The MMWR Weekly for September 9, 2011 / Vol. 60 / No. 35 includes:
– Maternal and Infant Outcomes Among Severely Ill Pregnant and Postpartum Women with 2009 Pandemic Influenza A (H1N1) — United States, April 2009–August 2010

– Swine-Origin Influenza A (H3N2) Virus Infection in Two Children — Indiana and Pennsylvania, July–August 2011

http://www.cdc.gov/mmwr/pdf/wk/mm6035.pdf

 WHO released a new issue of GIN (Global Immunization News) dated 31 August 2011, available at: http://www.who.int/entity/immunization/GIN_August_2011.pdf

The Weekly Epidemiological Record (WER) for 9 September 2011, vol. 86, 37 (pp 401–416) includes: Revised recommendations for yellow fever vaccination for international travelers; Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2011

http://www.who.int/entity/wer/2011/wer8637.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.

GAVIAlliance GAVI Alliance
Global rollout of pneumococcal #vaccine is underway across three continents.650,000 future deaths can be averted by 2015! http://ht.ly/6qIwX

PublicHealth APHA
Health impact assessments essential for solving nation’s health problems, says National Research Council report: goo.gl/WCsnI

Eurovaccine ECDC Eurovaccine
RT @hpscireland: Over 86% of measles cases in current outbreak are in Dublin. Ensure kids are vaccinated w/ 2 MMR doses bit.ly/rsFLOl

NIAIDNews NIAID News
A new #malaria #vaccine strategy? Results of a NIAID clinical trial and follow-up animal studies, and what comes next: go.usa.gov/09e

mrcglobal MRC Global Health
Do u have an innovative idea to strengthen #public & #political support for #vaccines in LMICs? http://www.vaccinechallenge.org

HIVEnterprise HIVVaccineEnterprise
by AIDSvaccine
AIDS Vaccine 2011 (#AIDSVax11) opens 12 Sept. in Bangkok – will present the latest advances in vaccine development and testing

British Medical Journal
10 September 2011 Volume 343, Issue 7822
http://www.bmj.com/content/current

Analysis
Evidence of comparative efficacy should have a formal role in European drug approvals
Corinna Sorenson, Huseyin Naci, Jonathan Cylus, Elias Mossialos
BMJ 2011;343:doi:10.1136/bmj.d4849 (Published 6 September 2011)

Extract
Despite methodological concerns, comparative efficacy evidence should be required at the time of drug approval, says Corinna Sorenson and colleagues, to allow patients, clinicians, and other healthcare decision makers to determine whether a new drug is superior, equivalent, or inferior to its existing alternatives

Manufacturers of new drugs need to demonstrate that their products are efficacious and safe for a defined group of patients to obtain market approval. However, demonstrating these outcomes relative to existing therapies is required by regulators only when use of placebo is deemed unethical. 1 2 Regulators, clinicians, patients, and payers therefore often lack the necessary information to distinguish between available medicines in terms of their comparative therapeutic value and safety.

Comparative efficacy evidence at the time of drug approval is important, and there are methodological tools available to generate such information. When one or more treatment alternatives are available, demonstrating lack of inferiority through comparative assessment should be a formal requirement, and there are ways to support this objective in European drug licensing.

Need for comparative efficacy evidence
When a drug comes to market, evidence on the comparative risks and benefits is needed to help regulatory authorities to safeguard public health from inferior and unsafe treatments, to ensure that health technology assessment agencies and payers make funding decisions based on the best available evidence of different treatments, and to aid clinicians’ and patients’ understanding of what therapies work best and their appropriate position in the treatment pathway. 3 However, comparative assessment (box 1) is often conducted or made available only once a therapy is already on the market. This is partly because pre-marketing comparative efficacy studies entail potential uncertainty and risk for manufacturers, as failure to demonstrate a therapeutic advantage over older, and less costly, alternatives may affect drug sales or result in a drug not being approved. 2 …

Health Economics, Policy and Law 
Volume 6 – Issue 04 – 01 October 2011
http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue

Articles
Searchers vs surveyors in estimating the monetary value of a QALY: resolving a nasty dilemma for NICE
Rachel Baker, Sue Chilton, Cam Donaldson, Michael Jones-Lee, Emily Lancsar, Helen Mason, Hugh Metcalf, Mark Pennington and John Wildman

Abstract
Recently, for many health economics researchers, empirical estimation of the monetary valuation of a quality-adjusted life year (QALY) has become an important endeavour. Different philosophical and practical approaches to this have emerged. On the one hand, there is a view that, with health-care budgets set centrally, decision-making bodies within the system can iterate, from observation of a series of previous decisions, towards the value of a QALY, thus searching for such a value. Alternatively, and more consistent with the approach taken in other public sectors, individual members of the public are surveyed with the aim of directly eliciting a preference-based – also known as a willingness-to-pay-based (WTP-based) – value of a QALY. While the former is based on supply-side factors and the latter on demand, both in fact suffer from informational deficiencies. Sole reliance on either would necessitate an acceptance or accommodation of chronic inefficiencies in health-care resource allocation. On the basis of this observation, this paper makes the case that in order to approach optimal decision making in health-care provision, a framework incorporating and thus, to a degree, reconciling these two approaches is to be preferred.

Health Economics, Policy and Law 
Volume 6 – Issue 04 – 01 October 2011
http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue

Articles
Social preferences for the inclusion of indirect benefits in the evaluation of publicly funded health services: results from an Australian survey
John McKiea and Jeff Richardsona

Abstract
The inclusion of both monetary and non-monetary indirect benefits in economic evaluations of public health programmes and services can have significant distributive effects between patient groups. As a result, some patients may be advantaged and others disadvantaged for reasons not directly related to health outcomes or (direct) treatment costs. In pluralistic democracies, there is a case for consulting the community on the fairness of policies that have such distributive implications. This paper reports the results of two pilot studies aimed at uncovering the preferences of the Australian public for the inclusion of indirect benefits in the evaluation of services for its national health scheme, Medicare. The initial survey found some support for taking account of non-monetary indirect benefits – for example, the social contribution made by parents of young children and carers of elderly relatives. By contrast, there was little support for giving high taxpayers priority access to general Medicare services, to life-saving organ transplants, or to very costly drugs, despite the indirect social benefits of doing so. However, such support increased significantly in the follow-up study when the outcomes were characterised as certain, identifiable and health related, and the opportunity costs of failing to take account of indirect benefits were made very clear. The follow-up survey provided evidence of public scepticism about the willingness or ability of government to use additional tax receipts for socially beneficial purposes, and/or a preference for programmes and services that focus on health rather than welfare more generally.

The Lancet  
Sep 10, 2011  Volume 378  Number 9795  p961 – 1048
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Time for action in New York on non-communicable diseases
The Lancet

Preview
A major opportunity to advance global health is in danger of being lost. On Sept 19–20, heads of states and governments will gather in New York, NY, USA, at the UN High-Level Meeting on Non-communicable Diseases (NCDs) to approve a political statement on responding to the global NCD crisis. These diseases, principally cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases, are responsible for two-thirds of the 57 million deaths worldwide each year, with four of five NCD deaths occurring in low-income and middle-income countries; at least half these deaths are readily preventable.

Nature Medicine
September 2011, Volume 17 No 9
http://www.nature.com/nm/index.html

Editorial
Get it together
Nature Medicine 17, 1021 (2011)
doi:10.1038/nm0911-1021
Published online
07 September 2011
Global health programs have made great strides in the last ten years, mobilizing billions of dollars to provide life-saving drugs and immunizations to people in resource-poor settings. But these myriad initiatives need to get in step to improve integration of healthcare delivery

New England Journal of Medicine
September 8, 2011  Vol. 365 No. 10
http://content.nejm.org/current.shtml

Perspective
HIV Vaccine Development — Improving on Natural Immunity
Margaret I. Johnston, Ph.D., and Anthony S. Fauci, M.D.
N Engl J Med 2011; 365:873-875September 8, 2011

[Free full text]
Although a number of methods of preventing infection with the human immunodeficiency virus (HIV) have proven effective to varying degrees, it is generally agreed that a safe and effective vaccine against HIV infection would be a critical component of a highly effective prevention toolkit for controlling and ultimately ending the global AIDS pandemic. For nearly all important pathogens for which effective vaccines have been developed, such as smallpox, measles, and poliovirus, there exists a natural model of protection: the immune response to the pathogen ultimately clears the microbe from the body and confers durable protection against reinfection. Under these circumstances, the human immune system has already provided us with proof of the concept that it can generate a protective response. This fact has led to a fundamental tenet of vaccinology: the best way to develop an effective vaccine is to design a candidate that mimics infection and induces responses akin to natural immunity.

