PLoS One
[Accessed 10 March 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Evaluating Temporal Factors in Combined Interventions of Workforce Shift and School Closure for Mitigating the Spread of Influenza
Tianyou Zhang, Xiuju Fu, Stefan Ma, Gaoxi Xiao, Limsoon Wong, Chee Keong Kwoh, Michael Lees, Gary Kee Khoon Lee, Terence Hung
PLoS ONE: Research Article, published 05 Mar 2012 10.1371/journal.pone.0032203

Abstract 
Background
It is believed that combined interventions may be more effective than individual interventions in mitigating epidemic. However there is a lack of quantitative studies on performance of the combination of individual interventions under different temporal settings.

Methodology/Principal Findings
To better understand the problem, we develop an individual-based simulation model running on top of contact networks based on real-life contact data in Singapore. We model and evaluate the spread of influenza epidemic with intervention strategies of workforce shift and its combination with school closure, and examine the impacts of temporal factors, namely the trigger threshold and the duration of an intervention. By comparing simulation results for intervention scenarios with different temporal factors, we find that combined interventions do not always outperform individual interventions and are more effective only when the duration is longer than 6 weeks or school closure is triggered at the 5% threshold; combined interventions may be more effective if school closure starts first when the duration is less than 4 weeks or workforce shift starts first when the duration is longer than 4 weeks.

Conclusions/Significance
We therefore conclude that identifying the appropriate timing configuration is crucial for achieving optimal or near optimal performance in mitigating the spread of influenza epidemic. The results of this study are useful to policy makers in deliberating and planning individual and combined interventions.

PLoS Medicine
(Accessed 10 March 2012)
http://www.plosmedicine.org/article/browse.action?field=date

Guidance for Evidence-Informed Policies about Health Systems: Rationale for and Challenges of Guidance Development
Xavier Bosch-Capblanch, John N. Lavis, Simon Lewin, Rifat Atun, John-Arne Røttingen, Daniel Dröschel, Lise Beck, Edgardo Abalos, Fadi El-Jardali, Lucy Gilson, Sandy Oliver, Kaspar Wyss, Peter Tugwell, Regina Kulier, Tikki Pang, Andy Haines Policy Forum, published 06 Mar 2012
doi:10.1371/journal.pmed.1001185

Summary Points
– Weak health systems hinder the implementation of effective interventions; policies to strengthen such systems need to draw on the best available evidence.

– Health systems evidence is best delivered in the form of guidance embedded in policy formulation processes, but health systems guidance is poorly developed at present.

– The translation of research on problems, interventions, and implementation into decisions and policies that affect how systems are organised is one challenge facing the development of health systems guidance.

– The development of guidance that is timely and usable by the broad range of health systems stakeholders, and of methods to appraise the quality of health systems guidance, are additional challenges.

– Further research is needed to adapt existing approaches (e.g., those used in clinical guidelines) to produce meaningful advice that accounts for the complexity of health systems, political systems, and contexts.

This is the first paper in a three-part series in PLoS Medicine on health systems guidance.

Public Health Ethics
Volume 4 Issue 3 November 2011
http://phe.oxfordjournals.org/content/current

Original Articles
Public Health and Public Goods
Jonny Anomaly
Public Health Ethics (2011) 4(3): 251-259 doi:10.1093/phe/phr027

Abstract
It has become increasingly difficult to distinguish public health (and public health ethics) from tangentially related fields like social work. I argue that we should reclaim the more traditional conception of public health as the provision of health-related public goods. The public goods account has the advantage of establishing a relatively clear and distinctive mission for public health. It also allows a consensus of people with different comprehensive moral and political commitments to endorse public health measures, even if they disagree about precisely why they are desirable.

Public Health Ethics
Volume 4 Issue 3 November 2011
http://phe.oxfordjournals.org/content/current
Original Articles

Vaccination Policy and Ethical Challenges Posed by Herd Immunity, Suboptimal Uptake and Subgroup Targeting
Jeroen Luyten, Antoon Vandevelde, Pierre Van Damme, and Philippe Beutels
Public Health Ethics (2011) 4(3): 280-291 doi:10.1093/phe/phr032

Abstract
Vaccination policy is an ethically challenging domain of public policy. It is a matter of collective importance that reaches into the most private sphere of citizens and unavoidably conflicts with individual-based ethics. Policy makers need to walk a tight rope in order to complement utilitarian public health values with individual autonomy rights, protection of privacy, non-discrimination and protection of the worst-off. Whether vaccination is voluntary or compulsory, universal or targeted, every option faces complex ethical hurdles because of the interdependence of humans in infectious disease matters. In this article, we explore the following three policy questions. (i) Ethically, which policy measures should be addressed when vaccination coverage is insufficient in a population? Information campaigns, legal compulsion, or the use of financial incentives can all be effective, but also controversial policy options. (ii) Is it ethical to target vaccination programs at certain risk-groups? If such measures are necessary, we argue that policymakers will often have to decide which is more important to uphold: non-discrimination or the protection of privacy. And (iii), what is the ethical significance of adverse herd immunity effects? Some vaccination programs will improve average population health, but will at the same time increase the risk of severe morbidity and mortality for individuals in the worst-off groups of society.

Public Health Ethics
Volume 4 Issue 3 November 2011
http://phe.oxfordjournals.org/content/current

Original Articles
Advance Monopoly Commitment?
Jorn Sonderholm
Public Health Ethics (2011) 4(3): 297-302 doi:10.1093/phe/phr012

Abstract
This article is a critical discussion of the Advance Market Commitment (AMC) proposal for how to incentivize research and development of drugs for neglected diseases. The main claim of the article is that the ‘winner-takes-all’ problem that mars a simple prize proposal for how to incentivize research and development of drugs for neglected diseases also tarnishes the AMC proposal. The conclusion of the article is that the AMC proposal should be rejected as an incentivizing scheme for research and development of drugs for neglected diseases. This conclusion follows from the main claim of the article together with two plausible assumptions that are not argued for in the article.

Science        
9 March 2012 vol 335, issue 6073, pages 1137-1268
http://www.sciencemag.org/current.dtl
News & Analysis

Avian Influenza
Surprising Twist in Debate Over Lab-Made H5N1
Jon Cohen*

For the past several months, the media, the public, scientific groups, and a key U.S. government advisory panel on biosecurity have wrestled with how to deal with two unpublished studies they thought described the creation of a bird flu virus capable of triggering an influenza pandemic with the potential to kill millions of people. Now, a researcher who created one of the H5N1 mutants and a leading U.S. health official are offering clarifications and “new data” to better gauge the risk it presents. The researcher revealed that the virus made in his lab does not kill ferrets infected by the aerosol route. And it is more difficult to transmit the virus than previously described. These revelations promise to influence—although certainly not end—a contentious debate about whether to publish details about this virus and a second, related one that’s less virulent.

Science        
9 March 2012 vol 335, issue 6073, pages 1137-1268
http://www.sciencemag.org/current.dtl

Policy Forum
Public Health
Surveillance of Animal Influenza for Pandemic Preparedness
J. S. M. Peiris, L. L. M. Poon, and Y. Guan
Science 9 March 2012: 1173-1174.
Published online 16 February 2012 [DOI:10.1126/science.1219936]

The 2009 H1N1 pandemic was not as severe as initially feared. This has led to complacency in some quarters that future pandemics will be of comparable impact and as readily dealt with. However, by September 2009, just 5 months after the recognition of the novel pandemic H1N1 virus, almost 50% of children in Hong Kong were already infected (1), which reflects the speed of spread of the virus to and within international travel hubs. In most parts of the world, vaccines were not available in time to substantially affect the first wave of disease. A more virulent virus, such as one comparable to the 1918 H1N1 virus or the H5N1 “bird flu,” spreading with such speed would be a global catastrophe.

If you would like to receive Vaccines: The Week in Review as a weekly email summary, please send your request via email to david.r.curry@centerforvaccineethicsandpolicy.org.

