Journal of Infectious Diseases
Volume 203 Issue 12 June 15, 2011
http://www.journals.uchicago.edu/toc/jid/current

MAJOR ARTICLES AND BRIEF REPORTS – VIRUSES
Joanne M. Langley, George Risi, Michael Caldwell, Larry Gilderman, Bruce Berwald, Charles Fogarty, Terry Poling, Dennis Riff, Mira Baron, Louise Frenette, Eric Sheldon, Harry Collins, Marc Shepard, Marc Dionne, Daniel Brune, Linda Ferguson, David Vaughn, Ping Li, and Louis Fries

Dose-Sparing H5N1 A/Indonesia/05/2005 Pre-pandemic Influenza Vaccine in Adults and Elderly Adults: A Phase III, Placebo-Controlled, Randomized Study
J Infect Dis. (2011) 203(12): 1729-1738 doi:10.1093/infdis/jir172

Abstract
Background. Highly pathogenic avian influenza H5N1 viruses remain a threat to human health, with potential to become pandemic agents.

Methods.This phase III, placebo-controlled, observer-blinded study evaluated the immunogenicity, cross-reactivity, safety, and lot  consistency of 2 doses of oil-in-water (AS03A) adjuvanted H5N1 A/Indonesia/05/2005 (3.75 μg hemagglutinin antigen) prepandemic candidate vaccine in 4561 adults aged 18–91 years.

Results. Humoral  antibody responses in the H5N1 vaccine groups fulfilled US and European immunogenicity licensure criteria for pandemic vaccines in all age strata 21 days after the second dose. At 6 months after the administration of the primary dose, serum antibody seroconversion rates continued to fulfill licensure criteria. Neutralizing cross-clade immune responses were demonstrated against clade 1 A/Vietnam/1194/2004. Consistency was demonstrated for 3 consecutive H5N1 vaccine lots. Temporary injection-site pain was more frequent with H5N1 vaccine than placebo (89.3% and 70.7% in the 18–64 and ≥65 years strata vs 22.2% and 14.4% in the placebo groups). Unsolicited adverse event frequency, including medically attended and serious events, was similar between groups through day 364.

Conclusions. In adults and elderly adults, AS03 A-adjuvanted H5N1 candidate vaccine was highly immunogenic for A/Indonesia/05/2005, with cross-reactivity against A/Vietnam/1194/2004. Temporary injection site reactions were more frequent with H5N1 vaccine than placebo, although the H5N1 vaccine was well tolerated overall.

Clinical Trials Registration. NCT00616928.

[Free full-text: http://jid.oxfordjournals.org/content/203/12/1729.full ]

The Lancet  
May 28, 2011  Volume 377  Number 9780  Pages 1807 – 1890
http://www.thelancet.com/journals/lancet/issue/current

Series
Maternal and child health in Brazil: progress and challenges
Cesar G Victora, Estela ML Aquino, Maria do Carmo Leal, Carlos Augusto Monteiro, Fernando C Barros, Celia L Szwarcwald

Preview
In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5·5% a year in the 1980s and 1990s, and by 4·4% a year since 2000 to reach 20 deaths per 1000 live births in 2008.

Successes and failures in the control of infectious diseases in Brazil: social and environmental context, policies, interventions, and research needs
Mauricio L Barreto, M Gloria Teixeira, Francisco I Bastos, Ricardo AA Ximenes, Rita B Barata, Laura C Rodrigues

Summary
Despite pronounced reductions in the number of deaths due to infectious diseases over the past six decades, infectious diseases are still a public health problem in Brazil. In this report, we discuss the major successes and failures in the control of infectious diseases in Brazil, and identify research needs and policies to further improve control or interrupt transmission. Control of diseases such as cholera, Chagas disease, and those preventable by vaccination has been successful through efficient public policies and concerted efforts from different levels of government and civil society. For these diseases, policies dealt with key determinants (eg, the quality of water and basic sanitation, vector control), provided access to preventive resources (such as vaccines), and successfully integrated health policies with broader social policies. Diseases for which control has failed (such as dengue fever and visceral leishmaniasis) are vector-borne diseases with changing epidemiological profiles and major difficulties in treatment (in the case of dengue fever, no treatment is available). Diseases for which control has been partly successful have complex transmission patterns related to adverse environmental, social, economic, or unknown determinants; are sometimes transmitted by insect vectors that are difficult to control; and are mostly chronic diseases with long infectious periods that require lengthy periods of treatment.

The Lancet Infectious Disease
Jun 2011  Volume 11  Number 6  Pages 417 – 488
http://www.thelancet.com/journals/laninf/issue/current

Comment
Is screening immigrants for latent tuberculosis cost-effective?
Anna M Mandalakas, Dick Menzies

Preview
The International Organization for Migration has estimated that more than 200 million individuals are permanently living in a country that is not their country of birth,1 and most have migrated from low-income and middle-income to high-income countries. In high-income countries, tuberculosis in the native-born population has declined rapidly and tuberculosis in foreign-born individuals accounts for an ever increasing proportion of the disease because many migrants carry latent tuberculosis infection that reactivates after arrival.

The Lancet Infectious Disease
Jun 2011  Volume 11  Number 6  Pages 417 – 488
http://www.thelancet.com/journals/laninf/issue/current

Outer-membrane-vesicle vaccines: old but not forgotten
David S Stephens

Preview
The Gram-negative bacterial pathogen serogroup B Neisseria meningitidis remains a worldwide cause of meningococcal disease. In The Lancet Infectious Diseases today, Caron and colleagues1 report on a meningococcal serogroup B clonal sequence type (ST)-32 outbreak in France, and the use of a serogroup B outer-membrane-vesicle vaccine designed 20 years earlier in Norway for the outbreak of a different but related ST-32 outbreak strain, which had the same PorA serosubtype. Although several issues complicated the study1 and its implementation (ie, vaccine shortages and manufacturing delays, different schedules in different age groups, and small numbers), the data support the conclusion that the previously designed and assessed vaccine had a positive effect in control of the new outbreak.

The Lancet Infectious Disease
Jun 2011  Volume 11  Number 6  Pages 417 – 488
http://www.thelancet.com/journals/laninf/issue/current

Articles
Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis
Manish Pareek, John P Watson, L Peter Ormerod, Onn Min Kon, Gerrit Woltmann, Peter J White, Ibrahim Abubakar, Ajit Lalvani

Summary
Background
Continuing rises in tuberculosis notifications in the UK are attributable to cases in foreign-born immigrants. National guidance for immigrant screening is hampered by a lack of data about the prevalence of, and risk factors for, latent tuberculosis infection in immigrants. We aimed to determine the prevalence of latent infection in immigrants to the UK to define which groups should be screened and to quantify cost-effectiveness.

Methods
In our multicentre cohort study and cost-effectiveness analysis we analysed demographic and test results from three centres in the UK (from 2008 to 2010) that used interferon-γ release-assay (IGRA) to screen immigrants aged 35 years or younger for latent tuberculosis infection. We assessed factors associated with latent infection by use of logistic regression and calculated the yields and cost-effectiveness of screening at different levels of tuberculosis incidence in immigrants’ countries of origin with a decision analysis model.

Findings
Results for IGRA-based screening were positive in 245 of 1229 immigrants (20%), negative in 982 (80%), and indeterminate in two (0·2%). Positive results were independently associated with increases in tuberculosis incidence in immigrants’ countries of origin (p=0·0006), male sex (p=0·046), and age (p<0·0001). National policy thus far would fail to detect 71% of individuals with latent infection. The two most cost-effective strategies were to screen individuals from countries with a tuberculosis incidence of more than 250 cases per 100 000 (incremental cost-effectiveness ratio [ICER] was £17 956 [£1=US$1·60] per prevented case of tuberculosis) and at more than 150 cases per 100 000 (including immigrants from the Indian subcontinent), which identified 92% of infected immigrants and prevented an additional 29 cases at an ICER of £20 819 per additional case averted.

Interpretation
Screening for latent infection can be implemented cost-effectively at a level of incidence that identifies most immigrants with latent tuberculosis, thereby preventing substantial numbers of future cases of active tuberculosis.

Funding
Medical Research Council and Wellcome Trust.

The Lancet Infectious Disease
Jun 2011  Volume 11  Number 6  Pages 417 – 488
http://www.thelancet.com/journals/laninf/issue/current

From tailor-made to ready-to-wear meningococcal B vaccines: longitudinal study of a clonal meningococcal B outbreak
François Caron, Isabelle Parent du Châtelet, Jean-Philippe Leroy, Corinne Ruckly, Myriam Blanchard, Nicole Bohic, Nathalie Massy, Isabelle Morer, Daniel Floret, Valérie Delbos, Eva Hong, Martin Révillion, Gilles Berthelot, Ludovic Lemée, Ala-Eddine Deghmane, Jacques Bénichou, Daniel Lévy-Bruhl, Muhamed-Kheir Taha

Summary
Background
Outer-membrane-vesicle vaccines for meningococcal B outbreaks are complex and time consuming to develop. We studied the use of already available vaccine to control an outbreak caused by a genetically close strain.

Methods
From 2006 to 2009, all individuals younger than 20 years living in the region of Normandy, France, in which an outbreak caused by a B:14:P1.7,16 strain occurred, were eligible to receive MenBvac, a Norwegian vaccine designed 20 years earlier against a strain sharing the same serosubtype (B:15:P1.7,16). The immunogenicity (in a randomly selected cohort of 400 children aged 1—5 years), safety, and epidemiological effect of the vaccination were assessed.

Findings
26 014 individuals were eligible to receive the vaccine. Shortage of vaccine production prompted start of the campaign in the highest incidence groups (1—5 years). 16 709 (64%) received a complete vaccination schedule of whom 13 589 (81%) received a 2+1 dose schedule (week 0, week 6, and month 8). At 6 weeks after the third dose, of 235 vaccinees for whom samples were available, 206 (88%) had a seroresponse, and 108 (56 %) of 193 had a seroresponse at 15 months. These results were similar to those described for tailor-made vaccines and their homologous strain. Only previously described adverse effects occurred. The incidence of B:14:P1.7,16 cases decreased significantly in the vaccine targeted population after the primary vaccination period (from 31·6 per 100 000 to 5·9 per 100 000; p=0·001).

