A systematic review of the social and economic burden of influenza in low- and middle-income countries

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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A systematic review of the social and economic burden of influenza in low- and middle-income countries
Review Article
Pages 6537-6544
Natasha de Francisco (Shapovalova), Morgane Donadel, Mark Jit, Raymond Hutubessy
Abstract
Objectives
The economic burden of seasonal influenza outbreaks as well as influenza pandemics in lower- and middle-income countries (LMIC) has yet to be specifically systematically reviewed. The aim of this systematic review is to assess the evidence of influenza economic burden assessment methods in LMIC and to quantify the economic consequences of influenza disease in these countries, including broader opportunity costs in terms of impaired social progress and economic development.
Methods
We conducted an all language literature search across 5 key databases using an extensive list of key words for the time period 1950–2013. We included studies which explored direct costs (medical and non-medical), indirect costs (productivity losses), and broader economic impact in LMIC associated with different influenza outcomes such as confirmed seasonal influenza infection, influenza-like illnesses, and pandemic influenza.
Results
We included 62 full-text studies in English, Spanish, Russian, Chinese languages, mostly from the countries of Latin American and the Caribbean and East Asia and Pacific with pertinent cost data found in 39 papers. Estimates for direct and indirect costs were the highest in Latin American and the Caribbean. Compared to high-income economies, direct costs in LMIC were lower and productivity losses higher. Evidence on broader impact of influenza included impact on the wider national economy, security dimension, medical insurance policy, legal frameworks, distributional impact, and investment flows.
Conclusion
The economic burden of influenza in LMIC encompasses multiple dimensions such as direct costs to the health service and households, indirect costs due to productivity losses as well as broader detriments to the wider economy. Evidence from sub-Saharan Africa and in pregnant women remains very limited. Heterogeneity of methods used to estimate cost components makes data synthesis challenging. There is a strong need for standardizing research, data collection and evaluation methods for both direct and indirect cost components

Is immunotherapy an opportunity for effective treatment of drug addiction?

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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Is immunotherapy an opportunity for effective treatment of drug addiction?
Review Article
Pages 6545-6551
Jadwiga Zalewska-Kaszubska
Abstract
Immunotherapy has a great potential of becoming a new therapeutic strategy in the treatment of addiction to psychoactive drugs. It may be used to treat addiction but also to prevent neurotoxic complications of drug overdose. In preclinical studies two immunological methods have been tested; active immunization, which relies on the administration of vaccines and passive immunization, which relies on the administration of monoclonal antibodies. Until now researchers have succeeded in developing vaccines and/or antibodies against addiction to heroin, cocaine, methamphetamine, nicotine and phencyclidine. Their effectiveness has been confirmed in preclinical studies. At present, clinical studies are being conducted for vaccines against nicotine and cocaine and also anti-methamphetamine monoclonal antibody. These preclinical and clinical studies suggest that immunotherapy may be useful in the treatment of addiction and drug overdose. However, there are a few problems to be solved. One of them is controlling the level of antibodies due to variability between subjects. But even obtaining a suitable antibody titer does not guarantee the effectiveness of the vaccine. Additionally, there is a risk of intentional or unintentional overdose. As vaccines prevent passing of drugs through the blood/brain barrier and thereby prevent their positive reinforcement, some addicted patients may erroneously seek higher doses of psychoactive substances to get “high”. Consequently, vaccination should be targeted at persons who have a strong motivation to free themselves from drug dependency. It seems that immunotherapy may be an opportunity for effective treatment of drug addiction if directed to adequate candidates for treatment. For other addicts, immunotherapy may be a very important element supporting psycho- and pharmacotherapy.

Burden of vaccine preventable diseases at large events

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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Burden of vaccine preventable diseases at large events
Review Article
Pages 6552-6563
Amani S. Alqahtani, Mohammad Alfelali, Paul Arbon, Robert Booy, Harunor Rashid
Abstract
Background
Large events or mass gatherings (MGs) are known to amplify the risk of infectious diseases, many of which can be prevented by vaccination. In this review we have evaluated the burden of vaccine preventable diseases (VPDs) in MGs.
Methods
Major databases like PubMed and Embase, Google Scholar and pertinent websites were searched by using MeSH terms and text words; this was supplemented by hand searching. Following data abstraction, the pooled estimate of the burden of VPDs was calculated when possible; otherwise a narrative synthesis was conducted.
Results
In the past, at religious MGs like Hajj and Kumbh Mela, cholera caused explosive outbreaks; but currently respiratory infections, notably influenza, are the commonest diseases not only at Hajj but also at World Youth Day and Winter Olympiad. The recent cumulative attack rate of influenza at Hajj is 8.7% (range 0.7–15.8%), and the cumulative prevalence is 3.6% (range: 0.3–38%). Small outbreaks of measles (13–42 cases per event) have been reported at sport, entertainment and religious events. A sizeable outbreak (>200 cases) was reported following a special Easter Festival in Austria. An outbreak of hepatitis A occurred following the ‘Jam bands’ music festival. Other VPDs including pneumococcal disease, pertussis and tuberculosis have been reported in relation to MG attendance.
Conclusion
VPDs not only affect the participants of MGs but also their contacts; vaccine uptake is variable and vaccine implementation is likely to have beneficial effects. Research to address the knowledge gaps surrounding VPDs at MGs is needed.

