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_29 September 2012

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

– Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…

GPEI Media Release: Global Luminaries Unite to Issue Urgent Call for a Polio-Free World
“…The high-level event, “Our Commitment to the Next Generation: The Legacy of a Polio-free World,” featured opening remarks from UN Secretary-General Ban Ki-moon and was moderated by Senator Timothy E. Wirth, president of the UN Foundation.
“Speakers included leaders of the three polio-endemic countries: President Hamid Karzai, Islamic Republic of Afghanistan; President Goodluck Jonathan, Federal Republic of Nigeria; and President Asif Ali Zardari, Islamic Republic of Pakistan. Earlier this year, these leaders launched national emergency plans to stop transmission of polio in their countries…”
http://www.polioeradication.org/tabid/461/iid/251/Default.aspx

 
Statement: UN Secretary-General’s remarks at side event on Polio Eradication
New York, 27 September 2012: http://www.un.org/sg/statements/index.asp?nid=6328

 
Joint Media Release: Leaders at UN event unite behind final push to eradicate polio
7 September 2012 – World leaders, donors and experts today hailed a “once-in-a-generation” opportunity to eradicate polio, as they gathered at the United Nations to celebrate efforts that have already reduced the incidence of the crippling and potentially fatal disease by 99 per cent around the globe.

“Globally, we have the lowest number of cases reported this year,” Secretary-General Ban Ki-moon told the high-level event on polio eradication, which took place on the sidelines of the General Assembly debate at UN Headquarters in New York.

“But everything hinges on stopping polio in a few districts in Nigeria, Pakistan and Afghanistan,” he said, referring to the three remaining countries where the disease is endemic.

The vaccine-preventable infectious disease raged in 125 countries when the global fight against it began in 1988 under the banner of the Global Polio Eradication Initiative (GPEI). While India had long been regarded as the nation facing the greatest challenges to eradication, it has been polio free for more than 18 months.

But Mr. Ban said the success of the final push depended on the “quality” of the world’s efforts in those remaining areas.

He called not only for close cooperation from government, religious, traditional and community leaders, but also for belligerents to play their part in helping end the disease.

“Where there is fighting and insecurity, we need warring parties to allow aid workers to operate,” he told the gathering, which included the participation of Presidents Hamid Karzai of Afghanistan, Goodluck Jonathan of Nigeria and Asif Ali Zardari of Pakistan. “I appeal to all parties to provide safe passage for health workers to access and vaccinate children.”

Polio is among five major afflictions Mr. Ban pledged to aggressively tackle during this, his second term as Secretary-General. He is also committed to tackling malaria, new paediatric HIV infections, maternal and neonatal tetanus, and measles.

“This is a matter of health and justice. Every child should have the right to start life with equal protection from these diseases,” Mr. Ban said.

The World Health Organization (WHO) spearheads the GPEI, whose ultimate success would mark an early milestone in the Decade of Vaccines, which in turn represents a global vision to provide all children with the vaccines they need.

“No single one of us can bring this long, hard drive over the last hurdle,” WHO Director-General Margaret Chan said. “But together we can.”

A major GPEI donor is the Bill & Melinda Gates Foundation, whose co-chair, Bill Gates, also spoke of the significance eradicating polio would have for combating other diseases. “When we defeat polio, it will motivate us to aim for other great health and development milestones,” he said.

GPEI is currently developing a long-term roadmap for ending polio through a strategy whose investment legacy will benefit other vaccine-preventable disease goals. This comes after 194 States of the World Health Assembly declared the final push towards polio eradication to be a “programmatic emergency for global public health.”

“Governments need to step up and honour their commitments,” Wilfred J. Wilkinson, Chair of Rotary Foundation Trustees, told today’s gathering. For its part, Rotary International, which already has contributed $1.2 billion to polio eradication, announced additional funding of $75 million over three years for GPEI.

Pledges, initiatives and simple reinforcement of commitments came from a host of leaders and senior government officials, including those of Australia, Canada, Japan, Pakistan, the United Kingdom and the United States.

The Islamic Development Bank, a new donor to the polio eradication effort, announced a three-year $227 million financing package to Pakistan, and a $3 million grant for Afghanistan.

Sandro Rosell, President, Football Club Barcelona (FCB) and FCB Foundation, announced the club’s engagement on the polio issue in collaboration with the Gates Foundation and Etisalat, the largest telecomm operator in the Middle East.

Among significant related upcoming events, some 60,000 people are expected to attend a concert in New York’s Central Park on 29 September. The organizers, Global Poverty Project, say their Global Citizen Festival aims to inspire a global movement to voice support for both eradicating polio and for advancing the group’s core cause, ending extreme poverty.

http://www.un.org/apps/news/story.asp?NewsID=43081&Cr=polio&Cr1=#.UGdvd67vwbQ

Update: Polio this week – As of 25 Sep 2012
Global Polio Eradication Initiative

[Editor’s Extract]
Afghanistan
One new case was reported in the past week (WPV1 from Kandahar), bringing the total number of cases for 2012 to 18. It is the most recent case in the country and had onset of paralysis on 28 August…

Nigeria
Two new cases were reported in the past week (WPV1s from Kaduna and Jigawa), bringing the total number of cases for 2012 to 90. The case from Kaduna is the most recent in the country and had onset of paralysis on 1 September…

Pakistan
Two new cases were reported in the past week (WPV1s from Khyber Pakhtunkhwa – KP – and Federally Administered Tribal Areas), bringing the total number of cases for 2012 to 37. The most recent case had onset of paralysis on 30 August (WPV1 from KP)…

http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

Media Release: Most of world will fail to meet goals for women’s and children’s health by 2015 amid declining donor funding
iERG on Information and Accountability for Women’s and Children’s Health
26 September 2012

The first report of the UN Secretary-General’s independent Expert Review Group (iERG)* on Information and Accountability for Women’s and Children’s Health, to be launched on September 26 at the UN General Assembly, concludes that although headline reductions in maternal and child mortality during the past decade have been impressive in some countries, millions of women and children still die every year from preventable causes. Unless those causes are more urgently addressed globally and in countries, Millennium Development Goals (MDGs) 4 and 5 will not be met by most nations by the target year of 2015. What is more, declining rates of donor funding and a failure to target resources to the countries with the greatest need could have devastating consequences for the survival of millions of women and children worldwide.

http://www.who.int/pmnch/media/news/2012/20120926_ierg_pr/en/index.html

Post: DoV Collaboration Leadership commits to making DoV vision a reality

September 25th, 2012

This pledge proclaims the commitment by the Decade of Vaccines Collaboration Leadership Council to make the vision of the Decade of Vaccines a reality through the implementation of the Global Vaccine Action Plan (GVAP). This pledge also shows the DoV Collaboration’s commitment to the principles of Every Woman Every Child.

The Decade of Vaccines is a vision to reach all people with the vaccines they need. The Leadership Council of the Decade of Vaccines has made a commitment to this vision and asks for your organization’s pledge to improve the health and lives of women and children everywhere by systematically addressing their unmet needs in immunization. Immunization throughout a person’s lifetime is crucial if we are to achieve the ambitious goals of the UN Secretary General’s Global Strategy for Women’s and Children’s Health.

As representatives of the numerous organizations that worked on the Decade of Vaccines Collaboration, we are proud to say that millions of lives will be saved thanks to the promise of the Global Vaccine Action Plan, an ambitious roadmap approved by the World Health Assembly in May 2012 to deliver universal access to immunizations.

The leadership of the World Health Organization, UNICEF, the Bill & Melinda Gates Foundation, the GAVI Alliance, the U.S. National Institute of Allergy and Infectious Diseases, the African Leaders Malaria Alliance and others that formed the Decade of Vaccines Collaboration, have pledged our support to this joint effort. Many governments, health leaders, non-government organizations and other agencies have joined us.

We are all committed to improving the health of every woman and every child on the planet.     Our vision to achieve this is straightforward: We will work together to extend, by 2020 and beyond, the full benefits of immunization to all people, regardless of where they are born, who they are or where they live. We will use the powerful tools already available to most, but not yet all people, including existing and new vaccines that prevent disease and save lives.

We have achieved many things through immunization: We eradicated smallpox from the world, in what has been called one of mankind’s greatest triumphs. We are on the verge of eradicating polio, and the toll of other diseases has dropped tremendously. The Region of the Americas has eliminated measles and rubella, saving many lives.

