Vaccines and Global Health: The Week in Review :: 20 October 2018

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy

Global health organizations commit to new ways of working together for greater impact

Milestones :: Perspectives

Global health organizations commit to new ways of working together for greater impact

Joint Press release
BERLIN, 16 October 2018  – Eleven heads of the world’s leading health and development organizations today signed a landmark commitment to find new ways of working together to accelerate progress towards achieving the United Nations’ Sustainable Development Goals.

Coordinated by the World Health Organization, the initiative unites the work of 11 organizations, with others set to join in the next phase.

The commitment follows a request from Chancellor Angela Merkel of Germany, President Nana Addo Dankwa Akufo-Addo of Ghana, and Prime Minister Erna Solberg of Norway, with support from United Nations Secretary-General Antonio Guterres, to develop a global action plan to define how global actors can better collaborate to accelerate progress towards the health-related targets of the 2030 Sustainable Development Agenda.

“Healthy people are essential for sustainable development – to ending poverty, promoting peaceful and inclusive societies and protecting the environment. However, despite great strides made against many of the leading causes of death and disease, we must redouble our efforts or we will not reach several of the health-related targets,” the organizations announced today at the World Health Summit in Berlin. “The Global Action Plan represents an historic commitment to new ways of working together to accelerate progress towards meeting the 2030 goals. We are committed to redefine how our organizations work together to deliver more effective and efficient support to countries and to achieve better health and well-being for all people.”

The group has agreed to develop new ways of working together to maximize resources and measure progress in a more transparent and engaging way. The first phase of the plan’s development is organized under three strategic approaches: align, accelerate and account:

Align: The organizations have committed to coordinate programmatic, financing and operational processes to increase collective efficiency and impact on a number of shared priorities such as gender equality and reproductive, maternal, newborn, child and adolescent health.

Accelerate: They have agreed to develop common approaches and coordinate action in areas of work that have the potential to increase the pace of progress in global health. The initial set of seven “accelerators” include community and civil society engagement, research and development, data and sustainable financing.

Account: To improve transparency and accountability to countries and development partners, the health organizations are breaking new ground by setting common milestones for nearly 50 health-related targets across 14 Sustainable Development Goals. These milestones will provide a critical checkpoint and common reference to determine where the world stands in 2023 and whether it is on track to reach the 2030 goals.

The Global Action Plan will also enhance collective action and leverage funds to address gender inequalities that act as barriers to accessing health, and to improve comprehensive quality health care for women and girls, including sexual and reproductive health services.

The organizations that have already signed up to the Global Action Plan for Healthy Lives and Well-being for All are:

:: Gavi the Vaccine Alliance
:: Global Fund to Fight AIDS, Tuberculosis and Malaria,
:: Global Financing Facility
:: Unitaid
:: UN Women
:: World Bank
:: WHO

[The World Food Programme has committed to join the plan in the coming months]

The final plan will be delivered in September 2019 at the United Nations General Assembly. For more information,


Vaccine maker Changsheng fined 9.1 billion yuan in safety scandal

Milestones :: Perspectives

Editor’s Note:
This China Daily story was posted on the National Health Commission of the People’s Republic of China site. No “official” announcement on the actions was posted.

Vaccine maker Changsheng fined 9.1 billion yuan in safety scandal

(China Daily)  Updated: 2018-10-17
Changchun Changsheng Biotech Co in Jilin province was forced to pay about 9.1 billion yuan ($1.3 billion) in penalties on Tuesday after the drugmaker was involved in a human rabies vaccine safety scandal in July, the State Drug Administration said in a statement on Tuesday.

A compensation plan for victims was also unveiled. Families of those who died due to the problematic vaccine will receive a oneoff compensation of 650,000 yuan for each victim, and victims who became severely disabled or paralyzed will get 500,000 yuan. The compensation will be 200,000 yuan for those mildly disabled, according to the plan.

The company, based in Changchun, Jilin, is a major vaccine producer and has been entangled in controversy since July 15, when the State Drug Administration announced it found the company to be engaged in falsifying production and inspection records in the making of rabies vaccines.

Changsheng’s illegal activities included using expired vaccine raw materials, altering production dates, forging permits and destroying evidence during inspections, the statement said.

The State Drug Administration annulled the rabies vaccine approval document and certificates for related products from the company and imposed a fine of 12.03 million yuan.

