UN Chronicle
Vol. L No. 3 2013  September 2013
http://unchronicle.un.org/

Theme: Migration
This issue, which features contributions from twelve leading experts from within and outside of the United Nations system, looks at international migration and development. The articles examine, among other things, lowering the costs and amplifying the benefits of migration; the protection of migrants’ rights and State sovereignty; labour migration and inclusive development; leveraging remittances for development; the reintegration of returning migrants; and strengthening migration cooperation.

Vaccine
Volume 31, Issue 44, Pages 5005-5146 (17 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Risks and safety of pandemic H1N1 influenza vaccine in pregnancy: Exposure prevalence, preterm delivery, and specific birth defects
Original Research Article
Pages 5033-5040
Carol Louik, Katherine Ahrens, Stephen Kerr, Junhee Pyo, Christina Chambers, Kenneth L. Jones, Michael Schatz, Allen A. Mitchell

Abstract
We estimated exposure prevalence and studied potential risks for preterm delivery (PTD) and specific birth defects associated with exposure to the unadjuvanted pH1N1-containing vaccines in the 2009–2010 and 2010–2011 influenza seasons.

We used data from 4 regional centers in the United States collected as part of the Slone Epidemiology Center’s Birth Defects Study. For PTD, propensity score-adjusted time-varying hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for exposure anytime in pregnancy and for each trimester. For 41 specific major birth defects, propensity score-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.

Among 4191 subjects, there were 3104 mothers of malformed (cases) and 1087 mothers of nonmalformed (controls). Exposure prevalences among controls were 47% for the 2009–2010 season and 38% for the 2010–2011 season; prevalence varied by geographic region. Results for PTD differed between the two seasons, with risks above and below the null for the 2009–2010 and 2010–2011 seasons, respectively. For 41 specific birth defects, most adjusted ORs were close to 1.0. Three defects had adjusted ORs > 2.0 and four had risks < 0.5; however, 95% CIs for these were wide.

Conclusions
Among women exposed to pH1N1 vaccine, we found a decreased risk for PTD in the 2010–2011 season; risk was increased in 2009–2010, particularly following exposure in the first trimester, though the decrease in gestational length was less than 2 days. For specific major defects, we found no meaningful evidence of increased risk for specific congenital malformations following pH1N1 influenza vaccinations in the 2009–2010 and 2010–2011 seasons.

Vaccine
Volume 31, Issue 44, Pages 5005-5146 (17 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Assessment of causality of individual adverse events following immunization (AEFI): A WHO tool for global use
Original Research Article
Pages 5041-5046
Alberto E. Tozzi, Edwin J. Asturias, Madhava Ram Balakrishnan, Neal A. Halsey, Barbara Law, Patrick L.F. Zuber

Abstract
Serious illnesses or even deaths may rarely occur after childhood vaccinations. Public health programs are faced with great challenges to establish if the events presenting after the administration of a vaccine are due to other conditions, and hence a coincidental presentation, rather than caused by the administered vaccines. Given its priority, the Global Advisory Committee for Vaccine Safety (GACVS) commissioned a group of experts to review the previously published World Health Organization (WHO) Adverse Event Following Immunization (AEFI) causality assessment methodology and aide-memoire, and to develop a standardized and user friendly tool to assist health care personnel in the processing and interpretation of data on individual events, and to assess the causality after AEFIs. We describe a tool developed for causality assessment of individual AEFIs that includes: (a) an eligibility component for the assessment that reviews the diagnosis associated with the event and identifies the administered vaccines; (b) a checklist that systematically guides users to gather available information to feed a decision algorithm; and (c) a decision support algorithm that assists the assessors to come to a classification of the individual AEFI. Final classification generated by the process includes four categories in which the event is either: (1) consistent; (2) inconsistent; or (3) indeterminate with respect of causal association; or (4) unclassifiable. Subcategories are identified to assist assessors in resulting public health decisions that can be used for action. This proposed tool should support the classification of AEFI cases in a standardized, transparent manner and to collect essential information during AEFI investigation. The algorithm should provide countries and health officials at the global level with an instrument to respond to vaccine safety alerts, and support the education, research and policy decisions on immunization safety.

Vaccine
Volume 31, Issue 44, Pages 5005-5146 (17 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Hepatitis B and influenza vaccines: Important occupational vaccines differently perceived among medical students

Original Research Article
Pages 5111-5117
Sabine Wicker, Holger F. Rabenau, Laura von Gierke, Guido François, Ramona Hambach, Antoon De Schryver

Abstract
Healthcare personnel (HCP) are at risk from occupational exposure to airborne and bloodborne pathogens, and the risk of infection among HCP is greater than among the general population.

The aim of the study was to characterize attitudes toward occupational recommended vaccines as well as the perception of risks of occupationally acquired infections. We surveyed 650 medical students to assess their perception of influenza and hepatitis B and their opinions and beliefs about influenza and hepatitis B vaccines.

We found differences between pre-clinical and clinical students regarding the uptake of influenza and hepatitis B vaccines, about the chances of being occupationally infected with influenza or hepatitis B, and about the likelihood of suffering from severe side-effects following immunization.

Interestingly, the risk perception varied drastically between the two vaccine-preventable diseases hepatitis B and influenza. Medical students rated the probability of contracting hepatitis B due to a work-related exposure and the severity of disease significantly higher than for influenza, and this may be an explanation for the greater acceptance of the hepatitis B vaccine.

