Twitter Watch [accessed 28 July 2012 – 18:42]
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.

USAID Global Health ‏@USAIDGH
A new #GlobalHealth journal is seeking submissions. Learn more: http://ow.ly/ctf6D #AIDS2012 @GHSPJournal @JohnsHopkinsCCP @K4Health
8:50 AM – 28 Jul 12

GAVI Alliance @GAVIAlliance
Today is World Hepatitis Day! #Vaccines are critical 2 protecting kids against hepatitis B. http://ht.ly/cz1aV #worldhepday @GAVIAlliance
8:44 AM – 28 Jul 12

Seth Berkley @GAVISeth
Really exciting! Fiji with AusAid help will introduce 3 life saving vax: Pneumo, Rota & HPV in Q3. First country to do so! #vaccineswork
4:47 PM – 27 Jul 12

IVAC at JHSPH ‏@IVACtweets
Tomorrow is World Hepatitis Day! A shocking 1 in 12 people live with either chronic #hepatitis B or C. http://bit.ly/OqCtCQ #worldhepday
11:25 AM – 27 Jul 12

Kaiser Family Found @KaiserFamFound
VIDEO http://ow.ly/cxPIA Check out “The Global Fund: The Next 5 Years” from @aids2012 conference #AIDS2012 #HIV
10:33 AM – 27 Jul 12

Americas Quarterly @AmerQuarterly
AQ’s new issue: Lessons from #cholera in the Americas by Jonathan Weigel and Paul Farmer, co-founder of @PIH | http://bit.ly/NYUNU7 #Haiti
Retweeted by Partners In Health
5:45 PM – 26 Jul 12

The Wistar Institute ‏@TheWistar
With #pertussis (whooping cough) on the rise, Wistar’s Dr. Ertl comments on “Halting the Backwards Slide…” http://www.wistar.org/wistar-today/wistar-wire/2012-07-26/halting-the-backward-slide-toward-epidemic #vaccines
10:25 AM – 26 Jul 12

AIDS2012 @aids2012
Barton Haynes: Towards an HIV Vaccine: We Now Understand the Face of the Enemy http://youtu.be/8BYcQrce8CI #AIDS2012
Retweeted by IAVI
8:10 PM – 25 Jul 12

CDC Global Health @CDCGlobal
A7: Currently NIH, CDC, DOD, & IAVI do vaccine research in Kenya & are launching new trials of promising new vaccines #CDCiac3 #AIDS2012
Retweeted by IAVI
1:56 PM – 25 Jul 12

APHA ‏@PublicHealth
UK to offer free flu vaccine to all kids,  @dhgovuk announces: http://goo.gl/GlJtR
6:09 PM – 25 Jul 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_21 July 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…

Conference: The XIXth International AIDS Conference
Washington DC, USA
22–27 July 2012 Conference web site
The XIXth International AIDS Conference (AIDS2012) will be one of the central events of the year in global health and HIV. The conference theme is “Turning the tide together”, which emphasizes the decisive actions needed in today’s defining phase of the epidemic.
http://www.aids2012.org/Default.aspx?pageId=369

  WHO said that it will introduce new proposals tomorrow (22 July 2012) at the XIX International AIDS Conference focused on more strategic use of antiretroviral HIV medications to significantly reduce the transmission of the virus.  WHO Director-General Dr Margaret Chan said, “Every year, more than a million more people in low- and middle-income countries start taking antiretroviral drugs. But for every person who starts treatment, another two are newly infected. Further scale-up and strategic use of the medicines could radically change this. We now have evidence that the same medicines we use to save lives and keep people healthy can also stop people from transmitting the virus and reduce the chance they will pass it to another person.” Over the next 12 months, WHO will compile a new, consolidated set of recommendations related to the use of ARVs for both HIV treatment and prevention. The document will provide countries with clinical, programmatic and operational guidance so they can make the most effective and strategic use of ARVs, WHO said.
http://www.who.int/mediacentre/news/releases/2012/hiv_medication_20120718/en/index.html

The International Vaccine Institute (IVI) and the Sabin Vaccine Institute signed a memorandum of understanding (MOU) to “form a strategic alliance around research, development and advocacy among other stipulations.” The strategic alliance “will allow both organizations to benefit by complementing their current capabilities, such as focused disease areas and networks. In addition, the two organizations will collaborate to leverage their presence in different geographical regions, IVI in Asia and Africa and Sabin in the U.S. and Latin America.”  IVI and Sabin said the MOU includes: 1) Mutual introduction for product development programs; 2) Joint grant applications for development projects; 3) Joint grant applications for advocacy; 4) Establishment of offices in respective headquarters upon request; 5) Provision of policy presence and education of respective governmental entities where each organization has a strong presence; 6) Collaboration on fundraising; 7) Sharing of resources and personnel in the areas of regulatory affairs and submissions, quality assurance, and contract resource organization inputs.

Dr. Christian Loucq, Director-General of IVI, said, “I am thrilled to be signing this agreement with Sabin. Sabin shares common values with IVI and we look forward to seeking means to promote effective and efficient ways to advocate vaccine development in, and introduction to, developing countries.” Michael W. Marine, CEO at Sabin, said, “The strategic alliance between Sabin and IVI will allow our two organizations to strengthen the core activities that are required to build out a pipeline of vaccines for the world’s poorest communities. We look forward to collaborating with IVI on fundamental organizational priorities, including fundraising and advocacy efforts.”

http://www.ivi.org/web/www/07_01?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=276

The MMWR Weekly for July 20, 2012 / Vol. 61 / No. 28 includes:
– Pertussis Epidemic — Washington, 2012
– Notes from the Field: Tuberculosis Cluster Associated with Homelessness — Duval County, Florida, 2004–2012
– Notes from the Field: Severe Varicella in an Immunocompromised Child Exposed to an Unvaccinated Sibling with Varicella — Minnesota, 2011

Pertussis Epidemic — Washington, 2012
Since mid-2011, a substantial rise in pertussis cases has been reported in the state of Washington. In response to this increase, the Washington State Secretary of Health declared a pertussis epidemic on April 3, 2012. By June 16, the reported number of cases in 2012 had reached 2,520 (37.5 cases per 100,000 residents), a nearly 1,300% increase compared with the same period in 2011 and the highest number of cases reported in any year since 1942. To assess clinical, epidemiologic, and laboratory factors associated with this increase, all pertussis cases reported during January 1–June 16, 2012, were reviewed. This report describes the results of that review.
– CDC Telebriefing: Pertussis Epidemic in Washington State- 2012 Media Advisory – July 18, 2012
– Reported NNDSS pertussis cases: 1922-2011  [PDF – 108KB]
– Transcript

The Global Fund and the Government of Ethiopia signed two grant agreements valued at US$424 million “with the aim of achieving universal coverage of HIV treatment and completely eliminating malaria deaths in Ethiopia by 2015.” The announcement noted that “Ethiopia is widely recognized for its achievements in the health field in recent years. HIV-related deaths dropped from 99,000 in 2005 to 44,000 in 2011, a direct result of expanded treatment with anti-retroviral drugs. There has also been a 50 per cent decline in death rates for children under the age of five, from 2000 to 2011.”

http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-07-19_Global_Fund_and_Ethiopia_Sign_Agreements_For_US_dollars_424_Million/

The Global Fund made public a preliminary report of an independent evaluation of the pilot phase of the Affordable Medicines Facility–malaria, also known as AMFm. The evaluation “assesses 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 final report will be available in late August.

The goal of AMFm is to improve access to artemisinin-based combination therapies (ACTs), the most ef(AMFmfective anti-malaria treatment, saving lives and delaying the onset of widespread resistance to this class of medicines. 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 seven countries: Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania, and Uganda. The independent evaluation assessed the program in each of the pilot countries. Preliminary Report webpage: http://www.theglobalfund.org/en/amfm/independentevaluation/

Call for Public Comment on Paper: Study Designs for the Safety Evaluation of Different Childhood Immunization Schedules. By Martin Kulldorff, Ph.D

IOM Committee on Assessment of Studies of Health Outcomes Related to the Recommended Childhood Immunization Schedule.

The comment period has been extended until July 31, 2012, and can be accessed at: http://www.iom.edu/HealthOutcomesCommissionedPaper  For more information, please visit the Committee on Assessment of Studies of Health Outcomes Related to the Recommended Childhood Immunization Schedule’s webpage: http://www.iom.edu/Activities/PublicHealth/ChildhoodImmunization.aspx.

