Focus Issue: The microbiota

Nature Immunology
July 2013, Volume 14 No 7 pp645-763
http://www.nature.com/ni/journal/v14/n7/index.html

Focus Issue: The microbiota
Interactions between the immune system and microbiota influence local and systemic immune homeostasis. Nature Immunology presents a series of specially commissioned articles that discuss the reciprocal regulation between the host immune system and commensal microbiota, the dynamic interactions between commensals and pathogens, and emerging information on how resident viruses might influence immune homeostasis. The web focus also includes highlights of recent research in this area.

Perspective: Pandemic Influenza Viruses — Hoping for the Road Not Taken [H7N9]

New England Journal of Medicine
June 20, 2013  Vol. 368 No. 25
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Pandemic Influenza Viruses — Hoping for the Road Not Taken
David M. Morens, M.D., Jeffery K. Taubenberger, M.D., Ph.D., and Anthony S. Fauci, M.D.
N Engl J Med 2013; 368:2345-2348 June 20, 2013 DOI: 10.1056/NEJMp1307009

Excerpt [Closing paragraphs]
…Finally, there is remarkable clinical–epidemiologic similarity between H7N9 and H5N1, with the important distinction that since H5N1 is a highly pathogenic avian virus that kills domestic poultry, its movement is more visible than that of H7N9, whose low pathogenicity keeps it hidden until a rare human is infected. In most other respects, H5N1 and H7N9 are alike: many humans have been exposed to both without clinically apparent or immunologically detectable evidence of infection; disease in sporadic human cases has been far more severe than in cases caused by any human-adapted influenza A virus ever encountered (59% and 28% case fatality reported for H5N1 and H7N9, respectively, as of the end of May); the clinical presentation includes bilateral pneumonia progressing to acute respiratory distress syndrome and multiorgan failure; there has been little or no evidence of person-to-person transmission; and rare case clusters (tenuously identified so far in the case of H7N9) suggest common source exposures in genetically related persons.

As with H5N1,3,4 in H7N9 these epidemiologic features may be signatures of a fundamentally poorly adaptable avian virus that nevertheless productively infects those rare humans with unidentified genetic susceptibilities, who are “found” by widespread poultry epizootics that expose large human populations. Conceivably, questions raised by H5N1 and H7N9 will be faced repeatedly as large-scale domestic poultry raising and transport, coupled with exploding human populations, create opportunities for any avian virus that encounters domestic poultry to expose large numbers of humans.

Like every human influenza pandemic and major outbreak in more than a century,    H7N9 has left us surprised and puzzled. It is only slightly reassuring that since 1918, we have never seen an influenza pandemic emerge through direct viral mutations alone. But every pandemic emergence seems to be a law unto itself, and we cannot know whether or under what circumstances the highly unusual H7N9 virus might be able to become pandemic. Influenza viruses’ unpredictability renders     H7N9 pandemic preparedness essential. Indeed, preparation has already begun, with the goals of developing sensitive and specific diagnostics; determining drug sensitivity; establishing seed viruses, pilot lots, and potency assays for vaccine development; and setting up clinical trials to test appropriate vaccine doses for various demographic groups (children, adults, the elderly).

H7N9’s journey has just begun. We can only hope that the road to a pandemic is the road not taken.

Perspective
The H7N9 Influenza Virus in China — Changes since SARS
Yu Wang, M.D., Ph.D.
N Engl J Med 2013; 368:2348-2349June 20, 2013 DOI: 10.1056/NEJMp1305311
Ten years after the emergence in China of the severe acute respiratory syndrome, an avian influenza A (H7N9) virus has emerged there, causing substantial disease. But China is now better prepared to address emerging infectious diseases and potential pandemics.

Targeted Interventions for Improved Equity in Maternal and Child Health in Low- and Middle-Income Settings: A Systematic Review and Meta-Analysis

PLoS One
[Accessed 22 June 2013]
http://www.plosone.org/

Targeted Interventions for Improved Equity in Maternal and Child Health in Low- and Middle-Income Settings: A Systematic Review and Meta-Analysis
Mats Malqvist, Beibei Yuan, Nadja Trygg, Katarina Selling, Sarah Thomsen
Research Article | published 20 Jun 2013 | PLOS ONE 10.1371/journal.pone.0066453

Abstract
Background
Targeted interventions to improve maternal and child health is suggested as a feasible and sometimes even necessary strategy to reduce inequity. The objective of this systematic review was to gather the evidence of the effectiveness of targeted interventions to improve equity in MDG 4 and 5 outcomes.

Methods and Findings
We identified primary studies in all languages by searching nine health and social databases, including grey literature and dissertations. Studies evaluating the effect of an intervention tailored to address a structural determinant of inequity in maternal and child health were included. Thus general interventions targeting disadvantaged populations were excluded. Outcome measures were limited to indicators proposed for Millennium Development Goals 4 and 5. We identified 18 articles, whereof 15 evaluated various incentive programs, two evaluated a targeted policy intervention, and only one study evaluated an intervention addressing a cultural custom. Meta-analyses of the effectiveness of incentives programs showed a pooled effect size of RR 1.66 (95% CI 1.43–1.93) for antenatal care attendance (four studies with 2,476 participants) and RR 2.37 (95% CI 1.38–4.07) for health facility delivery (five studies with 25,625 participants). Meta-analyses were not performed for any of the other outcomes due to scarcity of studies.

Conclusions
The targeted interventions aiming to improve maternal and child health are mainly limited to addressing economic disparities through various incentive schemes like conditional cash transfers and voucher schemes. This is a feasible strategy to reduce inequity based on income. More innovative action-oriented research is needed to speed up progress in maternal and child survival among the most disadvantaged populations through interventions targeting the underlying structural determinants of inequity.

Influenza Illness and Hospitalizations Averted by Influenza Vaccination in the United States, 2005–2011

PLoS One
[Accessed 22 June 2013]
http://www.plosone.org/

Influenza Illness and Hospitalizations Averted by Influenza Vaccination in the United States, 2005–2011
Deliana Kostova, Carrie Reed, Lyn Finelli, Po-Yung Cheng, Paul M. Gargiullo, David K. Shay, James A. Singleton, Martin I. Meltzer, Peng-jun Lu, Joseph S. Bresee
Research Article | published 19 Jun 2013 | PLOS ONE 10.1371/journal.pone.0066312

Abstract
Context
The goal of influenza vaccination programs is to reduce influenza-associated disease outcomes. Therefore, estimating the reduced burden of influenza as a result of vaccination over time and by age group would allow for a clear understanding of the value of influenza vaccines in the US, and of areas where improvements could lead to greatest benefits.

Objective
To estimate the direct effect of influenza vaccination in the US in terms of averted number of cases, medically-attended cases, and hospitalizations over six recent influenza seasons.

Design
Using existing surveillance data, we present a method for assessing the impact of influenza vaccination where impact is defined as either the number of averted outcomes or as the prevented disease fraction (the number of cases estimated to have been averted relative to the number of cases that would have occurred in the absence of vaccination).

Results
We estimated that during our 6-year study period, the number of influenza illnesses averted by vaccination ranged from a low of approximately 1.1 million (95% confidence interval (CI) 0.6–1.7 million) during the 2006–2007 season to a high of 5 million (CI 2.9–8.6 million) during the 2010–2011 season while the number of averted hospitalizations ranged from a low of 7,700 (CI 3,700–14,100) in 2009–2010 to a high of 40,400 (CI 20,800–73,000) in 2010–2011. Prevented fractions varied across age groups and over time. The highest prevented fraction in the study period was observed in 2010–2011, reflecting the post-pandemic expansion of vaccination coverage.

Conclusions
Influenza vaccination programs in the US produce a substantial health benefit in terms of averted cases, clinic visits and hospitalizations. Our results underscore the potential for additional disease prevention through increased vaccination coverage, particularly among nonelderly adults, and increased vaccine effectiveness, particularly among the elderly.

Strategies to Improve Child Immunization via Antenatal Care Visits in India: A Propensity Score Matching Analysis

PLoS One
[Accessed 22 June 2013]
http://www.plosone.org/

Strategies to Improve Child Immunization via Antenatal Care Visits in India: A Propensity Score Matching Analysis
Priyanka Dixit, Laxmi Kant Dwivedi, Faujdar Ram
Research Article | published 18 Jun 2013 | PLOS ONE 10.1371/journal.pone.0066175

Abstract
Numerous studies have examined the empirical evidence concerning the influence of demographic and socio-economic factors influencing child immunization, but no documentation is available which shows the actual impact of antenatal care (ANC) visits on subsequent child immunization. Therefore, this paper aims to examine the net impact of ANC visits on subsequent utilization of child immunization after removing the presence of selection bias. Nationwide data from India’s latest National Family Health Survey conducted during 2005–06 is used for the present study. The analysis has been carried out in the two separate models, in the first model 1–2 ANC visit and in the second model three or more ANC visits has been compared with no visit. We have used propensity score matching method with a counterfactual model that assesses the actual ANC visits effect on treated (ANC visits) and untreated groups (no ANC visit), and have employed Mantel-Haenszel bounds to examine whether result would be free from hidden bias or not. Using matched sample analysis result shows that child immunization among the groups of women who have completed 1–2 ANC visits and those who had more than two visits was about 13 percent and 19 percent respectively, higher than the group of women who have not made any ANC visit. Findings of nearest neighbor matching with replacement method, which completely eliminated the bias, indicate that selection bias present in data set leads to overestimates the positive effects of ANC visits on child immunization. Result based on Mantel-Haenszel bounds method suggest that if around 19 percent bias would be involved in the result then also we could observe the true positive effect of 1–2 ANC visits on child immunization. This also indicates that antenatal clinics are the conventional platforms for educating pregnant women on the benefits of child immunization.

