Commentary – Vaccine refrigeration: Thinking outside of the box

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
April 2014  Volume 10, Issue 4
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/4/

Commentary
Vaccine refrigeration: Thinking outside of the box
Patrick J McColloster and Andres Martin-de-Nicolas
http://dx.doi.org/10.4161/hv.27660
Abstract
This commentary reviews recent changes in Centers for Disease Control (CDC) vaccine storage guidelines that were developed in response to an investigative report by the Office of the Inspector General. The use of temperature data loggers with probes residing in glycol vials is advised along with storing vaccines in pharmaceutical refrigerators. These refrigerators provide good thermal distribution but can warm to 8 °C in less than one hour after the power is discontinued. Consequently, electric grid instability influences appropriate refrigerator selection and the need for power back-up. System Average Interruption Duration Index (SAIDI) values quantify this instability and can be used to formulate region-specific guidelines. A novel aftermarket refrigerator regulator with a battery back-up power supply and microprocessor control system is also described.

Commentary: Coercion and polio eradication efforts in Moradabad

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
April 2014  Volume 10, Issue 4
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/4/

Commentary
Coercion and polio eradication efforts in Moradabad
Christy A Rentmeester, Rajib Dasgupta, Kristen A Feemster and Randall M Packard
http://dx.doi.org/10.4161/hv.27667
Abstract
We introduce the problem of vaccine coercion as reported in Moradabad, India. We offer commentary and critical analysis on ethical complexities at the intersection of global public health and regional political strife and relate them to broader vaccine goals. We draw upon a historical example from malaria vaccine efforts, focusing specifically on ethical and health justice issues expressed through the use of coercion in vaccine administration. We suggest how coercion is indicative of failed leadership in public health and consider community-based collaborations as models for cultivating local investment and trust in vaccination campaigns and for success in global public health initiatives.

Measles epidemic from 1951 to 2012 and vaccine effectiveness in Guangzhou, southern China

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
April 2014  Volume 10, Issue 4
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/4/

Research Paper
Measles epidemic from 1951 to 2012 and vaccine effectiveness in Guangzhou, southern China
Zhicong Yang, Jianxiong Xu, Ming Wang, Biao Di, Huifeng Tan, Qing He, Yanshan Cai, Jianhua Liang, Wensui Hu, Zhiqiang Dong and Chuanxi Fu
http://dx.doi.org/10.4161/hv.27895

Abstract
Background:
Since the National Expanded Program on Immunization was implemented in China, considerable progress has been made in reducing the incidence of measles. However, the incidence of measles increased again in 2004. Few post-marketing studies on measles vaccine effectiveness was reported in China. In this study, we aimed to describe the measles epidemic and to evaluate the effectiveness of the measles vaccine in Guangzhou, southern China.
Methods:

Based on the surveillance data for measles, we investigated the epidemiology during different periods between 1951 and 2012. We analyzed the clinical characteristics of laboratory-confirmed cases of measles between 2009 and 2012 and conducted a case-control study using test-negative cases as controls. We determined the protective effect of measles vaccine.
Results:

The highest annual incidence in Guangzhou was 2187.15/100 000 in 1964, and the lowest was 0.32/100 000 in 2011. The average incidence of measles from 1951 to 2012 was 306.27/100 000. There was a significant tendency of decline in recent years. From 2009 to 2012, there are 700 laboratory-confirmed cases were reported with an average onset age of 2.5 (median) years. The non-vaccinated target population (age <8 months and ≥15 years) accounted for 56.7% of the cases. The transient (non-resident) population accounted for 51.3% of the cases. Fewer cases were observed in the population targeted for measles vaccine (aged 8 months to 14 years). The effectiveness of a single dose of the measles vaccine was 89.1% (95% confidence interval (CI), 44.5–97.9), and the effectiveness of ≥2 doses of the measles vaccine was 97.8% (95% CI, 88.3–99.6) in children aged 8 months to 14 years old.
Conclusions:

There is a significant overall decline in the incidence of measles (including clinical and laboratory confirmed cases) in the measles vaccine targeted population in Guangzhou. Two doses of measles vaccine are more effective than one dose in preventing measles in China. In order to accelerate the elimination of measles, vaccination should also be given to the transient and the non-vaccine targeted population in a national schedule.

Special Focus Articles: Therapeutic vaccines

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
April 2014  Volume 10, Issue 4
http://www.landesbioscience.com/journals/vaccines/toc/volume/10/issue/4/

Special Focus: Therapeutic vaccines

Review
Emerging immunotherapies for rheumatoid arthritis
Gary Reynolds, Faye AH Cooles, John D Isaacs and Catharien MU Hilkens
http://dx.doi.org/10.4161/hv.27910
Abstract

Review
Milestones in contraceptive vaccines development and hurdles in their application
Satish Kumar Gupta, Abhinav Shrestha and Vidisha Minhas
http://dx.doi.org/10.4161/hv.27202
Abstract

Review
 Non-antigenic and antigenic interventions in type 1 diabetes
nna KE Rydén, Johnna D Wesley, Ken T Coppieters and Matthias G Von Herrath
http://dx.doi.org/10.4161/hv.26890
Abstract

Review
Immunotherapeutic approaches to treat multiple myeloma
Mieke WH Roeven, Willemijn Hobo, Nicolaas Schaap and Harry Dolstra
http://dx.doi.org/10.4161/hv.27380
Abstract

Review
Current and potential immune therapies and vaccines in the management of psoriasis
Benjamin H Kaffenberger, Grace L Lee, Kelly Tyler, Derek V Chan, Wael Jarjour, Maria E Ariza, Marshall V Williams and Henry K Wong
http://dx.doi.org/10.4161/hv.27532
Abstract

Review
Obesity vaccines
Mariana P Monteiro
http://dx.doi.org/10.4161/hv.27537
Abstract

Review
Vaccination against Alzheimer disease: An update on future strategies
Antonia Fettelschoss, Franziska Zabel and Martin F Bachmann
http://dx.doi.org/10.4161/hv.28183

Lancet Comment – Global elderly care in crisis :: The right to participate in high-risk research

The Lancet  
Mar 15, 2014  Volume 383  Number 9921   p927 – 1012
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Global elderly care in crisis
The Lancet
Preview |
The world’s population is ageing rapidly at an unprecedented rate. The proportion of people aged over 60 years will double from about 11% to 22% between 2000 and 2050. Population ageing has profound implications for the burden of disease and social and health-care systems. How well prepared are countries to cope with these changing demographics? Unfortunately, current elderly care systems worldwide are already unable to address the soaring demand from fast growing numbers of older people, even in higher-income countries.

Viewpoint
The right to participate in high-risk research
David Shaw
Preview |
Institutional review boards have a reputation for impeding research. Indeed, many studies are poorly designed, exploit participants, or do not ask a relevant question;1 the rejection of such protocols by institutional review boards is entirely proper. However, institutional review boards also frequently reject or tamper with perfectly sound and relevant studies to protect participants from harm,2 in accordance with the widely accepted message that “clinical research is justified only when participants are protected from excessive risks”.

Proof of principle for epitope-focused vaccine design

Nature   
Volume 507 Number 7491 pp139-268  13 March 2014
http://www.nature.com/nature/current_issue.html

Nature | Article
Proof of principle for epitope-focused vaccine design
Bruno E. Correia, John T. Bates, Rebecca J. Loomis, Gretchen Baneyx, Chris Carrico, Joseph G. Jardine, Peter Rupert, Colin Correnti, Oleksandr Kalyuzhniy, Vinayak Vittal, Mary J. Connell, Eric Stevens, Alexandria Schroeter, Man Chen, Skye MacPherson, Andreia M. Serra, Yumiko Adachi,
Margaret A. Holmes, Yuxing Li, Rachel E. Klevit, Barney S. Graham, Richard T. Wyatt, David Baker, Roland K. Strong, James E. Crowe et al.

Abstract
Vaccines prevent infectious disease largely by inducing protective neutralizing antibodies against vulnerable epitopes. Several major pathogens have resisted traditional vaccine development, although vulnerable epitopes targeted by neutralizing antibodies have been identified for several such cases. Hence, new vaccine design methods to induce epitope-specific neutralizing antibodies are needed. Here we show, with a neutralization epitope from respiratory syncytial virus, that computational protein design can generate small, thermally and conformationally stable protein scaffolds that accurately mimic the viral epitope structure and induce potent neutralizing antibodies. These scaffolds represent promising leads for the research and development of a human respiratory syncytial virus vaccine needed to protect infants, young children and the elderly. More generally, the results provide proof of principle for epitope-focused and scaffold-based vaccine design, and encourage the evaluation and further development of these strategies for a variety of other vaccine targets, including antigenically highly variable pathogens such as human immunodeficiency virus and influenza.

The Impact of HPV Female Immunization in Italy: Model Based Predictions

PLoS One
[Accessed 15 March 2014]
http://www.plosone.org/

Research Article
The Impact of HPV Female Immunization in Italy: Model Based Predictions
Giorgio Guzzetta mail, Luca Faustini, Donatella Panatto, Roberto Gasparini, Piero Manfredi
Published: March 11, 2014
DOI: 10.1371/journal.pone.0091698
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0091698

Abstract
The Human Papillomavirus (HPV) is a sexually transmitted virus that causes cervical cancer. Since 2008 a vaccination program targeting 12-year-old girls has been initiated in Italy, backing up the cervical screening program already active since 1996. We propose a mathematical model of HPV transmission dynamics with the aim of evaluating the impact of these prevention strategies. The model considers heterosexual transmission of HPV types 16 and 18, structured by sex, age and sexual activity level, where transition to sexual activity is explicitly modeled from recent survey data. The epidemiological structure is a hybrid SIS/SIR, where a fraction of individuals recovering from infection develops permanent immunity against reinfection. Infections may progress to cervical lesions and cancer and heal spontaneously or upon treatment. Women undergoing hysterectomy (either after treatment of HPV lesions or by other causes) also transmit HPV infection. The model fits well both the age-specific prevalence of HPV infections and the incidence of cervical cancers in Italy, and accurately reproduces the decreasing trend in cancer incidence due to the introduction of the screening program. The model predicts that if the screening coverage is maintained at current levels, even in the absence of vaccination, such trend will continue in the next few decades, eventually plateauing at 25% below the current level. The additional initiation of routine vaccination targeting 12-year-old girls will further reduce cervical cancer incidence by two thirds at equilibrium, under realistic assumptions of 70% coverage and a duration of protective immunity of 50 years. If catch-up immunization of 25-year-old women at first cervical screening is also introduced, about 3,000 cervical cancer cases overall can be averted, corresponding to 9.6% of all cases expected in the scenario without catch-up. We conclude that HPV vaccination in addition to cervical screening will significantly reduce the burden of cervical cancer in Italy.

Knowledge and Awareness of HPV Vaccine and Acceptability to Vaccinate in Sub-Saharan Africa: A Systematic Review

PLoS One
[Accessed 15 March 2014]
http://www.plosone.org/

Research Article
Knowledge and Awareness of HPV Vaccine and Acceptability to Vaccinate in Sub-Saharan Africa: A Systematic Review
Stacey Perlman, Richard G. Wamai, Paul A. Bain, Thomas Welty, Edith Welty, Javier Gordon Ogembo mail
Published: March 11, 2014
DOI: 10.1371/journal.pone.0090912
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0090912

Abstract
Objectives
We assessed the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate in sub-Saharan African (SSA) countries. We further identified countries that fulfill the two GAVI Alliance eligibility criteria to support nationwide HPV vaccination.

