Reducing Cervical Cancer Incidence Using Evidence-Based Programs in Community Settings

American Journal of Preventive Medicine
August 2015 Volume 49, Issue 2, p161-334, e9-e12

Theme: Reduce Cervical Cancer Incidence Using Evidence-Based Programs in Community Settings
Guest Editors: Richard A. Crosby and Margaret L. McGladre

Implementation and Evaluation of a School-Based Human Papillomavirus Vaccination Program in Rural Kentucky
Robin C. Vanderpool, Patrick J. Breheny, Peggy A. Tiller, Carol A. Huckelby, Amy D. Edwards, Kristi D. Upchurch, Cynthia A. Phillips, Christine F. Weyman
Human papillomavirus (HPV) vaccination rates remain marginal across the U.S., including Kentucky, a state recognized for increased HPV-related cancer burden. School-based HPV immunization programs may be a viable approach to improving vaccination initiation and completion rates among youth. Therefore, the purpose of this study was to design, implement, and evaluate a school-based HPV vaccination program conducted in rural south-central Kentucky.
Guided by evidence-based approaches to increasing immunization rates, the practical expertise of school nursing staff, and a detailed study protocol, academic and health department–based investigators implemented an HPV vaccination project in two high schools during the 2012–2013 academic year; data were analyzed in 2013–2014. Rates of returned parental consent forms, parental consent/declination, and HPV vaccination rates were documented.
At the beginning of the school year, all 935 students at the two schools were given HPV vaccination parental consent forms. Five hundred eleven students returned consent forms (55% return rate), and 447 of these students were HPV vaccine naïve (87%). Of these students, 315 (70%) initiated the vaccine series, with 276 (62%) completing the entire three-dose series, so that 88% of students initiating the vaccine series successfully completed the series. In estimating rates for the entire school body, 45% of students had received all three doses by the end of the project.
Despite study design limitations, results of this project provide further evidence about school-based immunization programs as an effective strategy for improving HPV vaccination rates among Kentucky and U.S. adolescents.

American Journal of Public Health (August 2015)

American Journal of Public Health
Volume 105, Issue 8 (August 2015)

Addressing Complexities in Global Health and Inequities in Global Health Education
Julie D. Rosenberg, Keri J. Wachter, Abby C. Campbell, Joseph J. Rhatigan, Rebecca L. Weintraub, Global Health Delivery Project at Harvard University Case Writing Team
American Journal of Public Health: August 2015, Vol. 105, No. 8: e1–e1.

Searching the Web for Influenza Vaccines: HealthMap Vaccine Finder
Jane E. Huston, Sumiko R. Mekaru, Sheryl Kluberg, John S. Brownstein
American Journal of Public Health: August 2015, Vol. 105, No. 8: e134–e139.
Objectives. The goal of the HealthMap Vaccine Finder is to provide a free, comprehensive, online service where users can search for locations that offer immunizations. In this article, we describe the data and systems underlying the HealthMap Vaccine Finder (HVF) and summarize the project’s first year of operations.
Methods. We collected data on vaccination services from a variety of providers for 2012–2013. Data are used to populate an online, public, searchable map.
Results. In its first year, HVF collected information from 1256 providers representing 46 381 locations. The public Web site received 625 124 visits during the 2012–2013 influenza vaccination season.
Conclusions. HVF is a unique tool that connects the public to vaccine providers in their communities. During the 2012–2013 influenza season, HVF experienced significant usage and was able to respond to user feedback with new features.

Evolving Challenges and Research-Needs Concerning Ebola
Robert Klitzman
American Journal of Public Health: August 2015, Vol. 105, No. 8: 1513–1515.

Assessing Proposals for New Global Health Treaties: An Analytic Framework
Steven J. Hoffman, John-Arne Røttingen, Julio Frenk
American Journal of Public Health: August 2015, Vol. 105, No. 8: 1523–1530.
We have presented an analytic framework and 4 criteria for assessing when global health treaties have reasonable prospects of yielding net positive effects.
First, there must be a significant transnational dimension to the problem being addressed. Second, the goals should justify the coercive nature of treaties. Third, proposed global health treaties should have a reasonable chance of achieving benefits. Fourth, treaties should be the best commitment mechanism among the many competing alternatives.
Applying this analytic framework to 9 recent calls for new global health treaties revealed that none fully meet the 4 criteria. Efforts aiming to better use or revise existing international instruments may be more productive than is advocating new treaties.

HIV Treatment Scale-Up and HIV-Related Stigma in Sub-Saharan Africa: A Longitudinal Cross-Country Analysis
Brian T. Chan, Alexander C. Tsai, Mark J. Siedner
American Journal of Public Health: August 2015, Vol. 105, No. 8: 1581–1587.

BMC Public Health (Accessed 18 July 2015)

BMC Public Health
(Accessed 18 July 2015)

Research article
Perceptions of Sudanese women of reproductive age toward HIV/AIDS and services for Prevention of Mother-to-Child Transmission of HIV
Ibrahim Elsheikh, Rik Crutzen, H.W. Van den Borne
BMC Public Health 2015, 15:674 (17 July 2015)

Research article
Pilot to evaluate the feasibility of measuring seasonal influenza vaccine effectiveness using surveillance platforms in Central-America, 2012
Nathalie El Omeiri, Eduardo Azziz-Baumgartner, Wilfrido Clará, Guiselle Guzmán-Saborío, Miguel Elas, Homer Mejía, Ida Molina, Yadira De Molto, Sara Mirza, Marc-Alain Widdowson, Alba Ropero-Álvarez
BMC Public Health 2015, 15:673 (17 July 2015)
Since 2004, the uptake of seasonal influenza vaccines in Latin America and the Caribbean has markedly increased. However, vaccine effectiveness (VE) is not routinely measured in the region. We assessed the feasibility of using routine surveillance data collected by sentinel hospitals to estimate influenza VE during 2012 against laboratory-confirmed influenza hospitalizations in Costa-Rica, El Salvador, Honduras and Panama. We explored the completeness of variables needed for VE estimation.
We conducted the pilot case–control study at 23 severe acute respiratory infections (SARI) surveillance hospitals. Participant inclusion criteria included children 6 months–11 years and adults ≥60 years targeted for vaccination and hospitalized for SARI during January–December 2012. We abstracted information needed to estimate target group specific VE (i.e., date of illness onset and specimen collection, preexisting medical conditions, 2012 and 2011 vaccination status and date, and pneumococcal vaccination status for children and adults) from SARI case-reports and for children ≤9 years, inquired about the number of annual vaccine doses given. A case was defined as an influenza virus positive by RT-PCR in a person with SARI, while controls were RT-PCR negative. We recruited 3 controls per case from the same age group and month of onset of symptoms.
We identified 1,186 SARI case-patients (342 influenza cases; 849 influenza-negative controls), of which 994 (84 %) had all the information on key variables sought. In 893 (75 %) SARI case-patients, the vaccination status field was missing in the SARI case-report forms and had to be completed using national vaccination registers (36 %), vaccination cards (30 %), or other sources (34 %). After applying exclusion criteria for VE analyses, 541 (46 %) SARI case-patients with variables necessary for the group-specific VE analyses were selected (87 cases, 236 controls among children; 64 cases, 154 controls among older adults) and were insufficient to provide precise regional estimates (39 % for children and 25 % for adults of minimum sample size needed).
Sentinel surveillance networks in middle income countries, such as some Latin American and Caribbean countries, could provide a simple and timely platform to estimate regional influenza VE annually provided SARI forms collect all necessary information.

Research article
Double burden of malnutrition: increasing overweight and obesity and stall underweight trends among Ghanaian women
David Doku, Subas Neupane
BMC Public Health 2015, 15:670 (16 July 2015)

Research article
Latin American and Caribbean countries’ baseline clinical and policy guidelines for responding to intimate partner violence and sexual violence against women
Donna Stewart, Raquel Aviles, Alessandra Guedes, Ekaterina Riazantseva, Harriet MacMillan BMC Public Health 2015, 15:665 (15 July 2015)

Research article
Does introducing an immunization package of services for migrant children improve the coverage, service quality and understanding? An evidence from an intervention study among 1548 migrant children in eastern China
Yu Hu, Shuying Luo, Xuewen Tang, Linqiao Lou, Yaping Chen, Jing Guo, Bing Zhang
BMC Public Health 2015, 15:664 (15 July 2015)
An EPI (Expanded Program on Immunization) intervention package was implemented from October 2011 to May 2014 among migrant children in Yiwu, east China. This study aimed to evaluate its impacts on vaccination coverage, maternal understanding of EPI and the local immunization service performance.
A pre- and post-test design was used. The EPI intervention package included: (1) extending the EPI service time and increasing the frequency of vaccination service; (2) training program for vaccinators; (3) developing a screening tool to identify vaccination demands among migrant clinic attendants; (4) Social mobilization for immunization. Data were obtained from random sampling investigations, vaccination service statistics and qualitative interviews with vaccinators and mothers of migrant children. The analysis of quantitative data was based on a “before and after” evaluation and qualitative data were analyzed using content analysis.
The immunization registration (records kept by immunization clinics) rate increased from 87.4 to 91.9 % (P = 0.016) after implementation of the EPI intervention package and the EPI card holding (EPI card kept by caregivers) rate increased from 90.9 to 95.6 % (P = 0.003). The coverage of fully immunized increased from 71.5 to 88.6 % for migrant children aged 1–4 years (P < 0.001) and increased from 42.2 to 80.5 % for migrant children aged 2–4 years (P < 0.001). The correct response rates on valid doses and management of adverse events among vaccinators were over 90 % after training. The correct response rates on immunization among mothers of migrant children were 86.8–99.3 % after interventions.
Our study showed a substantial improvement in vaccination coverage among migrant children in Yiwu after implementation of the EPI intervention package. Further studies are needed to evaluate the cost-effectiveness of the interventions, to identify individual interventions that make the biggest contribution to coverage, and to examine the sustainability of the interventions within the existing vaccination service delivery system in a larger scale settings or in a longer term.

Research article
Improved stove interventions to reduce household air pollution in low and middle income countries: a descriptive systematic review
Emma Thomas, Kremlin Wickramasinghe, Shanthi Mendis, Nia Roberts, Charlie Foster
BMC Public Health 2015, 15:650 (14 July 2015)

Level of mother’s knowledge about neonatal danger signs and associated factors in North West of Ethiopia: a community based study

BMC Research Notes
(Accessed 18 July 2015)

Research article
Level of mother’s knowledge about neonatal danger signs and associated factors in North West of Ethiopia: a community based study
Solomon Nigatu, Abebaw Worku, Abel Dadi BMC Research Notes 2015, 8:309 (19 July 2015)

Protocol for a systematic review of the effects of interventions to inform or educate caregivers about childhood vaccination in low and middle-income countries

BMJ Open
2015, Volume 5, Issue 7

Protocol article
Protocol for a systematic review of the effects of interventions to inform or educate caregivers about childhood vaccination in low and middle-income countries
Lungeni A Lukusa, Nyanyiwe N Mbeye, Folasade B Adeniyi, Charles S Wiysonge
BMJ Open 2015;5:e008113 doi:10.1136/bmjopen-2015-008113
Despite their proven effectiveness in reducing childhood infectious diseases, the uptake of vaccines remains suboptimal in low and middle-income countries. Identifying strategies for transmitting accurate vaccine information to caregivers would boost childhood vaccination coverage in these countries. The purpose of this review is to assess the effects on childhood vaccination coverage of interventions for informing or educating caregivers about the importance of vaccines in low and middle-income countries, as defined by the World Bank.
Methods and analysis
Eligible study designs include randomised controlled trials (RCTs) as well as non-randomised controlled trials (non-RCTs). We will conduct a comprehensive search of both peer-reviewed and grey literature available up to 31 May 2015. We will search PubMed, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, Cumulative Index of Nursing and Allied Health, prospective trial registries and reference lists of relevant publications. Two authors will independently screen the search output, retrieve full texts of potentially eligible studies and assess the latter against predefined inclusion criteria. Disagreements between the two authors will be resolved through consensus and arbitration by a third author. We will pool data from studies with homogenous interventions and outcomes, using random-effects meta-analysis. We will assess statistical heterogeneity using the χ2 test of homogeneity (with significance defined at the 10% α-level) and quantify it using Higgins’ inconsistency index. We will explore the cause of any observed statistical heterogeneity using subgroup analysis, with subgroups defined by study design (RCTs vs non-RCTs) and type of intervention (information vs educational interventions).
Ethics and dissemination
The proposed systematic review will collect and analyse secondary data that are not associated with individuals. The review will make a significant contribution to the knowledge base of interventions for improving childhood vaccination coverage in low and middle-income countries.
Protocol registration number PROSPERO, CRD42014010141.

Immunogenicity, Safety, and Tolerability of 13-Valent Pneumococcal Conjugate Vaccine Followed by 23-Valent Pneumococcal Polysaccharide Vaccine in Recipients of Allogeneic Hematopoietic Stem Cell Transplant Aged ≥2 Years: An Open-Label Study

Clinical Infectious Diseases (CID)
Volume 61 Issue 3 August 1, 2015

Immunogenicity, Safety, and Tolerability of 13-Valent Pneumococcal Conjugate Vaccine Followed by 23-Valent Pneumococcal Polysaccharide Vaccine in Recipients of Allogeneic Hematopoietic Stem Cell Transplant Aged ≥2 Years: An Open-Label Study
Catherine Cordonnier, Per Ljungman, Christine Juergens, Johan Maertens, Dominik Selleslag, Vani Sundaraiyer, Peter C. Giardina, Keri Clarke, William C. Gruber, Daniel A. Scott, and Beate Schmoele-Thoma for the 3003 Study Group
Clin Infect Dis. (2015) 61 (3): 313-323 doi:10.1093/cid/civ287
Severe Streptococcus pneumoniae infections are frequent complications after hematopoietic stem cell transplant (HSCT). A 3-dose regimen of 13-valent pneumococcal conjugate vaccine, starting 3–6 months after HSCT and followed by a booster dose, may be required for adequate protection.

Eurosurveillance – 16 July 2015

Volume 20, Issue 28, 16 July 2015

Rapid communications
Targeted vaccination of teenagers following continued rapid endemic expansion of a single meningococcal group W clone (sequence type 11 clonal complex), United Kingdom 2015
by H Campbell, V Saliba, R Borrow, M Ramsay, SN Ladhani

Research articles
Estimating influenza vaccine effectiveness in Spain using sentinel surveillance data
by S Jiménez-Jorge, S de Mateo, C Delgado-Sanz, F Pozo, I Casas, M García-Cenoz, J Castilla, C Rodriguez, T Vega, C Quiñones, E Martínez, JM Vanrell, J Giménez, D Castrillejo, JM Altzíbar, F Carril, JM Ramos, MC Serrano, A Martínez, N Torner, E Pérez, V Gallardo, A Larrauri, on behalf of the Spanish Influenza Sentinel Surveillance System

Humanitarian Exchange Magazine – Issue 64, June 2015 :: The Ebola crisis in West Africa

Humanitarian Exchange Magazine
Issue 64 June 2015

The Ebola crisis in West Africa
This edition of Humanitarian Exchange focuses on the humanitarian crisis created in West Africa by the Ebola outbreak, the largest and most complex since the virus was discovered in 1976. More than 11,000 people are believed to have died and over 26,300 cases have been reported. While Liberia was declared Ebola-free on 9 May 2015, Sierra Leone and Guinea are still struggling to contain the disease and assess the social and economic impact of the crisis.

In her lead article, Florika Fink-Hooijer analyses the weaknesses and inefficiencies in global humanitarian health governance revealed by the Ebola crisis.
Aspects of humanitarian–military engagement are discussed by André Heller Pérache in the context of Médecins Sans Frontières (MSF)’s unprecedented call for biohazard containment teams.

