Vaccines: The Week in Review 27 April 2013

Editor’s Notes:

Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to

pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_27 April 2013

Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…

WHO: Human infection with avian influenza A(H7N9) virus – update 25 April 2013

WHO: Global Alert and Response (GAR) – Disease Outbreak News

Human infection with avian influenza A(H7N9) virus – update 25 April 2013
As of 25 April 2013 (16:30 CET), one laboratory-confirmed case of human infection with the virus has been reported by the Taipei Centres for Disease Control (CDC).

The patient is a 53-year-old man who had been working in Jiangsu province from 28 March to 9 April 2013. He returned from Jiangsu via Shanghai on 9 April 2013, and became ill on 12 April 2013. The patient was laboratory confirmed with the virus on 24 April 2013.

   To date, a total of 109 laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus including 22 deaths have been reported to WHO. Contacts of the confirmed cases are being closely monitored….

Investigations into the possible sources of infection and reservoirs of the virus are ongoing. Until the source of infection has been identified, it is expected that there will be further cases of human infection with the virus. So far, there is no evidence of sustained human-to-human transmission.

WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied.

A team of international and Chinese experts has completed its mission to visit Shanghai and Beijing and assess the avian influenza A (H7N9) situation, and to make recommendations to the National Health and Family Planning Commission.

International H7N9 assessment team completes mission to China
Media Release:

Joint press conference on the China-WHO Joint Mission on H7N9 Assessment
Opening statement by Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security
Beijing, China
24 April 2013

“…Almost all cases have been sporadic cases, but a few family clusters have been identified. However, we are not sure if the clusters were caused by common exposure to a source of virus or due to limited person to person transmission. Evidence so far is not sufficient to conclude there is person to person transmission. Moreover, no sustained person to person transmission has been found.

We want to note that if limited person to person transmission is demonstrated in the future, it will not be surprising. Enhancing surveillance is the way to early detect such occurrence.

The situation remains complex and difficult and is evolving. WHO will continue to work closely with China in combating this new threat.

For next steps to prevent and control H7N9, the joint mission team would like to make following recommendations.

– First, it is important to undertake intense and focused investigations to determine the source(s) of human H7N9 infections with a view to taking urgent action to prevent continuing virus spread and its potentially severe consequences for human and animal health.

– Second, it is critical to maintain a high level of alert, preparedness and response for the H7N9 virus even though human cases might drop in the summer, as occurs with many other avian influenza viruses, because of the seriousness of the risk posed by this virus and because much basic information remains unknown.

– Third, it is critical to continue to conduct and strengthen both epidemiological and laboratory-based surveillance in human and animals in all Provinces of China to identify changes that might indicate the virus is spreading geographically and gaining the ability to infect people more easily.

– Fourth, it is important to ensure that there is frequent two-way sharing of information, close and timely communications and, when appropriate, coordinated or joint investigations and research between ministries of health, agriculture and forestry because this threat requires the combined efforts of these sectors.

– Fifth, it is important to continue high level scientific collaborations, communications and sharing of sequence data and viruses with WHO and international partners because the threat of H7N9 is also an international shared risk and concern.

– Sixth, it is important to encourage and foster the scientific and epidemiological studies and research needed to close major gaps in critical knowledge and understanding…

Global Vaccine Summit: Abu Dhabi 2013 — Polio Eradication and Endgame Strategic Plan 2013-2018

The Global Vaccine Summit: Abu Dhabi 2013
Event website:

Media Release: Global Leaders Support New Six-Year Plan to Deliver a Polio-Free World by 2018
Global eradication programme will move simultaneously on multiple fronts expanding focus to improve childhood immunization and protect gains made to date.
25 April 2013
[posted on GPEI site at: ]
Today, at the Global Vaccine Summit, the Global Polio Eradication Initiative (GPEI) presented a comprehensive six-year plan, the first plan to eradicate all types of polio disease – both wild poliovirus and vaccine-derived cases – simultaneously. Global leaders and individual philanthropists signaled their confidence in the plan by pledging three-quarters of the plan’s projected US$ 5.5 billion cost over six years. They also called upon additional donors to commit up front the additional US$1.5 billion needed to ensure eradication….
…“After millennia battling polio, this plan puts us within sight of the endgame. We have new knowledge about the polioviruses, new technologies and new tactics to reach the most vulnerable communities. The extensive experience, infrastructure and knowledge gained from ending polio can help us reach all children and all communities with essential health services,” said World Health Organization Director-General Margaret Chan.
The Polio Eradication & Endgame Strategic Plan 2013-2018 was developed by the GPEI in extensive consultation with a broad range of stakeholders. The plan incorporates the lessons learnt from India’s success becoming polio free (no cases since January 2011) and cutting-edge knowledge about the risk of circulating vaccine-derived polioviruses. It also complements the tailored Emergency Action Plans being implemented since last year in the remaining polio-endemic countries – Afghanistan, Pakistan and Nigeria – including approaches in place to vaccinate children in insecure areas….

…The plan addresses the operational challenges of vaccinating children, including in densely populated urban areas, hard-to-reach areas and in areas of insecurity. The plan includes the use of polio eradication experience and resources to strengthen immunization systems in high-priority countries. It also lays out a process for planning how to transition the GPEI’s resources and lessons, particularly in reaching the most marginalized and vulnerable children and communities, so that they continue to be of service to other public health efforts. It is estimated that GPEI’s efforts to eradicate polio could deliver total net benefits of US$ 40-50 billion by 2035 from reduced treatment costs and gains in productivity…
…Bill Gates, co-chair of the Bill & Melinda Gates Foundation, announced that his foundation would commit one-third of the total cost of the GPEI’s budget over the plan’s six-year implementation, for a total of US$1.8 billion. The funds will be allocated with the goal of enabling the GPEI to operate effectively against all of the plan’s objectives. To encourage other donors to commit the remaining funding up front, the Gates funding for 2016-2018 will be released when GPEI secures funding that ensures the foundation’s contribution does not exceed one-third of the total budget for those years.
Joining Gates was a new group of individual philanthropists that announced its support for full implementation of the new plan. The total new pledges from philanthropists to the polio initiative amounted to an additional US$335 million toward the plan’s six-year budget. The donors commended the tremendous progress toward eradication made in the last year and their desire to help change history and end polio while the opportunity still exists. Commitments include:
– Albert L. Ueltschi Foundation
– Alwaleed Bin Talal Foundation-Global
– Bloomberg Philanthropies
– Carlos Slim Foundation
– Dalio Foundation
– The Foundation for a Greater Opportunity established by Carl C. Icahn
– The Tahir Foundation
…The plan’s US$ 5.5 billion budget over six years requires sustaining current yearly spending to eradicate polio. The new plan’s budget includes the costs of reaching and vaccinating more than 250 million children multiple times every year, monitoring and surveillance in more than 70 countries, and securing the infrastructure that can benefit other health and development programs.

[web video] Opening Event: Global Immunization Celebration
24 April 2013
“An interactive program highlighting recent immunization and global health successes, and honoring the individuals, communities and partners who have made them possible. We will celebrate how far we have come, and prepare to spend the following day focused on the challenges left to resolve.”

[web video] The Roadmap to Global Polio Eradication
25 April 2013

Polio Eradication and Endgame Strategic Plan 2013-2018
[version at 14 April 2013]
96 pages

GPEI Update: Polio this week – As of 24 April 2013

Update: Polio this week – As of 24 April 2013
Global Polio Eradication Initiative
[Editor’s extract and bolded text]

– No WPV3 has been reported from Pakistan in more than 12 months. The most recent WPV3 dates to 18 April 2012, from Khyber Agency in Federally Administered Tribal Areas (FATA). However, subnational surveillance gaps remain in FATA, and undetected circulation cannot be ruled out. As part of the national emergency action plan, efforts are ongoing to strengthen surveillance sensitivity, particularly in FATA which has seen a decline in reporting of acute flaccid paralysis (AFP) cases over the past 12 months.

– One new WPV case was reported in the past week, bringing the total number of WPV cases for 2013 to two. It is the most recent WPV case, and had onset of paralysis on 28 March (WPV1 from Kunar).

– Two new WPV cases were reported in the past week (WPV1s from Borno and Niger), bringing the total number of WPV cases for 2013 to 14. The new case from Borno is the most recent WPV case in the country, with onset of paralysis on 28 March.

The security situation continues to be monitored closely, in consultation with law enforcement agencies. Immunization activities continue to be implemented, in some areas staggered or postponed, depending on the security situation at the local level.

Horn of Africa
– Outbreak response is continuing in various parts of the Horn of Africa, in response to the ongoing cVDPV2 outbreak in south-central Somalia. Somalia conducted subnational activities on 26-29 March, and South Sudan conducted campaigns on 19-22 March. Further activities are planned in the second half of April.

WHO: Global Vaccine Safety Initiative (GVSI) activities portfolio

WHO: Global Vaccine Safety Initiative (GVSI) activities portfolio
The Global Vaccine Safety Initiative (GVSI) is the implementation mechanism for the global vaccine safety Blueprint (the Blueprint). The GVSI is a forum administered by WHO which provides its secretariat. In this regard, GVSI is not a separate legal entity. The Blueprint is the strategic framework reference document endorsed by WHO’s Strategic Advisory Group of Experts (SAGE) on immunization and is regarded as the vaccine safety strategy of the Global Vaccine Action Plan. The purpose of the Blueprint is to optimize the safety of vaccines through effective use of vaccine pharmacovigilance principles and methods.

The GVSI Planning Group (PG) provides overall direction for the Initiative. It is composed of the designated representatives of the GVSI and WHO is an ex-officio member. At present, GVSI Participants come from Brighton Collaboration Foundation, Switzerland; University of Ghana; Ministry of Health Sri Lanka; International Vaccine Institute, Korea; Ministry of Health, Brazil; Uppsala Monitoring Centre, Sweden

One of the tasks of the GVSI PG is to maintain a portfolio of activities to enhance vaccine pharmacovigilance capabilities in low- and middle-income countries. The GVSI portfolio is a dynamic listing of activities identified as priorities for implementing the Blueprint. Source the portfolio here: Global Vaccine Safety initiative activities portfolio 2012-2020.
pdf, 126kb

Each activity in the portfolio the PG has prioritized based on the following:
– Expected impact.
– Level of impact (global or national).
– Change of current practice.
– Anticipated exploitation.
– Valuable stand alone or enabling.

