Nature  
Volume 484 Number 7395 pp415-558  26 April 2012
http://www.nature.com/nature/current_issue.html

Specials
Outlook: Malaria
Malaria
Michelle Grayson

The numbers game
Priya Shetty

Drug development: Holding out for reinforcements
Michael Eisenstein

Public health: Death at the doorstep
Amy Maxmen

Perspectives: The missing pieces
Brendan S. Crabb, James G. Beeson, Rogerio Amino, Robert Ménard, Andy Waters, + et al.

Vaccines: The take-home lesson
Sarah DeWeerdt

Vector control: The last bite
Lauren Gravitz

The Pediatric Infectious Disease Journal
May 2012 – Volume 31 – Issue 5
pp: A7-A8,431-537,e73-e77

http://journals.lww.com/pidj/pages/currenttoc.aspx
The Worldwide Impact of the Seven-valent Pneumococcal Conjugate Vaccine
Fitzwater, Sean P.; Chandran, Aruna; Santosham, Mathuram; Johnson, Hope L.
Pediatric Infectious Disease Journal. 31(5):501-508, May 2012.
doi: 10.1097/INF.0b013e31824de9f6

Abstract:
Background: Pneumococcal conjugate vaccines (PCV) are emerging as one of the most promising means to prevent pediatric disease. The 7-valent PCV (PCV-7) has been extensively evaluated in clinical trials, and recent evidence from the introduction of PCV-7 through national immunization programs has demonstrated impact on pneumococcal disease.

Methods: Clinical trials have shown PCV-7 to be effective against the more severe forms of pneumococcal infections: pneumonia and invasive pneumococcal disease (IPD), as well as overall child mortality. A review shows the tremendous impact PCV-7 has had to date, and the potential further benefits of the emerging multi-valent vaccines.

Results: Since its introduction, the PCV-7 has substantially reduced the incidence of IPD, hospital admissions due to pneumonia and acute otitis media in numerous, mostly high income, low-disease burden countries. The reductions in IPD and pneumonia have also been observed among unvaccinated age groups in countries with routine use of PCV-7, demonstrating that PCV-7 provides herd immunity. Some settings observed an increase in rate of Nonvaccine serotype IPD, yet rates of overall and vaccine-serotype IPD show marked reductions post–PCV-7 introduction. Limited data are available on the impact of PCV-7 in lower income countries. The available data from efficacy trials from The Gambia and South Africa suggest that PCV-7 will have substantial impact on reducing pneumococcal disease.

Conclusion: PCV-7 has shown dramatic reduction in disease and mortality rates in the countries in which it has been introduced. The newly introduced 10-valent and 13-valent pneumococcal vaccines are expected to have substantial disease impact, but monitoring is essential to determine their true impact and sustain further introduction of pneumococcal conjugate vaccines.

PLoS One
[Accessed 28 April 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Synthetic Biology: Mapping the Scientific Landscape
Paul Oldham, Stephen Hall, Geoff Burton
PLoS ONE: Research Article, published 23 Apr 2012 10.1371/journal.pone.0034368

Abstract
This article uses data from Thomson Reuters Web of Science to map and analyse the scientific landscape for synthetic biology. The article draws on recent advances in data visualisation and analytics with the aim of informing upcoming international policy debates on the governance of synthetic biology by the Subsidiary Body on Scientific, Technical and Technological Advice (SBSTTA) of the United Nations Convention on Biological Diversity. We use mapping techniques to identify how synthetic biology can best be understood and the range of institutions, researchers and funding agencies involved. Debates under the Convention are likely to focus on a possible moratorium on the field release of synthetic organisms, cells or genomes. Based on the empirical evidence we propose that guidance could be provided to funding agencies to respect the letter and spirit of the Convention on Biological Diversity in making research investments. Building on the recommendations of the United States Presidential Commission for the Study of Bioethical Issues we demonstrate that it is possible to promote independent and transparent monitoring of developments in synthetic biology using modern information tools. In particular, public and policy understanding and engagement with synthetic biology can be enhanced through the use of online interactive tools. As a step forward in this process we make existing data on the scientific literature on synthetic biology available in an online interactive workbook so that researchers, policy makers and civil society can explore the data and draw conclusions for themselves.

PLoS Medicine
(Accessed 28 April 2012)
http://www.plosmedicine.org/article/browse.action?field=date

Where There Is No Health Research: What Can Be Done to Fill the Global Gaps in Health Research?
Martin McKee, David Stuckler, Sanjay Basu Essay, published 24 Apr 2012
doi:10.1371/journal.pmed.1001209

Summary Points
– Efforts to strengthen capacity in health research have, so far, concentrated on countries where there is existing capacity rather than those where it is almost completely lacking.

– Judged by absolute numbers of scientific papers, those with the fewest are mainly small islands and a few countries that are politically isolated.

– Judged by papers per capita, the lowest include countries in the former Soviet Union and Africa, both regions experiencing declines in life expectancy in recent years, and states experiencing conflict.

– Although there is a positive association between economic development and research output, some relatively wealthy countries seriously underperform.

– There are many examples of good practice, including regional networks and international partnerships.

– There is a strong argument for donors to look to the long term and consider how best to build health research capacity where it is virtually absent.

Science        
27 April 2012 vol 336, issue 6080, pages 381-508
http://www.sciencemag.org/current.dtl

Policy Forum
Public Health
Monitoring EU Emerging Infectious Disease Risk Due to Climate Change
Elisabet Lindgren 1, Yvonne Andersson 2, Jonathan E. Suk 3, Bertrand Sudre 3, Jan C. Semenza 3,*
1 Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
2 Formerly at the Swedish Institute for Communicable Disease Control l, SE-171 82 Solna, Sweden.
3 Office of the Chief Scientist, European Centre for Disease Prevention and Control, SE-171 83 Stockholm, Sweden.

In recent years, we have seen transmission of traditionally “tropical” diseases in continental Europe: chikungunya fever (CF) in Italy in 2007, large outbreaks of West Nile fever in Greece and Romania in 2010, and the first local transmission of dengue fever in France and Croatia in 2010 (1–3). These events support the notion that Europe is a potential “hot spot” for emerging and re-emerging infectious diseases (EIDs) (4). Major EID drivers that could threaten control efforts in Europe include globalization and environmental change (including climate change, travel, migration, and global trade); social and demographic drivers (including population aging, social inequality, and life-styles); and public health system drivers (including antimicrobial resistance, health care capacity, animal health, and food safety) (5, 6). Climate change is expected to aggravate existing local vulnerabilities by interacting with a complex web of these drivers (6). For example, increases in global trade and travel, in combination with climate change, are foreseen to facilitate the arrival, establishment, and dispersal of new pathogens, disease vectors, and reservoir species.

     The Sabin Vaccine Institute announced the release of its sponsored special supplement to Vaccine titled “Smallpox Eradication after 30 Years: Lessons, Legacies and Innovations.” Sabin said its President, Dr. Peter Hotez, and Sabin Executive Vice President Dr. Ciro de Quadros, “share their insights on global health innovations and advancements since the eradication of smallpox was certified by the World Health Assembly in 1980.” The issue captures content from a special symposium “which reviewed the major lessons from smallpox eradication and how they could be useful to future health initiatives, and also featured research and discussions regarding issues that require more attention from the global health community such as the need for new vaccines to confront infectious diseases in developing countries.” The symposium, organized by the Fogarty International Center, the Sabin Vaccine Institute and FIOCRUZ took place in Rio de Janeiro, Brazil in August of 2010. Dr. Breman commented, “The symposium went far beyond assembling many giants of smallpox eradication in one place. Scientific and public health leaders addressed the control and eradication of guinea worm, polio, measles, rubella, malaria and neglected tropical diseases. They were able to describe how research, epidemiological surveillance, and good management that contributed to smallpox eradication are being applied to their programs.” The entire special supplement and a summary of the 2010 symposium can be accessed at http://www.sciencedirect.com/science/journal/0264410X/29/supp/S4
24 April 2012

http://www.prnewswire.com/news-releases/smallpox-eradication-continues-to-inspire-innovations-in-global-health-148670685.html

Vaccine
http://www.sciencedirect.com/science/journal/0264410X

Volume 30, Supplement 1, Pages A1-A196 (27 April 2012)
Rotavirus Vaccines for Children in Developing Countries
Edited by A. Duncan Steele, Kathleen M. Neuzil and Umesh D. Parashar

Editorials and Commentaries
Rotavirus vaccines for children in developing countries: Understanding the science, maximizing the impact, and sustaining the effort
Kathleen M. Neuzil, Umesh D. Parashar, A. Duncan Steele
No preview or abstract

Rotavirus vaccines in developing countries: The potential impact, implementation challenges, and remaining questions
Original Research Article
Pages A3-A6
Thomas Cherian, Susan Wang, Carsten Mantel
Abstract
Diarrhoeal disease is one of the commonest causes of death in children, especially in developing countries in Africa and Asia. Rotavirus has been consistently identified as the commonest pathogen associated with severe diarrhoea. Hence, the availability of vaccines against this organism provides the opportunity to reduce child mortality. Data from efficacy trials in developing countries in Africa and Asia showed that the vaccine efficacy was lower than that observed in other countries. Nevertheless, the vaccines are expected to be of significant benefit in high mortality countries in these regions. While the reports published in this supplement add to our understanding about the performance of these vaccines in developing countries in these regions, questions remain over the overall impact of these vaccines when used in national programmes of developing countries in Africa and Asia, the optimal vaccination schedules and the impact of age restrictions for vaccine use on immunization coverage. Additional research is required to improve understanding on the performance of these vaccines in developing countries in Africa and Asia and measures that may improve performance. Data that will assist in the definition of the optimal immunization schedule and possibly allow relaxation of the age restrictions for vaccine use may help in enhancing the impact of the vaccines in these countries. Finally, disease surveillance and studies are required to document the impact of vaccination and monitor changes in disease epidemiology.

