Vaccines: The Week in Review 13 April 2013 Center for Vaccine Ethics & Policy (CVEP)

This weekly summary targets news, events, announcements, articles and research in the global vaccine ethics and policy space and is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it 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 blog posts at http://centerforvaccineethicsandpolicy.wordpress.com/. This blog allows full-text searching of over 3,500 entries. Comments and suggestions should be directed to David R. Curry, MS Editor and Executive Director Center for Vaccine Ethics & Policy david.r.curry@centerforvaccineethicsandpolicy.org

WHO: Human infection with influenza A(H7N9) virus WHO enhanced its reporting on A(H7N9) and issued a risk assessment and other information as below: WHO Risk Assessment as of 13 April 2013 [pdf, 122kb] Excerpt Risk assessment This initial risk assessment, which has been prepared in accordance with WHOs published recommendations for rapid risk assessment of acute public health events 1 will be updated as further information becomes available. - What is the risk of the occurrence of further cases in the affected areas of China and other areas? The epidemiology of this virus among animals, including the main reservoirs of infection among animals and the extent of geographic spread, is not yet established. However, it is likely that most human H7N9 infections so far are associated with infection among as of yet undetermined animals and that further human cases of infection should be expected. - What is the risk of human-to-human transmission? There is no evidence of sustained human-to-human transmission. However the two possible family clusters suggest that limited human-to-human transmission may occur where there is

close contact between cases and other individuals, as occurs in families and, potentially, healthcare settings. Moreover, the genetic changes seen among these viruses suggesting adaptation to mammals is of concern, and further adaptation may occur. - What is the risk of international spread? At this time, there is no information to indicate international spread of this virus. However, it is possible that an infected person, who may or may not have symptoms, could travel to another country. However, if the virus cannot sustain human-to-human transmission, as appears to be the current situation, then extensive community spread is unlikely. WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied. Access the weekly report on number of confirmed human cases for influenza A(H7N9) reported to WHO Data in WHO/HQ as of 10 April 2013, 14:22 GMT+1 Report will be updated once a week WHO: Global Alert and Response (GAR) Disease Outbreak News http://www.who.int/csr/don/2013_03_12/en/index.html Human infection with influenza A(H7N9) virus in China update as of 12 April 2013 As of 12 April 2013 (17:30 CET), the National Health and Family Planning Commission notified WHO of an additional five laboratory-confirmed cases of human infection with influenza A(H7N9) virus. Of the latest laboratory-confirmed cases, three are from Zhejiang and two from Shanghai. The first patient is a 66-year-old man from Zhejiang who became ill on 8 April 2013, the second patient is a 74-year-old man from Zhejiang who became ill on 13 April 2013, the third patient is a 54-year-old woman from Zhejiang who became ill on 13 April 2013, the fourth patient is a 53-year-old man from Shanghai who became ill on 3 April 2013, and the fifth patient is an 86-year-old man from Shanghai who became ill on 3 April 2013. In addition, a patient earlier reported from Shanghai has died. To date, a total of 43 patients have been laboratory confirmed with influenza A(H7N9) virus in China; including 11 deaths. More than a thousand close contacts of the confirmed cases are being closely monitored. The Chinese government is actively investigating this event and has heightened disease surveillance. Retrospective testing of recently reported cases with severe respiratory infection may uncover additional cases that were previously unrecognized. An inter-government task force has been formally established, with the National Health and Family Planning Commission leading the coordination along with the Ministry of Agriculture and other key ministries. The animal health sector has intensified investigations into the possible sources and reservoirs of the virus. WHO is in contact with national authorities and is following the event closely. The WHO-coordinated international response is also focusing on work with WHO Collaborating Centres for Reference and Research on Influenza and other partners to ensure that information is available and that materials are developed for diagnosis and treatment and vaccine development. No vaccine is currently available for this subtype of the influenza virus. Preliminary test results provided by the WHO

Collaborating Centre in China suggest that the virus is susceptible to the neuraminidase inhibitors (oseltamivir and zanamivir). At this time there is no evidence of ongoing human-to-human transmission. WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied. http://www.who.int/csr/don/2013_04_12/en/index.html

The Global Fund to Fight AIDS, Tuberculosis and Malaria announced a goal of raising US$15 billion in the 2014-2016 period so that it can effectively support countries in fighting these three infectious diseases. The Global Fund said it is determined to accelerate the gains achieved in recent years against AIDS, TB and malaria through strategic investment in programs that can save millions of lives and tens of billions of dollars in future costs. While acknowledging the challenging fiscal environment in many countries, the Global Fund and its partners point to the remarkable value for money that investing in health provides. Mark Dybul, Executive Director of the Global Fund, said, "We have a choice: we can invest now or pay forever. Innovations in science and implementation have given us a historic opportunity to completely control these diseases. If we do not, the long-term costs will be staggering." The Global Fund convened a donor's conference in Brussels on 9 and 10 April to present an overall needs assessment for the 2014-2016 period and an update on results and impact from recent years. Donors were invited to a once-every-threeyears pledging conference, known as the Global Fund's Fourth Replenishment, in late 2013. 08 April 2013 Full media release here: http://www.theglobalfund.org/en/mediacenter/newsreleases/2013-0408_Global_Fund_Targets_USD_15_Billion_to_Effectively_Fight_AIDS_TB_and_Malaria/

WHO/UNICEF: The integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD) Ending preventable child deaths from pneumonia and diarrhoea by 2025 Number of pages: 64 Publication date: 2013 Languages: English ISBN: 978 92 4 150523 9 Downloads - Ending preventable child deaths from pneumonia and diarrhoea by 2025: The integrated Global Action Plan for Pneumonia and Diarrhoea - Executive summary - English - Executive summary - French http://www.who.int/maternal_child_adolescent/documents/global_action_plan_pneu monia_diarrhoea/en/index.html News release 12 April 2013 | Geneva/Washington, DC Excerpt

WHO/UNICEF: New plan to address pneumonia and diarrhoea could save 2 million children a year A new Global Action Plan launched today by the WHO and UNICEF has the potential to save up to 2 million children every year from deaths caused by pneumonia and diarrhoea, some of the leading killers of children under five globally. The Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea calls for closer integration of efforts to prevent and treat these two diseases and sets ambitious targets to reduce mortality rates and raise levels of childrens access to life-saving interventions. Too often, strategies to tackle pneumonia and diarrhoea run in parallel, says Dr Elizabeth Mason, Director of Maternal, Newborn, Child and Adolescent Health at WHO. But as countries like Bangladesh, Cambodia, Ethiopia, Malawi, Pakistan and Tanzania are already showing, it makes good health sense and good economic sense to integrate those strategies more closely. Many factors contribute to these two conditions, so no single intervention can effectively prevent, treat or control either pneumonia or diarrhoea. However, as richer countries have demonstrated, a number of elements are key to reducing infections and deaths from both diseases. For example, good nutrition and a clean environment help protect children from both pneumonia and diarrhoea. New vaccines are being introduced to protect children from these diseases. Good access to health services and the right medicines can ensure they get the treatment they need. But many existing efforts to address pneumonia and diarrhoea in low- and middle-income countries have yet to capitalize on these common elements The new WHO/UNICEF Action Plan sets clear goals for the world to achieve by 2025: a 75% reduction in incidence of severe pneumonia and diarrhoea from 2010 levels among children under five, and the virtual elimination of deaths from both diseases in the same age-group. It also aims for a 40% reduction in the global number of children under five who are stunted. The Action Plans targets are significantly higher than current levels. For example, it calls for 90% of all children to have access to antibiotics for pneumonia and oral rehydration salts for diarrhoea, up from current levels of 31 and 35% respectively. As an interim target, at least half of all children under six months should be exclusively breastfed, against 2012 levels of 39%. All children should have access to improved sanitation and safe drinking water, from 63 and 89% respectively; and building on the good progress already made in some countries in introducing new vaccines against pneumococcal bacteria and rotavirus, it aims for 90% coverage by the target date. The Action Plan calls on governments and other stakeholders to prioritize investment in the population groups with the poorest access to services to prevent and treat pneumonia and diarrhoea. Nearly 90% of pneumonia and diarrhoea deaths in children currently occur in sub-Saharan Africa and South Asia Notes to Editors: The new integrated Global Action Plan builds on existing commitments and initiatives, such as the United Nations Secretary-Generals Global Strategy for Womens and Childrens Health and Every Woman Every Child; the UN Commission on Information and Accountability for Womens and Childrens Health; the UN Commission on Life-Saving Commodities for Women and Children; Committing to Child Survival: A Promise Renewed; the 2012 Declaration on scaling up treatment of diarrhoea and pneumonia; the Sanitation and Water for All partnership; the

