Editor’s Notes:
– Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.
– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_31 March 2012
– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
PATH announced that Steve Davis was appointed president and CEO, noting that Mr. Davis “brings leadership experience in numerous innovation-focused organizations, both nonprofit and for-profit, and has worked extensively in emerging economies throughout his career.” He comes to PATH most recently from McKinsey & Company, where he was global director of social innovation. Dr. Molly Joel Coye, chair of PATH’s board of directors, said, “We are delighted to have Steve bring his extensive global health and development expertise and insight to PATH. Steve brings a history with PATH as a previous board member and is a proven innovator and versatile leader with a longstanding commitment to social change. His deep knowledge of health needs in the developing world and impressive accomplishments in creating solutions tailored for the communities where PATH works immediately stood out among our extraordinarily high-caliber pool of applicants.” Mr. Davis commented, “I have long admired PATH for its spirit of innovation and its tremendous strides in addressing inequities and saving lives around the world. My work always has been fueled by a passion for creating genuine social impact with leading-edge innovations, and I am honored to join such a prominent and effective organization, to continue PATH’s powerful work in global health, and to advance the delivery of sustainable impact.” PATH noted that Mr. Davis will oversee an annual budget of US$305 million, a staff of nearly 1,200, and a robust portfolio of projects based in PATH offices in 22 countries.
MMWR Surveillance Summaries; March 30, 2012 / Vol. 61 / No. SS–3
Prevalence of Autism Spectrum Disorders — Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008
This report provides updated autism spectrum disorder (ASD) prevalence estimates from the 2008 surveillance year, representing 14 Autism and Developmental Disabilities Monitoring (ADDM) sites in the United States. For 2008, the overall estimated prevalence of ASDs among the 14 ADDM sites was 11.3 per 1,000 (one in 88) children aged 8 years who were living in these communities during 2008. The extent to which these increases reflect better case ascertainment as a result of increases in awareness and access to services or true increases in prevalence of ASD symptoms is not known.
PAHO said it will launch the Regional Platform for Access to Health Technologies and Innovation in early May, an initiative “to improve transparency, information flow, and cooperation among countries of the region in order to promote access, innovation, rational use, and governance of essential drugs, biological medicines, and diagnostics in public health.” PAHO noted that the interactive platform “encompasses research, development, and innovation for health technologies; pharmaceutical policies and health technologies; access to and rational use of medicines; and regulation and management of intellectual property. It is a tool for health authorities in the Americas; national regulatory authorities; departments of science, technology, and innovation; scientists, researchers, and research institutes; civil society, nongovernmental organizations, and foundations that work with medicines and health technologies; and sectors of the pharmaceutical industry. The new platform offers a series of virtual tools, including:
– Communities to Share Practices: This instrument enables people and institutions to work together to share and create knowledge about common interests.
– Innovation Forum: The forum is an opportunity to collaborate on solving problems related to health innovations.
– Annotated List of Medicines: This tool contains information on the essential and strategic drugs in use in the region, and will make it possible to examine the list of essential drugs of countries, evidence summaries, and the regulatory status of health technologies.
– Observatory: This instrument provides information on the sectors and processes involved in the development, production, and regulation of health technologies through the use of standardized and periodically updated indicators.
http://new.paho.org/hq/index.php?option=com_content&task=view&id=6553&Itemid=1926
Meeting: WHO SAGE
10-12 April 2012, Geneva
Draft agenda (as of 22 March 2012)
Agenda Sessions:
– Report from Director, IVB
– Polio Eradication
– Seasonal influenza vaccine
– Impact of introduction of new vaccines on the strengthening of immunization and health systems
– Vaccination in humanitarian emergencies
– Rotavirus vaccines schedules
– Use of hepatitis A vaccines
– Report from the GAVI Alliance Secretariat
– Information on vaccines for an Intergovernmental Negotiating Committee on Mercury
The Weekly Epidemiological Record (WER) 30 March 2012, vol. 87, 12 (pp 117–128) includes: Update on human cases of highly pathogenic avian influenza A(H5N1) virus infection, 2011; Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2011.
WHO: Immunization highlights – 2011
In 2011, there was important progress in a number of areas. About 180 countries across five WHO regions celebrated Immunization Week and the first official WHO-supported World Hepatitis Day was held to increase awareness and understanding of viral hepatitis and the diseases that it causes. The demand for new and underused vaccines is rising and more countries are introducing vaccines against meningococcal A epidemics, pneumococcal disease and rotavirus. A selection of the most notable immunization achievements and events of 2011 is featured here, together with data based on the latest WHO/UNICEF global estimates for 2010.
http://www.who.int/immunization/newsroom/highlights/2011/en/index.html
Twitter Watch [accessed 31 March 2012 – 16:55]
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.
GAVI Alliance @GAVIAlliance
“Preventing #measles will help #Myanmar reduce under 5 deaths & achieve #MDG4.” Pe Thet Khi, Myanmar Health Minister http://ht.ly/9ZGfw
4:38 AM – 31 Mar 12
PATH @PATHtweets
A plastic liner developed by PATH helps keep #vaccine coolers the right temperature. How does that work? http://ow.ly/9YZ16
12:47 PM – 30 Mar 12
Amanda Glassman @glassmanamanda
Linking Investments to Outcomes: Measuring Health System Effectiveness : come to our event http://www.cgdev.org/content/calendar/detail/1426059/ via @CGDev
3:15 PM – 29 Mar 12
CDCgov @CDCgov
Measles continues to be brought into U.S. Stay current on vaccines, including before travel abroad. http://go.usa.gov/Ee3
10:00 AM – 29 Mar 12
The Global Fund @globalfundnews
Our Corp Champion @Chevron talks about the key role of the private sector in the fight against #AIDS #TB & #malaria http://bit.ly/HiKPry
9:00 AM – 28 Mar 12
Amanda Glassman @glassmanamanda
MDGs should linked to human rights – “ensuring entitlements that link human rights provisions with laws and resources” http://bit.ly/HgAAnI
11:36 PM – 27 Mar 12
UNOCHA @UNOCHA
Providing life-saving measles immunizations in #Yemen: http://bit.ly/HhWlTg @UNCERF gives $5 million to support @UNICEF & @WHO response.
Retweeted by UNICEF
EndPolioNow @EndPolioNow
Rotarians in Côte d’Ivoire take part in polio immunizations as part of a coordinated 22 African country campaign. http://twitpic.com/9268qq
6:34 PM – 27 Mar 12
Sabin Vaccine Inst. @sabinvaccine
Via @nprnews: In Haiti, Bureaucratic Delays Stall Mass Cholera Vaccinations http://n.pr/GRaUwj
10:20 AM – 27 Mar 12
Report: An Investment Case for the Accelerated Introduction of Oral Cholera Vaccines
IVI (International Vaccines Institute); March 2012
IVI said its Policy & Economic Research Unit has developed an investment case in order to provide a global evidence base for investing in oral cholera vaccines (as part of a larger strategy that includes improvements to water, sanitation, and hygiene). This report was developed in response “to the fact that demand for oral cholera vaccines has been too uncertain for vaccine producers to invest in increasing their production capacity beyond current low levels. This has led to reluctance among suppliers, inadequate supply, and high prices that have delayed the introduction of new and under-utilized vaccines in developing countries where cholera remains a persistent public health problem.”
IVI said the report was developed “to meet the needs of groups that include the WHO Strategic Advisory Group of Experts on Immunization (SAGE), the global health community, vaccine manufacturers, prospective donor agencies, and policymakers from cholera-endemic countries for more information about the potential demand for cholera vaccines, the cost involved to meet this demand, and the impact and cost-effectiveness of vaccination.” The report provides further evidence to support the WHO’s recommendations (WHO Position Paper on Cholera Vaccines, March 2010) that include prioritizing cholera control measures such as immunization and water and sanitation improvements in endemic areas, consideration of preemptive vaccination in preventing outbreaks, and targeting high-risk areas and groups for vaccination in endemic countries.
Specifically the report provides:
– A detailed estimate of the cholera disease burden;
– The forecast of cholera vaccine demand for the control of endemic cholera;
– An estimate of the needs for a vaccine stockpile that could be used for pre-emptive vaccination to prevent outbreaks;
– An analysis of the global impact of vaccination on the disease based on the demand forecast results; and
– The cost and cost-effectiveness of vaccination
Financial support was provided by the Bill & Melinda Gates Foundation, the Swedish International Development Cooperation Agency (Sida), and the governments of the Republic of Korea, Sweden, and Kuwait.
Report: Shifting Paradigms: How the BRICS Are Reshaping Global Health and Development
Global Health Strategies initiatives (GHSi); March 2012
http://www.ghsinitiatives.org/brics-report
Executive Summary Extract
“…This report presents findings from a qualitative and quantitative survey of present and future efforts by Brazil, Russia, India, China and South Africa to improve global health. It examines these roles within the broader context of international development and foreign assistance, though health remains the primary focus. This report also includes a brief look at other emerging powers beyond the BRICS that have potential to
impact major global health issues. The goal was to examine existing BRICS assistance programs and contributions to health innovation in order to identify opportunities for the BRICS and other emerging powers to expand upon their achievements and increase their contributions to improving health in the poorest countries.”
