Science        
21 September 2012 vol 337, issue 6101, pages 1425-1572
http://www.sciencemag.org/current.dtl

News
Chronic Disease Vaccines Need Shot in the Arm
Bijal Trivedi*
It’s difficult enough to develop and obtain approval for a traditional vaccine against a bacterium or virus, let alone create one that rouses the immune system to target molecules that drive a chronic disease such as obesity. Potential vaccines for hypertension, asthma, Alzheimer’s disease, obesity, and smoking (because it is a risk factor for heart disease, cancer, stroke, and more) have all been hyped in recent years and then suffered high-profile failures. Vaccine developers also face the problem that society largely views addiction and obesity as moral failures rather than chronic diseases. It’s difficult to persuade drug companies and the general population to invest in treating something they view as a failure of willpower with an intervention like a vaccine. But researchers aren’t giving up.
http://www.sciencemag.org/content/337/6101/1479.summary

Review
Can Noncommunicable Diseases Be Prevented? Lessons from Studies of Populations and Individuals
Majid Ezzati*, Elio Riboli
MRC-HPA, Centre for Environment and Health and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK.
Noncommunicable diseases (NCDs)—mainly cancers, cardiovascular diseases, diabetes, and chronic respiratory diseases—are responsible for about two-thirds of deaths worldwide, mostly in low- and middle-income countries. There is an urgent need for policies and strategies that prevent NCDs by reducing their major risk factors. Effective approaches for large-scale NCD prevention include comprehensive tobacco and alcohol control through taxes and regulation of sales and advertising; reducing dietary salt, unhealthy fats, and sugars through regulation and well-designed public education; increasing the consumption of fresh fruits and vegetables, healthy fats, and whole grains by lowering prices and improving availability; and implementing a universal, effective, and equitable primary-care system that reduces NCD risk factors, including cardiometabolic risk factors and infections that are precursors to NCDs, through clinical interventions.
http://www.sciencemag.org/content/337/6101/1482.abstract

Perspective
Double Burden of Noncommunicable and Infectious Diseases in Developing Countries
I. C. Bygbjerg
Copenhagen School of Global Health, Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, 5 Øster Farimagsgade, DK-1014, Copenhagen K, Denmark. E-mail: iby@sund.ku.dk.

Abstract
On top of the unfinished agenda of infectious diseases in low- and middle-income countries, development, industrialization, urbanization, investment, and aging are drivers of an epidemic of noncommunicable diseases (NCDs). Malnutrition and infection in early life increase the risk of chronic NCDs in later life, and in adult life, combinations of major NCDs and infections, such as diabetes and tuberculosis, can interact adversely. Because intervention against either health problem will affect the other, intervening jointly against noncommunicable and infectious diseases, rather than competing for limited funds, is an important policy consideration requiring new thinking and approaches.
http://www.sciencemag.org/content/337/6101/1499.abstract

Editorial
Prevention and Cost Control
Ezekiel Emanuel
Ezekiel Emanuel is the Vice Provost for Global Initiatives and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, Philadelphia, PA.

Prevention is the key to cost control and improving the quality of health care in many nations. Most people think of prevention as vaccines and screening tests. But it is tertiary prevention—keeping people with established diseases from becoming worse—that holds the greatest promise for strengthening the health care system. Why? Health care costs are unevenly distributed across populations. In the United States, 50% of the population uses hardly any health care, whereas 10% consumes nearly two-thirds of all health care spending. The latter are patients with one or more chronic conditions, such as congestive heart failure, diabetes, or cancer. To control costs, we must prevent the conditions of this 10% of patients from worsening.
http://www.sciencemag.org/content/337/6101/1433.summary

Vaccine
Volume 30, Issue 45 pp. 6341-6508 (5 October 2012)
http://www.sciencedirect.com/science/journal/

The impact of new vaccine introduction on immunization and health systems: A review of the published literature
Review Article
Pages 6347-6358
Terri B. Hyde, Holly Dentz, Susan A. Wang, Helen E. Burchett, Sandra Mounier-Jack, Carsten F. Mantel, The New Vaccine Introduction Impact Published Literature Working Gro

Abstract
We conducted a systematic review of the published literature to examine the impact of new vaccine introduction on countries’ immunization and broader health systems. Six publication databases were searched using 104 vaccine and health system-related search terms. The search yielded 15,795 unique articles dating from December 31, 1911 to September 29, 2010. Based on review of the title and abstract, 654 (4%) of these articles were found to be potentially relevant and were referred for full review. After full review, 130 articles were found to be relevant and included in the analysis. These articles represented vaccines introduced to protect against 10 different diseases (hepatitis A, hepatitis B, Haemophilus influenzae type b disease, human papilloma virus infection, influenza, Japanese encephalitis, meningococcal meningitis, Streptococcus pneumoniae disease, rotavirus diarrhea and typhoid), in various formulations and combinations. Most reviewed articles (97 [75%]) reported experiences in high-income countries. New vaccine introduction was most efficient when the vaccine was introduced into an existing delivery platform and when introduced in combination with a vaccine already in the routine childhood immunization schedule (i.e., as a combination vaccine). New vaccine introduction did not impact coverage of vaccines already included in the routine childhood immunization schedule. The need for increased cold chain capacity was frequently reported. New vaccines facilitated the introduction and widespread use of auto-disable syringes into the immunization and the broader health systems. The importance of training and education for health care workers and social mobilization was frequently noted. There was evidence in high-income countries that new vaccine introduction was associated with reduced health-care costs. Future evaluations of new vaccine introductions should include the systematic and objective assessment of the impacts on a country’s immunization system and broader health system, especially in lower-income countries.

Vaccine
Volume 30, Issue 45 pp. 6341-6508 (5 October 2012)
http://www.sciencedirect.com/science/journal/

Economic impact of the 2009–2010 Guam mumps outbreak on the public health sector and affected families
Original Research Article
Pages 6444-6448
Abdirahman Mahamud, A. Parker Fiebelkorn, George Nelson, Annette Aguon, John McKenna, Gissela Villarruel, Kathleen Gallagher, Ismael R. Ortega-Sánc

Abstract
Background
The United States Territory of Guam reported a large mumps outbreak of 505 cases during 2009–2010. We assessed the economic impact of the outbreak from the perspectives of the local public health sector and affected families.

Methods
Using standard cost analysis methods, we retrospectively identified all public health personnel involved in the outbreak response and surveyed them about their outbreak-related activities. We then estimated the costs of outbreak-related personnel hours and materials. We also assessed out-of-pocket costs and costs incurred for work-time missed for persons with mumps and their families. We defined the analysis period as February 25–October 22, 2010.

Results
Seventy-six public health personnel were involved in outbreak response activities. Overall, the response required approximately 8264 person-hours, 2380 miles driven, and 3000 doses of measles-mumps-rubella vaccine ordered. The cost to the public health sector was 256,785 U.S. dollars (USD). Families of 102 persons with mumps were interviewed. An estimated 761 USD per person with mumps was spent by families; 88% of this cost was due to missed days of work. The estimated total cost to families of the 470 persons with mumps during the analysis period was 357,670 USD. Total outbreak-related costs were 614,455 USD.

Conclusions
The costs reported underscore the impact of mumps outbreaks in highly vaccinated populations and the need for effective mumps prevention and control strategies.

Vaccine
Volume 30, Issue 45 pp. 6341-6508 (5 October 2012)
http://www.sciencedirect.com/science/journal/

Barriers to HPV immunization for African American adolescent females
Original Research Article
Pages 6472-6476
Tamara Hamlish, Laura Clarke, Kenneth A. Alexander

Abstract
Purpose
The objective of this study was to identify motivations and barriers to HPV vaccination and culturally relevant and meaningful opportunities for vaccine promotion among African American mothers and adolescent daughters. Qualitative methods were employed to identify barriers to HPV immunization and understand mothers’ motivations to vaccinate their daughters. We conducted in-depth interviews with 19 mother–daughter pairs focused on 5 key areas: health history, prior vaccine experience, knowledge of HPV and HPV vaccine, relationship with physician, and experience of cervical dysplasia and cervical cancer (CD/CC).

