Commercializing diarrhea vaccines for travelers

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
June 2014 Volume 10, Issue 6
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/6/

Review
Commercializing diarrhea vaccines for travelers
Rosa López-Gigosos, Marina Segura-Moreno, Rosa Díez-Díaz, Elena Plaza and Alberto Mariscal
http://dx.doi.org/10.4161/hv.27737
Abstract
Continued growth in international travel and forecasts for a great increase in the number of people who travel from industrialized to emerging and developing countries make it necessary to develop and improve the capacity to provide health protection to travelers. Measures available to prevent some diseases include a currently limited number of marketed vaccines which represent extremely useful tools to protect travelers. Travelers very often experience diarrheal and gastrointestinal diseases for which some vaccines are available. Use of these vaccines should be evaluated based on traveler and travel destination and characteristics. Vaccines available include those against cholera, typhoid fever, hepatitis A, hepatitis E (only available in China), and rotavirus. The aim of this review is to provide an updated summary about each of the abovementioned vaccines that may be useful for making decisions regarding their use and assessing their indications in recommendations for travelers.

HPV vaccine uptake after introduction of the vaccine in Germany: An analysis of administrative data

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
June 2014 Volume 10, Issue 6
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/6/

Short Report
HPV vaccine uptake after introduction of the vaccine in Germany: An analysis of administrative data
Sabrina Hense, Kathrin Hillebrand, Johannes Horn, Rafael Mikolajczyk, Renate Schulze-Rath and Edeltraut Garbe
http://dx.doi.org/10.4161/hv.28450
Abstract
In Germany, vaccination against human papilloma virus (HPV) is recommended by the German Standing Vaccination Committee (STIKO) since March 2007 for girls aged 12–17 years. The vaccine is free of charge for this age group. Additionally, some statutory health insurance providers (SHI) offer reimbursement for women aged 18–26 years. Currently available information on the uptake or coverage of HPV vaccination is limited to specific regions, age groups, or study populations.
This report describes the HPV vaccine uptake in 2008 for females aged 12–26 years in Germany on a broad regional level based on data from one large SHI. HPV vaccinations were identified by outpatient codes used for reimbursement of vaccine administration. Vaccine uptake was calculated by dividing the number of females, who received at least one HPV vaccine dose by the number of female insurees in the respective age group. The overall study population consisted of 317,234 females, of whom 77,350 received at least one HPV vaccine dose in 2008. Vaccine uptake was 32.2% in the recommended age group, with a peak age at 14–16 years. In the age group of females aged 18–26 years, where HPV vaccination was not officially recommended by the STIKO, uptake was 12.3%. Vaccine uptake in 2008 reflects an early stage after the recommendation of HPV vaccination in 2007. Future changes in vaccine uptake should be further and more promptly monitored.

Knowledge and risk perception of measles and factors associated with vaccination decisions in subjects consulting university affiliated public hospitals in Lyon, France, after measles infection

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
June 2014 Volume 10, Issue 6
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/6/

Research Paper
Knowledge and risk perception of measles and factors associated with vaccination decisions in subjects consulting university affiliated public hospitals in Lyon, France, after measles infection
Abdoulaye Tour, Mitra Saadatian-Elahi, Daniel Floret, Bruno Lina, Jean-Sebastien Casalegno and Philippe Vanhems
Abstract
In 2011, a large number of European countries faced measles outbreaks, France accounting for more than half of the reported cases. The Rhône-Alpes region, located in south-east France, was one of the most affected provinces, with an incidence rate of 97.9 cases per 100,000 inhabitants. We conducted a retrospective survey of adults and parents of children consulting university affiliated public hospitals because of measles infections between January 1, 2010 and September 2012 in Lyon, France. Our main objectives were to evaluate: i) the level of study population knowledge of measles; ii) vaccination practices; and iii) changes in opinion with regard to measles vaccination after disease onset. Overall, 73.64% of patients were not vaccinated or partially vaccinated. The main reason for non-vaccination in children was inappropriate age while among non-vaccinated adults, 29.3% could not give any reason. In total, 29.1% of the responding parents and 24.2% of adult cases were opposed to vaccination “in principle”. Opposition to vaccination “in principle” was the third reason for non-vaccination. A large number of patients did not recognize measles as a serious illness and were unaware of its complications. Among parents of infected children, knowledge of transmission mode (odds ratio (OR) =5.9; 95% confidence interval (95% CI): 1.64-21.26), perceived severity of measles (OR=1.5; 95% CI: 1.06-2.13) and absence of hepatitis B vaccination (OR=0.17; 95% CI: 0.04-0.65) were independently associated with a more positive opinion about measles vaccination after disease onset. In adult patients, low education level (OR=3.39; 95% CI: 1.03-11.11) and lack of knowledge of sequelae (OR=10.19; 95% CI: 1.14-91.31) were linked with a more positive opinion. Individuals affected by vaccine-preventable diseases are interesting populations to study disease impact on vaccine perception.