The Jilin Food and Drug Administration revoked the company’s pharmaceutical production license, confiscated illegally produced vaccines and total income of 1.89 billion yuan from defective vaccine sales, and imposed a fine of 7.21 billion yuan, which was three times the value of the drugs it illegally produced and sold.

The total amount fined or confiscated stood at 9.1 billion yuan.

Fourteen company executives including Gao Junfang, board chairwoman, and others who bear direct responsibility were banned from engaging in drug production or marketing activities for life, according to the State Drug Administration.

Those suspected of crimes related to the case will be held criminally responsible by judicial organs, it said…


Statement on the October 2018 meeting of the IHR Emergency Committee on the Ebola virus disease outbreak in the Democratic Republic of the Congo


Milestones :: Perspectives

Ebola – Democratic Republic of the Congo

Statement on the October 2018 meeting of the IHR Emergency Committee on the Ebola virus disease outbreak in the Democratic Republic of the Congo

17 October 2018
The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo took place on Wednesday, 17 October 2018, from 13:00 to 17:00 Geneva time (CET).

It was the view of the Committee that a Public Health Emergency of International Concern (PHEIC) should not be declared at this time. But the Committee remains deeply concerned by the outbreak and emphasized that response activities need to be intensified and ongoing vigilance is critical. The Committee also noted the very complex security situation. Additionally, the Committee has provided public health advice below….

Proceedings of the Meeting
Members and advisors of the Emergency Committee met by teleconference. Presentations were made by representatives of the Ministry of Health of the Democratic Republic of the Congo on the epidemiological situation, the response strategies, and recent adaptations, including implementation of rapid response teams at community level, with a focus on Beni. A representative of the Office of the Deputy Special Representative of the Secretary-General (MONUSCO) reported on the work of MONUSCO, including its logistics and security activities to support the response. During the informational session, the WHO Secretariat provided an update on the situation and the response to the current Ebola outbreak and preparedness activities in neighbouring countries.

The Committee’s role was to provide to the Director-General its views and perspectives on:

:: Whether the event constitutes a Public Health Emergency of International Concern (PHEIC)

:: If the event constitutes a PHEIC, what Temporary Recommendations should be made.

Current situation

On 1 August, WHO was notified by the Ministry of Health of the Democratic Republic of the Congo of Ebola Virus Disease in North Kivu province. Cases were also subsequently found in Ituri Province. From 4 May to 15 October 2018, 216 EVD cases were reported, of which 181 are confirmed and 35 are probable; 139 total deaths have occurred, of which 104 are confirmed and 35 are probable. The global case fatality rate stands at 64% overall, and at 57% among confirmed cases.

Nine neighbouring countries have been advised that they are at high risk of spread and have been supported with equipment and personnel. Particular emphasis has been placed on Uganda, Rwanda, Burundi, and South Sudan in terms of preparedness activities.

Key challenges
After discussion and deliberation on the information provided, the Committee concluded that this Ebola outbreak is taking place in a particularly complex context and poses several important challenges:

:: This outbreak is taking place in an active conflict zone amidst prolonged humanitarian crises. Approximately 8 major security incidents have occurred in the Beni area in the past 8 weeks. These factors have complicated contact tracing and other aspects of the response.

:: Community mistrust, stemming from a variety of reasons, including the security situation, and people who avoid follow-up or delay seeking care, remain significant problems that require deepening engagement by community, national and international partners.

:: New cases being identified without epidemiological links are of great concern and require further detailed epidemiological mapping.

:: The assessment of the risk of spread is low at global level but it is very high at both national and regional levels. There has been no change to the risk assessment since 28 September.

:: Ring vaccination efforts have achieved high coverage rates among eligible populations but rely heavily on highly performing contact tracing in DRC and all countries that may be affected.

The Committee also noted positive developments:

:: The Committee commended the government of the DRC, WHO, and all response partners for the progress made under difficult circumstances.

:: All pillars of the response are working at scale and are being adjusted in real time.

:: Surveillance activities are commendable but need to be intensified.

:: MONUSCO is providing needed support for logistics and security for the response.

:: Investigational vaccines and therapeutics are being used for the first time at scale. 

:: Screening at border crossings is being undertaken on a very large scale.

