The Pediatric Infectious Disease Journal
December 2012 – Volume 31 – Issue 12  pp: 1217-1307,e232-e254
http://journals.lww.com/pidj/pages/currenttoc.aspx

Review Articles
Incidence and Use of Resources for Chickenpox and Herpes Zoster in Latin America and the Caribbean—A Systematic Review and Meta-analysis
Bardach, Ariel; Cafferata, María Luisa; Klein, Karen; Cormick, Gabriela; Gibbons, Luz; Ruvinsky, Silvina
Pediatric Infectious Disease Journal. 31(12):1263-1268, December 2012.
doi: 10.1097/INF.0b013e31826ff3a5

Abstract:
Background: Varicella-zoster virus causes chickenpox and herpes zoster. More than 90% of varicella cases occur in childhood. The aim of this study was to gather all relevant information on epidemiology and resource use in Latin America and the Caribbean since 2000.

Methods: Epidemiologic studies published since 2000 with at least 50 cases of varicella or herpes zoster, or at least 10 cases of congenital disease were included. Gray literature was also searched. Outcomes included incidence, admission rate, mortality and case-fatality ratio. Use of resources and both direct and indirect costs associated were extracted.

Results: From the 495 records identified, 23 were included in the meta-analysis to report varicella-zoster virus outcomes and 3 in the herpes zoster analysis. The global pooled varicella incidence in subjects under 15 years of age was 42.9 cases per 1000 individuals per year (95% confidence interval: 26.9–58.9); children under 5 years of age were the most affected. Pooled general admission rate was 3.5 per 100,000 population (95% confidence interval: 2.9–4.1) and median hospitalization was 5–9 days. The most common varicella complications reported in studies were skin infections (3–61%), followed by respiratory infections (0–15%) and neurologic problems (1–5%). Direct costs averaged (2011/international dollar [I$]) $2040 per admission (range, I$ 298–5369) and I$70 per clinical visit (range, 11–188 I$).

Conclusions: Limited information was available on the outcomes studied. Improvements in the surveillance of ambulatory cases are required to obtain a better epidemiologic picture. As of 2011, only 2 countries introduced the vaccine in national immunization programs in Latin America and the Caribbean.

The Pediatric Infectious Disease Journal
December 2012 – Volume 31 – Issue 12  pp: 1217-1307,e232-e254
http://journals.lww.com/pidj/pages/currenttoc.aspx

Completeness of Reporting in Randomized Controlled Trials of 3 Vaccines: A Review of Adherence to the CONSORT Checklist
Scott, Pippa; Ott, Franziska; Egger, Matthias; Low, Nicola
Pediatric Infectious Disease Journal. 31(12):1286-1294, December 2012.
doi: 10.1097/INF.0b013e31827032bb

Abstract:
Background: Clear reporting of randomized controlled trials (RCTs) of vaccines is important for understanding results and assessing their validity. The CONsolidated Standards of Reporting Trials (CONSORT) statement provides guidance to help authors reporting RCTs. The objective was to assess the completeness of reporting of RCTs of vaccines based on the CONSORT 2010 checklist.

Methods: We collected data about items required by the CONSORT checklist or specific to trials of vaccines. We used publications of RCTs identified in 3 systematic reviews of pneumococcal polysaccharide, pneumococcal conjugate and rotavirus vaccines. We included the first journal publication that reported clinical, carriage or immunological data for each trial and summarized results descriptively.

Results: We included 70 publications from 19 journals. Of these, 14 publications (20%) stated in the title that the trial was randomized and 26 publications (37%) nominated at least 1 primary outcome. The method for generating the random allocation sequence was fully reported in 24 publications (34%), the method of allocation concealment in 9 publications (13%) and 30 publications (43%) included a flow diagram. Trial registration numbers were reported in all articles published in 2010 to 2011. Actual age at vaccination was reported in 20% of trials of childhood schedules. Eleven of 19 journals endorsed the CONSORT statement.

Conclusions: The reporting of RCTs of vaccines is incomplete, with important methodological details missing from most reports. Journals could play a leading role in implementing changes. Improved reporting would make publications of vaccine trials easier to find, the findings easier to interpret and aid the incorporation of findings into policy.

Pediatrics
December 2012, VOLUME 130 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Impact of a Third Dose of Measles-Mumps-Rubella Vaccine on a Mumps Outbreak
Ikechukwu U. Ogbuanu, Preeta K. Kutty, Jean M. Hudson, Debra Blog, Glen R. Abedi, Stephen Goodell, Jacqueline Lawler, Huong Q. McLean, Lynn Pollock, Elizabeth Rausch-Phung, Cynthia Schulte, Barbara Valure, Gregory L. Armstrong, and Kathleen Gallagher
Pediatrics 2012; 130:e1567-e1574

Abstract
BACKGROUND AND OBJECTIVE: During 2009–2010, a northeastern US religious community experienced a large mumps outbreak despite high 2-dose measles-mumps-rubella (MMR) vaccine coverage. A third dose of MMR vaccine was offered to students in an affected community in an effort to control the outbreak.

METHODS: Eligible sixth- to 12th-grade students in 3 schools were offered a third dose of MMR vaccine. Baseline and follow-up surveys and physician case reports were used to monitor mumps attack rates (ARs). We calculated ARs for defined 3-week periods before and after the intervention.

RESULTS: Of 2265 eligible students, 2178 (96.2%) provided documentation of having received 2 previous doses of MMR vaccine, and a high proportion (1755 or 80.6%) chose to receive an additional vaccine dose. The overall AR for all sixth- to 12th-grade students declined from 4.93% in the prevaccination period to 0.13% after vaccination (P < .001). Villagewide, overall AR declined by 75.6% after the intervention. A decline occurred in all age groups but was significantly greater (96.0%) among 11- to 17-year-olds, the age group targeted for vaccination, than among all other age groups. The proportions of adverse events reported were lower than or within the range of those in previous reports of first- and second-dose MMR vaccine studies.

CONCLUSIONS: This is the first study to assess the impact of a third MMR vaccine dose for mumps outbreak control. The decline in incidence shortly after the intervention suggests that a third dose of MMR vaccine may help control mumps outbreaks among populations with preexisting high 2-dose vaccine coverage.

Pediatrics
December 2012, VOLUME 130 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

The Globalization of Pediatric Clinical Trials
Julia Dunne, M. Dianne Murphy, and William J. Rodriguez
Pediatrics 2012; 130:e1583-e1591

Abstract
OBJECTIVE: To examine the characteristics of pediatric trials conducted under US legislation and to compare results with data from 2002 to 2007.

METHODS: We reviewed all pediatric trials provided to the US Food and Drug Administration in submissions that were approved between September 28, 2007 and December 21, 2010. We extracted data for each trial including age range, therapeutic indication, design, duration, and patient and center enrollment by location.

RESULTS: Overall 346 studies on 113 drugs and biologicals enrolled 55 819 pediatric patients. The United States participated in 86% of the studies, providing 71% of the centers and 74% of the patients. Corresponding percentages for non-US countries were 43%, 29%, and 26% respectively. Developing or transition countries participated in 22% of the studies, providing 12% of the centers and 10% of the patients; our earlier analysis found corresponding percentages of 38%, 12%, and 23%. The most common therapeutic areas studied in the latter countries were infectious, neurologic, and pulmonary diseases. Seventy-eight vaccine studies enrolled 147 692 patients. The United States participated in 40% of the studies, providing 39% of the centers and 22% of the patients. Corresponding percentages for non-US countries were 74%, 61%, and 78% respectively. Developing or transition countries participated in 27% of the studies, providing 15% of the centers and 52% of the patients.

CONCLUSIONS: The United States remains an important location for pediatric trials. Developing country involvement in pediatric drug development is not increasing, although these countries participate significantly in vaccine trials.

Pediatrics
December 2012, VOLUME 130 / ISSUE 6
http://pediatrics.aappublications.org/current.shtml

Vaccination Coverage Among American Indian and Alaska Native Children, 2006–2010
Amy V. Groom, Tammy A. Santibanez, and Ralph T. Bryan
Pediatrics 2012; 130:e1592-e1599

Abstract
BACKGROUND AND OBJECTIVES: A previous study on vaccination coverage in the American Indian/Alaska Native (AI/AN) population found that disparities in coverage between AI/AN and white children existed from 2001 to 2004 but were absent in 2005. The objective of this study was to describe vaccination coverage levels for AI/AN children aged 19-35 months in the United States between 2006 and 2010, examining whether gains found for AI/AN children in 2005 have been sustained.

METHODS: Data from the 2006 through 2010 National Immunization Surveys were analyzed. Groups were defined as AI/AN (alone or in combination with any other race and excluding Hispanics) and white-only non-Hispanic children. Comparisons in demographics and vaccination coverage were made.

RESULTS: Demographic risk factors often associated with underimmunization were significantly higher for AI/AN respondents compared with white respondents in most years studied. Overall, vaccination coverage was similar between the 2 groups in most years, although coverage with 4 or more doses of pneumococcal conjugate vaccine was lower for AI/AN children in 2008 and 2009, as was coverage with vaccine series measures the series in 2006 and 2009. When stratified by geographic regions, AI/AN children had coverage that was similar to or higher than that of white children for most vaccines in most years studied.

CONCLUSIONS: The gains in vaccination coverage found in 2005 have been maintained. The absence of disparities in coverage with most vaccines between AI/AN children and white children from 2006 through 2010 is a clear success. These types of periodic reviews are important to ensure we remain vigilant.

PLoS One
[Accessed 1 December 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Vaccination Rates among the General Adult Population and High-Risk Groups in the United States
Kathy Annunziata, Aaron Rak, Heather Del Buono, Marco DiBonaventura, Girishanthy Krishnarajah
PLoS ONE: Research Article, published 30 Nov 2012 10.1371/journal.pone.0050553

Abstract 
Background
In order to adequately assess the effectiveness of vaccination in helping to control vaccine-preventable infectious disease, it is important to identify the adherence and uptake of risk-based recommendations.

