Eurosurveillance
Volume 18, Issue 45, 07 November 2013
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Perspectives
Ethics of mandatory vaccination for healthcare workers
E Galanakis 1, A Jansen2, P L Lopalco2, J Giesecke2
1.Department of Paediatrics and Joint Graduate Programme in Bioethics, University of Crete, Heraklion, Greece
2.European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20627

Abstract
Healthcare workers (HCWs) are at increased risk of contracting infections at work and further transmitting them to colleagues and patients. Immune HCWs would be protected themselves and act as a barrier against the spread of infections and maintain healthcare delivery during outbreaks, but vaccine uptake rates in HCWs have often been low. In order to achieve adequate immunisation rates in HCWs, mandatory vaccination policies are occasionally implemented by healthcare authorities, but such policies have raised considerable controversy. Here we review the background of this debate, analyse arguments for and against mandatory vaccination policies, and consider the principles and virtues of clinical, professional, institutional and public health ethics. We conclude that there is a moral imperative for HCWs to be immune and for healthcare institutions to ensure HCW vaccination, in particular for those working in settings with high-risk groups of patients. If voluntary uptake of vaccination by HCWs is not optimal, patients’ welfare, public health and also the HCW’s own health interests should outweigh concerns about individual autonomy: fair mandatory vaccination policies for HCWs might be acceptable. Differences in diseases, patient and HCW groups at risk and available vaccines should be taken into consideration when adopting the optimal policy.

JAMA   
November 6, 2013, Vol 310, No. 17
http://jama.jamanetwork.com/issue.aspx

Viewpoint | November 6, 2013
Managing the Human Toll Caused by Seasonal Influenza: New York State’s Mandate to Vaccinate or Mask
Arthur Caplan, PhD1; Nirav R. Shah, MD, MPH2
http://jama.jamanetwork.com/article.aspx?articleid=1746248

Initial Text [per JAMA convention]
New York State and the nation as a whole experienced one of the worst influenza seasons in a decade during the winter of 2012-2013. In the peak week ending January 19, 2013, New York alone reported more than 5000 cases of laboratory-confirmed influenza, more than 1120 hospitalizations as a result of influenza, and 5 flu-related pediatric deaths. By the season’s end, more than 45 000 cases had been confirmed, more than 9500 people had been hospitalized, and 14 children had died.1…

JAMA Pediatrics
November 2013, Vol 167, No. 11
http://archpedi.jamanetwork.com/issue.aspx

Association Between Undervaccination With Diphtheria, Tetanus Toxoids, and Acellular Pertussis (DTaP) Vaccine and Risk of Pertussis Infection in Children 3 to 36 Months of Age
Jason M. Glanz, PhD; Komal J. Narwaney, MD, PhD; Sophia R. Newcomer, MPH; Matthew F. Daley, MD; Simon J. Hambidge, MD, PhD; Ali Rowhani-Rahbar, MD, PhD; Grace M. Lee, MD, MPH; Jennifer C. Nelson, PhD; Allison L. Naleway, PhD; James D. Nordin, MD, MPH; Marlene M. Lugg, DrPH; Eric S. Weintraub, MPH

Abstract
Importance  Undervaccination is an increasing trend that potentially places children and their communities at an increased risk for serious infectious diseases.

Objective  To examine the association between undervaccination and pertussis in children 3 to 36 months of age.

Design  Matched case-control study with conditional logistic regression analysis.

Setting  Eight managed care organizations of the Vaccine Safety Datalink between 2004 and 2010.

Participants  Each laboratory-confirmed case of pertussis (72 patients) was matched to 4 randomly selected controls (for a total of 288 controls). The case patients were matched to controls by managed care organization site, sex, and age at the index date. The index date was defined as the date of pertussis diagnosis for the case patients.

Exposure  Undervaccination for the diphtheria, tetanus toxoids, and acellular pertussis (DTaP) vaccine. Undervaccination was defined as the number of doses of DTaP vaccine that was either missing or delayed by the index date. Case patients and controls could be undervaccinated by 0, 1, 2, 3, or 4 doses of DTaP vaccine. Children undervaccinated by 0 doses were considered age-appropriately vaccinated by the index date.

Main Outcome and Measure  Pertussis.

Results  Of the 72 case patients with pertussis, 12 (16.67%) were hospitalized, and 34 (47.22%) were undervaccinated for DTaP vaccine by the date of pertussis diagnosis. Of the 288 matched controls, 64 (22.22%) were undervaccinated for DTaP vaccine. Undervaccination was strongly associated with pertussis. Children undervaccinated for 3 or 4 doses of DTaP vaccine were 18.56 (95% CI, 4.92-69.95) and 28.38 (95% CI, 3.19-252.63) times more likely, respectively, to have received a diagnosis of pertussis than children who were age-appropriately vaccinated.

Conclusions and Relevance  Undervaccination with DTaP vaccine increases the risk of pertussis among children 3 to 36 months of age.

JAMA Pediatrics
November 2013, Vol 167, No. 11
http://archpedi.jamanetwork.com/issue.aspx

The Relationship Between Parent Attitudes About Childhood Vaccines Survey Scores and Future Child Immunization Status: A Validation Study
Douglas J. Opel, MD, MPH; James A. Taylor, MD; Chuan Zhou, PhD; Sheryl Catz, PhD; Mon Myaing, PhD; Rita Mangione-Smith, MD, MPH

Abstract
Importance  Acceptance of childhood vaccinations is waning, amplifying interest in developing and testing interventions that address parental barriers to immunization acceptance.

Objective  To determine the predictive validity and test-retest reliability of the Parent Attitudes About Childhood Vaccines survey (PACV), a recently developed measure of vaccine hesitancy.

Design, Setting, and Participants  Prospective cohort of English-speaking parents of children aged 2 months and born from July 10 through December 10, 2010, who belonged to an integrated health care delivery system based in Seattle and who returned a completed baseline PACV. Parents who completed a follow-up survey 8 weeks later were included in the reliability analysis. Parents who remained continuous members in the delivery system until their child was 19 months old were included in the validity analysis.

Exposure  The PACV, scored on a scale of 0 to 100 (100 indicates high vaccine hesitancy).

Main Outcomes and Measures  Child’s immunization status as measured by the percentage of days underimmunized from birth to 19 months of age.

Results  Four hundred thirty-seven parents completed the baseline PACV (response rate, 50.5%), and 220 (66.5%) completed the follow-up survey. Of the 437 parents who completed a baseline survey, 310 (70.9%) maintained continuous enrollment. Compared with parents who scored less than 50, parents who scored 50 to 69 on the survey had children who were underimmunized for 8.3% (95% CI, 3.6%-12.8%) more days from birth to 19 months of age; those who scored 70 to 100, 46.8% (40.3%-53.3%) more days. Baseline and 8-week follow-up PACV scores were highly concordant (ρ = 0.844).

Conclusions and Relevance  Scores on the PACV predict childhood immunization status and have high reliability. Our results should be validated in different geographic and demographic samples of parents

Journal of Community Health
Volume 38, Issue 6, December 2013
http://link.springer.com/journal/10900/38/6/page/1

Human Papillomavirus Knowledge and Awareness Among Vietnamese Mothers
Jenny K. Yi, Susan C. Lackey, Marion P. Zahn, Juan Castaneda, Jessica P. Hwang
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted disease in the US and the primary cause of cervical cancer. Vietnamese American women have the highest incidence rates of cervical cancer but one of the lowest HPV vaccination rates. Parental knowledge is an important predictor of HPV vaccination; however, little is known about HPV knowledge in the Vietnamese American community. We aimed to describe the HPV knowledge of Vietnamese mothers in Houston, Texas and their intention to vaccinate their daughters. We conducted face-to-face interviews with Vietnamese mothers who had daughters aged 9–26 years. We collected data on demographics, acculturation, HPV knowledge, and vaccination intention. Knowledge scores (0–5) were calculated using 5 knowledge questions. We used logistic regression to identify predictors of HPV knowledge. Participants had low levels of acculturation by report of reading (31 %) and writing (23 %) English well. Less than 50 % of participants (n = 47) had heard of HPV, and among these, the mean HPV knowledge score was 4. Although only 1 in 3 had discussed HPV with their medical provider, nearly 86 % of participants who had not heard of HPV would vaccinate their daughter if their doctor had recommended it. Good written English skills and belief that the HPV vaccine was not expensive were predictors of HPV awareness. HPV awareness is low among less acculturated Vietnamese mothers in Houston. Future educational efforts about the role of HPV vaccine in preventing cervical cancer should be made in their language when targeting parents of a high risk Vietnamese population.

HPV Vaccination and Sexual Behavior in a Community College Sample
Erica Marchand, Beth A. Glenn, Roshan Bastani
Abstract
Many US parents are concerned that vaccinating daughters against human papillomavirus (HPV) will communicate implicit approval for sexual activity and be associated with early or risky sexual behavior (Scarinci et al. in J Womens Health 16(8):1224–1233, 2007; Schuler et al. in Sex Transm Infect 87:349–353, 2011) [7, 8]. The aims of this study were to understand (a) whether the HPV vaccine was associated with risky sexual behavior among a diverse sample of female adolescents and young adults, and (b) to better understand the chronology of HPV vaccination and sexual behavior. An anonymous web-based survey was used to collect data from 114 female community college students. T test and Chi square analyses were used to compare vaccinated and unvaccinated groups on age at first intercourse and proportion who had ever had sexual intercourse. Linear multiple regression was used to predict frequency of condom use and number of sexual partners in the past year, using vaccination status and demographic factors as predictors. About 38 % reported receiving at least one dose of the HPV vaccine. Many of those vaccinated (45 %) received the vaccine after having initiated sexual activity. The proportion of women who were sexually experienced did not differ by HPV vaccine status, nor did age at first intercourse, number of partners in the past year, or frequency of condom use. Current findings suggest that HPV vaccination is not associated with riskier sexual activity for the young women in this sample. Adolescents and their parents may benefit from education about the need to receive the HPV vaccine before onset of sexual activity.

