BMC Public Health
(Accessed 10 November2012)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
Dynamic modelling of costs and health consequences of school closure during an influenza pandemic
Yiting Xue, Ivar Sønbø Kristiansen, Birgitte Freiesleben de Blasio BMC Public Health 2012, 12:962 (9 November 2012)

Abstract (provisional)
Background
The purpose of this article is to evaluate the cost-effectiveness of school closure during a potential influenza pandemic and to examine the trade-off between costs and health benefits for school closure involving different target groups and different closure durations.

Methods
We developed two models: a dynamic disease model capturing the spread of influenza and an economic model capturing the costs and benefits of school closure. Decisions were based on quality-adjusted life years gained using incremental cost-effectiveness ratios. The disease model is an age-structured SEIR compartmental model based on the population of Oslo. We studied the costs and benefits of school closure by varying the age targets (kindergarten, primary school, secondary school) and closure durations (1–10 weeks), given pandemics with basic reproductive number of 1.5, 2.0 or 2.5.

Results
The cost-effectiveness of school closure varies depending on the target group, duration and whether indirect costs are considered. Using a case fatality rate (CFR) of 0.1-0.2% and with current cost-effectiveness threshold for Norway, closing secondary school is the only cost-effective strategy, when indirect costs are included. The most cost-effective strategies would be closing secondary schools for 8 weeks if R0=1.5, 6 weeks if R0=2.0, and 4 weeks if R0= 2.5. For severe pandemics with case fatality rates of 1-2%, similar to the Spanish flu, or when indirect costs are disregarded, the optimal strategy is closing kindergarten, primary and secondary school for extended periods of time. For a pandemic with 2009 H1N1 characteristics (mild severity and low transmissibility), closing schools would not be cost-effective, regardless of the age target of school children.

Conclusions
School closure has moderate impact on the epidemic’s scope, but the resulting disruption to society imposes a potentially great cost in terms of lost productivity from parents’ work absenteeism.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

British Medical Journal
10 November 2012 (Vol 345, Issue 7882)
http://www.bmj.com/content/345/7882

Cost effectiveness of human papillomavirus test of cure after treatment for cervical intraepithelial neoplasia in England: economic analysis from NHS Sentinel Sites Study
BMJ 2012;345:e7086 (Published 1 November 2012) Open Access
Editorial
PDF
Press release

British Medical Journal
10 November 2012 (Vol 345, Issue 7882)
http://www.bmj.com/content/345/7882

Vaccination of risk groups in England using the 13 valent pneumococcal conjugate vaccine: economic analysis
BMJ 2012;345:e6879 (Published 26 October 2012) Open Access
PDF

Abstract
Objective – To estimate the cost effectiveness of vaccinating people with high risk conditions against invasive pneumococcal disease using the 13 valent pneumococcal conjugate vaccine.

Design Economic evaluation using a cohort model from the perspective of healthcare providers.

Setting – England.

Participants – People aged 2 years and older at increased risk of invasive pneumococcal disease due to chronic kidney disease; splenic dysfunction; HIV infection; a compromised immune system; chronic heart, liver, or respiratory disease; or diabetes.

Main outcome measures Costs, gains in life years and quality adjusted life years (QALYs), and incremental cost effectiveness ratios.

Results – Increasing indirect protection resulting from the vaccination programme of infants using the 13 valent pneumococcal conjugate vaccine means that the burden of disease preventable by targeting high risk groups will diminish in time. Under base case assumptions—that is, no overall impact on non bacteraemic pneumonia in high risk groups and assuming the high risk vaccination programme would be launched two to three years after the infant programme—the incremental cost effectiveness ratio was estimated to be more than £30 000 (€37 216; $48 210) per QALY gained for most risk groups. If, however, the vaccine does not offer protection against non-bacteraemic pneumococcal pneumonia or the vaccine was introduced concomitantly with the infant 13 valent pneumococcal conjugate vaccination programme then vaccinating high risk people would (more) likely be cost effective. Sensitivity analyses showed that the cost effectiveness was particularly sensitive to assumed herd benefits and vaccine efficacy estimates.

Conclusion – Under base case assumptions it is unlikely that a pneumococcal vaccination programme aimed at risk groups could be considered cost effective. Uncertainty could be substantially reduced by establishing the effectiveness of the 13 valent pneumococcal conjugate vaccine against non-bacteraemic pneumococcal pneumonia, particularly in at risk groups.

JAMA   
November 07, 2012, Vol 308, No. 17
http://jama.ama-assn.org/current.dtl

Lab Reports
Anthrax Vaccine Testing
Tracy Hampton, PhD
JAMA. 2012;308(17):1729. doi:10.1001/jama.2012.28156.

Clinical trials to assess the efficacy of vaccines against anthrax are not ethical or feasible, but data from 21 US government–sponsored animal studies on anthrax vaccine efficacy indicate that an in vitro anthrax lethal toxin neutralization activity assay (TNA), which measures how well antibodies in the blood can block anthrax toxin, can predict survival against an inhalation anthrax challenge within and across species and genera (Fay MP et al. Sci Transl Med. 2012;4[151]:151ra126).

The Lancet  
Nov 10, 2012  Volume 380  Number 9854  p1621 – 1712
http://www.thelancet.com/journals/lancet/issue/current

Comment
Progress and challenges in bacterial meningitis
Diederik van de Beek

Preview
Bacterial meningitis is a devastating disease that is associated with substantial mortality and morbidity. The major causative bacteria are Streptococcus pneumoniae and Neisseria meningitis, with case-fatality rates of 30% and 7%, respectively, in high-income countries.1 In resource-poor countries, fatality rates can be as high as 50%.2 Neurological sequelae, including hearing loss, developmental disorders, and neuropsychological impairment, occur in up to 50% of survivors of the disease.1,3 Although routine vaccination against the three most common causative bacteria has had a notable effect on the prevalence of bacterial meningitis, an estimated 1·2 million cases occur worldwide every year, resulting in 180 000 deaths in children aged 1–59 months in 2010.

Series
Bacterial Meningitis – Dilemmas in the diagnosis of acute community-acquired bacterial meningitis
Matthijs C Brouwer, Guy E Thwaites, Allan R Tunkel, Diederik van de Beek
Preview | Summary

Bacterial Meningitis – Advances in treatment of bacterial meningitis
Diederik van de Beek, Matthijs C Brouwer, Guy E Thwaites, Allan R Tunkel
Preview | Summary

Bacterial Meningitis – Effect of vaccines on bacterial meningitis worldwide
Peter B McIntyre, Katherine L O’Brien, Brian Greenwood, Diederik van de Beek
Summary
Three bacteria—Haemophilus influenzae, Streptococcus pneumoniae, and Neisseria meningitidis—account for most acute bacterial meningitis. Measurement of the effect of protein-polysaccharide conjugate vaccines is most reliable for H influenzae meningitis because one serotype and one age group account for more than 90% of cases and the incidence has been best measured in high-income countries where these vaccines have been used longest. Pneumococcal and meningococcal meningitis are caused by diverse serotypes and have a wide age distribution; measurement of their incidence is complicated by epidemics and scarcity of surveillance, especially in low-income countries. Near elimination of H influenzae meningitis has been documented after vaccine introduction. Despite greater than 90% reductions in disease attributable to vaccine serotypes, all-age pneumococcal meningitis has decreased by around 25%, with little data from low-income settings. Near elimination of serogroup C meningococcal meningitis has been documented in several high-income countries, boding well for the effect of a new serogroup A meningococcal conjugate vaccine in the African meningitis belt.

Nature Medicine
November 2012, Volume 18 No 11 pp1593-1715
http://www.nature.com/nm/journal/v18/n10/index.html

Editorial
Toward clinical transparency – p1593
doi:10.1038/nm.3000

Big pharma has historically made some substantial missteps regarding the full reporting of clinical trial results, but a new initiative by GlaxoSmithKline is a move in the right direction.

New England Journal of Medicine
November 8, 2012  Vol. 367 No. 19
http://content.nejm.org/current.shtml

Online First: http://www.nejm.org/doi/full/10.1056/NEJMoa1208394?query=featured_home

Original Article
A Phase 3 Trial of RTS,S/AS01 Malaria Vaccine in African Infants
The RTS,S Clinical Trials Partnership
November 9, 2012DOI: 10.1056/NEJMoa1208394

Abstract
Background
The candidate malaria vaccine RTS,S/AS01 reduced episodes of both clinical and severe malaria in children 5 to 17 months of age by approximately 50% in an ongoing phase 3 trial. We studied infants 6 to 12 weeks of age recruited for the same trial.
Full Text of Background…

Methods
We administered RTS,S/AS01 or a comparator vaccine to 6537 infants who were 6 to 12 weeks of age at the time of the first vaccination in conjunction with Expanded Program on Immunization (EPI) vaccines in a three-dose monthly schedule. Vaccine efficacy against the first or only episode of clinical malaria during the 12 months after vaccination, a coprimary end point, was analyzed with the use of Cox regression. Vaccine efficacy against all malaria episodes, vaccine efficacy against severe malaria, safety, and immunogenicity were also assessed.
Full Text of Methods…