Methods
We conducted a systematic review of peer-reviewed studies on the knowledge and awareness of cervical cancer, HPV and HPV vaccine, and willingness and acceptability to vaccinate. Trends in Diphtheria-tetanus-pertussis (DTP3) vaccine coverage in SSA countries from 1990–2011 were extracted from the World Health Organization database.

Findings
The review revealed high levels of willingness and acceptability of HPV vaccine but low levels of knowledge and awareness of cervical cancer, HPV or HPV vaccine. We identified only six countries to have met the two GAVI Alliance requirements for supporting introduction of HPV vaccine: 1) the ability to deliver multi-dose vaccines for no less than 50% of the target vaccination cohort in an average size district, and 2) achieving over 70% coverage of DTP3 vaccine nationally. From 2008 through 2011 all SSA countries, with the exception of Mauritania and Nigeria, have reached or maintained DTP3 coverage at 70% or above.

Conclusion
There is an urgent need for more education to inform the public about HPV, HPV vaccine, and cervical cancer, particularly to key demographics, (adolescents, parents and healthcare professionals), to leverage high levels of willingness and acceptability of HPV vaccine towards successful implementation of HPV vaccination programs. There is unpreparedness in most SSA countries to roll out national HPV vaccination as per the GAVI Alliance eligibility criteria for supporting introduction of the vaccine. In countries that have met 70% DTP3 coverage, pilot programs need to be rolled out to identify the best practice and strategies for delivering HPV vaccines to adolescents and also to qualify for GAVI Alliance support.

Building Research Capacity in Africa: Equity and Global Health Collaborations

PLoS Medicine
(Accessed 15 March 2014)
http://www.plosmedicine.org/

Essay
Building Research Capacity in Africa: Equity and Global Health Collaborations
Kathryn M. Chu mail, Sudha Jayaraman, Patrick Kyamanywa, Georges Ntakiyiruta
Published: March 11, 2014
DOI: 10.1371/journal.pmed.1001612
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001612

Summary Points
:: Global health has increased the number of high-income country (HIC) investigators conducting research in low- and middle-income countries (LMICs).

:: Partnerships with local collaborators rather than extractive research are needed.

:: LMICs have to take an active role in leading or directing these research collaborations in order to maximize the benefits and minimize the harm of inherently inequitable relationships.

:: This essay explores lessons from effective and equitable relationships that exist between African countries and HICs.

Introduction
Global health is a growing academic field where high-income country (HIC) faculty and students work in low- and middle-income countries (LMICs), especially in Africa; learn about new cultures, settings, and diseases; and possibly develop an expertise to address existing and emerging challenges in health care [1]. Global health has brought beneficial HIC medical knowledge particularly to African countries: expertise in health policy and planning from high-income settings has improved clinic and hospital infrastructure and practices such as neonatal resuscitation [2],[3]. In addition, research led and supported by HIC researchers has clearly identified preventive and therapeutic interventions for major causes of mortality such as severe malaria, HIV/AIDS, and childhood sepsis [4][7].

Worldwide, the highest burden of disease is from LMICs; however, medical research originating from these countries is low [8]. According to one study, sub-Saharan Africa (SSA) produces less than 1% of biomedical publications [9]. Effective research has four pre-requisites: individual research skills and ability, appropriate infrastructure, relevance to national policies, and the ability to contribute to global research and policy needs [10]. African research capacity has not paralleled capacity in HIC for many reasons: few qualified researchers, less funding, poor infrastructure such as laboratories and computers, and lack of expertise in preparing manuscripts for publication [8]. Collaboration with HIC colleagues and institutions has enormous promise to bring expertise, funding, and resources to Africa. However, there is great potential for a power imbalance in these relationships. Much of the research carried out in Africa is led, funded, and published by HIC researchers without equal collaboration from LMIC colleagues. HIC scientists have been accused of extractive research, flying into an LMIC to obtain data or samples and leaving with the recognition and benefits of the publication.

Researchers collecting blood samples for studies have been termed “mosquitoes” or “vampires” [11],[12]. HIC investigators secure most of the funding for global health research projects and often dictate the research agenda [11]. If their values and objectives are different from African partners this can lead to inappropriate projects unrelated to local research needs, and derive conclusions that do not have any direct local benefit [13]. Some participants have commented that these kinds of collaborations leave locals feeling like “prostitutes” [14]. Furthermore, when HIC researchers conduct studies in settings that are unprepared in terms of infrastructure and health workers, research can disrupt local medical and educational services and have a detrimental effect on local health care, usually by taking already overworked health care providers away from their clinical and teaching duties [11],[14],[15].

HIC academics work for universities that typically measure the success of their faculty by research funding and publications. Even if HIC scientists genuinely want to advance African research agendas, building the research capacity of African collaborators may not be an important objective to their institutions [13],[14].

The Challenge
A few questions arise when considering how to engage in equitable global health research:
–       How can African institutions and physicians benefit from international research collaborations without being exploited?
–       How can advancement of African research capacity and academic careers be prioritized while satisfying the “publish or perish” mandate of HIC universities?
–       How do African scientists and governments coordinate the great influx of HIC academics who view the continent as the next frontier in global health research?

This essay describes some of the important steps for African researchers and academic institutions to consider in managing global health research partnerships in their settings…

POLICY: Meeting the Demand for Pediatric Clinical Trials

Science Translational Medicine
12 March 2014 vol 6, issue 227
http://stm.sciencemag.org/content/current

POLICY
Meeting the Demand for Pediatric Clinical Trials
Edward M. Connor, William E. Smoyer, Jonathan M. Davis, Anne Zajicek, Linda Ulrich, Mary Purucker, and Steven Hirschfeld
12 March 2014: 227fs11
Abstract
The bid for high-quality, cost-effective pediatric clinical trials requires robust research and regulatory playgrounds and an appropriately trained workforce.

National Immunization Commission: Strengthening evidence-based decision making in Argentina

Vaccine
Volume 32, Issue 16, Pages 1775-1896 (1 April 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

National Immunization Commission: Strengthening evidence-based decision making in Argentina
Pages 1778-1780
Daniel Stecher, Alejandra Gaiano, Cristián Biscayart, Angela Gentile, Silvia Gonzalez Ayala, Eduardo López, Pablo Bonvehí, Pablo Yedlin, Cara Janusz, Carla Vizzotti
Abstract
In Argentina, the National Technical Advisory Group on Immunizations is represented by the National Immunization Commission (CoNaIn), an organization created by the Ministry of Health in 2000. Recently, the Argentine government has decided to prioritize vaccination as a state policy, emphasizing this strategy as a sign of social equity so CoNaIn was restructured to increase its capacity to formulate sound and evidence-based recommendations. The commission shall consist of a group of immunization experts, representatives of scientific societies, the immunization program and the Ministry of Health. Its functions include the formulation of recommendations on the introduction of vaccines into the immunization program. The recommendations are based on technical, programmatic and social criteria. This decision-making process transparent with the support and advice of experts and scientific societies and guided by available evidence decisions help strengthen the Ministry of Health immunization policy generating greater confidence and support from the population and health professionals.

Breastfeeding after maternal immunisation during pregnancy: Providing immunological protection to the newborn: A review

Vaccine
Volume 32, Issue 16, Pages 1775-1896 (1 April 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

Breastfeeding after maternal immunisation during pregnancy: Providing immunological protection to the newborn: A review
Review Article
Pages 1786-1792
Kirsten Maertens, Sara De Schutter, Tessa Braeckman, Lesley Baerts, Pierre Van Damme, Ingrid De Meester, Elke Leuridan
Abstract
Vaccination during pregnancy results in an augmentation of disease specific maternal antibodies. Immunoglobulin G (IgG) is mainly transferred through the placenta during the third trimester of pregnancy, while secretory Immunoglobulin A (sIgA) is passed through breast milk.    At birth, newborns are partially protected against infectious diseases by these antibodies.

This review aims to provide an overview of the effect of vaccination during pregnancy on the immunological protection of the newborn by the presence of disease specific sIgA antibodies in breast milk and their possible protective function against disease.

Our search produced 11 relevant papers; 1 on pertussis, 7 on pneumococcus, 2 on influenza and 1 on meningococcus.

All of the studies in this review that measured disease specific antibodies in breast milk (n = 8 papers), stressed the beneficial effect of maternal vaccination during pregnancy on the amount of disease specific sIgA in breast milk. Only a few studies demonstrated a potential protective effect, particularly with influenza vaccines. In an era where maternal vaccination is increasingly considered as a valuable strategy to protect both the mother and infant, further research is needed to assess the effect on breast milk sIgA and to understand the potentially beneficial effects to the infant.

Rising rates of vaccine exemptions: Problems with current policy and more promising remedies

Vaccine
Volume 32, Issue 16, Pages 1775-1896 (1 April 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

Rising rates of vaccine exemptions: Problems with current policy and more promising remedies
Review Article
Pages 1793-1797
Catherine Constable, Nina R. Blank, Arthur L. Caplan
Abstract
Parents of school-age children are increasingly claiming nonmedical exemptions to refuse vaccinations required for school entry. The resultant unvaccinated pockets in many areas of the country have been linked with outbreaks of vaccine-preventable diseases. Many states are now focused on reducing rates of nonmedical exemptions by making exemption processes more restrictive or burdensome for the exemptor. These strategies, however, pose ethical problems and may ultimately be inadequate. A shift to strategies that raise the financial liabilities of exemptors may lead to better success and prove ethically more sound. Potential areas of reform include tax law, health insurance, and private school funding programs. We advocate an approach that combines this type of incentive with more effective vaccination education.

Measles resurgence in southern Africa: Challenges to measles elimination

Vaccine
Volume 32, Issue 16, Pages 1775-1896 (1 April 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

Measles resurgence in southern Africa: Challenges to measles elimination
Original Research Article
Pages 1798-1807
Messeret E. Shibeshi, Balcha G. Masresha, Sheilagh B. Smit, Robin J. Biellik, Jennifer L. Nicholson, Charles Muitherero, Nestor Shivute, Oladapo Walker, Katsande Reggis, James L. Goodson
Abstract
Introduction
In seven southern African countries (Botswana, Lesotho, Malawi, Namibia, South Africa, Swaziland and Zimbabwe), following implementation of a measles mortality reduction strategy starting in 1996, the number of annually reported measles cases decreased sharply to less than one per million population during 2006–2008. However, during 2009–2010, large outbreaks occurred in these countries. In 2011, a goal for measles elimination by 2020 was set in the World Health Organization (WHO) African Region (AFR). We reviewed the implementation of the measles control strategy and measles epidemiology during the resurgence in the seven southern African countries.

Methods
Estimated coverage with routine measles vaccination, supplemental immunization activities (SIA), annually reported measles cases by country, and measles surveillance and laboratory data were analyzed using descriptive analysis.

Results
In the seven countries, coverage with the routine first dose of measles-containing vaccine (MCV1) decreased from 80% to 65% during 1996–2004, then increased to 84% in 2011; during 1996–2011, 79,696,523 people were reached with measles vaccination during 45 SIAs. Annually reported measles cases decreased from 61,160 cases to 60 cases and measles incidence decreased to <1 case per million during 1996–2008. During 2009–2010, large outbreaks that included cases among older children and adults were reported in all seven countries, starting in South Africa and Namibia in mid-2009 and in the other five countries by early 2010. The measles virus genotype detected was predominantly genotype B3.

