A Nation At Risk For Wider Health Disparities
Susan Dentzer
Health Aff October 2011 30:1818; doi:10.1377/hlthaff.2011.1091

Extract
Among the well-documented deficiencies of US health care is its pronounced lack of equity—not just in access, but also in the quality of care provided whites versus ethnic and racial minorities. We shouldn’t be surprised, because our society is inequitable, a fact that gives rise to inequities in health.

This month’s issue of Health Affairs, produced with the support of the Aetna Foundation, provides a progress report on where we are as a nation in addressing these health and health care disparities. It also underscores that a “change” agenda will have to tackle the very fundamentals of existence that characterize the lives of millions of people in twenty-first-century America…

Human Vaccines
Volume 7, Issue 10    October 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/10/

Research Papers
Cost-effectiveness analysis of pneumococcal polysaccharide vaccination from age 60 in São Paulo State, Brazil
Open Access Article
Joao Tonolio Neto, Gabriela Tannus Branco de Araujo, Anna Gagliardi, Amanda Pinho, Laure Durand and Marcelo Fonseca

Vaccination of adults aged 60 years and older against Streptococcus pneumonia is not recommended in Brazil. The 23-valent polysaccharide pneumococcal vaccine (PPV23) is only available for institutionalized persons or with underlying diseases despite the substantial medical and economic burden related to pneumococcal infections in adults over than 59 years. The study aimed at evaluating the cost effectiveness of implementing a large PPV program in this population.
This analysis was performed using a static decision tree model. Demographic and epidemiological data were obtained from Brazilian official sources and international literature. Economic data were obtained from a study performed in 2007 in a public and a private hospital located in Sao Paulo. Vaccination was assumed to protect for 5 years with 60% effectiveness against bacteremic pneumococcal pneumonia (BPP) and 21% effectiveness against non bacteremic pneumococcal pneumonia (NBPP). Deterministic and sensitivity analyses were performed.
The pneumococcal polysaccharide vaccination saved 5,218 life year gained (LYG). The vaccination program was found to be cost effective in the social security and public health care perspectives with a mean incremental cost-effectiveness ratio of R$10,887 and R$8,281 per LYG respectively. Results were sensitive to the vaccine effectiveness against NBPP, the incidence and case-fatality rate of NBPP. From a societal perspective, PPV23 program for adults 60 and older was found to be cost-saving.
Pneumococcal polysaccharide vaccination is clinically and economically favored over the present vaccination strategy, in which persons aged over 59 years in Sao Paulo, have not been vaccinated.

Human Vaccines
Volume 7, Issue 10    October 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/10/

Research Papers
Attitudes of seasonal influenza vaccination among healthcare worker and general community population after pandemic influenza A/H1N1 in Hangzhou
Shijun Liu, Hanyan Yuan, Yan Liu, Jian Du, Xiaoping Zhang, Jun Wang, Xinren Che and Erping Xu

Objective  To know the attitude towards seasonal influenza vaccination among healthcare worker (HCWs) and general community population (GCPs) in the post-pandemic influenza A/H1N1 period.

Method We conducted a cross-sectional investigation in the beginning of seasonal influenza vaccination between 2010 and 2011, employed logistic regression analysis to compute the relationship between the willingness of seasonal influenza vaccination and variables after pandemic influenza A/H1N1.

Results  A total of 489 participants including 126 HCWs and 363 GCPs completed the investigation. 33.33% individuals (34.92% HCWs vs 32.78% GCPs, p＞0.05) intended to accept the seasonal influenza vaccination after pandemic influenza A/H1N1. Individuals received seasonal influenza vaccination in the prior 3 years and monovalent A/H1N1 vaccination in 2009 were aggressive to vaccinate seasonal influenza vaccine with adjusted OR= 5.21(3.20~8.49) and 1.97(1.18~3.30).. According to the results of multivariable logistic regression model, the safety not efficacy of influenza vaccine was the significant factor for acceptability of seasonal influenza vaccination (OR: 3.11, 95%CI: 1.76~5.50). The positive attitude of serious degree of influenza A/H1N1 and occupational factor were also associated with the willingness of seasonal influenza vaccination and the adjusted ORs were 2.09(1.14~3.83) and 1.62(1.00~2.64).

Conclusion  Participants showed low acceptability of seasonal influenza vaccination after pandemic influenza A/H1N1. Need educational program concerning the advantages of vaccine, comprehensible information about possible adverse effects and the hazards of seasonal influenza disease, which might motivate individuals to accept seasonal influenza vaccination.