Global Perspectives
Projected health and economic impact of rotavirus vaccination in GAVI-eligible countries: 2011–2030
Original Research Article
Pages A7-A14
Deborah E. Atherly, Kristen D.C. Lewis, Jacqueline Tate, Umesh D. Parashar, Richard D. Rheingans

Abstract
Rotavirus is the leading cause of diarrheal disease in children under 5 years of age. It is responsible for more than 450,000 deaths each year, with more than 90% of these deaths occurring in low-resource countries eligible for support by the GAVI Alliance. Significant efforts made by the Alliance and its partners are providing countries with the opportunity to introduce rotavirus vaccines into their national immunization programs, to help prevent childhood illness and death. We projected the cost-effectiveness and health impact of rotavirus vaccines in GAVI-eligible countries, to assist decision makers in prioritizing resources to achieve the greatest health benefits for their populations.

A decision-analytic model was used to project the health outcomes and direct costs of a birth cohort in the target population, with and without a rotavirus vaccine. Current data on disease burden, vaccine efficacy, immunization rates, and costs were used in the model.

Vaccination in GAVI-eligible countries would prevent 2.46 million childhood deaths and 83 million disability-adjusted life years (DALYs) from 2011 to 2030, with annual reductions of 180,000 childhood deaths at peak vaccine uptake. The cost per DALY averted is $42 for all GAVI countries combined, over the entire period. Rotavirus vaccination would be considered very cost-effective for the entire cohort of GAVI countries, and in each country individually, as cost-effectiveness ratios are less than the gross domestic product (GDP) per capita. Vaccination is most cost-effective and has the greatest impact in regions with high rotavirus mortality.

Rotavirus vaccination in GAVI-eligible countries is very cost-effective and is projected to substantially reduce childhood mortality in this population.

Distributional impact of rotavirus vaccination in 25 GAVI countries: Estimating disparities in benefits and cost-effectiveness
Original Research Article
Pages A15-A23
Richard Rheingans, Deborah Atherly, John Anderson

Abstract
Background
Other studies have demonstrated that the impact and cost effectiveness of rotavirus vaccination differs among countries, with greater mortality reduction benefits and lower cost-effectiveness ratios in low-income and high-mortality countries. This analysis combines the results of a country level model of rotavirus vaccination published elsewhere with data from Demographic and Health Surveys on within-country patterns of vaccine coverage and diarrhea mortality risk factors to estimate within-country distributional effects of rotavirus vaccination. The study examined 25 countries eligible for funding through the GAVI Alliance.

Methods
For each country we estimate the benefits and cost-effectiveness of vaccination for each wealth quintile assuming current vaccination patterns and for a scenario where vaccine coverage is equalized to the highest quintile’s coverage. In the case of India, variations in coverage and risk proxies by state were modeled to estimate geographic distributional effects.

Results
In all countries, rates of vaccination were highest and risks of mortality were lowest in the top two wealth quintiles. However countries differ greatly in the relative inequities in these two underlying variables. Similarly, in all countries examined, the cost-effectiveness ratio for vaccination ($/Disability-Adjusted Life Year averted, DALY) is substantially greater in the higher quintiles (ranging from 2–10 times higher). In all countries, the greatest potential benefit of vaccination was in the poorest quintiles. However, due to reduced vaccination coverage, projected benefits for these quintiles were often lower. Equitable coverage was estimated to result in an 89% increase in mortality reduction for the poorest quintile and a 38% increase overall.

Conclusions
Rotavirus vaccination is most cost-effective in low-income groups and regions. However in many countries, simply adding new vaccines to existing systems targets investments to higher income children, due to disparities in vaccination coverage. Maximizing health benefits for the poorest children and value for money require increased attention to these distributional effects.

Additional articles in this Supplement are organized under the following headings:
– Rotavirus Vaccines in Africa

– Rotavirus Vaccines in Asia

– Rotavirus Strain Studies

– Clinical Studies

– Intussusception

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 April 2012

– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

The Executive Directors of the World Bank Group selected Dr. Jim Yong Kim as President for a five-year term beginning on July 1, 2012. The President is Chair of the Boards of Directors of the International Bank for Reconstruction and Development (IBRD) and the International Development Association (IDA). The President is also ex officio Chair of the Boards of Directors of the International Finance Corporation (IFC), the Multilateral Investment Guarantee Agency (MIGA), and the Administrative Council of the International Centre for Settlement of Investment Disputes (ICSID). In a statement,

the Executive Directors said “We, the Executive Directors, wish to express our deep appreciation to all the nominees, Jim Yong Kim, José Antonio Ocampo and Ngozi Okonjo-Iweala. Their candidacies enriched the discussion of the role of the President and of the World Bank Group’s future direction. The final nominees received support from different member countries, which reflected the high caliber of the candidates. We all look forward to working with Dr. Kim when he assumes his responsibilities.”

Dr. Jim Yong Kim is currently President of Dartmouth College. A U.S. national, Dr. Kim is a co-founder of Partners in Health (PIH) and a former director of the Department of HIV/AIDS at the World Health Organization (WHO). Before assuming the Dartmouth presidency, Dr. Kim held professorships at Harvard Medical School and the Harvard School of Public Health. He also served as chair of the Department of Global Health and Social Medicine at Harvard Medical School, chief of the Division of Global Health Equity at Brigham and Women’s Hospital, and director of the François Xavier Bagnoud Center for Health and Human Rights at the Harvard School of Public Health.

http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:23170638~pagePK:34370~piPK:34424~theSitePK:4607,00.html

   Dr. Jim Yong Kim released a statement in response to his selection by the World Bank’s Executive Directors as 12th President of the World Bank:

“I am honored to accept the Executive Directors’ decision to select me as the next President of the World Bank Group.  I am delighted to succeed Robert Zoellick, who has served with excellence and distinction during the last five years, and I am grateful to the Bank’s member countries for the broad support I have received….

I have spoken with Minister Okonjo-Iweala and Professor Ocampo.  They have both made important contributions to economic development, and I look forward to drawing on their expertise in the years to come.

It is befitting that I conclude my global listening tour in Peru.  It was here in the shantytowns of Lima that I learned how injustice and indignity may conspire to destroy the lives and hopes of the poor.  It was here that I saw how communities struggle to prosper because of a lack of infrastructure and basic services.  It was here that I learned that we must raise our sights to match the aspirations of those most excluded.  And it was here that I learned that we can triumph over adversity by empowering the poor and focusing on results.

As President, I will seek a new alignment of the World Bank Group with a rapidly changing world.  Together, with partners old and new, we will foster an institution that responds effectively to the needs of its diverse clients and donors; delivers more powerful results to support sustained growth; prioritizes evidence-based solutions over ideology; amplifies the voices of developing countries; and draws on the expertise and experience of the people we serve.

My discussions with the Board and member countries point to a global consensus around the importance of inclusive growth.  We are closer than ever to achieving the mission inscribed at the entrance of the World Bank – “Our Dream is a World Free of Poverty.”  The power of this mission is matched by the talent of the World Bank Group staff.  May this shared mission embolden our efforts to end the disparities which too often diminish our shared humanity.  Let us work together to provide every woman and man with the opportunity to determine their own future.”

http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:23170832~pagePK:34370~piPK:34424~theSitePK:4607,00.html

   The World Bank Board of Executive Directors said it approved in principle the creation of a Global Partnership for Social Accountability (GPSA). The GPSA is described as “a new mechanism to scale up and support social accountability by beneficiary groups and civil society organizations (CSOs) in developing countries.” The Bank’s Board will review operational details of the proposed Partnership in June. World Bank Group President Robert B. Zoellick commented, “The Bank understands now more than ever that citizen voice and the engagement of project beneficiaries are crucial for lasting development results. This new dedicated partnership will support critical work on social accountability, including beneficiary monitoring and oversight of projects and programs. I hope this new Partnership can become an integral part of the Bank Group’s work going forward.” The Bank said it plans to invest US$20 million in seed money to create the Partnership and will work with others to raise additional funds. The GSPA will focus on exchanging knowledge of best practice, as well as investing in projects to boost social accountability. The scope of the GPSA is global, and over 20 potential partners—including foundations, think tanks, governments and bilateral organizations – “have provided input to its design, along with more than 1,300 representatives of civil society organizations from 60 countries, who have participated in consultations on the proposed Partnership.” http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:23175490~pagePK:64257043~piPK:437376~theSitePK:4607,00.html?cid=EXT_TWBN_D_EXT

Meeting Documentation: SAGE meeting of April 2012
Geneva, 10-12 April 2012
The report of this meeting will be made available in French and English in the Weekly Epidemiological Record (WER) on 25 May 2012.

