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_11 August 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…

CDC Update on H3N2v Cases Telebriefing Transcript – August 9, 2012

MMWR Early Release
August 10, 2012 / Vol. 61 / Early Release
Evaluation of Rapid Influenza Diagnostic Tests for Influenza A (H3N2)v Virus and Updated Case Count — United States, 2012

The Bill & Melinda Gates Foundation named Dr. Orin Levine as Director of Vaccine Delivery within the Global Development Program. Dr. Levine is currently Professor of International Health and Executive Director of the International Vaccine Access Center (IVAC) at the Johns Hopkins University’s Bloomberg School of Public Health. He will start work at the foundation on October 1. Chris Elias, president of the foundation’s Global Development Program, said, “Dr. Levine is a recognized expert in the fields of international public health, immunization, child survival and pneumonia, and we are very fortunate to have him join the foundation. His leadership at IVAC has accelerated global access to vaccines, helping save millions of lives each year.” http://www.gatesfoundation.org/press-releases/Pages/orin-levine-joins-gatesfoundation.aspx

    IVAC named Deputy Director Kate O’Brien as Acting Executive Director while a process takes place to name a permanent Executive Director. The action follows the announcement that Dr. Orin Levine will be taking up a new position at the Bill & Melinda Gates Foundation as Director of Vaccine Delivery starting October 1st .
http://www.jhsph.edu/research/centers-and-institutes/ivac/about-us/news.html

The Global Fund to Fight AIDS, Tuberculosis and Malaria named Daniel Camus as Chief Financial Officer. Mr. Camus is described as having “more than 25 years of experience as a senior executive, implementing long-term expansion in complex financial operations, including a recent position as Group Executive Director of Electricité de France (EDF), where he also oversaw international operations at the largest electric utility company in the world.” He holds a PhD in Finance and Economics from the Sorbonne in Paris. Gabriel Jaramillo, General Manager of the Global Fund, commented, “Daniel is a keystone of our transformation. He brings rock-solid financial expertise, private-sector perspective and unparalleled strategic thinking to the Global Fund. We are thrilled to have him join us.” http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-08-06_Global_Fund_Appoints_Daniel_Camus_as_Chief_Financial_Officer/

 Solicitation: Nominations for GAVI Alliance Board Member Representing Technical and Heath Research Institutes
Applications deadline:  September 15, 2012
Background: GAVI’s board includes members representing specific constituencies in addition to several unaffiliated members. One seat on the board is designated for Technical and health research institutes. Nominations for a candidate to serve in this role are sought to replace outgoing board member, Dr. Anne Schuchat (Centers for Disease Control and Prevention) after her three-year term ends in December 2012.
Application instructions:  Nomination packages should include a cover letter documenting the nominee’s qualifications related to vaccines and immunization, global technical advisory experience, and institutional support to carry out duties associated with service on the Board and related committees.  The package should also include the candidate’s Curriculum Vitae as well as a letter confirming support from the nominee’s institution director.
Additional information related to the GAVI Alliance is available at www.gavialliance.org.
Applications should be submitted by email with the subject line ‘GAVI Nomination’ to
duk3@cdc.gov.
http://www.gavialliance.org/about/governance/

Global Immunization News  31 July 2012

– Country-specific Estimates of Immunization Coverage for 1980-2011

– Information on Vaccines for an Intergovernmental Negotiating Committee to Prepare a Global Legally Binding Instrument on the Use of Mercury

– Hepatitis A Vaccination should be part of a Comprehensive Plan for Prevention and Control of Viral Hepatitis

– Notes From the Field: Salmonella Typhi Infec-tions Associated with Contaminated Water in Zimbabwe

– Vaccine pharmacovigilance system in Ghana

– AMP’s Africhol Monitors Impact of Mass Cholera Vaccination Campaign in Guinea

should be part of a Comprehensive Plan for Prevention and Control of Viral Hepatitis AMERICAS

– The Dominican Republic Introduces Rotavirus Vaccine into National Immunization Schedule

– International Workshop on Cold Chain Operations in Nicaragua

– Guatemala Celebrates the World Hepatitis Day

SOUTH EAST ASIA

– DPR Korea Launches Pentavalent Vaccine

WESTERN PACIFIC

– Effective Vaccine Management (EVM) Assessment in Fiji

– China’s continued progress towards maternal and neonatal tetanus (MNT) elimination

– Regional Meetings & Key Events

http://www.who.int/entity/immunization/GIN_July_2012.pdf

Book: Ethical and Scientific Issues in Studying the Safety of Approved Drugs
Authoring Institutions:
Board on Population Health and Public Health Practice (BPH)
Institute of Medicine (IOM)
ISBN-10: 0-309-21813-6
ISBN-13: 978-0-309-21813-9
Free pdf: https://download.nap.edu/login.php?record_id=13219&page=%2Fcatalog.php%3Frecord_id%3D13219%26utm_medium%3Detmail%26utm_source%3DThe%2520National%2520Academies%2520Press%26utm_campaign%3DNAP%2Bmail%2Bnew%2B8.7.12%26utm_content%3D%26utm_term%3D

Description:
An estimated 48 percent of the population takes at least one prescription drug in a given month. Drugs provide great benefits to society by saving or improving lives. Many drugs are also associated with side effects or adverse events, some serious and some discovered only after the drug is on the market. The discovery of new adverse events in the postmarketing setting is part of the normal natural history of approved drugs, and timely identification and warning about drug risks are central to the mission of the Food and Drug Administration (FDA). Not all risks associated with a drug are known at the time of approval, because safety data are collected from studies that involve a relatively small number of human subjects during a relatively short period.

Written in response to a request by the FDA, Ethical and Scientific Issues in Studying the Safety of Approved Drugs discusses ethical and informed consent issues in conducting studies in the postmarketing setting. It evaluates the strengths and weaknesses of various approaches to generate evidence about safety questions, and makes recommendations for appropriate followup studies and randomized clinical trials. The book provides guidance to the FDA on how it should factor in different kinds of evidence in its regulatory decisions….

Book: The Impact of Health Insurance on Low- and Middle-Income Countries
EDITORS
Charles C. Griffin, Maria-Luisa Escobar, R. Paul Shaw
Publisher: Brookings Institution Press
ISBN-13: 978-0-8157-0546-8
Pdf: http://www.brookings.edu/~/media/press/books/2011/1/theimpactofhealthinsuranceonlowandmiddleincomecountries/theimpactofhealthinsurance_fulltext.pdf

Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets.
Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers’ productivity, and change the population’s health care use patterns, mirroring the development of health systems in most OECD countries.
Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means.
Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.

Journal of Infectious Diseases
Volume 206 Issue 5 September 1, 2012
http://www.journals.uchicago.edu/toc/jid/current
Deborah Watson-Jones, Kathy Baisley, Riziki Ponsiano, Francesca Lemme, Pieter Remes, David Ross, Saidi Kapiga, Philippe Mayaud, Silvia de Sanjosé, Daniel Wight, John Changalucha, and Richard Hayes

Human Papillomavirus Vaccination in Tanzanian Schoolgirls: Cluster-Randomized Trial Comparing 2 Vaccine-Delivery Strategies
J Infect Dis. (2012) 206(5): 678-686 doi:10.1093/infdis/jis407
Abstract
Background. We compared vaccine coverage achieved by 2 different delivery strategies for the quadrivalent human papillomavirus (HPV) vaccine in Tanzanian schoolgirls.

Methods. In a cluster-randomized trial of HPV vaccination conducted in Tanzania, 134 primary schools were randomly assigned to class-based (girls enrolled in primary school grade [class] 6) or age-based (girls born in 1998; 67 schools per arm) vaccine delivery. The primary outcome was coverage by dose.

Results. There were 3352 and 2180 eligible girls in schools randomized to class-based and age-based delivery, respectively. HPV vaccine coverage was 84.7% for dose 1, 81.4% for dose 2, and 76.1% for dose 3. For each dose, coverage was higher in class-based schools than in age-based schools (dose 1: 86.4% vs 82.0% [P = .30]; dose 2: 83.8% vs 77.8% [P = .05]; and dose 3: 78.7% vs 72.1% [P = .04]). Vaccine-related adverse events were rare. Reasons for not vaccinating included absenteeism (6.3%) and parent refusal (6.7%). School absenteeism rates prior to vaccination ranged from 8.1% to 23.5%.

