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_27 October 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…

World Polio Day – 24 October 2012: Statements/Media Releases

– GAVI Statement: http://www.gavialliance.org/library/news/statements/2012/world-polio-day/

– GAVI Commentary: Building on India’s Success on Polio  by Seth Berkley [see Wall Street Journal in Media Watch below]

– UNICEF: Vaccine suppliers integral to achieving polio free world
http://www.unicef.org/media/media_66238.html
[Excerpt]
COPENHAGEN, 24 October 2012 – On World Polio Day, UNICEF has commended the continued contribution of industry to global polio eradication efforts, particularly in helping meet a 410 million dose gap in 2012 and preventing a 300 million dose gap in 2013.

“This year has proven challenging in terms of oral polio vaccine (OPV) supply due to shortfalls from a few suppliers,” Shanelle Hall, Director UNICEF Supply, said.

Offers received from manufacturers in response to the UNICEF-issued OPV tender for the period covering 2013-2017 identified a gap of approximately 300 million doses for the first half of 2013, which would have seriously affected planned polio campaigns.

“The 2013 supply shortfall has been actively addressed through collaborative efforts by industry to increase or fast-track availability, and coordination with global partners to accelerate WHO prequalification of new products and adjust activity schedules. Sufficient OPV will now be available to meet programmatic requirements for the period,” Ms. Hall added.

UNICEF has also welcomed manufacturer’s contribution to affordable vaccine pricing. Through efforts by multiple manufacturers, cost savings equivalent to nearly 100 million doses are expected over the next five years.

“In times of increasing financial constraint and uncertainty, these savings will have significant impact as we make the final push towards eradicating this disease from the world. Vaccine suppliers, including BioFarma, GlaxoSmithKline, Haffkine, Novartis, Sanofi Pasteur, and the Serum Institute of India, are key partners to the Global Polio Eradication Initiative (GPEI),” said Ms. Hall.

The OPV market is complex and changing, and requires close management and coordination with countries and global programme partners, as well as with industry in order to achieve a polio-free world.

“As global efforts edge closer to realizing this goal, UNICEF remains committed to working with industry to secure OPV at affordable prices, and to ensure potential supply-related challenges are minimised,” she said…

Update: Polio this week – As of 24 Oct 2012
Global Polio Eradication Initiative

[Editor’s Extract]
– World Polio Day, October 24: Polio eradication partners around the world are marking the first World Polio Day since India was removed from the list of countries with active transmission of wild poliovirus. This development opened up a historic opportunity to complete polio eradication in the remaining endemic countries, powered by the World Health Assembly declaration of an ‘emergency for global public health’ and implemented through national emergency programmes run by the governments of Afghanistan, Nigeria and Pakistan.

– Since World Polio Day last year, the number of new cases of polio has declined by 64% (from 489 at this time last year to 175 this year).

– The next Independent Monitoring Board (IMB) meeting will take place next week in London, United Kingdom. During its deliberations, the IMB will review the latest status of the global polio eradication effort and progress and challenges with implementing national polio emergency action plans. The IMB’s meeting report is anticipated to be finalized in November.

Afghanistan
– One new WPV case was reported in the past week (WPV1 from Kandahar), bringing the total number of cases for 2012 to 26. The most recent case had onset of paralysis on 1 October (WPV1 from Paktya).
– The ‘Ending Polio Is My Responsibility’ social mobilization and media campaign continues to be rolled out, with public service announcements airing on TV and radio, and billboards set up around the country.

Nigeria
– Two new WPV cases were reported in the past week (WPV1s from Katsina), bringing the total number of cases for 2012 to 97. One of the newly-reported cases is the most recent case in the country, and had onset of paralysis on 23 September.

Pakistan
– Three new WPV cases were reported in the past week (two WPV1s from Khyber Pakhtunkhwa – KP – and one WPV1 from Balochistan), bringing the total number of cases for 2012 to 47. The newly-reported case from Balochistan is the most recent in the country, and had onset of paralysis on 2 October.
– Additionally, one new cVDPV2 case was reported, in Balochistan, from September.

Horn of Africa
– Outbreak response is ongoing in Kenya and parts of Somalia, following recent confirmation of a cVDPV2 outbreak in a Somali refugee camp in Dadaab, Kenya, and Kismayo, south-central Somalia.

WHO: Fact Sheet – Poliomyelitis
Fact sheet N°114
October 2012

Key facts [Excerpt]
– Polio (poliomyelitis) mainly affects children under five years of age.

– One in 200 infections leads to irreversible paralysis. Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.

– Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases then, to 650 reported cases in 2011. The reduction is the result of the global effort to eradicate the disease.

– In 2012, only three countries (Afghanistan, Nigeria and Pakistan) remain polio-endemic, down from more than 125 in 1988.

– As long as a single child remains infected, children in all countries are at risk of contracting polio. Failure to eradicate polio from these last remaining strongholds could result in as many as 200 000 new cases every year, within 10 years, all over the world.

– In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems…

http://www.who.int/mediacentre/factsheets/fs114/en/index.html

The Weekly Epidemiological Record (WER) for 26 October 2012, vol. 87, 43 (pp. 413–420) includes:
– Outbreak news
. Dengue fever in Madeira, Portugal
. Marburg haemorrhagic fever, Uganda
– Progress towards poliomyelitis eradication in Chad, January 2011–August 2012
– Monthly report on dracunculiasis cases, January–August 2012

http://www.who.int/entity/wer/2012/wer8743.pdf

ACIP Meeting Update: 24 October 2012

CDC Advisory Committee on Immunization Practices Recommends HibMenCY for Infants at Increased Risk for Meningococcal Disease
[Excerpt]
The Advisory Committee for Immunization Practices voted today 13 to 1, with 1 abstention, to recommend that infants at increased risk for meningococcal disease should be vaccinated with 4 doses of HibMenCY at 2, 4, 6, and 12 through 15 months.  These include infants with recognized persistent complement pathway deficiencies and infants who have anatomic or functional asplenia including sickle cell disease. HibMenCY can be used in infants ages 2 through 18 months who are in communities with serogroup C and Y meningococcal disease outbreaks…

CDC Advisory Committee for Immunization Practices Recommends Tdap Immunization for Pregnant Women
[Excerpt]
The Advisory Committee for Immunization Practices voted today 14 to 0, with one abstention, to recommend that providers of prenatal care implement a Tdap immunization program for all pregnant women.  Health-care personnel should administer a dose of Tdap during each pregnancy irrespective of the patient’s prior history of receiving Tdap.  If not administered during pregnancy, Tdap should be administered immediately postpartum.

This builds upon a previous recommendation made by ACIP in June 2011 to administer Tdap during pregnancy only to women who have not previously received Tdap. By getting Tdap during pregnancy, maternal pertussis antibodies transfer to the newborn, likely providing protection against pertussis in early life, before the baby starts getting DTaP vaccines. Tdap will also protect the mother at time of delivery, making her less likely to transmit pertussis to her infant. If not vaccinated during pregnancy, Tdap should be given immediately postpartum, before leaving the hospital or birthing center.

The U.S. remains on track to have the most reported pertussis cases since 1959, with more than 32,000 cases already reported along with 16 deaths, the majority of which are in infants…

PAHO: Recommendation Calls for Exploring Collaboration between Public Vaccine Producers in the Americas

PAHO’s Technical Advisory Group (TAG) on Vaccine-preventable Diseases “…recommended that opportunities for collaboration between public vaccine producers in the Americas be explored with a view to incentivizing regional production in order to meet local needs. This recommendation arises from the challenges currently being faced to guarantee a steady supply of priority vaccines and maintain the achievements to date in controlling and eradicating such diseases as poliomyelitis, measles, and rubella.” The Technical Advisory Group recommended that PAHO/WHO convene a working group, bringing together representatives of public vaccine producers in Latin America and the Caribbean, “to identify common areas of activity and draft a regional strategy for vaccine research, development, and production.”

The announcement noted that there are 40 vaccine providers in the world, 15 of which produce 95% of the total output, and 70% of vaccine production takes place in developing countries. In the Americas there are six public sector vaccine manufacturers, located in Argentina, Brazil, Colombia, Cuba, Mexico, and Venezuela. In addition, “the supply of traditional vaccines against polio, yellow fever, and whooping cough (also called pertussis), diphtheria, and tetanus continues to be erratic and often falls short of meeting the needs of the countries in the Region, which acquire them at an affordable price through the PAHO Revolving Fund. These vaccines are still essential.” However, TAG noted in the conclusions of its meeting that “they are no longer of commercial interest to the pharmaceutical companies, which in many cases have ceased to produce them or else have turned their interest toward the preparation of new combined vaccines.”

According to the conclusions of the meeting, “the establishment of agreements for technology transfer between the transnational pharmaceutical industry and producers in the Region has not yet been translated into improved local capacity to produce new vaccines. Hence, there is need for more in-depth analysis of the role that regional producers can play in meeting the needs of the countries of the Americas for high-quality, safe, and effective vaccines.” The PAHO/WHO Technical Advisory Group on Vaccine-preventable Diseases met from October 17 to 19 in Washington, D.C., to examine current issues and make recommendations on vaccination against polio, rotavirus, whooping cough, measles, rubella, and cholera, as well as to consider prospects for ramping up regional vaccine production capacity. http://new.paho.org/hq/index.php?option=com_content&view=article&id=7364%3Arecommendation-calls-for-exploring-collaboration-between-public-vaccine-producers-in-the-americas&catid=740%3Anews-press-releases&Itemid=1926&lang=en&Itemid=1926

Media Release: GAVI initiatives applauded in Japan
Programmes in public-private partnership, such as IFFIm, held up as models for Japanese corporate sector
Tokyo, 11 October 2012 – [Excerpt]
GAVI’s success in partnering with the private sector was highlighted at a global health symposium of Japanese companies in Tokyo today, supported by the Japanese Ministry of Foreign Affairs.

Companies can “make a reasonable profit and help people at the same time,” said Shiro Konuma, director of the Global Health Policy Division within the Japanese Ministry of Foreign Affairs.

“Governments always must keep in mind the raison d’etre of private companies. That is the starting point. But we all share the responsibility to help save lives.”

Vaccine bonds
Japan recently made its second direct donation to GAVI, and the Japanese public has been responsible for about a quarter of GAVI’s funding through Japan’s uridashi bond market, noted GAVI CEO Seth Berkley, a featured speaker alongside those from the Health & Global Policy Institite (HGPI) think tank, and a panel discussion with five Japanese companies and UNICEF.

Among them was Daiwa Securities, which helped introduce “vaccine bonds” in Japan to benefit GAVI through IFFIm, the International Finance Facility for Immunisation. IFFIm overall has raised US$ 3.7 billion through bonds backed by the pledges of nine donor governments, funding about half of GAVI’s programmes, Berkley notes. And about US$ 2 billion of it has come from Japanese investors.