Josiah Kaplan and Evan Easton-Calabria highlight how humanitarians are using innovations in military medicine to combat Ebola.
Clea Kahn argues that characterising the outbreak as a public health crisis resulted in a failure to adequately consider the dignity and humanity of affected people.
Chukwu-Emeka Chikezie sheds light on the role of the Sierra Leonean diaspora in the response.
Catherine Meredith and her co-authors report on Oxfam’s bottom-up approach to the response.
Craig Dean and Kelly Hawrylyshyn look at the role of children’s and youth groups.
Liz Hughes and Nick McWilliam explore how GIS mapping has been used in planning and targeting interventions.
Jean-Martin Bauer and his co-authors report on the innovative use of mobile technology for monitoring food security.
Articles by Lisa Reilly and Raquel Vazquez Llorente and Clara Hawkshaw highlight risk management and training approaches to the crisis.
Lisa Guppy reflects on the benefits and challenges of carrying out research during the outbreak.
The edition ends with an article by Nadia Berger and Grace Tang on the importance of translation in the response.

State Vaccination Requirements for HPV and Other Vaccines for Adolescents, 1990-2015

July 14, 2015, Vol 314, No. 2

Research Letter
State Vaccination Requirements for HPV and Other Vaccines for Adolescents, 1990-2015
Jason L. Schwartz, PhD, MBE; Laurel A. Easterling
[Initial text]
This study reports on the changes to the vaccination recommendations by the US Centers for Disease Control and Prevention Advisory Committee on Immunization Practices and the status of implementation of requirements by the states.

Eight years after human papillomavirus (HPV) vaccines were first recommended in the United States, vaccination coverage is substantially below the Healthy People 2020 target of 80%.1 Data from the US Centers for Disease Control and Prevention (CDC) show that 37.6% of adolescent girls and 13.9% of adolescent boys had completed the 3-dose series in 2013.2 Recent efforts to address these deficits emphasize that HPV vaccines should not be viewed or treated differently than other routinely recommended vaccines…

Critical Choices for the WHO After the Ebola Epidemic

July 14, 2015, Vol 314, No. 2

The JAMA Forum
Critical Choices for the WHO After the Ebola Epidemic FREE
Lawrence O. Gostin, JD
In the aftermath of an unconscionably inadequate response to the Ebola epidemic in West Africa, this year’s World Health Assembly was seen as critically important to the future of the World Health Organization (WHO). The assembly, the WHO’s decision-making forum, attended by delegations from all WHO member states, offered a historic opportunity for fundamental reform of the organization. A failure to decisively shore up its epidemic response leadership risked the loss of confidence in the WHO for a generation.

When the 68th World Health Assembly convened on May 18, 2015, the WHO was experiencing a crisis of confidence. The assembly took 3 key steps to address the organization’s global health security capacities: it combined the secretariat’s outbreak and emergency response programs, developed a new global health emergency workforce, and created a $100 million emergency contingency fund ( What the assembly did not do was address the deep structural problems that have plagued the WHO, undermining its effectiveness.

Margaret Chan, MD, DSc, director-general of the WHO, announced during the assembly that she plans to combine the existing outbreak and emergency response programs into a single program for health emergencies. This new unit will be designed for speed and flexibility, she said, with program performance benchmarks “showing what must happen within 24, 48, and 72 hours, not months” ( The program will partner with United Nations agencies, states, and nongovernmental organizations (NGOs), such as Médecins Sans Frontières (MSF) (

From an organizational perspective, the new unit will be more rational and designed for rapid response. Yet, there are no new funding sources to support outbreak and emergency response. If Chan diverts significant resources to its epidemic response, she risks further weakening already badly underfunded programs, such as for noncommunicable diseases and mental health.

The absence of a robust domestic workforce represented a signal failure of the West African Ebola response. The 3 most-affected countries—Guinea, Liberia, and Sierra Leone—had among the world’s lowest health worker-to-patient ratios, and lost more than 500 doctors, nurses, and other health workers to the epidemic ( Although NGOs such as MSF and foreign workers filled some of the gap, the paucity of human resources significantly impeded the response.

Although the WHO is doing very little to build human resource capacities in low- and middle-income countries, Chan announced in a report to the assembly that the agency does plan to launch a global health emergency workforce ( by January 2016, drawn from existing networks including the Global Outbreak Alert and Response Network (GOARN) ( the Global Health Cluster ( foreign medical teams, (, and NGOs, and coordinated by the new outbreak and emergency response unit. Chan also announced that the WHO is strengthening its own emergency staff, adding logisticians, medical anthropologists, and experts in risk communication. The assembly welcomed both of Director-General Chan’s proposals to establish for a global health workforce and to strengthen the WHO’s emergency response unit (

The Ebola response vividly demonstrated that effective action requires a range of human resources, including clinicians and community health workers, as well as public health professionals to conduct surveillance, laboratory analysis, and contact tracing. Other experts in communications, culture, and behavior are needed to gain insight into local belief systems. These skills should be ensured through comprehensive training and certification, which will be crucial WHO functions.

Although a global workforce reserve requires intensive training, medical equipment, and logistical acumen, the WHO is implementing the emergency workforce without any new resources. It is hard to conceive how such a vital operation can be conducted without a major injection of sustainable resources.

In 2011, after the influenza A(H1N1) pandemic, the independent WHO International Health Regulations (IHR) Review Committee found that the world is “ill-prepared” for a major epidemic and proposed a $100 million contingency fund ( But the WHO never adopted the committee’s recommendation. Chan’s strategy was to mobilize international funding when an emergency strikes, believing that rich states and philanthropists would react quickly to exigent circumstances (

However, as the WHO should have realized, once a rapidly moving infectious disease emerges, it may be too late to first begin resource mobilization. That turned out to be the case with Ebola, as the WHO’s funding appeals took too long to materialize. During the World Health Assembly, delegates approved the creation of a $100 million contingency fund, financed by flexible voluntary contributions (

Director-General Chan was heavily criticized for delays in declaring a Public Health Emergency of International Concern (PHEIC) under the IHR. Wisely, release of the contingency fund will not be tied to a PHEIC declaration. After a WHO committee discussed the more flexible approach of using the principles of the Emergency Response Framework grading system ( as the trigger for tapping the contingency fund (, the assembly ultimately left the decision to release funds at the director-general’s discretion.

The clear goal of a WHO contingency fund should be to prevent an event from escalating into a PHEIC or an even lesser–grade emergency. Yet at $100 million, the fund’s size is incommensurate with the need when one considers the billions of dollars in humanitarian assistance and the loss of approximately 12% of the GDP in the countries most affected by the epidemic ( It also requires voluntary contributions from member states or other donors. Adding it to WHO core funding through mandatory assessed dues would have been more viable and sustainable.

None of 5 proposals for structural reform of the WHO that I suggested in a previous JAMA Forum were on the assembly agenda in a meaningful form ( In particular, member states did not significantly increase the assessed dues of WHO member states to give the agency the funding and control it needs to meet its worldwide mandate. The lack of coherence between headquarters and its regional offices remains unaddressed. And although the secretariat is exploring new ways to harness the creativity of civil society and avoid conflicts with vested business interests, there was nothing on the assembly agenda to bring NGOs closer into the WHO’s governance (

Finally, and most importantly, the WHO has not developed a plan to build the core capacities of low- and middle-income countries for sustainable health systems. The idea of an international health systems fund to accomplish this was not on the agenda (

The WHO is too important to be sidelined or weakened further, but the organization’s ability to provide meaningful leadership is not assured ( To be sure, the WHO has improved its ability to put out fires in the form of rapidly emerging infectious diseases. Although there is a better fire brigade, the assembly has yet to take action to prevent fires from erupting with increasing frequency in every region of the globe.

Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries

The Lancet
Jul 18, 2015 Volume 386 Number 9990 p219-310 e1
Measuring the SDGs: a two-track solution
Austen Davis, Zoe Matthews, Sylvia Szabo, Helga Fogstad
The Millennium Development Goals (MDGs) expire in 2015 and substantial effort is being put into the negotiation of a new set of Sustainable Development Goals (SDGs). The SDG agenda is broader and goes further than that of the MDGs, and critics claim that it is unmeasurable and unmanageable. On the positive side, the consultation process has been far more inclusive and credible than for the MDGs. The resultant Open Working Group (OWG) proposal provides a global agenda for action that is relevant to all nations.

Universal health coverage: progressive taxes are key
Robert Yates
Published Online: 14 May 2015
Open Access

Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries
Dr Aaron Reeves, PhD, Yannis Gourtsoyannis, MD, Sanjay Basu, PhD, David McCoy, DrPH, Prof Martin McKee, MD, Prof David Stuckler, PhD
Published Online: 14 May 2015
Open access funded by Wellcome Trust
How to finance progress towards universal health coverage in low-income and middle-income countries is a subject of intense debate. We investigated how alternative tax systems affect the breadth, depth, and height of health system coverage.
We used cross-national longitudinal fixed effects models to assess the relationships between total and different types of tax revenue, health system coverage, and associated child and maternal health outcomes in 89 low-income and middle-income countries from 1995–2011.
Tax revenue was a major statistical determinant of progress towards universal health coverage. Each US$100 per capita per year of additional tax revenues corresponded to a yearly increase in government health spending of $9·86 (95% CI 3·92–15·8), adjusted for GDP per capita. This association was strong for taxes on capital gains, profits, and income ($16·7, 9·16 to 24·3), but not for consumption taxes on goods and services (−$4·37, −12·9 to 4·11). In countries with low tax revenues (<$1000 per capita per year), an additional $100 tax revenue per year substantially increased the proportion of births with a skilled attendant present by 6·74 percentage points (95% CI 0·87–12·6) and the extent of financial coverage by 11·4 percentage points (5·51–17·2). Consumption taxes, a more regressive form of taxation that might reduce the ability of the poor to afford essential goods, were associated with increased rates of post-neonatal mortality, infant mortality, and under-5 mortality rates. We did not detect these adverse associations with taxes on capital gains, profits, and income, which tend to be more progressive.
Increasing domestic tax revenues is integral to achieving universal health coverage, particularly in countries with low tax bases. Pro-poor taxes on profits and capital gains seem to support expanding health coverage without the adverse associations with health outcomes observed for higher consumption taxes. Progressive tax policies within a pro-poor framework might accelerate progress toward achieving major international health goals.
Commission of the European Communities (FP7–DEMETRIQ), the European Union’s HRES grants, and the Wellcome Trust.

Maternal and Child Health Journal – Volume 19, Issue 8, August 2015

Maternal and Child Health Journal
Volume 19, Issue 8, August 2015

Maternal Education and Immunization Status Among Children in Kenya
Elijah O. Onsomu, Benta A. Abuya, Irene N. Okech, DaKysha Moore, Janice Collins-McNeil
Child morbidity and mortality due to infectious diseases continues to be a major threat and public health concern worldwide. Although global vaccination coverage reached 90 % for diphtheria, tetanus and pertussis (DTP3) across 129 countries, Kenya and other sub-Saharan countries continue to experience under-vaccination. The purpose of this study was to examine the association between maternal education and child immunization (12–23 months) in Kenya. This study used retrospective cross-sectional data from the 2008–2009 Kenya Demographic and Health Survey for women aged 15–49, who had children aged 12–23 months, and who answered questions about vaccination in the survey (n = 1,707). The majority of the children had received vaccinations, with 77 % for poliomyelitis, 74 % for measles, 94 % for tuberculosis, and 91 % for diphtheria, whooping cough (pertussis), and tetanus. After adjusting for other covariates, women with primary, secondary, and college/university education were between 2.21 (p < 0.01) and 9.10 (p < 0.001) times more likely to immunize their children than those who had less than a primary education. Maternal education is clearly crucial in ensuring good health outcomes among children, and integrating immunization knowledge with maternal and child health services is imperative. More research is needed to identify factors influencing immunization decisions among less-educated women in Kenya.

A Review of e-Health Interventions for Maternal and Child Health in Sub-Sahara Africa
Oluwaseun Ireti Obasola, Iyabo Mabawonku, Ikeoluwa Lagunju
To review e-health interventions for maternal and child health (MCH) and to explore their influence on MCH practices in sub-Sahara Africa (SSA). Keyword searches were used to retrieve articles from four databases and the websites of organisations involved in e-health projects for MCH in SSA. A total of 18relevant articles were retrieved using inclusion and exclusion criteria. The researchers reveal the prevalence of the application of mobile phones for MCH care and the influence of the use of information and communication technology (ICT) for delivering MCH information and services to target populations. There is a need to move the application of ICT for MCH care from pilot initiatives to interventions involving all stakeholders on a sub-regional scale. These interventions should also adopt an integrated approach that takes care of the information needs at every stage along the continuum of care. It is anticipated that the study would be useful in the evolution and implementation of future ICT-based programmes for MCH in the region.

Perspective: The Trans-Pacific Partnership — Is It Bad for Your Health?

New England Journal of Medicine
July 16, 2015 Vol. 373 No. 3

The Trans-Pacific Partnership — Is It Bad for Your Health?
Amy Kapczynski, J.D.
N Engl J Med 2015; 373:201-203 July 16, 2015 DOI: 10.1056/NEJMp1506158

International trade deals once focused primarily on tariffs. As a result, they had little direct effect on health, and health experts could reasonably leave their details to trade professionals. Not so today. Modern trade pacts have implications for a wide range of health policy issues, from medicine prices to tobacco regulation, not only in the developing world but also in the United States.

The Trans-Pacific Partnership Agreement (TPP) is a case in point. A massive trade deal now reportedly on the verge of completion, the TPP has nearly 30 chapters. A draft chapter on intellectual property (IP) alone runs 77 single-spaced pages.

The full health implications of the TPP are hard to judge, not only because its provisions are complex but also because the draft text is a closely held secret. Even members of the U.S. Congress can see it only if they agree not to talk publicly about it and if they leave their pens and phones (and, until recently, their expert staffers) at the door. But several key chapters have recently been leaked and reveal that the TPP could have a substantial impact on health.

Groups including Médecins sans Frontières and Oxfam warn, for example, that the agreement could threaten the lives of millions of people in developing countries. Their concerns stem primarily from the leaked IP chapter and the effect that patents have on the prices of medicines. In the context of human immunodeficiency virus, for example, patents increase the annual cost of antiretroviral therapy from around $100 per person to $10,000 per person.

The TPP could impose obligations on developing countries that go far beyond any existing trade agreement. Indeed, some proposals in the leaked IP chapter seem directly targeted against innovative measures that developing countries have used to maximize the use of low-cost generic medicines.

For example, India allows patents on new drugs but not on new uses of old drugs or new forms of known drugs that do not increase therapeutic efficacy. These provisions have paved the way for generic versions of lifesaving drugs such as the cancer treatment imatinib mesylate (Gleevec) in that country.1 But such limits on patent eligibility could be outlawed by the TPP. Reports suggest that there may be some kind of phase-in period for developing-country members, but only for some parts of the agreement. And at best, a phase-in period would merely postpone some of the TPP’s effects for a few years.2

India is not a party to the TPP negotiations, which have been conducted by 12 Pacific Rim countries: Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, the United States, and Vietnam. Why, then, would India’s laws — sometimes word for word — be targeted in the TPP negotiations? For one thing, other developing countries have started to follow India’s lead. For another, the TPP is a platform agreement designed for other countries to join, and it will establish a new baseline for future international negotiations. The risk regarding access to medicines in developing countries is real.

Though it is less widely recognized, the TPP could also have a direct effect on health in developed countries. For example, the leaked IP chapter contemplates major extensions of “data exclusivity” provisions. These laws prevent drug regulatory agencies like the Food and Drug Administration from registering a generic version of a drug for a certain number of years — and as a result can substantially affect the prices of medicines.

