Vaccine
Volume 31, Issue 9, Pages 1255-1356 (18 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

Use of measles supplemental immunization activities (SIAs) as a delivery platform for other maternal and child health interventions: Opportunities and challenges
Pages 1259-1263
Mira Johri, Jitendar K. Sharma, Mark Jit, Stéphane Verguet

Abstract
Measles supplementary immunization activities (SIAs) offer children in countries with weaker immunization delivery systems like India a second opportunity for measles vaccination. They could also provide a platform to deliver additional interventions, but the feasibility and acceptability of including add-ons is uncertain. We surveyed Indian programme officers involved in the current (2010–2012) measles SIAs concerning opportunities and challenges of using SIAs as a delivery platform for other maternal and child health interventions. Respondents felt that an expanded SIA strategy including add-ons could be of great value in improving access and efficiency. They viewed management challenges, logistics, and safety as the most important potential barriers. They proposed that additional interventions be selected using several criteria, of which importance of the health problem, safety, and contribution to health equity figured most prominently. For children, they recommended inclusion of basic interventions to address nutritional deficiencies, diarrhoea and parasites over vaccines. For mothers, micronutrient interventions were highest ranked.

Vaccine
Volume 31, Issue 9, Pages 1255-1356 (18 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

Polio eradication in India: Progress, but environmental surveillance and vigilance still needed
Review Article
Pages 1268-1275
Animesh Chatterjee, Sanjukta Vidyant, Tapan N. Dhole

Abstract
Poliomyelitis has appeared in epidemic form, become endemic on a global scale, and has been reduced to near elimination, all within the span of documented medical history.

Nevertheless, effective vaccinations, global surveillance network, development of accurate viral diagnosis prompted the historical challenge, global polio eradication initiative (GPEI). Environmental surveillance of poliovirus means monitoring of wild polio virus (WPV) and vaccine derived polio virus (cVDPV) circulation in human populations by examining environmental specimens supposedly contaminated by human feces. The rationale for surveillance is based on the fact that PV-infected individuals, whether presenting with disease symptoms or not, shed large amounts of PV in the feces for several weeks. As the morbidity: infection ratio of PV infection is very low, and therefore this fact contributes to the sensitivity of poliovirus surveillance, which under optimal conditions can be better than that of the standard acute flaccid paralysis (AFP) surveillance. The World Health Organization (WHO) has included environmental surveillance of poliovirus in the new Strategic Plan of the Global Polio Eradication Initiative for years 2010–2012 to be increasingly used in PV surveillance, supplementing AFP surveillance and the strategic advisory group of experts on immunization (SAGE) recommended a switch from tOPV–bOPV to remove the threat of cVDPV2 and to accelerate the elimination of WPV type 1 and 3 as bOPV is a more immunogenic vaccine and to introduce one dose of IPV in their vaccination schedule prior to OPV cessation.

Vaccine
Volume 31, Issue 9, Pages 1255-1356 (18 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

Cost-effectiveness of vaccination of the elderly against herpes zoster in The Netherlands
Original Research Article
Pages 1276-1283
Pieter T. de Boer, Koen B. Pouwels, Juul M. Cox, Eelko Hak, Jan C. Wilschut, Maarten J. Postma

Abstract
Background
Each year a substantial number of Dutch elderly suffers from herpes zoster (HZ), caused by the reactivation of the varicella zoster virus (VZV). A potential complication of HZ is postherpetic neuralgia (PHN) which results in a prolonged loss of quality of life. A large randomized clinical trial, labelled the Shingles Prevention study (SPS), demonstrated that a live attenuated VZV vaccine can reduce the incidence of HZ and PHN.

Objective
We aimed to estimate the incremental cost-effectiveness ratio (ICER) of vaccination of the elderly against HZ versus no such vaccination in The Netherlands.

Methods
A cohort model was developed to compare the costs and effects in a vaccinated and a non-vaccinated age- and gender-stratified cohort of immune-competent elderly. Vaccination age was varied from 60 to 75 years. Data from published literature such as the SPS were used for transition probabilities. The study was performed from the societal as well as the health care payer’s perspective and results were expressed in euros per quality-adjusted life year (QALY) gained.

Results
In the base case, we estimated that vaccination of a cohort of 100,000 60-year-olds would prevent 4136 cases of HZ, 305 cases of PHN resulting in a QALY-gain of 209. From the societal perspective, a total of €1.9 million was saved and the ICER was €35,555 per QALY gained when a vaccine price of €87 was used. Vaccination of women resulted in a lower ICER than vaccination of men (€33,258 vs. €40,984 per QALY gained). The vaccination age with the most favourable ICER was 70 years (€29,664 per QALY gained). Parameters with a major impact on the ICER were the vaccine price and HZ incidence rates. In addition, the model was sensitive to utility of mild pain, vaccine efficacy at the moment of uptake and the duration of protection induced by the vaccine.

Conclusion
Vaccination against HZ might be cost-effective for ages ranging from 60 to 75 when a threshold of €50,000 per QALY gained would be used, at €20,000 per QALY this might not be the case. Additional information on the duration of vaccine-protection is needed to further optimize cost-effectiveness estimations.

From Google Scholar+: Dissertations, Theses, Selected Journal Articles

HIV Vaccine Development: Strategies for preclinical and clinical investigation
S Shapiro – AIDS Research and Human Retroviruses, 2013
This article discusses HIV vaccine discovery and candidate vaccine testing in the context of
current realities of funding and clinical trial practice. Lacking perfect animal models for
testing candidate HIV vaccines, clinical investigators have proposed a strategy of iterative…

[PDF] Effect of an Intervention on Medical Resident Knowledge and Adult Immunization Rates
LB Fick – FAMILY MEDICINE, 2013
… physician knowledge and awareness of vaccine recommendations, physician
behavior may be affected in a positive manner, leading to increased vaccination
rates in adult patients. This study assessed the change in adult…

[PDF] Factors Affecting HPV Vaccine Use Among Recent Family Medicine Residency Graduates
RE Post, PJ Carek, AG Mainous III, VA Diaz… – FAMILY MEDICINE, 2013
BACKGROUND AND OBJECTIVES: Many adolescents seek care by family physicians for
well visits and have the opportunity for HPV vaccination during these visits. Limited
information is available regarding what affects physicians in offering the vaccine. The…

DENDRITIC CELL (DC)-VACCINE THERAPY FOR PANCREATIC CANCER
AK Palucka, JF Banchereau, H Ueno – US Patent 20,130,028,915, 2013
Abstract: Compositions and methods for eliciting therapeutic immunity and improving clinical
outcomes in patients with pancreatic cancer are disclosed herein. The present invention
describes a dendritic cell (DC)-vaccine comprising DCs pulsed with peptides derived from…

Wall Street Journal
http://online.wsj.com/home-page
Accessed 9 February 2013

MIND & MATTER
February 8, 2013, 8:32 p.m. ET
When Species Extermination Is a Good Thing
By MATT RIDLEY
It’s not a race, exactly, but there’s an intriguing uncertainty about whether a former U.S. president or a software magnate will cause the next deliberate extinction of a species in the wild. Will Jimmy Carter eradicate Guinea worm before Bill Gates eradicates polio?

Guinea worm will probably beat polio to the finish line of extinction.

It is more than a third of a century since a human disease was extinguished. The last case of smallpox was in 1977, and in those days health experts expected other diseases to follow smallpox quickly into oblivion. Polio has repeatedly disappointed campaigners by hanging on, though it now affects less than 1% as many people as at its peak in the 1950s.

The generosity of Bill Gates has done much to speed the decline of polio, and he and most experts now see its end within six years at most. India, 10 years ago the worst-affected country, has been polio-free since 2011, and only three countries still host the virus: Pakistan, Afghanistan and especially Nigeria. Though the murder of nine polio vaccinators in Pakistan by Islamists in December was a tragic setback, last year there were just 222 new polio cases world-wide.

As Mr. Gates recounted in his 2013 annual letter from the Gates Foundation, the reason for his optimism is that a new approach is bearing fruit, especially in northern Nigeria. Volunteers on foot (but guided by GPS and satellite imagery) map unrecorded villages and houses to identify gaps in vaccination programs.

The Guinea worm, a disease that the Carter Center has relentlessly pursued, will probably edge out polio to the disease extinction line. In 1986, more than 3.5 million Africans and Asians were afflicted with Guinea worm, or dracunculiasis; in 2012, just 542 caught the parasite.

The larvae of this nematode worm live inside freshwater copepods, or “water fleas.” When the copepods are ingested in drinking water, the worms burrow through the stomach wall into the body cavity and mate. The females, which can reach 3 feet in length, then drill their way down the inside of the victim’s legs over a year before erupting painfully from a burning blister on the foot. The victim is tempted to immerse the blister in water to cool it, which allows the worm to release its larvae to seek copepods. The only cure is to pull the worm out over many weeks, inch by inch, winding it round a stick as it emerges. There is no vaccine.

Filtering water to prevent the ingestion of water fleas and making sure infected people do not enter water are the best means of prevention. Guinea worm was first targeted for eradication before polio, and it, too, has been disappointingly stubborn. But last year the number of cases halved from the year before, meaning that there are fewer guinea worms left in the world than black rhinos. The handful of cases in Chad (10), Mali (7) and Ethiopia (4) are expected to dwindle to nothing this year, but there were 521 cases in South Sudan (mostly in just one county), where eradication might take one or two more years of hard work, urged on by Mr. Carter and backed by money from the Gates Foundation, the British government and other donors. Guinea worm would be the first animal to be deliberately driven extinct.

Supposing these two welcome eradications do happen this decade, what parasites go next? Don Hopkins of the Carter Center says lymphatic filariasis, another worm carried by mosquitoes, could be gone by 2020. Onchocerciasis, or river blindness, carried by black flies, is almost gone from the Americas but will take longer to eradicate in Africa.

