vaccines_the week in review_20 february 2012

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Vaccines: The Week in Review20 February 2012Center for Vaccine Ethics & Policy (CVEP)This weekly summary targets news, announcements and events in global vaccines ethics and policygathered from key governmental, NGO and industry sources, key journals and other sources. Thissummary supports ongoing initiatives of the Center for Vaccine Ethics & Policy, and is not intended to be

exhaustive in its coverage. Vaccines: The Week in Review is also posted in pdf form and as a set of blogposts athttp://centerforvaccineethicsandpolicy.wordpress.com/. This blog allows full-text searching ofsome 2,500 entries..

Comments and suggestions should be directed toDavid R. Curry, MSEditor andExecutive DirectorCenter for Vaccine Ethics & Policy

[email protected]

A pdf of this issue is available here:http://centerforvaccineethicsandpolicy.wordpress.com/

WHO announced consensus from a technical consultation held lastweek on H5N1 research and will convene additional meetings on the issue.

The WHO media release noted that A small group of global public healthand influenza experts at a WHO-convened meeting reached consensus ontwo urgent issues related to the newly created H5N1 influenza viruses:extending the temporary moratorium on research with new laboratory-modified H5N1 viruses and recognition that research on naturally-occurringH5N1 influenza virus must continue in order to protect public health. Thegroup also came to a consensus that delayed publication of the entiremanuscripts would have more public health benefit than urgently partially

publishing. The announcement noted that broad issues raised, but notlimited to, these research studies will be discussed at future meetingsconvened by WHO soon with participation by a broader range of experts andinterested parties relevant to these issues.http://www.who.int/mediacentre/news/releases/2012/h5n1_research_20120217/en/index.html

WHO Technical consultation on H5N1 research issues - consensuspointsWHO Headquarters, Geneva16-17 February 2012[Full text]

Two recent research studies examining some factors affectingtransmissibility of influenza A(H5N1) viruses prompted WHO to convene atechnical consultation on 1617 February 2012. The participants at thismeeting reached consensus on the following points.

Recent work discussed at this meeting underscores that influenza A(H5N1)viruses remain an important risk for causing a future pandemic. Therefore,research on these viruses, including on transmissibility and pathogenicity,remains critical to close important gaps in knowledge in order to reduce thedanger posed; such research should continue. The PIP Framework, which was
http://centerforvaccineethicsandpolicy.wordpress.com/mailto:[email protected]://centerforvaccineethicsandpolicy.wordpress.com/http://www.who.int/mediacentre/news/releases/2012/h5n1_research_20120217/en/index.htmlhttp://www.who.int/mediacentre/news/releases/2012/h5n1_research_20120217/en/index.htmlmailto:[email protected]://centerforvaccineethicsandpolicy.wordpress.com/http://www.who.int/mediacentre/news/releases/2012/h5n1_research_20120217/en/index.htmlhttp://www.who.int/mediacentre/news/releases/2012/h5n1_research_20120217/en/index.htmlhttp://centerforvaccineethicsandpolicy.wordpress.com/


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adopted by all WHO Member States in 2011 now provides a global frameworkfor the sharing of influenza viruses with human pandemic potential and thesharing of benefits arising from such sharing. Implementation of thisFramework is integral to global pandemic preparedness and response. Futureresearch projects should involve countries from which source material wereobtained.

The two studies that were conducted to better understand thetransmissibility of H5N1 influenza viruses have shown that these viruses havethe potential to become more transmissible among mammals. In light of thecontinuing evolution of H5N1 viruses, the results of these studies provide animportant contribution to public health surveillance of H5N1 viruses and to abetter understanding of the properties of these viruses.

At the same time, these studies have raised important and valid concernsabout whether they increase risks to the safety of humans. Concerns whichhave been raised include the potential misuse of the results or methods aswell as potential breaches in biosafety and biosecurity related to pathogens.

These concerns highlight how important it is that researchers are aware ofsuch issues, exercise judgement about the conduct of their research,

dissemination of the results, and for institutional bodies reviewing suchstudies to identify and address potential concerns about "dual use". Suchsafeguards already exist, but continued emphasis should be placed onassuring and reinforcing safety and security.

The laboratory-modified H5N1 viruses are currently stored in well-established research facilities with high security and high safety (BSL3+).

There have been no safety breaches related to the storage of the laboratory-modified H5N1 viruses at these facilities. At the same time, the biosafety andbiosecurity conditions under which further research is conducted on thelaboratory-modified H5N1 viruses should be fully addressed by relevantauthorities. This is a matter of urgency and should be achieved as quickly aspossible. In the interim, the laboratory-modified H5N1 viruses should remainin their present locations. In addition, the current moratorium on research toenhance the transmissibility of H5N1 influenza viruses and the furtherresearch on the laboratory-modified viruses should continue until theconditions have been determined. Other research on H5N1 viruses should notstop.

There is a preference, from a public health perspective, for full disclosure ofthe information in these papers. However, there are significant socialconcerns surrounding this research. Two critical issues that must beaddressed before publication of the papers are: (1) a focusedcommunications plan to increase public awareness and understanding of thesignificance of these studies and the rationale for their publication, and (2) areview of the essential biosafety and biosecurity aspects of the newlydeveloped knowledge.

Participants discussed the concept of publication of redacted manuscriptswith a mechanism for providing the restricted information to legitimaterecipients. The group recognized the difficulty of rapidly creating andregulating such a mechanism in light of the complexity of international andnational legislation. A consensus was reached that the redaction option is notviable to deal with the two papers under discussion in view of the urgency of


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the above mentioned public health needs. The participants noted there maybe a need for such a mechanism in the future.

Apart from consideration of these two manuscripts, participantsacknowledged the existence of broader issues requiring more detailedexploration and advised that these be considered in subsequentconsultations involving other stakeholders.

http://www.who.int/influenza/human_animal_interface/consensus_points/en/index.html

[Editors Note: See also additional commentary and analysis form the currentissue of Science in Journal Watch below.]

