Emerging Infectious Diseases
Volume 20, Number 4—April 2014
http://www.cdc.gov/ncidod/EID/index.htm

Research
Efficiency of Points of Dispensing for Influenza A(H1N1)pdm09 Vaccination, Los Angeles County, California, USA, 2009
Shubhayu Saha , Brandon Dean, Steven Teutsch, Rebekah H. Borse, Martin I. Meltzer, DeeAnn Bagwell, Alonzo Plough, and Jonathan Fielding
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Saha, R.H. Borse, M.I. Meltzer); Los Angeles County Department of Public Health, Los Angeles, California, USA (B. Dean, S. Teutsch, D. Bagwell, A. Plough, J. Fielding)
http://wwwnc.cdc.gov/eid/article/20/4/13-0725_article.htm

Abstract
During October 23–December 8, 2009, the Los Angeles County Department of Public Health used points of dispensing (PODs) to improve access to and increase the number of vaccinations against influenza A(H1N1)pdm09. We assessed the efficiency of these units and access to vaccines among ethnic groups. An average of 251 persons per hour (SE 65) were vaccinated at the PODs; a 10% increase in use of live-attenuated monovalent vaccines reduced that rate by 23 persons per hour (SE 7). Vaccination rates were highest for Asians (257/10,000 persons), followed by Hispanics (114/10,000), whites (75/100,000), and African Americans (37/10,000). Average distance traveled to a POD was highest for whites (6.6 miles; SD 6.5) and lowest for Hispanics (4.7 miles; SD ±5.3). Placing PODs in areas of high population density could be an effective strategy to reach large numbers of persons for mass vaccination, but additional PODs may be needed to improve coverage for specific populations.

Eurosurveillance
Volume 19, Issue 11, 20 March 2014
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Editorials
Drug-resistance – a challenge for tuberculosis control in the European Union and European Economic Area

News
ECDC and WHO/Europe joint report on tuberculosis surveillance and monitoring in Europe

Global Public Health
Volume 9, Issue 3, 2014
http://www.tandfonline.com/toc/rgph20/current#.Uq0DgeKy-F9

Political commitment to tuberculosis control in Ghana
Joshua Amo-Adjei
pages 299-311
DOI:10.1080/17441692.2014.880500
Published online: 13 Feb 2014

Abstract
As part of expanding and sustaining tuberculosis (TB) control, the Stop TB Partnership of the World Health Organization initiative has called for strong political commitment to TB control, particularly in developing countries. Framing political commitment within the theoretical imperatives of the political economy of health, this study explores the existing and the expected dimensions of political commitment to TB control in Ghana. Semi-structured in-depth interviews were conducted with 29 purposively selected staff members of the Ghana Health Service and some political officeholders. In addition, the study analysed laws, policies and regulations relevant to TB control. Four dimensions of political commitment emerged from the interviews: provision of adequate resources (financial, human and infrastructural); political authorities’ participation in advocacy for TB; laws and policies’ promulgation and social protection interventions. Particularly in respect to financial resources, donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria presently give more than 60% of the working budget of the programme. The documentary review showed that laws, policies and regulations existed that were relevant to TB control, albeit they were not clearly linked.

The Lancet  
Mar 22, 2014  Volume 383  Number 9922  p1013 – 1098
http://www.thelancet.com/journals/lancet/issue/current

Editorial
A new brand for tuberculosis
The Lancet
Preview |
The Lancet received an interesting email last week—an invitation to participate in the research stage of a new Stop TB Partnership initiative to build a brand for tuberculosis from Siegel+Gale, a London-based branding agency who have been commissioned to undertake the work. The aim of the project is to develop an iconic and lasting identity for tuberculosis. The goal is to create a brand that will raise the profile of the disease, influence high-level decision makers, attract necessary resources, and amplify the voice of the tuberculosis community.

Comment
World TB Day 2014: finding the missing 3 million
Nick Herbert, Andrew George, Baroness Masham of Ilton, Virendra Sharma, Matt Oliver, Aaron Oxley, Mario Raviglione, Alimuddin I Zumla
Preview |
On April 23, 1993, WHO declared tuberculosis a global health emergency.1 Tuberculosis is now about to come of age as a global emergency—April, 2014 marks the 21st anniversary of that declaration. Arata Kochi, manager of WHO’s tuberculosis programme in 1993, aptly called the disease “a forgotten epidemic” and “humanity’s greatest killer”. Tuberculosis might no longer be humanity’s deadliest disease in terms of annual deaths but, 21 years after the declaration, it remains a serious and substantial threat to the health of people worldwide, causing 1·3 million unnecessary deaths every year.

Nature Immunology
April 2014, Volume 15 No 4 pp307-401
http://www.nature.com/ni/journal/v15/n4/index.html

Perspective
Vaccines that stimulate T cell immunity to HIV-1: the next step
Andrew J McMichael & Wayne C Koff
Affiliations
http://www.nature.com/ni/journal/v15/n4/abs/ni.2844.html

Abstract
The search for a vaccine against human immunodeficiency virus type 1 (HIV-1) has many hurdles to overcome. Ideally, the stimulation of both broadly neutralizing antibodies and cell-mediated immune responses remains the best option, but no candidate in clinical trials at present has elicited such antibodies, and efficacy trials have not demonstrated any benefit for vaccines designed to stimulate immune responses of CD8+ T cells. Findings obtained with the simian immunodeficiency virus (SIV) monkey model have provided new evidence that stimulating effective CD8+ T cell immunity could provide protection, and in this Perspective we explore the path forward for optimizing such responses in humans.

The Pediatric Infectious Disease Journal
April 2014 – Volume 33 – Issue 4  pp: 337-429,e87-e120
http://journals.lww.com/pidj/pages/currenttoc.aspx

Assessing the Evidence: Live Attenuated Influenza Vaccine in Children Younger than 2 Years. A Systematic Review
Prutsky, Gabriela J.; Domecq, Juan Pablo; Elraiyah, Tarig; More

Abstract
Background: Live attenuated influenza vaccine (LAIV) is effective in children but contraindicated in children <2 years of age.

Methods: We searched Medline, EMBASE, the Cochrane Library, Web of Science, Scopus, PsycInfo and CINAHL through February 2013 for existing systematic reviews, randomized controlled trials (RCTs) and observational studies (for safety). We included studies enrolling healthy children <2 years of age who received LAIV, compared with placebo or inactivated influenza vaccine (IIV). Data were extracted independently by 2 investigators. The relative risk (RR) was pooled across studies using the random effects model.

Results: We found 7 eligible randomized controlled trials and 2 observational studies. Randomized controlled trials included 6281 children and were at low to moderate risk of bias. LAIV reduced the incidence of influenza compared with placebo (relative risk = 0.36, 95% confidence interval: 0.23–0.58, P < 0.05) with a number needed to vaccinate of 17. LAIV increased the incidence of minor side effects (fever and rhinorrhea). LAIV had a similar effect in preventing influenza (relative risk = 0.76, 95% confidence interval: 0.45–1.30, P > 0.05) compared with inactivated influenza vaccine. There was an increase of hospitalization rate (post hoc analysis) and medical attended wheezing with LAIV.

Conclusions: LAIV is highly effective in children <2 years of age compared with placebo and is as effective to inactivated influenza vaccine. The safety profile of LAIV is reasonable although evidence is sparse. LAIV may be considered as an option in this age group particularly during seasons with vaccine shortage.

PLoS One
[Accessed 22 March 2014]
http://www.plosone.org/

Research Article
Prevention of HPV-Related Cancers in Norway: Cost-Effectiveness of Expanding the HPV Vaccination Program to Include Pre-Adolescent Boys
Emily A. Burger mail, Stephen Sy, Mari Nygård, Ivar S. Kristiansen, Jane J. Kim http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0089974

Abstract
Background
Increasingly, countries have introduced female vaccination against human papillomavirus (HPV), causally linked to several cancers and genital warts, but few have recommended vaccination of boys. Declining vaccine prices and strong evidence of vaccine impact on reducing HPV-related conditions in both women and men prompt countries to reevaluate whether HPV vaccination of boys is warranted.

Methods
A previously-published dynamic model of HPV transmission was empirically calibrated to Norway. Reductions in the incidence of HPV, including both direct and indirect benefits, were applied to a natural history model of cervical cancer, and to incidence-based models for other non-cervical HPV-related diseases. We calculated the health outcomes and costs of the different HPV-related conditions under a gender-neutral vaccination program compared to a female-only program.

Results
Vaccine price had a decisive impact on results. For example, assuming 71% coverage, high vaccine efficacy and a reasonable vaccine tender price of $75 per dose, we found vaccinating both girls and boys fell below a commonly cited cost-effectiveness threshold in Norway ($83,000/quality-adjusted life year (QALY) gained) when including vaccine benefit for all HPV-related diseases. However, at the current market price, including boys would not be considered ‘good value for money.’ For settings with a lower cost-effectiveness threshold ($30,000/QALY), it would not be considered cost-effective to expand the current program to include boys, unless the vaccine price was less than $36/dose. Increasing vaccination coverage to 90% among girls was more effective and less costly than the benefits achieved by vaccinating both genders with 71% coverage.

Conclusions
At the anticipated tender price, expanding the HPV vaccination program to boys may be cost-effective and may warrant a change in the current female-only vaccination policy in Norway. However, increasing coverage in girls is uniformly more effective and cost-effective than expanding vaccination coverage to boys and should be considered a priority.