The first bacterium to be driven extinct could be yaws, an infection of children related to the organism that causes syphilis, which disfigures many people, especially in Ghana, Ivory Coast, Papua New Guinea and the Solomon Islands. Easily treated now with a single dose of azithromycin, an antibiotic, yaws should be gone by 2020.

A version of this article appeared February 9, 2013, on page C4 in the U.S. edition of The Wall Street Journal, with the headline: When Species Extermination Is a Good Thing.

Twitter Watch (9 February 2013 – 19:59)
Items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and is by no means intended to be exhaustive.

Seth Berkley @GAVISeth
If you know people going to #TED2013 & they have something to contribute to the vaccine challenge pls tell them to get in touch
1:42 PM – 9 Feb 13

Seth Berkley ‏@GAVISeth
Going to #TED2013 in 2 wks to launch a TED challenge: Let No Vaccine Go To Waste. How to track every dose so that they are used & not wasted
1:40 PM – 9 Feb 13

UNICEF @UNICEF
These attacks are double tragedy: for health workers & family, and for children robbed of live-saving health. #protecthealthworkers @WHO
3:45 PM – 8 Feb 13

UNICEF ‏@UNICEF
We join Nigerian Govt in condemning attacks on health workers. UNICEF @WHO [statement] http://goo.gl/5RBYO  #ProtectHealthWorkers
3:20 PM – 8 Feb 13

WHO @WHO
WHO,  @UNICEF joint statement condemning attacks on health workers in Nigeria http://goo.gl/5RBYO  #ProtectHealthWorkers
3:05 PM – 8 Feb 13

Sabin Vaccine Inst.  @sabinvaccine
New Study Highlights Chagas Disease as a Growing Health and Socio-economic Challenge | Sabin http://www.sabin.org/updates/pressreleases/new-study-highlights-chagas-disease-growing-health-and-socio-economic …
8:51 AM – 8 Feb 13

IVAC at JHSPH ‏@IVACtweets
Final Reports Released: #Nigeria‘s 1st National #Vaccine Summit & Town Hall Meetings http://bit.ly/Wx5eTk 
9:12 AM – 6 Feb 13

UNICEF @UNICEF
From Jan 20-25, India administered #polio vaccines to 172m children. Lessons from India, via @nytimes http://goo.gl/OSBav  #Promise4Children
12:20 AM – 7 Feb 13

Editor’s Notes:

– Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_2 February 2013_PDF

– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

– Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…

UNICEF said that over 1 million children vaccinated against measles in the past week through in a joint immunization campaign by the Ministry of Public Health, WHO, UNICEF and its partner Merlin in eastern Democratic Republic of Congo (DR Congo). Preliminary results show that 96% of the targeted 1,180,000 million children aged between 6 months and 15 years of age were vaccinated in the seven health zones of North Kivu province during the five-day vaccination campaign. Barbara Bentein, UNICEF Representative in the DRC, said, “So far, children from North Kivu have survived fighting, displacement and hunger. Now they are at risk of dying from measles, an entirely preventable disease. An outbreak of measles can spread like a bushfire, and displaced children are especially vulnerable. We must ensure that all children aged between 6 months and 15 years are vaccinated.”

More at: http://www.unicef.org/media/media_67678.html

WHO recommends rotavirus vaccines in all national immunization programmes
Excerpt
“1 February 2013 – In an updated position paper, published in the Weekly Epidemiological Record , WHO recommends the use of rotavirus vaccines in all national immunization programmes, particularly in south and south-eastern Asia and sub-Saharan Africa.

“The use of rotavirus vaccines should be part of a comprehensive strategy to control diarrhoeal diseases with the scaling up of both prevention ― including promotion of early and exclusive breastfeeding, hand washing, improved water supply and sanitation ― and treatment packages….”

“…Plans for introduction of rotavirus vaccines should consider the epidemiology of the disease by age, the coverage and actual age at vaccination, and an evaluation of the estimated public health impact and potential risks (e.g. intussusception). In addition, cost-effectiveness assessment, issues of affordability of the vaccine, financial and operational impact on the immunization delivery system, and careful examination of current immunization practices should be taken into account.

“Introduction of rotavirus vaccine should be accompanied by measures to ensure high vaccination coverage and timely administration of each dose…”
http://www.who.int/immunization/newsroom/newsstory_rotavirus_vaccines_immunization_programmes/en/index.html

The Weekly Epidemiological Record (WER) for 1 February 2013, vol. 88, 5 (pp. 49–64) includes:
– Rotavirus vaccines: WHO position paper – January 2013
http://www.who.int/entity/wer/2013/wer8804.pdf

WHO: Executive Board appoints new Regional Director for the Americas

The WHO Executive Board, currently holding its 132nd session in Geneva, has appointed Dr Carissa Etienne as the new Regional Director for WHO’s Americas Region (WHO/AMR), following her nomination by the Regional Committee for the Americas in September 2012. Dr Etienne will take up her appointment for a five-year term on 1 February 2013, succeeding Dr Mirta Roses Periago of Argentina. Dr Etienne, in her acceptance speech, said, “I believe strongly that good health is rooted in equity, universality, solidarity and inclusiveness. I have learned that Universal Health Coverage is not only the best way to improve the health of every citizen in a country – but that it is entirely feasible.” Dr Etienne, from Dominica, holds degrees in medicine and surgery from the University of the West Indies, as well as a master’s in community health and an honorary diploma in public health from the London School of Hygiene and Tropical Medicine.

http://www.who.int/mediacentre/news/notes/2013/regional_director_20130122/en/index.html

   WHO Europe: Experts meet to discuss verification process for measles and rubella elimination – Countries are committed to eradicating measles and rubella in the WHO European Region by 2015.

Based on a recommendation from the Regional Verification Commission for Measles and Rubella Elimination (RVC), which evaluates progress towards the goal, Member States are setting up national verification committees (NVCs) to oversee the process at country level, and report their findings to the RVC. So far, 16 countries have established NVCs. WHO/Europe encourages all Member States to do so as soon as possible, and expects the NVCs to submit their first annual status reports to the RVC before the end of July 2013.

Members of the RVC and some NVCs, measles focal points in countries and virologists from 16 northern and western European Member States gathered in Copenhagen, Denmark on 29–30 January 2013 at a meeting jointly organized by WHO/Europe and the European Centre for Disease Prevention and Control (ECDC). The purpose of the meeting was to inform national experts about the process of documenting measles and rubella elimination, and to enable participants to share information on the situation at the national and regional levels and discuss action to increase vaccination coverage through routine and/or supplemental immunization activities.

Progress towards elimination
In 2012, 11 countries in the Region experienced measles outbreaks. From January to October 2012, over 20,000 cases of measles were reported in 51 countries in the WHO European Region, although 87% were reported in only 4 countries. Most cases were in young people aged 5–19 years:
<1 year: 10%
1–4 years: 23%
5–19 years: 39%
≥20 years: 28%.
Rubella showed a similar pattern in the first 10 months of 2012: over 28 000 cases were reported by 43 countries, with 99% of cases concentrated in 4 countries.

During the WHO/ECDC meeting, experts discussed how to increase vaccination coverage through routine and/or supplemental immunization.

More at: http://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/measles-and-rubella/news/news/2013/02/experts-meet-to-discuss-verification-process-for-measles-and-rubella-elimination

   GSK and Biological E Limited announced an agreement to form a 50/50 joint venture for the early stage research and development of a six-in-one combination paediatric vaccine “to help protect children in India and other developing countries from polio and other infectious diseases.”  The partnership “reinforces the commitment of both companies to support the World Health Organisation’s (WHO) global polio eradication programme.” The companies said that, if approved, the vaccine, which would combine GSK’s injectable polio vaccine (IPV) and Biological E’s pentavalent vaccine for diphtheria, tetanus, whooping cough (whole cell pertussis), hepatitis B, and Haemophilus influenzae type b, “could be the first of its kind.” The fully liquid formulation of the vaccine “means it would be ready to use with no additional ingredients or materials required, freeing up space at local storage facilities.” The JV will bear the development costs for the candidate vaccine, which is expected to enter phase 1 development in the next two years. A small initial cash investment will be made by both companies to cover start-up costs for the JV and subsequent development costs will be split equally.

http://www.gsk.com/media/press-releases/2013/GSK-and-Biological-E-announce-joint-venture.html

The MMWR for February 1, 2013 / Vol. 62 / No. 4 includes:
– Noninfluenza Vaccination Coverage Among Adults — United States, 2011
– QuickStats: Percentage of Adults Aged ≥65 Years Who Had Ever Received a Pneumococcal Vaccination, by Selected Race/Ethnicity — National Health Interview Survey, United States, 2000–2011

Noninfluenza Vaccination Coverage Among Adults — United States, 2011
MMWR – February 1, 2013 / 62(04);66-72
On January 29, 2013, this report was posted as an MMWR Early Release on the MMWR website (http://www.cdc.gov/mmwr).
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6204a2.htm?s_cid=mm6204a2_w

[Editor’s Excerpt]
Vaccinations are recommended throughout life to prevent vaccine-preventable diseases and their sequelae. Adult vaccination coverage, however, remains low for most routinely recommended vaccines (1) and well below Healthy People 2020 targets.* In October 2012, the Advisory Committee on Immunization Practices (ACIP) approved the adult immunization schedule for 2013 (2). Apart from influenza vaccination, which is now recommended for all adults, other vaccines recommended for adults target different populations based on age, certain medical conditions, behavioral risk factors (e.g., injection drug use), occupation, travel, and other indications (2). To assess adult (aged ≥19 years) vaccination coverage for select vaccines, CDC analyzed data from the 2011 National Health Interview Survey (NHIS). This report summarizes the results of that analysis for pneumococcal vaccine, tetanus toxoid–containing vaccines (including tetanus and diphtheria toxoid [Td] with acellular pertussis vaccine [Tdap]), and hepatitis A, hepatitis B, herpes zoster (shingles), and human papillomavirus (HPV) vaccines, by selected characteristics (age, race/ethnicity,† and vaccination target criteria). Influenza vaccination coverage estimates for the 2011–12 influenza season have been published separately (3). Compared with 2010 (1), the data indicate modest increases in Tdap vaccination among persons aged 19–64 years and HPV vaccination among women, but only little improvement in coverage for the other vaccines among adults in the United States. Coverage for tetanus vaccination (with any tetanus toxoid–containing vaccine) during the past 10 years was unchanged. Substantial increases in vaccination coverage are needed to reduce the occurrence of vaccine-preventable diseases among adults. The Community Preventive Services Task Force and other authorities have recommended that health-care providers incorporate vaccination needs assessment, recommendation, and offer of vaccination into routine clinical practice for adult patients (4,5)…

Update: Polio this week – As of 30 January 2013
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s Extract and bolded text]
– The WHO Executive Board (EB) met last week in Geneva, Switzerland. There was strong recognition among Member States of the progress achieved with the ‘emergency approach’ instituted since May, and real confidence in the ultimate feasibility of polio eradication in the near term. Consequently, there was strong endorsement of the vision, objectives, major activities and timelines for the new Polio Eradication and Endgame Strategic Plan 2013-2018…

No new cases of either WPV or circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported in the past week.

