Journal of Infectious Diseases
Volume 207 Issue 6 March 15, 2013
http://www.journals.uchicago.edu/toc/jid/current

VIRUSES
A Single Dose of Any of Four Different Live Attenuated Tetravalent Dengue Vaccines Is Safe and Immunogenic in Flavivirus-naive Adults: A Randomized, Double-blind Clinical Trial
J Infect Dis. (2013) 207(6): 957-965 doi:10.1093/infdis/jis936
Anna P. Durbin, Beth D. Kirkpatrick, Kristen K. Pierce, Daniel Elwood, Catherine J. Larsson, Janet C. Lindow, Cecilia Tibery, Beulah P. Sabundayo, Donna Shaffer, Kawsar R. Talaat, Noreen A. Hynes, Kimberli Wanionek, Marya P. Carmolli, Catherine J. Luke, Brian R. Murphy, Kanta Subbarao, and Stephen S. Whitehead

Abstract
Background. Dengue virus (DENV) causes hundreds of millions of infections annually. Four dengue serotypes exist, and previous infection  with one serotype increases the likelihood of severe disease with a second, heterotypic DENV infection.

Methods. In a randomized, placebo-controlled study, the safety and immunogenicity of 4 different admixtures of a live attenuated tetravalent (LATV) dengue vaccine were evaluated in 113 flavivirus-naive adults. Serum neutralizing antibody levels to all 4 dengue viruses were measured on days 0, 28, 42, and 180.

Results. A single dose of each LATV admixture induced a trivalent or better neutralizing antibody response in 75%–90% of vaccinees. There was no significant difference in the incidence of adverse events between vaccinees and placebo-recipients other than rash. A trivalent or better response correlated with rash and with non-black race (P < .0001). Black race was significantly associated with a reduced incidence of vaccine viremia.

Conclusions. TV003 induced a trivalent or greater antibody response in 90% of flavivirus-naive vaccinees and is a promising candidate for the prevention of dengue. Race was identified as a factor influencing the infectivity of the LATV viruses, reflecting observations of the effect of race on disease severity in natural dengue infection.

Clinical Trials Registration NCT01072786.

Journal of Infectious Diseases
Volume 207 Issue 6 March 15, 2013
http://www.journals.uchicago.edu/toc/jid/current

Largest Measles Epidemic in North America in a Decade—Quebec, Canada, 2011: Contribution of Susceptibility, Serendipity, and Superspreading Events
J Infect Dis. (2013) 207(6): 990-998 doi:10.1093/infdis/jis923
Gaston De Serres, France Markowski, Eveline Toth, Monique Landry, Danielle Auger, Marlène Mercier, Philippe Bélanger, Bruno Turmel, Horacio Arruda, Nicole Boulianne, Brian J. Ward, and Danuta M. Skowronski

Abstract
Background. The largest measles epidemic in North America in the last decade, occurred in 2011 in Quebec, Canada, where rates of 1- and 2-dose vaccine coverage among children 3 years of age were 95%–97% and 90%, respectively, with 3%–5% unvaccinated.

Methods. Case patients identified through passive surveillance and outbreak investigation were contacted to determine clinical course,  vaccination status, and possible source of infection.

Results. There were 21 measles importations and 725 cases. A superspreading event triggered by 1 importation resulted in sustained transmission and 678 cases. The overall incidence was 9.1 per 100 000; the highest incidence was in adolescents 12–17 years old (75.6 per 100 000), who comprised 56% of case patients. Among adolescents, 22% had received 2 vaccine doses. Outbreak investigation showed this proportion to have been an underestimate; active case finding identified 130% more cases among 2-dose recipients. Two-dose recipients had milder illness and a significantly lower risk of hospitalization than those who were unvaccinated or single-dose recipients.

Conclusions. A chance superspreading event revealed an overall level of immunity barely above the elimination threshold when unexpected vulnerability in 2-dose recipients was taken into account. Unvaccinated individuals remain the immunization priority, but a better understanding of susceptibility in 2-dose recipients is needed to define effective interventions if elimination is to be achieved.

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 2  Issue 1   March 2013
http://jpids.oxfordjournals.org/content/current

Washington State Licensed Child Care Facility Directors’ Perspectives on Childhood Immunization
Douglas J. Opel, Ashmita Banerjee, Peggy King, Cathe Paul, Danette Glassy, and Kyle Yasuda
J Ped Infect Dis (2013) 2(1): 40-49 doi:10.1093/jpids/pis088

Abstract
Background  The study objective was to determine Washington State childcare facility directors’ compliance with state immunization education and monitoring requirements and the role of directors’ immunization attitudes and beliefs on compliance.

Methods  We mailed a self-administered survey to 2000 randomly selected childcare facility directors in Washington State. The primary outcome measures were reported compliance with state requirements to educate parents about the importance of immunizations and monitor the immunization status of enrolled children.

Results  Our response rate was 28%. The majority of respondents worked at facilities with a licensed capacity of <25 children, had ≥11 years of experience, and were parents themselves. Overall, 68% agreed that they educated enrolled parents about the importance of immunizations and 90% agreed that they monitored the immunization status of enrolled children. However, 60% were concerned that children might have a serious side effect from an immunization, 51% were concerned that any one of the childhood immunizations might not be safe, and 11% were distrustful of the immunization information they received. These beliefs were associated with a statistically significant decreased likelihood of educating parents about immunization (adjusted odds ratios [aORs]: 0.57, 0.46, 0.19, respectively) and monitoring immunization status of children (aORs: 0.32, 0.32, 0.19, respectively).

Conclusions  Most Washington State child care facility directors who responded to our survey are compliant with state requirements for immunization education and monitoring. A substantial number of directors are concerned about vaccine safety, however, and these concerns may decrease the likelihood of these requirements being followed.

http://jpids.oxfordjournals.org/content/2/1/30.abstract

The Lancet  
Feb 16, 2013  Volume 381  Number 9866  p507 – 598
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Giving children a chance
The Lancet

Preview
Last week, the World Policy Analysis Centre released a new report, which for the first time systematically presented comparative data on laws and public policies in 191 countries covering areas essential to children’s healthy development. Changing Children’s Chances examines policy data and their impact in the areas of poverty, discrimination, education, health, child labour, child marriage, and parental care. The report provides a global picture of the policy tools governments can use to make a difference to children’s opportunities in life. http://childrenschances.org/

The Lancet  
Feb 16, 2013  Volume 381  Number 9866  p507 – 598
http://www.thelancet.com/journals/lancet/issue/current

Series
Non-Communicable Diseases
Embedding non-communicable diseases in the post-2015 development agenda
George Alleyne, Agnes Binagwaho, Andy Haines, Selim Jahan, Rachel Nugent, Ariella Rojhani, David Stuckler, The Lancet
Preview | Summary | Full Text | PDF

Country actions to meet UN commitments on non-communicable diseases: a stepwise approach
Ruth Bonita, Roger Magnusson, Pascal Bovet, Dong Zhao, Deborah C Malta, Robert Geneau, Il Suh, Kavumpurathu Raman Thankappan, Martin McKee, James Hospedales, Maximilian de Courten, Simon Capewell, Robert Beaglehole, The Lancet
Preview | Summary | Full Text | PDF

Inequalities in non-communicable diseases and effective responses
Mariachiara Di Cesare, Young-Ho Khang, Perviz Asaria, Tony Blakely, Melanie J Cowan, Farshad Farzadfar, Ramiro Guerrero, Nayu Ikeda, Catherine Kyobutungi, Kelias P Msyamboza, Sophal Oum, John W Lynch, Michael G Marmot, Majid Ezzati, on behalf of NCD Action Group
Preview | Summary | Full Text | PDF

New England Journal of Medicine
February 14, 2013  Vol. 368 No. 7
http://content.nejm.org/current.shtml

Perspective
Epidemic Influenza — Responding to the Expected but Unpredictable
Joseph Bresee, M.D., and Frederick G. Hayden, M.D.
N Engl J Med 2013; 368:589-592 February 14, 2013 DOI: 10.1056/NEJMp1300375

Preview
The number of U.S. cases of influenza-like illness has already exceeded the baseline for 7 weeks this season, and related hospitalizations and deaths are increasing. The causes of variability in the timing and severity of influenza epidemics are incompletely understood…

New England Journal of Medicine
February 14, 2013  Vol. 368 No. 7
http://content.nejm.org/current.shtml

Original Article
Cholera Surveillance during the Haiti Epidemic — The First 2 Years
Ezra J. Barzilay, M.D., Nicolas Schaad, M.P.H., Roc Magloire, M.D., Kam S. Mung, M.D., Jacques Boncy, M.D., Georges A. Dahourou, Pharm.D., Eric D. Mintz, M.D., Maria W. Steenland, M.P.H., John F. Vertefeuille, Ph.D., and Jordan W. Tappero, M.D.
N Engl J Med 2013; 368:599-609 February 14, 2013 DOI: 10.1056/NEJMoa1204927

Abstract
Background
In October 2010, nearly 10 months after a devastating earthquake, Haiti was stricken by epidemic cholera. Within days after detection, the Ministry of Public Health and Population established a National Cholera Surveillance System (NCSS).
Full Text of Background…

Methods
The NCSS used a modified World Health Organization case definition for cholera that included acute watery diarrhea, with or without vomiting, in persons of all ages residing in an area in which at least one case of Vibrio cholerae O1 infection had been confirmed by culture.
Full Text of Methods…