Poll: University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health – HPV Vaccination and Parental Consent

“Most U.S. adults support laws that allow teens to get medical care for sexually transmitted infections without parental consent. But when asked about the vaccine against the human papillomavirus (HPV), most adults want parents to have the final say on whether their teen or pre-teen gets the shots. The recently asked a national sample of adults about allowing adolescents age 12 to 17 years old to receive the HPV vaccinations without parental consent. Only 45 percent of those polled would support state laws allowing the HPV vaccination without parental consent…Those who did not support dropping parental consent were asked about their reasons. The most common reason, cited by 86 percent, was that HPV should be a parent’s decision; 43 percent cited the risk of side effects of the vaccine. About 40 percent said they have moral or ethical concerns about the vaccine.

Summary: http://mottnpch.org/reports-surveys/public-reluctant-support-teen-hpv-vaccination-without-parental-consent

Report: Together we will end AIDS
UNAIDS
July 2012

“This report contains the latest data on numbers of new HIV infections, numbers of people receiving antiretroviral treatment, AIDS-related deaths and HIV among children. It highlights new scientific opportunities and social progress which are bringing the world closer to UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. The report also gives an overview of international and domestic HIV investments and the need for greater value for money and sustainability. Calling for global solidarity and shared responsibility, the UNAIDS report contains commentaries from global and community leaders as well as people living with and affected by HIV.”

Report pdf: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2012/20120718_togetherwewillendaids_en.pdf

http://www.unaids.org/en/resources/campaigns/togetherwewillendaids/unaidsreport/

Report: Overview of the Consolidated Appeals and similar concerted humanitarian action plans at Mid-Year 2012
UN Office for the Coordination of Humanitarian Affairs
July 2012

“The number of people needing humanitarian aid around the world has risen from 51 million to 62 million – an increase of more than 20 per cent –during the first half of 2012…Halfway through this year we are seeing people in desperate need in twenty countries, whose lives and livelihoods have been shattered by conflict, hunger and disaster,” said Valerie Amos, UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator. “As well as providing effective emergency aid, humanitarian organizations are also working to improve the resilience of communities so that they can better cope with the impact of future natural disasters and conflicts.”

Some 560 humanitarian aid organizations are using the Consolidated Appeal Process to respond strategically to major crises and monitor the effectiveness of their work. Today, humanitarian partners have raised their funding requirements, from US$7.8 billion, at the beginning of the year, to $8.8 billion. 45 per cent of the funding required has been received but this leaves a gap of $4.8 billion for the remainder of 2012.

Report: Information and Communications for Development 2012: Maximizing Mobile
World Bank – infoDev
July 2012

The report notes that more than 30 billion mobile applications, or “apps,” were downloaded in 2011 – software that extends the capabilities of phones, for instance to become mobile wallets, navigational aids or price comparison tools. This trend is also “benefiting developing countries where people are increasingly using mobile phones to create new livelihoods and enhance their lifestyles, while governments are using them to improve service delivery and citizen feedback mechanisms.” World Bank Vice President for Sustainable Development Rachel Kyte said, “Mobile communications offer major opportunities to advance human and economic development – from providing basic access to health information to making cash payments, spurring job creation, and stimulating citizen involvement in democratic processes.” Around three-quarters of the world’s inhabitants now have access to a mobile phone and the mobile communications, and the number of mobile subscriptions in use worldwide, both pre-paid and post-paid, has grown from fewer than 1 billion in 2000 to over 6 billion now, of which nearly 5 billion are in developing countries. Ownership of multiple subscriptions is becoming increasingly common, suggesting that their number will soon exceed that of the human population.

http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTSDNET/0,,contentMDK:23241724~pagePK:64885161~piPK:64884432~theSitePK:5929282,00.html

British Medical Journal
21 July 2012 (Vol 345, Issue 7866)
http://www.bmj.com/content/345/7866

Analysis
Global threat from drug resistant HIV in sub-Saharan Africa
BMJ 2012; 344 doi: 10.1136/bmj.e4159 (Published 18 June 2012)
Cite this as: BMJ 2012;344:e4159
Ralph L Hamers, Cissy Kityo, Joep M A Lange, Tobias F Rinke de Wit, Peter Mugyenyi,

Excerpt
Roll-out of antiretroviral treatment for HIV in sub-Saharan Africa has been accompanied by rising rates of drug resistance. Raph Hamers and colleagues call for improved patient management and the integration of population based drug resistance surveillance into national treatment programmes

Since its introduction 16 years ago, combination antiretroviral therapy for HIV infection has saved millions of lives. In sub-Saharan Africa, the region with the highest HIV/AIDS burden, high level political commitment and substantial international funding have led to an unparalleled scale-up of access to treatment over the past eight years.1   More than five million Africans infected with HIV are receiving antiretroviral therapy today—nearly half of those who are in immediate need.1 However, little attention has been paid to the potential emergence and spread of drug resistant HIV and its public health implications. Drug resistant HIV variants selected for during treatment failure (acquired resistance) have the potential to limit the response to subsequent treatment and constitute a reservoir for onward transmission to newly infected individuals (transmitted resistance). Drug resistant HIV may severely restrict therapeutic options, and treatment costs will greatly increase when more people need second and third line antiretroviral regimens. It is therefore important for national HIV treatment programmes to monitor and manage mounting drug resistant HIV.

HIV drug resistance
In developed countries, management of combination antiretroviral therapy is based on individualised specialist care that includes frequent monitoring of plasma viral load to detect treatment failure, drug resistance testing to guide regimen choices, and a wide armamentarium of antiretroviral drugs (table⇓).2 In Europe and North America, HIV sequential mono and dual therapies of nucleoside reverse transcriptase inhibitors (NRTIs) initially led to high levels of acquired and transmitted resistance,3 4 5 but careful management and use of more potent antiretroviral regimens have seen levels of transmitted resistance stabilising …

Cost Effectiveness and Resource Allocation
(Accessed 21 July 2012)
http://www.resource-allocation.com/

From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decision making
Lalla Aïda Guindo, Monika Wagner, Rob Baltussen, Donna Rindress, Janine van Til, Paul Kind and Mireille M. Goetghebeur

Abstract (provisional)  [Open Access]
Objectives
Resource allocation is a challenging issue faced by health policy decisionmakers requiring careful consideration of many factors. Objectives of this study were to identify decision criteria reported in the literature on healthcare decisionmaking.

Method
An extensive literature search was performed in Medline and EMBASE to identify articles reporting healthcare decision criteria. Studies conducted with decisionmakers (e.g., focus groups, surveys, interviews), conceptual and review articles and articles describing tools were included. Criteria were extracted, organized using a classification system derived from the EVIDEM framework and applying multicriteria decision analysis (MCDA) principles, and the frequency of their occurrence was measured.

Results
Out of 3146 records identified, 2790 were excluded. Out of 356 articles assessed for eligibility, 39 were included in the study. Criteria were identified from studies performed in several regions of the world involving decisionmakers at micro, meso and macro levels of decision and from studies reporting on multicriteria tools. Large variations in terminology used to define criteria were observed and 338 different terms were identified. These were assigned to 58 criteria which were classified in 9 different categories including: health outcomes; types of benefit; disease impact; therapeutic context; economic impact; quality of evidence; implementation complexity; priority, fairness and ethics; and overall context. The most frequently mentioned criteria were: equity/fairness (33 times), efficacy/effectiveness (28), healthcare stakeholder interests and pressures (28), cost-effectiveness (24), strength of evidence (20), safety (19), mission and mandate of health system (18), need (16), organizational requirements and capacity (18) and patient-reported outcomes (16).

Conclusion
This study highlights the importance of considering both normative and feasibility criteria for fair allocation of resources and optimized decisionmaking for coverage and use of healthcare interventions. This analysis provides a foundation to develop a questionnaire for an international survey of decisionmakers on criteria and their relative importance. The ultimate objective is to develop sound multicriteria approaches to enlighten healthcare decisionmaking and priority-setting.

