Science        
13 December 2013 vol 342, issue 6164, pages 1281-1404
http://www.sciencemag.org/current.dtl

Perspective – Epidemiology
Coming to an Airport Near You
Angela R. McLean
Zoology Department, Oxford University, Oxford OX1 3PS, UK.
Faced with the complexity of the global spread of new infections, a common approach has been to create enormous computer simulations (1, 2). Most of these studies have yielded only tenuous insights, and scientific understanding has been slow to accrue. On page 1337 of this issue, Brockmann and Helbing (3) identify a useful metric—the effective distance—that helps to understand the spread of contagion across a travel network. Once this measure is specified, the global spread of infection can be understood as a simple reaction-diffusion process across the defined transportation network.

Research Article
The Hidden Geometry of Complex, Network-Driven Contagion Phenomena
Dirk Brockmann1,2,3,*, Dirk Helbing4,5
1Robert-Koch-Institute, Seestraße 10, 13353 Berlin, Germany.
2Institute for Theoretical Biology, Humboldt-University Berlin, Invalidenstraße 42, 10115 Berlin, Germany.
3Department of Engineering Sciences and Applied Mathematics and Northwestern Institute on Complex Systems, Northwestern University, Evanston, IL 60208, USA.
4ETH Zurich, Swiss Federal Institute of Technology, CLU E1, Clausiusstraße 50, 8092 Zurich, Switzerland.
5Risk Center, ETH Zurich, Scheuchzerstraße 7, 8092 Zurich, Switzerland.
http://www.sciencemag.org/content/342/6164/1337.abstract

Abstract
The global spread of epidemics, rumors, opinions, and innovations are complex, network-driven dynamic processes. The combined multiscale nature and intrinsic heterogeneity of the underlying networks make it difficult to develop an intuitive understanding of these processes, to distinguish relevant from peripheral factors, to predict their time course, and to locate their origin. However, we show that complex spatiotemporal patterns can be reduced to surprisingly simple, homogeneous wave propagation patterns, if conventional geographic distance is replaced by a probabilistically motivated effective distance. In the context of global, air-traffic–mediated epidemics, we show that effective distance reliably predicts disease arrival times. Even if epidemiological parameters are unknown, the method can still deliver relative arrival times. The approach can also identify the spatial origin of spreading processes and successfully be applied to data of the worldwide 2009 H1N1 influenza pandemic and 2003 SARS epidemic.

Vaccine
Volume 32, Issue 1, Pages 1-204 (17 December 2013)
http://www.sciencedirect.com/science/journal/0264410X/32

Priorities for CMV vaccine development
Review Article
Pages 4-10
Philip R. Krause, Stephanie R. Bialek, Suresh B. Boppana, Paul D. Griffiths, Catherine A. Laughlin, Per Ljungman, Edward S. Mocarski, Robert F. Pass, Jennifer S. Read, Mark R. Schleiss, Stanley A. Plotkin

Abstract
A multidisciplinary meeting addressed priorities related to development of vaccines against cytomegalovirus (CMV), the cause of congenital CMV (cCMV) disease and of serious disease in the immunocompromised. Participants discussed optimal uses of a CMV vaccine, aspects of clinical study design, and the value of additional research. A universal childhood CMV vaccine could potentially rapidly reduce cCMV disease, as infected children are sources of viral transmission to seronegative and seropositive mothers. A vaccine administered to adolescents or adult women could also reduce cCMV disease by making them immune prior to pregnancy. Clinical trials of CMV vaccines in women should evaluate protection against cCMV infection, an essential precursor of cCMV disease, which is a more practical and acceptable endpoint for assessing vaccine effects on maternal-fetal transmission. Clinical trials of vaccines to evaluate prevention of CMV disease in stem cell transplant recipients could use CMV viremia at a level triggering pre-emptive antiviral therapy as an endpoint, because widespread use of pre-emptive and prophylactic antivirals has rendered CMV-induced disease too rare to be a practical endpoint for clinical trials. In solid organ transplant patients, CMV-associated disease is sufficiently common for use as a primary endpoint. Additional research to advance CMV vaccine development should include identifying factors that predict fetal loss due to CMV, determining age-specific incidence and transmission rates, defining the mechanism and relative contributions of maternal reactivation and re-infection to cCMV disease, developing assays that can distinguish between reactivation and re-infection in seropositive vaccinees, further defining predictors of sequelae from cCMV infection, and identifying clinically relevant immune response parameters to CMV (including developing validated assays that could assess CMV antibody avidity) that could lead to the establishment of immune correlates of protection.

Vaccine
Volume 32, Issue 1, Pages 1-204 (17 December 2013)
http://www.sciencedirect.com/science/journal/0264410X/32

Acceptability and uptake of female adolescent HPV vaccination in Hong Kong: A survey of mothers and adolescents
Original Research Article
Pages 78-84
Horace C.W. Choi, Gabriel M. Leung, Pauline P.S. Woo, Mark Jit, Joseph T. Wu

Abstract
Background
Organized population-based HPV vaccination programs can be effective in reducing the burden of cervical cancer, especially in the absence of a comprehensive cervical screening program (e.g. Hong Kong). Assessment of vaccine acceptability is important when evaluating the feasibility and cost-effectiveness of such vaccination programs.

Methods
To provide a more representative and updated assessment on the acceptability of female adolescent HPV vaccination in Hong Kong, we conducted surveys in 2008 among 1022 mothers with daughters aged ≤18 years through random digit-dialing telephone interviewing and 2167 schoolgirls aged 11–18 years using two-stage stratified cluster sampling. We conducted the maternal survey again in 2012 with an independent group of 1005 mothers.

Results
In 2008, 2.4% (95% confidence interval [CI] = 1.8–3.2%) of the recruited schoolgirls reported having received HPV vaccination. In 2012, the mothers reported that 9.1% (7.0–11.6%) of their daughters who were in the same age range (11–18 years) as the schoolgirls had been vaccinated (p < 0.01). Regarding acceptability, 27.5% (24.8–30.4%) and 37.6% (34.5–40.8%) of the mothers were willing to have their daughters vaccinated at market price in 2008 and 2012 (p < 0.01), respectively. 27.1% (25.2–29.1%) of the schoolgirls were willing to receive HPV vaccination at market price in 2008. The willingness to pay for full-course vaccination among mothers had a median of US$128/HK$1000 (50% central range = US$64–192/HK$500–1500), i.e. substantially lower than the current market price.

Conclusions
The gap between acceptability and actual uptake of HPV vaccination among adolescent girls suggested that coverage is likely to be low without an organized HPV vaccination program, although the difference might be partially attributed to the possibility that at the time of the interview female adolescents who were willing to be vaccinated had not yet taken action. Policymakers should devise tailored, targeted and efficient vaccination strategies to achieve universal coverage for an effectively organized HPV vaccination program.

Vaccine
Volume 32, Issue 1, Pages 1-204 (17 December 2013)
http://www.sciencedirect.com/science/journal/0264410X/32

Socio-demographic determinants of timely adherence to BCG, Penta3, measles, and complete vaccination schedule in Burkina Faso
Original Research Article
Pages 96-102
A. Schoeps, N. Ouédraogo, M. Kagoné, A. Sié, O. Müller, H. Becher

Abstract
Objective
To identify the determinants of timely vaccination among young children in the North-West of Burkina Faso.

Methods
This study included 1665 children between 12 and 23 months of age from the Nouna Health and Demographic Surveillance System, born between September 2006 and December 2008. The effect of socio-demographic variables on timely adherence to the complete vaccination schedule was studied in multivariable ordinal logistic regression with 3 distinct endpoints: (i) complete timely adherence, (ii) failure, and (iii) missing vaccination. Three secondary endpoints were timely vaccination with BCG, Penta3, and measles, which were studied with standard multivariable logistic regression.

Results
Mothers’ education, socio-economic status, season of birth, and area of residence were significantly associated with failure of timely adherence to the complete vaccination schedule. Year of birth, ethnicity, and the number of siblings was significantly related to timely vaccination with Penta3 but not with BCG or measles vaccination. Children living in rural areas were more likely to fail timely vaccination with BCG than urban children (OR=1.79, 95%CI=1.24–2.58 (proximity to health facility), OR=3.02, 95%CI=2.18–4.19 (long distance to health facility)). In contrast, when looking at Penta3 and measles vaccination, children living in rural areas were far less likely to have failed timely vaccinations than urban children. Mother’s education positively influenced timely adherence to the vaccination schedule (OR=1.42, 95%CI 1.06–1.89). There was no effect of household size or the age of the mother.

Conclusions
Additional health facilities and encouragement of women to give birth in these facilities could improve timely vaccination with BCG. Rural children had an advantage over the urban children in timely vaccination, which is probably attributable to outreach vaccination teams amongst other factors. As urban children rely on their mothers’ own initiative to get vaccinated, urban mothers should be encouraged more strongly to get their children vaccinated in time.

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

Identification of vaccine-derived polioviruses using dual-stage real-time RT-PCR
DR Kilpatrick, K Ching, J Iber, Q Chen, SJ Yang, L De… – Journal of Virological …, 2013
Abstract Vaccine-derived polioviruses (VDPVs) are associated with polio outbreaks and prolonged infections in individuals with primary immunodeficiencies. VDPV-specific PCR assays for each of the three Sabin oral poliovirus vaccine (OPV) strains were developed, …

Effectiveness of Influenza Vaccination in Institutionalized Older Adults: A Systematic Review
TC Chan, I Fan-Ngai Hung, J Ka-Hay Luk, LW Chu… – Journal of the American …, 2013
… adults. Criticism regarding the effectiveness of influenza vaccine estimated by nonrandomized observational studies include the frailty selection bias and use of nonspecific outcome, such as all-cause mortality. Methods. We …

Foreign Affairs
http://www.foreignaffairs.com/
Accessed 14 December 2013

Rethinking Foreign Aid – Five Ways to Improve Development Assistance
By Paul Farmer
http://www.foreignaffairs.com/print/137485

Excerpt
So much is written and said about foreign aid that it has become difficult to contribute meaningfully to the debate about whether it is effective. But if we are charting our fates as citizens of a crowded, fragile planet, then any honest assessment must conclude that progress has been made, whether in terms of child survival or literacy or access to basic sanitation. Still, profound social disparities exist; so too does extreme poverty. And the prospects of those living on less than two dollars a day remain grim.

With the stakes as high as they are, the need to challenge the assumptions we make about aid is paramount. Myths and mystifications about aid persist. Whether we speak of feedback loops or best practices — or, perhaps, simply better practices — we have a long way to go.

Despite agreements on aid effectiveness reached in Rome, Paris, Accra, and Busan over the last decade, 80 percent of aid from major bilateral and multilateral donors to fragile countries still bypasses the systems of local public institutions. But the aspiration to improve the lives of those living in extreme poverty through better public health, public education, and public works by definition requires public-sector capacity.

