Human Vaccines
Volume , Issue 12  December 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/11/

Research Papers
Social and cultural determinants of anticipated acceptance of an oral cholera vaccine prior to a mass vaccination campaign in Zanzibar
Christian Schaetti, Claire-Lise Chaignat, Raymond Hutubessy, Ahmed M. Khatib, Said M. Ali, Christian Schindler and Mitchell G. Weiss

Abstract
Despite improvements in sanitation and water supply, cholera remains a serious public health burden. Vaccination is included among recommendations for cholera control. Cultural concepts of illness are likely to affect vaccine acceptance. This study examined social and cultural determinants of anticipated acceptance of an oral cholera vaccine (OCV) prior to a mass vaccination campaign in Zanzibar. Using a cultural epidemiological approach, 356 unaffected adult residents were studied with vignette-based semi-structured interviews. Anticipated acceptance was high for a free OCV (94%), but declined with increasing price. Logistic regression models examined social and cultural determinants of anticipated acceptance at low (USD 0.9), medium (USD 4.5) and high (USD 9) price. Models including somatic symptoms (low and high price), social impact (low and medium) and perceived causes (medium and high) explained anticipated OCV acceptance better than models containing only socio-demographic characteristics. Identifying thirst with cholera was positively associated with anticipated acceptance of the low-priced OCV, but acknowledging the value of home-based rehydration was negatively associated. Concern about spreading the infection to others was positively associated at low price among rural respondents. Confidence in the health system response to cholera outbreaks was negatively associated at medium price among peri-urban respondents. Identifying witchcraft as cause of cholera was negatively associated at medium and high price. Anticipated acceptance of free OCVs is nearly universal in cholera-endemic areas of Zanzibar; pre-intervention assessments of community demand for OCV should not only consider the social epidemiology, but also examine local socio-cultural features of cholera-like illness that explain vaccine acceptance.

Human Vaccines
Volume 7, Issue 12  December 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/11/

Research Papers
Determinants of tetanus and seasonal influenza vaccine uptake in adults living in Germany
Merle M. Böhmer, Dietmar Walter, Gérard Krause, Stephan Müters, Antje Gößwald and Ole Wichmann

Abstract
The primary objective of this study was to assess determinants of vaccine uptake in adults living in Germany exemplified by one standard vaccination (tetanus) and one vaccination targeting specific risk-groups (seasonal influenza). Data from 21,262 telephone household-interviews representative of the adult population in Germany were collected in 2009 and analysed. A total 73.1% of the adult population had a sufficient tetanus vaccination status according to national recommendations (i.e. last tetanus shot ≤10 years ago). Influenza vaccination coverage in the target population (i.e. persons ≥60 years, chronically ill, healthcare workers) was 44.1%. Persons who received professional vaccination advice within the past five years were more frequently vaccinated against tetanus and influenza than persons without (p<0.001). Private physicians were identified as the most important source for vaccination advice. Having a statutory health insurance, last physician contact <1 year ago, and living in the eastern part of Germany were independently associated with higher tetanus and influenza vaccine uptake. Low socio-economic status, two-sided migration background, and the feeling of being insufficiently informed on the benefits of vaccination were independently associated with low uptake of tetanus but not influenza vaccines. Our results show that tetanus vaccination coverage in the general adult population and influenza vaccination coverage in the target population are unsatisfactorily low in Germany. Since physicians’ advice has a major impact on the vaccination decision, physician reminder systems could provide a method to increase vaccination coverage in adults. For tetanus, information activities should target population groups with an increased risk of being undervaccinated.

Human Vaccines
Volume 7, Issue 12  December 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/11/

COMMENTARIES
Hepatitis B Vaccine in national immunization schedule: A preventive step in India
Ramesh Verma, Pardeep Khanna, Shankar Prinja, Meena Rajput, Suraj Chawla and Mohan Bairwa