Interpretation
The ready-to-wear approach is reliable if epidemic and vaccine strains are genetically close. Other meningococcal B clonal outbreaks might benefit from this strategy; and previously described outer-membrane-vesicle vaccines can be effective against various strains.

Funding: French Ministry of Health.

The Lancet Infectious Disease
Jun 2011  Volume 11  Number 6  Pages 417 – 488
http://www.thelancet.com/journals/laninf/issue/current

Personal View
New approaches to the assessment of vaccine herd protection in clinical trials
John Clemens, Sunheang Shin, Mohammad Ali

Summary
Criteria for the introduction of new vaccines into routine public health practice are becoming increasingly stringent. For vaccines that are expensive and those that provide moderate protection, the ability to confer herd protection could be crucial to policy deliberations about vaccine introduction. Traditionally, herd protection has been assessed after a vaccine is introduced, delaying the availability of data on herd effects to inform decisions about vaccine introduction. New methodological developments now provide the possibility to assess herd protection before the introduction of a vaccine into public health programmes. One approach is a cluster-randomised trial, which allows assessment of herd protection in a way that minimises biases. Analysis of individually randomised trials by appropriately selected clusters created post hoc can also provide measurements of herd protection. Here we discuss the use of these designs, which can generate an improved evidence base at an early stage for making decisions about the introduction of new vaccines.

Medical Decision Making (MDM)
May/June 2011; 31 (3)
http://mdm.sagepub.com/content/current

Risk Communication
Ellen Peters, P. Sol Hart, and Liana Fraenkel
Informing Patients: The Influence of Numeracy, Framing, and Format of Side Effect Information on Risk Perceptions
Med Decis Making May/June 2011 31: 432-436, first published on December 29, 2010 doi:10.1177/0272989X10391672

Abstract
Background. Given the importance of effective patient communication, findings about influences on risk perception in nonmedical domains need replication in medical domains. Objective. To examine whether numeracy influences risk perceptions when different information frames and number formats are used to present medication risks. Methods. The authors manipulated the frame and number format of risk information in a 3 (frame: positive, negative, combined) × 2 (number format: frequency, percentage) design. Participants from an Internet sample (N = 298), randomly assigned to condition, responded to a single, hypothetical scenario. The main effects and interactions of numeracy, framing, and number format on risk perception were measured. Results. Participants given the positive frame perceived the medication as less risky than those given the negative frame. Mean risk perceptions for the combined frame fell between the positive and negative frames. Numeracy did not moderate these framing effects. Risk perceptions also varied by number format and numeracy, with less-numerate participants given risk information in a percentage format perceiving the medication as less risky than when given risk information in a frequency format; highly numerate participants perceived similar risks in both formats. The generalizability of the findings is limited due to the use of non-patients, presented a hypothetical scenario. Given the design, one cannot know whether observed differences would translate into clinically significant differences in patient behaviors. Conclusions. Frequency formats appear to increase risk perceptions over percentage formats for less-numerate respondents. Health communicators need to be aware that different formats generate different risk perceptions among patients varying in numeracy.

Debra Sprague, Donna L. LaVallie, Fredric M. Wolf, Clemma Jacobsen, Kirsten Sayson, and Dedra Buchwald
Influence of Graphic Format on Comprehension of Risk Information among American Indians
Med Decis Making May/June 2011 31: 437-443, first published on December 29, 2010 doi:10.1177/0272989X10391096

Abstract
Background. Presentation of risk information influences patients’ ability to interpret health care options. Little is known about this relationship between risk presentation and interpretation among American Indians. Methods. Three hundred American Indian employees on a western American Indian reservation were invited to complete an anonymous written survey. All surveys included a vignette presenting baseline risk information about a hypothetical cancer and possible benefits of 2 prevention plans. Risk interpretation was assessed by correct answers to 3 questions evaluating the risk reduction associated with the plans. Numeric information was the same in all surveys, but framing varied; half expressed prevention benefits in terms of relative risk reduction and half in terms of absolute risk reduction. All surveys used text to describe the benefits of the 2 plans, but half included a graphic image. Surveys were distributed randomly. Responses were analyzed using binary logistic regression with the robust variance estimator to account for clustering of outcomes within participant. Results. Use of a graphic image was associated with higher odds of correctly answering 3 risk interpretation questions (odds ratio = 2.5, 95% confidence interval = 1.5–4.0, P < 0.001) compared to the text-only format. These findings were similar to those of previous studies carried out in the general population. Neither framing information as relative compared to absolute risk nor the interaction between graphic image and relative risk presentation was associated with risk interpretation. Conclusion. One type of graphic image was associated with increased understanding of risk in a small sample of American Indian adults. The authors recommend further investigation of the effectiveness of other types of graphic displays for conveying health risk information to this population.

Mirta Galesic and Rocio Garcia-Retamero
Graph Literacy: A Cross-Cultural Comparison
Med Decis Making May/June 2011 31: 444-457, first published on July 29, 2010 doi:10.1177/0272989X10373805

Abstract
Background. Visual displays are often used to communicate important medical information to patients. However, even the simplest graphs are not understood by everyone. Objective. To develop and test a scale to measure health-related graph literacy and investigate the level of graph literacy in the United States and Germany. Design. Experimental and questionnaire studies. Setting. Computerized studies in the laboratory and on probabilistic national samples in the United States and Germany. Participants. Nationally representative samples of people 25 to 69 years of age in Germany (n = 495) and the United States (n = 492). Laboratory pretest on 60 younger and 60 older people. Measurements. Psychometric properties of the scale (i.e., reliability, validity, discriminability) and level of graph literacy in the two countries. Results. The new graph literacy scale predicted which patients can benefit from visual aids and had promising measurement properties. Participants in both countries completed approximately 9 of 13 items correctly (in Germany, x¯ = 9.4, s = 2.6; in the United States, x¯ = 9.3, s = 2.9). Approximately one third of the population in both countries had both low graph literacy and low numeracy skills. Limitations. The authors focused on basic graph literacy only. They used a computerized scale; comparability with paper-and-pencil versions should be checked. Conclusions. The new graph literacy scale seems to be a suitable tool for assessing whether patients understand common graphical formats and shows that not everyone profits from standard visual displays. Research is needed on communication formats that can overcome the barriers of both low numeracy and graph literacy.

Nature  
Volume 473 Number 7348 pp419-550  26 May 2011
http://www.nature.com/nature/current_issue.html

Special Issue: Vaccines: New Promises, Old Doubts

Editorial
It is easy to see the heroic age of vaccines as one that ended decades ago. The Salk polio vaccine, after all, which swiftly and visibly transformed the disease into a distant memory in the developed world, was introduced in 1955. And the smallpox eradication campaign led by the World Health Organization had, by the late 1970s, reduced the virus from a killer of millions of people a year to a prisoner of biosafety labs. These were monumental feats, but the best could be still to come.

This week Nature explores the undiminished promise of vaccines, and the factors that threaten it — complacency, funding shortages and the unease that vaccines provoke in so many people.

Online collection

Worldwide, up to one-third of all deaths of children under five result from diarrhoea and pneumonia. In the past ten years or so, vaccines against the microorganisms that cause many of these cases have become a standard part of the childhood regimen in the developed world. If they could be made available worldwide, the lives of hundreds of thousands of children could be saved each year.

Research efforts are adding to the promise. Together, AIDS, malaria and tuberculosis kill more people each year than smallpox did when the global campaign to eradicate it began in 1967. The search for vaccines for all three diseases has been long and frustrating, but a Perspective on page 463 describes how new technologies are reviving it.

There is no room for complacency. The global campaign to eradicate polio made stunning progress from 1988 to the end of the twentieth century, reducing worldwide incidence by 99%. But the disease continues to smoulder in Pakistan, India, Afghanistan and Nigeria, where vaccinators have struggled with turmoil and corruption, high transmission rates and suspicion about the vaccine itself (see pages 427and 446).

Similarly, a long vaccination campaign against measles has reduced the global death toll from more than 2.5 million a year in 1980 to fewer than 200,000 today. But vaccination rates are still below 80% in much of Africa and India, and funds pledged to the global measles initiative have fallen. Some people think that the disease is poised to surge again in the developing world (see page 434). Europe has already seen outbreaks, in part because vaccination rates dipped after the combined measles, mumps and rubella (MMR) vaccine was falsely linked to autism.

Vaccines can become victims of their own success. In the developed world, for example, vaccination has already reduced measles to a rarity, which makes an ‘informed’ choice to shun the vaccine seem risk free. Even doctors and nurses can fall prey to this reasoning. They have a disproportionate influence over whether parents vaccinate their children, and when they lose sight of the overwhelming ratio of benefit to risk for most vaccines, they can amplify public fears (see page 443). Back in the 1950s, ’60s, and ’70s, when vaccines offered protection against clear and present menaces, it was easier to accept their small risk of harm.

Designing a cheap, effective vaccine against the more complex major killers of today is a harder task, and people everywhere are quicker to question the official line, on vaccines as on everything else. But the promise for vaccines to transform global health is as bright as ever, and funders and public-health experts must continue their heroic support for research, global vaccination efforts and communication strategies to win over the doubters.

Vaccines: The case of measles
Great advances in the development and distribution of vaccines mean that some diseases can be eradicated. Measles is an important case study: efforts to stem the disease have been successful, but uneven political commitment, lack of funds and public fear threaten to undermine the progress.

Vaccines: The real issues in vaccine safety
Hysteria about false vaccine risks often overshadows the challenges of detecting the real ones.
Roberta Kwok

Vaccines: His best shot
Can Bruce Walker transform HIV vaccine research?
Corie Lok

Comment
Target the fence-sitters
Past waves of vaccine rejection in industrialized nations have a lot to teach us about preventing future ones, argues Julie Leask.

