Vaccine
Volume 33, Issue 38, Pages 4737-5026 (11 September 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/38

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Perinatal survival and health after maternal influenza A(H1N1)pdm09 vaccination: A cohort study of pregnancies stratified by trimester of vaccination
Original Research Article
Pages 4850-4857
Ulrike Baum, Tuija Leino, Mika Gissler, Terhi Kilpi, Jukka Jokinen
Abstract
Large cohort studies demonstrated the safety of vaccination with the AS03 adjuvanted pandemic influenza vaccine, but data on first trimester vaccination safety are limited.
We conducted a nationwide register-based retrospective cohort study in Finland, included singleton pregnancies present on 01 November 2009 and followed them from 01 November 2009 until delivery. Pregnancies with abortive outcome, pregnancies that started before 01 February 2009 and pregnancies of women, who received the AS03 adjuvanted pandemic influenza vaccine prior to the onset of pregnancy, were excluded. Our main outcome measures were hazard ratios comparing the risk of stillbirth, early neonatal death, moderately preterm birth, very preterm birth, moderately low birth weight, very low birth weight, and being small for gestational age between pregnancies exposed and unexposed to maternal influenza A(H1N1)pdm09 vaccination.
The study population comprised 43,604 pregnancies; 34,241 (78.5%) women were vaccinated at some stage during pregnancy. The rates of stillbirth, early neonatal death, moderately preterm birth, and moderately low birth weight were similar between pregnant women exposed and unexposed to influenza A(H1N1)pdm09 vaccination. After adjusting for known risk factors, the relative rates were 0.90 (95% confidence interval 0.55–1.45) for very preterm birth, 0.84 (0.61–1.16) for very low birth weight, and 1.17 (0.98–1.40) for being small for gestational age. Also, in the subanalysis of 7839 women vaccinated during the first trimester, the rates did not indicate that maternal vaccination during the first trimester had any adverse impact on perinatal survival and health.
The risk of adverse pregnancy outcomes was not associated with the exposure to the AS03 adjuvanted pandemic influenza vaccine. This study adds reassuring evidence on the safety of AS03 adjuvanted influenza vaccines when given in the first trimester and supports the recommendation of influenza vaccination to all pregnant women through all stages of pregnancy.

Vaccine
Volume 33, Issue 38, Pages 4737-5026 (11 September 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/38

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Intussusception after monovalent rotavirus vaccine—United States, Vaccine Adverse Event Reporting System (VAERS), 2008–2014
Original Research Article
Pages 4873-4877
Penina Haber, Umesh D. Parashar, Michael Haber, Frank DeStefano
Abstract
Background
In 2006 and 2008, two new rotavirus vaccines (RotaTeq [RV5] and Rotarix [RV1]) were introduced in the United States. US data on intussusception have been mostly related to RV5, with limited data on RV1.
Methods
We assessed intussusception events following RV1 reported to the Vaccine Adverse Event Reporting System (VAERS), a US national passive surveillance system, during February 2008–December 2014. We conducted a self-controlled risk interval analysis using Poisson regression to estimate the daily reporting ratio (DRR) of intussusception after the first 2 doses of RV1 comparing average daily reports 3–6 versus 0–2 days after vaccination. We calculated the excess risk of intussusception per 100,000 vaccinations based on DRRs and background rates of intussusception. Sensitivity analyses were conducted to assess effects of differential reporting completeness and inaccuracy of baseline rates.
Results
VAERS received 108 confirmed insusceptible reports after RV1. A significant clustering was observed on days 3–8 after does1 (p = 0.001) and days 2–7 after dose 2 (p = 0.001). The DRR comparing the 3–6 day and the 0–2 day periods after RV1 dose 1 was 7.5 (95% CI = 2.3, 24.6), translating to an excess risk of 1.6 (95% CI = 0.3, 5.8) per 100,000 vaccinations. The DRR was elevated but not significant after dose 2 (2.4 [95% CI = 0.8,7.5]). The excess risk ranged from 1.2 to 2.8 per 100,000 in sensitivity analysis.
Conclusions
We observed a significant increased risk of intussusception 3–6 days after dose 1 of RV1. The estimated small number of intussusception cases attributable to RV1 is outweighed by the benefits of rotavirus vaccination.

