Attitudes of the General Public and General Practitioners in Five Countries towards Pandemic and Seasonal Influenza Vaccines during Season 2009/2010

PLoS One
[Accessed 13 October 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Attitudes of the General Public and General Practitioners in Five Countries towards Pandemic and Seasonal Influenza Vaccines during Season 2009/2010
Patricia R. Blank, Genevieve Bonnelye, Aurore Ducastel, Thomas D. Szucs
PLoS ONE: Research Article, published 11 Oct 2012 10.1371/journal.pone.0045450

Abstract 
Background
Vaccination coverage rates for seasonal influenza are not meeting national and international targets. Here, we investigated whether the 2009/2010 A/H1N1 pandemic influenza affected the uptake of influenza vaccines.

Methodology/Principal Findings
In December 2009/January 2010 and April 2010, 500 randomly selected members of the general public in Germany, France, the United States, China, and Mexico were surveyed by telephone about vaccination for seasonal and A/H1N1 pandemic influenza. Also, in April 2010, 100 randomly selected general practitioners were surveyed. Adult vaccine coverage in December 2009/January 2010 for A/H1N1 pandemic and seasonal influenza were, respectively, 12% and 29% in France, 11% and 25% in Germany, 41% and 46% in the US, 13% and 30% in Mexico, and 12% and 10% in China. Adult uptake rates in April 2010 were higher in Mexico but similar or slightly lower in the other countries. Coverage rates in children were higher than in adults in the US, Mexico, and China but mostly lower in Germany and France. Germans and French viewed the threat of A/H1N1 pandemic influenza as low to moderate, whereas Mexicans, Americans, and Chinese viewed it as moderate to serious, opinions generally mirrored by general practitioners. The recommendation of a general practitioner was a common reason for receiving the pandemic vaccine, while not feeling at risk and concerns with vaccine safety and efficacy were common reasons for not being vaccinated. Inclusion of the A/H1N1 pandemic strain increased willingness to be vaccinated for seasonal influenza in the United States, Mexico, and China but not in Germany or France.

Conclusions/Significance
The 2009/2010 A/H1N1 influenza pandemic increased vaccine uptake rates for seasonal influenza in Mexico but had little effect in other countries. Accurate communication of health information, especially by general practitioners, is needed to improve vaccine coverage rates.

Estimated size of the population at risk of severe adverse events after smallpox vaccination in Israel

Vaccine
Volume 30, Issue 47 pp. 6609-6728 (19 October 2012)
http://www.sciencedirect.com/science/journal/

Estimated size of the population at risk of severe adverse events after smallpox vaccination in Israel
Original Research Article
Pages 6632-6635
Yael Levy, Emilia Anis, Ehud Kaliner, Itamar Grotto, Yehuda L. Danon

Abstract
Background
The population at risk of adverse events after smallpox vaccination has increased in recent years. This has important implications for preparedness strategies against bioterrorism with the variola virus. The aim of the study was to estimate the size of this special population in Israel.

Methods
The study was conducted in January 2010. Data on patients with contraindications to smallpox vaccination, as delineated by the Israel Ministry of Health for planning post-event strategies, were retrieved from the computerized records of the Department of AIDS and Tuberculosis and the Transplantation Center of the Israel Ministry of Health. In addition, the database of the main Health Maintenance Organization in Israel which insures 60% of the national population was searched using ICD-9 codes and specific medications issued in the last quarter of 2009.

Results
Of the 7,563,800 persons residing in Israel in January 2010, 326,318 were at risk of an adverse event after smallpox vaccination.

Conclusion
Approximately 4.3% of the Israeli population should not be exposed to the currently used smallpox vaccine. This knowledge is important to ensure the effectiveness of mass vaccination programs in the event of a bioterror attack.

Probing the protective effects of a conformationally constrained nicotine vaccine

Vaccine
Volume 30, Issue 47 pp. 6609-6728 (19 October 2012)
http://www.sciencedirect.com/science/journal/

Probing the protective effects of a conformationally constrained nicotine vaccine
Original Research Article
Vaccine, Volume 30, Issue 47, Pages 6609-6728 (19 October 2012)
Pages 6665-6670
Amira Y. Moreno, Marc R. Azar, George F. Koob, Kim D. Janda

Abstract
Despite being consistently ranked as the leading cause of preventable death in the United States, about 20% of the population continues to smoke. Current smoking cessation therapies offer limited success, show high rates of relapse, and have potentially dangerous side effects, consequently emphasizing the need for alternative therapies. Immunopharmacotherapy aims to use highly specific antibodies to sequester nicotine in the bloodstream thus blunting passage into the brain and minimizing positive reinforcing effects. A successful vaccination strategy is dependent upon the appropriate hapten design, carrier protein and adjuvant which affect both the magnitude and affinity of the immune response elicited. Our laboratory previously demonstrated the use of molecular constraint as a means to increase the intrinsic immunogenicity and antigenicity of a nicotine vaccine. The present study expands upon those initial results and explores the protective effects of vaccination with both constrained hapten CNI and its unconstrained counterpart NIC. Our results demonstrate how immunization with CNI-KLH produces large amounts of moderate affinity anti-nicotine antibodies even when formulated with ALUM adjuvant, making it particularly relevant for human use. In contrast, vaccination with NIC-KLH produced moderate amounts of high affinity anti-nicotine antibodies. These differential responses proved critical in offering protecting effects. Vaccination with CNI, but not NIC, resulted in an increase of self-administration responding on a progressive ratio schedule using a high nicotine dose (0.03 mg/kg/infusion; ∼2 cigarettes in human) as compared to KLH-controls. Furthermore, vaccination with CNI was able to antagonize the analgesic effects of a heavy bolus dose of nicotine (0.35 mg/kg). These results support our hypothesis that molecular constraint can be advantageously utilized to increase the immunogenicity of a nicotine vaccine. Furthermore in correlating the behavioral effects with the differential responses elicited, we shed light on the distinct roles of antibody concentration and affinity.

Distinguishing vaccine efficacy and effectiveness

Vaccine
Volume 30, Issue 47 pp. 6609-6728 (19 October 2012)
http://www.sciencedirect.com/science/journal/

Distinguishing vaccine efficacy and effectiveness
Original Research Article
Pages 6700-6705
Eunha Shim, Alison P. Galvani

Abstract
Background
Mathematical models of disease transmission and vaccination typically assume that protective vaccine efficacy (i.e. the relative reduction in the transmission rate among vaccinated individuals) is equivalent to direct effectiveness of vaccine. This assumption has not been evaluated.

Methods
We used dynamic epidemiological models of influenza and measles vaccines to evaluate the common measures of vaccine effectiveness in terms of both the protection of individuals and disease control within populations. We determined how vaccine-mediated reductions in attack rates translate into vaccine efficacy as well as into the common population measures of ‘direct’, ‘indirect’, ‘total’, and ‘overall’ effects of vaccination with examples of compartmental models of influenza and measles vaccination.

Results
We found that the typical parameterization of vaccine efficacy using direct effectiveness of vaccine can lead to the underestimation of the impact of vaccine. Such underestimation occurs when the vaccine is assumed to offer partial protection to every vaccinated person, and becomes worse when the level of vaccine coverage is low. Nevertheless, estimates of ‘total’, ‘indirect’ and ‘overall’ effectiveness increase with vaccination coverage in the population. Furthermore, we show how the measures of vaccine efficacy and vaccine effectiveness can be correctly calculated.

Conclusions
Typical parameterization of vaccine efficacy in mathematical models may underestimate the actual protective effect of the vaccine, resulting in discordance between the actual effects of vaccination at the population level and predictions made by models. This work shows how models can be correctly parameterized from clinical trial data.

From Google Scholar: Dissertations, Theses, Selected Journal Articles

From Google Scholar: Dissertations, Theses, Selected Journal Articles

[PDF] Linear Categorical Marginal Modeling of Solicited Symptoms in Vaccine Clinical Trials
WP Bergsma, EMD Aris, FS Tibaldi – Journal of Biopharmaceutical Statistics. …, 2012
Abstract Analysis of the occurrence of adverse events, and in particular of solicited symptoms, following vaccination is often needed for the safety and benefit-risk evaluation of any candidate vaccine, and typically involves taking repeated measurements. In this …

[PDF] Cost-effectiveness analysis of intranasal live attenuated vaccine (LAIV) versus injectable inactivated influenza vaccine (TIV) for Canadian children and adolescents
JE Tarride, N Burke, C Von Keyserlingk, D O’Reilly… – … and Outcomes Research, 2012
Background: Influenza affects all age groups and is common in children. Between 15% and 42% of preschool-and school-aged children experience influenza each season. Recently, intranasal live attenuated influenza vaccine, trivalent (LAIV) has been approved in …

Twitter Watch [accessed 13 October 2012 17:46]

Twitter Watch  [accessed 13 October 2012  17:46]
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.