WHO – Global Alert and Response (GAR)
Disease Outbreak News – Most recent news items
1 February 2013
Avian influenza – situation in Cambodia – update
Excerpt
1 February 2013 – The Ministry of Health (MoH) of the Kingdom of Cambodia reported five new human cases of avian influenza that were confirmed positive for the H5N1 virus in January 2013…The cases all presented with fever, cough and other ILI symptoms. Four of the cases died, with 1 case, the 8 month old male, recovering after only experiencing mild ILI. Laboratory samples were tested by the National Institute of Public Health’s laboratory and by the Institut Pasteur du Cambodge. Preliminary evidence does not support human-to-human transmission and four of the cases are known to have had close contact with sick/dead poultry…

.

WHO – Humanitarian Health Action
No new reports
http://www.who.int/hac/en/index.html

.

 WHO: Global Immunization News, December 2012 includes:
News
– Djibouti celebrates Introduction of Pneumococcal vaccine in the National Immunization programme
– Growing Consensus on Strengthening National Vaccine Delivery Systems
– Timor-Leste launches introduction of new vaccine as part of intensification of routine immunization
– Review of National Immunization Programme in Tajikistan, 19-28 November 2012
– Eastern Mediterranean is the first WHO region launching Vaccine Safety E-learning course CD
– New technology for producing thermostable INFLUENZA vaccines

Meetings/Workshops
– The 2nd Hands-on Training Course to Implement Real-time Polymerase Chain Reaction (PCR) Technique for Rapid Detection and Characterization of Polioviruses in the Western Pacific Region
– 18th Meeting of the Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific Region
– First meeting on seasonal influenza vaccines in Western Pacific Region
– IPV recommended for countries to mitigate risks and consequences associated with OPV2 withdrawal
– Global Invasive Bacterial Vaccine Preventable Diseases Surveillance Meeting
– SOUTH EAST ASIA countries share experiences on intensification of routine immunization at GAVI Partners’ Forum
– National Polio Committees develop action plans for 2013 in Ouagadougou, Burkina Faso
– Immunizations Systems and Technologies for Tomorrow

http://www.who.int/entity/immunization/GIN_December_2012.pdf

WHO: Informal Consultation on Dual-Use Research of Concern (DURC)
26-28 February 2013
Geneva, Switzerland

WHO is convening an informal consultation on the broader issues regarding Dual-Use Research of Concern (DURC). The objective of this meeting is to share perspectives on key issues and concerns related to DURC, identify existing approaches and safeguards for managing DURC, consider critical gaps and actions to initiate. Stakeholders from public health, science, research policy, security, ethics, communications, and international agencies have been invited to participate. Following this consultation a report will be published on the WHO website.

http://www.who.int/mediacentre/events/meetings/2013/durc/en/index.html

BMC Public Health
(Accessed 2 February 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
How has the flu virus infected the Web? 2010 influenza and vaccine information available on the Internet
Loredana Covolo, Silvia Mascaretti, Anna Caruana, Grazia Orizio, Luigi Caimi, Umberto Gelatti BMC Public Health 2013, 13:83 (29 January 2013)

Abstract (provisional)
Background
The 2009–10 influenza pandemic was a major public health concern. Vaccination was recommended by the health authorities, but compliance was not optimal and perception of the presumed associated risks was high among the public.

The Internet is increasingly being used as a source of health information and advice.

The aim of the study was to investigate the characteristics of websites providing information about flu vaccine and the quality of the information provided.

Methods
Website selection was performed in autumn 2010 by entering eight keywords in two of the most commonly used search engines (Google.com and Yahoo.com).

The first three result pages were analysed for each search, giving a total of 480 occurrences. Page rank was evaluated to assess visibility.

Websites based on Web 2.0 philosophy, websites merely displaying popular news/articles and single files were excluded from the subsequent analysis. We analysed the selected websites (using WHO criteria) as well as the information provided, using a codebook for pro/neutral websites and a qualitative approach for the adverse ones.

Results
Of the 89 websites selected, 54 dealt with seasonal vaccination, three with anti-H1N1 vaccination and 32 with both.

Rank analysis showed that only classic websites (ones not falling in any other category) and one social network were provided on the first pages by Yahoo; 21 classic websites, six displaying popular news/articles and one blog by Google.

Analysis of the selected websites revealed that the majority of them (88.8%) had a positive/neutral attitude to flu vaccination. Pro/neutral websites distinguished themselves from the adverse ones by some revealing features like greater transparency, credibility and privacy protection.

Conclusions
We found that the majority of the websites providing information on flu vaccination were pro/neutral and gave sufficient information. We suggest that antivaccinationist information may have been spread by a different route, such as via Web 2.0 tools, which may be more prone to the dissemination of “viral” information.

The page ranking analysis revealed the crucial role of search engines regarding access to information on the Internet.

British Medical Journal
02 February 2013 (Vol 346, Issue 7893)
http://www.bmj.com/content/346/7893

Editorial
Preparing for the next pandemic
Greater cross sector collaboration between health, veterinary, wildlife and environmental experts is needed
BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f364 (Published 23 January 2013)
Cite this as: BMJ 2013;346:f364
Nigel Lightfoot, executive director1, Mark Rweyemamu, professor, transboundary and emerging infectious diseases2, David L Heymann, head and senior fellow3

There is mounting concern about the rate at which newly identified infectious agents are being detected as they cross the species barrier from animals to humans, causing human illness and death.1. Any of these agents, including new influenza viruses, have the potential to spread rapidly, such is the speed and extent of air travel.2

Seventy per cent of emerging infectious diseases are zoonoses.3 The discovery of a new Lassa fever-like virus—the highly lethal lujovirus4—and a new rhabdovirus with a reservoir in bats potentially adds to the burden of haemorrhagic fever outbreaks caused by Marburg and Ebola viruses. There have been 107 cases of infection with these last two viruses, and 55 deaths, in Uganda and the Democratic Republic of the Congo.5

There is also concern about the recent, sudden, and unheralded appearance of a new severe acute respiratory syndrome (SARS)-like virus—the “novel coronavirus”—in Saudi Arabia, Qatar, and Jordan. Nine laboratory confirmed human infections have been reported to the World Health Organization, five of which have resulted in death.6 The source of infection is not known. However, early research suggests that this virus might have the potential to infect several different animals, including bats and pigs.7 The virus may already be widespread in animals. Person to person transmission has not been ruled out for close contacts in the outbreak in Jordan, and it is difficult to determine the virus’s epidemic potential.

The 2009 H1N1 influenza pandemic virus spread from pigs and became transmissible between humans some time in early 2009 where experts least expected it. One month before the first infections were detected in the southern United States, the Mexican media were reporting unexpected severe cases of respiratory disease at the end of the flu season. However, the attention of flu planning experts was focused on avian influenza in the Far East. This year new variants of influenza viruses transmitted from pigs to humans in the US, especially at agricultural fairs, have resulted in more than 300 human infections with a new variant influenza A virus, H3N2v.8 Onward human to human transmission has not been reported, but vigilance is needed because pig farming is a global food industry.

Intensive farming practices, environmental degradation, and processes related to the mining industry could all increase opportunities for infectious agents to breech the species barrier; some of these infections may have epidemic or pandemic potential in humans. Responding effectively and efficiently to these cross species infections and all other emerging infections is a challenge for the international public health community, the Food and Agriculture Organization, the World Organization for Animal Health, and WHO.

Current surveillance and response systems in many countries are often compartmentalised, and in poorer countries they may be poorly resourced. Better generic disease surveillance may be achieved through the joining up of “vertical” single disease networks that would share molecular technologies for the fingerprinting of infectious agents. An example of joined up surveillance in the United Kingdom through the Human Animal Infections and Risk Surveillance (HAIRS) group has shown how veterinary and human medicine can effectively work together on risk assessment.9

The concept of “one health” has become a central idea in both veterinary science and public health,10 and a global initiative was launched in 2004. The aim is to highlight the links between animal diseases and public health and to champion a multidisciplinary approach to tackle emerging infectious diseases.11 The initiative has been driven by international health, veterinary, wild life, and environmental experts and supported by WHO, the World Organization for Animal Health, and the Food and Agriculture Organization.

Effective surveillance and a rapid response to an emerging epidemic or pandemic depend on good observation at local level and early communication of potential events to those who can assess and support the management of the risk. “One health” practitioners in the field need to be trained, equipped with diagnostic tests, and provided with rapid communication tools. Weak surveillance networks need to be strengthened. In the past few years new networks have been established in Africa, the Middle East, the Far East, and southeastern Europe.

