BMC Public Health
(Accessed 5 April 2014)
http://www.biomedcentral.com/bmcpublichealth/content
Research article
Two year mortality and associated factors in a cohort of children from rural Uganda
Patrick Nabongo, Suzanne Verver, Elizabeth Nangobi, Ronald Mutunzi, Anne Wajja, Harriet Mayanja-Kizza, Dan Kadobera, Edward Galiwango, Robert Colebunders and Philippa Musoke
Author Affiliations
BMC Public Health 2014, 14:314 doi:10.1186/1471-2458-14-314
Published: 5 April 2014
Abstract (provisional)
Background
As part of site development for clinical trials in novel TB vaccines, a cohort of infants was enrolled in eastern Uganda to estimate the incidence of tuberculosis. The study introduced several mortality reduction strategies, and evaluated the mortality among study participants at two years. The specific of objective of this sub-study was to estimate 2 year mortality and associated factors in this community-based cohort.
Methods
A community based cohort of 2500 infants was enrolled from birth up to 8 weeks of age and followed for 1-2 years. During follow up, several mortality reduction activities were implemented to enhance cohort survival and retention. The verbal autopsy process was used to assign causes of death.
Results
A total of 152 children died over a median follow up period of 2.0 years. The overall crude mortality rate was 60.8/1000 or 32.9/1000 person years with 40 deaths per 1000 for children who died in their first year of life. Anaemia, malaria, diarrhoeal diseases and pneumonia were the top causes of death. There was no death directly attributed to tuberculosis. Significant factors associated with mortality were young age of a mother and child’s birth place not being a health facility.
Conclusion
The overall two year mortality in the study cohort was unacceptably high and tuberculosis disease was not identified as a cause of death. Interventions to reduce mortality of children enrolled in the cohort study did not have a significant impact. Clinical trials involving infants and young children in this setting will have to strengthen local maternal and child health services to reduce infant and child mortality.

British Medical Journal
05 April 2014 (Vol 348, Issue 7952)
http://www.bmj.com/content/348/7952
Editorial
Introducing a new group B meningococcus vaccine
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2415 (Published 2 April 2014)
Cite this as: BMJ 2014;348:g2415

Many forces affect the final decision
The introduction of a new vaccine is highly complex, particularly a new category of vaccine with no biological precedent. The new group B meningococcus vaccine Bexsero (4CMenB),1 developed using a genomic based reverse vaccinology approach,2 is a case in point. When a vaccine is targeted against a relatively common disease, the company usually sponsors a large randomised controlled trial to show that the vaccine works. Group B meningococcal infection is sufficiently rare, however, that such a trial is not feasible.

In most countries, advice on vaccines and immunisation programmes is given to governments by independent committees. This advice includes data on vaccine effectiveness, the likelihood that the vaccine will confer herd immunity (protect some unimmunised people by reducing carriage or spread of disease), safety, and cost effectiveness. In the United Kingdom, the Joint Committee on Vaccination and Immunisation (JCVI) has such a role. In the UK,3 and in Australia, Canada, the United States, and many European countries, the government is not permitted in law to fund an immunisation programme unless the immunisation advisory committee says it is cost effective.

Different countries allow different assumptions in the modelling, so they do not always reach the same decision…

Bulletin of the World Health Organization
Volume 92, Number 4, April 2014, 229-308
http://www.who.int/bulletin/volumes/92/4/en/
Editorial
Human rabies in India: a problem needing more attention
Alakes Kumar Kole a, Rammohan Roy a & Dalia Chanda Kole b
a. Department of Medicine, Infectious Diseases Hospital 57, Beliaghata Main Road, Kolkata-700010, West Bengal, India.
b. BP Poddar Hospital & Medical Research Institute, Kolkata, India.
Correspondence to Alakes Kumar Kole
Bulletin of the World Health Organization 2014;92:230. doi: http://dx.doi.org/10.2471/BLT.14.136044
Initial text
Rabies is fully preventable. About 563 million United States dollars are spent annually in the world on measures to prevent rabies,1 yet in countries of south-eastern Asia the disease is still an important public health problem. An estimated 45% of all deaths from rabies occur in that part of the world.2 The situation is especially pronounced in India, which reports about 18 000 to 20 000 cases of rabies a year and about 36% of the world’s deaths from the disease.3 Rabies incidence in India has been constant for a decade, without any obvious declining trend, and reported incidence is probably an underestimation of true incidence because in India rabies is still not a notifiable disease.4 This situation is rooted in a general lack of awareness of preventive measures, which translates into insufficient dog vaccination, an uncontrolled canine population, poor knowledge of proper post-exposure prophylaxis on the part of many medical professionals, and an irregular supply of anti-rabies vaccine and immunoglobulin, particularly in primary-health-care facilities.