Results
Within 29 days after the first report, cases of V. cholerae O1 (serotype Ogawa, biotype El Tor) were confirmed in all 10 administrative departments (similar to states or provinces) in Haiti. Through October 20, 2012, the public health ministry reported 604,634 cases of infection, 329,697 hospitalizations, and 7436 deaths from cholera and isolated V. cholerae O1 from 1675 of 2703 stool specimens tested (62.0%). The cumulative attack rate was 5.1% at the end of the first year and 6.1% at the end of the second year. The cumulative case fatality rate consistently trended downward, reaching 1.2% at the close of year 2, with departmental cumulative rates ranging from 0.6% to 4.6% (median, 1.4%). Within 3 months after the start of the epidemic, the rolling 14-day case fatality rate was 1.0% and remained at or below this level with few, brief exceptions. Overall, the cholera epidemic in Haiti accounted for 57% of all cholera cases and 53% of all cholera deaths reported to the World Health Organization in 2010 and 58% of all cholera cases and 37% of all cholera deaths in 2011.
Full Text of Results…

Conclusions
A review of NCSS data shows that during the first 2 years of the cholera epidemic in Haiti, the cumulative attack rate was 6.1%, with cases reported in all 10 departments. Within 3 months after the first case was reported, there was a downward trend in mortality, with a 14-day case fatality rate of 1.0% or less in most areas.
http://www.nejm.org/doi/full/10.1056/NEJMoa1204927

The Pediatric Infectious Disease Journal
March 2013 – Volume 32 – Issue 3  p: A7-A8,199-305,e94-e127
http://journals.lww.com/pidj/pages/currenttoc.aspx

Early Trends for Invasive Pneumococcal Infections in Children After the Introduction of the 13-valent Pneumococcal Conjugate Vaccine
Kaplan, Sheldon L.; Barson, William J.; Lin, Philana Ling; Romero, José R.; Bradley, John S.; Tan, Tina Q.; Hoffman, Jill A.; Givner, Laurence B.; Mason, Edward O. Jr.
Pediatric Infectious Disease Journal. 32(3):203-207, March 2013.
doi: 10.1097/INF.0b013e318275614b

Abstract:
Background: The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced for routine administration to infants and children in 2010 in the United States. We have monitored clinical and microbiologic features of invasive pneumococcal infections among children before and after PCV13 use.

Methods: Infants and children cared for at 8 children hospitals in the United States with culture-proven invasive infections caused by S. pneumoniae were identified in an ongoing prospective surveillance study. Demographic and clinical data were recorded on a standard case report form. Serotype and antimicrobial susceptibilities of isolates were determined.

Results: Since routine PCV13 immunization in 2010, invasive pneumococcal infections decreased 42% overall and 53% for children <24 months of age in 2011 compared with the average number of cases for 2007 to 2009. PCV13 serotype isolates decreased 57% during these same time periods; 19A, 7F and 3 decreased by 58%, 54% and 68%, respectively. The number of infections caused by serotypes 1 and 6C also decreased in 2011. The most common non-PCV13 serotypes encountered in 2010 and 2011 combined were 33F, 22F, 12, 15B, 15C, 23A and 11. Bacteremia, pneumonia and mastoiditis cases decreased more than meningitis cases.

Conclusions: After the introduction of PCV13, invasive pneumococcal infections decreased among 8 children hospitals compared with the 3 years before PCV13 use. Slight increases in some non-PCV13 serotype isolates were noted in 2011. Continued surveillance is necessary to determine the effectiveness of PCV13 including herd protection as well as any emerging invasive serotypes.

PLoS One
[Accessed 16 February 2013]
http://www.plosone.org/

High Resolution Population Distribution Maps for Southeast Asia in 2010 and 2015
Andrea E. Gaughan, Forrest R. Stevens, Catherine Linard, Peng Jia, Andrew J. Tatem
Research Article | published 13 Feb 2013 | PLOS ONE 10.1371/journal.pone.0055882

Abstract
Spatially accurate, contemporary data on human population distributions are vitally important to many applied and theoretical researchers. The Southeast Asia region has undergone rapid urbanization and population growth over the past decade, yet existing spatial population distribution datasets covering the region are based principally on population count data from censuses circa 2000, with often insufficient spatial resolution or input data to map settlements precisely. Here we outline approaches to construct a database of GIS-linked circa 2010 census data and methods used to construct fine-scale (~100 meters spatial resolution) population distribution datasets for each country in the Southeast Asia region. Landsat-derived settlement maps and land cover information were combined with ancillary datasets on infrastructure to model population distributions for 2010 and 2015. These products were compared with those from two other methods used to construct commonly used global population datasets. Results indicate mapping accuracies are consistently higher when incorporating land cover and settlement information into the AsiaPop modelling process. Using existing data, it is possible to produce detailed, contemporary and easily updatable population distribution datasets for Southeast Asia. The 2010 and 2015 datasets produced are freely available as a product of the AsiaPop Project and can be downloaded from: www.asiapop.org.

PLoS One
[Accessed 16 February 2013]
http://www.plosone.org/

Characteristics of Randomized Trials Published in Latin America and the Caribbean According to Funding Source
Ludovic Reveiz, Stephanie Sangalang, Demian Glujovsky, Carlos E. Pinzon, Claudia Asenjo Lobos, Marcela Cortes, Martin Cañón, Ariel Bardach, Xavier Bonfill
Research Article | published 13 Feb 2013 | PLOS ONE 10.1371/journal.pone.0056410

Abstract
Introduction
Few studies have assessed the nature and quality of randomized controlled trials (RCTs) in Latin America and the Caribbean (LAC).

Methods and Findings
The aims of this systematic review are to evaluate the characteristics (including the risk of bias assessment) of RCT conducted in LAC according to funding source. A review of RCTs published in 2010 in which the author’s affiliation was from LAC was performed in PubMed and LILACS. Two reviewers independently extracted data and assessed the risk of bias. The primary outcomes were risk of bias assessment and funding source. A total of 1,695 references were found in PubMed and LILACS databases, of which 526 were RCTs (N = 73.513 participants). English was the dominant publication language (93%) and most of the RCTs were published in non-LAC journals (84.2%). Only five of the 19 identified countries accounted for nearly 95% of all RCTs conducted in the region (Brazil 70.9%, Mexico 10.1%, Argentina 5.9%, Colombia 3.8%, and Chile 3.4%). Few RCTs covered priority areas related with Millennium Development Goals like maternal health (6.7%) or high priority infectious diseases (3.8%). Regarding children, 3.6% and 0.4% RCT evaluated nutrition and diarrhea interventions respectively but none pneumonia. As a comparison, aesthetic and sport related interventions account for 4.6% of all trials. A random sample of RCTs (n = 358) was assessed for funding source: exclusively public (33.8%); private (e.g. pharmaceutical company) (15.3%); other (e.g. mixed, NGO) (15.1%); no funding (35.8%). Overall assessments for risk of bias showed no statistically significant differences between RCTs and type of funding source. Statistically significant differences favoring private and others type of funding was found when assessing trial registration and conflict of interest reporting.

Conclusion
Findings of this study could be used to provide more direction for future research to facilitate innovation, improve health outcomes or address priority health problems.

PLoS Medicine
(Accessed 16 February 2013)
http://www.plosmedicine.org/

Scaling Up mHealth: Where Is the Evidence?
Tomlinson M, Rotheram-Borus MJ, Swartz L, Tsai AC (2013) Scaling Up mHealth: Where Is the Evidence? PLoS Med 10(2): e1001382. doi:10.1371/journal.pmed.1001382

Summary Points
– Despite hundreds of mHealth pilot studies, there has been insufficient programmatic evidence to inform implementation and scale-up of mHealth.
– We discuss what constitutes appropriate research evidence to inform scale up.
– Potential innovative research designs such as multi-factorial strategies, randomized controlled trials, and data farming may provide this evidence base.
– We make a number of recommendations about evidence, interoperability, and the role of governments, private enterprise, and researchers in relation to the scale up of mHealth.

Excerpt
What Is the Problem?
There are over 6 billion mobile phone subscribers and 75% of the world has access to a mobile phone [1]. Service and care providers, researchers, and national governments are excited at the opportunities mobile health has to offer in terms of improving access to health care, engagement and delivery, and health outcomes [2]. Interventions categorized under the rubric “mobile health” or “mHealth”—broadly defined as medical and public health practice supported by mobile devices [2]—span a variety of applications ranging from the use of mobile phones to improve point of service data collection [3], care delivery [4], and patient communication [5] to the use of alternative wireless devices for real-time medication monitoring and adherence support [6].

A recent World Bank report tracked more than 500 mHealth studies, and many donor agencies are lining up to support the “scaling up” of mHealth interventions [7]. Yet, after completion of these 500 pilot studies, we know almost nothing about the likely uptake, best strategies for engagement, efficacy, or effectiveness of these initiatives. Currently, mHealth interventions lack a foundation of basic evidence [8], let alone a foundation that would permit evidence-based scale up. For example, in Uganda in 2008 and 2009 approximately 23 of 36 mHealth initiatives did not move beyond the pilot phase [9]. The current enthusiasm notwithstanding, the scatter-shot approach to piloting mHealth projects in the absence of a concomitant programmatic implementation and evaluation strategy may dampen opportunities to truly capitalize on the technology. This article discusses a number of points pertinent to developing a more robust evidence base for the scale up of mHealth interventions. The issues raised are primarily conceptual and methodological…

Science Translational Medicine
13 February 2013 vol 5, issue 172
http://stm.sciencemag.org/content/current

CANCER VACCINES
Vaccination Route Matters for Mucosal Tumors
Denise Nardelli-Haefliger, Jan C. Dudda, and Pedro Romero
13 February 2013: 172fs4

Abstract
Immunization route may be pivotal for tissue-specific localization of the effector T cell response (Sandoval et al., this issue).