Unfortunately, this lesson does not apply to HIV infection. We have known since the mid-1980s that the body’s natural immune response to HIV infection is completely inadequate. A “natural” immune response that might adequately control HIV infection does not occur at all, occurs too rarely, is too weak, or is too slow to begin. Thus, a key goal for an effective HIV vaccine is to induce in the recipient a response that differs qualitatively, quantitatively, or both from that induced by natural infection — a response that has been referred to as “unnatural immunity.”1

Although an HIV-vaccine candidate was recently shown to be modestly protective, it induced neither broadly neutralizing antiserum nor broadly reactive cytotoxic T-cell responses against HIV. This finding raises the possibility that a modest degree of protection against HIV acquisition could be mediated by non-neutralizing mechanisms — for example, antibody-dependent cell-mediated cytotoxicity, antibody-dependent cell-mediated viral inhibition, or other responses not classically associated with vaccine efficacy.2 Nonetheless, with most viral infections, the appearance of antibodies, particularly neutralizing antibodies, correlates closely with clearance of the virus and subsequent protection from reinfection. Thus, induction of neutralizing antibodies has served as the gold standard for vaccine-induced protection against infection — and is an appropriate goal for HIV infection as well, given that passive infusion of several broadly neutralizing antibodies completely prevented virus acquisition in nonhuman primate models of AIDS.3 Although non-neutralizing antibody functions appeared to contribute somewhat to protection in this model, and although conserved regions of internal proteins could serve as important vaccine targets, an HIV vaccine that results in the production of broadly neutralizing antibodies before or very soon after exposure to HIV is likely to be highly effective. Since HIV infection does not naturally induce broadly neutralizing antibodies, a key challenge is inducing such antibodies.

Neutralizing antibodies generated during HIV infection are mostly directed toward exposed, highly variable portions of the HIV envelope protein on the viral particle. Antibodies found early in the course of HIV infection are directed at the infecting viral strain, which rapidly evolves to escape recognition. In contrast, antibodies that neutralize a broad array of HIV strains — broadly neutralizing antibodies — are directed against highly conserved regions of the envelope that are essential for viral entry into the host cell. Unfortunately, these conserved sites are recessed, hidden by glycans, partially embedded in the viral membrane, or otherwise relatively inaccessible to recognition by the immune system. For these reasons, broadly neutralizing antibodies are rarely found in the serum of acutely infected persons. When they do appear, they are detected at least 1 to 2 years after initial infection and do not seem to be clinically relevant.4

An important challenge for HIV vaccinologists is to design vaccines that induce these unnatural immune responses. The application of new research tools to the study of broadly neutralizing antibodies is helping to guide the design of vaccines that might induce such antibodies. Until recently, the body was thought to be incapable of producing these antibodies; only a few monoclonal antibodies that were broadly neutralizing had been found, and rarely were they derived from the B cells of HIV-infected patients. However, with the utilization of extremely-high-throughput screening of B-cell clones derived from HIV-infected persons, the rapid cloning of their immunoglobulin genes, and characterization of the resulting monoclonal antibodies, it became clear that many patients can indeed make broadly neutralizing antibodies.3 Unfortunately, they do so only after the establishment of persistent infection. In this regard, the ability to screen tens of millions of B-cell clones for HIV-envelope specificity has allowed researchers to isolate additional broadly neutralizing monoclonal antibodies and precisely identify their target epitopes on the HIV envelope (see figureHIV-1 Epitopes Targeted by Broadly Neutralizing Human Monoclonal Antibodies.).

A recent research focus has been on “structure-based vaccine design” — that is, applying knowledge of the crystallographic structure and conformation of the HIV-envelope epitope in the context of the binding site of a broadly neutralizing monoclonal antibody to design a vaccine that effectively presents that epitope in its relevant conformation to the immune system. Crystallographic studies have revealed that broadly neutralizing and non-neutralizing antibodies can bind to the same conserved region of the envelope in similar but subtly different ways.5 Thus, determining how to replicate the precise three-dimensional conformation of the HIV-envelope epitope as it resides in the antibody binding site will prove challenging. One approach being actively pursued is scaffolding the desired epitope onto an exposed portion of a soluble or membrane-associated protein.

However, producing an antibody with high avidity to the highly conserved regions of the HIV envelope may prove to be more complex than simply presenting the desired envelope epitope to the immune system. All potent broadly neutralizing antibodies that have been described to date have one or more unusual structural features that may result only from years of chronic viral infection and exposure to viral antigen. These structural features appear to arise through a complex evolutionary process, referred to as “somatic hypermutation,” which over time generates B cells that produce antibodies of increasingly higher avidity. Whether a B cell must undergo a long evolutionary process to produce a broadly neutralizing antibody against HIV remains uncertain. If such a process were required, that would pose a sobering challenge to HIV vaccinologists. Researchers are now dissecting the steps in this evolutionary process to understand how B cells evolve for the production of broadly neutralizing HIV antibodies and to design novel vaccines that might accelerate that process.

Thus, we have learned that the body is indeed capable of producing potent, broadly neutralizing antibodies; however, it does not do so readily or efficiently. We are optimistic that the tools of modern science will enable us to develop HIV vaccines that induce effective immune responses that do better than natural immunity and prevent HIV infection.

New England Journal of Medicine
September 8, 2011  Vol. 365 No. 10
http://content.nejm.org/current.shtml

Perspective
Global Noncommunicable Diseases — Lessons from the HIV–AIDS Experience
K.M. Venkat Narayan, M.D., Mohammed K. Ali, M.B., Ch.B., Carlos del Rio, M.D., Jeffrey P. Koplan, M.D., and James Curran, M.D.
N Engl J Med 2011; 365:876-878 September 8, 2011

[Free full text: http://www.nejm.org/doi/full/10.1056/NEJMp1107189

PLoS Medicine
(Accessed 11 September 2011)
http://www.plosmedicine.org/article/browse.action?field=date

Informing the 2011 UN Session on Noncommunicable Diseases: Applying Lessons from the AIDS Response
Peter Lamptey, Michael Merson, Peter Piot, K. Srinath Reddy, Rebecca Dirks Policy Forum, published 06 Sep 2011
doi:10.1371/journal.pmed.1001086

Summary Points
– The September 2011 UN High-Level Meeting on Noncommunicable Diseases provides an opportunity for the international community and national stakeholders to raise awareness and launch an effective global response to noncommunicable diseases (NCDs).

– Valuable policy lessons have been learned in the control of AIDS that can help inform the global dialogue when designing a NCD response in developing countries.

– The AIDS response demonstrates successes in advocacy and resource mobilization, priority setting, coalition building, strong national and community leadership, strengthening of community health infrastructures, and health systems strengthening.

– Weaknesses of the AIDS response to avoid when building a NCD response include creation of stove-pipe vertical programs, ineffectiveness of prevention efforts, and inefficient and uncoordinated use of resources.

– The lessons learned in the global response to AIDS are relevant to the likely outcomes of the UN High-Level Meeting on NCDs: (1) improvement in advocacy and recognition of the NCD burden, (2) greater attention in national planning and resource allocation, (3) a longer-term investment of donors, and (4) greater emphasis on strengthening health systems.

