vaccines_the week in review_27 february 2012

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Vaccines: The Week in Review27 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. This

summary supports ongoing initiatives of the Center for Vaccine Ethics & Policy, and is not intended to beexhaustive 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/

UNICEF reported that the Central African Republic (CAR) launcheda national immunization campaign to eradicate polio aimed atreaching all children in the country, including hard-to-reach populations livingin conflict and post-conflict zones with limited access to health servicesinurgent response to four imported cases of polio discovered in CAR in 2011,the first in two years. Mary Louise Eagleton Meaney, Deputy Representativefor UNICEF, CAR, said Routine data shows that only 68 per cent of children inCAR under five years of age are completely vaccinated against polio, whichmeans that 260,000 children under five are at risk of contracting the virus.UNICEF noted that health workers will be going door-to-door to deliver poliovaccines starting February 24th to 806,825 children between the ages of 0-

59 months; to administer vitamin A supplements to 725,102 childrenbetween 6-59 months; and to provide deworming for 643,595 childrenbetween 12-59 months of age.http://www.unicef.org/media/media_61805.html

Interview: Voice of America interviews Dagfinn HybrtenGAVI Board Chair Dagfinn Hybrten talks to the official United Statesgovernment broadcaster about the role of vaccines in achieving MDGs 4 and5Source: Health Alliance/2011

In an interview with Voice of America, GAVI Alliance Board ChairmanDagfinn Hybrten discusses a wide range of issues with VoA correspondentLinord Moudou. He traces GAVIs history and explains that vaccines havecreated a moral imperative to act in order to save lives.Hybrten addsthat without achieving high levels of vaccination, it will be impossible toreach Millennium Development Goals 4 and 5 to reduce child mortality andimprove maternal health. By responding to country demand and prioritisinguptake of new and underused vaccines, GAVI support has helped countries toavert more than five and a half million future deaths.
http://centerforvaccineethicsandpolicy.wordpress.com/mailto:[email protected]://centerforvaccineethicsandpolicy.wordpress.com/http://www.unicef.org/media/media_61805.htmlmailto:[email protected]://centerforvaccineethicsandpolicy.wordpress.com/http://www.unicef.org/media/media_61805.htmlhttp://centerforvaccineethicsandpolicy.wordpress.com/


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

The MMWR weekly for February 24, 2012 / Vol. 61 / No. 7 includes:

- Influenza Vaccination Coverage Among Pregnant Women 29 States andNew York City, 200910 Season- Update: Influenza Activity United States, October 2, 2011February 11,2012- Announcement: Release of Online U.S. and State Trend Data for Health-Related Quality of Life

The Weekly Epidemiological Record (WER) for 24 February 2012,vol. 87, 7 (pp 6572) includes WHO Quantitative Immunization and Vaccine-Related Research meeting, October 2011 summary; Dengue and severe

dengue factsheet (Revised in January 2012)http://www.who.int/entity/wer/2012/wer8708.pdf

Twitter Watch [accessed 26 February 17:35]Items of interest from a variety of twitter feeds associated with immunization,vaccines and global public health. This capture is highly selective and is by nomeans intended to be exhaustive.

GAVI Alliance @GAVIAllianceHelen Evans - GAVI Deputy CEO - shares her insights into #GAVI's challengesand opportunities. ht.ly/9dSKY7:01 AM - 25 Feb 12 via web Details

EndPolioNow @EndPolioNowAt Polio Summit, India just announces that WHO has removed India from thepolio endemic list #polio1:15 AM - 25 Feb 12

IHME at UW @IHME_UWTrack #polio vaccination activities using Polio Campaign Monitoring Reports:bit.ly/w1iMey#GHDxData#globalhealth1:05 PM - 24 Feb 12

WHO @WHOIf we eradicate polio, we'll save US$40-50b in the next 20yrs. We can usethese $ to fight other diseases bit.ly/ycRnFG#poliochat12:08 PM - 24 Feb 12

HarvardPublicHealth @HarvardHSPH
http://www.gavialliance.org/library/news/gavi-features/2012/hoybraten-voice-of-america/http://www.gavialliance.org/library/news/gavi-features/2012/hoybraten-voice-of-america/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a1.htm?s_cid=mm6107a1_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a1.htm?s_cid=mm6107a1_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a3.htm?s_cid=mm6107a3_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a3.htm?s_cid=mm6107a3_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a4.htm?s_cid=mm6107a4_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a4.htm?s_cid=mm6107a4_whttp://www.who.int/entity/wer/2012/wer8708.pdfhttps://twitter.com/#!/GAVIAlliancehttps://twitter.com/#!/search/%23GAVIhttp://t.co/GNAXONAPhttps://twitter.com/#!/GAVIAlliance/status/173377193387364352https://twitter.com/#!/EndPolioNowhttps://twitter.com/#!/search/%23poliohttps://twitter.com/#!/IHME_UWhttps://twitter.com/#!/search/%23poliohttp://t.co/Z4r8IZ4Chttps://twitter.com/#!/search/%23GHDxDatahttps://twitter.com/#!/search/%23globalhealthhttps://twitter.com/#!/WHOhttp://t.co/pM9kNZKJhttps://twitter.com/#!/search/%23poliochathttps://twitter.com/#!/HarvardHSPHhttp://www.gavialliance.org/library/news/gavi-features/2012/hoybraten-voice-of-america/http://www.gavialliance.org/library/news/gavi-features/2012/hoybraten-voice-of-america/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a1.htm?s_cid=mm6107a1_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a1.htm?s_cid=mm6107a1_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a3.htm?s_cid=mm6107a3_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a3.htm?s_cid=mm6107a3_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a4.htm?s_cid=mm6107a4_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6107a4.htm?s_cid=mm6107a4_whttp://www.who.int/entity/wer/2012/wer8708.pdfhttps://twitter.com/#!/GAVIAlliancehttps://twitter.com/#!/search/%23GAVIhttp://t.co/GNAXONAPhttps://twitter.com/#!/GAVIAlliance/status/173377193387364352https://twitter.com/#!/EndPolioNowhttps://twitter.com/#!/search/%23poliohttps://twitter.com/#!/IHME_UWhttps://twitter.com/#!/search/%23poliohttp://t.co/Z4r8IZ4Chttps://twitter.com/#!/search/%23GHDxDatahttps://twitter.com/#!/search/%23globalhealthhttps://twitter.com/#!/WHOhttp://t.co/pM9kNZKJhttps://twitter.com/#!/search/%23poliochathttps://twitter.com/#!/HarvardHSPH


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Today in #publichealth history: Children receive the first polio vaccine in1954 ht.ly/9fFuq#TodayinHistory

EndPolioNow @EndPolioNowView a NEW infographic of the progress and current state of polio eradication.twitpic.com/8npwrg

1:46 PM - 23 Feb 12

Dagfinn Hybrten @HoybratenGreat opportunity to speak about the power of#vaccines to save lives atVoice of America: ht.ly/9c3vlRetweeted by GAVI Alliance9:26 AM - 21 Feb 12

PAHO/WHO @pahowho#PAHO Funds Training in Epidemiology for Health Officials in the Region -bit.ly/zzFPYE7:55 PM - 22 Feb 12

Sabin Vaccine Inst. @sabinvaccineToday on the blog: an update on sustainable immunization financingactivities in Cambodia bit.ly/xQcWcO3:42 PM - 22 Feb 12