Despite these accomplishments, and the lives that have been improved through immunization, we cannot rest while the lives of so many depend on our actions at this seminal moment. We must reach forward, work together and make this vision of the Decade of Vaccines a reality. We all have a role in making this happen. We ask that you make your voices heard and your actions count, in support of the Global Vaccine Action Plan.

http://www.dovcollaboration.org/dov-collaboration-updates/dov-collaboration-leadership-commits-to-making-dov-vision-a-reality/

[Editor’s Note: While no individual names are included in the pledge above, the DoV leadership is listed here: http://www.dovcollaboration.org/about-us/our-structure/ ]

IVI Director General Christian Loucq, MD announced that Dr. Alejandro Cravioto will join IVI as Chief Scientific Officer (CSO) effective October 15, 2012. As CSO, Dr. Cravioto will “assume responsibility for the oversight of all scientific affairs at IVI and will provide expert advice on matters relevant to vaccine science and technology, potential opportunities, and emerging orientations and trends in the field of vaccine research.” IVI noted that Dr. Cravioto brings a breadth of experience that will be critical for the further development of IVI.  For the past 7 years, he was the Deputy Director and Executive Director of ICDDR,B in Dhaka, Bangladesh. In 2011, he was appointed by the UN Secretary General Ban Ki-moon to head a panel investigating the cholera outbreak in Haiti. Dr. Cravioto is a Mexican National who obtained his MD at the Faculty of Medicine of the National Autonomous University of Mexico. He trained as  a Pediatrician (National Institute of Pediatric, Mexico City) and received a Diploma in Tropical Public Health and a Ph.D. at the London School of Hygiene and Tropical Medicine. While in Mexico Dr. Cravioto served as Head of the Research Department and Deputy Director of the National Institute of Health and Technology for Child Health. He later became Director of the Division of Microbiology at the National Institute of Public Health of Cuernavaca and Professor and Chair of the Department of Public Health of the Faculty of Medicine of the National Autonomous University of Mexico before being appointed as the Dean of the Faculty of Medicine from 1995 to 2003.

[IVI email announcement, 27 September 2012]

Atreca, Inc. announced a collaboration with the Bill & Melinda Gates Foundation to accelerate the discovery and development of novel vaccines and therapeutics for human infectious diseases. The US$6 million BMGF investment “…provides Atreca an opportunity to apply its Immune Repertoire Capture technology to meet key challenges in global health.” This technology “leverages next-generation sequencing to identify rapidly and comprehensively the set of functional antibodies produced in patients during an immune response. These antibodies both have utility themselves and can be employed to identify the targets of an immune response.  Applied to human disease, Immune Repertoire Capture is an engine for the discovery and development of antibody-based therapeutics, vaccines, diagnostics, and research reagents.  Atreca recently licensed exclusive rights to the technology for all fields of use from Stanford University.” Atreca is a privately held biopharmaceutical founded in 2010 with headquarters in San Carlos, California.

http://www.atreca.com/press/september-25-2012/

In a joint announcement, the Global Network for Neglected Tropical Diseases, the Sabin Vaccine Institute, and the Association of Research-Based Pharmaceutical Companies (vfa),  said “global health advocates and the pharmaceutical industry came together (in Berlin) to discuss strategies for improved collaboration and increased private sector involvement in neglected tropical disease (NTD) treatment and control programs. The announcement said the experts from WHO, BMGF, vfa, Merck KGaA, Merck & Co., Inc., Eisai Co. Ltd., Bayer HealthCare, Sanofi, and the British Parliament “exchanged new ideas and called for expanded partnerships in order to meet WHO’s target to control and eliminate the most common NTDs by 2020.” The workshop also evaluated progress made since the “London Declaration,” including drug donations from pharmaceutical companies, donor government support for NTD programs and new research and development initiatives. The group also discussed the need for new partnerships between the private sector and non-governmental organizations (NGOs) in order to create treatment models that will ultimately allow endemic countries to manage their NTD programs.

http://www.prnewswire.com/news-releases/industry-ngos-share-joint-progress-on-neglected-tropical-disease-control-171730051.html

WHO Europe: Updates

Pilot testing of behaviour-based immunization toolkit enters second phase in Bulgaria
27-09-2012
The second phase of a pilot project on implementation of a toolkit focused on vaccination behaviours among vulnerable populations took place in Sofia, Bulgaria, on 10–14 September 2012.  This second mission was dedicated to testing the formative phase of the toolkit.

European Immunization Week 2012 in review
26-09-2012
In 2012, all 53 Member States in the WHO European Region took part in European Immunization Week (EIW), a milestone in the initiative’s seven-year history. The 2012 campaign focused on the elimination of measles and rubella by 2015, and the vital role of health workers as the most trusted source of information about vaccines.

WHO contributes to strengthening Bulgaria’s vaccine regulatory system
24-09-2012
From 1 to 4 October 2012 WHO will conduct a reassessment of Bulgaria’s national regulatory authority (NRA) responsible for the regulatory oversight of vaccines. This is a key and mandatory step in the WHO vaccine prequalification procedure.

The MMWR Weekly for September 28, 2012 / Vol. 61 / No. 38 includes:

– Influenza Vaccination Coverage Among Health-Care Personnel — 2011–12 Influenza Season, United States
Extract
“Influenza vaccination of health-care personnel (HCP) is recommended by the Advisory Committee on Immunization Practices (ACIP) (1). Vaccination of HCP can reduce morbidity and mortality from influenza and its potentially serious consequences among HCP, their family members, and their patients (1–3). To provide timely estimates of influenza vaccination coverage and related data among HCP for the 2011–12 influenza season, CDC conducted an Internet panel survey with 2,348 HCP during April 2–20, 2012. This report summarizes the results of that survey, which found that, overall, 66.9% of HCP reported having had an influenza vaccination for the 2011–12 season. By occupation, vaccination coverage was 85.6% among physicians, 77.9% among nurses, and 62.8% among all other HCP participating in the survey. Vaccination coverage was 76.9% among HCP working in hospitals, 67.7% among those in physician offices, and 52.4% among those in long-term care facilities (LTCFs). Among HCP working in hospitals that required influenza vaccination, coverage was 95.2%; among HCP in hospitals not requiring vaccination, coverage was 68.2%. Widespread implementation of comprehensive HCP influenza vaccination strategies is needed, particularly among those who are not physicians or nurses and who work in LTCFs, to increase HCP vaccination coverage and minimize the risk for medical-care–acquired influenza illnesses…”

– Influenza Vaccination Coverage Among Pregnant Women — 2011–12 Influenza Season, United States

– Influenza A (H3N2) Variant Virus-Related Hospitalizations — Ohio, 2012

– Postvaccination Serologic Testing Results for Infants Aged ≤24 Months Exposed to Hepatitis B Virus at Birth — United States, 2008–2011

– Announcements: Final State-Level 2011–12 Influenza Vaccination Coverage Estimates Available Online

WHO: Vaccinate dogs to save human lives – World Rabies Day 2012
On 28 September – World Rabies Day – rabies experts at WHO and around the world are highlighting dog vaccination programmes as the most effective way to reduce the risk of this disease that kills around 50 000 people every year.
September 2012
http://www.who.int/features/2012/world_rabies_day/en/index.html

CDC: World Rabies Day
Raising Rabies Awareness
September 28 is World Rabies Day, a global health observance that seeks to raise awareness about rabies and enhance prevention and control efforts. Co-sponsored by CDC and the Alliance for Rabies Control (ARC) since 2007, World Rabies Day has been celebrated in countries throughout the world, including the U.S.

World Rabies Day is an excellent time to take steps that can help prevent and control rabies, such as vaccinating pets including dogs and cats and providing education on how to avoid the animals that typically transmit rabies: raccoons, bats, skunks, and foxes.
http://www.cdc.gov/worldrabiesday/

The Weekly Epidemiological Record (WER) for 28 September 2012, vol. 87, 39 (pp. 369–380) includes:

– Meetings of the WHO working group on surveillance of influenza antiviral susceptibility – Geneva, November 2011 and June 2012
– Meeting of the WHO working group on polymerase chain reaction protocols for detecting subtype influenza A viruses – Geneva, June 2012
– Monthly report on dracunculiasis cases, January–June 2012

http://www.who.int/entity/wer/2012/wer8739.pdf

WHO: Global Alert and Response (GAR)
Disease Outbreak News
Most recent news items

– 29 September 2012
Novel coronavirus infection – update – revised interim case definition

– 28 September 2012
Novel coronavirus infection – update

– 27 September 2012
Ebola outbreak in Democratic Republic of Congo – update

– 25 September 2012
Novel coronavirus infection – update

WHO: Vaccine Reaction Rates Information Sheets
The information sheets on this page provide details on reaction rates of selected vaccines – whether single antigen or combined in a single product. WHO’s Immunization, Vaccines and Biologicals department has developed these sheets within its priority area supporting the introduction of vaccines in Member States.

