The Lancet  
Dec 01, 2012  Volume 380  Number 9857  p1881 – 1966
http://www.thelancet.com/journals/lancet/issue/current

Editorial
A manifesto for the world we want
The Lancet
Preview
The era of sustainable development that is currently being debated for post-2015 represents a revolutionary change that goes beyond the current framework of the Millennium Development Goals (MDGs) and the driving ideal of ending poverty. It is a tremendous window of opportunity, since sustainable development is about all of us, not just some of us. It is about the interdependence we all share one with another. It is about the common threats we face and the solutions we have to find together

The Lancet  
Dec 01, 2012  Volume 380  Number 9857  p1881 – 1966
http://www.thelancet.com/journals/lancet/issue/current

Articles
Effect of the Affordable Medicines Facility—malaria (AMFm) on the availability, price, and market share of quality-assured artemisinin-based combination therapies in seven countries: a before-and-after analysis of outlet survey data
Sarah Tougher, the ACTwatch Group , Yazoume Ye, John H Amuasi, Idrissa A Kourgueni, Rebecca Thomson, Catherine Goodman, Andrea G Mann, Ruilin Ren, Barbara A Willey, Catherine A Adegoke, Abdinasir Amin, Daniel Ansong, Katia Bruxvoort, Diadier A Diallo, Graciela Diap, Charles Festo, Boniface Johanes, Elizabeth Juma, Admirabilis Kalolella, Oumarou Malam, Blessing Mberu, Salif Ndiaye, Samuel B Nguah, Moctar Seydou, Mark Taylor, Sergio Torres Rueda, Marilyn Wamukoya, Fred Arnold, Kara Hanson

Summary
Background
Malaria is one of the greatest causes of mortality worldwide. Use of the most effective treatments for malaria remains inadequate for those in need, and there is concern over the emergence of resistance to these treatments. In 2010, the Global Fund launched the Affordable Medicines Facility—malaria (AMFm), a series of national-scale pilot programmes designed to increase the access and use of quality-assured artemisinin based combination therapies (QAACTs) and reduce that of artemisinin monotherapies for treatment of malaria. AMFm involves manufacturer price negotiations, subsidies on the manufacturer price of each treatment purchased, and supporting interventions such as communications campaigns. We present findings on the effect of AMFm on QAACT price, availability, and market share, 6—15 months after the delivery of subsidised ACTs in Ghana, Kenya, Madagascar, Niger, Nigeria, Uganda, and Tanzania (including Zanzibar).

Methods
We did nationally representative baseline and endpoint surveys of public and private sector outlets that stock antimalarial treatments. QAACTs were identified on the basis of the Global Fund’s quality assurance policy. Changes in availability, price, and market share were assessed against specified success benchmarks for 1 year of AMFm implementation. Key informant interviews and document reviews recorded contextual factors and the implementation process.

Findings
In all pilots except Niger and Madagascar, there were large increases in QAACT availability (25·8—51·9 percentage points), and market share (15·9—40·3 percentage points), driven mainly by changes in the private for-profit sector. Large falls in median price for QAACTs per adult equivalent dose were seen in the private for-profit sector in six pilots, ranging from US$1·28 to $4·82. The market share of oral artemisinin monotherapies decreased in Nigeria and Zanzibar, the two pilots where it was more than 5% at baseline.

Interpretation
Subsidies combined with supporting interventions can be effective in rapidly improving availability, price, and market share of QAACTs, particularly in the private for-profit sector. Decisions about the future of AMFm should also consider the effect on use in vulnerable populations, access to malaria diagnostics, and cost-effectiveness.

Funding
The Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Bill & Melinda Gates Foundation.

The Lancet  
Dec 01, 2012  Volume 380  Number 9857  p1881 – 1966
http://www.thelancet.com/journals/lancet/issue/current

Comment
Anatomy of a pandemic
Peter Daszak
Preview
For millennia, human beings have been plagued by pathogens originating in other animal species. Pathogens that are now endemic in human beings, such as measles and smallpox, evolved from wildlife microbes that exploited our successful development for their own global spread.1 Zoonotic diseases have had a substantial effect on our social, cultural, and economic development. When these diseases first began to emerge is unknown,2 but causal factors include large-scale ecological and demographic changes, such as the domestication of livestock3 and the formation of dense human populations around 10 000 years ago.

Emerging infectious diseases: the role of social sciences
Craig R Janes, Kitty K Corbett, James H Jones, James Trostle
Preview
Popular and scientific representations of research into emerging infectious disease often focus on the pathogen itself—its molecular machinery, processes of reassortment and mutation, and how these factors indicate risk for human-to-human transmission. However, social and ecological processes that facilitate infection also deserve close attention, as emphasised in the Lancet Series on zoonoses.1–3 Present models of pathogen emergence and spread do not identify underlying drivers with sufficient clarity to allow effective prevention of disease.

Series – Zoonoses
Ecology of zoonoses: natural and unnatural histories
William B Karesh, Andy Dobson, James O Lloyd-Smith, Juan Lubroth, Matthew A Dixon, Malcolm Bennett, Stephen Aldrich, Todd Harrington, Pierre Formenty, Elizabeth H Loh, Catherine C Machalaba, Mathew Jason Thomas, David L Heymann
Preview
More than 60% of human infectious diseases are caused by pathogens shared with wild or domestic animals. Zoonotic disease organisms include those that are endemic in human populations or enzootic in animal populations with frequent cross-species transmission to people. Some of these diseases have only emerged recently. Together, these organisms are responsible for a substantial burden of disease, with endemic and enzootic zoonoses causing about a billion cases of illness in people and millions of deaths every year.