UNICEFVerified ‏@UNICEF
Know what’s the best way to control pandemics? No, it’s not scientists in white coats. It’s handwashing #iwashmyhands
12:17 PM – 13 Oct 12

World Bank @WorldBank
“It is time to bend the arc of history” – Pres Kim http://bit.ly/RkcBYD 
2:00 AM – 13 Oct 12

World Bank Live @WorldBankLive
New #MDGs should be a ‘catalytic’ force for eliminating poverty. – Kim http://bit.ly/Rn82Nf  #wblive
Retweeted by World Bank
8:10 PM – 12 Oct 12

Peter Speyer @PeterSpeyer
WHO Forum on Health Data Standardization and Interoperability, 12/3-4 in Geneva http://new.paho.org/equity/index.php?option=com_content&task=view&id=144&Itemid=1 … #healthdata
Retweeted by Amanda Glassman
5:23 PM – 12 Oct 12

CDCgov ‏@CDCgov
Join us Oct 16th at 1pm ET for the next #CDCGrandRounds: “Public Health Approaches to Reducing U.S. Infant Mortality” http://is.gd/kdxCbQ 
11:00 AM – 12 Oct 12

Seth Berkley @GAVISeth
Good talk with former Japanese PM Naoto Kan who is part of UNSG’s post 2015 MDGs high level commission on power of vaccines and GAVI’s model
7:53 AM – 12 Oct 12

Seth Berkley ‏@GAVISeth
Great WB&GAVI event on economic benefit of vaccines http://goo.gl/3i7w8  Encouraging finance ministers to prioritise immunisation funding
7:30 AM – 12 Oct 12

PAHO/WHO Equity @eqpaho
Health in the post-2015 UN development agenda Thematic Think Piece UNAIDS UNICEF UNFPA WHO http://www.un.org/millenniumgoals/pdf/Think%20Pieces/8_health.pdf …
Retweeted by PAHO/WHO
2:47 PM – 11 Oct 12

Vaccines: The Week in Review 6 October 2012

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_6 October 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…

Polio Round-up to 6 October 2012

Update: Polio this week – As of 03 Oct 2012
Global Polio Eradication Initiative
[Editor’s Extract]
Afghanistan
One new case was reported in the past week (WPV1 from the previously-uninfected province of Ghor), bringing the total number of cases for 2012 to 19. It was the most recent case, with onset of paralysis on 31 August.
Pakistan
Three new cases were reported in the past week (2 WPV1 from Khyber Pakhtunkhwa and 1 from Gilgit Baltistan) bringing the total number of cases for 2012 to 40. The most recent case was a WPV1 from Khyber Pakhtunkhwa with onset of paralysis on 13 September.

.
   The Weekly Epidemiological Record (WER) for 5 October 2012, vol. 87, 40 (pp. 381–388) includes:
– Progress towards eradicating poliomyelitis: Afghanistan and Pakistan, January 2011–August 2012
http://www.who.int/entity/wer/2012/wer8740.pdf

.
The World Bank’s Board of Directors approved a US$24 million second additional financing for the Third Partnership for Polio Eradication Project (TPPEP) “to support the Government of Pakistan’s efforts to immunize 34.8 million children against the crippling effects of polio with the goal of eradicating the disease from the country.” Rachid Benmessaoud, World Bank Country Director for Pakistan, commented, “Although Pakistan has seen great progress in the reduction of polio over the last 20 years, it remains one of the few countries where polio still impacts lives and recent cases are worrying. Pakistan still has a large role to play to aggressively stop transmission of polio virus to help achieve the global public good of polio eradication in the world”. The announcement noted that the recent floods also forced large scale population movements, resulting in large population groups living together in temporary housing with inadequate water and sanitation facilities. This, in turn, has led to exposure of people who had not been previously exposed to the polio virus. In addition, the prevailing security situation affecting the population in areas of Khyber Pakhtunkhwa (KP) and the Federally Administered Tribal Areas (FATA) has seriously affected immunization coverage, with an estimated 90% of children under 5 years no longer receiving adequate immunization.

More: http://www.worldbank.org/en/news/2012/10/02/world-bank-help-immunize-34-8-million-children-pakistan-polio

WHO: Global Vaccine Safety Initiative website launched

WHO: Global Vaccine Safety Initiative website launched

The GVSI promotes efforts to strengthen “vaccine pharmacovigilance” worldwide. This means identifying any “adverse events” that may occur following immunization and investigating them to see if they are related to the vaccine or the immunization procedure. The Blueprint refers to vaccine pharmacovigilance as “the science and activities relating to the detection, assessment, understanding, prevention and communication of adverse events following immunization, or of any other vaccine- or immunization-related issues”, as defined by CIOMS/WHO (2012). Adverse events are also sometimes referred to as “side-effects”. Vaccine pharmacovigilance is not just a scientific exercise. Its purpose is to ensure that vaccines are safe and to follow up if a case arises where a vaccination may be linked to harm.

This site provides a wide range of information about vaccine safety in general and the GVSI in particular. The site includes:

– information on established untoward effects of vaccines and estimates of their rates of occurrence;

– advice from an Expert Advisory Group on vaccine safety issues of global importance;

– links to tools and methods for enhancing local capacity in vaccine safety;

– up-to-date information on the management of the GVSI.

The GVSI is a global collaborative effort to ensure that everyone everywhere can be protected from serious infectious diseases with minimal untoward effects from the best available vaccines.

Training materials, tools for investigating vaccine safety concerns, and links to the web sites of other organizations are also provided.

http://www.who.int/vaccine_safety/initiative/en/index.html

Partners of Harmonization for Health in Africa – Tunis Declaration

WHO SEAR: Partners of Harmonization for Health in Africa discuss action plans for high quality, affordable healthcare and implementation of Tunis Declaration

“3 October 2012,  Nairobi, Kenya – Partners in the Harmonization for Health in Africa (HHA) initiative are convening in Nairobi this week as a follow-up to the recent Tunis ministerial conference for African health and finance ministers. Regional Directors, senior representatives and a multidisciplinary group of technical experts from the HHA partner agencies will use this opportunity to discuss how to further strengthen their support to countries in providing quality and affordable healthcare to African populations, particularly the under-served…”

More:

http://www.afro.who.int/en/media-centre/pressreleases/item/5000-partners-of-harmonization-for-health-in-africa-discuss-action-plans-for-high-quality-affordable-healthcare-and-implementation-of-tunis-declaration.html

PAHO Pushes Forward Roadmap to Support Parliamentary Activity on Health in the Americas

PAHO: PAHO/WHO Pushes Forward Roadmap to Support Parliamentary Activity on Health in the Americas
(10/03/2012)

“With the aim of supporting parliamentary work on health in the Americas, the Pan American Health Organization/World Health Organization (PAHO/WHO) will present a portal with information on legislative processes in health policy in the region and also convene roundtables where parliamentarians of all countries will be able to exchange experiences on parliamentary procedures for health issues.”

http://new.paho.org/hq/index.php?option=com_content&view=article&id=7294&Itemid=1926

Enhanced Routine Immunization Activity (ERIA) – Ethiopia

WHO: New immunization approach in Ethiopia reaches more children
October 2012

“A new approach to routine immunization in the rural Afar region in north-eastern Ethiopia nearly quadrupled the numbers of children vaccinated against measles, diphtheria, pertussis, tetanus, polio and other diseases in 2010 (from as low as 22% to nearly 80% coverage in the target area). The immunization activity used “community champions” to encourage nomadic, pastoral families to have their children vaccinated and introduced new approaches such as task shifting to improve service delivery to these hard-to-reach populations.

