Nature  
Volume 493 Number 7433 pp451-570  24 January 2013
http://www.nature.com/nature/current_issue.html

Nature | Editorial
Vigilance needed
Experiments that make deadly pathogens more dangerous demand the utmost scrutiny.
23 January 2013

Extract
The year-long voluntary moratorium on research to engineer strains of the H5N1 avian influenza virus that can transmit between mammals has already borne fruit. Claims of public-health benefits have received thorough scrutiny, and the researchers involved have better explained the biosafety and biosecurity precautions that they take. The debate has drawn attention to, and exposed gaps in, the rules that govern ‘dual-use’ research — work that can bring public benefit but might also be used for harmful purposes. The row has also, for example, prompted long-overdue national guidelines in the United States and made funders everywhere more aware of the need to assess risky research proposals proactively. In short, the moratorium — the lifting of which is announced this week (see page 460) — has seen serious thought on the complex issues involved…

Nature | News
Work resumes on lethal flu strains
Study of lab-made viruses a ‘public-health responsibility’.
Declan Butler
23 January 2013
http://www.nature.com/news/work-resumes-on-lethal-flu-strains-1.12266

Nature | Correspondence
H5N1 virus: Transmission studies resume for avian flu
Ron A. M. Fouchier, Adolfo García-Sastre, Yoshihiro Kawaoka & 37 co-authors
Nature (2013)
doi:10.1038/nature11858
Published online
23 January 2013

In January 2012, influenza virus researchers from around the world announced a voluntary pause of 60 days on any research involving highly pathogenic avian influenza H5N1 viruses leading to the generation of viruses that are more transmissible in mammals1. We declared a pause to this important research to provide time to explain the public-health benefits of this work, to describe the measures in place to minimize possible risks, and to enable organizations and governments around the world to review their policies (for example, on biosafety, biosecurity, oversight and communication) regarding these experiments.

During the past year, the benefits of this important research have been explained clearly in publications2, 3, 4, 5, 6, 7 and meetings8, 9, 10. Measures to mitigate the possible risks of the work have been detailed11, 12, 13. The World Health Organization has released recommendations on laboratory biosafety for those conducting this research14, and relevant authorities in several countries have reviewed the biosafety, biosecurity and funding conditions under which further research would be conducted on the laboratory-modified H5N1 viruses10, 15, 16, 17. Thus, acknowledging that the aims of the voluntary moratorium have been met in some countries and are close to being met in others, we declare an end to the voluntary moratorium on avian-flu transmission studies.

The controversy surrounding H5N1 virus-transmission research has highlighted the need for a global approach to dealing with dual-use research of concern. Developing comprehensive solutions to resolve all the issues will take time. Meanwhile, H5N1 viruses continue to evolve in nature.

Because H5N1 virus-transmission studies are essential for pandemic preparedness and understanding the adaptation of influenza viruses to mammals, researchers who have approval from their governments and institutions to conduct this research safely, under appropriate biosafety and biosecurity conditions, have a public-health responsibility to resume this important work. Scientists should not restart their work in countries where, as yet, no decision has been reached on the conditions for H5N1 virus transmission research. At this time, this includes the United States and US-funded research conducted in other countries. Scientists should never conduct this type of research without the appropriate facilities, oversight and all necessary approvals.

We consider biosafety level 3 conditions with the considerable enhancements (BSL-3+) as outlined in the referenced publications11, 12, 13 to be appropriate for this type of work, but recognize that some countries may require BSL-4 conditions in accordance with applicable standards (such as Canada). We fully acknowledge that this research — as with any work on infectious agents — is not without risks. However, because the risk exists in nature that an H5N1 virus capable of transmission in mammals may emerge, the benefits of this work outweigh the risks.

References

New England Journal of Medicine
January 24, 2013  Vol. 368 No. 4
http://content.nejm.org/current.shtml
[No relevant content]

Online First
Perspective
The Cure for Cholera — Improving Access to Safe Water and Sanitation
January 9, 2013
Waldman R.J., Mintz E.D., Papowitz H.E.

Whenever epidemics of cholera occur, the global public health community is energized. Experts meet, guidelines for control are reviewed and reissued, and new and modified interventions are proposed and promoted. In the past two decades, these things happened after cholera appeared in Latin America…
10.1056/NEJMp1214179
Free Full Text

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
December 2012  Vol. 32, No. 6
http://new.paho.org/journal/index.php?option=com_content&task=view&id=118&Itemid=219

ORIGINAL RESEARCH ARTICLES
Health and economic impact of human papillomavirus 16 and 18 vaccination of preadolescent girls and cervical cancer screening of adult women in Peru [Repercusiones sanitarias y económicas de la vacunación de niñas preadolescentes contra los tipos 16 y 18 del virus del papiloma humano y el tamizaje del cáncer cervicouterino en las mujeres adultas en el Perú]

Sue J. Goldie, Carol Levin, N. Rocio Mosqueira-Lovón,
Jesse Ortendahl, Jane Kim, Meredith O’Shea,
Mireia Diaz Sanchez, and Maria Ana Mendoza Araujo

The Pediatric Infectious Disease Journal
February 2013 – Volume 32 – Issue 2  pp: A11,99-196,e54-e93
http://journals.lww.com/pidj/pages/currenttoc.aspx

Original Studies
Australian Population Cohort Study of Newly Arrived Refugee Children: How Effective Is Predeparture Measles and Rubella Vaccination?
Joshua, Paul Robert; Smith, Mitchell M.; Koh, Alaric Sek Kai; Woodland, Lisa Anne; Zwi, Karen
Pediatric Infectious Disease Journal. 32(2):104-109, February 2013.
doi: 10.1097/INF.0b013e31827075c2

Abstract:
Background: Predeparture medical screening and measles-mumps-rubella vaccination are routinely given to refugee children before departure from most transit countries en route to Australia.

Objectives: The purpose of this study was to evaluate the effectiveness of this single measles-mumps-rubella vaccine and the reliability of its documentation. This is important in determining refugees’ susceptibility to measles and rubella and the risk to the nonvaccinated community.

Methods: We analyzed measles and rubella serology in a comprehensively screened population of newly arrived refugees. We reviewed seropositivity rates based on age, sex, country of departure and vaccine documentation.

Results: Of 164 children screened, 139 (84.8%) were immune to rubella; 143 (87.7%) to measles and 119 (73.0%) to both. There was no significant difference in immunity among those of different ages or those departing different continents. Immunity rates among those with documented measles-mumps-rubella tended to be higher: 91.1% for rubella, 89.1% for measles and 80.0% for both diseases, but this did not reach significance at the 5% level. There was a significant difference between males (65.9%) and females (81.3%) immune to both diseases (P = 0.042).

Conclusions: This cohort demonstrated similar measles and rubella seropositivity rates to those of the Australian population, but lower rates than population seroconversion studies, which have been estimated at 95%. Males were less likely to be immune. Rates in those with documented vaccination approximated seroconversion studies. This confirms the appropriateness of current guidelines which suggest that immunization is not required in the face of documented prior vaccination, but is required without such documentation.

The Pediatric Infectious Disease Journal
February 2013 – Volume 32 – Issue 2  pp: A11,99-196,e54-e93
http://journals.lww.com/pidj/pages/currenttoc.aspx

Vaccine Reports
Clinical Assessment of Serious Adverse Events in Children Receiving 2009 H1N1 Vaccination
Pahud, Barbara A.; Williams, S. Elizabeth; Dekker, Cornelia L.; Halsey, Neal; LaRussa, Philip; Baxter, Roger P.; Klein, Nicola P.; Marchant, Colin D.; Sparks, Robert C.; Jakob, Kathleen; Aukes, Laurie; Swope, Susan; Barnett, Elizabeth; Lewis, Paige; Berger, Melvin; Dreskin, Stephen C.; Donofrio, Peter D.; Sejvar, James J.; Slade, Barbara A.; Gidudu, Jane; Vellozzi, Claudia; Edwards, Kathryn M.
Pediatric Infectious Disease Journal. 32(2):163-168, February 2013.
doi: 10.1097/INF.0b013e318271b90a

Abstract:
Background: Monovalent 2009 H1N1 influenza vaccines were licensed and administered in the United States during the H1N1 influenza pandemic between 2009 and 2013.

Methods: Vaccine Adverse Event Reporting System received reports of adverse events following immunization (AEFI) after H1N1 vaccination. Selected reports were referred to the Centers for Disease Control and Prevention’s Clinical Immunization Safety Assessment network for additional review. We assessed causality using modified World Health Organization criteria.

Results: There were 3,928 reports of AEFI in children younger than age 18 years after 2009 H1N1 vaccination received by January 31, 2010. Of these, 214 (5.4%) were classified as serious nonfatal and 109 were referred to Clinical Immunization Safety Assessment for further evaluation. Ninety-nine (91%) had sufficient initial information to begin investigation and are described here. The mean age was 8 years (range, 6 months–17 years) and 38% were female. Median number of days between vaccination and symptom onset was 2 (range, −11 days to +41 days). Receipt of inactivated, live attenuated, or unknown type of 2009 H1N1 vaccines was reported by 68, 26 and 5 cases, respectively. Serious AEFI were categorized as neurologic events in 47 cases, as hypersensitivity in 15 cases and as respiratory events in 10 cases. At the time of evaluation, recovery was described as complete (61), partial (16), no improvement (1), or unknown (21). Causality assessment yielded the following likelihood of association with 2009 H1N1 vaccination: 8 definitely; 8 probably; 21 possibly; 43 unlikely; 17 unrelated; and 2 unclassifiable.