Drivers, dynamics, and control of emerging vector-borne zoonotic diseases
A Marm Kilpatrick, Sarah E Randolph
Preview
Emerging vector-borne diseases are an important issue in global health. Many vector-borne pathogens have appeared in new regions in the past two decades, while many endemic diseases have increased in incidence. Although introductions and emergence of endemic pathogens are often considered to be distinct processes, many endemic pathogens are actually spreading at a local scale coincident with habitat change. We draw attention to key differences between dynamics and disease burden that result from increased pathogen transmission after habitat change and after introduction into new regions.

Prediction and prevention of the next pandemic zoonosis
Stephen S Morse, Jonna AK Mazet, Mark Woolhouse, Colin R Parrish, Dennis Carroll, William B Karesh, Carlos Zambrana-Torrelio, W Ian Lipkin, Peter Daszak
Preview
Most pandemics—eg, HIV/AIDS, severe acute respiratory syndrome, pandemic influenza—originate in animals, are caused by viruses, and are driven to emerge by ecological, behavioural, or socioeconomic changes. Despite their substantial effects on global public health and growing understanding of the process by which they emerge, no pandemic has been predicted before infecting human beings. We review what is known about the pathogens that emerge, the hosts that they originate in, and the factors that drive their emergence.

Medical Decision Making (MDM)
November–December 2012; 32 (6)
http://mdm.sagepub.com/content/current

How Well Do Commonly Used Data Presentation Formats Support Comparative Effectiveness Evaluations?
James G. Dolan, Feng Qian, and Peter J. Veazie
Med Decis Making November–December 2012 32: 840-850, first published on May 22, 2012 doi:10.1177/0272989X12445284

Abstract
Background. Good decisions depend on an accurate understanding of the comparative effectiveness of decision alternatives. The best way to convey data needed to support these comparisons is unknown.

Objective. To determine how well 5 commonly used data presentation formats convey comparative effectiveness information.

Methods. The study was an Internet survey using a factorial design. Participants consisted of 279 members of an online survey panel. Study participants compared outcomes associated with 3 hypothetical screening test options relative to 5 possible outcomes with probabilities ranging from 2 per 5000 (0.04%) to 500 per 1000 (50%). Data presentation formats included a table, a “magnified” bar chart, a risk scale, a frequency diagram, and an icon array. Outcomes included the number of correct ordinal judgments regarding the more likely of 2 outcomes, the ratio of perceived versus actual relative likelihoods of the paired outcomes, the intersubject consistency of responses, and perceived clarity.

Results. The mean number of correct ordinal judgments was 12 of 15 (80%), with no differences among data formats. On average, there was a 3.3-fold difference between perceived and actual likelihood ratios (95% confidence interval = 3.0–3.6). Comparative judgments based on flowcharts, icon arrays, and tables were all significantly more accurate and consistent than those based on risk scales and bar charts (P < 0.001). The most clearly perceived formats were the table and the flowchart. Low subjective numeracy was associated with less accurate and more variable data interpretations and lower perceived clarity for icon displays, bar charts, and flow diagrams.

Conclusions. None of the data presentation formats studied can reliably provide patients, especially those with low subjective numeracy, with an accurate understanding of comparative effectiveness information.

The Pediatric Infectious Disease Journal
December 2012 – Volume 31 – Issue 12  pp: 1217-1307,e232-e254
http://journals.lww.com/pidj/pages/currenttoc.aspx

Review Articles
Incidence and Use of Resources for Chickenpox and Herpes Zoster in Latin America and the Caribbean—A Systematic Review and Meta-analysis
Bardach, Ariel; Cafferata, María Luisa; Klein, Karen; Cormick, Gabriela; Gibbons, Luz; Ruvinsky, Silvina
Pediatric Infectious Disease Journal. 31(12):1263-1268, December 2012.
doi: 10.1097/INF.0b013e31826ff3a5

Abstract:
Background: Varicella-zoster virus causes chickenpox and herpes zoster. More than 90% of varicella cases occur in childhood. The aim of this study was to gather all relevant information on epidemiology and resource use in Latin America and the Caribbean since 2000.

Methods: Epidemiologic studies published since 2000 with at least 50 cases of varicella or herpes zoster, or at least 10 cases of congenital disease were included. Gray literature was also searched. Outcomes included incidence, admission rate, mortality and case-fatality ratio. Use of resources and both direct and indirect costs associated were extracted.

Results: From the 495 records identified, 23 were included in the meta-analysis to report varicella-zoster virus outcomes and 3 in the herpes zoster analysis. The global pooled varicella incidence in subjects under 15 years of age was 42.9 cases per 1000 individuals per year (95% confidence interval: 26.9–58.9); children under 5 years of age were the most affected. Pooled general admission rate was 3.5 per 100,000 population (95% confidence interval: 2.9–4.1) and median hospitalization was 5–9 days. The most common varicella complications reported in studies were skin infections (3–61%), followed by respiratory infections (0–15%) and neurologic problems (1–5%). Direct costs averaged (2011/international dollar [I$]) $2040 per admission (range, I$ 298–5369) and I$70 per clinical visit (range, 11–188 I$).

Conclusions: Limited information was available on the outcomes studied. Improvements in the surveillance of ambulatory cases are required to obtain a better epidemiologic picture. As of 2011, only 2 countries introduced the vaccine in national immunization programs in Latin America and the Caribbean.