PLoS One
[Accessed 22 March 2014]
http://www.plosone.org/

Research Article
Weight-Based Policy of Hepatitis B Vaccination in Very Low Birth Weight Infants in Taiwan: A Retrospective Cross-Sectional Study
Chien-Yi Chen, Huey-Ling Chen, Hung-Chieh Chou, Po-Nien Tsao, Wu-Shiun Hsieh, Mei-Hwei Chang mail
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0092271

Abstract
Background
The current recommendation of giving the first dose of hepatitis B vaccine to very low birth weight (VLBW) infants at 30 days of chronologic age usually is not practical, because most VLBW infants are not medically stable at that age. We use an alternative body-weight-based protocol, and evaluate its efficacy in an endemic area under a universal immunization program.

Methods
The immunogenicity of the current hepatitis B vaccination strategy in 155 VLBW preterm infants was evaluated at age 2 to 13 years, with parental consent. All of the infants were born between 1995 and 2006, and received their first dose of hepatitis B vaccine when they reached 2,000–2,200 g, irrespective of chronological age. Hepatitis B immunoglobulin (HBIG) was given at birth to infants born to HBsAg(+)/HBeAg(+) mothers.

Results
All 155 of the recruited children were HBsAg and anti-HBc negative. The anti-HBs seropositivity rate (geometric mean titer) was 84.1% (146.5 mIU/mL) for children under 3 years, 73.5% (68.8 mIU/mL) for 4- to 7-year-olds, 27.7% (55.4 mIU/mL) for 8- to 11-year-olds and 20% (6.0 mIU/mL) for children ≥12 years of age. More than 90% of these children received the first vaccination after 30 days of age, half (51%) at 60 to 90 days, and 29 children (18.6%) after 90 days of age. Of the 26 infants born to HBsAg(+) mothers, 6/6 infants of HBeAg(+) mothers received HBIG at birth, and 12/20 infants of HBeAg(−) mothers received HBIG. None of the 26 infants became infected.

Conclusions
Delaying hepatitis B vaccinations in VLBW preterm infants until they reach a weight of 2,000 g, with the administration of HBIG at birth for infants of HBsAg(+) mothers provided adequate immunogenicity and protection in a highly endemic area. Weight-based policy of hepatitis B vaccination is an effective and practical alternative strategy for VLBW infants.

PLoS Neglected Tropical Diseases
February 2014
http://www.plosntds.org/article/browseIssue.action

Yellow Fever Outbreaks in Unvaccinated Populations, Brazil, 2008–2009
Alessandro Pecego Martins Romano, Zouraide Guerra Antunes Costa, Daniel Garkauskas Ramos, Maria Auxiliadora Andrade, Valéria de Sá Jayme, Marco Antônio Barreto de Almeida, Kátia Campomar Vettorello, Melissa Mascheretti, Brendan Flannery
Research Article | published 13 Mar 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0002740
http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002740

Abstract
Due to the risk of severe vaccine-associated adverse events, yellow fever vaccination in Brazil is only recommended in areas considered at risk for disease. From September 2008 through June 2009, two outbreaks of yellow fever in previously unvaccinated populations resulted in 21 confirmed cases with 9 deaths (case-fatality, 43%) in the southern state of Rio Grande do Sul and 28 cases with 11 deaths (39%) in Sao Paulo state. Epizootic deaths of non-human primates were reported before and during the outbreak. Over 5.5 million doses of yellow fever vaccine were administered in the two most affected states. Vaccine-associated adverse events were associated with six deaths due to acute viscerotropic disease (0.8 deaths per million doses administered) and 45 cases of acute neurotropic disease (5.6 per million doses administered). Yellow fever vaccine recommendations were revised to include areas in Brazil previously not considered at risk for yellow fever.

Author Summary
Yellow fever is a viral hemorrhagic disease transmitted by mosquitos, endemic in tropical regions of Africa and South America. Large urban outbreaks of yellow fever have been eliminated in the Americas, where most yellow fever cases result from human exposure to jungle or forested environments. Vaccination is effective but carries a risk of potentially fatal adverse events in a small number of vaccinees. In a large country such as Brazil, vaccination is recommended only in areas where there is a risk of exposure to yellow fever virus. We describe two outbreaks of yellow fever in areas without yellow fever vaccine recommendations. Numerous epizootics, or die-offs of non-human primates, were reported from areas with human cases. In response to the outbreaks and epizootic activity, over five million doses of vaccine were administered in previously unvaccinated populations, resulting in vaccine associated adverse events, six of which were fatal. The outbreaks resulted in expansion of areas with yellow fever vaccine recommendations, and highlight the need for safer yellow fever vaccines.

Pneumonia
Vol 3 (2014)
https://pneumonia.org.au/index.php/pneumonia/issue/current

ISPPD-9 Special Issue – The 9th International Symposium in Pneumococci and Pneumococcal Diseases
Hyderabad, India, 9-13 March 2014
Abstracts: ISPPD 2014 abstracts (PDF 3.9MB)

Vol 4 (2014)
Reflections on pneumonia in the tropics
Michael Alpers
Abstract
This review of pneumonia in the tropics is based on experience with respiratory infections in Papua New Guinea since the 1970s.  It discusses ideas, principles, historical aspects of pneumonia research and the need to work with the community.  In order to understand pneumonia in a tropical setting and evaluate new interventions it is essential to study the ecosystem of the causative infections, within the host and the community and between interacting microorganisms.  Vaccines are much-needed preventive tools, and for pneumonia in a highly endemic setting the prevention of severe and fatal disease takes priority over the prevention of infection.  In this setting mild infection plays an important role in preventing severe disease.  For achieving long-term sustainable outcomes, sometimes ‘less is more’.  A multipronged approach is required to control and prevent pneumonia, and in devising new ways of doing so.  This includes appropriate and accessible clinical care, a clean, smoke-free environment, good nutrition and a range of vaccines.  Also required are persistent advocacy from the global scientific community and strong engagement with and by the communities that bear the burden of disease.  Better health care must be pursued in conjunction with raising literacy rates and reducing poverty.

Public Health Ethics
Volume 7 Issue 1 April 2014
http://phe.oxfordjournals.org/content/current

Recruiting and Educating Participants for Enrollment in HIV-Vaccine Research: Ethical Implications of the Results of an Empirical Investigation
Sibusiso Sifunda*
HIV, AIDS, STIs & TB (HAST), Human Sciences Research Council, Pretoria, South Africa
Priscilla Reddy
Population Health, Health Systems & Innovation (PHHSI), Human Sciences Research Council, Cape Town, South Africa
Nasheen Naidoo
Health Promotion Research and Development Unit, Medical Research Council, Cape Town
Shamagonam James
Health Promotion Research and Development Unit, Medical Research Council, Cape Town
David Buchanan
+ Author Affiliations
School of Public Health and Health Sciences, University of Massachusetts at Amherst and Director of the Institute for Global Health
http://phe.oxfordjournals.org/content/7/1/78.abstract

Abstract
The study reports on the results of an empirical investigation of the education and recruitment processes used in HIV vaccine trials conducted in South Africa. Interviews were conducted with 21 key informants involved in HIV vaccine research in South Africa and three focus groups of community advisory board members. Data analysis identified seven major themes on the relationship between education and recruitment: the process of recruitment, the combined dual role of educators and recruiters, conflicts perceived by field staff, pressure to achieve recruitment targets, problems in achieving comprehension, accountability and education as capacity building. The results raise ethical concerns about the adequacy of current informed consent processes in these settings. The study findings bear directly on current debates about issues of exploitation and the scope of moral responsibilities of researchers and funding agencies to assure that HIV clinical prevention research is conducted

Public Health Ethics
Volume 7 Issue 1 April 2014
http://phe.oxfordjournals.org/content/current

Ethical Challenges in Implementation Research
Ruth Macklin*
Author Affiliations
Department of Epidemiology & Population Health, Albert Einstein College of Medicine
http://phe.oxfordjournals.org/content/7/1/86.abstract

Abstract
Implementation research is increasingly common in developing countries as a way of studying the introduction to the population of health interventions that have been proven to be effective elsewhere. Implementation studies are often conducted as cluster randomized trials, a design that raises ethical and conceptual questions different from those in conventional randomized controlled trials. It is often unclear who the subjects of the research are, informed consent may be difficult or impossible to obtain and controversy surrounds the use of comparison clusters that provide substandard care to the population where the research is carried out. An examination of protocols for this type of research reveals uncertainty on the part of researchers themselves about whom or what they are studying and from whom (if anyone) informed consent is required.