Timely Versus Delayed Early Childhood Vaccination and Seizures

Pediatrics
June 2014, VOLUME 133 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Article
Timely Versus Delayed Early Childhood Vaccination and Seizures
Simon J. Hambidge, MD, PhDa,b,c,d, Sophia R. Newcomer, MPHa, Komal J. Narwaney, MD, PhDa, Jason M. Glanz, PhDa,d, Matthew F. Daley, MDa,c, Stan Xu, PhDa, Jo Ann Shoupa, Ali Rowhani-Rahbar, MD, PhDe, Nicola P. Klein, MD, PhDf, Grace M. Lee, MD, MPHg,h, Jennifer C. Nelson, MPHi, Marlene Lugg, DrPHj, Allison L. Naleway, PhDk, James D. Nordin, MD, MPHl, Eric Weintraub, MPHm, and Frank DeStefano, MD, MPHm
Author Affiliations
aInstitute for Health Research, Kaiser Permanente Colorado, Denver, Colorado;
bDepartment of Community Health Services, Denver Health, Denver, Colorado;
cDepartment of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado;
dDepartment of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado;
eDepartment of Epidemiology, School of Public Health, University of Washington, Seattle, Washington;
fKaiser Permanente Vaccine Study Center, Oakland, California;
gDepartment of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts;
hDivision of Infectious Diseases and Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts;
iGroup Health Research Institute, Seattle, Washington;
jDepartment of Research and Evaluation, Southern California Kaiser Permanente, Pasadena, California;
kKaiser Foundation Hospital Center for Health Research, Kaiser Northwest, Portland, Oregon;
lHealth Partners Research Foundation, Minneapolis, Minnesota; and
mImmunization Safety Office, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Abstract
BACKGROUND: Little is known regarding the timing of childhood vaccination and postvaccination seizures.
METHODS: In a cohort of 323 247 US children from the Vaccine Safety Datalink born from 2004 to 2008, we analyzed the association between the timing of childhood vaccination and the first occurrence of seizure with a self-controlled case series analysis of the first doses of individual vaccines received in the first 2 years of life.
RESULTS: In infants, there was no association between the timing of infant vaccination and postvaccination seizures. In the second year of life, the incident rate ratio (IRR) for seizures after receipt of the first measles-mumps-rubella vaccine (MMR) dose at 12 to 15 months was 2.65 (95% confidence interval [CI] 1.99–3.55); the IRR after an MMR dose at 16 to 23 months was 6.53 (95% CI 3.15–13.53). The IRR for seizures after receipt of the first measles-mumps-rubella-varicella vaccine (MMRV) dose at 12 to 15 months was 4.95 (95% CI 3.68–6.66); the IRR after an MMRV dose at 16 to 23 months was 9.80 (95% CI 4.35 –22.06).
CONCLUSIONS: There is no increased risk of postvaccination seizure in infants regardless of timing of vaccination. In year 2, delaying MMR vaccine past 15 months of age results in a higher risk of seizures. The strength of the association is doubled with MMRV vaccine. These findings suggest that on-time vaccination is as safe with regard to seizures as delayed vaccination in the first year of life, and that delayed vaccination in the second year of life is associated with more postvaccination seizures than on-time vaccination.

Duration of Protection After Infant Hepatitis B Vaccination Series

Pediatrics
June 2014, VOLUME 133 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Article
Duration of Protection After Infant Hepatitis B Vaccination Series
Amy B. Middleman, MD, MSEd, MPHa, Carol J. Baker, MDb, Claudia A. Kozinetz, PhDb, Saleem Kamili, PhDc, Chi Nguyenb, Dale J. Hu, MDc, and Philip R. Spradling, MDc
Author Affiliations
aDepartment of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;
bDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas; and
cCenters for Disease Control and Prevention, Atlanta, Georgia
Abstract
BACKGROUND: Little is known about duration of protection after the infant primary series of hepatitis B (HB) vaccine in settings of low HB endemicity. This study sought to determine the proportion of adolescents immunized as infants who had protective titers of antibody to hepatitis B surface antigen (anti-HBs) before and after a challenge dose of vaccine.
METHODS: US-born 16- through 19-year-olds who received a recombinant HB vaccine 3-dose series initiated within 7 days of birth (group 1) or at ≥4 weeks of age (group 2) and completed by 12 months of age were enrolled. Participants had serologic testing before and 2 weeks after randomization to receive a challenge dose of 10 µg or 20 µg of Engerix-B. Baseline and postchallenge levels of anti-HBs were compared by group, challenge dosage, and demographic and behavioral characteristics.
RESULTS: At baseline, 24% had protective anti-HBs levels of ≥10 IU/mL; 92% achieved protective levels after challenge dose. Although group 1 had a lower proportion of seroprotection at baseline, group and challenge dosage were not associated with postchallenge proportion of seroprotection. Being in group 2, higher test dosage, higher baseline geometric mean titer, and nonwhite race were associated with significantly higher geometric mean titer after challenge dose.
CONCLUSIONS: More than 90% of study participants immunized against HB as infants exhibited a seroprotective response to a challenge dose of vaccine. Duration of protection from the primary infant HB vaccine series extended through the adolescent years in the setting of low HB endemicity.

Are Current Cost-Effectiveness Thresholds for Low- and Middle-Income Countries Useful? Examples from the World of Vaccines

Pharmacoeconomics
Volume 32, Issue 6, June 2014
http://link.springer.com/journal/40273/32/5/page/1

Are Current Cost-Effectiveness Thresholds for Low- and Middle-Income Countries Useful? Examples from the World of Vaccines
A. T. Newall, M. Jit, R. Hutubessy
Abstract
The World Health Organization’s CHOosing Interventions that are Cost Effective (WHO-CHOICE) thresholds for averting a disability-adjusted life-year of one to three times per capita income have been widely cited and used as a measure of cost effectiveness in evaluations of vaccination for low- and middle-income countries (LMICs). These thresholds were based upon criteria set out by the WHO Commission on Macroeconomics and Health, which reflected the potential economic returns of interventions. The CHOICE project sought to evaluate a variety of health interventions at a subregional level and classify them into broad categories to help assist decision makers, but the utility of the thresholds for within-country decision making for individual interventions (given budgetary constraints) has not been adequately explored. To examine whether the ‘WHO-CHOICE thresholds’ reflect funding decisions, we examined the results of two recent reviews of cost-effectiveness analyses of human papillomavirus and rotavirus vaccination in LMICs, and we assessed whether the results of these studies were reflected in funding decisions for these vaccination programmes. We found that in many cases, programmes that were deemed cost effective were not subsequently implemented in the country. We consider the implications of this finding, the advantages and disadvantages of alternative methods to estimate thresholds, and how cost perspectives and the funders of healthcare may impact on these choices