Conclusions. HPV vaccine can be delivered with high coverage in schools in sub-Saharan Africa. Compared with age-based vaccination, class-based vaccination located more eligible pupils and achieved higher coverage. HPV vaccination did not increase absenteeism rates in selected schools. Innovative strategies will be needed to reach out-of-school girls.

Clinical Trials Registration. NCT01173900.

Nature Medicine
August 2012, Volume 18 No 8 pp1155-1302
http://www.nature.com/nm/journal/v18/n7/index.html

Opinion
The time for pharmaceutical compulsory licensing has expired
Randall Kuhn & Reed F Beall
doi:10.1038/nm0812-1168
Published online
06 August 2012

The compulsory license mechanism is broken and will not bring drug access to the world’s poorest nations. It’s time to consider another option—a tax levied on patents—to fund drugs for developing countries, rather than the erratic compulsory licensing mechanism.

Pharmacoeconomics
September 1, 2012 – Volume 30 – Issue 9  pp: 749-858
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

Systematic Review
Assessing the Quality of Pharmacoeconomic Studies in India: A Systematic Review
Desai, Pooja R.; Chandwani, Hitesh S.; Rascati, Karen L.
Pharmacoeconomics. 30(9):749-762, September 1, 2012.
doi: 10.2165/11590140-000000000-00000

Abstract:
Objective: The aim of the study was to evaluate the quality of pharmacoeconomic studies based in India.

Methods: A literature search was conducted using PubMed, MEDLINE, EconLit, PsycInfo and Google Scholar to identify published work on pharmacoeconomics studies based in India. Articles were included if they were original studies that evaluated pharmaceuticals, were based in India and were conducted between 1990 and 2010. Two reviewers independently reviewed the articles using a subjective 10-point quality scale in addition to the 100-point Quality of Health Economic Studies (QHES) questionnaire.

Results: Twenty-nine articles published between 1998 and May 2010 were included in the review. The included articles were published in 23 different journals. Each article was written by an average of five authors. The mean subjective quality score of the 29 articles was 7.8 (standard deviation [SD] = 1.3) and the mean QHES scores for the complete pharmacoeconomic studies (n = 24) was 86 (SD = 6). The majority of authors resided in India (62%) at the time of publication and had a medical background (90%). The quality score was significantly (p ≤ 0.05) related to the country of residence of the primary author (non-India = higher) and the study design (randomized controlled trials = higher).

Conclusion: Although the overall quality scores were comparable to (e.g. Nigeria) or higher than (e.g. Zimbabwe) similar studies in other developing countries, key features such as an explicit study perspective and the use of sensitivity analyses were missing in about 40% of the articles. The need for economic evaluation of pharmaceuticals is imperative, especially in developing countries such as India as this helps decision makers allocate scarce resources in a justifiable manner.

PLoS One
[Accessed 11 August 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Optimizing Reactive Responses to Outbreaks of Immunizing Infections: Balancing Case Management and Vaccination
Petra Klepac, Ottar N. Bjørnstad, C. Jessica E. Metcalf, Bryan T. Grenfell
PLoS ONE: Research Article, published 10 Aug 2012 10.1371/journal.pone.0041428

Abstract 
For vaccine-preventable infections, immunization generally needs to be supplemented by palliative care of individuals missed by the vaccination. Costs and availability of vaccine doses and palliative care vary by disease and by region. In many situations, resources for delivery of palliative care are independent of resources required for vaccination; however we also need to consider the conservative scenario where there is some trade-off between efforts, which is of potential relevance for resource-poor settings. We formulate an SEIR model that includes those two control strategies – vaccination and palliative care. We consider their relative merit and optimal allocation in the context of a highly efficacious vaccine, and under the assumption that palliative care may reduce transmission. We investigate the utility of a range of mixed or pure strategies that can be implemented after an epidemic has started, and look for rule-of-thumb principles of how best to reduce the burden of disease during an acute outbreak over a spectrum of vaccine-preventable infections. Intuitively, we expect the best strategy to initially focus on vaccination, and enhanced palliative care after the infection has peaked, but a number of plausible realistic constraints for control result in important qualifications on the intervention strategy. The time in the epidemic when one should switch strategy depends sensitively on the relative cost of vaccine to palliative care, the available budget, and R0. Crucially, outbreak response vaccination may be more effective in managing low- diseases, while high R0 scenarios enhance the importance of routine vaccination and case management.

PLoS One
[Accessed 11 August 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Human Papillomavirus Infection: Knowledge, Attitudes, and Behaviors among Lesbian, Gay Men, and Bisexual in Italy
Concetta P. Pelullo, Gabriella Di Giuseppe, Italo F. Angelillo
PLoS ONE: Research Article, published 08 Aug 2012 10.1371/journal.pone.0042856

Abstract 
Background
This cross-sectional study assess knowledge, attitudes, and behavior towards the human papillomavirus (HPV) and the vaccination among a random sample of 1000 lesbian, gay men, and bisexual women and men.

Methods
A face-to-face interview sought information about: socio-demographic characteristics, knowledge about HPV infection, perception of risk towards HPV infection and/or cervical, anal, and oropharyngeal cancers, perception of the benefits of a vaccination to prevent cervical, anal, and oropharyngeal cancers, sexual behaviors, health-promoting behaviors, and willingness to receive the HPV vaccine.

Results
Only 60.6% had heard about the HPV infection and this knowledge was significantly higher in female, in those being a member of a homosexual association, in those having had the first sexual experience at a younger age, in those having received information about the HPV infection from physicians, and in those having no need of information about HPV infection. A higher perceived risk of contracting HPV infection has been observed in those younger, lesbian and gay men, who have heard of HPV infection and knew the risk factors and its related diseases, who have received information about HPV infection from physicians, and who need information about HPV infection. Only 1.7% have undergone HPV immunization and 73.3% professed intent to obtain it in the future. The significant predictors of the willingness to receive this vaccine were belief that the vaccination is useful, perception to be at higher risk of contracting HPV infection, and perception to be at higher risk of developing cervical, anal, and oropharyngeal cancers.

Conclusions
Information and interventions are strongly needed in order to overcome the lack of knowledge about HPV infection and its vaccination. Inclusion of boys in the national vaccination program and initiate a catch-up program for men who have sex with men up to 26 years may reduce their burden of HPV-related disease.

PLoS One
[Accessed 11 August 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Understanding Reduced Rotavirus Vaccine Efficacy in Low Socio-Economic Settings
Benjamin A. Lopman, Virginia E. Pitzer, Rajiv Sarkar, Beryl Gladstone, Manish Patel, John Glasser, Manoj Gambhir, Christina Atchison, Bryan T. Grenfell, W. John Edmunds, Gagandeep Kang, Umesh D. Parashar
PLoS ONE: Research Article, published 06 Aug 2012 10.1371/journal.pone.0041720

Abstract 
Introduction
Rotavirus vaccine efficacy ranges from >90% in high socio-economic settings (SES) to 50% in low SES. With the imminent introduction of rotavirus vaccine in low SES countries, understanding reasons for reduced efficacy in these settings could identify strategies to improve vaccine performance.

Methods
We developed a mathematical model to predict rotavirus vaccine efficacy in high, middle and low SES based on data specific for each setting on incidence, protection conferred by natural infection and immune response to vaccination. We then examined factors affecting efficacy.

Results
Vaccination was predicted to prevent 93%, 86% and 51% of severe rotavirus gastroenteritis in high, middle and low SES, respectively. Also predicted was that vaccines are most effective against severe disease and efficacy declines with age in low but not high SES. Reduced immunogenicity of vaccination and reduced protection conferred by natural infection are the main factors that compromise efficacy in low SES.

Discussion
The continued risk of severe disease in non-primary natural infections in low SES is a key factor underpinning reduced efficacy of rotavirus vaccines. Predicted efficacy was remarkably consistent with observed clinical trial results from different SES, validating the model. The phenomenon of reduced vaccine efficacy can be predicted by intrinsic immunological and epidemiological factors of low SES populations. Modifying aspects of the vaccine (e.g. improving immunogenicity in low SES) and vaccination program (e.g. additional doses) may bring improvements.