Pediatric provider vaccine hesitancy: An under-recognized obstacle to immunizing children

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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Pediatric provider vaccine hesitancy: An under-recognized obstacle to immunizing children
Original Research Article
Pages 6629-6634
Manika Suryadevara, Andrew Handel, Cynthia A. Bonville, Donald A. Cibula, Joseph B. Domachowske
Abstract
Objective
To describe vaccine attitudes among pediatric healthcare providers attending immunization conferences.
Study design
Attendees of 5 American Academy of Pediatrics (AAP)-sponsored vaccine conferences held between June and November 2013 anonymously completed a questionnaire assessing vaccine attitudes and practices prior to the opening of educational sessions. Pearson’s chi-square tests and Fisher’s exact tests were used to analyze associations between vaccine attitudes, vaccine practices and provider characteristics.
Results
680 providers attending AAP-sponsored vaccine conferences were included. 661/666 (99%) enrolled providers state they routinely recommend standard pediatric vaccines, yet, 30 (5%) state that they do not routinely recommend influenza and/or human papillomavirus (HPV) vaccines. These providers expressed vaccine safety (87/680 (13%)) and efficacy (21/680 (31%)) concerns and stated belief in vaccine misperceptions: vaccine causes autism (34/668, 5%), multiple vaccines at a single visit reduces vaccine efficacy (43/680, 6%) or overwhelms the immune system (63/680, 9%), and administering HPV vaccine will increase the likelihood of unprotected adolescent sexual activity (29/680, 4%). Six percent of providers who do not routinely recommend all pediatric vaccines correctly identified themselves as vaccine hesitant.
Conclusion
Vaccine hesitancy is under-recognized among pediatric providers attending AAP-sponsored immunization conferences. Educational interventions tailored to address provider vaccine concerns are needed to improve provider vaccine confidence.

“Everybody just wants to do what’s best for their child”: Understanding how pro-vaccine parents can support a culture of vaccine hesitancy

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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“Everybody just wants to do what’s best for their child”: Understanding how pro-vaccine parents can support a culture of vaccine hesitancy
Original Research Article
Pages 6703-6709
Eileen Wang, Yelena Baras, Alison M. Buttenheim
Abstract
Background
Although a large majority of parents vaccinate their children, vaccine hesitancy has become more widespread. It is not well understood how this culture of vaccine hesitancy has emerged and how it influences parents’ decisions about vaccine schedules.
Objective
We sought to examine how attitudes and beliefs of parents who self-report as pro-vaccine are developed and contribute to immunization decisions, including delaying or spacing vaccines.
Methods
Open-ended, in-depth interviews (N = 23) were conducted with upper-middle class parents with young children living in Philadelphia. Interview data were coded and key themes identified related to vaccine decision-making.
Results
Parents who sought out vaccine information were often overwhelmed by the quantity and ambiguity when interpreting that information, and, consequently, had to rely on their own instinct or judgment to make vaccine decisions. In particular, while parents in this sample did not refuse vaccines, and described themselves as pro-vaccine, they did frequently delay or space vaccines. This experience also generated sympathy for and tolerance of vaccine hesitancy in other parents. Parents also perceived minimal severe consequences for deviating from the recommended immunization schedule.
Conclusion
These findings suggest that the rise in and persistence of vaccine hesitancy and refusal are, in part, influenced by the conflicts in the information parents gather, making it difficult to interpret. Considerable deviations from the recommended vaccination schedule may manifest even within a pro-vaccine population due to this perceived ambiguity of available information and resulting tolerance for vaccine hesitancy.