You can also follow us on twitter: @vaxethicspolicy.

The pdf version of Vaccines: The Week in Review  5 March 2012, comprising te posts below for this date, is available here: Vaccines_The Week in Review_5 March 2012

WHO officially removed India “from the list of countries with active transmission of endemic polio, leaving only three countries which have never stopped indigenous wild poliovirus transmission: Afghanistan, Nigeria and Pakistan. India is no longer polio-endemic.” The official announcement was made at the Polio Summit 2012 in New Delhi. A letter written by WHO Director-General Dr Margaret Chan and delivered to the Indian Government on the morning of the Polio Summit confirmed the news. Prime Minister Manmohan Singh confirmed India’s commitment “to continuing to protect its children from possible re-importations of the poliovirus and to strengthening its routine immunization programme.” The Prime Minister noted that India’s success proved the viability of global polio eradication: “This gives us hope that we can finally eradicate polio not only from India but from the face of the entire mother earth.” The announcement was made “amidst thundering applause and a standing ovation by the 1400-plus participants from across the world, and India’s Health Minister, Ghulam Nabi Azad, said: “We have won the battle but the war is not yet over. Let us today rededicate ourselves and resolve that we will continue our efforts with the same vigour, so that India can be declared (certified) polio-free by 2014.”

http://www.polioeradication.org/tabid/461/iid/201/Default.aspx

Meeting Report and Documentation: SAGE extraordinary meeting to review the Global Vaccine Action Plan for the Decade of Vaccines (DoV)
WHO-HQ, 16-17 February 2012

Meeting Report
http://www.who.int/entity/immunization/sage/meetings/2012/february/SAGE_report_Feb2012_en.pdf

Background documents
– Session: Decade of Vaccines
Draft 3 of the Global Vaccine Action Plan
pdf, 1.16Mb
Memorandum
pdf, 181kb

– Session: Polio
Outline_Polio_EAP_16 Feb 2012_SAGE_final.pdf
pdf, 503kb

Presentations
– Session: Decade of Vaccines
Decade of Vaccine Collaboration: Global Vaccine Action Plan – consolidated presentation
pdf, 741kb
Disclaimer: Some of the information contained in this presentation is slightly at odd with version three of the Draft Global Vaccine Action Plan (GVAP) as circulated prior to the SAGE meeting and posted in the set of background documents. This has to do with the fact that the DoV Steering Committee met the day prior to SAGE and modified some of the goals sand indicators captured in the Draft. This presentation is also lacking some of the slides presented at the SAGE meeting and pertaining to Benefits, costs and funding. These slides contained preliminary figures and had to be treated as confidential.

– Session: Polio
Emergency Action Plan: Context & major elements
pdf, 888kb
Lessons from India
pdf, 789kb
Intensification of New Tactics to address Chronic Programme Gaps
pdf, 1.72Mb
Recommendations of Strategy Review Meeting
pdf, 643kb
Brief Orientation from the Polio Working Group on Policy Issues to be brought to SAGE at the April meeting
pdf, 428kb
http://www.who.int/immunization/sage/meetings/2012/february/presentations_background_docs/en/index.html

Speech: Anthony Lake, UNICEF Executive Director at the launch of State of the World’s Children report event

http://www.unicef.org/media/media_61867.html

Research Report: The State of the World’s Children 2012: Children in an Urban World.

UNICEF released its updated State of the World’s Children report, which notes that

“Greater urbanization is inevitable. In a few years…the majority of children will grow up in towns or cities rather than in rural areas. Children born in cities already account for 60 per cent of the increase in urban population.” UNICEF Executive Director Anthony Lake said,”When we think of poverty, the image that traditionally comes to mind is that of a child in a rural village. But today, an increasing number of children living in slums and shantytowns are among the most disadvantaged and vulnerable in the world, deprived of the most basic services and denied the right to thrive. Excluding these children in slums not only robs them of the chance to reach their full potential; it robs their societies of the economic benefits of having a well-educated, healthy urban population.”

IN the report, UNICEF urges governments “to put children at the heart of urban planning and to extend and improve services for all. To start, more focused, accurate data are needed to help identify disparities among children in urban areas and how to bridge them. The shortage of such data is evidence of the neglect of these issues.

While governments at all levels can do more, community-based action is also a key to success. The report calls for greater recognition of community-based efforts to tackle urban poverty and gives examples of effective partnerships with the urban poor, including children and adolescents.”

http://www.unicef.org/media/media_61839.html

UNICEF State of the World’s Children website:

http://www.unicef.org/sowc2012/

Full Report:

http://www.unicef.org/media/files/SOWC_2012-Main_Report_EN_21Dec2011.pdf

Research Report: IOM – Safe and Effective Medicines for Children: Pediatric Studies Conducted Under BPCA and PREA
Released: February 29, 2012
Board on Health Sciences Policy, Board on Children, Youth, and Families

Until 1997, most drugs used to treat children were tested for safety and effectiveness only in adults. It was then that Congress and the FDA created policies – including what are now the Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research Equity Act (PREA) – to encourage more pediatric studies of drugs used for children. The FDA asked the IOM to review aspects of pediatric studies and changes in product labeling that resulted from BPCA and PREA and their predecessor policies, as well as to assess the incentives for pediatric studies of biologics – drugs derived from human or animal sources, or microorganisms – and the extent to which biologics have been studied in children.

The IOM committee concludes that policies included in BPCA and PREA have helped provide clinicians who care for children with better information about the efficacy, safety, and appropriate prescribing of drugs. The IOM suggests that more can be done to increase knowledge about drugs used by children and thereby improve the clinical care, health, and well-being of the nation’s children.

http://www.iom.edu/Reports/2012/Safe-and-Effective-Medicines-for-Children.aspx

Research Report: Sustaining Progress: Creating US Policies to Spur Global Health Innovation – Global Health Technologies Coalition (GHTC)

GHTC released its third annual policy report which documents US leadership in driving the research and development that saves lives around the world. GHTC is housed at PATH and funded by the Bill & Melinda Gates Foundation. It includes almost 40 organizations advocating for research and development of tools to prevent, diagnose, and treat global diseases so health solutions are available when populations need them. The report also highlights recent scientific and policy achievements that have spurred the development of game-changing health products such as vaccines, drugs, and diagnostics. It also offers recommendations for how US policymakers can continue to make the critical investments that will produce the next generation of lifesaving health tools. The report makes recommendations in three areas: public financing, regulatory pathways, and incentives and innovative financing. http://www.ghtcoalition.org/policy-report/2012/index.php

IFPMA Code of Practice 2012

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) announced an expansion of its Code of Practice “to govern how companies interact with healthcare professionals, medical institutions and patient organizations.” IFPMA requires all member companies and member associations around the world to adopt and implement this new Code.” IFPMA noted that the new code of practice extends “coverage to all interactions with healthcare professionals, medical institutions, and patient organizations, and provides an effective framework for ethical business practices.”

Sabin Vaccine Institute executive vice president Ciro de Quadros, M.D., M.P.H., was awarded the BBVA Frontiers of Knowledge Award in Development Cooperation. Dr. de Quadros was honored for “leading the efforts to eliminate polio and measles from the western hemisphere and being one of the most important scientists in the eradication of smallpox around the world. These accomplishments, particularly the eradication of one of the most deadly enemies of mankind, represent one of the prime achievements of medicine.” The BBVA Foundation Frontiers of Knowledge Awards “recognize the role of science and cultural creation as levers of society’s progress and wellbeing. Their eight categories span the main scientific, technological, social and economic areas and challenges of our times.”

The prize jury noted that “De Quadros, furthermore, has championed a new supply model whereby a number of countries establish joint purchasing centers in order to acquire vaccines more cheaply…His programs have shown that introducing existing vaccines can be done in an economically sustainable way that promotes country ownership, particularly in low and middle income countries. This has facilitated an unprecedented effort against vaccine preventable diseases such as rubella, pertussis, rotavirus, pneumococcus and human papilloma virus, especially in high disease burden areas and underprivileged communities in Asia, Africa and the Americas.”

