Vaccine
Volume 31, Issue 42, Pages 4689-4932 (1 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Quantifying the impact of dissimilar HPV vaccination uptake among Manitoban school girls by ethnicity using a transmission dynamic model
Original Research Article
Pages 4848-4855
Leigh Anne Shafer, Ian Jeffrey, Brenda Elias, Brenna Shearer, Karen Canfell, Erich Kliewer
Abstract
Background
Gardasil, a human papillomavirus (HPV) vaccine, began among grade 6 girls in Manitoba, Canada in 2008. In Manitoba, there is evidence that First Nations, Métis, and Inuit women (FNMI) have higher HPV prevalence, lower invasive cervical cancer (ICC) screening, and higher ICC incidence than all other Manitoban (AOM) women. We developed a mathematical model to assess the plausible impact of unequal vaccination coverage among school girls on future cervical cancer incidence.
Methods
We fit model estimated HPV prevalence and ICC incidence to corresponding empirical estimates. We used the fitted model to evaluate the impact of varying levels of vaccination uptake by FNMI status on future ICC incidence, assuming cervical screening uptake among FNMI and AOM women remained unchanged.
Results
Depending on vaccination coverage, estimated ICC incidence by 2059 ranged from 15% to 68% lower than if there were no vaccination. The level of cross-ethnic sexual mixing influenced the impact that vaccination rates among FNMI has on ICC incidence among AOM, and vice versa. The same level of AOM vaccination could result in ICC incidence that differs by up to 10%, depending on the level of FNMI vaccination. Similarly, the same level of FNMI vaccination could result in ICC incidence that differs by almost 40%, depending on the level of AOM vaccination.
Conclusions
If we are unable to equalize vaccination uptake among all school girls, policy makers should prepare for higher levels of cervical cancer than would occur under equal vaccination uptake.

Vaccine
Volume 31, Issue 42, Pages 4689-4932 (1 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Associations between health communication behaviors, neighborhood social capital, vaccine knowledge, and parents’ H1N1 vaccination of their children
riginal Research Article
Pages 4860-4866
Minsoo Jung, Leesa Lin, K. Viswanath
Abstract
During the H1N1 pandemic in 2009–10, the vaccination behavior of parents played a critical role in preventing and containing the spread of the disease and the subsequent health outcomes among children. Several studies have examined the relationship between parents’ health communication behaviors and vaccinations for children in general. Little is known, however, about the link between parents’ health communication behaviors and the vaccination of their children against the H1N1 virus, and their level of vaccine-related knowledge. We drew on a national survey among parents with at least one child less than 18 years of age (n = 639) to investigate Parents’ H1N1-related health communication behaviors including sources of information, media exposure, information-seeking behaviors, H1N1-related knowledge, and neighborhood social capital, as well as the H1N1 vaccination rates of their children. Findings showed that there is a significant association between the degree at which parents obtained H1N1 vaccination for their children and health communication variables: watching the national television news and actively seeking H1N1 information. And this association was moderated by the extent of the parents’ H1N1-related knowledge. In addition, the parents’ degree of neighborhood social capital mediated the association between H1N1 knowledge of the parents and H1N1 vaccination acceptance for their children. We found, compared to those with a low-level of neighborhood social capital, parents who have a high-level of neighborhood social capital are more likely to vaccinate their children. These findings suggest that it is necessary to design a strategic health communication campaign segmented by parent health communication behaviors.

Vaccine
Volume 31, Issue 42, Pages 4689-4932 (1 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Human papillomavirus vaccine communication: Perspectives of 11–12 year-old girls, mothers, and clinicians
Original Research Article
Pages 4894-4901
Tanya L. Kowalczyk Mullins, Anne M. Griffioen, Susan Glynn, Gregory D. Zimet, Susan L. Rosenthal, J. Dennis Fortenberry, Jessica A. Kahn
Abstract
Objectives
Because little is known about the content of human papillomavirus (HPV) vaccine-related discussions with young adolescent girls in clinical settings, we explored communication between 11- and 12 year-old girls, mothers, and clinicians regarding HPV vaccines and concordance in reports of maternal and clinician communication.
Methods
We conducted individual interviews with 33 girls who had received the quadrivalent HPV vaccine in urban and suburban clinical settings, their mothers, and their clinicians. Data were analyzed using qualitative methods.
Results
From the perspectives of both girls and mothers, clinicians and parents were the preferred sources of HPV vaccine information for girls. Vaccine efficacy and risks/benefits of vaccination were the most commonly reported desired and actual topics of discussion by mothers, girls, and clinicians. Clinician recommendation of vaccination was reported by nearly one-fifth of girls and nearly half of mothers. The most common concordant messages were related to efficacy of the vaccine, with concordance in 70% of triads. The most common discordant messages were related to sexual health. Approximately half of clinicians (16) reported discussing sexual health, but only 5 mothers (15%) and 4 girls (12%) reported this. Triads recruited from suburban (vs. urban) practices had higher degrees of concordance in reported vaccination communication.
Conclusions
HPV vaccine efficacy and safety are important topics for clinicians to discuss with both girls and mothers; educating mothers is important because parents are a preferred source of vaccine-related information for girls. Because girls may be missing important vaccine-related messages, they should be encouraged to actively engage in vaccine discussions.

Vaccine
Volume 31, Issue 42, Pages 4689-4932 (1 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Public finance of rotavirus vaccination in India and Ethiopia: An extended cost-effectiveness analysis
Original Research Article
Pages 4902-4910
Stéphane Verguet, Shane Murphy, Benjamin Anderson, Kjell Arne Johansson, Roger Glass, Richard Rheing
Abstract
Background
An estimated 4% of global child deaths (approximately 300,000 deaths) were attributed to rotavirus in 2010. About a third of these deaths occurred in India and Ethiopia. Public finance of rotavirus vaccination in these two countries could substantially decrease child mortality and also reduce rotavirus-related hospitalizations, prevent health-related impoverishment and bring significant cost savings to households.
Methods
We use a methodology of ‘extended cost-effectiveness analysis’ (ECEA) to evaluate a hypothetical publicly financed program for rotavirus vaccination in India and Ethiopia. We measure program impact along four dimensions: 1) rotavirus deaths averted; 2) household expenditures averted; 3) financial risk protection afforded; 4) distributional consequences across the wealth strata of the country populations.
Results
In India and Ethiopia, the program would lead to a substantial decrease in rotavirus deaths, mainly among the poorer; it would reduce household expenditures across all income groups and it would effectively provide financial risk protection, mostly concentrated among the poorest. Potential indirect benefits of vaccination (herd immunity) would increase program benefits among all income groups, whereas potentially decreased vaccine efficacy among poorer households would reduce the equity benefits of the program.
Conclusions
Our approach incorporates financial risk protection and distributional consequences into the systematic economic evaluation of vaccine policy, illustrated here with the case study of public finance for rotavirus vaccination. This enables selection of vaccine packages based on the quantitative inclusion of information on equity and on how much financial risk protection is being bought per dollar expenditure on vaccine policy, in addition to how much health is being bought.

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

Academic Pediatrics
Volume 13, Issue 5, September–October 2013,

A Randomized Trial to Increase Acceptance of Childhood Vaccines by Vaccine-Hesitant Parents: A Pilot Study
S. Elizabeth Williams, MDa, Russell L. Rothman, MD, MPPb, Paul A. Offit, MDd, William Schaffner, MDc, Molly Sullivana, Kathryn M. Edwards, MDa
Pages 475–480
http://www.sciencedirect.com/science/article/pii/S1876285913000661
Abstract
Objective
A cluster randomized trial was performed to evaluate an educational intervention to improve parental attitudes and vaccine uptake in vaccine-hesitant parents.
Methods
Two primary care sites were randomized to provide families with either usual care or an intervention (video and written information) for vaccine-hesitant parents. Eligible parents included those presenting for their child’s 2-week well-child visit with performance on the Parent Attitudes about Childhood Vaccines (PACV) survey suggesting vaccine hesitancy (score ≥25). Enrollees completed PACV surveys at the 2-month well-child visit and vaccination status at 12 weeks of age was assessed. The primary outcome was the difference in PACV scores obtained at enrollment and 2 months between the 2 groups. The proportion of on-time vaccination was also compared at 12 weeks.
Results
A total of 454 parents were approached, and 369 (81.3%) participated; 132 had PACV scores of ≥25 and were enrolled, 67 in the control group (mean PACV score 37) and 55 in the intervention group (mean PACV score 40). Two-month PACV surveys were completed by 108 (∼90%) of enrollees. Parents in the intervention group had a significant decrease in PACV score at 2 months compared to control (median difference 6.7, P = .049); this remained significant after adjustment for baseline PACV score, race/ethnicity, and income (P = .044). There was no difference in the on-time receipt of vaccines between groups at 12 weeks.
Conclusions
A brief educational intervention for vaccine-hesitant parents was associated with a modest but significant increase in measured parental attitudes toward vaccines.

