PLoS One
[Accessed 21 April 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Single Endemic Genotype of Measles Virus Continuously Circulating in China for at Least 16 Years
Yan Zhang, Songtao Xu, Huiling Wang, Zhen Zhu, Yixin Ji, Chunyu Liu, Xiaojie Zhang, Liwei Sun, Jianhui Zhou, Peishan Lu, Ying Hu, Daxing Feng, Zhenying Zhang, Changyin Wang, Xueqiang Fang, Huanying Zheng, Leng Liu, Xiaodong Sun, Wei Tang, Yan Wang, Yan Liu, Hui Gao, Hong Tian, Jiangtao Ma, Suyi Gu, Shuang Wang, Yan Feng, Fang Bo, Jianfeng Liu, Yuan Si, Shujie Zhou, Yuyan Ma, Shengwei Wu, Shunde Zhou, Fangcai Li, Zhengrong Ding, Zhaohui Yang, Paul A. Rota, David Featherstone, Youngmee Jee, William J. Bellini, Wenbo Xu
PLoS ONE: Research Article, published 20 Apr 2012 10.1371/journal.pone.0034401

Abstract 
The incidence of measles in China from 1991 to 2008 was reviewed, and the nucleotide sequences from 1507 measles viruses (MeV) isolated during 1993 to 2008 were phylogenetically analyzed. The results showed that measles epidemics peaked approximately every 3 to 5 years with the range of measles cases detected between 56,850 and 140,048 per year. The Chinese MeV strains represented three genotypes; 1501 H1, 1 H2 and 5 A. Genotype H1 was the predominant genotype throughout China continuously circulating for at least 16 years. Genotype H1 sequences could be divided into two distinct clusters, H1a and H1b. A 4.2% average nucleotide divergence was found between the H1a and H1b clusters, and the nucleotide sequence and predicted amino acid homologies of H1a viruses were 92.3%–100% and 84.7%–100%, H1b were 97.1%–100% and 95.3%–100%, respectively. Viruses from both clusters were distributed throughout China with no apparent geographic restriction and multiple co-circulating lineages were present in many provinces. Cluster H1a and H1b viruses were co-circulating during 1993 to 2005, while no H1b viruses were detected after 2005 and the transmission of that cluster has presumably been interrupted. Analysis of the nucleotide and predicted amino acid changes in the N proteins of H1a and H1b viruses showed no evidence of selective pressure. This study investigated the genotype and cluster distribution of MeV in China over a 16-year period to establish a genetic baseline before MeV elimination in Western Pacific Region (WPR). Continuous and extensive MeV surveillance and the ability to quickly identify imported cases of measles will become more critical as measles elimination goals are achieved in China in the near future. This is the first report that a single endemic genotype of measles virus has been found to be continuously circulating in one country for at least 16 years

PLoS Medicine
(Accessed 21 April 2012)
http://www.plosmedicine.org/article/browse.action?field=date

New Methodology for Estimating the Burden of Infectious Diseases in Europe
Mirjam Kretzschmar, Marie-Josée J. Mangen, Paulo Pinheiro, Beate Jahn, Eric M. Fèvre, Silvia Longhi, Taavi Lai, Arie H. Havelaar, Claudia Stein, Alessandro Cassini, Piotr Kramarz, for the BCoDE consortium Policy Forum, published 17 Apr 2012
doi:10.1371/journal.pmed.1001205

Summary Points
– The major objectives of the Burden of Communicable Diseases in Europe (BCoDE) study are to further develop the methodology to estimate the burden of infectious diseases (IDs), and to estimate and report on the current and future burden of IDs in the European Union member states and European Economic Area/European Free Trade Association countries.

– The BCoDE project uses a pathogen-based incidence approach to generate estimates, fully taking into account all chronic and long-term sequelae that can be causally related to an infectious agent.

– An important focus is the assessment of underreporting and under-ascertainment in various types of incidence data.

– Future challenges are the integration of demographic changes

Tropical Medicine & International Health
May 2012  Volume 17, Issue 5  Pages 531–682
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue

Malaria
The Gates Malaria Partnership: a consortium approach to malaria research and capacity development (pages 558–563)
Brian Greenwood, Amit Bhasin and Geoffrey Targett
Article first published online: 16 MAR 2012 | DOI: 10.1111/j.1365-3156.2012.02970.x

Abstract
Recently, there has been a major increase in financial support for malaria control. Most of these funds have, appropriately, been spent on the tools needed for effective prevention and treatment of malaria such as insecticide-treated bed nets, indoor residual spraying and artemisinin combination therapy. There has been less investment in the training of the scientists from malaria-endemic countries needed to support these large and increasingly complex malaria control programmes, especially in Africa. In 2000, with support from the Bill & Melinda Gates Foundation, the Gates Malaria Partnership was established to support postgraduate training of African scientists wishing to pursue a career in malaria research. The programme had three research capacity development components: a PhD fellowship programme, a postdoctoral fellowship programme and a laboratory infrastructure programme. During an 8-year period, 36 African PhD students and six postdoctoral fellows were supported, and two research laboratories were built in Tanzania. Some of the lessons learnt during this project – such as the need to improve PhD supervision in African universities and to provide better support for postdoctoral fellows – are now being applied to a successor malaria research capacity development programme, the Malaria Capacity Development Consortium, and may be of interest to other groups involved in improving postgraduate training in health sciences in African universities.

Tropical Medicine & International Health
May 2012  Volume 17, Issue 5  Pages 531–682
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue

Health systems
Disease control and health systems in low- and middle-income countries: enhancing positive interrelation (pages 646–651)
Charles Collins, Miguel Angel Gonzalez Block and Shenglan Tang
Article first published online: 16 MAR 2012 | DOI: 10.1111/j.1365-3156.2012.02968.x

Abstract  [Open Access]
There is a growing interest in improving the relationship between disease control programmes and the rest of the health system in low- and middle-income countries. This short study seeks to contribute to this movement by providing a multi-dimensional approach for policy-makers and researchers. It recognizes the different and often conflicting perspectives in health systems held by stakeholders. Two such perspectives are those of disease control programmes and health systems. Both are based on perceived health needs and put forward requirements on each other through resource demands and organizational needs. Failure to reconcile these perspectives can lead to health system fragmentation. This study proposes a framework to address the importance of mutual support across stakeholder perspectives, striving to understand and analyse the consequences of their reciprocal views. In doing this, the study stresses the importance of common understanding around health system values, the political interplay between stakeholders, the contextual setting and the need to integrate research and capacity development in this area.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 23 pp. 3355-3488 (14 May 2012)

Regular Papers
Seroprevalence of measles among children affected by national measles elimination program in Korea, 2010
Original Research Article
Pages 3355-3359
Eun Seong Kim, Young June Choe, Heeyeon Cho, You-Jin Kim, Hee Sook Yoon, Jeong-Sun Yang, Kisoon Kim, Geun-Ryang Bae, Duk-hyoung Lee

Abstract
Background
Following the implementation of national measles elimination plan in Korea, the elimination was declared in 2006. In order to sustain the elimination, high population immunity should be continuously monitored. To evaluate the current age-related susceptibility within the Korean population, we conducted the seroprevalence in children and adolescents who were affected by the national measles elimination plan.

Methods
We used residual serum specimens to measure measles specific IgG and geometric mean titer (GMT) in birth cohorts 2007–2008 and 1997–2003. Among birth cohorts, 2007–2008 cohorts were grouped to evaluate the timeliness of first dose of MMR, 1994–2003 cohorts were grouped to evaluate the effect of keep-up MMR2 campaign, and 1992–1993 cohorts were grouped to evaluate the effect of catch-up campaign in 2001.

Results
Overall, measles seropositivity rate was 86%. The highest seroprevalence of measles IgG was in birth cohorts 2007–2008. Measles seropositivity declined continuously in age groups. The birth cohorts 1994–1996 showed significantly lower levels of seropositivity and GMT than did the other birth cohorts.