The Pediatric Infectious Disease Journal
December 2012 – Volume 31 – Issue 12  pp: 1217-1307,e232-e254
http://journals.lww.com/pidj/pages/currenttoc.aspx

Completeness of Reporting in Randomized Controlled Trials of 3 Vaccines: A Review of Adherence to the CONSORT Checklist
Scott, Pippa; Ott, Franziska; Egger, Matthias; Low, Nicola
Pediatric Infectious Disease Journal. 31(12):1286-1294, December 2012.
doi: 10.1097/INF.0b013e31827032bb

Abstract:
Background: Clear reporting of randomized controlled trials (RCTs) of vaccines is important for understanding results and assessing their validity. The CONsolidated Standards of Reporting Trials (CONSORT) statement provides guidance to help authors reporting RCTs. The objective was to assess the completeness of reporting of RCTs of vaccines based on the CONSORT 2010 checklist.

Methods: We collected data about items required by the CONSORT checklist or specific to trials of vaccines. We used publications of RCTs identified in 3 systematic reviews of pneumococcal polysaccharide, pneumococcal conjugate and rotavirus vaccines. We included the first journal publication that reported clinical, carriage or immunological data for each trial and summarized results descriptively.

Results: We included 70 publications from 19 journals. Of these, 14 publications (20%) stated in the title that the trial was randomized and 26 publications (37%) nominated at least 1 primary outcome. The method for generating the random allocation sequence was fully reported in 24 publications (34%), the method of allocation concealment in 9 publications (13%) and 30 publications (43%) included a flow diagram. Trial registration numbers were reported in all articles published in 2010 to 2011. Actual age at vaccination was reported in 20% of trials of childhood schedules. Eleven of 19 journals endorsed the CONSORT statement.

Conclusions: The reporting of RCTs of vaccines is incomplete, with important methodological details missing from most reports. Journals could play a leading role in implementing changes. Improved reporting would make publications of vaccine trials easier to find, the findings easier to interpret and aid the incorporation of findings into policy.

Pediatrics
December 2012, VOLUME 130 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Impact of a Third Dose of Measles-Mumps-Rubella Vaccine on a Mumps Outbreak
Ikechukwu U. Ogbuanu, Preeta K. Kutty, Jean M. Hudson, Debra Blog, Glen R. Abedi, Stephen Goodell, Jacqueline Lawler, Huong Q. McLean, Lynn Pollock, Elizabeth Rausch-Phung, Cynthia Schulte, Barbara Valure, Gregory L. Armstrong, and Kathleen Gallagher
Pediatrics 2012; 130:e1567-e1574

Abstract
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 an affected community in an effort to control the outbreak.

METHODS: Eligible sixth- to 12th-grade students in 3 schools were offered a third dose of MMR vaccine. Baseline and follow-up surveys and physician case reports were used to monitor mumps attack rates (ARs). We calculated ARs for defined 3-week periods before and after the intervention.

RESULTS: Of 2265 eligible students, 2178 (96.2%) provided documentation of having received 2 previous doses of MMR vaccine, and a high proportion (1755 or 80.6%) chose to receive an additional vaccine dose. The overall AR for all sixth- to 12th-grade students declined from 4.93% in the prevaccination period to 0.13% after vaccination (P < .001). Villagewide, overall AR declined by 75.6% after the intervention. A decline occurred in all age groups but was significantly greater (96.0%) among 11- to 17-year-olds, the age group targeted for vaccination, than among all other age groups. The proportions of adverse events reported were lower than or within the range of those in previous reports of first- and second-dose MMR vaccine studies.

CONCLUSIONS: This is the first study to assess the impact of a third MMR vaccine dose for mumps outbreak control. The decline in incidence shortly after the intervention suggests that a third dose of MMR vaccine may help control mumps outbreaks among populations with preexisting high 2-dose vaccine coverage.

Pediatrics
December 2012, VOLUME 130 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

The Globalization of Pediatric Clinical Trials
Julia Dunne, M. Dianne Murphy, and William J. Rodriguez
Pediatrics 2012; 130:e1583-e1591

Abstract
OBJECTIVE: To examine the characteristics of pediatric trials conducted under US legislation and to compare results with data from 2002 to 2007.

METHODS: We reviewed all pediatric trials provided to the US Food and Drug Administration in submissions that were approved between September 28, 2007 and December 21, 2010. We extracted data for each trial including age range, therapeutic indication, design, duration, and patient and center enrollment by location.

RESULTS: Overall 346 studies on 113 drugs and biologicals enrolled 55 819 pediatric patients. The United States participated in 86% of the studies, providing 71% of the centers and 74% of the patients. Corresponding percentages for non-US countries were 43%, 29%, and 26% respectively. Developing or transition countries participated in 22% of the studies, providing 12% of the centers and 10% of the patients; our earlier analysis found corresponding percentages of 38%, 12%, and 23%. The most common therapeutic areas studied in the latter countries were infectious, neurologic, and pulmonary diseases. Seventy-eight vaccine studies enrolled 147 692 patients. The United States participated in 40% of the studies, providing 39% of the centers and 22% of the patients. Corresponding percentages for non-US countries were 74%, 61%, and 78% respectively. Developing or transition countries participated in 27% of the studies, providing 15% of the centers and 52% of the patients.

CONCLUSIONS: The United States remains an important location for pediatric trials. Developing country involvement in pediatric drug development is not increasing, although these countries participate significantly in vaccine trials.