Speech/White Paper: Minister of Foreign Affairs Jonas Gahr StreLaunch of the Norwegian white paper on global healthOslo, 15 February 2012[Full text of speech outline]

The Minister based his presentation on the following points:Friends, Colleagues, Ladies and Gentlemen,

Great pleasure for me to present the Governments white paper on globalhealth in the presence of so many distinguished guests. A particularly warmwelcome to Margaret Chan, Director General of the World HealthOrganization (WHO) and to those of you who have travelled a long way totake part in the launch.

First ever white paper on global health. One of the purposes of theNorwegian global health policy is to be better at integrating health goals inforeign and development policies and strategies. Understand globalizationthrough the lens of health.

The new white paper sets out the direction of Norwegian policy on globalhealth for the years to come.1. Let me first emphasise Norways long traditions in the area of globalhealth.More than a century ago Norwegian missionaries travelled to many parts ofthe world. Many of them worked in the field of health. They were later joinedby representatives of the labour movement, for example, in Kerala, India, justafter the Second World War.

A more recent example of Norways commitment to this area, is Dr GroHarlem Brundtlands leadership of the WHO at the turn of the millennium. Weare pleased that she has agreed to give her perspectives at the end of thisevent.2. Second, the relevance of the white paper in todays global economy

The white paper sets out 3 priority areas:(i) Mobilising for womens and childrens rights and health(ii) Reducing the burden of disease with emphasis on prevention(iii) Promoting human security through health

There is a strong link between economic fundamentals and global health. Iam therefore happy to see so many leading economists here today, likeProfessor Bloom, as well as those who have fought for womens rights ingeneral, like Ms Gumbonzvanda.
http://www.who.int/influenza/human_animal_interface/consensus_points/en/index.htmlhttp://www.who.int/influenza/human_animal_interface/consensus_points/en/index.htmlhttp://www.who.int/influenza/human_animal_interface/consensus_points/en/index.htmlhttp://www.who.int/influenza/human_animal_interface/consensus_points/en/index.html


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Most striking change in Norway last century: womens participation in thelabour market.

I am pleased to launch here today an initiative as a follow-up to the whitepaper: A project that aims at identifying the economic benefits to be gainedfrom investing in womens health. So far Dr. Margaret Chan (DG WHO) andPresident Michelle Bachelet (UN Women) have joined the initiative by taking

part in the leadership group of the project.From experience we know that it is important to secure the involvement of

finance ministers and heads of government on the issue of global health aspart of our broader efforts to promote equality and human rights.

The initiative will last for 18 months and be led by leading experts in thefield.

The identification of economic benefits to be gained from investing inwomens health will culminate in a Lancet report.

Key partners will include Bill and Melinda Gates Foundation, Lancet, the UN,the WHO and the World Bank.

Invite all to participate in the initiative.3. Third, role of global health in national, foreign and development policies

No coincidence that Health Minister Anne Grete Strm-Erichsen is on thepodium here today.

Many of the health challenges we are facing in Norway are global andcannot be addressed by Norway alone. International action is needed.

Not primarily a question of development assistance. Also an important areafor the Norwegian Ministry of Health as well as a number of other ministries.

We will work actively to enhance collaboration across the variousministries. Coherence key.

Another close colleague present here today is Erik Solheim. He is here inthe capacity of minister of the environment as much as in the capacity asminister of international development.Climate change poses serious threats to peoples health and nutrition, butthere are situations where interventions for better health also can have apositive impact on the environment and vice versa.

Clean cookstoves and the reduction in emissions of black carbon andmethane are examples of this.4. Fourth, civil society and youth

Only partnerships can ensure effective action against the global challengesthat characterise our time.

New democratising technologies such as mobile phones and socialnetworks have increased the opportunities for civil society to play an activerole and hold governments accountable.

Pleased we have such an outstanding representative like MsGumbonzvanda at our panel today to represent the youth (World YWCA).Innovation requires the involvement of young people.

The most revolutionary innovations of our time have been created bycollege drop-outs like Bill Gates and Mark Zuckerberg.5. Fifth, role of the WHO

Last but not least, I should mention the WHO which is at the core of all ourglobal health efforts.


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Like to congratulate Margaret Chan on her nomination for a second term.Will follow with great interest your efforts to address the many challenges weare currently facing during your next five years in office.

The white paper emphasises the central role played by the WHO in relationto the global health agenda.

I congratulate Margaret Chan on the effectiveness of the WHO in recent

years in contributing to many other partnerships, not least the UN Secretary-Generals initiative in this area Every Woman Every Child.

Norway will continue to be a strong ally of the WHO. But a demanding ally.Thank you for your attention.http://www.regjeringen.no/en/dep/ud/aktuelt/taler_artikler/utenriksministeren/2012/stmeld_helse.html?id=672633White Paper CitationMeld. St. 11(20112012)Melding til StortingetGlobal helse i utenriks- og utviklingspolitikken

Tilrding fra Utenriksdepartementet 3. februar 2012, godkjent i statsrd

samme dag. (Regjeringen Stoltenberg II)Dokumentet i pdf-format (3,7 Mb)[No English version available]

The Weekly Epidemiological Record (WER) for 17 February 2012,vol. 87, 7 (pp 6164) includes: Fifth meeting of National Influenza Centres WHO Western Pacific and South-East Asia Regionshttp://www.who.int/entity/wer/2012/wer8707.pdf

Twitter Watch [accessed 20 February 03:35]Items of interest from a variety of twitter feeds associated with immunization,vaccines and global public health. This capture is highly selective and is by nomeans intended to be exhaustive.