Based on the above, the PG recommends funding for portfolio activities as follows:
– Priority 1- Key activity for which funding is immediately needed.
– Priority 2: Important activity for which funding is recommended.
– Priority 3: Desirable activity that should be part of a full GSVI work plan.

“Activities proposed in the portfolio reflect the work of their initiators, managers and donors regardless of the source of funding. They do not reflect WHO activities but have been identified by WHO as valuable contributions towards the shared goal of implementing the Blueprint. In this regard, WHO is not responsible nor accountable for activities implemented by individual GVSI Participants.”

Annual Albert B. Sabin Gold Medal Awarded to Dr. Anne Gershon

    The Sabin Vaccine Institute presented its annual Albert B. Sabin Gold Medal Award to Dr. Anne Gershon, of Columbia University, “for her outstanding research and public health efforts to combat the varicella zoster virus (VZV).   Dr. Gershon’s research was critical to the widespread adoption of the varicella vaccine, which prevents chickenpox.” Dr. Gershon is the director of the Division of Pediatric Infectious Disease and Professor of Pediatrics at Columbia University College of Physicians and Surgeons, a position she has held for the past 26 years. Her research, which included examining the epidemiology, diagnosis, immunology, latency, prevention and treatment of VZV, played a crucial role in the final steps of the vaccine’s licensure and broad public use.  Dr. Gershon continues to study the safety and efficacy of varicella vaccine, including the growth and pathogenesis of VZV in cell culture and latency of VZV in humans and animal models.

Full announcement:

Global Fund: President of Nigeria Joins Global Fund Support Efforts as Co-Chair

Global Fund: President of Nigeria Joins Global Fund Efforts to Broaden Fight Against HIV, TB and Malaria
23 April 2013

Nigeria’s President, Goodluck Jonathan, accepted an invitation be a Co-Chair in this year’s replenishment efforts by the Global Fund. Other Co-Chairs include UN Secretary-General Ban Ki-moon and heads of state from developed countries, emerging economies and the private sector. President Jonathan met with Mark Dybul, Executive Director of the Global Fund, on Monday to discuss joint efforts to control these deadly infectious diseases in Africa’s most populous nation and globally. Dr. Dybul praised President Jonathan’s effective leadership and personal commitment to expanding health services, embodied by Nigeria’s “Save One Million Lives” initiative that is aiming to dramatically increase access to basic quality health services, particularly for women and children.

Full media release:,_TB_and_Malaria/

PATH names Michael Kollins as chief operating officer,

   PATH named Michael Kollins as chief operating officer, a new position, noting that his career “spanning management of international entities in both the public and private sector brings great range and depth of experience to PATH. He has led multicountry, multiproduct teams at World Bicycle Relief and Morgan Stanley Investment Management in Africa, Asia, Europe, and the United States.” As PATH’s new chief operating officer, Mr. Kollins will be responsible for “addressing operational imperatives to maximize PATH’s impact on global health challenges worldwide. He will institute practices that ensure a highly effective organization, partner with leadership to improve innovative programs and services, assess PATH’s worldwide operations to identify emerging opportunities, collaborate with PATH’s board of directors and leadership to bring organizational priorities to fruition, and provide a strategic voice in integrating operational policies and procedures across PATH’s global offices…”

Full media release:

WHO: Request for nominations Strategic Advisory Group of Experts (SAGE) on immunization

WHO: Request for nominations Strategic Advisory Group of Experts (SAGE) on immunization
WHO is soliciting proposals for nominations for current vacancies on its Strategic Advisory Group of Experts (SAGE) on immunization. Nominations should be submitted no later than 28 June 2013. In view of the current SAGE membership, nominations are solicited for experts from the African, Eastern Mediterranean, European and Western Pacific regions. Nominations will then be carefully reviewed by the SAGE membership selection panel, which will propose the selection of nominees to the WHO Director-General for appointment.

SAGE is the principal advisory group to WHO for vaccines and immunization. SAGE reports directly to the Director-General and advises WHO on overall global policies and strategies, ranging from vaccine and technology research and development, to delivery of immunization and its linkages with other health interventions. Its remit extends to all vaccine-preventable diseases as well as to all age groups.

Members are acknowledged experts with an outstanding record of achievement in their own field and an understanding of the immunization issues covered by the group. Consideration is given to ensuring appropriate geographic representation and gender balance.

Please see this link for further information:

Instructions for nominations are available at the following link:

IFFIm has ratings downgrade by FitchRatings

The International Finance Facility for Immunisation (IFFIm) had a ratings downgrade by FitchRatings by one notch from AAA to AA+. The rating agency is resuming a stable outlook, with short-term issuer rating remaining unchanged at F1+. This rating action by Fitch “follows the recent downgrade by Fitch of the United Kingdom to AA+ from AAA. Fitch’s analysis of IFFIm closely links IFFIm’s rating to its two largest donors, the UK and France. IFFIm currently is rated AA+ by Fitch Ratings with a stable outlook, Aa1 by Moody’s with a negative outlook and AA+ with a negative outlook by Standard & Poor’s.” IFFIm was created in 2006 to help the international community achieve the Millennium Development Goals. IFFIm’s financial base consists of legally binding grant payments from its sovereign grantors (the UK, France, Italy, Norway, Australia, Spain, The Netherlands, Sweden and South Africa). IFFIm’s donors have made a total of about US$6.3 billion in legally-binding payment obligations to IFFIm. To date, IFFIm has raised a total of US$3.85 billion in the capital markets.

Full release:

WHO Europe: Immunization Week 2013 – Announcements

WHO Europe: Immunization Week Announcements

Guide to tailoring immunization programmes launched
Launched during European Immunization Week 2013, the guide helps national immunization programmes design targeted strategies to improve vaccination levels among babies and young children. It provides tools to identify susceptible populations, determine barriers to vaccination and implement evidence-based interventions.

New app will help parents keep track of their children’s vaccinations
Parents often cite being too busy or simply forgetting as reasons for not getting their children vaccinated fully and at the right time. WHO/Europe has developed a generic app code that countries can tailor quickly and cheaply into a simple telephone-based tool to remind parents when their children’s vaccinations are due.

Crown Princess Mary of Denmark: Elimination of preventable diseases at heart of human development
In her address to mark European Immunization Week 2013, Her Royal Highness Crown Princess Mary of Denmark, Patron of WHO/Europe, commends all 53 countries in the WHO European Region for their commitment to maintaining high vaccination coverage and raising awareness about immunization.

Measles costs
As European Immunization Week 2013 kicks off, WHO urges all 53 participating Member States in the European Region to consider the economic impact of measles and to restore or maintain effective national vaccination programmes, despite the difficulties of the economic downturn.

All countries take part in European Immunization Week

PAHO/WHO: Revolving Fund helps countries provide free vaccines during Vaccination Week in the Americas

PAHO/WHO: Revolving Fund helps countries provide free vaccines during Vaccination Week in the Americas
26 April 2013

Countries and territories participating in this year’s Vaccination Week in the Americas obtained most of their vaccines through the Pan American Health Organization/World Health Organization (PAHO/WHO) Revolving Fund, a cooperation mechanism that facilitates bulk purchases of vaccines and immunization supplies at lower prices. PAHO Director Carissa F. Etienne noted, “The PAHO Revolving Fund is an important reason why all the vaccines used during Vaccination Week in the Americas are free of charge to individuals and families….”  The PAHO/WHO Revolving Fund works by pooling member countries’ purchases of vaccines, syringes and immunization supplies and allows all countries to buy a given product at the same low price. The fund provides countries a 60-day line of credit for purchases, and PAHO/WHO staff handle all aspects of planning and consolidation of demand, negotiations with producers, placement of purchase orders, coordination with suppliers and monitoring of shipments, as well as financial aspects involving paying suppliers and billing countries. In turn, participating countries contribute 3% of the net purchase price on their orders to provide working capital for the fund. Countries can also get PAHO/WHO assistance in forecasting vaccine demand, monitoring vaccination coverage, and other areas of immunization planning. In 2012, 39 countries and territories in Latin America and the Caribbean purchased 60 different products through the Revolving Fund, worth a total of US$518 million. This included more than 200 million doses of vaccine containing 28 different antigens, including newer vaccines such as rotavirus, pneumococcal and human papillomavirus (HPV) vaccines…

Full release:

MSF-GAVI Exchange on Vaccine Pricing and Access to GAVI discount structures

MSF: Global Vaccines Community Must Bring Price of New Vaccines Down
Media Release
23 April 2013

MSF referenced the Global Vaccines Summit in calling on GAVI and pharmaceutical companies to extend discounts on critical vaccines “so more children can be reached” and warned that “high prices for new vaccines could put developing countries in the precarious situation of not being able to afford to fully vaccinate their children in the future.”
… MSF said it is also “troubled by the fact that non-governmental organizations and humanitarian actors are excluded from accessing the GAVI-negotiated price discounts. MSF is often in a position to vaccinate vulnerable groups, such as refugee children, HIV-positive children and older unvaccinated children who fall outside of the typical age range for standard vaccination programs. However, MSF has not been able to systematically access vaccines at the GAVI discounted price… “We’re asking GAVI to open up their discounted vaccine pricing to humanitarian actors that are often best placed to respond to vaccinating people in crisis…”
Full release:

GAVI responds to MSF campaign
23 April 2013

– First, we agree with MSF – we do all want the same things. We want all children everywhere to be protected by immunisation. In fact, GAVI is proud to include MSF as a member of the GAVI Alliance. They are an active member of the steering committee of the GAVI Board’s Civil Society Organisation Constituency

– MSF first formally raised the issue of access to the same prices GAVI pays for vaccines at the GAVI Board meeting in December 2012. This issue is currently being discussed through the Alliance’s Governance channels. We find it disappointing that MSF, which knows and is engaged in the GAVI Governance process, has chosen to take on this issue as a public campaign.