Results
Four key factors drive HPV immunization among African-American mothers of adolescent daughters. First, mothers’ CD/CC disease experiences motivated a strong commitment to protect daughters from the trauma of CD/CC. Second, limited understanding of HPV and its connection to CD/CC made it difficult for mothers to assess the risk of infection or explain the medical benefits of the vaccine to their daughters. Third, mothers anticipate the sexual debut of adolescent daughters and advocate for healthcare interventions to protect them. Mothers were not deterred by multiple visits to complete the vaccine series; they likened HPV immunization to injectable contraceptives that require a series of injections and offer protection from the unintended consequences of sexual activity. Finally, mothers trusted physicians to initiate discussion of HPV immunization. Physicians who failed to initiate discussion and offer unconditional endorsement generated doubt about the vaccine among mothers and missed opportunities for immunization.

Conclusions
Our initial results indicate that physicians can engage in culturally relevant vaccine promotion in urban, underserved African American communities by initiating discussions of HPV immunization that (1) acknowledge mothers’ own CD/CC experiences, (2) support parenting strategies that aim to protect daughters from the unintended consequences of sexual activity, and (3) make explicit the connection between CD/CC and HPV infection, and between prevention of HPV infection and HPV immunization.

Twitter Watch  [accessed 22 September 2012  15:08]
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.

UN Foundation @unfoundation
Download the @ShotAtLife #MobileApp: Incredible information for all parents – http://shotatlife.org/mobile
3:28 PM – 22 Sep 12

WHO @WHO
Dr Chan: Noncommunicable diseases: A slow-motion disaster http://goo.gl/R6cyj #NCDs
1:59 PM – 22 Sep 12

UN Development @UNDP
Join the Global Conversation! Watch the #SGSGlobal live stream in 7 languages here: http://on.undp.org/dU4Tx | Starting 1pmEST
11:14 AM – 22 Sep 12

PAHO/WHO @pahowho
Health situation in the Americas: #HealthIndicators2012 http://new.paho.org/hq/index.php?option=com_content&view=article&id=7170&Itemid=2395&lang=en#.UFzbx9aVngE.twitter #TT4Health @who
5:28 PM – 21 Sep 12

PAHO/WHO @pahowho
Important step 2improve international humanitarian aid in the health sector during disasters http://goo.gl/BbziY #PSC28 @pahodisasters
Pan American Sanitary Conference approves resolution on coordination…
A resolution that seeks to improve coordination of international humanitarian assistance in case of disasters in the Region was approved by the 28th Pan American Sanitary Conference. The ministers…
12:34 PM – 21 Sep 12

TB Alliance @TBAlliance
Sanofi and TB Alliance announce new collaboration http://shar.es/uKMeW @SanofiUS Goal is to select novel clinical development candidates
8:06 AM – 20 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_15 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…

UNICEF released the 2012 Progress Report on Committing to Child Survival: A Promise Renewed  noting that “countries across the world are making rapid progress in reducing child deaths, demonstrating that it is possible to radically reduce child mortality over the span of two decades.” The report examines trends in child mortality estimates since 1990, and shows that major reductions have been made in under-five mortality rates in all regions and diverse countries, translating into a sharp drop in the estimated number of under-five deaths worldwide. Data released today by UNICEF and the UN Inter-agency Group for Child Mortality Estimation show that the number of children under the age of five dying globally fell from nearly 12 million in 1990 to an estimated 6.9 million in 2011. The report “underscores that neither a country’s regional affiliation nor economic status need be a barrier to reducing child deaths. Low-income countries such as Bangladesh, Liberia and Rwanda, middle-income countries such as Brazil, Mongolia and Turkey, and high-income countries such as Oman and Portugal, have all made dramatic gains, lowering their under-five mortality rates by more than two-thirds between 1990 and 2011.” Anthony Lake, UNICEF Executive Director, commented, “The global decline in under-five mortality is a significant success that is a testament to the work and dedication of many, including governments, donors, agencies and families. But there is also unfinished business: Millions of children under five are still dying each year from largely preventable causes for which there are proven, affordable interventions. These lives could be saved with vaccines, adequate nutrition and basic medical and maternal care. The world has the technology and know-how to do so. The challenge is to make these available to every child.”
More at: http://www.unicef.org/media/media_65823.html

Report: Committing to Child Survival: A Promise Renewed
http://www.unicef.org/media/files/APR_Progress_Report_2012_final.pdf

Speech: WHO Director-General addresses Europe’s ministers of health
Dr Margaret Chan, Director-General of the World Health Organization
Address to the Regional Committee for Europe, Sixty-second session
Malta
11 September 2012

[Editor’s Extract, Bolding]

“…The target date for reaching the Millennium Development Goals (MDGs) is fast approaching. The debate about the post-2015 development agenda is in full swing. Rest assured, WHO is taking a leadership role in moving this debate through processes and procedures aimed at collecting a broad range of views. There are many political and technical processes under way. WHO is working with many partners, including other United Nations organizations.

Pursuit of the MDGs taught us many lessons. We learned the critical importance of a well-functioning and inclusive health system that offers financial protection against catastrophic health expenditures.

We learned that good aid builds self-reliance. It aims to eliminate the need for aid. It does so by channelling resources in ways that strengthen existing capacities and infrastructures, instead of circumventing, undermining, or overburdening them.

We learned the value of concentrating international efforts on a limited number of time-bound goals that resonate with the public and parliamentarians, and of course with the development community. Individual diseases benefited greatly from innovation, including new financing mechanisms and technical innovations, like new vaccines, better medicines, patient-friendly formulations and simplified point-of-care diagnostic tests.

These are some of the successes that helped drive dramatic reductions in morbidity and mortality. They have paved the way for a new agenda that builds on these achievements. And I’m happy to see our colleagues from GAVI and the Global Fund here; they are important partners.

But, as I said, we absolutely must get this right. The MDGs strongly influenced development priorities and directed resource flows. The temptation will be great to expand the number of goals, rather than keep the agenda sharp, focused, time bound and feasible. So competition is keen among sectors to get a goal on the list.

As we think about the post-2015 agenda, we must never forget that the health-related MDGs were largely an infectious disease agenda. At the start of this century, AIDS, tuberculosis, and malaria were public health emergencies that warranted sharply focused efforts to stop the epidemics from expanding further and reduce the number of deaths. This happened.

Efforts to control these diseases can now address them not as emergencies, but as part of general health services. In turn, general health services can benefit broadly from the refined and simplified strategies developed to control these diseases.

As just one example, the recent WHO policy requiring diagnostic confirmation of malaria before medicines are dispensed has strengthened detection capacity for all diseases.

My advice is this. We dare not reduce the current pressure on vaccine-preventable diseases, AIDS, tuberculosis, malaria, and the neglected tropical diseases. Constant mutation and adaptation are the survival mechanisms of the microbial world.

   Complacency gives infectious diseases the perfect opportunity to return with a vengeance. I need only mention the problems we are already facing with antimicrobial resistance. The momentum to control these diseases must not stop in 2015…”

http://www.who.int/dg/speeches/2012/euro_20120911/en/index.html

   CARPHA (Caribbean Public Health Agency) – a new regional health organization – has been created by the Caribbean Community (CARICOM) with support from the PAHO/WHO and international partners including Canada, the United States, and the United Kingdom. CARPHA merges the operations of five regional health institutions: the Caribbean Epidemiology Centre (CAREC), the Caribbean Food and Nutrition Institute (CFNI), the Caribbean Health Research Council (CHRC), Caribbean Environmental Health Institute (CEHI), and the Caribbean Regional Drug Testing Laboratory (CRDTL). Based in Port of Spain, Trinidad and Tobago, CARPHA is scheduled to become operational in January 2013. CARPHA will serve as the lead agency for coordinating pan-Caribbean action in areas including disease surveillance, development of human resources for health, emergency preparedness and response, health promotion and communication, and policy development. It will house a regional laboratory and will coordinate a network of laboratories in other Caribbean countries as well.

http://new.paho.org/hq/index.php?option=com_content&view=article&id=7180&Itemid=1926

The Sabin Vaccine Institute Product Development Partnership (Sabin PDP) announced a new collaboration with Eisai Co., Ltd. to advance vaccine development efforts for neglected tropical diseases (NTDs). Sabin said that Eisai’s adjuvant material donation will enable the Sabin PDP to expand ongoing research and development for its leishmaniasis and Chagas disease vaccine candidates. This new partnership “represents an important first step in what will be an ongoing effort to find solutions to some of the world’s most pervasive diseases of poverty.”  The announcement noted that Eisai is among 13 pharmaceutical companies and other global partners, including WHO, the World Bank, the Bill & Melinda Gates Foundation and several national governments, to commit resources to controlling or eliminating 10 NTDs by 2020. The historic announcement, known as the London Declaration, marked the first time that the global health community joined together in a renewed effort to fight NTDs by offering in-kind support, expertise and funding. As part of their commitment, Eisai is providing their E6020 adjuvant material free of charge.

