Vaccines_The Week in Review_27 July 2013

7/27/2019 Vaccines_The Week in Review_27 July 2013

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Vaccines: The Week in Review27 July 2013Center for Vaccine Ethics & Policy (CVEP)This weekly summary targets news, events, announcements, articles and research in the globalvaccine ethics and policy space and is aggregated from key governmental, NGO, internationalorganization and industry sources, key peer-reviewed journals, and other media channels. Thissummary proceeds from the broad base of themes and issues monitored by the Center for VaccineEthics & Policy in its work: it is not intended to be exhaustive in its coverage. Vaccines: The Week inReview is also posted in pdf form and as a set of blog posts athttp://centerforvaccineethicsandpolicy.wordpress.com/. This blog allows full-text searching of over3,500 entries.

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

[email protected]

CDC/MMWR Watch [to 27 July 2013]CDC Telebriefing on human papillomavirus (HPV) vaccination coverage andvaccine safety monitoring

Thursday, July 25, 2013 at Noon ET

Press Briefing TranscriptExcerpt [Editors text bolding]

TOM FRIEDEN:Just last month, I had a chance to share with you really good news that HPV

vaccination works even better than we anticipated. The types of HPV, thats humanpapillomavirus, that commonly cause cervical cancer in the U.S., had dropped byabout half in girls aged 14 to 19 in the seven years since we recommendedroutinely vaccinating against HPV. I noted at that time that the results werestriking, and would serve should serve as a wake-up call to increase vaccinationrates, because we really can protect the next generation of adolescents againstcancers caused by HPV. Unfortunately, today we have disappointing news.An article in todays MMWR shows that HPV vaccination coverage for girls

getting the anti-cancer vaccine has not increased at all from one year tothe next. Zero. Were dropping the ball. Were missing opportunities togive HPV vaccines, and that needs to change to protect girls from cervicalcancer. Ill provide some more detail and then discuss missed opportunities andinformation about vaccine safety.

But the article published today has data from whats called the NationalImmunization Survey on teen vaccinations. This is how we measure how weredoing. It collects vaccine information for 13 to 17-year-olds using a random digit
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sample of landlines and, starting in 2011, cellular telephone phones as well. After ateens parental guardian gives permission, we contact the vaccination provider,doctor, nurse practitioner or other provider and mail a questionnaire to get thevaccination history. The 2012 survey which were reporting about today includedvaccination records of about 19,000 teens. And todays article focuses on HPVvaccination among girls from 2007 to 2012. Next month well share the data we

collected last year on other vaccines recommended specifically for preteens andteens, and that will include vaccination coverage estimates for HPV vaccinationsamong boys, something thats only more recently been recommended.

These national data show no progress, zero, with HPV vaccine coveragein 2012. Were used to seeing coverage increases of 10 percent per yearwhen a new vaccine hits the market. Last year we were disappointed atthe increase in HPV vaccine was only 4 percentage points. This year, itszero percentage points. The HPV vaccine coverage hasnt kept pace withother vaccines recommended for preteens and teens. One dose does notprovide all of the protection that the HPV vaccine series has to offer so wewant all girls to get their second and third doses. By 2011, 34.8 percentof teen girls finished their three-dose series. 2012 data is not different.

Its 33.4 percent. Actually, slightly fewer teen girls are given all doses from theprevious years. This is a huge disappointment, but Im confident that we will turn itaround. And one of the reasons for that is in the next piece of data that we gotfrom this survey.

We assumed that one of the reasons we had such low rates was that adolescentsdont see the doctor regularly so its hard to get a three-dose series in. But actually,we found that that the data showed that if HPV vaccine were given every singletime a young person went to the doctor to get another vaccine, the completion ofthose series would be at 93 percent. Thats important, because if we get three-doseseries to 80 percent, an estimated 53,000 cases of cervical cancer could beprevented over the lifetimes of girls aged 12 and younger. Now there are lots ofways we can work together to increase vaccination rates. A key one is to takeadvantage of every opportunity to vaccinate against HPV. The teens are in thedoctors office, theyre getting another vaccination, but theyre not getting the HPVsecond and third doses.

We also asked parents why they havent gotten their daughters vaccinated. Andone of the top reasons is that their doctors didnt recommend it. This is critical.Research consistently showed that a providers recommendation to vaccinate is thesingle most influential factor in determining whether a parent gets their kidvaccinated. So we need to step up our efforts by talking to parents about theimportance of this vaccine. Doctors need to recommend this vaccine just as theyrecommend others, and ensure that theyre given every opportunity. Parents havealso told us in other research there are concerns about this this may be in someway a license or permission to have sex. But multiple studies have found thatpreteens and teens who receive this vaccine do not have sex any sooner than theirpeers who have not received the vaccine. HPV vaccine does not open the door tosex. HPV vaccine closes the door to cancer. The vaccine has to be given beforeonset of sexual activity. We cant let this opportunity go to waste. And I reallywould make the analogy to many of our other vaccines. We make sure that peopleget vaccinations well before they get exposed. Were not saying theyre going to beexposed immediately after. Just that we want to make sure they get vaccinatedwell before


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http://www.cdc.gov/media/releases/2013/t0725-Human-papillomavirus.htmlHuman Papillomavirus Vaccination Coverage Among Adolescent Girls,20072012, and Postlicensure Vaccine Safety Monitoring, 20062013 United StatesMMWR Weekly

July 26, 2013 / 62(29);591-595Excerpt

Since mid-2006, the Advisory Committee on Immunization Practices (ACIP) hasrecommended routine vaccination of adolescent girls at ages 11 or 12 years with 3doses of human papillomavirus (HPV) vaccine (1). Two HPV vaccines are currentlyavailable in the United States. Both the quadrivalent (HPV4) and bivalent (HPV2)vaccines protect against HPV types 16 and 18, which cause 70% of cervical cancersand the majority of other HPV-associated cancers; HPV4 also protects against HPVtypes 6 and 11, which cause 90% of genital warts.* This report summarizes nationalHPV vaccination coverage levels among adolescent girls aged 1317 years from the20072012 National Immunization Survey-Teen (NIS-Teen) and nationalpostlicensure vaccine safety monitoring. Although vaccination coverage with 1dose of any HPV vaccine increased from 25.1% in 2007 to 53.0% in 2011, coveragein 2012 (53.8%) was similar to 2011. If HPV vaccine had been administered duringhealth-care visits when another vaccine was administered, vaccination coverage for1 dose could have reached 92.6%. Safety monitoring data continue to indicatethat HPV4 is safe. Despite availability of safe and effective vaccines and ampleopportunities for vaccine delivery in the health-care setting, HPV vaccinationcoverage among adolescent girls failed to increase from 2011 to 2012http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm?s_cid=mm6229a4_w

Kingdom of Saudi Arabia: MOH Issues Health Regulations for ThoseFlocking to Saudi Arabia to Perform Umrah and Hajj-1434H12 July 2013http://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2013-07-12-001.aspx[Full text]

Proceeding from the keenness of the government of the Custodian of the TwoHoly Mosques to maintain the public health and ensure a safe and healthyatmosphere for the performers of Pilgrimage Hajj and Umrah, Allah Willing; inorder to enable them to perform the rituals easily, healthily and conveniently, andwithin the framework of the precautionary measures against Novel Coronavirus(MERS-COV), the Ministry of Health (MOH) has issued health regulations andrequirements that must be met by those coming to the Kingdom for performingUmrah and Hajj for the year 1434 H.These regulations included the recommendation of postponing the performance of

Umrah and Hajj this year in case of the elderly people and patients suffering fromchronic diseases such as heart, kidney, and respiratory diseases, not to forgetdiabetes, as well as patients with congenital and acquired immune deficiency, inaddition to patients suffering from tumors, and pregnant women and children.

Within the same vein, the regulations included some tips and health awarenessguidelines for citizens, residents and visitors to perform Umrah or Hajj such as:
http://www.cdc.gov/media/releases/2013/t0725-Human-papillomavirus.htmlhttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5602a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm?s_cid=mm6229a4_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm?s_cid=mm6229a4_whttp://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2013-07-12-001.aspxhttp://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2013-07-12-001.aspxhttp://www.cdc.gov/media/releases/2013/t0725-Human-papillomavirus.htmlhttp://www.cdc.gov/mmwr/preview/mmwrhtml/rr5602a1.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm?s_cid=mm6229a4_whttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm?s_cid=mm6229a4_whttp://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2013-07-12-001.aspxhttp://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2013-07-12-001.aspx


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washing hands well and continually with water and soap, or with other handdisinfectants, especially after coughing, sneezing, using a tissue when coughing orsneezing, then getting rid of it in a waste basket, avoiding touching eyes, nose ormouth directly with hands, limiting direct contact with infectious people andavoiding sharing their personal tools, wearing face-masks in overcrowded places,and maintaining hygiene in general. Furthermore, these regulations included

obtaining a valid certificate of vaccination against meningitis at least 10 days beforetravelling to the Kingdom, and up to 3 years, as well as getting a certificate ofvaccination against polio-affected countries, according to specific requirements.

It is worth mentioning that the health regulations have shed light on theimportance of vaccination against seasonal influenza vaccine, especially for peoplewith chronic diseases such as heart and kidney diseases, diabetes and respiratoryand neurological diseases, as well as people with congenital and acquired immunedeficiency diseases, metabolic diseases, pregnant women and children under 5years, aside from people suffering from obesity and overweight.