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

Cost Effectiveness and Resource Allocation
(Accessed 21 July 2012)
http://www.resource-allocation.com/

Methodology
Applying the net-benefit framework for assessing cost-effectiveness of interventions towards universal health coverage
Sennen Hounton and David Newlands

Abstract (provisional)  [Open Access]
In assessing the cost-effectiveness of an intervention, the interpretation and handling of uncertainties of the traditional summary measure, the Incremental Cost Effectiveness Ratio (ICER), can be problematic. This is particularly the case with strategies towards universal health coverage in which the decision makers are typically concerned with coverage and equity issues. We explored the feasibility and relative advantages of the net-benefit framework (NBF) (compared to the more traditional Incremental Cost-Effectiveness Ratio, ICER) in presenting results of cost-effectiveness analysis of a community based health insurance (CBHI) scheme in Nouna, a rural district of Burkina Faso. Data were collected from April to December 2007 from Nouna’s longitudinal Demographic Surveillance System on utilization of health services, membership of the CBHI, covariates, and CBHI costs. The incremental cost of a 1 increase in utilization of health services by household members of the CBHI was 4330 XOF ($1000 approximately). The incremental cost varies significantly by covariates. The probability of the CBHI achieving a 1% increase in utilization of health services, when the ceiling ratio is $1,000, is barely 30% for households in Nouna villages compared to 90% for households in Nouna town. Compared to the ICER, the NBF provides more useful information for policy making.

Eurosurveillance
Volume 17, Issue 29, 19 July 2012
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Rapid Communications
An ongoing large outbreak of measles in Merseyside, England, January to June 2012
by R Vivancos, A Keenan, S Farmer, J Atkinson, E Coffey, E Dardamissis, J Dillon, RJ Drew, M Fallon, R Huyton, R Jarvis, G Marsh, R Mason, T Shryane, A Stewart, S Ghebrehewet

Summary
From 1 January to 30 June 2012, 359 confirmed and 157 probable cases of measles were reported in Merseyside, England. The most affected age groups were children under five years and young adults from 15 years of age. Most cases have been sporadic. There have been few outbreaks in nurseries; however, no outbreaks have been reported in schools. Of the cases eligible for vaccination, only 3% of the confirmed cases were fully immunised.

Globalization and Health
[Accessed 21 July 2012]
http://www.globalizationandhealth.com/

Editorial
AIDS: Ushering in a new era of shared responsibility for global health
Kent Buse and Greg Martin

Abstract (provisional) [Open Access]
For the first time since AIDS erupted as worldwide emergency, global leaders, the scientific community, activists and people living with HIV are venturing to speak about the end to the pandemic. Signs of hope abound: over 8 million people are receiving life-saving treatment, the number of new infections is on significant decline, the remarkable evidence of treatment’s impact on preventing new infections and the aspiration of zero new HIV infections among children is firmly within grasp. This progress, won by countries with support from partners such as the US program PEPFAR, the Clinton Health Access Initiative and untold more, embodies global solidarity to bring about an AIDS-free generation. Shared responsibility and global solidarity represents a normative ideal to which both individual stakeholders and the global community must subscribe and embrace if our collective vision of an AIDS-free world is to be realised. The idea of shared responsibility and global solidarity needs to goes further than raising and investing resources and extend to the level of control countries take of their AIDS response. This editorial explores five areas that require specific attention.

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

Globalization and Health
[Accessed 21 July 2012]
http://www.globalizationandhealth.com/

Research
The effects of Global Fund financing on health governance in Brazil
Eduardo J. Gomez and Rifat Atun

Abstract (provisional)
Objectives
The impact of donors, such as national government (bi-lateral), private sector, and individual financial (philanthropic) contributions, on domestic health policies of developing nations has been the subject of scholarly discourse. Little is known, however, about the impact of global financial initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, on policies and health governance of countries receiving funding from such initiatives.

Methods
This study employs a qualitative methodological design based on a single case study: Brazil. Analysis at national, inter-governmental and community levels is based on in-depth interviews with the Global Fund and the Brazilian Ministry of Health and civil societal activists. Primary research is complemented with information from printed media, reports, journal articles, and books, which were used to deepen our analysis while providing supporting evidence.

Results
Our analysis suggests that in Brazil, Global Fund financing has helped to positively transform health governance at three tiers of analysis: the national-level, inter-governmental-level, and community-level. At the national-level, Global Fund financing has helped to increased political attention and commitment to relatively neglected diseases, such as tuberculosis, while harmonizing intra-bureaucratic relationships; at the inter-governmental-level, Global Fund financing has motivated the National Tuberculosis Programme to strengthen its ties with state and municipal health departments, and non-governmental organisations (NGOs); while at the community-level, the Global Fund’s financing of civil societal institutions has encouraged the emergence of new civic movements, participation, and the creation of new municipal participatory institutions designed to monitor the disbursement of funds for Global Fund grants.

Conclusions
Global Fund financing can help deepen health governance at multiple levels. Future work will need to explore how the financing of civil society by the Global Fund and other donors influence policy agenda-setting and institutional innovations for increased civic participation in health governance and accountability to citizens.

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

JAMA   
July 18, 2012, Vol 308, No. 3
http://jama.ama-assn.org/current.dtl

Grand Rounds | July 18, 2012 Clinician’s Corner
Current Approaches to Tuberculosis in the United States
Fred M. Gordin, MD; Henry Masur, MD

Abstract
Tuberculosis is a major threat to global health, infecting a third of the world’s population. In the United States, however, control of tuberculosis has been increasingly successful. Only 3.2% of the US population is estimated to have latent tuberculosis and there are only 11 000 cases annually of active disease. More than half the cases in this country occur in individuals born outside the United States. Human immunodeficiency virus coinfection is not a major factor in the United States, since only approximately 10% of cases are coinfected. Drug resistance is also uncommon in this country. Because the United States has more resources for the diagnosis, therapy, and public health control of tuberculosis than many regions of the world, and because many hospitals have more cases of clinically significant nontuberculous mycobacteria than tuberculosis, the management approaches to tuberculosis need to be quite different in this country than in other regions. The resurgence in interest in developing new tools and the investment in public health infrastructure will hopefully be sustained in the United States so that the effect of tuberculosis on the US population will continue to diminish, and these new tools and approaches can be adapted to both high and low prevalence areas to meet the global challenge.

Journal of Infectious Diseases
Volume 206 Issue 4 August 15, 2012
http://www.journals.uchicago.edu/toc/jid/current

Editorial Commentaries
Editor’s choice: Horizontal Transmission of Hepatitis B Virus—Why Discuss When We Can Vaccinate?
J Infect Dis. (2012) 206(4): 464-465 doi:10.1093/infdis/jis294
Ida Louise Heiberg and Birthe Hogh

Extract
Hepatitis B virus (HBV) infection remains an important global health problem despite the availability of a safe and effective vaccine; >350 million people worldwide are chronically infected [1]. Infection with HBV in adults most often results in self-limited, acute hepatitis that confers protective immunity and causes no further disease. In contrast, most children fail to clear the virus, resulting in chronic infection in 90% of children who are infected perinatally. Chronically infected children are generally asymptomatic but are at risk of developing liver cirrhosis and hepatocellular carcinoma [2, 3]. Since 1992, the World Health Organization has recommended global vaccination against HBV, and by the end of 2009, 177 countries had implemented a universal HBV immunization program for newborns, infants, and/or adolescents. Countries with a low level of HBV endemicity, such as Japan and many northern European countries, have adopted a strategy in which vaccination is offered to individuals at high risk of infection [4].

Spread of HBV occurs through contact with blood or other bodily fluids of an infected person. In countries with low endemicity, the spread of HBV is caused predominantly by sharing contaminated equipment during drug injections and through sexual contact.

In this issue of the Journal, Komatsu et al report their …

Journal of Infectious Diseases
Volume 206 Issue 4 August 15, 2012
http://www.journals.uchicago.edu/toc/jid/current

Measles Vaccine, HIV Infection, and Antiretroviral Therapy—A Window of Opportunity
J Infect Dis. (2012) 206(4): 466-468 doi:10.1093/infdis/jis392
Yvonne Maldonado

Extract
Measles virus infection, a systemic rash illness commonly acquired in infancy and early childhood, is one of the most contagious infectious diseases in humans [1]. Measles is also an important cause of global morbidity and mortality, primarily among infants and children living in resource-limited settings [2]. Since the development of measles vaccines in the 1960s, intensive vaccination efforts, especially in the 21st century, have led to substantial reductions in measles-related deaths on a global scale, resulting in a reduction in mortality from almost 750 000 childhood deaths worldwide in 2000 to 164 000 in 2008 [3]. Eradication of measles infection on a global scale can, in theory, be accomplished because measles virus has no nonhuman reservoirs, and vaccination strategies to prevent transmission are available and feasible [4]. However, because of the highly contagious nature of measles virus, at least 95% vaccination coverage with at least 1 dose (and preferably 2 doses) of measles vaccine must be achieved to suppress and eventually eradicate continued global measles transmission [5].