Dr. De Quadros commented, “I have no doubt that the 21st century will be known as the century of vaccines. Today we have a number of vaccines against chronic or degenerative diseases, and many more are being developed. We already have vaccines that help prevent liver and cervical cancer. Vaccines research is also underway to prevent diseases of extreme poverty. A century of vaccines could be extraordinary as long as we ensure that available vaccines reach everyone in the world who needs them.”

http://www.sabin.org/news-resources/in-news/2012/02/28/de-quadros-wins-bbva-foundation-frontiers-knowledge-award-developm

The National Institutes of Health (NIH) Clinical Center named Christine Grady, Ph.D. as chief of the Department of Bioethics. Dr. Grady has served as deputy director of the department since 1996 and served as acting chief since September 2011. Her research focuses on clinical research subject recruitment, incentives, vulnerability, consents, and international research ethics. Clinical Center Director John I. Gallin, M.D. commented, “Dr. Grady has had a strong international voice in human subjects protections, and under her leadership, the Department of Bioethics will continue its important, world-class work.” Grady is currently a member of President Obama’s Commission for the Study of Bioethical Issues and is a senior research fellow at the Kennedy Institute of Ethics. She is a fellow of both the American Academy of Nursing and the Hastings Center.

http://www.nih.gov/news/health/mar2012/cc-02.htm

PATH named David C. Kaslow, MD as director of the PATH Malaria Vaccine Initiative (MVI), which “drives the development of safe and effective vaccines for the fight against malaria.” PATH said Dr. Kaslow is a physician-scientist with more than 25 years of vaccine research and development experience, as well as a longstanding interest in the malaria parasite due to both its unique biology and its profound impact on global health. He has held key advisory positions with MVI and the Bill & Melinda Gates Foundation related to malaria vaccines, including—since 2008—serving as chair of MVI’s Vaccine Science Portfolio Advisory Council, the primary external advisory body for MVI. Dr. Kaslow is joining PATH from his position as vice president and head of Vaccines Project Leadership and Management at Merck Research Laboratories (MRL), where his responsibilities have included oversight of project leadership and management of Merck’s vaccine pipeline. http://www.path.org/news/pr120301-mvi-director.php

PATH and WHO announced the appointment of Dr. Marie-Pierre Préziosi as the new director of the PATH/WHO Meningitis Vaccine Project (MVP). Dr. Préziosi has been a member of the MVP team since 2003 and was most recently served director of Clinical Development for MVP, as part of her role as medical officer at WHO. Dr. Jean-Marie Okwo-Bele, director of WHO’s Immunization, Vaccines, and Biologicals department, commented, “We are very pleased that Marie-Pierre has been chosen to lead the MVP. Her wealth of experience, technical know-how, and dedication will be an asset as she takes on this important role. We are excited to work with Marie-Pierre to strengthen our partnership and continue rolling out MenAfriVac in all 25 countries in Africa’s meningitis belt.” Dr. Préziosi assumes this role from Dr. F. Marc LaForce, who announced last December that he was retiring after more than ten years with MVP. Under LaForce’s directorship, MVP successfully developed MenAfriVac™—a group A meningococcal meningitis conjugate vaccine specifically designed to eliminate the devastating meningitis epidemics that have been plaguing sub-Saharan Africa for more than a century. Around 55 million people aged 1 to 29 years have been vaccinated with MenAfriVac™ since the vaccine was introduced on the continent in December 2010.

http://www.path.org/news/pr1200301-mvp-director.php

The FDA said it approved first quadrivalent vaccine to prevent seasonal influenza – FluMist Quadrivalent – a vaccine to prevent seasonal influenza in people ages 2 years through 49 years, and the first influenza vaccine to contain four strains of the influenza virus, two influenza A strains and two influenza B strains. Karen Midthun, M.D., director of the FDA’s Center for Biologics Evaluation and Research, said, “Illness caused by Influenza B virus affects children, particularly young and school-aged, more than any other population. A vaccine containing the four virus strains most likely to spread and cause illness during the influenza season offers an additional option to aid in influenza prevention efforts.”

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm294057.htm

The Gates Foundation announced Round 9 of its Grand Challenges Explorations initiative, described s a US$100 million grant initiative encouraging innovation in global health and development research. Proposals are being accepted through May 15, 2012 around “a new kind of topic this round, which challenges people to find new ways to tell the story of development aid and the powerful impact it can have around the world.”

Topics for Grand Challenges Explorations Round 9:

– Aid is Working. Tell the World (new!) – in partnership with Cannes Lions

– New Approaches for the Interrogation of Anti-malarial Compounds (new!)

– Protect Crop Plants From Biotic Stresses From Field to Market

– Design New Approaches to Optimize Immunization Systems

– Explore New Solutions for Global Health Priority Areas

http://www.gatesfoundation.org/press-releases/Pages/gce-round-9.aspx

WHO released new tables presenting recommendations for current routine immunization as well as interrupted and delayed vaccination. The announcement noted:

Every immunization programme in the world has a national vaccination schedule that specifies the age at which antigens are to be given. But as we well know, in real life things rarely go according to plan!

Inevitably, children and individuals come late for their vaccinations or for whatever reason, are unable to stick to the usual schedule. These irregular situations can be challenging to health workers who may not know what to do. If a child starts a vaccination series late, how many doses should be given? If a vaccination series is interrupted, does it need to be restarted or can it simply be resumed without repeating the last dose?

The Global Immunization Vision & Strategy 2006-2015 aims to protect more people by expanding beyond the traditional immunization target group. This includes those who may be “off schedule”. Regardless of when children and individuals come in contact with immunization services, it is important that their immunization status be checked and that they are provided with the vaccines they need or have missed.

To help guide national programmes, WHO has consolidated its recommendations for interrupted and delayed vaccination into one summary table:

http://www.who.int/immunization/newsroom/newsstory_recommendations_interrupted_delayed/en/index.html

In order to assist programme managers develop optimal immunization schedules WHO has compiled key information on its current routine immunization recommendations into three summary tables.

Table 1
– pdf, 195kb

Table 2
– pdf, 151kb

Table 3
– pdf, 204kb

Table 1 – en français
– pdf, 206kb

Table 2 – en français
– pdf, 187kb

– A User’s Guide to the Summary Tables
pdf, 998kb

Table 1 summarizes recommended routine immunizations for all age groups – children, adolescents, and adults. As such, it provides an overview of vaccine recommendations across the lifespan, including both primary series and booster doses.

Table 2 provides detailed information for routine immunizations for children, including age at first dose and intervals. It reiterates recommendations on the primary series and booster doses.

In Table 3, WHO has consolidated its recommendations for interrupted and delayed vaccination. These irregular situations can be challenging to health workers who may not know what to do.

It is important to note that these recommendations are only a compilation of existing WHO routine immunization recommendations in a new format. All the recommendations come from WHO Position Papers that are published in the Weekly Epidemiological Record. The tables are updated as soon as any new WHO recommendation is published.

The tables are designed for use by national immunization managers and key decision-makers, chairs and members of national advisory committees on immunization, and partner organizations, including industry.

The tables are not intended for direct use by health workers. Rather their purpose is to aid technical decisions with respect to the national vaccination schedule.

By consolidating its many recommendations into summary tables, WHO hopes to provide easy access to its policy advice and support national immunization programmes to critically examine, and possibly modify, their schedules.

It is hoped that the tables will prove useful in highlighting disparities among countries and in bringing awareness to recommendations that do not get followed. Several countries are appropriately providing additional vaccine antigens, but they lag behind in providing the adequate number of doses or booster doses for traditional vaccines and give little consideration to older age groups. These tables can serve as a driving force and reference tool to help review and improve schedules in keeping with the Global Immunization Vision and Strategy (GIVS), which promotes immunizing more persons across wider age groups.