Lessons from polio eradication
Ridding the world of polio requires a global initiative that tailors strategies to communities, say Heidi J. Larson and Isaac Ghinai.

New England Journal of Medicine
May 26, 2011  Vol. 364 No. 21
http://content.nejm.org/current.shtml

Original Articles
Bacterial Meningitis in the United States, 1998–2007
M.C. Thigpen and Others

Background
The rate of bacterial meningitis declined by 55% in the United States in the early 1990s, when the Haemophilus influenzae type b (Hib) conjugate vaccine for infants was introduced. More recent prevention measures such as the pneumococcal conjugate vaccine and universal screening of pregnant women for group B streptococcus (GBS) have further changed the epidemiology of bacterial meningitis.

Methods
We analyzed data on cases of bacterial meningitis reported among residents in eight surveillance areas of the Emerging Infections Programs Network, consisting of approximately 17.4 million persons, during 1998–2007. We defined bacterial meningitis as the presence of H. influenzae, Streptococcus pneumoniae, GBS, Listeria monocytogenes, or Neisseria meningitidis in cerebrospinal fluid or other normally sterile site in association with a clinical diagnosis of meningitis.

Results
We identified 3188 patients with bacterial meningitis; of 3155 patients for whom outcome data were available, 466 (14.8%) died. The incidence of meningitis changed by −31% (95% confidence interval [CI], −33 to −29) during the surveillance period, from 2.00 cases per 100,000 population (95% CI, 1.85 to 2.15) in 1998–1999 to 1.38 cases per 100,000 population (95% CI 1.27 to 1.50) in 2006–2007. The median age of patients increased from 30.3 years in 1998–1999 to 41.9 years in 2006–2007 (P<0.001 by the Wilcoxon rank-sum test). The case fatality rate did not change significantly: it was 15.7% in 1998–1999 and 14.3% in 2006–2007 (P=0.50). Of the 1670 cases reported during 2003–2007, S. pneumoniae was the predominant infective species (58.0%), followed by GBS (18.1%), N. meningitidis (13.9%), H. influenzae (6.7%), and L. monocytogenes (3.4%). An estimated 4100 cases and 500 deaths from bacterial meningitis occurred annually in the United States during 2003–2007.

Conclusions
The rates of bacterial meningitis have decreased since 1998, but the disease still often results in death. With the success of pneumococcal and Hib conjugate vaccines in reducing the risk of meningitis among young children, the burden of bacterial meningitis is now borne more by older adults.

(Funded by the Emerging Infections Programs, Centers for Disease Control and Prevention.)
Presented in part at the 43rd annual meeting of the Infectious Diseases Society of America, San Francisco, October 6–9, 2005.
Supported by the Emerging Infections Programs, Centers for Disease Control and Prevention, Atlanta.

PLoS Medicine
(Accessed 29 May 2011)
http://www.plosmedicine.org/article/browse.action?field=date

Characterizing the Epidemiology of the 2009 Influenza A/H1N1 Pandemic in Mexico
Gerardo Chowell, Santiago Echevarría-Zuno, Cécile Viboud, Lone Simonsen, James Tamerius, Mark A. Miller, Víctor H. Borja-Aburto Research Article, published 24 May 2011
doi:10.1371/journal.pmed.1000436

Abstract
Mexico’s local and national authorities initiated an intense public health response during the early stages of the 2009 A/H1N1 pandemic. In this study we analyzed the epidemiological patterns of the pandemic during April–December 2009 in Mexico and evaluated the impact of nonmedical interventions, school cycles, and demographic factors on influenza transmission.

Methods and Findings
We used influenza surveillance data compiled by the Mexican Institute for Social Security, representing 40% of the population, to study patterns in influenza-like illness (ILIs) hospitalizations, deaths, and case-fatality rate by pandemic wave and geographical region. We also estimated the reproduction number (R) on the basis of the growth rate of daily cases, and used a transmission model to evaluate the effectiveness of mitigation strategies initiated during the spring pandemic wave. A total of 117,626 ILI cases were identified during April–December 2009, of which 30.6% were tested for influenza, and 23.3% were positive for the influenza A/H1N1 pandemic virus. A three-wave pandemic profile was identified, with an initial wave in April–May (Mexico City area), a second wave in June–July (southeastern states), and a geographically widespread third wave in August–December. The median age of laboratory confirmed ILI cases was ~18 years overall and increased to ~31 years during autumn (p<0.0001). The case-fatality ratio among ILI cases was 1.2% overall, and highest (5.5%) among people over 60 years. The regional R estimates were 1.8–2.1, 1.6–1.9, and 1.2–1.3 for the spring, summer, and fall waves, respectively. We estimate that the 18-day period of mandatory school closures and other social distancing measures implemented in the greater Mexico City area was associated with a 29%–37% reduction in influenza transmission in spring 2009. In addition, an increase in R was observed in late May and early June in the southeast states, after mandatory school suspension resumed and before summer vacation started. State-specific fall pandemic waves began 2–5 weeks after school reopened for the fall term, coinciding with an age shift in influenza cases.

Conclusions
We documented three spatially heterogeneous waves of the 2009 A/H1N1 pandemic virus in Mexico, which were characterized by a relatively young age distribution of cases. Our study highlights the importance of school cycles on the transmission dynamics of this pandemic influenza strain and suggests that school closure and other mitigation measures could be useful to mitigate future influenza pandemics.

PLoS Medicine
(Accessed 29 May 2011)
http://www.plosmedicine.org/article/browse.action?field=date

Migration and Health: A Framework for 21st Century Policy-Making
Cathy Zimmerman, Ligia Kiss, Mazeda Hossain Policy Forum, published 24 May 2011
doi:10.1371/journal.pmed.1001034

Summary Points
– Migration is a global phenomenon that influences the health of individuals and populations.

– Policy-making on migration and health is conducted within sector silos that frequently have different goals. Population mobility is wholly compatible with health-promoting strategies for migrants if decision-makers coordinate across borders and policy sectors.

– Policies to protect migrant and public health will be most effective if they address the multiple phases of the migratory process, including pre-departure, travel, destination, interception, and return. Health intervention opportunities exist at each stage.

– This article forms the introduction to a PLoS Medicine series on Migration & Health, laying out a new framework for understanding the migratory process and the five phases of migration, which are discussed in depth in five subsequent articles.

Vaccine
Volume 29, Issue 25 pp. 4183-4298 (6 June 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Acceptance of seasonal and pandemic a (H1N1) 2009 influenza vaccination by healthcare workers in a French Teaching Hospital
Pages 4190-4194
Maurice Tanguy, Cécile Boyeau, Stéphanie Pean, Eloi Marijon, Alain Delhumeau, Serge Fanello

Abstract
Introduction
The aim of this study was to highlight the perceived risks, behavioural changes and the rate of acceptance of seasonal and pandemic (H1N1) 2009 influenza vaccines by healthcare workers (HCWs) in a French Teaching Hospital.

Methods
We sampled HCWs from the Angers French Teaching Hospital (France) using a cross-sectional intercept design during phase 5A of the 2009 French National Plan for the Prevention and Control of ‘Pandemic Influenza’. From November 2009 to February 2010, HCWs were approached in the workplace to undertake the survey. The primary endpoint assessed immunization coverage among HCWs who had contact with at-risk-patients.

Results
Of the 532 HCWs who answered the questionnaire, 119 (22.4%) had received a seasonal vaccine and 194 (36.5%) the H1N1 pandemic vaccine. Coverage rate was significantly higher among physicians (45% for the seasonal vaccine, 61% for the H1N1 vaccine). The main reasons given for acceptance of the seasonal vaccine were “protection of the patient” and “self-protection”, whereas the main arguments against were “low risk of being infected” and “doubts about vaccine safety”. For the H1N1 vaccine, reasons for vaccination were to “protect the patient” and “protect the family”. The main arguments against were “fear of side effects” and “doubts about vaccine safety”.

Conclusion
This study emphasizes the lack of perception by HCWs of the importance of being immunized against seasonal and pandemic A (H1N1) 2009 Influenza. In the future, particular efforts are needed, during vaccination campaigns, to provide more information to HCWs regarding development process and safety of such vaccines.

Vaccine
Volume 29, Issue 25 pp. 4183-4298 (6 June 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Trends in US pediatric influenza vaccination from 2006 to 2010 among children with private insurance
Pages 4225-4229
Seth L. Toback, John Herley, Laurel Edelman, Christopher S. Ambrose

Abstract
In the United States, recommendations for the annual influenza vaccination of children have expanded significantly in recent years. Additionally, to facilitate influenza vaccination delivery by providers, recent recommendations have encouraged vaccination as soon as vaccine is available and throughout the influenza season. However, until now, there have been limited data published describing pediatric providers’ responses to these recent recommendations. De-identified, patient-level data from an electronic health care reimbursement claims database that contains more than 60% of all medical claims from outpatient settings in the US were analyzed. Only claims from privately insured children were available; administration of federally purchased vaccine (i.e., via the Vaccines for Children program) and vaccinations administered in settings where claims data are not generated were not captured. Weekly counts of influenza vaccinations administered to children 6 months through 18 years of age between August 1 and March 31 for the 2006–2007 through 2009–2010 seasons were projected to yield national estimates. Seasonal vaccination peaked in November for the 2006–2007 and 2007–2008 seasons, October for the 2008–2009 season, and September for the 2009–2010 season. The proportion of vaccinations administered before November 1 increased each season from 2006–2007 through 2009–2010. In all seasons, vaccination dramatically declined in December and continued at a steadily declining rate through the end of the season. Vaccine delivery to children 6–23 months of age was more dispersed over the vaccination season relative to older age groups. Among children 6–23 months and 2–18 years of age, use of preservative-free inactivated vaccine and live attenuated vaccine, respectively, increased significantly over the study period. While pediatric influenza vaccination occurred earlier each year, vaccination in later months has not increased in recent seasons, despite efforts to extend the vaccination season.