A Mixed Methods Study of Parental Vaccine Decision Making and Parent–Provider Trust
Jason M. Glanz, PhDa, Nicole M. Wagner, MPHa, Komal J. Narwaney, PhDa, Jo Ann Shoup, MS, MSWa, David L. McClure, PhDb, Emily V. McCormick, MPHc, Matthew F. Daley, MDa
a Kaiser Permanente Colorado—Institute for Health Research, Denver, Colo
b Marshfield Clinic Research Foundation, Marshfield, Wis
c Denver Public Health Department, Denver, Colo
Pages 481–48
http://www.sciencedirect.com/science/article/pii/S1876285913001563
Abstract
Objective
To describe parental vaccine decision making behaviors and characterize trust in physician advice among parents with varying childhood vaccination behaviors.
Methods
Between 2008 and 2011, a mixed methods study was conducted with parents of children aged <4 years who were members of Kaiser Permanente Colorado health plan. Seven focus groups were conducted with vaccine-hesitant parents. On the basis of findings from the focus groups, a survey was developed, pilot tested, and mailed to a stratified sample of 854 parents who accepted (n = 500), delayed (n = 227), or refused (n = 127) vaccinations for one of their children. Survey results were analyzed by chi-square tests and multivariable logistic regression.
Results
Several themes emerged from the focus groups, including: 1) the vaccine decision-making process begins prenatally, 2) vaccine decision making is an evolving process, and 3) there is overall trust in the pediatrician but a lack of trust in the information they provided about vaccines. The survey response rate was 52% (n = 443). Parents who refused or delayed vaccines were 2 times more likely to report that they began thinking about vaccines before their child was born and 8 times more likely to report that they constantly reevaluate their vaccine decisions than parents who accepted all vaccines. Although parents tended to report trusting their pediatrician’s advice on nutrition, behavior, and the physical examination, they did not believe their pediatrician provided “balanced” information on both the benefits and risks of vaccination.
Conclusions
These results have implications for future interventions to address parental vaccination concerns. Such interventions may be more effective if they are applied early (during pregnancy) and often (pregnancy through infancy), and cover both the risks and benefits of vaccination.

MIT Technology Review
12 September 2013
How Cell Phones Are Transforming Health Care in Africa
Seth Berkley
Mobile communications can help bridge a huge knowledge gap and reimagine healthcare across Africa.

http://www.technologyreview.com/view/519041/how-cell-phones-are-transforming-health-care-in-africa/

Vaccines: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated “29 June 2013″
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– 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.
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– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_7 Sep 2013
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– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links: We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

    GAVI reported that U.S. President Barack Obama and the prime ministers of the Nordic countries “underlined their collective commitment to supporting vaccination through the GAVI Alliance” in a joint statement issued on Wednesday after a high-level meeting in Stockholm. The jstatement noted: “We agree that vaccination through GAVI represents one of the most cost-effective approaches to save children’s lives. …Together, we envision a unified post-2015 agenda that addresses poverty, inclusive growth, and sustainability in clear, ambitious, and measurable goals.” The statement was agreed to at a joint meeting between the Nordic leaders and President Obama who visited Sweden from 4-5 September en route to the Group of 20 economic summit in Russia.

http://www.gavialliance.org/library/news/gavi-features/2013/us-president-and-nordic-leaders-describe-support-for-gavi-as-cost-effective/

[No link to the full statement was indicated in the GAVI announcement or evident in a web search]

The Global Fund said it “strongly welcomed a pledge of US$750 million by Nordic countries, a highly significant contribution to defeating these three infectious diseases.” The announcement was made in Stockholm on 4 September in a joint statement by Sweden, Norway, Finland, Denmark, Iceland and the United States. Collectively, the pledge represents over US$150 million in increased funds from the Nordic countries. The statement specified that the contribution would unlock an additional US$375 million from the U.S., signaling the leverage of every pledge. Dr. Nafsiah Mboi, Chair of the Board of the Global Fund, said, “The vision and foresight of our Nordic partners is a critical piece of seizing this historic moment to defeat HIV, tuberculosis and malaria. This is terrific leadership. We hope others will be inspired by and join these efforts.” Nordic countries have been strong supporters of the Global Fund since its inception in 2002.

http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-09-05_Nordic_Countries_Pledge_USD_750_Million_to_the_Global_Fund/

The International AIDS Vaccine Initiative (IAVI) announced the renewed commitment from the UK’s Department for International Development (DFID), which has confirmed a grant to IAVI of US $1.57 million annually for the next five years. Margaret McGlynn, IAVI President and CEO, said, “We are grateful to the U.K. Government for having been a long standing partner and supporter. The government’s continued trust in and financial support for IAVI will help ensure the development of preventive HIV vaccines that are safe, effective and accessible to all. Vaccines remain among our most effective and efficient tools for combating infectious diseases and can bring particular value to vulnerable populations, including women and children.”

http://www.iavi.org/Information-Center/Press-Releases/Pages/UK-Government-Pledges-Renewed-Funding-to-Support-IAVI-Quest-for-Effective-and-Accessible-AIDS-Vaccines.aspx

PaxVax announced that it has commenced its Phase 3 clinical trial program for its single-dose oral cholera vaccine candidate, PXVX0200 (also known as CVD 103-HgR). Approximately 3,000 participants will be enrolled in this pivotal program, which is comprised of cholera challenge, safety, and immunogenicity studies. PaxVax said that “a cholera vaccine is available in Europe and elsewhere for travelers, but it requires a two-dose regimen, which takes longer to complete. A single-dose, oral vaccine would be more convenient for all travelers to take, particularly for those traveling on short notice.” The pivotal efficacy cholera challenge studies will be randomized, double-blind, placebo-controlled, and conducted at three top vaccine testing centers, including the University of Maryland, the University of Vermont Vaccine Testing Center, and Cincinnati Children’s Hospital Medical Center. Volunteers enrolled in these studies will first be vaccinated and then challenged, or exposed to the cholera-causing agent (Vibrio cholerae bacterium). At 10 days following vaccination, and again at three months post vaccination, participants will be evaluated to determine the protective ability of PXVX0200. All standard clinical trial safety protocols and guidelines will be followed at each clinical research center. Additional trials will also be conducted at sites in Canada, Australia, and the U.S. to confirm vaccine safety in a larger population, measure immunogenicity, and demonstrate lot-to-lot consistency of different vaccine manufacturing batches required by the U.S. Food and Drug Administration (FDA). In recognition of the lack of any available traveler’s vaccine against cholera, and the corresponding unmet medical need, PXVX0200 has been granted Fast Track designation by FDA.

http://www.businesswire.com/news/home/20130906005107/en/PaxVax-Initiates-Phase-3-Clinical-Trial-Challenge

Update: Polio this week – As of 4 September 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s extract and bolded text]
:: The Global Polio Eradication Initiative has conducted a three month assessment of the responses to the Somalia and Kenya polio outbreaks, which concluded that the response was rapid and aggressive, with strong national leadership and international coordination.
:: In both countries, there is a significant risk that the outbreak will extend beyond six months. However, there are indications that the response activities to date are having an impact: fewer cases are being reported in the area considered the ‘engine’ of the outbreak – the Banadir region of Somalia, which includes Mogadishu. Concrete recommendations were made to ensure that the outbreak is stopped rapidly.

Nigeria
:: Two new WPV cases were reported in the past week, bringing the total of WPV1 cases for 2013 to 45. The most recent WPV1 case in the country had onset of paralysis on 14 August (from Borno)…

Pakistan
:: Two new cases of WPV were reported in the past week, both WPV1 from North Waziristan in the Federally Administered Tribal Areas (FATA), with the most recent case having onset of paralysis on 11 August. This brings the total number of WPV1 cases for 2013 to 27.
:: North Waziristan is one of the tribal agencies where a ban is in place against polio vaccination. Measures to prevent spread of the virus from this area include vaccination at transit points. FATA remains the major poliovirus reservoir in Pakistan and in Asia, both due to WPV1 and cVDPV2.

Horn of Africa
:: 32 new WPV1 cases were reported in the past week, in Somalia. The total number of WPV1 cases for 2013 in the Horn of Africa is 174 (160 from Somalia, 13 from Kenya, 1 from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on 7 August (from Somalia).

Israel and West Bank and Gaza
:: WPV1 has been detected in 91 sewage samples from 27 sampling sites in Israel, collected from 3 February to 25 August 2013, indicating widespread transmission throughout the country. :: A sampling site in Tulkarem in the West Bank has reported one positive sample, collected on 30 June. No case of paralytic polio has been reported in either Israel or The West Bank and Gaza.
:: To interrupt WPV1 transmission, a supplementary immunization activity (SIA) with bivalent oral polio vaccine (OPV) targeting children up to the age of nine years is taking place. The activity started on 05 August in southern Israel and was expanded to cover the entire country beginning on 18 August. The objective of the SIA with OPV is to boost intestinal immunity in children vaccinated with Inactivated Polio Vaccine (IPV) only in order to rapidly interrupt WPV transmission.
:: Following the positive sample from Tulkarem, West Bank subsequent samples in the West Bank have all tested negative. Discussions continue on a vaccination response to the positive sample in the West Bank, which uses both OPV and IPV in its routine immunization schedule.

The Weekly Epidemiological Record (WER) for 7 September 2013, vol. 88, 36 (pp. 381–388) includes:
:: Progress towards eliminating onchocerciasis in the WHO Region of the Americas: verification by WHO of elimination of transmission in Colombia
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2013

http://www.who.int/entity/wer/2013/wer8836.pdf

Report: International migration, health and human rights
WHO: Office of the High Commissioner for Human Rights and the International Organization for Migration
2013
Preface

Today, more than 214 million people are living outside their countries of origin. They have left their homes for a variety of reasons, including conflict, natural disasters or environmental degradation, political persecution, poverty, discrimination and lack of access to basic services and the search for new opportunities, particularly in terms of work or education.

