Changes in Infectious Disease Mortality in Children During the Past Three Decades

The Pediatric Infectious Disease Journal
September 2013 – Volume 32 – Issue 9  pp: A15,931-1044,e348-e382

Changes in Infectious Disease Mortality in Children During the Past Three Decades
Lantto, Marjo; Renko, Marjo; Uhari, Matti

Background: Our aim was to evaluate changes in infectious disease mortality in children in Finland from 1969 to 2004. We especially wanted to find out whether infection mortality could be further reduced by means of existing vaccines not included in national vaccination program.

Methods: We analyzed infectious disease mortality in Finland using data obtained from the official Cause of Death statistics for 1969 to 2004. Annual mortality rates were calculated in proportion to those at risk of dying. Infection mortality rates were calculated separately for neonates and children who were 1 month to 15 years.

Results: Childhood mortality due to infectious diseases decreased by 89%, from 0.12% in 1969 to 0.013% in 2004, and neonatal mortality by 69%, from 0.50% to 0.16%. Pneumonia, central nervous system infections and septicemia were the most common fatal infections in childhood. There were slightly more deaths due to all infections and respiratory tract infections in years marked by epidemics of respiratory syncytial virus. We estimated that pneumococcal conjugate vaccines would have prevented 2 deaths annually in our population, rotavirus vaccines 1 to 2 deaths, influenza vaccine 1 death and varicella vaccine 0.7 death.

Conclusions: We found that even though mortality from infectious diseases in childhood decreased markedly during the period concerned, it could have been further reduced by means of existing vaccines. Even though the number of deaths prevented would have been small, the number of years of life saved would have been great because the life expectancy of children is long.

A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregiv

PLoS One
[Accessed 31 August 2013]

Research Article
A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers
Ingrid T. Katz mail, Busisiwe Nkala, Janan Dietrich, Melissa Wallace, Linda-Gail Bekker, Kathryn Pollenz, Laura M. Bogart, Alexi A. Wright, Alexander C. Tsai, David R. Bangsberg, Glenda E. Gray

In South Africa, the prevalence of oncogenic Human Papillomavirus (HPV) may be as high as 64%, and cervical cancer is the leading cause of cancer-related death among women. The development of efficacious prophylactic vaccines has provided an opportunity for primary prevention. Given the importance of psycho-social forces in vaccine uptake, we sought to elucidate factors influencing HPV vaccination among a sample of low-income South African adolescents receiving the vaccine for the first time in Soweto.

The HPV vaccine was introduced to adolescents in low-income townships throughout South Africa as part of a nationwide trial to understand adolescent involvement in future vaccine research targeting human immunodeficiency virus (HIV). We performed in-depth semi-structured interviews with purposively-sampled adolescents and their care providers to understand what forces shaped HPV vaccine uptake. Interviews were recorded, transcribed, translated, and examined using thematic analysis.

Of 224 adolescents recruited, 201 initiated the vaccine; 192 (95.5%) received a second immunization; and 164 (81.6%) completed three doses. In our qualitative study of 39 adolescent-caregiver dyads, we found that factors driving vaccine uptake reflected a socio-cultural backdrop of high HIV endemnicity, sexual violence, poverty, and an abundance of female-headed households. Adolescents exercised a high level of autonomy and often initiated decision-making. Healthcare providers and peers provided support and guidance that was absent at home. The impact of the HIV epidemic on decision-making was substantial, leading participants to mistakenly conflate HPV and HIV.

In a setting of perceived rampant sexual violence and epidemic levels of HIV, adolescents and caregivers sought to decrease harm by seeking a vaccine targeting a sexually transmitted infection (STI). Despite careful consenting, there was confusion regarding the vaccine’s target. Future interventions promoting STI vaccines will need to provide substantial information for participants, particularly adolescents who may exercise a significant level of autonomy in decision-making.

Timeliness Vaccination of Measles Containing Vaccine and Barriers to Vaccination among Migrant Children in East Chin

PLoS One
[Accessed 31 August 2013]

Research Article
Timeliness Vaccination of Measles Containing Vaccine and Barriers to Vaccination among Migrant Children in East China
Yu Hu mail, Qian Li, Shuying Luo, Linqiao Lou, Xiaohua Qi, Shuyun Xie

The reported coverage rates of first and second doses of measles containing vaccine (MCV) are almost 95% in China, while measles cases are constantly being reported. This study evaluated the vaccine coverage, timeliness, and barriers to immunization of MCV1 and MCV2 in children aged from 8–48 months.

