NIH said Phase II clinical trials are underway for an investigational H7N9 avian influenza vaccine candidate. Researchers at nine sites nationwide have begun testing in two concurrent trials sponsored by the National Institute of Allergy and Infectious Diseases (NIAID). The trials “are designed to gather critical information about the safety of the candidate vaccine and the immune system responses it induces when administered at different dosages and with or without adjuvants, substances designed to boost the body’s immune response to vaccination.” Human cases of H7N9 influenza first emerged in China in February 2013, with the majority of reported infections occurring in the spring. As of Aug. 12, 135 confirmed human cases, including 44 deaths, have been reported by WHO. Most of these cases involved people who came into contact with infected poultry.

   Full media release: http://www.nih.gov/news/health/sep2013/niaid-18.htm

Update: Polio this week – As of 18 September 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]

:: The next meeting of the Independent Monitoring Board (IMB) will take place on 1-2 October, in London, UK. The IMB will review latest epidemiology and programme developments, and is expected to issue its report as usual within two weeks of the meeting.
:: Due to the Horn of Africa outbreak, the bulk of polio cases this year (over two-thirds) are in countries which were previously polio-free. In endemic countries, cases are down 40% over the same period last year, indicating progress particularly in Afghanistan and Nigeria.

Nigeria
:: One new WPV1 case was reported in the past week (from Borno), bringing the total number of WPV1 cases for 2013 to 47. The most recent WPV1 case in the country had onset of paralysis on 17 August (from Taraba)…

Horn of Africa
:: Seven new WPV1 cases were reported in the past week, six from Somalia and one from Kenya. The total number of WPV1 cases for 2013 in the Horn of Africa is 185 (169 from Somalia, 15 from Kenya and one from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on 14 August (from Somalia)…

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

Poliovirus detected from environmental samples in Israel and West Bank and Gaza Strip
21 September 2013 – WHO considers the risk of further international spread of wild poliovirus type 1 (WPV1) from Israel to be high. The risk assessment reflects evidence of increasing geographic extent of WPV1 circulation in Israel over a prolonged period of time. Recently,    WPV1 has also been isolated from sewage samples collected by the Palestinian Authority , both in West Bank and the Gaza Strip. No cases of paralytic polio have been reported by Israel or the Palestinian Authority.

Health authorities of Israel and the Palestinian Authority have taken steps to respond to the threat posed by WPV1 circulation by strengthening surveillance for acute flaccid paralysis and increasing the frequency of environmental sample collection. A supplementary immunization activity with bivalent oral polio vaccine (bOPV) is being conducted in Israel since early August, targeting children up to nine years of age to rapidly interrupt WPV1 circulation. As of now, 60 percent of the 1.38 million children targeted in Israel have been vaccinated. Health authorities of the Palestinian Authority are preparing to conduct two supplementary immunization activities with trivalent OPV in the Gaza Strip and in West Bank.

It is important that all polio-free countries, in particular those with frequent travel and contacts with poliovirus-affected countries and areas, strengthen surveillance for cases of acute flaccid paralysis in order to rapidly detect any new virus importations and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.

WHO’s ‘International Travel and Health’ recommends that all travellers to and from poliovirus-affected countries and areas be fully vaccinated against polio. Three countries remain endemic for indigenous transmission of wild poliovirus virus: Afghanistan, Nigeria and Pakistan.   Additionally, in 2013, the Horn of Africa has been affected by an outbreak of wild poliovirus type 1.

http://www.who.int/csr/don/2013_09_20_polio/en/index.html

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

Middle East respiratory syndrome coronavirus (MERS-CoV) – update
21 September 2013 – Two patients earlier reported as laboratory-confirmed with Middle East respiratory syndrome coronavirus (MERS-CoV) infection in Italy in the Disease Outbreak News on 2 June 2013 are being reclassified as probable cases.

The reclassification follows further analysis of the laboratory tests performed in May 2013, which has shown that the two cases do not fulfil the current WHO case definition for a “confirmed case” for MERS-CoV. The two cases are the two-year-old girl and a 42-year-old woman who were identified as close contacts of the index case who travelled from Jordan.

A “probable” designation by WHO criteria refers to patients who are considered to have a high likelihood of having been infected with MERS-CoV, but from whom adequate samples could not be obtained for complete testing according to the current criteria established for laboratory confirmation.

http://www.who.int/csr/don/2013_09_20/en/index.html

The Weekly Epidemiological Record (WER) for 21 September 2013, vol. 88, 38 (pp. 401–412) includes:
:: Meeting of the WHO working group on polymerase chain reaction protocols for detecting subtype influenza A viruses – Geneva, July 2013
:: Assessing and mitigating the risks of wild poliovirus outbreaks in polio-free African countries, January 2012–July 2013

http://www.who.int/entity/wer/2013/wer8838.pdf

Report: A Roadmap for Promoting Women’s Economic Empowerment
United Nations Foundation and the ExxonMobil Foundation
http://womeneconroadmap.org/

Research has demonstrated that when women are economically empowered, entire communities benefit. Yet until now, there has been a crucial knowledge gap regarding the most effective interventions to advance women’s economic opportunities. The report identifies interventions that are proven, promising or have a high potential to increase productivity and earnings for different groups of women in diverse country contexts.

Eighteen research studies were commissioned to help identify the most effective interventions to empower women economically across four categories of employment – entrepreneurship, farming, wage employment and young women’s employment. Some of the commissioned studies conducted new data analyses while others reviewed existing evidence – analyzing available evidence on the effectiveness, cost-effectiveness and sustainability of programs. The project includes a total of 136 published empirical evaluations.

Emerging Infectious Diseases
Volume 19, Number 10—October 2013
http://www.cdc.gov/ncidod/EID/index.htm

Research
Emergence of Vaccine-derived Polioviruses, Democratic Republic of Congo, 2004–2011
Nicksy Gumede , Olivia Lentsoane, Cara C. Burns, Mark Pallansch, Esther de Gourville, Riziki Yogolelo, Jean Jacques Muyembe-Tamfum, Adrian Puren, Barry D. Schoub, and Marietjie Venter
Author affiliations: National Institute for Communicable Diseases, Johannesburg, South Africa (N. Gumede, O. Lentsoane, A. Puren, B.D. Schoub, M. Venter); University of Witwatersrand, Johannesburg (N. Gumede, B.D. Schoub); University of Pretoria, Pretoria, South Africa (M. Venter); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C.C. Burns, M. Pallansch); World Health Organization, Geneva, Switzerland (E. de Gourville); National Institute for Biomedical Research, Kinshasa/Gombe, Democratic Republic of Congo (R. Yogolelo, J.J. Muyembe-Tamfum)
http://wwwnc.cdc.gov/eid/article/19/10/13-0028_article.htm

Abstract
Polioviruses isolated from 70 acute flaccid paralysis patients from the Democratic Republic of Congo (DRC) during 2004–2011 were characterized and found to be vaccine-derived type 2 polioviruses (VDPV2s). Partial genomic sequencing of the isolates revealed nucleotide sequence divergence of up to 3.5% in the viral protein 1 capsid region of the viral genome relative to the Sabin vaccine strain. Genetic analysis identified at least 7 circulating lineages localized to specific geographic regions. Multiple independent events of VDPV2 emergence occurred throughout DRC during this 7-year period. During 2010–2011, VDPV2 circulation in eastern DRC occurred in an area distinct from that of wild poliovirus circulation, whereas VDPV2 circulation in the southwestern part of DRC (in Kasai Occidental) occurred within the larger region of wild poliovirus circulation.

Emerging Infectious Diseases
Volume 19, Number 10—October 2013
http://www.cdc.gov/ncidod/EID/index.htm

Declining Influenza Vaccination Coverage among Nurses, Hong Kong, 2006–2012
Shui Shan Lee, Ngai Sze Wong, and Sing Lee
http://wwwnc.cdc.gov/eid/article/19/10/pdfs/13-0195.pdf

Seasonal influenza vaccination of nurses in Hong Kong fell from 57% in 2005 to 24% in 2012, paralleling concern for adverse reactions associated with vaccination. Decreased acceptance of vaccination was most prominent among nurses who had less work experience and more frequent contact with patients.

Eurosurveillance
Volume 18, Issue 38, 19 September 2013
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Rapid communications
Insidious reintroduction of wild poliovirus into Israel, 2013
by E Anis, E Kopel, SR Singer, E Kaliner, L Moerman, J Moran-Gilad, D Sofer, Y Manor, LM Shulman, E Mendelson, M Gdalevich, B Lev, R Gamzu, I Grotto

Pertussis immunisation and control in England and Wales, 1957 to 2012: a historical review
by G Amirthalingam, S Gupta, H Campbell

JAMA   
September 18, 2013, Vol 310, No. 11
http://jama.jamanetwork.com/issue.aspx

Viewpoint
PEPFAR’s Antiprostitution PledgeSpending Power and Free Speech in Tension
Lawrence O. Gostin, JD¹
http://jama.jamanetwork.com/article.aspx?articleid=1733774

Excerpt (per Jama convention)
The United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003, which established the President’s Emergency Plan for AIDS Relief (PEPFAR), exemplifies the nation’s extraordinary compassion and generosity—granting $48 billion over the current 5-year period (2009-2013). PEPFAR, however, has mired successive administrations in controversy for politicizing public health. PEPFAR must report to Congress if a country fails to spend at least one-half of its prevention funding to promote “abstinence, delay of sexual début, monogamy, fidelity, and partner reduction.” PEPFAR’s “conscience clause” allows organizations to withhold particular services (eg, condoms) or deny individuals care (eg, based on sexual orientation) if the organization has a moral or religious objection.

