American Journal of Infection Control
Vol 42 | No. 3 | March 2014 | Pages 215-344
http://www.ajicjournal.org/current

The impact of influenza vaccination requirements for hospital personnel in California: Knowledge, attitudes, and vaccine uptake
Katherine M. Harris, PhD, Lori Uscher-Pines, PhD, Bing Han, PhD, Megan C. Lindley, MPH, Suchita A. Lorick, DO, MPH
http://www.ajicjournal.org/article/S0196-6553%2813%2901315-1/abstract

Abstract
Background
Seasonal influenza infections are a leading cause of illness, death, and lost productivity. Vaccinating health care personnel (HCP) can reduce transmission of influenza virus to patients and reduce influenza-related absenteeism, enabling the health care system to meet elevated demand for care during influenza outbreaks.

Objectives
We evaluated the impact of California’s 2006 influenza vaccination requirement for hospital workers (requiring vaccination or signed declinations) on uptake and vaccination-related attitudes, beliefs, and knowledge among hospital HCP.

Methods
We used a causal difference-in-differences approach to compare changes over the prior 10 years in the self-reported frequency of influenza vaccination for California hospital HCP and those from other states without similar laws using data from a stratified sample (N = 3,529) of HCP drawn from online survey panels. We also examined cross-sectional differences in awareness of vaccination policies, promotion efforts, and attitudes toward influenza vaccination. All analyses used propensity score weighting to balance the observable characteristics of the 2 samples.

Results
We found that compared with their counterparts in other states, California hospital HCP were (1) more likely to report working under a formal written policy for influenza vaccination, (2) no more likely to be vaccinated, and (3) less likely to report working for an employer who provided financial incentives for vaccination or rewarded or recognized employees for being vaccinated.

Conclusion
Our results suggest that state-level vaccination requirements such as those enacted by California, may not be sufficient to increase uptake among hospital HCP.

American Journal of Infection Control
Vol 42 | No. 3 | March 2014 | Pages 215-344
http://www.ajicjournal.org/current

Employee influenza vaccination in residential care facilities
Bettye A. Apenteng, PhD, Samuel T. Opoku, MBChB
http://www.ajicjournal.org/article/S0196-6553%2813%2901303-5/abstract

Abstract
Background
The organizational literature on infection control in residential care facilities is limited. Using a nationally representative dataset, we examined the organizational factors associated with implementing at least 1 influenza-related employee vaccination policy/program, as well as the effect of vaccination policies on health care worker (HCW) influenza vaccine uptake in residential care facilities.

Methods
The study was a cross-sectional study using data from the 2010 National Survey of Residential Care Facilities. Multivariate logistic regression analysis was used to address the study’s objectives.

Results
Facility size, director’s educational attainment, and having a written influenza pandemic preparedness plan were significantly associated with the implementation of at least 1 influenza-related employee vaccination policy/program, after controlling for other facility-level factors. Recommending vaccination to employees, providing vaccination on site, providing vaccinations to employees at no cost, and requiring vaccination as a condition of employment were associated with higher employee influenza vaccination rates.

Conclusion
Residential care facilities can improve vaccination rates among employees by adopting effective employee vaccination policies

BMC Public Health
(Accessed 1 March 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Where is the Gap?: The contribution of disparities within developing countries to global inequalities in under-five mortality
Agbessi Amouzou, Naoko Kozuki and Davidson R Gwatkin
Author Affiliations
BMC Public Health 2014, 14:216  doi:10.1186/1471-2458-14-216
Published: 1 March 2014
http://www.biomedcentral.com/1471-2458/14/216/abstract

Abstract (provisional)
Background
Global health equity strategists have previously focused much on differences across countries. At first glance, the global health gap in health status appears to result primarily from disparities between the developing and developed regions. We examine how much of this disparity could be attributed to within-country disparities in developing nations.

Methods
We used data from Demographic and Health Surveys conducted between 1995 and 2010 in 67 developing countries. Using a population attributable risk approach, we computed the proportion of global under-five mortality gap and the absolute under-five deaths that would be reduced if the under-five mortality rate in each of these 67 countries was lowered to the level of the top 10% economic group in each country. As a sensitivity check, we also conducted comparable calculations replacing the top 10% with the top 5% and with the top 20%.

Results
In 2007, approximately 6.6 million under-five deaths were observed in the 67 countries used in the analysis. This could be reduced to only 600,000 deaths if these countries had the same under-five mortality rate as developed countries. If the under-five mortality rate in developing countries was lowered to the rate among the top 10% economic group in those same each of these countries, under-five deaths would be reduced to 3.7 million. This corresponds to a 48% reduction in the global mortality gap and 2.9 million under-five deaths averted. Using cutoff points of top 5% and top 20% economic groups showed reduction of 37% and 56% respectively in the global mortality gap. With these cutoff points, respectively 2.3 and 3.4 million deaths would be averted.

Conclusion
Under-five mortality disparities within developing countries account for roughly half of the global gap between developed and developing countries. Thus, within-country inequities deserve as much consideration as do inequalities between the world’s developing and developed regions.

BMC Public Health
(Accessed 1 March 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
The informed consent in Southern Italy does not adequately inform parents about infant vaccination
Francesco Attena, Amanda Valdes Abuadili and Sara Marino
Author Affiliations
BMC Public Health 2014, 14:211  doi:10.1186/1471-2458-14-211
Published: 28 February 2014
http://www.biomedcentral.com/1471-2458/14/211/abstract

Abstract (provisional)
Background
Vaccination centres in the Campania Region, southern Italy, vaccinate children with a hexavalent vaccine that contains the mandatory vaccines diphtheria, tetanus, poliomyelitis, and viral Hepatitis B. This vaccine also includes two non-mandatory vaccines, pertussis and Haemophilus influenzae type B. Information about these optional vaccines should be communicated to the parents, and informed consent should be obtained from parents before vaccination. We explored whether informed consent was delivered to the parents, whether they signed the consent form, and whether they read and acquired the information about the vaccination that their child would receive.

Methods
Childhood immunisations are provided at specific public health vaccination centres, “Unita Operative Materno-infantili’s” (UOMIs). We selected four UOMI from the Campania Region where we interviewed 1039 parents bringing their children for the 1st, 2nd, or 3rd doses of hexavalent vaccine. The consent forms were collected from the four vaccination centres and were analysed with respect to clarity and completeness.