Risk Analysis
March 2014  Volume 34, Issue 3  Pages 399–598
http://onlinelibrary.wiley.com/doi/10.1111/risa.2014.34.issue-2/issuetoc

Original Research Article
Modeling Uncertainties in Workforce Disruptions from Influenza Pandemics Using Dynamic Input-Output Analysis
Amine El Haimar and Joost R. Santos*
Article first published online: 13 SEP 2013
DOI: 10.1111/risa.12113
http://onlinelibrary.wiley.com/doi/10.1111/risa.12113/abstract

Abstract
Influenza pandemic is a serious disaster that can pose significant disruptions to the workforce and associated economic sectors. This article examines the impact of influenza pandemic on workforce availability within an interdependent set of economic sectors. We introduce a simulation model based on the dynamic input-output model to capture the propagation of pandemic consequences through the National Capital Region (NCR). The analysis conducted in this article is based on the 2009 H1N1 pandemic data. Two metrics were used to assess the impacts of the influenza pandemic on the economic sectors: (i) inoperability, which measures the percentage gap between the as-planned output and the actual output of a sector, and (ii) economic loss, which quantifies the associated monetary value of the degraded output. The inoperability and economic loss metrics generate two different rankings of the critical economic sectors. Results show that most of the critical sectors in terms of inoperability are sectors that are related to hospitals and health-care providers. On the other hand, most of the sectors that are critically ranked in terms of economic loss are sectors with significant total production outputs in the NCR such as federal government agencies. Therefore, policy recommendations relating to potential mitigation and recovery strategies should take into account the balance between the inoperability and economic loss metrics.

Risk Analysis
March 2014  Volume 34, Issue 3  Pages 399–598
http://onlinelibrary.wiley.com/doi/10.1111/risa.2014.34.issue-2/issuetoc

Original Research Article
Understanding Public Perceptions of Benefits and Risks of Childhood Vaccinations in the United States
Geoboo Song*
Article first published online: 13 SEP 2013
DOI: 10.1111/risa.12114
http://onlinelibrary.wiley.com/doi/10.1111/risa.12114/abstract

Abstract
In the face of a growing public health concern accompanying the reemerging threat of preventable diseases, this research seeks mainly to explain variations in the perceived benefits and risks of vaccinations among the general public in the United States. As Mary Douglas and Aaron Wildavsky’s grid-group cultural theory of risk perception claims, the analytical results based upon original data from a nationwide Internet survey of 1,213 American adults conducted in 2010 suggest that individuals’ cultural predispositions contribute to the formation of their perceptions pertaining to vaccine benefits and risks at both societal and individual levels, in conjunction with other factors suggested by previous risk perception literature, such as perceived prevalence of diseases, trust, knowledge level, and demographic characteristics. Those with a strong hierarch orientation tend to envision greater benefits and lesser risks and conceive of a relatively high ratio of benefit to risk when compared to other cultural types. By contrast, those with a strong fatalist tendency are inclined to emphasize risks and downplay benefits while conceiving of a low vaccination benefit-risk ratio. Situated between hierarchs and fatalists, strong egalitarians are prone to perceive greater benefits, smaller risks, and a more positive benefit-risk ratio than strong individualists.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 18, Pages 2017-2134 (11 April 2014)

Editorial
Rabies: Underused vaccines, unnecessary deaths
Pages 2017-2019
Betty Dodet, David N. Durrheim, Helen Rees
No abstract

Development of a multivalent paediatric human vaccine for rabies virus in combination with Measles–Mumps–Rubella (MMR)
Pages 2020-2021
Anthony R. Fooks, Penelope Koraka, Rik L. de Swart, Charles E. Rupprecht, Albert D.M.E. Osterhaus
No abstract

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 18, Pages 2017-2134 (11 April 2014)

Can the success of pneumococcal conjugate vaccines for the prevention of pneumococcal diseases in children be extrapolated to adults?
Review Article
Pages 2022-2026
Catherine Weil-Olivier, Jacques Gaillat

Abstract
Before conjugate pneumococcal vaccines (PCVs) were introduced it was estimated that Streptococcus pneumoniae caused 500,000 cases of pneumonia, 50,000 cases of bacteremia and 3000 cases of meningitis annually in the United States in both children and adults. After 10 years of routine use of the 7-valent pneumococcal conjugate vaccine (PCV7) the incidence of vaccine-type pneumococcal diseases (PDs) had significantly decreased in vaccinated children (direct effect) and unvaccinated subjects of all ages (indirect effect). Second generation, higher-valent PCVs, especially 13-valent (PCV13), routinely implemented since 2010, have reduced the incidence of PDs caused by the six additional non-PCV7 serotypes, in both vaccinated and unvaccinated subjects. The licence for this vaccine has recently been extended to include adults aged 18 to 49 in Europe. Although PCV13 has an indirect effect on IPD in adults, this will probably not achieve the same level of disease control in adults and the elderly (especially those at high risk) as that obtained in vaccinated children.

As highlighted in this paper, differences exist between children and adults for PD manifestations (incidence, morbidity and mortality) and serotypes isolated in nasopharyngeal carriage and diseases, so benefits from adult vaccination must be considered in this light. PCV13 induces an immune response in adults that is non-inferior for all serotypes common with the 23-valent plain polysaccharide vaccine that is currently recommended for adults and even superior for many serotypes. Although there is no evidence that this immune response translates to clinical efficacy in adults as seen in children, the results from a randomised trial in The Netherlands, expected in 2014, should provide the missing evidence. This evidence and efficient surveillance systems should provide the necessary data, essential for policy makers in their decisions on adult pneumococcal vaccination policies.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 18, Pages 2017-2134 (11 April 2014)

Community, parental and adolescent awareness and knowledge of meningococcal disease
Original Research Article
Pages 2042-2049
Bing Wang, Michelle Clarke, Hossein Haji Ali Afzali, Helen Marshall

Abstract
Objective
To assess knowledge of invasive meningococcal disease (IMD) and concern about the disease in the South Australian Community including adolescents, adults, parents and non-parents.

Methods
This cross-sectional study was conducted by face to face interviews in South Australia in 2012. Participants were scored on their knowledge and concern about IMD. Univariate and multivariate regression analyses were performed with the survey data weighted by age and gender in accordance with 2011 Census data.

Results
Of 5200 households randomly selected and stratified by metropolitan or rural location, 3055 participants were interviewed with a response rate of 60.3%. The majority were Australian born (74.2%, n = 2267) with 31.8% (n = 972) of those interviewed being parents, and 15.9% (n = 487) adolescents (15–24 years). Almost a quarter of participants (23.5%, n = 717) do not know what meningococcal disease is, with 9.1% (n = 278) believing incorrectly that IMD is a viral infection. 36.6% (n = 1114) had low overall knowledge of IMD. Adolescents (p < 0.050), non-Australian born (p < 0.001), low educational attainment (p = 0.019), low household income (p = 0.011), low/medium socio-economic status (p < 0.050) or living in a metropolitan area (p = 0.006) were more likely to have lower overall knowledge of IMD. Participants who were not parents (p < 0.001), male gender (p < 0.001), single (p < 0.001), highly educated (p = 0.022) or had high household income (p = 0.015), had lower concern about IMD.

Conclusion
Large community knowledge gaps for IMD were observed, particularly amongst adolescents and adults with low educational attainment and low socio-economic status. Improving community knowledge of IMD could help ensure optimal uptake of a new meningococcal vaccine. Our study results can help guide development of community tailored immunisation education programs.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32/17
Volume 32, Issue 17, Pages 1897-2016 (7 April 2014)

Educational interventions to increase HPV vaccination acceptance: A systematic review
Review Article
Pages 1901-1920
Linda Y. Fu, Lize-Anne Bonhomme, Spring Chenoa Cooper, Jill G. Joseph, Gregory D. Zimet

Abstract
Background
The Human papillomavirus (HPV) vaccine has been available for protection against HPV-associated cervical cancer and genital warts since 2006. Nonetheless, uptake has varied among countries and populations within countries. Studies have found that individuals’ knowledge and attitudes toward the vaccine are associated with immunization uptake. The purpose of the current review is to summarize and evaluate the evidence for educational interventions to increase HPV vaccination acceptance.

Methods
We searched the databases of PubMed and Web of Science for English-language articles describing educational interventions designed to improve HPV vaccination uptake, intention or attitude.

Results
We identified 33 studies of HPV vaccination educational interventions: 7 tested the effectiveness of interventions with parents, 8 with adolescents or young adults, and 18 compared the effectiveness of different message frames in an educational intervention among adolescents, young adults or their parents. Most studies involved populations with higher educational attainment and most interventions required participants to be literate. The minority of studies used the outcome of HPV vaccine uptake. Well-designed studies adequately powered to detect change in vaccine uptake were rare and generally did not demonstrate effectiveness of the tested intervention.

Conclusions
There is not strong evidence to recommend any specific educational intervention for wide-spread implementation. Future studies are required to determine the effectiveness of culturally-competent interventions reaching diverse populations.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32/17
Volume 32, Issue 17, Pages 1897-2016 (7 April 2014)

HPV vaccination: Are we initiating too late?
Original Research Article
Pages 1939-1945
Annika M. Hofstetter, Melissa S. Stockwell, Noor Al-Husayni, Danielle Ompad, Karthik Natarajan, Susan L. Rosenthal, Karen Soren

Abstract
Background
Human papillomavirus (HPV) vaccination is recommended in early adolescence. While limited data suggest that patients frequently delay initiation of the three-dose series, age-based variability in initiation of HPV vaccination and its clinical relevance are not well described. Thus, this study aims to characterize HPV vaccination delay among adolescent and young adult females.

