PLoS One
[Accessed 18 May 2013]
http://www.plosone.org/

Risk Perception, Preventive Behaviors, and Vaccination Coverage in the Korean Population during the 2009–2010 Pandemic Influenza A (H1N1): Comparison between High-Risk Group and Non–High-Risk Group
Jung Yeon Heo, Soung Hoon Chang, Min Jung Go, Young Mee Kim, Sun Hye Gu, Byung Chul Chun Research Article | published 17 May 2013 | PLOS ONE 10.1371/journal.pone.0064230
Abstract
Background
This study was carried out to estimate the vaccination coverage, public perception, and preventive behaviors against pandemic influenza A (H1N1) and to understand the motivation and barriers to vaccination between high-risk and non–high-risk groups during the outbreak of pandemic influenza A (H1N1).

Methodology/Principal Findings
A cross-sectional nationwide telephone survey of 1,650 community-dwelling Korean adults aged 19 years and older was conducted in the later stage of the 2009–2010 pandemic influenza A (H1N1) outbreak. The questionnaire identified the demographics, vaccination status of participants and all household members, barriers to non-vaccination, perceived threat, and preventive behaviors. In Korea, the overall rate of pandemic influenza vaccination coverage in the surveyed population was 15.5%; vaccination coverage in the high-risk group and non–high-risk group was 47.3% and 8.0%, respectively. In the high-risk group, the most important triggering event for vaccination was receiving a notice from a public health organization. In the non–high-risk group, vaccination was more strongly influenced by previous experience with influenza or mass media campaigns. In both groups, the most common reasons for not receiving vaccination was that their health was sufficient to forgo the vaccination, and lack of time. There was no significant difference in how either group perceived the threat or adopted preventive behavior. The predictive factors for pandemic influenza vaccination were being elderly (age ≥65 years), prior seasonal influenza vaccination, and chronic medical disease.

Conclusions/Significance
With the exception of vaccination coverage, the preventive behaviors of the high-risk group were not different from those of the non–high-risk group during the 2009–2010 pandemic. For future pandemic preparedness planning, it is crucial to reinforce preventive behaviors to avoid illness before vaccination and to increase vaccination coverage in the high-risk group

PLoS Medicine
(Accessed 18 May 2013)
http://www.plosmedicine.org/

Setting Research Priorities to Reduce Mortality and Morbidity of Childhood Diarrhoeal Disease in the Next 15 Years
Kerri Wazny, Alvin Zipursky, Robert Black, Valerie Curtis, Christopher Duggan, Richard Guerrant, Myron Levine, William A. Petri Jr, Mathuram Santosham, Rebecca Scharf, Philip M. Sherman, Evan Simpson, Mark Young, Zulfiqar A. Bhutta

Summary Points
This paper aims to identify research priorities, using the Child Health and Nutrition Research Initiative’s (CHNRI’s) method, for global childhood diarrhoeal disease over the next 15 years.

Ten teams were established, and over 150 experts participated on one or more teams, generating and scoring 466 research questions.

Research questions involving improving implementation, especially through behaviour change and other delivery strategies ranked highly; oral rehydration and zinc were also seen as priorities, as research questions asking to identify driving factors of caregiver demand for oral rehydration solution (ORS) and zinc and development of an ORS formulation that reduces stool output were ranked highly.

Despite a range of discovery-related research topics, implementation research questions related to known interventions for childhood diarrhoeal diseases were ranked highly by most experts.

In tandem with the Global Action Plan for Pneumonia and Diarrhoea, concerted efforts by a range of stakeholders in implementation research will be needed to equitably scale up already proven, effective interventions.

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001446

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
(Accessed 18 May 2013)
http://www.pnas.org/content/early/recent

Retrospective: Hilary Koprowski (1916–2013): Vaccine pioneer, art lover, and scientific leader
Carl M. Croce
PNAS 2013 ; published ahead of print May 17, 2013, doi:10.1073/pnas.1307665110

http://www.pnas.org/content/early/2013/05/16/1307665110.full.pdf+html

Science Translational Medicine
15 May 2013 vol 5, issue 185
http://stm.sciencemag.org/content/current

Perspective
Aging
The Gracefully Aging Immune System
Diana Boraschi, M. Teresa Aguado, Catherine Dutel, Jörg Goronzy, Jacques Louis, Beatrix Grubeck-Loebenstein, Rino Rappuoli and Giuseppe Del Giudice

Abstract
Prolonged life expectancy in the 20th century has been one of humankind’s greatest triumphs. However, the substantial increase in the human life span has ushered in a new concern: healthy aging. Because infectious diseases prominently contribute to morbidity in the particularly vulnerable elderly population, strategies for preventing these diseases would have a clear impact on improving healthy aging. Thus, vaccines and immunization strategies tailored for the elderly population are needed, and vaccines should be developed to take into consideration the peculiar age-induced variations of immune responsiveness. The conference “Ageing and Immunity“ recently held in Siena, Italy, has reviewed and discussed several possible causes of immune senescence, as well as strategies for counteracting this waning of immune responsiveness and for restoring immunocompetence. In addition, examples of diseases that should be targeted by vaccination in the senior population were considered.

http://stm.sciencemag.org/content/5/185/185ps8.abstract

Science Translational Medicine
15 May 2013 vol 5, issue 185
http://stm.sciencemag.org/content/current

Vaccines
Synthetic Generation of Influenza Vaccine Viruses for Rapid Response to Pandemics
Philip R. Dormitzer, Pirada Suphaphiphat, Daniel G. Gibson, David E. Wentworth, Timothy B. Stockwell, Mikkel A. Algire, Nina Alperovich, Mario Barro, David M. Brown, Stewart Craig,     Brian M. Dattilo, Evgeniya A. Denisova, Ivna De Souza, Markus Eickmann, Vivien G. Dugan,     Annette Ferrari, Raul C. Gomila, Liqun Han, Casey Judge, Sarthak Mane, Mikhail Matrosovich,     Chuck Merryman, Giuseppe Palladino, Gene A. Palmer, Terika Spencer, Thomas Strecker,     Heidi Trusheim, Jennifer Uhlendorff, Yingxia Wen, Anthony C. Yee, Jayshree Zaveri, Bin Zhou,     Stephan Becker, Armen Donabedian, Peter W. Mason, John I. Glass, Rino Rappuoli, and J. Craig Venter
15 May 2013: 185ra68

Abstract
During the 2009 H1N1 influenza pandemic, vaccines for the virus became available in large quantities only after human infections peaked. To accelerate vaccine availability for future pandemics, we developed a synthetic approach that very rapidly generated vaccine viruses from sequence data. Beginning with hemagglutinin (HA) and neuraminidase (NA) gene sequences, we combined an enzymatic, cell-free gene assembly technique with enzymatic error correction to allow rapid, accurate gene synthesis. We then used these synthetic HA and NA genes to transfect Madin-Darby canine kidney (MDCK) cells that were qualified for vaccine manufacture with viral RNA expression constructs encoding HA and NA and plasmid DNAs encoding viral backbone genes. Viruses for use in vaccines were rescued from these MDCK cells. We performed this rescue with improved vaccine virus backbones, increasing the yield of the essential vaccine antigen, HA. Generation of synthetic vaccine seeds, together with more efficient vaccine release assays, would accelerate responses to influenza pandemics through a system of instantaneous electronic data exchange followed by real-time, geographically dispersed vaccine production.

http://stm.sciencemag.org/content/5/185/185ra68.abstract

Vaccine
Volume 31, Issue 21, Pages 2481-2538 (17 May 2013)
http://www.sciencedirect.com/science/journal/0264410X
Theme: Human Immune Response to Vaccines in the First Year of Life
Edited by Professor Willem Hanekom, Assist.Prof.Tobias R. Kollmann and Assist.Prof.Ofer Levy

Human immune responses to vaccines in the first year of life: Biological, socio-economic and ethical issues – A viewpoint
Review Article
Pages 2483-2488
M.O.C. Ota, O.T. Idoko, E.O. Ogundare, M.O. Afolabi
Abstract
Human newborns are vulnerable to infectious diseases that account for majority of the morbidity and mortality, particularly in first year of life. Vaccines have become the most effective public health intervention strategy to curtail the prevalence of these infectious diseases. Although vaccines against a number of diseases exist, there are no vaccines against many other diseases that commonly affect children. The adequate assessment of immune responses to vaccines is an important step in the development of vaccines. However, a number of biological and “non-medical” socio-economic and ethical factors could influence either the administration and/or evaluation of vaccines in infants. Recognition and understanding of these determinants are crucial in planning interventions and for logical interpretations of results.

Vaccine
Volume 31, Issue 21, Pages 2481-2538 (17 May 2013)
http://www.sciencedirect.com/science/journal/0264410X
Theme: Human Immune Response to Vaccines in the First Year of Life
Edited by Professor Willem Hanekom, Assist.Prof.Tobias R. Kollmann and Assist.Prof.Ofer Levy

Vaccine-induced immunity in early life
Pages 2481-2482
Tobias R. Kollmann, Ofer Levy, Willem Hanekom
Human immune responses to vaccines in the first year of life: Biological, socio-economic and ethical issues – A viewpoint
Review Article
Pages 2483-2488
M.O.C. Ota, O.T. Idoko, E.O. Ogundare, M.O. Afolabi
Abstract
Human newborns are vulnerable to infectious diseases that account for majority of the morbidity and mortality, particularly in first year of life. Vaccines have become the most effective public health intervention strategy to curtail the prevalence of these infectious diseases. Although vaccines against a number of diseases exist, there are no vaccines against many other diseases that commonly affect children. The adequate assessment of immune responses to vaccines is an important step in the development of vaccines. However, a number of biological and “non-medical” socio-economic and ethical factors could influence either the administration and/or evaluation of vaccines in infants. Recognition and understanding of these determinants are crucial in planning interventions and for logical interpretations of results.