Conclusion
Despite efforts to eliminate measles for the past 10 years in Korea, our study revealed specific birth cohorts remaining at risk for transmission. The adolescents born during 1994–1996 had the lowest measles seropositivity levels, and might represent a ‘pocket’ that has potential at increased risk for measles transmission. Further discussion for follow-up immunization should be placed for consideration in the near future.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 23 pp. 3355-3488 (14 May 2012)

Regular Papers
Why did patients with cardiovascular disease in the Netherlands accept Q fever vaccination?
Original Research Article
Pages 3369-3375
Marloes Bults, Desirée J.M.A. Beaujean, Clementine J. Wijkmans, Aura Timen, Jan Hendrik Richardus, Hélène A.C.M. Voeten

Abstract
This study examines patient’s reasons for accepting Q fever vaccination, including risk perception, feelings of doubt, social influence, information-seeking behavior, preventive measures taken, and perceptions regarding received information and governmental action. Data was obtained from exit interviews conducted after Q fever vaccination, between January and April 2011. A total of 413 patients with specific cardiovascular conditions in the Netherlands participated in exit interviews; 70% were older than 60 years. Most reported reasons for accepting Q fever vaccination were: “I am at an increased risk for developing (chronic) Q fever” (69%) and “my general practitioner recommends Q fever vaccination for me” (34%). The majority (86%) reported a high perceived severity of Q fever, and only 6% felt vulnerable to Q fever after vaccination. One-third had doubts about getting vaccinated, primarily related to fears of side effects and practical barriers. Fifty-two percent solicited advice from their social networks; of these, 67% reported influence on their vaccination decision. General practitioners and family were the most reported sources of advice. Thirty percent actively sought information about Q fever vaccination. Twenty-two percent of all respondents had taken other preventive measures, such as avoiding contact with goats and sheep (74%), and cancelling or postponing visits to Q fever-affected areas (36%). Almost one-half of all respondents reported negative feelings regarding governmental action to control Q fever. Significant differences were observed regarding feelings of doubt, information-seeking behavior, perceived vulnerability, preventive measures taken, and perceptions regarding received information and governmental action regarding gender, age, educational level, and/or employment status. Vaccination decision-making may differ among socio-demographic subgroups. When preparing future vaccination campaigns, it is important to obtain greater insight into these differences and take these aspects into account in risk communication strategies by tailoring information to specific target groups.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 23 pp. 3355-3488 (14 May 2012)

Regular Papers
Potential overestimation of HPV vaccine impact due to unmasking of non-vaccine types: Quantification using a multi-type mathematical model
Original Research Article
Pages 3383-3388
Yoon Hong Choi, Ruth Chapman, Nigel Gay, Mark Jit

Abstract
Introduction
Estimates of human papillomavirus (HPV) vaccine impact in clinical trials and modelling studies rely on DNA tests of cytology or biopsy specimens to determine the HPV type responsible for a cervical lesion. DNA of several oncogenic HPV types may be detectable in a specimen. However, only one type may be responsible for a particular cervical lesion. Misattribution of the causal HPV type for a particular abnormality may give rise to an apparent increase in disease due to non-vaccine HPV types following vaccination (“unmasking”).

Methods
To investigate the existence and magnitude of unmasking, we analysed data from residual cytology and biopsy specimens in English women aged 20–64 years old using a stochastic type-specific individual-based model of HPV infection, progression and disease. The model parameters were calibrated to data on the prevalence of HPV DNA and cytological lesion of different grades, and used to assign causal HPV types to cervical lesions. The difference between the prevalence of all disease due to non-vaccine HPV types, and disease due to non-vaccine HPV types in the absence of vaccine HPV types, was then estimated.

Results
There could be an apparent maximum increase of 3–10% in long-term cervical cancer incidence due to non-vaccine HPV types following vaccination.

Conclusion
Unmasking may be an important phenomenon in HPV post-vaccination epidemiology, in the same way that has been observed following pneumococcal conjugate vaccination.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 23 pp. 3355-3488 (14 May 2012)

Regular Papers
Parental and societal values for the risks and benefits of childhood combination vaccines
Original Research Article
Pages 3445-3452
Courtney Gidengil, Tracy A. Lieu, Katherine Payne, Donna Rusinak, Mark Messonnier, Lisa A. Prosser

Abstract
Background
New combination vaccines reduce the number of injections needed for immunization. However, possible drawbacks include higher prices, extra doses of vaccine antigens and increased minor adverse events. Our objective was to measure parental and societal values for attributes of childhood combination vaccines.

Methods
We conducted a discrete choice experiment using an online survey of adults administered by Knowledge Networks. Values were measured for attributes of combination vaccines for a hypothetical child aged 6 months: (1) number of injections, (2) extra dose of hepatitis B vaccine, (3) 20% higher chance of fever, (4) community-level immunization coverage of 2-year-olds of 90% or 80%, and (5) cost per visit. Logistic regression with generalized estimating equations was used to analyze the value of different attributes and generate a marginal willingness-to-pay for a change in attribute level.

Results
The response rate was 64% (N = 558). Most respondents were parents (63%) and most respondents agreed that combination vaccines were safe (77%). Respondents were willing to pay $7.68 to avoid an injection (compared to $9.94 when looking at parents only). However, respondents were willing to pay $41.57 to avoid higher risk of fever after one set of immunizations (10% versus 30%) and $65.42 for higher immunization coverage rates. These results were very similar for parents only. There was no significant preference to avoid an extra dose of hepatitis B vaccine.

Conclusions
Respondents were willing to pay larger amounts to avoid increased risk of minor adverse events and to increase community-level immunization coverage than to avoid injections. These values should be taken into account when determining the risks and benefits of combination vaccines.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 23 pp. 3355-3488 (14 May 2012)

Regular Papers
Health and economic impact of the seasonal influenza vaccination programme in England
Original Research Article
Pages 3459-3462
Marc Baguelin, Mark Jit, Elizabeth Miller, William John Edmund

Abstract
Background
The seasonal influenza vaccination programme in England targets individuals over 65 years old and in clinical risk groups.

Methods
A model of influenza transmission and disease was fitted to weekly primary care consultations due to influenza in a typical pre-pandemic season (2006/2007). Different scenarios were constructed about influenza severity and how well vaccines match circulating strains to assess the impact and cost-effectiveness of the current vaccination programme.

Results
A well-matched vaccine may reduce the incidence of laboratory-confirmed influenza illness from 8.2% (95% range 4.3–13%) to 5.9% (95% range 2.9–9.7%), with 56–73% of this due to indirect protection. The programme is likely to be cost-effective unless both low severity and poor matching is assumed.

Conclusion
The current seasonal influenza vaccination programme appears to substantially reduce disease burden and provides good value for money.

Vaccine
Volume 30, Issue 22 pp. 3249-3350 (9 May 2012)

Letter to the Editor
Charting a course for equal access to immunization
Pages 3249-3250
Ciro A. de Quadros

[No preview or extract]

Vaccine
Volume 30, Issue 22 pp. 3249-3350 (9 May 2012)

Brief Report
Atypical forms of Guillain-Barré syndrome and H1N1-influenza vaccination
Pages 3251-3254
Aasef G. Shaikh, Pichet Termsarasab, Chinasa Nwankwo, Anitha Rao-Frisch, Bashar Katirji

Abstract
Recent epidemiological studies established extremely rare incidence of Guillain-Barre syndrome (GBS) after contemporary H1N1-influenza vaccine. We saw five patients with ‘atypical’ GBS variants that started within four weeks of 2010/2011 H1N1-influenza vaccine. There was no evidence for other etiologies of GBS. The patients presented with sensory ataxia, areflexia, extremity and oropharyngeal paresthesias, numbness, pain, weakness, sphincteric disturbances, and dysautonomia. One patient had Miller Fisher syndrome. All had elevated cerebrospinal fluid protein, and classic electrodiagnostic finding suggestive of GBS. All received the treatment with intravenous immunoglobulin with variable response. These pilot observations suggest that H1N1-influenza vaccine may be associated with rare and atypical variants of GBS. However, epidemiological studies with large cohorts are necessary to confirm excess cases of atypical GBS after H1N1-influenza vaccination.