One aspect of migration that is attracting renewed attention is the impact that it has on public health. Migrants may be subjected to multiple discrimination, violence and exploitation, all of which often directly affect their physical and mental health. In addition, migrants may have health problems that are not well known or understood in their new countries of residence.

To compound this problem, legal and socioeconomic barriers impede access to health services in many cases; in cases where migrants do have access to health services, these may not be migrant-sensitive or culturally and linguistically appropriate.

Communities receiving large numbers of migrants face new challenges, such as increased diversity of the population and the consequent change in the cultural profile and health perspectives of its patients. This inevitably impacts the day-to-day work of health professionals. Current approaches to managing the health of migrants need to keep pace with the growing challenges associated with the complexity, volume, speed, diversity and disparity of modern migration flows to ensure that all migrants are able to realize their fundamental right to health.

The right of everyone to the enjoyment of the highest attainable standard of physical and mental health has long been established in international human rights law. So, too, have the principles of equality and non-discrimination. It is therefore critical for national health systems and policies to address migrants’ right to health, regardless of the legal status of the migrant. Doing so requires active collaboration across the different sectors and close cooperation between governments and the many non-state actors involved in the migration process.

In this publication, the World Health Organization, the Office of the High Commissioner for Human Rights and the International Organization for Migration explore the multifaceted health and human rights challenges that migrants face and report on recent developments in this area. Our aim in producing this publication is to provide all stakeholders with a reference on key health and human rights issues in the context of international migration…

We hope that it provides inspiration to policymakers to devise migration policies and programmes that are guided by public health considerations and human rights imperatives, with a view to protecting the human rights and improving the health of both migrants and the communities in which they live.

British Medical Bulletin
Volume 107 Issue 1 September 2013
http://bmb.oxfordjournals.org/content/current

Immunization to prevent congenital cytomegalovirus infection
Stuart P. Adler*
+ Author Affiliations
Department of Microbiology, Medical College of Virginia Campus/Virginia Commonwealth University, Richmond, VA, USA
↵*Correspondence address. Department of Microbiology, Medical College of Virginia Campus/Virginia Commonwealth University, PO Box 163, Richmond, VA 23298, USA. E-mail: sadler@vcu.edu
Accepted July 9, 2013.
http://bmb.oxfordjournals.org/content/107/1/57.abstract

Abstract
Introduction  A primary maternal cytomegalovirus (CMV) during pregnancy causes newborn disease that includes hearing deficit and/or mental retardation.

Sources of data  Relevant published literature.

Areas of agreement  There are no biologic obstacles to immunization against fetal/placental infection with CMV.

Areas of uncertainty  CMV vaccine trials may be difficult due to a lack of public awareness of CMV. Vaccine trials that use fetal infection as an endpoint will be prolonged, since vaccination will need to occur preconception.

Areas timely for developing research  Vaccines in preclinical development include antigens of the CMV gB glycoprotein and the gH/gL UL128, 130 and 131 pentameric complex. These antigens induce antibodies that block viral entry into fibroblasts and endothelial/epithelial cells. Vaccines immunogenic in animals include an inactivated virus with a wild-type UL131 gene, a DNA vaccine using a wild-type UL130 gene and peptide vaccines using peptides from UL130 and 131.

Conclusions  In spite of these potential obstacles, successful evaluation of CMV vaccines is possible.

Globalization and Health
[Accessed 7 September 2013]
http://www.globalizationandhealth.com/

Debate
Canada and access to medicines in developing countries: intellectual property rights first
Lexchin J Globalization and Health 2013, 9:42 (3 September 2013)

Abstract (provisional)
Canadian reports have recommended that health as a human right must be Canada’s overarching global commitment and that the primacy of human rights should be prioritized over other elements of international law including international trade and investment law as it applies to access to pharmaceuticals. This paper uses a series of case reports to examine Canada’s commitment to this goal. Specifically it examines cases where improved access has been in conflict with increased intellectual property rights. The 6 cases are: Canada’s position when 39 pharmaceutical companies took South Africa to court in 1998 over its legislation to allow parallel importation of patented medicines and to regulate the price of medications; the stance that Canada took in the negotiations around the Doha Declaration in 2001; the passage of Canada’s Access to Medicines Regime in 2004 and subsequent attempts to amend the legislation in 2011 and 2012; Canada’s involvement in the final declaration at the United Nations High-Level meeting on non-communicable diseases in 2012; Canada’s views about the terms in the Anti-Counterfeiting Trade Agreement as expressed in 2009; and Canada’s 2013 position on the extension of the exemption for least developed countries from having to comply with the terms of the Trade Related Aspects of Intellectual Property Rights Agreement. In the first case Canada was neutral but in the remaining 5 cases Canada prioritized intellectual property rights over access. This position is consistent with how Canada has acted around domestic issues involving intellectual property rights for pharmaceutical products. Canada has supported strengthened rights despite the fact that their touted benefits have not been realized either domestically or in developing countries. As a result Canada has failed in its humanitarian duty to protect the human right to health in the form of safe and low cost medicines for the people in developing countries.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
September 2013  Volume 9, Issue 9
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/8/

Commentary
Making vaccines “on demand”: A potential solution for emerging pathogens and biodefense?
Anne S De Groot, Leo Einck, Leonard Moise, Michael Chambers, John Ballantyne, Robert W Malone, Matthew Ardito and William Martin  Pages 1877 – 1884 http://dx.doi.org/10.4161/hv.25611

Abstract
The integrated US Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) has made great strides in strategic preparedness and response capabilities. There have been numerous advances in planning, biothreat countermeasure development, licensure, manufacturing, stockpiling and deployment. Increased biodefense surveillance capability has dramatically improved, while new tools and increased awareness have fostered rapid identification of new potential public health pathogens. Unfortunately, structural delays in vaccine design, development, manufacture, clinical testing and licensure processes remain significant obstacles to an effective national biodefense rapid response capability. This is particularly true for the very real threat of “novel pathogens” such as the avian-origin influenzas H7N9 and H5N1, and new coronaviruses such as hCoV-EMC. Conventional approaches to vaccine development, production, clinical testing and licensure are incompatible with the prompt deployment needed for an effective public health response. An alternative approach, proposed here, is to apply computational vaccine design tools and rapid production technologies that now make it possible to engineer vaccines for novel emerging pathogen and WMD biowarfare agent countermeasures in record time. These new tools have the potential to significantly reduce the time needed to design string-of-epitope vaccines for previously unknown pathogens. The design process—from genome to gene sequence, ready to insert in a DNA plasmid—can now be accomplished in less than 24 h. While these vaccines are by no means “standard,” the need for innovation in the vaccine design and production process is great. Should such vaccines be developed, their 60-d start-to-finish timeline would represent a 2-fold faster response than the current standard.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
September 2013  Volume 9, Issue 9
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/8/

Product Review
Hexavalent IPV-based combination vaccines for public-sector markets of low-resource countries
Kutub Mahmood, Sonia Pelkowski, Deborah Atherly, Robert Sitrin and John J. Donnelly  Pages 1894 – 1902 http://dx.doi.org/10.4161/hv.25407

Abstract
In anticipation of the successful eradication of wild polio virus, alternative vaccination strategies for public-sector markets of low-resource countries are extremely important, but are still under development. Following polio eradication, inactivated polio vaccine (IPV) would be the only polio vaccine available, and would be needed for early childhood immunization for several years, as maintenance of herd immunity will be important for sustaining polio eradication. Low-cost combination vaccines containing IPV could provide reliable and continuous immunization in the post-polio eradication period. Combination vaccines can potentially simplify complex pediatric routine immunization schedules, improve compliance, and reduce costs. Hexavalent vaccines containing Diphtheria (D), Tetanus (T), whole cell pertussis (wP), Hepatitis B (HBV), Haemophilus b (Hib) and the three IPV serotype antigens have been considered as the ultimate combination vaccine for routine immunization. This product review evaluates potential hexavalent vaccine candidates by composition, probable time to market, expected cost of goods, presentation, and technical feasibility and offers suggestions for development of low-cost hexavalent combination vaccines. Because there are significant technical challenges facing wP-based hexavalent vaccine development, this review also discusses other alternative approaches to hexavalent that could also ensure a timely and reliable supply of low-cost IPV based combination vaccines.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
September 2013  Volume 9, Issue 9
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/8/

Research Paper
Knowledge and attitudes of postpartum women toward immunization during pregnancy and the peripartum period
Elizabeth Rossmann Beel, Marcia A. Rench, Diana P. Montesinos, Betsy Mayes and C. Mary Healy  Pages 1926 – 1931 http://dx.doi.org/10.4161/hv.25096