Bulletin of the World Health Organization
Volume 92, Number 4, April 2014, 229-308
http://www.who.int/bulletin/volumes/92/4/en/

Editorial
The lack of progress in reducing anaemia among women: the inconvenient truth
Francesco Branca a, Lina Mahy a & Thahira Shireen Mustafa a
a. United Nations System Standing Committee on Nutrition, c/o World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
Correspondence to Francesco Branca
Bulletin of the World Health Organization 2014;92:231. doi: http://dx.doi.org/10.2471/BLT.14.137810
Initial text
Most of the 1.62 billion people currently affected by anaemia are women or young children. Since 1995, the global prevalences of anaemia among non-pregnant women, pregnant women and children aged less than 5 years have fallen only slightly: from 33 to 29%, 43 to 38% and 47 to 43%, respectively.1 Although the corresponding prevalences of severe anaemia have shown more substantial declines over the same period –from 1.8 to 1.1%, 2.0 to 0.9% and 3.7 to 1.5%, respectively – the global prevalence of anaemia only fell by 0.2 to 0.3 percentage points per year between 1993 and 2013.2 Anaemia in women – especially among non-pregnant women in central, northern and western Africa, central Asia and the Middle East and among pregnant women in southern Africa and southern Asia – is a particularly persistent problem…

Bulletin of the World Health Organization
Volume 92, Number 4, April 2014, 229-308
http://www.who.int/bulletin/volumes/92/4/en/

Effect of breastfeeding on immunogenicity of oral live-attenuated human rotavirus vaccine: a randomized trial in HIV-uninfected infants in Soweto, South Africa
Michelle J Groome, Sung-Sil Moon, Daniel Velasquez, Stephanie Jones, Anthonet Koen, Nadia van Niekerk, Baoming Jiang, Umesh D Parashar & Shabir A Madhi
Abstract
Objective
To investigate the effect of abstention from breastfeeding, for an hour before and after each vaccination, on the immune responses of infants to two doses of rotavirus vaccine.
Methods
In Soweto, South Africa, mother–infant pairs who were uninfected with human immunodeficiency virus (HIV) were enrolled as they presented for the “6-week” immunizations of the infants. Each infant was randomly assigned to Group 1 – in which breastfeeding was deferred for at least 1 h before and after each dose of rotavirus vaccine – or Group 2 – in which unrestricted breastfeeding was encouraged. Enzyme-linked immunosorbent assays were used to evaluate the titres of rotavirus-specific IgA in samples of serum collected from each infant immediately before each vaccine dose and 1 month after the second dose. Among the infants, a fourfold or greater increase in titres of rotavirus-specific IgA following vaccination was considered indicative of seroconversion.
Findings
The evaluable infants in Group 1 (n = 98) were similar to those in Group 2 (n = 106) in their baseline demographic characteristics and their pre-vaccination titres of anti-rotavirus IgA. After the second vaccine doses, geometric mean titres of anti-rotavirus IgA in the sera of Group-1 infants were similar to those in the sera of Group-2 infants (P = 0.685) and the frequency of seroconversion in the Group-1 infants was similar to that in the Group-2 infants (P = 0.485).
Conclusion
Among HIV-uninfected South African infants, abstention from breastfeeding for at least 1 h before and after each vaccination dose had no significant effect on the infants’ immune response to a rotavirus vaccine.