Background documents
Session: Report from Director, IVB
– SAGE report of November 2011 meeting
pdf, 870kb
– SAGE report from the DoV meeting of February 2012
pdf, 299kb
– SAGE tracking record of recommendations and action points
pdf, 481kb
– Draft Global Vaccins Action Plan, 19 March 2012
pdf, 923kb
– Immunization and Vaccines related Implementation Research Advisory Committee (IVIR-AC) – Terms of reference
pdf, 254kb
– TFI members’ meeting, Summary report, Windhoek, Namibia, 2-3 December 2011
pdf, 660kb

Session: Reports from other advisory committees on immunization
– GACVS report
pdf, 1.10Mb

Documentation for the sessions below are available here:
http://www.who.int/immunization/sage/meetings/2012/april/presentations_background_docs/en/index.html

Session: Polio eradication
Session: Seasonal influenza vaccine
Session: Impact of introduction of new vaccines on the strengthening of immunization and health systems
Session: Vaccination in humanitarian emergencies
Session: Rotavirus vaccine schedules
Session: Use of hepatitis A vaccines
Session: Report from the GAVI Alliance Secretariat
Session: Information on vaccines for an Intergovernmental Negotiating Committee on Mercury

WHO Strategic Advisory Group of Experts (SAGE) on immunization: Request for nominations

WHO is soliciting proposals for nominations for current vacancies on its Strategic Advisory Group of Experts (SAGE) on immunization. Nominations should be submitted no later than 29 June 2012. In view of the current SAGE membership, nominations are solicited for experts from the African, American, Eastern Mediterranean, and Western Pacific regions. Nominations will then be carefully reviewed by the SAGE membership selection panel, which will propose the selection of nominees to the WHO Director-General for appointment. Please see this link for further information:

http://www.who.int/immunization/sage/en/

   The Board of Directors of the Global Health Council (GHC) announced “with deep regret” that the Council will close operations within the coming months following “serious deliberations about the state of global health issues, the role of the Council as a convenor, and the Council’s current operating model.”  GHC “is the world’s largest membership alliance dedicated to saving lives by improving health throughout the world, and worked to ensure that all who strive for improvement and equity in global health have the information and resources they need to succeed.” But the GHC Board said that “the compelling needs that gave rise to the Global Health Council’s mission have shifted. Funding that once existed to promote a broad-based health agenda is now focused on specific health issues. The fundamental shifts in the health landscape have led the Board to revisit the relevance of the organization and determine that the Council’s current operating model is no longer sustainable…We wish to thank our staff, leadership past and present and our members of the international community who have supported the Global Health Council for the last 40 years. We have accomplished much together, but despite the progress we have made, millions of people, many of them children, remain without access to basic health care. Our commitment to them must not waver. Although The Global Health Council will no longer play the same role, we will continue to fight for the goals that first inspired us to action.”
April 20, 2012

http://www.globalhealth.org/

The Global Fund reported that United Kingdom International Development Secretary, Andrew Mitchell, told a parliamentary hearing that “the speed and effectiveness of reforms underway at the Global Fund to Fight AIDS, Tuberculosis and Malaria are on target.” Mr. Mitchell told a select committee for international development on Tuesday that he “thought the new leadership at the Global Fund warranted renewed confidence, and he singled out the Global Fund’s new General Manager, Gabriel Jaramillo, for bringing in improved management and financial supervision.”  Mr. Mitchell told the hearing that the UK was already committed to giving the Global Fund 128 million pounds (204 million US dollars) “this year, next year and the year after,” and that the UK could significantly increase its annual contribution from 2013 to 2015 if reforms currently underway are successful.

http://www.theglobalfund.org/en/mediacenter/pressreleases/2012-04-19_UK_Development_Minister_Praises_Reforms_at_Global_Fund/

Statement: NSABB Review of Revised H5N1 Manuscripts
NIH Director Francis Collins, M.D., Ph.D.
April 20, 2012

Extract
“On March 29 and 30, the National Science Advisory Board for Biosecurity (NSABB), an independent expert committee that advises the National Institutes of Health (NIH), the Department of Health and Human Services (HHS) and other Federal departments and agencies on matters of biosecurity, convened to review unpublished revised manuscripts describing NIH-funded research on the transmissibility of H5N1 influenza virus—the strain commonly referred to as “bird flu.”…The NSABB reviewed the revised manuscripts to make recommendations as to whether, and if so how, they should be communicated…

“…During its March meeting, the NSABB took into account the new and clarified information in the manuscripts, additional perspectives provided by influenza biology experts, highly pertinent but as yet unpublished epidemiologic data, and relevant security information.

“After careful deliberation, the NSABB unanimously recommended the revised manuscript by Dr. Yoshihiro Kawaoka be communicated in full. The NSABB also recommended, in a 12-to-6 decision, that the data, methods, and conclusions presented in the revised manuscript by Dr. Ron Fouchier be communicated fully after a number of further scientific clarifications are made in the manuscript. The recommendation to communicate the research was based on the observation that the information in the revised manuscripts has direct applicability to ongoing and future influenza surveillance efforts and does not appear to enable direct misuse of the research in ways that would endanger public health or national security.

“The HHS Secretary and I concur with the NSABB’s recommendation that the information in the two manuscripts should be communicated fully and we have conveyed our concurrence to the journals considering publication of the manuscripts.   This information has clear value to national and international public health preparedness efforts and must be shared with those who are poised to realize the benefits of this research….”

http://www.nih.gov/about/director/04202012_NSABB.htm

Global Initiative: World Malaria Day, 25 April 2012

“In 2010, about 3.3 billion people – almost half of the world’s population – were at risk of malaria. Every year, this leads to about 216 million malaria cases and an estimated 655 000 deaths. People living in the poorest countries are the most vulnerable. World Malaria Day – which was instituted by the World Health Assembly at its 60th session in May 2007 – is a day for recognizing the global effort to provide effective control of malaria. It is an opportunity:

– for countries in the affected regions to learn from each other’s experiences and support each other’s efforts;

– for new donors to join a global partnership against malaria;

– for research and academic institutions to flag their scientific advances to both experts and general public; and

– for international partners, companies and foundations to showcase their efforts and reflect on how to scale up what has worked.

Related links

More about World Malaria Day

Roll Back Malaria Partnership

WHO Global Malaria Programme

http://www.who.int/mediacentre/events/annual/malaria/en/index.html

Global Initiative: World Meningitis Day, 24 April 2012

The Confederation of Meningitis Organisations (CoMO) “is urging people all over the world to ‘Join Hands Against Meningitis’ in an effort to reduce the global impact of the disease. The call-to-action encourages individuals, families and communities to learn the signs and symptoms of meningitis, the importance of urgent treatment of the disease, and that prevention is available through vaccination against some forms of meningitis.

http://www.multivu.com/mnr/55808-world-meningitis-day-join-the-fight-to-stop-meningitis

   The MMWR Weekly for April 20, 2012 / Vol. 61 / No. 15 includes”

– Measles — United States, 2011

– Human Papillomavirus–Associated Cancers — United States, 2004–2008

– Tracking Progress Toward Global Polio Eradication, 2010–2011

– Announcements: World Malaria Day — April 25, 2012

– Announcements: National Infant Immunization Week — April 21–28, 2012

    The Weekly Epidemiological Record (WER) for 20 April 2012, vol. 87, 16 (pp 153–160) includes: Tracking progress towards global polio eradication, 2010–2011

http://www.who.int/entity/wer/2012/wer8716.pdf

Twitter Watch [accessed 21 April 2012 – 15:20]
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.