Human Vaccines
Volume 7, Issue 10    October 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/10/

Research Papers
Challenges and opportunities in the Israeli 2009 Pandemic Influenza Vaccination Program
Hagai Levine, Ran D Balicer, Daniel Laor and Itamar Grotto

Abstract
Vaccines are a cornerstone in any pandemic influenza preparedness plan. Successful supplementary mass vaccination programs require proper advance planning. We aimed to identify general, and Israeli specific, challenges and opportunities before initiating the Israeli pandemic influenza vaccination program in order to better plan implementation of the program. Following the vaccination campaign the analysis was retrospectively examined in order to determine whether the challenges were properly identified and whether the opportunities were indeed realized. The major challenges identified were prioritization; ongoing communication with the public; balancing between central management and accessibility; and preventing vaccination errors. The major opportunity was expected to be the chance to enhance cooperation and communication between different organizations both within and outside of the health system at local, national and international levels. The vaccination program was planned based on this analysis. In retrospect, the analysis identified the key challenges and opportunities and appropriate measures were taken. However, the criticalness of acceptance of the vaccine among health care practitioners was not given sufficient attention and should be addressed in future vaccination programs. Analysis of global and local challenges and opportunities served as a useful tool for planning a pandemic influenza vaccination program. Lessons learned from this analysis could serve to foster cooperation and communication between various agencies in the event of planning rapid mass vaccination programs as well as for more routine public health vaccination campaigns.

Human Vaccines
Volume 7, Issue 10    October 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/10/

Commentary
Perceptions of malaria and vaccines in Kenya
David Ojakaa, Emmanuel Yamo, Yvette Collymore, Antoinette Ba-Nguz and Allison Bingham

Abstract
Malaria is a leading cause of morbidity and mortality in Kenya. To confront malaria, the Government of Kenya has been implementing and coordinating three approaches – vector control by distributing insecticide-treated bed nets and indoor residual spraying, case management, and the management of malaria during pregnancy. Immunization is recognized as one of the most cost-effective public health interventions. Efforts are underway to develop a malaria vaccine. The most advanced (RTS,S), is currently going through phase 3 trials. Although recent studies show the overwhelming support in the community for the introduction of a malaria vaccine, two issues – culture and the delivery of child immunization services – need to be considered.
Alongside the modern methods of malaria control described above, traditional methods coexist and act as barriers to attainment of universal immunization. The gender dimension of the immunization programme (where women are the main child caretakers) will also need to be addressed. There is an age dimension to child immunization programmes. Two age cohorts of parents, caregivers, or family members deserve particular attention. These are the youth who are about to initiate childbearing, and the elderly (particularly mother-in-laws who often play a role in child-rearing).     Mothers who are less privileged and socially disadvantaged need particular attention when it comes to child immunization. Access to immunization services is often characterized in some Kenyan rural communities in terms of living near the main road, or in the remote inaccessible areas. Should a malaria vaccine become available in the future, a strategy to integrate it into the immunization programme in Kenya should take into account at least two issues. First, it must address the fact that alongside the formal approach in malaria control, there exist the informal traditional practices among communities. Secondly, it must address particular issues in the delivery of immunization services.

Human Vaccines
Volume 7, Issue 10    October 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/10/

Research Papers
Introduction of a second dose of measles in National immunization program in India: A major step towards eradication
Ramesh Verma, Pardeep Khanna, Mohan Bairwa, Suraj Chawla, Shankar Prinja and Meena Rajput

Abstract
Measles is a highly infectious, acute respiratory illness that is caused by a virus of the genus Morbillivirus. The disease infects nearly 30 million children each year, and deaths usually occur from complications related to pneumonia, diarrhoea and malnutrition. A systematic review of published Indian literature depicts the median case fatality ratio (CFR) of measles to be 1.6%. Through immunization, measles deaths dropped a remarkable 78% from 733,000 in 2000 to 164,000 in 2008. As of 2008, 192 of 193 Member States of WHO use 2 doses of measles vaccine in their National immunization programs, India being the only exception. The Millennium Development Goal (MDG) 4 aims to reduce by two-thirds between 1990 and 2015 the under-five mortality rate (U5MR) in the world. Per the draft comprehensive Multi Year Strategic Plan (cMYP, 2010-17) for immunization of India, the country aims to reduce measles-related mortality by 90% by 2013 when compared to 2000. As recommended by the National Technical Advisory Group on Immunization (NTAGI), the implementation strategy of the second dose of measles vaccine at the state level is determined by the underlying performance of the routine immunization program. The second dose in the national immunization schedule gives extra immunity against measles infection that renders children more susceptible to secondary pneumonia and diarrhoeal diseases, which are the primary causes of under-5 child mortality in India.

The Lancet  
Oct 08, 2011  Volume 378  Number 9799  p1275 – 1354
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Early child development—a winning combination
The Lancet

Preview
4 years ago, a Lancet Series on child development reported that worldwide, more than 200 million children younger than 5 years were failing to reach their developmental potential. In today’s issue a follow-up Series documents progress in reduction of risk factors for poor development, such as inadequate cognitive stimulation, intrauterine growth restriction, HIV infection, and societal violence. The poorest and most vulnerable children benefit most from interventions, such as preschool programmes, because risk factors accumulated over a child’s short life produce greater inequality in educational achievements and development.