To view the Health Regulations for Travellers to Saudi Arabia to Perform Umrah &Hajj-1434H.http://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2013-07-12-001.aspx

Novartis announced a development and licensing agreement withBiological E Limited (BioE, India) ) for two vaccines to protect againsttyphoid and paratyphoid fevers. Under the license, Novartis Vaccines Institutefor Global Health (NVGH) will transfer technology to BioE, which will have financialand operational responsibility for manufacturing, further clinical development,approval and distribution in the developing world. The typhoid vaccine (Vi-CRM197)involved has achieved Proof of Concept, had successful Phase 2 results, and will betransferred to BioE. A combined typhoid-paratyphoid vaccine will be transferredonce Proof of Concept is completed through early, small-scale studies in humans todetermine safety and immunogenicity. The Wellcome Trust continues to support thedevelopment of the dual-acting vaccine through a Strategic Award that wasawarded in 2009. BioE said it is committed to achieving WHO pre-qualification andfulfill specific obligations to meet Novartis standards. The agreement is worldwideexcept for developed countries, where Novartis will retain rights.http://www.novartis.com/newsroom/media-releases/1714633.shtml

WHO: World Hepatitis Day 2013News release24 July 2013Excerpt

On World Hepatitis Day (28 July), WHO is urging governments to act against thefive hepatitis viruses that can cause severe liver infections and lead to 1.4 milliondeaths every year. Some of these hepatitis viruses, most notably types B and C, canalso lead to chronic and debilitating illnesses such as liver cancer and cirrhosis, andin addition to, loss of income and high medical expenses for hundreds of millions ofpeople worldwide

The fact that many hepatitis B and C infections are silent, causing nosymptoms until there is severe damage to the liver, points to the urgent need for
http://www.moh.gov.sa/en/Hajj/Pages/HealthRegulations.aspxhttp://www.moh.gov.sa/en/Hajj/Pages/HealthRegulations.aspxhttp://www.moh.gov.sa/en/Hajj/Pages/HealthRegulations.aspxhttp://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2013-07-12-001.aspxhttp://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2013-07-12-001.aspxhttp://www.novartis.com/newsroom/media-releases/1714633.shtmlhttp://www.moh.gov.sa/en/Hajj/Pages/HealthRegulations.aspxhttp://www.moh.gov.sa/en/Hajj/Pages/HealthRegulations.aspxhttp://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2013-07-12-001.aspxhttp://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2013-07-12-001.aspxhttp://www.novartis.com/newsroom/media-releases/1714633.shtml


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universal access to immunization, screening, diagnosis and antiviral therapy, saysDr Keiji Fukuda, WHO Assistant Director-General for Health Security and theEnvironment.

"Many of the measures needed to prevent the spread of viral hepatitis diseasecan be put in place right now, and doing so will offset the heavy economic costs oftreating and hospitalizing patients in future."

This year, in the run up to World Hepatitis Day, the Organization is releasing itsfirst-ever country hepatitis survey, covering 126 countries. The WHO "Global policyreport on the prevention and control of viral hepatitis in WHO Member States"identifies successes as well as gaps at country level in the implementation of fourpriority areas. The priority areas are raising awareness, evidence-based data foraction, prevention of transmission, and screening, care and treatment.The findings show that 37% of the countries have national strategies for viral

hepatitis, and more work is needed in treating hepatitis. It also highlights that whilemost of the countries (82%) have established hepatitis surveillance programmes,only half of them include the monitoring of chronic hepatitis B and C, which areresponsible for most severe illnesses and deathshttp://www.who.int/mediacentre/news/releases/2013/hepatitis_threat_20130724/en/index.htmlWorld Hepatitis Day Statement by HHS Secretary Kathleen Sebelius andHHS Assistant Secretary for Health Dr. Howard Kohhttp://www.businesswire.com/news/home/20130726005621/en/World-Hepatitis-Day-Statement

IVI said it launched a new matrix-based organization as part of itsefforts to increase efficiency and accountability in management andimplementation of its research projects. The key elements of the neworganization, which has been put in place in line with IVIs new Strategic Plan, arethe introduction of formal portfolio and project management, and a greater focus onvaccine pipeline and delivery. IVI now comprises of the following units::: Portfolio Management:: Development and Delivery:: Laboratory Sciences:: Finance & Administration:: Communications & Advocacy:: Human ResourcesThe Portfolio Management Unit has three main programs as of now: Cholera,

Typhoid and Dengue, and also includes the functions of Portfolio Manager, GrantManager, and Business Development Manager. The Development and Delivery Unithas four departments: Clinical Development and Regulatory, Epidemiology,Biostatistics and Data Management, and Access. As well, an internal PortfolioManagement Committee has been created to overlook IVIs research anddevelopment projects.

IVI noted that these changes have been made to ensure that IVI will be well-positioned to achieve maximal impact and deliver on its mission the discovery,development, and delivery of safe, effective and affordable vaccines for developingnations.
http://www.who.int/mediacentre/news/releases/2013/hepatitis_threat_20130724/en/index.htmlhttp://www.who.int/mediacentre/news/releases/2013/hepatitis_threat_20130724/en/index.htmlhttp://www.businesswire.com/news/home/20130726005621/en/World-Hepatitis-Day-Statementhttp://www.businesswire.com/news/home/20130726005621/en/World-Hepatitis-Day-Statementhttp://www.who.int/mediacentre/news/releases/2013/hepatitis_threat_20130724/en/index.htmlhttp://www.who.int/mediacentre/news/releases/2013/hepatitis_threat_20130724/en/index.htmlhttp://www.businesswire.com/news/home/20130726005621/en/World-Hepatitis-Day-Statementhttp://www.businesswire.com/news/home/20130726005621/en/World-Hepatitis-Day-Statement


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http://www.ivi.org/web/www/07_01?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=540

United Nations to establish WHO-led Interagency Task Force on the

Prevention and Control of Noncommunicable DiseasesNote for media

22 July 2013 | Geneva - The Economic and Social Council (ECOSOC) adopted aresolution requesting the UN Secretary-General to establish a United NationsInteragency Task Force on the Prevention and Control of NoncommunicableDiseases. The Task Force will be convened and led by the WHO and will be createdby expanding the mandate of the existing United Nations Ad Hoc Interagency TaskForce on Tobacco Control and the work to support the implementation of the WHOFramework Convention on Tobacco Control (WHO FCTC). The resolution wasadopted in ECOSOCs 2013 Substantive Session being held in Geneva, Switzerland.

The Task Force will coordinate the activities of all UN organizations to implementthe WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020,adopted by the World Health Assembly in May 2013. This is important because newWHO estimates show that 3 of the 4 leading causes of death worldwide are linked tononcommunicable diseases, specifically cardiovascular diseases and chronicobstructive pulmonary disease.

The Action Plan aims to achieve 9 voluntary global targets, including a 25%reduction in premature mortality from cardiovascular diseases, cancer, diabetes,and chronic respiratory diseases by 2025. The plan provides a road map and amenu of policy options for Member States, WHO, other UN organizations, NGOs andprivate sector entities to implement collectively.

Heads of State and Government in 2011 recognized the role and responsibility ofgovernments in reducing noncommunicable diseases through the United NationsPolitical Declaration on the Prevention and Control of NCDs. With this resolution,ECOSOC is following up on those commitments.

WHO will convene a formal meeting with Member States on 13 November 2013 tocomplete the work on a draft terms of reference for the UN Task Force on NCDs.http://www.who.int/mediacentre/news/notes/2013/ncds_ecosoc_20130722/en/index.html

EFPIA/PhRMA: Joint Principles for Responsible Clinical Trial Data Sharing toBenefit PatientsMedia Release: July 24, 2013Excerpt

The European Federation of Pharmaceutical Industries and Associations (EFPIA)and the Pharmaceutical Research and Manufacturers of America (PhRMA) todaystrengthened their long-standing commitment to enhancing public health byendorsing joint Principles for Responsible Clinical Trial Data Sharing: OurCommitment to Patients and Researchers.

Companies routinely publish their clinical research, collaborate with academicresearchers, and share clinical trial information on public websites, saidChristopher Viehbacher, President of EFPIA and CEO ofSanofi. By endorsing thePrinciples, biopharmaceutical companies commit to enhance these efforts by
http://www.ivi.org/web/www/07_01?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=540http://www.ivi.org/web/www/07_01?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=540http://www.ivi.org/web/www/07_01?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=540http://www.who.int/mediacentre/news/notes/2013/ncds_ecosoc_20130722/en/index.htmlhttp://www.who.int/mediacentre/news/notes/2013/ncds_ecosoc_20130722/en/index.htmlhttp://phrma.org/sites/default/files/pdf/PhRMAPrinciplesForResponsibleClinicalTrialDataSharing.pdfhttp://phrma.org/sites/default/files/pdf/PhRMAPrinciplesForResponsibleClinicalTrialDataSharing.pdfhttp://www.sanofi.us/l/us/en/index.jsphttp://www.ivi.org/web/www/07_01?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=540http://www.ivi.org/web/www/07_01?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=540http://www.ivi.org/web/www/07_01?p_p_id=EXT_BBS&p_p_lifecycle=0&p_p_state=normal&p_p_mode=view&_EXT_BBS_struts_action=%2Fext%2Fbbs%2Fview_message&_EXT_BBS_messageId=540http://www.who.int/mediacentre/news/notes/2013/ncds_ecosoc_20130722/en/index.htmlhttp://www.who.int/mediacentre/news/notes/2013/ncds_ecosoc_20130722/en/index.htmlhttp://phrma.org/sites/default/files/pdf/PhRMAPrinciplesForResponsibleClinicalTrialDataSharing.pdfhttp://phrma.org/sites/default/files/pdf/PhRMAPrinciplesForResponsibleClinicalTrialDataSharing.pdfhttp://www.sanofi.us/l/us/en/index.jsp


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making additional information available to the public, patients who participate inclinical trials, and to qualified researchers.