“The Enhanced Routine Immunization Activity (ERIA) had already generated strong results among nomadic, pastoral families on a small scale in the neighbouring Somali region. With support from WHO and partners, health officials replicated the approach on a larger scale in Afar to reach more children.”

http://www.who.int/features/2012/immunization_ethiopia/en/index.html

GAVI: High mark in 2012 aid transparency index

GAVI said it welcomed the 2012 aid transparency index that acknowledges the global health partnership for its increasing dedication to aid transparency. GAVI said the index gave it high marks for the “publication of high quality, current activity data” and calls on the organisation “to continue to lead on aid transparency”. The index – produced annually by Publish What You Fund – ranks 72 aid organisations across the world, from country donors to private foundations. GAVO CEO Dr Seth Berkley said, “Accountability for results in country is the highest order of what we do; therefore communicating effectively on what is being spent where, by whom, and with what results is the basic foundation of the GAVI model.” GAVI noted that it was a founding signatory to the International Aid Transparency Initiative (IATI) in 2008, and uses this global standard for publishing aid information to make information about aid spending easier to find, use and compare.

http://www.gavialliance.org/library/news/statements/2012/gavi-alliance-recognised-for-aid-transparency/

Malaria: History, Past Decade’s Achievements, and Future Priorities

Speech/Panel/Webcast: Malaria: History, Past Decade’s Achievements, and Future Priorities
Center for Strategic and International Studies
Wednesday, October 17th  3:00 – 5:00pm (EST)

The first hour, Sir Richard Feachem will speak to the historical patterns of malaria control, the outcomes of accelerated global efforts in the past decade, outstanding challenges, and policy priorities for the next Administration and Congress. The second hour will include a moderated discussion with Sir Richard Feachem and Rear Admiral Tim Ziemer on the U.S. anti-malaria agenda moving forward.

This event will be webcast live at: www.SmartGlobalHealth.org/Live
http://smartglobalhealth.org/page/s/malaria—history-past-decade-s-achievements-and-future-priorities

Global Fund: Final Report of the Independent Evaluation of AMFm Phase 1

Global Fund: Final Report of the Independent Evaluation of AMFm Phase 1
The Global Fund to Fight AIDS, Tuberculosis and Malaria
4 October 2012

The Global Fund made public the final report of an independent evaluation of the pilot phase of the Affordable Medicines Facility–malaria, also known as AMFm. The report was commissioned to provide an independent evaluation to assess the extent to which AMFm has achieved the main objectives laid out for its pilot phase, which ends in December 2012. The independent evaluation was mandated by the Global Fund Board and will inform its decision in November 2012, when the Board is expected to consider the future of AMFm beyond the pilot phase.

The goal of AMFm is to improve access to artemisinin-based combination therapies (ACTs), the most effective anti-malaria treatment. The AMFm pilot phase was launched in April 2009 and began operations in July 2010. It set out to increase availability, particularly through private outlets where most people seek their treatments, and drive down the price of ACTs through a factory-gate global subsidy of ACTs combined with country-level measures to support its implementation.

The AMFm pilot phase currently operates in eight countries: Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania, and Uganda. The independent evaluation assessed the program in each of the pilot countries that was operational at the time of the endline survey.

Links to Executive Summary and Full Report here: http://www.theglobalfund.org/en/amfm/independentevaluation/

What Primary Care Providers Need to Know About Preexposure Prophylaxis for HIV Prevention: A Narrative Review

Annals of Internal Medicine
2 October 2012, Vol. 157. No. 7
http://www.annals.org/content/current

What Primary Care Providers Need to Know About Preexposure Prophylaxis for HIV Prevention: A Narrative Review
Douglas Krakower, MD; and Kenneth H. Mayer, MD

Abstract [Free full-text]
As HIV prevalence climbs globally, including more than 50,000 new infections per year in the United States, we need more effective HIV prevention strategies. The use of antiretrovirals for preexposure prophylaxis (PrEP) among high-risk persons without HIV is emerging as one such strategy. Randomized, controlled trials have demonstrated that once-daily oral PrEP decreased HIV incidence among at-risk men who have sex with men and African heterosexuals, including serodiscordant couples. An additional randomized, controlled trial of a topical pericoital antiretroviral microbicide gel decreased HIV incidence among at-risk heterosexual South African women. Two other studies in African women did not demonstrate the efficacy of oral or topical PrEP, raising concerns about adherence patterns and efficacy in this population.

The U.S. Food and Drug Administration (FDA) Antiviral Drugs Advisory Committee reviewed these studies and additional data in May 2012 and voted to advise the approval of oral tenofovir–emtricitabine for PrEP in high-risk populations. On 16 July 2012, the FDA recommended that this combination medication be approved for use as PrEP in high-risk persons without HIV. Patients may seek PrEP from their primary care providers, and those receiving PrEP require monitoring. Thus, primary care providers should become familiar with PrEP. This review outlines current knowledge about PrEP as it pertains to primary care, including identifying persons likely to benefit from PrEP; counseling to maximize adherence and reduce potential increases in risky behavior; and monitoring for potential drug toxicities, HIV acquisition, and antiretroviral drug resistance. Issues related to cost and insurance coverage are also discussed. Recent data suggest that PrEP, combined with other prevention strategies, holds promise in helping to curtail the HIV epidemic.

Human immunodeficiency virus continues to spread, with more than 2 million new infections globally (1) and 50,000 new infections in the United States per year (2). Thus, more effective HIV prevention strategies are urgently needed. Administration of antiretroviral medications to uninfected persons at high risk to protect against HIV acquisition, known as preexposure prophylaxis (PrEP), has recently emerged as a promising prevention strategy.

Over the past 2 years, randomized, controlled trials have demonstrated that PrEP can decrease HIV incidence in high-risk populations (3 – 6). With the FDA’s approval of oral tenofovir–emtricitabine for PrEP in high-risk populations (7), clinicians can now prescribe PrEP to prevent HIV acquisition in their at-risk patients. Thus, it is important that practicing physicians understand this new evidence and its implications.

EDITORIAL – Stockpiling oral cholera vaccine

Bulletin of the World Health Organization
Volume 90, Number 10, October 2012, 713-792
http://www.who.int/bulletin/volumes/90/10/en/index.html

EDITORIAL
Stockpiling oral cholera vaccine
Stephen Martin a, Alejandro Costa a & William Perea a
a. Control of Epidemic Diseases Unit, Pandemic and Epidemic Diseases Department, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland.
Bulletin of the World Health Organization 2012;90:714-714. doi: 10.2471/BLT.12.112433

Cholera is re-emerging as a threat on the global public health stage. The number of reported cases worldwide is back at the peak level observed two decades ago,1 new Vibrio cholerae strains have appeared and antimicrobial resistance has increased. Weak surveillance systems and the possibility of travel and trade sanctions contribute to widespread underreporting of cholera cases, which results in great uncertainty surrounding global disease burden estimates. Such estimates suggest that about 1.4 billion people are at risk of cholera and that the risk is highest among children under five years of age. Annually 2.8 million cases and 91 000 deaths from cholera occur in endemic countries; non-endemic countries contribute another 87 000 cases and 2500 deaths.2 Although effective preventive and therapeutic regimens are well established, clearly cholera remains poorly controlled in both outbreak and endemic contexts.

Cholera-related morbidity and mortality are particularly high during humanitarian crises. Large cholera epidemics in Zimbabwe (2008–2009), Haiti (2011) and now Sierra Leone (2012) have made the international community aware of the need to not merely control endemic disease, but also to strengthen epidemic preparedness and response capacity. In 2011, the Sixty-fourth World Health Assembly issued a resolution calling for a reinvigorated focus on cholera and defined a range of actions required of the World Health Organization (WHO) and its Member States towards creating an integrated, comprehensive strategy for cholera prevention and control.3 As part of this strategy, WHO is facilitating a multi-partner initiative aimed at establishing a stockpile of oral cholera vaccine (OCV) for use in outbreak response as an adjunct to established prevention and control measures. This approach was endorsed in September 2011 by global cholera experts, who affirmed that such a stockpile is both necessary and feasible.4 There are currently two stockpile candidate oral cholera vaccines, both prequalified by WHO.

A WHO technical working group convened in April 2012 and defined the required characteristics of a stockpiled vaccine, the epidemiological and operational considerations for deployment, and the mechanisms for stockpile governance, replenishment and appraisal.5 This working group agreed on an initial OCV stockpile of 2 million annual doses to be available for epidemic response in low-income countries. The International Coordinating Group (ICG) has a decade of experience as a decision-making partnership that oversees the meningococcal and yellow fever vaccine stockpiles and their deployment. The ICG is composed of experts from four organizations: Médecins sans Frontières, the International Federation of the Red Cross and Red Crescent Societies, the United Nations Children’s Fund and WHO, which is both a decision-making partner and the ICG’s secretariat. All members of the ICG, including WHO, will oversee the proposed OCV stockpile.