– GAVI works with governments to protect children by providing quality life-saving vaccines at affordable prices to all children in the 73 poorest countries in the world. 65% of the children born today are born in GAVI–supported countries. Non-government organisations, including MSF, play a critical role in the distribution of vaccines in the immunisation programmes of these countries. This work is coordinated in each country by the Ministry of Health, and the large majority of vaccines are funded by GAVI and countries…

– …GAVI has been working hard to bring down the price of these key vaccines. In fact, just last week we announced a 30% reduction in the price of the key Pentavalent vaccine that protects children against five killer diseases.

– Obtaining such low price agreements with vaccines’ manufacturers for the world’s poorest countries is only possible when there are stable forecasts, long-term commitments to large volumes with secure financing agreements from donors and recipient governments working together. Any adjustment to the current way of working will require careful consideration and the support of key constituencies. It is by working together that we can best serve the needs of children and support the long-term development of the countries in which they are born.
Full statement:

WHO: World Malaria Day – 25 April 2013

WHO: World Malaria Day – 25 April 2013
The global campaign theme for 2013 and the coming years is Invest in the future. Defeat malaria. World Malaria Day was instituted by WHO Member States during the 2007 World Health Assembly. It is an occasion to highlight the need for continued investment and sustained political commitment for malaria prevention and control. It is also an opportunity for new donors to join the global malaria partnership, and for research and academic institutions to showcase their scientific work.
More at:

WHO calls for greater investment to eliminate malaria
SEAR/PR 1557
24 April 2013
Approximately 1.3 billion people in South-East Asia continue to be at risk of malaria, even though substantial progress has been made in controlling the disease. With support from WHO and other partner agencies, countries are aiming to reduce malaria cases and deaths by 75% by 2015 (from year 2000) and contain resistance to the antimalarial drug artemisinin, with the long-term goal of eliminating the disease. On World Malaria Day, WHO calls on all Member States and partners to increase investment in malaria…

NIH: Statement on World Malaria Day
April 25, 2013
B.F. (Lee) Hall, M.D., Ph.D., and Anthony S. Fauci, M.D.
National Institute of Allergy and Infectious Diseases
The National Institutes of Health marks World Malaria Day 2013, which has the world theme Invest in the Future: Defeat Malaria, by acknowledging the considerable toll the disease continues to exact in many parts of the world. We also renew our commitment to the research needed to better understand the disease process in malaria, find new ways to diagnose and treat people with malaria, control the mosquitoes that spread it, and prevent malaria through vaccination.

UN Watch [to 27 April 2013]

UN Watch to 27 April 2013
Selected meetings, press releases, and press conferences relevant to immunization, vaccines, infectious diseases, etc.

Press Conference on World Malaria Day (25 April 2013)
Marking World Malaria Day at a Headquarters press conference, the Secretary-General’s Special Envoy for Malaria and for the Financing of the Health-related Millennium Development Goals called for vigorous efforts to replenish the Global Fund to fight Aids, Tuberculosis and Malaria.

No Greater Gift than Healthy Start in Life, Secretary-General Says, But Millions of Children Denied Right to Healthy Future Because They Lack Simple Vaccination (24 April 2013)

With $3 Billion Annual Shortfall in Controlling Malaria, Secretary-General Says Replenishing Global Fund Should be Priority to Prevent Resurgence (23 April 2013)

WHO: Eliminating measles and strengthening health services in Cambodia

WHO: Eliminating measles and strengthening health services in Cambodia
April 2013

Cambodia has found a way to immunize more children against measles and improve access to other health services.
Immunizing the last 20%

Cambodia almost doubled the number of children being immunized against measles in the ten years after 2000. But by 2011, 20% of the country’s children were still not getting even the first of the two vaccinations they need to protect them from measles.

In 2011, the WHO helped Cambodia’s National Immunization Programme use two nationwide measles immunization campaigns to check the vaccination status of women and children and to map out which communities were at highest risk of missing out on immunization. Most proved to be poor, and many were from ethnic minorities and internal migrant populations – groups who often found it hard to access regular health services…

Full text at:

WHO: Improving measles control in India

WHO: Improving measles control in India
April 2013

India is building on its polio eradication campaign experience to ensure more children get vaccinated against measles.
It is now more than two years since a child has been infected with polio in India, once considered the global epicentre of the disease.

The country’s polio eradication campaign, led by the Government of India and its partners, including the World Health Organization, has been one of the biggest, most complex, and most meticulously implemented vaccination campaigns in human history.

Building on success of polio campaigns

Intense, six-day polio vaccination campaigns have been run several times a year in India since 1996. During each campaign, 2.3 million vaccinators go door-to-door, visiting 191 million homes to vaccinate 172 million children a year.

Now India is building on the success of the polio eradication strategy to ensure that more children are immunized against other dangerous illnesses.

Measles, for example, is still one of the leading causes of death in young children. A highly contagious disease, it spreads like wildfire in communities where children are unvaccinated. And because the virus reduces immunity, children who have had measles – especially those who are undernourished – may die of pneumonia, diarrhoea and encephalitis later on…

Full text at:

WHO-PAHO: New vaccine protects Haitian children from five diseases

WHO-PAHO: New vaccine protects Haitian children from five diseases
April 2013

Haiti has recently introduced the pentavalent vaccine, a combination vaccine designed to protect children from five dangerous diseases….

Haiti is among the countries in the Americas with highest child mortality rates. The main causes are acute respiratory infections like pneumonia, diarrhoeal diseases, anaemia and chronic malnutrition. Vaccines are an effective way of preventing many of these diseases. The “five-in-one” pentavalent vaccine protects children from diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenzae type b (Hib) which causes pneumonia and meningitis…

This is why the Pan American Health Organization (PAHO), WHO’s Regional Office for the Americas, has been working with Haiti’s Ministry of Health and Population to integrate the new vaccine into the national immunization programme – putting Haiti on par with the rest of the Americas…

Full release:

NIH: HVTN 505 clinical trial discontinued

NIH: HVTN 505 clinical trial discontinued
25 April 2013

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, will stop administering injections in its HVTN 505 clinical trial of an investigational HIV vaccine regimen because an independent data and safety monitoring board (DSMB) found during a scheduled interim review that the vaccine regimen did not prevent HIV infection nor reduce viral load (the amount of HIV in the blood) among vaccine recipients who became infected with HIV. The HVTN 505 study began in 2009 and was testing an investigational prime-boost vaccine regimen developed by NIAID’s Vaccine Research Center. The Phase IIb study, conducted by the NIAID-funded HIV Vaccine Trials Network (HVTN), was designed to determine whether the vaccine regimen could prevent HIV infection and/or reduce the amount of virus in the blood of vaccine recipients who became infected with HIV….

Full release:

Assessing parents’ knowledge and attitudes towards seasonal influenza vaccination of children – Kenya

BMC Public Health
(Accessed 27 April 2013)

Research article  
Assessing parents’ knowledge and attitudes towards seasonal influenza vaccination of children before and after a seasonal influenza vaccination effectiveness study in low-income urban and rural Kenya, 2010–2011
Prisca Adhiambo Oria, Geoffrey Arunga, Emmaculate Lebo, Joshua M Wong, Gideon Emukule, Philip Muthoka, Nancy Otieno, David Mutonga, Robert F Breiman, Mark A Katz BMC Public Health 2013, 13:391 (25 April 2013)

Abstract (provisional)
Influenza vaccine is rarely used in Kenya, and little is known about attitudes towards the vaccine. From June-September 2010, free seasonal influenza vaccine was offered to children between 6 months and 10 years old in two Population-Based Infectious Disease Surveillance (PBIDS) sites. This survey assessed attitudes about influenza, uptake of the vaccine and experiences with childhood influenza vaccination.

We administered a questionnaire and held focus group discussions with parents of children of enrollment age in the two sites before and after first year of the vaccine campaign. For pre-vaccination focus group discussions, we randomly selected mothers and fathers who had an eligible child from the PBIDS database to participate. For the post-vaccination focus group discussions we stratified parents whose children were eligible for vaccination into fully vaccinated, partially vaccinated and non-vaccinated groups.

Overall, 5284 and 5755 people completed pre and post-vaccination questionnaires, respectively, in Kibera and Lwak. From pre-vaccination questionnaire results, among parents who were planning on vaccinating their children, 2219 (77.6%) in Kibera and 1780 (89.6%) in Lwak said the main reason was to protect the children from seasonal influenza. In the pre-vaccination discussions, no parent had heard of the seasonal influenza vaccine. At the end of the vaccine campaign, of 18,652 eligible children, 5,817 (31.2%) were fully vaccinated, 2,073 (11.1%) were partially vaccinated and, 10,762 (57.7%) were not vaccinated. In focus group discussions, parents who declined vaccine were concerned about vaccine safety or believed seasonal influenza illness was not severe enough to warrant vaccination. Parents who declined the vaccine were mainly too busy [251(25%) in Kibera and 95 (10.5%) in Lwak], or their child was away during the vaccination period [199(19.8%) in Kibera; 94(10.4%) in Lwak].

If influenza vaccine were to be introduced more broadly in Kenya, effective health messaging will be needed on vaccine side effects and frequency and potential severity of influenza infection.

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

Social determinants of health and seasonal influenza vaccination in adults >=65 years

BMC Public Health
(Accessed 27 April 2013)

Research article  
Social determinants of health and seasonal influenza vaccination in adults >=65 years: a systematic review of qualitative and quantitative data
Jason M Nagata, Isabel Hernández-Ramos, Anand Sivasankara Kurup, Daniel Albrecht, Claudia Vivas-Torrealba, Carlos Franco-Paredes BMC Public Health 2013, 13:388 (25 April 2013)

Abstract (provisional)
Vaccination against influenza is considered the most important public health intervention to prevent unnecessary hospitalizations and premature deaths related to influenza in the elderly, though there are significant inequities among global influenza vaccine resources, capacities, and policies. The objective of this study was to assess the social determinants of health preventing adults >= 65 years old from accessing and accepting seasonal influenza vaccination.

A systematic search was performed in January 2011 using MEDLINE, ISI — Web of Science, PsycINFO, and CINAHL (1980–2011). Reference lists of articles were also examined. Selection criteria included qualitative and quantitative studies written in English that examined social determinants of and barriers against seasonal influenza vaccination among adults >= 65 years. Two authors performed the quality assessment and data extraction. Thematic analysis was the main approach for joint synthesis, using identification and juxtaposition of themes associated with vaccination.