Vaccine
Volume 30, Issue 22 pp. 3249-3350 (9 May 2012)

Regular Papers
Safety reporting in developing country vaccine clinical trials—A systematic review
Review Article
Pages 3255-3265
Susann Muehlhans, Georgina Richard, Mohammad Ali, Gabriela Codarini, Chris Elemuwa, Ali Khamesipour, Wolfgang Maurer, Edison Mworozi, Sonali Kochhar, Gabriella Rundblad, Dominique Vuitton, Barbara Rath

Abstract
With more vaccines becoming available worldwide, vaccine research is on the rise in developing countries. To gain a better understanding of safety reporting from vaccine clinical research in developing countries, we conducted a systematic review in Medline and Embase (1989–2011) of published randomized clinical trials (RCTs) reporting safety outcomes with ≥50% developing country participation (PROSPERO systematic review registration number: CRD42012002025). Developing country vaccine RCTs were analyzed with respect to the number of participants, age groups studied, inclusion of safety information, number of reported adverse events following immunization (AEFI), type and duration of safety follow-up, use of standardized AEFI case definitions, grading of AEFI severity, and the reporting of levels of diagnostic certainty for AEFI.

The systematic search yielded a total number of 50 randomized vaccine clinical trials investigating 12 different vaccines, most commonly rotavirus and malaria vaccines. In these trials, 94,459 AEFI were reported from 446,908 participants receiving 735,920 vaccine doses. All 50 RCTs mentioned safety outcomes with 70% using definitions for at least one AEFI. The most commonly defined AEFI was fever (27), followed by local (16) and systemic reactions (14). Logistic regression analysis revealed a positive correlation between the implementation of a fever case definition and the reporting rate for fever as an AEFI (p = 0.027). Overall, 16 different definitions for fever and 7 different definitions for erythema were applied. Predefined AEFI case definitions by the Brighton Collaboration were used in only two out of 50 RCTs.

The search was limited to RCTs published in English or German and may be missing studies published locally. The reported systematic review suggests room for improvement with respect to the harmonization of safety reporting from developing country vaccine clinical trials and the implementation of standardized case definitions.

Vaccine
Volume 30, Issue 22 pp. 3249-3350 (9 May 2012)

Regular Papers
A comparison of parent and provider reported influenza vaccination status of adolescents
Original Research Article
Pages 3278-3285
Peng-jun Lu, Christina Dorell, David Yankey, Tammy A. Santibanez, James A. Singleton

Abstract
Objective
To compare parent and provider reported influenza vaccination status among adolescents.

Methods
Data from the 2009 National Immunization Survey-Teen (NIS-Teen) were analyzed. The NIS-Teen is a nationally representative random-digit-dialed telephone survey of households with adolescents 13–17 years at the time of interview, followed by a mail survey to the adolescent’s vaccination providers to obtain provider-reported vaccination histories. During the interview a parent or guardian was asked if the adolescent had received an influenza vaccination and whether their response was based upon recall only or from consulting a parent-held vaccination record (i.e., shot card) with recall of additional vaccinations not recorded on the shot card. Parent-reported influenza vaccination status was compared with provider-reported vaccination status by calculating various validity measures (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and kappa), overall and stratified by several demographic characteristics. In the main analysis, provider-reported vaccinations were considered the gold standard. To evaluate the completeness of provider-reporting, we conducted additional analysis that also considered vaccinations reported by parents from the shot card or reported received in a non-medical setting as “true” vaccinations.

Results
During the 2008–2009 season, influenza vaccination coverage among adolescents based on provider report was 11.3%. Based on parent report, influenza vaccination coverage was 21.7%. Twenty-two percent of parents retrieved and referred to a shot card during the interview. In the shot card group, provider versus parent reported coverage was 12.5% versus 18.2% while among the recall only group coverage was 10.9% versus 22.7%, respectively. Overall, compared to provider report as the gold standard, parental report of influenza vaccination had a sensitivity of 86.7%, a specificity of 86.2%, a positive predictive value (PPV) of 43.1%, and a negative predictive value (NPV) of 98.0%. Among the shot card group, of vaccinations reported either by provider or by parent reading vaccination off shot card, only 66% were reported by providers. In the shot card group, the “true” vaccination level (16–17%) was closer to the parent reported coverage when it was assumed that vaccinations read by the parent from a shot card but not reported by a provider were considered true vaccinations. Overall, assuming that providers reported 64% of “true” vaccinations, sensitivity increased to 91%, specificity to 93%, and PPV to 71%.

Conclusions
Overall estimated influenza vaccination coverage was more than ten percentage points higher based on parental report than on provider report, with the difference between provider and parent report greater among the recall only group. The two estimates are closer for those with shot cards, but few parents utilized shot cards in our study and most national surveys do not ask parents to consult shot cards when responding about their adolescent’s vaccination. The actual vaccination coverage of adolescents studied is likely between coverage estimates obtained from parent report and provider report.

Vaccine
Volume 30, Issue 22 pp. 3249-3350 (9 May 2012)

Regular Papers
Economic evaluation of vaccination programme of 7-valent pneumococcal conjugate vaccine to the birth cohort in Japan
Original Research Article
Pages 3320-3328
Shu-ling Hoshi, Masahide Kondo, Ichiro Okubo

Abstract
Aiming to introduce 7-valent pneumococcal conjugate vaccine (PVC-7) into routine vaccination schedule, the government of Japan gives a temporary budget to encourage municipalities in launching public vaccination programme which started on November 26, 2010 and ends on March 31, 2012. This study aims to appraise the ‘value for money’ of PCV-7 vaccination programme from the societal perspective and the budget impact from the perspective of municipalities, which is responsible for providing routine vaccination.

We conducted a cost-effectiveness analysis with Markov modelling and calculated incremental cost-effectiveness ratio (ICER) value of launching such programme with two levels of co-payment, ¥1000 (US$13) or ¥0, and two scenarios of the uptake of vaccine (vaccinated-alone or co-vaccinated with other vaccines).

We found that when vaccinated-alone, ICERs in QALY were ¥7,441,000 (US$93,013) or ¥9,065,000 (US$113,313), and when co-vaccinated ¥7,441,000 (US$93,013) or ¥5,489,000 (US$68,613), without or with productivity loss, respectively, regardless of co-payment level of the programme. Co-vaccinated programmes had lower ICER than vaccinated-alone programmes due to the savings in productivity loss. By adopting WHO’s classification that an intervention is ‘cost-effective’ if ICER (in QALY) is between 1 and 3 times of GDP as a criterion, PCV-7 vaccination programme in Japan is concluded as “cost-effective” from the perspective of society.

The introduction of either no co-payment or ¥1000 (US$13) co-payment vaccination programme appears to be not budget saving for the first 6 years, whereas the level of budget impact are less than ¥11,000,000 (US$137,500) or ¥8,500,000 (US$106,250), respectively, for a municipality with 1000 birth cohort in the 1st year and 2nd to 5th year birth cohort proportional to the birth cohort population of estimated future population.

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_14 April 2012

– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

   The American Red Cross said it contributed US$1 million to purchase and distribute oral cholera vaccinations to 100,000 people in urban and rural Haitian communities. These funds will support a US$1.3 million vaccination project led by Partners In Health, the Haitian Ministry of Public Health and Population, and the Haitian nonprofit GHESKIO. This project is part of an ongoing effort to improve control and prevent the spread of the disease that has claimed more than 7,000 lives since its outbreak more than a year ago. The cholera epidemic in Haiti is currently the largest outbreak in the world. Dr. Louise Ivers, Senior Health and Policy Advisor to Partners In Health and Assistant Professor of Medicine at Harvard Medical School, commented, “Support from the American Red Cross is essential to our delivering this safe, affordable and effective oral cholera vaccine in Haiti. While access to clean water and sanitation systems is the ultimate solution to stopping the spread of cholera, we must utilize all tools available to help prevent continued needless deaths,” The vaccine, Shanchol, is delivered in two doses. Shanchol has been pre-qualified by the WHO and is 65 to 75 percent effective in protecting recipients for at least 36 months. To date, the American Red Cross has contributed more than US$17 million to fight the cholera outbreak in Haiti.

http://www.sacbee.com/2012/04/11/4407276/american-red-cross-funds-pioneer.html#storylink=cpy