The WHO technical working group emphasized that deployment of the stockpiled vaccine must be guided by epidemiological, technical and operational evidence, some of which remains incomplete and must be consolidated as experience is gained. While acknowledging the difficulties in predicting outbreaks and the need for more detailed empirical data, the working group created an advisory framework for assessing outbreak severity based on three criteria: the biological susceptibility of the population, the social vulnerability of the population and the risk of spatial extension. For each of these criteria, the working group defined epidemiological and demographic indicators, thresholds for deciding when to deploy the vaccine and indicators for determining the anticipated impact of a vaccination campaign. The framework proposed by the working group is intended only to inform decision-making; actual deployment of the OCV from the stockpile would follow not only an analysis of these indicators, but also an assessment of programmatic factors, such as local capacity to organize a mass vaccination campaign and prevailing security conditions.

Progress is being made on the working group’s action plans for 2012. The work streams are focused on advocacy for funding, negotiations with vaccine producers and preparedness planning for countries and regions. A stockpile evaluation group has been established to define and implement the detailed monitoring required. As experience and data accrue, the results of this evaluation should enable continuous improvement in the structure and functioning of the stockpile. Successful assessment of a stockpile vaccination campaign will require reinforcement of surveillance systems in most locations where an epidemic is likely to arise.

Public health interventions, such as case management, enhanced environmental control, improved hygiene and sanitation and social mobilization, should form the backbone of all cholera control programmes. In turn, these interventions depend on effective surveillance and strong health-care systems. This initial, necessarily small, OCV stockpile will not constitute sufficient preparedness for a large or sustained epidemic, its use should complement existing measures as part of a reinvigorated and comprehensive approach to meeting the new challenges involved in global cholera control and prevention.

References

Cholera annual report 2011. Wkly Epidemiol Rec 2012; 87: 289-304 pmid: 22905370.

Ali M, Lopez AL, You YA, Kim YE, Sah B, Maskery B, et al., et al. The global burden of cholera. Bull World Health Organ 2012; 90: 209-218 doi: 10.2471/BLT.11.093427 pmid: 22461716.

Resolution WHA64.15. Cholera: mechanism for control and prevention. In: Sixty-fourth World Health Assembly, Geneva, 16–24 May 2011. Volume 1. Resolutions, decisions and annexes. Geneva: World Health Organization; 2011 (WHA64/2011/REC/1). Available from: www.who.int/entity/cholera/…/Resolution_CholeraA64_R15-en.pdf [accessed 5 September 2012].

WHO Consultation on oral cholera vaccine (OCV) stockpile strategic framework: potential objectives and possible policy options. Geneva: Department of Immunization, Vaccines and Biologicals, World Health Organization; 2012 (WHO/IVB/12.05). Available from: http://www.who.int/immunization/documents/innovation/WHO_IVB_12.05/en/ [accessed 4 September 2012].

World Health Organization [Internet]. WHO Technical Working Group on creation of an oral cholera vaccine stockpile. Geneva: World Health Organization; 2012 (WHO/HSE/PED/2012.2). Available from: http://www.who.int/cholera/publications/oral_cholera_vaccine/en/index.html [accessed 1 September 2012].

A new entity for the negotiation of public procurement prices for patented medicines in Mexico

Bulletin of the World Health Organization
Volume 90, Number 10, October 2012, 713-792
http://www.who.int/bulletin/volumes/90/10/en/index.html

LESSONS FROM THE FIELD
A new entity for the negotiation of public procurement prices for patented medicines in Mexico
Octavio Gómez-Dantés, Veronika J Wirtz, Michael R Reich, Paulina Terrazas & Maki Ortiz

Problem
As countries expand health insurance coverage, their expenditures on medicines increase. To address this problem, WHO has recommended that every country draw up a list of essential medicines. Although most medicines on the list are generics, in many countries patented medicines represent a substantial portion of pharmaceutical expenditure.

Approach
To help control expenditure on patented medicines, in 2008 the Mexican Government created the Coordinating Commission for Negotiating the Price of Medicines and other Health Inputs (CCPNM), whose role, as the name suggests, is to enter into price negotiations with drug manufacturers for patented drugs on Mexico’s list of essential medicines.

Local setting
Mexico’s public expenditure on pharmaceuticals has increased substantially in the past decade owing to government efforts to achieve universal health-care coverage through Seguro Popular, an insurance programme introduced in 2004 that guarantees access to a comprehensive package of health services and medicines.

Relevant changes
Since 2008, the CCPNM has improved procurement practices in Mexico’s public health institutions and has achieved significant price reductions resulting in substantial savings in public pharmaceutical expenditure.

Lessons learnt
The CCPNM has successfully changed the landscape of price negotiation for patented medicines in Mexico. However, it is also facing challenges, including a lack of explicit indicators to assess CCPNM performance; a shortage of permanent staff with sufficient technical expertise; poor coordination among institutions in preparing background materials for the annual negotiation process in a timely manner; insufficient communication among committees and institutions; and a lack of political support to ensure the sustainability of the CCPNM.

Impact of rotavirus vaccination in regions with low and moderate vaccine uptake in Germany

Human Vaccines & Immunotherapeutics(formerly Human Vaccines)
Volume 8, Issue 10  October 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/10/

SPECIAL FOCUS: Allergy Vaccines and Immunotherapeutics
Research Papers
Impact of rotavirus vaccination in regions with low and moderate vaccine uptake in Germany
Sandra Dudareva-Vizule, Judith Koch, Matthias an der Heiden, Doris Oberle, Brigitte Keller-Stanislawski and Ole Wichmann
http://dx.doi.org/10.4161/hv.21593

Abstract:
In Germany, routine RV-vaccination is not adopted into the national immunization schedule as of 2012. Because RV-vaccines were already on the market since 2006, in 2010 a moderate (58%) and low (22%) vaccine uptake was observed in the 5 eastern federal states (EFS) and the 11 western federal states (WFS), respectively. To assess the impact of RV-vaccination, we compared the incidence rates (IR) of RV-related hospitalizations before (2004‒2006) and in seasons after (2008/09–2010/11) RV-vaccine introduction in Germany by utilizing data from the national mandatory disease reporting system. In the EFS, the IR was significantly reduced in age-groups < 18 mo in 2008/09 and in age-groups < 24 mo in 2009/10–2010/11. In the WFS an IR-reduction was observed only in age-groups < 12 mo in 2008/09 and in age-groups < 18 mo in 2009/10–2010/11. Overall IR-reduction in age-groups < 24 mo comparing 2008–11 with 2004–06 was 36% and 25% in EFS and WFS, respectively. In addition, we computed IR-ratios (IRR) in the seasons after mid-2006 with negative binomial regression. The effect of vaccination was independent from the geographic region. Vaccination was associated with a significant reduction in RV-related hospitalizations in the age-groups 6–23 mo. Most prominently, vaccination of 50% of infants led to an estimated decrease in age group 6–11 mo by 42%. No significant reduction was observed in age-groups ≥ 24 mo. In conclusion, in the German setting with low to moderate vaccine uptake, RV-related hospitalization incidence decreased substantially depending on the achieved vaccination coverage, but only in the first two years of life.

COMMENTARIES: Business models and opportunities for cancer vaccine developers

Human Vaccines & Immunotherapeutics(formerly Human Vaccines)
Volume 8, Issue 10  October 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/10/

COMMENTARIES
Business models and opportunities for cancer vaccine developers
Alex Kudrin
http://dx.doi.org/10.4161/hv.20629

Abstract:
Despite of growing oncology pipeline, cancer vaccines contribute only to a minor share of total oncology-attributed revenues. This is mainly because of a limited number of approved products and limited sales from products approved under compassionate or via early access entry in smaller and less developed markets. However revenue contribution from these products is extremely limited and it remains to be established whether developers are breaking even or achieving profitability with existing sales. Cancer vaccine field is well recognized for high development costs and risks, low historical rates of investment return and high probability of failures arising in ventures, partnerships and alliances. The cost of reimbursement for new oncology agents is not universally acceptable to payers limiting the potential for a global expansion, market access and reducing probability of commercial success. In addition, the innovation in cancer immunotherapy is currently focused in small and mid-size biotech companies and academic institutions struggling for investment. Existing R&D innovation models are deemed unsustainable in current “value-for-money” oriented healthcare environment. New business models should be much more open to collaborative, networked and federated styles, which could help to outreach global, markets and increase cost-efficiencies across an entire value chain. Lessons learned from some developing countries and especially from South Korea illustrate that further growth of cancer vaccine industry will depends not only on new business models but also will heavily rely on regional support and initiatives from different bodies, such as governments, payers and regulatory bodies.

