British Medical Journal
20 April 2013 (Vol 346, Issue 7904)
http://www.bmj.com/content/346/7904

Editorials
Rotavirus vaccine: a welcome addition to the immunisation schedule in the UK
BMJ 2013;346:f2347 (Published 15 April 2013)

Clinical Therapeutics
Vol 35 | No. 4 | April 2013 | Pages 351-540
http://www.clinicaltherapeutics.com/current

Editorial
Showcasing Pharmaceutical Economics, Outcomes, and Health Policy: An Update in Clinical Therapeutics
Denys T. Lau, PhD
http://www.clinicaltherapeutics.com/article/S0149-2918%2813%2900108-2/fulltext

Excerpt
Sound scientific evidence is in demand as part of health care decision making to demonstrate the effectiveness, quality, and safety of health care services, particularly pharmacotherapies, in real-world, routine clinical settings. As health care spending continues to rise, empirical analyses of costs and the relative value of treatment alternatives have gained prominence in informing prescribing and reimbursement decisions, while scrutiny over their analytical approaches for scientific rigor also has increased. In light of the continuing need for better evidence-based medicine, this special issue of Clinical Therapeutics showcases a collection of diverse, yet related, articles addressing the current state and future issues on pharmaceutical economics, treatment utilization, health outcomes, and drug-related health policy.

Despite the abundance of published health economic evaluations in recent decades, the International Society of Pharmacoeconomics and Outcomes Research Task Force on Quality Improvement in Cost-Effectiveness Research (chaired by Don Husereau) has found no guidelines, requirements, or checklists on health economic research. Along with several other peer-reviewed scientific journals, Clinical Therapeutics is co-publishing the society’s task force report on the Consolidated Health Economic Evaluation Reporting Standards, a checklist and explanatory guidance document that is intended to help improve the reporting of health economic evaluations. (10.1016/j.clinthera.2013.03.003)…

Comparative-Effectiveness Research to Aid Population Decision Making by Relating Clinical Outcomes and Quality-Adjusted Life Years
Jonathan D. Campbell, PhD, Judy Zerzan, MD, MPH; Louis P. Garrison Jr., PhD; Anne M. Libby, PhD
http://www.clinicaltherapeutics.com/article/S0149-2918%2813%2900067-2/abstract

Abstract 
Background
Comparative-effectiveness research (CER) at the population level is missing standardized approaches to quantify and weigh interventions in terms of their clinical risks, benefits, and uncertainty.

Objectives
We proposed an adapted CER framework for population decision making, provided example displays of the outputs, and discussed the implications for population decision makers.

Methods
Building on decision-analytical modeling but excluding cost, we proposed a 2-step approach to CER that explicitly compared interventions in terms of clinical risks and benefits and linked this evidence to the quality-adjusted life year (QALY). The first step was a traditional intervention-specific evidence synthesis of risks and benefits. The second step was a decision-analytical model to simulate intervention-specific progression of disease over an appropriate time. The output was the ability to compare and quantitatively link clinical outcomes with QALYs.

Conclusions
The outputs from these CER models include clinical risks, benefits, and QALYs over flexible and relevant time horizons. This approach yields an explicit, structured, and consistent quantitative framework to weigh all relevant clinical measures. Population decision makers can use this modeling framework and QALYs to aid in their judgment of the individual and collective risks and benefits of the alternatives over time. Future research should study effective communication of these domains for stakeholders.

Globalization and Health
[Accessed 20 April 2013]
http://www.globalizationandhealth.com/

Research
‘BRICS without straw’? A systematic literature review of newly emerging economies’ influence in global health
Harmer A, Xiao Y, Missoni E and Tediosi F Globalization and Health 2013, 9:15 (15 April 2013)

Abstract (provisional)
Background
Since 2010, five newly emerging economies collectively known as ‘BRICS’ (Brazil, India, Russia, China and South Africa) have caught the imagination, and scholarly attention, of political scientists, economists and development specialists. The prospect of a unified geopolitical bloc, consciously seeking to re-frame international (and global) health development with a new set of ideas and values, has also, if belatedly, begun to attract the attention of the global health community. But what influence, if any, do the BRICS wield in global health, and, if they do wield influence, how has that influence been conceptualized and recorded in the literature?

Provisional pdf: http://www.globalizationandhealth.com/content/pdf/1744-8603-9-15.pdf

The Lancet  
Apr 20, 2013  Volume 381  Number 9875  p1333 – 1430  e9
http://www.thelancet.com/journals/lancet/issue/current

Editorial
From SARS to H7N9: will history repeat itself?
The Lancet
Preview
China will never forget the epidemic of severe acute respiratory syndrome (SARS), for which it paid such a heavy and painful price a decade ago. According to WHO, from Nov 1, 2002, to July 31, 2003, 648 of the 7082 probable cases of SARS in mainland China and Hong Kong died. Many of the patients were front-line health workers. At that time, in the wake of its initial negative response to SARS, as well as proof of its fragmented and ineffective public health system, the Chinese Government’s international reputation and domestic credibility were seriously damaged.

The Lancet  
Apr 20, 2013  Volume 381  Number 9875  p1333 – 1430  e9
http://www.thelancet.com/journals/lancet/issue/current

Editorial
The Global Fund: “a historic opportunity”
The Lancet
Preview
At a donor conference on April 9–10 in Brussels, Belgium, the Global Fund to Fight AIDS, Tuberculosis and Malaria presented a compelling case for funding the organisation to not only tackle these diseases but also to accelerate gains against them. The message was simple—increased funding now could dramatically alter the course of these diseases, and eventually bring them under control thanks to recent advances in science, falling treatment costs, and implementation know-how.

The Lancet  
Apr 20, 2013  Volume 381  Number 9875  p1333 – 1430  e9
http://www.thelancet.com/journals/lancet/issue/current

Series – Childhood Pneumonia and Diarrhoea
Global burden of childhood pneumonia and diarrhoea
Christa L Fischer Walker, Igor Rudan, Li Liu, Harish Nair, Evropi Theodoratou, Zulfiqar A Bhutta, Katherine L O’Brien, Harry Campbell, Robert E Black
Preview |
Diarrhoea and pneumonia are the leading infectious causes of childhood morbidity and mortality. We comprehensively reviewed the epidemiology of childhood diarrhoea and pneumonia in 2010–11 to inform the planning of integrated control programmes for both illnesses. We estimated that, in 2010, there were 1·731 billion episodes of diarrhoea (36 million of which progressed to severe episodes) and 120 million episodes of pneumonia (14 million of which progressed to severe episodes) in children younger than 5 years.

Series – Childhood Pneumonia and Diarrhoea
Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost?
Zulfiqar A Bhutta, Jai K Das, Neff Walker, Arjumand Rizvi, Harry Campbell, Igor Rudan, Robert E Black, for The Lancet Diarrhoea and Pneumonia Interventions Study Group
Preview |
Global mortality in children younger than 5 years has fallen substantially in the past two decades from more than 12 million in 1990, to 6·9 million in 2011, but progress is inconsistent between countries. Pneumonia and diarrhoea are the two leading causes of death in this age group and have overlapping risk factors. Several interventions can effectively address these problems, but are not available to those in need. We systematically reviewed evidence showing the effectiveness of various potential preventive and therapeutic interventions against childhood diarrhoea and pneumonia, and relevant delivery strategies.

The Lancet  
Apr 20, 2013  Volume 381  Number 9875  p1333 – 1430  e9
http://www.thelancet.com/journals/lancet/issue/current

The changing epidemiology of malaria elimination: new strategies for new challenges
Chris Cotter MPH a, Hugh JW Sturrock PhD a, Michelle S Hsiang MD a, Jenny Liu PhD a, Allison A Phillips BA a, Jimee Hwang MD a, Cara Smith Gueye MPH a, Nancy Fullman MPH a, Roly D Gosling MD a, Prof Sir Richard GA Feachem DSc[Med] a

Summary
Malaria-eliminating countries achieved remarkable success in reducing their malaria burdens between 2000 and 2010. As a result, the epidemiology of malaria in these settings has become more complex. Malaria is increasingly imported, caused by Plasmodium vivax in settings outside sub-Saharan Africa, and clustered in small geographical areas or clustered demographically into subpopulations, which are often predominantly adult men, with shared social, behavioural, and geographical risk characteristics. The shift in the populations most at risk of malaria raises important questions for malaria-eliminating countries, since traditional control interventions are likely to be less effective. Approaches to elimination need to be aligned with these changes through the development and adoption of novel strategies and methods. Knowledge of the changing epidemiological trends of malaria in the eliminating countries will ensure improved targeting of interventions to continue to shrink the malaria map.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2960310-4/fulltext

Nature  
Volume 496 Number 7445 pp269-392  18 April 2013
http://www.nature.com/nature/current_issue.html

Public health: Polio’s moving target
Ewen Callaway
Finding and vaccinating Nigerian nomads may be one of the last obstacles to the eradication of polio.

Nature  
Volume 496 Number 7445 pp269-392  18 April 2013
http://www.nature.com/nature/current_issue.html

Nature | Letter
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
Affiliations
Published online  07 April 2013

Abstract
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 clinical or subclinical 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.