These networks work across borders, sectors, and national boundaries to collaborate on mounting an early response in the event of an infection threat. They have come together in a new non-governmental organisation, Connecting Organizations for Regional Disease Surveillance (CORDS).12 This organisation is funded by the Rockefeller, Skoll, and Bill & Melinda Gates Foundations, which hope to improve the capacity of these networks and to develop the culture of early communication and problem sharing globally.

If in the short term we are unable to prevent the next pandemic, we will still gain by being better prepared, whatever the threat is. Good response plans will have a chance of working only if surveillance and risk assessment are joined up across sectors and a culture of early communication of potential problems is entrenched.

Next week experts in human and animal public health, international global health bodies, and policy makers from a wide range of disciplines will meet to discuss cross sector responses to infectious disease and further debate on the “one health” initiative at the 2013 Prince Mahidol Conference in Bangkok, Thailand (www.pmaconference.mahidol.ac.th/).

http://www.bmj.com/content/346/bmj.f364

The Lancet  
Feb 02, 2013  Volume 381  Number 9864  p347 – 422  e4 – 5
http://www.thelancet.com/journals/lancet/issue/current

Comment
Prediction of immunisation performance
Celina M Hanson, Eliane Furrer, Nina Schwalbe, Seth Berkley

Preview | Full Text | PDF
Vaccines are extremely powerful disease prevention agents and have the potential to save millions of lives. Tremendous scientific progress has been made in the past decade with several new vaccines licensed, including those to prevent pneumococcal and rotavirus disease—the two leading killers of young children in developing countries. Thanks to concerted efforts by stakeholders through the GAVI Alliance, many of these new vaccines are now accessible to the lowest-income countries and the children who live there.

The Lancet  
Feb 02, 2013  Volume 381  Number 9864  p347 – 422  e4 – 5
http://www.thelancet.com/journals/lancet/issue/current

Public Health
WHO and the future of disease control programmes
Christopher Dye, Thierry Mertens, Gottfried Hirnschall, Winnie Mpanju-Shumbusho, Robert D Newman, Mario C Raviglione, Lorenzo Savioli, Hiroki Nakatani

Summary
Huge increases in funding for international health over the past two decades have led to a proliferation of donors, partnerships, and health organisations. Over the same period, the global burden of non-communicable diseases has increased absolutely and relative to communicable diseases. In this changing landscape, national programmes for the control of HIV/AIDS, tuberculosis, malaria, and neglected tropical diseases must be reinforced and adapted for three reasons: the global burden of these communicable diseases remains enormous, disease control programmes have an integral and supporting role in developing health systems, and the health benefits of these control programmes go beyond the containment of specific infections. WHO’s traditional role in promoting communicable disease control programmes must also adapt to new circumstances. Among a multiplicity of actors, WHO’s task is to enhance its normative role as convenor, coordinator, monitor, and standard-setter, fostering greater coherence in global health.

New England Journal of Medicine
January 31, 2013  Vol. 368 No. 5
http://content.nejm.org/current.shtml

Original Articles
Priming after a Fractional Dose of Inactivated Poliovirus Vaccine
S. Resik and Others

Background
To reduce the costs of maintaining a poliovirus immunization base in low-income areas, we assessed the extent of priming immune responses after the administration of inactivated poliovirus vaccine (IPV).

Methods
We compared the immunogenicity and reactogenicity of a fractional dose of IPV (one fifth of a full dose) administered intradermally with a full dose administered intramuscularly in Cuban infants at the ages of 4 and 8 months. Blood was collected from infants at the ages of 4 months, 8 months, 8 months 7 days, and 8 months 30 days to assess single-dose seroconversion, single-dose priming of immune responses, and two-dose seroconversion. Specimens were tested with a neutralization assay.

Results
A total of 320 infants underwent randomization, and 310 infants (96.9%) fulfilled the study requirements. In the group receiving the first fractional dose of IPV, seroconversion to poliovirus types 1, 2, and 3 occurred in 16.6%, 47.1%, and 14.7% of participants, respectively, as compared with 46.6%, 62.8%, and 32.0% in the group receiving the first full dose of IPV (P<0.008 for all comparisons). A priming immune response to poliovirus types 1, 2, and 3 occurred in 90.8%, 94.0%, and 89.6% of participants, respectively, in the group receiving the fractional dose as compared with 97.6%, 98.3%, and 98.1% in the group receiving the full dose (P=0.01 for the comparison with type 3). After the administration of the second dose of IPV in the group receiving fractional doses, cumulative two-dose seroconversion to poliovirus types 1, 2, and 3 occurred in 93.6%, 98.1%, and 93.0% of participants, respectively, as compared with 100.0%, 100.0%, and 99.4% in the group receiving the full dose (P<0.006 for the comparisons of types 1 and 3). The group receiving intradermal injections had the greatest number of adverse events, most of which were minor in intensity and none of which had serious consequences.

Conclusions
This evaluation shows that vaccinating infants with a single fractional dose of IPV can induce priming and seroconversion in more than 90% of immunized infants. (Funded by the World Health Organization and the Pan American Health Organization; Australian New Zealand Clinical Trials Registry number, ACTRN12610001046099.)

http://www.nejm.org/doi/full/10.1056/NEJMoa1202541

Pediatrics
February 2013, VOLUME 131 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml

The Burden of Influenza in Young Children, 2004–2009
Katherine A. Poehling, Kathryn M. Edwards, Marie R. Griffin, Peter G. Szilagyi, Mary A. Staat, Marika K. Iwane, Beverly M. Snively, Cynthia K. Suerken, Caroline B. Hall, Geoffrey A. Weinberg, Sandra S. Chaves, Yuwei Zhu, Monica M. McNeal, and Carolyn B. Bridges
Pediatrics 2013; 131:207-216

Abstract
OBJECTIVE: To characterize the health care burden of influenza from 2004 through 2009, years when influenza vaccine recommendations were expanded to all children aged ≥6 months.

METHODS: Population-based surveillance for laboratory-confirmed influenza was performed among children aged <5 years presenting with fever and/or acute respiratory illness to inpatient and outpatient settings during 5 influenza seasons in 3 US counties. Enrolled children had nasal/throat swabs tested for influenza by reverse transcriptase-polymerase chain reaction and their medical records reviewed. Rates of influenza hospitalizations per 1000 population and proportions of outpatients (emergency department and clinic) with influenza were computed.

RESULTS: The study population comprised 2970, 2698, and 2920 children from inpatient, emergency department, and clinic settings, respectively. The single-season influenza hospitalization rates were 0.4 to 1.0 per 1000 children aged <5 years and highest for infants <6 months. The proportion of outpatient children with influenza ranged from 10% to 25% annually. Among children hospitalized with influenza, 58% had physician-ordered influenza testing, 35% had discharge diagnoses of influenza, and 2% received antiviral medication. Among outpatients with influenza, 7% were tested for influenza, 7% were diagnosed with influenza, and <1% had antiviral treatment. Throughout the 5 study seasons, <45% of influenza-negative children ≥6 months were fully vaccinated against influenza.

CONCLUSIONS: Despite expanded vaccination recommendations, many children are insufficiently vaccinated, and substantial influenza burden remains. Antiviral use was low. Future studies need to evaluate trends in use of vaccine and antiviral agents and their impact on disease burden and identify strategies to prevent influenza in young infants.

http://pediatrics.aappublications.org/content/131/2/207.abstract

Pediatrics
February 2013, VOLUME 131 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml

Vaccination Site and Risk of Local Reactions in Children 1 Through 6 Years of Age
Lisa A. Jackson, Do Peterson, Jennifer C. Nelson, S. Michael Marcy, Allison L. Naleway, James D. Nordin, James G. Donahue, Simon J. Hambidge, Carolyn Balsbaugh, Roger Baxter, Tracey Marsh, Lawrence Madziwa, and Eric Weintraub
Pediatrics 2013; 131:283-289

Abstract
OBJECTIVE: Our objective was to assess whether the occurrence of medically attended local reactions to intramuscularly administered vaccines varies by injection site (arm versus thigh) in children 1 to 6 years of age.

METHODS: This is a retrospective cohort study of children in the Vaccine Safety Datalink population from 2002 to 2009. Site of injection and the outcome of medically attended local reactions were identified from administrative data.

RESULTS: The study cohort of 1.4 million children received 6.0 million intramuscular (IM) vaccines during the study period. The primary analyses evaluated the IM vaccines most commonly administered alone, which included inactivated influenza, hepatitis A, and diphtheria-tetanus-acellular pertussis (DTaP) vaccines. For inactivated influenza and hepatitis A vaccines, local reactions were relatively uncommon, and there was no difference in risk of these events with arm versus thigh injections. The rate of local reactions after DTaP vaccines was higher, and vaccination in the arm was associated with a significantly greater risk of this outcome compared with vaccination in the thigh, both for children 12 to 35 months (relative risk: 1.88 [95% confidence interval: 1.34–2.65]) and 3 to 6 years of age (relative risk: 1.41 [95% confidence interval: 0.84–2.34]), although this difference was not statistically significant in the older age group.