Overall, 58 studies were analyzed. Structural social determinants such as age, gender, marital status, education, ethnicity, socio-economic status, social and cultural values, as well as intermediary determinants including housing-place of residence, behavioral beliefs, social influences, previous vaccine experiences, perceived susceptibility, sources of information, and perceived health status influenced seasonal influenza vaccination. Healthcare system related factors including accessibility, affordability, knowledge and attitudes about vaccination, and physicians’ advice were also important determinants of vaccination.

Our results demonstrate that the ability of adults >=65 years to receive seasonal influenza vaccine is influenced by structural, intermediate, and healthcare-related social determinants which have an impact at the health system, provider, and individual levels.

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

Genetic and epigenetic susceptibility to early life infection

Current Opinion in Infectious Diseases.
June 2013 – Volume 26 – Issue 3  pp: v-v,213-293

Genetic and epigenetic susceptibility to early life infection
Strunk, Tobias; Jamieson, Sarra E.; Burgner, David
Current Opinion in Infectious Diseases. 26(3):241-247, June 2013.
doi: 10.1097/QCO.0b013e32835fb8d9

Purpose of review: This review aims to interpret the current literature on the role of genetic and epigenetic factors in susceptibility to neonatal infection, a leading cause of early life mortality and morbidity.

Recent findings: Epidemiological data indicate that the differential susceptibility to infection is partly heritable. To date there have been relatively few studies on genetic determinants of susceptibility to neonatal infection and many of these have methodological shortcomings. Most studies predominantly focus on the innate immune system. There is growing interest in the potential role of epigenetic mechanisms in disease susceptibility and data are emerging on the role of epigenetics in the maturation of the immune system in early life.

Summary: Infection is a leading cause of morbidity and mortality, especially in preterm infants, but it remains unclear why neonates are so susceptible or what mediates differential risk. Genetic and epigenetic epidemiologic studies may assist in the identification of critical protective and pathogenic pathways. Despite the current relative lack of robust data, such studies may facilitate the development of interventions that ultimately decrease the significant morbidity and mortality of this highly vulnerable population.

Maternal immunization as a strategy to decrease susceptibility to infection in newborn infants

Current Opinion in Infectious Diseases.
June 2013 – Volume 26 – Issue 3  pp: v-v,213-293

Maternal immunization as a strategy to decrease susceptibility to infection in newborn infants
Lindsey, Benjamin; Kampmann, Beate; Jones, Christine
Current Opinion in Infectious Diseases. 26(3):248-253, June 2013.
doi: 10.1097/QCO.0b013e3283607a58

Purpose of review: Following on from the success of maternal tetanus vaccination, recent research has shown that other vaccines given in pregnancy can protect against vaccine-preventable infections in early infancy. This review will outline these recent developments and highlight the impact on current clinical practice.

Recent findings: Maternal immunization provides protection to the newborn through the transfer of vaccine-induced IgG across the placenta, a process that is affected by multiple variables. The safety of newly recommended maternal vaccines has been further tested in recent studies. Maternal vaccination against influenza and pertussis is recommended in the United Kingdom and United States, with new studies indicating their efficacy. A number of additional maternal vaccines are also in the pipeline, which could be used to combat neonatal infection. Recent research findings have highlighted some of the reasons for the poor uptake of current recommendations among pregnant women.

Summary: Tetanus, influenza and pertussis vaccines are now recommended for use during pregnancy, with new vaccines, such as group B streptococcus and respiratory syncytial virus, being developed to prevent important neonatal infections in the future.

Evidence-Based Persuasion: An Ethical Imperative

April 24, 2013, Vol 309, No. 16

Evidence-Based Persuasion: An Ethical Imperative
David Shaw, PhD; Bernice Elger, MD

The primacy in modern medical ethics of the principle of respect for autonomy has led to the widespread assumption that it is unethical to change someone’s beliefs, because doing so would constitute coercion or paternalism.1– 2 In this Viewpoint we suggest that persuasion is not necessarily paternalistic and is an essential component of modern medical practice.

There are at least 3 different types of persuasion. The first is the removal of biases; the second is recommending a particular course of action and providing evidence and reasons in favor of it; and the third is the potential creation of new biases, which could cross the line into unethical manipulation. The first of these is always mandatory, the second is usually permissible but sometimes inappropriate, and the third is normally impermissible but sometimes acceptable in rare cases…

Stemming the Global Trade in Falsified and Substandard Medicines

April 24, 2013, Vol 309, No. 16

Stemming the Global Trade in Falsified and Substandard Medicines
Lawrence O. Gostin, JD; Gillian J. Buckley, MPH, PhD; Patrick W. Kelley, MD, DrPH

When Hippocrates advised physicians to never give a deadly drug, he assumed they would know for sure that the medicines they prescribed were safe. Today, criminals and unscrupulous manufacturers have permeated the global pharmaceutical market, calling into question this basic assumption of clinical practice. Between November 2012 and March 2013, an injectable drug compounded under unhygienic conditions at the New England Compounding Pharmacy was linked to more than 700 illnesses and 50 deaths.1 In poor countries, where drug regulatory oversight is weaker, the problem is worse, but blends with the background noise of high mortality and strained health systems. Only in rare cases, as when 120 Pakistanis died after taking a carelessly made batch of isosorbide mononitrate, do people in low- and middle-income countries learn of their vulnerability…2

Protection wanes 5 years after the 5th dose of DTaP

Journal of Pediatrics
May 2013, Vol. 162, No. 5

Protection wanes 5 years after the 5th dose of DTaP
Jennie S. Lavine, PhD

Among children immunized with 5 doses of diphtheria, tetanus, and acellular pertussis vaccine (DTaP), what is the association of development of pertussis with time elapsed from the last dose?

Case-control study comparing the time from the 5th dose of DTaP in children testing positive for pertussis, with both those testing negative for pertussis, and matched healthy controls.

49 medical clinics and 19 hospitals in Northern California.

Children, 4-12 years old, who are members of Kaiser Permanente of Northern California.

Secondary analysis of the Kaiser Permanente Database.

The primary outcome was comparison of patients who were polymerase chain reaction (PCR)-positive with patients who were PCR-negative controls. The secondary outcome was comparison of patients who were PCR-positive with matched healthy controls.

Main Results
277 children, 4 to 12 years of age, who were PCR-positive for pertussis were compared with 3318 PCR-negative controls and 6086 matched controls. Children who were PCR-positive were more likely to have received the 5th DTaP dose earlier than PCR-negative controls (P < .001) or matched controls (P = .005). Comparison with PCR-negative controls yielded an OR of 1.42 (95% CI: 1.21-1.66), indicating that after the 5th dose of DTaP, the odds of acquiring pertussis increased by an average of 42% per year.

Protection against pertussis waned during the 5 years after the fifth dose of DTaP.

Resurgence of pertussis has spurred many studies on the effectiveness of current vaccines.1 The switch from whole-cell to acellular vaccine (DTaP) in the 1990s may be partly to blame for the increased incidence. Klein et al demonstrate that immunity induced by DTaP wanes quickly (controlling for vaccination history and case diagnosis). Their study includes patients who should have received only DTaP and cases diagnosed by standardized PCR. Additionally, Klein et al address doctors’ varying propensity to test for pertussis by comparing the cases with children who were PCR-negative who experienced similar testing biases. The study does not include unvaccinated or whole-cell vaccinated controls, so factors other than DTaP’s efficacy may contribute. Nonetheless, this study is a wake-up call: DTaP’s short-lasting effectiveness means that protecting infants via herd immunity is impractical, even with booster doses. Future research is needed to ascertain the causes of the shortened duration of immunity and to develop a better vaccine.2, 3 In the mean time, strategies for protecting infants is the priority. Despite its short duration, DTaP’s primary efficacy is high. Given the results of the current study, “cocooning” infants (ie, administering booster doses to parents and older siblings) is both logical and necessary.

Comment: Back to basics: the miracle and tragedy of measles vaccine

The Lancet  
Apr 27, 2013  Volume 381 Number 9876  p1431 – 1510  e10 – 11

Back to basics: the miracle and tragedy of measles vaccine
Zsuzsanna Jakab, David M Salisbury

As we herald progress towards the Millennium Development Goals and strive to meet them, we have an approaching public health target that is sometimes forgotten. The global community has resolved to reduce measles deaths by 95% by 2015, and five of the six WHO regions plan to eliminate measles within this decade.1 The current outbreak of measles in Swansea, UK, is tragic in many ways, with hundreds of ill children, health staff stretched and working overtime to care for patients and trace contacts, the need for emergency vaccination clinics, and the spectre of death from measles.

Comment: Should the UK introduce compulsory vaccination?

The Lancet  
Apr 27, 2013  Volume 381 Number 9876  p1431 – 1510  e10 – 11

Should the UK introduce compulsory vaccination?
David Elliman, Helen Bedford

Inevitably, an outbreak of a vaccine-preventable disease in the UK triggers calls for compulsory vaccination. As of April 17, 2013, 808 cases of measles have been reported in the Swansea area, about 10% of which have led to hospital admission.1 One young adult who died is known to have had measles at the time, but it has not yet been confirmed if he died because of measles. Large outbreaks of measles have also occurred in northern England, with 865 confirmed cases in northwest England.2 Measles has a case fatality rate of between 1 per 1000 and 1 per 3000 reported measles cases,3 and unless the outbreaks are brought to a halt, more deaths will result.

The Lancet: Influenza vaccine and Guillain-Barré syndrome:

The Lancet  
Apr 27, 2013  Volume 381 Number 9876  p1431 – 1510  e10 – 11

Influenza vaccine and Guillain-Barré syndrome: making informed decisions
Gregory A Poland, Caroline M Poland, Charles L Howe
Fears about development of Guillain-Barré syndrome (GBS) after influenza vaccination have hampered individual and population-level vaccine coverage rates. Uncertainties began with the 1976 H1N1 swine influenza vaccine programme, which saw an estimated relative risk of GBS of 7–8 after vaccination,1 although the attributable risk was probably lower.2 Regardless, the Institute of Medicine stated in 2004 that evidence favours a causal relation between the 1976 H1N1 influenza vaccine and GBS3 but in 2011 concluded the evidence was inadequate for seasonal vaccines.