Methods
The current project includes data from five consecutive datasets of the National Health and Wellness Survey (NHWS): 2007 through 2011. The NHWS is an annual, Internet-based health questionnaire, administered to a nationwide sample of adults (aged 18 or older) which included items on vaccination history as well as high-risk group status. Vaccination rates and characteristics of vaccinees were reported descriptively. Logistic regressions were conducted to predict vaccination behavior from sociodemographics and risk-related variables.

Results
The influenza vaccination rate for all adults 18 years and older has increased significantly from 28.0% to 36.2% from 2007 to 2011 (ps<.05). Compared with those not at high risk (25.1%), all high-risk groups were vaccinated at a higher rate, from 36.8% (pregnant women) to 69.7% (those with renal/kidney disease); however, considerable variability among high-risk groups was observed. Vaccination rates among high-risk groups for other vaccines varied considerably though all were below 50%, with the exception of immunocompromised respondents (57.5% for the hepatitis B vaccine and 52.5% for the pneumococcal vaccine) and the elderly (50.4% for the pneumococcal). Multiple risk factors were associated with increased rate of vaccination for most vaccines. Significant racial/ethnic differences with influenza, hepatitis, and herpes zoster vaccination rates were also observed (ps<.05).

Conclusions
Rates of influenza vaccination have increased over time. Rates varied by high-risk status, demographics, and vaccine. There was a pattern of modest vaccination rate increases for individuals with multiple risk factors. However, there were relatively low rates of vaccination for most risk-based recommendations and all fell below national goals.

PLoS Neglected Tropical Diseases
November 2012
http://www.plosntds.org/article/browseIssue.action

Urban Cholera Transmission Hotspots and Their Implications for Reactive Vaccination: Evidence from Bissau City, Guinea Bissau
Andrew S. Azman, Francisco J. Luquero, Amabelia Rodrigues, Pedro Pablo Palma, Rebecca F. Grais, Cunhate Na Banga, Bryan T. Grenfell, Justin Lessler

Abstract 
Background
Use of cholera vaccines in response to epidemics (reactive vaccination) may provide an effective supplement to traditional control measures. In Haiti, reactive vaccination was considered but, until recently, rejected in part due to limited global supply of vaccine. Using Bissau City, Guinea-Bissau as a case study, we explore neighborhood-level transmission dynamics to understand if, with limited vaccine and likely delays, reactive vaccination can significantly change the course of a cholera epidemic.

Methods and Findings
We fit a spatially explicit meta-population model of cholera transmission within Bissau City to data from 7,551 suspected cholera cases from a 2008 epidemic. We estimated the effect reactive vaccination campaigns would have had on the epidemic under different levels of vaccine coverage and campaign start dates. We compared highly focused and diffuse strategies for distributing vaccine throughout the city. We found wide variation in the efficiency of cholera transmission both within and between areas of the city. “Hotspots”, where transmission was most efficient, appear to drive the epidemic. In particular one area, Bandim, was a necessary driver of the 2008 epidemic in Bissau City. If vaccine supply were limited but could have been distributed within the first 80 days of the epidemic, targeting vaccination at Bandim would have averted the most cases both within this area and throughout the city. Regardless of the distribution strategy used, timely distribution of vaccine in response to an ongoing cholera epidemic can prevent cases and save lives.

Conclusions
Reactive vaccination can be a useful tool for controlling cholera epidemics, especially in urban areas like Bissau City. Particular neighborhoods may be responsible for driving a city’s cholera epidemic; timely and targeted reactive vaccination at such neighborhoods may be the most effective way to prevent cholera cases both within that neighborhood and throughout the city.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 31, Issue 1, Pages 1-278 (17 December 2012)

Developing evidence-based immunization recommendations and GRADE
Original Research Article
Pages 12-19
P. Duclos, D.N. Durrheim, A.L. Reingold, Z.A. Bhutta, K. Vannice, H. Rees

Abstract
The Strategic Group of Advisory Experts (SAGE) on immunization is an independent advisory committee with a mandate to advise the World Health Organization (WHO) on the development of vaccine and immunization related policies. SAGE working groups are established on a time-limited basis to review and provide evidence-based recommendations, together with their implications, for open deliberation and decision-making by SAGE. In making its recommendations, SAGE takes into consideration: the epidemiologic and clinical characteristics of the disease; vaccine and immunization characteristics; economic analysis; health system considerations; the existence of and interaction with other intervention and control strategies; costing and social impacts; and legal and ethical concerns. Since 1998, WHO has produced evidence-based vaccine position papers for use primarily by national public health officials and immunization programme managers. Since April 2006 all new or updated position papers have been based on SAGE recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach has been adopted by WHO and, since 2008, GRADE tables that rate the quality of evidence have been produced in support of key recommendations. SAGE previously expressed concern that GRADE was not ideally suited to many immunization-specific issues such as the vaccine population level effect and the inclusion of surveillance system data, particularly for vaccine safety. Extensive productive interactions with various advisory groups including the US Advisory Committee on Immunization Practices, the European Centres for Disease Control, the German Standing Committee on Vaccination (STIKO), WHO’s Global Advisory Committee on Vaccine Safety and the GRADE working group resulted in key enhancements to accommodate vaccine-relevant evidence. This facilitated integration and acceptability of the GRADE approach in the development of immunization related SAGE and WHO recommendations. Ongoing utilisation should result in further fine-tuning of the approach to ensure that recommendations are based on the full range of appropriate evidence.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 31, Issue 1, Pages 1-278 (17 December 2012)

Brief Reports
Influenza vaccination coverage among patients and healthcare workers in a university hospital during the 2006–2007 influenza season
Pages 23-26
Caroline Landelle, Philippe Vanhems, Mitra Saadatian-Elahi, Nicolas Voirin

Abstract
Despite years of public health effort to increase vaccine uptake among populations recommended for influenza vaccination, immunization rates remain low among patients and healthcare workers (HCWs). The objective of this study was to report on influenza vaccination coverage of patients and HCWs for the same time period in 4 wards of a university hospital. A prospective cross-sectional study was conducted among patients and HCWs between December 11, 2006 and April 15, 2007 and individual factors associated with being vaccinated against influenza were assessed. Results indicated that older patients were significantly more vaccinated than younger patients. Physicians and residents were more likely to be vaccinated that the rest of staff, with possible differences between wards. Immunization of HCWs is a major issue in infection control in hospitals and long-term care facilities. However, the impact of influenza vaccination among HCWs in reducing hospital-acquired influenza and patient morbidity needs to be explored further.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 31, Issue 1, Pages 1-278 (17 December 2012)

Human papillomavirus vaccination in Auckland: Reducing ethnic and socioeconomic inequities
Original Research Article
Pages 84-88
Tracey Poole, Felicity Goodyear-Smith, Helen Petousis-Harris, Natalie Desmond, Daniel Exeter, Leah Pointon, Ranmalie Jayasinha

Abstract
Background
The New Zealand HPV publicly funded immunisation programme commenced in September 2008. Delivery through a school based programme was anticipated to result in higher coverage rates and reduced inequalities compared to vaccination delivered through other settings. The programme provided for on-going vaccination of girls in year 8 with an initial catch-up programme through general practices for young women born after 1 January 1990 until the end of 2010.

Objective
To assess the uptake of the funded HPV vaccine through school based vaccination programmes in secondary schools and general practices in 2009, and the factors associated with coverage by database matching.

Methods
Retrospective quantitative analysis of secondary anonymised data School-Based Vaccination Service and National Immunisation Register databases of female students from secondary schools in Auckland District Health Board catchment area. Data included student and school demographic and other variables. Binary logistic regression was used to estimate odds ratios and significance for univariables. Multivariable logistic regression estimated strength of association between individual factors and initiation and completion, adjusted for all other factors.

Results
The programme achieved overall coverage of 71.5%, with Pacific girls highest at 88% and Maori at 78%. Girls higher socioeconomic status were more likely be vaccinated in general practice.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 31, Issue 1, Pages 1-278 (17 December 2012)

Cost-effectiveness and economic benefits of vaccines in low- and middle-income countries: A systematic review
Original Research Article
Pages 96-108
Sachiko Ozawa, Andrew Mirelman, Meghan L. Stack, Damian G. Walker, Orin S. Levine

Abstract
Background
Public health interventions that prevent mortality and morbidity have greatly increased over the past decade. Immunization is one of these preventive interventions, with a potential to bring economic benefits beyond just health benefits. While vaccines are considered to be a cost-effective public health intervention, implementation has become increasingly challenging. As vaccine costs rise and competing priorities increase, economic evidence is likely to play an increasingly important role in vaccination decisions.

Methods
To assist policy decisions today and potential investments in the future, we provide a systematic review of the literature on the cost-effectiveness and economic benefits of vaccines in low- and middle-income countries from 2000 to 2010. The review identified 108 relevant articles from 51 countries spanning 23 vaccines from three major electronic databases (Pubmed, Embase and Econlit).

Results
Among the 44 articles that reported costs per disability-adjusted life year (DALY) averted, vaccines cost less than or equal to $100 per DALY averted in 23 articles (52%). Vaccines cost less than $500 per DALY averted in 34 articles (77%), and less than $1000 per DALY averted in 38 articles (86%) in one of the scenarios. 24 articles (22%) examined broad level economic benefits of vaccines such as greater future wage-earning capacity and cost savings from averting disease outbreaks. 60 articles (56%) gathered data from a primary source. There were little data on long-term and societal economic benefits such as morbidity-related productivity gains, averting catastrophic health expenditures, growth in gross domestic product (GDP), and economic implications of demographic changes resulting from vaccination.

Conclusions

This review documents the available evidence and shows that vaccination in low- and middle-income countries brings important economic benefits. The cost-effectiveness studies reviewed suggest to policy makers that vaccines are an efficient investment. This review further highlights key gaps in the available literature that would benefit from additional research, especially in the area of evaluating the broader economic benefits of vaccination in the developing world.