Nature Immunology
May 2013, Volume 14 No 5 pp415-522
http://www.nature.com/ni/journal/v14/n5/index.html

Understanding immunosenescence to improve responses to vaccines
Jörg J Goronzy & Cornelia M Weyand
Published online  18 April 2013
Author information

Abstract
In the older adult, the benefits of vaccination to prevent infectious disease are limited, mainly because of the adaptive immune system’s inability to generate protective immunity. The age-dependent decrease in immunological competence, often referred to as ‘immunosenescence’, results from the progressive deterioration of innate and adaptive immune responses. Most insights into mechanisms of immunological aging have been derived from studies of mouse models. In this Review, we explore how well such models are applicable to understanding the aging process throughout the 80–100 years of human life and discuss recent advances in identifying and characterizing the mechanisms that underlie age-associated defective adaptive immunity in humans.

Science Translational Medicine
17 April 2013 vol 5, issue 181
http://stm.sciencemag.org/content/current

Commentary
HEALTH POLICY
Systems and Capacity to Address Noncommunicable Diseases in Low- and Middle-Income Countries
Mohammed K. Ali1,*, Cristina Rabadán-Diehl2, John Flanigan3, Claire Blanchard4, K. M. Venkat Narayan1 and Michael E Engelgau

Abstract
Noncommunicable diseases (NCDs) are increasingly getting attention from different forums, including media outlets, health agencies, and the public and private sectors. Progress is being made in addressing NCDs, though more slowly in low- and middle-income countries (LMICs) as compared with high-income settings. Here, we offer an analysis of the challenges faced in LMICs. We discuss realistic strategies to understand and develop capacity needs (workforce, finances, and infrastructure) and systems (institutions and processes) to sustainably optimize NCD prevention and care in LMICs.

Vaccine
Volume 31, Supplement 2, Pages B1-B250 (18 April 2013)
Decade of Vaccines
18 April 2013
Edited by Pedro L. Alonso, Ciro A. de Quadros and Altaf A. Lal

Foreword
Seth Berkley, Margaret Chan, Christopher Elias, Anthony Fauci, Anthony Lake, Joy Phumaphi
[No abstract]

Editorial
Pages B3-B4
Pedro L. Alonso, Ciro A. de Quadros, Magdalena Robert, Altaf A. Lal

Global Vaccine Action Plan
Pages B5-B31

Vaccine
Volume 31, Supplement 2, Pages B1-B250 (18 April 2013)
Decade of Vaccines
18 April 2013

Commitment to Immunization
Measuring government commitment to vaccination
Review Article
Pages B32-B42
Amanda Glassman, Juan Ignacio Zoloa, Denizhan Duran

Vaccine development and deployment: Opportunities and challenges in India
Review Article
Pages B43-B53
Sanjukta Sen Gupta, G. Balakrish Nair, Narendra Kumar Arora, Nirmal Kumar Ganguly

Vaccine research, development, and innovation in Brazil: A translational science perspective
Review Article
Pages B54-B60
Akira Homma, Amilcar Tanuri, Alberto J.S. Duarte, Ernesto Marques, Alexandre de Almeida, Reinaldo Martins, Jarbas B. Silva-Junior, Cristina Possas

The estimated mortality impact of vaccinations forecast to be administered during 2011–2020 in 73 countries supported by the GAVI Alliance
Review Article
Pages B61-B72
Lisa A. Lee, Lauren Franzel, Jessica Atwell, S. Deblina Datta, Ingrid K. Friberg, Sue J. Goldie, Susan E. Reef, Nina Schwalbe, Emily Simons, Peter M. Strebel, Steven Sweet, Chutima Suraratdecha, Yvonne Tam, Emilia Vynnycky, Neff Walker, Damian G. Walker, Peter M. Hansen

Vaccine
Volume 31, Supplement 2, Pages B1-B250 (18 April 2013)
Decade of Vaccines
18 April 2013

Value of Immunization
The imperative for stronger vaccine supply and logistics systems
Review Article
Pages B73-B80
Michel Zaffran, Jos Vandelaer, Debra Kristensen, Bjørn Melgaard, Prashant Yadav, K.O. Antwi-Agyei, Heidi Lasher

Global support for new vaccine implementation in middle-income countries
Review Article
Pages B81-B96
Miloud Kaddar, Sarah Schmitt, Marty Makinen, Julie Milstien

Vaccine
Volume 31, Supplement 2, Pages B1-B250 (18 April 2013)
Decade of Vaccines
18 April 2013

Equitable Access of Immunization
Civil society organizations, the implementing partners of the Global Vaccine Action Plan
Review Article
Pages B97-B102
Naveen Thacker, Vipin M. Vashishtha, Joan Awunyo-Akaba, Rozina Farhad Mistry

Applying an equity lens in the Decade of Vaccines
Review Article
Pages B103-B107
Lara Brearley, Rudi Eggers, Robert Steinglass, Jos Vandelaer

Effective vaccine safety systems in all countries: A challenge for more equitable access to immunization
Review Article
Pages B108-B114
Ananda Amarasinghe, Steve Black, Jan Bonhoeffer, Sandra M. Deotti Carvalho, Alexander Dodoo, Juhani Eskola, Heidi Larson, Sunheang Shin, Sten Olsson, Madhava Ram Balakrishnan, Ahmed Bellah, Philipp Lambach, Christine Maure, David Wood, Patrick Zuber, Bartholomew Akanmori, Pamela Bravo, María Pombo, Houda Langar, Dina Pfeifer, et al.

Vaccine
Volume 31, Supplement 2, Pages B1-B250 (18 April 2013)
Decade of Vaccines
18 April 2013

Strengthening of Immunization Systems
Moving forward with strengthening routine immunization delivery as part of measles and rubella elimination activities
Review Article
Pages B115-B121
Rebecca Fields, Alya Dabbagh, Manish Jain, Karan Singh Sagar

New vaccine introductions: Assessing the impact and the opportunities for immunization and health systems strengthening
Review Article
Pages B122-B128
Susan A. Wang, Terri B. Hyde, Sandra Mounier-Jack, Logan Brenzel, Michael Favin, W. Scott Gordon, Jessica C. Shearer, Carsten F. Mantel, Narendra Arora, David Durrheim

The need for targeted implementation research to improve coverage of basic vaccines and introduction of new vaccines
Review Article
Pages B129-B136
Narendra K. Arora, Altaf A. Lal, Joachim M. Hombach, Jose I. Santos, Zulfiqar A. Bhutta, Samba O. Sow, Brian Greenwood

Vaccine
Volume 31, Supplement 2, Pages B1-B250 (18 April 2013)
Decade of Vaccines
18 April 2013

Sustainable Funding for Immunization
Projections of costs, financing, and additional resource requirements for low- and lower middle-income country immunization programs over the decade, 2011–2020
Review Article
Pages B137-B148
Gian Gandhi, Patrick Lydon, Santiago Cornejo, Logan Brenzel, Sandra Wrobel, Hugh Chang

Enabling implementation of the Global Vaccine Action Plan: Developing investment cases to achieve targets for measles and rubella prevention
Review Article
Pages B149-B156
Kimberly M. Thompson, Peter M. Strebel, Alya Dabbagh, Thomas Cherian, Stephen L. Cochi

Vaccine
Volume 31, Supplement 2, Pages B1-B250 (18 April 2013)
Decade of Vaccines
18 April 2013

Innovation in Vaccines and Immunization
Strategies to advance vaccine technologies for resource-poor settings
Review Article
Pages B157-B162
Debra Kristensen, Dexiang Chen

A global regulatory science agenda for vaccines
Review Article
Pages B163-B175
Lindsay Elmgren, Xuguang Li, Carolyn Wilson, Robert Ball, Junzhi Wang, Klaus Cichutek, Michael Pfleiderer, Atsushi Kato, Marco Cavaleri, James Southern, Teeranart Jivapaisarnpong, Philip Minor, Elwyn Griffiths, Yeowon Sohn, David Wood

Developing Countries Vaccine Manufacturers Network: Doing good by making high-quality vaccines affordable for all
Review Article
Pages B176-B183
Sonia Pagliusi, Luciana C.C. Leite, Mahima Datla, Morena Makhoana, Yongzhong Gao, Mahendra Suhardono, Suresh Jadhav, Gutla V.J.A. Harshavardhan, Akira Homma

Delivering the promise of the Decade of Vaccines: Opportunities and challenges in the development of high quality new vaccines
Review Article
Pages B184-B193
Jacqueline A. Keith, Laetitia Agostini Bigger, Phyllis A. Arthur, Edith Maes, Rutger Daems

Vaccine
Volume 31, Supplement 2, Pages B1-B250 (18 April 2013)
Decade of Vaccines
18 April 2013

Case Studies
The need and challenges for development of an Epstein-Barr virus vaccine
Review Article
Pages B194-B196
Jeffrey I. Cohen, Edward S. Mocarski, Nancy Raab-Traub, Lawrence Corey, Gary J. Nabel

Desirability and feasibility of a vaccine against cytomegalovirus
Review Article
Pages B197-B203
Paul Griffiths, Stanley Plotkin, Edward Mocarski, Robert Pass, Mark Schleiss, Philip Krause, Stephanie Bialek

Accelerating the development of a safe and effective HIV vaccine: HIV vaccine case study for the Decade of Vaccines
Review Article
Pages B204-B208
Wayne C. Koff, Nina D. Russell, Mark Walport, Mark B. Feinberg, John W. Shiver, Salim Abdool Karim, Bruce D. Walker, Margaret G. McGlynn, Chidi Victor Nweneka, Gary J. Nabel

Strategic priorities for respiratory syncytial virus (RSV) vaccine development
Review Article
Pages B209-B215
L.J. Anderson, P.R. Dormitzer, D.J. Nokes, R. Rappuoli, A. Roca, B.S. Graham

