Twitter Watch
A selection of items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and by no means intended to be exhaustive.

GAVIAlliance GAVI Alliance
President Johnson Sirleaf is a tireless advocate for the right of all people to health and immunisation.”-@GAVISeth http://ht.ly/6RKYR
21 hours ago

gatesfoundation Gates Foundation
Are we drawing closer to the end of #polio? @BillGates and @JeffRaikes meet with Nigeria’s leaders: gates.ly/oYKDqL
8 Oct

ShotAtLife Shot@Life
by GAVIAlliance
Committed to #vaccines: Ppl in Sierra Leone strap coolboxes of vaccines on backs & bike 2 remote villages @gavialliance bit.ly/p8fjO6
7 Oct

GAVIAlliance GAVI Alliance
Campaign to eradicate polio likely to fail unless combined w/vaccines that combat other deadly diseases such as measles http://ht.ly/6QjKX
7 Oct

GAVISeth Seth Berkley
#DavidCameron tells Conservative Party about the importance of vaccinating the world’s children: http://ow.ly/6QcEE @Number10gov

ShotAtLife Shot@Life
by GAVIAlliance
In 10 years, @MeaslesInit has protected 1 billion children from #measles with #vaccines. Read the story: bit.ly/n6yKO5
6 Oct

MeaslesInit Measles Initiative
by Eurovaccine
New research on a measles outbreak in Japan shows vaccination much more cost-effective than containment and treatment bit.ly/pqs5Hh
7 Oct

gatesfoundation Gates Foundation
Introducing the Gates Vaccine Innovation Award–Honoring revolutionary leaders in saving child lives: bit.ly/oISLRF #vaccines
6 Oct

PATHtweets PATH
START-UP project: Seeking to make prevention of cervical cancer available to all women, no matter where they live. http://ow.ly/6FkO2
6 Oct

sabinvaccine Sabin Vaccine Inst.
On this day in 1956 Dr. Albert Sabin introduced his live-virus oral #polio #vaccine, read more @wired bit.ly/r01vxA
6 Oct

DofVC DoV Collaboration
RT: @ISGLOBALorg “Access to safe and effective vaccines is a human right not currently enjoyed by everyone” @DofVC #ECTMIH bit.ly/q1hQ0q
4 Oct

British Medical Journal
8 October 2011 Volume 343, Issue 7826
http://www.bmj.com/content/current

Practice
Quality Improvement Report: Improving MMR vaccination rates: herd immunity is a realistic goal
Philippa Cockman, Luise Dawson, Rohini Mathur, Sally Hull
BMJ 2011;343:doi:10.1136/bmj.d5703 (Published 4 October 2011)

Abstract
Problem  As measles is a highly infectious disease, the United Kingdom recommendation is for at least 95% of children to receive a first vaccination with the measles, mumps, and rubella (MMR) vaccine before age 2 years and a booster before age 5 years to achieve herd immunity and prevent outbreaks. Reported vaccination rates for England have improved since a low level in 2003-4. Coverage for London is consistently lower than for England, however, and concerns have been expressed that there could be an epidemic of measles in the capital.

Design  Observational time series study.

Setting  London Borough of Tower Hamlets.

Key measurements for improvement Uptake rates for childhood vaccinations. The key target was to reach 95% coverage for the first MMR vaccine before age 2 years.

Strategies for change Financial support for the development of geographically based networks of general practices. Commissioning of care packages, incentivising delivery of high quality integrated care with network level vaccination targets of 95%. Innovative use of information technology to enable robust call and recall processes, active follow-up of defaulters, and increased knowledge about the demography of the children most difficult to reach.

Effects of change  The development of networks of practices facilitated collaborative working among primary care clinicians and other stakeholders; peer review of achievements; and an element of healthy competition. Uptake improved for all childhood vaccinations, and to herd immunity levels for most. Uptake of the first MMR vaccine before age 2 years rose from 80% in September 2009 to 94% in March 2011.

Lessons learnt Achieving herd immunity for childhood vaccinations is an achievable target in an ethnically mixed, socially deprived inner city borough. The ability to identify characteristics of the difficult to reach groups, including significant differences in uptake across different ethnicities, will allow targeted interventions that may further improve overall coverage.

Health Affairs
October 2011; Volume 30, Issue 10

Agenda For Fighting Disparities
http://content.healthaffairs.org/content/current

From The Editor-in-Chief
A Nation At Risk For Wider Health Disparities
Susan Dentzer
Health Aff October 2011 30:1818; doi:10.1377/hlthaff.2011.1091

Extract
Among the well-documented deficiencies of US health care is its pronounced lack of equity—not just in access, but also in the quality of care provided whites versus ethnic and racial minorities. We shouldn’t be surprised, because our society is inequitable, a fact that gives rise to inequities in health.

This month’s issue of Health Affairs, produced with the support of the Aetna Foundation, provides a progress report on where we are as a nation in addressing these health and health care disparities. It also underscores that a “change” agenda will have to tackle the very fundamentals of existence that characterize the lives of millions of people in twenty-first-century America…

Human Vaccines
Volume 7, Issue 10    October 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/10/

Research Papers
Cost-effectiveness analysis of pneumococcal polysaccharide vaccination from age 60 in São Paulo State, Brazil
Open Access Article
Joao Tonolio Neto, Gabriela Tannus Branco de Araujo, Anna Gagliardi, Amanda Pinho, Laure Durand and Marcelo Fonseca

Vaccination of adults aged 60 years and older against Streptococcus pneumonia is not recommended in Brazil. The 23-valent polysaccharide pneumococcal vaccine (PPV23) is only available for institutionalized persons or with underlying diseases despite the substantial medical and economic burden related to pneumococcal infections in adults over than 59 years. The study aimed at evaluating the cost effectiveness of implementing a large PPV program in this population.
This analysis was performed using a static decision tree model. Demographic and epidemiological data were obtained from Brazilian official sources and international literature. Economic data were obtained from a study performed in 2007 in a public and a private hospital located in Sao Paulo. Vaccination was assumed to protect for 5 years with 60% effectiveness against bacteremic pneumococcal pneumonia (BPP) and 21% effectiveness against non bacteremic pneumococcal pneumonia (NBPP). Deterministic and sensitivity analyses were performed.
The pneumococcal polysaccharide vaccination saved 5,218 life year gained (LYG). The vaccination program was found to be cost effective in the social security and public health care perspectives with a mean incremental cost-effectiveness ratio of R$10,887 and R$8,281 per LYG respectively. Results were sensitive to the vaccine effectiveness against NBPP, the incidence and case-fatality rate of NBPP. From a societal perspective, PPV23 program for adults 60 and older was found to be cost-saving.
Pneumococcal polysaccharide vaccination is clinically and economically favored over the present vaccination strategy, in which persons aged over 59 years in Sao Paulo, have not been vaccinated.

Human Vaccines
Volume 7, Issue 10    October 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/10/

Research Papers
Attitudes of seasonal influenza vaccination among healthcare worker and general community population after pandemic influenza A/H1N1 in Hangzhou
Shijun Liu, Hanyan Yuan, Yan Liu, Jian Du, Xiaoping Zhang, Jun Wang, Xinren Che and Erping Xu

Objective  To know the attitude towards seasonal influenza vaccination among healthcare worker (HCWs) and general community population (GCPs) in the post-pandemic influenza A/H1N1 period.

Method We conducted a cross-sectional investigation in the beginning of seasonal influenza vaccination between 2010 and 2011, employed logistic regression analysis to compute the relationship between the willingness of seasonal influenza vaccination and variables after pandemic influenza A/H1N1.

Results  A total of 489 participants including 126 HCWs and 363 GCPs completed the investigation. 33.33% individuals (34.92% HCWs vs 32.78% GCPs, p＞0.05) intended to accept the seasonal influenza vaccination after pandemic influenza A/H1N1. Individuals received seasonal influenza vaccination in the prior 3 years and monovalent A/H1N1 vaccination in 2009 were aggressive to vaccinate seasonal influenza vaccine with adjusted OR= 5.21(3.20~8.49) and 1.97(1.18~3.30).. According to the results of multivariable logistic regression model, the safety not efficacy of influenza vaccine was the significant factor for acceptability of seasonal influenza vaccination (OR: 3.11, 95%CI: 1.76~5.50). The positive attitude of serious degree of influenza A/H1N1 and occupational factor were also associated with the willingness of seasonal influenza vaccination and the adjusted ORs were 2.09(1.14~3.83) and 1.62(1.00~2.64).

Conclusion  Participants showed low acceptability of seasonal influenza vaccination after pandemic influenza A/H1N1. Need educational program concerning the advantages of vaccine, comprehensible information about possible adverse effects and the hazards of seasonal influenza disease, which might motivate individuals to accept seasonal influenza vaccination.