International Decade for Action Water for Life 2005-2015; Sustainable sanitation: The Drive to 2015; and the Global Vaccine Action Plan. The Action Plan is being launched in conjunction with a new Lancet Series on Childhood Pneumonia and Diarrhoea. The four papers in the Series provide the evidence base for integrated action on these two illnesses and include new data on burden, epidemiology, interventions that work, and the financial cost of ending preventable deaths from childhood diarrhoea and pneumonia by 2025. http://www.who.int/mediacentre/news/releases/2013/pneumonia_diarrhoea_plan_20 130412/en/index.html IVAC Blog Eliminating Childhood Disease Aspirational But Achievable By Dr. Kate OBrien, MD, MPH is Acting Executive Director of IVAC.

Radio Free Europe/Radio Liberty: Gunmen Shoot Policemen Protecting Polio Vaccination Team April 13, 2013 One policeman has been shot dead and another wounded as they escorted a team conducting a polio vaccination campaign in northwestern Pakistan. Police officials said two men riding a motorbike opened fire on the two policemen on April 10 as the vaccination team visited the Parhoti neighborhood of the town of Mardan in Khyber Pakhtunkhwa Province. The police were reportedly standing outside a home as the female polio workers were inside giving polio drops to children. No one immediately claimed responsibility for the attack http://www.rferl.org/content/pakistan-gunmen-shoot-policement-protecting-poliovaccination-team/24953543.html The MMWR Weekly for April 12, 2013 / Vol. 62 / No. 14 includes: - Varicella Death of an Unvaccinated, Previously Healthy Adolescent Ohio, 2009 - Human Contacts with Oral Rabies Vaccine Baits Distributed for Wildlife Rabies Management Ohio, 2012 -Evaluating Surveillance Indicators Supporting the Global Polio Eradication Initiative, 20112012 The Weekly Epidemiological Record (WER) for 12 April 2013, vol. 88, 15 (pp. 153160) includes: - Tracking progress towards global polio eradication, 20112012 http://www.who.int/entity/wer/2013/wer8815.pdf Update: Polio this week - As of 10 April 2013 Global Polio Eradication Initiative http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx [Editors extract and bolded text]

- More than 400 scientists from around the world, including Nobel laureates, public health school deans and other leading health experts, added their names to the Scientific Declaration on Polio Eradication today, asserting that polio eradication is possible and expressing their confidence in a new plan to create a polio-free world by 2018. [See full text of Declaration below] Nigeria - One new WPV case was reported in the past week (WPV1 from Gombe), bringing the total number of WPV cases for 2013 to eleven. This latest WPV case is the most recent in the country, and had onset of paralysis on 19 March. Pakistan - One new WPV case was reported in the past week (WPV1 from Sindh), bringing the total number of WPV cases for 2013 to six. This latest case is the most recent in the country, and had onset of paralysis on 22 March - The security situation continues to be monitored closely, in consultation with law enforcement agencies. Immunization activities continue to be implemented, in some areas staggered or postponed, depending on the security situation at the local level. Scientific Declaration on Polio Eradication http://vaccines.emory.edu/poliodeclaration/text.pdf Polio is a highly infectious disease that can cause irreversible paralysis and death. Today, the disease mostly affects children living in some of the worlds poorest and most marginalized communities. Yet we are closer than ever to a world where no child will ever again be crippled or die from this disease. At this unique moment, an international group of scientists has come together to stress the achievability of polio eradication and endorse the Eradication and Endgame Strategic Plan, a new strategy by the Global Polio Eradication Initiative (GPEI) to reach and sustain eradication by 2018. The plan was developed in consultation with a range of technical experts, governments, funding partners and stakeholders and received unanimous support from the WHO Executive Board in January 2013 . Whereas, 1. Unprecedented progress, scientific advances and new tools give us confidence that eradication is achievable. - New cases of wild poliovirus have dropped from an estimated 350,000 cases in more than 125 countries in 1988 to fewer than 250 cases in just five countries in 2012. - 2012 was a turning point for the remaining endemic countries. Nigeria, Afghanistan and Pakistan launched national emergency action plans that resulted in significant improvements in immunization campaign quality and the fewest new cases on record. - India stopped wild poliovirus transmission in 2011, proving that polio can be eliminated in the most challenging circumstances. - Two effective vaccines have protected hundreds of millions of children against the disease: oral polio vaccine (OPV) and inactivated polio vaccine (IPV). The worldwide elimination of one of the three types of wild poliovirus (type 2) more than a decade ago proves that eradication through the polio eradication strategy is feasible. - We have successful strategies to deliver vaccines and monitor coverage, strong surveillance to quickly detect and contain the virus, and innovative technologies and approaches such as geographic information system (GIS) mapping and new vaccine formulations to ensure that children are reached and protected.

2. The new Strategic Plan provides a clear path forward that capitalizes on this historic opportunity to end polio. - The plan is a long-term, comprehensive strategy to complete and sustain eradication. The plans strategies are sound and, when implemented, will interrupt transmission, sustain eradication and maximize post-eradication benefits. - The plan is a significant step forward over previous eradication strategies and offers strong solutions to challenges by including: - Data-driven strategies to overcome operational challengesincluding missed childrento ensure high quality immunization campaigns that can interrupt transmission globally; and - Plans to eliminate both wild poliovirus and vaccine-derived poliovirus, starting with the withdrawal of type 2 from OPV and introduction of IPV in all countries to boost immunity to remaining strains. - Insecurity in endemic countries is a serious threat to the program. To overcome this challenge, the GPEI will improve coordination between civilian and security services, increase community demand for vaccination services, enhance advocacy efforts by religious leaders and institutions, and increase vaccinations in areas bordering insecure places to reduce spread of the disease. 3. The new plan emphasizes the urgency of improving routine immunization systems and lays a foundation to protect children against other diseases. - The plan recognizes that eradication efforts are interdependent with strengthened routine immunization. High levels of routine immunization are needed to achieve and sustain polio eradication. At the same time, eradication efforts demonstrate that it is possible to reach nearly every child, even in the most underserved and remote areas, with vaccines and other life-saving interventions. - The Strategic Plan calls for GPEI to use its robust infrastructure to benefit routine immunization and other health programs. It includes strategies for polio eradication staff and processes to help strengthen routine immunization, in partnership with national immunization programs and the GAVI Alliance and in alignment with the Global Vaccine Action Plan. - Eradication would demonstrate that worldwide collaborations can successfully combat complex health threats, including in remote communities too often left behind. 4. Scaling back efforts would have devastating consequences. - For polioviruses to survive, they must be transmitted from infected persons to susceptible persons in a continuous chain of human-to-human transmission. When immunity levels are high, the chains are broken. Today, there are fewer chains than ever before, creating an unprecedented opportunity to stop transmission. - Weakening our efforts would lower immunity levels, setting the stage for a resurgence of outbreaks. Polio is highly infectious and spreads quickly. If we aim for control rather than eradicationrelying only on routine immunization to vaccinate against polio and eliminating mass vaccination and other eradication strategieswe can expect up to 200,000 cases annually. We, members of the scientific community, declare our conviction that the eradication of polio is an urgent and achievable global health priority. We endorse the Eradication and Endgame Strategic Plan and call on actors in the global community to do their part to ensure the full implementation of the plan. We urge:

- Scientists to develop new and better tools to accelerate and sustain eradication, including low-cost IPV options, and to continue providing technical support to endemic countries. - Partners, including GPEI and vaccine manufacturers, to ensure sufficient supply of and access to different types of vaccines required for eradication, including IPV use in resource-poor countries. - Endemic country leaders and international program officials to stay fully committed and accountable to stop transmission. They can build on emergency plans to increase accountability and strengthen campaign quality. They can continue to develop regional- and community-specific solutions to bottlenecks such as vaccine refusals. - Endemic country governments and partners to strengthen security measures and deepen engagement with community and religious leaders to promote demand and protect vaccination teams and volunteers, in light of recent attacks on health workers across Pakistan and Nigeria. - International partners and national programs to strengthen linkages across polio vaccination efforts, routine immunization and other initiatives, including measles prevention, maternal and child health and nutrition, to address the broad health needs of communities. - Partners, and national and global programs, to commit to strengthen routine immunization with the same urgency, robust technical and financial support and clear measurement indicators. - Partners to fully fund the Strategic Plan. Funding gaps in 2012 led to cancelled and scaled-back vaccination campaigns in 24 countries, leaving children in these areas more susceptible to polio. - Civil society to continue to support efforts to end polio forever . Polio eradication can be our generations legacy to all future generations. Only working together can we make history and end polio. For more information about the declaration and for a full list of signatories, please visit http://vaccines.emory.edu/poliodeclaration/ WHO - Humanitarian Health Action http://www.who.int/hac/en/index.html No updates published UN Secretary General Media Releases Heralding Great Progress, Secretary-General Calls World to Action in 1,000-Day Countdown to Millennium Development Goals Deadline (12 April 2013) SG/SM/14938-DEV/2981 Improving Global Health Demands Committed Leaders, Determined Partners, Engaged Global Citizens, Secretary-General Tells Envision 2013 Event (11 April 2013) SG/SM/14935

Reports/Research/Analysis/ Conferences/Meetings/Book Watch

Vaccines: The Week in Review has expanded its coverage of new reports, books, research and analysis published independent of the journal channel covered in Journal Watch below. Our interests span immunization and vaccines, as well as global public health, health governance, and associated themes. If you would like to suggest content to be included in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org No new research or conferences to report.

Journal Watch Vaccines: The Week in Review continues its weekly scanning of key peer-reviewed journals to identify and cite articles, commentary and editorials, books reviews and other content supporting our focus on vaccine ethics and policy. Journal Watch is not intended to be exhaustive, but indicative of themes and issues the Center is actively tracking. We selectively provide full text of some editorial and comment articles that are specifically relevant to our work. Successful access to some of the links provided may require subscription or other access arrangement unique to the publisher. If you would like to suggest other journal titles to include in this service, please contact David Curry at: david.r.curry@centerforvaccineethicsandpolicy.org American Journal of Infection Control Vol 41 | No. 4 | April 2013 | Pages 285-388 http://www.ajicjournal.org/current [Reviewed earlier] American Journal of Public Health Volume 103, Issue 5 (May 2013) http://ajph.aphapublications.org/toc/ajph/current [No relevant content] Annals of Internal Medicine 2 April 2013, Vol. 158. No. 7 http://www.annals.org/content/current [Reviewed earlier; No relevant content] BMC Public Health (Accessed 13 April 2013) http://www.biomedcentral.com/bmcpublichealth/content [No new relevant content] British Medical Bulletin Volume 105 Issue 1 March 2013

http://bmb.oxfordjournals.org/content/current Articles Policy reform to realize the commitments of the Political Declaration on noncommunicable diseases Shanthi Mendis and Oleg Chestnov Br Med Bull (2013) 105(1): 7-27 doi:10.1093/bmb/ldt001 Abstract Background Noncommunicable diseases (NCDs) caused an estimated 36 million deaths in 2008. Recognizing that NCDs are a global health and development priority, Heads of State and government adopted the Political Declaration on NCDs (resolution A/RES/66/2) at the United Nations General Assembly in September 2011. Sources of data The Political Declaration of the United Nations High Level meeting on NCDs, World Health Organization (WHO) reports on NCDs and WHO Country Cooperation Strategy documents. Areas of agreement NCDs are a growing threat to health and development. Cost of action and inaction are known. Areas of controversy Accountability of all stakeholders including the private sector is essential for an effective global public health response. More clarity is needed on the private sector contribution to the response to safeguard public health from any potential conflict of interest. Growing points A country-led public health policy response should include, at a minimum, national scale-up of very cost-effective, high impact NCD interventions to improve health outcomes and health equity with universal coverage as a long-term public health goal. Areas timely for developing research Policy reform and accelerated national scale-up action, particularly in low-andmiddle-income countries, must be guided by translation research and feedback information from monitoring and evaluation. British Medical Journal 13 April 2013 (Vol 346, Issue 7903) http://www.bmj.com/content/346/7903 [No relevant content] Bulletin of the World Health Organization Volume 91, Number 4, April 2013, 237-312 http://www.who.int/bulletin/volumes/91/4/en/index.html [Reviewed earlier] Clinical Therapeutics Vol 35 | No. 3 | March 2013 | Pages 199-350 http://www.clinicaltherapeutics.com/current

[Reviewed earlier] Cost Effectiveness and Resource Allocation (Accessed 13 April 2013) http://www.resource-allocation.com/ [No new relevant content] Current Opinion in Infectious Diseases. April 2013 - Volume 26 - Issue 2 pp: vii-vii,107-211 http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspx [Reviewed earlier; No relevant content] Development in Practice Volume 23, Issue 1, 2013 http://www.tandfonline.com/toc/cdip20/current [Reviewed earlier] Emerging Infectious Diseases Volume 19, Number 4April 2013 http://www.cdc.gov/ncidod/EID/index.htm [Reviewed earlier] Eurosurveillance Volume 18, Issue 15, 11 April 2013 http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678 Editorials A novel reassortant avian influenza A(H7N9) virus in China what are the implications for Europe by A Nicoll, N Danielsson Rapid communications Genetic analysis of novel avian A(H7N9) influenza viruses isolated from patients in China, February to April 2013 by T Kageyama, S Fujisaki, E Takashita, H Xu, S Yamada, Y Uchida, G Neumann, T Saito, Y Kawaoka, M Tashiro Forum for Development Studies Volume 40, Issue 1, 2013 http://www.tandfonline.com/toc/sfds20/current [Reviewed earlier] Global Health Governance Volume VI, Issue 1: Fall 2012 December 31, 2012

[Reviewed earlier] Globalization and Health [Accessed 13 April 2013] http://www.globalizationandhealth.com/ [No new relevant content] Health Affairs April 2013; Volume 32, Issue 4 http://content.healthaffairs.org/content/current Theme: The Triple Aim Goes Global [Reviewed earlier; No specific relevant content on vaccines/immunization] Health and Human Rights Vol 14, No 2 (2012) http://hhrjournal.org/index.php/hhr [Reviewed earlier] Health Economics, Policy and Law Volume 8 - Issue 02 - April 2013 http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue [Reviewed earlier] Health Policy and Planning Volume 28 Issue 2 March 2013 http://heapol.oxfordjournals.org/content/current [Reviewed earlier; No relevant content] Human Vaccines & Immunotherapeutics (formerly Human Vaccines) Volume 9, Issue 4 April 2013 http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/4/ Issue Theme: Novel Vaccines [Reviewed earlier] Infectious Diseases of Poverty http://www.idpjournal.com/content [Accessed 13 April 2013] [No new relevant content] International Journal of Epidemiology Volume 42 Issue 2 April 2013 http://ije.oxfordjournals.org/content/current