Results
The incidence of the first or only episode of clinical malaria in the intention-to-treat population during the 14 months after the first dose of vaccine was 0.31 per person-year in the RTS,S/AS01 group and 0.40 per person-year in the control group, for a vaccine efficacy of 30.1% (95% confidence interval [CI], 23.6 to 36.1). Vaccine efficacy in the per-protocol population was 31.3% (97.5% CI, 23.6 to 38.3). Vaccine efficacy against severe malaria was 26.0% (95% CI, −7.4 to 48.6) in the intention-to-treat population and 36.6% (95% CI, 4.6 to 57.7) in the per-protocol population. Serious adverse events occurred with a similar frequency in the two study groups. One month after administration of the third dose of RTS,S/AS01, 99.7% of children were positive for anti-circumsporozoite antibodies, with a geometric mean titer of 209 EU per milliliter (95% CI, 197 to 222).
Full Text of Results…

Conclusions
The RTS,S/AS01 vaccine coadministered with EPI vaccines provided modest protection against both clinical and severe malaria in young infants. (Funded by GlaxoSmithKline Biologicals and the PATH Malaria Vaccine Initiative; RTS,S ClinicalTrials.gov number, NCT00866619.)
Full Text of Discussion…

PLoS One
[Accessed 10 November 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Maternal Tetanus Toxoid Vaccination and Neonatal Mortality in Rural North India
Abhishek Singh, Saseendran Pallikadavath, Reuben Ogollah, William Stones
PLoS ONE: Research Article, published 09 Nov 2012 10.1371/journal.pone.0048891

Abstract 
Objectives
Preventable neonatal mortality due to tetanus infection remains common. We aimed to examine antenatal vaccination impact in a context of continuing high neonatal mortality in rural northern India.

Methods and Findings
Using the third round of the Indian National Family Health Survey (NFHS) 2005–06, mortality of most recent singleton births was analysed in discrete-time logistic model with maternal tetanus vaccination, together with antenatal care utilisation and supplementation with iron and folic acid. 59% of mothers reported receiving antenatal care, 48% reported receiving iron and folic acid supplementation and 68% reported receiving two or more doses of tetanus toxoid (TT) vaccination. The odds of all-cause neonatal death were reduced following one or more antenatal dose of TT with odds ratios (OR) of 0.46 (95% CI 0.26 to 0.78) after one dose and 0.45 (95% CI 0.31 to 0.66) after two or more doses. Reported utilisation of antenatal care and iron-folic acid supplementation did not influence neonatal mortality. In the statistical model, 16% (95% CI 5% to 27%) of neonatal deaths could be attributed to a lack of at least two doses of TT vaccination during pregnancy, representing an estimated 78,632 neonatal deaths in absolute terms.

Conclusions
Substantial gains in newborn survival could be achieved in rural North India through increased coverage of antenatal TT vaccination. The apparent substantial protective effect of a single antenatal dose of TT requires further study. It may reflect greater population vaccination coverage and indicates that health programming should prioritise universal antenatal coverage with at least one dose.

PLoS One
[Accessed 10 November 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Potential Benefits of Second-Generation Human Papillomavirus Vaccines
Sorapop Kiatpongsan, Nicole Gastineau Campos, Jane J. Kim
PLoS ONE: Research Article, published 07 Nov 2012 10.1371/journal.pone.0048426

Abstract 
Background
Current prophylactic vaccines against human papillomavirus (HPV) target two oncogenic types (16 and 18) that contribute to 70% of cervical cancer cases worldwide. Our objective was to quantify the range of additional benefits conferred by second-generation HPV prophylactic vaccines that are expected to expand protection to five additional oncogenic types (31, 33, 45, 52 and 58).

Methods
A microsimulation model of HPV and cervical cancer calibrated to epidemiological data from two countries (Kenya and Uganda) was used to estimate reductions in lifetime risk of cervical cancer from the second-generation HPV vaccines. We explored the independent and joint impact of uncertain factors (i.e., distribution of HPV types, co-infection with multiple HPV types, and unidentifiable HPV types in cancer) and vaccine properties (i.e., cross-protection against non-targeted HPV types), compared against currently-available vaccines.

Results
Assuming complete uptake of the second-generation vaccine, reductions in lifetime cancer risk were 86.3% in Kenya and 91.8% in Uganda, representing an absolute increase in cervical cancer reduction of 26.1% in Kenya and 17.9% in Uganda, compared with complete uptake of current vaccines. The range of added benefits was 19.6% to 29.1% in Kenya and 14.0% to 19.5% in Uganda, depending on assumptions of cancers attributable to multiple HPV infections and unidentifiable HPV types. These effects were blunted in both countries when assuming vaccine cross-protection with both the current and second-generation vaccines.

Conclusion
Second-generation HPV vaccines that protect against additional oncogenic HPV types have the potential to improve cervical cancer prevention. Co-infection with multiple HPV infections and unidentifiable HPV types can influence vaccine effectiveness, but the magnitude of effect may be moderated by vaccine cross-protective effects. These benefits must be weighed against the cost of the vaccines in future analyses.

PLoS One
[Accessed 10 November 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Dynamic Epidemiological Models for Dengue Transmission: A Systematic Review of Structural Approaches
Mathieu Andraud, Niel Hens, Christiaan Marais, Philippe Beutels
PLoS ONE: Research Article, published 06 Nov 2012 10.1371/journal.pone.0049085

Abstract
Dengue is a vector-borne disease recognized as the major arbovirose with four immunologically distant dengue serotypes coexisting in many endemic areas. Several mathematical models have been developed to understand the transmission dynamics of dengue, including the role of cross-reactive antibodies for the four different dengue serotypes. We aimed to review deterministic models of dengue transmission, in order to summarize the evolution of insights for, and provided by, such models, and to identify important characteristics for future model development. We identified relevant publications using PubMed and ISI Web of Knowledge, focusing on mathematical deterministic models of dengue transmission. Model assumptions were systematically extracted from each reviewed model structure, and were linked with their underlying epidemiological concepts. After defining common terms in vector-borne disease modelling, we generally categorised fourty-two published models of interest into single serotype and multiserotype models. The multi-serotype models assumed either vector-host or direct host-to-host transmission (ignoring the vector component). For each approach, we discussed the underlying structural and parameter assumptions, threshold behaviour and the projected impact of interventions. In view of the expected availability of dengue vaccines, modelling approaches will increasingly focus on the effectiveness and cost-effectiveness of vaccination options. For this purpose, the level of representation of the vector and host populations seems pivotal. Since vector-host transmission models would be required for projections of combined vaccination and vector control interventions, we advocate their use as most relevant to advice health policy in the future. The limited understanding of the factors which influence dengue transmission as well as limited data availability remain important concerns when applying dengue models to real-world decision problems.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 30, Issue 49, Pages 6957-7130 (19 November 2012)

Editorial
Pertussis outbreaks and pertussis vaccines: New insights, new concerns, new recommendations?
Pages 6957-6959
Gregory A. Poland

No abstract is available for this article.
Article Outline
1. Secondary vaccine failure
2. Skewing of vaccine-induced immune responses due to acellular vaccine
3. Vaccine-resistant B. pertussis strains
4. Inadequate and confusing vaccine recommendations
5. Summary

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 30, Issue 49, Pages 6957-7130 (19 November 2012)

Brief Report
Human papillomavirus vaccination coverage among Greek higher education female students and predictors of vaccine uptake
Pages 6967-6970
Elisavet M. Donadiki, Rodrigo Jiménez-García, Valentín Hernández-Barrera, Pilar Carrasco-Garrido, Ana López de Andrés, Emmanuel G. Velonakis

Abstract
One of the biggest public health measures to prevent HPV infection, and consequently, cervical cancer, is the HPV vaccine. Greece introduced HPV vaccines to its National Vaccination Program in 2008.

The aims of this study were to estimate HPV vaccination coverage among female Greek students in higher education and to identify uptake predictors. We conducted a cross-sectional study. Data was collected through a self-completed questionnaire. The sample size included 3153 women with an 87% participation rate. Overall 25.8% of students reported they had received three doses of the HPV vaccine. Positive predictors of vaccine uptake were: younger age, higher educational level (own and parents), ever previous visit(s) to the gynecologist, always use of condoms, not smokers, not being in a stable relationship and easy access to Health Care Services.