Furthermore, our findings suggest that medical students are frequently inaccurate in assessing their own risk level, and their specific knowledge about both diseases and the severity of these diseases proved to be unsatisfactory.

Vaccine
Volume 31, Issue 44, Pages 5005-5146 (17 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Acceptability of human papillomavirus vaccination among male university students in the United Arab Emirates
Original Research Article
Pages 5141-5144
Osman Ortashi, Hina Raheel, Jasem Khamis

Abstract
Objective
To assess the knowledge about and acceptability of human papillomavirus (HPV) vaccination among male university students in the United Arab Emirates (UAE).

Methods
Between June and August 2012 we approached 356 male university students from the UAE and asked them to fill out a 12-item self-administered questionnaire.

Results
Knowledge of HPV was low among the university students who participated (32%). Less than half of the students (46%) indicated they would accept HPV vaccination, and around 30% were unsure of their decision. Safety (68%), protection of their female partner (65%) and doctor’s recommendation (64%) were rated as the factors most likely to increase the uptake of HPV vaccination among participating students. The factors rated most likely to stop students from using the vaccine were fear of side effects (85%), absence of clear benefits (38%) and objections from a religious authority (25%). Marital status and sexual activity were associated with greater knowledge of HPV but not with greater acceptance of vaccination among university students in the UAE.

Conclusion
Overall acceptability of and knowledge about HPV infection and vaccination were low in a sample of male university students in the UAE. Marital status and sexual activity are associated with greater knowledge of HPV infection but have no effect on the acceptability of HPV vaccination.

Reuters
http://www.reuters.com/
Accessed 12 October 2013

Rabies kills 24,000 a year in Africa because vaccine costly: experts
DAKAR | Thu Oct 10, 2013 2:53pm EDT
http://www.reuters.com/article/2013/10/10/us-africa-rabies-idUSBRE9990XD20131010

(Reuters) – Rabies kills 24,000 people a year in Africa, most of them children, because many on the world’s poorest continent cannot afford the cost of the vaccine, experts said on Thursday.

Africa is home to nearly half the 55,000 people around the world who die each year from rabies, caused mainly by bites from dogs contaminated with the virus, according to a conference of experts on the disease in the Senegalese capital Dakar.

Vaccination of humans, as well as dogs and domestic pets, is the only way to prevent the spread of the disease.

“This is the disease of the poorest of the poor who can’t afford the vaccine,” Herve Bourhy, a doctor at France’s Pasteur Institute, told reporters.

An anti-rabies vaccine costs 10 euros per injection and four to five vaccinations are needed to create immunity. For many in poor rural African areas where the disease is endemic, this is prohibitively expensive…

Vaccines: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated “29 June 2013″
.
– Email Summary: Vaccines: The Week in Review is published as a single email summary, scheduled for release each Saturday eveningbefore midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.
.
– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_5 Oct 2013
.
– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
.
– 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.
.
– Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…
.
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

Update: Polio this week – As of 02 October 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]

:: Three wild poliovirus type 1 (WPV1) cases were reported from South Sudan this week. Genetic sequencing is underway to determine the origin of the isolated viruses and possible relation to the ongoing Horn of Africa outbreak. The cases are from North Bahr El Gazal state (close to the border to Sudan) and Eastern Equatoria state (close to the border with Kenya and Uganda). The cases have triggered a full outbreak response from the Global Polio Eradication Initiative (GPEI) operational perspective. For more information see the ‘Horn of Africa’ section below.
:: Eight new WPV cases were reported from north-west Pakistan. Seven are from the Federally Administered Tribal Areas (FATA) and one from Khyber Pakhtoon (KP). The majority (67%) of WPV from Pakistan this year are from FATA, the bulk of which are from North Waziristan (10) and Khyber (10).
:: Pakistan’s Prime Minister Nawaz Sharif reasserted Pakistan’s commitment to eradicate polio in a speech at the UN General Assembly on Friday 27 September 2013: “We have also made eradication of polio in Pakistan a matter of great importance for my Government, as we are determined to make Pakistan a polio free country.”
:: The Independent Monitoring Board met 1-2 October in London, UK. The IMB reviewed the latest epidemiology and programme developments. The next IMB report is expected to be issued within two weeks of the meeting…
:: On 26 September, the Polio Oversight Board (POB) met with donors and other key stakeholders to review progress against the GPEI’s Polio Eradication and Endgame Strategic Plan 2013-2018, launched earlier this year…[see full text of statement below]

Afghanistan
:: Two new WPV cases were reported from two previously infected districts in the past week. The two cases were reported from Watapur district in Kunar province and Batikot, Nangahar province. The total number of WPV cases for 2013 is now six. All six are WPV1 and all reported from Eastern Region.  The most recent WPV1 case had onset of paralysis on 27 August, from Kunar province…

Nigeria
:: Two new WPV cases were reported this week. The cases were reported from two previously infected districts, one from Bauchi Local Government Area (LGA) in Bauchi state and one from Bichi LGA in Kano state. The total number of WPV cases for 2013 is now 49 (all WPV1s). The most recent WPV1 case in the country had onset of paralysis on 10 September (from Kano)

