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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– 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.
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– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_28 Sep 2013
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– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
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– 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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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

Joint Statement on accelerating efforts to achieve the health MDGs
WHO, UNFPA, UNAIDS, UNICEF and the UN Secretary General’s Special Envoy for Financing the Health MDGs and for malaria on the occasion of the 68th General Assembly of the United Nations
25 September 2013
Excerpt
We have 829 days to go until the December 2015 MDG deadline. Over the past 12 and a half years, the world has made remarkable progress against the goals, especially the health-related MDGs. Child and maternal deaths have been almost halved from 1990 levels. Malaria deaths have dropped 50%, driven largely by the distribution of over 400 million mosquito nets in the past several years. Over 6 million people, of the 9 million who need TB treatment, are now on treatment. HIV, once a death sentence with virtually no one on treatment, has undergone a dramatic shift with almost 10 million people on treatment today – and if we can finish the job and put everyone on treatment, we will irreversibly halt the AIDS epidemic. These results are unmistakable proof that success is possible.

Now we must come together in one final big push to achieve the health MDGs, and lay the strongest of foundations for a post-2015 world.

We all know that the economic environment has been challenging, but despite that, the pace of our work to end maternal and child deaths, malaria deaths, AIDS-related deaths and eliminating new HIV infections among children has quickened over the past 3 years. This week, an unprecedented US$ 1.15 billion has been freshly mobilized to reach MDGs 4 and 5 – the largest amount ever mobilized for those goals. Funds of this magnitude fill a substantial portion of the remaining financing gap. Last year, at the London FP Summit, some $2.6 billion funds were mobilized for family planning. The Global Fund to Fight AIDS, TB and Malaria is working hard to achieve its replenishment figure of $15 billion…

…It is now time for an unprecedented acceleration of effort to achieve the goals. We know it will take nothing short of a moonshot to accomplish the goals in the time remaining. The lives we must save in this final MDG phase are in the most difficult to reach areas, and are people who are chronically underserved. With a rights-based approach, combined with utilizing the advancements in science (effective antiretroviral therapy, malarial drugs, rapid diagnostics for TB), we can reach more people in need, faster and efficiently. We must do everything we can, to get as far as we can, by December 2015. Anything less will steepen our climb even further post-2015…
http://www.who.int/mediacentre/news/statements/2013/mdgs_20130925/en/index.html

    The World Bank Group, UNICEF, USAID and the Government of Norway announced a collective USD$1.15 billion in funding over the next three years to accelerate progress toward the Millennium Development Goals (MDGs) 4 and 5, and to ensure essential services and medicines reach women and children who need them in developing countries with the highest burdens of maternal and child deaths.

These commitments “represent one of the largest infusions of funds for maternal and child health from global donors since the MDGs were established in 2000, and signal the global community’s determination to support countries in achieving the goals.”  The funding from these four development partners “will work in a complementary and coordinated way to target a set of high-burden countries, in support of each country’s own child and maternal health plan. The resources from the United States, UNICEF, and Norway will largely be used to strengthen existing supply systems, and provide a needed injection of life-saving commodities, to ensure they reach the communities that need them. The resources from the World Bank Group will help countries transform their health service delivery for women and children by explicitly tying payments to health service providers to the successful delivery and independent verification of pre-agreed results…”
http://www.unicef.org/media/media_70444.html

   The Global Fund confirmed that the U.S. will host its Fourth Replenishment Conference in early December 2013 through an announcement by Secretary of State John F. Kerry. The conference “will secure funding for 2014-2016, enabling the Global Fund to support programs in countries that fight AIDS, TB and malaria effectively, and to save the lives of millions of people.” In April, the U.S. announced a request for US$1.65 billion for the Global Fund in the budget for 2014. The Global Fund noted that “the architecture of this year’s Replenishment Conference signals a commitment to partnership in a 21st Century model, with leaders from implementing countries and leaders from the private sector and leaders from G8 countries, to co-host the event. In addition, thirteen presidents of African countries are acting as champions of the Global Fund Replenishment this year.”
http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-09-25_US_Will_Host_Global_Fund_Replenishment/

Separately, the Global Fund “congratulated the United Kingdom for demonstrating strong leadership in global health with a major contribution of £1 billion (US$1.6 billion) for the 2014-2016 period. The UK commitment “is geared toward encouraging other donors to maximize their own pledges to the Global Fund, effectively unlocking additional funds with each contribution, as the UK contribution is limited to a maximum of 10 per cent of the total raised for the Global Fund.”
http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-09-23_UK_Commits_GBP_1_Billion_to_the_Global_Fund/

    Investors led by JPMorgan Chase & Co. (JPM) and the Bill & Melinda Gates Foundation formed the Global Health Investment Fund, which “will back late-stage development of technologies to fight killer diseases in low-income countries.” A group of investors including the Canadian and German governments and the Children’s Investment Fund Foundation committed $94 million to the fund. The International Finance Corp., GlaxoSmithKline Plc (GSK), Merck & Co. (MRK), Pfizer Inc. (PFE)’s foundation, Storebrand ASA (STB) are participating.
http://www.bloomberg.com/news/2013-09-23/jpmorgan-joins-gates-foundation-drugmakers-in-investment-fund.html

Global Health Investment Fund – Prospectus Excerpt
http://ifcext.ifc.org/IFCExt/spiwebsite1.nsf/DocsByUNIDForPrint/7062F2FE8E6BA8BA85257AAE0066A86A?opendocument

General
The Fund will invest in multiple companies and/or Product Development Partnerships (PDPs) who are advancing the development of promising health products and technologies for diseases that disproportionately affect developing countries.

The project being proposed is a US$10mm equity investment in a mezzanine fund, the Global Health Investment Fund, LLC (“GHIF” or the “Fund”), sponsored by the Bill and Melinda Gates Foundation. GHIF is seeking to raise approximately US$100mm for the purpose of improving global health. The Fund would support the development of drugs, vaccines, preventatives, diagnostics and other related technologies aimed at infectious diseases that cause significant morbidity and mortality in developing countries (e.g. neglected infectious diseases), as well as those that provide solutions for maternal, neonatal and child-health challenges.

Expected Development Impact
Given the Fund’s focus on the late stage in the development of many of the drugs, vaccines and diagnostics in the pipeline, it is reasonable to expect a large development impact on several fronts:
(i) possible replication of the business model and scale-up of the flow of additional funding into late stage development of drugs for neglected diseases;
(ii) millions of patients, and especially those in vulnerable population (children and pregnant women) will benefit from the drugs that will be commercialized through this vehicle;
(iii) by demonstrating the commercial viability of the proposed funding structure, this could prove to be an important catalyst for the development of drugs that otherwise would not be developed; and
(iv) demonstration effect to other charitable foundations that their money could be multiplied and effects of their charitable giving amplified through this funding mechanism, which is expected to bring positive financial return to investors…

The HOOKVAC consortium said it was awarded a grant of six million Euros from the European Commission FP7 programme to expand the Sabin Vaccine Institute Product Development Partnership’s (Sabin PDP) work to develop and test a vaccine for human hookworm. Under this grant, the HOOKVAC consortium, which includes partners from the European Union, United States and Africa, will begin the first clinical testing of the human hookworm vaccine in the West African nation of Gabon. The Consortium noted that human hookworm infects 600-700 million of the world’s poorest people, primarily those living below the global poverty line, particularly pregnant women and children in sub-Saharan Africa, Southeast Asia, and Latin America. Left untreated, hookworm causes internal blood loss leading to iron-deficiency anemia and malnutrition. Hookworm also contributes to physical and cognitive impairment, poor school performance and attendance, and low birth weights. Ruxandra Draghia-Akli, MD, PhD, director of the Health Directorate at the Research DG of the European Commission, commented, “The European Commission is proud to support the critical work of the consortium for the development of a human hookworm vaccine. Ultimately, we hope that the knowledge, innovations and research expertise resulting from this global collaboration will accelerate the development of the world’s first, effective hookworm vaccine and encourage additional European SME partnerships to explore vaccines for NTDs.”
26 September 2013 – http://www.sabin.org/updates/pressreleases/new-global-consortium-advance-first-ever-clinical-testing-human-hookworm

Update: Polio this week – As of 25 September 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]

:: In the Horn of Africa, intensive outbreak response is continuing. The impact of the response is beginning to be seen, as the number of newly-reported cases from Banadir, Somalia (the epicentre of the outbreak) has declined. At the same time, operations are improving as more children are being reached, including in some inaccessible areas of south-central Somalia. The risk this outbreak poses for the entire region was again underscored this week, however, as two further cases from Ethiopia have been confirmed. See ‘Horn of Africa’ section below, for more information.

:: In Pakistan, 12 new cVDPV2 cases are reported this week, the bulk in North Waziristan, FATA. See ‘Pakistan’ section for more details….

