BMC Medical Ethics
(Accessed 9 August 2014)
http://www.biomedcentral.com/bmcmedethics/content

Debate
What makes public health studies ethical? Dissolving the boundary between research and practice
Donald J Willison, Nancy Ondrusek, Angus Dawson, Claudia Emerson, Lorraine E Ferris, Raphael Saginur, Heather Sampson and Ross Upshur
Author Affiliations
BMC Medical Ethics 2014, 15:61 doi:10.1186/1472-6939-15-61
Published: 8 August 2014
Abstract (provisional)
Background
The generation of evidence is integral to the work of public health and health service providers. Traditionally, ethics has been addressed differently in research projects, compared with other forms of evidence generation, such as quality improvement, program evaluation, and surveillance, with review of non-research activities falling outside the purview of the research ethics board. However, the boundaries between research and these other evaluative activities are not distinct. Efforts to delineate a boundary – whether on grounds of primary purpose, temporality, underlying legal authority, departure from usual practice, or direct benefits to participants – have been unsatisfactory.
Public Health Ontario has eschewed this distinction between research and other evaluative activities, choosing to adopt a common framework and process to guide ethical reflection on all public health evaluative projects throughout their lifecycle – from initial planning through to knowledge exchange.
Discussion
The Public Health Ontario framework was developed by a working group of public health and ethics professionals and scholars, in consultation with individuals representing a wide range of public health roles. The first part of the framework interprets the existing Canadian research ethics policy statement (commonly known as the TCPS 2) through a public health lens. The second part consists of ten questions that guide the investigator in the application of the core ethical principles to public health initiatives.
The framework is intended for use by those designing and executing public health evaluations, as well as those charged with ethics review of projects. The goal is to move toward a culture of ethical integrity among investigators, reviewers and decision-makers, rather than mere compliance with rules. The framework is consonant with the perspective of the learning organization and is generalizable to other public health organizations, to health services organizations, and beyond.
Summary
Public Health Ontario has developed an ethics framework that is applicable to any evidence-generating activity, regardless of whether it is labelled research. While developed in a public health context, it is readily adaptable to other health services organizations and beyond.

BMC Public Health
(Accessed 9 August 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Factors associated with hepatitis B vaccine series completion in a randomized trial for injection drug users reached through syringe exchange programs in three US cities
Sarah Bowman, Lauretta E Grau, Merrill Singer, Greg Scott, Robert Heimer BMC Public Health 2014, 14:820 (9 August 2014)
Provisional PDF

Commentary
Costs and benefits of influenza vaccination: more evidence, same challenges
Bruno Christian Ciancio and Giovanni Rezza
BMC Public Health 2014, 14:818 doi:10.1186/1471-2458-14-818
Published: 8 August 2014
Abstract (provisional)
Seasonal influenza vaccination coverage in most EU/EEA remains suboptimal. Providers’ and users’ confidence in influenza vaccines is undermined by reports of moderate to low vaccine effectiveness and by the lack of solid evidence on disease burden. A study from Preaud and co. indicates that even with current levels of vaccine effectiveness, increasing vaccination coverage would significantly reduce disease burden and health cost. The results of the study should be interpreted cautiously because some of the assumptions are not generalizable or are imprecise, especially those on vaccine coverage, disease burden and health cost. Increasing vaccination coverage in EU/EEA countries is very challenging. Multifaceted approaches and country specific strategies are needed to address vaccine hesitancy in health care workers and in the population, and to manage organisational and financial obstacles. One key element for increasing vaccination coverage is the development of better influenza vaccines, e.g. vaccines that are more effective, provide longer lasting immunity and do not require annual administration. Vaccine producers should consider this as the highest research priority in the field of influenza vaccine development..

Research article
Annual public health and economic benefits of seasonal influenza vaccination: a European estimate
Emmanuelle Preaud, Laure Durand, Bérengère Macabeo, Norbert Farkas, Brigitte Sloesen, Abraham Palache, Francis Shupo, Sandrine I Samson
BMC Public Health 2014, 14:813 (7 August 2014)
Provisional PDF

British Medical Journal
09 August 2014(vol 349, issue 7970)
http://www.bmj.com/content/349/7970

Research
Effect of BCG vaccination against Mycobacterium tuberculosis infection in children: systematic review and meta-analysis
A Roy, senior scientist1, M Eisenhut, consultant paediatrician2, R J Harris, statistician1, L C Rodrigues, professor of epidemiology3, S Sridhar, research associate4, S Habermann, junior doctor2, L Snell, junior doctor2, P Mangtani, senior lecturer3, I Adetifa, paediatrician and medical epidemiologist5, A Lalvani, professor of infectious disease4, I Abubakar, professor of infectious disease epidemiology16
Author affiliations
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g4643 (Published 05 August 2014) Cite this as: BMJ 2014;349:g4643
Accepted 11 July 2014
Abstract
Objectives
To determine whether BCG vaccination protects against Mycobacterium tuberculosis infection as assessed by interferon γ release assays (IGRA) in children.
Design
Systematic review and meta-analysis. Searches of electronic databases 1950 to November 2013, checking of reference lists, hand searching of journals, and contact with experts.
Setting
Community congregate settings and households.
Inclusion criteria Vaccinated and unvaccinated children aged under 16 with known recent exposure to patients with pulmonary tuberculosis. Children were screened for infection with M tuberculosis with interferon γ release assays.
Data extraction
Study results relating to diagnostic accuracy were extracted and risk estimates were combined with random effects meta-analysis.
Results
The primary analysis included 14 studies and 3855 participants. The estimated overall risk ratio was 0.81 (95% confidence interval 0.71 to 0.92), indicating a protective efficacy of 19% against infection among vaccinated children after exposure compared with unvaccinated children. The observed protection was similar when estimated with the two types of interferon γ release assays (ELISpot or QuantiFERON). Restriction of the analysis to the six studies (n=1745) with information on progression to active tuberculosis at the time of screening showed protection against infection of 27% (risk ratio 0.73, 0.61 to 0.87) compared with 71% (0.29, 0.15 to 0.58) against active tuberculosis. Among those infected, protection against progression to disease was 58% (0.42, 0.23 to 0.77).
Conclusions B
CG protects against M tuberculosis infection as well as progression from infection to disease.
Trial registration PROSPERO registration No CRD42011001698 (www.crd.york.ac.uk/prospero/).

Feature Infectious Diseases
Ebola: an opportunity for a clinical trial?
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g4997 (Published 06 August 2014) Cite this as: BMJ 2014;349:g4997
As the largest outbreak of Ebola virus has forced hitherto neglected tropical diseases on to the public agenda, debate is growing over whether affected patients should have the chance to try experimental drugs. Sophie Arie reports

Clinical Infectious Diseases (CID)
Volume 59 Issue 4 August 15, 2014
http://cid.oxfordjournals.org/content/current

Measles Vaccination in the Presence or Absence of Maternal Measles Antibody: Impact on Child Survival
Peter Aaby1,2, Cesário L. Martins1, May-Lill Garly1, Andreas Andersen1,2, Ane B. Fisker1, Mogens H. Claesson3, Henrik Ravn2, Amabelia Rodrigues1, Hilton C. Whittle4, and Christine S. Benn1,2
Author Affiliations
1Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
2Research Centre for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen
3Institute of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Denmark
4London School of Hygiene and Tropical Medicine, United Kingdom
Abstract
Background. Measles vaccine (MV) has a greater effect on child survival when administered in early infancy, when maternal antibody may still be present.
Methods. To test whether MV has a greater effect on overall survival if given in the presence of maternal measles antibody, we reanalyzed data from 2 previously published randomized trials of a 2-dose schedule with MV given at 4–6 months and at 9 months of age. In both trials antibody levels had been measured before early measles vaccination.
Results. In trial I (1993–1995), the mortality rate was 0.0 per 1000 person-years among children vaccinated with MV in the presence of maternal antibody and 32.3 per 1000 person-years without maternal antibody (mortality rate ratio [MRR], 0.0; 95% confidence interval [CI], 0–.52). In trial II (2003–2007), the mortality rate was 4.2 per 1000 person-years among children vaccinated in presence of maternal measles antibody and 14.5 per 1000 person-years without measles antibody (MRR, 0.29; 95% CI, .09–.91). Possible confounding factors did not explain the difference. In a combined analysis, children who had measles antibody detected when they received their first dose of MV at 4–6 months of age had lower mortality than children with no maternal antibody, the MRR being 0.22 (95% CI, .07–.64) between 4–6 months and 5 years.
Conclusions.  Child mortality in low-income countries may be reduced by vaccinating against measles in the presence of maternal antibody, using a 2-dose schedule with the first dose at 4–6 months (earlier than currently recommended) and a booster dose at 9–12 months of age.
Clinical Trials Registration. NCT00168558.

Clinical Infectious Diseases (CID)
Volume 59 Issue 4 August 15, 2014
http://cid.oxfordjournals.org/content/current

Maternal Immunization
Stanley A. Plotkin, Section Editor, Helen Y. Chu1 and Janet A. Englund2
Author Affiliations
1Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington
2Department of Pediatrics, Division of Infectious Diseases, Seattle Children’s Hospital, Washington
Abstract
Maternal immunization has the potential to protect the pregnant woman, fetus, and infant from vaccine-preventable diseases. Maternal immunoglobulin G is actively transported across the placenta, providing passive immunity to the neonate and infant prior to the infant’s ability to respond to vaccines. Currently inactivated influenza, tetanus toxoid, and acellular pertussis vaccines are recommended during pregnancy. Several other vaccines have been studied in pregnancy and found to be safe and immunogenic and to provide antibody to infants. These include pneumococcus, group B Streptococcus, Haemophilus influenzae type b, and meningococcus vaccines. Other vaccines in development for potential maternal immunization include respiratory syncytial virus, herpes simplex virus, and cytomegalovirus vaccines.

Infectious Diseases of Poverty
[Accessed 9 August 2014]
http://www.idpjournal.com/content

Letter to the Editor
Need of surveillance response systems to combat Ebola outbreaks and other emerging infectious diseases in African countries
Ernest Tambo, Emmanuel Chidiebere Ugwu and Jeane Yonkeu Ngogang
Author Affiliations
Infectious Diseases of Poverty 2014, 3:29 doi:10.1186/2049-9957-3-29
Published: 5 August 2014
Abstract (provisional)
There is growing concern in Sub-Saharan Africa about the spread of the Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, and the public health burden that it ensues. Since 1976, there have been 884,955 suspected and laboratory confirmed cases of EVD and the disease has claimed 2,309 lives including 729 lives in West Africa. There are certain requirements that must be met when responding to EVD outbreaks and this process could incur certain challenges. For the purposes of this paper, five have been identified: (i) the deficiency in the development and implementation of surveillance response systems against Ebola and others infectious disease outbreaks in Africa; (ii) the lack of education and knowledge resulting in an EVD outbreak triggering panic, anxiety, psychosocial trauma, isolation and dignity impounding, stigmatisation, community ostracism and resistance to associated socio-ecological and public health consequences; (iii) limited financial resources, human technical capacity and weak community and national health system operational plans for prevention and control responses, practices and management; (iv) inadequate leadership and coordination; and (v) the lack of development of new strategies, tools and approaches, such as improved diagnostics and novel therapies including vaccines which can assist in preventing, controlling and containing Ebola outbreaks as well as the spread of the disease. Hence, there is an urgent need to develop and implement an active early warning alert and surveillance response system for outbreak response and control of emerging infectious diseases. Understanding the unending risks of transmission dynamics and resurgence is essential in implementing rapid effective response interventions tailored to specific local settings and contexts. Therefore, the following actions are recommended: (i) national and regional inter-sectorial and trans-disciplinary surveillance response systems that include early warnings, as well as critical human resources development, must be quickly adopted by allied ministries and organisations in African countries in epidemic and pandemic responses; (ii) harnessing all stakeholders commitment and advocacy in sustained funding, collaboration, communication and networking including community participation to enhance a coordinated responses, as well as tracking and prompt case management to combat challenges; (iii) more research and development in new drug discovery and vaccines; and (iv) understanding the involvement of global health to promote the establishment of public health surveillance response systems with functions of early warning, as well as monitoring and evaluation in upholding research-action programmes and innovative interventions.