The papers are primarily designed for use by national public health officials and immunization programme managers but may appeal to others interested in such information. Data from these sheets can be used for the evaluation of Adverse Events Following Immunization (AEFI) reported during national immunization programmes, but also for preparing communication materials about specific vaccines.

http://www.who.int/vaccine_safety/initiative/tools/vaccinfosheets/en/index.html

Eurosurveillance
Volume 17, Issue 39, 27 September 2012
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Perspectives
I-MOVE: a European network to measure the effectiveness of influenza vaccines
by M Valenciano, BC Ciancio, on behalf of the I-MOVE study team

Since 2007, the European Centre for Disease Prevention and Control (ECDC) has supported I-MOVE (influenza monitoring vaccine effectiveness), a network to monitor seasonal and pandemic influenza vaccine effectiveness (IVE) in the European Union (EU) and European Economic Area (EEA). To set up I-MOVE, we conducted a literature review and a survey on methods used in the EU/EEA to measure IVE and held expert consultations to guide the development of generic protocols to estimate IVE in the EU/EEA. On the basis of these protocols, from the 2008/09 season, I-MOVE teams have conducted multicentre case–control, cohort and screening method studies, undertaken within existing sentinel influenza surveillance systems. The estimates obtained include effectiveness against medically attended laboratory-confirmed influenza and are adjusted for the main confounding factors described in the literature. I-MOVE studies are methodologically sound and feasible: the availability of various study designs, settings and outcomes provides complementary evidence, facilitating the interpretation of the results. The IVE estimates have been useful in helping to guide influenza vaccine policy at national and European level. I-MOVE is a unique platform for exchanging views on methods to estimate IVE. The scientific knowledge and experience in practical, managerial and logistic issues can be adapted to monitor surveillance of the effectiveness of other vaccines.

Journal of Medical Ethics
October 2012, Volume 38, Issue 10
http://jme.bmj.com/content/current

Research ethics
A randomised controlled trial to compare opt-in and opt-out parental consent for childhood vaccine safety surveillance using data linkage
Jesia G Berry, Philip Ryan, Michael S Gold, Annette J Braunack-Mayer, Katherine M Duszynski, for the Vaccine Assessment Using Linked Data (VALiD) Working Group
J Med Ethics 2012;38:619-625 Published Online First: 19 April 2012 doi:10.1136/medethics-2011-100145

Abstract
Introduction No consent for health and medical research is appropriate when the criteria for a waiver of consent are met, yet some ethics committees and data custodians still require informed consent.

Methods A single-blind parallel-group randomised controlled trial: 1129 families of children born at a South Australian hospital were sent information explaining data linkage of childhood immunisation and hospital records for vaccine safety surveillance with 4 weeks to opt in or opt out by reply form, telephone or email. A subsequent telephone interview gauged the intent of 1026 parents (91%) in relation to their actions and the sociodemographic differences between participants and non-participants in each arm.

Results The participation rate was 21% (n=120/564) in the opt-in arm and 96% (n=540/565) in the opt-out arm (χ2 (1 df) = 567.7, p<0.001). Participants in the opt-in arm were more likely than non-participants to be older, married/de facto, university educated and of higher socioeconomic status. Participants in the opt-out arm were similar to non-participants, except men were more likely to opt out. Substantial proportions did not receive, understand or properly consider study invitations, and opting in or opting out behaviour was often at odds with parents’ stated underlying intentions.

Conclusions The opt-in approach resulted in low participation and a biased sample that would render any subsequent data linkage unfeasible, while the opt-out approach achieved high participation and a representative sample. The waiver of consent afforded under current privacy regulations for data linkage studies meeting all appropriate criteria should be granted by ethics committees, and supported by data custodians.

Trial registration number Australian New Zealand Clinical Trials Registry ACTRN12610000332022.

The Lancet  
Sep 29, 2012  Volume 380  Number 9848  p1121 – 1202
http://www.thelancet.com/journals/lancet/issue/current

Comment
The Countdown for 2015: what lies ahead?
Zulfiqar A Bhutta, Mickey Chopra

Preview
As the 2015 deadline for achieving the Millennium Development Goals (MDGs) approaches, there is a growing sense of urgency to accelerate progress, especially for reducing child and maternal deaths. The most recent Countdown Report1 suggests that at the present rate of progress 23 (31%) of 75 countries are on track to achieve the MDG 4 target for child survival, whereas only nine (12%) are projected to reach the MDG 5 target for maternal mortality. Other estimates from the Institute of Health Metrics and Evaluation2 suggest that only nine and four of the 75 countries are expected to reach the MDG 4 and MDG 5 targets, respectively, by 2015.

Articles
How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys
Cesar G Victora, Aluisio JD Barros, Henrik Axelson, Zulfiqar A Bhutta, Mickey Chopra, Giovanny VA França, Kate Kerber, Betty R Kirkwood, Holly Newby, Carine Ronsmans, J Ties Boerma

Summary
Background
Achievement of global health goals will require assessment of progress not only nationally but also for population subgroups. We aimed to assess how the magnitude of socioeconomic inequalities in health changes in relation to different rates of national progress in coverage of interventions for the health of mothers and children.

Methods
We assessed coverage in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. We calculated changes in overall coverage of skilled birth attendants, measles vaccination, and a composite coverage index, and examined coverage of a newly introduced intervention, use of insecticide-treated bednets by children. We stratified coverage data according to asset-based wealth quintiles, and calculated relative and absolute indices of inequality. We adjusted correlation analyses for time between surveys and baseline coverage levels.

Findings
We included 35 countries with surveys done an average of 9·1 years apart. Pro-rich inequalities were very prevalent. We noted increased coverage of skilled birth attendants, measles vaccination, and the composite index in most countries from the first to the second survey, while inequalities were reduced. Rapid changes in overall coverage were associated with improved equity. These findings were not due to a capping effect associated with limited scope for improvement in rich households. For use of insecticide-treated bednets, coverage was high for the richest households, but countries making rapid progress did almost as well in reaching the poorest groups. National increases in coverage were primarily driven by how rapidly coverage increased in the poorest quintiles.

Interpretation
Equity should be accounted for when planning the scaling up of interventions and assessing national progress.

Funding
Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Brazil, Canada, Norway, Sweden, and UK.

Countdown to 2015: changes in official development assistance to maternal, newborn, and child health in 2009–10, and assessment of progress since 2003
Justine Hsu, Catherine Pitt, Giulia Greco, Peter Berman, Anne Mills

Summary
Background
Tracking of financial resources to maternal, newborn, and child health provides crucial information to assess accountability of donors. We analysed official development assistance (ODA) flows to maternal, newborn, and child health for 2009 and 2010, and assessed progress since our monitoring began in 2003.

Methods
We coded and analysed all 2009 and 2010 aid activities from the database of the Organisation for Economic Co-operation and Development, according to a functional classification of activities and whether all or a proportion of the value of the disbursement contributed towards maternal, newborn, and child health. We analysed trends since 2003, and reported two indicators for monitoring donor disbursements: ODA to child health per child and ODA to maternal and newborn health per livebirth. We analysed the degree to which donors allocated ODA to 74 countries with the highest maternal and child mortality rates (Countdown priority countries) with time and by type of donor.

Findings
Donor disbursements to maternal, newborn, and child health activities in all countries continued to increase, to $6511 million in 2009, but slightly decreased for the first time since our monitoring started, to $6480 million in 2010. ODA for such activities to the 74 Countdown priority countries continued to increase in real terms, but its rate of increase has been slowing since 2008. We identified strong evidence that targeting of ODA to countries with high rates of maternal mortality improved from 2005 to 2010. Targeting of ODA to child health also improved but to a lesser degree. The share of multilateral funding continued to decrease but, relative to bilaterals and global health initiatives, was better targeted.

Interpretation
The recent slowdown in the rate of funding increases is worrying and likely to partly result from the present financial crisis. Tracking of donor aid should continue, to encourage donor accountability and to monitor performance in targeting aid flows to those in most need.

Funding
Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Canada, Norway, Sweden, and the UK.

The Lancet Infectious Disease
Oct 2012  Volume 12  Number 10  p737 – 816  e1
http://www.thelancet.com/journals/laninf/issue/current

Comment
A vaccine to prevent epidemic meningitis in Africa
Brian Greenwood, James M Stuart

Preview
Epidemics of meningococcal meningitis continue to occur at frequent but irregular intervals in countries of the African meningitis belt.1 Most of these large epidemics are caused by meningococci belonging to serogroup A. For the past three decades, control of epidemic meningitis in Africa has relied on reactive vaccination initiated only after the incidence of meningitis in a particular district or region has passed the epidemic threshold.2 This approach has prevented many cases but it has not reduced the frequency of epidemics because the polysaccharide vaccines used in these campaigns are poorly immunogenic in young children, do not induce immunological memory, and have little or no effect on pharyngeal carriage.

Articles
Serogroup A meningococcal conjugate vaccination in Burkina Faso: analysis of national surveillance data
Ryan T Novak, Jean Ludovic Kambou, Fabien VK Diomandé, Tiga F Tarbangdo, Rasmata Ouédraogo-Traoré, Lassana Sangaré, Clement Lingani, Stacey W Martin, Cynthia Hatcher, Leonard W Mayer, F Marc LaForce, Fenella Avokey, Mamoudou H Djingarey, Nancy E Messonnier, Sylvestre R Tiendrébéogo, Thomas A Clark

Summary
Background
An affordable, highly immunogenic Neisseria meningitidis serogroup A meningococcal conjugate vaccine (PsA—TT) was licensed for use in sub-Saharan Africa in 2009. In 2010, Burkina Faso became the first country to implement a national prevention campaign, vaccinating 11·4 million people aged 1—29 years. We analysed national surveillance data around PsA—TT introduction to investigate the early effect of the vaccine on meningitis incidence and epidemics.