BIO Ventures for Global Health (BVGH); March 2012
“…Understanding the neglected disease R&D pipeline as well as the spectrum of organizations participating in the development of these new drugs and vaccines is essential to evaluating the efficiency and effectiveness of current R&D programs — and to inform the design of new ones. Until now, this type of analysis has been hindered in part because neglected disease pipelines have not been systematically tracked or analyzed. Recognizing this…BVGH collected and reviewed data from our Global Health Primer to — for the first time — shed light on the different types of organizations that are participating in product development for a broad range of neglected diseases…academic and research institutions participate in 43% of all neglected disease products in development. That participation is broad and deep but often under recognized. Product development partnerships, or PDPs, support approximately 40% of the overall neglected disease pipeline. Industry participation in product development is similar for products with and without PDP development partners. We note in the report that these findings are quantitative and do not reflect the scope and depth of the valuable work produced by these organizations through the R&D work they have undertaken…”
Report: Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response
IOM; March 21, 2012
At the request of the HHS, the IOM formed a committee in 2009, which developed guidance that health officials could use to establish and implement standards of care during disasters. In its first report, the committee defined “crisis standards of care” (CSC) as a state of being that indicates a substantial change in health care operations and the level of care that can be delivered in a public health emergency, justified by specific circumstances. During disasters, medical care must promote the use of limited resources to benefit the population as a whole. In this report, the IOM examines the effect of its 2009 report, and develops vital templates to guide the efforts of professionals and organizations responsible for CSC planning and implementations. http://www.iom.edu/Reports/2012/Crisis-Standards-of-Care-A-Systems-Framework-for-Catastrophic-Disaster-Response.aspx
[Editor’s Note: The report includes case examples involving the H1N1 pandemic and vaccine availability in its analysis]
Bulletin of the World Health Organization
Volume 90, Number 4, April 2012, 245-320
http://www.who.int/bulletin/volumes/90/4/en/index.html
Special theme: influenza
In this special theme issue, Michael L Perdue & Tim Nguyen (246) look at the WHO public health research agenda for influenza two years from its initial publication. Nahoko Shindo & Sylvie Briand (247) discuss influenza at the beginning of the 21st century, while, in an interview, William Ampofo (254–255) tells Ben Jones why it is essential to track the burden of influenza in Africa.
Foreign Affairs
March/April 2012 Volume 91, Number 2
http://www.foreignaffairs.com/
Features: Snapshots
India‘s Polio Win
One Step Closer To Eliminating The Virus
Kathleen Sebelius
March 28, 2012
http://www.foreignaffairs.com/articles/137357/kathleen-sebelius/indias-polio-win
The Lancet
Mar 31, 2012 Volume 379 Number 9822 p1171 – 1272 e45 – 47
http://www.thelancet.com/journals/lancet/issue/current
Articles
Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries
Aluísio JD Barros, Carine Ronsmans, Henrik Axelson, Edilberto Loaiza, Andréa D Bertoldi, Giovanny VA França, Jennifer Bryce, J Ties Boerma, Cesar G Victora
Summary
Background
Countdown to 2015 tracks progress towards achievement of Millennium Development Goals (MDGs) 4 and 5, with particular emphasis on within-country inequalities. We assessed how inequalities in maternal, newborn, and child health interventions vary by intervention and country.
Methods
We reanalysed data for 12 maternal, newborn, and child health interventions from national surveys done in 54 Countdown countries between Jan 1, 2000, and Dec 31, 2008. We calculated coverage indicators for interventions according to standard definitions, and stratified them by wealth quintiles on the basis of asset indices. We assessed inequalities with two summary indices for absolute inequality and two for relative inequality.
Findings
Skilled birth attendant coverage was the least equitable intervention, according to all four summary indices, followed by four or more antenatal care visits. The most equitable intervention was early initiation of breastfeeding. Chad, Nigeria, Somalia, Ethiopia, Laos, and Niger were the most inequitable countries for the interventions examined, followed by Madagascar, Pakistan, and India. The most equitable countries were Uzbekistan and Kyrgyzstan. Community-based interventions were more equally distributed than those delivered in health facilities. For all interventions, variability in coverage between countries was larger for the poorest than for the richest individuals.
Interpretation
We noted substantial variations in coverage levels between interventions and countries. The most inequitable interventions should receive attention to ensure that all social groups are reached. Interventions delivered in health facilities need specific strategies to enable the countries’ poorest individuals to be reached. The most inequitable countries need additional efforts to reduce the gap between the poorest individuals and those who are more affluent.
Funding
Bill & Melinda Gates Foundation, Norad, The World Bank.
[Editor’s Note: includes metrics on DPT, measles andf “full” immunization]
The Lancet Infectious Disease
Apr 2012 Volume 12 Number 4 p255 – 354
http://www.thelancet.com/journals/laninf/issue/current
Comment
New studies of BCG: implications for tuberculosis vaccines
C Fordham von Reyn
Preview
BCG has been given to over 3 billion people since the early part of the 20th century. Although the vaccine is effective, its use was implemented before clinical-trial design had reached its current sophistication, and before sensitive in-vitro techniques of assessing cellular immune responses were available. Recent studies and reinterpretation of previous trials have helped to clarify the true efficacy of BCG against both infection with and disease caused by Mycobacterium tuberculosis, while large cohort studies have provided an accurate side-effect profile in recipients with HIV infection.
Articles
Effectiveness and cost-effectiveness of first BCG vaccination against tuberculosis in school-age children without previous tuberculin test (BCG-REVAC trial): a cluster-randomised trial
Susan M Pereira, Mauricio L Barreto, Daniel Pilger, Alvaro A Cruz, Clemax Sant’Anna, Miguel A Hijjar, Maria Y Ichihara, Andreia C Santos, Bernd Genser, Laura C Rodrigues
Summary
Background
Neonatal BCG vaccination is part of routine vaccination schedules in many developing countries; vaccination at school age has not been assessed in trials in low-income and middle-income countries. Catch-up BCG vaccination of school-age children who missed neonatal BCG vaccination could be indicated if it confers protection and is cost-effective. We did a cluster-randomised trial (BCG REVAC) to estimate the effectiveness (efficacy given in routine settings) of school-age vaccination.
Methods
We assessed the effectiveness of BCG vaccination in school-age children (aged 7—14 years) with unknown tuberculin status who did not receive neonatal BCG vaccination (subpopulation of the BCG REVAC cluster-randomised trial), between July, 1997, and June, 2006, in Salvador, Brazil, and between January, 1999, and December, 2007, in Manaus, Brazil. 763 schools were randomly assigned into BCG vaccination group or a not-vaccinated control group. Neither allocation nor intervention was concealed. Incidence of tuberculosis was the primary outcome. Cases were identified via the Brazilian Tuberculosis Control Programme. Study staff were masked to vaccination status when identified cases were linked to the study population. We estimated cost-effectiveness in Salvador by comparison of the cost for vaccination to prevent one case of tuberculosis (censored at 9 years) with the average cost of treating one case of tuberculosis. Analysis of all included children was by intention to treat. For calculation of the incidence rate we used generalised estimating equations and correlated observations over time.
Findings
We randomly assigned 20 622 children from 385 schools to the BCG vaccination group and 18 507 children from 365 schools to the control group. The crude incidence of tuberculosis was 54·9 (95% CI 45·3—66·7) per 100 000 person-years in the BCG vaccination group and 72·7 (62·8—86·8) per 100 000 person-years in the control group. The overall vaccine effectiveness of a first BCG vaccination at school age was 25% (3—43%). In Salvador, where vaccine effectiveness was 34% (8—53%), vaccination of 381 children would prevent one case of tuberculosis and was cheaper than treatment. The frequency of adverse events was very low with only one axillary lymphadenitis and one ulcer greater than 1 cm in 11 980 BCG vaccinations.
Interpretation
Vaccination of school-age children without previous tuberculin testing can reduce the incidence of tuberculosis and could reduce the costs of tuberculosis control. Restriction of BCG vaccination to the first year of life is not in the best interests of the public nor of programmes for tuberculosis control.
Funding
UK Department for International Development, National Health Foundation.
The Lancet Infectious Disease
Apr 2012 Volume 12 Number 4 p255 – 354
http://www.thelancet.com/journals/laninf/issue/current
Comment
Cytomegalovirus vaccine: light on the horizon
Christoph Steininger
Preview
In The Lancet Infectious Diseases, Mohamed Kharfan-Dabaja and colleagues describe a phase 2, placebo-controlled trial1 of a therapeutic cytomegalovirus DNA vaccine (TransVax; Vical, San Diego, CA, USA) for patients undergoing haemopoietic stem-cell transplantation. Occurrence and duration of episodes of cytomegalovirus viraemia were significantly reduced when cytomegalovirus-seropositive patients, who are at highest risk for cytomegalovirus disease, received up to four doses of the vaccine. The results of this study are exciting, particularly in view of the frustrating failures of previous trials.
Articles
A novel therapeutic cytomegalovirus DNA vaccine in allogeneic haemopoietic stem-cell transplantation: a randomised, double-blind, placebo-controlled, phase 2 trial
Mohamed A Kharfan-Dabaja, Michael Boeckh, Marissa B Wilck, Amelia A Langston, Alice H Chu, Mary K Wloch, Don F Guterwill, Larry R Smith, Alain P Rolland, Richard T Kenney
Preview
We show proof of concept for an immunotherapeutic cytomegalovirus vaccine (TransVax) for clinically significant viraemia in the HSCT setting. The reported safety and efficacy outcomes support further development in a phase 3 trial, notwithstanding a lack of significant reduction in the use of cytomegalovirus-specific antiviral therapy compared with placebo in this phase 2 trial.
Medical Decision Making (MDM)
March–April 2012; 32 (2)
http://mdm.sagepub.com/content/current
Original Articles
Ellen A. Lipstein, William B. Brinkman, and Maria T. Britto
What Is Known about Parents’ Treatment Decisions? A Narrative Review of Pediatric Decision Making
Med Decis Making March–April 2012 32: 246-258, first published on October 3, 2011 doi:10.1177/0272989X11421528
Abstract
Background. With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process.
Objective. To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation.
Methods. Articles presenting original research on parent decision making were identified from MEDLINE (1966–6/2011), using the terms “decision making,” “parent,” and “child.” We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions.
Results. We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents’ preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child’s health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making.
Conclusions. Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions.