    The Global Fund “hailed a call by G8 Foreign Ministers for new donors to support the organization’s lifesaving work as a ringing endorsement of major reforms that are underway to strengthen the Global Fund’s management and financial oversight.” G8 Foreign Ministers meeting in Washington on April 12 also called on existing donors to meet their pledges of support and appealed to implementing countries to show leadership in taking on health challenges. The statement noted: “The G8 supports the call for an AIDS-free generation and efforts to achieve universal access to prevention, treatment, care, and support with respect to HIV/AIDS. The G8 renews and recommits to supporting the Global Fund to Fight AIDS, Tuberculosis, and Malaria on the tenth anniversary of its establishment and as the Fund adopts a comprehensive reform agenda.”

http://www.theglobalfund.org/en/mediacenter/pressreleases/2012-04-13_G8_Foreign_Ministers_call_on_Donors_to_support_Global_Fund_Reform_agenda_endorsed/

    GAVI said it secured lower prices for rotavirus vaccine through supply agreements that result is pricing 67% lower than before. GAVI noted that “had (it) been prepared to buy the vaccine at the previous price, it would have needed to pay US$650 million more.” The bulk of the supply volume contracted —132 million doses—will be procured at a cost of $5 dollars per (two-dose) course, a two-third price reduction compared to the previous lowest price offered to GAVI of US$15 a course. This price drop “is the result of an acceleration of GAVI’s market shaping activities and discussions with manufacturers carried out together with the Bill & Melinda Gates Foundation and the Supply Division of UNICEF, key Alliance partners.” GAVI CEO Dr Seth Berkley said, “Influencing vaccine markets to the benefit of children in the poorest countries is core to GAVI’s mandate. We strive to make our donors’ funds go further so we can help developing countries protect more children against deadly diseases and accelerate efforts towards reaching the Millennium Development Goals.” The supply agreements, covering purchases to 2016, were concluded with the two rotavirus vaccine manufacturers, GlaxoSmithKline (GSK) and Merck & Co. Inc. The announcement also noted that GAVI partners, including PATH, supported by the Bill & Melinda Gates Foundation, “are advancing the development of several promising new rotavirus vaccines by collaborating with emerging country manufacturers in the hope of new market entrances from 2015.”

GAVI, through its supply partner UNICEF, “applied some of the key elements of its new vaccine supply and procurement strategy” in achieving this pricing. These elements include:

– Committing to an “advance” purchase: by prepaying a portion of the vaccine supply, GAVI allows manufacturers to recoup their fixed costs earlier and offer a more competitive price.

– Offering mid-term market certainty: by extending the deal period – to five years in the case of the rotavirus vaccines deal – GAVI provides manufacturers with increased visibility, another incentive to commit to lower prices in return for more predictability of demand.

– Offering a long-term view of the market: by sending signals of a viable market to future manufacturers, GAVI aims at enlarging the vaccine supplier base and encouraging developing country manufacturers to join the market. Moving forward, GAVI said it will continue its proactive efforts to shape the vaccine market, and will seek to apply innovative measures specifically tailored to each vaccine. http://www.gavialliance.org/library/news/press-releases/2012/gavi-secures-lower-price-rotavirus-vaccine/

GAVI Board Chair Dagfinn Høybråten said the appointment of three women to the GAVI Alliance Board “achieves a key target on gender.” Her Royal Highness the Infanta Cristina of Spain, Dr Maria C. Freire, and Yifei Li take up their positions with immediate effect. These appointments result in 11 out of 26 Board members being women. GAVI’s Board achieved its target of at least 40 percent representation for both genders within two years of approving guidelines at its meeting in July 2010. At that time, only 10% of Board members were women. “This new balance positions us as a leader on gender policy among international organisations. We make high-impact decisions that affect the lives of millions of women and children and it is critical that we as a Board are properly represented and have a diversity of viewpoints,” Mr Høybråten said.

Geneva, 13 April 2012

http://www.gavialliance.org/library/news/gavi-features/2012/gavi-board-achieves-goal-on-gender/

The International AIDS Vaccine Initiative (IAVI) announced the appointment of Dr. Adel A.F. Mahmoud to its Board of Directors. Dr. Mahmoud is a professor at Princeton University, former President of Merck Vaccines and former Chairman of Medicine at Case Western Reserve University. He joins a “diverse group of 12 directors from ten countries with backgrounds in finance, vaccinology, international development, academia and HIV treatment and prevention that oversees IAVI’s progress and shapes its long-term strategy.” IAVI President & CEO Margaret McGlynn said, “We are very pleased to have Adel join IAVI’s Board of Directors. His experience in the private sector, especially the development and delivery of preventive vaccines, and his in-depth knowledge of immunology and infectious diseases combined with his passion for the development of an AIDS vaccine will prove invaluable to IAVI. I look forward to working closely with Adel again, and welcome his addition to our Board.”

http://www.businesswire.com/news/home/20120409005637/en/Leading-Global-Health-Expert-Dr.-Adel-A.F.

Global Initiative: World Immunization Week
21–28 April 2012

“To underscore the importance of immunization in saving lives, and to encourage families to vaccinate their children against deadly diseases WHO is uniting countries across the globe for a week of vaccination campaigns, public education and information sharing under the umbrella of World Immunization Week.

“Worldwide collaboration provides an opportunity to boost momentum and focus on specific actions such as:
– raising awareness on how immunization saves lives;
– increasing vaccination coverage to prevent disease outbreaks;
– reaching underserved and marginalized communities (e.g. those living in remote areas, deprived urban settings, fragile states and strife-torn regions) with existing and newly available vaccines;
– reinforcing the medium- and long-term benefits of immunization (e.g. giving children a chance to grow up healthy, go to school and improve their life prospects).

“Immunization is one of the most successful and cost-effective health interventions. It prevents between 2 and 3 million deaths every year. Immunization prevents debilitating illness, disability and death from vaccine-preventable diseases such as diphtheria, hepatitis A and B, measles, mumps, pneumococcal disease, polio, rotavirus diarrhoea, tetanus and yellow fever. The benefits of immunization are increasingly being extended to adolescents and adults, providing protection against life-threatening diseases such as influenza, meningitis, and cancers (e.g. cervical and liver cancers) that occur in adulthood.

Related links
World Immunization Week 2012

http://www.who.int/mediacentre/events/annual/immunization_week/en/index.html

Cartagena, Colombia, 13 April 2011 (PAHO/WHO) — The Pan American Health Organization/World Health Organization (PAHO/WHO), with support from partner organizations, launched the 10th annual Vaccination Week in the Americas on April 13 in the lead-up to the VI Summit of the Americas, being held this weekend in Cartagena, Colombia.
http://new.paho.org/hq/index.php?option=com_content&task=view&id=6641&Itemid=1926

Meeting Documentation: Sixty-fifth World Health Assembly
21–26 May 2012
Geneva, Switzerland

The Sixty-fifth session of the World Health Assembly will take place in Geneva during 21-26 May 2012. At this session, the Health Assembly will discuss a number of public health issues such as universal health coverage, Millennium Development Goals, noncommunicable diseases, mental disorders, nutrition and adolescent pregnancy.
The Health Assembly will also discuss the programme budget, administration and management matters of WHO.

Documentation
Provisional agenda [pdf 34.4kb]
Complete documentation

[Editor’s note: we will update as below documentation supporting agenda items related broadly to immunization and global vaccines]
A65/14
Monitoring of the achievement of the health-related Millennium Development Goals
Progress in the achievement of the health-related Millennium Development Goals, and global health goals after 2015

A65/15
Monitoring the achievement of the health-related Millennium Development Goals Implementation of the recommendations of the Commission on Information and Accountability for Women’s and Children’s Health

A65/16
Social determinants of health: outcome of the World Conference on Social Determinants of Health (Rio de Janeiro, Brazil, October 2011)

A65/17
Implementation of the International Health Regulations (2005)
Report by the Director-General

A65/18
Global mass gatherings: implications and opportunities for global health security

A65/19
Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits: report of the Advisory Group

A65/20
Poliomyelitis: intensification of global eradication initiative

A65/21
Elimination of schistosomiasis

A65/23
Substandard/spurious/falsely-labelled/falsified/counterfeit medical products: report of the Working Group of Member States

A65/25
WHO’s response, and role as the health cluster lead, in meeting the growing demands of health in humanitarian emergencies

UNICEF said it joined the International Aid Transparency Initiative (IATI) “to improve public accessibility to information on how aid is spent,” joining the World Bank, Britain’s Department for International Development, the African Development Bank, the European Commission and others in the initiative. As part of its commitment to greater transparency and accountability, UNICEF will make public online the volume, allocation and results of development expenditure. This will allow better tracking of what aid is used for and what it achieves by taxpayers and those who benefit from aid. IATI provides a common, open and international standard, agreed in 2011, for publishing more and better information about aid.

http://www.unicef.org/media/media_62210.html

The Weekly Epidemiological Record (WER) 13 April 2012, vol. 87, 15 (pp 145–152) includes: Validation of maternal and neonatal tetanus elimination in Ghana, 2011

http://www.who.int/entity/wer/2012/wer8715.pdf

Twitter Watch [accessed 14 April 2012 – 15:10]
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.

