Pediatrics
August 2015, VOLUME 136 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml

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Addressing Vaccine Hesitancy With Values
Holly O. Witteman
Pediatrics 2015; 136:215-217

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Pediatrics Perspective
Children and Armed Conflict
Sherry Shenoda, MDa, Ayesha Kadir, MD, MScb, and Jeffrey Goldhagen, MD, MPHa
Author Affiliations
aDepartment of Pediatrics, University of Florida, Jacksonville, Florida; and
bLondon School of Hygiene and Tropical Medicine, London, United Kingdom
[Initial text]
We are really tired of these wars… I’m speaking up for peace. Malala Yousafzai, Nobel Peace Prize laureate and child rights activist
Multiple armed conflicts throughout the world are profoundly impacting the physical and mental health of children. The conflict in Gaza, Syria’s civil war, the targeting of children in Iraq, the kidnapping and murder of schoolchildren in Nigeria, the recruitment of child soldiers by ISIS, and the street violence in inner-city America are among the reasons UNICEF identified 2014 as the most dangerous year in recent history for children.1 In past conflicts, children were collateral damage; now, they are targeted victims of war.
In the shadow of this carnage, it is incumbent upon pediatricians as child advocates to respond to these gross violations of children’s rights. We know that we owe children our voices and protection, but it is not always clear how we can advocate for and protect them. This dilemma is especially true with regard to advocacy and support for children affected by wars and violent conflicts distant from the United States. To date, no American Academy of Pediatrics policy has been established regarding the impact of armed conflict on children.
In these circumstances, the principles, standards, and norms of child rights, equity, and social justice provide pediatricians with the capacity to advocate for affected children with the strength of a unified global voice and the power of legal precedent. The United Nations Convention on the Rights of the Child (CRC)2 provides clear guidelines, through the explicit articulation of 40 substantive child rights, for the protection of children affected by humanitarian crises, as well as the promotion of their well-being and participation in decisions that are being made on their behalf. The CRC establishes the legal basis and precedent for these rights, in addition…

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Immunogenicity, Safety, and Tolerability of a Hexavalent Vaccine in Infants
Gary S. Marshall, Gregory L. Adams, Michael L. Leonardi, Maria Petrecz, Sheryl A. Flores, Angela L. Ngai, Jin Xu, Guanghan Liu, Jon E. Stek, Ginamarie Foglia, and Andrew W. Lee
Pediatrics 2015; 136:e323-e332

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Identifying Priorities for Mental Health Interventions in War-Affected Youth: A Longitudinal Study
Theresa S. Betancourt, Stephen E. Gilman, Robert T. Brennan, Ista Zahn, and Tyler J. VanderWeele
Pediatrics 2015; 136:e344-e350

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 1 August 2015)

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Noncommunicable Diseases: A Globalization of Disparity?
Peter J. Hotez, Larry Peiperl
Editorial | published 28 Jul 2015 | PLOS Medicine 10.1371/journal.pmed.1001859
[Initial text]
A year ago, the editors of PLOS Neglected Tropical Diseases and PLOS Medicine launched the PLOS Blue Marble Health Collection, subtitled “the mismatch between national wealth and population health” [1]. The term “blue marble health” (which recalls the appearance of the earth from space) was coined as a differentiator from prior conceptualizations of global health that divided the world’s population according to national economic indices [2]. The basic tenet of blue marble health is that impoverished populations living amidst wealth bear a disproportionate burden of neglected diseases, irrespective of the overall economic strength of their home country. Such an approach is increasingly relevant as differential disease burdens between wealthier countries and regions (including North America, Europe, and Japan) and lower-income countries (including many in Africa, Asia, and Central and South America), evolve through a pronounced, but uneven, economic rise across the planet that leaves pockets of intense poverty in its wake.