Methods
This retrospective cohort study examined age at HPV vaccination initiation and missed opportunities for receipt of the first vaccine dose (HPV1) among 11–26 year-old females (n = 22,900) receiving care at 16 urban academically-affiliated ambulatory care clinics between 2007 and 2011. Predictors of timely vaccination and post-licensure trends in age at HPV1 receipt were assessed using multivariable logistic regression and a generalized linear mixed model, respectively. Chlamydia trachomatis and Papanicolaou screening before HPV vaccination initiation, as markers of prior sexual experience and associated morbidity, were examined in a subcohort of subjects (n = 15,049).

Results
The proportion of 11–12 year-olds who initiated HPV vaccination increased over time (44.4% [2007] vs. 74.5% [2011], p < 0.01). Initiation rates also improved among 13–26 year-olds. Thus, the mean age at HPV1 receipt remained unchanged between 2007 and 2011 (16.0 ± 2.7 vs. 15.9 ± 4.0 years, p = 0.45). Spanish language was a positive predictor (AOR 1.62, 95% CI 1.05–2.48) of HPV vaccination initiation among 11–12 year-olds in 2011. The majority (70.8–76.4%) of unvaccinated subjects experienced missed vaccination opportunities. Of the subcohort, 36.9% underwent Chlamydia screening before HPV1 receipt (19.1% with ≥1 positive result). Of those with prior Papanicolaou screening (16.6%), 32.1% had ≥1 abnormal result.

Conclusions
These low-income, minority females frequently delayed initiation of HPV vaccination. Many had evidence of prior sexual experience and associated morbidity, placing them at risk of HPV-related complications. Promoting timely HPV vaccination and reducing missed vaccination opportunities are crucial.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32/17
Volume 32, Issue 17, Pages 1897-2016 (7 April 2014)

Associations between race, sex and immune response variations to rubella vaccination in two independent cohorts
Original Research Article
Pages 1946-1953
Iana H. Haralambieva, Hannah M. Salk, Nathaniel D. Lambert, Inna G. Ovsyannikova, Richard B. Kennedy, Nathaniel D. Warner, V.Shane Pankratz, Gregory A. Poland

Abstract
Introduction
Immune response variations after vaccination are influenced by host genetic factors and demographic variables, such as race, ethnicity and sex. The latter have not been systematically studied in regard to live rubella vaccine, but are of interest for developing next generation vaccines for diverse populations, for predicting immune responses after vaccination, and for better understanding the variables that impact immune response.

Methods
We assessed associations between demographic variables, including race, ethnicity and sex, and rubella-specific neutralizing antibody levels and secreted cytokines (IFNγ, IL-6) in two independent cohorts (1994 subjects), using linear and linear mixed models approaches, and genetically defined racial and ethnic categorizations.

Results
Our replicated findings in two independent, large, racially diverse cohorts indicate that individuals of African descent have significantly higher rubella-specific neutralizing antibody levels compared to individuals of European descent and/or Hispanic ethnicity (p < 0.001).

Conclusion
Our study provides consistent evidence for racial/ethnic differences in humoral immune response following rubella vaccination.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32/17
Volume 32, Issue 17, Pages 1897-2016 (7 April 2014)

Cost-effectiveness of childhood rotavirus vaccination in Germany
Original Research Article
Pages 1964-1974
Pamela Aidelsburger, Kristin Grabein, Katharina Böhm, Markus Dietl, Jürgen Wasem, Judith Koch, Bernhard Ultsch, Felix Weidemann, Ole Wichman

Abstract
Background
Rotavirus (RV) causes a highly contagious gastroenteritis especially in children under five years of age. Since 2006 two RV-vaccines are available in Europe (Rotarix® and RotaTeq®). To support informed decision-making within the German Standing Committee on Vaccination (STIKO) the cost-effectiveness of these two vaccines was evaluated for the German healthcare setting.

Methods
A Markov model was developed to evaluate the cost-effectiveness from the statutory health insurance (SHI) and from the societal perspective. RV-cases prevented, RV-associated hospitalizations avoided, and quality-adjusted life years (QALY) gained were considered as health outcomes. RV-incidences were calculated based on data from the national mandatory disease reporting system. RV-vaccine efficacy was determined as pooled estimates based on data from randomized controlled trials. Vaccine list prices and price catalogues were used for cost-assessment. Effects and costs were discounted with an annual discount rate of 3%.

Results
The base-case analysis (SHI-perspective) resulted in an incremental cost-effectiveness and cost-utility ratio for Rotarix® of € 184 per RV-case prevented, € 2457 per RV-associated hospitalization avoided, and € 116,973 per QALY gained. For RotaTeq®, the results were € 234 per RV-case prevented, € 2622 per RV-associated hospitalization avoided, and € 142,732 per QALY gained. Variation of various parameters in sensitivity analyses showed effects on the ICERs without changing the overall trend of base-case results. When applying base-case results to the 2012 birth cohort in Germany with 80% vaccination coverage, an estimated 206,000–242,000 RV-cases and 18,000 RV-associated hospitalizations can be prevented in this birth cohort over five years for an incremental cost of 44.5–48.2 million €.

Conclusion
Our analyses demonstrate that routine RV-vaccination could prevent a substantial number of RV-cases and hospitalizations in the German healthcare system, but the saved treatment costs are counteracted by costs for vaccination. However, with vaccine prices reduced by ∼62–66%, RV-vaccination could even become a cost-saving preventive measure.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32/17
Volume 32, Issue 17, Pages 1897-2016 (7 April 2014)

Costs of vaccine delivery in the Gambia before and after, pentavalent and pneumococcal conjugate vaccine introductions
Original Research Article
Pages 1975-1981
E. Usuf, G. Mackenzie, Y. Lowe-Jallow, B. Boye, D. Atherly, C. Suraratdecha, U.K. Griffiths

Abstract
Background
The Gambia introduced seven-valent pneumococcal conjugate vaccine (PCV) in August 2009 and switched to 13-valent PCV in April 2011. In April 2009 monovalent hepatitis B and combined Diphtheria–Tetanus–Pertussis and Haemophilus influenzae type b vaccines were transitioned to a combined pentavalent vaccine. The current schedule offers three doses of PCV and pentavalent, and continues to give children monovalent hepatitis B vaccine at birth. We estimated the overall costs of the Gambian immunisation programme and the incremental costs of introducing pentavalent and the seven-valent PCV.

Methods
Twenty health facilities out of a total of 56 were surveyed. Data collected included number of vaccine doses delivered, staff time spent on vaccine delivery, distance travelled to collect vaccines, and cold chain expansion due to new vaccine introduction. National level data were collected from key informant interviews. Annualised costs were calculated in 2009 US$.

Results
With a PCV price of US$7 per dose, the incremental costs of introducing PCV was US$1.6 million, equivalent to US$25 per fully immunised child, with systems costs accounting for US$1.90. The switch to pentavalent vaccine resulted in cost savings of US$0.45 per fully immunised child. Total annual costs increased by 45% after the introduction of the new vaccines, amounting to US$ 3.0 million, or US$45 per fully immunised child.

Conclusion
Vaccine prices were the most important determinant of total incremental costs and cold chain expansion the biggest cost component of systems costs.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32/17
Volume 32, Issue 17, Pages 1897-2016 (7 April 2014)

School-based vaccination of young US males: Impact of health beliefs on intent and first dose acceptance
Original Research Article
Pages 1982-1987
Vaughn I. Rickert, Beth A. Auslander, Dena S. Cox, Susan L. Rosenthal, Jeffrey A. Rickert, Richard Rupp, Gregory D. Zimet

Abstract
Little is known about adolescent males and their parents with respect to intent and first dose uptake of the human papillomavirus (HPV) vaccine outside of primary care settings. The purpose of this study was to evaluate potential predictors of parental intent to vaccinate (study was conducted in November 2010–December 2012) and of first dose uptake of HPV vaccine among a sample of young adolescent males, 11–15 years of age, who received care at a school-based health center (SBHC). We also examined intent as a potential mediator of the relationships between predictors (health beliefs and perceived spousal agreement) and vaccination. Slightly more than half (n = 135 of 249) of parents reported an intention to vaccinate and 28% (n = 69) of males received their first dose of the HPV vaccine. Two of three health beliefs were significantly associated with both intention and uptake as was perceived spousal agreement. We found intention to vaccinate was a partial meditator between the perceived benefits of HPV vaccine and first dose acceptance. We also determined that intent was a strong mediator between both general immunization benefits and perceived spousal agreement and first dose uptake. While vaccine uptake was lower than expected, particularly considering that many barriers to vaccine initiation were eliminated because of the SBHC setting, this rate is higher than in traditional settings. After controlling for intent, only perceived benefits of the HPV vaccine remained a significant predictor of first dose acceptance.

Value in Health                  
Vol 17 | No. 2 | March 2014 | Pages 141-306
http://www.valueinhealthjournal.com/current

A Questionnaire to Assess the Relevance and Credibility of Observational Studies to Inform Health Care Decision Making: An ISPOR-AMCP-NPC Good Practice Task Force Report  
Marc L. Berger, Bradley C. Martin, Don Husereau, Karen Worley, et al.
Abstract 
Evidence-based health care decisions are best informed by comparisons of all relevant interventions used to treat conditions in specific patient populations. Observational studies are being performed to help fill evidence gaps. Widespread adoption of evidence from observational studies, however, has been limited because of various factors, including the lack of consensus regarding accepted principles for their evaluation and interpretation. Two task forces were formed to develop questionnaires to assist decision makers in evaluating observational studies, with one Task Force addressing retrospective research and the other Task Force addressing prospective research. The intent was to promote a structured approach to reduce the potential for subjective interpretation of evidence and drive consistency in decision making. Separately developed questionnaires were combined into a single questionnaire consisting of 33 items. These were divided into two domains: relevance and credibility. Relevance addresses the extent to which findings, if accurate, apply to the setting of interest to the decision maker. Credibility addresses the extent to which the study findings accurately answer the study question. The questionnaire provides a guide for assessing the degree of confidence that should be placed from observational studies and promotes awareness of the subtleties involved in evaluating those.