Perceptions and acceptability of HPV vaccination among parents of young adolescents: A multicenter national survey in China

Vaccine
Volume 31, Issue 32, Pages 3207-3308 (11 July 2013)
http://www.sciencedirect.com/science/journal/0264410X

Perceptions and acceptability of HPV vaccination among parents of young adolescents: A multicenter national survey in China
Original Research Article
Pages 3244-3249
Shao-Kai Zhang, Xiong-Fei Pan, Shao-Ming Wang, Chun-Xia Yang, Xiao-Hong Gao, Zeng-Zhen Wang, Man Li, Ze-Fang Ren, Fang-Hui Zhao, You-Lin Qiao

Abstract
Prophylactic HPV vaccines target young adolescents to prevent related cervical lesions and even genital warts prior to onset of sexual activity. Parental consent is often essential for success of vaccination program for this age group. We conducted a national multicenter study to explore the acceptability of HPV vaccination among parents of young adolescents and associated factors in relevant parent decision making in China. A total of 2899 parents of young adolescents (11–17 years) participated in the survey between November 28, 2011 and May 9, 2012, but four were excluded from analysis because of inconsistencies in their given information in the questionnaire. Mothers accounted for 62.8% of the parent participants. The mean age of the parents was 40.40 (standard deviation, 4.68) years. Only 36.2% of the parents accepted the vaccine for their children. Knowledge about HPV and HPV vaccine was a positive correlate with HPV vaccination acceptability (Ptrend = 0.003). Grade of child (Ptrend = 0.015), prior vaccination experience outside the National Expanded Program on Immunization (OR: 1.43; 95%CI: 1.19–1.72), fear of cervical cancer and/or genital warts (OR: 2.47; 95%CI: 2.00–3.05), and prior consultation regarding HPV vaccine information (OR: 2.35; 95%CI: 1.57–3.52) were also positively associated with higher HPV vaccine acceptability. The acceptability was lower in mothers (OR: 0.45; 95%CI: 0.37–0.54) and who had better education (PTREND = 0.009). 57.3% of the parents agreed that the most appropriate venue for HPV vaccination was the local center for disease prevention and control. In conclusion, our study indicates a low acceptability of HPV vaccination among parents of young adolescents in China. We understand there are many challenges in implementing HPV vaccination program. Our findings will serve as valuable references for future HPV vaccination policies and campaigns after HPV vaccines are approved in China.

Cost-effectiveness of rotavirus immunization in Indonesia: Taking breastfeeding patterns into account

Vaccine
Volume 31, Issue 32, Pages 3207-3308 (11 July 2013)
http://www.sciencedirect.com/science/journal/0264410X

Cost-effectiveness of rotavirus immunization in Indonesia: Taking breastfeeding patterns into account
Original Research Article
Pages 3300-3307
Auliya A. Suwantika, Hong Anh T. Tu, Maarten J. Postma

Abstract
Objective
This study aims to assess the cost-effectiveness of rotavirus immunization in Indonesia, taking breastfeeding patterns explicitly into account.

Method
An age-structured cohort model was developed for the 2011 Indonesia birth cohort. Next, we compared two strategies, the current situation without rotavirus immunization versus the alternative of a national immunization program. The model applies a 5 year time horizon, with 1 monthly analytical cycles for children less than 1 year of age and annually thereafter. Three scenarios were compared to the base case reflecting the actual distribution over the different breastfeeding modes as present in Indonesia; i.e., the population under 2 years old with (i) 100% exclusive breastfeeding, (ii) 100% partial breastfeeding and (iii) 100% no breastfeeding. Monte Carlo simulations were used to examine the economic acceptability and affordability of the rotavirus vaccination.

Results
Rotavirus immunization would effectively reduce severe cases of rotavirus during the first 5 years of life of a child. Under the market vaccine price the total yearly vaccine cost would amount to US$ 65 million. The incremental cost per quality-adjusted-life-year (QALY) in the base case was US$ 174 from the societal perspective. Obviously, it was much lower than the 2011 Indonesian Gross Domestic Product (GDP) per capita of US$ 3495. Affordability results showed that at the Global Alliance for Vaccines and Immunization (GAVI)-subsidized vaccine price, rotavirus vaccination could be affordable for the Indonesian health system. Increased uptake of breastfeeding might slightly reduce cost-effectiveness results.

Conclusion
Rotavirus immunization in Indonesia would be a highly cost-effective health intervention even under the market vaccine price. The results illustrate that rotavirus immunization would greatly reduce the burden of disease due to rotavirus infection. Even within increased uptake of breastfeeding, cost-effectiveness remains favorable.

From Google Scholar + [to 22 June 2013]

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

Translational Research Insights From Completed HIV Vaccine Efficacy Trials
HV Tieu, M Rolland, SM Hammer, ME Sobieszczyk – JAIDS Journal of Acquired …, 2013
Abstract: The development of a safe and effective HIV vaccine remains a challenge. The modest efficacy seen in the RV144 vaccine trial represented an important milestone for the field. Results from all efficacy studies done to date have generated new information, which…

Preparing for the Unexpected: The Pivotal Role of Social and Behavioral Sciences in Trials of Biomedical HIV Prevention Interventions
BA Koblin, M Andrasik, J Austin – JAIDS Journal of Acquired Immune Deficiency …, 2013
… HIV Vaccine Trials Network, Fred Hutchinson Cancer Research Center, Seattle, WA; and. … For example, recent work within the HIV Vaccine Trials Network (HVTN) provided valuable insight into factors affecting recruitment of MSM and transgender women into HVTN 505…

Herpes Simplex and Herpes Zoster Eye Disease: Presentation and Management at a City Hospital for the Underserved in the United States
ARP Edell, EJ Cohen – Eye & Contact Lens, 2013
… Underuse of the vaccine against HZ is also a major concern, with only 14.4% of eligible patients receiving it as of 2010.10 Ocular herpes simplex is caused by the HSV and affects nearly half a million individuals in the United States….

Childhood pneumonia in developing countries
The Lancet Respiratory Medicine | 18 June 2013
…A large part of the approach to control of pneumococcal pneumonia has depended on vaccination programmes. However, more than 90 individual serotypes of the bacteria exist, and effective immunisation against pneumococcus necessitates neutralisation of the specific capsular polysaccharides that stimulate the immune system and cause lung inflammation. Available vaccines have progressively incorporated more serotypes, focusing on those associated with the greatest disease burden, and whole-cell techniques could provide greater immunogenicity. …More importantly, studies in Finland, USA, and The Gambia have shown greater effectiveness of pneumococcal vaccines than would have been expected based on targeted serotypes.

Editorial: A Surprisingly Successful HPV Vaccine

New York Times
http://www.nytimes.com/

Editorial
A Surprisingly Successful HPV Vaccine
By THE EDITORIAL BOARD
Published: June 21, 2013

A vaccine to protect teenage girls against dangerous strains of the human papillomavirus, or HPV, that are a leading cause of cervical cancer has proved to be enormously effective.

A study published Wednesday by the Centers for Disease Control and Prevention found that the prevalence of high-risk strains in teenage girls dropped by half after the vaccine was introduced in 2006, from 7.2 percent in 2006 to 3.6 percent in 2010.

Unfortunately, many parents still resist having their daughters immunized. A study published in March found that 44 percent of parents said in 2010 that they did not intend to vaccinate their daughters, up from 40 percent in 2008.

Some parents fear that vaccination might promote promiscuity (the new study found no sign of that); some see no need to vaccinate girls before they become sexually active, even though vaccination beforehand offers the best protection.

Health officials were surprised at the steep decline in infection rates because only about a third of American teenage girls have received the full course of three doses. In other advanced countries and even in a developing nation like Rwanda, vaccination rates have reached 80 percent or higher. Increasing the vaccination rate to 80 percent in this country could prevent an additional 53,000 cervical cancers and 17,000 deaths among girls now 13 years old and younger over the course of their lives.

Doctors need to recommend, and parents need to accept, a vaccine that can save thousands of lives.

Vaccines: The Week in Review 15 June 2013

Editor’s Notes:

Vaccines: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated “8 June 2013″

Email Summary: Vaccines: The Week in Review is published as a single email summary, scheduled for release each Saturday eveningbefore midnight (EDT in the U.S.). If you would like to receive the email version, 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_15 June 2013
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 Alliance Board to develop a long-term strategy to support IPV introduction

The GAVI Alliance Board said it has requested an “in-depth analysis to inform its decisions on the future of GAVI’s vaccines portfolio and requested the GAVI Secretariat to develop a long-term strategy on how GAVI will support the introduction of Inactivated Polio Vaccine in partner countries.”  The request “…was taken based on initial assessments of the potential effect of vaccine interventions on a range of life-threatening diseases. The cost and user-friendliness of vaccines, as well as their potential to benefit vulnerable groups and to aid outbreak prevention were also considered.” The requested analysis WILL “evaluate the potential impact vaccines could have in five disease areas under consideration for future Alliance support: cholera, influenza (for pregnant women), malaria, rabies and further support for yellow fever.” Final decisions on future vaccine support are expected to be taken at the November 2013 GAVI Board meeting. GAVI’s support for vaccines already in its portfolio remains unchanged.

Separately, the Board agreed that the GAVI Alliance “should play a lead role in the introduction of Inactivated Polio Vaccine (IPV) into routine immunisation services in countries where GAVI currently works” and “recognised the importance of strong partnership and complementarity between the GAVI Alliance and the Global Polio Eradication Initiative and requested the GAVI Secretariat to present a long-term strategy in support of the Alliance’s specific role and activities in relation to IPV to the Board by November 2013. “

http://www.gavialliance.org/library/news/statements/2013/gavi-board-asks-to-begin-preparations-for-introduction-of-inactivated-polio-vaccine-and-considers-investment-in-other-new-vaccines/

GPEI: Emergency meeting called in response to the polio outbreak in the Horn of Africa, 9–10 June 2013

GPEI: Emergency meeting called in response to the polio outbreak in the Horn of Africa, 9–10 June 2013

WHO Regional Office for the Eastern Mediterranean hosted a two-day emergency meeting in Cairo, Egypt, from 9 to 10 June 2013, on the response to the polio outbreak in the Horn of Africa. The meeting was to be attended by the Chairman of the Horn of Africa Technical Advisory Group, and representatives of WHO headquarters, WHO Regional Office for Africa, and WHO country offices in Kenya, Ethiopia, Somalia and Yemen. It will be chaired by Dr Ala Alwan, WHO Regional Director for the Eastern Mediterranean.

The objectives of the meeting were to:

:: review the current status and risks for poliovirus circulation in Somalia, Kenya, Ethiopia and Yemen

:: review and strengthen national response plans to rapidly stop the polio outbreak and prevent its spread to Ethiopia, Yemen and other countries

:: review and strengthen intercountry and inter-regional coordination of the outbreak response in the Horn of Africa

:: activate and implement the necessary emergency protocols and process to urgently deploy human, logistic and financial resources for a robust outbreak response and develop advocacy plans to optimize access to children in Somalia

:: enhance political commitment and support for the national outbreak response.

Optimal mechanisms and protocols for intercountry and inter-regional coordination will be discussed in the meeting, together with the advocacy and outreach needed to optimize access to children in Somalia and enhance political commitment and support for the national outbreak response.

http://www.emro.who.int/polio/polio-events/response-polio-outbreak-horn-of-africa.html

GPEI Update: Polio this week – As of 12 June 2013

Update: Polio this week – As of 12 June 2013
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]

:: An emergency Horn of Africa polio outbreak meeting was held this week (9-10 June) in Cairo, Egypt, hosted by the WHO Regional Office for the Eastern Mediterranean (EMRO). Chaired by EMRO Regional Director Dr Ala Alwan, the meeting was attended by the Chair of the Horn of Africa Technical Advisory Group, as well as representatives from WHO headquarters (including Dr Bruce Aylward, Assistant Director-General for Polio, Emergencies and Country Collaboration), EMRO, and country office teams from Somalia, Kenya, Ethiopia and Yemen.