Epidemic Process over the Commute Network in a Metropolitan Area

PLoS One
[Accessed 7 June 2014]
http://www.plosone.org/

Research Article
Epidemic Process over the Commute Network in a Metropolitan Area
Kenta Yashima mail,
Akira Sasaki
Published: June 06, 2014
DOI: 10.1371/journal.pone.0098518
Abstract
An understanding of epidemiological dynamics is important for prevention and control of epidemic outbreaks. However, previous studies tend to focus only on specific areas, indicating that application to another area or intervention strategy requires a similar time-consuming simulation. Here, we study the epidemic dynamics of the disease-spread over a commute network, using the Tokyo metropolitan area as an example, in an attempt to elucidate the general properties of epidemic spread over a commute network that could be used for a prediction in any metropolitan area. The model is formulated on the basis of a metapopulation network in which local populations are interconnected by actual commuter flows in the Tokyo metropolitan area and the spread of infection is simulated by an individual-based model. We find that the probability of a global epidemic as well as the final epidemic sizes in both global and local populations, the timing of the epidemic peak, and the time at which the epidemic reaches a local population are mainly determined by the joint distribution of the local population sizes connected by the commuter flows, but are insensitive to geographical or topological structure of the network. Moreover, there is a strong relation between the population size and the time that the epidemic reaches this local population and we are able to determine the reason for this relation as well as its dependence on the commute network structure and epidemic parameters. This study shows that the model based on the connection between the population size classes is sufficient to predict both global and local epidemic dynamics in metropolitan area. Moreover, the clear relation of the time taken by the epidemic to reach each local population can be used as a novel measure for intervention; this enables efficient intervention strategies in each local population prior to the actual arrival.

The Potential Cost-Effectiveness of Quadrivalent versus Trivalent Influenza Vaccine in Elderly People and Clinical Risk Groups in the UK: A Lifetime Multi-Cohort Model

PLoS One
[Accessed 7 June 2014]
http://www.plosone.org/

Research Article
The Potential Cost-Effectiveness of Quadrivalent versus Trivalent Influenza Vaccine in Elderly People and Clinical Risk Groups in the UK: A Lifetime Multi-Cohort Model
Laure-Anne Van Bellinghen, Genevieve Meier mail, Ilse Van Vlaenderen
Published: June 06, 2014
DOI: 10.1371/journal.pone.0098437
Abstract
Objective
To estimate the potential cost-effectiveness of quadrivalent influenza vaccine compared with trivalent influenza vaccine in the UK.
Methods
A lifetime, multi-cohort, static Markov model was constructed, with nine age groups each divided into healthy and at-risk categories. Influenza A and B were accounted for separately. The model was run in one-year cycles for a lifetime (maximum age: 100 years). The analysis was from the perspective of the UK National Health Service. Costs and benefits were discounted at 3.5%. 2010 UK vaccination policy (vaccination of people at risk and those aged ≥65 years) was applied. Herd effect was not included. Inputs were derived from national databases and published sources where possible. The quadrivalent influenza vaccine price was not available when the study was conducted. It was estimated at £6.72,15% above the trivalent vaccine price of £5.85. Sensitivity analyses used an incremental price of up to 50%.
Results
Compared with trivalent influenza vaccine, the quadrivalent influenza vaccine would be expected to reduce the numbers of influenza cases by 1,393,720, medical visits by 439,852 complications by 167,357, hospitalisations for complications by 26,424 and influenza deaths by 16,471. The estimated base case incremental cost-effectiveness ratio (ICER) was £5,299/quality-adjusted life-year (QALY). Sensitivity analyses indicated that the ICER was sensitive to changes in circulation of influenza virus subtypes and vaccine mismatch; all other parameters had little effect. In 96% of simulations the ICER was <£20,000/QALY. Since this analysis was completed, quadrivalent influenza vaccine has become available in the UK at a list price of £9.94. Using this price in the model, the estimated ICER for quadrivalent compared with trivalent vaccination was £27,378/QALY, still within the NICE cost-effectiveness threshold (£20,000-£30,000).
Conclusions
Quadrivalent influenza vaccine could reduce influenza disease burden and would be cost-effective compared with trivalent influenza vaccine in elderly people and clinical risk groups in the UK.

Direct Effect of 10-Valent Conjugate Pneumococcal Vaccination on Pneumococcal Carriage in Children Brazil

