Science
18 April 2014 vol 344, issue 6181, pages 225-332
http://www.sciencemag.org/current.dtl
Editorial
Influenza and the Live Poultry Trade
George F. Gao
George F. Gao is director of the CAS Key Laboratory of Pathogenic Microbiology and Immunology at the Institute for Microbiology of the Chinese Academy of Sciences, Beijing; vice president of the Beijing Institutes of Life Science, Beijing; president of the Chinese Society for Virology, Beijing; and deputy director general of the Chinese Center for Disease Control and Prevention, Beijing.
Preview
Live poultry trade at local markets has long been a part of China’s national identity. From small villages to big cities, the gathering and selling of different birds in this vibrant atmosphere is at the heart of the country’s cuisine culture. Unfortunately, the backdrop to this tradition has changed. Last year, the H7N9 virus, a new strain of influenza A, jumped from birds to humans, causing 144 cases of human infection and 47 deaths in China. Now a second wave of this flu is coursing through the country, with 258 confirmed cases and 99 deaths as of 8 April 2014. Scientific evidence points to a connection between the conditions at these live markets and the spread of flu, suggesting that until other means are found to prevent the transmission of or effectively treat the illness, China must shut down live poultry markets to prevent further spread of the virus and a possible global pandemic.
Read the Full Text

Vaccine
Volume 32, Issue 22, Pages 2521-2666 (7 May 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

Progress on pursuit of human cytomegalovirus vaccines for prevention of congenital infection and disease
Review Article
Pages 2525-2533
Tong-Ming Fu, Zhiqiang An, Dai Wang
Abstract
Congenital infection of human cytomegalovirus (HCMV) is the leading cause of childhood hearing loss and mental retardation. Unfortunately, a preventive vaccine remains elusive. Two strategies have been employed to develop HCMV vaccines, including (1) attenuating HCMV to generate modified virus vaccines and (2) isolating subunit viral antigen(s) to create individual antigen vaccines. The most studied candidate in each category is live attenuated Towne virus and recombinant gB/MF59 vaccine, respectively. Although both were moderately efficacious, neither could induce the durable, robust humoral and cellular immunity commonly seen in HCMV seropositive subjects. In addition, both vaccines failed to induce neutralizing antibodies against viral infection of endothelial cells, epithelial cells and leukocytes. This review summarizes the recent understanding of host natural immunity to HCMV, including the importance of antibodies targeting HCMV epithelial tropism, and discusses its implications for vaccine design. We also highlight some recent key discoveries that may lead to the development of an effective HCMV vaccine.

Vaccine
Volume 32, Issue 22, Pages 2521-2666 (7 May 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

Acceptability of immunization in adult contacts of infants: Possibility of expanding platforms to increase adult vaccine uptake
Original Research Article
Pages 2540-2545
Elizabeth Rossmann Beel, Marcia A. Rench, Diana P. Montesinos, C. Mary Healy
Highlights
:: Adult contacts of infants are willing to receive recommended vaccines during prenatal clinic appointments, infant hospital or clinic visits.
:: Males had higher vaccine hesitancy than females. Perceived barriers to vaccination differed between males and females.
:: Expanding existing immunization platforms may increase adult vaccine uptake.
Abstract
Objective
Adult vaccination coverage is low and current strategies are unlikely to achieve Healthy People 2020 targets. We determined the attitude of adult infant contacts toward recommended adult vaccines and their willingness to receive vaccines should they be available during hospital visits or prenatal or infant clinic appointments.
Methods
Survey of predominantly Hispanic, underinsured and medically underserved infant contacts at a county hospital in Houston, Texas where a pertussis cocooning program is offered.
Results
Two hundred and eighty-five contacts (mean age 32.8 years [18–73]; 94.8% Hispanic) participated. Most were fathers (58.2%), followed by aunts (19%), and grandparents (12.3%). Participants used many health information sources. 221 (77.5%) considered healthcare providers the most influential on their decisions but only 51.6% reported healthcare visits within the prior year. Forty-one (14.4%) discussed family vaccinations during prenatal visits. Preferred locations for adult vaccination were hospital or clinic-based (96.5%). Lack of knowledge (22.8%), fear of pain/needles (14.7%), work commitments (14%), lack of transport (11.2%), cost (10.2%) and fear of side effects (5.3%) were barriers to vaccination. More males than females reported fear of pain/needles and work commitments (P 0.01 and P 0.02, respectively), and more females lack of transport (P < 0.001) as barriers. Most planned to (76.1%) or had received (7%) pertussis vaccine; if available, 73.3%, 53.3% and 50.5% expressed willingness to receive vaccines against influenza, pneumonia and meningitis, respectively. Age, ethnicity or education was not associated with willingness to be vaccinated. Vaccine acceptance was higher in females than males for pertussis (P 0.04), influenza (P 0.008), pneumonia (P 0.04), and meningitis (P 0.006) vaccines by multiple regression analysis.
Conclusions
Most adults were willing to be vaccinated if offered during hospital visits or clinic appointments for mother or infant. Development and expansion of recommended immunization platforms, such as the cocooning platform, offers the opportunity to increase adult vaccination coverage.

Vaccine
Volume 32, Issue 22, Pages 2521-2666 (7 May 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

Ready or not? School preparedness for California’s new personal beliefs exemption law
Original Research Article
Pages 2563-2569
Marissa Wheeler, Alison M. Buttenheim
Abstract
Objective
This paper describes elementary school officials’ awareness of and preparedness for the implementation of California’s new exemption law that went into effect on January 1, 2014. The new law prescribes stricter requirements for claiming a personal beliefs exemption from mandated school-entry immunizations.
Method
We used cross-sectional data collected from a stratified random sample of 315 schools with low, middle, and high rates of personal beliefs exemptions. We described schools’ awareness and specific knowledge of the new legislation and tested for differences across school types. We additionally tested for associations between outcome variables and school and respondent characteristics using ordered logit and negative binomial regression. Finally, we described schools’ plans and needs for implementing the new legislation.
Results
Elementary school staff reported an overall low level of awareness and knowledge about the new legislation and could identify few of its features. We observed, however, that across the exemption-level strata, respondents from high-PBE schools reported significantly higher awareness, knowledge and feature identification compared to respondents from low-PBE schools. Multivariate analyses revealed only one significant association with awareness, knowledge and identification: respondent role. Support staff roles were associated with lower odds of having high self-rated awareness or knowledge compared to health workers, as well as with a reduced log count of features identified. Though most school officials were able to identify a communication plan, schools were still in need of resources and support for successful implementation, in particular, the need for information on the new law.
Conclusion
Schools need additional information and support from state and local agencies in order to successfully implement and enforce California’s new school immunization law. In particular, our results suggest the need to ensure information on the new law reaches all levels of school staff.

Vaccine
Volume 32, Issue 22, Pages 2521-2666 (7 May 2014)
http://www.sciencedirect.com/science/journal/0264410X/32
Cost-effectiveness and equity impacts of three HPV vaccination programmes for school-aged girls in New Zealand
Original Research Article
Pages 2645-2656
Tony Blakely, Giorgi Kvizhinadze, Tanja Karvonen, Amber L. Pearson, Megan Smith, Nick Wilson
Abstract
Background
As with many high-income countries, vaccination coverage against human papilloma virus (HPV) infection is not high in New Zealand (NZ) at 47% in school-aged girls for three doses. We estimate the health gains, net-cost and cost-effectiveness of the currently implemented HPV national vaccination programme of vaccination dispersed across schools and primary care, and two alternatives: school-based only (assumed coverage as per Australia: 73%), and mandatory school-based vaccination but with opt-out permitted (coverage 93%). We also generate estimates by social group (sex, ethnic and deprivation group).
Methods
A Markov macro-simulation model was developed for 12-year-old girls and boys in 2011, with future health states of: cervical cancer, pre-cancer (CIN I–III), genital warts, and three other HPV-related cancers (oropharyngeal, anal, vulvar cancer). In each state health sector costs, including additional health sector costs from extra life, and quality-adjusted life years (QALYs) were accumulated.
Results
The current HPV vaccination programme has an estimated cost-effectiveness of NZ$18,800/QALY gained (about US$9700/QALY gained using the OECD’s purchasing power parities; 95% UI: US$6900 to $33,700) compared to the status quo in NZ prior to 2008 (no vaccination, screening alone). The incremental cost-effectiveness ratio (ICER) of an intensive school-based only programme of girls, compared to the current situation, was US$33,000/QALY gained. Mandatory vaccination appeared least cost-effective (ICER compared to school-based of US$117,000/QALY gained, but with wide 95% uncertainty limits from $56,000 to $220,000). All interventions generated more QALYs per 12-year-old for Māori (indigenous population) and people living in deprived areas (range 5–25% greater QALYs gained).
Interpretation
A more intensive school-only vaccination programme seems warranted. Reductions in vaccine price will greatly improve cost-effectiveness of all options, possibly making a law for mandatory vaccination optimal from a health sector perspective. All interventions could reduce ethnic and socioeconomic disparities in HPV-related disease.

Vaccine: Development and Therapy
(Accessed 19 April 2014)
http://www.dovepress.com/vaccine-development-and-therapy-journal
Current progress toward vaccines against Toxoplasma gondii
Review
João Luis Garcia,1 Elisabeth A Innes,2 Frank Katzer2
1Department of Preventative Veterinary Medicine, Center of Agricultural Science, State University of Londrina, Parana, Brazil; 2Moredun Research Institute, Pentlands Science Park, Edinburgh, Scotland
Published Date April 2014 Volume 2014:4 Pages 23 – 37
DOI: http://dx.doi.org/10.2147/VDT.S57474
Abstract:
Toxoplasma gondii is an intracellular protozoan parasite that can infect many warm-blooded animal species and humans. Despite substantial knowledge of the biology, epidemiology, and host-pathogen interactions of T. gondii, there are still very few effective control strategies to prevent oocyst shedding in cats, tissue cysts in livestock for consumption, and infection and disease in humans. This article reviews current progress and targets for vaccination against T. gondii.