:: The meeting reviewed the current status and risks associated with the outbreak, as well as outbreak response activities and their expected impact and discussed strategies to further increasing support to countries and strengthening the outbreak response. [see meeting coverage above]

Nigeria
::One new WPV case was reported in the past week (WPV1 from Kano), bringing the total number of WPV cases for 2013 to 25. It is the most recent WPV case in the country and had onset of paralysis on 4 May.

Pakistan
:: Four new WPV cases were reported in the past week (WPV1s from Federally Administered Tribal Areas – FATA, including three from Khyber Agency), bringing the total number of WPV cases for 2013 to 14. One of the newly-reported cases is the most recent WPV case in the country and had onset of paralysis on 19 May.

:: One new cVDPV2 case was reported in the past week (from Gadap town, greater Karachi, Sindh), bringing the total number of cVDPV2 cases for 2013 to five. It is the most recent cVDPV2 case in the country and had onset of paralysis on 8 May

Horn of Africa
:: Five new WPV cases were reported in the past week (two WPV1s from Somalia and three WPV1s from Kenya), bringing the total number of WPV1 cases in the region to 14 (nine WPV1s from Somalia and five WPV1s from Kenya). Two of these new cases are the most recent and had onset of paralysis on 18 May (both from Kenya).

:: Outbreak response activities are continuing across the Horn of Africa.

:: In Somalia, two large-scale immunization campaigns have already been implemented, including in Banadir (which includes Mogadishu), including targeting children aged less than ten years. Lessons from these campaigns are now being addressed in preparation of the next rounds starting on 12 June. In Banadir, all age groups are being targeted. Focus is on fine-tuning microplans to include schools, more clearly define vaccinator team daily workloads, improving supervision and expanding the scope and content of monitoring activities.

:: In Kenya, immunization activities began on 26 May to reach nearly 440,000 children aged less than 15 years across the Dadaab area. Preparations are ongoing for the next SNIDs, on 15 June, covering broader areas including all age groups in the Dadaab area. Further campaigns planned for late June and mid-August.

:: Immunization campaigns are also planned and being conducted in other areas of the Horn of Africa, notably Ethiopia and Yemen, to urgently boost population immunity levels and minimize the risk of spread of the outbreak.

:: In Ethiopia, in border areas with Kenya and Somalia, an immunization activity was held on 31 May (targeting children aged less than 15 years). Focus was particularly on reaching children in refugee camps. Broader activities are planned to start 16 June and in early July.

:: In Yemen, activities were held last week (2-5 June) to reach 2.1 million children, with a second round planned for late June to reach 3.5 million children and National Immunization Days in August.

WHO: Global Alert and Response (GAR) – Disease Outbreak News MERS-CoV; Yellow Fever

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

Middle East respiratory syndrome coronavirus (MERS-CoV) – update 14 June 2013
Excerpt
14 June 2013 – The Ministry of Health in Saudi Arabia has announced an additional three laboratory-confirmed cases, including one death with Middle East respiratory syndrome coronavirus (MERS-CoV)…
…Globally, from September 2012 to date, WHO has been informed of a total of 58 laboratory-confirmed cases of infection with MERS-CoV, including 33 deaths.

WHO has received reports of laboratory-confirmed cases originating in the following countries in the Middle East to date: Jordan, Qatar, Saudi Arabia, and the United Arab Emirates (UAE). France, Germany, Italy, Tunisia and the United Kingdom also reported laboratory-confirmed cases; they were either transferred there for care of the disease or returned from the Middle East and subsequently became ill. In France, Italy, Tunisia and the United Kingdom, there has been limited local transmission among patients who had not been to the Middle East but had been in close contact with the laboratory-confirmed or probable cases…

Yellow fever in the Democratic Republic of Congo 14 June 2013
Excerpt
14 June 2013 – The Ministry of Health of the Democratic Republic of Congo (DRC) is launching an emergency mass vaccination campaign against yellow fever from 20 June 2013, following laboratory confirmation of six cases in the country on 6 June 2013…

…The mass vaccination campaign aims to cover at least 503,426 people in the three affected health zones.

The International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG11) will provide 559,000 doses of yellow fever vaccine for the mass vaccination campaign run by the Ministry of Health in DRC, with support from the GAVI Alliance, Medicins Sans Frontiers and other partners. WHO is closely supporting the management of the outbreak in monitoring, preventive and control activities in the field, and resource mobilization…

Organization of American States’ Resolution “Elimination of Neglected Diseases and Other Poverty-Related Infections”

Statement: On the Occasion of the Organization of American States’ Resolution “Elimination of Neglected Diseases and Other Poverty-Related Infections”
Sabin Vaccine Institute
June 13, 2013

Excerpt
Last week, the Organization of American States (OAS), the main political and social governmental forum for nations in Latin America and the Caribbean, approved a resolution supporting the control and elimination of neglected tropical diseases (NTDs) during the 43rd General Assembly in Antigua, Guatemala.

Ambassador Hubert J. Charles, Permanent Representative of Dominica to OAS, presented a resolution to endorse the Pan American Health Organization’s 2009 resolution, “Elimination of Neglected Diseases and Other Poverty-Related Infections.” While not every Member State has NTDs, there was broad agreement that the OAS resolution would add value to existing efforts and renew a collective commitment to significantly reduce the prevalence of these diseases in the region by 2015. Fifteen countries co-sponsored the resolution and it received approval from the majority of the 35 independent states represented in the OAS.

Dr. Peter Hotez, president of the Sabin Vaccine Institute, issued the following statement applauding the OAS for their leadership in the fight against NTDs:

We applaud the Organization of American States for its recognition of the important goal of reducing the burden of infectious and neglected tropical diseases in Latin America and the Caribbean.

   These diseases continue to perpetuate the cycle of poverty, often holding back marginalized communities. Though the region has made significant progress towards NTD control and elimination, more work still needs to be done to alleviate the suffering of the 100 million people currently infected in this region.  This resolution aligns with the OAS’ core mission to reduce poverty among its Member States. Success in eliminating these diseases will bolster the region’s ongoing efforts to improve health systems, equity and economic development.

   We expect this new political endorsement to stimulate interest, action and the necessary resources to meet the targets outlined by the Pan American Health Organization as we approach the 2015 deadline for a number of NTD elimination goals.

http://www.sabin.org/updates/pressreleases/statement-sabin-vaccine-institute-occasion-organization-american-states%E2%80%99

FDA approves sBLA for sanofi four-strain influenza vaccine,

Media Release:  New Four-Strain Influenza Vaccine from Now Licensed By FDA for Broad Age Range of Children and Adults
Sanofi Pasteur: 10 June 2013
Excerpt
“…the U.S. Food and Drug Administration has approved the supplemental biologics license application (sBLA) for licensure of its four-strain influenza vaccine, Fluzone Quadrivalent vaccine. Fluzone Quadrivalent vaccine is the newest addition to the Fluzone family of influenza vaccines. Like Sanofi Pasteur’s Fluzone vaccine, which is administered to more than 50 million people in the U.S. each year, Fluzone Quadrivalent vaccine is licensed for use in children six months of age and older, adolescents, and adults.

The 2013 influenza season will be the first in which quadrivalent influenza vaccines will be available in the U.S. Until this year, seasonal influenza vaccines included only one B strain. Fluzone Quadrivalent vaccine includes two A strains and two B strains to help protect against influenza disease. Epidemics of influenza B occur every two to four years in all age groups. Influenza B is a common cause of influenza-related morbidity and mortality in children and has been associated with pneumonia and other respiratory illnesses, nervous system disease, muscle pain and inflammation, and other complications. In recent years, up to 44 percent of influenza-associated deaths in children and adolescents 18 years of age and younger were due to influenza B…

http://www.multivu.com/mnr/61694-sanofi-pasteur-fluzone-quadrivalent-influenza-virus-vaccine-fda-approval

WHO: Pandemic Influenza Risk Management

WHO: Pandemic Influenza Risk Management
Interim Guidance
Overview Publication date: 10 June 2013
Languages: English
This interim guidance replaces the 2009 Pandemic Influenza Preparedness and Response: a WHO guidance document.
Key highlights include the following:
. Focus upon risk assessment at national level to guide national level actions

. Revised approach to global phases

. Flexibility through uncoupling of national actions from global phases

. Inclusion of principles of emergency risk management for health

. New and updated annexes on planning assumptions, ethical considerations, whole-of-society approach, business continuity planning, representative parameters for core severity indicators, and containment measures.

The guidance has been released in this interim form in order to support the risk management of pandemic threats, at the request of Member States.

Guidance document: http://www.who.int/entity/influenza/preparedness/pandemic/GIP_PandemicInfluenzaRiskManagementInterimGuidance_Jun2013.pdf

Frequently Asked Questions
pdf, 92kb

Map of Vaccine-Preventable Outbreaks – Council on Foreign Relations

Map of Vaccine-Preventable Outbreaks
Council on Foreign Relations |
12 June 2013
This interactive map visually plots global outbreaks of measles, mumps, whooping cough, polio, rubella, and other diseases as undertaken by the Global Health Program at the Council on Foreign Relations which has been tracking news reports on these outbreaks since the fall of 2008.
http://www.cfr.org/interactives/GH_Vaccine_Map/index.html#map

Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation

BMC Public Health
(Accessed 15 June 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation
Wiku Adisasmito, Dewi Nur Aisyah, Tjandra Yoga Aditama, Rita Kusriastuti, Trihono, Agus Suwandono, Ondri Dwi Sampurno, Prasenohadi, Nurshanty A Sapada, MJN Mamahit, Anna Swenson, Nancy A Dreyer and Richard Coker
http://www.biomedcentral.com/1471-2458/13/571/abstract

Abstract (provisional)
Background
Indonesia has had more recorded human cases of influenza A H5N1 than any other country, with one of the world’s highest case fatality rates. Understanding barriers to treatment may help ensure life-saving influenza-specific treatment is provided early enough to meaningfully improve clinical outcomes.

Methods
Data for this observational study of humans infected with influenza A H5N1 were obtained primarily from Ministry of Health, Provincial and District Health Office clinical records. Data included time from symptom onset to presentation for medical care, source of medical care provided, influenza virology, time to initiation of influenza-specific treatment with antiviral drugs, and survival.