Conclusion
The measles resurgence highlighted challenges to achieving measles elimination in AFR by 2020. To achieve this goal, high two-dose measles vaccine coverage by strengthening routine immunization systems and conducting timely SIAs targeting expanded age groups, potentially including young adults, and maintaining outbreak preparedness to rapidly respond to outbreaks will be needed.

Impact of measles national vaccination coverage on burden of measles across 29 Member States of the European Union and European Economic Area, 2006–2

Vaccine
Volume 32, Issue 16, Pages 1775-1896 (1 April 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

Impact of measles national vaccination coverage on burden of measles across 29 Member States of the European Union and European Economic Area, 2006–2011
Original Research Article
Pages 1814-1819
E. Colzani, S.A. McDonald, P. Carrillo-Santisteve, M.C. Busana, P. Lopalco, A. Cassini
Abstract
Background
Challenges in reaching good vaccination coverage against measles emerged in several European Union/European Economic Area Member States (EU/EEA MS) leading to progressive accumulation of susceptible individuals and outbreaks. The Burden of Communicable Diseases in Europe (BCoDE) project developed a methodology for measuring the burden of communicable diseases expressed in Disability-Adjusted Life Years (DALYs) in the EU/EEA MS. The aim of this study was to compare national vaccination coverage and burden of measles across EU/EEA MS.

Methods
Country-specific data on measles national vaccination coverage 2006–2011 from 29 EU/EEA MS (MCV1) were retrieved from Centralized Information System for Infectious Diseases (CISID). DALYs were calculated for each country separately using a disease progression model with a single input parameter (annual measles incidence, adjusted for under-estimation). A software application was used to compute estimated DALYs according to country-specific and year-specific population age-distributions (data retrieved from Eurostat). Log-linear mixed-effect regression modeling approach was used to investigate a linear relation between natural logarithm-transformed DALYs and coverage.

Results
The reported annual vaccination coverage ranged from 72.6% to 100%. The estimated national annual burden ranged from 0 to 30.6 DALYs/100,000. Adjusting for year, there was a significant negative relationship between coverage and burden. For a given country there was a decrease in log-transformed DALYs/100,000 of 0.025 (95% confidence interval: −0.047 to −0.003) for every percentage increase in vaccination coverage. The largest effect of calendar time on estimated burden of measles was observed for the year 2011, the smallest was for the year 2007.

Conclusions
This study shows that the degree of success of national measles vaccination programs, when measured by the coverage obtained, is significantly associated with overall impact of measles across EU/EEA MS. In EU/EEA MS each percentage point increase in national vaccination coverage seems to lead to early significant reduction of overall burden of measles

Cost-effectiveness of vaccination against herpes zoster and postherpetic neuralgia: a critical review

Vaccine
Volume 32, Issue 15, Pages 1641-1774 (26 March 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/15

Cost-effectiveness of vaccination against herpes zoster and postherpetic neuralgia: a critical review
Review Article
Pages 1645-1653
Kosuke Kawai, Emmanuelle Preaud, Florence Baron-Papillon, Nathalie Largeron, Camilo J. Acosta
Abstract
Objective
The objective of this study was to systematically review cost-effectiveness studies of vaccination against herpes zoster (HZ) and postherpetic neuralgia (PHN).

Methods
We searched MEDLINE and EMBASE databases for eligible studies published prior to November 2013. We extracted information regarding model structure, model input parameters, and study results. We compared the results across studies by projecting the health and economic impacts of vaccinating one million adults over their lifetimes.

Results
We identified 15 cost-effectiveness studies performed in North America and Europe. Results ranged from approximately US$10,000 to more than US$100,000 per quality-adjusted life years (QALY) gained. Most studies in Europe concluded that zoster vaccination is likely to be cost-effective. Differences in results among studies are largely due to differing assumptions regarding duration of vaccine protection and a loss in quality of life associated with HZ and to a larger extent, PHN. Moreover, vaccine efficacy against PHN, age at vaccination, and vaccine cost strongly influenced the results in sensitivity analyses.

Conclusion
Most studies included in this review shows that vaccination against HZ is likely to be cost-effective. Future research addressing key model parameters and cost-effectiveness studies in other parts of the world are needed.

Methodological quality of systematic reviews on influenza vaccination

Vaccine
Volume 32, Issue 15, Pages 1641-1774 (26 March 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/15

Methodological quality of systematic reviews on influenza vaccination
Original Research Article
Pages 1678-1684
Cornelius Remschmidt, Ole Wichmann, Thomas Harder
Abstract
Background
There is a growing body of evidence on the risks and benefits of influenza vaccination in various target groups. Systematic reviews are of particular importance for policy decisions. However, their methodological quality can vary considerably.

Objectives
To investigate the methodological quality of systematic reviews on influenza vaccination (efficacy, effectiveness, safety) and to identify influencing factors.

Methods
A systematic literature search on systematic reviews on influenza vaccination was performed, using MEDLINE, EMBASE and three additional databases (1990–2013). Review characteristics were extracted and the methodological quality of the reviews was evaluated using the assessment of multiple systematic reviews (AMSTAR) tool. U-test, Kruskal–Wallis test, chi-square test, and multivariable linear regression analysis were used to assess the influence of review characteristics on AMSTAR-score.

Results
Fourty-six systematic reviews fulfilled the inclusion criteria. Average methodological quality was high (median AMSTAR-score: 8), but variability was large (AMSTAR range: 0–11). Quality did not differ significantly according to vaccination target group. Cochrane reviews had higher methodological quality than non-Cochrane reviews (p = 0.001). Detailed analysis showed that this was due to better study selection and data extraction, inclusion of unpublished studies, and better reporting of study characteristics (all p < 0.05). In the adjusted analysis, no other factor, including industry sponsorship or journal impact factor had an influence on AMSTAR score.

Conclusions
Systematic reviews on influenza vaccination showed large differences regarding their methodological quality. Reviews conducted by the Cochrane collaboration were of higher quality than others. When using systematic reviews to guide the development of vaccination recommendations, the methodological quality of a review in addition to its content should be considered.

Socioecological and message framing factors influencing maternal influenza immunization among minority women

Vaccine
Volume 32, Issue 15, Pages 1641-1774 (26 March 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/15

Socioecological and message framing factors influencing maternal influenza immunization among minority women
Original Research Article
Pages 1736-1744
Paula M. Frew, Diane S. Saint-Victor, Lauren E. Owens, Saad B. Omer
Abstract
Objective
A suboptimal level of seasonal influenza vaccination among pregnant minority women is an intractable public health problem, requiring effective message resonance with this population. We evaluated the effects of randomized exposure to messages which emphasize positive outcomes of vaccination (“gain-frame”), or messages which emphasize negative outcomes of forgoing vaccination (“loss-frame”). We also assessed multilevel social and community factors that influence maternal immunization among racially and ethnically diverse populations.

Study design
Minority pregnant women in metropolitan Atlanta were enrolled in the longitudinal study and randomized to receive intervention or control messages. A postpartum questionnaire administered 30 days postpartum evaluated immunization outcomes following baseline message exposure among the study population. We evaluated key outcomes using bivariate and multivariate analyses.

Results
Neither gain- [OR = 0.5176, (95% CI: 0.203,1.322)] nor loss-framed [OR = 0.5000, 95% CI: (0.192,1.304)] messages were significantly associated with increased likelihood of immunization during pregnancy. Significant correlates of seasonal influenza immunization during pregnancy included healthcare provider recommendation [OR = 3.934, 95% CI: (1.331,11.627)], use of hospital-based practices as primary source of prenatal care [OR = 2.584, 95% CI: (1.091,6.122)], and perceived interpersonal support for influenza immunization [OR = 3.405, 95% CI: (1.412,8.212)].

Conclusion
Dissemination of vaccine education messages via healthcare providers, and cultivating support from social networks, will improve seasonal influenza immunization among pregnant minority women.

From Google Scholar+ [to 15 March 2014]

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

Journal of Immigrant and Minority Health
March 2014
http://link.springer.com/journal/10903
Low Human Papillomavirus (HPV) Vaccine Knowledge Among Latino Parents in Utah
Deanna Kepka, Echo L. Warner, Anita Y. Kinney, Michael G. Spigarelli, Kathi Mooney
http://link.springer.com/article/10.1007/s10903-014-0003-1
Abstract
Latinas have the highest incidence of cervical cancer, yet Latino parents/guardians’ knowledge about and willingness to have their children receive the human papillomavirus (HPV) vaccine is unknown. Latino parents/guardians (N = 67) of children aged 11–17 were recruited from two community organizations to complete a survey, including HPV vaccine knowledge, child’s uptake, demographic characteristics, and acculturation. Descriptive statistics and correlates of parents’ HPV knowledge and uptake were calculated using Chi square tests and multivariable logistic regression. Receipt of at least one dose of the HPV vaccine was moderate for daughters (49.1 %) and low for sons (23.4 %). Parents/guardians reported limited knowledge as the main barrier to vaccine receipt. Among parents/guardians with vaccinated daughters, 92.6 % did not know the vaccine requires three doses. Adjusting for income, low-acculturated parents were more likely than high-acculturated parents to report inadequate information (OR 8.59, 95 % CI 2.11–34.92). Interventions addressing low knowledge and children’s uptake of the HPV vaccine are needed among Latino parents/guardians.

Special Focus Newsletters
Rotaflash  March 14, 2014
:: GACVS review of intussusception data provides reassurance that the benefits of rotavirus vaccines still outweigh risks
WHO recommendation for universal rotavirus vaccination remains unchanged

Vaccines and Global Health: The Week in Review 8 Mar 2014

Vaccines and Global Health: The Week in Review is a weekly digest — summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

.
Email Summary: Vaccines and Global health : The Week in Review is published as a single email summary, scheduled for release each Saturday eveningbefore midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.
.
pdf versionA pdf of the current issues is available here: Vaccines and Global Health_The Week in Review_8 Mar 2014

Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
.
Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
.
Support:  If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…
.

.
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

GAVI Watch [to 8 March 2014]

GAVI Watch [to 8 March 2014]
http://www.gavialliance.org/library/news/press-releases/
:: The GAVI Alliance announced that it will support HPV vaccination programmes in Rwanda, Uganda and Uzbekistan “aiming to protect 1.5 million girls against the cause of cervical cancer.” The first GAVI-supported national rollouts of the vaccine will begin in Uganda and Uzbekistan in 2015 while Rwanda will switch from a vaccine manufacturer’s donation to GAVI Alliance support this year to secure the sustainability of its existing national programme. The three countries “have developed detailed plans to ensure that girls aged 10 – 12 years are vaccinated with HPV vaccine in schools and also that those who are not in the classroom are reached in communities through outreach by health workers.”
Full announcement – 8 March 2014: http://www.gavialliance.org/library/news/press-releases/2014/1-5-million-girls-set-to-benefit-from-vaccine-against-cervical-cancer/#

:: GAVI noted that The Obama Administration has requested a record US$200 million in its fiscal year 2015 budget to support the GAVI Alliance, the largest amount the United States has ever requested for the Alliance.
Full announcement: http://www.gavialliance.org/library/news/press-releases/2014/us-presidents-budget-proposes-record-usd-200-million-to-the-gavi-alliance/

International Women’s Day: WHO, Global Fund, IAVI

Statement: Message from WHO Director-General on International Women’s Day
WHO Director-General, Dr Margaret Chan
7 March 2014

[Full text; Editor’s bolded text]
On this day, WHO joins others in celebrating women’s achievements. These achievements are inspiring, and they can inspire change. In health development, as in many other areas, women are agents of change. They are the driving force that creates better lives for families, communities and, increasingly, the countries they have been elected to govern.