Pakistan
:: …12 new cVDPV2 cases were reported in the past week, 11 from North Waziristan, Federally Administered Tribal Areas (FATA) and one from Gadap, greater Karachi, Sindh. Onsets of paralysis of the new cases are from 3 July to 21 August. This brings the total number of cVDPV2 cases for 2013 to 24.
:: The cases in North Waziristan are particularly concerning, as it is in an area where immunizations have been suspended by local leaders since last June. Immunizations in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak. North Waziristan is also affected by WPV1 transmission.
:: Additionally, four new environmental samples tested positive for WPV1, from Peshawar, FATA; Gadap, Sindh; Rawalpindi, Punjab; and, Multan, Punjab. Detection of the sample in Multan is particularly concerning, as WPV1 had not been detected in this area since early 2012.
:: Confirmation of these latest cases in FATA underscores the risk ongoing polio transmission (be it due to WPV or cVDPV) in this area continues to pose to children everywhere, and in particular to children living in areas where access has not been possible for extended periods of time. :: FATA is the major poliovirus reservoir in Pakistan and in Asia, with confirmed circulation of both WPV1 and cVDPV2. More than 350,000 children in this area are regularly missed in inaccessible areas, during immunization activities. Efforts are ongoing to curb transmission in this area, including through vaccination at transit points and conducting Short Interval Additional Dose (SIADs) campaigns in areas that have recently become accessible.

Horn of Africa
:: Seven new WPV1 cases were reported in the past week, five from Somalia and two from Ethiopia. The total number of WPV1 cases for 2013 in the Horn of Africa is 191 (174 from Somalia, 14 from Kenya and three from Ethiopia. The most recent WPV1 case in the region had onset of paralysis on 30 August (from Ethiopia).
:: The two new cases from Ethiopia are both from Somali region, bordering Somalia. It is from this region that the first case from the country had been reported. Active case searches for any additional potential cases is continuing.
:: Because of routes of poliovirus spread in previous Horn of Africa outbreaks, this area of Ethiopia had been considered at ‘high risk’, and since June had been conducting large-scale immunization campaigns. The response continues to be further strengthened. For example, World Food Programme (WFP) field monitors have been sensitized on AFP surveillance, and a proposal is being evaluated to use community volunteers to further intensify surveillance.
:: Nationally and regionally, public-private partnership coordination is continuing, with National Command Post meetings being held every Monday, chaired by the Health State Minister or Director MCH. Similar coordination meetings are taking place in Somali region.
:: 28 Permanent Vaccination Posts have now been established along the Ethiopia-Somalia border areas and at large transit points.
:: Social mobilization and mass media activities continue to be scaled up in the country, including jingles on TV and radio and banner productions for local levels…

WHO: Global Alert and Response (GAR) – Disease Outbreak News
http://www.who.int/csr/don/2013_03_12/en/index.html
Disease outbreak news
No new DON items

WHO Statement on the Third Meeting of the IHR Emergency Committee concerning MERS-CoV
25 September 2013
Excerpt, Bolded text by Editor
The third meeting of the Emergency Committee convened by the Director-General under the International Health Regulations (2005) [IHR (2005)] was held by teleconference on Wednesday, 25 September 2013, from 12:00 to 14:30 Geneva time (CET).

During the informational session, Kingdom of Saudi Arabia and Qatar presented on recent developments in their countries. The WHO Secretariat provided an update on epidemiological developments, Hajj and Umrah and recent WHO activities related to MERS-CoV. The Committee reviewed and deliberated on the information provided.

The Committee concluded that it saw no reason to change its advice to the Director-General. Based on the current information, and using a risk-assessment approach, it was the unanimous decision of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.

While not considering the events to constitute a PHEIC, Members of the Committee reiterated their prior advice for consideration by WHO and Member States and emphasized the importance of:
:: strengthening surveillance, especially in countries with pilgrims participating in Umrah and the Hajj;
:: continuing to increase awareness and effective risk communication concerning MERS-CoV, including with pilgrims;
:: supporting countries that are particularly vulnerable, especially in Sub-Saharan Africa taking into account the regional challenges;
:: increasing relevant diagnostic testing capacities;
:: continuing with investigative work, including identifying the source of the virus and relevant exposures through case control studies and other research; and
:: timely sharing of information in accordance with the International Health Regulations (2005) and ongoing active coordination with WHO…
http://www.who.int/mediacentre/news/statements/2013/mers_cov_20130925/en/index.html

The Weekly Epidemiological Record (WER) for 27 September 2013, vol. 88, 39 (pp. 413–428) includes:
:: Haemophilus influenzae type b (Hib) Vaccination Position Paper – July 2013
:: Monthly report on dracunculiasis cases, January–July 2013
http://www.who.int/entity/wer/2013/wer8839.pdf

WHO: Recommendation on use of Hib vaccines in all national immunization programmes
In an updated position paper, WHO continues to recommend the inclusion of Haemophilus influenzae type b (Hib) vaccines in all national immunization programmes. Vaccination remains the only effective means of preventing Hib disease and is becoming increasingly important as Hib antibiotic resistance grows. The use of Hib vaccines should be part of a comprehensive strategy to control pneumonia including: exclusive breastfeeding for six months; hand washing with soap; improved water supply and sanitation; reduction of household air pollution; and improved case management at community and health facility levels.

WHO Position Paper on Hib vaccination – September 2013
pdf, 1.27Mb
http://www.who.int/immunization/newsroom/hib_in_national_immunization_programmes/en/index.html

WHO, FAO, OIE Joint Statement: Elimination of human rabies and rabies control in animals
28 September is World Rabies Day. This joint statement promises to eliminate human rabies and control the disease in animals. Rabies kills more than 60 000 people annually, most of them children.
Full details
Read statement
Round table discussion–Rabies
00:14:31 [mp3 13.3Mb]
http://www.who.int/neglected_diseases/en/index.html

CDC/MMWR Watch [to 28 September 2013]
September 27, 2013 / Vol. 62 / No. 38
:: Influenza Vaccination Coverage Among Health-Care Personnel — United States, 2012–13 Influenza Season
:: Influenza Vaccination Coverage Among Pregnant Women — United States, 2012–13 Influenza Season
:: Updated Information on the Epidemiology of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection and Guidance for the Public, Clinicians, and Public Health Authorities, 2012–2013
:: Notes from the Field: Department of Defense Response to a Multistate Outbreak of Fungal Meningitis — United States, October 2012
:: Announcement: Final National and State-Level 2012–13 Influenza Vaccination Coverage Estimates Available Online

Influenza Vaccination Coverage Among Health-Care Personnel — United States, 2012–13 Influenza Season
Weekly http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6238a2.htm?s_cid=mm6238a2_w
September 27, 2013 / 62(38);781-786

Excerpt, Bolded text by Editor
Routine influenza vaccination of health-care personnel (HCP) every influenza season can reduce influenza-related illness and its potentially serious consequences among HCP and their patients (1–5). To protect HCP and their patients, the Advisory Committee on Immunization Practices (ACIP) recommends that all HCP be vaccinated against influenza during each influenza season (5). To estimate influenza vaccination coverage among HCP during the 2012–13 season, CDC conducted an opt-in Internet panel survey of 1,944 self-selected HCP during April 1–16, 2013. This report summarizes the results of that survey, which found that, overall, 72.0% of HCP reported having had an influenza vaccination for the 2012–13 season, an increase from 66.9% vaccination coverage during the 2011–12 season (6). By occupation type, coverage was 92.3% among physicians, 89.1% among pharmacists, 88.5% among nurse practitioners/physician assistants, and 84.8% among nurses. By occupational setting, vaccination coverage was highest among hospital-based HCP (83.1%) and was lowest among HCP at long-term care facilities (LTCF) (58.9%). Vaccination coverage was higher for HCP in occupational settings offering vaccination on-site at no cost for one (75.7%) or multiple (86.2%) days compared with HCP in occupational settings not offering vaccination on-site at no cost (55.3%). Widespread implementation of comprehensive influenza vaccination strategies that focus on improving access to vaccination services is needed to improve HCP vaccination coverage. Influenza vaccination of HCP in all health-care settings might be increased by providing 1) HCP with information on vaccination benefits and risks for themselves and their patients, 2) vaccinations in the workplace at convenient locations and times, and 3) influenza vaccinations at no cost (7,8)…

Report: Ending Poverty in Our Generation: The Next MDG Framework
Save the Children
September 2013
http://www.savethechildren.org/site/c.8rKLIXMGIpI4E/b.8687749/k.CFBF/Post2015.htm

“The world’s current global goals to address extreme poverty – the MDGs – expire in 2015. World leaders have a chance to take this agenda further and finally end extreme poverty in our generation. But it will require more than business as usual – Save the Children’s new report explores how addressing income inequality and improving governance would rapidly accelerate progress.

“A historic achievement is within reach. We can be the generation that ends poverty, forever. For the first time, it is feasible to imagine that in the next couple of decades no child will die from preventable causes, every child will be in school and learning, every child will have protection from violence and we will eradicate absolute poverty.

“The Millennium Development Goals (MDGs), one of the most resonant and unifying agreements in political history, reach a turning point in 2015, the deadline for their realization. We must do everything in our power to achieve them, since they provided an important framework to direct political and financial commitments as well as technical breakthroughs for children. We must also find an agreed way forward on work that will remain to be accomplished.