One important characteristic of measles infection is that it produces more serious illness and increased mortality among immunocompromised individuals, primarily those with defects in T-cell immunity [6]. Because >90% of human immunodeficiency virus (HIV)–infected children live in regions where measles is still endemic [7, 8], achieving high rates of measles vaccine coverage is especially important among these populations to suppress excess measles-associated morbidity and mortality. However, live virus vaccines may also result in disease and, in general, are not recommended for administration to severely immunocompromised individuals. Measles vaccines are also known to induce short-term immunosuppressive effects and, therefore, the risk of further adverse events among HIV-infected infants and children is of concern. Moreover, it is well known that …

Medical Decision Making (MDM)
July–August 2012; 32 (4)
http://mdm.sagepub.com/content/current
Theme: Patients’ Choices: Perceived Risk, Health State Values, and Decisions

Original Articles/Presenting Probabilities to Patients
The Influence of Graphic Display Format on the Interpretations of Quantitative Risk Information among Adults with Lower Education and Literacy: A Randomized Experimental Study
Kirsten J. McCaffery, Ann Dixon, Andrew Hayen, Jesse Jansen, Sian Smith, and Judy M. Simpson
Med Decis Making July–August 2012 32: 532-544, first published on November 10, 2011 doi:10.1177/0272989X11424926

Abstract
Objective To test optimal graphic risk communication formats for presenting small probabilities using graphics with a denominator of 1000 to adults with lower education and literacy.

Methods A randomized experimental study, which took place in adult basic education classes in Sydney, Australia. The participants were 120 adults with lower education and literacy. An experimental computer-based manipulation compared 1) pictographs in 2 forms, shaded “blocks” and unshaded “dots”; and 2) bar charts across different orientations (horizontal/vertical) and numerator size (small <100, medium 100–499, large 500–999). Accuracy (size of error) and ease of processing (reaction time) were assessed on a gist task (estimating the larger chance of survival) and a verbatim task (estimating the size of difference). Preferences for different graph types were also assessed.

Results Accuracy on the gist task was very high across all conditions (>95%) and not tested further. For the verbatim task, optimal graph type depended on the numerator size. For small numerators, pictographs resulted in fewer errors than bar charts (blocks: odds ratio [OR] = 0.047, 95% confidence interval [CI] = 0.023–0.098; dots: OR = 0.049, 95% CI = 0.024–0.099). For medium and large numerators, bar charts were more accurate (e.g., medium dots: OR = 4.29, 95% CI = 2.9–6.35). Pictographs were generally processed faster for small numerators (e.g., blocks: 14.9 seconds v. bars: 16.2 seconds) and bar charts for medium or large numerators (e.g., large blocks: 41.6 seconds v. 26.7 seconds). Vertical formats were processed slightly faster than horizontal graphs with no difference in accuracy. Most participants preferred bar charts (64%); however, there was no relationship with performance.

Conclusions For adults with low education and literacy, pictographs are likely to be the best format to use when displaying small numerators (<100/1000) and bar charts for larger numerators (>100/1000).

Medical Decision Making (MDM)
July–August 2012; 32 (4)
http://mdm.sagepub.com/content/current
Theme: Patients’ Choices: Perceived Risk, Health State Values, and Decisions

Valuing Health: A Brief Report on Subjective Well-Being versus Preferences
Paul Dolan and Robert Metcalfe
Med Decis Making July–August 2012 32: 578-582, first published on February 2, 2012 doi:10.1177/0272989X11435173

Extract
Health care can improve people’s quality of life, and it can help them live longer. The quality-adjusted-life-years (QALYs) approach has been developed to express these twin components of benefit (quality and quantity of life) in a single number. It expresses different health states on a scale between 0 for death and 1 for full health and then multiplies these values by how long the states last. One QALY is equivalent to 1 year of life in full health.1 By comparing how many QALYs different interventions are expected to generate with how much those interventions are expected to cost, it is possible to show the cost-effectiveness of different uses of resources.

In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) recommends that “the value of changes in patients’ health related quality of life should be based on public preferences using a choice-based method . . . [and] the EQ-5D is the preferred measure of HRQL in adults.”2 The EQ-5D™ defines health in terms of 1 of 3 levels of severity (broadly, no problems, some problems, and extreme problems) associated with each of 5 dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression). Each of the 243 (35) health states are represented by a 5-digit code, ranging from 11111 for full health to 33333 for extreme problems on all 5 dimensions. Values for these states have been elicited by asking members of the public for their time tradeoff (TTO) preferences, that is, to state how many years of life in 11111 they consider to be equivalent to a longer period of time in one of the remaining 242 “poor” health states.3,4

There is a long tradition of asking for people’s preferences over future, hypothetical prospects. 5,6 It is also not without its …

Medical Decision Making (MDM)
July–August 2012; 32 (4)
http://mdm.sagepub.com/content/current
Theme: Patients’ Choices: Perceived Risk, Health State Values, and Decisions

A Direct Method for Measuring Discounting and QALYs More Easily and Reliably
Arthur E. Attema, Han Bleichrodt, and Peter P. Wakker
Med Decis Making July–August 2012 32: 583-593, first published on June 15, 2012 doi:10.1177/0272989X12451654

Abstract
Time discounting and quality of life are two important factors in evaluations of medical interventions. The measurement of these two factors is complicated because they interact. Existing methods either simply assume one factor given, based on heuristic assumptions, or invoke complicating extraneous factors, such as risk, that generate extra biases. The authors introduce a method for measuring discounting (and then quality of life) that involves no extraneous factors and that avoids distorting interactions. Their method is considerably simpler and more realistic for subjects than existing methods. It is entirely choice based and thus can be founded on economic rationality requirements. An experiment demonstrates the feasibility of this method and its advantages over classical methods.

Pharmacoeconomics
August 1, 2012 – Volume 30 – Issue 8  pp: 633-747,e1-e15
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

Commentary
Valuing Children’s Health: Whose Quality of Life Matters?
Wittenberg, Eve
Pharmacoeconomics. 30(8):633-635, August 1, 2012.
doi: 10.2165/11632490-000000000-00000

[No abstract]

Pharmacoeconomics
August 1, 2012 – Volume 30 – Issue 8  pp: 633-747,e1-e15
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

Current Opinion
Comparative Effectiveness and Child Health
Prosser, Lisa A.
Pharmacoeconomics. 30(8):637-645, August 1, 2012.
doi: 10.2165/11633830-000000000-00000

Abstract
Comparative effectiveness research is expected to play an important role in future clinical and policy decision making in the US; however, the application of comparative effectiveness methodologies to child health requires special attention to aspects of health and healthcare that are specific to children. These special considerations include the role of parent/caregiver as joint decision maker and co-participant in many types of interventions, how the effectiveness of an intervention varies by age and developmental stage, and the difficulties in translating short-term data from childhood into projected effectiveness over the lifespan. Each aspect of comparative effectiveness, such as conducting new studies, synthesizing existing evidence, emphasizing real-world settings, considering multiple decision makers, and measuring patient-relevant outcomes, will require expanded definitions when considered in the context of child health.

This paper discusses how comparative effectiveness methods and concepts will differ when applied to child health and suggests a potential role for decision analysis as a method to synthesize data and project long-term outcomes. The initiation of comparative effectiveness studies for children represents an exciting opportunity to provide evidence that can guide clinical and policy decisions for child health.

Pharmacoeconomics
August 1, 2012 – Volume 30 – Issue 8  pp: 633-747,e1-e15
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

Review Article
Economic Evaluations of Childhood Influenza Vaccination: A Critical Review
Newall, Anthony T.; Jit, Mark; Beutels, Philippe
Pharmacoeconomics. 30(8):647-660, August 1, 2012.
doi: 10.2165/11599130-000000000-00000

Abstract:
The potential benefits of influenza vaccination programmes targeted at children have gained increasing attention in recent years.

We conducted a literature search of economic evaluations of influenza vaccination in those aged ≤18 years. The search revealed 20 relevant articles, which were reviewed.    The studies differed widely in terms of the costs and benefits that were included. The conclusions were generally favourable for vaccination, but often applied a wider perspective (i.e. including productivity losses) than the reference case for economic evaluations used in many countries. Several evaluations estimated outcomes from a single-year epidemiological study, which may limit their validity given the year-to-year variation in influenza transmissibility, virulence, vaccine match and prior immunity. Only one study used a dynamic transmission model able to fully incorporate the indirect herd protection to the wider community.

The use of dynamic models offers great scope to capture the population-wide implications of seasonal vaccination efforts, particularly those targeted at children.