By way of example, consider some data from Haiti after the 2010 earthquake. Based on United Nations estimates, bilateral and multilateral donors channeled $6.04 billion in humanitarian and recovery funding to Haiti from 2010 to 2012, but disbursed less than 10 percent of it directly to the Haitian government. Just 0.9 percent of immediate relief aid right after the earthquake (totaling $2.41 billion) made it directly to the Haitian government. Even the local NGOs and businesses were excluded: less than 0.6 percent of that $6.04 billion was invested in Haitian organizations and businesses. One of the top bilateral donors in Haiti awarded only 1.4 percent of its contracts to local companies….

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_7 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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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

Global Fund: Donors Pledge US$12 Billion
The Global Fund said that donors at the launch of its Fourth Replenishment meeting pledged US$12.0 billion for the next three years, “the largest amount ever committed to fight against AIDS, tuberculosis and malaria.” The contributions announced include commitments from 25 countries, as well as the European Commission, private foundations, corporations and faith-based organizations. Among the ledges mage included:

:: The United States pledged US$4 billion, although that could rise as additional pledges are made by other donors, up to a maximum of US$5 billion.

:: The Government of Japan announced a contribution of US$800 million.

:: Canada announced that it is contributing US$612 million to the Global Fund for the 2014-2016 period.

:: Germany announced it is signing a binding agreement to contribute €600 million to the Global Fund for 2014-2016, consistent with an earlier pledge.

:: In recent months, France, the United Kingdom and Nordic countries also announced large new commitments to the Global Fund.

:: Bill Gates announced on Monday that the Bill & Melinda Gates Foundation is committing up to US$500 million to the Global Fund for the 2014-2016 period. This includes US$300 million previously announced and up to US$200 million in new money that will be used to match other donor commitments.

:: (RED) said that it is contributing US$40 million over the next two years.

:: Other companies and faith-based organizations also made significant pledges, including Chevron, BHP Billiton, Vale, Ecobank, Takeda Pharmaceutical Company and the United Methodist Church.

http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-12-03_Global_Fund_Donors_Pledge_USD_12_Billion/

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) and the Global Fund announced “a broad-based partnership to help prevent patients from being harmed by fake medicines.” The organizations noted that “fake medicines are reported in virtually every region of the world. In high-income countries, incidence of fake medicines is less than 1% of market value according to the estimates of the countries concerned. Figures about sales of fake medicines rise to 10% globally, but in some areas of Asia, Africa and Latin America fake medicines may account for up to 30% of medicines in circulation. In Africa, one-third of all malaria medicines are probably fake. It is estimated that one in two medicines purchased on illegal Internet sites that hide their physical addresses is fake.” Mark Dybul, Executive Director of the Global Fund, said, “We are at an historic moment. Effective treatments and technologies exist for HIV, TB and Malaria and our challenge at the Global Fund is to get those effective interventions to all patients that need them. Fake medicines compromise our mission to save lives. We are delighted to join forces with IFPMA and invite other partners to join our efforts to get effective, safe, genuine treatments to the people who need them.”

http://www.ifpma.org/news/news-releases/news-details/article/ifpma-and-global-fund-collaborate-to-help-protect.html

WHO: Global Vaccine Action Plan — SAGE Assessment Report, 2013
20 pages
Summary of the SAGE Working Group evaluation of the progress against 12 indicator areas of the GVAP and associated recommendations.
http://www.who.int/entity/immunization/global_vaccine_action_plan/sage_dov_gvap_progress_report_2013.pdf

GAVI Watch: Media Releases/Statements
http://www.gavialliance.org/library/news/statements/

:: Pneumococcal vaccine to protect more than a million children in Afghanistan from leading child killer 07 December 2013
Pneumonia accounts for 25% of deaths of children under five in Afghanistan each year.

:: GAVI Alliance names global health leader as Director of US strategy 04 December 2013
Natasha Bilimoria to lead U.S. mobilisation, building strong support for life-saving vaccines for children in developing countries.”

WHO “Feature”: Syrian Arab Republic: put polio risk above all other interests
December 2013
The push to immunize all children against polio has been hampered by the ongoing crisis in the Syrian Arab Republic. WHO and UNICEF have appealed to all parties to cooperate, including through temporary pauses in hostilities where needed, to allow vaccination campaigns to take place and for all children to be protected…
More: http://www.who.int/features/2013/syria-polio-vaccination/en/index.html

Update: Polio this week – As of 4 December 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: The ‘high season’ for polio transmission is seeing a dramatic expansion of polio in Pakistan. Over the past four months, 45 cases of wild poliovirus have been reported since August, with evidence of widespread geographic transmission across the country. By contrast, 25 cases had been reported for the period January to July.
:: The situation in Pakistan is increasingly worrying to the global eradication effort, especially in Federally Administered Tribal Areas (FATA) which remains the main transmission zone in Pakistan. This area is also affected by an outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2). The risk of spread within the country and internationally is high.
:: By contrast, cases during the ‘high season’ are on the decline in Nigeria. Since August, 8 cases have been reported, primarily from Borno and Kano states, compared to 42 cases for the January to July period.

Afghanistan
:: Two new WPV1 cases were reported in the past week. The total number of WPV cases for 2013 is now 11 (all WPV1). The two cases were reported from Batikot and Behsud districts in Nangarhar province. All WPV1 cases in 2013 are reported from Eastern Region, close to the Pakistan border. The most recent WPV1 case had onset of paralysis on 12 November from Batikot.

Pakistan
:: Six new WPV1 cases were reported in the past week. Five of the cases were reported from FATA and one from Peshawar, Khyber Pakhtunkhwa (KP). The total number of WPV1 cases for Pakistan in 2013 is now 70. The most recent WPV1 case had onset of paralysis on 16 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 these areas are vaccinated and protected from poliovirus. Immunizations in neighboring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak

The Weekly Epidemiological Record (WER) for 6 December 2013, vol. 88, 49 (pp. 521–532) includes:
:: Rubella and congenital rubella syndrome control and elimination – global progress, 2012
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2013
http://www.who.int/entity/wer/2013/wer8849.pdf

WHO: Global Alert and Response (GAR) – Disease Outbreak News
http://www.who.int/csr/don/2013_03_12/en/index.html
:: Yellow fever in Sudan – update 3 December 2013
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 2 December 2013

WHO Statement: Fourth Meeting of the IHR Emergency Committee concerning MERS-CoV
4 December 2013
Excerpt
The fourth meeting of the Emergency Committee convened by the Director-General under the International Health Regulations (2005) [IHR (2005)] concerning MERS-CoV was held by teleconference on Wednesday, 4 December 2013, from 12:00 to 15:50 Geneva time (CET).

In addition to Members of the Emergency Committee, two expert advisors also participated1. A number of affected States Parties reporting recent cases of MERS-CoV – Kingdom of Saudi Arabia, Kuwait, Oman, Qatar and Spain – were also on the teleconference.

During the informational session of the meeting, the WHO Secretariat provided an update on and assessment of epidemiological and scientific developments, including a description of cases over time, notable recent clusters, detection by polymerase chain reaction testing of MERS-CoV in camels, and the public health preparation and experience of the Hajj pilgrimage.

The above affected States Parties presented on recent developments in their countries.

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

…Based on events since its last meeting, the Committee emphasized the need for:
:: investigative studies, including international case-control, serological, environmental, and animal-human interface studies, to better understand risk factors and the epidemiology;
:: further review and strengthening of such tools as standardized case definitions and surveillance and further emphasis on infection control and prevention…
http://www.who.int/mediacentre/news/statements/2013/mers_cov_20131204/en/index.html

CDC/MMWR Watch [to 7 December 2013]
:: Measles Press Conference: 50th Anniversary of Measles Vaccine – Transcript December 5, 2013
:: Measles Still Threatens Health Security – Digital Press Kit December 5, 2013
:: Measles Still Threatens Health Security – Press Release December 5, 2013
:: President Obama Signs Reauthorization of PEPFAR  December 5, 2013

MMWR – December 6, 2013 / Vol. 62 / No. 48
:: Vaccination Coverage Among Persons with Asthma — United States, 2010–2011 Influenza Season
:: Rubella and Congenital Rubella Syndrome Control and Elimination — Global Progress, 2000–2012
:: Announcement: National Influenza Vaccination Week — December 8–14, 2013

Annals of Internal Medicine
3 December 2013, Vol. 159. No. 11
http://annals.org/issue.aspx

Examination of Links Between Herpes Zoster Incidence and Childhood Varicella Vaccination
Craig M. Hales, MD, MPH; Rafael Harpaz, MD, MPH; M. Riduan Joesoef, MD, PhD; and Stephanie R. Bialek, MD, MPH
Ann Intern Med. 2013;159(11):739-745. doi:10.7326/0003-4819-159-11-201312030-00006
http://annals.org/article.aspx?articleid=1784289

Abstract
Background: Introduction of a universal varicella vaccine program for U.S. children in 1996 sparked concern that less-frequent exposure to varicella would decrease external boosting of immunity to varicella zoster virus and thereby increase incidence of herpes zoster (HZ).

Objective: To determine whether the varicella vaccination program has influenced trends in HZ incidence in the U.S. population older than 65 years.

Design: Retrospective study of Medicare claims.

Setting: Medicare, 1992 through 2010.

Participants: 2 848 765 beneficiaries older than 65 years.

Measurements: Annual HZ incidence from 1992 through 2010; rate ratios (RRs) for HZ incidence by age, sex, and race or ethnicity; and state-level varicella vaccination coverage.

Results: 281 317 incident cases of HZ occurred. Age- and sex-standardized HZ incidence increased 39% from 10.0 per 1000 person-years in 1992 to 13.9 per 1000 person-years in 2010 with no evidence of a statistically significant change in the rate of increase after introduction of the varicella vaccination program. Before introduction of this program, HZ incidence was higher in women (RR, 1.21 [95% CI, 1.19 to 1.24]) than men and was lower in black persons (RR, 0.51 [CI, 0.48 to 0.53]) and Hispanic persons (RR, 0.76 [CI, 0.72 to 0.81]) than white persons. In a model adjusted for sex, age, and calendar year from 1997 to 2010, HZ incidence did not vary by state varicella vaccination coverage (RR, 0.9998 [CI, 0.9993 to 1.0003]).

Limitation: Uncertain level and consistency of health-seeking behavior and access and uncertain accuracy of disease coding.

Conclusion: Age-specific HZ incidence increased in the U.S. population older than 65 years even before implementation of the childhood varicella vaccination program. Introduction and widespread use of the vaccine did not seem to affect this increase. This information is reassuring for countries considering universal varicella vaccination.