Orin Levine @OrinLevine
This@GAVIAlliance video is why i’m going 2 Ghana next week, & why we do the work we do @IVACtweets http://vimeo.com/38946570
Retweeted by GAVI Alliance
11:48 AM – 20 Apr 12

Dagfinn Høybråten @Hoybraten
Celebrating 1st World Immunisation Week in Haiti and 10 years of Vaccination Week in the Americas @pahowho http://pic.twitter.com/jNIvClD9
Retweeted by GAVI Alliance
1:50 PM – 21 Apr 12

PATH MVI @MalariaVaccine
T-4 days to #WorldMalariaDay | #Malaria accounts for up to 40% of Africa’s public health expenditures. http://bit.ly/MVIwmd
2:00 PM – 21 Apr 12

UNICEF @UNICEF
Join the first ever World #Immunization Week, 21-28 April. Vaccines save lives, protect kids against deadly diseases http://goo.gl/M37Yb
10:25 AM – 21 Apr 12

RWJF PublicHealth @RWJF_PubHealth
2011 was the worst year for #measles in 15 years: http://bit.ly/IW2XW6 #publichealth
9:35 AM – 20 Apr 12

GHS @GHS
Why is it important to engage the public ahead of #vaccine introductions? Check out LSHTM’s reasons here: http://bit.ly/IXULtH
Retweeted by Sabin Vaccine Inst.
5:45 PM – 19 Apr 12

DoV Collaboration @DofVC
Decade of Vaccines Collaboration – April 2012 News Report – http://eepurl.com/k7XwX
5:10 AM – 20 Apr 12

IHME at UW @IHME_UW
Close
Jimmy Carter: Key to changing health outcomes is reaching journalists in countries afflicted by hard-to-eradicate diseases. #AHCJ12
6:19 PM – 19 Apr 12

WHO @WHO
Close
Over 19 million infants did not receive the basic vaccine against diphtheria-tetanus-pertussis in 2010 http://goo.gl/tCakV #vaccineswork
5:10 PM – 19 Apr 12

GAVI Alliance @GAVIAlliance
DTP3 coverage in low-income countries has increased from 66% in 2000 to 82% in 2011 – highest level ever! http://ht.ly/aoCeb #vaccineswork
5:07 PM – 19 Apr 12

WHO @WHO
Ten years of vaccination weeks in the Americas, 365m people have been vaccinated since http://goo.gl/fUicI #vaccineswork
12:04 PM – 19 Apr 12

Partners In Health @PIH
VIDEO: In #Haiti, health workers deliver the first of two doses of #cholera vaccine: http://ow.ly/ao6c4
11:29 AM – 19 Apr 12

Partners In Health @PIH
Dr. Jim Yong Kim ( @PIH co-founder) named @WorldBank president! http://ow.ly/ajyMP via @washingtonpost
Retweeted by USAID Global Health
1:42 PM – 16 Apr 12

   The Pharmaceutical Research and Manufacturers of America (PhRMA) released  Report (2012): Medicines in Development for Vaccines, profiling “nearly 300 vaccines for the prevention and treatment of a wide variety of diseases in development by America’s biopharmaceutical research companies.” The vaccines – all either currently tested in clinical trials or under review by the Food and Drug Administration – include 170 for infectious diseases, 102 for cancers and eight for neurological disorders. PhRMA noted that the report includes discussion of vaccines currently in development including:

– A genetically-modified vaccine for the treatment of pancreatic cancer.

– A therapeutic vaccine that increases the immune response against the HIV virus.

– A vaccine that protects infants against meningococcal disease, a leading cause of meningitis.

– An immunotherapeutic vaccine for the treatment of Alzheimer’s disease.

– A recombinant vaccine to prevent malaria.

REPORT: Report (2012): Medicines in Development for Vaccines

April 20, 2012

http://www.phrma.org/media/releases/nearly-300-vaccines-development-prevention-treatment-disease

The World Bank released the 2012 edition of World Development Indicators (WDI), providing “updated data on global development, the quality of people’s lives, the environment, the economy, the functioning of states and markets, and global links – how actions in one part of the world affect people elsewhere.” WDI 2012 “includes data for the first ten years of the Millennium Development Goals (MDGs), providing an important data resource for the Global Monitoring Report (GMR)…Measured against 1990 benchmarks, progress accelerated in the past decade, lifting millions out of poverty, enrolling millions of children in school, and sharply reducing the loss of life due to preventable causes.”

WDI and Regional Highlights: http://data.worldbank.org/data-catalog/world-development-indicators

April 19, 2012

http://web.worldbank.org/WBSITE/EXTERNAL/NEWS/0,,contentMDK:23175850~pagePK:34370~piPK:34424~theSitePK:4607,00.html

Annals of Internal Medicine
April 17, 2012; 156 (8)
http://www.annals.org/content/current

Original Research
The Cost-Effectiveness of Preexposure Prophylaxis for HIV Prevention in the United States in Men Who Have Sex With Men
Jessie L. Juusola, Margaret L. Brandeau, Douglas K. Owens, and Eran Bendavid
Ann Intern Med April 17, 2012 156:541-550;

Abstract
Preexposure chemoprophylaxis (PrEP) with antiretroviral drugs significantly reduces the risk for HIV infection in HIV-negative men who have sex with men (MSM), but its cost-effectiveness is uncertain. In a dynamic model of HIV transmission and progression, a strategy that targeted PrEP to the 20% of MSM considered to be at highest risk for HIV prevented twice as many infections over the long term, and at better economic value, than one that provided PrEP to 20% of all HIV-negative MSM. Targeted PreP could have a substantial impact on the U.S. HIV epidemic at an acceptable cost.

British Medical Journal
21 April 2012 (Vol 344, Issue 7853)
http://www.bmj.com/content/344/7853

Editorial
Reducing neonatal mortality in resource poor settings
BMJ 2012; 344 doi: 10.1136/bmj.e2197 (Published 21 March 2012)
Cite this as: BMJ 2012;344:e2197
Kim Eva Dickson, Mickey Chopra

Extract
What works is now clearer but implementation is a challenge

Since the announcement in 2000 of the millennium development goals (MDGs), progress towards achieving these goals has resulted in considerable reductions in deaths from communicable diseases such as HIV, tuberculosis, and malaria (MDG 6); maternal mortality (MDG 5); and child deaths (MDG 4). Child deaths for instance have declined from more than 12 million in 1990 to 7.6 million in 2010.1 However, progress in reducing neonatal deaths—deaths within the first month of life—has lagged behind. Neonatal deaths now account for a greater proportion of global child deaths than ever before—nearly 41% of all deaths in children under 5 years occur during the neonatal period.2

In this context, the results of the linked trial by Bhandari and colleagues (doi:10.1136/bmj.e1634) are of particular interest and importance.3 It is the first study to evaluate India’s large and complex Integrated Management of Neonatal and Childhood Illness (IMNCI) programme, which is an approach to neonatal and child care that is being implemented across

Emerging Infectious Diseases
Volume 18, Number 5—May 201
http://www.cdc.gov/ncidod/EID/index.htm

Transmission Dynamics, Border Entry Screening, and School Holidays during the 2009 Influenza A (H1N1) Pandemic, China
H. Yu et al.

Abstract
Pandemic influenza A (H1N1) 2009 virus spread rapidly around the world in 2009. We used multiple data sources from surveillance systems and specific investigations to characterize the transmission patterns of this virus in China during May–November 2009 and analyze the effectiveness of border entry screening and holiday-related school closures on transmission. In China, age distribution and transmission dynamic characteristics were similar to those in Northern Hemisphere temperate countries. The epidemic was focused in children, with an effective reproduction number of ≈1.2–1.3. The 8 days of national holidays in October reduced the effective reproduction number by 37% (95% credible interval 28%–45%) and increased underreporting by ≈20%–30%. Border entry screening detected at most 37% of international travel–related cases, with most (89%) persons identified as having fever at time of entry. These findings suggest that border entry screening was unlikely to have delayed spread in China by >4 days.

Health Policy and Planning
Volume 27 Issue 3 May 2012
http://heapol.oxfordjournals.org/content/current

Original articles
Influencing policy change: the experience of health think tanks in low- and middle-income countries
Sara Bennett, Adrijana Corluka, Jane Doherty, Viroj Tangcharoensathien, Walaiporn Patcharanarumol, Amar Jesani, Joseph Kyabaggu, Grace Namaganda, A M Zakir Hussain, and Ama de-Graft Aikins
Health Policy Plan. (2012) 27(3): 194-203 doi:10.1093/heapol/czr035

[Open access]
Abstract

In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings.      Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy  advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within government faced considerable difficulties.

Health Policy and Planning
Volume 27 Issue 3 May 2012
http://heapol.oxfordjournals.org/content/current

Editor’s Choice: 10 best resources on … the current effects of global health initiatives on country health systems
Neil Spicer and Aisling Walsh
Health Policy Plan. (2012) 27(3): 265-269 doi:10.1093/heapol/czr034

Extract
The last decade has seen momentous shifts in the global development assistance architecture for health. Actors at global level are changing. In addition to the WHO, UNICEF, the World Bank and donor governments, new actors including philanthropic trusts and other civil society organizations, private-for-profit organizations, global health initiatives (GHIs) and partnerships are becoming increasingly significant (Brugha 2008; Walt et al. 2009). GHIs are mobilizing substantial new resources for disease control programmes in low- and middle- income countries (LMICs) leading to dramatic scaling up of services, especially for HIV and AIDS. The Global Fund to Fight AIDS, Tuberculosis and Malaria, the President’s Emergency Plan For AIDS Relief (PEPFAR) and the World Bank’s HIV and AIDS programmes including the Multi-Country AIDS Program (MAP) collectively contribute more than two-thirds of all external funding for HIV and AIDS-related programmes in LMICs (Global Fund 2007; Oomman et al. 2007).1 They have also introduced new forms of governance, engaged non-traditional actors—private-for-profit actors and civil society—and promoted increased political support around focal diseases and public health issues.