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

Editorial
Nigeria: “Ground Zero” for the High Prevalence Neglected Tropical Diseases
Peter J. Hotez, Oluwatoyin A. Asojo, Adekunle M. Adesina

Among all of the African nations, Nigeria has the greatest number of people infected with neglected tropical diseases (NTDs). With the right political will, the country has sufficient resources to expand its current investments for the important work of Nigeria’s NTD program.

Science        
10 August 2012 vol 337, issue 6095, pages 613-768
http://www.sciencemag.org/current.dtl

Perspective
Virology
A Henipavirus Vaccine in Sight
Veronika von Messling, Roberto Cattaneo

Nipah virus emerged in pig farms in Malaysia in the 1990s. Outbreaks were difficult to miss: The cough of infected animals could be heard 1 mile away from the farms. It soon became clear that Nipah is an important zoonotic threat. Fruit bats can transmit the virus to many mammals, including humans (1). The frequency of recurring Nipah virus outbreaks is on the rise (2). These outbreaks, which often affect Bangladesh or India, have caused more than 300 human fatalities since 1999 often due to encephalitis.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 40, Pages 5801-5900 (31 August 2012)

Editorial
Influenza vaccine, Guillain–Barré syndrome, and chasing zero
Pages 5801-5803
Gregory A. Poland, Steven J. Jacobsen
No abstract

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 40, Pages 5801-5900 (31 August 2012)

Student nurses’ reasons behind the decision to receive or decline influenza vaccine: A cross-sectional survey
Original Research Article
Pages 5824-5829
Charlotte Hunt, Antony Arthur

Abstract
This cross-sectional questionnaire survey examined influenza vaccination among 430 student nurses. Only 12.2% (95% CI 9.1–15.3%) of student nurses received the seasonal vaccine regularly with 27.6% (95% CI 23.3–31.8%) ever having received seasonal or pandemic H1N1 vaccine. Intention to be vaccinated was associated with having previously been vaccinated (p < 0.001) but not whether the vaccine was perceived as beneficial (p = 0.36). Previous influenza illness was associated with having the influenza vaccine (p < 0.001). The most frequently reported reason for receiving the seasonal influenza vaccine was being deemed at risk (42.4%) and for H1N1 vaccine was because it was offered for free (32.6%). For both vaccines the most reported reason for not being vaccinated was a perception of it not being needed. Student nurses form a substantial and influential part of the future healthcare workforce but to translate the widely held acceptance that influenza vaccine is beneficial into actual uptake, a more targeted and persuasive message is needed.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 40, Pages 5801-5900 (31 August 2012)

Vaccine trials in the developing world: Operational lessons learnt from a phase IV poliomyelitis vaccine trial in South Africa
Original Research Article
Pages 5839-5843
H. Geldenhuys, Z. Waggie, M. Jacks, M. Geldenhuys, L. Traut, M. Tameris, M. Hatherill, W.A. Hanekom, R. Sutter, G. Hussey, H. Mahomed

Abstract
Background
Conducting vaccine trials in developing nations is necessary but operationally complex. We describe operational lessons learnt from a phase IV poliomyelitis vaccine trial in a semi-rural region of South Africa.

Methods
We reviewed operational data collected over the duration of the trial with respect to staff recruitment and training, participant recruitment and retention, and cold chain maintenance.

Results-Lessons Learnt
The recruitment model we used that relied on the 24 h physical presence of a team member in the birthing unit was expensive and challenging to manage. Forecasting of enrolment rates was complicated by incomplete baseline data and by the linear nature of forecasts that do not take into account changing variables. We found that analyzing key operational data to monitor progress of the trial enabled us to identify problem areas timeously, and to facilitate a collegial problem-solving process by the extended trial team.

Pro-actively nurturing a working relationship with the public sector health care system and the community was critical to our success. Despite the wide geographical area and lack of fixed addresses, we maintained an excellent retention rate through community assistance and the use of descriptive residential information. Training needs of team members were ongoing and dynamic and we discovered that these needs that were best met by an in-house, targeted and systemized training programme. The use of vaccine refrigerators instead of standard frost-free refrigerators is cost-effective and necessary to maintain the cold-chain.

Conclusion
Operational challenges of a vaccine trial in developing world populations include inexperienced staff, the close liaison required between researchers and public health care services, impoverished participants that require complex recruitment and retention strategies, and challenges of distance and access. These challenges can be overcome by innovative strategies that allow for the unique characteristics of the setting, trial population, and trial team.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 40, Pages 5801-5900 (31 August 2012)

Socioeconomic inequalities in completion of hepatitis B vaccine series among Korean women: Results from a nationwide interview survey
Original Research Article
Pages 5844-5848
Boyoung Park, Kui Son Choi, Hoo-Yeon Lee, Jae Kwan Jun, Eun-Cheol Park

Abstract
Background
Hepatitis B virus (HBV) infection and its sequelae are major global health problems. This study was conducted to investigate the association between factors related to socioeconomic status and HBV vaccination in the general population of women in Korea.

Methods
Data from annual nationwide cross-sectional interview surveys conducted between 2005 and 2008 were reviewed. These surveys included representative samples of cancer-free people and 4350 women interviewed within the study period were included in the present report. Polychotomous logistic regression was used in the analysis.

Results
The complete HBV coverage rate was 39.8%. Older age, lower household income and lower education level showed significant unfavorable influences on the completion of the HBV vaccine series (P-trend <0.001 for all three variables). Lack of private insurance and having a routine and manual job were also associated with a lower complete vaccination rate (OR: 0.69, 95% CI: 0.57–0.84; OR: 0.56, 95% CI: 0.38–0.82, respectively), whereas living in an urban area was related to a higher rate (OR: 1.18, 95% CI: 1.02–1.37). Older age, lower education level, and not having private insurance were associated with incomplete vaccination compared with unvaccination (P-trend 0.001, <0.001, OR: 0.68, 95% CI: 0.53–0.78, respectively). Among women of reproductive age, similar results were seen for education level, household income, and occupation. Significant disparities in vaccination status according to socioeconomic status, as indicated by the combination of household income and education level, were seen (P-trend <0.001). The most common reason for unvaccination was lack of knowledge about the necessity for HBV vaccination.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 40, Pages 5801-5900 (31 August 2012)

Acceptance of a post-partum influenza vaccination (cocooning) strategy for neonates in Greece
Original Research Article
Pages 5871-5874
Helena C. Maltezou, Kleopatra Kalogriopoulou, Vasileios Pergialiotis, Tania Siahanidou, Anna V. Skiathitou, Panos Katerelos, Nikolaos Goumalatsos, Evangelos Kostis, Aristides Antsaklis, Maria Theodoridou

Abstract
Young infants are at increased risk for influenza-associated serious illness, onset of complications, utilization of health-care services, and hospitalization. We investigated the feasibility and acceptance of an influenza vaccination (cocooning) strategy by household contacts implemented in a maternity hospital and the neonatal unit of a pediatric hospital in Athens. A total of 224 mothers (mean age: 30.2 years) who gave birth to 242 neonates were studied. Of them, 165 (73.7%) mothers were vaccinated. Multiple logistic regression revealed that statistically significant factors associated with increased vaccination rates among mothers were: being of Roma origin (p-value = 0.002), being an immigrant (p-value = 0.025), giving birth to a neonate with birth weight <2500 g (p-value = 0.012), and residing in a family with ≥4 family members (p-value = 0.017). Of the 224 fathers, 125 (55.8%) received the influenza vaccine. Fathers of neonates whose mothers were vaccinated had 6-fold higher vaccination rates compared to fathers of neonates whose mothers refused vaccination (p-value < 0.001). Overall, influenza vaccine was administered to 348 (46.9%) of a total of 742 household contacts of the 242 neonates. Upon entering the 2011–2012 influenza season, 51 (22.7%) of 224 families had all household contacts vaccinated against influenza (complete cocoon). Among parents, the statement “I do not want to receive the vaccine” was the prevalent reason for declining influenza vaccination, followed by the misconception “I am not at risk for contacting influenza” (41.1% and 38.2%, respectively).