Abstract
Influenza and pertussis prevention in young infants requires immunizing pregnant women and all caregivers (cocooning). We evaluated the knowledge and attitude of postpartum women about these two recommendations. A survey of predominantly Hispanic, underinsured, medically underserved postpartum women in Houston, Texas was performed during June 2010 through July 2012. 511 postpartum women [mean age 28.8 y (18–45); 94% Hispanic] with a mean of 3 children (1–12) participated. Ninety-one (17.8%) were first-time mothers. Four hundred ninety-six (97.1%) received prenatal care; care was delayed in 24.3%. Only 313 (61.3%) received vaccine education while pregnant, and 291 (57%) were immunized. Four hundred seventy-four women (93%) were willing to be immunized during pregnancy if recommended by their healthcare provider, (the most trusted information source for 62%). Immunization of infants or infant caregivers had been discussed with 41% and 10% of mothers, respectively. 230 women (45%) had received influenza vaccine; most intended to (79%) or had already received (15%) tetanus, diphtheria, and acellular pertussis (Tdap) vaccine. Preferred locations for cocooning were hospital or community clinics (97%). Insufficient knowledge (46.6%), cost (31.4%), lack of transportation (26%), work commitments (13.3%), and fear of needles (13.3%) were perceived barriers to cocooning. Level of formal education received by mothers had no effect on the quantity or quality of immunization education received during PNC or their attitude toward immunization. Immunization during pregnancy and cocooning, if recommended by providers, are acceptable in this high-risk population. Healthcare providers, as reported in infant studies, have the greatest influence on vaccine acceptance by pregnant and postpartum women.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
September 2013  Volume 9, Issue 9
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/8/

Review
Economic evaluation of Varicella vaccination: results of a systematic review
Brigid Unim, Rosella Saulle, Sara Boccalini, Cristina Taddei, Vega Ceccherini, Antonio Boccia, Paolo Bonanni and Giuseppe La Torre  Pages 1932 – 1942 http://dx.doi.org/10.4161/hv.25228

Abstract
Introduction
The aim of the present study is to review the economic burden of varicella disease and the benefit of universal varicella vaccination in different settings pending its implementation in all Italian regions.

Materials and Methods
Research was conducted using PubMed, Scopus and ISI databases. Score quality and data extraction were performed for all included studies.

Results
Twenty-three articles met the criteria: 15 cost-effectiveness, 8 cost-benefit and one cost-utility analysis. Varicella vaccination could save the society from €637,762 (infant strategy) to 53 million annually (combined infant and adolescent strategy). The median and the mean quality scores resulted in 91.8% and 85.4% respectively; 11 studies were considered of high quality and 12 of low quality.

Discussion
The studies are favorable to the introduction of universal varicella vaccination in Italy, being cost saving and having a positive impact on morbidity. The quality score of the studies varied greatly: recent analyses were of comparable quality to older studies.

JAMA   
September 4, 2013, Vol 310, No. 9
http://jama.jamanetwork.com/issue.aspx

Viewpoint | September 4, 2013
Poverty, Health, and Societies of the Future
Jim Yong Kim, MD, PhD1; Margaret Chan, MD2
[+] Author Affiliations
JAMA. 2013;310(9):901-902. doi:10.1001/jama.2013.276910
http://jama.jamanetwork.com/article.aspx?articleid=1734712

Initial content per JAMA convention
The relationship between clinician and patient has been the bedrock of the global health equity movement. It was the call for access to basic medical services for patients—and patients demanding empowerment for their community health workers—that drove the Health for All movement in the 1970s. It was the insistence by patients, activists, and clinicians for all people with AIDS to receive treatment that led to the transformation in access starting just 10 years ago in the developing world. That insistence will continue to be the energy and lifeblood of the movement—patients claiming their rights, and physicians supporting their patients—together advocating for a world in which a child born anywhere can have a life of opportunity, dignity, and access to quality health care…

JAMA   
September 4, 2013, Vol 310, No. 9
http://jama.jamanetwork.com/issue.aspx

Viewpoint | September 4, 2013
Conflict and Polio – Winning the Polio Wars
Zulfiqar A. Bhutta, MB, BS, FRCP, FRCPCH, PhD1,2
[+] Author Affiliations
JAMA. 2013;310(9):905-906. doi:10.1001/jama.2013.276583.
http://jama.jamanetwork.com/article.aspx?articleid=1734711

Initial content per JAMA convention
The global polio eradication initiative is at a critical crossroads. Some 25 years ago, the World Health Organization (WHO), supported by Rotary International, launched a global goal of eradicating polio from the world by 2000.1 Although the eradication target may not have been achieved, there has been remarkable progress. From more than 350 000 cases of poliomyelitis globally spread over 125 countries with endemic disease in 1990, a mere 223 cases were reported in 2012, with the disease largely restricted to a few regions of Nigeria, Pakistan, and Afghanistan. These hotspots of polio, with a total population exceeding 380 million, include geographic diversity, conflict, and population displacement. Although all 3 countries have made tremendous strides in controlling endemic disease affecting thousands of children annually, they face many residual pockets of polio and widespread virus circulation….

Viewpoint | September 4, 2013

JAMA   
September 4, 2013, Vol 310, No. 9
http://jama.jamanetwork.com/issue.aspx

Viewpoint | September 4, 2013
Industry-Sponsored Clinical Trials in Emerging MarketsTime to Review the Terms of Engagement
Stephen MacMahon, DSc, FMedSci1,2,3; Vlado Perkovic, MBBS, PhD1,3; Anushka Patel, MBBS, PhD1,3
[+] Author Affiliations
JAMA. 2013;310(9):907-908. doi:10.1001/jama.2013.276913.
http://jama.jamanetwork.com/article.aspx?articleid=1734713

Initial content per JAMA convention
A decade ago, clinical trial sponsors routinely excluded low- and middle-income countries such as India and China from participation. These regions contribute large numbers of patients to pivotal trials across a range of clinical conditions. For example, in China the number of pharmaceutical company–sponsored trials doubled between 2005 and 2010. Today, more than 3000 trials are under way in China, a large proportion of which are sponsored by global pharmaceutical companies.1 The key drivers for this change include reduced costs due to lower investigator fees and staff salaries and larger patient numbers, given the greater population sizes and disease burdens. Additionally, enhanced access to treatment-naive participants is thought to be an advantage in certain circumstances. Moreover, the belated acceptance that the emerging markets will soon be the largest global market for pharmaceutical sales is also driving the shift in focus. However, the rapid expansion of clinical trial activity in emerging markets has raised concerns, including questions about the quality of data generated and the relevance of the products being tested to local health care priorities…

JAMA   
September 4, 2013, Vol 310, No. 9
http://jama.jamanetwork.com/issue.aspx

Editorial | September 4, 2013
Optimizing the Use of Pneumococcal Conjugate Vaccine Globally
Katherine L. O’Brien, MD, MPH1
[+] Author Affiliations
JAMA. 2013;310(9):911-913. doi:10.1001/jama.2013.228062.

Initial content per JAMA convention
Pneumococcal conjugate vaccine (PCV) was first licensed in 2000 as a 7-valent product and is now available as 10- and 13-valent products (PCV10 and PCV13). As recommended by the World Health Organization,1 PCVs are now in routine use in more than 95 of 194 countries globally, including use in 27 GAVI Alliance–eligible countries and approval for use in an additional 24 such countries.2 Financial investments by individual countries and the international community, through the GAVI Alliance, are ensuring the sustainable availability of PCV in the places where it is most needed—the poorest countries where children have a substantial risk of serious illness and death from pneumococcal disease. In 2008, more than 500 000 children under 5 years died from pneumococcal disease.3 This mortality and the larger burden of serious morbidity, mostly from pneumococcal pneumonia,4 is the focus of PCV programs.

JAMA   
September 4, 2013, Vol 310, No. 9
http://jama.jamanetwork.com/issue.aspx

Immunogenicity of 13-Valent Pneumococcal Conjugate Vaccine Administered According to 4 Different Primary Immunization Schedules in Infants: A Randomized Clinical Trial
Judith Spijkerman, MD1,2; Reinier H. Veenhoven, MD, PhD2; Alienke J. Wijmenga-Monsuur, PhD3; Karin E. M. Elberse, PhD3; Pieter G. M. van Gageldonk, BASc3; Mirjam J. Knol, PhD3; Hester E. de Melker, PhD3; Elisabeth A. M. Sanders, MD, PhD1; Leo M. Schouls, PhD3; Guy A. M. Berbers, PhD3
[+] Author Affiliations
JAMA. 2013;310(9):930-937. doi:10.1001/jama.2013.228052.
http://jama.jamanetwork.com/article.aspx?articleid=1734703

ABSTRACT
Importance   Immunization schedules with pneumococcal conjugate vaccine (PCV) differ among countries regarding the number of doses, age at vaccinations, and interval between doses.

Objective   To assess the optimal primary vaccination schedule by comparing immunogenicity of 13-valent PCV (PCV13) in 4 different immunization schedules.

Design, Setting, and Participants   An open-label, parallel-group, randomized clinical trial of healthy term infants in a general community in the Netherlands conducted between June 30, 2010, and January 25, 2011, with 99% follow-up until age 12 months.

Interventions   Infants (N = 400) were randomly assigned (1:1:1:1) to receive PCV13 either at ages 2, 4, and 6 months (2-4-6); at ages 3 and 5 months (3-5); at ages 2, 3, and 4 months (2-3-4); or at ages 2 and 4 months (2-4), with a booster dose at age 11.5 months.

Main Outcomes and Measures   Primary outcome measure was antibody geometric mean concentrations (GMCs) against PCV13-included serotypes 1 month after the booster dose measured by multiplex immunoassay. Secondary outcomes included GMCs measured 1 month after the primary series, at 8 months of age, and before the booster.