Tetanus toxoid vaccine: Elimination of neonatal tetanus in selected states of India

Human Vaccines & Immunotherapeutics(formerly Human Vaccines)
Volume 8, Issue 10  October 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/10/

Tetanus toxoid vaccine: Elimination of neonatal tetanus in selected states of India
Ramesh Verma and Pardeep Khanna

Abstract:
Tetanus is caused by a neurotoxin produced by Clostridium tetani (C. tetani), a spore-forming bacterium. Infection begins when tetanus spores are introduced into damaged tissue. Tetanus is characterized by muscle rigidity and painful muscle spasms caused by tetanus toxin’s blockade of inhibitory neurons that normally oppose and modulate the action of excitatory motor neurons. Maternal and neonatal tetanus (MNT) are caused by unhygienic methods of delivery, abortion, or umbilical-cord care. Maternal and neonatal tetanus are both forms of generalized tetanus and have similar clinical courses. About 90% of neonates with tetanus develop symptoms in the first 3–14 d of life, mostly on days 6–8, distinguishing neonatal tetanus from other causes of neonatal mortality which typically occur during the first two days of life. Overall case fatality rates for patients admitted to the hospital with neonatal tetanus in developing countries are 8–50%, while the fatality rate can be as high as 100% without hospital care. Tetanus toxoid (TT) vaccination of pregnant women to prevent neonatal tetanus was included in WHO’s Expanded Program on Immunization (EPI) a few years after its inception in 1974. In 2000, WHO, UNICEF, and UNFPA formed a partnership to relaunch efforts toward this goal, adding the elimination of maternal tetanus as a program objective, and setting a new target date of 2005. By February 2007, 40 countries had implemented tetanus vaccination campaigns in high-risk areas, targeting more than 94 million women, and protecting more than 70 million subjects with at least two doses of TT. In 2011, 653 NT cases were reported in India compared with 9313 in 1990. As of February 2012, 25 countries and 15 States and Union Territories of India, all of Ethiopia except Somaliland, and almost 29 of 34 provinces in Indonesia have been validated to have eliminated MNT.

CDC Grand Rounds: the TB/HIV Syndemic

JAMA   
October 03, 2012, Vol 308, No. 13
http://jama.ama-assn.org/current.dtl

CDC Grand Rounds: the TB/HIV Syndemic
JAMA. 2012;308(13):1311-1317. doi:.

Extract [Free full-text]
Since Robert Koch’s 1882 discovery of Mycobacterium tuberculosis, substantial progress has been made in tuberculosis (TB) control. Nevertheless, in the latter part of the 20th century, a long period of neglect of both quality program implementation and research led to persistently high TB incidence rates and failure to develop new tools to adequately address the problem. Today, most of the world continues to rely on the same diagnostic test invented by Koch approximately 125 years ago and on drugs developed 40 years ago. The world now faces a situation in which approximately 160 persons die of TB each hour (1.45 million died in 2009), in which a quarter of all deaths in persons with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (PWHA) are caused by TB, and in which the evolution of the bacteria has outpaced the evolution of its treatment to such an extent that some forms of TB are now untreatable.1 More recently, renewed attention has been given to reducing the global burden of TB,2 but much remains to be done…

The quest for universal health coverage: achieving social protection for all in Mexico

The Lancet  
Oct 06, 2012  Volume 380  Number 9849  p1203 – 1280
http://www.thelancet.com/journals/lancet/issue/current

Health Policy
The quest for universal health coverage: achieving social protection for all in Mexico
Felicia Marie Knaul, Eduardo González-Pier, Octavio Gómez-Dantés, David García-Junco, Héctor Arreola-Ornelas, Mariana Barraza-Lloréns, Rosa Sandoval, Francisco Caballero, Mauricio Hernández-Avila, Mercedes Juan, David Kershenobich, Gustavo Nigenda, Enrique Ruelas, Jaime Sepúlveda, Roberto Tapia, Guillermo Soberón, Salomón Chertorivski, Julio Frenk

Summary
Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries

Background Rates of Adverse Pregnancy Outcomes for Assessing the Safety of Maternal Vaccine Trials in Sub-Saharan Africa

PLoS One
[Accessed 6 October 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Background Rates of Adverse Pregnancy Outcomes for Assessing the Safety of Maternal Vaccine Trials in Sub-Saharan Africa
Lauren A. V. Orenstein, Evan W. Orenstein, Ibrahima Teguete, Mamoudou Kodio, Milagritos Tapia, Samba O. Sow, Myron M.
PLoS ONE: Research Article, published 04 Oct 2012 10.1371/journal.pone.0046638

Abstract 
Background
Maternal immunization has gained traction as a strategy to diminish maternal and young infant mortality attributable to infectious diseases. Background rates of adverse pregnancy outcomes are crucial to interpret results of clinical trials in Sub-Saharan Africa.

Methods
We developed a mathematical model that calculates a clinical trial’s expected number of neonatal and maternal deaths at an interim safety assessment based on the person-time observed during different risk windows. This model was compared to crude multiplication of the maternal mortality ratio and neonatal mortality rate by the number of live births. Systematic reviews of severe acute maternal morbidity (SAMM), low birth weight (LBW), prematurity, and major congenital malformations (MCM) in Sub-Saharan African countries were also performed.

Findings
Accounting for the person-time observed during different risk periods yields lower, more conservative estimates of expected maternal and neonatal deaths, particularly at an interim safety evaluation soon after a large number of deliveries. Median incidence of SAMM in 16 reports was 40.7 (IQR: 10.6–73.3) per 1,000 total births, and the most common causes were hemorrhage (34%), dystocia (22%), and severe hypertensive disorders of pregnancy (22%). Proportions of liveborn infants who were LBW (median 13.3%, IQR: 9.9–16.4) or premature (median 15.4%, IQR: 10.6–19.1) were similar across geographic region, study design, and institutional setting. The median incidence of MCM per 1,000 live births was 14.4 (IQR: 5.5–17.6), with the musculoskeletal system comprising 30%.

Interpretation
Some clinical trials assessing whether maternal immunization can improve pregnancy and young infant outcomes in the developing world have made ethics-based decisions not to use a pure placebo control. Consequently, reliable background rates of adverse pregnancy outcomes are necessary to distinguish between vaccine benefits and safety concerns. Local studies that quantify population-based background rates of adverse pregnancy outcomes will improve safety assessment of interventions during pregnancy.

Interplay of Public Intervention and Private Choices in Determining the Outcome of Vaccination Programmes

PLoS One
[Accessed 6 October 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

The Interplay of Public Intervention and Private Choices in Determining the Outcome of Vaccination Programmes
Alberto d’Onofrio, Piero Manfredi, Piero Poletti
PLoS ONE: Research Article, published 01 Oct 2012 10.1371/journal.pone.0045653

Abstract 
After a long period of stagnation, traditionally explained by the voluntary nature of the programme, a considerable increase in routine measles vaccine uptake has been recently observed in Italy after a set of public interventions aiming to promote MMR immunization, whilst retaining its voluntary aspect. To account for this take-off in coverage we propose a simple SIR transmission model with vaccination choice, where, unlike similar works, vaccinating behaviour spreads not only through the diffusion of “private” information spontaneously circulating among parents of children to be vaccinated, which we call imitation, but also through public information communicated by the public health authorities. We show that public intervention has a stabilising role which is able to reduce the strength of imitation-induced oscillations, to allow disease elimination, and to even make the disease-free equilibrium where everyone is vaccinated globally attractive. The available Italian data are used to evaluate the main behavioural parameters, showing that the proposed model seems to provide a much more plausible behavioural explanation of the observed take-off of uptake of vaccine against measles than models based on pure imitation alone.

Review: Lipidated promiscuous peptides vaccine for tuberculosis-endemic regions

Trends in Molecular Medicine
Volume 18, Issue 10, Pages 575-626 (October 2012)
http://www.sciencedirect.com/science/journal/14714914

Reviews
Lipidated promiscuous peptides vaccine for tuberculosis-endemic regions
Review Article
Pages 607-614
Uthaman Gowthaman, Pradeep K. Rai, Nargis Khan, David C. Jackson, Javed N. Agrewala

Abstract
Despite nine decades of Bacillus Calmette–Guérin (BCG) vaccination, tuberculosis continues to be a major global health challenge. Clinical trials worldwide have proved the inadequacy of the BCG vaccine in preventing the manifestation of pulmonary tuberculosis in adults. Ironically, the efficacy of BCG is poorest in tuberculosis endemic areas. Factors such as nontuberculous or environmental mycobacteria and helminth infestation have been suggested to limit the efficacy of BCG. Hence, in high TB-burden countries, radically novel strategies of vaccination are urgently required. Here we showcase the properties of lipidated promiscuous peptide vaccines that target and activate cells of the innate and adaptive immune systems by employing a Toll-like receptor-2 agonist, S-[2,3-bis(palmitoyloxy)propyl]cysteine (Pam2Cys). Such a strategy elicits robust protection and enduring memory responses by type 1 T helper cells (Th1). Consequently, lipidated peptides may yield a better vaccine than BCG.