As I have learned from my discussions with parliaments in several countries, women are increasingly winning top leadership roles, in rich and poor countries alike, and this helps shape entire societies in broadly beneficial ways. Every time a women excels in a high-profile position, her achievement lifts the social status of women everywhere.

To inspire change, all women need to be free to achieve their full potential. This means freedom from all forms of discrimination, freedom to pursue all opportunities, including education, freedom to earn and spend their own income, and freedom to follow the career paths they decide they want.

The health sector can do much to free women by ensuring they have access to all the health services they need, including sexual and reproductive health services. Participants at last year’s London Summit on Family Planning achieved a breakthrough commitment to halve the number of girls and women in developing countries who want modern contraceptives but have no access. This commitment will give 120 million additional women the right to decide whether, when, and how many children they want to have. This, too, is freedom.

Throughout history, women have been associated with care and compassion. Worldwide, up to 80% of health care is provided in the home, almost always by women. This should inspire our admiration, but it should also underscore the need for change. Most of this work is unsupported, unrecognized, and unpaid.

   Polio is on the verge of eradication largely thanks to the millions of women – from vaccinators to administrators to medical doctors and mothers – who have made the vaccination and protection of children their life’s mission. On this International Women’s Day, let me thank these women for a level of dedication that can improve the world in a permanent way.

   The Global Fund said it is “expanding action on gender equality and emphasising the importance of saving the lives of women and girls through increased high-impact, gender-responsive investments to tackle HIV, TB and malaria.” As it observes International Women’s Day, 8 March, the Global Fund cited the health needs of women and girls as a central part of gender equality work that is essential to have significant impact on responses to AIDS, tuberculosis and malaria. Discussions on gender equality were highlighted at a Board Meeting of the Global Fund that concluded on 7 March. Board delegations “were briefed on the new Action Plan of the Global Fund Gender Equality Strategy. Women and men from diverse communities in India, Indonesia, Malawi, Myanmar and Zimbabwe spoke of their experiences with the Global Fund and urged leaders to translate words into action. Over 50 representatives from donor governments, technical agencies and affected women met to determine strategy on concrete steps toward gender equality and to target the world’s health investments towards the populations who need them most…”

Separately, the Board of the Global Fund approved strategic, financial and operational components of a new approach to funding that “offers more predictability, more flexibility, more inclusive country dialogue and a greater impact to defeat AIDS, TB and malaria”… “opening the way for its full implementation to begin this month.”     Full text of announcements:
:: http://www.theglobalfund.org/en/mediacenter/newsreleases/2014-03-07_Gender_Equality_Central_to_Global_Fund_Next_Steps/
:: http://www.theglobalfund.org/en/mediacenter/newsreleases/2014-03-07_Global_Fund_Board_Moves_Forward_on_New_Funding_Model/

IWD 2014: An AIDS Vaccine as a Force for Women’s Equality
Posted by Margaret G. McGlynn, President and CEO, the International AIDS Vaccine Initiative
on Friday, March 7th 2014

Excerpt
We’ve come a long way in 104 years of marking International Women’s Day. But far too many women remain left behind in far too many parts of the world.

In sub-Saharan Africa, AIDS is the leading killer of women of reproductive age. Limited education, economic and social dependence on men, and gender-based violence severely restrict women’s power over their own health. Imagine what an AIDS vaccine could change for African women and their children. Photo Credit: Frederic Courbet

In Africa, a vicious cycle of HIV and AIDS and gender inequity continues to thwart women’s hopes for a healthy and productive life. AIDS is the number-one killer of women of reproductive age in sub-Saharan Africa and the world, and women account for more than half of the people living with HIV in low- and middle-income countries. It’s a human tragedy and an economic one.  Beyond the epidemic’s direct costs, women are a driving force behind Africa’s economy, and their productivity loss takes a toll. Women own nearly one-third of firms in sub-Saharan Africa and grow at least 80 percent of the food.

Inequity in daily life explains much of the disproportional impact of HIV on women. Limited education, economic and social dependence on men, and gender-based violence severely restrict African women’s power over their own lives and health. An effective and widely available AIDS vaccine will help break through many of the related social and cultural barriers…

Full text: http://blog.usaid.gov/2014/03/iwd-2014-an-aids-vaccine-as-a-force-for-womens-equality/

GPEI Update+: Polio this week – As of 5 March 2014 :: IMB Letter

GPEI Independent Monitoring Board: Letter to WHO Director-General
26 February 2014
Full text: More
Excerpts [Editor’s bolded text]
“…The current situation in Pakistan is a powder key that could ignite widespread polio transmission. The number of cases in this country is going in the wrong direction…the adequacy of the government’s plans will be in full public view at our May meeting and at the subsequent World Health Assembly…”

“..At our suggestion, the program has identified a Red List of the countries most vulnerable to a polio outbreak. In the IMB’s view, when a country is placed on the Red List, all possible means must be used to get it out of this precarious situation as swiftly as possible. As the ongoing outbreak in the Horn of Africa demonstrates, the program softens its focus on such countries at its peril…We are deeply worried about the present situation in the Ukraine, which was very vulnerable even before the recent civil conflict, and recommend that the country be included in the program’s Red List.

“Since our October meeting, a new outbreak has emerged in Syria. The program has done a commendable job of responding to this outbreak, within the constraints of a major conflict. Protecting children from this scourge should be part of a core humanitarian response. We suggest that when humanitarian emergencies occur in countries where the reintroduction (or export) of poliovirus is possible, the GPEI seek to work with the United Nations – OCHA – as a key partner, and that OCHA be asked to include polio vaccination as a priority of the health clusters under the Humanitarian Reform system…”

.
GPEI Update: Polio this week – As of 5 March 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: On 28 February, UNICEF concluded its tender process which makes accessible sufficient quantities of affordable inactivated polio vaccine (IPV) to support country introductions. The vaccine will now be available to GAVI-supported countries for as little as EUR0.75 per dose (approximately US$1 at current exchange rate) in ten-dose vials. The introduction of IPV globally, prior to a phased removal of oral polio vaccines (OPV), is a major element of the comprehensive plan to end all polio disease. More than 120 countries have yet to introduce IPV, more than half of which are eligible for GAVI support. The conclusion of UNICEF’s tender ensures that affordable IPV will be made available, removing a major obstacle to global introduction. More.
:: On 27 February, the world’s leading Islamic scholars, led by the Grand Imam of the Holy Mosque of Mecca, stated that protection against diseases is obligatory and admissible under Islamic Shariah, and that any actions which do not support these preventive measures and cause harm to humanity are un-Islamic. The scholars adopted a strong ‘Jeddah Declaration’ and a focused six-month Plan of Action to address critical challenges facing polio eradication efforts in the few remaining polio-endemic parts of the Islamic world: a ban on vaccinations and lack of access to children in some areas, deadly attacks on health workers, and misconceptions by communities about mass vaccination campaigns. More.
:: The Independent Monitoring Board (IMB) issued its letter to the heads of the GPEI partner agencies, following the group’s additional meeting two weeks ago, and ahead of the group’s next regularly meeting on 6-7 May. The IMB reviewed the current global epidemiology, and expressed concern by the persistent shortfall in funds, seemingly due to significant delays in some donors following through on their pledges. More.
:: In Nigeria, the first wild poliovirus type 1 (WPV1) case of 2014 has been reported, from Kano state. It is the first WPV1 case in the country since December. Since September 2013, seven WPV1 cases have been reported, five from Kano. Together with Borno (the location of the last previous case from December), Kano state holds the key to a polio-free Nigeria.

Nigeria
:: One new WPV1 case was reported in the past week, the first in 2014. The case had onset of paralysis on 1 February, from Gaya Local Government Area (LGA), Kano. The total number of WPV cases for 2013 remains 53 (all WPV1).
:: A full case investigation of this latest WPV1 case has been launched. Technical support to Gaya LGA and surrounding areas was maximised for this week’s national Immunization Plus Days (IPDs – 1-4 March, with bivalent OPV), to ensure high-quality implementation, supervision and monitoring.
:: The IMB underscored that stopping polio transmission in 2014 is potentially feasible, though far from certain. The group welcomed the country’s determination to succeed this year, but warned Nigeria needed continuity and unwavering commitment particularly in the face of election-related distraction. The IMB underscored that the governors of Kano and Borno are vital figures in global polio eradication, and should be strongly supported and encouraged to apply their unique influence at this critical time.

Pakistan
:: Three new WPV1 cases were reported in the past week, all from Federally Administered Tribal Areas (FATA – two from North Waziristan and one from FR Bannu). The total number of cases for 2014 is now 24. The total number of cases for 2013 remains 93..
:: The IMB expressed particular concern at the polio situation in Pakistan, concluding that the country risked being the last place on earth in which polio exists, if current trend continues. While commending some new initiatives, the IMB cautioned that authorities needed to fully grasp the fundamental seriousness of the situation.
:: North Waziristan is the district with the largest number of children being paralyzed by poliovirus in the world (both wild and cVDPV2). Immunization activities have been suspended by local leaders since June 2012. It is critical that children in all areas are vaccinated and protected from poliovirus. Immunizations in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.
:: The densely populated Peshawar valley is considered to be the main ‘engine’ of poliovirus transmission, alongside North Waziristan, due to large-scale population movements through Peshawar from across this region, and into other areas of Pakistan. The quality of operations must be urgently improved in Peshawar, and immunizations resumed in North Waziristan.
However, at the same time, concerning trends have been noted in greater Karachi, Sindh and in Quetta, Balochistan. Environmental positives isolates from every major city of Punjab confirm widespread virus circulation

Horn of Africa
:: One new WPV1 case was reported from Somalia in the past week, with onset of paralysis on 8 August 2013 from Middle Shabelle. The case was reported late due to laboratory processing backlog.

Middle East
:: One new WPV1 case was reported in the past week (onset of paralysis on 1 October 2013 from Deir Al Zour). The total number of laboratory-confirmed WPV1 cases is 25. The most recent case had onset of paralysis on 17 December and was reported from Mara, Edleb governorate.
:: Additionally, there are 13 cases confirmed from contested areas but not yet reflected in official figures.
:: In the Middle East, a comprehensive outbreak response continues to be implemented across the region. The most recent SIAs in Syria were held in early January and early February. Initial reporting indicates that over three million children were reached during both SIAs, with OPV reaching most if not all districts, and coverage attaining more than 85% in all but three governorates.

.
Cross border movements threaten Afghan polio eradication efforts – IRIN

.
Polio-free certification: WHO South-East Asia

.
7th Meeting of the South-East Asia Regional Certification Commission for Polio Eradication (SEA-RCCPE) – New Delhi, India, 27 March 2014
The WHO South-East Asia Region has been maintaining its polio-free status for the last 3 years. After the last wild polio case was reported from India on 13 January 2011, the Region is firmly on track for polio-free certification in March 2014.
In order to ensure all the requirements for certification of polio eradication are met by the Member States, a review of the annual updates of respective national documentation including phase-1 wild poliovirus laboratory containment will be conducted during the 7th meeting of the SEA-RCCPE. This review will take place in the WHO Regional Office in New Delhi, India on 27 March 2014….
http://www.searo.who.int/entity/immunization/topics/polio/eradication/sea-polio-free/en/

MSF responds to inactivated polio vaccine price announcement
http://www.msfaccess.org/content/msf-responds-inactivated-polio-vaccine-price-announcement

Sanofi: Inactivated Polio Vaccines Broadly Available for the World’s Children in the Drive toward Polio Eradication

Industry Watch  [to 8 March 2014]
Selected media releases and other selected content from industry.

