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

Q&A with WHO: Cholera vaccine stockpile – a new tool to avoid needless suffering
Thomson Reuters Foundation – Mon, 3 Mar 2014 11:20 AM
Alisa Tang
Excerpt
The World Health Organization (WHO) has activated for the first time a new cholera vaccine emergency stockpile to protect hundreds of thousands displaced by conflict in South Sudan and living in temporary camps.

Although there is currently no outbreak of cholera – an acute diarrhoeal infection caused by ingestion of contaminated food or water – the risk is high due to poor sanitary conditions and overcrowding, the WHO said.

With WHO coordinating the campaign, Médecins Sans Frontières (MSF) on Feb. 22 started vaccinations for 94,000 people in Minkaman camp in Awerial county, and the humanitarian organisation Medair was to vaccinate an additional 43,000 in camps in South Sudan’s capital, Juba.

Two oral doses of the cholera vaccine are required for an individual to be protected. The campaign begins with an initial round of vaccinations followed after a required 14-day interval by a second round.

William Perea, the WHO’s coordinator for the control of epidemic diseases, spoke to Thomson Reuters Foundation by phone from Geneva about the emergency stockpile – which is managed by WHO, the International Federation of the Red Cross and Red Crescent Societies (IFRC), MSF and UNICEF – as a tool to fight cholera…

Special Focus Newsletter/Projects
The Vaccine Confidence Project :: Confidence Commentary from Dr Heidi Larson
“Why we need “\’science understanding the public’ more than just ‘public understanding of science’: the case of vaccines”
London School of Hygiene and Tropical Medicine
www.vaccineconfidence.org

BMC Health Services Research
2014, 14:111
http://www.biomedcentral.com/bmchealthservres/content
Research article
Urban settings do not ensure access to services: findings from the immunisation programme in Kampala Uganda
Juliet N Babirye, Ingunn MS Engebretsen, Elizeus Rutebemberwa, Juliet Kiguli and Fred Nuwaha
Published: 6 March 2014
Author Affiliations
http://www.biomedcentral.com/1472-6963/14/111/abstract
Abstract (provisional)
Background
Previous studies on vaccination coverage in developing countries focus on individual- and community-level barriers to routine vaccination mostly in rural settings. This paper examines health system barriers to childhood immunisation in urban Kampala Uganda.
Methods
Mixed methods were employed with a survey among child caretakers, 9 focus group discussions (FGDs), and 9 key informant interviews (KIIs). Survey data underwent descriptive statistical analysis. Latent content analysis was used for qualitative data.
Results
Of the 821 respondents in the survey, 96% (785/821) were mothers with a mean age of 26 years (95% CI 24-27). Poor geographical access to immunisation facilities was reported in this urban setting by FGDs, KIIs and survey respondents (24%, 95% CI 21-27). This coupled with reports of few health workers providing immunisation services led to long queues and long waiting times at facilities. Consumers reported waiting for 3-6 hours before receipt of services although this was more common at public facilities. Only 33% (95% CI 30-37) of survey respondents were willing to wait for three or more hours before receipt of services. Although private-for-profit facilities were engaged in immunisation service provision their participation was low as only 30% (95% CI 27-34) of the survey respondents utilised these facilities. The low participation could be due to lack of financial support for immunisation activities at these facilities. This in turn could explain the rampant informal charges for services in this setting. Charges ranged from US$ 0.2 to US$4 and these were more commonly reported at private (70%, 95% CI 65-76) than at public (58%, 95% CI 54-63) facilities. There were intermittent availability of vaccines and transport for immunisation services at both private and public facilities.
Conclusions
Complex health system barriers to childhood immunisation still exist in this urban setting; emphasizing that even in urban areas with great physical access, there are hard to reach people. As the rate of urbanization increases especially in sub-Saharan Africa, governments should strengthen health systems to cater for increasing urban populations.

Journal of Epidemiology and Community Health
Online First doi:10.1136/jech-2013-203272
Commentary
International institutional legitimacy and the World Health Organization
Jennifer Prah Ruger
http://jech.bmj.com/content/early/2014/03/05/jech-2013-203272.extract
Extract
The global health community continues to look to the World Health Organization (WHO) to solve current global health governance (GHG) problems. Until the 1990s, nation-states and multilateral organisations with state members governed international health, and WHO played a prominent role, coordinating worldwide efforts such as smallpox eradication with a few partner organisations. WHO also provided international reporting and handled disease outbreaks through the International Health Regulations. The world still sees WHO as the leading global health governor, and proposals abound to reform it,1–4 to use its treaty abilities more regularly and to give it enforcement powers—all in the absence of real institutional alternatives.

But today’s WHO is a compromised institution; some interrogate its relevance altogether2 and WHO Director-General Margaret Chan herself questions WHO’s ability to respond to global health challenges.5 On a theoretical level, WHO lacks a substantive justice oriented conception of international institutional legitimacy. On a more pragmatic plane, WHO is riddled with budgetary weaknesses, power politics and diminishing reputation and effectiveness. WHO’s early successes were laudable and the organisation has the potential to make an impact on future global health problems, but the institution lacks a number of key ingredients of success: coordination capacity, authority, accountability, fairness, a master global health plan, effectiveness and credible compliance mechanisms.

While WHO reforms could help it do its job better, a new vision, based on a substantive conception of justice and legitimacy, and associated reforms in the broader GHG system will more effectively and efficiently serve GHG functions and the WHO itself. WHO Director-General Margaret Chan states “[t]he level of WHO engagement should not be governed by the size of a health problem. Instead it should be governed by the extent to which WHO can have an impact on the problem. Others may be positioned to do a …

Communication, Somali culture and decision-making about the human papillomavirus (HPV) Vaccine
Dailey, Phokeng 2014-02
28th Edward F. Hayes Graduate Research Forum. Ohio State University
http://hdl.handle.net/1811/59265
Abstract
The current study uses a multiple goals theoretical perspective to explore how Somali immigrant families in the United States make decisions regarding whether to vaccinate their children against human papillomavirus (HPV). A focus was placed on the communication goals of parents in HPV vaccine discussions with their child and health care provider. 16 semi-structured interviews were audiotaped, transcribed, and analyzed using a grounded theory approach. Key themes were the implications of the vaccine for early sexual activity, confusion between HPV and human immunodeficiency virus (HIV), the perception that the HPV vaccine is unnecessary, uncertainty about the vaccine’s efficacy and side effects, avoidance of parent-child communication about the vaccine, and a preference for framing the vaccine as a health promotion behavior. Framing the threat of HPV in the context of initiation of sexual activity, uncertainty regarding vaccine efficacy, and anticipated regret account for the inconsistency in HPV vaccine uptake among Somali parents. Health care providers should consider talking about HPV as a distal versus an immediate threat and HPV vaccine uptake as a health-promotion rather than a sexually transmitted infection (STI) prevention behavior.

Trends in HPV Vaccination of US Adolescent Females: How Policies, Education, and Health Care Providers Influence Immunization Rates
Grant, Jennifer Lyn (2013)
Dissertation (88 pages)
Program: Laney Graduate School, Health Services and Research Health Policy
Permanent url: http://pid.emory.edu/ark:/25593/f4mjs
Abstract
In my first paper, The Impact of State Immunization Financing Policies on HPV Vaccination Rates among US Adolescent Females, I examine the impact of expanded enrollment eligibility for The Vaccines for Children (VFC) program on HPV vaccine series initiation and completion among US adolescent girls. The VFC program provides certain vaccines at a reduced or no cost to eligible children. It was designed to help ensure all children receive recommended vaccinations on schedule, even if their parents are not be able to afford them. Specifically, I hypothesized that adolescent girls living in states in which all recommended vaccines were provided free of cost to all children in the state would be more likely to initiate and complete the HPV vaccine series than their peers living in states with more restricted VFC eligibility requirements.

In my second paper, Maternal Educational Inequalities in HPV Vaccine Utilization among US adolescent females- The relative roles of economics and awareness, I evaluate the relative influences of household-level socioeconomic status, specific health knowledge, and general healthcare utilization and timeliness in mediating the relationship between maternal educational attainment and HPV vaccine utilization among adolescent girls.

In my third and final paper, Factors Associated with Health Care Provider Recommendation of the Human Papillomavirus Vaccine and effect of provider recommendation on vaccine series initiation and completion, I examine the relative influences of adolescent and household sociodemographic characteristics and characteristics of their health-seeking behavior on the likelihood of receiving a health care provider recommendation of the HPV vaccine for US Adolescent girls. I also estimate the effect of provider recommendation on vaccine series initiation and completion

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

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WHO Briefing: Health situation in Syria
Dr Margaret Chan, Director-General of the World Health Organization
Briefing to the UN General Assembly
25 February 2014

Full text [Editor’s bolded text]

Mr President, Secretary-General, distinguished delegates, ladies and gentlemen,

I am speaking to you with a heavy heart. In March, the Syrian crisis will enter its fourth year. The long duration of the conflict has created a crisis for health. The health needs of the Syrian people are enormous, as is their suffering.

In the course of this conflict, more than 100,000 people have been killed, and more than 600,000 have been injured.

At least 6.5 million Syrians have been internally displaced, often crowded together under unsanitary conditions that favour the spread of disease. Another 2.3 million have fled to Lebanon, Jordan, Turkey, Iraq, and Egypt, creating a heavy burden on these countries.

Health needs have skyrocketed at a time when domestic capacity to respond has been decimated. The country’s previously excellent health system has collapsed in a significant number of areas.

More than half the country’s public hospitals have been damaged, often following direct attacks, and many no longer function. The number of doctors, nurses, and other health workers still at work has dropped by more than half.

A once vibrant pharmaceutical manufacturing industry has nearly ceased operations, resulting in severe shortages of drugs. Many patients with chronic diseases, like heart disease, cancer, and diabetes, are not being treated.

Immunization programmes, which reached 90% of children before the conflict, have been disrupted, leaving young children vulnerable to entirely preventable diseases. Safe childbirth is no longer readily accessible, placing pregnant women with life-threatening complications at heightened risk of losing their lives.

The suffering of the Syrian people is reflected in increased mental health disorders, food shortages, undernutrition, and an increase in sexual violence.

   The steep drop in childhood immunization opened the door for vaccine-preventable diseases to return to Syria. And they did, including polio.

   The first cases of polio in Syria since 1999 were reported in October 2013. This marked a significant added threat to Syria’s children, but also a setback to the global initiative to eradicate polio. Most significantly, it confirmed the renewed vulnerability of the Syrian people to diseases that had long disappeared from the country.

   Since detection of the polio cases in October, four mass vaccination campaigns have been conducted in Syria. The most recent campaigns, undertaken in January and February of this year, appear to have reached all districts in all governorates. Preliminary results indicate that immunization coverage was higher than 80% in all but two governorates.

   However, to control the outbreak, efforts on a similarly massive scale need to be sustained during three to four additional campaigns extending until at least June. The future of many Syrian children, and a worldwide eradication effort, are at stake.

Ladies and gentlemen,

Last year, life-saving medicines and supplies reached nearly 5 million Syrians. Much more needs to be done, despite the challenges.