Group A streptococcal vaccines: Paving a path for accelerated development
Review Article
Pages B216-B222
James B. Dale, Vincent A. Fischetti, Jonathan R. Carapetis, Andrew C. Steer, Samba Sow, Rajesh Kumar, Bongani M. Mayosi, Fran A. Rubin, Kim Mulholland, Joachim Maria Hombach, Florian Schödel, Ana Maria Henao-Restrepo

Preventive vaccines for tuberculosis
Review Article
Pages B223-B226
Thomas G. Evans, Michael J. Brennan, Lew Barker, Jelle Thole

The Human Hookworm Vaccine
Review Article
Pages B227-B232
Peter J. Hotez, David Diemert, Kristina M. Bacon, Coreen Beaumier, Jeffrey M. Bethony, Maria Elena Bottazzi, Simon Brooker, Artur Roberto Couto, Marcos da Silva Freire, Akira Homma, Bruce Y. Lee, Alex Loukas, Marva Loblack, Carlos Medicis Morel, Rodrigo Correa Oliveira, Philip K. Russell

Malaria vaccine R&D in the Decade of Vaccines: Breakthroughs, challenges and opportunities
Review Article
Pages B233-B243
Ashley J. Birkett, Vasee S. Moorthy, Christian Loucq, Chetan E. Chitnis, David C. Kaslow

Case study for a vaccine against leishmaniasis
Review Article
Pages B244-B249
Jorge Alvar, Simon L. Croft, Paul Kaye, Ali Khamesipour, Shyam Sundar, Steven G. Reed

From Google Scholar & other sources: Selected Journal Articles, Dissertations, Theses

[PDF] EVALUATION OF VACCINE WASTAGE IN SURAT
S Mehta, P Umrigar, P Patel, RK Bansal – Community Med, 2013
www.njcmindia.org/home/download/367
ABSTRACT
Introduction: Vaccine wastage is one of the key factors to be considered with regards to vaccine forecasting and need estimation.
Objective: This study was conducted to assess the amount of vaccine wastage; its correlation with type of vaccine and place of vaccination; with route of administration and wastage and with beneficiaries per session and wastage factor (WF).
Methods and Materials: Session wise data on vaccine usage and its beneficiaries were collected from 36 Urban health centre (UHC) of Surat Municipal Corporation (SMC). Vaccine wastage rate ,vaccine wastage factor were calculated for each type of vaccine and each site of session and correlation analysis was done between the variables beneficiaries per session and wastage factor per session.
Results: The overall wastage factor for BCG vaccine was 1.83, for OPV was 1.33, for DPT was 1.19, for Hepatitis B vaccine was 1.26 and for Measles vaccine was 1.39. The WF was highest for sessions held at ICDS for BCG vaccination (3.38) followed by sessions held at mobile sites for BCG vaccination (2.50). The WF was lowest for sessions held at UHC for DPT vaccination (1.11) followed by sessions held at subcentres for DPT vaccination (1.13) and sessions held at UHC for Hepatitis vaccination (1.13).
Conclusions: BCG vaccine and Measles vaccine had WF greater than the allowable WF 1.33, OPV had WF of 1.33, DPT vaccine and Hepatitis vaccine had WF less than 1.33. WF was less for fixed sites of vaccination like the UHCs and subcentres while the WF was more ICDS and mobile sites.

Differential Profiles and Inhibitory Effect on Rotavirus Vaccines of Non-Antibody Components in Breast Milk from Mothers in Developing and Developed Countries
SS Moon, JE Tate, P Ray, PH Dennehy, D Archary… – The Pediatric Infectious …, 2013
… Abbreviated title: Effect of Breast Milk on Rotavirus Vaccine Running head: Breast Milk and Rotavirus Vaccine 1. Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA … rotavirus vaccine we observed. …

[PDF] GLOBAL PREVALENCE OF DENGUE VIRAL INFECTION, ITS PATHOGENESIS DIAGNOSTIC AND PREVENTIVE APPROACHES
Zafar, KT Bukhari, GM Lodhi – Asian J. Agri. Biol. Vol, 2013
… Reason behind this is the absence of specific tetravalent vaccine and the anti virals. … Dengue A Global Health Problem The absences of specific vaccine and anti viral treatment of DF are the main reasons for making it a global health problem (Hapugoda, 2007; Gathatry, 2009). …

Economist
http://www.economist.com/
Accessed 20 April 2013

Measles
Pox Britannica
The long shadow of a health scare
Apr 20th 2013 | http://www.economist.com/news/britain/21576449-long-shadow-health-scare-pox-britannica

UNTIL recently most British doctors had never seen a case of measles. Along with old childhood illnesses such as tetanus and polio, it had almost vanished. Yet in the past few years a series of outbreaks has caused them to dust off their diagnostic manuals (see chart below). The latest is centred on Swansea, in south Wales. As The Economist went to press, at least 765 people there had caught measles since the outbreak began in November. That number seems certain to rise…

Economist
http://www.economist.com/
Accessed 20 April 2013

Pandemic preparedness
Coming, ready or not
Despite progress, the world is still unprepared for a new pandemic disease
Apr 20th 2013 http://www.economist.com/news/leaders/21576390-despite-progress-world-still-unprepared-new-pandemic-disease-coming-ready-or-not

THE threat of a global pandemic is rising again. In China an influenza virus never before seen in people had, as The Economist went to press, infected at least 82 and killed 17. Meanwhile a new type of coronavirus, the family that brought severe acute respiratory syndrome (SARS), is festering in the Middle East. The risk of such an outbreak turning into a pandemic is low, but the danger, if it does, is huge: in 1918 50m-100m people were killed by Spanish flu, compared with 16m in the first world war and 30m so far from AIDS.

Fortunately, the world is better prepared for an outbreak than ever before (see article). SARS in 2003, the H5N1 bird flu of 2005 and the H1N1 swine flu of 2009 have prompted action. By 2011, 158 countries had pandemic-preparedness plans. America has poured money into the development of new vaccines and antiviral drugs. Researchers have a better understanding of influenza and other risky pathogens. Rapid amplification of DNA segments helps scientists identify viruses quickly. Full genomic sequencing allows them to explore worrying strains. Mathematical models predict where a new disease might emerge and how it might spread…

The Huffington Post
http://www.huffingtonpost.com/
Accessed 20 April 2013

Childhood Immunization Leaves Adults Behind
Michael Hodin
Executive Director, Global Coalition on Aging
http://www.huffingtonpost.com/michael-hodin/childhood-immunization-le_b_3108828.html

The World Vaccine Congress meets this week for its annual marquee event in Washington D.C.

For an event that is supposed to “tackle the full spectrum of industry concerns,” one item is conspicuously missing from their agenda: adult vaccines. As the global population ages, a “life-course approach” to immunization — one that stresses vaccination in the adult years — may become one of the great drivers of health and wellness in the 21st century.

The Vaccine Congress isn’t alone in missing this point. The global health community has barely begun to recognize how vaccination can enable a healthy, active aging process. This aha! moment had better come soon, because vaccination isn’t just good health policy, it’s great economic policy. We learned this lesson with childhood vaccination — which was, to be sure, one of the 20th century’s greatest public health victories and economic achievements…

New York Times
http://www.nytimes.com/
Accessed 20 April 2013

Sierra Leone’s Health Care System Becomes a Cautionary Tale for Donors
By ADAM NOSSITER
Published: April 13, 2013
http://www.nytimes.com/2013/04/14/world/africa/sierra-leone-graft-charges-imperil-care-and-aid.html?hpw

“…Last month, the country’s 29 top health officials found themselves indicted by Sierra Leone’s anticorruption agency on charges of misappropriating a half-million dollars in grants from a global vaccine provider, GAVI Alliance, started by the Bill & Melinda Gates Foundation. The amount may not seem huge in some places, but in Sierra Leone, one of the least developed nations in the world, it looms particularly large, and the list of suspects is stunning…”

Wall Street Journal
http://online.wsj.com/home-page
Accessed 20 April 2013

Interview: Bill Gates Talks About Tech Innovations for Vaccines Ahead of Global Confab
Kara Swisher
April 19, 2013 at 12:26 pm PT
http://allthingsd.com/20130419/interview-bill-gates-talks-about-tech-innovations-for-vaccines-ahead-of-global-confab/?KEYWORDS=vaccine
Earlier today, Microsoft co-founder Bill Gates discussed technological innovations for vaccines, ahead of a Global Vaccine Summit being held next week in Abu Dhabi.

Editor’s Notes:

– Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_13 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: Human infection with influenza A(H7N9) virus
WHO enhanced its reporting on A(H7N9) and issued a risk assessment and other information as below:

WHO Risk Assessment as of 13 April 2013 [pdf, 122kb]
Excerpt
…Risk assessment
This initial risk assessment, which has been prepared in accordance with WHO’s published recommendations for rapid risk assessment of acute public health events 1 will be updated as further information becomes available.

– What is the risk of the occurrence of further cases in the affected areas of China and other areas?
The epidemiology of this virus among animals, including the main reservoirs of infection among animals and the extent of geographic spread, is not yet established. However, it is likely that most human H7N9 infections so far are associated with infection among as – of yet undetermined animals and that further human cases of infection should be expected.

– What is the risk of human-to-human transmission?
There is no evidence of sustained human-to-human transmission. However the two possible family clusters suggest that limited human-to-human transmission may occur where there is close contact between cases and other individuals, as occurs in families and, potentially, healthcare settings. Moreover, the genetic changes seen among these viruses suggesting adaptation to mammals is of concern, and further adaptation may occur.