Pediatrics
December 2012, VOLUME 130 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Vaccination Coverage Among American Indian and Alaska Native Children, 2006–2010
Amy V. Groom, Tammy A. Santibanez, and Ralph T. Bryan
Pediatrics 2012; 130:e1592-e1599

Abstract
BACKGROUND AND OBJECTIVES: A previous study on vaccination coverage in the American Indian/Alaska Native (AI/AN) population found that disparities in coverage between AI/AN and white children existed from 2001 to 2004 but were absent in 2005. The objective of this study was to describe vaccination coverage levels for AI/AN children aged 19-35 months in the United States between 2006 and 2010, examining whether gains found for AI/AN children in 2005 have been sustained.

METHODS: Data from the 2006 through 2010 National Immunization Surveys were analyzed. Groups were defined as AI/AN (alone or in combination with any other race and excluding Hispanics) and white-only non-Hispanic children. Comparisons in demographics and vaccination coverage were made.

RESULTS: Demographic risk factors often associated with underimmunization were significantly higher for AI/AN respondents compared with white respondents in most years studied. Overall, vaccination coverage was similar between the 2 groups in most years, although coverage with 4 or more doses of pneumococcal conjugate vaccine was lower for AI/AN children in 2008 and 2009, as was coverage with vaccine series measures the series in 2006 and 2009. When stratified by geographic regions, AI/AN children had coverage that was similar to or higher than that of white children for most vaccines in most years studied.

CONCLUSIONS: The gains in vaccination coverage found in 2005 have been maintained. The absence of disparities in coverage with most vaccines between AI/AN children and white children from 2006 through 2010 is a clear success. These types of periodic reviews are important to ensure we remain vigilant.

PLoS One
[Accessed 1 December 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Vaccination Rates among the General Adult Population and High-Risk Groups in the United States
Kathy Annunziata, Aaron Rak, Heather Del Buono, Marco DiBonaventura, Girishanthy Krishnarajah
PLoS ONE: Research Article, published 30 Nov 2012 10.1371/journal.pone.0050553

Abstract 
Background
In order to adequately assess the effectiveness of vaccination in helping to control vaccine-preventable infectious disease, it is important to identify the adherence and uptake of risk-based recommendations.

Methods
The current project includes data from five consecutive datasets of the National Health and Wellness Survey (NHWS): 2007 through 2011. The NHWS is an annual, Internet-based health questionnaire, administered to a nationwide sample of adults (aged 18 or older) which included items on vaccination history as well as high-risk group status. Vaccination rates and characteristics of vaccinees were reported descriptively. Logistic regressions were conducted to predict vaccination behavior from sociodemographics and risk-related variables.

Results
The influenza vaccination rate for all adults 18 years and older has increased significantly from 28.0% to 36.2% from 2007 to 2011 (ps<.05). Compared with those not at high risk (25.1%), all high-risk groups were vaccinated at a higher rate, from 36.8% (pregnant women) to 69.7% (those with renal/kidney disease); however, considerable variability among high-risk groups was observed. Vaccination rates among high-risk groups for other vaccines varied considerably though all were below 50%, with the exception of immunocompromised respondents (57.5% for the hepatitis B vaccine and 52.5% for the pneumococcal vaccine) and the elderly (50.4% for the pneumococcal). Multiple risk factors were associated with increased rate of vaccination for most vaccines. Significant racial/ethnic differences with influenza, hepatitis, and herpes zoster vaccination rates were also observed (ps<.05).

Conclusions
Rates of influenza vaccination have increased over time. Rates varied by high-risk status, demographics, and vaccine. There was a pattern of modest vaccination rate increases for individuals with multiple risk factors. However, there were relatively low rates of vaccination for most risk-based recommendations and all fell below national goals.

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

Urban Cholera Transmission Hotspots and Their Implications for Reactive Vaccination: Evidence from Bissau City, Guinea Bissau
Andrew S. Azman, Francisco J. Luquero, Amabelia Rodrigues, Pedro Pablo Palma, Rebecca F. Grais, Cunhate Na Banga, Bryan T. Grenfell, Justin Lessler

Abstract 
Background
Use of cholera vaccines in response to epidemics (reactive vaccination) may provide an effective supplement to traditional control measures. In Haiti, reactive vaccination was considered but, until recently, rejected in part due to limited global supply of vaccine. Using Bissau City, Guinea-Bissau as a case study, we explore neighborhood-level transmission dynamics to understand if, with limited vaccine and likely delays, reactive vaccination can significantly change the course of a cholera epidemic.

Methods and Findings
We fit a spatially explicit meta-population model of cholera transmission within Bissau City to data from 7,551 suspected cholera cases from a 2008 epidemic. We estimated the effect reactive vaccination campaigns would have had on the epidemic under different levels of vaccine coverage and campaign start dates. We compared highly focused and diffuse strategies for distributing vaccine throughout the city. We found wide variation in the efficiency of cholera transmission both within and between areas of the city. “Hotspots”, where transmission was most efficient, appear to drive the epidemic. In particular one area, Bandim, was a necessary driver of the 2008 epidemic in Bissau City. If vaccine supply were limited but could have been distributed within the first 80 days of the epidemic, targeting vaccination at Bandim would have averted the most cases both within this area and throughout the city. Regardless of the distribution strategy used, timely distribution of vaccine in response to an ongoing cholera epidemic can prevent cases and save lives.