Vaccine compliance was unacceptably low despite the fact that the vaccination is free-of-charge. Interventions on college campuses should stress vaccination as a normative behavior.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 30, Issue 49, Pages 6957-7130 (19 November 2012)

Adjuvants and inactivated polio vaccine: A systematic review
Review Article
Pages 6971-6979
Jennifer Hawken, Stephanie B. Troy

Abstract
Poliomyelitis is nearing universal eradication; in 2011, there were 650 cases reported globally. When wild polio is eradicated, global oral polio vaccine (OPV) cessation followed by use of universal inactivated polio vaccine (IPV) is believed to be the safest vaccination strategy as IPV does not mutate or run the risk of vaccine derived outbreaks that OPV does. However, IPV is significantly more expensive than OPV. One strategy to make IPV more affordable is to reduce the dose by adding adjuvants, compounds that augment the immune response to the vaccine. No adjuvants are currently utilized in stand-alone IPV; however, several have been explored over the past six decades. From aluminum, used in many licensed vaccines, to newer and more experimental adjuvants such as synthetic DNA, a diverse group of compounds has been assessed with varying strengths and weaknesses. This review summarizes the studies to date evaluating the efficacy and safety of adjuvants used with IPV.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 30, Issue 49, Pages 6957-7130 (19 November 2012)

The next generation recombinant human cytomegalovirus vaccine candidates—Beyond gB
Review Article
Pages 6980-6990
Anders E. Lilja, Peter W. Mason

Abstract
Human cytomegalovirus (HCMV) infects the majority of the global population and persists within the infected host for life; infection of healthy adults rarely leads to severe acute clinical symptoms. In contrast, HCMV is a leading infectious cause of congenital disease and a common cause of complications in transplant recipients. A vaccine to prevent HCMV disease in these populations is a widely recognized medical need. We review recent advances in our understanding of the candidate vaccine antigens and published clinical trial data for the four most recent HCMV vaccine candidates: a gB subunit adjuvanted with MF59, a DNA vaccine expressing gB and pp65, alphavirus replicon particles (VRPs) expressing gB and a pp65–IE1 fusion protein, and a pp65 peptide vaccine. The candidates are safe, although some adverse events were reported for an adjuvanted variant of the pp65 peptide vaccine. The gB/MF59 vaccine elicited strong humoral responses with limited durability. The gB/pp65 DNA vaccine elicited cellular immunity, and the pp65 peptide vaccine elicited modest cellular immunity, but only when formulated with an adjuvant. Only the VRP vaccine expressing gB and pp65–IE1 elicited both humoral and cellular immunity. The gB/MF59 vaccine showed a short-term 50% efficacy at preventing infection of seronegative women and significantly reduced viremia and need for antivirals in solid organ transplant recipients, and the gB/pp65 DNA vaccine showed signs of clinical benefit in hematopoietic stem cell transplant recipients. Importantly, the partial efficacy of the subunit and DNA vaccines is new evidence that both humoral and cellular immunity contribute to controlling HCMV-related disease. These data show the clinical feasibility of a recombinant HCMV vaccine. We discuss areas for potential improvements in the next generation of vaccine candidates.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 30, Issue 49, Pages 6957-7130 (19 November 2012)

Predicting vaccination using numerical and affective risk perceptions: The case of A/H1N1 influenza
Original Research Article
Pages 7019-7026
Britta Renner, Tabea Reuter

Abstract
During the 2009 A/H1N1 flu pandemic, German health authorities recommended vaccination; however, the efficacy of such programs largely depends on individuals’ risk perception. Risk perceptions are commonly determined through numerical-cognitive estimates such as the perceived likelihood and severity of the hazard. Instead, we argue that risk perceptions, which include more affect-related aspects such as worry and threat, are more powerful predictors of protective behaviors. Moreover, vaccines are often perceived as double-edged since they offer protection but also involve adverse side-effects. As such, in the context of the A/H1N1 vaccine uptake, risk perception is not only disease-related (A/H1N1 infection) but also vaccine-related (A/H1N1 vaccine). The present longitudinal study was conducted during the run-up to the German A/H1N1 vaccination campaign and measured cognitive and affective risk perceptions associated with both the A/H1N1 infection and its vaccine (T1, October 2009, N = 397) in order to assess their impact on (self-reported) A/H1N1 vaccination eight weeks later (T2, December 2009; N = 285). As assumed, greater perceived likelihood and severity of infection were associated with greater affective risk perception at T1. The more threatened and worried people felt, the more they intended to get vaccinated; however, the greater the perceived likelihood and severity of vaccine adverse side-effects, the greater the amount of vaccine related affective risk perception, impeding vaccination intention. Finally, vaccination intention predicted vaccination eight weeks later at T2 (OR = 2.2). The results suggest that numerical-cognitive risk perceptions, which are typically the target of public vaccination campaigns, do not impact preventive intention directly; instead, they facilitate affect-related risk perceptions, which motivate protective action.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 30, Issue 49, Pages 6957-7130 (19 November 2012)

A qualitative study investigating knowledge and attitudes regarding human papillomavirus (HPV) and the HPV vaccine among parents of immunosuppressed children
Original Research Article
Pages 7027-7031
Holly Seale, Linda Trung, Fiona E. Mackie, Sean E. Kennedy, Christina Boros, Helen Marshall, Jane Tidswell, Peter J. Shaw, Kay Montgomery, C. Raina MacIntyre

Abstract
Barriers influencing the willingness of parents to vaccinate immunocompetent children include a lack of knowledge about human papillomavirus (HPV) and low perception of risk regarding their child’s acquisition of HPV infection. However, it cannot be assumed that the facilitators and barriers of HPV vaccination are the same for parents/guardians of children who are immunocompromised, or who have chronic medical conditions. This study aimed to document the knowledge and attitudes of parents/guardians of immunosuppressed children and adolescents towards HPV infection and the vaccine.

A study using qualitative methods which incorporated 27 semi-structured interviews was undertaken with parents/guardians of immunosuppressed children vaccinated against HPV at three hospitals in two states of Australia. Thematic analysis revealed that while participants acknowledged that they had heard of HPV, they did not have a strong sense of what it actually was. The level of concern held about their child acquiring an HPV infection (prior to vaccination) ranged from ‘not at all’ to ‘extremely’. Some believed that their child was at increased risk of developing a severe HPV-related illness because of their underlying condition. The participants supported their child receiving the HPV vaccine, as they did not want to take a risk with a disease that may cause their child to return to hospital for treatment. The majority had little apprehension about the use of the HPV vaccine but expressed some concern that potential adverse effects would be more severe for immunosuppressed children. However, they stressed their belief in the safety of the vaccine and their trust in the child’s health team.

Our study results show that parents of children with impaired immunity would benefit from further information about the safety of the vaccine and about the important role of the vaccine for boys as well as girls.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 30, Issue 49, Pages 6957-7130 (19 November 2012)

Childhood immunization reporting laws in the United States: Current status
Original Research Article
Pages 7059-7066
Erika M. Hedden, Amy B. Jessop, Robert I. Field

Abstract
Context
Immunization Information Systems (IIS), or registries, were developed to improve effectiveness and efficiency in immunization services. Complex laws that govern IIS and immunization records are developed at the state-level, interact with each other, and may impact utility for all immunization stakeholders. As states develop Health Information Exchange laws they may also interact with IIS laws.

Objectives
To provide immunization stakeholders an overview of the laws applicable to healthcare providers and health departments. Comparisons are provided to illustrate the trends since the previous studies.

Methods
IIS relevant statutes, regulations and ordinances of jurisdictions (states, large cities) of 56 “Grantees” receiving funding under the 317b Public Health Service Act were identified via legal databases then systematically reviewed for authorization, reporting and consent requirements. Key provisions were coded and mapped according to 131 variables.

Results
Including subsections, 984 laws across Grantees relate to immunization records, falling under many administrative sections of state and city government. Most Grantees have more than one law that addresses immunization records reporting, exchange and privacy protections. Not all of these laws are in alignment, but there is a trend toward increased Grantee IIS authorizing laws, mandated reporting and implied consent provisions. Of the 56 Grantees, 37 (66%) had IIS authorizing laws, and 46 (82%) had laws addressing healthcare provider and vital statistics reporting. However, much variation remains, even within the provisions of these laws. The coding instrument received 93.7% agreement and a K-α of 0.791.

Conclusions
The trend toward laws that encourage participation should continue to improve functionality and value, but inconsistencies among laws should be addressed, both across jurisdictions within states and between different states. They may impair the value of the information that is collected. Greater uniformity could improve the overall usefulness of IIS.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 30, Issue 49, Pages 6957-7130 (19 November 2012)

The potential economic value of a human norovirus vaccine for the United States
Original Research Article
Pages 7097-7104
Sarah M. Bartsch, Benjamin A. Lopman, Aron J. Hall, Umesh D. Parashar, Bruce Y. Lee

Abstract
Vaccines against human norovirus are currently under development. We developed a simulation model to determine their potential economic value. Vaccination prevented 100–6125 norovirus gastroenteritis cases per 10,000 vaccinees. Low vaccine cost (≤$50) garnered cost-savings and a more expensive vaccine led to costs per case averted comparable to other vaccines. In the US, vaccination could avert approximately 1.0–2.2 million cases (efficacy 50%, 12 month duration), costing an additional $400 million to $1.0 billion, but could save ≤$2.1 billion (48 month duration). Human norovirus vaccination can offer economic value while averting clinical outcomes, depending on price, efficacy, and protection duration.

Vaccine
Volume 30, Issue 48, Pages 6729-6956 (6 November 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/48

The importance of pertussis in older adults: A growing case for reviewing vaccination strategy in the elderly
Review Article
Pages 6745-6752
Iman Ridda, Jiehui Kevin Yin, Catherine King, C. Raina MacIntyre, Peter McIntyre

Abstract
Pertussis or whooping cough is increasingly being shown to be a respiratory infection affecting the elderly and a significant percentage of older people infected with Bordetella pertussis experience considerable morbidity and even mortality. However, current knowledge of burden of disease is limited largely to passive surveillance data with little well-designed active surveillance to better ascertain the true burden of pertussis in the elderly, to inform vaccination strategies. The current review aims to identify gaps in knowledge to inform policy considerations relating to pertussis vaccination among the elderly.