GAVI Alliance @GAVIAllianceNearly 70% of all vax consumed come from India; great potential 2 sustain

growth momentum --RajeevDhere,SerumInstitute ht.ly/9bQqK8:20 AM - 22 Feb 12

Measles Initiative @MeaslesInitWhy do measles outbreaks occur in middle- and higher-income communities?wp.me/p1UXPA-38Retweeted by ECDC Eurovaccine5:41 AM - 17 Feb 12

ECDC Eurovaccine @EurovaccineLatest ECDC #measles monitoring provides 2011 analyses of surveillancedata; 2011 cases is 4-fold increase from 2009. bit.ly/xkePx510:47 AM - 21 Feb 12

GAVI Alliance @GAVIAllianceGAVI Board Chair, @Hoybraten talks about the role of vaccines in achievingMDGs 4 and 5: ht.ly/9c3vl8:28 AM - 21 Feb 12

Journal WatchVaccines: The Week in Review continues its weekly scanning of key journalsto identify and cite articles, commentary and editorials, books reviews and
https://twitter.com/#!/search/%23publichealthhttp://t.co/72MbzGy5https://twitter.com/#!/search/%23TodayinHistoryhttps://twitter.com/#!/EndPolioNowhttp://t.co/UO66y1Ijhttps://twitter.com/#!/Hoybratenhttps://twitter.com/#!/search/%23vaccineshttp://t.co/tqgtQlXEhttps://twitter.com/#!/GAVIAlliancehttps://twitter.com/#!/pahowhohttps://twitter.com/#!/search/%23PAHOhttp://t.co/kDKn4FMHhttps://twitter.com/#!/sabinvaccinehttps://twitter.com/#!/sabinvaccinehttp://t.co/L4zeOM33https://twitter.com/#!/GAVIAlliancehttp://t.co/rCaraiqShttps://twitter.com/#!/MeaslesInithttp://t.co/hqPbw6Duhttps://twitter.com/#!/Eurovaccinehttps://twitter.com/#!/Eurovaccinehttps://twitter.com/#!/search/%23measleshttp://t.co/GGDsXE8Phttps://twitter.com/#!/GAVIAlliancehttps://twitter.com/#!/Hoybratenhttp://t.co/BtQchtwihttps://twitter.com/#!/search/%23publichealthhttp://t.co/72MbzGy5https://twitter.com/#!/search/%23TodayinHistoryhttps://twitter.com/#!/EndPolioNowhttp://t.co/UO66y1Ijhttps://twitter.com/#!/Hoybratenhttps://twitter.com/#!/search/%23vaccineshttp://t.co/tqgtQlXEhttps://twitter.com/#!/GAVIAlliancehttps://twitter.com/#!/pahowhohttps://twitter.com/#!/search/%23PAHOhttp://t.co/kDKn4FMHhttps://twitter.com/#!/sabinvaccinehttp://t.co/L4zeOM33https://twitter.com/#!/GAVIAlliancehttp://t.co/rCaraiqShttps://twitter.com/#!/MeaslesInithttp://t.co/hqPbw6Duhttps://twitter.com/#!/Eurovaccinehttps://twitter.com/#!/Eurovaccinehttps://twitter.com/#!/search/%23measleshttp://t.co/GGDsXE8Phttps://twitter.com/#!/GAVIAlliancehttps://twitter.com/#!/Hoybratenhttp://t.co/BtQchtwi


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other 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 you

would like to suggest other journal titles to include in this service, pleasecontact David Curry at: [email protected]

Annals of Internal MedicineFebruary 21, 2012; 156 (4)http://www.annals.org/content/current[No relevant content]

British Medical BulletinVolume 100 Issue 1 December 2011

http://bmb.oxfordjournals.org/content/current[Reviewed earlier; No relevant content]

British Medical Journal25 February 2012 (Vol 344, Issue 7845)http://www.bmj.com/content/current[No relevant content]

Cost Effectiveness and Resource Allocation(Accessed 26 February 2012)http://www.resource-allocation.com/[No new relevant content]

Emerging Infectious DiseasesVolume 18, Number 3March 2012http://www.cdc.gov/ncidod/EID/index.htm[No relevant content]

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

Globalization and Health[Accessed 26 February 2012]http://www.globalizationandhealth.com/[No new relevant content]
mailto:[email protected]://www.annals.org/content/currenthttp://bmb.oxfordjournals.org/content/currenthttp://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/mailto:[email protected]://www.annals.org/content/currenthttp://bmb.oxfordjournals.org/content/currenthttp://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/


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

Theme: The Future of The Small Business Insurance Exchange

[No relevant content]

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]

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

AbstractShortages, geographic imbalances and poor performance of health workerspose major challenges for improving health service delivery in developingcountries. In response, multilateral agencies have increasingly recognized theneed to invest in human resources for health (HRH) to assist countries inachieving their health system goals. In this paper we analyse the HRH-relatedactivities of three agencies: the Global Alliance for Vaccines andImmunisation (GAVI); the Global Fund for Aids, Tuberculosis, and Malaria (theGlobal Fund); and the World Bank. First, we reviewed the type of HRH-relatedactivities that are eligible for financing within each agency. Second, wereviewed the HRH-related activities that each agency is actually financing.

Third, we reviewed the literature to understand the impact that GAVI, GlobalFund and World Bank investments in HRH have had on the health workforcein developing countries. Our analysis found that by far the most commonactivity supported across all agencies is short-term, in-service training. Thereis relatively little investment in expanding pre-service training capacity,despite large health worker shortages in developing countries. We also found
http://content.healthaffairs.org/content/currenthttp://hhrjournal.org/index.php/hhrhttp://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissuehttp://heapol.oxfordjournals.org/content/currenthttp://content.healthaffairs.org/content/currenthttp://hhrjournal.org/index.php/hhrhttp://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissuehttp://heapol.oxfordjournals.org/content/current


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that the majority of GAVI and the Global Fund grants finance health workerremuneration, largely through supplemental allowances, with littleinformation available on how payment rates are determined, how thepotential negative consequences are mitigated, and how payments are to besustained at the end of the grant period. Based on the analysis, we arguethere is an opportunity for improved co-ordination between the three

agencies at the country level in supporting HRH-related activities. Existinginitiatives, such as the International Health Partnership and the HealthSystems Funding Platform, could present viable and timely vehicles for thethree agencies to implement this improved co-ordination.

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/12019712[Reviewed last week]

JAMAFebruary 22/29, 2012, Vol 307, No. 8, pp 749-874http://jama.ama-assn.org/current.dtlOriginal ContributionsCost-effectiveness of Adult Vaccination Strategies UsingPneumococcal Conjugate Vaccine Compared With PneumococcalPolysaccharide VaccineKenneth J. Smith, Angela R. Wateska, Mary Patricia Nowalk, Mahlon Raymund,

J. Pekka Nuorti, Richard K. ZimmermanJAMA. 2012;307(8):804-812.doi:10.1001/jama.2012.169Abstract

Context The cost-effectiveness of 13-valent pneumococcal conjugatevaccine (PCV13) compared with 23-valent pneumococcal polysaccharidevaccine (PPSV23) among US adults is unclear.