All of these efforts to address the deteriorating health situation are being conducted under extremely difficult and dangerous conditions. Despite the greatest possible will to provide assistance, lack of access to people in need, wherever they reside, remains the most critical barrier to improving the health situation in Syria.

I began my intervention with a heavy heart, and conclude with a heartfelt plea. All parties in the conflict must respect the integrity and neutrality of health facilities.

They must ensure the protection of health workers and patients, in line with their obligations under international humanitarian law.

Thank you.

Joint GPEI-GAVI statement on the Availability and Price of Inactivated Polio Vaccine
Excerpt
The Global Polio Eradication Initiative (GPEI) and the GAVI Alliance “welcome the conclusion of UNICEF’s tender process, which makes accessible sufficient quantities of affordable inactivated polio vaccine (IPV) to support country introductions, in line with the ambitious timeline of GPEI’s Eradication and Endgame Strategic Plan 2013-2018.” The vaccine will now be available to GAVI-supported countries for as little as EUR 0.75 per dose (approximately USD 1.00 per dose at current exchange rates) in ten-dose vials. For middle-income countries, 10-dose presentations will be available through UNICEF from July 2014 at a price of EUR 1.49-2.40 (approximately USD 2.04-3.28 at current exchange rates). In addition, the awards by UNICEF include a price of USD 1.90 per dose for IPV in five-dose vials and USD 2.80 for IPV in single-dose vials. These vaccine presentations are accessible to both GAVI- supported and middle-income countries.

Further reductions in the cost of IPV are being pursued for the medium-term (i.e., post-2018) through continued efforts to develop and license new products.

As recommended by the World Health Organization’s Strategic Advisory Group of Experts on Immunization (SAGE) and endorsed by the World Health Assembly, the introduction of IPV globally – prior to a phased removal of the oral polio vaccine (OPV) during 2016-2018 – is a major element of the comprehensive plan to end all polio disease and secure a polio-free future.

Introduction of IPV will also help accelerate eradication of the remaining polioviruses by boosting global immunity.

GPEI’s plan calls for the introduction of IPV into routine immunisation programmes globally by the end of 2015. More than 120 countries have yet to introduce IPV, more than half of which are eligible for GAVI support.

Today’s publication of prices following conclusion of the UNICEF tender ensures that affordable IPV will be made available, removing a major obstacle to global introduction…With this tender completed, more than 120 countries can now move forward with their plans to introduce at least one dose of IPV into their routine immunisation schedules.
Full text: http://www.gavialliance.org/library/news/statements/2014/joint-gpei-gavi-statement-on-the-availability-and-price-of-inactivated-polio-vaccine/

GPEI Update: Polio this week – As of 26 February 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s extract and bolded text]
:: Seven new cases (six wild poliovirus type 1 – WPV1 – and one circulating vaccine-derived poliovirus type 2 – cVDPV2) are reported this week from Federally Administered Tribal Areas and Khyber Pakhtunkhwa in Pakistan. This area is largely considered the ‘engine’ for polio transmission in the country.

Pakistan
:: Six new WPV1 cases were reported in the past week, five from North Waziristan, FATA and one from Peshawar, Khyber Pakhtunkhwa (KP). The total number of cases for 2013 remains 93. :: The total number of cases in 2014 is now 21. The most recent case had onset of paralysis on 10 February (WPV1 from Peshawar).
:: One new cVDPV2 case was reported in the past week, from FR Bannu, FATA, with onset of paralysis on 27 January. It is the most recent cVDPV2 case in the country. The total number of cVDPV2 cases for 2013 is 45, and four for 2014.
:: 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 19 June 2013. The case was reported late due to laboratory processing backlog.
:::The total number of WPV1 cases in the Horn of Africa is now 216 (193 from Somalia, 14 from Kenya and nine from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on 20 December 2013 (from Bari, Somalia).
:: Outbreak response across the Horn of Africa is continuing. Recommendations from the recently held Horn of Africa Technical Advisory Group (TAG) are now actively being incorporated into outbreak response planning. The TAG had underscored that the initial response to the outbreak was appropriate, however expressed grave concern that gaps in SIA quality and surveillance remained in key infected areas of the region. Consequently, the group concluded there is a serious risk of the outbreak continuing and of further spread both within and beyond countries of the Horn of Africa. The group recommended that infected countries should focus efforts on high-risk and infected areas, by conducting high-quality SIAs no more than four weeks apart.

Associated Press: Bombs Kill 11 Pakistan Police Guarding Polio Teams
Two Bombs Struck Minutes Apart
March 1, 2014 7:16 a.m. ET
PESHAWAR, Pakistan—Two bombs minutes apart struck tribal police assigned to guard polio workers in northwest Pakistan on Saturday, killing 11, police said.
Police official Nawabzada Khan said the first of the two bombs struck an escort vehicle in the Lashora village of Jamrud tribal region in Khyber Pakhtunkhwa province. It wounded six officers, but caused no deaths.

Mr. Khan said minutes later, another roadside bomb struck a convoy of tribal police officers dispatched there to transport victims of the first attack, killing 11 officers and wounding six. He said gunmen also opened fire on officers, triggering a shootout that was still going on.

A government administrator named Nasir Khan said a hunt had been launched to trace and arrest the attackers. He confirmed 11 deaths and 12 injuries.

No one claimed responsibility for the two separate bombings, but antipolio teams or their guards have been frequently targeted in Pakistan by Islamic militants, who say the campaigns are a tool for spying and claim the vaccine makes boys sterile…

The Weekly Epidemiological Report (WER) for 28 February 2014, vol. 89, 9 (pp. 73–92) includes:
:: Polio vaccines: WHO position paper, January 2014
http://www.who.int/entity/wer/2014/wer8909.pdf?ua=1

  IVI announced the resignation of Dr. Alejandro Cravioto effective April 30, 2014. Dr. Cravioto will step down as Chief Scientific Officer on February 28, 2014 and will support IVI as a Senior Scientific Consultant until April 30th. Separately, IVI said its Board of Trustees has begun an executive recruitment search for IVI’s next Director General. IVI has retained the global search firm Russell Reynolds Associates to assist in the process with a deadline for applications of 17 March 2014.

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

:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 28 February 2014
On 3 and 15 February 2014, the Ministry of Health of Saudi Arabia announced two additional   laboratory-confirmed cases of Middle East Respiratory Syndrome coronavirus (MERS-CoV) infection… WHO does not advise special screening at points of entry with regard to this event nor does it currently recommend the application of any travel or trade restrictions.

:: Human infection with avian influenza A(H7N9) virus – update 27 February 2014
…The overall risk assessment has not changed…
:: Human infection with avian influenza A(H7N9) virus – update 27 February 2014
:: Human infection with avian influenza A(H7N9) virus – update 24 February 2014

Industry Watch  [to 1 March 2014]
Selected media releases and other selected content from industry.

:: Gardasil: New 2-dose Schedule Granted Positive CHMP Opinion for Europe’s Leading HPV Vaccine
Press release | 27 February 2014
Sanofi Pasteur MSD announced today that its quadrivalent HPV vaccine, Gardasil® has received a positive opinion from the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) for the use of a two-dose schedule in 9 to and including 13 year old adolescent girls and boys.

:: Novartis provides second US university with Bexsero to help protect students and staff against potentially deadly meningitis B disease
– FDA granted special use of Bexsero for nearly 20,000 UCSB students and staff in response to outbreak; the vaccine is licensed in Europe, Australia and Canada
– Novartis is pursuing a US license that would allow immediate public health response to outbreaks and make Bexsero available to American families
– MenB is an unpredictable disease, easily misdiagnosed, can kill within 24 hours and leaves those affected with serious lifelong disabilities
http://www.prnewswire.com/news-releases/novartis-provides-second-us-university-with-bexsero-to-help-protect-students-and-staff-against-potentially-deadly-meningitis-b-disease-246858901.html\
CAMBRIDGE, Mass., Feb. 24, 2014 /PRNewswire/ — Novartis announced today that its meningococcal serogroup B (MenB) vaccine, Bexsero® (Meningococcal Group B Vaccine [rDNA, component, adsorbed]), will be used as part of a vaccination program at the University of California Santa Barbara (UCSB) that began today and will end on March 7. In the last three months, the Food and Drug Administration (FDA) has approved the use of Bexsero twice in response to MenB outbreaks at US college campuses1. More than 5,000 students were vaccinated at Princeton University and 20,000 students will be offered vaccination at UCSB2.
Bexsero is the only licensed broad coverage vaccine approved in Europe, Canada and Australia to help protect against invasive meningococcal disease caused by serogroup B. It was approved for use in the US under a treatment Investigational New Drug (IND) designation…

:: Pfizer Announces Positive Top-Line Results Of Landmark Community-Acquired Pneumonia Immunization Trial In Adults (CAPiTA) Evaluating Efficacy Of Prevenar 13
Data to Be Presented at 9th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD) on March 12, 2014
February 24, 2014 07:00 AM Eastern Standard Time
NEW YORK–(BUSINESS WIRE)–Pfizer Inc. (NYSE:PFE) today announced that the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA), the landmark study of approximately 85,000 subjects evaluating the efficacy of Prevenar 13* (pneumococcal polysaccharide conjugate vaccine [13-valent, adsorbed]) in adults 65 years of age and older, achieved its primary clinical objective and both secondary clinical objectives. CAPiTA is the largest double-blind, randomized, placebo-controlled vaccine efficacy trial ever conducted in adults.
“We are pleased with the outcome of the CAPiTA study, which demonstrated that Prevenar 13 can prevent vaccine-type pneumococcal community-acquired pneumonia in adults”
The primary objective of the study was to demonstrate efficacy of Prevenar 13 against a first episode of vaccine-type community-acquired pneumonia (CAP). The CAPiTA study also met both secondary objectives, which were efficacy against (i) a first episode of non-bacteremic/non-invasive vaccine-type CAP and (ii) a first episode of vaccine-type invasive pneumococcal disease (IPD).
Vaccine-type CAP (VT-CAP) was defined as CAP caused by any S. pneumoniae serotype included in the vaccine. Non-bacteremic/non-invasive VT-CAP was defined as CAP in which vaccine-type S. pneumoniae caused the pneumonia, but was not detected concurrently in the bloodstream or any other normally sterile site. Vaccine-type IPD was defined as a case in which vaccine-type S. pneumoniae was present in the bloodstream or any other normally sterile site, with or without pneumonia.
http://www.businesswire.com/news/home/20140224005899/en/Pfizer-Announces-Positive-Top-Line-Results-Landmark-Community-Acquired#.UxJGFYUt6F8

American Journal of Infection Control
Vol 42 | No. 3 | March 2014 | Pages 215-344
http://www.ajicjournal.org/current

The impact of influenza vaccination requirements for hospital personnel in California: Knowledge, attitudes, and vaccine uptake
Katherine M. Harris, PhD, Lori Uscher-Pines, PhD, Bing Han, PhD, Megan C. Lindley, MPH, Suchita A. Lorick, DO, MPH
http://www.ajicjournal.org/article/S0196-6553%2813%2901315-1/abstract

Abstract
Background
Seasonal influenza infections are a leading cause of illness, death, and lost productivity. Vaccinating health care personnel (HCP) can reduce transmission of influenza virus to patients and reduce influenza-related absenteeism, enabling the health care system to meet elevated demand for care during influenza outbreaks.