:: Preparedness activities in neighbouring countries are ongoing, although these will require substantial additional financial support.

In conclusion, the Emergency Committee, while advising that a PHEIC should not be declared at this time, offered the following Public Health Advice:

:: The government of the Democratic Republic of the Congo, WHO, and partners must intensify the current response. Without this, the situation is likely to deteriorate significantly. This response should be supported by the entire international community.

:: A critical determining factor is the safety and security of the population, which, in turn, affects the community’s perception of the response. The safety and security of responders should be ensured, and the protection of health workers and health facilities be prioritized.

:: Therefore, we commend the outreach to the United Nations Security Council and hope it will remain engaged in this matter.

:: Special emphasis should be placed on the response in Beni and Butembo, including continuing attention to community engagement.

: Efforts to link epidemiological data with real-time full-genome sequencing should be supported. This will clarify chains of transmission.

:: Encourage consideration of population-based Ebola control strategies, for example, the SAGE recommendations on geographic vaccination strategies.

:: Licensure of vaccines should be urgently sought and efforts made to increase the limited global supply.

:: Because there is a very high risk of regional spread, neighbouring countries should accelerate preparedness and surveillance, and request partners to increase their support. For example, they should consider vaccination of health care workers and front-line workers in high-risk districts neighbouring DRC.

:: It is particularly important that no international travel or trade restrictions should be applied.

:: Exit screening, including at airports, ports, and land crossings, is of great importance; however, entry screening, particularly in distant airports, is not considered to be of any public health or cost-benefit value.

:: The DG should continue to monitor the situation closely and reconvene the Emergency Committee as needed.

The Committee emphasized the importance of continued support by WHO and other national and international partners towards the effective implementation and monitoring of this advice.

Based on this advice, the reports made by the affected State Party, and the currently available information, the Director-General accepted the Committee’s assessment and on 17 October did not declare the Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern. In light of the advice of the Emergency Committee, WHO advises against the application of any travel or trade restrictions. The Director-General thanked the Committee Members and Advisors for their advice.


Public Health Emergency of International Concern (PHEIC)
Polio this week as of 16 October 2018 [GPEI]
:: World Polio Day is coming up on 24 October: join partners around the world in making this year’s World Polio Day a success.
Summary of new viruses this week:
Afghanistan – one wild poliovirus type 1 (WPV1) case and five WPV1-positive environmental samples
Pakistan – two WPV1-positive environmental samples
Niger – three circulating vaccine-derived poliovirus type 2 (cVDPV2) cases
Papua New Guinea – three cVDPV type 1 cases
Somalia – one cVDPV type 3 case
Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.
WHO Grade 3 Emergencies  [to 20 Oct 2018 ]
Democratic Republic of the Congo
:: 11: Situation report on the Ebola outbreak in North Kivu  17 October 2018
:: Disease Outbreak News (DONs)  Ebola virus disease – Democratic Republic of the Congo
18 October 2018
[See Milestones above for more detail]
Bangladesh – Rohingya crisis
:: Weekly Situation Report 46 – 11 October 2018 pdf, 398kb
::  Acute respiratory infection and acute watery diarrhoea are showing increasing trends.
::  Suspected malaria cases continue to be reported in relatively high number. It is possible that these cases represent variety of syndromes with different etiologies.
::  A refresher training was conducted to improve the capacity of health workers for preparedness and response to diarrhoeal disease outbreaks in Cox’s Bazar.

::  There are an estimated 921,000 Rohingya refugees (215,796 families) in Cox’s Bazar, according to the latest Needs and Population Monitoring (NPM) round 12 exercise. The Rohingya refugees continue to arrive in Bangladesh, though the overall influx has slowed since the onset of the crisis in late August 2017. From 1 January-15 September 2018, UNHCR has recorded 13,764 new arrivals to Bangladesh.
::  The dense population, continuous contamination of the environment in the camps and the rainy season, indicate that continuous vigilance for disease outbreaks is needed. WHO through EWARS is continuously monitoring diseases and coordinating health response. More than 8,200 cases of Diphtheria have been reported since November 2017 and the risk of water-borne and vector-borne diseases remain. Other acute watery diarrhoea (AWD) and related clinical conditions, more specifically cholera and shigella, may potentially cause outbreaks. Due to endemicity of rotavirus in the camp areas and long-term knowledge on rotavirus in the community, an annual increase in rotavirus case notifications is also anticipated.