Nature
Volume 483 Number 7391 pp509-642 29 March 2012
http://www.nature.com/nature/current_issue.html
Nature | Editorial
Under surveillance
Global systems for monitoring threats from flu need a radical overhaul.
Imagine a global weather and climate forecasting system that collects data regularly in just a handful of countries, and takes measurements elsewhere only during extreme weather events. That is what today’s global flu-surveillance system mostly looks like.
The shortcomings of flu surveillance have long been recognized (see Nature 440, 6–7; 2006), but they are attracting renewed attention following the creation in labs of strains of the H5N1 avian influenza virus that can spread between mammals. The main cited public-health benefit of the research is that it will allow for monitoring for such mutations in the wild, and give a remote chance of containing an emerging pandemic.
It is certainly urgent to monitor wild flu strains for mutations that might make them transmissible between mammals (see Nature 482, 439; 2012). But as Malik Peiris, a flu virologist at the University of Hong Kong, says, detection of a breaking pandemic is “a very ambitious goal, and this is where vastly enhanced global surveillance is needed”.
“Current surveillance can barely identify threats, let alone track them.”
Current surveillance can barely identify threats, let alone track them. The precursor to the H1N1 virus that caused a pandemic in 2009 had been circulating worldwide for years in pigs, and the pandemic virus had been infecting humans in Mexico for months, before either was detected. That virus is also a reminder that threats come from many flu subtypes other than H5N1.
An analysis by Nature shows that timely, continued and representative global surveillance of the genetic sequences of flu isolates from pigs and poultry just isn’t happening (see page 520). From 2003 to 2011, most countries collected few or no sequences, and genetic surveillance of flu in pigs was and is almost non-existent. There is typically a lag of years between collection of viruses and the release of their sequences into public databases, so there are very few data on their recent evolution.
Yet the analysis gives hope that this situation could be rectified, given political will, modest funding and international coordination. Hong Kong has collected the most flu sequences from pigs after the United States and China, and most of those come from labs at the University of Hong Kong, including Peiris’s; this shows what a few dedicated centres can achieve. Similarly, the Influenza Genome Sequencing Project of the US National Institute of Allergy and Infectious Diseases, which was launched in 2004 and sequences whole flu genomes from isolates collected globally, accounts for around half of sequences generated worldwide. And in the past decade, many nations affected by H5N1 have greatly improved their surveillance, often despite limited resources and poor veterinary and health infrastructure.
More sequencing alone is not enough. Sequences tend currently to come in fits and starts, in response to an outbreak, one-off projects or as funding allows, and there is little sustained passive surveillance. Global, scientific and representative sampling is needed, from multiple outbreaks and diverse populations, taking into account risk factors such as the size of livestock populations, husbandry practices and proximity to waterfowl reservoirs.
Funding is not the only problem. Few countries, for example, compensate for culled animals to encourage farmers to report outbreaks; and some might conceal, or not actively look for, flu infections for trade reasons. Nations can be reluctant to share viral isolates if they do not get anything in return, although the World Health Organization’s Pandemic Influenza Preparedness Framework, published last year, should help to ensure that they do get appropriate benefits, including access to vaccines.
Surveillance makes sense even without the promise of tracking a pandemic. Detecting outbreaks in livestock allows control through culling or vaccination to avoid crippling losses, and limits the opportunities for viruses to mutate, outpace vaccines and possibly turn pandemic. Surveillance also generates crucial data for epidemiology and drug-resistance monitoring, yet it remains a low priority. Sequencing costs can fall all they like, but without greater, and more sustained, routine surveillance efforts, there will be few samples to sequence.
Comment
H5N1 surveillance: Shift expertise to where it matters
Tools and training for responding to diseases such as avian flu must relocate to countries where infections are most likely to emerge, says Jeremy Farrar.
H5N1: How to track a flu virus
Four experts pinpoint ways to improve monitoring of H5N1 avian influenza in the field.
PLoS One
[Accessed 31 March 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date
Increased Incidence and Clinical Picture of Childhood Narcolepsy following the 2009 H1N1 Pandemic Vaccination Campaign in Finland
Markku Partinen, Outi Saarenpää-Heikkilä, Ismo Ilveskoski, Christer Hublin, Miika Linna, Päivi Olsén, Pekka Nokelainen, Reija Alén, Tiina Wallden, Merimaaria Espo, Harri Rusanen, Jan Olme, Heli Sätilä, Harri Arikka, Pekka Kaipainen, Ilkka Julkunen, Turkka Kirjavainen
PLoS ONE: Research Article, published 28 Mar 2012 10.1371/journal.pone.0033723
Abstract
Background
Narcolepsy is a rare neurological sleep disorder especially in children who are younger than 10 years. In the beginning of 2010, an exceptionally large number of Finnish children suffered from an abrupt onset of excessive daytime sleepiness (EDS) and cataplexy. Therefore, we carried out a systematic analysis of the incidence of narcolepsy in Finland between the years 2002–2010.
Methods
All Finnish hospitals and sleep clinics were contacted to find out the incidence of narcolepsy in 2010. The national hospital discharge register from 2002 to 2009 was used as a reference.
Findings
Altogether 335 cases (all ages) of narcolepsy were diagnosed in Finland during 2002–2009 giving an annual incidence of 0.79 per 100 000 inhabitants (95% confidence interval 0.62–0.96). The average annual incidence among subjects under 17 years of age was 0.31 (0.12–0.51) per 100 000 inhabitants. In 2010, 54 children under age 17 were diagnosed with narcolepsy (5.3/100 000; 17-fold increase). Among adults ≥20 years of age the incidence rate in 2010 was 0.87/100 000, which equals that in 2002–2009. Thirty-four of the 54 children were HLA-typed, and they were all positive for narcolepsy risk allele DQB1*0602/DRB1*15. 50/54 children had received Pandemrix vaccination 0 to 242 days (median 42) before onset. All 50 had EDS with abnormal multiple sleep latency test (sleep latency <8 min and ≥2 sleep onset REM periods). The symptoms started abruptly. Forty-seven (94%) had cataplexy, which started at the same time or soon after the onset of EDS. Psychiatric symptoms were common. Otherwise the clinical picture was similar to that described in childhood narcolepsy.
Interpretation
A sudden increase in the incidence of abrupt childhood narcolepsy was observed in Finland in 2010. We consider it likely that Pandemrix vaccination contributed, perhaps together with other environmental factors, to this increase in genetically susceptible children.
AS03 Adjuvanted AH1N1 Vaccine Associated with an Abrupt Increase in the Incidence of Childhood Narcolepsy in Finland
Hanna Nohynek, Jukka Jokinen, Markku Partinen, Outi Vaarala, Turkka Kirjavainen, Jonas Sundman, Sari-Leena Himanen, Christer Hublin, Ilkka Julkunen, Päivi Olsén, Outi Saarenpää-Heikkilä, Terhi Kilpi
PLoS ONE: Research Article, published 28 Mar 2012 10.1371/journal.pone.0033536
PLoS Medicine
(Accessed 31 March 2012)
http://www.plosmedicine.org/article/browse.action?field=date
Improving Ethical Review of Research Involving Incentives for Health Promotion
Alex John London, David A. Borasky, Anant Bhan, for the Ethics Working Group of the HIV Prevention Trials Network Policy Forum, published 27 Mar 2012
doi:10.1371/journal.pmed.1001193
Summary Points
– Advances in behavioral economics are driving efforts to use material or financial incentives to promote health-related behavior in international development, public health, and clinical medicine.
– Current ethical frameworks for human research assume that material or financial incentives are provided to participants either as compensation for their time and expenses, or as an inducement to participate in research.
– We argue that some common concerns about using incentives to increase participation in research, such as that attractive incentives will undermine participant autonomy, are misplaced when incentives are used to overcome economic obstacles or a lack of effective motivation, and when recipients are incentivized to engage in health-related behaviors or practices with which they are already familiar and which they regard as beneficial or worthwhile.
– We offer additional guidance to research ethics committees aimed at improving the evaluation of research in which incentives are used as an intervention intended to promote healthy behavior.
PLoS Neglected Tropical Diseases
March 2012
http://www.plosntds.org/article/browseIssue.action
Editorial
Texas and Mexico: Sharing a Legacy of Poverty and Neglected Tropical Diseases
Peter J. Hotez, Maria Elena Bottazzi, Eric Dumonteil, Jesus G. Valenzuela, Shaden Kamhawi, Jaime Ortega, Samuel Ponce de Leon Rosales, Miguel Betancourt Cravioto, Roberto Tapia-Conyer
A consortium of institutions from Texas and Mexico has launched a new initiative for developing vaccines and other tools to control and eliminate neglected tropical diseases in Mesoamerica.
PLoS Neglected Tropical Diseases
March 2012
http://www.plosntds.org/article/browseIssue.action
Policy Platform
Assessing the Potential of a Candidate Dengue Vaccine with Mathematical Modeling
WHO-VMI Dengue Vaccine Modeling Group
Science
30 March 2012 vol 335, issue 6076, pages 1533-1660
http://www.sciencemag.org/current.dtl
Policy Forum
Research Ethics
To Protect Human Subjects, Review What Was Done, Not Proposed
Robert Klitzman and Paul S. Appelbaum
Science 30 March 2012: 1576-1577.