Association between Guillain-Barré syndrome and influenza A (H1N1) 2009 monovalent inactivated vaccines in the USA: a meta-analysis
Daniel A Salmon, Michael Proschan, Richard Forshee, Paul Gargiullo, William Bleser, Dale R Burwen, Francesca Cunningham, Patrick Garman, Sharon K Greene, Grace M Lee, Claudia Vellozzi, W Katherine Yih, Bruce Gellin, Nicole Lurie, the H1N1 GBS Meta-Analysis Working Group

The influenza A (H1N1) 2009 monovalent vaccination programme was the largest mass vaccination initiative in recent US history. Commensurate with the size and scope of the vaccination programme, a project to monitor vaccine adverse events was undertaken, the most comprehensive safety surveillance agenda in the USA to date. The adverse event monitoring project identified an increased risk of Guillain-Barré syndrome after vaccination; however, some individual variability in results was noted. Guillain-Barré syndrome is a rare but serious health disorder in which a person’s own immune system damages their nerve cells, causing muscle weakness, sometimes paralysis, and infrequently death. We did a meta-analysis of data from the adverse event monitoring project to ascertain whether influenza A (H1N1) 2009 monovalent inactivated vaccines used in the USA increased the risk of Guillain-Barré syndrome.

Data were obtained from six adverse event monitoring systems. About 23 million vaccinated people were included in the analysis. The primary analysis entailed calculation of incidence rate ratios and attributable risks of excess cases of Guillain-Barré syndrome per million vaccinations. We used a self-controlled risk-interval design.

Influenza A (H1N1) 2009 monovalent inactivated vaccines were associated with a small increased risk of Guillain-Barré syndrome (incidence rate ratio 2·35, 95% CI 1·42—4·01, p=0·0003). This finding translated to about 1·6 excess cases of Guillain-Barré syndrome per million people vaccinated.

The modest risk of Guillain-Barré syndrome attributed to vaccination is consistent with previous estimates of the disorder after seasonal influenza vaccination. A risk of this small magnitude would be difficult to capture during routine seasonal influenza vaccine programmes, which have extensive, but comparatively less, safety monitoring. In view of the morbidity and mortality caused by 2009 H1N1 influenza and the effectiveness of the vaccine, clinicians, policy makers, and those eligible for vaccination should be assured that the benefits of inactivated pandemic vaccines greatly outweigh the risks.

US Federal Government.

Lancet Series – Childhood Pneumonia and Diarrhoea

The Lancet  
Apr 27, 2013  Volume 381 Number 9876  p1431 – 1510  e10 – 11

Childhood Pneumonia and Diarrhoea
Bottlenecks, barriers, and solutions: results from multicountry consultations focused on reduction of childhood pneumonia and diarrhoea deaths
Christopher J Gill, Mark Young, Kate Schroder, Liliana Carvajal-Velez, Marion McNabb, Samira Aboubaker, Shamim Qazi, Zulfiqar A Bhutta
Preview | Summary | Full Text | PDF

Childhood Pneumonia and Diarrhoea
Ending of preventable deaths from pneumonia and diarrhoea: an achievable goal
Mickey Chopra, Elizabeth Mason, John Borrazzo, Harry Campbell, Igor Rudan, Li Liu, Robert E Black, Zulfiqar A Bhutta
Preview | Summary | Full Text | PDF

Applying lessons from SARS to a newly identified coronavirus

The Lancet Infectious Diseases
May 2013  Volume 13  Number 5  p377 – 464

Applying lessons from SARS to a newly identified coronavirus
Brian McCloskey, Alimuddin Zumla, Gwen Stephens, David L Heymann, Ziad A Memish
Preview | Full Text | PDF

Human infection with a newly identified novel coronavirus has rapidly focused global attention on risk assessment1–6 because its epidemic potential is not known. First detected in September, 2012, in a patient who had died of an acute respiratory illness in Saudi Arabia,4 it was soon confirmed in a Qatari patient with a similar illness in London, UK. These cases triggered collaborations between the Kingdom of Saudi Arabia Ministry of Health (KSA-MoH), Qatar, and other global partners. The immediate need was to ensure the safety of the 3 million pilgrims attending the Hajj pilgrimage in October, 2012.

Nature – Editorial: The fight against bird flu Worldview: H7N9 is a virus worth worrying about

Volume 496 Number 7446 pp397-542  25 April 2013

Nature | Editorial
The fight against bird flu
China’s well-handled response to outbreaks of H7N9 avian influenza belies the country’s bad reputation from its past dealings with disease. But there are still improvements to be made.
24 April 2013

China deserves credit for its rapid response to the outbreaks of H7N9 avian influenza, and its early openness in the reporting and sharing of data.

A bad reputation is difficult to shake. A decade ago, China failed to report early cases of severe acute respiratory syndrome (SARS) and fumbled its initial response to the threat. Today, some commentators view its reaction to H7N9 with mistrust. But from all the evidence so far,   China’s response to the virus, which had caused 104 confirmed human cases and 21 deaths as Nature went to press, is next to exemplary.

China reported the H7N9 outbreak to the World Health Organization (WHO) on 31 March, just six weeks after the first known person fell ill. On the same day, it published the genomic sequences of viruses from the three human cases then identified on the database of the Global Initiative on Sharing Avian Influenza Data (GISAID). It has also shared all the sequences with the WHO, and live virus with the WHO and other laboratories. This has allowed scientists to identify the virus’s mutations, trace its origins and develop crucial diagnostic tests. China continues to report new cases daily, and its media discusses H7N9 fairly openly. Chinese and other researchers have quickly published detailed analyses of the virus in journals (R. Gao N. Engl. J. Med.; 2013). Chinese President Xi Jinping added political clout last week when he called for an effective response, and said that the government must ensure the release of accurate information about the outbreaks.

China’s response to the epidemic has also been brisk. Diagnostic tests have been distributed to hospitals and research labs across the country. The response, spearheaded by the Chinese Center for Disease Control and Prevention in Beijing, has united clinicians, virologists, and epidemiologists. Live-bird markets at which H7N9 has been found have been shut down, and birds culled. The agriculture ministry has tested tens of thousands of birds and other animals for the virus, to try to pin down the sources of human infections and explain their occurrence in cities hundreds of kilometres apart — no mean task given that China has some 6 billion domestic fowl and half a billion pigs, which can also carry the virus. So far, however, apart from birds at the live markets, the sources of infection remain elusive. To help track them down, and to collaborate in efforts to control H7N9, China has invited a team of WHO scientists and international flu experts to the country. They arrived last week, and are expected to report their preliminary conclusions this week.

Yet suspicions linger. Some critics have questioned, for example, the time between the first person falling ill on 19 February and China’s first announcement about the virus, and have asked whether the announcement was deliberately delayed. This is unfair. With just a handful of severe pneumonia cases caused by the virus by mid-March, it is impressive that China realized as quickly as it did that something was amiss. It took the United States, which has one of the world’s most advanced disease-surveillance systems, an almost identical amount of time to identify a novel H3N2 swine virus that caused serious illness in a child in 2011.

“China has made a good start, but it is crucial for the country to continue its openness over the H7N9 outbreaks.”

China has made a good start, but it is crucial for the country to continue its openness over the H7N9 outbreaks. In particular, it must promptly report any evidence of human-to-human spread. There are also areas for improvement: data made public on human cases are often limited to basic facts such as age, sex, date of onset of illness and location. Epidemiologists also need more detailed data, including possible exposures to infection and underlying medical conditions. Case reports should be published in full in journals or online as quickly as possible.

It is also important that sequences from as many cases as possible are submitted to publicly accessible databases, because sequence data are important in tracking evolutionary changes such as new mutations that could allow the virus to spread between humans more easily. They can also provide clues to the source of infection (see page 399).

Even as the Chinese authorities are being open and transparent on H7N9, some scientists are hoarding epidemiological and other data, because of intense competition to be the first to publish. Competition can be healthy, but in the face of a virus that has the potential to cause a pandemic, researchers have a duty above all else to share important data. Journals must be ready and willing, as in any public-health emergency, to fast-track peer review of H7N9 papers, and not let rapid publication of preprints stand in the way of considering papers for publication. Meanwhile, observers should continue to scrutinize China’s response to H7N9, but they should also give credit where credit is due. It is time to recognize that China has changed.

Nature | Column: World View
H7N9 is a virus worth worrying about
Warnings about the emergence of another influenza virus may elicit skepticism, but we should not be complacent, cautions Peter Horby.
24 April 2013

Once again an animal influenza A virus has crossed the species barrier to cause an appreciable number of human cases. Now, two months after the first known human infections with the H7N9 virus, the question is: which of the paths set by previous emerging influenza viruses will it follow?

One predecessor, H5N1, generated alarm owing to its high pathogenicity in humans. It has proved to be a tenacious adversary, remaining endemic in poultry across large parts of Asia, but thankfully it has not adapted to humans and person-to-person transmission remains rare. A second, H7N7, caused a number of mostly mild human infections in the Netherlands in 2003, with some evidence of limited person-to-person spread, but extensive poultry culling controlled it. A third, the H1N1 swine influenza virus that emerged in 2009, successfully adapted to humans and caused a pandemic.

So will H7N9 prove to be controllable? Will it remain entrenched in animals? Or will it, like the H1N1 virus, stably adapt to humans and cause a pandemic? The fine line between foresight and alarmism can only be drawn in retrospect. Nevertheless, my colleagues and I consider that H7N9 has many of the traits that make a new flu virus worrisome.

The H7N9 haemagglutinin protein — which binds to target cells — resembles those of other avian flu viruses that cause only mild disease in birds. This means that the virus is likely to spread silently in domestic and probably wild birds. Human infections are therefore the sentinel events, and the numbers and geographic extent of human cases — all of them so far in China — suggest that a hidden epidemic in other animals is well under way.

The small number of poultry in which H7N9 has so far been detected is rather puzzling, as are the 20% of people infected with the virus who have not reported exposure to poultry. Nevertheless, domestic birds are likely to be the main source of human infections. And the animal epidemic is likely to spread farther, with large suppliers distributing poultry across China.  Flying wild birds are another possible mode of spread. Given that the virus probably does not cause severe disease in birds, and the uncertainty surrounding the animal source, containing the animal epidemic poses an enormous challenge.