Dagfinn Høybråten @Hoybraten
Thanks to Foundation Atletico de Madrid for supporting @GAVIAlliance http://pic.twitter.com/H0VYCGgl
Retweeted by GAVI Alliance
5:06 AM – 13 Apr 12

The Global Fund@globalfundnews
G8 Foreign Ministers call on Donors to support the Global Fund http://www.theglobalfund.org/en/mediacenter/pressreleases/2012-04-13_G8_Foreign_Ministers_call_on_Donors_to_support_Global_Fund_Reform_agenda_endorsed/
12:43 PM – 13 Apr 12

Partners In Health @PIH
“If cholera had exploded in the US like it did in Haiti, everybody would have gotten the
12:30 PM – 13 Apr 12

PATH MVI @MalariaVaccine
Video: Introduction to MVI’s director, Dr. David Kaslow http://bit.ly/J6Tfk4
12:15 PM – 13 Apr 12

EndPolioNow @EndPolioNow
The birth of polio eradication: the Salk Vaccine turns 57. Thank you to everyone for fighting polio. http://bit.ly/HEpoBV
5:46 PM – 12 Apr 12

PATH MVI @MalariaVaccine
Straight talk with… David Kaslow | @naturemedicine Q&A with our director http://bit.ly/HOyBIC
4:57 PM – 12 Apr 12

GAVI Alliance @GAVIAlliance
T-9: From 2011-2015, GAVI support will immunise 90M more children against pneumococcal disease. http://ht.ly/af91N #vaccineswork
3:43 PM – 12 Apr 12

Partners In Health @PIH
Vaccination Against #Cholera Finally Begins In #Haiti: http://ow.ly/aeSFU via @NPRHealth @nprnews
12:53 PM – 12 Apr 12

Orin Levine @OrinLevine
Today @IVACtweets released our Landscape Analysis of Routine #Immunization in #Nigeria read: http://bit.ly/I4nM14 #globalhealth
12:26 PM – 11 Apr 12

Arthur Caplan @ArthurCaplan
Good summary meeting at RS on engineering flu http://bit.ly/IgWHtU
11:38 AM – 11 Apr 12

IAVI @AIDSvaccine
If you missed IAVI CEO Margie McGlynn’s #wvcusa presentation yesterday, @vaccinenation has a short recap http://bit.ly/IkJ4Nk #globalhealth
10:54 AM – 11 Apr 12

Sabin Vaccine Inst. @sabinvaccine
#wvcusa Mcquestion PPt available! From paternalism to country ownership of national immunization programs http://slidesha.re/HxfmoW
10:06 AM – 11 Apr 12

USAID Global Health @USAIDGH
Close
@GAVIalliance just signed a deal to reduce rotavirus vaccine costs by 2/3, for a value of US$650M http://ow.ly/abYhA
3:27 PM – 10 Apr 12

IVAC at JHSPH @IVACtweets
New blog! Reflections on 40+ yr old @WHO docs, & how they inspire today’s #globalhealth & #vaccine efforts: http://bit.ly/Hv1kVz @dofvc
10:14 AM – 10 Apr 12

WHO/Europe @WHO_Europe
Can new media help parents to make informed #vaccination decisions?: http://youtu.be/pYbhMTyk9_g #immunization
6:33 AM – 7 Apr 12

Research: Landscape Analysis of Routine Immunization in Nigeria (LARI)

International Vaccine Access Center (IVAC)/Johns Hopkins Bloomberg School of Public Health

April 2012

The study was conducted with the collaboration of the government of Nigeria and Solina Health and identified high-impact solutions in the areas of financing and vaccine security, transportation, cold chain technology, performance management, advocacy, leadership and demand creation that together have the potential to significantly improve vaccine access. Currently, access to and availability of vaccines varies widely among the country’s 36 states and vaccine stock-outs remain common, particularly in the poorest and most remote areas.

“Nigerian government leaders have made major improvements in routine immunizations over the past three years,” said Dr. Orin Levine, Executive Director of IVAC. “But the full promise of immunization and its economic benefits won’t be fully realized until vaccines reach every Nigerian child.”

Some of the specific solutions proposed in the LARI study include the establishment of government basket funds for local immunization programs; transportation contracts and ongoing vehicle maintenance to improve delivery from state cold stores to community clinics; provision of solar refrigeration and satellite cold storage units to keep vaccines at a viable temperature despite challenges involving distance and power outages; mid-level management training to staff responsible for vaccine delivery; and text message reminders and incentive programs such as conditional cash transfers to parents to improve vaccine uptake and timeliness.

http://nigeriavaccinesummit.org/.

The World Bank announced that it will implement a new Open Access policy for its research outputs and knowledge products effective July 1, 2012. The new policy builds on recent efforts to increase access to information at the World Bank and to make its research as widely available as possible. As the first phase of this policy, the Bank launched today a new Open Knowledge Repository and adopted a set of Creative Commons copyright licenses.  World Bank Group President Robert B. Zoellick said, “Knowledge is power. Making our knowledge widely and readily available will empower others to come up with solutions to the world’s toughest problems. Our new Open Access policy is the natural evolution for a World Bank that is opening up more and more.” http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:23164491~pagePK:34370~piPK:34424~theSitePK:4607,00.html

Globalization and Health
[Accessed 14 April 2012]
http://www.globalizationandhealth.com/

Editorial
Global health funding and economic development
Martin G, Grant A and D’Agostino M Globalization and Health 2012, 8:8 (10 April 2012) [Open Access]

Abstract (provisional)
The impact of increased national wealth, as measured by Gross Domestic Product (GDP), on public health is widely understood, however an equally important but less well-acclaimed relationship exists between improvements in health and the growth of an economy. Communicable diseases such as HIV, TB, Malaria and the Neglected Tropical Diseases (NTDs) are impacting many of the world’s poorest and most vulnerable populations, and depressing economic development. Sickness and disease has decreased the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI). There is clear evidence that by investing in health improvements a significant increase in GDP per capita can be attained in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example); thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian ‘economic multiplier’ effect. Continued under-investment in health and health systems represent an important threat to our future global prosperity. This editorial calls for a recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries.

Health Affairs
April 2012; Volume 31, Issue 4
http://content.healthaffairs.org/content/current
Theme: Issues In Cancer Care: Value, Quality & Costs

How Cancer Patients Value Hope And The Implications For Cost-Effectiveness Assessments Of High-Cost Cancer Therapies
Darius N. Lakdawalla, John A. Romley, Yuri Sanchez, J. Ross Maclean, John R. Penrod, and Tomas Philipson
Health Aff April 2012 31:676-682; doi:10.1377/hlthaff.2011.1300

Abstract
Assessments of the medical and economic value of therapies in diseases such as cancer traditionally focus on average or median gains in patients’ survival. This focus ignores the value that patients may place on a therapy with a wider “spread” of outcomes that offer the potential of a longer period of survival. We call such treatments “hopeful gambles” and contrast them with “safe bets” that offer similar average survival but less chance of a large gain. Real-world therapy options do not have these stylized forms, but they can differ in the spread of survival gains that patients face. We found that 77 percent of surveyed cancer patients with melanoma, breast cancer, or other kinds of solid tumors preferred hopeful gambles to safe bets. This suggests that current technology assessments, which often determine access to such cancer therapies, may be missing an important source of value to patients and should either incorporate hope into the value of therapies or set a higher threshold for an acceptable cost-effectiveness ratio in the end-of-life context.