Vaccines — Open Access Journal
(Accessed 19 April 2014)
http://www.mdpi.com/journal/vaccines
Review
Vaccine Potentiation by Combination Adjuvants
by Benoît Levast, Sunita Awate, Lorne Babiuk, George Mutwiri, Volker Gerdts and Sylvia van Drunen Littel-van den Hurk
Vaccines 2014, 2(2), 297-322; doi:10.3390/vaccines2020297 – published online 14 April 2014
Abstract:
Adjuvants are crucial components of vaccines. They significantly improve vaccine efficacy by modulating, enhancing, or extending the immune response and at the same time reducing the amount of antigen needed. In contrast to previously licensed adjuvants, current successful adjuvant formulations often consist of several molecules, that when combined, act synergistically by activating a variety of immune mechanisms. These “combination adjuvants” are already registered with several vaccines, both in humans and animals, and novel combination adjuvants are in the pipeline. With improved knowledge of the type of immune responses needed to successfully induce disease protection by vaccination, combination adjuvants are particularly suited to not only enhance, but also direct the immune responses desired to be either Th1-, Th2- or Th17-biased. Indeed, in view of the variety of disease and population targets for vaccine development, a panel of adjuvants will be needed to address different disease targets and populations. Here, we will review well-known and new combination adjuvants already licensed or currently in development—including ISCOMs, liposomes, Adjuvant Systems Montanides, and triple adjuvant combinations—and summarize their performance in preclinical and clinical trials. Several of these combination adjuvants are promising having promoted improved and balanced immune responses.

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

Neurology
April 8, 2014 vol. 82 no. 10 Supplement S34.005
http://www.neurology.org/content/current
Vaccines and the Risk of Multiple Sclerosis and Other CNS Demyelinating Diseases (S34. 005)
Annette Langer-Gould1, Lie Chen2, Sara Tartof2, Chun Chao2 and Hung-Fu Tseng2
Abstract
OBJECTIVE: To determine whether vaccines increase the risk of multiple sclerosis (MS) or other CNS demyelinating diseases over the short and longer-term.
BACKGROUND: Clinicians have reported temporal associations between vaccine administration and onset of MS or other CNS demyelinating diseases. Yet, whether vaccines, particularly for hepatitis B (HepB) and human papilloma virus (HPV), can trigger MS or other CNS demyelinating diseases remains controversial.
DESIGN/METHODS: We conducted a case-control study from the membership of Kaiser Permanente Southern California (KPSC). Cases were identified through the KPSC Acquired Demyelinating Diseases (ADS) Cohort between 2008 and 2011. Five controls per case were matched on age, sex and zip code. Data were obtained from the complete electronic health record and analyzed using conditional logistic regression, adjusted for race/ethnicity, health care utilization, and infectious illnesses prior to symptom onset.
RESULTS: We identified 780 incident cases of CNS ADS and 3885 controls, of which 92 cases and 459 controls were women ages 9-26 years, the indicated age rage for HPV vaccination. There were no associations between hepatitis B vaccination (OR 1.12, 95% CI 0.72-1.73); HPV vaccination (OR 1.05 95% CI 0.62-1.78); or any vaccination (OR 1.03, 95% CI 0.86-1.22) and the risk of CNS ADS up to 3 years later. Vaccination of any type was associated with an increased risk of CNS ADS onset within the first 30 days after vaccination in younger (<50 years) individuals only (OR 2.32, 95%CI 1.18-4.57).
CONCLUSIONS: We found no longer-term association of vaccines with MS or other CNS demyelinating diseases, which argues against a causal association. The short-term increase in risk suggests vaccines may accelerate the transition from subclinical to overt autoimmunity in patients with existing disease. Our findings do not suggest a need for change in vaccine policy.
Study Supported by: Kaiser Permanente Direct Community Benefit Funds and NIH-NINDS, 1R01NS075308 PI: Langer-Gould)
Disclosure: Dr. Langer-Gould has received research support from Biogen Idec and Roche. Dr. Chen has nothing to disclose. Dr. Tartof has nothing to disclose. Dr. Chao has nothing to disclose. Dr. Tseng has nothing to disclose.

Current Opinion in Pediatrics
April 2014 – Volume 26 – Issue 2 pp: v-vi,137-264
http://journals.lww.com/co-pediatrics/pages/currenttoc.aspx
CURRENT OPINION Child and adolescent immunizations: selected review of recent US recommendations and literature
Kao, Carol M.; Schneyer, Rebecca J.; Bocchini, Joseph A. Jr.
Abstract
Purpose of review: To provide a clinically relevant summary of the latest research and recommendations regarding childhood and adolescent immunizations.
Recent findings: Childhood vaccination has dramatically reduced pediatric morbidity and mortality in the United States. Recent research on childhood and adolescent immunizations has focused on expanding the use of current vaccines for additional subpopulations as well as the development of new vaccines. In particular, data confirming the safety and immunogenicity of vaccines in various groups of children have shaped national guidelines. Furthermore, studies on vaccine uptake, cost-effectiveness, and impact of vaccination have reinforced the importance of adhering to these guidelines. More work needs to be done by providers and parents to increase vaccination coverage rates to better protect children and adolescents from these serious diseases. In this article, selected recent publications and recommendations on the following vaccines are reviewed: influenza, meningococcal conjugate, childhood and adolescent/adult formulations of diphtheria and tetanus toxoids and acellular pertussis, pneumococcal conjugate, and human papillomavirus.
Summary: Research on childhood and adolescent vaccinations continues to shape future guidelines. Through this work, we can learn how to optimize the protection of all children and adolescents against vaccine-preventable diseases.

Cell
Volume 157, Issue 2 April 10, 2014
http://www.cell.com/cell/current
Essay
Peering into the Crystal Ball: Influenza Pandemics and Vaccine Efficacy
Matthew S. Miller, Peter Palese
Volume 157, Issue 2, p294–299, 10 April 2014
DOI: http://dx.doi.org/10.1016/j.cell.2014.03.023
Summary
The looming threat of a new influenza virus pandemic has fueled ambitious efforts to devise more predictive parameters for assessing the risks associated with emergent virus strains. At the same time, a comprehensive understanding of critical factors that can accurately predict the outcome of vaccination is sorely needed in order to improve the effectiveness of influenza virus vaccines. Will new studies aimed at identifying adaptations required for virus transmissibility and systems-level analyses of influenza virus vaccine responses provide an improved framework for predictive models of viral adaptation and vaccine efficacy?

GAVI Watch [to 12 April 2014]
http://www.gavialliance.org/library/news/press-releases/

:: Anuradha Gupta appointed Deputy CEO of the GAVI Alliance
The GAVI Alliance announced the appointment of Anuradha Gupta as its new Deputy CEO, noting that “with more than 30 years of experience in public health and public policy, Ms. Gupta brings with her a wealth of management and leadership expertise, a proven track record of success and a passion for making a profound social impact.” Ms. Gupta is currently Additional Secretary, Ministry of Health and Family Welfare and Mission Director of the National Health Mission, Government of India. During this time “she has played an integral role in India’s hugely successful polio eradication program, taking strategic decisions that helped secure a polio-free India – a feat once considered impossible by many observers.” Ms Gupta will join the GAVI Executive Office on 2nd June and will be based at the Alliance’s headquarters in Geneva.

Dr Seth Berkley, CEO of the GAVI Alliance, said, “I am personally very excited to see Anuradha become part of our team, bringing her tremendous expertise, experience and passion. We are moving forward into a phase of massive expansion of GAVI-supported immunisation programmes so Anuradha’s extensive management experience and deep understanding of country-level immunisation challenges will prove invaluable. Additionally, with 20 countries expected to graduate away from GAVI support by 2020, Anuradha’s broad multi-sectorial expertise and proven ability to deliver results will help to steer the Alliance through this unprecedented transitional phase.” Ms. Gupta holds an MBA from Wollongong University in Australia and has read Public Policy at Maxwell School in the United States. She has also received executive education at Stanford Business School and John F. Kennedy School, Harvard University.

Ms. Gupta succeeds current GAVI Alliance Deputy CEO Helen Evans, “who is retiring after a career that has also seen her hold key positions in the Australian Health Ministry and the Global Fund to Fight AIDS, Tuberculosis and Malaria. She joined the GAVI Alliance in 2009 and was interim CEO during the successful replenishment event in 2011 which saw donors commit US$ 7.4 billion towards Alliance immunisation programmes.” Dr Berkley noted, “Helen will be greatly missed by all connected with GAVI. Her successful spell as interim CEO laid the foundations for the huge acceleration of vaccine introductions that we are able to support today. We are sad that she is retiring but we are pleased for her that she will be able to be closer geographically to her family for the first time in more than a decade.”

Full media release: Geneva, 10 April 2014 http://www.gavialliance.org/Library/News/Press-releases/2014/Anuradha-Gupta-appointed-Deputy-CEO-of-the-GAVI-Alliance/

UNICEF Watch [to 12 April 2014]
http://www.unicef.org/media/media_67204.html

Joint press release: First mass vaccination campaigns start since polio found in Iraq
WHO-UNICEF
AMMAN, 6 April 2014
Excerpt – Editor’s text bolding
Polio vaccination campaigns commenced in Syria, Iraq and Egypt today, aiming to reach more than 20 million children over the next five days. For Iraq, this will be the first nationwide vaccination campaign since a case of polio was confirmed by the Ministry of Health on 30 March in a six-month-old boy from Rusafa, northern Baghdad. Maria Calivis, UNICEF Regional Director for the Middle East and North Africa, said, “The recent detection of a polio case in Iraq after a 14-year absence is a reminder of the risk currently facing children throughout the region. It is now even more imperative to boost routine immunisations to reach every child multiple times and do whatever we can to vaccinate children we could not reach in previous rounds. That’s the only way we will prevent this outbreak from spreading further.”..
…“Midway into the implementation of this outbreak response plan, we’re reaching the vast majority of children across the Middle East,” said Chris Maher, WHO Manager for Polio Eradication and Emergency Support. “In the second phase of the outbreak response we must work with local partners to reach the hardest-to-reach – those pockets of children who continue to miss out, especially in Syria’s besieged and conflict areas and in remote areas of Iraq. We won’t stop until we reach them.” …Since the outbreak was announced UNICEF has delivered 14 million doses of polio vaccines to Syria.
http://www.unicef.org/media/media_73006.html

WHO: Summary of the SAGE April 2014 meeting
Excerpt – Editor’s text bolding
4 April 2014 – SAGE reviewed the status of inactivated polio vaccine (IPV) introduction globally and the outcomes of the recent UNICEF tender process for IPV. SAGE noted that the vaccine will now be available to GAVI-supported countries for EURO 0.75 per dose (approximately US$1 per dose at current exchange rates) and EURO 1.50 to 2.40 per dose (approximately USD$2.1-3.3 per dose at current exchange rates) for middle-income countries. SAGE concurred that these represent the best possible IPV prices in the near term and constitute a firm basis for proceeding with the goal of global IPV introduction by the end of 2015 as an integral part of the polio endgame strategy. SAGE reaffirmed the need for all countries to have completed planning for IPV introduction before the end of 2014.