Research Articles
Cancer Vaccine
Mucosal Imprinting of Vaccine-Induced CD8+ T Cells Is Crucial to Inhibit the Growth of Mucosal Tumors
Federico Sandoval, Magali Terme, Mevyn Nizard, Cécile Badoual, Michel-Francis Bureau, Ludovic Freyburger, Olivier Clement, Elie Marcheteau, Alain Gey, Guillaume Fraisse, Cécilia Bouguin, Nathalie Merillon, Estelle Dransart, Thi Tran, Françoise Quintin-Colonna, Gwennhael Autret, Marine Thiebaud, Muhammed Suleman, Sabine Riffault, Tzyy-Choou Wu, Odile Launay, Claire Danel, Julien Taieb, Jennifer Richardson, Laurence Zitvogel, Wolf H. Fridman, Ludger Johannes, and Eric Tartour
13 February 2013: 172ra20

Abstract
Although many human cancers are located in mucosal sites, most cancer vaccines are tested against subcutaneous tumors in preclinical models. We therefore wondered whether mucosa-specific homing instructions to the immune system might influence mucosal tumor outgrowth. We showed that the growth of orthotopic head and neck or lung cancers was inhibited when a cancer vaccine was delivered by the intranasal mucosal route but not the intramuscular route. This antitumor effect was dependent on CD8+ T cells. Indeed, only intranasal vaccination elicited mucosal-specific CD8+ T cells expressing the mucosal integrin CD49a. Blockade of CD49a decreased intratumoral CD8+ T cell infiltration and the efficacy of cancer vaccine on mucosal tumor. We then showed that after intranasal vaccination, dendritic cells from lung parenchyma, but not those from spleen, induced the expression of CD49a on cocultured specific CD8+ T cells. Tumor-infiltrating lymphocytes from human mucosal lung cancer also expressed CD49a, which supports the relevance and possible extrapolation of these results in humans. We thus identified a link between the route of vaccination and the induction of a mucosal homing program on induced CD8+ T cells that controlled their trafficking. Immunization route directly affected the efficacy of the cancer vaccine to control mucosal tumors.

Vaccine
Volume 31, Issue 10, Pages 1357-1452 (27 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

Editorial
United Nations mercury treaty jeopardizes vaccine protection of the world’s most vulnerable children
Pages 1357-1358
David N. Durrheim, Gregory A. Poland

No abstract

Vaccine
Volume 31, Issue 10, Pages 1357-1452 (27 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

A perspective for atherosclerosis vaccination: Is there a place for plant-based vaccines?
Review Article
Pages 1364-1369
Jorge Alberto Salazar-González, Sergio Rosales-Mendoza

Abstract
Alternatives to pharmacological treatments for atherosclerosis are highly desirable in terms of cost and compliance. During the last two decades several vaccination strategies have been reported as an effort to develop immunotherapeutic treatments. This approach consists on eliciting immune responses able to modulate either the atherosclerosis-associated inflammatory processes or the activity of some physiological mechanisms that are up-regulated under this pathologic condition. In particular, the apolipoprotein B100 (ApoB100) and the cholesterilester transferase protein (CETP) have been targeted in these strategies. It is considered that recent progress in the development of experimental models of oral vaccines against atherosclerosis has opened a new avenue in the field: as plant-based vaccines are considered a viable platform for vaccine production and delivery at low costs, they could serve as an oral-delivered therapeutic approach for atherosclerosis in an economical and patient-friendly manner. The rationale of the design, development and evaluation of possible plant-based vaccines against atherosclerosis is discussed in this review. We identify within this approach a significant trend that will positively impact the field of atherosclerosis vaccination.

Vaccine
Volume 31, Issue 10, Pages 1357-1452 (27 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

What college women know, think, and do about human papillomavirus (HPV) and HPV vaccine
Original Research Article
Pages 1370-1376
Nop T. Ratanasiripong, An-Lin Cheng, Maithe Enriquez

Abstract
Objectives
This cross-sectional study, guided by Ajzen’s Theory of Planned Behavior, aimed to identify factors that influence the decision to obtain an HPV vaccine among college women and to examine the relationships among these factors.

Methods
An electronic self-administered survey was utilized to collect data. An email invitation was sent to 3074 college women attending a large, public university in southern California, aged between 18 and 26 years. The email directed the recipient to click on a link to a web-based survey if she wanted to participate in the study.

Results
Participants in this study were college women (n = 384; 175 HPV non-vaccinees and 209 HPV vaccinees). Women in this study knew that a Pap test is still needed after HPV vaccination and that the HPV vaccine does not protect against other Sexually Transmitted Infections. Both non-vaccinees and vaccinees had positive attitudes about mandating HPV vaccine. Knowledge and attitudes toward the vaccine were not directly linked to the outcome predictors – intention to obtain the vaccine and vaccine uptake. Attitude about receiving HPV vaccine, subjective norms (complying with the expectations of others), and perceived behavioral control were correlated with the outcome predictors. Subjective norms consistently predicted intention to obtain HPV vaccine and vaccine uptake.

Conclusions
A proposal to mandate the HPV vaccine among young girls/women was acceptable to this population. Vaccination promotion strategies to increase the vaccine uptake rate among the catch-up group (aged 13–26) should include attention to college women’s subjective norms. Health care provider’s recommendation and encouragement from significant others (i.e., mother and peers) are critical in order for the college women to obtain the vaccine.

Vaccine
Volume 31, Issue 10, Pages 1357-1452 (27 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

Evaluation of Australia’s varicella vaccination program for children and adolescents
Original Research Article
Pages 1413-1419
Kirsten Ward, Aditi Dey, Brynley Hull, Helen E. Quinn, Kristine Macartney, Robert Menzies

Abstract
Objective
This paper examines how the monovalent varicella vaccine for children, with an adolescent catch-up dose, was introduced into Australia’s National Immunisation Program (NIP), focusing on programme implementation.

Methods
Semi-structured interviews were conducted with key informants involved in programme implementation. Key themes from interviews were identified through content analysis. Childhood coverage was assessed using data from the Australian Childhood Immunisation Register (ACIR) with adolescent coverage obtained from state/territory immunisation programmes. Seroprevalence data were analysed from national serosurveys conducted before and after programme commencement.

Results
Implementation challenges for both parents and providers included: (a) parental report of previous infection as an exclusion criterion; (b) introducing a vaccine on its own at 18 months of age; and (c) adding the adolescent dose into existing school-based vaccination programmes with parental reported exclusion criteria. Despite these challenges, coverage rapidly reached 83% by 24 months of age and 30–33% for the adolescent catch-up dose. When considered in conjunction with estimated pre-vaccination natural immunity in both target groups (20% and 83%, respectively) coverage can be considered high. The serosurvey under-estimated coverage in 2-year-old children but was useful to assess trends in population immunity.

Conclusion
The introduction of a single dose of monovalent varicella vaccine at 18 months of age and a school-based catch-up programme at 11–13 years of age successfully achieved high coverage, notwithstanding some challenges. Reported natural infection has been an exclusion criterion for vaccination, but as the programme matures and circulation of wild-type virus decreases, the need for this warrants consideration. There is a need for sensitive laboratory assays to measure vaccine-induced immunity at a population level.

Vaccine
Volume 31, Issue 10, Pages 1357-1452 (27 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

U.S. Postlicensure safety surveillance for adolescent and adult tetanus, diphtheria and acellular pertussis vaccines: 2005–2007
Original Research Article
Pages 1447-1452
Soju Chang, Patrick M. O’Connor, Barbara A. Slade, Emily Jane Woo

Abstract
Background
Pre-licensure clinical trials for two U.S. licensed tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccines did not reveal any major safety concerns. However, routine use in large adolescent and adult populations could reveal rare and potentially serious adverse events (AEs).

Methods
To characterize reported AEs following Tdap vaccination and identify potential safety concerns warranting further evaluation, we analyzed data from the Vaccine Adverse Event Reporting System (VAERS) and assessed the frequency and proportions of AEs and reporting rates (reports per 100,000 vaccine doses distributed).

Results
A total of 2090 reports (7% were serious; 55% listed Tdap alone) involving Tdap vaccines were submitted to VAERS May 2005–June 2007. The crude reporting rate was 10.2 per 100,000 vaccine doses distributed. The median age of vaccinees was 22 years, and the female to male ratio was about 2 to 1. The majority of reports described common local and systemic signs and symptoms, such as injection site reactions, fever, and headache. Rarely reported AEs included myopericarditis, demyelinating diseases of the central nervous system, Guillain–Barré Syndrome, syncope, encephalopathy/encephalitis, seizure, Bell’s palsy, anaphylaxis, and thrombocytopenia.

Conclusions
Because adolescents and adults were not routinely vaccinated against pertussis in the past, this surveillance summary provides important – and reassuring – information about the use of Tdap in these age groups. Although subject to the limitations of passive surveillance, the findings of this VAERS review support the pre-licensure clinical trial data with regard to the safety of the U.S. licensed Tdap vaccines. Continued monitoring of clinically significant AEs that are temporally associated with Tdap vaccination and further assessment of such events using controlled observational studies may provide additional information about the safety of these vaccines.

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

Lessons learnt from the first efficacy trial of a new infant tuberculosis vaccine since BCG
M Tameris, H McShane, JB lMcClain, B Landry… – Tuberculosis, 2013
Background New tuberculosis (TB) vaccines are being developed to combat the global
epidemic. A phase IIb trial of a candidate vaccine, MVA85A, was conducted in a high burden
setting in South Africa to evaluate proof-of-concept efficacy for prevention of TB in infants….

