The Global Fund said it appointed Kate Thomson as “Head of the Critical Enablers and Civil Society hub,” a new position that “underlines the Global Fund’s strengthened efforts to promote human rights and deeper partnership with civil society.” Ms. Thomson joins the Global Fund from UNAIDS, and “brings extensive experience in policy and advocacy, having worked within civil society organizations and multilateral institutions with a particular emphasis on people living with HIV and communities at higher risk,” the announcement noted.
Security Council Press Statement on POLIO VACCINATION IN SUDAN
11 October 2013
SC/11145 AFR/2719 UN Security Council
The following Security Council press statement was issued today by Council President Agshin Mehdiyev ( Azerbaijan):
On 10 October, the United Nations Security Council was briefed by the Under Secretary-General for Peacekeeping, Hervé Ladsous, and United Nations Interim Security Force in Abyei Force Commander, Major General Yohannes Tesfamariam, on the situation in Sudan and South Sudan.
The members of the Security Council expressed alarm and grave concern at the imminent threat of the spread of polio through South Kordofan, and the continuing outbreak of polio in the Horn of Africa. According to the United Nations Office for the Coordination of Humanitarian Affairs, this threat affects more than 165,000 children in South Kordofan and Blue Nile due to a lack of immunization in the border area in more than two years. Failure to vaccinate exacerbates the risk of the further spread of the disease which the international community has made great strides to eliminate.
The members of the Security Council called upon the Government of Sudan and the Sudan People’s Liberation Movement-North to urgently resolve differences over the technical plans necessary, including for safe passage, to implement the polio vaccination campaign, as proposed by the United Nations Office for the Coordination of Humanitarian Affairs, United Nations Children’s Fund and the World Health Organization, as soon as possible in order for the two-week vaccination campaign to go forward in South Kordofan and Blue Nile on 5 November as planned. The members of the Security Council reiterated their support for the United Nations’ work in this regard and encouraged the Secretary-General to engage with both sides to ensure full vaccination in the coming weeks.
Update: Polio this week – As of 9 October 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: All 43 circulating vaccine derived poliovirus (cVDPV) polio cases this year are type 2 (cVDPV2) with the majority reported from Asia (Pakistan 29, Afghanistan 3). Most of these cases (22) are from North Waziristan in the Federally Administered Tribal Areas (FATA), Pakistan. The bulk of the remaining cVDPV2 cases (10) are from Chad and an area in and around the connecting borders of Cameroon, Chad, Niger and Nigeria. One case was reported from Somalia in January.
:: The Independent Monitoring Board met 1-2 October in London, UK. The IMB reviewed the latest epidemiology and programme developments. The next IMB report is expected to be issued within two weeks of the meeting..
:: Three new WPV1 cases were reported in the past week. All were reported from FATA (one from North Waziristan and two from Khyber). The total number of WPV1 cases for Pakistan in 2013 is now 39. The most recent WPV1 case had onset of paralysis on 10 September (from North Waziristan).
:: The majority of WPV1 cases in Pakistan this year, 27 (69%), are from FATA, of which 11 are from North Waziristan and 12 from Khyber.
:: Five new cVDPV2 cases were reported in the past week. All are from North Waziristan. The total number of cVDPV2 cases for Pakistan is now 29. The majority of Pakistan’s cVDPV2 cases, 23 (79%), come from FATA, of which all but one are from North Waziristan. The latest cVDPV2 case had onset of paralysis 12 September (from North Waziristan).
:: The situation in North Waziristan is particularly concerning, as it is in an area where immunization activities have been suspended by local leaders since June 2012. 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.
:: NIDs were conducted on 30 September to 2 October targeted 34.5 million children with tOPV.
Horn of Africa
:: The three cases reported from South Sudan in the previous week triggered a full outbreak response from a GPEI operational perspective. South Sudan has launched an immediate response covering children up to 15 years of age in the infected areas, targeting 544,000 children. This will be followed by a SNID and three NIDs using bOPV by the end of year. The last WPV in the country occurred in 2009 in Eastern Equatoria, an area connected with Kakuma refugee camp in northern Kenya with a large Somali population.
:: At risk countries have been put on alert. Sudan will synchronize its October SNID with South Sudan, and SIAs are on-going in Uganda.
:: Because of routes of poliovirus spread in previous Horn of Africa outbreaks, both Ethiopia and South Sudan were already considered at ‘high risk’ this year, and have been conducting immunization campaigns since the current Horn of Africa outbreak was first confirmed in May 2013.
:: Ethiopia and Somalia have deployed permanent vaccination points at all major entry points.
:: Outbreak response in Somalia and Kenya is continuing, as well as in other areas of the greater Horn of Africa, notably in Yemen. Yemen conducted a SNID in 5-8 October, targeting 65% of the country’s children. The next SNID in Yemen is planned for December. Somalia will conduct an all-age campaign covering the whole country from 20 October…
WHO: Global Alert and Response (GAR) – Disease Outbreak News
Yellow fever in Cameroon
8 October 2013 – The Ministry of Health of Cameroon carried out a yellow fever mass vaccination campaign with a reported 94% coverage of the targeted population of 663 900 in 13 health districts considered to be at high risk of yellow fever.
The vaccination campaign was carried out between 27 August to 1 September 2013 in the Littoral Region, following laboratory-confirmation of two cases with yellow fever in the area in April 2013. The index case was a 43-year-old woman from Ndom Health district who became ill on 15 March 2013.
The patients were laboratory confirmed at the Institute Pasteur of Cameroon by IgM ELISA (antibody) test, which was followed by the seroneutralizing test (PRNT) for yellow fever by the Institute Pasteur in Dakar, Senegal, a WHO regional reference laboratory for yellow fever.
In 2012, suspected cases were reported from the South-West area which includes North-West, South-West and West regions. These cases were identified as part of the surveillance system which identifies patients with fever and jaundice within the 14 days of onset.
WHO country office has been working with the health authorities in the field investigation and response to the outbreak. There is ongoing surveillance for yellow fever in the country.
GAVI Alliance and the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG1) supported the reactive mass vaccination campaign which covered over 663 900 people in 13 health districts considered to be at high risk for yellow fever, namely Dibombari, Edea, Loum, Manjo, Manoka, Mbanga, Melong, Ndom, Ngambe, Nkondjock, Nkongsamba, Pouma and Yabass.
1The YF-ICG is a partnership that manages the stockpile of yellow fever vaccines for emergency response on the basis of a rotation fund. It is represented by United Nations Children’s Fund (UNICEF), Médecins Sans Frontières (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO, which also serves as the Secretariat. The stockpile was created by GAVI Alliance.
The Weekly Epidemiological Record (WER) for 11 October 2013, vol. 88, 41 (pp. 437–448) includes:
:: Recommended composition of influenza virus vaccines for use in the 2014 southern hemisphere influenza season
Analysis: The State of the Poor – Where Are The Poor, Where Is Extreme Poverty Harder to End, and What Is the Current Profile of the World’s Poor?
World Bank – Pedro Olinto, Kathleen Beegle, Carlos Sobrado, and Hiroki Uematsu
October 2013 – Number 125
Report Finds 400 Million Children Living in Extreme Poverty new study
Although the world witnessed an unprecedented pace of poverty reduction over the last decades, reducing the number of people living in extreme poverty by more than 700 million, approximately 1.2 billion people remained entrenched in destitution in 2010.1 In order to leverage developing country efforts and galvanize the international development community to exert concerted effort to end extreme poverty, the World Bank has established the twin goals of ending extreme poverty by 2030 and promoting shared prosperity by fostering income growth of the bottom 40 percent of the population in every country. Ending extreme poverty in just one generation is a formidable challenge by all accounts that requires a thorough understanding of the state of the poor.
American Journal of Public Health
Volume 103, Issue 11 (November 2013)
Modern Cholera in the Americas: An Opportunistic Societal Infection
Rodrigo Cerda, Patrick T. Lee
American Journal of Public Health: November 2013, Vol. 103, No. 11: 1934–1937.
In the Americas, the only two cholera epidemics of the past century have occurred in the past 25 years.
Lessons from the 1991 Peruvian cholera epidemic can help to focus and refine the response to the current Haitian epidemic. After three years of acute epidemic response, we have an opportunity to refocus on the chronic conditions that make societies vulnerable to cholera.
More importantly, even as international attention wanes in the aftermath of the earthquake and acute epidemic, we are faced with a need for continued and coordinated investment in improving Haiti’s structural defenses against cholera, in particular access to improved water and sanitation.
American Journal of Public Health
Volume 103, Issue 11 (November 2013)
Linking Research to Global Health Equity: The Contribution of Product Development Partnerships to Access to Medicines and Research Capacity Building
Bridget Pratt, Bebe Loff
American Journal of Public Health: November 2013, Vol. 103, No. 11: 1968–1978.
Certain product development partnerships (PDPs) recognize that to promote the reduction of global health disparities they must create access to their products and strengthen research capacity in developing countries.