Results
Most of the respondents (89.5%) were mothers between 20 and 39 years of age (80.4% vs 59.6% of the fathers), they were married (87.2% vs 93.5% of the fathers), and only one-half of them were employed (50.2% vs 92.6% of the fathers). The informed consent form was received from 58.1% of the parents and signed by 52.8%, but read by 35.0% of them. Only 1.5% of parents knew which vaccines were mandatory, and 25.0% of them believed that the entire hexavalent vaccine was mandatory. When we asked the parents which non-mandatory vaccinations were administered to their children, only 0.5% indicated the Haemophilus influenzae type B and none indicated the pertussis vaccine. Thirty-six per cent of the parents replied that their child had not received any non-mandatory vaccines. No parents were informed by the operators that their children would receive non-mandatory vaccines.

Conclusion
In our study, consent procedures did not allow parents to acquire correct information about vaccine options for their children. Furthermore, not one health care provider informed parents that their child was receiving non-mandatory vaccines. The informed consent process and the individual health care providers did not properly inform parents about the vaccines administered to their children.

BMC Public Health
(Accessed 1 March 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Vaccination coverage and its determinants among migrant children in Guangdong, China
Ke Han12, Huizhen Zheng2*, Zhixiong Huang3, Quan Qiu2, Hong Zeng3, Banghua Chen4 and Jianxiong Xu5
Author Affiliations
For all author emails, please log on.
BMC Public Health 2014, 14:203  doi:10.1186/1471-2458-14-203
Published: 26 February 2014
http://www.biomedcentral.com/1471-2458/14/203/abstract

Abstract
Background
Guangdong province attracted more than 31 million migrants in 2010. But few studies were performed to estimate the complete and age-appropriate immunization coverage and determine risk factors of migrant children.

Methods
1610 migrant children aged 12–59 months from 70 villages were interviewed in Guangdong. Demographic characteristics, primary caregiver’s knowledge and attitude toward immunization, and child’s immunization history were obtained. UTD and age-appropriate immunization rates for the following five vaccines and the overall series (1:3:3:3:1 immunization series) were assessed: one dose of BCG, three doses of DTP, OPV and HepB, one dose of MCV. Risk factors for not being UTD for the 1:3:3:3:1 immunization series were explored.

Results
For each antigen, the UTD immunization rate was above 71%, but the age-appropriate immunization rates for BCG, HepB, OPV, DPT and MCV were only 47.8%, 45.1%, 47.1%, 46.8% and 37.2%, respectively. The 1st dose was most likely to be delayed within them. For the 1:3:3:3:1 immunization series, the UTD immunization rate and age-appropriate immunization rate were 64.9% and 12.4% respectively. Several factors as below were significantly associated with UTD immunization. The primary caregiver’s determinants were their occupation, knowledge and attitude toward immunization. The child’s determinants were sex, Hukou, birth place, residential buildings and family income.

Conclusions
Alarmingly low immunization coverage of migrant children should be closely monitored by NIISS. Primary caregiver and child’s determinants should be considered when taking measures. Strategies to strengthen active out-reach activities and health education for primary caregivers needed to be developed to improve their immunization coverage.

British Medical Journal
01 March 2014 (Vol 348, Issue 7947)
http://www.bmj.com/content/348/7947

Analysis
Prevention is better than cure for emerging infectious diseases
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g1499 (Published 21 February 2014)
Cite this as: BMJ 2014;348:g1499
David L Heymann, professor of infectious disease epidemiology123, Osman A Dar, locum consultant global health 13
Author Affiliations

Excerpt
Emerging infectious diseases have the potential to cause considerable morbidity, mortality, and economic damage. David Heymann and Osman Dar explain why we need to shift the emphasis from responding to emerging infections once they are detected to preventing them from occurring in the first place and describe one initiative that is working to achieve this

Emerging infectious diseases (emerging infections) have caused tens of billions of dollars worth of damage in the past 20 years and the costs are continuing to rise.1 2 Emerging infections can be new infections, such as HIV (when first discovered), which is thought to have emerged in human populations from a non-human primate; or existing infections that are becoming more common or spreading in geographically new areas as a result of changes in the micro-organisms or changing climate and include West Nile fever, Dengue fever, and chikungunya.3

Many people assume that emerging infections are a matter for tropical disease specialists, but they are important to doctors and policy makers, vets, farmers, traders, and economies globally. Although some emerging infections are specific to tropical areas, such as Ebola and Marburg haemorrhagic fevers, infections that emerge there can spread to other parts of the world, as seen with HIV. There are also many examples of diseases originating in non-tropical settings, including severe acute respiratory syndrome (SARS), influenza A (H5N1), variant Creutzfeldt-Jakob disease/bovine spongiform encephalopathy (BSE), and foodborne Escherichia coli O157 infections.4 5 Another problem is infections that have emerged in new forms—for example, multidrug resistant Staphylococcal and Mycobacterial species.

Over the past decades there has been increasing recognition that the way we deal with infectious disease is often reactive and too late. New diseases are often identified only after they have transferred to humans and sometimes many years after the breach in the species …

British Medical Journal
01 March 2014 (Vol 348, Issue 7947)
http://www.bmj.com/content/348/7947

Views & Reviews – Personal View
Research that does not consider participants’ health needs is unethical
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g1423 (Published 11 February 2014)
Cite this as: BMJ 2014;348:g1423
Allen G P Ross, professor, Griffith Health Institute, Griffith University, Gold Coast Campus, Australia
http://www.bmj.com/content/348/bmj.g1423

Excerpt
Research in poor countries must put patients first, writes Allen G P Ross, and ethics committees should insist that this happens

My colleagues and I currently coordinate a five year clinical trial investigating the neglected tropical disease schistosomiasis in the remote Philippines. Twenty two villages and almost 20,000 residents in the municipalities of Laoang and Palapag are taking part.