Objective To estimate the cost-effectiveness of PCV13 vaccinationstrategies in adults.Design, Setting, and Participants A Markov state-transition model, lifetimetime horizon, societal perspective. Simulations were performed inhypothetical cohorts of US 50-year-olds. Vaccination strategies andeffectiveness estimates were developed by a Delphi expert panel; indirect(herd immunity) effects resulting from childhood PCV13 vaccination wereextrapolated based on observed PCV7 effects. Data sources for modelparameters included Centers for Disease Control and Prevention ActiveBacterial Core surveillance, National Hospital Discharge Survey andNationwide Inpatient Sample data, and the National Health Interview Survey.
http://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/2/http://www.sciencedirect.com/science/journal/12019712http://jama.ama-assn.org/current.dtlhttp://www.landesbioscience.com/journals/vaccines/toc/volume/8/issue/2/http://www.sciencedirect.com/science/journal/12019712http://jama.ama-assn.org/current.dtl


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Main Outcome Measures Pneumococcal disease cases prevented andincremental costs per quality-adjusted life-year (QALY) gained.Results In the base case scenario, administration of PCV13 as a substitute forPPSV23 in current recommendations (ie, vaccination at age 65 years and atyounger ages if comorbidities are present) cost $28 900 per QALY gainedcompared with no vaccination and was more cost-effective than the currently

recommended PPSV23 strategy. Routine PCV13 at ages 50 and 65 years cost$45 100 per QALY compared with PCV13 substituted in currentrecommendations. Adding PPSV23 at age 75 years to PCV13 at ages 50 and65 years gained 0.00002 QALYs, costing $496 000 per QALY gained. Resultswere robust in sensitivity analyses and alternative scenarios, except whenlow PCV13 effectiveness against nonbacteremic pneumococcal pneumoniawas assumed or when greater childhood vaccination indirect effects weremodeled. In these cases, PPSV23 as currently recommended was favored.

Conclusion Overall, PCV13 vaccination was favored compared with PPSV23,but the analysis was sensitive to assumptions about PCV13 effectivenessagainst nonbacteremic pneumococcal pneumonia and the magnitude ofpotential indirect effects from childhood PCV13 on pneumococcal serotype

distribution.Risk of Febrile Seizures and Epilepsy After Vaccination WithDiphtheria, Tetanus, Acellular Pertussis, Inactivated Poliovirus, andHaemophilus Influenzae Type b

Yuelian Sun, Jakob Christensen, Anders Hviid, Jiong Li, Peter Vedsted, JrnOlsen,Mogens Vestergaard

JAMA. 2012;307(8):823-831.doi:10.1001/jama.2012.165Abstract

Context Vaccination with whole-cell pertussis vaccine carries an increasedrisk of febrile seizures, but whether this risk applies to the acellular pertussisvaccine is not known. In Denmark, acellular pertussis vaccine has beenincluded in the combined diphtheria-tetanus toxoids-acellular pertussisinactivated poliovirus Haemophilus influenzae type b (DTaP-IPV-Hib) vaccinesince September 2002.

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

Design, Setting, and Participants A population-based cohort study of378 834 children who were born in Denmark between January 1, 2003, andDecember 31, 2008, and followed up through December 31, 2009; and a self-controlled case series (SCCS) study based on children with febrile seizuresduring follow-up of the cohort.Main Outcome Measures Hazard ratio (HR) of febrile seizures within 0 to 7days (0, 1-3, and 4-7 days) after each vaccination and HR of epilepsy afterfirst vaccination in the cohort study. Relative incidence of febrile seizureswithin 0 to 7 days (0, 1-3, and 4-7 days) after each vaccination in the SCCSstudy.

Results A total of 7811 children were diagnosed with febrile seizures before18 months, of whom 17 were diagnosed within 0 to 7 days after the first(incidence rate, 0.8 per 100 000 person-days), 32 children after the second(1.3 per 100 000 person-days), and 201 children after the third (8.5 per100 000 person-days) vaccinations. Overall, children did not have higher risks


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of febrile seizures during the 0 to 7 days after the 3 vaccinations vs areference cohort of children who were not within 0 to 7 days of vaccination.However, a higher risk of febrile seizures was found on the day of the first(HR, 6.02; 95% CI, 2.86-12.65) and on the day of the second (HR, 3.94; 95%CI, 2.18-7.10), but not on the day of the third vaccination (HR, 1.07; 95% CI,0.73-1.57) vs the reference cohort. On the day of vaccination, 9 children were

diagnosed with febrile seizures after the first (5.5 per 100 000 person-days),12 children after the second (5.7 per 100 000 person-days), and 27 childrenafter the third (13.1 per 100 000 person-days) vaccinations. The relativeincidences from the SCCS study design were similar to the cohort studydesign. Within 7 years of follow-up, 131 unvaccinated children and 2117vaccinated children were diagnosed with epilepsy, 813 diagnosed between 3and 15 months (2.4 per 1000 person-years) and 1304 diagnosed later in life(1.3 per 1000 person-years). After vaccination, children had a lower risk ofepilepsy between 3 and 15 months (HR, 0.63; 95% CI, 0.50-0.79) and asimilar risk for epilepsy later in life (HR, 1.01; 95% CI, 0.66-1.56) vsunvaccinated children.

Conclusions DTaP-IPV-Hib vaccination was associated with an increased

risk of febrile seizures on the day of the first 2 vaccinations given at 3 and 5months, although the absolute risk was small. Vaccination with DTaP-IPV-Hibwas not associated with an increased risk of epilepsy.EditorialsPrevention of Pneumococcal Infection With Vaccines: An EvolvingStoryEugene D. Shapiro

JAMA. 2012;307(8):847-849.doi:10.1001/jama.2012.194Extract [first 150 words per JAMA convention]

The first vaccines to prevent pneumococcal infections, crude preparations ofkilled bacteria, were developed by Sir Almroth Wright in 1911 to try toalleviate the high mortality and morbidity among gold miners in SouthAfrica.1 Discovery that antibodies against purified polysaccharides of thecapsular surface of pneumococci were protective led to development ofpolysaccharide vaccines that were marketed in the 1940s. These vaccineswere commercial failures because the advent of antimicrobials led to aperception that pneumococcal infections were no longer a major threat.2Subsequent evidence of the persistence of significant morbidity frompneumococcal infections, as well as mortality rates of 25% to 30% in patientswith invasive (including bacteremic) pneumococcal infections despite earlytreatment with antimicrobials, led to redevelopment of a polysaccharidevaccine, approved in the United States in 1977, that contained 14 of themore than 90 serotypes of pneumococci (responsible for about 80% ofinvasive

Journal of Infectious DiseasesVolume 205 Issue 6 March 15, 2012http://www.journals.uchicago.edu/toc/jid/current[No relevant content]
http://www.journals.uchicago.edu/toc/jid/currenthttp://www.journals.uchicago.edu/toc/jid/current


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The LancetFeb 25, 2012 Volume 379 Number 9817 p685 - 776http://www.thelancet.com/journals/lancet/issue/currentCommentCommunity-based treatment of severe childhood pneumoniaRobert E Black, Shams El Arifeen

In 2010, an estimated 76 million children died before their fifth birthday, andmore than a million of these deaths were due to pneumonia.1 Althoughprogress is being made in expanding the use of vaccines to preventpneumonia, many countries have yet to introduce these vaccines, especiallythe pneumococcal vaccine.2 Correct breastfeeding of children can also helpprevent pneumonia deaths, but a high prevalence of suboptimumbreastfeeding practices (eg, low rates of exclusive breastfeeding up to 6months of age) is seen in all regions of the world.