Syrian Arab Republic
:: WHO helps restore primary health care services in Aleppo  11 October 2018

:: Internally displaced persons from Hudaydah endure harsh circumstances in Sana’a
8 October 2018
Nigeria – No new announcements identified
Somalia – No new announcements identified
South Sudan – No new announcements identified

WHO Grade 2 Emergencies  [to 20 Oct 2018 ]
Brazil (in Portugese) – No new announcements identified
Cameroon  – No new announcements identified
Central African Republic  – No new announcements identified
Ethiopia – No new announcements identified
Hurricane Irma and Maria in the Caribbean – No new announcements identified
Iraq – No new announcements identified
occupied Palestinian territory – No new announcements identified
Libya – No new announcements identified
MERS-CoV – No new announcements identified
Myanmar – No new announcements identified
Niger – No new announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new announcements identified
Sudan – No new announcements identified
Ukraine – No new announcements identified
Zimbabwe – No new announcements identified

Outbreaks and Emergencies Bulletin, Week 41: 12 October 2018
The WHO Health Emergencies Programme is currently monitoring 58 events in the AFRO region. This week’s edition covers key ongoing events, including:
:: Ebola virus disease outbreak in the Democratic Republic of the Congo
:: Cholera outbreak in Zimbabwe
:: Cholera outbreak in Niger
:: Humanitarian crisis in the Democratic Republic of the Congo
:: Humanitarian crisis in South Sudan

WHO Grade 1 Emergencies  [to 20 Oct 2018 ]
Angola (in Portuguese)
Lao People’s Democratic Republic
Papua New Guinea
Tropical Cyclone Gira
UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
:: Yemen: Al Hudaydah Update Situation Report No. 13, Reporting period: 3 – 15 October 2018
Published on 17 Oct 2018

Syrian Arab Republic   No new announcements identified.


UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
:: Ethiopia Humanitarian Bulletin Issue 65 | 01-14 October 2018

Somalia  No new announcements identified.

Editor’s Note:

We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
EBOLA/EVD  [to 20 Oct 2018 ]
[See Milestones above for more detail]
MERS-CoV [to 20 Oct 2018 ]
No new announcements identified.
Yellow Fever  [to 20 Oct 2018 ]
:: 2nd EYE Annual Partners Meeting: Strengthening partnership and country commitment to eliminate yellow fever epidemics
18 October 2018
The second EYE Annual Partners Meeting was held on 11-13 September in Dakar, Senegal. The event was hosted by UNICEF WCARO and jointly organized by WHO, Gavi, and UNICEF. Partners, country representatives, vaccine manufacturers, donors, and experts came together to discuss the Eliminate Yellow Fever Epidemics (EYE) Strategy achievements to date, and what the main challenges are anticipated looking forward. Mechanisms to accelerate the EYE strategy in the implementation of immunization activities with reliable vaccine supply were the main focus of the meeting.
Zika virus  [to 20 Oct 2018 ]
No new announcements identified.

WHO & Regional Offices [to 20 Oct 2018 ]

WHO & Regional Offices [to 20 Oct 2018 ]

WHO SAGE Meeting
23-25 October 2018.

:: Draft agenda for SAGE October 2018 meeting pdf, 147kb [as of 10 October 2018]
:: Declaration of interests for SAGE October 2018 meeting pdf, 301kb

Weekly Epidemiological Record, 19 October 2018, vol. 93, 42 (pp. 553–576)
:: Recommended composition of influenza virus vaccines for use in the 2019 southern hemisphere influenza season
:: Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness

WHO Regional Offices
Selected Press Releases, Announcements
WHO African Region AFRO
Selected Featured News
:: The Ministry of Health of South Sudan successfully conducts its first ever diagnostic test for Ebola  19 October 2018
:: Ghana launches a nationwide campaign to fight Measles-Rubella  17 October 2018
:: Liberia Commemorates World Rabies Day  15 October 2018
:: WHO is using strategic approaches to provide lifesaving health and nutrition services in hard to reach areas of South Sudan  14 October 2018

WHO Region of the Americas PAHO
:: Caribbean Ministers of Health meet to approve plan on health system resilience in the face of climate change (10/16/2018)