Vaccine
http://www.sciencedirect.com/science/journal/
Volume 31, Issue 1, Pages 1-278 (17 December 2012)

Vaccine-related standard of care and willingness to respond to public health emergencies: A cross-sectional survey of California vaccine providers
Original Research Article
Pages 196-201
Katherine Seib, Daniel J. Barnett, Paul S. Weiss, Saad B. Omer

Abstract
Introduction
Responding to a vaccine-related public health emergency involves a broad spectrum of provider types, some of whom may not routinely administer vaccines including obstetricians, pharmacists and other specialists. These providers may have less experience administering vaccines and thus less confidence or self-efficacy in doing so. Self-efficacy is known to have a significant impact on provider willingness to respond in emergency situations.

Methods
We conducted a survey of 800 California vaccine providers to investigate standard of care, willingness to respond, and how vaccine-related standard of care impacts willingness to respond among these providers. We used linear regression to examine how willingness to respond was impacted by vaccine-related standard of care.

Results
Forty percent of respondents indicated that they had participated in emergency preparedness training, actual disaster response, or surge capacity initiatives with significant differences among provider types for all measures (p = 0.007). When asked to identify barriers to responding to a public health emergency, respondents indicated that staff size or capacity, training and resources were the top concerns. Respondents in practices with a higher vaccine-related standard of care had a higher willing to respond index (β = 0.190, p = 0.001). Respondents who had participated in emergency training or actual emergency response had a higher willing to respond index (β = 1.323, p < 0.0001).

Conclusion
Our study suggests that concerns about staff size and surge capacity need to be more explicitly addressed in current emergency preparedness training efforts. In the context of boosting response willingness, larger practice environments stand to benefit from self-efficacy focused training and exercise efforts that also incorporate standard of care.

Vaccine
Volume 30, Issue 52, Pages 7439-7668 (14 December 2012)
http://www.sciencedirect.com/science/journal/0264410X/30

Do income inequality and social capital associate with measles-containing vaccine coverage rate?
Original Research Article
Pages 7481-7488
Kei Nagaoka, Takeo Fujiwara, Jun Ito

Abstract
Objective
We investigated the association between income inequality and social capital with measles-containing vaccine (MCV) coverage rates in Japan.

Methods
MCV coverage data for all 1750 municipalities were collected from statistics publicized by the Ministry of Health, Labour and Welfare of Japan in 2010. Prefectural Gini coefficients in 2009 (an indicator of income inequality) and social capital indicators (including voting rates, volunteer rates at the prefectural level, and move-in ratios at the municipal level) were linked to MCV coverage using a multilevel analysis adjusting for covariates (population, age distribution, average income, average number of household members).

Results
Coverage of the first dose of MCV (MCV1), and second dose (MCV2), decreased by 3.98% (95% confidence interval [CI]: 0.26–7.71) and 4.28% (95% CI: 0.60–7.60) per each 0.1-unit increase in Gini coefficients within large municipalities (with a population 50,000 or more), respectively. Conversely, coverage of MCV2 increased by 0.26% (95% CI: 0.08–0.45) per 1% increase in voting rate within large municipalities. Volunteer rates were inversely associated with MCV2 coverage within large municipalities. Move-in ratios at the municipal level were inversely associated with MCV2 coverage within medium-sized municipalities (with a population between 10,000 and 50,000).

Conclusions
While higher income inequality at a prefectural level was associated with lower MCV coverage rates, higher social capital was associated with higher coverage in large municipalities. To enhance MCV coverage in Japan, we recommend that income inequality be addressed and social capital boosted at the prefectural level.

Vaccine
Volume 30, Issue 52, Pages 7439-7668 (14 December 2012)
http://www.sciencedirect.com/science/journal/0264410X/30

Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: Regional analyses according to the endemic context
Original Research Article
Pages 7489-7497
Ana Marli C. Sartori, Patrícia Coelho de Soárez, Hillegonda Maria Dutilh Novaes, Marcos Amaku, Raymundo Soares de Azevedo, Regina Célia Moreira, Leila Maria Moreira Beltrão Pereira, Ricardo Arraes de Alencar Ximenes, Celina Maria Turchi Martelli

Abstract
Objective
To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil.

Methods
An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South + Southeast (low endemicity) and one for the North + Northeast + Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real).

Results
A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs.

Conclusions
Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program.

Vaccine
Volume 30, Issue 52, Pages 7439-7668 (14 December 2012)
http://www.sciencedirect.com/science/journal/0264410X/30

The impact of new vaccine introduction on the coverage of existing vaccines: A cross-national, multivariable analysis
Original Research Article
Pages 7582-7587
Jessica C. Shearer, Damian G. Walker, Nicholas Risko, Orin S. Levine

Abstract
Background
A surge of new and underutilized vaccine introductions into national immunization programmes has called into question the effect of new vaccine introduction on immunization and health systems. In particular, countries deciding whether to introduce a new or underutilized vaccine into their routine immunization programme may query possible effects on the delivery and coverage of existing vaccines. Using coverage of diphtheria–tetanus–pertussis (DTP) vaccine as a proxy for immunization system performance, this study aims to test whether new vaccine introduction into national immunization programs was associated with changes in coverage of three doses of DTP vaccine among infants.

Methods and findings
DTP3 vaccine coverage was analyzed in 187 countries during 1999–2009 using multivariable cross-national mixed-effect longitudinal models. Controlling for other possible determinants of DTP3 coverage at the national level these models found minimal association between the introduction of Hepatitis-, Haemophilus influenzae type b-, and rotavirus-containing vaccines and DTP3 coverage. Instead, frequent and sometimes large fluctuations in coverage are associated with other development and health systems variables, including the presence of armed conflict, coverage of antenatal care services, infant mortality, the percent of health expenditures that are private and total health expenditures per capita.

Conclusions
Introductions of new vaccines did not affect national coverage of DTP3 vaccine in the countries studied. Introductions of other new vaccines and multiple vaccine introductions should be monitored for immunization and health systems impacts.

Vaccine
Volume 30, Issue 52, Pages 7439-7668 (14 December 2012)
http://www.sciencedirect.com/science/journal/0264410X/30

Individual-, family- and community-level determinants of full vaccination coverage among children aged 12–23 months in western Kenya
Original Research Article
Pages 7588-7593
Yoshito Kawakatsu, Sumihisa Honda

Abstract
To identify individual-, family-, and community-level determinants of full vaccination status at most challenging areas in Kenya, we conducted a cross-sectional study among children aged 12–23 months and their mothers. 1965 children were involved in this research and their mothers completed a questionnaire. Middle or high knowledge of vaccination schedule (Adjusted Odds Ratio (AOR) = 2.69, 95%CI: 2.01–3.60 or AOR = 8.12, 95%CI:5.50–11.97), medium/long birth interval or first birth (AOR = 2.46, 95%CI: 1.29–4.69 or AOR = 1.84, 95%CI:1.10–3.09 or AOR = 2.14, 95%CI: 1.20–3.84), less than 5 children under five years old (AOR = 1.39, 95%CI: 1.04–1.88) and highest community health worker’s (CHWs) performance (AOR = 2.20, 95%CI: 1.39–3.47) were significantly associated with complete vaccination status in the final multiple regression model. In addition, a interaction between literacy and wealth was significantly related in full vaccination status (AOR = 1.38, 95%CI: 1.08–1.75). Increased frequency and quality of CHW visits could be effective intervention to enhance vaccination coverage. Future interventions focusing on vaccination coverage should be given more attention especially to high risk group identified in this study.

Vaccine
Volume 30, Issue 51, Pages 7343-7438 (7 December 2012)
http://www.sciencedirect.com/science/journal/0264410X/30/51

Fourth ESWI Influenza Conference
Malta
11–14 September 2011

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

Satellite imagery for rapid estimation of displaced populations: a validation and feasibility study[PDF]
B Stewart, J Palmer, P Füreder, D Tiede, T Markmiller… – 2012
Page 1. Satellite imagery for rapid estimation of displaced populations: a validation and feasibility
study Final project report 20 November 2012 Main authors: Francesco Checchi Chris Grundy
London School of Hygiene and Tropical Medicine, London, UK Contributors: …

Rules and tools that improved vaccines for children vaccine-ordering practices in Oregon: a 2010 pilot project.
R Hewett, A Vancuren, L Trocio, S Beaudrault, A Gund… – Journal of public health …, 2013
OBJECTIVE:: This project’s objective was to enhance efforts to improve vaccine-ordering
efficiencies among targeted clinics using publicly purchased vaccines. DESIGN:: Using an
assessment of ordering behavior developed by the Centers for Disease Control and …

Does the Success of a School-based HPV Vaccine Programme Depend on Teachers’ Knowledge and Religion?-a Survey in a Multicultural Society.
WY Ling, SM Razali, CK Ren, SZ Omar – Asian Pacific journal of cancer prevention: …, 2012
Organized introduction of prophylactic human papillomavirus (HPV) vaccination can reduce
the burden of cervical cancer in developing countries. One of the most effective ways is
through a national school-based program. Information on teachers is therefore important …

Factors Affecting Medical Students’ Uptake of the 2009 Pandemic Influenza A (H1N1) Vaccine[HTML]
SI Lee, EM Aung, IS Chin, JW Hing, S Mummadi… – Influenza Research and …, 2012
Background. Pandemic influenza vaccination rate amongst healthcare workers in England
2009/2010 was suboptimal (40.3%). Targeting medical students before they enter the
healthcare workforce is an attractive future option. This study assessed the H1N1 vaccine …

Crying wolf? Impact of the H1N1 2009 influenza pandemic on anticipated public response to a future pandemic
Melanie R Taylor, Garry J Stevens, Kingsley E Agho, Sheree A Kable and Beverley Raphael
Med J Aust 2012; 197 (10): 561-564.
doi: 10.5694/mja11.11623
Abstract
Objective: To determine changes in public threat perception and anticipated compliance with health-protective behaviours in response to a future pandemic; using data collected before and after the H1N1 2009 influenza pandemic.