The Northern Samar province is considered the second poorest in the country, with more than half of its rural inhabitants living below the poverty line. The prevalence of malnutrition is high, with stunting, thinness, and wasting seen in 49%, 28%, and 60% of all children respectively (unpublished data). The burden of infectious disease is also high. The prevalence of schistosomiasis was found to be 27.1% (n=10 436; 95% confidence interval 26.3% to 28.0%) and for infection with any soil transmitted helminth (Ascaris, Trichuris, and hookworm) 77.2% (n=10 434; 76.4% to 78.0%).1

While examining participants I am often asked to help with health problems …

Bulletin of the World Health Organization
Volume 92, Number 3, March 2014, 153-228
http://www.who.int/bulletin/volumes/92/3/en/

Monitoring polio supplementary immunization activities using an automated short text messaging system in Karachi, Pakistan
AM Kazi, A Murtaza, S Khoja, AK Zaidi & SA Ali
http://www.who.int/bulletin/volumes/92/3/13-122564-ab/en/

Abstract
Problem
Polio remains endemic in many areas of Pakistan, including large urban centres such as Karachi.

Approach
During each of seven supplementary immunization activities against polio in Karachi, mobile phone numbers of the caregivers of a random sample of eligible children were obtained. A computer-based system was developed to send two questions – as short message service (SMS) texts – automatically to each number after the immunization activity: “Did the vaccinator visit your house?” and “Did the enrolled child in your household receive oral polio vaccine?” Persistent non-responders were phoned directly by an investigator.

Local setting
A cluster sampling technique was used to select representative samples of the caregivers of young children in Karachi in general and of such caregivers in three of the six “high-risk” districts of the city where polio cases were detected in 2011.

Relevant changes
In most of the supplementary immunization activities investigated, vaccine coverages estimated using the SMS system were very similar to those estimated by interviewing by phone those caregivers who never responded to the SMS messages. In the high-risk districts investigated, coverages estimated using the SMS system were also similar to those recorded – using lot quality assurance sampling – by the World Health Organization.

Lessons learnt
For the monitoring of coverage in supplementary immunization activities, automated SMS-based systems appear to be an attractive and relatively inexpensive option. Further research is needed to determine if coverage data collected by SMS-based systems provide estimates that are sufficiently accurate. Such systems may be useful in other large-scale immunization campaigns.

JAMA   
February 2014, Vol 311, No. 8
http://jama.jamanetwork.com/issue.aspx

Viewpoint | February 26, 2014
A Unified Code of Ethics for Health Professionals – Insights From an IOM Workshop
JAMA. 2014;311(8):799-800. doi:10.1001/jama.2014.504
http://jama.jamanetwork.com/article.aspx?articleid=1832552

A transdiciplinary code of ethics – applicable to all health professionals and created with oublic input – would be a first step toward generating a social contract that can meet the contemporary needs of health professionals and the patients and communities they serve.

JAMA   
February 2014, Vol 311, No. 8
http://jama.jamanetwork.com/issue.aspx

Editorial | February 26, 2014
Nonspecific Effects of Vaccines
David Goldblatt, MBChB, PhD1; Elizabeth Miller, FRCPath2
JAMA. 2014;311(8):804-805. doi:10.1001/jama.2014.471.

Initial text
Vaccination is one of the great public health achievements of the last 100 years.1 The development of vaccination has led to the eradication of smallpox, the reduction of the worldwide incidence of polio by 99%, and the control of measles, with a 74% decline in global measles deaths since 2000.2

With the decline in vaccine-preventable diseases that were once major causes of morbidity and mortality and with the availability of many new vaccines, some targeting diseases that are not major causes of morbidity and mortality in developed countries, public opinion has at times focused on the possible adverse events associated with vaccination rather than their benefit. In recent years these have included high-profile concerns surrounding the association of autism with either combined live viral vaccines (measles-mumps-rubella [MMR]) or preservatives (thimerosal) in combination vaccines. Both associations have now been refuted following careful scientific studies.3 Unexpected benefits of vaccination have also been reported but have attracted less attention. These include the apparent effect of live vaccines such as measles and BCG on reducing mortality from infections other than measles or tuberculosis…4

…

Journal of Community Health
Volume 39, Issue 2, April 2014
http://link.springer.com/journal/10900/39/1/page/1

Attitudes Affecting the Potential Use of Human Papillomavirus Vaccination: A Survey of Health Promotion Students in Mexico City
Angélica Dolores Ramírez-Rios, William Bonnez
http://link.springer.com/article/10.1007/s10900-013-9770-1

Abstract
Our aim was to explore the knowledge and attitudes of Mexican college students towards human papillomavirus (HPV) vaccination. We conducted a written questionnaire survey of a group of male and female undergraduate students in Health Promotion at the Autonomous University of Mexico City. A total of 163 subjects (40 males and 123 females, median age 24 years) took part. Only 13 % identified the risks factors of cervical cancer and 32 % knew the diseases caused by HPV. Females had a better knowledge than males on matters related to HPV vaccine. Seventy percent (110 of 157) of the respondents completely agreed on the importance of including protection against genital warts in the vaccine. Eighty-eight percent (141/161) of subjects would have accepted receiving the vaccine, but 8 % (13/161) were ambivalent. There was a strong desire in this group of young adults who are not yet included in the current vaccination programs to receive the HPV vaccine, preferably the quadrivalent one. In conclusion, attitudes towards vaccination could be complex and opposed.

Journal of Community Health
Volume 39, Issue 2, April 2014
http://link.springer.com/journal/10900/39/1/page/1

Ethnic and Gender Differences in HPV Knowledge, Awareness, and Vaccine Acceptability Among White and Hispanic Men and Women
Rachel A. Reimer, Julie A. Schommer, Amy E. Houlihan, Meg Gerrard
http://link.springer.com/article/10.1007/s10900-013-9773-y

Abstract
The purpose of this study was to examine factors associated with human papillomavirus (HPV) knowledge and awareness, and HPV vaccination among White and Hispanic males and females. Differences in HPV knowledge, sources of information, vaccine awareness, vaccination status, and interest in vaccination were examined. A community sample was recruited from local health care clinics in a medium sized Midwestern city between May 2010 and December 2011. Participants (N = 507) were White (n = 243) and Hispanic, males (n = 202) and females between the ages of 15–30. Results indicate that White and female participants were significantly more likely to have heard of HPV, have higher levels of HPV knowledge, have been diagnosed with HPV, and be aware of the HPV vaccine for women. White and female participants were also more likely to have heard of HPV from their physician and were significantly more interested in receiving the HPV vaccine in the future. There was no effect of ethnicity on interest in the vaccine per a doctor’s recommendation, however. Findings suggest that Whites and females have greater levels of HPV awareness and knowledge and that, while Hispanic participants are less likely than White participants to be told about the HPV vaccine from their provider, they may be equally receptive to such a recommendation.