Vaccine
Volume 30, Issue 39, Pages 5699-5800 (24 August 2012)

Acceptance of and attitudes towards human papillomavirus vaccination in Japanese mothers of adolescent girls
Original Research Article
Pages 5740-5747
Sharon J.B. Hanley, Eiji Yoshioka, Yoshiya Ito, Ryo Konno, Yuri Hayashi, Reiko Kishi, Noriaki Sakuragi

Abstract
To better understand how to achieve high uptake rates of human papillomavirus (HPV) vaccination in Japan, we investigated acceptance of and attitudes towards HPV vaccination in 2192 mothers of girls aged 11–14 yrs. A school-based survey was conducted in five elementary and fourteen junior high schools in Sapporo, Japan. Responses from 862 participants were analyzed. Ninety-three percent of mothers would accept the vaccine for their daughter if free, but only 1.5% was willing to pay the minimum recommended price of ¥40,000. Vaccine acceptance was higher in mothers who had heard of HPV vaccine (adjusted odds ratio, aOR = 2.58, confidence interval, CI = 1.47–4.53), and who believed susceptibility to (aOR = 2.30, CI = 1.34–3.92) and severity of (aOR = 3.73, CI = 1.41–9.88) HPV to be high. Recommendations from a doctor (aOR = 12.60, CI = 7.06–21.48) and local health board (aOR = 27.80, CI = 13.88–55.86) were also positively associated with increased HPV vaccine acceptance. Concerns about side effects of both the HPV vaccine (aOR = 0.03, CI = 0.01–0.08) and routine childhood vaccines in general (aOR = 0.11, CI = 0.02–0.78) emerged as barriers to vaccination. Not participating in routine cervical screening also emerged as a deterrent (aOR = 0.49, CI = 0.27–0.91). While most mothers (66.8%) agreed that 10–14 yr was an appropriate age for vaccination, a further 30.6% believed >15 yr to be more appropriate.

In conclusion, attitudes of Japanese mothers toward HPV vaccination are encouraging. While lower vaccine acceptance in mothers who do not undergo regular cervical screening needs further investigation, this study indicates that high uptake may be possible in a publically funded HPV vaccination program if physicians actively address safety concerns and justify why the vaccine is needed at a particular age.

Vaccine
Volume 30, Issue 39, Pages 5699-5800 (24 August 2012)

Acceptability of human papillomavirus vaccination and sexual experience prior to disclosure to health care providers among men who have sex with men in Vancouver, Canada: Implications for targeted vaccination programs
Original Research Article
Pages 5755-5760
Claudia Rank, Mark Gilbert, Gina Ogilvie, Gayatri C. Jayaraman, Rick Marchand, Terry Trussler, Robert S. Hogg, Reka Gustafson, Tom Wong, The ManCount Study Team

Abstract
Background
Men who have sex with men (MSM) may benefit from human papillomavirus (HPV) vaccine due to increased risk for HPV infection and related disease. We assessed HPV vaccine acceptability and sexual experience prior to disclosure to Health Care Providers (HCP) to understand implications of targeted vaccination strategies for MSM.

Methods
From July 2008 to February 2009, 1169 MSM aged ≥19 years were recruited at community venues in Vancouver. We assessed key variables from a self-administered questionnaire and independent predictors of HPV vaccine acceptability using multivariate logistic regression.

Results
Of 1041 respondents, 697 (67.0%) were willing to receive HPV vaccine and 71.3% had heard of HPV. Significant multivariate predictors of higher vaccine acceptability were (adjusted odds ratio [95% CI]): previous diagnosis of genital warts (1.7 [1.1, 2.6]), disclosure of sexual behavior to HCP (1.6 [1.1, 2.3]), annual income at least $20,000 (1.5 [1.1, 2.1]), previous hepatitis A or B vaccination (1.4 [1.0, 2.0]), and no recent recreational drug use (1.4 [1.0, 2.0]). Most MSM (78.7%) had disclosed sexual behavior to HCP and median time from first sexual contact with males to disclosure was 6.0 years (IQR 2–14 years); for men ≤26 years these were 72.0% and 3.0 years (IQR 1–8 years) respectively.

Conclusions
Willingness to receive HPV vaccine was substantial among MSM in Vancouver; however, acceptability varied by demographics, risk, and health history. HPV vaccine programs delivered by HCP would offer limited benefit given the duration of time from sexual debut to disclosure to HCP.

Value in Health
Vol 15 | No. 5 | July-August 2012 | Pages 593-790
http://www.valueinhealthjournal.com/current

Cost-Effectiveness Analysis of the Bivalent Compared with the Quadrivalent Human Papillomavirus Vaccines in Taiwan
Nadia Demarteau, Chao-Hsiun Tang, Hui-Chi Chen, Chien-Jen Chen, et al.

Abstract 
Objective
To compare the epidemiological and economic impact of additional cross-protection against oncogenic human papillomavirus (HPV) types beyond 16/18 of the bivalent vaccine (BV) versus protection against nononcogenic HPV types 6/11 of the quadrivalent vaccine (QV) in Taiwan.

Methods
A lifetime Markov model calibrated to the Taiwanese setting simulated the natural history of low-risk (engendering cervical intraepithelial neoplasia [CIN] 1 and genital warts) and high-risk HPV (engendering CIN1, CIN2/3, and cervical cancer [CC]) infections, screening, and vaccination (100% coverage) for a cohort of 12-year-old girls (N = 153,000). Transition probabilities, costs, and utilities were estimated from published data and expert opinion. Vaccine efficacy was obtained from each vaccine’s respective clinical trials. Price-parity and lifelong protection was assumed for both vaccines. The number of CIN lesions, CC cases, CC deaths and genital wart (GW) cases, and quality-adjusted life-years were estimated. Costs and outcomes (discounted at 3% and 1.5%, respectively) were compared from a payer’s perspective.

Results
The model estimated that the BV led to an additional, undiscounted, 11,484 CIN1, 1,779 (+34.3% vs. QV) CIN2/3, 188 (+29.0% vs. QV) CC, and 69 (+29.0% vs. QV) CC deaths prevented compared with the QV, while the QV prevented 4,150 GW (+71%). This resulted in an additional 768 quality-adjusted life-years (QALY) and 11.6 million new Taiwan dollars costs saved for the BV versus the QV after discounting.

Conclusion
Both vaccines have a different epidemiological impact with an increased number of CC-related lesions potentially prevented for the BV because of additional cross-protection. In the Taiwanese setting, HPV mass vaccination using the BV was estimated to dominate vaccination using the QV.

Financial Times
http://www.ft.com
Accessed 11 August 2012

Opinion
August 9, 2012
The folly of resuming avian flu research
By Peter Hale, Simon Wain-Hobson and Robert May
http://www.ft.com/cms/s/0/e8bbee94-e20d-11e1-b3ff-00144feab49a.html#ixzz23CUYBFWG

Extract
“Few pathogens known to man are as dangerous as the H5N1 avian influenza virus. Of the 600 reported cases of people infected, almost 60 per cent have died. The virus is considered so dangerous in the UK and Canada that research can only be performed in the highest biosafety level laboratory, a so-called BSL-4 lab. If the virus were to become readily transmissible from one person to another (it is readily transmissible between birds but not humans) it could cause a catastrophic global pandemic that would decimate the world’s population.

“The 1918 Spanish flu pandemic was caused by a virus that killed less than 2 per cent of its victims, yet went on to kill 50m worldwide. A highly pathogenic H5N1 virus that was as easily transmitted between humans could kill hundreds of millions more.

“This is why it is so important to maintain the moratorium on H5N1 research that involves dangerous experiments to see “what it would take” for the virus to become airborne – and therefore as transmissible from one person to another as the seasonal flu…

The Guardian
http://www.guardiannews.com/
Accessed 11 August 2012

Anti-polio campaign is hit by setbacks in Nigeria
The Guardian – Nigeria

NIGERIA will not be able to meet the Presidential target of stopping the transmission of the Wild Polio Virus (WPV) by December 2012, and eventually eradication by December 2013, following the sustained transmission of the virus.

Reasons: Insecurity has forced the federal government to postpone the Immunisation Plus Days (IPDs) campaign especially in northern states. A recent polio campaign was postponed in Kaduna, Yobe and Borno due to insecurity. The three states were part of the 11 northern states scheduled for IPDs between July 7 and 10, 2012.

It is feared that the number of new polio cases in Nigeria will continue to rise following the beginning of the rainy season, a “high season” for polio transmission. In many countries, the high transmission season for poliovirus begins with the rainy season.

Some Nigerians especially in the northern region have continued to reject the vaccine due to controversy on whether the administration of polio vaccines on children causes infertility among women and Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS).