PLoS One
[Accessed 7 June 2014]
http://www.plosone.org/

Research Article
Direct Effect of 10-Valent Conjugate Pneumococcal Vaccination on Pneumococcal Carriage in Children Brazil
Ana Lucia Andrade mail, Yves Mauro Ternes, Maria Aparecida Vieira, Weslley Garcia Moreira, Juliana Lamaro-Cardoso, André Kipnis, Maria Regina Cardoso, Maria Cristina Brandileone,
Iaci Moura, Fabiana C. Pimenta, Maria da Gloria Carvalho, Fabricia Oliveira Saraiva, Cristiana Maria Toscano, Ruth Minamisava
Published: June 03, 2014
DOI: 10.1371/journal.pone.0098128
Abstract
Background
10-valent conjugate pneumococcal vaccine/PCV10 was introduced in the Brazilian National Immunization Program along the year of 2010. We assessed the direct effectiveness of PCV10 vaccination in preventing nasopharyngeal/NP pneumococcal carriage in infants.
Methods
A cross-sectional population-based household survey was conducted in Goiania Brazil, from December/2010-February/2011 targeting children aged 7–11 m and 15–18 m. Participants were selected using a systematic sampling. NP swabs, demographic data, and vaccination status were collected from 1,287 children during home visits. Main outcome and exposure of interest were PCV10 vaccine-type carriage and dosing schedules (3p+0, 2p+0, and one catch-up dose), respectively. Pneumococcal carriage was defined by a positive culture and serotyping was performed by Quellung reaction. Rate ratio/RR was calculated as the ratio between the prevalence of vaccine-types carriage in children exposed to different schedules and unvaccinated for PCV10. Adjusted RR was estimated using Poisson regression. PCV10 effectiveness/VE on vaccine-type carriage was calculated as 1-RR*100.
Results
The prevalence of pneumococcal carriage was 41.0% (95%CI: 38.4–43.7). Serotypes covered by PCV10 and PCV13 were 35.2% and 53.0%, respectively. Vaccine serotypes 6B (11.6%), 23F (7.8%), 14 (6.8%), and 19F (6.6%) were the most frequently observed. After adjusted for confounders, children who had received 2p+0 or 3p+0 dosing schedule presented a significant reduction in pneumococcal vaccine-type carriage, with PCV10 VE equal to 35.9% (95%CI: 4.2–57.1; p = 0.030) and 44.0% (95%CI: 14.–63.5; p = 0.008), respectively, when compared with unvaccinated children. For children who received one catch-up dose, no significant VE was detected (p = 0.905).
Conclusion
PCV10 was associated with high protection against vaccine-type carriage with 2p+0 and 3p+0 doses for children vaccinated before the second semester of life. The continuous evaluation of carriage serotypes distribution is likely to be useful for evaluating the long-term effectiveness and impact of pneumococcal vaccination on serotypes reduction.

Efficacy of Pneumococcal Nontypable Haemophilus influenzae Protein D Conjugate Vaccine (PHiD-CV) in Young Latin American Children: A Double-Blind Randomized Controlled Trial

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 7 June 2014)

Research Article
Efficacy of Pneumococcal Nontypable Haemophilus influenzae Protein D Conjugate Vaccine (PHiD-CV) in Young Latin American Children: A Double-Blind Randomized Controlled Trial
Miguel W. Tregnaghi, Xavier Sáez-Llorens mail, Pio López, Hector Abate, Enrique Smith, Adriana Pósleman, Arlene Calvo, Digna Wong, Carlos Cortes-Barbosa, Ana Ceballos, Marcelo Tregnaghi, Alexandra Sierra, Mirna Rodriguez, [ … ], on behalf of the COMPAS Group
Published: June 03, 2014
DOI: 10.1371/journal.pmed.1001657
Abstract
Background
The relationship between pneumococcal conjugate vaccine–induced antibody responses and protection against community-acquired pneumonia (CAP) and acute otitis media (AOM) is unclear. This study assessed the impact of the ten-valent pneumococcal nontypable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on these end points. The primary objective was to demonstrate vaccine efficacy (VE) in a per-protocol analysis against likely bacterial CAP (B-CAP: radiologically confirmed CAP with alveolar consolidation/pleural effusion on chest X-ray, or non-alveolar infiltrates and C-reactive protein ≥ 40 µg/ml); other protocol-specified outcomes were also assessed.
Methods and Findings
This phase III double-blind randomized controlled study was conducted between 28 June 2007 and 28 July 2011 in Argentine, Panamanian, and Colombian populations with good access to health care. Approximately 24,000 infants received PHiD-CV or hepatitis control vaccine (hepatitis B for primary vaccination, hepatitis A at booster) at 2, 4, 6, and 15–18 mo of age. Interim analysis of the primary end point was planned when 535 first B-CAP episodes, occurring ≥2 wk after dose 3, were identified in the per-protocol cohort. After a mean follow-up of 23 mo (PHiD-CV, n = 10,295; control, n = 10,201), per-protocol VE was 22.0% (95% CI: 7.7, 34.2; one-sided p = 0.002) against B-CAP (conclusive for primary objective) and 25.7% (95% CI: 8.4%, 39.6%) against World Health Organization–defined consolidated CAP. Intent-to-treat VE was 18.2% (95% CI: 5.5%, 29.1%) against B-CAP and 23.4% (95% CI: 8.8%, 35.7%) against consolidated CAP. End-of-study per-protocol analyses were performed after a mean follow-up of 28–30 mo for CAP and invasive pneumococcal disease (IPD) (PHiD-CV, n = 10,211; control, n = 10,140) and AOM (n = 3,010 and 2,979, respectively). Per-protocol VE was 16.1% (95% CI: −1.1%, 30.4%; one-sided p = 0.032) against clinically confirmed AOM, 67.1% (95% CI: 17.0%, 86.9%) against vaccine serotype clinically confirmed AOM, 100% (95% CI: 74.3%, 100%) against vaccine serotype IPD, and 65.0% (95% CI: 11.1%, 86.2%) against any IPD. Results were consistent between intent-to-treat and per-protocol analyses. Serious adverse events were reported for 21.5% (95% CI: 20.7%, 22.2%) and 22.6% (95% CI: 21.9%, 23.4%) of PHiD-CV and control recipients, respectively. There were 19 deaths (n = 11,798; 0.16%) in the PHiD-CV group and 26 deaths (n = 11,799; 0.22%) in the control group. A significant study limitation was the lower than expected number of captured AOM cases.