Series
Inequality in early childhood: risk and protective factors for early child development
Susan P Walker, Theodore D Wachs, Sally Grantham-McGregor, Maureen M Black, Charles A Nelson, Sandra L Huffman, Helen Baker-Henningham, Susan M Chang, Jena D Hamadani, Betsy Lozoff, Julie M Meeks Gardner, Christine A Powell, Atif Rahman, Linda Richter

Summary
Inequality between and within populations has origins in adverse early experiences. Developmental neuroscience shows how early biological and psychosocial experiences affect brain development. We previously identified inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anaemia as key risks that prevent millions of young children from attaining their developmental potential. Recent research emphasises the importance of these risks, strengthens the evidence for other risk factors including intrauterine growth restriction, malaria, lead exposure, HIV infection, maternal depression, institutionalisation, and exposure to societal violence, and identifies protective factors such as breastfeeding and maternal education. Evidence on risks resulting from prenatal maternal nutrition, maternal stress, and families affected with HIV is emerging. Interventions are urgently needed to reduce children’s risk exposure and to promote development in affected children. Our goal is to provide information to help the setting of priorities for early child development programmes and policies to benefit the world’s poorest children and reduce persistent inequalities.

Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries
Patrice L Engle, Lia CH Fernald, Harold Alderman, Jere Behrman, Chloe O’Gara, Aisha Yousafzai, Meena Cabral de Mello, Melissa Hidrobo, Nurper Ulkuer, Ilgi Ertem, Selim Iltus, the Global Child Development Steering Group

Summary
This report is the second in a Series on early child development in low-income and middle-income countries and assesses the effectiveness of early child development interventions, such as parenting support and preschool enrolment. The evidence reviewed suggests that early child development can be improved through these interventions, with effects greater for programmes of higher quality and for the most vulnerable children. Other promising interventions for the promotion of early child development include children’s educational media, interventions with children at high risk, and combining the promotion of early child development with conditional cash transfer programmes. Effective investments in early child development have the potential to reduce inequalities perpetuated by poverty, poor nutrition, and restricted learning opportunities. A simulation model of the potential long-term economic effects of increasing preschool enrolment to 25% or 50% in every low-income and middle-income country showed a benefit-to-cost ratio ranging

New England Journal of Medicine
October 6, 2011  Vol. 365 No. 14
http://content.nejm.org/current.shtml

Perspective
Routine HIV Screening — What Counts in Evidence-Based Policy?
R. Bayer and G.M. Oppenheimer

[Free full-text]

Pediatrics
October 2011, VOLUME 128 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Advance Online

Multicomponent Interventions to Enhance Influenza Vaccine Delivery to Adolescents
Lisa M. Gargano, Karen Pazol, Jessica M. Sales, Julia E. Painter, Christopher Morfaw, LaDawna M. Jones, Paul Weiss, James W. Buehler, Dennis L. Murray, Gina M. Wingood, Walter A. Orenstein, Ralph J. DiClemente, and James M. Hughes
Pediatrics 2011; peds.2011-0453; Published online October 10, 2011 (10.1542/peds.2011-0453)

Abstract
Objective: To compare school- versus provider-based approaches to improving influenza vaccination coverage among adolescents in rural Georgia.

Methods: We used a nonrandomized, 3-armed design: (1) a middle- and high school-based influenza vaccination intervention in 1 county; (2) a provider-based influenza vaccination intervention in a second county; and (3) a standard-of-care condition in a third county. Interventions also included distribution of an educational brochure, school presentations, and community-based outreach to enhance vaccine knowledge and awareness among adolescents and their parents.

Results: During the 2008–2009 influenza season, 70 (19%) of 370 students were vaccinated in the school-based county and 110 (15%) of 736 students were vaccinated in the provider-based county, compared with 71 (8%) of 889 students in the standard-of-care county (risk ratio [RR]school: 2.4 [95% confidence interval (CI): 1.7–3.2]; RRprovider: 1.9 [95% CI: 1.4–2.5]). During 2009–2010, seasonal influenza vaccination coverage was 114 (30.4%) of 375 of students in the school-based county, 122 (16.9%) of 663 of students in the provider-based county, and 131 (15.2%) of 861 students in the standard-of-care county (RRschool: 2.3 [95% CI: 1.9–2.9]; RRprovider: 1.2 [95% CI: 0.97–1.5]).

Conclusions: Special efforts to promote influenza vaccination among rural, predominantly black students were associated with increased vaccination coverage. The school-based influenza vaccination intervention was associated with the highest levels of vaccination coverage. This study revealed the efficacy of school-based influenza education to improve vaccination rates among adolescents.

Pediatrics
October 2011, VOLUME 128 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Advance Online

Alternative Vaccination Schedule Preferences Among Parents of Young Children
Amanda F. Dempsey, Sarah Schaffer, Dianne Singer, Amy Butchart, Matthew Davis, and Gary L. Freed
Pediatrics 2011; peds.2011-0400; Published online October 3, 2011 (10.1542/peds.2011-0400)

Abstract
Objective: Increasing numbers of parents use alternative vaccination schedules that differ from the recommended childhood vaccination schedule for their children. We sought to describe national patterns of alternative vaccination schedule use and the potential “malleability” of parents’ current vaccination schedule choices.

Methods: We performed a cross-sectional, Internet-based survey of a nationally representative sample of parents of children 6 months to 6 years of age. Bivariate and multivariate analyses determined associations between demographic and attitudinal factors and alternative vaccination schedule use.