We evaluated the contribution of 3 PDPs—Medicines for Malaria Venture, Drugs for Neglected Diseases Initiative, and Institute for One World Health—according to Frost and Reich’s access framework. We also evaluated PDPs’ capacity building in low- and middle-income countries at the individual, institutional, and system levels.
We found that these PDPs advance public health by ensuring their products’ registration, distribution, and adoption into national treatment policies in disease-endemic countries. Nonetheless, ensuring broad, equitable access for these populations—high distribution coverage; affordability, particularly for the poor; and adoption at provider and end-user levels—remains a challenge.
American Journal of Tropical Medicine and Hygiene
October 2013; 89 (4)
Perspective Piece – ASTMH Presidential Address
Eyes on the Prize: Lessons from the Cholera Wars for Modern Scientists, Physicians, and Public Health Officials
Edward T. Ryan
Am J Trop Med Hyg 2013 89:610-614; doi:10.4269/ajtmh.13-0173
AJTMH and PAHO: Commemorating the 3rd Anniversary of the Cholera Outbreak in Haiti: Invited Papers
Cholera Elimination in Hispaniola
Carissa F. Etienne, Jordan W. Tappero, Barbara J. Marston, Thomas R. Frieden, Thomas A. Kenyon, and Jon K. Andrus
Am J Trop Med Hyg 2013 89:615-616; doi:10.4269/ajtmh.13-0510
Use of Oral Cholera Vaccine in Haiti: A Rural Demonstration Project
Am J Trop Med Hyg 2013 89:617-624; doi:10.4269/ajtmh.13-0183
Louise C. Ivers, Jessica E. Teng, Jonathan Lascher, Max Raymond, Jonathan Weigel, Nadia Victor, J. Gregory Jerome, Isabelle J. Hilaire, Charles P. Almazor, Ralph Ternier, Jean Cadet, Jeannot Francois, Florence D. Guillaume, and Paul E. Farmer
Predictors of Disease Severity in Patients Admitted to a Cholera Treatment Center in Urban Haiti
Am J Trop Med Hyg 2013 89:625-632; doi:10.4269/ajtmh.13-0170
Claude-Lyne Valcin, Karine Severe, Claudia T. Riche, Benedict S. Anglade, Colette Guiteau oise, Michael Woodworth, Macarthur Charles, Zhongze Li, Patrice Joseph, Jean W. Pape, and Peter F. Wright
Modeling the Effect of Water, Sanitation, and Hygiene and Oral Cholera Vaccine Implementation in Haiti
Isaac Chun-Hai Fung, David L. Fitter, Rebekah H. Borse, Martin I. Meltzer, and Jordan W. Tappero
Am J Trop Med Hyg 2013 89:633-640; doi:10.4269/ajtmh.13-0201
Laboratory-Confirmed Cholera and Rotavirus among Patients with Acute Diarrhea in Four Hospitals in Haiti, 2012–2013
Maria W. Steenland, Gerard A. Joseph, Mentor Ali Ber Lucien, Nicole Freeman, Marisa Hast, Benjamin L. Nygren, Eyal Leshem, Stanley Juin, Michele B. Parsons, Deborah F. Talkington, Eric D. Mintz, John Vertefeuille, S. Arunmozhi Balajee, Jacques Boncy, and Mark A. Katz
Am J Trop Med Hyg 2013 89:641-646; doi:10.4269/ajtmh.13-0307
Access to Safe Water in Rural Artibonite, Haiti 16 Months after the Onset of the Cholera Epidemic
Molly Patrick, David Berendes, Jennifer Murphy, Fabienne Bertrand, Farah Husain, and Thomas Handzel
Am J Trop Med Hyg 2013 89:647-653; doi:10.4269/ajtmh.13-0308
Seroepidemiologic Survey of Epidemic Cholera in Haiti to Assess Spectrum of Illness and Risk Factors for Severe Disease
Brendan R. Jackson, Deborah F. Talkington, James M. Pruckler, M. D. Bernadette Fouché, Elsie Lafosse, Benjamin Nygren, Gerardo A. Gómez, Georges A. Dahourou, W. Roodly Archer, Amanda B. Payne, W. Craig Hooper, Jordan W. Tappero, Gordana Derado, Roc Magloire, Peter Gerner-Smidt, Nicole Freeman, Jacques Boncy, Eric D. Mintz, and the Cholera Serosurvey Working Group
Am J Trop Med Hyg 2013 89:654-664; doi:10.4269/ajtmh.13-0208
Water, Sanitation and Hygiene in Haiti: Past, Present, and Future
Richard Gelting, Katherine Bliss, Molly Patrick, Gabriella Lockhart, and Thomas Handzel
Am J Trop Med Hyg 2013 89:665-670; doi:10.4269/ajtmh.13-0217
Cholera Vaccination in Urban Haiti
Vanessa Rouzier, Karine Severe, Marc Antoine Jean Juste, Mireille Peck, Christian Perodin, Patrice Severe, Marie Marcelle Deschamps, Rose Irene Verdier, Sabine Prince, Jeannot Francois, Jean Ronald Cadet, Florence D. Guillaume, Peter F. Wright, and Jean W. Pape
Am J Trop Med Hyg 2013 89:671-681; doi:10.4269/ajtmh.13-0171
Development of a Cholera Vaccination Policy on the Island of Hispaniola, 2010–2013
Andrea S. Vicari, Cuauhtémoc Ruiz-Matus, Ciro de Quadros, and Jon K. Andrus
Am J Trop Med Hyg 2013 89:682-687; doi:10.4269/ajtmh.13-0200
Implementation of an Alert and Response System in Haiti during the Early Stage of the Response to the Cholera Epidemic
Patricia Santa-Olalla, Michelle Gayer, Roc Magloire, Robert Barrais, Marta Valenciano, Carmen Aramburu, Jean Luc Poncelet, Juan Carlos Gustavo Alonso, Dana Van Alphen, Florence Heuschen, Roberta Andraghetti, Robert Lee, Patrick Drury, and Sylvain AldighieriAm J Trop Med Hyg 2013 89:688-697; doi:10.4269/ajtmh.13-0267
Cost Effectiveness and Resource Allocation
(Accessed 12 October 2013)
Balancing efficiency, equity and feasibility of HIV treatment in South Africa – development of programmatic guidance
Baltussen R, Mikkelsen E, Tromp N, Hurtig AK, Byskov J, Olsen Ø, Bærøe K, Hontelez JA et al. Cost Effectiveness and Resource Allocation 2013, 11:26 (9 October 2013
South Africa, the country with the largest HIV epidemic worldwide, has been scaling up treatment since 2003 and is rapidly expanding its eligibility criteria. The HIV treatment programme has achieved significant results, and had 1.8 million people on treatment per 2011. Despite these achievements, it is now facing major concerns regarding (i) efficiency: alternative treatment policies may save more lives for the same budget; (ii) equity: there are large inequalities in who receives treatment; (iii) feasibility: still only 52% of the eligible population receives treatment.
Hence, decisions on the design of the present HIV treatment programme in South Africa can be considered suboptimal. We argue there are two fundamental reasons to this. First, while there is a rapidly growing evidence-base to guide priority setting decisions on HIV treatment, its included studies typically consider only one criterion at a time and thus fail to capture the broad range of values that stakeholders have. Second, priority setting on HIV treatment is a highly political process but it seems no adequate participatory processes are in place to incorporate stakeholders’ views and evidences of all sorts.
We propose an alternative approach that provides a better evidence base and outlines a fair policy process to improve priority setting in HIV treatment. The approach integrates two increasingly important frameworks on health care priority setting: accountability for reasonableness (A4R) to foster procedural fairness, and multi-criteria decision analysis (MCDA) to construct an evidence-base on the feasibility, efficiency, and equity of programme options including trade-offs. The approach provides programmatic guidance on the choice of treatment strategies at various decisions levels based on a sound conceptual framework, and holds large potential to improve HIV priority setting in South Africa.
Special Issue: Civil societies at crossroads: eruptions, initiatives, and evolution in citizen activism
This Special Issue has grown from the sense that important changes in the last two decades pose dilemmas and challenges for civil societies in many countries. The Issue reports on a series of studies of the evolving roles of civil society sectors and citizen initiatives in several regions of the world. This introduction identifies a series of events and forces that over the last two decades have fundamentally changed the contexts of civil society activities in many countries. These changes have catalyzed a wide range of citizen eruptions and initiatives on particular issues as well as national civil society evolutions in many countries. The papers in this Special Issue have resulted from a multi-country collective reflection organized by five civil society support organizations from different regions. They sought to identify roles, capacities, contributions, and limitations of civil society in these changing contexts using a variety of approaches to data collection and analysis. This introduction briefly describes the papers in the Special Issue. They include regional overviews, descriptions of national sector evolution, and cases of citizen activism in Southern and Eastern Africa, Asia, Southern Latin America, Western Europe and Russia. The final paper provides an overview of the lessons learned from comparative analysis across these and other cases and draws some of the implication of those lessons for practitioners and policy makers.
