WHO: World Immunization Week campaign
Immunize for a healthy future – Know. Check. Protect
24 April 2014
This year’s World Immunization Week campaign asks “Are you up-to-date?” with your immunizations. It focuses on providing people with the information they need to make informed decisions about vaccination.
:: World Immunization Week on Facebook
:: Twitter #RUuptodate
:: More on World Immunization Week

World Malaria Day 2014: WHO helps countries assess feasibility of eliminating malaria
24 April 2014 | GENEVA – On World Malaria Day (25 April), WHO is launching a manual to help countries to assess the technical, operational and financial feasibility of moving towards malaria elimination…The WHO manual will help countries assess what resources they need to reduce malaria transmission to very low levels, i.e. the point at which focused elimination programmes can start in earnest. It will also help them consider appropriate timelines and provide them with essential knowledge for long-term strategic planning for malaria programmes. “This long-term view on malaria is critical: it is vital to plan for the period after elimination,” says Dr John Reeder, Director of WHO’s Global Malaria Programme. “If interventions are eased or abandoned, malaria transmission can re-establish relatively quickly in areas that are prone to the disease, leading to a resurgence in infections and deaths.”
http://www.who.int/mediacentre/news/notes/2014/world-malaria-day/en/

WHO Manual: From malaria control to malaria elimination: a manual for elimination scenario planning
April 2014 68 pages
ISBN: 978 92 4 150702 8
Overview
Since 2000, there has been a 42% reduction in malaria mortality rates globally, and a 49% decline in the WHO African Region. This progress has led many malaria-endemic countries, even those with historically high burdens of malaria, to explore the possibility of accelerating towards elimination.
The elimination scenario planning (ESP) manual provides malaria-endemic countries with a comprehensive framework to assess different scenarios for moving towards this goal, depending on programme coverage and funding availability. It also helps countries set realistic timelines and provides essential knowledge for strategic planning in the long term.
The manual was produced in collaboration with colleagues from the Clinton Health Access Initiative, Imperial College United Kingdom, Johns Hopkins University, the University of Southampton and the Global Health Group at the University of California.
Related tools
The ESP manual can be used in conjunction with malaria transmission modelling software to better understand what levels of intervention coverage might be needed to make elimination possible. Malaria Tools, available from Imperial College London, is a malaria intervention model which has been tested as a means to carry out calculations suggested in the manual…
Malaria Tools

Global Fund: Partners Press for Accelerated Progress against Malaria
24 April 2014
Excerpt
GENEVA – Partners in global health are working together to accelerate progress toward a world free of malaria, with ambitious planning and optimized use of all funding, in order to increase impact and reach more people affected by the disease.
In its message for World Malaria Day, which is 25 April, Roll Back Malaria cited the great progress that has been made against the disease, reducing death rates and shrinking the malaria map. But it also called on the world to “strengthen the potential of individuals, communities and countries to achieve our ultimate goal – a world free from malaria.”…

NIH World Malaria Day statement
B.F. (Lee) Hall, M.D., Ph.D., and Anthony S. Fauci, M.D. National Institute of Allergy and Infectious Diseases
Excerpt
On World Malaria Day, it is encouraging to note that enhanced global efforts to control and eliminate malaria have saved an estimated 3.3 million lives since 2000.
However, the mosquito-borne disease continues to sicken and kill far too many people each year, most of them children. In 2012, roughly 207 million cases of malaria occurred worldwide resulting in 627,000 deaths, according to the World Health Organization (WHO). In 2013, 97 countries had ongoing malaria transmission, placing 3.4 billion people at risk for the disease. And in a globally connected world, even people living in the United States can be at risk. In 2011, nearly 2,000 people in this country were diagnosed with malaria — the highest number since 1971. Virtually all of those cases occurred in U.S. residents or citizens who had travelled abroad.
The WHO World Malaria Day theme is “Invest in the Future. Defeat Malaria.” The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), affirms its continued commitment to supporting and applying innovative research approaches to find new treatments and tools for addressing this infectious disease. For example, through the establishment of the International Centers of Excellence for Malaria Research in 2010, we have worked to strengthen research capacity in the countries most affected by malaria. The 10 research centers, which operate 50 sites in 20 countries, have established dynamic programs to understand the epidemiology of malaria as it changes over time due to the implementation of malaria control and elimination programs. The research centers have also created capacity for clinical trials of novel antimalarial interventions…
Full statement: http://www.nih.gov/news/health/apr2014/niaid-25.htm

PATH marks World Malaria Day 2014
Announcement | April 17, 2014
Events in Seattle and Berkeley, California, highlight progress and commitment toward eliminating malaria.

CDC/MMWR Watch [to 26 April 2014]
http://www.cdc.gov/mmwr/mmwr_wk.html

:: CDC Telebriefing: Report shows 20-year U.S. immunization program spares millions of children from diseases – Transcript
April 24, 2014, 3:30 PM
Excerpt
…TOM FRIEDEN: Thank you very much for joining us. This year marks the 20th anniversary of the implementation of the U.S. Vaccines for Children Program, VFC. Since 1994 VFC has provided vaccines at no cost to uninsured children throughout the country and today we’re releasing a report that shows that our national immunization program and VFC will save hundreds of thousands of lives and over $1 trillion…The program allows CDC to buy vaccines at a discount and to distribute them at no charge to more than 44,000 enrolled VFC providers across the country. To summarize the impact of the U.S. immunization program on the health of all children, both VFC eligible and VFC non-eligible children, CDC used information from a variety of sources and previously published models to estimate how many illnesses, how many hospitalizations and how many premature deaths were saved in this 20-year period and what we found was that for the 79 million children born in this 20-year period, vaccination over the course of their lifetimes, will prevent 322 million illnesses, 21 million hospitalizations, and 730,000 early deaths. In addition, the net financial costs saved because these illnesses will not occur are substantial. According to the report, use of the vaccination will avert $295 billion dollars in direct costs and $1.38 trillion– with a “t” — dollars in societal costs because of illnesses prevented in these cohorts. This is an enormous impact. It demonstrates why the VFC program is one of our country’s most successful public/private partnerships to improve the health of our children and our country…

:: MMWR for April 25, 2014 / Vol. 63 / No. 16
Benefits from Immunization During the Vaccines for Children Program Era — United States, 1994–2013
Excerpt
…Among 78.6 million children born during 1994–2013, routine childhood immunization was estimated to prevent 322 million illnesses (averaging 4.1 illnesses per child) and 21 million hospitalizations (0.27 per child) over the course of their lifetimes and avert 732,000 premature deaths from vaccine-preventable illnesses (Table). Illnesses prevented ranged from 3,000 for tetanus to >70 million for measles. The highest estimated cumulative numbers of hospitalizations and deaths that will be prevented were 8.9 million hospitalizations for measles and 507,000 deaths for diphtheria. The routine childhood vaccines introduced during the VFC era (excluding influenza and hepatitis A) together will prevent about 1.4 million hospitalizations and 56,300 deaths.

Vaccination will potentially avert $402 billion in direct costs and $1.5 trillion in societal costs because of illnesses prevented in these birth cohorts. After accounting for $107 billion and $121 billion in direct and societal costs of routine childhood immunization, respectively, the net present values (net savings) of routine childhood immunization from the payers’ and societal perspectives were $295 billion and $1.38 trillion, respectively….

Surveillance Systems to Track Progress Toward Global Polio Eradication — Worldwide, 2012–2013
Notes from the Field: Measles — California, January 1–April 18, 2014
Announcements: National Infant Immunization Week
Announcements: World Malaria Day — April 25, 2014

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 26 April 2014]
http://www.who.int/csr/don/2013_03_12/en/index.html
:: Human infection with avian influenza A(H7N9) virus – update 24 April 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 24 April 2014
:: Yellow fever in the Democratic Republic of Congo update 24 April 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 23 April 2014
:: Ebola virus disease, West Africa – update 22 April 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 20 April 2014

WHO vigilant on new Middle East respiratory syndrome developments
Cairo, 23 April, 2014 – The World Health Organization (WHO) is concerned about the rising number of cases of Middle East respiratory syndrome coronavirus (MERS-CoV) in recent weeks, especially in Saudi Arabia and the United Arab Emirates, and in particular that two significant outbreaks occurred in health facilities.

“Approximately 75% of the recently reported cases are secondary cases, meaning that they are considered to have acquired the infection from another case through human-to-human transmission,” WHO Regional Director for the Eastern Mediterranean Dr Ala Alwan said. “The majority of these secondary cases have been infected within the healthcare setting and are mainly healthcare workers, although several patients are also considered to have been infected with MERS-CoV while in hospital for other reasons.”

Although the majority of the cases had either no or only minor symptoms, and most do not continue to spread the virus, WHO acknowledges that some critical information gaps remain to better understand the transmission of the virus as well as the route of infection. WHO is unaware at this point in time of the specific types of exposure in the health care facilities that have resulted in transmission of these infections, but this remains a concern.

Therefore, WHO has offered its assistance to mobilize international expertise to work jointly with national health authorities in Saudi Arabia and the United Arab Emirates to investigate the current outbreaks in order to determine the transmission chain of this recent cluster and whether there is any evolving risk that may be associated with the current transmissibility pattern of the virus.
Since the emergence of MERS in April 2012, a total of 253 laboratory-confirmed cases of human infections with MERS have been reported to WHO, including 93 deaths. These cases have been reported in the Middle East (including Jordan, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates); in Europe (France, Germany, Greece, Italy and the United Kingdom of Great Britain and Northern Ireland); in North Africa (Tunisia); and in Asia (Malaysia and the Philippines). The source and mode of infection for the virus remain undetermined.

Several recent cases of people becoming infected in either Saudi Arabia or United Arab Emirates and travelling to a third country have also been reported. Greece, Jordan, Malaysia, and Philippines each reported one such case. So far no further spread of the virus in those countries has been detected. Imported cases already occurred in the past that resulted in limited further human-to-human transmission in France and United Kingdom.