Abstract
Hepatitis B is a disease of the liver caused by Hepatitis B virus (HBV) infection. HBV is transmitted through contact with infected blood or body fluids, unprotected sexual intercourse and the perinatal route but not through casual contact. About two billion people worldwide have been infected with the virus, an estimated 360 million live with chronic infection, and at least 600,000 people die annually from acute or chronic consequences of Hepatitis B, such that Hepatitis B is a major public health problem worldwide. HBV is 50 to 100 times more infectious than HIV. It has been estimated that, of the 25 million infants born every year in India, over one million run the lifetime risk of developing chronic HBV infection. Every year over 100,000 Indians die due to illnesses related to HBV infection. Following the launch of the Global Alliance for Vaccines and Immunization (GAVI) to intensify National Immunization Programs (NIPs) in developing countries worldwide. World Health Organization (WHO) recommends that Hepatitis B vaccine should be given to all infants. Several cost-effectiveness analyses of inclusion of Hepatitis B vaccine in India’s NIP have been performed. These indicate that universal childhood Hepatitis B immunization in India will be highly cost-effective. The Government of India is also supporting planned state programs for introducing new vaccines as part of routine immunization. The current immunization schedule for hepatitis B vaccine includes a dose given as early as possible after birth, preferably within 24 hours for all institutional deliveries because the birth dose of Hepatitis B vaccine is effective in preventing perinatal transmission of Hepatitis B. Irrespective of the birth dose, 3 doses are to be given at 6, 10, 14 weeks at the same time as DPT and OPV.

The Lancet  
Dec 03, 2011  Volume 378  Number 9807  p1895 – 1974  e12 – 18
http://www.thelancet.com/journals/lancet/issue/current

Editorial
The Global Fund and a new modus operandi
The Lancet

Preview
On Nov 21–22, the Global Fund to Fight AIDS, Tuberculosis and Malaria held its 25th Board meeting in Accra, Ghana. Tensions were high as the Fund had to make difficult decisions in a year that has been plagued by financial shortfalls, corruption, and calls for organisational reforms. In view of the financial challenges presented by the US budget environment and the Euro crisis, the Fund has now decided to cancel grant funding for round 11, which will be a huge setback to these disease programmes worldwide.

The Lancet  
Dec 03, 2011  Volume 378  Number 9807  p1895 – 1974  e12 – 18
http://www.thelancet.com/journals/lancet/issue/current

Articles
Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis
Harish Nair, W Abdullah Brooks, Mark Katz, Anna Roca, James A Berkley, Shabir A Madhi, James Mark Simmerman, Aubree Gordon, Masatoki Sato, Stephen Howie, Anand Krishnan, Maurice Ope, Kim A Lindblade, Phyllis Carosone-Link, Marilla Lucero, Walter Ochieng, Laurie Kamimoto, Erica Dueger, Niranjan Bhat, Sirenda Vong, Evropi Theodoratou, Malinee Chittaganpitch, Osaretin Chimah, Angel Balmaseda, Philippe Buchy, Eva Harris, Valerie Evans, Masahiko Katayose, Bharti Gaur, Cristina O’Callaghan-Gordo, Doli Goswami, Wences Arvelo, Marietjie Venter, Thomas Briese, Rafal Tokarz, Marc-Alain Widdowson, Anthony W Mounts, Robert F Breiman, Daniel R Feikin, Keith P Klugman, Sonja J Olsen, Bradford D Gessner, Peter F Wright, Igor Rudan, Shobha Broor, Eric AF Simões, Harry Campbell

Summary
Background

The global burden of disease attributable to seasonal influenza virus in children is unknown. We aimed to estimate the global incidence of and mortality from lower respiratory infections associated with influenza in children younger than 5 years.

Methods
We estimated the incidence of influenza episodes, influenza-associated acute lower respiratory infections (ALRI), and influenza-associated severe ALRI in children younger than 5 years, stratified by age, with data from a systematic review of studies published between Jan 1, 1995, and Oct 31, 2010, and 16 unpublished population-based studies. We applied these incidence estimates to global population estimates for 2008 to calculate estimates for that year. We estimated possible bounds for influenza-associated ALRI mortality by combining incidence estimates with case fatality ratios from hospital-based reports and identifying studies with population-based data for influenza seasonality and monthly ALRI mortality.

Findings
We identified 43 suitable studies, with data for around 8 million children. We estimated that, in 2008, 90 million (95% CI 49—162 million) new cases of influenza (data from nine studies), 20 million (13—32 million) cases of influenza-associated ALRI (13% of all cases of paediatric ALRI; data from six studies), and 1 million (1—2 million) cases of influenza-associated severe ALRI (7% of cases of all severe paediatric ALRI; data from 39 studies) occurred worldwide in children younger than 5 years. We estimated there were 28 000—111 500 deaths in children younger than 5 years attributable to influenza-associated ALRI in 2008, with 99% of these deaths occurring in developing countries. Incidence and mortality varied substantially from year to year in any one setting.

Interpretation
Influenza is a common pathogen identified in children with ALRI and results in a substantial burden on health services worldwide. Sufficient data to precisely estimate the role of influenza in childhood mortality from ALRI are not available.