The Lancet  
Mar 01, 2014  Volume 383  Number 9919   p755 – 844
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Every newborn, every mother, every adolescent girl
The Lancet
Preview |
With the launch of a new report by Save the Children this week, the momentum to achieve substantial reductions in neonatal mortality is accelerating. Ending Newborn Deaths: Ensuring Every Baby Survives is a continuation of Save the Children’s No Child Born to Die campaign. The report presents a powerful reminder of the reasons for neonatal deaths, identifies eight essential areas for intervention, and proposes a five-point Newborn Promise plan to end all preventable newborn deaths, which governments and others should commit to this year.

The Lancet Global Health
Mar 2014   Volume 2  Number 3  e117 – 181
http://www.thelancet.com/journals/langlo/issue/current

Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries
Dr Andrea Nove PhD a, Prof Zoë Matthews PhD b, Sarah Neal PhD b, Alma Virginia Camacho MD c
http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2813%2970179-7/abstract

Summary
Background
Adolescents are often noted to have an increased risk of death during pregnancy or childbirth compared with older women, but the existing evidence is inconsistent and in many cases contradictory. We aimed to quantify the risk of maternal death in adolescents by estimating maternal mortality ratios for women aged 15—19 years by country, region, and worldwide, and to compare these ratios with those for women in other 5-year age groups.

Methods
We used data from 144 countries and territories (65 with vital registration data and 79 with nationally representative survey data) to calculate the proportion of maternal deaths among deaths of females of reproductive age (PMDF) for each 5-year age group from 15—19 to 45—49 years. We adjusted these estimates to take into account under-reporting of maternal deaths, and deaths during pregnancy from non-maternal causes. We then applied the adjusted PMDFs to the most reliable age-specific estimates of deaths and livebirths to derive age-specific maternal mortality ratios.

Findings
The aggregated data show a J-shaped curve for the age distribution of maternal mortality, with a slightly increased risk of mortality in adolescents compared with women aged 20—24 years (maternal mortality ratio 260 [uncertainty 100—410] vs 190 [120—260] maternal deaths per 100 000 livebirths for all 144 countries combined), and the highest risk in women older than 30 years. Analysis for individual countries showed substantial heterogeneity; some showed a clear J-shaped curve, whereas in others adolescents had a slightly lower maternal mortality ratio than women in their early 20s. No obvious groupings were apparent in terms of economic development, demographic characteristics, or geographical region for countries with these different age patterns.

Interpretation
Our findings suggest that the excess mortality risk to adolescent mothers might be less than previously believed, and in most countries the adolescent maternal mortality ratio is low compared with women older than 30 years. However, these findings should not divert focus away from efforts to reduce adolescent pregnancy, which are central to the promotion of women’s educational, social, and economic development.

Funding
WHO, UN Population Fund.

The Lancet Global Health
Mar 2014   Volume 2  Number 3  e117 – 181
http://www.thelancet.com/journals/langlo/issue/current

Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis
Britt McKinnon MSc a, Sam Harper PhD a, Prof Jay S Kaufman PhD a, Yves Bergevin MD b
http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2814%2970008-7/abstract

Summary
Background
Neonatal mortality rates (NMRs) in countries of low and middle income have been only slowly decreasing; coverage of essential maternal and newborn health services needs to increase, particularly for disadvantaged populations. Our aim was to produce comparable estimates of changes in socioeconomic inequalities in NMR in the past two decades across these countries.

Methods
We used data from Demographic and Health Surveys (DHS) for countries in which a survey was done in 2008 or later and one about 10 years previously. We measured absolute inequalities with the slope index of inequality and relative inequalities with the relative index of inequality. We used an asset-based wealth index and maternal education as measures of socioeconomic position and summarised inequality estimates for all included countries with random-effects meta-analysis.

Findings
24 low-income and middle-income countries were eligible for inclusion. In most countries, absolute and relative wealth-related and educational inequalities in NMR decreased between survey 1 and survey 2. In five countries (Cameroon, Nigeria, Malawi, Mozambique, and Uganda), the difference in NMR between the top and bottom of the wealth distribution was reduced by more than two neonatal deaths per 1000 livebirths per year. By contrast, wealth-related inequality increased by more than 1·5 neonatal deaths per 1000 livebirths per year in Ethiopia and Cambodia. Patterns of change in absolute and relative educational inequalities in NMR were similar to those of wealth-related NMR inequalities, although the size of educational inequalities tended to be slightly larger.

Interpretation
Socioeconomic inequality in NMR seems to have decreased in the past two decades in most countries of low and middle income. However, a substantial survival advantage remains for babies born into wealthier households with a high educational level, which should be considered in global efforts to further reduce NMR.

Funding
Canadian Institutes of Health Research.

The Lancet Infectious Diseases
Mar 2014  Volume 14  Number 3   p173 – 256
http://www.thelancet.com/journals/laninf/issue/current

Efficacy and safety of a patch vaccine containing heat-labile toxin from Escherichia coli against travellers’ diarrhoea: a phase 3, randomised, double-blind, placebo-controlled field trial in travellers from Europe to Mexico and Guatemala
Ronald H Behrens, Jakob P Cramer, Tomas Jelinek, Hilary Shaw, Frank von Sonnenburg, Darren Wilbraham, Thomas Weinke, David J Bell, Edwin Asturias, Hermann L Enkerlin Pauwells, Roberto Maxwell, Mercedes Paredes-Paredes, Gregory M Glenn, Shailesh Dewasthaly, Donald M Stablein, Zhi-Dong Jiang, Herbert L DuPont
Preview |
Although the LT antigen was delivered effectively by the skin patch, the vaccine did not protect travellers against diarrhoea caused by ETEC or other organisms. Future vaccines against travellers’ diarrhoea might need to include several antigens against various diarrhoeal pathogens, and might need to be able to generate mucosal and higher systemic immunity.