Vaccine/b>
Volume 31, Issue 21, Pages 2481-2538 (17 May 2013)
http://www.sciencedirect.com/science/journal/0264410X
Theme: Human Immune Response to Vaccines in the First Year of Life
Edited by Professor Willem Hanekom, Assist.Prof.Tobias R. Kollmann and Assist.Prof.Ofer Levy

Oral and inactivated poliovirus vaccines in the newborn: A review
Review Article
Pages 2517-2524
Farrah J. Mateen, Russell T. Shinohara, Roland W. Sutter
Abstract
Background
Oral poliovirus vaccine (OPV) remains the vaccine-of-choice for routine immunization and supplemental immunization activities (SIAs) to eradicate poliomyelitis globally. Recent data from India suggested lower than expected immunogenicity of an OPV birth dose, prompting a review of the immunogenicity of OPV or inactivated poliovirus vaccine (IPV) when administered at birth.

Methods
We evaluated the seroconversion and reported adverse events among infants given a single birth dose (given ≤7 days of life) of OPV or IPV through a systematic review of published articles and conference abstracts from 1959 to 2011 in any language found on PubMed, Google Scholar, or reference lists of selected articles.

Results
25 articles from 13 countries published between 1959 and 2011 documented seroconversion rates in newborns following an OPV dose given within the first seven days of life. There were 10 studies that measured seroconversion rates between 4 and 8 weeks of a single birth dose of TOPV, using an umbilical cord blood draw at the time of birth to establish baseline antibody levels. The percentage of newborns who seroconverted at 8 weeks range from 6–42% for poliovirus type 1, 2–63% for type 2, and 1–35% for type 3. For mOPV type 1, seroconversion ranged from 10 to 76%; mOPV type 3, the range was 12–58%; and for the one study reporting bOPV, it was 20% for type 1 and 7% for type 3. There were four studies of IPV in newborns with a seroconversion rate of 8–100% for serotype 1, 15–100% for serotype 2, and 15–94% for serotype 3, measured at 4–6 weeks of life. No serious adverse events related to newborn OPV or IPV dosing were reported, including no cases of acute flaccid paralysis.

Conclusions
There is great variability of the immunogenicity of a birth dose of OPV for reasons largely unknown. Our review confirms the utility of a birth dose of OPV, particularly in countries where early induction of polio immunity is imperative. IPV has higher seroconversion rates in newborns and may be a superior choice in countries which can afford IPV, but there have been few studies of an IPV dose for newborns.

Vaccine
Volume 31, Issue 21, Pages 2481-2538 (17 May 2013)
http://www.sciencedirect.com/science/journal/0264410X
Theme: Human Immune Response to Vaccines in the First Year of Life

Immunization of newborns with bacterial conjugate vaccines
Review Article
Pages 2525-2530
Anita H.J. van den Biggelaar, William S. Pomat
Abstract
Bacterial conjugate vaccines are based on the principle of coupling immunogenic bacterial capsular polysaccharides to a carrier protein to facilitate the induction of memory T-cell responses. Following the success of Haemophilus influenzae type b conjugate vaccines in the 1980s, conjugate vaccines for Streptococcus pneumoniae and Neisseria meningitidis infections were developed and proven to be effective in protecting children against invasive disease. In this review, the use of conjugate vaccines in human newborns is discussed. Neonatal Haemophilus influenzae type b and pneumococcal conjugate vaccination schedules have been trialed and proven to be safe, with the majority of studies demonstrating no evidence for the induction of immune tolerance. Whether their neonatal administration also results in an earlier induction of clinical protection in the first 2–3 critical months of life is still to be demonstrated.

From Google Scholar & other sources: Selected Journal Articles, Dissertations, Theses
… of Safety Signals in the Vaccine Adverse Event Reporting System (VAERS): A Case Study of Febrile Seizures after a 2010-2011 Seasonal Influenza Virus Vaccine.
D Martin, D Menschik, M Bryant-Genevier, R Ball – Drug safety: an international …, 2013
BACKGROUND: Reports of data mining results as an initial indication of a prospectively
detected safety signal in the US Vaccine Adverse Event Reporting System (VAERS) have
been limited. In April 2010 a vaccine safety signal for febrile seizures after Fluvax (®) …

Immunogenicity and Safety of the Human Papillomavirus-6,-11,-16,-18 Vaccine in HIV-Infected Young Women
JA Kahn, J Xu, BG Kapogiannis, B Rudy, R Gonin… – Clinical Infectious Diseases, 2013
Background. The objective of this study was to determine whether the 3-dose quadrivalent
(HPV-6,-11,-16,-18) HPV vaccine series is immunogenic and safe in HIV-infected young
women. Methods. We enrolled 99 16-to 23-year-old women in a phase II, open-label, multi …

[PDF] Evaluating primary healthcare service revitalization interventions though a knowledge, practice and coverage survey in earthquake-affected areas in Pakistan
RU Zaman, T Zulfiqar, R Nazir, S Allen, I Cheema… – Journal of Public Health, 2013
… A child was considered fully vaccinated if she/he received one dose of bacille calmette Guerin
(BCG) vaccine against tuberculosis, three doses of diphtheria, pertussis, tetanus (DPT) for
diphtheria, pertussis and tetanus, three doses of oral polio vaccine (OPV) for polio, and one …

[PDF] Determinants of suboptimal hepatitis B vaccine uptake among men in the Republic of Korea: where should our efforts be focused: results from cross-sectional study
B Park, KS Choi, HY Lee, MS Kwak, JK Jun, EC Park – BMC Infectious Diseases, 2013
Background Liver cancer is the second most-frequent cause of cancer death in Korea.
Hepatitis B virus (HBV) infection is a major cause of liver cancer, and this disease is
effectively prevented by HBV vaccination. This study was conducted to investigate factors …

Economist
http://www.economist.com/
Accessed 18 May 2013

Flu vaccines and synthetic biology – Going viral
A speedy way to make a vaccine
May 18th 2013 |From the print edition

IF a new and deadly strain of influenza were to arise, putting together a vaccine against it in the least possible time would be a priority. To test how quickly that could be done a group of researchers have just had a race with themselves. They have not quite matched the show sometimes given by workers at the Venetian arsenal, who would assemble a galley in a single day in order to overawe visiting foreign dignitaries. But Philip Dormitzer, Craig Venter and their colleagues did create the crucial component of a flu jab in four days and four hours.

Dr Dormitzer, who works for Novartis, a drug company, and Dr Venter, eponymous founder of the J. Craig Venter Institute in San Diego, reported their record-breaking attempt in this week’s Science Translational Medicine. It began with the transmission to them from America’s Biomedical Advanced Research and Development Authority of the sequence data for the haemagglutinin and neuraminidase genes of a (to them) unknown flu virus.

The team took this information and used it to make DNA that contained both the gene sequences themselves and the genetic apparatus needed to let a cell read those sequences and produce proteins from them. They then put these pieces of synthetic DNA—which were, in effect, tiny chromosomes—into cell cultures derived from dog kidneys, which have been found particularly effective for this kind of work.

The dog-kidney cells duly churned out viruses, suitable for seeding the process of vaccine manufacture, that contained the proteins in question. Since these two proteins are the variable elements that stop new strains of flu being recognised by the immune systems of people who have had influenza in the past, this is an important step forward. Experiments on ferrets (which are often used as stand-ins for people in tests of flu vaccines) showed that these seed viruses stimulated the animals’ immune systems in the desired way, producing protective immunity.

Having a seed is not the same thing as being able to make a vaccine in large quantities. But it is an important first step. Novartis, in collaboration with the commercial arm of Dr Venter’s enterprise, Synthetic Genomics, hopes to create a bank of seed viruses using this method. That will speed matters up even more. But the fact that something not actually in the bank could be knocked up at short notice if necessary is comforting.

http://www.economist.com/news/science-and-technology/21578026-speedy-way-make-vaccine-going-viral

The Hindu – Business Line
http://www.thehindubusinessline.com/

After $1  diarrhoea vaccine, Govt wants same for malaria, TB
A. M. Jigeesh
Partnership with industry helps pool research abilities, expertise
New Delhi, May 16:

Excerpt
Buoyed by the success of the public Private partnership experiment in developing the first indigenous rotavirus vaccine to combat a deadly form of viral diarrhoea, the Department of Biotechnology will now shift its focus to researching vaccines for dengue, tuberculosis and malaria.

Maintaining that affordability is the Government’s main mantra, the Department is ready to co-operate with the pharmaceutical industry to make vaccines that prevent killer diseases.