More at: http://www.sabin.org/news-resources/in-news/2012/09/12/eisai-and-sabin-vaccine-institute-partner-develop-vaccines-chagas-

The Board of the Global Fund to Fight AIDS, Tuberculosis and Malaria said it approved “a new approach to funding grants that will enable the organization to invest the world’s money more strategically and for greater impact.” The announcement noted that the new funding model “is designed to significantly improve grant-making, with a process that is more predictable and reliable, and also more flexible, so that it can achieve a higher success rate in all grants and more effectively save the lives of people affected by the three diseases.” Further, the new funding model “will change the way implementers apply for financing, get approval of their proposals and then manage their grants. Once fully developed, it will encourage national strategic plans in each country, and strive for more simplicity and efficiency.” Several aspects of the new funding model require further preparation, and the Board agreed to consider them at its next meeting in November.

The Global Fund said that one key element of the new system will be for applicants to submit a concept note, shorter than previous applications, and then get early feedback from the Global Fund, other donors and technical experts on how the proposal may need adjusting before moving forward. That is expected to reduce waiting times, and to improve the overall success rate of applications.  Another important change will be more flexible timing for grant applications: instead of having to apply at one set time, implementers will be able to better align the submission of grant proposals with their own national budgeting schedules. Also under the new approach, countries will be grouped in bands, which will enable the Board to ensure focus is placed on countries with the highest disease burden and least ability to pay, among other factors.

More at: http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-09-14_Global_Fund_Adopts_New_Approach_to_Funding_Grants/

The Weekly Epidemiological Record (WER) for 14 September 2012, vol. 87, 37 (pp. 345–356) includes:

– Outbreak news; Hantavirus pulmonary syndrome, Yosemite National Park, United States of America;
– Global programme to eliminate lymphatic filariasis: progress report, 2011

http://www.who.int/entity/wer/2012/REH_37.pdf

Update: Polio this week – As of 11 Sep 2012
Global Polio Eradication Initiative
[Editor’s Extract]
– In the previous six months, 92 cases have been reported worldwide, 63 of which from Nigeria, 15 from Pakistan, 12 from Afghanistan, and two from Chad. Nigeria currently accounts for more than two-thirds (68%) of global polio cases over the previous six months.

Nigeria
– One new case was reported in the past week (WPV3 from Borno, with onset of paralysis on 10 August), bringing the total number of cases for 2012 to 84. The most recent case had onset of paralysis on 15 August (WPV1 from Kaduna).
Nigeria continues to be the only country in the world affected by transmission of all three serotypes: WPV1, WPV3 and a cVDPV type 2…
– The Expert Review Committee on Polio Eradication and Routine Immunization (ERC) met this week (10-11 September), to review impact of the national emergency action plan and recommend strategies going forward.

Pakistan
– One new case was reported in the past week (WPV1 from Khyber Pakhtunkhwa – KP, with onset of paralysis on 22 August), bringing the total number of cases for 2012 to 30. This case is the most recent case in the country.
– Additionally, two new positive environmental samples were reported, from northern Sindh and southern Sindh…
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

Nigeria Not On Track To Achieving Polio Eradication – WHO
Leadership [Newspaper, Nigeria]
[Editor’s Extract]
The World Health Organisation (WHO) on Tuesday said Nigeria was not on track in the effort to eradicate wild polio virus before the end of December this year.

Dr Bruce Alyward, WHO Assistant Director-General, Polio, Emergencies and Country Collaboration, said in Abuja that the increasing cases of the virus in the country constitutes “real and growing danger to international public health.”

Alyward said during the 24th session of Expert Review Committee Meeting on Polio Eradication, that the country had the tools and capacity to rapidly reverse the trend.

“Every country is expected to operate in the emergency mode, Congo, India and China have stopped polio in the last three months, Nigeria is the only country in the world that has polio type 1 and type 2 in the last three months. It is also the only country in the world with increasing cases; it is the number that puts the country at risk not the quality of prevalence.”

He recommended eight major steps for polio eradication for the country, including the implementation of the new house-based micro planning and monitoring method.

Alyward said the new house based micro plan was initiated in August this year to improve polio immunisation.

Other recommendations are optimising the emergency surge through cross agency refresher training for all personnel, identifying chronically missed children, establishing true emergency oversight and having planned programme for insecure areas, among others. Alyward urged the country to address the chronic surveillance gaps, and called for urgent implementation of environmental surveillance in Maiduguri…

http://leadership.ng/nga/articles/34656/2012/09/11/nigeria_not_track_achieving_polio_eradication_who.html

    Pfizer announced that WHO granted an expansion to the prequalification of Pfizer’s pneumococcal conjugate vaccine, Prevenar 13 (Pneumococcal polysaccharide conjugate vaccine [13-valent, adsorbed]), to include adults 50 years of age and older against pneumonia and invasive disease caused by the 13 pneumococcal serotypes (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F) contained in the vaccine. Luis Jodar, vice president, Vaccines, Global, Medicines Development Group and Scientific Affairs, Pfizer, said, “This expanded designation will allow for broader global access to the vaccine and provide the opportunity for a new prevention option for adults 50 years of age and older in developing nations.”

http://www.businesswire.com/news/home/20120911005783/en/World-Health-Organization-Grants-Expansion-Prequalification-Prevenar

WHO: Initiative for Vaccine Research (IVR)
Dengue vaccine research
Dengue is a mosquito-borne flavivirus disease that has spread to most tropical and many subtropical areas. The disease is caused by four closely related viruses, the Dengue viruses 1-4. There are no specific dengue therapeutics and prevention is currently limited to vector control measures. A dengue vaccine would therefore represent a major advance in the control of the disease.

Status of vaccine development
While no licensed dengue vaccine is available, several vaccine candidates are currently being evaluated in clinical studies.

The candidate currently at the most advanced clinical development stage, a live-attenuated tetravalent vaccine based on chimeric yellow fever-dengue virus (CYD-TDV), has progressed to phase III efficacy studies. Results from a phase IIb efficacy study in Thailand have been published in September 2012.
More information on the phase IIb study of CYD-TDV (September 2012)
pdf, 55kb

Several other live-attenuated vaccines, as well as subunit, DNA and purified inactivated vaccine candidates, are at earlier stages of clinical development. Additional technological approaches, such as virus-vectored and VLP-based vaccines, are under evaluation in preclinical studies…

http://www.who.int/vaccine_research/diseases/dengue/dengue_vaccines/en/index.html

WHO: Global Alert and Response (GAR)

Disease Outbreak News

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

– 12 September 2012  Hantavirus pulmonary syndrome – Yosemite National Park, United States of America – update

– 8 September 2012  Cholera in Sierra Leone – update

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

WHO Europe: WHO Epidemiological Brief 26: Measles, rubella and polio update
“This issue provides an overview of selected epidemiological characteristics of measles and rubella in the WHO European Region for the first seven months of 2012. The analysis is based on cases with disease onset dates during this period. The report also provides information on acute flaccid paralysis (AFP) surveillance.”

http://www.euro.who.int/__data/assets/pdf_file/0017/173060/EpiBrief-Issue-26-Sept-2012.pdf

SHEA Guidance Statement

Infection Control and Hospital Epidemiology
Vol. 33, No. 10, October 2012
http://www.jstor.org/stable/10.1086/667772

The Use of Live Attenuated Influenza Vaccine (LAIV) in Healthcare Personnel (HCP): Guidance from the Society for Healthcare Epidemiology of America (SHEA)
Thomas R. Talbot, MD, MPH,1 Hilary Babcock, MD, MPH,2 Deborah Cotton, MD, MPH,3,4 Lisa L. Maragakis, MD, MPH,5 Gregory A. Poland, MD,6 Edward J. Septimus, MD,7,8 Michael L. Tapper, MD,9 David J. Weber, MD, MPH,10 and writing as the SHEA Task Force on Healthcare Personnel Influenza Vaccination