We assessed 718 children aged 8–48 months, of which 499 children aged 18–48 months in September 2011. Face to face interviews were administered with children’s mothers to estimate MCV1 and MCV2 coverage rate, its timeliness and barriers to vaccine uptake.

The coverage rates were 76.9% for MCV1 and 44.7% for MCV2 in average. Only 47.5% of surveyed children received the MCV1 timely, which postpone vaccination by up to one month beyond the stipulated age of 8 months. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. Being unaware of the necessity for vaccination and its schedule, misunderstanding of side-effect of vaccine, and child being sick during the recommended vaccination period were significant preventive factors for both MCV1 and MCV2 vaccination. Having multiple children, mother’s education level, household income and children with working mothers were significantly associated with delayed or missing MCV1 immunization.

To avoid future outbreaks, it is crucial to attain high coverage levels by timely vaccination, thus, accurate information should be delivered and a systematic approach should be targeted to high-risk groups.

Addressing Ethical, Social, and Cultural Issues in Global Health Research

PLoS Neglected Tropical Diseases
August 2013

Policy Platform
Addressing Ethical, Social, and Cultural Issues in Global Health Research
James V. Lavery mail, Shane K. Green, Sunita V. S. Bandewar, Anant Bhan, Abdallah Daar, Claudia I. Emerson, Hassan Masum, Filippo M. Randazzo, Jerome A. Singh, Ross E. G. Upshur, Peter A. Singer;jsessionid=04509CEF62F57E8BDF1743A89C443DDF

The purpose of this paper is to encourage reflection among the global health research community and the research ethics community about how a wide range of ethical, social, and cultural (ESC) influences on the conduct, success, and impact of global health research can best be addressed by consultation services in research ethics (CSRE). We draw on lessons we have learned during our experiences with the ESC Program of the Grand Challenges in Global Health initiative to propose key features of CSRE that may prove useful for those designing or implementing similar programs.

Poverty Impedes Cognitive Function

30 August 2013 vol 341, issue 6149, pages 929-1032

Research Article
Poverty Impedes Cognitive Function
Anandi Mani1, Sendhil Mullainathan2,*, Eldar Shafir3,*, Jiaying Zhao4
+ Author Affiliations
1Department of Economics, University of Warwick, Coventry CV4 7AL, UK.
2Department of Economics, Harvard University, Cambridge, MA 02138, USA.
3Department of Psychology and Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ 08540, USA.
4Department of Psychology and Institute for Resources, Environment and Sustainability, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada.
*Corresponding author. E-mail: (S.M.); (E.S.)

The poor often behave in less capable ways, which can further perpetuate poverty. We hypothesize that poverty directly impedes cognitive function and present two studies that test this hypothesis. First, we experimentally induced thoughts about finances and found that this reduces cognitive performance among poor but not in well-off participants. Second, we examined the cognitive function of farmers over the planting cycle. We found that the same farmer shows diminished cognitive performance before harvest, when poor, as compared with after harvest, when rich. This cannot be explained by differences in time available, nutrition, or work effort. Nor can it be explained with stress: Although farmers do show more stress before harvest, that does not account for diminished cognitive performance. Instead, it appears that poverty itself reduces cognitive capacity. We suggest that this is because poverty-related concerns consume mental resources, leaving less for other tasks. These data provide a previously unexamined perspective and help explain a spectrum of behaviors among the poor. We discuss some implications for poverty policy.

From Google Scholar+ [ to 31 August 2013]

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

Further Evidence for Bias in Observational Studies of Influenza Vaccine Effectiveness: The 2009 Influenza A (H1N1) Pandemic
ML Jackson, O Yu, JC Nelson, A Naleway, EA Belongia… – American Journal of …, 2013
Abstract Preinfluenza periods have been used to test for uncontrolled confounding in studies
of influenza vaccine effectiveness, but some authors have claimed that confounding differs
in preinfluenza and influenza periods. We tested this claim by comparing estimates of the

Risk Factors for Non-Initiation of the Human Papillomavirus (HPV) Vaccine among Adolescent Survivors of Childhood Cancer
J Klosky, K Russell, K Canavera, H Gammel… – Cancer Prevention …, 2013
Abstract Effective vaccination is now available to prevent human papillomavirus (HPV), the
most common sexually transmitted infection and cause of cervical cancer. This study aimed
to estimate the prevalence of HPV vaccination among childhood cancer survivors and

Vaccines: The Week in Review 24 August 2013

NOTICE: Vaccines: The Week in Review resumes publication on 24 August 2013 following duty travel by the editor.

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 “29 June 2013″
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Associate Faculty, Division of Medical Ethics, NYU Medical School