[The global medical record + (DMG+), tool for prevention in first line care]

The "global medical record +" can be offered to all 45 to 75 year-old patients in the form of a prevention module within the global medical record and which the general practitioner and the patient will regularly update. It will include in particular an assessment of cardiovascular risk, cervical, breast and colon cancer screening, a check of main adult vaccinations, as well as a primary prevention section focused on smoking, alcohol consumption and various hygiene and dietary measures. The inclusion of this module in a computerized medical record will make it more efficient and will lighten the practitioner's workload.

[Economic effectiveness of vaccination against papilloma virus in the Russian Federation]

AIM

Perform pharmacoeconomic analysis of effectiveness of implementation of program of pre-exposition vaccination against HPV-associated diseases in the Russian Federation.

MATERIALS AND METHODS

Pharmacoeconomic analysis consisted of comparison of vaccination costs and assumed benefits of prevented losses from HPV-associated diseases from the society perspective as a whole under the condition of cohort vaccination of girls aged 12 years. A population model executed in MS Excel that allows to perform calculations and obtain results when initial data are changed was adapted for the analysis. The number of prevented HPV-associated diseases was determined by multiplying the number of disease cases observed per year and the effectiveness of the vaccine against each type of the disease. The resulting number of prevented cases was then multiplied by the cost of every HPV-associated condition, and as a result the benefit of vaccine use against human papilloma virus was determined.

RESULTS

The cervical cancer (CC) morbidity parameter in the Russian Federation is 13 807. By method of simple proportional extrapolation based on the European data, a calculation of morbidity in the Russian Federation was performed: atypical squamous cells of undetermined significance (ASCUS)--1 454 015; low grade cervical intraepithelial neoplasia (CIN 1)--660 207; high grade CIN2, CIN3--142 153. Vaccine effectiveness against CIN1, CIN2, CIN3 and CC would presumably be 45.9%, 65.1%, 85.7%, respectively. Vaccine effectiveness against these diseases caused by HPV type 16 and 18 would be 98%, and HPV type 31, 33, 45, 52, 58, 35, 39, 51, 56, 59 cumulatively--47.7%. The cost of HPV-associated diseases (per case) was 8200 RUR (Russian ruble) for ASCUS, 25 200 RUR for CIN1, 60 020 RUR for CIN2 and CIN3, average weighted cost of CC--188 772 RUR. The number of prevented cases of ASCUS, CIN1, CIN2, CIN3 and CC when vaccine was used was 322 791, 303 050, 92 496 and 11 827, respectively. The cost of vaccination of 1 cohort was 3.4 milliards RUR, and the prevented losses in Russian Federation were 19.4 milliards RUR.

CONCLUSION

The results of pharmacoeconomic analysis allow to assume that the cost of implementation of a program of vaccination against CC and other HPV-associated diseases in the Russian Federation are 5.4 times less compared with yearly preventable losses, that has a significant social and economical effect.

The implications of metapopulation dynamics on the design of vaccination campaigns

Control programmes for vaccine preventable diseases typically operate under logistic constraints such as limited resources and in spatially structured populations where the assumption of homogeneous mixing is invalid. It is unclear, therefore, how to maximise the effectiveness of campaigns in such populations. We investigate how to deploy vaccine in metapopulations by comparing the effectiveness of alternative vaccination strategies on reducing disease occurrence (presence/absence), using canine rabies as a model system, and a domestic dog population within a Tanzanian district divided into sub-populations corresponding to villages. We use patch-occupancy models to quantify the contribution of sub-populations to disease occurrence ("risk") and model allocation strategies for a limited number of vaccine doses that prioritize villages based on their size, risk, or the reduction in risk for the entire population that would result from vaccination. We assume that a maximum of 70% of susceptible individuals in a village could be vaccinated, and that only susceptible dogs are vaccinated. The most effective strategy maximised the reduction in risk of the entire population, and was up to 62% more effective than the other strategies. Large, single-pulse campaigns provided the greatest short-term protection, but higher frequencies of smaller pulses were more effective at reducing long-term disease occurrence. Vaccine allocation on a per-dose basis was substantially more effective than a per-village strategy, indicating that operational constraints can reduce control effectiveness. The spatial distribution and abundance of hosts have an important influence on disease dynamics and these results demonstrate that metapopulation models can be used to substantially improve the effectiveness of vaccination campaigns and optimize the allocation of limited control resources.

[The evolution of Polish immunization schedule during the last 10 years]

The Polish Immunization Program has improved for the last ten years. The most of available new vaccines were in short order included in voluntary vaccination schedule during this time. Nevertheless, the improvement of mandatory vaccination schedule was not sufficient, therefore the Polish Immunization Program diverged significantly from the most of European programs.