Questionnaire to Assess Relevance and Credibility of Modeling Studies for Informing Health Care Decision Making: An ISPOR-AMCP-NPC Good Practice Task Force Report
J. Jaime Caro, David M. Eddy, Hong Kan, Cheryl Kaltz, et al.
Abstract 
The evaluation of the cost and health implications of agreeing to cover a new health technology is best accomplished using a model that mathematically combines inputs from various sources, together with assumptions about how these fit together and what might happen in reality. This need to make assumptions, the complexity of the resulting framework, the technical knowledge required, as well as funding by interested parties have led many decision makers to distrust the results of models. To assist stakeholders reviewing a model’s report, questions pertaining to the credibility of a model were developed. Because credibility is insufficient, questions regarding relevance of the model results were also created. The questions are formulated such that they are readily answered and they are supplemented by helper questions that provide additional detail. Some responses indicate strongly that a model should not be used for decision making: these trigger a “fatal flaw” indicator. It is hoped that the use of this questionnaire, along with the three others in the series, will help disseminate what to look for in comparative effectiveness evidence, improve practices by researchers supplying these data, and ultimately facilitate their use by health care decision makers.

The path of malaria vaccine development: challenges and perspectives
C Arama, M Troye‐Blomberg – Journal of Internal Medicine, 2014
Abstract
Malaria is a life-threatening disease caused by parasites of the Plasmodium genus. In many parts of the world, the parasites have developed resistance to a number of anti-malarial agents. Key interventions to control malaria include prompt and effective treatment with artemisinin-based combination therapies, use of insecticidal nets by individuals at risk and active research into malaria vaccines. Protection against malaria through vaccination was demonstrated more than 30 years ago when individuals were vaccinated via repeated bites by Plasmodium falciparum-infected and irradiated but still metabolically active mosquitoes. However, vaccination with high doses of irradiated sporozoites injected into humans has long been considered impractical. Yet, following recent success using whole-organism vaccines, the approach has received renewed interest; it was recently reported that repeated injections of irradiated sporozoites increased protection in 80 vaccinated individuals. Other approaches include subunit malaria vaccines, such as the current leading candidate RTS,S (consisting of fusion between a portion of the P. falciparum-derived circumsporozoite protein and the hepatitis B surface antigen), which has been demonstrated to induce reasonably good protection. Although results have been encouraging, the level of protection is generally considered to be too low to achieve eradication of malaria. There is great interest in developing new and better formulations and stable delivery systems to improve immunogenicity. In this review we will discuss recent strategies to develop efficient malaria vaccines.

Combining multiple healthcare databases for post‐marketing drug and vaccine safety surveillance: why and how?
G Trifirò, PM Coloma, PR Rijnbeek, S Romio… – Journal of Internal Medicine, 2014
Abstract
A growing number of international initiatives (e.g. EU-ADR, Sentinel, OMOP, PROTECT and VAESCO) are based on the combined use of multiple healthcare databases for the conduct of active surveillance studies in the area of drug and vaccine safety. The motivation behind combining multiple healthcare databases is the earlier detection and validation, and hence earlier management, of potential safety issues. Overall, the combination of multiple healthcare databases increases statistical sample size and heterogeneity of exposure for post-marketing drug and vaccine safety surveillance, despite posing several technical challenges. Healthcare databases generally differ by underlying healthcare systems, type of information collected, drug/vaccine and medical event coding systems and language. Therefore, harmonization of medical data extraction through homogeneous coding algorithms across highly different databases is necessary. Although no standard procedure is currently available to achieve this, several approaches have been developed in recent projects. Another main challenge involves choosing the work models for data management and analyses while respecting country-specific regulations in terms of data privacy and anonymization. Dedicated software (e.g. Jerboa) has been produced to deal with privacy issues by sharing only anonymized and aggregated data using a common data model. Finally, storage and safe access to the data from different databases requires the development of a proper remote research environment. The aim of this review is to provide a summary of the potential, disadvantages, methodological issues and possible solutions concerning the conduct of post-marketing multi-database drug and vaccine safety studies, as demonstrated by several international initiatives.

A Randomized Controlled Trial of Clinician-Led Tactile Stimulation to Reduce Pain During Vaccination in Infants
A Taddio, T Ho, C Vyas, S Thivakaran, A Jamal… – Clinical Pediatrics, 2014
Abstract
Background. Clinician-led tactile stimulation (rubbing the skin adjacent to the injection site or applying pressure) has been demonstrated to reduce pain in children and adults undergoing vaccination. Objective. To evaluate the analgesic effectiveness of clinician-led tactile stimulation in infants undergoing vaccination. Methods. This was a partially blinded randomized controlled trial that included infants undergoing vaccination in a private clinic in Toronto. Infants were randomly allocated to tactile stimulation or no tactile stimulation immediately prior to, during, and after vaccination. The primary outcome was infant pain, assessed using a validated observational measure, the Modified Behavioral Pain Scale (MBPS; range = 0-10). Results. Altogether, 121 infants participated (n = 62 tactile stimulation; n = 59 control); demographics did not differ (P > .05) between groups. MBPS scores did not differ between groups: mean = 7.2 (standard deviation = 2.4) versus 7.6 (1.9); P = .245. Conclusion. Tactile stimulation cannot be recommended as a strategy to reduce vaccination pain in infants because of insufficient evidence of a benefit.

Forbes
http://www.forbes.com/
Accessed 22 March 2014

A Doctor’s Take On The Anti-Vaccine Movement
Today, there are safe and effective vaccines to prevent many types of diseases. Yet a growing number of parents choose not to vaccinate their children, resulting in long-term disability and unnecessary deaths. read »
Robert Pearl, M.D., Contributor

Washington Post
http://www.washingtonpost.com/
Accessed 22 March 2014

Obituaries
Albert Z. Kapikian, prominent National Institutes of Health virologist, dies at 83
Dr. Kapikian led advances in the understanding of the norovirus and the rotavirus.

Vaccines and Global Health: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

.
– Email Summary: Vaccines and Global health : The Week in Review is published as a single email summary, scheduled for release each Saturday eveningbefore midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.
.
– pdf version:  A pdf of the current issues is available here: Vaccines and Global Health_The Week in Review_15 Mar 2014

– 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

Novel Vaccine Trial Design Aims to Answer Key Tuberculosis Questions and Enhance Vaccine Development Strategy
Prevention of infection study underway in South Africa

Excerpt from Media Release
ROCKVILLE, MD, USA & CAPE TOWN, ZA, March 11, 2014 – Aeras today announced the initiation of the first randomized, controlled tuberculosis (TB) vaccine trial designed to study prevention of Mycobacterium tuberculosis (Mtb) infection by vaccination. The Phase II study of the TB vaccine candidate, H4+IC31 (AERAS-404), will evaluate its safety, immunogenicity, and ability to prevent infection by Mtb, the bacterium that causes TB. The trial, which will be conducted in South Africa, will also evaluate BCG revaccination.

This novel trial design establishes a potential new paradigm in TB vaccine development. Clinical development of TB vaccines is hampered by the lack of biologic correlates of protection and lack of validated preclinical models, which could provide evidence of likely efficacy in early stages of development. The prevention of infection trial design enables a smaller, faster proof of concept to help in deciding on advancement into large-scale disease-prevention trials. While a TB vaccine would not need to prevent infection with Mtb to prevent TB disease, prevention of infection with Mtb would be an important marker of biologic impact.

“For the first time in a TB vaccine trial, we will be testing for infection by Mtb, rather than waiting to measure the occurrence of clinical disease, which is more expensive and requires much larger studies,” said Thomas G. Evans, MD, Aeras President and CEO. “This will enable us to obtain results much more quickly and with fewer subjects, and the data we generate will ensure that the entire field of TB vaccine R&D progresses in a more informed and streamlined way.”…
Full text of media release: http://www.aeras.org/pressreleases/novel-vaccine-trial-design-aims-to-answer-key-tuberculosis-questions-and-en#.UyTTyYUWNdc

GPEI Update: Polio this week – As of 12 March 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: In Cameroon, two new wild poliovirus type 1 (WPV1) cases are reported this week, from 2014. The new cases confirm continued transmission of this strain and geographic expansion of infected areas following detection of four cases in October.
:: Newsweek Pakistan published an in-depth interview with Dr Hamid Jafari, WHO, about the current situation of polio eradication in Pakistan. The interview can be accessed here.

Pakistan
:: Three new WPV1 cases were reported in the past week, all from Federally Administered Tribal Areas (FATA – two from North Waziristan and one from South Waziristan). The total number of cases for 2014 is now 27. The total number of cases for 2013 remains 93. The most recent case had onset of paralysis on 15 February 2014 (one of the two WPV1s reported this week from North Waziristan).