SAGE reviewed the progress towards eventual confirmation of a specific date for global type 2 oral polio vaccine (OPV2) withdrawal, which requires the absence of ‘persistent’ type 2 circulating vaccine-derived poliovirus (cVDPV2) for at least 6 months globally. SAGE was alarmed by the persistent cVDPV2 circulation in northern Nigeria (since July 2005) and Pakistan (since August 2012), highlighting that these areas overlapped with some of the last wild poliovirus (WPV) reservoirs in the world. Stopping circulation of both WPVs and cVDPVs requires addressing gaps in supplementary immunization activity quality, increasing access, and using an appropriate mix of trivalent and bivalent oral poliovirus vaccine over the coming 10 months. SAGE emphasized that the elimination of persistent cVDPV2s by the end of 2014 or early-2015 must be a high priority to ensure that the global eradication effort remain on-track for achieving the major milestones of the Polio Eradication & Endgame Strategic Plan 2013-18. SAGE urged countries to rectify the mix of OPV being used in large-scale immunization campaigns in cVDPV2-infected areas to ensure that OPV2 can be withdrawn during the ‘low season’ for poliovirus transmission in 2016, as originally scheduled.

Upon reviewing the relevant scientific evidence, SAGE endorsed the updates made to the existing WHO vaccination recommendations for travellers from polio-infected countries in International Travel and Health (ITH).

SAGE reiterated the importance of providing human papillomavirus immunization to girls as early as necessary, i.e. in girls aged 9 to 13 years prior to sexual debut, based on local data and patterns of sexual activity. Upon review of the evidence, SAGE recommended a 2-dose schedule for girls, if vaccination is initiated prior to 15 years of age. A 3-dose schedule remains necessary if immunization is initiated after the girls’ 15th birthday. The recommended minimal interval between the 2 doses is 6 months. This interval may be extended to 12 months if this facilitates administration. A 3-dose schedule (i.e. at 0, 1-2, and 6 months) remains recommended for immunocompromised individuals, including those known to be HIV-infected.

Following the review of data on pertussis, SAGE concluded that the licensed acellular pertussis vaccines (aP) have lower initial efficacy, faster waning of immunity, and possibly a reduced impact on disease transmission relative to currently internationally available whole-cell vaccines (wP). The risk of resurgence of pertussis associated with the use of aP vaccines including increased infant disease, indicates that countries currently using wP should continue using wP vaccines for early infant vaccination.

SAGE reviewed current initiatives to improve coordination and integration of vaccination with other critical maternal and child health services, and assessed what additional measures in this context may be needed to strengthen synergies at the global, regional, national, district and service delivery levels. SAGE was pleased to hear of Ethiopia’s experience in improving child survival and achieving the fourth Millennium development goal to cut child deaths by two-thirds between 1990 and 2015 through integrated delivery of life-saving interventions.

The full meeting report will be published in the WHO Weekly Epidemiological Record on 23 May 2014.
:: View the meeting documents, including presentations and background readings
http://www.who.int/immunization/sage/meetings/2014/april/report_summary_april_2014/en/

GPEI Update: Polio this week – As of 9 April 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: First mass vaccination campaigns started in the Middle East since a polio case was reported in Iraq. Polio vaccination campaigns commenced in Syria, Iraq and Egypt on 6 April and Turkey on 7 April, aiming to reach more than 20 million children over five days. For Iraq, this is the first nationwide vaccination campaign since a case of polio in a six-month-old boy from northern Baghdad was confirmed by the Ministry of Health on 30 March.
:: Last week, WHO’s Strategic Advisory Group of Experts on immunization (SAGE) convened in Geneva. In addition to reviewing the global epidemiology of polio transmission, SAGE endorsed the updates made to the existing WHO vaccination recommendations for travelers from polio-infected countries in International Travel and Health (ITH). Additionally, SAGE reviewed progress towards setting a confirmed date for the trivalent to bivalent OPV switch, which requires the absence of persistent circulating vaccine-derived poliovirus type 2 (cVDPV2) for at least six months globally.
:: SAGE expressed alarm at the persistent cVDPV2s in northern Nigeria and Pakistan, highlighting that these areas overlapped with some of the last wild poliovirus (WPV) reservoirs in the world. Stopping circulating of both cVDPV2s and WPVs requires addressing gaps in supplementary immunization activity (SIA) quality, increasing access and using an appropriate mix of trivalent and bivalent OPV over the coming months. A summary of the SAGE meeting is available here. The full SAGE meeting report will be published in the WHO Weekly Epidemiological Record (WER) on 23 May 2014.
Pakistan
:: Three new WPV1 cases were reported this week from North Waziristan, Federally Administered Tribal Areas – FATA, and one new WPV1 from Bannu district, Khyber Pakhtunkhwa (KP), bringing the total number of cases for 2014 to 43. The most recent reported case had onset of paralysis on 20 March from North Waziristan.
:: One new cVDPV2 case was reported in the past week with onset of paralysis on 21 February, from FR Bannu, FATA. The total number of cVDPV2 cases is 45 for 2013, and seven for 2014
Central Africa
:: A new WPV1 case was reported this week from Malabo, the capital of Equatorial Guinea, with onset of paralysis on 19 March. The total number of WPV1 cases reported from Equatorial Guinea for 2014 is two.
:: Due to continued poliovirus circulation in Cameroon, gaps in surveillance quality and influx of vulnerable populations from Central African Republic (CAR), WHO had elevated the risk assessment of international spread of polio from Cameroon to ‘very high’ in March of 2014.
:: Since confirmation of the outbreak in Cameroon in October, five nationwide campaigns have been conducted. However, the quality of implementation varied greatly by region, and serious coverage gaps remain. As many as 40% of children remain under-immunized (with 30% having received zero doses) during SIAs.
:: The recent confirmation of new cases in Cameroon has resulted in planning additional emergency outbreak response activities, including converting a subnational immunization campaign to a full nationwide activity on 11-13 April, and implementing nationwide campaigns in May and June. Critical to success will be to ensure substantial improvement in the quality campaigns so that all children are reached 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.
:: Immunity levels and surveillance sensitivity are also being assessed in neighboring countries, in particular in Gabon and the Republic of Congo, and additional immunization activities are being planned in these countries in April (Gabon) and May (Republic of Congo).

The Weekly Epidemiological Record (WER) for 11 April 2014, vol. 89, 15 (pp. 153–160) Includes:
:: Meeting of the International Task Force for Disease Eradication, January 2014
http://www.who.int/entity/wer/2014/wer8915.pdf?ua=1

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 12 April 2014]
http://www.who.int/csr/don/2013_03_12/en/index.html
:: Human infection with avian influenza A(H7N9) virus – update 11 April 2014
The Centre for Health Protection (CHP), Hong Kong, SAR, China and the National Health and
Family Planning Commission (NHFPC) of China recently notified WHO of 2 additional
laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus…The
overall risk assessment has not changed
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 11 April 2014
On 9 April 2014, the Ministries of Health of Jordan notified WHO of an additional laboratory-
confirmed case of infection with Middle East respiratory syndrome coronavirus (MERS-CoV)…
Globally, from September 2012 to date, WHO has been informed of a total of 212 laboratory-
confirmed cases of infection with MERS-CoV, including 88 deaths. [No change in WHO
recommendations]
:: Ebola virus disease, West Africa – update 10 April 2014
…WHO’s response
WHO, in collaboration with technical partners in the Global Outbreak Alert and Response
Network (GOARN) has deployed field laboratory support, and continues to identify and deploy
experts in anthropology, epidemiology and data management, outbreak logistics, clinical case
management and infection prevention and control, social mobilisation, risk communications
and outbreak coordination to support the response in all of the affected countries. Over 50
experts have been deployed to date and response supplies, including PPE and a variety of
EVD communication and education materials for local adaptation, have been dispatched to
affected and neighbouring countries.
As EVD in West Africa continues to evolve, the number of reported cases and deaths,
contacts under medical observation and the number of laboratory results are subject to
change due to consolidation of case, contact and laboratory data, enhanced surveillance and
contact tracing activities and ongoing laboratory investigations.
WHO does not recommend that any travel or trade restrictions be applied to Guinea,
Liberia, Mali or Sierra Leone based on the current information available for this event.
:: Human infection with avian influenza A(H7N9) virus – update 10 April 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 10 April 2014
:: Human infection with avian influenza A(H7N9) virus – update 8 April 2014
:: Human infection with avian influenza A(H7N9) virus – update 8 April 2014
:: Ebola virus disease, West Africa – update7 April 2014

The EU Commission approved a Joint Procurement Agreement “which will enable all EU countries to procure pandemic vaccines and other medical countermeasures as a group, rather than individually.” The approach is intended “to ensure that pandemic vaccines and medicines are available in sufficient quantities and at a correct price should a cross border health threat emerge. The mechanism will benefit all EU countries, in particular the ones which encountered difficulties in purchasing vaccines developed for the H1N1 pandemic in 2009. 27 EU countries have declared their intention to sign the Agreement. The Joint Procurement Agreement is voluntary, and will enter into force two weeks after it has been signed by a third of participating Member States (10 countries) and the Commission.”
http://europa.eu/rapid/press-release_IP-14-418_en.htm