Results: The response rate was 61% (N = 748). Of the 13% of parents who reported following an alternative vaccination schedule, most refused only certain vaccines (53%) and/or delayed some vaccines until the child was older (55%). Only 17% reported refusing all vaccines. In multivariate models, nonblack race and not having a regular health care provider for the child were the only factors significantly associated with higher odds of using an alternative schedule. A large proportion of alternative vaccinators (30%) reported having initially followed the recommended vaccination schedule. Among parents following the recommended vaccination schedule, 28% thought that delaying vaccine doses was safer than the schedule they used, and 22% disagreed that the best vaccination schedule to follow was the one recommended by vaccination experts.

Conclusions: More than 1 of 10 parents of young children currently use an alternative vaccination schedule. In addition, a large proportion of parents currently following the recommended schedule seem to be “at risk” for switching to an alternative schedule

PLoS One
[Accessed 10 October 2011]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Meningococcal Disease in Children in Merseyside, England: A 31 Year Descriptive Study
Michelle C. Stanton, David Taylor-Robinson, David Harris, Fauzia Paize, Nick Makwana, Scott J. Hackett, Paul B. Baines, F. Andrew I. Riordan, Omnia Marzouk, Alistair P. J. Thomson, Peter J. Diggle, C. Anthony Hart, Enitan D. Carrol of the meningococcal C conjugate (MCC) vaccine. The proportion … ] , and the introduction of the meningococcal C conjugate vaccine [8 … in the introduction of the Meningococcal C vaccine in November 1999 PLoS ONE: Research Article, published 07 Oct 2011 10.1371/journal.pone.0025957

Abstract 
Meningococcal disease (MCD) is the leading infectious cause of death in early childhood in the United Kingdom, making it a public health priority. MCD most commonly presents as meningococcal meningitis (MM), septicaemia (MS), or as a combination of the two syndromes (MM/MS). We describe the changing epidemiology and clinical presentation of MCD, and explore associations with socioeconomic status and other risk factors. A hospital-based study of children admitted to a tertiary children’s centre, Alder Hey Children’s Foundation Trust, with MCD, was undertaken between 1977 to 2007 (n = 1157). Demographics, clinical presentations, microbiological confirmation and measures of deprivation were described. The majority of cases occurred in the 1–4 year age group and there was a dramatic fall in serogroup C cases observed with the introduction of the meningococcal C conjugate (MCC) vaccine. The proportion of MS cases increased over the study period, from 11% in the first quarter to 35% in the final quarter. Presentation with MS (compared to MM) and serogroup C disease (compared to serogroup B) were demonstrated to be independent risk factors for mortality, with odds ratios of 3.5 (95% CI 1.18 to 10.08) and 2.18 (95% CI 1.26 to 3.80) respectively. Cases admitted to Alder Hey were from a relatively more deprived population (mean Townsend score 1.25, 95% CI 1.09 to 1.41) than the Merseyside reference population. Our findings represent one of the largest single-centre studies of MCD. The presentation of MS is confirmed to be a risk factor of mortality from MCD. Our study supports the association between social deprivation and MCD.

PLoS One
[Accessed 10 October 2011]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Communicable Diseases Prioritized for Surveillance and Epidemiological Research: Results of a Standardized Prioritization Procedure in Germany, 2011
Yanina Balabanova, Andreas Gilsdorf, Silke Buda, Reinhard Burger, Tim Eckmanns, Barbara Gärtner, Uwe Groß, Walter Haas, Osamah Hamouda, Johannes Hübner, Thomas Jänisch, Manfred Kist, Michael H. Kramer, Thomas Ledig, Martin Mielke, Matthias Pulz, Klaus Stark, Norbert Suttorp, Uta Ulbrich, Ole Wichmann, Gérard Krause possibilities and needs (including vaccines) ** Preventive … of a routine childhood Varicella vaccination program in 2004 … trends of vaccine-preventable diseases that followed PLoS ONE: Research Article, published 04 Oct 2011 10.1371/journal.pone.00256

Abstract 
Introduction
To establish strategic priorities for the German national public health institute (RKI) and guide the institute’s mid-term strategic decisions, we prioritized infectious pathogens in accordance with their importance for national surveillance and epidemiological research.

Methods
We used the Delphi process with internal (RKI) and external experts and a metric-consensus approach to score pathogens according to ten three-tiered criteria. Additional experts were invited to weight each criterion, leading to the calculation of a median weight by which each score was multiplied. We ranked the pathogens according to the total weighted score and divided them into four priority groups.

Results
127 pathogens were scored. Eighty-six experts participated in the weighting; “Case fatality rate” was rated as the most important criterion. Twenty-six pathogens were ranked in the highest priority group; among those were pathogens with internationally recognised importance (e.g., Human Immunodeficiency Virus, Mycobacterium tuberculosis, Influenza virus, Hepatitis C virus, Neisseria meningitides), pathogens frequently causing large outbreaks (e.g., Campylobacter spp.), and nosocomial pathogens associated with antimicrobial resistance. Other pathogens in the highest priority group included Helicobacter pylori, Respiratory Syncytial Virus, Varicella zoster virus and Hantavirus.

Discussion
While several pathogens from the highest priority group already have a high profile in national and international health policy documents, high scores for other pathogens (e.g., Helicobacter pylori, Respiratory syncytial virus or Hantavirus) indicate a possible under-recognised importance within the current German public health framework. A process to strengthen respective surveillance systems and research has been started. The prioritization methodology has worked well; its modular structure makes it potentially useful for other settings.