Funding
WHO; Bill & Melinda Gates Foundation.

The Lancet  
Dec 03, 2011  Volume 378  Number 9807  p1895 – 1974  e12 – 18
http://www.thelancet.com/journals/lancet/issue/current

Review
Serotype replacement in disease after pneumococcal vaccination
Daniel M Weinberger, Richard Malley, Marc Lipsitch

Summary
Vaccination with heptavalent pneumococcal conjugate vaccine (PCV7) has significantly reduced the burden of pneumococcal disease and has had an important public health benefit. Because this vaccine targets only seven of the more than 92 pneumococcal serotypes, concerns have been raised that non-vaccine serotypes (NVTs) could increase in prevalence and reduce the benefits of vaccination. Indeed, among asymptomatic carriers, the prevalence of NVTs has increased substantially, and consequently, there has been little or no net change in the bacterial carriage prevalence. In many populations, pneumococcal disease caused by NVT has increased, but in most cases this increase has been less than the increase in NVT carriage. We review the evidence for serotype replacement in carriage and disease, and address the surveillance biases that might affect these findings. We then discuss possible reasons for the discrepancy between near-complete replacement in carriage and partial replacement for disease, including differences in invasiveness between vaccine serotypes. We contend that the magnitude of serotype replacement in disease can be attributed, in part, to a combination of lower invasiveness of the replacing serotypes, biases in the pre-vaccine carriage data (unmasking), and biases in the disease surveillance systems that could underestimate the true amount of replacement. We conclude by discussing the future potential for serotype replacement in disease and the need for continuing surveillance.

New England Journal of Medicine
December 1, 2011  Vol. 365 No. 22
http://content.nejm.org/current.shtml

Correspondence
2137-2138
Intussusception Risk of Rotavirus Vaccination
[Free Full Text]

Intussusception after Rotavirus Vaccination — Spontaneous Reports
[Free Full Text]

Pediatrics
December 2011, VOLUME 128 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Articles
Immunogenicity and Safety of MMRV and PCV-7 Administered Concomitantly in Healthy Children
Michael Leonardi, Kenneth Bromberg, Roger Baxter, Julie L. Gardner, Stephanie Klopfer, Ouzama Nicholson, Michael Brockley, James Trammel, Vicky Leamy, Wendy Williams, Barbara Kuter, and Florian Schödel
Pediatrics 2011; 128:e1387-e1394

Abstract
OBJECTIVE: We assessed the immunogenicity and safety of a combination measles, mump, rubella, and varicella vaccine (MMRV) (ProQuad [Merck & Co, Inc, West Point, PA]) administered to healthy children concomitantly with a pneumococcal 7-valent conjugate vaccine (PCV-7) (Prevnar [Pfizer, Philadelphia, PA]).

PATIENTS AND METHODS: Healthy 12- to 15-month-old children who lacked vaccination and clinical histories for measles, mumps, rubella, varicella, and zoster but had written documentation of receipt of a 3-dose primary series of PCV-7 were randomly assigned in a 2:1:1 ratio to receive either the MMRV and PCV-7 (group 1), PCV-7 followed 6 weeks later by MMRV (group 2), or MMRV followed 6 weeks later by PCV-7 (group 3). The primary safety analysis was 56 days (28 days after each visit). Immunogenicity was evaluated 6 weeks after each vaccination.

RESULTS: A total of 1027 children were enrolled (group 1: 510; group 2: 258; group 3: 259). For all 3 groups, the antibody response rate was ≥96.8% for measles, mumps, and rubella, ≥88.0% for varicella-zoster virus, and ≥98.3% for all of the 7 Streptococcus pneumoniae serotypes. The immune responses to all antigens present in MMRV and PCV-7 were similar whether administered concomitantly or sequentially. The incidence of local and systemic adverse experiences (AEs) was comparable between group 1 and groups 2 and 3 combined. No vaccine-related serious AEs were reported.

CONCLUSIONS: Concomitant administration of the MMRV and PCV-7 is highly immunogenic and generally well tolerated. Similar immune responses between the groups support concomitant administration of the MMRV and PCV-7 to healthy children 12 to 15 months of age.

Pediatrics
December 2011, VOLUME 128 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Articles
Varicella in Infants After Implementation of the US Varicella Vaccination Program
Sandra S. Chaves, Adriana S. Lopez, Tureka L. Watson, Rachel Civen, Barbara Watson, Laurene Mascola, and Jane F. Seward
Pediatrics 2011; 128:1071-1077

Abstract
OBJECTIVE: To describe varicella disease in infants since implementation of the varicella vaccination program in the United States.