Inactivated Polio Vaccines Broadly Available for the World’s Children in the Drive toward Polio Eradication
Excerpt
Lyon, France, – February 28, 2014 – Sanofi Pasteur announced “its further commitment to the international community’s efforts to complete polio eradication. UNICEF, the organization that procures the vaccine to meet global needs, announced it will purchase significant quantities of Inactivated Polio Vaccine (IPV) from Sanofi Pasteur and make it available based on country needs and vaccination plans. To achieve the goal of polio eradication by 2018, the World Health Organization (WHO) recommends that by end 2015, all children receive routinely at least one dose of IPV in over 120 countries that solely use Oral Polio Vaccine.”

In order to support rapid and widespread adoption of IPV, Sanofi Pasteur – the world’s largest producer of IPV – and the Bill & Melinda Gates Foundation ”have developed a joint price support mechanism, including a financial contribution from both organizations. This mechanism allows Sanofi Pasteur to offer IPV at a price of €0.75 per dose (approximately US$ 1) to 73 of the world’s poorest countries. The GAVI Alliance, a global immunisation partnership, will make IPV available for inclusion in routine immunisation schedules in these countries.”

This announcement “underscores Sanofi Pasteur’s commitment to offer unparalleled volumes of high-quality IPV across a broad range of countries and economic situations at differential prices in an unprecedented, global rollout.”

Sanofi Pasteur “has made significant investments in modern technology to produce very large quantities of IPV — up to 300 million doses a year. As well as this substantial investment in production capacity, Sanofi Pasteur support to IPV now includes development of a five-dose vial presentation (as well as the standard ten-dose vial presentation) to reduce wastage, a massive regulatory and licensing program in about 100 countries and expert contributions on scientific, program and technical questions.” Sanofi Pasteur has been a partner of the Global Polio Eradication Initiative for over 20 years…

Full text of media release: http://www.reuters.com/article/2014/02/28/idUSnHUGdxHX+73+ONE20140228

PATH names Katherine (Kate) Wilson to lead its Digital Health Solutions group

PATH named Katherine (Kate) Wilson to lead its Digital Health Solutions group. She will “build on PATH’s work using innovative digital technologies to develop and improve health solutions worldwide. In addition, she will serve as a global thought leader on digital health and will establish, maintain, and build connections with stakeholders and partners around the world for PATH.” PATH said it Digital Health Solutions group “strengthens health system performance through the design and deployment of effective, scalable, and sustainable digital health solutions and by encouraging use of those systems to impact health.”

Full Announcement: http://www.path.org/news/press-room/671/

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 8 March 2014]

WHO: Global Alert and Response (GAR) – Disease Outbreak News
http://www.who.int/csr/don/2013_03_12/en/index.html

:: Human infection with avian influenza A(H7N9) virus – update 7 March 2014
7 March 2014 – On 4 March 2014, the Centre for Health Protection (CHP) of the Department of Health, Hong Kong SAR, China, notified WHO of an additional laboratory-confirmed case of human infection with avian influenza A(H7N9) virus…
…The overall risk assessment has not changed…The previous report of avian influenza A(H7N9) virus detection in live poultry exported from mainland China to Hong Kong SAR shows the potential for the virus to spread through movement of live poultry, at this time there is no indication that international spread of avian influenza A(H7N9) has occurred. However as the virus infection does not cause signs of disease in poultry, continued surveillance is needed.
Further sporadic human cases of avian influenza A(H7N9) infection are expected in affected and possibly neighbouring areas…

:: Human infection with avian influenza A(H7N9) virus – update 5 March 2014

:: Human infection with avian influenza A(H7N9) virus – update 3 March 2014

WHO: South Sudan humanitarian medical assistance

WHO: Humanitarian Health Action
http://www.who.int/hac/en/index.html

South Sudan humanitarian medical assistance
5 March 2014 — According to UNOCHA since the 15 December 2013 over 908 000 people have been displaced by violence. There are 705 800 IDP’s within South Sudan and 202 500 South Sudanese refugees in neighbouring countries. The cholera vaccination campaigns continued in Mingkaman and Tomping IDP camps and the number of new measles cases is declining in all the major IDP sites. Cases of suspected meningitis was reported in four states.
Read the latest situation report – 5 March 2014
pdf, 600kb

Keynote lecture: Research for Universal Health Coverage — 2014 Global vaccine and immunization research forum

Keynote lecture: Research for Universal Health Coverage
WHO Director-General Dr Margaret Chan
Global vaccine and immunization research forum
Bethesda, Maryland – 5 March 2014
Full text: http://www.who.int/dg/speeches/2014/research-uhc/en/

Excerpt
Distinguished conference participants, experts in science and public health, representatives of sister UN agencies and industry, ladies and gentlemen,

WHO is proud to join the Bill and Melinda Gates Foundation and the National Institutes of Allergy and Infectious Diseases as an organizer of this event. The combination of cutting-edge science, down-to-earth public health experience, and well-conceived and generous funding is unbeatable.

The Forum further benefits from the engagement of industry and its commitment to develop new vaccines and constantly improve existing ones, with a particular focus on the needs of users in remote and understaffed areas…

…Last month, I travelled to India to celebrate the country’s remarkable polio-free status for the past three years. India’s success tells the world there is no such thing as impossible.

This has been the spirit of EPI during its four decades of evolution. This is the spirit of the Decade of Vaccines and the cutting-edge science being presented during this Forum.

This is the spirit of the Bill and Melinda Gates Foundation: set ever higher goals and use research to make them feasible.

Immunization, like universal coverage, is a magnet for solidarity that transcends borders and sectors. It has compelling public and political appeal, and is an especially rewarding investment for national governments and donors.

And it still has tremendous unrealized potential.

In a sense, immunization programmes have matured to the point where they can now take a great leap ahead. And in this sense, we are just getting started as we aim ever higher.

Thank you.

The Global Crisis of Drug-Resistant Tuberculosis and Leadership of China and the BRICS

The Global Crisis of Drug-Resistant Tuberculosis and Leadership of China and the BRICS: Challenges and Opportunities: Summary of a Joint Workshop by the Institute of Medicine and the Institute of Microbiology, Chinese Academy of Sciences
Steve Olson, Rebecca A. English, and Anne B. Claiborne, Rapporteurs; Forum on Drug Discovery, Development, and Translation; Board on Health Sciences Policy; Institute of Medicine
https://download.nap.edu/login.php?record_id=18346&page=%2Fdownload.php%3Frecord_id%3D18346

Description
Multidrug-resistant tuberculosis (TB) is caused by bacteria resistant to isoniazid and rifampicin, the two most effective first-line anti-TB drugs, originally developed and introduced in the 1950 and 1960s. Since 2008, the Forum on Drug Discovery, Development, and Translation of the Institute of Medicine has hosted or co-hosted six domestic and international workshops addressing the global crisis of drug-resistant TB, with special attention to the BRICS countries – Brazil, Russia, India, China, and South Africa.

The Global Crisis of Drug-Resistant Tuberculosis and Leadership of China and the BRICS is the summary of a workshop convened to address the current status of drug-resistant TB globally and in China. This report considers lessons learned from high burden countries; highlights global challenges to controlling the spread of drug-resistant strains; and discusses innovative strategies to advance and harmonize local and international efforts to prevent and treat drug-resistant TB. Additionally, the report examines the problem of MDR TB and emergent TB strains that are potentially untreatable with drugs available and considers the critical leadership role of the BRICS countries in addressing the threats and opportunities in drug-resistant TB.

American Journal of Tropical Medicine and Hygiene – March 2014

American Journal of Tropical Medicine and Hygiene
March 2014; 90 (3)
http://www.ajtmh.org/content/current

Editorial
Economic Burden of West Nile Virus in the United States
Alan D. T. Barrett
Am J Trop Med Hyg 2014 90:389-390; Published online February 10, 2014, doi:10.4269/ajtmh.14-0009
Full Text

Initial and Long-Term Costs of Patients Hospitalized with West Nile Virus Disease
J. Erin Staples*, Manjunath B. Shankar, James J. Sejvar, Martin I. Meltzer and Marc Fischer
Author Affiliations
Arboviral Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado; Prion and Health Office, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, Georgia
http://www.ajtmh.org/content/90/3/402.abstract
Abst
There are no published data on the economic burden for specific West Nile virus (WNV) clinical syndromes (i.e., fever, meningitis, encephalitis, and acute flaccid paralysis [AFP]). We estimated initial hospital and lost-productivity costs from 80 patients hospitalized with WNV disease in Colorado during 2003; 38 of these patients were followed for 5 years to determine long-term medical and lost-productivity costs. Initial costs were highest for patients with AFP (median $25,117; range $5,385–$283,381) and encephalitis (median $20,105; range $3,965–$324,167). Long-term costs were highest for patients with AFP (median $22,628; range $624–$439,945) and meningitis (median $10,556; range $0–$260,748). Extrapolating from this small cohort to national surveillance data, we estimated the total cumulative costs of reported WNV hospitalized cases from 1999 through 2012 to be $778 million (95% confidence interval $673 million–$1.01 billion). These estimates can be used in assessing the cost-effectiveness of interventions to prevent WNV disease.
Disclaimer: The findings and conclusions of this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Importance of Cholera and Other Etiologies of Acute Diarrhea in Post-Earthquake Port-au-Prince, Haiti
Macarthur Charles, Glavdia G. Delva, Jethro Boutin, Karine Severe, Mireille Peck, Marie Marcelle abou, Peter F. Wright, and Jean W. Pape
Am J Trop Med Hyg 2014 90:511-517; Published online January 20, 2014, doi:10.4269/ajtmh.13-0514
Abstract

Pre-Travel Preparation of US Travelers Going Abroad to Provide Humanitarian Service, Global TravEpiNet 2009–2011
Rhett J. Stoney, Emily S. Jentes, Mark J. Sotir, Phyllis Kozarsky, Sowmya R. Rao, Regina C. LaRocque, Edward T. Ryan, and the Global TravEpiNet Consortium
Am J Trop Med Hyg 2014 90:553-559; Published online January 20, 2014, doi:10.4269/ajtmh.13-0479
href=”http://www.ajtmh.org/content/90/3/553.abstract”>Abstract

Effects of Malnutrition on Children’s Immunity to Bacterial Antigens in Northern Senegal
Lobna Gaayeb, Jean B. Sarr, Cecile Cames, Claire Pinçon, Jean-Baptiste Hanon, Mamadou O. Ndiath, Modou Seck, Fabien Herbert, Andre B. Sagna, Anne-Marie Schacht, Franck Remoue,
Gilles Riveau, and Emmanuel Hermann
Am J Trop Med Hyg 2014 90:566-573; Published online January 20, 2014, doi:10.4269/ajtmh.12-0657
Abstract

Factors associated with non-utilization of child immunization in Pakistan: evidence from the Demographic and Health Survey 2006-07

BMC Public Health
(Accessed 8 March 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Factors associated with non-utilization of child immunization in Pakistan: evidence from the Demographic and Health Survey 2006-07
Ayesha Siddiqa Bugvi, Rahla Rahat, Rubeena Zakar, Muhammad Zakria Zakar, Florian Fischer, Muazzam Nasrullah and Riffat Manawar
Author Affiliations
BMC Public Health 2014, 14:232  doi:10.1186/1471-2458-14-232
Published: 6 March 2014
http://www.biomedcentral.com/1471-2458/14/232/abstract

Abstract (provisional)
Background
The proportion of incompletely immunized children in Pakistan varies from 37-58%, and this has recently resulted in outbreaks of measles and polio. The aim of this paper is to determine the factors associated with incomplete immunization among children aged 12-23?months in Pakistan.