[Editor’s Extract]
“…SHEA endorses the use of LAIV as an alternative to the inactivated influenza vaccine, particularly for those HCP who avoid an annual influenza vaccination because of fear of needle injections. SHEA also agrees with the restriction of LAIV from those HCP who, in the week following vaccination, have frequent contact with patients who reside in a protective environment (eg, HCP in a bone marrow transplantation unit), but it notes that this recommendation is made as a result of an abundance of caution. Those HCP who have frequent contact with patients in protective environments but who will not care for such patients in the week following vaccination may still receive LAIV. HCP who have the potential for infrequent contact with patients in protective environments (ie, when the majority of patients contacted do not reside in a protective environment, such as a radiology technologist performing a chest radiograph or an emergency department physician during the initial patient evaluation) should not be excluded from vaccination with LAIV. Finally, HCP who provide care to other immunosuppressed populations (eg, neonatal and burn unit patients and oncologic patients undergoing chemotherapy but not requiring a formal protective environment) may still receive LAIV…”

Meeting: IOM – Improving Health, Health Systems, and Health Policy Around the World
September 24, 2012
The Conference Center at The New York Academy of Medicine (Library Reading Room) • 1216 Fifth Avenue, New York, NY 10029 Map

The Institute of Medicine’s Roundtable on Health Literacy will host its next workshop on September 24, 2012 at The Conference Center at The New York Academy of Medicine. International Approaches to Health Literacy is the topic of the workshop. Experts will present material on the subject to the Roundtable. The workshop is free and open to the public.  If you would like to register to attend, please do so under “attend this meeting”. Please see the posted agenda for a schedule of the day.
http://www.iom.edu/Activities/PublicHealth/HealthLiteracy/2012-SEP-24.aspx?utm_medium=etmail&utm_source=Institute%20of%20Medicine&utm_campaign=09.11.12+Meeting+Alert&utm_content=Meetings%20&%20Events&utm_term=Academic

IOM Report: How Far Have We Come in Reducing Health Disparities?  Progress Since 2000 – Workshop Summary
https://download.nap.edu/login.php?record_id=13383&page=%2Fcatalog.php%3Frecord_id%3D13383
Released: September 12, 2012

At the turn of the 21st century, several important reports and events designed to raise awareness of health disparities and to describe initial efforts to reduce health disparities took place. The Surgeon General’s office released several reports that showed dramatic disparities, for example, in tobacco use and access to mental health services by race and ethnicity. Second, the first real legislation focused on reducing health disparities was signed into law, creating the National Center for Minority Health and Health Disparities within the NIH. In 2001, the IOM released its landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century, highlighting the importance of a focus on health care quality rather than a focus on only access and cost issues. Building upon these reports and events, the IOM held a workshop on April 8, 2010, that discussed progress to address health disparities and focused on the success of various federal initiatives to reduce health disparities. This document summarizes the workshop.

Book: Genome-Based Therapeutics: Targeted Drug Discovery and Development: Workshop Summary
Authors:
Adam C. Berger and Steve Olson, Rapporteurs; Roundtable on Translating Genomic-Based Research for Health; Board on Health Sciences Policy; Institute of Medicine
IOM
September 5, 2012
http://iom.edu/Reports/2012/Genome-Based-Therapeutics-Targeted-Drug-Discovery-and-Development.aspx?utm_medium=etmail&utm_source=Institute%20of%20Medicine&utm_campaign=09.05.12+Report+-+Genomics+Therapeutics&utm_content=New%20Reports&utm_term=Academic

Description
Genome-Based Therapeutics summarizes a workshop that was held on March 21, 2012, titled New Paradigms in Drug Discovery: How Genomic Data Are Being Used to Revolutionize the Drug Discovery and Development Process. At this workshop the goal was to examine the general approaches being used to apply successes achieved so far, and the challenges ahead.

Genome-Based Therapeutics explains that new technologies have the potential to open up avenues of development and to identify new drug targets to pursue. Specifically, improved validation of gene-disease associations through genomics research has the potential to revolutionize drug production and lower development costs. Genetic information has helped developers by increasing their understanding of the mechanisms of disease as well as individual patients’ reactions to their medications. There is a need to identify the success factors for the various models that are being developed, whether they are industry-led, academia-led, or collaborations between the two.

Directory: Developing World Health Partnerships
The International Federation of Pharmaceutical Manufacturers & Associations (IFPMA)
September 2012

Now totaling 220 and reaching people in more than 160 countries, these health partnerships highlight the commitment of research-based pharmaceutical industry and its many partners including governments, intergovernmental organizations, nongovernmental organizations, private sector companies and universities to improve health around the world.

The launch of this directory coincides with the release of an independent review of the contributions these health partnerships’ make to the health of people in low- and middle-income countries. This review was conducted by BSR, a global business network and consultancy focused on sustainability.

“Global health issues are complex, and solutions often require a range of organizations working together,” said Eduardo Pisani, IFPMA Director General. “Understanding the value of partnerships, our industry and partners have increased these programs dramatically in recent years as highlighted in our directory. This year, we are pleased that BSR analyzed these programs and made suggestions for increasing the benefit people in developing countries.”

The industry-led health partnerships catalogued in the IFPMA’s Developing World Health Partnerships Directory focus on a wide range of activities from developing new treatments and improving their availability to strengthening health systems, raising awareness, prevention and training. They also cover various types of diseases such as HIV/AIDS, neglected tropical diseases, malaria, non-communicable diseases and more cross-cutting challenges such as women and children’s health.

Developing World Health Partnerships Directory or BSR’s review can be found at: http://partnerships.ifpma.org/

http://www.ifpma.org/fileadmin/content/News/2012/FINAL_IFPMA_press_release_-_partnerships_-_11_September_2012.pdf

British Medical Journal
14 September 2012 (Vol 345, Issue 7874)
http://www.bmj.com/content/345/7874

Editorial
WHO’s ambitious new European health strategy
BMJ 2012; 345 doi: 10.1136/bmj.e5928 (Published 5 September 2012)
Cite this as: BMJ 2012;345:e5928
David J Hunter, professor of health policy and management

[Extract]
Political will must be galvanised for Health 2020 to succeed

It may seem the wrong moment to launch an ambitious European health policy framework and strategy and invite governments to adopt it, as the World Health Organization’s Regional Office for Europe is asking its 53 member states to do. However, the architects of Health 2020,1 2 WHO’s flagship strategy that has been in preparation for almost two years and will be launched at the 62nd Regional Committee in Malta, 10-14 September 2012, regard the timing as propitious. They insist that, although the economic and fiscal crises facing Europe present major challenges, they also present opportunities to renew efforts to improve the health of European people. The argument that lies at the heart of Health 2020 is that “good health is essential for economic and social development.” It echoes Derek Wanless’s recommendation a decade ago to the UK government that it should emphasise public health more strongly to ensure the survival of the NHS.3

WHO issues its European health report every three years. The 2012 report provides the context that explains why the Health 2020 strategy needs to be taken seriously.4 Although people across Europe are generally living longer, often in better health, these improvements are not being shared equally. Substantial health inequalities persist between and within countries and are increasing in some cases, as set out in WHO’s European review of social determinants of health …

Eurosurveillance
Volume 17, Issue 37, 13 September 2012
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

News
Health requirements for pilgrims attending the Hajj in Mecca, Kingdom of Saudi Arabia, 24–29 October 2012
Eurosurveillance editorial team
European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

Hajj is the annual pilgrimage to Mecca, the Kingdom of Saudi Arabia (KSA). The 2012 Hajj is expected to gather over two million Muslims from more than 180 countries across the globe between 24 and 29 October and is by far the largest mass gathering in the world. With the Hajj approaching, the Ministry of Health of Saudi Arabia has issued information in Arabic and English about health requirements and recommendations on its website [1].
A publication in the Weekly Epidemiological Record informs visitors in English and French of the full requirements for entry into Saudi Arabia and information is also available in English from The National Travel Health Network and Centre (NaTHNaC) website [2,3].
Special requirements for visitors to the Hajj concern vaccinations against meningococcal meningitis, polio and yellow fever.
Health authorities in countries of origin are required to provide information to pilgrims on infectious diseases symptoms, methods of transmission, complications and means of prevention. In an attempt to prevent the spread of foodborne infections Hajj performers are not allowed to bring fresh food to Saudi Arabia. Only properly canned or sealed food or food stored in containers with easy access for inspection is allowed in small quantities, sufficient for one person for the duration of his or her trip.
The KSA provides free healthcare to all visiting pilgrims during the Hajj, with the KSA Ministry of Health as one of the main contributors.