Journal of Infectious Diseases
Volume 210 Issue 4 August 15, 2014
http://jid.oxfordjournals.org/content/curren

Naturally Acquired Immunity Against Human Papillomavirus (HPV): Why It Matters in the HPV Vaccine Era
Silvia Franceschi and Iacopo Baussano
Author Affiliations
International Agency for Research on Cancer, Lyon, France
(See the major article by Castellsagué et al on pages 517–34.)
Extract
Scientists do not know precisely which elements of the immune system are important in preventing or resolving human papillomavirus (HPV) infections in unvaccinated women. HPV has a battery of immune-evasion mechanisms that include hiding within the host mucosal cells, low-level production of late (L) proteins, and inhibition of innate immunity and cell-mediated response by early proteins [1].
HPV vaccine trials show that sufficiently high levels of neutralizing antibodies against viral capsid strongly protect women who are negative for vaccine types at baseline against homologous (same-type) HPV infection. The measurement of HPV antibodies is also important for identifying unvaccinated women who have mounted an antibody response following previous exposure to HPV infection and may, therefore, be naturally protected. However, only approximately half of women seroconvert within 18 months after HPV infection [2]. The interpretation of HPV serology is additionally complicated by substantial differences across assays used in different studies (eg, detection ranges, targeted HPV types, and epitopes) [3–5]. Despite these limitations, seroprevalence studies have been essential in understanding HPV exposure [6] and infection trends [7], and have more recently started providing prospective estimates of naturally acquired immunity after HPV infection [4].
In this issue of The Journal of Infectious Diseases, Castellsagué and colleagues [8] report on the association of HPV types 16 and 18 antibody levels …

Journal of Infectious Diseases
Volume 210 Issue 4 August 15, 2014
http://jid.oxfordjournals.org/content/current

Risk of Newly Detected Infections and Cervical Abnormalities in Women Seropositive for Naturally Acquired Human Papillomavirus Type 16/18 Antibodies: Analysis of the Control Arm of PATRICIA
Xavier Castellsagué, Paulo Naud, Song-Nan Chow, Cosette M. Wheeler, Maria Julieta V. Germar,
Matti Lehtinen, Jorma Paavonen, Unnop Jaisamrarn, Suzanne M. Garland, Jorge Salmerón, Dan Apter, Henry Kitchener, Julio C. Teixeira, S. Rachel Skinner, Genara Limson, Anne Szarewski, Barbara Romanowski, Fred Y. Aoki, Tino F. Schwarz, Willy A. J. Poppe, F. Xavier Bosch, Newton S. de Carvalho, Klaus Peters, Wiebren A. A. Tjalma, Mahboobeh Safaeian, Alice Raillard, Dominique Descamps, Frank Struyf, Gary Dubin, Dominique Rosillon, and Laurence Baril
J Infect Dis. (2014) 210 (4): 517-534 doi:10.1093/infdis/jiu139
Free Full Text (HTML)

Journal of Infectious Diseases
Volume 210 Issue 4 August 15, 2014
http://jid.oxfordjournals.org/content/current

Relative Efficacy of AS03-Adjuvanted Pandemic Influenza A(H1N1) Vaccine in Children: Results of a Controlled, Randomized Efficacy Trial
Terry Nolan1,2,a, Sumita Roy-Ghanta3,a, May Montellano5, Lily Weckx8, Rolando Ulloa-Gutierrez11, Eduardo Lazcano-Ponce12, Angkool Kerdpanich16, Marco Aurélio Palazzi afadi9,10,
Aurelio Cruz-Valdez12, Sandra Litao6, Fong Seng Lim18, Abiel Mascareñas de Los Santos13, Miguel Angel Rodriguez Weber14, Juan-Carlos Tinoco15, Marcela Hernandez-de Mezerville11, Idis Faingezicht11, Pensri Kosuwon17, Pio Lopez19, Charissa Borja-Tabora7, Ping Li3, Serge Durviaux20, Louis Fries4, Gary Dubin3, Thomas Breuer20, Bruce L. Innis3 and David W. Vaughn21
Abstract
Background. The vaccine efficacy (VE) of 1 or 2 doses of AS03-adjuvanted influenza A(H1N1) vaccine relative to that of 2 doses of nonadjuvanted influenza A(H1N1) vaccine in children 6 months to Methods. A total of 6145 children were randomly assigned at a ratio of 1:1:1 to receive 2 injections 21 days apart of A/CNCT00alifornia/7/2009(H1N1)-AS03 vaccine at dose 1 and saline placebo at dose 2, 2 doses 21 days apart of A/California/7/2009(H1N1)-AS03 vaccine (the Ad2 group), or 2 doses 21 days apart of nonadjuvanted A/California/7/2009(H1N1) vaccine (the NAd2 group). Active surveillance for influenza-like illnesses continued from days 14 to 385. Nose and throat samples obtained during influenza-like illnesses were tested for A/California/7/2009(H1N1), using reverse-transcriptase polymerase chain reaction. Immunogenicity, reactogenicity, and safety were assessed.
Results. There were 23 cases of confirmed 2009 pandemic influenza A(H1N1) (A[H1N1]pdm09) infection for the primary relative VE analysis. The VE in the Ad2 group relative to that in the NAd2 group was 76.8% (95% confidence interval, 18.5%–93.4%). The benefit of the AS03 adjuvant was demonstrated in terms of the greater immunogenicity observed in the Ad2 group, compared with the NAd2 group.
Conclusion. The 4–8-fold antigen-sparing adjuvanted pandemic influenza vaccine demonstrated superior and clinically important prevention of A(H1N1)pdm09 infection, compared with nonadjuvanted vaccine, with no observed increase in medically attended or serious adverse events. These data support the use of adjuvanted influenza vaccines during influenza pandemics.
Clinical Trials Registration. NCT01051661.

PLoS One
[Accessed 9 August 2014]
http://www.plosone.org/
Research Article
Incremental Benefits of Male HPV Vaccination: Accounting for Inequality in Population Uptake
Megan A. Smith mail, Karen Canfell
Abstract
Background
Vaccines against HPV16/18 are approved for use in females and males but most countries currently have female-only programs. Cultural and geographic factors associated with HPV vaccine uptake might also influence sexual partner choice; this might impact post-vaccination outcomes. Our aims were to examine the population-level impact of adding males to HPV vaccination programs if factors influencing vaccine uptake also influence partner choice, and additionally to quantify how this changes the post-vaccination distribution of disease between subgroups, using incident infections as the outcome measure.
Methods
A dynamic model simulated vaccination of pre-adolescents in two scenarios: 1) vaccine uptake was correlated with factors which also affect sexual partner choice (“correlated”); 2) vaccine uptake was unrelated to these factors (“unrelated”). Coverage and degree of heterogeneity in uptake were informed by observed data from Australia and the USA. Population impact was examined via the effect on incident HPV16 infections. The rate ratio for post-vaccination incident HPV16 in the lowest compared to the highest coverage subgroup (RRL) was calculated to quantify between-group differences in outcomes.
Results
The population-level incremental impact of adding males was lower if vaccine uptake was “correlated”, however the difference in population-level impact was extremely small (<1%) in the Australia and USA scenarios, even under the conservative and extreme assumption that subgroups according to coverage did not mix at all sexually. At the subgroup level, “correlated” female-only vaccination resulted in RRL = 1.9 (Australia) and 1.5 (USA) in females, and RRL = 1.5 and 1.3 in males. “Correlated” both-sex vaccination increased RRL to 4.2 and 2.1 in females and 3.9 and 2.0 in males in the Australia and USA scenarios respectively.
Conclusions
The population-level incremental impact of male vaccination is unlikely to be substantially impacted by feasible levels of heterogeneity in uptake. However, these findings emphasize the continuing importance of prioritizing high coverage across all groups in HPV vaccination programs in terms of achieving equality of outcomes.

PLoS Medicine
(Accessed 9 August 2014)
http://www.plosmedicine.org/
Health in Action
From Intense Rejection to Advocacy: How Muslim Clerics Were Engaged in a Polio Eradication Initiative in Northern Nigeria
Sani-Gwarzo Nasir, Gambo Aliyu mail, Inuwa Ya’u, Muktar Gadanya, Muktar Mohammad, Mahmud Zubair, Samer S. El-Kamary
Published: August 05, 2014
DOI: 10.1371/journal.pmed.1001687
Summary Points
:: Of the several setbacks suffered by the polio eradication initiative in Nigeria, vaccination rejection by Muslim clerics (imams) is perhaps the most profound.
:: Anti-polio propaganda, misconceptions, and violence against vaccinators at the community level present huge challenges to polio eradication in Nigeria and globally.
:: However, the intense opposition to polio vaccination is systematically being reversed by the active engagement of imams to promote uptake of polio vaccination in areas worst hit by the disease.
:: A coalition campaign involving imams, Islamic school teachers, traditional rulers, doctors, journalists, and polio survivors is gradually turning the tide against polio vaccine rejection in northern Nigeria.
:: Innovative engagement and the coalition campaign at the community level should be part of the focus of the polio eradication initiative in Nigeria.

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

Expert Review of Vaccines
Volume 13, Number 8 (August 2014)
http://informahealthcare.com/toc/erv/current
Special Focus: Pertussis – Review
Waning vaccine immunity in teenagers primed with whole cell and acellular pertussis vaccine: recent epidemiology
Posted online on August 5, 2014. (doi:10.1586/14760584.2014.944167)
Sarah L Sheridan1,2, Katie Frith3, Thomas L Snelling4,5, Keith Grimwood1,6, Peter B McIntyre7 and Stephen B Lambert *1,8
Abstract
The recent epidemics of pertussis (whooping cough) in parts of the USA and Australia have led to the largest numbers of annual cases reported in over half a century. These epidemics demonstrated a new pattern, with particularly high rates of disease among pre-adolescents and early adolescents. These high rates of pertussis coincided with the first cohorts vaccinated with purely acellular pertussis vaccine, which replaced whole-cell pertussis (wP) vaccine in the later 1990s in the USA and Australia. Studies undertaken during these epidemics provide new evidence of more rapid waning of acellular pertussis-containing vaccines and longer-term protection from effective wP-containing vaccines. There is evidence that receiving wP as at least the first dose of pertussis-containing vaccine provides greater and more long-lived protection, irrespective of the nature of subsequent doses. This evidence will be reviewed together with the immunobiology associated with both vaccines, and the implications for pertussis control discussed.

Special Focus Newsletters
RotaFlash (PATH)
August 4, 2014
Headline: Rotavirus technical experts meet to prioritize intussusception research agenda

Special Request Posting
Cell Host & Microbe
2014 Jun 11;15(6):729-40. doi: 10.1016/j.chom.2014.05.009.
http://www.cell.com/cell-host-microbe/current
The classical lancefield antigen of group a Streptococcus is a virulence determinant with implications for vaccine design.
van Sorge NM1, Cole JN2, Kuipers K3, Henningham A2, Aziz RK4, Kasirer-Friede A5, Lin L3, Berends ET6, Davies MR7, Dougan G8, Zhang F9, Dahesh S3, Shaw L3, Gin J10, Cunningham M11, Merriman JA12, Hütter J13, Lepenies B13, Rooijakkers SH6, Malley R9, Walker MJ14, Shattil SJ5, Schlievert PM12, Choudhury B15, Nizet V16.
Author information
Abstract
Group A Streptococcus (GAS) is a leading cause of infection-related mortality in humans. All GAS serotypes express the Lancefield group A carbohydrate (GAC), comprising a polyrhamnose backbone with an immunodominant N-acetylglucosamine (GlcNAc) side chain, which is the basis of rapid diagnostic tests. No biological function has been attributed to this conserved antigen. Here we identify and characterize the GAC biosynthesis genes, gacA through gacL. An isogenic mutant of the glycosyltransferase gacI, which is defective for GlcNAc side-chain addition, is attenuated for virulence in two infection models, in association with increased sensitivity to neutrophil killing, platelet-derived antimicrobials in serum, and the cathelicidin antimicrobial peptide LL-37. Antibodies to GAC lacking the GlcNAc side chain and containing only polyrhamnose promoted opsonophagocytic killing of multiple GAS serotypes and protected against systemic GAS challenge after passive immunization. Thus, the Lancefield antigen plays a functional role in GAS pathogenesis, and a deeper understanding of this unique polysaccharide has implications for vaccine development.

Al Jazeera
http://www.aljazeera.com/Services/Search/?q=vaccine
Accessed 9 August 2014
Experts: Give new US Ebola drug to Africans
World’s top Ebola specialists question why only US aid workers given experimental drug, but firm says little available

The Atlantic
http://www.theatlantic.com/magazine/
Accessed 9 August 2014
An Ebola Vaccine Is Not the Answer
Instead, we need a treatment and better quarantine measures.
Olga Khazan
5 August 2014
In a widely shared Onion article from a few days ago, scientists “announced” that an Ebola vaccine was still 50 white people away. This was a jab at pharmaceutical companies, who, cynics think, will only set their R&D wheels in motion if there’s money on the horizon….