The Impact of 7-valent Pneumococcal Conjugate Vaccine on Invasive Pneumococcal Disease: A Literature Review.
TT Myint, H Madhava, P Balmer, D Christopoulou… – Advances in therapy, 2013
INTRODUCTION: Streptococcus pneumoniae can cause invasive pneumococcal diseases
(IPD), such as bacteremic pneumonia, bacteremia, meningitis, and sepsis, and non-IPDs,
such as otitis media, nonbacteremic pneumonia, and upper respiratory tract infections…

Sequential Methods for Vaccine Safety Evaluation and Surveillance in Public Health
J Bartroff, TL Lai, MC Shih – Sequential Experimentation in Clinical Trials, 2013
Abstract In this chapter we describe the applications of sequential testing methodology to the
problem of testing the incidence rates of adverse events in vaccine clinical trials and post-
marketing safety evaluation. Section 5.1 describes typical design considerations for…

Safety of the Pandemic H1N1 Influenza Vaccine Among Pregnant US Military Women and Their Newborns
AMS Conlin, AT Bukowinski, CJ Sevick, C DeScisciolo… – Obstetrics & Gynecology, 2013
OBJECTIVES: To assess adverse pregnancy outcomes among active-duty US military
women who received pandemic H1N1 vaccine during pregnancy as well as adverse health
outcomes among the newborns resulting from these pregnancies…

Maternal Safety of Trivalent Inactivated Influenza Vaccine in Pregnant Women
JD Nordin, EO Kharbanda, GV Benitez, K Nichol… – Obstetrics & Gynecology, 2013
OBJECTIVE: To estimate the risks for medically attended events occurring within 42 days of
receiving trivalent inactivated influenza vaccine and to evaluate specific risks of first-
trimester vaccination. METHODS: This retrospective observational cohort study compared…

Twitter Watch (16 February 2013 – 18:59)
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.

WHO ‏@WHO
Catastrophic payments for health care push about 100m people below the poverty line each year. Universal coverage can help address this #UHC
7:48 a.m. – Feb 16

WHO @WHO
How do we measure progress towards universal coverage? Range of services; % of costs for health services and % of population covered #UHC
7:58 a.m. – Feb 16

Seth Berkley ‏@GAVISeth
GAVI awarded €2.5m which matched will be €5m from the Dutch Postcode Lottery @ annual Gala. Grt donation for children http://www.noodls.com/viewNoodl/17551807/gavi-alliance/gavi-receives-8364-25-million-from-dutch-postcode-lotter …
1:25 p.m. – Feb 15, 2013

CDCgov @CDCgov
>41,000 whooping cough cases reported in 2012. Vaccine especially important for expectant mothers. http://go.usa.gov/4e34 
11:02 a.m. – Feb 15, 2013

ECDC ‏@ECDC_EU
Weekly #influenza update, week 6/2013: 20 of 28 countries reported concomitantly high/medium-intensity transmission http://bit.ly/15hH8z3 
6:10 a.m. – Feb 15, 2013

WHO @WHO
>100 countries do not have a system registering births, deaths; only 34 countries produce quality cause-of-death data http://goo.gl/p2LU9 
3:58 a.m. – Feb 15, 2013

Sabin Vaccine Inst.  @sabinvaccine
Recent Acts of Violence Undermine Efforts to Eradicate Polio Worldwide | Sabin http://www.sabin.org/updates/blog/recent-acts-violence-undermine-efforts-eradicate-polio-worldwide …
11:32 a.m. – Feb 14, 2013

GAVI Alliance @GAVIAlliance
Follow @GAVI_Daniel 2 learn about #knowledgemanagement #supplychainmanagement & how he’s improving @GAVIAlliance systems in these areas!
6:07 a.m. – Feb 14, 2013

WHO @WHO
Gov’t of Chad will launch mass-vax campaign against #yellowfever on 22 Feb in 3 districts bordering Darfur, Sudan http://goo.gl/Bv019 
3:07 a.m. – Feb 14, 2013

The Global Fund @globalfundnews
We’re reading: ‘An Optimistic Era for Global Infectious Disease Control’ via @theAtlantic #thebigpush http://bit.ly/XadWnb 
2:07 a.m. – Feb 14, 2013

PAHO/WHO @pahowho
@PAHOWHO Director discusses expanded cooperation with Global Fund http://new.paho.org/hq/index.php?option=com_content&view=article&id=8265%3Apaho-director-discusses-expanded-cooperation-with-global-fund&catid=1443%3Anews-front-page-items&lang=en&Itemid=1926#.URvoh4GmiRI.twitter …
11:25 a.m. – Feb 13, 2013

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_9 February 2013_PDF

– 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…

Nigerian polio vaccinators shot dead in Kano
BBC: 8 February 2013

Extract
“Nine female polio vaccinators have been killed in two shootings at health centres in northern Nigeria, police have told the BBC.

In the first attack in Kano the polio vaccinators were shot dead by gunmen who drove up on a motor tricycle.

Thirty minutes later gunmen targeted a clinic outside Kano city as the vaccinators prepared to start work…

…On Thursday, a controversial Islamic cleric spoke out against the polio vaccination campaign, telling people that new cases of polio were caused by contaminated medicine.

Such opposition is a major reason why Nigeria is one of just three countries where polio is still endemic.

But this is believed to be the first time polio vaccinators have been attacked in the country…

…A health official confirmed to the BBC that those killed in the second attack in Hotoro were female health workers – there were earlier reports that people waiting at the clinic may have been among those shot.

Witnesses in Hotoro told the BBC gunmen also approached the health centre using a motor tricycle…”

http://www.bbc.co.uk/news/world-africa-21381773

Joint WHO/UNICEF Statement: UNICEF and WHO condemn attacks on healthworkers in Nigeria
UNICEF and The World Health Organization (WHO) join the Government of Nigeria in condemning attacks in Kano state, Nigeria, that have killed and injured healthworkers.

Such attacks are a double tragedy; for the health workers and their families and for the children and vulnerable populations who are robbed of basic life-saving health interventions. These attacks are unacceptable under any circumstance.

WHO and UNICEF extend their deepest sympathy to the families of the healthworkers. We remain committed to supporting the Government of Nigeria and the people of Nigeria in their efforts to better the health and lives of its people.

8 February 2013 http://www.who.int/mediacentre/news/statements/2013/polio_worker_killings_20130208/en/index.html

Update: Polio this week – As of 06 February 2013
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s Extract and bolded text]
– The first WPV case of 2013 was reported this week, a WPV1 from greater Karachi, Pakistan. The 14-month old child had onset of paralysis on 14 January 2013. Case response activities are being planned.
– Response activities are also ongoing in both Niger and Egypt, in response to recent detection of a case (in Niger) and environmental isolates (in Egypt).

Pakistan
– One new WPV case was reported in the past week (WPV1 from Sindh, with onset of paralysis on 14 January 2013). It is the first WPV case of 2013. The total number of WPV cases for 2012 remains 58.
– One new cVDPV2 case was reported in the past week, bringing the total number of cVDPV2 cases for 2012 to 16. It is the most recent cVDPV2 case in the country, and had onset of paralysis on 14 December 2012 (from Balochistan).
– The security situation continues to be monitored closely, in consultation with law enforcement agencies.

Families of slain polio workers receive cheques – Karachi, Pakistan
M. Waqar Bhatti, The News International
Thursday, February 07, 2013   Print Edition

Extract
“The families of the polio workers, who were murdered in Karachi in December, each received a cheque of Rs200,000 (about USD$2,000) from the provincial government on Wednesday.

Speaking at the hotel where the cheques were distributed, Sindh Health Minister Dr Sagheer Ahmed declared the slain polio workers martyrs, as they had “sacrificed their lives to protect children from the crippling disease”.

“Money cannot compensate for the loss of lives, but this meagre amount will help solve some of the monetary problems faced by the polio workers’ families,” he added.

“Earlier such incidents used to happen only in Khyber Pakhtunkhwa, but now terrorist activities are also taking place in Karachi which is alarming. Anti-social elements don’t want the well-being of the future Pakistani generations.”

The minister said all eminent Ulema in the country had issued Fatwas in favour of polio vaccination, but the ignorant terrorists were still opposing it and wanted to spread chaos in the country.

“Polio vaccination will be carried on despite threats and violence. Children will not be allowed to get crippled due to polio.”

Fateha and prayers were offered for the murdered vaccinators. The event was organised by the Rotary International….”

http://www.thenews.com.pk/Todays-News-4-158497-Families-of-slain-polio-workers-receive-cheques

GAVI confirmed that Ghana, Kenya, Lao PDR, Madagascar, Malawi, Niger, Sierra Leone and Tanzania “will become the first countries to receive GAVI support to start HPV vaccine demonstration programmes.” GAVI said the demonstration programmes “will give each country the opportunity to test their ability to put in place the systems that would be needed to roll out the HPV vaccines nationally and to inform their decisions.”  Dr. Seth Berkley, GAVI CEO, said, “Introducing the HPV vaccine in developing countries is the start of a global effort to protect all girls against cervical cancer. Of the 275,000 women who die of cervical cancer annually, 85% live in the world’s poorest countries. Cervical cancer is one of the leading cancer killers of women in the developing world.” UNICEF will procure the vaccines following a competitive tender process that is currently being completed. Merck and GlaxoSmithKline (GSK) are currently the only two manufacturers who have prequalified HPV vaccines. GAVI noted that it has been “working with vaccine manufacturers to secure the most affordable price for HPV vaccines. To date, one manufacturer has announced an indicative price of US$ 5 per dose, a 64% reduction on the current lowest public price. GAVI expects to secure a lower price for procurement of HPV vaccines, vital to the sustainability of current and future programmes.” The GAVI announcement described one of the challenges to effectively delivering HPV vaccines is that “many developing countries do not offer routine health services for girls in the 9 to 13 age group. Other challenges include identifying the appropriate target group, engaging with those at highest risk who may not be easily reached, and preventing a sexually transmitted cancer-causing infection that is minimally symptomatic or asymptomatic.”

http://www.gavialliance.org/library/news/press-releases/2013/gavi-funds-vaccines-to-protect-girls-against-cervical-cancer/