Objectives
We evaluated the impact of California’s 2006 influenza vaccination requirement for hospital workers (requiring vaccination or signed declinations) on uptake and vaccination-related attitudes, beliefs, and knowledge among hospital HCP.

Methods
We used a causal difference-in-differences approach to compare changes over the prior 10 years in the self-reported frequency of influenza vaccination for California hospital HCP and those from other states without similar laws using data from a stratified sample (N = 3,529) of HCP drawn from online survey panels. We also examined cross-sectional differences in awareness of vaccination policies, promotion efforts, and attitudes toward influenza vaccination. All analyses used propensity score weighting to balance the observable characteristics of the 2 samples.

Results
We found that compared with their counterparts in other states, California hospital HCP were (1) more likely to report working under a formal written policy for influenza vaccination, (2) no more likely to be vaccinated, and (3) less likely to report working for an employer who provided financial incentives for vaccination or rewarded or recognized employees for being vaccinated.

Conclusion
Our results suggest that state-level vaccination requirements such as those enacted by California, may not be sufficient to increase uptake among hospital HCP.

American Journal of Infection Control
Vol 42 | No. 3 | March 2014 | Pages 215-344
http://www.ajicjournal.org/current

Employee influenza vaccination in residential care facilities
Bettye A. Apenteng, PhD, Samuel T. Opoku, MBChB
http://www.ajicjournal.org/article/S0196-6553%2813%2901303-5/abstract

Abstract
Background
The organizational literature on infection control in residential care facilities is limited. Using a nationally representative dataset, we examined the organizational factors associated with implementing at least 1 influenza-related employee vaccination policy/program, as well as the effect of vaccination policies on health care worker (HCW) influenza vaccine uptake in residential care facilities.

Methods
The study was a cross-sectional study using data from the 2010 National Survey of Residential Care Facilities. Multivariate logistic regression analysis was used to address the study’s objectives.

Results
Facility size, director’s educational attainment, and having a written influenza pandemic preparedness plan were significantly associated with the implementation of at least 1 influenza-related employee vaccination policy/program, after controlling for other facility-level factors. Recommending vaccination to employees, providing vaccination on site, providing vaccinations to employees at no cost, and requiring vaccination as a condition of employment were associated with higher employee influenza vaccination rates.

Conclusion
Residential care facilities can improve vaccination rates among employees by adopting effective employee vaccination policies

BMC Public Health
(Accessed 1 March 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Where is the Gap?: The contribution of disparities within developing countries to global inequalities in under-five mortality
Agbessi Amouzou, Naoko Kozuki and Davidson R Gwatkin
Author Affiliations
BMC Public Health 2014, 14:216  doi:10.1186/1471-2458-14-216
Published: 1 March 2014
http://www.biomedcentral.com/1471-2458/14/216/abstract

Abstract (provisional)
Background
Global health equity strategists have previously focused much on differences across countries. At first glance, the global health gap in health status appears to result primarily from disparities between the developing and developed regions. We examine how much of this disparity could be attributed to within-country disparities in developing nations.

Methods
We used data from Demographic and Health Surveys conducted between 1995 and 2010 in 67 developing countries. Using a population attributable risk approach, we computed the proportion of global under-five mortality gap and the absolute under-five deaths that would be reduced if the under-five mortality rate in each of these 67 countries was lowered to the level of the top 10% economic group in each country. As a sensitivity check, we also conducted comparable calculations replacing the top 10% with the top 5% and with the top 20%.

Results
In 2007, approximately 6.6 million under-five deaths were observed in the 67 countries used in the analysis. This could be reduced to only 600,000 deaths if these countries had the same under-five mortality rate as developed countries. If the under-five mortality rate in developing countries was lowered to the rate among the top 10% economic group in those same each of these countries, under-five deaths would be reduced to 3.7 million. This corresponds to a 48% reduction in the global mortality gap and 2.9 million under-five deaths averted. Using cutoff points of top 5% and top 20% economic groups showed reduction of 37% and 56% respectively in the global mortality gap. With these cutoff points, respectively 2.3 and 3.4 million deaths would be averted.

Conclusion
Under-five mortality disparities within developing countries account for roughly half of the global gap between developed and developing countries. Thus, within-country inequities deserve as much consideration as do inequalities between the world’s developing and developed regions.

BMC Public Health
(Accessed 1 March 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
The informed consent in Southern Italy does not adequately inform parents about infant vaccination
Francesco Attena, Amanda Valdes Abuadili and Sara Marino
Author Affiliations
BMC Public Health 2014, 14:211  doi:10.1186/1471-2458-14-211
Published: 28 February 2014
http://www.biomedcentral.com/1471-2458/14/211/abstract

Abstract (provisional)
Background
Vaccination centres in the Campania Region, southern Italy, vaccinate children with a hexavalent vaccine that contains the mandatory vaccines diphtheria, tetanus, poliomyelitis, and viral Hepatitis B. This vaccine also includes two non-mandatory vaccines, pertussis and Haemophilus influenzae type B. Information about these optional vaccines should be communicated to the parents, and informed consent should be obtained from parents before vaccination. We explored whether informed consent was delivered to the parents, whether they signed the consent form, and whether they read and acquired the information about the vaccination that their child would receive.

Methods
Childhood immunisations are provided at specific public health vaccination centres, “Unita Operative Materno-infantili’s” (UOMIs). We selected four UOMI from the Campania Region where we interviewed 1039 parents bringing their children for the 1st, 2nd, or 3rd doses of hexavalent vaccine. The consent forms were collected from the four vaccination centres and were analysed with respect to clarity and completeness.

Results
Most of the respondents (89.5%) were mothers between 20 and 39 years of age (80.4% vs 59.6% of the fathers), they were married (87.2% vs 93.5% of the fathers), and only one-half of them were employed (50.2% vs 92.6% of the fathers). The informed consent form was received from 58.1% of the parents and signed by 52.8%, but read by 35.0% of them. Only 1.5% of parents knew which vaccines were mandatory, and 25.0% of them believed that the entire hexavalent vaccine was mandatory. When we asked the parents which non-mandatory vaccinations were administered to their children, only 0.5% indicated the Haemophilus influenzae type B and none indicated the pertussis vaccine. Thirty-six per cent of the parents replied that their child had not received any non-mandatory vaccines. No parents were informed by the operators that their children would receive non-mandatory vaccines.

Conclusion
In our study, consent procedures did not allow parents to acquire correct information about vaccine options for their children. Furthermore, not one health care provider informed parents that their child was receiving non-mandatory vaccines. The informed consent process and the individual health care providers did not properly inform parents about the vaccines administered to their children.

BMC Public Health
(Accessed 1 March 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Vaccination coverage and its determinants among migrant children in Guangdong, China
Ke Han12, Huizhen Zheng2*, Zhixiong Huang3, Quan Qiu2, Hong Zeng3, Banghua Chen4 and Jianxiong Xu5
Author Affiliations
For all author emails, please log on.
BMC Public Health 2014, 14:203  doi:10.1186/1471-2458-14-203
Published: 26 February 2014
http://www.biomedcentral.com/1471-2458/14/203/abstract

Abstract
Background
Guangdong province attracted more than 31 million migrants in 2010. But few studies were performed to estimate the complete and age-appropriate immunization coverage and determine risk factors of migrant children.

Methods
1610 migrant children aged 12–59 months from 70 villages were interviewed in Guangdong. Demographic characteristics, primary caregiver’s knowledge and attitude toward immunization, and child’s immunization history were obtained. UTD and age-appropriate immunization rates for the following five vaccines and the overall series (1:3:3:3:1 immunization series) were assessed: one dose of BCG, three doses of DTP, OPV and HepB, one dose of MCV. Risk factors for not being UTD for the 1:3:3:3:1 immunization series were explored.

Results
For each antigen, the UTD immunization rate was above 71%, but the age-appropriate immunization rates for BCG, HepB, OPV, DPT and MCV were only 47.8%, 45.1%, 47.1%, 46.8% and 37.2%, respectively. The 1st dose was most likely to be delayed within them. For the 1:3:3:3:1 immunization series, the UTD immunization rate and age-appropriate immunization rate were 64.9% and 12.4% respectively. Several factors as below were significantly associated with UTD immunization. The primary caregiver’s determinants were their occupation, knowledge and attitude toward immunization. The child’s determinants were sex, Hukou, birth place, residential buildings and family income.

Conclusions
Alarmingly low immunization coverage of migrant children should be closely monitored by NIISS. Primary caregiver and child’s determinants should be considered when taking measures. Strategies to strengthen active out-reach activities and health education for primary caregivers needed to be developed to improve their immunization coverage.

British Medical Journal
01 March 2014 (Vol 348, Issue 7947)
http://www.bmj.com/content/348/7947

Analysis
Prevention is better than cure for emerging infectious diseases
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g1499 (Published 21 February 2014)
Cite this as: BMJ 2014;348:g1499
David L Heymann, professor of infectious disease epidemiology123, Osman A Dar, locum consultant global health 13
Author Affiliations

Excerpt
Emerging infectious diseases have the potential to cause considerable morbidity, mortality, and economic damage. David Heymann and Osman Dar explain why we need to shift the emphasis from responding to emerging infections once they are detected to preventing them from occurring in the first place and describe one initiative that is working to achieve this

Emerging infectious diseases (emerging infections) have caused tens of billions of dollars worth of damage in the past 20 years and the costs are continuing to rise.1 2 Emerging infections can be new infections, such as HIV (when first discovered), which is thought to have emerged in human populations from a non-human primate; or existing infections that are becoming more common or spreading in geographically new areas as a result of changes in the micro-organisms or changing climate and include West Nile fever, Dengue fever, and chikungunya.3

Many people assume that emerging infections are a matter for tropical disease specialists, but they are important to doctors and policy makers, vets, farmers, traders, and economies globally. Although some emerging infections are specific to tropical areas, such as Ebola and Marburg haemorrhagic fevers, infections that emerge there can spread to other parts of the world, as seen with HIV. There are also many examples of diseases originating in non-tropical settings, including severe acute respiratory syndrome (SARS), influenza A (H5N1), variant Creutzfeldt-Jakob disease/bovine spongiform encephalopathy (BSE), and foodborne Escherichia coli O157 infections.4 5 Another problem is infections that have emerged in new forms—for example, multidrug resistant Staphylococcal and Mycobacterial species.