Results
Data on 124 human cases of virologically confirmed avian influenza were collected between September 2005 and December 2010, representing 73% of all reported Indonesia cases. The median time from health service presentation to antiviral drug initiation was 7.0 days. Time to viral testing was highly correlated with starting antiviral treatment (p < 0.0001). We found substantial variability in the time to viral testing (p = 0.04) by type of medical care provider. Antivirals were started promptly after diagnosis (median 0 days).

Conclusions
Delays in the delivery of appropriate care to human cases of avian influenza H5N1 in Indonesia appear related to delays in diagnosis rather than presentation to health care settings. Either cases are not suspected of being H5N1 cases until nearly one week after presenting for medical care, or viral testing and/or antiviral treatment is not available where patients are presenting for care. Health system delays have increased since 2007.

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

Molecular Evolution of the HIV-1 Thai Epidemic between the Time of RV144 Immunogen Selection to the Execution of the Vaccine Efficacy Tria

Journal of Virology
July 2013, volume 87, issue 13
http://jvi.asm.org/content/current

Molecular Evolution of the HIV-1 Thai Epidemic between the Time of RV144 Immunogen Selection to the Execution of the Vaccine Efficacy Trial
Gustavo H. Kijak, Sodsai Tovanabutra, Supachai Rerks-Ngarm, Sorachai Nitayaphan, Chirapa Eamsila, Prayura Kunasol, Chirasak Khamboonruang, Prasert Thongcharoen, Chawetsan Namwat, Nakorn Premsri, Michael Benenson, Patricia Morgan, Meera Bose, Eric Sanders-Buell, Robert Paris, Merlin L. Robb, Deborah L. Birx, Mark S. De Souza, Francine E. McCutchan, Nelson L. Michael, and Jerome H. Kim
J. Virol. July 2013 87:7265-7281; published ahead of print 10 April 2013 , doi:10.1128/JVI.03070-12
http://jvi.asm.org/content/87/13/7265.abstract
Open Access
ABSTRACT
The RV144 HIV-1 vaccine trial (Thailand, 2003 to 2009), using immunogens genetically matched to the regional epidemic, demonstrated the first evidence of efficacy for an HIV-1 vaccine. Here we studied the molecular evolution of the HIV-1 epidemic from the time of immunogen selection to the execution of the efficacy trial. We studied HIV-1 genetic diversity among 390 volunteers who were deferred from enrollment in RV144 due to preexisting HIV-1 infection using a multiregion hybridization assay, full-genome sequencing, and phylogenetic analyses. The subtype distribution was 91.7% CRF01_AE, 3.5% subtype B, 4.3% B/CRF01_AE recombinants, and 0.5% dual infections. CRF01_AE strains were 31% more diverse than the ones from the 1990s Thai epidemic. Sixty-nine percent of subtype B strains clustered with the cosmopolitan Western B strains. Ninety-three percent of B/CRF01_AE recombinants were unique; recombination breakpoint analysis showed that these strains were highly embedded within the larger network that integrates recombinants from East/Southeast Asia. Compared to Thai sequences from the early 1990s, the distance to the RV144 immunogens increased 52% to 68% for CRF01_AE Env immunogens and 12% to 29% for subtype B immunogens. Forty-three percent to 48% of CRF01_AE sequences differed from the sequence of the vaccine insert in Env variable region 2 positions 169 and 181, which were implicated in vaccine sieve effects in RV144. In conclusion, compared to the molecular picture at the early stages of vaccine development, our results show an overall increase in the genetic complexity of viruses in the Thai epidemic and in the distance to vaccine immunogens, which should be considered at the time of the analysis of the trial results.

Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening

The Lancet  
Jun 15, 2013  Volume 381  Number 9883  p2055 – 2134
http://www.thelancet.com/journals/lancet/issue/current

Health Policy
Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening
Dina Balabanova, Anne Mills, Lesong Conteh, Baktygul Akkazieva, Hailom Banteyerga, Umakant Dash, Lucy Gilson, Andrew Harmer, Ainura Ibraimova, Ziaul Islam, Aklilu Kidanu, Tracey P Koehlmoos, Supon Limwattananon, VR Muraleedharan, Gulgun Murzalieva, Benjamin Palafox, Warisa Panichkriangkrai, Walaiporn Patcharanarumol, Loveday Penn-Kekana, Timothy Powell-Jackson, Viroj Tangcharoensathien, Martin McKee
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2962000-5/abstract

Summary
In 1985, the Rockefeller Foundation published Good health at low cost to discuss why some countries or regions achieve better health and social outcomes than do others at a similar level of income and to show the role of political will and socially progressive policies. 25 years on, the Good Health at Low Cost project revisited these places but looked anew at Bangladesh, Ethiopia, Kyrgyzstan, Thailand, and the Indian state of Tamil Nadu, which have all either achieved substantial improvements in health or access to services or implemented innovative health policies relative to their neighbours. A series of comparative case studies (2009—11) looked at how and why each region accomplished these changes. Attributes of success included good governance and political commitment, effective bureaucracies that preserve institutional memory and can learn from experience, and the ability to innovate and adapt to resource limitations. Furthermore, the capacity to respond to population needs and build resilience into health systems in the face of political unrest, economic crises, and natural disasters was important. Transport infrastructure, female empowerment, and education also played a part. Health systems are complex and no simple recipe exists for success. Yet in the countries and regions studied, progress has been assisted by institutional stability, with continuity of reforms despite political and economic turmoil, learning lessons from experience, seizing windows of opportunity, and ensuring sensitivity to context. These experiences show that improvements in health can still be achieved in countries with relatively few resources, though strategic investment is necessary to address new challenges such as complex chronic diseases and growing population expectations.

Clinical Findings in 111 Cases of Influenza A (H7N9) Virus Infectio

New England Journal of Medicine
June 13, 2013  Vol. 368 No. 24
http://www.nejm.org/toc/nejm/medical-journal

Original Article
Clinical Findings in 111 Cases of Influenza A (H7N9) Virus Infection
Hai-Nv Gao, M.D., Hong-Zhou Lu, M.D., Ph.D., Bin Cao, M.D., Bin Du, M.D., Hong Shang, M.D., Jian-He Gan, M.D., Shui-Hua Lu, M.D., Yi-Da Yang, M.D., Qiang Fang, M.D., Yin-Zhong Shen, M.D., Xiu-Ming Xi, M.D., Qin Gu, M.D., Xian-Mei Zhou, M.D., Hong-Ping Qu, M.D., Zheng Yan, M.D., Fang-Ming Li, M.D., Wei Zhao, M.D., Zhan-Cheng Gao, M.D., Guang-Fa Wang, M.D., Ling-Xiang Ruan, M.D., Wei-Hong Wang, M.D., Jun Ye, M.D., Hui-Fang Cao, M.D., Xing-Wang Li, M.D., Wen-Hong Zhang, M.D., Xu-Chen Fang, M.D., Jian He, M.D., Wei-Feng Liang, M.D., Juan Xie, M.D., Mei Zeng, M.D., Xian-Zheng Wu, M.D., Jun Li, M.D., Qi Xia, M.D., Zhao-Chen Jin, M.D., Qi Chen, M.D., Chao Tang, M.D., Zhi-Yong Zhang, M.D., Bao-Min Hou, M.D., Zhi-Xian Feng, M.D., Ji-Fang Sheng, M.D., Nan-Shan Zhong, M.D., and Lan-Juan Li, M.D.
N Engl J Med 2013; 368:2277-2285June 13, 2013DOI: 10.1056/NEJMoa1305584
http://www.nejm.org/doi/full/10.1056/NEJMoa1305584

Abstract
Background
During the spring of 2013, a novel avian-origin influenza A (H7N9) virus emerged and spread among humans in China. Data were lacking on the clinical characteristics of the infections caused by this virus.
Full Text of Background…

Methods
Using medical charts, we collected data on 111 patients with laboratory-confirmed avian-origin influenza A (H7N9) infection through May 10, 2013.
Full Text of Methods…

Results
Of the 111 patients we studied, 76.6% were admitted to an intensive care unit (ICU), and 27.0% died. The median age was 61 years, and 42.3% were 65 years of age or older; 31.5% were female. A total of 61.3% of the patients had at least one underlying medical condition. Fever and cough were the most common presenting symptoms. On admission, 108 patients (97.3%) had findings consistent with pneumonia. Bilateral ground-glass opacities and consolidation were the typical radiologic findings. Lymphocytopenia was observed in 88.3% of patients, and thrombocytopenia in 73.0%. Treatment with antiviral drugs was initiated in 108 patients (97.3%) at a median of 7 days after the onset of illness. The median times from the onset of illness and from the initiation of antiviral therapy to a negative viral test result on real-time reverse-transcriptase–polymerase-chain-reaction assay were 11 days (interquartile range, 9 to 16) and 6 days (interquartile range, 4 to 7), respectively. Multivariate analysis revealed that the presence of a coexisting medical condition was the only independent risk factor for the acute respiratory distress syndrome (ARDS) (odds ratio, 3.42; 95% confidence interval, 1.21 to 9.70; P=0.02).
Full Text of Results…

Conclusions
During the evaluation period, the novel H7N9 virus caused severe illness, including pneumonia and ARDS, with high rates of ICU admission and death. (Funded by the National Natural Science Foundation of China and others.)

Predicting U.S. Tuberculosis Case Counts through 2020

PLoS One
[Accessed 15 June 2013]
http://www.plosone.org/

Predicting U.S. Tuberculosis Case Counts through 2020
Rachel S. Y e l k Woodruff, Carla A. Winston, Roque Miramontes
Research Article | published 13 Jun 2013 | PLOS ONE 10.1371/journal.pone.0065276
Abstract
In 2010, foreign-born persons accounted for 60% of all tuberculosis (TB) cases in the United States. Understanding which national groups make up the highest proportion of TB cases will assist TB control programs in concentrating limited resources where they can provide the greatest impact on preventing transmission of TB disease. The objective of our study was to predict through 2020 the numbers of U.S. TB cases among U.S.-born, foreign-born and foreign-born persons from selected countries of birth. TB case counts reported through the National Tuberculosis Surveillance System from 2000–2010 were log-transformed, and linear regression was performed to calculate predicted annual case counts and 95% prediction intervals for 2011–2020. Data were analyzed in 2011 before 2011 case counts were known. Decreases were predicted between 2010 observed and 2020 predicted counts for total TB cases (11,182 to 8,117 [95% prediction interval 7,262–9,073]) as well as TB cases among foreign-born persons from Mexico (1,541 to 1,420 [1,066–1,892]), the Philippines (740 to 724 [569–922]), India (578 to 553 [455–672]), Vietnam (532 to 429 [367–502]) and China (364 to 328 [249–433]). TB cases among persons who are U.S.-born and foreign-born were predicted to decline 47% (4,393 to 2,338 [2,113–2,586]) and 6% (6,720 to 6,343 [5,382–7,476]), respectively. Assuming rates of declines observed from 2000–2010 continue until 2020, a widening gap between the numbers of U.S.-born and foreign-born TB cases was predicted. TB case count predictions will help TB control programs identify needs for cultural competency, such as languages and interpreters needed for translating materials or engaging in appropriate community outreach.