Pharmacoeconomics
August 1, 2012 – Volume 30 – Issue 8  pp: 633-747,e1-e15
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

The Impact of Rotavirus Vaccination on Discounted Net Tax Revenue in Egypt: A Government Perspective Analysis
Connolly, Mark P.; Topachevskyi, Oleksandr; Standaert, Baudouin; Ortega, Omayra; Postma, Maarten
Pharmacoeconomics. 30(8):681-695, August 1, 2012.
doi: 10.2165/11597750-000000000-00000

Abstract
Background: We evaluated national rotavirus (RV) immunization programme costs to estimate how resulting changes in morbidity and mortality will influence government fiscal accounts over time. The assumption was that increased childhood survival in vaccinated cohorts leads to increased numbers of children consuming government resource, and an increased number of future tax payers.

Objective: Our objective was to evaluate the difference in lifetime discounted net tax revenue generated by RV vaccinated and unvaccinated cohorts from the Egyptian government perspective.

Methods: The model framework adopts the Egyptian government perspective for RV immunization costs (year 2009 values) and all government transfers (e.g. education costs, health costs, pensions). To reflect the government tax revenue, we applied a fixed income tax burden to earnings over the lifetime of vaccinated and unvaccinated cohorts. At each year of the model, we derive net taxes (gross taxes less transfers) discounted to the immunization year to reflect the present value of RV vaccination investment costs.

Results: Projected incremental net present values of the vaccinated cohort versus the unvaccinated cohort are $US6.1 million, $US58.1 million and $US55.7 million at 25-, 50- and 72-year time horizons, respectively. The internal rate of return for the government based on RV vaccination at years 25, 50 and 72 was 10.8%, 15.1% and 14.9, respectively. Within the first 5 years of vaccination, 76% of vaccine acquisition costs were offset due to direct and indirect cost savings attributed to a reduction in RV-related disease burden. Investments in RV vaccination in a single year are entirely offset when the vaccinated cohort of newborns reach 22 years of age.

Conclusion: The government perspective is useful for evaluating investments in RV vaccination because of ongoing government transfers and tax receipts attributed to changes in RV-attributed morbidity and mortality. The analysis described here illustrates that investing in RV offers tangible long-term fiscal benefits for government over many generations that would not ordinarily be captured in economic evaluations typically applied to healthcare interventions.

PLoS One
[Accessed 21 July 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Effect of Serotype on Focus and Mortality of Invasive Pneumococcal Disease: Coverage of Different Vaccines and Insight into Non-Vaccine Serotypes
Albert Jan van Hoek, Nick Andrews, Pauline A. Waight, Robert George, Elizabeth Miller PLoS ONE: Research Article, published 16 Jul 2012 10.1371/journal.pone.0039150

Abstract 
Background
Differences in pathogenicity between pneumococcal serotypes are important when assessing the potential benefit of different valency vaccines. We investigated the effect of serotype on clinical presentation, outcome, and quality of life lost from invasive pneumococcal disease (IPD) in the context of the 7, 10, and 13 valent pneumococcal conjugate vaccines (PCV7, PCV10, PCV13).

Method
Serotyped IPD cases in England were linked to the national dataset of hospital admissions for April 2002 to March 2011. Based on patients’ diagnostic codes and vital status at the end of the admission, disease focus (meningitis, empyema, sepsis, or respiratory disease) and case fatality rates by serotype and age group (5, 5–64, and 65 years and over) were obtained. Using these data the quality adjusted life years (QALY) lost from the IPD remaining when use of PCV7 stopped in 2010 was estimated for the serotypes covered by higher valency vaccines.

Results
The linked dataset contained 23,688 cases with information on diagnosis, mortality, and serotype. There were significant differences between serotypes in the propensity to cause meningitis, death, and QALY loss in each of the investigated age groups. As a result, vaccines’ coverage of disease burden differed by endpoint. For example, in children under 5 years in 2009/10, PCV10 covered 39% of meningitis, 19% of deaths and 28% of the QALY loss of attributable to IPD, whereas the respective percentages for PCV13 were 65%, 67%, and 66%. The highest QALY loss per serotype in this age group was for 6A. Non-PCV serotypes causing the highest QALY loss were 22F and 33F in <5 year olds and 31 in older individuals.

Conclusion
Marked differences exist between serotypes in clinical presentation and outcome, and these should be considered when evaluating the potential impact of higher valency vaccines on overall disease burden and associated QALY loss.

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
(Accessed 21 July 2012)
http://www.pnas.org/content/early/recent

Biological Sciences – Microbiology:
Sibao Wang, Anil K. Ghosh, Nicholas Bongio, Kevin A. Stebbings, David J. Lampe, and Marcelo Jacobs-Lorena
Fighting malaria with engineered symbiotic bacteria from vector mosquitoes
PNAS 2012 ; published ahead of print July 16, 2012, doi:10.1073/pnas.1204158109

Abstract
The most vulnerable stages of Plasmodium development occur in the lumen of the mosquito midgut, a compartment shared with symbiotic bacteria. Here, we describe a strategy that uses symbiotic bacteria to deliver antimalaria effector molecules to the midgut lumen, thus rendering host mosquitoes refractory to malaria infection. The Escherichia coli hemolysin A secretion system was used to promote the secretion of a variety of anti-Plasmodium effector proteins by Pantoea agglomerans, a common mosquito symbiotic bacterium. These engineered P. agglomerans strains inhibited development of the human malaria parasite Plasmodium falciparum and rodent malaria parasite Plasmodium berghei by up to 98%. Significantly, the proportion of mosquitoes carrying parasites (prevalence) decreased by up to 84% for two of the effector molecules, scorpine, a potent antiplasmodial peptide and (EPIP)4, four copies of Plasmodium enolase–plasminogen interaction peptide that prevents plasminogen binding to the ookinete surface. We demonstrate the use of an engineered symbiotic bacterium to interfere with the development of P. falciparum in the mosquito. These findings provide the foundation for the use of genetically modified symbiotic bacteria as a powerful tool to combat malaria.

Science Translational Medicine
18 July 2012 vol 4, issue 143
http://stm.sciencemag.org/content/current

Commentary: Policy
Reporting Actionable Research Results: Shared Secrets Can Save Lives
Lawrence E. Hunter, Christian Hopfer, Sharon F. Terry, and Marilyn E. Coors
18 July 2012: 143cm8

Abstract
In this Commentary, we describe a cryptographic method for returning research results to individuals who participate in clinical studies. Controlled use of this method, which relaxes the typical anonymization guarantee, can ensure that clinically actionable results reach participants while also addressing most privacy concerns.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 36 pp. 5299-5448 (3 August 2012)

Regular Papers
Feasibility of a randomized controlled trial to evaluate Text Reminders for Immunization Compliance in Kids (TRICKs)
Original Research Article
Pages 5305-5309
Carolyn R. Ahlers-Schmidt, Amy K. Chesser, Tuan Nguyen, Jennifer Brannon, Traci A. Hart, Katherine S. Williams, Robert R. Wittler

Abstract
Objective
To pilot test the Text Reminders for Immunization Compliance in Kids (TRICKs) program to evaluate its feasibility and potential to increase immunization coverage.

Design
Randomized controlled trial (RCT).

Setting
Pediatric clinic.

Participants
Parents of newborns being discharged from a local hospital who intended to seek child health care at the University-sponsored pediatric resident and faculty clinic.

Intervention
Text message immunization reminders prior to immunization due dates.

Main Outcome Measures
Receipt and timeliness of immunizations at 2, 4 and 6 months of age.

Results
Participants (N = 90) were English (83%) or Spanish (17%) speaking. The majority were female (83%), on public insurance (59%), and had adequate health literacy (96%). Parents were married or a member of an unmarried couple (62%). Over 66% had a high school diploma or less. Greater numbers of intervention children received immunizations and were “on time” using per protocol analysis; though not statistically significance. Limitations include sample size, problematic text messaging software, and loss of phone service at 7 months for 40% of intervention parents. However, post-intervention interviews (N = 18) indicated strong support for TRICKs; 83% found the text message reminders very helpful and 17% somewhat helpful.