[Reviewed earlier] International Journal of Infectious Diseases Vol 17 | No. 5 | May 2013 http://www.ijidonline.com/current [No relevant content] JAMA April 10, 2013, Vol 309, No. 14 http://jama.ama-assn.org/current.dtl [No relevant content] JAMA Pediatrics April 2013, Vol 167, No. 4 http://archpedi.jamanetwork.com/issue.aspx [Reviewed earlier; No relevant content] Journal of Community Health Volume 38, Issue 2, April 2013 http://link.springer.com/journal/10900/38/2/page/1 [Reviewed earlier; No relevant content] Journal of Health Organization and Management Volume 27 issue 2 - Published: 2013 http://www.emeraldinsight.com/journals.htm?issn=1477-7266&show=latest [Reviewed earlier; No relevant content] Journal of Infectious Diseases Volume 207 Issue 9 May 1, 2013 http://www.journals.uchicago.edu/toc/jid/current [Reviewed earlier; No relevant content] Journal of Global Infectious Diseases (JGID) January-March 2013 Volume 5 | Issue 1 Page Nos. 1-36 http://www.jgid.org/currentissue.asp?sabs=n [Reviewed earlier; No relevant content] Journal of Medical Ethics April 2013, Volume 39, Issue 4 http://jme.bmj.com/content/current [Reviewed earlier]

Journal of Medical Microbiology April 2013; 62 (Pt 4) http://jmm.sgmjournals.org/content/current [Reviewed earlier] Journal of the Pediatric Infectious Diseases Society (JPIDS) Volume 2 Issue 1 March 2013 http://jpids.oxfordjournals.org/content/current [Reviewed earlier] Journal of Pediatrics April 2013, Vol. 162, No. 4 http://www.jpeds.com/ [Reviewed earlier] Journal of Virology May 2013, volume 87, issue 9 http://jvi.asm.org/content/current Multiple Independent Emergences of Type 2 Vaccine-Derived Polioviruses during a Large Outbreak in Northern Nigeria Cara C. Burns, Jing Shaw, Jaume Jorba, David Bukbuk, Festus Adu, Nicksy Gumede, Muhammed Ali Pate, Emmanuel Ade Abanida, Alex Gasasira, Qi Chen, Annelet Vincent, Paul Chenoweth, Elizabeth Henderson, Kathleen Wannemuehler, Asif Naeem, Rifqiyah Nur Umami, Yorihiro Nishimura, Hiroyuki Shimizu, Marycelin Baba, Adekunle Adeniji, A. J. Williams, David R. Kilpatrick, M. Steven Oberste, Steven G. Wassilak, Oyewale Tomori, Mark A. Pallansch, and Olen Kew J. Virol. May 2013 87:4907-4922; published ahead of print 13 February 2013 , doi:10.1128/JVI.02954-12 http://jvi.asm.org/content/87/9/4907.abstract ABSTRACT Since 2005, a large poliomyelitis outbreak associated with type 2 circulating vaccine-derived poliovirus (cVDPV2) has occurred in northern Nigeria, where immunization coverage with trivalent oral poliovirus vaccine (tOPV) has been low. Phylogenetic analysis of P1/capsid region sequences of isolates from each of the 403 cases reported in 2005 to 2011 resolved the outbreak into 23 independent type 2 vaccine-derived poliovirus (VDPV2) emergences, at least 7 of which established circulating lineage groups. Virus from one emergence (lineage group 2005-8; 361 isolates) was estimated to have circulated for over 6 years. The population of the major cVDPV2 lineage group expanded rapidly in early 2009, fell sharply after two tOPV rounds in mid-2009, and gradually expanded again through 2011. The two major determinants of attenuation of the Sabin 2 oral poliovirus vaccine strain (A481 in the 5-untranslated region [5-UTR] and VP1-Ile143) had been replaced in all VDPV2 isolates; most A481 5-UTR replacements occurred by recombination with other enteroviruses. cVDPV2 isolates representing different lineage groups had biological properties indistinguishable from those of wild polioviruses, including

efficient growth in neuron-derived HEK293 cells, the capacity to cause paralytic disease in both humans and PVR-Tg21 transgenic mice, loss of the temperaturesensitive phenotype, and the capacity for sustained person-to-person transmission. We estimate from the poliomyelitis case count and the paralytic case-to-infection ratio for type 2 wild poliovirus infections that 700,000 cVDPV2 infections have occurred during the outbreak. The detection of multiple concurrent cVDPV2 outbreaks in northern Nigeria highlights the risks of cVDPV emergence accompanying tOPV use at low rates of coverage in developing countries. The Lancet Apr 13, 2013 Volume 381 Number 9874 p1247 - 1332 http://www.thelancet.com/journals/lancet/issue/current Editorial Measuring universities' commitments to global health The Lancet Preview The University Global Health Impact Report Card http://globalhealthgrades.org/ was released on April 4, marking a new effort to identify the standings of leading North American research universities in bridging the gap between research and roll out of treatments for neglected diseases. The report, sponsored by the Universities Allied for Essential Medicines, assesses the performance of 54 institutions on two key aspectscommitment to innovation in research that bears on the developing world and the use of open, socially responsible technology licensing that helps to ensure affordable access. Comment Cash-transfer programmes in developing countries Stuart Gilmour, Tomohiro Hamakawa, Kenji Shibuya Preview In The Lancet, Laura Robertson and colleagues present research that adds to the impressive record of cash-transfer programmes.1 In a cluster-randomised trial undertaken in difficult circumstances in Zimbabwe, Robertson and colleagues1 show that a conditional cash transfer (CCT) programme improved the proportion of children aged 612 years who attend school regularly by 76% (95% CI 12141) and that of children aged 04 years with birth certificates by 164% (78250) compared with a control group. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%29621680/abstract Effects of unconditional and conditional cash transfers on child health and development in Zimbabwe: a cluster-randomised trial Laura Robertson, Phyllis Mushati, Jeffrey W Eaton, Lovemore Dumba, Gideon Mavise, Jeremiah Makoni, Christina Schumacher, Tom Crea, Roeland Monasch, Lorraine Sherr, Geoffrey P Garnett, Constance Nyamukapa, Simon Gregson Summary Background Cash-transfer programmes can improve the wellbeing of vulnerable children, but few studies have rigorously assessed their effectiveness in sub-Saharan Africa. We investigated the effects of unconditional cash transfers (UCTs) and conditional cash transfers (CCTs) on birth registration, vaccination uptake, and school attendance in children in Zimbabwe.

Methods We did a matched, cluster-randomised controlled trial in ten sites in Manicaland, Zimbabwe. We divided each study site into three clusters. After a baseline survey between July, and September, 2009, clusters in each site were randomly assigned to UCT, CCT, or control, by drawing of lots from a hat. Eligible households contained children younger than 18 years and satisfied at least one other criteria: head of household was younger than 18 years; household cared for at least one orphan younger than 18 years, a disabled person, or an individual who was chronically ill; or household was in poorest wealth quintile. Between January, 2010, and January, 2011, households in UCT clusters collected payments every 2 months. Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing. Eligible households in all clusters, including control clusters, had access to parenting skills classes and received maize seed and fertiliser in December, 2009, and August, 2010. Households and individuals delivering the intervention were not masked, but data analysts were. The primary endpoints were proportion of children younger than 5 years with a birth certificate, proportion younger than 5 years with up-to-date vaccinations, and proportion aged 612 years attending school at least 80% of the time. This trial is registered with ClinicalTrials.gov, number NCT00966849. Findings 1,199 eligible households were allocated to the control group, 1,525 to the UCT group, and 1,319 to the CCT group. Compared with control clusters, the proportion of children aged 0-4 years with birth certificates had increased by 1.5% (95% CI-7.1 to 10.1) in the UCT group and by 16.4% (7.8-25.0) in the CCT group by the end of the intervention period. The proportions of children aged 0-4 years with complete vaccination records was 3.1% (-3.8 to 9.9) greater in the UCT group and 1.8% (-5.0 to 8.7) greater in the CCT group than in the control group. The proportions of children aged 6-12 years who attended school at least 80% of the time was 7.2% (0.8-13.7) higher in the UCT group and 7.6% (1.2-14.1) in the CCT group than in the control group. Interpretation Our results support strategies to integrate cash transfers into social welfare programming in sub-Saharan Africa, but further evidence is needed for the comparative effectiveness of UCT and CCT programmes in this region. Funding Wellcome Trust, the World Bank through the Partnership for Child Development, and the Programme of Support for the Zimbabwe National Action Plan for Orphans and Vulnerable Children. The Lancet Infectious Diseases Apr 2013 Volume 13 Number 4 p277 - 376 http://www.thelancet.com/journals/laninf/issue/current [Reviewed earlier] Medical Decision Making (MDM) April 2013; 33 (3) http://mdm.sagepub.com/content/current Special Issue: Health Technology Assessment to Inform Policy