Human Vaccines
Volume 7, Issue 10    October 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/10/

Research Papers
Challenges and opportunities in the Israeli 2009 Pandemic Influenza Vaccination Program
Hagai Levine, Ran D Balicer, Daniel Laor and Itamar Grotto

Abstract
Vaccines are a cornerstone in any pandemic influenza preparedness plan. Successful supplementary mass vaccination programs require proper advance planning. We aimed to identify general, and Israeli specific, challenges and opportunities before initiating the Israeli pandemic influenza vaccination program in order to better plan implementation of the program. Following the vaccination campaign the analysis was retrospectively examined in order to determine whether the challenges were properly identified and whether the opportunities were indeed realized. The major challenges identified were prioritization; ongoing communication with the public; balancing between central management and accessibility; and preventing vaccination errors. The major opportunity was expected to be the chance to enhance cooperation and communication between different organizations both within and outside of the health system at local, national and international levels. The vaccination program was planned based on this analysis. In retrospect, the analysis identified the key challenges and opportunities and appropriate measures were taken. However, the criticalness of acceptance of the vaccine among health care practitioners was not given sufficient attention and should be addressed in future vaccination programs. Analysis of global and local challenges and opportunities served as a useful tool for planning a pandemic influenza vaccination program. Lessons learned from this analysis could serve to foster cooperation and communication between various agencies in the event of planning rapid mass vaccination programs as well as for more routine public health vaccination campaigns.

Human Vaccines
Volume 7, Issue 10    October 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/10/

Commentary
Perceptions of malaria and vaccines in Kenya
David Ojakaa, Emmanuel Yamo, Yvette Collymore, Antoinette Ba-Nguz and Allison Bingham

Abstract
Malaria is a leading cause of morbidity and mortality in Kenya. To confront malaria, the Government of Kenya has been implementing and coordinating three approaches – vector control by distributing insecticide-treated bed nets and indoor residual spraying, case management, and the management of malaria during pregnancy. Immunization is recognized as one of the most cost-effective public health interventions. Efforts are underway to develop a malaria vaccine. The most advanced (RTS,S), is currently going through phase 3 trials. Although recent studies show the overwhelming support in the community for the introduction of a malaria vaccine, two issues – culture and the delivery of child immunization services – need to be considered.
Alongside the modern methods of malaria control described above, traditional methods coexist and act as barriers to attainment of universal immunization. The gender dimension of the immunization programme (where women are the main child caretakers) will also need to be addressed. There is an age dimension to child immunization programmes. Two age cohorts of parents, caregivers, or family members deserve particular attention. These are the youth who are about to initiate childbearing, and the elderly (particularly mother-in-laws who often play a role in child-rearing).     Mothers who are less privileged and socially disadvantaged need particular attention when it comes to child immunization. Access to immunization services is often characterized in some Kenyan rural communities in terms of living near the main road, or in the remote inaccessible areas. Should a malaria vaccine become available in the future, a strategy to integrate it into the immunization programme in Kenya should take into account at least two issues. First, it must address the fact that alongside the formal approach in malaria control, there exist the informal traditional practices among communities. Secondly, it must address particular issues in the delivery of immunization services.

Human Vaccines
Volume 7, Issue 10    October 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/10/

Research Papers
Introduction of a second dose of measles in National immunization program in India: A major step towards eradication
Ramesh Verma, Pardeep Khanna, Mohan Bairwa, Suraj Chawla, Shankar Prinja and Meena Rajput

Abstract
Measles is a highly infectious, acute respiratory illness that is caused by a virus of the genus Morbillivirus. The disease infects nearly 30 million children each year, and deaths usually occur from complications related to pneumonia, diarrhoea and malnutrition. A systematic review of published Indian literature depicts the median case fatality ratio (CFR) of measles to be 1.6%. Through immunization, measles deaths dropped a remarkable 78% from 733,000 in 2000 to 164,000 in 2008. As of 2008, 192 of 193 Member States of WHO use 2 doses of measles vaccine in their National immunization programs, India being the only exception. The Millennium Development Goal (MDG) 4 aims to reduce by two-thirds between 1990 and 2015 the under-five mortality rate (U5MR) in the world. Per the draft comprehensive Multi Year Strategic Plan (cMYP, 2010-17) for immunization of India, the country aims to reduce measles-related mortality by 90% by 2013 when compared to 2000. As recommended by the National Technical Advisory Group on Immunization (NTAGI), the implementation strategy of the second dose of measles vaccine at the state level is determined by the underlying performance of the routine immunization program. The second dose in the national immunization schedule gives extra immunity against measles infection that renders children more susceptible to secondary pneumonia and diarrhoeal diseases, which are the primary causes of under-5 child mortality in India.

The Lancet  
Oct 08, 2011  Volume 378  Number 9799  p1275 – 1354
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Early child development—a winning combination
The Lancet

Preview
4 years ago, a Lancet Series on child development reported that worldwide, more than 200 million children younger than 5 years were failing to reach their developmental potential. In today’s issue a follow-up Series documents progress in reduction of risk factors for poor development, such as inadequate cognitive stimulation, intrauterine growth restriction, HIV infection, and societal violence. The poorest and most vulnerable children benefit most from interventions, such as preschool programmes, because risk factors accumulated over a child’s short life produce greater inequality in educational achievements and development.

Series
Inequality in early childhood: risk and protective factors for early child development
Susan P Walker, Theodore D Wachs, Sally Grantham-McGregor, Maureen M Black, Charles A Nelson, Sandra L Huffman, Helen Baker-Henningham, Susan M Chang, Jena D Hamadani, Betsy Lozoff, Julie M Meeks Gardner, Christine A Powell, Atif Rahman, Linda Richter

Summary
Inequality between and within populations has origins in adverse early experiences. Developmental neuroscience shows how early biological and psychosocial experiences affect brain development. We previously identified inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anaemia as key risks that prevent millions of young children from attaining their developmental potential. Recent research emphasises the importance of these risks, strengthens the evidence for other risk factors including intrauterine growth restriction, malaria, lead exposure, HIV infection, maternal depression, institutionalisation, and exposure to societal violence, and identifies protective factors such as breastfeeding and maternal education. Evidence on risks resulting from prenatal maternal nutrition, maternal stress, and families affected with HIV is emerging. Interventions are urgently needed to reduce children’s risk exposure and to promote development in affected children. Our goal is to provide information to help the setting of priorities for early child development programmes and policies to benefit the world’s poorest children and reduce persistent inequalities.

Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries
Patrice L Engle, Lia CH Fernald, Harold Alderman, Jere Behrman, Chloe O’Gara, Aisha Yousafzai, Meena Cabral de Mello, Melissa Hidrobo, Nurper Ulkuer, Ilgi Ertem, Selim Iltus, the Global Child Development Steering Group

Summary
This report is the second in a Series on early child development in low-income and middle-income countries and assesses the effectiveness of early child development interventions, such as parenting support and preschool enrolment. The evidence reviewed suggests that early child development can be improved through these interventions, with effects greater for programmes of higher quality and for the most vulnerable children. Other promising interventions for the promotion of early child development include children’s educational media, interventions with children at high risk, and combining the promotion of early child development with conditional cash transfer programmes. Effective investments in early child development have the potential to reduce inequalities perpetuated by poverty, poor nutrition, and restricted learning opportunities. A simulation model of the potential long-term economic effects of increasing preschool enrolment to 25% or 50% in every low-income and middle-income country showed a benefit-to-cost ratio ranging

New England Journal of Medicine
October 6, 2011  Vol. 365 No. 14
http://content.nejm.org/current.shtml

Perspective
Routine HIV Screening — What Counts in Evidence-Based Policy?
R. Bayer and G.M. Oppenheimer

[Free full-text]

Pediatrics
October 2011, VOLUME 128 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Advance Online

Multicomponent Interventions to Enhance Influenza Vaccine Delivery to Adolescents
Lisa M. Gargano, Karen Pazol, Jessica M. Sales, Julia E. Painter, Christopher Morfaw, LaDawna M. Jones, Paul Weiss, James W. Buehler, Dennis L. Murray, Gina M. Wingood, Walter A. Orenstein, Ralph J. DiClemente, and James M. Hughes
Pediatrics 2011; peds.2011-0453; Published online October 10, 2011 (10.1542/peds.2011-0453)

Abstract
Objective: To compare school- versus provider-based approaches to improving influenza vaccination coverage among adolescents in rural Georgia.

Methods: We used a nonrandomized, 3-armed design: (1) a middle- and high school-based influenza vaccination intervention in 1 county; (2) a provider-based influenza vaccination intervention in a second county; and (3) a standard-of-care condition in a third county. Interventions also included distribution of an educational brochure, school presentations, and community-based outreach to enhance vaccine knowledge and awareness among adolescents and their parents.

Results: During the 2008–2009 influenza season, 70 (19%) of 370 students were vaccinated in the school-based county and 110 (15%) of 736 students were vaccinated in the provider-based county, compared with 71 (8%) of 889 students in the standard-of-care county (risk ratio [RR]school: 2.4 [95% confidence interval (CI): 1.7–3.2]; RRprovider: 1.9 [95% CI: 1.4–2.5]). During 2009–2010, seasonal influenza vaccination coverage was 114 (30.4%) of 375 of students in the school-based county, 122 (16.9%) of 663 of students in the provider-based county, and 131 (15.2%) of 861 students in the standard-of-care county (RRschool: 2.3 [95% CI: 1.9–2.9]; RRprovider: 1.2 [95% CI: 0.97–1.5]).

Conclusions: Special efforts to promote influenza vaccination among rural, predominantly black students were associated with increased vaccination coverage. The school-based influenza vaccination intervention was associated with the highest levels of vaccination coverage. This study revealed the efficacy of school-based influenza education to improve vaccination rates among adolescents.

Pediatrics
October 2011, VOLUME 128 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Advance Online

Alternative Vaccination Schedule Preferences Among Parents of Young Children
Amanda F. Dempsey, Sarah Schaffer, Dianne Singer, Amy Butchart, Matthew Davis, and Gary L. Freed
Pediatrics 2011; peds.2011-0400; Published online October 3, 2011 (10.1542/peds.2011-0400)

Abstract
Objective: Increasing numbers of parents use alternative vaccination schedules that differ from the recommended childhood vaccination schedule for their children. We sought to describe national patterns of alternative vaccination schedule use and the potential “malleability” of parents’ current vaccination schedule choices.