Volume 18, Issue 41, 10 October 2013
Hajj pilgrims’ knowledge about Middle East respiratory syndrome coronavirus, August to September 2013
by P Gautret, S Benkouiten, I Salaheddine, K Belhouchat, T Drali, P Parola, P Brouqui
In preparation for Hajj 2013, 360 French pilgrims were interviewed regarding their knowledge about Middle East respiratory syndrome (MERS). Respondents were aged 20–85 years, male-female ratio was 1.05:1; 64.7% were aware of the MERS situation in Saudi Arabia; 35.3% knew about the Saudi Ministry of Health recommendations for at-risk pilgrims to postpone participation in the 2013 Hajj. None of 179 at-risk individuals (49.9%) decided to cancel their Hajj participation even after advice during consultation.
Health Policy and Planning
Volume 28 Issue 7 October 2013
Access to medicines from a health system perspective
Health Policy Plan. (2013) 28 (7): 692-704 doi:10.1093/heapol/czs108
Maryam Bigdeli, Bart Jacobs, Goran Tomson, Richard Laing, Abdul Ghaffar, Bruno Dujardin, and Wim Van Damme
Most health system strengthening interventions ignore interconnections between systems components. In particular, complex relationships between medicines and health financing, human resources, health information and service delivery are not given sufficient consideration. As a consequence, populations’ access to medicines (ATM) is addressed mainly through fragmented, often vertical approaches usually focusing on supply, unrelated to the wider issue of access to health services and interventions. The objective of this article is to embed ATM in a health system perspective. For this purpose, we perform a structured literature review: we examine existing ATM frameworks, review determinants of ATM and define at which level of the health system they are likely to occur; we analyse to which extent existing ATM frameworks take into account access constraints at different levels of the health system. Our findings suggest that ATM barriers are complex and interconnected as they occur at multiple levels of the health system. Existing ATM frameworks only partially address the full range of ATM barriers. We propose three essential paradigm shifts that take into account complex and dynamic relationships between medicines and other components of the health system. A holistic view of demand-side constraints in tandem with consideration of multiple and dynamic relationships between medicines and other health system resources should be applied; it should be recognized that determinants of ATM are rooted in national, regional and international contexts. These are schematized in a new framework proposing a health system perspective on ATM.
Health Policy and Planning
Volume 28 Issue 7 October 2013
For-profit sector immunization service provision: does low provision create a barrier to take-up?
Neeraj Sood and Zachary Wagner
Health Policy Plan. (2013) 28 (7): 730-738 doi:10.1093/heapol/czs113
Achievement of the health-related Millennium Development Goals is dependent on increasing take-up of preventive public health services (PHSs) in developing countries. Poor country governments often lack the resources to provide optimal access to preventive services and a great deal of attention is being directed towards the private sector to fill this void. In many developing countries, the private sector already plays a large role in health care. However, the for-profit private sector has little incentive to provide PHSs. The lack of provision of services by the for-profit sector may create a barrier to take-up of these services. In this study, we use data from a census of health facilities combined with data from community and provider surveys from Kenya to analyse whether the private for-profit sector has lower provision rates of child immunization services, and subsequently whether this creates a barrier that results in lower immunization take-up. We show that only 34% of for-profit facilities provide immunizations and that in areas with a larger share of for-profit providers, children are more likely to have no immunization coverage. Our model predicts that the odds of a child receiving no immunization coverage are 4.8 times higher in areas where all health facilities are for-profit compared to areas with no for-profit facilities. This indicates that a policy of engagement with the private for-profit sector aimed at increasing provision of immunization services may be an effective strategy for increasing take-up.
Journal of Infectious Diseases
Volume 208 suppl 1 November 1, 2013
Supplement: Cholera in Africa: Microbiology, Epidemiology, Prevention and Control
Editorial Committee Introduction
Martin Mengel1, Eric Mintz2, Gopinath Balakrish Nair3 and Bradford D. Gessner1
1 Agence de Medecine Preventive, Paris, France
2 US Centers for Disease Control and Prevention, Atlanta, Georgia
3 National Institute of Cholera and Enteric Diseases, Kolkata, India
The current supplement presents an overview of cholera disease burden and critical issues for the diagnosis, detection, prevention, and control of cholera in Africa. In 2013, the seventh cholera pandemic reached its 43rd year in Africa, with no evidence that it will end soon. More than 20 African countries have reported cholera to the World Health Organization (WHO) every year between 2007 and 2012, including large recent epidemics in the Democratic Republic of Congo (DRC), Sierra Leone, Uganda, Ghana, Niger, and Guinea .
In the current supplement, articles from individual countries highlight the human toll of cholera, including more than 200 000 cases and 7000 deaths in DRC from 2000 through 2008 ; 68 000 cases and 2600 deaths in Kenya from 1998 through 2010 ; 28 000 cases and 1300 deaths in Cameroon from 2010 through 2011 ; 25 000 cases and 220 deaths in Mozambique from 2009 through 2011 ; and more than 12 000 cases and 500 deaths in Togo from 1996 through 2010 . Two patterns emerge from these reports. The first is endemic, as in DRC, where cholera has occurred continuously in specific regions with an increase in the number of outbreaks during the rainy season. The second pattern is epidemic or outbreak driven, as in Mozambique, where many districts have been affected over relatively short periods, separated by prolonged quiescent periods. Although factors such as climate might increase outbreak risk, in these settings it remains difficult to predict the specific districts or communities that will be affected during any given year.
Difficulties in interpreting country-level data exist. Most African countries currently rely on reporting of aggregate data from the district level, whose completeness remains unknown. This could lead to serious underestimation of …
Oct 12, 2013 Volume 382 Number 9900 p1225 – 1308 e11 – 20
Mapping of available health research and development data: what’s there, what’s missing, and what role is there for a global observatory?
Prof John-Arne Røttingen MD a b c, Sadie Regmi BSc d, Mari Eide e, Alison J Young MA f, Roderik F Viergever MD g h, Christine Årdal MBA a i, Javier Guzman MD j, Danny Edwards MBioeth k, Stephen A Matlin DSc l, Robert F Terry MPhil m
The need to align investments in health research and development (R&D) with public health demands is one of the most pressing global public health challenges. We aim to provide a comprehensive description of available data sources, propose a set of indicators for monitoring the global landscape of health R&D, and present a sample of country indicators on research inputs (investments), processes (clinical trials), and outputs (publications), based on data from international databases. Total global investments in health R&D (both public and private sector) in 2009 reached US$240 billion. Of the US$214 billion invested in high-income countries, 60% of health R&D investments came from the business sector, 30% from the public sector, and about 10% from other sources (including private non-profit organisations). Only about 1% of all health R&D investments were allocated to neglected diseases in 2010. Diseases of relevance to high-income countries were investigated in clinical trials seven-to-eight-times more often than were diseases whose burden lies mainly in low-income and middle-income countries. This report confirms that substantial gaps in the global landscape of health R&D remain, especially for and in low-income and middle-income countries. Too few investments are targeted towards the health needs of these countries. Better data are needed to improve priority setting and coordination for health R&D, ultimately to ensure that resources are allocated to diseases and regions where they are needed the most. The establishment of a global observatory on health R&D, which is being discussed at WHO, could address the absence of a comprehensive and sustainable mechanism for regular global monitoring of health R&D.
Volume 502 Number 7470 pp141-264 10 October 2013
Epidemiology: A mortal foe
Drug development: A combined effort
Perspective: Graduation time
David G. Russell & Carl F. Nathan
Vaccines: An age-old problem
Diagnosis: Waiting for results
Catherine de Lange
Perspective: Weigh all TB risks
Christopher Dye & Mario Raviglione
Latency: A sleeping giant
Transmission: Control issues
October 2013, Volume 19 No 10 pp1191-1350
Focus on 2013 Albert Lasker Medical Research Awards – An interview with Bill and Melinda Gates – pp1249 – 1251
Bill and Melinda Gates have led a profound transformation in the way we view the world’s most pressing health concerns, looking for effective ways to improve the lives of millions of people. Claire Pomeroy, president of the Albert and Mary Lasker Foundation, spoke with them about their current concerns and plans to advance their agenda.
Volume 31, Issue 10, October 2013
National regulatory agencies often have to use cost-effectiveness (CE) data from multinational randomized controlled trials (RCTs) for national decision making on reimbursement of new drugs. We need to make the best use of these patient-level data to obtain estimates of country-specific CE. Several methods, ranging from simple to statistically complex, have existed for years. We investigated which of these methods are used to estimate CE ratios in economic evaluations performed alongside recent, multinational RCTs that enrolled at least 500 patients.
In this systematic literature review, studies were classified based on whether resource use, unit costs, health outcomes and utility value sets were obtained from all countries, a subset of countries or one country. We recorded if the study presented trial-wide and country-specific CE results and reported the statistical analyses that were used to estimate them.