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The Individualised versus the Public Health Approach to Treating Ebola
Tom H. Boyles
Perspective | published 28 Jul 2015 | PLOS Medicine 10.1371/journal.pmed.1001858

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Ebola Virus Disease: Experience and Decision Making for the First Patients outside of Africa
David S. Stephens, Bruce S. Ribner, Bryce D. Gartland, Nancye R. Feistritzer, Monica M. Farley, Christian P. Larsen, John T. Fox
Essay | published 28 Jul 2015 | PLOS Medicine 10.1371/journal.pmed.1001857

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 1 August 2015)

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Blue Marble Health Redux: Neglected Tropical Diseases and Human Development in the Group of 20 (G20) Nations and Nigeria
Peter J. Hotez
Editorial | published 28 Jul 2015 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003672

PLoS One
http://www.plosone.org/
[Accessed 1 August 2015]

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Net Costs Due to Seasonal Influenza Vaccination — United States, 2005–2009
Cristina Carias, Carrie Reed, Inkyu K. Kim, Ivo M. Foppa, Matthew Biggerstaff, Martin I. Meltzer, Lyn Finelli, David L. Swerdlow
Research Article | published 31 Jul 2015 | PLOS ONE 10.1371/journal.pone.0132922

An Assessment of the Expected Cost-Effectiveness of Quadrivalent Influenza Vaccines in Ontario, Canada Using a Static Model
Ayman Chit, Julie Roiz, Samuel Aballea
Research Article | published 29 Jul 2015 | PLOS ONE 10.1371/journal.pone.0133606

The Participation of HPV-Vaccinated Women in a National Cervical Screening Program: Population-Based Cohort Study
Eva Herweijer, Adina L. Feldman, Alexander Ploner, Lisen Arnheim-Dahlström, Ingrid Uhnoo, Eva Netterlid, Joakim Dillner, Pär Sparén, Karin Sundström
Research Article | published 28 Jul 2015 | PLOS ONE 10.1371/journal.pone.0134185

Investigation of a Measles Outbreak in China to Identify Gaps in Vaccination Coverage, Routes of Transmission, and Interventions
Xiang Zheng, Ningjing Zhang, Xiaoshu Zhang, Lixin Hao, Qiru Su, Haijun Wang, Kongyan Meng, Binglin Zhang, Jianfeng Liu, Huaqing Wang, Huiming Luo, Li Li, Hui Li, Chao Ma
Research Article | published 24 Jul 2015 | PLOS ONE 10.1371/journal.pone.0133983

Research Article
A Scoping Review of Empirical Research Relating to Quality and Effectiveness of Research Ethics Review
Stuart G. Nicholls, Tavis P. Hayes, Jamie C. Brehaut, Michael McDonald, Charles Weijer, Raphael Saginur, Dean Fergusson
Published: July 30, 2015
DOI: 10.1371/journal.pone.0133639
Abstract
Background
To date there is no established consensus of assessment criteria for evaluating research ethics review.
Methods
We conducted a scoping review of empirical research assessing ethics review processes in order to identify common elements assessed, research foci, and research gaps to aid in the development of assessment criteria. Electronic searches of Ovid Medline, PsychInfo, and the Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED, were conducted. After de-duplication, 4234 titles and abstracts were reviewed. Altogether 4036 articles were excluded following screening of titles, abstracts and full text. A total of 198 articles included for final data extraction.
Results
Few studies originated from outside North America and Europe. No study reported using an underlying theory or framework of quality/effectiveness to guide study design or analyses. We did not identify any studies that had involved a controlled trial – randomised or otherwise – of ethics review procedures or processes. Studies varied substantially with respect to outcomes assessed, although tended to focus on structure and timeliness of ethics review.
Discussion
Our findings indicate a lack of consensus on appropriate assessment criteria, exemplified by the varied study outcomes identified, but also a fragmented body of research. To date research has been largely quantitative, with little attention given to stakeholder experiences, and is largely cross sectional. A lack of longitudinal research to date precludes analyses of change or assessment of quality improvement in ethics review.