WHO urges all Member States to remain vigilant and enhance surveillance to detect any early sign that the virus has changed and has attained the possibilities of causing sustained person-to-person transmission. WHO expects that it is only through an enhanced coordinated effort the mystery and the risk to global health associated with the emergence of this virus can be unraveled.
http://www.emro.who.int/media/news/mers-developments.html

.

Announcements: Ministry of Health Portal – Kingdom of Saudi Arabia
:: 20 April 2014
Dr. Al-Rabeeah Says no Coronavirus Cases Recorded among School Students, We Are Ready for the Umrah Season
Excerpt
His Excellency the Minister of Health, Dr. Abdullah bin Abdulaziz Al-Rabeeah, has announced that 13 new cases of the novel Coronavirus have been recently recorded in the Kingdom’s regions, including seven cases in Jeddah, four cases in Riyadh, one case in each of Madinah and Najran. “Thus, the total number of affected cases reaches 244 ones all over the Kingdom’s regions,” Dr. Al-Rabeeah said, stressing that the Ministry exerts strenuous efforts to control the situation in the Kingdom. Within the same vein, Dr. Al-Rabeeah highlighted that the MOH is fully ready for the Umrah and Hajj seasons of this year thanks to its remarkable experiences, making it a scientific reference in the mass gathering medicine…
http://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/news-2014-04-20-004.aspx
:: 22 April 2014
Al-Rabeeah Leaves His Office for the Royal Court, Labor Minister to Lead the Ministry of Health
Excerpt
The Custodian of the Two Holy Mosques, King Abdullah bin Abdulaziz Al-Saud, issued today a Royal Decree, relieving His Excellency the Minister of Health Dr. Abdullah bin Abdulaziz Al-Rabeeah of his post and appointing him as an adviser at the Royal Court (Diwan). Instead, His Excellency the Labor Minister Adel bin Mohamed bin Abdel Qader Faqih will occupy the ministerial position, besides his current post. Here is the wording of the Royal Decree:
http://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2014-04-22-003.aspx
:: 24 April 2014
The Acting Minister of Health Issues a Decision Appointing Dr. Tarek Madani as an Independent Medical Advisor for the MOH
Excerpt
His Excellency Eng. Adel bin Mohammed Fakeih, the acting Minister of Health issued, today, a decision appointing Dr. Tarek Madani as a medical advisor for the Ministry of Health (MOH).
This decision came according to the acting Minister of Health’s statement made shortly after taking the office, in which he took a pledge to constantly communicate with the community, and to coordinate with the health care experts with the aim of gathering all the information, helping determine the current situation, the seriousness of the situation, and potential risks…
…The acting Minister of Health, Eng. Adel Fakeih said “according to the extensive medical experience he possesses, Dr. Tarek is to work on coordinating the imperative medical plan in relation to fighting the CoronaVirus (CoV). We intend to draw on the expertise and caliber to help us apply our plan in an effective way, in turn enabling us to guarantee safety of the public.
He went on adding “I would like to reiterate my commitment to working ceaselessly on fighting the CoronaVirus, and the decision of appointing Dr. Tarek is a key step towards achieving that goal.”…
http://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/News-2014-04-24-002.aspx

PAHO/WHO urges vaccination against measles and rubella to protect the Americas during the 2014 FIFA World Cup
04/24/2014
Transmission has been interrupted in the Americas, but measles and rubella continue to circulate in other parts of the world. More than 600,000 people are expected to attend the FIFA World Cup in Brazil. With the theme “Vaccination: Your best shot!” Vaccination Week in the Americas highlights the importance of immunization.

GAVI Watch [to 26 April 2014]
http://www.gavialliance.org/library/news/press-releases/

:: Independent report recommends strong U.S. support for GAVI Alliance
Press Release
Excerpt
Washington, DC, 25 April 2014 – The U.S. government should expand its support of the GAVI Alliance with an increased, multi-year pledge toward the 2016-2020 programme period, while also strengthening its field activities to back GAVI-financed work in implementing countries, according to an independent report by a leading think tank…

:: GAVI Alliance to present plans to expand impact of vaccines by 2020
Press Release
Excerpt
Geneva, 23 April 2014 –
“…the GAVI Alliance will be preparing for a key meeting to be held next month in Brussels, where the Alliance will set out the significantly increased impact that can be achieved by supporting immunisation programmes in the world’s poorest countries through to 2020.

European Commissioner for Development, Andris Piebalgs, will host the meeting on May 20 where GAVI Alliance will present to its partners the funding requirements needed during the five-year period from the beginning of 2016 to build upon the gains already achieved against the biggest killers of children.

“We are on the eve of a unprecedented expansion of vaccination programmes,” said Dagfinn Høybråten, Chair of the GAVI Alliance. “Since 2000, GAVI Alliance partners have vaccinated an additional 440 million children, saving six million lives. In Brussels, we will present an historical opportunity to go even further and secure a healthy future for a generation of vaccinated children in developing countries, a generation that hold the keys to their countries’ futures.”

Immunisation is widely recognised as one of the most successful and cost-effective health interventions ever introduced, preventing between 2 and 3 million deaths every year. Yet each year more than 22 million children – many of them in the poorest and most remote communities – have little or no access to a full course of the most basic vaccines. One in five of all children who die before the age of five lose their lives to vaccine-preventable diseases.

Central to the Alliance’s on-going drive to immunise more children has been an unprecedented acceleration in the number of new vaccines introduced by the 73 countries that receive GAVI support. Between 2011 and the end of 2013, 93 new vaccine introductions were initiated with GAVI support and a further 50 are projected for 2014.

In 2011, donors backed the Alliance with US$ 7.4 billion of funding for programmes from 2011 to 2015. The Alliance set itself the target of immunising nearly a quarter of a billion children, during that period. Last October in Stockholm, the GAVI Mid-Term Review confirmed that the Alliance partners are on track to meet this goal.
Full text: http://www.gavialliance.org/Library/News/Press-releases/2014/GAVI-Alliance-to-present-plans-to-expand-impact-of-vaccines-by-2020/

GPEI Update: Polio this week – As of 23 April 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: Pakistan continues to be the country with most polio cases in the world this year. This week, five new cases were reported (two wild poliovirus type 1 – WPV1, and three circulating vaccine-derived poliovirus type 2 – cVDPV2). Four of the cases are from Federally Administered Tribal Areas (FATA) and one is from Gadap, greater Karachi.
:: In Nigeria, the Expert Review Committee on Polio Eradication and Routine Immunization (ERC) is convening this week in Abuja. The ERC is expected to review the current epidemiology of poliovirus transmission in the country, and put forward recommendations to rapidly achieve a polio-free Nigeria.
Pakistan
:: Two new WPV1 cases were reported in the past week (from North Waziristan, FATA, and Gadap, greater Karachi), bringing the total number of WPV1 cases for 2014 to 49. The most recent WPV1 case had onset of paralysis on 2 April (from North Waziristan).
:: Three new cVDPV2 cases were reported in the past week (two from FR Bannu and one from North Waziristan, FATA). The most recent cVDPV2 case had onset of paralysis on 27 March (from North Waziristan). The total number of cVDPV2 cases is 45 for 2013, and ten for 2014.
:: North Waziristan is the district with the largest number of children being paralyzed by poliovirus in the world (both wild and cVDPV2). Immunization activities have been suspended by local leaders since June 2012. It is critical that children in all areas are vaccinated and protected from poliovirus. Immunizations in neighboring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.
:: The densely populated Peshawar valley is considered to be the main ‘engine’ of poliovirus transmission, alongside North Waziristan, due to large-scale population movements through Peshawar from across this region, and into other areas of Pakistan. The quality of operations must be urgently improved in Peshawar, and immunization activities urgently resumed in North Waziristan.

The Weekly Epidemiological Record (WER) for 25 April 2014, vol. 89, 17 (pp. 165–176) includes:
:: Surveillance systems to track progress towards global polio eradication, 2012–2013
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2014
http://www.who.int/entity/wer/2014/wer8917.pdf?ua=1

WHO: Humanitarian Health Action
http://www.who.int/hac/en/

Heads of UN humanitarian agencies issue a joint statement on the Syrian Arab Republic crisis
23 April 2014 — The heads of UN humanitarian agencies issued a joint statement on behalf of the millions of people affected by the crisis in the Syrian Arab Republic. The appeal calls on all parties to the conflict to 1) take urgent action to enable unconditional humanitarian access to all people in need; 2) lift the sieges on civilians; and 3) end the indiscriminate bombing and shelling of civilians.

IAVI Media Release: Scientists Find New Point of Attack on HIV for Vaccine Development
April 24, 2014
Excerpt
NEW YORK — Scientists from The Scripps Research Institute (TSRI) and the International AIDS Vaccine Initiative (IAVI) have discovered a new vulnerable site on HIV that antibodies can attack to prevent infection from a broad range of the virus’ many variants.

“HIV has very few known sites of vulnerability, but in this work we’ve described a new one, and we expect it will be useful in developing a vaccine,” said Dennis R. Burton, professor in TSRI’s Department of Immunology and Microbial Science and scientific director of the IAVI Neutralizing Antibody Center (NAC) and of the National Institutes of Health’s Center for HIV/AIDS Vaccine Immunology and Immunogen Discovery (CHAVI-ID).

“HIV mutates very quickly, within the individual and across populations,” said IAVI Chief Scientific Officer Wayne Koff. “This new target offers a stable mark for vaccine design, increasing the potential to find a vaccine that can provide broad, lasting protection to people around the world.”