IFFIm link
IFFIm was consistently cited by the panel as an example of good business that has benefited public health. It “seems like water and oil, but IFFIm is the link,” said Satoru Yamamoto, director/head of International Investors Services at Daiwa. Underwriters like Daiwa can expand and market their business to Japanese investors, who secure both a financial and a social return…

http://www.iffim.org/library/news/press-releases/2012/gavi-initiatives-applauded-in-japan/

Meeting: WHO – Strategic Advisory Group of Experts (SAGE) on Immunization
6-8 November 2012, Geneva

[Selected agenda topics]:
– Report from GAVI
– Global polio eradication initiative
– DoV – GVAP (GVAP key steps to implementation; Decade of Vaccine M&E/Accountability Framework; GVAP Costing, Financing and impact update and tracking commitments; Independent review of progress and reporting to governing bodies)
– Hib immunization schedules
– Measles and rubella status report
– Vaccination in humanitarian emergencies
– New vaccine introduction in middle-income countries: current initiatives to address financial challenges

Draft Agenda at 22 October 2012:
http://www.who.int/entity/immunization/sage/Annotated_draft_Agenda_6-8_Nov_SAGE_2012_22Oct.pdf

Symposium: Second Global Symposium on Health Systems Research (HSR)
31 October–3 November 2012 – Beijing, China

The Symposium will be dedicated to evaluating progress, sharing insights and recalibrating the agenda of science to accelerate universal health coverage (UHC).

A primary theme for the symposium will be innovation and inclusion, highlighting ‘neglected’ themes such as research on neglected public health priorities, causes of exclusion of populations or problems, and on what works in reducing these exclusions.

Each day, 17 concurrent sessions will provide examples of innovations across all health systems building blocks that facilitate faster progress towards universal health coverage in an affordable manner.

In addition, the WHO strategy on health systems research and the member-based Society for HSR will be launched. Anticipated is the establishment of a Beijing Agenda for further advancing the HSR and in particular, the initiation of a process to construct and agree on measures to monitor UHC.

All plenary sessions will be webcast live and are available from the Symposium web site’s home page. In addition, WHO will be tweeting daily from the meeting.

Second Global Symposium on Health Systems Research (HSR)

Emerging Infectious Diseases
Volume 18, Number 11—November 2012
http://www.cdc.gov/ncidod/EID/index.htm

Commentaries
Call to Action on World Pneumonia Day
PDF Version  [PDF – 155 KB – 2 pages]
R. Hajjeh and C. G. Whitney

[Excerpt]
This month, on November 12, the world will recognize the fourth annual World Pneumonia Day. First launched in 2009 by a coalition of global health leaders (1), World Pneumonia Day aims to raise awareness about pneumonia’s toll on the world’s children and to promote interventions to protect against, treat, and prevent the disease. Pneumonia continues to be the leading killer of young children around the world, causing ≈14% of all deaths in children 1 month to 5 years of age (2). It is a critical disease for countries to conquer in order to reach Millennium Development Goal 4: reducing the child mortality rate by two thirds from 1990 to 2015 (3). Most children who die from pneumonia live in developing countries, where such factors as malnutrition, crowding, and lack of access to quality health care increase the risk for death. Pneumonia kills few children in industrialized countries, although it remains among the top 10 causes of deaths in the United States, for example, because of deaths in older adults (4).

Fortunately, many interventions are now available to reduce deaths due to pneumonia among children throughout the world. On the first World Pneumonia Day in 2009, the World Health Organization and the United Nations Children’s Fund, together with many global experts and partners, launched the Global Action Plan for Prevention and Control of Pneumonia (GAPP) (5). GAPP recommends a strategy of prevention, protection, and treatment that is designed to implement readily available interventions that can reduce pneumonia deaths in children. GAPP focuses on improving nutrition (through measures such as exclusive breastfeeding), increasing access to vaccines that protect from agents that cause pneumonia (such as Haemphilus influenzae type b and pneumococcal vaccines), reducing exposure to indoor air pollution, and increasing access to antimicrobial drugs that can treat pneumonia…

Emerging Infectious Diseases
Volume 18, Number 11—November 2012
http://www.cdc.gov/ncidod/EID/index.htm

Online Reports
Integrating Genome-based Informatics to Modernize Global Disease Monitoring, Information Sharing, and Response
F. M. Aarestrup et al.

Abstract
The rapid advancement of genome technologies holds great promise for improving the quality and speed of clinical and public health laboratory investigations and for decreasing their cost. The latest generation of genome DNA sequencers can provide highly detailed and robust information on disease-causing microbes, and in the near future these technologies will be suitable for routine use in national, regional, and global public health laboratories. With additional improvements in instrumentation, these next- or third-generation sequencers are likely to replace conventional culture-based and molecular typing methods to provide point-of-care clinical diagnosis and other essential information for quicker and better treatment of patients. Provided there is free-sharing of information by all clinical and public health laboratories, these genomic tools could spawn a global system of linked databases of pathogen genomes that would ensure more efficient detection, prevention, and control of endemic, emerging, and other infectious disease outbreaks worldwide.

Infectious Diseases of Poverty
2012, 1
http://www.idpjournal.com/content
[Accessed 27 October 2012]
Aims & scope
Infectious Diseases of Poverty is an open access, peer-reviewed journal publishing topic areas and methods that address essential public health questions relating to infectious diseases of poverty. These include various aspects of the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. Transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology are also considered.

IDP aims to identify and assess research and information gaps that hinder progress towards new interventions for a particular public health problem in the developing world. Moreover, to provide a platform for discussion of the issues raised, in order to advance research and evidence building for improved public health interventions in poor settings.

Research Article  
Infectious disease emergence and global change: thinking systemically in a shrinking world
Colin D Butler Infectious Diseases of Poverty 2012, 1:5 (25 October 2012)

Abstract [Open Access]
Background
Concern intensifying that emerging infectious diseases and global environmental changes that could generate major future human pandemics.

Method
A focused literature review was undertaken, partly informed by a forthcoming report on environment, agriculture and infectious diseases of poverty, facilitated by the Special Programme for Tropical Diseases.

Results
More than ten categories of infectious disease emergence exist, but none formally analyse past, current or future burden of disease. Other evidence suggests that the dominant public health concern focuses on two informal groupings. Most important is the perceived threat of newly recognised infections, especially viruses that arise or are newly discovered in developing countries that originate in species exotic to developed countries, such as non-human primates, bats and rodents. These pathogens may be transmitted by insects or bats, or via direct human contact with bushmeat. The second group is new strains of influenza arising from intensively farmed chickens or pigs, or emerging from Asian “wet markets” where several bird species have close contact. Both forms appear justified because of two great pandemics: HIV/AIDS (which appears to have originated from bushmeat hunting in Africa before emerging globally) and Spanish influenza, which killed up to 2.5% of the human population around the end of World War I. Insufficiently appreciated is the contribution of the milieu which appeared to facilitate the high disease burden in these pandemics. Additionally, excess anxiety over emerging infectious diseases diverts attention from issues of greater public health importance, especially: (i) existing (including neglected) infectious diseases and (ii) the changing milieu that is eroding the determinants of immunity and public health, caused by adverse global environmental changes, including climate change and other components of stressed life and civilisation-supporting systems.

Conclusions
The focus on novel pathogens and minor forms of anti-microbial resistance in emerging disease literature is unjustified by their burden of disease, actual and potential, and diverts attention from far more important health problems and determinants. There is insufficient understanding of systemic factors that promote pandemics. Adverse global change could generate circumstances conducive to future pandemics with a high burden of disease, arising via anti-microbial and insecticidal resistance, under-nutrition, conflict, and public health breakdown.

Infectious Diseases of Poverty
2012, 1
http://www.idpjournal.com/content
[Accessed 27 October 2012]
Aims & scope
Infectious Diseases of Poverty is an open access, peer-reviewed journal publishing topic areas and methods that address essential public health questions relating to infectious diseases of poverty. These include various aspects of the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies and application. Transdisciplinary or multisectoral effects on health systems, ecohealth, environmental management, and innovative technology are also considered.

IDP aims to identify and assess research and information gaps that hinder progress towards new interventions for a particular public health problem in the developing world. Moreover, to provide a platform for discussion of the issues raised, in order to advance research and evidence building for improved public health interventions in poor settings.

Opinion  
Technology innovation for infectious diseases in the developing world
Anthony D So, Quentin Ruiz-Esparza Infectious Diseases of Poverty 2012, 1:2 (25 October 2012)

Abstract [Open Access]
Enabling innovation and access to health technologies remains a key strategy in combating infectious diseases in low- and middle-income countries (LMICs). However, a gulf between paying markets and the endemicity of such diseases has contributed to the dearth of R&D in meeting these public health needs. While the pharmaceutical industry views emerging economies as potential new markets, most of the world’s poorest bottom billion now reside in middle-income countries–a fact that has complicated tiered access arrangements. However, product development partnerships–particularly those involving academic institutions and small firms–find commercial opportunities in pursuing even neglected diseases; and a growing pharmaceutical sector in BRICS countries offers hope for an indigenous base of innovation. Such innovation will be shaped by 1) access to building blocks of knowledge; 2) strategic use of intellectual property and innovative financing to meet public health goals; 3) collaborative norms of open innovation; and 4) alternative business models, some with a double bottom line. Facing such resource constraints, LMICs are poised to develop a new, more resource-effective model of innovation that holds exciting promise in meeting the needs of global health.

The Lancet  
Oct 27, 2012  Volume 380  Number 9852  p1445 – 1530
http://www.thelancet.com/journals/lancet/issue/current

Comment
Offline: Can WHO survive?
Richard Horton

Preview
The title of last week’s Global Health Lab, held at the London School of Hygiene and Tropical Medicine, was meant to incite interest, not signal aggression. But some interpreted the symposium as an attack before it had even taken place. I was texted, tweeted, and emailed to encourage diplomacy. None of these rearguard protective manoeuvres turned out to be necessary. In our debate about WHO, led by Gill Walt (from the School), Kathryn Tyson (UK Department of Health), Anders Nordström (Sweden’s Ambassador for Global Health), and Martin McKee (Director of ECOHOST), the answer to the question was unambiguously “yes”.

The Lancet  
Oct 27, 2012  Volume 380  Number 9852  p1445 – 1530
http://www.thelancet.com/journals/lancet/issue/current

Perspectives: The art of medicine
Riding the waves: optimism and realism in the treatment of TB
Helen Bynum

Preview
The history of treatment for pulmonary tuberculosis can be divided into two eras: before and after the advent of antibiotics. What had been treated but had proven incurable for millennia became curable in the early 1950s, when the combination of streptomycin, para-aminosalicylic acid (PAS), and isoniazid effectively cleansed the body of invading mycobacteria. Subsequently more easily administered, better-tolerated drugs advanced treatment protocols and brought greater benefits. It would be wrong to suggest that drugs were the only solution; education, screening, vaccination, and prevention measures were essential.