Pakistan
:: Eight new WPV cases were reported in the past week. Seven of the cases were reported from FATA province (five from North Waziristan, one from Khyber and one from a newly infected district – FR Dikhan).
:: One WPV was reported in Peshawar, KP.
:: The total number of WPV1 cases for 2013 is now 36. Of these, the majority, 24 (67%), are from FATA, of which 10 are from North Waziristan and 10 from Khyber…
:: The situation in North Waziristan is particularly concerning, as it is in an area where immunizations have been suspended by local leaders since last June. Immunizations in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.
:: The most recent cases in FATA underscore the risk of ongoing polio transmission (be it due to WPV or cVDPV) in this area and the threat it continues to pose to children everywhere, in particular to children living in areas where access has not been possible for extended periods of time. FATA is the major poliovirus reservoir in Pakistan and in Asia, with confirmed circulation of both WPV1 and cVDPV2.  More than 350,000 children in this area are regularly missed in inaccessible areas, during immunization activities.  Efforts are ongoing to curb transmission in this area, including through vaccination at transit points and conducting Short Interval Additional Dose (SIADs) campaigns in areas that have recently become accessible.

Chad, Cameroon and Central African Republic
:: …In Cameroon, one new cVDPV2 case was reported in Kolofata, Extreme-Nord in the past week. The total number of cVDPV2 cases for 2013 is now four. The most recent case had onset of paralysis on 12 August (from Extreme-Nord). NIDs are planned for 11-13 October.
:: Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, ongoing insecurity and humanitarian crises, and destruction of health infrastructure. :: To minimize the risk and consequences of potential re-infection, SNIDs were conducted 30 September – 2 October and NIDs are planned for end October.

Horn of Africa
:: Three cases were reported from North Bahr El Gazal and Eastern Equatoria areas over the past week, all three with onset of paralysis between 15-24 August. The new cases have triggered a full country outbreak response from a GPEI operational perspective.
:: South Sudan will launch immediate response covering children up to 15 years of age in the infected areas, targeting 140,000 children. This will be followed by a SNID in mid-October using bivalent oral polio vaccine (bOPV). Two national immunization days (NIDs) were already planned for November and December…
:: One new wild poliovirus case has been reported from the previously infected Somali region of Ethiopia. Onset of paralysis 7 September. No new WPV1 cases were reported from Somalia and Kenya in the past week. The total number of WPV1 cases for 2013 in the Horn of Africa is now 196 (175 from Somalia, 14 from Kenya, four from Ethiopia and three from South Sudan). The most recent WPV1 case in the region had onset of paralysis on 7 September (from Ethiopia).

WHO: Global Alert and Response (GAR) – Disease Outbreak News
http://www.who.int/csr/don/2013_03_12/en/index.html
Wild poliovirus in the Horn of Africa – update – 1 October 2013
Excerpt
Three suspected cases of wild poliovirus type 1 (WPV1) from South Sudan are currently being investigated. All three patients are girls, two of whom are approximately two-years-old and one is eight-years-old. All had previously been immunized with oral polio vaccine (OPV).

Two of the patients are from North Bahr El Gazal state (close to the border with Sudan), and one is from Eastern Equatorial state (close to the border with Kenya and Uganda). They developed paralysis between 15-24 August 2013. Genetic sequencing is ongoing to provide final confirmation of the laboratory results to determine the origin of the isolated viruses.

The Horn of Africa is currently experiencing an outbreak of WPV1, with 174 cases in Somalia, 14 cases in Kenya and three cases in Ethiopia. Because of the routes of poliovirus spread in previous Horn of Africa outbreaks, South Sudan had been considered at high risk of re-infection. In 2013, South Sudan conducted two National Immunization Days (NIDs) in March 2013 and April 2013, with additional NIDs planned for November 2013 and December 2013. Subnational Immunization Days (SNIDs) were conducted in August 2013.

Contingency plans for an emergency outbreak response are currently being finalized, including an immediate supplementary immunization activity (SIA) in and around the infected areas.

An international team of experts is being deployed to South Sudan, to assist the local authorities in further case investigations, planning for appropriate outbreak response, and further intensifying active searches for additional potential cases….

Statement: Oversight Board reaffirms unflagging commitment
Heads of agencies of the Global Polio Eradication Initiative
30 September 2013
http://www.polioeradication.org/tabid/488/iid/323/Default.aspx

   On 26 September, the Polio Oversight Board (POB) – made up of the heads of Global Polio Eradication Initiative (GPEI) partners WHO, UNICEF, Rotary International and the United States Centers for Disease Control and Prevention, and senior leadership of the Bill & Melinda Gates Foundation— met for the first time with donors such as Norway, the US, Canada, Japan and the Islamic Development Bank, and other key stakeholders such as the Nigerian and Pakistani governments and the GAVI Alliance, to review progress against the GPEI’s Polio Eradication and Endgame Strategic Plan 2013-2018, launched earlier this year.
The POB’s mandate is to provide strong, active leadership of the global polio eradication program and to maintain the highest levels of accountability and transparency among the GPEI’s core agencies.
Last September, during the UN General Assembly, United Nations Secretary-General Ban Ki-moon joined heads of state from Afghanistan, Nigeria and Pakistan, as well as donor government officials and donors from the public and private sectors, to commit the political leadership needed to stamp out polio forever. Earlier this year, the World Health Assembly unanimously approved a six-year Polio Eradication and Endgame Strategic Plan to achieve a polio-free world by 2018. World leaders had previously met in Abu Dhabi to pledge US$4 billion in support of the plan, more than three-quarters of its projected cost.
[Full text]

###

   “Today, we reaffirm our agencies’ unflagging commitment to support governments and national authorities to implement the GPEI’s Polio Eradication and Endgame Strategic Plan 2013-2018, and to realize the health benefits polio eradication will bring worldwide.