The Lancet  
Apr 14, 2012  Volume 379  Number 9824  p1365 – 1460 e48
http://www.thelancet.com/journals/lancet/issue/current

Correspondence
Serotype replacement after pneumococcal vaccination
Kim Mulholland, Catherine Satzke

Serotype replacement after pneumococcal vaccination
William P Hausdorff, Melissa K Van Dyke, Thierry Van Effelterre

Serotype replacement after pneumococcal vaccination
Mark J DiNubile

Serotype replacement after pneumococcal vaccination – Authors’ reply
Daniel M Weinberger, Richard Malley, Marc Lipsitch

The Lancet  
Apr 14, 2012  Volume 379  Number 9824  p1365 – 1460 e48
http://www.thelancet.com/journals/lancet/issue/current

Viewpoint
Balance between clinical and environmental responses to infectious diseases
Justin V Remais, Joseph NS Eisenberg

Preview
A child enters a village clinic in China, presenting with symptoms of lead poisoning. She is treated and the area around her house is investigated to find the source of the poisoning—an environmental response designed to prevent re-exposure. A child enters the same clinic, presenting with symptoms of acute schistosomiasis. He is treated and sent home, only to be reinfected in his contaminated community. This contrasting response to chemical and infectious environmental hazards is not an isolated example; rather, it is a reflection of the largely clinical orientation of many efforts to control infectious diseases worldwide,1 despite the potential for environmental interventions to sustainably and cost effectively limit re-exposure to environmental pathogens.

Nature Medicine
April 2012, Volume 18 No 4 pp469-630
http://www.nature.com/nm/journal/v18/n4/index.html

Q&A
Straight talk with…David Kaslow
Roxanne Khamsi
doi:10.1038/nm0412-479

Abstract
The precise human cost of malaria has come into dispute following the publication of a February paper that revised the estimated death toll to more than 1.2 million annually (Lancet 379, 413–431, 2012). But one thing that most people in the public health field can agree on is that a vaccine against malaria is necessary to make real strides against this global killer. To that effect, in 1999 the Bill & Melinda Gates Foundation funded the Malaria Vaccine Initiative (MVI) through the Program for Appropriate Technology in Health, the Seattle-based nonprofit now simply known as PATH.
Since MVI’s inception, the Washington, DC–based initiative has played an instrumental part in advancing a number of leading vaccine candidates, including RTS,S, the first to show clinical efficacy in a major phase 3 trial. Steering the ship in the next phase of the journey is David Kaslow, who joined MVI as its director in March. As former head of the Merck Research Laboratories’ vaccine pipeline and architect of the Malaria Vaccine Development Unit at the US National Institutes of Health (NIH), Kaslow spoke with Roxanne Khamsi about how his experience in the public and private sectors will help inform his decisions in the nonprofit world.

New England Journal of Medicine
April 12, 2012  Vol. 366 No. 15
http://content.nejm.org/current.shtml

Review Article
Dengue
Cameron P. Simmons, Ph.D., Jeremy J. Farrar, M.D., Ph.D., Nguyen van Vinh Chau, M.D., Ph.D., and Bridget Wills, M.D., D.M.
N Engl J Med 2012; 366:1423-1432April 12, 2012
This article has no abstract; the first 100 words appear below.

Dengue is a self-limited, systemic viral infection transmitted between humans by mosquitoes. The rapidly expanding global footprint of dengue is a public health challenge with an economic burden that is currently unmet by licensed vaccines, specific therapeutic agents, or efficient vector-control strategies. This review highlights our current understanding of dengue, including its clinical manifestations, pathogenesis, tests that are used to diagnose it, and its management and prevention.

Determinants of the Current Dengue Pandemic

The global burden of dengue is large; an estimated 50 million infections per year occur across approximately 100 countries, with potential for further spread (Figure 1).1 Central . . .

Pharmacoeconomics
May 1, 2012 – Volume 30 – Issue 5  pp: 355-445
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

Review Articles
Issues in the Economic Evaluation of Influenza Vaccination by Injection of Healthy Working Adults in the US: A Review and Decision Analysis of Ten Published Studies
Hogan, Thomas J.
Pharmacoeconomics. 30(5):355-371, May 1, 2012.
doi: 10.2165/11596890-000000000-00000

Abstract
The objective was to review recent economic evaluations of influenza vaccination by injection in the US, assess their evidence, and conclude on their collective findings.

The literature was searched for economic evaluations of influenza vaccination injection in healthy working adults in the US published since 1995. Ten evaluations described in nine papers were identified. These were synopsized and their results evaluated, the basic structure of all evaluations was ascertained, and sensitivity of outcomes to changes in parameter values were explored using a decision model. Areas to improve economic evaluations were noted.

Eight of nine evaluations with credible economic outcomes were favourable to vaccination, representing a statistically significant result compared with a proportion of 50% that would be expected if vaccination and no vaccination were economically equivalent. Evaluations shared a basic structure, but differed considerably with respect to cost components, assumptions, methods, and parameter estimates. Sensitivity analysis indicated that changes in parameter values within the feasible range, individually or simultaneously, could reverse economic outcomes. Given stated misgivings, the methods of estimating influenza reduction ascribed to vaccination must be researched to confirm that they produce accurate and reliable estimates. Research is also needed to improve estimates of the costs per case of influenza illness and the costs of vaccination.

Based on their assumptions, the reviewed papers collectively appear to support the economic benefits of influenza vaccination of healthy adults. Yet the underlying assumptions, methods and parameter estimates themselves warrant further research to confirm they are accurate, reliable and appropriate to economic evaluation purposes.

PLoS One
[Accessed 14 April 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Gender Based Within-Household Inequality in Childhood Immunization in India: Changes over Time and across Regions
Ashish Singh
PLoS ONE: Research Article, published 11 Apr 2012 10.1371/journal.pone.0035045

Abstract 
Background and Objectives
Despite India’s substantial economic growth in the past two decades, girls in India are discriminated against in access to preventive healthcare including immunizations. Surprisingly, no study has assessed the contribution of gender based within-household discrimination to the overall inequality in immunization status of Indian children. This study therefore has two objectives: to estimate the gender based within-household inequality (GWHI) in immunization status of Indian children and to examine the inter-regional and inter-temporal variations in the GWHI.

Data and Methods
The present study used households with a pair of male-female siblings (aged 1–5 years) from two rounds of National Family Health Survey (NFHS, 1992–93 and 2005–06). The overall inequality in the immunization status (after controlling for age and birth order) of children was decomposed into within-households and between-households components using Mean log deviation to obtain the GWHI component. The analysis was conducted at the all-India level as well as for six specified geographical regions and at two time points (1992–93 and 2005–06). Household fixed-effects models for immunization status of children were also estimated.

Results and Conclusions
Findings from household fixed effects analysis indicated that the immunization scores of girls were significantly lower than that of boys. The inequality decompositions revealed that, at the all-India level, the absolute level of GWHI in immunization status decreased from 0.035 in 1992–93 to 0.023 in 2005–06. However, as a percentage of total inequality, it increased marginally (15.5% to 16.5%). In absolute terms, GWHI decreased in all the regions except in the North-East. But, as a percentage of total inequality it increased in the North-Eastern, Western and Southern regions. The main conclusions are the following: GWHI contributes substantially to the overall inequality in immunization status of Indian children; and though the overall inequality in immunization status declined in all the regions, the changes in GWHI were mixed.

PLoS One
[Accessed 14 April 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Determinants of Refusal of A/H1N1 Pandemic Vaccination in a High Risk Population: A Qualitative Approach
Eugenie d’Alessandro, Dominique Hubert, Odile Launay, Laurence Bassinet, Olivier Lortholary, Yannick Jaffre, Isabelle Sermet-Gaudelus
PLoS ONE: Research Article, published 10 Apr 2012 10.1371/journal.pone.0034054

Abstract
Background
Our study analyses the main determinants of refusal or acceptance of the 2009 A/H1N1 vaccine in patients with cystic fibrosis, a high-risk population for severe flu infection, usually very compliant for seasonal flu vaccine.