Costing RTS,S introduction in Burkina Faso, Ghana, Kenya, Senegal, Tanzania, and Uganda: A generalizable approach drawing on publicly available data

Vaccine
Volume 33, Issue 48, Pages 6503-6946 (27 November 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/48
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Costing RTS,S introduction in Burkina Faso, Ghana, Kenya, Senegal, Tanzania, and Uganda: A generalizable approach drawing on publicly available data
Original Research Article
Pages 6710-6718
Katya Galactionova, Melanie Bertram, Jeremy Lauer, Fabrizio Tediosi
Abstract
Recent results from the phase 3 trial of RTS,S/AS01 malaria vaccine show that the vaccine induced partial protection against clinical malaria in infants and children; given the high burden of the disease it is currently considered for use in malaria endemic countries. To inform adoption decisions the paper proposes a generalizable methodology to estimate the cost of vaccine introduction using routinely collected and publicly available data from the cMYP, UNICEF, and WHO-CHOICE. Costing is carried out around a set of generic activities, assumptions, and inputs for delivery of immunization services adapted to a given country and deployment modality to capture among other factors the structure of the EPI program, distribution model, geography, and demographics particular to the setting. The methodology is applied to estimate the cost of RTS,S introduction in Burkina Faso, Ghana, Kenya, Senegal, Tanzania, and Uganda. At an assumed vaccine price of $5 per dose and given our assumptions on coverage and deployment strategy, we estimate total economic program costs for a 6–9 months cohort within $23.11–$28.28 per fully vaccinated child across the 6 countries. Net of procurement, costs at country level are substantial; for instance in Tanzania these could add as much as $4.2 million per year or an additional $2.4 per infant depending on the level of spare capacity in the system. Differences in cost of vaccine introduction across countries are primarily driven by differences in cost of labour. Overall estimates generated with the methodology result in costs within the ranges reported for other new vaccines introduced in SSA and capture multiple sources of heterogeneity in costs across countries. Further validation with data from field trials will support use of the methodology while also serving as a validation for cMYP and WHO-CHOICE as resources for costing health interventions in the region.

Media/Policy Watch [to 5 December 2015]

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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The Atlantic
http://www.theatlantic.com/magazine/
Accessed 5 December 2015
Measles Outbreaks Are a Sign of Bigger Problems
For health agencies tracking global vaccine coverage, the disease is the canary in the coal mine.
Seth Berkley
1 December 2015
This year was supposed to mark the point when measles—one of the most infectious diseases on the planet—was finally under control. As a step in its plan to eliminate measles worldwide by 2020, the World Health Organization set a target to reduce the number of cases by 95 percent between 2000 and 2015. The effect has been significant: Measles deaths have fallen from more than 700,000 in 2000 to around 115,000 last year. But for a disease that’s easily preventable, 115,000 deaths—the majority of them children under 5 years old—is still too high. And as the WHO reported in November, progress has flat-lined over the past five years, and outbreaks are still common.

What, exactly, went wrong?

At first glance, it seems impossible to pinpoint just one reason for all the various outbreaks around the world. In the Nuba mountains of Sudan, a key factor is the lack of access to humanitarian aid for people trapped in conflict zones; in West Africa, a measles resurgence can be attributed largely to the Ebola epidemic’s crippling effect on local health systems. And in California, the blame rests squarely on the shoulders of anti-vaccine groups for whipping up unfounded fears about the safety of measles-mumps-rubella (MMR) vaccines.

However, all of these seemingly disparate cases—and all other measles outbreaks, for that matter—still have a common underlying cause. Whenever measles strikes, it’s more than just an outbreak of a single disease, or an indication that children aren’t receiving their measles shots; it’s also a warning that immunization coverage in general, for all vaccine-preventable diseases, is lower than it should be. To put it another way: When rates of routine vaccination—children receiving all their shots on schedule, as a preventive measure rather than a reaction to an outbreak—start to fall, the first sign is usually a measles outbreak. In global-health security terms, these outbreaks are the proverbial canaries in the coal mine…

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The Huffington Post
http://www.huffingtonpost.com/
Accessed 5 December 2015
COP21: A Defining Moment for Human Health
Margaret Chan
3 December 2015
This week’s United Nations Climate Change Conference (COP21) in Paris offers a chance to save the planet from severe, pervasive and irreversible damage. Though often lost in the debate, saving the planet also means saving the conditions that sustain human life in good health. If sufficiently ambitious and effective, the climate agreement will be a major turning point in environmental policy, but also a far-reaching treaty for protecting public health.

The stakes are high. Unless a deal is clinched to keep the temperature rise within two degrees Celsius, the consequences will be catastrophic. Many of the same inefficient and polluting energy choices that are driving climate change are also devastating human health. Climate change degrades air quality, reduces food security and compromises water supplies and sanitation.

WHO estimates that, each year, more than 7 million deaths worldwide can be attributed to air pollution. Climate change is also causing tens of thousands of yearly deaths from other causes. Records for extreme weather events — like droughts and floods, storm surges, heatwaves and wildfires — are being broken a record number of times, claiming human lives and livelihoods. The World Meteorological Organization says 2015 is already the hottest year since records began in 1880. Next year is predicted to be even hotter…

…The health sector has critical evidence, and positive arguments, to bring to the climate talks. Existing strategies that work well to combat climate change also bring important health gains. Investments in low-carbon development, clean renewable energy, and greater climate resilience are investments in better health….