Science        
7 October 2011 vol 334, issue 6052, pages 1-144
http://www.sciencemag.org/current.dtl

EDITORIAL:
Genomics Is Not Enough
Aravinda Chakravarti
Science 7 October 2011: 15.

Next week, the international congress of human genetics convenes in Montreal, where genomic science, its technologies, genetic disease, and personalized medicine will be discussed. Translating current knowledge into medical practice is an important goal for the public who support medical research, and for the scientists and clinicians who articulate the critical research needs of our time. However, despite innumerable successful gene discoveries through genomics, a major impediment is our lack of knowledge of how these genes affect the fundamental biological mechanisms that are dysregulated in disease. If genomic medicine is to prosper, we need to turn our attention to this gaping hole.

Science Translational Medicine
5 October 2011 vol 3, issue 103
http://stm.sciencemag.org/content/current

Commentary
Science and Health Policy
The Changing Burden of Infectious Disease in Europe
Robin Fears, Jos W. M. van der Meer, and Volker ter Meulen
5 October 2011: 103cm30

Abstract
Infectious diseases continue to pose major public health challenges in developed, as well as developing, countries. The European Academies Science Advisory Council aims to integrate multidisciplinary analyses to define priorities for European surveillance of new, growing, or potential threats from antimicrobial resistance, vector-borne disease, and pandemic influenza. There is a concomitant need to apply such knowledge toward the development of improved health care and robust policies. We discuss how translational medicine can bridge these global issues by helping to mobilize resources between academia, industry, health care services, and policy-makers.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Regular Papers
Guillain–Barré syndrome and H1N1 (2009) pandemic influenza vaccination using an AS03 adjuvanted vaccine in the United Kingdom: Self-controlled case series
Pages 7878-7882
Nick Andrews, Julia Stowe, Rustam Al-Shahi Salman, Elizabeth Miller

Abstract
In 1976 a swine influenza vaccine was associated with an increased risk of Guillain–Barré syndrome (GBS). Although subsequent studies did not find an increased risk of GBS following seasonal influenza vaccine, there was concern that the monovalent H1N1 vaccines developed against the swine influenza pandemic of 2009 might increase the risk of GBS. In the UK a split-virion AS03 oil-in-water adjuvanted vaccine (Pandemrix™) was predominantly used. To determine whether the risk of GBS increased after Pandemrix administration, we sought GBS cases during the period of vaccine use from neurologists and a patient support group, and following the vaccination period from hospital episode statistics (HES) in England. We obtained cases’ vaccination histories and illness onset dates from general practitioners. We determined the relative incidence of GBS in the 6 weeks after vaccination using the self-controlled case series method on the cases identified in HES. We included 327 GBS cases, of whom 37 received pandemic vaccine in the study period, nine of whom developed GBS within 6 weeks of vaccination (relative incidence 1.05 [95% confidence interval (CI) 0.37 to 2.24]). We found no evidence of an increased risk of GBS in the 6 weeks following pandemic influenza vaccination.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Regular Papers
MMR vaccine effectiveness in an outbreak that involved day-care and primary schools
Pages 8024-8031
Irene Barrabeig, Ariadna Rovira, Pilar Muñoz, Joan Batalla, Cristina Rius, Josep Anton Sánchez, Àngela Domínguez

Abstract
Objective
In 2006, a large measles outbreak occurred in Catalonia (Spain), where the immunization schedule included two doses of MMR vaccine at 15 months and 4 years. The aim of this study was to investigate the vaccine effectiveness (VE) of MMR in children attending day-care and pre-school centres and to estimate the number of cases that would have been avoided by administering the first dose of MMR at 12 months.

Methods
A retrospective cohort study was carried out between October 2006 and January 2007 in day-care and pre-school centres with confirmed measles cases. VE was calculated in children aged ≥15 months without previous measles infection. Cases avoided by advancing the first dose of MMR to 12 months were estimated by calculating the basic and effective reproduction number in centres where transmission outside the class was observed.

Results
Fifteen centres and 1394 children were included. There were 77 confirmed cases (attack rate = 5.5%). Vaccination coverage of the 1121 children aged ≥15 months was 91.6% and VE was 96% (95%CI 89–98%).

There were 33 (41%) cases in the 81 children aged 12–14 months. Advancing the first dose to 12 months would have prevented 74 cases (91.5%) and lowered the attack rate from 41% to 8.6%.