Conclusions
Reactive vaccination can be a useful tool for controlling cholera epidemics, especially in urban areas like Bissau City. Particular neighborhoods may be responsible for driving a city’s cholera epidemic; timely and targeted reactive vaccination at such neighborhoods may be the most effective way to prevent cholera cases both within that neighborhood and throughout the city.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 31, Issue 1, Pages 1-278 (17 December 2012)

Developing evidence-based immunization recommendations and GRADE
Original Research Article
Pages 12-19
P. Duclos, D.N. Durrheim, A.L. Reingold, Z.A. Bhutta, K. Vannice, H. Rees

Abstract
The Strategic Group of Advisory Experts (SAGE) on immunization is an independent advisory committee with a mandate to advise the World Health Organization (WHO) on the development of vaccine and immunization related policies. SAGE working groups are established on a time-limited basis to review and provide evidence-based recommendations, together with their implications, for open deliberation and decision-making by SAGE. In making its recommendations, SAGE takes into consideration: the epidemiologic and clinical characteristics of the disease; vaccine and immunization characteristics; economic analysis; health system considerations; the existence of and interaction with other intervention and control strategies; costing and social impacts; and legal and ethical concerns. Since 1998, WHO has produced evidence-based vaccine position papers for use primarily by national public health officials and immunization programme managers. Since April 2006 all new or updated position papers have been based on SAGE recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach has been adopted by WHO and, since 2008, GRADE tables that rate the quality of evidence have been produced in support of key recommendations. SAGE previously expressed concern that GRADE was not ideally suited to many immunization-specific issues such as the vaccine population level effect and the inclusion of surveillance system data, particularly for vaccine safety. Extensive productive interactions with various advisory groups including the US Advisory Committee on Immunization Practices, the European Centres for Disease Control, the German Standing Committee on Vaccination (STIKO), WHO’s Global Advisory Committee on Vaccine Safety and the GRADE working group resulted in key enhancements to accommodate vaccine-relevant evidence. This facilitated integration and acceptability of the GRADE approach in the development of immunization related SAGE and WHO recommendations. Ongoing utilisation should result in further fine-tuning of the approach to ensure that recommendations are based on the full range of appropriate evidence.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 31, Issue 1, Pages 1-278 (17 December 2012)

Brief Reports
Influenza vaccination coverage among patients and healthcare workers in a university hospital during the 2006–2007 influenza season
Pages 23-26
Caroline Landelle, Philippe Vanhems, Mitra Saadatian-Elahi, Nicolas Voirin

Abstract
Despite years of public health effort to increase vaccine uptake among populations recommended for influenza vaccination, immunization rates remain low among patients and healthcare workers (HCWs). The objective of this study was to report on influenza vaccination coverage of patients and HCWs for the same time period in 4 wards of a university hospital. A prospective cross-sectional study was conducted among patients and HCWs between December 11, 2006 and April 15, 2007 and individual factors associated with being vaccinated against influenza were assessed. Results indicated that older patients were significantly more vaccinated than younger patients. Physicians and residents were more likely to be vaccinated that the rest of staff, with possible differences between wards. Immunization of HCWs is a major issue in infection control in hospitals and long-term care facilities. However, the impact of influenza vaccination among HCWs in reducing hospital-acquired influenza and patient morbidity needs to be explored further.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 31, Issue 1, Pages 1-278 (17 December 2012)

Human papillomavirus vaccination in Auckland: Reducing ethnic and socioeconomic inequities
Original Research Article
Pages 84-88
Tracey Poole, Felicity Goodyear-Smith, Helen Petousis-Harris, Natalie Desmond, Daniel Exeter, Leah Pointon, Ranmalie Jayasinha

Abstract
Background
The New Zealand HPV publicly funded immunisation programme commenced in September 2008. Delivery through a school based programme was anticipated to result in higher coverage rates and reduced inequalities compared to vaccination delivered through other settings. The programme provided for on-going vaccination of girls in year 8 with an initial catch-up programme through general practices for young women born after 1 January 1990 until the end of 2010.

Objective
To assess the uptake of the funded HPV vaccine through school based vaccination programmes in secondary schools and general practices in 2009, and the factors associated with coverage by database matching.

Methods
Retrospective quantitative analysis of secondary anonymised data School-Based Vaccination Service and National Immunisation Register databases of female students from secondary schools in Auckland District Health Board catchment area. Data included student and school demographic and other variables. Binary logistic regression was used to estimate odds ratios and significance for univariables. Multivariable logistic regression estimated strength of association between individual factors and initiation and completion, adjusted for all other factors.

Results
The programme achieved overall coverage of 71.5%, with Pacific girls highest at 88% and Maori at 78%. Girls higher socioeconomic status were more likely be vaccinated in general practice.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 31, Issue 1, Pages 1-278 (17 December 2012)

Cost-effectiveness and economic benefits of vaccines in low- and middle-income countries: A systematic review
Original Research Article
Pages 96-108
Sachiko Ozawa, Andrew Mirelman, Meghan L. Stack, Damian G. Walker, Orin S. Levine

Abstract
Background
Public health interventions that prevent mortality and morbidity have greatly increased over the past decade. Immunization is one of these preventive interventions, with a potential to bring economic benefits beyond just health benefits. While vaccines are considered to be a cost-effective public health intervention, implementation has become increasingly challenging. As vaccine costs rise and competing priorities increase, economic evidence is likely to play an increasingly important role in vaccination decisions.

Methods
To assist policy decisions today and potential investments in the future, we provide a systematic review of the literature on the cost-effectiveness and economic benefits of vaccines in low- and middle-income countries from 2000 to 2010. The review identified 108 relevant articles from 51 countries spanning 23 vaccines from three major electronic databases (Pubmed, Embase and Econlit).