Over the past decades there has been increasing recognition that the way we deal with infectious disease is often reactive and too late. New diseases are often identified only after they have transferred to humans and sometimes many years after the breach in the species …

British Medical Journal
01 March 2014 (Vol 348, Issue 7947)
http://www.bmj.com/content/348/7947

Views & Reviews – Personal View
Research that does not consider participants’ health needs is unethical
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g1423 (Published 11 February 2014)
Cite this as: BMJ 2014;348:g1423
Allen G P Ross, professor, Griffith Health Institute, Griffith University, Gold Coast Campus, Australia
http://www.bmj.com/content/348/bmj.g1423

Excerpt
Research in poor countries must put patients first, writes Allen G P Ross, and ethics committees should insist that this happens

My colleagues and I currently coordinate a five year clinical trial investigating the neglected tropical disease schistosomiasis in the remote Philippines. Twenty two villages and almost 20,000 residents in the municipalities of Laoang and Palapag are taking part.

The Northern Samar province is considered the second poorest in the country, with more than half of its rural inhabitants living below the poverty line. The prevalence of malnutrition is high, with stunting, thinness, and wasting seen in 49%, 28%, and 60% of all children respectively (unpublished data). The burden of infectious disease is also high. The prevalence of schistosomiasis was found to be 27.1% (n=10 436; 95% confidence interval 26.3% to 28.0%) and for infection with any soil transmitted helminth (Ascaris, Trichuris, and hookworm) 77.2% (n=10 434; 76.4% to 78.0%).1

While examining participants I am often asked to help with health problems …

Bulletin of the World Health Organization
Volume 92, Number 3, March 2014, 153-228
http://www.who.int/bulletin/volumes/92/3/en/

Monitoring polio supplementary immunization activities using an automated short text messaging system in Karachi, Pakistan
AM Kazi, A Murtaza, S Khoja, AK Zaidi & SA Ali
http://www.who.int/bulletin/volumes/92/3/13-122564-ab/en/

Abstract
Problem
Polio remains endemic in many areas of Pakistan, including large urban centres such as Karachi.

Approach
During each of seven supplementary immunization activities against polio in Karachi, mobile phone numbers of the caregivers of a random sample of eligible children were obtained. A computer-based system was developed to send two questions – as short message service (SMS) texts – automatically to each number after the immunization activity: “Did the vaccinator visit your house?” and “Did the enrolled child in your household receive oral polio vaccine?” Persistent non-responders were phoned directly by an investigator.

Local setting
A cluster sampling technique was used to select representative samples of the caregivers of young children in Karachi in general and of such caregivers in three of the six “high-risk” districts of the city where polio cases were detected in 2011.

Relevant changes
In most of the supplementary immunization activities investigated, vaccine coverages estimated using the SMS system were very similar to those estimated by interviewing by phone those caregivers who never responded to the SMS messages. In the high-risk districts investigated, coverages estimated using the SMS system were also similar to those recorded – using lot quality assurance sampling – by the World Health Organization.

Lessons learnt
For the monitoring of coverage in supplementary immunization activities, automated SMS-based systems appear to be an attractive and relatively inexpensive option. Further research is needed to determine if coverage data collected by SMS-based systems provide estimates that are sufficiently accurate. Such systems may be useful in other large-scale immunization campaigns.

JAMA   
February 2014, Vol 311, No. 8
http://jama.jamanetwork.com/issue.aspx

Viewpoint | February 26, 2014
A Unified Code of Ethics for Health Professionals – Insights From an IOM Workshop
JAMA. 2014;311(8):799-800. doi:10.1001/jama.2014.504
http://jama.jamanetwork.com/article.aspx?articleid=1832552

A transdiciplinary code of ethics – applicable to all health professionals and created with oublic input – would be a first step toward generating a social contract that can meet the contemporary needs of health professionals and the patients and communities they serve.

JAMA   
February 2014, Vol 311, No. 8
http://jama.jamanetwork.com/issue.aspx

Editorial | February 26, 2014
Nonspecific Effects of Vaccines
David Goldblatt, MBChB, PhD1; Elizabeth Miller, FRCPath2
JAMA. 2014;311(8):804-805. doi:10.1001/jama.2014.471.

Initial text
Vaccination is one of the great public health achievements of the last 100 years.1 The development of vaccination has led to the eradication of smallpox, the reduction of the worldwide incidence of polio by 99%, and the control of measles, with a 74% decline in global measles deaths since 2000.2

With the decline in vaccine-preventable diseases that were once major causes of morbidity and mortality and with the availability of many new vaccines, some targeting diseases that are not major causes of morbidity and mortality in developed countries, public opinion has at times focused on the possible adverse events associated with vaccination rather than their benefit. In recent years these have included high-profile concerns surrounding the association of autism with either combined live viral vaccines (measles-mumps-rubella [MMR]) or preservatives (thimerosal) in combination vaccines. Both associations have now been refuted following careful scientific studies.3 Unexpected benefits of vaccination have also been reported but have attracted less attention. These include the apparent effect of live vaccines such as measles and BCG on reducing mortality from infections other than measles or tuberculosis…4

…

Journal of Community Health
Volume 39, Issue 2, April 2014
http://link.springer.com/journal/10900/39/1/page/1

Attitudes Affecting the Potential Use of Human Papillomavirus Vaccination: A Survey of Health Promotion Students in Mexico City
Angélica Dolores Ramírez-Rios, William Bonnez
http://link.springer.com/article/10.1007/s10900-013-9770-1

Abstract
Our aim was to explore the knowledge and attitudes of Mexican college students towards human papillomavirus (HPV) vaccination. We conducted a written questionnaire survey of a group of male and female undergraduate students in Health Promotion at the Autonomous University of Mexico City. A total of 163 subjects (40 males and 123 females, median age 24 years) took part. Only 13 % identified the risks factors of cervical cancer and 32 % knew the diseases caused by HPV. Females had a better knowledge than males on matters related to HPV vaccine. Seventy percent (110 of 157) of the respondents completely agreed on the importance of including protection against genital warts in the vaccine. Eighty-eight percent (141/161) of subjects would have accepted receiving the vaccine, but 8 % (13/161) were ambivalent. There was a strong desire in this group of young adults who are not yet included in the current vaccination programs to receive the HPV vaccine, preferably the quadrivalent one. In conclusion, attitudes towards vaccination could be complex and opposed.

Journal of Community Health
Volume 39, Issue 2, April 2014
http://link.springer.com/journal/10900/39/1/page/1

Ethnic and Gender Differences in HPV Knowledge, Awareness, and Vaccine Acceptability Among White and Hispanic Men and Women
Rachel A. Reimer, Julie A. Schommer, Amy E. Houlihan, Meg Gerrard
http://link.springer.com/article/10.1007/s10900-013-9773-y

Abstract
The purpose of this study was to examine factors associated with human papillomavirus (HPV) knowledge and awareness, and HPV vaccination among White and Hispanic males and females. Differences in HPV knowledge, sources of information, vaccine awareness, vaccination status, and interest in vaccination were examined. A community sample was recruited from local health care clinics in a medium sized Midwestern city between May 2010 and December 2011. Participants (N = 507) were White (n = 243) and Hispanic, males (n = 202) and females between the ages of 15–30. Results indicate that White and female participants were significantly more likely to have heard of HPV, have higher levels of HPV knowledge, have been diagnosed with HPV, and be aware of the HPV vaccine for women. White and female participants were also more likely to have heard of HPV from their physician and were significantly more interested in receiving the HPV vaccine in the future. There was no effect of ethnicity on interest in the vaccine per a doctor’s recommendation, however. Findings suggest that Whites and females have greater levels of HPV awareness and knowledge and that, while Hispanic participants are less likely than White participants to be told about the HPV vaccine from their provider, they may be equally receptive to such a recommendation.

The Lancet  
Mar 01, 2014  Volume 383  Number 9919   p755 – 844
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Every newborn, every mother, every adolescent girl
The Lancet
Preview |
With the launch of a new report by Save the Children this week, the momentum to achieve substantial reductions in neonatal mortality is accelerating. Ending Newborn Deaths: Ensuring Every Baby Survives is a continuation of Save the Children’s No Child Born to Die campaign. The report presents a powerful reminder of the reasons for neonatal deaths, identifies eight essential areas for intervention, and proposes a five-point Newborn Promise plan to end all preventable newborn deaths, which governments and others should commit to this year.

The Lancet Global Health
Mar 2014   Volume 2  Number 3  e117 – 181
http://www.thelancet.com/journals/langlo/issue/current

Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries
Dr Andrea Nove PhD a, Prof Zoë Matthews PhD b, Sarah Neal PhD b, Alma Virginia Camacho MD c
http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2813%2970179-7/abstract

Summary
Background
Adolescents are often noted to have an increased risk of death during pregnancy or childbirth compared with older women, but the existing evidence is inconsistent and in many cases contradictory. We aimed to quantify the risk of maternal death in adolescents by estimating maternal mortality ratios for women aged 15—19 years by country, region, and worldwide, and to compare these ratios with those for women in other 5-year age groups.

Methods
We used data from 144 countries and territories (65 with vital registration data and 79 with nationally representative survey data) to calculate the proportion of maternal deaths among deaths of females of reproductive age (PMDF) for each 5-year age group from 15—19 to 45—49 years. We adjusted these estimates to take into account under-reporting of maternal deaths, and deaths during pregnancy from non-maternal causes. We then applied the adjusted PMDFs to the most reliable age-specific estimates of deaths and livebirths to derive age-specific maternal mortality ratios.

Findings
The aggregated data show a J-shaped curve for the age distribution of maternal mortality, with a slightly increased risk of mortality in adolescents compared with women aged 20—24 years (maternal mortality ratio 260 [uncertainty 100—410] vs 190 [120—260] maternal deaths per 100 000 livebirths for all 144 countries combined), and the highest risk in women older than 30 years. Analysis for individual countries showed substantial heterogeneity; some showed a clear J-shaped curve, whereas in others adolescents had a slightly lower maternal mortality ratio than women in their early 20s. No obvious groupings were apparent in terms of economic development, demographic characteristics, or geographical region for countries with these different age patterns.

Interpretation
Our findings suggest that the excess mortality risk to adolescent mothers might be less than previously believed, and in most countries the adolescent maternal mortality ratio is low compared with women older than 30 years. However, these findings should not divert focus away from efforts to reduce adolescent pregnancy, which are central to the promotion of women’s educational, social, and economic development.

Funding
WHO, UN Population Fund.

The Lancet Global Health
Mar 2014   Volume 2  Number 3  e117 – 181
http://www.thelancet.com/journals/langlo/issue/current

Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis
Britt McKinnon MSc a, Sam Harper PhD a, Prof Jay S Kaufman PhD a, Yves Bergevin MD b
http://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2814%2970008-7/abstract

Summary
Background
Neonatal mortality rates (NMRs) in countries of low and middle income have been only slowly decreasing; coverage of essential maternal and newborn health services needs to increase, particularly for disadvantaged populations. Our aim was to produce comparable estimates of changes in socioeconomic inequalities in NMR in the past two decades across these countries.

Methods
We used data from Demographic and Health Surveys (DHS) for countries in which a survey was done in 2008 or later and one about 10 years previously. We measured absolute inequalities with the slope index of inequality and relative inequalities with the relative index of inequality. We used an asset-based wealth index and maternal education as measures of socioeconomic position and summarised inequality estimates for all included countries with random-effects meta-analysis.