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New York Times
http://www.nytimes.com/
Accessed 5 December 2015
Health
Ebola Crisis Passes, but Questions on Quarantines Persist
By SHERI FINKDEC. 2, 2015
The Ebola epidemic has subsided, but in the United States the fallout over how health care workers and their families were treated during the crisis continues.

Throughout the months of fear and uncertainty, the federal Centers for Disease Control and Prevention recommended monitoring people entering the United States from Ebola-affected countries, not confining them, because research showed that people with Ebola are not contagious before they show symptoms. But states, which have the legal authority to impose quarantines, often exceeded those guidelines, restricting the movements of returning health workers and others.

Interviews with more than a dozen people who either were quarantined or were involved in imposing quarantines revealed troubling details about the steps that were taken. Some said they were left without basic necessities like garbage removal and without psychological support. In one case in New York, a stove was left inoperable after an apartment was cleaned and no one was allowed to come fix it. Others were not given the legally required notice of the restrictions to be imposed.

Similar findings are documented in a report released on Thursday by the Yale Global Health Justice Partnership and the American Civil Liberties Union, which for the first time tried to quantify how widespread quarantines were in response to the Ebola epidemic…

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Washington Post
http://www.washingtonpost.com/
Accessed 5 December 2015
Everything went wrong in the Ebola outbreak. We’re still not ready if it happens again.
By Editorial Board 28 November 2015
ALMOST EVERYTHING that could go wrong did go wrong in the world’s early response to the outbreak of the Ebola virus in West Africa in 2014. Before it was over, the virus infected some 28,634 people and claimed more than 11,000 lives. It could happen again — and the world is still not ready.

Guinea had a weak health-care system when the virus took root in its remote regions, making it easier for the virus to spread to neighboring Liberia and Sierra Leone. Guinean authorities played down the seriousness for fear of creating panic and disrupting business. The World Health Organization declared the outbreak “relatively small still” in April 2014, and expert teams that had been sent in to the region were pulled out prematurely in May. WHO outbreak response teams had been “disproportionally” cut in a wave of headquarters layoffs. Margaret Chan, director general of the WHO, did not use her authority to declare a public-health emergency of international concern until five months after Guinea and Sierra Leone had notified the organization. Even after the emergency was declared, and a substantial global response was mobilized, “this response arrived late, was slow to deliver funds and health workers, was inflexible in adapting to rapidly changing conditions on the ground, was inadequately informed about cultural factors relevant to outbreak control, and was poorly coordinated,” according to a new study. “The result was, in essence, a $5 billion scramble.”

This is a sample of the findings contained in a report made public Nov. 22 by an independent panel of 19 experts who examined responses to the outbreak, particularly by the WHO, an agency of the United Nations. The report describes a cascade of failures and serves as a reminder that the existing methods of coping with infectious disease outbreaks are fragmented and fragile. The panel, launched by the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine, found that during the Ebola outbreak, the WHO fell down in all of its core functions: helping nations build up health-care capacity, providing early warning, establishing technical norms and mobilizing resources. The agency now faces an “existential crisis of confidence,” is “starved” of resources and “seems to have lost its way,” the experts write. “Confidence in the organization’s capacity to lead is at an all-time low.”

Before another bacterium or virus goes on a rampage, the panel recommends bolstering the WHO’s ability to respond quickly, including with a worldwide research and development fund for diagnostics, drugs and vaccines for diseases that have been neglected by the pharmaceutical industry. In many poor countries, basic health-care systems are still lacking, hampering their ability to fight outbreaks. It is also essential that governments give early warning of disease, regardless of the consequences. Response teams must take into account not only health and science concerns but also the beliefs, traditions, cultures and fears of local populations. The world fails to learn these lessons of Ebola at its peril.

Commitment to Development Index – 2015

Center for Global Development
http://www.cgdev.org/

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Briefs
Commitment to Development Index 2015
12/4/15
Petra Krylováa and Owen Barder
The Commitment to Development Index ranks 27 of the world’s richest countries on policies that affect the more than five billion people living in poorer nations. Those policies extend well beyond giving foreign aid, which is just one of seven components on the CDI:
Aid; Finance; Technology; Environment; Trade; Security; Migration

The Index gives credit for generous and high-quality aid, financial transparency and incentives for foreign direct investment, robust support for technological research and development, policies that protect the environment, open and fair trade policies, contributions to global security, and open immigration policies. Scores are reduced for barriers to imports from developing countries, selling arms to poor and undemocratic nations, barriers to sharing technology, and policies that harm shared environmental resources.

Visit cgdev.org/cdi to explore the Commitment to Development Index, view additional publications and background papers, and dive deeper into the CDI methodology, data, and code.