Methods: We performed a cross-sectional, Internet-based survey of a nationally representative sample of parents of children 6 months to 6 years of age. Bivariate and multivariate analyses determined associations between demographic and attitudinal factors and alternative vaccination schedule use.

Results: The response rate was 61% (N = 748). Of the 13% of parents who reported following an alternative vaccination schedule, most refused only certain vaccines (53%) and/or delayed some vaccines until the child was older (55%). Only 17% reported refusing all vaccines. In multivariate models, nonblack race and not having a regular health care provider for the child were the only factors significantly associated with higher odds of using an alternative schedule. A large proportion of alternative vaccinators (30%) reported having initially followed the recommended vaccination schedule. Among parents following the recommended vaccination schedule, 28% thought that delaying vaccine doses was safer than the schedule they used, and 22% disagreed that the best vaccination schedule to follow was the one recommended by vaccination experts.

Conclusions: More than 1 of 10 parents of young children currently use an alternative vaccination schedule. In addition, a large proportion of parents currently following the recommended schedule seem to be “at risk” for switching to an alternative schedule

PLoS One
[Accessed 10 October 2011]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Meningococcal Disease in Children in Merseyside, England: A 31 Year Descriptive Study
Michelle C. Stanton, David Taylor-Robinson, David Harris, Fauzia Paize, Nick Makwana, Scott J. Hackett, Paul B. Baines, F. Andrew I. Riordan, Omnia Marzouk, Alistair P. J. Thomson, Peter J. Diggle, C. Anthony Hart, Enitan D. Carrol of the meningococcal C conjugate (MCC) vaccine. The proportion … ] , and the introduction of the meningococcal C conjugate vaccine [8 … in the introduction of the Meningococcal C vaccine in November 1999 PLoS ONE: Research Article, published 07 Oct 2011 10.1371/journal.pone.0025957

Abstract 
Meningococcal disease (MCD) is the leading infectious cause of death in early childhood in the United Kingdom, making it a public health priority. MCD most commonly presents as meningococcal meningitis (MM), septicaemia (MS), or as a combination of the two syndromes (MM/MS). We describe the changing epidemiology and clinical presentation of MCD, and explore associations with socioeconomic status and other risk factors. A hospital-based study of children admitted to a tertiary children’s centre, Alder Hey Children’s Foundation Trust, with MCD, was undertaken between 1977 to 2007 (n = 1157). Demographics, clinical presentations, microbiological confirmation and measures of deprivation were described. The majority of cases occurred in the 1–4 year age group and there was a dramatic fall in serogroup C cases observed with the introduction of the meningococcal C conjugate (MCC) vaccine. The proportion of MS cases increased over the study period, from 11% in the first quarter to 35% in the final quarter. Presentation with MS (compared to MM) and serogroup C disease (compared to serogroup B) were demonstrated to be independent risk factors for mortality, with odds ratios of 3.5 (95% CI 1.18 to 10.08) and 2.18 (95% CI 1.26 to 3.80) respectively. Cases admitted to Alder Hey were from a relatively more deprived population (mean Townsend score 1.25, 95% CI 1.09 to 1.41) than the Merseyside reference population. Our findings represent one of the largest single-centre studies of MCD. The presentation of MS is confirmed to be a risk factor of mortality from MCD. Our study supports the association between social deprivation and MCD.

PLoS One
[Accessed 10 October 2011]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date

Communicable Diseases Prioritized for Surveillance and Epidemiological Research: Results of a Standardized Prioritization Procedure in Germany, 2011
Yanina Balabanova, Andreas Gilsdorf, Silke Buda, Reinhard Burger, Tim Eckmanns, Barbara Gärtner, Uwe Groß, Walter Haas, Osamah Hamouda, Johannes Hübner, Thomas Jänisch, Manfred Kist, Michael H. Kramer, Thomas Ledig, Martin Mielke, Matthias Pulz, Klaus Stark, Norbert Suttorp, Uta Ulbrich, Ole Wichmann, Gérard Krause possibilities and needs (including vaccines) ** Preventive … of a routine childhood Varicella vaccination program in 2004 … trends of vaccine-preventable diseases that followed PLoS ONE: Research Article, published 04 Oct 2011 10.1371/journal.pone.00256

Abstract 
Introduction
To establish strategic priorities for the German national public health institute (RKI) and guide the institute’s mid-term strategic decisions, we prioritized infectious pathogens in accordance with their importance for national surveillance and epidemiological research.

Methods
We used the Delphi process with internal (RKI) and external experts and a metric-consensus approach to score pathogens according to ten three-tiered criteria. Additional experts were invited to weight each criterion, leading to the calculation of a median weight by which each score was multiplied. We ranked the pathogens according to the total weighted score and divided them into four priority groups.

Results
127 pathogens were scored. Eighty-six experts participated in the weighting; “Case fatality rate” was rated as the most important criterion. Twenty-six pathogens were ranked in the highest priority group; among those were pathogens with internationally recognised importance (e.g., Human Immunodeficiency Virus, Mycobacterium tuberculosis, Influenza virus, Hepatitis C virus, Neisseria meningitides), pathogens frequently causing large outbreaks (e.g., Campylobacter spp.), and nosocomial pathogens associated with antimicrobial resistance. Other pathogens in the highest priority group included Helicobacter pylori, Respiratory Syncytial Virus, Varicella zoster virus and Hantavirus.

Discussion
While several pathogens from the highest priority group already have a high profile in national and international health policy documents, high scores for other pathogens (e.g., Helicobacter pylori, Respiratory syncytial virus or Hantavirus) indicate a possible under-recognised importance within the current German public health framework. A process to strengthen respective surveillance systems and research has been started. The prioritization methodology has worked well; its modular structure makes it potentially useful for other settings.

Science        
7 October 2011 vol 334, issue 6052, pages 1-144
http://www.sciencemag.org/current.dtl

EDITORIAL:
Genomics Is Not Enough
Aravinda Chakravarti
Science 7 October 2011: 15.

Next week, the international congress of human genetics convenes in Montreal, where genomic science, its technologies, genetic disease, and personalized medicine will be discussed. Translating current knowledge into medical practice is an important goal for the public who support medical research, and for the scientists and clinicians who articulate the critical research needs of our time. However, despite innumerable successful gene discoveries through genomics, a major impediment is our lack of knowledge of how these genes affect the fundamental biological mechanisms that are dysregulated in disease. If genomic medicine is to prosper, we need to turn our attention to this gaping hole.

Science Translational Medicine
5 October 2011 vol 3, issue 103
http://stm.sciencemag.org/content/current

Commentary
Science and Health Policy
The Changing Burden of Infectious Disease in Europe
Robin Fears, Jos W. M. van der Meer, and Volker ter Meulen
5 October 2011: 103cm30

Abstract
Infectious diseases continue to pose major public health challenges in developed, as well as developing, countries. The European Academies Science Advisory Council aims to integrate multidisciplinary analyses to define priorities for European surveillance of new, growing, or potential threats from antimicrobial resistance, vector-borne disease, and pandemic influenza. There is a concomitant need to apply such knowledge toward the development of improved health care and robust policies. We discuss how translational medicine can bridge these global issues by helping to mobilize resources between academia, industry, health care services, and policy-makers.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Regular Papers
Guillain–Barré syndrome and H1N1 (2009) pandemic influenza vaccination using an AS03 adjuvanted vaccine in the United Kingdom: Self-controlled case series
Pages 7878-7882
Nick Andrews, Julia Stowe, Rustam Al-Shahi Salman, Elizabeth Miller

Abstract
In 1976 a swine influenza vaccine was associated with an increased risk of Guillain–Barré syndrome (GBS). Although subsequent studies did not find an increased risk of GBS following seasonal influenza vaccine, there was concern that the monovalent H1N1 vaccines developed against the swine influenza pandemic of 2009 might increase the risk of GBS. In the UK a split-virion AS03 oil-in-water adjuvanted vaccine (Pandemrix™) was predominantly used. To determine whether the risk of GBS increased after Pandemrix administration, we sought GBS cases during the period of vaccine use from neurologists and a patient support group, and following the vaccination period from hospital episode statistics (HES) in England. We obtained cases’ vaccination histories and illness onset dates from general practitioners. We determined the relative incidence of GBS in the 6 weeks after vaccination using the self-controlled case series method on the cases identified in HES. We included 327 GBS cases, of whom 37 received pandemic vaccine in the study period, nine of whom developed GBS within 6 weeks of vaccination (relative incidence 1.05 [95% confidence interval (CI) 0.37 to 2.24]). We found no evidence of an increased risk of GBS in the 6 weeks following pandemic influenza vaccination.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Regular Papers
MMR vaccine effectiveness in an outbreak that involved day-care and primary schools
Pages 8024-8031
Irene Barrabeig, Ariadna Rovira, Pilar Muñoz, Joan Batalla, Cristina Rius, Josep Anton Sánchez, Àngela Domínguez

Abstract
Objective
In 2006, a large measles outbreak occurred in Catalonia (Spain), where the immunization schedule included two doses of MMR vaccine at 15 months and 4 years. The aim of this study was to investigate the vaccine effectiveness (VE) of MMR in children attending day-care and pre-school centres and to estimate the number of cases that would have been avoided by administering the first dose of MMR at 12 months.