Methods
Secondary analysis was conducted on nationally representative cross-sectional survey data from the Pakistan Demographic and Health Survey, 2006-07. The analysis was limited to ever-married mothers who had delivered their last child during the 23?months immediately preceding the survey (n?=?2,435). `Complete immunization? was defined as the child having received twelve doses of five vaccines, and `incomplete immunization? was defined if he/she had missed at least one of these twelve doses. The association between child immunization status and determinants of non-utilization of vaccines was assessed by calculating unadjusted and adjusted odds ratios (AOR) with 95% confidence intervals using a multivariable binary logistic regression.

Results
The findings of this research showed that nearly 66% of children were incompletely immunized against seven preventable childhood diseases. The likelihood of incomplete immunization was significantly associated with the father?s occupation as a manual worker (AOR = 1.47; 95% CI: 1.10-1.97), lack of access to information (AOR = 1.35; 95% CI: 1.09-1.66), non-use of antenatal care (AOR = 1.33; 95% CI: 1.07-1.66), children born in Baluchistan region (AOR = 1.74; 95% CI: 1.12-2.70) and delivery at home (AOR = 1.39; 95% CI: 1.14-1.69).

Conclusions
Despite governmental efforts to increase rates of immunization against childhood diseases, the proportion of incompletely immunized children in Pakistan is still high. Targeted interventions are needed to increase the immunization rates in Pakistan. These interventions need to concentrate on people with low socioeconomic and educational status in order to improve their knowledge of this topic.

From the parents’ perspective: a user-satisfaction survey of immunization services in Guatemala

BMC Public Health
(Accessed 8 March 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
From the parents’ perspective: a user-satisfaction survey of immunization services in Guatemala
Lissette Barrera, Silas Pierson Trumbo, Pamela Bravo-Alcántara, Martha Velandia-González and M Carolina Danovaro-Holliday
Author Affiliations
BMC Public Health 2014, 14:231  doi:10.1186/1471-2458-14-231
Published: 6 March 2014
http://www.biomedcentral.com/1471-2458/14/231/abstract

Abstract (provisional)
Background
Immunization coverage levels in Guatemala have increased over the last two decades, but national targets of >=95% have yet to be reached. To determine factors related to undervaccination, Guatemala’s National Immunization Program conducted a user-satisfaction survey of parents and guardians of children aged 0-5 years. Variables evaluated included parental immunization attitudes, preferences, and practices; the impact of immunization campaigns and marketing strategies; and factors inhibiting immunization.

Methods
Based on administrative coverage levels and socio-demographic indicators in Guatemala’s 22 geographical departments, five were designated as low-coverage and five as high-coverage areas. Overall, 1194 parents and guardians of children aged 0-5 years were interviewed in these 10 departments. We compared indicators between low- and high-coverage areas and identified risk factors associated with undervaccination.

Results
Of the 1593 children studied, 29 (1.8%) were determined to be unvaccinated, 458 (28.8%) undervaccinated, and 1106 (69.4%) fully vaccinated. In low-coverage areas, children of less educated (no education: RR = 1.49, p = 0.01; primary or less: 1.39, p = 0.009), older (aged >39 years: RR =1.31, p = 0.05), and single (RR = 1.32, p = 0.03) parents were more likely to have incomplete vaccination schedules. Similarly, factors associated with undervaccination in high-coverage areas included the caregiver’s lack of education (none: RR = 1.72, p = 0.0007; primary or less: RR = 1.30, p = 0.05) and single marital status (RR = 1.36, p = 0.03), as well as the child’s birth order (second: RR = 1.68, p = 0.003). Although users generally approved of immunization services, problems in service quality were identified. According to participants, topics such as the risk of adverse events (47.4%) and next vaccination appointments (32.3%) were inconsistently communicated to parents. Additionally, 179 (15.0%) participants reported the inability to vaccinate their child on at least one occasion. Compared to high-coverage areas, participants in low-coverage areas reported poorer service, longer wait times, and greater distances to health centers. In high-coverage areas, participants reported less knowledge about the availability of services.

Conclusions
Generally, immunization barriers in Guatemala are related to problems in accessing and attaining high-quality immunization services rather than to a population that does not adequately value vaccination. We provide recommendations to aid the country in maintaining its achievements and addressing new challenges.

Vaccination coverage of children aged 12-23 months in Gaziantep, Turkey: comparative results of two studies carried out by lot quality technique: what changed after family medicine?

BMC Public Health
(Accessed 8 March 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Vaccination coverage of children aged 12-23 months in Gaziantep, Turkey: comparative results of two studies carried out by lot quality technique: what changed after family medicine?
Birgul Ozcirpici, Neriman Aydin, Ferhat Coskun, Hakan Tuzun and Servet Ozgur
Author Affiliations
BMC Public Health 2014, 14:217  doi:10.1186/1471-2458-14-217
Published: 3 March 2014
http://www.biomedcentral.com/1471-2458/14/217/abstract

Abstract (provisional)
Background
Health care systems in many countries are changing for a variety of reasons. Monitoring of community-based services, especially vaccination coverage, is important during transition periods to ensure program effectiveness. In 2005, Turkey began a transformation from a “socialization of health services” system to a “family medicine” system. The family medicine system was implemented in the city of Gaziantep, in December, 2010.

Methods
Two descriptive, cross-sectional studies were conducted in Gaziantep city center; the first study was before the transition to the family medicine system and the second study was one year after the transition. The Lot Quality Technique methodology was used to determine the quality of vaccination services. The population studied was children aged 12-23 months. Data from the two studies were compared in terms of vaccination coverage and lot service quality to determine whether there were any changes in these parameters after the transition to a family service system.

Results
A total of 93.7% of children in Gaziantep were fully vaccinated before the transition. Vaccination rates decreased significantly to 84.0% (p <0.005) after the family medicine system was implemented. The number of unacceptable vaccine lots increased from 5 lots before the transition to 21 lots after the establishment of the family medicine system.

Conclusions
The number of first doses of vaccine given was higher after family medicine was implemented; however, the numbers of second, third, and booster doses, and the number of children fully vaccinated were lower than before transition. Acceptable and unacceptable lots were not the same before and after the transition. Different health care personnel were employed at the lots after family medicine was implemented. This result suggests that individual characteristics of the health care personnel working in a geographic area are as important as the socioeconomic and cultural characteristics of the community.

Effectiveness of quadrivalent human papillomavirus vaccine for the prevention of cervical abnormalities: case-control study nested within a population based screening programme in Australia

British Medical Journal
08 March 2014 (Vol 348, Issue 7948)
http://www.bmj.com/content/348/7948

Research
Effectiveness of quadrivalent human papillomavirus vaccine for the prevention of cervical abnormalities: case-control study nested within a population based screening programme in Australia
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g1458 (Published 4 March 2014)
Elizabeth Crowe, public health physician12, Nirmala Pandeya, biostatistician1, Julia M L Brotherton, public health physician and medical epidemiologist3, Annette J Dobson, iostatistician1, Stephen Kisely, public health physician4, Stephen B Lambert, public health physician56, David C Whiteman, cancer epidemiologist17
http://www.bmj.com/content/348/bmj.g1458

Abstract
Objective
To measure the effectiveness of the quadrivalent human papillomavirus (HPV) vaccine against cervical abnormalities four years after implementation of a nationally funded vaccination programme in Queensland, Australia.

Design
Case-control analysis of linked administrative health datasets.

Setting
Queensland, Australia.

Participants
Women eligible for free vaccination (aged 12-26 years in 2007) and attending for their first cervical smear test between April 2007 and March 2011. High grade cases were women with histologically confirmed high grade cervical abnormalities (n=1062) and “other cases” were women with any other abnormality at cytology or histology (n=10 887). Controls were women with normal cytology (n=96 404).

Main outcome measures
Exposure odds ratio (ratio of odds of antecedent vaccination (one, two, or three vaccine doses compared with no doses) among cases compared with controls), vaccine effectiveness ((1−adjusted odds ratio)×100), and number needed to vaccinate to prevent one cervical abnormality at first screening round. We stratified by four age groups adjusted for follow-up time, year of birth, and measures of socioeconomic status and remoteness. The primary analysis concerned women whose first ever smear test defined their status as a case or a control.

Results
The adjusted odds ratio for exposure to three doses of HPV vaccine compared with no vaccine was 0.54 (95% confidence interval 0.43 to 0.67) for high grade cases and 0.66 (0.62 to 0.70) for other cases compared with controls with normal cytology, equating to vaccine effectiveness of 46% and 34%, respectively. The adjusted numbers needed to vaccinate were 125 (95% confidence interval 97 to 174) and 22 (19 to 25), respectively. The adjusted exposure odds ratios for two vaccine doses were 0.79 (95% confidence interval 0.64 to 0.98) for high grade cases and 0.79 (0.74 to 0.85) for other cases, equating to vaccine effectiveness of 21%.

Conclusion
The quadrivalent HPV vaccine conferred statistically significant protection against cervical abnormalities in young women who had not started screening before the implementation of the vaccination programme in Queensland, Australia.

Tuberculosis control in big cities and urban risk groups in the European Union: Epidemiology; Consensus Statement

Eurosurveillance
Volume 19, Issue 9, 06 March 2014
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Surveillance and outbreak reports
Epidemiology of tuberculosis in big cities of the European Union and European Economic Area countries
by G de Vries, RW Aldridge, JA Caylà, WH Haas, A Sandgren, NA van Hest, I Abubakar, the Tuberculosis in European Union Big Cities Working Group

Perspectives
Tuberculosis control in big cities and urban risk groups in the European Union: a consensus statement
N A van Hest1, R W Aldridge2, G de Vries3, A Sandgren4, B Hauer5, A Hayward2, W Arrazola de Oñate6, W Haas5, L R Codecasa7, J A Caylà8, A Story9, D Antoine10, A Gori11, L Quabeck12, J Jonsson13, M Wanlin6, À Orcau8, A Rodes14, M Dedicoat15, F Antoun16, H van Deutekom17, S T Keizer17, I Abubakar18
Date of submission: 26 February 2013
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20728

In low-incidence countries in the European Union (EU), tuberculosis (TB) is concentrated in big cities, especially among certain urban high-risk groups including immigrants from TB high-incidence countries, homeless people, and those with a history of drug and alcohol misuse. Elimination of TB in European big cities requires control measures focused on multiple layers of the urban population. The particular complexities of major EU metropolises, for example high population density and social structure, create specific opportunities for transmission, but also enable targeted TB control interventions, not efficient in the general population, to be effective or cost effective. Lessons can be learnt from across the EU and this consensus statement on TB control in big cities and urban risk groups was prepared by a working group representing various EU big cities, brought together on the initiative of the European Centre for Disease Prevention and Control. The consensus statement describes general and specific social, educational, operational, organisational, legal and monitoring TB control interventions in EU big cities, as well as providing recommendations for big city TB control, based upon a conceptual TB transmission and control model.