PAHO/WHO launched the “Women’s Cancer Initiative: A joint commitment to save lives” described as a new initiative which “brings together partners from different sectors to step up action for the prevention and control of cervical and breast cancer, the leading women’s cancers in Latin America and the Caribbean.” The effort will include “joint efforts in areas including advocacy and communication; capacity building for detection, diagnosis, treatment and care in health services; improved access to services and treatment; wider vaccination against human papillomavirus (HPV); and expanded research.”  PAHO said that the Women’s Cancer Initiative is being organized by the Pan American Forum of Action on the Non-communicable Diseases (PAFNCDs), which brings together representatives of governments, academia, civil society, and the private sector to fight the growing epidemic of non-communicable diseases in the Americas. Members include ministries of health from throughout the Americas as well as the National Cancer Institutes Network (RINC/UNASUR), the International Agency for Cancer Research (IARC), the American Cancer Society, the American Society of Clinical Oncology (ASCO), Basic Health International, the Canadian Partnership against Cancer, Grounds for Health, the Fred Hutchinson Cancer Research Center, the CIMAB Foundation, and the Global Task Force for Cancer Control in Developing Countries of the Harvard Global Equity Initiative. Other participants include the Healthy Caribbean Coalition, FEMAMA, the Albert & Mary Lasker Foundation, LIVESTRONG Foundation, the International Union for Cancer Control, NIH Foundation, JHPIEGO, the Pan American Health and Education Foundation, PATH, Susan G. Komen for the Cure, Becton Dickinson & Co., Merck, Pfizer, Policy Wisdom, Qiagen, Roche, phRMA, Spectrum, and GSK.

http://new.paho.org/hq/index.php?option=com_content&view=article&id=8257&Itemid=

The Weekly Epidemiological Record (WER) for 8 February 2013, vol. 88, 6 (pp. 65–72) includes:
– Global Advisory Committee on Vaccine Safety, December 2012
http://www.who.int/entity/wer/2013/wer8806.pdf

WHO – Vaccines prequalification priority list 2013-14
Priorities for vaccine evaluations for prequalification for 2013-2014
http://www.who.int/immunization_standards/vaccine_quality/pq_priorities/en/index.html

Editor’s Extract

“The prioritization list below is a tool published every two years by the WHO prequalification programme to guide decisions as to the vaccines on which to focus resources. Vaccines are categorized in four groups: high, medium, low and no priority. At each deadline for application submission, WHO will accept for evaluation vaccine applications in any of the first three groups as long as the resources are sufficient to evaluate them. If the number of applications exceeds the capacity at WHO, vaccines will be taken up for evaluation according to the assigned priority. Evaluation of applications for vaccines in the lowest priority group may be postponed to the subsequent deadline. Applicants will be informed accordingly. Within the same category, applications will be considered for evaluation in order of receipt . A vaccine given no priority will not be accepted for evaluation during the period the list is in force….

“The priority list was developed by consultation between WHO and the two United Nations purchasing agencies (UNICEF and the Pan American Health Organization Revolving Fund) which use the prequalification service for vaccines…

Criteria used for decision-making
a) Demand in the respective UN-supplied markets, with consideration given to plans for introduction;
b) WHO programmatic needs (e.g. to comply with International Health Regulations; to comply with eradication, elimination or control initiatives; to comply with immunization programme considerations);
c) recommendations of WHO’s Strategic Advisory Group of Experts (SAGE) on immunization;
d) security of supplies: number, diversity, and production capacity of suppliers in the market…

Vaccines prequalification priority list 2013-14
http://www.who.int/immunization_standards/vaccine_quality/priority_pq_vaccines_2013_14/en/index.html
Extract
High priority vaccines
Bivalent oral polio (bOPV1+3)
DTwP based pentavalent combination (fully liquid DTwP-Hep B-Hib)
Diphtheria-tetanus-pertussis (DTwP)
Inactivated polio (IPV)
Measles-Rubella
Pneumococcal conjugate
Rotavirus
Trivalent oral polio (tOPV)
Yellow fever

Report: WHO, WIPO, WTO – Promoting Access to Medical Technologies and Innovation: Intersections between Public Health, Intellectual Property and Trade

Extract from media release
For the first time, the three global intergovernmental bodies dealing with health, intellectual property and trade have pooled their expertise on a study of policies needed to advance medical and health technologies and to ensure they reach the people who need them. This report ‘demystifies an intricate and extremely complex landscape of laws and policies and makes them accessible to the non-specialist.’ WHO Director-General Dr Margaret Chan noted that the report “demystifies an intricate and extremely complex landscape of laws and policies and makes them accessible to the non-specialist. In so doing, it sets out a comprehensive and coherent inventory of legal instruments and policy options that can be drawn on to craft measures that meet national public health objectives.”…

The book looks at the need for international cooperation, who is involved, and how to address the challenges that the sector is facing. It examines in detail the range of policy issues from health and human rights and national, regional and global regulation policies, to intellectual property, trade and tariffs, procurement, free trade agreements and other aspects of policy. It studies a range of issues, such as: patents in the pharmaceutical sector; traditional medical knowledge; the importance of knowing what is patented and where, and how easy it is to find out; and questions of affordability and availability of medicines and market failure.

It looks in some depth at the development of medical technologies, modern research and development, ways of providing incentives for innovation, and ways of dealing with market failures, in particular with new products for treating neglected diseases. It includes comprehensive sections on trade and intellectual property rules and the flexibilities they contain for governments to meet various public health objectives.

See press release graphs and instructions on how to order the book
pdf, 407kb

Read a summary of the book
pdf, 78kb

http://www.who.int/mediacentre/news/releases/2013/book_launch_20130205/en/index.html

Meeting: 8th International Conference on Typhoid Fever and Other Invasive Salmonelloses
1-2 March 2013
Dhaka, Bangladesh
Coalition against Typhoid, Bangladesh Pediatric Association, International Vaccine Institute, and icddr,b.

The primary goal of the conference will be to provide updates on research and public health agendas related to typhoid fever and other invasive salmonelloses and to present progress on typhoid, paratyphoid and non-typhoidal salmonella vaccines for public health use. A secondary goal of the conference will be to strengthen linkages between researchers and policy makers in the public health arena and in national governments. The conference discussion is expected to reveal knowledge gaps and to generate consensus regarding the typhoid, paratyphoid and non-typhoidal salmonelloses (NTS) research agenda.

http://www.typhoidconference.org/about

American Journal of Public Health
Volume 103, Issue 3 (March 2013)
http://ajph.aphapublications.org/toc/ajph/current

Mortality and Morbidity Among Military Personnel and Civilians During the 1930s and World War II From Transmission of Hepatitis During Yellow Fever Vaccination: Systematic Review
Roger E. Thomas, Diane L. Lorenzetti, Wendy Spragins
American Journal of Public Health: March 2013, Vol. 103, No. 3: e16–e29.

Abstract
During World War II, nearly all US and Allied troops received yellow fever vaccine. Until May 1942, it was both grown and suspended in human serum. In April 1942, major epidemics of hepatitis occurred in US and Allied troops who had received yellow fever vaccine. A rapid and thorough investigation by the US surgeon general followed, and a directive was issued discontinuing the use of human serum in vaccine production.

The large number of cases of hepatitis caused by the administration of this vaccine could have been avoided. Had authorities undertaken a thorough review of the literature, they would have discovered published reports, as early as 1885, of postvaccination epidemics of hepatitis in both men and horses.

It would take 4 additional decades of experiments and epidemiological research before viruses of hepatitis A, B, C, D, and E were identified, their modes of transmission understood, and their genomes sequenced.

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301158

Annals of Internal Medicine
5 February 2013, Vol. 158. No. 3
http://www.annals.org/content/current

Letters
Assessing Whether Consent for a Clinical Trial Is Voluntary
Russell H. Horwitz, MD, PhD; Laura W. Roberts, MD; David W. Seal, PhD; Patrice Joseph, MD; Karen J. Maschke, PhD; Rose I. Verdier, MD; Sandy Nerette, MD; Jean W. Pape, MD; and Daniel W. Fitzgerald, MD

Background: Consent is necessary for the ethical conduct of clinical research, but ensuring that consent is both voluntary and informed is challenging in resource-poor settings. Previous efforts have focused on participant comprehension (1). We report the results of a study assessing whether consent to participate in an HIV vaccine trial done in Haiti was voluntary.

http://annals.org/article.aspx?articleid=1567858

BMC Public Health
(Accessed 9 February 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Correspondence  
Rome consensus conference – statement; Human Papilloma Virus diseases in males
Andrea Lenzi, Vincenzo Mirone, Vincenzo Gentile, Riccardo Bartoletti, Vincenzo Ficarra, Carlo Foresta, Luciano Mariani, Sandra Mazzoli, Saverio G Parisi, Antonio Perino, Mauro Picardo, Carla Maria Zotti BMC Public Health 2013, 13:117 (7 February 2013)

Abstract (provisional)
Background
Human Papillomavirus (HPV) is a very resistant, ubiquitous virus that can survive in the environment without a host. The decision to analyze HPV-related diseases in males was due to the broad dissemination of the virus, and, above all, by the need to stress the importance of primary and secondary prevention measures (currently available for women exclusively). The objective of the Consensus Conference was to make evidence-based recommendations that were designed to facilitate the adoption of a standard approach in clinical practice in Italy.

Methods
The Sponsoring Panel put a series of questions to the members of the Scientific Committee who prepared a summary of the currently available information, relevant for each question, after the review and grading of the existing scientific literature. The summaries were presented to a Jury, also called multidisciplinary Consensus Panel, who drafted a series of recommendations.

Results
The prevalence of HPV in males ranges between 1.3–72.9%. The prevalence curve in males is much higher than that in females and does not tend to decline with age. Women appear to have a higher probability of acquiring HPV genotypes associated with a high oncogenic risk, whereas in males the probability of acquiring low- or high-risk genotypes is similar. The HPV-related diseases that affect males are anogenital warts and cancers of the penis, anus and oropharynx. The quadrivalent vaccine against HPV has proved to be effective in preventing external genital lesions in males aged 16–26 years in 90.4% (95% CI: 69.2–98.1) of cases. It has also proved to be effective in preventing precancerous anal lesions in 77.5% (95% CI: 39.6–93.3) of cases in a per-protocol analysis and in 91.7% (95% CI: 44.6–99.8) of cases in a post-hoc analysis. Early ecological studies demonstrate reduction of genital warts in vaccinated females and some herd immunity in males when vaccine coverage is high, although males who have sex with males gained no benefit at all. Males with an immunodeficiency disease are at greater risk of developing disease. Infertility seems to be caused by HPV in some cases. Studies demonstrate vaccination to both genders can be more efficacious and social equity matters are to be taken into consideration.