Making new vaccines affordable: a comparison of financing processes used to develop and deploy new meningococcal and pneumococcal conjugate vaccines

Mechanisms to increase access to health products are varied and controversial. Two innovative mechanisms have been used to accelerate the development of low-price supply lines for conjugate vaccines. The Meningitis Vaccine Project is a so-called push mechanism that facilitated technology transfer to an Indian company to establish capacity to manufacture a vaccine. The Advanced Market Commitment for pneumococcal vaccines is a so-called pull mechanism that guarantees companies a supplement paid in addition to the purchase price for vaccines for a specific period. We compare these approaches, identifying key dimensions of each and considering their potential for replication. We also discuss issues that the Global Alliance for Vaccines and Immunisation (GAVI) face now that these new vaccines are available. Progress towards GAVI's strategic aims is needed and funding is crucial. Approaches that decrease the financial pressure on GAVI and greatly increase political and financial engagement by low-income countries should also be considered.

Enhancing community partnerships during a public health emergency: the school-located vaccination clinics model in Kanawha County, WV during the 2009 influenza A (H1N1) pandemic

Broad based community support is vital in developing a comprehensive national strategy to protect the public's health prior to, during and after a disaster such as pandemic influenza. When disaster strikes, the successful response is often dependent upon the degree of collaboration, coordination, and shared decision making occurring among a wide-ranging group of public and private stakeholders in the community. Since these preparedness and response activities must occur at a local level, the degree to which a certain community can become resilient after an event is directly dependent upon the success of the response activities. In order to protect its citizens, the Kanawha-Charleston Health Department (KCHD) led a comprehensive community based response to the 2009 Influenza A (H1N1) pandemic. By organizing a high level strategic team consisting of major community stakeholders, KCHD was able to develop broad based community support for its mitigation and countermeasure delivery strategies. The timely enhancement of the existing community partnerships enabled us to successfully conduct several response activities with local community support including school-located vaccination (SLV) clinics. We describe the process, results and challenges faced during our SLV clinics campaign which resulted in exceptionally high vaccination rates for school aged children compared to other jurisdictions across the nation. We also discuss how such partnerships can be sustained resulting in resilient communities and mention some strategies for those contemplating such partnerships in future public health emergency.

Influenza vaccination and its impact on hospitalization events in nursing homes

OBJECTIVES

To examine trends of influenza vaccination in nursing homes before and after public reporting (objective-1), and to assess the effect of influenza vaccinations on hospitalization events (objective-2).

RESEARCH DESIGN

Nursing Home Compare (NHC) database was used to obtain influenza vaccination rates during the 2005-2006, 2006-2007, and 2007-2008 flu seasons (objective-1). The 2005-2007 Minimum Data Set for New York State (NYS) was obtained and linked with the NHC data (objective-2).

SETTINGS AND PARTICIPANTS

All nursing homes in the United States were included in the analysis of objective-1. All eligible NYS nursing homes and their residents, during 2005-2006 and 2006-2007 flu seasons, were included in the analysis of objective-2.

MEASUREMENTS

Nursing home was the unit of analysis. Influenza vaccination rates in nursing homes over the 3 flu seasons were compared nationwide. A first-differenced model was fit to examine the relationship between facility vaccination rates and hospitalization rates in NYS.

RESULTS

There was an increase in influenza vaccination rates in nursing homes over the 3 flu seasons, but this increase was no greater than that among community-dwelling elderly. In NYS facilities with high baseline vaccination rates, the effect of vaccination on reducing hospitalizations was small. In NYS facilities with a low baseline rate, a 10.0% increase in vaccination rate for long-term care residents was correlated with a 6.2% decline in baseline hospitalization rates. However, a 10.0% increase in vaccination rate for short-term care residents was correlated with a 4.6% increase in baseline hospitalization rates.

CONCLUSIONS

There is no clear evidence that public reporting improves vaccination rates in nursing homes. The effects of vaccination on hospitalization events in nursing homes are mixed.

Lessons from smallpox eradication campaign in Bihar State and in India

Following several key breakthroughs during the mid-1960s under the global smallpox eradication programme namely, development of a thermo-stable vaccine, efficient and acceptable technique of it's delivery by bifurcated needle and evolution of a strategy (in lieu of mass vaccination) of active case search and containment, an intensified campaign of smallpox eradication from India was successfully implemented during 1973-1975. A formidable battle was fought, particularly in Bihar state leading to the occurrence of last indigenous case on 17 May 1975. The rapid achievement of eradication of the scourge from India in a record time was hailed as unprecedented in public health history. The single key factor in the achievement was the sustained efforts of a band of national and international epidemiologists, supported by young medical interns heading mobile containment teams, working under trying field conditions. Through the campaign several important lessons were learnt and innovations made. Important among these were: (i) need for refinement of tools, techniques, and strategies for attaining the objective; (ii) implementation of a time and target oriented campaign; (iii) support of adequate and dedicated short term personnel to supplement supervision and field activities; (iv) providing of flexible funding and a convenient disbursement procedure; (v) building private-public partnership; (vi) devising of simple innovations, based on feedback from field, to support activities; (vii) development of political commitment; (viii) improved communication from field to higher levels to enable action on recent information; (ix) regular periodic staff meetings at each administrative level to facilitate early recognition and correction of deficiencies; (x) mobilization of support from international community, whenever required.