Central Africa
:: In Cameroon, two new WPV1 cases were reported in the past week, with onset of paralysis on 6 and 25 January 2014, confirming continued WPV1 transmission and geographic expansion of infected areas following detection of four cases in October.
:: Genetic sequencing suggests prolonged undetected circulation.
:: Since confirmation of the outbreak in October, three nationwide campaigns have been conducted, and a fourth is currently underway. However, quality varies greatly by region, and serious gaps remain. As many as 40% of children remain under-immunized (with 30% having received zero doses).
:: The confirmation of new cases has resulted in planning additional emergency outbreak response activities, including converting a subnational immunization campaign to a full nationwide activity in April 2014, and implementing nationwide campaigns in May and June 2014. Critical to success will be to ensure substantial improvement in the quality campaigns that reach all children multiple times with OPV. Equally important will be efforts to rapidly improve the quality of surveillance so that the full extent of the outbreak can be determined and tracked.

2 killed in latest attack on Pakistan polio workers
Agence France Presse
Published — Tuesday 11 March 2014
PESHAWAR, Pakistan: Two policemen guarding a polio vaccination team in northwest Pakistan were shot dead by armed men on Tuesday, police said, the latest setback to efforts to eradicate the crippling disease.
Militant strikes and threats of violence have badly hampered a campaign to stamp out polio in Pakistan, which along with Nigeria and Afghanistan are the only countries where the disease remains endemic.
Tuesday’s attack took place in the village of Gandi Umar Khan, about 20 km west of the nearest city of Dera Ismail Khan, on the second day of an innoculation drive, senior police official Sadiq Baluch said.
Nisar Khan Marwat, another police officer, confirmed the attack, adding: “Two police officials were accompanying two local polio workers when four gunmen riding on two motorbikes shot at them.”…

Roadside bomb kills 3 polio vaccinators in Afghanistan
ANS
Kabul, March 11: A roadside bomb planted by militants struck a vehicle, killing three polio vaccinators in Afghanistan Tuesday, an official said.
“The vaccinators were going to a village in Sangin district (in Helmand province) at midday today to give polio drops to children when their car ran over a mine. As a result, all three were killed,” Omar Zawak, spokesman of the Helmand provincial government, told Xinhua…

Pakistan to pay parents in new polio vaccination drive
Parents in Khyber Pakhtunkhwa province to get 1,000 rupees for each child who completes vaccinations after Peshawar declared largest reservoir of endemic polio
Jon Boone in Peshawar
theguardian.com, Monday 10 March 2014 08.45 EDT
Parents in one of Pakistan‘s most troubled provinces are to be paid to vaccinate their children against polio, the crippling disease the world is tantalisingly close to eradicating.

It is hoped some 2 million children from some of the most disadvantaged areas of Khyber Pakhtunkhwa (KP), the north-western province wracked by Taliban violence, will benefit from the scheme.

Parents will be entitled to claim 1,000 rupees (almost £6) for each newborn child who completes a 15-month programme of vaccinations that will protect them against a number of diseases including measles, hepatitis and polio.

It is the first time the country has resorted to monetary incentives, which are rarely used around the world.

Public health officials battling childhood diseases face immense challenges in KP, where militant attacks are a daily routine, poverty is entrenched and many people are deeply suspicious of programmes enthusiastically backed by western powers.

“It has to be a good amount of money to be attractive, even in the very poorest districts of the province,” said Janbaz Afridi, deputy director of the province’s expanded programme on immunisation. “If it is a success we will extend it to every child in the province.”…

The Weekly Epidemiological Report (WER) for 14 March 2014, vol. 89, 11 (pp. 105–116) includes:
:: Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness
:: Monthly report on dracunculiasis cases, January 2014
http://www.who.int/entity/wer/2014/wer8911.pdf?ua=1

WHO: Global Alert and Response (GAR) – Disease Outbreak News

http://www.who.int/csr/don/2013_03_12/en/index.html
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 12 March 2014
:: Human infection with avian influenza A(H7N9) virus – update 11 March 2014
:: Human infection with avian influenza A(H7N9) virus – update 11 March 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 11 March 2014

Industry Watch  [to 15 March 2014]
Selected media releases and other selected content from industry.

3/12/14 6:37am EDT
Pfizer Presents Detailed Results From Landmark Community-Acquired Pneumonia Immunization Trial In Adults (CAPiTA) Evaluating Efficacy Of Prevenar 13*
Study Findings, Presented at ISPPD, Demonstrate that Prevenar 13 Can Prevent Vaccine-Type Community-Acquired Pneumonia
Pfizer Inc. (NYSE:PFE) today presented detailed results of the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA), the landmark study of approximately 85,000 subjects, demonstrating that Prevenar 13* (pneumococcal polysaccharide conjugate vaccine [13-valent, adsorbed]) prevented a first episode of vaccine-type community-acquired pneumonia (CAP) in adults 65 years of age and older, the study’s primary objective. This trial is the first in adults to clearly demonstrate a significant reduction in vaccine-type pneumococcal CAP, and importantly, non-bacteremic/non-invasive vaccine-type pneumococcal CAP. Results were presented during the late-breaker session at the 9th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) in Hyderabad, India, on March 12, 2014…

Comment: GAVI Moves on Better Data Verification
Center for Global Development | 11 March 20143/11/14
Victoria Fan  This is a joint post with Kate McQueston.

Excerpt
Data quality and rigorous measurement is important for any funder using performance-based or results-based aid. Poorly measured or self-reported data are often subject to major biases. Indeed, recent CGD research by Justin Sandefur and Amanda Glassman found a clear increase in over-reporting of DTP3 vaccination after GAVI introduced a now defunct pay-for-performance program (its immunization services support program) in the early 2000s.  Thus, strengthening systems to verify data is important and increasingly feasible; recent experience from the World Bank’s HRITF suggests that independent verification of data isn’t overly expensive.

So we’re encouraged by the GAVI Alliance’s new application guidelines, which outline strengthened requirements for data verification of the immunization outcomes used for performance payments as part of its Health System Strengthening (HSS) support. Per the new guidelines, countries must meet both performance goals and “checks and balances for data verification based on WHO/UNICEF estimates, independent assessments of the quality of administrative data, and periodic household surveys.”…

The American Journal of Bioethics
Volume 14, Issue 3, 2014
http://www.tandfonline.com/toc/uajb20/current

The Ethics of Advertising for Health Care Services
Yael Schenkera, Robert M. Arnolda & Alex John Londonb
pages 34-43
Published online: 04 Mar 2014
DOI:10.1080/15265161.2013.879943
http://www.tandfonline.com/doi/abs/10.1080/15265161.2013.879943#.UyTmTYUWNdc

Abstract
Advertising by health care institutions has increased steadily in recent years. While direct-to-consumer prescription drug advertising is subject to unique oversight by the Federal Drug Administration, advertisements for health care services are regulated by the Federal Trade Commission and treated no differently from advertisements for consumer goods. In this article, we argue that decisions about pursuing health care services are distinguished by informational asymmetries, high stakes, and patient vulnerabilities, grounding fiduciary responsibilities on the part of health care providers and health care institutions. Using examples, we illustrate how common advertising techniques may mislead patients and compromise fiduciary relationships, thereby posing ethical risks to patients, providers, health care institutions, and society. We conclude by proposing that these risks justify new standards for advertising when considered as part of the moral obligation of health care institutions and suggest that mechanisms currently in place to regulate advertising for prescription pharmaceuticals should be applied to advertising for health care services more broadly.

American Journal of Public Health
Volume 104, Issue 4 (April 2014)
http://ajph.aphapublications.org/toc/ajph/current

Cumulative Risk of Guillain–Barré Syndrome Among Vaccinated and Unvaccinated Populations During the 2009 H1N1 Influenza Pandemic
Claudia Vellozzi, MD, MPH, Shahed Iqbal, PhD, MBBS, MPH, Brock Stewart, PhD, Jerome Tokars, MD, MPH, and Frank DeStefano, MD, MPH
Claudia Vellozzi, Shahed Iqbal, Brock Stewart, and Frank DeStefano are with the Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Jerome Tokars is with the Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301651

Abstract
Objectives. We sought to assess risk of Guillain–Barré syndrome (GBS) among influenza A (H1N1) 2009 monovalent (pH1N1) vaccinated and unvaccinated populations at the end of the 2009 pandemic.

Methods. We applied GBS surveillance data from a US population catchment area of 45 million from October 15, 2009, through May 31, 2010. GBS cases meeting Brighton Collaboration criteria were included. We calculated the incidence density ratio (IDR) among pH1N1 vaccinated and unvaccinated populations. We also estimated cumulative GBS risk using life table analysis. Additionally, we used vaccine coverage data and census population estimates to calculate denominators.

Results. There were 392 GBS cases; 64 (16%) occurred after pH1N1vaccination. The vaccinated population had lower average risk (IDR = 0.83, 95% confidence interval = 0.63, 1.08) and lower cumulative risk (6.6 vs 9.2 cases per million persons, P = .012) of GBS.