Results
Among the 44 articles that reported costs per disability-adjusted life year (DALY) averted, vaccines cost less than or equal to $100 per DALY averted in 23 articles (52%). Vaccines cost less than $500 per DALY averted in 34 articles (77%), and less than $1000 per DALY averted in 38 articles (86%) in one of the scenarios. 24 articles (22%) examined broad level economic benefits of vaccines such as greater future wage-earning capacity and cost savings from averting disease outbreaks. 60 articles (56%) gathered data from a primary source. There were little data on long-term and societal economic benefits such as morbidity-related productivity gains, averting catastrophic health expenditures, growth in gross domestic product (GDP), and economic implications of demographic changes resulting from vaccination.

Conclusions

This review documents the available evidence and shows that vaccination in low- and middle-income countries brings important economic benefits. The cost-effectiveness studies reviewed suggest to policy makers that vaccines are an efficient investment. This review further highlights key gaps in the available literature that would benefit from additional research, especially in the area of evaluating the broader economic benefits of vaccination in the developing world.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 31, Issue 1, Pages 1-278 (17 December 2012)

Vaccine-related standard of care and willingness to respond to public health emergencies: A cross-sectional survey of California vaccine providers
Original Research Article
Pages 196-201
Katherine Seib, Daniel J. Barnett, Paul S. Weiss, Saad B. Omer

Abstract
Introduction
Responding to a vaccine-related public health emergency involves a broad spectrum of provider types, some of whom may not routinely administer vaccines including obstetricians, pharmacists and other specialists. These providers may have less experience administering vaccines and thus less confidence or self-efficacy in doing so. Self-efficacy is known to have a significant impact on provider willingness to respond in emergency situations.

Methods
We conducted a survey of 800 California vaccine providers to investigate standard of care, willingness to respond, and how vaccine-related standard of care impacts willingness to respond among these providers. We used linear regression to examine how willingness to respond was impacted by vaccine-related standard of care.

Results
Forty percent of respondents indicated that they had participated in emergency preparedness training, actual disaster response, or surge capacity initiatives with significant differences among provider types for all measures (p = 0.007). When asked to identify barriers to responding to a public health emergency, respondents indicated that staff size or capacity, training and resources were the top concerns. Respondents in practices with a higher vaccine-related standard of care had a higher willing to respond index (β = 0.190, p = 0.001). Respondents who had participated in emergency training or actual emergency response had a higher willing to respond index (β = 1.323, p < 0.0001).

Conclusion
Our study suggests that concerns about staff size and surge capacity need to be more explicitly addressed in current emergency preparedness training efforts. In the context of boosting response willingness, larger practice environments stand to benefit from self-efficacy focused training and exercise efforts that also incorporate standard of care.

Vaccine
Volume 30, Issue 52, Pages 7439-7668 (14 December 2012)
http://www.sciencedirect.com/science/journal/0264410X/30

Do income inequality and social capital associate with measles-containing vaccine coverage rate?
Original Research Article
Pages 7481-7488
Kei Nagaoka, Takeo Fujiwara, Jun Ito

Abstract
Objective
We investigated the association between income inequality and social capital with measles-containing vaccine (MCV) coverage rates in Japan.

Methods
MCV coverage data for all 1750 municipalities were collected from statistics publicized by the Ministry of Health, Labour and Welfare of Japan in 2010. Prefectural Gini coefficients in 2009 (an indicator of income inequality) and social capital indicators (including voting rates, volunteer rates at the prefectural level, and move-in ratios at the municipal level) were linked to MCV coverage using a multilevel analysis adjusting for covariates (population, age distribution, average income, average number of household members).

Results
Coverage of the first dose of MCV (MCV1), and second dose (MCV2), decreased by 3.98% (95% confidence interval [CI]: 0.26–7.71) and 4.28% (95% CI: 0.60–7.60) per each 0.1-unit increase in Gini coefficients within large municipalities (with a population 50,000 or more), respectively. Conversely, coverage of MCV2 increased by 0.26% (95% CI: 0.08–0.45) per 1% increase in voting rate within large municipalities. Volunteer rates were inversely associated with MCV2 coverage within large municipalities. Move-in ratios at the municipal level were inversely associated with MCV2 coverage within medium-sized municipalities (with a population between 10,000 and 50,000).

Conclusions
While higher income inequality at a prefectural level was associated with lower MCV coverage rates, higher social capital was associated with higher coverage in large municipalities. To enhance MCV coverage in Japan, we recommend that income inequality be addressed and social capital boosted at the prefectural level.

Vaccine
Volume 30, Issue 52, Pages 7439-7668 (14 December 2012)
http://www.sciencedirect.com/science/journal/0264410X/30

Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: Regional analyses according to the endemic context
Original Research Article
Pages 7489-7497
Ana Marli C. Sartori, Patrícia Coelho de Soárez, Hillegonda Maria Dutilh Novaes, Marcos Amaku, Raymundo Soares de Azevedo, Regina Célia Moreira, Leila Maria Moreira Beltrão Pereira, Ricardo Arraes de Alencar Ximenes, Celina Maria Turchi Martelli

Abstract
Objective
To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil.

Methods
An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South + Southeast (low endemicity) and one for the North + Northeast + Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real).

Results
A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs.

Conclusions
Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program.