Bulletin of the World Health Organization
Volume 92, Number 4, April 2014, 229-308
http://www.who.int/bulletin/volumes/92/4/en/

Early response to the emergence of influenza A(H7N9) virus in humans in China: the central role of prompt information sharing and public communication
Sirenda Vong, Michael O’Leary & Zijian Feng
Abstract
Problem
In 2003, China’s handling of the early stages of the epidemic of severe acute respiratory syndrome (SARS) was heavily criticized and generally considered to be suboptimal.
Approach
Following the SARS outbreak, China made huge investments to improve surveillance, emergency preparedness and response capacity and strengthen public health institutions. In 2013, the return on these investments was evaluated by investigating China’s early response to the emergence of avian influenza A(H7N9) virus in humans.
Local setting
Clusters of human infection with a novel influenza virus were detected in China – by national surveillance of pneumonia of unknown etiology – on 26 February 2013.
Relevant changes
On 31 March 2013, China notified the World Health Organization (WHO) of the first recorded human infections with A(H7N9) virus. Poultry markets – which were rapidly identified as a major source of transmission of A(H7N9) to humans – were closed down in the affected areas. Surveillance in humans and poultry was heightened and technical guidelines were quickly updated and disseminated. The health authorities collaborated with WHO in risk assessments and risk communication. New cases were reported promptly and publicly.
Lessons learnt
The relevant infrastructures, surveillance systems and response capacity need to be strengthened in preparation for future emergencies caused by emerging or existing disease threats. Results of risk assessments and other data should be released promptly and publicly and such release should not jeopardize future publication of the data in scientific journals. Coordination between public health and veterinary services would be stronger during an emergency if these services had already undertaken joint preparedness planning.

Eurosurveillance
Volume 19, Issue 13, 03 April 2014
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678
Editorials
Integrated surveillance for prevention and control of emerging vector-borne diseases in Europe
J C Semenza 1, H Zeller1
European Centre for Disease Prevention and Control, Stockholm, Sweden
World Health Day, celebrated on 7 April, marks the anniversary of the founding of the World Health Organization (WHO) in 1948. This year, vector-borne diseases which are transmitted mainly by bites of vectors such as mosquitoes, ticks and sandflies are highlighted as a global public health priority. This issue of Eurosurveillance focuses on vector-borne diseases and their impact on public health in Europe and other parts of the world such as the recent outbreaks of Chikungunya fever in the Caribbean and Zika virus fever in the Pacific [1-6].

New England Journal of Medicine
April 3, 2014 Vol. 370 No. 14
http://www.nejm.org/toc/nejm/medical-journal
Review Article – Global Health
Pandemic Preparedness and Response — Lessons from the H1N1 Influenza of 2009
Harvey V. Fineberg, M.D., Ph.D.
N Engl J Med 2014; 370:1335-1342April 3, 2014DOI: 10.1056/NEJMra1208802
[Free full text]

Pediatrics
April 2014, VOLUME 133 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml
Article
Effective Messages in Vaccine Promotion: A Randomized Trial
Brendan Nyhan, PhDa, Jason Reifler, PhDb, Sean Richey, PhDc, and Gary L. Freed, MD, MPHd,e
Author Affiliations
aDepartment of Government, Dartmouth College, Hanover, New Hampshire;
bDepartment of Politics, University of Exeter, Exeter, United Kingdom;
cDepartment of Political Science, Georgia State University, Atlanta, Georgia;
dThe Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan; and
eDepartment of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
http://pediatrics.aappublications.org/content/133/4/e835.abstract
Abstract
OBJECTIVES: To test the effectiveness of messages designed to reduce vaccine misperceptions and increase vaccination rates for measles-mumps-rubella (MMR).
METHODS: A Web-based nationally representative 2-wave survey experiment was conducted with 1759 parents age 18 years and older residing in the United States who have children in their household age 17 years or younger (conducted June–July 2011). Parents were randomly assigned to receive 1 of 4 interventions: (1) information explaining the lack of evidence that MMR causes autism from the Centers for Disease Control and Prevention; (2) textual information about the dangers of the diseases prevented by MMR from the Vaccine Information Statement; (3) images of children who have diseases prevented by the MMR vaccine; (4) a dramatic narrative about an infant who almost died of measles from a Centers for Disease Control and Prevention fact sheet; or to a control group.
RESULTS: None of the interventions increased parental intent to vaccinate a future child. Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects.
CONCLUSIONS: Current public health communications about vaccines may not be effective. For some parents, they may actually increase misperceptions or reduce vaccination intention. Attempts to increase concerns about communicable diseases or correct false claims about vaccines may be especially likely to be counterproductive. More study of pro-vaccine messaging is needed.