– What is the risk of international spread?
At this time, there is no information to indicate international spread of this virus. However, it is possible that an infected person, who may or may not have symptoms, could travel to another country. However, if the virus cannot sustain human-to-human transmission, as appears to be the current situation, then extensive community spread is unlikely.

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.

Access the weekly report on number of confirmed human cases for influenza A(H7N9) reported to WHO
Data in WHO/HQ as of 10 April 2013, 14:22 GMT+1
Report will be updated once a week

WHO: Global Alert and Response (GAR) – Disease Outbreak News
http://www.who.int/csr/don/2013_03_12/en/index.html
Human infection with influenza A(H7N9) virus in China – update as of 12 April 2013
As of 12 April 2013 (17:30 CET), the National Health and Family Planning Commission notified WHO of an additional five laboratory-confirmed cases of human infection with influenza A(H7N9) virus. Of the latest laboratory-confirmed cases, three are from Zhejiang and two from Shanghai.

The first patient is a 66-year-old man from Zhejiang who became ill on 8 April 2013, the second patient is a 74-year-old man from Zhejiang who became ill on 13 April 2013, the third patient is a 54-year-old woman from Zhejiang who became ill on 13 April 2013, the fourth patient is a 53-year-old man from Shanghai who became ill on 3 April 2013, and the fifth patient is an 86-year-old man from Shanghai who became ill on 3 April 2013.

In addition, a patient earlier reported from Shanghai has died. To date, a total of 43 patients have been laboratory confirmed with influenza A(H7N9) virus in China; including 11 deaths. More than a thousand close contacts of the confirmed cases are being closely monitored.

The Chinese government is actively investigating this event and has heightened disease surveillance. Retrospective testing of recently reported cases with severe respiratory infection may uncover additional cases that were previously unrecognized. An inter-government task force has been formally established, with the National Health and Family Planning Commission leading the coordination along with the Ministry of Agriculture and other key ministries. The animal health sector has intensified investigations into the possible sources and reservoirs of the virus.

WHO is in contact with national authorities and is following the event closely. The WHO-coordinated international response is also focusing on work with WHO Collaborating Centres for Reference and Research on Influenza and other partners to ensure that information is available and that materials are developed for diagnosis and treatment and vaccine development. No vaccine is currently available for this subtype of the influenza virus. Preliminary test results provided by the WHO Collaborating Centre in China suggest that the virus is susceptible to the neuraminidase inhibitors (oseltamivir and zanamivir).

At this time 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.
http://www.who.int/csr/don/2013_04_12/en/index.html

   The Global Fund to Fight AIDS, Tuberculosis and Malaria announced a goal of raising US$15 billion in the 2014-2016 period “so that it can effectively support countries in fighting these three infectious diseases. The Global Fund said it “is determined to accelerate the gains achieved in recent years against AIDS, TB and malaria through strategic investment in programs that can save millions of lives and tens of billions of dollars in future costs. While acknowledging the challenging fiscal environment in many countries, the Global Fund and its partners point to the remarkable value for money that investing in health provides.” Mark Dybul, Executive Director of the Global Fund, said, “We have a choice: we can invest now or pay forever.  Innovations in science and implementation have given us a historic opportunity to completely control these diseases. If we do not, the long-term costs will be staggering.”

The Global Fund convened a donor’s conference in Brussels on 9 and 10 April to present an overall needs assessment for the 2014-2016 period and an update on results and impact from recent years. Donors were invited to a once-every-three-years pledging conference, known as the Global Fund’s Fourth Replenishment, in late 2013.
08 April 2013
Full media release here: http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-04-08_Global_Fund_Targets_USD_15_Billion_to_Effectively_Fight_AIDS_TB_and_Malaria/

WHO/UNICEF: The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD)
Ending preventable child deaths from pneumonia and diarrhoea by 2025
Number of pages: 64
Publication date: 2013
Languages: English
ISBN: 978 92 4 150523 9

Downloads
– Ending preventable child deaths from pneumonia and diarrhoea by 2025: The integrated Global Action Plan for Pneumonia and Diarrhoea
– Executive summary – English
– Executive summary – French
http://www.who.int/maternal_child_adolescent/documents/global_action_plan_pneumonia_diarrhoea/en/index.html

News release 12 April 2013 | Geneva/Washington, DC
Excerpt
WHO/UNICEF: New plan to address pneumonia and diarrhoea could save 2 million children a year
“A new Global Action Plan launched today by the WHO and UNICEF has the potential to save up to 2 million children every year from deaths caused by pneumonia and diarrhoea, some of the leading killers of children under five globally.

The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea calls for closer integration of efforts to prevent and treat these two diseases and sets ambitious targets to reduce mortality rates and raise levels of children’s access to life-saving interventions.

“Too often, strategies to tackle pneumonia and diarrhoea run in parallel,” says Dr Elizabeth Mason, Director of Maternal, Newborn, Child and Adolescent Health at WHO. “But as countries like Bangladesh, Cambodia, Ethiopia, Malawi, Pakistan and Tanzania are already showing, it makes good health sense and good economic sense to integrate those strategies more closely.”

“Many factors contribute to these two conditions, so no single intervention can effectively prevent, treat or control either pneumonia or diarrhoea. However, as richer countries have demonstrated, a number of elements are key to reducing infections and deaths from both diseases. For example, good nutrition and a clean environment help protect children from both pneumonia and diarrhoea. New vaccines are being introduced to protect children from these diseases. Good access to health services and the right medicines can ensure they get the treatment they need. But many existing efforts to address pneumonia and diarrhoea in low- and middle-income countries have yet to capitalize on these common elements…

“…The new WHO/UNICEF Action Plan sets clear goals for the world to achieve by 2025: a 75% reduction in incidence of severe pneumonia and diarrhoea from 2010 levels among children under five, and the virtual elimination of deaths from both diseases in the same age-group. It also aims for a 40% reduction in the global number of children under five who are stunted.

“The Action Plan’s targets are significantly higher than current levels. For example, it calls for 90% of all children to have access to antibiotics for pneumonia and oral rehydration salts for diarrhoea, up from current levels of 31 and 35% respectively. As an interim target, at least half of all children under six months should be exclusively breastfed, against 2012 levels of 39%. All children should have access to improved sanitation and safe drinking water, from 63 and 89% respectively; and building on the good progress already made in some countries in introducing new vaccines against pneumococcal bacteria and rotavirus, it aims for 90% coverage by the target date.

“The Action Plan calls on governments and other stakeholders to prioritize investment in the population groups with the poorest access to services to prevent and treat pneumonia and diarrhoea. Nearly 90% of pneumonia and diarrhoea deaths in children currently occur in sub-Saharan Africa and South Asia…

Notes to Editors:
“The new integrated Global Action Plan builds on existing commitments and initiatives, such as the United Nations Secretary-General’s Global Strategy for Women’s and Children’s Health and Every Woman Every Child; the UN Commission on Information and Accountability for Women’s and Children’s Health; the UN Commission on Life-Saving Commodities for Women and Children; Committing to Child Survival: A Promise Renewed; the 2012 Declaration on scaling up treatment of diarrhoea and pneumonia; the Sanitation and Water for All partnership; the International Decade for Action ‘Water for Life’ 2005-2015; Sustainable sanitation: The Drive to 2015; and the Global Vaccine Action Plan.

“The Action Plan is being launched in conjunction with a new Lancet Series on Childhood Pneumonia and Diarrhoea. The four papers in the Series provide the evidence base for integrated action on these two illnesses and include new data on burden, epidemiology, interventions that work, and the financial cost of ending preventable deaths from childhood diarrhoea and pneumonia by 2025.
http://www.who.int/mediacentre/news/releases/2013/pneumonia_diarrhoea_plan_20130412/en/index.html

IVAC Blog
Eliminating Childhood Disease – Aspirational But Achievable
By Dr. Kate O’Brien, MD, MPH is Acting Executive Director of IVAC.

The MMWR Weekly for April 12, 2013 / Vol. 62 / No. 14 includes:
– Varicella Death of an Unvaccinated, Previously Healthy Adolescent — Ohio, 2009

– Human Contacts with Oral Rabies Vaccine Baits Distributed for Wildlife Rabies Management — Ohio, 2012

–Evaluating Surveillance Indicators Supporting the Global Polio Eradication Initiative, 2011–2012

The Weekly Epidemiological Record (WER) for 12 April 2013, vol. 88, 15 (pp. 153–160) includes:
– Tracking progress towards global polio eradication, 2011–2012

http://www.who.int/entity/wer/2013/wer8815.pdf

Update: Polio this week – As of 10 April 2013
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s extract and bolded text]
– More than 400 scientists from around the world, including Nobel laureates, public health school deans and other leading health experts, added their names to the Scientific Declaration on Polio Eradication today, asserting that polio eradication is possible and expressing their confidence in a new plan to create a polio-free world by 2018.

Nigeria
– One new WPV case was reported in the past week (WPV1 from Gombe), bringing the total number of WPV cases for 2013 to eleven. This latest WPV case is the most recent in the country, and had onset of paralysis on 19 March.

Pakistan
– One new WPV case was reported in the past week (WPV1 from Sindh), bringing the total number of WPV cases for 2013 to six. This latest case is the most recent in the country, and had onset of paralysis on 22 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.