The Lancet Infectious Diseases
Mar 2014  Volume 14  Number 3   p173 – 256
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Pandemic potential of emerging influenza
The Lancet Infectious Diseases
Preview |
In January this year, the first case of highly pathogenic avian influenza H5N1 was detected in the Americas when a Canadian man returning from Beijing fell ill and subsequently died. January also saw a sharp upturn in the number of cases of H7N9 avian influenza in China with 169 cases detected in 1 month, compared with 144 up to the end of last year since it was first identified in March 2013. Another familiar virus, 2009 pandemic influenza A H1N1 has also been hitting the headlines in Egypt, where there have been over 300 cases and around 38 deaths since December, and in Mexico over 400 deaths have been associated with H1N1 this year.

Review
Pandemic influenza A H1N1 vaccines and narcolepsy: vaccine safety surveillance in action
Charlotte I S Barker, Matthew D Snape
Preview |
The 2009 influenza A H1N1 pandemic placed unprecedented demand on public health authorities and the vaccine industry. Efforts were coordinated internationally to maximise the speed of vaccine development, distribution, and delivery, and the European Union’s novel fast-track authorisation procedures mandated increased postmarketing surveillance to monitor vaccine safety. Clinicians in Finland and Sweden later identified an apparent increase in the incidence of narcolepsy associated with a specific adjuvanted pandemic influenza vaccine.

The Pediatric Infectious Disease Journal
March 2014 – Volume 33 – Issue 3  pp: 233-335,e67-e86
http://journals.lww.com/pidj/pages/currenttoc.aspx

A Consensus Statement: Meningococcal Disease Among Infants, Children and Adolescents in Latin America
Rüttimann, Ricardo Walter; Gentile, Angela; Parra, Mercedes Macias; More

Abstract
Invasive meningococcal disease is a serious infection that occurs worldwide. Neisseria meningitidis remains one of the leading causes of bacterial meningitis in all ages. Despite the availability of safe and effective vaccines against invasive meningococcal disease, few countries in Latin America implemented routine immunization programs with these vaccines. The Americas Health Foundation along with Fighting Infectious Disease in Emerging Countries recently sponsored a consensus conference. Six experts in infectious diseases from across the region addressed questions related to this topic and formulated the following recommendations: (1) standardized passive and active surveillance systems should be developed and carriage studies are mandatory; (2) a better understanding of the incidence, case fatality rates and prevalent serogroups in Latin America is needed; (3) countries should make greater use of the polymerase chain reaction assays to improve the sensitivity of diagnosis and surveillance of invasive meningococcal disease; (4) vaccines with broader coverage and more immunogenicity are desirable in young infants; (5) prevention strategies should include immunization of young infants and catch-up children and adolescents and (6) because of the crowded infant immunization schedule, the development of combined meningococcal vaccines and the co-administration with other infant vaccines should be explored.

Pediatrics
March 2014, VOLUME 133 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml

Article
Duration of Protection After First Dose of Acellular Pertussis Vaccine in Infants
Helen E. Quinn, PhD, MAEa,b, Thomas L. Snelling, BMBS (Hons), Grad Dip Clin Epidc,
Kristine K. Macartney, MBBS, BMedSci, MDa,b, and Peter B. McIntyre, MBBS, PhDa,b
Author Affiliations
aNational Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, and
bDiscipline of Paediatrics and Child Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia; and
cTelethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, West Perth, Western Australia, Australia
http://pediatrics.aappublications.org/content/133/3/e513.abstract

Abstract
OBJECTIVE: Data on the effectiveness of the diphtheria–tetanus–acellular pertussis (DTaP) vaccine in the first 4 years of life are sparse. We evaluated the vaccine effectiveness (VE) of 1 and 2 doses of DTaP before 6 months of age and of 3 doses from 6 months of age in Australia, where, since 2003, a fourth dose is not given until 4 years.

METHODS: We matched reported pertussis cases aged 2 to 47 months between January 2005 and December 2009 to controls from a population-based immunization register by date of birth and region of residence. VE by number of doses and age group was calculated as (1 – odds ratio) × 100%.

RESULTS: VE against hospitalization increased from 55.3% (95% confidence interval [CI], 42.7%–65.1%) for 1 dose before 4 months of age to 83.0% (95% CI, 70.2%–90.3%) for 2 doses before 6 months. The VE of 3 doses of DTaP against all reported pertussis was 83.5% (95% CI, 79.1%–87.8%) between 6 and 11 months, declining to 70.7% (95% CI, 64.5%–75.8%) between 2 and 3 years of age and 59.2% (95% CI, 51.0%–66.0%) between 3 and 4 years of age.

CONCLUSIONS: DTaP provided good protection against pertussis in the first year of life from the first dose. Without a booster dose, the effectiveness of 3 doses waned more rapidly from 2 to 4 years of age than previously documented for children >6 years of age who had received 5 doses.

Pediatrics
March 2014, VOLUME 133 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml

Article
Vaccine Financing From the Perspective of Primary Care Physicians
Sean T. O’Leary, MD, MPHa,b, Mandy A. Allison, MD, MSPHa,b, Megan C. Lindley, MPHc, Lori A. Crane, PhD, MPHa,d, Laura P. Hurley, MD, MPHa,e,f, Michaela Brtnikova, PhDa, Brenda L. Beaty, MSPHa,f, Christine I. Babbel, MSPHa, Andrea Jimenez-Zambrano, MPHa, Stephen Berman, MDb, and Allison Kempe, MD, MPHa,b,f
Author Affiliations
aChildren’s Outcomes Research, Children’s Hospital Colorado, Aurora, Colorado;
bDepartment of Pediatrics, and
fColorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado;
cNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
dDepartment of Community & Behavioral Health, Colorado School of Public Health, Denver, Colorado; and
eDivision of General Internal Medicine, Denver Health and Hospital Authority, Denver, Colorado
http://pediatrics.aappublications.org/content/133/3/367.abstract

Abstract
OBJECTIVES: Because of high purchase costs of newer vaccines, financial risk to private vaccination providers has increased. We assessed among pediatricians and family physicians satisfaction with insurance payment for vaccine purchase and administration by payer type, the proportion who have considered discontinuing provision of all childhood vaccines for financial reasons, and strategies used for handling uncertainty about insurance coverage when new vaccines first become available.

METHODS: A national survey among private pediatricians and family physicians April to September 2011.