[Immunization of adolescents and adults as the strategy of improvement of epidemiology of pertussis]

Increase of pertussis incidence has been recognised mainly among adolescents and adults since 90. As adolescents and adults sustain the reservoir of infection for non immunized and not completely immunized newborns and neonates, increased rates of pertussis are dangerous. The improvement of pertussis epidemiology might have been obtained through routine immunization of adolescents and adults able to interrupt of B. pertussis circulation in the population. The improvement of surveillance and diagnostics might have result in better detection of the disease in children at the age up to first year and in older age groups.

[Contribution of D I Ivanovsky Research Institute of Virology to monitoring influenza viruses during epidemics and 2009 pandemic in Russia]

The data on monitoring influenza viruses in Russia are presented based on the research underway at Ivanovsky Research Institute of Virology since 1959. The Institute's priority in isolation and identification of influenza viruses during epidemics and 2009 pandemic is confirmed. Results of assessment of influenza vaccines and etiotropic preparations, development and introduction of new methods for diagnostics of influenza are discussed.

[H1N1 pandemic. Measures and experiences on the state level]

In order to establish a joint pandemic strategy, the German states ("Länder") together with the German federal government ("Bund") agreed on joint preparations for pandemic scenarios. This included the description of procedures, such as infection control measures, stockpiling of antiviral drugs, and contracts with vaccine manufacturers to ensure supply of vaccines in the event of a pandemic. The situation during the influenza H1N1 pandemic differed from that planned so that many short-term adjustments were required. It highlighted the need to make pandemic planning more flexible. In spite of several obstacles which had to be overcome during the situation, the states managed to achieve a relatively coordinated procedure and provided the availability of vaccines. In the course of the pandemic, gaps and shortcoming in existing surveillance systems were identified, which should lead to further improvements. A key point for future pandemic events is successful communication between all interested parties, especially with the medical profession, to increase the acceptance of public policies.

Pandemic risk prevention in European countries: role of the ECDC in preparing for pandemics. Development and experience with a national self-assessment procedure, 2005-2008

To be effective risk prevention work takes place well before pandemics through the three Ps: Planning, Preparedness and Practise. Between 2005 and 2008 the European Centre for Disease Prevention and Control (ECDC) worked with the European Commission (EC) and the WHO Regional Office for Europe (WHO-Euro) to assist European countries in preparing themselves for a future influenza pandemic. All eligible countries in the European Union and European Economic Area participated with energy and commitment. Indicators of preparedness were developed based on WHO planning guidance and these were set within a simple assessment which included a formal country visit. The procedure evolved considerably with field experience. As the complexity of pandemic preparedness was appreciated it changed from being a classical short external assessment to longer national self-assessments with demonstrable impact, especially when self-assessments were published. There were essential supporting activities undertaken including a series of pan-European pandemic preparedness workshops organised by EC, WHO-Euro, ECDC and countries holding the European Union Presidency. The self-assessments highlighted additional work and documentation that was needed by national authorities from the ECDC. This work was undertaken and the document produced. The benefits of the self-assessments were seen in the 2009 pandemic in that EU/EEA countries performed better than some others. A number of the guidance documents were updated to fit the specific features of the pandemic. However the pandemic revealed many weaknesses and brought new challenges for European countries, notably over communication and vaccines, the need to prepare for a variety of scenarios and to factor severity estimates into preparedness, to improve surveillance for severe disease and to deliver seroepidemiology. Any revised self-assessment procedure will need to respond to these challenges.

Improving influenza vaccine distribution in preparation for an H1N1 influenza pandemic: lessons from the field

Vaccine distribution is an essential component of any healthcare organization's pandemic influenza plan. Variables surrounding distribution in these circumstances are often difficult to anticipate and require careful consideration. The 2009 H1N1 influenza pandemic provided organizations with an opportunity to test current models and overall organizational readiness for the next influenza pandemic. This article describes the experiences at a large, midwestern, multispecialty medical system in responding to the unique circumstances surrounding distribution of the 2009 H1N1 influenza vaccine. We discuss challenges, variables to consider when choosing a vaccine distribution model, institutional response, and lessons learned.

[Epidemiological surveillance over the organization and performance of immunoprophylaxis in the Russian Federation]

Vaccine prophylaxis is the most accessible and economic way of protecting and promoting the population's health, which is the most important part of prophylactic direction of modern medicine. The accumulated experience of mass immunization suggests the ability of a vaccine to cause 80, 96, and 92% reductions in the number of disease cases, the rate of admissions, and mortality rates, respectively.

Role of the nurse immuniser in implementing and maintaining the National Human Papillomavirus 'Cervical Cancer' Vaccine rollout through a school-based program in Victoria

In an effort to understand the strengths and limitations of current approaches to human papillomavirus vaccine (HPV) delivery in schools, we conducted an audit of nurse immunisers (NI). In this survey of 159 Victorian NI, the NI perceived that knowledge, safety and side effects were among the most important issues raised by parents, schoolgirls, and teachers in the school setting. The most common concern identified by NIs was the physical layout of the vaccination setting (41%), followed by safety, then knowledge of the vaccine. There is a need for ongoing assessment of factors that improve or impede the delivery of HPV vaccines.