Vaccine
Volume 29, Issue 25 pp. 4183-4298 (6 June 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Knowledge and intention to participate in cervical cancer screening after the human papillomavirus vaccine
Pages 4238-4243
Rebecca Anhang Price, Jill Koshiol, Sarah Kobrin, Jasmin A. Tiro

Abstract
Background
If women who receive the human papillomavirus (HPV) vaccine are unduly reassured about the cancer prevention benefits of vaccination, they may choose not to participate in screening, thereby increasing their risk for cervical cancer. This study assesses adult women’s knowledge of the need to continue cervical cancer screening after HPV vaccination, describes Pap test intentions of vaccinated young adult women, and evaluates whether knowledge and intentions differ across groups at greatest risk for cervical cancer.

Methods
Data were from the 2008 Health Information National Trends Survey (HINTS) and the 2008 National Health Interview Survey (NHIS), which initiated data collection approximately 18 months after the first FDA approval of an HPV vaccine. We calculated associations between independent variables and the outcomes using chi-square tests.

Results
Of 1586 female HINTS respondents ages 18 through 74, 95.6% knew that HPV-vaccinated women should continue to receive Pap tests. This knowledge did not vary significantly by race/ethnicity, education, income, or healthcare access. Among 1101 female NHIS respondents ages 18–26 who had ever received a Pap test, the proportion (12.7%; n = 139) who reported receipt of the HPV vaccine were more likely than those not vaccinated to plan to receive a Pap test within three years (98.1% vs. 92.5%, p < 0.001).

Conclusions
US adult women possess high knowledge and intention to participate in Pap testing after HPV vaccination. The vast majority of young adult women who received the HPV vaccine within its first two years on the market intend to participate in cervical cancer screening in the near future. Future studies are needed to examine whether those vaccinated in adolescence will become aware of, and adhere to, screening guidelines as they become eligible.

Vaccine
Volume 29, Issue 25 pp. 4183-4298 (6 June 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Hepatitis B vaccination coverage in healthcare workers in Gauteng Province, South Africa
Pages 4293-4297
Rosemary J. Burnett, Guido François, M. Jeffrey Mphahlele, John G. Mureithi, Patricia N. Africa, Mpho M. Satekge, D. Maggie Mokonoto, André Meheus, Marc van Sprundel

Abstract
Hepatitis B (HB) virus (HBV) is highly endemic and HBV infection is a major public health problem in sub-Saharan Africa. Percutaneous/parenteral transmission is an important mode of spread of HBV in the healthcare setting, thus healthcare workers (HCWs) and their patients are at risk for acquiring HBV infections. This study was conducted on three HCW populations in Gauteng Province during 2009, in order to (1) determine HB vaccination coverage of HCWs, and (2) investigate demographic predictors of vaccination uptake. Being a doctor was a statistically significant predictor of vaccination uptake (odds ratio [OR]: 3.2; 95% confidence interval [CI]: 1.48–6.72; p-value: 0.003), while working in the private sector was also statistically significantly associated with vaccination uptake (OR: 1.73; 95% CI: 1.01–2.98; chi-square p-value: 0.035). The majority (67.9% [491/723]) of HCWs had received at least 1 dose of vaccine, but where data on number of doses was available, only 19.9% (94/472) were fully vaccinated. In conclusion, there is a need to increase HB vaccination uptake in Gauteng HCWs through a policy that is properly implemented and routinely monitored and evaluated, and this policy must ensure that all three doses of vaccine are administered.

Vaccines: The Week in Review  23 May 2011 — comprising all the posts below for this date — is available as a pdf:

Vaccines_The Week in Review_23 May 2011

The Sixty-fourth World Health Assembly (16–24 May 2011) continues in Geneva. WHO Media Center meeting documentation available here: http://www.who.int/mediacentre/events/2011/wha64/en/index.html

Twitter updates by whonews and tags #worldhealthassembly #globalhealth

Speeches
Dr Margaret Chan
WHO Director-General
Opening address
Opening address video
Streaming wmv, 00:32:50

Bill Gates
Co-chair of the Bill & Melinda Gates Foundation
Read the speech
Video of speech
Streaming wmv, 00:28:42

Her Excellency Sheikh Hasina
Prime Minister of Bangladesh
Read the speech
Video of speech
Streaming wmv, 00:27:23

Dr Christos Patsalides
President, Sixty-fourth World Health Assembly
Video of speech
Streaming wmv, 00:19:22

Complete documentation of WHAT actions are included in the daily WHA Journal here:
http://apps.who.int/gb/e/e_wha64.html

Bill Gates addressed the 64^th World Health Assembly during its first week. The full text of the Gates Foundation media release is below:

GENEVA, May 17, 2011 /PRNewswire/ —
Bill Gates, co-chair of the Bill & Melinda Gates Foundation, called on government leaders to increase their investments in vaccines and to hold themselves accountable for extending the benefits of vaccines to every child.

In a keynote address at the 64th World Health Assembly, an annual gathering of health ministers and global health leaders, Gates laid out his vision for the impact that broadening access to vaccines can have on the world. “Strong immunization systems will put an end to polio and help us reach all children with five to six new vaccines,” Gates said. “We can save four million lives by 2015, and 10 million lives by 2020.”

Gates is more optimistic than ever about the impact of vaccines. “Vaccines are inexpensive, they are easy to deliver, and they are proven to protect children from disease,” he declared.

Recognizing that leadership is essential to achieving his vision, Gates announced that starting in 2012, his foundation would bestow an award on an individual or organization that has made a uniquely innovative contribution to the Decade of Vaccines. The innovation could be in the science, the delivery, or the financing of vaccines.

“The best immunization systems work because leaders hold themselves accountable for results,” he said. “Leaders diagnose weaknesses, innovate to address them, and spread the best ideas.”

Gates cited leaders in India and Nigeria who are responsible for increasing immunization rates in their states, and praised the success of the new Meningitis A vaccine that was rolled out in Burkina Faso, Mali and Niger last December, to emphasize the importance of commitments to immunization.

Gates also called on pharmaceutical manufacturers to commit to making sure vaccines are affordable for poor countries. “I believe we have the opportunity to make a new future in which global health is the cornerstone of global prosperity,” he said.

Achieving his vision for the next decade would depend on doing difficult, necessary things. Specifically, Gates called on:
– Donor countries to increase their investment in vaccines and immunization, even though they are coping with budget crises. He cited the GAVI Alliance pledging meeting in London on June 13 as an opportunity to show their support.
– Pharmaceutical companies to make sure vaccines are affordable for poor countries. Specifically, they must make a commitment to affordable pricing. Gates said he was confident that the combined price of the pentavalent, pneumococcus, and rotavirus vaccines can be cut in half by 2015.
– All 193 member states to make vaccines a central focus of their health systems. He said they must pledge to meet vaccine coverage targets of 90 percent at the country level with no district below 80 percent, and ensure that all children have access to existing vaccines and to new ones as they become available.
http://multivu.prnewswire.com/mnr/gatesfoundation/49363/

   Special WHA Focus: Among key issues CVEP is tracking includes WHA on the Pandemic Influenza Preparedness (PIP) Framework addressing “sharing of influenza viruses and access to vaccines and other benefits from base documents: A64/8 and  A64/8 Corr.1  As reported in the WHA Journal: N° 6 21 May 2011: http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_JOUR6-en.pdf
*
Eighth meeting of Committee A
Chairman: Dr Walid Ammar (Lebanon)
– – Draft third report of Committee A
The Chairman opened the meeting and called upon the Rapporteur (Dr-Mast Kulzhanov [Kazakhstan]) to read out the third draft report of Committee A, document (draft) A64/57 containing one resolution entitled: − Pandemic influenza preparedness: sharing of influenza viruses and access to vaccines and other benefits
The resolution http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_57Draft-en.pdf was approved and the first report of the Committee was adopted.
*
[Editor’s Note: At the recent symposium Global Vaccins 202X: Access, Equity, Ethics, 2-4 May 2011, an update on details and open issues associated with the PIP Framework was presented by Michael Watson, sanofi pasteur, and Chair IFPMA Biotherapeutics & Vaccines Committee. The video is available here: Part I, Part II ]

   Special WHA Focus: CVEP is tracking the response to the GIVS update session at WHA, which included discussion of the Decade of Vaccines Collaboration and planned global vaccine action plan. The WHA Journal reports this as:
*
Item 13 (continued) Technical and health matters
Item 13.5 (continued) – Global immunization vision and strategy
Discussion of this subitem resumed with the Chairman inviting comments from the floor. The Secretariat was invited to respond to the issues raised. The report of the Secretariat contained in document A64/14 was noted, closing the agenda subitem.
*
The WHO reported on this WHA GIVS discussion as below [full text]:

20 May 2011 – Fifty-five speakers ― including country delegates, partners such as UNICEF and the GAVI Alliance, as well as five civil society organizations meeting at the 64th World Health Assembly ― took the floor in massive support of the Global Immunization Vision and Strategy and its impact in guiding national immunization strategies to reach child survival goals. The immunization agenda item was debated over five hours by delegates from WHO’s 193 Member States and elicited the highest number of interventions on technical and health matters reviewed so far at this year’s Health Assembly.

Several countries spoke of their achievements in: increasing immunization coverage; reaching more children with existing vaccines; eliminating maternal and neonatal tetanus; reducing measles cases and deaths; using new vaccines against diarrhoea and pneumonia thanks to innovative financing; and implementing advocacy events such as the regional immunization weeks to highlight the importance of vaccines and immunization in saving lives.

But several complex challenges need to be addressed by countries and the international community including:
– mobilizing more resources to strengthen national immunization programmes and calling for increased support from the GAVI Alliance and other donors;
– ensuring a balanced approach towards competing priorities such as strengthening immunization systems, introducing new vaccines and eradicating polio;
– preventing a resurgence of measles through high vaccination coverage to reach the 2015 target of 95% measles mortality reduction and with the eventual goal of eradicating the disease;
– facilitating vaccine technology transfer to developing countries and promoting strategies to bring down vaccine prices; and
– strengthening surveillance for vaccine-preventable diseases.