Conclusions

The Jury made Recommendations based on the scientific evidence presented by the Scientific Committee. Accordingly, for prevention purposes and social fairness and equality, as both sexes are affected by the disease, the vaccination of 12-year-old males against HPV should be recommended in order to guaranty protection to everyone. Aspects related to healthcare policy and economic sustainability, are to be discussed by respective public system representatives. More campaigns to raise awareness through all institutional channels are needed, not only regarding anogenital warts, but for HPV-related diseases in general in males in accordance to new scientific evidences.

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

BMC Public Health
(Accessed 9 February 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
Determinants of HPV vaccination intentions among Dutch girls and their mothers: a cross-sectional study
Hilde M van Keulen, Wilma Otten, Robert AC Ruiter, Minne Fekkes, Jim van Steenbergen, Elise Dusseldorp, Theo WGM Paulussen BMC Public Health 2013, 13:111 (6 February 2013)

Abstract (provisional)
Background
The Dutch government recently added universal Human Papilloma Virus (HPV) vaccination for 12-year-old girls to the existing national immunization program. The participation rate for the initial catch-up campaign for girls aged 13 to 16 years in 2009 was lower (47%) than expected (70%). To inform future HPV information campaigns, this paper examines the social and psychological determinants of the HPV vaccination intentions of girls aged 13 to 16 years and their mothers who were targeted by the Dutch catch-up campaign of 2009.

Methods
A random sample of girls and their mothers was chosen from the Dutch vaccination register and received a letter inviting them to participate (n = 5,998 mothers and daughters). In addition, a random sample was recruited via an online panel by a marketing research company (n = 650 mothers; n = 350 daughters). Both groups were asked to complete a web-based questionnaire with questions on social demographic characteristics, social-psychological factors and HPV vaccination intention. Backward linear regression analyses were conducted to examine which social-psychological factors were most dominantly associated with vaccination intention.

Results
Data from 952 mothers (14%) and 642 daughters (10%) were available for the intended analyses. The contribution of social demographic variables to the explained variance of HPV vaccination intention was small but significant for mothers (DeltaR2 = .01; p = .007), but not significant for daughters (DeltaR2 = .02; p = .17) after controlling for HPV vaccination uptake and the sample. In addition, social-psychological determinants largely contributed to the explained variance of HPV vaccination intention of mothers (DeltaR2 = .35; p < .001) and daughters (DeltaR2 = .34; p < .001). Attitudes, beliefs, subjective norms and habit strength were significantly associated with participants’ HPV vaccination intentions.

Conclusions
Because of the large contribution of social-psychological variables to the explained variance of HPV vaccination intentions among the mothers and daughters, future communication strategies targeting HPV vaccination uptake should address attitudes, beliefs, subjective norms and habit strength. There is a need for longitudinal research to confirm the causality of the association between these determinants and HPV vaccination behavior indicated by this study.

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

Eurosurveillance
Volume 18, Issue 6, 07 February 2013
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Surveillance and outbreak reports
Large measles outbreak in Geneva, Switzerland, January to August 2011: descriptive epidemiology and demonstration of quarantine effectiveness
by E Delaporte, CA Wyler Lazarevic, A Iten, P Sudr

Between January and August 2011, the canton of Geneva, Switzerland, experienced a large measles outbreak with 219 cases (47 cases per 100,000 inhabitants) in the context of an extensive epidemic in a neighbouring region of France. Most cases were young adults (median age: 18 years), often unaware of their vaccination status. The vast majority of cases were either not (81%) or incompletely vaccinated (8%). Thirty clusters with a total of 119 cases and a median cluster size of three (range: 2–15 cases) were identified. Overall, 44 cases were imported or linked to imported cases. Of 73 contacts of cases who were quarantined, 50 developed measles and caused six secondary cases. This compares to 81 secondary cases among 173 non-quarantined cases (relative risk: 0.26; 95% confidence interval: 0.06–0.65), demonstrating the effectiveness of well targeted quarantine measures in reducing transmission.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 9, Issue 2  February 2013
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/1/

COMMENTARIES
New generation of dendritic cell vaccines
Kristen J. Radford and Irina Caminschi
http://dx.doi.org/10.4161/hv.22487

Abstract:
Dendritic cells (DC) play a pivotal role in the induction and regulation of immune responses, including the induction of cytotoxic T lymphocytes (CTL) responses. These are essential for the eradication of cancers and pathogens including HIV and malaria, for which there are currently no effective vaccines. New developments in our understanding of DC biology have identified the key DC subset responsible for CTL induction, which is now an attractive candidate to target for vaccination. These DC are characterized by expression of novel markers Clec9A and XCR1, and a specialized capacity to cross-present antigen (Ag) from tumors and pathogens that do not directly infect DC. New generation DC vaccines that specifically target the cross-presenting DC in vivo have already demonstrated potential in preclinical animal models but the challenge remains to translate these findings into clinically efficacous vaccines in man. This has been greatly facilitated by the recent identification of the equivalent Clec9A+XCR1+ cross-presenting DC in human lymphoid tissues and peripheral tissues that are key sites for vaccination administration. These findings combined with further studies on DC subset biology have important implications for the design of new CTL-mediated vaccines.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 9, Issue 2  February 2013
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/1/

SHORT REPORT
Knowledge of the HPV vaccine and its association with vaccine uptake among female higher-education students in Greece
Elisavet M. Donadiki, Rodrigo Jiménez-García, Valentin Hernandez-Barrera, Pilar Carrasco-Garrido, Ana López de Andrés, Isabel Jimenez-Trujillo and Emmanuel G. Velonakis
http://dx.doi.org/10.4161/hv.22548

Abstract:
The aims of the study were to assess the awareness and knowledge of HPV vaccination among female university and technological institutes students, and their association with vaccine uptake, and to identify the variables associated with higher levels of knowledge.

We conducted a cross-sectional study among females (age 18–26 y) at institutions of higher education (universities and technological institutes) in Athens (Greece). Data was collected by way of a self-completed questionnaire that included questions on vaccine uptake and four questions about knowledge. A new variable was created by adding up the correct answers (range 0–4) and categorizing them as “low level” (0–2) and high level of knowledge (> 2).

Independent variables included: Vaccine uptake, socio-demographic characteristics and health and sexual behavior variables.

3,153 female students took part in this research (participation rate 87%), 25.82% of whom were vaccinated against HPV. Most participants (97.15%) correctly answered the question about the existence of HPV, but only 28.41% knew at which age the vaccination is recommended. Overall, 59.1% of respondents had a high level of knowledge regarding the vaccine. The multivariate logistic model showed that being vaccinated was positively and significantly associated with a high level of knowledge. Positive predictors of higher levels of knowledge were: older age; being in a relationship; being a health sciences student; past HPV infection.

In conclusion, the level of knowledge and vaccine uptake among female higher-education students in Greece was below desirable levels. A high level of knowledge is positively associated with vaccine uptake. Health education efforts are needed to improve knowledge among all higher education students in Greece.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 9, Issue 2  February 2013
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/1/

RESEARCH PAPERS
Correlates of comfort with alternative settings for HPV vaccine delivery
Annie-Laurie McRee, Paul L. Reiter, Jessica K. Pepper and Noel T. Brewer
http://dx.doi.org/10.4161/hv.22614

Abstract:
Low uptake of human papillomavirus (HPV) vaccine calls for innovative approaches. Offering the vaccine in settings outside the traditional medical home, such as schools and pharmacies, could increase use. We sought to characterize the acceptability of HPV vaccine delivery in these alternative settings using a national (US) sample of parents of adolescent males ages 11–17 y (n = 506) and their sons (n = 391) who completed our online surveys in Fall 2010. We used multivariable regression to identify correlates of parents’ and sons’ comfort with (i.e., acceptability of) alternative settings. Half of parents (50%) and over one-third of sons (37%) reported that they were comfortable with schools or pharmacies as locations for the sons to receive HPV vaccine. Parents and sons were more comfortable with HPV vaccination in alternative settings if the sons had not recently visited their health care providers or had previously received vaccines at school, or if parents and sons were comfortable talking with each other about new vaccines. Parents who perceived greater barriers to HPV vaccination were more comfortable with alternative settings, as were sons who perceived that their peers were more accepting of HPV vaccine (all p < 0.05). Offering HPV vaccine in alternative settings may increase vaccination, especially among hard-to-reach adolescents. For example, our results suggest that offering the vaccine in alternative settings to boys who had not had recent health care visits could increase uptake by more than 10%. Study findings also highlight factors that should be addressed to maximize the potential success of HPV vaccination programs.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 9, Issue 2  February 2013
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/1/

Do the quality of the trials and the year of publication affect the efficacy of intervention to improve seasonal influenza vaccination among healthcare workers?: Results of a systematic review
Silvia Schmidt, Rosella Saulle, Domitilla Di Thiene, Antonio Boccia and Giuseppe La Torre
http://dx.doi.org/10.4161/hv.22736

Abstract:
Introduction: Despite longstanding recommendations by public-health authorities vaccination coverage in health care workers worldwide are poor. The aim of this study is to conduct a systematic review of the trials conducted to increase seasonal influenza vaccination rates among health care workers.
Results: 10 articles met the pre-determined criteria. For all article the score calculation was performed.