Findings
24 low-income and middle-income countries were eligible for inclusion. In most countries, absolute and relative wealth-related and educational inequalities in NMR decreased between survey 1 and survey 2. In five countries (Cameroon, Nigeria, Malawi, Mozambique, and Uganda), the difference in NMR between the top and bottom of the wealth distribution was reduced by more than two neonatal deaths per 1000 livebirths per year. By contrast, wealth-related inequality increased by more than 1·5 neonatal deaths per 1000 livebirths per year in Ethiopia and Cambodia. Patterns of change in absolute and relative educational inequalities in NMR were similar to those of wealth-related NMR inequalities, although the size of educational inequalities tended to be slightly larger.

Interpretation
Socioeconomic inequality in NMR seems to have decreased in the past two decades in most countries of low and middle income. However, a substantial survival advantage remains for babies born into wealthier households with a high educational level, which should be considered in global efforts to further reduce NMR.

Funding
Canadian Institutes of Health Research.

The Lancet Infectious Diseases
Mar 2014  Volume 14  Number 3   p173 – 256
http://www.thelancet.com/journals/laninf/issue/current

Efficacy and safety of a patch vaccine containing heat-labile toxin from Escherichia coli against travellers’ diarrhoea: a phase 3, randomised, double-blind, placebo-controlled field trial in travellers from Europe to Mexico and Guatemala
Ronald H Behrens, Jakob P Cramer, Tomas Jelinek, Hilary Shaw, Frank von Sonnenburg, Darren Wilbraham, Thomas Weinke, David J Bell, Edwin Asturias, Hermann L Enkerlin Pauwells, Roberto Maxwell, Mercedes Paredes-Paredes, Gregory M Glenn, Shailesh Dewasthaly, Donald M Stablein, Zhi-Dong Jiang, Herbert L DuPont
Preview |
Although the LT antigen was delivered effectively by the skin patch, the vaccine did not protect travellers against diarrhoea caused by ETEC or other organisms. Future vaccines against travellers’ diarrhoea might need to include several antigens against various diarrhoeal pathogens, and might need to be able to generate mucosal and higher systemic immunity.

The Lancet Infectious Diseases
Mar 2014  Volume 14  Number 3   p173 – 256
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Pandemic potential of emerging influenza
The Lancet Infectious Diseases
Preview |
In January this year, the first case of highly pathogenic avian influenza H5N1 was detected in the Americas when a Canadian man returning from Beijing fell ill and subsequently died. January also saw a sharp upturn in the number of cases of H7N9 avian influenza in China with 169 cases detected in 1 month, compared with 144 up to the end of last year since it was first identified in March 2013. Another familiar virus, 2009 pandemic influenza A H1N1 has also been hitting the headlines in Egypt, where there have been over 300 cases and around 38 deaths since December, and in Mexico over 400 deaths have been associated with H1N1 this year.

Review
Pandemic influenza A H1N1 vaccines and narcolepsy: vaccine safety surveillance in action
Charlotte I S Barker, Matthew D Snape
Preview |
The 2009 influenza A H1N1 pandemic placed unprecedented demand on public health authorities and the vaccine industry. Efforts were coordinated internationally to maximise the speed of vaccine development, distribution, and delivery, and the European Union’s novel fast-track authorisation procedures mandated increased postmarketing surveillance to monitor vaccine safety. Clinicians in Finland and Sweden later identified an apparent increase in the incidence of narcolepsy associated with a specific adjuvanted pandemic influenza vaccine.

The Pediatric Infectious Disease Journal
March 2014 – Volume 33 – Issue 3  pp: 233-335,e67-e86
http://journals.lww.com/pidj/pages/currenttoc.aspx

A Consensus Statement: Meningococcal Disease Among Infants, Children and Adolescents in Latin America
Rüttimann, Ricardo Walter; Gentile, Angela; Parra, Mercedes Macias; More

Abstract
Invasive meningococcal disease is a serious infection that occurs worldwide. Neisseria meningitidis remains one of the leading causes of bacterial meningitis in all ages. Despite the availability of safe and effective vaccines against invasive meningococcal disease, few countries in Latin America implemented routine immunization programs with these vaccines. The Americas Health Foundation along with Fighting Infectious Disease in Emerging Countries recently sponsored a consensus conference. Six experts in infectious diseases from across the region addressed questions related to this topic and formulated the following recommendations: (1) standardized passive and active surveillance systems should be developed and carriage studies are mandatory; (2) a better understanding of the incidence, case fatality rates and prevalent serogroups in Latin America is needed; (3) countries should make greater use of the polymerase chain reaction assays to improve the sensitivity of diagnosis and surveillance of invasive meningococcal disease; (4) vaccines with broader coverage and more immunogenicity are desirable in young infants; (5) prevention strategies should include immunization of young infants and catch-up children and adolescents and (6) because of the crowded infant immunization schedule, the development of combined meningococcal vaccines and the co-administration with other infant vaccines should be explored.

Pediatrics
March 2014, VOLUME 133 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml

Article
Duration of Protection After First Dose of Acellular Pertussis Vaccine in Infants
Helen E. Quinn, PhD, MAEa,b, Thomas L. Snelling, BMBS (Hons), Grad Dip Clin Epidc,
Kristine K. Macartney, MBBS, BMedSci, MDa,b, and Peter B. McIntyre, MBBS, PhDa,b
Author Affiliations
aNational Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, and
bDiscipline of Paediatrics and Child Health, University of Sydney, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia; and
cTelethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, West Perth, Western Australia, Australia
http://pediatrics.aappublications.org/content/133/3/e513.abstract

Abstract
OBJECTIVE: Data on the effectiveness of the diphtheria–tetanus–acellular pertussis (DTaP) vaccine in the first 4 years of life are sparse. We evaluated the vaccine effectiveness (VE) of 1 and 2 doses of DTaP before 6 months of age and of 3 doses from 6 months of age in Australia, where, since 2003, a fourth dose is not given until 4 years.

METHODS: We matched reported pertussis cases aged 2 to 47 months between January 2005 and December 2009 to controls from a population-based immunization register by date of birth and region of residence. VE by number of doses and age group was calculated as (1 – odds ratio) × 100%.

RESULTS: VE against hospitalization increased from 55.3% (95% confidence interval [CI], 42.7%–65.1%) for 1 dose before 4 months of age to 83.0% (95% CI, 70.2%–90.3%) for 2 doses before 6 months. The VE of 3 doses of DTaP against all reported pertussis was 83.5% (95% CI, 79.1%–87.8%) between 6 and 11 months, declining to 70.7% (95% CI, 64.5%–75.8%) between 2 and 3 years of age and 59.2% (95% CI, 51.0%–66.0%) between 3 and 4 years of age.

CONCLUSIONS: DTaP provided good protection against pertussis in the first year of life from the first dose. Without a booster dose, the effectiveness of 3 doses waned more rapidly from 2 to 4 years of age than previously documented for children >6 years of age who had received 5 doses.

Pediatrics
March 2014, VOLUME 133 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml

Article
Vaccine Financing From the Perspective of Primary Care Physicians
Sean T. O’Leary, MD, MPHa,b, Mandy A. Allison, MD, MSPHa,b, Megan C. Lindley, MPHc, Lori A. Crane, PhD, MPHa,d, Laura P. Hurley, MD, MPHa,e,f, Michaela Brtnikova, PhDa, Brenda L. Beaty, MSPHa,f, Christine I. Babbel, MSPHa, Andrea Jimenez-Zambrano, MPHa, Stephen Berman, MDb, and Allison Kempe, MD, MPHa,b,f
Author Affiliations
aChildren’s Outcomes Research, Children’s Hospital Colorado, Aurora, Colorado;
bDepartment of Pediatrics, and
fColorado Health Outcomes Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado;
cNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
dDepartment of Community & Behavioral Health, Colorado School of Public Health, Denver, Colorado; and
eDivision of General Internal Medicine, Denver Health and Hospital Authority, Denver, Colorado
http://pediatrics.aappublications.org/content/133/3/367.abstract

Abstract
OBJECTIVES: Because of high purchase costs of newer vaccines, financial risk to private vaccination providers has increased. We assessed among pediatricians and family physicians satisfaction with insurance payment for vaccine purchase and administration by payer type, the proportion who have considered discontinuing provision of all childhood vaccines for financial reasons, and strategies used for handling uncertainty about insurance coverage when new vaccines first become available.

METHODS: A national survey among private pediatricians and family physicians April to September 2011.

RESULTS: Response rates were 69% (190/277) for pediatricians and 70% (181/260) for family physicians. Level of dissatisfaction varied significantly by payer type for payment for vaccine administration (Medicaid, 63%; Children’s Health Insurance Program, 56%; managed care organizations, 48%; preferred provider organizations, 38%; fee for service, 37%; P < .001), but not for payment for vaccine purchase (health maintenance organization or managed care organization, 52%; Child Health Insurance Program, 47%; preferred provider organization, 45%; fee for service, 41%; P = .11). Ten percent of physicians had seriously considered discontinuing providing all childhood vaccines to privately insured patients because of cost issues. The most commonly used strategy for handling uncertainty about insurance coverage for new vaccines was to inform parents that they may be billed for the vaccine; 67% of physicians reported using 3 or more strategies to handle this uncertainty.

CONCLUSIONS: Many primary care physicians are dissatisfied with payment for vaccine purchase and administration from third-party payers, particularly public insurance for vaccine administration. Physicians report a variety of strategies for dealing with the uncertainty of insurance coverage for new vaccines.

Pediatrics
March 2014, VOLUME 133 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml

Article
Risk Perceptions and Subsequent Sexual Behaviors After HPV Vaccination in Adolescents
Allison Mayhew, BAa, Tanya L. Kowalczyk Mullins, MD, MSa,b, Lili Ding, PhDb, Susan L. Rosenthal, PhDc, Gregory D. Zimet, PhDd, Charlene Morrow, RNb, and Jessica A. Kahn, MD, MPHa,b
Author Affiliations
aUniversity of Cincinnati College of Medicine, Cincinnati, Ohio;
bDepartment of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
cDepartment of Pediatrics, Columbia University Medical Center and New York-Presbyterian Morgan Stanley Children’s Hospital, New York, New York; and
dDepartment of Pediatrics, Indiana University, Indianapolis, Indiana
http://pediatrics.aappublications.org/content/133/3/404.abstract

Abstract
OBJECTIVES: Concerns have been raised that human papillomavirus (HPV) vaccination could lead to altered risk perceptions and an increase in risky sexual behaviors among adolescents. The aim of this study was to assess whether adolescent risk perceptions after the first vaccine dose predicted subsequent sexual behaviors.

METHODS: Young women 13 to 21 years of age (N=339) completed questionnaires immediately after HPV vaccination, and 2 and 6 months later, assessing demographic characteristics, knowledge/attitudes about HPV vaccination, risk perceptions, and sexual behaviors. Risk perceptions were measured by using 2 5-item scales assessing: (1) perceived risk of sexually transmitted infections (STI) other than HPV, and (2) perceived need for safer sexual behaviors after HPV vaccination. We assessed associations between risk perceptions at baseline and sexual behaviors over the next 6 months by using logistic regression, stratifying participants by sexual experience at baseline and age (13–15 vs 16–21 years).