Methodology/Principal Findings
We conducted a qualitative study based on semi-structured interviews in 3 cystic fibrosis referral centres in Paris, France. The study included 42 patients with cystic fibrosis: 24 who refused the vaccine and 18 who were vaccinated. The two groups differed quite substantially in their perceptions of vaccine- and disease-related risks. Those who refused the vaccine were motivated mainly by the fears it aroused and did not explicitly consider the 2009 A/H1N1 flu a potentially severe disease. People who were vaccinated explained their choice, first and foremost, as intended to prevent the flu’s potential consequences on respiratory cystic fibrosis disease. Moreover, they considered vaccination to be an indirect collective prevention tool. Patients who refused the vaccine mentioned multiple, contradictory information sources and did not appear to consider the recommendation of their local health care provider as predominant. On the contrary, those who were vaccinated stated that they had based their decision solely on the clear and unequivocal advice of their health care provider.

Conclusions/Significance
These results of our survey led us to formulate three main recommendations for improving adhesion to new pandemic vaccines. (1) it appears necessary to reinforce patient education about the disease and its specific risks, but also general population information about community immunity. (2) it is essential to disseminate a clear and effective message about the safety of novel vaccines. (3) this message should be conveyed by local health care providers, who should be involved in implementing immunization.

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_7 April 2012

– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

    The GAVI Alliance said it will now include HPV and combined measles-rubella vaccines in its portfolio for the first time as it opens a new round of applications for support from eligible countries. GAVI Alliance Board Chair Dagfinn Høybråten commented, “Making it possible for children and women in developing countries to have the same access to these life-saving vaccines as their counterparts in richer nations is what GAVI was created to do. By opening this new application round, we take another step towards our goal to avert close to four million future deaths by 2015 through immunisation. Ours is an investment that helps build healthy communities and accelerates development.”

http://www.gavialliance.org/library/news/press-releases/2012/new-vaccine-support-against-cervical-cancer-rubella/

   Rotary International President Kalyan Banerjee presented a medal to Afghan President Hamid Karzai on 2 April in Kabul, in recognition of Karzai’s support for the Global Polio Eradication Initiative. Rotary describes itself as a “spearheading partner” of the GPEI; Mr. Banerjee is the first RI president to visit Afghanistan. During their 45-minute meeting, President Karzai and Mr. Banerjee “discussed how lessons learned from India’s success might be applied in Afghanistan.”  http://www.rotary.org/en/MediaAndNews/News/Pages/120404_news_afghanistan.aspx

    The Global Fund to Fight AIDS, Tuberculosis and Malaria announced “a transformation of its grant administration with simpler procedures that make it easier to access funding and facilitates operations in the field.” Gabriel Jaramillo, General Manager of the Global Fund, said, “Significant changes to strengthen grant management and improve efficiency are reshaping the Global Fund as part of a broad transformation to raise overall effectiveness. We are building a system that starts and ends with impeccable grant management. What we do best is invest the world’s money to save lives, and this transformation will enable us to do it even better. It will strengthen our partnership with the implementers who are on the front line of the fight against the diseases.” The announcement noted that the Global Fund has made a 33 per cent increase in staff positions in the Grant Management Division, and a 38 per cent reduction in other departments, “as part of a stronger emphasis on managing the grants that fund disease prevention and treatment.”

http://www.theglobalfund.org/en/mediacenter/pressreleases/2012-04-02_Global_Fund_Transformation_to_Simplify_Procedures_for_Grant_Administration/

New Policy: US Government Issues Policy on Oversight of Life Science Dual Use Research of Concern:

The purpose of this Policy is to establish regular review of United States Government funded or conducted research with certain high-consequence pathogens and toxins for its potential to be dual use research of concern (DURC) in order to: (a) mitigate risks where appropriate; and (b) collect information needed to inform the development of an updated policy, as needed, for the oversight of DURC. The fundamental aim of this oversight is to preserve the benefits of life sciences research while minimizing the risk of misuse of the knowledge, information, products, or technologies provided by such research. (March 29, 2012)

Policy Update: Manuscripts on Transmissibility of A/H5N1 Influenza Virus

NATIONAL SCIENCE ADVISORY BOARD FOR BIOSECURITY

March 29‐30, 2012 Meeting of the National Science Advisory Board for Biosecurity to Review Revised Manuscripts on Transmissibility of A/H5N1 Influenza Virus

STATEMENT OF THE NSABB [full text]

The United States Department of Health and Human Services convened the National Science Advisory Board for Biosecurity (NSABB) on March 29‐30, 2012, to examine two revised manuscripts regarding the transmissibility of A/H5N1 influenza virus (avian flu) in ferrets. Earlier versions of these manuscripts had been submitted for publication in Science and Nature and were reviewed by the Board.

The NSABB is an independent federal advisory committee chartered to provide advice and guidance on the biosecurity oversight of dual use research to the Secretary of the Department of Health and Human Services, the Director of the National Institutes of Health, and all federal entities that conduct, support or have an interest in life sciences research. Dual use research is defined as biological research with legitimate scientific purpose that may be misused to pose a threat to public health and/or national security.

The Board was asked to consider the revised manuscripts from Dr. Ron Fouchier of Erasmus Medical Center and Dr. Yoshihiro Kawaoka of the University of Wisconsin and to recommend whether the information they contain should be communicated and, if so, to what extent. In their evaluation, the Board used analytical tools that it previously developed for considering the risks and benefits associated with the communication of dual use research of concern (available at http://www.biosecurityboard.gov). After careful deliberation, the NSABB unanimously recommended that this revised Kawaoka manuscript should be communicated in full. The NSABB also recommended, in a 12 to 6 decision, the communication of the data, methods, and conclusions presented in this revised Fouchier manuscript.

As a general principle, the NSABB strongly supports the unrestricted communication of research information unless that information could be directly misused to pose a significant and immediate risk to public health and safety. While the communication of the information in these revised manuscripts still presents dual use concerns, the additional information changed the Board’s risk/benefit calculation.

– The data described in the revised manuscripts do not appear to provide information that would immediately enable misuse of the research in ways that would endanger public health or national security.

– New evidence has emerged that underscores the fact that understanding specific mutations may improve international surveillance and public health and safety. Global cooperation, critical for pandemic influenza preparedness efforts, is predicated upon the free sharing of information and was a fundamental principle in evaluating these manuscripts.

The Board’s recommendations were informed by the newly released United States Government Policy for Oversight of Life Sciences Dual Use Research of Concern. This policy applies to federally funded life sciences research and will ensure that dual use concerns are addressed during evaluation of ongoing and future research on A/H5N1 influenza virus.

As a part of these deliberations, the Board emphasized the urgent need for the further development of processes for the responsible communication of dual use research of concern. It noted that improving public health and safety will require a sustained global approach to addressing dual use concerns presented by life sciences research while encouraging a robust research enterprise.

The NSABB recommendations from this meeting will be forwarded to the U.S. Government for review and consideration.

http://oba.od.nih.gov/oba/biosecurity/PDF/NSABB_Statement_March_2012_Meeting.pdf

New Policy: US Government Issues Policy on Oversight of Life Science Dual Use Research of Concern:

The purpose of this Policy is to establish regular review of United States Government funded or conducted research with certain high-consequence pathogens and toxins for its potential to be dual use research of concern (DURC) in order to: (a) mitigate risks where appropriate; and (b) collect information needed to inform the development of an updated policy, as needed, for the oversight of DURC. The fundamental aim of this oversight is to preserve the benefits of life sciences research while minimizing the risk of misuse of the knowledge, information, products, or technologies provided by such research. (March 29, 2012)

Meeting/Webcast: H5N1 research: biosafety, biosecurity and bioethics

The Royal Society, London  03-04 April 2012

An international scientific meeting to discuss the practice and policy of H5N1 research, with a programme of talks and discussions organised by Professor John Skehel FRS and Professor Simon Wain-Hobson with a particular focus on the papers that Nature and Science have in review for publication. Biographies of the organisers and speakers are available here: download the programme (PDF). Video recordings of the presentations will be available from this website within the next two weeks.