Council on Foreign Relations
http://www.cfr.org/
Accessed 9 August 2014
Transcript : The Ebola Outbreak
with John Campbell, Laurie Garrett, Robert McMahon August 5, 2014
CFR fellows discuss the recent Ebola outbreak in western Africa and its effect on the region.

Forbes
http://www.forbes.com/
Accessed 9 August 2014
BioWar Lab Helping To Develop Treatment For Ebola
Paul Rodgers, Contributor Aug 04, 2014
A top U.S. biological-warfare unit is developing a treatment for the deadly Ebola virus and could have it in the field within two years. The virus, which has killed more than 800 people in West Africa as of August 4, is a “Category A Bioterrorism Agent” along with anthrax, botulism, bubonic…

The Guardian
http://www.guardiannews.com/
Accessed 9 August 2014
Ebola rages in Africa as west agonises over ethics of vaccine and drug testing
31 July 2014
In 2002, scientists writing in a leading American medical journal discussed the possibility that the Ebola virus could be used in a biochemical weapon. It would be technically difficult and unlikely to cause mass destruction because those infected quickly die and the virus is not as transmissible as many assume. But, the scientists warned, if it could be done, there would be no protection. No vaccine or drug treatment exists…

New Yorker
http://www.newyorker.com/
Accessed 9 August 2014
After Ebola – The New Yorker
Jul 31, 2014 … There are several vaccines under development; in early animal tests, more than one has shown promise. But it will be years before they are …

New York Times
http://www.nytimes.com/
Accessed 9 August 2014
Ebola Drug Could Save a Few Lives. But Whose?
By ANDREW POLLACK AUG. 8, 2014
With hundreds of Africans dying from the outbreak of Ebola, some activists have said it is wrong that extremely scarce supplies of an experimental drug went to two white American aid workers.
But others wonder: What if the first doses of the drug — which had never been used in people and had not even finished the typical animal safety testing — had been given to African patients instead?
“It would have been the front-page screaming headline: ‘Africans used as guinea pigs for American drug company’s medicine,’ ” said Dr. Salim S. Abdool Karim, director of Caprisa, an AIDS research center in South Africa.
A history of controversy about drug testing in Africa is just one of the complexities facing public health authorities as they wrestle with whether and how to bring that drug and possibly other experimental ones to the countries afflicted with Ebola. Who should get such a scarce supply of medicine? Health workers? Children? The newly infected who are not yet as sick?
There are virtually no remaining supplies of the drug, called ZMapp, that was used to treat the two Americans, United States officials say. And even a few months from now, according to various estimates, there may be no more than a few hundred doses….
Inside Hospital’s Ebola Battle
August 9, 2014
At the government hospital in Kenema, Sierra Leone, health care workers struggle to contain the Ebola epidemic, which has killed almost 1,000 people across West Africa.

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 2 August 2014]
http://www.who.int/csr/don/en/
:: Ebola virus disease, West Africa – update 31 July 2014

Briefing: WHO Director-General assesses the Ebola outbreak with three West African presidents
Overview of the Ebola situation delivered to the Presidents of Guinea, Liberia, and Sierra Leone
Conakry, Guinea
1 August 2014
Dr Margaret Chan briefed the presidents on the Ebola situation in Conakry, Guinea. She underscored the many unprecedented dimensions of the outbreak, the extraordinary challenges that have emerged, and the need for a turning point in the international response. She announced that on 6-7 August, WHO will convene an Emergency Committee meeting in order to ascertain whether the ongoing Ebola outbreak in West Africa constitutes a “public health emergency of international concern” (PHEIC) and, if it does, to recommend appropriate action.
:: Ebola Virus Disease Outbreak Response Plan in West Africa July – December 2014
:: Ebola outbreak response update pdf, 793kb 28 July 2014

CDC/MMWR Watch [to 2 August 2014]
http://www.cdc.gov/mmwr/mmwr_wk.html
:: CDC Telebriefing on Ebola outbreak in West Africa – Transcript July 31, 2014
CDC hosted a media telebriefing to discuss the on-going outbreak of Ebola in West Africa.
:: As West Africa Ebola outbreak worsens, CDC issues Level 3 Travel Warning – Press Release July 31, 2014
The Centers for Disease Control and Prevention (CDC) today issued a warning to avoid nonessential travel to the West African nations of Guinea, Liberia, and Sierra Leone. This Level 3 travel warning is a reflection of the worsening Ebola outbreak in this region.
MMWR Weekly – August 1, 2014 / Vol. 63 / No. 30
:: Notes from the Field: Outbreak of Pertussis in a School and Religious Community Averse to Health Care and Vaccinations — Columbia County, Florida, 2013

POLIO [to 2 August 2014]
GPEI Update: Polio this week – As of 31 July 2014
Global Polio Eradication Initiative
Editor’s Excerpt and text bolding
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: In Pakistan, three new cases have been reported, including one from Balochistan. It is the first case in this province since October 2012. However, four positive environmental samples were collected in 2014 from Quetta, Balochistan, the most recent of which on 20 June. This case is linked to these positive environmental samples, suggesting local circulation of WPV1 this year in this area.
:: In Nigeria, more cases due to circulating vaccine-derived poliovirus type 2 (cVDPV2) have been reported this year (18) than those due to wild poliovirus type 1 (5 WPV1). Four new cVDPV2 cases were reported this week alone.
Nigeria
:: Four new cVDPV2 cases were reported in the past week, three from Kano and one from Borno. The total number of cVDPV2 cases for 2014 is now 18. The most recent cVDPV2 case had onset of paralysis on 22 June, from Kano.
:: Mop-up vaccination activities took place in parts of four northern Nigerian states from 12-15 July. Larger subnational activities are planned for the country’s north during 9-12 August (trivalent OPV), as part of urgent efforts to address the spread of cVDPV2, and 20-23 September (bivalent OPV).
Pakistan
:: Three new WPV1 cases were reported in the past week, from Federally Administered Tribal Areas (FATA – from Khyber Agency and South Waziristan), and from Balochistan (Killa Abdullah), bringing the total number of WPV1 cases for 2014 to 102. The case from South Waziristan is the most recent in the country, with onset of paralysis on 9 July.

Editorial: Polio eradication: placing health before conflict
The Lancet
Aug 02, 2014 Volume 384 Number 9941 p377 – 468 e30 – 31

Taliban In Pakistan Derail World Polio Eradication
NPR | 28 July 2014
Excerpt
…Today the militant group continues to threaten to kill not only vaccinators but also parents who get their children immunized. That threat has had a chilling effect on anti-polio efforts nationwide. And it completely halted vaccination drives in some Taliban-controlled areas. It’s in these places that the crippling virus has come roaring back — and threatened to stymie global efforts to wipe out polio. The worldwide campaign to eradicate polio has been going on for more than two decades. It has cost more than $10 billion. Now the success of the campaign hinges on whether Pakistan can control the virus…..

The Weekly Epidemiological Record (WER) 1 August 2014, vol. 89, 31 (pp. 345–356) includes:
Cholera, 2013
http://www.who.int/entity/wer/2014/wer8931.pdf?ua=1

GAVI Watch [to 2 August 2014]
http://www.gavialliance.org/library/news/press-releases/

:: 5-in-1 vaccine now in all 73 poorest countries
30 July 2014
The five-in-one pentavalent vaccine is now being used in all GAVI Alliance-supported countries – now the race is on to increase coverage of the vaccine which protects children against five life-threatening diseases.
Pentavalent, which protects against diphtheria, tetanus and pertussis (DTP) as well as Hepatitis B (HepB) and Haemophilus influenza type B (Hib), was first introduced with GAVI support in Kenya in 2001. South Sudan became the 73rd and final GAVI-supported country to introduce the vaccine on 16th July 2014…

Global Fund Welcomes Germany’s Increased Contribution
31 July 2014
Excerpt
GENEVA – The Global Fund to Fight AIDS, Tuberculosis and Malaria warmly welcomed a decision by the German parliament to increase Germany’s contribution to €245 million for 2014 in the budget for this year, reaffirming a strong commitment to global health.

At the launch of the Global Fund’s Fourth Replenishment last December, Germany had already announced a pledge of €200 million for this year as part of a total commitment of €600 million for the 2014-2016 period. By signing a Multi-Year Contribution Agreement that same month, Germany was able to provide the Global Fund with a predictable flow of resources to fight the three diseases.

With the 2014 budget now taking effect after its passage by parliament and signed into law by Federal President Joachim Gauck, the additional sum of €45 million can be added to the overall German contribution, representing an increase of more than 20 percent for 2014.
On top of that, the German contribution unlocks about US$30 million in additional contribution from the United States, which devised its pledge in a way that partially matches additional contributions by other donors…

Pfizer Enters Into Agreement to Acquire Baxter’s Portfolio of Marketed Vaccines
July 30, 2014
Excerpt
Pfizer announced that it has entered into a definitive agreement to acquire Baxter International Inc.’s portfolio of marketed vaccines for US$635 million. As part of the transaction, Pfizer will also acquire a portion of Baxter’s facility in Orth, Austria, where these vaccines are manufactured…
…Baxter’s portfolio of marketed vaccines consists of NeisVac-C and FSME-IMMUN/TicoVac. NeisVac-C is a vaccine that helps protect against meningitis caused by group C meningococcal meningitis (MenC)…FSME-IMMUN/TicoVac is a vaccine that helps protect against tick-borne encephalitis (TBE), an infection of the brain, which is transmitted by the bite of ticks infected with the TBE-virus….
…“Vaccines make a tremendous and valuable impact on public health around the world. They have significantly reduced the threat of widespread and often fatal diseases and every day people of all ages benefit from safe and effective vaccines,” said Susan Silbermann, Pfizer Vaccines President. “For over a decade Pfizer has been the global leader in pneumococcal disease prevention. We are working hard to bring innovative vaccines to market that prevent and treat serious diseases. Through this acquisition, we will add two high-quality and life-saving vaccines that bring scale and depth to our portfolio.”…

American Journal of Infection Control
Volume 42, Issue 8, p819-940 August 2014
http://www.ajicjournal.org/current

Health care workers—part of the system or part of the public? Ambivalent risk perception in health care workers
Anat Gesser-Edelsburg, PhD, Nathan Walter, MA, Manfred S. Green, MSc, MBChB, MPH, PhD
Published Online: June 14, 2014
DOI: http://dx.doi.org/10.1016/j.ajic.2014.04.012
Abstract
Background
The emergence of the avian influenza A (H7N9) in China during 2013 illustrates the importance of health care professionals as a mediating channel between health agencies and the public. Our study examined health care professionals’ risk perceptions considering their unique position as representing the health care system and yet also being part of the public, hence a risk group. Recent studies have examined the role of health professionals’ personal risk perceptions and attitudes regarding compliance of the general public with vaccination. Our study examined how risk perception affects their risk analysis.
Methods
We employed an online survey of Israeli health care professionals and the general public in Israel (N = 240).
Results
When risk perception is relatively low, health care professionals tend to base their attitudes toward vaccines on analytical knowledge (Rc = 0.315; P < .05), whereas in situations with high risk perception, the results did not indicate any significant difference between Israeli health professionals and the Israeli general public, hence both groups base their attitudes more on emotions and personal experience than on analytical knowledge. Conclusions Public health organizations must consider the fact that health professionals are a group that cannot be automatically treated as an extension of the organization. When the risk is tangible and relevant, health care workers behave and act like everybody else. Our study contributes to understanding health care professionals’ perceptions about vaccines and the thinking processes underlying such perceptions.