Under the new commitments, biopharmaceutical companies will dramaticallyincrease the amount of information available to researchers, patients, and membersof the public.Patient-level clinical trial data, study-level clinical trial data, full clinical study

reports, and protocols from clinical trials in patients for medicines approved in theUnited States and European Union will be shared with qualified scientific andmedical researchers upon request and subject to terms necessary to protect patientprivacy and confidential commercial information. Researchers who obtain suchclinical trial data will be encouraged to publish their findings.

Companies will work with regulators to provide a factual summary of clinical trialresults to patients who participate in clinical trials.

The synopses of clinical study reports for clinical trials in patients submitted to theFood and Drug Administration [FDA], European Medicines Agency [EMA], or nationalauthorities of EU member states will be made publicly available upon the approvalof a new medicine or new indication.

Biopharmaceutical companies have also reaffirmed their commitment to publishclinical trial results regardless of the outcome. At a minimum, results from all phase3 clinical trials and clinical trial results of significant medical importance should besubmitted for publication.

Implementation of the commitments begins on January 1, 2014. The Principles areavailable at http://transparency.efpia.eu/responsible-data-sharing andhttp://onphr.ma/18yru3e.

http://phrma.org/press-release/EFPIA-and-phrma-release-joint-principles-for-responsible-clinical-trial-data-sharing-to-benefit-patients

WHO: Global Alert and Response (GAR) Disease Outbreak Newshttp://www.who.int/csr/don/2013_03_12/en/index.htmlMiddle East respiratory syndrome coronavirus (MERS-CoV) update21 July2013Excerpt

WHO has been informed of two additional laboratory-confirmed cases of MiddleEast respiratory syndrome coronavirus (MERS-CoV) infection in Saudi Arabia.

Both the cases are currently critically ill and hospitalized in ICUs. The first case isa 41-year-old Saudi male in Riyadh who presented to the hospital with symptoms on15 July. The second patient is a 59-year-old Saudi female in the Al-Ahsagovernorate. She presented with symptoms on 11 July.

Both patients have underlying medical conditions, but neither patient has hadcontact with known MERS-CoV confirmed cases or animals.

WHO is seeking more information from the National IHR Focal Point of Saudi

Arabia.Globally, from September 2012 to date, WHO has been informed of a total of 90

laboratory-confirmed cases of infection with MERS-CoV, including 45 deaths

Update: Polio this week -As of 24 July 2013Global Polio Eradication Initiativehttp://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
http://transparency.efpia.eu/responsible-data-sharinghttp://onphr.ma/18yru3ehttp://phrma.org/press-release/EFPIA-and-phrma-release-joint-principles-for-responsible-clinical-trial-data-sharing-to-benefit-patientshttp://phrma.org/press-release/EFPIA-and-phrma-release-joint-principles-for-responsible-clinical-trial-data-sharing-to-benefit-patientshttp://www.who.int/csr/don/2013_03_12/en/index.htmlhttp://www.who.int/entity/csr/don/2013_07_21/en/index.htmlhttp://www.who.int/entity/csr/don/2013_07_21/en/index.htmlhttp://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspxhttp://transparency.efpia.eu/responsible-data-sharinghttp://onphr.ma/18yru3ehttp://phrma.org/press-release/EFPIA-and-phrma-release-joint-principles-for-responsible-clinical-trial-data-sharing-to-benefit-patientshttp://phrma.org/press-release/EFPIA-and-phrma-release-joint-principles-for-responsible-clinical-trial-data-sharing-to-benefit-patientshttp://www.who.int/csr/don/2013_03_12/en/index.htmlhttp://www.who.int/entity/csr/don/2013_07_21/en/index.htmlhttp://www.who.int/entity/csr/don/2013_07_21/en/index.htmlhttp://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx


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[Editors extract and bolded text]:: In Nigeria, the first circulating vaccine-derived poliovirus type 2 (cVDPV2) case of2013 was reported, from Borno state. It is linked to cVDPV2 currently circulating inChad. Previously, no cVDPV2 cases had been reported from Nigeria sinceNovember. See Nigeria section for more.Nigeria

:: One new cVDPV2 case was reported in the past week the first in the country in2013. Previously, no cVDPV2 cases had been reported since November 2012. Thismost recent cVDPV2 case had onset of paralysis on 6 June (from Borno).:: This latest case is linked to cVDPV2 currently circulating in Chad, which have alsobeen detected in Cameroon. In addition to the case in Borno, cVDPV2 linked to thistransmission chain had previously been isolated from an environmental sample inKano in March, indicating circulation in Nigeria.Horn of Africa:: Eight new WPV1 cases were reported in the past week (seven from Somalia andone from Kenya), bringing the total number of WPV1 cases in the region to 81 (72from Somalia and nine from Kenya). The most recent case in the region had onsetof paralysis on 3 July (from Kenya).:: One of the newly-reported cases from Somaliland, in the north, the first in thatarea associated with this outbreak and close to the border with Ethiopia.Additionally, some of the newly-reported cases are from inaccessible areas of south-central Somalia.:: In Somalia, NIDs are currently ongoing (21-25 July), targeting children under theage of five years. Specific radio messages had been developed with theinvolvement of the Ministry of Religious Affairs, as this latest campaign is beingimplemented during Ramadan.:: The next SIAs in Kenya are planned for 27-30 July, targeting host communitiesaround the Dadaab camps.:: Campaigns across the Horn of Africa, including in Ethiopia and Yemen, willcontinue throughout August.

The Weekly Epidemiological Record (WER) for 26 July 2013, vol. 88, 30 (pp.313320) includes::: Validation of maternal and neonatal tetanus elimination in United Republic of

Tanzania, 2012http://www.who.int/entity/wer/2013/wer8830.pdf

WHO - Humanitarian Health Actionhttp://www.who.int/hac/en/index.htmlNo new content.

UN Watchto 27 July 2013Selected meetings, press releases, and press conferences relevant to immunization,vaccines, infectious diseases, global health, etc. http://www.un.org/en/unpress/No new content.

World Bank/IMF Watchto 27 July 2013
http://www.who.int/entity/wer/2013/wer8830.pdfhttp://www.who.int/hac/en/index.htmlhttp://www.un.org/en/unpress/http://www.who.int/entity/wer/2013/wer8830.pdfhttp://www.who.int/hac/en/index.htmlhttp://www.un.org/en/unpress/


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Selected press releases and other selected content relevant to immunization,vaccines, infectious diseases, global health, etc.http://www.worldbank.org/en/news/allNo new content.

Reports/Research/Analysis/ Conferences/Meetings/Book WatchVaccines: 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 asglobal public health, health governance, and associated themes. If you would like tosuggest content to be included in this service, please contact David Curry at:[email protected]

Global policy report on the prevention and control of viral hepatitisWorld Health OrganizationNumber of pages: 220Publication date: July 2013Languages: EnglishISBN: 978 92 4 156463 2

The periodic evaluation of implementation of the WHO strategy requires an initialbaseline survey of all Member States. In mid-2012, WHO, in collaboration with theWorld Hepatitis Alliance, conducted such a survey, asking Member States to provideinformation relating to the four axes of the WHO strategy. In particular, MemberStates were asked whether key prevention and control activities are beingconducted. This report presents the results.

The first chapter provides an introduction to viral hepatitis and to the globalresponse to this group of diseases. The second chapter provides a global overviewof the survey findings. Chapters three through eight present findings from the sixWHO regions, including summaries of data from all responding countries. Additionalsurvey data, study methodology information and the survey instrument can befound in Annexes AE.

Journal WatchVaccines: The Week in Review continues its weekly scanning of key peer-reviewed

journals to identify and cite articles, commentary and editorials, books reviews andother content supporting our focus on vaccine ethics and policy.Journal Watch isnot intended to be exhaustive, but indicative of themes and issues theCenter is actively tracking. We selectively provide full text of some editorial andcomment articles that are specifically relevant to our work. Successful access tosome of the links provided may require subscription or other access arrangementunique to the publisher.