Dr T.S. Rao, who heads the vaccines and diagnostics section of the Department, told Business Line that an inter-ministerial group has been formed to help the Rotavac, the one-dollar rotavirus vaccine, to get the necessary policy clearances…

Full story: http://www.thehindubusinessline.com/companies/after-1-diarrhoea-vaccine-govt-wants-same-for-malaria-tb/article4721390.ece

Washington Post
http://www.washingtonpost.com/
Accessed 18 May 2013

Interview
Bill Gates: ‘Death is something we really understand extremely well’
By Ezra Klein, Published: May 17, 2013
“I always use this chart of childhood death,” Bill Gates says. “In 1960, 25% of kids died before the age of 5. And now we’re down below 6% of kids dying before the age of 5.”

We’re sitting in a bare conference room at his foundation’s D.C. headquarters. Gates — who Bloomberg News calculates is once again the world’s richest man — is in town to talk to members of Congress about his top priority this year: Global health – and, in particular, the total eradication of polio. He wants to drive that 6 percent even lower, and he believes he can. Wiping out a disease like polio sounds impossible. But it’s actually, Gates tells me, completely achievable. Perhaps even by the end of 2013. This is a transcript of our conversation, edited for length and clarity.

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/17/bill-gates-death-is-something-we-really-understand-extremely-well/

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_11 May 2013_PDF

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

– Links: We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

– 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…

GAVI announced “a new record low price for human papillomavirus (HPV) vaccines (which) will help ensure millions of girls in developing countries can be protected against cervical cancer.” UNICEF acted as procurement partner for the GAVI Alliance in running a public tender process, and, under the new GAVI HPV Vaccine Programme, will now purchase HPV vaccines from Merck & Co. at US$ 4.50 per dose and from GlaxoSmithKline at US$ 4.60 per dose for the award period, 2013-2017. Additionally, Merck has agreed to extend significantly lower prices to GAVI if total volumes increase in the future.

GAVI said its “market shaping efforts…work to address market failures for vaccines by aggregating volume, increasing certainty of demand, stimulating competition where possible and ensuring that a sufficient quantity of appropriate, quality vaccines is available through a diverse manufacturer base at affordable and sustainable prices.” GAVI noted that among stakeholders involved are WHO, PATH, UNICEF, UNFPA, National Cancer Institute, World Bank, Union for International Cancer Control, Pink Ribbon Red Ribbon, UNAIDS, International Agency for Research on Cancer, and the US Centers for Disease Control. GAVI also said that in addition to “bringing down dramatically the price of the HPV vaccines, GAVI has also helped to halve the time lag that can exist in getting new vaccines out to poor countries, down to just six years. Since GAVI began accepting applications for HPV vaccines support in 2012 it has received unprecedented demand, with 15 countries applying last year and a further 15 to 20 expected this year.”

Dr Seth Berkley, CEO of the GAVI Alliance, commented, “A vast health gap currently exists between girls in rich and poor countries. With GAVI’s programmes we can begin to bridge that gap so that all girls can be protected against cervical cancer no matter where they are born. By 2020 we hope to reach more than 30 million girls in more than 40 countries. This is a transformational moment for the health of women and girls across the world. We thank the manufacturers for working with us to help make this happen.” GAVI will begin support for HPV vaccines in Kenya as early as this month followed by Ghana, Lao PDR, Madagascar, Malawi, Niger, Sierra Leone and the United Republic of Tanzania.

Full media release: http://www.gavialliance.org/library/news/press-releases/2013/hpv-price-announcement/

GlaxoSmithKline (GSK) announced “a new commitment to the GAVI Alliance to supply its cervical cancer vaccine as part of a new long term programme to help protect girls against cervical cancer in the world’s poorest countries.” To start the programme and over the next two years, GSK will supply doses of Cervarix® (Human Papillomavirus vaccine [Types 16, 18] (Recombinant, adjuvanted, adsorbed)) to four new GAVI demonstration projects at a significantly discounted price of $4.60 per dose. Christophe Weber, President and General Manager, GSK Vaccines, said, “Cervical cancer is a significant issue especially in poorer countries where the availability of screening is limited. We are pleased to be expanding our commitment to GAVI by delivering our Cervarix^® vaccine to help protect girls in the developing world. This continues our significant commitment to make our vaccines accessible to as many people as possible, no matter where in the world they live. We hope that this will help reduce the burden of cervical cancer and positively impact future generations.”
Full media release:
http://www.gsk.com/media/press-releases/2013/gsk-enters-new-commitment-with-the-gavi-alliance-to-supply-cervi.html

Merck/MSD announced an award for “a significant portion of the UNICEF human papillomavirus (HPV) vaccine tender, and will provide sustained supply of GARDASIL^® [Human Papillomavirus Quadrivalent (Types 6, 11, 16, and 18) Vaccine, Recombinant] to GAVI-eligible countries.” Through this initial tender award, Merck said it expects to supply approximately 2.4 million doses of GARDASIL to GAVI-eligible countries between 2013 to 2017 to help meet vaccine demand for countries already approved or recommended for approval by GAVI for HPV vaccine demonstration projects and national introductions. Julie L. Gerberding, M.D., president, Merck Vaccines, said, “It is essential that every young girl around the world have access to HPV vaccines. Today’s decision by UNICEF is an important step forward. This partnership highlights Merck’s commitment to working closely with GAVI to ensure broad and sustained access to GARDASIL in the world’s poorest countries, where the burden of cervical cancer is greatest.”
Full media release: http://www.businesswire.com/news/home/20130509005227/en/GARDASIL%C2%AE-Human-Papillomavirus-Quadrivalent-Types-6-11

Update: Polio this week – As of 8 May 2013
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
– Two new wild poliovirus (WPV) cases are officially reported this week, both from Nigeria, bringing the total number of WPV cases in 2013 to 26 (compared to 53 at this time last year). Additionally, a new circulating vaccine-derived poliovirus type 2 (cVDPV2) case is reported in Pakistan. Please see country-specific sections below, for more information.
– The Independent Monitoring Board (IMB) is meeting this week in London, United Kingdom (UK), to review the latest global polio epidemiology. The report from the meeting is expected by end-May. The agenda for the meeting and country-level presentations available here.
– Health ministers from around the world will convene in Geneva at the annual World Health Assembly (WHA), starting on 20 May. Polio eradication will also feature on the health ministers’ agenda, and to facilitate discussions, the GPEI has prepared a report for the WHA: here.

Nigeria
-Two new WPV cases were reported in the past week (WPV1s from Kano and Taraba), bringing the total number of WPV cases for 2013 to 18. The case from Kano is the most recent WPV case in the country, and had onset of paralysis on 12 April.

Pakistan
-One new cVDPV2 case was reported in the past week, bringing the total number of cVDVP2 cases in 2013 to three. It is the most recent cVDPV2 case in the country, and had onset of paralysis on 10 April (from Federally Administered Tribal Areas – FATA).
-This latest cVDPV2 case is from North Waziristan, an area where immunizations have been suspended by local leaders since last June. To minimize the risk of an outbreak in this area, it is critical that access to children is granted as quickly as possible. Immunizations in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.
-Genetic sequencing has confirmed that this cVDPV2 case is linked to the ongoing outbreak previously restricted to Balochistan and parts of Karachi, resulting in 19 cases in Pakistan since middle of last year. In 2012, this strain had also spread into Afghanistan, causing 12 cases there since August.
– Pakistan is also affected by transmission of WPV1, with six cases this year (compared to 13 cases for the same period in 2012). Wild poliovirus type 3 has not been detected in the country in more than 12 months (since April 2012, from Khyber Agency, FATA).
– Confirmation of this latest cases underscores the risk ongoing polio transmission (be it due to WPV or cVDPV) in the country continues to pose to children everywhere, and in particular to children living in areas where access has not been possible for extended periods of time.
– One new positive environmental sample was confirmed this week (WPV1, collected on 10 April), from Hyderabad, Sindh. This year, 14 environmental samples positive for WPV1 have been reported, most from Peshawar, Khyber Pakhtunkhwa and Hyderabad.
-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.

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

http://www.who.int/csr/don/2013_03_12/en/index.html

Novel coronavirus infection – update 9 May 2013
– The Ministry of Health in Saudi Arabia has informed WHO of an additional two laboratory confirmed cases of infection with the novel coronavirus (nCoV).

The first patient is a 48-year-old man with multiple coexisting medical conditions who became ill on 29 April 2013. He is in stable condition. The second patient is a 58-year-old man with existing medical condition who became ill on 6 April 2013. He fully recovered and was discharged from the hospital on 3 May 2013.

The two patients are from the same cluster reported since the beginning of May 2013, which is linked to an outbreak in a health care facility. The government is conducting ongoing investigation into this outbreak. Since the beginning of May 2013, a total of 15 patients have been reported from this outbreak, of which seven have died. Of the 15 patients, 12 are men and three women. The age range of the patients are from 24 to 94 years old.

From September 2012 to date, WHO has been informed of a global total of 33 laboratory confirmed cases of human infection with nCoV, including 18 deaths…

Human infection with avian influenza A(H7N9) virus – update 8 May 2013
– As of 8 May 2013 (11:00 CET), the National Health and Family Planning Commission, China notified WHO of an additional laboratory-confirmed case of human infection with avian influenza A(H7N9) virus.

The patient is a 79-year-old woman from Jiangxi province who became ill on 3 May 2013.

Additionally, a patient earlier reported has died.