Methods
We examined national population-based meningitis surveillance data from Burkina Faso using two sources, one with cases and deaths aggregated at the district level from 1997 to 2011, and the other enhanced with results of cerebrospinal fluid examination and laboratory testing from 2007 to 2011. We compared mortality rates and incidence of suspected meningitis, probable meningococcal meningitis by age, and serogroup-specific meningococcal disease before and during the first year after PsA—TT implementation. We assessed the risk of meningitis disease and death between years.

Findings
During the 14 year period before PsA—TT introduction, Burkina Faso had 148,603 cases of suspected meningitis with 17,965 deaths, and 174 district-level epidemics. After vaccine introduction, there was a 71% decline in risk of meningitis (hazard ratio 0.29, 95% CI 0.28—0.30, p<0·0001) and a 64% decline in risk of fatal meningitis (0.36, 0.33—0.40, p<0·0001). We identified a statistically significant decline in risk of probable meningococcal meningitis across the age group targeted for vaccination (62%, cumulative incidence ratio [CIR] 0.38, 95% CI 0.31—0.45, p<0.0001), and among children aged less than 1 year (54%, 0.46, 0.24—0.86, p=0.02) and people aged 30 years and older (55%, 0.45, 0.22—0.91, p=0.003) who were ineligible for vaccination. No cases of serogroup A meningococcal meningitis occurred among vaccinated individuals, and epidemics were eliminated. The incidence of laboratory-confirmed serogroup A N meningitidis dropped significantly to 0.01 per 100,000 individuals per year, representing a 99.8% reduction in the risk of meningococcal A meningitis (CIR 0.002, 95% CI 0.0004—0.02, p<0.0001).

Interpretation
Early evidence suggests the conjugate vaccine has substantially reduced the rate of meningitis in people in the target age group, and in the general population because of high coverage and herd immunity. These data suggest that fully implementing the PsA—TT vaccine could end epidemic meningitis of serogroup A in sub-Saharan Africa.

Funding
None.

The Lancet Infectious Disease
Oct 2012  Volume 12  Number 10  p737 – 816  e1
http://www.thelancet.com/journals/laninf/issue/current

Review
Burden of disease associated with human cytomegalovirus and prospects for elimination by universal immunisation
Paul D Griffiths

Summary
Cytomegalovirus is the most frequent cause of intrauterine infection and the commonest infectious agent to affect allograft recipients, yet the virus is acknowledged rarely as an occupational hazard for women of childbearing age or as a nosocomial infection. The potential role of cytomegalovirus in hastening the death of patients with AIDS, elderly people, individuals admitted to intensive-care units, and the general population is not emphasised. Development of vaccines against this important human pathogen has been delayed by reluctance to initiate proof-of-concept studies, but after recent trials, protection is a distinct possibility.

Cytomegalovirus deserves to be eliminated from selected populations by means of universal immunisation as soon as suitable vaccines become licensed. This action should control disease in neonates and transplant recipients and could provide substantial additional benefits if other disease associations prove to be causal.

Nature Immunology
October 2012, Volume 13 No 10 pp901-1019
http://www.nature.com/ni/journal/v13/n9/index.html

Focus issue:
Checks and Balances in the Immune System

Contents

Editorial

Commentary

Reviews

Research Highlights

Immune cells drive a potent response after encounter with a pathogen. Nature Immunology presents a series of specially commissioned articles that discuss the metabolic requirements of immune responses and the regulatory circuits that balance eradication of the pathogen with minimal collateral damage to the host.

New England Journal of Medicine
September 27, 2012  Vol. 367 No. 13
http://content.nejm.org/current.shtml

Review Article
Current Concepts: Hepatitis E
J.H. Hoofnagle, K.E. Nelson, and R.H. Purcell

Hepatitis E may be the most common cause of acute hepatitis in the world, occurring primarily in developing countries but increasingly recognized in developed countries. It can have striking clinical manifestations, including acute-on-chronic liver failure and neurologic complications

The Pediatric Infectious Disease Journal
October 2012 – Volume 31 – Issue 10  pp: 9-1105,e176-e188
http://journals.lww.com/pidj/pages/currenttoc.aspx

Evolving Picture of Invasive Pneumococcal Disease in Massachusetts Children: A Comparison of Disease in 2007–2009 With Earlier Periods
Yildirim, Inci; Stevenson, Abbie; Hsu, Katherine K.; Pelton, Stephen I.
Pediatric Infectious Disease Journal. 31(10):1016-1021, October 2012.
doi: 10.1097/INF.0b013e3182615615

Abstract:
Background: As expected, the heptavalent pneumococcal conjugate vaccine (PCV7) had a significant impact on invasive pneumococcal disease (IPD) in children. In addition to the substantial decline in IPD, increased disease due to nonvaccine serotypes and a changing clinical presentation emerged. The objective of this study is to describe these trends in IPD in the late PCV7-era.

Methods: We report on continued, prospective, population-based surveillance of childhood IPD in Massachusetts children during the period 2007 to 2009 and make comparisons with the earlier 2001 to 2006 PCV7-era. Demographic and clinical data were collected for all cases. Streptococcus pneumoniae isolates from normally sterile sites were serotyped and further evaluated using antimicrobial susceptibility testing, multilocus sequence typing and eBURST analysis. IPD incidence rates are calculated by age, year and serotype.

Results: There were 326 cases of IPD between 2007 and 2009 in children < 18 years of age. Overall IPD incidence rate was 7.5 cases per 100,000 population and was not statistically different from the observed incidence in 2001 to 2006 (P > 0.05). As compared with the earlier period, the proportion of bacteremic pneumonia among all IPD cases was almost 3-fold greater in 2009 to 2010 (P < 0.01). PCV7 serotypes accounted for 7%, whereas the 13-valent pneumococcal conjugate vaccine serotypes accounted for 77% of all cases between 2007 and 2009. IPD due to serotypes 19A and 7F increased, and 19A and 7F were isolated in 41% and 20% of all IPD cases in the same period, respectively. Serotype 19A also comprised a majority of the penicillin- and ceftriaxone-resistant isolates. Analysis of multilocus sequence typing data showed a significant increase in ST191, ST695 and ST320 and a significant decrease in ST199 and ST180.

Conclusions: The reduction in IPD after introduction of PCV7 persists in Massachusetts children; however, serotypes causing IPD have changed significantly in the last decade. Continued surveillance is necessary to determine the impact of 13-valent pneumococcal conjugate vaccine, as well as track potential changes in disease incidence and character due to non–13-valent pneumococcal conjugate vaccine serotypes.

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

Fatigue and Fear with Shifting Polio Eradication Strategies in India: A Study of Social Resistance to Vaccination
Rashid S. Hussain, Stephen T. McGarvey, Tabassam Shahab, Lina M. Fruzzetti Resistance to Vaccination Fatigue and Fear with Polio
PLoS ONE: Research Article, published 26 Sep 2012 10.1371/journal.pone.0046274

Abstract 
Shifting polio eradication strategies may have generated fear and “resistance” to the eradication program in Aligarh, India during the summer of 2009. Participant observation and formal interviews with 107 people from May to August 2009 indicated that the intensified frequency of vaccination was correlated with patients’ doubt in the efficacy of the vaccine. This doubt was exacerbated in a few cases as families were uninformed of the use of monovalent mOPV1, while P3 cases continued to occur. Many families had also come to believe that their children had been adversely affected by OPV after being told the vaccine carried no risk. Though polio is now largely eradicated in India, with only a single case in 2011, greater transparency about changes with vaccination policy may need to be considered to build trust with the public in future eradication programs.

PLoS Medicine
(Accessed 29 September 2012)
http://www.plosmedicine.org/article/browse.action?field=date

Who Sets the Global Health Research Agenda? The Challenge of Multi-Bi Financing
Devi Sridhar Essay, published 25 Sep 2012
doi:10.1371/journal.pmed.1001312

Summary Points
– A major challenge in the governance of research funding is agenda-setting, given that the priorities of funding bodies largely dictate what health issues and diseases are studied.

– The challenge of agenda-setting is a consequence of a larger phenomenon in global health—“multi-bi financing.”

– Multi-bi financing refers to the practice of donors choosing to route non-core funding—earmarked for specific sectors, themes, countries, or regions—through multilateral agencies such as the World Health Organization (WHO) and the World Bank and to the emergence of new multistakeholder initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the GAVI Alliance.

– These new multistakeholder initiatives have five distinct characteristics: a wider set of stakeholders that include non-state institutions, narrower problem-based mandates, financing based on voluntary contributions, no country presence, and legitimacy based on effectiveness, not process.

– The shift to multi-bi financing likely reflects a desire by participating governments, and others, to control international agencies more tightly.