RESULTS: Among all sexually inexperienced participants (42.5%), baseline risk perceptions were not associated with subsequent sexual initiation; in age-stratified analyses, girls 16 to 21 years of age who reported lower perceived risk for other STI (an inappropriate perception) were less likely to initiate sex (odds ratio [OR] 0.13, 95% confidence interval [CI] 0.03–0.69). Among all sexually experienced participants (57.5%) and in age-stratified analyses, baseline risk perceptions were not associated with subsequent number of sexual partners or condom use.

CONCLUSIONS: Risk perceptions after HPV vaccination were not associated with riskier sexual behaviors over the subsequent 6 months in this study sample

PLoS One
[Accessed 1 March 2014]
http://www.plosone.org/

Research Article
Monitoring What Governments “Give for” and “Spend on” Vaccine Procurement: Vaccine Procurement Assistance and Vaccine Procurement Baseline
E. A. S. Nelson mail, David E. Bloom, Richard T. Mahoney
Published: February 20, 2014
DOI: 10.1371/journal.pone.0089593
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0089593

Abstract
Background
The Global Vaccine Action Plan will require, inter alia, the mobilization of financial resources from donors and national governments – both rich and poor. Vaccine Procurement Assistance (VPA) and Vaccine Procurement Baseline (VPB) are two metrics that could measure government performance and track resources in this arena. VPA is proposed as a new subcategory of Official Development Assistance (ODA) given for the procurement of vaccines and VPB is a previously suggested measure of the share of Gross Domestic Product (GDP) that governments spend on their own vaccine procurement.

Objective
To determine realistic targets for VPA and VPB.

Methods
Organization for Economic Co-Operation and Development (OECD) and World Bank data for 2009 were analyzed to determine the proportions of bilateral ODA from the 23 Development Assistance Committee (DAC) countries disbursed (as % of GDP in current US$) for infectious disease control. DAC country contributions to the GAVI Alliance for 2009 were assessed as a measure of multilateral donor support for vaccines and immunization programs.

Findings
In 2009, total DAC bilateral ODA was 0.16% of global GDP and 0.25% of DAC GDP. As a percentage of GDP, Norway (0.013%) and United Kingdom (0.0085%) disbursed the greatest proportion of bilateral ODA for infectious disease control, and Norway (0.024%) and Canada (0.008%) made the greatest contributions to the GAVI Alliance. In 2009 0.02% of DAC GDP was US$7.61 billion and 0.02% of the GDP of the poorest 117 countries was US$2.88 billion.

Conclusions
Adopting 0.02% GDP as minimum targets for both VPA and VPB is based on realistic estimates of what both developed and developing countries should spend, and can afford to spend, to jointly ensure procurement of vaccines recommended by national and global bodies. New OECD purpose codes are needed to specifically track ODA disbursed for a) vaccine procurement; and b) immunization programs

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

Editorial
Indonesia: An Emerging Market Economy Beset by Neglected Tropical Diseases (NTDs)
Melody Tan, Rita Kusriastuti, Lorenzo Savioli, Peter J. Hotez mail
Published: February 27, 2014
DOI: 10.1371/journal.pntd.0002449
http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0002449;jsessionid=5C7F466B45FE35D9D6526E55F6C5F59E

Despite an enormous population and growing economy, the nation of Indonesia has some of the world’s highest concentrations of neglected tropical diseases (NTDs). These NTDs may thwart future national growth and recent gains. Yet, Indonesia and its Ministry of Health, together with the World Health Organization (WHO), have embarked on an ambitious effort to quickly assemble a health and scientific infrastructure suitable for eliminating its NTDs.

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH
January 2014 Vol. 35, No. 1

http://www.paho.org/journal/index.php?option=com_content&view=article&id=137&Itemid=233&lang=en

Gasto en salud, la desigualdad en el ingreso y el índice de marginación en el sistema de salud de México [Health expenditures, income inequality, and the marginalization index in Mexico’s health system]
Carlos Eduardo Pinzón Florez, Ludovic Reveiz, Elvaro J. Idrovo y Hortensia Reyes Morales

Functioning outcomes for abused immigrant women and their children 4 months after initiating intervention [Resultados en cuanto al desempeño de mujeres inmigrantes maltratadas y sus hijos, 4 meses después de iniciada una intervención]
Sandra K. Cesario, Angeles Nava, Ann Bianchi, Judith McFarlane, and John Maddoux

Structural social determinants and catastrophic illnesses in municipalities in the Colombian department of Valle del Cauca [Determinantes sociales estructurales y enfermedades catastróficas en los municipios del departamento colombiano del Valle del Cauca]
Luis Miguel Tovar Cuevas and Fernando Arteaga Suárez

Fatores associados a cárie dental e doença periodontal em indígenas na América Latina: revisão sistemática [Factors associated with dental caries and periodontal diseases in Latin American indigenous peoples: a systematic review]
Pedro Alves Filho, Ricardo Ventura Santos e Mario Vianna Vettore

Vaccine
Volume 32, Issue 13, Pages 1421-1522 (14 March 2014)
http://www.sciencedirect.com/science/journal/0264410X/32

Benefits of using vaccines out of the cold chain: Delivering Meningitis A vaccine in a controlled temperature chain during the mass immunization campaign in Benin
Original Research Article
Pages 1431-1435
Simona Zipursky, Mamoudou Harouna Djingarey, Jean-Claude Lodjo, Laifoya Olodo, Sylvestre Tiendrebeogo, Olivier Ronveaux

Abstract
Background
In October 2012, the Meningococcal A conjugate vaccine MenAfriVac was granted a label variation to allow for its use in a controlled temperature chain (CTC), at temperatures of up to 40 °C for not more than four days. This paper describes the first field use of MenAfriVac in a CTC during a campaign in Benin, December 2012, and assesses the feasibility and acceptability of the practice.

Methods
We implemented CTC in one selected district, Banikoara (target population of 147,207; 1–29 years of age), across 14 health facilities and 150 villages. We monitored the CTC practice using temperature indicators and daily monitoring sheets. At the end of the campaign we conducted a face-to-face survey to assess vaccinators’ and supervisors’ experience with CTC.

Findings
A mix of strategies were implemented in the field to maximize the benefits from CTC practice, depending on the distance from health centre to populations and the availability of a functioning refrigerator in the health centre. Coverage across Banikoara was 105.7%. Over the course of the campaign only nine out of approx. 15,000 vials were discarded due to surpassing the 4 day CTC limit and no vial was discarded because of exposure to a temperature higher than 40 °C or due to the Vaccine Vial Monitor (VVM) reaching its endpoint. Overall confidence and perceived usefulness of the CTC approach were very high among vaccinators and supervisors.

Interpretation
Vaccinators and supervisors see clear benefits from the CTC approach in low income settings, especially in hard-to-reach areas or where cold chain is weak. Taking advantage of the flexibility offered by CTC opens the door for the implementation of new immunization strategies to ensure all those at risk are protected.

Vaccine
Volume 32, Issue 12, Pages 1323-1420 (10 March 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/12

The cost-effectiveness of influenza vaccination in elderly Australians: An exploratory analysis of the vaccine efficacy required
Pages 1323-1325
Anthony T. Newall, Juan Pablo Dehollain

Abstract
It is important to consider the value for money offered by existing elderly influenza vaccination programs, particularly as doubts persist about the magnitude of the effectiveness of such programs. An informative approach to explore the value of vaccination is to consider what vaccine efficacy would be required for a program to be considered cost-effective. To estimate the cost-effectiveness of the current elderly (65+ years) influenza vaccination program in Australia, we modelled how the hypothetical removal of vaccination would increase current disease burden estimates depending on alternative vaccine efficacy assumptions. The base-case results of the analysis found that the existing elderly vaccination program is likely to be cost-effective (under A$50,000 per quality-adjusted life year gained) if the vaccine efficacy is above ∼30%. This study offers reassurance that the influenza vaccination of elderly Australians is likely to offer value for money.

Vaccine
Volume 32, Issue 12, Pages 1323-1420 (10 March 2014)
Refusal of oral polio vaccine in northwestern Pakistan: A qualitative and quantitative study

Original Research Article
Pages 1382-1387
Hitoshi Murakami, Makoto Kobayashi, Masahiko Hachiya, Zahir S. Khan, Syed Q. Hassan, Shinsaku Sakurada

Abstract
Background
Refusal of the oral polio vaccine (OPV) is a difficulty faced by the Polio Eradication Initiative (PEI) in multiple endemic areas, including the Khyber Pakhtunkhwa Province (KPP), Pakistan. In 2007, we investigated community perceptions of the OPV and estimated the prevalence of OPV refusal in three districts in Swat Valley, KPP, a polio-endemic area.

Methods
Qualitative data concerning community perceptions were collected by focus group discussions among lady health workers (LHWs) and mothers with children <1 year old and by key informant interviews with local health managers and officials. Quantitative data collection followed using a questionnaire survey of 200 LHWs and a cluster sampling survey of 210 mothers (per district) with children <1 year old.

Results
The qualitative assessments identified the grounded theory of OPV refusal involving facts known by the residents that are related to the OPV (too frequent OPV campaigns, an OPV boycott in northern Nigeria in 2003 and that birth control is viewed as is against Islam), the local interpretations of these facts (perceptions that OPV contained birth control or pork, that OPV was a foreign/central plot against Muslims, and that the vaccination was against the Hadith and the fate determined by God) and different manifestations of OPV refusal. Among the three districts studied, the proportion of LHWs who encountered OPV refusal ranged from 0 to 33%, whereas among the districts, the proportions of mothers unwilling to give OPV to their children ranged from 0.5 to 5.7%. Refusal of other injectable vaccines was almost equally prevalent for reasons that were very similar.

Conclusions
The PEI needs to reflect local value system in the path to polio eradication in the studied districts in the Swat Valley. The religious and cultural values as well as the interpretation of the international political situation are of particular importance.

Vaccine
Volume 32, Issue 12, Pages 1323-1420 (10 March 2014)
http://www.sciencedirect.com/science/journal/0264410X/32/12

Overcoming the knowledge–behavior gap: The effect of evidence-based HPV vaccination leaflets on understanding, intention, and actual vaccination decision
Original Research Article
Pages 1388-1393
O. Wegwarth, S. Kurzenhäuser-Carstens, G. Gigerenzer

Abstract
Objective
Informed decision making requires transparent and evidence-based (=balanced) information on the potential benefit and harms of medical preventions. An analysis of German HPV vaccination leaflets revealed, however, that none met the standards of balanced risk communication.

Methods
We surveyed a sample of 225 girl–parent pairs in a before–after design on the effects of balanced and unbalanced risk communication on participants’ knowledge about cervical cancer and the HPV vaccination, their perceived risk, their intention to have the vaccine, and their actual vaccination decision.