The Indonesia Health Fund was established by a group led by Dato Sri Dr. Tahir, Chairman of the Tahir Foundation in Indonesia, and an initial investment of US$40 million from eight Indonesian business leaders in partnership with the Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Bill Gates, co-chair of the Bill & Melinda Gates Foundation, took part in a signing ceremony in Jakarta on 5 April with Dr. Tahir and the other philanthropists. The Gates Foundation will match the investment, which is for health programs in Indonesia. Dr. Tahir, who is also Chairman and CEO of the Mayapada Group in Indonesia, previously announced a separate investment of US$65 million, the largest ever made by a private foundation in an emerging economy to the Global Fund. Dr. Nafsiah Mboi, who is Minister of Health of Indonesia and also Chair of the Board of the Global Fund, said the establishment of the Indonesia Health Fund was a significant step toward making Indonesia self-reliant in health funding. She praised the exemplary leadership by private sector investors who partner with the Global Fund as an effective vehicle to reach more people affected by the diseases. Each of eight business leaders “signed a commitment to providing US$5 million, and each agreement was cosigned by Mr. Gates.” The goal of the Indonesia Health Fund is to bring along additional private donors. The Global Fund noted that over the past decade, its financing has supported Indonesia’s efforts to treat 1.3 million cases of TB, distribute nearly 9 million insecticide-treated nets to prevent malaria, and provide nearly 30,000 Indonesians with access to HIV treatment.
http://www.theglobalfund.org/en/mediacenter/newsreleases/2014-04-09_Innovative_Investment_in_Indonesia_Health_Fund/

WHO: Guidelines for the screening, care and treatment of persons with hepatitis C infection
April 2014 124 pages
ISBN: 978 92 4 154875 5
Overview
These are the first guidelines dealing with hepatitis C treatment produced by the World Health Organization (WHO) and complement existing guidance on the prevention of transmission of bloodborne viruses, including HCV. They are intended for policy-makers, government officials, and others working in low- and middle-income countries who are developing programmes for the screening, care and treatment of persons with HCV infection.
These guidelines serve as a framework that can allow the expansion of clinical services to patients with HCV infection, as they provide key recommendations in these areas and discuss considerations for implementation. The guidelines are also intended for health-care providers who care for persons with HCV infection in low- and middle-countries and provide them guidance in the management of patients infected with HCV.
Download: http://www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/

Brazil’s National Technical Commission for Biosecurity (CTNBio) approved the commercial release of the genetically modified (GM) mosquito, OX513A, “which can be used to control the dengue mosquito [Aedes aegypti]. CTNBio is “the collegiate body responsible for approval and regulation of transgenic organisms in Brazil.” OX513A, developed by Oxitec, is described as “the first GM insect to be considered safe for commercial use in Brazil and the latest of a long series of biotechnology approvals by CTNBio.” The Oxitec mosquito is a strain of the wild species that contains two additional genes. The Oxitec males (which cannot bite) are released to seek out and mate with the wild females. Their offspring inherit the additional genes and die before becoming functional adults. They also inherit a marker that is visible under a special light, making monitoring in the field simple and helping ensure that dengue mosquito control programmes succeed.”
Full media release: CAMPINAS, Brazil, April 10, 2014 /PRNewswire/ —
http://www.prnewswire.com/news-releases/high-tech-solution-for-controlling-the-dengue-mosquito-is-approved-by-ctnbio-254765081.html

BMC Health Services Research
(Accessed 12 April 2014)
http://www.biomedcentral.com/bmchealthservres/content

Research article
Cervical cancer prevention in reproductive health services: knowledge, attitudes and practices of midwives in Cote d’Ivoire, West Africa
Boris K Tchounga, Antoine Jaquet, Patrick A Coffie, Apollinaire Horo, Catherine Sauvaget, Innocent Adoubi, Privat Guie, François Dabis, Annie J Sasco and Didier K Ekouevi
Author Affiliations
BMC Health Services Research 2014, 14:165 doi:10.1186/1472-6963-14-165
Published: 11 April 2014
http://www.biomedcentral.com/1472-6963/14/165/abstract
Abstract (provisional)
Background
Cervical cancer is the most common cancer among women and the leading cause of cancer deaths in women in Cote d’Ivoire. Low resource countries can now prevent this cancer by using HPV vaccine and effective and affordable screening tests. However the implementation of these prevention strategies needs well-trained human resources. Part of the solution could come from midwives by integrating cervical cancer prevention into reproductive health services. The aim of this survey was to assess knowledge, attitudes and practices of midwives towards cervical cancer prevention in Abidjan, Cote d’Ivoire, and to find out factors associated with appropriate knowledge.
Methods
A cross-sectional survey was conducted among midwives in the urban district of Abidjan, using a self-administered questionnaire. Knowledge was assessed by two scores. Factors associated with appropriate knowledge were determined using a logistic regression analysis. Attitudes and practices were described and compare using the Chi2 test.
Results
A total of 592 midwives were enrolled, including 24.5% of final-year students. 55.7% of midwives had appropriate knowledge on cervical cancer, and 42.4% of them had appropriate knowledge on cervical cancer prevention strategies. Conferences, courses taken at school of midwifery and special training sessions on cervical cancer (OR = 4.9, 95% CI [1.9 to 12.6], p <0.01) were associated with good knowledge on the management of this disease. Among these midwives, 18.4% had already benefited from a screening test for themselves, 37.7% had already advised screening to patients and 8.4% were able to perform a visual inspection. 50.3% of midwives knew HPV vaccine as a preventive method; among them 70.8% usually recommended it to young girls.
Conclusion
Despite sufficient knowledge about cervical cancer prevention, attitudes and practices of midwives should be improved by organizing capacity building activities. This would ensure the success of integration of cervical cancer prevention into reproductive health services in countries like Cote d’Ivoire.

British Medical Journal
12 April 2014 (Vol 348, Issue 7953)
http://www.bmj.com/content/348/7953
Editor’s Choice
The missing data that cost $20bn
Kamran Abbasi, international editor
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2695 (Published 10 April 2014)
BMJ 2014;348:g2695
Excerpt
Marketing is what you do when your product is no good, said Edward Land, scientist and inventor of the Polaroid instant camera. The same notion filled Tom Jefferson’s head when he began to reappraise his initial conclusions about neuraminidase inhibitors and the risk of influenza complications and hospital admissions (doi:10.1136/bmj.g2227). Keiji Hayashi, a Japanese researcher, alerted him to the existence of unpublished trials, trials that were not included in his Cochrane review of 2006. From trusting the literature, researchers, and companies, Jefferson moved to a position of deep scepticism. Many trials were unpublished, data weren’t shared, and decisions on purchasing, stockpiling, and using the drugs were based on a slim and skewed representation of the total evidence base.
This week is the culmination of a five year campaign led by Jefferson’s Cochrane research team, supported by The BMJ, to ensure the release of the full clinical trial data on neuraminidase inhibitors (doi:10.1136/bmj.g2630). The studies, analyses, and editorials in this issue strike like a hammer blow
Editorials
The Tamiflu trials
BMJ 2014;348:g2630 (Published 10 April 2014)
:: Tamiflu open data campaign

Cost Effectiveness and Resource Allocation
(Accessed 12 April 2014)
http://www.resource-allocation.com/

Research
Ownership and technical efficiency of hospitals: evidence from Ghana using data envelopment analysis
Caroline Jehu-Appiah1*, Serufusa Sekidde2, Martin Adjuik3, James Akazili3, Selassi D Almeida4, Frank Nyonator5, Rob Baltussen6, Eyob Zere Asbu7 and Joses Muthuri Kirigia8
Author Affiliations
1 African Development Bank, OSHD.3, BP323, Tunis, Belvedere, Tunisia
2 Oxford Policy Management, Oxford, UK
3 Navrongo Health Research Center, Navrongo, Ghana
4 World Health Organization, Accra, Ghana
5 Ministry of Health, Accra, Ghana
6 Radboud University, Nijmegen, Netherlands
7 Health Authority, Abu Dhabi, United Arab Emirates
8 World Health Organization Regional Office for Africa, Brazzaville, Congo
Cost Effectiveness and Resource Allocation 2014, 12:9 doi:10.1186/1478-7547-12-9
http://www.resource-allocation.com/content/12/1/9
The electronic version of this article is the complete one and can be found online at: http://www.resource-allocation.com/content/12/1/9
Abstract
Background
In order to measure and analyse the technical efficiency of district hospitals in Ghana, the specific objectives of this study were to (a) estimate the relative technical and scale efficiency of government, mission, private and quasi-government district hospitals in Ghana in 2005; (b) estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient; and (c) use Tobit regression analysis to estimate the impact of ownership on hospital efficiency.
Methods
In the first stage, we used data envelopment analysis (DEA) to estimate the efficiency of 128 hospitals comprising of 73 government hospitals, 42 mission hospitals, 7 quasi-government hospitals and 6 private hospitals. In the second stage, the estimated DEA efficiency scores are regressed against hospital ownership variable using a Tobit model. This was a retrospective study.
Results
In our DEA analysis, using the variable returns to scale model, out of 128 district hospitals, 31 (24.0%) were 100% efficient, 25 (19.5%) were very close to being efficient with efficiency scores ranging from 70% to 99.9% and 71 (56.2%) had efficiency scores below 50%. The lowest-performing hospitals had efficiency scores ranging from 21% to 30%.
Quasi-government hospitals had the highest mean efficiency score (83.9%) followed by public hospitals (70.4%), mission hospitals (68.6%) and private hospitals (55.8%). However, public hospitals also got the lowest mean technical efficiency scores (27.4%), implying they have some of the most inefficient hospitals.
Regarding regional performance, Northern region hospitals had the highest mean efficiency score (83.0%) and Volta Region hospitals had the lowest mean score (43.0%).
From our Tobit regression, we found out that while quasi-government ownership is positively associated with hospital technical efficiency, private ownership negatively affects hospital efficiency.
Conclusions
It would be prudent for policy-makers to examine the least efficient hospitals to correct widespread inefficiency. This would include reconsidering the number of hospitals and their distribution, improving efficiency and reducing duplication by closing or scaling down hospitals with efficiency scores below a certain threshold. For private hospitals with inefficiency related to large size, there is a need to break down such hospitals into manageable sizes.