Scientific Declaration on Polio Eradication
http://vaccines.emory.edu/poliodeclaration/text.pdf

Polio is a highly infectious disease that can cause irreversible paralysis and death. Today, the disease mostly affects children living in some of the world’s poorest and most marginalized communities. Yet we are closer than ever to a world where no child will ever again be crippled or die from this disease. At this unique moment, an international group of scientists has come together to stress the achievability of polio eradication and endorse the Eradication and Endgame Strategic Plan, a new strategy by the Global Polio Eradication Initiative (GPEI) to

reach and sustain eradication by 2018. The plan was developed in consultation with a range of technical experts, governments, funding partners and stakeholders and received unanimous support from the WHO Executive Board in January 2013.

Whereas,
1. Unprecedented progress, scientific advances and new tools give us confidence that eradication is achievable.

– New cases of wild poliovirus have dropped from an estimated 350,000 cases in more than 125 countries in 1988 to fewer than 250 cases in just five countries in 2012.

– 2012 was a turning point for the remaining endemic countries. Nigeria, Afghanistan and Pakistan launched national emergency action plans that resulted in significant improvements in immunization campaign quality and the fewest new cases on record.

– India stopped wild poliovirus transmission in 2011, proving that polio can be eliminated in the most challenging circumstances.

– Two effective vaccines have protected hundreds of millions of children against the disease: oral polio vaccine (OPV) and inactivated polio vaccine (IPV). The worldwide elimination of one of the three types of wild poliovirus (type 2) more than a decade ago proves that eradication through the polio eradication strategy is feasible.

– We have successful strategies to deliver vaccines and monitor coverage, strong surveillance to quickly detect and contain the virus, and innovative technologies and approaches such as geographic information system (GIS) mapping and new vaccine formulations to ensure that children are reached and protected.

2. The new Strategic Plan provides a clear path forward that capitalizes on this historic opportunity to end polio.

– The plan is a long-term, comprehensive strategy to complete and sustain eradication. The plan’s strategies are sound and, when implemented, will interrupt transmission, sustain eradication and maximize post-eradication benefits.

– The plan is a significant step forward over previous eradication strategies and offers strong solutions to challenges by including:

– Data-driven strategies to overcome operational challenges—including missed children—to ensure high quality immunization campaigns that can interrupt transmission globally; and

– Plans to eliminate both wild poliovirus and vaccine-derived poliovirus, starting with the withdrawal of type 2 from OPV and introduction of IPV in all countries to boost immunity to remaining strains.

– Insecurity in endemic countries is a serious threat to the program. To overcome this challenge, the GPEI will improve coordination between civilian and security services, increase community demand for vaccination services, enhance advocacy efforts by religious leaders and institutions, and increase vaccinations in areas bordering insecure places to reduce spread of the disease.

3. The new plan emphasizes the urgency of improving routine immunization systems and lays a foundation to protect children against other diseases.

– The plan recognizes that eradication efforts are interdependent with strengthened routine immunization. High levels of routine immunization are needed to achieve and sustain polio eradication. At the same time, eradication efforts demonstrate that it is possible to reach nearly every child, even in the most underserved and remote areas, with vaccines and other life-saving interventions.

– The Strategic Plan calls for GPEI to use its robust infrastructure to benefit routine immunization and other health programs. It includes strategies for polio eradication staff and processes to help strengthen routine immunization, in partnership with national immunization programs and the GAVI Alliance and in alignment with the Global Vaccine Action Plan.

– Eradication would demonstrate that worldwide collaborations can successfully combat complex health threats, including in remote communities too often left behind.

4. Scaling back efforts would have devastating consequences.

– For polioviruses to survive, they must be transmitted from infected persons to susceptible persons in a continuous chain of human-to-human transmission. When immunity levels are high, the chains are broken. Today, there are fewer chains than ever before, creating an unprecedented opportunity to stop transmission.

– Weakening our efforts would lower immunity levels, setting the stage for a resurgence of outbreaks. Polio is highly infectious and spreads quickly. If we aim for control rather than eradication—relying only on routine immunization to vaccinate against polio and eliminating mass vaccination and other eradication strategies—we can expect up to 200,000 cases annually.

   We, members of the scientific community, declare our conviction that the eradication of polio is an urgent and achievable global health priority. We endorse the Eradication and Endgame Strategic Plan and call on actors in the global community to do their part to ensure the full implementation of the plan.

   We urge:

– Scientists to develop new and better tools to accelerate and sustain eradication, including low-cost IPV options, and to continue providing technical support to endemic countries.

– Partners, including GPEI and vaccine manufacturers, to ensure sufficient supply of and access to different types of vaccines required for eradication, including IPV use in resource-poor countries.

– Endemic country leaders and international program officials to stay fully committed and accountable to stop transmission. They can build on emergency plans to increase accountability and strengthen campaign quality. They can continue to develop regional- and community-specific solutions to bottlenecks such as vaccine refusals.

– Endemic country governments and partners to strengthen security measures and deepen engagement with community and religious leaders to promote demand and protect vaccination teams and volunteers, in light of recent attacks on health workers across Pakistan and Nigeria.

– International partners and national programs to strengthen linkages across polio vaccination efforts, routine immunization and other initiatives, including measles prevention, maternal and child health and nutrition, to address the broad health needs of communities.

– Partners, and national and global programs, to commit to strengthen routine immunization with the same urgency, robust technical and financial support and clear measurement indicators.

– Partners to fully fund the Strategic Plan. Funding gaps in 2012 led to cancelled and scaled-back vaccination campaigns in 24 countries, leaving children in these areas more susceptible to polio.

– Civil society to continue to support efforts to end polio forever. Polio eradication can be our generation’s legacy to all future generations. Only working together can we make history and end polio.

For more information about the declaration and for a full list of signatories, please visit http://vaccines.emory.edu/poliodeclaration/

British Medical Bulletin
Volume 105 Issue 1 March 2013
http://bmb.oxfordjournals.org/content/current

Articles
Policy reform to realize the commitments of the Political Declaration on noncommunicable diseases
Shanthi Mendis and Oleg Chestnov
Br Med Bull (2013) 105(1): 7-27 doi:10.1093/bmb/ldt001

Abstract
Background
Noncommunicable diseases (NCDs) caused an estimated 36 million deaths in 2008. Recognizing that NCDs are a global health and development priority, Heads of State and government adopted the Political Declaration on NCDs (resolution A/RES/66/2) at the United Nations General Assembly in September 2011.

Sources of data
The Political Declaration of the United Nations High Level meeting on NCDs, World Health Organization (WHO) reports on NCDs and WHO Country Cooperation Strategy documents.

Areas of agreement
NCDs are a growing threat to health and development. Cost of action and inaction are known.

Areas of controversy
Accountability of all stakeholders including the private sector is essential for an effective global public health response. More clarity is needed on the private sector contribution to the response to safeguard public health from any potential conflict of interest.

Growing points
A country-led public health policy response should include, at a minimum, national scale-up of very cost-effective, high impact NCD interventions to improve health outcomes and health equity with universal coverage as a long-term public health goal.

Areas timely for developing research
Policy reform and accelerated national scale-up action, particularly in low-and-middle-income countries, must be guided by translation research and feedback information from monitoring and evaluation.

Eurosurveillance
Volume 18, Issue 15, 11 April 2013
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Editorials
A novel reassortant avian influenza A(H7N9) virus in China – what are the implications for Europe
by A Nicoll, N Danielsson

Rapid communications
Genetic analysis of novel avian A(H7N9) influenza viruses isolated from patients in China, February to April 2013
by T Kageyama, S Fujisaki, E Takashita, H Xu, S Yamada, Y Uchida, G Neumann, T Saito, Y Kawaoka, M Tashiro

Journal of Virology
May 2013, volume 87, issue 9
http://jvi.asm.org/content/current

Multiple Independent Emergences of Type 2 Vaccine-Derived Polioviruses during a Large Outbreak in Northern Nigeria
Cara C. Burns, Jing Shaw, Jaume Jorba, David Bukbuk, Festus Adu, Nicksy Gumede, Muhammed Ali Pate, Emmanuel Ade Abanida, Alex Gasasira, Qi Chen, Annelet Vincent, Paul Chenoweth, Elizabeth Henderson, Kathleen Wannemuehler, Asif Naeem, Rifqiyah Nur Umami, Yorihiro Nishimura, Hiroyuki Shimizu, Marycelin Baba, Adekunle Adeniji, A. J. Williams, David R. Kilpatrick, M. Steven Oberste, Steven G. Wassilak, Oyewale Tomori, Mark A. Pallansch, and Olen Kew
J. Virol. May 2013 87:4907-4922; published ahead of print 13 February 2013 , doi:10.1128/JVI.02954-12
http://jvi.asm.org/content/87/9/4907.abstract

ABSTRACT
Since 2005, a large poliomyelitis outbreak associated with type 2 circulating vaccine-derived poliovirus (cVDPV2) has occurred in northern Nigeria, where immunization coverage with trivalent oral poliovirus vaccine (tOPV) has been low. Phylogenetic analysis of P1/capsid region sequences of isolates from each of the 403 cases reported in 2005 to 2011 resolved the outbreak into 23 independent type 2 vaccine-derived poliovirus (VDPV2) emergences, at least 7 of which established circulating lineage groups. Virus from one emergence (lineage group 2005-8; 361 isolates) was estimated to have circulated for over 6 years. The population of the major cVDPV2 lineage group expanded rapidly in early 2009, fell sharply after two tOPV rounds in mid-2009, and gradually expanded again through 2011. The two major determinants of attenuation of the Sabin 2 oral poliovirus vaccine strain (A481 in the 5′-untranslated region [5′-UTR] and VP1-Ile143) had been replaced in all VDPV2 isolates; most A481 5′-UTR replacements occurred by recombination with other enteroviruses. cVDPV2 isolates representing different lineage groups had biological properties indistinguishable from those of wild polioviruses, including efficient growth in neuron-derived HEK293 cells, the capacity to cause paralytic disease in both humans and PVR-Tg21 transgenic mice, loss of the temperature-sensitive phenotype, and the capacity for sustained person-to-person transmission. We estimate from the poliomyelitis case count and the paralytic case-to-infection ratio for type 2 wild poliovirus infections that ∼700,000 cVDPV2 infections have occurred during the outbreak. The detection of multiple concurrent cVDPV2 outbreaks in northern Nigeria highlights the risks of cVDPV emergence accompanying tOPV use at low rates of coverage in developing countries.