References
– Saudi Ministry of Health Requirements and Health Matters. Riyadh: Ministry of Hajj. Kingdom of Saudi Arabia. [Accessed 13 Sep 2012]. Available from: http://www.hajinformation.com/main/t20.htm

– Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj). Wkly Epidemiol Rec. 2012;87(30):277-80.

– National Travel Health Network and Centre. Advice for Pilgrims for the Hajj and Umrah Season of 1433 (2012).  London: Health protection Agency. [accessed 13 Sep 2012]. Available from: http://www.nathnac.org/pro/factsheets/pdfs/Hajj_Umrah.pdf

Globalization and Health
[Accessed 15 September 2012]
http://www.globalizationandhealth.com/

Review
Understanding India, globalisation and health care systems: a mapping of research in the social sciences
Bisht R, Pitchforth E and Murray SF
Globalization and Health 2012, 8:32 (10 September 2012)

The Lancet  
Sep 15, 2012  Volume 380  Number 9846  p949 – 1030  e2 – 6
http://www.thelancet.com/journals/lancet/issue/current

Comment
Treatment of tuberculosis: have we turned the corner?
Giovanni Battista Migliori, Giovanni Sotgiu

Preview
The number of multidrug-resistant (MDR) tuberculosis cases officially reported to WHO increased from 29 000 to 53 000 between 2008 and 2010,1 still representing only 18% of the estimated 290 000 patients potentially identifiable if drug susceptibility testing was done in all notified cases of tuberculosis.1 A recent study done in Belarus2 showed a new global record for prevalence of MDR tuberculosis with 35·3% of new patients and 76·5% of previously treated patients diagnosed with the disease. This finding clearly shows how far case mismanagement can affect the chances to control (and eventually eliminate) the disease.

The Lancet  
Sep 15, 2012  Volume 380  Number 9846  p949 – 1030  e2 – 6
http://www.thelancet.com/journals/lancet/issue/current

Articles
Effect of intermittent preventive treatment for malaria during infancy on serological responses to measles and other vaccines used in the Expanded Programme on Immunization: results from five randomised controlled trials
Jane Crawley, Charalambos Sismanidis, Tracey Goodman, Paul Milligan, WHO Advisory Committee on serological responses to vaccines used in the Expanded Programme on Immunization in infants receiving Intermittent Preventive Treatment for malaria

Preview
IPTi with sulfadoxine-pyrimethamine does not affect serological responses to EPI vaccines. This analysis, therefore, supports the WHO recommendation for coadministration of IPTi with sulfadoxine-pyrimethamine to infants at the time of the second and third doses of DTP and measles vaccination, in areas of sub-Saharan Africa with moderate to high malaria transmission and where malaria parasites are sensitive to these drugs. It also suggests that treatment of clinical malaria at or around the time of vaccination does not compromise vaccine responsiveness.

The Lancet  
Sep 15, 2012  Volume 380  Number 9846  p949 – 1030  e2 – 6
http://www.thelancet.com/journals/lancet/issue/current

Review
WHO European review of social determinants of health and the health divide
Michael Marmot, Jessica Allen, Ruth Bell, Ellen Bloomer, Peter Goldblatt, on behalf of the Consortium for the European Review of Social Determinants of Health and the Health Divide

Summary
The European region has seen remarkable heath gains in those populations that have experienced progressive improvements in the conditions in which people are born, grow, live, and work. However, inequities, both between and within countries, persist. The review reported here, of inequities in health between and within countries across the 53 Member States of the WHO European region, was commissioned to support the development of the new health policy framework for Europe: Health 2020. Much more is understood now about the extent, and social causes, of these inequities, particularly since the publication in 2008 of the report of the Commission on Social Determinants of Health. The European review builds on the global evidence and recommends policies to ensure that progress can be made in reducing health inequities and the health divide across all countries, including those with low incomes. Action is needed—on the social determinants of health, across the life course, and in wider social and economic spheres—to achieve greater health equity and protect future generations

New England Journal of Medicine
September 13, 2012  Vol. 367 No. 11
http://content.nejm.org/current.shtml

Original Article
Waning Protection after Fifth Dose of Acellular Pertussis Vaccine in Children
Nicola P. Klein, M.D., Ph.D., Joan Bartlett, M.P.H., M.P.P., Ali Rowhani-Rahbar, M.D., M.P.H., Ph.D., Bruce Fireman, M.A., and Roger Baxter, M.D.
N Engl J Med 2012; 367:1012-1019 September 13, 2012

Background
In the United States, children receive five doses of diphtheria, tetanus, and acellular pertussis (DTaP) vaccine before 7 years of age. The duration of protection after five doses of DTaP is unknown.

Methods
We assessed the risk of pertussis in children in California relative to the time since the fifth dose of DTaP from 2006 to 2011. This period included a large outbreak in 2010. We conducted a case–control study involving members of Kaiser Permanente Northern California who were vaccinated with DTaP at 47 to 84 months of age. We compared children with pertussis confirmed by a positive polymerase-chain-reaction (PCR) assay with two sets of controls: those who were PCR-negative for pertussis and closely matched controls from the general population of health-plan members. We used logistic regression to examine the risk of pertussis in relation to the duration of time since the fifth DTaP dose. Children who received whole-cell pertussis vaccine during infancy or who received any pertussis-containing vaccine after their fifth dose of DTaP were excluded.

Results
We compared 277 children, 4 to 12 years of age, who were PCR-positive for pertussis with 3318 PCR-negative controls and 6086 matched controls. PCR-positive children were more likely to have received the fifth DTaP dose earlier than PCR-negative controls (P<0.001) or matched controls (P=0.005). Comparison with PCR-negative controls yielded an odds ratio of 1.42 (95% confidence interval, 1.21 to 1.66), indicating that after the fifth dose of DTaP, the odds of acquiring pertussis increased by an average of 42% per year.

Conclusions
Protection against pertussis waned during the 5 years after the fifth dose of DTaP. (Funded by Kaiser Permanente).

Drs. Klein and Baxter report receiving grant support to their institution from Sanofi Pasteur, GlaxoSmithKline, Novartis, Merck, and Pfizer. No other potential conflict of interest relevant to this article was reported.

PLoS One
[Accessed 15 September 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Addressing Health Inequalities in the Delivery of the Human Papillomavirus Vaccination Programme: Examining the Role of the School Nurse
Tammy Boyce, Alison Holmes
PLoS ONE: Research Article, published 13 Sep 2012 10.1371/journal.pone.0043416

Abstract 
Background
HPV immunisation of adolescent girls is expected to have a significant impact in the reduction of cervical cancer. UK The HPV immunisation programme is primarily delivered by school nurses. We examine the role of school nurses in delivering the HPV immunisation programme and their impact on minimising health inequalities in vaccine uptake.

Methods and Findings
A rapid evidence assessment (REA) and semi-structured interviews with health professionals were conducted and analysed using thematic analysis. 80 health professionals from across the UK are interviewed, primarily school nurses and HPV immunisation programme coordinators. The REA identified 2,795 articles and after analysis and hand searches, 34 relevant articles were identified and analysed. Interviews revealed that health inequalities in HPV vaccination uptake were mainly related to income and other social factors in contrast to published research which emphasises potential inequalities related to ethnicity and/or religion. Most school nurses interviewed understood local health inequalities and made particular efforts to target girls who did not attend or missed doses. Interviews also revealed maintaining accurate and consistent records influenced both school nurses’ understanding and efforts to target inequalities in HPV vaccination uptake.