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

American Journal of Infection ControlVol 41 | No. 7 | July 2013 | Pages 575-666http://www.ajicjournal.org/current
http://www.worldbank.org/en/news/allmailto:[email protected]://apps.who.int/iris/bitstream/10665/85397/1/9789241564632_eng.pdfmailto:[email protected]://www.ajicjournal.org/currenthttp://www.worldbank.org/en/news/allmailto:[email protected]://apps.who.int/iris/bitstream/10665/85397/1/9789241564632_eng.pdfmailto:[email protected]://www.ajicjournal.org/current


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[Reviewed earlier]

American Journal of Public HealthVolume 103, Issue 8 (August 2013)http://ajph.aphapublications.org/toc/ajph/current

[Reviewed earlier]

Annals of Internal Medicine16 July 2013, Vol. 159. No. 2http://annals.org/issue.aspx[Reviewed earlier; No relevant content]

BMC Public Health(Accessed 27 July 2013)http://www.biomedcentral.com/bmcpublichealth/contentResearch articlepH1N1 - a comparative analysis of public health responses in Ontario tothe influenza outbreak, public health and primary care: lessons learnedand policy suggestionsPaul Masotti, Michael E Green, Richard Birtwhistle, Ian Gemmill, Kieran Moore,Kathleen OConnor, Adrienne Hansen-Taugher, Ralph Shaw BMC Public Health2013, 13:687 (27 July 20Abstract (provisional)BackgroundOntario's 36 Public Health Units (PHUs) were responsible for implementing the H1N1Pandemic Influenza Plans (PIPs) to address the first pandemic influenza virus in over40 years. It was the first under conditions which permitted mass immunization. Thisis therefore the first opportunity to learn and document what worked well, and didnot work well, in Ontario's response to pH1N1, and to make recommendationsbased on experience.MethodsOur objectives were to: describe the PIP models, obtain perceptions on outcomes,lessons learned and to solicit policy suggestions for improvement. We conducted a3-phase comparative analysis study comprised of semi-structured key informantinterviews with local Medical Officers of Health (n = 29 of 36), and Primary CarePhysicians (n = 20) and in Phase 3 with provincial Chief-Medical Officers of Health (n= 6) and a provincial Medical Organization. Phase 2 data came from a Pan-Ontariosymposium (n = 44) comprised leaders representing: Public Health, Primary Care,Provincial and Federal Government.ResultsPIPs varied resulting in diverse experiences and lessons learned. This was in partdue to different PHU characteristics that included: degree of planning, PHU andPrimary Care capacity, population, geographic and relationships with Primary Care.Main lessons learned were: 1) Planning should be more comprehensive andoperationalized at all levels. 2) Improve national and provincial communicationstrategies and eliminate contradictory messages from different sources. 3) Anintegrated community-wide response may be the best approach to decrease theimpact of a pandemic. 4) The best Mass Immunization models can be quickly
http://ajph.aphapublications.org/toc/ajph/currenthttp://annals.org/issue.aspxhttp://www.biomedcentral.com/bmcpublichealth/contenthttp://www.biomedcentral.com/1471-2458/13/687http://www.biomedcentral.com/1471-2458/13/687http://www.biomedcentral.com/1471-2458/13/687http://ajph.aphapublications.org/toc/ajph/currenthttp://annals.org/issue.aspxhttp://www.biomedcentral.com/bmcpublichealth/contenthttp://www.biomedcentral.com/1471-2458/13/687http://www.biomedcentral.com/1471-2458/13/687http://www.biomedcentral.com/1471-2458/13/687


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implemented and have high immunization rates. They should be flexible and allowfor incremental responses that are based upon: i) pandemic severity, ii) local healthsystem, population and geographic characteristics, iii) immunization objectives, andiv) vaccine supply.Conclusion"We were very lucky that pH1N1 was not more severe." Consensus existed for more

detailed planning and the inclusion of multiple health system and communitystakeholders. PIPs should be flexible, allow for incremental responses and haveimportant decisions (E.g., under which conditions Public Health, Primary Care,Pharmacists or others act as vaccine delivery agents.) made prior to a crisis.The complete article is available as aprovisional PDF. The fully formatted PDF andHTML versions are in production.Research articleA cross sectional survey of attitudes, awareness and uptake of theparental pertussis booster vaccine as part of a cocooning strategy,Victoria, AustraliaEllen J Donnan, James E Fielding, Stacey L Rowe, Lucinda J Franklin, Hassan VallyBMC Public Health 2013, 13:676 (23 July 2013)

Abstract (provisional)Background

The Victorian Government Department of Health funded a diphtheria, tetanus andacellular pertussis vaccine for parents of infants from June 2009 to June 2012 aspart of a cocooning strategy for the control of pertussis. The aim of this study wasto assess parents' attitudes and awareness of the vaccination program, and toestimate vaccine uptake.MethodsA cross-sectional survey of 253 families with a child born in the first quarter of 2010residing within five metropolitan and four rural local government areas in Victoriawas conducted. Univariate analyses were performed to describe the relationshipbetween demographic variables, knowledge and awareness of the disease, thevaccine program and vaccine uptake. Multivariate analyses examining predictors forawareness of the vaccine program and for the uptake of vaccination were alsoconducted.ResultsOne hundred and five families were surveyed (response rate 43%). Of these, 93%indicated that they had heard of 'pertussis' or 'whooping cough' and 75% ofmothers and 69% of fathers were aware the pertussis vaccine was available andfunded for new parents. Overall, 70% of mothers and 53% of fathers werevaccinated following their child's birth, with metropolitan fathers less likely to bevaccinated as rural fathers (RR = 0.6, p = 0.002). Being a younger mother (p =0.02) or father (p = 0.047), and being an Australian-born father (RR = 1.9, p = 0.03)were found to predict uptake of the vaccine in parents.ConclusionParents indicated a reasonable level of knowledge of pertussis and a willingness tobe vaccinated to protect their child. However, vaccine uptake estimates indicatedfurther opportunity for program improvement. Future cocooning strategies wouldbenefit from specifically targeting fathers and metropolitan maternity hospitals toincrease vaccine uptake. Wider promotion of the availability of vaccine providersmay increase uptake to maximise the success of cocooning programs. Further
http://www.biomedcentral.com/content/pdf/1471-2458-13-687.pdfhttp://www.biomedcentral.com/1471-2458/13/676http://www.biomedcentral.com/1471-2458/13/676http://www.biomedcentral.com/1471-2458/13/676http://www.biomedcentral.com/content/pdf/1471-2458-13-687.pdfhttp://www.biomedcentral.com/1471-2458/13/676http://www.biomedcentral.com/1471-2458/13/676http://www.biomedcentral.com/1471-2458/13/676


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investigation of the effectiveness of the cocooning strategy in decreasing infantmorbidity and mortality is required.The complete article is available as aprovisional PDF. The fully formatted PDF andHTML versions are in production.Research articleDeterminants of government HIV/AIDS financing: A 10-year trend analysis

from 125 low- and middle-income countriesCarlos vila, Dejan Loncar, Peter Amico, Paul De Lay BMC Public Health 2013,13:673 (19 July 2013)

Abstract (provisional)Background

Trends and predictors of domestic spending from public sources provide nationalauthorities and international donors with a better understanding of the HIVfinancing architecture, the fulfillment of governments' commitments and potentialfor long-term sustainability.MethodsWe analyzed government financing of HIV using evidence from country reports ondomestic spending. Panel data from 2000 to 2010 included information from 647country-years amongst 125 countries. A random-effects model was used to analyzeten year trends and identify independent predictors of public HIV spending.ResultsLow- and middle-income countries spent US$ 2.1 billion from government sources in2000, growing to US$ 6.6 billion in 2010, a three-fold increase. Per capita spendingin 2010 ranged from 5 cents in low-level HIV epidemics in the Middle East to US$ 32in upper-middle income countries with generalized HIV epidemics in SouthernAfrica. The analysis found that GDP per capita and HIV prevalence are positivelyassociated with increasing levels of HIV-spending from public sources; a 10 percentincrease in HIV prevalence is associated with a 2.5 percent increase in domesticfunding for HIV. Additionally, a 10 percent increase in GDP per capita is associatedwith an 11.49 percent increase in public spending for HIV and these associationswere highly significant at the .001 percent level.ConclusionDomestic resources in low- and middle-income countries showed a threefoldincrease between 2000 and 2010 and currently support 50 percent of the globalresponse with 41 percent coming from sub-Saharan Africa. Domestic spending inLMICs was associated with increased economic growth and an increased burden ofHIV. Sustained increases in funding for HIV from public sources were observed in allregions and emphasize the increasing importance of government financing.The complete article is available as aprovisional PDF. The fully formatted PDF andHTML versions are in production.

British Medical BulletinVolume 106 Issue 1 June 2013http://bmb.oxfordjournals.org/content/current[Reviewed earlier; No relevant content]

British Medical Journal27 July 2013 (Vol 347, Issue 7918)
http://www.biomedcentral.com/content/pdf/1471-2458-13-676.pdfhttp://www.biomedcentral.com/1471-2458/13/673http://www.biomedcentral.com/1471-2458/13/673http://www.biomedcentral.com/content/pdf/1471-2458-13-673.pdfhttp://bmb.oxfordjournals.org/content/currenthttp://www.biomedcentral.com/content/pdf/1471-2458-13-676.pdfhttp://www.biomedcentral.com/1471-2458/13/673http://www.biomedcentral.com/1471-2458/13/673http://www.biomedcentral.com/content/pdf/1471-2458-13-673.pdfhttp://bmb.oxfordjournals.org/content/current


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http://www.bmj.com/content/347/7918EditorialThe next step in controlling HBV in ChinaBMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4503 (Published 16 July 2013)Cite this as: BMJ 2013;347:f4503

Yuanyong Xu, associate professor1, Huihui Liu, research assistant2, Yong Wang,

associate professor1, Rongzhang Hao, research assistant1, Zhenjun Li, associateprofessor3, Hongbin Song, professor1http://www.bmj.com/content/347/bmj.f4503Focus on preventing perinatal transmission of the virus

Infection with hepatitis B virus (HBV) is one of the most important infectiousdiseases in China.1 Although highly effective vaccines against HBV have beenavailable since 1982, about 93 million people in China carry the virus, andtreatment costs about 100bn (10.6bn; 12.3bn; $16bn) a year.2 As well as beingat increased risk of developing cirrhosis and hepatocellular carcinoma,3 carriersoften encounter discrimination at school, at work, in relationships, and withfamilies.4

The Chinese government introduced infant vaccination with HPV vaccine in 1992,followed by a national expanded programme for immunisation in 1999, with specialefforts to provide a timely dose at birth. Since 2002, the government has paid forthe vaccine. Furthermore, from 2009 to 2011, the government provided the vaccinefree of charge to all children under 15 who had not been vaccinated.