PLoS Medicine
(Accessed 29 September 2012)
http://www.plosmedicine.org/article/browse.action?field=date

The World Health Report 2012 That Wasn’t
The PLOS Medicine Editors
Editorial, published 25 Sep 2012
doi:10.1371/journal.pmed.1001317

A year and a half ago, PLOS Medicine announced a collaboration with the World Health Organization (WHO), inviting submission of articles to PLOS Medicine on the theme of “no health without research” [1]. That call for papers was intended to culminate in an open-access collection of original research and commentary articles to coincide with the launch in 2012 of a World Health Report on the same topic. The collection was to focus on eight key areas (detailed in [1]) relating to how countries can strengthen their health research systems, to better inform healthcare delivery and policymaking. The importance of a strategic, evidence-informed approach, particularly for low- and middle-income countries, is highlighted in a statement made at the 2008 Global Ministerial Forum on Research for Health, in Bamako, Mali, that “Countries don’t need a national airline, but they do need a national health research strategy” [2].

The collection (available at http://www.ploscollections.org/whr2012) has been continually updated throughout 2011 and 2012, and includes articles published across the PLOS journals. It includes a wealth of studies and commentary that, for example, reflect countries’ experiences with establishing and maintaining robust research systems such as developing evidence-based priority setting for maternal, neonatal, and child health in Africa [3]; the creation of regional vaccine research networks in Asia [4]; and the evaluation of research capacity strengthening programmes in low- and middle-income countries [5]. The collection also includes four commissioned pieces from leading scholars in the area that contextualize and critically reflect on the intended theme of the 2012 World Health Report [2],[6],[7],[8].

In light of the interest in the collection, it is disappointing to learn now that the 2012 World Health Report will not exist, at least as originally envisaged. Communications to WHO staff on behalf of the Director-General Margaret Chan reveal that the report has been delayed until 2013. The original webpage describing the intended report has been removed and replaced by a new page that notes the report’s focus will now be oriented towards “the contributions of research to universal health coverage” [9]. The reasons for these delays and for the changes in scope of WHO’s flagship publication, are unclear. Previous World Health Reports, for example the 2000 edition on “Health Systems: Improving Performance,” described as “an act of remarkable courage” [10], have represented bold political statements. Most notably, the 2000 Report, which ranked nations’ health systems performance (to the delight or ire of many countries) has subsequently been described as leaving a clear legacy—for example, in stimulating critical research and filling data gaps on the performance of health systems [10]. At this stage the scope of the forthcoming Report is still vague, and linkages to the 2010 Report on Health Systems Financing are not yet apparent based on information in the public domain [9]. However, we look forward to seeing how the forthcoming Report develops, and hope that this publication makes a similarly bold and influential contribution as previous Reports have done.

We are proud of the papers that we have published as part of the current collection. PLOS would like to thank the authors who have responded enthusiastically to our call for papers and enabled us to publish such a diverse and incisive range of research and commentary reflecting the original theme of our collaboration with WHO [1]. While the 2012 World Health Report will not appear as previously envisioned, the WHO/PLOS Collection on “No Health Without Research,” now closed to new submissions, remains an important resource for investigators, policy makers, and other readers, reflecting the original intentions of both WHO and PLOS.

PLoS Neglected Tropical Diseases
September 2012
http://www.plosntds.org/article/browseIssue.action

A Long Neglected World Malaria Map: Plasmodium vivax Endemicity in 2010
Peter W. Gething, Iqbal R. F. Elyazar, Catherine L. Moyes, David L. Smith, Katherine E. Battle, Carlos A. Guerra, Anand P. Patil, Andrew J. Tatem, Rosalind E. Howes, Monica F. Myers, Dylan B. George, Peter Horby, Heiman F. L. Wertheim, Ric N. Price, Ivo Müeller, J. Kevin Baird, Simon I. Hay

Abstract 
Background
Current understanding of the spatial epidemiology and geographical distribution of Plasmodium vivax is far less developed than that for P. falciparum, representing a barrier to rational strategies for control and elimination. Here we present the first systematic effort to map the global endemicity of this hitherto neglected parasite.

Methodology and Findings
We first updated to the year 2010 our earlier estimate of the geographical limits of P. vivax transmission. Within areas of stable transmission, an assembly of 9,970 geopositioned P. vivax parasite rate (PvPR) surveys collected from 1985 to 2010 were used with a spatiotemporal Bayesian model-based geostatistical approach to estimate endemicity age-standardised to the 1–99 year age range (PvPR1–99) within every 5×5 km resolution grid square. The model incorporated data on Duffy negative phenotype frequency to suppress endemicity predictions, particularly in Africa. Endemicity was predicted within a relatively narrow range throughout the endemic world, with the point estimate rarely exceeding 7% PvPR1–99. The Americas contributed 22% of the global area at risk of P. vivax transmission, but high endemic areas were generally sparsely populated and the region contributed only 6% of the 2.5 billion people at risk (PAR) globally. In Africa, Duffy negativity meant stable transmission was constrained to Madagascar and parts of the Horn, contributing 3.5% of global PAR. Central Asia was home to 82% of global PAR with important high endemic areas coinciding with dense populations particularly in India and Myanmar. South East Asia contained areas of the highest endemicity in Indonesia and Papua New Guinea and contributed 9% of global PAR.

Conclusions and Significance
This detailed depiction of spatially varying endemicity is intended to contribute to a much-needed paradigm shift towards geographically stratified and evidence-based planning for P. vivax control and elimination.

The Huffington Post
http://www.huffingtonpost.com/
Accessed 29 September 2012

The Big Push
Posted: 09/24/2012 11:40 am
Arianna Huffington

Extract
“…In fact, with the launch today of The Big Push campaign — co-sponsored by The Global Fund and The Huffington Post — this might be more than a thought exercise (except for Bill Gates going back to Microsoft). That’s because the progress that’s been made against these diseases in only the last 10 years has been so staggering that we may actually be in sight of the day when no child is born with HIV, nobody dies of malaria and we stop the spread of tuberculosis…”

New York Times
http://www.nytimes.com/
Accessed 29 September 2012

Editorial
An Unfinished Campaign Against Polio
Published: September 28, 2012

Leaders of the global fight to eradicate polio vowed at the United Nations on Thursday to step up their efforts to eliminate the virus from the three countries where the disease still has a foothold — Afghanistan, Pakistan and Nigeria. The challenge is that those countries are troubled by political unrest, violence and social customs that can interfere with the delivery of vaccines to the children and adults who need protection.

Polio erupted in frightening epidemics around the world during the 20th century and crippled or killed hundreds of thousands of victims a year. There is no cure, but vaccines eliminated the virus from advanced countries and relegated it to poorer regions of the world.

In 1988, a global campaign was organized by public and private organizations to eradicate the disease. It has been an enormous success. At its start, more than 350,000 children were paralyzed each year in more than 125 countries. This year, only 145 cases have been reported, and the disease remains endemic in only three countries.

Afghanistan pushed down the number of cases to 17 so far this year from 80 last year. Pakistan drove its polio burden down to 30 cases as of mid-August, but has run into difficulties because of opposition from the Taliban and Muslim religious leaders who depict vaccination campaigns as a cover for espionage. Nigeria experienced a drop in cases in 2010 followed by an upsurge to 84 cases this year, mostly in areas where militant groups are fighting and people distrust Western vaccines.

Ban Ki-moon, the secretary-general of the United Nations, said he would enlist agencies of the United Nations to make eradication a top priority this year. Ridding the world of polio should be a crucial part of a broad campaign to immunize all children against infectious diseases.

http://www.nytimes.com/2012/09/29/opinion/an-unfinished-campaign-against-polio.html

New York Times
http://www.nytimes.com/
Accessed 29 September 2012

Editorial
A Duty of Health Care Workers
Published: September 27, 2012

Health care workers should know better than anyone that it is important to get vaccinated against the flu virus to protect their own health and prevent the possibility of infecting patients. There were some encouraging signs in an analysis issued Thursday by the Centers for Disease Control and Prevention that doctors and nurses are beginning to get the message. But other health care workers — a broad group that includes clinical personnel like nurse practitioners and physician assistants and various nonprofessional aides and assistants — show remarkable indifference to performing what ought to be considered their civic duty.

The C.D.C. survey found that 67 percent of all health care workers were vaccinated during the 2011-12 flu season, up slightly from 64 percent the season before. Looking back over the past three seasons, the C.D.C. found that the percentage of physicians getting flu vaccine rose from 81 to 86 percent; the percentage of nurses jumped from 69 to 80 percent. Those rates don’t meet the national goal of 90 percent, but they are headed in the right direction.

Vaccination rates for other health care personnel remained roughly similar for all three years, in the low-60 percent range. Most disturbing, excluding doctors and nurses, only about half of the workers in long-term care facilities, which treat patients at high risk of complications if they get the flu, got vaccinated last season. When respondents were asked why they were not vaccinated, the most common reasons were a belief that they did not need it, concern about whether the vaccine was effective and worries about side effects.

Vaccinations of health care personnel should be required, either by state laws or by employers. The survey found that 95 percent of workers in hospitals that required vaccinations got them, compared with only 68 percent of those in hospitals without such a rule.