Last week, we met to review progress on commitments made last year to an emergency approach to complete polio eradication by 2018. We assessed the impact of those commitments, and noted the progress made against the Strategic Plan in the face of serious challenges.

The GPEI’s top priority remains interrupting polio transmission in endemic countries, and success is now largely dependent on eliminating the virus in relatively small geographic areas of Pakistan and Nigeria. We are encouraged that polio cases are down 45 percent in Nigeria, Pakistan and Afghanistan from this point last year. Afghanistan has had the most striking decline, down more than 80% compared to last year, and has recorded just four cases this year. We heard from health ministers from Pakistan and Nigeria about critical actions being taken to address continuing transmission in their countries, including establishing access to those few remaining areas where children have not received the polio vaccine.

Threats of violence against the heroic women and men who deliver polio vaccines remain a serious concern and we discussed the GPEI partner agencies’ and country governments’ responses to the distinct challenges of reaching children in insecure areas, including building trust in high-risk areas by expanding health services and engaging local and religious leaders.

We remain hopeful that the global program is closing in on the elimination of one of the last two remaining types of wild poliovirus (type 3), which has not been detected anywhere in the world in more than 10 months. The upcoming low transmission season (November to April) in countries currently affected by polio transmission will be crucial, and we agreed that endemic country plans could be further refined to capitalize on this unprecedented opportunity.

The outbreak in the Horn of Africa, where more than 190 cases have been reported following importation of the virus earlier this year, and the recent detection of poliovirus in sewage samples in Israel are grave reminders of the ongoing risks to previously polio-free areas of the world if we do not complete eradication. We reviewed measures underway to quickly halt these outbreaks to prevent further spread, and we will evaluate progress and areas of risk again in two months. We also examined the ongoing transmission of poliovirus in Israel following an importation into that country, and discussed the measures being taken to interrupt that transmission and prevent polio cases in Israel and surrounding countries.
The new GPEI Strategic Plan emphasizes strengthening immunization systems and accelerating the introduction of Inactivated Polio Vaccine (IPV). We heard specific plans to leverage the polio infrastructure to improve routine immunization in 10 focus countries. Work is already underway in Nigeria, Ethiopia, the Democratic Republic of the Congo, Chad, India and Pakistan, with the goal of achieving at least 10 percent annual increase in DTP3 coverage in 80% of high-risk districts. Strengthening these systems is critical to halting polio transmission and ensuring delivery of other critical health interventions to the world’s most vulnerable children.

We also reviewed concrete strategies for tackling the major challenge of introducing at least one dose of IPV in more than 100 countries by the end of 2015, which we are pursuing in close coordination with our partners in the GAVI Alliance. These strategies include communicating the rationale for and urgency of IPV introduction to national policy makers and ensuring the availability of appropriate and affordable IPV and Oral Polio Vaccine (OPV) products for all settings.

As leaders of the agencies charged with implementing the GPEI Strategic Plan, we are committed to closely monitoring our organizations’ work and ensuring we are doing everything possible to fulfill the plan’s objectives. The Polio Oversight Board’s stewardship and guidance will be measured against specific operational, financing and human resource metrics that were shared today with donors and key stakeholders. This enhanced accountability will play a critical role in ensuring we achieve a polio-free world by 2018.”

###

   The Global Polio Eradication Initiative (GPEI), launched in 1988, is spearheaded by national governments, the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, and supported by key partners including the Bill & Melinda Gates Foundation.
   The GPEI Polio Oversight Board is made up of the heads of agencies of GPEI partners (WHO Director General Dr. Margaret Chan, UNICEF Executive Director Anthony Lake, Rotary International Past President Wilf Wilkinson, and CDC Director Dr. Thomas Frieden) and Bill & Melinda Gates Foundation Global Development President Dr. Chris Elias.  

WHO: Lao PDR first S.E. Asian nation to introduce pneumococcal vaccine; launches demonstration project for HPV vaccine.
The Lao People’s Democratic Republic (PDR) became the first South-East Asian nation to introduce pneumococcal vaccine and begin a demonstration project for Human papillomavirus (HPV) vaccine, “simultaneously tackling two major killers of children and women respectively – pneumococcal disease and cervical cancer.” The Lao PDR government will begin vaccinations at a ceremony in Vientiane on Wednesday morning involving hundreds of infants and school girls. About 180,000 infants will receive pneumococcal conjugate vaccine (PCV) and 13,000 girls will receive the HPV vaccine in the next year…

2 October 2013: http://www.who.int/immunization/newsroom/lao_introduction_pneumococcal_vaccine_and_cervical_cancer/en/index.html

The International Vaccine Access Center (IVAC) appointed Katherine L. O’Brien, MD, MPH, as Executive Director, a year after assuming the role of Acting Director.  The announcement noted that Dr. O’Brien is a Professor in the Departments of International Health and Epidemiology at the Bloomberg School, and “brings a wealth of experience as a pediatric infectious disease physician, epidemiologist, and vaccinologist.”

http://www.jhsph.edu/research/centers-and-institutes/ivac/about-us/news.html#Kate_ExecDir_PressRelease