Summary
The Advance Notice of Proposed Rulemaking (ANPRM) released in 2011 by the U.S. Department of Health and Human Services (HHS) (1) recommends many important changes to federal regulations on protection of human research subjects. Perhaps most important, through the 74 questions it poses, it offers the opportunity to rethink approaches to research oversight. The current regulatory model of prospective review, based on what researchers say they plan to do, focuses the attention of Institutional Review Boards (IRBs, which must approve proposed research) and researchers on perfecting protocols and consent forms rather than interacting with subjects. Such a regulatory model may discourage innovation in human subjects protection. In contrast, we describe how a system based on retrospective, audit-like review of a subset of projects could stimulate assessment of the effectiveness of current approaches and the development of creative alternatives, with efficiencies for all concerned
Tropical Medicine & International Health
April 2012 Volume 17, Issue 4 Pages 405–530
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue
Child Health
Improved equity in measles vaccination from integrating insecticide-treated bednets in a vaccination campaign, Madagascar (pages 430–437)
James L. Goodson, Manisha A. Kulkarni, Jodi L. Vanden Eng, Kathleen A. Wannemuehler, Annett H. Cotte, Rachelle E. Desrochers, Bakolalao Randriamanalina and Elizabeth T. Luman
Article first published online: 24 JAN 2012 | DOI: 10.1111/j.1365-3156.2011.02953.x
[Free access]
Abstract
Objective To evaluate the effect of integrating ITN distribution on measles vaccination campaign coverage in Madagascar.
Methods Nationwide cross-sectional survey to estimate measles vaccination coverage, nationally, and in districts with and without ITN integration. To evaluate the effect of ITN integration, propensity score matching was used to create comparable samples in ITN and non-ITN districts. Relative risks (RR) and 95% confidence intervals (CI) were estimated via log-binomial models. Equity ratios, defined as the coverage ratio between the lowest and highest household wealth quintile (Q), were used to assess equity in measles vaccination coverage.
Results National measles vaccination coverage during the campaign was 66.9% (95% CI 63.0–70.7). Among the propensity score subset, vaccination campaign coverage was higher in ITN districts (70.8%) than non-ITN districts (59.1%) (RR = 1.3, 95% CI 1.1–1.6). Among children in the poorest wealth quintile, vaccination coverage was higher in ITN than in non-ITN districts (Q1; RR = 2.4, 95% CI 1.2–4.8) and equity for measles vaccination was greater in ITN districts (equity ratio = 1.0, 95% CI 0.8–1.3) than in non-ITN districts (equity ratio = 0.4, 95% CI 0.2–0.8).
Conclusion Integration of ITN distribution with a vaccination campaign might improve measles vaccination coverage among the poor, thus providing protection for the most vulnerable and difficult to reach children.
Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 18, Pages 2805-2914 (16 April 2012)
Regular Papers
Health outcomes of interest for evaluation in the Post-Licensure Rapid Immunization Safety Monitoring Program
Original Research Article
Pages 2824-2830
Tracy A. Lieu, Michael D. Nguyen, Robert Ball, David B. Martin
Abstract
Active vaccine safety surveillance systems commonly use computerized diagnostic codes to identify potential health outcomes of interest. Evidence concerning the accuracy of these codes is variable, and few systematic reviews are available. This project’s aim was to select a list of health outcomes of interest most suitable for evaluation in the Food and Drug Administration’s Post-Licensure Rapid Immunization Safety Monitoring (PRISM) program. We conducted an expert elicitation process to develop the list. A comprehensive list of potential health outcomes of interest was formed based on input from a wide variety of vaccine safety experts. We then selected five panelists with senior leadership roles in vaccine safety from both within and outside the FDA. We elicited the experts’ recommendations via a structured, iterative process that included an Internet-assisted telephone conference call and formal voting procedures. The expert panelists identified several criteria as important in their choices, including clinical severity, public health importance, rare or uncommon incidence, relevance to two or more vaccines, and historical association with vaccines. The list of 24 outcomes chosen by the experts and refined by the FDA included ten neurologic outcomes, two circulatory system outcomes, and two musculoskeletal outcomes. The PRISM program plans to conduct a set of evidence reviews on the positive predictive value and other characteristics of existing computerized codes and algorithms to identify these health outcomes of interest.
Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 18, Pages 2805-2914 (16 April 2012)
Regular Papers
Economic analysis for evidence-based policy-making on a national immunization program: A case of rotavirus vaccine in Thailand
Original Research Article
Pages 2839-2847
Charung Muangchana, Arthorn Riewpaiboon, Suchada Jiamsiri, Piyanit Thamapornpilas, Porpit Warinsatian
Abstract
Severe diarrhea caused by rotavirus is a health problem worldwide, including Thailand. The World Health Organization has recommended incorporating rotavirus vaccination into national immunization programs. This policy has been implemented in several countries, but not in Thailand where the mortality rate is not high. This leads to the question of whether it would be cost-effective to implement such a policy. The Thai National Vaccine Committee, through the Immunization Practice Subcommittee, has conducted an economic analysis. Their study aimed to estimate the costs of rotavirus diarrhea and of a rotavirus vaccination program, and the cost-effectiveness of such a program including budget impact analysis. The study was designed as an economic evaluation, employing modeling technique in both provider and societal perspectives. A birth cohort of Thai children in 2009 was used in the analysis, with a 5-year time horizon. Costs were composed of cost of the illness and the vaccination program. Outcomes were measured in the form of lives saved and DALYs averted. Both costs and outcomes were discounted at 3%. The study found the discounted number of deaths to be 7.02 and 20.52 for vaccinated and unvaccinated cohorts, respectively (13.5 deaths averted). Discounted DALYs were 263.33 and 826.57 for vaccinated and unvaccinated cohorts, respectively (563.24 DALYs averted). Costs of rotavirus diarrhea in a societal perspective were US$6.6 million and US$21.0 million for vaccinated and unvaccinated cohorts, respectively. At base case, the costs per additional death averted were US$5.1 million and US$5.7 for 2-dose and 3-dose vaccines, respectively, in a societal perspective. Costs per additional DALYs averted were US$128,063 and US$142,144, respectively. In a societal perspective, with a cost-effectiveness threshold at 1 GDP per capita per DALYs averted, vaccine prices per dose were US$4.98 and US$3.32 for 2-dose and 3-dose vaccines, respectively; in a provider perspective, they were US$2.90 and US$1.93. One-way and probabilistic sensitivity analyses were included. The budget required for vaccine purchase was calculated for all scenarios.
Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 18, Pages 2805-2914 (16 April 2012)
Regular Papers
Acceptance of vaccination during pregnancy: Experience with 2009 influenza A (H1N1) in the Netherlands
Original Research Article
Pages 2892-2899
Alies van Lier, Anneke Steens, José A. Ferreira, Nicoline A.T. van der Maas, Hester E. de Melker
Abstract
Objectives
In 2009, the Dutch government advised pregnant women to get vaccinated against influenza A (H1N1). A study was set up to gain insight into vaccination coverage and reasons why pregnant women seek vaccination or not.
Methods
We invited 14,529 pregnant women to complete an internet survey on vaccination during pregnancy in general and against 2009 influenza A (H1N1). Differences in background characteristics between unvaccinated and vaccinated women were investigated. Prediction analyses were carried out to determine which survey statement had the greatest impact on vaccination status or intention to get vaccinated during pregnancy.
Results
Of the 2993 included respondents, 63% reported to be vaccinated against 2009 influenza A (H1N1). Vaccination coverage was higher among older birth cohorts, women who had been pregnant before, women with underlying medical conditions, and women who reported no defined ‘life philosophy’. Protection of the child (after birth), the government’s advice and possible harmful effects of the vaccine for the unborn child had the greatest predictive value for vaccination status. With regards vaccination during future pregnancies, 39% had a positive intention to obtain vaccination and 45% were neutral. The government’s advice was the strongest predictor for intention. Furthermore, women expressed concern over lack of sufficient knowledge about vaccine safety.
Conclusions
A considerable number of pregnant women in the Netherlands reported to be vaccinated against 2009 influenza A (H1N1). The challenge for the government in the future will be to provide pregnant women and health care professionals with sufficient and clear information about disease severity and the benefits and safety of vaccination.
Editor’s Notes:
– Email Summary: Vaccines: The Week in Review is available as a weekly email summary, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.
– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_24 March 2012
– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
Joint news note: How to meet 111 million children in four days – West and Central Africa Polio Campaign Enters Decisive Phase
Global Polio Eradication Initiative (GPEI), WHO, UNICEF
“Health Ministries, UN agencies and communities are uniting with tens of thousands of volunteer immunizers over four days to go door-to-door and hut to hut for a vaccination campaign against polio in 20 African countries starting on 23 March. Across West and Central Africa, over 111.1 million children below the age of five are expected to be vaccinated through this campaign. Nigeria, the only polio endemic country in Africa, aims to get two drops of the oral vaccine into the mouths of 57.7 million children. Nineteen other countries, which are at risk of re-infection, are stepping up efforts to reach nearly 53.3 million children. This gigantic exercise represents a dramatic effort of will by governments and partners, and relies on hundreds of thousands of health workers and volunteers who will be administering the drops to all children under the age of five, irrespective of their previous immunization status…” WHO Regional Director for Africa Dr Luis Sambo said, “The upcoming campaign in West and Central Africa will aim to cover all children, immunized or not, in order to boost their protection levels and deprive the virus of the fertile seedbed on which it depends for survival. This exercise should bring us closer to reaching our goal of interrupting wild polio virus transmission in our region in 2012.”
The Global Polio Eradication Initiative (GPEI) “is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, and supported by Bill & Melinda Gates Foundation (BMGF). Since 1988 (the year the GPEI was launched), the incidence of polio has been reduced by more than 99 percent. At the time, more than 350,000 children were paralyzed every year in more than 125 endemic countries. In 2011, 650 cases have been reported worldwide. Only three countries remain endemic: Afghanistan, Nigeria and Pakistan.
http://www.unicef.org/media/media_62054.html
WHO: Meningococcal Disease – situation in the African Meningitis Belt
23 March 2012
From 1 January to 11 March (epidemiologic week 10), outbreaks of meningococcal disease have been reported in 15 districts in Benin, Burkina Faso, Chad, Côte d’Ivoire and Ghana. These outbreaks have been detected as part of the enhanced surveillance in the African Meningitis Belt conducted in 14 countries where a total of 6,685 suspected meningitis cases including 639 deaths have been reported… The countries are responding to these outbreaks by enhancing surveillance, reinforcing treatment of patients and implementing mass vaccination campaigns. The International Coordinating Group (ICG) on Vaccine Provision for Epidemic Meningitis Control has approved the release of vaccines to respond. The ICG constitutes of UNICEF, Médecins Sans Frontières (MSF), International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO. WHO continues to monitor the epidemiological situation closely, in collaboration with partners and Ministry of Health in the affected countries. The supply of the appropriate vaccine to respond to W135 outbreaks is presently limited, and WHO and UNICEF “are working closely with the vaccine manufacturers to ensure that this stock is maintained and adapted to the evolving outbreak situation.”