Developing Countries Vaccine Manufacturers Network (DCVMN): Engaging to step up for vaccine discovery and access. Meeting Report 2012

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 31, Issue 31, Pages 3111-3206 (28 June 2013)

Developing Countries Vaccine Manufacturers Network (DCVMN): Engaging to step up for vaccine discovery and access. Meeting Report 2012
Pages 3111-3115
Sonia Pagliusi, Morena Makhoana, Mahima Datla, Luciana Leite, Jan Hendriks, Alireza Gholami, Weidan Huang, Yongzhong Gao, Suresh Jadhav, Gutla V.J.A. Harshavardhan, Yonglin Wu, Mahendra Suhardono, Akira Homma
Abstract
At the annual general meeting of the Developing Countries Vaccine Manufacturers Network (DCVMN) members renewed their engagement and cooperative spirit in pursuing the mission of increasing the quality and availability of affordable vaccines for all people.

Thirteen years after its establishment, DCVMN moves into the Decade of Vaccines with renewed dynamism and synergy to create greater impact and shape the global and regional vaccination landscape, while supporting national growth. The DCVMN is growing: 12 new members joined in 2012, making a total of 37 members from 14 countries; 9 of these 37 manufacturers make WHO-prequalified vaccines.

More than one hundred and forty delegates from 23 countries attended the annual general meeting, representing 24 vaccine manufacturers and leaders of 20 major global health institutions. Over the course of two days, delegates exchanged information and ideas on how to jointly achieve the common goal of protecting people against known and emerging infectious diseases.

In an increasingly complex environment of new technologies, demanding regulatory requirements, higher cost of production, and a growing number of legal and intellectual property issues, it is observed that many manufacturers and stakeholders are engaged in technology transfer initiatives.

This well-attended meeting highlighted the growing impact and important contributions of developing country vaccine manufacturers in shaping the global vaccine landscape. The successful introduction of the first ever vaccine against hepatitis E and of a new vaccine against meningitis A, tailored for African meningitis belt countries, illustrate the innovative capacity of DCVMN members. An increase in the variety of collaborations, partnerships and alliances between DCVM and various institutions was observed. Interestingly, bilateral technology transfer partnerships between DCVMs themselves are on the rise.

Correlates of HPV vaccination among adolescent females from Appalachia and reasons why their parents do not intend to vaccinate

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 31, Issue 31, Pages 3111-3206 (28 June 2013)

Correlates of HPV vaccination among adolescent females from Appalachia and reasons why their parents do not intend to vaccinate
Pages 3121-3125
Paul L. Reiter, Mira L. Katz, Electra D. Paskett
Abstract
Limited research has examined HPV vaccination in Appalachia, a region with cervical cancer disparities. We analyzed 2008–2010 National Immunization Survey-Teen data for adolescent females ages 13–17 from Appalachia (n = 1951) to identify correlates of HPV vaccination and reasons why their parents do not intend to vaccinate. HPV vaccine initiation was 40.8%, completion was 27.7%, and follow-through was 67.8%. Vaccination outcomes tended to be higher among females who were older, had visited their healthcare provider in the last year, or whose parents reported receiving a provider recommendation to vaccinate. Only 41.0% of parents with unvaccinated daughters intended to vaccinate in the next year. The most common reasons for not intending to vaccinate were believing vaccination is not needed or not necessary (21.5%) and lack of knowledge (18.5%). Efforts to reduce missed opportunities for vaccination at healthcare visits and address reasons why parents are not vaccinating may help increase HPV vaccination in Appalachia.

Prospective cost–benefit analysis of a two-dimensional barcode for vaccine production, clinical documentation, and public health reporting and tracking

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 31, Issue 31, Pages 3111-3206 (28 June 2013)

Prospective cost–benefit analysis of a two-dimensional barcode for vaccine production, clinical documentation, and public health reporting and tracking
Original Research Article
Pages 3179-3186
Alan . O’Connor, Erin D. Kennedy, Ross J. Loomis, Saira N. Haque, Christine M. Layton, Warren W. Williams, Jacqueline B. Amoozegar, Fern M. Braun, Amanda A. Honeycutt, Cindy Weinbaum

Abstract
In the United States recording accurate vaccine lot numbers in immunization records is required by the National Childhood Vaccine Injury Act and is necessary for public health surveillance and implementation of vaccine product recalls. However, this information is often missing or inaccurate in records. The Food and Drug Administration (FDA) requires a linear barcode of the National Drug Code (NDC) on vaccine product labels as a medication verification measure, but lot number and expiration date must still be recorded by hand. Beginning in 2011, FDA permitted manufacturers to replace linear barcodes with two-dimensional (2D) barcodes on unit-of-use product labels. A 2D barcode can contain the NDC, expiration date, and lot number in a symbol small enough to fit on a unit-of-use label. All three data elements could be scanned into a patient record. To assess 2D barcodes’ potential impacts, a mixed-methods approach of time–motion data analysis, interview and survey data collection, and cost–benefit analysis was employed. Analysis of a time–motion study conducted at 33 practices suggests scanning 2D-barcoded vaccines could reduce immunization documentation time by 36–39 s per dose. Data from an internet survey of primary care providers and local health officials indicate that 60% of pediatric practices, 54% of family medicine practices, and 39% of health departments would use the 2D barcode, with more indicating they would do so if they used electronic health records. Inclusive of manufacturer and immunization provider costs and benefits, we forecast lower-bound net benefits to be $310–334 million between 2011 and 2023 with a benefit-to-cost ratio of 3.1:1–3.2:1. Although we were unable to monetize benefits for expected improved immunization coverage, surveillance, or reduced medication errors, based on our findings, we expect that using 2D barcodes will lower vaccine documentation costs, facilitate data capture, and enhance immunization data quality.

Parental and societal support for adolescent immunization through school based immunization programs

Vaccine
Volume 31, Issue 30, Pages 3035-3110 (26 June 2013)
http://www.sciencedirect.com/science/journal/0264410X/31/30

Parental and societal support for adolescent immunization through school based immunization programs
Original Research Article
Pages 3059-3064
Helen S. Marshall, Joanne Collins, Thomas Sullivan, Rebecca Tooher, Maree O’Keefe, S. Rachel Skinner, Maureen Watson, Teresa Burgess, Heather Ashmeade, Annette Braunack-Mayer
Abstract
Objectives
Adolescent immunizations such as human papillomavirus vaccine have been implemented through school based immunization programs (SBIPs) in Australia. We assessed community attitudes toward immunization of adolescents though SBIPs.

Methods
A cross-sectional population survey of rural and metropolitan households in South Australia in 2011. Univariate and multiple regression analyses identified predictors of support for a SBIP.

Results
Participation rate was 57.3% with 1926 adults interviewed. Overall, 75.9% regarded school as the best place to offer adolescent immunizations, with 16.4% preferring the family physician. Parents of high school students were most supportive (88.4%) of a SBIP with 87.9% of their adolescents reported as having participated in the program. Adults 18–34 years (79.4%) were more likely to support a SBIP compared to older adults (68.7% of >55 years) [adjusted OR = 2.39, p = 0.002] and men were more supportive (80.3%) than women (71.7%) [adjusted OR = 1.54, p = 0.003]. Reasons for participation in the SBIP included convenience (39.9%), public funding for the service (32.4%), and confidence in immunization recommendations (21.0%).

Conclusions
Public support for the SBIP was very high particularly amongst parents whose adolescent/s had participated in the program

Influences on parental acceptance of HPV vaccination in demonstration projects in Uganda and Vietnam

Vaccine
Volume 31, Issue 30, Pages 3035-3110 (26 June 2013)
http://www.sciencedirect.com/science/journal/0264410X/31/30

Influences on parental acceptance of HPV vaccination in demonstration projects in Uganda and Vietnam
Original Research Article
Pages 3072-3078
Sean R. Galagan, Proma Paul, Lysander Menezes, D. Scott LaMontagne
Abstract
This study investigates the effect of communication strategies on human papillomavirus (HPV) vaccine uptake in HPV vaccine demonstration projects in Uganda and Vietnam. Secondary analysis was conducted on data from surveys of a representative sample of parents and guardians of girls eligible for HPV vaccine, measuring three-dose coverage achieved in demonstration projects in 2008–2010. Univariate and multivariate logistic regression analysis calculated the unadjusted and adjusted odds of receiving at least one dose of HPV vaccine depending on exposure to community influencers; information, education, and communication (IEC) channels; and demographic factors. This study found that exposure to community influencers was associated with HPV vaccine uptake in a multivariate model controlling for other factors. Exposure to non-interactive IEC channels was only marginally associated with HPV vaccine uptake. These results underscore the need of HPV vaccine programs in low- and middle-income countries to involve and utilize key community influencers and stakeholders to maximize HPV vaccine uptake.

Factors associated with human papillomavirus vaccination among young adult women in the United States

Vaccine
Volume 31, Issue 28, Pages 2911-2972 (19 June 2013)
http://www.sciencedirect.com/science/journal/0264410X/31/28
Factors associated with human papillomavirus vaccination among young adult women in the United States

Original Research Article
Pages 2937-2946
Walter W. Williams, Peng-Jun Lu, Mona Saraiya, David Yankey, Christina Dorell, Juan L. Rodriguez, Deanna Kepka, Lauri E. Markowitz
Abstract
Background
Human papillomavirus (HPV) vaccination is recommended to protect against HPV-related diseases.

Objective
To estimate HPV vaccine coverage and assess factors associated with vaccine awareness, initiation and receipt of 3 doses among women age 18–30 years.

Methods
Data from the 2010 National Health Interview Survey were analyzed to assess associations of HPV vaccination among women age 18–26 (n = 1866) and 27–30 years (n = 1028) with previous HPV exposure, cervical cancer screening and selected demographic, health care and behavioral characteristics using bivariate analysis and multivariable logistic regression.

Results
Overall, 23.2% of women age 18–26 and 6.7% of women age 27–30 years reported receiving at least 1 dose of HPV vaccine. In multivariable analyses among women age 18–26 years, not being married, having a regular physician, seeing a physician or obstetrician/gynecologist in the past year, influenza vaccination in the past year, and receipt of other recommended vaccines were associated with HPV vaccination. One-third of unvaccinated women age 18–26 years (n = 490) were interested in receiving HPV vaccine. Among women who were not interested in receiving HPV vaccine (n = 920), the main reasons reported included: not needing the vaccine (41.3%); concerns about safety of the vaccine (12.5%); not knowing enough about the vaccine (11.9%); not being sexually active (8.2%); a doctor not recommending the vaccine (7.6%); and already having HPV (2.7%). Among women with health insurance, 10 or more physician contacts within the past year and no contraindications, 74.5% reported not receiving HPV vaccine.