Conclusions: Most AEFI in children evaluated were not causally related to vaccine and resolved without sequelae. Detailed clinical assessment of individual serious AEFI can provide reassurance of vaccine safety.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 31, Issue 7, Pages 1009-1134 (4 February 2013)

Knowledge and awareness of HPV and the HPV vaccine among young women in the first routinely vaccinated cohort in England
Original Research Article
Pages 1051-1056
Harriet L. Bowyer, Laura A.V. Marlow, Sam Hibbitts, Kevin G. Pollock, Jo Waller

Abstract
A national school-based human papillomavirus (HPV) vaccination programme has been available for 12–13 year old females in the UK since 2008, offering protection against HPV types 16 and 18, which are responsible for the majority of cervical cancer. Little is known about HPV knowledge in girls who have been offered the vaccine. Girls offered the school-based vaccine in the first routine cohort (n = 1033) were recruited from 13 schools in London three years post-vaccination. Participants completed a questionnaire about HPV awareness, knowledge about HPV and the vaccine, and demographic characteristics including vaccine status. About a fifth of the girls reported they were unaware of the HPV infection. Among those who reported being aware of HPV (n = 759) knowledge was relatively low. Approximately half of the participants knew that HPV infection causes cervical cancer, condoms can reduce the risk of transmission and that cervical screening is needed regardless of vaccination status. These results are helpful in benchmarking HPV-related knowledge in vaccinated girls and could be used in the development of appropriate educational messages to accompany the first cervical screening invitation in this cohort in the future.

Vaccine
Volume 31, Issue 6, Pages 857-1008 (30 January 2013)
Pandemic influenza A(H1N1)pdm09 improves vaccination routine in subsequent years: A cohort study from 2009 to 2011
Original Research Article
Pages 900-905
Margot A.J.B. Tacken, Birgit Jansen, Jan Mulder, Stefan Visscher, Marie-Louise A. Heijnen, Stephen M. Campbell, Jozé C.C. Braspenning

Abstract
Background
In 2009 the pandemic influenza virus A(H1N1)pdm09 emerged with guidance that people at risk should be vaccinated. It is unclear how this event affected the underlying seasonal vaccination rate in subsequent years.

Purpose
To investigate the association of pandemic influenza A(H1N1)pdm09 and seasonal flu vaccination status in 2009 with vaccination rates in 2010 and 2011.

Methods
Data were collected in 40 Dutch family practices on patients at risk for influenza during 2009–2011; data analysis was conducted in 2012.

Results
A multilevel logistic regression model (n = 41,843 patients) adjusted for practice and patient characteristics (age and gender, as well as those patient groups at risk), showed that people who were vaccinated against A(H1N1)pdm09 in 2009 were more likely to have been vaccinated in 2010 (OR 6.02; 95%CI 5.62–6.45, p < .0001). This likelihood was even more for people who were vaccinated against seasonal flu in 2009 (OR 13.83; 95%CI 12.93–14.78, p < .0001). A second analysis on the uptake rate in 2011 (n = 39,468 patients) showed that the influence of the vaccination state in 2009 declined after two years, but the diminishing effect was smaller for people vaccinated against A(H1N1)pdm09 than for seasonal flu (OR 5.50; 95%CI 5.13–5.90, p < .0001; OR 10.98; 95%CI 10.26–11.75, p < .0001, respectively).

Conclusion

Being vaccinated against A(H1N1)pdm09 and seasonal influenza in the pandemic year 2009 enhanced the probability of vaccination in the next year and this was still effective in 2011. This suggests that peoples’ vaccination routines were not changed by the rumor around the outbreak of A(H1N1)pdm09, but rather confirmed underlying behavior.

Vaccine
Volume 31, Issue 6, Pages 857-1008 (30 January 2013)
Cost-effectiveness of childhood influenza vaccination in England and Wales: Results from a dynamic transmission model

Original Research Article
Pages 927-942
R.J. Pitman, L.D. Nagy, M.J. Sculpher

Abstract
This study uses a dynamic influenza transmission model to directly compare the cost-effectiveness of various policies of annual paediatric influenza vaccination in England and Wales, varying the target age range and level of coverage. The model accounts for both the protection of those immunised and the indirect protection of the rest of the population via herd immunity. The impact of augmenting current practice with a policy to vaccinate pre-school age children, on their own or with school age children, was assessed in terms of quality adjusted life years and health service costs. Vaccinating 2–18 year olds was estimated to be the most cost-effective policy in an incremental cost-effectiveness analysis, at an assumed annual vaccine uptake rate of 50%. The mean incremental cost-effectiveness ratios for this policy was estimated at £251/QALY relative to current practice. Paediatric vaccination would appear to be a highly cost-effective intervention that directly protects those targeted for vaccination, with indirect protection extending to both the very young and the elderly.

Vaccine
Volume 31, Issue 6, Pages 857-1008 (30 January 2013)
Number-needed-to-vaccinate calculations: Fallacies associated with exclusion of transmission
Original Research Article
Pages 973-978
Ashleigh R. Tuite, David N. Fisman

Abstract
Background
Number-needed-to-vaccinate (NNV) calculations are used with increasing frequency as metrics of the attractiveness of vaccination programs. However, such calculations as typically applied consider only the direct protective effects of vaccination and ignore indirect effects generated through reduction of force of infection (i.e., risk of infection in susceptible individuals). We postulated that such calculations could produce profoundly biased estimates of vaccine attractiveness.

Methods
We used mathematical models simulating endemic and epidemic diseases with a variety of epidemiological characteristics, and in the face of varying approaches to immunization, to evaluate biases associated with exclusion of transmission. We generated number-needed-to-vaccinate calculations using both traditional methods, and using a more realistic approach that defines this quantity as the ratio of cases prevented through vaccination (directly or indirectly) to individuals vaccinated. We quantified bias as the ratio of estimates produced using these two different methods.

Results
Across a range of simulated infectious diseases with variable epidemiological characteristics, and in the context of both pulsed vaccination and ongoing vaccine programs, traditional NNV calculations based on systems using plausible infectious disease parameters produced estimates biased by up to 3 orders of magnitude (i.e., 1000 fold). Unbiased NNV estimates were seen only in the context of diseases with extremely high reproductive numbers that could be prevented with highly efficacious vaccines.

Conclusions
When evaluated using mathematical models that simulate common vaccine-preventable diseases of public health importance, typical number-needed-to-vaccinate calculation produce marked over-estimates relative to NNV calculations incorporating the fundamental transmissibility of communicable diseases. NNV calculations should be used with caution and interpreted critically when used as metrics for the potential community-level impact of vaccination programs.

Vaccine
Volume 31, Issue 6, Pages 857-1008 (30 January 2013)
The feasibility of using mobile-phone based SMS reminders and conditional cash transfers to improve timely immunization in rural Kenya

Original Research Article
Pages 987-993
Hotenzia Wakadha, Subhash Chandir, Elijah Victor Were, Alan Rubin, David Obor, Orin S. Levine, Dustin G. Gibson, Frank Odhiambo, Kayla F. Laserson, Daniel R. Feikin

Abstract
Background
Demand-side strategies could contribute to achieving high and timely vaccine coverage in rural Africa, but require platforms to deliver either messages or conditional cash transfers (CCTs). We studied the feasibility of using short message services (SMS) reminders and mobile phone-based conditional cash transfers (CCTs) to reach parents in rural Western Kenya.

Methods
In a Health and Demographic Surveillance System (HDSS), mothers with children aged 0–3 weeks old were approached to determine who had access to a mobile phone. SMS reminders were sent three days prior to and on the scheduled day of immunization for 1st (age 6 weeks) and 2nd doses (age 10 weeks) of DTP-HepB-Hib (Pentavalent) vaccine, using open-source Rapid SMS software. Approximately $2.00 USD was sent as cash using mPESA, a mobile money transfer platform (2/3 of mothers), or airtime (1/3 of mothers) via phone if the child was vaccinated within 4 weeks of the scheduled date. Follow-up surveys were done when children reached 14 weeks of age.

Results
We approached 77 mothers; 72 were enrolled into the study (26% owned a phone and 74% used someone else’s). Of the 63 children with known vaccination status at 14 weeks of age, 57 (90%) received pentavalent1 and 54 (86%) received pentavalent2 within 4 weeks of their scheduled date. Of the 61 mothers with follow-up surveys administered at 14 weeks of age, 55 (90%) reported having received SMS reminders. Of the 54 women who reported having received SMS reminders and answered the CCT questions on the survey, 45 (83%) reported receiving their CCT. Most (89%) of mothers in the mPESA group obtained their cash within 3 days of being sent their credit via mobile phone. All mothers stated they preferred CCTs as cash via mobile phone rather than airtime. Of the 9 participants who did not vaccinate their children at the designated clinic 2(22%) cited refusals by husbands to participate in the study.

Conclusion

The data show that in rural Western Kenya mobile phone-based strategies are a potentially useful platform to deliver reminders and cash transfers. Follow-up studies are needed that provide evidence for the effectiveness of these strategies in improving vaccine coverage and timeliness.

Vaccine
Volume 31, Issue 5, Pages 725-856 (21 January 2013)

WHO Article
Global production capacity of seasonal influenza vaccine in 2011
Original Research Article
Pages 728-731
Jeffrey Partridge, Marie Paule Kieny

Abstract
The effectiveness of vaccines to mitigate the impact of annual seasonal influenza epidemics and influenza pandemics has been well documented. However, the steady increase in global capacity to produce annual seasonal influenza vaccine has not been matched with increased demand, and thus actual vaccine production. Currently, without a significant increase in demand for seasonal influenza vaccine, global capacity will be far from able to meet even the essential needs for a monovalent vaccine in the event of a severe influenza pandemic. Global commitment to the development of influenza vaccine production capacity was renewed at a consultation leading to the Second Global Action Plan on Influenza Vaccines (GAP) in July 2011. To monitor progress on the GAP, the World Health Organization has carried out periodic surveys of influenza vaccine manufacturers. This latest survey compares current maximum global capacity and actual production of seasonal influenza vaccine in 2011 with data from surveys carried out in 2009 and 2010; analyses global influenza production capacity in the context of sustainability; and discusses options to increase demand, based on strong evidence of public health benefit.