Member States commend WHO’s leadership on the Decade of Vaccines, a vision for using the next 10 years to achieve immunization goals and reach important milestones in vaccine research, development, financing and public support. There was strong backing for the objectives proposed by WHO and UNICEF to improve delivery of immunization services in the next decade. Member States request that countries and relevant stakeholders are involved in the consultation process in developing the global vaccine action plan.

Other immunization-related topics for discussion by delegates at the Health Assembly include the control and prevention of cholera, managing the potential risks to polio eradication and access to influenza vaccines as a benefit of sharing of virus strains.

http://www.who.int/immunization/newsroom/newsstory_increased_investment_global_goals/en/index.html
*
[Editor’s Note: At the recent symposium Global Vaccines 202X: Access, Equity, Ethics, 2-4 May 2011, an update on the Decade of Vaccines Collaboration and the status of its four Working Groups was presented and discussed. Video of these presentations is available as below:
Decade of Vaccines Collaboration: Overview/Update
Moderator:  Chris Elias, PATH
[video: Part I, Part II]

DoV Work Group Updates:
Delivery: JM Okwo-Bele, WHO, IVB
[video: Part I, Part II ]

Global Access: Sandy Wrobel, Applied Strategies
[video: here ]

Public/Political Support: Lauren Leahy, MRC Global
[video: here ]

R&D:  David Salisbury, UK Department of Health
[video: here ]

Keynote: Global Vaccine Access – Why Now?

Chris Elias, PATH
[video: Part I, Part II ]

Keynote: Priorities, policies, perceptions & the public

David Salisbury, Department of Health, United Kingdom
[video: Part I, Part II, Part III, Part IV ]

The Weekly Epidemiological Record (WER) for 20 May 2011, vol. 86, 21 (pp 205–220) includes: Meeting of the Strategic Advisory Group of Experts on immunization, April 2011.
http://www.who.int/entity/wer/2011/wer8621.pdf

Sabin Vaccine Institute awarded its 2011 Albert B. Sabin Gold Medal Award to Drs. Douglas R. Lowy and John T. Schiller recognizing “several watershed discoveries that advanced the development of vaccines against human papillomavirus (HPV).” Dr. Peter Hotez, President of Sabin, commented, “The Sabin Vaccine Institute is honored to bestow Drs. Lowy and Schiller with the 2011 Albert B. Sabin Gold Medal Award for their pioneering work in the fields of vaccinology and oncology. Millions of lives will be positively affected by Lowy and Schiller’s dedication in developing the world’s first vaccines against cervical cancer. We applaud their efforts to rid the world of this silent killer.” Sabin noted that its Gold Medal Award, awarded annually since 1994, “commemorates the legacy of Dr. Sabin, who developed the oral live virus polio vaccine that is widely heralded with contributing to the near elimination of polio worldwide. Dr. Sabin, in whose honor the Sabin Vaccine Institute was founded in 1993, was also an advocate of using science to reduce poverty.”

http://sabin.org/news-resources/releases/2011/05/18/drs-douglas-r-lowy-and-john-t-schiller-receive-2011-albert-b-sabi

     The GAVI Alliance said it has concluded that US$563,000 was misused in two of its cash-based programmes in Mali. GAVI said that “sixty percent of the misused amount, or $335,000, was judged by investigators as ineligible expenses, which although used in the health sector, were outside the scope of GAVI’s funding agreement. The remaining 40% of the funds, $228,000, were spent on nonexistent activities or on fictitious procurement of goods and services.” GAVI added that the Malian Government, which fully cooperated in the investigation, has committed to reimburse the total amount to GAVI and has arrested four individuals under suspicion for the misuse. Helen Evans, interim GAVI CEO, said, “We appreciate the partnership with the Malian government in this investigation and the speed at which it is reacting to ensure that the missing funds are promptly repaid,” said. ”GAVI vigorously condemns any misuse of its funding. Children’s lives are jeopardised when GAVI funds are not used as they are intended.”

http://www.gavialliance.org/media_centre/statements/mali.php

Twitter Watch
A selection of items of interest this week from a variety of twitter feeds. This capture is highly selective and by no means intended to be exhaustive.

PIH Partners In Health
“When unjust systems or structures prevent people from achieving good health, this is structural violence in action” http://ow.ly/4ZbUU

pahowho PAHO/WHO
TDR Wins 2011 Gates Award for Global Health new.paho.org/hq/index.php?o…

PATHtweets PATH
A first: PATH receives a grant for tuberculosis work through Vietnam’s Ministry of Health. http://ow.ly/4ZwSR #globalhealth #TB

MalariaNoMore Malaria No More
Hey @NASCAR fans! Bid on tickets and meet&greet w/ Carl Edwards for May 29 race in Concord, NC to fight malaria! http://bit.ly/jh7LGy

pahowho PAHO/WHO
55 speakers, delegates, UNICEF, GAVI Alliance took the floor in massive support of Global Immunization Vision/Strategy http://bit.ly/mGXYE8

GAVIAlliance GAVI Alliance
10 Facts on Immunisation http://ht.ly/4Z7GF

AIDSvaccine IAVI
#India #Science & #Tech Min calls for global partnerships to address scientific challenges on path to an #HIV #vaccine http://bit.ly/luXfNS

VaxEthicsPolicy CVEP:UPenn
#globalvaccines202X Art Caplan keynote – Vaccination: Personal Responsibility; Community Imperative http://tinyurl.com/3hvqlco

GAVIAlliance GAVI Alliance
Quotes on GAVI from BillGates, Dr.Chan, MinistersOfHealth, HillaryClinton, AndrewMitchell, BanKi-moon,Bono,Sarkozy&more! http://ht.ly/4Y3fA

RWJF_PubHealth RWJF PublicHealth
Today is #HIV #Vaccine Awareness Day: http://bit.ly/l0KIsZ #HVAD

sabinvaccine Sabin Vaccine Inst.
Congratulations Drs. Douglas Lowy & John Schiller, 2011 Albert B. Sabin Gold Medal Award recipients!: http://bit.ly/mumF9a #HPV

gatesfoundation Gates Foundation
Bill Gates’ vision: #polio eradication & affordable #vaccines for every child. http://gates.ly/mEp27v #worldhealthassembly

GAVIAlliance GAVI Alliance
Dr. Wecker writes on “Multilateral partnerships help protect children from deadly diseases” @PATH @ONE #Vaccines http://ht.ly/4Vz3H

AIDSvaccine IAVI
@IAVISeth‘s keynote “Realizing the Potential of Global #Vaccines” at #globalvaccines202X conf via @vaxethicspolicy http://bit.ly/mQg3Yq #HIV

Annals of Internal Medicine
May 17, 2011; 154 (10)
http://www.annals.org/content/current

Ideas and Opinions
Advancing the Science of Patient Safety
Paul G. Shekelle, Peter J. Pronovost, Robert M. Wachter, Stephanie L. Taylor, Sydney M. Dy, Robbie Foy, Susanne Hempel, Kathryn M. McDonald, John Ovretveit, Lisa V. Rubenstein, Alyce S. Adams, Peter B. Angood, David W. Bates, Leonard Bickman, Pascale Carayon, Sir Liam Donaldson, Naihua Duan, Donna O. Farley, Trisha Greenhalgh, John Haughom, Eileen T. Lake, Richard Lilford, Kathleen N. Lohr, Gregg S. Meyer, Marlene R. Miller, Duncan V. Neuhauser, Gery Ryan, Sanjay Saint, Kaveh G. Shojania, Stephen M. Shortell, David P. Stevens, and Kieran Walshe
Ann Intern Med May 17, 2011 154:693-696;

Abstract
Despite a decade’s worth of effort, patient safety has improved slowly, in part because of the limited evidence base for the development and widespread dissemination of successful patient safety practices. The Agency for Healthcare Research and Quality sponsored an international group of experts in patient safety and evaluation methods to develop criteria to improve the design, evaluation, and reporting of practice research in patient safety. This article reports the findings and recommendations of this group, which include greater use of theory and logic models, more detailed descriptions of interventions and their implementation, enhanced explanation of desired and unintended outcomes, and better description and measurement of context and of how context influences interventions. Using these criteria and measuring and reporting contexts will improve the science of patient safety.

British Medical Journal
21 May 2011 Volume 342, Issue 7807
http://www.bmj.com/content/current

Inadequate reporting of research ethics review and informed consent in cluster randomised trials: review of random sample of published trials
Monica Taljaard, Andrew D McRae, Charles Weijer, Carol Bennett, Stephanie Dixon, Julia Taleban, Zoe Skea, Martin P Eccles, Jamie C Brehaut, Allan Donner, Raphael Saginur, Robert F Boruch, Jeremy M Grimshaw
BMJ 2011;342:doi:10.1136/bmj.d2496 (Published 11 May 2011)

[Free full text]
Abstract

Objectives To investigate the extent to which authors of cluster randomised trials adhered to two basic requirements of the World Medical Association’s Declaration of Helsinki and the International Committee of Medical Journal Editors’ uniform requirements for manuscripts (namely, reporting of research ethics review and informed consent), to determine whether the adequacy of reporting has improved over time, and to identify characteristics of cluster randomised trials associated with reporting of ethics practices.

Design Review of a random sample of published cluster randomised trials from an electronic search in Medline.

Setting Cluster randomised trials in health research published in English language journals from 2000 to 2008.

Study sample 300 cluster randomised trials published in 150 journals.

Results 77 (26%, 95% confidence interval 21% to 31%) trials failed to report ethics review. The proportion reporting ethics review increased significantly over time (P<0.001). Trials with data collection interventions at the individual level were more likely to report ethics review than were trials that used routine data sources only (79% (n=151) v 55% (23); P=0.008). Trials that accounted for clustering in the design and analysis were more likely to report ethics review. The median impact factor of the journal of publication was higher for trials that reported ethics review (3.4 v 2.3; P<0.001). 93 (31%, 26% to 36%) trials failed to report consent. Reporting of consent increased significantly over time (P<0.001). Trials with interventions targeting participants at the individual level were more likely to report consent than were trials with interventions targeting the cluster level (87% (90) v 48% (41); P<0.001). Trials with data collection interventions at the individual level were more likely to report consent than were those that used routine data sources only (78% (146) v 29% (11); P<0.001).