Conclusions
HPV vaccination coverage among women age 18–26 years remains low. Opportunities to vaccinate are missed. Healthcare providers can play an important role in educating young women about HPV and encouraging vaccination. Successful public health and educational interventions will need to address physician attitudes and practice patterns and other factors that influence vaccination behaviors.

From Google Scholar & other sources to 15 June 2013

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

Timeliness and completeness of vaccination and risk factors for low and late vaccine uptake in young children living in rural southern Tanzania
OLP de Waroux, JRA Schellenberg, F Manzi, M Mrisho… – International Health, 2013
Background We studied coverage and timeliness of vaccination and risk factors for low and delayed vaccine uptake in children aged< 2 years in rural Tanzania. Methods We used data
from a cluster survey conducted in 2004, which included 1403 children. Risk factors were …

Promoting public health
J Martin, R Director, RCNS West, L Benison, L Elsden… – Practice Nursing, 2013
… But perhaps no professional is more important in the process of conveying vaccine information to parents than the practice nurse. in a brief consultation, usually with
mum and a wriggling infant or two, a practice nurse can help …

Long-term effect of the influenza A/H1N1 pandemic: attitudes and preventive behaviours one year after the pandemic
X Garcia-Continente, G Serral, MJ López, A Pérez… – The European Journal of …, 2013
… The questionnaire also gathered questions about attitudes towards health care services consultation and perceptions about the influenza A/H1N1 vaccine. … Otherwise, perceptions on
the safety and efficacy of the vaccine against influenza A/H1N1 markedly increased. …

Preventing the spread of measles
H Ringwood – Practice Nursing, 2013
… the number of recorded cases of measles in 2013 has reached 1225 (Public Health Wales, 2013a). Public Health Wales has also announced the results of a preliminary analysis of
the effectiveness of measles, mumps and rubella vaccine (mmR). …

The Pandemic and All-Hazards Preparedness Act: Its Contributions and New Potential to Increase Public Health Preparedness
R Morhard, C Franco – … and Bioterrorism: Biodefense Strategy, Practice, and …, 2013
… After working closely with manufactur- ers to prepare a virus strain for vaccine production, perform necessary clinical trials, and license multiple vaccines, HHS began a voluntary national
vaccination program. … Title IV. Pandemic and Biodefense Vaccine and Drug Development …

… Papillomavirus Vaccination Intentions: Comparative Utility of the Theory of Reasoned Action and the Theory of Planned Behavior in Vaccine Target Age Women and …
WA Fisher, T Kohut, C Salisbury, MI Salvadori – The Journal of Sexual Medicine, 2013
Aims This research applies two major theories of health behavior uptake, the Theory of Reasoned Action and the Theory of Planned Behavior, in an effort to understand intentions
to receive HPV vaccine among vaccine target age women and men. The Theory of …

 

How Will We End Preventable Child Deaths By 2035?

Forbes
http://www.forbes.com/
Accessed 15 June 2013

How Will We End Preventable Child Deaths By 2035?
11 June 2013
By Ariel Pablos-Méndez, Assistant Administrator for Global Health at USAID
http://www.forbes.com/sites/skollworldforum/2013/06/10/how-will-we-end-preventable-child-deaths-by-2035/
Excerpt
“…Nearly 30 years ago, USAID and UNICEF, with the support of the U.S. Congress, launched a “child survival revolution” aimed at reducing the number of deaths among young children in developing countries.  At the time, an estimated 15 million children under age 5 in the developing world died from common preventable diseases each year.  If the world had done nothing, that number today would be about 17 million each year. Instead, it was 6.9 million in 2011.  This progress gives us great hope for success in the future…”

Pakistani Villagers Vow ‘No Electricity, No Polio Vaccinations’

Radio Free Europe
10 June 2013

Pakistani Villagers Vow ‘No Electricity, No Polio Vaccinations’
http://www.rferl.org/content/polio-eradication-pakistan-electricity-politics/25012852.html
Excerpt
By Sailab Mahsud and  Antoine Blua
June 10, 2013
Tribal elders in a a northwestern Pakistani region are taking extreme measures in an effort to bring electricity to their area, saying that as long as they have no electricity they won’t vaccinate their children against polio.
Several hundred residents from villages in Lakki Marwat district staged a protest demonstration on June 10 and turned away polio-eradication teams.
Village elder Zaitullah Betanai told RFE/RL’s Radio Mashaal that polio teams will not be allowed to go about their work until the central government accepts the villagers’ demands.
“There is an electricity supply line but no electricity, and there is no electricity transformer in the area,” Zaitullah said. “We have no mosquito kits and no spray against mosquitoes is arranged so far. Also, there is no ambulance in the area. We want the government to address the four demands immediately.”…

Vaccines: The Week in Review 8 June 2013

Editor’s Notes:

Vaccines: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated “8 June 2013”

Email Summary: Vaccines: The Week in Review is published as a single email summary, scheduled for release each Saturday eveningbefore midnight (EDT in the U.S.). If you would like to receive the email version, 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_8 June 2013

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.

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Ban appeals to philanthropists to help fight five deadly diseases, curb cholera in Haiti

UN Watch to 8 June 2013
Selected meetings, press releases, and press conferences relevant to immunization, vaccines, infectious diseases, global health, etc. http://www.un.org/en/unpress/

Speech: Ban appeals to philanthropists to help fight five deadly diseases, curb cholera in Haiti
UN News Centre
5 June 2013
Excerpt
Secretary-General ban Ki-moon today appealed to philanthropists to “make a smart investment in the world’s future” by joining the United Nations in accelerating the fight against five of the most deadly infectious diseases which kill millions of people every year.

“Today we have the power and the knowledge to wipe out deaths from five of the world’s biggest health threats: malaria, polio, tetanus, measles and HIV infections in newborns,” Mr. Ban told the Second Annual Forbes 400 Summit, which took place at UN Headquarters in New York.

“We can do this not just in our lifetimes, but in just five years,” he declared.

While there has been progress on many of these diseases, most notably polio, malaria and HIV infections, Mr. Ban stressed that increased engagement from the private sector and the philanthropic community is needed to keep the world on track to a prosperous path.

“Supporting these challenges is a smart investment in the world’s future well-being,” Mr. Ban said, noting how every dollar spent in fighting malaria in Africa generates $40 in gross domestic product, strengthening national economies…

…Tetanus and measles do not get as much international attention, Mr. Ban noted, adding that they too have the same potential for significant results.

“Tetanus is often contracted by mothers and babies during unhygienic deliveries. The fatality rate can be 100 per cent. But a vaccine and other simple measures can eliminate the threat,” Mr. Ban said. “Measles deaths have been cut by more than 70 per cent since 2000. But this disease is still a leading killer of children.

“I ask all of you here to help us finish the job. Five diseases. Five years. We can do it.”

Mr. Ban also drew attention to the elimination of cholera in Haiti, where the disease has claimed the lives of more than 7,750 people and infected over 620,000 since the outbreak in 2010.

“The United Nations is striving to do everything it can to eliminate cholera from Haiti. But to support the Government, we need to fill a severe funding gap,” Mr. Ban said.

In the long-term, the country’s health system needs to be strengthened and clean drinking water and sanitation must be available to all citizens. However, Mr. Ban noted that in the oral cholera vaccine is a need that needs to be addressed immediately.

“What Haiti needs is a partner ready to provide $1 million a year for the next three to five years to underwrite free vaccines for the poor and vulnerable people who need them most,” he said. “The United Nations will do its part to raise resources and strengthen the cholera response, but we also need partners who can make a difference for the people of Haiti.”

Mr. Ban underlined the UN’s support to translate philanthropic initiatives to the ground and establish partnerships to “save millions of lives and set the world on course for a better future.”

http://www.un.org/apps/news/story.asp?NewsID=45089&Cr=mdg&Cr1=#.UbPDoJwXaul

IMB May 2013 – Success against polio by end-2014 realistic prospect; Key fundamental changes needed

Meeting Report: IMB May 2013 – Success against polio by end-2014 realistic prospect; Key fundamental changes needed
Excerpt
June 05, 2013
The Independent Monitoring Board (IMB) for polio eradication has underscored that ‘stopping polio transmission by end 2014 is a realistic prospect’. In the report of its 7-9 May meeting, the Board commended the programme on the fundamental changes that have transformed the effort into a more responsive and coordinated health initiative, which has brought polio to the lowest levels ever.

At the same time, however, the IMB put forward key recommendations to address fundamental changes that are still needed. In the words of the IMB: “Whilst the poliovirus has been knocked down, it is certainly not knocked out… In the midst of so many strengths, why focus on the weaknesses? Because the poliovirus will seize on them. Impressive as recent progress has been, the IMB is firmly of the view that the task of stopping transmission in the remaining endemic areas is enormous and should not be under-estimated.”

The IMB highlighted three programme areas in particular that needed to be addressed:
1. Communications & social mobilization: across the entire Global Polio Eradication Initiative (GPEI), a fundamental change is essential to ensure that parental and community concerns about vaccine safety and efficacy can be adequately addressed, and to generate genuine demand for polio vaccinations.
2. Inactivated polio vaccine (IPV) in endemic countries: a final decision is urgently required (by end-2013) whether to introduce IPV in the remaining endemic countries prior to the universal introduction of IPV as outlined in the new Polio Eradication and Endgame Strategic Plan 2013-2018.
3. Responsive and coordinated global management: a more focused approach is needed at the global level to ensure that countries receive the most optimal support possible.

The IMB put forward key recommendations to the remaining endemic countries, as well as to urgently address the outbreak currently affecting the Horn of Africa. On financing, the IMB commended the pledges made at the recent Global Vaccine Summit, however cautioned that the remaining US$1.5 billion for the life of the new Endgame Plan needed to be found, and that pledged funds must quickly reach the frontline: “There is no room for complacency on these crucial financial matters.”