WHO @WHOTranscript from news conference on WHO preliminary consultation on #H5N1research available here goo.gl/cdCB8#birdflu4:10 AM - 19 Feb 12 via web

HarvardPublicHealth @HarvardHSPH

RT @Harvard: Have efforts to combat bird flu increased the risk to publichealth? hvrd.me/z2J4kh#fluforum

WHO @WHOWHO press release on the preliminary consultation on #H5N1 researchgoo.gl/Pzt4Y#birdflu1:05 PM - 17 Feb 12 via web Details
http://www.regjeringen.no/en/dep/ud/aktuelt/taler_artikler/utenriksministeren/2012/stmeld_helse.html?id=672633http://www.regjeringen.no/en/dep/ud/aktuelt/taler_artikler/utenriksministeren/2012/stmeld_helse.html?id=672633http://www.regjeringen.no/pages/36900525/PDFS/STM201120120011000DDDPDFS.pdfhttp://www.who.int/entity/wer/2012/wer8707.pdfhttps://twitter.com/#!/WHOhttps://twitter.com/#!/search?q=%23H5N1http://t.co/noEsOTUKhttps://twitter.com/#!/search?q=%23birdfluhttps://twitter.com/#!/HarvardHSPHhttps://twitter.com/#!/Harvardhttp://t.co/5CE6Ypejhttps://twitter.com/#!/search?q=%23fluforumhttps://twitter.com/#!/WHOhttps://twitter.com/#!/search?q=%23H5N1http://t.co/Az627ZfIhttps://twitter.com/#!/search?q=%23birdfluhttps://twitter.com/#!/WHO/status/170569634179858434http://www.regjeringen.no/en/dep/ud/aktuelt/taler_artikler/utenriksministeren/2012/stmeld_helse.html?id=672633http://www.regjeringen.no/en/dep/ud/aktuelt/taler_artikler/utenriksministeren/2012/stmeld_helse.html?id=672633http://www.regjeringen.no/pages/36900525/PDFS/STM201120120011000DDDPDFS.pdfhttp://www.who.int/entity/wer/2012/wer8707.pdfhttps://twitter.com/#!/WHOhttps://twitter.com/#!/search?q=%23H5N1http://t.co/noEsOTUKhttps://twitter.com/#!/search?q=%23birdfluhttps://twitter.com/#!/HarvardHSPHhttps://twitter.com/#!/Harvardhttp://t.co/5CE6Ypejhttps://twitter.com/#!/search?q=%23fluforumhttps://twitter.com/#!/WHOhttps://twitter.com/#!/search?q=%23H5N1http://t.co/Az627ZfIhttps://twitter.com/#!/search?q=%23birdfluhttps://twitter.com/#!/WHO/status/170569634179858434


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RWJF PublicHealth @RWJF_PubHealthThe role of social media in reporting critical health information: bit.ly/z7EAyI#hcsm#dhcx#sm

Arthur Caplan @ArthurCaplanImportant article on anti-vaccine movemnt slate.me/xT8ju5

Amanda Glassman @glassmanamandaSystematic review of costs and cost-eff of malaria interventionsmalariajournal.com/content/10/1/3

Dagfinn Hybrten @HoybratenFirst White Paper on Global Health from the Norwegian government confirmsit's strong commitment to #GAVIregjeringen.no/nb/dep/ud/dok/Retweeted by GAVI Alliance8:23 AM - 14 Feb 12 via web Details

Health Evidence @HealthEvidence

Did you know that the @PHAC_GC 'Parents' Guide to Immunization' isavailable in 11 languages? goo.gl/m6sqy9:31 AM - 15 Feb 12 via web Details

Journal WatchVaccines: The Week in Review continues its weekly scanning of key journalsto identify and cite articles, commentary and editorials, books reviews andother content supporting our focus on vaccine ethics and policy.JournalWatch is not intended to be exhaustive, but indicative of themes andissues the Center is actively tracking. We selectively provide full text ofsome editorial and comment articles that are specifically relevant to ourwork. Successful access to some of the links provided may requiresubscription or other access arrangement unique to the publisher. If youwould like to suggest other journal titles to include in this service, pleasecontact David Curry at: [email protected]

Annals of Internal MedicineFebruary 7, 2012; 156 (3)http://www.annals.org/content/current[Reviewed last week]

British Medical BulletinVolume 100 Issue 1 December 2011http://bmb.oxfordjournals.org/content/current[Reviewed earlier; No relevant content]

British Medical Journal
https://twitter.com/#!/RWJF_PubHealthhttp://t.co/Ng4ohQ7khttps://twitter.com/#!/search?q=%23hcsmhttps://twitter.com/#!/search?q=%23dhcxhttps://twitter.com/#!/search?q=%23smhttps://twitter.com/#!/ArthurCaplanhttp://t.co/9ckt2r9ahttps://twitter.com/#!/glassmanamandahttp://t.co/LmzJU6JChttps://twitter.com/#!/Hoybratenhttps://twitter.com/#!/search?q=%23GAVIhttp://t.co/HI7icy0Thttps://twitter.com/#!/GAVIAlliancehttps://twitter.com/#!/Hoybraten/status/169411487843094528https://twitter.com/#!/HealthEvidencehttps://twitter.com/#!/PHAC_GChttp://t.co/bCv824ukhttps://twitter.com/#!/HealthEvidence/status/169790994991169536mailto:[email protected]://www.annals.org/content/currenthttp://bmb.oxfordjournals.org/content/currenthttps://twitter.com/#!/RWJF_PubHealthhttp://t.co/Ng4ohQ7khttps://twitter.com/#!/search?q=%23hcsmhttps://twitter.com/#!/search?q=%23dhcxhttps://twitter.com/#!/search?q=%23smhttps://twitter.com/#!/ArthurCaplanhttp://t.co/9ckt2r9ahttps://twitter.com/#!/glassmanamandahttp://t.co/LmzJU6JChttps://twitter.com/#!/Hoybratenhttps://twitter.com/#!/search?q=%23GAVIhttp://t.co/HI7icy0Thttps://twitter.com/#!/GAVIAlliancehttps://twitter.com/#!/Hoybraten/status/169411487843094528https://twitter.com/#!/HealthEvidencehttps://twitter.com/#!/PHAC_GChttp://t.co/bCv824ukhttps://twitter.com/#!/HealthEvidence/status/169790994991169536mailto:[email protected]://www.annals.org/content/currenthttp://bmb.oxfordjournals.org/content/current


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18 February 2012 (Vol 344, Issue 7844)http://www.bmj.com/content/currentEditorialImproving the delivery of safe and effective healthcare in low andmiddle income countriesBMJ 2012; 344 doi: 10.1136/bmj.e981 (Published 14 February 2012)