Journal of Infectious Diseases
Volume 208 Issue 8 October 15, 2013
http://jid.oxfordjournals.org/content/current

Immunogenicity of Quadrivalent HPV Vaccine Among Girls 11 to 13 Years of Age Vaccinated Using Alternative Dosing Schedules: Results 29 to 32 Months After Third Dose
D. Scott LaMontagne1,2, Vu Dinh Thiem3, Vu Minh Huong1,2, Yuxiao Tang1,2 and Kathleen M. Neuzil1,2

Abstract
Background.  Immune response to quadrivalent human papillomavirus (HPV) vaccine delivered at 0, 2, and 6 months in young adolescent females plateaus around 24 months after immunization. Antibody levels >24 months postvaccination using extended dosing schedules is unknown.

Methods. We conducted a follow-up immunogenicity study of adolescent girls in Vietnam who participated in a noninferiority trial to investigate whether immune responses using 3 alternative dosing schedules (0, 3, 9 months; 0, 6, 12 months; or 0, 12, 24 months) are noninferior to the standard schedule at >2 years after immunization.

Results.  Quadrivalent HPV vaccine immunogenicity delivered on 3 alternative dosing schedules was noninferior for types 6, 11, 16, and 18 at 32 months post-dose 3 compared to the standard schedule. Pre-dose 3 antibody levels for the 0, 12, 24 month schedule were similar to those measured 32-months post-dose 3.

Conclusions. We found similar antibody concentrations ≥29 months after 3 doses of HPV vaccine regardless of dose-timing, and extended schedules do not produce inferior immune responses. Our findings also suggested that 2 doses of HPV vaccine delivered at 0 and 12 months might afford similar protection. Evidence supporting dosing flexibility could be important for national HPV vaccination policies.

The Lancet  
Sep 21, 2013  Volume 382  Number 9897  p999 – 1070
http://www.thelancet.com/journals/lancet/issue/current

Patterns in coverage of maternal, newborn, and child health interventions: projections of neonatal and under-5 mortality to 2035
Dr Neff Walker PhD a, Gayane Yenokyan PhD b, Ingrid K Friberg PhD a, Jennifer Bryce EdD a
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961748-1/abstract

Summary
Background
Urgent calls have been made for improved understanding of changes in coverage of maternal, newborn, and child health interventions, and their country-level determinants. We examined historical trends in coverage of interventions with proven effectiveness, and used them to project rates of child and neonatal mortality in 2035 in 74 Countdown to 2015 priority countries.

Methods
We investigated coverage of all interventions for which evidence was available to suggest effective reductions in maternal and child mortality, for which indicators have been defined, and data have been obtained through household surveys. We reanalysed coverage data from 312 nationally-representative household surveys done between 1990 and 2011 in 69 countries, including 58 Countdown countries. We developed logistic Loess regression models for patterns of coverage change for each intervention, and used k-means cluster analysis to divide interventions into three groups with different historical patterns of coverage change. Within each intervention group, we examined performance of each country in achieving coverage gains. We constructed models that included baseline coverage, region, gross domestic product, conflict, and governance to examine country-specific annual percentage coverage change for each group of indicators. We used the Lives Saved Tool (LiST) to predict mortality rates of children younger than 5 years (henceforth, under 5) and in the neonatal period in 2035 for Countdown countries if trends in coverage continue unchanged (historical trends scenario) and if each country accelerates intervention coverage to the highest level achieved by a Countdown country with similar baseline coverage level (best performer scenario).

Results
Odds of coverage of three interventions (antimalarial treatment, skilled attendant at birth, and use of improved sanitation facilities) have decreased since 1990, with a mean annual decrease of 5·5% (SD 2·7%). Odds of coverage of four interventions—all related to the prevention of malaria—have increased rapidly, with a mean annual increase of 27·9% (7·3%). Odds of coverage of other interventions have slowly increased, with a mean annual increase of 5·3% (3·5%). Rates of coverage change varied widely across countries; we could not explain the differences by measures of gross domestic product, conflict, or governance. On the basis of LiST projections, we predicted that the number of Countdown countries with an under-5 mortality rate of fewer than 20 deaths per 1000 livebirths per year would increase from four (5%) of the 74 in 2010, to nine (12%) by 2035 under the historical trends scenario, and to 15 (20%) under the best performer scenario. The number of countries with neonatal mortality rates of fewer than 11 per 1000 livebirths per year would increase from three (4%) in 2010, to ten (14%) by 2035 under the historical trends scenario, and 67 (91%) under the best performer scenario. The number of under-5 deaths per year would decrease from an estimated 7·6 million in 2010, to 5·4 million (28% decrease) if historical trends continue, and to 2·3 million (71% decrease) under the best performer scenario.

Interpretation
Substantial reductions in child deaths are possible, but only if intensified efforts to achieve intervention coverage are implemented successfully within each of the Countdown countries.

Funding
The Bill & Melinda Gates Foundation.

The Lancet  
Sep 21, 2013  Volume 382  Number 9897  p999 – 1070
http://www.thelancet.com/journals/lancet/issue/current

The unfinished agenda in child survival
Jennifer Bryce EdD a  Prof Cesar G Victora MD b, Prof Robert E Black MD a
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961753-5/abstract

Summary
10 years ago, The Lancet published a Series about child survival. In this Review, we examine progress in the past decade in child survival, with a focus on epidemiology, interventions and intervention coverage, strategies of health programmes, equity, evidence, accountability, and global leadership. Knowledge of child health epidemiology has greatly increased, and although more and better interventions are available, they still do not reach large numbers of mothers and children. Child survival should remain at the heart of global goals in the post-2015 era. Many countries are now making good progress and need the time and support required to finish the task. The global health community should show its steadfast commitment to child survival by amassing knowledge and experience as a basis for ever more effective programmes. Leadership and accountability for child survival should be strengthened and shared among the UN system; governments in high-income, middle-income, and low-income countries; and non-governmental organisations.

The Lancet  
Sep 21, 2013  Volume 382  Number 9897  p999 – 1070
http://www.thelancet.com/journals/lancet/issue/current

Redefining global health-care delivery
Jim Yong Kim MD a, Paul Farmer MD b, Michael E Porter PhD c
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961047-8/abstract

Summary
Initiatives to address the unmet needs of those facing both poverty and serious illness have expanded significantly over the past decade. But many of them are designed in an ad-hoc manner to address one health problem among many; they are too rarely assessed; best practices spread slowly. When assessments of delivery do occur, they are often narrow studies of the cost-effectiveness of a single intervention rather than the complex set of them required to deliver value to patients and their families. We propose a framework for global health-care delivery and evaluation by considering efforts to introduce HIV/AIDS care to resource-poor settings. The framework introduces the notion of care delivery value chains that apply a systems-level analysis to the complex processes and interventions that must occur, across a health-care system and over time, to deliver high-value care for patients with HIV/AIDS and cooccurring conditions, from tuberculosis to malnutrition. To deliver value, vertical or stand-alone projects must be integrated into shared delivery infrastructure so that personnel and facilities are used wisely and economies of scale reaped. Two other integrative processes are necessary for delivering and assessing value in global health: one is the alignment of delivery with local context by incorporating knowledge of both barriers to good outcomes (from poor nutrition to a lack of water and sanitation) and broader social and economic determinants of health and wellbeing (jobs, housing, physical infrastructure). The second is the use of effective investments in care delivery to promote equitable economic development, especially for those struggling against poverty and high burdens of disease. We close by reporting our own shared experience of seeking to move towards a science of delivery by harnessing research and training to understand and improve care delivery.

Medical Decision Making (MDM)
October 2013; 33 (7)
http://mdm.sagepub.com/content/current

Too Much of a Good Thing? When to Stop Catch-Up Vaccination
David W. Hutton, PhD, Margaret L. Brandeau, PhD
Department of Health Management and Policy, University of Michigan, Ann Arbor (DWH)
Department of Management Science and Engineering, Stanford University, Stanford, California (MLB)

Abstract
During the 20th century, deaths from a range of serious infectious diseases decreased dramatically due to the development of safe and effective vaccines. However, infant immunization coverage has increased only marginally since the 1960s, and many people remain susceptible to vaccine-preventable diseases. “Catch-up vaccination” for age groups beyond infancy can be an attractive and effective means of immunizing people who were missed earlier. However, as newborn vaccination rates increase, catch-up vaccination becomes less attractive: the number of susceptible people decreases, so the cost to find and vaccinate each unvaccinated person may increase; in addition, the number of infected individuals decreases, so each unvaccinated person faces a lower risk of infection. This article presents a general framework for determining the optimal time to discontinue a catch-up vaccination program. We use a cost-effectiveness framework: we consider the cost per quality-adjusted life year gained of catch-up vaccination efforts as a function of newborn immunization rates over time and consequent disease prevalence and incidence. We illustrate our results with the example of hepatitis B catch-up vaccination in China. We contrast results from a dynamic modeling approach with an approach that ignores the impact of vaccination on future disease incidence. The latter approach is likely to be simpler for decision makers to understand and implement because of lower data requirements.