In response to the IMB’s report, the GPEI partners are undertaking a number of inter-agency and cross-regional consultations to discuss the recommendations and their appropriate integration into polio eradication plans.
The IMB started its report with a tribute to those who have given their lives in the name of polio eradication, in particular those tragically killed in Pakistan and northern Nigeria. “Their loss is deeply felt by the whole public health world. Their lives and service to public health will be honoured if the goal of eradication is achieved quickly and decisively.”

http://www.polioeradication.org/tabid/488/iid/306/Default.aspx
IMB Report – May 2013: http://www.polioeradication.org/Portals/0/Document/Aboutus/Governance/IMB/8IMBMeeting/8IMB_Report_EN.pdf [download problem at 21h09 – 8 June 2013]

GPEI Update: Polio this week – As of 5 June 2013

Update: Polio this week – As of 5 June 2013
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]

. The Independent Monitoring Board (IMB) meeting report… [see next post]

. Wild poliovirus type 1 (WPV1) was isolated from environmental sampling from Israel [see WHO GAR below]

. Outbreak response in the Horn of Africa is continuing, following detection of WPV cases in Somalia and Kenya. Two large-scale campaigns have already been implemented in Somalia, with overall good coverage and community participation reported. See ‘Horn of Africa’ section for more.

Pakistan
. One new WPV case was reported in the past week (WPV1 from Khyber Agency, Federally Administered Tribal Areas – FATA), bringing the total number of WPV cases for 2013 to ten. It is the most recent WPV case in the country and had onset of paralysis on 10 May.
. One new positive environmental sample (WPV1) has been confirmed, from Peshawar, Khyber Pakhtunkhwa (KP). This year, 18 environmental samples positive for WPV1 have been reported (of which 12 were collected in Peshawar, FATA and Hyderabad, Sindh).

Horn of Africa
. Three new WPV cases were reported in the past week (all from Banadir, Somalia), bringing the total number of WPV1 cases in the region to nine (two WPV1s from Kenya and seven WPV1s from Somalia). The most recent WPV1 case in the region had onset of paralysis on 14 May (WPV1 from Kenya).
. Outbreak response activities are continuing across the Horn of Africa.
. In Somalia, the second large-scale immunization campaign was conducted last week, including in Banadir (which includes Mogadishu), including targeting children aged less than ten years. Overall, high-quality coverage was reported with strong community participation. Two-large scale campaigns have now been implemented in Somalia.
. Lessons from these campaigns are now being addressed in preparation of the next rounds on 12 June. Focus is on fine-tuning microplans to include schools, more clearly define vaccinator team daily workloads, improving supervision and expanding the scope and content of monitoring activities.
. In Kenya, immunization activities began on 26 May to reach nearly 440,000 children aged less than 15 years across Dadaab. Preparations are already ongoing for the next SNIDs, including parts of Nairobi, on 15 June.
. Immunization campaigns are also planned and being conducted in other areas of the Horn of Africa, notably Ethiopia and Yemen, to urgently boost population immunity levels and minimize the risk of spread of the outbreak. In Ethiopia, in border areas with Kenya and Somalia, an immunization activity was held on 31 May (targeting children aged less than 15 years). Focus was particularly on reaching children in refugee camps. Broader activities are planned for late June. In Yemen, activities were held this week (2-5 June) to reach 2.1 million children, with a second round planned for late June to reach 3.5 million children.
. A full Horn of Africa outbreak response plan for the end of 2013 and the first half of 2014 is being finalized.

WHO Europe: Polio commission calls on Europe to improve surveillance and reporting

WHO Europe: Polio commission calls on Europe to improve surveillance and reporting
06-06-2013
On the basis of evidence provided by the Member States in the WHO European Region, summarizing their efforts for poliomyelitis (polio) surveillance, monitoring and immunization, the European Regional Commission for the Certification of Poliomyelitis Eradication (RCC) reaffirmed the Region’s polio-free status at its 27th annual meeting in Copenhagen, Denmark on 30–31 May 2013.

Nevertheless, the RCC called for significantly greater engagement in the Region to maintain polio-fee status until global eradication is achieved. Professor David Salisbury of the United Kingdom, RCC chair, expressed its concern that national programmes are “not sustaining the level of quality needed”…

http://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/news/news/2013/06/polio-commission-calls-on-europe-to-improve-surveillance-and-reporting

Media Report: Islamic Scholars Declare ‘Those attacking polio workers are infidels’

[Editor’s Note: We are generally conservative in the range of general media sources we include in this digest, even where the news and opinion is generally relevant to our interests in vaccine ethics and policy. We judged that this report from dawn.com of Pakistan was important enough in its content to include.]

‘Those attacking polio workers are infidels’
Ikram Junaidi
dawn.com
June 6, ISLAMABAD,: Religious scholars from Pakistan and abroad here on Thursday declared that anybody attacking health workers assigned the job to administer polio vaccine to children will be considered as an infidel.

Moreover, they also said polio vaccine being used in Pakistan was Halal, dispelling the impression as if the medicine was made of some material banned in Islam. Hitting out at drone attacks in the tribal areas, the scholars argued that it was because of these attacks Taliban had banned administration of polio drops to 261,000 children in the area.

The unanimous declaration was announced by the scholars belonging to Pakistan, Egypt, Saudi Arabia and Yemen during the closing ceremony of a two-day conference on ‘Polio eradication in the light of Islam’ hosted by the International Islamic University Islamabad (IIUI) in collaboration with the Al-Azhar University of Egypt. The conference was a follow-up to the March 5-6, 2013, Ulema Conference held in Cairo under the aegis of the Al-Azhar University.

Senior scholars Dar Al Ifta Al Missriya, Dr Mohammad Wesam, secretary general Council of Health Services Dr Yagoub Al Mazrou, director of Fatwa Department at the International Islamic Fiqh Academy, Jeddah, Dr Abdulqahir Mohammed Qamar and others participated from abroad.

The head of Jamiah Darul Uloom Haqqaniah, Nowshera, Senator Maulana Samiul Haq, Chairman Pakistan Ulema Council, Lahore, Maulana Tahir Ashrafi, President Darul Uloom, Korangi, Karachi, Maulana Rafi Usmani and others represented Pakistan.

The participants lashed out at Dr Shakeel Afridi who was allegedly funded by the CIA for using a polio eradication campaign to trace Osama Bin Laden. They were of the view that Dr Afridi had not only betrayed his country but also put the polio eradication campaign at risk.    They suggested that the health department should not be used for spying anywhere in the world. The scholars also recommended that Dr Afridi should be punished strictly.

Declaration
The participants of the conference showed concerns over hurdles being created by some elements against the polio eradication campaign. They also condemned the killing of polio workers and suggested that compensation should be paid to the families of the victims. It was demanded that the government of Pakistan should ensure peace in the tribal areas.

The scholars said they had reached the conclusion that the vaccine being used in Pakistan was Halal and it did not damage the reproductive system of the male or female child.

They suggested that polio vaccine should be given to children during each campaign. The participants vowed to play their role in removing the cultural and political hurdles in the way of the polio campaign.

It is pertinent to mention that while Pakistan was trying to eliminate the crippling disease, some elements started attacking polio workers all over the country in 2012 and killed 14 of them along with two policemen in different parts of the country.

Maulana Samiul Haq declared that drone attacks were a major hurdle in the way of the polio eradication campaign. He suggested that drone attacks should be stopped by using all possible resources.

“People of Pakistan, especially in the KP and tribal areas, assume that there must be some hidden interest of the West in the polio campaign because it is killing us through the drones and by giving us the vaccine on the pretext of eradicating polio,” he said.

The scholars, however, vowed to achieve a polio-free Islamic world by the end of 2014. They said it was the religious obligation of parents to ensure immunisation of their children.

However, the Saudi Fatwa department director, Dr Abdulqahir Mohammad Qamar, said his country may impose travel restrictions on Pakistanis if Islamabad failed to check transmition of polio virus to Saudi Arabia.

http://beta.dawn.com/news/1016644/those-attacking-polio-workers-are-infidels

WHO: Global Alert and Response (GAR) [to 8 June]

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

Middle East respiratory syndrome coronavirus (MERS-CoV) – update 7 June 2013
7 June 2013 – The Ministry of Health in Saudi Arabia has notified WHO of an additional laboratory-confirmed case with Middle East respiratory syndrome coronavirus (MERS-CoV).

The patient is a 83-year-old man with underlying medical conditions, who became ill on 27 May 2013 and died on 31 May 2013. He is from Al-Ahsa, where an outbreak began in a health care facility since April 2013.

Globally, from September 2012 to date, WHO has been informed of a total of 55 laboratory-confirmed cases of infection with MERS-CoV, including 31 deaths…
.
Meningococcal disease: 2013 epidemic season in the African Meningitis Belt – update 6 June 2013
6 June 2013 – From 1 January to 12 May 2013 (epidemiologic week 19), 9 249 suspected cases of meningitis, including 857 deaths, with a case fatality ratio of 9.3 percent, have been reported from 18 of the 19 African countries under enhanced surveillance1 for meningitis. The number of cases reported so far are the lowest recorded during the epidemic season in the last ten years…

…The decrease in the number of cases of meningitis reported during the period under review is thought to be due to the progressive introduction of the newly developed Meningococcal A conjugate vaccine in countries of the African Meningitis Belt since 2010. The introduction of this first meningococcal vaccine available for preventive purposes in Africa has enabled the immunization of over 100 million people from 10 countries in the Meningitis Belt in the past three years (2010-2012). The reduced case load and epidemic activity observed this year, adds to the evidence on the impact of the introduction of this vaccine, which is expected to eliminate epidemics of Nm A, which is the predominant cause of the disease in Africa. Given that large-scale epidemics in the African Meningitis Belt appear to occur in waves of 4 to 10 years, close surveillance for meningitis remains essential…
.
Poliovirus detected from environmental samples in Israel – update 3 June 2013
3 June 2013 – In Israel, wild poliovirus type 1 (WPV1) was isolated from sewage samples collected on 9 April 2013 in Rahat, southern Israel. The virus has been detected in sewage only; no case of paralytic polio has been reported. Genetic sequencing and epidemiological investigations are ongoing to determine its origin. Preliminary analyses indicate the strain is not related to the virus currently affecting the Horn of Africa. The virus isolate was detected through routine environmental surveillance in Israel that involves regular testing of sewage water. Israel has been free of indigenous WPV transmission since 1988. In the past, wild poliovirus has been detected in environmental samples collected in this region between 1991 and 2002 without occurrence of cases of paralytic polio in the area…

WHO: Health priorities in the appeals for the crises in the Syrian Arab Republic and neighbouring countries

WHO – Humanitarian Health Action
http://www.who.int/hac/en/index.html

Health priorities in the appeals for the crises in the Syrian Arab Republic and neighbouring countries
The United Nations and its partners have dramatically increased their 2013 humanitarian appeal for the Syrian Arab Republic and neighbouring countries to approximately US$4.4 billion. Health requirements in this appeal amount to US$177 million for the Syrian Arab Republic, representing 12% of the total, and US$242 million for neighbouring countries, representing 19% of the total. The health aspects of the two appeals are restricted to priority life-saving health needs and medicines, and by no means aim to cover all that is needed for comprehensive health care. Within Syria, the health system has been severely disrupted. More than half of the country’s public hospitals have been affected by the conflict, with 20% damaged and 37% no longer functioning at all. Hospitals that continue to operate are heavily overburdened.

http://www.who.int/hac/en/index.html

WHO Feature: HPV vaccine in Argentina: a leap forward for girls’ and women’s health

WHO Feature: HPV vaccine in Argentina: a leap forward for girls’ and women’s health
5 June 2013 Argentina is one of the first countries in the Region of the Americas to provide the WHO-recommended human papillomavirus (HPV) vaccine to girls to prevent cervical cancer later in life. The Pan American Health Organization (PAHO), WHO’s Regional Office for the Americas, runs a Revolving Fund for the procurement of vaccines, syringes and related supplies for participating Member States. It ensures that immunization programmes have a continuous supply of high-quality products for a low price. Argentina acquires the HPV vaccines through the PAHO Revolving Fund.