Vaccine
Volume 30, Issue 52, Pages 7439-7668 (14 December 2012)
http://www.sciencedirect.com/science/journal/0264410X/30

The impact of new vaccine introduction on the coverage of existing vaccines: A cross-national, multivariable analysis
Original Research Article
Pages 7582-7587
Jessica C. Shearer, Damian G. Walker, Nicholas Risko, Orin S. Levine

Abstract
Background
A surge of new and underutilized vaccine introductions into national immunization programmes has called into question the effect of new vaccine introduction on immunization and health systems. In particular, countries deciding whether to introduce a new or underutilized vaccine into their routine immunization programme may query possible effects on the delivery and coverage of existing vaccines. Using coverage of diphtheria–tetanus–pertussis (DTP) vaccine as a proxy for immunization system performance, this study aims to test whether new vaccine introduction into national immunization programs was associated with changes in coverage of three doses of DTP vaccine among infants.

Methods and findings
DTP3 vaccine coverage was analyzed in 187 countries during 1999–2009 using multivariable cross-national mixed-effect longitudinal models. Controlling for other possible determinants of DTP3 coverage at the national level these models found minimal association between the introduction of Hepatitis-, Haemophilus influenzae type b-, and rotavirus-containing vaccines and DTP3 coverage. Instead, frequent and sometimes large fluctuations in coverage are associated with other development and health systems variables, including the presence of armed conflict, coverage of antenatal care services, infant mortality, the percent of health expenditures that are private and total health expenditures per capita.

Conclusions
Introductions of new vaccines did not affect national coverage of DTP3 vaccine in the countries studied. Introductions of other new vaccines and multiple vaccine introductions should be monitored for immunization and health systems impacts.

Vaccine
Volume 30, Issue 52, Pages 7439-7668 (14 December 2012)
http://www.sciencedirect.com/science/journal/0264410X/30

Individual-, family- and community-level determinants of full vaccination coverage among children aged 12–23 months in western Kenya
Original Research Article
Pages 7588-7593
Yoshito Kawakatsu, Sumihisa Honda

Abstract
To identify individual-, family-, and community-level determinants of full vaccination status at most challenging areas in Kenya, we conducted a cross-sectional study among children aged 12–23 months and their mothers. 1965 children were involved in this research and their mothers completed a questionnaire. Middle or high knowledge of vaccination schedule (Adjusted Odds Ratio (AOR) = 2.69, 95%CI: 2.01–3.60 or AOR = 8.12, 95%CI:5.50–11.97), medium/long birth interval or first birth (AOR = 2.46, 95%CI: 1.29–4.69 or AOR = 1.84, 95%CI:1.10–3.09 or AOR = 2.14, 95%CI: 1.20–3.84), less than 5 children under five years old (AOR = 1.39, 95%CI: 1.04–1.88) and highest community health worker’s (CHWs) performance (AOR = 2.20, 95%CI: 1.39–3.47) were significantly associated with complete vaccination status in the final multiple regression model. In addition, a interaction between literacy and wealth was significantly related in full vaccination status (AOR = 1.38, 95%CI: 1.08–1.75). Increased frequency and quality of CHW visits could be effective intervention to enhance vaccination coverage. Future interventions focusing on vaccination coverage should be given more attention especially to high risk group identified in this study.

Vaccine
Volume 30, Issue 51, Pages 7343-7438 (7 December 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/51

Fourth ESWI Influenza Conference
Malta
11–14 September 2011

From Google Scholar+: Dissertations, Theses, Selected Journal Articles

Satellite imagery for rapid estimation of displaced populations: a validation and feasibility study[PDF]
B Stewart, J Palmer, P Füreder, D Tiede, T Markmiller… – 2012
Page 1. Satellite imagery for rapid estimation of displaced populations: a validation and feasibility
study Final project report 20 November 2012 Main authors: Francesco Checchi Chris Grundy
London School of Hygiene and Tropical Medicine, London, UK Contributors: …

Rules and tools that improved vaccines for children vaccine-ordering practices in Oregon: a 2010 pilot project.
R Hewett, A Vancuren, L Trocio, S Beaudrault, A Gund… – Journal of public health …, 2013
OBJECTIVE:: This project’s objective was to enhance efforts to improve vaccine-ordering
efficiencies among targeted clinics using publicly purchased vaccines. DESIGN:: Using an
assessment of ordering behavior developed by the Centers for Disease Control and …

Does the Success of a School-based HPV Vaccine Programme Depend on Teachers’ Knowledge and Religion?-a Survey in a Multicultural Society.
WY Ling, SM Razali, CK Ren, SZ Omar – Asian Pacific journal of cancer prevention: …, 2012
Organized introduction of prophylactic human papillomavirus (HPV) vaccination can reduce
the burden of cervical cancer in developing countries. One of the most effective ways is
through a national school-based program. Information on teachers is therefore important …

Factors Affecting Medical Students’ Uptake of the 2009 Pandemic Influenza A (H1N1) Vaccine[HTML]
SI Lee, EM Aung, IS Chin, JW Hing, S Mummadi… – Influenza Research and …, 2012
Background. Pandemic influenza vaccination rate amongst healthcare workers in England
2009/2010 was suboptimal (40.3%). Targeting medical students before they enter the
healthcare workforce is an attractive future option. This study assessed the H1N1 vaccine …

Crying wolf? Impact of the H1N1 2009 influenza pandemic on anticipated public response to a future pandemic
Melanie R Taylor, Garry J Stevens, Kingsley E Agho, Sheree A Kable and Beverley Raphael
Med J Aust 2012; 197 (10): 561-564.
doi: 10.5694/mja11.11623
Abstract
Objective: To determine changes in public threat perception and anticipated compliance with health-protective behaviours in response to a future pandemic; using data collected before and after the H1N1 2009 influenza pandemic.