The Pediatric Infectious Disease Journal
October 2013 – Volume 32 – Issue 10  pp: e383-e413,1045-1158
http://journals.lww.com/pidj/pages/currenttoc.aspx

Prospective Surveillance Study of Invasive Pneumococcal Disease Among Urban Children in the Philippines
Capeding, Maria Rosario; Bravo, Lulu; Santos, Jaime; et al

Abstract
Background: Worldwide, invasive pneumococcal disease (IPD) causes considerable morbidity and mortality among children, but incidence data in Asia are lacking. This 2-year hospital-based, prospective, surveillance study was conducted at 3 study sites in urban areas of the Philippines to estimate IPD and pneumonia incidence in children and describe the serotype distribution of invasive Streptococcus pneumoniae isolates.

Methods: Children aged 28 days to <60 months residing within the 3 surveillance areas presenting with possible IPD were enrolled. Initial diagnosis, history of pneumococcal vaccine receipt and previous antimicrobial treatment were recorded. Blood specimens were collected for S. pneumoniae identification and serotyping. Final diagnosis was determined for hospitalized subjects, subjects whose culture yielded S. pneumoniae and subjects with clinically suspected meningitis.

Results: A total of 5940 subjects were enrolled, 47 IPD cases identified. IPD site rates were 33.49 per 100,000, 25.38 per 100,000 and 25.85 per 100,000. Chest radiograph-confirmed pneumonia incidence ranged from 633.74 to 1683.59 per 100,000. Highest chest radiograph-confirmed pneumonia incidence occurred in those 28 days to <6 months of age at 2 sites (2166.16 and 3891.94 per 100,000) and those 6–12 months of age at the third site (3847.52 per 100,000). Thirty-five S. pneumoniae isolates were serotyped; most commonly identified were serotypes 1, 2, 5, 6B, 14 and 18F. One serotype 14 isolate was erythromycin resistant. Previous antibiotic therapy was documented in 17–53% of subjects; 2 subjects had received pneumococcal vaccine. At 2 sites, one-third of IPD subjects died.

Conclusions: IPD is an important cause of morbidity and mortality among urban children in the Philippines. Our data support the expectation that widespread immunization would decrease IPD disease burden

PLoS One
[Accessed 21 September 2013]
http://www.plosone.org/

Enhancement of Collective Immunity in Tokyo Metropolitan Area by Selective Vaccination against an Emerging Influenza Pandemic
Masaya M. Saito, Seiya Imoto, Rui Yamaguchi, Masaharu Tsubokura, Masahiro Kami, Haruka Nakada, Hiroki Sato, Satoru Miyano, Tomoyuki Higuchi
Research Article | published 18 Sep 2013 | PLOS ONE 10.1371/journal.pone.0072866

Abstract
Vaccination is a preventive measure against influenza that does not require placing restrictions on social activities. However, since the stockpile of vaccine that can be prepared before the arrival of an emerging pandemic strain is generally quite limited, one has to select priority target groups to which the first stockpile is distributed. In this paper, we study a simulation-based priority target selection method with the goal of enhancing the collective immunity of the whole population. To model the region in which the disease spreads, we consider an urban area composed of suburbs and central areas connected by a single commuter train line. Human activity is modelled following an agent-based approach. The degree to which collective immunity is enhanced is judged by the attack rate in unvaccinated people. The simulation results show that if students and office workers are given exclusive priority in the first three months, the attack rate can be reduced from in the baseline case down to 1–2%. In contrast, random vaccination only slightly reduces the attack rate. It should be noted that giving preference to active social groups does not mean sacrificing those at high risk, which corresponds to the elderly in our simulation model. Compared with the random administration of vaccine to all social groups, this design successfully reduces the attack rate across all age groups.

PLoS One
[Accessed 21 September 2013]
http://www.plosone.org/

Research Article
Patterns of Rotavirus Vaccine Uptake and Use in Privately-Insured US Infants, 2006–2010
Catherine A. Panozzo, Sylvia Becker-Dreps, Virginia Pate, Michele Jonsson Funk, Til Stürmer,
David J. Weber, M. Alan Brookhart
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0073825

Abstract
Rotavirus vaccines are highly effective at preventing gastroenteritis in young children and are now universally recommended for infants in the US. We studied patterns of use of rotavirus vaccines among US infants with commercial insurance. We identified a large cohort of infants in the MarketScan Research Databases, 2006–2010. The analysis was restricted to infants residing in states without state-funded rotavirus vaccination programs. We computed summary statistics and used multivariable regression to assess the association between patient-, provider-, and ecologic-level variables of rotavirus vaccine receipt and series completion. Approximately 69% of 594,117 eligible infants received at least one dose of rotavirus vaccine from 2006–2010. Most infants received the rotavirus vaccines at the recommended ages, but more infants completed the series for monovalent rotavirus vaccine than pentavalent rotavirus vaccine or a mix of the vaccines (87% versus 79% versus 73%, P<0.001). In multivariable analyses, the strongest predictors of rotavirus vaccine series initiation and completion were receipt of the diphtheria, tetanus and acellular pertussis vaccine (Initiation: RR=7.91, 95% CI= 7.69–8.13; Completion: RR=1.26, 95% CI=1.23–1.29), visiting a pediatrician versus family physician (Initiation: RR=1.51, 95% CI=1.49–1.52; Completion: RR=1.13, 95% CI=1.11–1.14), and living in a large metropolitan versus smaller metropolitan, urban, or rural area. We observed rapid diffusion of the rotavirus vaccine in routine practice; however, approximately one-fifth of infants did not receive at least one dose of vaccine as recently as 2010. Interventions to increase rotavirus vaccine coverage should consider targeting family physicians and encouraging completion of the vaccine series.

Science        
20 September 2013 vol 341, issue 6152, pages 1313-1420
http://www.sciencemag.org/current.dtl

Perspective – Immunology
Pasteur Approach to a Malaria Vaccine May Take the Lead
Michael F. Good
+ Author Affiliations
Institute for Glycomics, Griffith University, Gold Coast 4222, Australia.
Malaria is an infectious disease that is responsible for more loss of young lives than any other health condition. Eighty percent of the cases and nearly 1 million deaths from malaria occur in Africa each year. Although mortality has decreased in recent years, more must be done to improve and save the lives of sufferers. On page 1359 of this issue, Seder et al. (1) report that an attenuated form of the causative parasite can be administered intravenously and provide protection against malaria, taking us a step closer to achieving the goal of an effective vaccine.

.
Protection Against Malaria by Intravenous Immunization with a Nonreplicating Sporozoite Vaccine
Robert A. Seder, Lee-Jah Chang, Mary E. Enama, Kathryn L. Zephir, Uzma N. Sarwar, Ingelise J. Gordon, LaSonji A. Holman, Eric R. James, Peter F. Billingsley, Anusha Gunasekera, Adam Richman, Sumana Chakravarty, Anita Manoj, Soundarapandian Velmurugan, MingLin Li, Adam J. Ruben, Tao Li, Abraham G. Eappen, Richard E. Stafford, Sarah H. Plummer, Cynthia S. Hendel, Laura Novik, Pamela J. M. Costner, Floreliz H. Mendoza, Jamie G. Saunders, Martha C. Nason, Jason H. Richardson, Silas A. Davidson, Thomas L. Richie, Martha Sedegah, Awalludin Sutamihardja, Gary A. Fahle, Kirsten E. Lyke, Matthew B. Laurens, Mario Roederer, Kavita Tewari, Judith E. Epstein, B. Kim Lee Sim, Julie E. Ledgerwood, Barney S. Graham, Stephen L. Hoffman, and the VRC 312 Study Team
Science 20 September 2013: 1359-1365.
Published online 8 August 2013 [DOI:10.1126/science.1241800]
http://www.sciencemag.org/content/341/6152/1359.abstract
Abstract
Consistent, high-level, vaccine-induced protection against human malaria has only been achieved by inoculation of Plasmodium falciparum (Pf) sporozoites (SPZ) by mosquito bites. We report that the PfSPZ Vaccine—composed of attenuated, aseptic, purified, cryopreserved PfSPZ—was safe and wel-tolerated when administered four to six times intravenously (IV) to 40 adults. Zero of six subjects receiving five doses and three of nine subjects receiving four doses of 1.35 × 105 PfSPZ Vaccine and five of six nonvaccinated controls developed malaria after controlled human malaria infection (P = 0.015 in the five-dose group and P = 0.028 for overall, both versus controls). PfSPZ-specific antibody and T cell responses were dose-dependent. These data indicate that there is a dose-dependent immunological threshold for establishing high-level protection against malaria that can be achieved with IV administration of a vaccine that is safe and meets regulatory standards.