The Lancet Infectious Disease
Nov 2012  Volume 12  Number 11  p817 – 896
http://www.thelancet.com/journals/laninf/issue/current

Comment
A case for control of cholera in Africa by vaccination
Jan Holmgren

Preview
In The Lancet Infectious Diseases, Ahmed Khatib and colleagues1 describe the direct and indirect (herd protection) effectiveness of an oral killed Vibrio cholerae whole-cell B-subunit cholera vaccine deployed in a mass vaccination campaign in almost 50 000 individuals in Zanzibar, east Africa, a region that has had regular outbreaks of cholera since 1978. Two vaccine doses were offered and given through the public health services to individuals in the study areas aged 2 years and older. Over the next 14 months the vaccine was shown to confer 79% direct protection against cholera and also significant indirect protection (50% in the non-vaccinated residents and as much as 75–90% in clusters with the highest vaccine coverage).

Articles
Effectiveness of an oral cholera vaccine in Zanzibar: findings from a mass vaccination campaign and observational cohort study
Ahmed M Khatib, Mohammad Ali, Lorenz von Seidlein, Deok Ryun Kim, Ramadhan Hashim, Rita Reyburn, Benedikt Ley, Kamala Thriemer, Godwin Enwere, Raymond Hutubessy, Maria Teresa Aguado, Marie-Paule Kieny, Anna Lena Lopez, Thomas F Wierzba, Said Mohammed Ali, Abdul A Saleh, Asish K Mukhopadhyay, John Clemens, Mohamed Saleh Jiddawi, Jacqueline Deen

Summary
Background
Zanzibar, in east Africa, has been severely and repeatedly affected by cholera since 1978. We assessed the effectiveness of oral cholera vaccination in high-risk populations in the archipelago to estimate the indirect (herd) protection conferred by the vaccine and direct vaccine effectiveness.

Methods
We offered two doses of a killed whole-cell B-subunit cholera vaccine to individuals aged 2 years and older in six rural and urban sites. To estimate vaccine direct protection, we compared the incidence of cholera between recipients and non-recipients using generalised estimating equations with the log link function while controlling for potential confounding variables. To estimate indirect effects, we used a geographic information systems approach and assessed the association between neighbourhood-level vaccine coverage and the risk for cholera in the non-vaccinated residents of that neighbourhood, after controlling for potential confounding variables. This study is registered with ClinicalTrials.gov, number NCT00709410.

Findings
Of 48 178 individuals eligible to receive the vaccine, 23 921 (50%) received two doses. Between February, 2009, and May, 2010, there was an outbreak of cholera, enabling us to assess vaccine effectiveness. The vaccine conferred 79% (95% CI 47—92) direct protection against cholera in participants who received two doses. Indirect (herd) protection was shown by a decrease in the risk for cholera of non-vaccinated residents within a household’s neighbourhood as the vaccine coverage in that neighbourhood increased.

Interpretation
Our findings suggest that the oral cholera vaccine offers both direct and indirect (herd) protection in a sub-Saharan African setting. Mass oral cholera immunisation campaigns have the potential to provide not only protection for vaccinated individuals but also for the unvaccinated members of the community and should be strongly considered for wider use. Because this is an internationally-licensed vaccine, we could not undertake a randomised placebo-controlled trial, but the absence of vaccine effectiveness against non-cholera diarrhoea indicates that the noted protection against cholera could not be explained by bias.

Funding
Bill & Melinda Gates Foundation, Swedish International Development Cooperation Agency, and the South Korean Government.

The Lancet Infectious Disease
Nov 2012  Volume 12  Number 11  p817 – 896
http://www.thelancet.com/journals/laninf/issue/current

Public response to the 2009 influenza A H1N1 pandemic: a polling study in five countries
Gillian K SteelFisher, Robert J Blendon, Johanna RM Ward, Robyn Rapoport, Emily B Kahn, Katrin S Kohl

Summary
Background
Many important strategies to reduce the spread of pandemic influenza need public participation. To assess public receptivity to such strategies, we compared adoption of preventive behaviours in response to the 2009 H1N1 influenza pandemic among the public in five countries and examined whether certain non-pharmaceutical behaviours (such as handwashing) were deterrents to vaccination. We also assessed public support for related public health recommendations.

Methods
We used data from simultaneous telephone polls (mobile telephone and landline) in Argentina, Japan, Mexico, the UK, and the USA. In each country, interviews were done in a nationally representative sample of adults, who were selected by the use of random digit dial techniques. The questionnaire asked people whether or not they had adopted each of various preventive behaviours (non-pharmaceutical—such as personal protective and social distancing behaviour—or vaccinations) to protect themselves or their family from H1N1 at any point during the pandemic. Two-tailed t tests were used for statistical analysis.

Findings
900 people were surveyed in each country except the USA where 911 people were contacted. There were wide differences in the adoption of preventive behaviours between countries, although certain personal protective behaviours (eg, handwashing) were more commonly adopted than social distancing behaviours (eg, avoiding places where many people gather) across countries (53—89% vs 11—69%). These non-pharmaceutical behaviours did not reduce the likelihood of getting vaccinated in any country. There was also support across all countries for government recommendations related to school closure, avoiding places where many people gather, and wearing masks in public.

Interpretation
There is a need for country-specific approaches in pandemic policy planning that use both non-pharmaceutical approaches and vaccination.

Funding
US Centers for Disease Control and Prevention and the National Public Health Information Coalition.

PLoS One
[Accessed 27 October 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

A Cost Effectiveness and Capacity Analysis for the Introduction of Universal Rotavirus Vaccination in Kenya: Comparison between Rotarix and RotaTeq Vaccines
Albert Jan van Hoek, Mwanajuma Ngama, Amina Ismail, Jane Chuma, Samuel Cheburet, David Mutonga, Tatu Kamau, D. James Nokes
PLoS ONE: Research Article, published 24 Oct 2012 10.1371/journal.pone.0047511

Abstract 
Background
Diarrhoea is an important cause of death in the developing world, and rotavirus is the single most important cause of diarrhoea associated mortality. Two vaccines (Rotarix and RotaTeq) are available to prevent rotavirus disease. This analysis was undertaken to aid the decision in Kenya as to which vaccine to choose when introducing rotavirus vaccination.

Methods
Cost-effectiveness modelling, using national and sentinel surveillance data, and an impact assessment on the cold chain.

Results
The median estimated incidence of rotavirus disease in Kenya was 3015 outpatient visits, 279 hospitalisations and 65 deaths per 100,000 children under five years of age per year. Cumulated over the first five years of life vaccination was predicted to prevent 34% of the outpatient visits, 31% of the hospitalizations and 42% of the deaths. The estimated prevented costs accumulated over five years totalled US$1,782,761 (direct and indirect costs) with an associated 48,585 DALYs. From a societal perspective Rotarix had a cost-effectiveness ratio of US$142 per DALY (US$5 for the full course of two doses) and RotaTeq US$288 per DALY ($10.5 for the full course of three doses). RotaTeq will have a bigger impact on the cold chain compared to Rotarix.

Conclusion
Vaccination against rotavirus disease is cost-effective for Kenya irrespective of the vaccine. Of the two vaccines Rotarix was the preferred choice due to a better cost-effectiveness ratio, the presence of a vaccine vial monitor, the requirement of fewer doses and less storage space, and proven thermo-stability.

PLoS One
[Accessed 27 October 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Reasons for Receiving or Not Receiving HPV Vaccination in Primary Schoolgirls in Tanzania: A Case Control Study
Deborah Watson-Jones, Keith Tomlin, Pieter Remes, Kathy Baisley, Riziki Ponsiano, Selephina Soteli, Silvia de Sanjosé, John Changalucha, Saidi Kapiga, Richard J. Hayes
PLoS ONE: Research Article, published 24 Oct 2012 10.1371/journal.pone.0045231

Abstract 
Background
There are few data on factors influencing human papillomavirus (HPV) vaccination uptake in sub-Saharan Africa. We examined the characteristics of receivers and non-receivers of HPV vaccination in Tanzania and identified reasons for not receiving the vaccine.

Methods
We conducted a case control study of HPV vaccine receivers and non-receivers within a phase IV cluster-randomised trial of HPV vaccination in 134 primary schools in Tanzania. Girls who failed to receive vaccine (pupil cases) and their parents/guardians (adult cases) and girls who received dose 1 (pupil controls) of the quadrivalent vaccine (Gardasil™) and their parents/guardians (adult controls) were enrolled from 39 schools in a 1:1 ratio and interviewed about cervical cancer, HPV vaccine knowledge and reasons why they might have received or not received the vaccine. Conditional logistic regression was used to determine factors independently associated with not receiving HPV vaccine.

Results
We interviewed 159 pupil/adult cases and 245 pupil/adult controls. Adult-factors independently associated with a daughter being a case were older age, owning fewer household items, not attending a school meeting about HPV vaccine, and not knowing anyone with cancer. Pupil-factors for being a case included having a non-positive opinion about the school de-worming programme, poor knowledge about the location of the cervix, and not knowing that a vaccine could prevent cervical cancer. Reasons for actively refusing vaccination included concerns about side effects and infertility. Most adult and pupil cases reported that they would accept the HPV vaccine if it were offered again (97% and 93% respectively).

Conclusions
Sensitisation messages, especially targeted at older and poorer parents, knowledge retention and parent meetings are critical for vaccine acceptance in Tanzania. Vaccine side effects and fertility concerns should be addressed prior to a national vaccination program. Parents and pupils who initially decline vaccination should be given an opportunity to reconsider their decision.

PLoS Medicine
(Accessed 27 October 2012)
http://www.plosmedicine.org/article/browse.action?field=date

Removing the Age Restrictions for Rotavirus Vaccination: A Benefit-Risk Modeling Analysis
Manish M. Patel, Andrew D. Clark, Colin F. B. Sanderson, Jacqueline Tate, Umesh D. Parashar Research Article, published 23 Oct 2012
doi:10.1371/journal.pmed.1001330

Abstract 
Background
To minimize potential risk of intussusception, the World Health Organization (WHO) recommended in 2009 that rotavirus immunization should be initiated by age 15 weeks and completed before 32 weeks. These restrictions could adversely impact vaccination coverage and thereby its health impact, particularly in developing countries where delays in vaccination often occur.

Methods and Findings
We conducted a modeling study to estimate the number of rotavirus deaths prevented and the number of intussusception deaths caused by vaccination when administered on the restricted schedule versus an unrestricted schedule whereby rotavirus vaccine would be administered with DTP vaccine up to age 3 years. Countries were grouped on the basis of child mortality rates, using WHO data. Inputs were estimates of WHO rotavirus mortality by week of age from a recent study, intussusception mortality based on a literature review, predicted vaccination rates by week of age from USAID Demographic and Health Surveys, the United Nations Children’s Fund (UNICEF) Multiple Indicator Cluster Surveys (MICS), and WHO-UNICEF 2010 country-specific coverage estimates, and published estimates of vaccine efficacy and vaccine-associated intussusception risk. On the basis of the error estimates and distributions for model inputs, we conducted 2,000 simulations to obtain median estimates of deaths averted and caused as well as the uncertainty ranges, defined as the 5th–95th percentile, to provide an indication of the uncertainty in the estimates.