These measures have helped control the transmission of HBV in China, and theproportion of carriers in the population has dropped from 9.8% to 7.2% between1992 and 2006. Over the ResearchEffectiveness of pertussis vaccines for adolescents and adults: case-control studyBMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4249 (Published 17 July 2013)Cite this as: BMJ 2013;347:f4249Roger Baxter, codirector, Joan Bartlett, analyst/programmer, Ali Rowhani-Rahbar,vaccine safety fellow, Bruce Fireman, statistician, Nicola P Klein, codirectorhttp://www.bmj.com/content/347/bmj.f4249

AbstractObjective: To assess the effectiveness of reduced acellular pertussis (Tdap)vaccines in adolescents and adults.Setting: Kaiser Permanente Northern California.Design: Case-control study.Participants: All polymerase chain reaction (PCR) confirmed cases of pertussis inmembers aged 11 years and older from January 2006 to December 2011. Wecompared the Tdap vaccination status of PCR positive cases with two controlgroups: people testing negative for pertussis by PCR and closely matched peoplefrom the general Kaiser Permanente Northern California population.Main outcome measure: PCR confirmed pertussis. The association of Tdapvaccination with the odds of pertussis infection was estimated by conditional logisticregression, with adjustment for calendar time, pertussis vaccine type received inearly childhood, age, sex, race or ethnic group, and medical clinic. We calculated

Tdap vaccine effectiveness as 1 minus the adjusted odds ratio.Results: The study population included 668 PCR positive cases, 10 098 PCRnegative controls, and 21 599 Kaiser Permanente Northern California matched
http://www.bmj.com/content/347/7918http://www.bmj.com/content/347/bmj.f4503http://www.bmj.com/content/347/bmj.f4249http://www.bmj.com/content/347/7918http://www.bmj.com/content/347/bmj.f4503http://www.bmj.com/content/347/bmj.f4249


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controls. Tdap vaccination rates were 24.0% in PCR positive cases and 31.9% in PCRnegative controls (P


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Costs per quality-adjusted life-year gained seemed to be related to the number ofcohorts targeted: a single cohort of girls aged 12 years (10,955 [95% CI, 1,021 to28,212]) revealed the lowest cost among the 4 alternative strategies evaluated. Thereal option valuation challenged the cost-effectiveness dominance of a single cohortof 12-year-old girls. The simultaneous vaccination of 2 cohorts of girls aged 12 and15 years yielded a real option value (17,723) equivalent to that attributed to a

single cohort of 12-year-old girls (17,460).Conclusions

The payoff method showed distinctive advantages in the valuation of the cost-effectiveness of competing health care interventions, essentially determined by thereplacement of the nonfuzzy numbers that are commonly used in cost-effectivenessanalysis models, with fuzzy numbers as an input to inform the real option pricingmethod. The real option approach to value uncertainty makes policy making inhealth care an evolutionary process and creates a new space for decision-makingchoices.

Cost Effectiveness and Resource Allocation

(Accessed 27 July 2013)http://www.resource-allocation.com/[No new relevant content]

Current Opinion in Infectious Diseases.August 2013 - Volume 26 - Issue 4 pp: v-vi,295-398http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspx[Reviewed earlier]

Development in Practice

Volume 23, Issue 4, 2013http://www.tandfonline.com/toc/cdip20/current[Reviewed earlier; No relevant content]

Emerging Infectious DiseasesVolume 19, Number 8August 2013http://www.cdc.gov/ncidod/EID/index.htmPerspectiveThe New Global HealthKevin M. De Cock , Patricia M. Simone, Veronica Davison, and Laurence Slutskerhttp://wwwnc.cdc.gov/eid/article/19/8/13-0121_article.htmAbstractGlobal health reflects the realities of globalization, including worldwidedissemination of infectious and noninfectious public health risks. Global healtharchitecture is complex and better coordination is needed between multipleorganizations. Three overlapping themes determine global health action andprioritization: development, security, and public health. These themes play outagainst a background of demographic change, socioeconomic development, andurbanization. Infectious diseases remain critical factors, but are no longer the major
http://www.resource-allocation.com/http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspxhttp://www.tandfonline.com/loi/cdip20?open=23#vol_23http://www.tandfonline.com/toc/cdip20/currenthttp://www.cdc.gov/ncidod/EID/index.htmhttp://wwwnc.cdc.gov/eid/article/19/8/13-0121_article.htmhttp://www.resource-allocation.com/http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspxhttp://www.tandfonline.com/loi/cdip20?open=23#vol_23http://www.tandfonline.com/toc/cdip20/currenthttp://www.cdc.gov/ncidod/EID/index.htmhttp://wwwnc.cdc.gov/eid/article/19/8/13-0121_article.htm


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cause of global illness and death. Traditional indicators of public health, such asmaternal and infant mortality rates no longer describe the health status of wholesocieties; this change highlights the need for investment in vital registration anddisease-specific reporting. Noncommunicable diseases, injuries, and mental healthwill require greater attention from the world in the future. The new global healthrequires broader engagement by health organizations and all countries for the

objectives of health equity, access, and coverage as priorities beyond theMillennium Development Goals are set.PerspectiveNorovirus Disease in the United StateAron J. Hall , Ben A. Lopman, Daniel C. Payne, Manish M. Patel, Paul A. Gastaaduy,

Jan Vinj, and Umesh D. Parasharhttp://wwwnc.cdc.gov/eid/article/19/8/13-0465_article.htm

AbstractAlthough recognized as the leading cause of epidemic acute gastroenteritis acrossall age groups, norovirus has remained poorly characterized with respect to itsendemic disease incidence. Use of different methods, including attributableproportion extrapolation, population-based surveillance, and indirect modeling, inseveral recent studies has considerably improved norovirus disease incidenceestimates for the United States. Norovirus causes an average of 570800 deaths,56,00071,000 hospitalizations, 400,000 emergency department visits, 1.71.9million outpatient visits, and 1921 million total illnesses per year. Persons >65years of age are at greatest risk for norovirus-associated death, and children


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simplified application is presented using seasonal data of morbidity and severityamong Italian children influenza-like illness for the period 200310.

Principal Findings: Established literature results predict an average attack rate ofnot less than 15% for the next pandemic influenza [Meltzer M, Cox N, Fukuda K. Theeconomic impact of pandemic influenza in the United States: implications for settingpriorities for interventions. Emerg Infect Dis 1999;5:65971; Meltzer M, Cox N,

Fukuda K. Modeling the Economic Impact of Pandemic Influenza in the UnitedStates: Implications for Setting Priorities for Intervention. Background paper.Atlanta, GA: CDC, 1999. Available at:http://www.cdc.gov/ncidod/eid/vol5no5/melt_back.htm (7 January 2011, date lastaccessed))]. The strong version of the Precautionary Principle would suggest usingthis prediction for vaccination campaigns. On the contrary, the non-extensivemaximum entropy principle predicts a lower attack rate, which induces a 20%saving in public funding for vaccines doses.

Conclusions: The need for an effective influenza pandemic prevention program,coupled with an efficient use of public funding, calls for a rethinking of thePrecautionary Principle. The non-extensive maximum entropy principle, whichincorporates vague and incomplete information available to decision makers,produces a more coherent forecast of possible influenza pandemic and aconservative spending in public funding.Modelling the riskbenefit impact of H1N1 influenza vaccinesLawrence D. Phillips1,2, Barbara Fasolo1,2, Nikolaos Zafiropoulous1, Hans-GeorgEichler1, Falk Ehmann1, Veronika Jekerle1, Piotr Kramarz3, Angus Nicoll3 and