Risk Analysis
July 2015 Volume 35, Issue 7 Pages 1187–1387
http://onlinelibrary.wiley.com/doi/10.1111/risa.2015.35.issue-7/issuetoc

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Predicting Vaccination Intention and Benefit and Risk Perceptions: The Incorporation of Affect, Trust, and Television Influence in a Dual-Mode Model (pages 1268–1280)
Nien-Tsu Nancy Chen
Article first published online: 24 MAR 2015 | DOI: 10.1111/risa.12348
Abstract
Major health behavior change models tend to consider health decisions as primarily resulting from a systematic appraisal of relevant beliefs, such as the perceived benefits and risks of a pharmacological intervention. Drawing on research from the disciplines of risk management, communication, and psychology, this study proposed the inclusion of a heuristic route in established theory and tested the direction of influence between heuristic and systematic process variables. Affect and social trust were included as key heuristics in the proposed dual-mode framework of health decision making. Furthermore, exposure to health-related coverage on television was considered potentially influential over both heuristic and systematic process variables. To test this framework, data were collected from a national probability sample of 584 adults in the United States in 2012 regarding their decision to vaccinate against a hypothetical avian flu. The results provided some support for the bidirectional influence between heuristic and systematic processing. Affect toward flu vaccination and trust in the Food and Drug Administration were found to be powerful predictors of vaccination intention, enhancing intention both directly and indirectly via certain systematic process variables. The direction of influence between perceived susceptibility and severity, on the one hand, and affect, on the other, is less clear, suggesting the need for further research. Contrary to the opinion of media critics, exposure to televised health coverage was negatively associated with the perceived risks of vaccination. Results from this study carry theoretical and practical implications, and applying this model to the acceptance of different health interventions constitutes an area for future inquiries.