Varicella seroprevalence among health care workers in Korea: Validity of self-reported history and cost-effectiveness of prevaccination screening
Ji-Hea Kang, RN1, Yoon Soo Park, MD1, Shin Young Park, RN, Sae Bom Kim, RN, Kwang-Pil Ko, MD, Yiel-Hea Seo, MD 1These authors contributed equally to this work. DOI: http://dx.doi.org/10.1016/j.ajic.2014.05.013
Abstract
Background The validity of self-reported varicella history and cost-effectiveness of a prevaccination screening strategy have not been examined among health care workers (HCWs) living in Korea.
Methods We investigated varicella-zoster virus immunity of all HCWs in high-risk departments. To determine the history of varicella, all applicants completed a standardized questionnaire at the time of blood sampling for serologic testing.
Results Of the 550 HCWs, 526 (96%) were varicella seropositive. Although self-reported history was highly predictive of seropositivity (≥96%) among all age groups, the negative predictive value was extremely low (4%-5%) among all age groups. The prevaccination screening strategy was cheaper than vaccination without antibody screening if the varicella seroprevalence was >28%.
Conclusion
Seroprevalence was high (≥95%) among HCWs born in Korea before 1988. The self-reported varicella history did not accurately predict immunity, especially for individuals who have negative or uncertain varicella history. Given the high seroprevalence of varicella in Korean HCWs, serologic screening before vaccination was more cost-effective than universal vaccination.

BMC Public Health
(Accessed 2 August 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Analysis of prices paid by low-income countries – how price sensitive is government demand for medicines?
Divya Srivastava and Alistair McGuire
Author Affiliations
BMC Public Health 2014, 14:767 doi:10.1186/1471-2458-14-767
Published: 30 July 2014
Abstract (provisional)
Background
Access to medicines is an important health policy issue. This paper considers demand structures in a selection of low-income countries from the perspective of public authorities as the evidence base is limited. Analysis of the demand for medicines in low-income countries is critical for effective pharmaceutical policy where regulation is less developed, health systems are cash constrained and medicines are not typically subsidised by a public health insurance system
Methods
This study analyses the demand for medicines in low-income countries from the perspective of the prices paid by public authorities. The analysis draws on a unique dataset from World Health Organization (WHO) and Health Action International (HAI) using 2003 data on procurement prices of medicines across 16 low-income countries covering 48 branded drugs and 18 therapeutic categories. Variation in prices, the mark-ups over marginal costs and estimation of price elasticities allows assessment of whether these elasticities are correlated with a country’s national income.
Results
Using the Ramsey pricing rule, the study’s findings suggest that substantial cross-country variation in prices and mark-ups exist, with price elasticities ranging from -1 to -2, which are weakly correlated with national income.
Conclusions
Government demand for medicines thus appears to be price elastic, raising important policy implications aimed at improving access to medicines for patients in low-income countries.

British Medical Journal
02 August 2014(vol 349, issue 7969)
http://www.bmj.com/content/349/7969

Editorials
HPV vaccination – What about the boys?
Margaret Stanley, professor 1,
Colm O’Mahony, consultant in sexual health and HIV2, Simon Barton, clinical director HIV/genitourinary medicine and dermatology3
Author affiliations
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g4783 (Published 29 July 2014) Cite this as: BMJ 2014;349:g4783
Excerpt
A year ago an editorial in The BMJ highlighted the limitations of HPV vaccination in the UK1 and called for decisive action to maximise the public health benefits by thinking about vaccinating boys and some men. Similarly, a recent review by Stanley concluded, after consideration of cost effectiveness, that “failure to implement male vaccination looks like a missed public health opportunity.”2 We therefore share the disappointment expressed by the Royal College of Surgeons’ cancer services committee about the lack of response to its concerns about the inequity of vaccinating only girls against HPV in the UK.3
To summarise, the UK vaccination programme initially opted for Cervarix, a bivalent vaccine against HPV types 16 and 18, which are associated with cervical cancer. The programme switched to the quadrivalent Gardasil (which also protects against genital warts caused by HPV types 6 and 11) in September 2012 but still vaccinates only 12-13 year old girls. Interestingly, new data show that at that age the immune response to these vaccines is excellent and that only two doses of either vaccine is sufficient for long lasting immunity, rather than the three required at older ages…
…The only sensible answer to these dilemmas is a gender neutral vaccination strategy in schools that gives two doses of the vaccine to all 12-13 year old boys and girls. Anything else is discriminatory, inequitable, less effective, and difficult to explain. Can the UK afford to do it? If the price is right, we can’t afford not to.

Views and Reviews
Vaccinate boys as well as girls against HPV: it works, and it may be cost effective
BMJ 2014;349:g4834 (Published 29 July 2014)

Bulletin of the World Health Organization
Volume 92, Number 7, July 2014, 465-544
http://www.who.int/bulletin/volumes/92/7/en/

Varicella and herpes zoster hospitalizations before and after implementation of one-dose varicella vaccination in Australia: an ecological study
Anita E Heywood, Han Wang, Kristine K Macartney & Peter McIntyre
Objective
To examine trends in varicella and herpes zoster (HZ) hospitalization following the availability and subsequent National Immunization Programme funding of one-dose varicella vaccination in Australia.
Methods
Varicella vaccination coverage for children born between 2001 and 2009 was obtained from the Australian Childhood Immunization Register. Principal or any coded varicella or HZ hospitalizations were retrieved from the national hospital morbidity database from 1998 to 2010. Trends in hospitalization rates in different age groups and indigenous status were assessed. Incidence rate ratios (IRR) were calculated between periods before and after implementation of immunization programme funding.
Findings
In the first year of the funded immunization programme, varicella vaccine coverage reached 75% in children aged 24 months and more than 80% in children aged 60 months. Compared with the pre-vaccine period, varicella hospitalization rates during the funded programme were significantly lower for age groups younger than 40 years; with the greatest reduction in children aged 18–59 months (IRR: 0.25; 95% confidence interval, CI: 0.22–0.29). Indigenous children had a higher varicella hospitalization rate compared with non-indigenous children before vaccine implementation (IRR: 1.9; 95% CI: 1.4–2.7), but afterwards reached equivalence (IRR: 1.1; 95% CI: 0.7–1.6). The age-standardized HZ hospitalization rate declined between the periods (IRR: 0.95; 95% CI: 0.92–0.97).
Conclusion
Rapid attainment of high coverage reduced varicella hospitalizations in the targeted age group, particularly for indigenous children, but also in non-targeted age groups, with no increase in HZ hospitalizations. This suggests high one-dose varicella vaccine coverage can have a substantial impact on severe disease.

A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries
Sarah Saleem, Elizabeth M McClure, Shivaprasad S Goudar, Archana Patel, Fabian Esamai, Ana Garces, Elwyn Chomba, Fernando Althabe, Janet Moore, Bhalachandra Kodkany, Omrana Pasha, Jose Belizan, Albert Mayansyan, Richard J Derman, Patricia L Hibberd, Edward A Liechty, Nancy F Krebs, K Michael Hambidge, Pierre Buekens, Waldemar A Carlo, Linda L Wright, Marion Koso-Thomas, Alan H Jobe, Robert L Goldenberg & on behalf of the Global Network Maternal Newborn Health Registry Study Investigators
Objective
To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and neonatal deaths.
Methods
A prospective study of pregnancy outcomes was performed in 106 communities at seven sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Pregnant women were enrolled and followed until six weeks postpartum.
Findings
Between 2010 and 2012, 214 070 of 220 235 enrolled women (97.2%) completed follow-up. The maternal mortality ratio was 168 per 100 000 live births, ranging from 69 per 100 000 in Argentina to 316 per 100 000 in Pakistan. Overall, 29% (98/336) of maternal deaths occurred around the time of delivery: most were attributed to haemorrhage (86/336), pre-eclampsia or eclampsia (55/336) or sepsis (39/336). Around 70% (4349/6213) of stillbirths were probably intrapartum; 34% (1804/5230) of neonates died on the day of delivery and 14% (755/5230) died the day after. Stillbirths were more common in women who died than in those alive six weeks postpartum (risk ratio, RR: 9.48; 95% confidence interval, CI: 7.97–11.27), as were perinatal deaths (RR: 4.30; 95% CI: 3.26–5.67) and 7-day (RR: 3.94; 95% CI: 2.74–5.65) and 28-day neonatal deaths (RR: 7.36; 95% CI: 5.54–9.77).
Conclusion
Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal death increased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
July 2014 Volume 10, Issue 7
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/7/

Effect of the decision-making process in the family on HPV vaccination rates among adolescents 9–17 years of age
Abbey B Berenson*, Tabassum H Laz, Jacqueline M Hirth, Christine J McGrath, Mahbubur Rahman
Abstract
The purpose of this study was to examine the relationship between human papillomavirus (HPV) vaccine uptake among adolescents aged 9–17 years and the decision-making process used by families in determining whether to vaccinate their children against HPV. A cross-sectional sample of women with at least one child aged 9–17 years (n = 1256) was recruited from 3 reproductive health clinics in Southeast Texas during 2011–2013. Self-administered survey included questions about the HPV vaccination decision-making process, HPV vaccine uptake (initiation and 3-dose series completion), and demographics. Among mothers with at least one 9 to 17-year-old daughter (n = 783), 40% independently decided whether or not to vaccinate their daughter against HPV, 22% involved their husbands/partners, and 31% their daughters. Only 7% of respondents reported other formats in the decision-making (husband/partner alone or daughter alone). Similarly, for women with at least one eligible son (n = 759), 39% decided alone, 30% with their husbands/partners, 24% with their sons, and 7% reported other formats. Among mothers with a daughter, those who made the decision independently were more likely to report that their daughters had initiated the HPV vaccine series (30%) compared with women who included their husbands/partners (10%) or daughters (20%) in the decision process or stated other types (18%) of decision making (P < 0.001). The respective figures for the completion of the entire series among daughters were 16%, 6%, 11%, and 11% (P = 0.012). Among mothers with a son, a similar scenario was observed for vaccine initiation (17%, 4%, 10%, and 0%, respectively) (P < 0.001) and completion (7%, 1%, 4%, and 0%, respectively) (P = 0.003). These associations remained significant after adjusting for confounder variables. Awareness programs to increase HPV vaccine uptake should include both parents and children, as all have an important role in deciding whether or not children will be vaccinated.

Human papillomaviruses-related cancers: Presence and prevention strategies in the Middle East and North African Regions
Ala-Eddin Al Moustafa*, Rana Al-Awadhi, Nabiha Missaoui, Ishag Adam, Raika Durusoy, Lina Ghabreau, Nizar Akil, Hussain Gadelkarim Ahmed, Amber Yasmeen, Ghazi Alsbeih
Abstract
Human papillomavirus (HPV) infections are estimated to be the most common sexually transmitted infections worldwide. Meanwhile, it is well established that infection by high-risk HPVs is considered the major cause of cervical cancer since more than 96% of these cancers are positive for high-risk HPVs, especially types 16 and 18. Moreover, during the last 2 decades, numerous studies pointed-out the possible involvement of high-risk HPV in several human carcinomas including head and neck, colorectal and breast cancers. The association between high-risk HPVs and cervical cancer and potentially other human malignancies would necessitate the introduction of vaccines which were generated against the 2 most frequent high-risk HPVs (HPV types 16 and 18) worldwide, including the Middle East (ME) as well as North African countries. The presence of high-risk HPVs in the pathogenesis of human cancers in the ME, which is essential in order to evaluate the importance of vaccination against HPVs, has not been fully investigated yet. In this review, we present an overview of the existing epidemiological evidence regarding the presence of HPV in human cancers in the ME and the potential impact of vaccination against HPV infections and its outcome on human health in this region.

A few years later: Update of the cost-effectiveness of infant pneumococcal vaccination in Dutch children
Pepijn Vemer*, Maarten J Postma
Abstract
This study aimed to calculate the cost-effectiveness of infant pneumococcal vaccination in the Netherlands, using the 13-valent PCV13 vs. the currently used 10-valent PCV10. We adapted a previously published model, using recent estimates of epidemiological and efficacy data. In 12 scenarios, we explored the impact of different assumptions on the incremental cost-effectiveness ration (ICER) of PCV13 over PCV10.Taking only direct effects on invasive pneumococcal disease into account, PCV13 was not found to be cost-effective, at a price difference of €11 per dose. If herd protection, replacement and non-invasive disease were also taken into account, the ICER of PCV13 compared with PCV10 was below €30 000/QALY gained in 11 of 12 scenarios. PCV13 was considered dominant in the primary scenario with a price difference below €2.63 per dose.