Design, setting and participants: Repeat cross-sectional computer-assisted telephone surveys with representative samples of the general New South Wales population in 2007 (2081 participants) and 2010 (2038 participants).

Main outcome measures: Perceived likelihood of a future pandemic in Australia; concern that respondents or their families would be affected; degree of change made to life because of the possibility of a pandemic; and willingness to comply with health-protective behaviours (to be vaccinated, to be isolated if necessary, and to wear a face mask).

Results: In 2007, 14.9% of the general population considered that an influenza pandemic would be highly likely to occur in future; this proportion rose to 42.8% in 2010 (odds ratio [OR], 4.96; 95% CI, 3.99–6.16; P < 0.001). Conversely, in the same period concern that respondents or their families would be directly affected by a future pandemic dropped from 45.5% to 32.5% (OR, 0.57; 95% CI, 0.44–0.74; P < 0.001). Willingness to be vaccinated against influenza in a future pandemic decreased from 75.4% to 64.6% (OR, 0.69; 95% CI, 0.55–0.86; P < 0.001). A general decrease in willingness to be vaccinated was noted across all age groups, most notably for those aged 35–44 years.

Conclusions: Data collected before and after the H1N1 2009 influenza pandemic indicated significant shifts in public threat perception and anticipated response to a future pandemic. The H1N1 2009 pandemic has altered public perceptions of the probability of a pandemic in the future, but has left the public feeling less vulnerable. Shifts in perception have the potential to reduce future public compliance with health-protective measures, including critical elements of the public health response, such as vaccination.

https://www.mja.com.au/journal/2012/197/10/crying-wolf-impact-h1n1-2009-influenza-pandemic-anticipated-public-response

The Huffington Post
http://www.huffingtonpost.com/
Accessed 1 December 2012

Vaccines as a Sign of Progress in Myanmar
Posted: 11/27/2012 3:22 pm
By Dagfinn Høybråten
Vice President, Norwegian Parliament; Chair, GAVI Alliance Board

Extract
Myanmar made news this week, but not for reasons you might expect. The scene at the little health center in Thagaya in Yedashe township is an unmistakable sign of progress as the country emerges from decades of social and political isolation. For the first time, with support from the GAVI Alliance, a pentavalent vaccine was introduced that will defend children against five potentially fatal diseases. Over the next six months, more than half a million children in Myanmar will be protected from diphtheria, pertussis, tetanus, hepatitis B (hepB) and Haemophilus influenzae type b (Hib)…

http://www.huffingtonpost.com/dagfinn-hoybraten/myanmar-vaccines_b_2092515.html

Wall Street Journal
http://online.wsj.com/home-page
Accessed 1 December 2012

ESSAY
November 23, 2012, 5:59 p.m. ET
A Vaccine to Curb Addicts’ Highs
New research shows that our immune system can mute the effects of cocaine and other stimulant drugs
By KEITH HUMPHREYS
http://online.wsj.com/article/SB10001424127887324352004578130963934871462.html?KEYWORDS=vaccine

Twitter Watch [accessed 1 December 2012 – 16:43]
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.

Seth Berkley ‏@GAVISeth
Just arrived in Dar es Salaam to attend #GAVIpartners forum & GAVI Board mtg. Excited to see so many dedicated immunization people all week
1:50 PM – 1 Dec 12

gavi cso ‏@GaviCso
Want even more updates on @GAVIAlliance 2012 Partners Forum? Follow #GAVIpartners or visit webpage: http://ht.ly/fhDxP 
Retweeted by GAVI Alliance
7:11 PM – 29 Nov 12

World Bank Health ‏@worldbankhealth
Pres Kim: @PEPFAR Blueprint a major step forward in realizing a world free of #AIDS and poverty http://bit.ly/QsKz0P  #WorldAIDSDay 2012
7:00 AM – 1 Dec 12

UNAIDS ‏@UNAIDS
– Friends, today is World AIDS Day! We have moved from despair to hope. Let us renew our commitment to getting to ZERO! @UNAIDS #WAD2012
– UN Sec-Gen: Let us build on & amplify the encouraging successes of recent years to consign #HIV to the pages of history http://ow.ly/fHSgi 
– On World AIDS Day, let’s renew our commitment to zero! We have 1000 days to meet the 2015 global HIV targets http://ow.ly/fJMs7  #WAD2012

World Bank ‏@WorldBank
Kim: On this World AIDS Day, the goal of ending AIDS is within our reach – Read blog. http://bit.ly/V9tsO7  #WAD2012
6:00 AM – 1 Dec 12

GAVI Alliance ‏@GAVIAlliance
Today is World Aids Day! GAVI celebrates gains made in preventing and treating HIV. Statement by GAVI CEO @GAVISeth: http://ht.ly/fJHqf  5:08 AM – 1 Dec 12

UNICEF ‏@UNICEF
Globally, AIDS is the leading cause of death for girls and women age 15-44. #AIDSfree @unicef_aids
2:50 AM – 1 Dec 12

USAID ‏@usaid_info
Statement by Administrator Shah On The Occasion Of World AIDS Day… http://1.usa.gov/11crxPs 
2:41 PM – 30 Nov 12

USAID Global Health ‏@USAIDGH
Check out the new #PEPFARblueprint http://www.pepfar.gov  #worldAIDSDay
10:50 AM – 30 Nov 12

VaccinesToday ‏@VaccinesToday
Catholic board of Canadian schools overturns 4-year ban on #HPV vaccine http://www.calgaryherald.com/health/Catholic+board+overturns+vaccine/7624487/story.html … #cervicalcancer
4:42 AM – 30 Nov 12

*                      *                      *                      *

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_24 November 2012

– 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…

WHO recommends seasonal influenza vaccination to pregnant women as the highest priority
“In an updated position paper, published in the Weekly Epidemiological Record today, WHO recommends that countries considering the initiation or expansion of seasonal influenza vaccination programmes give the highest priority to pregnant women. Additional risk groups to be considered for vaccination, in no particular order of priority, are: children aged 6-59 months; the elderly; individuals with specific chronic medical conditions; and healthcare workers.”

http://www.who.int/immunization/en/
The Weekly Epidemiological Record (WER) for 23 November 2012, vol. 87, 47 (pp. 461–476) includes: Vaccines against influenza – WHO position paper – November 2012
http://www.who.int/entity/wer/2012/wer8747.pdf

   The FDA said it approved Flucelvax, described as the first seasonal influenza vaccine licensed in the United States produced using cultured animal cells, instead of fertilized chicken eggs. Flucelvax is approved to prevent seasonal influenza in people ages 18 years and older. The manufacturing process for Flucelvax is similar to the egg-based production method, but a significant difference is that the virus strains included in the vaccine are grown in animal cells of mammalian origin instead of in eggs. Cell culture technology has already been in use for several decades to produce other U.S. licensed vaccines. Karen Midthun, M.D., director of the FDA’s Center for Biologics Evaluation and Research, said, “Today’s approval represents the culmination of efforts to develop a seasonal influenza vaccine using cell culture as an alternative to the egg-based process.” Flucelvax is manufactured by Novartis Vaccines and Diagnostics GmbH, Marburg, Germany.

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm328982.htm

The European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) recommended the granting of a marketing authorisation for Bexsero, a new Novartis vaccine intended for the immunisation of individuals over two months of age against invasive meningococcal disease caused by Neisseria meningitidis group B. There is currently no authorised vaccine available in the European Union (EU) for bacterial meningitis caused by Neisseria meningitidis group B…In Europe, group B is the most prevalent meningococcal serogroup, with 3,406-4,819 cases reported annually between 2003 and 2007, according to a surveillance report published by the European Centre for Disease Prevention and Control….There are currently some geographical regions within the EU with higher incidence rates, mainly in Belgium, Ireland, Spain and the United Kingdom…The impact of invasive disease in different age groups as well as the variability of antigen epidemiology for group-B strains in different geographical areas should be considered when vaccinating. Vaccination with Bexsero should be in accordance with official recommendations applicable in the Member States. The CHMP’s opinion on Bexsero will now be sent to the European Commission for the granting of a marketing authorisation.

http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2012/11/news_detail_001656.jsp&mid=WC0b01ac058004d5c1

Update: Polio this week – As of 20 Nov 2012
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s Extract]
– This week, immunization campaigns are being implemented in all three remaining endemic countries, Nigeria, Pakistan and Afghanistan. Focus continues to be on urgently boosting immunity levels in known high-risk areas.

Afghanistan
– Three new WPV cases were reported in the past week (one WPV1 from Kandahar and two WPV1s from Hilmand), bringing the total number of WPV cases for 2012 to 30. The WPV1 from Kandahar is the most recent case in the country and had onset of paralysis on 28 October.
– Supplementary immunization activities (SIAs) are taking place this week (19-21 November), with the next activity planned for 01-06 December.
– The current campaign is being conducted in border areas with Pakistan, and uses a combination of trivalent OPV and bivalent OPV (depending on the area, in response either to recent WPV1 cases in the area, or to detection of a circulating vaccine-derived poliovirus type 2 outbreak – cVDPV2 – across the border in Pakistan).
– The Technical Advisory Group (TAG) is meeting next week in Kabul, to review the impact of the national polio emergency action plan and discuss additional tactics to address on-going immunity gaps in known high-risk districts.

Nigeria
– Four new WPV cases were reported in the past week (one WPV1 each from Jigawa, Kaduna, Kano and Katsina), bringing the total number of WPV cases for 2012 to 104. The WPV1 from Kaduna is the most recent case in the country and had onset of paralysis on 30 October.

Horn of Africa
– Efforts are continuing to stop an ongoing cVDPV2 outbreak in Kenya and parts of Somalia (in a Somali refugee camp in Dadaab, Kenya, and Kismayo, south-central Somalia).
– Immunizations of older age groups have taken place in Dadaab. In Somalia, campaigns have been conducted in border areas with Kenya and Ethiopia, and in some areas of central Somalia (access allowing).