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

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Clinical Journal of Pain
Post Acceptance: July 21, 2015
Taddio Special Topics Series: PDF Only
Psychological Interventions for Vaccine Injections in Young Children 0 to 3 Years: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials
Riddell, Rebecca Pillai PhD; Taddio, Anna BScPhm, MSc, PhD; McMurtry, C. Meghan PhD; Chambers, Christine T. PhD; Shah, Vibhuti MD, MSc; Noel, Melanie PhD; HELPinKIDS Team
Open Access
Published Ahead-of-Print
doi: 10.1097/AJP.0000000000000279
Abstract
Background: This systematic review evaluated the effectiveness of distraction for reducing infant distress during vaccinations in young children aged 0 to 3 years.
Design/Methods: Database searches identified relevant randomized and quasi-randomized controlled trials. Three separate clinical questions related to variants of the psychological strategy of distraction (directed video; directed toy; non-directed toy) were pursued. Distress was identified as the critical outcome to assess the benefits of distraction and extracted from relevant trials. Distress was analyzed by phase of procedure (distress pre-procedure; distress acute; distress recovery; idiosyncratic phases based on some or all of the three aforementioned phases).
Results: Ten studies were included in the review. Significant results are presented herein. For directed video distraction, moderate quality evidence suggested distress was lowered in the treatment group (SMD 0.68 lower [95% CI -1.04, -0.32]) for the acute+recovery phase as well as the pre-procedure phase (SMD 0.49 lower [95% CI -76, -0.22]). For directed toy distraction, the analysis of low quality evidence for a combined pre-procedure+acute+recovery phase of distress (analysis n=81), suggested distress was lowered in the treatment group (SMD 0.47 lower [95% CI -0.91, -0.02]). An effect for non-directed toy distraction was also seen, analyzing very low quality evidence, for the acute distress phase (n=290; SMD 0.93 lower, [95% CI -1.86, 0.00]).
Conclusions: Generally low to very low quality evidence suggests that there may be an effect of directed (toy and video) and non-directed toy distraction for children aged 0 to 3, for certain phases of the vaccination.
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Process Interventions for Vaccine Injections: Systematic Review of Randomized Controlled Trials and Quasi-randomized Controlled Trials
Pillai Riddell, Rebecca PhD; Anna, Taddio BScPhm, MSc, PhD; McMurtry, C. Meghan PhD; Vibhuti, Shah MD, MSc; Melanie, Noel PhD; Chambers, Christine T. PhD; HELPinKIDS&Adults Team
doi: 10.1097/AJP.0000000000000280
Open Access
Abstract
Background: This systematic review evaluated the effectiveness of process interventions (education for clinicians, parent presence, education of parents [before and on day of vaccination], and education of patients on day of vaccination) on reducing vaccination pain, fear, and distress and increasing the use of interventions during vaccination.
Design/Methods: Databases were searched using a broad search strategy to identify relevant randomized and quasi-randomized controlled trials. Critical outcomes were pain, fear, distress [when applicable], and use of pain management interventions. Data were extracted according to procedure phase (pre-procedure, acute, recovery, combinations of these) and pooled using established methods. Analyses were conducted using Standardized Mean Differences (SMD) and Risk Ratios (RR).
Results: Thirteen studies were included. Results were generally mixed. Based on low to very low quality evidence, the following specific critical outcomes showed significant effects suggesting: (1) Clinicians should be educated about vaccine injection pain management [Use of interventions: SMD 0.66 (95% Confidence Interval [CI] 0.47, 0.85)]; (2) Parents should be present [Distress Pre-procedure: SMD -0.85 (95% CI -1.35, -0.35]; (3) Parents should be educated prior to the vaccination day [Use of Intervention pre-procedure: SMD 0.83 (95% CI 0.25, 1.41) and RR 2.08 (95% CI 1.51, 2.86); Distress Acute: SMD -0.35 (95% CI -0.57, -0.13)]; (4) Parents should be educated on the vaccination day [Use of interventions: 1.02 SMD (95% CI 0.22, 1.83) and RR 2.42 (1.47, 3.99); Distress Pre-Procedure+Acute+Recovery: -0.48 (95% CI -0.82, -0.15)]; and (5) Individuals 3 years of age and older should be educated on the day of vaccination [Fear pre-procedure: -0.67 SMD (95% CI -1.28, -0.07)].
Conclusions: Educating individuals involved in the vaccination procedure (clinicians, parents of children being vaccinated; individuals older than 3 y of age) is beneficial to increase use of pain management strategies, reduce distress surrounding with vaccination, and to reduce fear.
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Pharmacological and combined interventions to reduce vaccine injection pain in children and adults: systematic review and meta-analysis
doi: 10.1097/AJP.0000000000000281
Taddio Special Topics Series: PDF Only
Shah, Vibhuti FRCPC, MD, MSc; Taddio, Anna BScPhm, MSc, PhD; McMurtry, C. Meghan PhD, C Psych; Halperin, Scott A. MD; Noel, Melanie PhD; Riddell, Rebecca Pillai PhD, C Psych; Chambers, Christine T. PhD, C Psych; HELPinKIDS Team
Open Access
Published Ahead-of-Print
Abstract
Background: This systematic review assessed the effectiveness and safety of pharmacotherapy and combined interventions for reducing vaccine injection pain in individuals across the lifespan.
Design/Methods: Electronic databases were searched for relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear as well as observer-rated distress were critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI).
Results: Fifty-Five studies that examined breastfeeding (which combines sweet-tasting solution, holding and sucking), topical anesthetics, sweet-tasting solutions (sucrose, glucose), vapocoolants, oral analgesics, and combination of two versus one intervention were included. The following results report findings of analyses of critical outcomes with the largest number of participants. Compared to control, acute distress was lower for infants breastfed during vaccination (n=792): SMD -1.78 (CI: -2.35, -1.22) and before vaccination (n=100): SMD -1.43 (CI: -2.14, -0.72). Compared to control/placebo, topical anesthetics showed benefit on acute distress in children (n=1424): SMD -0.91, (CI: -1.36, -0.47) and self-reported pain in adults (n=60): SMD -0.85 (CI: -1.38, -0.32). Acute and recovery distress was lower for children who received sucrose (n=2071): SMD -0.76, (CI: -1.19, -0.34) or glucose (n=818): [SMD: -0.69, (CI: -1.03, -0.35)] compared to placebo/no treatment. Vapocoolants reduced acute pain in adults [(n=185) SMD -0.78, (CI: -1.08, -0.48)] but not children. Evidence from other needle procedures showed no benefit of acetaminophen or ibuprofen. The administration of topical anesthetics before and breastfeeding during vaccine injections showed mixed results when compared to topical anesthetics alone. There were no additive benefits of combining glucose and non-nutritive sucking (pacifier) compared to glucose or non-nutritive sucking (pacifier) alone or breastfeeding and sucrose compared to breastfeeding or sucrose alone.
Conclusions: Breastfeeding, topical anesthetics, sweet-tasting solutions and the combination of topical anesthetics and breastfeeding are effective in reducing vaccine injection pain in infants and children and its use should become the standard of care. In adults, limited data demonstrate some benefit of topical anesthetics and vapocoolants