In recognition of this fact, President Barack Obama’s fiscal year 2016 budget proposes rolling back the data-exclusivity period for biologic drugs in the United States to 7 years from 12 years, yielding a projected savings of more than $4 billion over the next decade.3 In the TPP negotiations, however, the United States is proposing a 12-year term of exclusivity. Such a requirement would lock the United States into a policy that many observers, including, apparently, the President himself, believe inflates the cost of medicines unjustifiably. Even if the number of years required by the TPP is negotiated downward, the lock-in effect remains a concern, because trade agreements can be extremely difficult to amend.

The cost of medicines is no small concern in the United States today: spending on prescription drugs in the United States jumped 13% in 2014 alone. The recent experience with new hepatitis C treatments shows that even lifesaving cures may be rationed in the United States — whether implicitly or explicitly — if we fail to contain drug costs and promote more efficient innovation. The TPP, however, could make moves toward more rational drug pricing in the United States difficult and even imperil existing provisions that help to contain costs for government programs.

A 2011 “annex” to the TPP, apparently proposed by the United States, would have mandated that all countries use “competitive market-derived prices” or benchmarks that “appropriately recognize the value” of the drug in question when establishing drug prices. A just-leaked December 2014 draft omits these provisions but still contemplates substantial procedural obligations for governments and makes clear that these rules apply to the Centers for Medicare and Medicaid Services (CMS). The text is difficult to decipher and still in flux. But consumer groups argue that the annex could create opportunities for interference in the decisions of CMS and render health programs in all TPP countries more vulnerable to drug-company influence and more difficult to reform.4

In March 2015, a third bombshell dropped: a draft chapter on “investor-state dispute settlement” (ISDS). It would empower foreign companies to sue member countries for hundreds of millions of dollars in damages in a wide range of cases in which they argue that their expected future profits have been undermined. These challenges would be heard by “arbiters” — typically private lawyers, many of whom cycle in and out of industry — with no prospect of independent review by a national court. Such provisions have been included in trade agreements before. But the scale of the TPP would substantially increase the number of companies that could bring such challenges. Firms have already used provisions like these to challenge an astonishing range of laws, from minimum-wage laws in Egypt, to tobacco regulations in Uruguay and Australia, to core aspects of patent law as they apply to medicines in Canada. The ISDS provisions alone could interfere with domestic health policy for decades to come. Under their auspices, policies covering a wide range of issues, from food and tobacco labeling, to patent law, to drug-pricing rules, to environmental protection could be challenged in participating countries — including, of course, the United States.

The course that the TPP takes is not yet set in stone. Negotiations continue, and the Obama administration could work toward an agreement that excludes provisions such as ISDS and the health care “annex” or that incorporates robust safeguards to protect health. Congress has an important role, too. As of early June, it was in the midst of a fierce legislative battle over whether the TPP and deals like it should be “fast-tracked.” If Congress takes this route, its ability to influence the treaty will be much diminished: fast tracking allows passage of a trade treaty with only a simple majority vote in Congress and also denies Congress any opportunity to make changes to the agreement’s text.

Much hangs in the balance in the coming weeks and months. If the TPP includes robust ISDS provisions and the expansive provisions proposed in the IP chapter and the health care annex, the United States could be signing away its authority to regulate critical aspects of health policy for years to come.

Human Onchocerciasis: Modelling the Potential Long-term Consequences of a Vaccination Programme

PLoS Neglected Tropical Diseases
(Accessed 18 July 2015)

Human Onchocerciasis: Modelling the Potential Long-term Consequences of a Vaccination Programme
Hugo C. Turner, Martin Walker, Sara Lustigman, David W. Taylor, María-Gloria Basáñez Research Article | published 17 Jul 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003938
Currently, the predominant onchocerciasis control strategy in Africa is annual mass drug administration (MDA) with ivermectin. However, there is a consensus among the global health community, supported by mathematical modelling, that onchocerciasis in Africa will not be eliminated within proposed time frameworks in all endemic foci with only annual MDA, and novel and alternative strategies are urgently needed. Furthermore, use of MDA with ivermectin is already compromised in large areas of central Africa co-endemic with Loa loa, and there are areas where suboptimal or atypical responses to ivermectin have been documented. An onchocerciasis vaccine would be highly advantageous in these areas.
Methodology/Principal Findings
We used a previously developed onchocerciasis transmission model (EPIONCHO) to investigate the impact of vaccination in areas where loiasis and onchocerciasis are co-endemic and ivermectin is contraindicated. We also explore the potential influence of a vaccination programme on infection resurgence in areas where local elimination has been successfully achieved. Based on the age range included in the Expanded Programme on Immunization (EPI), the vaccine was assumed to target 1 to 5 year olds. Our modelling results indicate that the deployment of an onchocerciasis vaccine would have a beneficial impact in onchocerciasis–loiasis co-endemic areas, markedly reducing microfilarial load in the young (under 20 yr) age groups.
An onchocerciasis prophylactic vaccine would reduce the onchocerciasis disease burden in populations where ivermectin cannot be administered safely. Moreover, a vaccine could substantially decrease the chance of re-emergence of Onchocerca volvulus infection in areas where it is deemed that MDA with ivermectin can be stopped. Therefore, a vaccine would protect the substantial investments made by present and past onchocerciasis control programmes, decreasing the chance of disease recrudescence and offering an important additional tool to mitigate the potentially devastating impact of emerging ivermectin resistance.

Author Summary
Novel and alternative strategies are required to meet the demanding control and elimination (of infection) goals for human onchocerciasis (river blindness) in Africa. Due to the overlapping distribution of onchocerciasis and loiasis (African eye worm) in forested areas of central Africa, millions of people living in such areas are not well served by current interventions because they cannot safely receive the antiparasitic drug ivermectin that is distributed en masse to treat onchocerciasis elsewhere in Africa. The Onchocerciasis Vaccine for Africa—TOVA—Initiative has been established to develop and trial an onchocerciasis vaccine. We model the potential impact of a hypothetical childhood vaccination programme rolled out in areas where co-endemicity of onchocerciasis and African eye worm makes mass distribution of ivermectin difficult and potentially unsafe for treating, controlling and eliminating river blindness. We find that, 15 years into the programme, a vaccine would substantially reduce infection levels in children and young adults, protecting them from the morbidity and mortality associated with onchocerciasis. Most benefit would be reaped from a long-lived vaccine, even if only partially protective. We also discuss how a vaccine could substantially reduce the risk of re-emergence of onchocerciasis in areas freed from infection after years of successful intervention.

PLoS One [Accessed 18 July 2015]

PLoS One
[Accessed 18 July 2015]

Tuberculous Meningitis in Children and Adults: A 10-Year Retrospective Comparative Analysis
Egidia G. Miftode, Olivia S. Dorneanu, Daniela A. Leca, Gabriela Juganariu, Andra Teodor, Mihnea Hurmuzache, Eduard V. Nastase, Dana T. Anton-Paduraru
Research Article | published 17 Jul 2015 | PLOS ONE 10.1371/journal.pone.0133477

Acceptability and Feasibility of Delivering Pentavalent Vaccines in a Compact, Prefilled, Autodisable Device in Vietnam and Senegal
Elise Guillermet, Hamadou M. Dicko, Le Thi Phuong Mai, Mamadou N’Diaye, Fatoumata Hane, Seydina Ousmane Ba, Khadidjatou Gomis, Nguyen Thi Thi Tho, Nguyen Thi Phuong Lien, Phan Dang Than, Tran Van Dinh, Philippe Jaillard, Bradford D. Gessner, Anais Colombini
Research Article | published 17 Jul 2015 | PLOS ONE 10.1371/journal.pone.0132292

The French Connection: The First Large Population-Based Contact Survey in France Relevant for the Spread of Infectious Diseases
Guillaume Béraud, Sabine Kazmercziak, Philippe Beutels, Daniel Levy-Bruhl, Xavier Lenne, Nathalie Mielcarek, Yazdan Yazdanpanah, Pierre-Yves Boëlle, Niel Hens, Benoit Dervaux
Research Article | published 15 Jul 2015 | PLOS ONE 10.1371/journal.pone.0133203

Do Maternal Living Arrangements Influence the Vaccination Status of Children Age 12–23 Months? A Data Analysis of Demographic Health Surveys 2010–11 from Zimbabwe
Rodolfo Rossi
Research Article | published 13 Jul 2015 | PLOS ONE 10.1371/journal.pone.0132357

Research Synthesis Methods: A Cross-Disciplinary Approach

Risk Analysis
June 2015 Volume 35, Issue 6 Pages 961–1186

Special Issue: Special Series on Research Synthesis Methods: A Cross-Disciplinary Approach
Introduction to the Special Series on Research Synthesis: A Cross-Disciplinary Approach (pages 963–970)
Lisa A. Robinson and James K. Hammitt
Article first published online: 17 JUN 2015 | DOI: 10.1111/risa.12437
To estimate the effects of a policy change, analysts must often rely on available data as time and resource constraints limit their ability to commission new primary research. Research synthesis methods—including systematic review, meta-analysis, and expert elicitation—play an important role in ensuring that this evidence is appropriately weighed and considered. We present the conclusions of a multidisciplinary Harvard Center for Risk Analysis project that evaluated and applied these methods, and introduce the resulting series of articles. The first step in any analysis is to clearly define the problem to be addressed; the second is a systematic review of the literature. Whether additional analysis is needed depends on the quality and relevance of the available data to the policy question, and the likely effect of uncertainty on the policy decision. Meta-analysis promotes understanding the variation between studies and may be used to combine the estimates to develop values for application in policy analysis. Formal, structured expert elicitation promotes careful consideration of the evidence when data are limited or inconsistent, and aids in extrapolating to the policy context. Regardless of the methods used, clear communication of the approach, assumptions, and uncertainty is essential.

Research Synthesis and the Value per Statistical Life (pages 1086–1100)
Lisa A. Robinson and James K. Hammitt
Article first published online: 7 APR 2015 | DOI: 10.1111/risa.12366

Discounting in the evaluation of the cost-effectiveness of a vaccination programme: A critical review

Volume 33, Issue 32, Pages 3779-4046 (31 July 2015)


Discounting in the evaluation of the cost-effectiveness of a vaccination programme: A critical review
Review Article
Pages 3788-3794
Mark Jit, Walter Mibei
Discounting future costs and health benefits usually has a large effect on results of cost-effectiveness evaluations of vaccination because of delays between the initial expenditure in the programme and the health benefits from averting disease. Most guidelines currently recommend discounting both costs and health effects at a positive, constant, common rate back to a common point in time. A review of 84 published economic evaluations of vaccines found that most of them apply these recommendations. However, both technical and normative arguments have been presented for discounting health at a different rate to consumption (differential discounting), discounting at a rate that changes over time (non-constant discounting), discounting intra-generational and inter-generational effects at a different rate (two-stage discounting), and discounting the health gains from an intervention to a different discount year from the time of intervention (delayed discounting). These considerations are particularly acute for vaccines, because their effects can occur in a different generation from the one paying for them, and because the time of vaccination, of infection aversion, and of disease aversion usually differ. Using differential, two-stage or delayed discounting in model-based cost-effectiveness evaluations of vaccination raises technical challenges, but mechanisms have been proposed to overcome them.

Estimating the herd immunity effect of rotavirus vaccine

Volume 33, Issue 32, Pages 3779-4046 (31 July 2015)


Estimating the herd immunity effect of rotavirus vaccine
Review Article
Pages 3795-3800
Suzanne L. Pollard, Tanya Malpica-Llanos, Ingrid K. Friberg, Christa Fischer-Walker, Sania Ashraf, Neff Walker
Diarrhea is one of the leading causes of death in children under 5, and an estimated 39% of these deaths are attributable to rotavirus. Currently two live, oral rotavirus vaccines have been introduced on the market; however, the herd immunity effect associated with rotavirus vaccine has not yet been quantified. The purpose of this meta-analysis was to estimate the herd immunity effects associated with rotavirus vaccines.
We performed a systematic literature review of articles published between 2008 and 2014 that measured the impact of rotavirus vaccine on severe gastroenteritis (GE) morbidity or mortality. We assessed the quality of published studies using a standard protocol and conducted meta-analyses to estimate the herd immunity effect in children less than one year of age across all years presented in the studies. We conducted these analyses separately for studies reporting a rotavirus-specific GE outcome and those reporting an all-cause GE outcome.
In studies reporting a rotavirus-specific GE outcome, four of five of which were conducted in the United States, the median herd effect across all study years was 22% [19–25%]. In studies reporting an all-cause GE outcome, all of which were conducted in Latin America, the median herd effect was 24.9% [11–30%].
There is evidence that rotavirus vaccination confers a herd immunity effect in children under one year of age in the United States and Latin American countries. Given the high variability in vaccine efficacy across regions, more studies are needed to better examine herd immunity effects in high mortality regions.

Three randomized trials of maternal influenza immunization in Mali, Nepal, and South Africa: Methods and expectations

Volume 33, Issue 32, Pages 3779-4046 (31 July 2015)


Three randomized trials of maternal influenza immunization in Mali, Nepal, and South Africa: Methods and expectations
Review Article
Pages 3801-3812
Saad B. Omer, Jennifer L. Richards, Shabir A. Madhi, Milagritos D. Tapia, Mark C. Steinhoff, Anushka R. Aqil, Niteen Wairagkar, for the BMGF Supported Maternal Influenza Immunization Trials Investigators Group
Influenza infection in pregnancy can have adverse impacts on maternal, fetal, and infant outcomes. Influenza vaccination in pregnancy is an appealing strategy to protect pregnant women and their infants. The Bill & Melinda Gates Foundation is supporting three large, randomized trials in Nepal, Mali, and South Africa evaluating the efficacy and safety of maternal immunization to prevent influenza disease in pregnant women and their infants <6 months of age. Results from these individual studies are expected in 2014 and 2015. While the results from the three maternal immunization trials are likely to strengthen the evidence base regarding the impact of influenza immunization in pregnancy, expectations for these results should be realistic. For example, evidence from previous influenza vaccine studies – conducted in general, non-pregnant populations – suggests substantial geographic and year-to-year variability in influenza incidence and vaccine efficacy/effectiveness. Since the evidence generated from the three maternal influenza immunization trials will be complementary, in this paper we present a side-by-side description of the three studies as well as the similarities and differences between these trials in terms of study location, design, outcome evaluation, and laboratory and epidemiological methods. We also describe the likely remaining knowledge gap after the results from these trials become available along with a description of the analyses that will be conducted when the results from these individual data are pooled. Moreover, we highlight that additional research on logistics of seasonal influenza vaccine supply, surveillance and strain matching, and optimal delivery strategies for pregnant women will be important for informing global policy related to maternal influenza immunization.

Attitudes and perceptions among the pediatric health care providers toward influenza vaccination in Qatar: A cross-sectional study

Volume 33, Issue 32, Pages 3779-4046 (31 July 2015)


Attitudes and perceptions among the pediatric health care providers toward influenza vaccination in Qatar: A cross-sectional study
Original Research Article
Pages 3821-3828
Ahmed Alhammadi, Mohamed Khalifa, Hatem Abdulrahman, Eman. Almuslemani, Abdullah Alhothi, Mohamed Janahi
Influenza is a communicable but preventable viral illness. Despite safe and effective vaccine availability, compliance rates are globally low. Neither local data on percentage of vaccination nor reasons for poor compliance among pediatric health providers are available in Qatar.
To estimate the percentage of vaccinated health care providers at pediatrics department and know their perception and attitudes toward influenza vaccinations.
Cross-sectional survey, conducted on 300 pediatrics healthcare professionals from January through April 2013 at the main tertiary teaching hospital in Qatar, included details of demographics, frequency, perceptions and suggestive ways to improve the compliance.
From among 230 respondents, 90 physicians and 133 allied health care professionals participated in this survey. Our study showed that percentages of participants who received flu vaccination were 67.7% and those who did not receive vaccination were 32.3%. Allied HCPs (69%) are more likely to get the vaccine compared to the physicians (66%). flu vaccination was approximately 5 times likely to be higher in the age group more than 40 years (P = 0.002) compared to age less than or equals 40 years. Overall 70% healthcare providers were willing to recommend immunization to colleagues and patients compared to 30%, who were not willing. The reasons for noncompliance included fear of side effects, contracting the flu, vaccine safety and lack of awareness about the effectiveness. In order to promote immunization, participants believe that use of evidence-based statement, participating in an educational campaign, provides no cost/on site campaigns and leadership support is the most practical interventions.
In the present study, the vaccine coverage among pediatrics HCPs seems higher than previously reported rates. Despite their positive attitude toward influenza vaccination, low acceptance and misconceptions of seasonal influenza vaccination by pediatric HCPs may have a negative effect on the successful immunization delivery and children immunization rate. Our findings would be useful for designing and implementing educational programs targeted to improve vaccination coverage rates.