[Reviewed earlier] The Milbank Quarterly A Multidisciplinary Journal of Population Health and Health Policy March 2013 Volume 91, Issue 1 Pages 1218 http://onlinelibrary.wiley.com/doi/10.1111/milq.2013.91.issue-1/issuetoc [Reviewed earlier] Medical Surveillance Monthly Report (MSMR) March 2013 - Volume 20 / Number 03 http://www.afhsc.mil/viewMSMR?file=2013/v20_n02.pdf#Page=01 Mid-season influenza vaccine effectiveness for the 2012-2013 influenza season Nature Volume 496 Number 7444 pp137-264 11 April 2013 http://www.nature.com/nature/current_issue.html [No relevant content] Nature Immunology April 2013, Volume 14 No 4 pp307-413 http://www.nature.com/ni/journal/v14/n4/index.html [Reviewed earlier; No relevant content] Nature Medicine April 2013, Volume 19 No 4 pp379-505 http://www.nature.com/nm/journal/v19/n4/index.html [Reviewed earlier] Nature Reviews Immunology April 2013 Vol 13 No 4 http://www.nature.com/nri/journal/v13/n4/index.html [Reviewed earlier; No relevant content] New England Journal of Medicine April 11, 2013 Vol. 368 No. 15 http://www.nejm.org/toc/nejm/medical-journal Perspective Go Big and Go Fast Vaccine Refusal and Disease Eradication Saad B. Omer, M.B., B.S., Ph.D., M.P.H., Walter A. Orenstein, M.D., and Jeffrey P. Koplan, M.D., M.P.H. N Engl J Med 2013; 368:1374-1376April 11, 2013 DOI: 10.1056/NEJMp1300765 [Free full text]

Disease eradication is an attractive public health goal. In addition to eliminating illnesses and deaths, eradication can lead to substantial cost savings. Eradication has been attempted for many human and animal diseases, such as smallpox, malaria, hookworm disease, polio, rinderpest, yaws, dracunculiasis (guinea worm disease), and yellow fever, and many tools have been employed in these efforts. But in the two diseases that were successfully eradicated, smallpox and rinderpest, the main tool was a vaccine. Eradication strategies for polio (a major current focus of global eradication efforts) and measles (whose eradication is being considered) rely on high vaccination coverage through routine and supplementary immunization. Eradication efforts for vaccine-preventable diseases face many challenges, including vaccine refusal. Such refusal in communities in northern Nigeria and Pakistan, for example, has caused major setbacks to global polio eradication, contributing to continued endemic transmission of poliovirus in these countries and to the reintroduction of wild-type poliovirus into countries where transmission had been interrupted. Although wild-type polioviruses are no longer endemic in India, refusal played some role in delaying elimination. The resurgence of measles in Europe, partially attributed to vaccine refusal, threatens its regional elimination and eventual global eradication. It is therefore important to understand the determinants and dynamics of vaccine refusal affecting disease-eradication initiatives. Many factors contribute to the development of clusters of people who refuse vaccines, including changes over time in attitudes toward vaccines. If aggressive control efforts have substantially reduced a disease's incidence, few people in a given community may have direct (or indirect) experience with that disease. Therefore, successive age cohorts have only a vague collective memory of the disease's dangers, whereas people may frequently hear about real and perceived adverse effects of vaccination. Parental perception of risks and benefits associated with vaccines is thus altered, and vaccine refusals often increase.1 North American and European countries, for example, have seen substantial reductions in the rates of vaccine-preventable diseases. Since vaccines against measles, mumps, rubella, and diphtheria were introduced in the United States, their incidence has been reduced by more than 99%, and the incidence of tetanus has fallen by 94% since routine tetanus vaccination began.2,3 These decreases have coincided with increases in vaccine refusal in the United States and Europe. The notion that vaccine acceptance is influenced by rates of vaccine-preventable diseases is supported by theories from behavioral sciences. For example, a useful framework for understanding vaccine acceptance is the health-belief model, according to which the uptake of a health intervention is associated with perceived susceptibility to and severity of the relevant disease and the intervention's safety and efficacy. Empirical studies have validated this model as a predictor of vaccine refusal. In the context of eradication, reduction in disease incidence reduces the perceptions of susceptibility to disease and its complications, diminishing an important motivation for accepting a vaccine. It is often assumed that this phenomenon does not apply to low-income countries where there is increasing opposition to vaccines, despite the high burden of infectious diseases. This perspective misses an important point: perceptions regarding vaccines are often vaccine-specific and disease-specific. For example, in high-income countries, although many parents have generalized concerns regarding immunization, perceptions of specific vaccines vary considerably. Similarly, the

more prominent instances of vaccine refusal in low-income countries have been specific to vaccines for diseases with actual or perceived low incidence. Refusal of the polio vaccine in northern Nigeria and parts of northern India, for instance, was vaccine-specific: communities that refused polio vaccine were still demanding measles vaccines. In fact, the low polio rates, achieved through intensive immunization efforts in previous years, were a reason why many did not consider polio eradication a priority: Some people have never even seen polio, but yet they keep giving us medicine for it, one Nigerian told a researcher. If you look around it is hard to find 2 or 3 people with polio, but it is easy to go to the hospital and find 50 people sick with no money to buy the medicine they need to be treated with. Help them instead, but No! You find a small baby who is well and drop medicine in his mouth, for free!4 Although change in the epidemiology of a vaccine-preventable disease is important in determining support for the vaccine, it is not the only important factor involved. Local sociopolitical, demographic, and health-systemrelated issues and competing health problems (e.g., HIV infection and malnutrition) affect both the response of parents and the community and the effectiveness of control programs. For example, in Nigeria, local politics, distrust of the central government and the West, and the history of unethical practices of Western pharmaceutical companies all contributed to polio-vaccination resistance.4 Similarly, in northern India, the resistance to polio vaccination was centered in the Muslim minority communities that have historically felt marginalized. But local factors operate in a milieu of decreased appreciation of vaccines an argument supported by the specificity of opposition to polio vaccine. Other major challenges to disease eradication include suboptimal vaccine effectiveness in certain populations, emergence of vaccine-derived pathogenic strains, difficulties in reaching migrant populations, chronic underfunding, international conflict, and violence against health workers. The relative importance of various challenges, including vaccine refusal, varies among and within countries. Resistance to vaccination can be overcome with carefully planned and executed social mobilization initiatives and bundling of eradication-related vaccination with other services that have higher acceptance among the target population. For example, polio-eradication efforts in India led to the successful elimination of polio transmission in January 2011. But addressing vaccine refusal may require substantial human and financial resources. In northern India, it took sustained multiyear efforts and involvement of nontraditional stakeholders (such as Muslim religious leaders) to overcome resistance to vaccination. Implementing highintensity communication and social mobilization programs is more challenging when factors such as lack of security are at play, as is the case for polio elimination in Afghanistan and Pakistan. The next vaccine-preventable disease being considered for global eradication is measles. A global technical consultation commissioned by the World Health Organization (WHO) to assess the feasibility of global measles eradication concluded that measles can and should be eradicated.5 This conclusion has been endorsed by the WHO Strategic Advisory Group of Experts on Immunization, and regional elimination goals have been established by all WHO regions except the Southeast Asian region. However, there has been no target date set for global eradication. Initiatives for eradicating diseases with a high herd-immunity threshold (such as measles, which has a threshold of approximately 94%) are more vulnerable to the effects of pockets of vaccine refusal than are attempts to eradicate disease

