The pdf version of Vaccines: The Week in Review  30 January 2012 , comprising the posts below for this date, is available here: Vaccines_The Week in Review_30 January 2012

[Editor’s Note: The Global Fund released separate announcements last week on leadership changes and new funding commitments which are distilled below, each with links to the associated full text]

   The Global Fund to Fight AIDS, Tuberculosis and Malaria announced that it will appoint Gabriel Jaramillo as General Manager, “a newly created position intended to oversee a process of transformation as it accelerates the fight against the three pandemics by focusing on its management of risk and grants.” Mr. Jaramillo, a former Chairman and CEO of Sovereign Bank, “has more than 35 years of experience in executive positions in the financial sector, where he won broad recognition as a highly skilled leader and administrator with impeccable integrity. Since he retired a year ago, he has served as a Special Advisor to the Office of the Special Envoy for Malaria of the Secretary General of the United Nations, and was a Member of the High-Level, Independent Panel that looked at the Global Fund’s fiduciary controls and oversight mechanisms.” The announcement noted that the Global Fund’s Board in November “approved a Consolidated Transformation Plan to address the findings of the Panel, along with a new, ambitious, four-year strategy and decided to appoint a General Manager to oversee this transformation. The General Manager will report to the Board, and will assume full executive responsibilities for the Global Fund.”

Mr. Jaramillo commented, “My priorities at the Global Fund are to achieve maximum efficiency, accountability and concrete results that save lives. In essence, we will start with a reorganization that emphasizes simplicity, discipline and rigor, with grant-management as the core activity of the institution.” Mr. Jaramillo is described as a native of Colombia and a Brazilian citizen. He studied at California State University, where he earned a Bachelor’s degree in marketing and a Master’s degree in Business Administration.  Over the next three decades, “he excelled as a manager at successive institutions, including Marine Midland Bank, Citibank, Banco Santander and Sovereign Bank, where he became Chairman and CEO in 2009.  He retired from that position in January 2011, and remained as Chairman until June 2011.” Mr. Jaramillo will take up a 12-month appointment on 1 February 2012. http://www.theglobalfund.org/en/mediacenter/pressreleases/2012-01-24_The_Global_Fund_appoints_Gabriel_Jaramillo_as_General_Manager/

    The Global Fund announced that Executive Director Michel Kazatchkine “has decided to step down in mid-March after leading the organization for five years, during which time he oversaw a dramatic expansion in the organization’s life-saving work.” In a statement to staff, Prof. Kazatchkine said, “For the last ten years, the Global Fund has been my passion and my most important undertaking. I am immensely proud of what the Global Fund has achieved in these ten years, and I am tremendously grateful that I have been able to play a central part in its evolution and success.”  Prof. Kazatchkine also said that “while he respects the Board’s decision to appoint a General Manager and ‘trusts that it was made in the best interests of the Global Fund,’ he has concluded that he should not continue as Executive Director in these circumstances.” Prof. Kazatchkine concluded, “I am committed to an orderly transition and I will do all that I can to ensure that the Global Fund emerges from it as a stronger organization.” Global Fund Board Chair Simon Bland said, “Few individuals have played a more central role in the creation and evolution of the Global Fund than Michel. The Global Fund as we know it today, the millions of lives it has saved, and the many other successes and innovations with which the Fund is associated, all bear Michel’s imprint.  Most importantly, his unwavering commitment to health, to human rights and to supporting the weakest and the unprotected, has helped shape the Global Fund into the beacon of hope it is today for tens of millions of people around the world.”
– Read Message from the Executive Director to Staff and Partners
– Read Message from Chair of the Board to the Board of the Global Fund
http://www.theglobalfund.org/en/mediacenter/pressreleases/2012-01-24_The_Global_Fund_Executive_Director_to_step_down_in_March/

GAVI congratulates Michel Kazatchkine on a great decade with The Global Fund

The Bill & Melinda Gates Foundation renewed its commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria via a US$750 million promissory note, described as a “a new and innovative funding mechanism…(which) gives the Global Fund the flexibility and authority to distribute funds efficiently based on immediate needs, leading to greater impact.” The announced said the Global Fund “continues to save 100,000 lives a month. The Fund has provided antiretroviral treatment to 3.3 million people, detected and treated 8.2 million people with tuberculosis, and provided 230 million bed nets to families to prevent malaria.”
http://www.gatesfoundation.org/press-releases/Pages/renewing-commitment-to-the-global-fund-120126.aspx

   The Global Fund said it welcomed the recent announcement by the Kingdom of Saudi Arabia of a contribution worth US$25 million. The contribution, to be paid in full by 2013, will bring the total contribution from Saudi Arabia to the Global Fund in the decade since it was established to US$53 million. The announcement by the Kingdom of Saudi Arabia came in a letter to United Nations Secretary-General Ban Ki-moon in response to an appeal Mr. Ban had made on the Global Fund’s behalf. Saudi Arabia is described as one of the main donors from the Gulf region to the Global Fund. In the Middle-East and North Africa, the Global Fund is currently supporting 20 countries and territories in their fight against HIV/AIDS and tuberculosis and malaria. http://www.theglobalfund.org/en/mediacenter/pressreleases/2012-01-24_Saudi_Arabia_donates_USD_25000000_to_the_Global_Fund/

The Gates Foundation announced the winner of the first Gates Vaccine Innovation Award, recognizing the work of Dr. Asm Amjad Hossain, a former district immunization and surveillance medical officer in Bangladesh. The announcement noted that “to help vaccinators reach children, Dr. Hossain instituted a new and improved process to help register, track and locate pregnant mothers. He also implemented annual vaccination schedules for communities and other simple steps like adding the phone numbers of vaccinators to children’s immunization cards, which increased accountability and allowed parents to easily access health workers.” Dr. Hossain oversaw routine immunization programs in two Bangladeshi districts with low immunization rates, Brahmanbaria and Habiganj. He was tasked with immunizing more than 150,000 children against vaccine-preventable diseases including diphtheria, pertussis, tetanus, polio, and measles. In the course of a single year, his application of creative methods contributed to an increase in immunization coverage by more than 15 percentage points. Dr. Hossain’s achievements will be recognized with an award of US$250,000, the majority of which will be donated to a charity of his choice.

The Gates Vaccine Innovation Award “celebrates revolutionary ways in which children in the poorest parts of the world receive life-saving vaccines. The award is bestowed on an individual or organization nominated by the public that has made a uniquely innovative contribution to the Decade of Vaccines, in the hope of shining a light on the most powerful innovations in global health. Nominees are assessed on the tangible health impact, creativity, and scale of their innovation in the science, delivery, or funding of vaccines.”

http://www.gatesfoundation.org/press-releases/Pages/gates-vaccine-innovation-award-winner-120124.aspx

    The GAVI Alliance said it will receive at least US$4.5 million for child immunisation from two new partners to its unique GAVI Matching Fund program. The new funding was committed by Comic Relief, a UK-based charity that fights poverty and social injustice, and The Children’s Investment Fund Foundation (CIFF), a UK-based charity that works to improve the lives of children living in poverty in developing countries. The new funding will be matched by the British Government and the Gates Foundation, bringing the total to US$9 million. Separately, GAVI said that “an anonymous private foundation also hopes to make use of a GAVI innovative finance vehicle by investing in the International Finance Facility for Immunisation (IFFIm), The anonymous foundation has discussed an investment in IFFIm bonds whereby it could donate the interest generated to GAVI through the Matching Fund. Under such an arrangement, the coupon (interest) has the potential to exceed US$5 million, which would be matched by the Gates Foundation. http://www.gavialliance.org/library/news/press-releases/2012/gavi-alliance-programme-raises–us$-38-million-for-child-immunisation/

UNICEF appealed for US$1.28 billion to fund its humanitarian operations in 2012, assisting children in more than 25 countries globally. Supporting the appeal, UNICEF released a new report – UNICEF 2012 – Humanitarian Action for Children – which notes that “throughout the world, millions of children are living amidst crises that persist for years. While some of these emergencies attract significant media and political attention, others never reach international awareness, and many become silent emergencies in which deep humanitarian need, existing far from the public eye, is too easily and quickly overlooked.” The UNICEF report “describes the daily situation of some of the world’s most vulnerable children and women caught up in emergencies across the world and the funding required to meet their immediate and long-term needs.” UNICEF said that it requires adequate funding in order to fulfill its commitments towards children as “they not only represent the future but are the most vulnerable, and deserve generous and consistent support from the donor community.”

UNICEF’s 2012 Humanitarian Action for Children report: http://www.unicefusa.org/har.

http://www.prnewswire.com/news-releases/unicef-report-children-in-more-than-25-countries-caught-in-emergencies-138188249.html

Bill & Melinda Gates Foundation co-chair Bill Gates released his fourth annual letter which “challenged global leaders to invest in innovations that are accelerating progress against poverty, or risk a future in which millions needlessly starve.” The Gates Foundation media release noted that “the letter describes remarkable progress in the developing world and makes the case to continue investing in efforts that have made a difference for millions of the world’s poorest people. Over the past 50 years, for example, the percentage of the population living in poverty has fallen from 40 percent to 15 percent, or about 1 billion people. Gates believes it is possible to continue the progress, but only with innovative investments in areas like helping small farmers grow more food, which is the best way to fight hunger and poverty among the poor.”