WHO South-East Asia Region SEARO
– No new announcement identified


WHO European Region EURO
:: Romania – investing in primary health care and bringing care to where it’s most needed 18-10-2018
:: WHO Summer School on Refugee and Migrant Health: sharing experiences and best practices 15-10-2018
:: Policies to limit marketing of unhealthy foods to children fall short of protecting their health and rights 15-10-2018

WHO Eastern Mediterranean Region EMRO
:: Polio vaccinators in Pakistan conduct measles campaign   15 October 2018

– More than 32 million Pakistani children are to be vaccinated against measles in late October in a countrywide immunization campaign that pulls together national funding and the polio programme’s greatest asset: its human resources.
From 15 to 27 October, Pakistan’s Expanded Programme on Immunization (EPI) plans to carry out a nationwide measles campaign targeting approximately 31.8 million children aged from 9 to 59 months (and 6 to 83 months in Punjab province). Measles is a highly contagious disease which can be fatal in children, but is preventable with vaccination.
The October measles immunization campaign comes as a response to the ongoing measles outbreak in Pakistan. More than 24 000 suspected measles cases were reported in Pakistan in 2017, and so far this year there have been 30 000 suspected reported cases.
Pakistan typically encounters a measles outbreak every 8 to 10 years, and the Federal Ministry of Health, through the EPI, works proactively to stop these outbreaks with regular vaccination campaigns. Although the Polio Eradication Initiative (PEI) and EPI are separate entities, both work hand in hand on efforts to improve immunization in Pakistan, with the understanding that achieving strong essential immunization coverage is a critical step in bringing Pakistan closer to ending polio, and once this goal is reached, in maintaining polio-free status.
During the upcoming national measles campaign, the polio programme will lend its human, physical and systems resources, knowledge and expertise to the task of achieving highest possible immunization coverage against measles across the country. It’s a good fit: many of the areas at highest risk for polio are also at high risk for measles…

WHO Western Pacific Region
– No new announcement identified

CDC/ACIP [to 20 Oct 2018 ]

CDC/ACIP [to 20 Oct 2018 ]

Tuesday, October 16, 2018
Transcript for CDC Update on Acute Flaccid Myelitis (AFM)
NANCY MESSONNIER: Thank you. Good afternoon and thank you for joining us today to talk about acute flaccid myelitis or AFM. Today I want to update you on CDC’s work on AFM including what we know and what we don’t know about the condition and advice for clinicians and parents. AFM is a rare, but serious condition that affects the nervous system. It specifically affects the area of spinal cord called gray matter and causes muscles and reflexes to become weak. We know this can be frightening for parents. I know many parents want to know what the signs and symptoms are that they should be looking for in their child. I encourage parents to seek medical care right away if you or your child develop sudden weakness or loss of muscle tone in the arms or legs.

CDC has been actively investigating AFM, testing specimens and monitoring disease since 2014 when we first saw an increase in cases. The number of cases reported in this time period in 2018 is similar to what was reported in the fall of 2014 and 2016. Since 2014, most of the AFM cases have been among children. In 2018 so far, CDC has received reports of 127 patients under investigation or PUIs; 62 cases have been confirmed as AFM (in 22 states) –edited for clarity. CDC and state and local health departments are still investigating some of these PUIs. Of the confirmed cases, the average age is about 4 years old. More than 90 percent of the cases are in children age 18 years and younger. We plan to post updated PUI and AFM counts on our website this afternoon.

Going forward, we will report updated case counts on our website every Monday afternoon. We expect that the case count may vary from week to week as our experts work with local and state health departments to investigate their PUIs. Based on previous years, most AFM cases occur in the late summer and fall. The data we are reporting today is a substantially larger number than in previous months this year. CDC recently received increased reports for patients suspected to have AFM with an onset of symptoms in August and September. With enhanced efforts working with state and local health departments and hospitals we were able to confirm a number of these cases faster. Also, CDC is now providing a number of patients still under investigation or PUIs, so people can better investigate increases in confirmed cases over the coming months.