Conclusions. Our findings suggest that at the end of the influenza season cumulative GBS risk was less among the pH1N1vaccinated than the unvaccinated population, suggesting the benefit of vaccination as it relates to GBS. The observed potential protective effect on GBS attributed to vaccination warrants further study

Developing World Bioethics
April 2014   Volume 14, Issue 1  Pages ii–ii, 1–57
http://onlinelibrary.wiley.com/doi/10.1111/dewb.2014.14.issue-1/issuetoc

ARTICLE
Impact of Three Years Training on Operations Capacities of Research Ethics Committees in Nigeria
Morenike Oluwatoyin Folayan, Aisha Adaranijo, Florita Durueke, Ademola Ajuwon, Adebayo Adejumo, Oliver Ezechi, Kola Oyedeji and Olayide Akanni
Article first published online: 24 SEP 2012
DOI: 10.1111/j.1471-8847.2012.00340.x
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-8847.2012.00340.x/abstract

Abstract
This paper describes a three-year project designed to build the capacity of members of research ethics committees to perform their roles and responsibilities efficiently and effectively. The project participants were made up of a cross-section of the membership of 13 Research Ethics Committees (RECs) functioning in Nigeria. They received training to develop their capacity to evaluate research protocols, monitor trial implementation, provide constructive input to trial staff, and assess the trial’s success in promoting community engagement in the research.

Following the training, technical assistance was provided to participants on an ongoing basis and the project’s impacts were assessed quantitatively and qualitatively. Results indicate that sustained investment in capacity building efforts (including training, ongoing technical assistance, and the provision of multiple tools) improved the participants’ knowledge of both the ethical principles relevant to biomedical research and how effective REC should function. Such investment was also shown to have a positive impact on the knowledge levels of other RECs members (those who did not receive training) and the overall operations of the RECs to which the participants belonged. Building the capacity of REC members to fulfill their roles effectively requires sustained effort and investment and pays off by enabling RECs to fulfill their essential mission of ensuring that trials are conducted safely and ethically.

Developing World Bioethics
April 2014   Volume 14, Issue 1  Pages ii–ii, 1–57
http://onlinelibrary.wiley.com/doi/10.1111/dewb.2014.14.issue-1/issuetoc

ARTICLE
The Ethics of Engaged Presence: A Framework for Health Professionals in Humanitarian Assistance and Development Work
Matthew R. Hunt, Lisa Schwartz, Christina Sinding and Laurie Elit
Article first published online: 21 DEC 2012
DOI: 10.1111/dewb.12013
http://onlinelibrary.wiley.com/doi/10.1111/dewb.12013/abstract

Abstract
In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships.

Globalization and Health
[Accessed 15 March 2014]
http://www.globalizationandhealth.com/

Research
Local production of pharmaceuticals in Africa and access to essential medicines: ‘urban bias’ in access to imported medicines in Tanzania and its policy implications
Phares GM Mujinja, Maureen Mackintosh, Mary Justin-Temu and Marc Wuyts
Author Affiliations
Globalization and Health 2014, 10:12  doi:10.1186/1744-8603-10-12
Published: 10 March 2014
http://www.globalizationandhealth.com/content/10/1/12/abstract

Abstract (provisional)
Background
International policy towards access to essential medicines in Africa has focused until recently on international procurement of large volumes of medicines, mainly from Indian manufacturers, and their import and distribution. This emphasis is now being challenged by renewed policy interest in the potential benefits of local pharmaceutical production and supply. However, there is a shortage of evidence on the role of locally produced medicines in African markets, and on potential benefits of local production for access to medicines. This article contributes to filling that gap.

Methods
This article uses WHO/HAI data from Tanzania for 2006 and 2009 on prices and sources of a set of tracer essential medicines. It employs innovative graphical methods of analysis alongside conventional statistical testing.

Results
Medicines produced in Tanzania were equally likely to be found in rural and in urban areas. Imported medicines, especially those imported from countries other than Kenya (mainly from India) displayed ‘urban bias’: that is, they were significantly more likely to be available in urban than in rural areas. This finding holds across the range of sample medicines studied, and cannot be explained by price differences alone. While different private distribution networks for essential medicines may provide part of the explanation, this cannot explain why the urban bias in availability of imported medicines is also found in the public sector.

Conclusions
The findings suggest that enhanced local production may improve rural access to medicines. The potential benefits of local production and scope for their improvement are an important field for further research, and indicate a key policy area in which economic development and health care objectives may reinforce each other.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
April 2014  Volume 10, Issue 4
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/4/

Commentary
Vaccine refrigeration: Thinking outside of the box
Patrick J McColloster and Andres Martin-de-Nicolas
http://dx.doi.org/10.4161/hv.27660
Abstract
This commentary reviews recent changes in Centers for Disease Control (CDC) vaccine storage guidelines that were developed in response to an investigative report by the Office of the Inspector General. The use of temperature data loggers with probes residing in glycol vials is advised along with storing vaccines in pharmaceutical refrigerators. These refrigerators provide good thermal distribution but can warm to 8 °C in less than one hour after the power is discontinued. Consequently, electric grid instability influences appropriate refrigerator selection and the need for power back-up. System Average Interruption Duration Index (SAIDI) values quantify this instability and can be used to formulate region-specific guidelines. A novel aftermarket refrigerator regulator with a battery back-up power supply and microprocessor control system is also described.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
April 2014  Volume 10, Issue 4
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/4/

Commentary
Coercion and polio eradication efforts in Moradabad
Christy A Rentmeester, Rajib Dasgupta, Kristen A Feemster and Randall M Packard
http://dx.doi.org/10.4161/hv.27667
Abstract
We introduce the problem of vaccine coercion as reported in Moradabad, India. We offer commentary and critical analysis on ethical complexities at the intersection of global public health and regional political strife and relate them to broader vaccine goals. We draw upon a historical example from malaria vaccine efforts, focusing specifically on ethical and health justice issues expressed through the use of coercion in vaccine administration. We suggest how coercion is indicative of failed leadership in public health and consider community-based collaborations as models for cultivating local investment and trust in vaccination campaigns and for success in global public health initiatives.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
April 2014  Volume 10, Issue 4
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/4/

Research Paper
Measles epidemic from 1951 to 2012 and vaccine effectiveness in Guangzhou, southern China
Zhicong Yang, Jianxiong Xu, Ming Wang, Biao Di, Huifeng Tan, Qing He, Yanshan Cai, Jianhua Liang, Wensui Hu, Zhiqiang Dong and Chuanxi Fu
http://dx.doi.org/10.4161/hv.27895

Abstract
Background:
Since the National Expanded Program on Immunization was implemented in China, considerable progress has been made in reducing the incidence of measles. However, the incidence of measles increased again in 2004. Few post-marketing studies on measles vaccine effectiveness was reported in China. In this study, we aimed to describe the measles epidemic and to evaluate the effectiveness of the measles vaccine in Guangzhou, southern China.
Methods:

Based on the surveillance data for measles, we investigated the epidemiology during different periods between 1951 and 2012. We analyzed the clinical characteristics of laboratory-confirmed cases of measles between 2009 and 2012 and conducted a case-control study using test-negative cases as controls. We determined the protective effect of measles vaccine.
Results:

The highest annual incidence in Guangzhou was 2187.15/100 000 in 1964, and the lowest was 0.32/100 000 in 2011. The average incidence of measles from 1951 to 2012 was 306.27/100 000. There was a significant tendency of decline in recent years. From 2009 to 2012, there are 700 laboratory-confirmed cases were reported with an average onset age of 2.5 (median) years. The non-vaccinated target population (age <8 months and ≥15 years) accounted for 56.7% of the cases. The transient (non-resident) population accounted for 51.3% of the cases. Fewer cases were observed in the population targeted for measles vaccine (aged 8 months to 14 years). The effectiveness of a single dose of the measles vaccine was 89.1% (95% confidence interval (CI), 44.5–97.9), and the effectiveness of ≥2 doses of the measles vaccine was 97.8% (95% CI, 88.3–99.6) in children aged 8 months to 14 years old.
Conclusions:

There is a significant overall decline in the incidence of measles (including clinical and laboratory confirmed cases) in the measles vaccine targeted population in Guangzhou. Two doses of measles vaccine are more effective than one dose in preventing measles in China. In order to accelerate the elimination of measles, vaccination should also be given to the transient and the non-vaccine targeted population in a national schedule.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
April 2014  Volume 10, Issue 4
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/4/

Special Focus: Therapeutic vaccines

Review
Emerging immunotherapies for rheumatoid arthritis
Gary Reynolds, Faye AH Cooles, John D Isaacs and Catharien MU Hilkens
http://dx.doi.org/10.4161/hv.27910
Abstract

Review
Milestones in contraceptive vaccines development and hurdles in their application
Satish Kumar Gupta, Abhinav Shrestha and Vidisha Minhas
http://dx.doi.org/10.4161/hv.27202
Abstract

Review
 Non-antigenic and antigenic interventions in type 1 diabetes
nna KE Rydén, Johnna D Wesley, Ken T Coppieters and Matthias G Von Herrath
http://dx.doi.org/10.4161/hv.26890
Abstract

Review
Immunotherapeutic approaches to treat multiple myeloma
Mieke WH Roeven, Willemijn Hobo, Nicolaas Schaap and Harry Dolstra
http://dx.doi.org/10.4161/hv.27380
Abstract

Review
Current and potential immune therapies and vaccines in the management of psoriasis
Benjamin H Kaffenberger, Grace L Lee, Kelly Tyler, Derek V Chan, Wael Jarjour, Maria E Ariza, Marshall V Williams and Henry K Wong
http://dx.doi.org/10.4161/hv.27532
Abstract

Review
Obesity vaccines
Mariana P Monteiro
http://dx.doi.org/10.4161/hv.27537
Abstract

Review
Vaccination against Alzheimer disease: An update on future strategies
Antonia Fettelschoss, Franziska Zabel and Martin F Bachmann
http://dx.doi.org/10.4161/hv.28183

The Lancet  
Mar 15, 2014  Volume 383  Number 9921   p927 – 1012
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Global elderly care in crisis
The Lancet
Preview |
The world’s population is ageing rapidly at an unprecedented rate. The proportion of people aged over 60 years will double from about 11% to 22% between 2000 and 2050. Population ageing has profound implications for the burden of disease and social and health-care systems. How well prepared are countries to cope with these changing demographics? Unfortunately, current elderly care systems worldwide are already unable to address the soaring demand from fast growing numbers of older people, even in higher-income countries.