The Lancet Infectious DiseaseMar 2012 Volume 12 Number 3 p167 - 254

http://www.thelancet.com/journals/laninf/issue/currentEditorialAvian influenza and the dual-use research debate

The Lancet Infectious DiseasesPreviewSince the first human cases of infection with avian influenza H5N1 werereported 15 years ago, the disease has caused 344 deaths among 583 knowncasesa case fatality of nearly 60%. Despite the highly lethal nature of thisvirus, it is very rarely transmitted from birds to people, and even lessfrequently, if ever, transmitted from person to person. Nonetheless, thepossibility of the virus mutating or recombining with another to developpandemic potential is a bleak prospect for public health. So it is not surprisingthat the news that two groups of researchers have purposefully generatedH5N1 strains that are transmitted easily in aerosols among ferrets, a widelyused model of human influenza transmission, has generated a fierce debateabout the conduct and dissemination of dual-use research, as reported in thismonth's Newsdesk.SeriesInfectious disease surveillance and modelling across geographicfrontiers and scientific specialtiesKamran Khan, Scott JN McNabb, Ziad A Memish, Rose Eckhardt, Wei Hu,David Kossowsky, Jennifer Sears, Julien Arino, Anders Johansson, MaurizioBarbeschi, Brian McCloskey, Bonnie Henry, Martin Cetron, John S BrownsteinSummaryInfectious disease surveillance for mass gatherings (MGs) can be directedlocally and globally; however, epidemic intelligence from these two levels isnot well integrated. Modelling activities related to MGs have historicallyfocused on crowd behaviours around MG focal points and their relation to thesafety of attendees. The integration of developments in internet-based globalinfectious disease surveillance, transportation modelling of populationstravelling to and from MGs, mobile phone technology for surveillance duringMGs, metapopulation epidemic modelling, and crowd behaviour modelling is
http://www.thelancet.com/journals/lancet/issue/currenthttp://www.thelancet.com/journals/laninf/issue/currenthttp://www.thelancet.com/journals/lancet/issue/currenthttp://www.thelancet.com/journals/laninf/issue/current


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important for progress in MG health. Integration of surveillance acrossgeographic frontiers and modelling across scientific specialties could producethe first real-time risk monitoring and assessment platform that couldstrengthen awareness of global infectious disease threats before, during, andimmediately after MGs. An integrated platform of this kind could help identifyinfectious disease threats of international concern at the earliest stages

possible; provide insights into which diseases are most likely to spread intothe MG; help with anticipatory surveillance at the MG; enable mathematicalmodelling to predict the spread of infectious diseases to and from MGs;simulate the effect of public health interventions aimed at different local andglobal levels; serve as a foundation for scientific research and innovation inMG health; and strengthen engagement between the scientific communityand stakeholders at local, national, and global levels.Research agenda for mass gatherings: a call to action

John S Tam, Maurizio Barbeschi, Natasha Shapovalova, Sylvie Briand, Ziad AMemish, Marie-Paule KienySummaryPublic health research is essential for the development of effective policies

and planning to address health security and risks associated with massgatherings (MGs). Crucial research topics related to MGs and their effects onglobal health security are discussed in this review. The research agenda forMGs consists of a framework of five major public health research directionsthat address issues related to reducing the risk of public health emergenciesduring MGs; restricting the occurrence of non-communicable andcommunicable diseases; minimisation of the effect of public health eventsassociated with MGs; optimisation of the medical services and treatment ofdiseases during MGs; and development and application of modern publichealth measures. Implementation of the proposed research topics would beexpected to provide benefits over the medium to long term in planning forMGs.ReviewAntiviral resistance during the 2009 influenza A H1N1 pandemic:public health, laboratory, and clinical perspectivesAeron C Hurt, Tawee Chotpitayasunondh, Nancy J Cox, Rod Daniels, Alicia MFry, Larisa V Gubareva, Frederick G Hayden, David S Hui, Olav Hungnes,Angie Lackenby, Wilina Lim, Adam Meijer, Charles Penn, Masato Tashiro,

Timothy M Uyeki, Maria Zambon, on behalf of the WHO Consultation onPandemic Influenza A (H1N1) 2009 Virus Resistance to AntiviralsSummaryInfluenza A H1N1 2009 virus caused the first pandemic in an era whenneuraminidase inhibitor antiviral drugs were available in many countries. Theexperiences of detecting and responding to resistance during the pandemicprovided important lessons for public health, laboratory testing, and clinicalmanagement. We propose recommendations for antiviral susceptibilitytesting, reporting results, and management of patients infected with 2009pandemic influenza A H1N1. Sustained global monitoring for antiviralresistance among circulating influenza viruses is crucial to inform publichealth and clinical recommendations for antiviral use, especially sincecommunity spread of oseltamivir-resistant A H1N1 2009 virus remains aconcern. Further studies are needed to better understand influenza


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management in specific patient groups, such as severelyimmunocompromised hosts, including optimisation of antiviral treatment,rapid sample testing, and timely reporting of susceptibility results.

Medical Decision Making (MDM)

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

NatureVolume 482 Number 7386 pp439-562 23 February 2012http://www.nature.com/nature/current_issue.htmlEditorialFlu papers warrant full publicationNature 482, 439 (23 February 2012)doi:10.1038/482439a

Published online 22 February 2012Although more debate is needed, the benefits of publishing sensitive dataoutweigh the risks that have so far been made public.

No one should presume to know all the ways in which influenza virus couldbe misused, and the motivations for doing so, but the consequences could becatastrophic. There are many scenarios to consider, ranging from mad lonescientists, desperate despots and members of millennial doomsday cults tonation states wanting mutually assured destruction options, bioterrorists or asingle person's random acts of craziness. These are low-probability events,but they could introduce a new evolutionary H5N1 seed into the environmentthat seems not to exist in nature. This might not cause a pandemic instantly,but it could start the virus on a new path for pandemic evolution.

That is the rationale provided by Paul Keim, acting chair of the US NationalScience Advisory Board for Biosecurity (NSABB), in response to questionsposed by Nature (P. S. Keim Nature 482, 156157; 2012) about the NSABB'srecommendation that recent work on the transmissibility in mammals ofartificial strains of avian H5N1 influenza virus should not be published in full.

The work was conducted in ferrets generally considered the best animalmodels for human transmission and shows that avian H5N1 viruses have agreater potential to evolve into transmissible forms in mammals, includinghumans, than had been thought. The work is reported in two papers acceptedbut not yet published in Nature and Science.

Last week, a group of flu and public-health experts gathered at the WorldHealth Organization (WHO) headquarters in Geneva, Switzerland, to discussthe matter (see go.nature.com/uyr1uu). And it was clear at the meeting thatthe above opening quote expresses the only rationale that attendees hadreceived.

To its credit and that of the US government, the NSABB is the only body inthe world set up to review these issues in a systematic fashion. It includes ex-officio representatives of all relevant government departments (includingintelligence and security agencies), as well as independent researchers. TheNSABB's guidance was an important first step in public consideration of the
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impacts and potential regulation of such research. The second step was lastweek's meeting at the WHO again, like the NSABB, a body empowered onlyto make recommendations.

Some context is important in considering the issues surroundingpublication. In 2003, Nature and many other journals met to establisheditorial procedures for considering papers that have public-health and

scientific benefits but that might also have biosecurity risks (see Nature 421,771; 2003). The statement that emerged from that meeting envisaged thepossibility that a journal would reject a paper if it was clear that the risks ofpublication outweighed the benefits. Nature accordingly used independentadvisers in considering the submission of the latest paper, and most of theadvisers recommended publication in full. This is also the first papersubmitted to any Nature journal for which recommendations have been madeagainst publication on biosecurity grounds.

Rather than simply reject the papers, given also the NSABB's opinion, bothNature and Science decided to investigate another option: to publish aredacted version omitting key methods and data. But a condition of such anapproach was that a method should exist for distributing a full version to

those in need of the results for public-health reasons and those capable ofpursuing the science. Both journals accordingly prepared full and redactedversions.There is already a substantial immediate risk to humans.