Cite this as: BMJ 2012;344:e981ExtractResearch is needed into creating workable systems that can deliver andsustain interventionsMany resource constrained countries are unlikely to attain their millenniumdevelopment goal targets by 2015,1 despite major global efforts and muchprogress (figure).2 3 For example, only 23 countries are currently estimatedto be on track to achieve the target of a 75% reduction in maternalmortality.4 In addition, the rate of new HIV infections continues to outpacethe number of HIV positive patients who start treatmentfor every fivepeople newly infected with HIV only two begin treatment each year, andabout 5.5 million people needing treatment for HIV in low and middle income

countries still do not receive it.5 6

Cost Effectiveness and Resource Allocation(Accessed 20 February 2012)http://www.resource-allocation.com/[No new relevant content]

Emerging Infectious DiseasesVolume 18, Number 2February 2012http://www.cdc.gov/ncidod/EID/index.htm[Reviewed earlier]

Global HealthWinter 2012http://www.globalhealthmagazine.com/in_this_issue/[Reviewed earlier]

Globalization and Health[Accessed 20 February 2012]http://www.globalizationandhealth.com/ResearchPositioning women's and children's health in African Union policy-making: A policy analysis

Toure K, Sankore R, Kuruvilla S, Scolaro E, Bustreo F and Osotimehin BGlobalization and Health 2012, 8:3 (16 February 2012)Abstract(provisional) [Open Access]Background
http://www.bmj.com/content/currenthttp://www.resource-allocation.com/http://www.cdc.gov/ncidod/EID/index.htmhttp://www.globalhealthmagazine.com/in_this_issue/http://www.globalizationandhealth.com/http://www.globalizationandhealth.com/content/8/1/3http://www.globalizationandhealth.com/content/8/1/3http://www.bmj.com/content/currenthttp://www.resource-allocation.com/http://www.cdc.gov/ncidod/EID/index.htmhttp://www.globalhealthmagazine.com/in_this_issue/http://www.globalizationandhealth.com/http://www.globalizationandhealth.com/content/8/1/3http://www.globalizationandhealth.com/content/8/1/3


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With limited time to achieve the Millennium Development Goals, progresstowards improving women's and children's health needs to be accelerated.With Africa accounting for over half of the world's maternal and child deaths,the African Union (AU) has a critical role in prioritizing related policies andcatalysing required investments and action. In this paper, the authors assessthe evolution of African Union policies related to women's and children's

health, and analyze how these policies are prioritized and framed.Methods

The main method used in this policy analysis was a document review of allAfrican Union policies developed from 1963 to 2010, focusing specifically onpolicies that explicitly mention health. The findings from this documentreview were discussed with key actors to identify policy implications.ResultsWith over 220 policies in total, peace and security is the most common AUpolicy topic. Social affairs and other development issues became moreprominent in the 1990s. The number of policies that mentioned health rosesteadily over the years (with 1 policy mentioning health in 1963 to 7 in 2010).

This change was catalysed by factors such as: a favourable shift in AU

priorities and systems towards development issues, spurred by the transitionfrom the Organization of African Unity to the African Union; the mandate ofthe African Commission on Human and People's Rights; health-relatedadvocacy initiatives, such as the Campaign for the Accelerated Reduction ofMaternal Mortality in Africa (CARMMA); action and accountabilityrequirements arising from international human rights treaties, the MillenniumDevelopment Goals (MDGs), and new health-funding mechanisms, such asthe Global Fund to Fight AIDS, Tuberculosis and Malaria. Prioritization ofwomen's and children's health issues in AU policies has been framedprimarily by human rights, advocacy and accountability considerations, moreby economic and health frames looking at investments and impact. AUpolicies related to reproductive, maternal, newborn and child health also usefewer policy frames than do AU policies related to HIV/AIDS, tuberculosis andmalaria.ConclusionWe suggest that more effective prioritization of women's and children'shealth in African Union policies would be supported by widening the range ofpolicy frames used (notably health and economic) and strengthening theevidence base of all policy frames used. In addition, we suggest it would bebeneficial if the partner groups advocating for women's and children's healthwere multi-stakeholder, and included, for instance, health care professionals,regional institutions, parliamentarians, the media, academia, NGOs,development partners and the public and private sectors.

Health AffairsFebruary 2012; Volume 31, Issue 2http://content.healthaffairs.org/content/current

Theme: The Future of The Small Business Insurance Exchange[No relevant content]
http://content.healthaffairs.org/content/currenthttp://content.healthaffairs.org/content/current


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Health and Human RightsVol 13, No 2 (2011)http://hhrjournal.org/index.php/hhr[Reviewed earlier]

Health Economics, Policy and LawVolume 7 - Special Issue 01 - January 2012http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue[Reviewed earlier]

Health Policy and PlanningVolume 27 Issue 1 January 2012http://heapol.oxfordjournals.org/content/current[Reviewed earlier]

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)Volume 8, Issue 2 February 2012http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/2/[Reviewed earlier]

International Journal of Infectious DiseasesVolume 16, Issue 3 pp. e151-e224 (March 2012)http://www.sciencedirect.com/science/journal/12019712Original ReportsEpidemiological analysis of measles and evaluation of measlessurveillance system performance in Iraq, 20052010

Original Research ArticlePages e166-e171

Jagar Jasem, Kawa Marof, Adnan Nawar, K.M. Monirul IslamAbstract | Figures/Tables | ReferencesSummaryObjectives