Results   The primary outcome, GMCs at 1 month after the booster dose, was not significantly different between schedules for 70 of 78 comparisons. The 2-4-6 schedule was superior to the 2-3-4 schedule for serotypes 18C (10.2 µg/mL [95% CI, 8.2-12.7] vs 6.5 µg/mL [95% CI, 5.4-7.8]) and 23F (10.9 µg/mL [95% CI, 9.0-13.3] vs 7.3 µg/mL [95% CI, 5.8-9.2]) and superior to the 2-4 schedule for serotypes 6B (8.5 µg/mL [95% CI, 7.1-10.2] vs 5.1 µg/mL [95% CI 3.8-6.7]), 18C (6.6 µg/mL [95% CI, 5.7-7.7]), and 23F (7.2 µg/mL [95% CI, 5.9-8.8]). For serotype 1, the 3-5 schedule (11.7 µg/mL [95% CI, 9.6-14.3]) was superior to the other schedules. Geometric mean concentrations for all 13 serotypes ranged between 1.6 and 19.9 µg/mL. Secondary outcomes demonstrated differences 1 month after the primary series. The 2-4-6 schedule was superior compared with the 3-5, 2-3-4, and 2-4 schedules for 3, 9, and 11 serotypes, respectively. Differences between schedules persisted until the booster dose.

Conclusions and Relevance   The use of 4 different PCV13 immunization schedules in healthy term infants resulted in no statistically significant differences in antibody levels after the booster dose for almost all serotypes. The choice of PCV schedule will require a balance between the need for early protection and maintaining protection between the primary series and the booster.

Trial Registration   trialregister.nl Identifier: NTR2316

JAMA   
September 4, 2013, Vol 310, No. 9
http://jama.jamanetwork.com/issue.aspx

Research Letter | September 4, 2013
Thirty-Year Outcomes of the National Hepatitis B Immunization Program in Taiwan
Chun-Ju Chiang, PhD1; Ya-Wen Yang, MSc2; San-Lin You, PhD3; Mei-Shu Lai, MD, PhD1; Chien-Jen Chen, ScD3
[+] Author Affiliations
JAMA. 2013;310(9):974-976. doi:10.1001/jama.2013.276701.
http://jama.jamanetwork.com/article.aspx?articleid=1734688

Initial content per JAMA convention
Hepatitis B virus (HBV) infection causes infant fulminant hepatitis (IFH), and chronic HBV infection may progress to chronic liver disease (CLD) and hepatocellular carcinoma (HCC). Taiwan launched a nationwide HBV immunization program for newborns in July 1984,1 which has successfully lowered the prevalence of chronic HBV carriers, incidence of HCC, and mortality of IFH in vaccinated birth cohorts.2- 4 The mortality of CLD before and after HBV immunization has never been examined. We assessed the 30-year outcomes of the immunization program…

Journal of Community Health
Volume 38, Issue 5, October 2013
http://link.springer.com/journal/10900/38/5/page/1

Eradication of Hepatitis B: A Nationwide Community Coalition Approach to Improving Vaccination, Screening, and Linkage to Care
Chari Cohen, Jeffrey Caballero, Melinda Martin… Pages 799-804

Original Papers
English Proficiency, Knowledge, and Receipt of HPV Vaccine in Vietnamese-American Women
Jenny K. Yi, Karen O. Anderson, Yen-Chi Le…

Human Papillomavirus-Mediated Cervical Cancer Awareness and Gardasil Vaccination: A Pilot Survey Among North Indian Women
Samya Pandey, Chandravati

Nature Medicine
September 2013, Volume 19 No 9 pp1073-1189
http://www.nature.com/nm/journal/v19/n9/index.html

Editorial
Privacy and protection in the genomic era – p1073
doi:10.1038/nm.3342
http://www.nature.com/nm/journal/v19/n9/abs/nm.3342.html

The establishment of an NIH working group managing access to HeLa cell genomic data highlights the limitations of assuring the privacy of participants in genomics studies. If, as this case illustrates, anonymity cannot be guaranteed, informed consent rules may need to be revised.

New England Journal of Medicine
September 5, 2013  Vol. 369 No. 10
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Risks (and Benefits) in Comparative Effectiveness Research Trials
Chris Feudtner, M.D., Ph.D., M.P.H., Mark Schreiner, M.D., and John D. Lantos, M.D.
N Engl J Med 2013; 369:892-894September 5, 2013DOI: 10.1056/NEJMp1309322
http://www.nejm.org/doi/full/10.1056/NEJMp1309322

To provide ethically appropriate oversight and informed consent for randomized, controlled comparative effectiveness research trials, investigators should consider, manage, and inform potential participants about at least nine different types of potential risk.

New England Journal of Medicine
September 5, 2013  Vol. 369 No. 10
http://www.nejm.org/toc/nejm/medical-journal

Perspective
Big Pharma and Social Responsibility — The Access to Medicine Index
Hans V. Hogerzeil, M.D., Ph.D.
N Engl J Med 2013; 369:896-899September 5, 2013DOI: 10.1056/NEJMp1303723
http://www.nejm.org/doi/full/10.1056/NEJMp1303723

The Access to Medicine Index, an independent initiative, ranks the world’s 20 largest research-based pharmaceutical companies according to their efforts to make their products more available, affordable, and accessible in developing countries.

PLoS One
[Accessed 7 September 2013]
http://www.plosone.org/

Research Article
Cost-Effectiveness Analysis of Tdap in the Prevention of Pertussis in the Elderly
Lisa J. McGarry mail, Girishanthy Krishnarajah, Gregory Hill, Michelle Skornicki, Narin Pruttivarasin, Cristina Masseria, Bhakti Arondekar, Stephen I. Pelton, Milton C. Weinstein

Abstract
Objectives
Health benefits and costs of combined reduced-antigen-content tetanus, diphtheria, and pertussis (Tdap) immunization among adults ≥65 years have not been evaluated. In February 2012, the Advisory Committee on Immunization Practices (ACIP) recommended expanding Tdap vaccination (one single dose) to include adults ≥65 years not previously vaccinated with Tdap. Our study estimated the health and economic outcomes of one-time replacement of the decennial tetanus and diphtheria (Td) booster with Tdap in the 10% of individuals aged 65 years assumed eligible each year compared with a baseline scenario of continued Td vaccination.

Methods
We constructed a model evaluating the cost-effectiveness of vaccinating a cohort of adults aged 65 with Tdap, by calculating pertussis cases averted due to direct vaccine effects only. Results are presented from societal and payer perspectives for a range of pertussis incidences (25–200 cases per 100,000), due to the uncertainty in estimating true annual incidence. Cases averted were accrued throughout the patient ‘s lifetime, and a probability tree used to estimate the clinical outcomes and costs (US$ 2010) for each case. Quality-adjusted life-years (QALYs) lost to acute disease were calculated by multiplying cases of mild/moderate/severe pertussis by the associated health-state disutility; QALY losses due to death and long-term sequelae were also considered. Incremental costs and QALYs were summed over the cohort to derive incremental cost-effectiveness ratios. Scenario analyses evaluated the effect of alternative plausible parameter estimates on results.

Results
At incidence levels of 25, 100, 200 cases/100,000, vaccinating adults aged 65 years costs an additional $336,000, $63,000 and $17,000/QALY gained, respectively. Vaccination has a cost-effectiveness ratio less than $50,000/QALY if pertussis incidence is >116 cases/100,000 from societal and payer perspectives. Results were robust to scenario analyses.

Vaccine
Volume 31, Issue 41, Pages 4465-4688 (23 September 2013)
http://www.sciencedirect.com/science/journal/0264410X
EPIVAC International Conference on Financial Sustainability of Immunization Programs in sub-Saharan Africa, February 16–18, 2012, Ouidah, Benin
Pages 4470-4476
Marcel Drach, Jean-Bernard Le Gargasson, Jacky Mathonnat, Alfred Da Silva, Miloud Kaddar, Anaïs Colombini

Abstract
The introduction of new vaccines with much higher prices than traditional vaccines results in increasing budgetary pressure on immunization programs in GAVI-eligible countries, increasing the need to ensure their financial sustainability. In this context, the third EPIVAC (Epidemiology and Vaccinology) technical conference was held from February 16 to 18, 2012 at the Regional Institute of Public Health in Ouidah, Benin. Managers of ministries of health and finance from 11 West African countries (GAVI eligible countries), as well as former EPIVAC students and European experts, shared their knowledge and best practices on immunization financing at district and country level.

The conference concluded by stressing five major priorities for the financial sustainability of national immunization programs (NIPs) in GAVI-eligible countries.
– Strengthen public financing by increasing resources and fiscal space, improving budget processes, increasing contribution of local governments and strengthen efficiency of budget spending.
– Promote equitable community financing which was recognized as a significant and essential contribution to the continuity of EPI operations.
– Widen private funding by exploring prospects offered by sponsorship through foundations dedicated to immunization and by corporate social responsibility programs.
– Contain the potential crowding-out effect of GAVI co-financing and ensure that decisions on new vaccine introductions are evidence-based.
– Seek out innovative financing mechanisms such as taxes on food products or a national solidarity fund.