PATIENTS AND METHODS: From 1995 to 2008, demographic, clinical, and epidemiologic data on cases of varicella in infants were collected prospectively through a community-based active surveillance project. We examined disease patterns for infants in 2 age groups: 0 to 5 and 6 to 11 months.

RESULTS: Infant varicella disease incidence declined 89.7% from 1995 to 2008. Infants aged 0 to 5 months had milder clinical disease than those aged 6 to 11 months: ≥50 lesions, 49% vs 58% (P = .038); fever (body temperature > 38°C), 12% vs 21% (P = .014); and varicella-related complications, 6% vs 14% (P = .009), respectively. Age was an independent predictor of the occurrence of complications.

CONCLUSIONS: The varicella vaccination program has resulted in substantial indirect benefits for infants, who are not eligible for vaccination. Presence of maternal varicella-zoster virus antibodies might explain attenuated disease in very young infants likely born to mothers with history of varicella. Although varicella disease incidence has declined, exposure to varicella-zoster virus continues to occur. Improving varicella vaccination coverage in all age groups will further reduce the risk of varicella exposure and protect those not eligible for varicella vaccination.

Pediatrics
December 2011, VOLUME 128 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Articles
Adolescent Vaccination-Coverage Levels in the United States: 2006–2009
Shannon Stokley, Amanda Cohn, Christina Dorell, Susan Hariri, David Yankey, Nancy Messonnier, and Pascale M. Wortley
Pediatrics 2011; 128:1078-1086

Abstract
BACKGROUND: From 2005 through 2007, 3 vaccines were added to the adolescent vaccination schedule: tetanus-diphtheria-acellular pertussis (TdaP); meningococcal conjugate (MenACWY); and human papillomavirus (HPV) for girls.

OBJECTIVE: To assess implementation of new adolescent vaccination recommendations.

METHODS: Data from the 2006–2009 National Immunization Survey–Teen, an annual provider-verified random-digit-dial survey of vaccination coverage in US adolescents aged 13 to 17 years, were analyzed. Main outcome measures included percentage of adolescents who received each vaccine according to survey year; potential coverage if all vaccines were administered during the same vaccination visit; and, among unvaccinated adolescents, the reasons for not receiving vaccine.

RESULTS: Between 2006 and 2009, ≥1 TdaP and ≥1 MenACWY coverage increased from 11% to 56% and 12% to 54%, respectively. Between 2007 and 2009, ≥1 HPV coverage among girls increased from 25% to 44%; between 2008 and 2009, ≥3 HPV coverage increased from 18% to 27%. In 2009, vaccination coverage could have been >80% for Td/TdaP and MenACWY and as high as 74% for the first HPV dose if providers had administered all recommended vaccines during the same vaccination visit. For all years, the top reported reasons for not vaccinating were no knowledge about the vaccine, provider did not recommend, and vaccine is not needed/necessary (for TdaP and MenACWY) and adolescent is not sexually active, no knowledge about the vaccine, and vaccine is not needed/necessary (for HPV).

CONCLUSIONS: Adolescent vaccination coverage is increasing but could be improved. Strategies are needed to increase parental knowledge about adolescent vaccines and improve provider recommendation and administration of all vaccines during the same visit.

Pediatrics
December 2011, VOLUME 128 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Articles
Financial Impact to Providers Using Pediatric Combination Vaccines
Angela K. Shen, Elizabeth Sobczyk, Lone Simonsen, Farid Khan, Allahna Esber, and Margie C. Andreae
Pediatrics 2011; 128:1087-1093

Abstract
OBJECTIVE: To understand the financial impact to providers for using a combination vaccine (Pediarix [GlaxoSmithKline Biologicals, King of Prussia, PA]) versus its equivalent component vaccines for children aged 1 year or younger.

METHODS: Using a subscription remittance billing service offered to private-practice office-based physicians, we analyzed charge and payment information submitted by providers to insurance payers from June 2007 through July 2009. We analyzed provider and payer characteristics, payer comments, and the ratio of vaccine product to immunization administration (IA) codes and computed total charges and payments to providers for both arms of the study.