To view the letter click here: www.gatesfoundation.org/annualletter

http://www.gatesfoundation.org/press-releases/Pages/fourth-annual-letter-120124.aspx

Twitter Watch  [accessed 29 January 2012: 19:45]
Items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and is by no means intended to be exhaustive.

UNDP UN Development
Amazing set of infographics, videos and data on the #futureofaid on.undp.org/ybvK8Q v @AlertNet
26 minutes ago

UNDP UN Development
“Under-five mortality will be five million by 2025 compared to 21 million in 1955” says @WHO on.undp.org/zBR03Z v @Bworldonlinecom
13 hours ago

PIH Partners In Health
The Global Fund just turned 10! Check out why @pih thinks the #GlobalFund matters: pih.org/GFmatters @globalfundnews
22 hours ago

PIH Partners In Health
Did you know? The #GlobalFund provides 82% of international funding for #TB treatment: ow.ly/8JcJE @globalfundnews
28 Jan

WHO WHO
Once widely dispersed, neglected tropical diseases now concentrated in settings of extreme poverty, urban slums j.mp/wDgkLl #NTD
27 Jan

CDCgov CDCgov
CDC started the fight against malaria. Now let’s finish it together. go.usa.gov/nIW #CDC247
27 Jan

UNICEF UNICEF
The well-being of millions of children is at stake. Check out UNICEF’s Humanitarian Action for Children 2012 Report uni.cf/xIcD2T
27 Jan

GAVIAlliance GAVI Alliance
With gifts and matches from supporters, the #GAVI Matching Fund has secured at least $38 million in pledges! ht.ly/8IvJq
27 Jan

GAVIAlliance GAVI Alliance
Dr. Asm Amjad Hossain has won the @GatesFoundation Inaugural #Vaccine Innovation Award- ht.ly/8HBQH
26 Jan

UNDP UN Development
New edition of Global Risk Report by @davos – amazing interactive visual of worrying data on.undp.org/zmEC72 #WEF #bigdata
26 Jan

globalfundnews The Global Fund
Celebrating the big 10 theglobalfund.org/en/blog/27748/
25 Jan

GAVISeth Seth Berkley
I join global leaders in congrats for Michael Kazatchkine on great decade with GFATM including 5yrs as ED Wishing him best in next endeavor
24 Jan

globalfundnews The Global Fund
The Global Fund’s Executive Director to step down in March theglobalfund.org/en/mediacenter…
24 Jan

globalfundnews The Global Fund
The Global Fund appoints Gabriel Jaramillo as General Manager theglobalfund.org/en/mediacenter…
24 Jan

OrinLevine Orin Levine
Provocative read. Should Google Try To Stop the Spread of Anti-Vaccine Activism? slate.com/articles/techn… via @Slate #vaccine
23 Jan

British Medical Journal
28 January 2012 (Vol 344, Issue 7841)
http://www.bmj.com/content/current

Effectiveness of vaccine against pandemic influenza A/H1N1 among people with underlying chronic diseases: cohort study, Denmark, 2009-10
BMJ 2012;344:d7901 (Published 25 January 2012)
Hanne-Dorthe Emborg, Tyra Grove Krause, Anders Hviid, Jacob Simonsen, Kåre Mølbak,

Abstract
Objective
To determine the effectiveness of an adjuvanted monovalent vaccine against pandemic influenza A/H1N1 among people with underlying chronic diseases.

Design
Historical cohort study.

Setting
Mandatory national reporting systems, 2 November 2009 to 31 January 2010, Denmark.

Participants
388 069 people under 65 years of age with a diagnosis in the past five years of at least one underlying disease expected to increase the risk of severe illness after influenza.

Main outcome measures
Laboratory confirmed H1N1 infection and influenza related hospital admission with laboratory confirmed H1N1 infection. Estimates of vaccine effectiveness were adjusted for age and underlying disease.

Results
The effectiveness of pandemic vaccine against confirmed H1N1 infection 14 days after one dose of vaccine was 49% (95% confidence interval 10% to 71%). The effectiveness of vaccine against admission to hospital for confirmed H1N1 infection was 44% (−19% to 73%).

Conclusions
The adjuvanted monovalent vaccine against pandemic influenza A/H1N1 was offered late in the 2009-10 influenza season. Among chronically ill people, this vaccine offered protection against laboratory confirmed H1N1 infection but only offered non-significant protection against influenza related hospital admissions confirmed as H1N1 infection. This finding is of public health relevance because the population of chronically ill people is a major target group for pandemic vaccinations and because of the delayed availability of pandemic vaccines in a forthcoming pandemic.

Emerging Infectious Diseases
Volume 18, Number 2—February 2012
http://www.cdc.gov/ncidod/EID/index.htm

Perspective
Pathogenic Responses among Young Adults during the 1918 Influenza Pandemic
G. Shanks and J. F. Brundage

Abstract
Of the unexplained characteristics of the 1918–19 influenza pandemic, the extreme mortality rate among young adults (W-shaped mortality curve) is the foremost. Lack of a coherent explanation of this and other epidemiologic and clinical manifestations of the pandemic contributes to uncertainty in preparing for future pandemics. Contemporaneous records suggest that immunopathologic responses were a critical determinant of the high mortality rate among young adults and other high-risk subgroups. Historical records and findings from laboratory animal studies suggest that persons who were exposed to influenza once before 1918 (e.g., A/H3Nx 1890 pandemic strain) were likely to have dysregulated, pathologic cellular immune responses to infections with the A/H1N1 1918 pandemic strain. The immunopathologic effects transiently increased susceptibility to ultimately lethal secondary bacterial pneumonia. The extreme mortality rate associated with the 1918–19 pandemic is unlikely to recur naturally. However, T-cell–mediated immunopathologic effects should be carefully monitored in developing and using universal influenza vaccines.

Commentaries
1918 Influenza, a Puzzle with Missing Pieces
D. M. Morens and J. K. Taubenberger

Emerging Infectious Diseases
Volume 18, Number 2—February 2012
http://www.cdc.gov/ncidod/EID/index.htm

Research
Diphtheria in the Postepidemic Period, Europe, 2000–2009
K. S. Wagner et al.

Abstract
Diphtheria incidence has decreased in Europe since its resurgence in the 1990s, but circulation continues in some countries in eastern Europe, and sporadic cases have been reported elsewhere. Surveillance data from Diphtheria Surveillance Network countries and the World Health Organization European Region for 2000–2009 were analyzed. Latvia reported the highest annual incidence in Europe each year, but the Russian Federation and Ukraine accounted for 83% of all cases. Over the past 10 years, diphtheria incidence has decreased by >95% across the region. Although most deaths occurred in disease-endemic countries, case-fatality rates were highest in countries to which diphtheria is not endemic, where unfamiliarity can lead to delays in diagnosis and treatment. In western Europe, toxigenic Corynebacterium ulcerans has increasingly been identified as the etiologic agent. Reduction in diphtheria incidence over the past 10 years is encouraging, but maintaining high vaccination coverage is essential to prevent indigenous C. ulcerans and reemergence of C. diphtheriae infections.

JAMA   
January 25, 2012, Vol 307, No. 4, pp 335-421
http://jama.ama-assn.org/current.dtl

Original Contributions
Serum Vaccine Antibody Concentrations in Children Exposed to Perfluorinated Compounds
Philippe Grandjean, Elisabeth Wreford Andersen, Esben Budtz-Jørgensen, Flemming Nielsen, Kåre Mølbak, Pal Weihe, Carsten Heilmann
JAMA. 2012;307(4):391-397.doi:10.1001/jama.2011.2034

Abstract
Context
Perfluorinated compounds (PFCs) have emerged as important food contaminants. They cause immune suppression in a rodent model at serum concentrations similar to those occurring in the US population, but adverse health effects of PFC exposure are poorly understood.

Objective
To determine whether PFC exposure is associated with antibody response to childhood vaccinations.

Design, Setting, and Participants
Prospective study of a birth cohort from the National Hospital in the Faroe Islands. A total of 656 consecutive singleton births were recruited during 1999-2001, and 587 participated in follow-up through 2008.

Main Outcome
Measures Serum antibody concentrations against tetanus and diphtheria toxoids at ages 5 and 7 years.

Results
Similar to results of prior studies in the United States, the PFCs with the highest serum concentrations were perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA). Among PFCs in maternal pregnancy serum, PFOS showed the strongest negative correlations with antibody concentrations at age 5 years, for which a 2-fold greater concentration of exposure was associated with a difference of −39% (95% CI, −55% to −17%) in the diphtheria antibody concentration. PFCs in the child’s serum at age 5 years showed uniformly negative associations with antibody levels, especially at age 7 years, except that the tetanus antibody level following PFOS exposure was not statistically significant. In a structural equation model, a 2-fold greater concentration of major PFCs in child serum was associated with a difference of −49% (95% CI, −67% to −23%) in the overall antibody concentration. A 2-fold increase in PFOS and PFOA concentrations at age 5 years was associated with odds ratios between 2.38 (95% CI, 0.89 to 6.35) and 4.20 (95% CI, 1.54 to 11.44) for falling below a clinically protective level of 0.1 IU/mL for tetanus and diphtheria antibodies at age 7 years.