To date, a total of 131 laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus including 32 deaths have been reported to WHO. Contacts of the confirmed cases are being closely monitored…

The MMWR Weekly for May 10, 2013 / Vol. 62 / No. 18 includes:

–       Prevention and Control of Influenza with Vaccines: Interim Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2013

–       Emergence of Avian Influenza A(H7N9) Virus Causing Severe Human Illness — China, February–April 2013

The Sabin Vaccine Institute announced new Neglected Tropical Disease (NTD) Special Envoys supporting the Global Network for Neglected Tropical Diseases.  His Excellency, President Alvaro Arzú Irigoyen of Guatemala (1996-2000), His Excellency, President Ricardo Lagos Escobar of Chile (2000-2006) and former Pan American Health Organization (PAHO) Director Dr. Mirta Roses Periago has joined the initiative. They join current NTD Special Envoy: His Excellency, President John A. Kufuor of the Republic of Ghana (2001-2009), who was appointed in April 2012. The collaboration was announced at a panel hosted by the Global Network and the Center for Strategic and International Studies (CSIS).

Full media release: http://www.sabin.org/updates/pressreleases/new-advocates-join-global-effort-eliminate-neglected-tropical-diseases

Aeras, the University of Oxford, and Okairos, a biopharmaceutical company specializing in T-cell vaccines announced a US$2.9 million grant to Aeras “in support of a collaboration among the three parties to support the development of vaccines against tuberculosis, HIV and malaria.” The grant, provided by the Bill & Melinda Gates Foundation, “allows the three groups to work together to develop scalable methods to enable large-scale production of multiple novel chimpanzee adenovirus vector constructs.” Novel constructs to be pursued include Okairos’ proprietary technology platform that “uses potent chimpanzee adenovirus vectors to stimulate robust T-cell and antibody responses against selected antigens.”

Full media release: http://www.businesswire.com/news/home/20130507005346/en/Aeras-Oxford-University-Okairos-TB-HIV-Malaria

   The Scripps Research Institute (TSRI) announced a five-year agreement with Janssen Pharmaceuticals, Inc. (Janssen) to collaborate on focused research projects in the infectious disease area, with the initial project targeting the influenza virus. Under the agreement Janssen will receive certain license rights to the results of the research. Janssen Pharmaceuticals will collaborate in the research on influenza through its Crucell Vaccine Institute. The new agreement builds on research on the influenza virus conducted jointly by TSRI and Janssen’s Crucell Vaccine Institute.

Full media release: http://www.prnewswire.com/news-releases/the-scripps-research-institute-announces-new-research-and-license-agreement-with-janssen-pharmaceuticals-inc-206392741.html

    The Global Fund to Fight AIDS, Tuberculosis and Malaria “welcomed an announcement from Switzerland that it intends to increase its contribution to the Global Fund by 43 per cent in 2013.” Swiss Federal Councillor Didier Burkhalter said that Switzerland would increase its contribution for 2013 to 10 million Swiss francs from an initial pledge of 7 million Swiss francs, and also indicated that Switzerland wanted to make a big increase in its support to the Global Fund in the 2014-16 period but did not confirm a figure.

Full media release: http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-05-06_Switzerland_Raises_Contribution_to_Global_Fund_by_43_Percent/

WHO SAGE Meeting of April 2013: GVAP Updates
-Global vaccine action plan – Report by the Secretariat
A66/19
Provisional agenda item 16.1
22 March 2013
SIXTY-SIXTH WORLD HEALTH ASSEMBLY
http://www.who.int/immunization/sage/meetings/2013/april/2_GVAP_final.pdf

-Global Report: key updates & challenges – including from the Regions
J M Okwo-Bele, Director, Immunization Vaccines & Biologicals, WHO
Slide 8:
GVAP Monitoring & Accountability
SAGE Decade of Vaccine Working Group:
–       Narendra Arora
–       Yagob Al-Mazrou
–       Alejandro Cravioto
–       Funqiang Cui
–       Elizabeth Ferdinand
–       Shawn Gilchrist
–       Alan Hinman
–       Stephen Inglis
–       Amani Mustafa Mahmoud
–       Rebecca Martin
–       Rozina Mistry
–       David Salisbury
http://www.who.int/immunization/sage/meetings/2013/april/SAGE_Apr_2013_Okwo_Bele.pdf

American Journal of Public Health
Volume 103, Issue 6 (June 2013)
http://ajph.aphapublications.org/toc/ajph/current

Population-Based Versus Practice-Based Recall for Childhood Immunizations: A Randomized Controlled Comparative Effectiveness Trial
Allison Kempe, MD, MPH, Alison Saville, MSPH, MSW, L. Miriam Dickinson, PhD, Sheri Eisert, PhD, Joni Reynolds, RN, MSN, Diana Herrero, MS, Brenda Beaty, MSPH, Karen Albright, PhD, Eva Dibert, MHA, Vicky Koehler, MPH, Steven Lockhart, BA, and Ned Calonge, MD
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301035

Abstract
Objectives. We compared the effectiveness and cost-effectiveness of population-based recall (Pop-recall) versus practice-based recall (PCP-recall) at increasing immunizations among preschool children.

Methods. This cluster-randomized trial involved children aged 19 to 35 months needing immunizations in 8 rural and 6 urban Colorado counties. In Pop-recall counties, recall was conducted centrally using the Colorado Immunization Information System (CIIS). In PCP-recall counties, practices were invited to attend webinar training using CIIS and offered financial support for mailings. The percentage of up-to-date (UTD) and vaccine documentation were compared 6 months after recall. A mixed-effects model assessed the association between intervention and whether a child became UTD.

Results. Ten of 195 practices (5%) implemented recall in PCP-recall counties. Among children needing immunizations, 18.7% became UTD in Pop-recall versus 12.8% in PCP-recall counties (P < .001); 31.8% had documented receipt of 1 or more vaccines in Pop-recall versus 22.6% in PCP-recall counties (P  < .001). Relative risk estimates from multivariable modeling were 1.23 (95% confidence interval [CI] = 1.10, 1.37) for becoming UTD and 1.26 (95% CI = 1.15, 1.38) for receipt of any vaccine. Costs for Pop-recall versus PCP-recall were $215 versus $1981 per practice and $17 versus $62 per child brought UTD.

Conclusions. Population-based recall conducted centrally was more effective and cost-effective at increasing immunization rates in preschool children.
Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301035

British Medical Journal
11 May 2013 (Vol 346, Issue 7907)
http://www.bmj.com/content/346/7907

Editorial
Revising the Declaration of Helsinki
Vivienne Nathanson

Excerpt
Your chance to influence research governance
In the middle of the 20th century, the Nuremberg trials laid bare the abuse of medical knowledge and techniques used in human experimentation, with perhaps the most famous offender being Joseph Mengele. The outcomes of the trials included the Nuremberg Code—a legal document intended to stop such abuses—and the establishment of the World Medical Association (WMA). Both were intended to ensure that doctors never again performed such inhuman experiments.

Over the next two decades the newly formed WMA began to put together a core set of policies, designed to reflect ethical thinking, to which doctors were expected to conform. The Declaration of Helsinki, published in 1964,1 set out rules and limits for human experimentation based on the findings of the Nuremberg trials and an unshakeable conviction that human experimental subjects have fundamental rights that drive a series of duties for the experimenter. Key to its development and adoption was that it was essentially written by doctors for doctors.

Since then, the declaration has been incorporated into national laws in several countries and has been a touchstone for researchers. It has not remained static; changes have been made on eight occasions. Another revision is now under way, and a draft document is currently open …

http://www.bmj.com/content/346/bmj.f2837

British Medical Journal
11 May 2013 (Vol 346, Issue 7907)
http://www.bmj.com/content/346/7907

Editorial
HPV vaccination—reaping the rewards of the appliance of science
Simon Barton
Excerpt
National programmes could virtually eliminate certain diseases and substantially reduce costs
The optimism generated by scientific breakthroughs often turns to disappointment when applied to the real world of clinical care. It is therefore worth celebrating the extraordinary success of Australia’s national human papillomavirus (HPV) vaccination programme, which was implemented five years ago, as reported in the linked paper by Ali and colleagues (doi:10.1136/bmj.f2032).1 This analysis of data on 85 770 new patients from six Australian sexual health clinics shows a remarkable reduction in the proportion of women under 21 years of age presenting with genital warts—from 11.5% in 2007 to 0.85% in 2011 (P<0.001). Only 13 cases of genital warts were diagnosed in women under the age of 21 across all six health clinics in 2011. Such a reduction in this distressing disease caused by a sexually transmitted virus is a major public health achievement. Furthermore, the near eradication of genital warts in young Australian women will probably have a major impact on the costs of sexual healthcare…
http://www.bmj.com/content/346/bmj.f2184

Research
Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data
Hammad Ali, lecturer1, Basil Donovan, professor12, Handan Wand, senior lecturer1, Tim R H Read, sexual health physician34, David G Regan, senior lecturer1, Andrew E Grulich, Professor1, Christopher K Fairley, professor34, Rebecca J Guy, associate professor1
Open Access: http://www.bmj.com/content/346/bmj.f2032

Abstract
Objective To measure the effect on genital warts of the national human papillomavirus vaccination programme in Australia, which started in mid-2007.

Design Trend analysis of national surveillance data.