Vaccine
Volume 31, Issue 5, Pages 725-856 (21 January 2013)
Correlates of high vaccination exemption rates among kindergartens

Original Research Article
Pages 750-756
Michael S. Birnbaum, Elizabeth T. Jacobs, Jennifer Ralston-King, Kacey C. Ernst

Abstract
Objectives
The present study was designed to characterize Arizona schools with high rates of permanent PBE among kindergartners, and to determine the degree to which they aggregate across the state.

Methods
Data for permanent personal belief exemptions (PBE) were accessed through the 2010–2011 kindergarten Immunization Data Report (IDR) from the Arizona Department of Health Services (AZDHS), and were linked to the 2009–2010 data from the National Center of Education Statistics (NCES). Incidence rate ratios (IRR) were calculated using negative binomial regression, and hotspots were identified using Getis-Ord Gi*.

Results
Schools with highest proportion of white students compared to the lowest had the highest exemption rates (IRR = 14.11; 95% confidence interval [CI], 9.47–21.03); furthermore charter schools and those with low prevalence of free and reduced lunches had significantly higher rates of PBE. Statewide analyses of PBE identified higher rates of permanent PBE in northern vs. southern Arizona, while a more focused examination of the central Arizona region demonstrated a pattern of increased PBE from west to east.

Conclusion
In Arizona, the profile of a high PBE school is that of a charter school attended by predominantly white, higher-income students. The local and statewide hotspots serve as a challenge that requires a multi-faceted approach that calls upon all healthcare professionals. It is important that both local and statewide pockets be targeted by local and state officials either to improve vaccination uptake or to employ careful monitoring to identify outbreaks at their onset.

Vaccine
Volume 31, Issue 5, Pages 725-856 (21 January 2013)
Coverage from Ontario, Canada’s school-based HPV vaccine program: The first three years

Original Research Article
Pages 757-762
Sarah E. Wilson, Tara Harris, Pam Sethi, Jill Fediurek, Liane Macdonald, Shelley L. Deeks

Abstract
Background
In 2007, Ontario implemented a school-based human papillomavirus (HPV) vaccination program targeting grade 8 girls. Girls may complete the series in grade 9 (extended eligibility). Limitations in the existing provincial data sources for assessing HPV vaccine coverage in Ontario prompted the use of two surveys of Health Units (HUs) to calculate provincial vaccine coverage for the first three years of the vaccination program.

Methods
We surveyed Ontario’s 36 HUs in March and November 2011 to obtain vaccine coverage information, including source of denominator data, and use of local information systems. The second survey was necessary in order to assess coverage including extended eligibility for the third year. HU-reported HPV vaccine coverage was compared to coverage estimates obtained from two provincial systems: the Immunization Records Information System (IRIS) and the HPV reimbursement database, a system used to remunerate HUs for HPV vaccine doses administered.

Results
100% of HUs participated in the two surveys. The provincial coverage estimates using HU-reported data were: 51% (2007–2008), 58% (2008–2009), and 59% (2009–2010) with large variation by HU. Coverage increased significantly over time. The number of HUs that were able to report on doses given as part of extended eligibility also increased over time (47% in 2007–2008 to 89% in 2009–2010; p = 0.0008). Comparisons across the three data sources (survey, IRIS and reimbursement database) revealed significantly different coverage estimates. Class or school lists were the most common source of denominator data used by HUs (27/36, 75%), however independent schools were not included by all.

Conclusions
As not all HUs were able to report on HPV vaccine coverage including extended eligibility doses these findings likely underestimate the true coverage attained by Ontario’s program. Although coverage is below the Canadian Immunization Committee benchmark of 80% within two years of program implementation, the upward trend in coverage is encouraging.

Vaccine
Volume 31, Issue 5, Pages 725-856 (21 January 2013)
Knowledge of human papillomavirus (HPV) and HPV vaccination: An international comparison

Original Research Article
Pages 763-769
Laura A.V. Marlow, Gregory D. Zimet, Kirsten J. McCaffery, Remo Ostini, Jo Waller

Abstract
Since vaccination against human papillomavirus (HPV) became available, awareness of HPV has dramatically increased. Implementation of a vaccine program varies internationally yet no studies have explored the influence this has on the public’s knowledge of HPV. The present study aimed to explore differences in awareness of HPV and HPV knowledge across three countries: The US, UK and Australia.

Participants (n = 2409) completed a validated measure of HPV knowledge as part of an online survey. There were higher levels of HPV awareness among men and women in the US than the UK and Australia. Being male and having a lower educational level was associated with lower HPV awareness in all three countries. Awareness of HPV vaccine was higher in women from the US than the UK and Australia. Women in the US scored significantly higher on general HPV knowledge (on a 15-item scale) than women in the UK and Australia, but there were no between country differences in HPV vaccine knowledge (on a 6-item scale). When asked about country-specific vaccine availability, participants in the US were less able to identify the correct answers than participants in the UK and Australia. More than half of participants did not know: HPV can cause genital warts; most sexually active people will get HPV at some point in their life; or HPV doesn’t usually need treatment.

Pharmaceutical advertising campaigns could explain why awareness of HPV and HPV vaccine is higher in the US and this has helped to get some important messages across. Significant gaps in HPV knowledge remain across all three countries.

Vaccine
Volume 31, Issue 5, Pages 725-856 (21 January 2013)
State law and influenza vaccination of health care personnel

Original Research Article
Pages 827-832
Alexandra M. Stewart, Marisa A. Cox
Abstract
Nosocomial influenza outbreaks, attributed to the unvaccinated health care workforce, have contributed to patient complications or death, worker illness and absenteeism, and increased economic costs to the health care system. Since 1981, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) has recommended that all HCP receive an annual influenza vaccination.

Health care employers (HCE) have adopted various strategies to encourage health care personnel (HCP) to voluntarily receive influenza vaccination, including: sponsoring educational and promotional campaigns, increasing access to seasonal influenza vaccine, permitting the use of declination statements, and combining multiple approaches. However, these measures failed to significantly increase uptake among HCP. As a result, beginning in 2004, health care facilities and local health departments began to require certain HCP to receive influenza vaccination as a condition of employment and annually. Today, hundreds of facilities throughout the country have developed and implemented similar policies. Mandatory vaccination programs have been endorsed by professional and non-profit organizations, state health departments, and public health. These programs have been more effective at increasing coverage rates than any voluntary strategy, with some health systems reporting coverage rates up to 99.3%.

Several states have enacted laws requiring HCEs to implement vaccination programs for the workforce. These laws present an example of how states will respond to threats to the public’s health and constrain personal choice in order to protect vulnerable populations.

This study analyzes laws in twenty states that address influenza vaccination requirements for HCP who practice in acute or long-term care facilities in the United States. The laws vary in the extent to which they incorporate the six elements of a mandatory HCP influenza vaccination program. Four of the twenty states have adopted a broad definition of HCP or HCE. While 16/20 of the laws require employers to “provide,” “arrange for,” “ensure,” “require” or “offer” influenza vaccinations to HCP, only four states explicitly require HCEs to cover the cost of vaccination. Fifteen of the twenty laws allow HCP to decline the vaccination due to medical contraindication, religious or philosophical beliefs, or by signing a declination statement. Finally, three states address how to sanction noncompliant HCPs. The analysis also discusses the development of a model legal policy that legislators could use as they draft and revise influenza prevention guidelines in health care settings.

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

Physicians’ Confidence in Vaccine Safety Studies.
ST O’Leary, MA Allison, S Stokley, LA Crane, LP Hurley… – Preventive medicine, 2013
OBJECTIVES: To ascertain, through two separate surveys among nationally representative networks of pediatricians (Peds) and family physicians (FM): 1) physicians’ reported level of confidence in pre-and post-licensure vaccine safety studies; and 2) changes in reported…

Toward a Universal Influenza Vaccine: Prospects and Challenges
P Palese – Annual Review of Medicine, 2013
Current influenza virus vaccines are annually reformulated to elicit protection by generating an immune response toward the virus strains that are predicted to circulate in the upcoming influenza season. These vaccines provide limited protection in cases of antigenic…

Predictors of Initial Uptake of Human Papillomavirus Vaccine Uptake Among Rural Appalachian Young Women.
BR Casey, RA Crosby, RC Vanderpool, M Dignan… – Journal of Primary Prevention  2013 Jan 17. [Epub ahead of print]
Women in Appalachian Kentucky experience a high burden of cervical cancer and have low rates of human papillomavirus (HPV) vaccination. The purpose of this study was to identify normative influences predicting initial HPV vaccine uptake among a sample of young…

Early Lessons Learned From Extramural School Programs That Offer HPV Vaccine
KA Hayes, P Entzel, W Berger, RN Caskey, JC Shlay… – Journal of School Health, 2013
BACKGROUND There has been little evaluation of school-located vaccination programs that offer human papillomavirus (HPV) vaccine in US schools without health centers (ie, extramural programs). This article summarizes lessons learned from such programs…

HPV at the time of vaccine: has screening reached its goal?
E Tartaglia, D Iafusco, A Cocca, S Palomba, M Rotondi… – European Journal of Gynaecological Oncology  2012;33(6):591-7.
INTRODUCTION: The human papillomavirus (HPV) prevalence recognized a geographic distribution of genotypes but, in the last years, the change of sexual behaviours, the increase number of sex partners, and the reduction of geographic distances have changed its…

The Huffington Post
http://www.huffingtonpost.com/
Accessed 26 January 2013

The Big Push to Defeat AIDS, TB and Malaria
Dr. Mark Dybul
Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria
Posted: 01/21/2013 12:00 am

Extract
Every era offers something special. I think the most special thing about our current time is the incredible opportunity that scientific advances have provided in the field of global health, giving us the ability to completely control highly dangerous infectious diseases such as AIDS, tuberculosis and malaria. The recent progress is breathtaking. If we can harness the funds needed, we can essentially take these diseases off the table as threats to greater development…

Wall Street Journal
http://online.wsj.com/home-page
Accessed 26 January 2013

THE SATURDAY ESSAY
January 25, 2013, 8:12 p.m. ET
Bill Gates: My Plan to Fix The World’s Biggest Problems
From the fight against polio to fixing education, what’s missing is often good measurement and a commitment to follow the data. We can do better. We have the tools at hand.

http://online.wsj.com/article/SB10001424127887323539804578261780648285770.html?KEYWORDS=vaccine

Twitter Watch  (26January 2013 – 18:36)
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.