Globalization and Health
[Accessed 12 April 2014]
http://www.globalizationandhealth.com/

Commentary
Open access: academic publishing and its implications for knowledge equity in Kenya
Duncan Mwangangi Matheka, Joseph Nderitu, Daniel Mutonga, Mary Iwaret Otiti, Karen Siegel and Alessandro Rhyll Demaio
Author Affiliations
Globalization and Health 2014, 10:26 doi:10.1186/1744-8603-10-26
Published: 9 April 2014
http://www.globalizationandhealth.com/content/10/1/26/abstract
Abstract (provisional)
Traditional, subscription-based scientific publishing has its limitations: often, articles are inaccessible to the majority of researchers in low- and middle-income countries (LMICs), where journal subscriptions or one-time access fees are cost-prohibitive. Open access (OA) publishing, in which journals provide online access to articles free of charge, breaks this barrier and allows unrestricted access to scientific and scholarly information to researchers all over the globe. At the same time, one major limitation to OA is a high publishing cost that is placed on authors. Following recent developments to OA publishing policies in the UK and even LMICs, this article highlights the current status and future challenges of OA in Africa. We place particular emphasis on Kenya, where multidisciplinary efforts to improve access have been established. We note that these efforts in Kenya can be further strengthened and potentially replicated in other African countries, with the goal of elevating the visibility of African research and improving access for African researchers to global research, and, ultimately, bring social and economic benefits to the region. We (1) offer recommendations for overcoming the challenges of implementing OA in Africa and (2) call for urgent action by African governments to follow the suit of high-income countries like the UK and Australia, mandating OA for publicly-funded research in their region and supporting future research into how OA might bring social and economic benefits to Africa.

Journal of Infectious Diseases
Volume 209 Issue 9 May 1, 2014
http://jid.oxfordjournals.org/content/current

A Case for Immunization of Human Papillomavirus (HPV) 6/11–Infected Pregnant Women With the Quadrivalent HPV Vaccine to Prevent Juvenile-Onset Laryngeal Papilloma
Keerti V. Shah
Author Affiliations
Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Presented in part: Second International Neonatal and Maternal Immunization Symposium, Antalya, Turkey, 1–3 March 2013.
http://jid.oxfordjournals.org/content/209/9/1307.abstract
Abstract
Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a rare disease caused by intrapartum or perinatal transmission of human papillomavirus (HPV) types 6 and 11 from an infected mother to the newborn. Immunization of a pregnant woman who has condyloma or HPV-6/11 infection with the quadrivalent HPV vaccine will result in a high neutralizing antibody response to HPV 6 and HPV 11 in her serum, and these antibodies transferred to the newborn will likely protect the child against the development of JORRP. Because of the low incidence of disease in at-risk children, it may be difficult to test the effectiveness of maternal immunization for prevention of JORRP.

Journal of Infectious Diseases
Volume 209 Issue 9 May 1, 2014
http://jid.oxfordjournals.org/content/current

Vaccine-Associated Paralytic Poliomyelitis in the Postelimination Era in Latin America and the Caribbean, 1992–2011
J. Mauricio Landaverde1, Silas Pierson Trumbo2, M. Carolina Danovaro-Holliday1, Shea E. Cochi3, Raghunathan Gandhi1 and Cuauhtémoc Ruiz-Matus1
Author Affiliations
1Comprehensive Family Immunization Unit, Pan American Health Organization/World Health Organization, Washington, D. C.
2Vanderbilt School of Medicine, Nashville, Tennessee
3Emory School of Medicine, Atlanta, Georgia
http://jid.oxfordjournals.org/content/209/9/1393.abstract
Abstract
The Americas interrupted the transmission of poliovirus in 1991; most Latin American and Caribbean (LAC) countries rely on the oral polio vaccine (OPV) to maintain elimination. We estimated the risk of vaccine-associated paralytic polio (VAPP) in LAC for 1992–2011. VAPP cases were identified using LAC’s acute flaccid paralysis (AFP) surveillance system. VAPP was defined as any AFP case with residual paralysis 60 days following onset that did not have a clear alternative etiology and with isolation of vaccine-strain poliovirus. Recipient VAPP cases were defined as those with paralysis onset 4–40 days following OPV; cases meeting these criteria but with unknown residual paralysis were added. Nonrecipient VAPP cases were defined as those in individuals with an unknown vaccination status, those in individuals who received 0 doses, or those with paralysis onset outside the 4–40-day interval. Of 40 926 AFP cases reported in LAC from 1992–2011, we identified 72 recipient and 119 nonrecipient VAPP cases. The estimated risk of recipient VAPP was 1 case per 3.15 million newborns (95% confidence interval [CI], 1 case per 2.56–4.10 million newborns), and the estimated overall risk was 1 case per 1.19 million newborns (95% CI, 1 case per 1.04–1.39 million newborns). In this multicountry VAPP analysis in a postelimination period, we found that the risk of VAPP in LAC was lower than previously estimated.

The Lancet
Apr 12, 2014 Volume 383 Number 9925 p1269 – 1358
http://www.thelancet.com/journals/lancet/issue/current

Comment
Prevention of varicella: time for two-dose vaccination
Kristine Macartney
Preview | Full Text | PDF
Live-attenuated varicella zoster virus (VZV) vaccines have been available for decades, but their potential to reduce disease worldwide has not been fully realised. Few countries have incorporated varicella vaccination into public programmes, even though rapid and large decreases in varicella deaths and admissions have been achieved in the USA and Australia.1,2 One reason for reluctance to vaccinate is that, despite high efficacy of 88–100% reported in the randomised controlled trials of one-dose live-attenuated monovalent varicella vaccines in children (Varilrix, GSK3 and Varivax, Merck4), field effectiveness has turned out to be lower at 72–81%.
Protection against varicella with two doses of combined measles-mumps-rubella-varicella vaccine versus one dose of monovalent varicella vaccine: a multicentre, observer-blind, randomised, controlled trial
Prof Roman Prymula MD a, Marianne Riise Bergsaker MD b, Susanna Esposito MD c, Prof Leif Gothefors MD d e, Sorin Man MD f, Nadezhda Snegova MD g, Mária Štefkovičova MD h, Prof Vytautas Usonis MD i, Prof Jacek Wysocki MD j k, Martine Douha MSc m, Ventzislav Vassilev PhD m, Dr Ouzama Nicholson MD l, Bruce L Innis MD l, Paul Willems MD m
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961461-5/abstract
Summary
Background
Rates of varicella have decreased substantially in countries implementing routine varicella vaccination. Immunisation is possible with monovalent varicella vaccine or a combined measles-mumps-rubella-varicella vaccine (MMRV). We assessed protection against varicella in naive children administered one dose of varicella vaccine or two doses of MMRV.
Methods
This study was done in ten European countries with endemic varicella. Healthy children aged 12—22 months were randomised (3:3:1 ratio, by computer-generated randomisation list, with block size seven) to receive 42 days apart (1) two doses of MMRV (MMRV group), or (2) MMR at dose one and monovalent varicella vaccine at dose two (MMR+V group), or (3) two doses of MMR (MMR group; control). Participants and their parents or guardians, individuals involved in assessment of any outcome, and sponsor staff involved in review or analysis of data were masked to treatment assignment. The primary efficacy endpoint was occurrence of confirmed varicella (by detection of varicella zoster virus DNA or epidemiological link) from 42 days after the second vaccine dose to the end of the first phase of the trial. Cases were graded for severity. Efficacy analyses were per protocol. Safety analyses included all participants who received at least one vaccine dose. This trial is registered with ClinicalTrials.gov, number NCT00226499.
Findings
Between Sept 1, 2005, and May 10, 2006, 5803 children (mean age 14•2 months, SD 2•5) were vaccinated. In the efficacy cohort of 5285 children, the mean duration of follow-up in the MMRV group was 36 months (SD 8•8), in the MMR+V group was 36 months (8•5) and in the MMR group was 35 months (8•9). Varicella cases were confirmed for 37 participants in the MMRV group (two moderate to severe), 243 in the MMR+V group, and 201 in the MMR group. Second cases occurred for three participants (all in the MMR+V group). Varicella cases were moderate to severe for two participants in the MMRV group, 37 in the MMR+V group (one being a second case that followed a mild first case); and 117 in the MMR group. Efficacy of two-dose MMRV against all varicella was 94•9% (97•5% CI 92•4—96•6), and against moderate to severe varicella was 99•5% (97•5—99•9). Efficacy of one-dose varicella vaccine against all varicella was 65•4% (57•2—72•1), and against moderate to severe varicella (post hoc) was 90•7% (85•9—93•9). The most common adverse event in all groups was injection-site redness (up to 25% of participants). Within 15 days after dose one, 57•4% (95% CI 53•9—60•9) of participants in the MMRV group reported fever of 38°C or more, by contrast with 44•5% (41•0—48•1) with MMR+V, and 39•8% (33•8—46•1) with MMR. Eight serious adverse events were deemed related to vaccination (three MMRV, four MMR+V, one MMR). All resolved within the study period.
Interpretation
These results support the implementation of two-dose varicella vaccination on a short course, to ensure optimum protection from all forms of varicella disease.
Funding
GlaxoSmithKline Vaccines.

The Lancet
Apr 12, 2014 Volume 383 Number 9925 p1269 – 1358
http://www.thelancet.com/journals/lancet/issue/current

Health Policy
Advancing social and economic development by investing in women’s and children’s health: a new Global Investment Framework
Karin Stenberg MSc a, Henrik Axelson MSc e, Peter Sheehan DPhil p, Ian Anderson MSc q, A Metin Gülmezoglu PhD c, Marleen Temmerman PhD c, Elizabeth Mason MSc d, Howard S Friedman PhD n, Prof Zulfiqar A Bhutta PhD g h, Joy E Lawn PhD k, Kim Sweeny PhD p, Jim Tulloch MBBS r, Peter Hansen PhD i, Mickey Chopra MD m, Anuradha Gupta MBA l, Joshua P Vogel MBBS c, Mikael Ostergren MD d, Bruce Rasmussen PhD p, Carol Levin PhD s, Colin Boyle MBA t, Shyama Kuruvilla PhD f, Marjorie Koblinsky PhD o, Neff Walker PhD j, Andres de Francisco MD f, Nebojsa Novcic MPhil f, Carole Presern PhD f, Prof Dean Jamison PhD s, Flavia Bustreo MD b, on behalf of the Study Group for the Global Investment Framework for Women’s Children’s Health
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2962231-X/abstract
Summary
A new Global Investment Framework for Women’s and Children’s Health demonstrates how investment in women’s and children’s health will secure high health, social, and economic returns. We costed health systems strengthening and six investment packages for: maternal and newborn health, child health, immunisation, family planning, HIV/AIDS, and malaria. Nutrition is a cross-cutting theme. We then used simulation modelling to estimate the health and socioeconomic returns of these investments. Increasing health expenditure by just $5 per person per year up to 2035 in 74 high-burden countries could yield up to nine times that value in economic and social benefits. These returns include greater gross domestic product (GDP) growth through improved productivity, and prevention of the needless deaths of 147 million children, 32 million stillbirths, and 5 million women by 2035. These gains could be achieved by an additional investment of $30 billion per year, equivalent to a 2% increase above current spending.