“As a leading independent organization for children, Save the Children is focused on ensuring that the post-2015 framework clearly accounts for the needs and rights of all children…”

Meeting: The best shot: reaching 22 million missed children. A seminar on accelerating access to vaccination
MSF
14 October 2013; Oslo, Norway.
“While there have been significant improvements in immunization, more than 1.5 million children die each year of vaccine-preventable diseases. Significant barriers to expanding the reach of vaccines still remain, including the cost of vaccines and the lack of field-adapted products. With more than 22 million children born each year missing their basic immunizations, the international community needs a critical and constructive debate on how to improve universal vaccination coverage.
“The seminar will bring together experienced field practitioners that can share the challenges faced at country level in delivering vaccines with high level policy and decision makers so that we can have a concrete dialogue on what is working and what needs improvement. Speakers include representatives from Médecins Sans Frontières, International Rescue Committee, Duke University, Serum Institute of India, Bill & Melinda Gates Foundation, Harvard University, representatives from country governments, among others.”
Programme and registration: http://www.legerutengrenser.no/Vaart-Arbeid/Vaksineseminar

American Journal of Infection Control
Vol 41 | No. 10 | October 2013 | Pages 853-948
http://www.ajicjournal.org/current

Viral outbreaks in neonatal intensive care units: What we do not know
Elisa Civardi, MD, Chryssoula Tzialla, MD, Fausto Baldanti, MD, Luisa Strocchio, MD, Paolo Manzoni, MD, Mauro Stronati, MD
http://www.ajicjournal.org/article/S0196-6553%2813%2900189-2/abstract

Abstract
Background
Nosocomial infection is among the most important causes of morbidity, prolonged hospital stay, increased hospital costs, and mortality in neonates, particularly those born preterm. The vast majority of scientific articles dealing with nosocomial infections address bacterial or fungal infections, and viral agents are often disregarded. This analysis reviews the medical literature in an effort to establish the incidence, types of pathogens, and clinical features of noncongenital neonatal viral infections.

Methods
This analysis was performed using the worldwide database of health care–associated outbreaks (http://www.outbreak-database.com). Items analyzed included causative pathogens, types of infection, source of outbreaks, and measures taken to stop outbreaks.

Results
The outbreak database contained a total of 590 neonatal outbreaks, of which 64 were originated by viruses, 44 of which (68.75%) were reported from neonatal intensive care units (NICUs). The 5 most frequent viral agents were rotavirus (23.44%), respiratory syncytial virus (17.19%), enterovirus (15.63%), hepatitis A virus (10.94%), and adenovirus (9.38%).

Conclusion
Our analysis of the viral origins of nosocomial infections in NICUs can be a valuable tool in the investigation of neonatal infections. The mortality rates reported in this analysis demonstrate the significance of noncongenital viral infections in NICUs and the need for more effective outbreak prevention strategies.

American Journal of Infection Control
Vol 41 | No. 10 | October 2013 | Pages 853-948
http://www.ajicjournal.org/current

Low level of immunity against hepatitis A among Korean adolescents: Vaccination rate and related factors
Jung Yeon Heo, MD, Joon Young Song, MD, Ji Yun Noh, MD, Yu Bin Seo, MD, In Sun Kim, MD,     Won Suk Choi, MD, Woo Joo Kim, MD, PhD, Gum Joo Cho, MD, Taik Gun Hwang, MD, Hee Jin Cheong, MD, PhD
http://www.ajicjournal.org/article/S0196-6553%2813%2900667-6/abstract

Abstract
Background
We evaluated the current vaccination rate and immunity in the Korean adolescent population and analyzed their parents’ attitudes toward hepatitis A virus (HAV) vaccination.

Methods
Between March and April 2011, sera were collected for immunoglobulin (Ig) G anti-HAV testing from students in their first year of high school from 12 different high schools located in southwestern Seoul. Simultaneously, questionnaires were given to the parents of the students to evaluate factors related to HAV vaccination, including demographics, HAV vaccination status, reason for getting the vaccination, and awareness regarding HAV.

Results
Sera from 2,879 subjects and questionnaires from their parents were collected. The HAV vaccination rate among adolescents aged between 14 and 17 years was 18.9%, and the seroprevalence was 15.4%. Among subjects who reported receiving the HAV vaccination, the IgG anti-HAV seropositivity rate was only 42.2%. For subjects who were not vaccinated, the IgG anti-HAV seropositivity rate was 9.1%. The most significant reason for receiving the vaccination was recommendation from health care providers; the most important source of information regarding the vaccination was public health organizations.

Conclusion
HAV vaccination rate and anti-HAV seroprevalence in Korean adolescents was low; the seropositivity rate in the vaccinated group was lower than expected. Actively recommending HAV vaccination in this group is required, and routine, nationwide, government-sponsored vaccination of adolescents against HAV should be considered.

The European Journal of Public Health
Volume 23 Issue 5 October 2013
http://eurpub.oxfordjournals.org/content/current

European public health research in Horizon 2020
John Browne1 and Thorkild I. A. Sørensen2
+ Author Affiliations
1 Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
2 Faculty of Health and Medical Sciences, University of Copenhagen
Correspondence: John Browne, Department of Epidemiology and Public Health, University College Cork, Cork, Ireland, e-mail: j.browne@ucc.ie

The Directorate General for Research & Innovation of the European Commission (DG-RTD) has provided funding of €425.46 million for public health research since 2000. In September 2012, we were asked to lead as chair (T.I.A.) and rapporteur (J.B.) an Independent Expert Group commissioned by DG-RTD to make recommendations about the future of European public health research in the period 2014–20, the Horizon 2020 funding stream. We here report the main recommendations, supported by all group members.

The group was asked to address four questions:
:: What should the thematic priorities for EU-funded public health research under Horizon 2020 be?
:: How to best structure European Public Health Research in the future?
:: How to develop stronger links and synergies between EU-funded research and national research activities, EU policy agendas and national policy agendas?
:: How to improve the uptake of evidence generated from public health research in the development of public health policy?

An important recommendation is …
http://eurpub.oxfordjournals.org/content/23/5/722.extract

Values and ethics amidst the economic crisis
Peter Schröder-Bäck1,2,3, Louise Stjernberg2,4 and Ann Marie Borg1
+ Author Affiliations
1Department of International Health, School CAPHRI, Maastricht University, Maastricht, The Netherlands, 2Working Group “Ethics and Values in Public Health”, Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium, 3Section “Ethics in Public Health”, European Public Health Association (EUPHA), Utrecht, The Netherlands and 4School of Health Science, Blekinge Institute of Technology, Karlskrona, Sweden
Correspondence: Peter Schröder-Bäck, Department of International Health, School CAPHRI, Maastricht University, Postbox 616, 6200 MD Maastricht, The Netherlands

Austerity measures and trade-offs
The current protracted economic crisis is giving rise to the scarcity of public health resources across Europe. In response to budgetary pressures and the Eurozone public debt crisis, decision makers resort to a short-term solution: the introduction of austerity measures in diverse policy fields. Health and social policy tend to be easy targets in this regard, and budget cuts often include a reduction of healthcare expenditure or social welfare benefits.

In fact, in their analysis of the austerity measures being adopted in Europe, Mladovsky et al. have identified that in some countries, we see a shift of public money across sectoral budgets.1 Against this background, it is argued that ‘trade-offs should be understood and made explicit so decision makers can openly weigh evidence against ideology in line with societal values’.1 But what are these so-called social values that should guide the decisions and policy responses of European decision makers?
http://eurpub.oxfordjournals.org/content/23/5/723.extract

The Lancet  
Sep 28, 2013  Volume 382  Number 9898  p1071 – 1152  e6 – 9
http://www.thelancet.com/journals/lancet/issue/current

Comment
Secure use of individual patient data from clinical trials
Patrick Vallance, Iain Chalmers

Preview |
Publishing the results of all clinical trials, whoever funds them, is required for ethical, scientific, economic, and societal reasons.1 Individuals who take part in trials need to be sure that data they contribute are used to further knowledge, prevent unnecessary duplication of research, and improve the prospects for patients.

The Lancet  
Sep 28, 2013  Volume 382  Number 9898  p1071 – 1152  e6 – 9
http://www.thelancet.com/journals/lancet/issue/current

Letter
Poliomyelitis: threats to eradication
Mohammed Umer Mir, Mehreen Bhamani

Preview |
The recent isolation of wild poliovirus from Israeli sewage samples1 (environmental sampling) elucidates an important consideration for polio eradication. The Iocal population has humoral immunity against the poliovirus because of high rates of coverage with inactivated polio vaccine (IPV).2 But not everyone has mucosal (intestinal) immunity because of removal of oral polio vaccine (OPV) from routine immunisation since 2005, and absence of endemic wild poliovirus conferring natural immunity. People immunised with IPV are protected from disease but the poliovirus replicates in their intestines and is shed with stools for about 3 weeks after initial infection.

The Lancet Global Health
Oct 2013  Volume 1  Number 4  e169 – 237
http://www.thelancet.com/journals/langlo/issue/current

Comment
The Global Health Innovative Technology (GHIT) Fund: financing medical innovations for neglected populations
BT Slingsby, Kiyoshi Kurokawa

Preview |
The newly launched Global Health Innovative Technology (GHIT) Fund, which is multisectoral, interdisciplinary, and not for profit, aims to expedite the generation of novel medical technologies and drugs to diagnose, prevent, and treat high-prevalence infectious diseases worldwide. The GHIT Fund represents the first public–private partnership to involve a national government, a UN agency, a consortium of pharmaceutical companies, and an international philanthropic foundation (founding partners are the Japanese Ministry of Foreign Affairs; the Japanese Ministry of Health, Labour and Welfare; the UN Development Programme; Astellas Pharma; Daiichi Sankyo Company; Eisai Company; Shionogi & Company; Takeda; and the Bill & Melinda Gates Foundation).