Vaccine
Volume 30, Issue 48, Pages 6729-6956 (6 November 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/48

The cost-effectiveness of pentavalent rotavirus vaccination in England and Wales
Original Research Article
Pages 6766-6776
Katherine E. Atkins, Eunha Shim, Stuart Carroll, Sibilia Quilici, Alison P. Galvani

Abstract
Rotavirus vaccines have shown great potential for reducing the disease burden of the major cause of severe childhood gastroenteritis. The decision regarding whether rotavirus vaccination will be introduced into the national immunization program is currently being reviewed. The conclusions of previous evaluations of rotavirus vaccination cost-effectiveness contradict each other. This is the first analysis to incorporate a dynamic transmission model to assess the cost-effectiveness of rotavirus vaccination in England and Wales. Most previously reported models do not include herd protection, and thus may underestimate the cost-effectiveness of vaccination against rotavirus. We incorporate a dynamic model of rotavirus transmission in England and Wales into a cost-effectiveness analysis to determine the probability that the pentavalent rotavirus vaccination will be cost-effective over a range of full-course vaccine prices. This novel approach allows the cost-effectiveness analysis to include a feasible level of herd protection provided by a vaccination program. Our base case model predicts that pentavalent rotavirus vaccination is likely to be cost-effective in England and Wales at £60 per course. In some scenarios the vaccination is predicted to be not only cost-effective but also cost-saving. These savings could be generated within ten years after vaccine introduction. Our budget impact analysis demonstrates that for the realistic base case scenarios, 58–96% of the cost outlay for vaccination will be recouped within the first four years of a program. Our results indicate that rotavirus vaccination would be beneficial to public health and could be economically sound. Since rotavirus vaccination is not presently on the immunization schedule for England and Wales but is currently under review, this study can inform policymakers of the cost-effectiveness and budget impact of implementing a mass rotavirus vaccine strategy.

Vaccine
Volume 30, Issue 48, Pages 6729-6956 (6 November 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/48

“Who will take the blame?”: Understanding the reasons why Romanian mothers decline HPV vaccination for their daughters

Original Research Article
Pages 6789-6793
Catrinel Craciun, Adriana Baban

Abstract
Because Romania has the highest incidence of cervical cancer in Europe, in 2008 a HPV vaccination campaign was introduced targeting 10–11 year old girls. However, only 2.5% of the eligible girls were given parental for vaccination. Campaign failure makes it important to look for possible reasons and investigate mothers’ attitudes and perceptions of the HPV vaccine. Three focus groups and 11 interviews were conducted with mothers from urban areas. Data were transcribed verbatim and analysed with thematic analysis.

Results show as main reasons for not vaccinating their daughters perceiving the vaccine as risky, the belief that the vaccine represents an experiment that uses their daughters as guinea pigs, the belief that the vaccine embodies a conspiracy theory that aims to reduce the world’s population and general mistrust in the ineffective health system. Mothers stated they would need clear, factual information about the HPV vaccine and its link to cervical cancer in order to motivate them to accept it for their daughters.

The study offers insight into the beliefs and attitudes towards the vaccine and provides ideas for structuring future health communication campaigns regarding the HPV vaccine.

Vaccine
Volume 30, Issue 48, Pages 6729-6956 (6 November 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/48

Conducting vaccine clinical trials in sub-Saharan Africa: Operational challenges and lessons learned from the Meningitis Vaccine Project
Original Research Article
Pages 6859-6863
Elisa Marchetti, Véronique Mazarin-Diop, Julie Chaumont, Lionel Martellet, Marie-Françoise Makadi, Simonetta Viviani, Prasad S. Kulkarni, Marie-Pierre Preziosi

Abstract
Group A Neisseria meningitidis epidemics have been an important and unresolved public health problem in sub-Saharan Africa for over a century. The Meningitis Vaccine Project (MVP) was established in 2001 with the goal of developing, testing, licensing, and introducing an affordable group A meningococcal conjugate vaccine for Africa. A monovalent group A conjugate vaccine, MenAfriVac™, was developed at the Serum Institute of India Ltd. and tested in clinical trials at multiple trial sites in sub-Saharan African countries.

The setup and successful conduct of ICH-GCP standard vaccine trials across multiple trial sites located in low-resource settings are challenging. We describe the main operational issues encountered in three randomized, observer-blind, active controlled studies to evaluate the safety and immunogenicity of MenAfriVac™. The studies were conducted in parallel among 2700 subjects aged between 2 months and 29 years of age enrolled across four trial sites located in Mali, The Gambia, Senegal, and Ghana between September 2006 and August 2009.

Many important lessons were learned during the preparation, setup, and implementation of the Meningitis Vaccine Project clinical program. They are summarized here to help vaccine development programs identify efficient pathways for successful implementation of clinical trials in low-resource settings.

Vaccine
Volume 30, Issue 48, Pages 6729-6956 (6 November 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/48

Implementation of a hepatitis A/B vaccination program using an accelerated schedule among high-risk inmates, Los Angeles County Jail, 2007–2010
Original Research Article
Pages 6878-6882
John Costumbrado, Ali Stirland, Garrett Cox, Alvin Nelson El-Amin, Armidia Miranda, Ann Carter, Mark Malek

Abstract
Background
The Centers for Disease Control and Prevention recommend vaccination for men who have sex with men (MSM) and injection drug users against hepatitis A and B. This study is the first report of a hepatitis vaccination program in a United States jail with a combined vaccine using an accelerated schedule. Los Angeles County has the largest jail system in the nation and Men’s Central Jail (MCJ) is the largest facility within that system. MCJ includes a unit for self-identified MSM, where approximately 2700 inmates are housed per year.

Methods and findings
Starting in August 2007, a combined hepatitis A and B vaccine was offered to all inmates housed in this special unit. Using an accelerated schedule (0-, 7-, 21–30 days, 12-month booster), a total of 3931 doses were administered to 1633 inmates as of June 2010. Of those, 77% received 2 doses, 58% received 3 doses, and 11% received the booster dose. Inmates who screened positive for a sexually transmitted infection in this unit were 1.3 times more likely to be vaccinated (95% CI 1.2–1.4) compared to others in the same housing unit who screened negative.

Conclusions
Hepatitis vaccination initiatives can be successfully implemented in an urban jail among an extremely high-risk population using the accelerated, combined hepatitis A/B vaccine. Ours may be a useful model for other programs to vaccinate incarcerated populations.

Vaccine
Volume 30, Issue 48, Pages 6729-6956 (6 November 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/48

Measles, mumps, and rubella virus vaccine (M–M–R™II): A review of 32 years of clinical and postmarketing experience
Original Research Article
Pages 6918-6926
Fabio Lievano, Susan A. Galea, Michele Thornton, Richard T. Wiedmann, Susan B. Manoff, Trung N. Tran, Manisha A. Amin, Margaret M. Seminack, Kristen A. Vagie, Adrian Dana, Stanley A. Plotkin

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

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

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

Vaccine
Volume 30, Issue 48, Pages 6729-6956 (6 November 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/48

Perceptions matter: Beliefs about influenza vaccine and vaccination behavior among elderly white, black and Hispanic Americans
Original Research Article
Pages 6927-6934
Karen G. Wooten, Pascale M. Wortley, James A. Singleton, Gary L. Euler

Abstract
Background
Knowledge and beliefs about influenza vaccine that differ across racial or ethnic groups may promote racial or ethnic disparities in vaccination.

Objective
To identify associations between vaccination behavior and personal beliefs about influenza vaccine by race or ethnicity and education levels among the U.S. elderly population.

Methods
Data from a national telephone survey conducted in 2004 were used for this study. Reponses for 3875 adults ≥65 years of age were analyzed using logistic regression methods.

Results
Racial and ethnic differences in beliefs were observed. For example, whites were more likely to believe influenza vaccine is very effective in preventing influenza compared to blacks and Hispanics (whites, 60%; blacks, 47%, and Hispanics, 51%, p < 0.01). Among adults who believed the vaccine is very effective, self-reported vaccination was substantially higher across all racial/ethnic groups (whites, 93%; blacks, 76%; Hispanics, 78%) compared to adults who believed the vaccine was only somewhat effective (whites 67%; blacks 61%, Hispanics 61%). Also, vaccination coverage differed by education level and personal beliefs of whites, blacks, and Hispanics.

Conclusions
Knowledge and beliefs about influenza vaccine may be important determinants of influenza vaccination among racial/ethnic groups. Strategies to increase coverage should highlight the burden of influenza disease in racial and ethnic populations, the benefits and safety of vaccinations and personal vulnerability to influenza disease if not vaccinated. For greater effectiveness, factors associated with the education levels of some communities may need to be considered when developing or implementing new strategies that target specific racial or ethnic groups.

Vaccine
Volume 30, Issue 48, Pages 6729-6956 (6 November 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/48

Projected health impact and cost-effectiveness of rotavirus vaccination among children <5 years of age in China
Original Research Article
Pages 6940-6945
Na Liu, Catherine Yen, Zhao-yin Fang, Jacqueline E. Tate, Baoming Jiang, Umesh D. Parashar, Guang Zeng, Zhao-jun Duan

Abstract
Introduction
Two rotavirus vaccines have been licensed globally since 2006. In China, only a lamb rotavirus vaccine is licensed and several new rotavirus vaccines are in development. Data regarding the projected health impact and cost-effectiveness of vaccination of children in China against rotavirus will assist policy makers in developing recommendations for vaccination.

Methods
Using a Microsoft Excel model, we compared the national health and economic burden of rotavirus disease in China with and without a vaccination program. Model inputs included 2007 data on burden and cost of rotavirus outcomes (deaths, hospitalizations, outpatient visits), projected vaccine efficacy, coverage, and cost. Cost-effectiveness was measured in US dollars per disability-adjusted life-year (DALY) and US dollars per life saved.