Methods
A retrospective cohort study was carried out between October 2006 and January 2007 in day-care and pre-school centres with confirmed measles cases. VE was calculated in children aged ≥15 months without previous measles infection. Cases avoided by advancing the first dose of MMR to 12 months were estimated by calculating the basic and effective reproduction number in centres where transmission outside the class was observed.

Results
Fifteen centres and 1394 children were included. There were 77 confirmed cases (attack rate = 5.5%). Vaccination coverage of the 1121 children aged ≥15 months was 91.6% and VE was 96% (95%CI 89–98%).

There were 33 (41%) cases in the 81 children aged 12–14 months. Advancing the first dose to 12 months would have prevented 74 cases (91.5%) and lowered the attack rate from 41% to 8.6%.

Conclusions
Over 90% of cases in children aged 12–14 months would have been avoided by MMR administration at 12 rather than 15 months. We strongly recommend advancing the first dose of MMR to 12 months in order to reduce the risk of measles outbreaks.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Regular Papers
Health beliefs and attitudes associated with HPV vaccine intention among young gay and bisexual men in the southeastern United States
Pages 8060-8065
Christopher W. Wheldon, Ellen M. Daley, Eric R. Buhi, Alan G. Nyitray, Anna R. Giuliano

Abstract
Gay and bisexual men are at increased risk of anal cancer as a result of human papillomavirus (HPV) infection. Prophylactic vaccination is a potentially effective strategy for preventing anal cancer in this population. The purpose of this study was to identify factors associated with gay and bisexual men’s intention to receive HPV vaccine. In the fall of 2010, 179 self-identified gay and bisexual men (mean age 22 years) completed an Internet-based questionnaire assessing beliefs and attitudes toward HPV vaccination. Men were recruited from college-based and Internet venues throughout the southeastern United States. The probability of intent to receive HPV vaccine was modeled using logistic regression. A majority of men (93%) had heard of HPV prior to participation but were generally unaware of the association of HPV with anal, penile, and oral cancers. Only 26% were aware of an HPV vaccine for males. Of the 179 participants, 64 (36%) were likely to be vaccinated. Men most likely to receive HPV vaccine perceived stronger physical and psychological benefits from vaccination and had more positive attitudes toward the vaccine. Conversely, intent to be vaccinated was negatively associated with concern over the financial cost of vaccination. Findings from this study can inform college-based health education programs aimed at increasing vaccine uptake among gay and bisexual men.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Regular Papers
Pharmacists as providers: Targeting pneumococcal vaccinations to high risk populations
Pages 8073-8076
Michael Taitel, Ed Cohen, Ian Duncan, Cheryl Pegus

Abstract
Background
Older adults and persons with chronic conditions are at increased risk for pneumococcal disease. Severe pneumococcal disease represents a substantial humanistic and economic burden to society. Although pneumococcal vaccination (PPSV) can decrease risk for serious consequences, vaccination rates are suboptimal. As more people seek annual influenza vaccinations at community pharmacies, pharmacists have the ability to identify at-risk patients and provide PPSV.

Objectives
The objective of this study was to evaluate the impact of pharmacists educating at-risk patients on the importance of receiving a pneumococcal vaccination.

Methods
Using de-identified claims from a large, national pharmacy chain, all patients who had received an influenza vaccination between August 1, 2010 and November 14, 2010 and who were eligible for PPSV were identified for the analysis. Based on the Advisory Committee on Immunization Practices recommendations, at-risk patients were identified as over 65 years of age or as aged 2–64 with a comorbid conditions. A benchmark medical and pharmacy claims database of commercial and Medicare health plan members was used to derive a PPSV vaccination rate typical of traditional care delivery to compare to pharmacy-based vaccination. Period incidence of PPSV was calculated and compared.

Results
Among the 1.3 million at-risk patients who were vaccinated by a pharmacist during the study period, 65,598 (4.88%) also received a pneumococcal vaccine. This vaccination rate was significantly higher than the benchmark rate of 2.90% (34,917/1,204,104; p < .001) representing traditional care. Patients aged 60–70 years had the highest vaccination rate (6.60%; 26,430/400,454) of any age group.

Conclusions
Pharmacists were successful at identifying at-risk patients and providing additional immunization services. Concurrent immunization of PPSV with influenza vaccination by pharmacists has potential to improve PPSV coverage. These results support the expanding role of community pharmacists in the provision of wellness and prevention services.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

The potential cost-effectiveness of infant pneumococcal vaccines in Australia
Pages 8077-8085
Anthony T. Newall, Prudence Creighton, David J. Philp, James G. Wood, C. Raina MacIntyre

Abstract
Over the last decade infant pneumococcal vaccination has been adopted as part of routine immunisation schedules in many developed countries. Although highly successful in many settings such as Australia and the United States, rapid serotype replacement has occurred in some European countries. Recently two pneumococcal conjugate vaccines (PCVs) with extended serotype coverage have been licensed for use, a 10-valent (PHiD-CV) and a 13-valent (PCV-13) vaccine, and offer potential replacements for the existing vaccine (PCV-7) in Australia. To evaluate the cost-effectiveness of PCV programs we developed a static, deterministic state-transition model. The perspective for costs included those to the government and healthcare system. When compared to current practice (PCV-7) both vaccines offered potential benefits, with those estimated for PHiD-CV due primarily to prevention of otitis media and PCV-13 due to a further reduction in invasive disease in Australia. At equivalent total cost to vaccinate an infant, compared to no PCV the base-case cost per QALY saved were estimated at A$64,900 (current practice, PCV-7; 3 + 0), A$50,200 (PHiD-CV; 3 + 1) and A$55,300 (PCV-13; 3 + 0), respectively. However, assumptions regarding herd protection, serotype protection, otitis media efficacy, and vaccination cost changed the relative cost-effectiveness of alternative PCV programs. The high proportion of current invasive disease caused by serotype 19A (as included in PCV-13) may be a decisive factor in determining vaccine policy in Australia.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Healthy-days time equivalents for outcomes of acute rotavirus infections
Pages 8086-8093
A. Brett Hauber, Robbin Itzler, F. Reed Johnson, Ateesha F. Mohamed, Juan Marcos González, John R. Cook, Emmanuel B. Walter

Abstract
Rotavirus is the most common cause of severe gastroenteritis in infants and young children worldwide. Health-state utility measures used in economic evaluations of rotavirus vaccines do not reflect differences between mild and severe symptoms of rotavirus gastroenteritis and, therefore, do not adequately capture preferences for non-fatal outcomes associated with rotavirus common in industrialized countries. This paper describes the development and results of a survey specifically designed to develop quality-adjusted time equivalents for rotavirus gastroenteritis among a sample of parents with young children in the United States as an alternative to conventional QALY measures in assessing cost-effectiveness.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
 
Volume 29, Issue 45 pp. 7875-8174 (19 October 2011)

Dentists’ awareness toward vaccine preventable diseases
Pages 8108-8112
Stefano Petti, Giuseppe A. Messano, Antonella Polimeni

Abstract
Effective infection control in dentistry is unfeasible without an adequate immunization program for dental health care providers (DHCPs). Such an assumption is demonstrated for some vaccine preventable infectious diseases (VPIDs), such as Hepatitis B, Influenza and Varicella. However, excluding Hepatitis B vaccine, immunization programs for DHCPs are few and often unclear about which vaccinations are recommended, thus leading to generally low awareness and consequent low vaccination rates. This survey investigated dentists’ awareness toward VPIDs. At the moment of registration to a dental congress, a questionnaire regarding the immunization status toward VPIDs was anonymously filled in by 379 Italian dentists (86% of the contacted dentists), with at least fifteen years of activity. DHCP specific awareness was considered high if dentists reported to have controlled the serum level of anti-HBs during the last ten years and have received seasonal influenza vaccine annually. Awareness toward VPIDs was classified high if dentists reported to be immune against six or seven of the following VIPDs, Hepatitis B, Influenza, Varicella, Measles, Mumps, Rubella and Tetanus. DHCP specific awareness resulted high for 32.5% of subjects and low for 31.1%. None of the subjects reported high awareness toward VPIDs, while for 60% of them, such awareness was low (immunization status reported for none or one of the seven VPIDs). Low dentists’ awareness stresses the need for a transparent immunization program which is effective in controlling VPID transmission in the dental health care settings and focuses on those VPIDs which pose a true risk of infection for DHCPs and patients

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Editorial
Developing vaccine policy: Attributes of “just policy” and a proposed template to guide decision and policy making
Pages 7577-7578
Gregory A. Poland, Edgar K. Marcuse

[No abstract]

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Short Communications
College students’ perceptions of H1N1 flu risk and attitudes toward vaccination
Pages 7599-7601
Meagan A. Ramsey, Cecile A. Marczinski

Abstract
College students are highly susceptible to the H1N1 virus, yet previous studies suggest that college students perceive themselves at low risk for the flu. We surveyed 514 undergraduates to assess their perceptions of H1N1 flu risk and opinions about flu vaccines. A third of respondents stated that they were not at risk of getting the H1N1 flu because they were young. Responses indicated a distrust of the safety and effectiveness of influenza vaccinations; only 15.8% of participants planned on receiving H1N1 vaccination. Top reasons for refusing the H1N1 vaccine included questioning vaccine safety and effectiveness, and concerns about potential serious and/or benign side effects. Top reasons for H1N1 vaccination acceptance included receiving a doctor recommendation for the vaccine, having previously gotten a seasonal vaccine, and being at high-risk for influenza. Our findings suggest that college students are inaccurate in assessing their risk level and are unlikely to seek vaccinations.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Regular Papers
Cost-effectiveness of the introduction of the pneumococcal polysaccharide vaccine in elderly Colombian population
Pages 7644-7650
Carlos Castañeda-Orjuela, Nelson Alvis-Guzmán, Ángel José Paternina, Fernando De la Hoz-Restrepo

Abstract
Background
Streptococcus pneumoniae causes community-acquired pneumonia, otitis media and meningitis, with higher incidences at the extremes of life. PPV-23 vaccine is widely used in prevention of pneumonia and invasive pneumococcal disease in older adults in developed countries. We developed an evaluation of cost-effectiveness of implementing PPV-23 in Colombian population over 60 years.