Annual influenza vaccination: Uptake, barriers, and enablers among student health care providers at the University of Notre Dame Australia, Fremantle
David A Kelly*, David J Macey, Donna B Mak
Abstract
Despite national and international recommendations, annual influenza vaccination uptake among health care providers (HCPs) remains sub-optimal. This study investigated the uptake, enablers, and barriers to annual influenza vaccination in medicine, nursing, and physiotherapy students at the University of Notre Dame Australia, Fremantle, using an online survey and semi-structured interviews. In 2013, uptake rate of influenza vaccination was 36.3% (95% CI = 31.8–40.8%). Employment as a HCP (OR 1.6, 95% CI 1.1–2.5), being a medical student (OR 2.5, 95% CI 1.2–5.1) and eligibility for government-funded vaccine (OR 7.1, 95% CI 2.7–18.6) were independently associated with increased uptake. Awareness, cost, and convenience were identified as key barriers to vaccination with interview data suggesting that raising awareness of the benefits of influenza vaccination, along with improving student HCPs’ access to affordable, convenient vaccination are likely to improve uptake. Responsibility to increase uptake should be shared between universities and student HCPs.

Cost-effectiveness of vaccination against herpes zoster
Pieter T de Boer*, Jan C Wilschut, Maarten J Postma
Abstract
Herpes zoster (HZ) is a common disease among elderly, which may develop into a severe pain syndrome labeled postherpetic neuralgia (PHN). A live-attenuated varicella zoster virus vaccine has been shown to be effective in reducing the incidence and burden of illness of HZ and PHN, providing the opportunity to prevent significant health-related and financial consequences of HZ. In this review, we summarize the available literature on cost-effectiveness of HZ vaccination and discuss critical parameters for cost-effectiveness results. A search in PubMed and EMBASE was performed to identify full cost-effectiveness studies published before April 2013. Fourteen cost-effectiveness studies were included, all performed in western countries. All studies evaluated cost-effectiveness among elderly above 50 years and used costs per quality-adjusted life year (QALY) gained as primary outcome. The vast majority of studies showed vaccination of 60- to 75-year- old individuals to be cost-effective, when duration of vaccine efficacy was longer than 10 years. Duration of vaccine efficacy, vaccine price, HZ incidence, HZ incidence and discount rates were influential to the incremental cost-effectiveness ratio (ICER). HZ vaccination may be a worthwhile intervention from a cost-effectiveness point of view. More extensive reporting on methodology and more detailed results of sensitivity analyses would be desirable to address uncertainty and to guarantee optimal comparability between studies, for example regarding model structure, discounting, vaccine characteristics and loss of quality of life due to HZ and PHN.

Influenza vaccine hesitancy in a low-income community in central New York State
Manika Suryadevara*, Cynthia A Bonville, Paula F Rosenbaum, Joseph B Domachowske
Abstract
Objective: Influenza vaccine (IV) coverage rates remain suboptimal among US adults. Socioeconomic disparities exist in IV coverage. We describe influenza vaccine attitudes among a low-income community in central New York.
Methods: Adults attending a Salvation Army function during December 2012 were surveyed regarding IV including their intention to be immunized. On-site IV was offered to eligible participants.
Results: The 1041 participants included Whites (non-Hispanics), African Americans, Hispanics, Native Americans, and multi-racial ethnicities. At time of enrollment, 386 (37%) participants had already received 2012–13 IV. Of the 655 unimmunized participants, 299 (46%) stated intent to receive IV, evenly distributed by age, gender, and ethnicity. Of the 312 participants who declined IV, 46% did so because of IV misperceptions. Of the 299 participants who intended to receive vaccine but had not yet done so, 284 (95%) stated the reason for delay was difficult access to vaccine. Intent to receive vaccine was strongly associated with the belief that IV is safe and/or effective (P < 0.05).
Conclusion: IV misperceptions regarding IV efficacy and safety result in suboptimal vaccine uptake in this low-income community, regardless of age, gender, or ethnicity.

Infectious Diseases of Poverty
[Accessed 2 August 2014]
http://www.idpjournal.com/content

Scoping Review
Tackling the existing burden of infectious diseases in the developing world: existing gaps and way forward
Zulfiqar A Bhutta, Rehana A Salam, Jai K Das and Zohra S Lassi
Author Affiliations
Infectious Diseases of Poverty 2014, 3:28 doi:10.1186/2049-9957-3-28
Published: 1 August 2014
Abstract (provisional)
This series evaluates the effectiveness of community-based interventions (CBIs) to prevent and control infectious diseases of poverty (IDoP). Evidence from our reviews suggests that CBIs and school-based delivery platforms are effective in averting risk behaviors and reducing the disease burden. Co-implementation of interventions through existing community-based programs including immunization campaigns, antenatal care (ANT), and maternal and child health programs have the potential to scale-up interventions for IDoP. Future research should focus on the process of developing and implementing efficient community-based programs through a comprehensive approach, and to gauge the effectiveness of various existing delivery models in order to improve morbidity and mortality outcomes.

Scoping Review
The conceptual framework and assessment methodology for the systematic reviews of community-based interventions for the prevention and control of infectious diseases of poverty
Zohra S Lassi, Rehana A Salam, Jai K Das and Zulfiqar A Bhutta
Author Affiliations
Infectious Diseases of Poverty 2014, 3:22 doi:10.1186/2049-9957-3-22
Published: 31 July 2014
Abstract (provisional)
This paper describes the conceptual framework and the methodology used to guide the systematic reviews of community-based interventions (CBIs) for the prevention and control of infectious diseases of poverty (IDoPs). We adapted the conceptual framework from the 3ie work on the ‘Community-Based Intervention Packages for Preventing Maternal Morbidity and Mortality and Improving Neonatal Outcomes’ to aid in the analyzing of the existing CBIs for IDoPs. The conceptual framework revolves around objectives, inputs, processes, outputs, outcomes, and impacts showing the theoretical linkages between the delivery of the interventions targeting these diseases through various community delivery platforms and the consequent health impacts. We also describe the methodology undertaken to conduct the systematic reviews and the meta-analyses.

Scoping Review
Global burden, distribution, and interventions for infectious diseases of poverty
Zulfiqar A Bhutta, Johannes Sommerfeld, Zohra S Lassi, Rehana A Salam and Jai K Das
Author Affiliations
Infectious Diseases of Poverty 2014, 3:21 doi:10.1186/2049-9957-3-21
Published: 31 July 2014
Abstract (provisional)
Infectious diseases of poverty (IDoPs) disproportionately affect the poorest populations in the world and contribute to a cycle of poverty as a result of decreased productivity ensuing from long-term illness, disability, and social stigma. In 2010, the global deaths from the human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) have increased to 1.5 million, and malaria mortality rose to 1.17 million. Mortality from neglected tropical diseases (NTDs) rose to 152,000, while tuberculosis (TB) killed 1.2 million people that same year. Substantial regional variations exist in the distribution of these diseases as they are primarily concentrated in rural areas of Sub-Saharan Africa, Asia, and Latin America, with geographic overlap and high levels of co-infection. Evidence-based interventions exist to prevent and control these diseases, however, the coverage still remains low with an emerging challenge of antimicrobial resistance. Therefore, community-based delivery platforms are increasingly being advocated to ensure sustainability and combat co-infections.Because of the high morbidity and mortality burden of these diseases, especially in resource-poor settings, it is imperative to conduct a systematic review to identify strategies to prevent and control these diseases. Therefore, we have attempted to evaluate the effectiveness of one of these strategies, that is community-based delivery for the prevention and treatment of IDoPs. In this paper, we describe the burden, epidemiology, and potential interventions for IDoPs. In subsequent papers of this series, we describe the analytical framework and the methodology used to guide the systematic reviews, and report the findings and interpretations of our analyses of the impact of community-based strategies on individual IDoPs.

The Lancet
Aug 02, 2014 Volume 384 Number 9941 p377 – 468 e30 – 31
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Polio eradication: placing health before conflict
The Lancet
In a recent interview with Reuters, Bill Gates was optimistic that efforts to eradicate polio in Nigeria could result in the country being declared free of the disease by 2018. Although a commendable goal, ongoing violence in Nigeria makes this timescale unrealistic. National polio eradication efforts have already been hindered by local insurgency groups, and, until health is prioritised over conflict, polio will continue to spread between those who are vulnerable.
Aside from Nigeria, polio is also endemic in other conflict-ridden countries, namely Afghanistan and Pakistan, and 38 cases have emerged in Syria and Iraq. Access to vaccines in some countries is made almost impossible by ongoing conflict. Indeed, a July report by UNICEF on polio in the Middle East outlines the many challenges faced by people working in Syria to eliminate polio. Health workers have difficulty vaccinating the 765 500 children who live in areas under siege or inaccessible because of fighting. Vaccinators are trying desperately to reach every child, frequently being held at gunpoint or having their medical equipment targeted, and often risking their lives to travel into dangerous areas. To prevent polio transmission, the report recommends that health workers must be granted unrestricted access across the country, and health centres and equipment, which are already in short supply, should never be targeted.
On May 5, the WHO Director-General Margaret Chan announced that the spread of polio was a public health emergency of international concern. And earlier this year, WHO placed travel restrictions on Cameroon, Pakistan, and Syria to prevent the international spread of polio, meaning that people from these countries are required to receive a dose of polio vaccine before they travel. Although a step in the right direction, polio spread needs to be curbed within countries themselves. In countries of conflict, it is essential for the neutrality of health care to be respected and that a long enough ceasefire is maintained to allow all children access not only to polio vaccines but also to all basic health care that is currently denied.

The Lancet
Aug 02, 2014 Volume 384 Number 9941 p377 – 468 e30 – 31
http://www.thelancet.com/journals/lancet/issue/current

Contribution of six risk factors to achieving the 25×25 non-communicable disease mortality reduction target: a modelling study
Vasilis Kontis PhD a, Colin D Mathers PhD b, Prof Jürgen Rehm PhD e f g, Gretchen A Stevens DSc b, Kevin D Shield MHSc e, Prof Ruth Bonita PhD h, Leanne M Riley MSc c, Vladimir Poznyak PhD d, Prof Robert Beaglehole DSc h, Prof Majid Ezzati PhD a
Summary
Background
Countries have agreed to reduce premature mortality (defined as the probability of dying between the ages of 30 years and 70 years) from four main non-communicable diseases (NCDs)—cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes—by 25% from 2010 levels by 2025 (referred to as 25×25 target). Targets for selected NCD risk factors have also been agreed on. We estimated the contribution of achieving six risk factor targets towards meeting the 25×25 mortality target.
Methods
We estimated the impact of achieving the targets for six risk factors (tobacco and alcohol use, salt intake, obesity, and raised blood pressure and glucose) on NCD mortality between 2010 and 2025. Our methods accounted for multi-causality of NCDs and for the fact that when risk factor exposure increases or decreases, the harmful or beneficial effects on NCDs accumulate gradually. We used data for risk factor and mortality trends from systematic analyses of available country data. Relative risks for the effects of individual and multiple risks, and for change in risk after decreases or increases in exposure, were from re-analyses and meta-analyses of epidemiological studies.
Findings
If risk factor targets are achieved, the probability of dying from the four main NCDs between the ages of 30 years and 70 years will decrease by 22% in men and by 19% in women between 2010 and 2025, compared with a decrease of 11% in men and 10% in women under the so-called business-as-usual trends (ie, projections based on current trends with no additional action). Achieving the risk factor targets will delay or prevent more than 37 million deaths (16 million in people aged 30—69 years and 21 million in people aged 70 years or older) from the main NCDs over these 15 years compared with a situation of rising or stagnating risk factor trends. Most of the benefits of achieving the risk factor targets, including 31 million of the delayed or prevented deaths, will be in low-income and middle-income countries, and will help to reduce the global inequality in premature NCD mortality. A more ambitious target on tobacco use (a 50% reduction) will almost reach the target in men (>24% reduction in the probability of death), and enhance the benefits to a 20% reduction in women.
Interpretation
If the agreed risk factor targets are met, premature mortality from the four main NCDs will decrease to levels that are close to the 25×25 target, with most of these benefits seen in low-income and middle-income countries. On the basis of mortality benefits and feasibility, a more ambitious target than currently agreed should be adopted for tobacco use.
Funding
UK MRC.

The Lancet
Aug 02, 2014 Volume 384 Number 9941 p377 – 468 e30 – 31
http://www.thelancet.com/journals/lancet/issue/current

Every Newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries
Kim E Dickson, Aline Simen-Kapeu, Mary V Kinney, Luis Huicho, Linda Vesel, Eve Lackritz, Joseph de Graft Johnson, Severin von Xylander, Nuzhat Rafique, Mariame Sylla, Charles Mwansambo, Bernadette Daelmans, Joy E Lawn, for The Lancet Every Newborn Study Group
Preview
Universal coverage of essential interventions would reduce neonatal deaths by an estimated 71%, benefit women and children after the first month, and reduce stillbirths. However, the packages with the greatest effect (care around birth, care of small and ill newborn babies), have low and inequitable coverage and are the most sensitive markers of health system function. In eight of the 13 countries with the most neonatal deaths (55% worldwide), we undertook a systematic assessment of bottlenecks to essential maternal and newborn health care, involving more than 600 experts.