Pediatrics
April 2014, VOLUME 133 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Article
Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009
Fangjun Zhou, PhDa, Abigail Shefer, MDa, Jay Wenger, MDa, Mark Messonnier, PhDa, Li Yan Wang, MBAb, Adriana Lopez, MHSa, Matthew Moore, MD, MPHa, Trudy V. Murphy, MDb, Margaret Cortese, MDa, and Lance Rodewald, MDa
Author Affiliations
aNational Center for Immunization and Respiratory Diseases, and
bNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Dr Wenger is currently affiliated with the Bill & Melinda Gates Foundation, Seattle, WA.
http://pediatrics.aappublications.org/content/133/4/577.abstract
Abstract
OBJECTIVES: To evaluate the economic impact of the 2009 routine US childhood immunization schedule, including diphtheria and tetanus toxoids and acellular pertussis, Haemophilus influenzae type b conjugate, inactivated poliovirus, measles/mumps/rubella, hepatitis B, varicella, 7-valent pneumococcal conjugate, hepatitis A, and rotavirus vaccines; influenza vaccine was not included.
METHODS: Decision analysis was conducted using population-based vaccination coverage, published vaccine efficacies, historical data on disease incidence before vaccination, and disease incidence reported during 2005 to 2009. Costs were estimated using the direct cost and societal (direct and indirect costs) perspectives. Program costs included vaccine, administration, vaccine-associated adverse events, and parent travel and work time lost. All costs were inflated to 2009 dollars, and all costs and benefits in the future were discounted at a 3% annual rate. A hypothetical 2009 US birth cohort of 4 261 494 infants over their lifetime was followed up from birth through death. Net present value (net savings) and benefit-cost ratios of routine childhood immunization were calculated.
RESULTS: Analyses showed that routine childhood immunization among members of the 2009 US birth cohort will prevent ∼42 000 early deaths and 20 million cases of disease, with net savings of $13.5 billion in direct costs and $68.8 billion in total societal costs, respectively. The direct and societal benefit-cost ratios for routine childhood vaccination with these 9 vaccines were 3.0 and 10.1.
CONCLUSIONS: From both direct cost and societal perspectives, vaccinating children as recommended with these vaccines results in substantial cost savings.

Pediatrics
April 2014, VOLUME 133 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Quality Report
Improving Immunization Rates in a Hospital-Based Primary Care Practice
Clement J. Bottino, MD, MPHa,b, Joanne E. Cox, MDa,b, Prerna Singh Kahlon, BDS, MPAH, CPHQc, and Ronald C. Samuels, MD, MPHa,b
Author Affiliations
aDivision of General Pediatrics, Department of Medicine and
cProgram for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts; and
bDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts
http://pediatrics.aappublications.org/content/133/4/e1047.abstract
Abstract
OBJECTIVE: We implemented a quality improvement initiative aimed at reaching a 95% immunization rate for patients aged 24 months. The setting was a hospital-based pediatric primary care practice in Boston, Massachusetts. We defined immunization as full receipt of the vaccine series as recommended by the Centers for Disease Control and Prevention.
METHODS: The initiative was team-based and structured around 3 core interventions: systematic identification and capture of target patients, use of a patient-tracking registry, and patient outreach and care coordination. We measured monthly overall and modified immunization rates for patients aged 24 months. The modified rate excluded vaccine refusals and practice transfers. We plotted monthly overall and modified immunization rates on statistical process control charts to monitor progress and evaluate impact.
RESULTS: We measured immunization rates for 3298 patients aged 24 months between January 2009 and December 2012. Patients were 48% (n = 1576) female, 77.3% (n = 2548) were African American or Hispanic, and 70.2% (n = 2015) were publicly insured. Using control charts, we established mean overall and modified immunization rates of 90% and 93%, respectively. After implementation, we observed an increase in the mean modified immunization rate to 95%.
CONCLUSIONS: A quality improvement initiative enabled our pediatric practice to increase its modified immunization rate to 95% for children aged 24 months. We attribute the improvement to the incorporation of medical home elements including a multidisciplinary team, patient registry, and care coordination.

