Journal of Pediatrics
March 2016 Volume 170, p1-350
http://www.jpeds.com/current

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Medical Progress
Moving Towards a More Aggressive and Comprehensive Model of Care for Children with Ebola
Indi Trehan, Tracy Kelly, Regan H. Marsh, Peter Matthew George, Charles W. Callahan
p28–33.e7
Published online: January 8 2016
Preview
Ebola is a devastating illness for children, particularly those under 5 years of age.1-3 Although children are proportionally less affected than adults during outbreaks of Ebola, including in the current West Africa outbreak,4 it remains a major threat to child health in the affected nations and a neglected area of investigation and discussion.5 The threat is not only for those infected with Ebola, but for all children in the affected region because of the tremendous impact of this outbreak on national health care systems.

PharmacoEconomics
Volume 34, Issue 2, February 2016
http://link.springer.com/journal/40273/34/2/page/1
Big Data Themed Issue

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Editorial
Big Data and Its Role in Health Economics and Outcomes Research: A Collection of Perspectives on Data Sources, Measurement, and Analysis
Eberechukwu Onukwugha
Initial text
Health economists and outcomes researchers have watched the term ‘big data’ increase in prominence over the last several years. However, to date, the use of big data in medicine has not been concretely illustrated across a variety of health economics and outcomes research (HEOR). At the same time, many of the same observers agree that fundamental questions remain unanswered and include (1) “What does the term ‘big data’ mean?” and (2) “What does the availability of big data mean for individuals who produce and use findings from HEOR?” This editorial tackles the first question and leaves contributors to this issue of PharmacoEconomics to discuss the promises, possibilities and potential pitfalls of using big data in HEOR….

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Current Opinion
Big Data and Health Economics: Strengths, Weaknesses, Opportunities and Threats
Brendan Collins
Abstract
‘Big data’ is the collective name for the increasing capacity of information systems to collect and store large volumes of data, which are often unstructured and time stamped, and to analyse these data by using regression and other statistical techniques. This is a review of the potential applications of big data and health economics, using a SWOT (strengths, weaknesses, opportunities, threats) approach. In health economics, large pseudonymized databases, such as the planned care.data programme in the UK, have the potential to increase understanding of how drugs work in the real world, taking into account adherence, co-morbidities, interactions and side effects. This ‘real-world evidence’ has applications in individualized medicine. More routine and larger-scale cost and outcomes data collection will make health economic analyses more disease specific and population specific but may require new skill sets. There is potential for biomonitoring and lifestyle data to inform health economic analyses and public health policy.

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 27 February 2016]

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Characteristics of an Effective International Humanitarian Assistance: A Systematic Review
February 25, 2016 · Research Article
Introduction: The objective of this study is to identify the effectiveness characteristics, review the definition of them, and develop a conceptual mapping of existing domains in the field of International Humanitarian Assistance (IHA).
Methods: We conducted a systematic review and searched the major databases (Science Direct, Scopus, Springer and Pubmed) and grey literature, including references of potentially eligible articles and conference proceedings through March 2015. Articles were included if they focused on IHA effectiveness. Reviewers independently identified the eligible studies and extracted data.
Results: 10 studies were included and 48 characteristics were identified. There is a lack of scientific studies and agreement on the characteristics of IHA effectiveness.
Conclusion: This study could be the step toward an understanding of IHA effectiveness characteristics and its definitions with the findings making a base line for more research in this area.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 27 February 2016)

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Reducing Cost of Rabies Post Exposure Prophylaxis: Experience of a Tertiary Care Hospital in Pakistan
Naseem Salahuddin, M. Aftab Gohar, Naila Baig-Ansari
Research Article | published 26 Feb 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004448