The Lancet Infectious Diseases
Oct 2013  Volume 13  Number 10  p823 – 906
http://www.thelancet.com/journals/laninf/issue/current

Comment
Preventive measures against MERS-CoV for Hajj pilgrims
Philippe Gautret, Samir Benkouiten, Imane Salaheddine, Philippe Parola, Philippe Brouqui
Preview |
Assiri and colleagues1 provide a clinical synopsis of 47 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection identified between September, 2012, and June, 2013, in Saudi Arabia. Of note is the high rate of underlying comorbidity in patients with MERS (table). Since the first cases were reported in April, 2012, from Jordan, most cases have been reported from Saudi Arabia where the Hajj, the largest religious mass gathering, takes place annually. Given the predicted population movements out of Saudi Arabia, potential for worldwide spread of MERS-CoV exists according to Kahn and colleagues.

PLoS One
[Accessed 28 September 2013]
http://www.plosone.org/

Research Article
Vaccinating Women Previously Exposed to Human Papillomavirus: A Cost-Effectiveness Analysis of the Bivalent Vaccine
Hugo C. Turner, Iacopo Baussano, Geoff P. Garnett
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0075552

Abstract
Recent trials have indicated that women with prior exposure to Human papillomavirus (HPV) subtypes 16/18 receive protection against reinfection from the HPV vaccines. However, many of the original models investigating the cost effectiveness of different vaccination strategies for the protection of cervical cancer assumed, based on the trial results at that time, that these women received no protection. We developed a deterministic, dynamic transmission model that incorporates the vaccine-induced protection of women with prior exposure to HPV. The model was used to estimate the cost effectiveness of progressively extending a vaccination programme using the bivalent vaccine to older age groups both with and without protection of women with prior exposure. We did this under a range of assumptions on the level of natural immunity. Our modelling projections indicate that including the protection of women with prior HPV exposure can have a profound effect on the cost effectiveness of vaccinating adults. The impact of this protection is inversely related to the level of natural immunity. Our results indicate that adult vaccination strategies should potentially be reassessed, and that it is important to include the protection of non-naive women previously infected with HPV in future studies. Furthermore, they also highlight the need for a more thorough investigation of this protection.

PLoS Neglected Tropical Diseases
September 2013
http://www.plosntds.org/article/browseIssue.action

Policy Platform
Preparing for Dengue Vaccine Introduction: Recommendations from the 1st Dengue v2V International Meeting
Joseph Torresi, Roberto Tapia-Conyer, Harold Margolis
PLOS Neglected Tropical Diseases: published 26 Sep 2013 | info:doi/10.1371/journal.pntd.0002261

PLoS Neglected Tropical Diseases
September 2013
http://www.plosntds.org/article/browseIssue.action

Integration of Water, Sanitation, and Hygiene for the Prevention and Control of Neglected Tropical Diseases: A Rationale for Inter-Sectoral Collaboration
Matthew C. Freeman, Stephanie Ogden, Julie Jacobson, Daniel Abbott, David G. Addiss, Asrat G. Amnie, Colin Beckwith, Sandy Cairncross, Rafael Callejas, Jack M. Colford Jr, Paul M. Emerson, Alan Fenwick, Rebecca Fishman, Kerry Gallo, Jack Grimes, Gagik Karapetyan, Brooks Keene, Patrick J. Lammie, Chad MacArthur, Peter Lochery, Helen Petach, Jennifer Platt, Sarina Prabasi, Jan Willem Rosenboom, Sharon Roy, Darren Saywell, Lisa Schechtman, Anupama Tantri, Yael Velleman, Jürg Utzinger
PLOS Neglected Tropical Diseases: published 26 Sep 2013 | info:doi/10.1371/journal.pntd.0002439

PLoS Neglected Tropical Diseases
September 2013
http://www.plosntds.org/article/browseIssue.action

Public Acceptance and Willingness-to-Pay for a Future Dengue Vaccine: A Community-Based Survey in Bandung, Indonesia
Panji Fortuna Hadisoemarto, Marcia C. Castro
PLOS Neglected Tropical Diseases: published 19 Sep 2013 | info:doi/10.1371/journal.pntd.0002427

Abstract
Background
All four serotypes of dengue virus are endemic in Indonesia, where the population at risk for infection exceeds 200 million people. Despite continuous control efforts that were initiated more than four decades ago, Indonesia still suffers from multi-annual cycles of dengue outbreak and dengue remains as a major public health problem. Dengue vaccines have been viewed as a promising solution for controlling dengue in Indonesia, but thus far its potential acceptability has not been assessed.

Methodology/Principal Findings
We conducted a household survey in the city of Bandung, Indonesia by administering a questionnaire to examine (i) acceptance of a hypothetical pediatric dengue vaccine; (ii) participant’s willingness-to-pay (WTP) for the vaccine, had it not been provided for free; and (iii) whether people think vector control would be unnecessary if the vaccine was available. A proportional odds model and an interval regression model were employed to identify determinants of acceptance and WTP, respectively. We demonstrated that out of 500 heads of household being interviewed, 94.2% would agree to vaccinate their children with the vaccine. Of all participants, 94.6% were willing to pay for the vaccine with a median WTP of US$1.94. In addition, 7.2% stated that vector control would not be necessary had there been a dengue vaccination program.

Conclusions/Significance
Our results suggest that future dengue vaccines can have a very high uptake even when delivered through the private market. This, however, can be influenced by vaccine characteristics and price. In addition, reduction in community vector control efforts may be observed following vaccine introduction but its potential impact in the transmission of dengue and other vector-borne diseases requires further study.

Science Translational Medicine
25 September 2013 vol 5, issue 204
http://stm.sciencemag.org/content/current

Editorial – POLICY
Vaccine Economics: What Price Human Life?
http://stm.sciencemag.org/content/5/204/204ed16.full
John J. Mekalanos

In the age of Google “Images,” a few keystrokes reveal the forgotten human experience in the prevaccination era of public health. With only a few search terms—such as polio iron lungs, tetanus spasms, smallpox scars, or meningitis amputations—we receive vivid reminders of the horrendous price of ignorance, paid before we knew how to prevent infectious diseases through vaccination campaigns and childhood immunization. Therefore, it is more than a little ironic when we are told that we cannot “afford” a needed vaccine despite the fact that it will save lives.

Such a telling tale has surfaced in the UK. The UK Joint Committee on Vaccination and Immunisation (JCVI)—which recommends vaccines for inclusion in the country’s childhood immunization program—failed to recommend a recently approved vaccine against bacterial meningitis primarily on the basis of a fallacious argument of low cost-effectiveness (1). The committee’s action undermines an unheralded guideline that has served science and society for nearly a century: We must develop and deploy vaccines to prevent death and alleviate human suffering, rather than have the anticipated cost benefits drive the process.

The new trend, epitomized by the recent JCVI opinion, prioritizes health care outcomes in economic rather than humanistic terms. This represents a type of health care rationing that threatens not only our immediate well-being but also the long-term viability of an essential business sector—vaccine development and manufacturing. Would anyone be surprised if vaccine developers began to seek more fruitful areas of investment?

COURAGE AND CONSEQUENCES
On 24 July 2013, JCVI chose not to recommend for routine use in the UK a vaccine called 4CMenB (licensed in Europe as Bexsero by Novartis) (1), which very likely protects against a highly infectious form of invasive meningococcal disease (IMD) called MenB. Some 10,000 cases of this bacterial infection occurred in the UK over the past decade, resulting in ~500 deaths and 5000 victims who suffer long-term disabilities ranging from brain damage to limb amputations (2).

The world burden of MenB is high, particularly in developing countries. Vaccines developed for other forms of IMD are highly effective and have virtually eliminated the disease where they have been introduced and thus have saved countless lives and limbs. The approach used to make earlier non-MenB vaccines (that is, polysaccharide protein conjugation) cannot be applied to MenB because of immunological cross-reaction of the MenB polysaccharide antigen with human polysaccharides. 4CMenB is the first of a new generation of nonconjugate vaccines that are predicted to be protective by inducing bactericidal antibodies to nonpolysaccharide protein surface determinants of the meningococcus—a property that led in part to its licensure in Europe.

The 4CMenB vaccine is safe, but JCVI chose to focus its analysis largely on (i) the vaccine’s cost-effectiveness and (ii) the design of the human clinical studies performed to determine the vaccine’s ability to protect specifically against MenB. JCVI stated that the 4CMenB vaccine is not cost-effective at any price—meaning that even if a company provided the vaccine for free, the cost of vaccine implementation alone would exceed the value of the vaccine to society. The ability of vaccines to prevent disease has traditionally been determined in clinical trials. But because the occurrence of MenB in the developed world is low and epidemics are hard to predict, classical placebo-controlled clinical trials to determine the ability of 4CMenB to protect against MenB are virtually impossible to conduct. Much larger, population-based studies would be needed to define the vaccine’s efficacy, duration of protection, and ability to induce herd immunity (the concept that even unvaccinated individuals benefit because their vaccinated neighbors slow or prevent spread of the microbe in their community). However, such post-deployment studies presuppose that advisory agencies have the courage to recommend a needed and safe vaccine for implementation in a public health setting without prioritizing economic arguments to support the decision.