CONCLUSIONS: Injection in the thigh is associated with a significantly lower risk of a medically attended local reaction to a DTaP vaccination among children 12 to 35 months of age, supporting current recommendations to administer IM vaccinations in the thigh for children younger than 3 years of age.

http://pediatrics.aappublications.org/content/131/2/283.abstract

Pharmacoeconomics
January 2013 – Volume 31 – Issue 1  pp: 1-91
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

Operationalizing Value-Based Pricing of Medicines
Sussex, Jon; Towse, Adrian; Devlin, Nancy

Abstract
The UK Government is proposing a novel form of price regulation for branded medicines, which it has dubbed ‘value-based pricing’ (VBP). The specifics of how VBP will work are unclear. We provide an account of the possible means by which VBP of medicines might be operationalized, and a taxonomy to describe and categorize the various approaches. We begin with a brief discussion of the UK Government’s proposal for VBP and proceed to define a taxonomy of approaches to VBP. The taxonomy has five main dimensions: (1) what is identified as being of value, (2) how each element is measured, (3) how it is valued, (4) how the different elements of value are aggregated, and (5) how the result is then used to determine the price of a medicine. We take as our starting point that VBP will include a measure of health gain and that, as proposed by the UK Government, this will be built on the QALY. Our principal interest is in the way criteria other than QALYs are taken into account, including severity of illness, the extent of unmet need, and wider societal considerations such as impacts on carers. We set out to: (1) identify and describe the full range of alternative means by which ‘value’ might be measured and valued, (2) identify and describe the options available for aggregating the different components of value to establish a maximum price, and (3) note the challenges and relative advantages associated with these approaches. We review the means by which aspects of VBP are currently operationalized in a selection of countries and place these, and proposals for the UK, in the context of our taxonomy. Finally, we give an initial assessment of the challenges, pros and cons of each approach. We conclude that identifying where VBP should lie on each of the five dimensions entails value judgements: there are no simple ‘right or wrong’ solutions. If a wider definition of value than incremental QALYs gained is adopted, as is desirable, then a pragmatic way to aggregate the different elements of value, including both QALYs and benefits unrelated to QALYs, is to use a multi-criteria decision analysis (MCDA) approach. All approaches to VBP ultimately require the conversion of value, however assessed, into a monetary price. This requires assessment of the marginal values of all types of benefit, not just of QALYs. All stages of the VBP process are subject to uncertainty and margins of error. Consequently, the assessment of overall value can provide bounds to a price negotiation but cannot be expected to identify a precise value-based price.

http://adisonline.com/pharmacoeconomics/Abstract/2013/01000/Operationalizing_Value_Based_Pricing_of_Medicines.1.aspx

Vaccine
Volume 31, Issue 8, Pages 1135-1254 (6 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

Brief Reports
Parent “cocoon” immunization to prevent pertussis-related hospitalization in infants: The case of Piemonte in Italy
Pages 1135-1137
Michela Meregaglia, Lorenza Ferrara, Alessia Melegaro, Vittorio Demicheli

Abstract
Pertussis incidence in Piemonte (Italy) is now at the lowest level ever reached (0.85 per 100,000 in 2010) but the disease is still endemic in infants (54 per 100,000 in 2005–2010).

Parental “cocoon” immunization has been proposed in some countries (i.e. United States, France) as a measure to protect newborns from serious pertussis outcomes. We assessed the number needed to vaccinate (NNV) to prevent hospital admissions in infants (<12 months) and the potential cost-effectiveness of this strategy in Piemonte. The NNV for parental immunization was at least 5000 to prevent one infant hospitalization in the latest epidemic cycle (2005–2010) at the cost of >€100,000. The “cocoon” programme leads to net costs from a National Health Service (NHS) perspective (ROI < 1).

In contexts of low incidence and without reliable data on a high parent-attributable infant risk, the parental “cocoon” programme is poorly efficient and very resource intensive in preventing pertussis in infants.

Vaccine
Volume 31, Issue 8, Pages 1135-1254 (6 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

Brief Reports
Completion of the human papillomavirus (HPV) vaccine series among males with private insurance between 2006 and 2009
Pages 1138-1140
Jacqueline M. Hirth, Alai Tan, Gregg S. Wilkinson, Abbey B. Berenson

Abstract
Little is known about initiation and completion among males who received the HPV vaccine on an off-label basis before 2009. This study utilized administrative claims data from a private insurance company to examine completion of the 3 dose HPV series among 514 males who initiated the vaccine between 2006 and May of 2009. Frequencies of HPV vaccination were examined and multivariate logistic regression estimated the odds of completing the entire series within 365 days of initiation. We found that only 21% of male initiators completed all 3 vaccine doses within 12 months and completion decreased over time. Series completion did not vary significantly by provider type. These findings suggest that difficulties may be encountered in fully vaccinating enough males to achieve adequate herd immunity in the future.

Vaccine
Volume 31, Issue 8, Pages 1135-1254 (6 February 2013)
http://www.sciencedirect.com/science/journal/0264410X

Brighton Collaboration paper
The incidence of narcolepsy in Europe: Before, during, and after the influenza A(H1N1)pdm09 pandemic and vaccination campaigns
Original Research Article
Pages 1246-1254
Leonoor Wijnans, Coralie Lecomte, Corinne de Vries, Daniel Weibel, Cormac Sammon, Anders Hviid, Henrik Svanström, Ditte Mølgaard-Nielsen, Harald Heijbel, Lisen Arnheim Dahlström, Jonas Hallgren, Par Sparen, Poul Jennum, Mees Mosseveld, Martijn Schuemie, Nicoline van der Maas, Markku Partinen, Silvana Romio, Francesco Trotta, Carmela Santuccio, et al.

Abstract
Background
In August 2010 reports of a possible association between exposure to AS03 adjuvanted pandemic A(H1N1)pdm09 vaccine and occurrence of narcolepsy in children and adolescents emerged in Sweden and Finland. In response to this signal, the background rates of narcolepsy in Europe were assessed to rapidly provide information for signal verification.

Methods
We used a dynamic retrospective cohort study to assess the narcolepsy diagnosis rates during the period 2000–2010 using large linked automated health care databases in six countries: Denmark, Finland, Italy, the Netherlands, Sweden and the United Kingdom.

Results
Overall, 2608 narcolepsy cases were identified in almost 280 million person years (PY) of follow up. The pooled incidence rate was 0.93 (95% CI: 0. 90–0.97) per 100,000 PY. There were peaks between 15 and 30 year of age (women > men) and around 60 years of age. In the age group 5–19 years olds rates were increased after the start of pandemic vaccination compared to the period before the start of campaigns, with rate ratios (RR) of 1.9 (95% CI: 1.1–3.1) in Denmark, 6.4 (95% CI: 4.2–9.7) in Finland and 7.5 (95% CI: 5.2–10.7) in Sweden. Cases verification in the Netherlands had a significant effect on the pattern of incidence over time.

Conclusions

The results of this incidence study provided useful information for signal verification on a population level. The safety signal of increased narcolepsy diagnoses following the start of the pandemic vaccination campaign as observed in Sweden and Finland could be observed with this approach. An increase in narcolepsy diagnoses was not observed in other countries, where vaccination coverage was low in the affected age group, or did not follow influenza A(H1N1)pdm09 vaccination. Patient level analyses in these countries are being conducted to verify the signal in more detail.

From Google Scholar+: Dissertations, Theses, Selected Journal Articles

A Vaccine against Streptococcus pyogenes: The Potential to Prevent Rheumatic Fever and Rheumatic Heart Disease.
L Guilherme, FM Ferreira, KF Köhler, E Postol, J Kalil – American journal of …, 2013
Streptococcus pyogenes causes severe, invasive infections such as the sequelae associated with acute rheumatic fever, rheumatic heart disease, acute glomerulonephritis, uncomplicated pharyngitis, and pyoderma. Efforts to produce a vaccine against S…

Herd protection by a bivalent-killed-whole-cell oral cholera vaccine in the slums of Kolkata, India
M Ali, D Sur, YA You, S Kanungo, B Sah, B Manna… – Clinical Infectious Diseases, 2013
Background. We evaluated the herd protection conferred by an oral cholera vaccine using two approaches: cluster design and geographic information systems (GIS) design. Methods. Residents living in 3,933 dwellings (clusters) in Kolkata, India were cluster-randomized to …

Long-term follow-up of human papillomavirus vaccine efficacy
M Lehtinen – Clinical Investigation, 2013
Oncogenic, high-risk human papillomaviruses (HPV) have, in less than four decades, become the showcase of translational science. Harald zur Hausen first suggested the concept of oncogenic high-risk HPV in 1975, before confirming HPV’s link to cervical …

Current status of registry of vaccine clinical trials conducted by Korean investigators in ClinicalTrials. gov, database of US National Institutes of Health
[PDF] J Cho, BB Kim, CW Bae, SH Cha – Clinical and Experimental Vaccine Research, 2013
Purpose: PubMed is not only includes international medical journals but also has a registration site for the ongoing clinical trials, such as ClinicalTrials. gov, under the supervision of US National Institutes of Health. We analyzed current status of vaccine …

Twitter Watch (2 February 2013 – 18:56)
Items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and is by no means intended to be exhaustive.

WHO @WHO
Life-saving interventions for #cancer incl. cervical cancer screening, vax against hepatitis B & HPV, palliative care for cancer patients
1:27 PM – 2 Feb 13

MSF Canada ‏@MSF_canada
Increase in #measles in eastern Balochistan, #Pakistan http://bit.ly/XYbjEF  #MSF medical teams reaching out to identify patients w symptoms
Retweeted by M&R Initiative
10:14 PM – 1 Feb 13

IVAC at JHSPH ‏@IVACtweets
Addressing diarrhea’s toll on Africa – ‘Achieving Prosperity through Disease Prevention’: http://bit.ly/VuroBL  #Nigeria #Ghana
12:48 AM – 2 Feb 13

UNICEF @UNICEF
One week. One million children vaccinated against #measles in North Kivu, #DRC. Here’s how it happened: http://uni.cf/U9DxB4 
1:20 PM – 1 Feb 13

PAHO/WHO @pahowho
Hear from our new Director @CarissaEtienne about her priorities for health in the Americas. http://youtu.be/-i1Zie_XzMY  #pahohealth4change
12:24 PM – 1 Feb 13 ·

Gates Foundation @gatesfoundation
“The fight to #endpolio is my top priority.”  @BillGates on innovative tools bringing this goal closer: http://gates.ly/WjJE4F  #BillsLetter
8:23 AM – 1 Feb 13 ·

richard horton @richardhorton1
A stellar group of WHO scientists challenge the agency to strengthen its role in global health. http://bit.ly/14CrxKf .
1:57 AM – 1 Feb 13

M&R Initiative @MeaslesRubella
#DRCongo: >1 million kids #vaccinated against #measles in North Kivu, in joint campaign by MOH, #UNICEF, #WHO & #Merlin.http://uni.cf/YnuOZv 
11:28 PM – 31

PATH ‏@PATHtweets
Video: Steve Davis sits down with @edielush of @hubculture to talk about state of #globalhealth in 2013. http://ow.ly/hcjNj  #wef #davos
4:15 PM – 28 Jan 13

Editor’s Notes:

– Email Summary: Vaccines: The Week in Review is available as a weekly email summary: please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version: A pdf of the current issues is available here: Vaccines_The Week in Review_26 January 2013_PDF

– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

– Support: If you would like to join the growing list of individuals who support this service and its contribution to their roles in public health, clinical practice, government, IGOs/NGOs, research, industry and academia, please visit this page at The Wistar Institute, our co-founder and fiduciary. Thank you…

Meeting: 132nd WHO Executive Board
21–29 January 2013
Geneva, Switzerland
Provisional agenda
All documentation for the session

Speech: Report by the Director-General to the WHO Executive Board
Dr Margaret Chan
21 January 2013
http://www.who.int/dg/speeches/2013/eb132_20130121/en/index.html
Editor’s Excerpt

“…Finally, in a most welcome trend, a new culture of accountability, for resources and results, is emerging. The recommendations of the Commission on information and accountability for women’s and children’s health, which supports Every Woman Every Child, have been the model for several other accountability frameworks, including the one for vaccines which you will be discussing during this session.