HPV and HPV Vaccines: The Knowledge Levels, Opinions, and Behavior of Parents
Marlee Grabiel, Thomas J. Reutzel, Sheila Wang…
Abstract
To measure parent knowledge levels and opinions related to the human papillomavirus (HPV) and the two vaccines used to prevent it. To measure parent behavior in terms of whether or not to have their children vaccinated. Between June 19, 2012, and August 24, 2012, questionnaires were distributed to parents while waiting for their child to see their pediatrician at a local group practice. The survey was reviewed for face validity by College of Pharmacy social science and clinical faculty members, and an earlier version of it had been used successfully in a published study of biomedical students’ knowledge of and attitudes toward the HPV vaccine. 129 usable surveys were obtained. 48.1 % of subjects said they learned about the HPV vaccines from the media, while 47.3 % identified health care practitioner(s) as a source of knowledge. The mean score on a 20-item knowledge test regarding the infection and vaccines was 36 % (range 0–80 %). Opinions on the subject varied widely. For example, 22.4 % of subjects agreed that schools should require that students be vaccinated before enrolling, while 3.2 % agreed that vaccination causes patients to become sexually active. Subjects reported vaccination status for 253 children (mean age 13) as follows: 33 % vaccinated; 28 % not vaccinated but will be; 11 % will never be vaccinated; and 28 % not decided. These results are somewhat encouraging, because many parents are hearing about the vaccines from their providers. Although not an equally valid source, the media are also raising awareness. Based on the knowledge and opinion results of this study, there is a need for pharmacists and other providers to educate their patients about the vaccines and the virus and to converse with them regarding the moral and psychological implications of vaccination. Still, it is encouraging that these subjects had or plan to have over half (61 %) of their children vaccinated.

Knowledge and Beliefs Regarding Human Papillomavirus Among College Nursing Students at a Minority-Serving Institution
Geri L. Schmotzer, Kerryn W. Reding
Abstract
Cervical cancer is a leading cause of death in US women, with Hispanic women at higher risk of mortality than non-Hispanic white women. While the human papillomavirus (HPV) vaccine represents substantial progress towards cervical cancer prevention, little is currently known about Hispanic student’s beliefs regarding the HPV vaccine. To assess the knowledge, attitudes, behaviors, and beliefs of college students in the US–Mexico border region following the release of the HPV vaccine for both males and females. This survey was conducted using a convenience sample were participants were recruited from pre-nursing and nursing courses. The self-administered questionnaire ascertained HPV vaccination status, and knowledge and beliefs regarding the HPV vaccine. 202 male and female students responded. 28.9 % of respondents reported having received the HPV vaccine. Of the non-vaccinated students under age 27, 27.3 % Hispanic students reported an intention to receive the vaccine. Misinformation about HPV was common and was associated with intention to get vaccinated among non-Hispanic white students. We found a relatively small proportion of unvaccinated Hispanic and non-Hispanic nursing students intend to be vaccinated for HPV. Findings indicate an intervention to increase vaccination rates among college-aged students may not be as straightforward as increasing knowledge of HPV. Nurses are in a unique position to educate and recommend HPV to underserved patients. Thus, educating nursing students regarding HPV and the associated cancers is paramount if we are to encourage ethnic minorities to receive the HPV vaccine.

New England Journal of Medicine
November 7, 2013  Vol. 369 No. 19
http://www.nejm.org/toc/nejm/medical-journal

Review Article
Global Health
Natural Disasters, Armed Conflict, and Public Health
Jennifer Leaning, M.D., and Debarati Guha-Sapir, Ph.D.
N Engl J Med 2013; 369:1836-1842November 7, 2013DOI: 10.1056/NEJMra1109877
http://www.nejm.org/doi/full/10.1056/NEJMra1109877

Excerpt
Natural disasters and armed conflict have marked human existence throughout history and have always caused peaks in mortality and morbidity. But in recent times, the scale and scope of these events have increased markedly. Since 1990, natural disasters have affected about 217 million people every year,1 and about 300 million people now live amidst violent insecurity around the world.2 The immediate and longer-term effects of these disruptions on large populations constitute humanitarian crises. In recent decades, public health interventions in the humanitarian response have made gains in the equity and quality of emergency assistance…

…Conclusions
The effects of armed conflict and natural disasters on global public health are widespread. Much progress has been made in the technical quality, normative coherence, and efficiency of the health care response. But action after the fact remains insufficient. In the years ahead, the international community must address the root causes of these crises. Natural disasters, particularly floods and storms, will become more frequent and severe because of climate change. Organized deadly onslaughts against civilian populations will continue, fueled by the availability of small arms, persistent social and political inequities, and, increasingly, by a struggle for natural resources. These events affect the mortality, morbidity, and well-being of large populations. Humanitarian relief will always be required, and there is a demonstrable need, as in other areas of global health, to place greater emphasis on prevention and mitigation.

PLoS One
[Accessed 9 November 2013]
http://www.plosone.org/

Research Article
Timeliness Vaccination of Measles Containing Vaccine and Barriers to Vaccination among Migrant Children in East China
Yu Hu mail, Qian Li, Shuying Luo, Linqiao Lou, Xiaohua Qi, Shuyun Xie
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0073264

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

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

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

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

PLoS One
[Accessed 9 November 2013]
http://www.plosone.org/

Potential Benefits of Second-Generation Human Papillomavirus Vaccines
Sorapop Kiatpongsan, Nicole Gastineau Campos, Jane J. Kim
Research Article | published 07 Nov 2012 | PLOS ONE 10.1371/journal.pone.0048426

Abstract
Background
Current prophylactic vaccines against human papillomavirus (HPV) target two oncogenic types (16 and 18) that contribute to 70% of cervical cancer cases worldwide. Our objective was to quantify the range of additional benefits conferred by second-generation HPV prophylactic vaccines that are expected to expand protection to five additional oncogenic types (31, 33, 45, 52 and 58).

Methods
A microsimulation model of HPV and cervical cancer calibrated to epidemiological data from two countries (Kenya and Uganda) was used to estimate reductions in lifetime risk of cervical cancer from the second-generation HPV vaccines. We explored the independent and joint impact of uncertain factors (i.e., distribution of HPV types, co-infection with multiple HPV types, and unidentifiable HPV types in cancer) and vaccine properties (i.e., cross-protection against non-targeted HPV types), compared against currently-available vaccines.

Results
Assuming complete uptake of the second-generation vaccine, reductions in lifetime cancer risk were 86.3% in Kenya and 91.8% in Uganda, representing an absolute increase in cervical cancer reduction of 26.1% in Kenya and 17.9% in Uganda, compared with complete uptake of current vaccines. The range of added benefits was 19.6% to 29.1% in Kenya and 14.0% to 19.5% in Uganda, depending on assumptions of cancers attributable to multiple HPV infections and unidentifiable HPV types. These effects were blunted in both countries when assuming vaccine cross-protection with both the current and second-generation vaccines.

Conclusion
Second-generation HPV vaccines that protect against additional oncogenic HPV types have the potential to improve cervical cancer prevention. Co-infection with multiple HPV infections and unidentifiable HPV types can influence vaccine effectiveness, but the magnitude of effect may be moderated by vaccine cross-protective effects. These benefits must be weighed against the cost of the vaccines in future analyses.

PLoS Medicine
(Accessed 9 November 2013)
http://www.plosmedicine.org/

Measles Outbreak Response Immunization Is Context-Specific: Insight from the Recent Experience of Médecins Sans Frontières
Andrea Minetti mail, Cameron Bopp, Florence Fermon, Gwenola François, Rebecca F. Grais, Lise Grout, Northan Hurtado, Francisco J. Luquero, Klaudia Porten, Laurent Sury, Meguerditch Terzian
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001544

Summary Points
:: During the recent resurgence of measles in sub-Saharan Africa, the majority of cases were reported from the Democratic Republic of the Congo and Malawi, two countries with vastly different measles epidemiology.
:: Non-selective mass vaccination campaigns targeting children aged 6 months to <15 years old are the commonly implemented strategy for responding to measles outbreaks in humanitarian emergencies.
:: Differences in measles epidemiology and country-specific control goals necessitate more than a one-size-fits-all strategy.
:: Measles outbreak responses should be tailored to local measles epidemiology following early assessment: the age distribution of early cases should guide the decision on which age groups to vaccinate.
:: In settings where the main objective is mortality reduction, the youngest children—who account for the most deaths and complications—should be prioritized by the outbreak response.

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

Hepatitis B vaccination coverage among health-care personnel in the United States.
KK Byrd, PJ Lu, TV Murphy – Public health reports (Washington, DC: 1974), 2013
… OBJECTIVES: We compared self-reported hepatitis B (HepB) vaccine coverage among health-care personnel (HCP) with HepB vaccine coverage among the general population and determined trends in vaccination coverage among HCP. …

A systematic evaluation of different methods for calculating adolescent vaccination levels using immunization information system data.
C Gowda, S Dong, RC Potter, KJ Dombkowski… – Public health reports ( …, 2013
… We explored alternative methods for estimating the vaccine-eligible population when calculating adolescent immunization levels using a statewide IIS. … Further research is needed to ascertain the most appropriate method for estimating vaccine coverage levels using IIS data. …

[PDF] Estimation of HPV prevalence in young women in Scotland; monitoring of future vaccine impact
K Kavanagh, K Sinka, K Cuschieri, J Love, A Potts… – BMC Infectious Diseases, 2013
Background Estimation of pre-immunisation prevalence of HPV and distribution of HPV types is fundamental to understanding the subsequent impact of HPV vaccination. We describe the type specific prevalence of HPV in females aged 20–21 in Scotland who ..
 