The findings, reported in two studies published online today and in the May issue of Immunity, are part of a large effort sponsored by IAVI and the U.S. National Institutes of Health (NIH) to develop AIDS vaccines that can trigger the human immune system to produce broadly neutralizing antibodies (bNAbs). Since 2009, researchers have: determined that a small proportion of HIV-infected individuals naturally generate bNAbs against a wide range of HIV variants; isolated scores of these bNAbs; identified a handful of regions they target on HIV; and found they can prevent HIV infection in non-human primates. The next step is to design immunogens to elicit these bNAbs in humans…

UNICEF and Global Fund Coordinate Efforts to Reach Mothers, Newborns and Children
22 April 2014
Full Release
GENEVA/NEW YORK – UNICEF and the Global Fund today reinforced their long-standing partnership through a new agreement to better coordinate efforts aimed at reducing the burden of HIV, tuberculosis and malaria and improving the health of mothers, newborns, and children.

Mark Dybul, Executive Director of the Global Fund, and UNICEF Executive Director Anthony Lake signed a new Memorandum of Understanding that emphasizes the importance of coordinating investments in commodities to prevent and treat HIV, tuberculosis and malaria with those designed to improve overall maternal, newborn, and child health.

“The Global Fund has helped expand access for millions of mothers and children to lifesaving commodities that prevent and treat HIV, TB, and malaria,” said Lake. “This new agreement will help governments integrate these critical investments with health services that support basic maternal, newborn, and child health. This integration will increase the effectiveness of both efforts and potentially save millions of lives.”

Specifically, the Global Fund and UNICEF agreed to jointly identify countries where HIV and malaria investments for mothers and children could be better aligned with investments in basic maternal, newborn and child health. As a first step, these commodities could include iron and folic acid, tetanus vaccinations, syphilis screening and treatment for pregnant women, and antibiotics to treat pneumonia and oral rehydration salts and zinc to treat diarrheal disease in children.

Under the new agreement, the Global Fund and UNICEF will encourage governments and Country Coordinating Mechanisms to integrate packages of care and support for mothers and children, and to apply for Global Fund grants that align HIV, TB and malaria programming with broader maternal, newborn and child health efforts. UNICEF will support governments that wish to review and revise national strategies to strengthen this alignment and will help mobilize additional funding where necessary to purchase supplies and equipment for the care of mothers, newborns and children.

“This partnership between UNICEF and the Global Fund strengthens what is already operating on the ground in many countries,” said Dr. Dybul. “We have much further to go, and by working together we can achieve tremendous progress for women and children around the world.”
http://www.theglobalfund.org/en/mediacenter/newsreleases/2014-04-22_UNICEF_and_Global_Fund_Coordinate_Efforts_to_Reach_Mothers_Newborns_and_Children/

GSK plc announces major three-part transaction with Novartis to drive sustainable sales growth, improve long-term earnings and deliver increasing returns to shareholders
Media Release: 22 April 2014, London UK
Editor’s Excerpt
GlaxoSmithKline plc today announces a major 3-part inter-conditional transaction with Novartis AG involving its Consumer Healthcare, Vaccines and Oncology… In summary:
:: GSK and Novartis will create a new world-leading Consumer Healthcare business with 2013 pro forma revenues of £6.5 billion. GSK will have majority control with an equity interest of 63.5%
:: GSK will acquire Novartis’ global Vaccines business (excluding influenza vaccines) for an initial cash consideration of $5.25 billion with subsequent potential milestone payments of up to $1.8 billion and ongoing royalties
:: GSK will divest its marketed Oncology portfolio, related R&D activities and rights to its AKT inhibitor and also grant of commercialisation partner rights for future oncology products to Novartis for an aggregate cash consideration of $16 billion (of which up to $1.5 billion depends on the results of the COMBI-d trial)
:: GSK shareholders to receive £4 billion capital return funded by net cash transaction proceeds and expected to be delivered via a B share scheme…
:: Transaction is expected to complete during the first half of 2015 subject to approvals

Sir Andrew Witty, Chief Executive Officer, GSK said: “This proposed 3-part transaction accelerates our strategy to generate sustainable, broadly sourced sales growth and improve long-term earnings. Opportunities to build greater scale and combine high quality assets in Vaccines and Consumer Healthcare are scarce. With this transaction we will substantially strengthen two of our core businesses and create significant new options to increase value for shareholders…The acquisition of Novartis’ Vaccines business will significantly enhance the breadth of our vaccines portfolio and pipeline, notably in meningitis, with the addition of Bexsero, an exciting new vaccine for prevention of meningitis B. The acquisition will also strengthen our manufacturing network and reduce supply costs…

…Strengthening global leadership in Vaccines
The acquisition of Novartis’ global Vaccines business (excluding influenza vaccines) further improves GSK’s position as the world’s leading global vaccines supplier. Demand for vaccination remains significant with the global vaccine market projected to grow approximately 10% per annum over the next 10 years.

The transaction will strengthen the breadth of GSK’s portfolio, notably in meningitis, including the addition of Bexsero, a new vaccine for prevention of meningitis B and a further candidate vaccine in late-stage development, MenABCWY.

This portfolio expansion will be of benefit to GSK in all markets and notably in the USA, where Novartis has a strong track record of delivery. GSK’s significant presence in emerging and developing markets will also provide new opportunities for introduction and growth of Novartis’ vaccines.

GSK and Novartis’ Vaccines R&D organisations are highly complementary, bringing together respective expertise in virology, bacterial infection and different adjuvant platforms. The new business would have more than 20 different vaccines in development, including assets to prevent hospital and maternal infections and diseases prevalent in developing countries such as malaria and tuberculosis.

The acquisition is expected to strengthen GSK’s manufacturing network and increase overall capacity, notably with the addition of Novartis’ secondary packaging and supply facilities in Rosia, Italy and Marburg, Germany. GSK would also acquire new manufacturing sites in India and China. In addition, the integration of the supply of a number of key antigens, currently provided to GSK by Novartis, will provide immediate improvements and enhance the future flexibility of the business, particularly in paediatric vaccines…
Full Release: http://www.gsk.com/media/press-releases/2014/gsk-announces-major-three-part-transaction-with-novartis.html
:: Novartis announces portfolio transformation, focusing company on leading businesses with innovation power and global scale: Pharmaceuticals, Eye Care and Generics
Media Release: April 22, 2014
Editor’s Excerpt
:: Acquires GSK oncology products, strengthening Novartis’ leading Oncology business with novel therapies and becomes GSK’s preferred commercialization partner for its oncology pipeline
:: Combines Novartis OTC with GSK’s consumer business in a joint venture, creating a world-leading consumer healthcare business and maintaining Novartis’ presence in this sector
:: Divests Vaccines business (excluding flu) to GSK, creating a global leader in vaccines
:: In a separate transaction, divests Novartis Animal Health to Lilly

Basel, April 22, 2014 – Novartis announced today that it has reached a definitive agreement with GlaxoSmithKline plc (GSK) to exchange certain assets, building global leadership in key segments and focusing the company’s portfolio. Under the agreement, Novartis would strengthen the company’s innovative pharmaceuticals business by acquiring GSK oncology products, and would divest Vaccines (excluding flu) to them. The two companies would also create a joint venture, combining their consumer divisions to create a world-leading consumer healthcare business. Separately, the company announced a definitive agreement with Eli Lilly and Company (Lilly) to divest the Animal Health Division, further focusing its portfolio on the leading businesses of innovative pharmaceuticals, eye care and generics…

Joseph Jimenez, CEO of Novartis, said, “The transactions mark a transformational moment for Novartis. They focus the company on leading businesses with innovation power and global scale. They also improve our financial strength, and are expected to add to our growth rates and margins immediately. We have also created a world-leading consumer healthcare business in our joint venture with GSK. We believe the divestment of our smaller Vaccines and Animal Health Divisions will enable us to realize immediate value from these businesses for our shareholders, and those divisions will benefit from being part of large, global businesses that are also leaders in their segments. Patients will benefit from even higher levels of innovation that this focus may afford. Looking ahead, this positions Novartis well for future healthcare industry dynamics.”…

…Divestment of Vaccines to GSK
Novartis has agreed to divest its Vaccines business to GSK, currently excluding its flu business, for USD 7.1 billion plus royalties. The USD 7.1 billion consists of USD 5.25 billion upfront and up to USD 1.8 billion in milestones. As a part of a value-maximization strategy in the context of the portfolio review, Novartis has initiated a separate sales process for its flu business…

…Novartis Vaccines would become part of a world leader in the vaccines segment, under GSK’s ownership. The combined business is expected to have a compelling position in pediatric and meningitis franchises. GSK’s position in the market is further likely to strengthen the commercial launch power behind Bexsero. In addition, GSK has the capacity to fully fund the vaccines pipeline to potentially expand the R&D efforts of the rich vaccines pipeline portfolio…
Full release: http://www.novartis.com/newsroom/media-releases/en/2014/1778515.shtml

Sabin Vaccine Institute: 20th Anniversary Scientific Symposium
Friday, April 25, 2014
Excerpt
…To celebrate wide-ranging global immunization and vaccine development achievements over the past twenty years since its founding, the Sabin Vaccine Institute convened a Scientific Symposium of some of the world’s leading health experts at the Pan American Health Organization (PAHO) to examine the innovations needed to overcome remaining obstacles to universal access to immunizations.

“Vaccines are one of the most powerful, cost-effective interventions that save lives and catalyze economic growth,” said, executive vice president of the Sabin Vaccine Institute. “Partner coordination, advocacy, and country ownership has led to the eradication and elimination of diseases such as smallpox, and polio is on the verge of being eradicated. The introduction of life-saving vaccines for rotavirus and pneumococcal, among other diseases, has occurred in many areas around the world. But we must continue to fulfill a shared responsibility to ensure that all individuals in every country have access to vaccines, a fundamental human right to health.”…

[Editor’s Note: PAHO made a special announcement during the Symposium honoring Dr. Ciro de Quadros as a “Public Health Hero” – reflecting his career-long contributions to immunization across many sectors and organizations beginning with his initial role at PAHO in 1957.]