RESULTS: Most providers in our data set were pediatricians (74%), and most payers were commercial (75%), primarily managed care. The ratio of the number of vaccine products to the number of IAs was 1:1 in the majority of the claims. Twenty percent of claims were paid with no adjustment by the payer, whereas 76% of the claims were adjusted for charges that exceeded the contract arrangement or the fee schedule. Providers received $23 less from commercial payers and $13 less from Medicaid for the use of Pediarix compared with the equivalent component vaccines. The mean commercial payment was greater for age-specific Current Procedural Terminology IA codes 90465 and 90466 than for non–age-specific codes 90471 and 90472, whereas the reverse was true for Medicaid.

CONCLUSIONS: Providers who administer vaccines to children face a reduction in payment when choosing to provide combination vaccines. The new IA codes should be monitored for correction of financial barriers to the use of combination vaccines.

Pediatrics
December 2011, VOLUME 128 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Articles
Welfare, Maternal Work, and On-Time Childhood Vaccination Rates
Min-Woong Sohn, Joan Yoo, Elissa H. Oh, Laura B. Amsden, and Jane L. Holl
Pediatrics 2011; 128:1109-1116

Abstract
OBJECTIVE: To examine effects of Temporary Assistance for Needy Families welfare cash assistance and maternal work requirements on “on-time” childhood vaccination rates.

METHODS: A stratified random sample of Illinois children from low-income families affected by welfare reform was monitored from 1997 to 2004. Medical records from pediatricians’ offices and Medicaid claims data were used to identify the timeliness of 18 recommended vaccinations. Random-intercept logistic models were used to estimate on-time vaccine administration as a function of welfare receipt and maternal work with adjustment for characteristics of the children and mothers and time-varying covariates pertaining to the administration window for each recommended vaccine dose.

RESULTS: Of all recommended vaccinations, 55.9% were administered on time. On-time vaccination rates were higher when families were receiving welfare than not (57.4% vs 52.8%). Children in families that either were receiving welfare or had working mothers were 1.7 to 2.1 times more likely to receive vaccinations on time compared with children in families that were not receiving welfare and did not have working mothers. When vaccine doses were stratified according to welfare status, maternal work was associated with decreased on-time vaccination rates (odds ratio: 0.73 [95% confidence interval: 0.59–0.90]) when families received welfare but increased on-time vaccination rates (odds ratio: 1.68 [95% confidence interval: 1.27–2.22]) when they did not receive welfare.

CONCLUSIONS: These results indicate that maternal work requirements of Temporary Assistance for Needy Families had negative effects on timely administration of childhood vaccinations, although receipt of welfare itself was associated with increased on-time rates.

Pediatrics
December 2011, VOLUME 128 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Commentaries
Reflections on US Immunization Challenges: Lady Montague, Where Are You?
Edgar K. Marcuse
Pediatrics 2011; 128:1192-1194

Extract
Dickens’ oft-quoted words describe well the opportunities and challenges of US immunization programs: “… the best of times… the worst of times … the age of wisdom … the age of foolishness … .”1 Vaccine-preventable disease rates are low, and immunization rates are high, but the broad societal consensus that supported the US immunization program has eroded.2 Our new understanding of immunology, along with new technologies, has launched a renaissance in vaccine research that holds real promise of preventing more infections and their sequelae, but not all US children are yet ensured timely access to all recommended vaccines. The transfer of most immunization from public clinics to physicians’ offices has resulted in the cross-subsidy of public health by primary care, which, because of the economics of vaccine administration, is unsustainable. In the world of adult medicine, the gap between what we have and what we could achieve if we fully used the vaccines now in hand is even greater. As a nation, we talk of the value of prevention, of reining in health care costs, but we fail to walk the talk. We seem to have lost sight of the interface between public health and the individual health of all the members of our communities.3 Today there …

PLoS One
[Accessed 4 December 2011]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Do People Taking Flu Vaccines Need Them the Most?
Qian Gu, Neeraj Sood
PLoS ONE: Research Article, published 02 Dec 2011 10.1371/journal.pone.0026347

Abstract 
Background
A well targeted flu vaccine strategy can ensure that vaccines go to those who are at the highest risk of getting infected if unvaccinated. However, prior research has not explicitly examined the association between the risk of flu infection and vaccination rates.

Purpose
This study examines the relationship between the risk of flu infection and the probability of getting vaccinated.

Methods
Nationally representative data from the US and multivariate regression models were used to estimate what individual characteristics are associated with (1) the risk of flu infection when unvaccinated and (2) flu vaccination rates. These results were used to estimate the correlation between the probability of infection and the probability of getting vaccinated. Separate analyses were performed for the general population and the high priority population that is at increased risk of flu related complications.