Conclusion
Elevated exposures to PFCs were associated with reduced humoral immune response to routine childhood immunizations in children aged 5 and 7 years.

Journal of Infectious Diseases
Volume 205 Issue 4 February 15, 2012
http://www.journals.uchicago.edu/toc/jid/current

Viruses
Dennis K. M. Ip, Martin Schutten, Vicky J. Fang, Rita O. P. Fung, Regina T. Dutkowski, Kwok-Hung Chan, Gabriel M. Leung, J. S. Malik Peiris, and Benjamin J. Cowling
Validation of Self-swab for Virologic Confirmation of Influenza Virus Infections in a Community Setting
J Infect Dis. (2012) 205(4): 631-634 doi:10.1093/infdis/jir803

Abstract
Few studies have investigated the validity of self-collected nose and throat swabs for influenza confirmation in community settings. We followed outpatients with confirmed influenza with sequential measurement of viral loads and applied log-linear regression models to the viral shedding patterns. Among 176 outpatients with confirmed influenza, the detection of virus and quantitative viral loads obtained from self-swabs was consistent with statistical predictions based on earlier and later measurements, suggesting that self-collected nose and throat swabs can be a valid alternative for virologic confirmation of influenza A or B infection in a community setting.

The Lancet  
Jan 28, 2012  Volume 379  Number 9813  p287 – 384  e20 – 26
http://www.thelancet.com/journals/lancet/issue/current

Comment
Moral science and the Presidential Commission for the Study of Bioethical Issues
Amy Gutmann, James W Wagner

[No abstract]

The Lancet  
Jan 28, 2012  Volume 379  Number 9813  p287 – 384  e20 – 26
http://www.thelancet.com/journals/lancet/issue/current

Tackling the spread of drug-resistant tuberculosis in Europe
Ibrahim Abubakar, Masoud Dara, Davide Manissero, Alimuddin Zumla

Preview
Multidrug-resistant (MDR) tuberculosis and extensively drug-resistant (XDR) tuberculosis have become an important health problem in many countries of the WHO European region and currently threaten global efforts to control tuberculosis.1–4 About 81 000 (18·4%) of the 440 000 patients worldwide with MDR tuberculosis live in this region.2 The highest rates occur predominantly in eastern Europe; however, population movement means that drug-resistant tuberculosis is a priority public health issue for all European countries.

The Lancet  
Jan 28, 2012  Volume 379  Number 9813  p287 – 384  e20 – 26
http://www.thelancet.com/journals/lancet/issue/current

Correspondence
Action to preserve WHO’s core functions cannot wait for organisational reform
Mohga M Kamal-Yanni

Preview
While WHO undergoes a wide-ranging reform sparked by a US$300 million budget shortfall, the agency is facing an exodus of qualified staff that is affecting its ability to work.1 The Executive Board is due to meet on Jan 16 to agree long-term principles and priorities for the organisation; it must ensure, in particular, that core functions are accorded the priority they merit. Oxfam is especially concerned that inadequate funding will severely diminish the WHO Essential Medicines Department, which for more than three decades has had an indispensable role in enabling developing countries to access affordable medicines.

The Lancet Infectious Disease
Feb 2012  Volume 12  Number 2  p89 – 166
http://www.thelancet.com/journals/laninf/issue/current

Comment
Inactivated polio vaccine and global polio eradication
John F Modlin

Preview
2012 will mark the 24th year of WHO’s Global Poliomyelitis Eradication Initiative.1 Eradication has proven more difficult than originally envisioned because of geopolitical events, such as war, social disruption, and political indifference; social and cultural issues, such as distrust of poliovirus vaccines and vaccinators; and the unanticipated emergence of virulent vaccine-derived polioviruses in many locations. Few of these obstacles have bewildered the scientific community as much as the low efficacy of the major weapon in the arsenal, trivalent oral polio vaccine (OPV) in regions with dense populations, high birthrates, and poor sanitation resulting from diarrhoea due to enteric pathogens, particularly rotaviruses, and perhaps nutritional deficiencies and other factors.

The Lancet Infectious Disease
Feb 2012 Volume 12  Number 2  p89 – 166
http://www.thelancet.com/journals/laninf/issue/current

Articles
Immunogenicity of supplemental doses of poliovirus vaccine for children aged 6–9 months in Moradabad, India: a community-based, randomised controlled trial
Concepción F Estívariz, Hamid Jafari, Roland W Sutter, T Jacob John, Vibhor Jain, Ashutosh Agarwal, Harish Verma, Mark A Pallansch, Ajit P Singh, Sherine Guirguis, Jitendra Awale, Anthony Burton, Sunil Bahl, Arani Chatterjee, R Bruce Aylward

Summary
Background

The continued presence of polio in northern India poses challenges to the interruption of wild poliovirus transmission and the management of poliovirus risks in the post-eradication era. We aimed to assess the current immunity profile after routine doses of trivalent oral poliovirus vaccine (OPV) and numerous supplemental doses of type-1 monovalent OPV (mOPV1), and compared the effect of five vaccine formulations and dosages on residual immunity gaps.

Methods
We did a community-based, randomised controlled trial of healthy infants aged 6—9 months at ten sites in Moradabad, India. Serum neutralising antibody was measured before infants were randomly assigned to a study group and given standard-potency or higher-potency mOPV1, intradermal fractional-dose inactivated poliovirus vaccine (IPV, GlaxoSmithKline), or intramuscular full-dose IPV from two different manufacturers (GlaxoSmithKline or Panacea). Follow-up sera were taken at days 7 and 28. Our primary endpoint was an increase of more than four times in antibody titres. We did analyses by per-protocol in children with a blood sample available before, and 28 days after, receiving study vaccine (or who completed study procedures). This trial is registered with Current Controlled Trials, number ISRCTN90744784.

Findings
Of 1002 children enrolled, 869 (87%) completed study procedures (ie, blood sample available at day 0 and day 28). At baseline, 862 (99%), 625 (72%), and 418 (48%) had detectable antibodies to poliovirus types 1, 2, and 3, respectively. In children who were type-1 seropositive, an increase of more than four times in antibody titre was detected 28 days after they were given standard-potency mOPV1 (5/13 [38%]), higher-potency mOPV1 (6/21 [29%]), intradermal IPV (9/16 [56%]), GlaxoSmithKline intramuscular IPV (19/22 [86%]), and Panacea intramuscular IPV (11/13 [85%]). In those who were type-2 seronegative, 42 (100%) of 42 seroconverted after GlaxoSmithKline intramuscular IPV, and 24 (59%) of 41 after intradermal IPV (p<0·0001). 87 (90%) of 97 infants who were type-3 seronegative seroconverted after intramuscular IPV, and 21 (36%) of 49 after intradermal IPV (p<0·0001).

Interpretation
Supplemental mOPV1 resulted in almost total seroprevalence against poliovirus type 1, which is consistent with recent absence of poliomyelitis cases; whereas seroprevalence against types 2 and 3 was expected for routine vaccination histories. The immunogenicity of IPV produced in India (Panacea) was similar to that of an internationally manufactured IPV (GSK). Intradermal IPV was less immunogenic.

Funding
Global Alliance for Vaccines and Immunization (GAVI), WHO.

The Lancet Infectious Disease
Feb 2012  Volume 12  Number 2  p89 – 166
http://www.thelancet.com/journals/laninf/issue/current

2008 estimate of worldwide rotavirus-associated mortality in children younger than 5 years before the introduction of universal rotavirus vaccination programmes: a systematic review and meta-analysis
Jacqueline E Tate, Anthony H Burton, Cynthia Boschi-Pinto, A Duncan Steele, Jazmin Duque, Umesh D Parashar, the WHO-coordinated Global Rotavirus Surveillance Network

Summary
Background
WHO recommends routine use of rotavirus vaccines in all countries, particularly in those with high mortality attributable to diarrhoeal diseases. To establish the burden of life-threatening rotavirus disease before the introduction of a rotavirus vaccine, we aimed to update the estimated number of deaths worldwide in children younger than 5 years due to diarrhoea attributable to rotavirus infection.

Methods
We used PubMed to identify studies of at least 100 children younger than 5 years who had been admitted to hospital with diarrhoea. Additionally, we required the studies to have a data collection midpoint of the year 2000 or later, to be done in full-year increments, and to assesses diarrhoea attributable to rotavirus with EIAs or polyacrylamide gel electrophoresis. We also included data from countries that participated in the WHO-coordinated Global Rotavirus Surveillance Network (consisting of participating member states during 2009) and that met study criteria. For countries that have introduced a rotavirus vaccine into their national immunisation programmes, we excluded data subsequent to the introduction. We classified studies into one of five groups on the basis of region and the level of child mortality in the country in which the study was done. For each group, to obtain estimates of rotavirus-associated mortality, we multiplied the random-effect mean rotavirus detection rate by the 2008 diarrhoea-related mortality figures for countries in that group. We derived the worldwide mortality estimate by summing our regional estimates.