We included 21 studies, of which the majority used measurements of health care utilization and health outcomes from all countries to estimate CE. Thirteen studies used a one-country valuation of health care utilization; six used a multi-country valuation. Despite the availability of country-specific utility value sets, none of the studies that presented quality-adjusted life-years (QALYs) used multi-country valuation. Valuation of health care utilization and health outcomes was not always consistent within a study: three studies combined a multi-country valuation of health care utilization, with a one-country valuation of health outcomes. Most studies calculated trial-wide CE estimates, while 11 studies calculated country- or region-specific estimates. Thirteen studies used relatively simple methods, which do not take the possible interaction between the country and treatment effect on health care utilization and health outcomes into account. Eight studies used more advanced statistical methods. Three of them used a fixed-effects modeling approach. Five studies explicitly took the hierarchical structure of the data into account, which leads to more appropriate estimates of population average results and associated standard errors. In this way, they help improve transferability of the published results.
Based on this systematic review, we concluded that the uptake of more advanced statistical methods has been relatively slow, while simpler naïve methods are still routinely employed.
[Accessed 12 October 2013]
Vaccination against Foot-And-Mouth Disease: Do Initial Conditions Affect Its Benefit?
Thibaud Porphyre, Harriet K. Auty, Michael J. Tildesley, George J. Gunn, Mark E. J. Woolhouse Research Article | published 04 Oct 2013 | PLOS ONE 10.1371/journal.pone.0077616
When facing incursion of a major livestock infectious disease, the decision to implement a vaccination programme is made at the national level. To make this decision, governments must consider whether the benefits of vaccination are sufficient to outweigh potential additional costs, including further trade restrictions that may be imposed due to the implementation of vaccination. However, little consensus exists on the factors triggering its implementation on the field. This work explores the effect of several triggers in the implementation of a reactive vaccination-to-live policy when facing epidemics of foot-and-mouth disease. In particular, we tested whether changes in the location of the incursion and the delay of implementation would affect the epidemiological benefit of such a policy in the context of Scotland. To reach this goal, we used a spatial, premises-based model that has been extensively used to investigate the effectiveness of mitigation procedures in Great Britain. The results show that the decision to vaccinate, or not, is not straightforward and strongly depends on the underlying local structure of the population-at-risk. With regards to disease incursion preparedness, simply identifying areas of highest population density may not capture all complexities that may influence the spread of disease as well as the benefit of implementing vaccination. However, if a decision to vaccinate is made, we show that delaying its implementation in the field may markedly reduce its benefit. This work provides guidelines to support policy makers in their decision to implement, or not, a vaccination-to-live policy when facing epidemics of infectious livestock disease.
(Accessed 12 October 2013)
Assessing Optimal Target Populations for Influenza Vaccination Programmes: An Evidence Synthesis and Modelling Study
Marc Baguelin, Stefan Flasche, Anton Camacho, Nikolaos Demiris, Elizabeth Miller, W. John Edmunds
Influenza vaccine policies that maximise health benefit through efficient use of limited resources are needed. Generally, influenza vaccination programmes have targeted individuals 65 y and over and those at risk, according to World Health Organization recommendations. We developed methods to synthesise the multiplicity of surveillance datasets in order to evaluate how changing target populations in the seasonal vaccination programme would affect infection rate and mortality.
Methods and Findings
Using a contemporary evidence-synthesis approach, we use virological, clinical, epidemiological, and behavioural data to develop an age- and risk-stratified transmission model that reproduces the strain-specific behaviour of influenza over 14 seasons in England and Wales, having accounted for the vaccination uptake over this period. We estimate the reduction in infections and deaths achieved by the historical programme compared with no vaccination, and the reduction had different policies been in place over the period. We find that the current programme has averted 0.39 (95% credible interval 0.34–0.45) infections per dose of vaccine and 1.74 (1.16–3.02) deaths per 1,000 doses. Targeting transmitters by extending the current programme to 5–16-y-old children would increase the efficiency of the total programme, resulting in an overall reduction of 0.70 (0.52–0.81) infections per dose and 1.95 (1.28–3.39) deaths per 1,000 doses. In comparison, choosing the next group most at risk (50–64-y-olds) would prevent only 0.43 (0.35–0.52) infections per dose and 1.77 (1.15–3.14) deaths per 1,000 doses.
This study proposes a framework to integrate influenza surveillance data into transmission models. Application to data from England and Wales confirms the role of children as key infection spreaders. The most efficient use of vaccine to reduce overall influenza morbidity and mortality is thus to target children in addition to older adults.
(Accessed 12 October 2013)
The Final Push for Polio Eradication: Addressing the Challenge of Violence in Afghanistan, Pakistan, and Nigeria
Seye Abimbola, Asmat Ullah Malik, Ghulam Farooq Mansoor
:: Polio eradication in Nigeria, Pakistan, and Afghanistan (the three remaining endemic countries) depends on understanding the common determinants and country-specific factors that underlie the failure to eradicate polio in these countries.
:: Our review of the current situation suggests that the global health community and the governments of Afghanistan, Pakistan, and Nigeria need to build trust and to prioritise polio eradication as part of routine health services rather than highlighting it as “the only” health problem.
:: Coercive strategies for making people take the polio vaccine and censorship of discussions around the controversies about polio vaccines need to be avoided.
:: Because polio workers are a newly recognised soft target for anti-West terrorist groups in these countries, the publicity surrounding vaccination activities should be minimised.
:: The global health community and national governments need to work directly with community members and their immediate leaders to dispel myths about polio vaccination rather than engaging only with regional or provincial religious leaders.
Why We Must Provide Better Support for Pakistan’s Female Frontline Health Workers
Svea Closserl, Rashid Jooma
:: As the Global Polio Eradication Initiative deploys its endgame strategy, the commitment and effectiveness of field health workers in polio-endemic countries is critical.
:: Ongoing attacks on Lady Health Workers and other frontline health staff in Pakistan appear to be an unintended consequence of the high political profile of polio eradication.
:: Achieving polio eradication and strengthening Pakistan’s health system now depends on a shift in the center of gravity of international engagement, away from high-profile engagement with federal leaders and towards supportive partnerships with Lady Health Workers and other ground-level staff.
:: Nearly all women who work on the health frontline in Pakistan do so because poverty and a lack of other opportunities force them to accept a job with pay of under US$5 per day.
:: Steps to support Lady Health Workers and to engage them as strong partners should include paying a living wage, developing world-class security strategies, and providing opportunities for career development and advancement.
Vol. L No. 3 2013 September 2013
This issue, which features contributions from twelve leading experts from within and outside of the United Nations system, looks at international migration and development. The articles examine, among other things, lowering the costs and amplifying the benefits of migration; the protection of migrants’ rights and State sovereignty; labour migration and inclusive development; leveraging remittances for development; the reintegration of returning migrants; and strengthening migration cooperation.
Volume 31, Issue 44, Pages 5005-5146 (17 October 2013)
Risks and safety of pandemic H1N1 influenza vaccine in pregnancy: Exposure prevalence, preterm delivery, and specific birth defects
Original Research Article
Carol Louik, Katherine Ahrens, Stephen Kerr, Junhee Pyo, Christina Chambers, Kenneth L. Jones, Michael Schatz, Allen A. Mitchell
We estimated exposure prevalence and studied potential risks for preterm delivery (PTD) and specific birth defects associated with exposure to the unadjuvanted pH1N1-containing vaccines in the 2009–2010 and 2010–2011 influenza seasons.
We used data from 4 regional centers in the United States collected as part of the Slone Epidemiology Center’s Birth Defects Study. For PTD, propensity score-adjusted time-varying hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for exposure anytime in pregnancy and for each trimester. For 41 specific major birth defects, propensity score-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.
Among 4191 subjects, there were 3104 mothers of malformed (cases) and 1087 mothers of nonmalformed (controls). Exposure prevalences among controls were 47% for the 2009–2010 season and 38% for the 2010–2011 season; prevalence varied by geographic region. Results for PTD differed between the two seasons, with risks above and below the null for the 2009–2010 and 2010–2011 seasons, respectively. For 41 specific birth defects, most adjusted ORs were close to 1.0. Three defects had adjusted ORs > 2.0 and four had risks < 0.5; however, 95% CIs for these were wide.
Among women exposed to pH1N1 vaccine, we found a decreased risk for PTD in the 2010–2011 season; risk was increased in 2009–2010, particularly following exposure in the first trimester, though the decrease in gestational length was less than 2 days. For specific major defects, we found no meaningful evidence of increased risk for specific congenital malformations following pH1N1 influenza vaccinations in the 2009–2010 and 2010–2011 seasons.