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

[HTML] The Effectiveness of Conjugate Haemophilus influenzae type b (Hib) Vaccine in The Gambia 14 years after Introduction
SRC Howie, C Oluwalana, O Secka, S Scott, RC Ideh… – Clinical Infectious Diseases, 2013
Background. The Gambia was the first country in Africa to introduce Conjugate Hib vaccine, which like other developing countries but unlike industrialised countries is delivered as 3-dose primary series with no booster. This study assessed its effectiveness 14 years post- …

[HTML] Patterns of Rotavirus Vaccine Uptake and Use in Privately-Insured US Infants, 2006–2010
CA Panozzo, S Becker-Dreps, V Pate, MJ Funk… – PLOS ONE, 2013
Abstract Rotavirus vaccines are highly effective at preventing gastroenteritis in young children and are now universally recommended for infants in the US. We studied patterns of use of rotavirus vaccines among US infants with commercial insurance. We identified a …

Evaluation of an Intervention Providing HPV Vaccine in Schools
BW Stubbs, CA Panozzo, JL Moss, PL Reiter… – American Journal of Health …, 2014
Objectives: To conduct outcome and process evaluations of school-located HPV vaccination clinics in partnership with a local health department. Methods: Temporary clinics provided the HPV vaccine to middle school girls in Guilford County, North Carolina, in 2009-2010. …

Cost-effectiveness of the vaccine against human papillomavirus in the Brazilian Amazon region
AJ Fonseca, LCL Ferreira, GB Neto – Revista da Associação Médica Brasileira, 2013
Objective To assess the cost-utility of the human papillomavirus (HPV) vaccination on the prevention of cervical cancer in the Brazilian Amazon region. Methods A Markov cohort model was developed to simulate the natural evolution of HPV and its progress to cervical …

The risk of Guillain-Barré syndrome after influenza vaccination
MP Walberg – 2013 … When patients with a preceding gastrointestinal or respiratory illness were controlled for, only 5 cases of GBS were noted in almost 7 million influenza vaccine recipients. … 8. CDC. Interim adjusted estimates of influenza vaccine effectiveness — United States, February 2013. …

Maternal Underestimation of Child’s Sexual Experience: Suggested Implications for HPV Vaccine Uptake at Recommended Ages
N Liddon, SL Michael, P Dittus, LE Markowitz – Journal of Adolescent Health, 2013
Purpose Despite official recommendation for routine HPV vaccination of boys and girls at age 11–12 years, parents and providers are more likely to vaccinate their children/patients at older ages. Preferences for vaccinating older adolescents may be related to beliefs …

BBC
http://www.bbc.co.uk/
Accessed 21 September 2013

Way opened for Pandemrix swine flu jab compensation
Excerpt
Four families have been told they can apply for government compensation over side-effects of the Pandemrix swine flu vaccine.

Studies have shown the jab increased the risk of narcolepsy tenfold.

Families could be entitled to £120,000 through the Vaccine Damage Payments Scheme if they can prove “severe” disability.

If the bid fails they and other families could still pursue compensation through the courts.

Pandemrix was the most widely used flu vaccine in the UK during the 2009-10 pandemic.    Almost six million doses were given, one million to young children.

However, evidence from across Europe has suggested a higher rate of narcolepsy in children after being given the jab.

Approximately one in 55,000 children vaccinated – about 20 in the UK – were thought to have developed narcolepsy…

http://www.bbc.co.uk/news/health-24172715

Vaccines: 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 “29 June 2013″
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– Email Summary: Vaccines: 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_The Week in Review_14 Sep 2013
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– 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

    The 11 Member States of the WHO South-East Asia Region committed to eliminating measles and controlling rubella and congenital syndrome (CRS) by 2020. The commitment came at the Sixty-sixth Session of the WHO Regional Committee for South-East Asia. The announcement noted that these 11 countries constitute some 45% of global measles deaths and that WHO estimates that US$800 million will be needed to achieve these goals by 2020.  The announcement also reported that “in order to reach the goal of measles elimination and rubella control, governments will need to achieve and maintain 95% population immunity against these diseases within each district through routine immunization and/or supplementary campaigns. Countries will also need to develop and sustain a sensitive and timely case-based measles and rubella/CRS surveillance system. The regional network of accredited measles and rubella laboratories needs to be expanded and strengthened. Strategic plans are being developed by all countries in the Region. These plans will need allocation of adequate funds and human resources.”

http://www.searo.who.int/mediacentre/releases/2013/pr1565/en/index.html

   IVI announced that the Yanghyun Foundation donated 30 million Korean won to support IVI programs for this year. The announcement came during a ceremony at the Hanjin Shipping Building in Seoul, Korea on September 6. As one of IVI’s long-term donors, the philanthropic foundation has supported IVI since 2008, contributing a cumulative total of 243 million won.
Full announcement: http://www.ivi.org/web/www/07_01?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=551

The Bill & Melinda Gates Foundation announced that CEO Jeff Raikes will retire, remaining in his position until a successor is named. In an email to BMGF employees, Mr. Raikes noted: “…I am proud of the work we’ve all done together in the past five years. We are having an impact on people’s lives every single day, and we are set up to keep on having an even bigger impact in the years to come…Now, I’m looking forward to doing some things I haven’t had time for, including my work at the Raikes Foundation, which is tackling youth and education issues. I have learned so much from Bill, Melinda, our grantees and partners, and all of you about catalytic philanthropy and specific issues like agriculture and education. I have also learned from—and been deeply moved by—the people I’ve met in the field, whether they’re Ethiopian farmers trying to grow enough food to feed their children or a teacher in New Orleans helping students make a better future. These lessons will not only inspire me but also serve me day-to-day, because I will continue to invest my time and energy in these areas…”

Full media release: http://www.gatesfoundation.org/Media-Center/Press-Releases/2013/09/Jeff-Raikes-to-Retire-as-CEO-of-the-Bill-and-Melinda-Gates-Foundation

   Aeras said it appointed Lewis K. Schrager, M.D., M.A., as Vice President of Scientific Affairs.  As a member of the senior leadership team, Dr. Schrager “will oversee and maintain key external relationships focused on research and development and represent Aeras at major scientific meetings and symposiums (as well as) oversee the Regulatory Affairs, Global Affairs, Safety & Pharmacovigilance, Medical Writing and Market Access departments, and function s a member of the Vaccine Advisory Committee and the Aeras Portfolio Review Committee. Dr. Schrager fills the position left by Dr. Ann Ginsberg, who assumed the position of Chief Medical Officer earlier this year.

Full release: http://www.aeras.org/pressreleases/respected-vaccine-expert-lewis-schrager-joins-aeras#.UjT3sD_9qFg

The Albert and Mary Lasker Foundation announced the winners of the 2013 Lasker Awards –

:: Richard H. Scheller and Thomas C. Sudhof for basic medical research on discoveries concerning neurotransmitters;

:: Graeme M. Clark, Ingeborg Hochmair and Blake S. Wilson for clinical research leading to the development of the modern Cochlear Implant, and

:: Bill Gates and Melinda Gates for public service in improving the lives of the world’s most vulnerable people.”  Alfred Sommer, Chair of the Lasker Foundation’s Board of Directors, commented, “The Lasker Awards showcase the power of biomedical research to advance science, save lives, and avert suffering the world over. This year’s awards celebrate that (68-year old) tradition by honoring fundamental discoveries about brain function, the creation of an innovative technology that confers hearing to profoundly deaf people, and the powerful impact of results-driven philanthropy that has enhanced the quality of life for millions around the globe.”

Full media release: http://www.prnewswire.com/news-releases/2013-lasker-awards-honor-scientists-for-pioneering-medical-research-222955411.html

   The Pharmaceutical Research and Manufacturers of America (PhRMA) announced today the recipients of the 2013 Research & Hope Awards, “honoring outstanding achievements in vaccines research and immunization by individuals and research teams in the biopharmaceutical sector, academic/public research and health care provider communities.” Recipients of the PhRMA 2013 Research & Hope Awards are:

   :: The PhRMA Research & Hope Award for Biopharmaceutical Industry Research in Vaccine Development  –  GlaxoSmithKline Malaria Vaccine Team
“The GlaxoSmithKline Malaria Vaccine Team, led by Dr. Sophie Biernaux, is receiving the 2013 PhRMA Research & Hope Award for Biopharmaceutical Industry Research for its ongoing development of a vaccine against malaria targeted to children in Sub-Saharan Africa. For more information on the team’s work, now in the final stages of a large, multi-center Phase III clinical trial, see the video and team bio.”

   :: The PhRMA Research & Hope Award for Academic or Public Research in Vaccine Development – Douglas R. Lowy, MD, National Cancer Institute; John T. Schiller, PhD, National Cancer Institute
“Drs. Lowy and Schiller are receiving the 2013 PhRMA Research & Hope Award for Academic or Public Research for the discovery of the human papilloma virus (HPV) vaccine for the prevention of cervical cancer. For more information on their pivotal work, see the video and bios.”

   :: The PhRMA Research & Hope Award for Patient and Community Health – Linda Yu-Sing Fu, M.D., M.Sc., Children’s National Medical Center (CNMC)
“Dr. Fu, on behalf of her team at CNMC, is receiving the 2013 PhRMA Research & Hope Award for Patient and Community Health for their efforts to increase awareness of the importance of childhood immunization and raise the quality of immunization delivery to an at-risk population in the District of Columbia. For more information, see the video and bio.”

PhRMA noted that recipients of the Biopharmaceutical Industry Research and Academic or Public Research Awards were selected by the Science Advisory Board of the PhRMA Foundation following an open nominations process. The recipient of the Patient and Community Health Award was chosen by an inter-departmental committee of representatives from PhRMA.

Full media release: http://www.businesswire.com/news/home/20130911005390/en/PhRMA-Honors-Vaccines-Pioneers-Research-Hope-Awards

Update: Polio this week – As of 11 September 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: Due to the Horn of Africa outbreak, the bulk of polio cases this year (over two-thirds) are in countries which were previously polio-free.
:: Between the endemic countries, cases are down 40% over the same period last year (78 compared to 131); this indicates progress particularly in Afghanistan and Nigeria, which are poised to enter the traditional ‘high season’ for polio transmission in a strong position. The subsequent ‘low season’ will be the most critical in the history of polio eradication.