Methods
The number of cases of pneumonia and meningitis in patients over 60 years and the proportion by S. pneumoniae was estimated based on a review of literature. A decision tree model with a 5-year time horizon was built to evaluate the cost-effectiveness of the implementation of the PPV-23 in this population. Direct health care costs of out- and in-patients were calculated based on expenditure records from the Bogota public health system. Incremental cost-effectiveness ratios per life saved and per year of life gained were estimated based on the decision tree model. Deterministic and probabilistic sensitivity analyses were performed.

Results
Without vaccination 4460 (range 2384–8162) bacteremic pneumococcal pneumonias and 141 (range 73–183) pneumococcal meningitis would occur among people over 60 years old in Colombia. In the first year, vaccination with PPV-23 at US$8/dose would save 480 (range 100–1753) deaths due to Invasive and non-invasive pneumococcal disease. Vaccination would results in US$3400/deaths averted (range US$1028–10,862) and US$1514/life years gained (range US$408–5404).

Conclusion
Vaccination with PPV-23 in over 60 years is a highly cost-effective public health measure in Colombia. Despite some limitations, the results are robust, and may help developing countries to perform informed decisions about the introduction of the vaccine.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Parent and adolescent perspectives about adolescent vaccine delivery: Practical considerations for vaccine communication
Pages 7651-7658
Cynthia M. Rand, Sharon G. Humiston, Stanley J. Schaffer, Christina S. Albertin, Laura P. Shone, Aaron K. Blumkin, Shannon Stokley, Peter G. Szilagyi

Abstract
We surveyed parents of adolescents (n = 430) and their adolescents ages 15–17 years (n = 208) in 9 primary-care settings in Monroe County, NY to assess perceptions about adolescent vaccine delivery. Parents and adolescents most wanted to discuss vaccine side effects and the diseases prevented with the adolescents’ provider. Those who perceived vaccines as very safe were more accepting of adolescent vaccines. Most participants agreed with vaccinating the teen during a mild illness and with providing multiple vaccines concomitantly. Participants most preferred medical, as opposed to other settings, for receipt of adolescent vaccines. For parents and adolescents who are wary of vaccination, strategies are needed to enhance communication about risks and benefits of vaccinations.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Parental acceptance of human papillomavirus (HPV) vaccination in Indonesia: A cross-sectional study
Pages 7785-7793
L. Jaspers, S. Budiningsih, R. Wolterbeek, F.C. Henderson, A.A.W. Peters

Abstract
Background
Cervical cancer ranks the second most frequent cancer in Indonesian women. In Indonesia, human papillomavirus (HPV) vaccine acceptance has not been studied before.

Objective
To determine parental HPV vaccine acceptance in Indonesia, and factors that influence their decision. Factors include sociodemographic factors, knowledge of HPV, HPV vaccination and cervical cancer, health beliefs about cervical cancer, and attitudes towards vaccination in general.

Methods
746 parents, with at least 1 daughter aged 0–14, were interviewed using questionnaires based on published and adjusted interviews. Interviews were done in sub district public health centers, general governmental hospitals, and via house-visits, in 5 Indonesian provinces.

Results
Parental HPV vaccine acceptance was 96.1%. Logistic regression revealed that age, beliefs regarding cervical cancer, and attitudes towards vaccination in general were significantly associated with HPV vaccine acceptance. Of the participants, 66.0%, 16.6%, and 15.8% had heard about cervical cancer, HPV, and HPV vaccination respectively. The mean total knowledge score was 1.91(Standard Deviation 2.31) on a 0–8 scale. Health beliefs about cervical cancer and attitudes towards vaccination in general were positive. Participants named the high cost of the vaccine, fear for side-effects, and chosen vaccination locations as possible barriers towards HPV vaccine implementation.

Discussion
Parental HPV vaccine acceptance is high, but knowledge about HPV and cervical cancer is low. During HPV vaccination programs, focus should not only be on providing information, but also on existing beliefs and attitudes towards cervical cancer and vaccination in general. If HPV vaccination programs were to be implemented in Indonesia, the indicated barriers should be taken into account.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 44 pp. 7577-7874 (13 October 2011)

Hospital-based study of the economic burden associated with rotavirus diarrhea in eastern China
Pages 7801-7806
Hui Jin, Bei Wang, Zhaoyin Fang, Zhaojun Duan, Qian Gao, Na Liu, Lijie Zhang, Yuan Qian, Sitang Gong, Qirong Zhu, Xiaona Shen, Qingbin Wu

Abstract
Rotavirus infection is one of the most common causes of severe diarrhea in China. To evaluate the economic burden associated with rotavirus infection of children in China, we combined data on the disease burden of rotavirus-associated costs for samples comprising 832 outpatients and 604 inpatients from five seaside cities. The average social costs and direct medical costs for rotavirus-associated admissions were calculated to be US $61.64 and US $40.73 for outpatients, and US $684.15 and US $559.48 for inpatients, respectively, from October 1, 2006 to December 1, 2007. On average, the private cost ranged from US $54.64 for outpatients to US $454.24 for inpatients when children suffered from rotavirus infection. Accordingly, this cost accounted for 35.19–293% of the monthly income of an unskilled or service worker. We estimated that the annual number of children with rotavirus diarrhea was 12.10 million. Consequently, the total annual direct cost, total annual social cost, and total annual private cost were US $271.4 million, US $365.0 million, and US $290.0 million, respectively. Furthermore, rotavirus diarrhea affected children’s behavior and emotions, which had a great influence on the caretakers’ quality of life. These data indicate the potential requirement for a safe and effective rotavirus vaccine to reduce the economic burden associated with rotavirus disease.

The pdf version of Vaccines: The Week in Review  3 October 2011, comprising the posts for this date below, is available here: Vaccines_The Week in Review_3 Oct 2011

The GAVI Alliance announced it will provide funding for 16 more developing countries to introduce rotavirus vaccines and 18 more countries to introduce pneumococcal vaccines, noting that the roll out of rotavirus vaccines across Africa has already begun in Sudan. GAVI CEO Seth Berkley M.D. said, “Thanks to our donors and partners, the GAVI Alliance is now delivering on its promise to protect more children across the developing world against rotavirus, pneumococcal disease and other life-threatening yet preventable diseases. The death toll of rotavirus and pneumococcal infections in Africa is particularly devastating, and this is where these vaccines will make the most significant impact, not only in lives saved, but also in terms of healthy lives lived. Immunisation enables good health and healthy people are more productive and ultimately fuel economic growth.” GAVI also approved applications from five countries for pentavalent vaccine, and 12 for other types of vaccines (see detailed list of approved countries). http://www.who.int/immunization/newsroom/press/vaccines_to_reach_37_more_countries/en/index.html

J.P. Morgan, the World Bank and the International Finance Facility for Immunisation (IFFIm) announced the issuance of US$169.4 million (equivalent) of IFFIm “vaccine bonds” in Japan. The proceeds will support GAVI Alliance programs. Alan Gillespie, IFFIm Board Chair, said, “The investment by the Japanese people in IFFIm is a testament to their commitment to GAVI’s life-saving work. We also greatly appreciate J.P. Morgan and our three Japanese distributors for their role in placing IFFIm’s AAA-rated bonds.”

http://www.iffim.org/library/news/press-releases/2011/new-iffim-vaccine-bonds-issued-to-support-life-saving-immunisation-in-poorest-countries/

A Thomson Reuters-NPR Health Poll in the U.S. found that 26.6 percent of respondents expressed concern over the safety of vaccines. Households with children under the age of 18 demonstrated the greatest level of concern (30.8%).  The lowest level of concern (18.5%) was found in respondents 65 years old and up. Thomson Reuters and NPR conduct a monthly poll to gauge attitudes and opinions on a wide range of health issues.