Analysis: Replenishing GAVI in 2014 – Options for U.S. Engagement
CSIS; Katherine Bliss
Apr 23, 2014
Overview
Toward the end of 2014, the GAVI Alliance will host a pledging conference to generate funds for activities to be carried out during 2016–2020. Launched as a public-private partnership in January 2000, GAVI supports immunization programs for children living in the world’s least developed countries. Drawing on donor contributions of $7.6 billion since the alliance’s first replenishment in 2011, GAVI has reported solid progress in reaching its goals for the period between 2011 and 2015. GAVI’s continued success is important to the United States for several reasons.
This report reviews GAVI’s progress and challenges during the current phase of operations and offers recommendations for U.S. policymakers to consider as they develop an approach to the upcoming GAVI replenishment. It suggests that in recognition of GAVI’s strategic importance, accomplishments to date, and potential for future success, the United States should increase its commitment to GAVI for the 2016–2020 period. It also notes that U.S. policymakers may want to condition any future increases (beyond 2020) on GAVI’s success in the next phase in ensuring the sustainability of the current “graduation” schemes and clearly expanding the number of donor countries that are able to commit $50 to $75 million per year or more.
Download PDF file of “Replenishing GAVI in 2014”
[see also GAVI Watch above for GAVI media release on this analysis]

MSF Issue Brief: Vaccinating Children beyond the ‘Cold Chain’
25 April 2014, 12 pages
Excerpt from p.1
“Shipping and storing vaccines in a ‘cold chain’ in’ in the tropical heat of many resource-limited countries – whereby the vaccine is kept at temperatures between 2°C to 8°C from the point of manufacture until reaching the recipient – is a tremendous challenge and a major cause of poor immunisation coverage rates. Ministries of Health and organisations such as Médecins Sans Frontières (MSF), which carry out vaccination in developing countries, struggle with the immense task of keeping vaccines within the recommended temperatures in contexts where infrastructure is weak and electricity supply and refrigeration unstable.

“Growing evidence shows that some vaccines can be safely kept outside the cold chain for certain periods of time. This more flexible use of the cold chain is called the ‘controlled temperature chain’ (CTC) or a ‘flexible cold chain.’ This approach has considerable potential benefits, including cost savings, preventing vaccine damage caused by accidental freezing, and, most importantly, making it easier to reach children living in remote places who would otherwise remain unvaccinated. However, very few vaccine manufacturers have released information on, or further studied, the stability of their vaccines outside the typical recommendation of keeping vaccines at between 2 to 8°C. This is in part because there is little to no need for a more flexible cold chain in wealthy countries, where refrigeration is unproblematic, and therefore there is little incentive for companies to pursue this matter. It is crucial that manufacturers, regulators and national immunisation programmes work towards evaluating and approving the use of vaccines in a CTC where possible.”
http://www.msfaccess.org/sites/default/files/MSF_assets/Vaccines/Docs/MSF_Access_IssueBrief_thermostability%20updated%2025%20April.pdf

BMC Health Services Research
(Accessed 26 April 2014)
http://www.biomedcentral.com/bmchealthservres/content

Research article
Effective access to health care in Mexico
Juan Pablo Gutiérrez, Sebastián García-Saisó, Germán Fajardo Dolci and Mauricio Hernández Ávila
Author Affiliations
BMC Health Services Research 2014, 14:186 doi:10.1186/1472-6963-14-186
Published: 23 April 2014
Abstract (provisional)
Background
Effective access measures are intended to reflect progress toward universal health coverage. This study proposes an operative approach to measuring effective access: in addition to the lack of financial protection, the willingness to make out-of-pocket payments for health care signifies a lack of effective access to pre-paid services.
Methods
Using data from a nationally representative health survey in Mexico, effective access at the individual level was determined by combining financial protection and effective utilization of pre-paid health services as required. The measure of effective access was estimated overall, by sex, by socioeconomic level, and by federal state for 2006 and 2012.
Results
In 2012, 48.49% of the Mexican population had no effective access to health services. Though this represents an improvement since 2006, when 65.9% lacked effective access, it still constitutes a major challenge for the health system. Effective access in Mexico presents significant heterogeneity in terms of federal state and socioeconomic level.
Conclusions
Measuring effective access will contribute to better target strategies toward universal health coverage. The analysis presented here highlights a need to improve quality, availability, and opportuneness (location and time) of health services provision in Mexico.

Research article
A scoping study on task shifting; the case of Uganda
Sebastian Olikira Baine and Arabat Kasangaki
Author Affiliations
BMC Health Services Research 2014, 14:184 doi:10.1186/1472-6963-14-184
Published: 23 April 2014
Abstract (provisional)
Background
Task shifting has been implemented in Uganda for decades with little documentation. This study’s objectives were to; gather evidence on task-shifting experiences in Uganda, establish its acceptability and perceptions among health managers and policymakers, and make recommendations.
Methods
This was a qualitative study. Data collection involved; review of published and gray literature, and key informant interviews of stakeholders in health policy and decision making in Uganda. Data was analyzed by thematic content analysis.
Results
Task shifting was the mainstay of health service delivery in Uganda. Lower cadre of health workers performed duties of specialized health workers. However, Uganda has no task shifting policy and guidelines, and task shifting was practiced informally.
Lower cadre of health workers were deemed to be incompetent to handle shifted roles and already overworked, and support supervision was poor.
Advocates of task shifting argued that lower cadre of health workers already performed the roles of highly trained health workers. They needed a supporting policy and support supervision.
Opponents argued that lower cadre of health workers were; incompetent, overworked, and task shifting was more expensive than recruiting appropriately trained health workers.
Conclusions
Task shifting was unacceptable to most health managers and policy makers because lower cadres of health workers were; incompetent, overworked and support supervision was poor. Recruitment of existing unemployed well trained health workers, implementation of human resource motivation and retention strategies, and government sponsored graduates to work for a defined mandatory period of time were recommended.

Study protocol
Design of an impact evaluation using a mixed methods model – an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi
Stephan Brenner, Adamson S Muula, Paul Jacob Robyn, Till Bärnighausen, Malabika Sarker, Don P Mathanga, Thomas Bossert and Manuela De Allegri
Author Affiliations
BMC Health Services Research 2014, 14:180 doi:10.1186/1472-6963-14-180
Published: 22 April 2014
Abstract (provisional)
Background
In this article we present a study design to evaluate the causal impact of providing supply-side performance-based financing incentives in combination with a demand-side cash transfer component on equitable access to and quality of maternal and neonatal healthcare services. This intervention is introduced to selected emergency obstetric care facilities and catchment area populations in four districts in Malawi. We here describe and discuss our study protocol with regard to the research aims, the local implementation context, and our rationale for selecting a mixed methods explanatory design with a quasi-experimental quantitative component.
Design
The quantitative research component consists of a controlled pre- and post-test design with multiple post-test measurements. This allows us to quantitatively measure ‘equitable access to healthcare services’ at the community level and ‘healthcare quality’ at the health facility level. Guided by a theoretical framework of causal relationships, we determined a number of input, process, and output indicators to evaluate both intended and unintended effects of the intervention. Overall causal impact estimates will result from a difference-in-difference analysis comparing selected indicators across intervention and control facilities/catchment populations over time.
To further explain heterogeneity of quantitatively observed effects and to understand the experiential dimensions of financial incentives on clients and providers, we designed a qualitative component in line with the overall explanatory mixed methods approach. This component consists of in-depth interviews and focus group discussions with providers, service user, non-users, and policy stakeholders. In this explanatory design comprehensive understanding of expected and unexpected effects of the intervention on both access and quality will emerge through careful triangulation at two levels: across multiple quantitative elements and across quantitative and qualitative elements.
Discussion
Combining a traditional quasi-experimental controlled pre- and post-test design with an explanatory mixed methods model permits an additional assessment of organizational and behavioral changes affecting complex processes. Through this impact evaluation approach, our design will not only create robust evidence measures for the outcome of interest, but also generate insights on how and why the investigated interventions produce certain intended and unintended effects and allows for a more in-depth evaluation approach.

BMC Public Health
(Accessed 26 April 2014)
http://www.biomedcentral.com/bmcpublichealth/content

Research article
Diarrhea incidence and intestinal infections among rotavirus vaccinated infants from a poor area in Brazil: a spatial analysis
Claudimary Bispo Santos, Karina Conceição Araújo, Anne Jardim-Botelho, Márcio Bezerra Santos, Alda Rodrigues, Silvio Santana Dolabella and Ricardo Queiroz Gurgel
Author Affiliations
BMC Public Health 2014, 14:399 doi:10.1186/1471-2458-14-399
Published: 24 April 2014
Abstract (provisional)
Background
Acute diarrhea is the second leading cause of mortality among children under 5 years of age in developing countries. The pathogen most strongly associated with diarrhea is rotavirus followed by enteric pathogens such as bacteria, helminthes and protozoan. Adequate sanitation and water supply contribute to decrease acute diarrhea incidence of most etiologic agents, although vaccination remains the most important intervention to control rotavirus acute diarrhea. This study aimed to describe environmental conditions and analyze spatially the acute diarrhea and intestinal infection among rotavirus vaccinated infants from Laranjeiras-Sergipe, Brazil.
Methods
Children were enrolled between 2 and 11 months of age and followed through 12 months. Demographic, socioeconomic and environmental data were obtained from a questionnaire, and immunization data were obtained from children vaccination card. Children stool samples were collected each month in order to run laboratory analyses. The household spatial localization was obtained by using a Global Positioning System (GPS). Spatial analysis was performed using the TerraView computer program and Kernel intensity estimation.
Results
A total of 1,113 stool samples were collected with 80 being diarrhea associated. Diarrhea incidence rate was 0.5 +/- 1.0 episodes/child/year. The overall infection rates by Ascaris lumbricoides, Endolimax nana, Giardia lamblia and rotavirus were 5.1%, 3.0%, 0.9% and 2.6%, respectively. 3.8% of diarrhea-associated stool samples were positive for rotavirus and 11.3% were positive for helminths and protozoans. There were some changes on spatial distribution of intestinal infections and diarrhea episodes along the four trimesters evaluated.
Conclusions
The studied infants live equally in precarious conditions of sanitation which probably explain the significant rates of parasitic infections appearing in early life. The low acute diarrhea incidence in the studied rotavirus vaccinated population and the low number of symptomatic rotavirus infection may indicate vaccination efficacy to prevent acute diarrhea among young children in a poor environmental sanitary setting.