The Roadmap for Childhood TB: Toward Zero Deaths was launched in Washington D.C. by “global TB leaders” including WHO, the International Union Against Tuberculosis and Lung Disease (The Union), Stop TB Partnership, UNICEF, CDC, USAID, and Treatment Action Group (TAG). The group noted that “the deaths of more than 74,000 children from tuberculosis (TB) could be prevented each year through measures outlined in the first ever action plan developed specifically on TB and children, and that “US$120 million per year could have a major impact on saving tens of thousands of children’s lives from TB, including among children infected with both TB and HIV.}
:: Download The Roadmap for Childhood TB: Toward Zero Deaths
:: View the Roadmap online in flipbook format

http://www.who.int/tb/challenges/children/en/

The Global Fund to Fight AIDS, Tuberculosis and Malaria “congratulated Luxembourg for its decision to commit EUR 7.5 million (US$10.1 million) for 2014-2016, making it one of the most generous donors on a per capita basis.” The Global Fund said the commitment, subject to parliamentary approval, “will effectively unlock an additional US$4 million in contributions from the United States and the United Kingdom, which have geared their own contributions to maximize what is donated by other countries.” http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-10-02_Luxembourg_Commitment_is_Very_Generous_Per_Capita/

The Weekly Epidemiological Record (WER) for 4 October 2013, vol. 88, 40 (pp. 429–436) includes:
:: Outbreak news
– Wild poliovirus in the Horn of Africa
:: Meeting of the International Task Force for Disease Eradication – July 2013
:: WHO Statement on the third meeting of the IHR Emergency committee concerning Middle East respiratory syndrome coronavirus (MERS-CoV)

http://www.who.int/entity/wer/2013/wer8840.pdf

IOM: Ranking Vaccines: A Prioritization Software Tool – Phase II: Prototype of a Decision-Support System

In 2012, the IOM released Ranking Vaccines: A Prioritization Framework (Phase I: Demonstration of Concept and a Software Blueprint) which offered a framework and proof of concept for a software prototype called SMART Vaccines to account for various factors influencing vaccine prioritization – demographic, economic, health, scientific, business, programmatic, social, policy factors and public concerns. In this report, Ranking Vaccines: A Prioritization Software Tool (Phase II: Prototype of a Decision-Support System) a functional version of SMART Vaccines 1.0 is discussed and elaborated along with its potential application in making decisions about new vaccine development.

:: Read the Report >>
:: Download the Software >>

BMC Public Health
(Accessed 5 October 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
Effect of an educational intervention on HPV knowledge and vaccine attitudes among urban employed women and female undergraduate students in China: a cross-sectional study
Irene J Chang, Rong Huang, Wei He, Shao-Kai Zhang, Shao-Ming Wang, Fang-Hui Zhao, Jennifer S Smith, You-Lin Qiao BMC Public Health 2013, 13:9

Abstract (provisional)
Background
Due to the potential of human papillomavirus (HPV) vaccination for decreasing cervical cancer rates in Mainland China, where some of the highest incidences in the world have been reported, our study aimed to assess HPV and HPV vaccine knowledge, and to evaluate the effect of a brief educational intervention on HPV knowledge and vaccine acceptability in Chinese undergraduate students and employed women.

Methods
This multi-center, cross-sectional study was conducted across five representative cities of the five main geographical regions of Mainland China. Participants were selected from one comprehensive university and three to four companies in each city for a total of six comprehensive universities and 16 companies. A 62-item questionnaire on HPV knowledge and HPV vaccine acceptability was administered to participants before and after an educational intervention. The intervention consisted of an informative group lecture.

Results
A total of 1146 employed women and 557 female undergraduate students were surveyed between August and November 2011. Baseline HPV knowledge was low among both groups– 320/1146 (28%) of employed women and 66/557 (12%) of students had heard of HPV, while only 237/1146 (21%) of employed women and 40/557 (7.2%) of students knew that HPV is related to cervical cancer. After educational instruction, 947/1061 (89%) of employed women and 193/325 (59%) of students knew the relationship between HPV and cervical cancer (chi2 = 1041.8, p < 0.001 and chi2 = 278.5, p < 0.001, respectively). Post-intervention, vaccine acceptability increased from 881/1146 (77%) to 953/1061 (90%), (p = <0.001) in employed women and 405/557 (73%) in students to 266/325 (82%), (p < 0.001). Women in both groups cited concerns about the HPV vaccine’s safety, efficacy, and limited use to date as reasons for being unwilling to receive vaccination. 502/1146 (44%) of women were willing to vaccinate their children at baseline, which increased to 857/1061 (81%) post-intervention, p < 0.001.

Conclusions
Incorporation of our lecture-based education initiative into a government-sponsored or school-based program may improve HPV-related knowledge and HPV vaccine acceptability. Further studies are needed to evaluate and standardize HPV education programs in China.

BMC Public Health
(Accessed 5 October 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
Immunization coverage and predictive factors for complete and age-appropriate vaccination among preschoolers in Athens, Greece: a cross- sectional study
Ioanna D Pavlopoulou, Koralia A Michail, Evangelia Samoli, George Tsiftis, Konstantinos Tsoumakas BMC Public Health 2013, 13:908 (2 October 2013)

Abstract
Background
In Greece, several new childhood vaccines were introduced recently but were reimbursed gradually and at different time points. The aim of this study was to assess immunization coverage and identify factors influencing complete and age-appropriate vaccination among children attending public nurseries in the municipal district of Athens.