Results
The balanced leaflet increased the number of participants who were correctly informed about cervical cancer and the HPV vaccine by 33 to 66 absolute percentage points. In contrast, the unbalanced leaflet decreased the number of participants who were correctly informed about these facts by 0 to 18 absolute percentage points. Whereas the actual uptake of the HPV vaccination 14 months after the initial study did not differ between the two groups (22% balanced leaflet vs. 23% unbalanced leaflet; p=.93, r=.01), the originally stated intention to have the vaccine reliably predicted the actual vaccination decision for the balanced leaflet group only (concordance between intention and actual uptake: 97% in the balanced leaflet group, rs=.92, p=.00; 60% in the unbalanced leaflet group, rs=.37, p=.08).

Conclusion
In contrast to a unbalanced leaflet, a balanced leaflet increased people’s knowledge of the HPV vaccination, improved perceived risk judgments, and led to an actual vaccination uptake, which first was robustly predicted by people’s intention and second did not differ from the uptake in the unbalanced leaflet group. These findings suggest that balanced reporting about HPV vaccination increases informed decisions about whether to be vaccinated and does not undermine actual uptake.

Vaccines — Open Access Journal
(Accessed 1 March 2014)
http://www.mdpi.com/journal/vaccines

Review: DNA/MVA Vaccines for HIV/AIDS
by Smita S. Iyer and Rama R. Amara
Vaccines 2014, 2(1), 160-178; doi:10.3390/vaccines2010160 – published online 28 February 2014
Abstract:
Since the initial proof-of-concept studies examining the ability of antigen-encoded plasmid DNA to serve as an immunogen, DNA vaccines have evolved as a clinically safe and effective platform for priming HIV-specific cellular and humoral responses in heterologous “prime-boost” vaccination regimens. Direct injection of plasmid DNA into the muscle induces T- and B-cell responses against foreign antigens. However, the insufficient magnitude of this response has led to the development of approaches for enhancing the immunogenicity of DNA vaccines. The last two decades have seen significant progress in the DNA-based vaccine platform with optimized plasmid constructs, improved delivery methods, such as electroporation, the use of molecular adjuvants and novel strategies combining DNA with viral vectors and subunit proteins. These innovations are paving the way for the clinical application of DNA-based HIV vaccines. Here, we review preclinical studies on the DNA-prime/modified vaccinia Ankara (MVA)-boost vaccine modality for HIV. There is a great deal of interest in enhancing the immunogenicity of DNA by engineering DNA vaccines to co-express immune modulatory adjuvants. Some of these adjuvants have demonstrated encouraging results in preclinical and clinical studies, and these data will be examined, as well.

Review: DNA Immunization for HIV Vaccine Development
by Yuxin Chen, Shixia Wang and Shan Lu
Vaccines 2014, 2(1), 138-159; doi:10.3390/vaccines2010138 – published online 25 February 2014
Abstract:
DNA vaccination has been studied in the last 20 years for HIV vaccine research. Significant experience has been accumulated in vector design, antigen optimization, delivery approaches and the use of DNA immunization as part of a prime-boost HIV vaccination strategy. Key historical data and future outlook are presented. With better understanding on the potential of DNA immunization and recent progress in HIV vaccine research, it is anticipated that DNA immunization will play a more significant role in the future of HIV vaccine development.

Current Opinion in Immunology
Volume 28,   In Progress   (June 2014)
http://www.sciencedirect.com/science/journal/09527915

Challenges and responses in human vaccine development
Stefan HE Kaufmann1, M Juliana McElrath2, David JM Lewis3, Giuseppe Del Giudice4

Highlights
:: Reverse, structural and synthetic vaccinology to accelerate novel vaccine design.
:: Systems analysis of multiparametric data to predict reactogenicity and efficacy.
:: Current pipeline for major infectious diseases promises partially effective vaccines.
:: Vaccine trials can be harnessed for further vaccine improvement.
:: Concerns of use of adenovirus vectors in persons at risk for HIV infection.

Abstract
Human vaccine development remains challenging because of the highly sophisticated evasion mechanisms of pathogens for which vaccines are not yet available. Recent years have witnessed both successes and failures of novel vaccine design and the strength of iterative approaches is increasingly appreciated. These combine discovery of novel antigens, adjuvants and vectors in the preclinical stage with computational analyses of clinical data to accelerate vaccine design. Reverse and structural vaccinology have revealed novel antigen candidates and molecular immunology has led to the formulation of promising adjuvants. Gene expression profiles and immune parameters in patients, vaccinees and healthy controls have formed the basis for biosignatures that will provide guidelines for future vaccine design.

Economist
http://www.economist.com/
Accessed 1 March 2014

Cancer in the developing world
Worse than AIDS
The burden of cancer is falling increasingly heavily on the poor
Mar 1st 2014 | From the print edition

Excerpt
SARA STULAC is a paediatrician, but doctors in Rwanda must be adaptable. One of her first patients after arriving from America in 2005 was a young girl with a tumour the size of a cauliflower on her face. The girl’s father, a subsistence farmer, had tried traditional healers and local doctors, but the tumour had grown, along with his expenses. An oncologist was needed. If only the country had one. Eventually Dr Stulac called one in America who talked her through the treatment that would save the girl’s life.

What makes this story unusual is its happy ending. According to the International Agency for Research on Cancer (IARC), part of the World Health Organisation (WHO), low- and middle-income countries accounted for 57% of the 14m people diagnosed with cancer worldwide in 2012—but 65% of the deaths. Cancer kills more people in poor countries than AIDS, malaria and tuberculosis combined…

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

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– 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.
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– pdf version: A pdf of the current issues is available here: Vaccines and Global Health_The Week in Review_22 Feb 2014

– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links: We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

WHO: 140,000 people to get cholera vaccine in South Sudan
News release – Excerpt
22 February 2014 | GENEVA – WHO is working with the South Sudan Government and partners to provide vaccines to protect nearly 140,000 people living in temporary camps in South Sudan against cholera.

The vaccines come from an emergency stockpile managed by WHO, the International Federation of the Red Cross and Red Crescent Societies (IFRC), Médecins Sans Frontières (MSF) and UNICEF. It is the first time the stockpile, created in 2013 by WHO, is being activated.

Although currently there is not a cholera outbreak, people displaced by the recent conflict and living in the camps are at risk due to poor sanitary conditions and overcrowding.

Starting today, 94,000 people will be vaccinated in the Minkaman camp, Awerial County, targeting displaced people and host communities, followed by vaccination campaigns in camps based in Juba, covering an additional 43 000 people.

Two doses of vaccine are required for an individual to be protected. The campaign begins with an initial round of vaccinations followed by – after a required 14 day interval – a second round of doses, which will complete the vaccination. For such a campaign to be effective, it is vital that a second dose is administered and this factor has led to the decision to begin with Minkaman, Awerial County, and Juba camps.

“Minkaman camp in Awerial County and Juba camp have been selected because of the relative stability of the situation and easier access in those places,” says Dr Abdinasir Abubakar, from WHO’s Disease Surveillance and Response team, in South Sudan. “We are also looking at other camps, and once the accessibility and security improves, we will expand the cholera vaccination campaigns into these areas. We will be reviewing the situation day by day.” …
http://www.who.int/mediacentre/news/releases/2014/cholera-vaccine-20140221/en/

Update: Polio this week – As of 19 February 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s extract and bolded text]
:: In Pakistan, six new wild poliovirus type 1 (WPV1) and two new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases are reported, all from the Federally Administered Tribal Areas (FATA) and Khyber Pakhtunkhwa (KP). Five of the cases are from North Waziristan and Peshawar, largely considered the ‘engine’ for polio transmission in the country.

Afghanistan
:: One new WPV1 case was reported in the past week from 2014. The total number of WPV1 cases remains 14 for 2013 and is now three for 2014. The most recent WPV1 case had onset of paralysis on 31 January 2014 from Kunar province, Eastern Region

Pakistan
:: Six new WPV1 cases were reported in the past week, four from North Waziristan, FATA and one from Bannu and Peshawar, respectively, in KP. The total number of cases for 2013 remains 93. The total number of cases in 2014 is now 15. The most recent case had onset of paralysis on 31 January (WPV1 from FR Bannu, FATA).
:: Two new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 45, and three for 2014. The most recent cVDPV2 case had onset of paralysis on 24 January (from FR Bannu, FATA).
:: 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
:: Two new WPV1 cases from Somalia were reported in the past week. Onset of paralysis for both cases was in June 2013. The cases were reported late due to a laboratory processing backlog. The total number of WPV1 cases in the Horn of Africa is now 215 (192 from Somalia, 14 from Kenya and nine from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on 20 December 2013 (from Bari, Somalia).
:: Outbreak response across the Horn of Africa is continuing. Recommendations from the recently held Horn of Africa Technical Advisory Group (TAG), which convened two weeks ago in Nairobi, are now actively being incorporated into outbreak response planning. The TAG had underscored that the initial response to the outbreak was appropriate, however expressed grave concern that gaps in SIA quality and surveillance remained in key infected areas of the region. Consequently, the group concluded there is a serious risk of the outbreak continuing and of further spread both within and beyond countries of the Horn of Africa. The group recommended that infected countries should focus efforts on high-risk and infected areas, by conducting high-quality SIAs no more than four weeks apart.

Middle East
:: In Syria, one new WPV1 case was reported in the past week from Hasakeh governorate. The total number of laboratory-confirmed WPV1 cases is now 24. 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.

Editor’s Note: Please see post below for:
Editorials
The polio eradication end game: what it means for Europe
D Heymann 1,2, Q Ahmed3
Eurosurveillance
Volume 19, Issue 7, 20 February 2014

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Gunmen kidnap six-member polio team in Pakistan
The Global Post/AFP via Agence France-Presse
February 17, 2014 14:12
The kidnapping is the latest setback to efforts to eradicate the disease in Pakistan. It followed a bombing on Sunday targeting a polio team in Peshawar which killed a policeman.
Excerpt
A Pakistani health worker administers a polio vaccination to a child during a polio immunization campaign in Peshawar on Feb. 2, 2014

Masked gunmen kidnapped a six-member polio vaccination team — a doctor, two local employees of the World Health Organization (WHO) and three guards — in northwest Pakistan on Monday, an official said.

Local administration official Niamat Ullah Khan said the team was seized some 190 miles southwest of Peshawar, in Ping village at the border of South Waziristan.