Setting Data collated from eight sexual health services from 2004 to 2011; the two largest clinics also collected self-reported human papillomavirus vaccination status from 2009.

Participants Between 2004 and 2011, 85 770 Australian born patients were seen for the first time; 7686 (9.0%) were found to have genital warts.

Main outcome measure Rate ratios comparing trends in proportion of new patients diagnosed as having genital warts in the pre-vaccination period (2004 to mid-2007) and vaccination period (mid-2007 to the end of 2011).

Results Large declines occurred in the proportions of under 21 year old (92.6%) and 21-30 year old (72.6%) women diagnosed as having genital warts in the vaccination period—from 11.5% in 2007 to 0.85% in 2011 (P<0.001) and from 11.3% in 2007 to 3.1% in 2011 (P<0.001), respectively. No significant decline in wart diagnoses was seen in women over 30 years of age. Significant declines occurred in proportions of under 21 year old (81.8%) and 21-30 year old (51.1%) heterosexual men diagnosed as having genital warts in the vaccination period—from 12.1% in 2007 to 2.2% in 2011 (P<0.001) and from 18.2% in 2007 to 8.9% in 2011 (P<0.001), respectively. No significant decline in genital wart diagnoses was seen in heterosexual men over 30 years of age. In 2011 no genital wart diagnoses were made among 235 women under 21 years of age who reported prior human papillomavirus vaccination.

Conclusions The significant declines in the proportion of young women found to have genital warts and the absence of genital warts in vaccinated women in 2011 suggests that the human papillomavirus vaccine has a high efficacy outside of the trial setting. Large declines in diagnoses of genital warts in heterosexual men are probably due to herd immunity.

Globalization and Health
[Accessed 11 May 2013]
http://www.globalizationandhealth.com/

Research
Emergence of multilateral proto-institutions in global health and new approaches to governance: analysis using path dependency and institutional theory
Eduardo J Gómez and Rifat Atun

Abstract (provisional)
The role of multilateral donor agencies in global health is a new area of research, with limited research on how these agencies differ in terms of their governance arrangements, especially in relation to transparency, inclusiveness, accountability, and responsiveness to civil society. We argue that historical analysis of the origins of these agencies and their coalition formation processes can help to explain these differences. We propose an analytical approach that links the theoretical literature discussing institutional origins to path dependency and institutional theory relating to proto institutions in order to illustrate the differences in coalition formation processes that shape governance within four multilateral agencies involved in global health. We find that two new multilateral donor agencies that were created by a diverse coalition of state and non-state actors, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and GAVI, what we call proto-institutions, were more adaptive in strengthening their governance processes. This contrasts with two well-established multilateral donor agencies, such as the World Bank and the Asian Development Bank, what we call Bretton Woods (BW) institutions, which were created by nation states alone; and hence, have different origins and consequently different path dependent processes.

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

PLoS One
[Accessed 11 May 2013]
http://www.plosone.org/

Identifying Optimal Vaccination Strategies for Serogroup A Neisseria meningitidis Conjugate Vaccine in the African Meningitis Belt
Sara Tartof, Amanda Cohn, Félix Tarbangdo, Mamoudou H. Djingarey, Nancy Messonnier, Thomas A. Clark, Jean Ludovic Kambou, Ryan Novak, Fabien V. K. Diomandé, Isaïe Medah, Michael L. Jackson
Research Article | published 09 May 2013 | PLOS ONE 10.1371/journal.pone.0063605

Abstract
Objective
The optimal long-term vaccination strategies to provide population-level protection against serogroup A Neisseria meningitidis (MenA) are unknown. We developed an age-structured mathematical model of MenA transmission, colonization, and disease in the African meningitis belt, and used this model to explore the impact of various vaccination strategies.

Methods
The model stratifies the simulated population into groups based on age, infection status, and MenA antibody levels. We defined the model parameters (such as birth and death rates, age-specific incidence rates, and age-specific duration of protection) using published data and maximum likelihood estimation. We assessed the validity of the model by comparing simulated incidence of invasive MenA and prevalence of MenA carriage to observed incidence and carriage data.

Results
The model fit well to observed age- and season-specific prevalence of carriage (mean pseudo-R2 0.84) and incidence of invasive disease (mean R2 0.89). The model is able to reproduce the observed dynamics of MenA epidemics in the African meningitis belt, including seasonal increases in incidence, with large epidemics occurring every eight to twelve years. Following a mass vaccination campaign of all persons 1–29 years of age, the most effective modeled vaccination strategy is to conduct mass vaccination campaigns every 5 years for children 1–5 years of age. Less frequent campaigns covering broader age groups would also be effective, although somewhat less so. Introducing conjugate MenA vaccine into the EPI vaccination schedule at 9 months of age results in higher predicted incidence than periodic mass campaigns.

Discussion
We have developed the first mathematical model of MenA in Africa to incorporate age structures and progressively waning protection over time. Our model accurately reproduces key features of MenA epidemiology in the African meningitis belt. This model can help policy makers consider vaccine program effectiveness when determining the feasibility and benefits of MenA vaccination strategies.

The National Academy of Sciences of the United States
of America
(Accessed 11 May 2013)
http://www.pnas.org/content/early/recent

Biological Sciences – Population Biology: Interventions for avian influenza A (H5N1) risk management in live bird market networks
Guillaume Fournié, Javier Guitian, Stéphanie Desvaux, Vu Chi Cuong, Do Huu Dung, Dirk Udo Pfeiffer, Punam Mangtani, and Azra C. Ghani
PNAS 2013 ; published ahead of print May 6, 2013, doi:10.1073/pnas.1220815110
http://www.pnas.org/content/early/2013/05/01/1220815110.abstract

Abstract
Highly pathogenic avian influenza virus subtype H5N1 is endemic in Asia, with live bird trade as a major disease transmission pathway. A cross-sectional survey was undertaken in northern Vietnam to investigate the structure of the live bird market (LBM) contact network and the implications for virus spread. Based on the movements of traders between LBMs, weighted and directed networks were constructed and used for social network analysis and individual-based modeling. Most LBMs were connected to one another, suggesting that the LBM network may support large-scale disease spread. Because of cross-border trade, it also may promote transboundary virus circulation. However, opportunities for disease control do exist. The implementation of thorough, daily disinfection of the market environment as well as of traders’ vehicles and equipment in only a small number of hubs can disconnect the network dramatically, preventing disease spread. These targeted interventions would be an effective alternative to the current policy of a complete ban of LBMs in some areas. Some LBMs that have been banned still are very active, and they likely have a substantial impact on disease dynamics, exhibiting the highest levels of susceptibility and infectiousness. The number of trader visits to markets, information that can be collected quickly and easily, may be used to identify LBMs suitable for implementing interventions. This would not require prior knowledge of the force of infection, for which laboratory-confirmed surveillance would be necessary. These findings are of particular relevance for policy development in resource-scarce settings.

Value in Health                  
Vol 16 | No. 3 | May 2013
http://www.valueinhealthjournal.com/current

Examining Ontario’s Universal Influenza Immunization Program With A New Dynamic Influenza Model
E.W. Thommes, C.T. Bauch, G. Meier, A. Chit
Preview
In 2000, Ontario initiated the world’s first universal influenza immunization program (UIIP). Our objective was to simulate the effect of this program on influenza attack rates using a new multi-strai…
http://www.valueinhealthjournal.com/article/S1098-3015%2813%2900118-6/fulltext

From Google Scholar & other sources: Selected Journal Articles, Dissertations, Theses
.
Non-febrile Seizures after Mumps-, Measles-, Rubella-, Varicella-combination Vaccination with Detection of Measles Vaccine Virus RNA in Serum, Throat and Urine
I Eckerle, B Keller-Stanislawski, S Santibanez… – Clinical and Vaccine …, 2013
ABSTRACT We report the case of a child presenting with non-febrile seizures 6 and 13 days
after the first vaccination with a measles-, mumps-, rubella-and varicella-(MMRV-)
combination vaccine. Measles virus RNA was detected in the patient’s serum, throat, and .