with lower herd-immunity thresholds, such as smallpox (which had a threshold of approximately 80 to 85%). One lesson from past eradication efforts is that the last mile is the longest. Aggressive early efforts often cause dramatic reductions in disease rates, which paradoxically increase the risk of vaccine refusal. It is difficult to quantify the precise rate of decline in favorable perceptions of a vaccine, so it's challenging to predict the exact timing and location of emergence of clusters of vaccine refusers. Yet it's reasonable to assume that the longer it takes to move from aggressive control or regional elimination to global eradication, the more likely it is that vaccine refusal will emerge. Eradication should therefore not be a halfhearted effort. Aggressive disease control is in itself a worthy public health goal, but it shouldn't be assumed to be an automatic stepping-stone to eradication. If a disease such as measles is considered a priority by the global public health community, human and financial resources should be committed up front to a full-scale eradication initiative, conducted with a sense of urgency. If we don't go big and go fast, we may have to spend a prolonged period on eradication efforts with a diminished likelihood of success. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. Source Information From the Hubert Department of Global Health, Emory University Rollins School of Public Health (S.B.O.); the Emory Vaccine Center (S.B.O., W.A.O.) and the Emory Global Health Institute (J.P.K.), Emory University; and the Center for Health Research Southeast (S.B.O) all in Atlanta. OMICS: A Journal of Integrative Biology April 2013, 17(4) http://online.liebertpub.com/toc/omi/17/4 [No relevant content] Revista Panamericana de Salud Pblica/Pan American Journal of Public Health (RPSP/PAJPH) March 2013 Vol. 33, No. 3 http://www.paho.org/journal/index.php? option=com_content&task=view&id=122&Itemid=222 Socioeconomic determinants of cervical cancer screening in Latin America [Determinantes socioeconmicos de las pruebas de deteccin sistemtica del cncer cervicouterino en Amrica Latina] Samir Soneji and Natsu Fukui INFORMES ESPECIALES / SPECIAL REPORTS Bellagio Report on Healthy Agriculture, Healthy Nutrition, Healthy People [Informe Bellagio sobre la actividad agropecuaria y la nutricin para la salud de las personas] Artemis P. Simopoulos, Peter G. Bourne, and Ole Faergeman The Pediatric Infectious Disease Journal April 2013 - Volume 32 - Issue 4 pp: A15-A16,307-429,e128-e181

http://journals.lww.com/pidj/pages/currenttoc.aspx [Reviewed earlier] Pediatrics April 2013, VOLUME 131 / ISSUE 4 http://pediatrics.aappublications.org/current.shtml [Reviewed earlier] Pharmaceutics Volume 5, Issue 1 (March 2013) http://www.mdpi.com/1999-4923/5/1 [Reviewed earlier] Pharmacoeconomics Volume 31, Issue 4, April 2013 http://link.springer.com/journal/40273/31/4/page/1 [Reviewed earlier] PLoS One [Accessed 13 April 2013] http://www.plosone.org/ The Cost Effectiveness of Pandemic Influenza Interventions: A Pandemic Severity Based Analysis George J. Milne, Nilimesh Halder, Joel K. Kelso Research Article | published 09 Apr 2013 | PLOS ONE 10.1371/journal.pone.0061504 Abstract Background The impact of a newly emerged influenza pandemic will depend on its transmissibility and severity. Understanding how these pandemic features impact on the effectiveness and cost effectiveness of alternative intervention strategies is important for pandemic planning. Methods A cost effectiveness analysis of a comprehensive range of social distancing and antiviral drug strategies intended to mitigate a future pandemic was conducted using a simulation model of a community of ~30,000 in Australia. Six pandemic severity categories were defined based on case fatality ratio (CFR), using data from the 2009/2010 pandemic to relate hospitalisation rates to CFR. Results Intervention strategies combining school closure with antiviral treatment and prophylaxis are the most cost effective strategies in terms of cost per life year saved (LYS) for all severity categories. The cost component in the cost per LYS ratio varies depending on pandemic severity: for a severe pandemic (CFR of 2.5%) the cost is ~$9 k per LYS; for a low severity pandemic (CFR of 0.1%) this strategy costs ~$58 k per LYS; for a pandemic with very low severity similar to the 2009 pandemic (CFR of 0.03%) the cost is ~$155 per LYS. With high severity pandemics (CFR >0.75%) the most effective attack rate reduction strategies are also the most cost

effective. During low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, while for high severity pandemics costs are dominated by hospitalisation costs and productivity losses due to death. Conclusions The most cost effective strategies for mitigating an influenza pandemic involve combining sustained social distancing with the use of antiviral agents. For low severity pandemics the most cost effective strategies involve antiviral treatment, prophylaxis and short durations of school closure; while these are cost effective they are less effective than other strategies in reducing the infection rate. PLoS Medicine (Accessed 13 April 2013) http://www.plosmedicine.org/ Herpes Zoster Vaccine Effectiveness against Incident Herpes Zoster and Post-herpetic Neuralgia in an Older US Population: A Cohort Study Sinad M. Langan, Liam Smeeth, David J. Margolis, Sara L. Thomas Abstract Background Herpes zoster is common and has serious consequences, notably post-herpetic neuralgia (PHN). Vaccine efficacy against incident zoster and PHN has been demonstrated in clinical trials, but effectiveness has not been studied in unselected general populations unrestricted by region, full health insurance coverage, or immune status. Our objective was to assess zoster vaccine effectiveness (VE) against incident zoster and PHN in a general population-based setting. Methods and Findings A cohort study of 766,330 fully eligible individuals aged 65 years was undertaken in a 5% random sample of Medicare who received and did not receive zoster vaccination between 1st January 2007 and 31st December 2009. Incidence rates and hazard ratios for zoster and PHN were determined in vaccinated and unvaccinated individuals. Analyses were adjusted for age, gender, race, low income, immunosuppression, and important comorbidities associated with zoster, and then stratified by immunosuppression status. Adjusted hazard ratios were estimated using time-updated Cox proportional hazards models. Vaccine uptake was low (3.9%) particularly among black people (0.3%) and those with evidence of low income (0.6%). 13,112 US Medicare beneficiaries developed incident zoster; the overall zoster incidence rate was 10.0 (9.810.2) per 1,000 person-years in the unvaccinated group and 5.4 (95% CI 4.66.4) per 1,000 personyears in vaccinees, giving an adjusted VE against incident zoster of 0.48 (95% CI 0.390.56). In immunosuppressed individuals, VE against zoster was 0.37 (95% CI 0.060.58). VE against PHN was 0.59 (95% CI 0.210.79). Conclusions Vaccine uptake was low with variation in specific patient groups. In a general population cohort of older individuals, zoster vaccination was associated with reduction in incident zoster, including among those with immunosuppression. Importantly, this study demonstrates that zoster vaccination is associated with a reduction in PHN. Please see later in the article for the Editors' Summary Editors' Summary Background