Results
A 2-dose rotavirus vaccination program could annually avert 3013 (62%) deaths, 194,794 (59%) hospitalizations and 1,333,356 (51%) outpatient visits associated with rotavirus disease in China. The medical break-even price of the vaccine is $1.19 per dose. From a societal perspective, a vaccination program would be highly cost-effective in China at the vaccine price of $2.50 to $5 per dose, and be cost-effective at the price of $10 to $20 per dose.

Conclusions
A national rotavirus vaccination program could be a cost-effective measure to effectively reduce deaths, hospitalizations, and outpatient visits due to rotavirus disease in China.

From Google Scholar: Dissertations, Theses, Selected Journal Articles

Impact of a third dose of measles-mumps-rubella vaccine on a mumps outbreak
IU Ogbuanu, PK Kutty, JM Hudson, GR Abedi… – Pediatrics, 2012
BACKGROUND AND OBJECTIVE: During 2009–2010, a northeastern US religious
community experienced a large mumps outbreak despite high 2-dose measles-mumps-
rubella (MMR) vaccine coverage. A third dose of MMR vaccine was offered to students in …

Risk of adverse events following oseltamivir treatment in influenza outpatients, Vaccine Safety Datalink Project, 2007–2010
SK Greene, L Li, DK Shay, AM Fry, GM Lee… – … and Drug Safety, 2012
Purpose An association between the influenza antiviral medication oseltamivir and
neuropsychiatric events has been suggested by post-marketing case reports in Japan. This
possible association was not supported by cohort studies in the US conducted prior to the …

Success Of Program Linking Data Sources To Monitor H1N1 Vaccine Safety Points To Potential For Even Broader Safety Surveillance
D Salmon, WK Yih, G Lee, R Rosofsky, J Brown… – Health Affairs, 2012
Abstract In response to the 2009 H1N1 pandemic and subsequent vaccination program, the
Department of Health and Human Services and collaborators developed the Post-Licensure
Rapid Immunization Safety Monitoring (PRISM) Program as a demonstration project to …

[PDF] Research Advancement in RV Novel Vaccine
W Jiao, X Yin, X Li, J Liu – 2012
ABSTRACT ln this study, we reviewed the international research progress on the novel
vaccines of rabies. Rabies is a lethal infectious disease, causing nearly 55,000 deaths
worldwide each year. To date, pre-exposure vaccination is the most effective method to …

American Journal of Epidemiology
Volume 176 Issue 10 November 15, 2012

Advance Access
Underestimating the Safety Benefits of a New Vaccine: The Impact of Acellular Pertussis Vaccine Versus Whole-Cell Pertussis Vaccine on Health Services Utilization
Steven Hawken, Douglas G. Manuel, Shelley L. Deeks, Jeffrey C. Kwong, Natasha S. Crowcroft and Kumanan Wilson*

Abstract
The population-level safety benefits of the acellular pertussis vaccine may have been underestimated because only specific adverse events were considered, not overall impact on health services utilization. Using the Vaccine and Immunization Surveillance in Ontario (VISION) system, the authors analyzed data on 567,378 children born between April 1994 and March 1996 (before introduction of acellular pertussis vaccine) and between April 1998 and March 2000 (after introduction of acellular pertussis vaccine) in Ontario, Canada. Using the self-controlled case series study design, they examined emergency room visits and hospital admissions occurring after routine pediatric vaccinations. The authors determined the relative incidence of events taking place before introduction of the acellular vaccine versus after introduction by calculating relative incidence ratios (RIRs). The observed RIRs demonstrated a highly statistically significant reduction in relative incidence after introduction of the acellular vaccine. RIRs for vaccine administered at ages 2, 4, 6, and 18 months were 1.82 (95% confidence interval (CI): 1.64, 2.01), 1.91 (95% CI: 1.71, 2.13), 1.54 (95% CI: 1.38, 1.72), and 1.51 (95% CI: 1.34, 1.69), respectively, comparing event rates before the introduction of acellular vaccine with those after introduction. The authors estimated that approximately 90 emergency room visits and 9 admissions per month were avoided by switching to the acellular vaccine, which is a 38-fold higher impact than when they considered only admissions for febrile and afebrile convulsions. Future analyses comparing vaccines for safety should examine specific endpoints and general health services utilization.

New York Times
http://www.nytimes.com/
Accessed 10 November 2012

Global Update
Polio: Eradication Efforts in Pakistan Put Focus on High-Risk Pashtun Community
5 November 2012

http://www.nytimes.com/2012/11/06/health/polio-eradication-efforts-in-pakistan-focus-on-pashtuns.html

Polio will never be eradicated in Pakistan until a way is found to persuade poor Pashtuns to embrace the vaccine, according to a study released by the World Health Organization.

A survey of 1,017 parents of young children found that 41 percent had never heard of polio and 11 percent refused to vaccinate their children against it. The survey was done in Karachi, Pakistan’s largest city and the only big city in the world where polio persists; it was published in the agency’s November bulletin.

Parents from poor families “cited lack of permission from family elders,” said Dr. Anita Zaidi, who teaches pediatrics at the Aga Khan University in Karachi. Some rich parents also disdained the vaccine, saying it was “harmful or unnecessary,” she added.

Pashtuns account for 75 percent of Pakistan’s polio cases even though they are only 15 percent of the population. Wealthy children are safer because the virus travels in sewage, and their neighborhoods may have covered sewers and be less flood-prone.

Pashtuns are the largest ethnic group in next-door Afghanistan, where polio has also never been wiped out. Most Taliban fighters are Pashtun, and some Taliban threatened to kill vaccinators earlier this year. Two W.H.O. vaccinators were shot in Karachi in July.

Rumors persist that the vaccine is a plot to sterilize Muslims. But the eradication drive is recruiting Pashtuns as vaccinators and asking prominent religious leaders from various sects to make videos endorsing the vaccine.

Twitter Watch  [accessed 10 November 2012 – 01:11]

World Bank @WorldBank
How the economic downturn is affecting #health systems around the world. http://bit.ly/WGgsXt  #longreads
5:20 PM – 9 Nov 12

WHO ‏@WHO
The draft global monitoring framework on noncommunicable diseases is now online – find it here http://goo.gl/jC9Dn  #NCDs
10:35 AM – 9 Nov 12 ·

Doctors w/o Borders ‏@MSF_USA
New research supports the evidence that the two existing rotavirus vaccines may not be best adapted for use in Africa. http://bit.ly/TNInB8 
9:55 AM – 9 Nov 12

PATH @PATHtweets
The director of the PATH Malaria Vaccine Initiative comments on results of recent vaccine trials. See our blog. http://ow.ly/fa747 …
9:12 AM – 9 Nov 12

IHME at UW @IHME_UW
Thx 4 sharing! MT@devisridhar Save the Date: Second Global Health Metrics and Evaluation Conference, June 17-19 2013, http://ghme.org 
7:55 AM – 9 Nov 12

The Global Fund @lobalfundnews
Global Fund Appoints Elizabeth O’Donnell as Head of Human Resources http://bitly.com/UzwScV 
7:34 AM – 9 Nov 12

The Global Fund @lobalfundnews
Global Fund Appoints Christopher Game as Chief Procurement Officer http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-11-09_Global_Fund_Appoints_Christopher_Game_as_Chief_Procurement_Officer/ …
5:17 AM – 9 Nov 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_3 November 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…

WHO: Routine vaccination reaching four in five children but 22 million still miss out
Note for the media [full text]

1 November 2012 | GENEVA – Four in five children (83%) worldwide received the recommended three doses of diphtheria–tetanus–pertussis (DTP) vaccine during infancy in 2011, according to new data released in the Morbidity and Mortality Weekly Report and in the WHO Weekly Epidemiological Record (WER).

Sustained progress
The new data show sustained progress from the previous two years, and a significant achievement from when WHO’s Expanded Programme on Immunization (EPI) was established nearly 40 years ago. At that time, fewer than 5% of the world’s children were being vaccinated against these three deadly diseases.

Achieving DTP vaccination of infants before they reach 12 months is one of the most important indicators of how effective vaccination programmes are in reaching children with life-saving vaccines.

22 million children still miss out
While substantial progress has been made, the new data show more than 22 million children, mostly living in less-developed countries, missed out on the three basic vaccinations during their first year of life in 2011.

About half of all incompletely vaccinated children live in three countries: India, Indonesia and Nigeria. These countries have large child populations and their immunization programmes are hampered by occasional problems with vaccine supply and inaccessibility of vulnerable populations…

“An accessible and well-functioning immunization programme should be a key component of public health services in every country,” says Dr Jean-Marie Okwo-Bele, Director of WHO’s Department of Immunization, Vaccines and Biologicals. “By supporting countries to strengthen their health systems through the implementation of the new Global Vaccine Action Plan, we can increase global access to vaccines and make an impact on the lives of millions of people.”

Strengthening routine immunization services
An estimated 130 million infants are born each year. Vaccinating these children to protect them from diphtheria, tetanus, whooping cough (pertussis) as well as measles, polio, and other preventable diseases is vital to keeping them alive and healthy. WHO estimates that immunizations save between two and three million lives per year.