We estimated that in low and low-middle income countries a restricted schedule would prevent 155,800 rotavirus deaths (5th–95th centiles, 83,300–217,700) while causing potentially 253 intussusception deaths (76–689). In contrast, vaccination without age restrictions would prevent 203,000 rotavirus deaths (102,000–281,500) while potentially causing 547 intussusception deaths (237–1,160). Thus, removing the age restrictions would avert an additional 47,200 rotavirus deaths (18,700–63,700) and cause an additional 294 (161–471) intussusception deaths, for an incremental benefit-risk ratio of 154 deaths averted for every death caused by vaccine. These extra deaths prevented under an unrestricted schedule reflect vaccination of an additional 21%–25% children, beyond the 63%–73% of the children who would be vaccinated under the restricted schedule. Importantly, these estimates err on the side of safety in that they assume high vaccine-associated risk of intussusception and do not account for potential herd immunity or non-fatal outcomes.

Conclusions
Our analysis suggests that in low- and middle-income countries the additional lives saved by removing age restrictions for rotavirus vaccination would far outnumber the potential excess vaccine-associated intussusception deaths.

Please see later in the article for the Editors’ Summary

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

Policy Platform
Analysis of Neglected Tropical Disease Drug and Vaccine Development Pipelines to Predict Issuance of FDA Priority Review Vouchers over the Next Decade
Rianna Stefanakis, Andrew S. Robertson, Elizabeth L. Ponder, Melinda Moree

[Excerpt]
The need for new drugs and vaccines for neglected tropical diseases (NTDs) is widely accepted [1]. Yet, encouraging pharmaceutical and biotechnology company investment in developing these much-needed treatments remains a challenge due to a lack of a commercial market driving companies to pursue NTD projects [2]. To address this challenge, economists Ridley, Grabowski, and Moe at Duke University conceived of an incentive to encourage investment in the development of new drugs and vaccines for NTDs: the US Food and Drug Administration’s (FDA) priority review voucher (PRV) program [3]. The program was signed into law on September 27, 2007 [4], and went into effect one year later.

Under the program, the FDA awards a voucher to the sponsor of a newly approved drug or vaccine that targets an NTD (such as cholera or dengue) or malaria and tuberculosis (TB). The voucher, which can be traded or sold, entitles the holder to a 6-month priority review for a future new drug application that would not otherwise qualify for priority review—potentially shaving between 4 and 12 months from the standard FDA review process [5].

Since the program’s inception, only one PRV has been awarded, to Novartis Pharmaceuticals Co. for their 2009 approval of the antimalarial drug Coartem. Novartis used the voucher to accelerate the review of one of its own products, rather than selling it on the marketplace. Because a product resulting from a PRV has not yet been sold in the marketplace, the value remains uncertain. Early economic models estimated that the worth of a PRV could range from US$50 million to US$500 million, with an average value of US$322 million, and a variation in value based on the therapeutic area for which it is used [5], [6]. Part of predicting the value relies on the supply and demand of vouchers; that is, will the number of vouchers awarded be absorbed by the blockbuster products that are likely to be the intended recipients of benefit from accelerated review? The lack of understanding as to how many PRVs may be awarded in the future limits companies from predicting the potential value of a voucher that might be earned.

In the absence of a tangible example of a voucher’s market value, companies, the FDA, policymakers, and other program stakeholders could benefit from examining NTD product pipelines, understanding when the next PRV(s) are expected to be issued, and ultimately quantifying the supply side of the PRV market. In addition, it is unclear to global health stakeholders whether companies are actively pursuing PRV-eligible products, and if they are, whether the PRV incentive has had an impact on their motivation [5], [6].

Here, we present an analysis of the drug and vaccine development pipeline to a) identify products that meet eligibility criteria to earn a PRV, and b) predict the number of PRVs that will be issued over the next 10 years. Of those products currently in clinical development, standard industry probabilities of success (POS) were applied to predict how many drugs and vaccines will ultimately earn regulatory approval, and therefore a PRV. Presumably, if stakeholders are armed with a supply forecast of the PRV market over the next decade, companies can conduct more informed calculations of value estimates, policymakers can assess whether the demand market for PRVs absorbs those vouchers being awarded, and the FDA can more accurately predict their expected workload increases when the PRVs are used…

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

Controlling Dengue with Vaccines in Thailand
Dennis L. Chao, Scott B. Halstead, M. Elizabeth Halloran, Ira M. Longini Jr.

Author Summary 
An estimated 40% of the world’s population is at risk of infection with dengue, a mosquito-borne disease that can lead to hospitalization or death. Dengue vaccines are currently being tested in clinical trials and at least one product will likely be available within a couple of years. Before widespread deployment, one should plan how best to use limited supplies of vaccine. We developed a mathematical model of dengue transmission in semi-rural Thailand to help evaluate different vaccination strategies. Our modeling results indicate that children should be prioritized to receive vaccine to reduce dengue-related morbidity, but adults will also need to be vaccinated if one wants to eliminate local dengue transmission. Dengue is a challenging disease to study because of its four interacting serotypes, seasonality of its transmission, and pre-existing immunity in a population. Models such as this one are useful coherent framework for synthesizing these complex issues and evaluating potential public health interventions such as mass vaccination.

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

Costs of Illness Due to Cholera, Costs of Immunization and Cost-Effectiveness of an Oral Cholera Mass Vaccination Campaign in Zanzibar
Christian Schaetti, Mitchell G. Weiss, Said M. Ali, Claire-Lise Chaignat, Ahmed M. Khatib, Rita Reyburn, Radboud J. Duintjer Tebbens, Raymond Hutubessy

Abstract
Background
The World Health Organization (WHO) recommends oral cholera vaccines (OCVs) as a supplementary tool to conventional prevention of cholera. Dukoral, a killed whole-cell two-dose OCV, was used in a mass vaccination campaign in 2009 in Zanzibar. Public and private costs of illness (COI) due to endemic cholera and costs of the mass vaccination campaign were estimated to assess the cost-effectiveness of OCV for this particular campaign from both the health care provider and the societal perspective.

Methodology/Principal Findings
Public and private COI were obtained from interviews with local experts, with patients from three outbreaks and from reports and record review. Cost data for the vaccination campaign were collected based on actual expenditure and planned budget data. A static cohort of 50,000 individuals was examined, including herd protection. Primary outcome measures were incremental cost-effectiveness ratios (ICER) per death, per case and per disability-adjusted life-year (DALY) averted. One-way sensitivity and threshold analyses were conducted. The ICER was evaluated with regard to WHO criteria for cost-effectiveness. Base-case ICERs were USD 750,000 per death averted, USD 6,000 per case averted and USD 30,000 per DALY averted, without differences between the health care provider and the societal perspective. Threshold analyses using Shanchol and assuming high incidence and case-fatality rate indicated that the purchase price per course would have to be as low as USD 1.2 to render the mass vaccination campaign cost-effective from a health care provider perspective (societal perspective: USD 1.3).

Conclusions/Significance
Based on empirical and site-specific cost and effectiveness data from Zanzibar, the 2009 mass vaccination campaign was cost-ineffective mainly due to the relatively high OCV purchase price and a relatively low incidence. However, mass vaccination campaigns in Zanzibar to control endemic cholera may meet criteria for cost-effectiveness under certain circumstances, especially in high-incidence areas and at OCV prices below USD 1.3.

Science        
26 October 2012 vol 338, issue 6106, pages 429-568
http://www.sciencemag.org/current.dtl

Perspective – Medicine
Can Intellectual Property Save Drug Development?
Garret A. FitzGerald
The Institute for Translational Medicine and Therapeutics, Perelman School of Medicine Translational Research Center, 10th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104–5158, USA.

Summary
The imbalance between the roughly constant rate of new drug approvals and the exploding cost estimates of drug development—mostly the cost of failure—has raised concern about the declining productivity of the pharmaceutical industry. Efforts to address the situation have included an investment in human capital—particularly those individuals who can project science across the translational divide (bench to clinic)—and investment in infrastructure, as exemplified by Clinical and Translational Science Awards in the United States and Biomedical Research Centers in the United Kingdom, and an increase in partnerships between academia and industry (1). However, radical reform of the iron rules of intellectual property (IP) worldwide will be necessary if we are to harvest and integrate the efforts of scientists and clinicians scattered across companies, universities, and countries, best qualified to generate new therapies.

Cell Host & Microbe
Volume 12, Issue 4, Pages 391-604 (18 October 2012)
http://www.sciencedirect.com/science/journal/19313128/12/4

A Blueprint for HIV Vaccine Discovery
Review Article
Pages 396-407
Dennis R. Burton, Rafi Ahmed, Dan H. Barouch, Salvatore T. Butera, Shane Crotty, Adam Godzik, Daniel E. Kaufmann, M. Juliana McElrath, Michel C. Nussenzweig, Bali Pulendran, Chris N. Scanlan, William R. Schief, Guido Silvestri, Hendrik Streeck, Bruce D. Walker, Laura M. Walker, Andrew B. Ward, Ian A. Wilson, Richard Wyatt

Abstract
Despite numerous attempts over many years to develop an HIV vaccine based on classical strategies, none has convincingly succeeded to date. A number of approaches are being pursued in the field, including building upon possible efficacy indicated by the recent RV144 clinical trial, which combined two HIV vaccines. Here, we argue for an approach based, in part, on understanding the HIV envelope spike and its interaction with broadly neutralizing antibodies (bnAbs) at the molecular level and using this understanding to design immunogens as possible vaccines. BnAbs can protect against virus challenge in animal models, and many such antibodies have been isolated recently. We further propose that studies focused on how best to provide T cell help to B cells that produce bnAbs are crucial for optimal immunization strategies. The synthesis of rational immunogen design and immunization strategies, together with iterative improvements, offers great promise for advancing toward an HIV vaccine.

AIDS and Behavior
2012, DOI: 10.1007/s10461-012-0351-6
http://www.springerlink.com/content/r251m4612482624u/

Original Paper
Recruitment of Urban US Women at Risk for HIV Infection and Willingness to Participate in Future HIV Vaccine Trials
Barbara Metch, Ian Frank, Richard Novak, Edith Swann, David Metzger, Cecilia Morgan, Debbie Lucy, Debora Dunbar, Parrie Graham and Tamra Madenwald, et al.