Even without making it mandatory, employers can make a difference by promoting vaccination through educational campaigns, by providing incentives and making vaccine easily available at no cost. Some 75 percent of workers whose institutions promoted vaccination got the flu vaccine. Employers need to press more of their workers to do so.

http://www.nytimes.com/2012/09/28/opinion/health-care-workers-have-a-duty-to-get-vaccinated.html?ref=opinion

Twitter Watch  [accessed 29 September 2012  16:46]
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
It’s live! Video of @TheGPP CEO Hugh Evans and @GAVISeth talking about vaccines, equity, polio & more: http://ht.ly/e5Fly  #vaccineswork
10:50 AM – 29 Sep 12

WHO ‏@WHO
.@WHO does not advise special screening at airports, seaports, etc with regard to this new #coronavirus http://goo.gl/eKPJD 
10:22 AM – 29 Sep 12

UN Foundation ‏@unfoundation
Did you miss the action at the Social Good Summit? No worries we have all the [Video] highlights here: http://bit.ly/SiMwIJ  #SGSglobal
2012 Social Good Summit
1:26 PM – 28 Sep 12

WHO ‏@WHO
Every year, more than 20m people worldwide are vaccinated against rabies after being bitten. http://goo.gl/2lL05 
5:44 AM – 28 Sep 12

WHO ‏@WHO
Potentially dog rabies threatens over 3b people in Asia and Africa where more than 95% of human deaths occur. http://goo.gl/2lL05 
5:33 AM – 28 Sep 12

WHO ‏@WHO
Dog vaccination programmes are the most effective way to reduce the risk of rabies. http://goo.gl/2lL05 
5:24 AM – 28 Sep 12

United Nations ‏@UN
Vaccinate dogs to save human lives – Friday is #WorldRabiesDay. Details from @WHO: http://j.mp/OXRsHt 
Retweeted by PAHO/WHO
3:00 PM – 27 Sep 12

Seth Berkley ‏@GAVISeth
Great meeting this AM with Liberian President Ellen Johnson Sirleaf who is prioritizing children & will work on improving vaccine coverage
11:56 AM – 27 Sep 12

Seth Berkley ‏@GAVISeth
Amazing high level meeting on Polio at UN with Presidents of Nigeria, Pakistan & Afghanistan with Bill Gates, Aust. PM, UNSG and US Sec HHS
11:50 AM – 27 Sep 12

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_22 September 2012

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

– Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…

    The Decade of Vaccine Collaboration (DoVC) made two announcements regarding the continuing development of GVAP (Global Vaccine Action Plan). The first was a request for further input on GVAP’s Monitoring & Evaluation (M&E) indicators, noting that the “final set of GVAP indicators” will be presented to the WHO’s Strategic Advisory Group of Experts (SAGE) during its November 2012 meeting, to the WHO Executive Board in January 2013 and at the World Health Assembly in May 2013. The DoVC said that “as with the GVAP itself, a wider consultation process is requested to secure further input to the indicators before they are finalized for WHO review.” A matrix with the M&E indicators, including operational definitions, data sources, baselines, targets and milestones is available here: http://www.dovcollaboration.org/wp-content/uploads/2012/09/Indicator-work-sheet-11-Sep-2012.xlsx Feedback should be directed to Laurie Werner (lwerner@path.org) by Friday, 5 October 2012.

The second announcement related to defining an accountability framework. The DoVC said that “accountability refers to the cyclical process of assessing progress, documenting success, identifying problems and taking prompt action when and where appropriate. The WHO is taking the lead on strengthening and expanding existing immunization review mechanisms to include the Decade of Vaccines and the GVAP’s indicators.” At the global level, the DoVC announced that “the primary mechanism is the WHO Strategic Advisory Group of Experts (SAGE).” The announcement noted that “WHO Regional Immunization Technical Advisory Groups and existing mechanisms at the national level, such as the Interagency Coordinating Committees (ICCs) and the National Immunization Technical Advisory Groups (NITAGs), could take on a role similar to that which SAGE has at the global level.”

http://www.dovcollaboration.org/dov-collaboration-updates/september-2012-dov-collaboration-update/

PAHO Member States elected Dr. Carissa Etienne as the new Director of the Pan American Health Organization during the 28th Pan American Sanitary Conference. Dr. Etienne begins her five-year term on 1 February 2013, succeeding Dr. Mirta Roses Periago of Argentina, who has been PAHO Director since 2003. Dr. Etienne, a native of Dominica, is currently Assistant Director General, Health Systems and Services, at WHO in Geneva. From 2003 to 2008, she served as Assistant Director of PAHO. Dr. Etienne commented, “Our Region is strong. We now see political stability and economic prosperity in the Region at unprecedented levels. At the same time, there are millions of people, some of them in our wealthiest Member States, who do not have access to the social determinants of health or the health care they desperately need. Seventy-four million are living in conditions of extreme poverty. This is a reflection of the inequities that afflict many of our Member States and our Region and present a challenge to us all to strive for social justice, to ensure social inclusion, and to be proactive in addressing the needs of vulnerable and marginalized peoples.” Dr. Etienne said her vision of the Americas is one of “societies free of inequality, where people have access to healthy social determinants and environments that allow them to live long, dignified, healthy, and productive lives. This includes access to universal health services without fear of being impoverished.” Dr. Etienne holds degrees in medicine and surgery from the University of the West Indies as well as a master’s in community health and an honorary diploma in public health from the London School of Hygiene and Tropical Medicine.

http://new.paho.org/hq/index.php?option=com_content&view=article&id=7208&Itemid=1926

PAHO member country representatives “discussed options for maintaining support from the GAVI Alliance for acquisition of new vaccines, strengthening health systems and other vaccine-related interventions in six countries that have been benefiting from this support.” The discussions occurred during the 28th Pan American Sanitary Conference, held at PAHO headquarters, in Washington D.C.  PAHO said that four countries in the Americas—Bolivia, Cuba, Guyana and Honduras— began a “graduation process” in 2011 when their gross national income surpassed US$1,500 per capita, the threshold for GAVI eligibility. GAVI support for their national immunization programs is scheduled to be phased out over the next four years. From 2000 to -2012, the GAVI Alliance provided US$62 million in support for vaccination programs for these four countries and for Nicaragua and Haiti, which continue to be eligible for GAVI support. Country representatives noted that “despite their new status as ‘graduating countries,’ they continue to face important challenges in maintaining the strong performance of their national immunization programs. They called on GAVI to explore different options for continued support. Some countries face a simultaneous phase-out of the resources from the Global Fund for AIDS, Tuberculosis and Malaria, making the transition particularly challenging in the current economic climate.”

http://new.paho.org/hq/index.php?option=com_content&view=article&id=7213%3Alow-income-countries-of-the-americas-seek-continued-gavi-support-for-their-national-immunization-programs&catid=1443%3Anews-front-page-items&lang=en&Itemid=1926

   GAVI said that Health Minister Professor Chen Zhu “marked the Chinese Government’s first high-level meeting with the GAVI Alliance on Monday by signaling China’s willingness to expand collaboration with the Alliance.” Minister Chen, meeting with GAVI CEO Dr. Seth Berkley in Beijing, “indicated his Government’s interest in sponsoring and engaging with multilateral aid efforts in the public health sector, such as the GAVI Alliance. In parallel, the Minister is keen for China to work closely with GAVI to help its domestic vaccine manufacturers meet international standards.” Dr. Berkley commented, “Both China and India are two countries that need to produce large quantities of vaccines to immunise their very large birth cohorts. GAVI looks forward to working with Chinese manufacturers in producing affordable life-saving vaccines in sufficient quantities to enable their distribution to children throughout Africa and Asia.” GAVI added that “with Chinese vaccine companies growing fast, Minister Chen expressed his confidence in their future capacity to meet large-scale demand. However, the Minister added that the Chinese Government places even greater emphasis on the research and development of new vaccines, with plans to establish a vaccine centre at the national Centre for Disease Control (CDC).”

http://www.gavialliance.org/library/news/gavi-features/2012/china-ready-to-expand-collaboration-with-gavi/

The Weekly Epidemiological Record (WER) for 21 September 2012, vol. 87, 38 (pp. 357–368) includes:

– Outbreak news – Ebola, Democratic Republic of Congo – update

– Update on vaccine-derived polioviruses detected worldwide, April 2011– June 2012
http://www.who.int/entity/wer/2012/wer8738.pdf

Update: Polio this week – As of 19 Sep 2012
Global Polio Eradication Initiative

[Editor’s Extract]
Next week (on 27 September), UN Secretary General Ban Ki-moon will host a high-level event on polio eradication, in the margins of the UN General Assembly in New York. The event, ‘Our Commitment to the Next Generation: The Legacy of a Polio-free World’ will bring together leaders of the remaining endemic countries, donor governments, development agencies, spearheading partners and representatives of the media, to draw attention to the urgent need for focus and commitment to eradicate the remaining 1% of polio cases worldwide.