Strengthening routine immunization services is crucial to achieve the Millennium Development Goal 4 of reducing deaths among children under-five by two-thirds by 2015 compared to 1990.

http://www.who.int/mediacentre/news/notes/2012/vaccination_20121101/en/index.html

The Weekly Epidemiological Record (WER) for 2 November 2012, vol. 87, 44 (pp. 421–436) includes:
– Outbreak news: Ebola, Democratic Republic of the Congo
– Review of the 2012 winter influenza season, southern hemisphere
– Global routine vaccination coverage, 2011
http://www.who.int/entity/wer/2012/wer8744.pdf

The MMWR Weekly for November 2, 2012 / Vol. 61 / No. 43 includes:
Global Routine Vaccination Coverage, 2011

GAVI Media Release: Malawi to protect thousands of children’s lives with rotavirus vaccines
Malawi becomes the 10th GAVI-supported country to introduce vaccines against most common cause of severe and fatal diarrhoea

Geneva, 29 October 2012 — Malawi has become the latest in a growing number of African countries to introduce rotavirus vaccine into its national immunisation programme, offering its children the best possible protection against the primary cause of severe and fatal diarrhoea.   “This is an important day for all the children of Malawi”, said GAVI Alliance CEO, Dr Seth Berkley. “Rotavirus immunisation is their best hope for protection against rotavirus disease and the deadly dehydrating diarrhoea it can cause.”

http://www.gavialliance.org/library/news/press-releases/2012/malawi-protect-thousands-childrens-lives-rotavirus-vaccines/

IVI – in conjunction with the celebration of the Institute’s 15th Anniversary in October – formally announced the appointment of  Dr. Alejandro Cravioto as Chief Scientific Officer. In this role, Dr. Cravioto will oversee all of the Institute’s scientific affairs and will lend his expertise and advice on matters relevant to vaccine science and technology and potential opportunities. IVI noted that Dr. Cravioto brings a breadth of experience to the Institute. He worked successively as Head of the Research Department and Deputy Director of the National Institute of Health and Technology for Child Health, Director of the Division of Microbiology on the National Institute of Public Health of Cuernavaca, and Professor and Chair of the Department of Public Health of the Faculty of Medicine of the National Autonomous University of Mexico (UNAM) before being appointed as the Dean of the Faculty of Medicine. For the past seven years, he worked as Deputy Director and as Executive Director of the International Centre for Diarrheal Disease Research (icddr,b) in Dhaka, Bangladesh. Most recently in 2011, he was appointed by UN Secretary-General Ban Ki-Moon to head a panel investigating the outbreak of cholera in Haiti.

http://www.ivi.org/web/www/07_03?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=462

Update: Polio this week – As of 31 Oct 2012
Global Polio Eradication Initiative

[Editor’s Extract]
– The Independent Monitoring Board (IMB) is meeting this week in London, United Kingdom (UK). The IMB is reviewing the latest status of the global polio eradication effort and progress and challenges with implementing national polio emergency action plans in priority countries. The IMB’s meeting report is anticipated to be finalized in November. Reports from partners and presentations by country delegations to the IMB are available here.

– Last week, polio eradication partners from around the world marked World Polio Day. A vast array of awareness- and fund-raising activities took place around the world, including by Rotarians all over the globe – including the maiden voyage of a special Rotary ‘End Polio Now’ express train which will travel Germany’s rail network for the next 12 months. Political and traditional leaders in polio-infected and donor countries publicly offered their support to the global eradication effort, as did development partners and public health leaders. More

– Next week (6-8 November), the Strategic Advisory Group of Experts on immunization (SAGE) is meeting in Geneva, Switzerland, and will devote one meeting session for a detailed review of the current status of the Global Polio Eradication Initiative and plans

Nigeria
– Two new WPV cases were reported in the past week (WPV1s from Kano and Katsina), bringing the total number of WPV cases for 2012 to 99. The most recent WPV case had onset of paralysis on 23 September (WPV1 from Katsina).

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.
– Additionally, OPV continues to be added to broader humanitarian response activities. The polio programme is continuing to work closely with other UN agencies, partners and

WHO: World Pneumonia Day – 12 November 2012

World Pneumonia Day seeks to raise awareness of pneumonia as a public health issue and help prevent the millions of avoidable child deaths from pneumonia that occur each year. It is organized by the Global Coalition against Child Pneumonia (a network of international, government, non-governmental and community-based organizations, research and academic institutions, foundations, and individuals) to bring much-needed attention to pneumonia among donors, policy makers, health care professionals, and the general public. http://www.who.int/mediacentre/events/annual/world_pneumonia_day/en/index.html

WHO Feature: Thailand: eHealth strengthening fight against malaria drug resistance
October 2012

A new project has accelerated progress in the fight against artemisinin-resistant malaria parasites in Thailand by using smart phones to capture data on patients and monitor treatment.

http://www.who.int/features/2012/malaria_drug_resistance_thailand/en/index.html

13th Annual General Meeting- DCVMN (Developing Country Vaccine Manufacturers Network)
31 October – 3 November 2012
Bali – Indonesia

DCVMN has the following objectives within developing countries:

– To promote consistent and sustainable supply of quality vaccines at an affordable price.

– To combat infectious diseases especially those from the developing world, by strengthening the capacity of vaccine, vaccine related product manufactures, and potentially other health technology producers.

– To encourage Research and Development efforts meeting emerging vaccine needs.

– To foster production and delivery of high quality vaccines and other health technologies effectively on a long term basis for national immunization programmes.

Meeting Agenda: http://www.13thdcvmn.com/index.php?option=com_content&view=article&id=50&Itemid=63

IOM Report: An Integrated Framework for Assessing the Value of Community-Based Prevention
November 2, 2012
Type: Consensus Report
Board: Board on Population Health and Public Health Practice

Over the last century, the major causes of disease and death among Americans have changed, shifting from predominantly communicable diseases spread by germs to chronic ailments. This shift has been accompanied by a deeper understanding about what keeps people healthy or leaves them vulnerable to becoming ill. To get at the heart of the challenges to living a healthy life, we must increasingly emphasize factors that affect today’s causes of morbidity and mortality.

Despite their importance to preventing illness, determining the value of community-based interventions has proven difficult. Preventing illness requires immediate investments with benefits that might not be realized for many years.

This report proposes a framework to assess the value of community-based, non-clinical prevention policies and wellness strategies. The framework represents a valuable step toward realizing the elusive goal of appropriately and comprehensively valuing community-based prevention.

http://www.iom.edu/Reports/2012/An-Integrated-Framework-for-Assessing-the-Value-of-Community-Based-Prevention.aspx

WHO/WMO: Atlas of Health and Climate
October 2012
WHO and the World Meteorological Organization (WMO) jointly published a new atlas that represents “a unique collaboration between the meteorological and public health communities. It provides sound scientific information on the connections between weather and climate and major health challenges. These range from diseases of poverty to emergencies arising from extreme weather events and disease outbreaks. They also include environmental degradation, the increasing prevalence of noncommunicable diseases and the universal trend of demographic ageing.”

http://www.who.int/globalchange/publications/atlas/report/en/index.html

BMC Public Health
(Accessed 3 November 2012)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
Evaluation of adult dTPaP vaccination coverage in France: experience in Lyon city, 2010–2011
Dominique Baratin, Corinne Signore, Jacques Thierry, Evelyne Caulin, Philippe Vanhems BMC Public Health 2012, 12:940 (1 November 2012)
Open Access

Abstract (provisional)
Background
Compliance with official recommendations can be assessed by evaluating vaccination coverage (VC) in populations. The main objective of our study was to assess VC of adults against diphtheria, tetanus, poliomyelitis and pertussis (dTPaP) according to age. The second objective was to explore if vaccination status could be confirmed by documentation.

Methods
A cross-sectional study was conducted in 680 adults consulting for biological examination in private laboratories in Lyon (France) to evaluate VC for diphtheria, tetanus, poliomyelitis and pertussis (dTPaP) and enabled reported vaccinations to be compared with documented, confirmed vaccinations.

Results
Verification of documented, confirmed vaccinations disclosed VC of 78.7% for tetanus, 63.6% for poliomyelitis, 57.8% for diphtheria and 10.7% for pertussis. Comparison of confirmed and self-reported vaccinations revealed that a large percentage of people who thought that they were vaccinated were not. VC significantly decreased with age for diphtheria and poliomyelitis and did not vary by gender. The VC rate for pertussis has increased since the 2008 recommendations were made.

Conclusions
The main thrust of this study was to compare reported and confirmed data. A significant percentage of people wrongly believed that they were up to date with their vaccination.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

BMC Public Health
(Accessed 3 November 2012)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
Barriers to pandemic influenza vaccination and uptake of seasonal influenza vaccine in the post-pandemic season in Germany
Merle M Böhmer, Dietmar Walter, Gerhard Falkenhorst, Stephan Müters, Gérard Krause, Ole Wichmann
BMC Public Health 2012, 12:938 (31 October 2012)
Open Access

Abstract (provisional)
Background
In Germany, annual vaccination against seasonal influenza is recommended for certain target groups (e.g. persons aged [greater than or equal to] 60 years, chronically ill persons, healthcare workers (HCW)). In season 2009/10, vaccination against pandemic influenza A(H1N1)pdm09, which was controversially discussed in the public, was recommended for the whole population. The objectives of this study were to assess vaccination coverage for seasonal (seasons 2008/09-2010/11) and pandemic influenza (season 2009/10), to identify predictors of and barriers to pandemic vaccine uptake and whether the controversial discussions on pandemic vaccination has had a negative impact on seasonal influenza vaccine uptake in Germany.