Due to the magnitude of funding there is a growing interest in the effects of these and other major GHIs, including the GAVI Alliance (Global Alliance for Vaccines and Immunisations).2 Among the concerns expressed about GHIs are the unintended negative effects of disease-specific programmes (often perceived as ‘vertical’ programmes) including whether they undermine efforts to improve donor harmonization (co-ordination between donors) and alignment (co-ordination between donors and recipient government policies and programmes),3 place increased burdens on already weak health systems and unintentionally weaken the delivery of services for non-focal diseases (Brugha 2008; WHO Maximizing Positive Synergies Academic Consortium 2009).

Evidence is beginning to emerge from empirical studies conducted in several countries on GHI effects on country health systems. Much of …

[Full Text of this Article]

JAMA   
April 18, 2012, Vol 307, No. 15, pp 1555-1657
http://jama.ama-assn.org/current.dtl

Theme Issue: Comparative Effectiveness Research
Viewpoints
The Patient-Centered Outcomes Research Institute (PCORI) National Priorities for Research and Initial Research Agenda
Joe V. Selby, Anne C. Beal, Lori Frank
JAMA. 2012;307(15):1583-1584.doi:10.1001/jama.2012.500

Extract
The Patient Protection and Affordable Care Act of 2010 created the Patient-Centered Outcomes Research Institute (PCORI) to fund and promote comparative clinical effectiveness research (CER) that will “assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis.”1 CER is not a new concept,2,3 but appreciation of its potential for providing patients and their clinicians with uniquely valuable information on what works, tailored to the clinical situation and to patient priorities, has increased rapidly in recent years.

The research institute founded by this legislation was named to emphasize the critical importance of a patient-centered perspective in conducting this research.4 The PCORI Board of Governors determined early on that taking this …

Special Communication
Methodological Standards and Patient-Centeredness in Comparative Effectiveness Research: The PCORI Perspective
Methodology Committee of the Patient-Centered Outcomes Research Institute (PCORI)
JAMA. 2012;307(15):1636-1640.doi:10.1001/jama.2012.466

Abstract
Rigorous methodological standards help to ensure that medical research produces information that is valid and generalizable, and are essential in patient-centered outcomes research (PCOR). Patient-centeredness refers to the extent to which the preferences, decision-making needs, and characteristics of patients are addressed, and is the key characteristic differentiating PCOR from comparative effectiveness research. The Patient Protection and Affordable Care Act signed into law in 2010 created the Patient-Centered Outcomes Research Institute (PCORI), which includes an independent, federally appointed Methodology Committee. The Methodology Committee is charged to develop methodological standards for PCOR. The 4 general areas identified by the committee in which standards will be developed are (1) prioritizing research questions, (2) using appropriate study designs and analyses, (3) incorporating patient perspectives throughout the research continuum, and (4) fostering efficient dissemination and implementation of results. A Congressionally mandated PCORI methodology report (to be issued in its first iteration in May 2012) will begin to provide standards in each of these areas, and will inform future PCORI funding announcements and review criteria. The work of the Methodology Committee is intended to enable generation of information that is relevant and trustworthy for patients, and to enable decisions that improve patient-centered outcomes.

Editorials
Is It Time for Medicine-Based Evidence?
John Concato

Comparative Effectiveness Research: Relative Successes
Robert M. Golub, Phil B. Fontanarosa

The Lancet  
Apr 21, 2012  Volume 379  Number 9825  p1461 – 1560
http://www.thelancet.com/journals/lancet/issue/current

Series
The importance of quantitative systemic thinking in medicine
Geoffrey B West

Preview
The study and practice of medicine could benefit from an enhanced engagement with the new perspectives provided by the emerging areas of complexity science and systems biology. A more integrated, systemic approach is needed to fully understand the processes of health, disease, and dysfunction, and the many challenges in medical research and education. Integral to this approach is the search for a quantitative, predictive, multilevel, theoretical conceptual framework that both complements the present approaches and stimulates a more integrated research agenda that will lead to novel questions and experimental programmes.

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

Single Endemic Genotype of Measles Virus Continuously Circulating in China for at Least 16 Years
Yan Zhang, Songtao Xu, Huiling Wang, Zhen Zhu, Yixin Ji, Chunyu Liu, Xiaojie Zhang, Liwei Sun, Jianhui Zhou, Peishan Lu, Ying Hu, Daxing Feng, Zhenying Zhang, Changyin Wang, Xueqiang Fang, Huanying Zheng, Leng Liu, Xiaodong Sun, Wei Tang, Yan Wang, Yan Liu, Hui Gao, Hong Tian, Jiangtao Ma, Suyi Gu, Shuang Wang, Yan Feng, Fang Bo, Jianfeng Liu, Yuan Si, Shujie Zhou, Yuyan Ma, Shengwei Wu, Shunde Zhou, Fangcai Li, Zhengrong Ding, Zhaohui Yang, Paul A. Rota, David Featherstone, Youngmee Jee, William J. Bellini, Wenbo Xu
PLoS ONE: Research Article, published 20 Apr 2012 10.1371/journal.pone.0034401

Abstract 
The incidence of measles in China from 1991 to 2008 was reviewed, and the nucleotide sequences from 1507 measles viruses (MeV) isolated during 1993 to 2008 were phylogenetically analyzed. The results showed that measles epidemics peaked approximately every 3 to 5 years with the range of measles cases detected between 56,850 and 140,048 per year. The Chinese MeV strains represented three genotypes; 1501 H1, 1 H2 and 5 A. Genotype H1 was the predominant genotype throughout China continuously circulating for at least 16 years. Genotype H1 sequences could be divided into two distinct clusters, H1a and H1b. A 4.2% average nucleotide divergence was found between the H1a and H1b clusters, and the nucleotide sequence and predicted amino acid homologies of H1a viruses were 92.3%–100% and 84.7%–100%, H1b were 97.1%–100% and 95.3%–100%, respectively. Viruses from both clusters were distributed throughout China with no apparent geographic restriction and multiple co-circulating lineages were present in many provinces. Cluster H1a and H1b viruses were co-circulating during 1993 to 2005, while no H1b viruses were detected after 2005 and the transmission of that cluster has presumably been interrupted. Analysis of the nucleotide and predicted amino acid changes in the N proteins of H1a and H1b viruses showed no evidence of selective pressure. This study investigated the genotype and cluster distribution of MeV in China over a 16-year period to establish a genetic baseline before MeV elimination in Western Pacific Region (WPR). Continuous and extensive MeV surveillance and the ability to quickly identify imported cases of measles will become more critical as measles elimination goals are achieved in China in the near future. This is the first report that a single endemic genotype of measles virus has been found to be continuously circulating in one country for at least 16 years

PLoS Medicine
(Accessed 21 April 2012)
http://www.plosmedicine.org/article/browse.action?field=date

New Methodology for Estimating the Burden of Infectious Diseases in Europe
Mirjam Kretzschmar, Marie-Josée J. Mangen, Paulo Pinheiro, Beate Jahn, Eric M. Fèvre, Silvia Longhi, Taavi Lai, Arie H. Havelaar, Claudia Stein, Alessandro Cassini, Piotr Kramarz, for the BCoDE consortium Policy Forum, published 17 Apr 2012
doi:10.1371/journal.pmed.1001205

Summary Points
– The major objectives of the Burden of Communicable Diseases in Europe (BCoDE) study are to further develop the methodology to estimate the burden of infectious diseases (IDs), and to estimate and report on the current and future burden of IDs in the European Union member states and European Economic Area/European Free Trade Association countries.

– The BCoDE project uses a pathogen-based incidence approach to generate estimates, fully taking into account all chronic and long-term sequelae that can be causally related to an infectious agent.

– An important focus is the assessment of underreporting and under-ascertainment in various types of incidence data.