New research found high incidence rates and deaths meningococcal disease in first-ever analysis of the disease impacts in Latin America. The work was coordinated by the Sabin Vaccine Institute in partnership with the Pan American Health Organization (PAHO), the International Vaccine Access Center at Johns Hopkins University (JHU’s IVAC) and CDC. The study “found a need for improved surveillance and better understanding of meningococcal epidemiology and information on costs to help devise meningitis vaccination programs.” Dr. Ciro de Quadros, Executive Vice President of the Sabin Vaccine Institute, said, “Clearly, meningitis is a real health and economic burden in Latin America. Too many children are debilitated or die from this serious disease, yet it is preventable by vaccines. Our new research proves that we need to improve our strategies to fight meningococcal disease.” Dr. de Quadros spoke at the conclusion of the first Regional Meningococcal Symposium, convened by the Sabin Vaccine Institute and the Pan American Health Organization (PAHO) held March 19 and 20 in Buenos Aires. The meeting “brought together more than 150 researchers, vaccine experts, economists and others to evaluate the extent and cost of meningococcal disease and what obstacles impede its prevention through vaccination.”
Tuberculosis Vaccines: A Strategic Blueprint for the Next Decade
Supplement to Tuberculosis Vol. 92/S1 (2012) S1–S35 ELSEVIER
http://www.tuberculosisjournal.com/supplements
Co-Editors: Michael J. Brennan and Jelle Thole
Contents
EDITORIALS
A New TB Vaccine Blueprint
P.J. Brennan S1
This special Supplement to Tuberculosis is distinguished by the presentation of the important document Tuberculosis Vaccines: A Strategic Blueprint for the Next Decade. This roadmap for the future of vaccine development against tuberculosis was preceded by the former Blueprint for Tuberculosis Vaccine Development arising from a workshop held in the Washington DC area under the chairmanship of Dr. Barry Bloom in 1998 and A Framework for the Development, Clinical Study and Introduction of Improved TB Vaccines for the Global Community, developed by the Global Forum on TB Vaccines Research and Development at WHO Headquarters, Geneva, June 2001 organized by Dr. Uli Fruth and Dr. Michael Brennan…
Transforming Biomedical Research to Develop Effective TB Vaccines: The Next Ten Years
C.F. Sizemore, A.S. Fauci S2
Planning in the Context of a Virtuous Cycle for Tuberculosis Vaccine Development
P.M. Small S4
THE TB VACCINE BLUEPRINT
Tuberculosis Vaccines: A Strategic Blueprint for the Next Decade
M.J. Brennan, J. Thole (Co-Editors) S6
OPINION PIECES: OPINIONS AND PERSPECTIVES ON THE TB VACCINE BLUEPRINT
Creativity in tuberculosis research and discovery
D. Young, F.A.W. Verreck S14
Ten challenges for TB biomarkers
T.H.M. Ottenhoff, J.J. Ellner, S.H.E. Kaufmann S17
Clinical trials of TB vaccines: Harmonization and cooperation
H. Mahomed, P.B. Fourie S21
Rational approach to selection and clinical development of TB vaccine candidates
L. Barker, L. Hessel, B. Walker S25
Bridging the gap: Engaging researchers and advocates to build support for TB vaccine research and development
M. Kennell, J. Woolley S30
The blueprint for vaccine research & development: Walking the path for better TB vaccines
C. Lienhardt, U. Fruth, M. Greco S33
The Global Fund to Fight AIDS, Tuberculosis and Malaria recognized TB Day, noting its ten years of sustained support involving some US$2 billion invested in more than 100 countries since 2002. Gabriel Jaramillo, General Manager of the Global Fund, said, “The world is currently seeing a fall in TB incidence and both national and international efforts are, together, turning the tide on the epidemic. After many years of using the same diagnosis method we have come to a breakthrough with a method that gives the results within hours as opposed to months.” The announcement noted that “in 2011 the Global Fund provided an estimated 84 percent of international TB financing, complementing the financing by the governments of the countries affected by TB. With ongoing support for a revitalised, streamlined and more efficient Global Fund, the prospects are encouraging.” http://www.theglobalfund.org/en/mediacenter/pressreleases/2012-03-23_World_TB_Day_10_years_of_sustained_Global_Fund_support/
Statement: NIAID – World TB Day
Christine F. Sizemore, Ph.D., Richard E. Hafner, M.D., and Anthony S. Fauci, M.D., National Institute of Allergy and Infectious Diseases, National Institutes of Health
March 24, 2012
The theme of World TB Day 2012, “Eliminate TB in My Lifetime”, boldly challenges us to improve and expand tuberculosis (TB) control and related research efforts that recently have led to slowly declining rates of illness and death from this ancient disease. Even with the technological advances available in the early part of the 21st century, the elimination of TB will be an enormous task. TB claimed 1.45 million lives worldwide in 2010, according to the World Health Organization. An estimated one-third of the world’s population is latently infected with the bacterium that causes TB, meaning they experience no symptoms but are at risk for developing active disease. Among people with HIV/AIDS, TB is a major co-infection and the leading cause of death, responsible for killing approximately 350,000 HIV-infected individuals in 2010. The interface of the TB and HIV epidemics and the continuing emergence of drug-resistant TB are serious threats to achieving TB control worldwide. Although recent progress against the disease is heartening, the control and eventual elimination of TB will require a long-term, multifaceted commitment from the global health and research communities.
TB control and the care of TB-infected people are being improved by making existing TB interventions more accessible and affordable, as well as simpler to administer. Comprehensive TB control can be markedly enhanced, however, with better medical tools. To transform the field, we must address long-standing challenges in TB research, such as identifying the factors involved in the immune control of latent TB infection that allow 90 percent of otherwise healthy TB-infected individuals to never develop active disease. We need to use novel scientific tools and apply modern approaches to answer this and other fundamental questions. High-throughput sequencing, for example, can efficiently analyze the genomes of drug-sensitive and drug-resistant TB strains and help us to identify genetic markers useful for developing tests to quickly detect resistance to anti-TB drugs. A systems biology approach helps us make sense of the complex networks of biological responses in the TB bacterium on the part of the human host so we can better understand the disease and give direction to vaccine and drug discovery projects…
An important milestone in modernizing TB control was the WHO Global Tuberculosis Control Report 2011, which for the first time included biomedical research as a critical component of the global fight against TB. Integrating biomedical research into the framework of global TB control is an essential component of the WHO report as well as other recent strategic documents developed by the TB research community, including An International Roadmap for Tuberculosis Research and the updated Strategic Blueprint for TB vaccines. These collaborative efforts to identify gaps and opportunities in biomedical research are critical for developing new interventions and control strategies…
Eliminating TB in a generation, while an ambitious goal, can become a reality through the continued commitment and collaboration of the key stakeholders in biomedical research and global health. To date, these efforts have provided the knowledge and novel methodologies to develop a robust pipeline of new TB countermeasures. Fostering even closer integration of biomedical research with the TB control community will help assure that new medical tools are applied in the most effective manner to make TB a disease of the past.
The MMWR Weekly for March 23, 2012 / Vol. 61 / No. 11 includes:
– World TB Day — March 24, 2012
March 24 is World TB Day, which commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes tuberculosis (TB), a leading cause of death from infectious disease worldwide. World TB Day provides an opportunity to raise awareness about TB-related problems and solutions and to support worldwide TB control efforts. The U.S. slogan for the 2012 observance is “Stop TB in My Lifetime”.
Despite the continued decline in U.S. TB cases and rates since 1993, the 2011 rate of 3.4 per 100,000 population has not achieved the 2010 goal of TB elimination (less than one case per 1,000,000) established in 1989 (1). Although TB cases and rates decreased among foreign-born and U.S.-born persons in 2011, foreign-born persons and U.S.-born racial/ethnic minorities continue to be affected disproportionately (2).
CDC is committed to a world free of TB. Progress toward TB elimination in the United States will require ongoing surveillance and improved TB control and prevention activities. Sustained focus on domestic TB control activities and further support of international TB control initiatives are needed to address persistent disparities between whites and nonwhites and between U.S.-born and foreign-born persons. Additional information about World TB Day and CDC’s TB elimination activities is available at http://www.cdc.gov/tb/events/worldtbday.
– Trends in Tuberculosis — United States, 2011
– Tuberculosis Outbreak Associated with a Homeless Shelter — Kane County, Illinois, 2007–2011
– Progress Toward Global Polio Eradication — Africa, 2011
– Announcement: International Course in Applied Epidemiology
The Weekly Epidemiological Record (WER) 23 March 2012, vol. 87, 12 (pp 109–116) includes: Progress towards global polio eradication – status of wild poliovirus circulation in Africa, 2011; Monthly report on dracunculiasis cases, January 2012
The Board of Executive Directors of the World Bank confirmed the three nominees who will be considered for the position of President of the World Bank:
– Jim Yong Kim, a US national and President of Dartmouth College, New Hampshire;
– José Antonio Ocampo, a Colombian national and Professor at Columbia University, New York; and
– Ngozi Okonjo-Iweala, a Nigerian national and Coordinating Minister of the Economy and Minister of Finance, Nigeria.