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Phase 1/2a Trial of Plasmodium vivax Malaria Vaccine Candidate VMP001/AS01B in Malaria-Naive Adults: Safety, Immunogenicity, and Efficacy
Jason W. Bennett, Anjali Yadava, Donna Tosh, Jetsumon Sattabongkot, Jack Komisar, Lisa A. Ware, William F. McCarthy, Jessica J. Cowden, Jason Regules, Michele D. Spring, Kristopher Paolino, Joshua D. Hartzell, James F. Cummings, Thomas L. Richie, Joanne Lumsden, Edwin Kamau, Jittawadee Murphy, Cynthia Lee, Falgunee Parekh, Ashley Birkett, Joe Cohen, W. Ripley Ballou, Mark E. Polhemus, Yannick F. Vanloubbeeck, Johan Vekemans, Christian F. Ockenhouse
Research Article | published 26 Feb 2016 | PLOS Neglected Tropical Diseases
10.1371/journal.pntd.0004423

PLoS One
http://www.plosone.org/
[Accessed 27 February 2016]

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Do Maternal Knowledge and Attitudes towards Childhood Immunizations in Rural Uganda Correlate with Complete Childhood Vaccination?
Bryan J. Vonasek, Francis Bajunirwe, Laura E. Jacobson, Leonidas Twesigye, James Dahm, Monica J. Grant, Ajay K. Sethi, James H. Conway
Research Article | published 26 Feb 2016 | PLOS ONE
10.1371/journal.pone.0150131
Abstract
Improving childhood vaccination coverage and timeliness is a key health policy objective in many developing countries such as Uganda. Of the many factors known to influence uptake of childhood immunizations in under resourced settings, parents’ understanding and perception of childhood immunizations has largely been overlooked. The aims of this study were to survey mothers’ knowledge and attitudes towards childhood immunizations and then determine if these variables correlate with the timely vaccination coverage of their children. From September to December 2013, we conducted a cross-sectional survey of 1,000 parous women in rural Sheema district in southwest Uganda. The survey collected socio-demographic data and knowledge and attitudes towards childhood immunizations. For the women with at least one child between the age of one month and five years who also had a vaccination card available for the child (N = 302), the vaccination status of this child was assessed. 88% of these children received age-appropriate, on-time immunizations. 93.5% of the women were able to state that childhood immunizations protect children from diseases. The women not able to point this out were significantly more likely to have an under-vaccinated child (PR 1.354: 95% CI 1.018–1.802). When asked why vaccination rates may be low in their community, the two most common responses were “fearful of side effects” and “ignorance/disinterest/laziness” (44% each). The factors influencing caregivers’ demand for childhood immunizations vary widely between, and also within, developing countries. Research that elucidates local knowledge and attitudes, like this study, allows for decisions and policy pertaining to vaccination programs to be more effective at improving child vaccination rates.

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Cost-Effectiveness of Vaccinating Immunocompetent ≥65 Year Olds with the 13-Valent Pneumococcal Conjugate Vaccine in England
Albert Jan van Hoek, Elizabeth Miller
Research Article | published 25 Feb 2016 | PLOS ONE
10.1371/journal.pone.0149540

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
December 2015 Vol. 38, No. 6
http://www.paho.org/journal/

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SECCIÓN ESPECIAL / SPECIAL SECTION
Declaración SPIRIT 2013: definición de los elementos estándares del protocolo de un ensayo clínico [SPIRIT 2013 Statement: defining standard protocol items for clinical trials]
An-Wen Chan, Jennifer M. Tetzlaff, Douglas G. Altman, Andreas Laupacis,
Peter C. Gøtzsche, Karmela Krleža-Jerić, Asbjørn Hrobjartsson, Howard Mann,
Kay Dickersin, Jesse A. Berlin, Caroline J. Dore, Wendy R. Parulekar,
William S. M. Summerskill, Trish Groves, Kenneth F. Schulz, Harold C. Sox,
Frank W. Rockhold, Drummond Rennie y David Moher
Abstract
The protocol of a clinical trial serves as the foundation for study planning, conduct, reporting, and appraisal. However, trial protocols and existing protocol guidelines vary greatly in content and quality. This article describes the systematic development and scope of SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013, a guideline for the minimum content of a clinical trial protocol. The 33-item SPIRIT checklist applies to protocols for all clinical trials and focuses on content rather than format. The checklist recommends a full description of what is planned; it does not prescribe how to design or conduct a trial. By providing guidance for key content, the SPIRIT recommendations aim to facilitate the drafting of high-quality protocols. Adherence to SPIRIT would also enhance the transparency and completeness of trial protocols for the benefit of investigators, trial participants, patients, sponsors, funders, research ethics committees or institutional review boards, peer reviewers, journals, trial registries, policymakers, regulators, and other key stakeholders.