Methods
A cross-sectional study, using stratified sampling was performed. Immunization history was obtained from vaccination booklets. Demographic and socioeconomic data were obtained from school registries and telephone interviews. Vaccination rates were estimated by sample weighted proportions while associations between complete and age-appropriate immunization and potential determinants by logistic regression analysis.

Results
A total of 731 children (mean age: 46, median: 48, range: 10–65 months) were included. Overall immunization coverage with traditional vaccines (DTP, polio, Hib, HBV, 1st dose MMR) was satisfactory, exceeding 90%, but the administration of booster doses was delayed (range: 33.7- 97.4%, at 60 months of age). Complete vaccination rates were lower for new vaccines (Men C, PCV7, varicella, hepatitis A), ranging between 61-92%. In addition, a significant delay in timely administration of Men C, PCV7, as well as HBV was noted (22.9%, 16.0% and 27.7% at 12 months of age, respectively). Child’s age was strongly associated with incomplete vaccination with all vaccines (p< 0.001), while as immigrant status was a predictor of incomplete (p=0.034) and delayed vaccination (p<0.001) with traditional vaccines. Increasing household size and higher maternal education were negatively associated with the receipt of all and newly licensed vaccines, respectively (p=0.035).

Conclusions
Our findings highlight the need to monitor uptake of new vaccines and improve age- appropriate administration of booster doses as well as early vaccination against hepatitis B. Immigrant status, increased household size and high maternal education may warrant targeted intervention.

Bulletin of the World Health Organization
Volume 91, Number 10, October 2013, 717-796
http://www.who.int/bulletin/volumes/91/10/en/index.html

PERSPECTIVES
Towards a framework convention on global health
Lawrence O Gostin, Eric A Friedman, Kent Buse, Attiya Waris, Moses Mulumba, Mayowa Joel, Lola Dare, Ames Dhai & Devi Sridhar
doi: 10.2471/BLT.12.114447
Article [HTML]

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
October 2013  Volume 9, Issue 10
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/10

Review
The current state of tuberculosis vaccines
David A. Hokey*, Ann Ginsberg

Abstract
Tuberculosis continues to persist despite widespread use of BCG, the only licensed vaccine to prevent TB. BCG’s limited efficacy coupled with the emergence of drug-resistant strains of Mycobacterium tuberculosis emphasizes the need for a more effective vaccine for combatting this disease. However, the development of a TB vaccine is hindered by the lack of immune correlates, suboptimal animal models, and limited funding. An adolescent/adult vaccine would have the greatest public health impact, but effective delivery of such a vaccine will require a better understanding of global TB epidemiology, improved infrastructure, and engagement of public health leaders and global manufacturers. Here we discuss the current state of tuberculosis vaccine research and development, including our understanding of the underlying immunology as well as the challenges and opportunities that may hinder or facilitate the development of a new and efficacious vaccine.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 5 October 2013]

Scoping Review  
Challenges and needs for China to eliminate rabies
Wenwu Yin, Jie Dong, Changchun Tu, John Edwards, Fusheng Guo, Hang Zhou, Hongjie Yu, Sirenda Vong Infectious Diseases of Poverty 2013, 2:23 (2 October 2013)
Abstract

Commentary  
Towards a science of rabies elimination
Jakob Zinsstag Infectious Diseases of Poverty 2013, 2:22 (2 October 2013)
Abstract

Pediatrics
October 2013, VOLUME 132 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Article
Nonmedical Vaccine Exemptions and Pertussis in California, 2010
Jessica E. Atwell, MPHa, Josh Van Otterloo, MSPHb, Jennifer Zipprich, PhDc, Kathleen Winter, MPHc, Kathleen Harriman, PhD, MPH, RNc, Daniel A. Salmon, PhDa, Neal A. Halsey, MDa, and
Saad B. Omer, MBBS, MPH, PhDb
Author Affiliations
A Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
B Emory University School of Public Health, Atlanta, Georgia; and
C Immunization Branch, California Department of Public Health, Richmond, California
http://pediatrics.aappublications.org/content/132/4/624.abstract

Abstract
BACKGROUND: In 2010, 9120 cases of pertussis were reported in California, more than any year since 1947. Although this resurgence has been widely attributed to waning immunity of the acellular vaccine, the role of vaccine refusal has not been explored in the published literature. Many factors likely contributed to the outbreak, including the cyclical nature of pertussis, improved diagnosis, and waning immunity; however, it is important to understand if clustering of unvaccinated individuals also played a role.

METHODS: We analyzed nonmedical exemptions (NMEs) for children entering kindergarten from 2005 through 2010 and pertussis cases with onset in 2010 in California to determine if NMEs increased in that period, if children obtaining NMEs clustered spatially, if pertussis cases clustered spatially and temporally, and if there was statistically significant overlap between clusters of NMEs and cases.

RESULTS: Kulldorff’s scan statistics identified 39 statistically significant clusters of high NME rates and 2 statistically significant clusters of pertussis cases in this time period. Census tracts within an exemptions cluster were 2.5 times more likely to be in a pertussis cluster (odds ratio = 2.47, 95% confidence interval: 2.22–2.75). More cases occurred within as compared with outside exemptions clusters (incident rate ratios = 1.20, 95% confidence interval: 1.10–1.30). The association remained significant after adjustment for demographic factors. NMEs clustered spatially and were associated with clusters of pertussis cases.

CONCLUSIONS: Our data suggest clustering of NMEs may have been 1 of several factors in the 2010 California pertussis resurgence.