Primary Funding Source: None.

BMC Public Health
(Accessed 7 December 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Trends in influenza vaccination coverage in Portugal from 1998 to 2010: effect of major pandemic threats
Cátia Sousa Pinto, Baltazar Nunes, Maria João Branco and José Marinho Falcão
BMC Public Health 2013, 13:1130  doi:10.1186/1471-2458-13-1130
Published: 5 December 2013
http://www.biomedcentral.com/1471-2458/13/1130/abstract

Abstract (provisional)
Background
Vaccination is the key measure available for prevention of the public health burden of annual influenza epidemics. This article describes national trends in seasonal influenza vaccine (IV) coverage in Portugal from 1998/99 to 2010/11, analyzes progress towards meeting WHO 2010 coverage goals, and addresses the effect of major public health threats of the last 12 years (SARS in 2003/04, influenza A (H5N1) in 2005/06, and the influenza A (H1N1)2009 pandemic) on vaccination trends.

Methods
The National Institute of Health surveyed (12 times) a random sample of Portuguese families. IV coverage was estimated and was adjusted for age distribution and country region. Independence of age and sex coverage distribution was tested using a modified F-statistic with a 5% significance level. The effect of SARS, A (H5N1), and the A (H1N1)2009 pandemic was tested using a meta-regression model. The model was adjusted for IV coverage in the general population and in the age groups.

Results
Between 1998/99 and 2010/11 IV, coverage in the general population varied between 14.2% (CI 95%: 11.6%–16.8%) and 17.5% (CI 95%: 17.6%–21.6%). There was no trend in coverage (p = 0.097). In the younger age group (<15 years) a declining trend was identified until 2008/09 (p = 0.005). This trend reversed in 2009/10. There was also a gradual and significant increase in seasonal IV coverage in the elderly (p for trend < 0.001). After 2006/07, IV coverage remained near 50%. Adjusting for baseline trends, there was significantly higher coverage in the general population in 2003/04 (p = 0.032) and 2005/06 (p = 0.018). The high coverage observed in the <15-year age group in season 2009/10 was also significant (p = 0.015).

Conclusions
IV coverage in the elderly population displayed an increasing trend, but the 75% WHO 2010 target was not met. This result indicates that influenza vaccination strategy should be improved to meet the ambitious WHO coverage goals. The major pandemic threats of the past decade had a modest but significant effect on seasonal influenza vaccination. There was an increase in vaccine uptake proportion in the general population in 2003/04 and in 2005/06, and in individuals <15 years old in 2009/10.

BMC Public Health
(Accessed 7 December 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Effect of breastfeeding promotion interventions on cost-effectiveness of rotavirus immunization in Indonesia
Auliya A Suwantika and Maarten J Postma
BMC Public Health 2013, 13:1106  doi:10.1186/1471-2458-13-1106
Published: 1 December 2013
http://www.biomedcentral.com/1471-2458/13/1106/abstract

Abstract (provisional)
Background

Rotavirus infection has been reported to be responsible for the majority of severe diarrhea in children under-5-years-old in Indonesia. Breast milk is considered to protect against rotavirus infection and increasing breastfeeding promotion programs could be an alternative target to reduce the incidence of rotavirus diarrhea. This study aims to investigate the effect of breastfeeding promotion interventions on cost-effectiveness of rotavirus immunization in Indonesia, focusing on breastfeeding education and support interventions.

Methods

An age-structured cohort model was developed for the 2011 Indonesia birth cohort. We compared four interventions in scenarios: (i) base-case (I0) reflecting the current situation for the population of under-5-years-old, (ii) with an additional breastfeeding education intervention (I1), (iii) with a support intervention on initiation and duration (I2) and (iv) with both of these two interventions combined (I3). The model applied a 5-year-time-horizon, with 1 month analytical cycles for children less than 1 year of age and annually thereafter. Monte Carlo simulations were used to examine the economic acceptability and affordability of rotavirus vaccination.

Results

Rotavirus immunization would effectively reduce severe cases of rotavirus during the first 5 years of a child’s life even assuming various breastfeeding promotion interventions. The total yearly vaccine cost would amount to US$ 64 million under the market vaccine price. Cost-effectiveness would increase to US$ 153 (societal perspective) with an optimal breastfeeding promotion intervention. Obviously, this is much lower than the 2011 Gross Domestic Product (GDP) per capita of US$ 3,495. Affordability results showed that at the market vaccine price, rotavirus vaccination could be affordable for the Indonesian health system.

Conclusions

Rotavirus immunization would be a highly cost-effective public health intervention for Indonesia even under various breastfeeding promotion interventions based on the WHO’s criteria for cost-effectiveness in universal immunization.

British Medical Journal
07 December 2013 (Vol 347, Issue 7936)
http://www.bmj.com/content/347/7936

Research
Global determinants of mortality in under 5s: 10 year worldwide longitudinal study
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6427 (Published 8 November 2013)
Cite this as: BMJ 2013;347:f6427
http://www.bmj.com/content/347/bmj.f6427
Open Access

Abstract
Objective To assess at country level the association of mortality in under 5s with a large set of determinants.

Design Longitudinal study.

Setting 193 United Nations member countries, 2000-09.

Methods Yearly data between 2000 and 2009 based on 12 world development indicators were used in a multivariable general additive mixed model allowing for non-linear relations and lag effects.

Main outcome measure National rate of deaths in under 5s per 1000 live births

Results The model retained the variables: gross domestic product per capita; percentage of the population having access to improved water sources, having access to improved sanitation facilities, and living in urban areas; adolescent fertility rate; public health expenditure per capita; prevalence of HIV; perceived level of corruption and of violence; and mean number of years in school for women of reproductive age. Most of these variables exhibited non-linear behaviours and lag effects.

Conclusions By providing a unified framework for mortality in under 5s, encompassing both high and low income countries this study showed non-linear behaviours and lag effects of known or suspected determinants of mortality in this age group. Although some of the determinants presented a linear action on log mortality indicating that whatever the context, acting on them would be a pertinent strategy to effectively reduce mortality, others had a threshold based relation potentially mediated by lag effects. These findings could help designing efficient strategies to achieve maximum progress towards millennium development goal 4, which aims to reduce mortality in under 5s by two thirds between 1990 and 2015.

Global Public Health
Volume 8, Issue 9, 2013
http://www.tandfonline.com/toc/rgph20/current#.UqNd7eKy_Kc

Social capital and health in the least developed countries: A critical review of the literature and implications for a future research agenda
William T. Story
pages 983-999

Abstract
Research on the linkage between social capital and health has grown in recent years; however, there is a dearth of evidence from resource-poor countries. This review examines the association between social capital and physical health (including health behaviours) in the least developed countries (LDCs). Citations were searched using three databases from 1990 to 2011 using the keyword ‘social capital’ combined with the name of each of the 48 LDCs. Of the 14 studies reviewed, 12 took place in Africa and 2 in South Asia. All used cross-sectional study designs, including five qualitative and nine quantitative studies. The literature reviewed suggests that social capital is an important factor for improving health in resource-poor settings; however, more research is needed in order to determine the best measures for social capital and elucidate the mechanisms through which social capital affects health in the developing world. Future research on social capital and health in the developing world should focus on applying appropriate theoretical conceptualisations of social capital to the developing country context, adapting and validating instruments for measuring social capital, and examining multilevel models of social capital and health in developing countries.

Health Policy and Planning
Volume 28 Issue 8 December 2013
http://heapol.oxfordjournals.org/content/current

Diarrhoeal diseases and the global health agenda: measuring and changing priority
Jesse B. Bump1,*, Michael R. Reich2 and Anne M. Johnson2
Author Affiliations
1Department of International Health, Georgetown University, 3700 Reservoir RD NW, Washington, DC 20057, USA, 2Department of Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
Accepted October 22, 2012.

Abstract
We investigate priority setting and the global health agenda by analysing the control of diarrhoeal diseases (CDD). CDD was one of the ‘twin engines’ of the 1980s’ child survival movement, but now has a low priority on the global health agenda, even though diarrhoeal diseases still claim around 1.5 million children annually. In this article, we develop a framework and four indicators of priority to measure CDD’s overall prominence on the global health agenda over the last three decades: trends in treatment coverage, changes in perceived priority, changes in financial support and institutional involvement and bibliographic trends. We find that CDD’s priority is now one-sixth to one-third of its level in 1985. We then use political analysis to suggest strategies for reframing CDD as an issue and promoting its priority on the global health agenda.

Health Policy and Planning
Volume 28 Issue 8 December 2013
http://heapol.oxfordjournals.org/content/current

Lessons learned in shaping vaccine markets in low-income countries: a review of the vaccine market segment supported by the GAVI Alliance
Shawn A.N. Gilchrist1,* and Angeline Nanni2
Accepted October 24, 2012.
http://heapol.oxfordjournals.org/content/28/8/838.abstract

Abstract
Objectives The Global Alliance for Vaccines and Immunization (GAVI) anticipated that growing demand for new vaccines could sufficiently impact the vaccines market to allow low-income countries (LICs) to self-finance new vaccines. But the time required to lower vaccine prices was underestimated and the amount that prices would decline overestimated. To better understand how prices in the LIC vaccine market can be impacted, the vaccine market was retrospectively examined.

Design GAVI archives and the published literature on the vaccine markets in LICs were reviewed for the purpose of identifying GAVI’s early assumptions for the evolution of vaccine prices, and contrasting these retrospectively with actual outcomes.

Results The prices in Phases I and II of GAVI-supported vaccines failed to decline to a desirable level within a projected 5-year timeframe. GAVI-eligible countries were unable to sustain newly introduced vaccines without prolonged donor support. Two key lessons can be applied to future vaccine market-shaping strategies: (1) accurate demand forecasting together with committed donor funding can increase supply to the LIC vaccines market, but even greater strides can be made to increase the certainty of purchase; and (2) the expected time to lower prices took much longer than 5 years; market competition is inherently linked to the development time for new vaccines—a minimum of 5–10 or more years. Other factors that can lower vaccine prices include: large-scale production or alternate financing mechanisms that can hasten vaccine price maturation.