Special Focus Newsletters
RotaFlash
November 8, 2013
PATH
Lead story: Rotavirus vaccines will help 2.8 million Ethiopian children live healthier lives
Celebration in Addis Ababa marks start of nationwide introduction
http://vad.createsend4.com/t/r-e-niuguy-mhyjuirjk-j/

Vaccines and Global Health: 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 and Global health : 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 and Global Health_The Week in Review_2 Nov 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

Media Release: UNICEF and senior Syrian officials agree on urgency of reaching more war-affected children, as UNICEF Executive Director visits Syria

DAMASCUS, 29 October 2013 – Following ‘businesslike and encouraging’ discussions, senior Syrian officials and UNICEF Executive Director Anthony Lake agreed on the importance of reaching hundreds of thousands of children in some of the worst-affected parts of war-torn Syria with life-saving vaccines, including those against polio, as Mr Lake ended a two-day visit to Damascus.

The need to immunize every child quickly and without obstacle was a key focus of Mr. Lake’s discussions with Syrian Prime Minister Wael Al Halqi, Vice Minister of Foreign Affairs Dr. Faisal Miqdad, and Deputy Minister of Foreign Affairs Hosam Eddin A’ala.

“Immunizing children is in its very nature non-political and has no connection to any military considerations,” said Mr. Lake. “With cases of polio now emerging in Syria for the first time since 1999, reaching every child with polio and other vaccinations is an urgent and critical priority not only for Syria but for the whole world.”

In a meeting with frontline volunteers from the Syrian Arab Red Crescent (SARC) Mr. Lake expressed on behalf of UNICEF his admiration for all the work SARC volunteers are doing, their courage, and the sacrifices they have made in this cause.

With SARC and with national and other partners UNICEF will be working to reach the more than 500,000 children who have not been reached with vaccinations due to the conflict in some of the hardest to reach parts of the country.

http://www.unicef.org/media/media_70763.html

GAVI and its partners met in Stockholm to review their progress since June 2011. The meeting convened donor and implementing country representatives and Alliance partners including the World Health Organization, UNICEF, the World Bank, the Bill & Melinda Gates Foundation, civil society organisations and vaccine manufacturers. GAVI CEO Dr Seth Berkley presented “a detailed update on progress since the successful London pledging conference in June 2011. This success has been made possible through GAVI’s unique funding model which brings together donor funding, financial contributions from developing countries, and supply and price commitments from vaccine industry partners.” New pledges were announced including from Sweden, who in 2011 pledged US$40 million per year to GAVI to 2015, will now provide a total of US$129 million for 2013 and 2014, and from the Republic of Korea which announced a new commitment to GAVI of a total of US$5 million from 2013-2017.

GAVI said delegates also “engaged in detailed discussions around the challenges of maintaining vaccination programmes while also reaching the 22 million children who go unvaccinated each year.” The event closed with a Ministerial Conversation on Sustainable Funding which highlighted the opportunities and challenges of securing long-term, predictable funding to secure vaccination programmes. The European Commission also announced that it will host a high-level preparatory meeting for GAVI partners in early 2014 ahead of the Alliance’s next funding cycle.

More at: http://www.gavialliance.org/library/news/press-releases/2013/gavi-alliance-partners-reaching-more-children-than-ever-before-with-accelerated-access-to-vital-vaccines/#sthash.gNJsgkeG.dpuf

MSF made a series of recommendations to the GAVI Alliance and the Mid-Term Review meetings in four key areas “where changes at GAVI could make an important difference.” The recommendation includes “making GAVI prices available to humanitarian actors like MSF, further lowering vaccine prices for all in need, extending vaccination to children above one year of age, and incentivizing for development of vaccines that do not rely on cold-chain logistics.” MSF also released a series of videos that “summarize the views of key experts, stakeholders and influencers in the field of global immunization that met in Oslo in October 2013 to share ideas on how to overcome current barriers, and effectively reach out to the one in five children currently unprotected from killer diseases each year.” More here:

http://www.doctorswithoutborders.org/press/release.cfm?id=7125&cat=press-release

   The Gates Foundation announced formation of the Vaccine Discovery Partnership, which it described as “a way for our foundation to work directly with pharmaceutical companies on promising new vaccines for global health.” Gates said GlaxoSmithKline (GSK) and Sanofi are the first two companies involved and said it is “optimistic that other pharmaceutical companies will also join the partnership.” Gates said it will “work with each company individually to identify a promising set of research projects that are aligned with our foundation’s priorities. Projects funded through the Vaccine Discovery Partnership will span the R&D lifecycle – from preclinical to experimental medicine Phase IIa trials.” One of the first projects under the program involves GSK and “focuses on increasing the thermostabilization of new generation vaccines to facilitate delivery of such vaccines in special administration and campaign settings in resource-limited countries. The goal would be to build thermostability into vaccines as an integral  part of new generation vaccine development.” The Foundation noted that “by working together with pharmaceutical companies, these new partnerships will reduce the risks associated with early-stage vaccine research, and increase the likelihood that the most promising new vaccines are developed quickly, and at lower cost. This will be a win for everyone involved but most importantly for the children around the world who will get the life-saving vaccines they need.’

http://www.impatientoptimists.org/Posts/2013/10/A-New-Partnership-to-Accelerate-Vaccine-Research-amp-Development

WHO: Oral cholera vaccine stockpile
November 2013

A global stockpile of oral cholera vaccine (OCV) has been created, as an additional tool to help control cholera epidemics. Over the period July 2013 /June 2014 the stockpile will have available 2 million doses of vaccine.

The OCV stockpile, is managed as a rotating fund, by the International Coordinating Group (ICG) which already manages similar stockpiles of meningococcal meningitis and Yellow Fever vaccines for outbreak response.

The ICG is comprised of four decision making partners: the International Federation of Red Cross and Red Crescent Societies (IFRC), Médecins Sans Frontières (MSF), United Nations Children’s Fund (UNICEF) and WHO, which also serves as the Secretariat.

The ICG members will continue to communicate with partners and stakeholders to increase awareness of the OCV stockpile, placing vaccine in the context of an integrated cholera response which is based around early detection, case management, provision of safe water, sanitation, and raising awareness among the affected communities.

More information, applications and guidance is available here:
http://www.who.int/cholera/vaccines/ocv_stockpile_2013/en/index.html

Independent Monitoring Board of the Global Polio Eradication Initiative
Eighth Report  October 2013  
[60 pages: http://www.polioeradication.org/Portals/0/Document/Aboutus/Governance/IMB/9IMBMeeting/9IMB_Report_EN.pdf ]
The Independent Monitoring Board provides an independent assessment of the progress being made by the Global Polio Eradication Initiative in the detection and interruption of polio transmission globally.
This eighth report follows our ninth meeting, held in London from 1 to 3 October 2013.
At our meetings, we benefit from the time and energy of many partners of the Global Polio Eradication Initiative. We value our open discussions with these many people, but the views presented here are our own. Independence remains at the heart of our role. Each of us sits on the board in a personal capacity. As always, this report presents our findings frankly, objectively, and without fear or favour.

Selected Excerpts
[From p. 40]
The Red List: countries at highest risk of a polio outbreak
YEMEN  UGANDA  SYRIA  LEBANON  JORDAN  IRAQ  CENTRAL AFRICAN REPUBLIC  UKRAINE
MALI  DJIBOUTI  ERITREA  SUDAN  SOUTH SUDAN
The IMB considers these countries to be on the Red List. The program needs to establish a definitive Red List and act on it quickly.

[Full text of Conclusions And Recommendations beginning p.57 minus a graphic on Program Standards unable to be reproduced here]
Conclusions and recommendations
Unprecedented challenges loom over today’s polio eradication program. Levels of intimidation and violence – including horrific deaths of polio workers – have reached such a level that those giving or accepting the vaccine too often do so in harrowing and hazardous circumstances. The program is banned from accessing crucial areas, in which polio is paralysing and killing children – one million children in Somalia and another million in Pakistan cannot be vaccinated against polio because those in control of the territories are not allowing the program to operate there.

The program has dealt with insecurity before (and continues to do so), but these are different, unprecedented phenomena. All who support the eradication of the second ever disease for humankind should have no greater priority than finding ways to resolve these huge challenges. This is the greatest test of the World Health Assembly’s declaration that global polio eradication is a “programmatic emergency for global public health”.

Operationally, the program has far from perfect control in such circumstances. Whilst we are sympathetic to the challenge that this creates, it is more important than ever that the program’s performance is as eradication-ready – as worthy of a global public health emergency – as it can be, in the many aspects that remain within its control. There are too many instances in which this is not the case. The performance issues to be addressed are illustrated by (but not limited to) the fact that the Horn of Africa was not better protected against an outbreak and that too many other countries remain vulnerable. They are illustrated too by the response in the Horn of Africa, which could not be described as a robust response to a public health emergency of global importance.

It is now fourteen months until the primary goal of the Strategic Plan (stopping global polio transmission) needs to be met. The list of problems to be resolved is formidable. The program needs to address insecurity and inaccessibility in each of the endemic countries, whilst continuing to tackle the campaigns that remain stubbornly suboptimal. It needs to regain lost ground in the Horn of Africa. It needs to pay attention to the considerable ‘Red List’ of vulnerable countries where neglect could enable the polio virus to run amok in parts of the world from which it has been thankfully absent for some time.