Results
We find that the high priority population was more likely to get vaccinated compared to the general population. However, within both the high priority and general populations the risk of flu infection when unvaccinated was negatively correlated with vaccination rates (r = −0.067, p<0.01). This negative association between the risk of infection when unvaccinated and the probability of vaccination was stronger for the high priority population (r = −0.361, p<0.01).

Conclusions
There is a poor match between those who get flu vaccines and those who have a high risk of flu infection within both the high priority and general populations. Targeting vaccination to people with low socioeconomic status, people who are engaged in unhealthy behaviors, working people, and families with kids will likely improve effectiveness of flu vaccine policy.

PLoS One
[Accessed 4 December 2011]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Using the Indirect Cohort Design to Estimate the Effectiveness of the Seven Valent Pneumococcal Conjugate Vaccine in England and Wales
Nick Andrews, Pauline A. Waight, Ray Borrow, Shamez Ladhani, Robert C. George, Mary P. E. Slack, Elizabeth Miller
PLoS ONE: Research Article, published 02 Dec 2011 10.1371/journal.pone.0028435

Abstract 
Background
The 7-valent pneumococcal conjugate vaccine (PCV-7) was introduced in the United Kingdom in 2006 with a 2,3 and 13month schedule, and has led to large decreases in invasive pneumococcal disease (IPD) caused by the vaccine serotypes in both vaccinated and unvaccinated cohorts. We estimated the effectiveness of PCV-7 against IPD.

Methods and Findings
We used enhanced surveillance data, collated at the Health Protection Agency, on vaccine type (n = 153) and non vaccine type (n = 919) IPD cases eligible for PCV-7. The indirect cohort method, a case-control type design which uses non vaccine type cases as controls, was used to estimate effectiveness of various numbers of doses as well as for each vaccine serotype. Possible bias with this design, caused by differential serotype replacement in vaccinated and unvaccinated individuals, was estimated after deriving formulae to quantify the bias. The results showed good effectiveness, increasing from 56% (95% confidence interval (CI): -7-82) for a single dose given under one year of age to 93% (95% CI: 70-98) for two doses under one year of age plus a booster dose in the second year of life. Serotype specific estimates indicated higher effectiveness against serotypes 4, 14 and 18C and lower effectiveness against 6B. Under the assumption of complete serotype replacement by non vaccine serotypes in carriage, we estimated that effectiveness estimates may be overestimated by about 2 to 5%.

Conclusions
This study shows high effectiveness of PCV-7 under the reduced schedule used in the UK. This finding agrees with the large reductions seen in vaccine type IPD in recent years in England and Wales. The formulae derived to assess the bias of the indirect cohort method for PCV-7 can also be used when using the design for other vaccines that affect carriage such as the recently introduced 13 valent pneumococcal conjugate vaccine.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 1 pp. 1-102 (9 December 2011)

Regular Papers
Progress in newborn hepatitis B vaccination by birth year cohorts—1998–2007, USA
Pages 14-20
Zhen Zhao, Trudy V. Murphy, Lisa Jacques-Carroll

Abstract
Background
In 1999, the American Academy of Pediatrics (AAP) and the U.S. Public Health Service (USPHS) issued a joint statement on thimerosal in vaccines, which advised clinicians to temporarily postpone the first dose of hepatitis B vaccine for infants born to hepatitis B surface antigen (HBsAg)-negative women. In 2005, the Advisory Committee on Immunization Practices (ACIP) updated the strategy to improve prevention of perinatal and early childhood hepatitis B virus (HBV) transmission.

Objectives
To evaluate the progress in hepatitis B birth dose vaccination coverage in birth year cohort from 1998 to 2007 and assess the impact of changes in ACIP recommendations on the birth dose coverage.

Methods
Birth year cohort study of hepatitis B birth dose vaccination status of 200,865 children aged 19–35 months in the United States and by selected socio-demographic factors; percentage increases of hepatitis B birth dose vaccination coverage between two consecutive birth year cohorts from 1998 to 2007.

Results
From 1998 to 1999, hepatitis B birth dose vaccination coverage declined overall in the United States and among selected socio-demographic groups (P < 0.001). Conversely, from 1999 to 2007 hepatitis B birth dose vaccination coverage increased significantly by birth year cohort (P < 0.001), from approximately 30% in the 1999 birth year cohort to approximately 60% in the 2007 birth year cohort. The first significant increase in hepatitis B birth dose vaccination coverage occurred from 2000 to 2001 birth year cohort. Coverage increases ranged from 8.4% to 11.9% (P < 0.001) in the U.S. and across all socio-demographic strata. The second largest increase in hepatitis B birth dose vaccination coverage occurred from 2005 to 2006 birth year cohort in the U.S. and among almost all socio-demographic strata, ranging from 5.6% to 8.7% (P < 0.001). Forty-one of the 50 states and the District of Columbia (80%) in the U.S. had increases in hepatitis B birth dose vaccination coverage from 2005 to 2006 birth year cohort.