This is despite efforts by the Presidential Taskforce on Polio Eradication and the National Primary Health Care Development Agency (NPHCDA) to educate the Nigerian public on the causes of WPV spread and the need for them to allow their children to be administered with the Oral Polio Vaccine (OPV) to prevent the disease and the imminent paralysis…

New York Times
http://www.nytimes.com/
Accessed 11 August 2012

(WHO) HEALTH AGENCY OVERSHADOWED BUT VITAL
By YANZHONG HUANG
http://nytweekly.com/columns/intelarchives/08-03-12/

Extract
“…Historically, the organization has undertaken a wide range of campaigns against major disease threats, which culminated in the successful eradication of smallpox in the 1970s. Beginning in the 1980s, the complex challenges posed by H.I.V./AIDS called into question the W.H.O.’s lead role in global health governance. The organization’s failed 3 by 5 Initiative, which aimed to provide the three million people living with H.I.V./AIDS in low- and middle-income countries with life-prolonging antiretroviral drugs by the end of 2005, was a setback in its efforts to play a major role in tackling pressing global health problems. It is no coincidence that the director general of the W.H.O., Margaret Chan, was not one of the “prominent voices” to address the 2012 International AIDS Conference in Washington last month, even though the W.H.O. initiated the world’s most attended conference on H.I.V./AIDS 17 years ago.

In the 21st century, while the rise of noncommunicable diseases expands the discrepancy between the organization’s mandate and its capacity, the W.H.O. finds it hard to adapt to a world that is focused on the “bottom line” and “value for money.” As its budget and influence erode in a time of austerity, the W.H.O. is overshadowed by other health organizations and initiatives like the World Bank, which has substantial lending power, and the Gates Foundation, whose global health budget is about twice the size of W.H.O.’s core budget. Yet the W.H.O. is the organization that facilitates access to medicines for H.I.V./AIDS, malaria and tuberculosis; it rapidly mobilized an alert and response network in response to the 2003 SARS outbreak; and used its treaty-making power to negotiate the Framework Convention on Tobacco Control, one of the most widely and rapidly ratified of United Nations treaties. Any serious W.H.O. reform efforts should reflect its advantages.

During the H1N1 flu pandemic in 2009, the developing world did not look to the World Bank for information on how to respond to the spread of the unknown virus, nor did it go to the Gates Foundation for coordinating distribution of limited vaccines. In the wake of the swine flu pandemic, it was the W.H.O. that sponsored the landmark agreement to pave the way for virus sharing and access to affordable vaccines for Indonesia and the rest of the developing world. Like it or not, the W.H.O. is still the chief reference body for support in handling global health threats. To paraphrase Voltaire: If the W.H.O. didn’t exist, it would be necessary to invent it.

Unfortunately, the W.H.O. is underfunded and overstretched, limiting its ability to respond effectively to health challenges. For the past two decades, the organization has seen zero nominal growth in contributions from its member states. The organization has to rely on voluntary contributions. Today, 75 percent of its funding is from voluntary contributions, which are usually set aside for specific diseases, sectors or regions. The lack of predictable, flexible and sustainable funding has seriously compromised its ability to fulfill its core functions. For example, a mere 3 percent of its 2012-13 budget is for addressing noncommunicable diseases…”

(Yanzhong Huang is a Senior Fellow for Global Health at the Council on Foreign Relations and associate professor at the John C. Whitehead School of Diplomacy and International Relations, Seton Hall University in New Jersey.)

Twitter Watch  [accessed 10 August 2012 – 19:42]
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.

CDCgov @CDCgov
Heard about pertussis outbreaks? Vaccine-preventable diseases are still real. Is your preteen protected? http://shout.lt/b0RS
2:30 PM – 10 Aug 12

World Bank @WorldBank
World Bank Group Announces Jin-Yong Cai as New Executive Vice President & CEO of the International Finance Corporation http://bit.ly/QlEIEM
11:30 AM – 10 Aug 12

GAVI Alliance ‏@GAVIAlliance
. @OrinLevine : Congratulations on your appointment as Director of Vaccine Delivery at the @gatesfoundation ! #vaccineswork
6:06 AM – 10 Aug 12

CDCgov ‏@CDCgov
U.S. will likely have most whooping cough cases since 1959. Vaccine urged for all, esp pregnant moms. http://shout.lt/b0am
3:30 PM – 9 Aug 12

UNICEF @UNICEF
On #UNIndigenousDay, today, we celebrate the unique worldview of indigenous children and richness of their voices http://uni.cf/QJyqDa
2:05 PM – 9 Aug 12

ECDC Eurovaccine @Eurovaccine
#Measles transmission currently slow in Europe; read latest ECDC measles and #rubella monitoring report http://bit.ly/QeUXTW
9:32 AM – 8 Aug 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_4 August 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: Disease Outbreak News – Ebola Virus

3 August 2012
Ebola in Uganda – update
3 August 2012 — Experts continue the fight to control the Ebola haemorrhagic outbreak in western Uganda. The outbreak, now in its second week, has claimed at least 16 lives out of 53 cases reported. Ebola is caused by one of the most virulent pathogens known to humankind. WHO is supporting the screening of patients, follow-up of contacts and surveillance, providing personal protection suits and essential equipment, as well as social mobilization and education activities.

29 July 2012
Ebola in Uganda

Transcript: CDC Telebriefing: Influenza A (H3N2) Variant Virus
August 3, 2012

Extract
“…This is Joe Bresee at the flu division at CDC. Today I’m going to give you a quick update on an increase in the number of cases of influenza A H3N2 variant virus because on August 3rd, today, CDC’s FluView U.S. weekly influenza surveillance report, announced 12 new cases of H3N2 variant virus infection from three different states: Hawaii, Indiana and Ohio.  The virus was first detected in humans late last summer, July of 2011 and since July 12th, 2011, there have been 29 total cases of H3N2 variant virus infection detected, including the 16 cases occurring in the last three weeks.  Twenty-nine cases of infection with this H3N2 virus since the fall of 2011 is a significant increase in the number of detections for these types of virus we’ve seen in recent years.  All 29 cases were infected with H3N2v viruses that contain the matrix or M gene from the influenza A H1 pandemic virus.  This M gene may confirm increased transmissibility to and among humans compared with other variant influenza viruses…

“…So a summary of the recent cases.  Each of the recent 16 H3N2 variant cases reported in the last few weeks reported contact with swine prior to their illness onset.  In 15 of these cases contact occurred while attending or exhibiting swine at agricultural fairs.  All cases have been laboratory confirmed at CDC.  While no human-to-human spread has been identified in recent cases, limited transmission from person to person is thought to have occurred on three occasions in the fall and winter of 2011.  Importantly, sustained efficient community transmission of this virus, H3N2v virus has not been detected to date.  Clinical symptoms of the H3N2 virus infections have been generally consistent with symptoms associated with seasonal influenza virus, such as fever, cough, sore throat, muscle aches and headache.  No hospitalizations or deaths have occurred from the 16 confirmed cases but three cases were hospitalized among those detected last year in 2011.  All of those hospitalizations occurred among people with underlying diseases that put them at high risk for severe influenza infection.  Of the 16 recent cases, 13 of the cases are among children and three are among adults.  This is similar to the ages of the cases in 2011 and early 2012 that comprise the whole 29 and it actually is consistent with data from research studies that indicate that children may be more susceptible to the infection than adults…

“…CDC, along with state and local health departments and our colleagues in animal health will continue to monitor for these cases and provide information on how to prevent them.  Because influenza viruses are always evolving, we will watch closely for signs that the virus has gained an increased capacity for efficient and sustained human-to-human transmission.  Thus far we have not seen this type of transmission and therefore are not seeing features consistent with the earlier influenza pandemic.  Even so, the H3N2 variant virus vaccine has been prepared or the candidate has been prepared in clinical trials are being planned for this year.  So in summary, while sporadic cases of this variant virus have been observed for many years — variant viruses have been observed for many years, we’ve detected cases of this variant virus with increasing frequency over the last year, particularly in the last month.  We expect that additional cases of human infection with H3N2v virus will be identified either from contact with infected swine or through subsequent limited human-to-human spread, we also expect that some of the cases might be severe…”