Discussion: The combination of an educational and a promotional element appeared the most effective in augmenting the influenza vaccination coverage among health care workers. But some cases, the intervention did not contribute to increasing the vaccination rates among health care workers. In any case, the quality of controlled trials plays an important role in the results obtained by carrying out a specific intervention and contributed to obtaining these debatable results.

Materials and Methods: Research was conducted using Scopus and PubMed database. We selected all clinical trials to perform the meta-analyses.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 9, Issue 2  February 2013
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/1/

Research Papers
Adherence to rotavirus vaccination quality measures in a commercially insured population
Debra F. Eisenberg, T Gu and G Krishnarajah

Abstract:
Background
This retrospective study determined the level of compliance to rotavirus vaccination guidelines within a large, commercially insured US population, as well as compliance with PI, ACIP and HEDIS measures for rotavirus vaccination.

Methods
Medical and pharmacy claims were obtained from the HealthCore Integrated Research Database. Enrolled children were stratified into PI, ACIP and HEDIS cohorts. The PI cohort was subdivided into RV5 and RV1 cohorts due to the differences in dosing schedules and patients with mixed dosing were excluded from the these two cohorts. Patients identified in the HEDIS cohort were linked to the administering physicians.

Results
Of 162,614 patients in PI cohort, 27% did not receive rotavirus vaccinations, 24% (RV5) and 15% (RV1) had incomplete doses (p < 0.0001; RV1 vs. RV5). A total of 76% of patients completed RV5 series but not on schedule, 54% completed on schedule. A total of 85% of patients completed the RV1 series at any time, 69% completed on schedule. Among health plans, 53% of patients completed the series, 22% (RV5) and 15% (RV1) had incomplete doses (p < 0.0001). Of 2,086 physicians who treated ≥ 10 patients within the plan (regardless of vaccination status), 78% had > 50% of patients complete, 22% had > 90% of patients completed.

Conclusion
Despite both two effective rotavirus vaccines and national immunization recommendations, rotavirus vaccination remains underutilized for infants.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 9, Issue 2  February 2013
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/1/

Special Focus: Vaccine Hesitancy
RESEARCH PAPERS
Does the relative importance of MMR vaccine concerns differ by degree of parental vaccine hesitancy?: An exploratory study
Charitha Gowda, Sarah E. Schaffer, Kristin Kopec, Arielle Markel and Amanda F. Dempsey
http://dx.doi.org/10.4161/hv.22065
Abstract

A pilot study on the effects of individually tailored education for MMR vaccine-hesitant parents on MMR vaccination intention
Charitha Gowda, Sarah E. Schaffer, Kristin Kopec, Arielle Markel and Amanda F. Dempsey
http://dx.doi.org/10.4161/hv.22821
Abstract

Journal of Infectious Diseases
Volume 207 Issue 5   March 1, 2013
http://www.journals.uchicago.edu/toc/jid/current

EDITORIAL COMMENTARY
Anna P. Durbin and Stephen S. Whitehead
The Dengue Human Challenge Model: Has the Time Come to Accept This Challenge?
J Infect Dis. (2013) 207(5): 697-699 doi:10.1093/infdis/jis749

Extract
(See the major article by Sun et al on pages 700–8.)
In an important article in this issue of the Journal, Sun et al describe the first human challenge of recipients of a live attenuated tetravalent dengue vaccine (TDV) with dengue virus (DENV) known to induce symptomatic disease [1]. The challenge viruses were originally evaluated as candidate vaccines for inclusion in a TDV vaccine but were underattenuated and induced mild dengue illness in vaccinees [2, 3]. In the current study, investigators evaluated the relationship between neutralizing antibody at the time of challenge and the ability to protect against viremia and symptomatic illness. Although the number of subjects was small, the authors found that subjects with higher titers of neutralizing antibody were protected. Importantly, enhanced viremia and enhanced disease were not observed.

A human challenge model for dengue could be useful in addressing the complexities of vaccine and drug development for dengue. These include the lack of an animal model that reproduces the disease observed in humans, the necessity of the vaccine to be effective against all 4 DENV serotypes, and the lack of an identified correlate of protection. Previously, experimental infection of humans was essential in identifying the individual DENV serotypes, the mode of transmission of dengue, the incubation period of DENV, the kinetics of viremia, and the role of antibody in protection [4, 5].

Human challenge models have been used effectively in early phase clinical trials to provide a preliminary estimate of vaccine efficacy prior to engaging in large field efficacy studies and have also been used for drug development [6– …

MAJOR ARTICLES AND BRIEF REPORTS
Wellington Sun, Kenneth H. Eckels, J. Robert Putnak, Arthur G. Lyons, Stephen J. Thomas, David W. Vaughn, Robert V. Gibbons, Stefan Fernandez, Vicky J. Gunther, Mammen P. Mammen, Jr, John D. Statler, and Bruce L. Innis
Experimental Dengue Virus Challenge of Human Subjects Previously Vaccinated With Live Attenuated Tetravalent Dengue Vaccines
J Infect Dis. (2013) 207(5): 700-708 doi:10.1093/infdis/jis744

Abstract
Background. Protection against dengue requires immunity against all 4 serotypes of dengue virus (DENV). Experimental challenge may be  useful in evaluating vaccine-induced immunity.

Methods. Ten subjects previously vaccinated with a live attenuated tetravalent dengue vaccine (TDV) and 4 DENV-naive control subjects  were challenged by subcutaneous inoculation of either 103 plaque-forming units (PFU) of DENV-1 or 105 PFU of DENV-3. Two additional subjects who did not develop DENV-3 neutralizing antibody (NAb) from TDV were revaccinated with 104 PFU of live attenuated DENV-3 vaccine to evaluate memory response.

Results. All 5 TDV recipients were protected against DENV-1 challenge. Of the 5 TDV recipients challenged with DENV-3, 2 were protected. All DENV-3–challenge subjects who developed viremia also developed elevated liver enzyme levels, and 2 had values that were >10 times greater than normal. Of the 2 subjects revaccinated with DENV-3 vaccine, 1 showed a secondary response to DENV-2, while neither showed such response to DENV-3. All 4 control subjects developed dengue fever from challenge. Protection was associated with presence of NAb, although 1 subject was protected despite a lack of measurable NAb at the time of DENV-1 challenge.

Conclusions. Vaccination with TDV induced variable protection against subcutaneous challenge. DENV-3 experimental challenge was associated  with transient but marked elevations of transaminases.

Nature Medicine
February 2013, Volume 19 No 2 pp113-246
http://www.nature.com/nm/journal/v19/n2/index.html

Perspectives
Harnessing CD4+ T cell responses in HIV vaccine development – pp143 – 149
Hendrik Streeck, M Patricia D’Souza, Dan R Littman & Shane Crotty
doi:10.1038/nm.3054

There is renewed enthusiasm in developing an HIV vaccine and in understanding the requirements to elicit broadly neutralizing HIV-specific antibodies. In May 2012, a workshop convened researchers to discuss the interplay of CD4+ T cell and antibody responses to help identify key questions and areas of research that can inform future vaccine development. This Perspective summarizes the discussion of three main topics on the role of CD4+ T cells in HIV vaccine design.

Abstract
CD4+ T cells can perform a panoply of tasks to shape an effective response against a pathogen. Limited attention has been paid to the potential importance of functional CD4+ T cell responses in the context of the development of next-generation vaccines, including HIV vaccines. Many CD4+ T cell functions are newly appreciated and only partially understood. A workshop was held as a forum to bring together a small group of experts to exchange ideas on the role of CD4+ T cells in developing durable functional antibody responses, via follicular helper T cells, as well as on the roles of CD4+ T cells in other aspects of protective immunity. Here we discuss whether CD4+ T cell responses may represent a beneficial component of an efficacious HIV vaccine.

Nature Medicine
February 2013, Volume 19 No 2 pp113-246
http://www.nature.com/nm/journal/v19/n2/index.html

Public health challenges and prospects for malaria control and elimination – pp150 – 155
Pedro L Alonso & Marcel Tanner
doi:10.1038/nm.3077

Malaria’s death toll has been reduced as a result of global efforts over the last decade. Yet the rise of drug resistance and the plateauing of funding are still obstacles to eradicating the disease and reducing malaria burden. This review brings up the goals and challenges faced by researchers and the public health workforce and a way forward to effectively control and eliminate malaria.

Abstract
The past decade witnessed unprecedented efforts to control malaria, including renewed political and financial commitment and increased availability of both old and new strategies and tools. However, malaria still represents a major health burden, particularly in Africa. Important challenges such as the fragility of many health systems, the rise of insecticide and drug resistance, and particularly the expected decline both in funding and in the coverage of key interventions if they are not replaced as needed, urgently need to be addressed. Further research and development is also becoming increasingly crucial. Among other needs, common methodologies for estimating and tracking the malaria burden, new strategies to measure transmission, better understanding of immunity, and increased knowledge of the mechanisms and effects of resistance to drugs and insecticides stand out. The ongoing efforts in research and development for new antimalarial drugs, more sensitive point-of-care rapid diagnostic tests and new insecticides need further innovation and substantial strengthening. Clearly, efforts should focus not only on Plasmodium falciparum but also and increasingly on Plasmodium vivax, the neglected human malaria parasite. Addressing these challenges in a comprehensive and timely way will allow us to sustain the gains made so far and make further progress in control and progressive elimination.

Immune mechanisms in malaria: new insights in vaccine development – pp168 – 178
FOCUS ON MALARIA
Eleanor M Riley & V Ann Stewart
doi:10.1038/nm.3083

Abstract
Early data emerging from the first phase 3 trial of a malaria vaccine are raising hopes that a licensed vaccine will soon be available for use in endemic countries, but given the relatively low efficacy of the vaccine, this needs to be seen as a major step forward on the road to a malaria vaccine rather than as arrival at the final destination. The focus for vaccine developers now moves to the next generation of malaria vaccines, but it is not yet clear what characteristics these new vaccines should have or how they can be evaluated. Here we briefly review the epidemiological and immunological requirements for malaria vaccines and the recent history of malaria vaccine development and then put forward a manifesto for future research in this area.     We argue that rational design of more effective malaria vaccines will be accelerated by a better understanding of the immune effector mechanisms involved in parasite regulation, control and elimination.