Volume 31, Issue 44, Pages 5005-5146 (17 October 2013)
Assessment of causality of individual adverse events following immunization (AEFI): A WHO tool for global use
Original Research Article
Alberto E. Tozzi, Edwin J. Asturias, Madhava Ram Balakrishnan, Neal A. Halsey, Barbara Law, Patrick L.F. Zuber
Serious illnesses or even deaths may rarely occur after childhood vaccinations. Public health programs are faced with great challenges to establish if the events presenting after the administration of a vaccine are due to other conditions, and hence a coincidental presentation, rather than caused by the administered vaccines. Given its priority, the Global Advisory Committee for Vaccine Safety (GACVS) commissioned a group of experts to review the previously published World Health Organization (WHO) Adverse Event Following Immunization (AEFI) causality assessment methodology and aide-memoire, and to develop a standardized and user friendly tool to assist health care personnel in the processing and interpretation of data on individual events, and to assess the causality after AEFIs. We describe a tool developed for causality assessment of individual AEFIs that includes: (a) an eligibility component for the assessment that reviews the diagnosis associated with the event and identifies the administered vaccines; (b) a checklist that systematically guides users to gather available information to feed a decision algorithm; and (c) a decision support algorithm that assists the assessors to come to a classification of the individual AEFI. Final classification generated by the process includes four categories in which the event is either: (1) consistent; (2) inconsistent; or (3) indeterminate with respect of causal association; or (4) unclassifiable. Subcategories are identified to assist assessors in resulting public health decisions that can be used for action. This proposed tool should support the classification of AEFI cases in a standardized, transparent manner and to collect essential information during AEFI investigation. The algorithm should provide countries and health officials at the global level with an instrument to respond to vaccine safety alerts, and support the education, research and policy decisions on immunization safety.
Volume 31, Issue 44, Pages 5005-5146 (17 October 2013)
Original Research Article
Sabine Wicker, Holger F. Rabenau, Laura von Gierke, Guido François, Ramona Hambach, Antoon De Schryver
Healthcare personnel (HCP) are at risk from occupational exposure to airborne and bloodborne pathogens, and the risk of infection among HCP is greater than among the general population.
The aim of the study was to characterize attitudes toward occupational recommended vaccines as well as the perception of risks of occupationally acquired infections. We surveyed 650 medical students to assess their perception of influenza and hepatitis B and their opinions and beliefs about influenza and hepatitis B vaccines.
We found differences between pre-clinical and clinical students regarding the uptake of influenza and hepatitis B vaccines, about the chances of being occupationally infected with influenza or hepatitis B, and about the likelihood of suffering from severe side-effects following immunization.
Interestingly, the risk perception varied drastically between the two vaccine-preventable diseases hepatitis B and influenza. Medical students rated the probability of contracting hepatitis B due to a work-related exposure and the severity of disease significantly higher than for influenza, and this may be an explanation for the greater acceptance of the hepatitis B vaccine.
Furthermore, our findings suggest that medical students are frequently inaccurate in assessing their own risk level, and their specific knowledge about both diseases and the severity of these diseases proved to be unsatisfactory.
Volume 31, Issue 44, Pages 5005-5146 (17 October 2013)
Acceptability of human papillomavirus vaccination among male university students in the United Arab Emirates
Original Research Article
Osman Ortashi, Hina Raheel, Jasem Khamis
To assess the knowledge about and acceptability of human papillomavirus (HPV) vaccination among male university students in the United Arab Emirates (UAE).
Between June and August 2012 we approached 356 male university students from the UAE and asked them to fill out a 12-item self-administered questionnaire.
Knowledge of HPV was low among the university students who participated (32%). Less than half of the students (46%) indicated they would accept HPV vaccination, and around 30% were unsure of their decision. Safety (68%), protection of their female partner (65%) and doctor’s recommendation (64%) were rated as the factors most likely to increase the uptake of HPV vaccination among participating students. The factors rated most likely to stop students from using the vaccine were fear of side effects (85%), absence of clear benefits (38%) and objections from a religious authority (25%). Marital status and sexual activity were associated with greater knowledge of HPV but not with greater acceptance of vaccination among university students in the UAE.
Overall acceptability of and knowledge about HPV infection and vaccination were low in a sample of male university students in the UAE. Marital status and sexual activity are associated with greater knowledge of HPV infection but have no effect on the acceptability of HPV vaccination.
Accessed 12 October 2013
Rabies kills 24,000 a year in Africa because vaccine costly: experts
DAKAR | Thu Oct 10, 2013 2:53pm EDT
(Reuters) – Rabies kills 24,000 people a year in Africa, most of them children, because many on the world’s poorest continent cannot afford the cost of the vaccine, experts said on Thursday.
Africa is home to nearly half the 55,000 people around the world who die each year from rabies, caused mainly by bites from dogs contaminated with the virus, according to a conference of experts on the disease in the Senegalese capital Dakar.
Vaccination of humans, as well as dogs and domestic pets, is the only way to prevent the spread of the disease.
“This is the disease of the poorest of the poor who can’t afford the vaccine,” Herve Bourhy, a doctor at France’s Pasteur Institute, told reporters.
An anti-rabies vaccine costs 10 euros per injection and four to five vaccinations are needed to create immunity. For many in poor rural African areas where the disease is endemic, this is prohibitively expensive…
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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David R. Curry, MS
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
Update: Polio this week – As of 02 October 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: Three wild poliovirus type 1 (WPV1) cases were reported from South Sudan this week. Genetic sequencing is underway to determine the origin of the isolated viruses and possible relation to the ongoing Horn of Africa outbreak. The cases are from North Bahr El Gazal state (close to the border to Sudan) and Eastern Equatoria state (close to the border with Kenya and Uganda). The cases have triggered a full outbreak response from the Global Polio Eradication Initiative (GPEI) operational perspective. For more information see the ‘Horn of Africa’ section below.
:: Eight new WPV cases were reported from north-west Pakistan. Seven are from the Federally Administered Tribal Areas (FATA) and one from Khyber Pakhtoon (KP). The majority (67%) of WPV from Pakistan this year are from FATA, the bulk of which are from North Waziristan (10) and Khyber (10).
:: Pakistan’s Prime Minister Nawaz Sharif reasserted Pakistan’s commitment to eradicate polio in a speech at the UN General Assembly on Friday 27 September 2013: “We have also made eradication of polio in Pakistan a matter of great importance for my Government, as we are determined to make Pakistan a polio free country.”
:: The Independent Monitoring Board met 1-2 October in London, UK. The IMB reviewed the latest epidemiology and programme developments. The next IMB report is expected to be issued within two weeks of the meeting…
:: On 26 September, the Polio Oversight Board (POB) met with donors and other key stakeholders to review progress against the GPEI’s Polio Eradication and Endgame Strategic Plan 2013-2018, launched earlier this year…[see full text of statement below]
:: Two new WPV cases were reported from two previously infected districts in the past week. The two cases were reported from Watapur district in Kunar province and Batikot, Nangahar province. The total number of WPV cases for 2013 is now six. All six are WPV1 and all reported from Eastern Region. The most recent WPV1 case had onset of paralysis on 27 August, from Kunar province…
:: Two new WPV cases were reported this week. The cases were reported from two previously infected districts, one from Bauchi Local Government Area (LGA) in Bauchi state and one from Bichi LGA in Kano state. The total number of WPV cases for 2013 is now 49 (all WPV1s). The most recent WPV1 case in the country had onset of paralysis on 10 September (from Kano)
:: Eight new WPV cases were reported in the past week. Seven of the cases were reported from FATA province (five from North Waziristan, one from Khyber and one from a newly infected district – FR Dikhan).
:: One WPV was reported in Peshawar, KP.
:: The total number of WPV1 cases for 2013 is now 36. Of these, the majority, 24 (67%), are from FATA, of which 10 are from North Waziristan and 10 from Khyber…
:: The situation in North Waziristan is 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.
:: The most recent cases in FATA underscore the risk of ongoing polio transmission (be it due to WPV or cVDPV) in this area and the threat it continues to pose to children everywhere, 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.
Chad, Cameroon and Central African Republic
:: …In Cameroon, one new cVDPV2 case was reported in Kolofata, Extreme-Nord in the past week. The total number of cVDPV2 cases for 2013 is now four. The most recent case had onset of paralysis on 12 August (from Extreme-Nord). NIDs are planned for 11-13 October.
:: Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, ongoing insecurity and humanitarian crises, and destruction of health infrastructure. :: To minimize the risk and consequences of potential re-infection, SNIDs were conducted 30 September – 2 October and NIDs are planned for end October.
Horn of Africa
:: Three cases were reported from North Bahr El Gazal and Eastern Equatoria areas over the past week, all three with onset of paralysis between 15-24 August. The new cases have triggered a full country outbreak response from a GPEI operational perspective.
:: South Sudan will launch immediate response covering children up to 15 years of age in the infected areas, targeting 140,000 children. This will be followed by a SNID in mid-October using bivalent oral polio vaccine (bOPV). Two national immunization days (NIDs) were already planned for November and December…
:: One new wild poliovirus case has been reported from the previously infected Somali region of Ethiopia. Onset of paralysis 7 September. No new WPV1 cases were reported from Somalia and Kenya in the past week. The total number of WPV1 cases for 2013 in the Horn of Africa is now 196 (175 from Somalia, 14 from Kenya, four from Ethiopia and three from South Sudan). The most recent WPV1 case in the region had onset of paralysis on 7 September (from Ethiopia).
WHO: Global Alert and Response (GAR) – Disease Outbreak News
Wild poliovirus in the Horn of Africa – update – 1 October 2013
Three suspected cases of wild poliovirus type 1 (WPV1) from South Sudan are currently being investigated. All three patients are girls, two of whom are approximately two-years-old and one is eight-years-old. All had previously been immunized with oral polio vaccine (OPV).