WHO:  Global Alert and Response (GAR) – Disease Outbreak News

– Announcement: WHO to change the way it reports H5N1 cases
Henceforward, WHO will publish information on human cases with H5N1 avian influenza infection on a monthly basis on the Influenza webpage:
Influenza at human-animal interface – Monthly Risk Assessment Summary
Cases of human infection with H5N1 will only be reported on Disease Outbreak News for events that are unusual or associated with potential increased risks.
Member States will be continued to require to report information on every sporadic case of H5N1 human infection or novel influenza virus infection to WHO as per Article 6 of the International Health Regulations (2005).

Most recent news items
– Ebola in Uganda  23 November 2012
– Novel coronavirus infection – update  23 November 2012
– Marburg haemorrhagic fever in Uganda – update  23 November 2012
– Yellow fever in Sudan – update  22 November 2012
http://www.who.int/csr/don/en/index.html

British Medical Journal
24 November 2012 (Vol 345, Issue 7884)
http://www.bmj.com/content/345/7884

Time for global action on fake and substandard drugs
BMJ 2012;345:e7917 (Published 21 November 2012)

Excerpt
“In an article this week a self defined “diverse group of authors from the health professions, health charities, legal and medical academia, and former or current government officials in health” present us with a troubling paradox: the world currently has tighter laws to tackle fake tobacco products than it does to tackle fake drugs (doi:10.1136/bmj.e7381). At the moment, as they explain, there are laws that promote an open global medicines trade but no binding international health law on drug safety. The result is that fake and substandard drugs continue to harm and kill people around the world, affecting both proprietary and generic drugs, and haunting rich countries as well as poor. As Andrew Jack explains (doi:10.1136/bmj.e7836), the rapid growth of unregulated internet sales of drugs has raised the stakes even further. In the accompanying podcast, Amir Attiran emphasises the absurd situation by which trading fake medicines is currently legal under international law, and Sania Nishtar highlights worryingly weak pharmacovigilance systems in Pakistan (www.bmj.com/multimedia).

Why the lack of progress on this globally damaging health problem? There’s no simple answer to what is clearly a complex problem, but the authors suggest that the main barriers have been the lack of an internationally agreed terminology and a focus in law on commercial interests rather than public health…”

Faking it
BMJ 2012;345:e7836 (Published 20 November 2012)
Analysis
Podcast

How to achieve international action on falsified and substandard medicines
BMJ 2012;345:e7381 (Published 13 November 2012)
Analysis
Podcast
Feature
Press release

Commentary: Substandard medicines are the priority for neglected tropical diseases
BMJ 2012;345:e7518 (Published 14 November 2012)
Analysis

Health Policy and Planning
Volume 27 Issue 7   October 2012
http://heapol.oxfordjournals.org/content/current

Advance Access
http://heapol.oxfordjournals.org/content/early/2012/11/21/heapol.czs123.abstract
Lessons learned in shaping vaccine markets in low-income countries: a review of the vaccine market segment supported by the GAVI Alliance
Shawn A.N. Gilchrist and Angeline Nanni

Abstract
Objectives  The Global Alliance for Vaccines and Immunization (GAVI) anticipated that growing demand for new vaccines could sufficiently impact the vaccines market to allow low-income countries (LICs) to self-finance new vaccines. But the time required to lower vaccine prices was underestimated and the amount that prices would decline overestimated. To better understand how prices in the LIC vaccine market can be impacted, the vaccine market was retrospectively examined.

Design  GAVI archives and the published literature on the vaccine markets in LICs were reviewed for the purpose of identifying GAVI’s early assumptions for the evolution of vaccine prices, and contrasting these retrospectively with actual outcomes.

Results  The prices in Phases I and II of GAVI-supported vaccines failed to decline to a desirable level within a projected 5-year timeframe. GAVI-eligible countries were unable to sustain newly introduced vaccines without prolonged donor support. Two key lessons can be applied to future vaccine market-shaping strategies: (1) accurate demand forecasting together with committed donor funding can increase supply to the LIC vaccines market, but even greater strides can be made to increase the certainty of purchase; and (2) the expected time to lower prices took much longer than 5 years; market competition is inherently linked to the development time for new vaccines—a minimum of 5–10 or more years. Other factors that can lower vaccine prices include: large-scale production or alternate financing mechanisms that can hasten vaccine price maturation.

Conclusions  The impacts of competition on vaccine prices in the LIC new-vaccines market occurred after almost 10 years. The time for research and development, acquisition of technological know-how and to scale production must be accounted for to more accurately predict significant declines on vaccine prices. Alternate financing mechanisms and the use of purchase agreements should also be considered for lowering prices when planning new vaccine introductions.

The Lancet Infectious Disease
Dec 2012  Volume 12  Number 12   p897 – 984
http://www.thelancet.com/journals/laninf/issue/current

Review
Strategies to increase responsiveness to hepatitis B vaccination in adults with HIV-1
Jennifer A Whitaker, Nadine G Rouphael, Srilatha Edupuganti, Lilin Lai, Mark J Mulligan

Summary
HIV and hepatitis B virus co-infection leads to substantially increased morbidity and mortality compared with either infection alone. Immunisation with hepatitis B virus vaccine is the most effective way to prevent the infection in people with HIV; however, these patients have decreased vaccine responses and a short duration of protection compared with immunocompetent individuals. Control of HIV replication with highly active antiretroviral therapy and increased CD4 cell counts are associated with improved immune responses to hepatitis B vaccination. New vaccination strategies, such as increased vaccine dose, use of the intradermal route, and addition of adjuvants, could improve response rates in adults with HIV.

PLoS One
[Accessed 24 November 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Longitudinal Investigation of Public Trust in Institutions Relative to the 2009 H1N1 Pandemic in Switzerland
Adrian Bangerter, Franciska Krings, Audrey Mouton, Ingrid Gilles, Eva G. T. Green, Alain Clémence
PLoS ONE: Research Article, published 21 Nov 2012 10.1371/journal.pone.0049806

Abstract
Background
The 2009 H1N1 pandemic left a legacy of mistrust in the public relative to how outbreaks of emerging infectious diseases are managed. To prepare for future outbreaks, it is crucial to explore the phenomenon of public trust in the institutions responsible for managing disease outbreaks. We investigated the evolution of public trust in institutions during and after the 2009 pandemic in Switzerland. We also explored respondents’ perceptions of the prevention campaign and the roles of the government and media.

Methodology/Principal Findings
A two-wave longitudinal survey was mailed to 2,400 members of the Swiss public. Wave 1 was in Spring 2009. Wave 2 was in Spring 2010. Six hundred and two participants responded in both waves. Participants indicated moderate to high levels of trust in medical organizations, the WHO, the Swiss government, the pharmaceutical industry, and the EU. On the other hand, trust in the media was low. Moreover, trust in almost all institutions decreased over time. Participants were satisfied with the amount of information received and indicated having followed official recommendations, but widespread concerns about the vaccine were evident. A large majority of participants agreed the vaccine might have unknown or undesirable side effects. Perceptions of the government’s and the media’s role in handling the outbreak were characterized by a substantial degree of skepticism and mistrust.

Conclusions/Significance
Results show clear patterns of skepticism and mistrust on the part of the public relative to various institutions and their actions. Results underscore the importance of systematically investigating trust of the public relative to epidemics. Moreover, studies investigating the evolution of the public’s memories of the pandemic over the coming years may be important to understand reactions to future pandemics. A systematic research program on trust can inform public health communication campaigns, enabling tailored communication initiatives.

PLoS One
[Accessed 24 November 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Economic Burden of Human Papillomavirus-Related Diseases in Italy
Gianluca Baio, Alessandro Capone, Andrea Marcellusi, Francesco Saverio Mennini, Giampiero Favato
PLoS ONE: Research Article, published 21 Nov 2012 10.1371/journal.pone.0049699

Abstract 
Introduction
Human papilloma virus (HPV) genotypes 6, 11, 16, and 18 impose a substantial burden of direct costs on the Italian National Health Service that has never been quantified fully. The main objective of the present study was to address this gap: (1) by estimating the total direct medical costs associated with nine major HPV-related diseases, namely invasive cervical cancer, cervical dysplasia, cancer of the vulva, vagina, anus, penis, and head and neck, anogenital warts, and recurrent respiratory papillomatosis, and (2) by providing an aggregate measure of the total economic burden attributable to HPV 6, 11, 16, and 18 infection.

Methods
For each of the nine conditions, we used available Italian secondary data to estimate the lifetime cost per case, the number of incident cases of each disease, the total economic burden, and the relative prevalence of HPV types 6, 11, 16, and 18, in order to estimate the aggregate fraction of the total economic burden attributable to HPV infection.

Results
The total direct costs (expressed in 2011 Euro) associated with the annual incident cases of the nine HPV-related conditions included in the analysis were estimated to be €528.6 million, with a plausible range of €480.1–686.2 million. The fraction attributable to HPV 6, 11, 16, and 18 was €291.0 (range €274.5–315.7 million), accounting for approximately 55% of the total annual burden of HPV-related disease in Italy.

Conclusions
The results provided a plausible estimate of the significant economic burden imposed by the most prevalent HPV-related diseases on the Italian welfare system. The fraction of the total direct lifetime costs attributable to HPV 6, 11, 16, and 18 infections, and the economic burden of noncervical HPV-related diseases carried by men, were found to be cost drivers relevant to the making of informed decisions about future investments in programmes of HPV prevention.

PLoS Medicine
(Accessed 24 November 2012)
http://www.plosmedicine.org/article/browse.action?field=date

The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials
Charles Weijer, Jeremy M. Grimshaw, Martin P. Eccles, Andrew D. McRae, Angela White, Jamie C. Brehaut, Monica Taljaard, Ottawa Ethics of Cluster Randomized Trials Consensus Group published 20 Nov 2012
doi:10.1371/journal.pmed.1001346

Summary Points
– In cluster randomized trials (CRTs), the units of allocation, intervention, and outcome measurement may differ within a single trial. As a result of the unique design of CRTs, the interpretation of existing research ethics guidelines is complicated.