Vaccine
Volume 34, Issue 11, Pages 1325-1422 (8 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/11

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Meeting report
Implementing efficient and sustainable collaboration between National Immunization Technical Advisory Groups: Report on the 3rd International Technical Meeting, Paris, France, 8–9 December 2014
Pages 1325-1330
Christian Perronne, Alex Adjagba, Philippe Duclos, Daniel Floret, Hans Houweling, Corinne Le Goaster, Daniel Lévy-Brühl, François Meyer, Kamel Senouci, Ole Wichmann
Abstract
Many experts on vaccination are convinced that efforts should be made to encourage increased collaboration between National Immunization Technical Advisory Groups on immunization (NITAGs) worldwide. International meetings were held in Berlin, Germany, in 2010 and 2011, to discuss improvement of the methodologies for the development of evidence-based vaccination recommendations, recognizing the need for collaboration and/or sharing of resources in this effort. A third meeting was held in Paris, France, in December 2014, to consider the design of specific practical activities and an organizational structure to enable effective and sustained collaboration. The following conclusions were reached:
(i) The proposed collaboration needs a core functional structure and the establishment or strengthening of an international network of NITAGs.
(ii).Priority subjects for collaborative work are background information for recommendations, systematic reviews, mathematical models, health economic evaluations and establishment of common frameworks and methodologies for reviewing and grading the evidence.
(iii).The programme of collaborative work should begin with participation of a limited number of NITAGs which already have a high level of expertise. The amount of joint work could be increased progressively through practical activities and pragmatic examples. Due to similar priorities and already existing structures, this should be organized at regional or subregional level. For example, in the European Union a project is funded by the European Centre for Disease Prevention and Control (ECDC) with the aim to set up a network for improving data, methodology and resource sharing and thereby supporting NITAGs. Such regional networking activities should be carried out in collaboration with the World Health Organization (WHO).
(iv).A global steering committee should be set up to promote international exchange between regional networks and to increase the involvement of less experienced NITAGs. NITAGs already collaborate at the global level via the NITAG Resource Centre, a web-based platform developed by the Health Policy and Institutional Development Unit (WHO Collaborating Centre) of the Agence de Médecine Préventive (AMP-HPID). It would be appropriate to continue facilitating the coordination of this global network through the AMP-HPID NITAG Resource Centre.
(v).While sharing work products and experiences, each NITAG would retain responsibility for its own decision-making and country-specific recommendations.

Vaccine
Volume 34, Issue 11, Pages 1325-1422 (8 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/11

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A qualitative study of healthcare provider awareness and informational needs regarding the nine-valent HPV vaccine
Pages 1331-1334
Monica L. Kasting, Shannon Wilson, Brian E. Dixon, Stephen M. Downs, Amit Kulkarni, Gregory D. Zimet
Abstract
The 9-valent Human Papillomavirus (HPV) vaccine, 9vHPV, was licensed in the U.S. in December, 2014. We assessed healthcare provider (HCP) awareness of the newly approved vaccine and identified questions HCPs have about the vaccine. As part of a larger study, we used semi-structured interviews to ask 22 pediatric HCPs about their awareness of 9vHPV, questions they have about the vaccine, and questions they anticipate from patients and parents. Interviews were audio-recorded and transcribed then analyzed using inductive content analysis. Over half were aware of the vaccine but few HCPs claimed to be familiar with it. HCPs indicated several questions with common themes pertaining to efficacy, side effects, and cost. Only half of HCPs believed patients or parents would have questions. The results suggest strategies and areas for health systems and public health organizations to target in order to resolve unmet educational needs among HCPs regarding 9vHPV.