HarvardPublicHealth ‏@HarvardHSPH
Video: Trust in vaccines — & why it matters http://ht.ly/h9FQu  #publichealth
Download: MP3 Audio
SUMMARY AND BACKGROUND [Video]
Long a cost-effective stalwart in the public health armament, vaccines have become a target for misinformation that has undermined immunization efforts in parts of the U.S., U.K. and elsewhere, contributing to dangerous and potentially lethal disease outbreaks of measles, polio and more. At the same time, in this “Decade of Vaccines,” steps have been taken to boost vaccine access in areas of the world where people live with, and die unnecessarily from, infectious illnesses that could be controlled by immunization programs. This Forum event examined the importance of immunization, the safety of vaccines, and the consequences of vaccine hesitancy.
10:56 AM – 26 Jan 13

GAVI Alliance ‏@GAVIAlliance
#VIDEO: An interesting dialogue to watch between PM @jensstoltenberg from @noradno and @BillGates, in Oslo last week: http://ht.ly/h9xlV 
8:45 AM – 26 Jan 13

UNICEF ‏@UNICEF
RT @IshmaelBeah UNICEF’s Humanitarian Action for Children report highlights challenges for most vulnerable children & women #HAC2013
9:35 AM – 25 Jan 13

UNICEF ‏@UNICEF
In 2012, we vaccinated 38.3m children. We need your help to do it again in 2013. http://uni.cf/SMhChx  #HAC2013
7:51 AM – 25 Jan 13

Dagfinn Høybråten ‏@Hoybraten
How do we immunize a quarter billion children by 2015 http:// http://bit.ly/10Stpys 
Retweeted by GAVI Alliance
6:59 AM – 25 Jan 13

PAHO/WHO ‏@pahowho
Rt @UN: Watch: @UNICEF message to #Davos. Investing in children’s health pays the biggest dividends http://uni.cf/WMSZyX  #WEF #mdgs”
Investment in children – the best buy in global health
As world leaders, economists and captains of industry meet in Davos, Switzerland, to tackle the health of the economy, UNICEF Health Chief Dr. Mickey Chopra …
5:41 AM – 25 Jan 13

WHO ‏@WHO
Polio Team Leader, @WHO Pakistan, Dr Elias Durry, op/ed piece on #polio situation in #Pakistan http://goo.gl/oLhsE  via @etribune
3:51 AM – 25 Jan 13

GAVI Alliance ‏@GAVIAlliance
New commitments from @comicrelief @ldscharities & @VodafoneGroup bring total raised under GAVI Matching Fund to US$ 78M http://ht.ly/h7oPI 
1:54 AM – 25 Jan 13

UNICEF ‏@UNICEF
The Humanitarian Action for Children report highlights challenges for most vulnerable children and women http://uni.cf/WLL3Oy  #HAC2013
1:50 AM – 25 Jan 13

UNICEF ‏@UNICEF
#Egypt to vaccinate after #polio found in sewer, via @AP: http://uni.cf/XDghGR  Highlights need to #protecthealthworkers in #Pakistan
2:10 PM – 24 Jan 13

Doctors w/o Borders ‏@MSF_USA
“Decade of Vaccines” blueprint ignores high prices, lacks ambition on better-adapted vaccines to reach more children: http://bit.ly/UnQDZ8 
10:45 AM – 24 Jan 13

The Global Fund ‏@globalfundnews
Big News: Germany announces 1b Euros for the Global Fund’s #thebigpush to defeat #AIDS #TB & #Malaria #Davos http://bit.ly/10U7isi 
6:57 AM – 24 Jan 13

M&R Initiative ‏@MeaslesRubella
Human Rights Commission of #Pakistan flays rising death toll from #measles – as epidemic
2:42 AM – 24 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_19 January 2013

– 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…

The Minamata Convention on Mercury was approved on Saturday, 19 January 2013. The new Convention “provides controls and reductions across a range of products, processes and industries where mercury is used, released or emitted. These range from medical equipment such as thermometers and energy-saving light bulbs to the mining, cement and coal-fired power sectors. The treaty, which has been four years in negotiation and which will be open for signature at a special meeting in Japan in October, also addresses the direct mining of mercury, export and import of the metal and safe storage of waste mercury…” Achim Steiner, UN Under-Secretary General and Executive Director of the UN Environment Programme (UNEP) which convened the negotiations among over 140 member states in Geneva, said at the close:” After complex and often all night sessions here in Geneva, nations have today laid the foundations for a global response to a pollutant whose notoriety has been recognized for well over a century.”  Vaccines where mercury is used as a preservative have been excluded from the treaty as have products used in religious or traditional activities.

– Background to the fifth session of the Intergovernmental Negotiating Committee to prepare a global legally binding instrument on mercury (INC5) http://unep.org/hazardoussubstances/Mercury/Negotiations/INC5/tabid/3471/Default.aspx
– Global Mercury Assessment 2013 http://www.unep.org/publications/contents/pub_details_search.asp?ID=6282
– Time to Act http://www.unep.org/publications/contents/pub_details_search.asp?ID=6281
http://www.unep.org/NewsCentre/default.aspx?DocumentID=2702&ArticleID=9373&l=en

Editor’s Note: See separate post on GAVI CEO Seth Berkley’s op-ed on the treaty in the New York Times.

PATH said it “coordinated advocacy efforts” to ensure the final treaty language did not restrict access to vaccines containing thiomersal.” PATH noted that it worked in partnership with WHO, UNICEF, the GAVI Alliance, civil society organizations, as well as animal health experts, to educate country representatives involved in the deliberations. In finalizing the treaty language, many country delegations “made strong statements about the essential role of thiomersal-containing vaccines in protecting health.” More than 140 countries and 900 delegates participated in the final negotiations, which were hosted by the United Nations Environment Programme in Geneva, Switzerland.
Posted January 18, 2013.
http://www.path.org/news/an130118-mercury-treaty.php

IOM Research: Childhood Immunization Schedule and Safety: Stakeholder Concerns, Scientific Evidence, and Future Studies
January 16, 2013
Board on Population Health and Public Health Practice

Abstract [Bolded language by Editor]
Vaccines are among the most safe and effective public health interventions to prevent serious disease and death. Because of the success of vaccines, most Americans today have no firsthand experience with such devastating illnesses as polio or diphtheria. Health care providers who vaccinate young children follow a schedule prepared by the U.S. Advisory Committee on Immunization Practices. Under the current schedule, children younger than six may receive as many as 24 immunizations by their second birthday. New vaccines undergo rigorous testing prior to receiving FDA approval; however, like all medicines and medical interventions, vaccines carry some risk.

Driven largely by concerns about potential side effects, there has been a shift in some parents’ attitudes toward the child immunization schedule. HHS asked the IOM to identify research approaches, methodologies, and study designs that could address questions about the safety of the current schedule.

   This report is the most comprehensive examination of the immunization schedule to date. The IOM committee uncovered no evidence of major safety concerns associated with adherence to the childhood immunization schedule. Should signals arise that there may be need for investigation, however, the report offers a framework for conducting safety research using existing or new data collection systems.

http://www.iom.edu/Reports/2013/The-Childhood-Immunization-Schedule-and-Safety.aspx

The U.S. Food and Drug Administration said it approved Flublok, described as the first trivalent influenza vaccine made using an insect virus (baculovirus) expression system and recombinant DNA technology. Flublok is approved for the prevention of seasonal influenza in people 18 through 49 years of age. The FDA announcement noted that unlike current flu vaccines, Flublok does not use the influenza virus or eggs in its production. Flublok’s novel manufacturing technology allows for production of large quantities of the influenza virus protein, hemagglutinin (HA) – the active ingredient in all inactivated influenza vaccines that is essential for entry of the virus into cells in the body. The majority of antibodies that prevent influenza virus infection are directed against HA. While the technology is new to flu vaccine production, it is used to make vaccines that have been approved by the FDA to prevent other infectious diseases. Karen Midthun, M.D., director of the FDA’s Center for Biologics Evaluation and Research, said, “This approval represents a technological advance in the manufacturing of an influenza vaccine. The new technology offers the potential for faster start-up of the vaccine manufacturing process in the event of a pandemic, because it is not dependent on an egg supply or on availability of the influenza virus.”