As the program enters what is supposed to be the last low season in which polio circulates, we ask ourselves (as should all within the program): it this a program that is eradication-ready? Does what we are seeing really look like a programmatic emergency for global public health?    This report has identified too many ways in which this is not the case.

The goal of stopping polio transmission by the end of 2014 now stands at serious risk. This situation must be turned round with the greatest possible urgency.

This report has made 14 recommendations:
Pakistan
1. We recommend that achieving access in FATA be top priority for Pakistan’s polio program and all who support it, using all diplomatic means available

Nigeria
2. We recommend that the Nigerian Expert Review Committee ensures that detailed area-specific plans are in place to overcome the challenges in each of the Local Government Areas (LGAs) that need priority focus

Horn of Africa outbreak
3. We recommend that a joint WHO-UNICEF central command unit is established for the Horn of Africa, led by a single senior commander
4. We recommend that the Polio Oversight Board is immediately appraised of what partner staff are required in, and in support of, the Horn of Africa and oversees measures to get them in place by the end of November
5. We recommend that environmental surveillance be urgently established in Nairobi, Kenya

The novel situation in Israel
6. We recommend that Israel immediately schedules a second national OPV campaign, to be completed as quickly as possible
7. We recommend that the WHO Director General briefs Member States whose populations are currently protected against polio by IPV only on the implications of circulating poliovirus in Israel

Outbreaks waiting to happen
8. We recommend that a global action plan be drawn up, identifying a definitive Red List of the world’s most polio-vulnerable countries and actions to protect each of them
9. We restate our earlier recommendation that the International Health Regulations be used to ensure that all people travelling from a polio-endemic country be required to have vaccination prior to travel, and add that this should be extended to any persistently affected country

Insecurity and impositions of restrictions to access
10. We recommend that the Polio Oversight Board ensures that all of the planned security posts within the partner agencies are filled by the end of November, even if this requires extraordinary measures
11. We recommend that the partners consult and seek advice from the highest levels of the UN Security system and other experts
12. We recommend that all means be used to ensure that the polio program in every country is known to be politically neutral

Management and oversight of the global program
13. We recommend that the Polio Oversight Board commissions a comprehensive review of the program’s oversight and strategic and operational management, making a decision now about how to optimally time this

Potential IPV use in interrupting transmission
14. We recommend that the program agrees and makes a clear statement of policy on the use of IPV in stopping polio transmission, addressing the questions raised by the IMB in its May and October 2013 reports

Update: Polio this week – As of 30 October 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]

:: Following reports of a cluster of 22 acute flaccid paralysis (AFP) cases on 17 October 2013 in the Syrian Arab Republic, wild poliovirus type 1 (WPV1) has been isolated from ten of the cases under investigation. Final genetic sequencing results are pending. Wild poliovirus was last reported in Syria in 1999. A wide-ranging outbreak response plan is urgently being finalized for Syria and countries in the region. For more on the Syria outbreak, please click here
:: South Sudan has been removed from the list of countries with WPV1. Results of additional molecular and genetic testing by the Global Polio Specialized Laboratory at the US Centers for Disease Control and Prevention (CDC) have revealed that an initial instance of simultaneous handling of test specimens from a number of countries in the Horn of Africa resulted in the unintended contamination of the South Sudan specimens with WPV1.
:: The Independent Monitoring Board (IMB) for polio eradication, following its 1-3 October meeting, has published its IMB report to the Polio Oversight Board. For the full report in English, please click here [see excerpt above]

Pakistan
:: Seven new WPV1 cases were reported in the past week. Four were reported from Federally Administered Tribal Areas (FATA) and one from Khyber Pakhtunkhwa (KP), Punjab and Sindh respectively.
:: The total number of WPV1 cases for Pakistan in 2013 is now 53. The most recent WPV1 case had onset of paralysis on 5 October (from Khyber Agency, FATA). The majority of WPV1 cases in Pakistan this year, 38 (72%), are from FATA, of which 16 are from Khyber Agency and 15 from North Waziristan.
:: One new cVDPV2 case was reported in the past week. The total number of cVDPV2 cases for Pakistan is now 30. The most recent cVDPV2 case had onset of paralysis 26 September (from North Waziristan).
:: The situation in North Waziristan is dire. It is the area with the largest number of children being paralyzed by poliovirus in all of Asia (15 WP1 and 23 cVDPV2 cases). It is in an area where immunization activities have been suspended by local leaders since June 2012. It is critical that children in these areas are vaccinated and protected from poliovirus. Immunizations in neighboring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.

Horn of Africa
:: In Ethiopia, one new WPV1 case was reported from the Somali region in the past week.
:: In Somalia, six new WPV1 cases were reported this week (two from Bay region and one from Bakool, Lower Juba, Middle Juba, and Lower Shabelle regions respectively).
:: The total number of WPV cases (all WPV1) for 2013 in the Horn of Africa is now 201 (180 from Somalia, 14 from Kenya and seven from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on 30 September (from Lower Shabelle, Somalia)

Syrian Arab Republic
:: Following reports of a cluster of 22 acute flaccid paralysis (AFP) cases on 17 October 2013 in the Syrian Arab Republic, wild poliovirus type 1 (WPV1) has been isolated from ten of the cases under investigation. Final genetic sequencing results are pending. Wild poliovirus was last reported in Syria in 1999.
:: A comprehensive outbreak response is currently underway. Supplementary immunization activities commenced in Syria on 24 October. The main aim is to rapidly reach children in the immediately-affected and high-risk areas, followed by wider scale immunization campaigns.
:: In further response to the Syria outbreak, multiple large-scale SIAs targeting 22 million children over the next 6 months (starting from early November) are being planned across the region (including Lebanon, Jordan, Turkey, Egypt, Iraq and occupied Palestinian territory (West Bank and Gaza).

.
WHO: Global Alert and Response (GAR) – Disease Outbreak News
http://www.who.int/csr/don/2013_03_12/en/index.html
Polio in the Syrian Arab Republic
29 October 2013 – Following reports of a cluster of 22 acute flaccid paralysis (AFP) cases on 17 October 2013 in the Syrian Arab Republic, wild poliovirus type 1 (WPV1) has been isolated from ten of the cases under investigation. Final genetic sequencing results are pending to determine the origin of the isolated viruses. Wild poliovirus had not been detected in the Syrian Arab Republic since 1999.

Most of the cases are very young (below two years of age), and were un- or under-immunized. Estimated immunization rates in the Syrian Arab Republic declined from 91 percent in 2010 to 68 percent in 2012.

Even before this laboratory confirmation, health authorities in the Syrian Arab Republic and neighbouring countries had begun the planning and implementation of a comprehensive outbreak response. On 24 October 2013, an already-planned large-scale supplementary immunization activity (SIA) was launched in the Syrian Arab Republic to vaccinate 1.6 million children against polio, measles, mumps and rubella, in both government-controlled and contested areas.

Implementation of an SIA in Deir Al Zour province commenced promptly when the first ‘hot cases’ were reported. Larger-scale outbreak response across the Syrian Arab Republic and neighbouring countries is anticipated to begin in early November 2013, to last for at least six to eight months depending on the area and based on evolving epidemiology.

Given the current situation in the Syrian Arab Republic, frequent population movements across the region and subnational immunity gaps in key areas, the risk of further international spread of wild poliovirus type 1 across the region is considered to be high. A surveillance alert has been issued for the region to actively search for additional potential cases.

WHO’s International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.
http://www.who.int/csr/don/2013_10_29/en/index.html

The Weekly Epidemiological Record (WER) for 1 November 2013, vol. 88, 44/45 (pp. 477–488) includes:
:: Meeting of the WHO expert working group on surveillance of influenza antiviral susceptibility, Geneva, July 2013
:: Global routine vaccination coverage, 2012
:: WHO advisory committee on immunization and vaccine related implementation research (IVIR, formerly QUIVER): executive summary report of 7th meeting

http://www.who.int/entity/wer/2013/wer8844_45.pdf

WHO: Immunization coverage
Fact sheet N°378
Updated November 2013

Excerpt
Key facts:
:: Immunization prevents illness, disability and death from vaccine-preventable diseases including diphtheria, measles, pertussis, pneumonia, polio, rotavirus diarrhoea, rubella and tetanus.

:: Global vaccination coverage is holding steady.

:: Immunization currently averts an estimated 2 to 3 million deaths every year.

:: But an estimated 22.6 million infants worldwide are still missing out on basic vaccines.

http://www.who.int/mediacentre/factsheets/fs378/en/index.html

WHO: Expert consultation on the use of placebos in vaccine trials.
November 2013
ISBN 978 92 4 150625 0 (NLM classification: QW 805)

The Expert Consultation on the Use of Placebos in Vaccine Trials was convened by the World Health Organization (WHO) in Annecy, France on 17–18 January 2013 under the overall guidance of Rüdiger Krech, WHO Director of the Department of Ethics and Social Determinants, and Marie-Paule Kieny, Assistant Director-General, Health Systems and Innovation.

Excerpt
Conclusion
The use of placebos in a vaccine clinical trial when there is already an effective or partially effective vaccine raises challenging ethical questions. National and international documents on research involving human subjects have set forth valuable guidelines on the circumstances in which use of placebos is ethically acceptable in a randomized controlled trial. However, none of these documents specifically addresses the use of placebos in vaccine trials. The purpose of the expert consultation described in this report was to address the ethical ambiguity in this area and formulate concrete and practical guidance for action. The critical need to develop new and improved vaccines, especially for use in LMICs that bear the heaviest disease burden, provided the impetus for this consultation and the resulting recommendations.

This report presents a typology of cases in which the use of placebos in vaccine clinical trials may be justified, and offers procedural and substantive recommendations to help trial sponsors and researchers, policy-makers, RECs, and other stakeholders evaluate proposed trial designs. The report specifies five situations in which placebos may be ethically acceptable even in the presence of an efficacious vaccine. In these situations, it is recommended that there be ongoing consultation between trial sponsors and host country actors, thorough assessment of and communication about risks, and consideration of alternative trial designs.

Researchers should consider whether risks associated with the use of placebos can be adequately mitigated, and research protocols should explain the scientific necessity and social and public health value of a placebo design. Researchers should also undertake activities to mitigate risks related to the use of placebos. Additionally, the post-trial availability of the vaccine in the trial country should be carefully examined.

This document is not intended to suggest a definitive course of action for all vaccine trials when an effective or partially effective vaccine already exists. Rather, the recommendations set forth here are designed to provide an analytic framework to aid decision-making. Participants at the expert consultation agreed that the ultimate judgement about the use of placebos in these cases will depend on the specifics of the trial vaccine and the circumstances of the country in which the trial will be conducted. A careful weighing of numerous considerations by stakeholders will therefore be required. The overarching goal of these recommendations is two-fold: to assure that participants in vaccine clinical trials are protected from unjustifiable risks, and to facilitate the conduct of beneficial and urgently needed vaccine research. WHO encourages ongoing discussion of these issues and welcomes feedback on the guidance provided here.

UNICEF: Ethical Research Involving Children
Online Resource, November 2013
This on-line resource “brings together the best thinking internationally about key ethical issues involving children and how these might be addressed in different research contexts…The point of the Ethical Research Involving Children Project is to help ensure that the human dignity of children is honoured and that their rights and well-being are respected in all research, irrespective of context.”

The new resources include:
:: An International Charter for Ethical Research Involving Children;
:: A Compendium on ethical issues and challenges, including a collection of over 20 case studies as well as structured questions to guide ethical research involving children (called ‘Getting Started’);
:: A website www.childethics.com specifically designed to provide a rich repository of evidence-based information, resources and links to journal articles to guide and improve research involving children and to provide a platform for further critical reflection and dialogue.

Nearly 400 members of the international research and NGO communities have contributed to this project that has developed a range of resources to provide clear guidance on ethical issues and concerns that can be applied in multiple research contexts.

To view the project www.childethics.com
http://www.unicef.org/media/media_70778.html

American Journal of Infection Control
Vol 41 | No. 11 | November 2013 | Pages 949-114
http://www.ajicjournal.org/current
Immunizing health care workers against influenza: A glimpse into the challenges with voluntary programs and considerations for mandatory policies
Susan Quach, MSc, Jennifer A. Pereira, PhD, Jeffrey C. Kwong, MD, MSc, Sherman Quan, MSc
Lois Crowe, BA, Maryse Guay, MD, Julie A. Bettinger, PhD, MPH
Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (PCIRN) Program Delivery and Evaluation Theme Group
http://www.ajicjournal.org/article/S0196-6553%2813%2900941-3/abstract

Abstract
Background
Vaccination of health care workers (HCWs) is an important patient safety initiative. It prevents influenza infection among patients and reduces staff illness and absenteeism. Despite these benefits, HCW influenza immunization uptake is low. Therefore, strategies to achieve high immunization coverage in HCWs, barriers to uptake, and perceptions of mandatory influenza immunization policies were discussed in key informant interviews with influenza immunization program planners.

Methods
We conducted telephone interviews with 23 influenza immunization program planners from 21 organizations (7 acute care hospitals, 6 continuing care facilities, and 8 public health organizations) across Canada. We used content analysis to identify themes from the interviews.

Results
Participants used a variety of promotional and educational activities, and many vaccine delivery approaches, to support HCW immunization programs. Barriers to achieving high coverage in HCWs included misconceptions about the safety and effectiveness of the influenza vaccine, negative personal experiences associated with the vaccine, and antivaccine sentiments. Participants mentioned mandatory influenza immunizations as a solution to low coverage. However, they identified challenges with this approach such as obtaining support from stakeholders, enforcement, and limiting personal autonomy.

Conclusion
Participants believed immunization coverage in health care organizations will continue to be suboptimal using existing program strategies. Although participants discussed mandatory immunization as a way to improve uptake, potential obstacles will need to be addressed for this to be implemented successfully.

BMC Public Health
(Accessed 2 November 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Cost-effectiveness and cost utility analysis of three pneumococcal conjugate vaccines in children of Peru
Jorge Alberto Gomez, Juan Carlos Tirado, Aldo Amador Navarro Rojas, Maria Mercedes Castrejon Alba and Oleksandr Topachevskyi
http://www.biomedcentral.com/1471-2458/13/1025/abstract

Abstract (provisional)
Background
The clinical and economic burden associated with invasive and non-invasive pneumococcal and non-typeable Haemophilus influenzae (NTHi) diseases is substantial in the Latin America and Caribbean region, where pneumococcal vaccines have only been introduced to a few countries. This study analyzed the cost-effectiveness and cost utility of three different pneumococcal conjugate vaccines (PCVs) for Peru.

Methods
A Markov model that simulated the disease processes in a birth cohort over a lifetime, within 1,128 month cycles was used to evaluate the cost-effectiveness of 10-valent pneumococcal NTHi protein D conjugate vaccine (PHiD-CV) and 7- and 13-valent PCVs (PCV-7 and PCV-13). Expected quality-adjusted life years (QALYs), cost-savings and incremental cost-effectiveness ratios (ICERs) were calculated.

Results
Without vaccination, pneumonia was associated with the greatest health economic burden (90% of QALYs lost and 63% of lifetime direct medical costs); while acute otitis media (AOM) was responsible for 1% of QALYs lost and 25% of direct medical costs. All vaccines were predicted to be cost-effective for Peru, with PHiD-CV being most cost-effective. PHiD-CV was predicted to generate 50 more QALYs gained and required a reduced investment (-US$ 3.4 million) versus PCV-13 (discounted data), and was therefore dominant and cost saving. The probabilistic sensitivity analysis showed that PHiD-CV generated more QALYs gained at a reduced cost than PCV-13 in 84% of the simulations and less QALYs gains at a reduced cost in 16%. Additional scenarios using different assumptions on vaccine efficacies based on previous evidence were explored, but no significant change in the overall cost-effective results were observed.

Conclusions
The results of this modeling study predict that PCVs are likely to be a cost-effective strategy to help relieve the epidemiological and economic burden associated with pediatric pneumococcal and NTHi diseases for Peru. PHiD-CV is likely to be a dominant (better health gains at a reduced net cost) intervention compared to PCV-13 or PCV-7. The most significant drivers for these results are the better health and economic profile of PHiD-CV against AOM and its reduced cost per dose available through the PAHO Revolving Fund in the LAC region.

Emerging Infectious Diseases
Volume 19, Number 11—November 2013
http://www.cdc.gov/ncidod/EID/index.htm

Research
Mobile Phone–based Syndromic Surveillance System, Papua New Guinea
Alexander Rosewell, Berry Ropa, Heather Randall, Rosheila Dagina, Samuel Hurim, Sibauk Bieb, Siddhartha Datta, Sundar Ramamurthy, Glen Mola, Anthony B. Zwi, Pradeep Ray, and C. Raina MacIntyre
http://wwwnc.cdc.gov/eid/article/19/11/12-1843_article.htm

Abstract
The health care system in Papua New Guinea is fragile, and surveillance systems infrequently meet international standards. To strengthen outbreak identification, health authorities piloted a mobile phone–based syndromic surveillance system and used established frameworks to evaluate whether the system was meeting objectives. Stakeholder experience was investigated by using standardized questionnaires and focus groups. Nine sites reported data that included 7 outbreaks and 92 cases of acute watery diarrhea. The new system was more timely (2.4 vs. 84 days), complete (70% vs. 40%), and sensitive (95% vs. 26%) than existing systems. The system was simple, stable, useful, and acceptable; however, feedback and subnational involvement were weak. A simple syndromic surveillance system implemented in a fragile state enabled more timely, complete, and sensitive data reporting for disease risk assessment. Feedback and provincial involvement require improvement. Use of mobile phone technology might improve the timeliness and efficiency of public health surveillance.

Eurosurveillance
Volume 18, Issue 44, 31 October 201
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Research articles
Dramatic change in public attitudes towards vaccination during the 2009 influenza A(H1N1) pandemic in France
P Peretti-Water ^1,2,3, P Verger^1,2,3, J Raude^4,2, A Constant^2,1, A Gautier⁵, C Jestin⁵, F Beck^5,6
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20623

Abstract
We investigated the potential impact of the 2009 influenza A(H1N1) pandemic on attitudes towards vaccination among people aged 18 to 75 years and living in metropolitan France. We used data from three national telephone surveys conducted on representative samples in 2000, 2005 and 2010 (n=12,256, n=23,931, n=8,573 respectively). In France, unfavourable attitudes towards vaccination in general dramatically increased from 8.5% in 2000 and 9.6% in 2005 to 38.2% in 2010. In 2010, among respondents who held unfavourable attitudes towards vaccination, 50% mentioned specifically their opposition to the influenza A(H1N1) vaccine. The sociodemographic profile associated with these attitudes also changed greatly. In particular, unfavourable attitudes towards vaccination in general became significantly more frequent among less educated people in 2010. These attitudes were also correlated with vaccination behaviours. For example, parents who were unfavourable towards vaccination in general were more likely to report that they had at least one child who did not get the measles-mumps-rubella vaccine. As this shift in attitude may have a significant impact on future vaccination coverage, health authorities should urgently address the vaccine confidence gap.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
November 2013  Volume 9, Issue 11
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/11/

A critical review of cost-effectiveness analyses of vaccinating males against human papillomavirus
Yiling Jiang, Aline Gauthier, Maarten J Postma, Laureen Ribassin-Majed, Nathalie Largeron, Xavier Bresse*
https://www.landesbioscience.com/journals/vaccines/article/25754/

Abstract
A critical review of cost-effectiveness analyses of HPV vaccination in males was conducted and nine studies were identified in different countries. Due to the heterogeneity among these studies in terms of modeling approach, vaccination strategies, health outcomes considered, assumptions and parameters, limited conclusions can be drawn with regard to the absolute cost-effectiveness. Nevertheless, key drivers were identified. More favorable cost-effectiveness appeared when all HPV-related diseases outcomes were considered, a suboptimal vaccine coverage among girls and/or lower vaccine prices were assumed. There was a general lack of transparency to fully describe the details of the methodological approach of modeling and calibration. Further research should be conducted to generate robust evidence-based data sets (HPV-related diseases epidemiology, costs and quality of life). The best modeling practice for HPV vaccination and how to better capture the true economic value of vaccination beyond cost-effectiveness in a broader policy context need to be investigated.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
November 2013  Volume 9, Issue 11
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/11/

Overcoming perceptions of financial barriers to rotavirus vaccine introduction in Asia
E Anthony S Nelson*, Ciro A de Quadros, Mathuram Santosham, Umesh D Parashar, Duncan Steele
https://www.landesbioscience.com/journals/vaccines/article/26107/

Abstract
Despite a WHO recommendation in 2009, reaffirmed in 2013, that all countries should consider introducing rotavirus vaccines into their National Immunization Programs, as of June 2013 only 45 have done so. One major consideration appears to have been the costs of the vaccine to countries. Of concern, is that Asian countries have been slow to introduce rotavirus vaccines despite having robust data that could inform the decision-making process. Although decisions on new vaccine introduction are very complex and vary by country and region, economic evaluations are often pivotal once vaccine efficacy and safety has been established, and disease burden documented and communicated. Unfortunately, with private sector list prices of vaccines often used in economic evaluations, rather than a potential public health sector pricing structure, policy-makers may defer decisions on rotavirus vaccine introduction based on the belief that “the vaccine price is too high,” even though this might be based on erroneous data. The Pan American Health Organization’s Revolving Fund provides one example of how vaccine price can be made more competitive and transparent through a regional tendering process. Other mechanisms, such as tiered pricing and UNICEF procurement, also exist that could help Asian and other countries move forward more quickly with rotavirus vaccine introduction.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
November 2013  Volume 9, Issue 11
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/11/

Social media microblogs as an HPV vaccination forum
Chupei Zhang*, Marientina Gotsis, Maryalice Jordan-Marsh
https://www.landesbioscience.com/journals/vaccines/article/25599/

Abstract
The 2006 US FDA approval of the human papillomavirus (HPV) vaccine brought new hope for cancer prevention. Gardasil and Cervarix are widely available vaccines that can deter HPV infection, which causes 70% of cervical cancer. Acceptance of vaccination varies due to a lack of HPV awareness and HPV vaccine knowledge. Recent observations of the Chinese microblog “SinaWeibo” suggest a new approach to engage health professionals and consumer website bloggers. Websites that present the latest fashion, fitness or beauty news and ways to obtain “deals” have created informative blogs or online communities that appeal to female users. Some users raise health questions of their peers. Health professionals, as website bloggers, can introduce vaccine news or respond to conversations between bloggers and their followers. By transforming medical vocabulary into ordinary chat, microblogs may promote efficiency in vaccine education and communication. A web-based, interactive social media-microblog could offer an ideal platform to speed up information dissemination and increase targeted communication.

The Lancet  
Nov 02, 2013   Volume 382  Number 9903  p1459 – 1534
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Equity in child survival
The Lancet

Preview |
Efforts to meet Millennium Development Goal 4 (MDG 4)—a two-thirds reduction in child mortality by 2015—have led to a substantial decrease in deaths of children younger than 5 years. However, not all children have benefited equally from these gains. Furthermore, despite many country successes, the world as a whole remains off-track in meeting this goal. A growing consensus exists that fresh approaches will be needed in the years up to the MDG deadline and beyond to accelerate progress. A new report from Save the Children—Lives on the Line: An Agenda for Ending Preventable Deaths—highlights how countries need to shift their strategies based on the current child mortality landscape.

The Pediatric Infectious Disease Journal
November 2013 – Volume 32 – Issue 11  pp: 1159-1302,e414-e42
http://journals.lww.com/pidj/pages/currenttoc.aspx
Effectiveness of Pneumococcal Conjugate Vaccine in Infants by Maternal Influenza Vaccination Status
van Santen, Katharina L.; Bednarczyk, Robert A.; Adjaye-Gbewonyo, Dzifa; M

Abstract
Background:  Influenza virus infection can predispose patients to secondary pneumococcal infections. Children are at greatest risk for pneumococcal infection in the first year of life and are not considered fully protected by pneumococcal conjugate vaccine (PCV) until their third dose at 6 months of age. Infants less than 6 months cannot receive influenza vaccination, though maternal influenza vaccination can protect infants.

Methods:  We conducted a retrospective cohort study of 9807 mother–infant pairs enrolled in a managed care organization for infants born June 1, 2002, to December 31, 2009. Exposure was assessed for receipt of infant PCV only and the combination of PCV and maternal influenza vaccine (trivalent inactivated vaccine). Outcomes of interest were acute otitis media and medically attended acute respiratory infection in the first year of life. We estimated the adjusted incidence of illness, incidence rate ratios and vaccine effectiveness using the ratio of incidence rate ratios between the periods of noncirculating influenza and that of at least local influenza circulation.

Results:  For medically attended acute respiratory infection, vaccine effectiveness for the combination of trivalent inactivated vaccine and PCV was 39.6% (95% confidence interval [CI]: 31.6%–46.7%) and for PCV only was 29.8% (95% CI: 11.4%–44.3%). For acute otitis media, vaccine effectiveness for the combination of trivalent inactivated vaccine and PCV was 47.9% (95% CI: 42%–53.3%) and for PCV only was 37.6% (95% CI: 23.1%–49.4%).

Conclusion:  In infants, the combination of maternal influenza vaccine and infant pneumococcal conjugate vaccination confers greater protection from acute otitis media infections and medically attended acute respiratory infections than does PCV alone.

The Pediatric Infectious Disease Journal
November 2013 – Volume 32 – Issue 11  pp: 1159-1302,e414-e42
http://journals.lww.com/pidj/pages/currenttoc.aspx

Comparing Haemophilus influenzae Type b Conjugate Vaccine Schedules: A Systematic Review and Meta-analysis of Vaccine Trials
Low, Nicola; Redmond, Shelagh M.; Rutjes, Anne W. S.; MoreAbstract
Background:  The optimal schedule and the need for a booster dose are unclear for Haemophilus influenzae type b (Hib) conjugate vaccines. We systematically reviewed relative effects of Hib vaccine schedules.Methods:  We searched 21 databases to May 2010 or June 2012 and selected randomized controlled trials or quasi-randomized controlled trials that compared different Hib schedules (3 primary doses with no booster dose [3p+0], 3p+1 and 2p+1) or different intervals in primary schedules and between primary and booster schedules. Outcomes were clinical efficacy, nasopharyngeal carriage and immunological response. Results were combined in random-effects meta-analysis.Results:  Twenty trials from 15 countries were included; 16 used vaccines conjugated to tetanus toxoid (polyribosylribitol phosphate conjugated to tetanus toxoid). No trials assessed clinical or carriage outcomes. Twenty trials examined immunological outcomes and found few relevant differences. Comparing polyribosylribitol phosphate conjugated to tetanus toxoid 3p+0 with 2p+0, there was no difference in seropositivity at the 1.0 μg/mL threshold by 6 months after the last primary dose (combined risk difference −0.02; 95% confidence interval: −0.10, 0.06). Only small differences were seen between schedules starting at different ages, with different intervals between primary doses, or with different intervals between primary and booster doses. Individuals receiving a booster were more likely to be seropositive than those at the same age who did not.Conclusions:  There is no clear evidence from trials that any 2p+1, 3p+0 or 3p+1 schedule of Hib conjugate vaccine is likely to provide better protection against Hib disease than other schedules. Until more data become available, scheduling is likely to be determined by epidemiological and programmatic considerations in individual settings.

Pediatrics
November 2013, VOLUME 132 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

Article
Measles in Children Vaccinated With 2 Doses of MMR
Fannie Defay, MSca, Gaston De Serres, MD, PhDa,b,c, Danuta M. Skowronski, MD, FRCPCd, Nicole Boulianne, RN, MSca,b, Manale Ouakki, MScb, Monique Landry, MDe, Nicholas Brousseau, MD, FRCPCf, and Brian J. Ward, MD, FRCPCg
http://pediatrics.aappublications.org/content/132/5/e1126.abstract

Abstract
OBJECTIVE: A previous measles outbreak investigation in a high school in Quebec, Canada identified 2-dose vaccine effectiveness of 94%. The risk of measles in 2-dose recipients was significantly higher (2–4 times) when measles vaccine was first administered at 12 versus ≥15 months of age, with no significant effect of the age at second dose. Generalizability of this association was also assessed in the expanded provincial data set of notified cases.

METHODS: This matched case–control study included only 2-dose recipients. All confirmed (laboratory or epidemiologically linked) cases in patients aged 5 to 17 years were included. Each case was matched to 5 controls.

RESULTS: A total of 102 cases and 510 controls were included; 89% of cases were in patients 13 to 17 years old. When the first dose was administered at 12 to 13 months compared with ≥15 months of age, the risk of measles in participants outside the outbreak school was 6 times higher (95% confidence interval, 1.33–29.3) and was 5.2 times higher (95% confidence interval, 1.91–14.3) in the pooled estimate (participants from the outbreak school + outside that school).

CONCLUSIONS: A significantly greater risk of measles among 2-dose recipients whose first dose was given at 12 to 13 months rather than ≥15 months of age is confirmed in the larger Quebec data set. The mechanism remains unknown, but vaccine failures in 2-dose recipients could have substantial implications for measles elimination efforts through 2-dose vaccination. The optimal age at first dose may warrant additional evaluation.

Pediatrics
November 2013, VOLUME 132 / ISSUE 5
http://pediatrics.aappublications.org/current.shtml

Article
Impact of a Routine Two-Dose Varicella Vaccination Program on Varicella Epidemiology
Stephanie R. Bialek, MD, MPHa, Dana Perella, MPHb, John Zhang, PhDa, Laurene Mascola, MD, MPHc, Kendra Viner, PhD, MPHb, Christina Jackson, MPHc, Adriana S. Lopez, MHSa, Barbara Watson, MB, ChB, FRCP, FAAPb, and Rachel Civen, MD, MPHc

Abstract
OBJECTIVE: One-dose varicella vaccination for children was introduced in the United States in 1995. In 2006, a second dose was recommended to further decrease varicella disease and outbreaks. We describe the impact of the 2-dose vaccination program on varicella incidence, severity, and outbreaks in 2 varicella active surveillance areas.

METHODS: We examined varicella incidence rates and disease characteristics in Antelope Valley (AV), CA, and West Philadelphia, PA, and varicella outbreak characteristics in AV during 1995–2010.

RESULTS: In 2010, varicella incidence was 0.3 cases per 1000 population in AV and 0.1 cases per 1000 population in West Philadelphia: 76% and 67% declines, respectively, since 2006 and 98% declines in both sites since 1995; incidence declined in all age groups during 2006–2010. From 2006–2010, 61.7% of case patients in both surveillance areas had been vaccinated with 1 dose of varicella vaccine and 7.5% with 2 doses. Most vaccinated case patients had <50 lesions with no statistically significant differences among 1- and 2-dose cases (62.8% and 70.3%, respectively). Varicella-related hospitalizations during 2006–2010 declined >40% compared with 2002–2005 and >85% compared with 1995–1998. Twelve varicella outbreaks occurred in AV during 2007–2010, compared with 47 during 2003–2006 and 236 during 1995–1998 (P < .01).

CONCLUSIONS: Varicella incidence, hospitalizations, and outbreaks in 2 active surveillance areas declined substantially during the first 5 years of the 2-dose varicella vaccination program. Declines in incidence across all ages, including infants who are not eligible for varicella vaccination, and adults, in whom vaccination levels are low, provide evidence of the benefit of high levels of immunity in the population.

PLoS One
[Accessed 2 November 2013]
http://www.plosone.org/

Research Article
Political and Institutional Influences on the Use of Evidence in Public Health Policy. A Systematic Review
Marc Liverani a, Benjamin Hawkins, Justin O. Parkhurst
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0077404

<iAbstract
Background
There is increasing recognition that the development of evidence-informed health policy is not only a technical problem of knowledge exchange or translation, but also a political challenge. Yet, while political scientists have long considered the nature of political systems, the role of institutional structures, and the political contestation of policy issues as central to understanding policy decisions, these issues remain largely unexplored by scholars of evidence-informed policy making.

Methods
We conducted a systematic review of empirical studies that examined the influence of key features of political systems and institutional mechanisms on evidence use, and contextual factors that may contribute to the politicisation of health evidence. Eligible studies were identified through searches of seven health and social sciences databases, websites of relevant organisations, the British Library database, and manual searches of academic journals. Relevant findings were extracted using a uniform data extraction tool and synthesised by narrative review.

Findings
56 studies were selected for inclusion. Relevant political and institutional aspects affecting the use of health evidence included the level of state centralisation and democratisation, the influence of external donors and organisations, the organisation and function of bureaucracies, and the framing of evidence in relation to social norms and values. However, our understanding of such influences remains piecemeal given the limited number of empirical analyses on this subject, the paucity of comparative works, and the limited consideration of political and institutional theory in these studies.

Conclusions
This review highlights the need for a more explicit engagement with the political and institutional factors affecting the use of health evidence in decision-making. A more nuanced understanding of evidence use in health policy making requires both additional empirical studies of evidence use, and an engagement with theories and approaches beyond the current remit of public health or knowledge utilisation studies.

PLoS Medicine
(Accessed 2 November 2013)
http://www.plosmedicine.org/

Guidelines and Guidance
Complexity in Mathematical Models of Public Health Policies: A Guide for Consumers of Models
Sanjay Basu, Jason Andrews
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001540

Summary Points
:: Mathematical models are increasingly used to inform public health policy, but a major dilemma faced by readers is how to evaluate the quality of models.
:: All models require simplifying assumptions, and there are tradeoffs between creating models that are more “realistic” versus those that are grounded in more well-characterized data on the behavior of disease processes.
:: Complex models are not necessarily more accurate or reliable simply because they can more easily fit real-world data than simpler models; complex models can suffer parameter estimation problems that can be difficult to detect and often cannot be fixed by “calibrating” models to external data. Conversely, complexity can be important to include when uncertain factors are central to a disease process or research question.
:: In many cases, alternative model structures can appear reasonable for the same policy problem. Sensitivity analyses not only around parameter values but also using alternative model structures can help determine which factors are particularly important to disease outcomes of interest. Explicit methods are now available to transparently and objectively compare different model structures.

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

Research Article
First Outbreak Response Using an Oral Cholera Vaccine in Africa: Vaccine Coverage, Acceptability and Surveillance of Adverse Events, Guinea, 2012

Francisco J. Luquero, Lise Grout, Iza Ciglenecki, Keita Sakoba, Bala Traore, Melat Heile, Alpha Amadou Dialo, Christian Itama, , icaela Serafini, Dominique Legros, Rebecca F. Grais
Abstract
Background
Despite World Health Organization (WHO) prequalification of two safe and effective oral cholera vaccines (OCV), concerns about the acceptability, potential diversion of resources, cost and feasibility of implementing timely campaigns has discouraged their use. In 2012, the Ministry of Health of Guinea, with the support of Médecins Sans Frontières organized the first mass vaccination campaign using a two-dose OCV (Shanchol) as an additional control measure to respond to the on-going nationwide epidemic. Overall, 316,250 vaccines were delivered. Here, we present the results of vaccination coverage, acceptability and surveillance of adverse events.

Methodology/Principal Findings
We performed a cross-sectional cluster survey and implemented adverse event surveillance. The study population included individuals older than 12 months, eligible for vaccination, and residing in the areas targeted for vaccination (Forécariah and Boffa, Guinea). Data sources were household interviews with verification by vaccination card and notifications of adverse events from surveillance at vaccination posts and health centres. In total 5,248 people were included in the survey, 3,993 in Boffa and 1,255 in Forécariah. Overall, 89.4% [95%CI:86.4–91.8%] and 87.7% [95%CI:84.2–90.6%] were vaccinated during the first round and 79.8% [95%CI:75.6–83.4%] and 82.9% [95%CI:76.6–87.7%] during the second round in Boffa and Forécariah respectively. The two dose vaccine coverage (including card and oral reporting) was 75.8% [95%CI: 71.2–75.9%] in Boffa and 75.9% [95%CI: 69.8–80.9%] in Forécariah respectively. Vaccination coverage was higher in children. The main reason for non-vaccination was absence. No severe adverse events were notified.

Conclusions/Significance
The well-accepted mass vaccination campaign reached high coverage in a remote area with a mobile population. Although OCV should not be foreseen as the long-term solution for global cholera control, they should be integrated as an additional tool into the response.

Vaccine
Volume 31, Issue 48, Pages 5623-5784 (19 November 2013)
http://www.sciencedirect.com/science/journal/0264410X

Vaccine effects and impact of vaccination programmes in post-licensure studies
Review Article
Pages 5634-5642
Germaine Hanquet, Marta Valenciano, François Simondon, Alain Moren

Abstract
Once a vaccine is licensed and introduced in the population, post-licensure studies are required to measure vaccine effectiveness and impact of vaccination programmes on the population at large. However, confusion still prevails around these concepts, making it difficult to discern which effects are measured in such studies and how their findings should be interpreted. We review from the public health evaluation perspective the effects of vaccine-related exposures, describe the methods used to measure them and their assumptions.

We distinguish effects due to exposure to individual vaccination from those due to exposure to a vaccination programme, as the latter depends on vaccine coverage, other population factors and includes indirect effects as well. Vaccine (direct) effectiveness is estimated by comparing vaccinated and unvaccinated individuals exposed to the same vaccination programme. The impact of a vaccination programme, defined here as the population prevented fraction when exposure is the programme, is measured by comparing populations with and without a vaccination programme, most commonly the same population before and after vaccination. These designs are based on a number of assumptions for valid inference. In particular, they assume that vaccinees and non-vaccinees do not differ in terms of susceptibility and exposure to the disease or in ascertainment of vaccination and disease status. In pre and post-vaccination design, the population is assumed to have similar baseline transmission, case detection and reporting, risk factors and medical practices in both periods.

These principles are frequently violated in post-licensure studies. Potential confounding and biases must be minimized in study design and analyses, or taken into account during result interpretation. It is also essential to define which exposure is evaluated (individual vaccination or vaccination programme) and which effect is measured. This may help decision-makers clarify which type of study is needed and how to interpret the results.