Malaria in the Post-Genome Era

Science        
5 October 2012 vol 338, issue 6103, pages 1-160
http://www.sciencemag.org/current.dtl

Perspective –
Epidemiology
Malaria in the Post-Genome Era
Brian Greenwood1,
Seth Owusu-Agyei2

Summary
Ten years ago, the genome sequence of the mosquito Anopheles gambiae, the most important vector of malaria in Africa, and the genome sequence of Plasmodium falciparum, the most dangerous human malaria parasite, were published (1, 2). It was anticipated that these remarkable pieces of research heralded a bright future for malaria control. Has this happened? The genome projects have made some contribution to the development of new malaria tools, such as new vaccine candidates, but a decade is probably too short a period for the research to be translated into success in the field. Knowledge gained from the genome projects may contribute more substantially in the coming decade as efforts to control infection increasingly focus on development of new drugs, insecticides, and vaccines.

A tale of two vaccines: Lessons from polio that could inform the development of an HIV vaccine

From Google Scholar: Dissertations, Theses, Selected Journal Articles

A tale of two vaccines: Lessons from polio that could inform the development of an HIV vaccine
J Esparza – AIDS, 2012

Abstract Two vaccine trials that were conducted 50 years apart are reviewed and compared: The 1954 field trial of the Salk inactivated polio vaccine and the RV144 HIV vaccine trial conducted in Thailand between 2003 and 2009. Despite the obvious differences in…

Human Papillomavirus (HPV) Vaccines as an Option for Preventing Cervical Malignancies:(How) Effective and Safe?

From Google Scholar: Dissertations, Theses, Selected Journal Articles

Human Papillomavirus (HPV) Vaccines as an Option for Preventing Cervical Malignancies:(How) Effective and Safe?
L Tomljenovic, CA Shaw, JP Spinosa – Current pharmaceutical design, 2012

… We carried out a systematic review of HPV vaccine pre- and post-licensure trials to assess the evidence of their effectiveness and safety. We find that HPV vaccine clinical trials design, and data interpretation of both efficacy and safety outcomes, were largely inadequate…

Parents’ Source of Vaccine Information and Impact on Vaccine Attitudes, Beliefs, and Nonmedical Exemptions

From Google Scholar: Dissertations, Theses, Selected Journal Articles

[PDF] Parents’ Source of Vaccine Information and Impact on Vaccine Attitudes, Beliefs, and Nonmedical Exemptions
AM Jones, SB Omer, RA Bednarczyk, NA Halsey… – Advances in Preventive …, 2012
In recent years, use of the Internet to obtain vaccine information has increased. Historical
data are necessary to evaluate current vaccine information seeking trends in context.
Between 2002 and 2003, surveys were mailed to 1,630 parents of fully vaccinated…

Interview – GAVI Alliance CEO: Leadership Is About Vision and Responsibility, Not Power

Forbes
http://www.forbes.com/
Accessed 6 October 2012

Leadership
10/04/2012 @ 1:21PM |
RahimKanani, Contributor

GAVI Alliance CEO: Leadership Is About Vision and Responsibility, Not Power

Extract
Recently, I interviewed Seth Berkley, CEO of the GAVI Alliance, a public-private global health partnership committed to saving children’s lives and protecting people’s health by increasing access to immunization in poor countries. We discussed the evolution and impact of the organization, their unique approach to development, their secret to successful collaborations, and much more….

China close to entering WHO-approved global vaccine market

Reuters
http://www.reuters.com/

China close to entering WHO-approved global vaccine market
Extract
A Chinese-made vaccine is on the verge of being approved for aid agency use by the World Health Organization, a move that would be a first for China and open the door to lucrative regional and global markets, a leading health alliance said on Thursday.

The vaccine is against Japanese encephalitis, a debilitating mosquito-borne disease prevalent in Southeast Asia and the Far East that can be fatal, especially in children.

Made by Chengdu Institute, part of China’s top vaccine maker China National Biotech Group (CNBG), the vaccine is likely to win so-called prequalification status from the World Health Organization (WHO), Seth Berkley, chief executive of the Global Alliance for Vaccines and Immunization (GAVI), said…

http://www.reuters.com/article/2012/10/04/us-vaccines-idUSBRE89313220121004

Twitter Watch [accessed 6 October 2012 17:46]

Twitter Watch  [accessed 6 October 2012  17:46]
Items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and is by no means intended to be exhaustive.

HarvardPublicHealth @HarvardHSPH
RT @ForumHSPH: Health is a fundamental human right, and it can in no condition be delayed. – R. Akdag http://ht.ly/e1941 
1:17 PM – 6 Oct 12

PAHO/WHO Equity ‏@eqpaho
Sir Michael Marmot on Knowledge networks and Social Determinants of Health WHO commission #SDOH #healthequity #crics9 http://bit.ly/Su0ixP 
Retweeted by PAHO/WHO
2:59 PM – 5 Oct 12

Kaiser Family Found @KaiserFamFound
What is the role of Dept. of Defense in global health? http://ow.ly/e8DR6  Report explores activities, strategy, policy & budget.
3:11 PM – 5 Oct 12

PAHO/WHO Equity @eqpaho
Global Conference on Health Promotion Helsinki, Finland, on June 10-14 2013 #SDOH http://bit.ly/K5p273 
Retweeted by PAHO/WHO
11:45 AM – 5 Oct 12 ·

Seth Berkley @GAVISeth
Fun interview with me in Forbes on leadership and changes at GAVI http://tinyurl.com/9hwb7af 
4:21 AM – 5 Oct 12

PATH @PATHtweets
We promised we’d deliver a meningitis A vaccine. How’re we doing? Our CEO reports from #CGI2012. http://ow.ly/eeqW0 
2:31 PM – 4 Oct 12 ·

Jeff Raikes @jeffraikes
Pls read my latest annual letter and @gatesfoundation annual report-released today. “Building Better Lives Together” http://bit.ly/SwJO6l 
Retweeted by Gates Foundation
11:10 AM – 4 Oct 12

Gates Health @gateshealth
Pasteur, Koch, Salk, Sabin, [You]. Be the next great vaccine pioneer. Grand Challenges wants your ideas to stop #TB: http://gates.ly/O2uLRc 
Retweeted by GAVI Alliance
8:00 AM – 3 Oct 12

GAVI Alliance @GAVIAlliance
Good news! Efforts 2 eliminate meningitis takes big step fwd as 50M people receive vaccinations in 7 African countries! http://ht.ly/edMwc 
8:46 AM – 4 Oct 12

VAC at JHSPH @IVACtweets
A New Chapter for IVAC – Blog post by Acting Director, Dr. Kate O’Brien http://bit.ly/OF4bil 
6:08 AM – 4 Oct 12

Vaccines: The Week in Review 29 September 2012

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_29 September 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…

UN Event – Our Commitment to the Next Generation: The Legacy of a Polio-free World

GPEI Media Release: Global Luminaries Unite to Issue Urgent Call for a Polio-Free World
“…The high-level event, “Our Commitment to the Next Generation: The Legacy of a Polio-free World,” featured opening remarks from UN Secretary-General Ban Ki-moon and was moderated by Senator Timothy E. Wirth, president of the UN Foundation.
“Speakers included leaders of the three polio-endemic countries: President Hamid Karzai, Islamic Republic of Afghanistan; President Goodluck Jonathan, Federal Republic of Nigeria; and President Asif Ali Zardari, Islamic Republic of Pakistan. Earlier this year, these leaders launched national emergency plans to stop transmission of polio in their countries…”
http://www.polioeradication.org/tabid/461/iid/251/Default.aspx

 
Statement: UN Secretary-General’s remarks at side event on Polio Eradication
New York, 27 September 2012: http://www.un.org/sg/statements/index.asp?nid=6328

 
Joint Media Release: Leaders at UN event unite behind final push to eradicate polio
7 September 2012 – World leaders, donors and experts today hailed a “once-in-a-generation” opportunity to eradicate polio, as they gathered at the United Nations to celebrate efforts that have already reduced the incidence of the crippling and potentially fatal disease by 99 per cent around the globe.