Abstract
Enrollment of US women with sufficient risk of HIV infection into HIV vaccine efficacy trials has proved challenging. A cohort of 799 HIV-negative women, aged 18–45, recruited from three US cities was enrolled to assess recruitment strategies based on geographic risk pockets, social and sexual networks and occurrence of sexual concurrency and to assess HIV seroincidence during follow-up (to be reported later). Among enrolled women, 90% lived or engaged in risk behaviors within a local risk pocket, 64% had a male partner who had concurrent partners and 50% had a male partner who had been recently incarcerated. Nearly half (46%) were recruited through peer referral. At enrollment, 86% of women said they were willing to participate in a vaccine efficacy trial. Results indicate that participant and partner risk behaviors combined with a peer referral recruitment strategy may best identify an at-risk cohort willing to participate in future trials.

New York Times
http://www.nytimes.com/
Accessed 27 October 2012

Global Edition – India
October 24, 2012, 3:40 am
Comment
A Conversation With: Polio Expert Naveen Thacker
By PAMPOSH RAINA
India appears to have succeeded in the fight against polio, with no new cases reported in the country since January 2011. The country will be certified “polio-free” in January 2014 by the World Health Organization if no new cases are reported between now and then, and has already been removed from a list of countries with “active transmission of wild poliovirus.”

The difficulty India has had controlling other infectious diseases, like tuberculosis and dengue, makes polio’s eradication here even more remarkable. In honor of World Polio Day, which is Wednesday, India Ink interviewed Dr. Naveen Thacker, part of the team that led India’s eradication effort.

http://india.blogs.nytimes.com/2012/10/24/a-conversation-with-polio-expert-naveen-thacker/
October 24, 2012, 4:31 am 3 Comments
Documenting India’s Fierce Battle Against Polio
By SEPHI BERGERSON

http://india.blogs.nytimes.com/2012/10/24/documenting-indias-fierce-battle-against-polio/?src=twrhp

Wall Street Journal
http://online.wsj.com/home-page
Accessed 27 October 2012

India Edition
October 24, 2012, 4:41 PM IST

Building on India’s Success on Polio
By Seth Berkley

More than 26 million children were born in India last year, many of them in remote parts of the country or in areas of poverty, poor sanitation and weak infrastructure.

Yet, nearly every one of these children received vaccines that protected them against polio.

Today, on World Polio Day, we recognize India’s achievement.  The country has not seen a case of polio in more than 18 months. This is a tremendous blow against a disease that has crippled and killed countless Indian children. India’s success is one of the biggest public health achievements in recent history. It has brought us closer than ever to eradicating the disease. There are now only three countries where natural polio transmission continues: Pakistan, Afghanistan and Nigeria.

India’s success against polio is a model of remarkable progress against all odds. It shows that even in the toughest circumstances—despite poverty, high birth rates, a large population and hard-to-reach migrant communities—polio can be defeated. It also provides a lesson that overcoming polio can pave the way to reach nearly every child with immunizations and protect them against other vaccine-preventable diseases.

Political commitment has been critical to India’s achievement. In 2009, when India had the highest number of polio cases in the world, the polio program implemented an aggressive strategy to target highest-risk populations, which was supported by all levels of government. India has also contributed significant financial resources to end polio: by 2013, the government will have invested $2 billion to defeat polio, supplemented by assistance from external partners. The program has ensured that more than 170 million children are vaccinated in two national polio immunization campaigns each year.

To reach nearly every child with polio vaccines, India used innovative strategies. India has implemented a system to track newborns to ensure they are reached with polio vaccines and other health interventions. Health workers have worked tirelessly to vaccinate children wherever they were— around brick kilns, on trains and boats and on the Pakistani border.  The government has partnered with traditional and religious leaders to convince parents to have their children vaccinated, and social mobilizers  have effectively delivered these messages across the country.

India can now apply the lessons learnt from the polio eradication effort to effectively provide routine immunizations to all, including children who live in remote areas beyond the reach of adequate healthcare facilities. Nomadic families are among the most challenging populations to reach. By using local community workers and mapping technology, India’s polio program identified nomadic settlements in the states of Bihar and Uttar Pradesh and was able to reach these communities not just with polio vaccines, but with routine immunizations that protect against a range of diseases.

India’s polio program has built a robust surveillance network consisting of 33,700 reporting sites, an army of 2.5 million vaccinators that are deployed during national immunization days, and effective strategies to vaccinate children in the country’s farthest reaches. The program also manages measles immunization campaigns and surveillance for other diseases, and delivers other health services to children.

Reaching this polio milestone provides a tremendous opportunity for India to strengthen its routine immunization and ensure that every child is protected from vaccine-preventable diseases.

Vaccines are cost-effective tools that can save lives and India is the world’s largest producer of these powerful low-cost vaccines. Yet, nineteen million children in developing countries, including in India, still do not receive life-saving vaccines that parents in wealthy nations take for granted, such as immunizations to protect against severe diarrhea and pneumococcal disease.

On World Polio Day, it is important to recognize India’s impressive achievement on polio. It provides a model for Nigeria, Pakistan and Afghanistan to stop the disease. And it demonstrates that with sufficient political commitment and funding, India and other countries can provide life-saving vaccines to all children who need them, wherever they are.

Seth Berkley, M.D., is a global advocate on the power of vaccines and CEO of the GAVI Alliance, a public-private partnership that focuses on promoting vaccination for children. GAVI last year worked with the Indian government to roll out vaccines to protect children against five life-threatening diseases in one shot. A medical epidemiologist by training, Dr. Berkley is also the founder and former President and CEO of the International AIDS Vaccine Initiative.

http://blogs.wsj.com/indiarealtime/2012/10/24/building-on-indias-success-on-polio/

Twitter Watch  [accessed 27 October 2012  16:43]
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.

Bill Gates ‏@BillGates
Why has India been so successful at helping to #endpolio? Great interview from The New York Times: http://b-gat.es/TH2gpi 
Retweeted by Sabin Vaccine Inst.
5:03 PM – 24 Oct 12

Health Evidence ‏@HealthEvidence
Influenza Immunization Awareness Month: 43 high quality reviews on the flu shot http://goo.gl/Xmoe8 

The Wistar Institute ‏@TheWistar
The rotavirus vaccine developed at Wistar helps prevent an infection that kills >500K kids each year. #40DaysofWistar http://bit.ly/TtgHx9 
6:48 AM – 26 Oct 12 ·

PAHO/WHO ‏@pahowho
The @WHO Region of the Americas has had no endemic (naturally-transmitted) cases of #rubella infection since 2009. http://www.who.int/mediacentre/factsheets/fs367/en/index.html …
5:50 AM – 26 Oct 12

WHO ‏@WHO
Improving vaccination coverage, especially with rubella virus, for children, women helps prevent congenital anomalies http://goo.gl/3VsRd 
2:50 AM – 26 Oct 12

M&R Initiative ‏@MeaslesRubella
#LionsClubs meet #Gates Challenge by contributing US$10 million to protect children from measles and other diseases. http://bit.ly/TZQFC1 
1:42 AM – 26 Oct 12

EveryWomanEveryChild ‏@UnfEWEC
For <$5, vaccines protect against measles, pneumonia, diarrhea & polio. Yet 1 in 5 kids are not vaccinated. #vaccineswork #APromiseRenewed
Retweeted by M&R Initiative
1:47 PM – 24 Oct 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_20 October 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…

Pediatrics
October 2012, VOLUME 130 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml
[No relevant content]

Pediatrics eFirst Pages
Sexual Activity–Related Outcomes After Human Papillomavirus Vaccination of 11- to 12-Year-Olds
Robert A. Bednarczyk, Robert Davis, Kevin Ault, Walter Orenstein, and Saad B. Omer
Pediatrics peds.2012-1516; Published online October 15, 2012 (10.1542/peds.2012-1516)

Abstract
OBJECTIVE: Previous surveys on hypothesized sexual activity changes after human papillomavirus (HPV) vaccination may be subject to self-response biases. To date, no studies measured clinical markers of sexual activity after HPV vaccination. This study evaluated sexual activity–related clinical outcomes after adolescent vaccination.

METHODS: We conducted a retrospective cohort study utilizing longitudinal electronic data from a large managed care organization. Girls enrolled in the managed care organization, aged 11 through 12 years between July 2006 and December 2007, were classified by adolescent vaccine (HPV; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed; quadrivalent meningococcal conjugate) receipt. Outcomes (pregnancy/sexually transmitted infection testing or diagnosis; contraceptive counseling) were assessed through December 31, 2010, providing up to 3 years of follow-up. Incidence rate ratios comparing vaccination categories were estimated with multivariate Poisson regression, adjusting for health care–seeking behavior and demographic characteristics.

RESULTS: The cohort included 1398 girls (493 HPV vaccine–exposed; 905 HPV vaccine–unexposed). Risk of the composite outcome (any pregnancy/sexually transmitted infection testing or diagnosis or contraceptive counseling) was not significantly elevated in HPV vaccine–exposed girls relative to HPV vaccine–unexposed girls (adjusted incidence rate ratio: 1.29, 95% confidence interval [CI]: 0.92 to1.80; incidence rate difference: 1.6/100 person-years; 95% CI: −0.03 to 3.24). Incidence rate difference for Chlamydia infection (0.06/100 person-years [95% CI: −0.30 to 0.18]) and pregnancy diagnoses (0.07/100 person-years [95% CI: −0.20 to 0.35]), indicating little clinically meaningful absolute risk differences.

CONCLUSIONS: HPV vaccination in the recommended ages was not associated with increased sexual activity–related outcome rates.

Media Release: HPV Vaccination Not Associated with Increased Sexual Activity Among Girls

Kaiser Permanente Study First to Examine Clinical Markers of Sexual Activity After HPV Vaccine

Media Release Excerpt:

ATLANTA, Oct. 15, 2012 /PRNewswire/ — The human papillomavirus (HPV) vaccine known as Gardasil is not associated with an increase in pregnancy, sexually transmitted infections, or contraceptive counseling, according to a Kaiser Permanente study published online today in the journal Pediatrics.

Since 2006, the Centers for Disease Control and Prevention has recommended that girls ages 11–12 receive three doses of the vaccine to protect them from HPV, which is transmitted through sexual activity and can cause genital warts and cervical, penile, vaginal, and head and neck cancers. The vaccine is also recommended for females ages 13–26 who did not receive the vaccine when they were younger, and for males ages 11–21.

But the vaccine has been slow to catch on. By 2010, fewer than half of girls eligible for Gardasil had received even one dose. Since the introduction of Gardasil, there have been concerns—raised both in peer-reviewed literature and the popular media—that use of the vaccine might lead to increased sexual activity, due in part to the mistaken belief that Gardasil protects against pregnancy and sexually transmitted diseases other than HPV. This new study, which was an independent research project funded by Kaiser Permanente and Emory University, shows there is no evidence to support these concerns.