Chickenpox is an extremely common childhood infectious disease that is caused by the herpes varicella-zoster virus. Children usually recover quickly from chickenpox, but dormant varicella-zoster virus persists throughout life inside the nervous system. The dormant virus causes no symptoms but if it becomes reactivated, it causes shingles (zoster), a painful skin rash. Anyone who has had chickenpox can develop shingles but shingles is most common and most severe in 6080-year-old people. Indeed, about half of people who live to 85 will have an episode of shingles. Early signs of shingles include burning or shooting pain and tingling or itching. Blister-like sores, which last from 114 days, then develop in a region of one side of the body or on one side of the face. The pain of shingles can be debilitating and can continue after the rash disappearspost-herpetic neuralgia, which can last for months to years, greatly reduces the quality of life. There is no cure for shingles but early treatment with antivirals may help to prevent lingering pain by inhibiting viral replication. Why Was This Study Done? Shingles vaccination can prevent shingles or lessen its effects. In clinical trials, vaccination reduced the incidence of shingles (the proportion of a population who develop shingles in a year) and the incidence of post-herpetic neuralgia, and vaccination against shingles is now recommended in the US for everyone over the age of 60 except individuals with a weakened immune system (for example, people with HIV/AIDS). However, these clinical trials determined the vaccine's efficacy in selected populations under controlled conditions. How effective is the vaccine in unselected populations in routine clinical use? In this cohort study, the researchers assess zoster (shingles) vaccine effectiveness against incident shingles and postherpetic neuralgia in an unselected population of older individuals in the US. A cohort study follows a group of individuals who differ with respect to specific factors (in this study, vaccination against shingles) to determine how these factors affect the rates of specific outcomes (shingles and post-herpetic neuralgia). What Did the Researchers Do and Find? The researchers undertook their cohort study in 766,330 randomly chosen Medicare beneficiaries aged 65 years or more. Medicare is a US government health insurance scheme that mainly helps to pay the health care costs of people aged 65 or older. The researchers used Medicare administrative data to identify which cohort members received zoster vaccination between January 2007 and December 2009 and which developed incident shingles (defined as a first diagnosis of shingles combined with the use of antivirals) or post-herpetic neuralgia (defined as a code for post-herpetic neuralgia, non-specific neuralgia, or a second diagnostic code for shingles 90 days after the first diagnosis combined with a prescription for pain relief, an anticonvulsant, or an antidepressant). Vaccine uptake was low in this unselected study populationonly 3.9% of the participants were vaccinated. The vaccination rate was particularly low among black people (0.6% of person-time) and among people with a low income (0.3%). About 13,000 participants developed incident shingles. The shingles incidence rate was 10.0 per 1,000 person-years among unvaccinated participants and 5.4 per 1,000 person-years among vaccinated participants. Vaccine effectiveness against incident shingles was 48%. That is, vaccination reduced the incidence of shingles by 48% (in other words, approximately half as many vaccinated individuals developed shingles as those who were not vaccinated). Vaccine effectiveness against incident shingles among immunosuppressed individuals was lower (37%). Finally, vaccine effectiveness against post-herpetic neuralgia was 59%.

What Do These Findings Mean? These findings show that shingles vaccine uptake is low among elderly people in the US and varies between different patient groups. They show that shingles vaccination is effective against incident shingles in a general population of older individuals, including those who are immunosuppressed, and suggest that shingles vaccination is effective against post-herpetic neuralgia. However, because these findings rely on administrative data, their accuracy may be affected by misclassification of vaccination and of outcomes. Moreover, because shingles vaccination was not randomized, the vaccinated individuals might have shared other characteristics that were actually responsible for their lower incidence of shingles and/or post-herpetic neuralgia compared to unvaccinated individuals. Despite these limitations, these findings provide useful information for policy makers in countries that are currently considering the introduction of shingles vaccination into routine practice. Moreover, they highlight the need to increase shingles vaccination among elderly individuals in the US, the section of the population at the highest risk of post-herpetic neuralgia. Additional Information Please access these Web sites via the online version of this summary at http://dx.doi.org/ 10.1371/journal.pmed.1001420. PLoS Neglected Tropical Diseases March 2013 http://www.plosntds.org/article/browseIssue.action [Reviewed earlier] PNAS - Proceedings of the National Academy of Sciences of the United States of America (Accessed 13 April 2013) http://www.pnas.org/content/early/recent [No new relevant content] Public Health Ethics Volume 6 Issue 1 April 2013 http://phe.oxfordjournals.org/content/current [Reviewed earlier] Qualitative Health Research May 2013; 23 (5) http://qhr.sagepub.com/content/current [Reviewed earlier] Risk Analysis April 2013 Volume 33, Issue 4 Pages 505749 http://onlinelibrary.wiley.com/doi/10.1111/risa.2013.33.issue-4/issuetoc

Special Issue Theme: Poliovirus Eradication [Reviewed earlier] Science 12 April 2013 vol 340, issue 6129, pages 109-236 http://www.sciencemag.org/current.dtl [No relevant content] Science Translational Medicine 10 April 2013 vol 5, issue 180 http://stm.sciencemag.org/content/current [No relevant content] Social Science & Medicine Volume 82, Pages 1-164 (April 2013) http://www.sciencedirect.com/science/journal/02779536/82 [Reviewed earlier] Vaccine Volume 31, Issue 19, Pages 2323-2416 (1 May 2013) http://www.sciencedirect.com/science/journal/0264410X Letter to the Editor The Coalition for Cholera Prevention and Control meeting Page 2323 Alan R. Hinman, Paul E. Farmer No abstract Trends in vaccination coverage disparities among children, United States, 20012010 Brief Report Pages 2324-2327 Zhen Zhao, Philip J. Smith Abstract Introduction One of two overarching goals of the Healthy People 2010 initiative was to eliminate health disparities. We evaluate trends in children vaccination coverage disparities by socio-demographic characteristics in the United States from 2001 through 2010. Methods Disparities in vaccination coverage for the 4:3:1:3:3:1 vaccine series was assessed with National Immunization Survey (NIS) 20012010 data. The disparities between two categories of population were independently evaluated yearly from 2001 through 2010. Results In 2001, 10 out of 12 disparities were significant (P-value <0.05). Six disparities were reduced from statistically significant in 2001 to not significant in 2010. Across 20012010, 8 disparities narrowed significantly; the average change in disparities per year were negative and ranged from 0.30% to 0.64% (P-value <0.05).

Conclusions Significant success has been achieved in reducing disparities in vaccination coverage for young children among most of the major socio-demographic subpopulations in the United States by 2010. Hepatitis A vaccination coverage among adults 1849 years traveling to a country of high or intermediate endemicity, United States Original Research Article Pages 2348-2357 Peng-jun Lu, Kathy K. Byrd, Trudy V. Murphy Abstract Background Since 1996, hepatitis A vaccine (HepA) has been recommended for adults at increased risk for infection including travelers to high or intermediate hepatitis A endemic countries. In 2009, travel outside the United States and Canada was the most common exposure nationally reported for persons with hepatitis A virus (HAV) infection. Objective To assess HepA vaccination coverage among adults 1849 years traveling to a country of high or intermediate endemicity in the United States. Methods We analyzed data from the 2010 National Health Interview Survey (NHIS), to determine self-reported HepA vaccination coverage (1 dose) and series completion (2 dose) among persons 1849 years who traveled, since 1995, to a country of high or intermediate HAV endemicity. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with HepA vaccine receipt. Results In 2010, approximately 36.6% of adults 1849 years reported traveling to high or intermediate hepatitis A endemic countries; among this group unadjusted HepA vaccination coverage was 26.6% compared to 12.7% among non-travelers (Pvalues < 0.001) and series completion were 16.9% and 7.6%, respectively (Pvalues < 0.001). On multivariable analysis among all respondents, travel status was an independent predictor of HepA coverage and series completion (both Pvalues < 0.001). Among travelers, HepA coverage and series completion (2 doses) were higher for travelers 1825 years (prevalence ratios 2.3, 2.8, respectively, Pvalues < 0.001) and for travelers 2639 years (prevalence ratios 1.5, 1.5, respectively, P-value < 0.001, P-value = 0.002, respectively) compared to travelers 4049 years. Other characteristics independently associated with a higher likelihood of HepA receipt among travelers included Asian race/ethnicity, male sex, never having been married, having a high school or higher education, living in the western United States, having greater number of physician contacts or receipt of influenza vaccination in the previous year. HepB vaccination was excluded from the model because of the significant correlation between receipt of HepA vaccination and HepB vaccination could distort the model. Conclusions Although travel to a country of high or intermediate hepatitis A endemicity was associated with higher likelihood of HepA vaccination in 2010 among adults 1849 years, self-reported HepA vaccination coverage was low among adult travelers to these areas. Healthcare providers should ask their patients upcoming travel plans and recommend and offer travel related vaccinations to their patients.