GAVI reported that, “in the face of a severe humanitarian crisis, the government of Yemen will introduce rotavirus vaccine, supported by GAVI and its partners, with an aim to vaccinate the one million children born each year. Prof. Ahmad Qasim Al-A’nsi, Minister of Public Health and Population of Yemen, commented, “These tools are vital if we want to protect the children of Yemen from such deadly diseases. We aim to reach all children of Yemen especially in remote communities.”

http://www.gavialliance.org/library/news/press-releases/2012/yemen-introduces-rotavirus-vaccines/

NIAID Director Anthony Fauci, speaking at the annual meeting of the NIAID’s Centers of Excellence for Influenza Research and Surveillance (CEIRS), reportedly said that a voluntary moratorium on H5N1 transmission experiments aimed should continue for the time being, but that scientists “should redouble their efforts to engage with the larger public to gain support for the vital but risky work.” Dr. Fauci is quoted as saying “The flu scientific community can no longer be the only player in the discussion about this research. You will unquestionably lose the battle for public support for your research if you ignore this issue.”

http://news.sciencemag.org/scienceinsider/2012/07/us-infectious-disease-chief-urge.html

UN Secretary-General Ban Ki-moon announced the members of a High-level Panel to advise on the global development agenda beyond 2015, the target date for the Millennium Development Goals. The panel includes 26 members representing government, civil society, and the private sector. Three co-Chairs will lead the panel: President Susilo Bambang Yudhoyono of Indonesia; President Ellen Johnson Sirleaf of Liberia; and Prime Minister David Cameron of the United Kingdom.  The full list of Panel members is available below. The Secretary-General noted, “I have asked my High-level Panel to prepare a bold yet practical development vision to present to Member States next year. I look forward to the Panel’s recommendations on a global post-2015 agenda with shared responsibilities for all countries and with the fight against poverty and sustainable development at its core.” The Panel will hold its first meeting at the end of September and is expected to submit a report to the Secretary-General in the first half of 2013. Member States “have called for open, inclusive consultations involving civil society, the private sector, academia and research institutions from all regions, in addition to the United Nations system, to advance the development agenda beyond 2015.”

http://www.un.org/News/Press/docs//2012/sga1364.doc.htm

    IAVI (International AIDS Vaccine Initiative) announced the election of two new members to its Board of Directors: Alice P. Albright, Executive Vice President and Chief Operating Officer of the Export-Import Bank of the United States, and Dr. Purnima Mane, President and CEO of Pathfinder International. IAVI said “they join a diverse group of directors from 10 countries with backgrounds in finance, vaccinology, international development, academia and HIV treatment and prevention that oversees IAVI, evaluates its progress and shapes its long-term strategy.” Margaret McGlynn, President and CEO of IAVI, commented, “I am pleased to welcome Alice and Purnima to IAVI’s Board of Directors. They both bring to the organization a wealth of experience in global health and nonprofit management, and will no doubt provide strong strategic counsel to help guide IAVI in the coming years. A seasoned Board of Directors is essential to maintaining a successful global organization, and I am confident that Alice and Purnima will be vital members of this team.” http://www.businesswire.com/news/home/20120731006148/en/IAVI-Welcomes-Members-Board-Directors

The Weekly Epidemiological Record (WER) for 3 August 2012, vol. 87, 31/32 (pp. 289–304) includes: Cholera, 2011; WHO cholera information http://www.who.int/entity/wer/2012/wer8731_32.pdf

British Medical Journal
04 August 2012 (Vol 345, Issue 7868)
http://www.bmj.com/content/345/7868

Research
Cost effectiveness of vaccination against pandemic influenza in European countries: mathematical modelling analysis
BMJ 2012; 345 doi: 10.1136/bmj.e4445 (Published 12 July 2012)
Anna K Lugnér, researcher, Michiel van Boven, Robin de Vries, Maarten J Postma, Jacco Wallinga

Abstract
Objective
To investigate whether a single optimal vaccination strategy exists across countries to deal with a future influenza pandemic by comparing the cost effectiveness of different strategies in various pandemic scenarios for three European countries.

Design
Economic and epidemic modelling study.

Settings
General populations in Germany, the Netherlands, and the United Kingdom.

Data sources
Country specific patterns of social contact and demographic data.

Model
An age structured susceptible-exposed-infected-recovered transmission model that describes how an influenza A virus will spread in the populations of Germany, the Netherlands, and the United Kingdom.

Interventions
Comparison of four vaccination strategies: no vaccination, blanket vaccination, vaccination of elderly people (≥65 years), and vaccination of high transmitters (5-19 years). The four strategies were evaluated for scenarios in which a vaccine became available early or at the peak of the pandemic, and in which either everyone was initially susceptible or older age groups had pre-existing immunity.

Main outcome measure
Cost per quality adjusted life years (QALYs) gained.

Results
All vaccination strategies were cost effective (incremental cost per QALY gained, comparing intervention with non-intervention). In scenarios where the vaccine became available at the peak of the pandemic and there was pre-existing immunity among elderly people the incremental cost effectiveness ratios for vaccinating high transmitters were €7325 (£5815; $10 470) per QALY gained for Germany, €10 216 per QALY gained for the Netherlands, and €7280 per QALY gained for the United Kingdom. The most cost effective strategy not only differed across the pandemic scenarios but also between countries. Specifically, when the vaccine was available early in the pandemic and there was no pre-existing immunity, in Germany it would be most cost effective to vaccinate elderly people ( €940 per QALY gained), whereas it would be most cost effective to vaccinate high transmitters in both the Netherlands (€525 per QALY gained) and the United Kingdom (€163 per QALY gained). This difference in optimal strategies was due to differences in the demographic characteristics of the countries: Germany has a significantly higher proportion of elderly people compared with the Netherlands and the United Kingdom.

Conclusions
No single vaccination strategy was most cost effective across countries. With aging populations, pre-existing immunity in particular could be of crucial importance for the cost effectiveness of options to mitigate a future influenza pandemic.

Bulletin of the World Health Organization
Volume 90, Number 8, August 2012, 557-632
http://www.who.int/bulletin/volumes/90/8/en/index.html

Editorials
Performance-based financing in low- and middle-income countries: still more questions than answers
– Atle Fretheim et al.
doi: 10.2471/BLT.12.106468

Extract
Performance-based financing is promoted as a promising strategy for improving health service delivery and helping to reach the Millennium Development Goals.1,2 But what is the evidence supporting its use?

Performance-based financing may be defined as “the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target”.2 We recently conducted a Cochrane review of the available evidence on the effectiveness of performance-based financing in low- and middle- income countries.3 Nine studies, of which fewer than half had been published in scientific journals, fulfilled our inclusion criteria: one randomized controlled trial (RCT) and two interrupted time series conducted in Asia, and six controlled before–after studies conducted in Africa. Only two outcomes related to health care utilization – institutional deliveries and antenatal care – were assessed in more than one trial. Inconsistent results across studies made summarizing and interpreting the evidence difficult.

The most rigorous African study reported a moderate increase in institutional deliveries, from around 35% to 42% (i.e. 7 percentage points; 95% confidence interval, CI: 1–14).4 Findings from studies in Burundi,5 the Democratic Republic of the Congo6 and Rwanda7 showed disparate findings: one reported a significant increase in institutional deliveries, another found little or no change and the third showed a significant decrease. For these findings the risk of bias is high, partly because intervention and control areas were not randomly allocated and the same people who implemented the programmes also evaluated them. Two additional studies reporting on institutional deliveries were programme evaluations with a substantial risk of bias due to questionable data quality. The results on antenatal care attendance were also heterogeneous.

These findings clearly show that no general conclusion can be drawn regarding the likely impact of performance-based financing in low-and middle-income countries. For one thing, most of the studies found through the review were methodologically weak and had poor internal validity. Furthermore, since the impact of complex interventions such as performance-based financing depends largely on the context in which they are implemented, results may vary. Finally, the studies differed substantially in the way in which the performance-based financing scheme was designed and implemented…”

Bulletin of the World Health Organization
Volume 90, Number 8, August 2012, 557-632
http://www.who.int/bulletin/volumes/90/8/en/index.html

Sentinel versus population-based surveillance of pneumococcal conjugate vaccine effectiveness
Lee M Hampton, Elizabeth R Zell, Stephanie Schrag & Adam L Cohen

Abstract
Objective
To compare sentinel and population-based surveillance of the effect of seven-valent pneumococcal conjugate vaccine (PCV7), introduced in 2000, on the hospitalization of children aged under 5 years with invasive pneumococcal disease (IPD) in the United States of America.