“Our study found a very similar rate of testing, diagnosis and counseling among girls who received the vaccine and girls who did not,” said Robert Bednarczyk, PhD, an epidemiologist and the study’s lead author. “We saw no increase in pregnancies, sexually transmitted infections or birth control counseling – all of which suggest the HPV vaccine does not have an impact on increased sexual activity…”

http://www.prnewswire.com/news-releases/hpv-vaccination-not-associated-with-increased-sexual-activity-among-girls-174131171.html

See also article abstract in Pediatrics [Journal Watch below] and New York Times editorial [Media Watch below]

New York Times
http://www.nytimes.com/
Accessed 20 October 2012

Editorial
An HPV Vaccine Myth Debunked
Published: October 18, 2012

One of the most preposterous arguments raised by religious and social conservatives against administering a vaccine to girls to protect them from human papillomavirus, or HPV, has been that it might encourage them to become promiscuous. That notion has now been thoroughly repudiated by a study published on Monday in Pediatrics, a journal of the American Academy of Pediatrics.

Although most women infected with HPV, the most common sexually transmitted virus, experience no symptoms, persistent infections with some strains of the virus can cause cervical and other types of cancer, as well as genital warts. In 2006, the government’s top committee of experts on immunization practices recommended that all girls ages 11 or 12, and even some as young as 9, receive the vaccine so that they could develop immunity before they became sexually active. The Centers for Disease Control and Prevention, the American Academy of Pediatrics, the American Cancer Society and the American Academy of Family Physicians have all endorsed the recommendations and attest to the vaccine’s safety.

In previous surveys, teenage girls have said they would not modify their sexual behavior after getting the HPV vaccine, but those were based on self-reporting which is not considered highly reliable. The new study, conducted by researchers from Kaiser Permanente and Emory University, analyzed medical data collected by the Kaiser Permanente managed care plan in metropolitan Atlanta. It looked at 1,400 girls who were 11 or 12 in 2006, roughly a third of whom had received the HPV vaccine, and followed them for up to three years.

Over all, there was no difference between girls who had received the vaccine and those who had not in such indicators of sexual activity as pregnancies, sexually transmitted diseases, testing for sexually transmitted diseases and counseling on how to use contraceptives. As one expert said, parents should think of the vaccine as they would a bicycle helmet; it is protection, not an invitation to risky behavior.

A version of this editorial appeared in print on October 19, 2012, on page A30 of the New York edition with the headline: An HPV Vaccine Myth Debunked.

Speech – Beyond 2015: The Future of Development Goals next generation of MDGs
Remarks to the 4th OECD World Forum, Round Table 2, October 17, 2012, New Delhi
Otaviano Canuto, Vice President, Poverty Reduction and Economic Management, The World Bank
http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:23295537~pagePK:34370~piPK:34424~theSitePK:4607,00.html

Editor’s Excerpt:
“…At the Rio+20 Summit, the international community agreed to adopt a new set of universal sustainable development goals (SDGs), a more focused and quantitative set of goals directly addressing environmental and social sustainability.  Integrating this framework with the next set of goals has a number of advantages:  it will help donors, practitioners, and policy makers face a consolidated set of incentives and accountabilities, and it will help more inextricably link sustainability and development, further diminishing the legitimacy of the “grow now, clean up later” argument.

Most importantly, it will foster synergies among our development objectives:  for instance, how can we alleviate poverty without addressing water and sanitation problems?  Water is essential for livelihood security, reducing health risks, eradicating hunger, minimizing vulnerability to water-related disasters, and fostering pro-poor economic growth.  Furthermore, women almost exclusively bear the burden of water-hauling.  This not only exposes them to safety risks in many cases, but also reduces or entirely eliminates their time for education and productive activities, consequently holding them back from seizing opportunities for economic empowerment.

A number of issues on the design of the SDGs remain to be discussed, but we already have a clear picture of the elements required for them to be effective.

First, a meaningful SDGs framework will embrace the need to move beyond GDP to a more comprehensive accounting of nations’ wealth, including natural, human, social, and physical capital—thereby providing countries with the means to monitor their progress.

Second, it should encompass all three pillars of sustainable development, based on indicators of inclusiveness and equity in addition to environmental sustainability.

Third, the SDGs will inevitably include a mix of local and global public goods, and should thus be crafted in a way that enables geographic differentiation in targets, perhaps with a globally agreed minimum standard.  It makes sense to include both top-down and bottom-up approaches:  the former involves translating a global objective into national commitments, while the latter entails countries committing to individual levels of effort, the sum of which is the global goal.

Fourth, contrary to the results-based MDGs, targeting relative or absolute gains with respect to specific indicators, the SDGs will likely benefit from a blend of results-based targets for 2030 (or even 2050, 2100) and policy targets for the shorter term.

Finally, the complexity of sustainability may require more detailed and precise goals that simplify the operationalization of goals into policy changes.  Ideally, we would include a limited number of easy-to-communicate goals – comparable to the MDG poverty goals – and a series of more precise, sector-specific goals…”

The Weekly Epidemiological Record (WER) for 19 October 2012, vol. 87, 42 (pp. 401–412) includes:
– Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness

http://www.who.int/entity/wer/2012/wer8742.pdf

Update: Polio this week – As of 17 Oct 2012
Global Polio Eradication Initiative

[Editor’s Extract]
– World Polio Day, October 24: Polio eradication partners around the world are marking the first World Polio Day since India was removed from the list of countries with active transmission of wild poliovirus. This development opened up a historic opportunity to complete polio eradication in the remaining endemic countries, powered by the World Health Assembly declaration of an ‘emergency for global public health’ and implemented through national emergency programmes run by the governments of Afghanistan, Nigeria and Pakistan.
– Since World Polio Day last year, the number of new cases of polio has declined (from 467 at this time last year to 171 this year)

Afghanistan
– Four new cases were reported in the past week. All cases were type WPV1. These cases occurred in Kandahar, Khost, Kunar, and Paktya provinces. This brings the total number of cases for 2012 to 25. The most recent case was the one in Paktya Province, with onset of paralysis on 1 October.
– A delegation that included the governors of Kandahar and Helmand, the Ministry of Public Health, UNICEF, and WHO met Bill Gates in Abu Dhabi on 9 October to discuss the enhanced engagement of the President, challenges to monitoring vaccination team performance and possible new technologies to help improve team performance.
– National Immunization Days (NID) were held during 14–16 October. The launch of this campaign coincided with Global Handwashing Day. Polio information was distributed to children at this time.

Nigeria
– Four new cases were reported in the past week. All were type WPV1. The cases occurred in Kaduna, Kano, Katsina, and Sokoto states. The most recent case was the one from Kaduna State, with onset of paralysis on 22 September. The total number of cases for 2012 is 97.

Pakistan
– One new case of WPV was reported in the past week, WPV1 in the Bajour District of Federally Administrated Tribal Areas. This brings the total number of cases for 2012 to 44. This was the most recent case, with onset of paralysis on 25 September.
– National immunization Days were held during 15–17 October, excluding North and South Waziristan. In Quetta, Balochistan, investigations have begun into the fatal shooting of a volunteer vaccinator. Apart from parts of Quetta, the campaign continued in the rest of the province.

The MMWR Weekly for October 19, 2012 / Vol. 61 / No. 41 includes:
– Announcement: World Polio Day — October 24, 2012

World Polio Day (October 24) was established by Rotary International over a decade ago to commemorate the birth of Jonas Salk, who led the first team to develop a vaccine against poliomyelitis. Use of this inactivated poliovirus vaccine and subsequent widespread use of the oral poliovirus vaccine developed by Albert Sabin led to establishment of the Global Polio Eradication Initiative (GPEI) in 1988. Since then, GPEI has reduced polio worldwide by 99%; however, in 2012, transmission of indigenous wild poliovirus has continued uninterrupted in three countries (Nigeria, Afghanistan, and Pakistan) (1). In April 2012, the World Health Assembly declared the completion of polio eradication a programmatic emergency for global public health (2).

As of October 9, 2012, a total of 162 polio cases had been reported during the year, with 97% reported from three countries (Nigeria, Afghanistan and Pakistan). The number of polio cases reported is the lowest number ever recorded worldwide during a 9-month period.

Eradication of polio is an important public health priority for CDC. On December 2, 2011, the CDC Emergency Operations Center was activated to strengthen the agency’s partnership engagement through GPEI. Additional information regarding CDC’s polio eradication activities is available at http://www.cdc.gov/polio/updates, and additional information about GPEI and the global partnership is available at http://www.polioeradication.org.

References

CDC. Progress toward poliomyelitis eradication—Afghanistan and Pakistan, January 2011–August 2012. MMWR 2012;61:790–5.

2. World Health Assembly. Poliomyelitis: intensification of the global eradication initiative. Agenda item A65/20. Geneva, Switzerland: World Health Organization; 2012. Available at http://apps.who.int/gb/ebwha/pdf_files/wha65/A65_20-en.pdf  Accessed October 15, 2012.

Report: Preventive Care and Healthy Ageing: A Global Perspective
Source: Economist Intelligence Unit (EIU), sponsored by Pfizer
October 2012
http://digitalresearch.eiu.com/healthyageing/

The report “concludes that when governments increase investment in healthy ageing, healthcare costs go down. The report, which sheds light on ways countries are promoting preventive healthcare, suggests preventive care can pay dividends for cash-strapped governments…(and) provides a deep dive on Brazil, China, India, Japan, Russia, South Africa, the United Kingdom, and the United States, highlights compelling insights about the factors contributing to this global healthcare challenge:

– Age-related, infectious diseases such as pneumonia and influenza, as well as noninfectious chronic diseases like heart disease and stroke, are affecting older adults for longer periods of time,1 adding to healthcare costs and severely impacting a person’s productivity and need for support1

– Global healthcare reforms, increased mobility and evolving attitudes mean that governments must foot the bill for caring for their older citizens,1 and these governments are finding it difficult to keep up with the rise in chronic conditions since, to date, most healthcare systems have focused on treating acute illness1

– Immunization is highlighted in the report as one of the most cost-effective preventive measures for older people, but that measure is vastly underused due to structural and social barriers.

In developing countries, where they struggle with basic medical services, preventive care measures are seen as unaffordable luxuries.

http://www.businesswire.com/news/home/20121010005187/en/Report-Reveals-Programs-Promote-Healthy-Ageing-Reduce

Report Excerpt:
Vaccines: The low-hanging fruit
Vaccines offer a quick, cost-effective and easy way of reducing infectious disease. But adult immunisation rates remain low in both developed and developing countries. Why is this highly effective preventive measure under-used?

Older people with chronic conditions such as respiratory diseases, heart disease, kidney failure and diabetes are more susceptible to infectious diseases. Adults aged 60 years or older continue to be the highest-risk group for tetanus, while those older than 50 years are at greater risk for death and severe disability from influenza than younger people. In the UK, between 3,000 and 4,000 people die from influenza each year, and large numbers are hospitalised owing to the disease. More than 85% of influenza-related deaths occur in individuals over the age of 65 years. Thus, vaccination can significantly lower the risk of influenza-related hospitalisation and death and reduce the associated costs of the disease. A Spanish study showed that for older people with cardiac disease, influenza vaccination reduced the risk of winter mortality by 37%.