Conclusions Reporting of research ethics protections in cluster randomised trials is inadequate. In addition to research ethics approval, authors should report whether informed consent was sought, from whom consent was sought, and what consent was for.

Clinical Infectious Diseases
Volume 52 Issue 11 June 1, 2011
http://www.journals.uchicago.edu/toc/cid/current

Mark H. Eckman, Tiffany E. Kaiser, and Kenneth E. Sherman
The Cost-effectiveness of Screening for Chronic Hepatitis B Infection in the United States
Clin Infect Dis. (2011) 52(11): 1294-1306 doi:10.1093/cid/cir199

Abstract
(See the editorial commentary by Lo Re III, on pages 1307–1309.)

Background.  Hepatitis B virus (HBV) continues to cause significant morbidity and mortality in the United States. Current guidelines suggest screening populations with a prevalence of ≥2%. Our objective was to determine whether this screening threshold is cost-effective and whether screening lower-prevalence populations might also be cost-effective.

Methods.We  developed a Markov state transition model to examine screening of asymptomatic outpatients in the United States. The base case was a 35-year-old man living in a region with an HBV infection prevalence of 2%. Interventions (versus no screening) included screening for Hepatitis B surface antigen followed by treatment of appropriate patients with (1) pegylated interferon-α2a for 48 weeks, (2) a low-cost nucleoside or nucleotide agent with a high rate of developing viral resistance for 48 weeks, (3) prolonged treatment with low-cost, high-resistance nucleoside or nucleotide, or (4) prolonged treatment with a high-cost nucleoside or nucleotide with a low rate of developing viral resistance. Effectiveness was measured in quality-adjusted life years (QALYs) and costs in 2008 US dollars.

Results.  Screening followed by treatment with a low-cost, high-resistance nucleoside or nucleotide was cost-effective ($29,230 per QALY). Sensitivity analyses revealed that screening costs <$50,000 per QALY in extremely low-risk populations unless the prevalence of chronic HBV infection is <.3%.

Conclusions.The  2% threshold for prevalence of chronic HBV infection in current Centers for Disease Control and Prevention/US Public Health Service screening guidelines is cost-effective. Furthermore, screening of adults in the United States in lower-prevalence populations (eg, as low as .3%) also is likely to be cost-effective, suggesting that current health policy should be reconsidered.

Received November 10, 2010.
Accepted February 2, 2011

Clinical Infectious Diseases
Volume 52 Issue 11 June 1, 2011
http://www.journals.uchicago.edu/toc/cid/current

Vincent Lo Re III
Editorial Commentary: Economic Analysis of Hepatitis B Screening and Treatment
Clin Infect Dis. (2011) 52(11): 1307-1309 doi:10.1093/cid/cir238

Extract
Approximately 350 million people worldwide are living with chronic hepatitis B virus (HBV) infection, and an estimated 620,000 die annually from complications of HBV-related liver disease [ 1]. In the United States, the incidence of acute HBV infection has declined substantially since 1985 as a result of the availability of effective HBV vaccines and widespread immunization of infants and high-risk populations [ 2]. Nevertheless, approximately 43,000 new cases of acute HBV infection occur each year in the United States [ 3]. Further, although vaccination programs have successfully reduced the incidence, the prevalence of chronic HBV infection has not declined, primarily because of the immigration of chronically infected persons from countries with high or intermediate HBV endemicity [ 4]. National surveys indicate that approximately 1.25 million US residents have chronic HBV infection (prevalence, 0.3%–0.5%) [ 5], and many are likely unaware of their infection status [ 6].

The public health impact of chronic HBV infection is almost entirely related to its long-term effects on liver-related complications [ 7, 8]. Specifically, chronic HBV infection is a major cause of cirrhosis, hepatic decompensation, and hepatocellular carcinoma, and the risk of these complications increases with higher HBV DNA levels [ 9, 10]. The number of hospitalizations, outpatient visits, and expenditures associated with chronic HBV infection has persistently increased over the past 20 years [ 4, 11], and as the influx of patients with chronic HBV infection in the United States continues, utilization of HBV-related health care …

Clinical Infectious Diseases
Volume 52 Issue 11 June 1, 2011
http://www.journals.uchicago.edu/toc/cid/current

James B. Wing, Lynne Smart, Ray Borrow, Jamie Findlow, Helen Findlow, Andrew W. Heath, and Robert C. Read
Editor’s Choice: Kinetics of Immune Responses to Nasal Challenge With Meningococcal Polysaccharide One Year After Serogroup-C Glycoconjugate Vaccination
Clin Infect Dis. (2011) 52(11): 1317-1323 doi:10.1093/cid/cir198

Abstract
Background.  Recipients of serogroup-C glycoconjugate meningococcal vaccine (MCC) exhibit waning of serum bactericidal antibody (SBA) titers, but the rate of decline and the speed of their immunological memory in response to new meningococcal nasopharyngeal colonization are unknown.

Methods.In a prospective challenge study, we measured persistence of SBA and anti– Neisseria meningitidis serogroup-C (MenC) immunoglobulin (Ig) G and IgA in adults aged 18–39, 28 days and 12 months after receiving MCC. Volunteers were then challenged intranasally with 50 μg MenC polysaccharide to mimic meningococcal colonization, and systemic and mucosal antibody responses were measured.

Results.All  subjects had protective SBA titers (≥8) 28 days after MCC vaccination, but 12.3% and 20.2% had unprotective (<8) or low (<128) levels, respectively, after 12 months. Following rechallenge (12 months postvaccination) and measurement of antibody responses after 4, 7, and 10 days, rises in SBA titers were only observed in subjects with low (<128) or nonprotective (<8) prerechallenge SBA titers. In subjects with pre rechallenge SBA titers <8, the majority did not reach a protective SBA titer until 7 days post-rechallenge. MenC-specific IgG levels rose in both serum and saliva in correlation with SBA titers. No detectable rise in salivary IgA was observed.

Conclusions. In those individuals who fail to retain protective SBA 12 months after MCC, immunological memory fails to generate protective systemic and mucosal antibodies until 7 days post intranasal challenge with cognate meningococcal polysaccharide. This is likely too slow to protect from natural meningococcal infection. MCC vaccinees rely on persistence of antibody levels rather than immunological memory for sustained protection.

Clinical Infectious Diseases
Volume 52 Issue 11 June 1, 2011
http://www.journals.uchicago.edu/toc/cid/current

Vaccines
Sunheang Shin, Sachin N. Desai, Binod K. Sah, and John D. Clemens
Oral Vaccines Against Cholera
Clin Infect Dis. (2011) 52(11): 1343-1349 doi:10.1093/cid/cir141

Abstract
The current seventh pandemic of cholera, caused by serogroup O1, El Tor biotype, has now involved almost the entire developing world. The ongoing dynamic epidemiology of cholera, involving evolution of new strains, prolonged and more frequent epidemics, increased antimicrobial resistance, and awareness of the role of climate change upon the global burden has returned cholera to the forefront of global public health discussions. Improved water and sanitation should continue to be the mainstays of cholera-prevention efforts, but major improvements are a far-off goal for much of the cholera-affected developing world. The advent of safe and effective, new-generation oral vaccines against cholera has created renewed interest in the use of vaccines as a tool to control cholera.

JAMA   
May 18, 2011, Vol 305, No. 19, pp 1937-2024
http://jama.ama-assn.org/current.dtl

Commentaries
From Efficacy to Effectiveness in the Face of Uncertainty: Indication Creep and Prevention Creep
Benjamin Djulbegovic, Ash Paul
JAMA. 2011;305(19):2005-2006.doi:10.1001/jama.2011.650

Extract
Therapeutic and prevention clinical research is typically performed to address questions of efficacy (“Can intervention work in the ideal study setting?”), effectiveness (“Does it work, generalized to real-world settings and applied to individual patients?”), and cost-effectiveness (“Is it worth it and should it be paid for?”). To date, both public and private research enterprise has predominantly funded efficacy research. Comparative effectiveness research holds promise to generate much-needed effectiveness data. However, given the large number of important clinical questions, it will not be possible to provide reliable empirical efficacy, effectiveness, and cost-effectiveness data for every question to help guide individual decision-making. 1 Instead, practitioners will continue to rely on inductive reasoning to apply the results of the study (“group averages” from an efficacy trial) to individual patients who often differ in important ways from patients enrolled in the efficacy trial (eg, these patients may be older, have comorbid conditions, or might …

Journal of Infectious Diseases
Volume 203 Issue 11 June 1, 2011
http://www.journals.uchicago.edu/toc/jid/current

EDITORIAL COMMENTARIES
Stephen M. Ostroff
Editor’s Choice: Measles: Going, Going, But Not Gone
J Infect Dis. (2011) 203(11): 1507-1509 doi:10.1093/infdis/jir125

Extract
For those of us engaged in disease investigation and response at the state and local level, the report by Chen and colleagues [ 1] in this issue of the Journal makes for sobering reading. It describes an outbreak of measles in Arizona where virus transmission predominantly occurred in the health care setting, a scenario of great concern to us all. In reading through the report, I was repeatedly reminded of the adage “What a fool does in the end, the wise do in the beginning.” One hopes that a report of this nature will spur at least some health care systems, hospitals, and physicians’ offices to act wisely before they too are confronted with a case of measles in their facilities. The Tucson outbreak also highlights many of the challenges faced by public health departments around the country with respect to a disease that, vaccine controversies notwithstanding, has been receding in memory and importance for many health care practitioners, institutions, and the public