The objectives of this study were to identify the risk factors for measles andlow vaccination rates, to evaluate the performance of surveillance, and tocalculate vaccine effectiveness and failure in Iraq for the years 2005 to 2010.MethodsLogistic regression was used on measles surveillance data from Iraq obtainedduring the period 1 January 2005 to 31 December 2010; adjusted odds ratioswere calculated. The performance of surveillance was evaluated according toWorld Health Organization (WHO) guidelines.ResultsOf 18 746 suspected cases, a measles diagnosis was made for 81.4%.Children aged 15 years were the most affected (>48%). The odds ofmeasles were significantly higher in the central and southern provinces thanin the northern provinces. Those vaccinated with at least one dose ofmeasles-containing vaccine had a 3.7-times lower risk of contracting measles
http://hhrjournal.org/index.php/hhrhttp://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissuehttp://heapol.oxfordjournals.org/content/currenthttp://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/2/http://www.sciencedirect.com/science/journal/12019712http://www.sciencedirect.com/science/article/pii/S1201971211002372http://www.sciencedirect.com/science/article/pii/S1201971211002372http://getcontent%28%27http//www.sciencedirect.com/science/preview/figTables?_rdoc=4&_origin=browse&_srch=hubEid(1-s2.0-S1201971212X00031)&_ct=15&_zone=rslt_list_item&_fmt=full&_pii=S1201971211002372&_issn=12019712&_tab=afr&absLinks=y&md5=b288c5ff7dfbc5875b89d8d6def49b91%27,%271-s20-S1201971211002372-figs%27,%271-s20-S1201971211002372-abs%27,%271-s20-S1201971211002372-refs%27)http://getcontent%28%27http//www.sciencedirect.com/science/preview/references?_rdoc=4&_origin=browse&_srch=hubEid(1-s2.0-S1201971212X00031)&_ct=15&_zone=rslt_list_item&_fmt=full&_pii=S1201971211002372&_issn=12019712&_tab=afr&absLinks=y&md5=b288c5ff7dfbc5875b89d8d6def49b91%27,%271-s20-S1201971211002372-refs%27,%271-s20-S1201971211002372-abs%27,%271-s20-S1201971211002372-figs%27)http://hhrjournal.org/index.php/hhrhttp://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissuehttp://heapol.oxfordjournals.org/content/currenthttp://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/2/http://www.sciencedirect.com/science/journal/12019712http://www.sciencedirect.com/science/article/pii/S1201971211002372http://www.sciencedirect.com/science/article/pii/S1201971211002372http://getcontent%28%27http//www.sciencedirect.com/science/preview/figTables?_rdoc=4&_origin=browse&_srch=hubEid(1-s2.0-S1201971212X00031)&_ct=15&_zone=rslt_list_item&_fmt=full&_pii=S1201971211002372&_issn=12019712&_tab=afr&absLinks=y&md5=b288c5ff7dfbc5875b89d8d6def49b91%27,%271-s20-S1201971211002372-figs%27,%271-s20-S1201971211002372-abs%27,%271-s20-S1201971211002372-refs%27)http://getcontent%28%27http//www.sciencedirect.com/science/preview/references?_rdoc=4&_origin=browse&_srch=hubEid(1-s2.0-S1201971212X00031)&_ct=15&_zone=rslt_list_item&_fmt=full&_pii=S1201971211002372&_issn=12019712&_tab=afr&absLinks=y&md5=b288c5ff7dfbc5875b89d8d6def49b91%27,%271-s20-S1201971211002372-refs%27,%271-s20-S1201971211002372-abs%27,%271-s20-S1201971211002372-figs%27)


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than those who were not vaccinated. Lower odds of vaccination were notedfor adults aged 18 years and older and those living in central and southernprovinces, as well as those living outside the capital city of a province. ThreeWHO performance indicators were lower than the recommended cut-offlevels. A vaccine failure rate of 66.1% and effectiveness of 90.03% wereestimated.

ConclusionsMeasles continues to be an important cause of morbidity in Iraq.Improvements in vaccine coverage, proper vaccine handling, and promptreporting of suspected cases are all necessary to eliminate measles fromIraq.Early impact of pneumococcal conjugate vaccine on invasivepneumococcal disease in Singapore children, 2005 through 2010Original Research ArticlePages e209-e215Koh Cheng Thoon, Chia Yin Chong, Nancy Wen Sim TeeAbstract | Figures/Tables | ReferencesSummary

BackgroundIn a previous study covering the period 19982004, we estimated theincidence of invasive pneumococcal disease (IPD) in Singapore to be 13.6 per105 children aged


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JAMAFebruary 15, 2012, Vol 307, No. 7, pp 637-742http://jama.ama-assn.org/current.dtlViewpointsThe Unintended Consequences of Conflict of Interest DisclosureGeorge Loewenstein,

Sunita Sah,Daylian M. Cain

JAMA. 2012;307(7):669-670.doi:10.1001/jama.2012.154[No abstract; Initial language per JAMA convention]Conflicts of interest, both financial and nonfinancial, are ubiquitous inmedicine, and the most commonly prescribed remedy is disclosure. TheMedicare Payment Advisory Commission and the Accountable Care Actimpose a range of disclosure requirements for physicians, and almost allmedical journals now require authors to disclose conflicts of interest(although these requirements may be imperfectly heeded). Given that somerelationships between physicians and industry are fruitful and some conflictsare unavoidable, can disclosure correct the problems that arise when

economic interests prevent physicians from putting patients' interests first?Disclosure has appeal across the political spectrum because it acknowledgesthe problem of conflicts but involves minimal regulation and is less expensiveto implement than more comprehensive remedies. More importantly, even ifdisclosure is rarely seen as providing a complete solution to the problem, it isbroadly perceived to have beneficial effects. There are, however, reasonsthat disclosure can have adverse

Journal of Infectious DiseasesVolume 205 Issue 5 March 1, 2012http://www.journals.uchicago.edu/toc/jid/current[Reviewed last week]

The LancetFeb 18, 2012 Volume 379 Number 9816 p589 684 e33http://www.thelancet.com/journals/lancet/issue/currentCommentPrevention of serogroup B meningococcal diseaseDavid S StephensPreviewIn The Lancet, Mara Elena Santolaya and colleagues1 describe theimmunogenicity and safety in healthy Hispanic adolescents of a newmulticomponent vaccine, 4CMenB, a potential breakthrough in protectionagainst meningitis, sepsis, and other infections caused by Neisseriameningitidis serogroup B. With the successful development and use ofeffective polysaccharide-protein glycoconjugate vaccines for serogroups A, C,

Y, and W-135,2,3 serogroup B N meningitidis (distinguished by the expressionof an [28]-linked polysialic acid capsule) is now the leading cause ofmeningococcal disease, especially in infants and young children in manycountries.
http://jama.ama-assn.org/current.dtlhttp://www.journals.uchicago.edu/toc/jid/currenthttp://www.thelancet.com/journals/lancet/issue/currenthttp://jama.ama-assn.org/current.dtlhttp://www.journals.uchicago.edu/toc/jid/currenthttp://www.thelancet.com/journals/lancet/issue/current