Those at the WHO meeting, under conditions of strict security, examinedboth versions of the two papers. It had already been said in blogs and newscoverage that, because the methods used are not novel, and because one ofthe papers had been presented at an open meeting, redaction would bepointless. As one WHO participant said: It was only when I'd seen bothversions that I realized how ineffective redaction would be. What was alsoconcluded was that a system for distributing the full paper only to selectedindividuals would be impossible to set up on any relevant timescale.

But what also became clear, partly from unpublished data, was that notonly does the mammalian transmissibility threat seem greater thanpreviously thought, but also that current avian viruses have some of themutations identified in the new work. In other words, there is already asubstantial immediate risk to humans. The meeting also concluded that thenew data are of value for surveillance, and that the results should be built onto explore the mechanisms underlying transmissibility and the high fatalityrate observed in humans infected by H5N1.

Given the inadequacy of redaction, and the immediate risks to global publichealth, the biosecurity objections expressed above seem too general andhypothetical to justify obstructing publication and further research. Moreover,with regard to the NSABB's recommendations and the recommendations ofthe WHO meeting (see go.nature.com/ky2skc), neither of the discussions thatpreceded them were sufficiently inclusive of the security, societal andresearch interests at stake.

Therefore, further discussion is essential. That must include a review of thesafety regimes (lab equipment, buildings and practices) in which future workshould be conducted. The two laboratories in which the latest researchoriginated are categorized as 'BSL-3 enhanced' (see Nature 480, 421422;2011), a classification that, although rigorous in these cases, is not well
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defined in general. The Public Health Agency of Canada has deemed thehighest level of BSL-4 to be required (see page 447). Safety-standardscommittees in the United States and Europe are currently assessing requiredsafety levels, and may report within a few weeks.

As was agreed by the journals and the lead authors at the meeting,publication of the papers must wait at least for the outcome of those

discussions. There may yet be regulatory or legal obstacles to publication, orbiosecurity or biosafety risks sufficient to outweigh the health risks.Otherwise, it is Nature's view that the papers should ultimately be publishedin full.

Nature MedicineFebruary 2012, Volume 18 No 2 pp179-321http://www.nature.com/nm/journal/v18/n2/index.html[Reviewed last week]

Nature Reviews ImmunologyMarch 2012 Vol 12 No 3http://www.nature.com/nri/journal/v12/n3/index.html[No relevant content]

New England Journal of MedicineFebruary 23, 2012 Vol. 366 No. 8http://content.nejm.org/current.shtml[No relevant content]

OMICS: A Journal of Integrative BiologyJanuary/February 2012, 16(1-2): 1-2http://online.liebertpub.com/toc/omi/16/1-2#[No relevant content]

The Pediatric Infectious Disease JournalMarch 2012 - Volume 31 - Issue 3 pp: 217-286,e52-e58,A11-A12http://journals.lww.com/pidj/pages/currenttoc.aspxOriginal StudiesComparative Coverage of Supplementary and UniversallyRecommended Immunizations in Children at 24 Months of AgeHug, Salome; Weibel, Daniel; Delaporte, Elisabeth; Gervaix, Alain; Heininger,UlrichPediatric Infectious Disease Journal. 31(3):217-220, March 2012.doi: 10.1097/INF.0b013e31823cbaa5

Abstract:Background: The introduction of pneumococcal and meningococcal group C

conjugate vaccinations as supplementary (a new category in Swiss
http://www.nature.com/doifinder/10.1038/482447ahttp://www.nature.com/nm/journal/v18/n2/index.htmlhttp://www.nature.com/nri/journal/v12/n3/index.htmlhttp://content.nejm.org/current.shtmlhttp://online.liebertpub.com/toc/omi/16/1-2#http://journals.lww.com/pidj/pages/currenttoc.aspxhttp://journals.lww.com/pidj/Abstract/2012/03000/Comparative_Coverage_of_Supplementary_and.1.aspxhttp://journals.lww.com/pidj/Abstract/2012/03000/Comparative_Coverage_of_Supplementary_and.1.aspxhttp://www.nature.com/doifinder/10.1038/482447ahttp://www.nature.com/nm/journal/v18/n2/index.htmlhttp://www.nature.com/nri/journal/v12/n3/index.htmlhttp://content.nejm.org/current.shtmlhttp://online.liebertpub.com/toc/omi/16/1-2#http://journals.lww.com/pidj/pages/currenttoc.aspxhttp://journals.lww.com/pidj/Abstract/2012/03000/Comparative_Coverage_of_Supplementary_and.1.aspxhttp://journals.lww.com/pidj/Abstract/2012/03000/Comparative_Coverage_of_Supplementary_and.1.aspx


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immunization recommendations) to universally recommended vaccinations in2006 prompted this study to investigate their acceptance.

Methods: The study was performed in 24-month-old healthy children born inthe Geneva or Basel areas in Switzerland between January and April 2007.After informed consent had been obtained from caregivers (for this particularstudy in Basel and in general for providing immunization data in Geneva on

an ongoing basis), all universally recommended and supplementaryvaccinations administered by 24 months of age were analyzed forcompleteness and timeliness according to set definitions. Sample sizecalculations and standard statistical tests were applied for comparative dataanalyses.

Results: Of 592 children at the age of 12 months, 94% and 73% hadreceived complete diphtheria-tetanus-pertussis component combination andpneumococcal conjugate vaccinations, respectively. At the age of 24 months,coverage rates for complete booster doses were 77% and 70%, respectively.Rates for MMR doses 1 and 2 at 24 months were 92% and 72%, respectively,and the rate for meningococcal conjugate vaccine (single dose) was 62%. Onan average, coverage rates were similar in the 2 study regions except those

for pneumococcal conjugate and second dose of MMR, which wereapproximately 10% higher in Geneva.

Conclusions: Compliance with supplementary vaccinations was lower thanthat with universally recommended vaccinations. This can be explained bythe recent introduction of supplementary vaccinations or by the publicperception that they are less important than universal vaccinations.The Changing Epidemiology of Invasive Pneumococcal Disease at aTertiary Children's Hospital Through the 7-valent PneumococcalConjugate Vaccine Era: A Case for Continuous SurveillanceAmpofo, Krow; Pavia, Andrew T.; Stockmann, Chris; Hersh, Adam L.; Bender,

Jeffrey M.; Blaschke, Anne J.; Weng, Hsin Yi Cindy; Korgenski, Kent E.; Daly,Judy; Mason, Edward O.; Byington, Carrie L.Pediatric Infectious Disease Journal. 31(3):228-234, March 2012.doi: 10.1097/INF.0b013e31823dcc72

Abstract:Background: In 2000, a 7-valent pneumococcal conjugate vaccine (PCV7)

was licensed for use among US children. Many sites have since reportedchanges in invasive pneumococcal disease (IPD). We recognized anopportunity to describe the changes in epidemiology, clinical syndromes, andserotype distribution during a 14-year period including 4 years before vaccineintroduction and spanning the entire PCV7 era.

Methods: Cases were defined as children


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29% to 50% (P < 0.001). This increase was primarily attributable to anincrease in complicated pneumonia (17% to 33%, P < 0.001). Nonvaccineserotypes 7F, 19A, 22F, and 3 emerged as the dominant serotypes in thepostvaccine period. In children with IPD who were younger than 5 years, forwhom vaccine is recommended, 67% of the cases were caused by serotypesin 13-valent PCV during 2005 to 2010.