– The Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials aims to provide researchers and research ethics committees (RECs) with detailed guidance on the ethical design, conduct, and review of CRTs.

– A five-year mixed methods research project explored the ethical challenges of CRTs. Empirical studies documented the reporting of ethical issues in published CRTs, interviewed experienced trialists, and surveyed trialists and REC chairs. The ethical issues identified were explored in a series of background papers that provided detailed ethical analyses and policy options, and a panel of experts using a systematic process developed a consensus statement.

– The Ottawa Statement sets out 15 recommendations for the ethical design and conduct of CRTs. The recommendations provide guidance on the justification of a cluster randomized design, the need for REC review, the identification of research participants, obtaining informed consent, the role of gatekeepers in protecting group interests, the assessment of benefits and harms, and the protection of vulnerable participants.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
(Accessed 24 November 2012)
http://www.pnas.org/content/early/recent

Biological Sciences – Population Biology:
Self-boosting vaccines and their implications for herd immunity
Nimalan Arinaminpathy, Jennie S. Lavine, and Bryan T. Grenfell
PNAS 2012 ; published ahead of print November 19, 2012, doi:10.1073/pnas.1209683109

Abstract
Advances in vaccine technology over the past two centuries have facilitated far-reaching impact in the control of many infections, and today’s emerging vaccines could likewise open new opportunities in the control of several diseases. Here we consider the potential, population-level effects of a particular class of emerging vaccines that use specific viral vectors to establish long-term, intermittent antigen presentation within a vaccinated host: in essence, “self-boosting” vaccines. In particular, we use mathematical models to explore the potential role of such vaccines in situations where current immunization raises only relatively short-lived protection. Vaccination programs in such cases are generally limited in their ability to raise lasting herd immunity. Moreover, in certain cases mass vaccination can have the counterproductive effect of allowing an increase in severe disease, through reducing opportunities for immunity to be boosted through natural exposure to infection. Such dynamics have been proposed, for example, in relation to pertussis and varicella-zoster virus. In this context we show how self-boosting vaccines could open qualitatively new opportunities, for example by broadening the effective duration of herd immunity that can be achieved with currently used immunogens. At intermediate rates of self-boosting, these vaccines also alleviate the potential counterproductive effects of mass vaccination, through compensating for losses in natural boosting. Importantly, however, we also show how sufficiently high boosting rates may introduce a new regime of unintended consequences, wherein the unvaccinated bear an increased disease burden. Finally, we discuss important caveats and data needs arising from this work.

Vaccine
Volume 30, Issue 50, Pages 7131-7342 (26 November 2012)
http://www.sciencedirect.com/science/journal/

Meeting Report
Translating vaccine policy into action: A report from the Bill & Melinda Gates Foundation Consultation on the prevention of maternal and early infant influenza in resource-limited settings
Pages 7134-7140
Justin R. Ortiz, Kathleen M. Neuzil, Vincent I. Ahonkhai, Bruce G. Gellin, David M. Salisbury, Jennifer S. Read, Richard A. Adegbola, Jon S. Abramson

Abstract
Immunization of pregnant women against influenza is a promising strategy to protect the mother, fetus, and young infant from influenza-related diseases. The burden of influenza during pregnancy, the vaccine immunogenicity during this period, and the robust influenza vaccine safety database underpin recommendations that all pregnant women receive the vaccine to decrease complications of influenza disease during their pregnancies. Recent data also support maternal immunization for the additional purpose of preventing disease in the infant during the first six months of life.

In April 2012, the WHO Strategic Advisory Group of Experts (SAGE) on Immunization recommended revisions to the WHO position paper on influenza vaccines. For the first time, SAGE recommended pregnant women should be made the highest priority for inactivated seasonal influenza vaccination. However, the variable maternal influenza vaccination coverage in countries with pre-existing maternal influenza vaccine recommendations underscores the need to understand and to address the discrepancy between recommendations and implementation success.

We present the outcome of a multi-stakeholder expert consultation on inactivated influenza vaccination in pregnancy. The creation and implementation of vaccine policies and regulations require substantial resources and capacity. As with all public health interventions, the existence of perceived and real risks of vaccination will necessitate effective and transparent risk communication. Potential risk allocation and sharing mechanisms should be addressed by governments, vaccine manufacturers, and other stakeholders. In resource-limited settings, vaccine-related issues concerning supply, formulation, regulation, evidence evaluation, distribution, cost-utility, and post-marketing safety surveillance need to be addressed. Lessons can be learned from the Maternal and Neonatal Tetanus Elimination Initiative as well as efforts to increase vaccine coverage among pregnant women during the 2009 influenza pandemic. We conclude with an analysis of data gaps and necessary activities to facilitate implementation of maternal influenza immunization programs in resource-limited settings.

Vaccine
Volume 30, Issue 50, Pages 7131-7342 (26 November 2012)
http://www.sciencedirect.com/science/journal/

WHO Article
Monitoring of progress in the establishment and strengthening of national immunization technical advisory groups
Original Research Article
Pages 7147-7152
Philippe Duclos, Stephanie Ortynsky, Nihal Abeysinghe, Niyazi Cakmak, Cara Bess Janusz, Barbara Jauregui, Richard Mihigo, Liudmila Mosina, Nahad Sadr-Azodi, Yashohiro Takashima, Laure Dumolard, Marta Gacic-Dobo

Abstract
The majority of industrialized and some developing countries have established technical advisory bodies to guide and formulate national immunization policies and strategies. These are referred to as National Immunization Technical Advisory Groups (NITAGs), WHO and its partners have placed a high priority on assisting in the establishment or strengthening of functional, sustainable, and independent NITAGs. To enable systematic global monitoring of the existence and functionality of NITAGs, in 2010, WHO and UNICEF included related questions in the WHO–UNICEF Joint Reporting Form (JRF) that provides an official means for WHO and UNICEF to collect indicators of immunization programme performance.

This paper presents the status of NITAGs based on the analysis of the 2010 JRF. Although 115 countries (64% of responders) reported having a NITAG in 2010, only 50% of countries reported the existence of a NITAG with a formal administrative or legislative basis. Despite limitations in the ability to compare 2010 JRF data with that from a 2008 global survey, it appears that substantial progress has been achieved globally over with 43 committees reporting affirmatively about six NITAG process indicators, compared with 23 in the 2008 survey. Impressive progress has been observed in the proportion of countries reporting NITAGs with formal terms of reference (24% increase), a legislative or administrative basis (10% increase), and a requirement for members to disclose their interests (14% increase). Some of the poorest developing countries now enjoy support from a NITAG which meet all six process indicators. These may serve as examples for other countries.

Vaccine
Volume 30, Issue 50, Pages 7131-7342 (26 November 2012)
http://www.sciencedirect.com/science/journal/

The cost-effectiveness of a 13-valent pneumococcal conjugate vaccination for infants in England
Original Research Article
Pages 7205-7213
Albert Jan van Hoek, Yoon Hong Choi, Caroline Trotter, Elizabeth Miller, Mark Jit

Abstract
Background
In the immunisation schedule in England and Wales, the 7-valent pneumococcal conjugate vaccine (PCV-7) was replaced by the 13-valent vaccine (PCV-13) in April 2010 after having been used since September 2006. The introduction of PCV-7 was informed by a cost effectiveness analysis using an infectious disease model which projected herd immunity and serotype replacement effects based on the post-vaccine experience in the United States at that time.

Aim
To investigate the cost effectiveness of the introduction of PCV-13.

Method
Invasive disease incidence following vaccination was projected from a dynamic infectious disease model, and combined with serotype specific disease outcomes obtained from a large hospital dataset linked to laboratory confirmation of invasive pneumococcal disease. The economic impact of replacing PCV-7 with PCV-13 was compared to stopping the use of pneumococcal conjugate vaccination altogether.

Results
Discontinuing PCV-7 would lead to a projected increase in invasive pneumococcal disease, costs and loss of quality of life compared to the introduction of PCV-13. However under base case assumptions (assuming no impact on non-invasive disease, maximal competition between vaccine and non-vaccine types, time horizon of 30 years, vaccine price of £49.60 a dose + £7.50 administration costs and discounting of costs and benefits at 3.5%) the introduction of PCV-13 is only borderline cost effective compared to a scenario of discontinuing of PCV-7. The intervention becomes more cost-effective when projected impact of non-invasive disease is included or the discount factor for benefits is reduced to 1.5%.

Conclusion
To our knowledge this is the first evaluation of a transition from PCV-7 to PCV-13 based on a dynamic model. The cost-effectiveness of such a policy change depends on a number of crucial assumptions for which evidence is limited, particularly the impact of PCV-13 on non-invasive disease.

Vaccine
Volume 30, Issue 50, Pages 7131-7342 (26 November 2012)
http://www.sciencedirect.com/science/journal/

Re-emergence of diphtheria and pertussis: Implications for Nigeria
Original Research Article
Pages 7221-7228
A.E. Sadoh, R.E. Oladokun

Abstract
In the prevaccine era pertussis and diphtheria were responsible for significant morbidity and mortality in children. In the United States of America more than 125,000 cases of diphtheria with 10,000 deaths were reported annually in the 1920s. In the same period about 1.7 million cases of pertussis with 73,000 deaths were also reported. Vaccination against these two diseases has caused remarkable reduction in the morbidity and mortality from these diseases both in developed and developing countries. The initial vaccines were the combined diphtheria toxoid and whole cell pertussis vaccine.

The recent reported increases in the incidence of these two diseases in countries, which maintain high childhood vaccination coverage is a source of concern not only to these countries but also for developing countries with weak immunization programmes. Nigeria for example reported 11,281 cases of pertussis, the second highest number of cases worldwide in 2009.

Waning immunity in adult and adolescent populations has been reported and epidemiologically, more cases are being reported in adults and adolescents. Also a high proportion of pertussis cases are being reported in infants and most of these infant cases are linked to adult/adolescent sources.