Reasons for low influenza vaccination coverage among adults in Puerto Rico, influenza season 2013–2014

Volume 33, Issue 32, Pages 3779-4046 (31 July 2015)


Reasons for low influenza vaccination coverage among adults in Puerto Rico, influenza season 2013–2014
Original Research Article
Pages 3829-3835
Carmen S. Arriola, Melissa C. Mercado-Crespo, Brenda Rivera, Ruby Serrano-Rodriguez, Nora Macklin, Angel Rivera, Samuel Graitcer, Mayra Lacen, Carolyn B. Bridges, Erin D. Kennedy
Influenza vaccination is recommended annually for all persons 6 months and older. Reports of increased influenza-related morbidity and mortality during the 2013–2014 influenza season raised concerns about low adult influenza immunization rates in Puerto Rico. In order to inform public health actions to increase vaccination rates, we surveyed adults in Puerto Rico regarding influenza vaccination-related attitudes and barriers.
A random-digit-dialing telephone survey (50% landline: 50% cellphone) regarding influenza vaccination, attitudes, practices and barriers was conducted November 19–25, 2013 among adults in Puerto Rico. Survey results were weighted to reflect sampling design and adjustments for non-response.
Among 439 surveyed, 229 completed the survey with a 52% response rate. Respondents’ median age was 55 years; 18% reported receiving 2013–2014 influenza vaccination. Among 180 unvaccinated respondents, 38% reported barriers associated with limited access to vaccination, 24% reported they did not want or need influenza vaccination, and 20% reported safety concerns. Vaccinated respondents were more likely to know if they were recommended for influenza vaccination, to report greater perceived risk of influenza illness, and to report being less concerned about influenza vaccine safety (p-value < 0.05). Of the 175 respondents who saw a healthcare provider (HCP) since July 1, 2013, 38% reported their HCP recommended influenza vaccination and 17% were offered vaccination. Vaccination rates were higher among adults who received a recommendation and/or offer of influenza vaccination (43% vs. 14%; p-value < 0.01).
Failure of HCP to recommend and/or offer influenza vaccination and patient attitudes (low perceived risk of influenza virus infection) may have contributed to low vaccination rates during the 2013–2014 season. HCP and public health practitioners should strongly recommend influenza vaccination and provide vaccinations during clinical encounters or refer patients for vaccination.

Risk perceptions, sexual attitudes, and sexual behavior after HPV vaccination in 11–12 year-old girls

Volume 33, Issue 32, Pages 3779-4046 (31 July 2015)


Risk perceptions, sexual attitudes, and sexual behavior after HPV vaccination in 11–12 year-old girls
Original Research Article
Pages 3907-3912
Tanya L. Kowalczyk Mullins, Lea E. Widdice, Susan L. Rosenthal, Gregory D. Zimet, Jessica A. Kahn
Among 11–12 year-old girls who received the human papillomavirus (HPV) vaccine, we explored, over the subsequent 30 months: (1) trajectories of knowledge about HPV/HPV vaccines and vaccine-related risk perceptions; (2) whether knowledge and risk perceptions impacted sexual attitudes and sexual experience; (3) whether mothers, clinicians, and media influenced girls’ risk perceptions, attitudes, and behavior.
Girls and mothers (n = 25 dyads) completed separate, semi-structured interviews within 2 days of, and 6, 18, and 30 months after, their first HPV vaccine dose. Knowledge, risk perceptions related to HPV and other sexually transmitted infections (STIs), and attitudes about sexual behaviors were assessed. Sexual experience was assessed at girls’ 30 month interviews. Clinicians completed interviews at baseline. Transcribed interviews were analyzed using framework analysis.
Girls’ baseline knowledge was poor but often improved with time. Most girls (n = 18) developed accurate risk perceptions about HPV but only half (n = 12) developed accurate risk perceptions about other STIs by 30 months. The vast majority of girls thought that safer sex was still important, regardless of knowledge, risk perceptions, or sexual experience. Girls whose HPV knowledge was high at baseline or increased over time tended to articulate accurate risk perceptions; those who were able to articulate accurate risk perceptions tended to report not having initiated sexual activity. Girls whose mothers demonstrated higher knowledge and/or communication about HPV vaccination tended to articulate accurate risk perceptions, whereas clinicians and media exposure did not appear to influence risk perceptions.
Higher knowledge about HPV vaccines among mothers and girls was linked with more accurate risk perceptions among girls. Clinicians may play an important role in providing education about HPV vaccines to mothers and girls.

Influenza vaccine: Delayed vaccination schedules and missed opportunities in children under 2 years old

Volume 33, Issue 32, Pages 3779-4046 (31 July 2015)


Influenza vaccine: Delayed vaccination schedules and missed opportunities in children under 2 years old
Original Research Article
Pages 3913-3917
A. Gentile, M. Juárez, S. Hernandez, A. Moya, J. Bakir, M. Lucion
In Argentina respiratory disease is the third leading cause of death in children under 5 years. In 2011 influenza vaccination was included in the National Calendar for children between 6 and 24 months (two doses schedule). Influenza vaccine coverage for second dose was 46.1% in 2013. The aim was to determine the proportion of delayed schedules and missed opportunities, to assess the characteristics of missed opportunities for vaccination and to explore the perception of influenza disease and vaccination from the parents of children between 6 and 24 months in different regions of Argentina in 2013.
Analytical observational multicenter cross-sectional study. Structured surveys were carried out to the children’s parents who were between 6 and 24 months of age during the influenza virus vaccination season (April–October 2013). Chi-Square test was used to assess association and differences between proportions and categorical variables. A logistic regression model was built to identify delay predictor variables in the vaccination schedules. Missed opportunities for vaccination were characterized through the estimation of proportions.
1350 surveys were conducted in the three centers. We detected 65% (884/1340) of delayed influenza vaccination schedules, 97% of them associated with missed opportunities of vaccination. The independent protective factors associated with a decreases risk of delayed schedules were: (a) perception of the importance of influenza vaccination (OR = 0.42(0.18–0.94); p = 0.035), (b) having less than one year of age (OR = 0.75(0.59–0.96); p = 0.022), (c) to have received information in pediatric visits or in any media (OR = 0.71(0.56–0.90); p = 0.004). There was 38% of MOIV in 1st dose and 63.4% in 2nd dose. The main cause of MOIV in 1st dose was not detecting the need for vaccination (39%) and in 2nd dose the unknowledge of the vaccination schedule (35.3%). No cultural reasons were detected.
High frequency of delayed vaccination schedules and missed opportunities were detected. Parents had little concern about the safety of influenza vaccine.

Effect of rotavirus vaccine on childhood diarrhea mortality in five Latin American countries

Volume 33, Issue 32, Pages 3779-4046 (31 July 2015)


Effect of rotavirus vaccine on childhood diarrhea mortality in five Latin American countries
Original Research Article
Pages 3923-3928
Angel Paternina-Caicedo, Umesh D. Parashar, Nelson Alvis-Guzmán, Lucia Helena De Oliveira, Andres Castaño-Zuluaga, Karol Cotes-Cantillo, Oscar Gamboa-Garay, Wilfrido Coronell-Rodríguez, Fernando De la Hoz-Restrepo
The aim of this study was to estimate the association between rotavirus vaccine (RV) introduction and reduction of all-cause diarrhea death rates among children in five Latin American countries that introduced RV in 2006.
Diarrhea mortality data was gathered from 2002 until 2009 from the Pan American Health Organization Mortality Database for five “vaccine adopter” countries (Brazil, El Salvador, Mexico, Nicaragua, and Panama) that introduced RV in 2006 and four “control” countries (Argentina, Chile, Costa Rica, and Paraguay) that did not introduce RV by 2009. Time trend analyses were carried out, and effects and 95% confidence intervals (CI) were estimated.
Each of the five vaccine adopter countries, except Panama, showed a significant trend in declining mortality rates during the post-vaccine period from 2006 to 2009, whereas no decline was seen in control countries during these years. Furthermore, trends of reduction of all-cause diarrhea mortality in both children <1 year of age and <5 years of age were greater in the post-vaccination period compared with the pre-vaccine period in all vaccine adopter countries (except for Nicaragua), whereas in control countries, a reverse pattern was seen with greater reduction in the early years from 2002 to 2005 versus 2006–2009. An estimatedtotal of 1777 of annual under-5 deaths were avoided in Brazil, El Salvador, Mexico, and Nicaragua during the post-vaccination period.
All vaccine adopter countries, except Panama, showed a significant decrease in all-cause diarrhea-related deaths after RV implementation, even after adjusting for declining trends over time in diarrhea mortality. These data strongly support continuous efforts to increase vaccination coverage of RV vaccines, particularly in countries with high levels of child mortality from diarrhea.

Vaccines — Open Access Journal (Accessed 18 July 2015)

Vaccines — Open Access Journal
(Accessed 18 July 2015)

Addressing the Vaccine Hesitancy Continuum: An Audience Segmentation Analysis of American Adults Who Did Not Receive the 2009 H1N1 Vaccine
by Shoba Ramanadhan, Ezequiel Galarce, Ziming Xuan, Jaclyn Alexander-Molloy and Kasisomayajula Viswanath
Vaccines 2015, 3(3), 556-578; doi:10.3390/vaccines3030556 – published 15 July 2015
Understanding the heterogeneity of groups along the vaccine hesitancy continuum presents an opportunity to tailor and increase the impact of public engagement efforts with these groups. Audience segmentation can support these goals, as demonstrated here in the context of the 2009 H1N1 vaccine. In March 2010, we surveyed 1569 respondents, drawn from a nationally representative sample of American adults, with oversampling of racial/ethnic minorities and persons living below the United States Federal Poverty Level. Guided by the Structural Influence Model, we assessed knowledge, attitudes, and behaviors related to H1N1; communication outcomes; and social determinants. Among those who did not receive the vaccine (n = 1166), cluster analysis identified three vaccine-hesitant subgroups. Disengaged Skeptics (67%) were furthest from vaccine acceptance, with low levels of concern and engagement. The Informed Unconvinced (19%) were sophisticated consumers of media and health information who may not have been reached with information to motivate vaccination. The Open to Persuasion cluster (14%) had the highest levels of concern and motivation and may have required engagement about vaccination broadly. There were significant sociodemographic differences between groups. This analysis highlights the potential to use segmentation techniques to identify subgroups on the vaccine hesitancy continuum and tailor public engagement efforts accordingly.

Systems Biology Approach for Cancer Vaccine Development and Evaluation
by Luisa Circelli, Annacarmen Petrizzo, Maria Tagliamonte, Maria Lina Tornesello, Franco M. Buonaguro and Luigi Buonaguro
Vaccines 2015, 3(3), 544-555; doi:10.3390/vaccines3030544 – published 14 July 2015
Therapeutic cancer vaccines do not hold promise yet as an effective anti-cancer treatment. Lack of efficacy or poor clinical outcomes are due to several antigenic and immunological aspects that need to be addressed in order to reverse such trends and significantly improve cancer vaccines’ efficacy. The newly developed high throughput technologies and computational tools are instrumental to this aim allowing the identification of more specific antigens and the comprehensive analysis of the innate and adaptive immunities. Here, we review the potentiality of systems biology in providing novel insights in the mechanisms of the action of vaccines to improve their design and effectiveness.

From Google Scholar + [to 18 July 2015]

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary
Pediatric Infectious Disease Journal
Published Ahead-of-Print
An Overview of Quadrivalent Human Papillomavirus Vaccine Safety – 2006 to 2015.
Vichnin, Michelle MD; Bonanni, Paolo MD; Klein, Nicola P. MD, PhD; Garland, Suzanne M. MD; Block, Stan L. MD; Kjaer, Susanne K. MD; Sings, Heather L. PhD; Perez, Gonzalo MD; Haupt, Richard M. MD MPH; Saah, Alfred J. MD; Lievano, Fabio MD; Velicer, Christine PhD; Drury, Rosybel PhD; Kuter, Barbara J. PhD, MPH
doi: 10.1097/INF.0000000000000793
A quadrivalent human papillomavirus (HPV4) type 6/11/16/18 vaccine (GARDASIL/SILGARD(R)) has been licensed in many countries around the world for the prevention of cervical, vulvar, vaginal, and anal cancers and pre-cancers, as well as external genital warts causally related to HPV types 6/11/16/18. Across 7 phase 3 clinical trials involving more than 29,000 males and females ages 9-45, vaccination was generally well tolerated. Because of its expected public health benefit in reducing cervical cancer and other HPV-related diseases, the vaccine has been implemented in the national vaccination programs of several countries, with over 178 million doses distributed worldwide.
Extensive efforts to assess the safety of the vaccine in routine practice have been conducted over the past 8 years since licensure, including more than 15 studies in more than one million pre-adolescents, adolescents, and adults from various countries. Most have been performed in the general population though there have been some in special populations (pregnant women, human immunodeficiency virus infected individuals, and those with Systemic Lupus Erythematosus).
We present a summary of the published, post-licensure safety data from active and passive surveillance. Only syncope, and possibly skin infections were associated with vaccination in the post-licensure setting. Serious adverse events such as adverse pregnancy outcomes, autoimmune diseases (including Guillain-Barre Syndrome and multiple sclerosis), anaphylaxis, venous thromboembolism, and stroke, were extensively studied, and no increase in the incidence of these events was found compared with background rates.
These results, along with the safety data from the pre-licensure clinical trials, confirm that the HPV4 vaccine has a favorable safety profile. Key policy, medical, and regulatory organizations around the world have independently reviewed these data and continue to recommend routine HPV vaccination.
The Cochrane Library
Published Online: 3 JUL 2015
Qualitative Protocol
Parents’ and informal caregivers’ views and experiences of routine early childhood vaccination communication: qualitative evidence synthesis
Heather MR Ames1,*, Claire Glenton1, Simon Lewin1,2
Assessed as up-to-date: 1 JUL 2015
DOI: 10.1002/14651858.CD011787
This is the protocol for a review and there is no abstract. The objectives are as follows:
The specific objectives of the review are to identify, appraise and synthesise qualitative studies exploring:
:: Parents’ and informal caregivers’ views and experiences regarding communication about childhood vaccinations and the manner in which it is communicated
:: The influence that vaccination communication has on parents’ and informal caregivers’ decisions regarding childhood vaccination
Western Pacific Surveillance and Response Journal
2015, 6(3).
An assessment of measles vaccine effectiveness, Australia, 2006–2012
Alexis Pillsburyab and Helen Quinnac
a National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead and the University of Sydney, New South Wales, Australia.
b National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.
c Discipline of Paediatrics and Child Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia.
Vaccine effectiveness analysis serves as a critical evaluation for immunization programmes and vaccination coverage. It also contributes to maintaining public confidence with the vaccine providers. This study estimated measles vaccine effectiveness at the population level using Australian national notifications data between 2006 and 2012.
Notification data were obtained from the National Notifiable Diseases Surveillance System. Vaccination status was classified according to whether a case had received zero, one or two doses of measles-containing vaccine. Cases aged less than 1 year and those with unknown vaccination status were excluded. All children with disease onset between 1 January 2006 and 31 December 2012 who were born after 1996 were included. Cases were matched to controls extracted from the Australian Childhood Immunisation Register according to date of birth and jurisdiction of residence. Vaccine effectiveness was estimated by conditional logistic regression. Sensitivity analyses were conducted to test data robustness.
Vaccine effectiveness was estimated at 96.7% (95% confidence interval [CI]: 94.5–98.0%) for one dose and 99.7% (95% CI: 99.2–99.9%) for two doses of measles vaccine. For at least one dose, effectiveness was estimated at 98.7% (95% CI: 97.9–99.2%). Sensitivity analyses did not significantly alter the base estimates.
Vaccine effectiveness estimates suggested that the measles vaccine was protective at the population level between 2006 and 2012. However, vaccination coverage gaps may have contributed to recent measles outbreaks and may represent a serious barrier for Australia to maintain measles elimination status.