The Lancet  
Apr 13, 2013  Volume 381  Number 9874   p1247 – 1332
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Measuring universities’ commitments to global health
The Lancet

Preview
The University Global Health Impact Report Card  http://globalhealthgrades.org/ was released on April 4, marking a new effort to identify the standings of leading North American research universities in bridging the gap between research and roll out of treatments for neglected diseases. The report, sponsored by the Universities Allied for Essential Medicines, assesses the performance of 54 institutions on two key aspects—commitment to innovation in research that bears on the developing world and the use of open, socially responsible technology licensing that helps to ensure affordable access.

The Lancet  
Apr 13, 2013  Volume 381  Number 9874   p1247 – 1332
http://www.thelancet.com/journals/lancet/issue/current

Comment
Cash-transfer programmes in developing countries
Stuart Gilmour, Tomohiro Hamakawa, Kenji Shibuya

Preview
In The Lancet, Laura Robertson and colleagues present research that adds to the impressive record of cash-transfer programmes.1 In a cluster-randomised trial undertaken in difficult circumstances in Zimbabwe, Robertson and colleagues1 show that a conditional cash transfer (CCT) programme improved the proportion of children aged 6–12 years who attend school regularly by 7·6% (95% CI 1·2–14·1) and that of children aged 0–4 years with birth certificates by 16·4% (7·8–25·0) compared with a control group.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2962168-0/abstract

Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomised trial
Laura Robertson, Phyllis Mushati, Jeffrey W Eaton, Lovemore Dumba, Gideon Mavise, Jeremiah Makoni, Christina Schumacher, Tom Crea, Roeland Monasch, Lorraine Sherr, Geoffrey P Garnett, Constance Nyamukapa, Simon Gregson

Summary
Background
Cash-transfer programmes can improve the wellbeing of vulnerable children, but few studies have rigorously assessed their effectiveness in sub-Saharan Africa. We investigated the effects of unconditional cash transfers (UCTs) and conditional cash transfers (CCTs) on birth registration, vaccination uptake, and school attendance in children in Zimbabwe.

Methods
We did a matched, cluster-randomised controlled trial in ten sites in Manicaland, Zimbabwe. We divided each study site into three clusters. After a baseline survey between July, and September, 2009, clusters in each site were randomly assigned to UCT, CCT, or control, by drawing of lots from a hat. Eligible households contained children younger than 18 years and satisfied at least one other criteria: head of household was younger than 18 years; household cared for at least one orphan younger than 18 years, a disabled person, or an individual who was chronically ill; or household was in poorest wealth quintile. Between January, 2010, and January, 2011, households in UCT clusters collected payments every 2 months. Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing. Eligible households in all clusters, including control clusters, had access to parenting skills classes and received maize seed and fertiliser in December, 2009, and August, 2010. Households and individuals delivering the intervention were not masked, but data analysts were. The primary endpoints were proportion of children younger than 5 years with a birth certificate, proportion younger than 5 years with up-to-date vaccinations, and proportion aged 6—12 years attending school at least 80% of the time. This trial is registered with ClinicalTrials.gov, number NCT00966849.

Findings
1,199 eligible households were allocated to the control group, 1,525 to the UCT group, and 1,319 to the CCT group. Compared with control clusters, the proportion of children aged 0-4 years with birth certificates had increased by 1.5% (95% CI-7.1 to 10.1) in the UCT group and by 16.4% (7.8-25.0) in the CCT group by the end of the intervention period. The proportions of children aged 0-4 years with complete vaccination records was 3.1% (-3.8 to 9.9) greater in the UCT group and 1.8% (-5.0 to 8.7) greater in the CCT group than in the control group. The proportions of children aged 6-12 years who attended school at least 80% of the time was 7.2% (0.8-13.7) higher in the UCT group and 7.6% (1.2-14.1) in the CCT group than in the control group.

Interpretation
Our results support strategies to integrate cash transfers into social welfare programming in sub-Saharan Africa, but further evidence is needed for the comparative effectiveness of UCT and CCT programmes in this region.

Funding
Wellcome Trust, the World Bank through the Partnership for Child Development, and the Programme of Support for the Zimbabwe National Action Plan for Orphans and Vulnerable Children.

New England Journal of Medicine
April 11, 2013  Vol. 368 No. 15
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Go Big and Go Fast — Vaccine Refusal and Disease Eradication
Saad B. Omer, M.B., B.S., Ph.D., M.P.H., Walter A. Orenstein, M.D., and Jeffrey P. Koplan, M.D., M.P.H.
N Engl J Med 2013; 368:1374-1376April 11, 2013 DOI: 10.1056/NEJMp1300765

[Free full text]
Disease eradication is an attractive public health goal. In addition to eliminating illnesses and deaths, eradication can lead to substantial cost savings. Eradication has been attempted for many human and animal diseases, such as smallpox, malaria, hookworm disease, polio, rinderpest, yaws, dracunculiasis (guinea worm disease), and yellow fever, and many tools have been employed in these efforts. But in the two diseases that were successfully eradicated, smallpox and rinderpest, the main tool was a vaccine. Eradication strategies for polio (a major current focus of global eradication efforts) and measles (whose eradication is being considered) rely on high vaccination coverage through routine and supplementary immunization.

Eradication efforts for vaccine-preventable diseases face many challenges, including vaccine refusal. Such refusal in communities in northern Nigeria and Pakistan, for example, has caused major setbacks to global polio eradication, contributing to continued endemic transmission of poliovirus in these countries and to the reintroduction of wild-type poliovirus into countries where transmission had been interrupted. Although wild-type polioviruses are no longer endemic in India, refusal played some role in delaying elimination. The resurgence of measles in Europe, partially attributed to vaccine refusal, threatens its regional elimination and eventual global eradication. It is therefore important to understand the determinants and dynamics of vaccine refusal affecting disease-eradication initiatives.

Many factors contribute to the development of clusters of people who refuse vaccines, including changes over time in attitudes toward vaccines. If aggressive control efforts have substantially reduced a disease’s incidence, few people in a given community may have direct (or indirect) experience with that disease. Therefore, successive age cohorts have only a vague collective memory of the disease’s dangers, whereas people may frequently hear about real and perceived adverse effects of vaccination. Parental perception of risks and benefits associated with vaccines is thus altered, and vaccine refusals often increase.1 North American and European countries, for example, have seen substantial reductions in the rates of vaccine-preventable diseases. Since vaccines against measles, mumps, rubella, and diphtheria were introduced in the United States, their incidence has been reduced by more than 99%, and the incidence of tetanus has fallen by 94% since routine tetanus vaccination began.2,3 These decreases have coincided with increases in vaccine refusal in the United States and Europe.

The notion that vaccine acceptance is influenced by rates of vaccine-preventable diseases is supported by theories from behavioral sciences. For example, a useful framework for understanding vaccine acceptance is the health-belief model, according to which the uptake of a health intervention is associated with perceived susceptibility to and severity of the relevant disease and the intervention’s safety and efficacy. Empirical studies have validated this model as a predictor of vaccine refusal. In the context of eradication, reduction in disease incidence reduces the perceptions of susceptibility to disease and its complications, diminishing an important motivation for accepting a vaccine.

It is often assumed that this phenomenon does not apply to low-income countries where there is increasing opposition to vaccines, despite the high burden of infectious diseases. This perspective misses an important point: perceptions regarding vaccines are often vaccine-specific and disease-specific. For example, in high-income countries, although many parents have generalized concerns regarding immunization, perceptions of specific vaccines vary considerably. Similarly, the more prominent instances of vaccine refusal in low-income countries have been specific to vaccines for diseases with actual or perceived low incidence. Refusal of the polio vaccine in northern Nigeria and parts of northern India, for instance, was vaccine-specific: communities that refused polio vaccine were still demanding measles vaccines. In fact, the low polio rates, achieved through intensive immunization efforts in previous years, were a reason why many did not consider polio eradication a priority: “Some people have never even seen polio, but yet they keep giving us medicine for it,” one Nigerian told a researcher. “If you look around it is hard to find 2 or 3 people with polio, but it is easy to go to the hospital and find 50 people sick with no money to buy the medicine they need to be treated with. Help them instead, but No! You find a small baby who is well and drop medicine in his mouth, for free!”4

Although change in the epidemiology of a vaccine-preventable disease is important in determining support for the vaccine, it is not the only important factor involved. Local sociopolitical, demographic, and health-system–related issues and competing health problems (e.g., HIV infection and malnutrition) affect both the response of parents and the community and the effectiveness of control programs. For example, in Nigeria, local politics, distrust of the central government and the West, and the history of unethical practices of Western pharmaceutical companies all contributed to polio-vaccination resistance.4 Similarly, in northern India, the resistance to polio vaccination was centered in the Muslim minority communities that have historically felt marginalized. But local factors operate in a milieu of decreased appreciation of vaccines — an argument supported by the specificity of opposition to polio vaccine.