[HTML] Rift Valley fever virus vaccine strategies
N Lagerqvist – 2013
Rift Valley fever virus circulates throughout Africa and the Arabian Peninsula and is of great
concern for animal and public health. Infections in humans are often manifested as mild self‐
limiting illness, although in some cases there are more severe symptoms such as …

Working together: interactions between vaccine antigens and adjuvants
CB Fox, RM Kramer, L Barnes, QM Dowling… – Therapeutic Advances in …, 2013
Abstract The development of vaccines containing adjuvants has the potential to enhance
antibody and cellular immune responses, broaden protective immunity against
heterogeneous pathogen strains, enable antigen dose sparing, and facilitate efficacy in …

Rotavirus vaccine-Vaccinations-NHS Choices
NHS Choices – 2013
We bust common vaccine myths, for example, did you know that you CAN take your baby swimming
after they’ve had their jabs? … Did you know that the fascinating story of vaccination goes back
all the way to ancient Greece? … From July 1 2013 a new vaccine against rotavirus …

An international regulatory clinical trial comparative
BA Fiedler, RJ Bebber – International Journal of Pharmaceutical and Healthcare …, 2013
… Findings and practical implications – Outstanding best practices in national vaccine clinical trials
can guide the international economic development, manufacturing, and distribution policy
strategies necessary to form the basis of a cross-cultural global delivery system. Page 2. …

Population genomics of post-vaccine changes in pneumococcal epidemiology
NJ Croucher, JA Finkelstein, SI Pelton, PK Mitchell… – Nature Genetics, 2013
Whole-genome sequencing of 616 asymptomatically carried Streptococcus pneumoniae
isolates was used to study the impact of the 7-valent pneumococcal conjugate vaccine.
Comparison of closely related isolates showed the role of transformation in facilitating …

Dynamic vaccine blocks relapse to compulsive intake of heroin
JE Schlosburg, LF Vendruscolo, PT Bremer… – Proceedings of the National …, 2013
Abstract Heroin addiction, a chronic relapsing disorder characterized by excessive drug
taking and seeking, requires constant psychotherapeutic and pharmacotherapeutic
interventions to minimize the potential for further abuse. Vaccine strategies against many …

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_4 May 2013_PDF

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

– Links: We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

– 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…

UNICEF: Mass vaccination campaigns in Syria, Jordan, Lebanon, Iraq and Turkey amid measles outbreaks
Press release – 30 April 2013

Excerpt
UNICEF and partners have stepped up vaccination campaigns in Syria, Jordan, Lebanon, Iraq and Turkey amid a number of measles outbreaks in a region already struggling to provide humanitarian assistance to millions of people affected by the Syrian crisis.

“With large population movements and the breakdown of regular health services in Syria, additional precautions are required to ensure that children are protected against killer diseases like measles no matter where they are,” said Mahendra Sheth, UNICEF Regional Health Advisor…

…Since the start of the crisis more than two years ago, over 1.4 million Syrian refugees have fled into neighbouring Jordan, Lebanon, Iraq, Turkey and Egypt, with a current average of up to 8,000 Syrians fleeing the country daily.

In addition, some 4.25 million Syrians have been internally displaced – nearly half of them children. Many live in cramped and unsanitary conditions where disease can easily spread.  The on-going conflict has seriously damaged the health system including the national routine immunization programme.

In Iraq, since December 2012, about 332 cases of measles have been reported in the northern Domiz refugee camp.  In Lebanon, since January, some 300 cases of measles have been reported by the Ministry of Health, while Syria has registered 133 confirmed cases.  In Jordan, at least five cases have been identified among Syrian refugees in the densely populated Za’atari refugee camp.  Meanwhile in Turkey over the past year, there have been some 3,000 to 4,000 reported measles cases, including 300 among Syrian refugees…

…In Syria, some 550,000 children have been vaccinated by Ministry of Health teams recently as part of a national campaign that is targeting 2.5 million children with the support of UNICEF and the WHO. In Lebanon, 462,000 Syrian, Lebanese and Palestinian children have been vaccinated this year alone.

In Jordan, a mass vaccination campaign at Za’atari camp has immunized 60,000 refugees against measles. A national vaccination campaign is expected shortly.

Meanwhile, in Iraq’s Domiz camp, about 19,300 refugees from the age of six months to 30 years were vaccinated with the support of UNICEF.  In Turkey, the Ministry of Health has stepped up immunizations in eight provinces where most of the around 292,000 Syrian refugees are concentrated…
http://www.unicef.org/media/media_68943.html

Update: Polio this week – As of 1 May 2013
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s extract and bolded text]
– Multi-country immunization campaigns took place this week (26-29 April) across West Africa. Benin, Burkina Faso, Côte d’Ivoire, Guinea, Liberia, Mali and Sierra Leone all participated, aiming to reach nearly 30 million children under the age of five years with oral polio vaccine (OPV).
– The Horn of Africa TAG is meeting this week (30 April to 1 May) in Nairobi, Kenya, to review the status of polio eradication activities and impact in the region. Outbreak response is ongoing, to an ongoing circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak in south-central Somalia, which in 2012 had also spread across the border into Kenya.

Nigeria
Two new WPV cases were reported in the past week (WPV1s from Borno), bringing the total number of WPV cases for 2013 to 16. The most recent WPV case had onset of paralysis on 28 March (WPV1 from Borno).

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. Staggered SNIDs are being implemented in parts of Somalia throughout May.

WHO: Global Alert and Response (GAR) – Disease Outbreak News
http://www.who.int/csr/don/2013_03_12/en/index.html

Novel coronavirus infection – update 2 May 2013
Excerpt
The Ministry of Health in Saudi Arabia has informed WHO of seven new laboratory confirmed cases of infection with the novel coronavirus (nCoV), including five deaths.

Two patients are currently in critical condition.

The government is conducting ongoing investigation into this outbreak.

Preliminary investigation show no indication of recent travel or animal contact of any of the confirmed cases. The confirmed cases are not from the same family.

From September 2012 to date, WHO has been informed of a global total of 24 laboratory confirmed cases of human infection with nCoV, including 16 deaths…

Human infection with avian influenza A(H7N9) virus – update 2 May 2013
Excerpt
As of 2 May 2013 (16:00 CET), the National Health and Family Planning Commission, China notified WHO of an additional two laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus.

The first patient is a 58-year-old man from Fujian province who became ill on 21 April 2013 and the second patient is a 69-year-old man from Hunan province who became ill on 23 April 2013.

Additionally, two patients earlier reported have died…

…So far, there is no evidence of sustained human-to-human transmission…

WHO Europe: Regional decline in measles with large rubella outbreaks in two countries: epidemiological overview for 2012
WHO EpiBrief
2 May 2013

Excerpt
The EpiBrief provides an epidemiological assessment based on surveillance data for selected vaccine-preventable diseases in the WHO European Region for 2012. The report reveals that measles declined by over a third in the European Region last year (with 23 871 cases) compared with the total number of reported cases in 2011. Despite gains in controlling rubella in most countries of the Region, however, outbreaks in Poland and Romania contributed to a more than 200% increase in the total number of rubella cases in the Region in 2012 (with 29 361 cases) compared with 2011, when 9461 cases were reported.

Data for the first two months of 2013, published today in “WHO EpiData” summary tables, indicate that outbreaks of both diseases continue in various parts of the Region. Measles outbreaks have been reported in Azerbaijan, Georgia, Turkey and the United Kingdom totalling over 3500 cases in January and February. For the same period, over 4500 cases of rubella have been reported, primarily in Poland. More cases are expected to be reported over the next few weeks as outbreaks persist, but these numbers are, so far, lower than those reported for the same period in 2011 and 2012…
http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/news/news/2013/05/regional-decline-in-measles-with-large-rubella-outbreaks-in-two-countries-epidemiological-overview-for-2012

–       WHO EpiBrief, Issue 1, April 2013
Epidemiological overview and analysis of measles and rubella in the WHO European Region in 2012
–       WHO EpiData, March 2012–February 2013
Summary tables of epidemiological data on selected vaccine-preventable diseases in the WHO European Region

WHO Campaign: SAVE LIVES – Clean Your Hands   Hand Hygiene Day – 5 May
WHO’s global annual campaign
http://www.who.int/gpsc/5may/en/index.html

WHO encourages patient participation for hand hygiene in health care
News release – Excerpt
3 May 2013 | Geneva – On Hand Hygiene Day (5 May), the World Health Organization (WHO) is encouraging patients and their family members to join health workers in their efforts to practice good hand hygiene. Every year, hundreds of millions of patients around the world are affected by health care-associated infections. These lead to significant physical and psychological suffering and sometimes death of patients, and financial losses for health systems. More than half of these infections could be prevented by caregivers properly cleaning their hands at key moments in patient care…
http://www.who.int/mediacentre/news/releases/2013/hand_hygiene_20130503/en/index.html

WHO: SAGE meeting of April 2013
Salle A, CCV, Geneva, 9-11 April 2013

Presentations:
http://www.who.int/immunization/sage/meetings/2013/april/presentations_background_docs/en/index1.html

Background documents:
http://www.who.int/immunization/sage/meetings/2013/april/presentations_background_docs/en/index.html

The Weekly Epidemiological Record (WER) for 3 May 2013, vol. 88, 18(pp. 181–188) includes:

–       Progress towards global interruption of wild poliovirus transmission, January 2012– March 2013

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

http://www.who.int/entity/wer/2013/wer8818.pdf

Report: Yellow Fever Vaccination: The Potential of Dose-Sparing to Increase Vaccine Supply and Availability
PATH*
May 2013

Excerpt
A new special report commissioned and published by PATH concludes that delivering yellow fever vaccine at a reduced dose through a method referred to as dose-sparing could be a pragmatic and low-risk strategy for maximizing the availability of yellow fever vaccine…

… Each year, yellow fever affects more than 200,000 people, with about 30,000 dying of the infection. Although there is no cure, the infection can be prevented with one dose of live attenuated yellow fever vaccine. Only four manufacturers currently produce yellow fever vaccines that have received prequalification status from the World Health Organization (WHO), allowing for the purchase and use of the vaccine by United Nations agencies. This can result in insufficient vaccine supply to compensate for problems or disruptions in vaccine production or to meet spikes in demand when outbreaks occur.

As part of PATH’s ongoing efforts to explore innovative ways to improve vaccine delivery in low-resource settings, the new report investigates the potential benefits, obstacles, and costs of dose-sparing for yellow fever vaccine. It also assesses to what extent different delivery routes and novel delivery devices, such as needle-free jet injectors, could help facilitate the implementation of dose-reduction strategies.