New England Journal of Medicine
February 7, 2013  Vol. 368 No. 6
http://content.nejm.org/current.shtml

Review Article – Global Health
Designing Tomorrow’s Vaccines
Gary J. Nabel, M.D., Ph.D.
N Engl J Med 2013; 368:551-560
February 7, 2013 DOI: 10.1056/NEJMra1204186

Free full text:
http://www.nejm.org/doi/full/10.1056/NEJMra1204186

Pharmacoeconomics
February 2013 – Volume 31 – Issue 2  pp: 93-176
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

A Systematic Review of the Cost Effectiveness of Herpes Zoster Vaccination
Szucs, Thomas D.; Pfeil, Alena M.
Pharmacoeconomics. 31(2):125-136, February 2013.
doi: 10.1007/s40273-012-0020-7

Abstract:
Background: The varicella zoster virus (VZV) can cause two infections: chickenpox or herpes zoster (HZ). Whereas chickenpox infections are normally mild but common among children, HZ infections are common among elderly people and can give rise to post‐herpetic neuralgia (PHN), a severe and painful complication.

Objectives: This review aimed to summarize the literature available on the cost effectiveness of HZ vaccination and to summarize key issues for decision makers to consider when deciding on the reimbursement of HZ vaccination.

Methods: We conducted a literature search of the databases PubMed and EMBASE using EndNote X4 from Thomson Reuters. The following combinations of keywords were used: ‘herpes zoster vaccine’ AND ‘cost()effectiveness’ or AND ‘economic evaluation’, ‘herpes zoster vaccination’ AND ‘cost()effectiveness’ or AND ‘economic evaluation’, ‘varicella zoster vaccine’ AND ‘cost()effectiveness’ or AND ‘economic evaluation’, and ‘varicella zoster vaccination’ AND ‘cost()effectiveness’ or AND ‘economic evaluation’.

Results: A total of 11 studies were identified and included. Cost‐effectiveness analyses of varicella zoster vaccination were excluded. The quality of the included studies ranged from ‘moderate’ to ‘moderate to good’ according to the British Medical Journal guidelines of Drummond and Jefferson and the Quality of Health Economic Studies (QHES) score of Ofman et al. Most studies evaluated the cost effectiveness of universal HZ vaccination in adults aged 50 years or 60 years and older. Data sources and model assumptions regarding epidemiology, utility estimates and costs varied between studies. All studies calculated costs per QALY, which allows comparing costs of interventions in different diseases. The costs per QALY gained and the incremental cost‐effectiveness ratio (ICER) differed between studies depending on the age at vaccination, duration of vaccine efficacy, cost of vaccine course and economic perspective. All but one of the studies concluded that most vaccination scenarios are cost effective and the vaccination of specific subgroups such as the older age group is most cost effective.

Conclusions: Model input parameters such as age at vaccination, vaccine costs, HZ incidence, PHN length and duration of vaccine efficacy had a great impact on the estimated cost effectiveness of HZ vaccination. To compare the results of different cost‐effectiveness studies of HZ vaccination, uniform methods should be used and the most important input parameters used for the different models should be critically assessed.

PLoS One
[Accessed 9 February 2013]
http://www.plosone.org/

The Effect of Perceived Risks on the Demand for Vaccination: Results from a Discrete Choice Experiment
Md Z. Sadique, Nancy Devlin, William J. Edmunds, David Parkin Research Article | published 08 Feb 2013 | PLOS ONE 10.1371/journal.pone.0054149

Abstract
The demand for vaccination against infectious diseases involves a choice between vaccinating and not vaccinating, in which there is a trade-off between the benefits and costs of each option. The aim of this paper is to investigate these trade-offs and to estimate how the perceived prevalence and severity of both the disease against which the vaccine is given and any vaccine associated adverse events (VAAE) might affect demand. A Discrete Choice Experiment (DCE) was used to elicit stated preferences from a representative sample of 369 UK mothers of children below 5 years of age, for three hypothetical vaccines. Cost was included as an attribute, which enabled estimation of the willingness to pay for different vaccines having differing levels of the probability of occurrence and severity of both the infection and VAAE. The results suggest that the severity of the health effects associated with both the diseases and VAAEs exert an important influence on the demand for vaccination, whereas the probability of these events occurring was not a significant predictor. This has important implications for public health policy, which has tended to focus on the probability of these health effects as the main influence on decision making. Our results also suggest that anticipated regrets about the consequences of making the wrong decision also exert an influence on demand.

Vaccine
Volume 31, Issue 9, Pages 1255-1356 (18 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

Use of measles supplemental immunization activities (SIAs) as a delivery platform for other maternal and child health interventions: Opportunities and challenges
Pages 1259-1263
Mira Johri, Jitendar K. Sharma, Mark Jit, Stéphane Verguet

Abstract
Measles supplementary immunization activities (SIAs) offer children in countries with weaker immunization delivery systems like India a second opportunity for measles vaccination. They could also provide a platform to deliver additional interventions, but the feasibility and acceptability of including add-ons is uncertain. We surveyed Indian programme officers involved in the current (2010–2012) measles SIAs concerning opportunities and challenges of using SIAs as a delivery platform for other maternal and child health interventions. Respondents felt that an expanded SIA strategy including add-ons could be of great value in improving access and efficiency. They viewed management challenges, logistics, and safety as the most important potential barriers. They proposed that additional interventions be selected using several criteria, of which importance of the health problem, safety, and contribution to health equity figured most prominently. For children, they recommended inclusion of basic interventions to address nutritional deficiencies, diarrhoea and parasites over vaccines. For mothers, micronutrient interventions were highest ranked.

Vaccine
Volume 31, Issue 9, Pages 1255-1356 (18 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

Polio eradication in India: Progress, but environmental surveillance and vigilance still needed
Review Article
Pages 1268-1275
Animesh Chatterjee, Sanjukta Vidyant, Tapan N. Dhole

Abstract
Poliomyelitis has appeared in epidemic form, become endemic on a global scale, and has been reduced to near elimination, all within the span of documented medical history.

Nevertheless, effective vaccinations, global surveillance network, development of accurate viral diagnosis prompted the historical challenge, global polio eradication initiative (GPEI). Environmental surveillance of poliovirus means monitoring of wild polio virus (WPV) and vaccine derived polio virus (cVDPV) circulation in human populations by examining environmental specimens supposedly contaminated by human feces. The rationale for surveillance is based on the fact that PV-infected individuals, whether presenting with disease symptoms or not, shed large amounts of PV in the feces for several weeks. As the morbidity: infection ratio of PV infection is very low, and therefore this fact contributes to the sensitivity of poliovirus surveillance, which under optimal conditions can be better than that of the standard acute flaccid paralysis (AFP) surveillance. The World Health Organization (WHO) has included environmental surveillance of poliovirus in the new Strategic Plan of the Global Polio Eradication Initiative for years 2010–2012 to be increasingly used in PV surveillance, supplementing AFP surveillance and the strategic advisory group of experts on immunization (SAGE) recommended a switch from tOPV–bOPV to remove the threat of cVDPV2 and to accelerate the elimination of WPV type 1 and 3 as bOPV is a more immunogenic vaccine and to introduce one dose of IPV in their vaccination schedule prior to OPV cessation.

Vaccine
Volume 31, Issue 9, Pages 1255-1356 (18 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

Cost-effectiveness of vaccination of the elderly against herpes zoster in The Netherlands
Original Research Article
Pages 1276-1283
Pieter T. de Boer, Koen B. Pouwels, Juul M. Cox, Eelko Hak, Jan C. Wilschut, Maarten J. Postma

Abstract
Background
Each year a substantial number of Dutch elderly suffers from herpes zoster (HZ), caused by the reactivation of the varicella zoster virus (VZV). A potential complication of HZ is postherpetic neuralgia (PHN) which results in a prolonged loss of quality of life. A large randomized clinical trial, labelled the Shingles Prevention study (SPS), demonstrated that a live attenuated VZV vaccine can reduce the incidence of HZ and PHN.

Objective
We aimed to estimate the incremental cost-effectiveness ratio (ICER) of vaccination of the elderly against HZ versus no such vaccination in The Netherlands.

Methods
A cohort model was developed to compare the costs and effects in a vaccinated and a non-vaccinated age- and gender-stratified cohort of immune-competent elderly. Vaccination age was varied from 60 to 75 years. Data from published literature such as the SPS were used for transition probabilities. The study was performed from the societal as well as the health care payer’s perspective and results were expressed in euros per quality-adjusted life year (QALY) gained.

Results
In the base case, we estimated that vaccination of a cohort of 100,000 60-year-olds would prevent 4136 cases of HZ, 305 cases of PHN resulting in a QALY-gain of 209. From the societal perspective, a total of €1.9 million was saved and the ICER was €35,555 per QALY gained when a vaccine price of €87 was used. Vaccination of women resulted in a lower ICER than vaccination of men (€33,258 vs. €40,984 per QALY gained). The vaccination age with the most favourable ICER was 70 years (€29,664 per QALY gained). Parameters with a major impact on the ICER were the vaccine price and HZ incidence rates. In addition, the model was sensitive to utility of mild pain, vaccine efficacy at the moment of uptake and the duration of protection induced by the vaccine.

Conclusion
Vaccination against HZ might be cost-effective for ages ranging from 60 to 75 when a threshold of €50,000 per QALY gained would be used, at €20,000 per QALY this might not be the case. Additional information on the duration of vaccine-protection is needed to further optimize cost-effectiveness estimations.

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

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