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Women’s Health Issues (WHI)
Published Online: July 23, 2015
Knowledge of HPV and HPV Vaccine among Women Ages 19 to 26
Zoe Unger, MPH, Abby Maitra, MPH, Julia Kohn, PhD, MPA, Sangita Devaskar, MPH, Lisa Stern, RN, MSN, Ashlesha Patel, MD, MPH
Publication stage: In Press Corrected Proof
DOI: http://dx.doi.org/10.1016/j.whi.2015.06.003
Abstract
Objective
To describe knowledge about human papillomavirus (HPV) and HPV vaccination among women ages 19 to 26 seeking a variety of services at reproductive health centers. A secondary objective was to identify common sources of HPV information.
Methods
Ten reproductive health centers enrolled 365 women ages 19 to 26 in a randomized, controlled trial to determine the effect of automated reminder messages on HPV vaccine completion. Using responses from a 61-item self-administered baseline questionnaire completed before initiating the HPV vaccine, this subanalysis assessed participants’ knowledge regarding HPV and the HPV vaccine.
Results
Knowledge of HPV prevention, transmission, and disease outcomes among the study population was highly variable. The mean HPV knowledge score was 11.0 of a possible 19 (SD = 3.8). Most participants (77%) had heard of the HPV vaccine before completing the questionnaire and indicated that their primary sources of information about the vaccine were television ads (61%), health care providers (52%), and friends (45%).
Conclusions
Despite a relatively high awareness of the vaccine, specific knowledge regarding HPV and the HPV vaccine varied substantially and participant scores highlighted knowledge gaps among vaccine-eligible young women. Media, health care providers, and friends were identified by participants as sources of information and may influence their knowledge of HPV and the HPV vaccine.

Media/Policy Watch
This section is intended to alert readers to substantive news, analysis and opinion from the general media on vaccines, immunization, global; public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

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Forbes
http://www.forbes.com/
Accessed 1 August 2015
Vaccines That Alter Evolution
An evolutionary biologist has finally found experimental backing for a controversial idea that could change the course of vaccine development. In 2001, Penn State professor Andrew Read proposed that “leaky” vaccines – ones that allow transmission of disease organisms – might prompt the evolution of more dangerous strains. Many existing vaccines are […]
Faye Flam, Contributor Jul 28, 2015

How Big Data Can Make People Healthier In Emerging Markets
In many emerging markets, reliable data on healthcare systems is limited or nonexistent. This makes it difficult to address urgent healthcare challenges in some of the world’s least developed countries. But a growing number of tech entrepreneurs and public health activists are finding ways to fill the data gaps. And as smartphones and other […]
Techonomy, Contributor Jul 30, 2015

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New York Times
http://www.nytimes.com/
Accessed 1 August 2015
New Meningitis Strain in Africa Brings Call for More Vaccines
Meningitis may be poised for a ferocious comeback in Africa, international aid organizations are warning, and vaccine manufacturers must step up production if the outbreak is to be averted.
Meningitis is caused by one of several strains of the bacteria Neisseria meningitidis. A vaccine introduced five years ago has all but defeated meningitis A infections in Africa. But infections with another strain, Type C, are on the rise.
Some experts fear the new strain will explode next year, while others say too little is known to predict its course reliably.
Meningitis C vaccines exist but are expensive: $20 per shot is the lowest price offered thus far to an international public health consortium, led by the World Health Organization, that stockpiles vaccines for emergencies.
The consortium, the International Coordinating Group for Vaccine Provision for Epidemic Meningitis Control, is seeking five million doses. To be effective, they must be shipped and injected before January, when meningitis normally returns to Africa with the dry harmattan winds.
Unless something drastic happens — a surge of donor money, or huge price cuts — the consortium’s experts do not hold out much hope…