Conclusions: After PCV7 was introduced, significant changes in IPD werenoted. One-third of IPD occurred in children older than 5 years, who wereoutside the age-group for which PCV is recommended. Continued surveillanceis warranted to identify further evolution of the epidemiology, clinicalsyndromes, and serotype distribution of S. pneumoniae after 13-valent PCVlicensure.Vaccine ReportsIncidence of Intussusception Among Infants in a Large CommerciallyInsured Population in the United StatesMona Eng, Patricia; Mast, T. Christopher; Loughlin, Jeanne; Clifford, C. Robin;Wong, Judy; Seeger, John D.Pediatric Infectious Disease Journal. 31(3):287-291, March 2012.

doi: 10.1097/INF.0b013e31824213b1Abstract:

Background: To estimate the incidence of intussusception among infantstreated in inpatient and emergency department settings during the periodpreceding the US launch of second-generation rotavirus vaccines.

Methods: From a large US health insurance claims database, we sampled100,000 infants aged 1 to 3 months at first diphtheria-tetanus-acellularpertussis vaccination between 2001 and 2005. Potential intussusceptioncases were identified on the basis of claims and were confirmed by medicalrecord review. Incidence rates (IRs) and 95% confidence intervals (CIs) wereestimated based on follow-up from first diphtheria-tetanus-acellular pertussisdose to up to 1 year of age, and within 21, 30, and 60 days after each dose.

Results: The IR of intussusception in the first year of life was 0.33/1000person-years based on 22 confirmed cases (95% CI: 0.210.50/1000 person-years). The age-specific incidence peaked among infants aged 5 months (IR:0.82/1000 person-years; 95% CI: 0.301.78/1000 person-years). During the21, 30, and 60 days following any dose, the incidence per 1000 person-yearswas 0.27, 0.24, and 0.33, respectively.Conclusion: The rates described in this study can serve as a benchmark forcomparison with incidences observed after the introduction of the second-generation rotavirus vaccines.Postmarketing Evaluation of the Short-term Safety of thePentavalent Rotavirus VaccineLoughlin, Jeanne; Mast, T. Christopher; Doherty, Michael C.; Wang, Florence

T.; Wong, Judy; Seeger, John D.Pediatric Infectious Disease Journal. 31(3):292-296, March 2012.doi: 10.1097/INF.0b013e3182421390

Abstract:Background: A pentavalent rotavirus vaccine (RV5) demonstrated efficacy

and safety in a large clinical trial before US licensure in 2006. The primaryobjective of this observational study was to assess the occurrence ofintussusception (IS) among infants who received RV5 in routine use.
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Secondary objectives assessed the occurrence of Kawasaki disease (KD) andgeneral safety.

Methods: We identified and followed infants with a health insurance claimfor RV5 during the first 2 years of RV5 availability. Concurrent and historicalcohorts receiving diphtheria-tetanus-acellular pertussis (DTaP) vaccine wereused as comparators; the historical DTaP cohort informed sequential

monitoring boundaries for IS and KD. Medical records from potential IS andKD cases were reviewed to confirm outcomes. General safety was evaluatedacross a wide range of outcomes using prespecified criteria. Incidence ratesfor outcomes along with relative risks and 95% confidence intervals (CIs)were estimated.

Results: The 85,397 RV5 and 62,820 DTaP recipients contributed 17,433and 12,339 person-years, resulting in 6 and 5 confirmed cases of IS,respectively, within 30 days following any dose. The relative risk of IS was 0.8(95% confidence interval: 0.223.52). The number of IS or KD cases did notcross the monitoring boundaries. The general safety evaluation did notidentify any specific diagnoses or patterns of diagnoses that might suggestother safety concerns.

Conclusion: RV5 was not associated with an increased risk of IS, KD, or anyother recognized health outcome.

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

PharmacoeconomicsMarch 1, 2012 - Volume 30 - Issue 3 pp: 171-256http://adisonline.com/pharmacoeconomics/pages/currenttoc.aspx[Reviewed last week]

PLoS One[Accessed 26 February 2012]http://www.plosone.org/article/browse.action;jsessionid=577FD8B9E1F322DAA533C413369CD6F3.ambra01?field=date[No new relevant content]

PLoS Medicine(Accessed 26 February 2012)http://www.plosmedicine.org/article/browse.action?field=dateMobile Phone Text Messaging: Tool for Malaria Control in AfricaDejan Zurovac, Ambrose O. Talisuna, Robert W. Snow Essay, published 21Feb 2012doi:10.1371/journal.pmed.1001176Summary Points
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- Across many malaria-endemic areas in rural Africa, the communication gapbetween managers, health workers, and patients is a significant barrier toefficient malaria control.- The rapid expansion of mobile network coverage and the widespreadavailability of basic handsets have the potential to substantively bridge thecommunication gap.

- Text messaging, as the least-expensive mobile phone function found on allhandsets, could improve the delivery of health services and health outcomes.- Six major areas of malaria control in which deficiencies are apparent andtext messaging interventions could be beneficial are: (1) disease andtreatment effectiveness surveillance, (2) monitoring of the availability ofhealth commodities, (3) pharmacovigilance and post-marketing surveillanceof the safety and quality of antimalarial drugs, (4) health worker adherence toguidelines, (5) patient adherence to medication regimens, and (6) post-treatment review.- Text messages transmitting information from the periphery of the healthsystems to malaria control managers are in the first three malaria controlareas: (1) disease and treatment effectiveness surveillance, (2) monitoring of

the availability of health commodities, and (3) pharmacovigilance and post-marketing surveillance of the safety and quality of antimalarial medicines.Future projects in these three areas should demonstrate responses to datasignals and comparative advantages with routine information systems.- Text messages in the second three areas transmit information to healthworkers and patients to support the management of malaria patients byimproving (4) health workers' adherence to guidelines, (5) patient adherenceto medicines, and (6) post-treatment review. Future priorities in these areasare cost-effectiveness evaluations, qualitative research, and studiesmeasuring impact on the processes of care and health outcomes.

PNAS - Proceedings of the National Academy of Sciences of theUnited Statesof America(Accessed 26 February 2012)http://www.pnas.org/content/early/recent[No new relevant content]

Science24 February 2012 vol 335, issue 6071, pages 881-1008http://www.sciencemag.org/current.dtl[No relevant content]

Tropical Medicine & International HealthMarch 2012 Volume 17, Issue 3 Pages 263403http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-3156/currentissueChild HealthExpanding and improving urban outreach immunization in Patna,India
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Narottam Pradhan, Tove K. Ryman, Sherin Varkey, Alok Ranjan, Satish K.Gupta, Gopal Krishna, R. P. Swetanki and Randall YoungArticle first published online: 14 DEC 2011 | DOI: 10.1111/j.1365-3156.2011.02916.x

AbstractObjectives We conducted a case study of an urban immunization outreach

strategy to determine the feasibility of the intervention and to measureadministrative immunization coverage outcomes.Methods A multipronged strategy for improving immunization coverage in

Urban Patna, India, was implemented for 1 year (2009/2010). The strategywas designed to increase immunization sites, shift human resources, planlogistics, improve community mobilization, provide supervision, strengthendata flow and implement special vaccination drives.Results Over 1 year, the coverage of all primary vaccines of the Universal

Immunization Program improved by over 100%.Conclusion Coverage can be rapidly improved through outreach

immunization in low socioeconomic areas if existing opportunities arecarefully utilized.MalariaAcceptability of coupling Intermittent Preventive Treatment ininfants with the Expanded Programme on Immunization in threefrancophone countries in AfricaAlexandra de Sousa, Leon P. Rabarijaona, Jean L. Ndiaye, Doudou Sow,Mouhamed Ndyiae, Jacques Hassan, Nilda Lambo, Paul Adovohekpe, FlaviaGuidetti, Judith Recht and Alphonse AffoArticle first published online: 29 NOV 2011 | DOI: 10.1111/j.1365-3156.2011.02915.x