More: http://www.who.int/immunization/en/

Meeting: The 8th Global Conference on Health Promotion 10–14 June 2013

Meeting: The 8th Global Conference on Health Promotion
Finlandia Hall, Helsinki, Finland
10–14 June 2013

This conference is co-hosted by WHO and the Ministry of Social Affairs and Health, Finland. The main theme of the conference is “Health in All Policies” (HiAP) and its focus is on implementation, the “how-to”. It is structured around six themes.

The conference aims to:

. facilitate the exchange of experiences and lessons learnt and give guidance on effective mechanisms for promoting intersectoral action;

. review approaches to address barriers and build capacity for implementing Health in All Policies;

. identify opportunities to implement the recommendations of the Commission on Social Determinants of Health through Health in All Policies;

. establish and review economic, developmental and social case for investing in HiAP;

. address the contribution of health promotion in the renewal and reform of primary health care; and

. review progress, impact and achievements of health promotion since the Ottawa Conference.

http://www.who.int/mediacentre/events/meetings/2013/health_promotion/en/index.html

Timeliness of Pediatric Influenza Vaccination Compared With Seasonal Influenza Activity in an Urban Community, 2004–2008

American Journal of Public Health
Volume 103, Issue 7 (July 2013)
http://ajph.aphapublications.org/toc/ajph/current

Timeliness of Pediatric Influenza Vaccination Compared With Seasonal Influenza Activity in an Urban Community, 2004–2008
Annika M. Hofstetter, MD, PhD, MPH, Karthik Natarajan, PhD, Daniel Rabinowitz, PhD, Raquel Andres Martinez, PhD, David Vawdrey, PhD, Stephen Arpadi, MD, MS, and Melissa S. Stockwell, MD, MPH
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301351

Abstract
Objectives. We assessed pediatric influenza vaccination in relation to community influenza activity.

Methods. We examined seasonal influenza vaccination in 34 012 children aged 6 months through 18 years from 5 academically affiliated clinics in northern Manhattan, New York (an urban low-income community) during the 2004–2008 seasons using hospital and city immunization registries. We calculated the cumulative number of administered influenza vaccine doses and proportion of children with any (≥ 1 dose) or full (1–2 doses per age recommendations) vaccination at the onset and peak of community polymerase chain reaction–confirmed influenza activity according to state surveillance reports and by March 31 each season.

Results. Influenza vaccine administration began before October 1, peaked before influenza activity onset, and declined gradually over each season. Coverage at influenza activity onset, peak, and by March 31 increased over the 5 seasons. However, most children lacked full vaccination at these time points, particularly adolescents, minorities, and those requiring 2 doses.

Conclusions. Despite early initiation of influenza vaccination, few children were fully vaccinated when influenza began circulating. Interventions should address factors negatively affecting timely influenza vaccination, especially in high-risk populations.

Community Health Workers in Low- and Middle-Income Countries: What Do We Know About Scaling Up and Sustainability?

American Journal of Public Health
Volume 103, Issue 7 (July 2013)
http://ajph.aphapublications.org/toc/ajph/current

Community Health Workers in Low- and Middle-Income Countries: What Do We Know About Scaling Up and Sustainability?
Sarah Wood Pallas, MPhil, Dilpreet Minhas, MPH, Rafael Pérez-Escamilla, PhD, Lauren Taylor, MPH, Leslie Curry, PhD, and Elizabeth H. Bradley, PhD
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301102

Abstract
Objectives. We sought to provide a systematic review of the determinants of success in scaling up and sustaining community health worker (CHW) programs in low- and middle-income countries (LMICs).

Methods. We searched 11 electronic databases for academic literature published through December 2010 (n = 603 articles). Two independent reviewers applied exclusion criteria to identify articles that provided empirical evidence about the scale-up or sustainability of CHW programs in LMICs, then extracted data from each article by using a standardized form. We analyzed the resulting data for determinants and themes through iterated categorization.

Results. The final sample of articles (n = 19) present data on CHW programs in 16 countries. We identified 23 enabling factors and 15 barriers to scale-up and sustainability, which were grouped into 3 thematic categories: program design and management, community fit, and integration with the broader environment.

Conclusions. Scaling up and sustaining CHW programs in LMICs requires effective program design and management, including adequate training, supervision, motivation, and funding; acceptability of the program to the communities served; and securing support for the program from political leaders and other health care providers.

A qualitative study of the coverage of influenza vaccination on Dutch news sites and social media websites

BMC Public Health
(Accessed 8 June 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
A qualitative study of the coverage of influenza vaccination on Dutch news sites and social media websites
Birthe A Lehmann, Robert AC Ruiter, Gerjo Kok BMC Public Health 2013, 13:547 (5 June 2013)

Abstract
Background
Information about influenza and the effectiveness of vaccination against influenza is largely available on the Internet, and may influence individual decision making about participation in future influenza vaccination rounds. E-health information has often been found to be inaccurate, or even to contradict Health Authority recommendations, especially when it concerns controversial topics.

Methods
By means of an online media monitoring programme, Dutch news sites and social media websites were scanned for the Dutch counterparts of the terms influenza, vaccination, vaccine and epidemic during February, March and April 2012. Data were processed with QSR NVivo 8.0 and analysed using a general inductive approach.

Results
Three overarching themes were found in both media sources: (1) the (upcoming) influenza epidemic, (2) general information regarding the virus, its prevention and treatment, and (3) uncertainty and mistrust regarding influenza vaccination. Social media tended to report earlier on developments such as the occurrence of an influenza epidemic. The greatest difference was that in social media, influenza was not considered to be a serious disease, and more opposition to the flu shot was expressed in social media, as compared to news media.

Conclusions
News media and social media discussed the same topics regarding influenza, but differed in message tone. Whereas news media reports tended to be more objective and non-judgmental, social media more critically evaluated the harmfulness of influenza and the necessity of the flu shot. Media may influence decision making and behaviours of Internet users and may thereby influence the success of vaccination campaigns and recommendations made by health authorities. Social media may be more of a problem in this sense, since it is neither controlled nor censored. Future research should investigate the actual impact of Internet media on the influenza decision making process of its users.

Understanding how and why health is integrated into foreign policy – a case study of health is global, a UK Government Strategy 2008–2013

Globalization and Health
[Accessed 8 June 2013]
http://www.globalizationandhealth.com/

Research
Understanding how and why health is integrated into foreign policy – a case study of health is global, a UK Government Strategy 2008–2013
Gagnon ML and Labonté R
Globalization and Health 2013, 9:24 (6 June 2013)

Abstract (provisional)
Background
Over the past decade, global health issues have become more prominent in foreign policies at the national level. The process to develop state level global health strategies is arguably a form of global health diplomacy (GHD). Despite an increase in the volume of secondary research and analysis in this area, little primary research, particularly that which draws directly on the perspectives of those involved in these processes, has been conducted. This study seeks to fill this knowledge gap through an empirical case study of Health is Global: A UK Government Strategy 2008–2013. It aims to build understanding about how and why health is integrated into foreign policy and derive lessons of potential relevance to other nations interested in developing whole-of-government global health strategies.

Methods
The major element of the study consisted of an in-depth investigation and analysis of the UK global health strategy. Document analysis and twenty interviews were conducted. Data was organized and described using an adapted version of Walt and Gilson’s policy analysis triangle. A general inductive approach was used to identify themes in the data, which were then analysed and interpreted using Fidler’s health and foreign policy conceptualizations and Kingdon’s multiples streams model of the policymaking process.

Results
The primary reason that the UK decided to focus more on global health is self-interest – to protect national and international security and economic interests. Investing in global health was also seen as a way to enhance the UK’s international reputation. A focus on global health to primarily benefit other nations and improve global health per se was a prevalent through weaker theme. A well organized, credible policy community played a critical role in the process and a policy entrepreneur with expertise in both international relations and health helped catalyze attention and action on global health when the time was right. Support from the Prime Minister and from the Foreign and Commonwealth Office was essential. The process to arrive at a government-wide strategy was complex and time-consuming, but also broke down silos. Significant negotiation and compromise were required from actors with widely varying perspectives on global health and conflicting priorities.

Conclusions
As primarily an exploratory study, this research sheds significant light on the global health policymaking process at the level of the state. It provides a useful and important starting point for further hypothesis driven empirical research that focuses on the integration of health in foreign policy, how and why this happens and whether or not it makes an impact on improving global health.

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

Vaccination against RSV: Is maternal vaccination a good alternative to other approaches?

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume , Issue 6    June 2013
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/5/

Commentary
Vaccination against RSV: Is maternal vaccination a good alternative to other approaches?
http://dx.doi.org/10.4161/hv.24096
Patricia Kaaijk, Willem Luytjes and Nynke Y. Rots
Abstract:
The respiratory syncytial virus (RSV) is the major cause of lower respiratory tract illness (LRI) in infants worldwide. Also persons with heart/lung disease or an immunodeficiency disorder, and the elderly are at increased risk for severe LRI upon RSV infection. Although there is at present no licensed RSV vaccine available, it is a priority target for several vaccine developers. For the implementation of a future RSV vaccination within national immunization schemes, various strategies can be considered even without the availability of extended clinical data on RSV vaccines. For this purpose, the extensive knowledge on RSV with respect to disease pathology, epidemiology and immunology can be used. This article discusses different aspects that should be considered to enable a successful implementation of a new RSV vaccine in national immunization programs. In addition, gaps in knowledge that needs further attention are identified. The maternal immunization strategy is highlighted, but also vaccination in the youngest infants and specific risk group immunization strategies are evaluated in this paper. Key factors such as the seasonality of RSV disease, interference of maternal antibodies and the immaturity of the infants’ immune system are addressed.