Every Newborn: From evidence to action to deliver a healthy start for the next generation
Elizabeth Mason, Lori McDougall, Joy E Lawn, Anuradha Gupta, Mariam Claeson, Yogan Pillay, Carole Presern, Martina Baye Lukong, Gillian Mann, Marijke Wijnroks, Kishwar Azad, Katherine Taylor, Allison Beattie, Zulfiqar A Bhutta, Mickey Chopra, for The Lancet Every Newborn Study Group , on behalf of the Every Newborn Steering Committee
Preview |
Remarkable progress has been made towards halving of maternal deaths and deaths of children aged 1–59 months, although the task is incomplete. Newborn deaths and stillbirths were largely invisible in the Millennium Development Goals, and have continued to fall between maternal and child health efforts, with much slower reduction. This Series and the Every Newborn Action Plan outline mortality goals for newborn babies (ten or fewer per 1000 livebirths) and stillbirths (ten or fewer per 1000 total births) by 2035, aligning with A Promise Renewed target for children and the vision of Every Woman Every Child.

Pediatrics
August 2014, VOLUME 134 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml

Article
Increasing Provision of Adolescent Vaccines in Primary Care: A Randomized Controlled Trial
Melissa B. Gilkey, PhDa,b, Amanda M. Dayton, MAc, Jennifer L. Moss, MSPHb, Alicia C. Sparks, MPHb, Amy H. Grimshaw, MS, MSWc, James M. Bowling, PhDb, and Noel T. Brewer, PhDa,b
Author Affiliations
aLineberger Comprehensive Cancer Center, and
bGillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; and
cNorth Carolina Division of Public Health, Raleigh, North Carolina
Abstract
OBJECTIVES: To assess the effectiveness of in-person and webinar-delivered AFIX (Assessment, Feedback, Incentives, and eXchange) consultations for increasing adolescent vaccine coverage.
METHODS: We randomly assigned 91 primary care clinics in North Carolina, serving 107 443 adolescents, to receive no consultation or an in-person or webinar AFIX consultation. We delivered in-person consultations in April through May 2011 and webinar consultations in May through August 2011. The state’s immunization registry provided vaccine coverage data for younger patients (ages 11–12 years) and older patients (ages 13–18 years) for 3 adolescent vaccines: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); meningococcal; and human papillomavirus (HPV) vaccines (≥1 dose, females only).
RESULTS: At the 5-month follow-up, AFIX consultations increased vaccine coverage among younger adolescents. Patients in the in-person arm experienced coverage changes that exceeded those in the control arm for Tdap (3.4% [95% confidence interval (CI): 2.2 to 4.6]), meningococcal (4.7% [95% CI: 2.3 to 7.2], and HPV (1.5% [95% CI: 0.3 to 2.7]) vaccines. Patients in the webinar versus control arm also experienced larger changes for these vaccines. AFIX did little to improve coverage among older adolescents. At 1 year, the 3 arms showed similar coverage changes. The effectiveness of in-person and webinar consultations was not statistically different at either time point (all, P >.05).
CONCLUSIONS: Webinar AFIX consultations were as effective as in-person consultations in achieving short-term increases in vaccine coverage for younger adolescents. AFIX consultations for adolescents need improvement to have a stronger and more durable impact, especially for HPV vaccine.

Pediatrics
August 2014, VOLUME 134 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml

Article
Invasive Pneumococcal Disease After Implementation of 13-Valent Conjugate Vaccine
Pui-Ying Iroh Tam, MDa, Lawrence C. Madoff, MDb,c, Brandon Coombes, BSd, and Stephen I. Pelton, MDe
Author Affiliations
aUniversity of Minnesota Children’s Hospital, Minneapolis, Minnesota;
bMassachusetts Department of Public Health, Boston, Massachusetts;
cUniversity of Massachusetts Medical School, Worcester, Massachusetts;
dClinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota; and
eBoston University Medical Center, Boston, Massachusetts
Abstract
OBJECTIVE: To examine whether there is a different clinical profile and severity of invasive pneumococcal disease (IPD) in children caused by nonvaccine types in the era of 13-valent pneumococcal conjugate vaccine (PCV13).
METHODS: Observational study of childhood IPD in Massachusetts based on state public health surveillance data comparing pre-PCV13 (2007–2009) and post-PCV13 (2010–2012) eras.
RESULTS: There were 168 pre-PCV13 cases of IPD and 85 post-PCV13 cases of IPD in Massachusetts children ≤5 years of age. PCV13 serotypes declined by 18% in the first 2 years after PCV13 use (P = .011). In the post-PCV13 phase, a higher proportion of children were hospitalized (57.6% vs 50.6%), and a higher proportion of children had comorbidity (23.5% vs 19.6%). Neither difference was statistically significant, nor were comparisons of IPD caused by vaccine and nonvaccine types. Children with comorbidities had higher rates of IPD caused by a nonvaccine type (27.6% vs 17.2%; P = .085), were more likely to be hospitalized (80.4% vs 50%; P < .0001), and were more likely to have a longer hospital stay (median of 3 days vs 0.5 days; P = .0001).
CONCLUSIONS: Initial data suggest that nonvaccine serotypes are more common in children with underlying conditions, who have greater morbidity from disease. In the post-PCV13 era, a larger proportion of patients are hospitalized, but mortality rates are unchanged. Routine vaccination with PCV13 may not be enough to reduce the risk in patients with comorbidity.

Pediatrics
August 2014, VOLUME 134 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml

Review Article
Safety of Vaccines Used for Routine Immunization of US Children: A Systematic Review
Margaret A. Maglione, MPPa, Lopamudra Das, MPHa, Laura Raaen, MPHa, Alexandria Smith, MPHa, Ramya Chari, PhDa, Sydne Newberry, PhDa, Roberta Shanman, MLSa, Tanja Perry, BHMa, Matthew Bidwell Goetz, MDb, and Courtney Gidengil, MD, MPHa,c
Author Affiliations
aRAND Corporation, Santa Monica, California;
bVA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and
cBoston Children’s Hospital, Boston, Massachusetts
Abstract
BACKGROUND: Concerns about vaccine safety have led some parents to decline recommended vaccination of their children, leading to the resurgence of diseases. Reassurance of vaccine safety remains critical for population health. This study systematically reviewed the literature on the safety of routine vaccines recommended for children in the United States.
METHODS: Data sources included PubMed, Advisory Committee on Immunization Practices statements, package inserts, existing reviews, manufacturer information packets, and the 2011 Institute of Medicine consensus report on vaccine safety. We augmented the Institute of Medicine report with more recent studies and increased the scope to include more vaccines. Only studies that used active surveillance and had a control mechanism were included. Formulations not used in the United States were excluded. Adverse events and patient and vaccine characteristics were abstracted. Adverse event collection and reporting was evaluated by using the McHarm scale. We were unable to pool results. Strength of evidence was rated as high, moderate, low, or insufficient.
RESULTS: Of 20 478 titles identified, 67 were included. Strength of evidence was high for measles/mumps/rubella (MMR) vaccine and febrile seizures; the varicella vaccine was associated with complications in immunodeficient individuals. There is strong evidence that MMR vaccine is not associated with autism. There is moderate evidence that rotavirus vaccines are associated with intussusception. Limitations of the study include that the majority of studies did not investigate or identify risk factors for AEs; and the severity of AEs was inconsistently reported.
CONCLUSIONS: We found evidence that some vaccines are associated with serious AEs; however, these events are extremely rare and must be weighed against the protective benefits that vaccines provide.

PLoS Medicine
(Accessed 2 August 2014)
http://www.plosmedicine.org/

Research Article
Efficacy and Safety of the RTS,S/AS01 Malaria Vaccine during 18 Months after Vaccination: A Phase 3 Randomized, Controlled Trial in Children and Young Infants at 11 African Sites
The RTS,S Clinical Trials Partnership (2014) mail
Published: July 29, 2014
DOI: 10.1371/journal.pmed.1001685
Abstract
Background
A malaria vaccine could be an important addition to current control strategies. We report the safety and vaccine efficacy (VE) of the RTS,S/AS01 vaccine during 18 mo following vaccination at 11 African sites with varying malaria transmission.
Methods and Findings
6,537 infants aged 6–12 wk and 8,923 children aged 5–17 mo were randomized to receive three doses of RTS,S/AS01 or comparator vaccine.
VE against clinical malaria in children during the 18 mo after vaccine dose 3 (per protocol) was 46% (95% CI 42% to 50%) (range 40% to 77%; VE, p VE against clinical malaria in infants was 27% (95% CI 20% to 32%, per protocol; 27% [95% CI 21% to 33%], ITT), with no significant protection against severe malaria, malaria hospitalization, or all-cause hospitalization.
Post-vaccination anti-circumsporozoite antibody geometric mean titer varied from 348 to 787 EU/ml across sites in children and from 117 to 335 EU/ml in infants (per protocol).
VE waned over time in both age categories (Schoenfeld residuals p<0.001). The number of clinical and severe malaria cases averted per 1,000 children vaccinated ranged across sites from 37 to 2,365 and from −1 to 49, respectively; corresponding ranges among infants were −10 to 1,402 and −13 to 37, respectively (ITT). Meningitis was reported as a serious adverse event in 16/5,949 and 1/2,974 children and in 9/4,358 and 3/2,179 infants in the RTS,S/AS01 and control groups, respectively.
Conclusions
RTS,S/AS01 prevented many cases of clinical and severe malaria over the 18 mo after vaccine dose 3, with the highest impact in areas with the greatest malaria incidence. VE was higher in children than in infants, but even at modest levels of VE, the number of malaria cases averted was substantial. RTS,S/AS01 could be an important addition to current malaria control in Africa.
Trial registration
http://www.ClinicalTrials.gov NCT00866619

Editors’ Summary
Background
Every year, more than 200 million cases of malaria occur worldwide, and more than 600,000 people, mainly children living in sub-Saharan Africa, die from this parasitic disease. Malaria parasites are transmitted to people through the bites of infected night-flying mosquitoes and cause fever that needs to be treated promptly with anti-malarial drugs to prevent anemia (a reduction in red blood cell numbers) and life-threatening organ damage. Malaria transmission can be prevented by using long-lasting insecticides sprayed on the indoor walls of homes to kill the mosquitoes that spread the malaria parasite or by sleeping under insecticide-treated nets to avoid mosquito bites and further reduce mosquito numbers. Widespread use of these preventative measures, together with the introduction of artemisinin combination therapy (an effective anti-malarial treatment), has reduced the global burden of malaria by 45% in all age groups, and by 51% among young children, since 2000.
Why Was This Study Done?
Unfortunately, the emergence of insecticide and drug resistance is threatening this advance in malaria control. Moreover, additional interventions—specifically, effective malaria vaccines—will be needed to eliminate malaria in the large areas of Africa where malaria transmission remains high. Currently, there is no licensed malaria vaccine, but RTS,S/AS01, the most advanced malaria vaccine candidate, is undergoing phase 3 clinical trials (the last stage of testing before licensing) in infants and children in seven African countries. The RTS,S Clinical Trials Partnership reported encouraging results on the efficacy and safety of RTS,S/AS01 during 12 months of follow-up in 2011 and 2012. Here, researchers report on the 18-month efficacy and safety of RTS,S/AS01. Vaccine efficacy (VE) is the reduction in the incidence of a disease (the number of new cases that occur in a population in a given period) among trial participants who receive the vaccine compared to the incidence among participants who do not receive the vaccine.
What Did the Researchers Do and Find?
The researchers randomly assigned 6,537 infants aged 6–12 weeks and 8,923 children aged 5–17 months to receive three doses of RTS,S/AS01 or a control vaccine. During 18 months of follow-up, there were 0.69 episodes of clinical malaria (a high temperature and parasites in the blood) per person-year among the children who received all the planned doses of RTS,S/AS01 (the “per protocol” population) and 1.17 episodes per person-year among the control children—a VE against clinical malaria in the per-protocol population of 46%. A similar VE was seen in an intention-to-treat analysis that included all the enrolled children, regardless of whether they received all of the planned vaccine doses; intention-to-treat analyses reflect the real-life situation—in which children sometimes miss vaccine doses—better than per-protocol analyses. In intention-to-treat analyses, the VE among children against severe malaria (fever, parasites in the blood, and symptoms such as anemia) and hospitalization for malaria was 34% and 41%, respectively. Among infants, the VE against clinical malaria was 27% in both per-protocol and intention-to-treat analyses; the vaccine showed no protection against severe malaria or hospitalization. In both infants and children, VE waned with time since vaccination. Across all the study sites, RTS,S/AS01 averted an average of 829 and 449 cases of clinical malaria per 1,000 children and infants vaccinated, respectively. Finally, the serious adverse event meningitis (inflammation of the tissues lining the brain and spinal cord) occurred more frequently in trial participants given RTS,S/AS01 than in those given the control vaccine, but the incidence of other serious adverse events was similar in both groups of participants.
What Do These Findings Mean?
These and other findings show that, during 18 months of follow-up, vaccination of children and young infants with RTS,S/AS01 prevented many cases of clinical and severe malaria and that the impact of vaccination was highest in regions with the highest incidence of malaria. They indicate, as in the earlier analysis, that the VE against clinical and severe malaria is higher in children than in young infants and suggest that protection wanes over time. Whether or not the vaccine played a causal role in the observed cases of meningitis cannot be determined from these results, and the occurrence of meningitis will be followed closely during the remainder of the trial. Other study limitations (for example, variations in the clinical characteristics of participants from one center to another) may also affect the accuracy of these findings and their interpretation. However, by showing that even a modest VE can avert a substantial number of malaria cases, these findings suggest that vaccination with RTS,S/AS01 could have a major public health impact in sub-Saharan Africa