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH), April 2014 Vol. 35, No. 4

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
April 2014 Vol. 35, No. 4
http://www.paho.org/journal/index.php?option=com_content&view=article&id=143&Itemid=236&lang=en
Contribution of Mexico’s Universal Immunization Program to the Fourth Millennium Development Goal [Contribución del Programa de Vacunación Universal de México al cuarto Objetivo de Desarrollo del Milenio]
Vesta Richardson,1 Edgar Sánchez-Uribe,1 Marcelino Esparza-Aguilar,1
Alejandra Esteves-Jaramillo,1 and Lorena Suárez-Idueta1
Abstract
Objective. To identify and describe 1) progress achieved thus far in meeting the commitments of the Fourth Millennium Development Goal (MDG 4) in Mexico, mainly the contribution
of the Universal Immunization Program (UIP) over the last 20 years, and 2) new opportunities for further reducing mortality among children under 5 years old.
Methods. An observational, descriptive, retrospective study was carried out to examine registered causes of death in children under 5 between 1990 and 2010. Indicators were built
according to the recommendations of the United Nations.
Results. In 2010, deaths among children under 5 decreased 64.3% compared to the baseline (1990) figure. Of the total deaths of the children under 5, the neonatal period was the most
affected (52.8%), followed by the 1 to 11 months (30.9%), and the 12 to 59 months (16.2%) groups. A 34% overall mortality reduction was observed after the universalization of immunization
against influenza, rotavirus, and pneumococcus in children under 5.
Conclusions. Despite a significant reduction in under-5 mortality in Mexico over the last 20 years, largely due to the successes of the UIP, several challenges remain, particularly in
improving preventive and curative services during pre- and postnatal care.

La desigualdad en salud de grupos vulnerables de México: adultos mayores, indígenas y migrantes [Health inequality among vulnerable groups in Mexico: older adults, indigenous people, and migrants]
Clara Juárez-Ramírez, Margarita Márquez-Serrano, Nelly Salgado de Snyder, Blanca Estela elcastre-Villafuerte, María Guadalupe Ruelas-González y Hortensia Reyes-Morales
Synopsis
Health vulnerability refers to a lack of protection for specific population groups with specific health problems, as well as the disadvantages they face in solving them in comparison
with other population groups. This major public health problem has multiple and diverse causes, including a shortage of trained health care personnel and the lack of family, social, economic, and institutional support in obtaining care and minimizing health risks. Health vulnerability is a
dynamic condition arising from the confluence of multiple social determinants. This article attempts to describe the health situation of three vulnerable groups in Mexico—older adults, indigenous people, and migrants—and, after defining the needs of each, explore measures that could contribute to the design and implementation of public health policies better tailored to their respective needs.

Rethinking the global supply chain

Science
6 June 2014 vol 344, issue 6188, pages 1057-1196
http://www.sciencemag.org/current.dtl

Special Issue: Rethinking the Global Supply Chain
Introduction to Special Issue
Rethinking the global supply chain
Brad Wible, Jeffrey Mervis, Nicholas S. Wigginton
We are all part of a global economy, capable of producing and transporting seemingly anything, from anywhere, to anyone. Its lifeblood is an interconnected network of suppliers and producers, retailers and consumers, spanning the planet. But the public typically knows far more about Apple, Nike, and other brands than the logistics empires many tiers below, where firms such as Foxconn and Pou Chen connect vast underlying commodity and labor markets that are relatively hidden from the public eye. This sprawling web of supply chains can raise living standards, improve conditions for workers, and help alleviate poverty. But feeding its unquenchable thirst for energy, water, and other resources puts a strain on the planet. Finding ways to relieve that strain is an enormous challenge and will undoubtedly require greater traceability and transparency.

One step forward is providing better measurements and models and making efforts to standardize and coordinate their use. Researchers are intensely studying how to account for supply-chain demands on ecosystems by integrating carbon, water, energy, and other “footprints” into coordinated schemes (see Hoekstra and Wiedmann, p. 1114). They are also developing better ways to inventory material and energy inputs, from the conception of a product to its grave, via life-cycle assessment tools (see Hellweg and Milà i Canals, p. 1109).

Yet academic insights alone cannot solve these problems. The large-scale cooperation of industry is essential. Many companies and industries are seeking to improve how they collect, synthesize, standardize, and communicate supply-chain data to better inform decision-making (see O’Rourke, p. 1124). A study of the Brazilian Amazon shows how supply-chain initiatives in the beef and soy industries, interacting with economic, social, and policy drivers, can slow deforestation of one of the world’s major sources of biodiversity and carbon sequestration (see Nepstad et al., p. 1118).

Logistics and transportation are also ripe for improvement. One approach is drawing inspiration from the digital Internet to create a Physical Internet. The initiative envisions using standardized “packets” and protocols for shipping, and forging the types of industry-wide partnerships that are normally anathema to a free-market system, but perhaps necessary to reduce the congestion, pollution, and inefficiency that make the current system ultimately unsustainable (see Mervis, p. 1104). Although many companies may initially be motivated by improved efficiencies and profit margins, such improvements in supply chains hold out the hope of improving conditions for humanity (see Dooley, p. 1108).

Online: Podcast at http://www.sciencemag.org/special/supply

Acceptability of the human papillomavirus vaccine and reasons for non-vaccination among parents of adolescent sons

Vaccine
Volume 32, Issue 31, Pages 3879-4012 (30 June 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/31

Acceptability of the human papillomavirus vaccine and reasons for non-vaccination among parents of adolescent sons
Pages 3883-3885
Kelly L. Donahue, Nathan W. Stupiansky, Andreia B. Alexander, Gregory D. Zimet
Abstract
Routine administration of the quadrivalent human papillomavirus (HPV) vaccine has been recommended for 11–12-year-old males since 2011, but coverage remains low. In a U.S. national sample of parents of 11–17-year-old males (n = 779), 78.6% of parents reported their sons had not received the HPV vaccine. The most common reason for non-vaccination (56.7%) was “My doctor or healthcare provider has not recommended it.” Parents citing only logistical reasons for non-vaccination (e.g., lack of recommendation, access, or education, n = 384) reported significantly higher vaccine acceptability than parents reporting a combination of attitudinal (e.g., concerns about vaccine safety or efficacy) and logistical barriers (n = 92), while parents citing only attitudinal barriers (n = 73) reported the lowest level of vaccine acceptability. In sum, many parents are willing but have not vaccinated sons due to logistical barriers, most commonly lack of healthcare provider recommendation. These findings have important implications for increasing HPV vaccination coverage among adolescent males.