Pharmacoeconomics
Volume 32, Issue 4, April 2014
http://link.springer.com/journal/40273/32/3/page/1

How to Estimate Productivity Costs in Economic Evaluations
Marieke Krol, Werner Brouwer
http://link.springer.com/article/10.1007/s40273-014-0132-3
Abstract
Productivity costs are frequently omitted from economic evaluations, despite their often strong impact on cost-effectiveness outcomes. This neglect may be partly explained by the lack of standardization regarding the methodology of estimating productivity costs. This paper aims to contribute to standardization of productivity cost methodology by offering practical guidance on how to estimate productivity costs in economic evaluations. The paper discusses the identification, measurement and valuation of productivity losses. It is recommended to include not only productivity losses related to absenteeism from and reduced productivity at paid work, but also those related to unpaid work. Hence, it is recommended to use a measurement instrument including questions about both paid and unpaid productivity, such as the iMTA Productivity Cost Questionnaire (iPCQ) or the Valuation of Lost Productivity (VOLP). We indicate how to apply the friction cost and the human capital approach and give practical guidance on deriving final cost estimates.

Differential Time Preferences for Money and Quality of Life
M. B. Y. Parouty, H. H. Le, D. Krooshof, M. J. Postma
http://link.springer.com/article/10.1007/s40273-013-0124-8
Abstract
Background
This study provides an empirical investigation into differential time preferences between money and quality of life. Thus far, time preference investigations in health have mostly involved life-years gained and lives saved. However, the quality-adjusted life-year, which is recommended by several bodies, is a multiplicative measure of life duration and quality of life. To our knowledge, our study is the first to follow this approach specifically for quality of life.
Methods
A questionnaire was developed to elicit time preferences for quality of life and for money, and it was distributed to a representative sample of the Dutch population. We also investigated the impact of population characteristics, such as current health state, optimistic/pessimistic future views or gender, on time preferences.
Results
We found that discount rates for both money and quality of life decrease with increasing time of delay, with rates of the former being consistently at least two times higher than those of the latter. Similar trends in time preferences were observed across the subgroups, with the exception of the relatively high education subgroup.
Conclusion
In agreement with the results of other studies, our empirically derived discount rates are higher than the rates featured in national guidelines for health care economic assessment. Our empirical study adds to the evidence for differential discounting, both with regards to money and health, as well as in time

Pneumonia
Vol 3 (2014)
https://pneumonia.org.au/index.php/pneumonia/issue/current
Reflections on pneumonia in the tropics
Michael Alpers
https://pneumonia.org.au/index.php/pneumonia/article/view/416
Abstract
This review of pneumonia in the tropics is based on experience with respiratory infections in Papua New Guinea since the 1970s. It discusses ideas, principles, historical aspects of pneumonia research and the need to work with the community. In order to understand pneumonia in a tropical setting and evaluate new interventions it is essential to study the ecosystem of the causative infections, within the host and the community and between interacting microorganisms. Vaccines are much-needed preventive tools, and for pneumonia in a highly endemic setting the prevention of severe and fatal disease takes priority over the prevention of infection. In this setting mild infection plays an important role in preventing severe disease. For achieving long-term sustainable outcomes, sometimes ‘less is more’. A multipronged approach is required to control and prevent pneumonia, and in devising new ways of doing so. This includes appropriate and accessible clinical care, a clean, smoke-free environment, good nutrition and a range of vaccines. Also required are persistent advocacy from the global scientific community and strong engagement with and by the communities that bear the burden of disease. Better health care must be pursued in conjunction with raising literacy rates and reducing poverty.