RESULTS: Response rates were 69% (190/277) for pediatricians and 70% (181/260) for family physicians. Level of dissatisfaction varied significantly by payer type for payment for vaccine administration (Medicaid, 63%; Children’s Health Insurance Program, 56%; managed care organizations, 48%; preferred provider organizations, 38%; fee for service, 37%; P < .001), but not for payment for vaccine purchase (health maintenance organization or managed care organization, 52%; Child Health Insurance Program, 47%; preferred provider organization, 45%; fee for service, 41%; P = .11). Ten percent of physicians had seriously considered discontinuing providing all childhood vaccines to privately insured patients because of cost issues. The most commonly used strategy for handling uncertainty about insurance coverage for new vaccines was to inform parents that they may be billed for the vaccine; 67% of physicians reported using 3 or more strategies to handle this uncertainty.

CONCLUSIONS: Many primary care physicians are dissatisfied with payment for vaccine purchase and administration from third-party payers, particularly public insurance for vaccine administration. Physicians report a variety of strategies for dealing with the uncertainty of insurance coverage for new vaccines.

Pediatrics
March 2014, VOLUME 133 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml

Article
Risk Perceptions and Subsequent Sexual Behaviors After HPV Vaccination in Adolescents
Allison Mayhew, BAa, Tanya L. Kowalczyk Mullins, MD, MSa,b, Lili Ding, PhDb, Susan L. Rosenthal, PhDc, Gregory D. Zimet, PhDd, Charlene Morrow, RNb, and Jessica A. Kahn, MD, MPHa,b
Author Affiliations
aUniversity of Cincinnati College of Medicine, Cincinnati, Ohio;
bDepartment of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
cDepartment of Pediatrics, Columbia University Medical Center and New York-Presbyterian Morgan Stanley Children’s Hospital, New York, New York; and
dDepartment of Pediatrics, Indiana University, Indianapolis, Indiana
http://pediatrics.aappublications.org/content/133/3/404.abstract

Abstract
OBJECTIVES: Concerns have been raised that human papillomavirus (HPV) vaccination could lead to altered risk perceptions and an increase in risky sexual behaviors among adolescents. The aim of this study was to assess whether adolescent risk perceptions after the first vaccine dose predicted subsequent sexual behaviors.

METHODS: Young women 13 to 21 years of age (N=339) completed questionnaires immediately after HPV vaccination, and 2 and 6 months later, assessing demographic characteristics, knowledge/attitudes about HPV vaccination, risk perceptions, and sexual behaviors. Risk perceptions were measured by using 2 5-item scales assessing: (1) perceived risk of sexually transmitted infections (STI) other than HPV, and (2) perceived need for safer sexual behaviors after HPV vaccination. We assessed associations between risk perceptions at baseline and sexual behaviors over the next 6 months by using logistic regression, stratifying participants by sexual experience at baseline and age (13–15 vs 16–21 years).

RESULTS: Among all sexually inexperienced participants (42.5%), baseline risk perceptions were not associated with subsequent sexual initiation; in age-stratified analyses, girls 16 to 21 years of age who reported lower perceived risk for other STI (an inappropriate perception) were less likely to initiate sex (odds ratio [OR] 0.13, 95% confidence interval [CI] 0.03–0.69). Among all sexually experienced participants (57.5%) and in age-stratified analyses, baseline risk perceptions were not associated with subsequent number of sexual partners or condom use.

CONCLUSIONS: Risk perceptions after HPV vaccination were not associated with riskier sexual behaviors over the subsequent 6 months in this study sample

PLoS One
[Accessed 1 March 2014]
http://www.plosone.org/

Research Article
Monitoring What Governments “Give for” and “Spend on” Vaccine Procurement: Vaccine Procurement Assistance and Vaccine Procurement Baseline
E. A. S. Nelson mail, David E. Bloom, Richard T. Mahoney
Published: February 20, 2014
DOI: 10.1371/journal.pone.0089593
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0089593

Abstract
Background
The Global Vaccine Action Plan will require, inter alia, the mobilization of financial resources from donors and national governments – both rich and poor. Vaccine Procurement Assistance (VPA) and Vaccine Procurement Baseline (VPB) are two metrics that could measure government performance and track resources in this arena. VPA is proposed as a new subcategory of Official Development Assistance (ODA) given for the procurement of vaccines and VPB is a previously suggested measure of the share of Gross Domestic Product (GDP) that governments spend on their own vaccine procurement.

Objective
To determine realistic targets for VPA and VPB.

Methods
Organization for Economic Co-Operation and Development (OECD) and World Bank data for 2009 were analyzed to determine the proportions of bilateral ODA from the 23 Development Assistance Committee (DAC) countries disbursed (as % of GDP in current US$) for infectious disease control. DAC country contributions to the GAVI Alliance for 2009 were assessed as a measure of multilateral donor support for vaccines and immunization programs.

Findings
In 2009, total DAC bilateral ODA was 0.16% of global GDP and 0.25% of DAC GDP. As a percentage of GDP, Norway (0.013%) and United Kingdom (0.0085%) disbursed the greatest proportion of bilateral ODA for infectious disease control, and Norway (0.024%) and Canada (0.008%) made the greatest contributions to the GAVI Alliance. In 2009 0.02% of DAC GDP was US$7.61 billion and 0.02% of the GDP of the poorest 117 countries was US$2.88 billion.

Conclusions
Adopting 0.02% GDP as minimum targets for both VPA and VPB is based on realistic estimates of what both developed and developing countries should spend, and can afford to spend, to jointly ensure procurement of vaccines recommended by national and global bodies. New OECD purpose codes are needed to specifically track ODA disbursed for a) vaccine procurement; and b) immunization programs

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

Editorial
Indonesia: An Emerging Market Economy Beset by Neglected Tropical Diseases (NTDs)
Melody Tan, Rita Kusriastuti, Lorenzo Savioli, Peter J. Hotez mail
Published: February 27, 2014
DOI: 10.1371/journal.pntd.0002449
http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002449;jsessionid=5C7F466B45FE35D9D6526E55F6C5F59E

Despite an enormous population and growing economy, the nation of Indonesia has some of the world’s highest concentrations of neglected tropical diseases (NTDs). These NTDs may thwart future national growth and recent gains. Yet, Indonesia and its Ministry of Health, together with the World Health Organization (WHO), have embarked on an ambitious effort to quickly assemble a health and scientific infrastructure suitable for eliminating its NTDs.