Vaccine
Volume 31, Issue 41, Pages 4465-4688 (23 September 2013)
http://www.sciencedirect.com/science/journal/0264410X

Effectiveness of meningococcal serogroup C vaccine programmes
Review Article
Pages 4477-4486
Ray Borrow, Raquel Abad, Caroline Trotter, Fiona R.M. van der Klis, Julio A. Vazquez

Abstract
Since the introduction of monovalent meningococcal serogroup C (MenC) glycoconjugate (MCC) vaccines and the implementation of national vaccination programmes, the incidence of MenC disease has declined markedly as a result of effective short-term vaccination and reduction in acquisition of MenC carriage leading to herd protection. Monovalent and quadrivalent conjugate vaccines are commonly used vaccines to provide protection against MenC disease worldwide. Studies have demonstrated that MCC vaccination confers protection in infancy (0–12 months) from the first dose but this is only short-term. NeisVac-C has the greatest longevity of the currently licensed MCC vaccines in terms of antibody persistence, however antibody levels have been found to fall rapidly after early infant vaccination with two doses of all MCC vaccines – necessitating a booster at ∼12 months. In toddlers, only one dose of the MCC vaccine is required for routine immunization. If herd protection wanes following catch-up campaigns, many children may become vulnerable to infection. This has led many to question whether an adolescent booster is also required.

Vaccine
Volume 31, Issue 41, Pages 4465-4688 (23 September 2013)
http://www.sciencedirect.com/science/journal/0264410X

Trends and disparity in zoster vaccine uptake in a managed care population
Original Research Article
Pages 4564-4568
Rulin C. Hechter, Sara Y. Tartof, Steven J. Jacobsen, Ning Smith, Hung Fu Tseng

Abstract
Objectives
Zoster vaccine is recommended for prevention of herpes zoster among adults aged 60 years and older. We examined the zoster vaccination rates during 2007–2011 and assessed association with age, sex, race/ethnicity, neighborhood income and education attainment in eligible adults at Kaiser Permanente Southern California, a managed care organization in the US.

Methods
We calculated annual zoster vaccination rate among members ≥60 years without documented contraindications. Multivariable logistic regression was performed to examine factors associated with zoster vaccine uptake in an open cohort of 819,466 adults.

Results
The zoster vaccination rates increased annually in all groups and the overall rate reached 21.7% in 2011 (P-trend < 0.001). Coverage was highest among individuals aged 65–74 years, who were female and non-Hispanic White. In the adjusted analysis, odds of vaccination decreased by age. Females (odds ratio [OR]=1.19, 95% confidence interval [CI]=1.17–1.20) and those who lived in neighborhoods with higher education attainment were more likely to be vaccinated (>75% vs. <50% adults with some college education: OR=1.76, 95% CI=1.73–1.80). Compared to Whites, non-Hispanic Blacks and Hispanics were less likely to receive the vaccine (non-Hispanic Blacks: OR=0.56, 95% CI=0.55–0.58; Hispanics: OR=0.59, 95% CI=0.58–0.60).

Conclusion
The zoster vaccine coverage is higher in this insured population than previously reported in the US general population, but it remains low. Significant racial/ethnic disparity was observed and worsened even among individuals with relatively equal access to zoster vaccination.

Vaccine
Volume 31, Issue 41, Pages 4465-4688 (23 September 2013)
http://www.sciencedirect.com/science/journal/0264410X

Association of vaccine-related attitudes and beliefs between parents and health care providers
Original Research Article
Pages 4591-4595
Michelle J. Mergler, Saad B. Omer, William K.Y. Pan, Ann Marie Navar-Boggan, Walter Orenstein, Edgar K. Marcuse, James Taylor, M. Patricia deHart, Terrell C. Carter, Anthony Damico, Neal Halsey, Daniel A. Salmon

Abstract
Objectives
Health care providers influence parental vaccination decisions. Over 90% of parents report receiving vaccine information from their child’s health care provider. The majority of parents of vaccinated children and children exempt from school immunization requirements report their child’s primary provider is a good source for vaccine information. The role of health care providers in influencing parents who refuse vaccines has not been fully explored. The objective of the study was to determine the association between vaccine-related attitudes and beliefs of health care providers and parents.

Methods
We surveyed parents and primary care providers of vaccinated and unvaccinated school age children in four states in 2002–2003 and 2005. We measured key immunization beliefs including perceived risks and benefits of vaccination. Odds ratios for associations between parental and provider responses were calculated using logistic regression.

Results
Surveys were completed by 1367 parents (56.1% response rate) and 551 providers (84.3% response rate). Parents with high confidence in vaccine safety were more likely to have providers with similar beliefs, however viewpoints regarding disease susceptibility and severity and vaccine efficacy were not associated. Parents whose providers believed that children get more immunizations than are good for them had 4.6 higher odds of holding that same belief compared to parents whose providers did not have that belief.

Conclusions
The beliefs of children’s health care providers and parents, including those regarding vaccine safety, are similar. Provider beliefs may contribute to parental decisions to accept, delay or forgo vaccinations. Parents may selectively choose providers who have similar beliefs to their own.

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

 
Optimal Two-Phase Vaccine Allocation to Geographically Different Regions under Uncertainty
H Yarmand, JS Ivy, B Denton, AL Lloyd – European Journal of Operational Research, 2013
Abstract In this article, we consider a decision process in which vaccination is performed in
two phases to contain the outbreak of an infectious disease in a set of geographic regions. In
the first phase, a limited number of vaccine doses are allocated to each region; in the …

[HTML] A Qualitative Analysis of Factors Influencing HPV Vaccine Uptake in Soweto, South Africa among Adolescents and Their Caregivers
IT Katz, B Nkala, J Dietrich, M Wallace, LG Bekker… – PLOS ONE, 2013
Background In South Africa, the prevalence of oncogenic Human Papillomavirus (HPV) may
be as high as 64%, and cervical cancer is the leading cause of cancer-related death among
women. The development of efficacious prophylactic vaccines has provided an …

Risk Factors for Transmission of Mumps in a Highly Vaccinated Population in Orange County, New York, 2009-2010
PK Kutty, HQ McLean, J Lawler, C Schulte, JM Hudson… – The Pediatric Infectious …, 2013
… In 2009-2010, we investigated a mumps outbreak among a highly vaccinated Orthodox Jewish population in a village in Orange County (OC), New York, to identify risk factors associated with mumps transmission among persons with two doses of mumps-containing vaccine. …

Which Newborns Missed the Hepatitis B Birth Dose Vaccination among US Children?
Z Zhao, TV Murphy – Preventive medicine, 2013
… Chldren who reside in states without a universal hepatitis B vaccine supply policy, are
not covered by health insurance, and have only 1 vaccination provider are significantly
associated with non-receipt of the birth dose hepatitis B vaccination. …

Achieving high and equitable coverage of adolescent HPV vaccine in Scotland
K Sinka, K Kavanagh, R Gordon, J Love, A Potts… – Journal of epidemiology and …, 2013
Abstract Background and methods The national immunisation records of over 220 000 girls
offered vaccine in the routine or catch-up programme of the Human papillomavirus (HPV)
programme in Scotland were analysed. Descriptive statistics and multilevel modelling …

Human papillomavirus (HPV) vaccine uptake: Does HPV vaccine legislation work?
J Lin – 141st APHA Annual Meeting (November 2-November 6 …, 2013
Background Prophylactic vaccination against HPV is undoubtedly beneficial to the public’s
health, as it can largely reduce the incidence of HPV-associated cancers in the population,
yet general awareness of both the disease and vaccine remain low. Currently, 23 states …

[PDF] Communication Strategy of Importance of Vaccination using Social Media and Public Relations
N Nurlaela, H Hudrasyah – The Indonesian Journal of Business Administration, 2013

– 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.
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– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_31 August 2013
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– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links: We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
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– Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

Update: Polio this week – As of 28 August 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]

:: The outbreak of wild poliovirus type 1 (WPV1) in the Horn of Africa, which affects Somalia, Kenya and Ethiopia, has spread into two new states of Somalia.
:: In Israel, the number of sewage samples which have tested positive for WPV1 has reached 85; one sewage sample collected in West Bank and Gaza has tested positive for WPV1.

Pakistan
:: One new case of WPV was reported in the past week, a WPV1 from FR Bannu in the Federally Administered Tribal Areas, with onset of paralysis on 27 July. This is the most recent case in the country and brings the total number of WPV1 cases for 2013 to 25.
:: The total number of cVDPV2 cases for 2013 remains 12.

Chad, Cameroon and Central African Republic
:: In Cameroon, one new cVDPV2 case was reported in the past week, bringing the total number of cVDPV2 cases for 2013 to three. This new case had onset of paralysis on 19 July (from Extreme-Nord).
:: 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, two subnational immunization campaigns were conducted in June and July. A SNID is planned for September and a NID for October.

Horn of Africa
:: 20 new WPV1 cases were reported in the past week in Somalia and one in Kenya. The total number of WPV1 cases for 2013 is 142 (128 from Somalia, 13 from Kenya, 1 from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on 30 July (from Somalia).
:: The outbreak is spreading geographically in Somalia, with two new states reporting cases: Galgadud and Gedo. Anticipation of this spread has driven intense vaccination activities across the country, in an effort to raise immunity.