WHO would like to receive feedback on the content and format of these tables.

http://www.who.int/immunization/policy/immunization_tables/en/index.html

The Weekly Epidemiological Record (WER) for 2 March 2012, vol. 87, 9 (pp 73–80) includes: Measles virus nomenclature update: 2012

http://www.who.int/entity/wer/2012/wer8709.pdf

Twitter Watch  [accessed 4 March 2012 18:05]
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.

Partners In Health ‏ @PIH
We have a plan to vaccinate 50,000 Haitians at risk of cholera infection. We need your support to scale up: ow.ly/9qlqX
2:00 PM – 3 Mar 12

GAVI Alliance ‏ @GAVIAlliance
Zambia launches multifaceted attack to combat #rotavirus and other causes of diarrhea. ht.ly/9kxBb
12:52 PM – 3 Mar 12

CDCgov ‏ @CDCgov
Children 11-18 without insurance coverage for the HPV vaccine may qualify for Vaccines for Children program. go.usa.gov/U6P
11:47 AM – 2 Mar 12

UNDP Policy Centre ‏ @UNDP_IPC
From @policypress: Ground-breaking International Study Reveals Extent of Global Child #Poverty – bit.ly/yVQJDM @UNICEFUS
3:35 PM – 1 Mar 12

Sabin Vaccine Inst. ‏ @sabinvaccine
“The 20th century was the century of antibiotics and chemotherapy. The 21st century will be the century of vaccines.” -de Quadros
1:15 PM – 1 Mar 12

Orin Levine ‏ @OrinLevine
In 2011 @UNICEF procured $955 million of #vaccines & 2.47 billion in 2,105 shipments. Wow! pic.twitter.com/JcJxD2Ag
Retweeted by GAVI Alliance
Hide photo
5:36 PM – 23 Feb 12

Brown University ‏ @BrownUniversity
Brown creates center for evidence-based medicine news.brown.edu/pressreleases/…
Retweeted by Amanda Glassman
2:51 PM – 2 Mar 12

PAHO/WHO ‏ @pahowho
Meeting of the Pan American Forum for Action on Noncommunicable Diseases – bit.ly/y0VAZQ
3:19 PM – 29 Feb 12

Seth Berkley ‏ @GAVISeth
Wonderful work taking place in Chad to immunise children against #measles a terrible disease: ht.ly/9m76U #vaccines #globalhealth
3:11 PM – 29 Feb 12

GAVI Alliance ‏ @GAVIAlliance
Track rollouts of #rotavirus #vaccine! Poorest countries will receive vax @ the same time as industrialised countries. ht.ly/9jfBL
4:34 AM – 29 Feb 12

CDCgov ‏ @CDCgov
Girls AND boys need 3 doses of HPV vaccine at 11 or 12 years old to protect them in the future. go.usa.gov/UVn
3:24 PM – 28 Feb 12

United Nations Photo ‏ @UN_Photo
Secretary-General Administers Polio Vaccine in Angola bit.ly/zObMkc #UN
5:33 PM – 27 Feb 12

AMA ‏ @AmerMedicalAssn
RT @amednews: Should flu vaccine be mandated for health care workers? bit.ly/AkYSQb
5:13 PM – 27 Feb 12

Forbes ‏ @Forbes
Should Doctors Fire Their Anti-Vaccine Patients? bit.ly/wU30Sl
11:36 AM – 26 Feb 12

Health Economics, Policy and Law 
Volume 7 – Issue 02 – April 2012
http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue

Empirically evaluating the impact of adjudicative tribunals in the health sector: context, challenges and opportunities
Steven J. Hoffman and Lorne Sossin
Health Economics, Policy and Law / Volume 7 / Issue 02, pp 147 – 174
Copyright © Cambridge University Press 2011
Published online: 26 August 2011
DOI:10.1017/S1744133111000156

Abstract
Adjudicative tribunals are an integral part of health system governance, yet their real-world impact remains largely unknown. Most assessments focus on internal accountability and use anecdotal methodologies; few, studies if any, empirically evaluate their external impact and use these data to test effectiveness, track performance, inform service improvements and ultimately strengthen health systems. Given that such assessments would yield important benefits and have been conducted successfully in similar settings (e.g. specialist courts), their absence is likely attributable to complexity in the health system, methodological difficulties and the legal environment within which tribunals operate. We suggest practical steps for potential evaluators to conduct empirical impact evaluations along with an evaluation matrix template featuring possible target outcomes and corresponding surrogate endpoints, performance indicators and empirical methodologies. Several system-level strategies for supporting such assessments have also been suggested for academics, health system institutions, health planners and research funders. Action is necessary to ensure that policymakers do not continue operating without evidence but can rather pursue data-driven strategies that are more likely to achieve their health system goals in a cost-effective way.

Health Economics, Policy and Law 
Volume 7 – Issue 02 – April 2012
http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue

Healthcare policy tools as determinants of health-system efficiency: evidence from the OECD
Dominika Wranik
Health Economics, Policy and Law / Volume 7 / Issue 02, pp 197 – 226
Copyright © Cambridge University Press 2011
Published online: 12 December 2011
DOI:10.1017/S1744133111000211

Abstract
This paper assesses which policy-relevant characteristics of a healthcare system contribute to health-system efficiency. Health-system efficiency is measured using the stochastic frontier approach. Characteristics of the health system are included as determinants of efficiency. Data from 21 OECD countries from 1970 to 2008 are analysed. Results indicate that broader health-system structures, such as Beveridgian or Bismarckian financing arrangements or gatekeeping, are not significant determinants of efficiency. Significant contributors to efficiency are policy instruments that directly target patient behaviours, such as insurance coverage and cost sharing, and those that directly target physician behaviours, such as physician payment methods. From the perspective of the policymaker, changes in cost-sharing arrangements or physician remuneration are politically easier to implement than changes to the foundational financing structure of the system.

Health Policy and Planning
Volume 27 Issue 2 March 2012
http://heapol.oxfordjournals.org/content/current

Review
Sheila Leatherman, Marcia Metcalfe, Kimberley Geissler, and Christopher Dunford
Editor’s Choice: Integrating microfinance and health strategies: examining the evidence to inform policy and practice
Health Policy Plan. (2012) 27(2): 85-101 doi:10.1093/heapol/czr014

Abstract
Introduction Single solutions continue to be inadequate in confronting the prevalent problems of poverty, ill health and insufficient health system capacity worldwide. The poor need access to an integrated set of financial and health services to have income security and better health.

Over 3500 microfinance institutions (MFIs) provide microcredit and financial services to more than 155 million households worldwide. Conservative estimates indicate that at least 34 million of these households are very poor by the definition in the Millennium Development Goals, representing around 170 million people, many in remote areas beyond the reach of health agencies, both private and governmental. A small but increasing number of MFIs offer health-related services, such as education, clinical care, community health workers, health-financing and linkages to public and private health providers.

Review of evidence Multiple studies indicate the effectiveness of microfinance and its impact on poverty. A small but growing number of studies also attempt to show that MFIs are capable of contributing to health improvement by increasing knowledge that leads to behavioural changes, and by enhancing access to health services through addressing financial, geographic and other barriers. While these studies are of uneven quality, they indicate positive health benefits in diverse areas such as maternal and child health, malaria and other infectious disease, and domestic violence. While more rigorous research is needed to inform policy and guide programme implementation to integrate microfinance and health interventions that can reliably enhance the well-being of the poor, there is useful evidence to support the design and delivery of integrated programmes now.

Conclusion Worldwide, current public health programmes and health systems are proving to be inadequate to meet population needs. The microfinance sector offers an underutilized opportunity for delivery of health-related services to many hard-to-reach populations.

The Lancet  
Mar 03, 2012  Volume 379  Number 9818  p777 – 866
http://www.thelancet.com/journals/lancet/issue/current

Comment
Offline: Is CDC a science-based organisation?
Richard Horton
Preview
When we published our first report describing discontent about the work of the Center for Global Health (CGH) at the US Centers for Disease Control and Prevention, CDC immediately contacted us to ask for an opportunity to reply. We agreed and await their response. Meanwhile, two further letters have arrived. They again signal severe concerns about the way in which CDC organises its global health work. Both correspondents are well informed about the details of the CDC’s work in global health. Their allegations are serious.