The Executive Directors said it will conduct formal interviews of the three candidates in Washington, D.C., during the following weeks, with the expectation of selecting the new President by consensus by the 2012 Spring Meetings.
U.S. President Obama announced that the United States is nominating Dr. Jim Yong Kim to be President of the World Bank, describing him as “a leader who has devoted his career to improving the lives of people in developing countries and championing the cause of global health.” President Obama said, “Jim has spent more than two decades working to improve conditions in developing countries around the world. The World Bank is one of the most powerful tools we have to reduce poverty and raise standards of living around the globe, and Jim’s personal experience and years of service make him an ideal candidate for this job.”
The announcement noted that Jim Yong Kim has served as the President of Dartmouth College since 2009. During this time, Dr. Kim has launched the Dartmouth Center for Health Care Delivery Science, which is the first of its kind in establishing an international network of researchers and practitioners to design, implement, and scale new models of high-quality low-cost care. He has also instituted the National College Health Improvement Project. Prior to that, he held professorships in medicine and social medicine at Harvard Medical School and served as the director of the Francois-Xavier Bagnoud Center for Health and Human Rights. He is a co-founder of Partners In Health and a pioneer in the treatment of multi-drug-resistant tuberculosis.
As Director of the World Health Organization’s Department of HIV/AIDS, Dr. Kim launched the “3 by 5” initiative, which sought to treat 3 million patients living with HIV and is regarded today as one of the most successful modern global health initiatives. He was elected to the National Academy of Sciences’ Institute of Medicine in 2004, and his work in the field of global health has earned him widespread recognition, including a MacArthur “Genius” Fellowship, selection as one of TIME Magazine’s “100 Most Influential People in the World,” and numerous other awards.
He has published extensively over the past two decades, authoring and co-authoring articles for leading academic and scientific journals and contributing to many books on public health issues. Born in Seoul, Korea, President Kim moved to the United States at the age of five. He graduated magna cum laude from Brown University, earned a medical degree from Harvard Medical School and a doctorate in anthropology from Harvard University.
Statement: Health Metrics Network/World Health Organization welcome birth registration resolution of UN Human Right Council
23 March 2012
The Health Metrics Network (HMN) and WHO welcome adoption by the United Nations Human Rights Council of a resolution on birth registration. The resolution, entitled “Birth registration and the right of everyone to recognition everywhere as a person before the law”, seeks action for universal registration at birth of all individuals, in order to reduce the high number of individuals throughout the world who are not registered and may never be registered during their lifetime. HMN and WHO participated in consultations on the draft resolution and provided technical input.
WHO estimates that 40 million, or approximately one third of, births are not registered each year. Dr Flavia Bustreo, WHO Assistant Director-General for Family, Women’s and Children’s Health, commented, “Lack of birth registration not only impacts the enjoyment of rights to which all persons are entitled, but may also hinder access to a range of essential services, including health care. Moreover, without data on births, national governments will not have credible evidence as a basis for planning, implementing and monitoring public health policies and programmes, and the global community will have less facility in reaching internationally-agreed development goals. The Council’s resolution is therefore important and timely, and will provide further incentive for countries to ensure birth registration for all children.”
http://www.who.int/mediacentre/news/statements/2012/HMN_birth_registration/en/index.html
UN HRC: Action on Resolution on Birth Registration and the Right of Everyone to Recognition Everywhere as a Person Before the Law
“In a resolution (A/HRC/19/L.24) regarding birth registration and the right to everyone to recognition everywhere as a person before the law, adopted without a vote, the Council expresses:
– concern at the high number of persons throughout the world whose birth is not registered;
– calls upon States to establish or strengthen existing governmental institutions responsible for birth registration and the preservation and security of such records, and to ensure they have sufficient resources to fulfil their mandate;
– also calls upon States to ensure free birth registration, including free or low-fee late birth registration, by means of universal, accessible, simple, expeditious and effective registration procedures without discrimination of any kind;
– urges States to identify and remove physical, administrative and any other barriers that impede access to birth registration, including late registration, paying due attention to, among others, those barriers relating to poverty, disability, multicultural contexts and persons in vulnerable situations; and
– encourages States to request technical assistance, if required, from relevant United Nations bodies, agencies, funds and programmes in order to fulfil their obligation to undertake birth registration as a means to respect the right of everyone to be recognized everywhere as a person before the law.
“Mexico, introducing draft resolution L.24, said the right of all individuals to recognition as a person before the law, which was enshrined in a significant number of international instruments, was a fundamental right. Its importance was reflected in the prohibition of its derogation as per article 4 of the International Covenant on Civil and Political Rights. One of the most effective ways of doing this was birth registration, which involved the official recognition of the existence of a human being and promoted a culture of effective protection. Worldwide, 51 million children were not registered every year. Birth registration was important for building effective statistics, which engendered the deployment of effective development programmes and the attainment of the Millennium Development Goals.
The resolution document is available here: http://daccess-ods.un.org/access.nsf/Get?Open&DS=A/HRC/19/L.24&Lang=E
http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=12004&LangID=E
Statement: WHO welcomes launch of UN Commission on Life-Saving Commodities for Women and Children
23 March 2012
The Commission “has one critical objective: to make affordable and effective medicines and health supplies available to the women and children who need them most. Worldwide, 358,000 women currently die during pregnancy and childbirth every year. Every year an estimated 7.6 million children die before their fifth birthday because of preventable and treatable conditions…The major obstacles are inefficient procurement and supply systems, poor partner collaboration, and lack of crucial reproductive, maternal, newborn and child health commodities on national essential medicines lists. Solving bottlenecks in these areas would radically help country health systems function better, enabling more people have access to vital health services.”
“Drawing on the best evidence available today, the Commission will recommend changes in the way life-saving commodities like oxytocin, misoprostol, magnesium sulfate, zinc and amoxicillin are made available, distributed and used. The Commission will also review and make recommendations regarding essential but underutilized contraceptives, like the female condom, hormonal implants, and emergency contraceptives.
“Co-chairs President Goodluck Jonathan of Nigeria and Prime Minister Jens Stoltenberg of Norway, together with a wide range of Commissioners including private sector CEOs, NGO representatives, government ministers, representatives from donor organizations, social media leaders, and other experts “will use high-level advocacy to translate technical knowledge into political action.” UNICEF Executive Director Anthony Lake and UNFPA Executive Director Babatunde Osotimehin will serve as Vice-Chairs. The Commission is working in support of Every Woman, Every Child – the unprecedented global movement spearheaded by UN Secretary-General Ban Ki-moon to save 16 million lives by 2015. It aims to finalize its recommendations for action by June 2012, and release its final report shortly afterwards.
WHO “actively contributed to the development of background materials for the commission. The Organization will continue to play an active role in following up on its forthcoming recommendations in country and regional settings, providing policy advice to governments. WHO will focus on regulatory processes for commodities, support prequalification of medicines and other health supplies, and contribute to negotiations of public sector price for these commodities.”
http://www.who.int/reproductivehealth/news/un_commission/en/index.html
Twitter Watch [accessed 24 March 2012 – 16:55]
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.
GAVI Alliance @GAVIAlliance
Delivering on Canada’s Musoka Initiative – Canadian MPs trip to Tanzania with @GAVIAlliance & RESULTS_Canada. Watch: http://ht.ly/9Oylm
3:45 PM – 24 Mar 12
USAID Global Health @USAIDGH
1.4M people die of #TB each year #WorldTBDay http://ow.ly/9Hrmq
2:50 PM – 24 Mar 12
The Global Fund @globalfundnews
Today is World #TB Day! Here’s everything you need to know plus some amazing stories: http://www.theglobalfund.org/en/events/2012_World_TB_Day/
2:06 PM – 24 Mar 12
PATH @PATHtweets
RT @SciSpeaksBlog Advocates announce Civil Society Declaration on #TB in Africa http://bit.ly/GMG2i2 #worldtbday
1:20 PM – 24 Mar 12
Partners In Health @PIH
Today is #WorldTBDay. Learn more about @PIH‘s work to treat & prevent this deadly but curable disease: http://ow.ly/9R6T0
12:04 PM – 24 Mar 12
WHO @WHO
Better data on births allows countries to better plan and monitor success of public health policies and programmes. http://goo.gl/m67qi
5:31 PM – 23 Mar 12
The Global Fund @globalfundnews
Powerful story of overcoming #TB. Same treatment the #GlobalFund has provided for 8.6m ppl in +100 countries http://bit.ly/GCRTP2
3:48 PM – 23 Mar 12
Partners In Health @PIH
BREAKING NEWS UPDATE: @BarackObama nominates @PIH Co-Founder & @Dartmouth Pres. Jim Kim to head @WorldBank: http://ow.ly/9Q4mz
11:08 AM – 23 Mar 12
Gates Foundation@gatesfoundation
.@UN backed effort aims to vaccinate 111 million children against #polio in four days: http://gates.ly/GTqLJZ
10:05 AM – 23 Mar 12
EndPolioNow @EndPolioNow
Eradicating polio among govt’s top priorities, says Pakistan President Asif Ali Zardari. http://bit.ly/GIfEY3
5:23 PM – 22 Mar 12
PAHO/WHO Equity @eqpaho
Conceptual Issues Related to Health Systems Research to Inform a WHO Global Strategy on Health Systems Research http://bit.ly/GHPhRP
Retweeted by Amanda Glassman
12:14 PM – 21 Mar 12
ECDC @ECDC_EU
#Measles keeps spreading in Ukraine. Without effective measures, transmission expected to continue during #EURO2012 cuphttp://bit.ly/GD18Pm
10:53 AM – 21 Mar 12
Annals of Internal Medicine
March 20, 2012; 156 (6)
http://www.annals.org/content/current
Ideas and Opinions
Engineered H5N1: A Rare Time for Restraint in Science
Thomas V. Inglesby
Ann Intern Med March 20, 2012 156:460-462; published ahead of print January 26, 2012,
Abstract
Two scientific teams have recently engineered the H5N1 virus to make it readily transmissible between ferrets. Given that ferrets are considered the most reliable animal surrogate for human influenza infection, the newly engineered H5N1 strain is probably transmissible between humans as well. The potential consequences of an engineered human-transmissible H5N1 strain are stunning. Although seasonal flu infects as much as 20% of the world’s population—more than 1 billion persons—each year, only a small fraction of those with seasonal flu dies, most often the oldest, youngest, and sickest. If the newly engineered strain were to escape the laboratory (either by design or by accident) and spread as widely as seasonal flu with anywhere near the current confirmed H5N1 human case-fatality rate, it could endanger the lives of hundreds of millions of persons. The possible benefits of this work do not justify taking such risks. As clinicians, we have a stake in this issue with our responsibilities for the diagnosis and treatment of influenza. We embrace the principle of free and open exchange of scientific information, but we also believe in the principle of “first, do no harm.” These 2 principles have come into a moment of rare conflict. It seems most reasonable and prudent to request that the involved scientific community and its institutions exercise restraint by restricting dissemination of the experimental results and discontinuing work on the engineered H5N1 strains. If a highly compelling case is made for continued work on this strain despite the risks, the work should be controlled and should merit the greatest scrutiny.