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm335891.htm

The Johns Hopkins School of Public Health reported that the “Deans of twelve of the most eminent American schools of public health sent a letter to President Barack Obama vigorously protesting the precedent that was set when the Central Intelligence Agency (CIA) used the guise of a vaccination campaign to hunt for Osama Bin Laden in Pakistan.” The announcement noted that “this disguising of an intelligence-gathering effort as a humanitarian public health service has resulted in serious collateral consequences that affect the public health community. In September of 2012, after working for 30 years in Pakistan, Save the Children was ordered to remove all expatriate staff from the country…Last month, eight polio vaccination workers were assassinated, resulting in the suspension of U.N. polio eradication efforts in Pakistan.”

The letter expresses concern that the “humanitarian space” historically afforded aid workers may be greatly curtailed by the precedent set by the CIA in Pakistan. The deans state that, “international public health work builds peace and is one of the most constructive means by which our past, present, and future public health students can pursue a life of fulfillment and service.  Please do not allow that outlet of common good to be closed to them because of political and/or security interests that ignore the type of unintended negative public health impacts we are witnessing in Pakistan.” Those signing the letter included Deans: Buekens from Tulane, Curran from Emory, Finnegan from Univ. of Minnesota, Frenk from Harvard, Fried from Columbia, Frumkin from Univ. of Washington, Goldman from George Washington, Haymann from UCLA, Klag from John Hopkins, Philbert from Univ. of Michigan, Rimer from UNC Chapel Hill, and Shortell from UC Berkeley.

January 8, 2013

http://www.jhsph.edu/news/news-releases/2013/klag-CIA-vaccination-cover-pakistan.html

Speech: The place of health on the post-2015 development agenda
Dr Margaret Chan, Director-General of the World Health Organization
Opening remarks at an informal Member State consultation on health in the post-2015 development agenda
Geneva, Switzerland
14 December 2012
http://www.who.int/dg/speeches/2012/mdgs_post2015/en/index.html

.
Speech: Biological security as part of health security
Dr Margaret Chan, Director-General of the World Health Organization
Opening remarks at a meeting on Global health security collaboration between the Global Partnership against the Spread of Weapons and Materials of Mass Destruction and international organizations
Geneva, Switzerland
17 December 2012

Extract
“…I am pleased to share this session with the heads of OIE and FAO. Let me congratulate these two agencies on the successful eradication of rinderpest.

Implementation of the International Health Regulations is not an exclusive function of the health sector. The need to engage non-health as well as health sectors was explicitly recognized earlier this year when the World Health Assembly adopted a resolution on implementation of the Regulations.

As discussions about the Regulations revealed, WHO Member States are worried about the continuing lack of capacity, in many countries, to respond to emerging and re-emerging infections.

Too many countries are not yet able to detect an unusual disease event and investigate it, find the cause, report to WHO, gear up their health systems for heightened surveillance, and marshal the appropriate equipment, supplies, and other logistical support. These weaknesses come from a lack of routine surveillance systems, a lack of laboratory capacity, a lack of resources, and a severe shortage of epidemiologists and other specialists.

One statistic tells a disturbing story. Some 85 countries, representing 65% of the world’s population, do not have reliable systems of vital registration. This means that causes of death are neither investigated nor recorded.

This is why many emerging diseases, including highly fatal ones, can smoulder undetected for weeks if not months. Outbreaks frequently become visible only after amplification of infection in a hospital or clinic leads to an explosion of cases that is too big to miss.

In other instances, new diseases, were recognized only after people fell ill and were air-evacuated for treatment to countries with sophisticated diagnostic capacity. This is what happened with the novel coronavirus. Such lapses in vigilance weaken our collective security…

http://www.who.int/dg/speeches/2012/health_security_20121217/en/index.html

Update: Polio this week – As of 16 January 2013
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s Extract and bolded text]
– 13 January 2013 marked two years since the last wild poliovirus (WPV) case in India….
– The WHO Executive Board (EB), meeting in Geneva, Switzerland from 21-29 January, will consider a report on progress in polio eradication, remaining challenges and the new eradication and endgame strategy. The full report in English.

Nigeria
– One new WPV case was reported in the past week (WPV1 from Kano), bringing the total number of WPV cases for 2012 to 122. The most recent WPV case had onset of paralysis on 3 December 2012 (WPV1 from Federal Capital Territory – FCT).

– Two new cases of cVDVP2, both occurring in Sokoto, were reported in the past week, bringing the total number of cVDPV2 cases for 2012 to 8. The most recent cVDPV2 case had onset of paralysis on 24 November 2012 (from Kebbi).

Pakistan
– District officials are assessing security conditions locally, in close consultation with law enforcement. A decentralized approach to vaccination activities is being used due to insecurity for polio workers.

WHO: Measles deaths decline, but elimination progress stalls in some regions
Improved vaccination rates critical for success
17 January 2013 | GENEVA – The number of measles deaths globally decreased by 71% between 2000 and 2011, from 542,000 to 158,000. Over the same period, new cases dropped 58% from 853,500 in 2000 to 355,000 in 2011. Although the WHO Region of the Americas has sustained measles elimination since 2002, and the WHO Western Pacific Region is on track to achieve elimination, large outbreaks of measles are jeopardizing progress in the remaining regions that have these goals. Estimated global coverage with a first dose of measles vaccine increased from 72% in 2000 to 84% in 2011. The number of countries providing the second dose through routine services increased from 97 in 2000 to 141 in 2011. Since 2000, with support from the Measles & Rubella Initiative, more than 1 billion children have been reached through mass vaccination campaigns ― about 225 million of them in 2011.

An estimated 20 million children worldwide did not receive the first dose of vaccine in 2011. More than half of these children live in five countries:
– the Democratic Republic of the Congo (DRC) (0.8 million)
– Ethiopia (1 million)
– India (6.7 million)
– Nigeria (1.7 million)
– Pakistan (0.9 million)

Measles outbreaks
In 2011, large measles outbreaks were reported in all these countries and several others.

http://www.who.int/mediacentre/news/notes/2013/measles_20130117/en/index.html

The Weekly Epidemiological Record (WER) for 18 January 2013, vol. 88, 3 (pp 29–36) includes:
– Progress in global control and regional elimination of measles, 2000–2011

http://www.who.int/entity/wer/2013/wer8803.pdf

The MMWR for January 18, 2013 / Vol. 62 / No. 2 includes:
– Global Control and Regional Elimination of Measles, 2000–2011

– Early Estimates of Seasonal Influenza Vaccine Effectiveness — United States, January 2013

WHO: Second Report on NTDs – Sustaining the Drive to Overcome the Global Impact of Neglected Tropical Diseases
16 January 2013 | Geneva
“The World Health Organization’s second report on neglected tropical diseases published today highlights unprecedented progress during the past two years. Renewed momentum has shifted the world closer to eliminating many of these conditions that take their greatest toll among the poor, thanks to a new global strategy, a regular supply of quality-assured, cost-effective medicines and support from global partners.”

Full report:

http://www.who.int/iris/bitstream/10665/77950/1/9789241564540_eng.pdf

Report: Pharmaceutical R&D Projects to Discover Cures for Patients with Neglected Conditions
IFPMA
January 2013

Announcement text
The IFPMA (International Federation of Pharmaceutical Manufacturers & Associations) released its 2012 status report on pharmaceutical R&D to address neglected diseases that disproportionately affect people in low- and middle-income countries. Representing a 40 percent increase over 2011, the 132 R&D projects in the 2012 update focus on the following diseases prioritized by the World Health Organization’s Special Programme for Research and Training in Tropical Diseases (TDR): tuberculosis, malaria, human African trypanosomiasis (sleeping sickness), leishmaniasis, dengue, onchocerciasis (River blindness), American trypanosomiasis (Chagas disease), schistosomiasis, leprosy and lymphatic filariasis.

The only major sector increasing R&D funding for neglected diseases in 2011, the research-based pharmaceutical industry has a long-standing and continuing commitment to fighting these conditions. Industry’s holistic approach includes R&D projects, capacity-strengthening efforts, and medicine donations.

“We take a comprehensive approach to tacking neglected diseases,” says Eduardo Pisani, IFPMA Director General, “Donations of 14 billion treatments this decade address patients’ near-term needs while these 132 R&D programs will bring innovative vaccines and treatments to meet future needs and hopefully stop these dreaded diseases.”

http://www.ifpma.org/fileadmin/content/News/2013/IFPMA_News_Release_RD_Status_Report_16Jan2013.pdf

Report:
http://www.ifpma.org/fileadmin/content/Publication/2013/IFPMA_R_D_Status_Report_Neglected_Conditions.pdf

Meeting: Understanding the value of vaccines
GAVI
Annecy, France
Week of 14 January 2013

GAVI said it convened a group of 25 health economists and other experts from around the world experts “to better understand the full value of vaccines,” and to agree on a programme of future research to answer some of the key questions raised. The GAVI announcement noted that “…as well as preventing death and illness, we know that vaccines make a broader contribution to human and economic development. Some of the ways in which this happens are already well understood: children who are healthy do not require medical treatment or care that costs money; their families are then able to spend or save this money in other ways…Other known and potential impacts require further research. For example: what is the link between vaccines, health and educational achievement? How can we measure the connection between childhood health and future economic prospects?”

http://www.gavialliance.org/library/news/gavi-features/2013/understanding-the-value-of-vaccines/

British Medical Journal
19 January 2013 (Vol 346, Issue 7891)
http://www.bmj.com/content/346/7891

Editorial
What must be done about the killings of Pakistani healthcare workers?
Zulfiqar A Bhutta,
Founding Chair, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f280 (Published 16 January 2013)

Extract
It’s time to stop trying to accommodate those who spread fear and terror

In December 2012 nine volunteer polio workers, six of whom were young women, were murdered in Pakistan.1 A day later five female education workers were murdered on their way to work in Swabi (Khyber Pakhtunkhwa). The coordinated attacks sent a chilling message to civic society that female workers and volunteers, hitherto protected by a strict Pashtun moral code, were now terrorist targets. These murders begin to fade into a background of incessant conflict and insurgency around the border areas of Khyber Pakhtunkhwa, the federally administered tribal areas, and Baluchistan. The city of Karachi is caught in a spiral of targeted killings and kidnappings for ransom.2 In Baluchistan, the law of the government has all but collapsed and the Hazara minorities have been forced to demand army rule in the main city, Quetta, to protect themselves from the threat of ethnic cleansing at the hands of a well connected and funded underground network of terrorist organisations.3 The nation is inured to reports of violent deaths on a daily basis, however, and the recent targeted killings of health workers are already off…

The Lancet  
Jan 19, 2013  Volume 381  Number 9862  p177 – 266  e1
http://www.thelancet.com/journals/lancet/issue/current

Comment
More evidence for use of pneumococcal conjugate vaccines
Cynthia G Whitney

Preview
Pneumococcal conjugate vaccines (PCVs) are among the leading interventions for reducing deaths and improving the health of children around the world. These vaccines are now routinely used in about 88 countries, with the number of countries increasing quickly.1 PCVs are used on various schedules, designed to complement existing schedules for other vaccines that are already part of national immunisation programmes. Until now, however, clinical trial evidence to support some of the different ways PCVs can be used was missing.