Editor’s Note 1:
The “first report” referenced above is not cited but appears to be a section of an Offline column by the same author published in the 11 February 2012 here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960201-3/fulltext

We present it here for convenience:
“…Anonymous letters sometimes get submitted to editors. Here is one, a single page, neatly typed and addressed personally, but with no signature. I don’t know whether the critical statements made about the centre under scrutiny are true. But the questions being asked are interesting and worthy of answers. Here is a short sample of its contents. “Two years ago a new global health center was created at the [US] Centers for Disease Control and Prevention (CDC) with a lot of hope and promises. This new center was going to anchor the CDC commitment to global health. Unfortunately as 2012 begins it is unclear whether this new center will have the intended effect on global health, and it increasingly looks like a major missed opportunity…it is not too late to change the direction of this new and important global health center. An objective evaluation is urgently required to establish where to go from here with a clear strategic direction and key strategic priorities.” We would like to hear from the CDC about its Center for Global Health Leadership. What are its achievements? What is its strategy? What are its immediate priorities?…”

Editor’s Note 2 (8 March 2012):
The Lancet’s twitter feed included this reference to a letter by the CDC in response to the above published online at The Lancet on 7 March 2012 [see link]

TheLancet
Recently established @CDCGlobal plans to build on @CDCgov 60-year history of evidence-based global health programmes http://t.co/5zpArW5M

The Lancet  
Mar 03, 2012  Volume 379  Number 9818  p777 – 866
http://www.thelancet.com/journals/lancet/issue/current

Review
Early appraisal of China’s huge and complex health-care reforms
Winnie Chi-Man Yip, William C Hsiao, Wen Chen, Shanlian Hu, Jin Ma, Alan Maynard

Preview
China’s 3 year, CN¥850 billion (US$125 billion) reform plan, launched in 2009, marked the first phase towards achieving comprehensive universal health coverage by 2020. The government’s undertaking of systemic reform and its affirmation of its role in financing health care together with priorities for prevention, primary care, and redistribution of finance and human resources to poor regions are positive developments. Accomplishing nearly universal insurance coverage in such a short time is commendable.

Urbanisation and health in China
Peng Gong, Song Liang, Elizabeth J Carlton, Qingwu Jiang, Jianyong Wu, Lei Wang, Justin V Remais

Summary
China has seen the largest human migration in history, and the country’s rapid urbanisation has important consequences for public health. A provincial analysis of its urbanisation trends shows shifting and accelerating rural-to-urban migration across the country and accompanying rapid increases in city size and population. The growing disease burden in urban areas attributable to nutrition and lifestyle choices is a major public health challenge, as are troubling disparities in health-care access, vaccination coverage, and accidents and injuries in China’s rural-to-urban migrant population. Urban environmental quality, including air and water pollution, contributes to disease both in urban and in rural areas, and traffic-related accidents pose a major public health threat as the country becomes increasingly motorised. To address the health challenges and maximise the benefits that accompany this rapid urbanisation, innovative health policies focused on the needs of migrants and research that could close knowledge gaps on urban population exposures are needed.

Pediatrics
March 2012, VOLUME 129 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml

From the American Academy of Pediatrics
Policy Statement
HPV Vaccine Recommendations
COMMITTEE ON INFECTIOUS DISEASES

Abstract
On October 25, 2011, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention recommended that the quadrivalent human papillomavirus vaccine (Gardasil; Merck & Co, Inc, Whitehouse Station, NJ) be used routinely in males. The American Academy of Pediatrics has reviewed updated data provided by the Advisory Committee on Immunization Practices on vaccine efficacy, safety, and cost-effectiveness as well as programmatic considerations and supports this recommendation. This revised statement updates recommendations for human papillomavirus immunization of both males and females.

PLoS One
[Accessed 5 March 2012]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Systematic Review of Economic Evaluations of Preparedness Strategies and Interventions against Influenza Pandemics
Román Pérez Velasco, Naiyana Praditsitthikorn, Kamonthip Wichmann, Adun Mohara, Surachai Kotirum, Sripen Tantivess, Constanza Vallenas, Hande Harmanci, Yot Teerawattananon
PLoS ONE: Research Article, published 29 Feb 2012 10.1371/journal.pone.0030333

Abstract 
Background
Although public health guidelines have implications for resource allocation, these issues were not explicitly considered in previous WHO pandemic preparedness and response guidance. In order to ensure a thorough and informed revision of this guidance following the H1N1 2009 pandemic, a systematic review of published and unpublished economic evaluations of preparedness strategies and interventions against influenza pandemics was conducted.

Methods
The search was performed in September 2011 using 10 electronic databases, 2 internet search engines, reference list screening, cited reference searching, and direct communication with relevant authors. Full and partial economic evaluations considering both costs and outcomes were included. Conversely, reviews, editorials, and studies on economic impact or complications were excluded. Studies were selected by 2 independent reviewers.

Results
44 studies were included. Although most complied with the cost effectiveness guidelines, the quality of evidence was limited. However, the data sources used were of higher quality in economic evaluations conducted after the 2009 H1N1 pandemic. Vaccination and drug regimens were varied. Pharmaceutical plus non-pharmaceutical interventions are relatively cost effective in comparison to vaccines and/or antivirals alone. Pharmaceutical interventions vary from cost saving to high cost effectiveness ratios. According to ceiling thresholds (Gross National Income per capita), the reduction of non-essential contacts and the use of pharmaceutical prophylaxis plus the closure of schools are amongst the cost effective strategies for all countries. However, quarantine for household contacts is not cost effective even for low and middle income countries.

Conclusion
The available evidence is generally inconclusive regarding the cost effectiveness of preparedness strategies and interventions against influenza pandemics. Studies on their effectiveness and cost effectiveness should be readily implemented in forthcoming events that also involve the developing world. Guidelines for assessing the impact of disease and interventions should be drawn up to facilitate these studies.

Science        
2 March 2012 vol 335, issue 6072, pages 1009-1136
http://www.sciencemag.org/current.dtl

Policy Forum
Public Health and Biosecurity
The Limits of Government Regulation of Science
John D. Kraemer and Lawrence O. Gostin
Science 2 March 2012: 1047-1049.
Published online 19 January 2012 [DOI:10.1126/science.1219215]

A transparent institutional review process will balance scientific freedom and national security better than publication restrictions.

Vaccine
Volume 30, Issue 13 pp. 2237-2396 (16 March 2012)
http://www.sciencedirect.com/science/journal/0264410X

Conference Report
Report of the Second European Expert Meeting on Rotavirus Vaccination
Pages 2237-2244
Carlo Giaquinto, Amy E.M. Jackson, Timo Vesikari
[No abstract]

Vaccine
Volume 30, Issue 13 pp. 2237-2396 (16 March 2012)
http://www.sciencedirect.com/science/journal/0264410X

Brief Reports
Survey of national immunization programs and vaccine coverage rates in Asia Pacific countries
Pages 2250-2255
Chun-Yi Lu, APECI members, Mathuram Santosham

Abstract
Children in the Asia Pacific region are still suffering from certain vaccine-preventable diseases. The current study surveyed the national immunization programs and vaccine uptake of traditional and newly developed vaccines in 12 countries in this area. The results showed children in most countries were well protected from conventional vaccine-preventable diseases, while immunization programs for certain diseases such as poliovirus or measles should be strengthened in certain countries. Protection against pneumococcus, rotavirus, and human papillomavirus infections were obviously inadequate in most of the countries in the region. Promoting coverage of newly developed vaccines will benefit a great number of children in this area.