Conclusions The impacts of competition on vaccine prices in the LIC new-vaccines market occurred after almost 10 years. The time for research and development, acquisition of technological know-how and to scale production must be accounted for to more accurately predict significant declines on vaccine prices. Alternate financing mechanisms and the use of purchase agreements should also be considered for lowering prices when planning new vaccine introductions.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
December 2013  Volume 9, Issue 12
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/12/

Generation of more effective cancer vaccines
Daniela Fenoglio, Paolo Traverso, Alessia Parodi, Francesca Kalli, Maurizio Zanetti, Gilberto Filaci*
https://www.landesbioscience.com/journals/vaccines/article/26147/

Abstract
Cancer vaccines represent a promising therapeutic approach for which prime time is imminent. However, clinical efficacy must be improved in order for cancer vaccines to become a valid alternative or complement to traditional cancer treatments. Considerable efforts have been undertaken so far to better understand the fundamental requirements for clinically-effective cancer vaccines. Recent data emphasize that important requirements, among others, are (1) the use of multi-epitope immunogens, possibly deriving from different tumor antigens; (2) the selection of effective adjuvants; (3) the association of cancer vaccines with agents able to counteract the regulatory milieu present in the tumor microenvironment; and (4) the need to choose the definitive formulation and regimen of a vaccine after accurate preliminary tests comparing different antigen formulations. The first requirement deals with issues related to HLA restriction of tumor antigen presentation, as well as usefulness of tumor antigen spreading and counteraction of immune escape phenomena, linked to tumor antigen down-modulation, for an effective anti-cancer immune response. The second point underscores the necessity of optimal activation of innate immunity to achieve an efficient adaptive anti-cancer immune response. The third point focuses on the importance to inhibit subsets of regulatory cells. The last requirement stresses the concept that the regimen and formulation of the vaccine impacts profoundly on cancer vaccine efficacy. A new generation of cancer vaccines, provided with both immunological and clinical efficacy, will hopefully soon address these requirements.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
December 2013  Volume 9, Issue 12
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/12/

Influenza vaccination acceptance among diverse pregnant women and its impact on infant immunization
Paula M Frew*, Siyu Zhang, Diane S Saint-Victor, Ashley C Schade, Samantha Benedict, Maral Banan, Xiang Ren, Saad B Omer

Abstract
Objective: We examined pregnant women’s likelihood of vaccinating their infants against seasonal influenza via a randomized message framing study. Using Prospect Theory, we tested gain- and loss-frame message effects and demographic and psychosocial correlates of influenza immunization intention. We also explored interactions among pregnant women who viewed “Contagion” to understand cultural influences on message perception.
Methods: Pregnant women ages 18–50 participated in a randomized message framing study from September 2011 through May 2012 that included exposure to intervention or control messages, coupled with questionnaire completion. Venue-based sampling was used to recruit racial and ethnic minority female participants at locations throughout Atlanta, Georgia. Bivariate and multivariate analyses were conducted to evaluate key outcomes.
Results: The study population (n = 261) included many lower income (≤ $20 000/yearly household earnings) pregnant participants (69.2%, n = 171) inclusive of Black/African Americans (88.5%, n = 230), Hispanic/Latinas (7.3%, n = 19), and Other/Multicultural women (4.2%, n = 11). Both gain [OR = 2.13, 90% CI: (1.120, 4.048)] and loss-frame messages [OR = 2.02, 90% CI: (1.083, 3.787)] were significantly associated with infant influenza vaccination intention compared with the control condition. Intention to immunize against influenza during pregnancy had a strong effect on intent to immunize infants [OR = 10.83, 90%CI: (4.923, 23.825)]. Those who had seen the feature film “Contagion” (n = 54, 20.69%) viewed gain- and loss-framed messages as appealing (x2 = 6.03, p = 0.05), novel (x2 = 6.24, p = 0.03), and easy to remember (x2 = 16.33, p = 0.0003).
Conclusions: In this population, both gain- and loss-framed messages were positively associated with increased maternal intent to immunize infants against influenza. Message resonance was enhanced among those who saw the film “Contagion.” Additionally, history of immunization was strongly associated with infant immunization intention.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
December 2013  Volume 9, Issue 12
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/12/

Special Focus: Vaccine Acceptance
Research Paper
Influenza vaccination acceptance among diverse pregnant women and its impact on infant immunization
Paula M Frew, Siyu Zhang, Diane S Saint-Victor, Ashley C Schade, Samantha Benedict, Maral Banan, Xiang Ren and Saad B Omer http://dx.doi.org/10.4161/hv.26993

Research Paper
 Predictive factors associated with the acceptance of pandemic and seasonal influenza vaccination in health care workers and students in Tuscany, Central Italy
Guglielmo Bonaccorsi, Chiara Lorini, Francesca Santomauro, Silvia Guarducci, Elettra Pellegrino, Francesco Puggelli, Marta Balli and Paolo Bonanni
http://dx.doi.org/10.4161/hv.26036

Research Paper
Willingness to receive a hypothetical avian influenza vaccine among US military personnel in mid-deployment
Chad K Porter, Gina Fitamaurice, David R Tribble, Adam W Armstrong, Manal Mostafa and Mark S Riddle
http://dx.doi.org/10.4161/hv.25910

Research Paper
Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines
Lisa M Gargano, Natasha L Herbert, Julia E Painter, Jessica M Sales, Christopher Morfaw, Kimberly Rask, Dennis Murray, Ralph J DiClemente and James M Hughes
http://dx.doi.org/10.4161/hv.25823

Review
 An overview of current and potential use of information and communication technologies for immunization promotion among adolescents
Daniela Amicizia, Alexander Domnich, Roberto Gasparini, Nicola Luigi Bragazzi, Piero Luigi Lai and Donatella Panatto
http://dx.doi.org/10.4161/hv.26010

Review
Epidemiology of vaccine hesitancy in the United States
Mariam Siddiqui, Daniel A Salmon and Saad B Omer
http://dx.doi.org/10.4161/hv.27243

Review
Sources of HPV vaccine hesitancy in parents
Pooja R Patel and Abbey B Berenson
http://dx.doi.org/10.4161/hv.26224

Commentary
Practical approaches to vaccine hesitancy issues in the United States: 2013
Joseph B Domachowske and Manika Suryadevara
http://dx.doi.org/10.4161/hv.26783

Commentary
Vaccine acceptance: The UK perspective
John A Ford, Hamid Mahgoub and Ananda Giri Shankar http://dx.doi.org/10.4161/hv.26411
Commentary

Provider dismissal of vaccine-hesitant families: Misguided policy that fails to benefit children
Douglas S Diekema
http://dx.doi.org/10.4161/hv.26284

Commentary
“Model” patients and the consequences of provider responses to vaccine hesitancy
Jason L Schwartz
http://dx.doi.org/10.4161/hv.26371

Commentary
Liberty has its responsibilities: Holding non-vaccinators liable for the harm they do
Arthur Caplan
http://dx.doi.org/10.4161/hv.26252

Commentary
Why money will not cure under-immunization
John D Lantos
http://dx.doi.org/10.4161/hv.26467

Commentary
What you see is what you fear
Robert I Field
http://dx.doi.org/10.4161/hv.26653

Commentary
Rethinking vaccine policy making in an era of vaccine hesitancy: Time to rebuild, not remodel?
Douglas J Opel and Edgar K Marcuse
http://dx.doi.org/10.4161/hv.26651

Commentary
Making vaccine refusal less of a free ride
Alison M Buttenheim and David A Asch
http://dx.doi.org/10.4161/hv.26676

JAMA Pediatrics
December 2013, Vol 167, No. 12
http://archpedi.jamanetwork.com/issue.aspx

Viewpoint | December 2013
Rotavirus Vaccines, Intussusception, and Risk-Benefit Assessments
Jason L. Schwartz, PhD, MBE1
JAMA Pediatr. 2013;167(12):1093-1094. doi:10.1001/jamapediatrics.2013.3771.
http://archpedi.jamanetwork.com/article.aspx?articleid=1748358

Excerpt
Vaccination programs against rotavirus have the potential to dramatically improve the health of children worldwide. Two licensed rotavirus vaccines currently in use have been shown to be highly effective in reducing the burden and consequences of rotavirus-related disease.1 Recently, a third vaccine in late-stage development in India has shown positive results in a large clinical trial. Its approval would provide another option for global rotavirus vaccination efforts, one likely to be more affordable to developing nations where the vast majority of the approximately 500 000 annual deaths attributable to rotavirus occur…

JAMA Pediatrics
December 2013, Vol 167, No. 12
http://archpedi.jamanetwork.com/issue.aspx

Editorial | December 2013
Delaying Vaccination Is Not a Safer Choice
Kristen A. Feemster, MD, MPH, MSHPR1,2; Paul Offit, MD1,2
JAMA Pediatr. 2013;167(12):1097-1098. doi:10.1001/jamapediatrics.2013.3071.
http://archpedi.jamanetwork.com/article.aspx?articleid=1750202

Excerpt
According to a recent study of surveillance data from the Vaccine Safety Datalink published in this journal, 48.7% of children were undervaccinated at some time prior to their second birthday and 1 in 8 were undervaccinated owing to parental choice to delay or refuse certain vaccines.1 Undervaccination has been attributed to access to health care services and missed opportunities. Now, however, it has become increasingly evident that it is the result of vaccine hesitancy as parents question the need for certain vaccines and request alternate schedules…

JAMA Pediatrics
December 2013, Vol 167, No. 12
http://archpedi.jamanetwork.com/issue.aspx

Effect of Age on the Risk of Fever and Seizures Following Immunization With Measles-Containing Vaccines in Children
Ali Rowhani-Rahbar, MD, MPH, PhD1; Bruce Fireman, MA1; Edwin Lewis, MPH1; James Nordin, MD, MPH2; Allison Naleway, PhD3; Steven J. Jacobsen, MD, PhD4; Lisa A. Jackson, MD, MPH5; Alison Tse, ScD6; Edward A. Belongia, MD7; Simon J. Hambidge, MD, PhD8; Eric Weintraub, MPH9; Roger Baxter, MD1; Nicola P. Klein, MD, PhD1
JAMA Pediatr. 2013;167(12):1111-1117. doi:10.1001/jamapediatrics.2013.2745.
http://archpedi.jamanetwork.com/article.aspx?articleid=1750204
ABSTRACT
Importance
The first dose of live attenuated measles-containing vaccines is associated with an increased risk of febrile seizures 7 to 10 days following immunization among 12- to 23-month-old children. The combination measles, mumps, rubella, and varicella vaccine is associated with a 2-fold increased risk of febrile seizures 7 to 10 days following immunization compared with the separately administered measles, mumps, and rubella and varicella vaccines. It is unknown whether the magnitude of these increased risks depends on age at immunization.

Objective
To examine the potential modifying effect of age on the risk of fever and seizures following immunization with measles-containing vaccines.

Design, Setting, and Participants
Retrospective cohort study at 8 Vaccine Safety Datalink sites of a total of 840 348 children 12 to 23 months of age who had received a measles-containing vaccine from 2001 through 2011.

Exposures
Any measles-containing vaccines and measles-containing vaccines by type.

Main Outcomes and Measures
Fever and seizure events occurring during a 42-day postimmunization observation period.