Vaccine
Volume 34, Issue 11, Pages 1325-1422 (8 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/11

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Antenatal immunisation intentions of expectant parents: Relationship to immunisation timeliness during infancy
Original Research Article
Pages 1379-1388
Cameron C. Grant, Mei-Hua Chen, Dinusha K. Bandara, Emma J. Marks, Catherine A. Gilchrist, Sonia Lewycka, Polly E. Atatoa Carr, Elizabeth M. Robinson, Jan E. Pryor, Carlos A. Camargo, Susan M.B. Morton
Abstract
Background
Most women decide about infant immunisation during pregnancy. However, we have limited knowledge of the immunisation intentions of their partners. We aimed to describe what pregnant women and their partners intended for their future child’s immunisations, and to identify associations between parental intentions and the subsequent timeliness of infant immunisation.
Methods
We recruited a cohort of pregnant New Zealand (NZ) women expecting to deliver between April 2009 and March 2010. The cohort included 11% of births in NZ during the recruitment period and was generalisable to the national birth cohort. We completed antenatal interviews independently with mothers and partners. We determined immunisation receipt from the National Immunisation Register and defined timely immunisation as receiving all vaccines (scheduled at 6-weeks, 3- and 5-months) within 30 days of their due date. We described independent associations of immunisation intentions with timeliness using adjusted odds ratios (OR) and 95% confidence intervals (CI).
Results
Of 6172 women, 5014 (81%) intended full immunisation, 245 (4%) partial immunisation, 140 (2%) no immunisation and 773 (13%) were undecided. Of 4152 partners, 2942 (71%) intended full immunisation, 208 (5%) partial immunisation, 83 (2%) no immunisation and 921 (22%) were undecided. Agreement between mothers and partners was moderate (Kappa = 0.42).
Timely immunisation occurred in 70% of infants. Independent of their partner’s intentions, infants of pregnant women who decided upon full immunisation were more likely to be immunised on time (OR = 7.65, 95% CI: 4.87 − 12.18). Independent of the future mother’s intentions, infants of partners who had decided upon full immunisations were more likely to be immunised on time (OR = 3.33, 95% CI: 2.29 − 4.84).
Conclusions
During pregnancy, most future parents intend to fully immunise their child; however, more partners than mothers remain undecided about immunisation. Both future mothers’ and future fathers’ intentions are independently associated with the timeliness of their infant’s immunisations.

Vaccine
Volume 34, Issue 11, Pages 1325-1422 (8 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/11

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Changing the default to promote influenza vaccination among health care workers
Original Research Article
Pages 1389-1392
Birthe A Lehmann, Gretchen B Chapman, Frits ME Franssen, Gerjo Kok, Robert AC Ruiter
Abstract
Background
The prevention of health care acquired infections is an important objective for patient safety and infection control in all health care settings. Influenza vaccination uptake among health care workers (HCWs) is the most effective method to prevent transmission to patients, but vaccination coverage rates are low among HCWs. Several educational campaigns have been developed to increase the influenza vaccination coverage rates of HCWs, but showed only small
effects. The aim of this study was to test an opt-out strategy in promoting uptake among HCWs in a tertiary care center for patients with complex chronic organ failure.
Methods
HCWs were randomly assigned to one of two conditions. In the opt-out condition (N = 61), participants received an e-mail with a pre-scheduled appointment for influenza vaccination, which could be changed or canceled. In the opt-in condition (N = 61), participants received an e-mail explaining that they had to schedule an appointment if they wanted to get vaccinated.
Results
The findings show no statistically detectable effect of condition on being vaccinated against influenza. However, HCWs in the opt-out condition were more likely to have an appointment for influenza vaccination, which in turn increased the probability of getting vaccinated.
Conclusion
To change the default to promote influenza vaccination among HCWs might be an easy and cost-effective alternative to the complex vaccination campaigns that have been proposed in recent years.