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH
January 2014 Vol. 35, No. 1

http://www.paho.org/journal/index.php?option=com_content&view=article&id=137&Itemid=233&lang=en

Gasto en salud, la desigualdad en el ingreso y el índice de marginación en el sistema de salud de México [Health expenditures, income inequality, and the marginalization index in Mexico’s health system]
Carlos Eduardo Pinzón Florez, Ludovic Reveiz, Elvaro J. Idrovo y Hortensia Reyes Morales

Functioning outcomes for abused immigrant women and their children 4 months after initiating intervention [Resultados en cuanto al desempeño de mujeres inmigrantes maltratadas y sus hijos, 4 meses después de iniciada una intervención]
Sandra K. Cesario, Angeles Nava, Ann Bianchi, Judith McFarlane, and John Maddoux

Structural social determinants and catastrophic illnesses in municipalities in the Colombian department of Valle del Cauca [Determinantes sociales estructurales y enfermedades catastróficas en los municipios del departamento colombiano del Valle del Cauca]
Luis Miguel Tovar Cuevas and Fernando Arteaga Suárez

Fatores associados a cárie dental e doença periodontal em indígenas na América Latina: revisão sistemática [Factors associated with dental caries and periodontal diseases in Latin American indigenous peoples: a systematic review]
Pedro Alves Filho, Ricardo Ventura Santos e Mario Vianna Vettore

Vaccine
Volume 32, Issue 13, Pages 1421-1522 (14 March 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

Benefits of using vaccines out of the cold chain: Delivering Meningitis A vaccine in a controlled temperature chain during the mass immunization campaign in Benin
Original Research Article
Pages 1431-1435
Simona Zipursky, Mamoudou Harouna Djingarey, Jean-Claude Lodjo, Laifoya Olodo, Sylvestre Tiendrebeogo, Olivier Ronveaux

Abstract
Background
In October 2012, the Meningococcal A conjugate vaccine MenAfriVac was granted a label variation to allow for its use in a controlled temperature chain (CTC), at temperatures of up to 40 °C for not more than four days. This paper describes the first field use of MenAfriVac in a CTC during a campaign in Benin, December 2012, and assesses the feasibility and acceptability of the practice.

Methods
We implemented CTC in one selected district, Banikoara (target population of 147,207; 1–29 years of age), across 14 health facilities and 150 villages. We monitored the CTC practice using temperature indicators and daily monitoring sheets. At the end of the campaign we conducted a face-to-face survey to assess vaccinators’ and supervisors’ experience with CTC.

Findings
A mix of strategies were implemented in the field to maximize the benefits from CTC practice, depending on the distance from health centre to populations and the availability of a functioning refrigerator in the health centre. Coverage across Banikoara was 105.7%. Over the course of the campaign only nine out of approx. 15,000 vials were discarded due to surpassing the 4 day CTC limit and no vial was discarded because of exposure to a temperature higher than 40 °C or due to the Vaccine Vial Monitor (VVM) reaching its endpoint. Overall confidence and perceived usefulness of the CTC approach were very high among vaccinators and supervisors.

Interpretation
Vaccinators and supervisors see clear benefits from the CTC approach in low income settings, especially in hard-to-reach areas or where cold chain is weak. Taking advantage of the flexibility offered by CTC opens the door for the implementation of new immunization strategies to ensure all those at risk are protected.

Vaccine
Volume 32, Issue 12, Pages 1323-1420 (10 March 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/12

The cost-effectiveness of influenza vaccination in elderly Australians: An exploratory analysis of the vaccine efficacy required
Pages 1323-1325
Anthony T. Newall, Juan Pablo Dehollain

Abstract
It is important to consider the value for money offered by existing elderly influenza vaccination programs, particularly as doubts persist about the magnitude of the effectiveness of such programs. An informative approach to explore the value of vaccination is to consider what vaccine efficacy would be required for a program to be considered cost-effective. To estimate the cost-effectiveness of the current elderly (65+ years) influenza vaccination program in Australia, we modelled how the hypothetical removal of vaccination would increase current disease burden estimates depending on alternative vaccine efficacy assumptions. The base-case results of the analysis found that the existing elderly vaccination program is likely to be cost-effective (under A$50,000 per quality-adjusted life year gained) if the vaccine efficacy is above ∼30%. This study offers reassurance that the influenza vaccination of elderly Australians is likely to offer value for money.

Vaccine
Volume 32, Issue 12, Pages 1323-1420 (10 March 2014)
Refusal of oral polio vaccine in northwestern Pakistan: A qualitative and quantitative study

Original Research Article
Pages 1382-1387
Hitoshi Murakami, Makoto Kobayashi, Masahiko Hachiya, Zahir S. Khan, Syed Q. Hassan, Shinsaku Sakurada

Abstract
Background
Refusal of the oral polio vaccine (OPV) is a difficulty faced by the Polio Eradication Initiative (PEI) in multiple endemic areas, including the Khyber Pakhtunkhwa Province (KPP), Pakistan. In 2007, we investigated community perceptions of the OPV and estimated the prevalence of OPV refusal in three districts in Swat Valley, KPP, a polio-endemic area.

Methods
Qualitative data concerning community perceptions were collected by focus group discussions among lady health workers (LHWs) and mothers with children <1 year old and by key informant interviews with local health managers and officials. Quantitative data collection followed using a questionnaire survey of 200 LHWs and a cluster sampling survey of 210 mothers (per district) with children <1 year old.

Results
The qualitative assessments identified the grounded theory of OPV refusal involving facts known by the residents that are related to the OPV (too frequent OPV campaigns, an OPV boycott in northern Nigeria in 2003 and that birth control is viewed as is against Islam), the local interpretations of these facts (perceptions that OPV contained birth control or pork, that OPV was a foreign/central plot against Muslims, and that the vaccination was against the Hadith and the fate determined by God) and different manifestations of OPV refusal. Among the three districts studied, the proportion of LHWs who encountered OPV refusal ranged from 0 to 33%, whereas among the districts, the proportions of mothers unwilling to give OPV to their children ranged from 0.5 to 5.7%. Refusal of other injectable vaccines was almost equally prevalent for reasons that were very similar.

Conclusions
The PEI needs to reflect local value system in the path to polio eradication in the studied districts in the Swat Valley. The religious and cultural values as well as the interpretation of the international political situation are of particular importance.