– Future challenges are the integration of demographic changes

Tropical Medicine & International Health
May 2012  Volume 17, Issue 5  Pages 531–682
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue

Malaria
The Gates Malaria Partnership: a consortium approach to malaria research and capacity development (pages 558–563)
Brian Greenwood, Amit Bhasin and Geoffrey Targett
Article first published online: 16 MAR 2012 | DOI: 10.1111/j.1365-3156.2012.02970.x

Abstract
Recently, there has been a major increase in financial support for malaria control. Most of these funds have, appropriately, been spent on the tools needed for effective prevention and treatment of malaria such as insecticide-treated bed nets, indoor residual spraying and artemisinin combination therapy. There has been less investment in the training of the scientists from malaria-endemic countries needed to support these large and increasingly complex malaria control programmes, especially in Africa. In 2000, with support from the Bill & Melinda Gates Foundation, the Gates Malaria Partnership was established to support postgraduate training of African scientists wishing to pursue a career in malaria research. The programme had three research capacity development components: a PhD fellowship programme, a postdoctoral fellowship programme and a laboratory infrastructure programme. During an 8-year period, 36 African PhD students and six postdoctoral fellows were supported, and two research laboratories were built in Tanzania. Some of the lessons learnt during this project – such as the need to improve PhD supervision in African universities and to provide better support for postdoctoral fellows – are now being applied to a successor malaria research capacity development programme, the Malaria Capacity Development Consortium, and may be of interest to other groups involved in improving postgraduate training in health sciences in African universities.

Tropical Medicine & International Health
May 2012  Volume 17, Issue 5  Pages 531–682
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue

Health systems
Disease control and health systems in low- and middle-income countries: enhancing positive interrelation (pages 646–651)
Charles Collins, Miguel Angel Gonzalez Block and Shenglan Tang
Article first published online: 16 MAR 2012 | DOI: 10.1111/j.1365-3156.2012.02968.x

Abstract  [Open Access]
There is a growing interest in improving the relationship between disease control programmes and the rest of the health system in low- and middle-income countries. This short study seeks to contribute to this movement by providing a multi-dimensional approach for policy-makers and researchers. It recognizes the different and often conflicting perspectives in health systems held by stakeholders. Two such perspectives are those of disease control programmes and health systems. Both are based on perceived health needs and put forward requirements on each other through resource demands and organizational needs. Failure to reconcile these perspectives can lead to health system fragmentation. This study proposes a framework to address the importance of mutual support across stakeholder perspectives, striving to understand and analyse the consequences of their reciprocal views. In doing this, the study stresses the importance of common understanding around health system values, the political interplay between stakeholders, the contextual setting and the need to integrate research and capacity development in this area.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 23 pp. 3355-3488 (14 May 2012)

Regular Papers
Seroprevalence of measles among children affected by national measles elimination program in Korea, 2010
Original Research Article
Pages 3355-3359
Eun Seong Kim, Young June Choe, Heeyeon Cho, You-Jin Kim, Hee Sook Yoon, Jeong-Sun Yang, Kisoon Kim, Geun-Ryang Bae, Duk-hyoung Lee

Abstract
Background
Following the implementation of national measles elimination plan in Korea, the elimination was declared in 2006. In order to sustain the elimination, high population immunity should be continuously monitored. To evaluate the current age-related susceptibility within the Korean population, we conducted the seroprevalence in children and adolescents who were affected by the national measles elimination plan.

Methods
We used residual serum specimens to measure measles specific IgG and geometric mean titer (GMT) in birth cohorts 2007–2008 and 1997–2003. Among birth cohorts, 2007–2008 cohorts were grouped to evaluate the timeliness of first dose of MMR, 1994–2003 cohorts were grouped to evaluate the effect of keep-up MMR2 campaign, and 1992–1993 cohorts were grouped to evaluate the effect of catch-up campaign in 2001.

Results
Overall, measles seropositivity rate was 86%. The highest seroprevalence of measles IgG was in birth cohorts 2007–2008. Measles seropositivity declined continuously in age groups. The birth cohorts 1994–1996 showed significantly lower levels of seropositivity and GMT than did the other birth cohorts.

Conclusion
Despite efforts to eliminate measles for the past 10 years in Korea, our study revealed specific birth cohorts remaining at risk for transmission. The adolescents born during 1994–1996 had the lowest measles seropositivity levels, and might represent a ‘pocket’ that has potential at increased risk for measles transmission. Further discussion for follow-up immunization should be placed for consideration in the near future.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 23 pp. 3355-3488 (14 May 2012)

Regular Papers
Why did patients with cardiovascular disease in the Netherlands accept Q fever vaccination?
Original Research Article
Pages 3369-3375
Marloes Bults, Desirée J.M.A. Beaujean, Clementine J. Wijkmans, Aura Timen, Jan Hendrik Richardus, Hélène A.C.M. Voeten

Abstract
This study examines patient’s reasons for accepting Q fever vaccination, including risk perception, feelings of doubt, social influence, information-seeking behavior, preventive measures taken, and perceptions regarding received information and governmental action. Data was obtained from exit interviews conducted after Q fever vaccination, between January and April 2011. A total of 413 patients with specific cardiovascular conditions in the Netherlands participated in exit interviews; 70% were older than 60 years. Most reported reasons for accepting Q fever vaccination were: “I am at an increased risk for developing (chronic) Q fever” (69%) and “my general practitioner recommends Q fever vaccination for me” (34%). The majority (86%) reported a high perceived severity of Q fever, and only 6% felt vulnerable to Q fever after vaccination. One-third had doubts about getting vaccinated, primarily related to fears of side effects and practical barriers. Fifty-two percent solicited advice from their social networks; of these, 67% reported influence on their vaccination decision. General practitioners and family were the most reported sources of advice. Thirty percent actively sought information about Q fever vaccination. Twenty-two percent of all respondents had taken other preventive measures, such as avoiding contact with goats and sheep (74%), and cancelling or postponing visits to Q fever-affected areas (36%). Almost one-half of all respondents reported negative feelings regarding governmental action to control Q fever. Significant differences were observed regarding feelings of doubt, information-seeking behavior, perceived vulnerability, preventive measures taken, and perceptions regarding received information and governmental action regarding gender, age, educational level, and/or employment status. Vaccination decision-making may differ among socio-demographic subgroups. When preparing future vaccination campaigns, it is important to obtain greater insight into these differences and take these aspects into account in risk communication strategies by tailoring information to specific target groups.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 23 pp. 3355-3488 (14 May 2012)

Regular Papers
Potential overestimation of HPV vaccine impact due to unmasking of non-vaccine types: Quantification using a multi-type mathematical model
Original Research Article
Pages 3383-3388
Yoon Hong Choi, Ruth Chapman, Nigel Gay, Mark Jit

Abstract
Introduction
Estimates of human papillomavirus (HPV) vaccine impact in clinical trials and modelling studies rely on DNA tests of cytology or biopsy specimens to determine the HPV type responsible for a cervical lesion. DNA of several oncogenic HPV types may be detectable in a specimen. However, only one type may be responsible for a particular cervical lesion. Misattribution of the causal HPV type for a particular abnormality may give rise to an apparent increase in disease due to non-vaccine HPV types following vaccination (“unmasking”).

Methods
To investigate the existence and magnitude of unmasking, we analysed data from residual cytology and biopsy specimens in English women aged 20–64 years old using a stochastic type-specific individual-based model of HPV infection, progression and disease. The model parameters were calibrated to data on the prevalence of HPV DNA and cytological lesion of different grades, and used to assign causal HPV types to cervical lesions. The difference between the prevalence of all disease due to non-vaccine HPV types, and disease due to non-vaccine HPV types in the absence of vaccine HPV types, was then estimated.

Results
There could be an apparent maximum increase of 3–10% in long-term cervical cancer incidence due to non-vaccine HPV types following vaccination.

Conclusion
Unmasking may be an important phenomenon in HPV post-vaccination epidemiology, in the same way that has been observed following pneumococcal conjugate vaccination.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 23 pp. 3355-3488 (14 May 2012)

Regular Papers
Parental and societal values for the risks and benefits of childhood combination vaccines
Original Research Article
Pages 3445-3452
Courtney Gidengil, Tracy A. Lieu, Katherine Payne, Donna Rusinak, Mark Messonnier, Lisa A. Prosser

Abstract
Background
New combination vaccines reduce the number of injections needed for immunization. However, possible drawbacks include higher prices, extra doses of vaccine antigens and increased minor adverse events. Our objective was to measure parental and societal values for attributes of childhood combination vaccines.

Methods
We conducted a discrete choice experiment using an online survey of adults administered by Knowledge Networks. Values were measured for attributes of combination vaccines for a hypothetical child aged 6 months: (1) number of injections, (2) extra dose of hepatitis B vaccine, (3) 20% higher chance of fever, (4) community-level immunization coverage of 2-year-olds of 90% or 80%, and (5) cost per visit. Logistic regression with generalized estimating equations was used to analyze the value of different attributes and generate a marginal willingness-to-pay for a change in attribute level.

Results
The response rate was 64% (N = 558). Most respondents were parents (63%) and most respondents agreed that combination vaccines were safe (77%). Respondents were willing to pay $7.68 to avoid an injection (compared to $9.94 when looking at parents only). However, respondents were willing to pay $41.57 to avoid higher risk of fever after one set of immunizations (10% versus 30%) and $65.42 for higher immunization coverage rates. These results were very similar for parents only. There was no significant preference to avoid an extra dose of hepatitis B vaccine.