Eurosurveillance
Volume 19, Issue 16, 24 April 2014
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

Research articles
Seasonal influenza immunisation in Europe. Overview of recommendations and vaccination coverage for three seasons: pre-pandemic (2008/09), pandemic (2009/10) and post-pandemic (2010/11)
by J Mereckiene, S Cotter, A Nicoll, P Lopalco, T Noori, JT Weber, F D’Ancona, D Lévy-Bruhl, L Dematte, C Giambi, P Valentiner-Branth , I Stankiewicz, E Appelgren, D O’Flanagan, the VENICE project gatekeepers group

News
The European Medicines Agency publishes interim guidance on enhanced safety surveillance for seasonal influenza vaccines in the European Union
Eurosurveillance editorial team 1. European Centre for Disease Prevention and Control (ECDC) Stockholm, Sweden
On 15 April, the European Medicines Agency (EMA) published an interim guidance on enhanced safety surveillance for seasonal influenza vaccines in the European Union. The interim guidance focuses on enhanced safety surveillance and outlines principles to be followed for improved continuous routine surveillance for influenza vaccines [1].

Global Public Health
Volume 9, Issue 4, 2014
http://www.tandfonline.com/toc/rgph20/current#.Uq0DgeKy-F9

Review of the epidemiological evidence for physical activity and health from low- and middle-income countries
DOI: 10.1080/17441692.2014.894548
Karen Miltona*, Rona Macnivenb & Adrian Baumanb
pages 369-381
Abstract
Almost 80% of deaths from non-communicable diseases (NCDs) occur in low- and middle-income countries. Physical inactivity is a key risk factor for NCDs. Enhancing understanding of the scientific evidence linking physical activity and health in low- and middle-income countries is important for supporting national efforts to promote physical activity and reduce NCDs in these countries. A systematic review of three electronic databases was conducted in July 2013, including large population-based epidemiological studies with adult participants, conducted in low- and middle-income countries, and published in the past 30 years. Physical activity was consistently associated with a reduced risk of all-cause mortality, cardiovascular disease (CVD), diabetes and several types of cancer. Positive associations were also found between physical activity and body composition (including overweight and obesity), blood pressure, cholesterol, metabolic indices and bone mineral density. Overall, the results confirm that the epidemiological research into the health benefits of physical activity in low- and middle-income countries is consistent with previous research conducted in high-income countries. This summary of the available research can be used as an advocacy tool in low- and middle-income countries to support greater prominence of physical activity in NCD policies.

La situación económica: Social determinants of contraceptive use in rural Honduras
DOI: 10.1080/17441692.2014.890238
Marissa G. Hallab*, Jenna J. Garrettc & Clare Barringtonab
pages 455-468
Abstract
Contraceptive use is an important determinant of unintended pregnancy, but little is known about the social and structural factors that determine women’s contraceptive use in rural Honduras. In this study, we aim to characterise the individual and social determinants of contraceptive use among women in rural Honduras. In 2011 and 2012, we conducted 14 interviews and 2 focus groups with women 18 years and older. In our analysis, we created a family-planning narrative for each participant and coded transcripts around key emergent themes related to these determinants. We found that social determinants – including poverty, gender dynamics and availability of family-planning methods – had a strong influence on contraceptive use among women in our sample. Study participants stated that they were faced with a difficult economic situation compounded by rising prices of basic goods and diminishing job opportunities. Paradoxically, at the same time that the economic situation led women to seek contraception, it also contributed to the structural barriers that limited their ability to obtain their method of choice and maintain continuous contraceptive use. Our findings suggest the need for multi-level efforts to create an enabling and sustainable environment for family planning among women in rural Honduras.

International Journal of Epidemiology
Volume 43 Issue 2 April 2014
http://ije.oxfordjournals.org/content/current

Editorial
Psychiatric epidemiology and global mental health: joining forces
Ezra Susser1,*
1Department of Epidemiology, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, USA, and
Department of Epidemiology, Mailman School of Public Health, 722 W. 168th St, #1030, New York, NY 10032, USA.
Vikram Patel2,3,4
Author Affiliations
2London School of Hygiene and Tropical Medicine, London, UK, 3Sangath, Goa, India and 4Centre for Mental Health, Public Health Foundation of India, New Delhi, India.
In our view, population mental health is integral to population health, or put more simply, there can be ‘no health without mental health’.1 It follows that there can be ‘no epidemiology of health without mental health.’ One obvious reason for paying more attention to mental health is the large contribution of mental disorders to the burden of disease across the globe.2 Another reason is that people with severe mental disorders represent a vulnerable and socially excluded population.3 Their lives are more likely to be afflicted by poverty, discrimination, human rights violations and increased morbidity and mortality rates. If we wish to ameliorate social inequality, we need to find ways to improve the living conditions as well as the health of this especially disadvantaged group. There are also many other relationships between social inequality and mental health. For example, socially advantaged groups tend to have more access in early life to environments that stimulate social, emotional and cognitive development, and these early advantages are related to a range of better mental health and social outcomes across the life course. Taking the broadest view, one could argue that the most valuable resource of modern societies is ‘human capital’, that the benchmark of progress is ‘human development’ and that mental health is fundamental to both.4–7
The reviews in this issue portray a remarkably diverse range of contributions that epidemiologists and other researchers have made to understanding and improving the mental health of populations across the globe. The thread that connects them is an exploration of the interface between psychiatric epidemiology and global mental health, and how closer links might be forged to the mutual benefit of both fields. Our introduction and the three accompanying commentaries8–10 focus on this theme from different angles.

Commentary: Epidemiological mental health research: contribution from low- and middle-income countries is essential
Paulo Rossi Menezes
Author Affiliations
Faculdade de Medicina da Universidade de São Paulo, Av. Dr Arnaldo 455, São Paulo, SP Brazil.
The burden of mental disorders is very high all over the world, as already pointed out in the previous comments of this special issue of IJE. Hopefully, the relevance of mental disorders as one of the world’s main public health priorities has started to become acknowledged. In its 2014 meeting, the World Economic Forum had mental health as one of its relevant topics (http://www.weforum.org/events/world-economic-forum-annual-meeting-2014). Last year the World Health Organization and member states approved the Mental Health Action Plan 2013, during the 65th World Health Assembly, which highlights the need for improvement in research capacity and academic collaboration on research in mental health in Low- And Middle-Income Countries (LAMIC), especially for operational research that can lead to service development and implementation. However, the challenge ahead is not simple. An investigation in 114 LAMIC in three continents showed that there is scarcity of both resources and capacity for mental health research, and that existing resources and capacity are very unevenly distributed.1 This special issue of IJE, focused on reviewing research evidence related to global mental health on its methodological aspects, aetiology, burden and impact, prevention and service evaluation, confirms how limited is the production of scientific knowledge about these topics in LAMIC.
Good quality epidemiological mental health research in LAMIC is urgently needed for several reasons. For instance, it can give better understanding about the aetiology of mental disorders, which can then lead to preventive public health actions, and it is essential to produce data that …

Estimating the coverage of mental health programmes: a systematic review
Mary J De Silva1,*, Lucy Lee1, Daniela C Fuhr1, Sujit Rathod1, Dan Chisholm2, Joanna Schellenberg3 and Vikram Patel1,4
Author Affiliations
1Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK, 2Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland, 3Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK and 4Sangath, Alto-Porvorim, Goa, India
Corresponding author. Centre for Global Mental Health, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT. E-mail: mary.desilva@lshtm.ac.uk
Accepted August 21, 2013.
Abstract
Background The large treatment gap for people suffering from mental disorders has led to initiatives to scale up mental health services. In order to track progress, estimates of programme coverage, and changes in coverage over time, are needed.
Methods Systematic review of mental health programme evaluations that assess coverage, measured either as the proportion of the target population in contact with services (contact coverage) or as the proportion of the target population who receive appropriate and effective care (effective coverage). We performed a search of electronic databases and grey literature up to March 2013 and contacted experts in the field. Methods to estimate the numerator (service utilization) and the denominator (target population) were reviewed to explore methods which could be used in programme evaluations.
Results We identified 15 735 unique records of which only seven met the inclusion criteria. All studies reported contact coverage. No study explicitly measured effective coverage, but it was possible to estimate this for one study. In six studies the numerator of coverage, service utilization, was estimated using routine clinical information, whereas one study used a national community survey. The methods for estimating the denominator, the population in need of services, were more varied and included national prevalence surveys case registers, and estimates from the literature.
Conclusions Very few coverage estimates are available. Coverage could be estimated at low cost by combining routine programme data with population prevalence estimates from national surveys.

JAMA
April 23/30, 2014, Vol 311, No. 16
http://jama.jamanetwork.com/issue.aspx

Viewpoint |
Global Opportunities and Challenges for Clinical Neuroscience
Gretchen L. Birbeck, MD1,2; Michael G. Hanna, MD3; Robert C. Griggs, MD1
Author Affiliations
JAMA. 2014;311(16):1609-1610. doi:10.1001/jama.2014.2744.

Clinical neuroscience faces 2 challenges: (1) an increasing number of persons worldwide with neurodegenerative and neurovascular disorders and the increased expenditures necessary for their care; and (2) patients with rare neurologic diseases who also deserve and demand attention. Demographic changes and the “epidemiologic transition” (from infections to chronic diseases) have converged, causing an unprecedented global burden of disabling neurologic disorders: in 2010, approximately 35 million people were living with dementia; by 2030, this population is expected to reach 70 million and by 2050 is projected to exceed 115 million people, with most living in lower- and middle-income countries.1 Stroke, the principal cause of long-term disability irrespective of age, sex, ethnicity, or country, causes more deaths annually than AIDS, tuberculosis, and malaria combined; incidence of stroke is expected to increase over the next decade, primarily in regions already affected by these infectious diseases.