So far, extensive monitoring of contacts has not found evidence that the virus has spread efficiently between people. Limited human-to-human transmission may have occurred but, as we saw with H5N1 and H7N7, this does not necessarily represent the early stages of a trajectory towards full human adaptation. However, H7N9 viruses isolated from patients possess some genetic signatures that are associated with effective replication and transmission, and with high virulence in mammals. The regions of China where H7N9 seems to be circulating have large populations of pigs as well as humans, providing opportunities for further adaptation to mammals and for re-assortment with human- or pig-adapted viruses.

The clinical epidemiology of H7N9 cases has some similarities to human seasonal influenza. Unlike the H7N7 cases in 2003, which usually took the form of conjunctivitis, the H7N9 infections so far detected have caused respiratory illness, with cases in all ages but being most severe in the elderly and people with underlying illnesses. However, the fact that the average age of people infected is high — around 60 years — and that most reported infections have been severe suggests that the virus is not yet well adapted to humans. Only further clinical and epidemiological data will reveal the full spectrum of infection and severity.

Standardized collection and sharing of clinical data would aid risk assessment and treatment. A clinical protocol and case-record and informed-consent forms developed by the International Severe Acute Respiratory and Emerging Infection Consortium and the World Health Organization are available online (see

If H7N9 were to stably adapt to humans, it would probably meet with little or no human immunity. Detecting and tracking a partially human-adapted H7N9 virus in a city as vast as Shanghai or Beijing would be difficult; tracking a fully adapted virus would be impossible. And it could easily spread nationally and internationally. Eastern China is now one of the most ‘connected’ population centres in the world. Seventy per cent of the global population outside China lives within two hours of an airport linked to the outbreak regions by a direct flight or a single connection (see Travel restrictions or border screening will not contain pandemic influenza for long.

If there was an overreaction to H1N1, we should not compound the error by under-reacting to H7N9. Hopefully H7N9 will remain an animal virus, and maybe the fact that it has circulated for at least two months without stably adapting to humans indicates that the species barrier is too great for it; but maybe not. The first human case of H7N9 outside mainland China is perhaps only a matter of time. Then the public-health and clinical community will need to assess, carefully and quickly, whether it represents a single imported case of animal-to-human transmission, an animal epidemic that has spread abroad, or the international spread of a partially or fully human-adapted virus.

The global distribution and burden of dengue

Volume 496 Number 7446 pp397-542  25 April 2013

The global distribution and burden of dengue
Samir Bhatt, Peter W. Gething, Oliver J. Brady, Jane P. Messina, Andrew W. Farlow, Catherine L. Moyes, John M. Drake, John S. Brownstein, Anne G. Hoen, Osman Sankoh, Monica F. Myers,
Dylan B. George, Thomas Jaenisch, G. R. William Wint, Cameron P. Simmons, Thomas W. Scott,
Jeremy J. Farrar & Simon I. Hay
Nature 496, 504–507 (25 April 2013)

Dengue is a systemic viral infection transmitted between humans by Aedes mosquitoes1. For some patients, dengue is a life-threatening illness2. There are currently no licensed vaccines or specific therapeutics, and substantial vector control efforts have not stopped its rapid emergence and global spread3. The contemporary worldwide distribution of the risk of dengue virus infection4 and its public health burden are poorly known2, 5. Here we undertake an exhaustive assembly of known records of dengue occurrence worldwide, and use a formal modelling framework to map the global distribution of dengue risk. We then pair the resulting risk map with detailed longitudinal information from dengue cohort studies and population surfaces to infer the public health burden of dengue in 2010. We predict dengue to be ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and the degree of urbanization. Using cartographic approaches, we estimate there to be 390 million (95% credible interval 284–528) dengue infections per year, of which 96 million (67–136) manifest apparently (any level of disease severity). This infection total is more than three times the dengue burden estimate of the World Health Organization2.  Stratification of our estimates by country allows comparison with national dengue reporting, after taking into account the probability of an apparent infection being formally reported. The most notable differences are discussed. These new risk maps and infection estimates provide novel insights into the global, regional and national public health burden imposed by dengue. We anticipate that they will provide a starting point for a wider discussion about the global impact of this disease and will help to guide improvements in disease control strategies using vaccine, drug and vector control methods, and in their economic evaluation.

A School-Based Human Papillomavirus Vaccination Program in Barretos, Brazil: Final Results of a Demonstrative Study

PLoS One
[Accessed 27 April 2013]

A School-Based Human Papillomavirus Vaccination Program in Barretos, Brazil: Final Results of a Demonstrative Study
José Humberto Tavares Guerreiro Fregnani, André Lopes Carvalho, José Eluf-Neto, Karina de Cássia Braga Ribeiro, Larissa de Melo Kuil, Tauana Arcadepani da Silva, Silvia Lapola Rodrigues, Edmundo Carvalho Mauad, Adhemar Longatto-Filho, Luisa Lina Villa
Research Article | published 24 Apr 2013 | PLOS ONE 10.1371/journal.pone.0062647

The implementation of a public HPV vaccination program in several developing countries, especially in Latin America, is a great challenge for health care specialists.

To evaluate the uptake and the three-dose completion rates of a school-based HPV vaccination program in Barretos (Brazil).

The study included girls who were enrolled in public and private schools and who regularly attended the sixth and seventh grades of elementary school (mean age: 11.9 years). A meeting with the parents or guardians occurred approximately one week before the vaccination in order to explain the project and clarify the doubts. The quadrivalent vaccine was administered using the same schedule as in the product package (0–2–6 months). The school visits for regular vaccination occurred on previously scheduled dates. The vaccine was also made available at Barretos Cancer Hospital for the girls who could not be vaccinated on the day when the team visited the school.

Among the potential candidates for vaccination (n = 1,574), the parents or guardians of 1,513 girls (96.1%) responded to the invitation to participate in the study. A total of 1,389 parents or guardians agreed to participate in the program (acceptance rate = 91.8%). The main reason for refusing to participate in the vaccination program was fear of adverse events. The vaccine uptake rates for the first, second, and third doses were 87.5%, 86.3% and 85.0%, respectively. The three-dose completion rate was 97.2%.

This demonstrative study achieved high rates of vaccination uptake and completion of three vaccine doses in children 10–16 years old from Brazil. The feasibility and success of an HPV vaccination program for adolescents in a developing country may depend on the integration between the public health and schooling systems.

Knowledge, attitudes and beliefs of health care workers towards influenza vaccination [U.K.]

Knowledge, attitudes and beliefs of health care workers towards influenza vaccination
Occup Med (Lond) (2013) 63(3): 189-195 doi:10.1093/occmed/kqt002
O. T. Mytton, E. M. O’Moore, T. Sparkes, R. Baxi, and M. Abid

Influenza vaccination is routinely offered to health care workers in the UK to prevent nosocomial spread to patients and illness among health care workers. Despite its importance uptake has been low in the UK.

To describe the knowledge, attitudes and behaviour of health care workers towards influenza vaccination offered as part of occupational health and to understand their relative importance in promoting uptake of influenza vaccine. We also sought to make comparisons with other vaccines more readily accepted as part of occupational health.

An online survey was distributed by e-mail to health care workers in the South Central Strategic Health Authority. The questionnaire included the following: demographic characteristics; vaccination status; and knowledge, attitudes and behaviour towards influenza, MMR and hepatitis B vaccination. We used logistic regression to identify the independent predictors of receipt of influenza vaccine.

The survey was completed by 998 health care workers representing just over 1% of health care workers in the region. Of those, 69% thought that overall benefits of influenza vaccination were greater than the risks and inconvenience (versus 92% for hepatitis B and 86% for MMR). The following predicted receipt of influenza vaccine: belief that influenza poses a risk to one’s own health (OR 3.74; 95% CI 2.45–5.71); belief that influenza vaccine is harmful (OR 0.25; 95% CI 0.16–0.37); and belief that influenza vaccine will protect patients (OR 2.96; 95% CI 1.89–4.62).

Staff knowledge, attitudes and beliefs concerning influenza and its vaccine are an important predictor of uptake and should be a target for campaigns to promote uptake.

Comment: Achieving a Bold Vision for Global Health: Yes, it’s Possible [Steve Davis, PATH]

Accessed 27 April 2013
4/22/2013 @ 9:41PM |

Achieving a Bold Vision for Global Health: Yes, it’s Possible
Editor’s Note: Steve Davis is president and chief executive officer of PATH, a Seattle-based international nonprofit organization that transforms global health through innovation. This piece was published in partnership with the Skoll World Forum.

This week, 200 of the world’s most influential global health leaders will gather in the island city of Abu Dhabi to talk about a big, bold goal: ending polio. The devastating illness has dwindled almost entirely in the last 25 years, but children in a few pockets of the world are still becoming infected with polio despite decades of work to prevent it. The global health community is tantalizingly close to wiping out this scourge, and the Global Vaccine Summit promises a chance to put even more muscle into the global eradication campaign…

Unhealthy Practice [Pakistan polio workers]

Foreign Affairs
Accessed 27 April 2013
Unhealthy Practice
By Leonard S. Rubenstein
April 24, 2013

For the second time in less than six months, polio vaccine workers in Pakistan have come under fire. For the gunmen, killing health care workers has been seen as a legitimate response to a nefarious extension of Western power. And, for the CIA, faux vaccine campaigns have sometimes been justified as part of the war on terror. Both sides are wrong: denying or providing health care should never be an instrument of statecraft…

Vaccines: The Week in Review 20 April 2013

Editor’s Notes:

Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to

pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_20 April 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…

WHO: World Immunization Week 2013

WHO: World Immunization Week 2013
“…World Immunization Week starts 20 April with its call to “Protect your world, get vaccinated” and a range of activities in some 180 countries to help immunize more children against preventable diseases.

“We have seen some major advances in the development and delivery of vaccines in the past few years,” said Dr Flavia Bustreo, Assistant Director-General at WHO. “But many countries still face obstacles in getting life-saving vaccines to every child who needs them.”

Many countries encounter serious challenges in vaccine supply and logistics, from inability to keep vaccines at the correct temperature, to record keeping which enables community health workers to ensure the right vaccines reach the children who need them.

Inefficient health and delivery systems threaten access, availability, quality – and health outcomes….