Findings
Worldwide in 2008, diarrhoea attributable to rotavirus infection resulted in 453 000 deaths (95% CI 420 000—494 000) in children younger than 5 years—37% of deaths attributable to diarrhoea and 5% of all deaths in children younger than 5 years. Five countries accounted for more than half of all deaths attributable to rotavirus infection: Democratic Republic of the Congo, Ethiopia, India, Nigeria, and Pakistan; India alone accounted for 22% of deaths (98 621 deaths).

Interpretation
Introduction of effective and available rotavirus vaccines could substantially affect worldwide deaths attributable to diarrhoea. Our new estimates can be used to advocate for rotavirus vaccine introduction and to monitor the effect of vaccination on mortality once introduced.

The Lancet Infectious Disease
Feb 2012  Volume 12  Number 2  p89 – 166
http://www.thelancet.com/journals/laninf/issue/current

Series
Non-communicable health risks during mass gatherings
Robert Steffen, Abderrezak Bouchama, Anders Johansson, Jiri Dvorak, Nicolas Isla, Catherine Smallwood, Ziad A Memish
Preview | Summary |

Crowd and environmental management during mass gatherings
Anders Johansson, Michael Batty, Konrad Hayashi, Osama Al Bar, David Marcozzi, Ziad A Memish
Preview | Summary |

PLoS One
[Accessed 29 January 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Facemasks, Hand Hygiene, and Influenza among Young Adults: A Randomized Intervention Trial
Allison E. Aiello, Vanessa Perez, Rebecca M. Coulborn, Brian M. Davis, Monica Uddin, Arnold S. Monto
PLoS ONE: Research Article, published 25 Jan 2012 10.1371/journal.pone.0029744

Abstract 
Limited vaccine availability and the potential for resistance to antiviral medications have led to calls for establishing the efficacy of non-pharmaceutical measures for mitigating pandemic influenza. Our objective was to examine if the use of face masks and hand hygiene reduced rates of influenza-like illness (ILI) and laboratory-confirmed influenza in the natural setting. A cluster-randomized intervention trial was designed involving 1,178 young adults living in 37 residence houses in 5 university residence halls during the 2007–2008 influenza season. Participants were assigned to face mask and hand hygiene, face mask only, or control group during the study. Discrete-time survival models using generalized estimating equations to estimate intervention effects on ILI and confirmed influenza A/B infection over a 6-week study period were examined. A significant reduction in the rate of ILI was observed in weeks 3 through 6 of the study, with a maximum reduction of 75% during the final study week (rate ratio [RR] = 0.25, [95% CI, 0.07 to 0.87]). Both intervention groups compared to the control showed cumulative reductions in rates of influenza over the study period, although results did not reach statistical significance. Generalizability limited to similar settings and age groups. Face masks and hand hygiene combined may reduce the rate of ILI and confirmed influenza in community settings. These non-pharmaceutical measures should be recommended in crowded settings at the start of an influenza pandemic.

Trail Registration
Clinicaltrials.gov NCT00490633

PLoS One
[Accessed 29 January 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Pre-Vaccination Nasopharyngeal Pneumococcal Carriage in a Nigerian Population: Epidemiology and Population Biology
Ifedayo M. O. Adetifa, Martin Antonio, Christy A. N. Okoromah, Chinelo Ebruke, Victor Inem, David Nsekpong, Abdoulie Bojang, Richard A. Adegbola
PLoS ONE: Research Article, published 24 Jan 2012 10.1371/journal.pone.0030548

Abstract 
Background
Introduction of pneumococcal vaccines in Nigeria is a priority as part of the Accelerated Vaccine Introduction Initiative (AVI) of the Global Alliance for Vaccines and Immunisation (GAVI). However, country data on the burden of pneumococcal disease (IPD) is limited and coverage by available conjugate vaccines is unknown. This study was carried out to describe the pre vaccination epidemiology and population biology of pneumococcal carriage in Nigeria.

Methods
This was a cross sectional survey. Nasopharyngeal swabs (NPS) were obtained from a population sample in 14 contiguous peri-urban Nigerian communities. Data on demographic characteristics and risk factor for carriage were obtained from all study participants. Pneumococci isolated from NPS were characterised by serotyping, antimicrobial susceptibility and Multi Locus Sequencing Typing (MLST).

Results
The prevalence of pneumococcal carriage was 52.5%. Carriage was higher in children compared to adults (67.4% vs. 26%), highest (≈90%) in infants aged <9 months and reduced significantly with increasing age (P<0.001). Serotypes 19F (18.6%) and 6A (14.4%) were most predominant. Potential vaccine coverage was 43.8%, 45.0% and 62% for PCV-7, PCV-10 and PCV-13 respectively. There were 16 novel alleles, 72 different sequence types (STs) from the isolates and 3 Sequence Types (280, 310 and 5543) were associated with isolates of more than one serotype indicative of serotype switching. Antimicrobial resistance was high for cotrimoxazole (93%) and tetracycline (84%), a third of isolates had intermediate resistance to penicillin. Young age was the only risk factor significantly associated with carriage.

Conclusions
Pneumococcal carriage and serotype diversity is highly prevalent in Nigeria especially in infants. Based on the coverage of serotypes in this study, PCV-13 is the obvious choice to reduce disease burden and prevalence of drug resistant pneumococci. However, its use will require careful monitoring. Our findings provide sound baseline data for impact assessment following vaccine introduction in Nigeria.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
(Accessed 29 January 2012)
http://www.pnas.org/content/early/recent

Perspective:
Peter Palese and Taia T. Wang
H5N1 influenza viruses: Facts, not fear
PNAS 2012 ; published ahead of print January 25, 2012, doi:10.1073/pnas.1121297109

Abstract
The ongoing controversy over publication of two studies involving the transmission in ferrets of H5N1 (H5) subtype influenza viruses and the recommendations of the National Science Advisory Board for Biosecurity to redact key details in the manuscripts call for an examination of relevant scientific facts. In addition, there are calls in the media to destroy the viruses, curtail future research in this area, and protect the public from such “frightening” research efforts. Fear needs to be put to rest with solid science and not speculation.

*Details of the manuscripts have already been disclosed to many in the field of influenza virology; for example, one of us (P.P.) was sent one of the manuscripts in September 2011 as a courtesy and to elicit comments.

Science        
27 January 2012 vol 335, issue 6067, pages 369-492
http://www.sciencemag.org/current.dtl

News & Analysis
H5N1
Flu Controversy Spurs Research Moratorium
David Malakoff
Science 27 January 2012: 387-389.

Amid a growing global controversy over the potential dangers of experiments involving the H5N1 avian influenza virus, a group of leading influenza researchers last week agreed to a 60-day moratorium on some sensitive flu studies.

H5N1
Ron Fouchier: In the Eye of the Storm
Martin Enserink
Science 27 January 2012: 388-389.
Science talked to Ron Fouchier of Erasmus MC in Rotterdam, the Netherlands, who carried out one of the two controversial H5N1 avian influenza studies that triggered the international debate.

Letters
Pause on Avian Flu Transmission Research
Ron A. M. Fouchier, Adolfo García-Sastre, Yoshihiro Kawaoka, Wendy S. Barclay, Nicole M. Bouvier, Ian H. Brown, Ilaria Capua, Hualan Chen, Richard W. Compans, Robert B. Couch, Nancy J. Cox, Peter C. Doherty, Ruben O. Donis, Heinz Feldmann, Yi Guan, Jaqueline Katz, H. D. Klenk, Gary Kobinger, Jinhua Liu, Xiufan Liu, Anice Lowen, Thomas C. Mettenleiter, Albert D. M. E. Osterhaus, Peter Palese, J. S. Malik Peiris, Daniel R. Perez, Jürgen A. Richt, Stacey Schultz-Cherry, John Steel, Kanta Subbarao, David E. Swayne, Toru Takimoto, Masato Tashiro, Jeffery K. Taubenberger, Paul G. Thomas, Ralph A. Tripp, Terrence M. Tumpey, Richard J. Webby, and Robert G. Webster
Science 27 January 2012: 400-401.