Israel and West Bank and Gaza
:: WPV1 has been detected in 85 sewage samples from 27 sampling sites in Israel, collected from 3 February to 18 August 2013. Initially restricted to southern Israel, WPV1 has now also been detected in environmental sampling sites elsewhere in Israel, indicating transmission throughout the country. A sampling site in Tulkarem in the West Bank has also reported a positive sample, collected on 30 June. No case of paralytic polio has been reported in either Israel or the West Bank and Gaza.
:: To interrupt WPV1 transmission, a supplementary immunization activity (SIA) with bivalent oral polio vaccine (OPV) targeting children up to the age of nine years was initiated in the southern district of Israel during the week of 5 August; since August 18, the SIA was expanded to all of Israel. The objective of the SIA with OPV is to boost intestinal immunity in children vaccinated with IPV only in order to rapidly interrupt wild poliovirus transmission.
:: Following the positive sample from Tulkarem, subsequent samples in the West Bank and Gaza have all tested negative. Discussions have begun for a vaccination response to the positive sample in the West Bank.

West Africa
:: One new cVDPV2 was reported in the past week from Niger’s Diffa province, with onset of paralysis on 11 July. Niger has not reported a case of cVDPV since 2011. Genetic sequencing has shown that the virus is related to those seen in Cameroon, Chad and (Borno) Nigeria.

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

Disease outbreak news
Middle East respiratory syndrome coronavirus (MERS-CoV) – update
   30 August 2013 – WHO has been informed of an additional four laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Saudi Arabia.

The first patient is a 55-year-old man with an underlying medical condition from Medina who became ill on 17 August 2013 and is currently hospitalised.

The second patient is a 38-year-old man with an underlying medical condition from Hafar al-Batin who became ill on 8 August 2013 and died on 17 August 2013.

The third and the fourth cases are family contacts of the second patient. Both the cases, a 16-year-old boy and a seven year-old girl, tested positive for the MERS-CoV virus. They are both healthy and do not have any symptoms of illness.

Globally, from September 2012 to date, WHO has been informed of a total of 108 laboratory-confirmed cases of infection with MERS-CoV, including 50 deaths.

Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.

Health care providers are advised to maintain vigilance. Recent travellers returning from the Middle East who develop SARI should be tested for MERS-CoV as advised in the current surveillance recommendations…

The Weekly Epidemiological Record (WER) for 30 August 2013, vol. 88, 35 (pp. 365–380) includes:
:: Global leprosy: update on the 2012 situation
:: Monthly report on dracunculiasis cases, January–June 2013

http://www.who.int/entity/wer/2013/wer8835.pdf

CDC/MMWR Watch [to 31 August 2013]

August 30, 2013 / Vol. 62 / No. 34
National and State Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2012
Excerpt
At ages 11 through 12 years, the Advisory Committee on Immunization Practices (ACIP) recommends that preteens receive 1 dose of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, 1 dose of meningococcal conjugate (MenACWY) vaccine,* and 3 doses of human papillomavirus (HPV) vaccine (1–3). ACIP recommends administration of all age-appropriate vaccines during a single visit (4). ACIP also recommends that pre-teens and older adolescents receive an annual influenza vaccine as well as any overdue vaccines (e.g., varicella) (1). To monitor vaccination coverage among persons aged 13–17 years,† CDC analyzed data from the National Immunization Survey–Teen (NIS-Teen). This report highlights findings of that analysis.

From 2011 to 2012, coverage increased for ≥1 Tdap vaccine dose§ (from 78.2% to 84.6%), ≥1 MenACWY vaccine dose (from 70.5% to 74.0%) and, among males, ≥1 HPV vaccine dose (from 8.3% to 20.8%). Among females, vaccination coverage estimates for each HPV vaccine series dose were similar in 2012 compared with 2011. Coverage varied substantially among states.

Regarding Healthy People 2020 targets for adolescents (5), 36 states achieved targets for Tdap, 12 for MenACWY, and nine for varicella vaccine coverage. Large and increasing coverage differences between Tdap and other vaccines recommended for adolescents indicate that substantial missed opportunities remain for vaccinating teens, especially against HPV infection    (6).

Health-care providers should administer recommended HPV and meningococcal vaccinations to boys and girls during the same visits when Tdap vaccine is given. In addition, whether for health problems or well-checks, providers, parents, and adolescents should use every health-care visit as an opportunity to review adolescents’ immunization histories and ensure that every adolescent is fully vaccinated.

Statement from PATH: Cervical cancer demonstration project in India
30 August 2013
Excerpt
Today, the Indian Parliament’s Standing Committee on Health and Family Welfare released a report critical of a cervical cancer vaccine demonstration project conducted in India from 2009 to 2010 through a collaboration among PATH, the Indian Council of Medical Research (ICMR), and the state governments of Andhra Pradesh and Gujarat.

PATH welcomes public discussion about the role of vaccines in preventing life-threatening diseases such as cervical cancer, and we thank the committee members for their time and effort in reviewing this matter. We support the adoption of reasonable measures to further strengthen and clarify protections for individuals participating in research projects. However, we are troubled by the report’s inaccurate characterization of this important work.

…The demonstration project in India was part of a four-country project to explore suitable vaccine delivery strategies and help provide evidence for national health authorities to make informed decisions about the potential benefits and challenges of introducing vaccines against human papillomavirus (HPV), the primary cause of cervical cancer.

…The ICMR, India’s highest medical research authority, reviewed and approved the protocol for this project, including its design and methodology. At the time of its review, the ICMR determined the project was a post-licensure observational study and not a clinical trial. The project did not seek to evaluate the efficacy or long-term safety of the vaccines, which had already undergone clinical evaluation in India and had been licensed and approved by the Drugs Controller General of India.

The ICMR’s view was crucial, as it established the approval processes and protocols for the work that followed. PATH designed the project protocols in compliance with the ICMR’s instructions and fully complied with the ICMR’s requirements regarding the necessary approval processes and the requirements of state governments regarding consent processes.

We believe that by following the guidance provided by the ICMR, as well as two state governments and three ethical review committees, we designed a project that met or exceeded the country’s existing regulatory standards for demonstration projects while providing the greatest health benefit to Indian women…

–       Full PATH statement: http://www.path.org/news/press-room/642/
–       Standing Committee Report: [no link provided in PATH statement; no web version apparent after google search]

  The Global Fund said it appointed Paul Tuxford as Chief Information Officer and Jason Clark as Head of Controlling and Program Finance. Mr. Tuxford was most recently at  Credit Suisse where he was Director, Chief Operating Officer – Corporate Services Technology. Before joining Credit Suisse, he worked for Quintiles, a pharmaceutical research company, as Director, Global IT Business Solutions. Mr. Clark joins the Global Fund from RWE AG, one of Europe’s largest electricity and gas companies, where he has acted as Director, Finance and Controlling for the last 10 years, leading a team of about 300 people. Both positions will report to Daniel Camus, Chief Financial Officer.

http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-08-29_Global_Fund_Appoints_Paul_Tuxford_as_Chief_Information_Officer/

http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-08-29_Global_Fund_Appoints_Jason_Clark_as_Head_of_Controlling_and_Program_Finance/

American Journal of Infection Control
Vol 41 | No. 9 | September 2013 | Pages 759-852
http://www.ajicjournal.org/current

Prevalence and factors associated with 2009 to 2011 influenza vaccinations at a university medical center
Kathleen A. Crowley, RPA-C, MPH; Ronnie Myers, DDS; Lori A. Magda, MA; Stephen S. Morse, PhD; Paul Brandt-Rauf, MD, DrPH, SciD; Robyn R.M. Gershon, MT, MHS, DrPH

Abstract
Background
Information on the rates and factors associated with influenza vaccinations, although limited, is important because it can inform the development of effective vaccination campaigns in a university medical center setting.

Methods
A study was conducted in 2011 to identify individual and organizational level barriers and facilitators to influenza vaccination among clinical and nonclinical personnel (N = 428) from a major university medical center.

Results
Seventy-one percent of clinical personnel (n = 170) reported pandemic H1N1 vaccination compared with 27% of nonclinical personnel (n = 258), even though vaccine was made widely available to all personnel at no cost. Similarly, disparate rates between clinical and nonclinical personnel were noted for the 2009/2010 seasonal influenza vaccine (82% vs 42%, respectively) and 2010/2011 combination (pandemic plus seasonal) influenza vaccine (73% vs 28%, respectively). Factors associated with pandemic vaccination in nonclinical personnel included the following: high level of influenza-related knowledge, concern regarding influenza contagion, history of previous influenza vaccinations or influenza illness, participation in vaccine-related training, and awareness of the institution’s written pandemic plan. For clinicians, past history of seasonal influenza vaccination was associated with pandemic vaccination. For all participants, taking any 1 or more of the 3 influenza vaccines available in 2009 to 2011 was associated with intent to take a hypothetical future novel pandemic vaccine (odds ratio, 6.7; 95% confidence interval: 4.32-10.44; P < .001).