World Immunization Week, with its call to “Protect your world, get vaccinated” is an opportunity to raise global awareness of the health benefits of vaccination. Governments, development partners, international organizations, manufacturers, health professionals, academia, civil society, communities and individuals come together in 180 countries to promote the goal of universal immunization coverage – and to overcome challenges to achieving it.

Different geographical regions emphasize different themes to adapt to their specific needs. In World Immunization Week 2013 the regional focus is as follows:
– Africa: Save lives, Prevent disabilities, Vaccinate!
– The Americas: Vaccination, a shared responsibility.
– Eastern Mediterranean: Stop measles now!
– Europe: Protect. Prevent. Immunize.
– South-East Asia: Intensification of routine immunization.
– Western Pacific: Finish the job – No more measles for anyone.

WHO GAR: Human infection with avian influenza A(H7N9) virus in China – update 19 April 2013

WHO: Global Alert and Response (GAR) – Disease Outbreak News
Human infection with avian influenza A(H7N9) virus in China – update 19 April 2013

The National Health and Family Planning Commission of China notified WHO of an additional four laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus from Jiangsu 1 (0) and Zhejiang 3 (0). No additional death has been reported…

To date, there are a total of 91 laboratory confirmed human cases with influenza A(H7N9) virus including seventeen fatalities in China reported from four Provinces: Anhui 3 (1), Henan 3 (0), Jiangsu 22 (3) and Zhejiang 30 (2) and two Municipalities: Beijing 1 (0) and Shanghai 32 (11). Currently, 67 patients are hospitalized and seven have been discharged.

So far, there is no evidence of ongoing human-to-human transmission.

WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied.

At the invitation of the National Health and Family Planning Commission of China, WHO has convened a team of experts who will visit areas affected by avian influenza A(H7N9) in China in order to provide recommendations on the prevention and control of the disease. For more information, please see:

Transcript of the media briefing by Dr Michael O’Leary, WHO Representative in China: Situation update on avian influenza A(H7N9) in China
…JOURNALIST: I’m from China Radio International. Two questions. One, on Tuesday, Hong Kong Health Organization said that this might be a limited human-to-human transmission; do you have any comments on this? And the second question, it was reported before that this team will go to the bird market in Shanghai, where else are they going? Like labs or hospital?

DR MICHAEL O’LEARY: Yes, sure. About limited person-to-person transmission, I mentioned that these clusters are under investigations. It’s not usual even when a virus primarily is transmitting from animal-to-human, to have some rare or occasional cases, of very close contacts, coming down with the virus as well. That’s happened in H5N1 for example. But that’s a very different situation from easy and sustained transmission. And that’s what we do not see in this case. It’s not unexpected that if a person is sick and maybe receiving very close care, from a very close contact, that once in a while, it will pass to the other person, but this is not the same as sustained human-to-human transmissions. So, that’s what we are very alert for, because this becomes a different situation if the virus were to change in a way that enabled human-to-human transmission. Still, that’s not the case, we hope that will never be the case. But that’s what we watch for. Other question about where was the team visiting. Yes, bird markets, although as you know, the live bird markets in Shanghai have been closed. So there won’t be a lot to see. But the team is also on schedule to visit hospitals and other sites that have been the focus of the infection.

JOURNALIST: From BBC News. Could please just tell me, to be clear, what do you think the risks are in this outbreak? How serious do you think it is? You mentioned the concern about human-to-human, but what is the biggest concern to you?

DR MICHAEL O’LEARY: So, you know if the virus remains a primarily animal virus, then the risks to humans, would be expected, I think, to remain rare and sporadic, just as they have been. You know, this is a different virus from H5N1. It may ultimately act differently, but H5N1 has been the case 16 years and is still just the occasional, sporadic case, because it’s effectively an animal virus that once in a while, manages to jump to a human. So the situation changes, as I say, if the virus changes in a way that human-to-human transmission is possible, that’s a separate change from the one that has taken place already. You know, we can’t predict, there’s no way to predict, but it would really require now a separate mutation from the one we’ve seen, because there isn’t any evidence of that happening so far…

 WHO: Human infection with influenza A(H7N9) virus: updates
WHO has enhanced its reporting on A(H7N9) and is issuing risk assessments and other information as below:
– Weekly report: 16 April 2013 – Report 2 – data in WHO/HQ as of 16 April 2013, 13:26 GMT+1 pdf, 464kb
Number of confirmed human cases for avian influenza A(H7N9) reported to WHO: geographical location; cumulative number; epidemiological curve.
Standardization of the influenza A(H7N9) virus terminology as of 16 April 2013
pdf, 92kb

GPEI Update: Polio this week – As of 17 April 2013

Update: Polio this week – As of 17 April 2013
Global Polio Eradication Initiative

[Editor’s extract and bolded text]
– It has been 12 months since Asia reported its last case due to wild poliovirus type 3 (WPV3). The last case on the continent occurred on 18 April 2012 in Khyber Agency, Federally Administered Tribal Area (FATA), Pakistan. Globally, WPV3 transmission is at its lowest levels ever recorded. Over the past six months, only one case due to this strain was reported worldwide (from Yobe, Nigeria, with onset of paralysis on 10 November 2012).
– A Global Vaccine Summit will be held on 24-25 April in Abu Dhabi, United Arab Emirates (UAE), hosted by the Crown Prince of Abu Dhabi, Bill Gates and the UN General-Secretary. The Summit will endorse the critical role that vaccines and immunization play in saving lives and protecting children from preventable diseases such as polio. The Summit is held during World Immunization Week and will continue the momentum of the Decade of Vaccines – a vision and commitment to reach all people with the vaccines they need.

– One new circulating vaccine-derived poliovirus type 2 (cVDPV2) case was reported in the past week, bringing the total number of cVDPV2 cases in 2013 to three. It is the most recent cVDPV2 case in the country, and had onset of paralysis on 13 March (from Kandahar).

– One new WPV case was reported in the past week (WPV1 from Yobe, onset of paralysis on 5 March), bringing the total number of WPV cases for 2013 to 12. This is the most recent WPV case in the country.

Horn of Africa
– No new cases were reported in the past week. The most recent case was a cVDPV2 case from Somalia, with onset of paralysis on 9 January 2013.
– Outbreak response is continuing in various parts of the Horn of Africa, in response to the ongoing cVDPV2 outbreak in south-central Somalia. Somalia conducted subnational activities on 26-29 March, and South Sudan conducted campaigns on 19-22 March. Further activities are planned in the second half of April.
– Outcomes from a recently-conducted surveillance review in high-risk areas of Somalia indicate overall good surveillance. Subnational gaps in surveillance remain in Mogadishu and inaccessible areas of south-central Somalia and undetected circulation in those areas cannot be ruled out.
– Recommendations for further strengthening subnational surveillance were put forward, including activating a number of additional surveillance sites.
-Recognizing the risks associated with the cVDPV2 in south-central Somalia, an emergency action plan for this area is being implemented. Strategies are focusing on further boosting population immunity levels in accessible, polio-free areas of Somalia, and setting up vaccination posts in areas bordering inaccessible areas to immunize all populations entering/leaving such areas (including targeting older age groups). Assessments of high-risk areas and populations continue to be conducted, which help drive strategic approaches such as mapping chronic conflict-areas and major population movement routes. Local-level access negotiations have intensified, to increase access to populations in inaccessible areas.
– As a result of these efforts, access to populations is being achieved for the first time in three years in key areas of south-central Somalia in 2013.
– In border areas with Kenya (on both sides of the border), efforts are also focusing on strengthening population immunity levels to minimize the risk and consequences of further international spread of the outbreak.
– The Horn of Africa TAG is scheduled to meet on 30 April to 1 May in Nairobi, Kenya, to review the status of polio eradication activities and impact in the region.

UNICEF: Political support crucial to reach ‘the fifth child’ with vaccines

UNICEF: Political support crucial to reach ‘the fifth child’ with vaccines
Media Release – 19 April 2013

“…One and a half million children would not have died in 2011 had they been immunized, according to UNICEF at the start of World Immunization Week. But one in five children is not being reached with vital vaccines due to social or geographical exclusion, lack of resources, weak health systems or conflicts such as those raging today in Syria and parts of West Africa…

In 2011, however, 22.4 million children were not immunized – an increase of over one million from the preceding year.

UNICEF is concerned that global efforts to vaccinate every child are plateauing as funding falls and political will stagnates. In 2011, only 152 out of 193 World Health Organization member states had dedicated budget lines for immunization.

Inequalities persist within and between countries. Children from wealthy families have the greatest access to the best health services in any given country, and they enjoy the highest rates of immunization coverage.

Unless disparities are addressed every last child cannot be immunized, says UNICEF. At the same time, investment in routine immunization as part of improved health care systems will benefit all children – thus further reducing inequities. To do so, governments have to provide sufficient funding and innovation should be encouraged – such as the recent introduction of vaccines against pneumonia and diarrhoea.

And, most importantly, unwavering political support is needed to extend the benefits of vaccines to children living in the poorest families and the most remote communities.

UNICEF’s unique position
UNICEF procures vaccines that reach 36 per cent of the world’s children. In 2012, UNICEF procured almost 1.9 billion doses of vaccine and over 500 million syringes. As the largest buyer of vaccines in the world, UNICEF works to keep vaccine prices at levels that low- and middle-income countries can afford. UNICEF and its partners supported immunization programmes in over 100 countries last year…”

WHO: Immunization Coverage Fact Sheet – April 2013

WHO: Immunization Coverage
Fact sheet 378    April 2013

Key facts
– Immunization prevents illness, disability and death from vaccine-preventable diseases including diphtheria, measles, pertussis, pneumonia, polio, rotavirus diarrhoea, rubella and tetanus.
– Global vaccination coverage is holding steady.
– Immunization currently averts an estimated 2 to 3 million deaths every year.
– But an estimated 22 million infants worldwide are still missing out on basic vaccines.

…Current levels of access to recommended vaccines

– Haemophilus influenzae type b (Hib) causes meningitis and pneumonia. Hib vaccine was introduced in 177 countries by the end of 2011. Global coverage with three doses of Hib vaccine is estimated at 43%.