Results
In the analysis of any measles-containing vaccines, the increased risk of seizures during the 7- to 10-day risk interval, using the remainder of the observation period as the control interval, was significantly greater among older children (relative risk, 6.5; 95% CI, 5.3-8.1; attributable risk, 9.5 excess cases per 10 000 doses; 95% CI, 7.6-11.5) than among younger children (relative risk, 3.4; 95% CI, 3.0-3.9; attributable risk = 4.0 excess cases per 10 000 doses; 95% CI, 3.4-4.6). The relative risk of postimmunization fever was significantly greater among older children than among younger children; however, its attributable risk was not. In the analysis of vaccine type, measles, mumps, rubella, and varicella vaccine was associated with a 1.4-fold increase in the risk of fever and 2-fold increase in the risk of seizures compared with measles, mumps, and rubella vaccine administered with or without varicella vaccine in both younger and older children.

Conclusions and Relevance
Measles-containing vaccines are associated with a lower increased risk of seizures when administered at 12 to 15 months of age. Findings of this study that focused on safety outcomes highlight the importance of timely immunization of children with the first dose of measles-containing vaccines.

The Lancet  
Dec 07, 2013  Volume 382  Number 9908  p1857 – 1956  e33 – 40
http://www.thelancet.com/journals/lancet/issue/current

Editorial
The global crisis of severe acute malnutrition in children
The Lancet
Preview |
19 million children younger than 5 years had severe acute malnutrition (SAM) worldwide in 2011, most of whom lived in Africa and southeast Asia. Furthermore, more than 7% of all deaths in this age group were attributable to this disorder. These shocking numbers—calculated as part of the 2013 Lancet Series on Maternal and Child Nutrition—highlight how seriously the global problem of SAM should be taken. Therefore, the newly released WHO guidelines for the management of SAM in young children, to replace those produced in 1999, should be welcomed as a step in the right direction.

Comment
Investing in health: why, what, and three reflections
Richard Horton, Selina Lo
Preview |
When Dean Jamison proposed in 2012 that he and Lawrence Summers should reprise their work on investing in health—their 1993 World Development Report (WDR)1 remains the only World Bank annual publication dedicated to health—it seemed a huge and daunting task. WDR 1993, as it came to be known, is surrounded in global health mythology. For some, it was a milestone in making the case for health to heads of state and finance ministers. For others, it opened the door to private sector colonisation of health care, a door that, once opened, could never be closed again.

Reinvesting in health post-2015
Hillevi Engström, Pe Thet Khin, Awa Coll-Seck, Rasmus Helveg Petersen, Anarfi Asamoa-Baah, Graça Machel, Richard Sezibera, Joy Phumaphi, Ariel Pablos-Mendes, Ursula Müller, Lambert Grijns, Jasmine Whitbread, Lola Dare, Ramanan Laxminarayan, John E Lange, Anders Nordström
Preview |
During the past few years we have jointly forged a strong case for health and its links to sustainable development in the post-2015 agenda, with an overarching goal that seeks to maximise health at all stages of life, and with universal health coverage and access as the key means to its achievement. We have acknowledged the need to accelerate progress on the current Millennium Development Goals; to broaden the agenda to encompass non-communicable diseases; and to give more prominence to sexual and reproductive health, with particular emphasis on the health of adolescents.

Time for even greater ambition in global health
Jim Yong Kim
Preview |
Every so often, significant global trends can be traced back to a source. The 1993 World Development Report (WDR)1 was such a catalyst in global health and development policy, demonstrating to finance ministers, economists, and philanthropists that health is an investment with positive economic returns—and not simply a drain on scarce resources. The report helped set the stage for a major scale-up of health investments at global, regional, and national levels.

Investing in health: progress but hard choices remain
Margaret Chan
Preview |
The world has changed radically since the World Development Report (WDR) Investing in Health1 was published 20 years ago, so it is valuable and timely to look ahead once again. The Lancet Commission’s optimistic report on investing in health2 confirms my view that the best times for public health are still ahead of us.

Towards a more robust investment framework for health
Helen Clark
Preview |
On the 20th anniversary of the 1993 World Development Report (WDR),1 the report of the Lancet Commission on Investing in Health reaffirms that investing in health is a strategic investment with enormous economic returns.2 In recognition of the intrinsic value of health, the Commission used a “full income” approach to demonstrate an even higher total return from health investments than previously calculated. Measuring economic and intrinsic values together clearly shows that investments in health are investments in human development—in enlarging people’s choices, freedoms, and capabilities to lead lives they value.

A grand convergence and a historic opportunity
Mark Dybul
Preview |
The 1993 World Development Report (WDR)1 was a landmark publication: it put health squarely on the radar as a mainstream development opportunity. WDR 1993 made the important linkage between health gains and economic development, and it did so with arguments, metrics, and an audience that would have a substantial impact on how the world’s decision makers prioritised and financed health.

The Lancet Commissions – Global health 2035: a world converging within a generation
Dean T Jamison, Lawrence H Summers, George Alleyne, Kenneth J Arrow, Seth Berkley, Agnes Binagwaho, Flavia Bustreo, David Evans, Richard G A Feachem, Julio Frenk, Gargee Ghosh, Sue J Goldie, Yan Guo, Sanjeev Gupta, Richard Horton, Margaret E Kruk, Adel Mahmoud, Linah K Mohohlo, Mthuli Ncube, Ariel Pablos-Mendez, K Srinath Reddy, Helen Saxenian, Agnes Soucat, Karene H Ulltveit-Moe, Gavin Yamey
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2962105-4/fulltext
Executive summary
Prompted by the 20th anniversary of the 1993 World Development Report, a Lancet Commission revisited the case for investment in health and developed a new investment framework to achieve dramatic health gains by 2035. Our report has four key messages, each accompanied by opportunities for action by national governments of low-income and middle-income countries and by the international community.

Nature Medicine
December 2013, Volume 19 No 12 pp1547-1673
http://www.nature.com/nm/journal/v19/n12/index.html

Key roles of adjuvants in modern vaccines
Steven G Reed, Mark T Orr & Christopher B Fox
http://www.nature.com/nm/journal/v19/n12/abs/nm.3409.html

Abstract
Vaccines containing novel adjuvant formulations are increasingly reaching advanced development and licensing stages, providing new tools to fill previously unmet clinical needs. However, many adjuvants fail during product development owing to factors such as manufacturability, stability, lack of effectiveness, unacceptable levels of tolerability or safety concerns. This Review outlines the potential benefits of adjuvants in current and future vaccines and describes the importance of formulation and mechanisms of action of adjuvants. Moreover, we emphasize safety considerations and other crucial aspects in the clinical development of effective adjuvants that will help facilitate effective next-generation vaccines against devastating infectious diseases.

New England Journal of Medicine
December 5, 2013  Vol. 369 No. 23
http://www.nejm.org/toc/nejm/medical-journal

Review Article
Global Health
Global Maternal, Newborn, and Child Health — So Near and Yet So Far
Zulfiqar A. Bhutta, M.B., B.S., Ph.D., and Robert E. Black, M.D.
N Engl J Med 2013; 369:2226-2235December 5, 2013DOI: 10.1056/NEJMra1111853

Excerpt [Free full text] http://www.nejm.org/doi/full/10.1056/NEJMra1111853
…Recent assessment of global statistics suggests that despite major gains, among the 75 so-called Countdown countries that have 98% of all maternal deaths and deaths among children younger than 5 years of age, only 17 are on track to reach the MDG 4 target for child mortality and only 9 are on track to reach the MDG 5 target for maternal mortality.2 However, estimates from the Institute for Health Metrics and Evaluation suggest that 31 countries will achieve MDG 4, 13 countries will achieve MDG 5, and only 9 countries will achieve both targets.3 As we celebrate the fact that the annual number of deaths among children younger than 5 years of age has fallen to 6.6 million (uncertainty range, 6.3 to 7.0 million), which is a 48% reduction from the 12.6 million deaths (uncertainty range, 12.4 to 12.9 million) in 1990, despite an increased number of births in many high-burden countries during the same time period,4 the sobering realization is that even in countries that will reach their MDG 4 and 5 targets, many will still have high numbers of deaths, with much scope for improvement….

…Clearly, countries need to tackle multiple priorities, and many countries struggle with the growing demands for addressing the increasing burden of noncommunicable diseases as well as the challenges of maternal, newborn, and child health and infectious disease. Thus, there are enormous challenges regarding integration into generally fragmented health systems. The integration of new maternal and child health interventions with existing programs for maternal, newborn, and child health has been limited and has occurred only relatively recently at a global policy level. The situation is much worse with regard to integration across other, disease-specific programs and the management of various diseases. This lack of integration is most notable in large-scale vertical programs such as those addressing initiatives in HIV infection, AIDS, tuberculosis, and malaria, which have largely failed to link up with essential interventions for maternal, newborn, and child health and nutrition.

…Although the focus during the past decade has been on the saving of lives, it is also important to look beyond survival to issues of reducing morbidity and disability and improving long-term outcomes of relevance to human development. The close links among poverty, inequity, undernutrition, and human deprivation are well known, and all these factors have been shown to reduce the potential for human development considerably.43 There are promising interventions that can benefit survival as well as human development,44,45 and there is a huge public health need to integrate the two issues. Linking the agenda for maternal and child health and nutrition with the emerging issues of long-term development, human capital, and economic growth may well be the most appropriate strategy to ensure that we stay the course in solving one of the most important moral dilemmas of our times. Although the MDG target dates are in 2015, the need to keep a sustained focus on maternal and child health will remain.

Pediatrics
December 2013, VOLUME 132 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Article
The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits
Douglas J. Opel, MD, MPHa,b,c, John Heritage, PhDd, James A. Taylor, MDa, Rita Mangione-Smith, MD, MPHa,c, Halle Showalter Salas, MPhilc, Victoria DeVere, BSc, Chuan Zhou, PhDa,c, and Jeffrey D. Robinson, PhDe
http://pediatrics.aappublications.org/content/132/6/1037.abstract

Abstract
OBJECTIVE: To characterize provider-parent vaccine communication and determine the influence of specific provider communication practices on parent resistance to vaccine recommendations.

METHODS: We conducted a cross-sectional observational study in which we videotaped provider-parent vaccine discussions during health supervision visits. Parents of children aged 1 to 19 months old were screened by using the Parent Attitudes about Childhood Vaccines survey. We oversampled vaccine-hesitant parents (VHPs), defined as a score ≥50. We developed a coding scheme of 15 communication practices and applied it to all visits. We used multivariate logistic regression to explore the association between provider communication practices and parent resistance to vaccines, controlling for parental hesitancy status and demographic and visit characteristics.