We understand that people particularly parents are concerned about AFM. Right now, we know that poliovirus is not the cause of these AFM cases. CDC has tested every stool specimen from the AFM patients, none of the specimens have tested positive for the poliovirus. AFM can be caused by other viruses, such as enterovirus and west nile virus, environmental toxins and a condition where the body’s immune system attacks and destroys body tissue that it mistakes for foreign material. While we know that these can cause AFM, we have not been able to find a cause for the majority of these AFM cases. The reason why we don’t know about AFM — and I am frustrated that despite all of our efforts we haven’t been able to identify the cause of this mystery illness — we continue to investigate to better understand the clinical picture of AFM cases, risk factors and possible causes of the increase in cases.

Despite extensive laboratory testing, we have not determined what pathogen or immune response caused the arm or leg weakness and paralysis in most patients. We don’t know who may be at higher risk for developing AFM or the reasons why they may be at higher risk. We don’t fully understand the long-term consequences of AFM. We know that some patients diagnosed with AFM have recovered quickly and some continue to have paralysis and require ongoing care. And we know of one death in 2017 in a child that had AFM. For health care professionals, we have developed a provider tool kit that contains information on AFM and instructions for reporting PUIs to the health department. CDC’s website has information for families with patients with AFM, links to important resources and a section for health care providers. We will continue to post updates on our website.

As a parent myself, I understand what it is like to be scared for your child. Parents need to know that AFM is very rare, even with the increase in cases that we are seeing now. We recommend seeking medical care right away if you or your child develop sudden weakness of the arms or legs. As we work to better understand what is causing AFM, parents can help protect their children from serious diseases by following prevention steps like washing their hands, staying up to date on recommended immunizations and using insect repellent. While I am concerned about the increase in cases, I want folks to know this work is core to CDC’s mission to protect America from health threats. Thank you and we are happy to take any questions…

ACIP – October 2018 Draft Meeting Agenda

October 24-25, 2018
MMWR News Synopsis for October 18, 2018

West Nile Virus and Other Nationally Notifiable Arboviral Diseases — United States, 2017
Arboviral diseases (viruses spread to people by mosquitoes and ticks) cause severe illness in the United States each year. Public health surveillance is important to identify outbreaks and guide prevention strategies. This article summarizes surveillance data for arboviruses reported to CDC for 2017. West Nile virus is the most common arbovirus in the continental United States. Eastern equine encephalitis virus transmission via organ transplantation was reported for the first time. La Crosse virus was the most common arbovirus among children. More Jamestown Canyon and Powassan virus cases were reported in 2017 than in any previous year. Communities can prevent arboviral diseases by implementing vector control measures and screening blood donations. Individuals can protect themselves by using insect repellent, wearing long-sleeved shirts and long pants, using air conditioning when available, putting screens on windows and doors, and repairing screens to keep mosquitoes outside.

Mumps Outbreak in a Marshallese Community — Denver Metropolitan Area, Colorado, 2016–2017
Mumps is a serious viral infection that can be prevented by routine vaccination. People living or working in tight-knit networks, such as schools and athletic teams, are vulnerable to mumps outbreaks. Protect yourself and your community with the measles-mumps-rubella (MMR) vaccine. An outbreak of mumps occurred in the small Marshallese community in Denver, Colorado in 2017, likely linked to a larger, concurrent mumps outbreak in the Marshallese community in Arkansas. Mumps can be prevented by the MMR vaccine. Most patients in this outbreak did not have documentation of prior MMR vaccination. Rapid public health response to the outbreak included vaccinating 164 people during MMR vaccination clinics for the affected community, which might have limited spread of mumps to other local communities.

HIV Preexposure Prophylaxis, by Race and Ethnicity — United States, 2014–2016
Preexposure prophylaxis (PrEP) use is increasing, but it is still not reaching many of the Americans who could most benefit from it. Use ofPrEP, a daily pill to prevent HIV, is increasing, but not fast enough. A new CDC analysis found that between 2014 and 2016 the number of Americans who filled a prescription for PrEP increased by 470 percent, from nearly 14,000 to over 78,000 people. Still, this represents a small fraction of the estimated 1.1 million Americans who could benefit from PrEP. Uptake among racial and ethnic minorities is particularly low. While African Americans and Latinos represent approximately 44 percent and 26 percent of Americans who could benefit from PrEP, this study found they represent just 11 percent and 13 percent, respectively, of Americans prescribed PrEP in 2016. Addressing gaps in PrEP awareness and use is critical to stopping new HIV infections in the U.S