Vaccine
Volume 34, Issue 10, Pages 1233-1324 (4 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/10

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Place of influenza vaccination among children—United States, 2010–11 through 2013–14 influenza seasons
Original Research Article
Pages 1296-1303
Tammy A. Santibanez, Tara M. Vogt, Yusheng Zhai, Anne F. McIntyre
Abstract
Background
Studies are published on settings adults receive influenza vaccination but few have reported on settings children are vaccinated and how this might be changing over time or vary by socio-demographics.
Methods
Data from the National Immunization Survey-Flu were analyzed to assess place of influenza vaccination among vaccinated children 6 months–17 years during the 2010–11, 2011–12, 2012–13, and 2013–14 influenza seasons. The percentage of children vaccinated at each place was calculated overall and by age, race/ethnicity, income, and Metropolitan Statistical Area (MSA).
Results
The places children received influenza vaccination varied little over four recent influenza seasons. From the 2010–11 through 2013–14 influenza seasons the percentage of vaccinated children receiving influenza vaccination at a doctor’s office was 64.1%, 65.1%, 65.3%, and 65.3%, respectively with no differences from one season to the next. Likewise, for vaccination at clinics or health centers (17.8%, 17.5%, 17.0%. 18.0%), health departments (3.2%, 3.6%, 3.0%, 2.8%), and other non-medical places (1.6%, 1.4%, 1.2%, 1.1%), there were no differences from one season to the next. There were some differences for vaccinations at hospitals, pharmacies, and schools. There was considerable variability in the place of influenza vaccination by age, race/ethnicity, income, and MSA. Fewer Hispanic children were vaccinated at a doctor’s office than black, white, and other or multiple race children and fewer black children and children of other or multiple races were vaccinated at a doctor’s office than white children. More children at or below the poverty level were vaccinated at a clinic or health center than all of the other income groups.
Conclusion
Most vaccinated children receive their influenza vaccination at a doctor’s office. Place of vaccination changed little over four recent influenza seasons. Large variability in place of vaccination exists by age, race/ethnicity, income, and MSA. Monitoring place of vaccination can help shape future immunization programs.

Vaccine
Volume 34, Issue 10, Pages 1233-1324 (4 March 2016)
http://www.sciencedirect.com/science/journal/0264410X/34/10

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Conference report
Report on: “The 1st Workshop on National Immunization Programs and Vaccine Coverage in ASEAN Countries, April 30, 2015, Pattaya, Thailand”
Pages 1233-1240
Weerawan Hattasingh, Krisana Pengsaa, Usa Thisyakorn, 1st Workshop on National Immunization Programs and Vaccine Coverage in ASEAN Group
Abstract
The 1st Workshop on National Immunization Programs and Vaccine Coverage in Association of Southeast Asian Nations (ASEAN) Countries Group (WNIPVC-ASEAN) held a meeting on April 30, 2015, Pattaya, Thailand under the auspices of the Pediatric Infectious Diseases Society and the World Health Organization (WHO). Reports on the current status and initiatives of the national immunization program (NIP) in each ASEAN countries that attended were presented. These reports along with survey data collected from ministries of health in ASEAN countries NIPs demonstrate that good progress has been made toward the goal of the Global Vaccine Action Plan (GVAP). However, some ASEAN countries have fragile health care systems that still have insufficient vaccine coverage of some basic EPI antigens. Most ASEAN countries still do not have national coverage of some new and underused vaccines, and raising funds for the expansion of NIPs is challenging. Also, there is insufficient research into disease burden of vaccine preventable diseases and surveillance. Health care workers must advocate NIPs to government policy makers and other stakeholders as well as improve research and surveillance to achieve the goals of the GVAP.