Nigeria
::One new WPV1 case was reported in the past week (from Taraba), bringing the total number of WPV1 cases for 2013 to 46. It is the most recent WPV case in the country and had onset of paralysis on 17 August…

Pakistan
:: One new WPV1 case was reported in the past week (from Khyber Pakhtunkhwa – KP), bringing the total number of WPV1 cases for 2013 to 28. It is the most recent WPV case in the country and had onset of paralysis on 19 August.
:: FATA remains the major poliovirus reservoir in Pakistan and in Asia, both due to WPV1 and cVDPV2. Efforts are ongoing to curb transmission in this area, including through vaccination at transit points and conducting Short Interval Additional Dose (SIADs) campaigns in areas that have recently become accessible….

Horn of Africa
:: Four new WPV1 cases were reported in the past week, three from Somalia and one from Kenya. The total number of WPV1 cases for 2013 in the Horn of Africa is 179 (163 from Somalia, 14 from Kenya and one from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on 7 August (from Somalia).
:: The Global Polio Eradication Initiative has conducted a three month assessment of the polio outbreaks in Somalia and Kenya. The assessment conclusions are that the response was rapid and aggressive, with strong national leadership and international coordination.
:: In both countries, there is a significant risk that the outbreak will extend beyond six months, due to large numbers of under vaccinated children in Somalia and inconsistent campaign quality in Kenya. Outbreak response planning should therefore continue into 2014…

The Weekly Epidemiological Record (WER) for 13 September 2013, vol. 88, 37 (pp. 389–400) includes:
:: Global programme to eliminate lymphatic filariasis: progress report for 2012

http://www.who.int/entity/wer/2013/wer8837.pdf

CDC/MMWR Watch [to 14 September 2013]
:: National, State, and Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2012
:: Measles — United States, January 1–August 24, 2013
:: Influenza Vaccination Practices of Physicians and Caregivers of Children with Neurologic and Neurodevelopmental Conditions — United States, 2011–12 Influenza Season
:: Notes from the Field: Measles Outbreak Among Members of a Religious Community — Brooklyn, New York, March–June 2013
:: Notes from the Field: Measles Outbreak Associated with a Traveler Returning from India — North Carolina, April–May 2013

   CDC Telebriefing: National Immunization Survey, Vaccine for Children Program, and recent measles outbreaks in the U.S.
Thursday, September 12, 2013 Noon ET
http://www.cdc.gov/media/releases/2013/t0912_measles-outbreaks-data.html
Press Briefing Transcript [Audio recording  [MP3, 5.51 MB]
Excerpt:
ANNE SCHUCHAT:

“….Twenty years ago, the VFC program was developed to fix a national crisis of missed opportunities.  Today we have a strong public private partnership for immunizing children that reflects the success of the VFC program.  But today we also have local measles outbreaks representing a very different dynamic.  Instead of our system missing opportunities to vaccinate young children, in some communities people have been rejecting opportunities to be vaccinated.

Let me start with our National Immunization Report Card— National Immunization Survey of Toddlers, age 19 to 35 months, or the NIS. According to the 2012 NIS, the vast majority of parents are vaccinating their children against potentially serious diseases…

The 2012 NIS report shows most that children are complete on the recommended vaccinations.  The U.S. continues to have high rates of immunization coverage at the national level.  Vaccination coverage remains near or above 90 percent for measles, mumps and rubella vaccine or MMR.  For the polio series, for hepatitis B series, and for varicella or chicken pox vaccine.  The percentage of children who received no vaccinations remains low.  Only 0.8 percent or less than one percent of children in this survey had received no vaccines at all.  These are really good results, but there is opportunity for improvement.  Vaccination coverage varies by state.  Both for individual vaccines and for the series measure….

…So, next I want to briefly discuss the national measles situation so far this year.  It is a far cry from that crisis that we had 24 years ago.  But with measles things can change very quickly.  And we need to stay ahead of this virus which means we need to make sure that immunization coverage is high everywhere.  This year, the U.S. is experiencing a higher than usual number of measles cases.  There are three outbreaks that account for most of this year’s measles cases in New York City, North Carolina, and Texas.  From January 1st to August 24th, 159 measles cases have been reported across the United States.  That’s the second largest number of measles cases we have had in this country since measles was eliminated in 2000.       During this period, 16 states reported measles cases and the age of cases ranged widely from birth to 61 years.  Thirty-seven percent of the cases were children under  five.  And 18 or 11 percent of all cases were in babies under 12 months who are too young to be routinely vaccinated.  Seventeen or 11 percent of the cases required hospitalization. Four of the patients had pneumonia.  Fortunately none of the measles cases here in the U.S. this year died.  Most of this year’s cases were unvaccinated. One hundred and thirty-one or 82 percent.  Four had unknown vaccinations status, 16 cases or nine percent. Among the 140 U.S. residents, 117 were unvaccinated.

I want to tell you in particulars about why they were unvaccinated because it’s so different than what we were seeing in back in 1989 to 1991.  Seventy-nine percent of the U.S. residents cases that were unvaccinated had philosophical objections to the vaccine. A smaller numbers, 15 cases or 13 percent, were babies under 12 months that cannot directly be vaccinated but rely on those around them being vaccinated.  Let me say a few words about the outbreaks.  New York City reported 58 cases, making this the largest outbreak reported in the United States since 1996.  None of the patients in that outbreak had documentation of measles vaccination.  North Carolina reported the second largest outbreaks so far with 23 cases.  Cases mainly occurred among people who were unvaccinated due to philosophical objection.  And in the current outbreak in Texas, 20—actually 21 cases, more since we’ve made the report in the MMWR, have — been reported.  The numbers may continue to change as this outbreak may be ongoing.  Seventeen of those cases in Texas were unvaccinated.  As these outbreaks are showing, clusters of people with like-minded beliefs leading them to forego vaccines can be susceptible to outbreaks when measles outbreaks are imported from elsewhere.  Measles, as we know, is highly contagious and can lead to serious complications and even death. We need very high rates of immunization to protect the most vulnerable –children too young to be vaccinated and those who can’t be vaccinated due to health conditions.

Importation of measles in the U.S. continues to occur and it poses a threat to our country.  It poses a particular threat to people who are not vaccinated.  All of the measles cases reported in the U.S. in 2013 were associated with importations from other countries.  There were 42 actual importations from 18 other countries.  You can think of an import associated case as being linked back to a traveler who brought the disease into the U.S. from another country.  Half of the imported measles cases we had in the U.S. originated from Europe.  Not a place that many people think of when they try to update their vaccine records before travel.  Measles is still common in many parts of the world.  And, unfortunately, about 160,000 people around the world die from the disease each year.  Rapid public health response to measles is critical.  Given how very infectious measles is and the fact we still have pockets of unvaccinated people.  We have to rapidly investigate and respond to measles cases.  But thanks to the high vaccination rates and rapid public health response the outbreak in 2013 has been contained and it is – that is at the cost of tremendous effort on the part of public health workers who respond to these outbreaks when they occur….

20 Years of Success: CDC Celebrates 20th Anniversary of Vaccines for Children Program – Digital Press kit

GSK research released at the 2013 Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) reported that “the incidence of pertussis among U.S. adults 50 and older may be greatly under-reported and under-recognized.”  The research estimated that the actual number of pertussis cases was approximately 520,000 versus the 8,764 medically-attended cases among U.S. adults ages 50 to 64, and approximately 465,000 versus 6,359 medically-attended pertussis cases among adults 65 and older in the same database. That equates to an incidence on average of 202 per 100,000 in adults 50-64, and 257 per 100,000 among adults 65 and older. These estimated incidences were about 42 to 105 times higher than the medically-attended pertussis cases documented in the same database during the years 2006-2010. In 2010, the estimated incidence was 94 and 264 times higher than nationally reported incidences for individuals aged 50-64 and 65 and older, respectively. The GSK researchers who led the study, Cristina Masseria, Ph.D, and Girishanthy Krishnarajah, MPH, MBA/MS, utilized data from the IMS private practice database that included more than 80 million claims per year and analyzed approximately 48 million cases of cough-related illness in the U.S. between 2006 and 2010. The commercial laboratory testing database represents approximately 40 percent of respiratory-laboratory testing that took place in the U.S. during the years looked at in the study.

Leonard Friedland, M.D., Vice President and Director of Scientific Affairs and Public Health for GSK Vaccines, noted, “The CDC, other public health authorities and infectious disease experts have long suspected that pertussis cases in adults go undetected or are misdiagnosed as other respiratory ailments . To our knowledge, this is the first attempt to quantify the incidence of cough illness attributed to B. pertussis via regression modeling among those greater than 50 years old. The authors plan to share their research methods and welcome other researchers to further examine and build upon the findings of this study. These findings suggest a major need for healthcare providers to consider the possibility of pertussis in older patients they see who have respiratory symptoms.”

Full media release: http://www.prnewswire.com/news-releases/gsk-research-estimates-significantly-higher-rates-of-pertussis-among-older-adults-than-now-reported-223473661.html

Report: Medicines in Development – Vaccines – A Report on the Prevention and Treatment of Disease Through Vaccines
The Pharmaceutical Research and Manufacturers of America (PhRMA)
September 2013: 36 pages Link: report

PhRMA released a report which noted that America’s biopharmaceutical companies are currently developing 271 vaccines to prevent – and in some cases treat – a variety of conditions, including infectious diseases, various forms of cancer and neurological disorders. These potential vaccines – all in human clinical trials or under review by the Food and Drug Administration (FDA) – include 137 for infectious diseases, 99 for cancer, 15 for allergies and 10 for neurological disorders. The report also noted that there are 204 active clinical trials for vaccines in the U.S., including 107 that have not yet started recruiting patients or are just now seeking volunteers to participate.