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

Volume 29, Issue 42 pp. 7219-7284 (23 September 2011)
The Development of Dengue Vaccines
Edited by Beth-Ann Coller, Alan D.T. Barrett and Stephen J. Thomas

Introduction
Pages 7219-7220
Beth-Ann Coller, Alan D.T. Barrett, Stephen J. Thomas

The pathogenesis of dengue
Pages 7221-7228
Jamie Whitehorn, Cameron P. Simmons

From research to phase III: Preclinical, industrial and clinical development of the Sanofi Pasteur tetravalent dengue vaccine
Pages 7229-7241
Bruno Guy, Beatrice Barrere, Claire Malinowski, Melanie Saville, Remy Teyssou, Jean Lang

Development and clinical evaluation of multiple investigational monovalent DENV vaccines to identify components for inclusion in a live attenuated tetravalent DENV vaccine
Pages 7242-7250
Anna P. Durbin, Beth D. Kirkpatrick, Kristen K. Pierce, Alexander C. Schmidt, Stephen S. Whitehead

Development of DENVax: A chimeric dengue-2 PDK-53-based tetravalent vaccine for protection against dengue fever
Pages 7251-7260
Jorge E. Osorio, Claire Y.-H. Huang, Richard M. Kinney, Dan T. Stinchcomb

Development of dengue DNA vaccines
Pages 7261-7266
Janine R. Danko, Charmagne G. Beckett, Kevin R. Porter

The development of recombinant subunit envelope-based vaccines to protect against dengue virus induced disease
Pages 7267-7275
Beth-Ann G. Coller, David E. Clements, Andrew J. Bett, Sangeetha L. Sagar, Jan H. Ter Meulen

Next generation dengue vaccines: A review of candidates in preclinical development
Pages 7276-7284
Julia Schmitz, John Roehrig, Alan Barrett, Joachim Hombach

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

Volume 29, Issue 41 pp. 7115-7218 (22 September 2011)
Vaccine Technology III: Advances in Vaccine Technology

The pdf version of Vaccines: The Week in Review  5 September 2011 comprising all the posts on this date is available here: Vaccines_The Week in Review_5 Sep 2011

WHO Disease Outbreak Report: Wild poliovirus confirmed in China

1 September 2011 – The Ministry of Health, China, has informed WHO that wild poliovirus type 1 (WPV1) has been isolated from four young children, aged between four months and two years, with onset of paralysis between 3 and 27 July 2011. All four cases are from Hetian prefecture, Xinjiang Uygur autonomous region, China. Genetic sequencing of the isolated viruses indicates they are genetically-related to viruses currently circulating in Pakistan. The last WPV case in China was reported in 1999, due to an importation from India. The last indigenous polio case occurred in China in 1994…The Ministry of Health plans to conduct an initial response vaccination campaign in early September, targeting 3.8 million children aged under 15 years in the key affected outbreak area, and children aged under 5 years in other areas of Xinjiang. http://www.who.int/csr/don/2011_09_01/en/index.html

CDC released a national survey which found that immunization rates for children 19-35 months of age for most vaccine-preventable diseases are increasing or being sustained at high levels, with rates for most of the long-standing recommended vaccines are at or above 90 percent. Anne Schuchat, M.D., director of CDC’s National Center for Immunization and Respiratory Diseases, commented, “Today’s report is reassuring because it means that most parents are protecting their young children from diseases that can cause widespread and sometimes severe harm. We recommend vaccinations because they are one of the most effective, safest ways to keep children healthy.”

The 2010 National Immunization Survey (NIS) included “more than 17,000 households looked at children born between January 2007 and July 2009. Compared with the previous year, vaccine coverage increased for many vaccine-preventable diseases, including measles, mumps and rubella, rotavirus, pneumococcal disease, hepatitis A, and Haemophilus influenza type B (Hib).  Results from the survey also indicated that vaccination coverage rates against poliovirus, varicella (chickenpox) and the full series of hepatitis B remained stable at or above 90 percent.” http://www.cdc.gov/media/releases/2011/p0901_cdc_nationalsurvey.html

Speech: Despite financial constraints, health commands support at the top of the international agenda
Dr Margaret Chan, Director-General of the World Health Organization
Address to the Regional Committee for Africa, sixty-first session, Yamoussoukro, Côte d’Ivoire
29 August 2011

http://www.who.int/dg/speeches/2011/afro_rc_2011_08_29/en/index.html

Meeting Overview: United Nations high-level meeting on noncommunicable disease prevention and control
Date: 19-20 September 2011
Place: New York, USA

Background: “Noncommunicable diseases – or NCDs – like heart attacks and strokes, cancers, diabetes and chronic respiratory disease account for over 63% of deaths in the world today. Every year, NCDs kill 9 million people under 60. The socio-economic impact is staggering. Global leaders will meet at the United Nations in New York from 19-20 September 2011 to set a new international agenda on NCDs…This is only the second time in the history of the UN that the General Assembly meets on a health issue (the last issue was AIDS). The aim is for countries to adopt a concise, action-oriented outcome document that will shape the global agendas for generations to come.”

Overview
Overview brochure
pdf, 331kb
Q&A about the meeting
pdf, 250kb

http://www.who.int/nmh/events/un_ncd_summit2011/en/index.html

The MMWR Weekly September 2, 2011 / Vol. 60 / No. 34 includes:
– National and State Vaccination Coverage Among Children Aged 19–35 Months — United States, 2010

– Human Rabies — Wisconsin, 2010

– Notes from the Field: Measles Outbreak — Indiana, June–July 2011

http://www.cdc.gov/mmwr/pdf/wk/mm6034.pdf

WHO Epidemiological Brief 16: Measles outbreaks, rotavirus surveillance and response to importation of wild poliovirus

Measles outbreaks 
…For the period January – June 2011, of the 49 countries in the European Region that reported measles data, 39 countries reported a total of 24 493 cases of measles. Due to spread from countries that are experiencing large measles outbreaks, countries that have been measles‐free for many years are now challenged with re-occurrence of the disease….

http://www.euro.who.int/__data/assets/pdf_file/0018/149211/WHO_EPI_Brief_16_Aug_2011.pdf

The Weekly Epidemiological Record (WER) for 2 September 2011, vol. 86, 36 (pp 389–400) includes: Leprosy update, 2011

http://www.who.int/entity/wer/2011/wer8636.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.

GAVIAlliance GAVI Alliance
Most of us have never encountered whooping cough. Learn more from #vaccine inventor @DrPaulOffit . http://ht.ly/6kXQO

MSF_USA Doctors w/o Borders
If you’re interested in issues around access to essential medicines, make sure you’re also following @MSF_access.

Harvard_Health HarvardGlobalHealth
This week in World Health News bitURL.net/bgy Highlights from around the World in Global Health & Public Health #Journalism

MalariaVaccine PATH MVI
Progress Fighting Malaria: A Timeline bit.ly/okAWEQ via @ucsf

globalfundnews The Global Fund
A publication: Human Rights and the Global Fund to Fight AIDS, Tuberculosis and Malaria bit.ly/n2T0Cs

gatesfoundation Gates Foundation
Borders are irrelevant: #Polio returns to China after 12 yrs. Polio anywhere is a threat everywhere: gates.ly/oHWAa6

AIDSvaccine IAVI
If you missed IAVI’s policy brief on opps to accelerate #AIDS #vaccine R&D in #China, read it here: bit.ly/n2KK6k #globalhealth #HIV

British Medical Journal
3 September 2011 Volume 343, Issue 7821
http://www.bmj.com/content/current

Feature
Commentary: UN high level meeting on non-communicable diseases: an opportunity for whom?
David Stuckler, Sanjay Basu, Martin McKee,

Extract
In September, world leaders will meet at the United Nations in New York to discuss non-communicable diseases. 1 A decade ago, at a similar meeting on HIV/AIDS, they created the Global Fund for HIV/AIDS, Tuberculosis and Malaria—a revolutionary new global health funding mechanism. 2

The September meeting will focus on four leading conditions—heart disease, cancer, diabetes, and respiratory disease—that together cause more than half of all deaths in low and middle income countries. 3 Without action, the number of premature deaths (age < 60) caused by non-communicable diseases is expected to rise from 3.8 million each year to 5.1 million in poor countries by 2030, trapping a generation of families in cycles of poverty and disease. 4 5 6 As Thomas Frieden, director of the US Centers for Disease Control and Prevention, recently stated, developing countries must immediately tackle the rapid rise of non-communicable diseases because they will “kill four times as many people by 2020 as infectious diseases.” 7

Hopes are high that the UN meeting will mark a turning point and avoid the belated response that hampered HIV strategies. Progress on HIV required not only technical discussions about which drugs work and how to make them cost effective; it also needed to tackle the broader ethical, social, and political dimensions of the HIV pandemic. 8

Throughout the process, the imperative to act was presented as one of social justice. It emphasised that HIV was a manifestation of inequalities in power and resources. Efforts by drug companies to protect long term patents on antiretroviral drugs were met by activists fighting for access to treatment and declaring that human lives in poor countries were just as valuable as those in rich ones…

Clinical Infectious Diseases
Volume 53 Issue 7 October 1, 2011
http://www.journals.uchicago.edu/toc/cid/current

ARTICLES AND COMMENTARIES
J. Anthony G. Scott, John Ojal, Lindsey Ashton, Anne Muhoro, Polly Burbidge, and David Goldblatt
Pneumococcal Conjugate Vaccine Given Shortly After Birth Stimulates Effective Antibody Concentrations and Primes Immunological Memory for Sustained Infant Protection
Clin Infect Dis. (2011) 53(7): 663-670 doi:10.1093/cid/cir444

Immunization of Kenyan newborns with 7-valent pneumococcal conjugate vaccine is safe and immunogenic. Compared with the Expanded Programme on Immunization schedule beginning at 6 weeks, it stimulates similar antibody concentrations at 18 weeks and induces equal responses to a 9-month booster dose.