Vaccines and Global Health: The Week in Review 11 July 2015

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

.Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to

pdf version A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_11 July 2015

blog edition: comprised of the approx. 35+ entries posted below on this date.

Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

EBOLA/EVD [to 11 July 2015]

EBOLA/EVD [to 11 July 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Editor’s Note:
A number of key reports, recommendations, meetings and actions marked the past week in Ebola/EVD. In summary:
:: The weekly Ebola Situation Report – 8 July 2015 reported 30 new confirmed cases across the three affected countries, noting that “…significant challenges remain. A residual lack of trust in the response among some affected communities means that some cases still evade detection for too long, increasing the risk of further hidden transmission. The exportation of cases to densely populated urban areas such as Freetown and Conakry remains a risk, whilst the origin of the new cluster of cases in Liberia is not yet well understood…”

:: The IHR Emergency Committee held its sixth meeting, assessing the outbreak response and current status. The key result was that Committee recommended that the EVD outbreak “continues to constitute a Public Health Emergency of International Concern.”

:: The WHO-convened Ebola Interim Assessment Panel issued its report on the overall Ebola response, noting that it “… believes that this is a defining moment for the health of the global community. WHO must re-establish its pre-eminence as the guardian of global public health; this will require significant changes throughout WHO with the understanding that this includes both the Secretariat and the Member States [and] …The Ebola crisis not only exposed organizational failings in the functioning of WHO, but it also demonstrated shortcomings in the International Health Regulations (2005)…” The WHO issued a response to the report outlining a number of action items responding to the report and its recommendations.

:: The UN convened an International Ebola Recovery Conference in New York which ran 9-10 July 2015. The Conference was organized as a series of technical sessions focused on the continuing EVD response and post-outbreak recovery planning, with a concluding pledging meeting which generated commitments of several billion dollars.

:: GAVI announced support for rebuilding of immunisation programmes in Ebola-affected countries which were largely dormant during the Ebola response period, leaving “hundreds of thousands of children who either missed out or are at risk of missing out will now receive their vaccinations…”
Please see documentation below:
Ebola Situation Report – 8 July 2015
:: There were 30 confirmed cases of Ebola virus disease (EVD) reported in the week to 5 July: 18 in Guinea, 3 in Liberia, and 9 in Sierra Leone. Although this is the highest weekly total since mid-May, improvements to case investigation and contact tracing, together with enhanced incentives to encourage case reporting and compliance with quarantine measures have led to a better understanding of chains of transmission than was the case a month ago. This, in turn, has resulted in a decreasing proportion of cases arising from as-yet unknown sources of infection (5 of 30 cases in the week to 5 July), particularly in previously problematic areas such as Boke and Forecariah in Guinea, and Kambia and Port Loko in Sierra Leone. However, significant challenges remain. A residual lack of trust in the response among some affected communities means that some cases still evade detection for too long, increasing the risk of further hidden transmission. The exportation of cases to densely populated urban areas such as Freetown and Conakry remains a risk, whilst the origin of the new cluster of cases in Liberia is not yet well understood…

:: There have been a total of 27,573 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1) up to 5 July, with 11,246 reported deaths (this total includes reported deaths among probable and suspected cases, although outcomes for many cases are unknown). A total of 18 new confirmed cases were reported in Guinea, 3 in Liberia, and 9 in Sierra Leone in the week to 5 July…

Ebola/EVD: Statement on the 6th meeting of the IHR Emergency Committee regarding the Ebola outbreak in West Africa 7 July 2015

Statement on the 6th meeting of the IHR Emergency Committee regarding the Ebola outbreak in West Africa
7 July 2015

…As in previous meetings, the Committee’s role was to advise the WHO Director-General as to:
:: whether the event continues to constitute a Public Health Emergency of International Concern (PHEIC) and, if so,
:: whether the current temporary recommendations should be extended, or revised, or whether new temporary recommendations should be issued…

The Committee advised that the EVD outbreak continues to constitute a Public Health Emergency of International Concern and previously issued temporary recommendations should be extended…

…Based on this advice and information, the Director-General declared that the 2014-2015 Ebola outbreak in these West African countries continues to constitute a Public Health Emergency of International Concern. The Director-General endorsed the Committee’s advice, extended the existing Temporary Recommendations as appropriate and issued the additional advice as new Temporary Recommendations under the IHR…

Ebola/EVD: Report of the Ebola Interim Assessment Panel – July 2015 :: WHO Response

Report of the Ebola Interim Assessment Panel – July 2015
WHO Panel of independent experts
July 2015 :: 29 pages
Languages: English
Pdf: Report of the Ebola Interim Assessment Panelpdf, 625kb
Executive Summary [Excerpts]
The Panel believes that this is a defining moment for the health of the global community. WHO must re-establish its pre-eminence as the guardian of global public health; this will require significant changes throughout WHO with the understanding that this includes both the Secretariat and the Member States. At each of its three levels, the Secretariat must undergo significant transformation in order to better perform its core function of protecting global health. For their part, Member States must provide, at their highest political levels, the required political and financial support to their Organization. While WHO has already accepted the need for transformation of its organizational culture and delivery, it will need to be held accountable to ensure that this transformation is achieved.

The Ebola crisis not only exposed organizational failings in the functioning of WHO, but it also demonstrated shortcomings in the International Health Regulations (2005). If the world is to successfully manage the health threats, especially infectious diseases that can affect us all, then the Regulations need to be strengthened. We ask that the full Review Committee under the International Health Regulations (2005) to examine the role of the Regulations in the Ebola outbreak (the IHR Review Committee for Ebola), which follows our Panel, consider and take forward the implementation of our recommendations. Had the recommendations for revision made in 2011 by the Review Committee in relation to Pandemic (H1N1) 2009 been implemented,1 the global community would have been in a far better position to face the Ebola crisis. The world simply cannot afford another period of inaction until the next health crisis.

Our report and recommendations fall under the following three headings: the International Health Regulations (2005); WHO’s health emergency response capacity; and WHO’s role and cooperation with the wider health and humanitarian systems…
[The Panel discusses these three thematic areas and makes 21 recommendations]…

The Panel firmly believes that this is a defining moment not only for WHO and the global health emergency response but also for the governance of the entire global health system. The challenges raised in this report are critical to the delivery of the proposed Sustainable Development Goals, especially Goal 3: Ensure healthy lives and promote well-being for all ages.

The Panel recognizes that it has made recommendations to many different actors and that these recommendations are interdependent in their implementation. Significant political commitment at both global and national levels is needed to take them forward.


WHO response to the Ebola Interim Assessment Panel report
WHO statement
7 July 2015
WHO welcomes the report from the Ebola Interim Assessment Panel and thanks the hard-working members for their rapid review, analysis and recommendations.

The panel members divided their review and recommendations into 3 areas: the International Health Regulations, WHO’s health emergency response capacity and WHO’s role and cooperation with the wider health and humanitarian systems.

The International Health Regulations
In August 2015, the WHO Director-General will convene a Review Committee of the International Health Regulations, where Member States can discuss the recommendations of the panel, including the idea of establishing an intermediate level of alert to sound an alarm earlier than a full Public Health Emergency of International Concern.

WHO’s health emergency response capacity
The panel reiterated the need for a unified programme for health emergencies as committed to by the Director-General at the World Health Assembly to unite resources for emergencies across the 3 levels of the Organization.

WHO is already moving forward on some of the panel’s recommendations including the development of the global health emergency workforce and the contingency fund to ensure the necessary resources are available to mount an initial response.

WHO’s role and cooperation with the wider health and humanitarian systems
The Ebola outbreak highlighted the separation between systems for responding to health emergencies and systems for humanitarian response, and WHO agrees they must be better integrated for future emergency responses. This includes considering ways to coordinate the grading of its humanitarian emergencies with the grading of declarations of health emergencies under the International Health Regulations.

Going forward
The current Ebola outbreak is still ongoing and improved methods of working are incorporated into the response as they are developed. But it will take many more months of continued hard work to end the outbreak and to prevent it from spreading to other countries.
WHO is grateful for the commitment from all partners; it is essential to get to zero cases and to put in place the systems to stay there.

Ebola/EVD: Recovery Conference; International community pledges more than five billion dollars

International community pledges more than five billion dollars to help recovery of Ebola-affected countries
10 Jul 2015
New York – The international community has pledged more than five billion dollars to support Guinea, Liberia and Sierra Leone in their efforts to recover from the devastating effects of Ebola, at a high level United Nations Conference in New York today (Friday).

Opening the International Ebola Recovery Conference United Nations Secretary-General Ban Ki-moon said: “Together, let us jumpstart a robust recovery process over the next two years, and usher in a better future for generations to come.”

The Secretary-General was joined by the Presidents of Guinea, Liberia and Sierra Leone, and the Secretary-General of the Mano River Union, who were seeking international support as well as financial commitments for their national and regional recovery strategies over the next two years.

Helen Clark, UNDP Administrator, who chaired the Conference, said: “We have seen a very encouraging response today. The preliminary figure for funds announced today amount to $3.4 billion, taking the total resources pledged for the recovery of the Ebola-affected countries to around five billion dollars. The whole spirit of optimism around the conference and the willingness of partners to see this as a long-term endeavor is hugely encouraging.”

Dr. David Nabarro, the Secretary-General’s Special Envoy on Ebola, said: “This is a very promising moment. The amount pledged represents a tremendous springboard for recovery. Everyone today has stressed that the partnership we have for the response to the outbreak must be sustained in to the period of recovery. The world is going to stand by these countries as they recover and help them get back on the track of equitable economic and social development.”

The United Nations organized the International Ebola Recovery Conference in partnership with the African Union, European Union, the World Bank and the African Development Bank. A day of technical consultation on the recovery strategies on Thursday 9 July was followed by the high level event on 10 July, convened by the Secretary-General, and attended by the Chairperson of the African Union, the Presidents of Guinea, Liberia and Sierra Leone and the Secretary-General of the Mano River Union.
International Ebola Recovery Conference, 9-10 July 2015
10 July
Helen Clark (UNDP) and Dr. David Nabarro (Special Envoy of the Secretary-General on Ebola) following the conclusion of the International Ebola Recovery Conference – Media Stakeout
10 Jul 2015
[webcast: 0:08]
– Informal comments to the media by United nations Development Programme (UNDP) Administrator Helen Clark and Dr. David Nabarro, Special Envoy of the Secretary-General on Ebola following the conclusion of the International Ebola Recovery Conference.
[webcast: 2:53]

10 July
(Part 1) International Ebola Recovery Conference – Technical consultations
[webcast: 2:53]
The objective of the technical consultations is to have a high level discussion on the “how’ and the “what” of the recovery process, resulting in specific inputs to be reflected in the pledging conference on the 10th of July.
Secretary-General Ban Ki-moon will host an International Ebola Recovery Conference on 10 July 2015 at the United Nations Headquarters in New York in cooperation with the Presidents of Guinea, Liberia and Sierra Leone. The purpose of the conference is to ensure that the Ebola affected countries receive the support and resources they need to “get to zero, stay at zero and recover”.
The conference will take place in partnership with the African Union, European Union, the World Bank and the African Development Bank.
Participants at the high-level event will have an opportunity to pledge support to the National Recovery Strategies and the Manu River Union sub-regional Programme.
The conference is expected to secure international support for the affected countries and the Mano River Union (comprising Côte d’Ivoire, Guinea, Liberia and Sierra Leone), as well as concrete financial commitments for the implementation of national and regional recovery strategies over a 24-month time frame.

09 July 2015
(Part 3) International Ebola Recovery Conference – Technical consultations
[webcast: 1:51]
(Part 2) International Ebola Recovery Conference – Technical consultations
[webcast: 2:09]
(Part 1) International Ebola Recovery Conference – Technical consultations
[webcast: 4:12]

Ebola/EVD: Gavi, WHO, World Bank [to 11 July 2015]

GAVI [to 11 July 2015]
07 July 2015
Gavi to support rebuilding of immunisation programmes in Ebola-affected countries
Worryingly low immunisation rates risk further deaths as Ebola recedes.
Geneva, 7 July 2015 – Plans to rebuild immunisation services wrecked by the Ebola crisis in Guinea, Liberia and Sierra Leone will form the first stage of Gavi’s Ebola investment support and will ensure that hundreds of thousands of children who either missed out or are at risk of missing out will now receive their vaccinations. Additionally, as part of a coordinated approach to ensure the three countries are stronger and more resilient to infectious disease, Gavi is doubling its long-term support for their health systems through to 2020.

One of the big issues affecting immunisation has been trust in health services. Rumours circulating in the region have falsely claimed that childhood vaccines, such as those protecting against measles, pneumonia and diarrhoea, could be linked to Ebola. This has dealt a severe blow to immunisation coverage, with parents refusing to allow their children to be immunised against common but potentially-fatal conditions, leaving hundreds of thousands of children at risk.

Additionally, hundreds of health workers in the three countries were among the 10,000 people who lost their lives to Ebola during the crisis and many more were forced to abandon their posts as the epidemic took hold. As the three countries begin their return to normality there is now a severe shortage of trained health workers to administer vaccines.

Gavi support will include provision for civil society organisations to work with communities to hold meetings, briefing village chiefs and religious leaders on the importance of immunising children. It will also ensure that there are enough trained health workers to provide the vaccines to the children…

WHO: News
Liberia update: New information from genetic sequencing
10 July 2015
Sierra Leone: Inspiring confidence and trust in Ebola care
9 July 2015
World Bank [to 11 July 2015]
Disproportionate deaths among health care workers from Ebola could lead to sharp rise in maternal mortality last seen 20 years ago – World Bank report
WASHINGTON DC, July 8, 2015—The loss of health workers due to the Ebola epidemic in West Africa may result in an additional 4,022 deaths of women each year across Guinea, Liberia and Sierra Leone as a result of complications in pregnancy and childbirth. According to the new World Bank report Healthcare Worker Mortality and the Legacy of the Ebola Epidemic published in The Lancet Global Health today, the recent outbreak of Ebola in West Africa could leave a legacy significantly beyond the deaths and disability caused directly by the disease itself.“ The loss of health workers to Ebola could increase maternal deaths up to rates last seen in these countries 15-20 years ago,” says Markus Goldstein, Lead Economist at the World Bank Group and a co-author of the report who heads the World Bank’s Africa Gender Innovation Lab. The paper estimates how the loss of health workers to Ebola will likely affect non-Ebola mortality even after the countries are declared Ebola-free.
Date: July 8, 2015
Type: Press Release

POLIO [to 11 July 2015]

POLIO [to 11 July 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 8 July 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report:
:: Three new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) have been reported in Madagascar, bringing the total number of cases to 8 in 2015. This most recent case had onset of paralysis on 29 May in Boeni region. These cases are genetically linked to a case reported in September 2014, indicating prolonged and widespread circulation of the virus. The emergency outbreak response is now being intensified. Learn more about vaccine derived polioviruses here.