Two of the patients are from North Bahr El Gazal state (close to the border with Sudan), and one is from Eastern Equatorial state (close to the border with Kenya and Uganda). They developed paralysis between 15-24 August 2013. Genetic sequencing is ongoing to provide final confirmation of the laboratory results to determine the origin of the isolated viruses.
The Horn of Africa is currently experiencing an outbreak of WPV1, with 174 cases in Somalia, 14 cases in Kenya and three cases in Ethiopia. Because of the routes of poliovirus spread in previous Horn of Africa outbreaks, South Sudan had been considered at high risk of re-infection. In 2013, South Sudan conducted two National Immunization Days (NIDs) in March 2013 and April 2013, with additional NIDs planned for November 2013 and December 2013. Subnational Immunization Days (SNIDs) were conducted in August 2013.
Contingency plans for an emergency outbreak response are currently being finalized, including an immediate supplementary immunization activity (SIA) in and around the infected areas.
An international team of experts is being deployed to South Sudan, to assist the local authorities in further case investigations, planning for appropriate outbreak response, and further intensifying active searches for additional potential cases….
Statement: Oversight Board reaffirms unflagging commitment
Heads of agencies of the Global Polio Eradication Initiative
30 September 2013
On 26 September, the Polio Oversight Board (POB) – made up of the heads of Global Polio Eradication Initiative (GPEI) partners WHO, UNICEF, Rotary International and the United States Centers for Disease Control and Prevention, and senior leadership of the Bill & Melinda Gates Foundation— met for the first time with donors such as Norway, the US, Canada, Japan and the Islamic Development Bank, and other key stakeholders such as the Nigerian and Pakistani governments and the GAVI Alliance, to review progress against the GPEI’s Polio Eradication and Endgame Strategic Plan 2013-2018, launched earlier this year.
The POB’s mandate is to provide strong, active leadership of the global polio eradication program and to maintain the highest levels of accountability and transparency among the GPEI’s core agencies.
Last September, during the UN General Assembly, United Nations Secretary-General Ban Ki-moon joined heads of state from Afghanistan, Nigeria and Pakistan, as well as donor government officials and donors from the public and private sectors, to commit the political leadership needed to stamp out polio forever. Earlier this year, the World Health Assembly unanimously approved a six-year Polio Eradication and Endgame Strategic Plan to achieve a polio-free world by 2018. World leaders had previously met in Abu Dhabi to pledge US$4 billion in support of the plan, more than three-quarters of its projected cost.
“Today, we reaffirm our agencies’ unflagging commitment to support governments and national authorities to implement the GPEI’s Polio Eradication and Endgame Strategic Plan 2013-2018, and to realize the health benefits polio eradication will bring worldwide.
Last week, we met to review progress on commitments made last year to an emergency approach to complete polio eradication by 2018. We assessed the impact of those commitments, and noted the progress made against the Strategic Plan in the face of serious challenges.
The GPEI’s top priority remains interrupting polio transmission in endemic countries, and success is now largely dependent on eliminating the virus in relatively small geographic areas of Pakistan and Nigeria. We are encouraged that polio cases are down 45 percent in Nigeria, Pakistan and Afghanistan from this point last year. Afghanistan has had the most striking decline, down more than 80% compared to last year, and has recorded just four cases this year. We heard from health ministers from Pakistan and Nigeria about critical actions being taken to address continuing transmission in their countries, including establishing access to those few remaining areas where children have not received the polio vaccine.
Threats of violence against the heroic women and men who deliver polio vaccines remain a serious concern and we discussed the GPEI partner agencies’ and country governments’ responses to the distinct challenges of reaching children in insecure areas, including building trust in high-risk areas by expanding health services and engaging local and religious leaders.
We remain hopeful that the global program is closing in on the elimination of one of the last two remaining types of wild poliovirus (type 3), which has not been detected anywhere in the world in more than 10 months. The upcoming low transmission season (November to April) in countries currently affected by polio transmission will be crucial, and we agreed that endemic country plans could be further refined to capitalize on this unprecedented opportunity.
The outbreak in the Horn of Africa, where more than 190 cases have been reported following importation of the virus earlier this year, and the recent detection of poliovirus in sewage samples in Israel are grave reminders of the ongoing risks to previously polio-free areas of the world if we do not complete eradication. We reviewed measures underway to quickly halt these outbreaks to prevent further spread, and we will evaluate progress and areas of risk again in two months. We also examined the ongoing transmission of poliovirus in Israel following an importation into that country, and discussed the measures being taken to interrupt that transmission and prevent polio cases in Israel and surrounding countries.
The new GPEI Strategic Plan emphasizes strengthening immunization systems and accelerating the introduction of Inactivated Polio Vaccine (IPV). We heard specific plans to leverage the polio infrastructure to improve routine immunization in 10 focus countries. Work is already underway in Nigeria, Ethiopia, the Democratic Republic of the Congo, Chad, India and Pakistan, with the goal of achieving at least 10 percent annual increase in DTP3 coverage in 80% of high-risk districts. Strengthening these systems is critical to halting polio transmission and ensuring delivery of other critical health interventions to the world’s most vulnerable children.
We also reviewed concrete strategies for tackling the major challenge of introducing at least one dose of IPV in more than 100 countries by the end of 2015, which we are pursuing in close coordination with our partners in the GAVI Alliance. These strategies include communicating the rationale for and urgency of IPV introduction to national policy makers and ensuring the availability of appropriate and affordable IPV and Oral Polio Vaccine (OPV) products for all settings.
As leaders of the agencies charged with implementing the GPEI Strategic Plan, we are committed to closely monitoring our organizations’ work and ensuring we are doing everything possible to fulfill the plan’s objectives. The Polio Oversight Board’s stewardship and guidance will be measured against specific operational, financing and human resource metrics that were shared today with donors and key stakeholders. This enhanced accountability will play a critical role in ensuring we achieve a polio-free world by 2018.”
The Global Polio Eradication Initiative (GPEI), launched in 1988, is spearheaded by national governments, the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, and supported by key partners including the Bill & Melinda Gates Foundation.
The GPEI Polio Oversight Board is made up of the heads of agencies of GPEI partners (WHO Director General Dr. Margaret Chan, UNICEF Executive Director Anthony Lake, Rotary International Past President Wilf Wilkinson, and CDC Director Dr. Thomas Frieden) and Bill & Melinda Gates Foundation Global Development President Dr. Chris Elias.
WHO: Lao PDR first S.E. Asian nation to introduce pneumococcal vaccine; launches demonstration project for HPV vaccine.
The Lao People’s Democratic Republic (PDR) became the first South-East Asian nation to introduce pneumococcal vaccine and begin a demonstration project for Human papillomavirus (HPV) vaccine, “simultaneously tackling two major killers of children and women respectively – pneumococcal disease and cervical cancer.” The Lao PDR government will begin vaccinations at a ceremony in Vientiane on Wednesday morning involving hundreds of infants and school girls. About 180,000 infants will receive pneumococcal conjugate vaccine (PCV) and 13,000 girls will receive the HPV vaccine in the next year…
The International Vaccine Access Center (IVAC) appointed Katherine L. O’Brien, MD, MPH, as Executive Director, a year after assuming the role of Acting Director. The announcement noted that Dr. O’Brien is a Professor in the Departments of International Health and Epidemiology at the Bloomberg School, and “brings a wealth of experience as a pediatric infectious disease physician, epidemiologist, and vaccinologist.”
The Roadmap for Childhood TB: Toward Zero Deaths was launched in Washington D.C. by “global TB leaders” including WHO, the International Union Against Tuberculosis and Lung Disease (The Union), Stop TB Partnership, UNICEF, CDC, USAID, and Treatment Action Group (TAG). The group noted that “the deaths of more than 74,000 children from tuberculosis (TB) could be prevented each year through measures outlined in the first ever action plan developed specifically on TB and children, and that “US$120 million per year could have a major impact on saving tens of thousands of children’s lives from TB, including among children infected with both TB and HIV.}
:: Download The Roadmap for Childhood TB: Toward Zero Deaths
:: View the Roadmap online in flipbook format
The Global Fund to Fight AIDS, Tuberculosis and Malaria “congratulated Luxembourg for its decision to commit EUR 7.5 million (US$10.1 million) for 2014-2016, making it one of the most generous donors on a per capita basis.” The Global Fund said the commitment, subject to parliamentary approval, “will effectively unlock an additional US$4 million in contributions from the United States and the United Kingdom, which have geared their own contributions to maximize what is donated by other countries.” http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-10-02_Luxembourg_Commitment_is_Very_Generous_Per_Capita/
The Weekly Epidemiological Record (WER) for 4 October 2013, vol. 88, 40 (pp. 429–436) includes:
:: Outbreak news
– Wild poliovirus in the Horn of Africa
:: Meeting of the International Task Force for Disease Eradication – July 2013
:: WHO Statement on the third meeting of the IHR Emergency committee concerning Middle East respiratory syndrome coronavirus (MERS-CoV)
In 2012, the IOM released Ranking Vaccines: A Prioritization Framework (Phase I: Demonstration of Concept and a Software Blueprint) which offered a framework and proof of concept for a software prototype called SMART Vaccines to account for various factors influencing vaccine prioritization – demographic, economic, health, scientific, business, programmatic, social, policy factors and public concerns. In this report, Ranking Vaccines: A Prioritization Software Tool (Phase II: Prototype of a Decision-Support System) a functional version of SMART Vaccines 1.0 is discussed and elaborated along with its potential application in making decisions about new vaccine development.