Conclusions
Over 90% of cases in children aged 12–14 months would have been avoided by MMR administration at 12 rather than 15 months. We strongly recommend advancing the first dose of MMR to 12 months in order to reduce the risk of measles outbreaks.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Regular Papers
Health beliefs and attitudes associated with HPV vaccine intention among young gay and bisexual men in the southeastern United States
Pages 8060-8065
Christopher W. Wheldon, Ellen M. Daley, Eric R. Buhi, Alan G. Nyitray, Anna R. Giuliano

Abstract
Gay and bisexual men are at increased risk of anal cancer as a result of human papillomavirus (HPV) infection. Prophylactic vaccination is a potentially effective strategy for preventing anal cancer in this population. The purpose of this study was to identify factors associated with gay and bisexual men’s intention to receive HPV vaccine. In the fall of 2010, 179 self-identified gay and bisexual men (mean age 22 years) completed an Internet-based questionnaire assessing beliefs and attitudes toward HPV vaccination. Men were recruited from college-based and Internet venues throughout the southeastern United States. The probability of intent to receive HPV vaccine was modeled using logistic regression. A majority of men (93%) had heard of HPV prior to participation but were generally unaware of the association of HPV with anal, penile, and oral cancers. Only 26% were aware of an HPV vaccine for males. Of the 179 participants, 64 (36%) were likely to be vaccinated. Men most likely to receive HPV vaccine perceived stronger physical and psychological benefits from vaccination and had more positive attitudes toward the vaccine. Conversely, intent to be vaccinated was negatively associated with concern over the financial cost of vaccination. Findings from this study can inform college-based health education programs aimed at increasing vaccine uptake among gay and bisexual men.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Regular Papers
Pharmacists as providers: Targeting pneumococcal vaccinations to high risk populations
Pages 8073-8076
Michael Taitel, Ed Cohen, Ian Duncan, Cheryl Pegus

Abstract
Background
Older adults and persons with chronic conditions are at increased risk for pneumococcal disease. Severe pneumococcal disease represents a substantial humanistic and economic burden to society. Although pneumococcal vaccination (PPSV) can decrease risk for serious consequences, vaccination rates are suboptimal. As more people seek annual influenza vaccinations at community pharmacies, pharmacists have the ability to identify at-risk patients and provide PPSV.

Objectives
The objective of this study was to evaluate the impact of pharmacists educating at-risk patients on the importance of receiving a pneumococcal vaccination.

Methods
Using de-identified claims from a large, national pharmacy chain, all patients who had received an influenza vaccination between August 1, 2010 and November 14, 2010 and who were eligible for PPSV were identified for the analysis. Based on the Advisory Committee on Immunization Practices recommendations, at-risk patients were identified as over 65 years of age or as aged 2–64 with a comorbid conditions. A benchmark medical and pharmacy claims database of commercial and Medicare health plan members was used to derive a PPSV vaccination rate typical of traditional care delivery to compare to pharmacy-based vaccination. Period incidence of PPSV was calculated and compared.

Results
Among the 1.3 million at-risk patients who were vaccinated by a pharmacist during the study period, 65,598 (4.88%) also received a pneumococcal vaccine. This vaccination rate was significantly higher than the benchmark rate of 2.90% (34,917/1,204,104; p < .001) representing traditional care. Patients aged 60–70 years had the highest vaccination rate (6.60%; 26,430/400,454) of any age group.

Conclusions
Pharmacists were successful at identifying at-risk patients and providing additional immunization services. Concurrent immunization of PPSV with influenza vaccination by pharmacists has potential to improve PPSV coverage. These results support the expanding role of community pharmacists in the provision of wellness and prevention services.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

The potential cost-effectiveness of infant pneumococcal vaccines in Australia
Pages 8077-8085
Anthony T. Newall, Prudence Creighton, David J. Philp, James G. Wood, C. Raina MacIntyre

Abstract
Over the last decade infant pneumococcal vaccination has been adopted as part of routine immunisation schedules in many developed countries. Although highly successful in many settings such as Australia and the United States, rapid serotype replacement has occurred in some European countries. Recently two pneumococcal conjugate vaccines (PCVs) with extended serotype coverage have been licensed for use, a 10-valent (PHiD-CV) and a 13-valent (PCV-13) vaccine, and offer potential replacements for the existing vaccine (PCV-7) in Australia. To evaluate the cost-effectiveness of PCV programs we developed a static, deterministic state-transition model. The perspective for costs included those to the government and healthcare system. When compared to current practice (PCV-7) both vaccines offered potential benefits, with those estimated for PHiD-CV due primarily to prevention of otitis media and PCV-13 due to a further reduction in invasive disease in Australia. At equivalent total cost to vaccinate an infant, compared to no PCV the base-case cost per QALY saved were estimated at A$64,900 (current practice, PCV-7; 3 + 0), A$50,200 (PHiD-CV; 3 + 1) and A$55,300 (PCV-13; 3 + 0), respectively. However, assumptions regarding herd protection, serotype protection, otitis media efficacy, and vaccination cost changed the relative cost-effectiveness of alternative PCV programs. The high proportion of current invasive disease caused by serotype 19A (as included in PCV-13) may be a decisive factor in determining vaccine policy in Australia.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Healthy-days time equivalents for outcomes of acute rotavirus infections
Pages 8086-8093
A. Brett Hauber, Robbin Itzler, F. Reed Johnson, Ateesha F. Mohamed, Juan Marcos González, John R. Cook, Emmanuel B. Walter

Abstract
Rotavirus is the most common cause of severe gastroenteritis in infants and young children worldwide. Health-state utility measures used in economic evaluations of rotavirus vaccines do not reflect differences between mild and severe symptoms of rotavirus gastroenteritis and, therefore, do not adequately capture preferences for non-fatal outcomes associated with rotavirus common in industrialized countries. This paper describes the development and results of a survey specifically designed to develop quality-adjusted time equivalents for rotavirus gastroenteritis among a sample of parents with young children in the United States as an alternative to conventional QALY measures in assessing cost-effectiveness.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Dentists’ awareness toward vaccine preventable diseases
Pages 8108-8112
Stefano Petti, Giuseppe A. Messano, Antonella Polimeni

