Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 8  pp. 1411-1528 (14 February 2012)

Health economics of rotavirus immunization in Vietnam: Potentials for favorable cost-effectiveness in developing countries
Original Research Article
Pages 1521-1528
Hong-Anh T. Tu, Mark H. Rozenbaum, Peter C. Coyte, Shu Chuen Li, Herman J. Woerdenbag, Maarten J. Postma

Abstract
Introduction
Rotavirus is the most common cause of severe diarrhoea worldwide. Vietnam is situated in the region of high rotavirus infection incidence and eligible for financial support to introduce rotavirus vaccines into the Expanded Program of Immunization (EPI) from the GAVI. This study was designed to assess the cost-effectiveness of rotavirus immunization in Vietnam, explicitly the use of Rotateq® and to assess the affordability of implementing universal rotavirus immunization based on GAVI-subsidized vaccine price in the context of Vietnamese healthcare system for the next 5 years.

Methodology
An age-structured cohort model was developed for the 2009 birth cohort in Vietnam. Two strategies were compared: one being the current situation without vaccination, and the other being mass universal rotavirus vaccination. The time horizon of the model was 5 years with time cycles of 1 month for children less than 1 year of age and annual analysis thereafter. Outcomes included mild, moderate, severe cases and death. Multiple outcomes per rotavirus infection are possible in the model. Monte Carlo simulations were used to examine the acceptability and affordability of the rotavirus vaccination. All costs were expressed in 2009 US$.

Results
Rotavirus vaccination would not completely protect young children against rotavirus infection due to partial nature of vaccine immunity, however, would effectively reduce severe cases of rotavirus by roughly 55% during the first 5 years of life. Under GAVI-subsidized vaccine price (US$ 0.3/dose), the vaccine cost would amount to US$ 5.5 million per annum for 3-dose of the Rotateq® vaccine. In the base-case, the incremental cost per quality-adjusted-life-year (QALY) was US$ 665 from the health system perspective, much lower than per-capita GDP of ∼US$ 1150 in 2009. Affordability results showed that at the GAVI-subsidized vaccine price, rotavirus vaccination could be affordable for Vietnamese health system.

Conclusion
Rotavirus vaccination in Vietnam would be a cost-effective health intervention. Vaccination only becomes affordable if the country receives GAVI’s financial support due to the current high market vaccine price. Given the high mortality rate of under-five-year children, the results showed that rotavirus immunization is the “best hope” for prevention of rotavirus-related diarrhoeal disease in Vietnam. In the next five years, Vietnam is definitely in debt to financial support from international organizations in implementing rotavirus immunization. It is recommended that new rotavirus vaccine candidates be developed at cheaper price to speed up the introduction of rotavirus immunization in the developing world in general.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 7 pp. 1235-1410 (8 February 2012)

The determinants of 2009 pandemic A/H1N1 influenza vaccination: A systematic review
Review Article
Pages 1255-1264
Stephanie Brien, Jeffrey C. Kwong, David L. Buckeridge

Abstract
Background
Pandemic A/H1N1 influenza vaccine coverage varied widely across countries. To understand the factors influencing pandemic influenza vaccination and to guide the development of successful vaccination programs for future influenza pandemics, we identified and summarized studies examining the determinants of vaccination during the 2009 influenza pandemic.

Methods
We performed a systematic literature review using the PubMED electronic database from June 2009 to February 2011. We included studies examining an association between a possible predictive variable and actual receipt of the pandemic A/H1N1 influenza vaccine. We excluded studies examining intention or willingness to receive the vaccine.

Results
Twenty-seven studies were identified from twelve countries. Pandemic influenza vaccine coverage varied from 4.8% to 92%. Coverage varied by population sub-group, country, and assessment method used. Most studies used questionnaires to estimate vaccine coverage, however seven (26%) used a vaccination registry. Factors that positively influenced pandemic influenza vaccination were: male sex, younger age, higher education, being a doctor, being in a priority group for which vaccination was recommended, receiving a prior seasonal influenza vaccination, believing the vaccine to be safe and/or effective, and obtaining information from official medical sources.

Conclusions
Vaccine coverage during the pandemic varied widely across countries and population sub-groups. We identified some consistent determinants of this variation that can be targeted to increase vaccination during future influenza pandemics.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 7 pp. 1235-1410 (8 February 2012)

The concept of vaccination failure
Review Article
Pages 1265-1268
U. Heininger, N.S. Bachtiar, P. Bahri, A. Dana, A. Dodoo, J. Gidudu, E. Matos dos Santos

Abstract
Despite remarkable success of immunization programmes on a global perspective, vaccines are neither 100% efficacious nor 100% effective. Therefore, vaccination failure, i.e. occurrence of a specific disease in an individual despite previous vaccination, may occur. Vaccination failure may be due to actual vaccine failure or failure to vaccinate appropriately.

Universally accepted concepts and definitions of vaccination failure are required to assess and compare the benefit of vaccines used in populations. Here we propose general definitions for types of vaccination failure. In the future, these should be complemented by specific definitions for specific vaccines as needed depending on public health considerations.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 7 pp. 1235-1410 (8 February 2012)

Characterizing providers’ immunization communication practices during health supervision visits with vaccine-hesitant parents: A pilot study
Original Research Article
Pages 1269-1275
Douglas J. Opel, Jeffrey D. Robinson, John Heritage, Carolyn Korfiatis, James A. Taylor, Rita Mangione-Smith

Abstract
Objective
To determine the feasibility of using direct observation of provider–parent immunization discussions and to characterize provider communication practices with vaccine-hesitant parents.

Methods
Over a 6 month period in 2010, we videotaped immunization discussions between pediatric providers and vaccine-hesitant parents during health supervision visits involving children 2–15 months old (N = 24) in the Seattle area, Washington, USA. Videotapes were analyzed using the qualitative method of conversation analysis.

Results
We approached 96 parents seen by 9 different providers. Of those who were eligible (N = 56), we enrolled 43% (N = 24). Four videotaped visits were excluded from analysis for failure to obtain parental HIPAA authorization. Of the remaining 20 visits, there were ≥2 visits each that involved children aged 2, 4, 6, 9, 12, and 15 months, and all videotaped visits contained at least a brief immunization discussion. We identified 6 communication practices and several behavior types within each practice relevant to immunization: Practice 1, providers’ initiations of the topic of vaccination; Types: participatory or presumptive format; Practice 2, parents’ responses to providers’ topic initiations; Types: strong or weak acceptance or resistance; Practice 3, providers’ follow-ups to parent’s responses; Types: no, immediate, or delayed pursuit; Practice 4, parents’ vaccine-related questions or statements; Types: fact- or concern-based; Practice 5, providers’ explicit solicitations of parent’s questions/concerns; Types: designed to discourage or encourage discussion; and Practice 6, parents’ responses to providers’ solicitations of questions/concerns; Types: no question or fact- or concern-based inquiry.

Conclusion
Direct observation of immunization discussions in the primary care pediatric setting is feasible and yields insight into several provider–parent immunization communication practices that are worthy of further study to determine which are effective at improving parental acceptance of immunization.