Conclusions
The United States has made substantial progress in increasing hepatitis B birth dose vaccination and recovered from coverage declines associated with temporary postponement of the birth dose in 1999. The hepatitis B birth dose coverage in the U.S. remains substantially below the Healthy People 2020 target of 85%.

Vaccine
Volume 29, Issue 52 pp. 9573-9722 (6 December 2011)
http://www.sciencedirect.com/science/journal/0264410X

 
Editorial
Methods in vaccine effectiveness and safety studies: A critical need for vaccine confidence
Pages 9573-9574
Steven J. Jacobsen, Gregory A. Poland

Vaccine
Volume 29, Issue 52 pp. 9573-9722 (6 December 2011)
http://www.sciencedirect.com/science/journal/0264410X

Reviews
School-based vaccination: A systematic review of process evaluations
Pages 9588-9599
Spring Chenoa Cooper Robbins, Kirsten Ward, S. Rachel Skinner

Abstract
Objective
School-based vaccination is becoming a more widely used method of vaccine delivery. However, evaluations of school-based vaccination program implementation have not been systematically reviewed. This paper describes the results of a systematic review of the literature on process (or implementation) evaluations of school-based vaccination delivery.

Methods
Search terms: “school based vaccination” OR ((“schools” OR “school”) AND (“immunisation” OR “immunization” OR “vaccination”)). Limits: Humans; English language; Age: 6–18 (school-age children and adolescents); No editorials; No letters. Databases: PUBMED; ; Cochrane Database of Systematic Reviews; Cinahl; Web of Science; PsycINFO. Inclusions: Articles must have originated from an advanced economic ‘developed’ country, be peer-reviewed, available in English, randomised or non-randomised controlled design, published from 1970 to August 2010 and focused on vaccinations provided in the school setting and during school time which reported one or more outcomes. Exclusions: qualitative or descriptive papers without any evaluation component; papers that only reported on impact evaluation (i.e. number of students vaccinated); and those published before 1970.

Results
A total of 14 articles were identified as including some element of a process evaluation of a school-based vaccination program. Nurses, parents, teachers, and adolescents were involved in measures of procedural factors related to school-based vaccination implementation. Outcomes included return rates of consent forms; knowledge about the specific vaccine offered; attitudes toward vaccination and school-based vaccination; reasons for non-vaccination; resources, support, and procedures related to implementation; and environmental factors within the school that may impact vaccination success. Vaccination coverage was also reported in the majority of papers.

Vaccine
Volume 29, Issue 52 pp. 9573-9722 (6 December 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Financing and systems barriers to seasonal influenza vaccine delivery in community settings
Pages 9632-9639
Robert B. Penfold, Donna Rusinak, Tracy A. Lieu, Abigail Shefer, Mark Messonnier, Grace M. Lee

Abstract
Background
Recommendations for annual seasonal influenza vaccination have expanded to now include >300 million children and adults each year. Community settings have become increasingly important venues for influenza vaccination. We sought to identify barriers to and solutions for expanding influenza vaccination in community settings.

Methods
Semi-structured telephone interviews were conducted from 01/09 to 06/10 with a range of stakeholders involved in influenza vaccination, including health plans, medical services firms, retail based clinics, pharmacies, schools, and state and local public health immunization programs. Participants (n = 65) were asked about barriers and feasible solutions to influenza vaccine delivery to children and adults in community settings. Key themes were identified through iterative coding using a grounded theory approach.

Results
Stakeholders identified specific financial barriers to influenza vaccine delivery in 3 major areas: purchase and distribution, delivery, and reimbursement. Limited purchasing power, the uncertain nature of public demand, and unpredictable timing of influenza vaccine supply were important barriers to enhance delivery in community settings. Barriers to delivery included complexities in running off-site clinics, especially in school settings, the need to manage publicly vs. privately purchased vaccines separately, and state-to-state variability in requirements for credentialing, physician oversight, and reporting. Reimbursement barriers included a protracted credentialing process, the need to determine insurance eligibility at point-of-service, and lack of a billing infrastructure in off-site clinics. Opportunities to mitigate financial barriers to influenza vaccine delivery in community settings focused on coordination across providers and the role of public health as a “trusted broker” to overcome existing challenges.