[Free full text: http://cid.oxfordjournals.org/content/53/7/663.full ]

Human Vaccines
Volume 7, Issue 9   September 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/8/

Research Papers
Acceptability of school requirements for human papillomavirus vaccine
Jennifer S. Smith, Noel T. Brewer, Yuli Chang, Nicole Liddon, Sarah Guerry, Erica Pettigrew, Lauri E. Markowitz and Sami L. Gottlieb

We characterized parental attitudes regarding school HPV vaccination requirements for adolescent girls. Study participants were 889 parents of 10-18 year-old girls in areas of North Carolina with elevated cervical cancer incidence. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) by logistic regression. Approximately half (47%) of parents agreed that laws requiring HPV immunization for school attendance “are a good idea” when opt-out provisions were not mentioned. Far more agreed that “these laws are okay only if parents can opt out if they want to” (84%). Predictors of supporting requirements included believing HPV vaccine is highly effective against cervical cancer (OR=2.5, 95%CI:1.7-5.0) or is more beneficial if provided at an earlier age (OR=16.1, 95%CI:8.4-30.9). Parents were less likely to agree with vaccine requirements being a good idea if they expressed concerns related to HPV vaccine safety (OR=0.3, 95%CI:0.1-0.5), its recent introduction (OR=0.3,95%CI:0.2-0.6), or its potential to increase their daughters’ sexual activity (OR=0.4,95%CI:0.2-0.6). Parental acceptance of school requirements appears to depend on perceived HPV vaccine safety and efficacy, understanding of the optimal age for vaccine administration, and inclusion of opt-out provisions

Human Vaccines
Volume 7, Issue 9   September 2011
http://www.landesbioscience.com/journals/vaccines/toc/volume/7/issue/8/

Commentaries
Adverse events following immunization: Easily preventable in developing countries
Ramesh Verma, Pardeep Khanna, Mohan Bairwa, Suraj Chawla, Shankar Prinja and Meena Rajput

The development of vaccines is one of the most important achievements in public health for reducing morbidity and mortality due to communicable diseases in children. As the incidence of vaccine-preventable diseases is reduced by vaccination, the general public becomes increasingly concerned about the safety associated with vaccines. BCG, DPT, Polio, Measles, Hepatitis B, Hib and their various combinations may cause transient minor adverse events including swelling, redness or soreness at the injection site, and low-grade fever, crying and irritability (in infants). The adverse events caused by an error/accident in vaccination programs as these relate to manufacturing, handling, cold chain maintenance, vaccination schedule or administration are program errors. They are generally preventable and detract from the overall benefit of the immunization program.

AEFI (adverse event following immunization) surveillance allows the vaccination program to monitor the occurrence of adverse events and to differentiate the true from the false AEFI. The system will also ensures quality by monitoring program error, increasing public confidence, and helping to develop capacity to manage ‘crisis’ events within the vaccination program. These incidents, which result in needless deaths or life-threatening illness and damage to vaccination programs, should be generally preventable if proper reconstitution of vaccines and proper handling procedures are followed.

International Journal of Infectious Diseases
Volume 15, Issue 9 pp. e583-e654 (September 2011)
http://www.sciencedirect.com/science/journal/12019712

Reviews
Europe’s neglected infections of poverty
Pages e611-e619
Peter J. Hotez, Meredith Gurwith

Summary
Objectives
To review the prevalence, incidence, and geographic distribution of the major neglected infections of poverty in Europe as a basis for future policy recommendations.

Methods
We reviewed the literature from 1999 to 2010 for neglected tropical diseases listed by PLoS Neglected Tropical Diseases (http://www.plosntds.org/static/scope.action) and the geographic regions and countries of (continental) Europe. Reference lists of identified articles and reviews were also hand searched, as were World Health Organization databases.

Results

In Eastern Europe, the soil-transmitted helminth infections (especially ascariasis, trichuriasis, and toxocariasis), giardiasis, and toxoplasmosis remain endemic. High incidence rates of selected food-borne helminthiases including trichinellosis, opisthorchiasis, taeniasis, and echinococcosis also occur, while brucellosis and leptospirosis represent important bacterial zoonoses. Turmoil and economic collapse following the war in the Balkans, the fall of Communism, and Europe’s recent recession have helped to promote their high prevalence and incidence rates. In Southern Europe, vector-borne zoonoses have emerged, including leishmaniasis and Chagas disease, and key arboviral infections. Additional vulnerable populations include the Roma, orphans destined for international adoption, and some immigrant groups.

Conclusions
Among the policy recommendations are increased efforts to determine the prevalence, incidence, and geographic distribution of Europe’s neglected infections, epidemiological studies to understand the ecology and mechanisms of disease transmission, and research and development for new control tools.

Journal of Infectious Diseases
Volume 204 Issue 7 October 1, 2011
http://www.journals.uchicago.edu/toc/jid/current

EDITORIAL COMMENTARIES
Roger I. Glass
Editor’s Choice: Unexpected Benefits of Rotavirus Vaccination in the United States
J Infect Dis. (2011) 204(7): 975-977 doi:10.1093/infdis/jir477

The large-scale introduction of a new vaccine can uncover many secrets and surprises about the epidemiology of disease that might not be discovered in any other way. Examination of the outcome of a vaccine introduction can validate prior assumptions concerning the burden of disease and the economic consequences of the vaccination program, as well as determine herd effects of the program arising from either a reduction in the environmental load of the infectious agent or a decrease in the group of susceptibles that might blunt transmission of the agent. In this issue of the Journal, Lopman et al document the impact of the introduction of rotavirus vaccines in the United States and find some surprises that could not have been fully anticipated or predicted in advance [ 1].

In 2006, the United States introduced a new rotavirus vaccine that was immediately recommended for the routine immunization of all children [ 2]. Uptake was slow at first but by 2008, about 60% of American infants were being immunized. Small local surveys of diarrheal illnesses in children <2 years who had been immunized indicated a substantial reduction in hospitalizations and emergency room visits [ 3– 8], outcomes predicted by the large clinical trials that determined the vaccine’s efficacy to be 85% or more against severe disease [ 9, 10]. However, this was not the whole story. Lopman et al at the Centers for Disease Control and Prevention have analyzed a large database covering approximately 20% of all US hospital admissions and looked at the numbers of discharges coded for diarrhea due to rotavirus or for any unspecified cause among children from 0 to 24 years of age. They compared baseline rates of these …

[Full Text of this Article]

MAJOR ARTICLES AND BRIEF REPORTS
Ben A. Lopman, Aaron T. Curns, Catherine Yen, and Umesh D. Parashar
Editor’s Choice: Infant Rotavirus Vaccination May Provide Indirect Protection to Older Children and Adults in the United States
J Infect Dis. (2011) 204(7): 980-986 doi:10.1093/infdis/jir492

Abstract
Following the introduction of rotavirus vaccination in the United States, rotavirus and cause-unspecified gastroenteritis discharges significantly decreased in 2008 in the 0–4, 5–14, and 15–24-year age groups, with significant reductions observed in March, the historic peak rotavirus month, in all age groups. We estimate that 15% of the total 66 000 averted hospitalizations and 20% of the $204 million in averted direct medical costs attributable to the vaccination program were among unvaccinated 5–24 year-olds. This study demonstrates a previously unrecognized burden of severe rotavirus in the population >5 years and the primacy of very young children in the transmission of rotavirus.

New England Journal of Medicine
September 1, 2011  Vol. 365 No. 9
http://content.nejm.org/current.shtml

Global Health: Health Technologies and Innovation in the Global Health Arena
S.R. Sinha and M. Barry
[Free full text]

Extract
In recent years, interest in both global health and health care innovation has grown tremendously, and there has been increasing recognition of the importance of medical devices and other nonpharmaceutical health-related technologies to all aspects of health care. In 2007, for example, the World Health Organization (WHO) issued the first global directive on medical devices, recognizing that, like medicines, many health technologies are indispensible. Many appropriate technologies, however, are inaccessible to the majority of people who need them, particularly in low- and middle-income countries — largely because of capacity constraints, a perception that medical devices are out of the reach of or superfluous to developing countries, and the lack of assiduous, multidisciplinary needs assessment and innovation promotion in such countries.