Conclusion
Most of the risk factors associated with lack of vaccination uptake are amenable to organizational strategies

Bulletin of the World Health Organization
Volume 91, Number 9, September 2013, 621-715
http://www.who.int/bulletin/volumes/91/9/en/index.html

Special theme: women’s health beyond reproduction – a new agenda
EDITORIALS
At the crossroads: transforming health systems to address women’s health across the life course
Flavia Bustreo, Oleg Chestnov, Felicia Marie Knaul, Islene Araujo de Carvalho, Mario Merialdi, Marleen Temmerman & John R Beard
doi: 10.2471/BLT.13.128439

Article [HTML]

Cost Effectiveness and Resource Allocation
(Accessed 31 August 2013)
http://www.resource-allocation.com/

Research
A cost-effectiveness analysis of a 10-valent pneumococcal conjugate vaccine in children in six Latin American countries
Martí SG, Colantonio L, Bardach A, Galante J, Lopez A, Caporale J, Knerer G, Gomez JA et al. Cost Effectiveness and Resource Allocation 2013, 11:21 (30 August 2013)

Abstract (provisional)
Background
A recently developed 10-valent pneumococcal non-typeable H influenzae protein D-conjugate vaccine (PHiD-CV) is expected to afford protection against more than two thirds of isolates causing IPD in children in Latin America, and also against acute otitis media caused by both Spn and NTHi. The objective of this study is to assess the cost-effectiveness of PHiD-CV in comparison to non-vaccination in children under 10 years of age in Argentina, Brazil, Chile, Colombia, Mexico and Peru.

Methods
We used a static, deterministic, compartmental simulation model. The dosing regimen considered included three vaccine doses (at 2 months, 4 months and 6 months) and a booster dose (at 13 months) (3 + 1 schedule). Model outcomes included number of cases prevented, deaths averted, quality-adjusted life-years (QALYs) gained and costs. Discount for costs and benefits of long term sequelae was done at 3.5%, and currency reported in 2008-2009 U$S varying between countries.

Results
The largest effect in case prevention was observed in pneumococcal meningitis (from 27% in Peru to 47% in Colombia), neurologic sequelae after meningitis (from 38% in Peru to 65% in Brazil) and bacteremia (from 42% in Argentina to 49% in Colombia). The proportion of predicted deaths averted annually ranged from 18% in Peru to 33% in Brazil. Overall, the health benefits achieved with PHiD-CV vaccination resulted in a lower QALY loss (from 15% lower in Peru to 26% in Brazil). At a cost of USD 20 per vaccine dose, vaccination was cost-effective in all countries, from being cost saving in Chile to a maximum Incremental Cost-effectiveness Ratio of 7,088 US$ Dollars per QALY gained. Results were robust in the sensitivity analysis, and scenarios with indirect costs affected results more than those with herd immunity.

Conclusions
The incorporation of the 10-valent pneumococcal conjugate vaccine into routine infant immunization programs in Latin American countries could be a cost-effective strategy to improve infant population health in the region.

Current Opinion in Infectious Diseases.
October 2013 – Volume 26 – Issue 5  pp: v-vi,399-492
http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspx

Current issues in dengue vaccination
Thomas, Stephen J.; Endy, Timothy P.

Abstract
Purpose of review: Dengue is a global health problem and of concern to travelers and deploying military personnel, with development and licensure of an effective tetravalent dengue vaccine a public health priority. The recent performance of the lead dengue vaccine in a phase 2b efficacy trial underscores dengue vaccine development challenges. This review focuses on current issues in dengue vaccination.

Recent findings: The dengue viruses (DENVs) are mosquito-borne flaviviruses transmitted by infected Aedes mosquitoes. Illness manifests across a clinical spectrum with severe disease characterized by intravascular volume depletion and hemorrhage. Recent estimates on the burden of DENV infection determined that there are 390 million dengue infections per year, three times the current estimate by the WHO. There are no licensed antivirals or vaccines to treat or prevent dengue though many are in preclinical or clinical development. DENV illness results from a complex interaction of viral properties and host immune responses. Immunologic complexity, lack of an adequate animal model of disease, absence of an immune correlate of protection, and only partially informative immunogenicity assays are challenging dengue vaccine development efforts.

Summary: Dengue vaccine development efforts have numerous complex challenges to overcome before a well-tolerated and effective vaccine is licensed and available. In this review, the authors discuss the current issues in dengue vaccination.

Globalization and Health
[Accessed 31 August 2013]
http://www.globalizationandhealth.com/

Commentary
Open innovation as a new paradigm for global collaborations in health
Patricia Dandonoli
Globalization and Health 2013, 9:41 doi:10.1186/1744-8603-9-41
Published: 30 August 2013  http://www.globalizationandhealth.com/content/9/1/41/abstract

Abstract (provisional)
Open innovation, which refers to combining internal and external ideas and internal and external paths to market in order to achieve advances in processes or technologies, is an attractive paradigm for structuring collaborations between developed and developing country entities and people. Such open innovation collaborations can be designed to foster true co-creation among partners in rich and poor settings, thereby breaking down hierarchies and creating greater impact and value for each partner. Using an example from Concern Worldwide’s Innovations for Maternal, Newborn & Child Health initiative, this commentary describes an early-stage pilot project built around open innovation in a low resource setting, which puts communities at the center of a process involving a wide range of partners and expertise, and considers how it could be adapted and make more impactful and sustainable by extending the collaboration to include developed country partners.

Health Policy and Planning
Volume 28 Issue 6 September 2013
http://heapol.oxfordjournals.org/content/current

Transforming governance or reinforcing hierarchies and competition: examining the public and hidden transcripts of the Global Fund and HIV in India
Anuj Kapilashrami1,* and Barbara McPake2
Author Affiliations
1Global Public Health Unit, University of Edinburgh, Edinburgh EH8 9LD, UK and 2Institute for International Health & Development, Queen Margaret University, Edinburgh EH21 6UU, UK
↵*Corresponding author. Global Public Health Unit, University of Edinburgh, Edinburgh, UK. E-mail: anuj.kapilashrami@gmail.com
Accepted September 10, 2012.
http://heapol.oxfordjournals.org/content/28/6/626.abstract

Abstract
Global health initiatives (GHIs) have gained prominence as innovative and effective policy mechanisms to tackle global health priorities. More recent literature reveals governance-related challenges and their unintended health system effects. Much less attention is received by the relationship between these mechanisms, the ideas that underpin them and the country-level practices they generate. The Global Fund has leveraged significant funding and taken a lead in harmonizing disparate efforts to control HIV/AIDS. Its growing influence in recipient countries makes it a useful case to examine this relationship and evaluate the extent to which the dominant public discourse on Global Fund departs from the hidden resistances and conflicts in its operation. Drawing on insights from ethnographic fieldwork and 70 interviews with multiple stakeholders, this article aims to better understand and reveal the public and the hidden transcript of the Global Fund and its activities in India. We argue that while its public transcript abdicates its role in country-level operations, a critical ethnographic examination of the organization and governance of the Fund in India reveals a contrasting scenario. Its organizing principles prompt diverse actors with conflicting agendas to come together in response to the availability of funds. Multiple and discrete projects emerge, each leveraging control and resources and acting as conduits of power. We examine how management of HIV is punctuated with conflicts of power and interests in a competitive environment set off by the Fund protocol and discuss its system-wide effects. The findings also underscore the need for similar ethnographic research on the financing and policy-making architecture of GHIs.

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 2 Issue 3 September 2013
http://jpids.oxfordjournals.org/content/current

A School-Located Vaccination Adolescent Pilot Initiative in Chicago: Lessons Learned
Rachel N. Caskey1, Everly Macario2, Daniel C. Johnson2, Tamara Hamlish2 and Kenneth A. Alexander2
Author Affiliations
1Department of Pediatrics, University of Illinois at Chicago;
2Department of Pediatrics, University of Chicago
Corresponding Author: Everly Macario, ScD, MS, EdM, Department of Pediatrics, University of Chicago, 5629 S Dorchester Ave, Chicago, IL 60637. E-mail: everly.macario@gmail.com.
Received July 25, 2012.
Accepted November 9, 2012.
http://jpids.oxfordjournals.org/content/2/3/198.abstract

Abstract
Background
Many adolescents underutilize preventive services and are underimmunized.

Methods
To promote medical homes and increase immunization rates, we conceptualized and implemented a 3-year, 8-school pilot school-located vaccination collaborative program. We sought community, parent, and school nurse input the year prior to implementation. We selected schools with predominantly Medicaid-enrolled or Medicaid-eligible students to receive Vaccines For Children stock vaccines. Nurses employed by a mass immunizer delivered these vaccines at participating schools 3 times a year.

Results
Over 3 years, we delivered approximately 1800 vaccines at schools. School administrators, health centers, and neighboring private physicians generally welcomed the program. Parents did not express overt concerns about school-located vaccination. School nurses were not able to participate because of multiple school assignments. Obtaining parental consent via backpack mail was an inefficient process, and classroom incentives did not increase consent form return rate. The influenza vaccine had the most prolific uptake. The optimal time for administering vaccines was during regular school hours.

Conclusions
Although school-located vaccination for adolescents is feasible, this is a paradigm shift for community members and thus accompanies challenges in implementation. High principal or school personnel turnover led to a consequent lack of institutional memory. It was difficult to communicate directly with parents. Because we were uncertain about the proportion of parents who received consent forms, we are exploring Internet-based and back-to-school registration options for making the consent form distribution and return process more rigorous. Securing an immunization champion at each school helped the immunization processes. Identifying a financially sustainable school-located vaccination model is critical for national expansion of school-located vaccination.