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH
February 2014 Vol. 35, No. 2
http://www.paho.org/journal/index.php?option=com_content&view=article&id=137&Itemid=233&lang=en

Determinantes sociales de la exclusión a los servicios de salud y a medicamentos en tres países de América Central [Social determinants of exclusion from health services and medicines in three Central American countries]
Cecilia Acuña, Nelly Marin, Adriana Mendoza, Isabel Cristina Martins Emmerick, Vera Lucía Luiza, and Thiago Botelho Azeredo

Investigação participativa baseada na comunidade em saúde pública: potencialidades e desafios [Community-based participatory research in public health: potentials and challenges]
Sónia Dias e Ana Gama

Eficacia de la detección sistemática de la gripe en las fronteras en los viajeros que llegan por vía aérea [Effectiveness of border screening for detecting influenza in arriving airline travelers]
Patricia C. Priest, Lance C. Jennings, Alasdair R. Duncan, Cheryl R. Brunton y Michael G. Baker

Science
4 April 2014 vol 344, issue 6179, pages 1-116
http://www.sciencemag.org/current.dtl
Perspective – Immunology
Immune Activation with HIV Vaccines
Anthony S. Fauci1, Mary A. Marovich1, Carl W. Dieffenbach1, Eric Hunter2, Susan P. Buchbinder3
Author Affiliations
1National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892, USA.
2Department of Pathology and Laboratory Medicine, Emory Vaccine Center at Yerkes National Primate Research Center, Emory University, Atlanta, GA 30322, USA.
3San Francisco Department of Public Health, Department of Medicine, University of California, San Francisco, CA 94143, USA.

The development of a safe and effective HIV vaccine is perhaps the most important and challenging goal remaining in HIV-AIDS research. Recent progress using a poxvirus vector prime and envelope protein boost strategy demonstrated a modest but statistically significant level of efficacy and established the concept that a vaccine could prevent HIV infection (1), and approaches to boost durability and efficacy are currently in the planning stages (2). But the results of two vaccine concepts based on recombinant adenovirus serotype-5 (rAd5) (3–5) pointed to a potential major problem—that such vaccines might increase susceptibility to HIV infection. This also raised the question of whether the problem extends to some or all of the other recombinant adenovirus vectors currently in development or to other vector-based vaccines.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 20, Pages 2261-2388 (25 April 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/20
What a pandemic teaches us about vaccination attitudes of parents of children with asthma
Original Research Article
Pages 2275-2280
Betul Buyuktiryaki, Ozge Uysal Soyer, Mustafa Erkocoglu, Ayse Dogan, Dilek Azkur, Can Naci Kocabas, Yildiz Dallar, Ayfer Tuncer, Bulent Enis Seker
Abstract
Background
During the recent pandemic, Influenza A/H1N1 vaccine uptake remained far below the targeted rates. Associated factors regarding vaccine refusal in the general population have been reported in many studies, however the reasons behind refusals for asthmatic children have not yet been identified. We aimed to investigate Influenza A/H1N1 virus vaccine acceptance for children with asthma, to determine the attitudes and beliefs of parents concerning Influenza A/H1N1 disease and vaccine and to identify the association of asthma control parameters with vaccination.
Methods
The parents of asthmatic children aged 6–18 years participated in a cross-sectional survey study in three pediatric allergy outpatient clinics. The survey measured demographic factors, asthma control parameters, vaccination rates, and beliefs and attitudes regarding Influenza A/H1N1 vaccine.
Results
Of the 625 asthmatic children, 16.8% (n = 105) were immunized with Influenza A/H1N1 and 45.7% (n = 286) with seasonal influenza vaccine. Educational background of parents (p < 0.001 and p = 0.002, for father’s and mother’s educational level, respectively), previous vaccination with seasonal influenza (p < 0.001), and having a family member vaccinated against Influenza A/H1N1 (p < 0.001) had a significant influence on vaccine acceptance, while fear of side effects (88.6%) was the major parental reason for refusing the vaccine. Asthma control parameters had no influence on uptake of the vaccine. Physician recommendation (84.8%) was important in the decision-making process for immunization. The statement “Children with asthma should receive swine flu vaccine” increased the likelihood of being vaccinated [OR: 2.160, (95%CI 1.135–4.111), p = 0.019].
Conclusion
Although asthmatic children are considered to be a high-priority group for Influenza A/H1N1 vaccination, we found low uptake of vaccine among our patients. Beliefs and attitudes rather than asthma control parameters influenced parental decisions for immunization. Understanding the underlying determinants for refusing the vaccine will help to improve vaccine campaigns in advance of a future outbreak.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 20, Pages 2261-2388 (25 April 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/20
Cost and sustainability of a successful package of interventions to improve vaccination coverage for children in urban slums of Bangladesh
Original Research Article
Pages 2294-2299
K. Hayford, M.J. Uddin, T.P. Koehlmoos, D.M. Bishai
Abstract
Objective
To estimate the incremental economic costs and explore satisfaction with a highly effective intervention for improving immunization coverage among slum populations in Dhaka, Bangladesh. A package of interventions based on extended clinic hours, vaccinator training, active surveillance, and community participation was piloted in two slum areas of Dhaka, and resulted in an increase in valid fully immunized children (FIC) from 43% pre-intervention to 99% post-intervention.
Methods
Cost data and stakeholder perspectives were collected January–February 2010 via document review and 10 key stakeholders interviews to estimate the financial and opportunity costs of the intervention, including uncompensated time, training and supervision costs.
Results
The total economic cost of the 1-year intervention was $18,300, comprised of external management and supervision (73%), training (11%), coordination costs (1%), uncompensated staff time and clinic costs (2%), and communications, supplies and other costs (13%). An estimated 874 additional children were correctly and fully immunized due to the intervention, at an average cost of $20.95 per valid FIC. Key stakeholders ranked extended clinic hours and vaccinator training as the most important components of the intervention. External supervision was viewed as the most important factor for the intervention’s success but also the costliest. All stakeholders would like to reinstate the intervention because it was effective, but additional funding would be needed to make the intervention sustainable.
Conclusion
Targeting slum populations with an intensive immunization intervention was highly effective but would nearly triple the amount spent on immunization per FIC in slum areas. Those committed to increasing vaccination coverage for hard-to-reach children need to be prepared for substantially higher costs to achieve results.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X/32
Volume 32, Issue 20, Pages 2261-2388 (25 April 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/20
Vaccine preventable diseases: Time to re-examine global surveillance data?
Original Research Article
Pages 2315-2320
Adam MacNeil, Vance Dietz, Thomas Cherian
Abstract
While data driven estimates of the global burden of disease for some vaccine preventable diseases (VPDs) are limited, aggregate case numbers of VPDs are reported annually by country in the Joint Reporting Form (JRF). We examined pertussis surveillance data in the JRF, and vaccine coverage estimates, in comparison to measles, which is a priority disease for elimination and eradication efforts and is supported by the WHO Global Measles and Rubella Laboratory Network. In 2012, highest pertussis case numbers and incidence were reported from high income countries with high vaccine coverage, discordant with countries that had low vaccine coverage. Use of laboratory diagnostics for pertussis cases varied among countries. In contrast, highest reported numbers of measles cases and incidences tended to occur in low income countries. These observations imply poor quality global surveillance data for some VPDs, limiting capacity for monitoring global epidemiology or making vaccination policy decisions. Efforts are needed to improve the availability of quality surveillance data for all VPDs.