Full Text

Science Translational Medicine
25 January 2012 vol 4, issue 118
http://stm.scienceag.org/content/mcurrent

Commentary
Policy
Triggers for Research Ethics Consultation
Molly Havard, Mildred K. Cho and David Magnus*

Abstract
Research ethics consultation services are designed to help scientists address ethical and societal issues that may not be considered in the context of existing regulatory frameworks, such as institutional review boards. Here, we identify some types of biomedical research for which the research process can benefit from consultation with ethicists.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

Editorial
New influenza vaccines: Promises, perils, and pitfalls
Pages 983-984
Gregory A. Poland, Pritish K. Tosh

[No abstract or preview]

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

Brief Report
Contact transmission of vaccinia virus from smallpox vaccinees in the United States, 2003–2011
Pages 985-988
Ellen R. Wertheimer, Denise S. Olive, John F. Brundage, Leslie L. Clark

Abstract
Since 2002, approximately 40,000 US civilians and 2.1 million military personnel have been vaccinated against smallpox. The vaccine contains live vaccinia virus that can be transferred through physical contact. This report summarizes numbers, rates, and characteristics of contact vaccinia cases that presented between December 2002 and March 2011. Cases were identified from reports in adverse event reporting systems and peer-reviewed literature. One hundred fifteen cases of vaccinia transmission through contact were identified (5.4 per 100,000 vaccinees); 52 reports (45%) noted laboratory confirmation. Three-quarters of vaccinees, but fewer than 8% of contact vaccinia cases, were described as military members. Most cases were household or intimate contacts (n = 86, 75%) or wrestling partners (n = 18, 16%) of vaccinees. Nearly all cases manifested mild, local skin reactions; of 14 hospitalized cases, one was life-threatening. Vaccinia transmission from vaccinees is relatively infrequent. Continued attention to both vaccinee education and screening for contraindications to vaccination is appropriate.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Influenza vaccination coverage one year after the A(H1N1) influenza pandemic, France, 2010–2011
Pages 995-997
Jean-Paul Guthmann, Laure Fonteneau, Isabelle Bonmarin, Daniel Lévy-Bru

Abstract
We report influenza vaccination coverage in target groups for the 2010–2011 influenza season, one year after the A(H1N1) pandemic. Data were collected through a one-stage cross-sectional national random telephone survey conducted in January 2011 among a sample of the population of mainland France connected to a land telephone line. Influenza vaccination coverage was below 75%, ranging from 28% for health professionals to 71% in the “65+” group with an underlying condition. Coverage was higher in the “65+” compared to the “<65” with an underlying condition. It was not significantly lower compared to the previous season. Our results do not suggest that the controversies related to the pandemic vaccination campaign of 2009–2010 have had a negative impact on subsequent seasonal influenza vaccination coverage.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Evidence-based decision making for vaccines: The need for an ethical foundation
Original Research Article
Pages 1009-1013
Robert I. Field, Arthur L. Caplan

Abstract
Evidence-based decision making (EBDM) is a tool to assess the value of medical interventions by weighing costs and health outcomes that has increasingly been applied to vaccines. However, many of the ethical considerations that support EBDM when used to evaluate therapeutic care do not readily translate to prevention. This mismatch can result in policy decisions that produce unanticipated negative consequences, including public resistance. In its emphasis on quantifiable outcomes, EBDM invokes the ethical principle of rule-utilitarianism, which values the optimal long-run balance of benefit over harm. Vaccines raise a number of competing ethical concerns in ways that individual medical treatments do not. They rely on widespread compliance for effectiveness, which can limit individual autonomy, emphasize population over individual effects, which can obscure the imperative of beneficence to help the vulnerable, require a just allocation process within populations, and sometimes challenge strong social norms. For EBDM to effectively guide vaccine policy makers, such as the Advisory Committee on Immunization Practices (ACIP) in the United States, an ethical foundation is needed that systematically considers all relevant values and transparently places vaccination recommendations in the context of social norms and individual concerns.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Active surveillance for influenza vaccine adverse events: The integrated vaccine surveillance system
Original Research Article
Pages 1050-1055
Gabriella Newes-Adeyi, Jacey Greece, Sam Bozeman, Deborah Klein Walker, Faith Lewis, Jane Gidudu

Abstract
Objectives
We conducted a pilot study of the Integrated Vaccine Surveillance System (IVSS), a novel active surveillance system for monitoring influenza vaccine adverse events that could be used in mass vaccination settings.

Methods
We recruited 605 adult vaccinees from a convenience sample of 12 influenza vaccine clinics conducted by public health departments of two U.S. metropolitan regions. Vaccinees provided daily reports on adverse reactions following immunization (AEFI) using an interactive voice response system (IVR) or the internet for 14 consecutive days following immunization. Followup with nonrespondents was conducted through computer-assisted telephone interviewing (CATI). Data on vaccinee reports were available real-time through a dedicated secure website.

Results
90% (545) of vaccinees made at least one daily report and 49% (299) reported consecutively for the full 14-day period. 58% (315) used internet, 20% (110) IVR, 6% (31) CATI, and 16% (89) used a combination for daily reports. Of the 545 reporters, 339 (62%) reported one or more AEFI, for a total of 594 AEFIs reported. The majority (505 or 85%) of these AEFIs were mild symptoms.

Conclusions
It is feasible to develop a system to obtain real-time data on vaccine adverse events. Vaccinees are willing to provide daily reports for a considerable time post vaccination. Offering multiple modes of reporting encourages high response rates. Study findings on AEFIs showed that the IVSS was able to exhibit the emerging safety profile of the 2008 seasonal influenza vaccine.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Healthcare workers and H1N1 vaccination: Does having a chronic disease make a difference?
Original Research Article
Pages 1064-1070
Matthias Paul Han Sim Toh, Predeebha Kannan, Yongchang Chen, Florence Liong Cheu Chng, Wern Ee Tang

Abstract
Introduction
A novel H1N1 vaccine was manufactured in response to the pandemic in 2009. This study describes the willingness to be vaccinated for H1N1 among healthcare workers (HCWs) in primary healthcare clinics with and without chronic medical conditions, their reasons for refusing vaccination and whether they sought additional information to make an informed decision for the vaccination.

Materials and methods
An anonymous survey was conducted in November 2009 among all medical, nursing, allied health and operations HCWs in nine primary care clinics in Singapore. Participants were asked if they had any chronic medical conditions associated with influenza-related complications (example: asthma, stroke, heart disease, cancer, diabetes mellitus, renal disease), their perception towards vaccination for H1N1 and against seasonal influenza within the preceding 2 years.

Results
The initial response rate was 80%, of which 711 (54.7%) of the completed surveys were analysed. Among the 711 respondents, 16.6% reported having at least 1 chronic disease. Asthma (10.8%), hypertension (10.4%) and dyslipidaemia (9.8%) were the main chronic conditions. Only 39.4% of respondents were willing to be vaccinated against H1N1. Males were 2.07 (95% CI 1.19–3.62) times more likely than females to receive the H1N1 vaccination; the 45–54 and 55+ years old were 2.12 (95% CI 1.06–4.24) and 2.44 (95% CI 1.13–5.27) times more willing than those below 25 years old; and those who considered accepting the seasonal influenza vaccine were 7.0 times more likely than those who did not (95%CI 4.48–10.92). The 2 principal barriers were “fear of side effects” and “unsure of vaccine’s effectiveness”. Although 78% attended some H1N1-related talks, only 7% of all HCWs felt that they had sufficient information. Most wanted more information about the vaccine’s safety profile and contraindications.

Conclusion
Fewer than 40% of HCWs expressed willingness to receive the H1N1 vaccination, lower than past rates of influenza vaccine. HCWs in primary care clinics who had a chronic condition did not perceive themselves to be at higher risk of developing H1N1-related complications and were not more willing than the rest of the HCWs to accept H1N1 vaccination. Vaccine’s side effects and effectiveness were the main concerns. Uptake of H1N1 vaccine may improve with targeted health information covering the vaccine’s safety profile.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
A longitudinal study of UK military personnel offered anthrax vaccination: Informed choice, symptom reporting, uptake and pre-vaccination health
Original Research Article
Pages 1094-1100
D. Murphy, T.M. Marteau, S. Wessely

Abstract
Aim
To determine longer term health outcome in a cohort of UK service personnel who received the anthrax vaccination.

Method
We conducted a three year follow up of UK service personnel all of whom were in the Armed Forces at the start of the Iraq War. 3206 had been offered the anthrax vaccination as part of preparations for the 2003 invasion of Iraq. A further 1190 individuals who did not deploy to Iraq in 2003 were subsequently offered the vaccination as part of later deployments, and in whom we therefore had prospective pre-exposure data.

Results
There was no overall adverse health effect following receipt of the anthrax vaccination, with follow up data ranging from three to six years following vaccination. The previous retrospective association between making an uninformed choice to receive the anthrax vaccination and increased symptom reporting was replicated within a longitudinal sample where pre-vaccination health was known.

Conclusions
Anthrax vaccination was not associated with long term adverse health problems. However, symptoms were associated with making an uninformed choice to undergo the vaccination. The results are important both for the safety of the vaccine and for future policies should anthrax vaccination be required in either military or non military populations.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: Community and other influences on more skeptical parents in Oregon, 2006
Original Research Article
Pages 1132-1142
James A. Gaudino, Steve Robison

Abstract
Background and objectives
With vaccine-preventable diseases at record lows, few studies investigate rising parent-claimed exemptions to school immunization requirements. After finding exemption clusters in Oregon, we hypothesized that exemption risk factors may vary among communities. We surveyed parents to identify risk factors for exemptions and evaluated risk factor differences among communities with differing exemption rates.

Design
Retrospective cohort study, multi-staged, population-proportionate sampling.

Setting and participants
Parents of 2004–05 Oregon elementary school children (N = 2900).

Main outcome measure
Parent-reported exemption status.