The poll found that, among those with concerns, 47.3 percent attributed their fear of vaccines to future long-term impact on health and 46.0 percent said they were worried about side effects. Nearly one in five said they have questioned or refused a vaccine for themselves or their children — with a higher rate among those under 35 (28.1 percent) and a lower rate among those 65 and older (12.7 percent). When asked about specific safety concerns, 21.4 percent of respondents said they believe vaccines can cause of autism, 9.2 percent said they believe vaccines can be linked to cancer, 6.9 percent believe they play a role in diabetes, and 5.9 percent cite a connection between vaccines and heart disease. Overall, 24 percent of respondents said their opinions of vaccines have changed in the past five years. Of those, 59 percent say their views on vaccines have become less favorable. Poll survey results: http://healthcare.thomsonreuters.com/npr/assets/NPR_report_vaccines.pdf

http://www.prnewswire.com/news-releases/thomson-reuters-npr-health-poll-finds-one-in-four-americans-believe-vaccines-are-unsafe-130837193.html

The Board of the Global Fund announced adoption of recommendations “for major reforms made by an independent panel of distinguished individuals” designed to help the Global Fund evolve from an organization responding to an emergency into an even more effective one delivering a sustainable response.”  Global Fund Chair Simon Bland commented, “We are determined to carry out these changes quickly to ensure that donors and implementing countries maintain absolute confidence that the Global Fund is an efficient and effective funding channel that delivers value for money. Following the Board meeting we now have a clear way forward to make these changes.” The Board’s governance is being overhauled “to provide comprehensive oversight” with its four standing committees being reduced to three: one to focus on strategy and investment, a second one to concentrate on finance and operational performance, and a third committee — with a majority of independent members — dealing with audits and ethics.

http://www.theglobalfund.org/en/mediacenter/pressreleases/2011-09-27_Global_Fund_Board_adopts_Panel_recommendations_calling_for_urgent_reform/

The MMWR Weekly for September 30, 2011 / Vol. 60 / No. 38 includes:
– Severe Illness from 2009 Pandemic Influenza A (H1N1) — Utah, 2009–10 Influenza Season

– Progress in Implementing Measles Mortality Reduction Strategies — India, 2010–2011

The Weekly Epidemiological Record (WER) for 30 September 2011, vol. 86, 40 includes: Confirmed international spread of wild poliovirus from Pakistan; Progress in implementing measles mortality reduction strategies, India 2010–2011 http://www.who.int/entity/wer/2011/wer8640.pdf

Twitter Watch
A selection of items of interest from a variety of twitter feeds associated with immunization, vaccines and global public health. This capture is highly selective and by no means intended to be exhaustive.

ArthurCaplan Arthur Caplan
flu mandates for hcws taking off in usa! bit.ly/qLIjSe

gatespolio Gates Polio
by EndPolioNow
@billgates and Busuyi Onabolu, PolioPlus Chairman in Nigeria: ending polio is #morethanagoal @FCBarcelona @rotary gates.ly/qAPxUS

PIH Partners In Health
RT @seaif: Paul Farmer explains why global health has to first focus on #poverty: http://ow.ly/6JWgt via @TheHumanosphere #CGI2011 @PIH

PublicHealth APHA
State & local public health officials should decide where & how to store antibiotics against anthrax attack, says IOM: goo.gl/jlLJq

UNICEF UNICEF
bit.ly/rqP0Pv — Video report on how bednets are saving lives in #Mozambique — #Malaria — @Malaria_Envoy — @MalariaNoMore

AIDSvaccine IAVI
Economists panel w 3 Nobel Laureates finds #HIV vaccine R&D shld be a top priority as part of comp response to pandemic bit.ly/oHr5Y8

GAVIAlliance GAVI Alliance
Check out the latest blog from @OrinLevine – Progress That Demands Performance http://ht.ly/6IoOp

WHOnews WHO
It’s World Rabies Day. Worldwide, more than 55,000 people die of #rabies every year bit.ly/puYDRM #globalhealth
28 Sep

unfoundation UN Foundation
RT @gatespolio: Great news: Saudi Arabia gives $30 million toward #polio eradication gates.ly/oM5kFO @unfoundation @rotary
28 Sep

GAVISeth Seth Berkley
@GAVIAlliance delivers on the promise, approving an unprecedented 37 countries for #vaccines support: ht.ly/6Gbcb
28 Sep

British Medical Journal
1 October 2011 Volume 343, Issue 7825
http://www.bmj.com/content/current

Editor’s Choice
Why don’t we know how much vaccines cost?
Fiona Godlee, editor, BMJ
[Free full-text]

The Global Alliance on Vaccines and Immunisation can be proud of what it has achieved. As Sophie Arie reports, it has prevented more than five million premature deaths since it started in 2000 (doi:10.1136/bmj.d5182). It has also attracted huge amounts of funding, reflecting the confidence of major donors, so it’s well set to meet its target of saving a further four million lives by 2015.

But GAVI has prominent critics, raising challenges for its incoming chief executive officer, Seth Berkley, who is interviewed this week by Rebecca Coombes (bmj.com/podcasts). At issue is GAVI’s current strategy. Could it use its vast resources more effectively? Is it right to focus on access to new vaccines against rotavirus and pneumonia for children in countries that can afford to contribute financially? Or should it help the very poorest countries building health systems so their children can get basic vaccines against diphtheria, tetanus, and pertussis? Most vexed of all, is GAVI paying too much for vaccines? Could it vaccinate even more children with the funds it has been given if it negotiated a better deal from the industry?

Most of the vaccines acquired by GAVI and then bought by Unicef and other agencies come from the major vaccine manufacturers; GSK, Pfizer, and Merck. But as Arie explains, there is growing competition from emerging markets, notably India and China, where manufacturers can in some cases produce vaccines for less than half the standard price. This is in spite of GAVI getting vaccine manufacturers to agree to charge substantially less if they are paid in advance.

The major manufacturers have the important advantage of being able to provide rapid and reliable supplies. GAVI is clear that delays in supply cost lives. But one thing has introduced more competitive edge. Against fierce resistance from the major manufacturers, Unicef started publishing the prices for the drugs and vaccines it buys. This revealed substantial profits, in one case of around 180%.

So what about western governments’ decisions to buy vaccines? The UK must shortly decide which vaccine to buy if it is to continue its vaccination programme against human papilloma virus. The programme has been a success, according to René Verheijen (doi:10.1136/bmj.d5720). Coverage is on target at around 80% and the evidence on efficacy and safety is strong. But which is the most cost effective vaccine? In 2008 the UK chose the bivalent vaccine Cervarix. Compared with the quadrivalent vaccine Gardasil it provides greater protection against cervical cancer, but no protection against anogenital warts. As Mark Jit and colleagues reported in their modelling study in 2008 (BMJ 2008;337:a769) and again in an updated study this week (doi:10.1136/bmj.d5775), the bivalent vaccine is only cost effective if it is substantially cheaper. However, as Verhiejen says, because the price of the vaccines is confidential we don’t know whether the right decision has been made. “In the end then, the key determinant of cost effectiveness is the only factor that cannot be evaluated.”

Unicef’s brave decision to publish the price of the drugs and vaccines it buys has changed the conversation on global health. Why don’t governments, purchasing drugs and vaccines on our behalf, show equal courage

International Health : How should GAVI build on its success?
Sophie Arie
BMJ 2011;343:doi:10.1136/bmj.d5182 (Published 8 September 2011)

Extract
Immunisation programmes supported by GAVI have prevented more than five million deaths in a decade, but critics argue that the alliance could do more to bring prices down and help the most vulnerable countries. Sophie Arie reports

There are not many development organisations these days that can say they have raised the full amount of funding they need to meet their goals. But GAVI, the Global Alliance for Vaccines and Immunisation, is in that happy position only 10 years after it was created.

At GAVI’s first pledging conference in June this year, public and private donors pledged $4.3bn (£2.7bn; €3bn), bringing the alliance’s funds for 2011-15 to a total of $7.6bn. With that, the organisation says, it can achieve its aim of immunising more than 250 million of the world’s poorest children against life threatening diseases, thus preventing more than four million premature deaths by 2015. 1

Geneva based GAVI, which brings together governments of developing and donor countries, UN agencies, the World Bank, major philanthropists, and the drug industry, has prevented more than five million deaths since it began work in 2000, according to its 2011 progress report. 2

But can donors be sure that the money pledged will be spent in the best possible way? Could GAVI be vaccinating more children and saving even more lives if it did things differently?

Price concerns

Everyone agrees GAVI has made huge achievements and that vaccination is a highly efficient form of development aid. The knock on effects on the economies of recipient countries are huge in terms of children being able to attend school and become productive adults and their parents being able to work rather than care for sick and dying children.

The UK Department for International Development’s assessment of multilateral development organisations showed that GAVI was the best value in …

British Medical Journal
1 October 2011 Volume 343, Issue 7825
http://www.bmj.com/content/current

Research
Comparing bivalent and quadrivalent human papillomavirus vaccines: economic evaluation based on transmission model
Mark Jit, Ruth Chapman, Owain Hughes, Yoon Hong Choi
BMJ 2011;343:doi:10.1136/bmj.d5775 (Published 27 September 2011)

Abstract (Free full-text: http://www.bmj.com/content/343/bmj.d5775.full)
Objectives To compare the effect and cost effectiveness of bivalent and quadrivalent human papillomavirus (HPV) vaccination, taking into account differences in licensure indications, protection against non-vaccine type disease, protection against disease related to HPV types 6 and 11, and reported long term immunogenicity.

Design A model of HPV transmission and disease previously used to inform UK vaccination policy, updated with recent evidence and expanded to include scenarios where the two vaccines differ in duration of protection, cross protection, and end points prevented.

Setting United Kingdom.

Population Males and females aged 12–75 years.

Main outcome measure Incremental cost effectiveness ratios for both vaccines and additional cost per dose for the quadrivalent vaccine to be equally cost effective as the bivalent vaccine.

Results The bivalent vaccine needs to be cheaper than the quadrivalent vaccine to be equally cost effective, mainly because of its lack of protection against anogenital warts. The price difference per dose ranges from a median of £19 (interquartile range £12–£27) to £35 (£27–£44) across scenarios about vaccine duration, cross protection, and end points prevented (assuming one quality adjusted life year (QALY) is valued at £30 000 and both vaccines can prevent all types of HPV related cancers).