Vaccine
Volume 33, Issue 38, Pages 4737-5026 (11 September 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/38

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Dutch influenza vaccination rate drops for fifth consecutive year
Original Research Article
Pages 4886-4891
Margot A.J.B. Tacken, Birgit Jansen, Jan Mulder, Stephen M. Campbell, Jozé C.C. Braspenning
Abstract
Aim
To determine the prevalence and trend of the influenza vaccination-rate of the overall target population in the period 2008–2013, with a specific focus on groups at risk such as patients with cardiovascular diseases, lung diseases, diabetes and aged 60 years and older.
Methods
In an observational longitudinal study electronic medical records data from the Dutch representative network of general practices, LINH, were analyzed. For each influenza vaccination season, 2008–2013, the number of vaccinated and unvaccinated patients at risk are compared by chi-square tests (χ2) for linear trends, linear-by-linear association. The level of significance was set at p < 0.001 based on the large number of available records.
Results
The influenza vaccination rate of the overall at risk group decreased significantly from 71.5% in the 2008 season, to 59.6% in the 2013 vaccination season. The difference of 11.9% was gradual over the years, with a mean decrease of 2.4% per year. The decrease was seen in all specified groups at risk, but was mainly among patients aged 60–65 years (mean yearly decrease of 3.3%).
Conclusion
For the fifth subsequent year, we notice a lowering trend of the influenza vaccination rate in the population at risk. Reports in the mass media on questioning the effectiveness of the vaccination program may have been an influence; as well as the relatively light outbreaks of influenza in the past years, which may have affected the sense of urgency. The gradual decrease in vaccination rates over recent years requires further research and a public health debate is needed on the usefulness and necessity of the vaccination program.

Vaccine
Volume 33, Issue 38, Pages 4737-5026 (11 September 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/38

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Estimating the cost of cholera-vaccine delivery from the societal point of view: A case of introduction of cholera vaccine in Bangladesh
Original Research Article
Pages 4916-4921
Abdur Razzaque Sarker, Ziaul Islam, Iqbal Ansary Khan, Amit Saha, Fahima Chowdhury, Ashraful Islam Khan, Alejandro Cravioto, John David Clemens, Firdausi Qadri, Jahangir A.M. Khan
Abstract
Cholera is a major global public health problem that causes both epidemic and endemic disease. The World Health Organization recommends oral cholera vaccines as a public health tool in addition to traditional prevention practices and treatments in both epidemic and endemic settings. In many developing countries like Bangladesh, the major issue concerns the affordability of this vaccine. In February 2011, a feasibility study entitled, “Introduction of Cholera Vaccine in Bangladesh (ICVB)”, was conducted for a vaccination campaign using inactivated whole-cell cholera vaccine (Shanchol) in a high risk area of Mirpur, Dhaka. Empirical data obtained from this trial was used to determine the vaccination cost for a fully immunized person from the societal perspective. A total of 123,661 people were fully vaccinated receiving two doses of the vaccine, while 18,178 people received one dose of the same vaccine. The total cost for vaccine delivery was US$ 492,238 giving a total vaccination cost per fully-vaccinated individual of US$ 3.98. The purchase cost of the vaccine accounted for 58% of the overall cost of vaccination. Attempts to reduce the per-dose cost of the vaccine are likely to have a large impact on the cost of similar vaccination campaigns in the future.

Vaccine
Volume 33, Issue 38, Pages 4737-5026 (11 September 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/38

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The causal effect of childhood measles vaccination on educational attainment: A mother fixed-effects study in rural South Africa
Original Research Article
Pages 5020-5026
Tobenna D. Anekwe, Marie-Louise Newell, Frank Tanser, Deenan Pillay, Till Bärnighausen
Abstract
Background
Because measles vaccination prevents acute measles disease and morbidities secondary to measles, such as undernutrition, blindness, and brain damage, the vaccination may also lead to higher educational attainment. However, there has been little evidence to support this hypothesis at the population level. In this study, we estimate the causal effect of childhood measles vaccination on educational attainment among children born between 1995 and 2000 in South Africa.
Methods and findings
We use longitudinal data on measles vaccination status and school grade attainment among 4783 children. The data were collected by the Wellcome Trust Africa Centre Demographic Information System (ACDIS), which is one of Africa’s largest health and demographic surveillance systems. ACDIS is located in a poor, predominantly rural, Zulu-speaking community in KwaZulu-Natal, South Africa. Using mother fixed-effects regression, we compare the school grade attainment of siblings who are discordant in their measles vaccination status but share the same mother and household. This fixed-effects approach controls for confounding due to both observed and unobserved factors that do not vary between siblings, including sibling-invariant mother and household characteristics such as attitudes toward risk, conscientiousness, and aspirations for children. We further control for a range of potential confounders that vary between siblings, such as sex of the child, year of birth, mother’s age at child’s birth, and birth order. We find that measles vaccination on average increases school grade attainment by 0.188 grades (95% confidence interval, 0.0424–0.334; p = 0.011).
Conclusions
Measles vaccination increased educational attainment in this poor, largely rural community in South Africa. For every five to seven children vaccinated against measles, one additional school grade was gained. The presence of a measles vaccination effect in this community is plausible because (i) measles vaccination prevents measles complications including blindness, brain damage, and undernutrition; (ii) a large number of number of children were at risk of contracting measles because of the comparatively low measles vaccination coverage; and (iii) significant measles transmission occurred in the community where this study took place during the study observation period. Our results demonstrate for the first time that measles vaccination affects human development not only through its health effects but also through its effects on education.