RESULTS: We analyzed 111 vaccine discussions involving 16 providers from 9 practices; 50% included VHPs. Most providers (74%) initiated vaccine recommendations with presumptive (eg, “Well, we have to do some shots”) rather than participatory (eg, “What do you want to do about shots?”) formats. Among parents who voiced resistance to provider initiation (41%), significantly more were VHPs than non-VHPs. Parents had significantly higher odds of resisting vaccine recommendations if the provider used a participatory rather than a presumptive initiation format (adjusted odds ratio: 17.5; 95% confidence interval: 1.2-253.5). When parents resisted, 50% of providers pursued their original recommendations (eg, “He really needs these shots”), and 47% of initially resistant parents subsequently accepted recommendations when they did.

CONCLUSIONS: How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.

Risk Analysis
December 2013  Volume 33, Issue 12  Pages 2079–2224
http://onlinelibrary.wiley.com/doi/10.1111/risa.2013.33.issue-12/issuetoc

Perspective
On How to Deal with Deep Uncertainties in a Risk Assessment and Management Context
Terje Aven*
http://onlinelibrary.wiley.com/doi/10.1111/risa.12067/abstract
Abstract
Recently, several authors have presented interesting contributions on how to meet deep or severe uncertainties in a risk analysis setting. In this article, we provide some reflections on some of the foundational pillars that this work is based on, including the meaning of concepts such as deep uncertainty, known probabilities, and correct models, the aim being to contribute to a strengthening of the scientific platform of the work, as well as providing new insights on how to best implement management policies meeting these uncertainties. We also provide perspectives on the boundaries and limitations of analytical approaches for supporting decision making in cases of deep uncertainties. A main conclusion of the article is that deep uncertainties call for managerial review and judgment that sees beyond the analytical frameworks studied in risk assessment and risk management contexts, including those now often suggested to be used, such as robust optimization techniques. This managerial review and judgment should be seen as a basic element of the risk management.

Science        
6 December 2013 vol 342, issue 6163, pages 1133-1280
http://www.sciencemag.org/current.dtl

Essays on Science and Society
Science & SciLifeLab Prize
From Persistence to Cross-Species Emergence of a Viral Zoonosis
Daniel G. Streicker
+ Author Affiliations
Institute of Biodiversity, Animal Health, and Comparative Medicine, University of Glasgow, Glasgow, G12 8QQ, Scotland, UK.
http://www.sciencemag.org/content/342/6163/1185.summary

Summary
Emerging infectious diseases threaten all forms of life on Earth. Many pathogens of great historical and contemporary significance have originated from other species, triggering pandemics, disrupting agriculture, and challenging efforts to conserve endangered wildlife. Despite decades of research on species-jumping pathogens, the most central questions in the field remain major stumbling blocks for societies that seek to mitigate their impacts. These questions include which pathogens are most likely to emerge, which hosts are most likely to share pathogens, and what will be the long-term fate of newly emerged pathogens? Part of the challenge is that emergence, by nature, transcends scientific disciplines, occurring as the product of human behavior, environmental change, population, cellular and molecular biology, and evolution. Solutions therefore demand innovative pairing of theory and fundamental science with applied research and evidence-based policy-making

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

Book: Immunology of Aging
Editors: Ahmad Massoud, Nima Rezaei
ISBN: 978-3-642-39494-2 (Print) 978-3-642-39495-9 (Online)
http://link.springer.com/book/10.1007/978-3-642-39495-9
:: Chapter: An Introduction on the Old Age and the Aging of the Immune System
Mohamad Bagher Eslami PhD
Abstract
The immune system is vital for the well-being and general health of all individuals, especially elderly, while like other systems it undergoes several changes during aging. Aging influence not only the renewal potential of this system but also the elements of the cytokine network essential for communication between its different parts. It is therefore very necessary to acquire more knowledge on the effects of aging on this highly complex system. Although, there is a growing body of literature on this field, there are far more controversial and unresolved subjects in need of further research. The well-being, health of the old people, and possible restoration of the potential of this system rely largely on the valuable knowledge remained to be gained by further research on this subject
:: Chapter: Optimizing Response to Vaccination in the Elderly
D Boraschi, R Rappuoli, G Del
Abstract
The elderly population is generally “immunologically frail” and more susceptible to infectious diseases, making the need of preventive treatments (vaccination) a public health issue. However, normal vaccines that are effective in young and adult individuals are less immunogenic and less protective in the elderly, due to their impaired immune responsiveness. It is therefore necessary to design new vaccines especially suited to raise protective immunity in the elderly population. Among the several approaches recently undertaken in this direction, the case of influenza vaccination is exemplary and can be taken as paradigm of how a vaccine for the elderly is designed and developed. The approach includes higher antigen dosage, repeated challenges, different immunization routes, and use of strong adjuvants. Basically, a better knowledge of the anomalous immune responsiveness in the elderly remains the unrenounceable basis on which effective immunization strategies in immunologically frail populations should be based.

Oral polio vaccine plus inactivated polio vaccine versus oral polio vaccine alone for reducing polio in children under two years of age
F Jehan, MI Nisar, ZS Lassi, SB Omer, AKM Zaidi – The Cochrane Library, 2013
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows:
:: To determine the effects of combined immunisation with OPV and IPV on intestinal mucosal immunity
:: To determine any variation in effect with type of vaccine, number of doses, age at first dose, by human immunodeficiency virus (HIV) status or in high and low income countries
:: To determine any serious adverse outcomes

Med Sci (Paris). 2013 Nov;29(11):1034-41. doi: 10.1051/medsci/20132911021. Epub 2013 Nov 20.
[Eradication of poliomyelitis and emergence of pathogenic vaccine-derived polioviruses: from Madagascar to Cameroon].
[Article in French]
Delpeyroux F, Colbère-Garapin F, Razafindratsimandresy R, Sadeuh-Mba S, Joffret ML, Rousset D, Blondel B.
Source: Institut Pasteur, biologie des virus entériques, Inserm U994, 25, rue du Docteur Roux, 75724 Paris Cedex 15, France.
Abstract
The oral polio vaccine, a live vaccine made of attenuated poliovirus strains, is the main tool of the vaccination campaigns organised for eradicating poliomyelitis. these campaigns had led to the decline and, thereafter, to the disappearance of wild poliovirus strains of the three serotypes (1-3) in most parts of the world. However, when the polio vaccine coverage becomes too low, vaccine polioviruses can circulate in insufficiently immunized populations and become then pathogenic by mutations and genetic recombination with other enteroviruses of the same species, in particular some coxsackievirus A. These mutated and recombinant vaccine strains have been implicated in several epidemics of paralytic poliomyelitis. Two polio outbreaks associated with these pathogenic circulating vaccine-derived poliovirus (cVDPV) occurred in 2001-2002 and 2005 in the South of Madagascar where vaccine coverage was low. These cVDPV, of serotype 2 or 3, were isolated from paralyzed children and some of their healthy contacts. Other cVDPV were isolated in the same region from healthy children in 2011, indicating that these viruses were circulating again. Vaccination campaigns could stop the outbreaks in 2002 and 2005, and most probably prevent another one in 2011. Therefore, the genetic plasticity of polio vaccine strains that threatens the benefit of vaccination campaigns is the target of an accurate surveillance and an important theme of studies in the virology laboratories of the Institut Pasteur international network.

Critical Research Concepts in TB Vaccine Development
G Delogu, R Manganelli, MJ Brennan – Clinical Microbiology and Infection, 2013
Abstract A new and improved vaccine against tuberculosis (TB) would provide a powerful tool to conquer one of the most insidious infectious diseases of mankind. Protection afforded by Bacille Calmette-Guerin (BCG) has been shown to be limited and inconsistent…

Thesis: Designing and evaluating a health belief model based intervention to increase intent of HPV vaccination among college men: Use of qualitative and quantitative methodology
Mehta, Purvi
Year and Degree: 2013, PhD, University of Cincinnati, Education, Criminal Justice, and Human Services: Health Education.
https://etd.ohiolink.edu/ap:10:0::NO:10:P10_ACCESSION_NUM:ucin1368014093
Abstract
Humanpapilloma virus (HPV) is a common sexually transmitted disease/infection (STD/STI), leading to cervical and anal cancers. Annually, 6.2 million people are newly diagnosed with HPV and 20 million currently are diagnosed. According to the Centers for Disease Control and Prevention, 51.1% of men carry multiple strains of HPV. Recently, HPV vaccine was approved for use in boys and young men to help reduce the number of HPV cases. Currently limited research is available on HPV and HPV vaccination in men. The purpose of the study was to determine predictors of HPV vaccine acceptability among college men through the qualitative approach of focus groups and to develop an intervention to increase intent to seek vaccination in the target population
The study took place in two phases. During Phase I, six focus groups were conducted with 50 participants. In Phase II using a randomized controlled trial a HBM based intervention was compared with a traditional knowledge based intervention in 90 college men. In Phase I lack of perceived susceptibility, perceived severity of HPV and barriers towards taking the HPV vaccine were major themes identified from the focus groups. Participants for this phase and phase II were primarily single, heterosexual, about 20 years old, Caucasian males attending the University of Cincinnati. Phase II analysis was done for pretest/posttest and for pretest/posttest/follow-up. This was done due to a 17.8% retention rate at follow-up.
Repeated measures of ANOVA indicated significant positive changes in the intervention group. Scores for knowledge and HBM constructs, perceived severity, perceived susceptibility, perceived benefits, perceived barriers, self-efficacy, and cues to action improved over time while no significant findings were made for the control group. Regression analysis was done for change scores at pretest/posttest, follow-up/pretest, and follow-up/posttest. No significant model was found for follow-up/posttest. Results from the pretest/posttest regression analysis indicated self-efficacy for taking the vaccine (p=0.000), perceived barriers (p=0.007), and perceived severity (p=0.004) were significant positive predictors of vaccine acceptability. The model had an adjusted R2 of 0.351which indicated that these three predictors accounted for 35.1% variance. HBM is a robust model to predict HPV vaccine acceptability in college men. Results from follow-up/pretest found perceived benefits (p=.004) held a significant positive relationship towards intent to vaccinate. The model had an adjusted R2 of 0.453, which indicated this predictor accounted for 45.3% variance regarding whether participants would take the vaccine.
Overall, the intervention proved to be effective in creating positive change towards HPV vaccine acceptability. Some limitations had occurred, such as a low retention rate at follow-up, and differences between groups at baseline. Despite these issues, change in the intervention still occurred. This study indicates that more theory-based interventions are needed to increase HPV vaccination in college men.
…More

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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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

World AIDS Day 2013 – 1 December 2013

WHO: New HIV recommendations for adolescents
25 November 2013 — More than 2 million adolescents between the ages of 10 and 19 years are living with HIV, and many do not receive the care and support that they need to stay in good health and prevent transmission. In addition, millions more adolescents are at risk of infection. The failure to support effective and acceptable HIV services for adolescents has resulted in a 50% increase in reported AIDS-related deaths in this group compared with the 30% decline seen in the general population from 2005 to 2012.
New WHO recommendations released in the run-up to World AIDS Day 2013 are the first to address the specific needs of adolescents, both for those living with HIV and those who are at risk of infection.
:: Press release: Adolescents falling through gaps in HIV services
:: Guidance for HIV testing, counselling and care
:: Policy brief

UNICEF: More than 850,000 infants saved from HIV since 2005, but alarming trends seen among adolescents
NEW YORK, 29 November 2013 – A new report released today by UNICEF shows great progress has been made to prevent mother-to-child transmission of HIV, with more than 850,000 new childhood infections averted between 2005 and 2012 in low- and middle-income countries…

NIH Statement on World AIDS Day 2013 — December 1, 2013
Anthony S. Fauci, M.D., Director, National Institute of Allergy and Infectious Diseases; Jack Whitescarver, Ph.D., Director, NIH Office of AIDS Research; Francis S. Collins, M.D., Ph.D., NIH Director
http://www.nih.gov/news/health/nov2013/niaid-27.htm
Excerpt
In the 25 years that have passed since the first annual commemoration of World AIDS Day, extraordinary scientific progress has been made in the fight against HIV/AIDS. That progress has turned an HIV diagnosis from an almost-certain death sentence to what is now for many, a manageable medical condition and nearly normal lifespan. We have come far, yet not far enough.