Results
The response rate was 55%. Compared to vaccinators, exemptors were significantly more likely to have: strong vaccine concerns (weighted adjusted odds ratio (aOR) = 15.3, 95% CI 6.4–36.7); “vaccine-hesitant” concerns (aOR = 2.3; 95% CI 1.0–5.0); >1 childbirth(s) at a non-hospital, alternative setting (aOR = 3.6; 95% CI 1.6–8.0); distrust of local doctors (aOR = 2.7; 95% CI 1.0–7.5); reported chiropractic healthcare for their youngest school-age child (aOR = 3.9; 95% CI 1.8–8.5); and reported knowledge of someone with a vaccine-hurt child (aOR = 1.8; 95% CI 0.9–3.4). Exemptors were less likely to have “pro-vaccine” beliefs (aOR = 0.2; 95% CI 0.0–0.6) and less likely to report relying on print materials (aOR = 0.4; 95% CI 0.2–0.8).

The strengths of association differed significantly for those with strong vaccine concerns and those reporting knowledge of someone with a vaccine-hurt child, depending on residence in exemption-rate areas, e.g., exemptors in medium-rate areas were more likely to have strong vaccine concerns (aOR = 13.5; 95% CI 5.4–34.0) than those in high-rate areas (aOR = 9.7; 95% CI 3.7–25.4).

Conclusions
Vaccine beliefs were important risk factors. That differing community-level exemption use modified the effects of several individual-level factors suggests that communities also influence parent decisions. Therefore, understanding community contexts and norms may be important when designing interventions.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
E-health use, vaccination knowledge and perception of own risk: Drivers of vaccination uptake in medical students
Original Research Article
Pages 1143-1148
Cornelia Betsch, Sabine Wicker

Abstract
Objective
was to improve understanding of mechanisms contributing to healthcare personnel’s (HCP) reluctance to get vaccinated against seasonal influenza. We assessed the role of several drivers: vaccination knowledge, vaccination recommendations and the role of the Internet (so-called e-health) in creating vaccination knowledge. The key mechanism under consideration was the perceived own risk (regarding disease and the vaccine).

Method
310 medical students at the Frankfurt University Hospital answered an anonymous questionnaire assessing risk perceptions, intentions to get vaccinated, knowledge, preferences regarding information sources for personal health decisions and search-terms that they would use in a Google-search directed at seasonal influenza vaccination.

Results
The key driver of vaccination intentions was the perceived own risk (of contracting influenza and of suffering from vaccine adverse events). The recommendation to get vaccinated was a significant, yet weaker predictor. As an indirect driver we identified one’s knowledge concerning vaccination. 32% of the knowledge questions were answered incorrectly or as don’t know. 64% of the students were e-health users; therefore, additional information search via the Internet was likely. An analysis of the websites obtained by googling the search-terms provided by the students revealed 30% commercial e-health websites, 11% anti-vaccination websites and 10% public health websites. Explicit searches for vaccination risks led to fewer public health websites than searches without risk as a search term. Content analysis of the first three websites obtained revealed correct information regarding the questions of whether the doses of vaccine additives were dangerous, whether chronic diseases are triggered by vaccines and whether vaccines promote allergies in 58%, 53% and 34% of the websites, respectively. These questions were especially related to own risk, which strongly predicted intentions. Correct information on vaccination recommendations were provided on 85% of the websites.

Conclusion
Concentrating on the key drivers in early medical education (own risk of contracting influenza, vaccine safety, vaccination recommendation) promises to be a successful combination to increase vaccination uptake in HCP.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X
Homeschooling parents’ practices and beliefs about childhood immunizations

Original Research Article
Pages 1149-1153
Elizabeth L. Thorpe, Richard K. Zimmerman, Jonathan D. Steinhart, Kathleen N. Lewis, Marian G. Michaels

Abstract
Objective
Concern over the rise of vaccine preventable diseases (VPD) coupled with the increasing popularity of homeschooling makes understanding the attitudes and behaviors of homeschoolers regarding immunizations a critical area of investigation. This study was a pilot to investigate the immunization attitudes of homeschooling parents and the vaccination status of their children.

Methods
In the spring of 2010, online surveys were sent to a convenience sample of 707 homeschooling parents in Western Pennsylvania with children ages 0–18 years of age. Information was collected on demographic characteristics, vaccination status of children, and attitudes toward vaccination.

Results
Surveys were returned by 18 percent of respondents, representing 396 homeschooled children. Demographic characteristics mirrored national homeschooling trends. The majority (95%) surveyed felt that education about vaccines was important. Thirty-eight percent of families had fully vaccinated children while 56% reported partial vaccination and 6% said children had received no vaccines. Respondents who fully vaccinated their children were more likely to agree that vaccinating according to the American Academy of Pediatrics was a good idea (OR: 4.8 [95% CI: 2.0–11.7]) and were more likely to comply with the recommendations of their health care provider (OR: 8.3 [95% CI: 3.6–19.1]). Respondents who vaccinated their children were more likely to believe that vaccines are safe (OR: 7.6 [95% CI: 1.0–56.2]). Beliefs about autism, thimerosal and learning disabilities did not vary significantly with vaccination status in regression analysis.

Conclusions
While specific factors influencing vaccination practices were not identified, this study demonstrated that recommendations of physicians and the AAP do not significantly influence homeschooling vaccination practices in the pilot population. Given the results of this pilot study, more research is called for, particularly a larger study with public school controls.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

The vaccine adverse event reporting system and vaccine safety research in the genomics era
Original Research Article
Pages 1162-1164
Robert Lowell Davis

Abstract
Advances in genetics hold promise for integrating genomics into vaccine safety research. Given the rarity of many vaccine adverse effects, and the challenges in finding sufficient numbers of patients to study, consideration should be given to employing the Vaccine Adverse Event Reporting System (VAERS) for genetic studies of vaccine adverse events. VAERS could be used to build a repository of biospecimens allowing for the systematic evaluation of vaccine adverse events. If successful, such research would enable the identification of specific subgroups of people at particularly increased risk for adverse events.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Estimating the clinical impact of introducing paediatric influenza vaccination in England and Wales
Original Research Article
Pages 1208-1224
R.J. Pitman, L.J. White, M. Sculpher

Abstract
Influenza causes a significant burden of disease each year in England and Wales, with the young and the elderly suffering the greatest burden. Children are recognised as playing an important role in the dissemination of the influenza virus. This study examines the population impact of implementing a programme of paediatric vaccination.

A dynamic transmission model was used to simulate the impact of vaccination programmes with varying levels of coverage across pre-school and school age children. These analyses suggest that vaccinating as few as 50% of 2–18 year olds could result in a substantial reduction in the annual incidence of influenza related morbidity and mortality across the population. Herd immunity may extend this protection to the young and the elderly. It is assumed that such programmes would be implemented in concert with the current strategy of vaccinating the elderly and younger at risk groups with an inactivated vaccine.

In England and Wales, paediatric vaccination of two to eighteen year olds reduced the estimated number of general practice consultations, hospitalisations and deaths arising from influenza A and B infections by up to 95%. This translates into an annual average reduction of approximately 52,000, 1500 and 1200 events, respectively.

A policy of paediatric vaccination could significantly reduce the clinical burden of influenza in England and Wales, in all age groups, with the added value of herd immunity helping to protect the young and the elderly who are at highest risk of complications.

Vaccine
Volume 30, Issue 6 pp. 983-1234 (1 February 2012)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
The cost-effectiveness of varicella and combined varicella and herpes zoster vaccination programmes in the United Kingdom
Original Research Article
Pages 1225-1234
Albert Jan van Hoek, Alessia Melegaro, Nigel Gay, Joke Bilcke, W. John Edmunds

Abstract
Background
Despite the existence of varicella vaccine, many developed countries have not introduced it into their national schedules, partly because of concerns about whether herpes zoster (HZ, shingles) will increase due to a lack of exogenous boosting. The magnitude of any increase in zoster that might occur is dependent on rates at which adults and children mix – something that has only recently been quantified – and could be reduced by simultaneously vaccinating older individuals against shingles. This study is the first to assess the cost-effectiveness of combined varicella and zoster vaccination options and compare this to alternative programmes.

Methods and findings
The cost-effectiveness of various options for the use of varicella–zoster virus (VZV) containing vaccines was explored using a transmission dynamic model. Underlying contact rates are estimated from a contemporary survey of social mixing patterns, and uncertainty in these derived from bootstrapping the original sample. The model was calibrated to UK data on varicella and zoster incidence. Other parameters were taken from the literature. UK guidance on perspective and discount rates were followed. The results of the incremental cost-effectiveness analysis suggest that a combined policy is cost-effective. However, the cost-effectiveness of this policy (and indeed the childhood two-dose policy) is influenced by projected benefits that accrue many decades (80–100 years or more) after the start of vaccination. If the programme is evaluated over shorter time frames, then it would be unlikely to be deemed cost-effective, and may result in declines in population health, due to a projected rise in the incidence of HZ. The findings are also sensitive to a number of parameters that are inaccurately quantified, such as the risk of HZ in varicella vaccine responders.