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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Al Jazeera
http://america.aljazeera.com/search.html?q=vaccine
Accessed 5 September 2015
DR Congo measles epidemic ‘a looming crisis’
MSF warns onset of rainy season will destroy chances of ending epidemic that is quickly gaining ground in Katanga.
03 Sep 2015 22:41 GMT
The measles epidemic spreading through the Katanga province in the Democratic Republic of Congo (DRC) has to be halted within the next 60 days, or the country will face a major health crisis, medical charity Doctors without Borders (MSF) has warned.
Michel Janssens, coordinator for MSF in DRC, told Al Jazeera on Thursday that immediate action was needed to address the outbreak as it would be close to impossible to access those in need during the rainy season, expected within the two months…

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BBC
http://www.bbc.co.uk/
Accessed 5 September 2015
Sierra Leone village in quarantine after Ebola death
4 September 2015
Nearly 1,000 people in Sierra Leone have been put under quarantine following the death of a 67-year-old woman who tested positive for Ebola

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Brookings
http://www.brookings.edu/
Accessed 5 September 2015
Opinion | August 31, 2015
Stuffing data gaps with dollars: What will it cost to close the data deficit in poor countries?
By: Laurence Chandy and Christine Zhang
We calculate a financing gap for data needs based on an analysis of existing survey coverage for three pillars of development data: the population census, living standard surveys, and health surveys. We find that, at least in the case of living standard surveys and health surveys, the global financing gap is trivially small—approximately $23 million a year. This points to other constraints beyond finance that stand in the way of complete data coverage. We conclude by recommending three immediate actions the IMF, World Bank, USAID, and UNICEF could take to advance this agenda.

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Center for Global Development
http://www.cgdev.org/
The Politics of Priority Setting in Health: A Political Economy Perspective – Working Paper 414
Publications
9/3/15
Many health improving interventions in low-income countries are extremely good value for money.

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Forbes
http://www.forbes.com/
Accessed 5 September 2015
Polio Outbreak In Ukraine Is Grim Reminder Of Need For Continued Vigilance
The outbreak of polio in Europe where there had been no cases in five years is a grim reminder that the disease continues to threaten children around the world until it is completely eradicated around the world.
Devin Thorpe, Contributor Sep 04, 2015

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The Huffington Post
http://www.huffingtonpost.com/
Accessed 5 September 2015
A Plan to End All Preventable Deaths by 2030
(9/3)
Flavia Bustreo, World Health Organization Assistant Director-General for Family, Women’s and Children’s Health, and Vice Chair of the Board of Gavi, the Vaccine Alliance
…Everyone, Everywhere
As we move into the SDG era, we should look back on lessons learned as we strove to achieve the MDGs. With the SDGs, we must aim for progress across the board — in remote and rural areas and among the poorest and most disadvantaged residents of urban centers. We need to be able to identify the gaps so that we can allocate limited resources effectively.
The number of countries striving to provide health services equitably and universally is growing. In 2030, I hope that we can look back and affirm that indeed we have reached the health goal, and that the greatest advance of the SDGs was to ensure that the progress and improvement in health touched everyone, everywhere.
An Open Letter to the Generation That Will Grow Up With the Sustainable Development Goals: Anthony Lake
1 September 2015

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Washington Post
http://www.washingtonpost.com/
Accessed 5 September 2015
Failures of Dallas hospital during Ebola crisis detailed in new report
Amy Ellis Nutt
September 4
Lack of communication among emergency room staff, poor configuration of information on the patient’s electronic health record and diminished focus on patient safety were three of the main deficiencies of Texas Health Presbyterian Hospital in Dallas where a man infected with the Ebola virus was misdiagnosed last year and died, according to an independent report released by the hospital Friday….

As the school year begins, it’s time to think about vaccination policies
31 August 2015
…“States are beginning to realize that they have effective measures to combat these outbreaks, and philosophical exemptions are eroding these protections and resulting in significant costs to states,” says Carrie Byington, a professor of pediatrics at the University of Utah and the chairwoman of the American Academy of Pediatrics Committee on Infectious Diseases.
Research shows that eliminating or limiting exemptions can improve vaccination rates and reduce disease outbreaks.
California and Vermont passed laws this year eliminating exemptions for philosophical reasons starting next year; California’s law eliminates religious exemptions as well…

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 david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version:  A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_5 September 2015

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

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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– 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.

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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