Among the key findings:

–       Dose-sparing can induce levels of immunity comparable to a standard dose for some vaccines, including yellow fever vaccine, potentially helping to stretch limited supplies of existing vaccines.

–       Dose-sparing could result in a fivefold increase in the number of vaccine doses per vial.

–       Preventive yellow fever vaccination campaigns that include dose-sparing strategies could help conserve 24 to 42 million doses of yellow fever vaccine annually and up to 420 million doses by 2022—a savings of US$340 million in vaccine purchase costs over the next decade.

–       To prevent vaccine wastage, dose-sparing strategies are likely to be more appropriate for immunization settings that involve a large number of vaccinations, such as preventive or outbreak-control campaigns.

–       A reduced dose of yellow fever vaccine could potentially be administered through the intradermal and/or subcutaneous delivery route.

Additional clinical trials are needed to confirm the safety and immunogenicity of reduced doses of yellow fever vaccines and to determine the best route of delivery.

*Authorship
This report was written by Julian Hickling, MBA PhD, and Rebecca Jones, MSc, PhD, from Working in Tandem Ltd., and commissioned with funds provided by the Bill & Melinda Gates Foundation through the Disposable Syringe Jet Injector project within the Delivery portfolio of the Vaccine Technologies Group at PATH

http://www.path.org/news/an130425-yellow-fever.php

Conference: Sixth Conference of African Union Ministers of Health (CAMH6)
22-26 April 2013
ADDIS ABABA, ETHIOPIA

Excerpt
The Sabin Vaccine Institute reported that the CAMH6 conference concluded on April 26, 2013 “with a strong call for African countries and development partners to increase support for neglected tropical disease (NTD) control and elimination programs. This call for action supports the World Health Organization’s (WHO) goal to control or eliminate ten of the most common NTDs by 2020.”

…The African Ministers of Health acknowledged “the tremendous work done by country governments, the WHO Regional Office for Africa, and development partners, highlighting the development of 36 multi-year, national NTD control and elimination plans, the WHO Roadmap for Implementation titled, Accelerating Work to Overcome the Global Impact of Neglected Tropical Diseases, and the January 2012 London Declaration on NTDs. The Ministers called on African governments and partners to build on this momentum by making financial commitments towards the implementation of the national NTD control and elimination plans…”

http://www.sabin.org/updates/pressreleases/africa-union-joins-global-fight-end-neglected-tropical-diseases-2020

American Journal of Infection Control
Vol 41 | No. 5 | May 2013 | Pages 389-480
http://www.ajicjournal.org/current

Haemophilus influenzae as an airborne contamination in child day care centers
Danuta O. Lis, PhD, Rafał L. Górny, PhD
13 September 2012

Abstract
Background
The aim of this study was to assess the exposure of children to airborne Haemophilus influenzae in day care centers.

Methods
Air samples were taken using an Andersen impactor in 32 rooms designed for children stay. The concentrations of airborne bacteria were calculated as colony forming units (CFU) (growing on trypticase soy agar) per cubic meter of air (CFU/m3). The compositions of bioaerosol were determined on blood trypticase soy agar and Haemophilus selective agar. Isolated strains were identified using API NH strips and apiweb software. The antibiotic resistance of H influenzae strains was determined by the disk diffusion method.

Results
Compared with the proposed criteria for microbiologic quality of indoor air, the rooms were characterized by the very high bacterial contamination of the air. The prevailing component of bacterial aerosol was gram-positive cocci. Airborne H influenzae strains were found in 25% of the investigated rooms and were mostly classified as biotype II (33%).

Conclusion
It may be accepted that the exposure to airborne H influenzae is typical of child day care centers in contrast to indoor environments with older population. Child day care center contribute to the expansion of H influenzae in human population via air. Generally, airborne H influenzae isolates from the investigated child day care centers were susceptible to older antibiotics such as ampicillin and amoxicillin-clavulanic acid.

http://www.ajicjournal.org/article/S0196-6553%2812%2900885-1/abstract

American Journal of Infection Control
Vol 41 | No. 5 | May 2013 | Pages 389-480
http://www.ajicjournal.org/current

Compliance with hygiene guidelines: The effect of a multimodal hygiene intervention and validation of direct observations
Sara Mernelius, MS, Per-Olof Svensson, RN, BSc; Gunhild Rensfeldt, RN, BSc; Ewa Davidsson, RN, BSc; Barbro Isaksson, MD, PhD; Sture Löfgren, MD, PhD; Andreas Matussek, MD, PhD

Abstract
Background
Good compliance with hygiene guidelines is essential to prevent bacterial transmission and health care-associated infections. However, the compliance is usually <50%.

Methods
A multimodal and multidisciplinary hygiene intervention was launched once the baseline compliance was determined through direct observations in 4 departments of obstetrics and gynecology. Detailed evaluations of the compliance rates were performed at point of stability (at 80%) and follow-up (3 years after hygiene intervention). Validation of direct observations was performed using blinded double appraisal and multiappraisal.

Results
At baseline, the compliance with barrier precautions and the dress code at the 4 departments were 39% to 47% and 79% to 98%, respectively. Point of stability was reached approximately 1 year after the hygiene intervention was launched. The compliance with barrier precautions was significantly higher at follow-up compared with baseline in 3 departments. In the validation by double appraisal, 471 of 483 components were judged identical between observers. In the multiappraisal, 95% to 100% of the observers correctly judged the 7 components.

Conclusion
It is possible to improve compliance with hygiene guidelines, but, to ensure a long-lasting effect, a continuous focus on barrier precautions is required. Observation is a valid method to monitor compliance.
http://www.ajicjournal.org/article/S0196-6553%2812%2901249-7/abstract

BMC Public Health
(Accessed 4 May 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Health economics of rubella: a systematic review to assess the value of rubella vaccination
Joseph B Babigumira1,2*, Ian Morgan3 and Ann Levin4  

Abstract
Background
Most cases of rubella and congenital rubella syndrome (CRS) occur in low- and middle-income countries. The World Health Organization (WHO) has recently recommended that countries accelerate the uptake of rubella vaccination and the GAVI Alliance is now supporting large scale measles-rubella vaccination campaigns. We performed a review of health economic evaluations of rubella and CRS to identify gaps in the evidence base and suggest possible areas of future research to support the planned global expansion of rubella vaccination and efforts towards potential rubella elimination and eradication.

Methods
We performed a systematic search of on-line databases and identified articles published between 1970 and 2012 on costs of rubella and CRS treatment and the costs, cost-effectiveness or cost-benefit of rubella vaccination. We reviewed the studies and categorized them by the income level of the countries in which they were performed, study design, and research question answered. We analyzed their methodology, data sources, and other details. We used these data to identify gaps in the evidence and to suggest possible future areas of scientific study.

Results
We identified 27 studies: 11 cost analyses, 11 cost-benefit analyses, 4 cost-effectiveness analyses, and 1 cost-utility analysis. Of these, 20 studies were conducted in high-income countries, 5 in upper-middle income countries and two in lower-middle income countries. We did not find any studies conducted in low-income countries. CRS was estimated to cost (in 2012 US$) between $4,200 and $57,000 per case annually in middle-income countries and up to $140,000 over a lifetime in high-income countries. Rubella vaccination programs, including the vaccination of health workers, children, and women had favorable cost-effectiveness, cost-utility, or cost-benefit ratios in high- and middle-income countries.

Conclusions
Treatment of CRS is costly and rubella vaccination programs are highly cost-effective. However, in order for research to support the global expansion of rubella vaccination and the drive towards rubella elimination and eradication, additional studies are required in low-income countries, to tackle methodological limitations, and to determine the most cost-effective programmatic strategies for increased rubella vaccine coverage.
http://www.biomedcentral.com/1471-2458/13/406/abstract

British Medical Journal
04 May 2013 (Vol 346, Issue 7906)
http://www.bmj.com/content/346/7906

Editorial
Measles in the UK: a test of public health competency in a crisis
Can new agencies work effectively together to meet the challenge?
Felix Greaves, honorary clinical research fellow1, Liam Donaldson, professor of health policy2

Excerpt
The recent surge in measles cases in south Wales signals a discomfiting failure by a G8 nation to control an easily preventable disease. Far from the measles virus being holed up in outposts in poor countries, the spectre of large outbreaks of measles in England is now looming large. By contrast, elimination of endemic measles in the Americas has been achieved by treating it as an emergency.1 Prevention of more measles cases in the United Kingdom, and avoidance of embarrassment for the government, will turn on the effectiveness of the public health delivery system.

In the north of England there have been 354 cases in 2013 so far.2 The pool of vulnerable children nationally is worrying: 8% of those aged 10-16 years have had no measles, mumps, and rubella (MMR) vaccine, and 8% have had only one of the required two doses.3 Susceptible children are distributed throughout the country, making the site of the next outbreak impossible to predict. In London, where immunisation levels for all vaccines are traditionally lower,4 there have been few cases so far. However, London is a prime location for a major outbreak, with its transient and diverse population and its pockets of low MMR vaccination coverage.