Thomas Lnngren4http://eurpub.oxfordjournals.org/content/23/4/674.abstract

AbstractBackground: Shortly after the H1N1 influenza virus reached pandemic status in June2009, the benefitrisk project team at the European Medicines Agency recognizedthis presented a research opportunity for testing the usefulness of a decisionanalysis model in deliberations about approving vaccines soon based on limiteddata or waiting for more data. Undertaken purely as a research exercise, the modelwas not connected to the ongoing assessment by the European Medicines Agency,which approved the H1N1 vaccines on 25 September 2009. Methods: A decisiontree model constructed initially on 1 September 2009, and slightly revisedsubsequently as new data were obtained, represented an end-of-September or end-of-October approval of vaccines. The model showed combinations of uncertainevents, the severity of the disease and the vaccines efficacy and safety, leading toestimates of numbers of deaths and serious disabilities. The group based theirprobability assessments on available information and background knowledge aboutvaccines and similar pandemics in the past. Results: Weighting the numbers bytheir joint probabilities for all paths through the decision tree gave a weightedaverage for a September decision of 216 500 deaths and serious disabilities, and fora decision delayed to October of 291 547, showing that an early decision waspreferable. Conclusions: The process of constructing the model facilitatedcommunications among the groups members and led to new insights for severalparticipants, while its robustness built confidence in the decision. These findingssuggest that models might be helpful to regulators, as they form their preferencesduring the process of deliberation and debate, and more generally, for public healthissues when decision makers face considerable uncertainty.
http://www.cdc.gov/ncidod/eid/vol5no5/melt_back.htmhttp://eurpub.oxfordjournals.org/search?author1=Lawrence+D.+Phillips&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-2http://eurpub.oxfordjournals.org/search?author1=Barbara+Fasolo&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-2http://eurpub.oxfordjournals.org/search?author1=Nikolaos+Zafiropoulous&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/search?author1=Hans-Georg+Eichler&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/search?author1=Hans-Georg+Eichler&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/search?author1=Falk+Ehmann&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/search?author1=Veronika+Jekerle&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/search?author1=Piotr+Kramarz&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-3http://eurpub.oxfordjournals.org/search?author1=Angus+Nicoll&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/search?author1=Angus+Nicoll&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-3http://eurpub.oxfordjournals.org/search?author1=Thomas+L%C3%B6nngren&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-4http://eurpub.oxfordjournals.org/content/23/4/674.abstracthttp://www.cdc.gov/ncidod/eid/vol5no5/melt_back.htmhttp://eurpub.oxfordjournals.org/search?author1=Lawrence+D.+Phillips&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-2http://eurpub.oxfordjournals.org/search?author1=Barbara+Fasolo&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-2http://eurpub.oxfordjournals.org/search?author1=Nikolaos+Zafiropoulous&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/search?author1=Hans-Georg+Eichler&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/search?author1=Hans-Georg+Eichler&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/search?author1=Falk+Ehmann&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/search?author1=Veronika+Jekerle&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-1http://eurpub.oxfordjournals.org/search?author1=Piotr+Kramarz&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-3http://eurpub.oxfordjournals.org/search?author1=Angus+Nicoll&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-3http://eurpub.oxfordjournals.org/search?author1=Thomas+L%C3%B6nngren&sortspec=date&submit=Submithttp://eurpub.oxfordjournals.org/content/23/4/674.abstract#aff-4http://eurpub.oxfordjournals.org/content/23/4/674.abstract


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EurosurveillanceVolume 18, Issue 30, 25 July 2013http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678[No relevant content]

Forum for Development StudiesVolume 40, Issue 2, 2013http://www.tandfonline.com/toc/sfds20/current[Reviewed earlier; No relevant content]

Global Health GovernanceVolume VI, Issue 1: Fall 2012 December 31, 2012[Reviewed earlier]

Globalization and Health[Accessed 27 July 2013]http://www.globalizationandhealth.com/[No new relevant content]

Health AffairsJuly 2013; Volume 32, Issue 7http://content.healthaffairs.org/content/currentTheme: States, Medicaid & Countdown To Reform[Reviewed earlier]

Health and Human RightsVolume 15, Issue 1http://www.hhrjournal.org/Theme: Realizing the Right to Health Through a Framework Convention onGlobal Health[Reviewed earlier]

Health Economics, Policy and LawVolume 8 - Issue 03 - July 2013http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissue[Reviewed earlier; No relevant content]

Health Policy and PlanningVolume 28 Issue 4 July 2013http://heapol.oxfordjournals.org/content/current[No relevant content]
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678http://www.tandfonline.com/toc/sfds20/currenthttp://blogs.shu.edu/ghg/2012/12/31/volume-vi-issue-1-fall-2012/http://www.globalizationandhealth.com/http://content.healthaffairs.org/content/currenthttp://www.hhrjournal.org/http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissuehttp://heapol.oxfordjournals.org/content/currenthttp://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678http://www.tandfonline.com/toc/sfds20/currenthttp://blogs.shu.edu/ghg/2012/12/31/volume-vi-issue-1-fall-2012/http://www.globalizationandhealth.com/http://content.healthaffairs.org/content/currenthttp://www.hhrjournal.org/http://journals.cambridge.org/action/displayIssue?jid=HEP&tab=currentissuehttp://heapol.oxfordjournals.org/content/current


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Human Vaccines & Immunotherapeutics (formerly Human Vaccines)Volume 9, Issue 7 July 2013http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/7/Special Focus: VR6 Conference

[Reviewed earlier]

Infectious Agents and Cancerhttp://www.infectagentscancer.com/content[No new relevant content]

Infectious Diseases of Povertyhttp://www.idpjournal.com/content[Accessed 27 July 2013][No new relevant content]

International Journal of EpidemiologyVolume 42 Issue 2 April 2013http://ije.oxfordjournals.org/content/current[Reviewed earlier]

International Journal of Infectious DiseasesVol 17 | No. 8 | August 2013http://www.ijidonline.com/current[Reviewed earlier; No relevant content]

JAMAJuly 24/31, 2013, Vol 310, No. 4http://jama.jamanetwork.com/issue.aspx[No relevant content]

JAMA PediatricsJuly 2013, Vol 167, No. 7http://archpedi.jamanetwork.com/issue.aspx[Reviewed earlier; No relevant content]

Journal of Community HealthVolume 38, Issue 4, August 2013http://link.springer.com/journal/10900/38/4/page/1[Reviewed earlier; No relevant content]
http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/7/http://www.infectagentscancer.com/contenthttp://www.idpjournal.com/contenthttp://ije.oxfordjournals.org/content/currenthttp://www.ijidonline.com/currenthttp://jama.jamanetwork.com/issue.aspxhttp://archpedi.jamanetwork.com/issue.aspxhttp://link.springer.com/journal/10900/38/4/page/1http://www.landesbioscience.com/journals/vaccines/toc/volume/9/issue/7/http://www.infectagentscancer.com/contenthttp://www.idpjournal.com/contenthttp://ije.oxfordjournals.org/content/currenthttp://www.ijidonline.com/currenthttp://jama.jamanetwork.com/issue.aspxhttp://archpedi.jamanetwork.com/issue.aspxhttp://link.springer.com/journal/10900/38/4/page/1


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Journal of Health Organization and ManagementVolume 27 issue 5 - Latest Issuehttp://www.emeraldinsight.com/journals.htm?issn=1477-7266&show=latest[No relevant content]

Journal of Infectious DiseasesVolume 208 Issue 4 August 15, 2013http://jid.oxfordjournals.org/content/currentSafety of Zoster Vaccine in Elderly Adults Following Documented HerpesZosterVicki A. Morrison1, Michael N. Oxman2, Myron J. Levin3, Kenneth E. Schmader4,

John C. Guatelli2, Robert F. Betts5, Larry D. Gelb6, Constance T. Pachucki7, Susan K.Keay8, Barbara Menzies9, Marie R. Griffin10, Carol A. Kauffman11, Adriana R.Marques12,John F. Toney13,Michael S. Simberkoff14, Richard Serrao15, Robert D. Arbeit15,John W. Gnann16,Richard N. Greenberg17, Mark Holodniy18, Wendy A. Keitel19, Shingshing S. Yeh20,Larry E. Davis21, George E. Crawford22, Kathy M. Neuzil9, Gary R. Johnson23,JaneH. Zhang23, Rith Harbecke2,Ivan S. F. Chan24, Paul M. Keller24, Heather M. Williams2, Kathy D. Boardman25,

Jeffrey L. Silber24, Paula W. Annunziato24, for the Shingles Prevention Study Grouphttp://jid.oxfordjournals.org/content/208/4/559.abstract

AbstractBackground. After completion of the Shingles Prevention Study (SPS; Department ofVeterans Affairs Cooperative Studies Program Number 403), SPS participants whohad initially received placebo were offered investigational zoster vaccine withoutcharge. This provided an opportunity to determine the relative safety of zostervaccine in older adults following documented herpes zoster (HZ).Methods. A total of 13 681 SPS placebo recipients who elected to receive zostervaccine were followed for serious adverse events (SAE) for 28 days aftervaccination. In contrast to the SPS, a prior episode of HZ was not a contraindicationto receiving zoster vaccine. The SPS placebo recipients who received zoster vaccineincluded 420 who had developed documented HZ during the SPS.Results. The mean interval between the onset of HZ and the receipt of zostervaccine in the 420 recipients with prior HZ was 3.61 years (median interval, 3.77years [range, 385 months]); the interval was


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Stephanie B. Troy1, Georgina Musingwini2, Meira S. Halpern4, ChunHong Huang4,Lynda Stranix-Chibanda2,3, Diana Kouiavskaia5, Avinash K. Shetty2,6, KonstantinChumakov5,Kusum Nathoo3 andYvonne A. Maldonado2,4http://jid.oxfordjournals.org/content/208/4/672.abstract

Abstract

Background. With prolonged replication, attenuated polioviruses used in oral poliovaccine (OPV) can mutate into vaccine-derived poliovirus (VDPV) and causepoliomyelitis outbreaks. Individuals with primary humoral immunodeficiencies canbecome chronically infected with vaccine poliovirus, allowing it to mutate intoimmunodeficiency-associated VDPV (iVDPV). It is unclear if children perinatallyinfected with the human immunodeficiency virus (HIV), who have humoral as wellas cellular immunodeficiencies, might be sources of iVDPV.Methods. We conducted a prospective study collecting stool and blood samples atmultiple time points from Zimbabwean infants receiving OPV according to thenational schedule. Nucleic acid extracted from stool was analyzed by real-timepolymerase chain reaction for OPV serotypes.Results. We analyzed 825 stool samples: 285 samples from 92 HIV-infected childrenand 540 from 251 HIV-uninfected children. Poliovirus shedding was similar after 02OPV doses but significantly higher in the HIV-infected versus uninfected childrenafter 3 OPV doses, particularly within 42 days of an OPV dose, independent ofseroconversion status. HIV infection was not associated with prolonged or persistentpoliovirus shedding. HIV infection was associated with significantly lower polioseroconversion rates.Conclusions. HIV infection is associated with decreased mucosal and humoralimmune responses to OPV but not the prolonged viral shedding required to formiVDPV.