Equally welcome is the trend towards independent monitoring, with the Independent Monitoring Board for polio and the independent Expert Review Group for Every Woman Every Child being notable examples. Both are fiercely independent and do not shy away from frank criticism. We need this kind of guidance.

Rigorous mechanisms for accountability hold great promise as a way of spending resources wisely, honouring commitments, fine-tuning programme strategies in line with evidence of results, maintaining the confidence of donors, and winning the support of parliamentarians and ministries of finance.

The independent Expert Review Group issued its first report last September. Its main findings are summarized in your documents. Reports from the Independent Monitoring Board for polio have unquestionably helped reshape the eradication initiative at all levels, from headquarters down to country teams, and brought the initiative ever closer to success.

Ladies and gentlemen,

Concerning the polio situation, I need to speak from the heart. In December, nine volunteers distributing polio vaccines were killed in Pakistan in a targeted and coordinated attack.

This is a despicable and totally unacceptable act of violence. The tragedy hits especially hard as it comes at a time when we have had so much good news.

The last case of polio in India was confirmed on 13 January 2011. India, arguably the most challenging of all the remaining sanctuaries of poliovirus, has now been free of the virus for more than two years. I ask India to keep up the good work.

The Independent Monitoring Board titled its November 2012 report with a question: Polio’s last stand? The report also revised the figure of all but 1% of cases eradicated to 0.1%, and concluded that the prospects for success were more positive than ever.

I am optimistic that we can put this setback behind us quickly. I thank the government of Pakistan for remaining fully committed to polio eradication. I thank the continued dedication of head office staff and teams working in countries. The initial expressions of outrage, nationally and internationally, have turned into an outcry of unwavering support. Like the prospects for success, the determination is stronger than ever.

The country’s civil society and religious leaders have echoed the sentiment of the international community: the killing of humanitarian aid workers is totally unacceptable. The commitment of all spearheading partners is unwavering. We will press ahead. The risk of international spread remains real…”

2012 Annual Letter From Bill Gates
http://www.gatesfoundation.org/annual-letter/2012/Pages/home-en.aspx
Editor’s Excerpts and Bolding

…Vaccines
There are still years of work to be done to introduce the diarrhea and pneumonia vaccines into every country. Moreover, global coverage of basic childhood vaccines is around 80 percent, which is good compared to many other health interventions but leaves one out of five children unprotected. We need to recreate the high-level political focus that this issue received during the 1970s, when dedicated effort brought us from just 20 percent coverage to 80 percent coverage in most countries in just a decade…

Polio
The foundation’s top priority remains helping to complete the eradication of polio, perhaps the best-known vaccine-preventable disease in the world. I spend a lot of my time learning about the disease and being an advocate for doing what it takes to end polio. At the start of 2011, poliovirus was still spreading in three areas: 10 countries in Africa (with viruses that originated primarily in Nigeria), Afghanistan and Pakistan, and India.

Now India has reached a huge milestone. The country had only one case in 2011, which was recorded on January 13 in West Bengal. So on January 13, 2012, India celebrated its first year of being polio free. The challenge in India was mind-boggling. It’s hard to imagine how you would design a polio campaign that reached every Indian child. More than a billion people live in the country. Massive numbers of families migrate constantly to find work. One of the largest states, Bihar, is flood-prone. In some cases, the vaccine didn’t work as well as it had in other parts of the world, probably because of malnourishment, diarrhea, and other illnesses. But the government kept raising awareness and improving the quality of its campaigns, even in the toughest locations.

The Indian government deserves special credit for this achievement. In 2012 we need to keep India and all the other places that are polio free from getting re-infected.

The biggest focus for 2012 will be improving the polio vaccination campaigns in Nigeria, Chad, the Democratic Republic of Congo, Afghanistan, and Pakistan. I recently visited Chad and Nigeria to meet with leaders there, and it’s clear that we have high-level political support. Still, deploying high-quality vaccination teams and educating parents so that every single child is vaccinated will take a lot of work. In Nigeria our biggest problems are low-quality campaigns and the fact that some parents don’t trust that the vaccine is safe. In Pakistan these problems are compounded by the security situation.

It will be challenging to continue raising the approximately $1 billion per year it takes to run the global campaign. Last year the United States, the United Kingdom, Australia, Japan, Canada, Norway, Saudi Arabia, the Crown Prince of Abu Dhabi, and Rotary International provided substantial contributions. Rotary continues to be the heart and soul of polio eradication, supporting the program directly while also taking on a larger role in encouraging other donors to give more. A new partner, FC Barcelona, is spreading the message of polio eradication to millions of football fans across the globe.

We are continuing to invest in studies about how polio spreads and trying to model where we need to intensify the vaccination campaigns. We are also working on new vaccines. Finding every last poliovirus requires good tools along with trained and motivated workers in every single country.

These are enormous obstacles, but the success of the polio eradication program in India and 90 other countries gives me confidence that we can triumph in these final challenging countries and end polio once and for all…

Global Fund – Announcements:

– Germany Makes EUR 1 Billion Contribution to the Global Fund  24 January 2013  –

– Global Fund Executive Director Calls for Focused Action to Fight Infectious Disease 22 January 2013  –

Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria said today that concentrated action will achieve significantly greater impact on infectious diseases that threaten maternal and child health.

“We need to move past the tyranny of averages,” said Dr. Dybul. “We all see country and regional average rates of HIV, TB and malaria, but they mask micro-hyper-epidemics where transmission rates are very high.

A micro-hyper epidemic is an outbreak of disease that is highly concentrated among a part of the population, putting a wider population at risk of infection.

“By focusing high-impact interventions where new infections are occurring, countries will get the biggest bang for the buck. We can support them to control major killers – preventing many millions of new infections, and saving millions of lives. That will also save billions of dollars.”

Dr. Dybul was speaking at a global health conference in Oslo entitled, “Accelerating Progress: Saving Women’s and Children’s Lives in the Coming Decade.” In a thematic session on “How to get more health for the money,” Dr. Dybul took part in a discussion focused on commodity supply and distribution…

– Global Fund Appoints Osamu Kunii as Head of Strategy Investment and  Impact – 21 January 2013

– Mark Dybul Begins as Executive Director of the Global Fund – 21 January 2013

   The GAVI Alliance announced an additional US$25 million in matched pledges from three private organisations at a CEO breakfast hosted by Bill Gates and the UK during the World Economic Forum. The new commitments are being matched by the UK Government and the Bill & Melinda Gates Foundation through the GAVI Matching Fund. The pledges were made by three partners:

– Comic Relief, described as a UK-based charity that “fights poverty and social injustice through the power of entertainment,” committed an additional £5 million (US$8 million), bringing its total commitment to US$12 million.

– LDS Charities, described as the volunteer-driven relief and development arm of The Church of Jesus Christ of Latter-day Saints, pledged an additional US$3 million, bringing its total commitment to US$4.5 million.

– Vodafone, described as one of the world’s largest mobile communications companies, “committed to explore how mobile technology can help increase childhood vaccination levels in sub-Saharan Africa.” This first in-kind contribution to the GAVI Matching Fund initiative is valued at US$1.5 million and matched by the UK Government. The firm first announced its pledge last month.

http://www.gavialliance.org/library/news/press-releases/2013/gavi-alliance-significantly-expands-private-sector-involvement-in-saving-lives/

 The International Vaccine Institute (IVI) said it “has begun implementing major organizational changes to ensure continued success in both vaccine sciences and public health.” The changes include the election of Dr. Adel A. F. Mahmoud as Chairman of IVI’s Board of Trustees and Dr. Viveka Persson as Vice Chairperson of the Board. Dr. Mahmoud succeeds Professor Ragnar Norrby of the Swedish Institute for Infectious Disease Control. Professor Norrby served as the Chairman of IVI’s Board of Trustees since 2006. IVI also said it appointed new leadership including Dr. Alejandro Cravioto, serving as Chief Scientific Officer and Dr. Georges Thiry, serving as Deputy Director General Portfolio Management.

IVI noted that its new strategic direction includes a new vision statement – Developing Countries Free of Suffering from Infectious Disease – and a new mission statement – Discover, Develop and Deliver Safe, Effective and Affordable Vaccines for the World’s Developing Nations.

Under its new strategic plan, IVI will focus its efforts around the following four goals:

1) Accelerate the development and introduction of safe and effective vaccines;

2) Discover and pursue proof of concept for new vaccine candidates, with a particular on new vaccines against enteric and diarrheal diseases;

3) Advance science driving new achievements in vaccinology, specifically through conducting further research in vaccine-enhancing technology and understanding how the immune system works in response to vaccination; and

4) Contribute to building vaccine technology and systems capacity in developing countries.