Selected excerpts from Country-specific Reports
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week in Quetta district, Balochistan province. This most recent case had onset of paralysis on 6 June. The total number of WPV1 cases for 2015 is now 26, compared to 83 at this time last year.
:: Three new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) have been reported in the past week, one each in Anosy, Androy and Boeni regions. The most recent case had onset of paralysis on 29 May in Boeni. The total number of cVDPV1 cases for 2015 is now 8.
:: These cases are genetically linked to a case reported in September 2014, indicating prolonged and widespread circulation of the virus. Learn more about vaccine derived polioviruses here.
:: The emergency outbreak response is now being intensified. National Immunization Days (NIDs) are scheduled on 4 – 7 August using trivalent oral polio vaccine (OPV) and in September and October using bivalent OPV with dates to be confirmed.

MERS-CoV [to 11 July 2015]

MERS-CoV [to 11 July 2015]

Global Alert and Response (GAR) – Disease Outbreak News (DONs)
10 July 2015 Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Thailand (update)
10 July 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) – Republic of Korea
10 July 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) – The Philippines (update)
7 July 2015 Middle East respiratory syndrome coronavirus (MERS-CoV) – Republic of Korea

Summary of Current Situation, Literature Update and Risk Assessment
7 July 2015

MERS-CoV cases in the Republic of Korea as of 10 July 2015
xlsx, 19kb

WHO & Regionals [to 11 July 2015]

WHO & Regionals [to 11 July 2015]

WHO lays out plans for financing new global health goal: to ensure healthy lives and promote well-being for all at all ages
News release
10 JULY 2015 ¦ ADDIS ABABA ¦ GENEVA – WHO is urging countries to move towards universal health coverage and to scale up international investment in catalytic development funding. The call comes as world leaders travel to the Third UN Financing for Development Conference in Addis Ababa to discuss ways to pay for the new Sustainable Development Goals, to be launched in New York in September 2015.

“The best way to assure meaningful progress towards the new global health goal is for countries to move closer to universal health coverage,” says Dr Margaret Chan, WHO Director-General.

Many countries will need help to generate the funding to do this. This week’s conference will focus on strengthening international cooperation to build developing countries’ capacity to improve domestic tax policy and revenue collection as well as efforts to reduce illicit financial flows and tax avoidance at the international level.

Progress towards the Millennium Development Goals
By the end of this year, if current trends continue, the world will meet Millennium Development Goal targets for turning around the epidemics of HIV, malaria and tuberculosis and increasing access to safe drinking water. It will also have made substantial progress in reducing child under-nutrition, maternal and child deaths, and increasing access to basic sanitation.

But wide gaps remain between and within countries. Much still needs to be done – particularly in the poorest countries and countries affected by conflict. And new health challenges have emerged, as highlighted by the Ebola crisis in West Africa and the rise of noncommunicable diseases. Within this context, countries have agreed a new global health goal with a strong focus on equity – to ensure healthy lives and promote well-being for all at all ages.

A recent WHO and World Bank Group report, Tracking universal health coverage: First global monitoring report, shows that 400 million people do not have access to essential health services and 6% of people in developing countries are tipped into or pushed further into extreme poverty because of health spending.

“No one should risk financial ruin because they need health care,” says Dr Chan. “And no one should be denied health services, because they can’t afford to pay for them. ”

Moving towards universal health coverage
Universal health coverage, a major focus of WHO’s work for the past 5 years, aims to redress those imbalances. As a first step, the Organization recommends reducing the need for people to pay directly for services at the point of delivery – out of their own pockets. In countries that depend heavily on out-of-pocket payments, health bills push 100 million people into poverty each year.

Public funding is key to reducing out of pocket expenditure. As public spending on health goes up, dependence on out-of-pocket payments declines. Between 1995 to 2013, government spending on health increased from 3.4 to 4.1% of GDP – on average across 190 countries. The increase in low-income countries has been greater, from 1.7 to 2.6% of GDP.

Despite this improvement, there is a long way to go. The challenge for countries is twofold: to mobilize more domestic public resources for health, and to ensure health systems use resources more efficiently. At the Addis Ababa conference, WHO will urge the international community to strengthen cooperation with low- and lower-middle income countries to combine domestic and external funding so they provide sufficient resources to build robust health systems.

The Organization will also emphasize the importance of getting better results from the money spent by putting in place innovative service delivery arrangements, lowering prices of key inputs (e.g. medicines) procured internationally, and reducing fragmentation in aid flows to countries.
“If the world is serious about the health-related SDG targets, it needs to make serious investments – both at domestic and international levels,” adds Dr Chan.

WHO highlights the potential to generate additional public revenues through taxation of tobacco products. A recent report reveals that only 33 countries worldwide have introduced taxes that represent more than 75% of the retail price of a pack of cigarettes. Some have no or very little excise taxes on tobacco products, depriving themselves of a proven measure to improve health and generate funds for stronger health services.

The Organization also supports the push for high income countries to achieve the target of devoting 0.7% of their Gross National Income (GNI) to Official Development Assistance (ODA) and 0.15% to 0.20%of ODA/GNI to the least developed countries. It advocates for more efficient delivery of such aid, exploring, developing, and documenting ways to align behind comprehensive national health plans, in line with IHP+ (International Health Partnership) principles of development effectiveness.
The Weekly Epidemiological Record (WER) 10 July 2015, vol. 90, 28 (pp. 349–364) includes:
:: Human cases of influenza at the human-animal interface, January 2014-April 2015
:: Helping Guinean communities fight Ebola
:: WHO Regional Offices
WHO African Region AFRO
:: The World Health Organization (WHO) and the National Department of Health, South Africa host summit to accelerate action towards national and global health security
Cape Town, 10 July 2015 – Public health emergencies of international concern, including the Ebola virus disease (EVD) epidemic in West Africa, have demonstrated the need for countries to be prepared and act quickly in response to outbreaks and emergencies to maintain national and global health security.
:: Sierra Leone: Inspiring confidence and trust in Ebola care – 09 July 2015
:: Ebola recovery is impossible unless resilient health systems are rebuilt in Guinea, Liberia, and Sierra Leone – 06 July 2015

WHO Region of the Americas PAHO
No new digest content identified.

WHO South-East Asia Region SEARO
No new digest content identified.

WHO European Region EURO
:: Better prepared for health emergencies in Central Europe 08-07-2015

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
No new digest content identified.

CDC/MMWR/ACIP Watch [to 11 July 2015]

CDC/MMWR/ACIP Watch [to 11 July 2015]

CDC versus Ebola: The Road to Zero
JULY 9, 2015
The Ebola epidemic that began in West Africa in early 2014 continues today. With more than 27,000 reported Ebola cases and more than 11,000 deaths, the scope has been unprecedented. Equally extraordinary is the scale and duration of the response by the Centers for Disease Control and Prevention and partners. Today, CDC is releasing a multimedia report describing the experiences of the agency’s Ebola responders.
Since the outbreak began, CDC has sent more than 1,200 experts in various disciplines to Guinea, Liberia, Sierra Leone, and surrounding countries. Many deployed more than once and also volunteered to return as long as the epidemic persists. Thousands more CDC staff have worked on the response from the agency’s Atlanta headquarters, as well as in hospitals, labs and airports; other CDC campuses in the U.S., and CDC country offices around world…
MMWR July 10, 2015 / Vol. 64 / No. 26
:: Community Knowledge, Attitudes, and Practices Regarding Ebola Virus Disease — Five Counties, Liberia, September–October, 2014

Amid surging conflict in Yemen, UNICEF mobile teams respond to children’s urgent health needs

UNICEF [to 11 July 2015]

Amid surging conflict in Yemen, UNICEF mobile teams respond to children’s urgent health needs
ADEN, Yemen, 10 July 2015 – With health services across Yemen disintegrating under the impact of a brutal conflict, UNICEF and its partners are stepping up nutrition screening, vaccinations and other life-saving interventions for millions of children caught up in the ongoing crisis.

“Our mobile teams and staff have to brave extremely hazardous conditions, risking their lives to reach children and women wherever they can. If they don’t do that more children are likely to die from malnutrition and preventable diseases”, said Julien Harneis, UNICEF Representative in Yemen. “But what Yemen really needs now is a return to peace, a solution to the fuel and power crisis and restoration of regular health services”, Mr Harneis added.

Since the fighting escalated in March, over 40,000 children have been vaccinated against measles and polio while close to 10,000 pregnant women received support for safe pregnancy and delivery through outreach and mobile health teams. More than 16,000 children have so far been treated for severe malnutrition.

Much of the work is undertaken by some 40 UNICEF-supported mobile health teams (up from just 16 before March) which have been deployed across the country to reach displaced populations. The services they deliver include screening for malnutrition, vaccination, deworming, treatment of malnutrition and childhood diseases, and support to pregnant and lactating women. Vitamin A and other micronutrient supplements are also provided to children and mothers…

In the southern city of Aden, which has witnessed particularly heavy bombardment and fighting, UNICEF supplied emergency ambulances as well as blood testing and transfusion services in the first weeks of the conflict to ensure that injured children can receive immediate treatment.

Currently the UNICEF team in Aden is supporting an immunization campaign as part of a nation-wide drive that aims to vaccinate around a million children under the age of one against measles, polio and other vaccine-preventable diseases.

“In spite of the insecurity, we are taking every opportunity to ensure that we reach children with healthcare services, especially vaccinations to protect them at this time when the health system has crumbled” said Dr Gamila Hibatulla, Nutrition and Health Officer for UNICEF in Aden. She explains that the mobile teams have to use whatever sites they can find – including mosques and other public places – to deliver their services. “It’s encouraging to see the parents bringing their children to the vaccination centres. They just tell us how happy they are that their children can be protected against diseases”, Ms Hibatulla adds.

The deteriorating situation in Yemen is taking a heavy toll on children’s health. Today, over 2.5 million children are at risk of diarrhoeal diseases and half a million are at risk of severe acute malnutrition. Over 1.3 million children face the threat of acute respiratory tract infections and 2.6 million of them under the age of 15 are not protected against measles…

PATH, NIH, European Vaccine Initiative [to 11 July 2015]

PATH [to 11 July 2015]
Announcement | July 09, 2015
Clinical study results pave the way for a promising new approach to rotavirus vaccines
Injected, non-replicating vaccines hold potential for expanded impact in developing countries
Data published this week in Vaccine reveal a promising immune response among adults who received a novel non-replicating rotavirus vaccine candidate. Rotavirus accounts for more than one-third of all childhood diarrhea deaths worldwide, and PATH is evaluating the potential of non-replicating rotavirus vaccines, or NRRVs, as valuable additions to the global vaccine portfolio.
Live, orally administered rotavirus vaccines have made a major public health impact since they were first licensed nearly a decade ago. However, as with other oral vaccines, their efficacy is lower in developing countries in comparison to high- and middle-income nations, highlighting the need to consider new approaches. Reduced efficacy may be due to elevated maternal antibodies, potential interference from other oral vaccines, malnutrition, and co-infections in a child’s gut, among other issues. Inactivated vaccines like NRRVs, which are injected rather than orally administered, may circumvent some of these factors.
The Phase 1 clinical study, conducted at the Center for Immunization Research at the Johns Hopkins School of Public Health, evaluated the safety, reactogenicity, and tolerability of the P2-VP8 rotavirus vaccine candidate among healthy US adults not previously immunized against rotavirus. The study found the vaccine to be safe and to evoke a strong immune response. Study participants developed high levels of antibodies after immunization and also produced neutralizing antibodies against strains not included in the vaccine.
“Non-replicating rotavirus vaccines offer an exciting approach to preventing the most common cause of severe and deadly childhood diarrhea,” said Dr. Stan Cryz, director of PATH’s NRRV project. “These data are very promising, and further studies will help us investigate their potential to protect children worldwide.”…
NIH [to 11 July 2015]
NIH-funded vaccine for West Nile virus enters human clinical trials
July 6, 2015 — A clinical trial of a new investigational vaccine designed to protect against West Nile Virus infection will be sponsored by the National Institute of Allergy and Infectious Diseases (NIAID).
European Vaccine Initiative [to 11 July 2015]
Improving safety of medicines across Europe
EMA publication of safety reports for nationally authorised medicines will support timely and harmonised implementation of safety measures in EU Member States …

Industry / DCVMN / PhRMA / EFPIA / IFPMA / BIO Watch [to 11 July 2015]

Industry / DCVMN / PhRMA / EFPIA / IFPMA / BIO Watch [to 11 July 2015]

:: PhRMA Statement on House Passage of 21st Century Cures Act
Washington, D.C. (July 10, 2015) — Pharmaceutical Research and Manufacturers of America (PhRMA) president and chief executive officer John J. Castellani issued the following statement on passage of the 21st Century Cures Act (H.R. 6) by the U.S. House of Representatives:
“PhRMA applauds the House of Representatives for the overwhelming passage of the 21st Century Cures Act and looks forward to continuing our work with the Senate to ensure biomedical advances continue and are available to the patients who need them to live longer, healthier lives.

:: Pfizer Begins Phase 2b Study Of Its Investigational Multi-antigen Staphylococcus aureus Vaccine In Adults Undergoing Elective Spinal Fusion Surgery
July 07, 2015
Pfizer Inc. (NYSE: PFE) announced today enrollment of the first patient in a Phase 2b clinical trial of its investigational Staphylococcus aureus (S. aureus) multi-antigen vaccine (PF-06290510)…

International Infectious Disease Emergencies and Domestic Implications for the Public Health and Health Care Sectors—IOM Workshop in Brief

International Infectious Disease Emergencies and Domestic Implications for the Public Health and Health Care Sectors—Workshop in Brief
IOM Report
July 7, 2015 :: 11 pages
Emerging infectious disease events present a threat to U.S. national security, and we need improved efforts to coordinate a response both domestically and with global partners. The most recent outbreak of the Ebola virus disease in West Africa is the largest to date, affecting multiple countries simultaneously and once again bringing the challenges of global health security to the forefront of international preparedness discussions. The Institute of Medicine’s (IOM’s) Forum on Medical and Public Health Preparedness for Catastrophic Events organized a session at the 2015 Preparedness Summit to discuss international public health emergencies, such as Ebola, and their corresponding impact on state and local public health and health care systems. After briefing the audience on the World Health Organization’s 2005 International Health Regulations (IHR) and the Global Health Security Agenda (GHSA) launched in 2014, speakers discussed their experiences during the Ebola outbreak in the United States and as it was unfolding in West Africa. They also discussed remaining challenges and explored ways to effectively respond the next time a public health emergency of international concern (PHEIC) arises.

Global Tuberculosis Control: Toward the 2015 Targets and Beyond

Annals of Internal Medicine
7 July 2015, Vol. 163. No. 1

Medicine and Public Issues | 7 July 2015
Global Tuberculosis Control: Toward the 2015 Targets and Beyond
Emilio Dirlikov, PhD; Mario Raviglione, MD; and Fabio Scano, MD
Article, Author, and Disclosure Information
Ann Intern Med. 2015;163(1):52-58. doi:10.7326/M14-2210
has been made toward global tuberculosis (TB) control, as measured by targets set for 2015. However, TB remains a major threat to health around the world. In 2013, there were an estimated 11 million prevalent cases, and an estimated 9.0 million incident cases occurred globally. Approximately 1.5 million deaths were caused by TB, including 360 000 among people living with HIV. Substantial challenges threaten future control efforts. These include multidrug-resistant forms and co-infection with HIV, as well as other factors, such as the increased prominence of noncommunicable diseases and adverse socioeconomic conditions. Beyond 2015, TB control must be seen as both a public health imperative unto itself and a vital component of economic development plans. To that end, control strategies should exploit technical and operational innovations to improve TB control and care and should promote universal health coverage and social protection mechanisms to expand access to essential prevention, diagnostics, and treatment services while avoiding catastrophic costs incurred by patients.