Articles
Effectiveness of the ten-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) against invasive pneumococcal disease: a cluster randomised trial
Arto A Palmu, Jukka Jokinen, Dorota Borys, Heta Nieminen, Esa Ruokokoski, Lotta Siira, Taneli Puumalainen, Patricia Lommel, Marjan Hezareh, Marta Moreira, Lode Schuerman, Terhi M Kilpi
Preview | Summary

New England Journal of Medicine
January 17, 2013  Vol. 368 No. 3
http://content.nejm.org/current.shtml

Online First – Original Article
Risk of Fetal Death after Pandemic Influenza Virus Infection or Vaccination
Siri E. Håberg, M.D., Ph.D., Lill Trogstad, M.D., Ph.D., Nina Gunnes, Ph.D., Allen J. Wilcox, M.D., Ph.D., Håkon K. Gjessing, Ph.D., Sven Ove Samuelsen, Ph.D., Anders Skrondal, Ph.D., Inger Cappelen, Ph.D., Anders Engeland, Ph.D., Preben Aavitsland, M.D., Steinar Madsen, M.D., Ingebjørg Buajordet, Ph.D., Kari Furu, Ph.D., Per Nafstad, M.D., Ph.D., Stein Emil Vollset, M.D., Dr.P.H., Berit Feiring, M.Sc.Pharm., Hanne Nøkleby, M.D., Per Magnus, M.D., Ph.D., and Camilla Stoltenberg, M.D., Ph.D.
January 16, 2013DOI: 10.1056/NEJMoa1207210
http://www.nejm.org/doi/full/10.1056/NEJMoa1207210

Abstract
Background
During the 2009 influenza A (H1N1) pandemic, pregnant women were at risk for severe influenza illness. This concern was complicated by questions about vaccine safety in pregnant women that were raised by anecdotal reports of fetal deaths after vaccination.
Full Text of Background…

Methods
We explored the safety of influenza vaccination of pregnant women by linking Norwegian national registries and medical consultation data to determine influenza diagnosis, vaccination status, birth outcomes, and background information for pregnant women before, during, and after the pandemic. We used Cox regression models to estimate hazard ratios for fetal death, with the gestational day as the time metric and vaccination and pandemic exposure as time-dependent exposure variables.
Full Text of Methods…

Results
There were 117,347 eligible pregnancies in Norway from 2009 through 2010. Fetal mortality was 4.9 deaths per 1000 births. During the pandemic, 54% of pregnant women in their second or third trimester were vaccinated. Vaccination during pregnancy substantially reduced the risk of an influenza diagnosis (adjusted hazard ratio, 0.30; 95% confidence interval [CI], 0.25 to 0.34). Among pregnant women with a clinical diagnosis of influenza, the risk of fetal death was increased (adjusted hazard ratio, 1.91; 95% CI, 1.07 to 3.41). The risk of fetal death was reduced with vaccination during pregnancy, although this reduction was not significant (adjusted hazard ratio, 0.88; 95% CI, 0.66 to 1.17).
Full Text of Results…

Conclusions
Pandemic influenza virus infection in pregnancy was associated with an increased risk of fetal death. Vaccination during pregnancy reduced the risk of an influenza diagnosis. Vaccination itself was not associated with increased fetal mortality and may have reduced the risk of influenza-related fetal death during the pandemic. (Funded by the Norwegian Institute of Public Health.)
Full Text of Discussion…

Science        
18 January 2013 vol 339, issue 6117, pages 245-364
http://www.sciencemag.org/current.dtl

News & Analysis
Disease Eradication
Killings Force Rethinking of Pakistan’s Anti-Polio Drive
Leslie Roberts

Pakistan is one of just three countries where the poliovirus remains entrenched, and global cases are at an all-time low. Over the years, polio workers have been killed in conflict zones, but never in such numbers or in such deliberate attacks as in Pakistan. Health workers are asking, can the government safeguard its legions of vaccinators and still reach enough kids to keep the poliovirus in check? And if not and the virus regains steam, how big of a setback will that be to the global initiative, which, 13 years after it was due to be finished, is finally close to success?

http://www.sciencemag.org/content/339/6117/259.summary

Journal of Communication
Early View – ORIGINAL ARTICLE

“1-2-3 Pap” Intervention Improves HPV Vaccine Series Completion Among Appalachian Women
Robin C. Vanderpool1,*, Elisia Cohen2, Richard A. Crosby1, Maudella G. Jones3, Wallace Bates3, Baretta R. Casey1, Tom Collins3
Article first published online: 10 JAN 2013
DOI: 10.1111/jcom.12001
http://onlinelibrary.wiley.com/doi/10.1111/jcom.12001/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

Abstract
Completion of the Human Papillomavirus (HPV) vaccine series is a national priority. This study not only identified correlates of intent to complete the vaccine series and actual series completion, but also tested the efficacy of a DVD intervention to promote series completion. Women’s beliefs that all 3 doses reduced cancer risk predicted intent and completion. Intention predicted completion, as did the belief that having a friend accompany the woman would promote completion. Beyond these effects, women assigned to the intervention were 2.44 times more likely than women in the usual care group to complete the series. Thus, in controlled analyses, a theory-grounded DVD intervention successfully promoted HPV series completion in a community setting. This method of intervention has high translational potential.

Cancer Causes & Control
2013 Jan 5. [Epub ahead of print]
Prevalence of HPV types in cervical specimens from an integrated healthcare delivery system: baseline assessment to measure HPV vaccine impact.

Dunne EF, Klein NP, Naleway AL, Baxter R, Weinmann S, Riedlinger K, Fetterman B, Steinau M, Scarbrough MZ, Gee J, Markowitz LE, Unger ER.

http://www.ncbi.nlm.nih.gov/pubmed/23292130

Abstract
PURPOSE:
Two human papillomavirus (HPV) vaccines are available to prevent cervical cancer. One early measure of HPV vaccine impact would be a reduction in vaccine-related HPV types (HPV 6, 11, 16, or 18, or HPV 16, 18) in cervical samples from young women. We aimed to assess feasibility of specimen collection and baseline HPV prevalence in an integrated healthcare delivery system.

METHODS:
Residual cervical specimens collected during routine cervical cancer screening (2006-2008) were retained consecutively from eligible females aged 11-29 years, stratified by age group. Specimens were evaluated for 37 HPV genotypes using the Roche Linear Array assay.

RESULTS:
Of 10,124 specimens submitted, 10,103 (99 %) were adequate for HPV testing. Prevalence of HPV 6, 11, 16, or 18 genotype was 11.4 % overall and was the highest in the youngest age group (18.1 % in the 11-19-year-olds, 12.5 % in the 20-24-year-olds, and 7.0 % in the 25-29-year-olds).

CONCLUSIONS:
HPV types 6, 11, 16, or 18 prevalence could be measured over time to assess early HPV vaccine impact using residual specimens from an integrated healthcare delivery system, particularly if sampling focused on young women.

New York Times
http://www.nytimes.com/
Accessed 19 January 2013.

Op-Ed Contributor
Stick With the Science
By SETH BERKLEY
Published: January 17, 2013

GOVERNMENT representatives are meeting in Geneva this week to decide whether to introduce a global ban on mercury that could include thiomersal, a mercury-based preservative that has been used in some vaccine manufacturing since the 1930s to prevent bacterial or fungal contamination of multidose vials of vaccine.

Hosted by the United Nations Environment Program, the intergovernmental negotiating committee is charged with drafting a global treaty to rid the world of the threats posed by mercury.

Despite the ominous connotations of mercury, the decision should in theory be a no-brainer: The scientific and medical consensus is that thiomersal poses no human health risk, and that rather than saving lives, a ban would put millions of the world’s poorest children at risk of deadly diseases by disrupting vaccination programs.

But with vaccines, logic and evidence don’t always prevail. In the late 1990s we were at a similar juncture when, as part of a broader remit to find ways to reduce the human health hazards posed by mercury and under pressure from anti-vaccine lobbyists, the U.S. Food and Drug Administration turned its attention to the safety of thiomersal (known in the U.S. as thimerosal).

Despite a lack of evidence that it was harmful — and in the absence of any evidence to show that it wasn’t — the F.D.A. decided to take a precautionary approach and urged manufacturers to reduce or eliminate thiomersal from almost all vaccines in the United States.