The recognition that the “right to health” should include access to certain devices comes more than 30 years after similar recognition for essential medicines…

Pediatrics
September 2011, VOLUME 128 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml

Pediatrics Perspective
The First Measles Vaccine
Jeffrey P. Baker
Pediatrics 2011; 128:435-437

Extract [first 20%]
Like in the more familiar story of polio vaccine, the development of the first successful live attenuated vaccine against measles began in the laboratory of John Enders. One of the greatest virologists of the 20th century, Enders pioneered the technique of viral tissue culture, which makes it possible to grow viruses in vitro in cells nourished in laboratory media. 1 In 1949, he and his pediatric infectious disease fellows Thomas Weller and Frederick Robbins showed that poliovirus could be cultivated in tissue of nonneuronal origins, a discovery that set the stage for the first successful vaccines against the disease and led to a Nobel Prize in 1954. 2 Enders himself was a remarkable character. He never tried to patent his work or share results with the media before peer review. He was consistently generous in sharing his knowledge with potential competitors, and despite his personal wealth he was equally known for his frugality; fellows learned to wash their own glassware, and every year the “chief” returned unspent grant money to the National Institutes of Health. Above all, Enders took seriously the role of mentor, rounding each day beside the benches of his select group of fellows with his bow tie, vest, and jacket asking, “Well, what’s new?” A positive response was often rewarded by an hour-long conversation. 3

In 1954, while the national field trials of Jonas Salk’s polio vaccine captivated media attention, Enders and pediatrician Thomas Peebles successfully cultivated measles virus in human kidney cell culture for the first time. 4 Ever-ingenious in finding sources for his tissue cultures, Enders obtained kidneys from a neurosurgeon colleague who treated hydrocephalus by performing a unilateral nephrectomy and connecting a shunt to carry cerebrospinal fluid to the ureter. Peebles traveled the Boston, Massachusetts, area with a throat swab in search of measles …

Pediatrics
September 2011, VOLUME 128 / ISSUE 3
http://pediatrics.aappublications.org/current.shtml

Articles
Use of Models to Identify Cost-effective Interventions: Pertussis Vaccination for Pediatric Health Care Workers
Amy L. Greer and David N. Fisman
Pediatrics 2011; 128:e591-e599

Abstract
OBJECTIVE: Acellular pertussis vaccine is safe and effective in adults. An explicit recommendation for pertussis booster vaccination in pediatric health care workers is based on the importance of health care workers as a potential source of infection for patients. However, limited information is available on the economic attractiveness of this intervention. We sought to evaluate the health-economic attractiveness of a diphtheria-tetanus-acellular pertussis booster vaccination program for health care workers in a pediatric intensive care setting.

METHODS: We developed a Markov model to calculate the cost-effectiveness of vaccinating NICU health care workers in different proportions ranging from the current strategy of no pertussis booster vaccination program to a vaccination program that achieves between 25% and 95% vaccine coverage.

RESULTS: Implementation of a vaccination program that achieves 25% coverage was projected to be cost-saving compared with no vaccine program. At all coverage levels the intervention reduced costs, increased life expectancy, and was cost-effective. Projections were most sensitive to the risk of a pertussis introduction via an infected health care worker. Once the monthly risk of an introduction exceeded ∼0.3%, implementation of an immunization program with at least 25% coverage provided both greater health and greater economic benefits than having no vaccine program.

CONCLUSIONS: The implementation of a hospital-based and funded diphtheria-tetanus-acellular pertussis vaccine program administered through an occupational health program is cost-effective or cost-saving in the context of pediatric health care facilities in which many of the patients are at risk of serious morbidity and mortality should they acquire pertussis while hospitalized.

PLoS One
[Accessed 4 September 2011]
http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date
Avian Influenza Risk Perception and Preventive Behavior among Traditional Market Workers and Shoppers in Taiwan: Practical Implications for Prevention
Pei-Chun Kuo, Jiun-Hau Huang, Ming-Der Liu avian influenza, influenza vaccination, and use PLoS ONE: Research Article, published 02 Sep 2011 10.1371/journal.pone.0024157

Abstract 
Background
Avian influenza (AI) can be highly pathogenic and fatal. Preventive behavior such as handwashing and wearing face masks has been recommended. However, little is known about what psychosocial factors might influence people’s decision to adopt such preventive behavior. This study aims to explore risk perception and other factors associated with handwashing and wearing face masks to prevent AI.

Methodology/Principal Findings

An interviewer-administered survey was conducted among 352 traditional market workers and shoppers in Taiwan between December 2009 and January 2010. Factors associated with the recommended AI preventive behavior (i.e., when in a traditional market, wearing a face mask and also washing hands after any contact with poultry) included: having correct knowledge about the fatality rate of AI (adjusted odds ratio [AOR] = 4.18), knowing of severe cases of AI (AOR = 2.13), being informed of local AI outbreaks (AOR = 2.24), living in northeastern Taiwan (AOR = 6.01), having a senior high-school education (AOR = 3.33), and having a university or higher education (AOR = 6.86). Gender interactive effect was also found among participants with a senior high-school education, with males being less likely to engage in the recommended AI preventive behavior than their female counterparts (AOR = 0.34).

Conclusions/Significance
Specific information concerning AI risk perception was associated with the recommended AI preventive behavior. In particular, having correct knowledge about the fatality rate of AI and being informed of severe cases and local outbreaks of AI were linked to increased AI preventive behavior. These findings underscore the importance of transparency in dealing with epidemic information. These results also have practical implications for prevention and policy-making to more effectively promote the recommended AI preventive behavior in the public.

Vaccine
Volume 29, Issue 40 pp. 6823-7114 (16 September 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Overview of the Clinical Consult Case Review of adverse events following immunization: Clinical Immunization Safety Assessment (CISA) network 2004–2009
Pages 6920-6927
S. Elizabeth Williams, Nicola P. Klein, Neal Halsey, Cornelia L. Dekker, Roger P. Baxter, Colin D. Marchant, Philip S. LaRussa, Robert C. Sparks, Jerome I. Tokars, Barbara A. Pahud, Laurie Aukes, Kathleen Jakob, Silvia Coronel, Howard Choi, Barbara A. Slade, Kathryn M. Edwards

Abstract
Background
In 2004 the Clinical Consult Case Review (CCCR) working group was formed within the CDC-funded Clinical Immunization Safety Assessment (CISA) Network to review individual cases of adverse events following immunizations (AEFI).

Methods
Cases were referred by practitioners, health departments, or CDC employees. Vaccine Adverse Event Reporting System (VAERS) searches and literature reviews for similar cases were performed prior to review. After CCCR discussion, AEFI were assessed for a causal relationship with vaccination and recommendations regarding future immunizations were relayed back to the referring physicians. In 2010, surveys were sent to referring physicians to determine the utility and effectiveness of the CCCR service.

Results
CISA investigators reviewed 76 cases during 68 conference calls between April 2004 and December 2009. Almost half of the cases (35/76) were neurological in nature. Similar AEFI for the specific vaccines received were discovered for 63 cases through VAERS searches and for 38 cases through PubMed searches. Causality assessment using the modified WHO criteria resulted in classifying 3 cases as definitely related to vaccine administration, 12 as probably related, 16 as possibly related, 18 as unlikely related, 10 as unrelated, and 17 had insufficient information to assign causality. The physician satisfaction survey was returned by 30 (57.7%) of those surveyed and a majority of respondents (93.3%) felt that the CCCR service was useful.

Conclusions
The CCCR provides advice about AEFI to practitioners, assigns potential causality, and contributes to an improved understanding of adverse health events following immunizations

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 38 pp. 6427-6720 (2 September 2011)

Commentary
Response to the 2009 pandemic: Effect on influenza control in wealthy and poor countries
Pages 6427-6431
Arnold S. Monto, Steven Black, Stanley A. Plotkin, Walter A. Orenstein

Abstract
The declaration by the World Health Organization (WHO) that appearance of a swine-origin novel influenza virus in 2009 represented a pandemic was based on previously adopted guidelines and the new International Health Regulations. Severity of the pandemic was not part of the definition used, but it was stated to be less than severe at the time of declaration. It was necessary, when there was still uncertainty about the overall impact of the pandemic, for vaccine production to begin to have timely availability. Countries arranged to have vaccine for their populations, and WHO attempted to secure supplies for under-resourced countries.