European Geriatric Medicine
http://www.sciencedirect.com/science/journal/18787649
Available online 12 February 2016 – In Press, Corrected Proof

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The role of vaccination in successful independent ageing
JE McElhaney, G Gavazzi, J Flamaing, J Petermans –
Abstract
Ageing increases the risk and severity of infectious diseases, especially when chronic diseases are present. Healthcare providers generally view vaccination as a childhood intervention and consider vaccination of the elderly not to be sufficiently effective due to immunosenescence. However, the burden of frequent vaccine-preventable diseases, such as influenza, pneumococcal disease and herpes zoster, increases with age, so that the perceived lower vaccine effectiveness should be considered in the context of this higher burden. Vaccination can prevent infection and mortality hospitalization and functional decline, and their consequences thereby having a positive impact. The use of medications will be reduced (e.g. antibiotics, analgesics) and therefore the iatrogenic risk would be lower. This contributes to an improved quality of life and to successful ageing. Many countries recommend influenza and pneumococcal vaccination in the elderly and, more recently, some recommend the live-attenuated herpes zoster vaccine. However, better guidelines and recommendations, especially for frail individuals are needed. Protection may be improved by offering vaccination to younger, fitter individuals, before they become frail. In addition, offering vaccination to caregivers and others who are in contact with the elderly could also improve protection. Many studies have demonstrated that influenza, pneumococcal and herpes zoster vaccinations in the elderly are cost-effective and can even be cost-saving. Healthcare providers and public health decision-makers need to understand more fully the value of vaccination and to consider it as an important preventive tool in the promotion of successful ageing.

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 27 February 2016
The HPV Vaccine Is Working, But Why Are So Many Teens Still Not Getting It?
Since the Food and Drug Administration approved the first human papillomavirus (HPV) vaccine in 2006, infections with the four types of HPV it targets have declined in adolescent girls and young women, scientists reported Monday. Certain types of HPV–the most common sexually transmitted infection in the United States–cause cervical, vulvar and […]
Rita Rubin, Contributor Feb 22, 2016

Bringing Compassion To The Sick Is Not Easy
By Arthur Caplan and Kenneth Moch
Three events are taking place this week that shed light on the challenges posed by trying to help those seeking access to unapproved drugs or vaccines for their terminal, chronic or dangerous conditions. Each event shows how careful we must be in designing well intended, […]
Feb 22, 2016

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New Yorker
http://www.newyorker.com/
Accessed 27 February 2016
Daily Comment
February 25, 2016
The Dangerous Conspiracy Theories About the Zika Virus
By Michael Specter

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New York Times
http://www.nytimes.com/
Accessed 27 February 2016
Obama on Vaccine for Zika
President Obama said there is a “promising pathway” for developing a vaccine against Zika, adding that the virus is not, apparently, a very complicated one.
February 25, 2016 – By REUTERS –

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Wall Street Journal
http://online.wsj.com/home-page?_wsjregion=na,us&_homepage=/home/us
Accessed 27 February 2016
Sanofi’s Dengue Vaccine Made Widely Available for First Time
Philippines plans to immunize schoolchildren starting in April
By Cris Larano
Feb. 23, 2016 12:15 p.m. ET

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Washington Post
http://www.washingtonpost.com/
Accessed 27 February 2016
CDC issues Olympics advisory: Pregnant women should ‘consider not going’ to Rio
U.S. officials issued their strongest travel warning yet, urging pregnant women to “consider not going” to the 2016 Summer Olympics in Rio de Janeiro.
Ariana Eunjung Cha | National/health-science | Feb 27, 2016

‘Seriously flawed’ study linking behavioral problems to Gardasil has been retracted
The authors of the study have come under fire for vaccine-critical studies before.
Rachel Feltman | National/health-science | Feb 25, 2016