Vaccine
Volume 30, Issue 13 pp. 2237-2396 (16 March 2012)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Willingness to receive pandemic influenza A (H1N1) vaccine among doctors and nurses in public health facilities in Ibadan, Nigeria

Original Research Article
Pages 2315-2319
Akinola Ayoola Fatiregun, Adeola Aisha Adeyemo, Samuel Anu Olowookere

Abstract
Background
As part of global efforts to contain the spread of the 2009 pandemic influenza A (H1N1), the Federal Ministry of Health of Nigeria is embarking on the vaccination of health care workers employed in health facilities nationwide. This study was designed to assess the willingness of doctors and nurses working in public health facilities in Ibadan, Nigeria to receive the influenza A (H1N1) vaccine.

Methods
A descriptive cross-sectional study design was employed. Stratified simple random sampling was used to select a total of 304 doctors and nurses who worked at the public primary (70), secondary (51) and tertiary (183) levels of health care facilities in Ibadan. A self-administered, structured questionnaire that contained items on socio-demographics, sources of information, knowledge about the infection and the vaccine, risk perception, willingness to receive the vaccine and suggestions to improve vaccination acceptance by health-care workers was used to collect the data.

Main findings
A total of 255 providers responded for an overall response rate of 84%. The mean age of the respondents was 35.0 ± 9.7 years. A high proportion (88.2%) of the participants, including 94.9% of the doctors and 87.0% of the nurses, reported a willingness to receive the vaccine. Perceptions regarding the risk of contracting influenza, the availability of effective vaccinations for prevention and beliefs that the disease is fatal were reasons given by respondents who reported willingness to receive the vaccination. Those participants who reported ever hearing about the pandemic (AOR 2.0, 95% CI 1.2–3.2) and those who had a high-risk perception of contracting the disease (AOR 2.0, 95% CI 1.2–3.7) were likely to receive the vaccine.

Conclusion
Doctors and nurses at the three levels of health care facilities in Ibadan were willing to receive the pandemic influenza A (H1N1) vaccine. Efforts should be made to deliver the vaccines via adequate planning.

Vaccine
Volume 30, Issue 13 pp. 2237-2396 (16 March 2012)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Multilevel correlates for human papillomavirus vaccination of adolescent girls attending safety net clinics
Original Research Article
Pages 2368-2375
Jasmin A. Tiro, Sandi L. Pruitt, Corinne M. Bruce, Donna Persaud, May Lau, Sally W. Vernon, Jay Morrow, Celette Sugg Skinner

Abstract
Background
Adolescent HPV vaccination in minority and low income populations with high cervical cancer incidence and mortality could reduce disparities. Safety-net primary care clinics are a key delivery site for improving vaccination rates in these populations.

Purpose
To examine prevalence of HPV initiation (≥1 dose), completion (receipt of dose 3 within 12 months of initiation), and receipt of 3 doses in four safety-net clinics as well as individual-, household-, and clinic-level correlates of initiation.

Methods
We used multilevel modeling to investigate HPV initiation among 700 adolescent females who sought primary care in four safety-net clinics in Dallas, Texas from March 2007 to December 2009. Data were abstracted from patients’ paper and electronic medical records.

Results
HPV vaccine uptake varied significantly by clinic. Across clinics, initiation was 36.6% and completion was 39.7% among those who initiated. In the total study population, only 15.7% received all three doses. In multivariate, two-level logistic regression analyses, initiation was associated with receipt of other adolescent vaccines, influenza vaccination in the year prior to data abstraction, being sexually active, and having more chart documentation (presence of health maintenance questionnaire and/or immunization record). There was no association between initiation and age, race/ethnicity, or insurance status.

Conclusions
In four urban safety-net clinics, HPV initiation rates paralleled 2008 national rates. The correlation of HPV initiation with other adolescent vaccines underscores the importance of reviewing vaccination status at every health care visit. HPV vaccine uptake in safety-net clinics should continue to be monitored to understand impact on cervical cancer disparities.

The pdf version of Vaccines: The Week in Review  27 February 2012, comprising the posts for this date below, is available here: Vaccines_The Week in Review_27 February 2012

UNICEF reported that the Central African Republic (CAR) launched a national immunization campaign to eradicate polio “aimed at reaching all children in the country, including hard-to-reach populations living in conflict and post-conflict zones with limited access to health services…in urgent response to four imported cases of polio discovered in CAR in 2011, the first in two years.” Mary Louise Eagleton Meaney, Deputy Representative for UNICEF, CAR, said “Routine data shows that only 68 per cent of children in CAR under five years of age are completely vaccinated against polio, which means that 260,000 children under five are at risk of contracting the virus.” UNICEF noted that health workers “will be going door-to-door to deliver polio vaccines starting February 24th to 806,825 children between the ages of 0-59 months; to administer vitamin A supplements to 725,102 children between 6-59 months; and to provide deworming for 643,595 children between 12-59 months of age.” http://www.unicef.org/media/media_61805.html

Interview: Voice of America interviews Dagfinn Høybråten

GAVI Board Chair Dagfinn Høybråten talks to the official United States government broadcaster about the role of vaccines in achieving MDGs 4 and 5

Source: Health Alliance/2011

In an interview with Voice of America, GAVI Alliance Board Chairman Dagfinn Høybråten discusses a wide range of issues with VoA correspondent Linord Moudou. He traces GAVI’s history and explains that vaccines have created a moral imperative to act in order to save lives….Høybråten adds that without achieving high levels of vaccination, it will be impossible to reach Millennium Development Goals 4 and 5 to reduce child mortality and improve maternal health. By responding to country demand and prioritising uptake of new and underused vaccines, GAVI support has helped countries to avert more than five and a half million future deaths.

http://www.gavialliance.org/library/news/gavi-features/2012/hoybraten-voice-of-america/

The MMWR weekly for February 24, 2012 / Vol. 61 / No. 7 includes:
– Influenza Vaccination Coverage Among Pregnant Women — 29 States and New York City, 2009–10 Season

– Update: Influenza Activity — United States, October 2, 2011–February 11, 2012

– Announcement: Release of Online U.S. and State Trend Data for Health-Related Quality of Life

The Weekly Epidemiological Record (WER) for 24 February 2012, vol. 87, 7 (pp 65–72) includes WHO Quantitative Immunization and Vaccine-Related Research meeting, October 2011 – summary; Dengue and severe dengue factsheet (Revised in January 2012)

http://www.who.int/entity/wer/2012/wer8708.pdf

Twitter Watch  [accessed 26 February 17:35]
Items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and is by no means intended to be exhaustive.

GAVI Alliance ‏ @GAVIAlliance
Helen Evans – GAVI Deputy CEO – shares her insights into #GAVI‘s challenges and opportunities. ht.ly/9dSKY
7:01 AM – 25 Feb 12 via web · Details

EndPolioNow ‏ @EndPolioNow
At Polio Summit, India just announces that WHO has removed India from the polio endemic list #polio
1:15 AM – 25 Feb 12

IHME at UW ‏ @IHME_UW
Track #polio vaccination activities using Polio Campaign Monitoring Reports: bit.ly/w1iMey #GHDxData #globalhealth
1:05 PM – 24 Feb 12

WHO ‏ @WHO
If we eradicate polio, we’ll save US$40-50b in the next 20yrs. We can use these $ to fight other diseases bit.ly/ycRnFG #poliochat
12:08 PM – 24 Feb 12

HarvardPublicHealth ‏ @HarvardHSPH
Today in #publichealth history: Children receive the first polio vaccine in 1954 ht.ly/9fFuq #TodayinHistory

EndPolioNow ‏ @EndPolioNow
View a NEW infographic of the progress and current state of polio eradication. twitpic.com/8npwrg
1:46 PM – 23 Feb 12

Dagfinn Høybråten ‏ @Hoybraten
Great opportunity to speak about the power of #vaccines to save lives at Voice of America: ht.ly/9c3vl
Retweeted by GAVI Alliance
9:26 AM – 21 Feb 12

PAHO/WHO ‏ @pahowho
#PAHO Funds Training in Epidemiology for Health Officials in the Region – bit.ly/zzFPYE
7:55 PM – 22 Feb 12