HBV immunization and vaccine coverage among hospitalized children in Cameroon, Central African Republic and Senegal: a cross-sectional study

BMC Infectious Diseases
(Accessed 11 July 2015)

Research article
HBV immunization and vaccine coverage among hospitalized children in Cameroon, Central African Republic and Senegal: a cross-sectional study
Claudine Bekondi, Roberta Zanchi, Abdoulaye Seck, Benoit Garin, Tamara Giles-Vernick, Jean Gody, Petulla Bata, Angèle Pondy, Suzie Tetang, Mamadou Ba, Chantal Ekobo, Dominique Rousset, Jean-Marie Sire, Sarah Maylin, Loïc Chartier, Richard Njouom, Muriel Vray BMC Infectious Diseases 2015, 15:267 (12 July 2015)
Hepatitis B is a major health concern in Africa. The vaccine against hepatitis B virus (HBV) was introduced into the Expanded Programme on Immunization (EPI) of Cameroon and Senegal in 2005, and of CAR (Central African Republic) in 2008. A cross-sectional study was conducted to assess HBV immunization coverage following the vaccine’s introduction into the EPI and factors associated with having been vaccinated.
All hospitalized children, regardless of the reasons for their hospitalization, between 3 months and 6 years of age, for whom a blood test was scheduled during their stay and whose condition allowed for an additional 2 mL blood sample to be taken, and who provided the parent’s written consent were included. All children anti-HBs- and anti-HBc + were tested for HBsAg.
Vaccination coverage was assessed in three different ways: immunization card, maternal recall and serologic anti-HBs profile.
1783 children were enrolled between April 2009 and May 2010. An immunization card was only available for 24 % of the children. The median age was 21 months.
Overall HBV immunization coverage based on immunization cards was 99 %, 49 % and 100 % in Cameroon, CAR and Senegal, respectively (p < 0,001). The immunization rate based on maternal recall was 91 %, 17 % and 88 % in Cameroon, CAR and Senegal, respectively (p < 0,001). According to serology (anti-HBs titer ≥ 10 mUI/mL and anti-HBc-), the coverage rate was 68 %, 13 % and 46 % in Cameroon, CAR and Senegal, respectively (p < 0,001). In Senegal and Cameroon, factors associated with having been vaccinated were: mother’s higher education (OR = 2.2; 95 % CI [1.5–3.2]), no malnutrition (OR = 1.6; 95 % CI [1.1–2.2]), access to flushing toilets (OR = 1.6; 95 % CI [1.1–2.3]), and < 24 months old (OR = 2.1; 95 % CI [1.3–3.4] between 12 and 23 months and OR = 2.7; 95 % CI [1.6–4.4] < 12 months). The prevalence of HBV-infected children (HBsAg+) were 0.7 %, 5.1 %, and 0.2 % in Cameroon, CAR and Senegal, respectively (p < 0.001).
Assessing immunization coverage based on immunization cards, maternal recall or administrative data could be usefully reinforced by epidemiological data combined with immunological profiles. Serology-based studies should be implemented regularly in African countries, as recommended by the WHO. Malnutrition, lack of maternal education and poverty are factors associated with vaccine non-compliance. The countries’ vaccination programs should actively address these problems.

BMC Public Health (Accessed 11 July 2015)

BMC Public Health
(Accessed 11 July 2015)

Research article
Vaccine coverage and determinants of incomplete vaccination in children aged 12–23 months in Dschang, West Region, Cameroon: a cross-sectional survey during a polio outbreak
Gianluca Russo, Alessandro Miglietta, Patrizio Pezzotti, Rodrigue Biguioh, Georges Bouting Mayaka, Martin Sobze, Paola Stefanelli, Vincenzo Vullo, Giovanni Rezza BMC Public Health 2015, 15:630 (10 July 2015)
Inadequate immunization coverage with increased risk of vaccine preventable diseases outbreaks remains a problem in Africa. Moreover, different factors contribute to incomplete vaccination status. This study was performed in Dschang (West Region, Cameroon), during the polio outbreak occurred in October 2013, in order to estimate the immunization coverage among children aged 12–23 months, to identify determinants for incomplete vaccination status and to assess the risk of poliovirus spread in the study population.
A cross-sectional household survey was conducted in November-December 2013, using the WHO two-stage sampling design. An interviewer-administered questionnaire was used to obtain information from consenting parents of children aged 12–23 months. Vaccination coverage was assessed by vaccination card and parents’ recall. Chi-square test and multilevel logistic regression model were used to identify the determinants of incomplete immunization status. Statistical significance was set at p < 0.05.
Overall, 3248 households were visited and 502 children were enrolled. Complete immunization coverage was 85.9 % and 84.5 %, according to card plus parents’ recall and card only, respectively. All children had received at least one routine vaccination, the OPV-3 (Oral Polio Vaccine) coverage was >90 %, and 73.4 % children completed the recommended vaccinations before 1-year of age. In the final multilevel logistic regression model, factors significantly associated with incomplete immunization status were: retention of immunization card (AOR: 7.89; 95 % CI: 1.08–57.37), lower mothers’ utilization of antenatal care (ANC) services (AOR:1.25; 95 % CI: 1.07–63.75), being the ≥3 rd born child in the family (AOR: 425.4; 95 % CI: 9.6–18,808), younger mothers’ age (AOR: 49.55; 95 % CI: 1.59–1544), parents’ negative attitude towards immunization (AOR: 20.2; 95 % CI: 1.46–278.9), and poorer parents’ exposure to information on vaccination (AOR: 28.07; 95 % CI: 2.26–348.1). Longer distance from the vaccination centers was marginally significant (p = 0.05).
Vaccination coverage was high; however, 1 out of 7 children was partially vaccinated, and 1 out of 4 did not complete timely the recommended vaccinations. In order to improve the immunization coverage, it is necessary to strengthen ANC services, and to improve parents’ information and attitude towards immunization, targeting younger parents and families living far away from vaccination centers, using appropriate communication strategies. Finally, the estimated OPV-3 coverage is reassuring in relation to the ongoing polio outbreak.

Research article
Parental attitudes towards male human papillomavirus vaccination: a pan-European cross-sectional survey
Gitte Lee Mortensen, Marjorie Adam, Laïla Idtaleb BMC Public Health 2015, 15:624 (8 July 2015)
Human papillomavirus (HPV) is a common sexually transmitted virus that can lead to severe diseases in both women and men. Today, HPV vaccination is offered to females only across Europe. We aimed to examine parental attitudes to HPV vaccination of their sons given brief information about HPV in both genders.
A literature study on acceptability of male HPV vaccination was carried out to inform the construction of a study questionnaire. Following up on a Danish study from 2012, this questionnaire was applied in 1837 computer assisted interviews with parents of sons in the UK, Germany, France and Italy. In each country, the parents were representative in terms of geographical dispersion, city size and age of sons in the household. The applied questionnaires took the varying vaccination policies and delivery systems into account. The data were analysed pooled and for each country using significant statistical tests (chi-2) with a 95 % confidence interval.
Approximately ¾ of parents in the UK, Germany and Italy were in favour of HPV vaccination of their sons. In France, this applied to 49 % of respondents. Favourable parents wanted to protect their sons from disease and found gender equality important. Parents in doubt about male HPV vaccination needed more information about HPV diseases in men and male HPV vaccination; Rejecting parents were generally sceptical of vaccines and feared vaccination side-effects. Parents in countries with active vaccination policies (UK and Italy) tended to trust the importance of national vaccination programmes. Parents in countries with passive vaccination strategies (Germany and France) had greater need for information from health care professionals (HCP) and public health authorities.
Given brief information about HPV in both genders, parental acceptance of HPV vaccination of sons is as high as acceptance levels for girls. All parents should be informed about HPV to make informed decisions about HPV vaccination for their children. There is a need for joint efforts from public health authorities and HCPs to provide parents with such information.

Research article
Can opportunities be enhanced for vaccinating children in home visiting programs? A population-based cohort study
Michael R Isaac, Mariette Chartier, Marni Brownell, Dan Chateau, Nathan C Nickel, Patricia Martens, Alan Katz, Joykrishna Sarkar, Milton Hu, Elaine Burland, ChunYan Goh, Carole Taylor, PATHS Equity Team Members BMC Public Health 2015, 15:620 (7 July 2015)
Home visiting programs focused on improving early childhood environments are commonplace in North America. A goal of many of these programs is to improve the overall health of children, including promotion of age appropriate vaccination. In this study, population-based data are used to examine the effect of a home visiting program on vaccination rates in children.
Home visiting program data from Manitoba, Canada were linked to several databases, including a provincial vaccination registry to examine vaccination rates in a cohort of children born between 2003 and 2009. Propensity score weights were used to balance potential confounders between a group of children enrolled in the program (n = 4,562) and those who were eligible but not enrolled (n = 5,184). Complete and partial vaccination rates for one and two year old children were compared between groups, including stratification into area-level income quintiles.
Complete vaccination rates from birth to age 1 and 2 were higher for those enrolled in the Families First program [Average Treatment Effect Risk Ratio (ATE RR) 1.06 (95 % CI 1.03–1.08) and 1.10 (95 % CI 1.05–1.15) respectively]. No significant differences were found between groups having at least one vaccination at age 1 or 2 [ATE RR 1.01 (95 % CI 1.00–1.02) and 1.00 (95 % CI 1.00–1.01) respectively). The interaction between program and income quintiles was not statistically significant suggesting that the program effect did not differ by income quintile.
Home visiting programs have the potential to increase vaccination rates for children enrolled, despite limited program content directed towards this end. Evidence-based program enhancements have the potential to increase these rates further, however more research is needed to inform policy makers of optimal approaches in this regard, especially with respect to cost-effectiveness.

Research article
Factors associated with uptake of influenza vaccine in people aged 50 to 64 years in Hong Kong: a case–control study
May Yeung, Stephen Ng, Edmond Tong, Stephen Chan, Richard Coker BMC Public Health 2015, 15:617 (7 July 2015)

Epidemics – Volume 13, In Progress (December 2015)

Volume 13, In Progress (December 2015)

Estimating dynamic transmission model parameters for seasonal influenza by fitting to age and season-specific influenza-like illness incidence
Original Research Article
Pages 1-9
Nele Goeyvaerts, Lander Willem, Kim Van Kerckhove, Yannick Vandendijck, Germaine Hanquet, Philippe Beutels, Niel Hens
Dynamic transmission models are essential to design and evaluate control strategies for airborne infections. Our objective was to develop a dynamic transmission model for seasonal influenza allowing to evaluate the impact of vaccinating specific age groups on the incidence of infection, disease and mortality. Projections based on such models heavily rely on assumed ‘input’ parameter values. In previous seasonal influenza models, these parameter values were commonly chosen ad hoc, ignoring between-season variability and without formal model validation or sensitivity analyses. We propose to directly estimate the parameters by fitting the model to age-specific influenza-like illness (ILI) incidence data over multiple influenza seasons. We used a weighted least squares (WLS) criterion to assess model fit and applied our method to Belgian ILI data over six influenza seasons. After exploring parameter importance using symbolic regression, we evaluated a set of candidate models of differing complexity according to the number of season-specific parameters. The transmission parameters (average R0, seasonal amplitude and timing of the seasonal peak), waning rates and the scale factor used for WLS optimization, influenced the fit to the observed ILI incidence the most. Our results demonstrate the importance of between-season variability in influenza transmission and our estimates are in line with the classification of influenza seasons according to intensity and vaccine matching.

On the relative role of different age groups in influenza epidemics
Original Research Article
Pages 10-16
Colin J. Worby, Sandra S. Chaves, Jacco Wallinga, Marc Lipsitch, Lyn Finelli, Edward Goldstein
The identification of key “driver” groups in influenza epidemics is of much interest for the implementation of effective public health response strategies, including vaccination programs. However, the relative importance of different age groups in propagating epidemics is uncertain.
During a communicable disease outbreak, some groups may be disproportionately represented during the outbreak’s ascent due to increased susceptibility and/or contact rates. Such groups or subpopulations can be identified by considering the proportion of cases within the subpopulation occurring before (Bp) and after the epidemic peak (Ap) to calculate the subpopulation’s relative risk, RR =Bp/Ap. We estimated RR for several subpopulations (age groups) using data on laboratory-confirmed US influenza hospitalizations during epidemics between 2009 and 2014. Additionally, we simulated various influenza outbreaks in an age-stratified population, relating the RR to the impact of vaccination in each subpopulation on the epidemic’s initial effective reproductive number Re(0).
We found that children aged 5–17 had the highest estimates of RR during the five largest influenza A outbreaks, though the relative magnitude of RR in this age group compared to other age groups varied, being highest for the 2009 A/H1N1 pandemic. For the 2010–2011 and 2012–2013 influenza B epidemics, adults aged 18–49, and 0–4 year-olds had the highest estimates of RR, respectively.
For 83% of simulated epidemics, the group with the highest RR was also the group for which initial distribution of a given quantity of vaccine would result in the largest reduction of Re(0). In the largest 40% of simulated outbreaks, the group with the highest RR and the largest vaccination impact was children 5–17.
While the relative importance of different age groups in propagating influenza outbreaks varies, children aged 5–17 play the leading role during the largest influenza A epidemics. Extra vaccination efforts for this group may contribute to reducing the epidemic’s impact in the whole community.

One versus two doses: What is the best use of vaccine in an influenza pandemic?
Original Research Article
Pages 17-27
Laura Matrajt, Tom Britton, M. Elizabeth Halloran, Ira M. Longini Jr.
Avian influenza A (H7N9), emerged in China in April 2013, sparking fears of a new, highly pathogenic, influenza pandemic. In addition, avian influenza A (H5N1) continues to circulate and remains a threat. Currently, influenza H7N9 vaccines are being tested to be stockpiled along with H5N1 vaccines. These vaccines require two doses, 21 days apart, for maximal protection. We developed a mathematical model to evaluate two possible strategies for allocating limited vaccine supplies: a one-dose strategy, where a larger number of people are vaccinated with a single dose, or a two-dose strategy, where half as many people are vaccinated with two doses. We prove that there is a threshold in the level of protection obtained after the first dose, below which vaccinating with two doses results in a lower illness attack rate than with the one-dose strategy; but above the threshold, the one-dose strategy would be better. For reactive vaccination, we show that the optimal use of vaccine depends on several parameters, with the most important one being the level of protection obtained after the first dose. We describe how these vaccine dosing strategies can be integrated into effective pandemic control plans.