Conclusions
Despite high uptake in the UK, some girls remain at risk of not being vaccinated with all three doses. School nurses played a key role in reducing health inequalities in the delivery of the HPV programme. Other studies identified religious beliefs and ethnicity as potentially influencing HPV vaccination uptake but interviews for this research found this appeared not to have occurred. Instead school nurses stated girls who were more likely to be missed were those not in education. Improving understanding of the delivery processes of immunisation programmes and this impact on health inequalities can help to inform solutions to increase uptake and address health inequalities in childhood and adolescent vaccination programmes

Science        
14 September 2012 vol 337, issue 6100, pages 1265-1424
http://www.sciencemag.org/current.dtl

Editorial
The Dual-Use Conundrum
Paul Berg
Paul Berg is the Cahill Professor of Biochemistry, Emeritus, at the Stanford University School of Medicine, Palo Alto, CA. He received the Nobel Prize in Chemistry in 1980 and was an organizer of the Asilomar conference on recombinant DNA in 1975.

Summary
Scientists are increasingly able to create genetically modified microorganisms whose properties are perceived as being beneficial as well as potentially useful for malevolent purposes. In 2004, a committee of the U.S. National Academy of Sciences adopted the term “dual use” for instances in which genetic or biosynthetic manipulations create new microorganisms, which, although valuable scientifically, are susceptible to misuse.* The premise was that the prospects for malevolent outcomes derive from deliberate actions to inflict specific or widespread harm. But in those and subsequent discussions, too little attention was given to the likelihood of an accidental laboratory release of modified agents that would allow them to spread in susceptible human populations. Recent research with a highly pathogenic influenza virus has highlighted the importance of this issue. Reviews of the influenza research concluded that given “the risk of accidental or malicious release,” the benefits of such studies must be well justified.† Thus, specific guidelines must be enforced to thwart not only intentionally harmful outcomes but accidental releases as well.

Science        
14 September 2012 vol 337, issue 6100, pages 1265-1424
http://www.sciencemag.org/current.dtl

Review
Rinderpest Eradication: Appropriate Technology and Social Innovations
Jeffrey C. Mariner, James A. House, Charles A. Mebus, Albert E. Sollod, Dickens Chibeu, Bryony A. Jones, Peter L. Roeder, Berhanu Admassu, and Gijs G. M. van ’t Klooster

Abstract
Rinderpest is only the second infectious disease to have been globally eradicated. In the final stages of eradication, the virus was entrenched in pastoral areas of the Greater Horn of Africa, a region with weak governance, poor security, and little infrastructure that presented profound challenges to conventional control methods. Although the eradication process was a development activity rather than scientific research, its success owed much to several seminal research efforts in vaccine development and epidemiology and showed what scientific decision-making and management could accomplish with limited resources. The keys to success were the development of a thermostable vaccine and the application of participatory epidemiological techniques that allowed veterinary personnel to interact at a grassroots level with cattle herders to more effectively target control measures.

Vaccine
http://www.sciencedirect.com/science/journal/

Measles, mumps, and rubella virus vaccine (M–M–R™II): A review of 32 years of clinical and postmarketing experience
Available online 6 September 2012
In Press, Uncorrected Proof — Note to users
Fabio Lievanoa, Susan A. Galeaa, Michele Thornton, Richard T. Wiedmanna, Susan Manoffa, Trung N. Trana, Manisha A. Amina, Margaret M. Seminacka, Kristen A. Vagiea,
Adrian Danaa, Stanley A. Plotkin

Abstract
M–M–RII (measles, mumps, and rubella virus vaccine live; Merck & Co., Inc.) is indicated for simultaneous vaccination against measles, mumps, and rubella in individuals ≥12 months of age. Before the vaccine era, these viruses infected most exposed individuals, with subsequent morbidity and mortality. One of the greatest achievements of public health has been to eliminate these 3 diseases in large geographic areas.

The safety profile of M–M–RII is described using data from routine global postmarketing surveillance. Postmarketing surveillance has limitations (including incomplete reporting of case data), but allows collection of real-world information on large numbers of individuals, who may have concurrent medical problems excluding them from clinical trials. It can also identify rare adverse experiences (AEs).

Over its 32-year history, 575 million doses of M–M–RII have been distributed worldwide, with 17,536 AEs voluntarily reported for an overall rate of 30.5 AEs/1,000,000 doses distributed. This review provides evidence that the vaccine is safe and well-tolerated.

Scientific American
http://www.scientificamerican.com/
10 September 2012

A Human-Powered Refrigeration System To Save Lives In Developing Countries
Ariel Schwartz
It’s a big enough feat to ship much-needed vaccines to rural areas of the developing world. Finding a way to keep those vaccines refrigerated in places that have spotty access to electricity?
http://www.scientificamerican.com/article.cfm?id=a-human-powered-refrigeration-syste-2012-09

Twitter Watch  [accessed 15 September 2012  15:08]
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.

PAHO/WHO @pahowho
New regional agency will enhance joint action for public health in the Caribbean @carpha1 #carpha #caricom http://new.paho.org/hq/index.php?option=com_content&view=article&id=7180%3Anew-regional-agency-will-enhance-joint-action-for-public-health-in-the-caribbean&catid=1443%3Anews-front-page-items&lang=en&Itemid=1926#.UFTUZLp55C0.twitter …
12:18 PM – 15 Sep 12

Mirta Roses Periago ‏@mirtaroses
#CARPHA will become operational in Jan 2013 & merges the operations of 5 regional health institutions.Learn which here: http://psc28.wordpress.com/2012/09/14/third-caribbean-public-health-agency-carpha-international-partners-event/#more-204 …
Retweeted by PAHO/WHO
2:28 PM – 14 Sep 12

Partners In Health ‏@PIH
Sign the @HereIAmCampaign petition & urge world leaders to support a fully funded Global Fund to fight #AIDS #TB http://ow.ly/dJ55H 
9:01 AM – 15 Sep 12

Sabin Vaccine Inst.  ‏@sabinvaccine
Read about how @EmoryUniversity receives $6M #AIDS research grant from #GatesFoundation http://bit.ly/U7UMMJ 
1:11 PM – 14 Sep 12

HIVVaccineEnterprise ‏@HIVEnterprise
#AIDSVax2012 wraps up. Thanks to @HarvardCFAR and #Ragon Institute. Check our the webcasts, http://aidsvac.capitalreach.com/ . pic.twitter.com/pGBnvetK
Retweeted by IAVI
1:04 PM – 12 Sep 12

WHO ‏@WHO
WHO has deployed epidemiologists and logisticians from @WHOAFRO and HQ to support the #Ebola response in DR Congo http://goo.gl/PQ0rk 
5:44 AM – 14 Sep 12

World Bank @WorldBank
Free! Download the Global #Financial Development Report now: http://bit.ly/Q5rnBL 
12:07 PM – 13 Sep 12

Amanda Glassman @glassmanamanda
Where Will the World’s Poor Live? Updated Data on the Distribution of Global Poverty – http://www.cgdev.org/content/publications/detail/1426481/ … via @CGDev
8:21 AM – 13 Sep 12

GAVI Alliance ‏@GAVIAlliance
China ready to expand collaboration with @GAVIAlliance! Learn more on @GAVISeth 1st high-level visit to Beijing: http://ht.ly/dGyRx 
7:35 AM – 13 Sep 12

WHO ‏@WHO
Half of all children under-five deaths occurred in India, Nigeria, Democratic Republic of Congo, Pakistan and China http://goo.gl/ZJMx6 
10:51 PM – 12 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_8 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 European Centre for Disease Prevention and Control (ECDC) published an update to its 2008 guidance on human papillomavirus (HPV) vaccines in Europe “in light of the introduction of vaccination programmes in 19 European countries and new evidence from research studies in the past four years.” Randomised trials and observations from the field have demonstrated good safety profiles and efficacy against cervical cancer precursors. In spite of this, and that most of these countries are providing the vaccine for free, vaccination rates are lower than expected.

Vaccinating girls is shown to be more cost-effective than vaccinating boys. ECDC’s guidance is that public health initiatives should continue to focus on vaccinating girls.

Among the deterring factors for the slow uptake are the cost of the vaccine and the regime of three doses in six months. Routine vaccination targets girls between ages 10 to 14 years as the vaccines are clinically proven to be most effective when administered before the onset of sexual activity. These girls require parental permission to be vaccinated therefore the role of parents and healthcare workers is of utmost importance.

Nineteen countries out of the 29 EU/EEA countries have introduced HPV vaccination programmes following the authorisation of the vaccines but vaccination rates in EU countries range from only 17% to 84%. In 2010, only Portugal and the United Kingdom had full vaccination coverage rates above 80% for the target groups out of the seven countries reporting this data.