Methods
Population surveillance data were used to identify children hospitalized between 1998 and 2006 with IPD caused by Streptococcus pneumoniae serotypes. The change from 1998 and 1999 (baseline) to 2006 in the number of hospitalized IPD cases recorded by sentinel surveillance systems involving single hospitals or groups of hospitals was compared with the change in the incidence of hospitalized IPD cases measured by population-based surveillance.

Findings
The change in incidence in the eight surveillance areas varied from −37 to −82% for IPD caused by any serotype and from −96 to −100% for IPD caused by serotypes contained in PCV7. All individual sentinel hospitals with more than three cases annually at baseline reported a decrease in cases by 2006. In addition, over 95% of sentinel systems with an average of more than 30 cases annually at baseline recorded a change by 2006 in the number of cases caused by any serotype that fell within the 95% confidence interval for the change in the incidence of hospitalized cases in the corresponding population surveillance area. The change in cases caused by PCV7 serotypes was accurately measured by 93% and 100% of sentinel systems with ≤ 20 and > 20 cases annually at baseline, respectively.

Conclusion
Sentinel surveillance can accurately measure the effect of PCV7 on the number of children hospitalized with IPD, provided sufficient cases are detected at baseline. Serotyping increases accuracy.

Bulletin of the World Health Organization
Volume 90, Number 8, August 2012, 557-632
http://www.who.int/bulletin/volumes/90/8/en/index.html

LESSONS FROM THE FIELD
Achieving high coverage in Rwanda’s national human papillomavirus vaccination programme
Agnes Binagwaho, Claire M Wagner, Maurice Gatera, Corine Karema, Cameron T Nutt & Fidele Ngabo

Abstract
Problem
Virtually all women who have cervical cancer are infected with the human papillomavirus (HPV). Of the 275 000 women who die from cervical cancer every year, 88% live in developing countries. Two vaccines against the HPV have been approved. However, vaccine implementation in low-income countries tends to lag behind implementation in high-income countries by 15 to 20 years.

Approach
In 2011, Rwanda’s Ministry of Health partnered with Merck to offer the Gardasil HPV vaccine to all girls of appropriate age. The Ministry formed a “public–private community partnership” to ensure effective and equitable delivery.

Local setting
Thanks to a strong national focus on health systems strengthening, more than 90% of all Rwandan infants aged 12–23 months receive all basic immunizations recommended by the World Health Organization.

Relevant changes
In 2011, Rwanda’s HPV vaccination programme achieved 93.23% coverage after the first three-dose course of vaccination among girls in grade six. This was made possible through school-based vaccination and community involvement in identifying girls absent from or not enrolled in school. A nationwide sensitization campaign preceded delivery of the first dose.

Lessons learnt
Through a series of innovative partnerships, Rwanda reduced the historical two-decade gap in vaccine introduction between high- and low-income countries to just five years. High coverage rates were achieved due to a delivery strategy that built on Rwanda’s strong vaccination system and human resources framework. Following the GAVI Alliance’s decision to begin financing HPV vaccination, Rwanda’s example should motivate other countries to explore universal HPV vaccine coverage, although implementation must be tailored to the local context.

Eurosurveillance
Volume 17, Issue 31, 02 August 2012
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Rapid Communications
Did public health travel advice reach EURO 2012 football fans? A social network survey
by J Janiec, A Zielicka-Hardy, A Polkowska, J Rogalska, M Sadkowska-Todys

Perspectives
Infectious disease surveillance for the London 2012 Olympic and Paralympic Games
by E Severi, E Heinsbroek, C Watson, M Catchpole, HPA Olympics Surveillance Work Group

Surveillance and outbreak reports
A new surveillance system for undiagnosed serious infectious illness for the London 2012 Olympic and Paralympic Games
by E Heinsbroek, B Said, H Kirkbride, On behalf of the HPA USII Steering Group

Human Vaccines & Immunotherapeutics(formerly Human Vaccines)
Volume 8, Issue 8  August 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/7/

REVIEWS
New insights into rotavirus vaccines
Chiara Mameli, Valentina Fabiano and Gian Vincenzo Zuccotti
http://dx.doi.org/10.4161/hv.20295

Abstract:
Rotavirus vaccines have shown to be effective and well tolerated in clinical trials. However it’s crucial to point out that immunization occurs in “real-word” conditions different from ideal clinical trial settings. Thus, the impact of rotavirus vaccines in terms of effectiveness and safety needs to be evaluated in real-world conditions. Post-licensure data regarding vaccine impact, effectiveness and safety under routine use are now available and provide a “real-world view”. We reviewed published data about the impact of rotavirus vaccines in the post-licensure era.

Human Vaccines & Immunotherapeutics(formerly Human Vaccines)
Volume 8, Issue 8  August 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/7/

Research Papers
Size of clinical trials and Introductory prices of prophylactic vaccine series
Steven H. Weinberg, Amy T. Butchart and Matthew M. Davis
http://dx.doi.org/10.4161/hv.20506

Abstract:
Costs of completing the recommended immunization schedule have increased over the last decade. Access to prophylactic vaccines may become limited due to financing obstacles within current delivery systems. Vaccine prices reflect research and development expenses incurred by vaccine manufacturers, including costs associated with evaluating candidate vaccines in human subjects. If the number of subjects in clinical trials is increasing over time and associated with vaccine price, this may help explain increases in prices of vaccine series. We examined whether: (A) the initial public- and private-sector prices for recommended prophylactic vaccine series licensed and recommended in the US increased from 2000–2011, (B) the number of human subjects per licensed vaccine increased during the time period, and (C) the number of human subjects was associated with the initial public–and private–sector prices of the vaccine series. In regression analyses of 13 vaccines, approval year was not significantly associated with the number of human subjects, initial public-sector prices, or initial private-sector prices. While the number of phase II subjects was not significantly associated with prices, the numbers of phase III and combined late phase (phases II + III) subjects were significantly associated with initial public- and private-sector series prices (p < 0.05). The association between number of subjects and initial prices demonstrated diminishing marginal increases in price with increasing numbers of subjects. These findings may help guide the number of subjects required by the FDA in clinical trials, in order to reduce expenses for manufacturers and thereby help mitigate increases in initial vaccine series prices.

Human Vaccines & Immunotherapeutics(formerly Human Vaccines)
Volume 8, Issue 8  August 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/7/

Model-based projections of the population-level impact of hepatitis A vaccination in Mexico
Thierry Van Effelterre, Rodrigo De Antonio-Suarez, Adrian Cassidy, Luis Romano-Mazzotti and Cinzia Marano
http://dx.doi.org/10.4161/hv.20549

Abstract:
There are indications of a shift in the pattern of hepatitis A (HAV) in Mexico from high to intermediate endemicity, progressively increasing the mean age of infection and the proportion of cases which are symptomatic.

This study estimated the potential impact of universal infant HAV vaccination in Mexico with two doses of Havrix™ at 12 and 18 mo of age on all HAV infections and symptomatic HAV infections. We developed a dynamic transmission model that accounts for changes in demography and HAV epidemiology. It was calibrated using Mexican age-specific seroprevalence and symptomatic HAV incidence data.

With 70% first-dose coverage and 85% second-dose coverage, the calibrated model projected that HAV vaccination would reduce the incidence of all HAV infections (symptomatic and asymptomatic) after the first 25 y of vaccination by 71–76% (minimum and maximum for different transmission scenarios). The projected reduction in cumulative incidence of symptomatic HAV infections over the first 25 y of vaccination was 45–51%. With 90% first-dose coverage and 85% second-dose coverage, the projected reduction in incidence of all HAV infections was 85–93%, and the projected reduction in the cumulative incidence of symptomatic HAV infections was 61–67%, over a 25-y time frame. Sensitivity analyses indicated that second-dose coverage is important under the conservative base-case assumptions made about the duration of vaccine protection.

The model indicated that universal infant HAV vaccination could substantially reduce the burden of HAV disease in Mexico.