Conclusions The quadrivalent vaccine may have an advantage over the bivalent vaccine in reducing healthcare costs and QALYs lost. The bivalent vaccine may have an advantage in preventing death due to cancer. However, considerable uncertainty remains about the differential benefit of the two vaccines.

International Journal of Infectious Diseases
Volume 15, Issue 10  pp. e655-e730 (October 2011)
http://www.sciencedirect.com/science/journal/12019712

Correspondence
Pneumococcal vaccination and Hajj
Page e730
Philippe Gautret, Marie Bauge, Fabrice Simon, Samir Benkouiten, Philippe Parola, Philippe Brouqui

JAMA   
September 28, 2011, Vol 306, No. 12, pp 1289-1395
http://jama.ama-assn.org/current.dtl

Health Agencies Update
Toddler Flu Vaccinations
Bridget M. Kuehn
JAMA. 2011;306(12):1315.doi:10.1001/jama.2011.1376

Combining administration of intranasal and injectable influenza vaccines during the course of an infant or toddler’s vaccinations appears to be a safe and effective approach, according to a study funded by the National Institute of Allergy and Infectious Diseases.

The researchers compared the effects of 3 vaccination regimens—the injectable formulation only, the intranasal formulation only, or some combination of the 2—in 65 children aged 6 months to 36 months (Hoft DF et al. J Infect Dis. 2011;204[6]:845-853). Use of a single formulation for the prime dose and boost doses and the use of different formulations were comparable. However, only those regimens that included a dose of the intranasal formulation triggered the development of a wide array of T cells. These findings suggest that use of the intranasal vaccine in this age group may be more likely to provide cross-protection against influenza strains not included in the vaccine.

Journal of Infectious Diseases
Volume 204 Issue 9 November 1, 2011
http://www.journals.uchicago.edu/toc/jid/current

VIRUSES
Natasha Larke, Sara L. Thomas, Isabel dos Santos Silva, and Helen A. Weiss
Male Circumcision and Human Papillomavirus Infection in Men: A Systematic Review and Meta-Analysis
J Infect Dis. (2011) 204(9): 1375-1390 doi:10.1093/infdis/jir523

Abstract
Background. We systematically reviewed the evidence for an association between male circumcision and Human Papillomavirus (HPV) infection  and genital warts in men.

Methods. PubMed and Embase were searched to 15 September 2010. The measure of effect was the adjusted odds ratio (OR) or rate ratio (RR) when present and the crude estimate otherwise. Random effects meta-analyses were used to calculate summary measures of effect.

Results. We identified 23 papers about the association between circumcision and HPV DNA. Circumcised men were less likely to have prevalent genital HPV infection than uncircumcised men (summary OR, 0.57, 95% confidence interval [CI], 0.45–0.71) with between-study heterogeneity (P-heterogeneity = 0.006; I2 = 50.5%; 19 studies). Similar summary associations were seen in clinical and methodological subgroups. The effect of circumcision was stronger at the glans/corona (OR, 0.47; 95% CI, 0.37–0.60) and urethra (OR, 0.35; 95% CI, 0.12–1.05) compared with sites more distal to the foreskin. There was weak evidence that circumcision was associated with decreased HPV incidence (summary RR, 0.75, 95% CI, 0.57–0.99; 3 studies) and increased HPV clearance (summary RR, 1.33; 95% CI, 0.89–1.98; 3 studies) but no evidence of an association with prevalent genital warts (OR, 0.93, 95% CI, 0.65–1.33; 15 studies).

Conclusions. Several countries are expanding access to voluntary medical male circumcision to reduce HIV prevalence. This could provide  additional benefit in reducing HPV prevalence.

The Lancet  
Oct 01, 2011  Volume 378  Number 9798  p1197 – 1274
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Five reasons to fund the Global Fund
The Lancet

The Global Fund to Fight AIDS, Tuberculosis and Malaria is at a crossroads. Last week saw the release of the final report of the high-level independent review panel on fiduciary controls and oversight mechanisms at the Fund. The panel was set up in March to look at the way in which the Fund operates following allegations of grant fraud in several recipient countries. The panel’s report makes six broad recommendations. It calls for the Fund to move from an emergency to sustainable response, strengthen internal governance, streamline its grant approval process, develop and adopt a new risk-management framework, empower middle management’s decision making, and focus on results. Under each theme, the panel lists practical steps to be taken—eg, develop basic standards in the rules of fiduciary documentation and ethical behaviour.

The changes needed at the Fund are clearly substantial. However, as the report notes, there is “nothing that cannot be fixed by appropriate reform”. Whether governments in this era of austerity will stick by the Fund as it evolves is now a major concern. But there are good reasons for donors to keep funding the Global Fund. First, it saves lives. Programmes supported by the Fund have provided antiretroviral drugs to 3 million people, detected and treated 7·7 million cases of tuberculosis, and distributed 160 million insecticide-treated bednets, saving an estimated 6·5 million lives since 2002.   Second, the Fund gives the largest and broadest return on investment than any other financing mechanism in global health. Third, without continued and increased support, progress on the Millennium Development Goals will be curtailed, and even reversed.   Fourth, it, like no other multilateral organisation, is transparent about corruption allegations, making them public and taking swift measures to investigate. Fifth, it is   responsive to criticism and committed to continuous improvement. In response to the panel’s report, the Fund plans to accelerate organisational reforms, which will make it a more effective and efficient funding agency.

The case for continued support of the Fund is strong. As the panel’s report puts it: “Failure of the Global Fund would be a global health catastrophe.” It is a disaster that the global health community must not allow to happen.

The Lancet Infectious Disease
Oct 2011  Volume 11  Number 10  p721 – 800
http://www.thelancet.com/journals/laninf/issue/current

Editorial
Innovation for polio eradication
The Lancet Infectious Diseases

In 2010, WHO’s Director General, Margaret Chan, formed an independent monitoring board to assess progress towards achievement of the milestones of the Global Polio Eradication Initiative strategic plan 2010—12. The board’s report in April this year showed that the number of poliomyelitis cases has decreased from 350 000 in 1988 to 1294 in 2010. Endemic transmission of wild poliovirus types 1 and 3 continued only in Afghanistan, India, Nigeria, and Pakistan, the four countries in which poliovirus transmission has never been stopped. Wild poliovirus type 2 was eradicated in 1999.

Although in 2010 the number of polio cases fell by more than 90% in Nigeria and India and by 34% in Afghanistan, the situation in Pakistan was disappointing—the number of confirmed cases rose from 89 in 2009 to 144 in 2010, an increase of 62%. Pakistan has had 77 cases of poliomyelitis so far in 2011. In the first 3 months of 2011, the number of infections with wild poliovirus in Chad, the Democratic Republic of the Congo, and Pakistan was higher than was reported for the same period in 2010. The report noted that a funding gap of US$665 million exists from the $1·2 billion needed for the 2010—12 plan and concluded that the achievement of global eradication by the end of 2012 is at risk.

Poliomyelitis is an acute viral infection that affects mainly children younger than 5 years and leads to paralysis. It is not curable and can only be prevented by immunisation. In poliomyelitis-endemic countries, poliovirus types 1 and 3 both circulate. Prevention is typically through use of the oral polio vaccine (OPV). Introduction of effective immunisation strategies, such as the marking of either the front doors of houses visited by vaccinators or the fingers of children once they have been immunised, have improved the coverage of populations in poliomyelitis-endemic countries. The success of these strategies can be seen in western Uttar Pradesh, India, where, in a dense and constantly changing population, no cases of type 1 poliomyelitis have been registered for more than a year.

So what are the major challenges for the four remaining poliomyelitis-endemic countries? First, OPV might not be effective in the last phase of eradication. In Pakistan, 44% of 144 individuals with poliomyelitis reported in 2010 were given more than one dose of OPV, indicating that some pockets of the population remain unprotected after immunisation. Moreover, monovalent and trivalent vaccine is not effective against vaccine-derived type 2 poliovirus that emerged in the past 6 years in Nigeria.    Vaccination studies that combine inactivated poliomyelitis vaccine and OPV result in fewer children failing to seroconvert than those that use either vaccine alone, suggesting an innovative solution to vaccination failures.

However, the issues afflicting Pakistan and other countries in the fight against poliomyelitis are largely social. Children in these countries miss out on vaccination for several reasons, including lack of information and poor community mobilisation. Vaccine campaigns have been dogged by mistaken beliefs, such as that OPV causes infertility and illness—parental doubts about the motivation and need for vaccination campaigns also create a barrier. Members of isolated communities might be unwilling to accept vaccines from people who come from outside their community. Moreover, some parents are not aware that their children can be vaccinated with OPV and as a consequence do not seek routine vaccination. One of the greatest challenges in India and Pakistan is to reach the high risk and most vulnerable populations—those in the most remote villages with the poorest access to health care and those in Federally Administered Tribal Areas (a semi-autonomous tribal region in the northwest of Pakistan), which have been completely disrupted by conflicts. The motivation of health workers is essential for the eradication of poliomyelitis, as is communication with the people delivering vaccines to ensure they have the skills to support local needs. Health workers should work together with community mobilisation networks to increase house-to-house visits at the community and subdistrict level and build a stronger demand. And special training is needed for health workers to access the most vulnerable and isolated populations and to work with community health workers.