COSTLY DECISIONS
Most importantly, why is cost-benefit analysis driving the 4CMenB decision at all? Some might argue that we can accurately determine the value of young human lives and assess the impact of death and disability using purely economic concepts and algorithms. However, the criteria and mechanisms we use to estimate the value of preventive medical care in general, and vaccine implementation in particular, need more careful scrutiny and debate (3, 4). Such economic criteria are not routinely applied to the implementation of therapies that extend life marginally for patients with terminal illnesses frequently associated with aging. For example, we have no qualms about administering expensive treatments such as surgery and chemotherapy to some very sick cancer patients who will likely see only a minor extension of their life span at best. Sick adults have strong and loud political advocates that make insurers pick up the bill; healthy (but at-risk) children have far fewer. Clearly a disproportionate amount of our health care dollars goes to end-of-life care. If health care is a zero-sum game, then the societal benefit of such expenditures should be scrutinized no less rigorously than that of an efficacious new vaccine.

In the end, how should society value a young life? Although the absolute numbers of deaths and disabilities prevented by a MenB vaccine might be modest in comparison with other infectious diseases, the humanistic impact is immeasurable. Parents who have lost a young child to MenB or who must care for a meningococcal victim suffering from brain damage or multiple amputations are perhaps the best source of information when it comes to determining a reasonable price tag for prevention of such a devastating disease.

Decades ago, the aggressive use of antibiotics led some leading lights to pronounce the imminent elimination of infectious diseases. These opinions drove industry out of the antibiotic-discovery business and further drove many universities to disband their microbiology departments. Tens of millions of annual infectious-disease deaths later, we now know better: Week after week, news articles chronicle examples of the imminent threat of drug-resistant and emerging pathogens. There is no reason to assume that we will be spared from future new threats that require intervention in the form of vaccines, arguably the most effective public health measure ever put into practice.

The 4CMenB vaccine story is a watershed event in the field of vaccinology in that a badly needed vaccine is being effectively blocked by a policy driven by hypothetical financial concerns of cost-effectiveness. This vaccine took 17 years to develop, and its approval in Europe by regulatory agencies analogous to the U.S. Food and Drug Administration underscores the validity of the science that predicts the vaccine’s utility in saving lives. JCVI should consider carefully the effect that its recommendations have on enterprises that protect human health. Such decisions send shock waves through the very industries we must sustain for the public good, as no government agency or academic institution is currently equipped to step into the breach. Vaccinology is not like photography, in which new digital formats simply displaced old Kodachrome film in a matter of a few years. Technological replacements for traditional vaccines such as genetic immunization are nowhere on the horizon. Vaccines have prevented the loss of countless lives and have alleviated human suffering well beyond the capabilities of economists to measure in numerical terms. Policies that block access to vaccines or prioritize vaccine-development efforts purely on the basis of economic considerations are both ethically and strategically flawed.

References
:: JCVI interim position on use of Bexsero meningococcal B vaccine in the United Kingdom (July 2013); available at www.gov.uk/government/publications/jcvi-interim-position-statement-on-the-use-of-bexsero-meningococcal-b-vaccine-in-the-uk.
Invasive meningococcal infections (England and Wales), annual report for 2011/12. Health Protection Report 7, numbers 18–22 (2013); available at www.hpa.org.uk/hpr/archives/2013/hpr18-2213.pdf.
R. Moxon, M. D. Snape
The price of prevention: What now for immunisation against meningococcus B? Lancet 382, 369–370 (2013).
CrossRefMedlineWeb of Science
S. Black
The role of health economic analyses in vaccine decision making. Vaccine, published online 20 August 2013
CrossRefMedline

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

Geographic variation in human papillomavirus vaccination uptake among young adult women in the United States during 2008–2010
M Rahman, TH Laz, AB Berenson – Vaccine, 2013
Abstract Very little is known about geographic variation in human papillomavirus (HPV) vaccine uptake among young adult women in the US. To investigate this, we analyzed data from 12 US states collected through the Behavioral Risk Factor Surveillance System …

Social Justice and HIV Vaccine Research in the Age of Pre-Exposure Prophylaxis and Treatment as Prevention.
TC Bailey, J Sugarman – Current HIV research, 2013
The advent of treatment as prevention (TasP) and pre-exposure prophylaxis (PrEP) as means of HIV prevention raises issues of justice concerning how most fairly and equitably to apportion resources in support of the burgeoning variety of established HIV treatment and …

Highly Divergent Types 2 and 3 Vaccine-Derived Polioviruses Isolated from Sewage in Tallinn, Estonia
H Al-Hello, J Jorba, S Blomqvist, R Raud, O Kew… – Journal of Virology, 2013
ABSTRACT Highly divergent vaccine-derived polioviruses (VDPVs) have been isolated from sewage in Tallinn, Estonia, since 2002. Sequence analysis of VDPVs of serotypes 2 and 3 showed that they shared common noncapsid region recombination sites, indicating

Specialized program newsletters, online publications
Op.ti.mize
PATH-WHO
Issue #17 │ September 2013
http://e2.ma/message/x58uf/tm7peb
pdf: http://e2.ma/click/x58uf/tm7peb/5nkyqb

The Huffington Post
http://www.huffingtonpost.com/
Accessed 28 September 2013

Innovation in the Name of Global Partnership: What the Private Sector Must Bring to the Post-2015 Development Agenda
Duncan Learmouth, SVP Developing Countries & Market Access, GlaxoSmithKline
http://www.huffingtonpost.co.uk/duncan-learmouth/private-sector-and-global-health_b_3974481.html

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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– 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.
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– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_21 Sep 2013
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– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
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– 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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– 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…
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

The Global Fund to Fight AIDS, Tuberculosis and Malaria announced new results “that show significant gains in the treatment of people living with HIV and in the prevention of mother-to-child transmission of the virus.” The Global Fund results show that 5.3 million people living with HIV are receiving antiretroviral therapy under programs supported by the Global Fund as of 1 July 2013, up from 4.2 million at the end of 2012. The results also show a 21 percent increase in the number of women treated to prevent mother-to-child transmission of HIV, in the first half of 2013. The number of cases of malaria treated grew by 13 percent in the same half-year. Mark Dybul, Executive Director of the Global Fund, said, “These results show that we can have a transformative effect on these diseases by working together. More people affected by HIV today can go to work, send their children to school and lead healthy lives thanks to the hard work of all our partners.”

The increase of 1.1 million people on ARV therapy since late 2012 reflected a significant improvement in the quality of grant management in Nigeria and Malawi, enabling these two countries to fulfill all stringent criteria for inclusion of their national data in the Global Fund’s aggregated results. Zimbabwe also contributed, by significantly raising coverage of ARVs for new patients, to 11 percent of the increase. In the first half of 2013, the number of pregnant women living with HIV who have received a complete course of ARV therapy to prevent transmission to their unborn children under programs supported by the Global Fund grew to 2.1 million from 1.7 million. Four countries accounted for 65 percent of the increase from the end of 2012: Mozambique (28 percent), Zambia (15 percent), Tanzania (12 percent) and Zimbabwe (10 percent). In these countries, efforts in the prevention of mother-to-child transmission have accelerated sharply over the last year.

Full release: 21 September 2013 http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-09-20_Global_Fund_Results_Show_Dramatic_Gains/

   NIH said Phase II clinical trials are underway for an investigational H7N9 avian influenza vaccine candidate. Researchers at nine sites nationwide have begun testing in two concurrent trials sponsored by the National Institute of Allergy and Infectious Diseases (NIAID). The trials “are designed to gather critical information about the safety of the candidate vaccine and the immune system responses it induces when administered at different dosages and with or without adjuvants, substances designed to boost the body’s immune response to vaccination.” Human cases of H7N9 influenza first emerged in China in February 2013, with the majority of reported infections occurring in the spring. As of Aug. 12, 135 confirmed human cases, including 44 deaths, have been reported by WHO. Most of these cases involved people who came into contact with infected poultry.

   Full media release: http://www.nih.gov/news/health/sep2013/niaid-18.htm

Update: Polio this week – As of 18 September 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]

:: The next meeting of the Independent Monitoring Board (IMB) will take place on 1-2 October, in London, UK. The IMB will review latest epidemiology and programme developments, and is expected to issue its report as usual within two weeks of the meeting.
:: Due to the Horn of Africa outbreak, the bulk of polio cases this year (over two-thirds) are in countries which were previously polio-free. In endemic countries, cases are down 40% over the same period last year, indicating progress particularly in Afghanistan and Nigeria.

Nigeria
:: One new WPV1 case was reported in the past week (from Borno), bringing the total number of WPV1 cases for 2013 to 47. The most recent WPV1 case in the country had onset of paralysis on 17 August (from Taraba)…

Horn of Africa
:: Seven new WPV1 cases were reported in the past week, six from Somalia and one from Kenya. The total number of WPV1 cases for 2013 in the Horn of Africa is 185 (169 from Somalia, 15 from Kenya and one from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on 14 August (from Somalia)…

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

Poliovirus detected from environmental samples in Israel and West Bank and Gaza Strip
21 September 2013 – WHO considers the risk of further international spread of wild poliovirus type 1 (WPV1) from Israel to be high. The risk assessment reflects evidence of increasing geographic extent of WPV1 circulation in Israel over a prolonged period of time. Recently,    WPV1 has also been isolated from sewage samples collected by the Palestinian Authority , both in West Bank and the Gaza Strip. No cases of paralytic polio have been reported by Israel or the Palestinian Authority.

Health authorities of Israel and the Palestinian Authority have taken steps to respond to the threat posed by WPV1 circulation by strengthening surveillance for acute flaccid paralysis and increasing the frequency of environmental sample collection. A supplementary immunization activity with bivalent oral polio vaccine (bOPV) is being conducted in Israel since early August, targeting children up to nine years of age to rapidly interrupt WPV1 circulation. As of now, 60 percent of the 1.38 million children targeted in Israel have been vaccinated. Health authorities of the Palestinian Authority are preparing to conduct two supplementary immunization activities with trivalent OPV in the Gaza Strip and in West Bank.