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ArticlesImmunogenicity and tolerability of a multicomponent meningococcalserogroup B (4CMenB) vaccine in healthy adolescents in Chile: aphase 2b/3 randomised, observer-blind, placebo-controlled studyMara Elena Santolaya, Miguel L O'Ryan, Mara Teresa Valenzuela, ValeriaPrado, Rodrigo Vergara, Alma Muoz, Daniela Toneatto, Gabriela Graa,

Huajun Wang, Ralf Clemens, Peter M Dull, for the V72P10 Meningococcal BAdolescent Vaccine Study groupSummaryBackgroundEffective glycoconjugate vaccines against Neisseria meningitidis serogroupsA, C, W-135, and Y have been developed, but serogroup B remains a majorcause of severe invasive disease in infants and adolescents worldwide. Weassessed immunogenicity and tolerability of a four-component vaccine(4CMenB) in adolescents.MethodsWe did a randomised, observer-blind, placebo-controlled, study at 12 sites inSantiago and Valparaso, Chile. Adolescents aged 1117 years received one,

two, or three doses of 4CMenB at 1 month, 2 month, or 6 month intervals.Immunogenicity was assessed as serum bactericidal activity using humancomplement (hSBA) against three reference strains for individual vaccineantigens, and assessed by ELISA against the fourth strain. Local and systemicreactions were recorded 7 days after each vaccination, and adverse eventswere monitored throughout the study. Participants were initially randomisedto five groups (3:3:3:3:1) during the primary phase to receive either onedose, two doses 1 or 2 months apart, or three doses of 4CMenB, or threedoses of placebo, with an additional three groups generated for the boosterphase. All subjects received at least one dose of 4CMenB. Geometric meantitres, proportions of participants with serum bactericidal antibody titres of 4or more, and Clopper-Pearson 95% CIs were calculated. The study isregistered with ClinicalTrials.gov, number NCT00661713.FindingsOverall, 1631 adolescents (mean age 138 [SD 19] years) received at leastone dose of 4CMenB. After two or three doses, 99100% of recipients hadhSBA titres of 4 or more against test strains, compared with 9297% afterone dose (p


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Novartis Vaccines and Diagnostics.

The Lancet Infectious DiseaseFeb 2012 Volume 12 Number 2 p89 - 166http://www.thelancet.com/journals/laninf/issue/current

[Reviewed earlier]

Medical Decision Making (MDM)JanuaryFebruary 2012; 32 (1)http://mdm.sagepub.com/content/current[Reviewed earlier]

NatureVolume 482 Number 7385 pp275-434 16 February 2012http://www.nature.com/nature/current_issue.html

[No relevant content]

Nature MedicineFebruary 2012, Volume 18 No 2 pp179-321http://www.nature.com/nm/journal/v18/n1/index.htmlNewsIndia mulling stricter laws to curb unethical trials - p182Killugudi Jayaramandoi:10.1038/nm0212-182Full Text - India mulling stricter laws to curb unethical trials | PDF (188 KB)Clinicians call for greater transparency in trial recruitment - p186Rebecca Hersherdoi:10.1038/nm0212-186aFull Text - Clinicians call for greater transparency in trial recruitment | PDF(108 KB)

Nature Reviews ImmunologyFebruary 2012 Vol 12 No 2http://www.nature.com/nri/journal/v12/n2/index.html[No relevant content]

New England Journal of MedicineFebruary 16, 2012 Vol. 366 No. 7http://content.nejm.org/current.shtml[No relevant content]

OMICS: A Journal of Integrative BiologyVolume 15, Number 12
http://www.thelancet.com/journals/laninf/issue/currenthttp://mdm.sagepub.com/content/currenthttp://www.nature.com/nature/current_issue.htmlhttp://www.nature.com/nm/journal/v18/n1/index.htmlhttp://www.nature.com/nm/journal/v18/n2/full/nm0212-182.htmlhttp://www.nature.com/nm/journal/v18/n2/pdf/nm0212-182.pdfhttp://www.nature.com/nm/journal/v18/n2/full/nm0212-186a.htmlhttp://www.nature.com/nm/journal/v18/n2/pdf/nm0212-186a.pdfhttp://www.nature.com/nm/journal/v18/n2/pdf/nm0212-186a.pdfhttp://www.nature.com/nri/journal/v12/n2/index.htmlhttp://content.nejm.org/current.shtmlhttp://www.thelancet.com/journals/laninf/issue/currenthttp://mdm.sagepub.com/content/currenthttp://www.nature.com/nature/current_issue.htmlhttp://www.nature.com/nm/journal/v18/n1/index.htmlhttp://www.nature.com/nm/journal/v18/n2/full/nm0212-182.htmlhttp://www.nature.com/nm/journal/v18/n2/pdf/nm0212-182.pdfhttp://www.nature.com/nm/journal/v18/n2/full/nm0212-186a.htmlhttp://www.nature.com/nm/journal/v18/n2/pdf/nm0212-186a.pdfhttp://www.nature.com/nm/journal/v18/n2/pdf/nm0212-186a.pdfhttp://www.nature.com/nri/journal/v12/n2/index.htmlhttp://content.nejm.org/current.shtml


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http://online.liebertpub.com/toc/omi/15/12[No relevant content]

The Pediatric Infectious Disease JournalFebruary 2012 - Volume 31 - Issue 2 pp: A11-A12,109-214,e37-e51

http://journals.lww.com/pidj/pages/currenttoc.aspx[Reviewed earlier]

PediatricsFebruary 2012, VOLUME 129 / ISSUE 2http://pediatrics.aappublications.org/current.shtml[Reviewed earlier]

PharmacoeconomicsMarch 1, 2012 - Volume 30 - Issue 3 pp: 171-256

http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspxCurrent OpinionPopulation- versus Cohort-Based Modelling ApproachesEthgen, Olivier; Standaert, BaudouinPharmacoeconomics. 30(3):171-181, March 1, 2012.doi: 10.2165/11593050-000000000-00000Abstract

While no single type of model can provide adequate answers under allcircumstances, any modelling endeavour should incorporate threefundamental considerations in any decision-making question: the targetpopulation, the disease and the intervention characteristics.