Abstract
Effective infection control in dentistry is unfeasible without an adequate immunization program for dental health care providers (DHCPs). Such an assumption is demonstrated for some vaccine preventable infectious diseases (VPIDs), such as Hepatitis B, Influenza and Varicella. However, excluding Hepatitis B vaccine, immunization programs for DHCPs are few and often unclear about which vaccinations are recommended, thus leading to generally low awareness and consequent low vaccination rates. This survey investigated dentists’ awareness toward VPIDs. At the moment of registration to a dental congress, a questionnaire regarding the immunization status toward VPIDs was anonymously filled in by 379 Italian dentists (86% of the contacted dentists), with at least fifteen years of activity. DHCP specific awareness was considered high if dentists reported to have controlled the serum level of anti-HBs during the last ten years and have received seasonal influenza vaccine annually. Awareness toward VPIDs was classified high if dentists reported to be immune against six or seven of the following VIPDs, Hepatitis B, Influenza, Varicella, Measles, Mumps, Rubella and Tetanus. DHCP specific awareness resulted high for 32.5% of subjects and low for 31.1%. None of the subjects reported high awareness toward VPIDs, while for 60% of them, such awareness was low (immunization status reported for none or one of the seven VPIDs). Low dentists’ awareness stresses the need for a transparent immunization program which is effective in controlling VPID transmission in the dental health care settings and focuses on those VPIDs which pose a true risk of infection for DHCPs and patients

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Editorial
Developing vaccine policy: Attributes of “just policy” and a proposed template to guide decision and policy making
Pages 7577-7578
Gregory A. Poland, Edgar K. Marcuse

[No abstract]

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Short Communications
College students’ perceptions of H1N1 flu risk and attitudes toward vaccination
Pages 7599-7601
Meagan A. Ramsey, Cecile A. Marczinski

Abstract
College students are highly susceptible to the H1N1 virus, yet previous studies suggest that college students perceive themselves at low risk for the flu. We surveyed 514 undergraduates to assess their perceptions of H1N1 flu risk and opinions about flu vaccines. A third of respondents stated that they were not at risk of getting the H1N1 flu because they were young. Responses indicated a distrust of the safety and effectiveness of influenza vaccinations; only 15.8% of participants planned on receiving H1N1 vaccination. Top reasons for refusing the H1N1 vaccine included questioning vaccine safety and effectiveness, and concerns about potential serious and/or benign side effects. Top reasons for H1N1 vaccination acceptance included receiving a doctor recommendation for the vaccine, having previously gotten a seasonal vaccine, and being at high-risk for influenza. Our findings suggest that college students are inaccurate in assessing their risk level and are unlikely to seek vaccinations.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Regular Papers
Cost-effectiveness of the introduction of the pneumococcal polysaccharide vaccine in elderly Colombian population
Pages 7644-7650
Carlos Castañeda-Orjuela, Nelson Alvis-Guzmán, Ángel José Paternina, Fernando De la Hoz-Restrepo

Abstract
Background
Streptococcus pneumoniae causes community-acquired pneumonia, otitis media and meningitis, with higher incidences at the extremes of life. PPV-23 vaccine is widely used in prevention of pneumonia and invasive pneumococcal disease in older adults in developed countries. We developed an evaluation of cost-effectiveness of implementing PPV-23 in Colombian population over 60 years.

Methods
The number of cases of pneumonia and meningitis in patients over 60 years and the proportion by S. pneumoniae was estimated based on a review of literature. A decision tree model with a 5-year time horizon was built to evaluate the cost-effectiveness of the implementation of the PPV-23 in this population. Direct health care costs of out- and in-patients were calculated based on expenditure records from the Bogota public health system. Incremental cost-effectiveness ratios per life saved and per year of life gained were estimated based on the decision tree model. Deterministic and probabilistic sensitivity analyses were performed.

Results
Without vaccination 4460 (range 2384–8162) bacteremic pneumococcal pneumonias and 141 (range 73–183) pneumococcal meningitis would occur among people over 60 years old in Colombia. In the first year, vaccination with PPV-23 at US$8/dose would save 480 (range 100–1753) deaths due to Invasive and non-invasive pneumococcal disease. Vaccination would results in US$3400/deaths averted (range US$1028–10,862) and US$1514/life years gained (range US$408–5404).