Despite its proven benefits, vaccination for ageing populations remains below the rate recommended by the World Health Organisation. As a result, millions of people worldwide continue to die from vaccine-preventable diseases. Although a vaccine against hepatitis B was developed in 1981, around 600,000 adults died from the disease in 2002 (latest available figure).

In developing countries, overstretched healthcare systems that struggle to meet immediate needs have tended to underfund immunisation programmes, which are sometimes perceived as burdensome. For example, vaccines require an extensive infrastructure to ensure the “cold chain” that extends from manufacturing through shipment to final distribution and administration. They also require careful waste management and specific medical training. Once established, however, vaccination programmes are highly cost-effective.

Furthermore, existing programmes rarely target older people. In India, for example, the government does not have an adult immunisation strategy; vaccination schemes are limited to children. By contrast, in Brazil the government has successfully used the country’s passion for soap operas to increase awareness and immunisation rates among the elderly (see Country perspectives).

Meanwhile, developed countries have also struggled to achieve universal adult immunisation. The problem is often a lack of awareness. “One of the biggest challenges of implementation and delivery is to develop a vaccine mindset for adults,” says Pierce Gardner, who served for many years as the American College of Physicians’ liaison representative to the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention.

Developed countries have had some success in using the private sector to increase immunisation rates. In the US and the UK, retailers have created profitable flu vaccination business lines that help to bring shoppers into their stores and pharmacies.

Community pharmacists can also act as vaccination advocates. In Japan, a 2009 study showed that pharmacists who provided information about influenza risks and vaccination benefits to their elderly customers had a take-up rate of 82%, compared with 70% in a control group…”

Report: The Compelling Need for Game-Changing Influenza Vaccines: An Analysis of the Influenza Vaccine Enterprise and Recommendations for the Future
Source: CIDRAP
“From the CIDRAP Comprehensive Influenza Vaccine Initiative (CCIVI), the report follows a review of more than 12,000 peer-reviewed publications, documents, transcripts and notes dating back to 1936 and interviews and follow up with 88 experts in influenza vaccine research, development, and use.”

– Full CCIVI report
– Executive summary
Oct 15, 2012, press release

Report: Global Tuberculosis Report 2012
Source: WHO
October 2012
http://apps.who.int/iris/bitstream/10665/75938/1/9789241564502_eng.pdf

Extract:
Key findings
– Progress towards global targets for reductions in TB cases and deaths continues. The Millennium Development Goal (MDG) target to halt and reverse the TB epidemic by 2015 has already been achieved. New cases of TB have been falling for several years and fell at a rate of 2.2% between 2010 and 2011. The TB mortality rate has decreased 41% since 1990 and the world is on track to achieve the global target of a 50% reduction by 2015. Mortality and incidence rates are also falling in all of WHO’s six regions and in most of the 22 high-burden countries that account for over 80% of the world’s TB cases. At country level, Cambodia demonstrates what can be achieved in a low-income and high-burden country: new data show a 45% decrease in TB prevalence since 2002.

– However, the global burden of TB remains enormous. In 2011, there were an estimated 8.7 million new cases of TB (13% co-infected with HIV) and 1.4 million people died from TB, including almost one million deaths among HIV-negative individuals and 430 000 among people who were HIV-positive. TB is one of the top killers of women, with 300 000 deaths among HIV-negative women and 200 000 deaths among HIV-positive women in 2011. Global progress also conceals regional variations: the African and European regions are not on track to halve 1990 levels of mortality by 2015.

– Access to TB care has expanded substantially since the mid-1990s, when WHO launched a new global TB strategy and began systematically monitoring progress. Between 1995 and 2011, 51 million people were successfully treated for TB in countries that had adopted the WHO strategy, saving 20 million lives.

– Progress in responding to multidrug-resistant TB (MDR-TB) remains slow. While the number of cases of MDR-TB notified in the 27 high MDR-TB burden countries is increasing and reached almost 60,000 worldwide in 2011, this is only one in five (19%) of the notified TB patients estimated to have MDR-TB. In the two countries with the largest number of cases, India and China, the figure is less than one in ten; scale-up is expected in these countries in the next three years.

– There has been further progress in implementing collaborative TB/HIV activities (first recommended by WHO in 2004). These saved an estimated 1.3 million lives between 2005 and the end of 2011. In 2011, 69% of TB patients were tested for HIV in the African Region, up from 3% in 2004. Globally, 48% of the TB patients known to be living with HIV in 2011 were started on antiretroviral therapy (ART); coverage needs to double to meet WHO’s recommendation that all TB patients living with HIV are promptly started on ART. Kenya and Rwanda are top performers in HIV testing and provision of ART.

– Innovations in diagnostics are being implemented. The roll-out of Xpert MTB/RIF, a rapid molecular test that can diagnose TB and rifampicin resistance within 100 minutes, has been impressive. Between its endorsement by WHO in December 2010 and the end of June 2012, 1.1 million tests had been purchased by 67 low- and middle-income countries; South Africa (37% of purchased tests) is the leading adopter. A 41% price reduction (from US$ 16.86 to US$ 9.98) in August 2012 should accelerate uptake.

– The development of new drugs and new vaccines is also progressing. New or re-purposed TB drugs and novel TB regimens to treat drug-sensitive or drug-resistant TB are advancing in clinical trials and regulatory review. Eleven vaccines to prevent TB are moving through development stages.

– There are critical funding gaps for TB care and control. Between 2013 and 2015 up to US$ 8 billion per year is needed in low- and middle-income countries, with a funding gap of up to US$ 3 billion per year. International donor funding is especially critical to sustain recent gains and make further progress in 35 low-income countries (25 in Africa), where donors provide more than 60% of current funding.

– There are also critical funding gaps for research and development. US$ 2 billion per year is needed; the funding gap was US$ 1.4 billion in 2010…

UN report: Status of the Convention on the Rights of the Child – Indigenous children on the sidelines of society
Source: UN – Report of the Secretary-General
Co-drafted by UNICEF and the Office of the High Commissioner for Human Rights on behalf of the Secretary-General and presented annually to the Third Committee by UNICEF at UN headquarters in New York.
http://www.unicef.org/media/files/ANNEX_VI_Report_of_the_SG_on_the_Status_of_the_Convention_on_the_Rights_of_the_Child.pdf

Media Release excerpt:
“Indigenous children face extreme forms of exclusion and discrimination and are often deprived of access to education, health services, birth registration and social protection, UNICEF said today in a report presented to the United Nations.

Indigenous peoples constitute 15 per cent of the world’s poor and one-third of the world’s extremely poor rural people. Politically vulnerable, indigenous peoples are subject to displacement and migration whether being forcibly removed from ancestral land or having to leave because of environmental degradation or the loss of traditional livelihoods.

Children in indigenous communities are at the core of UNICEF’s equity agenda as they are often disadvantaged and disenfranchised from progress in health, education and protection.

Deprived of access to services available to non-indigenous children, indigenous children face numerous challenges from disabilities, HIV and AIDS and gender-based issues.

Many indigenous children are not in school due to the distance to the nearest school, the lack of bilingual instruction or a lack of consistency between the school calendar and seasonal employment typical of farming or hunter-gathering and pastoral occupations.

When in school, indigenous children are subject to language discrimination, low literacy rates, low enrolment, high dropout rates and disparities in national academic achievements.

As disaggregated statistics on indigenous children are not readily available, the report calls for better monitoring that should ultimately would lead to better access to basic services…
http://www.unicef.org/media/media_66215.html

Report: 2012 World Disasters Report
Source: International Federation of Red Cross Red Crescent Societies
October 2012

“Migration is a phenomenon that grows every year and affects in some way virtually every country. Many migrants move voluntarily – looking perhaps for economic opportunities, or for different lifestyles. But for others, migration is not a choice. More and more people are forced to flee their homes and communities because of many factors including conflicts, persecution, disasters and poverty. It is their plight that is the focus of the 2012 World Disasters Report.”

Full report: http://www.ifrcmedia.org/assets/pages/wdr2012/download/index.html
http://www.ifrcmedia.org/assets/pages/wdr2012/

[Editor’s Note: Very limited mention of vaccines, immunization in report]
Extract:
p.85
“…Other than in the immediate aftermath of a major disaster, such as an earthquake, when there are very specific health threats, most displaced populations fall prey to the same health problems as non-displaced population – but in greater numbers. Even in contexts of active conflict, mortality more typically reflects inflated risk of existing patterns of disease than deaths due directly to military action. The principal impact of conflict, in other words, is that the health system becomes less capable, or incapable, of providing child immunizations, supporting skilled delivery of a child, and other key measures supporting population health…”

BMC Public Health
(Accessed 20 October 2012)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
Systematic review of studies evaluating the broader economic impact of vaccination in low and middle income countries
Rohan Deogaonkar, Raymond Hutubessy, Inge Putten, Silvia Evers, Mark Jit
BMC Public Health 2012, 12:878 (16 October 2012)
Open Access

Abstract (provisional)
Background
Most health economic evaluations of childhood vaccination only capture the health and short-term economic benefits. Measuring broader, long-term effects of vaccination on productivity and externalities could provide a more complete picture of the value of vaccines.

Method
MEDLINE, EconLit and NHS-EED databases were searched for articles published between January 1990 and July 2011, which captured broader economic benefits of vaccines in low and middle income countries. Studies were included if they captured at least one of the following categories on broader economic impact: outcome-related productivity gains, behaviour-related productivity gains, ecological externalities, equity gains, financial sustainability gains or macroeconomic benefits.

Results
Twenty-six relevant studies were found, including observational studies, economic models and contingent valuation studies. Of the identified broader impacts, outcome-related productivity gains and ecological externalities were most commonly accounted for. No studies captured behaviour-related productivity gains or macroeconomic effects. There was some evidence to show that vaccinated children 8–14 years of age benefit from increased cognitive ability. Productivity loss due to morbidity and mortality was generally measured using the human capital approach. When included, herd immunity effects were functions of coverage rates or based on reduction in disease outcomes. External effects of vaccines were observed in terms of equitable health outcomes and contribution towards synergistic and financially sustainable healthcare programs.

Conclusion
Despite substantial variation in the methods of measurement and outcomes used, the inclusion of broader economic impact was found to improve the attractiveness of vaccination. Further research is needed on how different tools and techniques can be used in combination to capture the broader impact of vaccination in a way that is consistent with other health economic evaluations. In addition, more country level evidence is needed from low and middle income countries to justify future investments in vaccines and immunization programs. Finally, the proposed broader economic impact framework may contribute towards better communication of the economic arguments surrounding vaccine uptake, leading to investments in immunization by stakeholders outside of the traditional health care sector such as ministries of finance and national treasuries.