Discussion
Pilot testing allowed us to assess processes, including recruitment, retention, and software, which will increase the success of an RCT. Software with built-in backup systems is needed for follow-up when mobile service is interrupted. However, in spite of limitations, immunization rates were higher in the text message reminder group, though not statistically significant. Parent support and interest was high. A fully powered RCT is needed with follow-up over the full 4-3-1-3-3-1 series. Based on our results, for 80% power where we expected 90% compliance in the intervention group and 80% in the control group we need 219 per group, plus increases to address drop out and loss of follow-up.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 36 pp. 5299-5448 (3 August 2012)

Knowledge about human papillomavirus (HPV), and health beliefs and intention to recommend HPV vaccination for girls and boys among Korean health teachers
Original Research Article
Pages 5327-5334
Hae Won Kim

Abstract
The human papillomavirus (HPV) vaccination rate in Korea is very low because a school-based HPV vaccination program has not yet been introduced. This study was designed to assess HPV knowledge, compare the health beliefs toward HPV vaccination and intention to recommend HPV vaccination for girls and boys, and identify the factors influencing the intention to recommend HPV vaccination for girls and boys among Korean health teachers. A descriptive cross-sectional study design was employed, in which 757 health teachers who worked at elementary, middle, high, and special schools in Korea participated via an online survey. A self-administered, structured questionnaire was applied, which included items on sociodemographics, HPV awareness, HPV knowledge, perceived benefits, susceptibility, severity, and barriers toward HPV vaccination for girls and boys, and intention to recommend HPV vaccination for girls and boys. The rate of correct HPV knowledge items ranged from 5.2% to 89.2%; 23.4% of the health teachers answered that they had ever taught about HPV, 97% answered that both boys and girls should receive HPV vaccination, and 47.6% answered that the best time for HPV vaccination is when students are at middle school. There were differences regarding the perceived benefits (Z = −7.69, p < 0.001), perceived susceptibility (Z = −3.37, p = 0.001), perceived severity (Z = −4.13, p < 0.001), and perceived barriers (Z = −4.90, p < 0.001) toward HPV vaccination, and regarding intention to recommend HPV vaccination (Z = −15.21, p < 0.001) for girls and boys. Factors associated with the intention to recommend HPV vaccination for girls were the HPV vaccination status of the health teachers’ children [odds ratio (OR) = 4.24, 95% confidence interval (95% CI) = 1.14–15.72], and the teachers’ Pap-test experience (OR = 2.50, 95% CI = 1.05–5.91), perceived benefits (OR = 3.30, 95% CI = 1.26–7.40), perceived susceptibility (OR = 3.25, 95% CI = 1.58–6.68), and perceived barriers (OR = 0.51, 95% CI = 0.30–0.99); these factors for boys were the health teachers’ career duration (OR = 1.61, 95% CI = 1.12–2.32), HPV knowledge (OR = 1.45, 95% CI = 1.01–2.09), perceived benefits (OR = 3.46, 95% CI = 2.27–5.26), perceived susceptibility (OR = 1.55, 95% CI = 1.04–2.29), and perceived severity (OR = 1.71, 95% CI = 1.15–2.56). General awareness of HPV should be increased and more specific information about HPV—including that related to vaccination of boys and men—should be provided for health teachers. Although a school-based HPV vaccine program has yet to be introduced in Korea, health teachers should possess general knowledge about HPV and HPV vaccination, and differences in attitudes and intentions related to HPV vaccination between girls and boys should be reduced.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 36 pp. 5299-5448 (3 August 2012)

Human papillomavirus vaccine knowledge and hypothetical acceptance among women in Appalachia Ohio
Original Research Article
Pages 5349-5357
Mack T. Ruffin IV, Erinn M. Hade, Melissa R. Gorsline, Cecilia R. DeGraffinreid, Mira L. Katz, Sarah C. Kobrin, Electra D. Paske

Abstract
Objective
To assess hypothetical acceptance of the human papillomavirus (HPV) vaccine for themselves and a daughter age 9–12 years among Appalachia Ohio women.

Methods
Women with an abnormal Pap smear and randomly selected women with a normal Pap smear from 17 clinics completed an interview in 2006–2008.

Results
From 1131 original study participants, 807 (71%) completed a survey about the HPV vaccine for their daughters and themselves. Nearly half, 380 (47%), of the participants had heard of a vaccine to prevent cancer, and 362 (95%) of respondents had heard of HPV. The participants were then told that the FDA had approved a vaccine to prevent HPV. Only 379 (38%) participants identified girls ages 9–12 years as a group who should get the vaccine. After being given the official HPV vaccine recommendation statement, 252 (31%) wanted the vaccine; 198 (25%) were “not sure”; and 353 (44%) did not want the vaccine for themselves. With respect to giving the HPV vaccine to a daughter ages 9–12 years, participants responded “yes” 445 (55%); “not sure” 163 (20%); or “no” 185 (23%). Numerous reasons were provided supporting and opposing vaccine acceptance for themselves and for a daughter. Their physician’s recommendation for the HPV vaccine increased vaccine acceptance to 86% for themselves and 90% for a daughter.

Conclusion
Knowledge, acceptance, and barriers about the HPV vaccine vary among women living in Appalachia Ohio. Physician recommendation is a key facilitator for vaccine diffusion in this region.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 36 pp. 5299-5448 (3 August 2012)

A qualitative study of HPV vaccine acceptability among health workers, teachers, parents, female pupils, and religious leaders in northwest Tanzania
Original Research Article
Pages 5363-5367
Pieter Remes, Veronica Selestine, John Changalucha, David A. Ross, Daniel Wight, Silvia de Sanjosé, Saidi Kapiga, Richard J. Hayes, Deborah Watson-Jone

Abstract
Background
As human papillomavirus (HPV) vaccines become available in developing countries, acceptability studies can help to better understand potential barriers and facilitators of HPV vaccination and guide immunisation programs.

Methods
Prior to a cluster-randomised phase IV trial of HPV vaccination delivery strategies in Mwanza Region, Tanzania, qualitative research was conducted to assess attitudes and knowledge about cervical cancer and HPV, and acceptability of and potential barriers to HPV vaccination of Tanzanian primary schoolgirls. Semi-structured interviews (n = 31) and group discussions (n = 12) were conducted with a total of 169 respondents (parents, female pupils, teachers, health workers and religious leaders).

Results
While participants had heard of cancer in general, most respondents had no knowledge of cervical cancer, HPV, or HPV vaccines. Only health workers had heard of cervical cancer but very few knew its cause or had any awareness about HPV vaccines. After participants were provided with information about cervical cancer and HPV vaccination, the majority stated that they would support HPV vaccination of their daughter to protect them against cervical cancer. Opt-out consent for vaccination was considered acceptable. Most preferred age-based vaccination, saying this would target more girls before sexual debut than class-based vaccination. Potential side effects and infertility concerns were raised by 5/14 of participating male teachers.

Discussion
Reported acceptability of HPV vaccination amongst parents, teachers and other community members was high in this population. Respondents stressed the need to provide adequate information about the vaccine to parents, that also addresses side effects and infertility concerns.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 36 pp. 5299-5448 (3 August 2012)
Public health and economic impact of 13-valent pneumococcal conjugate vaccine in US adults aged ≥50 years
Original Research Article
Pages 5437-5444
Derek Weycker, Reiko Sato, David Strutton, John Edelsberg, Mark Atwood, Lisa A. Jackson

Abstract
Background
A 13-valent pneumococcal conjugate vaccine (PCV13) was recently developed for use in older adults, and may be effective not only against invasive pneumococcal disease (IPD) but also nonbacteremic pneumococcal pneumonia. The potential public health and economic impact of PCV13 in this population is unknown.

Methods
A microsimulation model depicting risk and costs of IPD and all-cause nonbacteremic pneumonia (NBP) in US adults aged ≥50 years (n = 96.1 million), as well as expected impact of vaccination, was developed. Effectiveness of PPSV23 was based on published literature, and for all-cause NBP, was zero; effectiveness of PCV13 was based on PCV7 data in children, and for all-cause NBP, was varied across a reasonable range. Lifetime outcomes and costs were projected assuming: (1) use of PCV13 in all subjects at model entry, with and without periodic revaccination; and (2) use of PPSV23 per current ACIP recommendations.

Results
Use of PCV13 in all subjects at model entry without revaccination – in lieu of PPSV23 use per recommendations – reduced cases of IPD by 15,000 (95% CI 9000–21,000); cases of NBP by 1.2 million (0.9–1.5); total healthcare costs by $3.5 billion (1.9–5.2); and total societal costs by $7.4 billion (5.3–9.8). Use of PCV13 with revaccination every 5–10 years resulted in fewest cases of disease and lowest total costs. Findings were largely unchanged in sensitivity analyses.