The Lancet
Apr 26, 2014 Volume 383 Number 9927 p1437 – 1520
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Time to contain artemisinin resistance
The Lancet
Preview |
Full Text | PDF
The theme of this year’s World Malaria Day (April 25) is elimination: invest in the future and defeat malaria. Good progress has been made towards controlling malaria and reducing disease incidence. Since 2000, mortality rates from malaria have fallen by 42% worldwide and by 49% in Africa. This success can be attributed, in part, to the use of artemisinin-based combination therapy in malaria-endemic countries. But does resistance to artemisinins in the Greater Mekong Subregion threaten a global health catastrophe?

Comment
Malaria: a molecular marker of artemisinin resistance
Nicholas J White
Preview |
Full Text | PDF
Global malaria morbidity and mortality are falling.1 Elimination of malaria is back on the table. Things are looking good—or are they? The two main developments that have achieved these advances—insecticides to repel or kill mosquitoes, and drugs to prevent and treat malaria—are both falling to resistance. Artemisinin, the cornerstone of antimalarial therapeutics, is the latest casualty. The artemisinin derivatives are remarkable antimalarials; they are very safe and well tolerated, and are rapidly effective.

The Lancet Global Health
May 2014 Volume 2 Number 5 e242 – 300
http://www.thelancet.com/journals/langlo/issue/current
Comment
Readiness of the primary care system for non-communicable diseases in sub-Saharan Africa
Andre Pascal Kengne, Bongani M Mayosi
Preview |
According to WHO global health estimates,1 chronic non-communicable diseases (NCDs) are the second leading cause of death in Africa. In 2011, NCDs accounted for 30% of the 9•5 million deaths, and 25•8% of the 675•4 million disability-adjusted life years (DALYs) recorded in Africa. NCDs are emerging in both rural and urban areas, most prominently in people living in low-income urban settings, and are resulting in increasing pressure on acute and chronic health-care services.2 Within the broad category of NCDs, stroke, hypertensive heart disease, diabetes, and chronic kidney disease have been identified as the leading disorders in the region.

Comment
Epidemiology of mental health in conflict-affected populations
Madelyn H Hicks
Preview |
In their Article in The Lancet Global Health, Derrick Silove and colleagues1 describe how different forms of recurrent political violence have affected mental health in Timor-Leste. The paper establishes several advances in epidemiological studies of mental health in conflict-affected populations. One of the most important is integration of high-quality epidemiological sampling and validated mental health measures with information about relevant social conditions, a good qualitative grounding, personally meaningful experience, and local historical context.

Comment
Reassessing the value of vaccines
Till Bärnighausen, Seth Berkley, Zulfiqar A Bhutta, David M Bishai, Maureen M Black, David E Bloom, Dagna Constenla, Julia Driessen, John Edmunds, David Evans, Ulla Griffiths, Peter Hansen, Farah Naz Hashmani, Raymond Hutubessy, Dean T Jamison, Prabhat Jha, Mark Jit, Hope Johnson, Ramanan Laxminarayan, Bruce Y Lee, Sharmila Mhatre, Anne Mills, Anders Nordström, Sachiko Ozawa, Lisa Prosser, Karlee Silver, Christine Stabell Benn, Baudouin Standaert, Damian Walker
Preview |
In May, 1974, WHO launched the Expanded Programme on Immunization—the global programme to immunise children worldwide with a set of (at the time) six core vaccines. 40 years on, the GAVI Alliance has brought us together, a group of 29 leading technical experts in health and development economics, cognitive development, epidemiology, disease burden, and economic modelling to review and understand the broader outcomes of vaccines beyond morbidity and mortality, to identify research opportunities, and to create a research agenda that will help to further quantify the value of this effect.

Preparedness of Tanzanian health facilities for outpatient primary care of hypertension and diabetes: a cross-sectional survey
Dr Robert Peck MD a b c, Janneth Mghamba MD d, Fiona Vanobberghen PhD a f, Bazil Kavishe MD a, Vivian Rugarabamu MD a, Prof Liam Smeeth PhD e, Prof Richard Hayes DSc f, Prof Heiner Grosskurth PhD f, Saidi Kapiga MD a f
Summary
Background
Historically, health facilities in sub-Saharan Africa have mainly managed acute, infectious diseases. Few data exist for the preparedness of African health facilities to handle the growing epidemic of chronic, non-communicable diseases (NCDs). We assessed the burden of NCDs in health facilities in northwestern Tanzania and investigated the strengths of the health system and areas for improvement with regard to primary care management of selected NCDs.
Methods
Between November, 2012, and May, 2013, we undertook a cross-sectional survey of a representative sample of 24 public and not-for-profit health facilities in urban and rural Tanzania (four hospitals, eight health centres, and 12 dispensaries). We did structured interviews of facility managers, inspected resources, and administered self-completed questionnaires to 335 health-care workers. We focused on hypertension, diabetes, and HIV (for comparison). Our key study outcomes related to service provision, availability of guidelines and supplies, management and training systems, and preparedness of human resources.
Findings
Of adult outpatient visits to hospitals, 58% were for chronic diseases compared with 20% at health centres, and 13% at dispensaries. In many facilities, guidelines, diagnostic equipment, and first-line drug therapy for the primary care of NCDs were inadequate, and management, training, and reporting systems were weak. Services for HIV accounted for most chronic disease visits and seemed stronger than did services for NCDs. Ten (42%) facilities had guidelines for HIV whereas three (13%) facilities did for NCDs. 261 (78%) health workers showed fair knowledge of HIV, whereas 198 (59%) did for hypertension and 187 (56%) did for diabetes. Generally, health systems were weaker in lower-level facilities. Front-line health-care workers (such as non-medical-doctor clinicians and nurses) did not have knowledge and experience of NCDs. For example, only 74 (49%) of 150 nurses had at least fair knowledge of diabetes care compared with 85 (57%) of 150 for hyptertension and 119 (79%) of 150 for HIV, and only 31 (21%) of 150 had seen more than five patients with diabetes in the past 3 months compared with 50 (33%) of 150 for hypertension and 111 (74%) of 150 for HIV.
Interpretation
Most outpatient services for NCDs in Tanzania are provided at hospitals, despite present policies stating that health centres and dispensaries should provide such services. We identified crucial weaknesses (and strengths) in health systems that should be considered to improve primary care for NCDs in Africa and identified ways that HIV programmes could serve as a model and structural platform for these improvements.
Funding
UK Medical Research Council.

Effects of recurrent violence on post-traumatic stress disorder and severe distress in conflict-affected Timor-Leste: a 6-year longitudinal study
Dr Derrick Silove MD a d, Belinda Liddell PhD b, Susan Rees PhD a d, Tien Chey MAppStat d, Angela Nickerson PhD b, Natalino Tam a, Anthony B Zwi PhD c, Robert Brooks PhD e, Lazaro Lelan Sila BPubHealth a, Zachary Steel PhD a d
Summary
Background
Little is known about the effect of recurrent episodes of communal violence on mental health in countries recovering from mass conflict. We report results of a 6-year longitudinal study in post-conflict Timor-Leste assessing changes in mental health after a period of communal violence.
Methods
We assessed 1022 adults (600 from a rural village, 422 from an urban district) exposed to mass conflict during the Indonesian occupation after independence in 2004, and again in 2010—11, following a period of internal conflict. We took a census of all adults living at the two sites. The survey included measures of post-traumatic stress disorder, severe distress, traumatic events, poverty, ongoing conflict, and injustice.
Findings
1247 (80%) of 1554 invited adults participated in the baseline survey. 1038 (89% of those eligible) were followed up. The analysis included 1022 people who had sufficient data at baseline and follow-up. The prevalence of post-traumatic stress disorder increased from 23 of 1022 (2.3%) in 2004, to 171 of 1022 (16.7%) in 2010. The prevalence of severe distress also increased, from 57 of 1022 (5.6%) in 2004, to 162 of 1022 (15.9%) in 2010. Both these outcomes were associated with disability at follow-up. Having post-traumatic stress at follow-up was associated with being a woman (odds ratio [OR] 1.63, 95% CI 1.14—2•32), experience of human rights trauma (OR 1.25, 95% CI 1.07—1.47), or exposure to murder (OR 1.71, 95% CI 1.38—2.10) during the Indonesian occupation (1975—99), human rights trauma during the period of internal violence in 2006—07 (OR 1.46, 95% CI 1.04—2•03), and ongoing family or community conflict (OR 1.80, 95% CI 1.15—2.80) or preoccupations with injustice for two or three historical periods (OR 4.06, 2.63—6.28). Severe distress at follow-up was associated with health stress (OR 1.47, 1.14—1.90), exposure to murder (OR 1.57, 1.27—1.95), and natural disaster (OR 1.65, 1.03—2.64) during the Indonesian occupation, conflict-related trauma during the internal violence (OR 1.33, 1.02—1.74), and ongoing poverty (OR 1.53, 1.36—1.72) or preoccupations with injustice for two or three historical periods (OR 2.09, 1.25—3.50).
Interpretation
Recurrent violence resulted in a major increase in post-traumatic stress disorder and severe distress in a community previously exposed to mass conflict. Poverty, ongoing community tensions, and persisting feelings of injustice contributed to mental disorders. The findings underscore the importance of preventing recurrent violence, alleviating poverty, and addressing injustices in countries emerging from conflict.
Funding
Australian National Health and Medical Research Council.

The Lancet Infectious Diseases
May 2014 Volume 14 Number 5 p359 – 440
http://www.thelancet.com/journals/laninf/issue/current
Editorial
The case for vaccinating against meningitis B
The Lancet Infectious Diseases
Preview |
The four-component meningococcal serogroup B vaccine (4CMenB; Bexsero, Novartis) is the first successful vaccine against the endemic form of this cause of serious bacterial meningitis and septicaemia. The vaccine has been in development for almost two decades and has been approved by licensing authorities in Europe, Canada, and Australia. But it is only now moving towards incorporation into routine infant immunisation programmes following a recommendation from the UK Joint Committee on Vaccination and Immunisation (JCVI), with the proviso that a cost-effective price be negotiated.