“Globally, we have the lowest number of cases reported this year,” Secretary-General Ban Ki-moon told the high-level event on polio eradication, which took place on the sidelines of the General Assembly debate at UN Headquarters in New York.

“But everything hinges on stopping polio in a few districts in Nigeria, Pakistan and Afghanistan,” he said, referring to the three remaining countries where the disease is endemic.

The vaccine-preventable infectious disease raged in 125 countries when the global fight against it began in 1988 under the banner of the Global Polio Eradication Initiative (GPEI). While India had long been regarded as the nation facing the greatest challenges to eradication, it has been polio free for more than 18 months.

But Mr. Ban said the success of the final push depended on the “quality” of the world’s efforts in those remaining areas.

He called not only for close cooperation from government, religious, traditional and community leaders, but also for belligerents to play their part in helping end the disease.

“Where there is fighting and insecurity, we need warring parties to allow aid workers to operate,” he told the gathering, which included the participation of Presidents Hamid Karzai of Afghanistan, Goodluck Jonathan of Nigeria and Asif Ali Zardari of Pakistan. “I appeal to all parties to provide safe passage for health workers to access and vaccinate children.”

Polio is among five major afflictions Mr. Ban pledged to aggressively tackle during this, his second term as Secretary-General. He is also committed to tackling malaria, new paediatric HIV infections, maternal and neonatal tetanus, and measles.

“This is a matter of health and justice. Every child should have the right to start life with equal protection from these diseases,” Mr. Ban said.

The World Health Organization (WHO) spearheads the GPEI, whose ultimate success would mark an early milestone in the Decade of Vaccines, which in turn represents a global vision to provide all children with the vaccines they need.

“No single one of us can bring this long, hard drive over the last hurdle,” WHO Director-General Margaret Chan said. “But together we can.”

A major GPEI donor is the Bill & Melinda Gates Foundation, whose co-chair, Bill Gates, also spoke of the significance eradicating polio would have for combating other diseases. “When we defeat polio, it will motivate us to aim for other great health and development milestones,” he said.

GPEI is currently developing a long-term roadmap for ending polio through a strategy whose investment legacy will benefit other vaccine-preventable disease goals. This comes after 194 States of the World Health Assembly declared the final push towards polio eradication to be a “programmatic emergency for global public health.”

“Governments need to step up and honour their commitments,” Wilfred J. Wilkinson, Chair of Rotary Foundation Trustees, told today’s gathering. For its part, Rotary International, which already has contributed $1.2 billion to polio eradication, announced additional funding of $75 million over three years for GPEI.

Pledges, initiatives and simple reinforcement of commitments came from a host of leaders and senior government officials, including those of Australia, Canada, Japan, Pakistan, the United Kingdom and the United States.

The Islamic Development Bank, a new donor to the polio eradication effort, announced a three-year $227 million financing package to Pakistan, and a $3 million grant for Afghanistan.

Sandro Rosell, President, Football Club Barcelona (FCB) and FCB Foundation, announced the club’s engagement on the polio issue in collaboration with the Gates Foundation and Etisalat, the largest telecomm operator in the Middle East.

Among significant related upcoming events, some 60,000 people are expected to attend a concert in New York’s Central Park on 29 September. The organizers, Global Poverty Project, say their Global Citizen Festival aims to inspire a global movement to voice support for both eradicating polio and for advancing the group’s core cause, ending extreme poverty.

http://www.un.org/apps/news/story.asp?NewsID=43081&Cr=polio&Cr1=#.UGdvd67vwbQ

GPEI Update: Polio this week – As of 25 Sep 2012

Update: Polio this week – As of 25 Sep 2012
Global Polio Eradication Initiative

[Editor’s Extract]
Afghanistan
One new case was reported in the past week (WPV1 from Kandahar), bringing the total number of cases for 2012 to 18. It is the most recent case in the country and had onset of paralysis on 28 August…

Nigeria
Two new cases were reported in the past week (WPV1s from Kaduna and Jigawa), bringing the total number of cases for 2012 to 90. The case from Kaduna is the most recent in the country and had onset of paralysis on 1 September…

Pakistan
Two new cases were reported in the past week (WPV1s from Khyber Pakhtunkhwa – KP – and Federally Administered Tribal Areas), bringing the total number of cases for 2012 to 37. The most recent case had onset of paralysis on 30 August (WPV1 from KP)…

http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

iERG on Information and Accountability for Women’s and Children’s Health

Media Release: Most of world will fail to meet goals for women’s and children’s health by 2015 amid declining donor funding
iERG on Information and Accountability for Women’s and Children’s Health
26 September 2012

The first report of the UN Secretary-General’s independent Expert Review Group (iERG)* on Information and Accountability for Women’s and Children’s Health, to be launched on September 26 at the UN General Assembly, concludes that although headline reductions in maternal and child mortality during the past decade have been impressive in some countries, millions of women and children still die every year from preventable causes. Unless those causes are more urgently addressed globally and in countries, Millennium Development Goals (MDGs) 4 and 5 will not be met by most nations by the target year of 2015. What is more, declining rates of donor funding and a failure to target resources to the countries with the greatest need could have devastating consequences for the survival of millions of women and children worldwide.

http://www.who.int/pmnch/media/news/2012/20120926_ierg_pr/en/index.html

Pledge: DoV Collaboration Leadership commits to making DoV vision a reality

Post: DoV Collaboration Leadership commits to making DoV vision a reality

September 25th, 2012

This pledge proclaims the commitment by the Decade of Vaccines Collaboration Leadership Council to make the vision of the Decade of Vaccines a reality through the implementation of the Global Vaccine Action Plan (GVAP). This pledge also shows the DoV Collaboration’s commitment to the principles of Every Woman Every Child.

The Decade of Vaccines is a vision to reach all people with the vaccines they need. The Leadership Council of the Decade of Vaccines has made a commitment to this vision and asks for your organization’s pledge to improve the health and lives of women and children everywhere by systematically addressing their unmet needs in immunization. Immunization throughout a person’s lifetime is crucial if we are to achieve the ambitious goals of the UN Secretary General’s Global Strategy for Women’s and Children’s Health.

As representatives of the numerous organizations that worked on the Decade of Vaccines Collaboration, we are proud to say that millions of lives will be saved thanks to the promise of the Global Vaccine Action Plan, an ambitious roadmap approved by the World Health Assembly in May 2012 to deliver universal access to immunizations.

The leadership of the World Health Organization, UNICEF, the Bill & Melinda Gates Foundation, the GAVI Alliance, the U.S. National Institute of Allergy and Infectious Diseases, the African Leaders Malaria Alliance and others that formed the Decade of Vaccines Collaboration, have pledged our support to this joint effort. Many governments, health leaders, non-government organizations and other agencies have joined us.

We are all committed to improving the health of every woman and every child on the planet.     Our vision to achieve this is straightforward: We will work together to extend, by 2020 and beyond, the full benefits of immunization to all people, regardless of where they are born, who they are or where they live. We will use the powerful tools already available to most, but not yet all people, including existing and new vaccines that prevent disease and save lives.

We have achieved many things through immunization: We eradicated smallpox from the world, in what has been called one of mankind’s greatest triumphs. We are on the verge of eradicating polio, and the toll of other diseases has dropped tremendously. The Region of the Americas has eliminated measles and rubella, saving many lives.

Despite these accomplishments, and the lives that have been improved through immunization, we cannot rest while the lives of so many depend on our actions at this seminal moment. We must reach forward, work together and make this vision of the Decade of Vaccines a reality. We all have a role in making this happen. We ask that you make your voices heard and your actions count, in support of the Global Vaccine Action Plan.

http://www.dovcollaboration.org/dov-collaboration-updates/dov-collaboration-leadership-commits-to-making-dov-vision-a-reality/

 

[Editor’s Note: While no individual names are included in the pledge above, the DoV leadership is listed here: http://www.dovcollaboration.org/about-us/our-structure/ ]

Dr. Alejandro Cravioto to join IVI as Chief Scientific Officer (CSO)

IVI Director General Christian Loucq, MD announced that Dr. Alejandro Cravioto will join IVI as Chief Scientific Officer (CSO) effective October 15, 2012. As CSO, Dr. Cravioto will “assume responsibility for the oversight of all scientific affairs at IVI and will provide expert advice on matters relevant to vaccine science and technology, potential opportunities, and emerging orientations and trends in the field of vaccine research.” IVI noted that Dr. Cravioto brings a breadth of experience that will be critical for the further development of IVI.  For the past 7 years, he was the Deputy Director and Executive Director of ICDDR,B in Dhaka, Bangladesh. In 2011, he was appointed by the UN Secretary General Ban Ki-moon to head a panel investigating the cholera outbreak in Haiti. Dr. Cravioto is a Mexican National who obtained his MD at the Faculty of Medicine of the National Autonomous University of Mexico. He trained as  a Pediatrician (National Institute of Pediatric, Mexico City) and received a Diploma in Tropical Public Health and a Ph.D. at the London School of Hygiene and Tropical Medicine. While in Mexico Dr. Cravioto served as Head of the Research Department and Deputy Director of the National Institute of Health and Technology for Child Health. He later became Director of the Division of Microbiology at the National Institute of Public Health of Cuernavaca and Professor and Chair of the Department of Public Health of the Faculty of Medicine of the National Autonomous University of Mexico before being appointed as the Dean of the Faculty of Medicine from 1995 to 2003.