In 2012, more than 2 million new HIV infections and 1.6 million AIDS-related deaths occurred globally. Although these numbers represent a decline from previous years, they also reflect a grim reality: far too many people become HIV-infected and die from the effects of the disease. On World AIDS Day, the National Institutes of Health (NIH) reaffirms its commitment to finding improved HIV treatments and tools for preventing infection (including a vaccine), addressing the conditions and diseases associated with long-term HIV infection, and, ultimately, finding a cure…

…A cornerstone of our HIV prevention efforts continues to be the search for a safe and effective vaccine. The pathway to an effective HIV vaccine has been challenging and marked by disappointments; however, basic research advances this year are charting the course for a new generation of investigational HIV vaccines. Through the work of NIH scientists and grantees, we have gained insights into how HIV and a strong antibody response to the virus co-evolve in an infected person and improved our understanding of how B-cells create potentially protective immune system responses. Further, NIH-funded researchers have developed a new tool for identifying broadly neutralizing antibodies against HIV that could help speed vaccine research and illuminated in exquisite detail the protein largely responsible for enabling HIV to enter human immune cells and cause infection.

Additionally, ongoing analyses of the landmark RV 144 HIV vaccine trial conducted in Thailand are providing important information about human immune responses and other factors that may explain why the investigational vaccine regimen reduced the risk of HIV acquisition by 31 percent. Large-scale investigational clinical trials to build on the RV 144 results are being planned for South Africa and Thailand….

IAVI: World AIDS Day – December 1, 2013: Honoring Their Memories. Finding a Vaccine.
November 25, 2013
Excerpt
On this World AIDS Day, the International AIDS Vaccine Initiative (IAVI) pays tribute to the tens of millions of people who have lost their lives by reaffirming our commitment to finding a vaccine that will help end the AIDS pandemic.
“There has been tremendous success in treating millions with HIV over the past three decades,” said IAVI President and Chief Executive Officer Margie McGlynn, “but a great deal of continued commitment, innovation and persistence will be needed to realize the vision of a world without AIDS…

http://www.iavi.org/Information-Center/Press-Releases/Pages/World-AIDS-Day-2013-Honoring-Their-Memories-Finding-a-Vaccine.aspx

UNICEF-WHO Joint news note: Children in typhoon-hit Tacloban, Philippines, receive vaccines against measles, polio
Excerpt
TACLOBAN/MANILA, Philippines, 26 November 2013 – Children in Tacloban – the city hit hardest by Typhoon Haiyan – were today vaccinated against measles and polio in the first phase of a mass campaign by the Government of the Philippines with support from UNICEF, the World Health Organization (WHO), and other partners. They also received Vitamin A supplements to help improve their immunity against infections.
Over 30,000 children are expected to be reached by the campaign which is taking place at fixed sites in evacuation centres and in communities using mobile health teams.

The vaccination drive in Tacloban is the first phase of a campaign targeting children under five years old in all the typhoon-affected areas. Fifteen teams (10 foreign and 5 national) including volunteers from the Department of Health, the Philippines Red Cross and other non-governmental organisations, were in locations across Tacloban giving vaccines today. The first to receive them were children in 20 evacuation centres – such as San Jose Elementary School, where more than 300 families currently live in conditions that can heighten the risk of infectious diseases…

…At the government’s request, UNICEF purchased over US$2 million worth of vaccines to replenish in-country stocks now being used for the campaign. In addition, UNICEF and WHO are helping to re-establish the broken cold chain, which is critical in keeping vaccines at the right temperature…
http://www.unicef.org/media/media_71017.html

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

:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 29 November 2013

:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update Arab Republic – update 26 November 2013

:: Cholera in Mexico – update 25 November 2013

:: Polio in the Syrian Arab Republic – update26 November 2013
Excerpt
A total of 17 cases due to wild poliovirus type 1 (WPV1) have been confirmed in the Syrian Arab Republic. In addition to 15 cases confirmed in Deir Al Zour province, two additional cases have been confirmed, one each in rural Damascus and Aleppo, confirming widespread circulation of the virus. The case with most recent onset developed paralysis on 8 October 2013.

A comprehensive outbreak response continues to be implemented across the region. Seven countries and territories are holding mass polio vaccination campaigns targeting 22 million children under the age of five years. 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 work with all organizations and agencies providing humanitarian assistance to Syrians affected by the conflict to ensure all Syrian children are vaccinated no matter where they live.

It is anticipated that outbreak response will need to continue for at least six to eight months, depending on the area and based on evolving epidemiology…

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

:: In Syria, four new wild polio virus type 1 (WPV1) cases were reported in the past week. New cases in Aleppo and Douma (rural Damascus) indicate that polio is spreading within the country and reaffirm the urgent need to vaccinate all children in Syria, regardless of who controls the area where they are.

:: In Kenya, the government declared polio a public health emergency on 22 November and directed the Ministry of Health to fast-track the immunization activities and to ensure the entire country is covered.

Pakistan
:: One new WPV1 case was reported in the past week from FR Bannu, Federally Administered Tribal Areas (FATA). The total number of WPV1 cases for Pakistan in 2013 is now 64. The most recent WPV1 case had onset of paralysis on 4 November (from FATA).
:: Two new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 is now 43. The most recent cVDPV2 case had onset of paralysis 27 October (from North Waziristan, FATA).
:: The situation in North Waziristan is alarming. It is the area with the largest number of children being paralyzed by poliovirus in all of Asia. Immunization activities have been suspended by local leaders since June 2012. It is critical that children in these areas are vaccinated and protected from poliovirus. Immunizations in neighboring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.

Chad, Cameroon and Central African Republic
:: In Cameroon, two new WPV1 cases were reported in the past week, both from Malentouen in Ouest region. The total number of WPV1 cases is now four. The most recent case in Cameroon had onset of paralysis on 30 October 2013 (WPV1 from Ouest).

Middle East
:: In Syria, four new WPV1 cases were reported in the past week, two from previously infected district Mayadeen in Deir-Al-Zour and one from Douma, rural Damascus and Fardous, Aleppo, respectively. The total number of WPV1 cases is now 17. The new cases in Aleppo and rural Damascus signal that polio is spreading in the country, but are also a sign that workers are actively looking for cases of polio. 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.

The European Medicines Agency (EMA), in collaboration with other organisations involved in assessing the benefits and risks of vaccines, launched the ADVANCE project “to deliver a blueprint for a pan-European framework for monitoring the benefits and risks of vaccines throughout their lifecycle, and for communicating these benefits and risks.” The five-year project, called accelerated development of vaccine benefit-risk collaboration in Europe  (ADVANCE), is supported by the Innovative Medicines Initiative (IMI) and brings together the EMA and the European Centre for Disease Prevention and Control (ECDC), as well as pharmaceutical companies that manufacture vaccines, national public-health and regulatory bodies, academic experts and small and medium-sized enterprises. ADVANCE is coordinated by the Erasmus Medical Center in the Netherlands and the Children’s Hospital Basel , University of Basel, Switzerland. This framework “will further facilitate health professionals, regulatory agencies, public-health institutions and the general public to make prompt, better-informed decisions regarding vaccination strategies.” The role of the EMA in ADVANCE will be to develop and test guidance for the conduct and reporting of studies in this area. This best-practice guidance will include methodological standards, governance rules, a code of conduct and a communication strategy.

26/11/2013: http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2013/11/news_detail_001976.jsp&mid=WC0b01ac058004d5c1

GAVI Watch: Media Releases/Statements
http://www.gavialliance.org/library/news/statements/

:: Guillaume Grosso appointed head resource mobilisation in European markets -28 November 2013
   Former director of ONE Campaign’s Paris office joins GAVI Alliance.

:: GAVI Alliance to support Nigeria’s first new national yellow fever vaccination campaign in 30 years – 26 November 2013
   Mass preventive campaign will protect close to 60 million children and adults

The Weekly Epidemiological Record (WER) for 29 November 2013, vol. 88, 48 (pp. 509–520) includes:
:: Review of the 2013 influenza season in the southern hemisphere
http://www.who.int/entity/wer/2013/wer8848.pdf

CDC/MMWR Watch [to 30 November 2013]

Princeton University will offer Meningitis B vaccines to recommended groups
Posted November 26, 2013; 03:00 p.m.
Excerpt
The Centers for Disease Control and Prevention (CDC) has now officially recommended that all Princeton University undergraduate students, and also graduate students living in undergraduate dormitories, the Graduate College and annexes, and other members of the University community with certain medical conditions, receive a vaccine that helps protect against meningococcal disease caused by serogroup B bacteria. The vaccine will be provided only to these groups, and it will not be administered anywhere else.

The specified groups were recommended by the CDC to receive the vaccine because young adults and people with certain medical conditions are at increased risk of getting meningitis, especially those who live in close quarters, such as dormitories.

Since March 2013 there have been eight cases of meningococcal disease contracted by Princeton University students and a student visitor, all of which were caused by meningococcal bacteria known as serogroup B, including the latest case reported on Nov. 21….

…The CDC recommends that all members of the University community who have problems with their spleen (including sickle cell disease) or complement pathway disorder (a specific type of immune deficiency) be considered for vaccination. Those who have these conditions would be required to present documentation or a physician’s note to University Health Services before receiving the vaccine.