Conclusions
Assuming that the effectiveness of PCV13 in adults is comparable to that observed for PCV7 in children and under reasonable assumptions regarding the underlying risks and costs of IPD and NBP, model projections suggest that routine use of PCV13 – in lieu of PPSV23 – would result in a greater reduction in the overall burden of pneumococcal disease in older US adults.

Vaccine
Volume 30, Issue 35 pp. 5179-5298 (27 July 2012)

Reviews
Acellular pertussis vaccine use in risk groups (adolescents, pregnant women, newborns and health care workers): A review of evidences and recommendations
Review Article
Pages 5179-5190
Angela Bechini, Emilia Tiscione, Sara Boccalini, Miriam Levi, Paolo Bonanni

Abstract
Objective
Our review aims at describing the current knowledge on the impact of acellular pertussis vaccination in adolescents and adults, with particular focus on specific risk groups: adolescents, pregnant women and their newborns, and health care workers (HCWs), and secondly at suggesting possible immunization strategies.

Methods
Data were retrieved by searches of Pubmed, references, from relevant articles and open-access websites.

Results
In countries where an adolescent booster dose was adopted, a certain decrease of incidence rates was observed. No serologic correlate of protection after immunization exists, but subjects with high antibody levels against pertussis antigens are less likely to develop the disease. Tdap vaccine was demonstrated to induce antibodies to pertussis antigens exceeding those associated with efficacy in infants, in both adolescents and adults. Tdap use in pregnant women seems to be safe and might represent a useful tool in order to prevent pertussis cases in the first months of life. Neonatal immunization with monovalent acellular pertussis vaccine can efficiently prime T and B cells and act as a basis for future immune responses. Cocooning strategies involving all those surrounding newborns have started to be implemented. Their impact on infant pertussis cases will be evaluated in the coming years. Coverage in HCWs should be increased, given their important role in pertussis transmission in health care settings.

Conclusions
Despite the more recent position paper of WHO gives priority to infant and childhood vaccination against pertussis and leaves adolescent, adult and risk group immunization as an option for the future, data are quickly accumulating to support the need to consider pertussis vaccination as a crucial preventative intervention even in adolescents and special risk groups.

Vaccine
Volume 30, Issue 35 pp. 5179-5298 (27 July 2012)

Reviews
Malaria vaccines: Focus on adenovirus based vectors
Review Article
Pages 5191-5198
Nathaniel J. Schuldt, Andrea Amalfitano

Abstract
Protection against malaria through vaccination is known to be achievable, as first demonstrated over 30 years ago. Vaccination via repeated bites with Plasmodium falciparum infected and irradiated mosquitoes provided short lived protection from malaria infection to these vaccinees. Though this method still remains the most protective malaria vaccine to date, it is likely impractical for widespread use. However, recent developments in sub-unit malaria vaccine platforms are bridging the gap between high levels of protection and feasibility. The current leading sub-unit vaccine, RTS,S (which consists of a fusion of a portion of the P. falciparum derived circumsporozoite protein to the Hepatitis B surface antigen), has demonstrated the ability to induce protection from malaria infection in up 56% of RTS,S vaccinees. Though encouraging, these results may fall short of protection levels generally considered to be required to achieve eradication of malaria. Therefore, the use of viral vectored vaccine platforms has recently been pursued to further improve the efficacy of malaria targeted vaccines. Adenovirus based vaccine platforms have demonstrated potent anti-malaria immune responses when used alone, as well when utilized in heterologous prime boost regimens. This review will provide an update as to the current advancements in malaria vaccine development, with a focus on the use of adenovirus vectored malaria vaccines.

Vaccine
Volume 30, Issue 35 pp. 5179-5298 (27 July 2012)

Regular Papers
Variation in adult vaccination policies across Europe: An overview from VENICE network on vaccine recommendations, funding and coverage
Original Research Article
Pages 5222-5228
Elisabeth E. Kanitz, Lauren A. Wu, Cristina Giambi, Raymond A. Strikas, Daniel Levy-Bruhl, Pawel Stefanoff, Jolita Mereckiene, Eva Appelgren, Fortunato D’Ancona, VENICE (Vaccine European New Integrated Collaboration Effort) National Gatekeepers, Contact Points

Abstract
Background
In 2010–2011, in the framework of the VENICE project, we surveyed European Union (EU) and Economic Area (EEA) countries to fill the gap of information regarding vaccination policies in adults. This project was carried out in collaboration with the United States National Vaccine Program Office, who conducted a similar survey in all developed countries.

Methods
VENICE representatives of all 29 EU/EEA-countries received an online questionnaire including vaccination schedule, recommendations, funding and coverage in adults for 17 vaccine-preventable diseases.

Results
The response rate was 100%. The definition of age threshold for adulthood for the purpose of vaccination ranged from 15 to 19 years (median = 18 years). EU/EEA-countries recommend between 4 and 16 vaccines for adults (median = 11 vaccines). Tetanus and diphtheria vaccines are recommended to all adults in 22 and 21 countries respectively. The other vaccines are mostly recommended to specific risk groups; recommendations for seasonal influenza and hepatitis B exist in all surveyed countries. Six countries have a comprehensive summary document or schedule describing all vaccines which are recommended for adults. None of the surveyed countries was able to provide coverage estimates for all the recommended adult vaccines.

Conclusions
Vaccination policies for adults are not consistent across Europe, including the meaning of “recommended vaccine” which is not comparable among countries. Coverage data for adults should be collected routinely like for children vaccination.

Vaccine
Volume 30, Issue 34  pp. 5059-5178 (20 July 2012)
Regular Papers
Perceptions of mumps and MMR vaccination among university students in England: An online survey

Original Research Article
Pages 5081-5085
Diane Bolton-Maggs, David Conrad, Alex Keenan, Ken Lamden, Sam Ghebrehewet, Roberto Vivancos

Abstract
Mumps is easily preventable through vaccination. Investigation of a number of recent mumps outbreaks in universities in the North West of England, however, found that affected students were either not vaccinated or only partially vaccinated. An online survey of students (n = 2456) attending five universities in the region was undertaken during 2010 to establish MMR vaccination status, knowledge of mumps and willingness to take up vaccination if offered. Regression analysis was undertaken to identify characteristics of unimmunized students to ascertain likely target groups for future vaccination campaigns. Students least likely to be fully vaccinated with MMR included males; those not registered with a GP; first year students; mature students; and those with poor knowledge of mumps. A high proportion of students were willing to accept MMR vaccination if offered at university. Those least likely to take up vaccination included students not registered with a GP; mature students; and those who did not consider mumps to be a serious disease. The survey also highlighted that misconceptions remain about both the MMR vaccine safety and perceptions of risk/benefit of the vaccine. Encouraging registration with a GP and awareness raising should be a key part of campaigns to improve vaccination uptake among university students.

Vaccine
Volume 30, Issue 34  pp. 5059-5178 (20 July 2012)
Regular Papers

Immunization coverage and timeliness of vaccination in Italian children with chronic diseases
Original Research Article
Pages 5172-5178
E. Pandolfi, E. Carloni, M.G. Marino, M.L. Ciofi degli Atti, F. Gesualdo, M. Romano, A. Giannattasio, A. Guarino, R. Carloni, P. Borgia, E. Volpe, F. Perrelli, R. Pizzuti, A.E. Tozz

Abstract
Since children with chronic diseases represent a primary target for immunization strategies, it is important that their immunization coverage and timeliness of vaccines is optimal. We performed a study to measure immunization coverage and timeliness of vaccines in children with type 1 diabetes, HIV infection, Down syndrome, cystic fibrosis, and neurological diseases. A total of 275 children aged 6 months–18 years were included in the study. Coverage for diphtheria–tetanus–pertussis (DTP), polio (Pol), and hepatitis B (HBV) vaccines approximated 85% at 24 months, while measles–mumps–rubella (MMR) coverage was 62%. Immunization coverage for seasonal influenza was 59%. The analysis of timeliness revealed that there was heterogeneity among children with different chronic diseases. A proportional hazard model showed that children with HIV infection had the longest time to complete three doses of DTP, Pol, and HBV, and those with neurological diseases received the first dose of MMR later than the other categories. Causes of missing or delayed vaccination mostly included a concurrent acute disease. Children with chronic diseases should be strictly monitored for routine and recommended vaccinations, and health care providers and families should be properly informed to avoid false contraindications.