AbstractObjective Intermittent preventive treatment in infants (IPTi) is a malaria

control strategy currently recommended by WHO for implementation at scalein Africa, consisting of administration of sulphadoxine-pyrimethamine (SP)coupled with routine immunizations offered to children under 1 year. In thisstudy, we analysed IPTi acceptability by communities and health staff.Methods Direct observation, in-depth interviews (IDIs) and focus group

discussions (FGDs) were conducted in Benin, Madagascar and Senegal duringIPTi pilot implementation. Villages were stratified by immunization coverage.Data were transcribed and analysed using NVivo7 software.Results Communities knowledge of malaria aetiology and diagnosis was

good, although generally villagers did not seek treatment at health centres astheir first choice. Perceptions and attitudes towards IPTi were very positiveamong communities and health workers. A misconception that SP was anantipyretic that prevents post-vaccinal fever contributed to IPTisacceptability. No refusals or negative rumours related to IPTi coupling withimmunizations were identified, and IPTi did not negatively influence attitudestowards other malaria control strategies. Healthcare decisions about children,normatively made by the father, are starting to shift to educated andfinancially independent mothers.Discussion Intermittent preventive treatment in infants is well accepted by

providers and communities, showing a synergic acceptability when coupled
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with routine immunizations. However, a misconception that SP alleviatesfever should be addressed when scaling up implementation.

Vaccinehttp://www.sciencedirect.com/science/journal/0264410X

Volume 30, Issue 12 pp. 2037-2236 (9 March 2012)Regular PapersKnowledge, attitude and practice in primary and secondary cervicalcancer prevention among young adult Italian womenOriginal Research ArticlePages 2075-2082Serena Donati, Cristina Giambi, Silvia Declich, Stefania Salmaso, AntoniettaFilia, Marta Luisa Ciofi degli Atti, Maria Pia Alibrandi, Silvia Brezzi, FrancescaCarozzi, Natalina Collina, Daniela Franchi, Amedeo Lattanzi, Margherita Meda,Maria Carmela Minna, Roberto Nannini, Giuseppina Gallicchio, Antonino Bella,

The PreGio Working group

AbstractIn Italy since 2007 vaccination against human papillomavirus (HPV) is offeredto 11-year-old females, whereas vaccination for older age groups is still amatter of debate. To assess Italian young women's knowledge, attitudes andpractice regarding primary and secondary cervical cancer prevention a cross-sectional study among young women aged 1826 years was conducted in2008. The survey collected information on in-depth awareness andknowledge regarding Pap testing, HPV infection, HPV vaccine and cervicalcancer. The response rate was 57.7% with a wide range of variability (3484%) amongst local health units. Among 667 women who participated in thesurvey poor awareness and various misconceptions regarding HPV andcervical cancer prevention were detected. Overall women were found to bemore knowledgeable about Pap smears and cervical cancer than about HPVinfection and the HPV vaccine. Respondents pointed to their healthcareproviders as their most trusted source for medical information.Understanding women's knowledge on cervical cancer prevention, as well asrelated factors is important in helping to achieve and maintain adherence tocervical cancer preventive strategies. Moreover in order to minimize cervicalcancer risk by improving women's adherence to preventive strategies,appropriate and adequate information dissemination, and guidance fromhealth professionals appear to be crucial elements.Risk factors of underutilization of childhood immunizations inultraorthodox Jewish communities in Israel despite high access tohealth care servicesOriginal Research ArticlePages 2109-2115Khitam Muhsen, Reem Abed El-Hai, Anat Amit-Aharon, Haim Nehama, MervatGondia, Nadav Davidovitch, Sophy Goren, Dani Cohen

AbstractBackground

The risk factors of underutilization of childhood vaccines in populations withhigh access to health services are not fully understood.
http://www.sciencedirect.com/science/journal/0264410Xhttp://www.sciencedirect.com/science/article/pii/S0264410X12000953http://www.sciencedirect.com/science/article/pii/S0264410X12000953http://www.sciencedirect.com/science/article/pii/S0264410X12000709http://www.sciencedirect.com/science/article/pii/S0264410X12000709http://www.sciencedirect.com/science/article/pii/S0264410X12000709http://www.sciencedirect.com/science/journal/0264410Xhttp://www.sciencedirect.com/science/article/pii/S0264410X12000953http://www.sciencedirect.com/science/article/pii/S0264410X12000953http://www.sciencedirect.com/science/article/pii/S0264410X12000709http://www.sciencedirect.com/science/article/pii/S0264410X12000709http://www.sciencedirect.com/science/article/pii/S0264410X12000709


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ObjectivesTo determine vaccination coverage and factors associated withunderutilization of childhood vaccines in a population with sub-optimalvaccination compliance, despite a high health care access.Methods

The study was conducted among 430 children from ultraorthodox Jewish

communities in the Bnei Brak city and Jerusalem district. Data onimmunization status, socio-demographic factors and on parents attitudesregarding vaccines were obtained from medical records and through parentsinterviews.Results

The proportion of fully vaccinated children was 65% in 2- to 5-year-oldultraorthodox children from Jerusalem district, and 86% in 2.5-year-oldchildren from Bnei Brak city. The factors that were significantly associatedwith vaccines underutilization in Bnei Brak were having >6 siblings, maternalacademic education, parental religious beliefs against vaccination, perceivedrisk of vaccine preventable diseases as low, and mistrust in the Ministry ofHealth (MOH). Similarly, in Jerusalem, religious beliefs against vaccination,

and the perceived low risk of vaccine preventable diseases significantlyincreased the likelihood of under-immunization, while having acomplementary health insurance was inversely related with vaccinesunderutilization.Conclusions

The risk factors of under-immunization are in part modifiable, by means ofhealth education on the risks of vaccine preventable diseases and byimproving the trust in the MOH. The leaders of the ultraorthodox communitiescould play an important role in such interventions.Pneumococcal disease in South Australia: Vaccine success but notime for complacencyOriginal Research ArticlePages 2206-2211David R. Johnson, Katina DOnise, Ros A. Holland, Jane C.A. Raupach, Ann P.Koehler

AbstractBackground

Trends in age specific and serotype specific incidence rates for invasivepneumococcal disease (IPD) were examined in South Australia 4 years beforeand 5 years after the commencement of the Australian universal childhood 7valent pneumococcal conjugate vaccine (7vPCV) program.MethodsIPD cases were identified by routine enhanced surveillance. IPD serotypeswere grouped according to those covered by the 7vPCV, the six serotypesspecific to the 13 valent pneumococcal conjugate vaccine (13vPCV), the 11serotypes specific to the 23 valent pneumococcal polysaccharide vaccine(23vPPV), as well as non-13vPCV and non-23vPPV groups. Poisson regressionwas used to calculate age-specific and serotype-specific incident rate ratios(IRRs) comparing pre (20022004) and post (20072009) universal childhood7vPCV periods.Results
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Following the introduction of the 7vPCV program, the rate of IPD in childrenaged