In the United States, we entered the “postelimination” era in 2000 [ 2]. But in the context of measles, “elimination” does not mean that there are no cases occurring. This is because the disease continues to be still too common in other parts of the world, and international travels produce opportunities for continued introduction [ 3]. As a result, between 2000 and 2008, an average of 56 cases per year have been confirmed in the United States [ 3]. And paradoxically, the number of cases may actually be rising as segments of the population increasingly opt out of vaccination, producing uneven vaccination rates and pockets of susceptibility [ 4]. This raises concerns that …

[Full Text of this Article]

Journal of Infectious Diseases
Volume 203 Issue 11 June 1, 2011
http://www.journals.uchicago.edu/toc/jid/current
Mark R. Schleiss

Editor’s Choice: Could Therapeutic Vaccination of Cytomegalovirus-Seropositive Persons Prevent Reinfection and Congenital Virus Transmission?
J Infect Dis. (2011) 203(11): 1513-1516 doi:10.1093/infdis/jir144

Extract
In the developed world, cytomegalovirus (CMV) is the most common congenital viral infection, with an overall birth prevalence of ∼0.6% [ 1]. Approximately 10% of congenitally infected infants have signs and symptoms of disease at birth, and these symptomatic infants have been reported to have a 40%–90% risk of subsequent neurologic sequelae, including mental retardation, microcephaly, development delay, seizure disorders, and cerebral palsy [ 2– 4]. Seven percent –to 20% of asymptomatically infected newborns will also demonstrate sequelae, particularly sensorineural hearing loss [ 5– 7]. The public health impact of congenital CMV infection is substantial and underrecognized; although more children suffer from long-term neurodevelopmental handicaps as a result of congenital CMV infection than either Down syndrome or fetal alcohol syndrome [ 8], awareness unfortunately remains low, particularly among women of childbearing age [ 9, 10]. An effective vaccine could, by preventing neurological sequelae and other disabilities, provide a newborn with a lifetime of benefit. For that reason, a report from the Institute of Medicine (IOM) of the National Academy of Sciences placed CMV in its highest priority category for vaccine development, concluding that a vaccine would be strongly cost saving [ 11, 12].

Among the various CMV vaccine candidates currently in clinical trials [ 13], the most encouraging results to date have been observed in studies of a vaccine based on the immunodominant envelope glycoprotein B (gB). Several clinical trials have been performed using a recombinant form of this protein expressed in Chinese hamster ovary cells, purified and combined with an oil-in-water adjuvant known as MF59 [ 14– 17]. Pass et al recently reported the results of a seminal phase II efficacy trial of the gB-MF59 …

Journal of Infectious Diseases
Volume 203 Issue 11 June 1, 2011
http://www.journals.uchicago.edu/toc/jid/current

VIRUSES
Sanny Y. Chen, Shoana Anderson, Preeta K. Kutty, Francelli Lugo, Michelle McDonald, Paul A. Rota, Ismael R. Ortega-Sanchez, Ken Komatsu, Gregory L. Armstrong, Rebecca Sunenshine, and Jane F. Seward
Editor’s Choice: Health Care–Associated Measles Outbreak in the United States After an Importation: Challenges and Economic Impact
J Infect Dis. (2011) 203(11): 1517-1525 doi:10.1093/infdis/jir115

[Free full text]
Abstract
(See the editorial commentary by Ostroff, on pages 1507–9.)

Background. On 12 February 2008, an infected Swiss traveler visited hospital A in Tucson, Arizona, and initiated a predominantly health care–associated measles outbreak involving 14 cases. We investigated risk factors that might have contributed to health care–associated transmission and assessed outbreak-associated hospital costs.

Methods. Epidemiologic data were obtained by case interviews and review of medical records. Health care personnel (HCP) immunization records were reviewed to identify non–measles-immune HCP. Outbreak-associated costs were estimated from 2 hospitals.

Results. Of 14 patients with confirmed cases, 7 (50%) were aged ≥18 years, 4 (29%) were hospitalized, 7 (50%) acquired measles in health care settings, and all (100%) were unvaccinated or had unknown vaccination status. Of the 11 patients (79%) who had accessed health care services while infectious, 1 (9%) was masked and isolated promptly after rash onset. HCP measles immunity data from 2 hospitals confirmed that 1776 (25%) of 7195 HCP lacked evidence of measles immunity. Among these HCPs, 139 (9%) of 1583 tested seronegative for measles immunoglobulin G, including 1 person who acquired measles. The 2 hospitals spent US$799,136 responding to and containing 7 cases in these facilities.

Conclusions. Suspecting measles as a diagnosis, instituting immediate airborne isolation, and ensuring rapidly retrievable measles immunity records for HCPs are paramount in preventing health care–associated spread and in minimizing hospital outbreak–response costs.

The Lancet  
May 21, 2011  Volume 377  Number 9779  Pages 1719 – 1806
http://www.thelancet.com/journals/lancet/issue/current

Editorial
HIV treatment as prevention—it works
The Lancet

Preview
Last week any doubts around treatment as an approach to halt the spread of the HIV epidemic were allayed. An international study showed that antiretroviral treatment can prevent the sexual transmission of HIV among heterosexual couples in whom one partner is HIV-infected and the other is not. UNAIDS described the result as a “serious game changer” for HIV prevention.

The Lancet  
May 21, 2011  Volume 377  Number 9779  Pages 1719 – 1806
http://www.thelancet.com/journals/lancet/issue/current

Articles
Long-term protection against malaria after experimental sporozoite inoculation: an open-label follow-up study
Meta Roestenberg, Anne C Teirlinck, Matthew BB McCall, Karina Teelen, Krystelle Nganou Makamdop, Jorien Wiersma, Theo Arens, Pieter Beckers, GeertJan van Gemert, Marga van de Vegte-Bolmer, André JAM van der Ven, Adrian JF Luty, Cornelus C Hermsen, Robert W Sauerwein

Preview
Artificially induced immunity lasts longer than generally recorded after natural exposure; providing a new avenue of research into the mechanisms of malaria immunity.

Pharmacoeconomics
June 1, 2011 – Volume 29 – Issue 6  pp: 455-547
http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx

Review Articles
Health Technology Funding Decision-Making Processes Around the World: The Same, Yet Different
Stafinski, Tania; Menon, Devidas; Philippon, Donald J.; McCabe, Christopher
Pharmacoeconomics. 29(6):475-495, June 1, 2011.
doi: 10.2165/11586420-000000000-00000

Abstract:
All healthcare systems routinely make resource allocation decisions that trade off potential health gains to different patient populations. However, when such trade-offs relate to the introduction of new, promising health technologies, perceived ‘winners’ and ‘losers’ are more apparent. In recent years, public scrutiny over such decisions has intensified, raising the need to better understand how they are currently made and how they might be improved. The objective of this paper is to critically review and compare current processes for making health technology funding decisions at the regional, state/provincial and national level in 20 countries.

A comprehensive search for published, peer-reviewed and grey literature describing actual national, state/provincial and regional/institutional technology decision-making processes was conducted. Information was extracted by two independent reviewers and tabulated to facilitate qualitative comparative analyses. To identify strengths and weaknesses of processes identified, websites of corresponding organizations were searched for commissioned reviews/evaluations, which were subsequently analysed using standard qualitative methods.

A total of 21 national, four provincial/state and six regional/institutional-level processes were found. Although information on each one varied, they could be grouped into four sequential categories: (i) identification of the decision problem; (ii) information inputs; (iii) elements of the decision-making process; and (iv) public accountability and decision implementation. While information requirements of all processes appeared substantial and decision-making factors comprehensive, the way in which they were utilized was often unclear, as were approaches used to incorporate social values or equity arguments into decisions.

A comprehensive inventory of approaches to implementing the four main components of all technology funding decision-making processes was compiled, from which areas for future work or research aimed at improving the acceptability of decisions were identified. They include the explication of decision criteria and social values underpinning processes

Vaccine
Volume 29, Issue 24  pp. 4079-4182 (31 May 2011)
http://www.sciencedirect.com/science/journal/0264410X

Short Communications
Patent data mining: A tool for accelerating HIV vaccine innovation
Pages 4086-4093
K. Clark, J. Cavicchi, K. Jensen, R. Fitzgerald, A. Bennett, S.P. Kowalski

Abstract
Global access to advanced vaccine technologies is challenged by the interrelated components of intellectual property (IP) management strategies, technology transfer (legal and technical) capabilities and the capacity necessary for accelerating R&D, commercialization and delivery of vaccines. Due to a negative association with the management of IP, patents are often overlooked as a vast resource of freely available, information akin to scientific journals as well as business and technological information and trends fundamental for formulating policies and IP management strategies. Therefore, a fundamental step towards facilitating global vaccine access will be the assembly, organization and analysis of patent landscapes, to identify the amount of patenting, ownership (assignees) and fields of technology covered. This is critical for making informed decisions (e.g., identifying licensees, building research and product development collaborations, and ascertaining freedom to operate). Such information is of particular interest to the HIV vaccine community where the HIV Vaccine Enterprise, have voiced concern that IP rights (particularly patents and trade secrets) may prevent data and materials sharing, delaying progress in research and development of a HIV vaccine. We have compiled and analyzed a representative HIV vaccine patent landscape for a prime-boost, DNA/adenoviral vaccine platform, as an example for identifying obstacles, maximizing opportunities and making informed IP management strategy decisions towards the development and deployment of an efficacious HIV vaccine.

Vaccine
Volume 29, Issue 24  pp. 4079-4182 (31 May 2011)
http://www.sciencedirect.com/science/journal/0264410X

Addressing the needs and gaps in safety assessment of vaccines during clinical trials in resource limited countries
Pages 4173-4174
Agnes Kisser, Ulrich Heininger, Vasee S. Moorthy, Bartholomew D. Akanmori, Odile Lero

[No abstract]

Vaccine
Volume 29, Issue 24  pp. 4079-4182 (31 May 2011)
http://www.sciencedirect.com/science/journal/0264410X

Regular Papers
Economic burden of rotavirus disease in children under 5 years in Kazakhstan
Pages 4175-4180
Renat Latipov, Aynagul Kuatbaeva, Olga Kristiansen, Saltanat Aubakirova, Ulbosin Akhanaeva, Ivar Sønbø Kristiansen, Elmira Flem

Abstract
Background
We aimed to estimate the societal costs of rotavirus cases among children less than 5 years in Kazakhstan, an upper-middle income country in Central Asia.