UN Report: Global child deaths down by almost half since 1990
WHO, UNICEF, World Bank Group, UN-DESA Population Division
13 September 2013

:: Download the report.
:: Detailed explanation of the B3 model used in developing the UN IGME child mortality estimates is available here.
:: Under-five mortality estimates: Rates and Deaths
:: Infant mortality estimates: Rates and Deaths
:: Neonatal mortality estimates: Rates and Deaths
:: Sex-specific under-five mortality rate: Estimates
:: Sex-specific infant mortality rate: Estimates
::: Annual rate of reduction of under-five mortality: Estimates and 90% uncertainty intervals
:: Country-specific methodological notes: Summary

The report notes that in 2012, approximately 6.6 million children worldwide – 18 000 children per day – before reaching their fifth birthday, roughly half the number of under-fives who died in 1990, when more than 12 million children died. Anthony Lake, UNICEF Executive Director, commented, “This trend is a positive one. Millions of lives have been saved. And we can do still better. Most of these deaths can be prevented, using simple steps that many countries have already put in place – what we need is a greater sense of urgency.” The leading causes of death among children aged less than five years include pneumonia, prematurity, birth asphyxia, diarrhoea and malaria. Globally, about 45% of under-five deaths are linked to undernutrition.

About half of under-five deaths occur in only five countries: China, Democratic Republic of the Congo, India, Nigeria, and Pakistan. India (22%) and Nigeria (13%) together account for more than one-third of all deaths of children under the age of five.

http://www.who.int/mediacentre/news/releases/2013/child_mortality_causes_20130913/en/index.html

Cost Effectiveness and Resource Allocation
(Accessed 14 September 2013)
http://www.resource-allocation.com/

Research
Drug versus vaccine investment: a modelled comparison of economic incentives
Stéphane A Régnier^12* and Jasper Huels²
http://www.resource-allocation.com/content/11/1/23
Abstract
Background
Investment by manufacturers in research and development of vaccines is relatively low compared with that of pharmaceuticals. If current evaluation technologies favour drugs over vaccines, then the vaccines market becomes relatively less attractive to manufacturers.
Methods
We developed a mathematical model simulating the decision-making process of regulators and payers, in order to understand manufacturers’ economic incentives to invest in vaccines rather than curative treatments. We analysed the objectives and strategies of manufacturers and payers when considering investment in technologies to combat a disease that affects children, and the interactions between them.
Results
The model confirmed that, for rare diseases, the economically justifiable prices of vaccines could be substantially lower than drug prices, and that, for diseases spread across multiple cohorts, the revenues derived from vaccinating one cohort per year (routine vaccination) could be substantially lower than those generated by treating sick individuals.
Conclusions
Manufacturers may see higher incentives to invest in curative treatments rather than in routine vaccines. To encourage investment in vaccines, health authorities could potentially revise their incentive schemes by: (1) committing to vaccinate all susceptible cohorts in the first year (catch-up campaign); (2) choosing a long-term horizon for health technology evaluation; (3) committing higher budgets for vaccines than for treatments; and (4) taking into account all intangible values derived from vaccines.

Eurosurveillance
Volume 18, Issue 37, 12 September 2013
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Research articles
The test-negative design: validity, accuracy and precision of vaccine efficacy estimates compared to the gold standard of randomised placebo-controlled clinical trials
by G De Serres, DM Skowronski, XW Wu, CS Ambrose

Laboratory-confirmed invasive meningococcal disease: effect of the Hajj vaccination policy, Saudi Arabia, 1995 to 2011
by Z Memish, R Al Hakeem, O Al Neel, K Danis, A Jasir, D Eibach

JAMA   
September 11, 2013, Vol 310, No. 10
http://jama.jamanetwork.com/issue.aspx

Viewpoint | September 11, 2013
Reconsidering the Politics of Public Health
Dave A. Chokshi, MD, MSc1; Nicholas W. Stine, MD2
http://jama.jamanetwork.com/article.aspx?articleid=1731672
Initial language
A central dilemma in public health is reconciling the role of the individual with the role of the government in promoting health. On the one hand, governmental policy approaches—taxes, bans, and other regulations—are seen as emblematic of “nanny state” overreach. In this view, public health regulation is part of a slippery slope toward escalating government intrusion on individual liberty. On the other hand, regulatory policy is described as a fundamental instrument for a “savvy state” to combat the conditions underlying an inexorable epidemic of chronic diseases. Proponents of public health regulation cite the association of aggressive tobacco control, physical activity, and nutritional interventions with demonstrable increases in life expectancy…1

The Lancet  
Sep 14, 2013  Volume 382  Number 9896  p913 – 998
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Closing the killer gap in children’s health inequality
The Lancet
Preview |
Globally, the pervasive disparities in the health and wellbeing of children are detrimental not only to the poorest and most vulnerable children and their families and communities, but also to the whole of society. To eliminate such disparities, three major questions need to be answered. How wide is the health gap? What are the underlying and driving factors? What can be done?

The Lancet Infectious Diseases
Sep 2013  Volume 13  Number 9   p725 – 822
http://www.thelancet.com/journals/laninf/issue/current

Editorial
USA missing opportunities for HPV vaccination
The Lancet Infectious Diseases
Preview
Since the US Advisory Committee for Immunization Practices (ACIP) recommended vaccination to protect against human papillomavirus (HPV) for girls at age 11–12 years, year-on-year increases in vaccine uptake have been disappointingly small. Data from the National Immunization Survey-Teen (NIS-Teen) show that the proportion of girls age 13–17 years who had received one dose of the vaccine increased from 25·1% in 2007 to just 53·0% in 2011. Despite substantial improvement in coverage in the early years, this slowed, and worryingly new figures released on July 26 indicate that uptake has stalled, with coverage at 53·8% in 2012.

The Lancet Infectious Diseases
Sep 2013  Volume 13  Number 9   p725 – 822
http://www.thelancet.com/journals/laninf/issue/current

Comment –
Association between vaccination and Guillain-Barré syndrome
Lucija Tomljenovic, Yehuda Shoenfeld
Preview |
Guillain-Barré syndrome is a serious neurological autoimmune disorder characterised by inflammatory demyelination of peripheral nerves.1 Up to 25% of patients experience respiratory failure,2 and 4% die within the first year from disease complications.3 The disorder can be triggered by viral infections and bacterial and viral vaccinations.1,4 After the 1976 influenza vaccine campaign in the USA, an increase in the rate of Guillain-Barré syndrome resulted in the suspension of the vaccination programme…

Risk of Guillain-Barré syndrome after seasonal influenza vaccination and influenza health-care encounters: a self-controlled study
Dr Jeffrey C Kwong MD a b c j k, Priya P Vasa MD b l, Michael A Campitelli MPH a, Steven Hawken MSc a, Kumanan Wilson MD a g h, Laura C Rosella PhD a c j, Prof Therese A Stukel PhD a d, Natasha S Crowcroft MD(Cantab) c e j, Prof Allison J McGeer MD c e, Lorne Zinman MD f i, Shelley L Deeks MD c j

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2813%2970104-X/abstract

Summary

Background

The possible risk of Guillain-Barré syndrome from influenza vaccines remains a potential obstacle to achieving high vaccination coverage. However, influenza infection might also be associated with Guillain-Barré syndrome. We aimed to assess the risk of Guillain-Barré syndrome after seasonal influenza vaccination and after influenza-coded health-care encounters.

Methods

We used the self-controlled risk interval design and linked universal health-care system databases from Ontario, Canada, with data obtained between 1993 and 2011. We used physician billing claims for influenza vaccination and influenza-coded health-care encounters to ascertain exposures. Using fixed-effects conditional Poisson regression, we estimated the relative incidence of hospitalisation for primary-coded Guillain-Barré syndrome during the risk interval compared with the control interval.

Findings

We identified 2831 incident admissions for Guillain-Barré syndrome; 330 received an influenza vaccine and 109 had an influenza-coded health-care encounter within 42 weeks before hospitalisation. The risk of Guillain-Barré syndrome within 6 weeks of vaccination was 52% higher than in the control interval of 9—42 weeks (relative incidence 1·52; 95% CI 1·17—1·99), with the greatest risk during weeks 2—4 after vaccination. The risk of Guillain-Barré syndrome within 6 weeks of an influenza-coded health-care encounter was greater than for vaccination (15·81; 10·28—24·32). The attributable risks were 1·03 Guillain-Barré syndrome admissions per million vaccinations, compared with 17·2 Guillain-Barré syndrome admissions per million influenza-coded health-care encounters.

Interpretation

The relative and attributable risks of Guillain-Barré syndrome after seasonal influenza vaccination are lower than those after influenza illness. Patients considering immunisation should be fully informed of the risks of Guillain-Barré syndrome from both influenza vaccines and influenza illness.

Funding

Canadian Institutes of Health Research.