It is important that all polio-free countries, in particular those with frequent travel and contacts with poliovirus-affected countries and areas, strengthen surveillance for cases of acute flaccid paralysis in order to rapidly detect any new virus importations and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.

WHO’s ‘International Travel and Health’ recommends that all travellers to and from poliovirus-affected countries and areas be fully vaccinated against polio. Three countries remain endemic for indigenous transmission of wild poliovirus virus: Afghanistan, Nigeria and Pakistan.   Additionally, in 2013, the Horn of Africa has been affected by an outbreak of wild poliovirus type 1.

http://www.who.int/csr/don/2013_09_20_polio/en/index.html

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

Middle East respiratory syndrome coronavirus (MERS-CoV) – update
21 September 2013 – Two patients earlier reported as laboratory-confirmed with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Italy in the Disease Outbreak News on 2 June 2013 are being reclassified as probable cases.

The reclassification follows further analysis of the laboratory tests performed in May 2013, which has shown that the two cases do not fulfil the current WHO case definition for a “confirmed case” for MERS-CoV. The two cases are the two-year-old girl and a 42-year-old woman who were identified as close contacts of the index case who travelled from Jordan.

A “probable” designation by WHO criteria refers to patients who are considered to have a high likelihood of having been infected with MERS-CoV, but from whom adequate samples could not be obtained for complete testing according to the current criteria established for laboratory confirmation.

http://www.who.int/csr/don/2013_09_20/en/index.html

The Weekly Epidemiological Record (WER) for 21 September 2013, vol. 88, 38 (pp. 401–412) includes:
:: Meeting of the WHO working group on polymerase chain reaction protocols for detecting subtype influenza A viruses – Geneva, July 2013
:: Assessing and mitigating the risks of wild poliovirus outbreaks in polio-free African countries, January 2012–July 2013

http://www.who.int/entity/wer/2013/wer8838.pdf

Report: A Roadmap for Promoting Women’s Economic Empowerment
United Nations Foundation and the ExxonMobil Foundation
http://womeneconroadmap.org/

Research has demonstrated that when women are economically empowered, entire communities benefit. Yet until now, there has been a crucial knowledge gap regarding the most effective interventions to advance women’s economic opportunities. The report identifies interventions that are proven, promising or have a high potential to increase productivity and earnings for different groups of women in diverse country contexts.

Eighteen research studies were commissioned to help identify the most effective interventions to empower women economically across four categories of employment – entrepreneurship, farming, wage employment and young women’s employment. Some of the commissioned studies conducted new data analyses while others reviewed existing evidence – analyzing available evidence on the effectiveness, cost-effectiveness and sustainability of programs. The project includes a total of 136 published empirical evaluations.

Emerging Infectious Diseases
Volume 19, Number 10—October 2013
http://www.cdc.gov/ncidod/EID/index.htm

Research
Emergence of Vaccine-derived Polioviruses, Democratic Republic of Congo, 2004–2011
Nicksy Gumede , Olivia Lentsoane, Cara C. Burns, Mark Pallansch, Esther de Gourville, Riziki Yogolelo, Jean Jacques Muyembe-Tamfum, Adrian Puren, Barry D. Schoub, and Marietjie Venter
Author affiliations: National Institute for Communicable Diseases, Johannesburg, South Africa (N. Gumede, O. Lentsoane, A. Puren, B.D. Schoub, M. Venter); University of Witwatersrand, Johannesburg (N. Gumede, B.D. Schoub); University of Pretoria, Pretoria, South Africa (M. Venter); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.C. Burns, M. Pallansch); World Health Organization, Geneva, Switzerland (E. de Gourville); National Institute for Biomedical Research, Kinshasa/Gombe, Democratic Republic of Congo (R. Yogolelo, J.J. Muyembe-Tamfum)
http://wwwnc.cdc.gov/eid/article/19/10/13-0028_article.htm

Abstract
Polioviruses isolated from 70 acute flaccid paralysis patients from the Democratic Republic of Congo (DRC) during 2004–2011 were characterized and found to be vaccine-derived type 2 polioviruses (VDPV2s). Partial genomic sequencing of the isolates revealed nucleotide sequence divergence of up to 3.5% in the viral protein 1 capsid region of the viral genome relative to the Sabin vaccine strain. Genetic analysis identified at least 7 circulating lineages localized to specific geographic regions. Multiple independent events of VDPV2 emergence occurred throughout DRC during this 7-year period. During 2010–2011, VDPV2 circulation in eastern DRC occurred in an area distinct from that of wild poliovirus circulation, whereas VDPV2 circulation in the southwestern part of DRC (in Kasai Occidental) occurred within the larger region of wild poliovirus circulation.

Emerging Infectious Diseases
Volume 19, Number 10—October 2013
http://www.cdc.gov/ncidod/EID/index.htm

Declining Influenza Vaccination Coverage among Nurses, Hong Kong, 2006–2012
Shui Shan Lee, Ngai Sze Wong, and Sing Lee
http://wwwnc.cdc.gov/eid/article/19/10/pdfs/13-0195.pdf

Seasonal influenza vaccination of nurses in Hong Kong fell from 57% in 2005 to 24% in 2012, paralleling concern for adverse reactions associated with vaccination. Decreased acceptance of vaccination was most prominent among nurses who had less work experience and more frequent contact with patients.

Eurosurveillance
Volume 18, Issue 38, 19 September 2013
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Rapid communications
Insidious reintroduction of wild poliovirus into Israel, 2013
by E Anis, E Kopel, SR Singer, E Kaliner, L Moerman, J Moran-Gilad, D Sofer, Y Manor, LM Shulman, E Mendelson, M Gdalevich, B Lev, R Gamzu, I Grotto

Pertussis immunisation and control in England and Wales, 1957 to 2012: a historical review
by G Amirthalingam, S Gupta, H Campbell

JAMA   
September 18, 2013, Vol 310, No. 11
http://jama.jamanetwork.com/issue.aspx

Viewpoint
PEPFAR’s Antiprostitution PledgeSpending Power and Free Speech in Tension
Lawrence O. Gostin, JD¹
http://jama.jamanetwork.com/article.aspx?articleid=1733774

Excerpt (per Jama convention)
The United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, which established the President’s Emergency Plan for AIDS Relief (PEPFAR), exemplifies the nation’s extraordinary compassion and generosity—granting $48 billion over the current 5-year period (2009-2013). PEPFAR, however, has mired successive administrations in controversy for politicizing public health. PEPFAR must report to Congress if a country fails to spend at least one-half of its prevention funding to promote “abstinence, delay of sexual début, monogamy, fidelity, and partner reduction.” PEPFAR’s “conscience clause” allows organizations to withhold particular services (eg, condoms) or deny individuals care (eg, based on sexual orientation) if the organization has a moral or religious objection.

Journal of Infectious Diseases
Volume 208 Issue 8 October 15, 2013
http://jid.oxfordjournals.org/content/current

Immunogenicity of Quadrivalent HPV Vaccine Among Girls 11 to 13 Years of Age Vaccinated Using Alternative Dosing Schedules: Results 29 to 32 Months After Third Dose
D. Scott LaMontagne1,2, Vu Dinh Thiem3, Vu Minh Huong1,2, Yuxiao Tang1,2 and Kathleen M. Neuzil1,2

Abstract
Background.  Immune response to quadrivalent human papillomavirus (HPV) vaccine delivered at 0, 2, and 6 months in young adolescent females plateaus around 24 months after immunization. Antibody levels >24 months postvaccination using extended dosing schedules is unknown.

Methods. We conducted a follow-up immunogenicity study of adolescent girls in Vietnam who participated in a noninferiority trial to investigate whether immune responses using 3 alternative dosing schedules (0, 3, 9 months; 0, 6, 12 months; or 0, 12, 24 months) are noninferior to the standard schedule at >2 years after immunization.

Results.  Quadrivalent HPV vaccine immunogenicity delivered on 3 alternative dosing schedules was noninferior for types 6, 11, 16, and 18 at 32 months post-dose 3 compared to the standard schedule. Pre-dose 3 antibody levels for the 0, 12, 24 month schedule were similar to those measured 32-months post-dose 3.

Conclusions. We found similar antibody concentrations ≥29 months after 3 doses of HPV vaccine regardless of dose-timing, and extended schedules do not produce inferior immune responses. Our findings also suggested that 2 doses of HPV vaccine delivered at 0 and 12 months might afford similar protection. Evidence supporting dosing flexibility could be important for national HPV vaccination policies.

The Lancet  
Sep 21, 2013  Volume 382  Number 9897  p999 – 1070
http://www.thelancet.com/journals/lancet/issue/current

Patterns in coverage of maternal, newborn, and child health interventions: projections of neonatal and under-5 mortality to 2035
Dr Neff Walker PhD a, Gayane Yenokyan PhD b, Ingrid K Friberg PhD a, Jennifer Bryce EdD a
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961748-1/abstract

Summary
Background
Urgent calls have been made for improved understanding of changes in coverage of maternal, newborn, and child health interventions, and their country-level determinants. We examined historical trends in coverage of interventions with proven effectiveness, and used them to project rates of child and neonatal mortality in 2035 in 74 Countdown to 2015 priority countries.