The Lancet
Apr 12, 2014 Volume 383 Number 9925 p1269 – 1358
http://www.thelancet.com/journals/lancet/issue/current

Viewpoint
Children growing up with HIV infection: the responsibility of success
Sarah Bernays, Prudence Jarrett, Katharina Kranzer, Rashida A Ferrand
Preview | Full Text | PDF
An estimated 3•4 million children are living with HIV, more than 90% in sub-Saharan Africa.1 Those working in paediatric HIV care are now cautiously optimistic. Comparing the landscape with 10 years ago when HIV-infected infants faced inevitable death, those born with HIV now have access to antiretroviral therapy (ART) so that increasing numbers of children are surviving to adolescence and beyond.2 Coupled with this progress, the number of new infections has substantially decreased (from 450 000 in 2005, to 260 000 in 2012) because of scale-up of interventions to prevent mother-to-child HIV transmission (PMTCT), resulting in a shift of burden of HIV towards older children.

Nature Medicine
April 2014, Volume 20 No 4 pp319-449
http://www.nature.com/nm/journal/v20/n4/index.html
Editorial
The price of good health
Nature Medicine
20, 319 (2014)
doi:10.1038/nm.3538
Published online 07 April 2014
Abstract
Efficacious new drugs to treat hepatitis C virus infection offer the potential to halt this epidemic. But their exorbitant cost may prove prohibitive for most patients in need. Strong patient and government advocacy will be necessary to ensure that accessibility to treatments is a right, not a privilege.

PLoS One
[Accessed 12 April 2014]
http://www.plosone.org/
The Recognition of and Care Seeking Behaviour for Childhood Illness in Developing Countries: A Systematic Review
Pascal Geldsetzer mail, Thomas Christie Williams, Amir Kirolos, Sarah Mitchell, Louise Alison Ratcliffe, Maya Kate Kohli-Lynch, Esther Jill Laura Bischoff, Sophie Cameron, Harry Campbell
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0093427
Abstract
Background
Pneumonia, diarrhoea, and malaria are among the leading causes of death in children. These deaths are largely preventable if appropriate care is sought early. This review aimed to determine the percentage of caregivers in low- and middle-income countries (LMICs) with a child less than 5 years who were able to recognise illness in their child and subsequently sought care from different types of healthcare providers.
Methods and Findings
We conducted a systematic literature review of studies that reported recognition of, and/or care seeking for episodes of diarrhoea, pneumonia or malaria in LMICs. The review is registered with PROSPERO (registration number: CRD42011001654). Ninety-one studies met the inclusion criteria. Eighteen studies reported data on caregiver recognition of disease and seventy-seven studies on care seeking. The median sensitivity of recognition of diarrhoea, malaria and pneumonia was low (36.0%, 37.4%, and 45.8%, respectively). A median of 73.0% of caregivers sought care outside the home. Care seeking from community health workers (median: 5.4% for diarrhoea, 4.2% for pneumonia, and 1.3% for malaria) and the use of oral rehydration therapy (median: 34%) was low.
Conclusions
Given the importance of this topic to child survival programmes there are few published studies. Recognition of diarrhoea, malaria and pneumonia by caregivers is generally poor and represents a key factor to address in attempts to improve health care utilisation. In addition, considering that oral rehydration therapy has been widely recommended for over forty years, its use remains disappointingly low. Similarly, the reported levels of care seeking from community health workers in the included studies are low even though global action plans to address these illnesses promote community case management. Giving greater priority to research on care seeking could provide crucial evidence to inform child mortality programmes.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 12 April 2014)

Policy Forum
The Use of Preliminary Scientific Evidence in Public Health: A Case Study of XMRV
Kumanan Wilson mail, Katherine Atkinson, Jennifer Keelan
Summary Points
:: The rapid response to XMRV as a novel pathogen has highlighted some challenges pertaining to policy making and editorial responsibilities in a policy environment influenced by the precautionary principle.
:: Once published, preliminary scientific evidence can result in rapid changes in policy and can undergo widespread dissemination via both the Internet and social media.
:: The impact on policy and the propagation of the initial scientific information may not cease if the evidence is disproven and retracted from peer-reviewed journals.
:: Regulators should consider the use of frameworks to guide the use of the precautionary principle and a separate, more flexible policy stream for precautionary policies.
:: Editors should continue to develop strategies to place preliminary scientific evidence of potential public health relevance in context for the public and for policy makers.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 21, Pages 2389-2520 (1 May 2014)

From refrigerator to arm: Issues in vaccination delivery
Pages 2389-2393
L.J. Tan, SHAPE Vaccine Delivery Working Group (Storage, Handling, Administration, and Preparation Experts) SHAPE Vaccine Delivery Working Group
Abstract
This report summarizes the first meeting of a panel of immunization experts who met in Washington, DC, on May 4–5, 2012. The panel consisted of experts from national immunization policy organizations; state, regional, and local immunization programs; and vaccinating health care practices. The primary objective of this meeting was to identify issues in the vaccine delivery process as a critical first step in the determination of where and how improvements can be made. Vaccines are one of the greatest achievements in public health. However, in order to maintain the integrity of vaccines and the success of vaccination programs, proper handling of vaccines from the receipt of shipment through administration to the patient is critical. Continuous improvement of the vaccine delivery process is important to ensure appropriate vaccine handling by all vaccine providers. The overarching consensus of the participants of this meeting was that the major challenge in vaccine delivery is the complexity throughout all areas of the vaccine delivery process, which is often underestimated, particularly in the areas of vaccine preparation and administration. The lack of detailed, consistent standards encompassing all areas of the vaccine delivery process, and the gaps in oversight, education, and training of vaccine providers, particularly providers of adult vaccines, were also identified as major issues. The next step for this panel is to reconvene to explore potential solutions to address the identified issues.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 21, Pages 2389-2520 (1 May 2014)

Geographic variation in human papillomavirus vaccination uptake among 13–17 year old adolescent girls in the United States
Pages 2394-2398
Mahbubur Rahman, Christine J. McGrath, Abbey B. Berenson
Abstract
Geographic variation in provider-verified human papillomavirus (HPV) vaccine uptake among adolescent girls in the US has not been examined. To investigate this, we analyzed 2011 National Immunization Survey-Teen data. Among 13–17 year old girls (n = 11,236), weighted vaccine initiation (48.4%) and completion rates (30.6%) were the lowest in the South when compared to the Northeast (53.4% and 39.9%), Midwest (51.1% and 33.5%) and West (61.6% and 38.7%) (P < .001, both for initiation and completion). Multivariable log-binomial regression analysis indicated that 13–17 year old girls living in the South were less likely to initiate [adjusted prevalence ratio (aPR) = 0.86, 95% confidence interval (CI) 0.75–0.97] and complete (aPR = 0.83, 95% CI, 0.74–0.93) the HPV vaccine series compared to girls living in the Northeast. Similar differences were observed when the uptake rates in the South were compared to other regions in the US. Intervention programs to increase HPV vaccine uptake and reduce regional disparities are warranted.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 21, Pages 2389-2520 (1 May 2014)

Staying on track: A cluster randomized controlled trial of automated reminders aimed at increasing human papillomavirus vaccine completion
Original Research Article
Pages 2428-2433
Ashlesha Patel, Lisa Stern, Zoe Unger, Elie Debevec, Alicia Roston, Rita Hanover, Johanna Morfesis
Abstract
Objectives
To evaluate whether automated reminders increase on-time completion of the three-dose human papillomavirus (HPV) vaccine series.
Methods
Ten reproductive health centers enrolled 365 women aged 19–26 to receive dose one of the HPV vaccine. Health centers were matched and randomized so that participants received either routine follow-up (control) or automated reminder messages for vaccine doses two and three (intervention). Intervention participants selected their preferred method of reminders – text, e-mail, phone, private Facebook message, or standard mail. We compared vaccine completion rates between groups over a period of 32 weeks.
Results
The reminder system did not increase completion rates, which overall were low at 17.2% in the intervention group and 18.9% in the control group (p = 0.881). Exploratory analyses revealed that participants who completed the series on-time were more likely to be older (OR = 1.15, 95% CI 1.01–1.31), report having completed a four-year college degree or more (age-adjusted OR = 2.51, 95% CI 1.29–4.90), and report three or more lifetime sexual partners (age-adjusted OR = 3.45, 95% CI 1.20–9.92).
Conclusions
The study intervention did not increase HPV vaccine series completion. Despite great public health interest in HPV vaccine completion and reminder technologies, completion rates remain low.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 21, Pages 2389-2520 (1 May 2014)