Laboratory Creation of a Highly Transmissible H5N1 Influenza Virus: Balancing Substantial Risks and Real Benefits
Andrew T. Pavia
Ann Intern Med March 20, 2012 156:463-465; published ahead of print January 26, 2012,
Abstract
Controversy erupted when influenza researchers announced that they had created an H5N1 influenza virus that was transmissible between ferrets. The controversy escalated when the National Science Advisory Board for Biosecurity (NSABB) recommended that the work be published but recommended significant voluntary redactions. The responses to the NSABB action and to the research itself have been polarized. A readily transmitted H5N1 virus could be extraordinarily lethal; therefore, the risk for accidental release is significant, and deliberate misuse of the data to create a biological weapon is possible. However, the knowledge gained by these and future experiments under appropriate safeguards is likely to allow critical understanding of influenza transmission and virulence. It would be irresponsible to adopt either extreme solution: to prevent and censor the research or to allow unlimited distribution without careful review by an independent group, such as the NSABB.
British Medical Journal
24 March 2012 (Vol 344, Issue 7849)
http://www.bmj.com/content/344/7849
Analysis
Who is shaping the future of European health systems?
BMJ 2012; 344 doi: 10.1136/bmj.e1712 (Published 13 March 2012)
Cite this as: BMJ 2012; 344:e1712
[Initial paragraphs]
The bailout deals for Ireland, Portugal, and Greece include startlingly detailed changes for their national health systems. Nick Fahy asks whether the tighter European rules proposed to save the euro will mean the EU steering national health systems across all of Europe?
Health systems are a central area of national policy; even within the European Union, the primary responsibility of the EU’s member states for their own health systems is explicitly stated.1 However, one of the consequences of the current financial crisis has been that European countries are facing the kind of detailed international involvement in their health systems that has more normally been seen only in developing countries. As part of the international “bailouts” for Ireland and Greece in 2010, and for Portugal in 2011, these countries had to agree (to) detailed economic adjustment programmes with the “troika” (the European Commission, the International Monetary Fund, and the European Central Bank). These programmes include some strikingly detailed prescriptions for change in the health systems.
It is not so much what is being done, but by whom that is important. Health is a major item of public expenditure in all European countries, and all are under pressure to ensure cost effectiveness of their health systems. Moreover, these three bailout programmes were negotiated and agreed—albeit under pressure—between the troika and the national governments concerned. But as the EU moves towards much greater supervision of national budgets, the health systems in all countries may become subject to international requirements like those set out in the bailout agreements and health ministries may need to discuss policy not only with national finance ministries but with the European Commission.
Emerging Infectious Diseases
Volume 18, Number 4—April 2012
http://www.cdc.gov/ncidod/EID/index.htm
Historical Review
Dengue and US Military Operations from Spanish–American War through Today
R. V. Gibbons et al.
Abstract
Dengue is a major cause of illness among travelers and a threat to military troops operating in areas to which it is endemic. Before and during World War II, dengue frequently occurred in US military personnel in Asia and the South Pacific. From the 1960s into the 1990s, dengue often occurred in US troops in Vietnam, the Philippines, Somalia, and Haiti. We found attack rates as high as 80% and periods of convalescence up to 3-1/2 weeks beyond the acute illness. The increase in dengue throughout the world suggests that it will remain a problem for military personnel until an effective vaccine is licensed.
Policy Review
Lessons Learned during Dengue Outbreaks in the United States, 2001–2011
A. A. Adalja et al.
Abstract
Since 2001, three autochthonous dengue fever outbreaks have occurred in the United States: in Hawaii (2001); Brownsville, Texas (2005); and southern Florida (2009–2011). We sought to characterize and describe the response to these outbreaks from the perspectives of public health and vector control officials. By conducting a medical literature review through PubMed and news media searches through Google, we identified persons involved in managing each outbreak; 26 persons then participated in qualitative, semistructured interviews. After analyzing the 3 outbreaks, we found the following prominent themes in the response efforts: timely detection of illness; communication of up-to-date, correct information; and development of a rapid response that engages the community. We therefore recommend that public health authorities involve the clinical and laboratory community promptly, provide accurate information, and engage the local community in vector control and case identification and reporting.
Globalization and Health
[Accessed 24 March 2012]
http://www.globalizationandhealth.com/
Research
Is the Brazilian pharmaceutical policy ensuring population access to essential medicines?
Bertoldi AD, Helfer AP, Camargo AL, Tavares NUL and Kanavos P Globalization and Health 2012, 8:6 (21 March 2012)
[Open access] Abstract (provisional)
Background
To evaluate medicine prices, availability and affordability in Brazil, considering the differences across three types of medicines (originator brands, generics and similar medicines) and different types of facilities (private pharmacies, public sector pharmacies and “popular pharmacies”).
Methods
Data on prices and availability of 50 medicines were collected in 56 pharmacies across six cities in Southern Brazil using the World Health Organization / Health Action International methodology. Median prices obtained were divided by international reference prices to derive the median price ratio (MPR).
Results
In the private sector, prices were 8.6 MPR for similar medicines, 11.3 MRP for generics and 18.7 MRP for originator brands, respectively. Mean availability was 65%, 74% and 48% for originator brands, generics and similar medicines, respectively. In the public sector, mean availability of similar medicines was 2-7 times higher than that of generics. Mean overall availability in the public sector ranged from 68.8% to 81.7%. In “popular pharmacies”, mean availability was greater than 90% in all cities.
Conclusions
Availability of medicines in the public sector does not meet the challenge of supplying essential medicines to the entire population, as stated in the Brazilian constitution. This has unavoidable repercussions for affordability, particularly amongst the lower socio-economic strata.
Journal of Infectious Diseases
Volume 205 Issue 8 April 15, 2012
http://www.journals.uchicago.edu/toc/jid/current
VIRUSES
Kimberly K. Repp, Carrie M. Nielson, Rongwei Fu, Sean Schafer, Eduardo Lazcano-once, Jorge Salmerón, Manuel Quiterio, Luisa L. Villa, and Anna R. Giuliano for the HIM study
Male Human Papillomavirus Prevalence and Association with Condom Use in Brazil, Mexico, and the United States
J Infect Dis. (2012) 205(8): 1287-1293 doi:10.1093/infdis/jis181
Abstract
Background. Reported associations of condom use and human papillomavirus (HPV) infection have been inconsistent. We investigated self-reported frequency of condom use and detection of genital HPV among men.
Methods. A cross-sectional analysis was conducted in men aged 18–70 years from Brazil, Mexico, and the United States. Men completed questionnaires on sexual history, condom use, and sociodemographic characteristics. Among 2621 men reporting recent vaginal sex, prevalence of any HPV, any oncogenic type, and nononcogenic types only was estimated by frequency of condom use (“always” or “not always”). Multivariable models were used to estimate prevalence ratios (PRs) for HPV according to frequency of condom use.
Results. The prevalence of any HPV was 70.5%; any oncogenic type, 34%, and nononcogenic types only, 22.2%. The adjusted PR for always vs not always using condoms was 0.87 (95% confidence interval [CI], .77–.97) for all countries combined. The association was stronger in the United States (PR, 0.70; CI, .55–.90) than in Brazil (PR, 0.84; CI, .71–1.01) or Mexico (PR, 1.05; CI, .89–1.25) (P for interaction = .025).
Conclusions. HPV prevalence was high even among those who reported always using condoms, and its associations with always using condoms varied among countries.
The Lancet
Mar 24, 2012 Volume 379 Number 9821 p1075 – 1170
http://www.thelancet.com/journals/lancet/issue/current
Editorial
Social determinants of health and outcomes in New Zealand
The Lancet
Preview
In this issue of The Lancet, Michael Baker and colleagues analyse more than 5 million hospital admissions in New Zealand for infectious diseases. Two messages stand out. First, hospitalisations ascribed to infection have risen in both absolute terms (by more than 25 000 per year) and as a proportion of overall acute admissions (from 20·5% in 1989–93 to 26·6% in 2004–08). Second, the risk of hospitalisation for serious infectious diseases in New Zealand is borne disproportionately by Māori and Pacific peoples and by those who are socioeconomically disadvantaged.