PLoS Neglected Tropical Diseases
(Accessed 2 August 2014)
http://www.plosntds.org/

Research Article
Using Mobile Health (mHealth) and Geospatial Mapping Technology in a Mass Campaign for Reactive Oral Cholera Vaccination in Rural Haiti
Jessica E. Teng, Dana R. Thomson, Jonathan S. Lascher, Max Raymond, Louise C. Ivers
Published: July 31, 2014
DOI: 10.1371/journal.pntd.0003050
Abstract
Background
In mass vaccination campaigns, large volumes of data must be managed efficiently and accurately. In a reactive oral cholera vaccination (OCV) campaign in rural Haiti during an ongoing epidemic, we used a mobile health (mHealth) system to manage data on 50,000 participants in two isolated communities.
Methods
Data were collected using 7-inch tablets. Teams pre-registered and distributed vaccine cards with unique barcodes to vaccine-eligible residents during a census in February 2012. First stored on devices, data were uploaded nightly via Wi-fi to a web-hosted database. During the vaccination campaign between April and June 2012, residents presented their cards at vaccination posts and their barcodes were scanned. Vaccinee data from the census were pre-loaded on tablets to autopopulate the electronic form. Nightly analysis of the day’s community coverage informed the following day’s vaccination strategy. We generated case-finding reports allowing us to identify those who had not yet been vaccinated.
Results
During 40 days of vaccination, we collected approximately 1.9 million pieces of data. A total of 45,417 people received at least one OCV dose; of those, 90.8% were documented to have received 2 doses. Though mHealth required up-front financial investment and training, it reduced the need for paper registries and manual data entry, which would have been costly, time-consuming, and is known to increase error. Using Global Positioning System coordinates, we mapped vaccine posts, population size, and vaccine coverage to understand the reach of the campaign. The hardware and software were usable by high school-educated staff.
Conclusion
The use of mHealth technology in an OCV campaign in rural Haiti allowed timely creation of an electronic registry with population-level census data, and a targeted vaccination strategy in a dispersed rural population receiving a two-dose vaccine regimen. The use of mHealth should be strongly considered in mass vaccination campaigns in future initiatives.
Author Summary
The World Health Organization (WHO) recently endorsed the creation of a global oral cholera vaccine (OCV) stockpile as part of an integrated, strategic framework to address the re-emerging threat that cholera causes worldwide. In conjunction, the WHO also called for continued monitoring and evaluation around the use of OCV in different settings. In response to the cholera epidemic in Haiti that began in October 2010, Partners In Health, an implementing partner of Haiti’s Ministry of Health, vaccinated 50,000 Haitians in two rural communities in the Artibonite Valley in 2012. In this paper, the authors describe the use of mobile health (mHealth) technology for data collection and geospatial mapping to document this rural OCV campaign, focusing on the utility, benefits, and challenges of mHealth in a reactive campaign in the midst of the ongoing epidemic.
Introducing a Dengue Vaccine to Mexico: Development of a System for Evidence-Based Public Policy Recommendations
Miguel Betancourt-Cravioto, Pablo Kuri-Morales, Jesús Felipe González-Roldán, Roberto Tapia-Conyer, the Mexican Dengue Expert Group Policy Platform | published 31 Jul 2014 | PLOS Neglected Tropical Diseases 10.1371/journal.pntd.0003009
No abstract

Risk Analysis
July 2014 Volume 34, Issue 7 Pages 1161–1358
http://onlinelibrary.wiley.com/doi/10.1111/risa.2014.34.issue-7/issuetoc

Original Research Article
A Scale of Risk
Paolo Gardoni1,* and
Colleen Murphy2
Article first published online: 20 DEC 2013
DOI: 10.1111/risa.12150
Abstract
This article proposes a conceptual framework for ranking the relative gravity of diverse risks. This framework identifies the moral considerations that should inform the evaluation and comparison of diverse risks. A common definition of risk includes two dimensions: the probability of occurrence and the associated consequences of a set of hazardous scenarios. This article first expands this definition to include a third dimension: the source of a risk. The source of a risk refers to the agents involved in the creation or maintenance of a risk and captures a central moral concern about risks. Then, a scale of risk is proposed to categorize risks along a multidimensional ranking, based on a comparative evaluation of the consequences, probability, and source of a given risk. A risk is ranked higher on the scale the larger the consequences, the greater the probability, and the more morally culpable the source. The information from the proposed comparative evaluation of risks can inform the selection of priorities for risk mitigation.

Vaccine
Volume 32, Issue 37, Pages 4703-4812 (20 August 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/37

Editorial
Measles and mumps outbreaks in the United States: Think globally, vaccinate locally
Pages 4703-4704
Jennifer A. Whitaker, Gregory A. Poland
No abstract

Discussion
Big science for vaccine development
Pages 4705-4707
Rino Rappuoli, Donata Medaglini
No abstract

Vaccine
Volume 32, Issue 37, Pages 4703-4812 (20 August 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/37

Placebo use in vaccine trials: Recommendations of a WHO expert panel
Pages 4708-4712
Annette Rid, Abha Saxena, Abdhullah H. Baqui, Anant Bhan, Julie Bines, Marie-Charlotte Bouesseau, Arthur Caplan, James Colgrove, Ames Dhai, Rita Gomez-Diaz, Shane K. Green, Gagandeep Kang, Rosanna Lagos, Patricia Loh, Alex John London, Kim Mulholland, Pieter Neels, Punee Pitisuttithum, Samba Cor Sarr, Michael Selgelid, Mark Sheehan, et al.
Abstract
Highlights
:: Placebo controls may be acceptable even when an efficacious vaccine exists, in the following four possible situations:
:: When developing a locally affordable vaccine.
:: When evaluating the local safety and efficacy of an existing vaccine.
:: When testing a new vaccine when an existing vaccine is not considered appropriate locally.
:: When determining the local burden of disease.

Vaccine
Volume 32, Issue 37, Pages 4703-4812 (20 August 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/37

HPV vaccination among lesbian and bisexual women: Findings from a national survey of young adults
Original Research Article
Pages 4736-4742
Annie-Laurie McRee, Mira L. Katz, Electra D. Paskett, Paul L. Reiter
Abstract
Background
Human papillomavirus (HPV) infection and associated cervical disease are common among all women, regardless of sexual identity, yet limited research has examined HPV vaccination among lesbian and bisexual women.
Methods
A national sample of lesbian and bisexual women ages 18–26 (n = 543) completed our online survey during Fall 2013. We used multivariable logistic regression to identify correlates of HPV vaccine initiation (receipt of at least 1 dose) and completion (receipt of all 3 recommended doses among initiators).
Results
Overall, 45% of respondents had initiated HPV vaccine and 70% of initiators reported completing the series. HPV vaccine initiation was higher among respondents who were students, had received a healthcare provider’s recommendation, perceived greater positive social vaccination norms, or anticipated greater regret if they did not get vaccinated and later got HPV. Initiation was lower among those who perceived greater HPV vaccine harms or greater barriers to getting the vaccine (all p < .05). HPV vaccine completion was higher among initiators who had a college degree while it was lower among those who perceived a greater likelihood of acquiring HPV or who anticipated greater regret if they got the vaccine and fainted (all p < .05). Among HPV vaccine initiators who had not yet completed the series, about half (47%) intended to get the remaining doses.
Conclusions
Many lesbian and bisexual women are not getting vaccinated against HPV. Healthcare provider recommendations and women’s health beliefs may be important leverage points for increasing vaccination among this population.

Vaccine
Volume 32, Issue 37, Pages 4703-4812 (20 August 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/37

Vaccination perceptions of school employees in a rural school district
Original Research Article
Pages 4766-4771
Janelle Macintosh, Karlen E. Luthy, Renea L. Beckstrand, Lacey M. Eden, Jennifer Orton
Abstract
Highlights
:: It is important to evaluate why school employees are not adequately vaccinated for highly virulent diseases, such as influenza and measles, mumps, and rubella.
:: Only about half of school employees in one rural Utah school district were adequately vaccinated against influenza.
:: About a third of school employees reported receiving a measles, mumps, and rubella vaccine during adulthood.
:: Even though almost half of school employees supported a vaccine mandate, no such vaccine requirement existed in the school district.
:: Public health officials, health care providers, and school administrators should collaborate to improve vaccination rates among school employees.

Vaccine
Volume 32, Issue 37, Pages 4703-4812 (20 August 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/37

Healthcare workers under a mandated H1N1 vaccination policy with employment termination penalty: A survey to assess employee perception
Original Research Article
Pages 4786-4790
Lori Winston, Stephanie Wagner, Shu Chan
Abstract
The ethical debate over mandatory healthcare worker (HCW) influenza vaccination is a heated one. Our study hospital instituted a mandatory employee influenza vaccination policy for the 2009–2010 influenza season during the highly publicized pandemic of the H1N1 “Swine Flu.” Under this mandate there was no informed declination option, and termination of employment was the consequence for noncompliance. Our objective was to examine HCW perceptions of the H1N1 influenza virus, the vaccine, and the strict mandated vaccination policy. A survey was designed, distributed, and anonymously collected. In total, 202 completed questionnaires were obtained via accidental sampling by the investigators achieving a 100% response rate. Data analysis showed that 31.7% of surveyed HCWs felt the mandate was an infringement on their rights and 3.5% of HCWs would electively seek employment elsewhere. Significantly more nurses and clerks/technicians were opposed to the mandate compared to other types of employees. 96% felt that the mandating hospital should be liable should a significant adverse effect occur from receiving the vaccine. While the mandate helped to increase HCW influenza vaccination rates dramatically, the strict consequence of employment termination created negative feelings of coercion. Adopting a policy that includes a declination option with mandatory masking during influenza season might be a more widely acceptable and still adequate approach.

Vaccines — Open Access Journal
(Accessed 2 August 2014)
http://www.mdpi.com/journal/vaccines

Review
Developments in Viral Vector-Based Vaccines
by Takehiro Ura, Kenji Okuda and Masaru Shimada
doi:10.3390/vaccines2030624 – published online 29 July 2014
Abstract:
Viral vectors are promising tools for gene therapy and vaccines. Viral vector-based vaccines can enhance immunogenicity without an adjuvant and induce a robust cytotoxic T lymphocyte (CTL) response to eliminate virus-infected cells. During the last several decades, many types of viruses have been developed as vaccine vectors. Each has unique features and parental virus-related risks. In addition, genetically altered vectors have been developed to improve efficacy and safety, reduce administration dose, and enable large-scale manufacturing. To date, both successful and unsuccessful results have been reported in clinical trials. These trials provide important information on factors such as toxicity, administration dose tolerated, and optimized vaccination strategy. This review highlights major viral vectors that are the best candidates for clinical use.

The Atlantic
http://www.theatlantic.com/magazine/
Accessed 2 August 2014

Cancer Vaccine Exists, Goes Unused
James Hamblin Jul 25 2014, 9:10 AM ET
The HPV vaccine could prevent thousands of people every year from getting cancer. But a new CDC report says most children still do not receive it.