Impact of user fees on maternal health service utilization and related health outcomes: a systematic review

Health Policy and Planning
Volume 29 Issue 2 March 2014
http://heapol.oxfordjournals.org/content/current

Impact of user fees on maternal health service utilization and related health outcomes: a systematic review
Susie Dzakpasu1, Timothy Powell-Jackson2 and Oona M.R. Campbell1
Author Affiliations
1Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK and 2Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
Accepted December 21, 2012.
http://heapol.oxfordjournals.org/content/29/2/137.abstract

Abstract
Objective
To assess the evidence of the impact of user fees on maternal health service utilization and related health outcomes in low- and middle-income countries, as well as their impact on inequalities in these outcomes.

Methods
Studies were identified by modifying a search strategy from a related systematic review. Primary studies of any design were included if they reported the effect of fee changes on maternal health service utilization, related health outcomes and inequalities in these outcomes. For each study, data were systematically extracted and a quality assessment conducted. Due to the heterogeneity of study methods, results were examined narratively.

Findings
Twenty studies were included. Designs and analytic approaches comprised: two interrupted time series, eight repeated cross-sectional, nine before-and-after without comparison groups and one before-and-after in three groups. Overall, the quality of studies was poor. Few studies addressed potential sources of bias, such as secular trends over time, and even basic tests of statistical significance were often not reported. Consistency in the direction of effects provided some evidence of an increase in facility delivery in particular after fees were removed, as well as possible increases in the number of managed delivery complications. There was little evidence of the effect on health outcomes or inequality in accessing care and, where available, the direction of effect varied.

Conclusion
Despite the global momentum to abolish user fees for maternal and child health services, robust evidence quantifying impact remains scant. Improved methods for evaluating and reporting on these interventions are recommended, including better descriptions of the interventions and context, looking at a range of outcome measures, and adopting robust analytical methods that allow for adjustment of underlying and seasonal trends, reporting immediate as well as longer-term (e.g. at 6 months and 1 year) effects and using comparison groups where possible.

Estimates of performance in the rate of decline of under-five mortality for 113 low- and middle-income countries, 1970–2010

Health Policy and Planning
Volume 29 Issue 2 March 2014
http://heapol.oxfordjournals.org/content/current

Estimates of performance in the rate of decline of under-five mortality for 113 low- and middle-income countries, 1970–2010
Stéphane Verguet and Dean T. Jamison
Author Affiliations
Department of Global Health, University of Washington, Seattle, WA, USA
Accepted December 21, 2012.
http://heapol.oxfordjournals.org/content/29/2/151.abstract

Abstract
Background
Measuring country performance in health has focused on assessing predicted vs observed levels of outcomes, an indicator that varies slowly over time. An alternative is to measure performance in terms of the rate of change in how a selected outcome compares to what would be expected given contextual determinants. Rates of change in health indicators can prove more sensitive than levels to changes in social, intersectoral or health policy context. It is thus similar to the growth rate of gross domestic product in the economic context. We assess performance in the rate of change (decline) of under-five mortality for 113 low- and middle-income countries.

Methods
For 1970–2010, we study the evolution in rates of decline of under-five mortality. For each decade, we define performance as the average of the difference between the observed rate of decline and a rate of decline predicted by a model controlling for the contextual factors of income, female education levels, decade and geographical location.

Results
In the 1970s, the top performer in the rate of decline of under-five mortality was Costa Rica. In the 2000s, the top performer was Turkey. Overall, performance in rates of decline correlated little with performance in levels of under-five mortality. A major transition in performance between decades suggests a change in underlying determinants and we report the magnitude of these transitions. For example, heavily AIDS impacted countries, such as Botswana, experienced major drops in performance between the 1980s and the 1990s and some, including Botswana, experienced major compensatory improvements between the 1990s and the 2000s.

Conclusions
Rate-based measures of country performance in health provide a starting point for assessments of the importance of health system, social and intersectoral determinants of performance.

Achieving comprehensive childhood immunization: an analysis of obstacles and opportunities in The Gambia

Health Policy and Planning
Volume 29 Issue 2 March 2014
http://heapol.oxfordjournals.org/content/current

Achieving comprehensive childhood immunization: an analysis of obstacles and opportunities in The Gambia
Sarah Payne1, John Townend3, Momodou Jasseh3, Yamundow Lowe Jallow4 and Beate Kampmann2,3
Author Affiliations
1School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK, 2Department of Paediatrics, St Mary’s Campus, Imperial College of Science, Technology & Medicine, Norfolk Place, London W2 1PG, UK, 3MRC-Unit, Atlantic Road, Fajara, The Gambia, West Africa and 4Ministry of Health and Social Welfare Government of The Gambia, The Quadrangle Banjul, The Gambia
Accepted January 11, 2013.
http://heapol.oxfordjournals.org/content/29/2/193.abstract

Abstract
Introduction
Immunization is a vital component in the drive to decrease global childhood mortality, yet challenges remain in ensuring wide coverage of immunization and full immunization, particularly in low- and middle-income countries. This study assessed immunization coverage and the determinants of immunization in a semi-rural area in The Gambia.

Methods
Data were drawn from the Farafenni Health and Demographic Surveillance System. Children born within the surveillance area between January 2000 and December 2010 were included. Main outcomes assessed included measles, BCG and DTP vaccination status and full immunization by 12 months of age as reported on child healthcards. Predictor variables were evaluated based on a literature review and included gender, ethnicity, area of residence, household wealth and mother’s age.

Results
Of the 7363 children included in the study, immunization coverage was 73% (CI 72–74) for measles, 86% (CI 86–87) for BCG, 79% (CI 78–80) for three doses of DTP and 52% (CI 51–53) for full immunization. Coverage was significantly associated with area of residence and ethnicity, with children in urban areas and of Mandinka ethnicity being least likely to be fully immunized.

Conclusions
Despite high levels of coverage of many individual vaccines, delivery of vaccinations later in the schedule and achieving high coverage of full immunization remain challenges, even in a country with a committed childhood immunization programme, such as The Gambia. Our data indicate areas for targeted interventions by the national Expanded Programme of Immunization.

Risk of Fever After Pediatric Trivalent Inactivated Influenza Vaccine and 13-Valent Pneumococcal Conjugate Vaccine

JAMA Pediatrics
March 2014, Vol 168, No. 3
http://archpedi.jamanetwork.com/issue.aspx

Original Investigation | March 2014
Risk of Fever After Pediatric Trivalent Inactivated Influenza Vaccine and 13-Valent Pneumococcal Conjugate Vaccine
Melissa S. Stockwell, MD, MPH1,2,3; Karen Broder, MD4; Philip LaRussa, MD1; Paige Lewis, MSPH4; Nadira Fernandez, MD1; Devindra Sharma, MSN, MPH4; Angela Barrett1; Jose Sosa, MD1; Claudia Vellozzi, MD, MPH4
Author Affiliations
JAMA Pediatr. 2014;168(3):211-219. doi:10.1001/jamapediatrics.2013.4469.

Importance  An observational study found an increased risk of febrile seizure on the day of or 1 day after vaccination (days 0-1) with trivalent inactivated influenza vaccine (TIV) in the 2010-2011 season; risk was highest with simultaneous vaccination with TIV and 13-valent pneumococcal vaccine (PCV13) in children who were 6 to 23 months old. Text messaging is a novel method for surveillance of adverse events after immunization that has not been used for hypothesis-driven vaccine safety research.

Lancet Editorial: An inspired change—stopping sexual violence against women

The Lancet  
Mar 08, 2014   Volume 383  Number 9920  p845 – 926
http://www.thelancet.com/journals/lancet/issue/current

Editorial
An inspired change—stopping sexual violence against women
The Lancet
Preview |
International Women’s Day, this year themed Inspiring Change, falls on March 8. For more than a century, this event has marked women’s achievements in a world where the sexes are far from equal in many countries. In promoting the education, health, and success of women, the Day has addressed the distressing but key topic of violence against women more than once

Social Media and Internet-Based Data in Global Systems for Public Health Surveillance: A Systematic Review

The Milbank Quarterly
A Multidisciplinary Journal of Population Health and Health Policy
March 2014  Volume 92, Issue 1  Pages 1–166
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1468-0009/currentissue

Review Article
Social Media and Internet-Based Data in Global Systems for Public Health Surveillance: A Systematic Review
EDWARD VELASCO1, TUMACHA AGHENEZA1, KERSTIN DENECKE2, GÖRAN KIRCHNER1, TIM ECKMANNS1
Article first published online: 6 MAR 2014
DOI: 10.1111/1468-0009.12038
http://onlinelibrary.wiley.com/doi/10.1111/1468-0009.12038/abstract
Abstract
Context
The exchange of health information on the Internet has been heralded as an opportunity to improve public health surveillance. In a field that has traditionally relied on an established system of mandatory and voluntary reporting of known infectious diseases by doctors and laboratories to governmental agencies, innovations in social media and so-called user-generated information could lead to faster recognition of cases of infectious disease. More direct access to such data could enable surveillance epidemiologists to detect potential public health threats such as rare, new diseases or early-level warnings for epidemics. But how useful are data from social media and the Internet, and what is the potential to enhance surveillance? The challenges of using these emerging surveillance systems for infectious disease epidemiology, including the specific resources needed, technical requirements, and acceptability to public health practitioners and policymakers, have wide-reaching implications for public health surveillance in the 21st century.

Methods
This article divides public health surveillance into indicator-based surveillance and event-based surveillance and provides an overview of each. We did an exhaustive review of published articles indexed in the databases PubMed, Scopus, and Scirus between 1990 and 2011 covering contemporary event-based systems for infectious disease surveillance.

Findings
Our literature review uncovered no event-based surveillance systems currently used in national surveillance programs. While much has been done to develop event-based surveillance, the existing systems have limitations. Accordingly, there is a need for further development of automated technologies that monitor health-related information on the Internet, especially to handle large amounts of data and to prevent information overload. The dissemination to health authorities of new information about health events is not always efficient and could be improved. No comprehensive evaluations show whether event-based surveillance systems have been integrated into actual epidemiological work during real-time health events.

Conclusions
The acceptability of data from the Internet and social media as a regular part of public health surveillance programs varies and is related to a circular challenge: the willingness to integrate is rooted in a lack of effectiveness studies, yet such effectiveness can be proved only through a structured evaluation of integrated systems. Issues related to changing technical and social paradigms in both individual perceptions of and interactions with personal health data, as well as social media and other data from the Internet, must be further addressed before such information can be integrated into official surveillance systems.

Nature: Special Report – Vaccines

Nature   
Volume 507 Number 7490 pp8-134  6 March 2014
http://www.nature.com/nature/current_issue.html

Outlook: Vaccines
Produced with support from: newventurefund, UNICEF, GAVI
:: Vaccines  Herb Brody

:: The age of vaccines  Tony Scully

:: Infectious disease: Beating the big three  Katherine Bourzac

:: Logistics: Keeping cool  Neil Savage

:: Drug development: Searching for patterns  Tom Paulson

:: Production: Vaccines from the East  Priya Shetty

:: Polio: The eradication endgame  Cassandra Willyard

:: Perspective: Elimination round  Andrew W. Artenstein & Gregory A. Poland

:: Public health: An injection of trust  Michael Eisenstein

:: Perspective: Ill prepared for a pandemic  Klaus Stöhr

.
A predictive fitness model for influenza
Marta Łuksza & Michael Lässig
A computational approach for predicting the future evolution of the human influenza virus, based on population-genetic data of previous strains, is presented; this model holds promise for improving vaccine strain selection for seasonal influenza.