A local official of the WHO in Peshawar confirmed the incident…

http://www.globalpost.com/dispatch/news/regions/asia-pacific/pakistan/140217/gunmen-kidnap-six-member-polio-team-pakistan

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  Rotary announced US$36 million in new grants supporting polio eradication. The grants include $6.8 million for Afghanistan, $7.7 million for Nigeria and $926,000 for Pakistan. Grant amounts “are based on requests from eradication initiative partners UNICEF and the World Health Organization, which work with the governments of polio-affected countries to plan and carry out immunization activities.” UNICEF will use a grant of $2.73 million to bolster vaccination activities throughout the Horn of Africa as part of an on-going response to an outbreak that began in 2013 and has now infected more than 200 children. The other countries where Rotary funds will be used to fight polio are Burkina Faso, $2.1 million; Cameroon, $3.4 million; Democratic Republic of Congo, $3.9 million; Niger, $2.3 million; Somalia, $1.3 million; South Sudan, $2.6 million; and Sudan, $1.2 million. WHO also received $934,000 to study the impact of introducing injectable, inactivated polio vaccine into the immunization program as part of the initiative’s endgame plan, as the goal of global eradication nears. Unrelated to this round of grants, Rotary released $500,000 in December 2013 as an emergency response to the polio outbreak in strife-torn Syria, which had not reported polio since 1999. Through Jan. 31, there were 23 confirmed cases in Syria since October 2013, all traceable to the polio strain circulating in Pakistan.
http://www.prnewswire.com/news-releases/rotary-releases-us359-million-to-fight-polio-in-africa-and-asia-246011091.html

The Weekly Epidemiological Report (WER) for 21 February 2014, vol. 89, 8 (pp. 61–72) includes:
:: Preventive chemotherapy: planning, requesting medicines, and reporting
:: WHO Strategic Advisory Group of Experts (SAGE) on immunization: request for nominations
:: Monthly report on dracunculiasis cases, January– December 2013
http://www.who.int/entity/wer/2014/wer8908.pdf?ua=1

GAVI Watch [to 22 February 2014]
http://www.gavialliance.org/library/news/press-releases/

GAVI has now opened its 2014 round of applications for new vaccines and health system strengthening support
New in 2014
Applications for both New Vaccine Support (NVS) and Health System Strengthening (HSS) will now be accepted through the same application and review timelines. The General Guidelines document offers an introduction to the principles, policies and processes that are applicable to all types of GAVI support.

Visit the updated section of the French website for all materials in French.

Countries are requested to submit an ‘Expression of Interest’ (EOI) as the first step in the application process. Submission of the EOI will be made mandatory starting with the September cut-off date for applications.

Country applications will be accepted on a rolling basis, so if a country misses a cut-off date, the application will be reviewed by the subsequent Independent Review Committee (IRC)

CDC/MMWR Watch [to 22 February 2014]
http://www.cdc.gov/mmwr/mmwr_wk.html

CDC Telebriefing: Update on Flu Activity and Vaccine Effectiveness Estimates – Transcript
Thursday, February 20, 2014, 12:00 PM
Telebriefing on articles that appear in today’s Morbidity and Mortality Weekly Report on Flu activity and 2013–14 Seasonal Influenza Vaccine Effectiveness.

MMWR Weekly
February 21, 2014 / Vol. 63 / No. 7
:: Interim Estimates of 2013–14 Seasonal Influenza Vaccine Effectiveness — United States, February 2014
February 21, 2014 / 63(07);137-142
Brendan Flannery, PhD1, Swathi N. Thaker, PhD1, Jessie Clippard, MPH1, Arnold S. Monto, MD2, Suzanne E. Ohmit, DrPH2, Richard K. Zimmerman, MD3, Mary Patricia Nowalk, PhD3, Manjusha Gaglani, MBBS4, Michael L. Jackson, PhD5, Lisa A. Jackson, MD5, Edward A. Belongia, MD6, Huong Q. McLean, PhD6, LaShondra Berman, MS1, Angie Foust, MA1, Wendy Sessions, MPH1, Sarah Spencer, PhD1, Alicia M. Fry, MD1

Excerpt
In the United States, annual vaccination against seasonal influenza is recommended for all persons aged ≥6 months (1). Each season since 2004–05, CDC has estimated the effectiveness of seasonal influenza vaccine to prevent influenza-associated, medically attended acute respiratory illness (ARI). This report uses data from 2,319 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness (Flu VE) Network during December 2, 2013–January 23, 2014, to estimate an interim adjusted effectiveness of seasonal influenza vaccine for preventing laboratory-confirmed influenza virus infection associated with medically attended ARI. During this period, overall vaccine effectiveness (VE) (adjusted for study site, age, sex, race/ethnicity, self-rated health, and days from illness onset to enrollment) against influenza A and B virus infection associated with medically attended ARI was 61%. The influenza A (H1N1)pdm09 (pH1N1) virus that emerged to cause a pandemic in 2009 accounted for 98% of influenza viruses detected. VE was estimated to be 62% against pH1N1 virus infections and was similar across age groups. As of February 8, 2014, influenza activity remained elevated in the United States, the proportion of persons seeing their health-care provider for influenza-like illness was lower than in early January but remained above the national baseline, and activity still might be increasing in some parts of the country (2). CDC and the Advisory Committee on Immunization Practices routinely recommend that annual influenza vaccination efforts continue as long as influenza viruses are circulating (1). Persons aged ≥6 months who have not yet been vaccinated this season should be vaccinated. Antiviral medications are an important second line of defense to treat influenza illness and should be used as recommended (3) among suspected or confirmed influenza patients, regardless of patient vaccination status. Early antiviral treatment is recommended for persons with suspected influenza with severe or progressive illness (e.g., hospitalized persons) and those at high risk for complications from influenza, no matter how severe the illness.

:: Influenza-Associated Intensive-Care Unit Admissions and Deaths — California, September 29, 2013–January 18, 2014
:: Update: Influenza Activity — United States, September 29, 2013–February 8, 2014
:: Notes from the Field: Varicella-Associated Death of a Vaccinated Child with Leukemia — California, 2012

WHO Fact sheet N°378: Immunization coverage:
Updated February 2014
Excerpt
Key facts
:: Immunization prevents illness, disability and death from vaccine-preventable diseases including diphtheria, measles, pertussis, pneumonia, polio, rotavirus diarrhoea, rubella and tetanus.
:: Global vaccination coverage is holding steady.
:: Immunization currently averts an estimated 2 to 3 million deaths every year.
:: But an estimated 22.6 million infants worldwide are still missing out on basic vaccines.

Overview
Immunization averts an estimated 2 to 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles. Global vaccination coverage—the proportion of the world’s children who receive recommended vaccines—has remained steady for the past few years. For example, the percentage of infants fully vaccinated against diphtheria-tetanus-pertussis (DTP3) has held steady at 83% for the last three years.

During 2012, about 110.6 million infants worldwide got three doses of DTP3 vaccine, protecting them against infectious diseases that can cause serious illness and disability or be fatal. By 2012, 131 countries had reached at least 90% coverage of DTP3…
http://www.who.int/mediacentre/factsheets/fs378/en/

WHO Fact sheet N°286: Measles
Updated February 2014
Excerpt
Key facts
:: Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
:: In 2012, there were 122 000 measles deaths globally – about 330 deaths every day or 14 deaths every hour.
:: Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2012 worldwide.
:: In 2012, about 84% of the world’s children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.
:: Since 2000, more than 1 billion children in high risk countries were vaccinated against the disease through mass vaccination campaigns ― about 145 million of them in 2012…
http://www.who.int/mediacentre/factsheets/fs286/en/

BMC Public Health
(Accessed 22 February 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Local discrepancies in measles vaccination opportunities: results of population-based surveys in Sub-Saharan Africa
Lise Grout, Nolwenn Conan, Aitana Juan Giner, Northan Hurtado, Florence Fermon, Alexandra N¿Goran, Emmanuel Grellety, Andrea Minetti, Klaudia Porten and Rebecca F Grais
Author Affiliations
BMC Public Health 2014, 14:193  doi:10.1186/1471-2458-14-193
Published: 21 February 2014
http://www.biomedcentral.com/1471-2458/14/193/abstract

Abstract (provisional)
Background
The World Health Organization recommends African children receive two doses of measles containing vaccine (MCV) through routine programs or supplemental immunization activities (SIA). Moreover, children have an additional opportunity to receive MCV through outbreak response immunization (ORI) mass campaigns in certain contexts. Here, we present the results of MCV coverage by dose estimated through surveys conducted after outbreak response in diverse settings in Sub-Saharan Africa. .

Methods
We included 24 household-based surveys conducted in six countries after a non-selective mass vaccination campaign. In the majority (22/24), the survey sample was selected using probability proportional to size cluster-based sampling. Others used Lot Quality Assurance Sampling.

Results
In total, data were collected on 60,895 children from 2005 to 2011. Routine coverage varied between countries (>95% in Malawi and Kirundo province (Burundi) while <35% in N’Djamena (Chad) in 2005), within a country and over time. SIA coverage was <75% in most settings. ORI coverage ranged from >95% in Malawi to 71.4% [95%CI: 68.9-73.8] in N’Djamena (Chad) in 2005.

In five sites, >5% of children remained unvaccinated after several opportunities. Conversely, in Malawi and DRC, over half of the children eligible for the last SIA received a third dose of MCV.

Conclusions
Control pre-elimination targets were still not reached, contributing to the occurrence of repeated measles outbreak in the Sub-Saharan African countries reported here. Although children receiving a dose of MCV through outbreak response benefit from the intervention, ensuring that programs effectively target hard to reach children remains the cornerstone of measles control.

BMC Public Health
(Accessed 22 February 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa
Clara B Aranda-Jan, Neo Mohutsiwa-Dibe and Svetla Loukanova
Author Affiliations
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BMC Public Health 2014, 14:188  doi:10.1186/1471-2458-14-188
Published: 21 February 2014
http://www.biomedcentral.com/1471-2458/14/188/abstract

Abstract (provisional)
Background
Access to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa.

Methods
A systematic review of peer-reviewed literature on mHealth projects in Africa, between 2003 and 2013, was carried out using PubMed and OvidSP. Data was synthesized using a SWOT analysis methodology. Results were grouped to assess specific aspects of project implementation in terms of sustainability and mid/long-term results, integration to the health system, management process, scale-up and replication, and legal issues, regulations and standards.

Results
Forty-four studies on mHealth projects in Africa were included and classified as: “patient follow-up and medication adherence” (n = 19), “staff training, support and motivation” (n = 2), “staff evaluation, monitoring and guidelines compliance” (n = 4), “drug supply-chain and stock management” (n = 2), “patient education and awareness” (n = 1), “disease surveillance and intervention monitoring” (n = 4), “data collection/transfer and reporting” (n = 10) and “overview of mHealth projects” (n = 2). In general, mHealth projects demonstrate positive health-related outcomes and their success is based on the accessibility, acceptance and low-cost of the technology, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement. Threats such as dependency on funding, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness challenge their implementation. mHealth projects can potentially be scaled-up to help tackle problems faced by healthcare systems like poor management of drug stocks, weak surveillance and reporting systems or lack of resources.

Conclusion
mHealth in Africa is an innovative approach to delivering health services. In this fast-growing technological field, research opportunities include assessing implications of scaling-up mHealth projects, evaluating cost-effectiveness and impacts on the overall health system.

Emerging Infectious Diseases
Volume 20, Number 3—March 2014
http://www.cdc.gov/ncidod/EID/index.htm

Invasive Fungal Infections after Natural Disasters
. Benedict and B. J. Park
Fungal infections in persons affected by natural disasters are a potentially overlooked public health problem.