Eliciting youth and adult recommendations through citizens’ juries to improve school based adolescent immunisation programs
Original Research Article
Pages 2434-2440
Helen S. Marshall, Claudia Proeve, Joanne Collins, Rebecca Tooher, Maree O’Keefe, Teresa Burgess, S. Rachel Skinner, Maureen Watson, Heather Ashmeade, Annette Braunack-Mayer
Abstract
Objectives
Completion of adolescent immunisation schedules in Australia is sub-optimal despite a well-established school based delivery program. The aim of this study was to seek adolescent and adult views on how existing adolescent school based immunisation policy and program delivery could be improved to increase adolescent immunisation uptake.
Method
Two citizens’ juries held separately, one with adolescent participants and one with adult participants deliberated on recommendations for public policy. Jury members were selected using a stratified sampling technique and recruited from a standing panel of community research participants through a market research company in South Australia. Juries were conducted in Metropolitan South Australia over two days and used university facilities with all meals and refreshments provided.
Results
Fifteen adults and 16 adolescents participated in the adult and youth juries respectively. Similar recommendations were made by both juries including increased ensuring the accuracy of information provided to adolescents and parents; employing a variety of formats for information delivery; and greater consideration of students’ physical and emotional comfort in order to improve the experience for adolescents. While the youth jury recommended that it should be compulsory for adolescents to receive vaccines through the school based immunisation program, the adult jury recommended an ‘opt-out’ system of consent. Both juries also recommended the use of incentives to improve immunisation uptake and immunisation course completion.
Conclusions
Eliciting adolescent views and including the perspectives of adolescents in discussions and development of strategies to improve engagement in the school based immunisation program provided valuable insight from the group most impacted by these policies and practices. Specifically, incorporation of adolescent and community views using citizens’ juries may lead to greater overall support from the community as their values and needs are more accurately reflected.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 21, Pages 2389-2520 (1 May 2014)

Universal paid leave increases influenza vaccinations among employees in the U.S.
Original Research Article
Pages 2441-2445
Fernando A. Wilson, Yang Wang, Jim P. Stimpson
Abstract
Objectives
We predict the impact of paid leave in increasing influenza vaccinations for employees, thus decreasing workdays lost and healthcare visits resulting from infection.
Methods
Nationally representative data from the 2006–2010 Medical Expenditure Panel Survey were used. We examined working adults aged 18 and above (N = 51,471). Logistic regression measured the association of paid leave with flu vaccination. We predicted the impact on labor and healthcare markets if universal paid leave were provided.
Results
The proportion of workers receiving vaccination annually was higher for those with paid leave versus without paid leave (34.0% vs. 21.0%, P < 0.001). Adjusted odds of having a vaccination increased with paid leave vs. without paid leave (OR = 1.42, CI: 1.31–1.53). Universal paid leave is predicted to increase vaccinations by 1.6 million, resulting in 63.8 thousand fewer absences from work and 18.2 thousand fewer healthcare visits for the flu annually.
Conclusions
Our study suggests that employees without paid leave are significantly less likely to have had a flu vaccination. Expanding paid leave could substantially increase flu vaccination, resulting in fewer workdays lost to influenza and savings in healthcare costs.

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

[PDF] Vaccination Decision-Making and HPV Knowledge: How Informed and Engaged Are Young Adult HPV Vaccine Recipients in Australia?
RC Laidsaar-Powell, KJ McCaffery, T Mather… – Journal of Vaccines, 2014
Objectives. To date, there has been limited research on the decision-making process of HPV
vaccine recipients. This study aimed to explore HPV-related knowledge, vaccination
decision-making, and post vaccination attitudes about sexual behaviour in women who …

The BCG replacement vaccine VPM1002: from drawing board to clinical trial
SHE Kaufmann, MF Cotton, B Eisele, M Gengenbacher… – Expert Review of Vaccines, 2014
Tuberculosis remains a major health threat and vaccines better than bacillus Calmette-
Guérin (BCG) are urgently required. Here we describe our experience with a recombinant
BCG expressing listeriolysin and deficient in urease. This potential replacement vaccine …

Contrasting the anti-vaccine prejudice: a public health perspective. Commentary.
P Stefanelli, G Rezza – Annali dell’Istituto superiore di sanità, 2014
Although immunization is one of the most successful and cost-effective health interventions,
there has been always opposition to vaccines. This may be due to several factors, some of
which are: 1) the vaccines are given to healthy individuals to prevent disease;

Council on Foreign Relations
http://www.cfr.org/
Accessed 12 April 2014
Article
The Shots Heard Around the World
by Laurie Garrett April 4, 2014
New shots are jeopardizing humanity’s battle to eradicate polio, and they don’t include syringes or vaccines. Rather, they’re the gunshots of Islamic terrorists, and they’re imperiling the fight to eliminate polio.

Economist
http://www.economist.com/
Accessed 12 April 2014
Aid for health care
New prescriptions
Chronic diseases and a cash squeeze are prompting donors to rethink spending
Apr 12th 2014 | From the print edition
IN 2000 policy wonks from governments and aid organisations agreed on what would become the Millennium Development Goals, an ambitious set of development targets for 2015. Surprisingly, the fine words prompted concerted action. From 2001 to 2010 the aid devoted to health care grew by more than 10% a year, compared with 7% a year in the 1990s. Most of the new money went on fighting the scourges on the list: HIV/AIDS, malaria, tuberculosis, and maternal and infant mortality

.The growth in health-care aid has now slowed to less than half the rate of the early 2000s. And as 2015 approaches, donors are mulling new health-care goals. Ideas will be discussed at a big meeting of the World Bank and IMF in Washington, DC, on April 11th-13th. One is to make aid money go further by increasing the use of cash incentives for patients or health-care providers. Rather than merely buy inputs such as vaccines, donors would pay for results, such as each child who is immunised.

Such schemes can improve outcomes: one in Rwanda that offered cash rewards for clinics increased the share of women giving birth in the clinic, rather than at home, by 23%. But the design and implementation need thought, says Tim Evans of the World Bank: another in the Democratic Republic of Congo that paid clinics for offering more services—more prenatal consultations and childhood immunisations, for example—made little difference, perhaps because the bonus payments were too small.

Since 2008 the World Bank has devoted $2.5 billion to programmes that pay at least partly by results. It, and other donors, are thinking of shifting more of their spending to such schemes. But even if the outcome is greater efficiency, it will not deal with a bigger problem: the growing burden of chronic diseases in the developing world.
Research by Christopher Murray of the University of Washington published on April 8th in the journal Health Affairs shows a growing mismatch between the ailments donors spend most on tackling, and those that are taking the heaviest toll. About 55% of all aid for health care in 2011, the most recent year for which global figures were available, went to areas identified by the Millennium Development Goals. Just 1% went to chronic ailments such as diabetes and heart disease, though these now account for half the years spent in bad health, or lost because of early death caused by illness, in developing countries.

Austerity in the rich world means that aid budgets are unlikely to start growing quickly again. And even if more money was forthcoming, chronic diseases are harder to target with aid programmes. A vaccine can be administered in one, or at most a few, doses and offers an easily calculated return on investment. Managing diabetes requires long-term monitoring and medication—that is, a functioning health-care system, which will have to be built by recipient countries’ governments.

It seems likely, then, that donors will continue to go for infectious diseases, leaving governments to tackle chronic ones. In a sign of the shift to come, Dr Murray reports that government spending on health care in poor and middle-income countries grew more quickly than health-care aid between 2010 and 2011. On April 11th ministers and aid specialists in Washington were due to discuss their next task: helping to ensure that by 2030 everyone, everywhere, has health care. The Millennium Development Goals look modest by comparison.

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

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Executive Director
Center for Vaccine Ethics and Policy
a program of the
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– The Wistar Institute Vaccine Center
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Associate Faculty, Division of Medical Ethics, NYU Medical School

GPEI Update: Polio this week – As of 2 April 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: The Strategic Advisory Group of Experts on Immunization (SAGE) has met in Geneva on 1-3 April to discuss measures to prevent further international spread of polio, progress in eliminating wild and vaccine derived poliovirus and the status of the preparation for global OPV2 withdrawal. Final recommendations will be published in the Weekly Epidemiological Record.
:: The outbreak in North Waziristan, Pakistan, continues, with three new cases of wild poliovirus type 1 (WPV1) and two new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases reported this week. In the Middle East, Syria reported two new WPV1 cases, one each from Aleppo and Hama provinces.
Pakistan
:: Three new WPV1 cases were reported this week from North Waziristan, Federally Administered Tribal Areas – FATA, North-West Pakistan, bringing the total number of cases for 2014 to 39. The most recent reported case had onset of paralysis on 8 March.
:: Two new cVDPV2 cases were reported in the past week with the onset of paralysis on 8 March, from North Waziristan, Federally Administered Tribal Areas – FATA. The total number of cVDPV2 cases is 45 for 2013, and six for 2014.
Middle East
:: Two new WPV1 cases were reported from Syria this week, one from Deir Hafer, Aleppo province with an onset of paralysis on 28 December 2013, and another one from Salamayeh, Hama province with onset of paralysis on 21 January – the first confirmed case in 2014. The total number of WPV1 cases reported from Syria since the outbreak was detected is 39: 27 cases reported by the Ministry of Health, and 12 cases from contested areas (Aleppo, Edleb and Deir Al Zour) not yet reflected in official figures. The most recent case had onset of paralysis on 21 January, 2014, in Salamayeh, Hama province, western Syria.