Conclusions
Policy makers should be aware of the potential negative benefits in the first 30–50 years after introduction of a childhood varicella vaccine. This can only be partly mitigated by the introduction of a herpes zoster vaccine. They have to decide how they value the potential benefits beyond this time to consider childhood vaccination cost effective.

The pdf version of Vaccines: The Week in Review  23 January 2012, comprising the posts below for this date, is available here: Vaccines_The Week in Review_23 January 2012.

WHO said that Dr. Margaret Chan was nominated today by the WHO’s Executive Board for a second term as Director-General. The nomination will be submitted for approval to the Sixty-fifth World Health Assembly, scheduled to meet in Geneva from 21–26 May 2012. If confirmed by the World Health Assembly, Dr Chan’s new term will begin on 1 July 2012 and continue until 30 June 2017.

http://www.who.int/mediacentre/news/releases/2012/dg_20120118/en/index.html

Speech: Dr Margaret Chan
Report by the WHO Director-General to the Executive Board at its 130th Session
16 January 2012

[Full text: http://www.who.int/dg/speeches/2012/eb_20120116/en/index.html ]

Excerpt

“…Polio eradication is also on your agenda. Authoritative bodies, like the Independent Monitoring Board and the Strategic Advisory Group of Experts on immunization, tell us: we must stay the course.

Should commitment falter, polio will come roaring back. Should our resolve waver, this will be the most expensive failure in the history of public health.

You will be considering a draft resolution that proposes declaration of the completion of polio eradication as a “programmatic emergency for global public health.” I urge you to consider this resolution with utmost urgency.

Implementation of the International Health Regulations is on your agenda, as are the framework for Pandemic Influenza Preparedness, and the Commission on Information and Accountability for Women’s and Children’s Health.

These items support my second observation. We see the success of WHO and its Member States in developing and implementing novel instruments for global health governance.

Let me comment on two.

The negotiations that culminated in the framework for Pandemic Influenza Preparedness were the most difficult and potentially explosive that I have ever witnessed in my 35 years in public health. But the spirit of consensus and fair play eventually won, and we got a square deal for everyone, including the pharmaceutical industry.

This tells us that countries really want risks to be proactively managed. They want rules of proper conduct, with clearly assigned responsibilities, and they want fairness, a square deal for everyone.

The framework for information and accountability is part of a chain of innovative mechanisms and instruments linked to the Global Strategy for Women’s and Children’s Health.

The Commission’s sharp, smart, and lean recommendations are now supported by a detailed workplan for translating these recommendations into action. The workplan greatly facilities rapid action, especially to develop systems for vital registration, by identifying existing instruments, methodologies, guidelines, and best practices that can be used immediately or easily modified to fill gaps.

Oversight, which includes identifying the best value-for-money approaches, has been assigned to an independent Expert Review Group. The Group was established in September of last year and held its first meeting two months later.

With these developments, public health breaks new ground by tackling a long-standing need. That is: to build national capacity to generate and analyse basic health data.

Without information, at country level, we can never have accountability. Without information, we can never know what a “best” or a “wise” investment really means. Without information, we are working in the dark, pouring money into a black hole.

This is totally unacceptable at a time when every dollar counts, and both donors and recipients must be held accountable…”

Rotary announced that, “despite a stagnant global economy,” its clubs around the world succeeded in raising more than US$200 million in new funding for polio eradication. The fundraising milestone was reached in response to a US$355 million challenge grant from the Bill & Melinda Gates Foundation. All funds have been earmarked to support polio immunization activities in affected countries. Rotary Foundation Trustee John F. Germ noted, “We’ll celebrate this milestone, but it doesn’t mean that we’ll stop raising money or spreading the word about polio eradication. We can’t stop until our entire world is certified as polio free.” Jeff Raikes, CEO of the Gates Foundation, said, “In recognition of Rotary’s great work, and to inspire Rotarians in the future, the foundation is committing an additional $50 million to extend our partnership. Rotary started the global fight against polio, and continues to set the tone for private fundraising, grassroots engagement and maintaining polio at the top of the agenda with key policy makers.”

http://www.prnewswire.com/news-releases/rotary-clubs-worldwide-meet-200-million-fundraising-challenge-for-polio-eradication-137526003.html

The Sabin Vaccine Institute announced the start of a Phase 1 clinical trial of its Na-GST-1 antigen, a candidate for the first human hookworm vaccine. The trial is described as a major milestone for the vaccine product development partnership (PDP) headquartered at Sabin. This trial advances Sabin’s goal “to develop a safe, efficacious and low-cost vaccine to reduce the global burden of human hookworm, which infects nearly 600 million people worldwide.” The trial is being conducted in Brazil, where the burden of human hookworm infection is high in endemic areas. Peter Hotez, M.D., Ph.D., president of the Sabin Vaccine Institute and director of the Texas Children’s Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor College of Medicine, commented, “This vaccine trial is monumental, not just for us, but also for the children living in poverty who bear the burden of hookworm infection. After more than 10 years of research and development work and with the help of Sabin’s PDP partners, especially our partners in Brazil, we are about to show that it’s possible to produce a vaccine candidate using a relatively low-cost model. We are filling a gap to produce a vaccine for underrepresented populations, where no traditional commercial market currently exists.”

http://www.sabin.org/news-resources/releases/2012/01/19/candidate-first-human-hookworm-vaccine-enters-phase-1-clinical-tr

WHO Global Alert and Response (GAR): Disease Outbreak News

Most recent news items:

20 January 2012
Avian influenza – situation in Viet Nam

19 January 2012
Avian influenza – situation in Indonesia – update

19 January 2012
Avian influenza – situation in Egypt – update

18 January 2012
Avian influenza – situation in Cambodia – update

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

GAVI said that following separate investigations into the misuse of GAVI funding in Cameroon and Niger, both Ministries of Health “have cooperated fully and confirmed their commitment to take all necessary measures, including the reimbursement of misused funds.” GAVI said the investigations began last year after GAVI’s oversight processes “raised credible concerns” that funds were misused during the period 2007-2010. The findings suggest that up to US$4.2 million allocated for health systems strengthening (HSS) has been misused in Cameroon, and up to US$2.5 million allocated for immunisation services support (ISS) has been misused in Niger. Of these amounts, GAVI noted, approximately US$ 1.8 million in Cameroon and US$ 1.5 million in Niger are under investigation for theft. Also of concern are the other misused funds which were spent without sufficient documentation or used to pay for activities in the health sector but outside the scope of GAVI’s grant agreements. GAVI originally announced the Niger and Cameroon investigations in 2011 and, at the same time, suspended funding to the affected cash-based programmes. Support to the rest of the two countries’ childhood immunisation programmes have continued uninterrupted. Since its launch in 2000, GAVI has confirmed two other cases of misuse of its funds (in Uganda and Mali). Both cases have since been resolved and funds recovered.

http://www.gavialliance.org/library/news/statements/2012/gavi-works-with-cameroon-and-niger-to-recover-misused-funds/

   Standard & Poor’s (S&P) downgraded the IFFIm (International Finance Facility for Immunisation Company) to AA+ from AAA with a negative outlook, following S&P’s rating actions announced on 13 January 2012, for euro zone countries that provide grants to IFFIm.  Earlier, S&P said in an analysis of IFFIm that it considers IFFIm’s credit rating to be closely associated with the rating of its largest grantors. France is IFFIm’s second-largest grantor, representing about 25% of the outstanding present value of IFFIm’s total grants. In all, euro zone countries represent about 39% of grants to IFFIm. The largest grantor to IFFIm is the UK (rated AAA/Aaa/AAA), representing 48% of IFFIm’s total grants. IFFIm is currently rated Aaa by Moody’s; AAA by Fitch, which updated IFFIm’s outlook to negative on 19 December 2011 when it changed France’s outlook to negative; and AA+ by S&P with negative outlook.

IFFIm was created in 2006 “to help the international community achieve the Millennium Development Goals. IFFIm’s financial base consists of legally binding grant payments from its sovereign grantors (the UK, France, Italy, Norway, Australia, Spain, The Netherlands, Sweden and South Africa). IFFIm has about US$ 6.3 billion in legally-binding payment obligations from its donors and has raised US$ 3.6 billion in the capital markets.”

http://www.iffim.org/library/news/press-releases/2012/rating-action-by-standard-and-poors-follows-sovereign-donor-downgrades/

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

GAVIAlliance GAVI Alliance
3 days until @WEF! This 3 minute long video speaks to the power of #vaccines– ht.ly/8Ca9C
1 hour ago

WHO WHO
WHO Executive Board passed a resolution on eliminating #schistosomiasis, a disease caused by parasitic worms bit.ly/xLPg4c #EB130
7 hours ago

WHO WHO
WHO Executive Board passed a resolution to combat noncommunicable diseases bit.ly/xsvVXB #EB130 #NCDs
21 Jan

AmerMedicalAssn AMA
RT @VMethics Should Participation in Vaccine Clinical Trials be Mandated? bit.ly/wAfbB0
20 Jan

UNICEF UNICEF
UNICEF’s Executive Board elects a new President for 2012 uni.cf/zHrJhT
20 Jan

AmerMedicalAssn AMA
RT @VMethics The National Childhood Vaccine Injury Act and the Supreme Court’s Interpretation bit.ly/yvC5px
20 Jan