Forbes
http://www.forbes.com/
Accessed 2 August 2014

Robert Kennedy’s Dangerous Anti-Vaccine Activism
Steven Salzberg, Contributor Jul 20, 2014
Robert F. Kennedy Jr. is coming out with a new book that claims thimerosal in vaccines causes autism. This claim has been thoroughly discredited, but RFK Jr. believes that it’s all a big conspiracy and that he’s right. His crazy anti-vaccine views coupled with his fame make for an especially dangerous combination.

Vaccines Are A Medical Miracle-And The Best Value In Healthcare
Henry I. Miller, Contributor Jul 30, 2014
Thanks to the availability of safe, effective, affordable vaccines, parents of small children today know little of the fear–much less the reality–of deadly childhood diseases. Vaccines are the best value in our healthcare system, but a New York Times medical writer thinks they’re too expensive.

PAHO/WHO: Haiti to launch cholera vaccination with PAHO/WHO support
Port-au-Prince, Haiti, 23 July 2014 (PAHO/WHO)
Excerpt
Haiti is set to vaccinate 200,000 people in three departments against cholera starting in August, with support from the Pan American Health Organization/World Health Organization (PAHO/WHO).
The campaign will be carried out in the Artibonite (Gonaives and Ennery), Central (Lascahobas, Saut d’Eau, Savanette and Mirebalais), and West (Arcahaie) departments, which were chosen by the Ministry of Public Health and Population (MSPP) because they are considered high-risk zones…

PAHO/WHO’s representative in Haiti, Jean-Luc Poncelet, noted that vaccination is one of a series of measures implemented by Haitian health authorities with support from PAHO/WHO and other international partners. Other key measures include timely treatment for people sickened by the disease, improved access to potable water and adequate sanitation, the promotion of community participation and strengthened epidemiological surveillance…

Last week, PAHO/WHO shipped 400,000 doses of oral cholera vaccine (OCV) to Haiti. UN Secretary-General Ban Ki-moon formally presented the vaccines to Minister of Health Florence Guillaume. They are being kept at Haiti’s PROMESS warehouse, which has been managed by PAHO/WHO since 1992.

Financed by the UN’s Central Emergency Response Fund (CERF), the vaccines are from a global stockpile created by the World Health Assembly in 2011 to provide an additional tool for controlling cholera epidemics around the world. Besides Haiti, the global stockpile—for which WHO serves as secretariat—has also provided vaccines to the Democratic Republic of Congo, South Sudan, Guinea and Ethiopia. The stockpile is also supported by the International Federation of Red Cross and Red Crescent Societies, Doctors without Borders and UNICEF.

PAHO/WHO is also assisting efforts to fight cholera in Haiti and the Dominican Republic along with other members of the Regional Coalition for Water and Sanitation to Eliminate Cholera in Hispaniola. The Coalition, for which PAHO/WHO serves as secretariat, provides technical expertise on cholera control and elimination and is seeking to mobilize resources to support the two countries’ national plans to eliminate cholera by 2022…

:: Oral cholera vaccine stockpile (WHO)
:: Regional Coalition for Water and Sanitation to Eliminate Cholera in Hispaniola

.

WHO: Humanitarian Health Action [to 26 July 2014]
:: The cholera outbreak and health situation in South Sudan
25 July 2014 –“General security situation remained calm in most parts of the country, with isolated incidents and clashes in Upper Nile, Jonglei and Unity states. No new significant displacements have been reported. Efforts to contain the cholera outbreak continue. Health facilities had recorded 5,141 (CFR 2.2%) cases by 21 July 2014. Acute Watery Diarrhoea (AWD) is the leading cause of morbidity among Internally Displaced People (IDP)…
:: Read the latest health situation report
pdf, 894kb
:: Read the latest Health Cluster bulletin
pdf, 883kb

POLIO [to 26 July 2014]

Report: Polio – Outbreak in the Middle East :: War in Syria Opens the Door to an Old Enemy
WHO, UNICEF
July 2014 12 pages
Excerpt from WHO announcement
Amman/ Cairo, 22 July 2014 – In a report released today, WHO and UNICEF announced completion of the first phase of the biggest polio vaccination campaign ever undertaken in the history of the Middle East; 25 million children under the age of five have been reached in seven countries in 37 rounds.

“Despite immense challenges and the desperate conditions around the region, children were vaccinated from three to six times. This gives a glimpse of hope and is largely thanks to thousands of unsung heroes: committed health workers and volunteers who undertook such a formidable task all over the region and inside Syria braving dangers to provide the polio vaccination to children,” said Maria Calivis, UNICEF’s Regional Director for the Middle East and North Africa.

The report attributes the return of polio to Syria after 14 years to the following factors: disruption of routine immunization; severe damage to Syria’s health infrastructure; continuous population displacement within Syria and across its borders; and missed children…

“Polio has forced its way back to Syria, adding to what was already a humanitarian disaster. We got to a point where we had to work with very limited resources to defeat what had been a long forgotten enemy in this region: one that does not know borders or checkpoints and can travel fast, infecting children not just in war torn Syria but across the region” said Chris Maher, WHO Manager for Polio Eradication and Emergency Support…

The report says that a number of critical actions must be undertaken to end the polio spread in the region:
:: Grant immediate and unhindered access to hard-to-reach children under the age of five inside Syria.
:: Guarantee the safe passage of health workers and protect medical vehicles and other cold chain equipment inside Syria.
:: Raise awareness on polio and the need to vaccinate all children under the age of five around the region multiple times.
:: Secure funding to undertake repeated vaccination rounds by the end of 2014…

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GPEI Update: Polio this week – As of 23 July 2014
Global Polio Eradication Initiative
Editor’s Excerpt and text bolding
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Polio vaccination campaigns reaching more than 25 million children multiple times in the Middle East since October have helped slow the outbreak: new report from UNICEF and WHO emphasises that the second phase of outbreak response focuses on reaching those children who continue to be missed.
:: In the Horn of Africa, further efforts are on to intensify the outbreak response, following confirmation of new cases from Somalia last week. These cases underscore the risk that ongoing low-level poliovirus transmission continues to pose to children across the region, and of the urgent need to fully stop the outbreak rapidly completely.
Afghanistan
:: Khost province borders Pakistan, where communities displaced by military action have been leaving North Waziristan, Pakistan. Health authorities in surrounding districts of Pakistan and across the border in Afghanistan have been vaccinating displaced children: more than 35,000 displaced children under the age of 10 are reported to have received a dose of bivalent oral polio vaccine (bivalent OPV) as they entered the Afghan provinces of Paktyka and Khost.
Nigeria
:: One new circulating vaccine-derived poliovirus type 2 (cVDPV2) case was reported in the past week, with onset of paralysis on 13 June from Borno. The total number of cVDPV2 cases for 2014 is now 14. It is the most recent cVDPV2 case in the country.
Pakistan
:: Five new WPV1 cases were reported in the past week, three from Federally Administered Tribal Areas (FATA – two from North Waziristan and one from South Waziristan), one from Khyber Pakhtunkhwa (KP) and one from Gadap, greater Karachi, Sindh. This brings the total number of WPV1 cases in the country to 99 for 2014. The case from South Waziristan is the most recent in the country, with onset of paralysis on 28 June.
:: In order to protect those displaced by the military action in North Waziristan, people of all ages continue to be vaccinated against polio at transit points within the country (over 394,000 vaccinated to date) and during several rounds of house-to-house immunization campaigns in the host communities (over 500,000 vaccinated in the first two rounds, with a third round just concluded)
Central Africa
:: The entire population of Equatorial Guinea, regardless of age, will be vaccinated in a campaign starting on 26 July. A house-to-house search for acute flaccid paralysis (AFP) cases will be conducted during the campaign; a similar search is currently taking place in Gabon. Cameroon, the Central African Republic (CAR), the Democratic Republic of the Congo (DR Congo), Gabon and the Republic of Congo also have mass vaccination campaigns planned for July.

PATH: New tools for polio surveillance could aid eradication efforts
July 22, 2014
Excerpt
With grant funding made possible by the Paul G. Allen Family Foundation, two new tools to help detect the poliovirus may soon strengthen global efforts to eradicate the disease. The foundation will invest up to US$5.3 million dollars in support of this goal.

The tools, a system to improve environmental surveillance and a simplified diagnostic test, were developed by PATH, a leading international health organization, and researchers at the University of Washington (UW). They have the potential to help workers identify and stop polio by making it easier to find the virus in sewage and among people. Although polio spreads very quickly and can be devastating, many people will never show symptoms—making early detection and response crucial for controlling the spread of disease.

The grant announcement, made today by PATH and UW, comes at a time of heightened attention to the spread of polio worldwide. In early May, the World Health Organization (WHO) declared it a Public Health Emergency of International Concern, warning that the recent spread of the virus from Pakistan, Syria, and Cameroon to neighboring countries could spark widespread epidemics if leaders do not take action.

The initial $2.4 million of the grant, administered in partnership with the Bill & Melinda Gates Foundation, will allow the PATH/UW team to accelerate development, evaluation, and introduction of the tools in coordination with global polio eradication partners. Additional technical and administrative support will be provided by the Gates Foundation as part of its longstanding support for eradication. PATH and UW will seek additional technical advice from the US Centers for Disease Control and Prevention (CDC) and WHO….

WHO Watch [to 26 July 2014]
:: WHO Director-General addresses conference on cervical cancer in Africa
Dr Margaret Chan, Director-General of the World Health Organization
Goodwill message to participants of the 8th Stop cervical, breast and prostate cancer in Africa conference: Moving forward to end cervical cancer by 2030: Universal access to cervical cancer prevention
Windhoek, Namibia , 20 July 2014

:: World Hepatitis Day 2014: Think again
25 July 2014 — On World Hepatitis Day, 28 July, WHO welcomes new progress in tackling one of the world’s most serious diseases. Viral hepatitis – a group of infectious diseases known as hepatitis A, B, C, D, and E – affects millions of people worldwide, causing acute and chronic liver disease and killing close to 1.4 million people every year. WHO and partners urge policy-makers, health workers and the public to “think again” about this silent killer.
Find out more about World Hepatitis Day 2014

GAVI Watch [to 26 July 2014]
http://www.gavialliance.org/library/news/press-releases

24 July 2014
German Government to host crucial GAVI Alliance pledging event under the patronage of Chancellor Angela Merkel
Excerpt
Berlin, 24 July 2014 – The German Government today announced that it will convene the GAVI Alliance replenishment pledging meeting under the patronage of Federal Chancellor Angela Merkel in Berlin on 27th January 2015.
The event will mark the final stage of the Alliance’s replenishment process, in which donors have been asked to commit an additional US$ 7.5 billion to support immunisation programmes in developing countries between 2016 and 2020…

CDC/MMWR Watch [to 26 July 2014]
http://www.cdc.gov/mmwr/mmwr_wk.html

Safe and effective vaccine that prevents cancer continues to be underutilized
Latest vaccination coverage estimates for adolescents show only small increase for HPV vaccine
July 24, 2014
Excerpt
CDC officials announced today that the number of girls and boys aged 13-17 years receiving human papillomavirus (HPV) vaccine remains unacceptably low despite a slight increase in vaccination coverage since 2012, according to data from CDC′s 2013 National Immunization Survey-Teen (NIS-Teen) published in this week′s Morbidity and Mortality Weekly Report (MMWR).
HPV vaccine prevents various forms of cancer, but HPV vaccine remains underutilized. There is a substantial gap between the number of adolescents receiving tetanus, diphtheria, and pertussis (Tdap) vaccine and the number receiving HPV vaccine. It is estimated that only 57 percent of adolescent girls and 35 percent of adolescent boys received one or more doses of HPV vaccine. However, nearly 86 percent of adolescents had received one dose of Tdap vaccine…

MMWR Weekly – July 25, 2014 / Vol. 63 / No. 29
:: World Hepatitis Day — July 28, 2014
:: Progress Toward Prevention of Transfusion-Transmitted Hepatitis B and Hepatitis C Infection — Sub-Saharan Africa, 2000–2011
:: Human Papillomavirus Vaccination Coverage Among Adolescents, 2007–2013, and Postlicensure Vaccine Safety Monitoring, 2006–2014 — United States
:: National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2013
:: WHO Global Rotavirus Surveillance Network: A Strategic Review of the First 5 Years, 2008–2012