Challenges in vaccination of neonates, infants and young children

Vaccine
Volume 32, Issue 31, Pages 3879-4012 (30 June 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/31

Challenges in vaccination of neonates, infants and young children
Review Article
Pages 3886-3894
Michael E. Pichichero
Abstract
All neonates, infants and young children receive multiple priming doses and booster vaccinations in the 1st and 2nd year of life to prevent infections by viral and bacterial pathogens. Despite high vaccine compliance, outbreaks of vaccine-preventable infections are occurring worldwide. These data strongly argue for an improved understanding of the immune responses of neonates, infants and young children to vaccine antigens and further study of the exploitable mechanisms to achieve more robust and prolonged immunity with fewer primary and booster vaccinations in the pediatric population. This review will focus on our recent work involving infant and young child immunity following routine recommended vaccinations. The discussion will address vaccine responses with respect to four areas: (1) systemic antibody responses, (2) memory B-cell generation, (3) CD4 T-cell responses, and (4) APC function.

How very young men who have sex with men view vaccination against human papillomavirus

Vaccine
Volume 32, Issue 31, Pages 3879-4012 (30 June 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/31

How very young men who have sex with men view vaccination against human papillomavirus
Original Research Article
Pages 3936-3941
Huachun Zou, Andrew E. Grulich, Alyssa M. Cornall, Sepehr N. Tabrizi, Suzanne M. Garland, Garrett Prestage, Catriona S. Bradshaw, Jane S. Hocking, Andrea Morrow, Christopher K. Fairley, Marcus Y. Chen
Abstract
Background
HPV vaccination of men who have sex with men (MSM) prior to the commencement of sexual activity would have the maximum impact on preventing HPV and anal cancer in this population. However, knowledge and attitudes towards HPV vaccination among very young MSM have not been previously studied.
Methods
Two hundred MSM aged 16 to 20 were recruited via community and other sources. Participants were asked about their knowledge and attitudes towards HPV and HPV vaccination.
Results
Most (80%, 95% confidence interval (CI) 72.2–87.2%) men were not willing to purchase the vaccine because of its cost (AUD$450). However, if the vaccine was offered to MSM free of charge, 86% (95% CI: 80–90%) reported they would be willing to disclose their sexuality to a health care provider in order to obtain the vaccine. Over half (54%, 95%: 47–61%) of men would only be willing to disclose their sexuality to receive the HPV vaccine after their first experience of anal intercourse. The age at first insertive anal intercourse and the age at first receptive anal intercourse were 0.21 (IQR: −2.5 to 3.2) and 0.17 (IQR: −2.9 to 2.7) years earlier than the age that men would be willing to disclose their sexuality to receive the HPV vaccine, respectively. Willingness to receive the vaccine at a younger age was associated with younger age at first insertive anal intercourse.
Conclusion
Overall, very young MSM expressed high acceptance of HPV vaccination. Early, opportunistic vaccination of very young MSM may be feasible in settings where very young MSM have not been vaccinated through universal programs targeting school aged males. However, given HPV infections occur early on, the effectiveness of this approach will be less than vaccination targeting school aged boys.

Effectiveness of typhoid vaccination in US travelers

Vaccine
Volume 32, Issue 29, Pages 3569-3712 (17 June 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/29

Effectiveness of typhoid vaccination in US travelers
Pages 3577-3579
Barbara E. Mahon, Anna E. Newton, Eric D. Mintz
Abstract
Typhoid vaccination is recommended in the United States before travel to countries where typhoid fever is endemic, though little information is available on its effectiveness in travelers.
We estimated typhoid vaccination effectiveness (VE) by comparing vaccination status in cases of typhoid fever and paratyphoid fever (Salmonella Paratyphi A infection, against which typhoid vaccine offers no protection) reported in the United States. We included travelers to Southern Asia and excluded persons <2 years old and cases in which vaccination status was not reported.
From 2008 through 2011, 744 eligible cases (602 typhoid, 142 paratyphoid A) were reported to CDC. Typhoid vaccination was reported for 5% (29/602) of typhoid patients and for 20% (29/142) of paratyphoid A patients. Estimated VE was 80% (95% confidence interval, 66–89%). Because of missing data, we could not estimate VE for specific vaccines.
We demonstrated moderate effectiveness of typhoid vaccination in US travelers, supporting vaccination recommendations.

Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies

Vaccine
Volume 32, Issue 29, Pages 3569-3712 (17 June 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/29

Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies
Original Research Article
Pages 3623-3629
Luke E. Taylor, Amy L. Swerdfeger, Guy D. Eslick
Abstract
There has been enormous debate regarding the possibility of a link between childhood vaccinations and the subsequent development of autism. This has in recent times become a major public health issue with vaccine preventable diseases increasing in the community due to the fear of a ‘link’ between vaccinations and autism. We performed a meta-analysis to summarise available evidence from case-control and cohort studies on this topic (MEDLINE, PubMed, EMBASE, Google Scholar up to April, 2014). Eligible studies assessed the relationship between vaccine administration and the subsequent development of autism or autism spectrum disorders (ASD). Two reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus with another author. Five cohort studies involving 1,256,407 children, and five case-control studies involving 9,920 children were included in this analysis. The cohort data revealed no relationship between vaccination and autism (OR: 0.99; 95% CI: 0.92 to 1.06) or ASD (OR: 0.91; 95% CI: 0.68 to 1.20), nor was there a relationship between autism and MMR (OR: 0.84; 95% CI: 0.70 to 1.01), or thimerosal (OR: 1.00; 95% CI: 0.77 to 1.31), or mercury (Hg) (OR: 1.00; 95% CI: 0.93 to 1.07). Similarly the case-control data found no evidence for increased risk of developing autism or ASD following MMR, Hg, or thimerosal exposure when grouped by condition (OR: 0.90, 95% CI: 0.83 to 0.98; p = 0.02) or grouped by exposure type (OR: 0.85, 95% CI: 0.76 to 0.95; p = 0.01). Findings of this meta-analysis suggest that vaccinations are not associated with the development of autism or autism spectrum disorder. Furthermore, the components of the vaccines (thimerosal or mercury) or multiple vaccines (MMR) are not associated with the development of autism or autism spectrum disorder.