– Hepatitis B is a viral infection that attacks the liver. Hepatitis B vaccine for infants had been introduced nationwide in 180 countries by the end of 2011. Global hepatitis B vaccine coverage is estimated at 75%.

– Human papillomavirus — the most common viral infection of the reproductive tract — can cause cervical cancer, and other types of cancer and genital warts in both men and women. Human papillomavirus vaccine was introduced in 43 countries by the end of 2011.

– Measles is a highly contagious disease caused by a virus, which usually results in a high fever and rash, and can lead to blindness, encephalitis or death. By the end of 2011, 84% of children had received one dose of measles vaccine by their second birthday, and 141 countries had included a second dose as part of routine immunization.

– Meningitis A is an infection that can cause severe brain damage and is often deadly. By the end of 2012—two years after its introduction—the MenAfriVac vaccine, developed by WHO and PATH, was available in 10 of the 26 African countries affected by the disease.

– Mumps is a highly contagious virus that causes painful swelling at the side of the face under the ears (the parotid glands), fever, headache and muscle aches. It can lead to viral meningitis. Mumps vaccine had been introduced nationwide in 120 countries by the end of 2011.

– Pneumococcal diseases include pneumonia, meningitis and febrile bacteraemia, as well as otitis media, sinusitis and bronchitis. Pneumococcal vaccine had been introduced in 72 countries by the end of 2011.

– Polio is a highly infectious viral disease that can cause irreversible paralysis. In 2011, 84% of infants around the world received three doses of polio vaccine. Only three countries—Afghanistan, Nigeria and Pakistan—remain polio-endemic.

– Rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world. Rotavirus vaccine was introduced in 31 countries by the end of 2011.

– Rubella is a viral disease which is usually mild in children, but infection during early pregnancy may cause fetal death or congenital rubella syndrome, which can lead to defects of the brain, heart, eyes and ears. Rubella vaccine was introduced nationwide in 130 countries by the end of 2011.

– Tetanus is caused by a bacterium which grows in the absence of oxygen, e.g. in dirty wounds or in the umbilical cord if it is not kept clean. It produces a toxin which can cause serious complications or death. The vaccine to prevent maternal and neonatal tetanus had been introduced in over 100 countries by the end of 2011. Vaccination coverage with at least two doses was estimated at 70%, and an estimated 82% of newborns were protected through immunization. Maternal and neonatal tetanus persist as public health problems in 36 countries, mainly in Africa and Asia.

– Yellow fever is an acute viral haemorrhagic disease transmitted by infected mosquitoes. As of 2011, yellow fever vaccine had been introduced in routine infant immunization programmes in 36 of the 48 countries and territories at risk for yellow fever in Africa and the Americas.

Key challenges
Despite improvements in global vaccine coverage during the past decade, there continue to be regional and local disparities resulting from:
– limited resources;
– competing health priorities;
– poor management of health systems; and
– inadequate monitoring and supervision.

In 2011, an estimated 22 million infants worldwide were not reached with routine immunization services. About half of them live in three countries: India, Indonesia and Nigeria.

Priority needs to be given to strengthening routine vaccination globally, especially in the countries that are home to the highest number of unvaccinated children. Particular efforts are needed to reach the underserved, especially those in remote areas, in deprived urban settings, in fragile states and strife-torn regions.

WHO response
WHO is working with countries and partners to improve global vaccination coverage, including through these initiatives adopted by the World Health Assembly in May 2012.

The Global Vaccine Action Plan
The Global Vaccine Action Plan (GVAP) is a roadmap to prevent millions of deaths through more equitable access to vaccines. Countries are aiming to achieve vaccination coverage of ≥90% nationally and ≥80% in every district by 2020. While the GVAP should accelerate control of all vaccine-preventable diseases, polio eradication is set as the first milestone. It also aims to spur research and development for the next generation of vaccines.

The plan was developed by multiple stakeholders—UN agencies, governments, global agencies, development partners, health professionals, academics, manufacturers and civil society. WHO is leading efforts to support regions and countries as they adapt the GVAP for implementation…

WHO: Prequalification to make high-quality, safe and affordable vaccines

WHO: Prequalification to make high-quality, safe and affordable vaccines
Feature article
April 2013

WHO’s vaccine prequalification programme ensures that the vaccines received by two thirds of the world’s babies are high-quality, safe and affordable.

Every year, more than 2.5 billion doses of vaccines are used globally to immunize children under 10 years old. Immunization is key to protecting children from many deadly diseases, including polio, measles, diphtheria, and tetanus. But it only works if vaccine quality and safety can be assured and consistent, and it can only be carried out if vaccines are affordable. So in 1987, WHO introduced a vaccine prequalification programme, initially as a service to UNICEF and other UN purchasing agencies. Today, that programme is the only one in the world to facilitate international harmonization of vaccine production standards…

Workshop Summary: Perspectives on Research with H5N1 Avian Influenza: Scientific Inquiry, Communication, Controversy

Workshop Summary: Perspectives on Research with H5N1 Avian Influenza: Scientific Inquiry, Communication, Controversy

When, in late 2011, it became public knowledge that two research groups had submitted for publication manuscripts that reported on their work on mammalian transmissibility of a lethal H5N1 avian influenza strain, the information caused an international debate about the appropriateness and communication of the researchers’ work, the risks associated with the work, partial or complete censorship of scientific publications, and dual-use research of concern in general.

Recognizing that the H5N1 research is only the most recent scientific activity subject to widespread attention due to safety and security concerns, on May 1, 2012, the National Research Council’s Committee on Science, Technology and Law, in conjunction with the Board on Life Sciences and the Institute of Medicine’s Forum on Microbial Threats, convened a one-day public workshop for the purposes of 1) discussing the H5N1 controversy; 2) considering responses by the National Institute of Allergy and Infectious Diseases (NIAID), which had funded this research, the World Health Organization, the U.S. National Science Advisory Board for Biosecurity (NSABB), scientific publishers, and members of the international research community; and 3) providing a forum wherein the concerns and interests of the broader community of stakeholders, including policy makers, biosafety and biosecurity experts, non-governmental organizations, international organizations, and the general public might be articulated.

Full text [html]:

Details and pdf:

CSIS Meeting: Countering the Problem of Falsified and Substandard Drugs

Meeting: Countering the Problem of Falsified and Substandard Drugs
Center for Strategic and International Studies
Monday, April 29, 2013 1:00 – 2:30 PM

This event will feature an expert discussion on the findings and recommendations of The Institute of Medicine’s recently released report titled “Countering the Problem of Falsified and Substandard Drugs.” Commissioned by the U.S. Food and Drug Administration, this report “raises important, indeed frightening, concerns about the quality and reliability of medicines around the world. The problem of illegitimate drugs has significant and sometimes tragic consequences in the U.S. and other developed nations, as well as in low- and middle-income countries that often have weaker capacities….”

Age-appropriate vaccination against measles and DPT-3 in India – closing the gaps

BMC Public Health
(Accessed 20 April 2013)

Research article  
Age-appropriate vaccination against measles and DPT-3 in India – closing the gaps
Niyi Awofeso, Anu Rammohan, Kazi Iqbal BMC Public Health 2013, 13:358 (17 April 2013)

Abstract (provisional)
In 2010, India accounted for 65,500 (47%) of the 139,300 measles-related deaths that occurred globally. Data on the quality of age-appropriate measles vaccination in rural India is sparse. We explored the following issues: (i) What proportion of Indian children were appropriately vaccinated against measles at 9 months of age, and DPT-3 at 4 months? (ii) Which health facilities administered measles vaccine to children prior to 9 months of age and DPT-3 prior to 14 weeks?

We analyzed data from the 2008 Indian District Level Health Survey (DLHS-3) to determine the extent of age-appropriate measles and DPT-3 vaccinations. Among 192,969 households in the dataset, vaccination cards with detailed records were available for 18,670 children aged between 12 and 23 months.

Among this cohort, 72.4% (13,511 infants) had received the first dose of measles vaccine. Only 30% of vaccinated infants received the measles vaccine at the recommended age of 9 months. Similarly, only 31% of infants in the cohort received DPT-3 vaccine at the recommended age of 14 weeks. About 82% of all prematurely vaccinated children were vaccinated at health sub-centres, ICDS and Pulse Polio centres.

Age-inappropriate vaccination impacts adversely on the effectiveness of India’s measles immunisation program due to sub-optimal seroconversion, if premature, and increased vulnerability to vaccine preventable diseases, if delayed. Capacity building approaches to improve age-appropriate vaccination are discussed.

Provisional pdf:

Understanding the school community’s response to school closures during the H1N1 2009 influenza pandemic

BMC Public Health
(Accessed 20 April 2013)

Research article  
Understanding the school community’s response to school closures during the H1N1 2009 influenza pandemic
Annette Braunack-Mayer, Rebecca Tooher, Joanne E Collins, Jackie M Street, Helen Marshall BMC Public Health 2013, 13:344 (15 April 2013)

Abstract (provisional)
During the 2009 H1N1 influenza pandemic, Australian public health officials closed schools as a strategy to mitigate the spread of the infection. This article examines school communities’ understanding of, and participation in, school closures and the beliefs and values which underpinned school responses to the closures.

We interviewed four school principals, 25 staff, 14 parents and 13 students in five schools in one Australian city which were either fully or partially closed during the 2009 H1N1 pandemic.

Drawing on Thompson et al’s ethical framework for pandemic planning, we show that considerable variation existed between and within schools in their attention to ethical processes and values. In all schools, health officials and school leaders were strongly committed to providing high quality care for members of the school community. There was variation in the extent to which information was shared openly and transparently, the degree to which school community members considered themselves participants in decision-making, and the responsiveness of decision-makers to the changing situation. Reservations were expressed about the need for closures and quarantine and there was a lack of understanding of the rationale for the closures. All schools displayed a strong duty of care toward those in need, although school communities had a broader view of care than that of the public health officials. Similarly, there was a clear understanding of and commitment to protect the public from harm and to demonstrate responsible stewardship.

We conclude that school closures during an influenza pandemic represent both a challenge for public health officials and a litmus test for the level of trust in public officials, government and the school as institution. In our study, trust was the foundation upon which effective responses to the school closure were built. Trust relations within the school were the basis on which different values and beliefs were used to develop and justify the practices and strategies in response to the pandemic.

Provisional pdf: