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Best wishes for success in your important work during 2014,

David Curry and Art Caplan

Arthur L. Caplan PhD
Drs. William F and Virginia Connolly Mitty Chair
Director, Division of Medical Ethics
NYU Langone Medical Center

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
email:    david.r.curry@centerforvaccineethicsandpolicy.org

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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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

The International AIDS Vaccine Initiative (IAVI) announced a US$378,000 grant from the Robert Wood Johnson Foundation to “convene international scientists and public-health experts to explore the creation of a Human Vaccines Project that could collectively leverage technological advances to accelerate the development of new vaccines against AIDS, tuberculosis, malaria, and other major diseases.” Wayne C. Koff, IAVI Chief Scientific Officer and Principal Investigator of the grant, commented, “New approaches are critically needed. Despite major advances in vaccine discovery and immune-system monitoring, common questions hinder development of vaccines against many diseases. Solving these trans-vaccinology questions in a global consortium could be transformative for individual and public health. IAVI is once again proud to serve as a catalyst in cutting-edge science by convening a forum to open this conversation.”

Dr.  Koff and eight fellow scientists wrote in Science (May 2013) describing a Human Vaccines Project which would aim to identify and prioritize the questions to solve. With support from the Robert Wood Johnson Foundation, IAVI will host three workshops to explore the viability, potential impact, and requirements of such a project. The first workshop, in February, will gather internationally recognized representatives from academia, the vaccine industry, government, and product-development partnerships and other non-government organizations to help identify needs and craft a potential scientific plan.

“There are many viral, bacterial, parasitic, and chronic diseases for which vaccines are needed,” said Stanley Plotkin, Emeritus Professor of the University of Pennsylvania and Chairman of the Human Vaccines Project Steering Committee. “This Project holds the potential to greatly accelerate the development of vaccines against major global killers, and provide a foundation for future prevention of new and emerging diseases.”

http://www.iavi.org/Information-Center/Press-Releases/Pages/IAVI-Receives-RWJF-Grant-to-Catalyze-a-Human-Vaccines-Project.aspx

    The Bill & Melinda Gates Foundation selected Susan Desmond-Hellmann, M.D., M.P.H. as its next chief executive officer. Dr. Desmond-Hellmann is currently the chancellor of the University of California, San Francisco (UCSF), and will assume her role on May 1, 2014. An oncologist by training, Desmond-Hellmann is “a recognized leader on issues of higher education, public health, drug development, regulatory innovation and health policy. She has led UCSF since August 2009, when she became the first woman to serve as the university’s chancellor, overseeing all aspects of the university and medical center’s strategy, academic programs and operations. She has extensive experience in product development, and a deep understanding of how to bridge applied research to delivery of product. Prior to her tenure at UCSF, she was President of Product Development at Genentech, where she led the development and introduction of two of the first gene-targeted therapies for cancer, Avastin and Herceptin.” Desmond-Hellmann also served as a member of Genentech’s executive committee, beginning in 1996. She sits on the boards of directors of Proctor and Gamble and Facebook, and was previously a member of the Federal Reserve Bank of San Francisco’s Economic Advisory Council. Desmond-Hellmann will take over from Jeff Raikes, who announced his retirement from the foundation in September 2013 after five years as CEO.

http://www.gatesfoundation.org/Media-Center/Press-Releases/2013/12/Susan-Desmond-Hellmann-Named-Chief-Executive-Officer-of-the-Bill-and-Melinda-Gates-Foundation

Update: Polio this week – As of 18 December 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s extract and bolded text]
As the year 2013 draws to a close, the GPEI takes stock:
:: In Afghanistan, no indigenous cases of wild poliovirus have occurred all year – all cases are linked to cross-border transmission with neighbouring Pakistan.
:: In Nigeria, poliovirus is increasingly geographically restricted – primarily to Kanod and Borno states. Over the past 4 months, only four cases have occurred in the country, despite the onset of the rainy season (the “high season” for polio transmission).
:: The Horn of Africa outbreak is on the decline, including in Banadir, Somalia, the “engine” of the outbreak (no cases since July).
:: A cross-regional emergency approach is being implemented in the Middle East.
:: In Pakistan, the main reservoir area is Federally Administered Tribal Areas (FATA), in particular North Waziristan.  During the ‘high season’ in the past four months, 52 cases of wild poliovirus have been reported from FATA, with evidence of widespread geographic transmission across the country.  Areas within Pakistan are being re-infected, as is neighbouring Afghanistan, and the outbreak in the Middle East originated in Pakistan.
:: The overriding operational priority for the GPEI is to ensure all children are reached during supplementary immunization activities during the 2014 ‘low season’ for polio transmission.

Pakistan
:: One new WPV1 case was reported in the past week from North Waziristan, FATA. The total number of WPV1 cases for Pakistan in 2013 is now 75. The most recent WPV1 case had onset of paralysis on 26 November (from North Waziristan, FATA).
:: North Waziristan is the area with the largest number of children being paralyzed by poliovirus in Pakistan. Immunization activities have been suspended by local leaders since June 2012. It is critical that children in all areas are vaccinated and protected from poliovirus. Immunizations in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.

The Weekly Epidemiological Record (WER) for 3 January 2014, vol. 89, 1 (pp. 1–20) includes:
:: Meeting of the Strategic Advisory Group of Experts on immunization, November 2013 – conclusions and recommendations
http://www.who.int/entity/wer/2014/wer8901.pdf

Ecobank and the Global Fund announced a partnership that includes innovative financing, advocacy and cash contributions worth a total of US$3 million over the next three years. Ecobank and the Ecobank Foundation “will partner with the Global Fund in innovative regional and country specific financing programs that will aim to strengthen the financial management capabilities of grant recipients. Ecobank will also contribute training in financial management skills, accounting and reporting expected to facilitate improved grant applications, as well as the implementation and evaluation processes.” Ecobank is described as a leading pan-African financial institution that operates in 35 countries in Africa and embraces a mission of contributing to the economic and financial development of Africa. Ecobank will provide advocacy for the Global Fund, and call on the innovative capabilities of its partners and over 18,000 employees. Ecobank will contribute US$1.5 million in cash, and half will be earmarked for strengthening the financial management capabilities of implementing partners. Additional contributions will include in-kind services, training and fundraising.

http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-12-19_Ecobank_and_the_Global_Fund_Launch_Partnership/

Report: The Outbreaks – Protecting Americans from Infectious Diseases
Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF),
December 2013
http://www.healthyamericans.org/assets/files/TFAH2013OutbreaksRpt11.pdf

Abstract [Excerpt with bolded text by Editor]
The report finds that a majority of states (32) score 5 or lower out of 10 key indicators of policies and capabilities to protect against infectious disease threats. Three states tied for the lowest score, achieving two out of 10 possible indicators – Georgia, Nebraska and New Jersey. New Hampshire had the highest score, with 8 out of 10.

Some key findings include:
:: One-third of states do not require healthcare facilities to report healthcare-associated infections (HAI).  Approximately one out of every 20 hospitalized patients will contract a HAI.
:: Only one-quarter of states vaccinated at-least half of their population against the seasonal flu.  The U.S. Centers for Disease Control and Prevention (CDC) recommends all Americans ages 6 months and older get vaccinated.  Twenty percent of Americans get the flu each year.
:: Only two states (Connecticut and Delaware) and Washington, D.C. meet the U.S. Department of Health and Human Services (HHS) goal of vaccinating at least 90 percent of preschoolers (19- to 35-month olds) against the whooping cough.
:: Fewer than half of states require human papillomavirus (HPV) vaccinations, education for parents about the vaccine or funding for vaccinations.  CDC and the American Academy of Pediatrics recommend the vaccination for both males and females at 11 or 12 years of age.
:: One-third of states do not cover routine HIV screening under their Medicaid program.  More than 1.1 million Americans are living with HIV/AIDS, and almost one in five do not know they are infected.
:: Just over half of public health laboratories did not test their Continuity of Operations (COOP) plans either through a drill or real event last year.
:: Two-thirds of states decreased funding for public health from Fiscal Year (FY) 2011-12 to FY 2012-13.

The report’s provides a series of recommendations that address many of the major gaps in infectious disease control and prevention, including:
:: Strengthening fundamental capabilities – maintaining an expert workforce and giving them state-of-the-art tools required to conduct investigations to quickly detect, control and treat disease outbreaks;
:: Countering antibiotic resistance and prioritizing research and development of medical countermeasures should be top health and national security priorities;
:: Increasing the number of Americans receiving recommended vaccinations and routine screenings for particular diseases, since these are the safest and most effective ways to reduce infectious diseases in the United States;
:: Modernizing disease surveillance and ensuring public health laboratories have the equipment and capacity to not only test for routine problems like foodborne illnesses but also for new and large-scale threats like bioterrorism or a pandemic;
:: Supporting policies and incentives to reduce the number of healthcare-associated infections, ensuring Americans can receive safe care;
:: Improving global coordination to prevent and contain emerging new illnesses like MERS while maintaining defenses against “old-school” threats like malaria and tuberculosis;
:: Shoring up the nation’s public health preparedness capabilities to respond to major disease outbreaks or acts of bioterrorism to ensure new threats can be rapidly identified and contained; and
:: Countering complacency around HIV/AIDS, hepatitis B and C (HBV and HCV) and tuberculosis– including countering an alarming rise in new HIV infections among young gay men, and screening millions of Baby Boomers who may be infected with HCV and do not know they are at risk for developing serious liver disease as they age.

Report: The Global Crisis of Drug-Resistant Tuberculosis and Leadership of China and the BRICS: Challenges and Opportunities – Summary of a Joint Workshop
IOM
December 19, 2013
http://iom.edu/Reports/2013/The-Global-Crisis-of-Drug-Resistant-Tuberculosis-and-Leadership-of-China-and-the-BRICS.aspx
Note: Workshop Summaries contain the opinion of the presenters, but do NOT reflect the conclusions of the IOM. 

Abstract
Although antibiotics to treat tuberculosis (TB) were developed in the 1950s and are effective against a majority of TB cases, resistance to these antibiotics has emerged over the years, resulting in the growing spread of drug-resistant TB. Since 2008, the IOM Forum on Drug Discovery, Development, and Translation has hosted or co-hosted six domestic and international workshops to address the global crisis of drug-resistant TB. The Forum held international workshops in South Africa and Russia in 2010, and in India in 2011.

On January 16-18, 2013, The IOM along with the Institute of Microbiology of the Chinese Academy of Sciences held a workshop to address the current status of drug-resistant TB globally and in China. Among other topics, participants at the workshop considered the opportunities for emerging leadership in drug-resistant TB control from Brazil, Russia, India, China, and South Africa (the BRICS countries), and discussed innovative strategies to advance and harmonize local and international efforts to prevent and treat drug-resistant TB. This document summarizes the workshop.

WHO: The right to health
Fact sheet N°323
Reviewed November 2013 http://www.who.int/mediacentre/factsheets/fs323/en/index.html

Excerpt
Key facts
:: The WHO Constitution enshrines the highest attainable standard of health as a fundamental right of every human being.
:: The right to health includes access to timely, acceptable, and affordable health care of appropriate quality.
:: Yet, about 150 million people globally suffer financial catastrophe annually, and 100 million are pushed below the poverty line as a result of health care expenditure.
:: The right to health means that States must generate conditions in which everyone can be as healthy as possible. It does not mean the right to be healthy.
:: Vulnerable and marginalized groups in societies tend to bear an undue proportion of health problems.

The right to health means that governments must generate conditions in which everyone can be as healthy as possible. Such conditions range from ensuring availability of health services, healthy and safe working conditions, adequate housing and nutritious food. The right to health does not mean the right to be healthy…
General Comment on the Right to Health
To clarify and operationalize the above provisions, the UN Committee on Economic, Social and Cultural Rights, which monitors compliance with the ICESCR, adopted a General Comment on the Right to Health in 2000.

The General Comment states that the right to health extends not only to timely and appropriate health care but also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information, including on sexual and reproductive health.

According to the General Comment, the right to health contains four elements:
:: Availability: A sufficient quantity of functioning public health and health care facilities, goods and services, as well as programmes.
:: Accessibility: Health facilities, goods and services accessible to everyone. Accessibility has four overlapping dimensions:
–       non-discrimination
–       physical accessibility
–       economical accessibility (affordability)
–       information accessibility.
:: Acceptability: All health facilities, goods and services must be respectful of medical ethics and culturally appropriate as well as sensitive to gender and life-cycle requirements.
:: Quality: Health facilities, goods and services must be scientifically and medically appropriate and of good quality.

The right to health, like all human rights, imposes on States Parties three types of obligations.
:: Respect: This means simply not to interfere with the enjoyment of the right to health (“do no harm”).
:: Protect: This means ensuring that third parties (non-state actors) do not infringe upon the enjoyment of the right to health (e.g. by regulating non-state actors).
:: Fulfil: This means taking positive steps to realize the right to health (e.g. by adopting appropriate legislation, policies or budgetary measures)…

American Journal of Preventive Medicine
Volume 46, Issue 1 , Pages 1-9, January 2014
http://www.ajpmonline.org/current

Seasonal Influenza Vaccination at School: A Randomized Controlled Trial  
Sharon G. Humiston, Stanley J. Schaffer, Peter G. Szilagyi, Christine E. Long, et al.
http://www.ajpmonline.org/article/S0749-3797%2813%2900537-0/abstract

Abstract
Background
Influenza vaccination coverage for U.S. school-aged children is below the 80% national goal. Primary care practices may not have the capacity to vaccinate all children during influenza vaccination season. No real-world models of school-located seasonal influenza (SLV-I) programs have been tested.

Purpose
Determine the feasibility, sustainability, and impact of an SLV-I program providing influenza vaccination to elementary school children during the school day.

Design
In this pragmatic randomized controlled trial of SLV-I during two vaccination seasons, schools were randomly assigned to SLV-I versus standard of care. Seasonal influenza vaccine receipt, as recorded in the state immunization information system (IIS), was measured.

Setting/participants
Intervention and control schools were located in a single western New York county. Participation (intervention or control) included the sole urban school district and suburban districts (five in Year 1, four in Year 2).

Intervention
After gathering parental consent and insurance information, live attenuated and inactivated seasonal influenza vaccines were offered in elementary schools during the school day.

Main outcome measures
Data on receipt of ≥1 seasonal influenza vaccination in Year 1 (2009–2010) and Year 2 (2010–2011) were collected on all student grades K through 5 at intervention and control schools from the IIS in the Spring of 2010 and 2011, respectively. Additionally, coverage achieved through SLV-I was compared to coverage of children vaccinated elsewhere. Preliminary data analysis for Year 1 occurred in Spring 2010; final quantitative analysis for both years was completed in late Fall 2012.

Results
Results are shown for 2009–2010 and 2010–2011, respectively: Children enrolled in suburban SLV-I versus control schools had vaccination coverage of 47% vs 36%, and 52% vs 36% (p<0.0001 both years). In urban areas, coverage was 36% vs 26%, and 31% vs 25% (p<0.001 both years). On multilevel logistic analysis with three nested levels (student, school, school district) during both vaccination seasons, children were more likely to be vaccinated in SLV-I versus control schools; ORs were 1.6 (95% CI=1.4, 1.9; p<0.001) and 1.5 (95% CI=1.3, 1.8; p<0.001).

Conclusions
Delivering influenza vaccine during school is a promising approach to improving pediatric influenza vaccination coverage.

Trial Registry
ClinicalTrials.govNCT01224301

American Journal of Preventive Medicine
Volume 46, Issue 1 , Pages 1-9, January 2014
http://www.ajpmonline.org/current

Physicians’ Human Papillomavirus Vaccine Recommendations, 2009 and 2011
Susan T. Vadaparampil, PhD, Teri L. Malo, PhD, Jessica A. Kahn, MD, Daniel A. Salmon, PhD, Ji-Hyun Lee, DrPH, Gwendolyn P. Quinn, PhD, Richard G. Roetzheim, MD, Karen L. Bruder, MD, Tina M. Proveaux, BS, Xiuhua Zhao, MPH, Neal A. Halsey, MD, Anna R. Giuliano, PhD

Abstract
Background
Physician recommendation is a key predictor of human papillomavirus (HPV) vaccine uptake. Understanding factors associated with recommendation is important for efforts to increase current suboptimal vaccine uptake.

Purpose
This study aimed to examine physician recommendations to vaccinate female patients aged 11–26 years, in 2009 and 2011, at 3 and 5 years postvaccine licensure, respectively. A second aim was to identify trends in factors associated with vaccine recommendation for ages 11 and 12 years.

Methods
Nationally representative samples of physicians practicing family medicine, pediatrics, and obstetrics and gynecology were randomly selected from the American Medical Association Physician Masterfile (n=1538 in 2009, n=1541 in 2011). A mailed survey asked physicians about patient and clinical practice characteristics; immunization support; and frequency of HPV vaccine recommendation (“always” ≥75% of the time vs other). Analyses were conducted in 2012.

Results
Completed surveys were received from 1013 eligible physicians (68% response rate) in 2009 and 928 (63%) in 2011. The proportion of physicians who reported always recommending HPV vaccine increased significantly from 2009 to 2011 for patients aged 11 or 12 years (35% vs 40%, respectively; p=0.03), but not for patients aged 13–17 years (53% vs 55%; p=0.28) or 18–26 years (50% vs 52%; p=0.52). Physician specialty, age, and perceived issues/barriers to vaccination were associated with vaccine recommendation for patients aged 11 or 12 in both years.

Conclusions
Results suggest a modest increase in recommendations for HPV vaccination of girls aged 11 or 12 years over a 2-year period; however, recommendations remain suboptimal for all age groups despite national recommendations for universal immunization.

American Journal of Public Health
Volume 104, Issue 1 (January 2014)
http://ajph.aphapublications.org/toc/ajph/current

Reaching Children Never Previously Vaccinated for Influenza Through a School-Located Vaccination Program
Susan M. Kansagra, Vikki Papadouka, Anita Geevarughese, Michael A. Hansen, Kevin J. Konty, Jane R. Zucker
American Journal of Public Health: January 2014, Vol. 104, No. 1: e45–e49.
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301671

Abstract
Objectives. We determined the success of the school-located vaccination (SLV) program, implemented in 2009 in New York City to deliver pandemic influenza A (H1N1) monovalent vaccine (pH1N1), versus provider offices in reaching children who had never previously received influenza vaccine.

Methods. We compared the immunization history of children vaccinated in school versus provider offices. We included records in the Citywide Immunization Registry with pH1N1 administered between October 2009 and March 2010 to elementary school-aged children.

Results. In total, 96 524 children received pH1N1 vaccine in schools, and 102 933 children received pH1N1 vaccine in provider offices. Of children vaccinated in schools, 34% had never received seasonal influenza vaccination in the past, compared with only 10% of children vaccinated at provider offices (P  < .001). Children vaccinated in schools were more likely to have received a second dose of pH1N1 in 2009–2010 than those vaccinated in provider offices (80% vs 45%).

Conclusions. The SLV program was more successful at reaching children who had never received influenza immunization in the past and should be considered as a strategy for delivering influenza vaccine in routine and emergency situations.

American Journal of Public Health
Volume 104, Issue 1 (January 2014)
http://ajph.aphapublications.org/toc/ajph/current

Effect of Vaccination Coordinators on Socioeconomic Disparities in Immunization Among the 2006 Connecticut Birth Cohort
Jessica A. Kattan, Kathy S. Kudish, Betsy L. Cadwell, Kristen Soto, James L. Hadler
American Journal of Public Health: January 2014, Vol. 104, No. 1: e74–e81.
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301418

Abstract
Objectives. We examined socioeconomic status (SES) disparities and the influence of state Immunization Action Plan–funded vaccination coordinators located in low-SES areas of Connecticut on childhood vaccination up-to-date (UTD) status at age 24 months.

Methods. We examined predictors of underimmunization among the 2006 birth cohort (n = 34 568) in the state’s Immunization Information System, including individual demographic and SES data, census tract SES data, and residence in an area with a vaccination coordinator. We conducted multilevel logistic regression analyses.

Results. Overall, 81% of children were UTD. Differences by race/ethnicity and census tract SES were typically under 5%. Not being UTD at age 7 months was the strongest predictor of underimmunization at age 24 months. Among children who were not UTD at age 7 months, only Medicaid enrollment (adjusted odds ratio [AOR] = 0.6; 95% confidence interval [CI] = 0.5, 0.7) and residence in an area with a vaccination coordinator (AOR = 0.7; 95% CI = 0.6, 0.9) significantly decreased the odds of subsequent underimmunization.

Conclusions. SES disparities associated with underimmunization at age 24 months were limited. Efforts focused on vaccinating infants born in low SES circumstances can minimize disparities.

BMC Public Health
(Accessed 21 December 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Parental information-seeking behaviour in childhood vaccinations
Irene A Harmsen, Gemma G Doorman, Liesbeth Mollema, Robert AC Ruiter, Gerjo Kok, Hester E de Melker
BMC Public Health 2013, 13:1219 (21 December 2013)

Abstract (provisional)
Background
People want to be well informed and ask for more information regarding their health. The public can use different sources (i.e. the Internet, health care providers, friends, family, television, radio, and newspapers) to access information about their health. Insight into the types and sources of vaccine related information that parents use, and reasons why they seek extra information is needed to improve the existing information supply about childhood vaccinations.

Methods
Dutch parents with one or more children aged 0-4 years received an online questionnaire (N = 4000) measuring psychosocial determinants of information-seeking behaviour and self-reports of types and sources of vaccine information searched for (response rate 14.8%). We also tested two invitation approaches (i.e., reply card versus Internet link in invitation letter) to observe the difference in response rate.

Results
Almost half of the parents (45.8%) searched for extra information. Of all the respondents, 13% indicated they had missed some information, particularly about side effects of vaccines (25%). Intention to search for vaccination information was influenced by positive attitude and perceived social norm towards information-seeking behaviour. There was no difference in the response rate between the two invitation approaches.

Conclusions
The information provided by the National Immunization Programme (NIP) might be sufficient for most parents. However, some parents mentioned that they did not receive enough information about side effects of vaccinations, which was also the topic most searched for by parents. Public Health Institutes (PHIs) and child healthcare workers should therefore be aware of the importance to mention this aspect in their communication (materials) towards parents. The PHIs must ensure that their website is easy to find with different search strategies. Since the child healthcare worker is perceived as the most reliable information source, they should be aware of their role in educating parents about the NIP.

BMC Public Health
(Accessed 21 December 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Why parents refuse childhood vaccination: a qualitative study using online focus groups
Irene A Harmsen, Liesbeth Mollema, Robert AC Ruiter, Theo GW Paulussen, Hester E de Melker, Gerjo Kok
BMC Public Health 2013, 13:1183 (16 December 2013)

Abstract
Background
In high income countries, vaccine-preventable diseases have been greatly reduced through routine vaccination programs. Despite this success, many parents question, and a small proportion even refuse vaccination for their children. As no qualitative studies have explored the factors behind these decisions among Dutch parents, we performed a study using online focus groups.

Methods
In total, eight online focus groups (n = 60) which included Dutch parents with at least one child, aged 0–4 years, for whom they refused all or part of the vaccinations within the National Immunization Program (NIP). A thematic analysis was performed to explore factors that influenced the parents’ decisions to refuse vaccination.

Results
Refusal of vaccination was found to reflect multiple factors including family lifestyle; perceptions about the child’s body and immune system; perceived risks of disease, vaccine efficacy, and side effects; perceived advantages of experiencing the disease; prior negative experience with vaccination; and social environment. The use of online focus groups proved to be an effective qualitative research method providing meaningful data.

Conclusion
Information provided by the NIP turned out to be insufficient for this group of parents. More trust in the NIP and deliberate decisions might result from increased parental understanding of lifestyle and disease susceptibility, the impact of vaccinations on the immune system, and the relative risks of diseases and their vaccines. The public health institute should also inform parents that the NIP is recommended but non-mandatory.

Infectious Agents and Cancer
http://www.infectagentscancer.com/content
[Accessed 21 December 2013]

Short report  
Clustering patterns of human papillomavirus infections among HIV-positive women in Kenya
Salvatore Vaccarella, Hugo De Vuyst, Nelly R Mugo, Samah R Sakr, Martyn Plummer, Daniëlle A Heideman, Silvia Franceschi, Michael Chung Infectious Agents and Cancer 2013, 8:50 (19 December 2013)

Abstract (provisional)
Background
HIV-positive women are at increased risk of human papillomavirus (HPV) infection, and, especially, multiple infections compared to HIV-negative women. Whether certain HPV types have a tendency to cluster in multiple infections beyond or below what would be expected by shared risk factors (e.g., sexual behavior and the degree of immunosuppression) is unclear. We, therefore, investigated clustering patterns of 44 HPV types in HIV-positive women from Kenya.

Findings: HPV status was assessed on cervical scrapings from 498 women using GP5+/6+ PCR and reverse line blot. Logistic regression was used to model type-specific HPV positivity, adjusted for age, specific HPV type prevalence, CD4, combination antiretroviral therapy, and, in the Full Model, individual-level random effects that represent unobservable risk factors common to all HPV types. We found a modest excess of women with co-infections with 2 HPV types (1.12; 95% credible intervals: 1.03-1.21) in the Full Model but no significant associations of individual types. No significant deviations of observed/expected counts were observed for any 2-way combination of HPV types at either the chosen level of significance, p = 0.00005, or at p = 0.01. Findings were substantially similar when women with CIN2/3 were excluded and when they were stratified by use of anti-retroviral therapy or CD4 count.

Conclusions
HPV co-infections occurred at random in the cervix of HIV-positive women as previously found in HIV-negative women. The removal of HPV types through vaccination should not result, therefore, in an increase or decrease in the prevalence of HPV types not targeted by vaccination in immunosuppressed women.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 21 December 2013]

Chinese social media reaction to the MERS-CoV and avian influenza A(H7N9) outbreaks
Isaac Chun-Hai Fung, King-Wa Fu, Yuchen Ying, Braydon Schaible, Yi Hao, Chung-Hong Chan, Zion Tsz-Ho Tse
Infectious Diseases of Poverty 2013, 2:31 (20 December 2013)

Abstract (provisional)
Background
As internet and social media use have skyrocketed, epidemiologists have begun to use online data such as Google query data and Twitter trends to track the activity levels of influenza and other infectious diseases. In China, Weibo is an extremely popular microblogging site that is equivalent to Twitter. Capitalizing on the wealth of public opinion data contained in posts on Weibo, this study used Weibo as a measure of the Chinese people’s reactions to two different outbreaks: the 2012 Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreak, and the 2013 outbreak of human infection of avian influenza A(H7N9) in China.

Methods
Keyword searches were performed in Weibo data collected by The University of Hong Kong’s Weiboscope project. Baseline values were determined for each keyword and reaction values per million posts in the days after outbreak information was released to the public.

Results
The results show that the Chinese people reacted significantly to both outbreaks online, where their social media reaction was two orders of magnitude stronger to the H7N9 influenza outbreak that happened in China than the MERS-CoV outbreak that was far away from China.

Conclusions
These results demonstrate that social media could be a useful measure of public awareness and reaction to disease outbreak information released by health authorities.

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 2 Issue 4 December 2013
http://jpids.oxfordjournals.org/content/current

Editorial Commentary: Vaccine Refusal Among Pediatric Travelers
Saad B. Omer1,2⇑ and Walter A. Orenstein1,2
Excerpt
United States residents make up the second largest group of individuals from any country traveling internationally [1]. Being a “country of immigrants,” many US residents have international family ties. One consequence of these ties is relatively frequent international travel by children, and approximately 5 million international trips are taken by US resident children [2].

International travel is epidemiologically relevant from 2 perspectives: first, it exposes US residents to infectious diseases prevalent in other parts of the world; second, it increases the risk of importation of infectious diseases—including vaccine-preventable diseases. Returning unvaccinated travelers are often responsible for outbreaks in the United States for diseases whose endemic transmission has been eliminated [3–6]. Therefore, it is important for US travelers—particularly children—to receive all recommended vaccines before they embark on their trips.

Routine vaccination has been very effective in controlling many infectious diseases in the United States; however, an increase in refusal and hesitancy to receiving routine childhood vaccines has been documented [7]. Likewise, vaccines for travelers—whether routine vaccines administered to those who have missed previous …

Pre-Travel Health Preparation of Pediatric International Travelers: Analysis From the Global TravEpiNet Consortium
Stefan Hagmann, Regina C. LaRocque, Sowmya R. Rao, Emily S. Jentes, Mark J. Sotir, Gary Brunette, Edward T. Ryan, and for the Global TravEpiNet Consortium
J Ped Infect Dis (2013) 2 (4): 327-334 doi:10.1093/jpids/pit023
http://jpids.oxfordjournals.org/content/2/4/327.abstract

Abstract
Background: Children frequently travel internationally. Health-related data on such children are limited. We sought to investigate the demographics, health characteristics, and preventive interventions of outbound US international pediatric travelers.

Methods: We analyzed data from 32 099 travelers presenting for pre-travel healthcare at the Global TravEpiNet (GTEN), a national consortium of 19 travel clinics, from January 1, 2009 to June 6, 2012.

Results: A total of 3332 (10%) of all GTEN travelers were children (<18 years of age). These children traveled mostly for leisure (36%) or to visit friends or relatives (VFR) (36%). Most popular destination regions were Africa (41%), Southeast Asia (16%), Central America (16%), and the Caribbean (16%). Compared with children traveling for leisure, VFR children were more likely to present <14 days before departure for pre-travel consultation (44% vs 28%), intended to travel for 28 days or longer (70% vs 22%), and to travel to Africa (62% vs 32%). Nearly half of the pediatric travelers (46%) received at least 1 routine vaccine, and most (83%) received at least 1 travel-related vaccine. Parents or guardians of one third of the children (30%) refused at least 1 recommended travel-related vaccine. Most pediatric travelers visiting a malaria-endemic country (72%) received a prescription for malaria chemoprophylaxis.

Conclusions: Ten percent of travelers seeking pre-travel healthcare at GTEN sites are children. VFR-travel, pre-travel consultation close to time of departure, and refusal of recommended vaccines may place children at risk for travel-associated illness. Strategies to engage pediatric travelers in timely, pre-travel care and improve acceptance of pre-travel healthcare interventions are needed.

The Lancet  
Dec 21, 2013  Volume 382  Number 9910  p2039 – 2114  e48 – 53
http://www.thelancet.com/journals/lancet/issue/current

Bangladesh’s health revolution
Fazle Hasan Abed
Preview |
My country, Bangladesh, has seen a health revolution in my lifetime. Maternal mortality has decreased by 75% since 1980,1 infant mortality has more than halved since 1990, and life expectancy has risen to 68·3 years, higher now than in neighbouring India and Pakistan.2 Such rapid changes in health have almost no historical precedent, save perhaps for Japan’s breakneck modernisation following the 19th-century Meiji Restoration.3 …

Health care for poor people in the urban slums of Bangladesh
Kaosar Afsana, Syed Shabab Wahid
Preview |
Bangladesh has witnessed substantial success with respect to health, as described in the Lancet Bangladesh Series and elsewhere.1 The daunting challenge now is the health of poor people living in urban areas. Massive and rapid urbanisation is occurring, with rural populations moving to cities in huge numbers, driven by poverty, climate change, and the promise of better economic opportunities.2,3 In the past 40 years the proportion of the population living in urban settings in Bangladesh has increased from 5% to 28%, with roughly 45 million people now living in urban areas.

Series
Bangladesh: Innovation for Universal Health Coverage
Reducing the health effect of natural hazards in Bangladesh
Richard A Cash, Shantana R Halder, Mushtuq Husain, Md Sirajul Islam, Fuad H Mallick, Maria A May, Mahmudur Rahman, M Aminur Rahman
Preview | Summary |

Innovation for universal health coverage in Bangladesh: a call to action
Alayne M Adams, Tanvir Ahmed, Shams El Arifeen, Timothy G Evans, Tanvir Huda, Laura Reichenbach, for The Lancet Bangladesh Team
Preview | Summary |

New England Journal of Medicine
December 19, 2013  Vol. 369 No. 25
http://www.nejm.org/toc/nejm/medical-journal

Shattuck Lecture
Chronic Infectious Disease and the Future of Health Care Delivery
Paul E. Farmer, M.D., Ph.D.
http://www.nejm.org/doi/full/10.1056/NEJMsa1310472

Excerpt
More than four decades after one U.S. Surgeon General reportedly declared it “time to close the book on infectious diseases,” drug-resistant pathogens have diminished the effectiveness of once-potent therapies.1 In the past three decades, newly described pathogens, including the human immunodeficiency virus (HIV), the severe acute respiratory syndrome (SARS) virus, and the H1N1 influenza virus, have caused pandemics, while old scourges from tuberculosis to cholera have persisted or resurged. Simultaneously, rising life expectancy and rapid social change have led to an increasing burden of chronic diseases for which we have effective therapies but inadequate innovation for delivering them efficiently to the neediest people — the so-called know–do, or delivery, gap.

As compared with discovery science and randomized trials, the 20th-century biomedical paradigm viewed care delivery as scientifically uninteresting — too messy for serious scrutiny, like the observational and qualitative methods that elucidate it. Yet understanding how and why care delivery does or does not happen and how to improve it may now represent medicine’s most important task.2

In settings of poverty, the delivery gap can be a gulf, especially in the case of chronic illness. In the rural villages and small towns in Rwanda, Malawi, and Lesotho, where the nongovernmental organization Partners in Health has worked over the past decade, adherence to daily regimens may seem unlikely. But rapid progress can be made toward closing the gap, as we had learned in rural Haiti. Work with local, national, and international partners to develop health systems able to respond to both acute and chronic disease shows that we can, with adequate resources, improve care delivery, sharply reducing morbidity and mortality. I believe that the lessons from 25 years of responding to the acquired immunodeficiency syndrome (AIDS) and other chronic infections have implications for the chronic afflictions now recognized as leading causes of premature death and disability in places rich and poor (a slide show is available with the full text of this article at NEJM.org)…

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

An Efficient Immunization Strategy for Community Networks
Kai Gong, Ming Tang, Pak Ming Hui, Hai Feng Zhang, Do Younghae, Ying-Cheng Lai
Research Article | published 20 Dec 2013 | PLOS ONE 10.1371/journal.pone.0083489

Abstract
An efficient algorithm that can properly identify the targets to immunize or quarantine for preventing an epidemic in a population without knowing the global structural information is of obvious importance. Typically, a population is characterized by its community structure and the heterogeneity in the weak ties among nodes bridging over communities. We propose and study an effective algorithm that searches for bridge hubs, which are bridge nodes with a larger number of weak ties, as immunizing targets based on the idea of referencing to an expanding friendship circle as a self-avoiding walk proceeds. Applying the algorithm to simulated networks and empirical networks constructed from social network data of five US universities, we show that the algorithm is more effective than other existing local algorithms for a given immunization coverage, with a reduced final epidemic ratio, lower peak prevalence and fewer nodes that need to be visited before identifying the target nodes. The effectiveness stems from the breaking up of community networks by successful searches on target nodes with more weak ties. The effectiveness remains robust even when errors exist in the structure of the networks.

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

Community-Based Interventions to Improve HPV Vaccination Coverage among 13- to 15-Year-Old Females: Measures Implemented by Local Governments in Japan
Hiroyuki Fujiwara, Yuji Takei, Yoshiki Ishikawa, Yasushi Saga, Shizuo Machida, Akiyo Taneichi, Mitsuaki Suzuki
Research Article | published 16 Dec 2013 | PLOS ONE 10.1371/journal.pone.0084126

Abstract
The purpose of this study was to examine the effect of various community-based interventions in support of HPV vaccination implemented by cities and towns within Tochigi prefecture, Japan with a view to identifying useful indicators which might guide future interventions to improve HPV vaccination coverage in the prefecture. A postal questionnaire survey of all 27 local governments in Tochigi Prefecture was conducted in December 2010. All 27 responded, and 22 provided the exact numbers of the targeted and vaccinated populations of 13- to 15-year-old girls from April to December 2010. The local governments also answered questions on the type of interventions implemented including public subsidies, school-based programs, direct mail, free tickets and recalls. Local governments that conducted a school-based vaccination program reported 96.8% coverage for the 1st dose, 96.2% for the 2nd dose, and 91.2% for the 3rd dose. Those that provided subsidies without school-based programs reported a wide range of vaccination rates: 45.7%–95.0% for the 1st dose, 41.1%–93.7% for the 2nd dose and 3.1%–90.1% for the 3rd dose. Among this group, the combination of a free ticket, direct mail and recall was most effective, with 95.0% coverage for the 1st dose, 93.7% for the 2nd dose, and 90.1% for the 3rd dose. The governments that did not offer a subsidy had the lowest vaccination coverage, with 0.8%–1.4% for the 1st dose, 0.0%–0.8% for the 2nd dose, and 0.1%–0.1% for the 3rd dose. The results of this survey indicate that school-based vaccinations and public subsidies are the most effective method to improve HPV vaccination coverage; however, the combination of a free ticket, direct mail, and recalls with public subsidies are also important measures in increasing the vaccination rate. These data may afford important indicators for the successful implementation of future HPV vaccination programs.

Science        
20 December 2013 vol 342, issue 6165, pages 1405-1544
http://www.sciencemag.org/current.dtl

Breakthrough of the Year
Cancer Immunotherapy
Jennifer Couzin-Frankel
Science’s editors have chosen cancer immunotherapy as Breakthrough of the Year for 2013, a strategy that harnesses the body’s immune system to combat tumors. It’s an attractive idea, and researchers have struggled for decades to make it work. Now, many oncologists say those efforts are paying off, as two different techniques show signs of helping some patients. One involves antibodies that release a brake on T cells, giving them the power to tackle tumors. Another involves genetically modifying an individual’s T cells outside the body to make them better able to target cancer, and then reinfusing them so they can do just that. Experts stress that these techniques have been tested in only small trials, and they don’t always work. But the results have raised hope that immunotherapy may give doctors new options for treatment in the future.
Read the Full Text

2013 Runners-Up
In Vaccine Design, Looks Do Matter
In work that Science ranked as a runner-up for Breakthrough of the Year, researchers used structural biology—the study of the molecules of life—to design the key ingredient of a vaccine against a dangerous childhood disease. Respiratory syncytial virus (RSV) infections hospitalize millions of infants every year. This year, scientists crystallized an antibody the body uses to combat RSV; then they analyzed its structure and used the information to design an immunogen that may lead to a vaccine. Other researchers hope a similar approach will yield new HIV drug
Read the Full Text

UN Chronicle
Vol. L No. 4 2013 December 2013
http://unchronicle.un.org/

Theme: Education
This edition of the UN Chronicle looks at the social impact of education as part of the third anniversary of the establishment of the United Nations Academic Impact. The articles, written by leading experts on education, examine issues such as the importance of educating young people about the UN; higher learning institutions and global citizen education; making academic research accessible; international mobility of Brazilian students; and education as the pathway towards gender equality.

Vaccine
Volume 32, Issue 2, Pages 205-310 (3 January 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

A reduction in chronic hepatitis B virus infection prevalence among children in Vietnam demonstrates the importance of vaccination
Review Article
Pages 217-222
Tran Hien Nguyen, Minh Huong Vu, Van Cuong Nguyen, Lien Huong Nguyen, Kohei Toda, Tuyet Nga Nguyen, Sang Dao, Kathleen A. Wannemuehler, Karen A. Hennesse
Abstract
Background
Vietnam has high endemic hepatitis B virus infection with >8% of adults estimated to have chronic infection. Hepatitis B vaccine was first introduced in the national childhood immunization program in 1997 in high-risk areas, expanded nationwide in 2002, and included birth dose vaccination in 2003. This survey aimed to assess the impact of Vietnam’s vaccination programme by estimating the prevalence of hepatitis B surface antigen (HBsAg) among children born during 2000–2008.
Methods
This nationally representative cross-sectional survey sampled children based on a stratified three-stage cluster design. Demographic and vaccination data were collected along with a whole blood specimen that was collected and interpreted in the field with a point-of-care HBsAg test.
Results
A total of 6,949 children were included in the survey analyses. The overall HBsAg prevalence among surveyed children was 2.70% (95% confidence interval (CI): 2.20–3.30). However, HBsAg prevalence was significantly higher among children born in 2000–2003 (3.64%) compared to children born 2007–2008 (1.64%) (prevalence ratio (PR: 2.22, CI 1.55–3.18)). Among all children included in the survey, unadjusted HBsAg prevalence among children with ≥3 doses of hepatitis B vaccine including a birth dose (1.75%) was significantly lower than among children with ≥3 doses of hepatitis B vaccine but lacked a birth dose (2.98%) (PR: 1.71, CI: 1.00–2.91) and significantly lower than among unvaccinated children (3.47%) (PR: 1.99, CI: 1.15–3.45). Infants receiving hepatitis B vaccine >7 days after birth had significantly higher HBsAg prevalence (3.20%) than those vaccinated 0-1 day after birth (1.52%) (PR: 2.09, CI: 1.27–3.46).
Conclusion
Childhood chronic HBV infection prevalence has been markedly reduced in Vietnam due to vaccination. Further strengthening of timely birth dose vaccination will be important for reducing chronic HBV infection prevalence of under 5 children to <1%, a national and Western Pacific regional hepatitis B control goal.

Vaccine
Volume 32, Issue 2, Pages 205-310 (3 January 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

System factors to explain 2009 pandemic H1N1 state vaccination rates for children and high-risk adults in US emergency response to pandemic
Original Research Article
Pages 246-251
Carlo Davila-Payan, Julie Swann, Pascale M. Wortley
Abstract
Introduction
During the 2009–2010 H1N1 pandemic, children and high-risk adults had priority for vaccination. Vaccine in short supply was allocated to states pro-rata by population, but vaccination rates as of January 2010 varied among states from 21.3% to 84.7% for children and 10.4% to 47.2% for high-risk adults. States had different campaign processes and decisions.

Objective
To determine program and system factors associated with higher state pandemic vaccination coverage for children and high-risk adults during an emergency response with short supply of vaccine.

Methods
Regression analysis of factors predicting state-specific H1N1 vaccination coverage in children and high-risk adults, including state campaign information, demographics, preventive or health-seeking behavior, preparedness funding, providers, state characteristics, and surveillance data.

Results
Our modeling explained variation in state-specific vaccination coverage with an adjusted R-squared of 0.82 for children and 0.78 for high-risk adults. We found that coverage of children was positively associated with programs focusing on school clinics and with a larger proportion of doses administered in public sites; negatively with the proportion of children in the population, and the proportion not visiting a doctor because of cost. The coverage for high-risk adults was positively associated with shipments of vaccine to “general access” locations, including pharmacy and retail, with the percentage of women with a Pap smear within the past 3 years and with past seasonal influenza vaccination. It was negatively associated with the expansion of vaccination to the general public by December 4, 2009. For children and high-risk adults, coverage was positively associated with the maximum number of ship-to-sites and negatively associated with the proportion of medically underserved population.

Conclusion
Findings suggest that distribution and system decisions such as vaccination venues and providers targeted can positively impact vaccination rates for children and high-risk adults. Additionally, existing health infrastructure, health-seeking behaviors, and access affected coverage.

.
Current situation of tuberculosis in Japan and requirement for new vaccine
Pages 304-305
Satoshi Mitarai
No abstract

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

School Nurses’ Role as Opinion Leaders Regarding the HPV Vaccine for Youth
Rosen, Brittany Leigh
Doctoral dissertation, Texas A & M University. Available electronically from http : / /hdl .handle .net /1969 .1 /151111.
Abstract
The most common sexually transmitted infection for both males and females is the human papillomavirus (HPV). HPV is responsible for nearly all cervical cancers. Currently, an HPV vaccine is available; however, HPV vaccination rates for US adolescents are dismal. School nurses serve as the person connecting medical and school communities, and are a critical component in assisting families traverse the medical and educational systems. Thus, there is reason to assume school nurses can be key opinion leaders regarding the HPV vaccine. The purpose of this study was to: (1) explain how the Diffusion of Innovations (DOI) theory explains school nurses’ roles as opinion leaders regarding the HPV vaccine; (2) document current literature regarding healthcare providers’ perspectives and practice regarding the HPV vaccine; and (3) evaluate school nurses’ knowledge, attitudes, perceptions of being an opinion leader and professional practice regarding the HPV vaccine for youth. DOI states opinion leaders influence the rate of an innovation (e.g., the HPV vaccine). We argue school nurses are opinion leaders for the HPV vaccine because of their unique leadership position through their cross-disciplinary understanding of the educational and health systems. The systematic literature review included 28 studies of healthcare providers. The main barrier, vaccine cost, was identified in 12 reports. Additionally, females and older adolescents were more frequently vaccinated than males and younger adolescents. To examine school nurses’ knowledge, attitudes, perceptions and professional practice regarding the HPV vaccine, the study included a sample of 413 school nurses. Structural equation modeling revealed knowledge influenced attitudes, attitudes affected perceptions and professional practices, and perceptions predicted professional practice. Furthermore, the perceptions variable was found to be a partial mediator in the model. Practitioners designing programs to engage school nurses in disseminating HPV vaccine education may benefit from questioning whether their programs might be emphasizing non-crucial elements for influencing vaccine dissemination practice (e.g., knowledge) and de-emphasizing influential elements such as attitudes and perceptions.

Special Focus Newsletters
Dengue Vaccine Initiative: Newsletter – December 2013
http://us2.campaign-archive2.com/?u=3805c2f42ef8400c2e9729b91&id=d19a996957&e=6898e601e9

PATH –RotaFlash – December 16, 2013
http://vad.createsend5.com/t/ViewEmail/r/F6E8B1F28B9C2F4C2540EF23F30FEDED/E38B11B8894CC5F5DBC23BD704D2542D

Brookings
http://www.brookings.edu/
Accessed 21 December 2013

Opinion | December 2013
The Equity of Universal Health Coverage: Some Reflections from Singapore
By: Calvin Wai Loon Ho
http://www.brookings.edu/research/opinions/2013/12/09-singapore-universal-health-coverage-ho

Excerpt
The challenges confronting health systems in Asia include known and emerging infectious diseases and an increasing prevalence of non-communicable diseases. For a number of countries, such as Singapore, a rapidly aging population is expected to exacerbate the latter. In 2005, member states of the World Health Organization (WHO) from East Asia and elsewhere made a commitment to develop their health financing systems in ways that will ensure that all people have access to health services and do not suffer financial hardship in paying for them.[1] By this initiative, how successfully health systems meet the challenges ahead will depend on the extent that equity in access and equity in financing are achieved. Equity is difficult to define simply, but it is regarded as a cornerstone not only of policy decisions, but also of ethically legitimate social institutions.[2] Broadly speaking, equity is concerned with maximizing the benefits, capabilities and general well-being of the worst off members of a society. In the context of universal health care (UHC), equity in access could be understood as necessitating the prioritization of those who with the greatest health needs in order to secure for them equality of opportunity or capability to the furthest extent possible. At the same time, health systems must ensure that households are not made to contribute more than their ability to pay in order for equity in financing to be also secured…

Forbes
http://www.forbes.com/
Accessed 21 December 2013

Op/Ed
12/16/2013 @ 6:00AM
Meningitis Outbreaks Call For FDA Leadership. Don’t Hold Your Breath.
Henry I. Miller
http://www.forbes.com/sites/henrymiller/2013/12/16/meningitis-outbreaks-call-for-fda-leadership-dont-hold-your-breath/

Excerpt
Vaccination is one of the most important advances in public health in recent centuries, and hundreds of vaccines have all but eradicated many of the infectious disease scourges of the past. But two recent college campus outbreaks of Meningitis B (MenB), which is caused by serotype B of a bacterium called Neisseria meningitidis, or meningococcus, show that more needs to be done.  What we need right now is not scientific or technological ingenuity, but more enlightened and responsive government oversight…

New York Times
http://www.nytimes.com/
Accessed 21 December 2013

Michiaki Takahashi, 85, Who Tamed Chickenpox, Dies
By WILLIAM YARDLEY
Published: December 21, 2013
http://www.nytimes.com/2013/12/22/health/michiaki-taka
Excerpt
Dr. Michiaki Takahashi, whose experience caring for his 3-year-old son after the boy contracted chickenpox led him to develop a vaccine for the virus that is now used all over the world, died on Monday in Osaka, Japan. He was 85…

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_14 Dec 2013
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– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links: We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
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– Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

WHO: World Malaria Report 2013
http://www.who.int/entity/malaria/publications/world_malaria_report_2013/report/en/index.html
Number of pages: 284
Publication date: 2013
Languages: English (summaries in French and Spanish)
ISBN: 9 789241 56469 4Media Release Excerpt

11 December 2013 | Geneva/Washington DC – Global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000, reducing malaria mortality rates by 45% globally and by 49% in Africa..

…The large majority of the 3.3 million lives saved between 2000 and 2012 were in the 10 countries with the highest malaria burden, and among children aged less than 5 years – the group most affected by the disease. Over the same period, malaria mortality rates in children in Africa were reduced by an estimated 54%.

…In 2012, there were an estimated 207 million cases of malaria (uncertainty interval: 135 – 287 million), which caused approximately 627 000 malaria deaths (uncertainty interval 473 000 – 789 000). An estimated 3.4 billion people continue to be at risk of malaria, mostly in Africa and south-east Asia. Around 80% of malaria cases occur in Africa.

The “World malaria report 2013” summarizes information received from 102 countries that had on-going malaria transmission during the 2000-2012 period, and other sources, and updates the analyses presented in 2012.

The report contains revised estimates of the number of malaria cases and deaths, which integrate new and updated under-5 mortality estimates produced by the United Nations Inter-agency Group for Child Mortality Estimation, as well as new data from the Child Health Epidemiology Reference Group.

http://www.who.int/mediacentre/news/releases/2013/world-malaria-report-20131211/en/index.html

From the report:
5.3 New therapies for malaria prevention
5.3.1 Malaria vaccine development
An effective vaccine against malaria has long been envisaged as a valuable addition to the available tools for malaria control. Although research towards the development of malaria vaccines has been pursued since the 1960s, as yet there are no licensed malaria vaccines.  However, a number of candidate vaccines are being evaluated in clinical trials, with one candidate vaccine currently being assessed in Phase 3 clinical trials (RTS,S/AS01) (8), and about 20 others in Phase 1 or Phase 2 clinical trials.5

Vaccine candidate RTS,S/AS01
The RTS,S/AS01 vaccine targets P. falciparum. Now in Phase 3 clinical trials, the vaccine is being developed in a partnership between GlaxoSmithKline (GSK) and PATH Malaria Vaccine

Initiative (MVI), with MVI receiving funds from the Bill & Melinda Gates Foundation. The vaccine comprises a fusion protein of a malaria antigen – the carboxy terminus of the P. falciparum

circumsporozoite (CS) antigen – with hepatitis B surface antigen, and includes a new and potent adjuvant. The manufacturer’s clinical development plan for the vaccine focuses on infants and young children living in malaria-endemic African countries.

In October 2013, a third set of results on the efficacy of the RTS,S/AS01 vaccine were reported for 6–14 week and 5–17 month age groups (9). In the 5–17 month age group, efficacy estimates, pooled across all trial sites, remained statistically significant against clinical malaria (46%) and severe malaria (35.5%).

Reductions in both malaria hospitalizations (41.5%) and all-cause hospitalizations (19%) were noted over 18 months. By contrast, at 27% in the 6–14 week age group, the efficacy estimate for severe malaria was not statistically significant (although efficacy against clinical malaria remained statistically significant). In the 5–17 month age group, site-specific efficacy was demonstrated in all 11 settings in seven African countries. The site-specific efficacy estimates over 18 months of follow-up ranged from 40% to 77%, with statistical significance at all sites.    By contrast, statistically significant efficacy was confirmed at four of the 11 sites in the younger 6–14 week age group. The reasons for this difference between the age groups are unclear, but co-administration with DTP-containing vaccines and the presence of maternally acquired antibodies to malaria may contribute to a lower immune response in infants aged 6–14 weeks.

The full Phase 3 trial results will become available to WHO in late 2014 and will include 30 months of follow-up safety and efficacy data from groups of children aged 6–14 weeks and

5–17 months, together with data on efficacy and safety of an 18-month booster dose and site-specific efficacy. The WHO Joint Technical Expert Group on Malaria Vaccines (together with the Global Malaria Programme and Department of Immunization, Vaccines and Biologicals), has advised that, in the light of the results published to date, a policy recommendation could be considered once the full trial results become available. The timelines of the Phase 3 trial may allow a WHO review and recommendation in late 2015, as a potential addition to the current WHO-recommended malaria preventive measures. The WHO process for review will also depend on the timings and outcome of the regulatory review that will be performed by the European Medicines Agency in 2014–2015.

Any possible recommendation related to vaccination in the 5–17 month age group would require at least two visits to be added to the routine immunization schedule.

   Other malaria vaccine candidates in development
Several other vaccine candidates are currently being explored, but their development is at least 5–10 years behind that of RTS,S/AS01. Details are provided in The Rainbow Tables: WHO’s comprehensive spreadsheets of global malaria vaccine project activity, which are updated every 6 months. In November 2013, WHO and the malaria vaccine funders group launched an update to the Malaria Vaccine Technology Roadmap,6 with two new strategic goals. These goals are the development of highly efficacious vaccines to prevent malaria disease and deaths, and of vaccines designed to interrupt malaria transmission and contribute towards the long-term aim of malaria eradication. The revised goals also expand the roadmap to include P. vivax as well as P. falciparum…

The International Vaccine Institute (IVI) said it was pleased to announce the receipt of a 1 million Euro grant from the German Federal Ministry of Education and Research (BMBF) for the Dengue Vaccine Initiative (DVI). This is the first time for it to receive such a grant from Germany. These funds will support the development of a new dengue vaccine through work with the Instituto Butantan, a biomedical research center in São Paulo, Brazil, and Vabiotech, a vaccine manufacturer in Hanoi, Vietnam. Both Brazil and Vietnam have been greatly impacted by dengue. The vaccines currently in development at these institutions is a live attenuated tetravalent vaccine (LATV) candidate that has received licensure from the US National Institutes of Health (NIH). It contains four modified strains of the dengue virus. The first clinical studies of the vaccine have shown positive results, being both safe and immunogenic.
Full media release: http://www.denguevaccines.org/news-events/dengue-vaccine-initiative-awarded-grant-germany-development-new-dengue-vaccines-brazil-a

http://www.ivi.org/web/www/07_01?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=581

GAVI Watch: Media Releases/Statements  [to 14 December 2013]
http://www.gavialliance.org/library/news/statements/

:: Pneumococcal vaccine to protect more than a million children in Afghanistan from leading child killer  7 December 2013
Excerpt
Afghanistan is to begin vaccinating more than 1.2 million children against pneumococcal disease every year, President Hamid Karzai announced today.

As part of the Government of Afghanistan’s ongoing efforts to improve the health of its children, life-saving pneumococcal conjugate vaccine (PCV) will be given to all infants under one year of age. The children will be protected against pneumococcal disease, the leading cause of pneumonia, which accounts for 25% of deaths in children under five years of age in Afghanistan.

With the support of the GAVI Alliance and its partners WHO and UNICEF, Afghanistan’s Ministry of Public Health will begin introducing PCV into routine immunisation programmes and the vaccine will be available for free at all health facilities across the country.

:: GAVI Alliance pays tribute to Nelson Mandela  06 December 2013
Following the death of Nelson Mandela, Dagfinn Høybråten, Chair of the GAVI Alliance Board, and Dr Seth Berkley, CEO of the GAVI Alliance, issued statements

UNICEF Watch
http://www.unicef.org/media/media_67204.html
Over 23 million children to be vaccinated in mass polio immunization campaign across Middle East
CAIRO/AMMAN, 9 December 2013 – The largest-ever immunization response in the Middle East is under way this week, aiming to vaccinate more than 23 million children against polio in Syria and neighbouring countries over the coming weeks.

Polio immunization campaign kicked off in the State of Palestine as part of massive regional efforts
GAZA, 9 December 2013 – Joining efforts to stop a polio outbreak in Syria from spreading across the region, UNICEF is supporting Palestinian Ministry of Health partners to immunize up to 630,000 children aged five years and younger against polio.

WHO/UNICEF: STRATEGIC PLAN FOR POLIO OUTBREAK RESPONSE
THE SYRIAN ARAB REPUBLIC AND SURROUNDING COUNTRIES – EGYPT, IRAQ, JORDAN, LEBANON, TURKEY, WEST BANK AND GAZA STRIP
DRAFT 26 NOVEMBER 2013  — 37 pages
http://www.polioeradication.org/Portals/0/Document/InfectedCountries/MiddleEast/ME_StrategicPlan_draft.pdf

Excerpt
EXECUTIVE SUMMARY
The “WHO/UNICEF Strategic Plan for Polio Outbreak Response in the Middle East” outlines the specific actions that will need to be implemented across the Syrian Arab Republic, Iraq, Jordan, Lebanon, Turkey, Egypt and the West Bank and Gaza Strip1 in response to the circulation of wild poliovirus (WPV) following importation. Successful implementation of all activities will meet the stated objective of the plan: to stop this outbreak by the end of March 2014.

New innovations and outbreak response guidelines form the backbone of this plan, based on lessons learnt over the past 10 years and capitalizing on new tools and tactics proven to more rapidly stop outbreaks following reinfection. The plan was jointly finalized by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in collaboration with the ministries of health and other humanitarian aid and United Nations (UN) partners.

…Given the current situation in the Syrian Arab Republic, frequent population movements across the region and the immunization level in key areas, the risk of further international spread of WPV1 across the region is considered to be high. Thus within 24 hours of confirmation that polio had returned to the Middle East, the ministers of health from across the Eastern Mediterranean declared this reinfection a public health emergency, calling for extraordinary joint action to combat this ancient scourge.

A comprehensive outbreak response will need to be implemented across the region, with seven countries and territories to conduct mass polio vaccination campaigns targeting more than 22 million children aged under 5 years. Depending on the area and based on the evolving epidemiology, the anticipated response will last at least six to eight months. Based on a comprehensive risk assessment, priority zones of intervention have been defined, and available resources will be allocated to these areas in order of priority. The repeated, large-scale immunization campaigns will need to reach at least 90% of the identified target

population, taking full advantage of the short interval additional dose approach, proven to more rapidly boost population immunity levels, in particular in difficult-to-access areas. A surveillance alert for the entire region has been issued, and efforts are ongoing to strengthen surveillance for acute flaccid paralysis (AFP). Extensive social mobilization activities are being scaled up, to further build on a history of strong community participation for immunization services across the region.

A critical challenge will be to access all children, including those living in areas difficult to reach due to conflict or insecurity. Outbreak response must therefore be conducted within the broader humanitarian response effort to the Syrian crisis, particularly in the Syrian Arab Republic and in refugee camps and host communities of neighbouring countries. Effective coordination with international humanitarian organizations, UN agencies, national Red Crescent societies, nongovernmental organizations (NGOs) and broader civil society forms a critical aspect of the plan. The primary goal is to ensure that oral polio vaccine (OPV) is urgently delivered into all communities.

Achieving this goal will require financial support. It is estimated that the overall cost for the six-month response in all zones will be approximately US$ 39.6 million with US$ 13.3 million for 2013 and US$ 26.3 million for 2014. Donors are invited to fund the polio outbreak response efforts in the Middle East through Regional Response Plan #6 (RRP6) of the Office of the United Nations High Commissioner for Refugees (UNHCR), the Syrian Humanitarian Assistance Response Plan (SHARP) and other emergency funding mechanisms. Specific funding projects for the polio outbreak and response efforts are being included in the RRP6 (surrounding countries) and in the SHARP (Syrian Arab Republic) to facilitate this process….

Update: Polio this week – As of 11 December 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: New cases reported in Pakistan, including in Federally Administered Tribal Areas (FATA) and Sindh.
:: The draft strategic plan for outbreak response in the Middle East is now available online here [and presented above].
Pakistan
:: Four new WPV1 cases were reported in the past week: two were reported from FATA and two from Sindh. The total number of WPV1 cases for Pakistan in 2013 is now 74. The most recent WPV1 case had onset of paralysis on 26 November (from North Waziristan, FATA).
:: One new cVDPV2 case was reported in the past week. The total number of cVDPV2 cases for 2013 is 44. The most recent cVDPV2 case had onset of paralysis on 10 November (from North Waziristan).
:: North Waziristan is the area with the largest number of children being paralyzed by poliovirus in Pakistan. Immunization activities have been suspended by local leaders since June 2012. It is critical that children in all 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.
Middle East
:: In Syria, no new WPV1 cases were reported in the past week. The total number of WPV1 cases remains 17. Prior to the outbreak, wild poliovirus was last reported in Syria in 1999.
:: In the Middle East, a comprehensive outbreak response continues to be implemented across the region. The large-scale supplementary immunization activity which started in Syria on 24 October to vaccinate 1.6 million children against polio, measles, mumps and rubella, in both government-controlled and contested areas has been completed.
:: Seven countries and territories are holding mass polio vaccination campaigns repeatedly targeting 22 million children under the age of five years over the next 6-8 months. In a joint resolution, all countries of the WHO Eastern Mediterranean Region have declared polio eradication to be an emergency, calling for support in negotiating and establishing access to those children who are currently unreached with polio vaccination.
:: WHO and UNICEF are committed to working with all organizations and agencies providing humanitarian assistance to Syrians affected by the conflict. This includes vaccinating all Syrian children no matter where they are, whether in government or contested areas, or outside Syria.

New York Times – World Briefing | Asia
Pakistan: Vaccine Teams Attacked
By THE ASSOCIATED PRESS
Published: December 14, 2013
Attacks on polio teams in northwest Pakistan on Friday killed a polio worker and two police officers assigned to protect one of the teams, the police and a government official said. No group claimed responsibility for the attacks, but Pakistani militants have killed more than a dozen polio workers and police officers protecting them over the past year. The militants accuse health workers of acting as spies for the United States and claim that the polio vaccine is intended to make Muslim children sterile. The first attack was near the town of Swabi, about 60 miles northeast of Peshawar in Khyber-Pakhtunkhwa Province. Hours later, a gunman killed a polio worker on his way home after vaccinating children in Jamrud, on the outskirts of Peshawar.

The Hindu – International » South Asia
ISLAMABAD, December 12, 2013
Pakistan visitors to India will have to take oral polio vaccine
The Indian High Commission in Pakistan has issued an advisory on Wednesday that all adults and children travelling to India from Pakistan after January 30, 2014 are required to obtain Oral Polio Vaccination (OPV) at least six weeks prior to their departure to India, but not more than one year before the date of travel.

A statement said that travellers from Pakistan to India after January 30, 2014 are required to carry their vaccination record as evidence of polio vaccination and it will be requested for entry into India thereafter. Record for administering OPV may be obtained from an authorised medical centre in the format laid out in the World Health Organisation’s International Health Regulations 2005 International Certificate of Vaccination (http://who.int/ihr/IVC-06-26.pdf)

Once administered OPV remains effective for one year, after which the vaccination should be taken again. The step is being taken to safeguard India’s polio-free status attained after sustained efforts and investment, the statement said. It is applicable to all travellers from all countries, where polio disease is endemic or where cases of polio are reported. It is also applicable to Indian nationals travelling to and from these countries…

The Hindu – International » South Asia
ISLAMABAD, December 12, 2013

Pakistan visitors to India will have to take oral polio vaccine
The Indian High Commission in Pakistan has issued an advisory on Wednesday that all adults and children travelling to India from Pakistan after January 30, 2014 are required to obtain Oral Polio Vaccination (OPV) at least six weeks prior to their departure to India, but not more than one year before the date of travel.

A statement said that travellers from Pakistan to India after January 30, 2014 are required to carry their vaccination record as evidence of polio vaccination and it will be requested for entry into India thereafter. Record for administering OPV may be obtained from an authorised medical centre in the format laid out in the World Health Organisation’s International Health Regulations 2005 International Certificate of Vaccination (http://who.int/ihr/IVC-06-26.pdf)

Once administered OPV remains effective for one year, after which the vaccination should be taken again. The step is being taken to safeguard India’s polio-free status attained after sustained efforts and investment, the statement said. It is applicable to all travellers from all countries, where polio disease is endemic or where cases of polio are reported. It is also applicable to Indian nationals travelling to and from these countries…
http://www.thehindu.com/news/international/south-asia/pakistan-visitors-to-india-will-have-to-take-oral-polio-vaccine/article5449097.ece

CDC/MMWR Watch [to 14 December 2013]
:: Flu Press Conference: New Report Highlights Benefits of Flu Vaccine – Transcript
:: New Report Highlights Benefits of Flu Vaccine – Press Release

MMWR December 13, 2013 / Vol. 62 / No. 49
:: Estimated Influenza Illnesses and Hospitalizations Averted by Influenza Vaccination — United States, 2012–13 Influenza Season
:: Seasonal Influenza Vaccination Coverage Among Women Who Delivered a Live-Born Infant — 21 States and New York City, 2009–10 and 2010–11 Influenza Seasons
:: Progress in Immunization Information Systems — United States, 2012
:: Progress Toward Poliomyelitis Eradication — Nigeria, January 2012–September 2013

Report: The Case for Improving Adolescent Health: Helping Prepare Adolescents for a Healthy Future
National Foundation for Infectious Diseases; Pfizer Inc.
December 2013

Excerpt for Media Release http://www.multivu.com/players/English/60287-nfid-myteenhealth-survey/
The Case for Improving Adolescent Health demonstrates the need for increased attention to adolescent preventive healthcare in the US and emphasizes the role(s) that parents, teens, providers, and adults who influence teens (coaches, youth leaders, school professionals) can play to help make improvements. From the gaps in adolescent-focused programs to the preventive health barriers that exist, The Case for Improving Adolescent Health shows how behaviors and actions may affect teen health.

…In addition to serving as a checkpoint for modifiable health risk behaviors, annual checkups can help ensure that teens are getting recommended health screenings and are immunized according to recommendations. They can also provide an opportunity for confidential health discussions. Modifiable behaviors, such as lack of physical activity, poor nutrition, and tobacco and alcohol use are responsible for much chronic disease.1 Further, not all adolescents are getting vaccinated as recommended,2 leaving them potentially vulnerable to vaccine-preventable diseases such as meningococcal meningitis, whooping cough, influenza, and infection with human papillomavirus (HPV).

Adolescent Health Risks Snapshot
Vaccine-Preventable Diseases: Vaccines administered during the adolescent years can be an important determinant of future health. Four in 10 teens surveyed3 and just over three in 10 parents surveyed4 believe that vaccines are not as important for teens as for babies. However, school-aged children have the highest flu infection rates;5 adolescents 16 to 21 years, along with infants less than one year, have higher rates of meningococcal disease than other age groups;6 and HPV prevalence is estimated to be as high as 64 percent in adolescent girls.7

Eurosurveillance
Volume 18, Issue 50, 12 December 2013
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Miscellaneous
Note from the editors: MERS-CoV – the quest for the reservoir continues
Eurosurveillance editorial team
European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
Two papers in this last Eurosurveillance issue of 2013, one by Reusken et al. [1] and one by Hemida et al. [2], look into the potential animal reservoir for the Middle East Respiratory Syndrome (MERS) coronavirus (CoV). This virus, which emerged in 2012 and was reported for the first time in September, has caused 163 cases and 71 deaths as of 2 December 2013 [3]. However, many questions remain on its origin, reservoir and transmission patterns [4].
The two papers investigate the seroprevalence of antibodies against MERS-CoV and MERS-like CoV in a similar set of domestic livestock, namely camels, cattle, goats, sheep and chicken, in two different geographic hotspots in Jordan and Saudi Arabia, respectively, where the largest described clusters of MERS have occurred to date. The papers complement each other and support the authors’ earlier findings that dromedary camels could be a potential reservoir for MERS-CoV [5,6]. The results presented now are compelling evidence that in the studied regions high proportions of dromedary camels are exposed to a MERS-CoV or MERS-like CoV already in their first year of life. Hemida at al. conclude that camels could be infected early in life, and Reusken et al. additionally raise the possibility that the serological reactivity early in life could be due to maternal antibodies.
While the presented studies confirm the potential role of dromedary camels as MERS-CoV reservoir, they do not support a similar role of other common domestic livestock in the affected regions in the Middle East. Neither of the two studies detected antibodies in chicken, cattle or goats. Although most tests in sheep were negative, one particular assay gave positive results in a few animals, and the authors stress that this needs further investigation.
While the papers in today’s issue provide further insight into the possible animal reservoir, the primary source of MERS-CoV infections remains unclear and the link to humans needs to be elucidated further as exposure to animals has only been documented for a limited number of human MERS cases. We look forward to seeing more studies in the near future that will shed light on the as yet unknown characteristics of this disease that raised much attention among infectious disease experts in 2013…

Rapid Communications
Middle East Respiratory Syndrome coronavirus (MERS-CoV) serology in major livestock species in an affected region in Jordan, June to September 2013
by CB Reusken, M Ababneh, VS Raj, B Meyer, A Eljarah, S Abutarbush, GJ Godeke, TM Bestebroer, I Zutt, MA Müller, BJ Bosch, PJ Rottier, AD Osterhaus, C Drosten, BL Haagmans, MP Koopmans

Middle East Respiratory Syndrome (MERS) coronavirus seroprevalence in domestic livestock in Saudi Arabia, 2010 to 2013
by MG Hemida, RA Perera, P Wang, MA Alhammadi, LY Siu, M Li, LL Poon, L Saif, A Alnaeem, M Peiris

Global Public Health
Volume 8, Issue 10, 2013
http://www.tandfonline.com/toc/rgph20/current#.Uq0DgeKy-F9

Cervical cancer and the global health agenda: Insights from multiple policy-analysis frameworks
Justin O. Parkhurst & Madhulika Vulimiri
pages 1093-1108
Open access
DOI:10.1080/17441692.2013.850524
Published online: 18 Nov 2013
http://www.tandfonline.com/doi/abs/10.1080/17441692.2013.850524#.Uq0Dw-Ky-F8

Abstract
Cervical cancer is the second leading cause of cancer deaths for women globally, with an estimated 88% of deaths occurring in the developing world. Available technologies have dramatically reduced mortality in high-income settings, yet cervical cancer receives considerably little attention on the global health policy landscape. The authors applied four policy-analysis frameworks to literature on global cervical cancer to explore the question of why cervical cancer may not be receiving the international attention it may otherwise warrant. Each framework explores the process of agenda setting and discerns factors that either facilitate or hinder policy change in cases where there is both a clear problem and a potential effective solution. In combination, these frameworks highlight a number of crucial elements that may be needed to raise the profile of cervical cancer on global health agendas, including improving local (national or sub-national) information on the condition; increasing mobilisation of affected civil society groups; framing cervical cancer debates in ways that build upon its classification as a non-communicable disease (NCD) and an issue of women’s rights; linking cervical cancer screening to well-funded services such as those for HIV treatment in some countries; and identifying key global policy windows of opportunity to promote the cervical cancer agenda, including emerging NCD global health discussions and post-2015 reviews of the Millennium Development Goals.

Global Public Health
Volume 8, Issue 10, 2013
http://www.tandfonline.com/toc/rgph20/current#.Uq0DgeKy-F9

Listening to the rumours: What the northern Nigeria polio vaccine boycott can tell us ten years on
Isaac Ghinai, Chris Willott, Ibrahim Dadari & Heidi J. Larson
pages 1138-1150
DOI:10.1080/17441692.2013.859720
Published online: 03 Dec 2013
http://www.tandfonline.com/doi/abs/10.1080/17441692.2013.859720#.Uq0EP-Ky-F8

Abstract
In 2003 five northern Nigerian states boycotted the oral polio vaccine due to fears that it was unsafe. Though the international responses have been scrutinised in the literature, this paper argues that lessons still need to be learnt from the boycott: that the origins and continuation of the boycott were due to specific local factors. We focus mainly on Kano state, which initiated the boycotts and continued to reject immunisations for the longest period, to provide a focused analysis of the internal dynamics and complex multifaceted causes of the boycott. We argue that the delay in resolving the year-long boycott was largely due to the spread of rumours at local levels, which were intensified by the outspoken involvement of high-profile individuals whose views were misunderstood or underestimated. We use sociological concepts to analyse why these men gained influence amongst northern Nigerian communities. This study has implications on contemporary policy: refusals still challenge the Global Polio Eradication Initiative; and polio remains endemic to Nigeria (Nigeria accounted for over half of global cases in 2012). This paper sheds light on how this problem may be tackled with the ultimate aim of vaccinating more children and eradicating polio.

Health and Human Rights
Volume 15, Issue 2
http://www.hhrjournal.org/

Editorial: The post-2015 development agenda, human rights, evidence, and open-access publishing
Carmel Williams
Health and Human Rights 2013, 15/2
http://www.hhrjournal.org/2013/12/10/editorial-the-post-2015-development-agenda-human-rights-evidence-and-open-access-publishing/

Excerpt
In the current planning phase for the post-2015 development agenda, there is guarded optimism that human rights will occupy a more central role than they did in the Millennium Development Goals (MDGs). The United Nations Development Programme (UNDP) facilitated global consultations in 2012 to shape the post-2015 development agenda. Nineteen UN Task Team “thematic think pieces” resulted, most of which specifically refer to the importance of integrating human rights into development goals. The UNDP acknowledged an emerging global endorsement of human rights-based approaches to development, based on the principles of participation, accountability, non-discrimination, empowerment and the rule of law, and that it must be the core of the post-2015 agenda.1…
Special Issue Articles in Collaboration with Open Society Foundations
Human Rights in Patient Care

The Lancet  
Dec 14, 2013  Volume 382  Number 9909  p1957 – 2038 e41 – 47
http://www.thelancet.com/journals/lancet/issue/current

Transmission and evolution of the Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive genomic study
Matthew Cotten PhD b †, Simon J Watson PhD b †, Prof Paul Kellam PhD b m †, Abdullah A Al-Rabeeah FRCS a, Hatem Q Makhdoom PhD c, Abdullah Assiri MD a, Jaffar A Al-Tawfiq MD d, Rafat F Alhakeem MD a, Hossam Madani PhD c, Fahad A AlRabiah MD g, Sami Al Hajjar MD g, Wafa N Al-nassir MD h, Ali Albarrak MD i, Hesham Flemban MD j, Hanan H Balkhy MD k, Sarah Alsubaie MD l, Anne L Palser PhD b, Astrid Gall Dr Med Vet b, Rachael Bashford-Rogers MChem b, Prof Andrew Rambaut Prof e f, Prof Alimuddin I Zumla FRCP a m n †, Prof Ziad A Memish FRCP a
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961887-5/abstract
Summary
Background
Since June, 2012, Middle East respiratory syndrome coronavirus (MERS-CoV) has, worldwide, caused 104 infections in people including 49 deaths, with 82 cases and 41 deaths reported from Saudi Arabia. In addition to confirming diagnosis, we generated the MERS-CoV genomic sequences obtained directly from patient samples to provide important information on MERS-CoV transmission, evolution, and origin.

Methods
Full genome deep sequencing was done on nucleic acid extracted directly from PCR-confirmed clinical samples. Viral genomes were obtained from 21 MERS cases of which 13 had 100%, four 85—95%, and four 30—50% genome coverage. Phylogenetic analysis of the 21 sequences, combined with nine published MERS-CoV genomes, was done.

Findings
Three distinct MERS-CoV genotypes were identified in Riyadh. Phylogeographic analyses suggest the MERS-CoV zoonotic reservoir is geographically disperse. Selection analysis of the MERS-CoV genomes reveals the expected accumulation of genetic diversity including changes in the S protein. The genetic diversity in the Al-Hasa cluster suggests that the hospital outbreak might have had more than one virus introduction.

Interpretation
We present the largest number of MERS-CoV genomes (21) described so far. MERS-CoV full genome sequences provide greater detail in tracking transmission. Multiple introductions of MERS-CoV are identified and suggest lower R0 values. Transmission within Saudi Arabia is consistent with either movement of an animal reservoir, animal products, or movement of infected people. Further definition of the exposures responsible for the sporadic introductions of MERS-CoV into human populations is urgently needed.

Funding
Saudi Arabian Ministry of Health, Wellcome Trust, European Community, and National Institute of Health Research University College London Hospitals Biomedical Research Centre.

The Lancet  
Dec 14, 2013  Volume 382  Number 9909  p1957 – 2038 e41 – 47
http://www.thelancet.com/journals/lancet/issue/current

Comment
What’s happening in Bangladesh?
Amartya Sen
Preview | Full Text | PDF
Self-assured commentators who saw Bangladesh as a “basket case” not many years ago could not have expected that the country would jump out of the basket and start sprinting ahead even as expressions of sympathy and pity were pouring in. This informative Lancet Series on Bangladesh1–6 helps to explain what happened—and why. It is important to understand how a country that was extremely poor a few decades ago, and is still very poor, can make such remarkable accomplishments particularly in the field of health, but also in social transformation in general.

Series
Bangladesh: Innovation for Universal Health Coverage
Community-based approaches and partnerships: innovations in health-service delivery in Bangladesh
Shams El Arifeen, Aliki Christou, Laura Reichenbach, Ferdous Arfina Osman, Kishwar Azad, Khaled Shamsul Islam, Faruque Ahmed, Henry B Perry, David H Peters
Preview | Summary | Full Text | PDF
Bangladesh: Innovation for Universal Health Coverage
Explaining equity gains in child survival in Bangladesh: scale, speed, and selectivity in health and development
Alayne M Adams, Atonu Rabbani, Shamim Ahmed, Shehrin Shaila Mahmood, Ahmed Al-Sabir, Sabina F Rashid, Timothy G Evans
Preview | Summary | Full Text | PDF

Medical Decision Making (MDM)
January 2014; 34 (1)
http://mdm.sagepub.com/content/current

Health Numeracy
The Importance of Domain in Assessing Numeracy
Helen Levy, PhD, Peter A. Ubel, MD, Amanda J. Dillard, PhD, David R. Weir, PhD, Angela Fagerlin, PhD
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI (HL, DRW)
School of Public Health, University of Michigan, Ann Arbor, MI (HL)
Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI (HL)
Fuqua School of Business, Sanford School of Public Policy, and School of Medicine, Duke University, Durham, NC (PAU)
Department of Psychology, Grand Valley State University, Allendale, MI (AJD)
VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI (AF)
Division of General Internal Medicine, University of Michigan, Ann Arbor, MI (AF)
Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI (AF)
Helen Levy, Survey Research Center, Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI 48104; e-mail: hlevy@umich.edu.

Abstract
Background and Objective. Existing research concludes that measures of general numeracy can be used to predict individuals’ ability to assess health risks. We posit that the domain in which questions are posed affects the ability to perform mathematical tasks, raising the possibility of a separate construct of “health numeracy” that is distinct from general numeracy. The objective was to determine whether older adults’ ability to perform simple math depends on domain.

Methods. Community-based participants completed 4 math questions posed in 3 different domains: a health domain, a financial domain, and a pure math domain. Participants were 962 individuals aged 55 and older, representative of the community-dwelling US population over age 54.

Results. We found that respondents performed significantly worse when questions were posed in the health domain (54% correct) than in either the pure math domain (66% correct) or the financial domain (63% correct). Our experimental measure of numeracy consisted of only 4 questions, and it is possible that the apparent effect of domain is specific to the mathematical tasks that these questions require.

Conclusions. These results suggest that health numeracy is strongly related to general numeracy but that the 2 constructs may not be the same. Further research is needed into how different aspects of general numeracy and health numeracy translate into actual medical decisions.

Pharmacoeconomics
Volume 31, Issue 12, December 2013
http://link.springer.com/journal/40273/31/12/page/1

Assessing the Cost Effectiveness of Pre-Exposure Prophylaxis for HIV Prevention in the US
Fred J. Hellinger
Download PDF (277 KB) View Article
http://link.springer.com/article/10.1007/s40273-013-0111-0

Abstract
About 50,000 people are infected with HIV in the US each year and this number has remained virtually the same for the past decade. Yet, in the last few years, evidence from several multinational randomized clinical trials has shown that the provision of antiretroviral drug to uninfected persons (i.e. pre-exposure prophylaxis) reduces the incidence of HIV by about 50 %. However, evidence from cost-effectiveness studies conducted in the US yield widely varying estimates of the cost per quality-adjusted life-year (QALY) gained, and this variation reflects the substantial uncertainty surrounding the determinants of HIV transmission (e.g. adherence rates to prophylactic medications, the average number of sexual partners, the number and types of sexual acts, the viral load of infected partners, and the proportion of contacts where condoms are used), as well as different approaches to translating a reduction in HIV cases into an estimate of the increase in the number of QALYs.

PLoS One
[Accessed 14 December 2013]
http://www.plosone.org/

Research Article
Next Generation Inactivated Polio Vaccine Manufacturing to Support Post Polio-Eradication Biosafety Goals
Yvonne E. Thomassenl, Aart G. van ’t Oever, Monique G. C. T. van Oijen, René H. Wijffels, Leo A. van der Pol, Wilfried A. M. Bakker
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0083374

Abstract
Worldwide efforts to eradicate polio caused a tipping point in polio vaccination strategies. A switch from the oral polio vaccine, which can cause circulating and virulent vaccine derived polioviruses, to inactivated polio vaccines (IPV) is scheduled. Moreover, a manufacturing process, using attenuated virus strains instead of wild-type polioviruses, is demanded to enhance worldwide production of IPV, especially in low- and middle income countries. Therefore, development of an IPV from attenuated (Sabin) poliovirus strains (sIPV) was pursued. Starting from the current IPV production process based on wild type Salk strains, adaptations, such as lower virus cultivation temperature, were implemented. sIPV was produced at industrial scale followed by formulation of both plain and aluminium adjuvanted sIPV. The final products met the quality criteria, were immunogenic in rats, showed no toxicity in rabbits and could be released for testing in the clinic. Concluding, sIPV was developed to manufacturing scale. The technology can be transferred worldwide to support post polio-eradication biosafety goals.

PLoS One
[Accessed 14 December 2013]
http://www.plosone.org/

Research Article
Gathering and Exploring Scientific Knowledge in Pharmacovigilance
Pedro Lopes, Tiago Nunes, David Campos, Laura Ines Furlong, Anna Bauer-Mehren, Ferran Sanz, Maria Carmen Carrascosa, Jordi Mestres, Jan Kors, Bharat Singh, Erik van Mulligen, Johan Van der Lei, Gayo Diallo,  [ … ],
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0083016

Abstract
Pharmacovigilance plays a key role in the healthcare domain through the assessment, monitoring and discovery of interactions amongst drugs and their effects in the human organism. However, technological advances in this field have been slowing down over the last decade due to miscellaneous legal, ethical and methodological constraints. Pharmaceutical companies started to realize that collaborative and integrative approaches boost current drug research and development processes. Hence, new strategies are required to connect researchers, datasets, biomedical knowledge and analysis algorithms, allowing them to fully exploit the true value behind state-of-the-art pharmacovigilance efforts. This manuscript introduces a new platform directed towards pharmacovigilance knowledge providers. This system, based on a service-oriented architecture, adopts a plugin-based approach to solve fundamental pharmacovigilance software challenges. With the wealth of collected clinical and pharmaceutical data, it is now possible to connect knowledge providers’ analysis and exploration algorithms with real data. As a result, new strategies allow a faster identification of high-risk interactions between marketed drugs and adverse events, and enable the automated uncovering of scientific evidence behind them. With this architecture, the pharmacovigilance field has a new platform to coordinate large-scale drug evaluation efforts in a unique ecosystem, publicly available at http://bioinformatics.ua.pt/euadr/.

PLoS Medicine
(Accessed 14 December 2013)
http://www.plosmedicine.org/

Data Sharing in a Humanitarian Organization: The Experience of Médecins Sans Frontières
Unni Karunakara
Published: December 10, 2013
DOI: 10.1371/journal.pmed.1001562
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001562

Summary Points
:: Public health crises such as the spread of drug-resistant tuberculosis highlight the need for improved sharing of data. For humanitarian organizations, there is a lack of guidance on the practical aspects of making such data available.

:: In 2012 the medical humanitarian organization Médecins Sans Frontières (MSF) decided to adopt a data sharing policy for routinely collected clinical and research data. Here we describe how this policy was developed, the principles underlying it, and the practical measures taken to facilitate data sharing.

:: The MSF policy builds on the principles of ethical, equitable, and efficient data sharing to include aspects relevant for an international humanitarian organization, in particular concerning highly sensitive data (non-maleficence), benefit sharing (social benefit), and intellectual property (open access).

:: There are aspirations to create a truly open dataset, but the initial aim is to enable data sharing via a managed access procedure so that security, legal, and ethical concerns can be addressed.