Global Health: Global Supply of Health Professionals

New England Journal of Medicine
March 6, 2014  Vol. 370 No. 10
http://www.nejm.org/toc/nejm/medical-journal

Review Article
Global Health: Global Supply of Health Professionals
N. Crisp and L. Chen
Free Full Text

Excerpt
There is a global crisis of severe shortages and marked maldistribution of health professionals that is exacerbated by three great global transitions — demographic changes, epidemiologic shifts, and redistribution of the disability burden. Each of these transitions exerts a powerful force for change in health care systems, the roles of health professionals, and the design of health professional education.1-5 Every country will have to respond to these global pressures for change.

There are many other reasons that it is important to think globally about the education and role of health professionals.6 The knowledge base of the profession is global in scope, and there is increasing cross-national transfer of technology, expertise, and services. Health professionals are migrating in what is now effectively a global market for their talent, while patients are also traveling for treatment. One quarter of the doctors in the United States come from abroad, and the “medical tourism” market for travel to such countries as Thailand and Singapore is growing at a rate of 20% annually.7,8 All people worldwide are threatened by risks such as global infectious epidemics and climate change. Health professionals globally are interlinked and interdependent, facing shared challenges

Incentives for Reporting Disease Outbreaks

PLoS One
[Accessed 8 March 2014]
http://www.plosone.org/

Research Article
Incentives for Reporting Disease Outbreaks
Ramanan Laxminarayan mail, Julian Reif, Anup Malani
Published: March 06, 2014
DOI: 10.1371/journal.pone.0090290
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0090290
Abstract
Background
Countries face conflicting incentives to report infectious disease outbreaks. Reports of outbreaks can prompt other countries to impose trade and travel restrictions, which has the potential to discourage reporting. However, reports can also bring medical assistance to contain the outbreak, including access to vaccines.

Methods
We compiled data on reports of meningococcal meningitis to the World Health Organization (WHO) from 54 African countries between 1966 and 2002, a period is marked by two events: first, a large outbreak reported from many countries in 1987 associated with the Hajj that resulted in more stringent requirements for meningitis vaccination among pilgrims; and second, another large outbreak in Sub-Saharan Africa in 1996 that led to a new international mechanism to supply vaccines to countries reporting a meningitis outbreak. We used fixed-effects regression modeling to statistically estimate the effect of external forcing events on the number of countries reporting cases of meningitis to WHO.

Findings
We find that the Hajj vaccination requirements started in 1988 were associated with reduced reporting, especially among countries with relatively fewer cases reported between 1966 and 1979. After the vaccine provision mechanism was in place in 1996, reporting among countries that had previously not reported meningitis outbreaks increased.

Interpretation
These results indicate that countries may respond to changing incentives to report outbreaks when they can do so. In the long term, these incentives are likely to be more important than surveillance assistance in prompt reporting of outbreaks.

Resource Planning for Neglected Tropical Disease (NTD) Control Programs: Feasibility Study of the Tool for Integrated Planning and Costing (TIPAC)

PLoS Neglected Tropical Diseases
February 2014
http://www.plosntds.org/article/browseIssue.action

From Innovation to Application
Resource Planning for Neglected Tropical Disease (NTD) Control Programs: Feasibility Study of the Tool for Integrated Planning and Costing (TIPAC)
Olivier J. Wouters, Philip W. Downs mail, Kathryn L. Zoerhoff, Kathryn R. Crowley, Hannah Frawley, Jennifer Einberg, Brian K. Chu, Molly A. Brady, Roland Oscar, Mireille Jeudi, Anne-Marie Desormeaux, Karleen Coly, Abdel N. Direny,  [ … ], Aya Yajima
Published: February 27, 2014
DOI: 10.1371/journal.pntd.0002619
http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002619;jsessionid=0A6EAED973FE58156CF54531355875C4

Excerpt
Neglected tropical diseases (NTDs) cause significant morbidity and mortality worldwide and impose a large economic burden on endemic countries [1]. In 2006, the United States Agency for International Development (USAID) founded the NTD Control Program to target five NTDs in African, Asian, and Latin American countries, namely, lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminthiases (STH), and trachoma; the three targeted STH infections are ascariasis, hookworm, and trichuriasis. The NTD Control Program supported national NTD control and elimination programs’ efforts to integrate and scale up delivery of preventive chemotherapy (PC) [2]. PC is the administration of safe, single-dose drugs, either alone or in combination, as a public health intervention against targeted NTDs. Administration is characterized by population-based diagnosis, population-based treatment, and implementation at regular intervals. PC can be delivered as universal chemotherapy (i.e., mass drug administration [MDA]), where the entire population of an area is targeted; targeted chemotherapy, where only high-risk groups (e.g., school age children) are targeted; or selective chemotherapy, where only screened individuals found or suspected to be infected are targeted [3]. Between October 2006 and March 2012, the program provided 589 million NTD treatments through the collaborative efforts of ministries of health, implementing partners, funders, and pharmaceutical donation programs.

The implementation of integrated NTD programs at the full national scale remains an important objective in many endemic countries [4][8]. Several theoretical frameworks for integration have been proposed; most protocols stress the importance of long-term commitments and concerted efforts of partnerships to realize NTD control and elimination objectives [9][14]. However, there is currently a paucity of economic evidence on the costs of integrated PC delivery for NTDs, primarily due to the significant variation in program structures and operations [14]. Given the scarce resources and substantial costs associated with NTD control and elimination, there is therefore a need to accurately determine the cost of program implementation. It is also important to delineate funding commitments to ensure that additional assistance is used to complement available resources, rather than duplicate or replace previous efforts.

To allow governments to more easily enumerate costs and funding commitments for NTD control and elimination, the NTD Control Program developed the Tool for Integrated Planning and Costing (TIPAC). The TIPAC, a versatile planning and costing instrument, is designed to be used by members of a NTD program at the national level. For countries with decentralized political structures, the TIPAC can also be implemented at a subnational administrative level. NTD program and financial managers are the primary users of the tool; the involvement of other personnel, including representatives from partner organizations and ministries of education, improves the accuracy and completeness of the TIPAC data…

A priority-setting aid for new vaccine candidates [SMART]

PNAS – Proceedings of the National Academy of Sciences of the United States
of America

http://www.pnas.org/content/early/
(Accessed 8 March 2014)

A priority-setting aid for new vaccine candidates
Charles Phelpsa,b, Guruprasad Madhavanc,1, Kinpritma Sanghac, Rino Rappuolid, Rita R. Colwelle,f, Rose Marie Martinezc, Patrick Kelleyc, and Lonnie King
Author Affiliations
Abstract
Policy and investment decisions regarding new health technologies are often complex. They require a careful balancing of multiple perspectives and differing objectives. On some occasions, policymakers or analysts approaching these decisions have access to cost-effectiveness or cost-benefit analyses to help guide their decisions, but almost invariably such analyses are inadequate.

Recent advances in decision-support systems have offered ways to embed a range of different preferences and parameters into formal modeling structures, known as multicriteria decision analysis. The Institute of Medicine (IOM) has released a software tool called SMART Vaccines, short for Strategic Multi-Attribute Ranking Tool for Vaccines. This early-stage prototype—the use of which needs to be evaluated by interested parties—is grounded on multiattribute utility theory (see screenshot in Fig. 1). The software and associated reports in the Ranking Vaccines series can be downloaded free of charge from http://www.nap.edu/smartvaccines (1, 2).

Report Altitudinal Changes in Malaria Incidence in Highlands of Ethiopia and Colombia

Science        
7 March 2014 vol 343, issue 6175, pages 1049-1168
http://www.sciencemag.org/current.dtl

Report
Altitudinal Changes in Malaria Incidence in Highlands of Ethiopia and Colombia
A. S. Siraj1, M. Santos-Vega2, M. J. Bouma3, D. Yadeta4, D. Ruiz Carrascal5,6, M. Pascual2,7,
Author Affiliations
1Department of Geography and the Environment, University of Denver, 235 Boettcher West, 2050 East Iliff Avenue Denver, CO 80208-0710, USA.
2Department of Ecology and Evolutionary Biology, University of Michigan, 2019 Kraus Natural Sciences Building, 830 North University, Ann Arbor, MI 48109-1048, USA.
3London School of Hygiene and Tropical Medicine, University of London, London WC1 E7HT, UK.
4Oromia Regional Health Bureau, Post Office Box 24341, Addis Ababa, Ethiopia.
5International Research Institute for Climate and Society, Columbia University in the City of New York, Lamont-Doherty Earth Observatory Post Office Box 1000, 61 Route 9W, Monell Building, Palisades, NY 10964-1000, USA.
6Escuela de Ingenieria de Antioquia, km 02+200 Vía al Aeropuerto José María Córdova, Envigado, Antioquia, Colombia.
7Howard Hughes Medical Institute, Chevy Chase, MD 20815-6789, USA.
http://www.sciencemag.org/content/343/6175/1154.abstract

Abstract
Editor’s Summary
The impact of global warming on insect-borne diseases and on highland malaria in particular remains controversial. Temperature is known to influence transmission intensity through its effects on the population growth of the mosquito vector and on pathogen development within the vector. Spatiotemporal data at a regional scale in highlands of Colombia and Ethiopia supplied an opportunity to examine how the spatial distribution of the disease changes with the interannual variability of temperature. We provide evidence for an increase in the altitude of malaria distribution in warmer years, which implies that climate change will, without mitigation, result in an increase of the malaria burden in the densely populated highlands of Africa and South America…

Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012

Vaccine
Volume 32, Issue 14, Pages 1523-1640 (20 March 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

Available online 2 March 2014
Review
Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012
Heidi J. Larson, Caitlin Jarrett, Elisabeth Eckersberger, David M.D. Smith, Pauline Paterson
http://www.sciencedirect.com/science/article/pii/S0264410X14001443
Highlights
:: Vaccine hesitancy is a complex issue driven by a variety of context-specific factors.
:: Most studies were conducted in Europe and the Americas, with a two-fold increase in research on this topic during the period 2007–2012.
:: Determinants examined are mostly from classic models (e.g., Health Belief Model) which do not adequately account for contextual influences.

Abstract
Vaccine “hesitancy” is an emerging term in the literature and discourse on vaccine decision-making and determinants of vaccine acceptance. It recognizes a continuum between the domains of vaccine acceptance and vaccine refusal and de-polarizes previous characterization of individuals and groups as either anti-vaccine or pro-vaccine.

The primary aims of this systematic review are to: 1) identify research on vaccine hesitancy; 2) identify determinants of vaccine hesitancy in different settings including its context-specific causes, its expression and its impact; and 3) inform the development of a model for assessing determinants of vaccine hesitancy in different settings as proposed by the Strategic Advisory Group of Experts Working Group (SAGE WG) for dealing with vaccine hesitancy.

A broad search strategy, built to capture multiple dimensions of public trust, confidence and hesitancy around vaccines, was applied across multiple databases. Peer-reviewed studies were selected for inclusion if they focused on childhood vaccines [≤7 years of age], used multivariate analyses, and were published between January 2007 and November 2012.

Our results show a variety of factors as being associated with vaccine hesitancy but they do not allow for a complete classification and confirmation of their independent and relative strength of influence. Determinants of vaccine hesitancy are complex and context-specific – varying across time, place and vaccines.