Journal of Infectious Diseases
Volume 206 Issue 10 November 15, 2012
http://www.journals.uchicago.edu/toc/jid/current

EDITORIAL COMMENTARIES
Editor’s choice: Reconsidering Hand Hygiene Monitoring
Titus L. Daniels
J Infect Dis. (2012) 206(10): 1488-1490 doi:10.1093/infdis/jis549

Extract
Hand hygiene (HH) is a fundamental component of any successful infection prevention and control program. Healthcare professionals and the public now accept the performance of HH before and after patient contact as an essential and expected behavior. Despite this broad acceptance of the importance of performing HH, compliance rates among healthcare professionals remain unacceptably low [1, 2]. Some might argue that these publicized rates are artificially low because of the small sampling of actual opportunities. Others may contend that the publicized rates are artificially high because of imperfect observation methodologies. Both are probably correct.

Direct observation of healthcare workers (HCW) interacting with patients and the environment continues to be considered the gold standard for assessing HH compliance [3]. Multiple challenges exist with this methodology. First, the investment in human capital all but ensures that undersampling will occur. As shown by Fries and colleagues, a 60-minute observation period captured only 0.5%–1.7% of the average total number of opportunities per day [4]. Observations are also generally limited to work shifts when a full complement of personnel is available for administrative tasks (ie, daytime). Further, the direct observation strategy for measuring HH compliance has long been limited by the “Hawthorne effect,” which refers to a change in behavior that results from the direct visualization of activities. Anecdotally, virtually every healthcare epidemiologist can almost certainly retell a conversation in which an HCW recounted performing HH only when observers were present and conducting compliance audits. Though many organizations attempt to mitigate this effect by using unknown, nonstaff, volunteer, or other types of “secret” observers, over time most individuals working in patient care units will be able to determine the purpose of any person not usually identified as…

The Lancet  
Oct 20, 2012  Volume 380  Number 9851  p1359 – 1444  e7
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Tuberculosis—from ancient plague to modern-day nemesis
The Lancet
Preview
This week sees the launch of the WHO Global Tuberculosis Report2012. This annual report provides the latest data and analysis about the tuberculosis epidemic and progress made in prevention, care, and control of the disease from 182 member states and a total of 204 countries and territories with over 99% of the disease burden. As well as improvements in measurement and reporting, which include more country and prevalence surveys, for the first time the burden of tuberculosis in women and children and estimates of lives saved by the implementation of collaborative tuberculosis/HIV activities are documented.

Unexpected high levels of multidrug-resistant tuberculosis present new challenges for tuberculosis control
Sven Hoffner
Preview
Most international recommendations for tuberculosis control have been developed for multidrug-resistant (MDR) tuberculosis prevalence of up to around 5%. Yet we now face prevalence up to ten times higher in some places, where almost half of the patients with infectious disease are transmitting MDR strains of Mycobacterium tuberculosis.1 The highest prevalence of MDR tuberculosis documented to date, 47·8%, was reported in 2011, in Minsk, Belarus.1 Among patients with infectious (smear-positive) pulmonary disease, MDR tuberculosis was seen in 35·3% of newly detected cases and in no less than 76·5% of previously treated patients.

PLoS One
[Accessed 20 October 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Effectiveness of HBV Vaccination in Infants and Prediction of HBV Prevalence Trend under New Vaccination Plan: Findings of a Large-Scale Investigation
Shi-gui Yang, Bing Wang, Ping Chen, Cheng-bo Yu, Min Deng, Jun Yao, Chun-xia Zhu, Jing-jing Ren, Wei Wu, Bin Ju, Jian-feng Shen, Yu Chen, Ming D. Li, Bing Ruan, Lanjuan Li
PLoS ONE: Research Article, published 19 Oct 2012 10.1371/journal.pone.0047808

Abstract 
Background
Hepatitis B virus (HBV) infection remains a severe public health problem. Investigating its prevalence and trends is essential to prevention.

Methods
To evaluate the effectiveness of HBV vaccination under the 1992 Intervention Program for infants and predicted HBV prevalence trends under the 2011 Program for all ages. We conducted a community-based investigation of 761,544 residents of 12 counties in Zhejiang Province selected according to their location, population density, and economic development. The HBV prevalence trends were predicted by a time-shifting approach. HBV surface antigen (HBsAg) and alanine amino transferase (ALT) were determined.

Results
Of the 761,544 persons screened for HBsAg, 54,132 were positive (adjusted carrier rate 6.13%); 9,455 had both elevated ALT and a positive HBsAg test (standardized rate 1.18%). The standardized HBsAg carrier rate for persons aged ≤20 years was 1.51%. Key factors influencing HBV infection were sex, age, family history, drinking, smoking, employment as a migrant worker, and occupation. With the vaccination program implemented in 2011, we predict that by 2020, the HBsAg carrier rate will be 5.27% and that for individuals aged ≤34 years will reach the 2% upper limit of low prevalence according to the WHO criteria, with a standardized rate of 1.86%.

Conclusions
The national HBV vaccination program for infants implemented in 1992 has greatly reduced the prevalence of HBV infection. The 2011 program is likely to reduce HBV infection in Zhejiang Province to a low moderate prevalence, and perinatal transmission is expected to be controlled by 2020.

PLoS Medicine
(Accessed 20 October 2012)
http://www.plosmedicine.org/article/browse.action?field=date

Policy Forum
Human Rights Research and Ethics Review: Protecting Individuals or Protecting the State? Joseph J. Amon, Stefan D. Baral, Chris Beyrer, Nancy Kass Policy Forum, published 16 Oct 2012
doi:10.1371/journal.pmed.1001325

Summary Points
– Recently there has been a dramatic expansion in research conducted in low- and middle-income countries, as well as research ethics committees (RECs) in these countries.

– RECs in low- and middle-income countries have little experience overseeing human rights research and may be subject to government control or influence that may favor the interests of the state over the interests of individual research participants.

– Many human rights investigators are trained in disciplines with ethical codes and professional norms, but do not typically engage RECs nor see human rights documentation as research, and they tend to view REC approval as counterproductive to the protection of research participants.

– Case studies of human rights research can provide important lessons on navigating conflicts of interest posed by some local (i.e., in country) RECs.

– Expanding the use of community engagement and developing strong ethical operating principles can help ensure that individuals and researchers are protected in human rights research and investigations.

The Journal of Law, Medicine & Ethics, 2012
Volume 40, Issue 3, pages 630–654, Fall 2012

Special Issue: SYMPOSIUM 1: Conflicts of Interest in the Practice of Medicine
The Challenge of Providing the Public with Actionable Information during a Pandemic
Leslie E. Gerwin
Article first published online: 12 OCT 2012
DOI: 10.1111/j.1748-720X.2012.00695.x

Abstract
Analysis of media reporting on the H1N1 vaccine during the 2009 pandemic reveals a dissonance between the nature and content of the reporting, the government’s messages, and the public’s perceptions of vaccine safety and desirability. Despite careful attention to history and especially the lessons offered by Richard Neustadt and Harvey Fineberg in their study of the 1976 “Epidemic that Never Was,” government officials failed to escape criticism for decisions made and actions taken in the midst of the unfolding contagion threat. Moreover, public opinion polls show that substantial portions of the population failed to hear, believe, or heed the government’s messages. Looking at the enduring narrative of the government’s vaccine efforts through the lens of newspaper reports exposes six points of distortion. These points — the pervasive uncertainty inherent in a novel contagion; advances in information technology and electronic communications; the new news environment; the political polarization of American society; the infrastructure of the American public health system; and the oddities of public health emergency and vaccination injury compensation laws — interfered with the public’s reception of the government’s message and infected the public’s perception of government veracity and leadership capability. They challenge us to consider whether current planning is sufficient to prepare Americans to respond effectively to a lives-threatening national crisis. If we are to ensure that the public receives and recognizes accurate and actionable information essential for the prevention or containment of a deadly contagion, we will need to understand and address the impact of these distorting forces.

http://onlinelibrary.wiley.com/doi/10.1111/j.1748-720X.2012.00695.x/abstract

BBC
http://www.bbc.co.uk/
17 October 2012 Last updated at 06:06 ET

Pakistan polio worker shot dead in Quetta
Gunmen have killed a member of a polio vaccination team in the western Pakistani city of Quetta. The team were administering polio drops to under-fives on the city outskirts when attackers on a motorcycle opened fire. One worker was fatally injured and died on the way to hospital. It is not clear who the gunmen were. The Taliban have issued threats against the polio drive in Pakistan, where polio is still endemic. In July a doctor who was administering polio vaccines was shot dead in the southern city of Karachi…

Officials say the vaccination programme has been suspended in several areas of Quetta following Tuesday’s shooting.

http://www.bbc.co.uk/news/world-asia-19977508

NPR/National Public Radio [U.S.]

Public Health
How The Taliban Is Thwarting The War On Polio
by Jackie Northam
October 17, 2012 3:00 PM

http://www.npr.org/blogs/health/2012/10/17/162595455/how-the-taliban-is-thwarting-the-war-on-polio
Public Health

At Polio’s Epicenter, Vaccinators Battle Chaos And Indifference
by Jason Beaubien
October 17, 2012 4:00 AM
http://www.npr.org/blogs/health/2012/10/17/162811569/at-polios-epicenter-vaccinators-battle-chaos-and-indifference

New York Times
http://www.nytimes.com/
Accessed 20 October 2012

Editorial
An HPV Vaccine Myth Debunked
Published: October 18, 2012

One of the most preposterous arguments raised by religious and social conservatives against administering a vaccine to girls to protect them from human papillomavirus, or HPV, has been that it might encourage them to become promiscuous. That notion has now been thoroughly repudiated by a study published on Monday in Pediatrics, a journal of the American Academy of Pediatrics.

Although most women infected with HPV, the most common sexually transmitted virus, experience no symptoms, persistent infections with some strains of the virus can cause cervical and other types of cancer, as well as genital warts. In 2006, the government’s top committee of experts on immunization practices recommended that all girls ages 11 or 12, and even some as young as 9, receive the vaccine so that they could develop immunity before they became sexually active. The Centers for Disease Control and Prevention, the American Academy of Pediatrics, the American Cancer Society and the American Academy of Family Physicians have all endorsed the recommendations and attest to the vaccine’s safety.

In previous surveys, teenage girls have said they would not modify their sexual behavior after getting the HPV vaccine, but those were based on self-reporting which is not considered highly reliable. The new study, conducted by researchers from Kaiser Permanente and Emory University, analyzed medical data collected by the Kaiser Permanente managed care plan in metropolitan Atlanta. It looked at 1,400 girls who were 11 or 12 in 2006, roughly a third of whom had received the HPV vaccine, and followed them for up to three years.

Over all, there was no difference between girls who had received the vaccine and those who had not in such indicators of sexual activity as pregnancies, sexually transmitted diseases, testing for sexually transmitted diseases and counseling on how to use contraceptives. As one expert said, parents should think of the vaccine as they would a bicycle helmet; it is protection, not an invitation to risky behavior.

A version of this editorial appeared in print on October 19, 2012, on page A30 of the New York edition with the headline: An HPV Vaccine Myth Debunked.