Sabin Vaccine Inst. ‏ @sabinvaccine
Today on the blog: an update on sustainable immunization financing activities in Cambodia bit.ly/xQcWcO
3:42 PM – 22 Feb 12

GAVI Alliance ‏ @GAVIAlliance
 Nearly 70% of all vax consumed come from India; great potential 2 sustain growth momentum –RajeevDhere,SerumInstitute ht.ly/9bQqK
8:20 AM – 22 Feb 12

Measles Initiative ‏ @MeaslesInit
Why do measles outbreaks occur in middle- and higher-income communities? wp.me/p1UXPA-38
Retweeted by ECDC Eurovaccine
5:41 AM – 17 Feb 12

ECDC Eurovaccine ‏ @Eurovaccine
Latest ECDC #measles monitoring provides 2011 analyses of surveillance data; 2011 cases is 4-fold increase from 2009. bit.ly/xkePx5
10:47 AM – 21 Feb 12

GAVI Alliance ‏ @GAVIAlliance
GAVI Board Chair, @Hoybraten talks about the role of vaccines in achieving MDGs 4 and 5: ht.ly/9c3vl
8:28 AM – 21 Feb 12

Health Policy and Planning
Volume 27 Issue 1 January 2012
http://heapol.oxfordjournals.org/content/current
Advanced access  February 13, 2012

Original Paper:
Marko Vujicic, Stephanie E Weber, Irina A Nikolic, Rifat Atun, and Ranjana Kumar
An analysis of GAVI, the Global Fund and World Bank support for human resources for health in developing countries
Health Policy Plan. first published online February 13, 2012 doi:10.1093/heapol/czs012 (9 pages)

Abstract
Shortages, geographic imbalances and poor performance of health workers pose major challenges for improving health service delivery in developing countries. In response, multilateral agencies have increasingly recognized the need to invest in human resources for health (HRH) to assist countries in achieving their health system goals. In this paper we analyse the HRH-related activities of three agencies: the Global Alliance for Vaccines and Immunisation (GAVI); the Global Fund for Aids, Tuberculosis, and Malaria (the Global Fund); and the World Bank. First, we reviewed the type of HRH-related activities that are eligible for financing within each agency. Second, we reviewed the HRH-related activities that each agency is actually financing. Third, we reviewed the literature to understand the impact that GAVI, Global Fund and World Bank investments in HRH have had on the health workforce in developing countries. Our analysis found that by far the most common activity supported across all agencies is short-term, in-service training. There is relatively little investment in expanding pre-service training capacity, despite large health worker shortages in developing countries. We also found that the majority of GAVI and the Global Fund grants finance health worker remuneration, largely through supplemental allowances, with little information available on how payment rates are determined, how the potential negative consequences are mitigated, and how payments are to be sustained at the end of the grant period. Based on the analysis, we argue there is an opportunity for improved co-ordination between the three agencies at the country level in supporting HRH-related activities. Existing initiatives, such as the International Health Partnership and the Health Systems Funding Platform, could present viable and timely vehicles for the three agencies to implement this improved co-ordination.

JAMA   
February 22/29, 2012, Vol 307, No. 8, pp 749-874
http://jama.ama-assn.org/current.dtl

Original Contributions
Cost-effectiveness of Adult Vaccination Strategies Using Pneumococcal Conjugate Vaccine Compared With Pneumococcal Polysaccharide Vaccine
Kenneth J. Smith, Angela R. Wateska, Mary Patricia Nowalk, Mahlon Raymund, J. Pekka Nuorti, Richard K. Zimmerman
JAMA. 2012;307(8):804-812.doi:10.1001/jama.2012.169

Abstract
Context  The cost-effectiveness of 13-valent pneumococcal conjugate vaccine (PCV13) compared with 23-valent pneumococcal polysaccharide vaccine (PPSV23) among US adults is unclear.

Objective  To estimate the cost-effectiveness of PCV13 vaccination strategies in adults.

Design, Setting, and Participants A Markov state-transition model, lifetime time horizon, societal perspective. Simulations were performed in hypothetical cohorts of US 50-year-olds. Vaccination strategies and effectiveness estimates were developed by a Delphi expert panel; indirect (herd immunity) effects resulting from childhood PCV13 vaccination were extrapolated based on observed PCV7 effects. Data sources for model parameters included Centers for Disease Control and Prevention Active Bacterial Core surveillance, National Hospital Discharge Survey and Nationwide Inpatient Sample data, and the National Health Interview Survey.

Main Outcome  Measures Pneumococcal disease cases prevented and incremental costs per quality-adjusted life-year (QALY) gained.

Results In the base case scenario, administration of PCV13 as a substitute for PPSV23 in current recommendations (ie, vaccination at age 65 years and at younger ages if comorbidities are present) cost $28 900 per QALY gained compared with no vaccination and was more cost-effective than the currently recommended PPSV23 strategy. Routine PCV13 at ages 50 and 65 years cost $45 100 per QALY compared with PCV13 substituted in current recommendations. Adding PPSV23 at age 75 years to PCV13 at ages 50 and 65 years gained 0.00002 QALYs, costing $496 000 per QALY gained. Results were robust in sensitivity analyses and alternative scenarios, except when low PCV13 effectiveness against nonbacteremic pneumococcal pneumonia was assumed or when greater childhood vaccination indirect effects were modeled. In these cases, PPSV23 as currently recommended was favored.

Conclusion  Overall, PCV13 vaccination was favored compared with PPSV23, but the analysis was sensitive to assumptions about PCV13 effectiveness against nonbacteremic pneumococcal pneumonia and the magnitude of potential indirect effects from childhood PCV13 on pneumococcal serotype distribution.

JAMA   
February 22/29, 2012, Vol 307, No. 8, pp 749-874
http://jama.ama-assn.org/current.dtl

Original Contributions
Risk of Febrile Seizures and Epilepsy After Vaccination With Diphtheria, Tetanus, Acellular Pertussis, Inactivated Poliovirus, and Haemophilus Influenzae Type b
Yuelian Sun, Jakob Christensen, Anders Hviid, Jiong Li, Peter Vedsted, Jørn Olsen, Mogens Vestergaard
JAMA. 2012;307(8):823-831.doi:10.1001/jama.2012.165

Abstract
Context  Vaccination with whole-cell pertussis vaccine carries an increased risk of febrile seizures, but whether this risk applies to the acellular pertussis vaccine is not known. In Denmark, acellular pertussis vaccine has been included in the combined diphtheria-tetanus toxoids-acellular pertussis–inactivated poliovirus– Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine since September 2002.

Objective To estimate the risk of febrile seizures and epilepsy after DTaP-IPV-Hib vaccination given at 3, 5, and 12 months.

Design, Setting, and Participants  A population-based cohort study of 378 834 children who were born in Denmark between January 1, 2003, and December 31, 2008, and followed up through December 31, 2009; and a self-controlled case series (SCCS) study based on children with febrile seizures during follow-up of the cohort.

Main Outcome  Measures Hazard ratio (HR) of febrile seizures within 0 to 7 days (0, 1-3, and 4-7 days) after each vaccination and HR of epilepsy after first vaccination in the cohort study. Relative incidence of febrile seizures within 0 to 7 days (0, 1-3, and 4-7 days) after each vaccination in the SCCS study.