[IVI email announcement, 27 September 2012]

Atreca, Inc. announces US$6 million Gates Foundation investment

Atreca, Inc. announced a collaboration with the Bill & Melinda Gates Foundation to accelerate the discovery and development of novel vaccines and therapeutics for human infectious diseases. The US$6 million BMGF investment “…provides Atreca an opportunity to apply its Immune Repertoire Capture technology to meet key challenges in global health.” This technology “leverages next-generation sequencing to identify rapidly and comprehensively the set of functional antibodies produced in patients during an immune response. These antibodies both have utility themselves and can be employed to identify the targets of an immune response.  Applied to human disease, Immune Repertoire Capture is an engine for the discovery and development of antibody-based therapeutics, vaccines, diagnostics, and research reagents.  Atreca recently licensed exclusive rights to the technology for all fields of use from Stanford University.” Atreca is a privately held biopharmaceutical founded in 2010 with headquarters in San Carlos, California.

http://www.atreca.com/press/september-25-2012/

Berlin meeting explores strategies for NTD treatment and control program

In a joint announcement, the Global Network for Neglected Tropical Diseases, the Sabin Vaccine Institute, and the Association of Research-Based Pharmaceutical Companies (vfa),  said “global health advocates and the pharmaceutical industry came together (in Berlin) to discuss strategies for improved collaboration and increased private sector involvement in neglected tropical disease (NTD) treatment and control programs. The announcement said the experts from WHO, BMGF, vfa, Merck KGaA, Merck & Co., Inc., Eisai Co. Ltd., Bayer HealthCare, Sanofi, and the British Parliament “exchanged new ideas and called for expanded partnerships in order to meet WHO’s target to control and eliminate the most common NTDs by 2020.” The workshop also evaluated progress made since the “London Declaration,” including drug donations from pharmaceutical companies, donor government support for NTD programs and new research and development initiatives. The group also discussed the need for new partnerships between the private sector and non-governmental organizations (NGOs) in order to create treatment models that will ultimately allow endemic countries to manage their NTD programs.

http://www.prnewswire.com/news-releases/industry-ngos-share-joint-progress-on-neglected-tropical-disease-control-171730051.html

WHO Europe: Updates to 29 Sep 2012

WHO Europe: Updates

Pilot testing of behaviour-based immunization toolkit enters second phase in Bulgaria
27-09-2012
The second phase of a pilot project on implementation of a toolkit focused on vaccination behaviours among vulnerable populations took place in Sofia, Bulgaria, on 10–14 September 2012.  This second mission was dedicated to testing the formative phase of the toolkit.

European Immunization Week 2012 in review
26-09-2012
In 2012, all 53 Member States in the WHO European Region took part in European Immunization Week (EIW), a milestone in the initiative’s seven-year history. The 2012 campaign focused on the elimination of measles and rubella by 2015, and the vital role of health workers as the most trusted source of information about vaccines.

WHO contributes to strengthening Bulgaria’s vaccine regulatory system
24-09-2012
From 1 to 4 October 2012 WHO will conduct a reassessment of Bulgaria’s national regulatory authority (NRA) responsible for the regulatory oversight of vaccines. This is a key and mandatory step in the WHO vaccine prequalification procedure.

MMWR Weekly for September 28, 2012

The MMWR Weekly for September 28, 2012 / Vol. 61 / No. 38 includes:

Influenza Vaccination Coverage Among Health-Care Personnel — 2011–12 Influenza Season, United States
Extract
“Influenza vaccination of health-care personnel (HCP) is recommended by the Advisory Committee on Immunization Practices (ACIP) (1). Vaccination of HCP can reduce morbidity and mortality from influenza and its potentially serious consequences among HCP, their family members, and their patients (1–3). To provide timely estimates of influenza vaccination coverage and related data among HCP for the 2011–12 influenza season, CDC conducted an Internet panel survey with 2,348 HCP during April 2–20, 2012. This report summarizes the results of that survey, which found that, overall, 66.9% of HCP reported having had an influenza vaccination for the 2011–12 season. By occupation, vaccination coverage was 85.6% among physicians, 77.9% among nurses, and 62.8% among all other HCP participating in the survey. Vaccination coverage was 76.9% among HCP working in hospitals, 67.7% among those in physician offices, and 52.4% among those in long-term care facilities (LTCFs). Among HCP working in hospitals that required influenza vaccination, coverage was 95.2%; among HCP in hospitals not requiring vaccination, coverage was 68.2%. Widespread implementation of comprehensive HCP influenza vaccination strategies is needed, particularly among those who are not physicians or nurses and who work in LTCFs, to increase HCP vaccination coverage and minimize the risk for medical-care–acquired influenza illnesses…”

Influenza Vaccination Coverage Among Pregnant Women — 2011–12 Influenza Season, United States

Influenza A (H3N2) Variant Virus-Related Hospitalizations — Ohio, 2012

Postvaccination Serologic Testing Results for Infants Aged ≤24 Months Exposed to Hepatitis B Virus at Birth — United States, 2008–2011

Announcements: Final State-Level 2011–12 Influenza Vaccination Coverage Estimates Available Online

World Rabies Day 2012

WHO: Vaccinate dogs to save human lives – World Rabies Day 2012
On 28 September – World Rabies Day – rabies experts at WHO and around the world are highlighting dog vaccination programmes as the most effective way to reduce the risk of this disease that kills around 50 000 people every year.
September 2012
http://www.who.int/features/2012/world_rabies_day/en/index.html

CDC: World Rabies Day
Raising Rabies Awareness
September 28 is World Rabies Day, a global health observance that seeks to raise awareness about rabies and enhance prevention and control efforts. Co-sponsored by CDC and the Alliance for Rabies Control (ARC) since 2007, World Rabies Day has been celebrated in countries throughout the world, including the U.S.

World Rabies Day is an excellent time to take steps that can help prevent and control rabies, such as vaccinating pets including dogs and cats and providing education on how to avoid the animals that typically transmit rabies: raccoons, bats, skunks, and foxes.
http://www.cdc.gov/worldrabiesday/

Weekly Epidemiological Record (WER) for 28 September 2012

The Weekly Epidemiological Record (WER) for 28 September 2012, vol. 87, 39 (pp. 369–380) includes:

– Meetings of the WHO working group on surveillance of influenza antiviral susceptibility – Geneva, November 2011 and June 2012
– Meeting of the WHO working group on polymerase chain reaction protocols for detecting subtype influenza A viruses – Geneva, June 2012
– Monthly report on dracunculiasis cases, January–June 2012

http://www.who.int/entity/wer/2012/wer8739.pdf

WHO: Global Alert and Response (GAR) – Disease Outbreak News 29 Sep 2012

WHO: Global Alert and Response (GAR)
Disease Outbreak News
Most recent news items

29 September 2012
Novel coronavirus infection – update – revised interim case definition

28 September 2012
Novel coronavirus infection – update

27 September 2012
Ebola outbreak in Democratic Republic of Congo – update

25 September 2012
Novel coronavirus infection – update

WHO: Vaccine Reaction Rates Information Sheets

WHO: Vaccine Reaction Rates Information Sheets
The information sheets on this page provide details on reaction rates of selected vaccines – whether single antigen or combined in a single product. WHO’s Immunization, Vaccines and Biologicals department has developed these sheets within its priority area supporting the introduction of vaccines in Member States.

The papers are primarily designed for use by national public health officials and immunization programme managers but may appeal to others interested in such information. Data from these sheets can be used for the evaluation of Adverse Events Following Immunization (AEFI) reported during national immunization programmes, but also for preparing communication materials about specific vaccines.

http://www.who.int/vaccine_safety/initiative/tools/vaccinfosheets/en/index.html