A target population is likely to be characterized by various types ofheterogeneity and a dynamic evolution over time. It is therefore important toadequately capture these population effects on the results of a model. Thereare essentially two different approaches in modelling a population over time:a cohort-based approach and a population-based approach.

In a cohort-based model, a closed group of individuals who have at leastone specific characteristic or experience in common over a defined period oftime is run through a state transition process. The cohort is generallycomposed of a hypothetical number of representative or average individuals(i.e. the target population is considered to be a homogeneous group).

The population-based approach projects the evolution of the estimatedprevalent target population and intends to reflect as much as possible thedemographic, epidemiological and clinical characteristics of the prevalenttarget population relevant for the decision problem.

A cohort-based approach is generally used in most published healthcaredecision models. However, this choice is rarely discussed by modellers. In thisarticle, we challenge this assumption. To address the underlying decisionproblem, we affirm it is crucial that modellers consider the characteristics ofthe target population. Then, they could opt for using the most appropriateapproach. Decision makers should also understand the impact on the resultsof both types of models in order to make informed healthcare decisions.
http://online.liebertpub.com/toc/omi/15/12http://journals.lww.com/pidj/pages/currenttoc.aspxhttp://pediatrics.aappublications.org/current.shtmlhttp://adisonline.com/pharmacoeconomics/pages/currenttoc.aspxhttp://adisonline.com/pharmacoeconomics/Abstract/2012/30030/Population__versus_Cohort_Based_Modelling.1.aspxhttp://online.liebertpub.com/toc/omi/15/12http://journals.lww.com/pidj/pages/currenttoc.aspxhttp://pediatrics.aappublications.org/current.shtmlhttp://adisonline.com/pharmacoeconomics/pages/currenttoc.aspxhttp://adisonline.com/pharmacoeconomics/Abstract/2012/30030/Population__versus_Cohort_Based_Modelling.1.aspx


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CommentaryPricing Human Papillomavirus Vaccines: Lessons from ItalyGarattini, Livio; van de Vooren, Katelijne; Curto, AlessandroPharmacoeconomics. 30(3):213-217, March 1, 2012.doi: 10.2165/11596560-000000000-00000[No abstract]

Original Research ArticlesMethodological Quality of Economic Evaluations of NewPharmaceuticals in the NetherlandsHoomans, Ties; Severens, Johan L.; van der Roer, Nicole; Delwel, Gepke O.Pharmacoeconomics. 30(3):219-227, March 1, 2012.doi: 10.2165/11539850-000000000-00000Abstract:

Background: In the Netherlands, decisions about the reimbursement of newpharmaceuticals are based on cost effectiveness, as well as therapeutic valueand budget impact. Since 1 January 2005, drug manufacturers are formallyrequired to substantiate the cost effectiveness of drugs that have therapeuticadded value in comparison with existing ones through pharmacoeconomic

evaluations. Dutch guidelines for pharmacoeconomic research providemethods guidance, ensuring consistency in both the evidence and thedecision-making process about drug reimbursement.

Aim: This study reviewed the methodological quality of all 21 formallyrequired pharmacoeconomic evaluations of new pharmaceuticals between 1

January 2005 and 1 October 2008, and verified whether these evaluationscomplied with pharmacoeconomic guidelines.

Methods: Data on the quality of the pharmacoeconomic evaluations wereextracted from the pharmacoeconomic reports published by the Dutch HealthCare Insurance Board (CVZ). The Board's newsletters provided information onthe advice to, and reimbursement decisions made by, the Dutch Minister ofHealth. All data extraction was carried out by two independent reviewers, anddescriptive analyses were conducted.

Results: The methodological quality was sound in only 8 of the 21pharmacoeconomic evaluations. In most cases, the perspective of analysis,the comparator drugs, and the reporting of both total and incremental costsand effects were correct. However, drug indication, form (i.e. cost utility/costeffectiveness) and time horizon of the evaluations were frequently flawed.Moreover, the costs and effects of the pharmaceuticals were not alwaysanalysed correctly, and modelling studies were often non-transparent. Twelvedrugs were reimbursed, and nine were not.

Conclusions: The compliance with pharmacoeconomic guidelines ineconomic evaluations of new pharmaceuticals can be improved. This wouldimprove the methodological quality of the pharmacoeconomic evaluationsand ensure consistency in the evidence and the decision-making process fordrug reimbursement in the Netherlands.

PLoS One[Accessed 20 February 2012]http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date
http://adisonline.com/pharmacoeconomics/Citation/2012/30030/Pricing_Human_Papillomavirus_Vaccines__Lessons.4.aspxhttp://adisonline.com/pharmacoeconomics/Abstract/2012/30030/Methodological_Quality_of_Economic_Evaluations_of.5.aspxhttp://adisonline.com/pharmacoeconomics/Abstract/2012/30030/Methodological_Quality_of_Economic_Evaluations_of.5.aspxhttp://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=datehttp://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=datehttp://adisonline.com/pharmacoeconomics/Citation/2012/30030/Pricing_Human_Papillomavirus_Vaccines__Lessons.4.aspxhttp://adisonline.com/pharmacoeconomics/Abstract/2012/30030/Methodological_Quality_of_Economic_Evaluations_of.5.aspxhttp://adisonline.com/pharmacoeconomics/Abstract/2012/30030/Methodological_Quality_of_Economic_Evaluations_of.5.aspxhttp://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=datehttp://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date


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Trends in Notifiable Infectious Diseases in China: Implications forSurveillance and Population Health PolicyLei Zhang, David P. WilsonPLoS ONE: Research Article, published 16 Feb 201210.1371/journal.pone.0031076Abstract

This study aimed to analyse trends in notifiable infectious diseases in China,in their historical context. Both English and Chinese literature was searchedand diseases were categorised according to the type of disease ortransmission route. Temporal trends of morbidity and mortality rates werecalculated for eight major infectious diseases types. Strong governmentcommitment to public health responses and improvements in quality of lifehas led to the eradication or containment of a wide range of infectiousdiseases in China. The overall infectious diseases burden experienced adramatic drop during 19751995, but since then, it reverted and maintaineda gradual upward trend to date. Most notifiable diseases are contained at alow endemic level; however, local small-scale outbreaks remain common.