The world had been concerned that the next pandemic might be a severe one, based on the specter of avian influenza with a case fatality of up to 80% in humans. After it was clear that the 2009 pandemic was not severe, there were accusations, especially in Europe, that countries had secured vaccine supplies mainly to benefit the manufacturers. Such charges, even when refuted, may undermine public confidence in the process which assures vaccine supply and availability of vaccine for seasonal use.

Production of pandemic vaccine is conditioned on the supply of seasonal influenza vaccine; it is unrealistic to expect vaccine to be available for pandemic use when none is used for seasonal influenza. This particularly applies to poorer counties. They have traditionally not recognized that influenza is a problem, although this attitude is changing. As we go forward, we need to keep in mind the global nature of the threat of influenza. Had the 2009 pandemic been more severe, demand would have been greater and poorer counties would have had little vaccine to meet their needs. Only by taking a broad view of influenza on an annual basis can vaccine supplies be ensured for all countries of the world.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 38 pp. 6427-6720 (2 September 2011)

Meeting Report
WHO Working Group discussion on revision of the WHO recommendations for the production and control of poliomyelitis vaccines (oral): TRS Nos. 904 and 910. Report of Meeting held on 20–22 July 2010, Geneva, Switzerland
Pages 6432-6436
Javier Martin, Catherine Milne, Philip Minor, Konstantin Chumakov, Maria Baca-Estrada, Jacqueline Fournier Caruana, Tiequn Zhou

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 38 pp. 6427-6720 (2 September 2011)

Regular Papers
Cost-effectiveness of conjugate pneumococcal vaccination in Singapore: Comparing estimates for 7-valent, 10-valent, and 13-valent vaccines
Pages 6686-6694
Karen Richards Tyo, Melissa M. Rosen, Wu Zeng, Mabel Yap, Keng Ho Pwee, Li Wei Ang, Donald S. Shepard

Abstract
Introduction
Although multiple studies of cost-effectiveness of pneumococcal conjugate vaccines have been conducted, no such study has examined Singapore’s situation nor compared the licensed conjugate vaccines in an Asian population. This paper estimates the costs and public health impacts of pneumococcal conjugate vaccine programs, varying estimates of serotype replacement and herd immunity effects as key parameters in the analysis. Based in part on a 2008 analysis also presented here, Singapore has approved the PCV-7, PHiD-10, and PCV-13 pneumococcal conjugate vaccines as part of its National Childhood Immunisation Programme.

Methods
An economic evaluation was performed using a Markov simulation model populated with Singapore-specific population parameters, vaccine costs, treatment costs, and disease incidence data. The vaccinated infant and child cohort of 226,000 was 6% of the Singapore resident population of 3.8 million. Vaccine efficacy estimates were constructed for PCV-7, PHiD-10, and PCV-13 vaccines based on their serotype coverage in Singapore and compared to ‘no vaccination’. The model estimated impacts over a five-year time horizon with 3% per year discounting of costs and health effects. Costs were presented in 2010 U.S. dollars (USD) and Singapore dollars (SGD). Sensitivity analyses included varying herd immunity, serotype replacement rates, vaccine cost, and efficacy against acute otitis media.

Results
Under base case assumptions for the revised analysis (i.e., herd effects in the unvaccinated population equivalent to 20% of direct effects) PCV-13 prevented 834 cases and 7 deaths due to pneumonia, meningitis, and bacteremia in the vaccinated population, and 952 cases and 191 deaths in the unvaccinated population over the 5-year time horizon. Including herd effects, the cost-effectiveness ratio for PCV-13 was USD $37,644 (SGD $51,854) per QALY. Without herd effects, however, the ratio was USD $204,535 (SGD $281,743) per QALY. The PCV-7 cost per QALY including herd effects was USD $43,275 (SGD $59,610) and for PHiD-10 the ratios were USD $45,100 (SGD $62,125). The original 2008 analysis, which had higher estimates of pneumonia prevention due to herd immunity and lower estimates of cost per dose, had found a cost-effectiveness ratio of USD $5562 (SGD $7661) per QALY for PCV-7.

Conclusions
When compared to cost-effectiveness thresholds recommended by the World Health Organization (WHO), our 2008 analysis found that vaccination of infants in Singapore with PCV-7 was very cost-effective if herd immunity effects were present. However, knowledge on herd immunity and serotype replacement that emerged subsequent to this analysis changed our expectations about indirect effects. Given these changed inputs, our current estimates of infant vaccination against pneumococcal disease in Singapore find such programs to be moderately cost-effective compared to WHO thresholds. The different findings from the 2008 and 2011 analyses suggest that the dynamic issue of serotype replacement should be monitored post-licensure and, as changes occur, vaccine effectiveness and cost-effectiveness analyses should be re-evaluated.

Vaccine
http://www.sciencedirect.com/science/journal/0264410X
Volume 29, Issue 38 pp. 6427-6720 (2 September 2011)

Cost-effectiveness of rotavirus vaccination in Bolivia from the state perspective
Pages 6704-6711
Emily R. Smith, Emily E. Rowlinson, Volga Iniguez, Kizee A. Etienne, Rosario Rivera, Nataniel Mamani, Rick Rheingans, Maritza Patzi, Percy Halkyer, Juan S. Leon

Abstract
Background

In Bolivia, in 2008, the under-five mortality rate is 54 per 1000 live births. Diarrhea causes 15% of these deaths, and 40% of pediatric diarrhea-related hospitalizations are caused by rotavirus illness (RI). Rotavirus vaccination (RV), subsidized by international donors, is expected to reduce morbidity, mortality, and economic burden to the Bolivian state. Estimates of illness and economic burden of RI and their reduction by RV are essential to the Bolivian state’s policies on RV program financing. The goal of this report is to estimate the economic burden of RI and the cost-effectiveness of the RV program.

Methods
To assess treatment costs incurred by the healthcare system, we abstracted medical records from 287 inpatients and 6751 outpatients with acute diarrhea between 2005 and 2006 at 5 sentinel hospitals in 4 geographic regions. RI prevalence rates were estimated from 4 years of national hospital surveillance. We used a decision-analytic model to assess the potential cost-effectiveness of universal RV in Bolivia.

Results
Our model estimates that, in a 5-year birth cohort, Bolivia will incur over US$3 million in direct medical costs due to RI. RV reduces, by at least 60%, outpatient visits, hospitalizations, deaths, and total direct medical costs associated with rotavirus diarrhea. Further, RV was cost-savings below a price of US$3.81 per dose and cost-effective below a price of US$194.10 per dose. Diarrheal mortality and hospitalization inputs were the most important drivers of rotavirus vaccine cost-effectiveness.

Discussion
Our data will guide Bolivia’s funding allocation for RV as international subsidies change.

Editor’s Note: Vaccines: The Week in Review resumes publication today covering the period 9 – 29 August 2011 following a vacation break. 

The pdf version of Vaccines: The Week in Review  29 August 2011 comprising the posts for this date below is available here: Vaccines_The Week in Review_29 Aug 2011

The European Regional Certification Commission for Poliomyelitis Eradication (RCC) announced that Europe will retain its polio-free status after the importation of wild poliovirus type 1 in 2010. At their 25th meeting in Copenhagen, Denmark this week, the RCC “noted that wild poliovirus transmission has been interrupted. No new cases have been reported since September 2010 because countries have taken effective action.” Zsuzsanna Jakab, WHO Regional Director for Europe, commented, “The RCC decision is tremendous news for the Region and a credit to all the Member States and partners that individually, collectively and promptly combated the first and largest outbreak of poliomyelitis the Region has seen since it was declared polio free in 2002. I am also very pleased that the hard work and personal commitments of the presidents, prime ministers and health ministers have produced this success, which shows the importance and value of political commitment and joint action. The WHO Regional Office for Europe will continue to work with Member States so that Europe remains vigilant and the polio-free status of the Region is sustained”. In 2010, four countries, Kazakhstan, the Russian Federation, Tajikistan and Turkmenistan, reported 475 laboratory-confirmed cases of wild poliovirus type 1, with 30 deaths.

http://www.euro.who.int/en/what-we-publish/information-for-the-media/sections/latest-press-releases/polio-kicked-out-of-europe-european-region-to-retain-polio-free-status,-but-constant-vigilance-is-needed

IOM Consensus Report: Adverse Effects of Vaccines: Evidence and Causality

Released: August 25, 2011
Board: Board on Population Health and Public Health Practice

Abstract: Immunizations are a cornerstone of the nation’s efforts to protect people from a host of infectious diseases. Though generally very rare or minor, there are side effects, or “adverse effects,” associated with some vaccines. Importantly, some adverse events following a vaccine may be due to coincidence and are not caused by the vaccine. To make this distinction, researchers use evidence to determine if adverse events following vaccination are causally linked to a specific vaccine; if so, these events are referred to as adverse effects. The Health Resources and Services Administration asked the IOM to review a list of adverse events associated with eight vaccines—varicella zoster, influenza (except 2009 H1N1), hepatitis B, HPV, MMR, hepatitis A, meningococcal, and those that contain tetanus—and evaluate the scientific evidence about the event–vaccine relationship. The IOM committee appointed to this task was not asked to assess the benefits or effectiveness of vaccines but only the risk of specific adverse events.