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Washington Post
http://www.washingtonpost.com/
Accessed 1 August 2015
Kenya’s Catholic bishops call for polio vaccine boycott
28 July 2015
By Fredrick Nzwili | Religion News Service
NAIROBI, Kenya — Roman Catholic bishops in Kenya have urged citizens to boycott a mass polio vaccination campaign, unless the safety of the vaccine has been confirmed through scientific tests.
The oral vaccination campaign, by the World Health Organization and UNICEF, is scheduled to begin in Kenya on Aug. 1.
Ahead of the campaign’s launch, the bishops questioned the safety of the vaccines, saying the manufacturer failed to provide requested information and the government disregarded the bishops’ request for tests.
Their concerns heightened after a recent unrelated incident in which about 30 children who received an injection of an anti-malarial drug in a dispensary in western Kenya appeared to be paralyzed. The drug, believed to be quinine for advanced cases, was found to contain the pain drug paracetamol, according to the bishops. Paracetamol is also known as acetaminophen.
The government Ministry of Health defended the vaccine in a statement issued Tuesday (July 28.)…

The Post’s View
Putting out the fire, next time
By Editorial Board
26 July 2015
THE EBOLA virus has not been eliminated from West Africa, but the public health crisis has eased. The virus, for which there is no ready cure, infected more than 27,000 people and caused more than 11,000 deaths since the outbreak began in early 2014. The pain and suffering have been immense. Now it is time to confront another hard problem: addressing the weaknesses in global response that allowed the virus to spread so rapidly. Without the urgency of another outbreak, national governments and the World Health Organization will be disinclined to change the way they do business. But change they must, or there will be another wave of disease, panic and unnecessary death.
The WHO’s lethargic response to Ebola in West Africa has brought calls for creation of a new organization that would have responsibility for emergency response. The belief in the need for rapid response to infectious disease has been gathering steam with a succession of outbreaks that spanned national borders: severe acute respiratory syndrome, or SARS; bird flu; swine flu; Middle East respiratory syndrome, or MERS; and Ebola virus disease. Although different in transmission, virulence and danger to people, all of these tested the ability of humankind to respond.

Now, a panel appointed by WHO Director General Margaret Chan has examined all aspects of the organization’s response to the Ebola outbreak and concluded that a new organization is not the right answer. The panel declared in a report that such an agency would take too much time to set up and be unnecessarily duplicative. Instead, the panel said, the WHO “must re-establish its pre-eminence as the guardian of global public health.”

This is a tall order, and the panel’s report explains why. A sea change in thinking and organization will be needed. The WHO “does not currently possess the capacity or organizational culture to deliver a full emergency public health response,” the panel stated. “There are no core funds for emergency response.” The WHO’s overall weakness in this field was underscored by the stark fact that it was not the WHO but rather Doctors Without Borders, a charity, that took the early lead in warning about Ebola and in battling the virus in West Africa.

The panel offered a host of valuable ideas for improvement, including creation of a WHO center for emergency response and a contingency fund to support it. The WHO says it is already working on the fund. The panel also pointed out that the WHO was slow in declaring a “public health emergency of international concern” because messages from the field about Ebola either “did not reach senior leaders or senior leaders did not recognize their significance.” A more sensitive early warning system is needed. The WHO is made up of member states, but they, too, performed poorly. Many have failed to implement stronger standards for public health adopted a decade ago with the goal of spotting and reporting local outbreaks that could become a global emergency. This neglect is irresponsible and could be repaid in deadly epidemics to come.