PLoS Medicine
(Accessed 5 October 2013)
http://www.plosmedicine.org/

Policy Forum
Methodological and Policy Limitations of Quantifying the Saving of Lives: A Case Study of the Global Fund’s Approach
David McCoy, Nele Jensen, Katharina Kranzer, Rashida A. Ferrand, Eline L. Korenromp
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001522

Summary Points
:: A recent trend in global health has been a growing emphasis on assessing the effectiveness and impact of specific health interventions.
:: For example, it has been estimated that 8.7 million lives were saved between 2002 and mid-2012 by “Global Fund–supported programmes” (as distinct from The Global Fund alone) through antiretroviral therapy (ART); directly observed tuberculosis treatment, short course (DOTS); and distribution of insecticide-treated mosquito nets (ITNs).
:: This paper assesses the methods used by The Global Fund to quantify “lives saved,” highlights the uncertainty associated with the figures calculated, and suggests that the methods are likely to overestimate the number of “lives saved.”
:: The paper also discusses how the attribution of “lives saved” to specific programmes or actors might negatively affect the overall governance and management of health systems, and how a narrow focus on just ART, DOTS, and ITNs could neglect other interventions and reinforce vertical programmes.
:: Furthermore, the attribution of “lives saved” to Global Fund–supported programmes is potentially misleading, because such programmes include an unstated degree of financial support from recipient governments and other donors.

Perspective
Saving Lives in Health: Global Estimates and Country Measurement
Daniel Low-Beer, Ryuichi Komatsu, Osamu Kunii
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001523

Extract
One of the most compelling reasons for development aid to health is that it saves lives, often for a few hundred dollars per year of life saved. Relatively uniquely in development, health has a set of high-impact interventions that can save lives directly. Insecticide-treated bednets (ITNs) protect families from malaria, antiretrovirals (ARVs) reduce mortality from HIV, and tuberculosis detection and treatment reduce TB mortality. Prevention activities, particularly for HIV, can save millions more lives. Yet, health programs have not always communicated with simple methods the lives they save.

In this week’s PLOS Medicine David McCoy and colleagues discuss the “lives saved” model of The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund). The Global Fund, together with WHO, UNAIDS, and scientists from the article by McCoy and colleagues [1],[2], have published simple peer-reviewed methods to calculate the lives saved from a restricted set of HIV, TB, and malaria interventions that have known mortality outcomes [3]–[7]. Our method includes only those health interventions with known, documented mortality effects: ARV treatment; directly observed treatment, short-course (DOTS); and ITNs. Our methodology uses documented data reported to the Global Fund on the individuals receiving these services. These results are first verified by national disease programs (we invest 5%–10% of our funds to build the capacity of country monitoring and evaluation systems), then by the Global Fund (which uses independent local fund agents to check the national data systems measuring these services every six months), and finally by on-site checks in a sample of health facilities to verify that people receive these services (as part of performance-based funding) [8].

In addition, the Global Fund’s method applies the agreed, partner mortality estimates and models from WHO and UNAIDS [4] to these service results—for example, the latest scientific data on how HIV treatment or TB treatment will reduce the chance that a person will die of HIV or TB.

Extensive criteria are used to exclude countries where The Global Fund is not a significant contributor; that is, where The Global Fund does not contribute at least US$50 million; is a significant percentage of HIV, TB, and malaria spending; and does not support a key national-level activity, such as drug procurement. Where this does not occur, as has been the case in Uganda, Kenya, or South Africa in recent years, the results are not included.

The method to assess lives saved provides a conservative estimate. The estimate [3],[4] does not include the impact of HIV prevention (which in certain countries—e.g., Thailand, Uganda, Kenya, and Zimbabwe—has saved several million lives per country); the impact of malaria outside Africa and among adults; and the significant, secondary impact of DOTS treatment on reducing TB (as shown by the declines in TB prevalence in China, and in TB prevalence by 45% in Cambodia). Furthermore, reporting of services by programs in country are subject to substantial delays before they are reported globally. The most recent scale up in ITNs and ARV treatment are not fully included; for example, the lives saved are only half the number of people reported on ARVs. We do acknowledge the method [3],[4] has major limitations. Most importantly, it does not directly measure mortality, because in many countries in which we work vital registration systems are too weak, so the method is based on the latest partner estimates of mortality from WHO and UNAIDS.

The article in this week’s PLOS Medicine by David McCoy and colleagues has great value in discussing the assumptions in the methods the Global Fund uses to assess lives saved and the partner estimates—of ARV adherence, use of ITNs, and the limitations of focusing only on a limited set of services. We agree that assumptions require additional sensitivity analysis, and we will update our estimates in 2014 as modeling is refined with new and improved data from country impact evaluations and updated WHO and UNAIDS estimates. We have published more detailed analysis of the ARV, ITN, and DOTS estimates as used by the McCoy and colleagues  [4]. Yet, the uncertainty ranges, with the lives saved from ITNs as low as 27,000, were based on very limited data and provided little additional value. We fully agree with the need for increased country data on estimates and mortality assumptions of lives saved. Most importantly, global modeling needs strengthening with wider and deeper country measurement of epidemic trends and lives saved…

Science        
4 October 2013 vol 342, issue 6154, pages 1-148
http://www.sciencemag.org/current.dtl

Perspective
Social Science
A Risky Science Communication Environment for Vaccines
Dan M. Kahan
Yale Law School, Post Office Box 20815, New Haven, CT 06520, USA.
http://www.sciencemag.org/content/342/6154/53.summary

Summary
Controversy over childhood vaccinations is an instance of what might be styled the “science communication problem”—the failure of compelling scientific evidence to resolve public dispute over risks and similar facts (1). This problem itself has been the focus of scientific study since the 1970s, when psychologists began to investigate the divergence between expert and public opinion on nuclear power. Indeed, the science of science communication that this body of work comprises can now be used not just to explain controversy over risk but also to predict, manage, and in theory avoid conditions likely to trigger it. The example of childhood vaccinations illustrates these points—and teaches an important practical lesson.