Conclusions
Financial and systems barriers hamper the optimal use of community settings to effectively deliver influenza vaccines. Public health partners at the federal, state, and local levels are well-positioned to facilitate the engagement of all stakeholders in this important and complex vaccine delivery system.

Vaccine
Volume 29, Issue 52 pp. 9573-9722 (6 December 2011)
http://www.sciencedirect.com/science/journal/0264410X

 
Regular Papers
Pharmacoeconomic assessment of implementing a universal PCV-13 vaccination programme in the Valencian public health system (Spain)
Pages 9640-9648
Javier Díez-Domingo, Manuel Ridao-López, M. Victoria Gutiérrez-Gimeno, Joan Puig-Barberá, Jose A. Lluch-Rodrigo, Eliseo Pastor-Villalba

Abstract
Background
Heptavalent pneumococcal conjugate vaccine (PCV-7) was licensed to provide immunity against pneumococcal disease caused by seven serotypes of S. pneumoniae. Thirteen-valent pneumococcal conjugate vaccine (PCV-13) includes 6 additional serotypes for preventing invasive pneumococcal disease.

Objective
The objective of this study was to estimate the potential health benefits, costs, and cost-effectiveness of vaccination with PCV-13 in the Community of Valencia and to generate valuable information for policy makers at regional and country levels.

Methods
A decision tree was designed to determine the health and economic outcomes in hypothetical cohorts of vaccinated and unvaccinated children followed over their lifetime. Information about disease incidence and serotype distribution were gathered from local databases and from published and unpublished local records. PCV-13 effectiveness was extrapolated from PCV-7 efficacy data. A 5% of herd effect and a serotype replacement of 25% were considered for the base case scenario. Only direct costs were taken into account and results were expressed in terms of life-years gained (LYG) and quality adjusted life years (QALY).

Results
Implementing a universal PCV-13 vaccination program in the Community of Valencia would decrease the number of hospital admitted pneumonia to less than 4571 cases while avoiding 310 cases of IPD and 82,596 cases of AOM throughout the cohort lifetime. A total of 190 S. pneumoniae related deaths would be averted over the same period. Total medical costs of non-vaccinating the cohort of newborns would reach up to 403,850.859 € compared to 438,762.712 € that would represent vaccinating the cohort. The incremental cost of vaccinating the children was estimated in 12,794 €/LYG and 10,407 €/QALY, respectively.

Vaccine
Volume 29, Issue 52 pp. 9573-9722 (6 December 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Uptake of the human papillomavirus-vaccination within the free-of-charge childhood vaccination programme in Denmark
Pages 9663-9667
Katarina Widgren, Jacob Simonsen, Palle Valentiner-Branth, Kåre Mølbak

Abstract
Background
Persistent infection with human papillomavirus (HPV) is a prerequisite for cervical cancer, which causes 175 yearly deaths and substantial morbidity in Denmark. In January 2009, HPV-vaccination for 12 year-old girls was introduced into the free-of-charge childhood vaccination programme. Due to concerns about potential poor compliance we determined the uptake and identified determinants for vaccination after the first year of the programme.

Methods
All vaccinations given within the vaccination programme are reported to a central register, which we linked to demographic information found in the Danish civil register. We calculated vaccination uptake and used Cox regression survival analysis to compare the uptake rates between demographic subgroups in the population, e.g. by number of siblings, age of mother (at the daughter’s birth) and place of origin.

Results
The uptake among the 33,838 eligible girls was 80%, 75% and 62% respectively for the three HPV-doses. All subgroups had uptake above 68% for the first HPV-vaccination. Girls with mothers younger or older than the reference group of 25–34 years had a lower uptake rate (adjHR 0.94, 95% CI 0.91–0.97 and adjHR 0.91, 95% CI 0.88–0.94 respectively). Girls with 5 or more siblings had lower uptake rate than girls without siblings (adjHR 0.79, 95% CI 0.71–0.87). Girls born in other EU/EFTA-countries had lower uptake rate than Danish-born girls with Danish-born parents (adjHR 0.74, 95% CI 0.67–0.82).

Conclusions
The introduction of routine HPV-vaccination in Denmark resulted in a relatively high uptake, indicating little reason for major concern about barriers towards the vaccination in Denmark. Population groups with reduced uptake were identified, but as they were small in number their effect on the overall vaccination coverage was marginal. Nonetheless, these groups should be targeted in future acceptance studies and vaccination awareness campaigns.