Organised by the Royal Society in partnership with the Academy of Medical Sciences and the Foundation for Vaccine Research with support from the American Society for Microbiology, the Bill & Melinda Gates Foundation, Fondation Mérieux, the German National Academy of Sciences Leopoldina, Institut Pasteur, and the Society for General Microbiology.

http://royalsociety.org/events/2012/viruses/

The Weekly Epidemiological Record (WER) for 6 April 2012, vol. 87, 14 (pp 129–144) includes: Pneumococcal vaccines – WHO position paper – 2012

http://www.who.int/entity/wer/2012/wer8714.pdf

The MMWR Weekly for April 6, 2012 / Vol. 61 / No. 13 includes:
– Outbreak of Meningococcal Disease Associated with an Elementary School — Oklahoma, March 2010

– Influenza Outbreaks at Two Correctional Facilities — Maine, March 2011

WHO Meeting: First European Conference on Patient Empowerment

Place: Copenhagen, Denmark
Date: 11–12 April 2012

The First European Conference on Patient Empowerment will address how patient and citizen empowerment can contribute to the future of health and social care in Europe.

Increased access to information and knowledge, social media, self-management programmes, new legal requirements for patient involvement, reorganization of health care systems, new technologies – all contribute to a new dynamic where patients and citizens are redefining their role in living with chronic disease.

The conference is organized in close technical collaboration with the WHO Regional Office for Europe under the auspices of the Danish Presidency of the Council of the European Union – the Danish Ministry of Health, the National Board of Health, Danish Committee for Health Education, Careum Foundation Switzerland and Expert Patient Programme, England.

http://www.who.int/mediacentre/events/meetings/2012/patient_empowerment/en/index.html

Twitter Watch [accessed 7 April 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.

WHO ‏ @WHO
More than 17 500 people viewed WHO’s World Health Day video http://goo.gl/2fNqp. Can you top 20 000?
2:26 AM – 7 Apr 12

WHO ‏ @WHO
Yeah, today, 7 April, is World Health Day. We also celebrate the World Health Organization’s 65th birthday. We #AddHealth2Life!
2:20 AM – 7 Apr 12

UNICEF ‏ @UNICEF
Meet the #polio fighters in #Nigeria! http://uni.cf/HiUdQi @unicefafrica
2:55 PM – 6 Apr 12

MorbillivirusRubeola ‏ @Rubeola
#MEasles news: Dutch Soccer Fans Advised to Get Measles Jab for Championship http://bloom.bg/Hx9WE2 #pathogenposse
Retweeted by VaccinesToday
12:03 PM – 5 Apr 12

VaccinesToday ‏ @VaccinesToday
Salk, Sabin and the Race Against Polio http://blogs.smithsonianmag.com/history/2012/04/salk-sabin-and-the-race-against-polio/ via @SmithsonianMag
6:09 AM – 5 Apr 12

Dr. Tom Frieden ‏ @DrFriedenCDC
Did you know? 75% of emerging infectious diseases affecting humans are of animal origin http://www.cdc.gov/ncezid #CDC247 #NPHW2012
Retweeted by CDCgov
12:09 PM – 4 Apr 12

Report: Australian Multilateral Assessment (AMA)
Australian Government
March 2012

   AusAid released the Australian Multilateral Assessment (AMA), an analyses of the effectiveness of 42 multilateral organisations, including United Nations agencies and global and regional development banks funded through the Australian aid program. Around 40 per cent of Australia’s aid budget is currently delivered through multilateral organisations. The AMA provides information that the Australian Government will use to guide future decisions on funding and to ensure that it delivers development results for the world’s poorest people. The AMA found that for 29 of the 42 organisations assessed, the Australian Government “could have a high degree of confidence that increases in funding represent value for money.”

Other key findings were:
– coordination is improving across the multilateral system but more is needed

– the UN ‘Delivering as One’ approach should become the norm

– joint assessments of multilateral effectiveness can be strengthened

– 15 of the 42 organisations assessed have reform efforts underway

– organisations are investing heavily in their capacity to measure and report on results

– in some cases more focus is needed on ‘value for money’ and cost effectiveness varies at country and regional levels

This is the first time the Australian aid program has undertaken such a comprehensive assessment of multilateral funding. The individual reports include analysis of the GAVI Alliance, The Global Fund, UNAIDS, UNICEF, WHO, and the World Bank, among others: http://www.ausaid.gov.au/publications/pubout.cfm?ID=7373_9810_453_4167_7175&Type=

http://www.ausaid.gov.au/hottopics/topic.cfm?ID=864_3564_3247_5781_2569&From=HT

Book: Adverse Effects of Vaccines: Evidence and Causality

Authors: Kathleen Stratton, Andrew Ford, Erin Rusch, and Ellen Wright Clayton

Editors; Committee to Review Adverse Effects of Vaccines; Institute of Medicine

In 1900, for every 1,000 babies born in the United States, 100 would die before their first birthday, often due to infectious diseases. Today, vaccines exist for many viral and bacterial diseases. The National Childhood Vaccine Injury Act, passed in 1986, was intended to bolster vaccine research and development through the federal coordination of vaccine initiatives and to provide relief to vaccine manufacturers facing financial burdens. The legislation also intended to address concerns about the safety of vaccines by instituting a compensation program, setting up a passive surveillance system for vaccine adverse events, and by providing information to consumers. A key component of the legislation required the U.S. Department of Health and Human Services to collaborate with the Institute of Medicine to assess concerns about the safety of vaccines and potential adverse events, especially in children.
Adverse Effects of Vaccines reviews the epidemiological, clinical, and biological evidence regarding adverse health events associated with specific vaccines covered by the National Vaccine Injury Compensation Program (VICP), including the varicella zoster vaccine, influenza vaccines, the hepatitis B vaccine, and the human papillomavirus vaccine, among others. For each possible adverse event, the report reviews peer-reviewed primary studies, summarizes their findings, and evaluates the epidemiological, clinical, and biological evidence. It finds that while no vaccine is 100 percent safe, very few adverse events are shown to be caused by vaccines. In addition, the evidence shows that vaccines do not cause several conditions. For example, the MMR vaccine is not associated with autism or childhood diabetes. Also, the DTaP vaccine is not associated with diabetes and the influenza vaccine given as a shot does not exacerbate asthma.

Adverse Effects of Vaccines will be of special interest to the National Vaccine Program Office, the VICP, the Centers for Disease Control and Prevention, vaccine safety researchers and manufacturers, parents, caregivers, and health professionals in the private and public sectors.

http://books.nap.edu/catalog.php?record_id=13164&utm_medium=etmail&utm_source=The%20National%20Academies%20Press&utm_campaign=NAP+mail+new+4.03.12+A&utm_content=&utm_term=

Annals of Internal Medicine
April 3, 2012; 156 (7)
http://www.annals.org/content/current

Antivirals for Treatment of Influenza: A Systematic Review and Meta-analysis of Observational Studies
Jonathan Hsu, Nancy Santesso, Reem Mustafa, Jan Brozek, Yao Long Chen, Jessica P. Hopkins, Adrienne Cheung, Gayane Hovhannisyan, Liudmila Ivanova, Signe A. Flottorp,
Ingvil Sæterdal, Arthur D. Wong, Jinhui Tian, Timothy M. Uyeki, Elie A. Akl, Pablo Alonso-Coello, Fiona Smaill, and Holger J. Schünemann
Ann Intern Med April 3, 2012 156:512-524; published ahead of print February 27, 2012,

Abstract
Antiviral therapy may reduce complications and mortality associated with influenza, but there have been concerns that randomized trials might not reflect that. This review of 74 observational studies found that oral oseltamivir may reduce mortality in high-risk populations compared with no treatment. Either oral oseltamivir or inhaled zanamivir might reduce hospitalizations and symptom duration. Costs and targeting strategies, however, were not evaluated. The studies focused on drug-sensitive infections, so the results may not be applicable if antiviral-resistant viruses are prevalent. Antivirals might improve outcomes in some situations, but more evidence is needed to guide decision making about when and in whom to use particular agents.