Methods
We analysed data from the ‘German Health Update’ (GEDA10) telephone survey (n=22,050) and a smaller GEDA10-follow-up survey (n=2,493), which were both representative of the general population aged [greater than or equal to]18 years living in Germany.

Results
Overall only 8.8% of the adult population in Germany received a vaccination against pandemic influenza. High socioeconomic status, having received a seasonal influenza shot in the previous season, and belonging to a target group for seasonal influenza vaccination were independently associated with the uptake of pandemic vaccines. The main reasons for not receiving a pandemic vaccination were ‘fear of side effects’ and the opinion that ‘vaccination was not necessary’. Seasonal influenza vaccine uptake in the pre-pandemic season 2008/09 was 52.8% among persons aged [greater than or equal to]60 years; 30.5% among HCW, and 43.3% among chronically ill persons. A decrease in vaccination coverage was observed across all target groups in the first post-pandemic season 2010/11 (50.6%, 25.8%, and 41.0% vaccination coverage, respectively).

Conclusions
Seasonal influenza vaccination coverage in Germany remains in all target groups below 75%, which is a declared goal of the European Union. Our results suggest that controversial public discussions about safety and the benefits of pandemic influenza vaccination may have contributed to both a very low uptake of pandemic vaccines and a decreased uptake of seasonal influenza vaccines in the first post-pandemic season. In the upcoming years, the uptake of seasonal influenza vaccines should be carefully monitored in all target groups to identify if this trend continues and to guide public health authorities in developing more effective vaccination and communication strategies for seasonal influenza vaccination.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

BMC Public Health
(Accessed 3 November 2012)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
Human papilloma virus vaccination programs reduce health inequity in most scenarios: a simulation Study
Natasha S Crowcroft, Jemila S Hamid, Shelley L Deeks, John Frank BMC Public Health 2012, 12:935 (31 October 2012)
Open Access

Abstract (provisional)
Background
The global and within-country epidemiology of cervical cancer exemplifies health inequity. Public health programs may reduce absolute risk but increase inequity; inequity may be further compounded by screening programs. In this context, we aimed to explore what the impact of human papillomavirus (HPV) vaccine might have on health equity allowing for uncertainty surrounding the long-term effect of HPV vaccination programs.

Methods
A simple static multi-way sensitivity analysis was carried out to compare the relative risk, comparing after to before implementation of a vaccination program, of infections which would cause invasive cervical cancer if neither prevented nor detected, using plausible ranges of vaccine effectiveness, vaccination coverage, screening sensitivity, screening uptake and changes in uptake.

Results
We considered a total number of 3,793,902 scenarios. In 63.9% of scenarios considered, vaccination would lead to a better outcome for a population or subgroup with that combination of parameters. Regardless of vaccine effectiveness and coverage, most simulations led to lower rates of disease.

Conclusions
If vaccination coverage and screening uptake are high, then communities are always better off with a vaccination program. The findings highlight the importance of achieving and maintaining high immunization coverage and screening uptake in high risk groups in the interest of health equity.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

BMC Public Health
(Accessed 3 November 2012)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
Cost-effectiveness of adding vaccination with the AS04-adjuvanted human papillomavirus 16/18 vaccine to cervical cancer screening in Hungary
Zoltán Vokó, László Nagyjánosi, Zoltán Kaló BMC Public Health 2012, 12:924 (30 October 2012)

Open Access
Abstract (provisional)
Background
The cervical cancer screening program implemented in Hungary to date has not been successful. Along with screening, vaccination is an effective intervention to prevent cervical cancer. The aim of this study was to assess the cost-effectiveness of adding vaccination with the human papillomavirus 16/18 vaccine to the current cervical cancer screening program in Hungary.

Methods
We developed a cohort simulation state-transition Markov model to model the life course of 12-year-old girls. Eighty percent participation in the HPV vaccination program at 12 years of age was assumed. Transitional probabilities were estimated using data from the literature. Local data were used regarding screening participation rates, and the costs were estimated in US $. We applied the purchasing power parity exchange rate of 129 HUF/$ to the cost data. Only direct health care costs were considered. We used a 3.7% discount rate for both the cost and quality-adjusted life years (QALYs). The time horizon was 88 years.

Results
Inclusion of HPV vaccination at age 12 in the cervical cancer prevention program was predicted to be cost-effective. The incremental cost-effectiveness ratio (ICER) of adding HPV vaccination to the current national cancer screening program was estimated to be 27 588 $/QALY. The results were sensitive to the price of the vaccine, the discount rate, the screening participation rate and whether herd immunity was taken into account.

Conclusions
Our modeling analysis showed that the vaccination of 12-year-old adolescent girls against cervical cancer with the AS04-adjuvanted human papillomavirus 16/18 vaccine would be a cost-effective strategy to prevent cervical cancer in Hungary.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

British Medical Journal
03 November 2012 (Vol 345, Issue 7881)
http://www.bmj.com/content/345/7881

Analysis
Future of WHO hangs in the balance
BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6877 (Published 25 October 2012)
Cite this as: BMJ 2012;345:e6877
http://www.bmj.com/content/345/bmj.e6877

BMJ Excerpt
   WHO is in crisis. Unless member states can be persuaded to “untie” their donations and give the organisation leeway to control its budget and set priorities WHO will slide further into irrelevance with disastrous consequences for global health, warns David Legge

A substantial shortfall in the funds available for basic administrative functions led WHO’s director general, Margaret Chan, to initiate another reform of the WHO in 2010. Although the reform programme has expanded to include priority setting, governance, and management,1 financing is the fundamental problem. The process of reform is also bedevilled by the same problem that led to the funding crisis in the first place—a switch in power from the assembly of member states to donors (including some member states as well as other donors) with specific interests. This article outlines the problems and what the reforms are trying to achieve.

When WHO was formed in 1948 its main funding came from its member states, who paid according to the size of their population and economy (their “assessed contributions”),2 but since its founding the large rich countries (the United States in particular) have sought to control WHO’s agenda by restricting its funding.3 Since the 1980s assessed contributions have been frozen, and the WHO has become increasingly reliant on voluntary contributions from member states, intergovernmental bodies, and various philanthropists. Assessed contributions as a proportion of total revenues have declined from 80% in 1978-79 to 25% in 2010-11. The budgetary gap has been met through the growth in voluntary contributions, 91% of which are earmarked for particular projects and programmes. As a consequence, WHO’s work is controlled by the donors rather than by its assembly of member states, distorting priorities and the coherence of its programmes.

Success of the current reform programme depends on resolving the contradiction between…

Bulletin of the World Health Organization
Volume 90, Number 11, November 2012, 793-868
http://www.who.int/bulletin/volumes/90/11/en/index.html

Parental perceptions surrounding polio and self-reported non-participation in polio supplementary immunization activities in Karachi, Pakistan: a mixed methods study
Asif Raza Khowaja, Sher Ali Khan, Naveeda Nizam, Saad Bin Omer & Anita Zaidi

Objective
To assess parent’s knowledge and perceptions surrounding polio and polio vaccination, self-reported participation in polio supplementary immunization activities (SIAs) targeting children aged < 5 years, and reasons for non-participation.

Methods
The mixed methods study began with a cross-sectional survey in Karachi, Pakistan. A structured questionnaire was administered to assess parental knowledge of polio and participation in polio SIAs conducted in September and October 2011. Additionally, 30 parents of Pashtun ethnicity (a high-risk group) who refused to vaccinate their children were interviewed in depth to determine why. Descriptive and bivariate analyses by ethnic and socioeconomic group were performed for quantitative data; thematic analysis was conducted for qualitative interviews with Pashtun parents.

Findings
Of 1017 parents surveyed, 412 (41%) had never heard of polio; 132 (13%) did not participate in one SIA and 157 (15.4%) did not participate in either SIA. Among non-participants, 34 (21.6%) reported not having been contacted by a vaccinator; 116 (73.9%) reported having refused to participate, and 7 (4.5%) reported that the child was absent from home when the vaccinator visited. Refusals clustered in low-income Pashtun (43/441; 9.8%) and high-income families of any ethnic background (71/153; 46.4%). Low-income Pashtuns were more likely to not have participated in polio SIAs than low-income non-Pashtuns (odds ratio, OR: 7.1; 95% confidence interval, CI: 3.47–14.5). Reasons commonly cited among Pashtuns for refusing vaccination included fear of sterility; lack of faith in the polio vaccine; scepticism about the vaccination programme, and fear that the vaccine might contain religiously forbidden ingredients.

Conclusion
In Karachi, interruption of polio transmission requires integrated and participatory community interventions targeting high-risk populations.