Vaccine
Volume 32, Issue 19, Pages 2135-2260 (17 April 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/19
Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012
Review Article
Pages 2150-2159
Heidi J. Larson, Caitlin Jarrett, Elisabeth Eckersberger, David M.D. Smith, Pauline Paterson
Abstract
Vaccine “hesitancy” is an emerging term in the literature and discourse on vaccine decision-making and determinants of vaccine acceptance. It recognizes a continuum between the domains of vaccine acceptance and vaccine refusal and de-polarizes previous characterization of individuals and groups as either anti-vaccine or pro-vaccine.
The primary aims of this systematic review are to: 1) identify research on vaccine hesitancy; 2) identify determinants of vaccine hesitancy in different settings including its context-specific causes, its expression and its impact; and 3) inform the development of a model for assessing determinants of vaccine hesitancy in different settings as proposed by the Strategic Advisory Group of Experts Working Group (SAGE WG) for dealing with vaccine hesitancy.
A broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy around vaccines, was applied across multiple databases. Peer-reviewed studies were selected for inclusion if they focused on childhood vaccines [≤7 years of age], used multivariate analyses, and were published between January 2007 and November 2012.
Our results show a variety of factors as being associated with vaccine hesitancy but they do not allow for a complete classification and confirmation of their independent and relative strength of influence. Determinants of vaccine hesitancy are complex and context-specific – varying across time, place and vaccines.