Viewpoint
The right to participate in high-risk research
David Shaw
Preview |
Institutional review boards have a reputation for impeding research. Indeed, many studies are poorly designed, exploit participants, or do not ask a relevant question;1 the rejection of such protocols by institutional review boards is entirely proper. However, institutional review boards also frequently reject or tamper with perfectly sound and relevant studies to protect participants from harm,2 in accordance with the widely accepted message that “clinical research is justified only when participants are protected from excessive risks”.

Nature   
Volume 507 Number 7491 pp139-268  13 March 2014
http://www.nature.com/nature/current_issue.html

Nature | Article
Proof of principle for epitope-focused vaccine design
Bruno E. Correia, John T. Bates, Rebecca J. Loomis, Gretchen Baneyx, Chris Carrico, Joseph G. Jardine, Peter Rupert, Colin Correnti, Oleksandr Kalyuzhniy, Vinayak Vittal, Mary J. Connell, Eric Stevens, Alexandria Schroeter, Man Chen, Skye MacPherson, Andreia M. Serra, Yumiko Adachi,
Margaret A. Holmes, Yuxing Li, Rachel E. Klevit, Barney S. Graham, Richard T. Wyatt, David Baker, Roland K. Strong, James E. Crowe et al.

Abstract
Vaccines prevent infectious disease largely by inducing protective neutralizing antibodies against vulnerable epitopes. Several major pathogens have resisted traditional vaccine development, although vulnerable epitopes targeted by neutralizing antibodies have been identified for several such cases. Hence, new vaccine design methods to induce epitope-specific neutralizing antibodies are needed. Here we show, with a neutralization epitope from respiratory syncytial virus, that computational protein design can generate small, thermally and conformationally stable protein scaffolds that accurately mimic the viral epitope structure and induce potent neutralizing antibodies. These scaffolds represent promising leads for the research and development of a human respiratory syncytial virus vaccine needed to protect infants, young children and the elderly. More generally, the results provide proof of principle for epitope-focused and scaffold-based vaccine design, and encourage the evaluation and further development of these strategies for a variety of other vaccine targets, including antigenically highly variable pathogens such as human immunodeficiency virus and influenza.

PLoS One
[Accessed 15 March 2014]
http://www.plosone.org/

Research Article
The Impact of HPV Female Immunization in Italy: Model Based Predictions
Giorgio Guzzetta mail, Luca Faustini, Donatella Panatto, Roberto Gasparini, Piero Manfredi
Published: March 11, 2014
DOI: 10.1371/journal.pone.0091698
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0091698

Abstract
The Human Papillomavirus (HPV) is a sexually transmitted virus that causes cervical cancer. Since 2008 a vaccination program targeting 12-year-old girls has been initiated in Italy, backing up the cervical screening program already active since 1996. We propose a mathematical model of HPV transmission dynamics with the aim of evaluating the impact of these prevention strategies. The model considers heterosexual transmission of HPV types 16 and 18, structured by sex, age and sexual activity level, where transition to sexual activity is explicitly modeled from recent survey data. The epidemiological structure is a hybrid SIS/SIR, where a fraction of individuals recovering from infection develops permanent immunity against reinfection. Infections may progress to cervical lesions and cancer and heal spontaneously or upon treatment. Women undergoing hysterectomy (either after treatment of HPV lesions or by other causes) also transmit HPV infection. The model fits well both the age-specific prevalence of HPV infections and the incidence of cervical cancers in Italy, and accurately reproduces the decreasing trend in cancer incidence due to the introduction of the screening program. The model predicts that if the screening coverage is maintained at current levels, even in the absence of vaccination, such trend will continue in the next few decades, eventually plateauing at 25% below the current level. The additional initiation of routine vaccination targeting 12-year-old girls will further reduce cervical cancer incidence by two thirds at equilibrium, under realistic assumptions of 70% coverage and a duration of protective immunity of 50 years. If catch-up immunization of 25-year-old women at first cervical screening is also introduced, about 3,000 cervical cancer cases overall can be averted, corresponding to 9.6% of all cases expected in the scenario without catch-up. We conclude that HPV vaccination in addition to cervical screening will significantly reduce the burden of cervical cancer in Italy.

PLoS One
[Accessed 15 March 2014]
http://www.plosone.org/

Research Article
Knowledge and Awareness of HPV Vaccine and Acceptability to Vaccinate in Sub-Saharan Africa: A Systematic Review
Stacey Perlman, Richard G. Wamai, Paul A. Bain, Thomas Welty, Edith Welty, Javier Gordon Ogembo mail
Published: March 11, 2014
DOI: 10.1371/journal.pone.0090912
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0090912

Abstract
Objectives
We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination.

Methods
We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990–2011 were extracted from the World Health Organization database.

Findings
The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above.

Conclusion
There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support.

PLoS Medicine
(Accessed 15 March 2014)
http://www.plosmedicine.org/

Essay
Building Research Capacity in Africa: Equity and Global Health Collaborations
Kathryn M. Chu mail, Sudha Jayaraman, Patrick Kyamanywa, Georges Ntakiyiruta
Published: March 11, 2014
DOI: 10.1371/journal.pmed.1001612
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001612

Summary Points
:: Global health has increased the number of high-income country (HIC) investigators conducting research in low- and middle-income countries (LMICs).

:: Partnerships with local collaborators rather than extractive research are needed.

:: LMICs have to take an active role in leading or directing these research collaborations in order to maximize the benefits and minimize the harm of inherently inequitable relationships.

:: This essay explores lessons from effective and equitable relationships that exist between African countries and HICs.

Introduction
Global health is a growing academic field where high-income country (HIC) faculty and students work in low- and middle-income countries (LMICs), especially in Africa; learn about new cultures, settings, and diseases; and possibly develop an expertise to address existing and emerging challenges in health care [1]. Global health has brought beneficial HIC medical knowledge particularly to African countries: expertise in health policy and planning from high-income settings has improved clinic and hospital infrastructure and practices such as neonatal resuscitation [2],[3]. In addition, research led and supported by HIC researchers has clearly identified preventive and therapeutic interventions for major causes of mortality such as severe malaria, HIV/AIDS, and childhood sepsis [4]–[7].

Worldwide, the highest burden of disease is from LMICs; however, medical research originating from these countries is low [8]. According to one study, sub-Saharan Africa (SSA) produces less than 1% of biomedical publications [9]. Effective research has four pre-requisites: individual research skills and ability, appropriate infrastructure, relevance to national policies, and the ability to contribute to global research and policy needs [10]. African research capacity has not paralleled capacity in HIC for many reasons: few qualified researchers, less funding, poor infrastructure such as laboratories and computers, and lack of expertise in preparing manuscripts for publication [8]. Collaboration with HIC colleagues and institutions has enormous promise to bring expertise, funding, and resources to Africa. However, there is great potential for a power imbalance in these relationships. Much of the research carried out in Africa is led, funded, and published by HIC researchers without equal collaboration from LMIC colleagues. HIC scientists have been accused of extractive research, flying into an LMIC to obtain data or samples and leaving with the recognition and benefits of the publication.

Researchers collecting blood samples for studies have been termed “mosquitoes” or “vampires” [11],[12]. HIC investigators secure most of the funding for global health research projects and often dictate the research agenda [11]. If their values and objectives are different from African partners this can lead to inappropriate projects unrelated to local research needs, and derive conclusions that do not have any direct local benefit [13]. Some participants have commented that these kinds of collaborations leave locals feeling like “prostitutes” [14]. Furthermore, when HIC researchers conduct studies in settings that are unprepared in terms of infrastructure and health workers, research can disrupt local medical and educational services and have a detrimental effect on local health care, usually by taking already overworked health care providers away from their clinical and teaching duties [11],[14],[15].

HIC academics work for universities that typically measure the success of their faculty by research funding and publications. Even if HIC scientists genuinely want to advance African research agendas, building the research capacity of African collaborators may not be an important objective to their institutions [13],[14].

The Challenge
A few questions arise when considering how to engage in equitable global health research:
–       How can African institutions and physicians benefit from international research collaborations without being exploited?
–       How can advancement of African research capacity and academic careers be prioritized while satisfying the “publish or perish” mandate of HIC universities?
–       How do African scientists and governments coordinate the great influx of HIC academics who view the continent as the next frontier in global health research?

This essay describes some of the important steps for African researchers and academic institutions to consider in managing global health research partnerships in their settings…