Bulletin of the World Health Organization
Volume 90, Number 11, November 2012, 793-868
http://www.who.int/bulletin/volumes/90/11/en/index.html

Use of evidence to support healthy public policy: a policy effectiveness–feasibility loop
Sarah Bowman, Nigel Unwin, Julia Critchley, Simon Capewell, Abdullatif Husseini, Wasim Maziak, Shahaduz Zaman, Habiba Ben Romdhane, Fouad Fouad, Peter Phillimore, Belgin Unal, Rana Khatib, Azza Shoaibi & Balsam Ahmad

Public policy plays a key role in improving population health and in the control of diseases, including non-communicable diseases. However, an evidence-based approach to formulating healthy public policy has been difficult to implement, partly on account of barriers that hinder integrated work between researchers and policy-makers. This paper describes a “policy effectiveness–feasibility loop” (PEFL) that brings together epidemiological modelling, local situation analysis and option appraisal to foster collaboration between researchers and policy-makers. Epidemiological modelling explores the determinants of trends in disease and the potential health benefits of modifying them. Situation analysis investigates the current conceptualization of policy, the level of policy awareness and commitment among key stakeholders, and what actually happens in practice, thereby helping to identify policy gaps.   Option appraisal integrates epidemiological modelling and situation analysis to investigate the feasibility, costs and likely health benefits of various policy options. The authors illustrate how PEFL was used in a project to inform public policy for the prevention of cardiovascular diseases and diabetes in four parts of the eastern Mediterranean. They conclude that PEFL may offer a useful framework for researchers and policy-makers to successfully work together to generate evidence-based policy, and they encourage further evaluation of this approach.

Bulletin of the World Health Organization
Volume 90, Number 11, November 2012, 793-868
http://www.who.int/bulletin/volumes/90/11/en/index.html

Decision-making on malaria vaccine introduction: the role of cost–effectiveness analyses
Vasee S Moorthy, Raymond Hutubessy, Robert D Newman & Joachim Hombach
Bulletin of the World Hhttp://www.who.int/bulletin/volumes/90/11/12-107482/en/index.htmlealth Organization 2012;90:864-866. doi: 10.2471/BLT.12.107482
Status of malaria vaccine development
Policy-makers in countries where malaria is endemic are facing increasingly complex decisions about which vaccines and malaria prevention measures to include in national immunization and malaria control programmes. Several new vaccines and malaria preventive measures are already competing for limited financing in developing countries. African countries with endemic malaria should be ready to make a national policy decision on the introduction of RTS,S/AS01, a first-generation malaria vaccine, by 2015.1 If clinical trials progress according to schedule, that same year the World Health Organization (WHO) will issue a policy recommendation on the public health use of this vaccine based on the findings of the full Phase III efficacy trial in progress, which will be available in late 2014.2 The vaccine’s manufacturers are targeting infants in malaria-endemic African countries who undergo routine vaccination through the Expanded Programme on Immunization (EPI) at 6, 10 and 14 weeks of age, with the possibility of a booster dose being needed at 9–18 months. At present WHO is assessing the evidence base for a policy position on this vaccine. The type of critical data that it will take into account during this process is shown in Box 1.

Box 1. Critical questions for formulation of policy on a new malaria vaccine

– What is the evidence that RTS,S/AS01 vaccination is not associated with serious adverse reactions in children aged less than 17 months?

– What level of protection against clinical malaria does RTS,S/AS01 confer on infants 6 to 14 weeks of age, over 30 months of follow-up, when co-administered with routine infant vaccines in sub-Saharan African settings?

– What is the evidence that a booster dose of RTS,S/AS01 at 18 months is needed to maintain benefit following a 3-dose primary immunization series?

– Is there evidence that the efficacy of RTS,S/AS01 varies in different transmission settings?

– Do available data support a WHO policy recommendation to introduce RTS,S/AS01 into routine immunization programmes in malaria-endemic countries? What is the optimal schedule? What flexibility is there for interrupted and delayed schedules?

– What is the evidence that co-administration leads to non-inferior responses for both RTS,S/AS01 and existing EPI vaccines?

– What is the evidence that RTS,S/AS01, when administered at 6,10 and14 weeks of age, provides at least as much protection against hepatitis B as the available hepatitis B vaccines?

– How cost–effective is RTS,S/AS01 as a preventive measure in addition to LLINs?

Cost–effectiveness is an important consideration in public health decision-making. This article summarizes critical parameters driving malaria vaccine cost–effectiveness predictions and discusses major uncertainties that remain in the cost–effectiveness modelling arena. It also highlights the need for ongoing work by modelling groups to further refine cost–effectiveness predictions….

Infectious Diseases of Poverty
2012, 1
http://www.idpjournal.com/content
[Accessed 3 November 2012]

Opinion  
Health Systems Perspectives – Infectious Diseases of Poverty
Dale Huntington Infectious Diseases of Poverty 2012, 1:12 (1 November 2012)
Open Access

Abstract (provisional)
The right to health as a fundamental human right is enshrined in the World Health Organization’s charter and has been reaffirmed in international agreements spanning decades. This new journal reminds us of the essential characteristic of poverty as a violent abuse of human rights. The context of poverty – its social, political and economic dimensions – remain in the reader’s mind as evidence is provided on technical solutions to managing the infectious diseases that afflict poor populations world-wide. Applying a health systems framework to a discussion on infectious diseases of poverty emerges from the papers in this journal’s first edition. Many of the articles discuss treatments, indicating the importance of pharmaceuticals for neglected diseases. Delivery strategies to reach impoverished populations also figure within this first round of papers. Innovative programs that provide diagnostics and treatment for infectious diseases to hard-to-reach rural and urban communities are needed clearly needed, and some good examples are discussed here. Future editions will explore other health system components, broadening the evidence base to increase understanding of effective and sustainable interventions to reduce the burden of infectious disease among the poor. The editors are to be congratulated on the release of this inaugural issue of the journal Infectious Diseases of Poverty. We look forward to reading subsequent editions.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Journal of Infectious Diseases
Volume 206 Issue 11 December 1, 2012
http://www.journals.uchicago.edu/toc/jid/current

EDITORIAL COMMENTARIES
Editor’s choice: Monitoring HPV Vaccine Impact: Early Results and Ongoing Challenges
Susan Hariri and Lauri Markowitz
J Infect Dis. (2012) 206(11): 1633-1635 doi:10.1093/infdis/jis593

(See the Major Article by Tabrizi et al, on pages 1645–51.)

Extract
In this issue of the Journal of Infectious Diseases, Tabrizi and colleagues present new data from Australia on genital human papillomavirus (HPV) infection prevalence in the periods immediately before and after HPV vaccine introduction [1]. Based on cross-sectional studies of women aged 18–24 years who received Papanicolaou screening in selected family planning clinics throughout the country, the authors report a 20% decrease in overall genital HPV prevalence and a more dramatic decrease of 77% in HPV types targeted by the quadrivalent vaccine (HPV types 6, 11, 16, and 18) from the 2 years before (2005–2007) to the 2 years after (2009–2010) the vaccine was widely implemented through a government-funded program. In addition to comparing HPV prevalence trends across periods, Tabrizi et al obtained HPV vaccination history from participants to more directly evaluate the effect of vaccination on HPV prevalence. Their results indicate significantly lower vaccine-type HPV prevalence among vaccinated women in the postvaccine sample (5.0%) compared with both unvaccinated women from the same period (15.8%) and women from the prevaccine period (28.7%). Using the age-adjusted HPV prevalence ratio of vaccinated to unvaccinated women, the authors calculate a vaccine effectiveness of 73% against infection with any of the 4 vaccine types.

Because the major benefit of HPV vaccination—prevention of cervical and other less common HPV-associated cancers—will not be evident for decades, a spectrum of intermediate outcomes are being monitored to assess the early impact of HPV vaccines. Although considered to be the simplest and earliest indicator of vaccine impact, a reduction in HPV vaccine type prevalence may not be sufficient to guide vaccine policy and practices. Therefore, in addition to ongoing HPV type prevalence monitoring, cancer and precancer outcomes as well as HPV-associated genital warts are …

MAJOR ARTICLES AND BRIEF REPORTS
VIRUSES
Editor’s choice: Fall in Human Papillomavirus Prevalence Following a National Vaccination Program
Sepehr N. Tabrizi, Julia M. L. Brotherton, John M. Kaldor, S. Rachel Skinner, Eleanor Cummins, Bette Liu, Deborah Bateson, Kathleen McNamee, Maria Garefalakis, and Suzanne M. Garland
J Infect Dis. (2012) 206(11): 1645-1651 doi:10.1093/infdis/jis590

Abstract
Background. In April 2007, Australia became the first country to introduce a national government-funded human papillomavirus (HPV) vaccination program. We evaluated the program’s impact on genotype-specific HPV infection prevalence through a repeat survey of women attending clinical services.

Methods. HPV genoprevalence in women aged 18–24 years attending family planning clinics in the prevaccine period (2005–2007) was compared with prevalence among women of the same age group in the postvaccine period (2010–2011). The same recruitment and testing strategies were utilized for both sets of samples, and comparisons were adjusted for potentially confounding variables.

Results. The prevalence of vaccine HPV genotypes (6, 11, 16, and 18) was significantly lower in the postvaccine sample than in the  prevaccine sample (6.7% vs 28.7%; P < .001), with lower prevalence observed in both vaccinated and unvaccinated women compared with the prevaccine population (5.0% [adjusted odds ratio, 0.11; 95% confidence interval, 0.06–0.21] and 15.8% [adjusted odds ratio, 0.42; 95% confidence interval, 0.19–0.93], respectively). A slightly lower prevalence of nonvaccine oncogenic HPV genotypes was also found in vaccinated women (30.8% vs 37.6%; adjusted odds ratio, 0.68; 95% confidence interval, 0.46–0.99).

Conclusions. Four years after the commencement of the Australian HPV vaccination program, a substantial decrease in vaccine-targeted genotypes is evident and should, in time, translate into reductions in HPV-related lesions.