The Lancet Infectious Diseases
Sep 2013  Volume 13  Number 9   p725 – 822
http://www.thelancet.com/journals/laninf/issue/current

The emergence of influenza A H7N9 in human beings 16 years after influenza A H5N1: a tale of two cities
Kelvin KW To FRCPath a †, Jasper FW Chan FRCPath a †, Honglin Chen PhD a c, Lanjuan Li MD b c, Dr Kwok-Yung Yuen MD a c
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2813%2970167-1/abstract
Summary
Infection with either influenza A H5N1 virus in 1997 or avian influenza A H7N9 virus in 2013 caused severe pneumonia that did not respond to typical or atypical antimicrobial treatment, and resulted in high mortality. Both viruses are reassortants with internal genes derived from avian influenza A H9N2 viruses that circulate in Asian poultry. Both viruses have genetic markers of mammalian adaptation in their haemagglutinin and polymerase PB2 subunits, which enhanced binding to human-type receptors and improved replication in mammals, respectively. Hong Kong (affected by H5N1 in 1997) and Shanghai (affected by H7N9 in 2013) are two rapidly flourishing cosmopolitan megacities that were increasing in human population and poultry consumption before the outbreaks. Both cities are located along the avian migratory route at the Pearl River delta and Yangtze River delta. Whether the widespread use of the H5N1 vaccine in east Asia—with suboptimum biosecurity measures in live poultry markets and farms—predisposed to the emergence of H7N9 or other virus subtypes needs further investigation. Why H7N9 seems to be more readily transmitted from poultry to people than H5N1 is still unclear.

PLoS Medicine
(Accessed 14 September 2013)
http://www.plosmedicine.org/

Feasibility of Mass Vaccination Campaign with Oral Cholera Vaccines in Response to an Outbreak in Guinea
Iza Ciglenecki mail, Keita Sakoba, Francisco J. Luquero, Melat Heile, Christian Itama, Martin Mengel, Rebecca F. Grais, Francois Verhoustraeten, Dominique Legros
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001512

Summary Points
:: Oral cholera vaccines are safe and effective, and in 2010 were added to WHO recommendations for cholera outbreak control. However, doubts about feasibility, timeliness, and acceptability by the population, and the fear of diverting resources from other preventive interventions, have discouraged their use during epidemics.
:: We report on the first large-scale use of oral cholera vaccine as an outbreak control measure in Africa; this was also the first time Shanchol vaccine was used in Africa.
:: We administered 312,650 doses of vaccine during two vaccination rounds in two coastal districts in Guinea. The feasibility, timeliness of implementation, and delivery cost were similar to those of other mass vaccination campaigns.
:: The campaign was well accepted by the population, and high vaccination coverage was achieved despite the short time available for preparation, the two-dose schedule, the remote rural setting, and the highly mobile population.
:: Oral cholera vaccines are a promising new tool in the arsenal of cholera control measures, alongside efforts to improve provision of safe water and sanitation and access to cholera treatment.

Risk Analysis
September 2013  Volume 33, Issue 9  Pages 1565–1757
http://onlinelibrary.wiley.com/doi/10.1111/risa.2013.33.issue-9/issuetoc

Risk-Based Input-Output Analysis of Influenza Epidemic Consequences on Interdependent Workforce Sectors (pages 1620–1635)
Joost R. Santos, Larissa May and Amine El Haimar
Article first published online: 24 DEC 2012 | DOI: 10.1111/risa.12002
http://onlinelibrary.wiley.com/doi/10.1111/risa.12002/abstract

Abstract
Outbreaks of contagious diseases underscore the ever-looming threat of new epidemics. Compared to other disasters that inflict physical damage to infrastructure systems, epidemics can have more devastating and prolonged impacts on the population. This article investigates the interdependent economic and productivity risks resulting from epidemic-induced workforce absenteeism. In particular, we develop a dynamic input-output model capable of generating sector-disaggregated economic losses based on different magnitudes of workforce disruptions. An ex post analysis of the 2009 H1N1 pandemic in the national capital region (NCR) reveals the distribution of consequences across different economic sectors. Consequences are categorized into two metrics: (i) economic loss, which measures the magnitude of monetary losses incurred in each sector, and (ii) inoperability, which measures the normalized monetary losses incurred in each sector relative to the total economic output of that sector. For a simulated mild pandemic scenario in NCR, two distinct rankings are generated using the economic loss and inoperability metrics. Results indicate that the majority of the critical sectors ranked according to the economic loss metric comprise of sectors that contribute the most to the NCR’s gross domestic product (e.g., federal government enterprises). In contrast, the majority of the critical sectors generated by the inoperability metric include sectors that are involved with epidemic management (e.g., hospitals). Hence, prioritizing sectors for recovery necessitates consideration of the balance between economic loss, inoperability, and other objectives. Although applied specifically to the NCR, the proposed methodology can be customized for other regions.

Vaccine
Volume 31, Issue 42, Pages 4689-4932 (1 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

EuSANH workshop “Reasons behind the differences in national vaccination schedules for under-five”, European Public Health pre-conference workshop, Malta, 8 November 2012
Meeting Report
Pages 4694-4696
H. Theeten, H. Nohynek, T.M.M. Coenen, European Science Advisory Network for Health (EuSANH)
Abstract
Vaccination schedules for under-five children in the EU member states differ markedly, mainly as a consequence of differences in programme organization, decision making and history, and to a limited extent by epidemiological differences. There is little willingness towards unification since little evidence exists to prefer one schedule over the others, but the differences might impact on public confidence. Monitoring key determinants influencing individual decision making on immunization (‘soft impacts’) is thus as important as other existing monitoring systems of the ‘hard’ impacts of immunization programmes, and both should focus on the impact of these schedule differences. Harmonization of vaccination schedules is not the main issue, but the reasons behind the differences should be explained in an understandable and coherent way to the public. Scientists and advisory bodies should look over the country borders and communicate any crucial information, in order to improve scientific consensus on immunization schedules and programmes. These were the main conclusions of a members’ experts panel of the European network of independent science advisory bodies on health (EuSANH), at a workshop in November 2012.

Vaccine
Volume 31, Issue 42, Pages 4689-4932 (1 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Use of alternative childhood immunization schedules in King County, Washington, USA
Pages 4699-4701
Douglas J. Opel, Ashmita Banerjee, James A. Taylor
Abstract
Objective
To determine the percentage of parents in King County, Washington using an alternative childhood immunization schedule (ACIS) and the type of ACIS used.
Patient and Methods
We distributed self-administered surveys to parents at 5 practices regarding the immunization schedule they planned to use or were using. Parents who selected an ACIS were asked to describe its main characteristics and information source.
Results
We received 517 surveys and included 502 in analysis. The percentage of parents using an ACIS was 9.4% (95% CI: 7%, 12.2%). Only 6% described their ACIS as the Dr. Sears Schedule, although the book in which it is featured was the most frequently cited ACIS information source (29%). There was a significant association between ACIS use and non-Hispanic white parents and parents of children 12–23 months old.
Conclusion(s)
A minority of King County parents use an ACIS. The Dr. Sears Schedule does not predominate.

Vaccine
Volume 31, Issue 42, Pages 4689-4932 (1 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Is there a lack of information on HPV vaccination given by health professionals to young women?
Pages 4710-4713
G. La Torre, E. De Vito, M.G. Ficarra, A. Firenze, P. Gregorio, A. Boccia, HPV Collaborative Group
Abstract
Objective
The aim of this survey is to compare the main sources of information about vaccination against Human papillomavirus (HPV) of young women aged over-18 and under-18 years.
Methods
A multicenter study was carried out in Italy through the administration of a questionnaire. Univariate analyses were conducted to evaluate possible differences between age groups and different locations (chi-square test and Fisher test where possible).
Results
The sample consisted of 987 young women. The main sources of information about HPV vaccination are represented by magazines/books (23.1%) and TV (20.5%) for the over-18s, while for the under-18s the sources are general practitioners (22.6%) and pediatricians (15.4%). The over-18s with health professionals as parents consult mostly gynecologists (27.7%) and general practitioners (20.5%).
Discussion
This study highlights lack of information on HPV vaccination given by health professionals to young women and underlines the need to improve education about cervical cancer, prevention and HPV vaccination.

Vaccine
Volume 31, Issue 42, Pages 4689-4932 (1 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Quantifying the impact of dissimilar HPV vaccination uptake among Manitoban school girls by ethnicity using a transmission dynamic model
Original Research Article
Pages 4848-4855
Leigh Anne Shafer, Ian Jeffrey, Brenda Elias, Brenna Shearer, Karen Canfell, Erich Kliewer
Abstract
Background
Gardasil, a human papillomavirus (HPV) vaccine, began among grade 6 girls in Manitoba, Canada in 2008. In Manitoba, there is evidence that First Nations, Métis, and Inuit women (FNMI) have higher HPV prevalence, lower invasive cervical cancer (ICC) screening, and higher ICC incidence than all other Manitoban (AOM) women. We developed a mathematical model to assess the plausible impact of unequal vaccination coverage among school girls on future cervical cancer incidence.
Methods
We fit model estimated HPV prevalence and ICC incidence to corresponding empirical estimates. We used the fitted model to evaluate the impact of varying levels of vaccination uptake by FNMI status on future ICC incidence, assuming cervical screening uptake among FNMI and AOM women remained unchanged.
Results
Depending on vaccination coverage, estimated ICC incidence by 2059 ranged from 15% to 68% lower than if there were no vaccination. The level of cross-ethnic sexual mixing influenced the impact that vaccination rates among FNMI has on ICC incidence among AOM, and vice versa. The same level of AOM vaccination could result in ICC incidence that differs by up to 10%, depending on the level of FNMI vaccination. Similarly, the same level of FNMI vaccination could result in ICC incidence that differs by almost 40%, depending on the level of AOM vaccination.
Conclusions
If we are unable to equalize vaccination uptake among all school girls, policy makers should prepare for higher levels of cervical cancer than would occur under equal vaccination uptake.