Journal of Global Infectious Diseases (JGID)

April-June 2013 Volume 5 | Issue 2 Page Nos. 43-90http://www.jgid.org/currentissue.asp?sabs=n[Reviewed earlier; No relevant content]

Journal of Medical EthicsAugust 2013, Volume 39, Issuehttp://jme.bmj.com/content/current[No relevant content]

Journal of Medical Microbiology

August 2013; 62 (Pt 8)http://jmm.sgmjournals.org/content/current[No relevant content]

Journal of the Pediatric Infectious Diseases Society (JPIDS)Volume 2 Issue 2 June 2013http://jpids.oxfordjournals.org/content/current
http://jid.oxfordjournals.org/search?author1=Stephanie+B.+Troy&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-1http://jid.oxfordjournals.org/search?author1=Georgina+Musingwini&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/search?author1=Georgina+Musingwini&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-2http://jid.oxfordjournals.org/search?author1=Meira+S.+Halpern&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-4http://jid.oxfordjournals.org/search?author1=ChunHong+Huang&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-4http://jid.oxfordjournals.org/search?author1=Lynda+Stranix-Chibanda&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-2http://jid.oxfordjournals.org/content/208/4/672.abstract#aff-3http://jid.oxfordjournals.org/search?author1=Diana+Kouiavskaia&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-5http://jid.oxfordjournals.org/search?author1=Avinash+K.+Shetty&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-2http://jid.oxfordjournals.org/content/208/4/672.abstract#aff-6http://jid.oxfordjournals.org/search?author1=Konstantin+Chumakov&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/search?author1=Konstantin+Chumakov&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-5http://jid.oxfordjournals.org/search?author1=Kusum+Nathoo&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-3http://jid.oxfordjournals.org/search?author1=Yvonne+A.+Maldonado&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-2http://jid.oxfordjournals.org/content/208/4/672.abstract#aff-4http://jid.oxfordjournals.org/content/208/4/672.abstracthttp://www.jgid.org/currentissue.asp?sabs=nhttp://jme.bmj.com/content/currenthttp://jmm.sgmjournals.org/content/currenthttp://jpids.oxfordjournals.org/content/currenthttp://jid.oxfordjournals.org/search?author1=Stephanie+B.+Troy&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-1http://jid.oxfordjournals.org/search?author1=Georgina+Musingwini&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-2http://jid.oxfordjournals.org/search?author1=Meira+S.+Halpern&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-4http://jid.oxfordjournals.org/search?author1=ChunHong+Huang&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-4http://jid.oxfordjournals.org/search?author1=Lynda+Stranix-Chibanda&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-2http://jid.oxfordjournals.org/content/208/4/672.abstract#aff-3http://jid.oxfordjournals.org/search?author1=Diana+Kouiavskaia&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-5http://jid.oxfordjournals.org/search?author1=Avinash+K.+Shetty&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-2http://jid.oxfordjournals.org/content/208/4/672.abstract#aff-6http://jid.oxfordjournals.org/search?author1=Konstantin+Chumakov&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/search?author1=Konstantin+Chumakov&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-5http://jid.oxfordjournals.org/search?author1=Kusum+Nathoo&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-3http://jid.oxfordjournals.org/search?author1=Yvonne+A.+Maldonado&sortspec=date&submit=Submithttp://jid.oxfordjournals.org/content/208/4/672.abstract#aff-2http://jid.oxfordjournals.org/content/208/4/672.abstract#aff-4http://jid.oxfordjournals.org/content/208/4/672.abstracthttp://www.jgid.org/currentissue.asp?sabs=nhttp://jme.bmj.com/content/currenthttp://jmm.sgmjournals.org/content/currenthttp://jpids.oxfordjournals.org/content/current


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[Reviewed earlier]

Journal of PediatricsVol 163 | No. 1 | July 2013 | Pages 1-308http://www.jpeds.com/current

[Reviewed earlier; No relevant content]Special Supplement: Haemophilus influenzae type b (Hib)

July 2013 14 articleshttp://www.jpeds.com/supplements#Progress towards Demonstrating the Impact ofHaemophilus influenzaeType b Conjugate Vaccines GloballyRana Hajjeh, MD,Kim Mulholland, MBBS, FRACP, MD,Anne Schuchat, MD,Mathuram Santosham, MD, MPH

AbstractPrior to the introduction of vaccines, Haemophilus influenzae type b (Hib) was themost common cause of bacterial meningitis and an important cause of severepneumonia in children


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http://www.thelancet.com/journals/lancet/issue/current[No relevant content]

The Lancet Global HealthAug 2013 Volume 1 Number 2 e55 - 115

http://www.thelancet.com/journals/langlo/issue/currentEditorialThe good, the bad, and the neglectedZo MullanPreviewThere is a lot to celebrate and applaud in this month's issue of The Lancet GlobalHealth, but also some sobering findings and a clear demonstration of the need formore research. To start with the positive, Osman Sankoh and fellow INDEPTHNetwork colleagues announce a new freely accessible repository of Health andDemographic Surveillance System data generated by its member centres acrossAfrica, Asia, and the Pacific. This triumph of dedication, which currently holds dataon around 800 000 individuals and more than 37 million person-years ofobservation, represents the first harmonised database of longitudinal population-based data from low-income and middle-income countries.Financing tuberculosis control: promising trends and remaining challengesAnna Vassall, Michelle RemmePreview

The financing of essential health services for the world's poor is changing.Development assistance to health (DAH) seems to be flat-lining, and use ofdomestic resources and value for money are increasingly emphasised.1,2 Manydevelopment agencies are re-examining thematic and geographic priorities andimplementing new cofinancing agreements. The Global Fund to Fight AIDS,

Tuberculosis and Malaria, for example, now requires 560% counterpart financing,depending on a country's income.3 Ensuring that scarce development funds flow ata sufficient scale to effective interventions that serve people who need them mostremains a challenge.A database on global health research in AfricaFrancis Collins, Alain Beaudet, Ruxandra Draghia-Akli, Peter Gruss, John Savill,Andr Syrota, Alice Dautry, Mats Ulfendahl, Mark Walport, James Onken, Roger IGlassPreview

Over the past decade, global concern about the disproportionate burden ofdisease and mortality in low-income countries, especially in sub-Saharan Africa, hasled to a substantial influx of funding for research by many donor and researchagencies.1 This investment has energised in-country research; advanced thediscovery and the use of new treatments for HIV/AIDS, tuberculosis, and malaria;and stimulated new research strategies for the prevention and control of these andother diseases. Questions have been raised about whether these internationalefforts could be better coordinated to increase efficiency and improve outcomes,while ensuring that research institutions and universities are supported with thesefunds.Domestic and donor financing for tuberculosis care and control in low-income and middle-income countries: an analysis of trends, 200211, andrequirements to meet 2015 targets
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Dr Katherine Floyd PhD a , Christopher Fitzpatrick MSc a, Andrea Pantoja MSc a,Mario Raviglione MD ahttp://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2813%2970032-9/abstractSummaryBackground

Progress in tuberculosis control worldwide, including achievement of 2015 globaltargets, requires adequate financing sustained for many years. WHO began yearlymonitoring of tuberculosis funding in 2002. We used data reported to WHO toanalyse tuberculosis funding from governments and international donors (in realterms, constant 2011 US$) and associated progress in tuberculosis control in low-income and middle-income countries between 2002 and 2011. We then assessedfunding needed to 2015 and how this funding could be mobilised.MethodsWe included low-income and middle-income countries that reported data aboutfinancing for tuberculosis to WHO and had at least three observations between2002 and 2011. When data were missing for specific countryyear combinations,we imputed the missing data. We aggregated country-specific results for eightcountry groups defined according to income level, political and economic profile,geography, and tuberculosis burden. We compared absolute changes in totalfunding with those in the total number of patients successfully treated and didcross-country comparisons of cost per successfully treated patient relative to grossdomestic product. We estimated funding needs for tuberculosis care and control forall low-income and middle-income countries to 2015, and compared these needswith domestic funding that could be mobilised.Findings

Total funding grew from $1.7 billion in 2002 to $44 billion in 2011. It was mostlyspent on diagnosis and treatment of drug-susceptible tuberculosis. 43 millionpatients were successfully treated, usually for $100500 per person in countrieswith high burdens of tuberculosis. Domestic funding rose from $1.5 billion to $3.9billion per year, mostly in Brazil, Russia, India, China, and South Africa (BRICS),which collectively account for 45% of global cases, where national contributionsaccounted for more than 95% of yearly funding. Donor funding increased from $0.2billion in 2002 to $0.5 billion in 2011, and accounted for a mean of 39% of fundingin the 17 countries with the highest burdens (excluding BRICS) and a mean of 67%in low-income countries by 2011. BRICS and upper middle-income countries couldmobilise almost all of their funding needs to 2015 from domestic sources. A fullresponse to the tuberculosis epidemic to 2015, including investments to tacklemultidrug-resistant tuberculosis, will require international donor funding of $1.62.3 billion each year.InterpretationFunding for tuberculosis control increased substantially between 2002 and 2011,resulting in impressive and cost-effective gains. The increasing self-sufficiency ofmany countries, including BRICS, which account for almost half the world'stuberculosis cases, is a success story for control of tuberculosis. Nonetheless,international donor funding remains crucial in many countries and more is neededto achieve 2015 targets.FundingNone.
http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Katherine+Floydhttp://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstract#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Christopher+Fitzpatrickhttp://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstract#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Andrea+Pantojahttp://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstract#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Mario+Raviglionehttp://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstract#aff1http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstracthttp://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstracthttp://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Katherine+Floydhttp://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstract#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Christopher+Fitzpatrickhttp://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstract#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Andrea+Pantojahttp://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstract#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Mario+Raviglionehttp://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstract#aff1http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstracthttp://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70032-9/abstract


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The Lancet Infectious DiseasesAug 2013 Volume 13 Number 8 p639 - 724http://www.thelancet.com/journals/laninf/issue/currentUniversal access to care for multidrug-resistant tuberculosis: an analysisof surveillance data

Dennis Falzon, Ernesto Jaramillo, Fraser Wares, Matteo Zignol, Katherine Floyd,Mario C RaviglionePreview |Six countries (Belarus, Brazil, Kazakhstan, Peru, South Africa, and Ukraine) canachieve universal access to MDR-tuberculosis care by 2015 should they sustaintheir current pace of progress. In other countries a radical scale-up will be neededfor them to have an effect on their MDR-tuberculosis burden. Unless barriers todiagnosis and successful treatment are urgently overcome, and new technologies indiagnostics and treatment effectively implemented, the global targets for 2015 areunlikely be achieved.