Using epidemiologic and mechanistic evidence, the committee developed 158 causality conclusions and assigned each relationship between a vaccine and an adverse health problem to one of four categories of causation:
– Evidence convincingly supports a causal relationship
– Evidence favors acceptance of a causal relationship
– Evidence favors rejection of a causal relationship
– Evidence is inadequate to accept or reject a causal relationship

The committee finds that evidence convincingly supports a causal relationship between some vaccines and some adverse events—such as MMR, varicella zoster, influenza, hepatitis B, meningococcal, and tetanus-containing vaccines linked to anaphylaxis. Additionally, evidence favors rejection of five vaccine-adverse event relationships, including MMR vaccine and autism and inactivated influenza vaccine and asthma episodes. However, for the majority of cases (135 vaccine-adverse event pairs), the evidence was inadequate to accept or reject a causal relationship. Overall, the committee concludes that few health problems are caused by or clearly associated with vaccines.

Supporting content:
– Graphic: Strength of Evidence that Determined the Causality Conclusions (PDF, HTML)

– Press Release (HTML)

– Report Brief (PDF, HTML)

– Table: Summary of Causality Conclusions (PDF)

http://www.iom.edu/Reports/2011/Adverse-Effects-of-Vaccines-Evidence-and-Causality.aspx

The Japan International Cooperation Agency (JICA) and the Bill & Melinda Gates Foundation announced “a strategic partnership to ensure continued progress in the fight against polio,” including “an innovative financing agreement to support the polio campaign in Pakistan.”  The financing agreement “represents a significant contribution towards the goal of eradication of polio in Pakistan. Based on the Global Polio Eradication Initiative’s (GPEI) current cost estimates, this 4.9 billion JPY (approximately $65 million) ODA Loan(1) to the government of Pakistan will help ensure that polio eradication activities in Pakistan are financed through 2013.”

Bill Gates commented, “This partnership comes at a critical time for Pakistan and will help us achieve our shared goal of a polio-free world. Japan’s remarkable commitment will benefit generations of children in Pakistan and throughout the world.” The announcement noted that Japan’s ODA loan will provide the country with funds for oral polio vaccine, immunization workers, and vaccination activities across the country and along the Pakistan/Afghanistan border. It will also involve working in partnership with stakeholders such as the World Bank for co-financing as well as the United Nations Children’s Fund (UNICEF) for vaccine procurement and the World Health Organization (WHO) for service delivery of the polio campaign.

The loan is “underpinned by an innovative financing approach referred to as a “Loan Conversion” mechanism. According to this model, the Gates Foundation will repay the credit to JICA on behalf of the Pakistani government if the project is successfully implemented. The aim of this mechanism is to support the government of Pakistan’s commitment to polio eradication without imposing a financial burden.”

http://www.prnewswire.com/news-releases/the-japan-international-cooperation-agency-jica-and-the-bill–melinda-gates-foundation-announce-partnership-on-polio-eradication-127978458.html

The U.S. HHS department awarded US$137 million to states to “to strengthen the public health infrastructure and provide jobs in core areas of public health. Awarded in nearly every state, the grants enhance state, tribal, local and territorial efforts to provide tobacco cessation services, strengthen public health laboratory and immunization services, (and) prevent healthcare-associated infections…”   The awards include:

– US$1 million to further enhance the nations’ public health laboratories by hiring and preparing scientists for careers in public health laboratories, providing training for scientists, and supporting public health initiatives related to infectious disease research.

– More than US$42 million to support: improvements to the Immunization Information Systems (registries) and other immunization information technologies; development of systems to improve billing for immunization services; planning and implementation of adult immunization programs; enhancement of vaccination capacity located in schools; and evaluations of the impact on disease of recent vaccine recommendations for children and adolescents.

– US$2.6 million to the Emerging Infections Programs around the country to continue improvement in disease monitoring, professional development and training, information technology development, and laboratory capacity.

– US$9.2 million to eight national non-profit professional public health organizations to assist state, tribal, local, and territorial health departments in adopting effective practices that strengthen their core public health systems and service delivery. They will also enhance the workforce by providing jobs in critical disciplines of epidemiology and informatics, thus attracting new talent to public health.

A full list of grantees is available at: http://www.hhs.gov/news/press/2011pres/08/state_prevention_grants.html

http://www.businesswire.com/news/home/20110825006099/en/HHS-awards-137-million-states-boost-prevention

    The Saudi Ministry of Health issued the entry visa requirements and other recommendations for the Hajj and Umra season in 2011, specifying health conditions for travelers to the Kingdom of Saudi Arabia for the pilgrimage to Mecca (Hajj). The Saudi Ministry of Health “plays a critical role in the management of the annual Hajj pilgrimage which occurs over a five-day period during “Dhul-Hijjah,” the final month of the Islamic calendar and is the world’s largest annual mass gathering, attracting 2-3 million pilgrims every year.”

Highlights from the full guidelines [http://www.jiph.org/article/S1876-0341%2811%2900051-7/fulltext] include:

– Yellow Fever: All travelers arriving from countries or areas at risk of yellow fever must present a valid yellow fever vaccination certificate showing that the person was vaccinated at least 10 days previously and not more than 10 years before arrival at the border.

– Meningococcal Meningitis: Visitors arriving for the purpose of Umra or pilgrimage or for seasonal work are required to produce a certificate of vaccination with the quadrivalent (ACYW135) vaccine against meningitis issued not more than 3 years previously and not less than 10 days before arrival in to Saudi Arabia.

– Poliomyelitis: All travelers arriving from polio-endemic countries and re-established transmission countries should receive 1 dose of OPV.

– Seasonal Influenza: International pilgrims should be vaccinated against seasonal influenza before arrival into Saudi Arabia with WHO approved strains specific to the northern or southern hemispheres. In Saudi Arabia, seasonal influenza vaccine is recommended for internal pilgrims, particularly those with pre-existing health conditions, and all staff working in the Hajj premises.

– Health Education: Health authorities in countries of origin are required to provide information to pilgrims on infectious diseases symptoms, methods of transmission, complications, and means of prevention.

– International Outbreaks Responses: Updating immunization against vaccine-preventable diseases in all travelers is strongly recommended.

His Excellency Dr. Abdullah Al Rabeeah, Saudi Minister of Health, stated, “The Department of Preventive Medicine at the Ministry of Health develops and updates these guidelines every year in close coordination with the International Health Regulations Coordination Department at WHO. This is carried out after critical review of the global situation of endemic and emerging communicable diseases, to ensure the establishment of evidence based guidelines to protect and prevent disease transmission among pilgrims and the global community.”

http://www.prnewswire.com/news-releases/2011-health-conditions-for-travel-to-mecca-hajj-pilgrimage-published-128232393.html

   The Bill & Melinda Gates Foundation announced Round 8 of its Grand Challenges Explorations, “a US$100 million grant initiative to encourage innovation in global health and development research.” The initiative “offers scientists, inventors, and entrepreneurs from around the world the opportunity to win $100,000 grants to pursue unconventional ideas that could transform health and agricultural development in the world’s poorest countries.” The topics in this round are:

– Protect Crop Plants from Biotic Stresses From Field to Market

– Explore Nutrition for Healthy Growth of Infants and Children

– Apply Synthetic Biology to Global Health Challenges

– Design New Approaches to Optimize Immunization Systems

– Explore New Solutions in Global Health Priority Areas

http://www.gatesfoundation.org/press-releases/Pages/round-eight-grand-challenges-explorations-110823.aspx