Estimating the long-term effects of HPV vaccination in Germany Original Research Article Pages 2372-2380 J. Horn, O. Damm, M.E.E. Kretzschmar, Y. Deler, O. Wichmann, A.M. Kaufmann, E. Garbe, A. Krmer, W. Greiner, R.T. Mikolajczyk Abstract In Germany, vaccination against the most oncogenic HPV types 16/18 is recommended by the Standing Committee on Vaccination (STIKO) for 1217 year old girls since March 2007. We developed a dynamic mathematical model for the natural history and transmission of HPV infections to estimate the impact of vaccination on incidence and mortality of cervical cancer and its pre-stages, and on anogenital warts. We focused on an extensive model calibration to epidemiologic data for all stages of the natural history model as well as on a detailed implementation of cervical cancer screening modalities in Germany. Our model predicts first a substantial reduction of cervical cancer incidence and mortality over the next 30 years, which is mainly attributable to an increase in screening participation in the 1990s and not to HPV vaccination, followed by a further reduction attributable to vaccination. Over the next 100 years, HPV vaccination will prevent approximately 37% of cervical cancer cases even if vaccination coverage is only 50% (as currently observed in Germany). Consideration of cross-protection results in a further reduction of approximately 7% of all cervical cancer cases for the bivalent and about 5% for the quadrivalent vaccine in our model. Vaccination of boys was only reasonable if moderate to high vaccination coverage in girls was not achieved. Strategies should be implemented in Germany to increase HPV vaccination coverage among girls thereby making better use of the demonstrated benefits of the vaccine. Vaccine: Development and Therapy (Accessed 13 April 2013) http://www.dovepress.com/vaccine-development-and-therapy-journal [No new relevant content] Value in Health Vol 16 | No. 2 | March-April 2013 | Pages 229-452 http://www.valueinhealthjournal.com/current [Reviewed earlier]

From Google Scholar & other sources: Selected Journal Articles, Dissertations, Theses
Parent perspectives on consent for the linkage of data to evaluate vaccine safety A randomised trial of opt-in and opt-out consent JG Berry, P Ryan, KM Duszynski, AJ Braunack-Mayer - Clinical Trials, 2013 Background We examined parents' consent preferences and understanding of an opt-in or opt-out invitation to participate in data linkage for post-marketing safety

surveillance of childhood vaccines. Methods A single-blind parallel-group randomised controlled trial: ... [HTML] Acceptability of human papilloma virus vaccine and cervical cancer screening among female health-care workers in Enugu, Southeast Nigeria EO Ugwu, SN Obi, PC Ezechukwu, II Okafor, AO Ugwu - Nigerian Journal of Clinical , 2013 Background: Cervical cancer, a leading cause of cancer deaths in women in developing countries can be prevented primarily by vaccinating adolescent girls and women against infection by the human papillomavirus (HPV) before their first sexual exposure, and ... Characterization and optimization of bilosomes for oral vaccine delivery JS Wilkhu, SE McNeil, DE Anderson, Y Perrie - Journal of Drug Targeting, 2013 Oral vaccines offer significant benefits due to the ease of administration, better patient compliance and non-invasive, needle-free administration. However, this route is marred by the harsh gastro intestinal environment which is detrimental to many vaccine formats. To ... Development of the Hepatitis E Vaccine: From Bench to Field J Zhang, JWK Shih, T Wu, SW Li, NS Xia - Seminars in Liver Disease, 2013 Abstract Along with the improvement of diagnostic techniques, hepatitis E has attracted increasing awareness in recent years. Hepatitis E virus infection leads to high mortality in pregnant women and patients with underlying liver disease. Several hepatitis E vaccine ... Preventing Pneumococcal Disease: Intergenerational Issues Toughest Cases JY Wick - The Consultant Pharmacist, 2013 ... lister hypothesized that immunizing half of a closed population would stop (or retard significantly) the organism's spread, and unimmunized members would benefit as well. He immunized all members of one compound, using those in different compounds as controls. ... HIV: Roadmaps to a vaccine H Mouquet, MC Nussenzweig - Nature, 2013 Our understanding of how humans respond to HIV has been revolutionized by the introduction of techniques for isolating anti-viral antibodies from single cells 1 . Such methods have led to the discovery of naturally occurring, potent antibodies that can neutralize a broad range of ...

Media/Policy Watch Beginning in June 2012, Vaccines: The Week in Review expanded to alert readers to substantive news, analysis and opinion from the general media on vaccines, immunization, global; public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peerreviewed journal ecology. We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook of adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level. The Atlantic http://www.theatlantic.com/magazine/ Accessed 13 April 2013 [No new, unique, relevant content] BBC http://www.bbc.co.uk/ Accessed 13 April 2013 [No new, unique, relevant content] Brookings http://www.brookings.edu/ Accessed 13 April 2013 [No new, unique, relevant content] Economist http://www.economist.com/ Accessed 13 April 2013 [No new, unique, relevant content] Financial Times http://www.ft.com Accessed 13 April 2013 [No new, unique, relevant content] Forbes http://www.forbes.com/ Accessed 13 April 2013 The Fight to End Pandemics Editors Note: Larry Brilliant is CEO of Skoll Global Threats Fund which works on climate, nuclear, pandemic, water and Middle East conflicts. Brilliant helped lead the successful WHO smallpox eradication programme in India.

This article was published as part of a special series for World Health Day and in advance of the 2013 Skoll World Forum. http://www.forbes.com/sites/skollworldforum/2013/04/07/the-fight-to-endpandemics/ Foreign Affairs http://www.foreignaffairs.com/ Accessed 13 April 2013 [No new, unique, relevant content] Foreign Policy http://www.foreignpolicy.com/ Accessed 13 April 2013 [No new, unique, relevant content] The Guardian http://www.guardiannews.com/ Accessed 13 April 2013 [No new, unique, relevant content] The Huffington Post http://www.huffingtonpost.com/ Accessed 13 April 2013 Why the Global Fund Is a Terrific Investment By Bill Gates, Co-chair of the Bill & Melinda Gates Foundation Excerpt The Global Fund to Fight AIDS, Tuberculosis and Malaria announced today that it will need $15 billion to continue its life-saving work. If the world comes together to meet this replenishment goal, it will build on one of its greatest achievements of the past decade by saving millions more lives. HIV, TB and malaria are three of the world's biggest killers, but thanks to the Global Fund we are starting to make significant progress in controlling them. Now is the time for governments and other donors to make new pledges to the Fund http://www.huffingtonpost.com/bill-gates/the-global-fund_b_3034610.html Le Monde http://www.lemonde.fr/ Accessed 13 April 2013 [No new, unique, relevant content] New Yorker http://www.newyorker.com/ Accessed 13 April 2013 [No new, unique, relevant content] NPR/National Public Radio [U.S.] Public Health Accessed 13 April 2013 [No new, unique, relevant content]

New York Times http://www.nytimes.com/ Accessed 13 April 2013 [No new, unique, relevant content] Reuters http://www.reuters.com/ Accessed 13 April 2013 [No new, unique, relevant content] Wall Street Journal http://online.wsj.com/home-page Accessed 13 April 2013 [No new, unique, relevant content] Washington Post http://www.washingtonpost.com/ Accessed 13 April 2013 [No new, unique, relevant content]

Twitter Watch (discontinuedto be re-evaluated in 90 days) Editors Note: We continue to follow the twitter feeds of a wide variety of organizations and institutions, but our observation is that twitter is functioning primarily (for our purposes) as a sentinel system, confirming availability of content we already capture for Vaccines: The Week in Review. We will continue to use twitter for this purpose and re-evaluate whether Twitter Watch can add important value to this weekly digest in 90 days. * * * *

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 is provided by its governing institutions Department of Medical Ethics, NYU Medical School; The Wistar Institute Vaccine Center and the Childrens Hospital of Philadelphia Vaccine Education Center. Additional support is provided by PATH Vaccine Development Program and the International Vaccine Institute (IVI), and by vaccine industry leaders including GSK, Pfizer, and sanofi pasteur (list in formation), as well as the Developing Countries Vaccine Manufacturers Network (DCVMN). Support is also provided by a growing list of individuals who use this service to support their roles in public health, clinical practice, government, NGOs and other international institutions, academia and research organizations, and industry.