Medical Decision Making (MDM)August 2013; 33 (6)http://mdm.sagepub.com/content/current[Reviewed earlier; No relevant content]

The Milbank QuarterlyA Multidisciplinary Journal of Population Health and Health PolicyJune 2013 Volume 91, Issue 2 Pages 219418http://onlinelibrary.wiley.com/doi/10.1111/milq.2013.91.issue-2/issuetoc[Reviewed earlier; No relevant content]

NatureVolume 499 Number 7459 pp379-514 25 July 2013http://www.nature.com/nature/current_issue.htmlBiological features of novel avian influenza A (H7N9) virus

Jianfang Zhou, Dayan Wang, Rongbao Gao, Baihui Zhao, Jingdong Song+ et al.An initial characterization of the receptor-binding properties of the novel avian

influenza A (H7N9) shows that the virus has acquired the ability to bind humanreceptors while retaining the ability to bind avian receptors; the virus infectsepithelial cells in the human lower respiratory tract and type II pneumocytes in thealveoli, and hypercytokinaemia was seen in infected patients.

Nature ImmunologyAugust 2013, Volume 14 No 8 pp765-877http://www.nature.com/ni/journal/v14/n8/index.html[Reviewed earlier; No relevant content]

Nature Medicine
http://www.thelancet.com/journals/laninf/issue/currenthttp://mdm.sagepub.com/content/currenthttp://onlinelibrary.wiley.com/doi/10.1111/milq.2013.91.issue-2/issuetochttp://www.nature.com/nature/current_issue.htmlhttp://www.nature.com/nature/journal/v499/n7459/full/nature12379.htmlhttp://www.nature.com/ni/journal/v14/n8/index.htmlhttp://removepreview%28%27previewright4%27%29/http://www.thelancet.com/journals/laninf/issue/currenthttp://mdm.sagepub.com/content/currenthttp://onlinelibrary.wiley.com/doi/10.1111/milq.2013.91.issue-2/issuetochttp://www.nature.com/nature/current_issue.htmlhttp://www.nature.com/nature/journal/v499/n7459/full/nature12379.htmlhttp://www.nature.com/ni/journal/v14/n8/index.html


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July 2013, Volume 19 No 7 pp791-945http://www.nature.com/nm/journal/v19/n7/index.html[Reviewed earlier]

Nature Reviews Immunology

July 2013 Vol 13 No 7http://www.nature.com/nri/journal/v13/n7/index.html[Reviewed earlier; No relevant content]

New England Journal of MedicineJuly 25, 2013 Vol. 369 No. 4http://www.nejm.org/toc/nejm/medical-journalMapping the Journey to an HIV VaccineMargaret Ackerman, Ph.D., and Galit Alter, Ph.D.N Engl J Med 2013; 369:389-391DOI: 10.1056/NEJMcibr130443http://www.nejm.org/doi/full/10.1056/NEJMcibr1304437

Universal vaccines that elicit cross-reactive and broadly neutralizing antibodies(bNAbs) are the ultimate goal of efforts to provide protective immunity against boththe influenza virus and the human immunodeficiency virus (HIV). Infection witheither virus leads to the induction of abundant strain-specific antibodies that areeasily evaded by subsequent viral variants. However, the circulating diversity of HIVis greater than that of influenza by orders of magnitude, posing a tremendouschallenge to the achievement of vaccine-mediated protection.

New hope for a universal sterilizing HIV vaccine arose several years ago with theevidence that bNAbs emerge in 10 to 30% of infected persons.1 Because thesebNAb responses typically appear after 2 to 3 years of infection, they fail to controlestablished infection: the kinetics of the evolving B-cell response lag behind therapidly diversifying virus, and they cannot catch up to control establishedinfection. However, these bNAbs have provided protection from infection atremarkably low doses in animals, suggesting that vaccine-induced bNAbs couldprovide sterilizing immunity if they were present before infection. Translating ourcurrent knowledge of bNAbs into a vaccine remains a daunting challenge, since themechanism by which such antibodies are induced remains enigmatic.

As compared with other antibodies, bNAbs have unusual characteristics, includingodd physical structures (e.g., elongated antigen-binding loops) and remarkably highlevels of mutation that affect antibodyantigen binding and structural domains.2

These changes accumulate over years of infection as exposure to diverse viralvariants drives antibody evolution, resulting in the generation of a set of antibodiesthat bears little similarity to their original antigen-naive B-cell ancestors (i.e.,germline sequences).

Liao et al.3 have recently described the path along which bNAbs develop. Theytracked the evolution of a single bNAb and the counter-evolution of an HIV virus(Figure 1Figure 1The Coevolution of Virus and Antibody.), starting in the first weeksof infection. Their findings offer a roadmap for the induction of bNAbs throughvaccination (Figure 2Figure 2Leading Antibodies Down the Path to Neutralization.).

Two key events distinguished the interaction of B-cell and virus during thedeveloping natural history of this bNAb. First, whereas in most scenarios the naive
http://www.nature.com/nm/journal/v19/n7/index.htmlhttp://www.nature.com/nri/journal/v13/n7/index.htmlhttp://www.nejm.org/toc/nejm/medical-journalhttp://www.nejm.org/doi/full/10.1056/NEJMcibr1304437http://www.nejm.org/doi/full/10.1056/NEJMcibr1304437#ref1http://www.nejm.org/doi/full/10.1056/NEJMcibr1304437#ref2http://www.nejm.org/doi/full/10.1056/NEJMcibr1304437#ref3http://www.nejm.org/action/showImage?doi=10.1056%2FNEJMcibr1304437&iid=f01http://www.nejm.org/action/showImage?doi=10.1056%2FNEJMcibr1304437&iid=f02http://www.nature.com/nm/journal/v19/n7/index.htmlhttp://www.nature.com/nri/journal/v13/n7/index.htmlhttp://www.nejm.org/toc/nejm/medical-journalhttp://www.nejm.org/doi/full/10.1056/NEJMcibr1304437http://www.nejm.org/doi/full/10.1056/NEJMcibr1304437#ref1http://www.nejm.org/doi/full/10.1056/NEJMcibr1304437#ref2http://www.nejm.org/doi/full/10.1056/NEJMcibr1304437#ref3http://www.nejm.org/action/showImage?doi=10.1056%2FNEJMcibr1304437&iid=f01http://www.nejm.org/action/showImage?doi=10.1056%2FNEJMcibr1304437&iid=f02


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B-cell population cannot bind to HIV, the naive B-cell repertoire in this infectedperson bound to the earliest incoming virus (the transmitted virus), which suggeststhat early rapid diversification of the B-cell response was initiated very soon afterinfection. Second, the rapid evolution of mutations affecting antibodies, which isrequired for potent antibody neutralization, occurs simultaneously with the rapiddiversification of the virus in the first few months of infection. This occurrence

suggests that the timing of the exposure to diverse viral variants may be crucial tothe induction of protective antibody immunity.

Although the early evolution of the antibody response predominantly occurredwithin the antigen-recognition site, Liao et al. found that later evolutionary changesin the antibody occurred in structural regions, which are thought to have a limitedrole in antigen recognition. However, in a recent publication by Klein et al.,4 theauthors report that mutations affecting these structural regions can potentiateantibody function. The authors found that among a set of diverse bNAbs, mutationsaffecting the structural regions are not just incidental to extensive mutation but areactually critical to neutralization, providing breadth and potency through multiplemechanisms by expanding the antigen-recognition footprint, by subtly alteringbinding-loop positioning, and perhaps by changing the conformational dynamics ofantibodyantigen binding.

Together, these studies highlight key features of the immune system's naturalinduction of bNAbs. First, effective initiation of the antibody response depends onthe early interactions between the virus and the naive B-cell repertoire. Second, anexplosion of viral diversity can drive the molecular evolution of a bNAb. Finally,neutralization potency arises in an unanticipated way by means of mutationsaffecting structural regions of the antibody.

Although we encode a finite number of B-cellreceptor sequences within our naiveantibody repertoire, these sequences can become hugely diversified after initialselection and driven in specific directions by subseq

Vaccines_The Week in Review_27 July 2013

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