Design, setting and participants: Repeat cross-sectional computer-assisted telephone surveys with representative samples of the general New South Wales population in 2007 (2081 participants) and 2010 (2038 participants).

Main outcome measures: Perceived likelihood of a future pandemic in Australia; concern that respondents or their families would be affected; degree of change made to life because of the possibility of a pandemic; and willingness to comply with health-protective behaviours (to be vaccinated, to be isolated if necessary, and to wear a face mask).

Results: In 2007, 14.9% of the general population considered that an influenza pandemic would be highly likely to occur in future; this proportion rose to 42.8% in 2010 (odds ratio [OR], 4.96; 95% CI, 3.99–6.16; P < 0.001). Conversely, in the same period concern that respondents or their families would be directly affected by a future pandemic dropped from 45.5% to 32.5% (OR, 0.57; 95% CI, 0.44–0.74; P < 0.001). Willingness to be vaccinated against influenza in a future pandemic decreased from 75.4% to 64.6% (OR, 0.69; 95% CI, 0.55–0.86; P < 0.001). A general decrease in willingness to be vaccinated was noted across all age groups, most notably for those aged 35–44 years.

Conclusions: Data collected before and after the H1N1 2009 influenza pandemic indicated significant shifts in public threat perception and anticipated response to a future pandemic. The H1N1 2009 pandemic has altered public perceptions of the probability of a pandemic in the future, but has left the public feeling less vulnerable. Shifts in perception have the potential to reduce future public compliance with health-protective measures, including critical elements of the public health response, such as vaccination.

https://www.mja.com.au/journal/2012/197/10/crying-wolf-impact-h1n1-2009-influenza-pandemic-anticipated-public-response

The Huffington Post
http://www.huffingtonpost.com/
Accessed 1 December 2012

Vaccines as a Sign of Progress in Myanmar
Posted: 11/27/2012 3:22 pm
By Dagfinn Høybråten
Vice President, Norwegian Parliament; Chair, GAVI Alliance Board

Extract
Myanmar made news this week, but not for reasons you might expect. The scene at the little health center in Thagaya in Yedashe township is an unmistakable sign of progress as the country emerges from decades of social and political isolation. For the first time, with support from the GAVI Alliance, a pentavalent vaccine was introduced that will defend children against five potentially fatal diseases. Over the next six months, more than half a million children in Myanmar will be protected from diphtheria, pertussis, tetanus, hepatitis B (hepB) and Haemophilus influenzae type b (Hib)…

http://www.huffingtonpost.com/dagfinn-hoybraten/myanmar-vaccines_b_2092515.html

Wall Street Journal
http://online.wsj.com/home-page
Accessed 1 December 2012

ESSAY
November 23, 2012, 5:59 p.m. ET
A Vaccine to Curb Addicts’ Highs
New research shows that our immune system can mute the effects of cocaine and other stimulant drugs
By KEITH HUMPHREYS
http://online.wsj.com/article/SB10001424127887324352004578130963934871462.html?KEYWORDS=vaccine

Twitter Watch [accessed 1 December 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.

Seth Berkley ‏@GAVISeth
Just arrived in Dar es Salaam to attend #GAVIpartners forum & GAVI Board mtg. Excited to see so many dedicated immunization people all week
1:50 PM – 1 Dec 12

gavi cso ‏@GaviCso
Want even more updates on @GAVIAlliance 2012 Partners Forum? Follow #GAVIpartners or visit webpage: http://ht.ly/fhDxP 
Retweeted by GAVI Alliance
7:11 PM – 29 Nov 12

World Bank Health ‏@worldbankhealth
Pres Kim: @PEPFAR Blueprint a major step forward in realizing a world free of #AIDS and poverty http://bit.ly/QsKz0P  #WorldAIDSDay 2012
7:00 AM – 1 Dec 12

UNAIDS ‏@UNAIDS
– Friends, today is World AIDS Day! We have moved from despair to hope. Let us renew our commitment to getting to ZERO! @UNAIDS #WAD2012
– UN Sec-Gen: Let us build on & amplify the encouraging successes of recent years to consign #HIV to the pages of history http://ow.ly/fHSgi 
– On World AIDS Day, let’s renew our commitment to zero! We have 1000 days to meet the 2015 global HIV targets http://ow.ly/fJMs7  #WAD2012

World Bank ‏@WorldBank
Kim: On this World AIDS Day, the goal of ending AIDS is within our reach – Read blog. http://bit.ly/V9tsO7  #WAD2012
6:00 AM – 1 Dec 12

GAVI Alliance ‏@GAVIAlliance
Today is World Aids Day! GAVI celebrates gains made in preventing and treating HIV. Statement by GAVI CEO @GAVISeth: http://ht.ly/fJHqf  5:08 AM – 1 Dec 12

UNICEF ‏@UNICEF
Globally, AIDS is the leading cause of death for girls and women age 15-44. #AIDSfree @unicef_aids
2:50 AM – 1 Dec 12

USAID ‏@usaid_info
Statement by Administrator Shah On The Occasion Of World AIDS Day… http://1.usa.gov/11crxPs 
2:41 PM – 30 Nov 12

USAID Global Health ‏@USAIDGH
Check out the new #PEPFARblueprint http://www.pepfar.gov  #worldAIDSDay
10:50 AM – 30 Nov 12

VaccinesToday ‏@VaccinesToday
Catholic board of Canadian schools overturns 4-year ban on #HPV vaccine http://www.calgaryherald.com/health/Catholic+board+overturns+vaccine/7624487/story.html … #cervicalcancer
4:42 AM – 30 Nov 12

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