Rotavirus vaccination in Europe: drivers and barriers
Dr N Parez PhD a, Prof C Giaquinto MD b, C Du Roure PhD c, F Martinon-Torres PhD d, V Spoulou PhD e, Prof P Van Damme PhD f, Prof T Vesikari MD g
Summary
Rotavirus gastroenteritis is a vaccine-preventable disease that confers a high medical and economic burden in more developed countries and can be fatal in less developed countries. Two vaccines with high efficacy and good safety profiles were approved and made available in Europe in 2006. We present an overview of the status of rotavirus vaccination in Europe. We discuss the drivers (including high effectiveness and effect of universal rotavirus vaccination) and barriers (including low awareness of disease burden, perception of unfavourable cost-effectiveness, and potential safety concerns) to the implementation of universal rotavirus vaccination in Europe. By February, 2014, national universal rotavirus vaccination had been implemented in Belgium, Luxembourg, Austria, Finland, Greece, Luxembourg, Norway, and the UK. Four other German states have issued recommendations and reimbursement is provided by sickness funds. Other countries were at various stages of recommending or implementing universal rotavirus vaccination.

A vaccine against serogroup B Neisseria meningitidis: dealing with uncertainty
Sophie M Andrews BSc a, Prof Andrew J Pollard PhD b c
Summary
Neisseria meningitidis is an important cause of invasive bacterial infection in children worldwide. Although serogroup C meningococcal disease has all but disappeared in the past decade as a direct result of immunisation programmes in Europe, Canada, and Australia, meningitis and septicaemia caused by serogroup B meningococci remain uncontrolled. A vaccine (4CMenB) has now been licensed for use in the European Union, comprising three immunogenic antigens (identified with use of reverse vaccinology) combined with bacterial outer-membrane vesicles. The vaccine has the potential to reduce mortality and morbidity associated with serogroup B meningococci infections, but uncertainty remains about the breadth of protection the vaccine might induce against the diverse serogroup B meningococci strains that cause disease. We discuss drawbacks in the techniques used to estimate coverage and potential efficacy of the vaccine, and their effects on estimates of cost-effectiveness, both with and without herd immunity. For parents, and clinicians treating individual patients, the predicted benefits of vaccination outweigh existing uncertainties if any cases can be prevented, but future use of the vaccine must be followed by rigorous post-implementation surveillance to reassess its value to health systems with directly recorded epidemiological data

Nature
Volume 508 Number 7497 pp432-560 24 April 2014
http://www.nature.com/nature/current_issue.html
Editorial
Take care
The United States must tread carefully when building a health-data system.
Guidelines for investigating causality of sequence variants in human disease
D. G. MacArthur, T. A. Manolio, D. P. Dimmock, H. L. Rehm, J. Shendure, G. R. Abecasis, D. R. Adams, R. B. Altman, S. E. Antonarakis, E. A. Ashley, J. C. Barrett, L. G. Biesecker, D. F. Conrad, G. M. Cooper, N. J. Cox, M. J. Daly, M. B. Gerstein, D. B. Goldstein, J. N. Hirschhorn, S. M. Leal, L. A. Pennacchio, J. A. Stamatoyannopoulos, S. R. Sunyaev, D. Valle, B. F. Voight et al.
Affiliations
The discovery of rare genetic variants is accelerating, and clear guidelines for distinguishing disease-causing sequence variants from the many potentially functional variants present in any human genome are urgently needed. Without rigorous standards we risk an acceleration of false-positive reports of causality, which would impede the translation of genomic research findings into the clinical diagnostic setting and hinder biological understanding of disease. Here we discuss the key challenges of assessing sequence variants in human disease, integrating both gene-level and variant-level support for causality. We propose guidelines for summarizing confidence in variant pathogenicity and highlight several areas that require further resource development.

Guidelines for investigating causality of sequence variants in human disease
D. G. MacArthur, T. A. Manolio, D. P. Dimmock, H. L. Rehm, J. Shendure, G. R. Abecasis, D. R. Adams, R. B. Altman, S. E. Antonarakis, E. A. Ashley, J. C. Barrett, L. G. Biesecker, D. F. Conrad, G. M. Cooper, N. J. Cox, M. J. Daly, M. B. Gerstein, D. B. Goldstein, J. N. Hirschhorn, S. M. Leal, L. A. Pennacchio, J. A. Stamatoyannopoulos, S. R. Sunyaev, D. Valle, B. F. Voight et al.
Affiliations
The discovery of rare genetic variants is accelerating, and clear guidelines for distinguishing disease-causing sequence variants from the many potentially functional variants present in any human genome are urgently needed. Without rigorous standards we risk an acceleration of false-positive reports of causality, which would impede the translation of genomic research findings into the clinical diagnostic setting and hinder biological understanding of disease. Here we discuss the key challenges of assessing sequence variants in human disease, integrating both gene-level and variant-level support for causality. We propose guidelines for summarizing confidence in variant pathogenicity and highlight several areas that require further resource development.

PLoS One
[Accessed 26 April 2014]
http://www.plosone.org/
Research Article
Correlates of Complete Childhood Vaccination in East African Countries
Maureen E. Canavan mail, Heather L. Sipsma, Getnet M. Kassie, Elizabeth H. Bradley
Published: April 21, 2014
DOI: 10.1371/journal.pone.0095709
Abstract
Background
Despite the benefits of childhood vaccinations, vaccination rates in low-income countries (LICs) vary widely. Increasing coverage of vaccines to 90% in the poorest countries over the next 10 years has been estimated to prevent 426 million cases of illness and avert nearly 6.4 million childhood deaths worldwide. Consequently, we sought to provide a comprehensive examination of contemporary vaccination patterns in East Africa and to identify common and country-specific barriers to complete childhood vaccination.
Methods
Using data from the Demographic and Health Surveys (DHS) for Burundi, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, we looked at the prevalence of complete vaccination for polio, measles, Bacillus Calmette–Guérin (BCG) and DTwPHibHep (DTP) as recommended by the WHO among children ages 12 to 23 months. We conducted multivariable logistic regression within each country to estimate associations between complete vaccination status and health care access and sociodemographic variables using backwards stepwise regression.
Results
Vaccination varied significantly by country. In all countries, the majority of children received at least one dose of a WHO recommended vaccine; however, in Ethiopia, Tanzania, and Uganda less than 50% of children received a complete schedule of recommended vaccines. Being delivered in a public or private institution compared with being delivered at home was associated with increased odds of complete vaccination status. Sociodemographic covariates were not consistently associated with complete vaccination status across countries.
Conclusions
Although no consistent set of predictors accounted for complete vaccination status, we observed differences based on region and the location of delivery. These differences point to the need to examine the historical, political, and economic context of each country in order to maximize vaccination coverage. Vaccination against these childhood diseases is a critical step towards reaching the Millennium Development Goal of reducing under-five mortality by two-thirds by 2015 and thus should be a global priority.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 26 April 2014)
Policy Forum
Optimal Evidence in Difficult Settings: Improving Health Interventions and Decision Making in Disasters
Martin Gerdin mail, Mike Clarke, Claire Allen, Bonnix Kayabu, William Summerskill, Declan Devane, Malcolm MacLachlan, Paul Spiegel, Anjan Ghosh, Rony Zachariah, Saurabh Gupta,
Virginia Barbour, Virginia Murray, Johan von Schreeb
Published: April 22, 2014
DOI: 10.1371/journal.pmed.1001632

Summary Points
:: As for any type of health care, decisions about interventions in the context of natural disasters, conflict, and other major healthcare emergencies must be guided by the best possible evidence.
:: Disaster health interventions and decision making can benefit from an evidence-based approach.
:: We outline how systematic reviews and methodologically sound research can build a much-needed evidence base.
:: We do this from the standpoint of Evidence Aid, an initiative that aims to improve access to evidence on the effects of interventions, actions, and policies before, during, and after disasters and other humanitarian emergencies, so as to improve health-related outcomes.

PLoS Neglected Tropical Diseases
April 2014
http://www.plosntds.org/article/browseIssue.action
Opportunity Cost for Early Treatment of Chagas Disease in Mexico
Janine M. Ramsey, Miguel Elizondo-Cano, Gilberto Sanchez-González, Adriana Peña-Nieves, Alejandro Figueroa-Lara

Abstract
Background
Given current neglect for Chagas disease in public health programs in Mexico, future healthcare and economic development policies will need a more robust model to analyze costs and impacts of timely clinical attention of infected populations.
Methodology/Principal Findings
A Markov decision model was constructed to simulate the natural history of a Chagas disease cohort in Mexico and to project the associated short and long-term clinical outcomes and corresponding costs. The lifetime cost for a timely diagnosed and treated Chagas disease patient is US$ 10,160, while the cost for an undiagnosed individual is US$ 11,877. The cost of a diagnosed and treated case increases 24-fold from early acute to indeterminate stage. The major cost component for lifetime cost was working days lost, between 44% and 75%, depending on the program scenario for timely diagnosis and treatment.
Conclusions/Significance
In the long term, it is cheaper to diagnose and treat chagasic patients early, instead of doing nothing. This finding by itself argues for the need to shift current policy, in order to prioritize and attend this neglected disease for the benefit of social and economic development, which implies including treatment drugs in the national formularies. Present results are even more relevant, if one considers that timely diagnosis and treatment can arrest clinical progression and enhance a chronic patient’s quality of life.

Science
25 April 2014 vol 344, issue 6182, pages 333-440
http://www.sciencemag.org/current.dtl
Editorial
Addressing Vaccine Hesitancy
Barry R. Bloom1, Edgar Marcuse2, Seth Mnookin3
1Barry R. Bloom is a professor at the Harvard School of Public Health, Boston, MA 02115.
2Edgar Marcuse is a professor emeritus at University of Washington School of Medicine, Seattle, WA 98195.
3Seth Mnookin is an assistant professor at the Massachusetts Institute of Technology, Cambridge, MA 02139.