BMC Public Health
(Accessed 5 October 2013)
Effect of an educational intervention on HPV knowledge and vaccine attitudes among urban employed women and female undergraduate students in China: a cross-sectional study
Irene J Chang, Rong Huang, Wei He, Shao-Kai Zhang, Shao-Ming Wang, Fang-Hui Zhao, Jennifer S Smith, You-Lin Qiao BMC Public Health 2013, 13:9
Due to the potential of human papillomavirus (HPV) vaccination for decreasing cervical cancer rates in Mainland China, where some of the highest incidences in the world have been reported, our study aimed to assess HPV and HPV vaccine knowledge, and to evaluate the effect of a brief educational intervention on HPV knowledge and vaccine acceptability in Chinese undergraduate students and employed women.
This multi-center, cross-sectional study was conducted across five representative cities of the five main geographical regions of Mainland China. Participants were selected from one comprehensive university and three to four companies in each city for a total of six comprehensive universities and 16 companies. A 62-item questionnaire on HPV knowledge and HPV vaccine acceptability was administered to participants before and after an educational intervention. The intervention consisted of an informative group lecture.
A total of 1146 employed women and 557 female undergraduate students were surveyed between August and November 2011. Baseline HPV knowledge was low among both groups– 320/1146 (28%) of employed women and 66/557 (12%) of students had heard of HPV, while only 237/1146 (21%) of employed women and 40/557 (7.2%) of students knew that HPV is related to cervical cancer. After educational instruction, 947/1061 (89%) of employed women and 193/325 (59%) of students knew the relationship between HPV and cervical cancer (chi2 = 1041.8, p < 0.001 and chi2 = 278.5, p < 0.001, respectively). Post-intervention, vaccine acceptability increased from 881/1146 (77%) to 953/1061 (90%), (p = <0.001) in employed women and 405/557 (73%) in students to 266/325 (82%), (p < 0.001). Women in both groups cited concerns about the HPV vaccine’s safety, efficacy, and limited use to date as reasons for being unwilling to receive vaccination. 502/1146 (44%) of women were willing to vaccinate their children at baseline, which increased to 857/1061 (81%) post-intervention, p < 0.001.
Incorporation of our lecture-based education initiative into a government-sponsored or school-based program may improve HPV-related knowledge and HPV vaccine acceptability. Further studies are needed to evaluate and standardize HPV education programs in China.
BMC Public Health
(Accessed 5 October 2013)
Immunization coverage and predictive factors for complete and age-appropriate vaccination among preschoolers in Athens, Greece: a cross- sectional study
Ioanna D Pavlopoulou, Koralia A Michail, Evangelia Samoli, George Tsiftis, Konstantinos Tsoumakas BMC Public Health 2013, 13:908 (2 October 2013)
In Greece, several new childhood vaccines were introduced recently but were reimbursed gradually and at different time points. The aim of this study was to assess immunization coverage and identify factors influencing complete and age-appropriate vaccination among children attending public nurseries in the municipal district of Athens.
A cross-sectional study, using stratified sampling was performed. Immunization history was obtained from vaccination booklets. Demographic and socioeconomic data were obtained from school registries and telephone interviews. Vaccination rates were estimated by sample weighted proportions while associations between complete and age-appropriate immunization and potential determinants by logistic regression analysis.
A total of 731 children (mean age: 46, median: 48, range: 10–65 months) were included. Overall immunization coverage with traditional vaccines (DTP, polio, Hib, HBV, 1st dose MMR) was satisfactory, exceeding 90%, but the administration of booster doses was delayed (range: 33.7- 97.4%, at 60 months of age). Complete vaccination rates were lower for new vaccines (Men C, PCV7, varicella, hepatitis A), ranging between 61-92%. In addition, a significant delay in timely administration of Men C, PCV7, as well as HBV was noted (22.9%, 16.0% and 27.7% at 12 months of age, respectively). Child’s age was strongly associated with incomplete vaccination with all vaccines (p< 0.001), while as immigrant status was a predictor of incomplete (p=0.034) and delayed vaccination (p<0.001) with traditional vaccines. Increasing household size and higher maternal education were negatively associated with the receipt of all and newly licensed vaccines, respectively (p=0.035).
Our findings highlight the need to monitor uptake of new vaccines and improve age- appropriate administration of booster doses as well as early vaccination against hepatitis B. Immigrant status, increased household size and high maternal education may warrant targeted intervention.
Bulletin of the World Health Organization
Volume 91, Number 10, October 2013, 717-796
Towards a framework convention on global health
Lawrence O Gostin, Eric A Friedman, Kent Buse, Attiya Waris, Moses Mulumba, Mayowa Joel, Lola Dare, Ames Dhai & Devi Sridhar
Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
October 2013 Volume 9, Issue 10
The current state of tuberculosis vaccines
David A. Hokey*, Ann Ginsberg
Tuberculosis continues to persist despite widespread use of BCG, the only licensed vaccine to prevent TB. BCG’s limited efficacy coupled with the emergence of drug-resistant strains of Mycobacterium tuberculosis emphasizes the need for a more effective vaccine for combatting this disease. However, the development of a TB vaccine is hindered by the lack of immune correlates, suboptimal animal models, and limited funding. An adolescent/adult vaccine would have the greatest public health impact, but effective delivery of such a vaccine will require a better understanding of global TB epidemiology, improved infrastructure, and engagement of public health leaders and global manufacturers. Here we discuss the current state of tuberculosis vaccine research and development, including our understanding of the underlying immunology as well as the challenges and opportunities that may hinder or facilitate the development of a new and efficacious vaccine.
Infectious Diseases of Poverty
[Accessed 5 October 2013]
Challenges and needs for China to eliminate rabies
Wenwu Yin, Jie Dong, Changchun Tu, John Edwards, Fusheng Guo, Hang Zhou, Hongjie Yu, Sirenda Vong Infectious Diseases of Poverty 2013, 2:23 (2 October 2013)
October 2013, VOLUME 132 / ISSUE 4
Nonmedical Vaccine Exemptions and Pertussis in California, 2010
Jessica E. Atwell, MPHa, Josh Van Otterloo, MSPHb, Jennifer Zipprich, PhDc, Kathleen Winter, MPHc, Kathleen Harriman, PhD, MPH, RNc, Daniel A. Salmon, PhDa, Neal A. Halsey, MDa, and
Saad B. Omer, MBBS, MPH, PhDb
A Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
B Emory University School of Public Health, Atlanta, Georgia; and
C Immunization Branch, California Department of Public Health, Richmond, California
BACKGROUND: In 2010, 9120 cases of pertussis were reported in California, more than any year since 1947. Although this resurgence has been widely attributed to waning immunity of the acellular vaccine, the role of vaccine refusal has not been explored in the published literature. Many factors likely contributed to the outbreak, including the cyclical nature of pertussis, improved diagnosis, and waning immunity; however, it is important to understand if clustering of unvaccinated individuals also played a role.
METHODS: We analyzed nonmedical exemptions (NMEs) for children entering kindergarten from 2005 through 2010 and pertussis cases with onset in 2010 in California to determine if NMEs increased in that period, if children obtaining NMEs clustered spatially, if pertussis cases clustered spatially and temporally, and if there was statistically significant overlap between clusters of NMEs and cases.
RESULTS: Kulldorff’s scan statistics identified 39 statistically significant clusters of high NME rates and 2 statistically significant clusters of pertussis cases in this time period. Census tracts within an exemptions cluster were 2.5 times more likely to be in a pertussis cluster (odds ratio = 2.47, 95% confidence interval: 2.22–2.75). More cases occurred within as compared with outside exemptions clusters (incident rate ratios = 1.20, 95% confidence interval: 1.10–1.30). The association remained significant after adjustment for demographic factors. NMEs clustered spatially and were associated with clusters of pertussis cases.
CONCLUSIONS: Our data suggest clustering of NMEs may have been 1 of several factors in the 2010 California pertussis resurgence.
(Accessed 5 October 2013)
Methodological and Policy Limitations of Quantifying the Saving of Lives: A Case Study of the Global Fund’s Approach
David McCoy, Nele Jensen, Katharina Kranzer, Rashida A. Ferrand, Eline L. Korenromp
:: A recent trend in global health has been a growing emphasis on assessing the effectiveness and impact of specific health interventions.