Results  A total of 7811 children were diagnosed with febrile seizures before 18 months, of whom 17 were diagnosed within 0 to 7 days after the first (incidence rate, 0.8 per 100 000 person-days), 32 children after the second (1.3 per 100 000 person-days), and 201 children after the third (8.5 per 100 000 person-days) vaccinations. Overall, children did not have higher risks of febrile seizures during the 0 to 7 days after the 3 vaccinations vs a reference cohort of children who were not within 0 to 7 days of vaccination. However, a higher risk of febrile seizures was found on the day of the first (HR, 6.02; 95% CI, 2.86-12.65) and on the day of the second (HR, 3.94; 95% CI, 2.18-7.10), but not on the day of the third vaccination (HR, 1.07; 95% CI, 0.73-1.57) vs the reference cohort. On the day of vaccination, 9 children were diagnosed with febrile seizures after the first (5.5 per 100 000 person-days), 12 children after the second (5.7 per 100 000 person-days), and 27 children after the third (13.1 per 100 000 person-days) vaccinations. The relative incidences from the SCCS study design were similar to the cohort study design. Within 7 years of follow-up, 131 unvaccinated children and 2117 vaccinated children were diagnosed with epilepsy, 813 diagnosed between 3 and 15 months (2.4 per 1000 person-years) and 1304 diagnosed later in life (1.3 per 1000 person-years). After vaccination, children had a lower risk of epilepsy between 3 and 15 months (HR, 0.63; 95% CI, 0.50-0.79) and a similar risk for epilepsy later in life (HR, 1.01; 95% CI, 0.66-1.56) vs unvaccinated children.

Conclusions  DTaP-IPV-Hib vaccination was associated with an increased risk of febrile seizures on the day of the first 2 vaccinations given at 3 and 5 months, although the absolute risk was small. Vaccination with DTaP-IPV-Hib was not associated with an increased risk of epilepsy.

JAMA   
February 22/29, 2012, Vol 307, No. 8, pp 749-874
http://jama.ama-assn.org/current.dtl

Editorials
Prevention of Pneumococcal Infection With Vaccines: An Evolving Story
Eugene D. Shapiro
JAMA. 2012;307(8):847-849.doi:10.1001/jama.2012.194

Extract [first 150 words per JAMA convention]
The first vaccines to prevent pneumococcal infections, crude preparations of killed bacteria, were developed by Sir Almroth Wright in 1911 to try to alleviate the high mortality and morbidity among gold miners in South Africa.1 Discovery that antibodies against purified polysaccharides of the capsular surface of pneumococci were protective led to development of polysaccharide vaccines that were marketed in the 1940s. These vaccines were commercial failures because the advent of antimicrobials led to a perception that pneumococcal infections were no longer a major threat.2 Subsequent evidence of the persistence of significant morbidity from pneumococcal infections, as well as mortality rates of 25% to 30% in patients with invasive (including bacteremic) pneumococcal infections despite early treatment with antimicrobials, led to redevelopment of a polysaccharide vaccine, approved in the United States in 1977, that contained 14 of the more than 90 serotypes of pneumococci (responsible for about 80% of invasive …

The Lancet  
Feb 25, 2012  Volume 379  Number 9817  p685 – 776
http://www.thelancet.com/journals/lancet/issue/current

Comment
Community-based treatment of severe childhood pneumonia
Robert E Black, Shams El Arifeen

In 2010, an estimated 7·6 million children died before their fifth birthday, and more than a million of these deaths were due to pneumonia.1 Although progress is being made in expanding the use of vaccines to prevent pneumonia, many countries have yet to introduce these vaccines, especially the pneumococcal vaccine.2 Correct breastfeeding of children can also help prevent pneumonia deaths, but a high prevalence of suboptimum breastfeeding practices (eg, low rates of exclusive breastfeeding up to 6 months of age) is seen in all regions of the world.

The Lancet Infectious Disease
Mar 2012  Volume 12  Number 3  p167 – 254
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Avian influenza and the dual-use research debate
The Lancet Infectious Diseases

Preview
Since the first human cases of infection with avian influenza H5N1 were reported 15 years ago, the disease has caused 344 deaths among 583 known cases—a case fatality of nearly 60%. Despite the highly lethal nature of this virus, it is very rarely transmitted from birds to people, and even less frequently, if ever, transmitted from person to person. Nonetheless, the possibility of the virus mutating or recombining with another to develop pandemic potential is a bleak prospect for public health. So it is not surprising that the news that two groups of researchers have purposefully generated H5N1 strains that are transmitted easily in aerosols among ferrets, a widely used model of human influenza transmission, has generated a fierce debate about the conduct and dissemination of dual-use research, as reported in this month’s Newsdesk.

The Lancet Infectious Disease
Mar 2012  Volume 12  Number 3  p167 – 254
http://www.thelancet.com/journals/laninf/issue/current

Series
Infectious disease surveillance and modelling across geographic frontiers and scientific specialties
Kamran Khan, Scott JN McNabb, Ziad A Memish, Rose Eckhardt, Wei Hu, David Kossowsky, Jennifer Sears, Julien Arino, Anders Johansson, Maurizio Barbeschi, Brian McCloskey, Bonnie Henry, Martin Cetron, John S Brownstein

Summary
Infectious disease surveillance for mass gatherings (MGs) can be directed locally and globally; however, epidemic intelligence from these two levels is not well integrated. Modelling activities related to MGs have historically focused on crowd behaviours around MG focal points and their relation to the safety of attendees. The integration of developments in internet-based global infectious disease surveillance, transportation modelling of populations travelling to and from MGs, mobile phone technology for surveillance during MGs, metapopulation epidemic modelling, and crowd behaviour modelling is important for progress in MG health. Integration of surveillance across geographic frontiers and modelling across scientific specialties could produce the first real-time risk monitoring and assessment platform that could strengthen awareness of global infectious disease threats before, during, and immediately after MGs. An integrated platform of this kind could help identify infectious disease threats of international concern at the earliest stages possible; provide insights into which diseases are most likely to spread into the MG; help with anticipatory surveillance at the MG; enable mathematical modelling to predict the spread of infectious diseases to and from MGs; simulate the effect of public health interventions aimed at different local and global levels; serve as a foundation for scientific research and innovation in MG health; and strengthen engagement between the scientific community and stakeholders at local, national, and global levels.

Research agenda for mass gatherings: a call to action
John S Tam, Maurizio Barbeschi, Natasha Shapovalova, Sylvie Briand, Ziad A Memish, Marie-Paule Kieny

Summary
Public health research is essential for the development of effective policies and planning to address health security and risks associated with mass gatherings (MGs). Crucial research topics related to MGs and their effects on global health security are discussed in this review. The research agenda for MGs consists of a framework of five major public health research directions that address issues related to reducing the risk of public health emergencies during MGs; restricting the occurrence of non-communicable and communicable diseases; minimisation of the effect of public health events associated with MGs; optimisation of the medical services and treatment of diseases during MGs; and development and application of modern public health measures. Implementation of the proposed research topics would be expected to provide benefits over the medium to long term in planning for MGs.

The Lancet Infectious Disease
Mar 2012  Volume 12  Number 3  p167 – 254
http://www.thelancet.com/journals/laninf/issue/current

Review
Antiviral resistance during the 2009 influenza A H1N1 pandemic: public health, laboratory, and clinical perspectives
Aeron C Hurt, Tawee Chotpitayasunondh, Nancy J Cox, Rod Daniels, Alicia M Fry, Larisa V Gubareva, Frederick G Hayden, David S Hui, Olav Hungnes, Angie Lackenby, Wilina Lim, Adam Meijer, Charles Penn, Masato Tashiro, Timothy M Uyeki, Maria Zambon, on behalf of the WHO Consultation on Pandemic Influenza A (H1N1) 2009 Virus Resistance to Antivirals

Summary
Influenza A H1N1 2009 virus caused the first pandemic in an era when neuraminidase inhibitor antiviral drugs were available in many countries. The experiences of detecting and responding to resistance during the pandemic provided important lessons for public health, laboratory testing, and clinical management. We propose recommendations for antiviral susceptibility testing, reporting results, and management of patients infected with 2009 pandemic influenza A H1N1. Sustained global monitoring for antiviral resistance among circulating influenza viruses is crucial to inform public health and clinical recommendations for antiviral use, especially since community spread of oseltamivir-resistant A H1N1 2009 virus remains a concern. Further studies are needed to better understand influenza management in specific patient groups, such as severely immunocompromised hosts, including optimisation of antiviral treatment, rapid sample testing, and timely reporting of susceptibility results.