Methods
We investigated coverage of all interventions for which evidence was available to suggest effective reductions in maternal and child mortality, for which indicators have been defined, and data have been obtained through household surveys. We reanalysed coverage data from 312 nationally-representative household surveys done between 1990 and 2011 in 69 countries, including 58 Countdown countries. We developed logistic Loess regression models for patterns of coverage change for each intervention, and used k-means cluster analysis to divide interventions into three groups with different historical patterns of coverage change. Within each intervention group, we examined performance of each country in achieving coverage gains. We constructed models that included baseline coverage, region, gross domestic product, conflict, and governance to examine country-specific annual percentage coverage change for each group of indicators. We used the Lives Saved Tool (LiST) to predict mortality rates of children younger than 5 years (henceforth, under 5) and in the neonatal period in 2035 for Countdown countries if trends in coverage continue unchanged (historical trends scenario) and if each country accelerates intervention coverage to the highest level achieved by a Countdown country with similar baseline coverage level (best performer scenario).

Results
Odds of coverage of three interventions (antimalarial treatment, skilled attendant at birth, and use of improved sanitation facilities) have decreased since 1990, with a mean annual decrease of 5·5% (SD 2·7%). Odds of coverage of four interventions—all related to the prevention of malaria—have increased rapidly, with a mean annual increase of 27·9% (7·3%). Odds of coverage of other interventions have slowly increased, with a mean annual increase of 5·3% (3·5%). Rates of coverage change varied widely across countries; we could not explain the differences by measures of gross domestic product, conflict, or governance. On the basis of LiST projections, we predicted that the number of Countdown countries with an under-5 mortality rate of fewer than 20 deaths per 1000 livebirths per year would increase from four (5%) of the 74 in 2010, to nine (12%) by 2035 under the historical trends scenario, and to 15 (20%) under the best performer scenario. The number of countries with neonatal mortality rates of fewer than 11 per 1000 livebirths per year would increase from three (4%) in 2010, to ten (14%) by 2035 under the historical trends scenario, and 67 (91%) under the best performer scenario. The number of under-5 deaths per year would decrease from an estimated 7·6 million in 2010, to 5·4 million (28% decrease) if historical trends continue, and to 2·3 million (71% decrease) under the best performer scenario.

Interpretation
Substantial reductions in child deaths are possible, but only if intensified efforts to achieve intervention coverage are implemented successfully within each of the Countdown countries.

Funding
The Bill & Melinda Gates Foundation.

The Lancet  
Sep 21, 2013  Volume 382  Number 9897  p999 – 1070
http://www.thelancet.com/journals/lancet/issue/current

The unfinished agenda in child survival
Jennifer Bryce EdD a  Prof Cesar G Victora MD b, Prof Robert E Black MD a
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961753-5/abstract

Summary
10 years ago, The Lancet published a Series about child survival. In this Review, we examine progress in the past decade in child survival, with a focus on epidemiology, interventions and intervention coverage, strategies of health programmes, equity, evidence, accountability, and global leadership. Knowledge of child health epidemiology has greatly increased, and although more and better interventions are available, they still do not reach large numbers of mothers and children. Child survival should remain at the heart of global goals in the post-2015 era. Many countries are now making good progress and need the time and support required to finish the task. The global health community should show its steadfast commitment to child survival by amassing knowledge and experience as a basis for ever more effective programmes. Leadership and accountability for child survival should be strengthened and shared among the UN system; governments in high-income, middle-income, and low-income countries; and non-governmental organisations.

The Lancet  
Sep 21, 2013  Volume 382  Number 9897  p999 – 1070
http://www.thelancet.com/journals/lancet/issue/current

Redefining global health-care delivery
Jim Yong Kim MD a, Paul Farmer MD b, Michael E Porter PhD c
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961047-8/abstract

Summary
Initiatives to address the unmet needs of those facing both poverty and serious illness have expanded significantly over the past decade. But many of them are designed in an ad-hoc manner to address one health problem among many; they are too rarely assessed; best practices spread slowly. When assessments of delivery do occur, they are often narrow studies of the cost-effectiveness of a single intervention rather than the complex set of them required to deliver value to patients and their families. We propose a framework for global health-care delivery and evaluation by considering efforts to introduce HIV/AIDS care to resource-poor settings. The framework introduces the notion of care delivery value chains that apply a systems-level analysis to the complex processes and interventions that must occur, across a health-care system and over time, to deliver high-value care for patients with HIV/AIDS and cooccurring conditions, from tuberculosis to malnutrition. To deliver value, vertical or stand-alone projects must be integrated into shared delivery infrastructure so that personnel and facilities are used wisely and economies of scale reaped. Two other integrative processes are necessary for delivering and assessing value in global health: one is the alignment of delivery with local context by incorporating knowledge of both barriers to good outcomes (from poor nutrition to a lack of water and sanitation) and broader social and economic determinants of health and wellbeing (jobs, housing, physical infrastructure). The second is the use of effective investments in care delivery to promote equitable economic development, especially for those struggling against poverty and high burdens of disease. We close by reporting our own shared experience of seeking to move towards a science of delivery by harnessing research and training to understand and improve care delivery.

Medical Decision Making (MDM)
October 2013; 33 (7)
http://mdm.sagepub.com/content/current

Too Much of a Good Thing? When to Stop Catch-Up Vaccination
David W. Hutton, PhD, Margaret L. Brandeau, PhD
Department of Health Management and Policy, University of Michigan, Ann Arbor (DWH)
Department of Management Science and Engineering, Stanford University, Stanford, California (MLB)

Abstract
During the 20th century, deaths from a range of serious infectious diseases decreased dramatically due to the development of safe and effective vaccines. However, infant immunization coverage has increased only marginally since the 1960s, and many people remain susceptible to vaccine-preventable diseases. “Catch-up vaccination” for age groups beyond infancy can be an attractive and effective means of immunizing people who were missed earlier. However, as newborn vaccination rates increase, catch-up vaccination becomes less attractive: the number of susceptible people decreases, so the cost to find and vaccinate each unvaccinated person may increase; in addition, the number of infected individuals decreases, so each unvaccinated person faces a lower risk of infection. This article presents a general framework for determining the optimal time to discontinue a catch-up vaccination program. We use a cost-effectiveness framework: we consider the cost per quality-adjusted life year gained of catch-up vaccination efforts as a function of newborn immunization rates over time and consequent disease prevalence and incidence. We illustrate our results with the example of hepatitis B catch-up vaccination in China. We contrast results from a dynamic modeling approach with an approach that ignores the impact of vaccination on future disease incidence. The latter approach is likely to be simpler for decision makers to understand and implement because of lower data requirements.

The Pediatric Infectious Disease Journal
October 2013 – Volume 32 – Issue 10  pp: e383-e413,1045-1158
http://journals.lww.com/pidj/pages/currenttoc.aspx

Prospective Surveillance Study of Invasive Pneumococcal Disease Among Urban Children in the Philippines
Capeding, Maria Rosario; Bravo, Lulu; Santos, Jaime; et al

Abstract
Background: Worldwide, invasive pneumococcal disease (IPD) causes considerable morbidity and mortality among children, but incidence data in Asia are lacking. This 2-year hospital-based, prospective, surveillance study was conducted at 3 study sites in urban areas of the Philippines to estimate IPD and pneumonia incidence in children and describe the serotype distribution of invasive Streptococcus pneumoniae isolates.

Methods: Children aged 28 days to <60 months residing within the 3 surveillance areas presenting with possible IPD were enrolled. Initial diagnosis, history of pneumococcal vaccine receipt and previous antimicrobial treatment were recorded. Blood specimens were collected for S. pneumoniae identification and serotyping. Final diagnosis was determined for hospitalized subjects, subjects whose culture yielded S. pneumoniae and subjects with clinically suspected meningitis.

Results: A total of 5940 subjects were enrolled, 47 IPD cases identified. IPD site rates were 33.49 per 100,000, 25.38 per 100,000 and 25.85 per 100,000. Chest radiograph-confirmed pneumonia incidence ranged from 633.74 to 1683.59 per 100,000. Highest chest radiograph-confirmed pneumonia incidence occurred in those 28 days to <6 months of age at 2 sites (2166.16 and 3891.94 per 100,000) and those 6–12 months of age at the third site (3847.52 per 100,000). Thirty-five S. pneumoniae isolates were serotyped; most commonly identified were serotypes 1, 2, 5, 6B, 14 and 18F. One serotype 14 isolate was erythromycin resistant. Previous antibiotic therapy was documented in 17–53% of subjects; 2 subjects had received pneumococcal vaccine. At 2 sites, one-third of IPD subjects died.