Tuberculosis, as a bacterial infection, has re-emerged since the 1990s and

has become prevalent in the country. Sexually transmitted infections are in arapid, exponential growth phase, spreading from core groups to the generalpopulation. Together human immunodeficiency virus (HIV), they account for39% of all death cases due to infectious diseases in China in 2008. Zoonoticinfections, such as severe acute respiratory syndrome (SARS), rabies andinfluenza, pose constant threats to Chinese residents and remain the mostdeadly disease type among the infected individuals. Therefore, second-generation surveillance of behavioural risks or vectors associated withpathogen transmission should be scaled up. It is necessary to implementpublic health interventions that target HIV and relevant coinfections, addresstransmission associated with highly mobile populations, and reduce the riskof cross-species transmission of zoonotic pathogens.

PLoS Medicine(Accessed 20 February 2012)http://www.plosmedicine.org/article/browse.action?field=date[No new relevant content]

PNAS - Proceedings of the National Academy of Sciences of theUnited Statesof America(Accessed 20 February 2012)http://www.pnas.org/content/early/recent[No new relevant content]

Science17 February 2012 vol 335, issue 6070, pages 765-880http://www.sciencemag.org/current.dtlPolicy Forum
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0031076http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0031076http://www.plosmedicine.org/article/browse.action?field=datehttp://www.pnas.org/content/early/recenthttp://www.sciencemag.org/current.dtlhttp://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0031076http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0031076http://www.plosmedicine.org/article/browse.action?field=datehttp://www.pnas.org/content/early/recenthttp://www.sciencemag.org/current.dtl


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Public Health and BiosecurityH5N1 Debates: Hung Up on the Wrong QuestionsDaniel R. PerezScience 17 February 2012: 799-801.Published online 19 January 2012 [DOI:10.1126/science.1219066]Information related to influenza transmissibility should be published in its

entirety.Summary Full Text Full Text (PDF)Public Health and BiosecurityLife Sciences at a Crossroads: Respiratory Transmissible H5N1Michael T. Osterholm and Donald A. HendersonScience 17 February 2012: 801-802.Published online 19 January 2012 [DOI:10.1126/science.1218612]Release of details of recent research on affecting influenza transmissibilityposes far more risk than any good that might occur.SummaryFull TextFull Text (PDF)Public Health and BiosecurityThe Obligation to Prevent the Next Dual-Use Controversy

Ruth R. Faden and Ruth A. KarronScience 17 February 2012: 802-804.Published online 9 February 2012 [DOI:10.1126/science.1219668]

The recent debates over H5N1 experiments highlight current shortcomings inoversight of potential dual-use research.SummaryFull TextFull Text (PDF)

Tropical Medicine & International HealthFebruary 2012 Volume 17, Issue 2 Pages 143261http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissue[Reviewed earlier]

VaccineVolume 30, Issue 9 pp. 1529-1752 (21 February 2012)http://www.sciencedirect.com/science/journal/0264410X[Reviewed last week]

Value in HealthJanuary 2012, Vol. 15, No. 1http://www.valueinhealthjournal.com/home

[Reviewed earlier]

* * * *

Vaccines: The Week in Review is a service of the Center for Vaccines Ethics and

Policy (CVEP) which is solely responsible for its content. Support for this service isprovided by CVEP co-founders -Penn Center for Bioethics, The Wistar Institute
http://www.sciencemag.org/content/335/6070/799.summaryhttp://www.sciencemag.org/content/335/6070/799.fullhttp://www.sciencemag.org/content/335/6070/799.full.pdfhttp://www.sciencemag.org/content/335/6070/801.summaryhttp://www.sciencemag.org/content/335/6070/801.fullhttp://www.sciencemag.org/content/335/6070/801.full.pdfhttp://www.sciencemag.org/content/335/6070/802.summaryhttp://www.sciencemag.org/content/335/6070/802.fullhttp://www.sciencemag.org/content/335/6070/802.full.pdfhttp://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissuehttp://www.sciencedirect.com/science/journal/0264410Xhttp://www.valueinhealthjournal.com/homehttp://centerforvaccineethicsandpolicy.wordpress.com/http://www.bioethics.upenn.edu/http://www.bioethics.upenn.edu/http://www.wistar.org/vaccinecenter/default.htmlhttp://www.sciencemag.org/content/335/6070/799.summaryhttp://www.sciencemag.org/content/335/6070/799.fullhttp://www.sciencemag.org/content/335/6070/799.full.pdfhttp://www.sciencemag.org/content/335/6070/801.summaryhttp://www.sciencemag.org/content/335/6070/801.fullhttp://www.sciencemag.org/content/335/6070/801.full.pdfhttp://www.sciencemag.org/content/335/6070/802.summaryhttp://www.sciencemag.org/content/335/6070/802.fullhttp://www.sciencemag.org/content/335/6070/802.full.pdfhttp://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissuehttp://www.sciencedirect.com/science/journal/0264410Xhttp://www.valueinhealthjournal.com/homehttp://centerforvaccineethicsandpolicy.wordpress.com/http://www.bioethics.upenn.edu/http://www.wistar.org/vaccinecenter/default.html


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Vaccine Centerand Childrens Hospital of Philadelphia Vaccine Education Center.Additional support is provided byPATH Vaccine Development Program and theInternational Vaccine Institute (IVI), and by vaccine industry leaders including GSKand Pfizer (list in formation), as well as the Developing Countries VaccineManufacturers Network (DCVMN). Support is also provided by a growing list ofindividuals who use this service to support their roles in public health, clinical

practice, government, IGOs/NGOs, research, industry and academia.
http://www.wistar.org/vaccinecenter/default.htmlhttp://www.chop.edu/service/vaccine-education-center/home.htmlhttp://sites.path.org/vaccinedevelopment/http://www.ivi.org/http://www.dcvmn.org/index.aspxhttp://www.wistar.org/vaccinecenter/default.htmlhttp://www.chop.edu/service/vaccine-education-center/home.htmlhttp://sites.path.org/vaccinedevelopment/http://www.ivi.org/http://www.dcvmn.org/index.aspx

vaccines_the week in review_20 february 2012

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