The MMWR Weekly issues from the last several weeks include:

August 26, 2011 / Vol. 60 / No. 33
– National and State Vaccination Coverage Among Adolescents Aged 13 Through 17 Years — United States, 2010

– Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011

– Announcement: Clinical Vaccinology Course — November 4–6, 2011

August 19, 2011 / Vol. 60 / No. 32 / Pg. 1073 – 1116
– Influenza Vaccination Coverage Among Pregnant Women — United States, 2010–11 Influenza Season

– Influenza Vaccination Coverage Among Health-Care Personnel — United States, 2010–11 Influenza Season
Summary
Although influenza vaccination levels have improved over the past few years, vaccination coverage among health-care personnel (HCP) remains below our 2020 national health objectives. All HCP should be vaccinated annually for influenza, according to recommendations from the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). In a national survey conducted in April 2011 of 1,931 HCP, influenza vaccination coverage among all HCP for the 2010-11 season was 63.5 percent, with coverage of 84 percent among physicians and 70 percent among nurses.  Near universal coverage was achieved among HCP who reported being subject to an employer requirement for vaccination.  In the absence of requirements, increased vaccination coverage was associated with vaccination being offered to HCP onsite free of charge for multiple days.  Influenza vaccination coverage among HCP is important for patient safety, and healthcare administrators should make vaccination readily accessible to all HCP as an important part of any comprehensive infection control program.

August 12, 2011 / Vol. 60 / No. 31 / Pg. 1045 – 1072
Progress Toward Poliomyelitis Eradication — Nigeria, January 2010–June 2011

The Weekly Epidemiological Record (WER) for 12 and 18 August 2011, include:

19 August 2011, vol. 86, 34 (pp 365–376)
– Outbreak news: Outbreak of illness in schools, Angola; West Nile virus infection in Europe
– Neglected zoonotic diseases: report from the third international conference, November 2010
– Yellow fever in the WHO African and American Regions, 2010

12 August 2011, vol. 86, 33 (pp 353–364)
– Third meeting of the Global Polio Eradication Initiative’s Independent Monitoring Board
– Progress towards eradicating poliomyelitis – Nigeria, January 2010–June 2011
– Monthly report on dracunculiasis cases, January–June 2011

Twitter Watch
A selection of items of interest [tracking to 19 August 2011] from a variety of twitter feeds. This capture is highly selective and by no means intended to be exhaustive.

PIH Partners In Health
New Report: Financing the Response to #AIDS in Low & Middle Income Countries http://ow.ly/6dZY7 via @unaids @KaiserFamFound

GAVIAlliance GAVI Alliance
Want to learn more about IFFIm? Check out our overview to learn more. http://ht.ly/6dyDt

GAVISeth Seth Berkley
A reminder of why vaccination campaigns in refugee camps are critically important: bit.ly/nShN9p  #vaccines @UNICEF

NIAIDNews NIAID News
Now online! CDC recommends seasonal #flu #shot for people with egg #allergy go.usa.gov/k7M

USAIDGH USAID
Happy birthday to Dr. Sabin! developer of oral #polio #vaccine that made prospect of #eradication possible. http://ow.ly/6dCtS

PublicHealth APHA
Vaccination rates among teens are up overall, but growth lags on HPV vaccine, says CDC research: goo.gl/pVS4Z

wellcometrust Wellcome Trust
Immunising at birth is safe and effective against severe pneumococcal disease wellc.me/mXBZk1

Eurovaccine ECDC Eurovaccine
‘Vaccinations : 20 objections and responses’ from Germany’s Robert Koch Institute & Paul-Ehrlich-Institute bit.ly/oUzWPN

gatesfoundation Gates Foundation
Congratulations to #Europe: @UN hails the #EU for fighting outbreaks to remain free of #polio: gates.ly/oEuTCy

MalariaVaccine PATH MVI
New Vision article discusses the need for the Ugandan government to prepare for a malaria vaccine: bit.ly/omdjqb

PATHtweets PATH
PATH CEO Chris Elias on @ModernizeAid blog: Budget cuts threaten lives abroad and the economy at home. http://ow.ly/6cORL

GAVISeth Seth Berkley
Robert Steinglass of @JSIhealth interviewed on how to improve #vaccine delivery #coldchain: ht.ly/6aaJu via @gplushealth

GAVIAlliance GAVI Alliance
“The dispassionate economic case for vaccination looks at least as strong as the compassionate medical one” The Economist http://ht.ly/69Mlz

sabinvaccine Sabin Vaccine Inst.
Today on Sabin’s blog: Immunization Financing in Latin America sabin.org/blog/immunizat…

unpublications UN Publications
On World Humanitarian Day UN pays tribute to aid workers around globe. Learn more about the campaign here: bit.ly/9wy17n

British Medical Journal
http://www.bmj.com/content/current
13 August 2011 Volume 343, Issue 7819

 Irrelevant” WHO outpaced by younger rivals
Nigel Hawkes, freelance journalist

Extract
The World Health Organization’s critics accuse it of being bogged down in red tape and internal politics. However, attempts at reform are raising concerns over conflicts of interest. Nigel Hawkes reports

For as long as many can remember, the World Health Organization has been facing a crisis. From decade to decade, the nature of that crisis might change, but it never quite goes away.

Despite its past accomplishments, WHO fits increasingly uneasily into a world with a growing number of international players who seem fleeter of foot and deeper of pocket. Set up as an agency to provide advice to governments at a time when government health departments were the prime movers in health policy and delivery, it seems passé beside such upstarts as the Global Fund to Fight Aids, Tuberculosis and Malaria, the GAVI Alliance (formerly known as the Global Alliance for Vaccines and Immunization), and private philanthropies such as the Bill and Melinda Gates Foundation.

Setting the agenda of global health?
The existence of such organisations is a reproach to WHO, whose bureaucracy and politicisation have been increasingly bypassed by governments in the interests of getting something done. Jack C Chow, a former assistant director general of WHO, claimed last year that the organisation was becoming irrelevant. 1 It was outmoded, underfunded, and overly politicised, he said. “WHO is no longer setting the agenda of global health; it’s struggling to keep up.” His theme was echoed this year by Barry R Bloom, professor of public health at Harvard, who pointed out that of WHO’s budget of $3.9bn (£2.4bn; €2.7bn) in 2008-9, less than $1bn came from member states’ mandatory contributions. 2 The rest were earmarked funds provided by countries or foundations for specific projects, indicating a lack of confidence in WHO’s ability to set the right priorities if left to itself…

Clinical Infectious Diseases
http://www.journals.uchicago.edu/toc/cid/current
Volume 53 Issue 5 September 1, 2011

Crossing Borders: One World, Global Health
Clive M. Brown, Martin S. Cetron, Section Editors
An editorial feature on globally mobile populations and infectious disease outbreaks, written by the Centers for Disease Control and Prevention’s Division of Global Migration and Quarantine

An End to the Era of the US HIV Entry Ban
(Kent Taylor and Stacy Howard)—

In 1991 human immunodeficiency virus (HIV) infection was added to the list of diseases that bar entry to the United States (US) for non-US citizens as a requirement stipulated by congressional statute. Under the Immigration and Nationality Act, the Secretary of Health and Human Services (HHS) has the authority to establish requirements for the medical examination of immigrants and refugees that determine admission into the United States. These requirements are promulgated in Title 42, Part 34 of the Code of Federal Regulations (CFR), which includes specific, serious contagious illnesses, known as a communicable disease of public health significance. Almost 20 years after the inclusion of HIV on this list of diseases, this action has been reversed. The reversal was made possible by ending the statutory ban imposed by Congress in 1987.

In 2004, the Joint United Nations Programme on HIV/AIDS (UN/AIDS) and the International Organization for Migration issued a statement on HIV/AIDS-related travel restrictions. This statement provided guidance to governments in addressing the public health, economic, and human rights concerns involved in HIV-related travel restrictions. As more information became available about HIV transmission, which cannot take place through casual contact, combined with the reality of globalization, this entry ban became increasingly contradictory to US policies supporting civil liberties. In addition, the ban was detrimental in the fight against HIV/AIDS. After a thorough medical and epidemiologic review of HIV transmission, the Centers for Disease Control and Prevention (CDC) made a policy decision that an entry ban for HIV infection was not a viable control strategy for HIV.

CDC initiated the first step in removing HIV infection as an inadmissible condition by …

[Full Text of this Article]