Human Vaccines & Immunotherapeutics(formerly Human Vaccines)
Volume 8, Issue 8  August 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/7/

COMMENTARIES
Military vaccines in today’s environment
Connie S. Schmaljohn, Leonard A. Smith and Arthur M. Friedlander

Abstract:
The US military has a long and highly distinguished record of developing effective vaccines against pathogens that threaten the armed forces. Many of these vaccines have also been of significant benefit to civilian populations around the world. The current requirements for force protection include vaccines against endemic disease threats as well as against biological warfare or bioterrorism agents, to include novel or genetically engineered threats. The cost of vaccine development and the modern regulatory requirements for licensing vaccines have strained the ability of the program to maintain this broad mission. Without innovative vaccine technologies, streamlined regulatory strategies, and coordinating efforts for use in civilian populations where appropriate, the military vaccine development program is in jeopardy.

Human Vaccines & Immunotherapeutics(formerly Human Vaccines)
Volume 8, Issue 8  August 2012
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/7/

Cancer Commentary Series
SPECIAL FOCUS COMMENTARIES
Overview of the cancer vaccine field: Are we moving forward?
Alex Kudrin and Michael G. Hanna, Jr
http://dx.doi.org/10.4161/hv.20474
Abstract | Full Text | PDF

Biological heterogeneity of cancer: Implication to therapy
Isaiah J. Fidler
http://dx.doi.org/10.4161/hv.19643
Abstract | Full Text | PDF

Inter-tumor heterogeneity
Mike Cusnir and Ludmila Cavalcante
Abstract | Full Text

A tale of two pities: Autologous melanoma vaccines on the brink
David Berd
http://dx.doi.org/10.4161/hv.20923
Abstract | Full Text | PDF

Challenges in the development of an autologous heat shock protein based anti-tumor vaccine
Dirk J. Reitsma and Austin J. Combest
Abstract | Full Text

Immunotherapy with autologous tumor cell vaccines for treatment of occult disease in early stage colon cancer
Michael G. Hanna, Jr
http://dx.doi.org/10.4161/hv.20740
Abstract | Full Text | PDF

Open Access Article
Cancer Vaccines: Are We There Yet?
Michael G. Hanna, Jr
http://dx.doi.org/10.4161/hv.21660

Abstract:
For nearly two decades there has been an abundance of research and clinical development programs underway to develop active specific immunotherapies, to educate the patient’s immune response, specifically the T-cell immunity and memory, to recognize and destroy tumor cells by cell-mediated cellular toxicity. While many of these technology platforms achieved promising results in preclinical and clinical phase I and II clinical trials, essentially all but one have failed to achieve FDA market approval as a therapeutic drug product.

International Journal of Infectious Diseases
Volume 16, Issue 8, Pages e573-e644 (August 2012)
http://www.sciencedirect.com/science/journal/12019712

Review
Meningococcal disease in the Middle East and North Africa: an important public health consideration that requires further attention
Review Article
Pages e574-e582
Mehmet Ceyhan, Sameh Anis, Latt Htun-Myint, Robert Pawinski, Montse Soriano-Gabarró, Andrew Vyse

Summary
This paper reviews the epidemiological data describing meningococcal disease in the Middle East and North Africa (MENA). While meningococcal disease remains an important cause of endemic and epidemic disease in many MENA countries, existing published epidemiological data appear limited, fragmented, and collected via disparate methodologies. Children aged 5 years and younger are predominantly affected, though outbreaks of the disease often affect older age groups. Whilst serogroup A remains a main cause of meningococcal disease in the region, cases of serogroup B, W-135, and Y have been increasingly reported over the last two decades in some countries. The Hajj pilgrimage is a key factor influencing outbreaks and transmission, and the use of vaccines has minimized the effects on the home countries of the pilgrims and has decreased global dissemination of disease. Wider use of available polyvalent meningococcal conjugate vaccines may provide broader protection against the range of serogroups causing disease or posing a threat in the region. In addition, strengthening regional surveillance systems and regularly publishing reports with reliable estimates of disease incidence, carriage, disease-related mortality, and sequelae may facilitate the development of appropriate interventions and public health strategies regarding meningococcal disease within the region.

JAMA   
August 01, 2012, Vol 308, No. 5
http://jama.ama-assn.org/current.dtl

Research Letters | August 1, 2012
Number and Order of Whole Cell Pertussis Vaccines in Infancy and Disease Protection
Sarah L. Sheridan, BMed, MAppEpid; Robert S. Ware, PhD; Keith Grimwood, MB, ChB, MD; Stephen B. Lambert, MBBS, PhD

To the Editor: Due to their lower rate of adverse events, acellular pertussis vaccines (diphtheria-tetanus-acellular pertussis; DTaP) replaced whole cell vaccines (diphtheria-tetanus-whole cell pertussis; DTwP) in many developed countries during the 1990s. DTaP became available in Queensland, Australia, in 1996 and replaced DTwP for publicly funded primary course immunizations delivered at ages 2 months, 4 months, and 6 months in March 1999. This meant children born in 1998 could receive a primary course consisting of only DTwP, only DTaP, or a mixed schedule…

The Lancet  
Aug 04, 2012  Volume 380  Number 9840  p447 – 536
http://www.thelancet.com/journals/lancet/issue/current

Comment
Polio vaccines and the eradication of poliomyelitis
Philip D Minor
Preview
In The Lancet, Kathleen O’Reilly and colleagues1 describe their findings from a case-control analysis of vaccination history data from children in Pakistan and Afghanistan, in which they estimated the clinical effectiveness of oral monovalent, bivalent, and trivalent poliovirus vaccines (OPVs) specifically related to type 1 poliomyelitis—a topic that might seem esoteric to those outside the poliomyelitis community. However, these results provide an example of the need to tailor immunisation programmes to epidemiological circumstances, particularly where the goal is eradication.

Articles
The effect of mass immunisation campaigns and new oral poliovirus vaccines on the incidence of poliomyelitis in Pakistan and Afghanistan, 2001–11: a retrospective analysis
Kathleen M O’Reilly, Elias Durry, Obaid ul Islam, Arshad Quddus, Ni’ma Abid, Tahir P Mir, Rudi H Tangermann, R Bruce Aylward, Nicholas C Grassly

Summary
Background
Pakistan and Afghanistan are two of the three remaining countries yet to interrupt wild-type poliovirus transmission. The increasing incidence of poliomyelitis in these countries during 2010—11 led the Executive Board of WHO in January, 2012, to declare polio eradication a “programmatic emergency for global public health”. We aimed to establish why incidence is rising in these countries despite programme innovations including the introduction of new vaccines.

Methods
We did a matched case-control analysis based on a database of 46 977 children aged 0—14 years with onset of acute flaccid paralysis between Jan 1, 2001, and Dec 31, 2011. The vaccination history of children with poliomyelitis was compared with that of children with acute flaccid paralysis due to other causes to estimate the clinical effectiveness of oral poliovirus vaccines (OPVs) in Afghanistan and Pakistan by conditional logistic regression. We estimated vaccine coverage and serotype-specific vaccine-induced population immunity in children aged 0—2 years and assessed their association with the incidence of poliomyelitis over time in seven regions of Afghanistan and Pakistan.

Findings
Between Jan 1, 2001, and Dec 31, 2011, there were 883 cases of serotype 1 poliomyelitis (710 in Pakistan and 173 in Afghanistan) and 272 cases of poliomyelitis serotype 3 (216 in Pakistan and 56 in Afghanistan). The estimated clinical effectiveness of a dose of trivalent OPV against serotype 1 poliomyelitis was 12·5% (95% CI 5·6—18·8) compared with 34·5% (16·1—48·9) for monovalent OPV (p=0·007) and 23·4% (10·4—34·6) for bivalent OPV (p=0·067). Bivalent OPV was non-inferior compared with monovalent OPV (p=0·21). Vaccination coverage decreased during 2006—11 in the Federally Administered Tribal Areas (FATA), Balochistan, and Khyber Pakhtunkhwa in Pakistan and in southern Afghanistan. Although partially mitigated by the use of more effective vaccines, these decreases in coverage resulted in lower vaccine-induced population immunity to poliovirus serotype 1 in FATA and Balochistan and associated increases in the incidence of poliomyelitis.

Interpretation
The effectiveness of bivalent OPV is comparable with monovalent OPV and can therefore be used in eradicating serotype 1 poliomyelitis whilst minimising the risks of serotype 3 outbreaks. However, decreases in vaccination coverage in parts of Pakistan and southern Afghanistan have severely limited the effect of this vaccine.

Funding
Poliovirus Research subcommittee of WHO, Royal Society, and Medical Research Council.