Princeton University will cover the cost of the vaccine.
http://www.princeton.edu/main/news/archive/S38/54/94A32/index.xml?section=topstories

American Journal of Infection Control
Vol 41 | No. 12 | December 2013 | Pages 1147-1302
http://www.ajicjournal.org/current

B95: A new respirator for health care personnel
Megan E. Gosch, MPH, Ronald E. Shaffer, PhD, Aaron E. Eagan, RN, BSN, Raymond J. Roberge, MD, MPH, Victoria J. Davey, PhD, MPH, RN, Lewis J. Radonovich Jr., MD
published online 31 May 2013.

Abstract
Background
Respiratory protection relies heavily on user compliance to be effective, but compliance among health care personnel is less than ideal.

Methods
In 2008, the Department of Veterans Affairs formed the Project Better Respiratory Equipment using Advanced Technologies for Healthcare Employees (BREATHE) Working Group, composed of a variety of federal stakeholders, to discuss strategies for improving respirator compliance, including the need for more comfortable respirators.

Results
The Working Group developed 28 desirable performance characteristics that can be grouped into 4 key themes: (1) respirators should perform their intended function safely and effectively; (2) respirators should support, not interfere, with occupational activities; (3) respirators should be comfortable and tolerable for the duration of wear; and (4) respiratory protective programs should comply with federal/state standards and guidelines and local policies. As a necessary next step, the Working Group identified the need for a new class of respirators, to be called “B95,” which would better address the unique needs of health care personnel.

Conclusion
This article summarizes the outputs of the Project BREATHE Working Group and provides a national strategy to develop clinically validated respirator test methods, to promulgate B95 respirator standards, and to invent novel design features, which together will lead to commercialized B95 respirators.

British Medical Bulletin
Volume 108 Issue 1 December 2013
http://bmb.oxfordjournals.org/content/current

Social media in public health
Taha A. Kass-Hout* and Hend Alhinnawi
Author Affiliations
Humanitarian Tracker, Washington, DC, USA
Accepted August 27, 2013.
http://bmb.oxfordjournals.org/content/108/1/5.abstract

Abstract
Introduction or background
While social media interactions are currently not fully understood, as individual health behaviors and outcomes are shared online, social media offers an increasingly clear picture of the dynamics of these processes.

Sources of data
Social media is becoming an increasingly common platform among clinicians and public health officials to share information with the public, track or predict diseases.

Areas of agreement
Social media can be used for engaging the public and communicating key public health interventions, while providing an important tool for public health surveillance.

Areas of controversy
Social media has advantages over traditional public health surveillance, as well as limitations, such as poor specificity, that warrant additional study.

Growing points
Social media can provide timely, relevant and transparent information of public health importance; such as tracking or predicting the spread or severity of influenza, west nile virus or meningitis as they propagate in the community, and, in identifying disease outbreaks or clusters of chronic illnesses.

Areas timely for developing research
Further work is needed on social media as a valid data source for detecting or predicting diseases or conditions. Also, whether or not it is an effective tool for communicating key public health messages and engaging both, the general public and policy-makers.

British Medical Journal
30 November 2013 (Vol 347, Issue 7935)
http://www.bmj.com/content/347/7935

Research
Non-publication of large randomized clinical trials: cross sectional analysis
BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6104 (Published 29 October 2013)
Cite this as: BMJ 2013;347:f6104
Christopher W Jones, attending physician1, Lara Handler, school of medicine liaison librarian2, Karen E Crowell, clinical information specialist2, Lukas G Keil, research assistant3, Mark A Weaver, assistant professor4, Timothy F Platts-Mills, assistant professor3
http://www.bmj.com/content/347/bmj.f6104

Abstract
Objective  To estimate the frequency with which results of large randomized clinical trials registered with ClinicalTrials.gov are not available to the public.

Design  Cross sectional analysis

Setting  Trials with at least 500 participants that were prospectively registered with ClinicalTrials.gov and completed prior to January 2009.

Data sources  PubMed, Google Scholar, and Embase were searched to identify published manuscripts containing trial results. The final literature search occurred in November 2012. Registry entries for unpublished trials were reviewed to determine whether results for these studies were available in the ClinicalTrials.gov results database.

Main outcome measures   The frequency of non-publication of trial results and, among unpublished studies, the frequency with which results are unavailable in the ClinicalTrials.gov database.

Results  Of 585 registered trials, 171 (29%) remained unpublished. These 171 unpublished trials had an estimated total enrollment of 299 763 study participants. The median time between study completion and the final literature search was 60 months for unpublished trials. Non-publication was more common among trials that received industry funding (150/468, 32%) than those that did not (21/117, 18%), P=0.003. Of the 171 unpublished trials, 133 (78%) had no results available in ClinicalTrials.gov.

Conclusions  Among this group of large clinical trials, non-publication of results was common and the availability of results in the ClinicalTrials.gov database was limited. A substantial number of study participants were exposed to the risks of trial participation without the societal benefits that accompany the dissemination of trial results.

Bulletin of the World Health Organization
Volume 91, Number 12, December 2013, 897-972http://www.who.int/bulletin/volumes/91/12/en/index.html

Editorial
Knowledge is power; information is liberation
Rachel Baggaley a, Jesus M Garcia Calleja a, Lawrence Marum b & Elizabeth Marum b
a. Department of HIV/AIDS, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
b. US Centers for Disease Control and Prevention, Lusaka, Zambia.
Bulletin of the World Health Organization 2013;91:898-898A. doi: http://dx.doi.org/10.2471/BLT.13.132464
http://www.who.int/bulletin/volumes/91/12/13-132464/en/index.html

Excerpt
In 1597 Francis Bacon stated that “knowledge itself is power”1 and Nelson Mandela, in the same vein, said in 2003 that “education is the most powerful weapon we can use to change the world”.2 In this issue of the Bulletin of the World Health Organization, Dermot Maher discusses the ethics of conducting population-based surveys involving clinical tests for research and surveillance purposes without routinely giving participants their test results, if these are positive, so that they can seek access to lifesaving treatment. Maher argues specifically that because antiretroviral treatment is now widely available, even in low- and middle-income countries, it is no longer ethical to fail to inform research participants when the result of a test for the detection of human immunodeficiency virus (HIV) infection turns out to be positive.3,4

According to the Council for International Organizations of Medical Sciences, “individual subjects will be informed of any finding that relates to their particular health status”.5 In 2004 and 2013, the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) issued ethical guidance for HIV surveillance that included a guiding principle particularly relevant to this discussion: in household or clinical surveys, “participants must be given the opportunity to be informed of their test results”.6 Currently, participants in many population-based surveys in which blood or other samples are collected for research purposes are “given the opportunity” to learn their test results, through testing services provided in the community or referral to local counselling and testing services, but are still allowed to “opt out” of learning their results…

Bulletin of the World Health Organization
Volume 91, Number 12, December 2013, 897-972http://www.who.int/bulletin/volumes/91/12/en/index.html

Editorial
Public health management of mass gatherings: the Saudi Arabian experience with MERS-CoV
Ziad A Memish & Abdullah A Al-Rabeeah
doi: 10.2471/BLT.13.132266
Excerpt
…Building on decades of experience, in October 2010 the Saudi Arabian health ministry established the Global Center for Mass Gathering Medicine, subsequently endorsed by health minis­ters of the League of Arab States. WHO’s Executive Board soon mandated a strat­egy for mass gatherings and established a framework to address the health chal­lenges these entail.

The scientific and practical methods applied in mass gathering medicine, as the field is called, were examined during the Second International Con­ference on Mass Gathering Medicine in Riyadh, Saudi Arabia, in September 2013. The conference highlighted the importance of research and of drawing on the experience of states and regional and international organizations to control accidents and diseases during mass gatherings. The resulting Riyadh declaration calls for cooperation and in­formation exchange between the Global Centre for Mass Gathering Medicine and other WHO collaborating centres and between states, international or­ganizations and scientific centres, with due observance of patient confidentiality and medical ethics. It also states that  global developments in the control of MERS-CoV transmission should be followed to inform arrangements for the hajj and other mass gatherings. Finally, it calls for the coordination of policies and procedures to better define the nature, methods and scope of mass gathering medicine and to launch media and educational campaigns for increas­ing awareness of the field. The confer­ence acknowledged the media’s role in conveying accurate and unbiased health information and underscored the im­portance of relying on reputable sources; ensuring balanced, non-alarmist cover­age based on scientific facts and mindful of public health ethics; and establishing benchmarks for the resources needed during mass gatherings.

The complex public health chal­lenges posed by mass gatherings are best addressed through mutual trust and equitable partnerships and col­laborations. In a globalized world, such collaborations inevitably extend beyond national and regional borders and hence require a fine balance be­tween respect for national sovereignty, public health ethics and global health security priorities.

Bulletin of the World Health Organization
Volume 91, Number 12, December 2013, 897-972http://www.who.int/bulletin/volumes/91/12/en/index.html

Frequent exposure to suboptimal temperatures in vaccine cold-chain system in India: results of temperature monitoring in 10 states
Manoj V Murhekar, Srihari Dutta, Ambujam Nair Kapoor, Sailaja Bitragunta, Raja Dodum, Pramit Ghosh, Karumanagounder Kolanda Swamy, Kalyanranjan Mukhopadhyay, Somorjit Ningombam, Kamlesh Parmar, Devegowda Ravishankar, Balraj Singh, Varsha Singh, Rajesh Sisodiya, Ramaratnam Subramanian & Tana Takum
http://www.who.int/bulletin/volumes/91/12/13-119974-ab/en/index.html
Abstract
Objective
To estimate the proportion of time the vaccines in the cold-chain system in India are exposed to temperatures of < 0 or > 8 °C.

Methods
In each of 10 states, the largest district and the one most distant from the state capital were selected for study. Four boxes, each containing an electronic temperature recorder and two vials of diphtheria, pertussis and tetanus vaccine, were placed in the state or regional vaccine store for each study state. Two of these boxes were then shipped – one per facility – towards the two most peripheral health facilities where vaccine was stored in each study district. The boxes were shipped, handled and stored as if they were routine vaccine supplies.

Findings
In state, regional and district vaccine stores and peripheral health facilities, respectively, the temperatures in the boxes exceeded 8 °C for 14.3%, 13.2%, 8.3% and 14.7% of their combined storage times and fell below 0 °C for 1.5%, 0.2%, 0.6% and 10.5% of these times. The boxes also spent about 18% and 7% of their combined times in transit at < 0 and > 8 °C, respectively. In shake tests conducted at the end of the study, two thirds of the vaccine vials in the boxes showed evidence of freezing.

Conclusion
While exposure to temperatures above 8 °C occurred at every level of vaccine storage, exposure to subzero temperatures was only frequent during vaccine storage at peripheral facilities and vaccine transportation. Systematic efforts are needed to improve temperature monitoring in the cold-chain system in India.