:: For example, it has been estimated that 8.7 million lives were saved between 2002 and mid-2012 by “Global Fund–supported programmes” (as distinct from The Global Fund alone) through antiretroviral therapy (ART); directly observed tuberculosis treatment, short course (DOTS); and distribution of insecticide-treated mosquito nets (ITNs).
:: This paper assesses the methods used by The Global Fund to quantify “lives saved,” highlights the uncertainty associated with the figures calculated, and suggests that the methods are likely to overestimate the number of “lives saved.”
:: The paper also discusses how the attribution of “lives saved” to specific programmes or actors might negatively affect the overall governance and management of health systems, and how a narrow focus on just ART, DOTS, and ITNs could neglect other interventions and reinforce vertical programmes.
:: Furthermore, the attribution of “lives saved” to Global Fund–supported programmes is potentially misleading, because such programmes include an unstated degree of financial support from recipient governments and other donors.
Saving Lives in Health: Global Estimates and Country Measurement
Daniel Low-Beer, Ryuichi Komatsu, Osamu Kunii
One of the most compelling reasons for development aid to health is that it saves lives, often for a few hundred dollars per year of life saved. Relatively uniquely in development, health has a set of high-impact interventions that can save lives directly. Insecticide-treated bednets (ITNs) protect families from malaria, antiretrovirals (ARVs) reduce mortality from HIV, and tuberculosis detection and treatment reduce TB mortality. Prevention activities, particularly for HIV, can save millions more lives. Yet, health programs have not always communicated with simple methods the lives they save.
In this week’s PLOS Medicine David McCoy and colleagues discuss the “lives saved” model of The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund). The Global Fund, together with WHO, UNAIDS, and scientists from the article by McCoy and colleagues ,, have published simple peer-reviewed methods to calculate the lives saved from a restricted set of HIV, TB, and malaria interventions that have known mortality outcomes –. Our method includes only those health interventions with known, documented mortality effects: ARV treatment; directly observed treatment, short-course (DOTS); and ITNs. Our methodology uses documented data reported to the Global Fund on the individuals receiving these services. These results are first verified by national disease programs (we invest 5%–10% of our funds to build the capacity of country monitoring and evaluation systems), then by the Global Fund (which uses independent local fund agents to check the national data systems measuring these services every six months), and finally by on-site checks in a sample of health facilities to verify that people receive these services (as part of performance-based funding) .
In addition, the Global Fund’s method applies the agreed, partner mortality estimates and models from WHO and UNAIDS  to these service results—for example, the latest scientific data on how HIV treatment or TB treatment will reduce the chance that a person will die of HIV or TB.
Extensive criteria are used to exclude countries where The Global Fund is not a significant contributor; that is, where The Global Fund does not contribute at least US$50 million; is a significant percentage of HIV, TB, and malaria spending; and does not support a key national-level activity, such as drug procurement. Where this does not occur, as has been the case in Uganda, Kenya, or South Africa in recent years, the results are not included.
The method to assess lives saved provides a conservative estimate. The estimate , does not include the impact of HIV prevention (which in certain countries—e.g., Thailand, Uganda, Kenya, and Zimbabwe—has saved several million lives per country); the impact of malaria outside Africa and among adults; and the significant, secondary impact of DOTS treatment on reducing TB (as shown by the declines in TB prevalence in China, and in TB prevalence by 45% in Cambodia). Furthermore, reporting of services by programs in country are subject to substantial delays before they are reported globally. The most recent scale up in ITNs and ARV treatment are not fully included; for example, the lives saved are only half the number of people reported on ARVs. We do acknowledge the method , has major limitations. Most importantly, it does not directly measure mortality, because in many countries in which we work vital registration systems are too weak, so the method is based on the latest partner estimates of mortality from WHO and UNAIDS.
The article in this week’s PLOS Medicine by David McCoy and colleagues has great value in discussing the assumptions in the methods the Global Fund uses to assess lives saved and the partner estimates—of ARV adherence, use of ITNs, and the limitations of focusing only on a limited set of services. We agree that assumptions require additional sensitivity analysis, and we will update our estimates in 2014 as modeling is refined with new and improved data from country impact evaluations and updated WHO and UNAIDS estimates. We have published more detailed analysis of the ARV, ITN, and DOTS estimates as used by the McCoy and colleagues . Yet, the uncertainty ranges, with the lives saved from ITNs as low as 27,000, were based on very limited data and provided little additional value. We fully agree with the need for increased country data on estimates and mortality assumptions of lives saved. Most importantly, global modeling needs strengthening with wider and deeper country measurement of epidemic trends and lives saved…
4 October 2013 vol 342, issue 6154, pages 1-148
A Risky Science Communication Environment for Vaccines
Dan M. Kahan
Yale Law School, Post Office Box 20815, New Haven, CT 06520, USA.
Controversy over childhood vaccinations is an instance of what might be styled the “science communication problem”—the failure of compelling scientific evidence to resolve public dispute over risks and similar facts (1). This problem itself has been the focus of scientific study since the 1970s, when psychologists began to investigate the divergence between expert and public opinion on nuclear power. Indeed, the science of science communication that this body of work comprises can now be used not just to explain controversy over risk but also to predict, manage, and in theory avoid conditions likely to trigger it. The example of childhood vaccinations illustrates these points—and teaches an important practical lesson.
From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary
[HTML] Preparing for Dengue Vaccine Introduction: Recommendations from the 1st Dengue v2V International Meeting
J Torresi, R Tapia-Conyer, H Margolis – PLOS Neglected Tropical Diseases, 2013
Copyright:© 2013 Torresi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
… Case Series and Misclassification Bias Induced by Case Selection from Administrative Hospital Databases: Application to Febrile Convulsions in Pediatric Vaccine …
C Quantin, E Benzenine, M Velten, F Huet… – American Journal of …, 2013
Abstract Vaccine safety studies are increasingly conducted by using administrative health databases and self-controlled case series designs that are based on cases only. Often, several criteria are available to define the cases, which may yield different positive …
Bias Correction of Risk Estimates in Vaccine Safety Studies With Rare Adverse Events Using a Self-controlled Case Series Design
C Zeng, SR Newcomer, JM Glanz, JA Shoup, MF Daley… – American Journal of …, 2013
Abstract The self-controlled case series (SCCS) method is often used to examine the temporal association between vaccination and adverse events using only data from patients who experienced such events. Conditional Poisson regression models are used to …
Developing an effective breast cancer vaccine: Challenges to achieving sterile immunity versus resetting equilibrium
G Curigliano, C Criscitiello, A Esposito, L Fumagalli… – The Breast, 2013
Discussion Active immunotherapy in breast cancer and its implementation into clinical trials has largely been a frustrating experience in the last decades. After many years of controversy, the concept that the immune system regulates cancer development is …
[PDF] Barriers and Facilitators in the Recruitment and Retention of Peruvian Female Sex Workers in a Randomized HPV Vaccine Trial
N Shroff, B Brown, J Kinsler, A Cabral, MM Blas – J Vaccines Vaccin, 2013
Cervical cancer is the second most common cancer in women worldwide, with 250,000 deaths per year, and persistent human papillomavirus (HPV) infection is found in nearly all cases . Female sex workers (FSWs) are at higher risk of HPV infection and subsequent …
Specialized program newsletters, online publications
RotaFlash: Rotavirus vaccines
2 October 2013
Accessed 5 October 2013
4 October 2013 Last updated at 02:27 ET
A programme to vaccinate schoolchildren against flu has been delayed in Glasgow after concerns from Muslim parents that it contains products derived from pork.
About 100,000 primary school pupils in Scottish health board areas taking part in a pilot programme are being offered the Fluenz vaccine.
It is given as a nasal spray rather than the traditional jab.
But parents in Pollokshields, which has a high number of Muslim pupils, have complained the spray contains gelatine.
A letter sent to Glasgow schools in the wake of concerns cites a World Health Organisation study in 2001 which indicated that Islamic and Jewish scholars had agreed pork gelatine was permissible within a vaccine.
However, NHS Greater Glasgow and Clyde (NHSGGC), whose area contains most of Scotland’s Muslims, said it had put back the rollout of the vaccinations “following concerns raised by a small number of parents”.
The programme is due to resume next week when parents will be offered a choice of the nasal spray or the more traditional jab…
Accessed 5 October 2013
Nigeria’s Kano state targets 3 million for vaccination despite fears of attack by extremists
By Associated Press, Published: October 4
KANO, Nigeria — Nigeria’s northern Kano state is starting to vaccinate 3 million children against polio and measles with tight security because of fears of attack by Islamic extremists.
Militants staging an Islamic uprising in northeastern Nigeria in February killed nine women health workers as they were vaccinating children in a house-to-house campaign in Kano city.
Dr. Shehu Usman Abubakar told The Associated Press on Friday that this time the vaccinations will be administered at 2,700 community centers — apparently ensuring more protection. Abubakar is executive secretary for primary health care.
He said 200 children died of measles in Kano state last year.
UNICEF says Nigeria has almost eradicated crippling polio. But northeast Borno state recorded 14 new cases in recent months. Officials blamed the Islamic insurgency for the lost ground…