Since then, scientists have published unequivocal evidence of its safety, including a 2006 study which showed that thiomersal is broken down by the body into ethylmercury. Unlike methylmercury, say from contaminated fish, which can make its way through the food chain and accumulate in the body, ethylmercury is naturally flushed out of the body within a couple of weeks. Despite such clinical and laboratory evidence, the damage to thiomersal’s reputation had already been done, and anti-vaccine campaigners are still trying to fan the flames.

Anti-vaccination groups have long campaigned against the use of thiomersal, claiming that this organic mercury derivative was responsible for increases in developmental disorders such as autism. What’s more, they argue that with a precautionary reduction already in place in the United States, denying children in developing countries access to the same thiomersal-free vaccines would be a global injustice.

Nothing could be further from the truth. Quite apart from the mountain of scientific evidence refuting any link between thiomersal and autism, with some studies involving hundreds of thousands of children [pdf], banning thiomersal or phasing out this agent would have a devastating impact on global health and lead to millions of children being denied access to life-saving vaccines.

To some extent, thiomersal is still used in vaccines in the United States and Europe, for example in some flu shots, but if there were a ban we could easily switch to single-dose vials.

In developing countries this is not so simple. Not only are single-dose vials less cost effective and less practical for mass vaccinations, they also take up more space in refrigerators, which are already at peak storage capacity. In the absence of any alternative preservative, far fewer vaccines would reach children in developing countries.

This would be a tragedy. In 2010 alone it is estimated that more than 1.4 million child deaths were prevented through the use of thiomersal-containing vaccines. Little wonder that organizations such as the World Health Organization, Doctors Without Borders, the American Academy of Pediatrics, the U.S. Institute of Medicine and the GAVI Alliance oppose a ban.

Indeed thiomersal is not the main target of the anti-mercury treaty, but rather an unfortunate bycatch. Even so, in many ways the situation mirrors the debate that took place more than a decade ago. This time it is the U.N.E.P. that is undertaking the laudable task of reducing the human health impact of mercury. The problem is that under pressure from anti-vaccine groups, hard scientific evidence is sometimes disregarded.

A recent example of this took place in December in a French case involving a claim by a former state employee that the aluminum content of vaccines given to him at work made him chronically ill. Although the court was not convinced of a probable link between the man’s illness and vaccinations, and in the absence of any scientific evidence of a link or any other explanation, it ruled in favor of the employee.

That is not to say that taking precautions isn’t intrinsically sensible; it’s just that sometimes dodging the issue in this way is not the best precaution, and instead of solving problems it sometimes creates them.

One of the core principles of medicine is “primum non nocere”: first, do no harm. But given the sheer numbers of lives at stake there is a strong argument that the burden of proof be shifted to the detractors.

Where a vaccine already has an established and strong safety record and is saving lives, the onus should be on producing evidence of a genuine risk before there is any change in policy related to its availability.

With millions of vulnerable lives at stake, the treaty negotiators need to engage and recognize that a ban on thiomersal would be bad policy based on bad science.

Seth Berkley is a medical epidemiologist and chief executive of the GAVI Alliance, a public-private global health partnership to increase access to immunization in poor countries.

Twitter Watch (19 January 2013 – 19:43)
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.

World Bank Data @worldbankdata
We’ve just updated the World Development Indicators – get the most current and accurate global development #opendata – http://cot.ag/X8snXG 
Retweeted by World Bank
12:28 PM – 18 Jan 13

CDC Flu ‏@CDCFlu
Today, CDC announced 48 states have reported widespread flu activity. http://1.usa.gov/gUUlCT . Get a flu vax to protect yourself from flu.
Retweeted by CDCgov
9:28 AM – 18 Jan 13

IHME at UW ‏@IHME_UW
RT @fogarty_nih: Recorded webcast of Dr Chris Murray of IHME @UW speaking yesterday at #NIH on #GBD2010 is now live > http://videocast.nih.gov/Summary.asp?File=17753 …
9:32 AM – 18 Jan 13

GAVI Alliance ‏@GAVIAlliance
Next week, GAVI CEO @GAVISeth & GAVI Board Chair @Hoybraten will attend #WEF Annual Meeting in #Davos! Follow them! http://ht.ly/gVb8f 
2:49 AM – 18 Jan 13

WHO @WHO
An estimated 20 million children worldwide did not receive the first dose of #measles vaccine in 2011
12:08 PM – 17 Jan 13

WHO ‏@WHO
In 2011, large #measles outbreaks were reported, among others, in DRC, Ethiopia, India, Nigeria, Pakistan, France, Italy, Spain
11:32 AM – 17 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_12 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…

The National Foundation for Infectious Diseases (NFID) announced that it will honor Dr. Paul A. Offit with the Maxwell Finland Award for Scientific Achievement at its Annual Awards Dinner on Tuesday, March 5, 2013. The award will be presented to Dr. Offit “for his outstanding work in the pediatric vaccine arena and his ongoing commitment to vaccine advocacy.” The Award is given to a scientist who has made outstanding contributions to the understanding of infectious diseases or public health. The announcement noted that ”Dr. Paul A. Offit is an impassioned advocate for immunization. He has rallied the scientific counterattack against the anti-vaccine movement. Dr. Offit is the co-inventor of the RotaTeg rotavirus vaccine which is recommended for universal use in infants in the US and is widely used in other countries. Dr. Offit is credited with saving countless lives worldwide.”

Vijay Samant, president and chief executive officer of Vical, Inc., commented “I believe Dr. Offit is a most appropriate candidate for the Maxwell Finland Awards for his broad influence on the pediatric vaccine field, from his development of the life-saving rotavirus vaccines, to his exemplary pediatric practice, to his staunch support of childhood immunization against zealous opponents. His insightful and approachable style of writing has helped bridge the gap between medical research and the general public. His legacy must include both the hundreds of thousands of lives already saved by the rotavirus vaccines, and the million more that will be saved by his advocacy for prudent vaccine policy.”

http://www.nfid.org/publications/helix/December-2012.pdf

Pfizer announced that the European Commission has approved expanding the use of Prevenar 13 to older children and adolescents aged 6 to 17 years for active immunization for the prevention of invasive disease, pneumonia and acute otitis media caused by vaccine-type Streptococcus pneumoniae. Children in this age group who have not previously received Prevenar 13 may receive a single dose of the vaccine.

http://www.businesswire.com/news/home/20130108005435/en/Pfizer-Receives-European-Approval-Expand-Prevenar-13

The PATH Malaria Vaccine Initiative (MVI) and Inovio Pharmaceuticals, Inc. announced a follow-on collaboration to advance malaria vaccine development and new vaccination delivery technologies. Researchers “will test whether a novel vaccine approach that combines genetically engineered DNA with an innovative vaccine delivery technology called electroporation could induce an immune response in humans that protects against malaria parasite infection.” This follow-on agreement for clinical development builds on a 2010 research and development collaboration between Inovio and MVI.  Electroporation “deploys controlled electrical impulses to create temporary pores in a cell membrane, allowing uptake of the synthetic DNA. The cell then uses the DNA’s instructions to produce proteins that mimic the presence of the malaria pathogen, with the aim of inducing an immune response that provides protection against malaria.” Dr. David C. Kaslow , director of MVI, said, “We are excited to bring this innovative delivery technology into clinical testing to see whether the compelling immune responses seen in animal models translate to humans. Determining if and how these potent immune responses lead to protection against infection with the most deadly form of malaria is a high priority in our efforts to develop a next generation malaria vaccine.”

http://www.prnewswire.com/news-releases/path-malaria-vaccine-initiative-and-inovio-pharmaceuticals-partner-to-accelerate-development-of-malaria-vaccines-and-innovative-delivery-technologies-185835962.html

GAVI said it welcomed results from its first ever review by MOPAN (Multilateral Organisation Performance Assessment Network) in which it was “…commended for its effectiveness in increasing access to immunisation and for its focus on results.” GAVI said the review noted strengths including financial management, accountability checks, country ownership support and relationship management, and that it “was rated adequate, strong or above for 95% of the key performance indicators as a result of the document review.” The review also highlighted areas where performance could be improved, such as iGAVI’s “strategic management, its use of indicators to measure progress towards Paris Declaration Commitments, the management practices used in its budgeting process and its guidelines on evaluation coverage.” MOPAN is a network of 17 donor countries, representing the majority of worldwide Overseas Development Assistance (ODA), which rates the effectiveness of multilateral organisations. MOPAN members share information, carry out joint assessments and draw on each other’s expertise in evaluation. This review was led by the governments of France, Spain and Sweden. To serve as a basis for the report, country-level surveys were undertaken in 15 GAVI-eligible countries, including Bangladesh, Cambodia, the Democratic Republic of the Congo, Georgia, Ghana, Honduras, Indonesia, Nicaragua, Niger, Nigeria, Pakistan, Rwanda, the United Republic of Tanzania, the Republic of Yemen and Zimbabwe. http://www.gavialliance.org/library/news/statements/2013/gavi-recognised-for-effectiveness-and-focus-on-results/

IFFIm (International Finance Facility for Immunisation) announced that “three longtime banking officials with significant international experience joined its board of directors on 1 January 2013. The 3-year terms were approved by the board in December and include:

– Cyrus Ardalan, Vice Chairman of Barclays, where he has served in several key roles in government relations, emerging markets and investment banking…

– Marcus Fedder, who most recently has focused on microfinance after a long career in banking, during which he held senior positions at Toronto Dominion Bank, CIBC and Deutsche Bank…

Christopher Egerton-Warburton, who helped create IFFIm as the lead banker at Goldman Sachs at its creation…

The appointments are in conjunction with the expiring term of John Cummins, who rotated off the board at year-end 2012, the upcoming expiration of the term of Dayanath Jayasuriya at end-June 2013, and the departure of Arunma Oteh at year-end 2011. “IFFIm is a multilateral development institution created to accelerate the availability of predictable, long-term funds for health and immunisation programmes through the GAVI Alliance in more than 50 of the world’s poorest countries. It has raised more than US$ 3.7 billion in the bond markets, backed by US$ 6.3 billion in pledges from nine countries.”

http://www.iffim.org/library/news/press-releases/2013/iffim-appoints-three-new-members-to-its-board-of-directors/

Update: Polio this week – As of 09 January 2013
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s Extract and bolded text]
– Two years polio-free: January 13 will mark two years since a child was paralyzed by wild poliovirus in India, a country once considered the most complex challenge to global polio eradication.
– Response to Niger outbreak: The first immunization activities start in Niger on 112 January 2013, in close coordination with Nigeria. This first outbreak of imported wild poliovirus in 2012 is due to virus of Nigerian origin.