WHO WHO
WHO Executive Board passed a resolution to reduce child mortality and improve maternal #health bit.ly/A9jTEo #EB130 #MDGs
20 Jan

Forbes Forbes
Bill Gates: The 7 Most Influential Vaccine Heroes onforb.es/wycTli
13 Jan

pahowho PAHO/WHO
Presentation of Preliminary Findings from the Global Burden of Disease Study 2010 – bit.ly/Ax4jjY
19 Jan

unfoundation UN Foundation
Congrats! RT @endpolionow: Rotary clubs worldwide meet $200 million fundraising challenge for polio eradication. bit.ly/zzYQJM
19 Jan

PublicHealth APHA
Hospitals can be a setting for measles transmission, 2009 Pennsylvania outbreak shows: goo.gl/KXE0D
19 Jan

sabinvaccine Sabin Vaccine Inst.
Dengue vaccine by 2015? Phase II clinical trial begins in Malaysia bit.ly/yi6TT8
19 Jan

ECDC_EU ECDC
ECDC updated measles maps show #measles cases reported monthly by #EU and EEA countries. bit.ly/wQvmSk
17 Jan

MeaslesInit Measles Initiative
CDC study: measles can spread fast in a hospital when parents choose not to vaccinate & workers are not fully immunized 1.usa.gov/xNkghp

International Journal of Infectious Diseases
Volume 16, Issue 2 pp. e75-e150 (February 2012)
http://www.sciencedirect.com/science/journal/12019712

Reviews
Impact of the implementation of a vaccination strategy on hepatitis B virus infections in China over a 20-year period
Review Article
Pages e82-e88
Zhuanbo Luo, Lanjuan Li, Bing Ruan

Summary
Hepatitis B virus (HBV) vaccination has been recommended for all neonates in China since 1992. This article reviews the impact of HBV vaccination throughout the past 20 years in China. Before the introduction of the HBV vaccination program, approximately 9.8% of the general Chinese population tested positive for hepatitis B virus surface antigen (HBsAg). Since 1992, vaccination coverage has increased each year. In 1999, a National Expanded Programme on Immunization (EPI) review showed that the immunization coverage with three doses of HBV vaccine was 70.7%, and reached 99.0% in Beijing. The HBsAg carrier rate in the general population decreased to 7.2% in 2006. In particular, the prevalence of HBsAg decreased to 2.3% among children aged 5–14 years and to 1.0% among children younger than 5 years. In addition, the administration of the HBV vaccine may have reduced the risk of hepatocellular carcinoma among adults. Despite the administration of hepatitis B immunoglobulin and the HBV vaccine to children with HBsAg-positive mothers, the failure rate of HBV immunoprophylaxis was 5–10%. In China, vaccine failure was related to HBV S gene mutation and inadequate administration of HBV vaccine. The prevalence of HBV carriers in China was markedly reduced after the introduction of the universal HBV vaccination program. If we immunize all susceptible individuals with the hepatitis B vaccine (especially children), interrupt transmission, and provide antiviral treatment for existing HBV carriers, the number of new cases may be reduced to close to zero in the future and this may eventually result in the eradication of HBV.

International Journal of Infectious Diseases
Volume 16, Issue 2 pp. e75-e150 (February 2012)
http://www.sciencedirect.com/science/journal/12019712

Original Reports
Impact of rotavirus vaccination on childhood gastroenteritis-related mortality and hospital discharges in Panama
Original Research Article
Pages e94-e98
Vicente Bayard, Rodrigo DeAntonio, Rodolfo Contreras, Olga Tinajero, Maria Mercedes Castrejon, Eduardo Ortega-Barría, Romulo E. Colindres

Summary
Background
Rotavirus vaccination was introduced in Panama in March 2006. This study was carried out in order to describe the trends in gastroenteritis-related (GER) hospitalizations and mortality in children <5 years of age during the pre- and post-vaccination periods.

Methods
Data from the Expanded Program on Immunization (Ministry of Health) were used to calculate vaccine coverage. GER mortality and hospitalizations were obtained through database review of the Contraloría General de la República and hospital discharge databases of five sentinel hospitals, for the period 2000–2008. Mean rates of GER mortality and mean numbers of hospitalizations during the baseline pre-vaccination period (2000-2005) were compared to those of 2007 and 2008.

Results
National coverage for the second rotavirus vaccine dose increased from 30% in 2006 to 62% in 2007 and 71% in 2008, varying from 62% in the West region to 77% in the Panama region. Overall, at 2-years post-vaccine introduction, the GER mortality rate in Panama had decreased by 50% (95% confidence interval (CI) 46–54). During 2000–2005, the GER mortality rate in children (<1 year) was 73/100 000, decreasing by 45% (95% CI 40–51) in 2008. In children aged 1–4 years, the GER mortality rate was 20.3/100 000 (2000–2005), decreasing by 54% (95% CI 48–60) in 2008. The Panama region registered the highest mortality rate reduction (69%; 95% CI 58–81) for 2008. During 2008, GER hospitalizations among children <5 years of age decreased by 30% (95% CI 21–37) from the mean number of hospitalizations during 2000–2005.

Conclusions
A substantial reduction in GER mortality and hospitalizations was observed following the introduction of rotavirus vaccine in Panama.

International Journal of Infectious Diseases
Volume 16, Issue 2 pp. e75-e150 (February 2012)
http://www.sciencedirect.com/science/journal/12019712

Evaluation of the mass measles vaccination campaign in Guangdong Province, China
Original Research Article
Pages e99-e103
Zhi Qiang Peng, Wei Shi Chen, Qun He, Guo Wen Peng, Cheng Gang Wu, Ning Xu, Zhan Jie Zhao, Jun Shu, Qiu Tan, Hui Zhen Zheng, Li Feng Lin, Hui Hong Deng, Jin Yan Lin, Yong Hui Zhang

Summary
Objective
To evaluate the mass measles vaccination campaign of 2009 in Guangdong Province, China.

Methods
Data on the campaign implementation, measles surveillance, and serological surveillance were reviewed and analyzed by statistical methods.

Results
Rapid coverage surveys showed that 98.09% of children were vaccinated during the campaign. The coverage of migrant children increased significantly from 67.10% to 97.32% (p < 0.01). From May to December 2009, after the campaign, the number of measles cases was reduced by 93.04% compared with the same period of 2008. The antibody positive rate in children aged less than 15 years reached above 95%. More than 1 million migrant children were identified and vaccinated during the campaign. Flyers, notices of information from doctors, and television programs were the best methods to inform parents of the campaign. Awareness of the campaign by residents increased significantly from 91.86% to 97.10% (p < 0.01) through the use of social mobilization materials.

Conclusions
A massive vaccination campaign approach for controlling measles in a developing region like Guangdong Province with a vast migrant population has proved effective. Comprehensive mobilization, communication with the mass media, and support from government departments were critical to the success of the campaign.

International Journal of Infectious Diseases
Volume 16, Issue 2 pp. e75-e150 (February 2012)
http://www.sciencedirect.com/science/journal/12019712

Gender inequities, relationship power, and childhood immunization uptake in Nigeria: a population-based cross-sectional study
Original Research Article
Pages e136-e145
Diddy Antai

Summary
Background
This study aimed to simultaneously examine the association between multiple dimensions of gender inequities and full childhood immunization.

Methods
A multilevel logistic regression analysis was performed on nationally representative sample data from the 2008 Nigeria Demographic and Health Survey, which included 33 385 women aged 15–49 years who had a total of 28 647 live-born children; 24 910 of these children were included in this study.

Results
A total of 4283 (17%) children had received full immunization. Children of women whose spouse did not contribute to household earnings had a higher likelihood of receiving full childhood immunization (odds ratio (OR) 1.96, 95% confidence interval (95% CI) 1.02–3.77), and children of women who lacked decision-making autonomy had a lower likelihood of receiving full childhood immunization (OR 0.74, 95% CI 0.60–0.91). The likelihood of receiving full childhood immunization was higher among female children (OR 1.28, 95% CI 1.06–1.54), Yoruba children (OR 2.45, 95% CI 1.19–4.26), and children resident in communities with low illiteracy (OR 1.82, 95% CI 1.06–3.12), but lower for children of birth order 5 or above (OR 0.64, 95% CI 0.45–0.96), children of women aged ≤24 years (OR 0.66, 95% CI 0.50–0.87) and 25–34 years (OR 0.79, 95% CI 0.63–0.99), children of women with no education (OR 0.33, 95% CI 0.21–0.54) and primary education (OR 0.66, 95% CI 0.45–0.97), as well as children of women resident in communities with high unemployment (OR 0.34, 95% CI 0.20–0.57).

Conclusions
The woman being the sole provider for her family (i.e., having a spouse who did not contribute to household earnings) was associated with a higher likelihood of fully immunizing the child, and the woman lacking decision-making autonomy was associated with a lower likelihood of fully immunizing the child. These findings draw attention to the need for interventions aimed at promoting women’s employment and earning possibilities, whilst changing gender-discriminatory attitudes within relationships, communities, and society in general.