ECDC Director Marc Sprenger said: “We, public health authorities, frontline healthcare workers and parents alike, have a shared responsibility to protect thousands of women from cervical cancer. We need to work together to ensure that all girls between 10 and 14 years of age are vaccinated. European countries may need to examine why HPV vaccination coverage rates in their countries are not higher and strengthen their vaccination campaigns accordingly.”

Since its introduction by some European countries in 2006 the inclusion of boys in HPV vaccination programmes has been an open question. Only the quadrivalent HPV vaccine has been evaluated for men but current data shows that it gives the same, if not better, levels of efficacy for boys as girls of the same age groups. But the personal benefit of the vaccine for men in terms of cancer prevention is very low, most likely resulting in few boys being vaccinated and low vaccination coverage rates.

Marc Sprenger said “ECDC’s conclusion is that including boys in the current HPV vaccination programmes is unlikely to be cost-effective. A better investment of public resources is to focus on immunising all girls. This issue can be re-assessed when vaccination costs are significantly reduced.”…

http://www.ecdc.europa.eu/en/press/Press%20Releases/20120905_pressrelease_HPVGuidanceUpdate%20(2).pdf

Speech: WHO Director-General Address to the Regional Committee for South-East Asia, Sixty-fifth Session
Dr Margaret Chan
Director-General of the World Health Organization
Yogyakarta, Indonesia
5 September 2012
http://www.who.int/dg/speeches/2012/searo_20120905/en/index.html

Excerpt:
“…Let me begin with some well-deserved praise. On present trends, this region is set to be declared polio-free in January 2014.

India, the skeptics said it could not be done. But you did it. You stopped wild poliovirus transmission dead in its tracks. You have silenced the critics.

You have provided definitive proof that eradication is technically feasible, and you have done so in what was arguably the most challenging of all the remaining strongholds of this virus.

This is what your experience tells the world. The poliovirus is not permanently entrenched. It is not destined to remain a perpetual threat to each new generation of children. It can indeed be driven out of existence.

I fully agree with the assessment of the Independent Monitoring Board. This is a “magnificent” achievement. The Indian government succeeded because of its passionate engagement in a mission to protect its people from a vicious disease.

I appreciate, too, the specific lessons from the Indian experience set out in your report on polio eradication.

The most critical factor for success is ownership of the programme, from the local to the national level. The Indian government owned this programme, operating as the principal source of staff and funds. Other lessons include the importance of tight-knit partnerships, constant innovation, and a relentless drive to improve quality and accountability.

The May World Health Assembly elevated polio eradication to the level of a global public health emergency. This region has the expertise, bolstered by success, to lead the world in such an emergency response.

Medical officers from India, Bangladesh, and Nepal are now directly assisting countries that are still battling polio. I urge you to continue this leadership role. We can and must win.

As the IMB report noted, polio is now at its lowest level worldwide since records began.

Public health faces some heavy challenges, some bad trouble heading our way. Any longstanding problem that can be solved, once and for all, will free much-needed capacity and resources…”

http://www.who.int/csr/don/2012_09_08/en/index.html

GAVI reported that the Government of Japan “underlined its commitment to protecting millions of children from vaccine-preventable diseases today by renewing its funding support for the GAVI Alliance.” Kimihiro Ishikane, Ambassador Extraordinary and Plenipotentiary Mission of Japan to the Association of Southeast Asian Nations, speaking at the Asia Pacific Development Summit, said, “For the fiscal year 2012, I am hereby happy to announce that Japan will make a contribution of US$9.07 million. Japan is also ready to make due contribution accordingly from the year 2013 onwards.”

http://www.gavialliance.org/library/news/press-releases/2012/japan-funds-life-saving-vaccines-for-developing-countries/

The MMWR Weekly for September 7, 2012 / Vol. 61 / No. 35
– National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2011

The Weekly Epidemiological Record (WER) for 7 September 2012, vol. 87, 36 (pp. 337–344) includes:
Outbreak news
– Cholera, Sierra Leone
– Ebola haemorrhagic fever, Democratic Republic of the Congo
– Ebola haemorrhagic fever, Uganda
Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2012

http://www.who.int/entity/wer/2012/wer8736.pdf

Update: Polio this week – As of 05 Sep 2012
Global Polio Eradication Initiative

–          The outbreak in Katsina, northern Nigeria, is continuing, with four new wild poliovirus (WPV) type 1 cases reported this week. Katsina has reported 16 cases of WPV1 since May, more than any other state in the country. Katsina now accounts for 40% of all WPV1 cases in Nigeria since May. Upwards of one-third of children remain under-immunized in the state. During the most recent supplementary immunization activity (SIA), nearly one-third of children were missed in Katsina city (the most populous part of the state and location of the bulk of cases).

–          The Strategic Advisory Group of Experts on immunization (SAGE) Polio Working Group met this week in Geneva, Switzerland. Among other topics, the SAGE Polio Working Group discussed concrete ways to more effectively manage the short- and long-term implications of vaccine-derived polioviruses (VDPVs), including a potential switch from trivalent oral polio vaccine (OPV) to bivalent OPV even before the interruption of the remaining strains of WPV type 1 and WPV type 3. This approach had previously been endorsed in principle by SAGE. In May, the World Health Assembly (WHA) had requested the development of a comprehensive polio eradication and endgame strategy, to feature the potential timing of such a switch. The outcomes of the discussions from the SAGE Polio Working Group, and with continued guidance from SAGE and the WHA, will help inform a comprehensive Polio Eradication and Endgame Strategy 2014-2018.

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

Conference: AIDS Vaccine
BOSTON 9-12 SEPTEMBER 2012
“…the largest and most diverse international meeting of researchers, advocates, clinicians, private sector partners and public health experts working collaboratively to advance HIV vaccine science. With a focus on new minds and new ideas, AIDS Vaccine 2012 will make a special effort to welcome the most promising young- and early-career researchers to share and debate cutting-edge ideas and approaches to HIV vaccine research and development with their colleagues from around the world”

http://vaccineenterprise.org/conference/2012/

Symposium: Health and Human Security in the Americas
PAHO, Japan Center for International Exchange (JCIE)
Lima, Peru, 6-9 September, 2012.

Preliminary Agenda:
http://new.paho.org/per/images/stories/FtPage/2012/20120905_agenda_eng.pdf

“PAHO/WHO and the Japan Center for International Exchange (JCIE) are co-hosting a Regional Meeting on Health and Human Security to be held in Lima, Peru, 6-9 September, 2012. The event will open on September 6th with a Symposium on Health and Human Security in the Americas.”
http://new.paho.org/per/index.php?option=com_content&task=view&id=1864&Itemid=724

British Medical Journal
08 September 2012 (Vol 345, Issue 7873)
http://www.bmj.com/content/345/7873

Analysis
No more disease silos for sub-Saharan Africa
BMJ 2012; 345 doi: 10.1136/bmj.e5812 (Published 31 August 2012)
Cite this as: BMJ 2012;345:e5812
Patricio V Marquez, lead health specialist, Eastern and Southern Africa Region1, Jill L Farrington, honorary senior lecturer2

Extract
Countries in sub-Saharan Africa are facing a double burden of communicable and non-communicable disease. Patricio Marquez and Jill Farrington argue that knowledge of their common determinants and the links between diseases should be used to spur development of coordinated programmes to prevent and treat both

While much of the health focus in sub-Saharan Africa, has been directed at communicable diseases (particularly HIV/AIDS, tuberculosis, and malaria), non-communicable diseases are a growing problem for the region, causing almost one third of total deaths.1 The May 2012 World Health Assembly resolution on setting a global target for reducing non-communicable diseases2 and the pronouncements made at the 19th International AIDS Conference in July remind us of the similar challenges faced by these two sets of disease and the potential shared solutions. The theme of the AIDS conference “turning the tide together” seems apt and should give pause for thought in the lead-up to further debate about non-communicable diseases at the UN and other international forums.

The approach to preventing and treating HIV/AIDS—exemplified by an intention to build on lessons learnt, take account of recent scientific advances, and demonstrable ability to scale-up key interventions—seems particularly relevant to non-communicable diseases. But how should sub-Saharan Africa, well represented at the AIDS conference, gear up to the challenge of non-communicable diseases in a way that avoids creating new vertical programmes in competition for scarce resources?