Other major challenges to disease eradication include suboptimal vaccine effectiveness in certain populations, emergence of vaccine-derived pathogenic strains, difficulties in reaching migrant populations, chronic underfunding, international conflict, and violence against health workers. The relative importance of various challenges, including vaccine refusal, varies among and within countries.

Resistance to vaccination can be overcome with carefully planned and executed social mobilization initiatives and bundling of eradication-related vaccination with other services that have higher acceptance among the target population. For example, polio-eradication efforts in India led to the successful elimination of polio transmission in January 2011. But addressing vaccine refusal may require substantial human and financial resources. In northern India, it took sustained multiyear efforts and involvement of nontraditional stakeholders (such as Muslim religious leaders) to overcome resistance to vaccination. Implementing high-intensity communication and social mobilization programs is more challenging when factors such as lack of security are at play, as is the case for polio elimination in Afghanistan and Pakistan.

The next vaccine-preventable disease being considered for global eradication is measles. A global technical consultation commissioned by the World Health Organization (WHO) to assess the feasibility of global measles eradication concluded that “measles can and should be eradicated.”5 This conclusion has been endorsed by the WHO Strategic Advisory Group of Experts on Immunization, and regional elimination goals have been established by all WHO regions except the Southeast Asian region. However, there has been no target date set for global eradication. Initiatives for eradicating diseases with a high herd-immunity threshold (such as measles, which has a threshold of approximately 94%) are more vulnerable to the effects of pockets of vaccine refusal than are attempts to eradicate disease with lower herd-immunity thresholds, such as smallpox (which had a threshold of approximately 80 to 85%).

One lesson from past eradication efforts is that the last mile is the longest. Aggressive early efforts often cause dramatic reductions in disease rates, which paradoxically increase the risk of vaccine refusal. It is difficult to quantify the precise rate of decline in favorable perceptions of a vaccine, so it’s challenging to predict the exact timing and location of emergence of clusters of vaccine refusers. Yet it’s reasonable to assume that the longer it takes to move from aggressive control or regional elimination to global eradication, the more likely it is that vaccine refusal will emerge.

Eradication should therefore not be a halfhearted effort. Aggressive disease control is in itself a worthy public health goal, but it shouldn’t be assumed to be an automatic stepping-stone to eradication. If a disease such as measles is considered a priority by the global public health community, human and financial resources should be committed up front to a full-scale eradication initiative, conducted with a sense of urgency. If we don’t “go big and go fast,” we may have to spend a prolonged period on eradication efforts with a diminished likelihood of success.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Source Information
From the Hubert Department of Global Health, Emory University Rollins School of Public Health (S.B.O.); the Emory Vaccine Center (S.B.O., W.A.O.) and the Emory Global Health Institute (J.P.K.), Emory University; and the Center for Health Research Southeast (S.B.O) — all in Atlanta.

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
March 2013  Vol. 33, No. 3
http://www.paho.org/journal/index.php?option=com_content&task=view&id=122&Itemid=222

Socioeconomic determinants of cervical cancer screening in Latin America [Determinantes socioeconómicos de las pruebas de detección sistemática del cáncer cervicouterino en América Latina]

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
March 2013  Vol. 33, No. 3
http://www.paho.org/journal/index.php?option=com_content&task=view&id=122&Itemid=222

INFORMES ESPECIALES / SPECIAL REPORTS
Bellagio Report on Healthy Agriculture, Healthy Nutrition, Healthy People [Informe Bellagio sobre la actividad agropecuaria y la nutrición para la salud de las personas]
Artemis P. Simopoulos, Peter G. Bourne, and Ole Faergeman

PLoS One
[Accessed 13 April 2013]
http://www.plosone.org/

The Cost Effectiveness of Pandemic Influenza Interventions: A Pandemic Severity Based Analysis
George J. Milne, Nilimesh Halder, Joel K. Kelso
Research Article | published 09 Apr 2013 | PLOS ONE 10.1371/journal.pone.0061504

Abstract
Background
The impact of a newly emerged influenza pandemic will depend on its transmissibility and severity. Understanding how these pandemic features impact on the effectiveness and cost effectiveness of alternative intervention strategies is important for pandemic planning.

Methods
A cost effectiveness analysis of a comprehensive range of social distancing and antiviral drug strategies intended to mitigate a future pandemic was conducted using a simulation model of a community of ~30,000 in Australia. Six pandemic severity categories were defined based on case fatality ratio (CFR), using data from the 2009/2010 pandemic to relate hospitalisation rates to CFR.

Results
Intervention strategies combining school closure with antiviral treatment and prophylaxis are the most cost effective strategies in terms of cost per life year saved (LYS) for all severity categories. The cost component in the cost per LYS ratio varies depending on pandemic severity: for a severe pandemic (CFR of 2.5%) the cost is ~$9 k per LYS; for a low severity pandemic (CFR of 0.1%) this strategy costs ~$58 k per LYS; for a pandemic with very low severity similar to the 2009 pandemic (CFR of 0.03%) the cost is ~$155 per LYS. With high severity pandemics (CFR >0.75%) the most effective attack rate reduction strategies are also the most cost effective. During low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, while for high severity pandemics costs are dominated by hospitalisation costs and productivity losses due to death.

Conclusions
The most cost effective strategies for mitigating an influenza pandemic involve combining sustained social distancing with the use of antiviral agents. For low severity pandemics the most cost effective strategies involve antiviral treatment, prophylaxis and short durations of school closure; while these are cost effective they are less effective than other strategies in reducing the infection rate.

PLoS Medicine
(Accessed 13 April 2013)
http://www.plosmedicine.org/

Herpes Zoster Vaccine Effectiveness against Incident Herpes Zoster and Post-herpetic Neuralgia in an Older US Population: A Cohort Study
Sinéad M. Langan, Liam Smeeth, David J. Margolis, Sara L. Thomas

Abstract
Background
Herpes zoster is common and has serious consequences, notably post-herpetic neuralgia (PHN). Vaccine efficacy against incident zoster and PHN has been demonstrated in clinical trials, but effectiveness has not been studied in unselected general populations unrestricted by region, full health insurance coverage, or immune status. Our objective was to assess zoster vaccine effectiveness (VE) against incident zoster and PHN in a general population-based setting.

Methods and Findings
A cohort study of 766,330 fully eligible individuals aged ≥65 years was undertaken in a 5% random sample of Medicare who received and did not receive zoster vaccination between 1st January 2007 and 31st December 2009.

Incidence rates and hazard ratios for zoster and PHN were determined in vaccinated and unvaccinated individuals. Analyses were adjusted for age, gender, race, low income, immunosuppression, and important comorbidities associated with zoster, and then stratified by immunosuppression status. Adjusted hazard ratios were estimated using time-updated Cox proportional hazards models.

Vaccine uptake was low (3.9%) particularly among black people (0.3%) and those with evidence of low income (0.6%). 13,112 US Medicare beneficiaries developed incident zoster; the overall zoster incidence rate was 10.0 (9.8–10.2) per 1,000 person-years in the unvaccinated group and 5.4 (95% CI 4.6–6.4) per 1,000 person-years in vaccinees, giving an adjusted VE against incident zoster of 0.48 (95% CI 0.39–0.56). In immunosuppressed individuals, VE against zoster was 0.37 (95% CI 0.06–0.58). VE against PHN was 0.59 (95% CI 0.21–0.79).

Conclusions
Vaccine uptake was low with variation in specific patient groups. In a general population cohort of older individuals, zoster vaccination was associated with reduction in incident zoster, including among those with immunosuppression. Importantly, this study demonstrates that zoster vaccination is associated with a reduction in PHN.

Editors’ Summary
Background
Chickenpox is an extremely common childhood infectious disease that is caused by the herpes varicella-zoster virus. Children usually recover quickly from chickenpox, but dormant varicella-zoster virus persists throughout life inside the nervous system. The dormant virus causes no symptoms but if it becomes reactivated, it causes shingles (zoster), a painful skin rash. Anyone who has had chickenpox can develop shingles but shingles is most common and most severe in 60–80-year-old people. Indeed, about half of people who live to 85 will have an episode of shingles. Early signs of shingles include burning or shooting pain and tingling or itching. Blister-like sores, which last from 1–14 days, then develop in a region of one side of the body or on one side of the face. The pain of shingles can be debilitating and can continue after the rash disappears—“post-herpetic neuralgia,” which can last for months to years, greatly reduces the quality of life. There is no cure for shingles but early treatment with antivirals may help to prevent lingering pain by inhibiting viral replication.

Why Was This Study Done?
Shingles vaccination can prevent shingles or lessen its effects. In clinical trials, vaccination reduced the incidence of shingles (the proportion of a population who develop shingles in a year) and the incidence of post-herpetic neuralgia, and vaccination against shingles is now recommended in the US for everyone over the age of 60 except individuals with a weakened immune system (for example, people with HIV/AIDS). However, these clinical trials determined the vaccine’s efficacy in selected populations under controlled conditions. How effective is the vaccine in unselected populations in routine clinical use? In this cohort study, the researchers assess zoster (shingles) vaccine effectiveness against incident shingles and post-herpetic neuralgia in an unselected population of older individuals in the US. A cohort study follows a group of individuals who differ with respect to specific factors (in this study, vaccination against shingles) to determine how these factors affect the rates of specific outcomes (shingles and post-herpetic neuralgia).