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

[HTML] Preparing for Dengue Vaccine Introduction: Recommendations from the 1st Dengue v2V International Meeting
J Torresi, R Tapia-Conyer, H Margolis – PLOS Neglected Tropical Diseases, 2013
Copyright:© 2013 Torresi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

… Case Series and Misclassification Bias Induced by Case Selection from Administrative Hospital Databases: Application to Febrile Convulsions in Pediatric Vaccine …
C Quantin, E Benzenine, M Velten, F Huet… – American Journal of …, 2013
Abstract Vaccine safety studies are increasingly conducted by using administrative health databases and self-controlled case series designs that are based on cases only. Often, several criteria are available to define the cases, which may yield different positive …

Bias Correction of Risk Estimates in Vaccine Safety Studies With Rare Adverse Events Using a Self-controlled Case Series Design
C Zeng, SR Newcomer, JM Glanz, JA Shoup, MF Daley… – American Journal of …, 2013
Abstract The self-controlled case series (SCCS) method is often used to examine the temporal association between vaccination and adverse events using only data from patients who experienced such events. Conditional Poisson regression models are used to …

Developing an effective breast cancer vaccine: Challenges to achieving sterile immunity versus resetting equilibrium
G Curigliano, C Criscitiello, A Esposito, L Fumagalli… – The Breast, 2013
Discussion Active immunotherapy in breast cancer and its implementation into clinical trials has largely been a frustrating experience in the last decades. After many years of controversy, the concept that the immune system regulates cancer development is …

[PDF] Barriers and Facilitators in the Recruitment and Retention of Peruvian Female Sex Workers in a Randomized HPV Vaccine Trial
N Shroff, B Brown, J Kinsler, A Cabral, MM Blas – J Vaccines Vaccin, 2013
Cervical cancer is the second most common cancer in women worldwide, with 250,000 deaths per year, and persistent human papillomavirus (HPV) infection is found in nearly all cases [1]. Female sex workers (FSWs) are at higher risk of HPV infection and subsequent …

Specialized program newsletters, online publications
RotaFlash: Rotavirus vaccines
2 October 2013
PATH
http://vad.createsend5.com/t/ViewEmail/r/AA3ECC32B8EA780C2540EF23F30FEDED/E38B11B8894CC5F5DBC23BD704D2542D

BBC
http://www.bbc.co.uk/
Accessed 5 October 2013
4 October 2013 Last updated at 02:27 ET

A programme to vaccinate schoolchildren against flu has been delayed in Glasgow after concerns from Muslim parents that it contains products derived from pork.

About 100,000 primary school pupils in Scottish health board areas taking part in a pilot programme are being offered the Fluenz vaccine.

It is given as a nasal spray rather than the traditional jab.

But parents in Pollokshields, which has a high number of Muslim pupils, have complained the spray contains gelatine.

A letter sent to Glasgow schools in the wake of concerns cites a World Health Organisation study in 2001 which indicated that Islamic and Jewish scholars had agreed pork gelatine was    permissible within a vaccine.

However, NHS Greater Glasgow and Clyde (NHSGGC), whose area contains most of Scotland’s Muslims, said it had put back the rollout of the vaccinations “following concerns raised by a small number of parents”.

The programme is due to resume next week when parents will be offered a choice of the nasal spray or the more traditional jab…
http://www.bbc.co.uk/news/uk-scotland-24394844

Washington Post
http://www.washingtonpost.com/
Accessed 5 October 2013

Nigeria’s Kano state targets 3 million for vaccination despite fears of attack by extremists
By Associated Press, Published: October 4
http://www.washingtonpost.com/world/africa/nigerias-kano-state-targets-3-million-for-vaccination-despite-fears-of-attack-by-extremists/2013/10/04/ac0bc16e-2cd9-11e3-b141-298f46539716_story.html

KANO, Nigeria — Nigeria’s northern Kano state is starting to vaccinate 3 million children against polio and measles with tight security because of fears of attack by Islamic extremists.

Militants staging an Islamic uprising in northeastern Nigeria in February killed nine women health workers as they were vaccinating children in a house-to-house campaign in Kano city.

Dr. Shehu Usman Abubakar told The Associated Press on Friday that this time the vaccinations will be administered at 2,700 community centers — apparently ensuring more protection. Abubakar is executive secretary for primary health care.

He said 200 children died of measles in Kano state last year.

UNICEF says Nigeria has almost eradicated crippling polio. But northeast Borno state recorded 14 new cases in recent months. Officials blamed the Islamic insurgency for the lost ground…

Vaccines: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated “29 June 2013″
.
– Email Summary: Vaccines: The Week in Review is published as a single email summary, scheduled for release each Saturday eveningbefore midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.
.
– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_28 Sep 2013
.
– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
.
– 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.
.
– Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…
.
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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