Conclusion
Vaccination with PPV-23 in over 60 years is a highly cost-effective public health measure in Colombia. Despite some limitations, the results are robust, and may help developing countries to perform informed decisions about the introduction of the vaccine.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Parent and adolescent perspectives about adolescent vaccine delivery: Practical considerations for vaccine communication
Pages 7651-7658
Cynthia M. Rand, Sharon G. Humiston, Stanley J. Schaffer, Christina S. Albertin, Laura P. Shone, Aaron K. Blumkin, Shannon Stokley, Peter G. Szilagyi

Abstract
We surveyed parents of adolescents (n = 430) and their adolescents ages 15–17 years (n = 208) in 9 primary-care settings in Monroe County, NY to assess perceptions about adolescent vaccine delivery. Parents and adolescents most wanted to discuss vaccine side effects and the diseases prevented with the adolescents’ provider. Those who perceived vaccines as very safe were more accepting of adolescent vaccines. Most participants agreed with vaccinating the teen during a mild illness and with providing multiple vaccines concomitantly. Participants most preferred medical, as opposed to other settings, for receipt of adolescent vaccines. For parents and adolescents who are wary of vaccination, strategies are needed to enhance communication about risks and benefits of vaccinations.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Parental acceptance of human papillomavirus (HPV) vaccination in Indonesia: A cross-sectional study
Pages 7785-7793
L. Jaspers, S. Budiningsih, R. Wolterbeek, F.C. Henderson, A.A.W. Peters

Abstract
Background
Cervical cancer ranks the second most frequent cancer in Indonesian women. In Indonesia, human papillomavirus (HPV) vaccine acceptance has not been studied before.

Objective
To determine parental HPV vaccine acceptance in Indonesia, and factors that influence their decision. Factors include sociodemographic factors, knowledge of HPV, HPV vaccination and cervical cancer, health beliefs about cervical cancer, and attitudes towards vaccination in general.

Methods
746 parents, with at least 1 daughter aged 0–14, were interviewed using questionnaires based on published and adjusted interviews. Interviews were done in sub district public health centers, general governmental hospitals, and via house-visits, in 5 Indonesian provinces.

Results
Parental HPV vaccine acceptance was 96.1%. Logistic regression revealed that age, beliefs regarding cervical cancer, and attitudes towards vaccination in general were significantly associated with HPV vaccine acceptance. Of the participants, 66.0%, 16.6%, and 15.8% had heard about cervical cancer, HPV, and HPV vaccination respectively. The mean total knowledge score was 1.91(Standard Deviation 2.31) on a 0–8 scale. Health beliefs about cervical cancer and attitudes towards vaccination in general were positive. Participants named the high cost of the vaccine, fear for side-effects, and chosen vaccination locations as possible barriers towards HPV vaccine implementation.

Discussion
Parental HPV vaccine acceptance is high, but knowledge about HPV and cervical cancer is low. During HPV vaccination programs, focus should not only be on providing information, but also on existing beliefs and attitudes towards cervical cancer and vaccination in general. If HPV vaccination programs were to be implemented in Indonesia, the indicated barriers should be taken into account.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Hospital-based study of the economic burden associated with rotavirus diarrhea in eastern China
Pages 7801-7806
Hui Jin, Bei Wang, Zhaoyin Fang, Zhaojun Duan, Qian Gao, Na Liu, Lijie Zhang, Yuan Qian, Sitang Gong, Qirong Zhu, Xiaona Shen, Qingbin Wu

Abstract
Rotavirus infection is one of the most common causes of severe diarrhea in China. To evaluate the economic burden associated with rotavirus infection of children in China, we combined data on the disease burden of rotavirus-associated costs for samples comprising 832 outpatients and 604 inpatients from five seaside cities. The average social costs and direct medical costs for rotavirus-associated admissions were calculated to be US $61.64 and US $40.73 for outpatients, and US $684.15 and US $559.48 for inpatients, respectively, from October 1, 2006 to December 1, 2007. On average, the private cost ranged from US $54.64 for outpatients to US $454.24 for inpatients when children suffered from rotavirus infection. Accordingly, this cost accounted for 35.19–293% of the monthly income of an unskilled or service worker. We estimated that the annual number of children with rotavirus diarrhea was 12.10 million. Consequently, the total annual direct cost, total annual social cost, and total annual private cost were US $271.4 million, US $365.0 million, and US $290.0 million, respectively. Furthermore, rotavirus diarrhea affected children’s behavior and emotions, which had a great influence on the caretakers’ quality of life. These data indicate the potential requirement for a safe and effective rotavirus vaccine to reduce the economic burden associated with rotavirus disease.

The pdf version of Vaccines: The Week in Review  3 October 2011, comprising the posts for this date below, is available here: Vaccines_The Week in Review_3 Oct 2011

The GAVI Alliance announced it will provide funding for 16 more developing countries to introduce rotavirus vaccines and 18 more countries to introduce pneumococcal vaccines, noting that the roll out of rotavirus vaccines across Africa has already begun in Sudan. GAVI CEO Seth Berkley M.D. said, “Thanks to our donors and partners, the GAVI Alliance is now delivering on its promise to protect more children across the developing world against rotavirus, pneumococcal disease and other life-threatening yet preventable diseases. The death toll of rotavirus and pneumococcal infections in Africa is particularly devastating, and this is where these vaccines will make the most significant impact, not only in lives saved, but also in terms of healthy lives lived. Immunisation enables good health and healthy people are more productive and ultimately fuel economic growth.” GAVI also approved applications from five countries for pentavalent vaccine, and 12 for other types of vaccines (see detailed list of approved countries). http://www.who.int/immunization/newsroom/press/vaccines_to_reach_37_more_countries/en/index.html