Methods
Data on medical, non-medical and indirect costs were collected for 190 patients less than 5 years, hospitalized with severe diarrhea in 2009 in two pediatric hospitals. Data on resource use for moderate and mild diarrhea cases were obtained from published sources. A probabilistic sensitivity analysis was performed to explore uncertainty in cost estimates.

Reults
Approximately 4,000 severe, 30,700 moderate, and 122,900 mild rotavirus cases were estimated annually in children <5 years old. The mean societal cost of a severe, moderate and mild rotavirus case was estimated at US$ 454, 82, and 21, respectively. The total annual cost of rotavirus disease was $37.53 million or on average $107.36 for a child under 5 years old in Kazakhstan. Ninety-four percent of total costs (35.13 million) are indirect costs (productivity losses) from fatal cases and parents’ job absenteeism, while direct medical costs account for 2.04 million (5.4%), and direct non-medical for 0.46 million (1.2%).

Conclusions
Rotavirus-associated diarrhea represents a significant economic burden in Kazakhstan, largely due to indirect costs. The costs of rotavirus infections should be considered when planning further preventive actions, including the introduction of rotavirus vaccination.

Art Caplan, Ph.D., Director of the Penn Center for Bioethics, addressed the symposium’s opening dinner (2 May 2011) attendees. His keynote is titled: Vaccination: Personal Responsibility; Community Imperative.

Video: Part I, Part II

Symposium – Global Vaccines 202X: Access, Equity, Ethics

Center for Vaccine Ethics and Policy

2-4 May 2011
The Franklin Institute Science Museum
Philadelphia

Global Vaccines 202X: Access, Equity, Ethics was a three-day symposium gathering approximately 100 leaders from global public health, government, academia, foundations and the NGO community to assess key issues and lay the foundation for an effective policy framework focused on access, equity and ethics for the decade-plus ahead.

Please find the final agenda and video documentation of the keynotes and presentations here.

More on the Global Vaccines 202X Symposium at: http://globalvaccines202xsymposium.wordpress.com/

PATH CEO Chris Elias addressed symposium participants during dinner in the Benjamin Franklin National Memorial on Day 2 of the meeting. The keynote is titled: “Global Vaccine Access — Why Now?”

[Video: Part I, Part II ]

.

Symposium – Global Vaccines 202X: Access, Equity, Ethics

Center for Vaccine Ethics and Policy

2-4 May 2011
The Franklin Institute Science Museum
Philadelphia

Global Vaccines 202X: Access, Equity, Ethics was a three-day symposium gathering approximately 100 leaders from global public health, government, academia, foundations and the NGO community to assess key issues and lay the foundation for an effective policy framework focused on access, equity and ethics for the decade-plus ahead.

Please find the final agenda and video documentation of the keynotes and presentations here.

More on the Global Vaccines 202X Symposium at: http://globalvaccines202xsymposium.wordpress.com/

Vaccines: The Week in Review  16 May 2011 pdf version, comprising all the psost below for this date: Vaccines_The Week in Review_16 May 2011

The Sixty-fourth World Health Assembly convenes 16–24 May 2011 in Geneva. Provisional agenda and meeting documentation available here: http://www.who.int/mediacentre/events/2011/wha64/en/index.html

Twitter updates by whonews and tags #worldhealthassembly #globalhealth

PAHO reported that Haiti “finalized a plan to ensure immunization against the country’s most prevalent childhood diseases for at least 90 percent of children under 1 by 2015.” The plan was said to reflect the Haitian Ministry of Public Health and Population’s “determination to re-launch routine vaccination efforts, which were lagging—relative to other countries of the Americas—even before the earthquake.”

PAHO said the plan’s specific goals include:

– increasing immunization coverage from around 60 percent to 90 percent among children under 1;
– maintaining the country free of polio, measles, and rubella;

– eliminating maternal and neonatal tetanus by 2015;

– introducing new rotavirus and pneumococcal vaccines, as well as the pentavalent vaccine which protects against diphtheria, pertussis (whooping cough), tetanus, Hepatitis B and Haemophilus influenzae type b (Hib), which is a bacteria responsible for some types of meningitis and pneumonias; and

– improving immunization surveillance for the early detection of vaccine-preventable diseases.

PAHO’s Deputy Director Dr. Jon Andrus commented, “When Haiti is well supported, its people can do incredible things. The earthquake and cholera outbreak have focused international support, providing an opportunity to help the country catch up in some areas and hopefully leap forward in others.” http://new.paho.org/hq/index.php?option=com_content&task=view&id=5406&Itemid=1

     “Men and women infected with HIV reduced the risk of transmitting the virus to their sexual partners by taking oral antiretroviral medicines when their immune systems were relatively healthy,” according to findings from a large-scale clinical study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. The clinical trial, known as HPTN 052, was slated to end in 2015 but NIH said the findings are being released early as the result of a scheduled interim review of the study data by an independent data and safety monitoring board (DSMB). The DSMB “concluded that it was clear that use of antiretrovirals by HIV-infected individuals with relatively healthier immune systems substantially reduced transmission to their partners. The results are the first from a major randomized clinical trial to indicate that treating an HIV-infected individual can reduce the risk of sexual transmission of HIV to an uninfected partner.” NIAID Director Anthony S. Fauci, M.D commented, “Previous data about the potential value of antiretrovirals in making HIV-infected individuals less infectious to their sexual partners came largely from observational and epidemiological studies. This new finding convincingly demonstrates that treating the infected individual—and doing so sooner rather than later—can have a major impact on reducing HIV transmission.”

http://www.nih.gov/news/health/may2011/niaid-12.htm

The GAVI Alliance said it committed US$100 million “to help tackle meningitis A in Cameroon, Chad, and Nigeria as part of a strategy to save tens of thousands of lives in Africa with a new life-saving vaccine, MenAfriVac.” Helen Evans, interim GAVI CEO, said,  “We accelerated our approvals process so that we can ensure this vaccine is available in Cameroon, Chad, and Nigeria, before next year’s epidemic season due to start in December. This is a breakthrough vaccine in the fight against meningitis A. If GAVI is fully funded for our 2011-2015 programme, this vaccine could save many lives and avoid the other terrible consequences of epidemics.” http://www.gavialliance.org/media_centre/press_releases/meningitis_a_funding.php

WHO released World Health Statistics 2011, noting that “an increasing number of countries are facing a double burden of disease as the prevalence of risk factors for chronic diseases such as diabetes, heart diseases and cancers increase and many countries still struggle to reduce maternal and child deaths caused by infectious diseases.”  The report identifies that “noncommunicable diseases such heart diseases, stroke, diabetes and cancer, now make up two-thirds of all deaths globally, due to the population aging and the spread of risk factors associated with globalization and urbanization. The control of risk factors such as tobacco use, sedentary lifestyle, unhealthy diet and excessive use of alcohol becomes more critical. The latest WHO figures showed that about 4 out of 10 men and 1 in 11 women are using tobacco and about 1 in 8 adults is obese.” Ties Boerma, Director of WHO’s Department of Health Statistics and Informatics, said, “This evidence really shows that no country in the world can address health from either an infectious disease perspective or a noncommunicable disease one. Everyone must develop a health system that addresses the full range of the health threats in both areas.” says

http://www.who.int/mediacentre/news/releases/2011/health_statistics_20110513/en/index.html

Gates Foundation blog
http://www.gatesfoundation.org/foundationnotes/Pages/margaret-chan-saving-lives-immunization.aspx

Posted by Margaret Chan on May 11, 2011

Saving Lives With Immunization
I am a believer in human ability and ingenuity. I believe it is our duty to try our best to make the health of each successive generation better.

As a public health expert, I reflect often on how this can be done. Diseases have plagued mankind for millennia but the human race has fought back with ingenuity. It was Edward Jenner’s innovation in 1796 that gave us the strongest public health tool that we have ever possessed: the vaccine.

New technology in the middle of the last century led to the development of vaccines for polio, measles, mumps, rubella, typhoid and tuberculosis. More recently we have developed vaccines for influenza, hepatitis B, meningitis and yellow fever. We are pushing forward in our quest to find vaccines for HIV and malaria. The time lag from discovery to delivery is getting shorter and more countries are receiving good quality vaccines that they can afford.

Today, four out of five children now receive routine vaccines and are protected from death, disease and disability. The numbers of people with polio are down 99 percent, and measles deaths in Africa are down 90percent. Immunization is estimated to save between 2and 3million lives each year, and the prevention of these childhood diseases is one of the greatest success stories in global public health.

But how did we get from a great idea to great results?

Thirty seven years ago, a World Health Assembly (WHA) resolution set an ambitious agenda for humanity. The Expanded Programme on Immunization (EPI) tasked the World Health Organization (WHO) with supporting immunization programmes in developing countries to increase vaccination coverage and help them obtain good quality vaccines at an affordable cost. In 2005, WHO adopted the Global Immunization Vision and Strategy, which took this even further.

But challenges remain. About 23 million infants worldwide are still not protected from life-threatening diseases. Many of them live in developing countries that are proving difficult to reach with vaccines.

Developing vaccines and getting them to every part of the world, regardless of a country’s ability to pay, is a complex and daunting task. Partners are a key part of the world’s machinery against diseases. The WHO and other United Nations agencies, the GAVI Alliance, and the Bill & Melinda Gates Foundation work through dynamic partnership to focus international attention on the importance of immunization.

Immunization can significantly contribute to achieving the health-related Millennium Development Goals (MDGs). With less than four years until the 2015 deadline, I urge countries to realize that vision. We must keep our promises by getting back on track to meet the global goals, and we need to do this together. Everyone – from world leaders to individuals – has a role to play to help save millions of lives in years to come.

It’s time to give more children a shot at life.

Dr. Margaret Chan is the Director-General of the World Health Organization.