Vaccine
Volume 31, Issue 47, Pages 5495-5622 (12 November 2013)
http://www.sciencedirect.com/science/journal/0264410X/31/47

Geographic variation in human papillomavirus vaccination uptake among young adult women in the United States during 2008–2010
Pages 5495-5499
Mahbubur Rahman, Tabassum H. Laz, Abbey B. Berenson

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 between 2008 and 2010. Among 2632 young adult women (18–26 years old) who responded to HPV vaccine uptake questions, weighted vaccine initiation and completion rates were: 28.0% and 17.0% overall, 14.0% and 6.6% in the South, 28.7% and 19.3% in the Midwest/West, and 37.2% and 23.1% in the Northeast (P < 0.001), respectively. Log-binomial regression analysis showed that women living in the South were less likely to initiate (adjusted prevalence ratio (aPR) 0.71, 95% confidence interval (CI) 0.60–0.83) or complete (aPR 0.61, 95% CI, 0.53–0.71) the HPV vaccine series compared to women living in the Northeast. Interventions programs to improve HPV vaccine uptake in the Southern states are warranted.

Vaccine
Volume 31, Issue 47, Pages 5495-5622 (12 November 2013)
http://www.sciencedirect.com/science/journal/0264410X/31/47

Human papillomavirus (HPV), HPV-associated oropharyngeal cancer, and HPV vaccine in the United States—Do we need a broader vaccine policy?
Review Article
Pages 5500-5505
N. Osazuwa-Peters
Abstract
Background
Human papillomavirus (HPV) is a sexually transmitted infection (STI) of global importance; it is the most prevalent STI in the United States, with strains causally linked to oropharyngeal and other cancers. Efforts to prevent HPV have been made to varying degrees by policies implemented by different state governments; however, HPV and associated oropharyngeal cancer continue to show increasing incidence rates in the US.

Design
A narrative review based on search on SciVerse, PubMed/Medline, Google Scholar, and EMBASE databases, as well as literature/documents from the World Health Organization, Centers for Disease Control and Prevention, American Cancer Society, National Conference of State legislatures, and the U.S. Department of Health and Human Services relevant to HPV and HPV vaccine policy in the US.

Results
Vaccination has proved to be a successful policy in the US, and an extant recommendation aimed at preventing HPV and associated cervical and other anogenital cancers is the routine use of HPV vaccines for males and females. However, HPV vaccines are presently not recommended for preventing oropharyngeal cancer, although they have been shown to be highly effective against the HPV strains that are most commonly found in the oropharynx. And while there is a history of successful vaccine mandate in the US with resulting decrease in occurrence of infectious diseases, implementing HPV vaccine mandate has proved to be very unpopular.

Conclusions
With emerging evidence of the efficacy of the use of the HPV vaccine in preventing oral-HPV, more focus should be put on extending HPV vaccine to present oral HPV infection and oropharyngeal cancer. Also, implementing a broader HPV vaccine policy that include mandating HPV vaccines as a school-entry requirement for both sexes may increase vaccine use in the US for the greater good of the public.

Vaccine
Volume 31, Issue 47, Pages 5495-5622 (12 November 2013)
http://www.sciencedirect.com/science/journal/0264410X/31/47

Well-woman visit of mothers and human papillomavirus vaccine intent and uptake among their 9–17 year old children
Original Research Article
Pages 5544-5548
Mahbubur Rahman, Lee B. Elam, Michael I. Balat, Abbey B. Berenson
Abstract
Objective
To examine the association between attending a well-woman clinic in the prior 2 years and obtaining the human papillomavirus (HPV) vaccine for their 9–17-year-old child.

Methods
Women (n = 1256) who attended reproductive health clinics during September 2011 to February 2013 and had ≥1 children 9–17 years of age were asked to complete a self-administered questionnaire containing questions on demographic characteristics, prior well-woman visits, HPV awareness, and HPV vaccine intent and uptake among their adolescent children.

Results
Nearly 78% of women reported having undergone a well-woman visit during the past 2 years. Bivariate analysis showed that the HPV vaccine initiation (23.9% vs. 14.0%, P = .004) and completion (13.6% vs. 6.7%, P = .011) among 9–17 daughters differed between mothers who did or did not have a well-woman visit during the past 2 years. However, intent to vaccinate them (47.2% vs. 53.3%, P = .173) did not differ between these two groups. With regard to 9–17 year old sons, vaccine initiation (10.1% vs. 9.6%, P = .871), completion (4.6% vs. 2.4%, P = .273) and intent to vaccinate (47.3% vs. 52.1%, P = .311) did not differ between these two groups. Multivariable logistic regression analyses confirmed the findings of these bivariate analyses after adjusting for confounder variables.

Conclusion
The well-woman visit may be a missed opportunity for physicians to educate their patients about the benefits of HPV vaccination for their adolescent children in general and sons in particular. Intervention studies are warranted to assess the benefits of using this setting to improve HPV vaccine uptake in the US.

Vaccine
Volume 31, Issue 47, Pages 5495-5622 (12 November 2013)
http://www.sciencedirect.com/science/journal/0264410X/31/47

Template protocol for clinical trials investigating vaccines—Focus on safety elements
Original Research Article
Pages 5602-5620
Jan Bonhoeffer, Egeruan B. Imoukhuede, Grace Aldrovandi, Novilia S. Bachtiar, Eng-Soon Chan, Soju Chang, Robert T. Chen, Rohini Fernandopulle, Karen L. Goldenthal, James D. Heffelfinger, Shah Hossain, Indira Jevaji, Ali Khamesipour, Sonali Kochhar, Mamodikoe Makhene, Elissa Malkin, David Nalin, Rebecca Prevots, Ranjan Ramasamy, Sarah Sellers, et al.

Abstract
This document is intended as a guide to the protocol development for trials of prophylactic vaccines. The template may serve phases I–IV clinical trials protocol development to include safety relevant information as required by the regulatory authorities and as deemed useful by the investigators. This document may also be helpful for future site strengthening efforts.

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

Association between health care workers’ knowledge of influenza vaccine and vaccine uptake
O Jaiyeoba, M Villers, DE Soper, J Korte, CD Salgado – American Journal of Infection …, 2013

Methods Vaccination was voluntary at our institution prior to 2010 and resulted in compliance rates ranging from 40% to 60%. Our institution adopted a policy for the 2010-2011 season and beyond that stated all employees who refused vaccine were required to …

Immunosignatures can predict vaccine efficacy
JB Legutki, SA Johnston – Proceedings of the National Academy of Sciences, 2013
Abstract The development of new vaccines would be greatly facilitated by having effective methods to predict vaccine performance. Such methods could also be helpful in monitoring individual vaccine responses to existing vaccines. We have developed “ …

Health disparities in human papillomavirus vaccine coverage: Trends analysis from NIS-Teen, 2008-2011
RA Bednarczyk, EA Curran, WA Orenstein, SB Omer – Clinical Infectious Diseases, 2013
Abstract Adolescent uptake of human papillomavirus (HPV) vaccine remains low. We evaluated HPV vaccine uptake patterns over 2008-2011 by race/ethnicity, poverty status, and the combination of race/ethnicity and poverty status, utilizing National Immunization …

[HTML] A Phase I Randomized Clinical Trial of Candidate Human Immunodeficiency Virus type 1 Vaccine MVA. HIVA Administered to Gambian Infants
MO Afolabi, J Ndure, A Drammeh, F Darboe… – PLOS ONE, 2013
Background A vaccine to decrease transmission of human immunodeficiency virus type 1 (HIV-1) during breast-feeding would complement efforts to eliminate infant HIV-1 infection by antiretroviral therapy. Relative to adults, infants have distinct immune development, …

A systems framework for vaccine design
M Mooney, S McWeeney, G Canderan, RP Sékaly – Current Opinion in Immunology, 2013
Numerous challenges have been identified in vaccine development, including variable efficacy as a function of population demographics and a lack of characterization and mechanistic understanding of immune correlates of protection able to guide delivery and …

Special Focus Newsletters
RotaFlash
November 1, 2013
PATH
http://vad.createsend1.com/t/ViewEmail/r/471294C4D2E5E67D2540EF23F30FEDED/E38B11B8894CC5F5DBC23BD704D2542D
Lead story
Burkina Faso takes on burden of diarrhea and pneumonia together
Dual vaccine launch follows success of MenAfriVac® introduction

A Non-State Centric Governance Framework for Global Health – Barcelona Institute for Global Health
A Global Social Contract for a Healthy Global Society: Why, What and How – Barcelona Institute for Global Health

The Huffington Post
http://www.huffingtonpost.com/
Accessed 2 November 2013

Is All Well in the World of Vaccination? We Think a Booster Is Desperately Needed
Huffington Post US | 31 October 2013
Dr. Manica Balasegaram, Executive director of MSF’s Access Campaign

Excerpt
“…Through its medical humanitarian work, Doctors Without Borders/Médecins Sans Frontières (MSF) has been delivering vaccines both in deadly disease outbreaks and through routine vaccination in our clinics for decades, often in places grappling with war and violence. A wake-up call about the fact that life-saving vaccines are not getting to children in some of the hardest-to-reach places, happened in the past several years when we began responding to repeated, massive outbreaks of measles. MSF vaccinated more than four million people in the Democratic Republic of Congo in 2010 alone.

Increasingly, we feel compelled to speak out about what we believe needs to change in the immunization world, both to make our work more effective and to decrease the number of children who miss out on the benefits of vaccines. As GAVI concludes its ‘mid-term review’ meeting — where it reflected on its accomplishments over the last few years and looked ahead to how it will position itself in the future — we think it’s a good time to suggest several short- and long-term changes that could help reach more of the children who are missing out on life-saving vaccination. GAVI now has a real opportunity to change certain policies, push for easier-to-use products, and negotiate lower prices for vaccines…