Conclusions
Respondents were willing to pay larger amounts to avoid increased risk of minor adverse events and to increase community-level immunization coverage than to avoid injections. These values should be taken into account when determining the risks and benefits of combination vaccines.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 30, Issue 23 pp. 3355-3488 (14 May 2012)

Regular Papers
Health and economic impact of the seasonal influenza vaccination programme in England
Original Research Article
Pages 3459-3462
Marc Baguelin, Mark Jit, Elizabeth Miller, William John Edmund

Abstract
Background
The seasonal influenza vaccination programme in England targets individuals over 65 years old and in clinical risk groups.

Methods
A model of influenza transmission and disease was fitted to weekly primary care consultations due to influenza in a typical pre-pandemic season (2006/2007). Different scenarios were constructed about influenza severity and how well vaccines match circulating strains to assess the impact and cost-effectiveness of the current vaccination programme.

Results
A well-matched vaccine may reduce the incidence of laboratory-confirmed influenza illness from 8.2% (95% range 4.3–13%) to 5.9% (95% range 2.9–9.7%), with 56–73% of this due to indirect protection. The programme is likely to be cost-effective unless both low severity and poor matching is assumed.

Conclusion
The current seasonal influenza vaccination programme appears to substantially reduce disease burden and provides good value for money.

Vaccine
Volume 30, Issue 22 pp. 3249-3350 (9 May 2012)

Letter to the Editor
Charting a course for equal access to immunization
Pages 3249-3250
Ciro A. de Quadros

[No preview or extract]

Vaccine
Volume 30, Issue 22 pp. 3249-3350 (9 May 2012)

Brief Report
Atypical forms of Guillain-Barré syndrome and H1N1-influenza vaccination
Pages 3251-3254
Aasef G. Shaikh, Pichet Termsarasab, Chinasa Nwankwo, Anitha Rao-Frisch, Bashar Katirji

Abstract
Recent epidemiological studies established extremely rare incidence of Guillain-Barre syndrome (GBS) after contemporary H1N1-influenza vaccine. We saw five patients with ‘atypical’ GBS variants that started within four weeks of 2010/2011 H1N1-influenza vaccine. There was no evidence for other etiologies of GBS. The patients presented with sensory ataxia, areflexia, extremity and oropharyngeal paresthesias, numbness, pain, weakness, sphincteric disturbances, and dysautonomia. One patient had Miller Fisher syndrome. All had elevated cerebrospinal fluid protein, and classic electrodiagnostic finding suggestive of GBS. All received the treatment with intravenous immunoglobulin with variable response. These pilot observations suggest that H1N1-influenza vaccine may be associated with rare and atypical variants of GBS. However, epidemiological studies with large cohorts are necessary to confirm excess cases of atypical GBS after H1N1-influenza vaccination.

Vaccine
Volume 30, Issue 22 pp. 3249-3350 (9 May 2012)

Regular Papers
Safety reporting in developing country vaccine clinical trials—A systematic review
Review Article
Pages 3255-3265
Susann Muehlhans, Georgina Richard, Mohammad Ali, Gabriela Codarini, Chris Elemuwa, Ali Khamesipour, Wolfgang Maurer, Edison Mworozi, Sonali Kochhar, Gabriella Rundblad, Dominique Vuitton, Barbara Rath

Abstract
With more vaccines becoming available worldwide, vaccine research is on the rise in developing countries. To gain a better understanding of safety reporting from vaccine clinical research in developing countries, we conducted a systematic review in Medline and Embase (1989–2011) of published randomized clinical trials (RCTs) reporting safety outcomes with ≥50% developing country participation (PROSPERO systematic review registration number: CRD42012002025). Developing country vaccine RCTs were analyzed with respect to the number of participants, age groups studied, inclusion of safety information, number of reported adverse events following immunization (AEFI), type and duration of safety follow-up, use of standardized AEFI case definitions, grading of AEFI severity, and the reporting of levels of diagnostic certainty for AEFI.

The systematic search yielded a total number of 50 randomized vaccine clinical trials investigating 12 different vaccines, most commonly rotavirus and malaria vaccines. In these trials, 94,459 AEFI were reported from 446,908 participants receiving 735,920 vaccine doses. All 50 RCTs mentioned safety outcomes with 70% using definitions for at least one AEFI. The most commonly defined AEFI was fever (27), followed by local (16) and systemic reactions (14). Logistic regression analysis revealed a positive correlation between the implementation of a fever case definition and the reporting rate for fever as an AEFI (p = 0.027). Overall, 16 different definitions for fever and 7 different definitions for erythema were applied. Predefined AEFI case definitions by the Brighton Collaboration were used in only two out of 50 RCTs.

The search was limited to RCTs published in English or German and may be missing studies published locally. The reported systematic review suggests room for improvement with respect to the harmonization of safety reporting from developing country vaccine clinical trials and the implementation of standardized case definitions.

Vaccine
Volume 30, Issue 22 pp. 3249-3350 (9 May 2012)

Regular Papers
A comparison of parent and provider reported influenza vaccination status of adolescents
Original Research Article
Pages 3278-3285
Peng-jun Lu, Christina Dorell, David Yankey, Tammy A. Santibanez, James A. Singleton

Abstract
Objective
To compare parent and provider reported influenza vaccination status among adolescents.

Methods
Data from the 2009 National Immunization Survey-Teen (NIS-Teen) were analyzed. The NIS-Teen is a nationally representative random-digit-dialed telephone survey of households with adolescents 13–17 years at the time of interview, followed by a mail survey to the adolescent’s vaccination providers to obtain provider-reported vaccination histories. During the interview a parent or guardian was asked if the adolescent had received an influenza vaccination and whether their response was based upon recall only or from consulting a parent-held vaccination record (i.e., shot card) with recall of additional vaccinations not recorded on the shot card. Parent-reported influenza vaccination status was compared with provider-reported vaccination status by calculating various validity measures (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and kappa), overall and stratified by several demographic characteristics. In the main analysis, provider-reported vaccinations were considered the gold standard. To evaluate the completeness of provider-reporting, we conducted additional analysis that also considered vaccinations reported by parents from the shot card or reported received in a non-medical setting as “true” vaccinations.

Results
During the 2008–2009 season, influenza vaccination coverage among adolescents based on provider report was 11.3%. Based on parent report, influenza vaccination coverage was 21.7%. Twenty-two percent of parents retrieved and referred to a shot card during the interview. In the shot card group, provider versus parent reported coverage was 12.5% versus 18.2% while among the recall only group coverage was 10.9% versus 22.7%, respectively. Overall, compared to provider report as the gold standard, parental report of influenza vaccination had a sensitivity of 86.7%, a specificity of 86.2%, a positive predictive value (PPV) of 43.1%, and a negative predictive value (NPV) of 98.0%. Among the shot card group, of vaccinations reported either by provider or by parent reading vaccination off shot card, only 66% were reported by providers. In the shot card group, the “true” vaccination level (16–17%) was closer to the parent reported coverage when it was assumed that vaccinations read by the parent from a shot card but not reported by a provider were considered true vaccinations. Overall, assuming that providers reported 64% of “true” vaccinations, sensitivity increased to 91%, specificity to 93%, and PPV to 71%.

Conclusions
Overall estimated influenza vaccination coverage was more than ten percentage points higher based on parental report than on provider report, with the difference between provider and parent report greater among the recall only group. The two estimates are closer for those with shot cards, but few parents utilized shot cards in our study and most national surveys do not ask parents to consult shot cards when responding about their adolescent’s vaccination. The actual vaccination coverage of adolescents studied is likely between coverage estimates obtained from parent report and provider report.

Vaccine
Volume 30, Issue 22 pp. 3249-3350 (9 May 2012)

Regular Papers
Economic evaluation of vaccination programme of 7-valent pneumococcal conjugate vaccine to the birth cohort in Japan
Original Research Article
Pages 3320-3328
Shu-ling Hoshi, Masahide Kondo, Ichiro Okubo

Abstract
Aiming to introduce 7-valent pneumococcal conjugate vaccine (PVC-7) into routine vaccination schedule, the government of Japan gives a temporary budget to encourage municipalities in launching public vaccination programme which started on November 26, 2010 and ends on March 31, 2012. This study aims to appraise the ‘value for money’ of PCV-7 vaccination programme from the societal perspective and the budget impact from the perspective of municipalities, which is responsible for providing routine vaccination.

We conducted a cost-effectiveness analysis with Markov modelling and calculated incremental cost-effectiveness ratio (ICER) value of launching such programme with two levels of co-payment, ¥1000 (US$13) or ¥0, and two scenarios of the uptake of vaccine (vaccinated-alone or co-vaccinated with other vaccines).