The new strategy reinforces IVI’s commitment of ensuring the availability of safe, effective and affordable vaccines to improve the health of the world’s most vulnerable people.

Full media release: 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=481

    PATH said that Dr. Anurag Mairal was named global program leader for Technology Solutions to lead technology solutions group, overseeing research and development, commercialization, and implementation of health technologies in the areas of maternal and neonatal health, nutrition, water and sanitation, health management information systems, reproductive health, vaccine-related technologies, and diagnostics for infectious and noncommunicable diseases. Dr. Mairal has an extensive background in medical device development, collaborating with partners in India, China, and other countries to advance product development, manufacturing, and distribution.

Full media release: http://www.path.org/news/an130125-mairal.php

Novartis announced that the European Commission has approved Bexsero (Meningococcal Group B Vaccine [rDNA, component, adsorbed]) for use in individuals from 2 months of age and older. Following this approval, EU member states will evaluate Bexsero for potential inclusion into national immunization programs and, where relevant, reimbursement schemes. Novartis said it is already engaging with governments interested in the early adoption of the vaccine. Full media release:

http://www.novartis.com/newsroom/media-releases/en/2013/1672036.shtml

Pfizer announced that the FDA granted approval for the expansion of the company’s pneumococcal conjugate vaccine, Prevnar 13®* (Pneumococcal 13-valent Conjugate Vaccine [Diphtheria CRM197 Protein]), for use in older children and adolescents aged 6 years through 17 years for active immunization for the prevention of invasive disease caused by the 13 Streptococcus pneumoniae serotypes contained in the vaccine. For this age group, Prevnar 13 is administered as a one-time dose to patients who have never received Prevnar 13.

Full media release: http://pfizer.newshq.businesswire.com/press-release/pfizer-receives-fda-approval-use-prevnar-13-vaccine-naive-children-and-adolescents-age

Update: Polio this week – As of 23 January 2013
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s Extract and bolded text]
– The polio Independent Monitoring Board (IMB) met by teleconference on 18 January, and concluded that although the Global Polio Eradication Initiative (GPEI) missed its end-2012 milestone of stopping all wild poliovirus transmission globally, the programme had brought the world to the brink of eradicating polio. “Now more than ever, the world must be absolute in its resolve to eradicate polio,” the Board said in a statement. “If the right things are done and commitment remains high, it will happen.” Confirming that polio eradication must be seen through to completion, the Board highlighted that the GPEI needed ‘unwavering global support’ in these final stages of its mission. For more, please click here…
– In Egypt, WPV has been isolated from environmental samples in two areas of greater Cairo. Virus has been detected in the sewage only; no case of paralytic polio has been reported. Genetic sequencing shows that the virus strains are closely related to virus from northern Sindh, Pakistan. The isolates were detected through routine environmental surveillance in Egypt that involves regular testing of sewage water from multiple sites. The last sample which tested positive for WPV was related to virus from Sudan, in December 2010. In response to these latest isolates, the Government of Egypt and GPEI partners are conducting further investigations, strengthening surveillance and planning large-scale immunization activities (targeting more than three million children).

Afghanistan
– No new WPV cases were reported in the past week. The total number of WPV cases for 2012 remains 37. The most recent case had onset of paralysis on 20 December 2012 (WPV1 from Nangarhar). Case response immunization with bivalent OPV in 10 districts of Nangarhar began on 23 January.

– Four new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported in the past week (from Hilmand and Kandahar), bringing the total number of cVDPV2 cases for 2012 to 8. The most recent cVDPV2 case had onset of paralysis on 21 December 2012 (from Hilmand).

Pakistan
– No new WPV cases were reported in the past week. The total number of WPV cases for 2012 remains 58. The most recent WPV case had onset of paralysis on 30 November 2012 (WPV1 from Khyber Pakhtunkhwa – KP).

– No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2012 remains 15. The most recent cVDPV2 case had onset of paralysis on 8 December 2012 (from Sindh).

– Sub-National Immunization Days (SNIDs) planned for 58 districts from 14-16 January were postponed in 29 districts due to security concerns. Postponed campaigns will be conducted over the next few weeks. An additional vaccination round will be conducted 28-30 January targeting high-risk areas.

– District officials are assessing security conditions locally, in close consultation with law enforcement.

The Weekly Epidemiological Record (WER) for 25 January 2013, vol. 88, 4 (pp 37–48) includes:
– Detection of influenza virus subtype A by polymerase chain reaction: WHO external quality
– WHO advisory committee on Immunization and Vaccine related Implementation Research (IVIR, formerly QUIVER): executive summary report of 6th meeting
http://www.who.int/entity/wer/2013/wer8804.pdf
WHO – Global Alert and Response (GAR)
Disease Outbreak News – Most recent news items
No new reports

WHO – Humanitarian Health Action
No new reports
http://www.who.int/hac/en/index.html

The MMWR for January 25, 2013 / Vol. 62 / No. 3 includes:
– Progress in Immunization Information Systems — United States, 2011

–  Infant Meningococcal Vaccination: Advisory Committee on Immunization Practices (ACIP) Recommendations and Rationale

– Notes from the Field: Emergence of New Norovirus Strain GII.4 Sydney — United States, 2012

   CDC Update: 2012-2013 Influenza Season – January 18, 2013
Media Advisory | Transcript

BMC Public Health
(Accessed 26 January 2013)
http://www.biomedcentral.com/bmcpublichealth/content

Research article  
Local perceptions of cholera and anticipated vaccine acceptance in Katanga province, democratic republic of Congo
Sonja Merten, Christian Schaetti, Cele Manianga, Bruno Lapika, Claire-Lise Chaignat, Raymond Hutubessy, Mitchell G Weiss BMC Public Health 2013, 13:60 (22 January 2013)

Open Access
Abstract (provisional)
Background
In regions where access to clean water and the provision of a sanitary infrastructure has not been sustainable, cholera continues to pose an important public health burden. Although oral cholera vaccines (OCV) are effective means to complement classical cholera control efforts, still relatively little is known about their acceptability in targeted communities. Clarification of vaccine acceptability prior to the introduction of a new vaccine provides important information for future policy and planning.

Methods
In a cross-sectional study in Katanga province, Democratic Republic of Congo (DRC), local perceptions of cholera and anticipated acceptance of an OCV were investigated. A random sample of 360 unaffected adults from a rural town and a remote fishing island was interviewed in 2010. In-depth interviews with a purposive sample of key informants and focus-group discussions provided contextual information. Socio-cultural determinants of anticipated OCV acceptance were assessed with logistic regression.

Results
Most respondents perceived contaminated water (63%) and food (61%) as main causes of cholera. Vaccines (28%), health education (18%) and the provision of clean water (15%) were considered the most effective measures of cholera control. Anticipated acceptance reached 97% if an OCV would be provided for free. Cholera-specific knowledge of hygiene and self-help in form of praying for healing were positively associated with anticipated OCV acceptance if costs of USD 5 were assumed. Conversely, respondents who feared negative social implications of cholera were less likely to anticipate acceptance of OCVs. These fears were especially prominent among respondents who generated their income through fishing. With an increase of assumed costs to USD 10.5, fear of financial constraints was negatively associated as well.

Conclusions
Results suggest a high motivation to use an OCV as long as it seems affordable. The needs of socially marginalized groups such as fishermen may have to be explicitly addressed when preparing for a mass vaccination campaign.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Emerging Infectious Diseases
http://www.cdc.gov/ncidod/EID/index.htm

Expedited Articles
Effects of Vaccine Program against Pandemic Influenza A(H1N1) Virus, United States, 2009–2010
R. H. Borse et al.

Abstract
In April 2009, the United States began a response to the emergence of a pandemic influenza virus strain: A(H1N1)pdm09. Vaccination began in October 2009. By using US surveillance data (April 12, 2009–April 10, 2010) and vaccine coverage estimates (October 3, 2009–April 18, 2010), we estimated that the A(H1N1)pdm09 virus vaccination program prevented 700,000–1,500,000 clinical cases, 4,000–10,000 hospitalizations, and 200–500 deaths. We found that the national health effects were greatly influenced by the timing of vaccine administration and the effectiveness of the vaccine. We estimated that recommendations for priority vaccination of targeted priority groups were not inferior to other vaccination prioritization strategies. These results emphasize the need for relevant surveillance data to facilitate a rapid evaluation of vaccine recommendations and effects.

Emerging Infectious Diseases
http://www.cdc.gov/ncidod/EID/index.htm
Volume 19, Number 2—February 2013

Lessons and Challenges for Measles Control from Unexpected Large Outbreak, Malawi
PDF Version  [PDF – 791 KB – 8 pages]
A. Minetti et al.

Abstract
Despite high reported coverage for routine and supplementary immunization, in 2010 in Malawi, a large measles outbreak occurred that comprised 134,000 cases and 304 deaths. Although the highest attack rates were for young children (2.3%, 7.6%, and 4.5% for children <6, 6–8, and 9–11 months, respectively), persons >15 years of age were highly affected (1.0% and 0.4% for persons 15–19 and >19 years, respectively; 28% of all cases). A survey in 8 districts showed routine coverage of 95.0% for children 12–23 months; 57.9% for children 9–11 months; and 60.7% for children covered during the last supplementary immunization activities in 2008. Vaccine effectiveness was 83.9% for 1 dose and 90.5% for 2 doses. A continuous accumulation of susceptible persons during the past decade probably accounts for this outbreak. Countries en route to measles elimination, such as Malawi, should improve outbreak preparedness. Timeliness and the population chosen are crucial elements for reactive campaigns.