It is hard to manage risk in epidemics, is even harder to explain risk to the public. In a well-nourished population, with good healthcare services, measles has a much lower mortality rate than in developing countries. Furthermore, within living memory, it was seen as a natural part of childhood. For most of those who catch it, measles is an unpleasant self-limiting illness. That said, so far in England in 2013, 18% of patients with the disease have been admitted to hospital, and in a small but important minority,3 the possibility of further complications and permanent disability, or even death, is real. The question society needs to answer is whether it is ethically acceptable to tolerate any serious complication, or death, from measles when an effective vaccine is available.

In a public health emergency, which is what the current measles threat is, it is vital that the response is well coordinated. All organisations and professionals involved in managing it must know their own role and each other’s, and they must work well together. Strong leadership, excellent communication, and a modicum of command and control are also essential. There is a concern that, with the recent health system reforms in England, bodies that were key in crises like severe acute respiratory syndrome, pandemic influenza, and foot-and-mouth disease (such as strategic health authorities and primary care trusts) have been devolved and swept away. Public health teams are now spread across local authorities, with links to the NHS much weaker than in the past. A newly established agency, Public Health England, is charged with protecting the population’s health, but resources for immunisation are with NHS England,5 an entity devoid of public health expertise at board level. It is not acceptable for the elements of this new public health system to learn on the job. An agreed operating relationship is needed quickly. There is the opportunity for a natural experiment to compare the performance of the more mature Welsh system and its brand new English equivalent. Rigorous evaluation of health sector reforms in their early stages would be a novel event in recent British public policy…

http://www.bmj.com/content/346/bmj.f2793

Bulletin of the World Health Organization
Volume 91, Number 5, May 2013, 313-388
http://www.who.int/bulletin/volumes/91/5/en/index.html

Policy coherence for improved medical innovation and access
Zafar Mirza a, Anatole Krattiger b, Antony Taubman c, Hans Georg Bartels c, Peter Beyer a, Roger Kampf c & Jayashree Watal c
a. World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
b. World Intellectual Property Organization, Geneva, Switzerland.
c. World Trade Organization, Geneva, Switzerland.
Bulletin of the World Health Organization 2013;91:315-315A. http://dx.doi.org/10.2471/BLT.13.122705

Excerpt
Public policy-making is an increasingly complex undertaking in a globalizing world, especially as policy domains formerly viewed in isolation become more intertwined. This complexity marks the interplay between health, intellectual property and trade policies. Can such interplay be managed so as to enhance the discovery, development and delivery of medical technologies for better health services and outcomes? This question is at the heart of a joint study on promoting access to medical technologies and innovation recently launched by the World Health Organization (WHO), the World Intellectual Property Organization (WIPO) and the World Trade Organization (WTO).1 The study, conceived as a coherent, systematic and transparent information base for the capacity-building programmes run by the three agencies, is a practical compendium of useful policy information that showcases the value of multilateral interagency cooperation…

http://www.who.int/bulletin/volumes/91/5/13-122705/en/index.html

Bulletin of the World Health Organization
Volume 91, Number 5, May 2013, 313-388
http://www.who.int/bulletin/volumes/91/5/en/index.html

Entry and exit screening of airline travellers during the A(H1N1) 2009 pandemic: a retrospective evaluation
Kamran Khan, Rose Eckhardt, John S Brownstein, Raza Naqvi, Wei Hu, David Kossowsky, David Scales, Julien Arino, Michael MacDonald, Jun Wang, Jennifer Sears & Martin S Cetron

Objective
To evaluate the screening measures that would have been required to assess all travellers at risk of transporting A(H1N1)pdm09 out of Mexico by air at the start of the 2009 pandemic.

Methods
Data from flight itineraries for travellers who flew from Mexico were used to estimate the number of international airports where health screening measures would have been needed, and the number of travellers who would have had to be screened, to assess all air travellers who could have transported the H1N1 influenza virus out of Mexico during the initial stages of the 2009 A(H1N1) pandemic.

Findings
Exit screening at 36 airports in Mexico, or entry screening of travellers arriving on direct flights from Mexico at 82 airports in 26 other countries, would have resulted in the assessment of all air travellers at risk of transporting A(H1N1)pdm09 out of Mexico at the start of the pandemic. Entry screening of 116 travellers arriving from Mexico by direct or connecting flights would have been necessary for every one traveller at risk of transporting A(H1N1)pdm09. Screening at just eight airports would have resulted in the assessment of 90% of all air travellers at risk of transporting A(H1N1)pdm09 out of Mexico in the early stages of the pandemic.

Conclusion
During the earliest stages of the A(H1N1) pandemic, most public health benefits potentially attainable through the screening of air travellers could have been achieved by screening travellers at only eight airports.

http://www.who.int/bulletin/volumes/91/5/12-114777/en/index.html

Health Policy and Planning
Volume 28 Issue 3 May 2013
http://heapol.oxfordjournals.org/content/current

Has Global Fund support for civil society advocacy in the Former Soviet Union established meaningful engagement or ‘a lot of jabber about nothing’?
Andrew Harmer1,*, Neil Spicer2, Julia Aleshkina3, Daryna Bogdan4, Ketevan Chkhatarashvili5,     Gulgun Murzalieva3, Natia Rukhadze5, Arnol Samiev6 and Gill Walt2
+ Author Affiliations
1Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy, 2London School of Hygiene and Tropical Medicine, London, UK, 3Health Policy Analysis Center, Bishkek, Kyrgyzstan, 4Kyiv-Mohyla Academy, Kyiv, Ukraine, 5Curatio International Foundation, Tbilisi, Georgia and 6Independent consultant, Bishkek, Kyrgyzstan
↵*Corresponding author. CERGAS, Bocconi University, via Roentgen, 1 – 20136 Milano, Italy. E-mail: andrew.harmer@unibocconi.it
Accepted April 20, 2012.

Abstract
Although civil society advocacy for health issues such as HIV transmission through injecting drug use is higher on the global health agenda than previously, its impact on national policy reform has been limited. In this paper we seek to understand why this is the case through an examination of civil society advocacy efforts to reform HIV/AIDS and drugs-related policies and their implementation in three former Soviet Union countries. In-depth semi-structured interviews were conducted in Georgia, Kyrgyzstan and Ukraine by national researchers with representatives from a sample of 49 civil society organizations (CSOs) and 22 national key informants. We found that Global Fund support resulted in the professionalization of CSOs, which increased confidence from government and increased CSO influence on policies relating to HIV/AIDS and illicit drugs. Interviewees also reported that the amount of funding for advocacy from the Global Fund was insufficient, indirect and often interrupted. CSOs were often in competition for Global Fund support, which caused resentment and limited collective action, further weakening capacity for effective advocacy.

http://heapol.oxfordjournals.org/content/28/3/299.abstract

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 9, Issue 5  May 2013
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/5/

Commentary
Tolerogenic vaccines for Multiple sclerosis
Volume 9, Issue 5   May 2013
http://dx.doi.org/10.4161/hv.23685
Mark D. Mannie and Alan D. Curtis, II

Abstract:
Tolerogenic vaccines represent a new class of vaccine designed to re-establish immunological tolerance, restore immune homeostasis, and thereby reverse autoimmune disease. Tolerogenic vaccines induce long-term, antigen-specific, inhibitory memory that blocks pathogenic T cell responses via loss of effector T cells and gain of regulatory T cell function. Substantial advances have been realized in the generation of tolerogenic vaccines that inhibit experimental autoimmune encephalomyelitis in a preclinical setting, and these vaccines may be a prequel of the tolerogenic vaccines that may have therapeutic benefit in Multiple Sclerosis. The purpose here is to provide a snapshot of the current concepts and future prospects of tolerogenic vaccination for Multiple Sclerosis, along with the central challenges to clinical application.

http://www.landesbioscience.com/journals/vaccines/article/23685/

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 9, Issue 5  May 2013
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/5/

Research Paper
Economic analysis of the first 20 y of universal hepatitis B vaccination program in Italy: An a posteriori evaluation and forecast of future benefits
Sara Boccalini, Cristina Taddei, Vega Ceccherini, Angela Bechini, Miriam Levi, Dario Bartolozzi and Paolo Bonanni

Abstract:
Italy was one of the first countries in the world to introduce a routine vaccination program against HBV for newborns and 12-y-old children. From a clinical point of view, such strategy was clearly successful. The objective of our study was to verify whether, at 20 y from its implementation, hepatitis B universal vaccination had positive effects also from an economic point of view. An a posteriori analysis evaluated the impact that the hepatitis B immunization program had up to the present day. The implementation of vaccination brought an extensive reduction of the burden of hepatitis B-related diseases in the Italian population. As a consequence, the past and future savings due to clinical costs avoided are particularly high. We obtained a return on investment nearly equal to 1 from the National Health Service perspective, and a benefit-to-cost ratio slightly less than 1 for the Societal perspective, considering only the first 20 y from the start of the program. In the longer-time horizon, ROI and BCR values were positive (2.78 and 2.46, respectively). The break-even point was already achieved few years ago for the NHS and for the Society, and since then more and more money is progressively saved. The implementation of universal hepatitis B vaccination was very favorable during the first 20 y of adoption, and further benefits will be increasingly evident in the future. The hepatitis B vaccination program in Italy is a clear example of the great impact that universal immunization is able to provide in the medium-long-term when health care authorities are so wise as to invest in prevention.

http://www.landesbioscience.com/journals/vaccines/article/23827/