2012 is the landmark year for global poliomyelitis eradication. Although progress towards eradication was substantial in 2010, data from the end of 2010 and the first quarter of 2011 indicate that urgent action needs to be taken. Better commitment from both poliomyelitis eradication partners and national and local governments of affected countries will be of strategic importance to address the real social barriers and to search for more creative and innovative solutions.

The Lancet Infectious Disease
Oct 2011  Volume 11  Number 10  p721 – 800
http://www.thelancet.com/journals/laninf/issue/current

Comment
Efficacy of RTS,S malaria vaccine given with EPI vaccines
Alassane Dicko, Ogobara Doumbo

Articles
Safety and efficacy of the RTS,S/AS01E candidate malaria vaccine given with expanded-programme-on-immunisation vaccines: 19 month follow-up of a randomised, open-label, phase 2 trial
Kwaku Poku Asante, Salim Abdulla, Selidji Agnandji, John Lyimo, Johan Vekemans, Solange Soulanoudjingar, Ruth Owusu, Mwanajaa Shomari, Amanda Leach, Erik Jongert, Nahya Salim, Jose F Fernandes, David Dosoo, Maria Chikawe, Saadou Issifou, Kingsley Osei-Kwakye, Marc Lievens, Maria Paricek, Tina Möller, Stephen Apanga, Grace Mwangoka, Marie-Claude Dubois, Tigani Madi, Evans Kwara, Rose Minja, Aurore B Hounkpatin, Owusu Boahen, Kingsley Kayan, George Adjei, Daniel Chandramohan, Terrell Carter, Preeti Vansadia, Marla Sillman, Barbara Savarese, Christian Loucq, Didier Lapierre, Brian Greenwood, Joe Cohen, Peter Kremsner, Seth Owusu-Agyei, Marcel Tanner, Bertrand Lell

Summary
Background
The RTS,S/AS01E candidate malaria vaccine is being developed for immunisation of infants in Africa through the expanded programme on immunisation (EPI). 8 month follow-up data have been reported for safety and immunogenicity of RTS,S/AS01E when integrated into the EPI. We report extended follow-up to 19 months, including efficacy results.

Methods
We did a randomised, open-label, phase 2 trial of safety and efficacy of the RTS,S/AS01E candidate malaria vaccine given with EPI vaccines between April 30, 2007, and Oct 7, 2009, in Ghana, Tanzania, and Gabon. Eligible children were 6—10 weeks of age at first vaccination, without serious acute or chronic illness. All children received the EPI diphtheria, tetanus, pertussis (inactivated whole-cell), and hepatitis-B vaccines, Haemophilus influenzae type b vaccine, and oral polio vaccine at study months 0, 1, and 2, and measles vaccine and yellow fever vaccines at study month 7. Participants were randomly assigned (1:1:1) to receive three doses of RTS,S/AS01E at 6, 10, and 14 weeks (0, 1, 2 month schedule) or at 6 weeks, 10 weeks, and 9 months (0, 2, 7 month schedule) or placebo. Randomisation was according to a predefined block list with a computer-generated randomisation code. Detection of serious adverse events and malaria was by passive case detection. Antibodies against Plasmodium falciparum circumsporozoite protein and HBsAg were monitored for 19 months. This study is registered with ClinicalTrials.gov, number NCT00436007.

Findings
511 children were enrolled. Serious adverse events occurred in 57 participants in the RTS,S/AS01E 0, 1, 2 month group (34%, 95% CI 27—41), 47 in the 0, 1, 7 month group (28%, 21—35), and 49 (29%, 22—36) in the control group; none were judged to be related to study vaccination. At month 19, anticircumsporozoite immune responses were significantly higher in the RTS,S/AS01E groups than in the control group. Vaccine efficacy for the 0, 1, 2 month schedule (2 weeks after dose three to month 19, site-adjusted according-to-protocol analysis) was 53% (95% CI 26—70; p=0·0012) against first malaria episodes and 59% (36—74; p=0·0001) against all malaria episodes. For the entire study period, (total vaccinated cohort) vaccine efficacy against all malaria episodes was higher with the 0, 1, 2 month schedule (57%, 95% CI 33—73; p=0·0002) than with the 0, 1, 7 month schedule (32% CI 16—45; p=0·0003). 1 year after dose three, vaccine efficacy against first malaria episodes was similar for both schedules (0, 1, 2 month group, 61·6% [95% CI 35·6—77·1], p<0·001; 0, 1, 7 month group, 63·8% [40·4—78·0], p<0·001, according-to-protocol cohort).

Interpretation
Vaccine efficacy was consistent with the target put forward by the WHO-sponsored malaria vaccine technology roadmap for a first-generation malaria vaccine. The 0, 1, 2 month vaccine schedule has been selected for phase 3 candidate vaccine assessment.

Funding
Program for Appropriate Technology in Health Malaria Vaccine Initiative; GlaxoSmithKline Biologicals.

The Lancet Infectious Disease
Oct 2011  Volume 11  Number 10  p721 – 800
http://www.thelancet.com/journals/laninf/issue/current

Herd immunity and serotype replacement 4 years after seven-valent pneumococcal conjugate vaccination in England and Wales: an observational cohort study
Elizabeth Miller, Nicholas J Andrews, Pauline A Waight, Mary PE Slack, Robert C George

Preview
Despite much serotype replacement, a substantial reduction in invasive pneumococcal disease in young children can be achieved with PCV7 vaccination, with some indirect benefit in older age groups. Further reductions should be achievable by use of higher valency vaccines. Robust surveillance data are needed to properly assess the epidemiological effect of multivalent pneumococcal disease vaccines.

The Lancet Infectious Disease
Oct 2011  Volume 11  Number 10  p721 – 800
http://www.thelancet.com/journals/laninf/issue/current

Historical Review
Determinants of mortality in naval units during the 1918–19 influenza pandemic
G Dennis Shanks, Michael Waller, Alison MacKenzie, John F Brundage

Preview
In 1918, two waves of epidemic influenza arose with very different clinical phenotypes. During the first wave, infection rates were high but mortality was low. During the second wave, high numbers of deaths occurred and mortality differed 30–100 times among seemingly similar groups of affected adults, but the reason for this variation is unclear. In 1918, the crews of most warships and some island populations were affected by influenza during both waves of infection and had no or very few deaths during the second wave.

PLoS Medicine
(Accessed 2 October 2011)
http://www.plosmedicine.org/article/browse.action?field=date

Editorial
Why Drug Safety Should Not Take a Back Seat to Efficacy
The PLoS Medicine Editors Editorial, published 27 Sep 2011
doi:10.1371/journal.pmed.1001097

PLoS Medicine
(Accessed 2 October 2011)
http://www.plosmedicine.org/article/browse.action?field=date

Setting Research Priorities to Reduce Global Mortality from Childhood Pneumonia by 2015
Igor Rudan, Shams El Arifeen, Zulfiqar A. Bhutta, Robert E. Black, Abdullah Brooks, Kit Yee Chan, Mickey Chopra, Trevor Duke, David Marsh, Antonio Pio, Eric A.F. Simoes, Giorgio Tamburlini, Evropi Theodoratou, Martin W. Weber, Cynthia G. Whitney, Harry Campbell, Shamim A. Qazi, and the WHO/CHNRI Expert Group on Childhood Pneumonia Guidelines and Guidance, published 27 Sep 2011
doi:10.1371/journal.pmed.1001099

Summary Points
– This paper aims to identify health research priorities that could assist the rate of progress in childhood pneumonia mortality reduction globally, as set out in the United Nation’s Millennium Development Goal 4.

– The authors applied the Child Health and Nutrition Research Initiative methodology for setting priorities in health research investments. The process was coordinated by the World Health Organization.

– Forty-five leading childhood pneumonia researchers suggested more than 500 research ideas, which were merged into 158 research questions that spanned the broad spectrum of epidemiological research, health policy and systems research, improvement of existing interventions, and development of new interventions.

– Within the short time frame in which gains were expected globally, the research priorities were dominated by health systems and policy research topics (e.g., studying barriers to health care seeking and access, as well as barriers to increased coverage with available vaccines; and evaluating the potential to safely scale up antibiotic treatment through community health workers).

– These were followed by epidemiological questions to identify the main gaps in knowledge (e.g., predictors of severe pneumonia that requires hospitalisation); priorities for improvement of the existing interventions (e.g., training of community health workers to recognise danger signs, refer, and treat sick children); and identifying cost reduction mechanisms for the available conjugate vaccines.

– Among the new interventions, the greatest support was shown for the development of low-cost conjugate vaccines and cross-protective common protein vaccines against the pneumococcus.

Science Translational Medicine
28 September 2011 vol 3, issue 102
http://stm.sciencemag.org/content/current

Commentary
Policy
Disclosure of Clinical Trial Results When Product Development Is Abandoned
Michael A. Rogawski and Howard J. Federoff
28 September 2011: 102cm29

Abstract
Currently, sponsors are not required to report the outcomes of clinical research on drugs or devices that do not lead to an approved product. Consequently, the public cannot benefit from scientific information derived from all failed or abandoned drugs and devices. Provisions in the U.S. Food and Drug Administration Amendments Act of 2007 provide an opportunity for the Department of Health and Human Services to rectify this situation. By reporting the results of clinical trials of abandoned products in a publicly accessible database and in the peer-reviewed journal literature, sponsors would satisfy a core ethical obligation of clinical research and enhance translational science.