Perceptions of personal belief vaccine exemption policy: A survey of Arizona vaccine providers

Vaccine
Volume 32, Issue 29, Pages 3569-3712 (17 June 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/29

Perceptions of personal belief vaccine exemption policy: A survey of Arizona vaccine providers
Original Research Article
Pages 3630-3635
Steven D. Haenchen, Elizabeth T. Jacobs, Kristin N. Bratton, Aubri S. Carman, Eyal Oren, Heidi L. Pottinger, Jessica A. Regan, Kacey C. Ernst
Abstract
Background
As exemptions to school-entry requirements rise, vaccination rates in Arizona school children are approaching levels that may threaten public health. Understanding the interactions physicians have with vaccine-hesitant parents, as well as the opinions physicians hold regarding vaccination, exemption, and exemption policies, are critical to our understanding of, and ability to affect, vaccination exemption rates among children.
Methods
Survey responses were elicited from practitioners listed in The Arizona Partnership for Immunization and the Arizona Medical Association databases using a multi-pronged recruitment approach. Respondents provided data regarding their practice, comfort with parental refusal of individual vaccines, opinions about the beliefs held by parents that seek exemptions, parent education strategies, issues regarding providing care to unvaccinated children, and potential changes to Arizona policy.
Results
A total of 152 practitioners providing care to a wide geographic and economic population of Arizona responded to the survey. Respondents were generally strong advocates of all immunizations but were more accepting of parents’ desires to refuse hepatitis B and rotavirus vaccines. Almost all providers indicated that they see patients whose parents request to refuse or delay from vaccinations at least occasionally (88% and 97%, respectively). Only 37% of respondents indicated that they would be supportive of a policy requiring them to sign off on a parent’s decision to refuse vaccination.
Conclusions
Vaccination providers in Arizona are generally very supportive of childhood immunizations but have varying comfort with exemption from individual vaccines. Responding providers tended to not support a requirement for a physician’s signature for vaccine exemptions due to varying concerns regarding the implementation of such a practice.

Cluster randomized trial of a toolkit and early vaccine delivery to improve childhood influenza vaccination rates in primary care

Vaccine
Volume 32, Issue 29, Pages 3569-3712 (17 June 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/29

Cluster randomized trial of a toolkit and early vaccine delivery to improve childhood influenza vaccination rates in primary care
Original Research Article
Pages 3656-3663
Richard K. Zimmerman, Mary Patricia Nowalk, Chyongchiou Jeng Lin, Kristin Hannibal, Krissy K. Moehling, Hsin-Hui Huang, Annamore Matambanadzo, Judith Troy, Norma J. Allred, Greg Gallik, Evelyn C. Reis
Abstract
Purpose
To increase childhood influenza vaccination rates using a toolkit and early vaccine delivery in a randomized cluster trial.
Methods
Twenty primary care practices treating children (range for n = 536–8183) were randomly assigned to Intervention and Control arms to test the effectiveness of an evidence-based practice improvement toolkit (4 Pillars Toolkit) and early vaccine supplies for use among disadvantaged children on influenza vaccination rates among children 6 months–18 years. Follow-up staff meetings and surveys were used to assess use and acceptability of the intervention strategies in the Intervention arm. Rates for the 2010–2011 and 2011–2012 influenza seasons were compared. Two-level generalized linear mixed modeling was used to evaluate outcomes.
Results
Overall increases in influenza vaccination rates were significantly greater in the Intervention arm (7.9 percentage points) compared with the Control arm (4.4 percentage points; P < 0.034). These rate changes represent 4522 additional doses in the Intervention arm vs. 1390 additional doses in the Control arm. This effect of the intervention was observed despite the fact that rates increased significantly in both arms – 8/10 Intervention (all P < 0.001) and 7/10 Control sites (P-values = 0.04 to <0.001). Rates in two Intervention sites with pre-intervention vaccination rates >58% did not significantly increase. In regression analyses, a child’s likelihood of being vaccinated was significantly higher with: younger age, white race (Odds ratio [OR] = 1.29; 95% confidence interval [CI] = 1.23–1.34), having commercial insurance (OR = 1.30; 95%CI = 1.25–1.35), higher pre-intervention practice vaccination rate (OR = 1.25; 95%CI = 1.16–1.34), and being in the Intervention arm (OR = 1.23; 95%CI = 1.01–1.50). Early delivery of influenza vaccine was rated by Intervention practices as an effective strategy for raising rates.
Conclusions
Implementation of a multi-strategy toolkit and early vaccine supplies can significantly improve influenza vaccination rates among children in primary care practices but the effect may be less pronounced in practices with moderate to high existing vaccination rates.