We found that when vaccinated-alone, ICERs in QALY were ¥7,441,000 (US$93,013) or ¥9,065,000 (US$113,313), and when co-vaccinated ¥7,441,000 (US$93,013) or ¥5,489,000 (US$68,613), without or with productivity loss, respectively, regardless of co-payment level of the programme. Co-vaccinated programmes had lower ICER than vaccinated-alone programmes due to the savings in productivity loss. By adopting WHO’s classification that an intervention is ‘cost-effective’ if ICER (in QALY) is between 1 and 3 times of GDP as a criterion, PCV-7 vaccination programme in Japan is concluded as “cost-effective” from the perspective of society.

The introduction of either no co-payment or ¥1000 (US$13) co-payment vaccination programme appears to be not budget saving for the first 6 years, whereas the level of budget impact are less than ¥11,000,000 (US$137,500) or ¥8,500,000 (US$106,250), respectively, for a municipality with 1000 birth cohort in the 1st year and 2nd to 5th year birth cohort proportional to the birth cohort population of estimated future population.

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 April 2012

– Twitter: Readers can also follow developments on twitter: @vaxethicspolicy.

   The American Red Cross said it contributed US$1 million to purchase and distribute oral cholera vaccinations to 100,000 people in urban and rural Haitian communities. These funds will support a US$1.3 million vaccination project led by Partners In Health, the Haitian Ministry of Public Health and Population, and the Haitian nonprofit GHESKIO. This project is part of an ongoing effort to improve control and prevent the spread of the disease that has claimed more than 7,000 lives since its outbreak more than a year ago. The cholera epidemic in Haiti is currently the largest outbreak in the world. Dr. Louise Ivers, Senior Health and Policy Advisor to Partners In Health and Assistant Professor of Medicine at Harvard Medical School, commented, “Support from the American Red Cross is essential to our delivering this safe, affordable and effective oral cholera vaccine in Haiti. While access to clean water and sanitation systems is the ultimate solution to stopping the spread of cholera, we must utilize all tools available to help prevent continued needless deaths,” The vaccine, Shanchol, is delivered in two doses. Shanchol has been pre-qualified by the WHO and is 65 to 75 percent effective in protecting recipients for at least 36 months. To date, the American Red Cross has contributed more than US$17 million to fight the cholera outbreak in Haiti.

http://www.sacbee.com/2012/04/11/4407276/american-red-cross-funds-pioneer.html#storylink=cpy

    The Global Fund “hailed a call by G8 Foreign Ministers for new donors to support the organization’s lifesaving work as a ringing endorsement of major reforms that are underway to strengthen the Global Fund’s management and financial oversight.” G8 Foreign Ministers meeting in Washington on April 12 also called on existing donors to meet their pledges of support and appealed to implementing countries to show leadership in taking on health challenges. The statement noted: “The G8 supports the call for an AIDS-free generation and efforts to achieve universal access to prevention, treatment, care, and support with respect to HIV/AIDS. The G8 renews and recommits to supporting the Global Fund to Fight AIDS, Tuberculosis, and Malaria on the tenth anniversary of its establishment and as the Fund adopts a comprehensive reform agenda.”

http://www.theglobalfund.org/en/mediacenter/pressreleases/2012-04-13_G8_Foreign_Ministers_call_on_Donors_to_support_Global_Fund_Reform_agenda_endorsed/

    GAVI said it secured lower prices for rotavirus vaccine through supply agreements that result is pricing 67% lower than before. GAVI noted that “had (it) been prepared to buy the vaccine at the previous price, it would have needed to pay US$650 million more.” The bulk of the supply volume contracted —132 million doses—will be procured at a cost of $5 dollars per (two-dose) course, a two-third price reduction compared to the previous lowest price offered to GAVI of US$15 a course. This price drop “is the result of an acceleration of GAVI’s market shaping activities and discussions with manufacturers carried out together with the Bill & Melinda Gates Foundation and the Supply Division of UNICEF, key Alliance partners.” GAVI CEO Dr Seth Berkley said, “Influencing vaccine markets to the benefit of children in the poorest countries is core to GAVI’s mandate. We strive to make our donors’ funds go further so we can help developing countries protect more children against deadly diseases and accelerate efforts towards reaching the Millennium Development Goals.” The supply agreements, covering purchases to 2016, were concluded with the two rotavirus vaccine manufacturers, GlaxoSmithKline (GSK) and Merck & Co. Inc. The announcement also noted that GAVI partners, including PATH, supported by the Bill & Melinda Gates Foundation, “are advancing the development of several promising new rotavirus vaccines by collaborating with emerging country manufacturers in the hope of new market entrances from 2015.”

GAVI, through its supply partner UNICEF, “applied some of the key elements of its new vaccine supply and procurement strategy” in achieving this pricing. These elements include:

– Committing to an “advance” purchase: by prepaying a portion of the vaccine supply, GAVI allows manufacturers to recoup their fixed costs earlier and offer a more competitive price.

– Offering mid-term market certainty: by extending the deal period – to five years in the case of the rotavirus vaccines deal – GAVI provides manufacturers with increased visibility, another incentive to commit to lower prices in return for more predictability of demand.

– Offering a long-term view of the market: by sending signals of a viable market to future manufacturers, GAVI aims at enlarging the vaccine supplier base and encouraging developing country manufacturers to join the market. Moving forward, GAVI said it will continue its proactive efforts to shape the vaccine market, and will seek to apply innovative measures specifically tailored to each vaccine. http://www.gavialliance.org/library/news/press-releases/2012/gavi-secures-lower-price-rotavirus-vaccine/

GAVI Board Chair Dagfinn Høybråten said the appointment of three women to the GAVI Alliance Board “achieves a key target on gender.” Her Royal Highness the Infanta Cristina of Spain, Dr Maria C. Freire, and Yifei Li take up their positions with immediate effect. These appointments result in 11 out of 26 Board members being women. GAVI’s Board achieved its target of at least 40 percent representation for both genders within two years of approving guidelines at its meeting in July 2010. At that time, only 10% of Board members were women. “This new balance positions us as a leader on gender policy among international organisations. We make high-impact decisions that affect the lives of millions of women and children and it is critical that we as a Board are properly represented and have a diversity of viewpoints,” Mr Høybråten said.

Geneva, 13 April 2012

http://www.gavialliance.org/library/news/gavi-features/2012/gavi-board-achieves-goal-on-gender/

The International AIDS Vaccine Initiative (IAVI) announced the appointment of Dr. Adel A.F. Mahmoud to its Board of Directors. Dr. Mahmoud is a professor at Princeton University, former President of Merck Vaccines and former Chairman of Medicine at Case Western Reserve University. He joins a “diverse group of 12 directors from ten countries with backgrounds in finance, vaccinology, international development, academia and HIV treatment and prevention that oversees IAVI’s progress and shapes its long-term strategy.” IAVI President & CEO Margaret McGlynn said, “We are very pleased to have Adel join IAVI’s Board of Directors. His experience in the private sector, especially the development and delivery of preventive vaccines, and his in-depth knowledge of immunology and infectious diseases combined with his passion for the development of an AIDS vaccine will prove invaluable to IAVI. I look forward to working closely with Adel again, and welcome his addition to our Board.”

http://www.businesswire.com/news/home/20120409005637/en/Leading-Global-Health-Expert-Dr.-Adel-A.F.

Global Initiative: World Immunization Week
21–28 April 2012

“To underscore the importance of immunization in saving lives, and to encourage families to vaccinate their children against deadly diseases WHO is uniting countries across the globe for a week of vaccination campaigns, public education and information sharing under the umbrella of World Immunization Week.

“Worldwide collaboration provides an opportunity to boost momentum and focus on specific actions such as:
– raising awareness on how immunization saves lives;
– increasing vaccination coverage to prevent disease outbreaks;
– reaching underserved and marginalized communities (e.g. those living in remote areas, deprived urban settings, fragile states and strife-torn regions) with existing and newly available vaccines;
– reinforcing the medium- and long-term benefits of immunization (e.g. giving children a chance to grow up healthy, go to school and improve their life prospects).

“Immunization is one of the most successful and cost-effective health interventions. It prevents between 2 and 3 million deaths every year. Immunization prevents debilitating illness, disability and death from vaccine-preventable diseases such as diphtheria, hepatitis A and B, measles, mumps, pneumococcal disease, polio, rotavirus diarrhoea, tetanus and yellow fever. The benefits of immunization are increasingly being extended to adolescents and adults, providing protection against life-threatening diseases such as influenza, meningitis, and cancers (e.g. cervical and liver cancers) that occur in adulthood.

Related links
World Immunization Week 2012

http://www.who.int/mediacentre/events/annual/immunization_week/en/index.html

Cartagena, Colombia, 13 April 2011 (PAHO/WHO) — The Pan American Health Organization/World Health Organization (PAHO/WHO), with support from partner organizations, launched the 10th annual Vaccination Week in the Americas on April 13 in the lead-up to the VI Summit of the Americas, being held this weekend in Cartagena, Colombia.
http://new.paho.org/hq/index.php?option=com_content&task=view&id=6641&Itemid=1926