What Did the Researchers Do and Find?
The researchers undertook their cohort study in 766,330 randomly chosen Medicare beneficiaries aged 65 years or more. Medicare is a US government health insurance scheme that mainly helps to pay the health care costs of people aged 65 or older. The researchers used Medicare administrative data to identify which cohort members received zoster vaccination between January 2007 and December 2009 and which developed incident shingles (defined as a first diagnosis of shingles combined with the use of antivirals) or post-herpetic neuralgia (defined as a code for post-herpetic neuralgia, non-specific neuralgia, or a second diagnostic code for shingles 90 days after the first diagnosis combined with a prescription for pain relief, an anticonvulsant, or an antidepressant). Vaccine uptake was low in this unselected study population—only 3.9% of the participants were vaccinated. The vaccination rate was particularly low among black people (0.6% of person-time) and among people with a low income (0.3%). About 13,000 participants developed incident shingles. The shingles incidence rate was 10.0 per 1,000 person-years among unvaccinated participants and 5.4 per 1,000 person-years among vaccinated participants. Vaccine effectiveness against incident shingles was 48%. That is, vaccination reduced the incidence of shingles by 48% (in other words, approximately half as many vaccinated individuals developed shingles as those who were not vaccinated). Vaccine effectiveness against incident shingles among immunosuppressed individuals was lower (37%). Finally, vaccine effectiveness against post-herpetic neuralgia was 59%.

What Do These Findings Mean?
These findings show that shingles vaccine uptake is low among elderly people in the US and varies between different patient groups. They show that shingles vaccination is effective against incident shingles in a general population of older individuals, including those who are immunosuppressed, and suggest that shingles vaccination is effective against post-herpetic neuralgia. However, because these findings rely on administrative data, their accuracy may be affected by misclassification of vaccination and of outcomes. Moreover, because shingles vaccination was not randomized, the vaccinated individuals might have shared other characteristics that were actually responsible for their lower incidence of shingles and/or post-herpetic neuralgia compared to unvaccinated individuals. Despite these limitations, these findings provide useful information for policy makers in countries that are currently considering the introduction of shingles vaccination into routine practice. Moreover, they highlight the need to increase shingles vaccination among elderly individuals in the US, the section of the population at the highest risk of post-herpetic neuralgia.

Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/ 10.1371/journal.pmed.1001420.

Vaccine
Volume 31, Issue 19, Pages 2323-2416 (1 May 2013)
http://www.sciencedirect.com/science/journal/0264410X

Letter to the Editor
The Coalition for Cholera Prevention and Control meeting
Page 2323
Alan R. Hinman, Paul E. Farmer
No abstract

Vaccine
Volume 31, Issue 19, Pages 2323-2416 (1 May 2013)
http://www.sciencedirect.com/science/journal/0264410X

Trends in vaccination coverage disparities among children, United States, 2001–2010
Brief Report
Pages 2324-2327
Zhen Zhao, Philip J. Smith

Abstract
Introduction
One of two overarching goals of the Healthy People 2010 initiative was to eliminate health disparities. We evaluate trends in children vaccination coverage disparities by socio-demographic characteristics in the United States from 2001 through 2010.

Methods
Disparities in vaccination coverage for the 4:3:1:3:3:1 vaccine series was assessed with National Immunization Survey (NIS) 2001–2010 data. The disparities between two categories of population were independently evaluated yearly from 2001 through 2010.

Results
In 2001, 10 out of 12 disparities were significant (P-value <0.05). Six disparities were reduced from statistically significant in 2001 to not significant in 2010. Across 2001–2010, 8 disparities narrowed significantly; the average change in disparities per year were negative and ranged from −0.30% to −0.64% (P-value <0.05).

Conclusions
Significant success has been achieved in reducing disparities in vaccination coverage for young children among most of the major socio-demographic subpopulations in the United States by 2010.

Vaccine
Volume 31, Issue 19, Pages 2323-2416 (1 May 2013)
http://www.sciencedirect.com/science/journal/0264410X

Estimating the long-term effects of HPV vaccination in Germany
Original Research Article
Pages 2372-2380
J. Horn, O. Damm, M.E.E. Kretzschmar, Y. Deleré, O. Wichmann, A.M. Kaufmann, E. Garbe, A. Krämer, W. Greiner, R.T. Mikolajczyk

Abstract
In Germany, vaccination against the most oncogenic HPV types 16/18 is recommended by the Standing Committee on Vaccination (STIKO) for 12–17 year old girls since March 2007. We developed a dynamic mathematical model for the natural history and transmission of HPV infections to estimate the impact of vaccination on incidence and mortality of cervical cancer and its pre-stages, and on anogenital warts. We focused on an extensive model calibration to epidemiologic data for all stages of the natural history model as well as on a detailed implementation of cervical cancer screening modalities in Germany. Our model predicts first a substantial reduction of cervical cancer incidence and mortality over the next 30 years, which is mainly attributable to an increase in screening participation in the 1990s and not to HPV vaccination, followed by a further reduction attributable to vaccination. Over the next 100 years, HPV vaccination will prevent approximately 37% of cervical cancer cases even if vaccination coverage is only 50% (as currently observed in Germany). Consideration of cross-protection results in a further reduction of approximately 7% of all cervical cancer cases for the bivalent and about 5% for the quadrivalent vaccine in our model. Vaccination of boys was only reasonable if moderate to high vaccination coverage in girls was not achieved. Strategies should be implemented in Germany to increase HPV vaccination coverage among girls thereby making better use of the demonstrated benefits of the vaccine.

From Google Scholar & other sources: Selected Journal Articles, Dissertations, Theses

Parent perspectives on consent for the linkage of data to evaluate vaccine safety A randomised trial of opt-in and opt-out consent
JG Berry, P Ryan, KM Duszynski, AJ Braunack-Mayer… – Clinical Trials, 2013
Background We examined parents’ consent preferences and understanding of an opt-in or opt-out invitation to participate in data linkage for post-marketing safety surveillance of childhood vaccines. Methods A single-blind parallel-group randomised controlled trial: …

[HTML] Acceptability of human papilloma virus vaccine and cervical cancer screening among female health-care workers in Enugu, Southeast Nigeria
EO Ugwu, SN Obi, PC Ezechukwu, II Okafor, AO Ugwu – Nigerian Journal of Clinical …, 2013
Background: Cervical cancer, a leading cause of cancer deaths in women in developing countries can be prevented primarily by vaccinating adolescent girls and women against infection by the human papillomavirus (HPV) before their first sexual exposure, and …

Characterization and optimization of bilosomes for oral vaccine delivery
JS Wilkhu, SE McNeil, DE Anderson, Y Perrie – Journal of Drug Targeting, 2013
Oral vaccines offer significant benefits due to the ease of administration, better patient compliance and non-invasive, needle-free administration. However, this route is marred by the harsh gastro intestinal environment which is detrimental to many vaccine formats. To …

Development of the Hepatitis E Vaccine: From Bench to Field
J Zhang, JWK Shih, T Wu, SW Li, NS Xia – Seminars in Liver Disease, 2013
Abstract Along with the improvement of diagnostic techniques, hepatitis E has attracted increasing awareness in recent years. Hepatitis E virus infection leads to high mortality in pregnant women and patients with underlying liver disease. Several hepatitis E vaccine …

Preventing Pneumococcal Disease: Intergenerational Issues Toughest Cases
JY Wick – The Consultant Pharmacist, 2013
… lister hypothesized that immunizing half of a closed population would stop (or retard significantly) the organism’s spread, and unimmunized members would benefit as well. He immunized all members of one compound, using those in different compounds as controls. …

HIV: Roadmaps to a vaccine
H Mouquet, MC Nussenzweig – Nature, 2013
Our understanding of how humans respond to HIV has been revolutionized by the introduction
of techniques for isolating anti-viral antibodies from single cells 1 . Such methods have led to
the discovery of naturally occurring, potent antibodies that can neutralize a broad range of …

Forbes
http://www.forbes.com/
Accessed 13 April 2013

The Fight to End Pandemics
Editor’s Note:  Larry Brilliant is CEO of Skoll Global Threats Fund which works on climate, nuclear, pandemic, water and Middle East conflicts. Brilliant helped lead the successful WHO smallpox eradication programme in India.

This article was published as part of a special series for World Health Day and in advance of the 2013 Skoll World Forum.
http://www.forbes.com/sites/skollworldforum/2013/04/07/the-fight-to-end-pandemics/

The Huffington Post
http://www.huffingtonpost.com/
Accessed 13 April 2013

Why the Global Fund Is a Terrific Investment
By Bill Gates, Co-chair of the Bill & Melinda Gates Foundation

Excerpt
The Global Fund to Fight AIDS, Tuberculosis and Malaria announced today that it will need $15 billion to continue its life-saving work. If the world comes together to meet this replenishment goal, it will build on one of its greatest achievements of the past decade by saving millions more lives. HIV, TB and malaria are three of the world’s biggest killers, but thanks to the Global Fund we are starting to make significant progress in controlling them. Now is the time for governments and other donors to make new pledges to the Fund…
http://www.huffingtonpost.com/bill-gates/the-global-fund_b_3034610.html

Editor’s Notes:

– Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_6 April 2013

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

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