Afghanistan
– Two new WPV cases were reported in the past week, bringing the total number of WPV cases for 2012 to 37. Both of the WPV cases occurred in Nangarhar (2 WPV1), a newly infected province, with onset of paralysis on 20 December 2012. Outbreak response immunization in 10 districts in Nangarhar will be conducted using bivalent OPV.
– No new cases of circulating vaccine-derived poliovirus type (cVDPV) were reported in the past week. The total number of cVDPV cases for 2012 remains 4.

Nigeria
– Two new WPV cases were reported in the past week (1 WPV1 from Kano and 1 WPV1 from Katsina), bringing the total number of WPV cases for 2012 to 121. The most recent case occurred in Federally Capital Territory and had onset of paralysis on 3 December 2012. Both of the cases reported this week occurred in previously-infected districts.
– Two new cVDPV2 cases were reported in the past week, bringing the total number of cVDPV2 cases for 2012 to 6. Both cases occurred in Kebbi (Koko/Besse district), a province that had not previously reported any cases of cVDPV in 2012. The most recent had onset of paralysis on 24 November 2012.
– Given the spread of WPV of Nigerian origin to Niger, targeted Supplementary Immunization Activities will take place in high-risk and under-served districts in Nigeria on 12-112 January and in the wards of Sokoto, Katsina and Zamfara states bordering Niger on 15-18 January, synchronized with Niger.
– Staggered National Immunization Days across Nigeria are planned for 26 Jan – 2 February and 23 Feb – 2 March, also to be synchronized with Niger.

Niger
– Niger reports polio: In the first outbreak of polio in 2012 outside of an endemic country or a country with re-established poliovirus, Niger has reported a case of wild poliovirus. This is the first case in the country since December 2011 and is related to virus originating in Nigeria.

The Weekly Epidemiological Record (WER) for 11 January 2013, vol. 88, 2 (pp 17–28) includes:
– Monitoring and evaluation of preventive chemotherapy
– Estimated number of people covered by preventive chemotherapy: update for 2010 and 2011
http://www.who.int/entity/wer/2013/wer8802.pdf

WHO – Global Alert and Response (GAR)
Disease Outbreak News – Most recent news items
12 December 2012
Yellow fever in the Republic of Congo
6 December 2012
Yellow fever in Sudan – update

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

Save the Children released a new report –  Ending Poverty in Our Generation – which outlines a new development system it said could “end extreme poverty in the next 20 years,” and includes “one of the first proposals for new targets to replace the Millennium Development Goals.” Save the Children’s CEO Carolyn Miles said, “With the 2015 deadline fast approaching, Save the Children is working globally to ensure that collectively, we learn the lessons of the current Millennium Development Goals and contribute to the evolution of an ambitious new global development framework. Our flagship report discusses what we believe are core priorities and identifies 10 key recommendations for fostering a post-2015 framework that emphasizes human development, equity, and accountability with a focus on our future – the children.”.”
http://www.savethechildren.org/site/apps/nlnet/content2.aspx?c=8rKLIXMGIpI4E&b=8486805&ct=12713395&notoc=1

[Editor’s Note: We extract a short portion of the Executive Summary below.]
“Save the Children’s suggested post-2015 development framework champions universal and equitable development, with human rights as its guiding principle and evidence as a foundation for its approaches.

“Human rights principles such as universality, equality and inalienability must underpin everything that is agreed. And, unlike with the MDGs, these principles must be visible in the targets established. Now is the time to aim at no less than:
– a zero target for absolute poverty reduction

– a zero target for hunger

– a zero target for preventable child and maternal deaths

– a zero target for those without safe drinking water and sanitation…

…We propose the following six goals for the new framework, to put in place the foundations for human development:
– Goal 1: By 2030 we will eradicate extreme poverty and reduce relative poverty through inclusive growth and decent work

– Goal 2: By 2030 we will eradicate hunger, halve stunting, and ensure universal access to sustainable food, water and sanitation

– Goal 3: By 2030 we will end preventable child and maternal mortality and provide basic healthcare for all

– Goal 4: By 2030 we will ensure children everywhere receive quality education and have good learning outcomes

– Goal 5: By 2030 we will ensure all children live a life free from all forms of violence, are protected in conflict and thrive in a safe family environment

– Goal 6: By 2030 governance will be more open, accountable and inclusive

To provide a supportive environment for these goals we propose four more:
– Goal 7: By 2030 we will establish effective global partnerships for development

– Goal 8: By 2030 we will build disaster-resilient societies

– Goal 9: By 2030 we will ensure a sustainable, healthy and resilient environment for all

– Goal 10: By 2030 we will deliver sustainable energy to all

http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/ENDING_POVERTY_IN_OUR_GENERATION_AFRICA_LOW_RES_US_VERSION.PDF

[Editor’s Note 2: A search of the report using the terms “vaccine” and “immunization” yielded one occurrence on P.31 in the discussion of potential indicators for Goal 3]

– Goal 3: By 2030 we will end preventable child and maternal mortality and provide healthcare for all
Potential Indicators: 2j Percentage of infants aged 12–23 months who received three doses of diphtheria, pertussis and tetanus vaccine
Statement: UNICEF
UNICEF said it welcomed the launch of the Save the Children report, noting it as an “important contribution to discussions on the critical question of how the world can best address the survival, development and protection of its children in the coming years and decades, as part of an overall framework for sustainable and effective development.”  UNICEF noted that the report “..provides concrete ideas on setting new goals that will accelerate efforts for the progress and protection of the world’s most marginalized children. Valuably, it also addresses the question of how the most deep-seated challenges for children and families – such as inequalities, environmental fragility, weak accountability, natural disasters and conflict – can be better targeted in the present and coming generations.” http://www.unicef.org/media/media_67149.html

WHO: Global Maternal Health Conference
15–17 January 2013
Arusha, Tanzania
The Global Maternal Health Conference is a technical conference for scientists, researchers, and policy-makers to network, share knowledge, and build on progress toward eradicating preventable maternal mortality and morbidity by improving quality of care.

The 2013 conference will build on the successful technical focus and abstract-driven structure of the 2010 conference. There will be 5 conference tracks:
– Programme approaches and tools to improve the quality of maternal health care.
– Measurement of the quality of maternal health care.
– Strengthening health systems for improving the quality of maternal health care.
– Access to and utilization of quality maternal health care.
– Evidence-informed policy and advocacy for quality maternal health care.

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

WHO: Technical consultative meeting on novel human coronavirus
14–15 January 2013
Cairo

9 January 2013 – To date, a total of nine laboratory-confirmed cases of infection with the novel human coronavirus have been reported to WHO – five cases, including three deaths, from Saudi Arabia, two cases from Qatar and two cases (both fatal) from Jordan.

The novel coronavirus first raised concerns in September 2012 when it caused severe respiratory disease in two patients from the Region. The subsequent discovery of two clusters of cases, one in a family in Saudi Arabia and the second in a group of health care workers in Jordan, increased the urgency of better understanding the virus. The potential of the virus to cause widespread serious consequences is thought to be significant, yet current knowledge of its epidemiology and natural history of infection with this agent is limited. Many critical questions about the source of the virus, its potential for transmission, important exposures and the clinical appearance of disease remain unanswered.

Many activities have already been conducted in investigating the new virus and managing its public health consequences. Within this context, WHO has organized a technical consultative meeting to take place at the WHO Regional Office in Cairo from 14 to 112 January 2013 on the novel human coronavirus. The meeting will bring together representatives of the three countries already affected, in addition to key partners and WHO collaborating centres involved in managing this public health issue, together with WHO experts…

http://www.emro.who.int/media/news/coronavirus-consultative-meeting.html

American Journal of Public Health
Volume 103, Issue 2 (February 2013)
http://ajph.aphapublications.org/toc/ajph/current

Effects of Socioeconomic Status and Health Care Access on Low Levels of Human Papillomavirus Vaccination Among Spanish-Speaking Hispanics in California
Shingisai Chando, Jasmin A. Tiro, T. Robert Harris, Sarah Kobrin, Nancy Breen
American Journal of Public Health: February 2013, Vol. 103, No. 2: 270–272.

ABSTRACT
Little is known about the effect of language preference, socioeconomic status, and health care access on human papillomavirus (HPV) vaccination. We examined these factors in Hispanic parents of daughters aged 11 to 17 years in California (n=1090). Spanish-speaking parents were less likely to have their daughters vaccinated than were English speakers (odds ratio [OR] = 0.55; 95% confidence interval [CI] =  0.31, 0.98). Adding income and access to multivariate analyses made language nonsignificant (OR = 0.68; 95% CI = 0.35, 1.29). This confirms that health care use is associated with language via income and access. Low-income Hispanics, who lack access, need information about free HPV vaccination programs.

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.300920