The event will be followed by a global civil society festival on 29 September, bringing together top artists with an audience of 60,000 to a concert in New York’s Central Park, to catalyse further action to end polio and extreme poverty. For more, please visit www.globalfestival.com

Nigeria
– Four new cases were reported in the past week (two WPV1s from Kano and two WPV1s from Jigawa), bringing the total number of cases for 2012 to 88. The most recent case had onset of paralysis on 20 August (WPV1 from Jigawa).
– Additionally, two new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported from Kano state, the most recent of which had onset of paralysis on 1 August. Nigeria remains the only country in the world with ongoing circulation of all three serotypes: WPV1, WPV3 and cVDPV2…

Pakistan
– Five new cases were reported in the past week (all WPV1s, four from Khyber Pakhtunkhwa – KP, and one from Punjab), bringing the total number of cases for 2012 to 35. The most recent case had onset of paralysis on 30 August (WPV1 from KP).
– These latest cases are not in the traditional reservoir areas of KP and FATA (mainly centred around Peshawar and Khyber Agency), but are from adjacent districts in north-eastern KP. A mop-up outbreak response is currently being planned in the area…

Horn of Africa
– Following confirmation two weeks ago of a cVDPV type 2 case in a Somali refugee camp in Dadaab, Kenya (linked to last year’s cVDPV type 2 in south-central Somalia), a further cVDPV2 case was reported from Kismayo, south-central Somalia. This case had onset of paralysis on 23 July.
– An immunization response is currently being planned, to reach more than 800,000 children in eastern Kenya, including in the Dadaab refugee camps (target age groups in the camps will be <15 years)…

http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

WHO: Global Alert and Response (GAR)
Disease Outbreak News
– 18 September 2012
Cholera in Sierra Leone – update
– 18 September 2012
Ebola outbreak in Democratic Republic of Congo – update

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

Meeting: 10th International Rotavirus Symposium
Bangkok, Thailand
Meeting website: www.rotavirus2012.org

The Sabin Institute said that more than 350 leading scientific, public and private sector experts convened to discuss progress and next steps in reducing the global incidence of rotavirus, the most common cause of diarrheal hospitalizations and deaths among children worldwide. Rotavirus takes the lives of approximately 188,000 Asian children under five each year. Vaccines are the best way to prevent rotavirus because interventions that prevent other forms of diarrhea – including improved hygiene, sanitation and safe drinking water – do not adequately prevent the spread of rotavirus. Combining rotavirus vaccines with other diarrhea protection and treatment methods such as oral rehydration therapy, zinc supplementation, breastfeeding and improved hygiene, sanitation and nutrition can significantly reduce child illnesses and deaths. Dr. Ciro de Quadros, executive vice president of the Sabin Vaccine Institute and co-chair of the Rotavirus Organization of Technical Allies (ROTA Council), said, “Rotavirus continues to pose a serious and unnecessary threat to children all over the world because there is insufficient access to existing vaccines. That is why we continue to press for expanded access to safe and effective rotavirus vaccines in order to achieve our ultimate objective of saving lives and reducing illness and needless suffering.” http://www.sabin.org/news-resources/in-news/2012/09/21/experts-convene-address-major-cause-childhood-illness-and-death

Meeting: CDC – ACIP Meeting
24-25 October 2012

Draft agenda as of 17 September 2012:
http://www.cdc.gov/vaccines/acip/meetings/downloads/agenda-archive/agenda-2012-10.pdf

Meeting: WHO – Strategic Advisory Group of Experts (SAGE) on Immunization
6-8 November 2012, Geneva
Draft agenda as of 6 September 2012
http://www.who.int/entity/immunization/sage/Annotated_draft_Agenda_6-8_Nov_SAGE_2012_September_6.pdf

Reference: Health in the Americas 2012 Edition – Regional Outlook and Country Profiles

In Health in the Americas, 2012 the Pan American Sanitary Bureau presents and analyzes the data and information from every country in the Region of the Americas. In drafting the publication, it has used data from many domestic and international, as well as unofficial, sources, trying as much as possible to identify and eliminate any discrepancies.

– High resolution version of Health in the Americas 2012 Edition for print

http://new.paho.org/saludenlasamericas/index.php?option=com_content&view=article&id=9&Itemid=14&lang=en

American Journal of Public Health
Volume 102, Issue 10 (October 2012)
http://ajph.aphapublications.org/toc/ajph/current

Contribution of communication inequalities to disparities in human papillomavirus vaccine awareness and knowledge.
Kontos EZ, Emmons KM, Puleo E, Viswanath K.

Source
Emily Z. Kontos is with Harvard School of Public Health, Department of Society, Human Development and Health, Boston, MA. Karen M. Emmons and K. Viswanath are with Harvard School of Public Health, Department of Society, Human Development and Health, and Dana-Farber Cancer Institute, Medical Oncology, Boston. Elaine Puleo is with University of Massachusetts, Amherst School of Public Health and Health Sciences, Amherst.

Abstract
Objectives. We examined the association of Internet-related communication inequalities on human papillomavirus (HPV) vaccine awareness and infection knowledge. Methods. We drew data from National Cancer Institute’s 2007 Health Information National Trends Survey (n = 7674). We estimated multivariable logistic regression models to assess Internet use and Internet health information seeking on HPV vaccine awareness and infection knowledge. Results. Non-Internet users, compared with general Internet users, had significantly lower odds of being aware of the HPV vaccine (odds ratio [OR] = 0.42; 95% confidence interval [CI] = 0.34, 0.51) and knowing that HPV causes cervical cancer (OR = 0.70; 95% CI = 0.52, 0.95). Among general health information seekers, non-Internet seekers compared with Internet information seekers exhibit significantly lower odds of HPV vaccine awareness (OR = 0.59; 95% CI = 0.46, 0.75), and of knowing about the link between HPV infection and cervical cancer (OR = 0.79; 95% CI = 0.63, 0.99) and the sexual transmission of HPV (OR = 0.71; 95% CI = 0.57, 0.89). Among cancer information seekers, there were no differences in outcomes between Internet seekers and non-Internet seekers. Conclusions. Use of a communication channel, such as the Internet, whose use is already socially and racially patterned, may widen observed disparities in vaccine completion rates.

British Medical Journal
22 September 2012 (Vol 345, Issue 7875)
http://www.bmj.com/content/345/7875

Editorial
Fighting neglected tropical diseases in the southern United States
Peter J Hotez

Extract
Poverty and lack of awareness need to be tackled
The neglected tropical diseases are a group of chronic parasitic and related infections such as hookworm, schistosomiasis, lymphatic filariasis, Chagas disease, and leishmaniasis that often affect the “bottom billion” in Africa, Asia, and Latin America.1 Extreme poverty, defined by the World Bank as average daily consumption of $1.25 (£0.8; €1.0) or less, is the main social factor associated with a high prevalence of these diseases.1 The World Health Organization, the World Bank, and professionals have advocated strongly for global programmes to deliver packages of essential drugs to treat the tropical diseases with the highest prevalence, such as tuberculosis and malaria, while simultaneously developing new or improved drugs and vaccines.2 Diseases such as Chagas disease, cysticercosis, leishmaniasis, and dengue are listed in the 17 tropical diseases being targeted by WHO for control or elimination in low and middle income countries.3 4 Others, such as toxocariasis, a chronic parasitic infection that causes asthma and epilepsy,5 6 and trichomoniasis, a sexually transmitted disease associated with vaginal HIV-1 shedding,7 are not. That these diseases affect literally millions of Americans living in poverty,8 with prevalence rates of selected tropical diseases in some areas of the US comparable to rates in low and middle income countries, is less well known…

Journal of Infectious Diseases
Volume 206 Issue 8 October 15, 2012
http://www.journals.uchicago.edu/toc/jid/current

VIRUSES
Editor’s choice: Influenza Vaccination for Immunocompromised Patients: Systematic Review and Meta-analysis by Etiology
J Infect Dis. (2012) 206(8): 1250-1259 doi:10.1093/infdis/jis487
Charles R. Beck, Bruce C. McKenzie, Ahmed B. Hashim, Rebecca C. Harris,
University of Nottingham Influenza and the ImmunoCompromised (UNIIC) Study Group, and Jonathan S. Nguyen-Van-Tam

Abstract
Many national guidelines recommend annual influenza vaccination of immunocompromised patients, although the decision to vaccinate is usually at clinical discretion. We conducted a systematic review and meta-analyses to assess the evidence for influenza vaccination in this group, and we report our results by etiology. Meta-analyses showed significantly lower odds of influenza-like illness after vaccination in patients with human immunodeficiency virus (HIV) infection, patients with cancer, and transplant recipients and of laboratory-confirmed influenza in HIV-positive patients, compared with patients receiving placebo or no vaccination. Pooled odds of seroconversion and seroprotection were typically lower in HIV-positive patients, patients with cancer, and transplant recipients, compared with immunocompetent controls. Vaccination was generally well tolerated, with variation in mild adverse events between etiological groups. Limited evidence of a transient increase in viremia and a decrease in the percentage of CD4+ cells in HIV-positive patients was found although not accompanied by worsening of clinical symptoms. Clinical judgment remains important when discussing the benefits and safety profile with immunocompromised patients.

