Vaccines: The Week in Review

8 February 2010
Center for Vaccine Ethics & Policy
http://www.centerforvaccineethicsandpolicy.org/
A program of
- Center for Bioethics, University of Pennsylvania
http://www.bioethics.upenn.edu/
- The Wistar Institute Vaccine Center
http://www.wistar.org/vaccinecenter/default.html
- Children’s Hospital of Philadelphia, Vaccine Education Center
http://www.chop.edu/consumer/jsp/microsite/microsite.jsp

This weekly summary targets news and events in the global vaccines field gathered
from key governmental, NGO and company announcements, key journals and
events. This summary provides support for ongoing initiatives of the Center for
Vaccine Ethics & Policy, and is not intended to be exhaustive in its coverage.
Vaccines: The Week in Review is now also posted in a blog format at
http://centerforvaccineethicsandpolicy.wordpress.com/. Each item is treated as an individual
post on the blog, allowing for more effective retrospective searching. Given email
system conventions and formats, you may find this alternative more effective. This
blog also allows for RSS feeds, etc.
Comments and suggestions should be directed to David Curry, Editor and
Executive Director of the Center, at
david.r.curry@centerforvaccineethicsandpolicy.org.

The WHO continues to issue weekly “updates” and briefing notes on the
H1N1 pandemic at: http://www.who.int/csr/disease/swineflu/en/index.html
Pandemic (H1N1) 2009 - update 86
Weekly update: 5 February 2010
As of 31 January 2010, worldwide more than 209 countries and overseas
territories or communities have reported laboratory confirmed cases of
pandemic influenza H1N1 2009, including at least 15174 deaths.
WHO is actively monitoring the progress of the pandemic through frequent
consultations with the WHO Regional Offices and member states and through
monitoring of multiple sources of information.
Situation update:
In the temperate zone of the northern hemisphere, overall pandemic
influenza activity continues to decline or remain low in most regions since
peaking during late October and November 2009. Several areas continue to
have evidence of active but declining transmission, particularly in North
Africa and in limited areas of Eastern Europe and East Asia… More at:
http://www.who.int/csr/don/2010_02_5/en/index.html

A new Harvard School of Public Health (HSPH) poll shows that

almost half of Americans believe the H1N1 flu outbreak is over
(44%), and levels of concern about getting sick with the virus
continue to decline. Few (18%) think it is “very likely” there will be
another widespread outbreak of the H1N1 virus in the U.S. during the next 12
months, although a larger share of the population (43%) does say such an
outbreak is “somewhat likely.” After an initial period of vaccine shortage,
70% of adults said there is now enough vaccine in their community for
everyone who wants it. The national poll was conducted January 20-24, 2010.
At this point, the study suggests that more than half of parents (53%)
either got the vaccine for their children (40%) or intend to get it before the
end of February 2010 (13%). The Centers for Disease Control and Prevention
(CDC) had identified children as a priority group for the vaccine. Among
adults, 37% either got the H1N1 vaccine for themselves (21%) or intend to do
so before February ends (16%). If perceptions that the outbreak is over
spread, those who now say they intend to get the vaccine may ultimately
decide not to. The poll also revealed a substantial share of adults who said
they have not gotten the vaccine and do not intend to (61%). More at:
http://www.hsph.harvard.edu/news/press-releases/2010-releases/poll-half-of-
americans-believe-h1n1-outbreak-over.html

The U.S. Food and Drug Administration (FDA) announced a

collaboration with PATH to advance development of a vaccine to
protect children against diseases caused by Streptococcus
pneumoniae (pneumococcus), especially pneumonia. The project is
expected to run for two years and is being conducted under the Cooperative
Research and Development Agreement (CRADA) program. The program
allows federal laboratories and businesses to form partnerships that help
expedite research activities. PATH “will help the FDA obtain materials needed
for the agency to develop the conjugate vaccine technology, and will also will
provide approximately $480,000 to the FDA for the development of both the
conjugation technology and tests to determine if the carrier proteins are
properly linked to the polysaccharides.” The stated goal of the CRADA is “to
evaluate the application of Center for Biologics Evaluation and Research
(CBER) conjugation technology to pneumococcal vaccines. If it holds promise
for fulfilling the goal of providing safe, effective, and affordable
pneumococcal vaccines, the CRADA permits transfer of the technology to the
China National Biotec Group’s Chengdu Institute of Biological Products, and
eventually to groups in other developing countries as appropriate.”
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199479
.htm

The fifth joint WHO-UNICEF-GAVI Global Immunization Meeting was

held in Geneva, 1-3 February 2010, “with the purpose of providing a
technical update to WHO and UNICEF Regional and country staff as well as
immunization partners...to give all involved in immunization a common
understanding of the current status and near future plans in the
immunization world, particularly after in the current context of the rapid
expansion of available vaccines and the financial crisis the world is facing.”
The meeting followed the basic structure in Global Immunization Vision and
Strategies (GIVS):
- how to the improve routine vaccination and support to the accelerated
disease control initiatives;
- introducing new vaccines, including an update on the Hib Initiative and the
status of pneumococcal and rotavirus vaccines;
- experiences in integration of EPI with other programmes (including malaria
interventions); and
- issues of global interdependence including vaccine supply and the
pandemic influenza vaccines.
More at: http://www.who.int/immunization_delivery/gim/en/index.html

The Weekly Epidemiological Record (WER) for 5 February 2009, vol.