Eurosurveillance – Volume 20, Issue 27, 09 July 2015

Volume 20, Issue 27, 09 July 2015

Rapid communications
Early intervention in pertussis outbreak with high attack rate in cohort of adolescents with complete acellular pertussis vaccination in Valencia, Spain, April to May 2015
by A Míguez Santiyán, R Ferrer Estrems, JL Chover Lara, J Alberola Enguídanos, JM Nogueira Coito, A Salazar Cifre

Assessing the risk of observing multiple generations of Middle East respiratory syndrome (MERS) cases given an imported case
by H Nishiura, Y Miyamatsu, G Chowell, M Saitoh

Health Affairs – July 2015

Health Affairs
July 2015; Volume 34, Issue 7
Focus: Medicaid’s Evolving Delivery Systems

Health Aid Is Allocated Efficiently, But Not Optimally: Insights From A Review Of Cost-Effectiveness Studies
Eran Bendavid1,*, Andrew Duong2, Charlotte Sagan3 and Gillian Raikes4
Author Affiliations
1Eran Bendavid ( is an assistant professor in the Department of Medicine at Stanford University, in California.
2Andrew Duong is a research assistant in the Program of Human Biology at Stanford University.
3Charlotte Sagan is a research assistant in the School of Medicine at Stanford University.
4Gillian Raikes is a research assistant in the Program of Human Biology at Stanford University.
*Corresponding author
Development assistance from high-income countries to the health sectors of low- and middle-income countries (health aid) is an important source of funding for health in low- and middle-income countries. However, the relationship between health aid and the expected health improvements from those expenditures—the cost-effectiveness of targeted interventions—remains unknown. We reviewed the literature for cost-effectiveness of interventions targeting five disease categories: HIV; malaria; tuberculosis; noncommunicable diseases; and maternal, newborn, and child health. We measured the alignment between health aid and cost-effectiveness, and we examined the possibility of better alignment by simulating health aid reallocation. The relationship between health aid and incremental cost-effectiveness ratios is negative and significant: More health aid is going to disease categories with more cost-effective interventions. Changing the allocation of health aid earmarked funding could lead to greater health gains even without expanding overall disbursements. The greatest improvements in the alignment would be achieved by reallocating some aid from HIV or maternal, newborn, and child health to malaria or TB. We conclude that health aid is generally aligned with cost-effectiveness considerations, but in some countries this alignment could be improved.

Simulations Show Diagnostic Testing For Malaria In Young African Children Can Be Cost-Saving Or Cost-Effective
Victoria Phillips1,*, Joseph Njau2, Shang Li3 and Patrick Kachur4
Author Affiliations
1Victoria Phillips ( is an associate professor in the Department of Health Policy and Management at the Rollins School of Public Health, Emory University, in Atlanta, Georgia.
2Joseph Njau is a prevention effectiveness fellow in the Global Immunization Division in the Center for Global Health, Centers for Disease Control and Prevention (CDC), in Atlanta.
3Shang Li is a health care analyst at Analysis Group, in New York City.
4Patrick Kachur is a medical epidemiologist and chief of the Malaria Branch, Division of Parasitic Disease and Malaria, Center for Global Health, CDC.
*Corresponding author
Malaria imposes a substantial global disease burden. It disproportionately affects sub-Saharan Africans, particularly young children. In an effort to improve disease management, the World Health Organization (WHO) recommended in 2010 that countries test children younger than age five who present with suspected malaria fever to confirm the diagnosis instead of treating them presumptively with antimalarial drugs. Costs and concerns about the overall health impact of such diagnostic testing for malaria in children remain barriers to full implementation. Using data from national Malaria Indicator Surveys, we estimated two-stage microsimulation models for Angola, Tanzania, and Uganda to assess the policy’s cost-effectiveness. We found that diagnostic testing for malaria in children younger than five is cost-saving in Angola. In Tanzania and Uganda the cost per life-year gained is $5.54 and $94.28, respectively. The costs projected for Tanzania and Uganda are less than the WHO standard of $150 per life-year gained. Our results were robust under varying assumptions about cost, prevalence of malaria, and behavior, and they strongly suggest the pursuit of policies that facilitate full implementation of testing for malaria in children younger than five.

Despite High Cost, Improved Pneumococcal Vaccine Expected To Return 10-Year Net Savings Of $12 Billion
Michele A. Kohli, Raymond A. Farkouh, Michael J. Maschio, Lisa J. McGarry, David R. Strutton,
and Milton C. Weinstein
Health Aff July 2015 34:1234-1240; published ahead of print July 1, 2015, doi:10.1377/hlthaff.2014.1274
In 2010 the US Advisory Committee on Immunization Practices recommended that the seven-valent pneumococcal conjugate vaccine (PCV7) be replaced by the thirteen-valent version (PCV13), which provides protection against six additional serotypes of the bacterium Streptococcus pneumoniae. The higher price of PCV13, compared to PCV7, may be a concern for funding agencies and payers, as has been the case with other new vaccines. This study estimated the budgetary impact on both public and private US insurance payers of the routine use of PCV13 instead of PCV7 from 2010 to 2019. Implementing the PCV13 vaccine is projected to cost public and private payers $3.5 billion and $2.6 billion, respectively, more than PCV7. However, PCV13 is expected to provide net cost savings of $6.1 billion and $4.2 billion, respectively, to those payers during the ten-year period by preventing pneumococcal disease and its associated costs. An additional $1.7 billion in cost savings would be realized for uninsured patients, whose costs ultimately fall on those payers. Despite its higher price, compared to PCV7, this new vaccine is expected to provide payers with substantial net budgetary savings.

International Health – Volume 7 Issue 4 July 2015

International Health
Volume 7 Issue 4 July 2015


Meningococcal meningitis: vaccination outbreak response and epidemiological changes in the African meningitis belt
Francisco Javier Carod Artal*
Author Affiliations
Neurology Department, Raigmore hospital, Old Perth road, Inverness, IV2 3UJ, UK and Universitat Internacional de Cataluya (UIC), Barcelona, Spain
*Corresponding author: Tel: +44 1463706229; E-mail:
Received February 23, 2015.
Revision received March 25, 2015.
Accepted March 25, 2015.
The main approach to controlling epidemics of meningococcal meningitis in the African meningitis belt has been reactive vaccination campaigns with serogroup A polysaccharide vaccine once the outbreak reached an incidence threshold. Early reactive vaccination is effective in reducing morbidity and mortality. A recent paper in International Health has shown that earlier reactive vaccination campaigns may be even more effective than increasing the coverage area of vaccination. Monovalent serogroup A conjugate vaccine programs have recently been launched to prevent transmission in endemic areas in the African meningitis belt. Conjugate vaccines can induce immunological memory and have impact on pharyngeal carriage. However, reactive vaccination still has a role to play taking into account the dynamic changes in the epidemiology of meningitis in this area.

Results from a survey of national immunization programmes on home-based vaccination record practices in 2013
Stacy L. Younga, Marta Gacic-Dobob and David W. Brownc,*
Author Affiliations
aConsultant to the World Health Organization, Geneva, Switzerland
bWorld Health Organization, Geneva, Switzerland
cUnited Nations Children’s Fund, UNICEF House, 3 UN Plaza, New York, USA
*Corresponding author: Tel: +1 212 303 7988; E-mail:
Received December 1, 2014.
Revision received January 29, 2015.
Accepted February 10, 2015.
Data on home-based records (HBRs) practices within national immunization programmes are non-existent, making it difficult to determine whether current efforts of immunization programmes related to basic recording of immunization services are appropriately focused.
During January 2014, WHO and the United Nations Children’s Fund sent a one-page questionnaire to 195 countries to obtain information on HBRs including type of record used, number of records printed, whether records were provided free-of-charge or required by schools, whether there was a stock-out and the duration of any stock-outs that occurred, as well as the total expenditure for printing HBRs during 2013.
A total of 140 countries returned a completed HBR questionnaire. Two countries were excluded from analysis because they did not use a HBR during 2013. HBR types varied across countries (vaccination only cards, 32/138 [23.1%]; vaccination plus growth monitoring records, 31/138 [22.4%]; child health books, 48/138 [34.7%]; combination of these, 27/138 [19.5%] countries). HBRs were provided free-of-charge in 124/138 (89.8%) respondent countries. HBRs were required for school entry in 62/138 (44.9%) countries. Nearly a quarter of countries reported HBR stock-outs during 2013. Computed printing cost per record was <US$0.50 in 53/77 (69%) of countries providing information.
These results provide a basis for national immunization programmes to develop, implement and monitor corrective activities to improve the availability and utilization of HBRs. Much work remains to improve forecasting where appropriate, to prevent HBR stock-outs, to identify and improve sustainable financing options and to explore viable market shaping opportunities.

Hepatitis B vaccination of healthcare workers at the Princess Marina Hospital, Botswana
Tichaona Machiya, Rosemary J. Burnett, Lucy Fernandes, Guido François, Antoon De Schryver,
Marc van Sprundel, and M. Jeffrey Mphahlele
Int. Health (2015) 7 (4): 256-261 doi:10.1093/inthealth/ihu084

JAMA Pediatrics – July 2015, Vol 169, No. 7

JAMA Pediatrics
July 2015, Vol 169, No. 7

Time to Improve the Global Human Immunodeficiency Virus/AIDS Care Continuum for Adolescents: A Generation at Stake
Sarah M. Wood, MD, AAHIVS; Nadia Dowshen, MD, AAHIVS; Elizabeth Lowenthal, MD, MSCE, AAHIVS
This Viewpoint discusses the importance of improving care globally for adolescents with human immunodeficiency virus (HIV)/AIDS.
Pediatricians have an obligation to protect the health of children and adolescents. Human immunodeficiency virus (HIV)/AIDS remains the second leading cause of death for adolescents worldwide and the leading cause for adolescents in sub-Saharan Africa.1 Youth aged 15 to 24 years represent one-third of new infections.2 While AIDS-related mortality declined for adults and children from 2005 to 2012, there was a 50% increase in mortality among HIV-infected adolescents.2 For perinatally HIV-infected youth, worse outcomes largely reflect developmental struggles with treatment adherence they face as they enter adolescence. For adolescents with behaviorally acquired HIV, late diagnosis, poor linkage to and retention in care, low rates of antiretroviral therapy (ART) prescription, and inadequate treatment adherence all affect mortality.2 In the United States, nearly 60% of HIV-infected youth do not know they are infected.3 In sub-Saharan Africa, only 1 in 5 HIV-infected young women knows her status…

International Child Health Competencies
Meaghann Shaw Weaver, MD, MPHc; Liza-Marie Johnson, MD, MSB, MPH
This Viewpoint reports that global health outreach partnerships with a bioethical foundation have the potential for immense societal benefit, personal growth, and professional enhancement for pediatric trainees.
Well-guided, sustainable global health outreach partnerships have the potential for immense societal benefit, personal growth, and professional enhancement for pediatric trainees. Yet, international pursuits lacking a bioethical foundation risk harming medically underserved populations and learners. Determining ethical competency in overseas training efforts rests on whether the pursuit is one of clinical skills practice or one of purposeful praxis (reflective experiential learning). Aristotle honored praxis as the highest form of knowledge, a practical knowledge; later philosophers used praxis to describe a shift from mindful reflection to social improvement. We define international child health praxis as a mentored, ethical approach that acknowledges system barriers, strives for solidarity with local stakeholders, and partners with them toward population wellness…

Remembering the Benefits of Vaccination
Kristen A. Feemster, MD, MPH, MSHP
Between 2009 and 2012, 36 bills were introduced in 18 states to change vaccine exemption laws related to school-entry requirements. Of the 31 bills that sought to loosen requirements for obtaining an exemption, none passed.1 Fortunately, the clear evidence showing that easy exemption laws lead to higher exemption rates and higher exemption rates lead to outbreaks of vaccine-preventable diseases was well-heeded.2- 5 Further proof is now visible as we face the largest number of measles cases in the United States since the disease was declared eliminated in 2000, including a large ongoing outbreak associated with Disneyland that has affected more than 140 individuals.6 Most measles cases are among unvaccinated children whose parents refused the measles, mumps, and rubella vaccine because of philosophical or religious beliefs. Since January 2015, legislators in at least 8 states have introduced bills to tighten exemptions to mandatory school-entry vaccination policies.7 The reemergence of measles has raised a sense of urgency and voices in support of vaccination have become much louder…

Invasive Pneumococcal Disease Following the Introduction of 13-Valent Conjugate Vaccine in Children in New York City From 2007 to 2012
Andrea C. Farnham, MPH; Christopher M. Zimmerman, MD, MPH; Vikki Papadouka, PhD, MPH; Kevin J. Konty, MS, MA; Jane R. Zucker, MD, MSc; Geetha V. Nattanmai, BS, MT, MS; Sherly Jose, AAS, CLT; Jennifer B. Rosen, MD
Practice- and Community-Based Interventions to Increase Human Papillomavirus Vaccine Coverage: A Systematic Review
Linda M. Niccolai, PhD; Caitlin E. Hansen, MD
Vaccines against human papillomavirus (HPV) are recommended for routine use in adolescents aged 11 to 12 years in the United States, but uptake remains suboptimal. Educational interventions focused on parents and patients to increase coverage have not generally demonstrated effectiveness.
To systematically review the literature on effectiveness of interventions conducted at the practice or community level to increase uptake of HPV vaccines in the United States.
Evidence Review
Keyword searches of the PubMed, Web of Science, and MEDLINE databases identified studies of adolescents that included the outcome of HPV vaccination published through July 2014. References of identified articles were also reviewed. A total of 366 records were screened, 38 full-text articles were reviewed, and 14 published studies were included. Results were summarized by different intervention approaches.
Practice- and community-based intervention approaches included reminder and recall (n = 7), physician-focused interventions (eg, audit and feedback) (n = 6), school-based programs (n = 2), and social marketing (n = 2) (2 interventions tested multiple approaches). Seven studies used a randomized design, and 8 used quasiexperimental approaches (one used both). Thirteen studies included girls, and 2 studies included boys. Studies were conducted in a variety of populations and geographic locations. Twelve studies reported significant increases in at least one HPV vaccination outcome, one reported a nonsignificant increase, and one reported mixed effects.
Conclusions and Relevance
Most practice- and community-based interventions significantly increased HPV vaccination rates using varied approaches across diverse populations. This finding is in stark contrast to a recent review that did not find effects to warrant widespread implementation for any educational intervention. To address the current suboptimal rates of HPV vaccination in the United States, future efforts should focus on programs that can be implemented within health care settings, such as reminder and recall strategies and physician-focused efforts, as well as the use of alternative community-based locations, such as schools.

Life course epidemiology: recognising the importance of adolescence

Journal of Epidemiology & Community Health
August 2015, Volume 69, Issue 8

Life course epidemiology: recognising the importance of adolescence
Russell M Viner, David Ross, Rebecca Hardy, Diana Kuh, Christine Power, Anne Johnson,
Kaye Wellings, Jim McCambridge, Tim J Cole, Yvonne Kelly, G David Batty
J Epidemiol Community Health 2015;69:719-720 Published Online First: 2 February 2015 doi:10.1136/jech-2014-20530
Life course epidemiology may be conceptualised as “the study of long term effects on later health or disease risk of physical or social exposures during gestation, childhood, adolescence, young adulthood and later adult life.”1 Adolescence, the period between childhood and adulthood defined by the WHO as 10–19 years, has an uneasy status in epidemiology. On the one hand, adolescents, who now number over 1.2 billion worldwide—around 20% of the global population—are highly visible in population-based studies. Young people’s behaviours have been an important subject of epidemiological inquiry, from tobacco and alcohol use to violence and sexual activity. Yet, concepts of adolescence as a discrete stage in the life course have been much less discussed within epidemiology. This is particularly so in studies of the developmental origins of adult health and disease, which have focused on the influence on adult health outcomes of exposures from the period of rapid physiological change in very early life. Similarly, investigators in the field of the social determinants of health and disease have concentrated their efforts on the effects of parenting and education in early childhood.

Journal of Infectious Diseases – Volume 212 Issue 3 August 1, 20

Journal of Infectious Diseases
Volume 212 Issue 3 August 1, 2015

Response to Hepatitis A Vaccination in Immunocompromised Travelers
Hannah M. Garcia Garrido, Rosanne W. Wieten, Martin P. Grobusch, and Abraham Goorhuis
J Infect Dis. (2015) 212 (3): 378-385 doi:10.1093/infdis/jiv060

Limited Efficacy of Antibacterial Vaccination Against Secondary Serotype 3 Pneumococcal Pneumonia Following Influenza Infection
Dennis W. Metzger, Yoichi Furuya, Sharon L. Salmon, Sean Roberts, and Keer Sun
J Infect Dis. (2015) 212 (3): 445-452 doi:10.1093/infdis/jiv066