Recent approaches to control of these diseases include booster doses of combined diphtheria, tetanus and acellular pertussis vaccine while the cocooning strategy (which is immunizing every person who is likely to have contact with a given infant such as mother, father, grandparents and health care workers) is being used in a number of countries.

For developing countries including Nigeria where the capacity for making the diagnosis of both diseases is limited, strengthening of routine immunization as well as diagnostic capacity is imperative. Research to determine current levels of immunity in children, adolescents and adults is required. This will enable the determination of the need for booster doses and the age at which such boosters should be administered. Improved surveillance will be needed to delineate current epidemiological profiles of both diseases.

Vaccine
Volume 30, Issue 50, Pages 7131-7342 (26 November 2012)
http://www.sciencedirect.com/science/journal/

Causality assessment of adverse events reported to the Vaccine Adverse Event Reporting System (VAERS)
Original Research Article
Pages 7253-7259
Anita M. Loughlin, Colin D. Marchant, William Adams, Elizabeth Barnett, Roger Baxter, Steve Black, Christine Casey, Cornelia Dekker, Katherine M. Edwards, Jerold Klein, Nicola P. Klein, Philip LaRussa, Robert Sparks, Kathleen Jakob

Abstract
Adverse events following immunization (AEFI) reported to the national Vaccine Adverse Event Reporting System (VAERS) represent true causally related events, as well as events that are temporally, but not necessarily causally related to vaccine.

Objective
We sought to determine if the causal relationships between the vaccine and the AEFI reported to VAERS could be assessed through expert review.

Design
A stratified random sample of 100 VAERS reports received in 2004 contained 13 fatal cases, 19 cases with non-fatal disabilities, 39 other serious non-fatal cases and 29 non-serious cases. Experts knowledgeable about vaccines and clinical outcomes, reviewed each VAERS report and available medical records.

Main outcome measures
Modified World Health Organization criteria were used to classify the causal relationship between vaccines and AEFI as definite, probable, possible, unlikely or unrelated. Five independent reviewers evaluated each report. If they did not reach a majority agreement on causality after initial review, the report was discussed on a telephone conference to achieve agreement.

Results
108 AEFIs were identified in the selected 100 VAERS reports. After initial review majority agreement was achieved for 83% of the AEFI and 17% required further discussion. In the end, only 3 (3%) of the AEFI were classified as definitely causally related to vaccine received. Of the remaining AEFI 22 (20%) were classified as probably and 22 (20%) were classified as possibly related to vaccine received; a majority (53%) were classified as either unlikely or unrelated to a vaccine received.

Conclusions
Using VAERS reports and additional documentation, causality could be assessed by expert review in the majority of VAERS reports. Assessment of VAERS reports identified that causality was thought to be probable or definite in less than one quarter of reports, and these were dominated by local reactions, allergic reactions, or symptoms known to be associated with the vaccine administered.

Vaccine
Volume 30, Issue 50, Pages 7131-7342 (26 November 2012)
http://www.sciencedirect.com/science/journal/

Cost-effectiveness of pertussis booster vaccination in the Netherlands
Original Research Article
Pages 7327-7331
Mark H. Rozenbaum, Elisabetta De Cao, Maarten J. Postma

Abstract
The aim of the current study is to estimate the epidemiological and economical consequences of several extended pertussis booster vaccination strategies and to explore the impact of parameters surrounded by large uncertainty on the cost-effectiveness.

We developed an age structured transmission dynamic model to evaluate the impact of programs targeting (i) adolescents or adults using a single booster dose, (ii) a combination of adolescent and adult vaccination, and (iii) an every 10 years booster dose.

The base case analysis, that is a single adolescent booster administered at the age of 12 years, resulted in a reduction of pertussis infections. However, due to an increase in the number of symptomatic infections in adults, the benefits in terms of QALYs gained and costs saved in children were partly offset. Despite these negative indirect effects in the adult population, administering an additional booster dose could still be considered cost effective with an ICER of €4200 per QALY gained. Combining an adolescent booster dose at the age of 10 (most cost-effective age for a single adolescent booster dose) with an adult (18–30 years) booster dose always resulted in favorable ICERs (<€10,000/QALY). Finally the every 10 year booster dose resulted in an ICER of €16,900 per QALY. The impact of different assumptions regarding the disease epidemiology, disease-related parameters, and vaccination program-related issues was limited.

To conclude, we show that extended pertussis booster vaccination strategies are likely to be considered as cost-effective.

American Journal of Preventive Medicine
Volume 43, Issue 6, Supplement 5, December 2012, Pages S490–S496

Research Collaboration with 2-1-1 to Eliminate Health Disparities
2-1-1 research and program innovation
Human Papillomavirus Vaccine: 2-1-1 Helplines and Minority Parent Decision-Making
Lara S. Savas, PhD, Maria E. Fernández, PhD, David Jobe, MSW, Chakema C. Carmack, PhD

Abstract
Background
Research is needed to understand parental factors influencing human papillomavirus (HPV) vaccination, particularly in groups with a higher burden of cervical cancer.

Purpose
To determine correlates of HPV vaccination among a sample of low-income parents of age-eligible daughters (aged 9–17 years) who called the 2-1-1 Helpline. Secondary analyses describe potential differences in HPV vaccination correlates by Hispanic and black parent groups, in particular.

Methods
This 2009 cross-sectional feasibility survey of cancer prevention needs was conducted in Houston at the 2-1-1 Texas/United Way Helpline. In 2012, to examine the association between parental psychosocial, cognitive, and decisional factors and HPV vaccination uptake (one or two doses), bivariate and multivariable logistic regression analyses were conducted for minority parents and for Hispanic and black parent groups, separately.

Results
Lower rates of HPV vaccination uptake were reported among minority daughters of 2-1-1 callers (29% overall) compared with national and Texas rates. In final adjusted analysis, factors positively associated with HPV vaccination uptake included being offered the vaccination by a doctor or nurse, belief that the vaccine would prevent cervical cancer, and Hispanic ethnicity. Secondary analyses detected differences in factors associated with vaccination in Hispanic and black groups.

Conclusions
Findings indicate low levels of vaccination among 2-1-1 callers. Increased understanding of determinants of HPV vaccination in low-income minority groups can guide interventions to increase coverage. Because 2-1-1 informational and referral services networks reach populations considered medically underserved, 2-1-1 can serve as a community hub for informing development of and implementing approaches aimed at hard-to-reach groups.

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

Epidemiology of Invasive Pneumococcal Disease among High-Risk Adults since Introduction of Pneumococcal Conjugate Vaccine for Children
RD Muhammad, R Oza-Frank, E Zell, R Link-Gelles… – Clinical Infectious Diseases, 2012
Background. Certain chronic diseases increase risk for invasive pneumococcal disease (IPD) and are indications for receipt of 23-valent pneumococcal polysaccharide vaccine (PPV23). Since the pediatric introduction of 7-valent pneumococcal conjugate vaccine ( …

Accelerating the development of a therapeutic vaccine for human Chagas disease: rationale and prospects
E Dumonteil, ME Bottazzi, B Zhan, MJ Heffernan… – Expert Review of Vaccines, 2012
Chagas disease is a leading cause of heart disease affecting approximately 10 million people in Latin America and elsewhere worldwide. The two major drugs available for the treatment of Chagas disease have limited efficacy in Trypanosoma cruzi-infected adults …

Science denial: a guide for scientists
J Rosenau – Trends in Microbiology, 2012
… You do not expect to see Draco Malfoy carrying a Hermione Granger poster, let alone one in which she touts the whooping cough vaccine. Yet at the … scientific consensus. The vaccine drive at Dragon*Con fits this model beautifully. The …

Interview: Future of immunotherapy for colorectal cancer
J Marshall – Colorectal Cancer, 2012
… maintaining his regular clinical practice. His own research focuses on the development of a novel vaccine for the treatment of advanced colon cancer. Q What led you to focus your research on immunotherapy in colorectal cancer? …

Reuters
http://www.reuters.com/
Accessed 24 November 2012

Nurses can help improve vaccination rates: study
By Genevra Pittman
NEW YORK | Fri Nov 23, 2012 9:58am EST

Excerpt
(Reuters Health) – More elderly and at-risk adults get their flu and pneumonia vaccinations when the shots are coordinated and given by nurses instead of doctors, a new analysis suggests.

Researchers linked the changeover to a 44-percent increase in patients’ chances of getting a flu shot and a more than doubling of their likelihood of getting vaccinated against pneumonia.

Jeffrey Johnson, who worked on the study, said there’s been a recent effort to get public health nurses and pharmacists involved in giving vaccines – although policies vary by state in the U.S.    He said shifting responsibility to non-doctors might be especially helpful for people with chronic diseases.

“The family physician has all of the responsibility to look after the patient, and so somebody with diabetes, for example, comes in and their first concern is their blood sugar and their blood pressure and pretty soon, the time for the visit is up,” Johnson, from the University of Alberta in Edmonton, Canada, told Reuters Health…

http://www.reuters.com/article/2012/11/23/us-nurses-vaccination-idUSBRE8AM0IK20121123

Twitter Watch [accessed 24 November 2012 – 09:14]
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.