Medical Decision Making (MDM)
September–October 2012; 32 (5)
http://mdm.sagepub.com/content/current

Special Issue: Recommendations of the ISPOR-SMDM Joint Modeling Good Research Practices Task Force
Note from the Editors
Michael Drummond, PhD; Mark Helfand, MD, MPH; C. Daniel Mullins, PhD

This issue contains seven articles that offer guidance for modeling studies for health outcomes research. To ensure that good research practices on modeling techniques remain useful for all current modeling techniques as well as to foster the use of model-based results to inform health care decisions, a Modeling Good Research Practices Task Force was created. The task force members consist of individuals from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the Society for Medical Decision Making (SMDM), and the journals of both societies, Value in Health and Medical Decision Making, agreed to publish the task force reports on the same date in both journals after a period of peer review.

Thus, the seven articles from the ISPOR-SMDM Task Force are being published simultaneously in Value in Health and Medical Decision Making. Each manuscript was submitted to both journals simultaneously. Before submission, as part of the guidance development process, the manuscripts underwent review by a panel of reviewers. In addition, the membership of each society was invited to comment on them. The original journal submissions included the comments of the reviewers as well as the authors’ responses to those comments…

New England Journal of Medicine
September 20, 2012  Vol. 367 No. 12
http://content.nejm.org/current.shtml

Correspondence
Vaccination Policies and Rates of Exemption from Immunization, 2005–2011
N Engl J Med 2012; 367:1170-1171September 20, 2012

To the Editor:
We computed the annual change in the rates of nonmedical exemptions from school immunization requirements and compared these rates between states that allow philosophical exemptions and states that allow only religious exemptions. We also compared states with respect to how difficult it is to obtain nonmedical exemptions because of certain administrative procedures. We used data compiled by the Centers for Disease Control and Prevention (CDC) for school years 2005–2006 through 2010–2011.1 State-specific categories of difficulty in obtaining exemptions were based on several factors: whether completion of a standardized form was permissible, as opposed to a letter from a parent; where the parent obtained the form (i.e., school vs. health department); whether the form had to be notarized; and whether a letter from a parent, if required, needed to be worded a specific way, resulting in extra effort on the part of the parent.

Over the study period, unadjusted rates for nonmedical exemptions in states that allowed philosophical exemptions were 2.54 times as high as rates in states that allowed only religious exemptions (incidence rate ratio [IRR], 2.54; 95% confidence interval [CI], 1.68 to 3.83) (see Table S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org).    Although the absolute rates were higher in states that allowed philosophical exemptions, the average annual rate increase among states that allowed only religious exemptions (IRR for change per year, 1.20; 95% CI, 1.11 to 1.30) was higher than the rate in states that allowed philosophical exemptions (IRR for change per year, 1.10; 95% CI, 1.05 to 1.14).

During the study period, unadjusted rates of nonmedical exemptions in states with easy exemption policies were 2.31 times as high as rates in states with difficult exemption policies (IRR, 2.31; 95% CI, 1.39 to 3.85). By 2011, the nonmedical exemption rate in states with easy exemption criteria increased to 3.3%, an average annual increase of 13% (IRR for change per year, 1.13; 95% CI, 1.05 to 1.21) (Figure 1Figure 1 Rates of Nonmedical Exemptions from School Immunization, According to Type of Exemption and Ease of Obtaining One, 2006–2011., and Table S1 in the Supplementary Appendix). In contrast, nonmedical exemption rates in states with difficult exemption criteria increased by 8% annually to 1.3% in 2011 (IRR for change per year, 1.08; 95% CI, 1.02 to 1.14). In states with exemption criteria of medium difficulty, rates increased by 18% annually to 2.0% in 2011 (IRR for change per year, 1.18; 95% CI, 1.10 to 1.26). For all analyses, adjusted results were qualitatively similar to unadjusted results (Table S1 in the Supplementary Appendix).

In an earlier analysis of data from 1991 through 2004, we found an increase in exemption rates only in states with philosophical exemptions and in states with easy exemption procedures. Even in these states the average rate of increase was lower than that found during the current study period.3 Our results show that nonmedical exemptions have continued to increase, and the rate of increase has accelerated.

Saad B. Omer, M.B., B.S., Ph.D.; Jennifer L. Richards, M.P.H.; Michelle Ward, A.B.; Robert A. Bednarczyk, Ph.D.; Rollins School of Public Health, Emory University, Atlanta, GA

Pharmacoeconomics
October 1, 2012 – Volume 30 – Issue 10  pp: 859-980
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

Leading Article
Private Manufacturers’ Thresholds to Invest in Comparative Effectiveness Trials
Basu, Anirban; Meltzer, David
Pharmacoeconomics. 30(10):859-868, October 1, 2012.
doi: 10.2165/11597730-000000000-00000

Abstract:
The recent rush of enthusiasm for public investment in comparative effectiveness research (CER) in the US has focussed attention on these public investments. However, little attention has been given to how changing public investment in CER may affect private manufacturers’ incentives for CER, which has long been a major source of CER. In this work, based on a simple revenue maximizing economic framework, we generate predictions on thresholds to invest in CER for a private manufacturer that compares its own product to a competitor’s product in head-to-head trials. Our analysis shows that private incentives to invest in CER are determined by how the results of CER may affect the price and quantity of the product sold and the duration over which resulting changes in revenue would accrue, given the time required to complete CER and the time from the completion of CER to the time of patent expiration. We highlight the result that private incentives may often be less than public incentives to invest in CER and may even be negative if the likelihood of adverse findings is sufficient. We find that these incentives imply a number of predictions about patterns of CER and how they will be affected by changes in public financing of CER and CER methods. For example, these incentives imply that incumbent patent holders may be less likely to invest in CER than entrants and that public investments in CER may crowd out similar private investments. In contrast, newer designs and methods for CER, such as Bayesian adaptive trials, which can reduce ex post risk of unfavourable results and shorten the time for the production of CER, may increase the expected benefits of CER and may tend to increase private investment in CER as long as the costs of such innovative designs are not excessive. Bayesian approaches to design also naturally highlight the dynamic aspects of CER, allowing less expensive initial studies to guide decisions about future investments and thereby encouraging greater initial investments in CER. However, whether the potential effects we highlight of public funding of CER and of Bayesian approaches to trial design actually produce changes in private investment in CER remains an empirical question.

Public Health Ethics
Volume 5 Issue 2 July 2012
http://phe.oxfordjournals.org/content/current

Behavior Change or Empowerment: On the Ethics of Health-Promotion Strategies
Public Health Ethics (2012) 5(2): 140-153 doi:10.1093/phe/phs022
Per-Anders Tengland

Abstract
There are several strategies to promote health in individuals and populations. Two general approaches to health promotion are behavior change and empowerment. The aim of this article is to present those two kinds of strategies, and show that the behavior-change approach has some moral problems, problems that the empowerment approach (on the whole) is better at handling. Two distinct ‘ideal types’ of these practices are presented and scrutinized. Behavior change interventions use various kinds of theories to target people’s behavior, which they do through information, persuasion, coercion and manipulation. Empowerment is a collaborative method where those ‘facilitated’ participate in the change process. Some ethical problems with the behavior-change model are that it does not sufficiently respect the right to autonomy of the individuals involved and risks reducing their ability for autonomy, and that it risks increasing health inequalities. Empowerment, on the other hand, respects the participant’s right to autonomy, tends to increase the ability for autonomy, as well as increasing other coping skills, and is likely to reduce inequalities. A drawback with this approach is that it often takes longer to realize.

Public Health Ethics
Volume 5 Issue 2 July 2012
http://phe.oxfordjournals.org/content/current

Why One Should Do One’s Bit: Thinking about Free Riding in the Context of Public Health Ethics
Public Health Ethics (2012) 5(2): 154-160 doi:10.1093/phe/phs023
Mariëtte van den Hoven

Abstract
Vaccination programmes against infectious diseases aim to protect individuals from serious illness but also offer collective protection once a sufficient number of people have been immunized. This so-called ‘herd immunity’ is important for individuals who, for health reasons, cannot be immunized or who respond less well to vaccines. For these individuals, it is pivotal that others establish group protection. However, herd immunity can be compromised when people deliberately decide not to be immunized and benefit from the herd’s protection. These agents are often referred to as free riders: their omissions are deemed to be unfair to those who do contribute to the collective’s health. This article addresses the unfairness of such ‘free riding’. An argument by Garett Cullity is examined, which asserts that the unfairness of moral free riding lies neither in one’s intentions, nor in one’s reluctance to embrace a public good. This argument offers a strong basis for justifiably arguing that free riding is unfair. However, it is then argued that other considerations also need to be taken into account before simply holding free riding against non-compliers.