85, 6 (pp 37–48) includes: Update on oseltamivir-resistant pandemic A
(H1N1) 2009 influenza virus: January 2010; Human plague: review of regional
morbidity and mortality, 2004–2009;
http://www.who.int/wer/2010/wer8506.pdf

Journal Watch
[Editor’s Note]
Vaccines: The Week in Review continues its weekly scanning of key 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. Our initial
scan list includes the journals below. If you would like to suggest other titles,
please write to David Curry at
david.r.curry@centerforvaccineethicsandpolicy.org

JAMA
Vol. 303 No. 5, pp. 391-470, February 3, 2010
http://jama.ama-assn.org/current.dtl
[No relevant content]

Journal of Infectious Diseases

1 March 2010 Volume 201, Number 5
http://www.journals.uchicago.edu/toc/jid/current
Editorial Commentaries
Pneumococcal Vaccination and Revaccination in the Elderly
Population
Kristin L. Nichol
[No abstract published]
The Lancet
Feb 06, 2010 Volume 375 Number 9713 Pages 433 - 524
http://www.thelancet.com/journals/lancet/issue/current
Comment
Unlicensed pandemic influenza A H1N1 vaccines
Arthur L Caplan
Preview
When WHO's Strategic Advisory Group of Experts (SAGE) on immunisation
met on July 7, 2009, they recognised that pandemic influenza A H1N1
vaccines, when they become available, are almost entirely committed under
contract to a small number of industrialised countries.1 SAGE commended
WHO for trying to improve real-time access in poor countries, but these
efforts will not have substantial effects in the short term.

The Lancet Infectious Disease

Feb 2010 Volume 10 Number 2 Pages 67 - 138
http://www.thelancet.com/journals/laninf/issue/current
[Reviewed last week]

Nature
Volume 463 Number 7281 pp587-700 4 February 2010
http://www.nature.com/nature/journal/v463/n7281/
[No relevant content]

New England Journal of Medicine

Volume 362 — February 4, 2010 — Number 5
http://content.nejm.org/current.shtml
[No relevant content
Pediatrics
February 2010 / VOLUME 125 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml
Estimated Burden of Rotavirus-Associated Diarrhea in Ambulatory
Settings in the United States
Anthony R. Flores, Peter G. Szilagyi, Peggy Auinger, and Susan G. Fisher
Effectiveness of Pentavalent Rotavirus Vaccine in a Large Urban
Population in the United States
Julie A. Boom, Jacqueline E. Tate, Leila C. Sahni, Marcia A. Rench, Jennifer J.
Hull, Jon R. Gentsch, Manish M. Patel, Carol J. Baker, and Umesh D. Parashar
Effectiveness of the Pentavalent Rotavirus Vaccine in Preventing
Gastroenteritis in the United States
Florence T. Wang, T. Christopher Mast, Roberta J. Glass, Jeanne Loughlin, and
John D. Seeger
Sibling Transmission of Vaccine-Derived Rotavirus (RotaTeq)
Associated With Rotavirus Gastroenteritis
Daniel C. Payne, Kathryn M. Edwards, Michael D. Bowen, Erin Keckley, Jody
Peters, Mathew D. Esona, Elizabeth N. Teel, Diane Kent, Umesh D. Parashar,
and Jon R. Gentsch
PLoS Medicine
(Accessed 8 February 2010)
http://medicine.plosjournals.org/perlserv/?request=browse&issn=1549-
1676&method=pubdate&search_fulltext=1&order=online_date&row_start=1
&limit=10&document_count=1533&ct=1&SESSID=aac96924d41874935d8e1
c2a2501181c#results
[No relevant content]

Science
5 February 2010 Vol 327, Issue 5966, Pages 609-746
http://www.sciencemag.org/current.dtl
[No relevant content]