GAVI Alliance ‏@GAVIAlliance
T-12: Over 500 global health and government leaders will gather #GAVIpartners Forum in Dar Es SDalam, Tanzania. http://ht.ly/fw9fW 
3:09 AM – 23 Nov 12

Seth Berkley ‏@GAVISeth
Despite good vax for A, C, Y, W135 mening meningitis, type B still cause morb/mort. New Grp B vax received EU approval http://reut.rs/QxfsT2 
1:16 AM – 23 Nov 12

Peter Singer ‏@PeterASinger
Inspired: Canada funds 68 bold, inventive ways to improve health, save lives in developing countries: http://bit.ly/ScDLnp  @globalhealth
Retweeted by Global Health
7:54 AM – 22 Nov 12

The Global Fund ‏@globalfundnews
News Flash Special: Interview with Mark Dybul http://tinyurl.com/d9lv2e3 
3:03 AM – 21 Nov 12

PAHO/WHO ‏@pahowho
Delegates from 76 countries launch Global Mechanism in Buenos Aires to fight Drug Counterfeiting cc: @who http://new.paho.org/hq/index.php?option=com_content&view=article&id=7484%3Adelegados-de-76-paises-ponen-en-marcha-en-buenos-aires-mecanismo-mundial-contra-la-falsificacion-de-medicamentos&catid=740%3Anews-press-releases&Itemid=1926&lang=en&Itemid=1926 …
5:41 PM – 20 Nov 12

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_17 November 2012

– 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…

WHO:  Global Alert and Response (GAR) – Yellow fever in Sudan

13 November 2012 – The Federal Ministry of Health (FMOH) in Sudan has notified WHO of a yellow fever outbreak affecting 23 localities in Greater Darfur. As of 11 November 2012, a total of 329 suspected cases including 97 deaths were reported from this outbreak. Central and South Darfur have reported most of the suspected cases.

Laboratory confirmation was conducted by WHO regional reference laboratory for yellow fever, the Institut Pasteur in Dakar, Senegal, on two samples which tested positive for yellow fever by IgM ELISA test and RT-PCR Differential diagnosis for other flavivirus was negative.

WHO is supporting the FMOH and other partners in the epidemiological investigation and response to the outbreak. Ongoing activities include strengthening of epidemiological surveillance, conducting entomological assessment and standardizing clinical case management. Community leaders are also being mobilized to support with raising awareness on yellow fever in the affected localities.

The government of Sudan has requested the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG) to provide support for a reactive mass vaccination campaign. The YF-ICG has approved of 2.4 million doses of vaccine, which is expected to arrive in the country shortly. Sudan, with support from WHO, is expected to start the emergency mass vaccination campaign in the affected areas in order to protect the at-risk populations and stop the spread of the disease.

The YF-ICG consists of representatives from United Nations Children’s Fund (UNICEF), Médecins sans Frontières (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) and WHO, which also serves as its Secretariat.

http://www.who.int/csr/don/2012_11_13/en/index.html

Media Release: Revolutionary meningitis vaccine breaks another barrier; first to gain approval to travel outside cold chain
14 November 2012

The Meningitis Vaccine Project (MVP) –  a partnership between PATH and the WHO to eliminate epidemic meningitis as a public health problem in sub-Saharan Africa – announced at the American Society of Tropical Medicine and Hygiene (ASTMH) conference that regulatory authorities, after conducting a rigorous review of stability data, will for the first time allow a vaccine in Africa to be transported and stored for as long as four days without refrigeration or even an icepack.” The vaccine involved is MenAfriVac, created to meet the needs of Africa’s meningitis belt, and the regulatory action means that the vaccine can now be kept in a controlled temperature chain (CTC) at temperatures of up to 40°C for up to four days, a decision that could help increase campaign efficiency and coverage and save funds normally spent maintaining the challenging cold chain during the “last mile” of vaccine delivery.

The outcome of the review and decisions of the Drugs Controller General of India (DCGI), supported by a Health Canada analysis and confirmed by WHO Vaccines Pre-qualification Programme. Michel Zaffran, director of Optimize, the PATH-WHO collaboration aimed at improving immunization systems and technologies, said, “The potential for some vaccines to remain safely outside the cold chain for short periods of time has been widely known for over 20 years. But this is the first time that a vaccine intended for use in Africa has been tested and submitted to regulatory review and approved for this type of use. And we expect this announcement to build momentum for applying the CTC concept to other vaccines and initiatives, allowing us to save more lives in low-income countries.”

More at: http://www.who.int/immunization/newsroom/menafrivac_20121114/en/index.html

WHO SAGE: Meeting Summary 6-8 November 2012
[Full text]

IPV recommended for countries to mitigate risks and consequences associated with OPV2 withdrawal

In May 2012, the World Health Assembly declared the completion of polio eradication a programmatic emergency for global public health and requested the Director-General to rapidly finalize a comprehensive eradication and endgame strategy for the period 2013-2018. The draft strategic plan and current status of the global polio eradication programme were presented to SAGE. Noting the substantive progress made in implementing polio emergency action plans in the remaining polio infected countries, detailed attention to oral polio vaccine (OPV) campaign planning in the field, and new evidence in improving performance, SAGE was alarmed by the considerable funding shortfalls at a time when eradication is in sight, with OPV campaigns already cancelled or scaled back in over 25 high risk countries in 2012.

SAGE endorsed the four major objectives and milestones in the new strategic plan. SAGE also recommended that all countries should introduce at least one dose of inactivated polio vaccine (IPV) in their routine immunization programmes to mitigate the risks and consequences associated with the eventual withdrawal of the type 2 component of OPV (OPV2). SAGE will review progress on achieving the pre-requisites for OPV2 withdrawal, including the availability of affordable IPV products, every six months to ensure the earliest possible date for OPV2 withdrawal but with sufficient advance notification to ensure programmatic readiness and vaccine availability.

SAGE reviewed and endorsed the monitoring and evaluation/accountability framework for the Decade of Vaccines Global Vaccine Action Plan (GVAP). A SAGE working group is being established to review progress in rolling out the GVAP and will submit annual reports to SAGE. Following SAGE’s input, the report will then be submitted to the WHO Executive Board and the World Health Assembly for discussion.

SAGE commended countries for the progress made in globally reducing measles mortality. While the Region of the Americas has achieved measles and rubella elimination and the Western Pacific region is close to interrupting endemic measles transmission, current data indicate that global and regional elimination targets for 2015 and 2020 will not be achieved on time. SAGE urges the South-East Asia region to establish a measles elimination goal and for the regions of Africa, Eastern Mediterranean, South-East Asia and Western Pacific to work towards establishing regional rubella elimination goals. SAGE also endorsed the Global Measles and Rubella Strategic Plan for 2012-2020 and recommended the full implementation of key strategies in a manner that elicits country ownership, strengthens routine immunization system, promotes equity and reinforces linkages with polio eradication and other health programmes.

SAGE welcomed the framework on Vaccination in Humanitarian Emergencies, which provides an objective approach to decision making and closes an existing gap on the use of vaccination in humanitarian emergencies. SAGE endorsed the framework and proposed some suggestions to be incorporated in the final document including piloting the framework before finalization.

SAGE noted that Middle Income Countries (MIC) representing a population of 5 billion now have the greatest proportion of the world’s poor. In addition, many of these countries are not eligible for GAVI Alliance funding or support and are lagging behind in their ability to sustainably introduce new vaccines. Reasons for this are broader than just prices and procurement of vaccines, and include equity, sustainability, capacity building and partner support. As the approach from all organizations to assist MICs is currently fragmented and incomplete, SAGE requested WHO to establish a task force to coordinate an inclusive stakeholder engagement mechanism to create an enabling environment and assist MICs.

The report of the meeting will be published in the WHO Weekly Epidemiological Record on 4 January 2013. The meeting documents, including presentations and background readings can be found here: SAGE november 2012 meeting documentation

http://www.who.int/immunization/sage/meetings/2012/november/news_sage_ipv_opv_nov2012/en/index.html

Media Release: SK Chemicals and International Vaccine Institute sign MOU on Typhoid Vaccine Development and Supply
Seoul, October 9, 2012

Under the terms of the MOU, SK Chemicals and IVI will exchange their technology for the development of a Typhoid vaccine and will collaborate on future clinical studies and application for the prequalification from the WHO. SK Chemicals will manufacture and supply about 10 million doses of the Typhoid vaccine to developing countries through the United Nations Children’s Fund (UNICEF).

More at: 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=465

Update: Polio this week – As of 14 Nov 2012
Global Polio Eradication Initiative
http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

[Editor’s Extract]
– The Strategic Advisory Group of Experts on immunization (SAGE) met last week in Geneva, Switzerland. During this meeting, the draft polio eradication and endgame strategy for 2013-2018 and current status of the global polio eradication programme were presented to SAGE. Substantial progress has been made in implementing polio emergency action plans in the remaining polio-infected countries, detailed attention to oral polio vaccine (OPV) campaign planning in the field, and new evidence in improving performance. SAGE was alarmed, however, by the considerable funding shortfalls at a time when eradication is in sight.

– SAGE endorsed the four major objectives and milestones in the new strategic plan. SAGE also recommended that all countries should introduce at least one dose of inactivated polio vaccine (IPV) in their routine immunization programmes to mitigate the risks and consequences associated with the eventual withdrawal of the type 2 component of OPV (OPV2). SAGE will review progress on achieving the pre-requisites for OPV2 withdrawal, including the availability of affordable IPV products, every six months to ensure the earliest possible date for OPV2 withdrawal but with sufficient advance notification to ensure programmatic readiness and vaccine availability.

Pakistan
– Six new WPV cases were reported in the past week (one WPV1 from Federally Administered Tribal Areas – FATA – and five WPV1s from Khyber Pakhtunkhwa – KP), bringing the total number of cases for 2012 to 54. The most recent case was one of the newly reported WPV1 cases from KP with onset of paralysis on 27 October.

– In addition to transmission of WPV, the country is also responding to a cVDPV2 outbreak (five cases, all from the greater Quetta area of Balochistan). The most recent NIDs held in October had been conducted with trivalent OPV.

– Initial data from the October NIDs indicates overall good progress achieved, including in key reservoir areas. Efforts to engage all levels of civil society are continuing, including through the distribution of 6.5 million SMS messages during the three-day campaign in polio reservoir areas.

Horn of Africa
– Efforts are continuing to stop an ongoing cVDPV2 outbreak in Kenya and parts of Somalia (in a Somali refugee camp in Dadaab, Kenya, and Kismayo, south-central Somalia).

– Immunizations of older age groups have taken place in Dadaab. In Somalia, campaigns have been conducted in border areas with Kenya and Ethiopia, and in some areas of central Somalia (access allowing).

– Across the region, OPV continues to be added to broader humanitarian response activities.