Emerging Infectious Diseases
http://www.cdc.gov/ncidod/EID/index.htm
Volume 19, Number 2—February 2013

Historical Review
Lessons from the History of Quarantine, from Plague to Influenza A
PDF Version PDF – 1.94 MB – 6 pages]
E. Tognotti

Abstract
In the new millennium, the centuries-old strategy of quarantine is becoming a powerful component of the public health response to emerging and reemerging infectious diseases. During the 2003 pandemic of severe acute respiratory syndrome, the use of quarantine, border controls, contact tracing, and surveillance proved effective in containing the global threat in just over 3 months. For centuries, these practices have been the cornerstone of organized responses to infectious disease outbreaks. However, the use of quarantine and other measures for controlling epidemic diseases has always been controversial because such strategies raise political, ethical, and socioeconomic issues and require a careful balance between public interest and individual rights. In a globalized world that is becoming ever more vulnerable to communicable diseases, a historical perspective can help clarify the use and implications of a still-valid public health strategy.

Eurosurveillance
Volume 18, Issue 4, 24 January 2013
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Editorials
From molecular to genomic epidemiology: transforming surveillance and control of infectious diseases
M J Struelens 1, S Brisse2
European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
Institut Pasteur, Paris, France

The use of increasingly powerful genotyping tools for the characterisation of pathogens has become a standard component of infectious disease surveillance and outbreak investigations. This thematic issue of Eurosurveillance, published in two parts, provides a series of review and original research articles that gauge progress in molecular epidemiology strategies and tools, and illustrate their applications in public health. Molecular epidemiology of infectious diseases combines traditional epidemiological methods with analysis of genome polymorphisms of pathogens over time, place and person across human populations and relevant reservoirs, to study host–pathogen interactions and infer hypotheses about host-to-host or source-to-host transmission [1-3]. Based on discriminant genotyping of human pathogens, clonally derived strains can be identified as likely links in a chain of transmission [1-3]. In this two-part issue of Eurosurveillance, Goering et al. explain that such biological evidence of clonal linkage complements but does not replace epidemiological evidence of person-to-person contact or common exposure to a potential source [3]. Muellner et al. provide clear examples how prediction about infectious disease outcome and transmission risks can be enhanced through integration of pathogen genetic information and epidemiological modelling to inform public health decisions about food-borne disease prevention [4].

Perspectives
The need for ethical reflection on the use of molecular microbial characterisation in outbreak management
B Rump1, C Cornelis2, F Woonink1, M Verweij2,3
Municipal Health Service (GGD) Midden-Nederland, Zeist, the Netherlands
Department of Philosophy, Utrecht University, Utrecht, the Netherlands
Ethics Institute, Utrecht University, Utrecht, the Netherlands

Abstract
Current thinking on the development of molecular microbial characterisation techniques in public health focuses mainly on operational issues that need to be resolved before incorporation into daily practice can take place. Notwithstanding the importance of these operational challenges, it is also essential to formulate conditions under which such microbial characterisation methods can be used from an ethical perspective. The potential ability of molecular techniques to show relational patterns between individuals with more certainty brings a new sense of urgency to already difficult ethical issues associated with privacy, consent and a moral obligation to avoid spreading a disease. It is therefore important that professionals reflect on the ethical implications of using these techniques in outbreak management, in order to be able to formulate the conditions under which they may be applied in public health practice.

Health Economics, Policy and Law 
Volume 8 – Issue 01 – January 2013
http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue

Special Section: ACA
The US Supreme Court decision on the constitutional legitimacy of the Affordable Care Act
Adam Oliver
Health Economics, Policy and Law / Volume 8 / Issue 01 / January 2013, pp 111 – 112
Copyright © Cambridge University Press 2013
DOI: http://dx.doi.org/10.1017/S1744133112000369 (About DOI), Published online: 22 January 2013

The Affordable Care Act and the Supreme Court: American health care reform inches forward despite dysfunctional political institutions and politics
 Timothy Jost
Health Economics, Policy and Law / Volume 8 / Issue 01 / January 2013, pp 113 – 118
Copyright © Cambridge University Press 2013
DOI: http://dx.doi.org/10.1017/S1744133112000370 (About DOI), Published online: 22 January 2013

NFIB vs Sebelius: the political expediency of the Roberts court
Michael K. Gusmano
Health Economics, Policy and Law / Volume 8 / Issue 01 / January 2013, pp 119 – 124
Copyright © Cambridge University Press 2013
DOI: http://dx.doi.org/10.1017/S1744133112000382 (About DOI), Published online: 22 January 2013

Much ado about nothing: the US Supreme Court’s rules on health reform
Uwe E. Reinhardt
Health Economics, Policy and Law / Volume 8 / Issue 01 / January 2013, pp 125 – 132
Copyright © Cambridge University Press 2013
DOI: http://dx.doi.org/10.1017/S1744133112000394 (About DOI), Published online: 22 January 2013

Medicaid after the Supreme Court decision
Howard S. Berliner
Health Economics, Policy and Law / Volume 8 / Issue 01 / January 2013, pp 133 – 137
Copyright © Cambridge University Press 2013
DOI: http://dx.doi.org/10.1017/S1744133112000400 (About DOI), Published online: 22 January 2013

Health care reform after the Supreme Court: even more known unknowns

Alex Waddan

Health Economics, Policy and Law / Volume 8 / Issue 01 / January 2013, pp 139 – 143

Copyright © Cambridge University Press 2013

DOI: http://dx.doi.org/10.1017/S1744133112000412 (About DOI), Published online: 22 January 2013

JAMA Pediatrics
January 2013  Vol 167, No. 1
http://archpedi.jamanetwork.com/issue.aspx?journalid=75&IssueID=926200

Online First
Article | January 21, 2013 
A Population-Based Cohort Study of Undervaccination in 8 Managed Care Organizations Across the United States
Jason M. Glanz, PhD; Sophia R. Newcomer, MPH; Komal J. Narwaney, MD, PhD; Simon J. Hambidge, MD, PhD; Matthew F. Daley, MD; Nicole M. Wagner, MPH; David L. McClure, PhD; Stan Xu, PhD; Ali Rowhani-Rahbar, MD, PhD; Grace M. Lee, MD, MPH; Jennifer C. Nelson, PhD; James G. Donahue, DVM, PhD; Allison L. Naleway, PhD; James D. Nordin, MD, MPH; Marlene M. Lugg, DrPH; Eric S. Weintraub, MPH
Includes: Supplemental Content

ABSTRACT
Objectives  To examine patterns and trends of undervaccination in children aged 2 to 24 months and to compare health care utilization rates between undervaccinated and age-appropriately vaccinated children.

Design  Retrospective matched cohort study.

Setting  Eight managed care organizations of the Vaccine Safety Datalink.

Participants  Children born between 2004 and 2008.

Main Exposure  Immunization records were used to calculate the average number of days undervaccinated. Two matched cohorts were created: 1 with children who were undervaccinated for any reason and 1 with children who were undervaccinated because of parental choice. For both cohorts, undervaccinated children were matched to age-appropriately vaccinated children by birth date, managed care organization, and sex.

Main Outcome Measures  Rates of undervaccination, specific patterns of undervaccination, and health care utilization rates.

Results  Of 323 247 children born between 2004 and 2008, 48.7% were undervaccinated for at least 1 day before age 24 months. The prevalence of undervaccination and specific patterns of undervaccination increased over time (P < .001). In a matched cohort analysis, undervaccinated children had lower outpatient visit rates compared with children who were age-appropriately vaccinated (incidence rate ratio [IRR], 0.89; 95% CI, 0.89- 0.90). In contrast, undervaccinated children had increased inpatient admission rates compared with age-appropriately vaccinated children (IRR, 1.21; 95% CI, 1.18-1.23). In a second matched cohort analysis, children who were undervaccinated because of parental choice had lower rates of outpatient visits (IRR, 0.94; 95% CI, 0.93-0.95) and emergency department encounters (IRR, 0.91; 95% CI, 0.88-0.94) than age-appropriately vaccinated children.

Conclusions  Undervaccination appears to be an increasing trend. Undervaccinated children appear to have different health care utilization patterns compared with age-appropriately vaccinated children.

JAMA Pediatrics
January 2013  Vol 167, No. 1
http://archpedi.jamanetwork.com/issue.aspx?journalid=75&IssueID=92620

Editorial | January 21, 2013 
The Enigma of Alternative Childhood Immunization Schedules: What Are the Questions?
Douglas J. Opel, MD, MPH; Edgar K. Marcuse, MD, MPH

Alternative childhood immunization schedules have emerged as a distinct phenomenon in response to parental concerns about the safety of the US immunization schedule and its component vaccines. Some alternative schedules have been put in writing,1 many more are ad hoc, and all endorse a spacing out, a delaying, or a forgoing of at least some vaccines (which is contrary to what is jointly recommended by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians). None of these alternative schedules have been tested for their safety and efficacy.

The Lancet  
Jan 26, 2013  Volume 381  Number 9863   p267 – 346  e2 – 3
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Neglected tropical diseases: progress and priorities
The Lancet

Preview |
This January marks the first anniversary of the London Declaration on Neglected Tropical Diseases—a coordinated effort by endemic countries, non-governmental organisations, drug companies, and donors to improve the lives of more than a billion of the world’s poorest people by the end of the decade. A year on from the launch, the results look promising.

The Lancet Infectious Disease
Feb 2013  Volume 13  Number 2  p97 – 182
http://www.thelancet.com/journals/laninf/issue/current

Editorial
The inexorable progress of norovirus
The Lancet Infectious Diseases

Preview
Perhaps because of its proclivity to cause outbreaks of explosive vomiting and diarrhoea that can sweep through closed and semiclosed communities (eg, hospital wards, schools, and cruise ships), norovirus is an infectious disease that attracts popular attention. Norovirus outbreaks can occur worldwide and all year round, although cases usually peak during the winter months, hence the name winter vomiting disease given to the illness caused by the virus. At the beginning of January, van Beek and colleagues warned of a worldwide increase in norovirus cases compared with previous seasons.