From Google Scholar+ [to 7 June 2014]

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

Value in Health Regional Issues
Volume 3, Pages 146-155
Economic Impact of Pneumococcal Protein-D Conjugate Vaccine (PHiD-CV) on the Malaysian National Immunization Programme
Syed Aljunid, Namaitijiang Maimaiti, Zafar Ahmed, Amrizal Muhammad Nur, Zaleha Md Isa, Soraya Azmi, Saperi Sulong
Abstract
Objective
To assess the cost-effectiveness of introducing pneumococcal polysaccharide and nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in the National Immunization Programme of Malaysia. This study compared introducing PHiD-CV (10 valent vaccine) with current no vaccination, as well as against the alternative 13-valent pneumococcal conjugate vaccine (PCV13).
Methods
A lifetime Markov cohort model was adapted using national estimates of disease burden, outcomes of pneumococcal disease, and treatment costs of disease manifestations including pneumonia, acute otitis media, septicemia, and meningitis for a hypothetical birth cohort of 550,000 infants. Clinical information was obtained by review of medical records from four public hospitals in Malaysia from the year 2008 to 2009. Inpatient cost from the four study hospitals was obtained from a diagnostic-related group–based costing system. Outpatient cost was estimated using clinical pathways developed by an expert panel. The perspective assessed was that of the Ministry of Health, Malaysia.
Results
The estimated disease incidence was 1.2, 3.7, 70, and 6.9 per 100,000 population for meningitis, bacteremia, pneumonia, and acute otitis media, respectively. The Markov model predicted medical costs of Malaysian ringgit (RM) 4.86 billion (US $1.51 billion) in the absence of vaccination. Vaccination with PHiD-CV would be highly cost-effective against no vaccination at RM30,290 (US $7,407) per quality-adjusted life-year gained. On comparing PHiD-CV with PCV13, it was found that PHiD-CV dominates PCV13, with 179 quality-adjusted life-years gained while saving RM35 million (US $10.87 million).
Conclusions
It is cost-effective to incorporate pneumococcal vaccination in the National Immunization Programme of Malaysia. Our model suggests that PHiD-CV would be more cost saving than PCV13 from the perspective of the Ministry of Health of Malaysia.

European Scientific Journal
May 2014 edition vol.10, No.15 ISSN: 1857 – 7881
[PDF] PROGRESS TOWARDS MEASLES ELIMINATION IN MOROCCO
Touria Benamar, National Institute of Hygiene / Ministry of Health, Rabat, Morocco; Amal Alla
Imad Cherkaoui, Epidemiology Department / Ministry of Health, Rabat, Morocco; Latifa Tajounte, Ahmed Laskri, National Institute of Hygiene / Ministry of Health, Rabat, Morocco; Moncef Ziani, Epidemiology Department / Ministry of Health, Rabat, Morocco; Abdelkarim Filali-Maltouf, Microbiology and Molecular Biology Laboratory, Faculty of Sciences, University Mohammed V, Rabat, Morocco; Rajae El Aouad, National Institute of Hygiene / Ministry of Health, Rabat, Morocco; School of Medicine and Pharmacy. University Mohamed V Souissi
Abstract
In order to eliminate measles in Morocco, a mass vaccination campaign targeting children aged from 9 months to14 years was conducted on May-June 2008. The vaccination coverage was estimated to be 99%. This study aims to assess the impact of the measles mass vaccination campaign on measles incidence based on sensitive surveillance system. For this purpose, a laboratory case-based surveillance was set up during 2010. Epidemiological definition of suspected measles cases was fixed. Specimens were collected through all primary health centers and hospitals at national level and suspected cases were confirmed by serological tests. Measles strains isolated during outbreaks were genotyped. The performance of the surveillance system was evaluated according to the World Health Organization indicators. The incidence was calculated based on the epidemiological surveillance data, and compared to the World Health Organization incidence, which is 1 case per million per year. 1214 suspected cases were notified and 1083 measles samples were analyzed and 45 % (491/1083) were serologically confirmed and 115 cases were confirmed by epidemiological linkage. Molecular 228 epidemiology shows that genotype D4 is endemic since 2008. The WHO indicators show that the sensitivity of surveillance system is low. Despite this weak sensitivity, epidemiological data show that measles incidence is higher than that recommended by WHO, and reached 19.18/1,000,000. In conclusions, Measles mass campaign did not reach the goal expected. A second mass campaign should be planned in the near future to eliminate the disease in the country.

The Neurohospitalist
May 28, 2014 1941874414533352
http://nho.sagepub.com/content/4/2.toc
Poliomyelitis Historical Facts, Epidemiology, and Current Challenges in Eradication
Man Mohan Mehndiratta, MD, DM, MNAMS, FAMS, FRCP1 Prachi Mehndiratta, MD2, Renuka Pande, MD3
1Department of Neurology, Janakpuri Superspeciality Hospital, Janakpuri, New Delhi, India
2Department of Neurology, subspecialty division Vascular neurology-StrokeDepartment of Neurology, subspecialty division Vascular neurology-Stroke, University of Virginia, Charlottesville, VA, USA
3Department of Microbiology, Janakpuri Superspeciality Hospital, New Delhi, India
Man Mohan Mehndiratta, Janakpuri Superspeciality Hospital, C-2/B, Janakpuri, New Delhi 110058, India.
Abstract
Poliomyelitis is a highly infectious disease caused by a virus belonging to the Picornaviridae family. It finds a mention even in ancient Egyptian paintings and carvings. The clinical features are varied ranging from mild cases of respiratory illness, gastroenteritis, and malaise to severe forms of paralysis. These have been categorized into inapparent infection without symptoms, mild illness (abortive poliomyelitis), aseptic meningitis (nonparalytic poliomyelitis), and paralytic poliomyelitis. This disease has been associated with crippling deformities affecting thousands of lives throughout the world. Only due to the perseverance and determination of great scientists in 1900s, the genomic structure of the virus and its pathogenesis could be elucidated. Contribution of Salk and Sabin in the form of vaccines—oral polio vaccine (OPV) and the inactivated polio vaccine—heralded a scientific revolution. In 1994, the World Health Organization (WHO) Region of The Americas was certified polio free followed by the WHO Western Pacific Region in 2000 and the WHO European Region in June 2002 of the 3 types of wild poliovirus (types 1, 2, and 3). In 2013, only 3 countries remained polio endemic—Nigeria, Pakistan, and Afghanistan. Global eradication of polio is imperative else the threat of an outbreak will hover forever. Today, all the governments of the world in collaboration with WHO stand unified in their fight against poliomyelitis and the task when achieved will pave the way for eliminating other infections in future.