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were influenced mainly by effectiveness against radiologically-confirmedpneumonia and AOM, vaccine price, and discount rate.ConclusionRoutine vaccination against Streptococcus pneumoniae in Colombia would becost-effective with PCV-10, with ICER below the per-capita GDP, but itsinclusion requires evaluating the budget impact. PCV-13 would prevent more

disease and deaths with a higher LYG, but PCV-10 would save more cost tothe healthcare system due its higher impact in the prevention of AOM. Thereis limitation in the clinical evidence of both strategies.Toward rubella elimination in Europe: An epidemiologicalassessmentOriginal Research ArticlePages 1999-2007Mark Muscat, Laura Zimmerman, Sabrina Bacci, Henrik Bang, SteffenGlismann, Kre Mlbak, Susan Reef, the EUVAC.NET group

AbstractBackground

The elimination of rubella and prevention of congenital rubella syndrome

(CRS) by 2015 are established goals for Europe. Our aim was to review theepidemiology of rubella in relation to this goal.Material and methodsNational surveillance institutions from 32 European countries providedinformation on rubella and CRS surveillance systems and data for 200008.We reported the number of notified rubella cases by year for countries with anational mandatory notification system for rubella covering total countrypopulation consistently throughout 200008 and analysed rubellasurveillance data for 2008.Results

Throughout 200008, 24 countries conducted passive routine surveillancebased on mandatory reporting rubella covering total country population.Altogether these countries reported 526,751 rubella cases. The medianincidence per million inhabitants declined from 7.2 in 2000 to 0.3 in 2008. By2008, the number of countries with mandatory notification systems forrubella increased to 28. These countries reported 21,475 rubella cases ofwhich 1.5% (n = 317) were laboratory-confirmed. Most cases (n = 21,075;98%) were reported from Poland, Italy and Romania. Ten countries reportedzero rubella cases and five others reported an incidence of


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Pages 2020-2023Z. Leroy, K. Broder, D. Menschik, T. Shimabukuro, D. MartinSignal identification and evaluation for risk of febrile seizures inchildren following trivalent inactivated influenza vaccine in theVaccine Safety Datalink Project, 20102011Original Research Article

Pages 2024-2031Alison Tse, Hung Fu Tseng, Sharon K. Greene, Claudia Vellozzi, Grace M. Lee,On behalf of the VSD Rapid Cycle Analysis Influenza Working GroupBridging the gap between data and public health needs. In the heatof a signal: Responding to a vaccine safety signal for febrile seizuresafter 201011 influenza vaccine in young children, United StatesPages 2032-2034Karen R. Broder, David B. Martin, Claudia Vellozzi

Volume 30, Issue 10 pp. 1753-1910 (27 February 2012)EditorialsThe nursing profession and patient safety and healthcare provider

influenza immunization: The puzzling stance of the American NursingAssociationPages 1753-1755Gregory A. Poland, Sharon Tucker[No abstract]Nursing leadership to ensure patient and health worker protectionfrom influenzaPages 1756-1758

Jo Anne Bennett, Derryl Block[No abstract]Regular PapersImpact of vaccine protection a gainst multiple HPV types on the cost-effectiveness of cervical screeningOriginal Research ArticlePages 1813-1822Veerle M.H. Coup, Johannes A. Bogaards, Chris J.L.M. Meijer, JohannesBerkhof

AbstractCross-protection against non-HPV16/18 types and the emergence of broad

spectrum vaccines protecting against multiple HPV types will influence thecost-effectiveness of future screening.

To assess this influence we used an individual-based simulation modeldescribing the relation between 14 HPV types and cervical disease, allowingthe occurrence of multiple type infections. Screening scenarios for vaccinatedwomen were evaluated, firstly for HPV16/18 vaccination with partial cross-protection against HPV 31, 33, 45 and 58 and secondly, for broad spectrumvaccination against 513 HPV types. The vaccine-induced incidence reductionof type-specific infection was varied from 0 to 95% in the cross-protectionsetting and set at 100% in the setting of broad spectrum vaccines. Scenariosof either cytology or HPV DNA screening were considered under varyinglifetime number of screening rounds. At a cost-effectiveness threshold of20,000/QALY, four times HPV DNA screening between 30 and 60 years was
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the selected scenario in addition to HPV16/18 vaccination, whether or notcross-protection was conferred (6707 and 9994/QALY, respectively). In theabsence of cross-protection, a fifth screening round might be considered(ICER 22,967/QALY). In addition to broad spectrum vaccination, one screenduring lifetime was cost-effective up to an 11-valent vaccine. If the vaccine-induced type-specific incidence reduction was lowered to 99%, one screen

during lifetime was cost-effective even in addition to 13-valent vaccination. Inconclusion, in a cohort of HPV16/18 vaccinated women, four rounds of HPVDNA screening is cost-effective. One screen during lifetime remains cost-effective in addition to broad spectrum vaccination offering protectionagainst many high-risk HPV types.UK parents decision-making about measlesmumpsrubella (MMR)vaccine 10 years after the MMR-autism controversy: A qualitativeanalysisOriginal Research ArticlePages 1855-1864Katrina F. Brown, Susannah J. Long, Mary Ramsay, Michael J. Hudson, JohnGreen, Charles A. Vincent, J. Simon Kroll, Graham Fraser, Nick Sevdalis

AbstractBackground and objectivesPublic concern about an unsubstantiated link between MMR vaccine andautism stemmed from a 1998 paper by Dr Andrew Wakefield and colleagues,and the substantial media coverage which that work attracted. Though theWakefield paper is now discredited and an MMR-autism link has never beendemonstrated empirically, this concern has manifested in over a decade ofsuboptimal MMR uptake. Few qualitative studies have explored parents MMRdecision-making since uptake began to improve in 2004. This study updatesand adds methodological rigour to the evidence base.Methods24 mothers planning to accept, postpone or decline the first MMR dose(MMR1) for their 1136 month-old children, described their decision-makingin semi-structured interviews. Mothers were recruited via General Practice,parents groups/online forums, and chain referral. MMR1 status was obtainedfrom General Practice records 6 months post-interview. Interview transcriptswere coded and interpreted using a modified Grounded Theory approach.ResultsFive themes were identified: MMR vaccine and controversy; Social andpersonal consequences of MMR decision; Health professionals and policy;Severity and prevalence of measles, mumps and rubella infections;Information about MMR and alternatives. Results indicated that MMR1acceptors were sympathetic toward Wakefield as a person, but universallyrejected his study which sparked the controversy; parents opting for singlevaccines expressed the sense that immune overload is not a considerationbut that not all three components of MMR are warranted by disease severity;and MMR1 rejectors openly criticised other parents MMR decisions anddecision-making.Conclusions

This study corroborated some previous qualitative work but indicated that theshrinking group of parents now rejecting MMR comprises mainly those withmore extreme and complex anti-immunisation views, whilst parents opting
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for single vaccines may use second-hand information about the controversy.In response, policymakers and practitioners should revise their expectationsof today's MMR decision-makers, and their methods for supporting them.The population based socioeconomic burden of pediatric influenza-associated hospitalization in Hong KongOriginal Research Article

Pages 1895-1900Susan S. Chiu, Kwok-Hung Chan, Lok Yee So, Robin Chen, Eunice L.Y. Chan,

J.S.M. PeirisAbstractWe described the monetary and non-monetary cost incurred by childrenhospitalized for virologically confirmed influenza virus infection in apopulation-based prospective 3-year study. The mean direct and indirect costof each child hospitalized was $1217.82 (95% CI, 1111.541324.23) and$1328.33 (95% CI, $1136.791520.00) for influenza A and B, respectively.School age patients took a mean (SD) of 4.70 (3.05) days and 5.31 (3.62)days of sick leave for influenza A and B infection, respectively. Pediatricinfluenza A and B hospitalization was associated with 6621046 days of

school absenteeism and 214336 days of parental work loss per 10,000population


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vaccines_the week in review_27 february 2012

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