Vaccine
Volume 31, Issue 42, Pages 4689-4932 (1 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Associations between health communication behaviors, neighborhood social capital, vaccine knowledge, and parents’ H1N1 vaccination of their children
riginal Research Article
Pages 4860-4866
Minsoo Jung, Leesa Lin, K. Viswanath
Abstract
During the H1N1 pandemic in 2009–10, the vaccination behavior of parents played a critical role in preventing and containing the spread of the disease and the subsequent health outcomes among children. Several studies have examined the relationship between parents’ health communication behaviors and vaccinations for children in general. Little is known, however, about the link between parents’ health communication behaviors and the vaccination of their children against the H1N1 virus, and their level of vaccine-related knowledge. We drew on a national survey among parents with at least one child less than 18 years of age (n = 639) to investigate Parents’ H1N1-related health communication behaviors including sources of information, media exposure, information-seeking behaviors, H1N1-related knowledge, and neighborhood social capital, as well as the H1N1 vaccination rates of their children. Findings showed that there is a significant association between the degree at which parents obtained H1N1 vaccination for their children and health communication variables: watching the national television news and actively seeking H1N1 information. And this association was moderated by the extent of the parents’ H1N1-related knowledge. In addition, the parents’ degree of neighborhood social capital mediated the association between H1N1 knowledge of the parents and H1N1 vaccination acceptance for their children. We found, compared to those with a low-level of neighborhood social capital, parents who have a high-level of neighborhood social capital are more likely to vaccinate their children. These findings suggest that it is necessary to design a strategic health communication campaign segmented by parent health communication behaviors.

Vaccine
Volume 31, Issue 42, Pages 4689-4932 (1 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Human papillomavirus vaccine communication: Perspectives of 11–12 year-old girls, mothers, and clinicians
Original Research Article
Pages 4894-4901
Tanya L. Kowalczyk Mullins, Anne M. Griffioen, Susan Glynn, Gregory D. Zimet, Susan L. Rosenthal, J. Dennis Fortenberry, Jessica A. Kahn
Abstract
Objectives
Because little is known about the content of human papillomavirus (HPV) vaccine-related discussions with young adolescent girls in clinical settings, we explored communication between 11- and 12 year-old girls, mothers, and clinicians regarding HPV vaccines and concordance in reports of maternal and clinician communication.
Methods
We conducted individual interviews with 33 girls who had received the quadrivalent HPV vaccine in urban and suburban clinical settings, their mothers, and their clinicians. Data were analyzed using qualitative methods.
Results
From the perspectives of both girls and mothers, clinicians and parents were the preferred sources of HPV vaccine information for girls. Vaccine efficacy and risks/benefits of vaccination were the most commonly reported desired and actual topics of discussion by mothers, girls, and clinicians. Clinician recommendation of vaccination was reported by nearly one-fifth of girls and nearly half of mothers. The most common concordant messages were related to efficacy of the vaccine, with concordance in 70% of triads. The most common discordant messages were related to sexual health. Approximately half of clinicians (16) reported discussing sexual health, but only 5 mothers (15%) and 4 girls (12%) reported this. Triads recruited from suburban (vs. urban) practices had higher degrees of concordance in reported vaccination communication.
Conclusions
HPV vaccine efficacy and safety are important topics for clinicians to discuss with both girls and mothers; educating mothers is important because parents are a preferred source of vaccine-related information for girls. Because girls may be missing important vaccine-related messages, they should be encouraged to actively engage in vaccine discussions.

Vaccine
Volume 31, Issue 42, Pages 4689-4932 (1 October 2013)
http://www.sciencedirect.com/science/journal/0264410X

Public finance of rotavirus vaccination in India and Ethiopia: An extended cost-effectiveness analysis
Original Research Article
Pages 4902-4910
Stéphane Verguet, Shane Murphy, Benjamin Anderson, Kjell Arne Johansson, Roger Glass, Richard Rheing
Abstract
Background
An estimated 4% of global child deaths (approximately 300,000 deaths) were attributed to rotavirus in 2010. About a third of these deaths occurred in India and Ethiopia. Public finance of rotavirus vaccination in these two countries could substantially decrease child mortality and also reduce rotavirus-related hospitalizations, prevent health-related impoverishment and bring significant cost savings to households.
Methods
We use a methodology of ‘extended cost-effectiveness analysis’ (ECEA) to evaluate a hypothetical publicly financed program for rotavirus vaccination in India and Ethiopia. We measure program impact along four dimensions: 1) rotavirus deaths averted; 2) household expenditures averted; 3) financial risk protection afforded; 4) distributional consequences across the wealth strata of the country populations.
Results
In India and Ethiopia, the program would lead to a substantial decrease in rotavirus deaths, mainly among the poorer; it would reduce household expenditures across all income groups and it would effectively provide financial risk protection, mostly concentrated among the poorest. Potential indirect benefits of vaccination (herd immunity) would increase program benefits among all income groups, whereas potentially decreased vaccine efficacy among poorer households would reduce the equity benefits of the program.
Conclusions
Our approach incorporates financial risk protection and distributional consequences into the systematic economic evaluation of vaccine policy, illustrated here with the case study of public finance for rotavirus vaccination. This enables selection of vaccine packages based on the quantitative inclusion of information on equity and on how much financial risk protection is being bought per dollar expenditure on vaccine policy, in addition to how much health is being bought.

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

Academic Pediatrics
Volume 13, Issue 5, September–October 2013,

A Randomized Trial to Increase Acceptance of Childhood Vaccines by Vaccine-Hesitant Parents: A Pilot Study
S. Elizabeth Williams, MDa, Russell L. Rothman, MD, MPPb, Paul A. Offit, MDd, William Schaffner, MDc, Molly Sullivana, Kathryn M. Edwards, MDa
Pages 475–480
http://www.sciencedirect.com/science/article/pii/S1876285913000661
Abstract
Objective
A cluster randomized trial was performed to evaluate an educational intervention to improve parental attitudes and vaccine uptake in vaccine-hesitant parents.
Methods
Two primary care sites were randomized to provide families with either usual care or an intervention (video and written information) for vaccine-hesitant parents. Eligible parents included those presenting for their child’s 2-week well-child visit with performance on the Parent Attitudes about Childhood Vaccines (PACV) survey suggesting vaccine hesitancy (score ≥25). Enrollees completed PACV surveys at the 2-month well-child visit and vaccination status at 12 weeks of age was assessed. The primary outcome was the difference in PACV scores obtained at enrollment and 2 months between the 2 groups. The proportion of on-time vaccination was also compared at 12 weeks.
Results
A total of 454 parents were approached, and 369 (81.3%) participated; 132 had PACV scores of ≥25 and were enrolled, 67 in the control group (mean PACV score 37) and 55 in the intervention group (mean PACV score 40). Two-month PACV surveys were completed by 108 (∼90%) of enrollees. Parents in the intervention group had a significant decrease in PACV score at 2 months compared to control (median difference 6.7, P = .049); this remained significant after adjustment for baseline PACV score, race/ethnicity, and income (P = .044). There was no difference in the on-time receipt of vaccines between groups at 12 weeks.
Conclusions
A brief educational intervention for vaccine-hesitant parents was associated with a modest but significant increase in measured parental attitudes toward vaccines.

A Mixed Methods Study of Parental Vaccine Decision Making and Parent–Provider Trust
Jason M. Glanz, PhDa, Nicole M. Wagner, MPHa, Komal J. Narwaney, PhDa, Jo Ann Shoup, MS, MSWa, David L. McClure, PhDb, Emily V. McCormick, MPHc, Matthew F. Daley, MDa
a Kaiser Permanente Colorado—Institute for Health Research, Denver, Colo
b Marshfield Clinic Research Foundation, Marshfield, Wis
c Denver Public Health Department, Denver, Colo
Pages 481–48
http://www.sciencedirect.com/science/article/pii/S1876285913001563
Abstract
Objective
To describe parental vaccine decision making behaviors and characterize trust in physician advice among parents with varying childhood vaccination behaviors.
Methods
Between 2008 and 2011, a mixed methods study was conducted with parents of children aged <4 years who were members of Kaiser Permanente Colorado health plan. Seven focus groups were conducted with vaccine-hesitant parents. On the basis of findings from the focus groups, a survey was developed, pilot tested, and mailed to a stratified sample of 854 parents who accepted (n = 500), delayed (n = 227), or refused (n = 127) vaccinations for one of their children. Survey results were analyzed by chi-square tests and multivariable logistic regression.
Results
Several themes emerged from the focus groups, including: 1) the vaccine decision-making process begins prenatally, 2) vaccine decision making is an evolving process, and 3) there is overall trust in the pediatrician but a lack of trust in the information they provided about vaccines. The survey response rate was 52% (n = 443). Parents who refused or delayed vaccines were 2 times more likely to report that they began thinking about vaccines before their child was born and 8 times more likely to report that they constantly reevaluate their vaccine decisions than parents who accepted all vaccines. Although parents tended to report trusting their pediatrician’s advice on nutrition, behavior, and the physical examination, they did not believe their pediatrician provided “balanced” information on both the benefits and risks of vaccination.
Conclusions
These results have implications for future interventions to address parental vaccination concerns. Such interventions may be more effective if they are applied early (during pregnancy) and often (pregnancy through infancy), and cover both the risks and benefits of vaccination.