Comment
Socioeconomic inequalities and infectious disease burden
Stephen S Lim, Ali H Mokdad
Preview
Valid, reliable, comparable, and timely statistics for levels, trends, and inequalities in morbidity and mortality by cause are essential to monitor progress towards improvements in population health, and to plan the delivery of health services. In The Lancet, Michael Baker and colleagues1 describe trends and inequalities in hospital admissions for infectious and non-infectious diseases by cause between 1989 and 2008. With use of a national hospital database in New Zealand, the investigators noted a relative increase of 51.3% in the age-standardised rate of hospital admissions for infectious diseases from 1989–93 to 2004–08, with the greatest increase noted in the indigenous Māori (age-standardised rate ratio 2·15, 95% CI 2·14–2·16) and Pacific peoples (2·35, 2·34–2·37) compared with those of European or other ethnic grouping; and in the most socioeconomically deprived quintile (2·81, 2·80–2·83) compared with the least deprived quintile.
Articles
Increasing incidence of serious infectious diseases and inequalities in New Zealand: a national epidemiological study
Michael G Baker, Lucy Telfar Barnard, Amanda Kvalsvig, Ayesha Verrall, Jane Zhang, Michael Keall, Nick Wilson, Teresa Wall, Philippa Howden-Chapman
Summary
Background
Although the burden of infectious diseases seems to be decreasing in developed countries, few national studies have measured the total incidence of these diseases. We aimed to develop and apply a robust systematic method for monitoring the epidemiology of serious infectious diseases.
Methods
We did a national epidemiological study with all hospital admissions for infectious and non-infectious diseases in New Zealand from 1989 to 2008, to investigate trends in incidence and distribution by ethnic group and socioeconomic status. We extended a recoding system based on the ninth revision of international classification of diseases (ICD-9) to the tenth revision (ICD-10), and applied this to data for hospital admissions from the New Zealand Ministry of Health, National Minimum Dataset. We filtered results to account for changes in health-care practices over time. Acute overnight admissions were the events of interest.
Findings
Infectious diseases made the largest contribution to hospital admissions of any cause. Their contribution increased from 20·5% of acute admissions in 1989—93, to 26·6% in 2004—08. We noted clear ethnic and social inequalities in infectious disease risk. In 2004—08, the age-standardised rate ratio was 2·15 (95% CI 2·14—2·16) for Māori (indigenous New Zealanders) and 2·35 (2·34—2·37) for Pacific peoples compared with the European and other group. The ratio was 2·81 (2·80—2·83) for the most socioeconomically deprived quintile compared with the least deprived quintile. These inequalities have increased substantially in the past 20 years, particularly for Māori and Pacific peoples in the most deprived quintile.
Interpretation
These findings support the need for stronger prevention efforts for infectious diseases, and reinforce the need to reduce ethnic and social inequalities and to address disparities in broad social determinants such as income levels, housing conditions, and access to health services. Our method could be adapted for infectious disease surveillance in other countries.
Funding
New Zealand Ministry of Health, New Zealand Health Research Council.
Pediatrics
http://pediatrics.aappublications.org/current.shtml
March 2012, VOLUME 129 / ISSUE Supplement 2
Evolution of the Pediatric Influenza Vaccination Program in the United States
Kathleen M. Neuzil, Anthony E. Fiore, and Richard A. Schieber
Pediatrics 2012; 129:S51-S53
[Initial text]
For many years, the Advisory Committee on Immunization Practices (ACIP) for the Centers for Disease Control and Prevention (CDC) focused its vaccination policy on persons at higher risk for influenza complications (eg, older adults, children and adults with certain high-risk conditions, pregnant women) and their contacts (eg, household contacts, health care personnel). Unfortunately, although vaccination coverage rates varied, they remained low for most adult and pediatric high-risk groups, other than persons aged ≥65 years.1 In conjunction with the recognition that influenza vaccination recommendations for high-risk target populations were not being optimally implemented, the adverse effects of influenza illness on all children was increasingly recognized. This led to the expansion of vaccination recommendations for children, beginning in 2002, when influenza vaccination was “encouraged” for children aged 6 through 23 months, and in 2004, when a full recommendation was issued for this age group.2,3 That recommendation was based largely on studies documenting that these young children had influenza-related hospitalization rates that were comparable to hospitalization rates in older persons with underlying risk conditions who were targeted to receive influenza vaccine.4–6 Full recommendation was added for other groups who are at risk, such as adults and children with neuromuscular and other conditions that can compromise respiratory function or the handling of respiratory secretions, as data became available.7
The gradual, incremental, group-by-group expansion of influenza recommendations to additional age and risk groups was challenging for providers and the public. In the ensuing years, immunization experts, professional organizations, and other stakeholders debated the advantages and challenges of expanding routine influenza vaccination to all persons in the United States.8–10 At a meeting of immunization and …
Expanding the Recommendations for Annual Influenza Vaccination to School-Age Children in the United States
Anthony E. Fiore, Scott Epperson, Dennis Perrotta, Henry Bernstein, and Kathleen Neuzil
Abstract
BACKGROUND Despite long-standing recommendations to vaccinate children who have underlying chronic medical conditions or who are contacts of high-risk persons, vaccination coverage among school-age children remains low. Community studies have indicated that school-age children have the highest incidence of influenza and are an important source of amplifying and sustaining community transmission that affects all age groups.
METHODS A consultation to discuss the advantages and disadvantages of a universal recommendation for annual influenza vaccination of all children age ≥6 months was held in Atlanta, Georgia, in September 2007. Consultants provided summaries of current data on vaccine effectiveness, safety, supply, successful program implementation, and economics studies and discussed challenges associated with continuing a risk- and contact-based vaccination strategy compared with a universal vaccination recommendation.
RESULTS Consultants noted that school-age children had a substantial illness burden caused by influenza that vaccine was safe and effective for children aged 6 months through 18 years, and that evidence suggested that vaccinating school-age children would provide benefits to both the vaccinated children and their unvaccinated household and community contacts. However, implementation of an annual recommendation for all school-age children would pose major challenges to parents, medical providers and health care systems. Alternative vaccination venues were needed, and of these school-located vaccination programs might offer the most promise as an alternative vaccination site for school-age children.
CONCLUSIONS Expansion of recommendations to include all school-age children will require additional development of an infrastructure to support implementation and methods to adequately evaluate impact.
A Theoretic Framework to Consider the Effect of Immunizing Schoolchildren Against Influenza: Implications for Research
Ira M. Longini Jr
Pediatrics 2012; 129:S63-S67
Early Experience Conducting School-located Vaccination Programs for Seasonal Influenza
Richard A. Schieber, Allison Kennedy, and Emily B. Kahn
Pediatrics 2012; 129:S68-S74
Promising Practices for School-located Vaccination Clinics—Part I: Preparation
John Lott and Jennifer Johnson
Pediatrics 2012; 129:S75-S80
Promising Practices for School-located Vaccination Clinics—: Part II: Clinic Operations and Program Sustainability
John Lott and Jennifer Johnson
Pediatrics 2012; 129:S81-S87
Successful Use of Volunteers to Conduct School-located Mass Influenza Vaccination Clinics
Ginny E. Cummings, Elizabeth Ruff, Stephen H. Guthrie, Margaret A. Hoffmaster, Larry L. Leitch, and James C. King Jr
Pediatrics 2012; 129:S88-S95
Pediatrician Attitudes Concerning School-located Vaccination Clinics for Seasonal Influenza
Virginia A. Keane, Andrew R. Hudson, and James C. King Jr
Pediatrics 2012; 129:S96-S100
Use of the Emergency Incident Command System for School-located Mass Influenza Vaccination Clinics
Marsha Fishbane, Anne Kist, and Richard A. Schieber
Pediatrics 2012; 129:S101-S106
Epilogue: School-located Influenza Vaccination During the 2009–2010 Pandemic and Beyond
Tara M. Vogt and Pascale M. Wortley
Pediatrics 2012; 129:S107-S109
PLoS Medicine
(Accessed 24 March 2012)
http://www.plosmedicine.org/article/browse.action?field=date
Guidance for Evidence-Informed Policies about Health Systems: Assessing How Much Confidence to Place in the Research Evidence
Simon Lewin, Xavier Bosch-Capblanch, Sandy Oliver, Elie A. Akl, Gunn E. Vist, John N. Lavis, Davina Ghersi, John-Arne Røttingen, Peter Steinmann, Metin Gulmezoglu, Peter Tugwell, Fadi El-Jardali, Andy Haines Policy Forum, published 20 Mar 2012
doi:10.1371/journal.pmed.1001187
Summary Points
– Assessing how much confidence to place in different types of research evidence is key to informing judgements regarding policy options to address health systems problems.
– Systematic and transparent approaches to such assessments are particularly important given the complexity of many health systems interventions.
– Useful tools are available to assess how much confidence to place in the different types of research evidence needed to support different steps in the policy-making process; those for assessing evidence of effectiveness are most developed.
– Tools need to be developed to assist judgements regarding evidence from systematic reviews on other key factors such as the acceptability of policy options to stakeholders, implementation feasibility, and equity.
– Research is also needed on ways to develop, structure, and present policy options within global health systems guidance.
This is the third paper in a three-part series in PLoS Medicine on health systems guidance.
Public Health Ethics
Volume 5 Issue 1 April 2012
http://phe.oxfordjournals.org/content/current
Case Discussion
Mat Walton and Eva Mengwasser
An Ethical Evaluation of Evidence: A Stewardship Approach to Public Health Policy
Public Health Ethics (2012) 5(1): 16-21 doi:10.1093/phe/phr037
Abstract
This article aims to contribute to the application of ethical frameworks to public health policy. In particular, the article considers the use of the Nuffield Council on Bioethics stewardship model as an applied framework for the evaluation of evidence within public health policymaking. The ‘Stewardship framework’ was applied to a policy proposal to restrict marketing of food and beverages to children. Reflections on applying the stewardship model as a framework are provided. The article concludes that the questions used to apply the stewardship model usefully introduced ethical considerations into the evidence review. However, the real value will likely come from the type of policy process within which the framework is used, identifying competing value positions and capturing local value requirements.
vaccines and global health :: ethics and policy 