What is the essence of the problem?

Although communicable diseases have traditionally been leading causes of disease and mortality in sub-Saharan Africa, rapid urbanisation, changes in dietary patterns, behavioural and biological factors, and major improvements in the prevention and treatment of communicable diseases, particularly AIDS, that are helping raise life expectancy, are all contributing to a shift in disease patterns. For some countries, such as Mauritius and Seychelles, and some populations, such as people aged over 45 years, …

http://www.bmj.com/content/345/bmj.e5812

Eurosurveillance
Volume 17, Issue 36, 06 September 2012
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Surveillance and outbreak reports
A report on the large measles outbreak in Lyon, France, 2010 to 2011
by C Huoi, JS Casalegno, T Bénet, A Neuraz, G Billaud, D Eibach, Y Mekki, R Rudigoz, J Massardier, C Huissoud, M Massoud, P Gaucherand, O Claris, Y Gillet, D Floret, B Lina, P Vanhems

[Summary]
In 2010 and 2011, the city of Lyon, located in the Rhône-Alpes region (France), has experienced one of the highest incidences of measles in Europe. We describe a measles outbreak in the Lyon area, where cases were diagnosed at Lyon University hospitals (LUH) between 2010 and mid-2011. Data were collected from the mandatory notification system of the regional public health agency, and from the virology department of the LUH. All patients and healthcare workers who had contracted measles were included. Overall, 407 cases were diagnosed, with children of less than one year of age accounting for the highest proportion (n=129, 32%), followed by individuals between 17 and 29 years-old (n=126, 31%). Of the total cases, 72 (18%) had complications. The proportions of patients and healthcare workers who were not immune to measles were higher among those aged up to 30 years. Consequently, women of childbearing age constituted a specific population at high risk to contract measles and during this outbreak, 13 cases of measles, seven under 30 years-old, were identified among pregnant women. This study highlights the importance of being vaccinated with two doses of measles vaccine, the only measure which could prevent and allow elimination of the disease.

Health Economics, Policy and Law 
Volume 7 – Issue 03 – July 2012
http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue

Articles
Incentives, health promotion and equality
Kristin Voigt

Abstract
The use of incentives to encourage individuals to adopt ‘healthier’ behaviours is an increasingly popular instrument in health policy. Much of the literature has been critical of ‘negative’ incentives, often due to concerns about equality; ‘positive’ incentives, however, have largely been welcomed as an instrument for the improvement of population health and possibly the reduction of health inequalities. The aim of this paper is to provide a more systematic assessment of the use of incentives from the perspective of equality. The paper begins with an overview of existing and proposed incentive schemes. I then suggest that the distinction between ‘positive’ and ‘negative’ incentives – or ‘carrots’ and ‘sticks’ – is of limited use in distinguishing those incentive schemes that raise concerns of equality from those that do not. The paper assesses incentive schemes with respect to two important considerations of equality: equality of access and equality of outcomes. While our assessment of incentive schemes will, ultimately, depend on various empirical facts, the paper aims to advance the debate by identifying some of the empirical questions we need to ask. The paper concludes by considering a number of trade-offs and caveats relevant to the assessment of incentive schemes.

Human Vaccines & Immunotherapeutics(formerly Human Vaccines)
Volume 8, Issue 9  September 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/8/

Short Report
Varicella vaccine uptake in Shandong province, China
http://dx.doi.org/10.4161/hv.20722
Authors: Aiqiang Xu, Qing Xu, Xueqiang Fang, Stephanie Bialek and Chengbin Wang

Abstract:
Varicella vaccine has been licensed in China for decade to be used as single dose in children aged ≥ 12 mo of age in private sector. Little data were available on varicella uptake to date in China yet. A cross-sectional study was conducted in Shandong Province in May 2011 to examine varicella vaccination coverage among children aged 16–40 mo and examine factors associated with varicella vaccine uptake. The overall coverage among children eligible for varicella vaccine was 62% (range 16.7–94.7% by county), much lower than the coverage of the eight vaccines included in the national immunization program (all above 97%). Though proximity to immunization services (< 5 km) was linked with higher vaccine uptake (62.6 vs. 37.4%, p = 0.02), county-level economic development (77.8, 61.0 and 47.1% for developed, sub-developed and developing regions, respectively, p < 0.001) played an even more important role in varicella vaccination. Moreover, there was little variation in coverage of vaccines included in the national immunization program along with county-level economic development. Even though varicella vaccine uptake is relatively high for use on a private basis, the vaccination coverage is not high enough to prevent epidemiology shift to adolescents and adults who are more prone to develop severe outcomes to varicella.    Further enhancement on varicella vaccination coverage is necessary and inclusion to national immunization program seems to be a promising option for achieving and maintaining high coverage.

Human Vaccines & Immunotherapeutics(formerly Human Vaccines)
Volume 8, Issue 9  September 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/8/

Research Paper
Social and cultural determinants of oral cholera vaccine uptake in Zanzibar
http://dx.doi.org/10.4161/hv.20901
Authors: Christian Schaetti, Said M. Ali, Raymond Hutubessy, Ahmed M. Khatib, Claire-Lise Chaignat and Mitchell G. Weiss

Abstract:
Effectiveness of mass cholera vaccination campaigns requires not only technical and financial capacity but also consideration of social and cultural factors affecting vaccine acceptance. This study examined the influence of local community views of cholera on oral cholera vaccine (OCV) uptake in a mass vaccination campaign in 2009 in peri-urban and rural areas of Zanzibar. It used data from interviews conducted before the campaign and followed previous research assessing determinants of anticipated OCV acceptance. OCV uptake was lower than the reported anticipated acceptance. Less than half of the 356 adult respondents (49.7%) drank the required two doses of OCV. Variables referring to socio-cultural features of diarrheal illness that respondents identified with a cholera case vignette explained uptake better than analysis only of socio-demographic characteristics. Somatic features of illness not specific for cholera were negative determinants. Recognition of unconsciousness as a serious sign of dehydration and concern that cholera outbreaks would overwhelm the local healthcare system in the rural area were positive determinants of acceptance. Female gender, rural residence and older age were also positive determinants of OCV uptake. For further vaccine action with OCVs, cholera as a cause of severe dehydration should be distinguished from other causes of diarrhea. Planning should acknowledge rural concern about the relationship of limited capacity of the healthcare system to cope with cholera outbreaks and the priority of a cholera vaccine. Findings recommend particular efforts to increase cholera immunization coverage among young adults, in peri-urban areas and for men.

Human Vaccines & Immunotherapeutics(formerly Human Vaccines)
Volume 8, Issue 9  September 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/8/

Research Paper
Individualism, acceptance and differentiation as attitude traits in the public’s response to vaccination
http://dx.doi.org/10.4161/hv.21183
Authors: Baruch Velan, Valentina Boyko, Liat Lerner-Geva, Arnona Ziv, Yaakov Yagar and Giora Kaplan

Abstract:
The attitude of the general public to vaccination was evaluated through a survey conducted on a representative sample of the Israeli population (n = 2,018), in which interviewees were requested to express their standpoints regarding five different vaccination programs. These included: pandemic influenza vaccination, seasonal influenza vaccination, travel vaccines, Human Papilloma Virus vaccine and childhood vaccinations. Analysis of the responses reveal three major attitude traits: a) acceptance, characterized by the opinion that targets should be vaccinated; b) individualism, characterized by the opinion that vaccination should be left to personal choice; and c) differentiation, characterized by the tendency to express different attitudes when addressing different vaccination programs. Interestingly, direct opposition to vaccination was found to be a minor attitude trait in this survey. Groups within the population could be defined according to their tendency to assume these different attitudes as Acceptors, Judicious-acceptors, Differentiators, Soft-individualists, and Hard-individualists. These groups expressed different standpoints on all five vaccination programs as well as on other health recommendations, such as screening for early detection of cancer. Attitude traits could be also correlated, to a certain extent, with actual compliance with vaccination programs. Interestingly, attitudes to vaccination were not correlated with social profiles related to income or education, although younger individuals exhibited higher degrees of individualism and differentiation. Taken together, all this is in accordance with the current social settings, underlining the individual’s tendency for critical evaluation and self-stirring. This should be taken into consideration by health authorities involved in vaccination programs.