Conclusions: IPD is an important cause of morbidity and mortality among urban children in the Philippines. Our data support the expectation that widespread immunization would decrease IPD disease burden

PLoS One
[Accessed 21 September 2013]
http://www.plosone.org/

Enhancement of Collective Immunity in Tokyo Metropolitan Area by Selective Vaccination against an Emerging Influenza Pandemic
Masaya M. Saito, Seiya Imoto, Rui Yamaguchi, Masaharu Tsubokura, Masahiro Kami, Haruka Nakada, Hiroki Sato, Satoru Miyano, Tomoyuki Higuchi
Research Article | published 18 Sep 2013 | PLOS ONE 10.1371/journal.pone.0072866

Abstract
Vaccination is a preventive measure against influenza that does not require placing restrictions on social activities. However, since the stockpile of vaccine that can be prepared before the arrival of an emerging pandemic strain is generally quite limited, one has to select priority target groups to which the first stockpile is distributed. In this paper, we study a simulation-based priority target selection method with the goal of enhancing the collective immunity of the whole population. To model the region in which the disease spreads, we consider an urban area composed of suburbs and central areas connected by a single commuter train line. Human activity is modelled following an agent-based approach. The degree to which collective immunity is enhanced is judged by the attack rate in unvaccinated people. The simulation results show that if students and office workers are given exclusive priority in the first three months, the attack rate can be reduced from in the baseline case down to 1–2%. In contrast, random vaccination only slightly reduces the attack rate. It should be noted that giving preference to active social groups does not mean sacrificing those at high risk, which corresponds to the elderly in our simulation model. Compared with the random administration of vaccine to all social groups, this design successfully reduces the attack rate across all age groups.

PLoS One
[Accessed 21 September 2013]
http://www.plosone.org/

Research Article
Patterns of Rotavirus Vaccine Uptake and Use in Privately-Insured US Infants, 2006–2010
Catherine A. Panozzo, Sylvia Becker-Dreps, Virginia Pate, Michele Jonsson Funk, Til Stürmer,
David J. Weber, M. Alan Brookhart
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0073825

Abstract
Rotavirus vaccines are highly effective at preventing gastroenteritis in young children and are now universally recommended for infants in the US. We studied patterns of use of rotavirus vaccines among US infants with commercial insurance. We identified a large cohort of infants in the MarketScan Research Databases, 2006–2010. The analysis was restricted to infants residing in states without state-funded rotavirus vaccination programs. We computed summary statistics and used multivariable regression to assess the association between patient-, provider-, and ecologic-level variables of rotavirus vaccine receipt and series completion. Approximately 69% of 594,117 eligible infants received at least one dose of rotavirus vaccine from 2006–2010. Most infants received the rotavirus vaccines at the recommended ages, but more infants completed the series for monovalent rotavirus vaccine than pentavalent rotavirus vaccine or a mix of the vaccines (87% versus 79% versus 73%, P<0.001). In multivariable analyses, the strongest predictors of rotavirus vaccine series initiation and completion were receipt of the diphtheria, tetanus and acellular pertussis vaccine (Initiation: RR=7.91, 95% CI= 7.69–8.13; Completion: RR=1.26, 95% CI=1.23–1.29), visiting a pediatrician versus family physician (Initiation: RR=1.51, 95% CI=1.49–1.52; Completion: RR=1.13, 95% CI=1.11–1.14), and living in a large metropolitan versus smaller metropolitan, urban, or rural area. We observed rapid diffusion of the rotavirus vaccine in routine practice; however, approximately one-fifth of infants did not receive at least one dose of vaccine as recently as 2010. Interventions to increase rotavirus vaccine coverage should consider targeting family physicians and encouraging completion of the vaccine series.

Science        
20 September 2013 vol 341, issue 6152, pages 1313-1420
http://www.sciencemag.org/current.dtl

Perspective – Immunology
Pasteur Approach to a Malaria Vaccine May Take the Lead
Michael F. Good
+ Author Affiliations
Institute for Glycomics, Griffith University, Gold Coast 4222, Australia.
Malaria is an infectious disease that is responsible for more loss of young lives than any other health condition. Eighty percent of the cases and nearly 1 million deaths from malaria occur in Africa each year. Although mortality has decreased in recent years, more must be done to improve and save the lives of sufferers. On page 1359 of this issue, Seder et al. (1) report that an attenuated form of the causative parasite can be administered intravenously and provide protection against malaria, taking us a step closer to achieving the goal of an effective vaccine.

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Protection Against Malaria by Intravenous Immunization with a Nonreplicating Sporozoite Vaccine
Robert A. Seder, Lee-Jah Chang, Mary E. Enama, Kathryn L. Zephir, Uzma N. Sarwar, Ingelise J. Gordon, LaSonji A. Holman, Eric R. James, Peter F. Billingsley, Anusha Gunasekera, Adam Richman, Sumana Chakravarty, Anita Manoj, Soundarapandian Velmurugan, MingLin Li, Adam J. Ruben, Tao Li, Abraham G. Eappen, Richard E. Stafford, Sarah H. Plummer, Cynthia S. Hendel, Laura Novik, Pamela J. M. Costner, Floreliz H. Mendoza, Jamie G. Saunders, Martha C. Nason, Jason H. Richardson, Silas A. Davidson, Thomas L. Richie, Martha Sedegah, Awalludin Sutamihardja, Gary A. Fahle, Kirsten E. Lyke, Matthew B. Laurens, Mario Roederer, Kavita Tewari, Judith E. Epstein, B. Kim Lee Sim, Julie E. Ledgerwood, Barney S. Graham, Stephen L. Hoffman, and the VRC 312 Study Team
Science 20 September 2013: 1359-1365.
Published online 8 August 2013 [DOI:10.1126/science.1241800]
http://www.sciencemag.org/content/341/6152/1359.abstract
Abstract
Consistent, high-level, vaccine-induced protection against human malaria has only been achieved by inoculation of Plasmodium falciparum (Pf) sporozoites (SPZ) by mosquito bites. We report that the PfSPZ Vaccine—composed of attenuated, aseptic, purified, cryopreserved PfSPZ—was safe and wel-tolerated when administered four to six times intravenously (IV) to 40 adults. Zero of six subjects receiving five doses and three of nine subjects receiving four doses of 1.35 × 105 PfSPZ Vaccine and five of six nonvaccinated controls developed malaria after controlled human malaria infection (P = 0.015 in the five-dose group and P = 0.028 for overall, both versus controls). PfSPZ-specific antibody and T cell responses were dose-dependent. These data indicate that there is a dose-dependent immunological threshold for establishing high-level protection against malaria that can be achieved with IV administration of a vaccine that is safe and meets regulatory standards.

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

[HTML] The Effectiveness of Conjugate Haemophilus influenzae type b (Hib) Vaccine in The Gambia 14 years after Introduction
SRC Howie, C Oluwalana, O Secka, S Scott, RC Ideh… – Clinical Infectious Diseases, 2013
Background. The Gambia was the first country in Africa to introduce Conjugate Hib vaccine, which like other developing countries but unlike industrialised countries is delivered as 3-dose primary series with no booster. This study assessed its effectiveness 14 years post- …

[HTML] Patterns of Rotavirus Vaccine Uptake and Use in Privately-Insured US Infants, 2006–2010
CA Panozzo, S Becker-Dreps, V Pate, MJ Funk… – PLOS ONE, 2013
Abstract Rotavirus vaccines are highly effective at preventing gastroenteritis in young children and are now universally recommended for infants in the US. We studied patterns of use of rotavirus vaccines among US infants with commercial insurance. We identified a …

Evaluation of an Intervention Providing HPV Vaccine in Schools
BW Stubbs, CA Panozzo, JL Moss, PL Reiter… – American Journal of Health …, 2014
Objectives: To conduct outcome and process evaluations of school-located HPV vaccination clinics in partnership with a local health department. Methods: Temporary clinics provided the HPV vaccine to middle school girls in Guilford County, North Carolina, in 2009-2010. …

Cost-effectiveness of the vaccine against human papillomavirus in the Brazilian Amazon region
AJ Fonseca, LCL Ferreira, GB Neto – Revista da Associação Médica Brasileira, 2013
Objective To assess the cost-utility of the human papillomavirus (HPV) vaccination on the prevention of cervical cancer in the Brazilian Amazon region. Methods A Markov cohort model was developed to simulate the natural evolution of HPV and its progress to cervical …

The risk of Guillain-Barré syndrome after influenza vaccination
MP Walberg – 2013 … When patients with a preceding gastrointestinal or respiratory illness were controlled for, only 5 cases of GBS were noted in almost 7 million influenza vaccine recipients. … 8. CDC. Interim adjusted estimates of influenza vaccine effectiveness — United States, February 2013. …

Maternal Underestimation of Child’s Sexual Experience: Suggested Implications for HPV Vaccine Uptake at Recommended Ages
N Liddon, SL Michael, P Dittus, LE Markowitz – Journal of Adolescent Health, 2013
Purpose Despite official recommendation for routine HPV vaccination of boys and girls at age 11–12 years, parents and providers are more likely to vaccinate their children/patients at older ages. Preferences for vaccinating older adolescents may be related to beliefs …

BBC
http://www.bbc.co.uk/
Accessed 21 September 2013

Way opened for Pandemrix swine flu jab compensation
Excerpt
Four families have been told they can apply for government compensation over side-effects of the Pandemrix swine flu vaccine.

Studies have shown the jab increased the risk of narcolepsy tenfold.

Families could be entitled to £120,000 through the Vaccine Damage Payments Scheme if they can prove “severe” disability.

If the bid fails they and other families could still pursue compensation through the courts.

Pandemrix was the most widely used flu vaccine in the UK during the 2009-10 pandemic.    Almost six million doses were given, one million to young children.

However, evidence from across Europe has suggested a higher rate of narcolepsy in children after being given the jab.

Approximately one in 55,000 children vaccinated – about 20 in the UK – were thought to have developed narcolepsy…

http://www.bbc.co.uk/news/health-24172715

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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Center for Vaccine Ethics and Policy
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Associate Faculty, Division of Medical Ethics, NYU Medical School