Vaccine
http://www.sciencedirect.com/science?
_ob=PublicationURL&_cdi=5188&_pubType=J&_acct=C000050221&_version
=1&_urlVersion=0&_userid=10&md5=06a70dff873c73731f4a31331c8deee2
&jchunk=28#28
Volume 28, Issue 7, Pages 1661-1892 (17 February 2010)
Letter to the Editor
Polio eradication in India: Have we reached the dead end?
Pages 1661-1662
Yash Paul
Short Communications
Understanding adolescents’ intentions to have the HPV vaccine
Pages 1673-1676
Alice S. Forster, Laura A.V. Marlow, Jane Wardle, Judith Stephenson, Jo Waller
Abstract
From September 2008, older adolescent girls in the UK are eligible to have
the HPV vaccine as part of the HPV vaccination ‘catch-up’ programme. Six
months before they were due to be offered the vaccine 16–18 year old girls
(N = 617) from eight further education/sixth-form colleges reported their
intentions to have the HPV vaccine and reasons for this decision. Most
intended to have the vaccine (around 70%). Some intentions were influenced
by perceptions of risk. Many participants wanted more information and a
small minority were scared of needles. Some ‘non-intenders’ were opposed to
vaccinations altogether. The HPV vaccine is likely to be popular but non-
intenders’ views may be difficult to change.
Regular Papers
Mothers’ preferences and willingness to pay for vaccinating
daughters against human papillomavirus
Pages 1702-1708
Derek S. Brown, F. Reed Johnson, Christine Poulos, Mark L. Messonnier
Abstract
A choice-format, conjoint-analysis survey was developed and fielded to
estimate how features of human papillomavirus (HPV) vaccines affect
mothers’ perceived benefit and stated vaccine uptake for daughters. Data
were collected from a national sample of 307 U.S. mothers of girls aged 13–
17 years who had not yet received an HPV vaccine. Preferences for four
features of HPV vaccines were evaluated: protection against cervical cancer,
protection against genital warts, duration of protection, and cost. We
estimate that mean maximum willingness-to-pay (WTP)—an economic
measure of the total benefits to consumers—for current HPV vaccine
technology ranges between $560 and $660. All vaccine features were
statistically significant determinants of WTP and uptake. Mothers were willing
to pay $238 more for a vaccine that provides 90% protection for genital warts
relative to a vaccine that provides no protection against warts. WTP for
lifetime protection vs. 10 years protection was $245. Mothers strongly valued
greater cervical cancer efficacy, with 100% protection against cervical
cancers the most desired feature overall. Adding a second HPV vaccine
choice to U.S. consumers’ alternatives is predicted to increase stated uptake
by 16%. Several features were significantly associated with stated choices
and uptake: age of mother, race/ethnicity, household income, and concern
about HPV risks. These findings provide new data on how HPV vaccines are
viewed and valued by mothers, and how uptake may change in the context of
evolving vaccine technology and as new data are reported on duration and
efficacy.
A postmodern Pandora's box: Anti-vaccination misinformation on the
Internet
Pages 1709-1716
Anna Kata
Abstract
The Internet plays a large role in disseminating anti-vaccination information.
This paper builds upon previous research by analyzing the arguments
proffered on anti-vaccination websites, determining the extent of
misinformation present, and examining discourses used to support vaccine
objections. Arguments around the themes of safety and effectiveness,
alternative medicine, civil liberties, conspiracy theories, and morality were
found on the majority of websites analyzed; misinformation was also
prevalent. The most commonly proposed method of combating this
misinformation is through better education, although this has proven
ineffective. Education does not consider the discourses supporting vaccine
rejection, such as those involving alternative explanatory models of health,
interpretations of parental responsibility, and distrust of expertise. Anti-
vaccination protestors make postmodern arguments that reject biomedical
and scientific “facts” in favour of their own interpretations. Pro-vaccination
advocates who focus on correcting misinformation reduce the controversy to
merely an “educational” problem; rather, these postmodern discourses must
be acknowledged in order to begin a dialogue.

Volume 28, Issue 6, Pages 1437-1660 (10 February 2010)

Editorial
VACCINE in the 21st century: What's next?
Page 1437
Gregory A. Poland, Mary Lowell Leary
Regular Papers
An analysis of the Human Papilloma Virus vaccine debate on
MySpace blogs
Pages 1535-1540
Jennifer Keelan, Vera Pavri, Ravin Balakrishnan, Kumanan Wilson
Abstract
Background
The roll out of HPV immunization programs across the United States was
hindered by controversy. We tracked the debate in the United States through
MySpace, then the most popular social networking site, in order to better
understand the public's reaction to the vaccine.
Methods
We searched MySpace for all blog discourse related to HPV immunization. We
analyzed each blog according to the overall portrayal of HPV immunization,
identified the characteristics of the bloggers, and developed a content
analysis to categorize the types of supporting arguments made.
Results
303 blogs met our inclusion criteria. 157 (52%) of the blogs were classified as
positive, 129 (43%) as negative, and 17 (6%) were ambivalent toward HPV
immunization. Positive blogs generally argued that HPV infection was
effective and there were no reasonable alternatives to immunizing. Negative
blogs focused on the risks of immunizing and relied heavily on vaccine-critical
publications to support their viewpoint. Of the blogs where gender could be
identified, 75 (25%) were posted by men and 214 (71%) by women. 60% of
blogs posted by men were explicitly critical about HPV immunization versus
36% of women's blogs. Male bloggers also had larger networks of friends.
Conclusions
We describe a novel and promising approach to the surveillance of public
opinions and attitudes toward immunization. In our analysis, men were far
more likely to hold negative views about HPV immunization than women and
disseminate negative messages through larger social networks. Blog analysis
is a useful tool for Public health officials to profile vaccine criticism and to
design appropriate educational information tailored to respond to alternative
media/alternative information actively disseminated via social media tools.
Public health officials should examine mechanisms by which to leverage this
media to better communicate their message through existing networks and
to engage in on-going dialogue with the public.