Vaccine
Volume 32, Issue 12, Pages 1323-1420 (10 March 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/12

Overcoming the knowledge–behavior gap: The effect of evidence-based HPV vaccination leaflets on understanding, intention, and actual vaccination decision
Original Research Article
Pages 1388-1393
O. Wegwarth, S. Kurzenhäuser-Carstens, G. Gigerenzer

Abstract
Objective
Informed decision making requires transparent and evidence-based (=balanced) information on the potential benefit and harms of medical preventions. An analysis of German HPV vaccination leaflets revealed, however, that none met the standards of balanced risk communication.

Methods
We surveyed a sample of 225 girl–parent pairs in a before–after design on the effects of balanced and unbalanced risk communication on participants’ knowledge about cervical cancer and the HPV vaccination, their perceived risk, their intention to have the vaccine, and their actual vaccination decision.

Results
The balanced leaflet increased the number of participants who were correctly informed about cervical cancer and the HPV vaccine by 33 to 66 absolute percentage points. In contrast, the unbalanced leaflet decreased the number of participants who were correctly informed about these facts by 0 to 18 absolute percentage points. Whereas the actual uptake of the HPV vaccination 14 months after the initial study did not differ between the two groups (22% balanced leaflet vs. 23% unbalanced leaflet; p=.93, r=.01), the originally stated intention to have the vaccine reliably predicted the actual vaccination decision for the balanced leaflet group only (concordance between intention and actual uptake: 97% in the balanced leaflet group, rs=.92, p=.00; 60% in the unbalanced leaflet group, rs=.37, p=.08).

Conclusion
In contrast to a unbalanced leaflet, a balanced leaflet increased people’s knowledge of the HPV vaccination, improved perceived risk judgments, and led to an actual vaccination uptake, which first was robustly predicted by people’s intention and second did not differ from the uptake in the unbalanced leaflet group. These findings suggest that balanced reporting about HPV vaccination increases informed decisions about whether to be vaccinated and does not undermine actual uptake.

Vaccines — Open Access Journal
(Accessed 1 March 2014)
http://www.mdpi.com/journal/vaccines

Review: DNA/MVA Vaccines for HIV/AIDS
by Smita S. Iyer and Rama R. Amara
Vaccines 2014, 2(1), 160-178; doi:10.3390/vaccines2010160 – published online 28 February 2014
Abstract:
Since the initial proof-of-concept studies examining the ability of antigen-encoded plasmid DNA to serve as an immunogen, DNA vaccines have evolved as a clinically safe and effective platform for priming HIV-specific cellular and humoral responses in heterologous “prime-boost” vaccination regimens. Direct injection of plasmid DNA into the muscle induces T- and B-cell responses against foreign antigens. However, the insufficient magnitude of this response has led to the development of approaches for enhancing the immunogenicity of DNA vaccines. The last two decades have seen significant progress in the DNA-based vaccine platform with optimized plasmid constructs, improved delivery methods, such as electroporation, the use of molecular adjuvants and novel strategies combining DNA with viral vectors and subunit proteins. These innovations are paving the way for the clinical application of DNA-based HIV vaccines. Here, we review preclinical studies on the DNA-prime/modified vaccinia Ankara (MVA)-boost vaccine modality for HIV. There is a great deal of interest in enhancing the immunogenicity of DNA by engineering DNA vaccines to co-express immune modulatory adjuvants. Some of these adjuvants have demonstrated encouraging results in preclinical and clinical studies, and these data will be examined, as well.

Review: DNA Immunization for HIV Vaccine Development
by Yuxin Chen, Shixia Wang and Shan Lu
Vaccines 2014, 2(1), 138-159; doi:10.3390/vaccines2010138 – published online 25 February 2014
Abstract:
DNA vaccination has been studied in the last 20 years for HIV vaccine research. Significant experience has been accumulated in vector design, antigen optimization, delivery approaches and the use of DNA immunization as part of a prime-boost HIV vaccination strategy. Key historical data and future outlook are presented. With better understanding on the potential of DNA immunization and recent progress in HIV vaccine research, it is anticipated that DNA immunization will play a more significant role in the future of HIV vaccine development.

Current Opinion in Immunology
Volume 28,   In Progress   (June 2014)
http://www.sciencedirect.com/science/journal/09527915

Challenges and responses in human vaccine development
Stefan HE Kaufmann1, M Juliana McElrath2, David JM Lewis3, Giuseppe Del Giudice4

Highlights
:: Reverse, structural and synthetic vaccinology to accelerate novel vaccine design.
:: Systems analysis of multiparametric data to predict reactogenicity and efficacy.
:: Current pipeline for major infectious diseases promises partially effective vaccines.
:: Vaccine trials can be harnessed for further vaccine improvement.
:: Concerns of use of adenovirus vectors in persons at risk for HIV infection.

Abstract
Human vaccine development remains challenging because of the highly sophisticated evasion mechanisms of pathogens for which vaccines are not yet available. Recent years have witnessed both successes and failures of novel vaccine design and the strength of iterative approaches is increasingly appreciated. These combine discovery of novel antigens, adjuvants and vectors in the preclinical stage with computational analyses of clinical data to accelerate vaccine design. Reverse and structural vaccinology have revealed novel antigen candidates and molecular immunology has led to the formulation of promising adjuvants. Gene expression profiles and immune parameters in patients, vaccinees and healthy controls have formed the basis for biosignatures that will provide guidelines for future vaccine design.

Economist
http://www.economist.com/
Accessed 1 March 2014

Cancer in the developing world
Worse than AIDS
The burden of cancer is falling increasingly heavily on the poor
Mar 1st 2014 | From the print edition

Excerpt
SARA STULAC is a paediatrician, but doctors in Rwanda must be adaptable. One of her first patients after arriving from America in 2005 was a young girl with a tumour the size of a cauliflower on her face. The girl’s father, a subsistence farmer, had tried traditional healers and local doctors, but the tumour had grown, along with his expenses. An oncologist was needed. If only the country had one. Eventually Dr Stulac called one in America who talked her through the treatment that would save the girl’s life.

What makes this story unusual is its happy ending. According to the International Agency for Research on Cancer (IARC), part of the World Health Organisation (WHO), low- and middle-income countries accounted for 57% of the 14m people diagnosed with cancer worldwide in 2012—but 65% of the deaths. Cancer kills more people in poor countries than AIDS, malaria and tuberculosis combined…