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Attack on polio team: Female worker killed in Bannu
The Express Tribune (Pakistan) (4/1)
A female polio worker was gunned down by two armed men on a motorcycle in the cantonment area of Bannu on Monday. The shooting occurred at around 8:30 in the morning, according to Deputy Superintendent of Police Sanaullah Khan Marwat…

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 5 April 2014]
http://www.who.int/csr/don/2013_03_12/en/index.html
:: Human infection with avian influenza A(H7N9) virus – update 4 April 2014
:: Ebola virus disease: background and summary 3 April 2014
:: Human infection with avian influenza A(H7N9) virus – update 3 April 2014
:: Ebola virus disease, West Africa – update 2 April 2014

Media release: Global Partners Are Taking the “Neglect” out of “Neglected Tropical Diseases” Private and public sector leaders release progress report and announce new funding
Excerpts
Global partners supporting the London Declaration on NTDs met in Paris to release a progress report of efforts around NTDs over the past two years, and to announce some US$240 million in new funding commitments. The 10 diseases covered by the London Declaration and its 2020 target include river blindness, Guinea worm, lymphatic filariasis, blinding trachoma, schistosomiasis, soil-transmitted helminths, leprosy, Chagas disease, visceral leishmaniasis and sleeping sickness.
Several partners also announced new funding towards the fight against NTDs. A group of partners is committing more than US$120 million to address intestinal worms common in communities with limited access to clean water and sanitation, including US$50 million from the Children’s Investment Fund Foundation (CIFF). In addition, the World Bank Group, which has long played an important role in fighting onchocerciasis (river blindness), is committing US$120 million toward the goal of NTD control and elimination in low-income countries in Africa, including funding for school-based deworming efforts.
Pharmaceutical companies are fulfilling their commitments to sustain and expand drug donations through 2020, which resulted in nearly 1.4 billion NTD treatments in 2013. Investments in NTD program implementation and delivery are leveraging these drug donations – valued at an estimated US$19 billion through 2020 – and ensuring they reach all people who need them. Every new dollar invested in NTD program implementation helps deliver up to US$10 in donated drugs.
“We’re taking the ‘neglect’ out of neglected tropical diseases, thanks to the commitment of partners from across the public and private sectors,” said Bill Gates, co-chair of the Bill & Melinda Gates Foundation. “Pharmaceutical companies are providing drugs free of charge, endemic countries are scaling up integrated screen-and-treat programs for multiple diseases and donors are delivering essential funding. If we stay focused, we can reach the London Declaration’s 2020 goals and help provide millions with access to health.”
Pharmaceutical companies are also accelerating research and development efforts for new diagnostic tools and treatments in partnership with non-profit and other research and development organizations, as well as driving new implementation strategies. Recent advances include:
The Global Health Innovative Technology Fund (GHIT Fund), a partnership between five Japanese pharmaceutical companies, two Japanese government ministries and the Bill & Melinda Gates Foundation, endorsed the London Declaration and dedicated new resources to fill priority research and development gaps needed to achieve the 2020 goals.
Beyond pharmaceutical companies, other private sector enterprises have joined the fight against NTDs. For example, DHL is working with pharmaceutical companies to deliver drugs directly to national warehouses in endemic countries, streamlining customs processes to ensure timely delivery to populations in need.
View the live webcast of the panel event at Institut Pasteur here.
Media release: http://www.gatesfoundation.org/Media-Center/Press-Releases/2014/04/Global-Partners-Are-Taking-the-Neglect-out-of-Neglected-Tropical-Diseases

Report: Delivering on Promises & Driving Progress: The Second Report on Uniting to Combat NTDs 2nd Progress Report on The London Declaration on Neglected Tropical Diseases
Uniting to Combat NTDs*
April 2014 46 pages Full report here: http://www.unitingtocombatNTDs.org
Synopsis [Full text]
Two years ago, leaders of many of the world’s most important global health and development organizations stood on a stage in London and pledged to work together to control, eliminate, or eradicate 10 neglected tropical diseases (NTDs). These diseases, many of which have afflicted humanity for millennia, affect more than 1.4 billion people. They sicken, disable, and disfigure, keeping people in cycles of poverty and costing developing economies billions of dollars every year.
Until recently, NTDs saw little attention from all but a small handful of dedicated supporters. But as their impact grew clearer, more were urged into action. In January 2012, the World Health Organization (WHO) released a plan to control, eliminate, or eradicate 17 NTDs by 2020, and the global NTD community—including pharmaceutical companies, donor and endemic countries, private foundations, civil society organizations, and others— responded, with each committing to do its part to reach those goals for 10 of these diseases. This informal group was called Uniting to Combat NTDs.
Since that day, Uniting to Combat NTDs has grown into much more: it is now a global movement, based on partnership and accountability, in which people and organizations from all over the world find unique and powerful ways to contribute to progress. Central to the London Declaration is its pledge to report annually on what its collaborators have done to achieve shared targets.
This report, coordinated by the London Declaration Stakeholders Working Group with input from many others, chronicles progress achieved in 2013. It highlights significant momentum, driven by political will in endemic countries, and the commitments of private donors and industry, but it also notes gaps where action is needed. By examining where we stand, we can identify areas of need, engage in coordinated planning, and move forward with clearly defined objectives.
** Under the banner of Uniting to Combat NTDs, a varied set of partners came together to provide different dimensions of support toward attaining the WHO 2020 goals for 10 NTDs as documented in the London Declaration. The collective work of Uniting to Combat NTDs complements WHO’s direct collaboration with endemic countries. The efforts of Uniting to Combat NTDs are coordinated by a Stakeholders Group (see image) that includes representatives from the following organizations or institutions:
:: United States Agency for International Development
:: The United Kingdom’s Department for International Development
:: World Bank
:: Partnership for Disease Control Initiatives
:: Global Network for Neglected Tropical Diseases
:: Coalition for Operational Research on NTDs
:: Drugs for Neglected Diseases initiative
:: Neglected Tropical Disease Non-Governmental Development Organizations Network
:: GlaxoSmithKline (representing industry)
:: Bill & Melinda Gates Foundation

Aeras appointed Jacqueline E. Shea PhD as Chief Operating Officer (COO). In the newly established role of COO, Dr. Shea joins Aeras’s senior leadership team “to advance organizational excellence and drive innovation and growth of our core capacities, including our contract manufacturing operations.” Shea was most recently Vice President of Business Development Europe for Emergent BioSolutions. “We are fortunate to have Jacqui Shea join Aeras as its operational model evolves to tackle the challenges of TB vaccine research and development,” said Tom Evans, MD, Aeras’s President and Chief Executive Officer.
Full media release: April 4, 2014 – http://www.aeras.org/pressreleases/jacqui-shea-appointed-chief-operating-officer-at-aeras#.U0BmtVcWNdc

The Weekly Epidemiological Record (WER) for 4 April 2014, vol. 89, 14 (pp. 141–152) includes:
:: Progress towards measles pre-elimination, African Region, 2011–2012
:: Monthly report on dracunculiasis cases, January– February 2014
http://www.who.int/entity/wer/2014/wer8914.pdf?ua=1

WHO: Principles and considerations for adding a vaccine to a national immunization programme
From decision to implementation and monitoring
World Health Organization
April 2014 136 pages
Languages: English (French, Spanish, Russian, and Arabic pending)
ISBN: 978 92 4 150689 2
English [3.77Mb]
Overview:
This essential resource document reviews the principles and issues to be considered when making decisions about, planning, and implementing the introduction of a vaccine into a national immunization programme. Importantly, the document highlights ways to use the opportunity provided by the vaccine introduction to strengthen immunization and health systems. The comprehensive guidance also describes the latest references and tools related to vaccine decision-making, economic analyses, cold chain, integrated disease control and health promotion, vaccine safety, communications, monitoring, and more, and provides key URL links to many of these resources.
http://www.who.int/immunization/programmes_systems/policies_strategies/vaccine_intro_resources/nvi_guidelines/en/

IOM: Considerations in Applying Benefit-Cost Analysis to Preventive Interventions for Children, Youth, and Families – Workshop Summary
Benefit-cost analyses hold great promise for influencing policies related to children, youth, and families. By comparing the costs of preventative interventions with the long-term benefits, benefit-cost analysis provides a tool for determining what kinds of investments have the greatest potential to reduce the physical, psychological, and behavioral health problems of children, youth, and families. However, the utility of benefit-cost analyses has been limited by a lack of uniformity in the methods and assumptions underlying these studies. To explore this issue, the IOM/NRC held a workshop that brought together leading practitioners in the field, researchers who study the methodological and analytic dimensions of benefit-cost analysis, and representatives of organizations that use the results of benefit-cost analyses to shape and implement public policies.

IOM: Considerations in Applying Benefit-Cost Analysis to Preventive Interventions for Children, Youth, and Families – Workshop Summary
Benefit-cost analyses hold great promise for influencing policies related to children, youth, and families. By comparing the costs of preventative interventions with the long-term benefits, benefit-cost analysis provides a tool for determining what kinds of investments have the greatest potential to reduce the physical, psychological, and behavioral health problems of children, youth, and families. However, the utility of benefit-cost analyses has been limited by a lack of uniformity in the methods and assumptions underlying these studies. To explore this issue, the IOM/NRC held a workshop that brought together leading practitioners in the field, researchers who study the methodological and analytic dimensions of benefit-cost analysis, and representatives of organizations that use the results of benefit-cost analyses to shape and implement public policies.

FDA, ONC, FCC: Health IT Risk-Based Framework
Health information technology, or health IT, is defined by the federal government’s Office of the National Coordinator for Health IT (ONC) as, “hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packaged solutions sold as services that are designed for or support the use by health care entities or patients for the electronic creation, maintenance, access, or exchange of health information.”
Health IT is the framework that enables the management of health information across multiple electronic systems and devices, such as wireless medical devices, hospital information systems, communications infrastructure, and electronic health record (EHR) systems. Three federal agencies, the FDA, ONC and the Federal Communications Commission (FCC) each have unique responsibilities in the health IT arena.
As health IT evolves, we believe that all stakeholders should understand regulatory requirements surrounding its use. Under the direction of the Food and Drug Administration Safety Innovation Act (FDASIA) of 2012, the FDA is working with FCC and ONC to propose a strategy and make recommendations on an appropriate, risk-based regulatory framework for health IT that promotes innovation, protects patient safety, and avoids unnecessary and duplicative regulation.
The three agencies are committed to a vision that supports a strong health system based on safe and innovative health IT that improves and advances public health.
On 4/3/2014, the FDA, FCC and ONC released the FDASIA Health IT Report outlining a proposed strategy and recommendations for a risk-based framework.
:: FDASIA Health IT Report
:: Press Release: New strategy proposed for health information technology products to promote innovation, protect patients, and clarify oversight

NFID: 17th Annual Conference on Vaccine Research
National Foundation for Infectious Diseases
April 28-30, 2014
Bethesda, MD
The Annual Conference on Vaccine Research (ACVR) provides high-quality, current reports of scientific progress and best practices featured in both invited presentations and submitted oral abstracts and posters. The ACVR brings together the diverse disciplines involved in the research and development of vaccines and associated technologies for disease control through immunization. By drawing upon an international audience of scientists and researchers, healthcare professionals and trainees, veterinarians, vaccine manufacturers, and public health officials, the conference is designed to encourage the exchange of ideas across a broad range of disciplines.
http://www.cvent.com/events/17th-annual-conference-on-vaccine-research/event-summary-742976fb42dc43849867074b2754bed7.aspx?refid=nfid