Twitter Watch [accessed 21 July 2012 – 18:23]
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.
Editor’s Note: Despite expanding the number of institutions and individuals we follow on twitter – all broadly active in the global pubic health space – we are finding fewer and fewer tweets of substance…. We will likely step away from TwitterWatch soon unless we see a change in this assessment…

joinRED ‏@joinRED
We’re excited: With the #HIV travel ban lifted the Int’l AIDS Conference is happening in the US for 1st time in over two decades. #AIDS2012
Retweeted by Gates Foundation
1:02 PM – 20 Jul 12

UNICEF ‏@UNICEF
#WHO and #UNICEF thoughts are with family and friends of community #polio worker Muhammad Ishaq, shot and killed in Karachi on Friday pm.
1:42 PM – 21 Jul 12

IAVI ‏@AIDSvaccine
IAVI 2011 interactive Annual Progress Report is out, highlighting several of our great partners worldwide: http://bit.ly/LAk4E6 #AIDS2012
1:19 PM – 19 Jul 12

The Guardian
http://www.guardiannews.com/
Accessed 21 July 2012

Comment
To deny schoolgirls a cervical cancer jab on religious grounds is scandalous
It’s absurd for schools to opt out because of ‘Christian values’. Policing girls’ bodies to satisfy outdated ideals puts lives at risk
Reni Eddo-Lodge
Thursday 19 July 2012 05.19 EDT

Extract
There’s something unique about women’s health initiatives that seems to incite moral panic. Last week’s 2012 London Summit on Family Planning discussed in detail the perceived and continued controversy around access to contraceptives for women in developing countries. But with issues such as reproductive rights and reproductive health, it’s always worth analysing affairs closer to home. Just yesterday it was revealed that a number of religious schools in the UK chose to opt out of providing female pupils the HPV vaccine – an immunisation that the World Health Organisation recommends young women receive to prevent cervical cancers…

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_14 July 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…

[Editor’s Note: Last week we provided the full text of a GAR update: Undiagnosed illness in Cambodia – update 6 July 2012  http://www.who.int/csr/don/2012_07_06a/en/index.html
The following announcement concludes the joint investigation undertaken:

Severe complications of hand, foot and mouth disease (HFMD) caused by EV-71 in Cambodia – conclusion of the joint investigation
Extract from announcement
13 July 2012 – The investigation into the illnesses and deaths in Cambodia, which mainly affected very young children, concluded that a severe form of hand, foot and mouth disease (HFMD) was the cause in the majority of cases reported to the Ministry of Health.
Samples from a total of 31 patients were obtained and tested for a number of pathogens by Institut Pasteur du Cambodge. Most of these samples tested positive for enterovirus 71 (EV-71) which causes HFMD. A small proportion of samples also tested positive for other pathogens including Haemophilus Influenzae type B and Streptococcus suis. It was not possible to test all the patients as some of them died before appropriate samples could be taken.

The investigation included:
– a thorough review of the hospital records of the patients from Kantha Bhopa hospital as well as from other hospitals;
– laboratory tests;
– active follow-up with the affected families by the local Rapid Response Teams (RRT); and
– evaluation of the data from the national surveillance system…
http://www.who.int/csr/don/2012_07_13/en/index.html

The Democratic People’s Republic of Korea launched the pentavalent vaccine at a ceremony at the People Palace of Culture in Pyongyang on 12 July 2012. This vaccine introduction “will mean that now around 350,000 children under one will be vaccinated every year against Hib” in addition to other diseases. The DPR Korea “will continue to co-finance the cost of GAVI vaccines at US$834,000 from 2012 to 2015.” GAVI said that, working closely with WHO and UNICEF which have staff in the country, it has supported DPR Korea since 2001 and “has helped the country strengthen its immunisation systems, including a major upgrade of the cold chain system to ensure sufficient space for introduction of pentavalent and potentially other new vaccines such as rotavirus and pneumococcal…” The announcement noted that “DPR Korea is one of the few countries in the WHO South-East Asia Region to achieve consistently high coverage for vaccines. There have been no reported cases of poliomyelitis since 1996 and no measles since the mass vaccination campaign in April 2007.” http://www.gavialliance.org/library/news/gavi-features/2012/dpr-korea-introduces-pentavalent-vaccine/

   The World Bank’s Board approved an International Development Association (IDA) credit of US$95 million for the Nigeria Polio Eradication Support Project, which will “help the country to achieve and sustain at least 80% polio immunization across all states, supporting the eventual eradication of the disease from Nigeria.” The project will finance roughly 655 million doses of oral polio vaccine for children under age five across Nigeria, with a special focus on the northern states where polio is more prevalent. The World Bank has worked with Nigeria’s National Primary Health Care Agency since 2003 to ensure timely vaccine supply. The project continues a “buy-down” arrangement by which the Gates Foundation, the US Centers for Diseases Control and Prevention, and Rotary International (via the UN Foundation), will repay the loan’s present value when pre-agreed results are met. Of the World Bank’s lending commitments to Nigeria for polio from 2003 to 2012—a total of $195 million—Nigeria has already qualified for a 70 percent buy-down.

http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:23240730~pagePK:34370~piPK:34424~theSitePK:4607,00.html

    NIH said it awarded US$31 million in first-year funding to Duke University and Scripps Research Institute to lead a new consortium: the Centers for HIV/AIDS Vaccine Immunology & Immunogen Discovery (CHAVI-ID). The funding is from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. The initiative is projected to receive up to US$186 million or more over the next six years with a goal “to accelerate HIV vaccine development by supporting multidisciplinary research into immune responses that prevent or contain HIV infection and generating model vaccine components that can induce these protective immune responses.” CHAVI-ID is described as a consortium of researchers at universities and academic medical centers which will build on advances made in several laboratories, including the Center for HIV/AIDS Vaccine Immunology (CHAVI) based at Duke. CHAVI’s seven-year funding award from NIAID ended in June. NIAID Director Anthony S. Fauci, M.D. commented, “In recent years, considerable progress has been made in identifying antibodies that can prevent a broad range of HIV strains from infecting human cells. CHAVI-ID will attempt to understand how those antibodies and other immune responses work to protect against HIV infection, providing scientists with a rational foundation for designing what we hope will be an effective HIV vaccine.”

More at: http://www.nih.gov/news/health/jul2012/niaid-13.htm

Conference: The International AIDS Conference
22-27 July 2012; Washington DC

Overview
“The International AIDS Conference is the premier gathering for those working in the field of HIV, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic. It is a chance to assess where we are, evaluate recent scientific developments and lessons learnt, and collectively chart a course forward.
“The AIDS 2012 programme will present new scientific knowledge and offer many opportunities for structured dialogue on the major issues facing the global response to HIV. A variety of session types – from abstract-driven presentations to symposia, bridging and plenary sessions – will meet the needs of various participants. Other related activities, including the Global Village, satellite meetings, exhibitions and affiliated independent events, will contribute to an exceptional opportunity for professional development and networking.”
http://www.aids2012.org/Default.aspx?pageId=305

The Global Fund released an analysis of audits and investigations by its Office of the Inspector General which showed “that 3.0 percent of funding audited or investigated between 2005 and 2012 had been misspent, fraudulently misappropriated or inadequately accounted for.” Cees Klumper, Chief Risk Officer at the Global Fund who conducted the analysis, said, “We do not tolerate any misuse of funds, no matter how minor. Although some of these funds were misspent, and are just ineligible expenses, a small percentage of funds are misappropriated through fraud. We actively pursue and expose all such cases.” The Office of the Inspector General is “fully independent and reports directly to the Board” and, since it was established in 2005, has compiled 28 reports on audits and investigations that it has carried out in 27 countries, where a total of $3.8 billion has been disbursed, approximately 23 percent of all disbursements that the Global Fund has made to date.

The analysis showed that, cumulatively, the 3 percent of the funding that not spent in compliance with the grant agreements included:

– Ineligible expenses – or activities not covered by the grant agreements – 1.1 percent

– Inadequately substantiated due to poor or missing documentation – 1.1 percent

– Fraud – 0.5 percent

– Failed to report funds as required – 0.3 percent

The Global Fund noted that the analysis “…did not represent a comprehensive accounting of all misspent funds. Instead, the analysis is a factual rendering of the percentages of funding that had been determined by Global Fund audits and investigations to be ineligible, fraudulently misappropriated or inadequately accounted for.” Further, the release “cautioned that audits and investigations conducted…tend to focus on high-risk areas and on grants where specific risks have been identified, and that it was “…not possible to extrapolate to say that this reflects an accurate picture of misused funds…Our audits and investigations are not a representative sampling of all Global Fund grants.”

http://www.theglobalfund.org/en/mediacenter/newsreleases/2012-07-10_Global_Fund_Releases_an_Analysis_of_Audits_and_Investigations_2012/