Last month, the World Health Organization certified India and Southeast Asia as being polio-free, an extraordinary achievement given that the polio vaccine was declared safe and effective only 59 years ago. Vaccines are one of the safest and most cost-effective medical interventions in history. By immunizing infants, children, and teenagers, vaccines protect the entire community. Nevertheless, there is a surge of outbreaks in vaccine-preventable diseases in the United States. What research is needed to reverse this trend?

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary

Journal of School Health
June 2014 Volume 84, Issue 6 Pages 349–415
http://onlinelibrary.wiley.com/doi/10.1111/josh.2014.84.issue-6/issuetoc
RESEARCH ARTICLE
Opportunities for Increasing Human Papillomavirus Vaccine Provision in School Health Centers
Jennifer L. Moss MSPH1, Ashley L. Feld MPH2, Brittany O’Malley MPH, CHES3, Pamela Entzel JD, MPH4, Jennifer S. Smith PhD, MPH5, Melissa B. Gilkey PhD6 and Noel T. Brewer PhD7,*
Article first published online: 21 APR 2014
DOI: 10.1111/josh.12158
ABSTRACT
BACKGROUND
Uptake of human papillomavirus (HPV) vaccine remains low among adolescents in the United States. We sought to assess barriers to HPV vaccine provision in school health centers to inform subsequent interventions.
METHODS
We conducted structured interviews in the fall of 2010 with staff from all 33 school health centers in North Carolina that stocked HPV vaccine.
RESULTS
Centers had heterogeneous policies and procedures. Out-of-pocket costs for children and youth to receive privately purchased HPV vaccine were a key barrier to providing HPV vaccine within school health centers. Other barriers included students not returning consent forms, costs to clinics of ordering and stocking privately purchased HPV vaccine, and difficulty using the statewide immunization registry. Most (82%) school health centers were interested in hosting interventions to increase HPV vaccine uptake, especially those that the centers could implement themselves, but many had limited staff to support such efforts. Activities rated as more likely to raise HPV vaccine uptake were student incentives, parent reminders, and obtaining consent from parents while they are at school (all ps < .05).
CONCLUSIONS
Although school health centers reported facing several key barriers to providing HPV vaccine, many were interested in partnering with outside organizations on low-cost interventions to increase HPV vaccine uptake among adolescents.

Drug and Alcohol Dependence
Available online 16 April 2014
http://www.sciencedirect.com/science/article/pii/S0376871614008291
Vaccine for Cocaine Dependence: A Randomized Double-Blind Placebo-Controlled Efficacy Trial
Thomas R. Kostena, Coreen B. Domingoa, Daryl Shortera, Frank Orsona, Charles Greenb, Eugene Somozac, Rachelle Sekerkac, Frances R. Levind, John J. Marianid, Maxine Stitzere, D. Andrew Tompkinse, John Rotrosenf, Vatsal Thakkarf, Benjamin Smoakf, Kyle Kampmang
Abstract
Aims
We evaluated the immunogenicity, efficacy, and safety of succinylnorcocaine conjugated to cholera toxin B protein as a vaccine for cocaine dependence.
Methods
This 6-site, 24 week Phase III randomized double-blind placebo-controlled trial assessed efficacy during weeks 8 to 16. We measured urine cocaine metabolites thrice weekly as the main outcome
Results
The 300 subjects (76% male, 72% African-American, mean age 46 years) had smoked cocaine on average for 13 days monthly at baseline. We hypothesized that retention might be better and positive urines lower for subjects with anti-cocaine IgG levels of ≥ 42 μg/mL (high IgG), which was attained by 67% of the 130 vaccine subjects receiving five vaccinations. Almost 3-times fewer high than low IgG subjects dropped out (7% vs 20%). Although for the full 16 weeks cocaine positive urine rates showed no significant difference between the three groups (placebo, high, low IgG), after week 8, more vaccinated than placebo subjects attained abstinence for at least two weeks of the trial (24% vs 18%), and the high IgG group had the most cocaine-free urines for the last 2 weeks of treatment (OR = 3.02), but neither were significant. Injection site reactions of induration and tenderness differed between placebo and active vaccine, and the 29 serious adverse events did not lead to treatment related withdrawals, or deaths
Conclusions
The vaccine was safe, but it only partially replicated the efficacy found in the previous study based on retention and attaining abstinence.

Agence France-Presse
April 23, 2014
WHO hits back at anti-vaccine deniers
Excerpt
The World Health Organization hit back on Wednesday against vaccine deniers who claim that immunisation is pointless, risky and that the body is better off fighting disease unaided.
“The impact of vaccines on people’s lives is truly one of the best things that one could see out there,” said Jean-Marie Okwo-Bele, head of the UN health agency’s immunisation and vaccines division.

Opposition to routine vaccination of children against contagious diseases such as measles and whooping cough has been on the rise in recent years, notably in the United States and Britain.
A hardline minority disputes the necessity of vaccination outright, while doubters focus on fears such as the alleged links between measles vaccines and autism, rejected by the overwhelming majority of scientists.

“We’re trying hard to contain and reverse the trend,” Okwo-Bele told reporters. “We have a huge proportion of people who believe in vaccines. They need to help us convey the messages,” he added.

The total or near-complete disappearance of many killer or crippling diseases in rich nations has bred complacency, according to the WHO.

“The important thing about complacency is that the number of susceptible people who resist or reject facts and information will accumulate, and the disease will come back, as you’re seeing in the United States with measles and whooping cough, which are terrible diseases,” said WHO immunisation expert Tracey Goodman….

The Huffington Post
http://www.huffingtonpost.com/
Accessed 26 April 2014
A Remarkable Achievement: 80 Percent of the World Now Polio-Free
Posted: 04/21/2014 8:05 am EDT
Tom Frieden, MD, MPH
Director, Centers for Disease Control and Prevention (CDC)
Excerpt
I’m recently back from New Delhi where I attended meetings on global health security, tuberculosis, and HIV — and very importantly, participated in the World Health Organization’s event to certify Southeast Asia free of polio.
The 11 countries of Southeast Asia — Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste — are home to 1.8 billion people.
This means 80 percent of the world is now polio-free — a remarkable achievement.

Even as we celebrated this important milestone, we acknowledged there’s more to do…

New York Times
http://www.nytimes.com/
Accessed 26 April 2014
U.N. Struggles to Stem Haiti Cholera Epidemic
By RANDAL C. ARCHIBOLD and SOMINI SENGUPTA
APRIL 19, 2014
Excerpt
CHAPOTEAU, Haiti — For three years, the United Nations has refused to address whether its peacekeepers brought a deadly strain of cholera to Haiti, insisting instead that it was more important to help the country stanch the disease once and for all.
But on that score, it is still very far behind. In some ways, Haiti is even less equipped to tackle cholera than it was three years ago.
The United Nations raised barely a fourth of the $38 million it needed last year to provide lifesaving supplies, including the most basic, like water purification tablets. Clinics have run short of oral rehydration salts to treat the debilitating diarrhea that accompanies the disease. Some treatment centers in the countryside have shut down as the aid groups that ran them have moved on to other crises. And a growing share of patients are dying after they finally reach hospitals, according to the United Nations’ own assessments…

…The United Nations has yet to raise the $5 million necessary to vaccinate 600,000 vulnerable people right away — as the rainy season approaches and the threat of waterborne illnesses like cholera looms — let alone the $2 billion that it promised to raise from rich countries to build Haiti’s water and sanitation infrastructure, which public health experts say is vital to ridding the country of cholera.

Pedro Medrano Rojas, the United Nations secretary general’s newly appointed envoy for the cholera outbreak, attributed the shortfall to global “donor fatigue” in the face of other humanitarian crises.
“Had we had the resources it would have been different,” Mr. Medrano said. “It’s not expensive. No one should be dying from cholera.”
Since the outbreak began in October 2010, 8,562 people in Haiti have died of cholera. New infections have declined, following the typical trajectory of an epidemic, from a peak of more than 350,000 reported cases in 2011 to a little more than 50,000 cases in 2013….

WHO: World Immunization Week 2014: Know, Check, Protect
17 April 2014 — Immunize for a healthy future: Know, Check, Protect. This is the message of this year’s World Immunization Week, on 24-30 April. This short video encourages you to ask your local health clinic which vaccines you need, check whether your vaccinations are up-to-date, and to get the vaccines you need, when you need them.
Find out more about World Immunization Week

GAVI Watch [to 19 April 2014]
http://www.gavialliance.org/library/news/press-releases/

:: Press Release: East Africa – Germany Contributes 20 Million Euros to EAC to Support Immunisation Programme in Collaboration With GAVI
AllAfrica | 16 April 2014
Excerpt
East African Community Secretariat; Arusha; 16 April 2014: The Federal Republic of Germany today signed an intergovernmental agreement with the East African Community (EAC) in order to support vaccinations in the region. Germany makes available a financial contribution of 20 million Euros in support of an immunisation programme that will be implemented in collaboration with the GAVI Alliance.

The GAVI Alliance is a public-private global health partnership committed to saving children’s lives and protecting people’s health by increasing access to immunization in poor countries.
Amb. Dr. Richard Sezibera, Secretary General of the EAC and Member of the GAVI Board, during the signing ceremony expressed his appreciation to the Federal Republic of Germany for its support in saving lives. “This is a very important and critical programme, and I am sure with such commitment, it will grow. There is need for immediate support in the coordination of cold chain logistics,” Amb. Sezibera said. The Secretary General stated the EAC Partner States are all introducing antigens simultaneously, making cold chain logistics support vital…

GPEI Update: Polio this week – As of 16 April 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: In central Africa, a new wild poliovirus type 1 (WPV1) case was reported in Equatorial Guinea. In total, three cases have now been reported from the country; genetic sequencing indicates the cases are linked to an ongoing WPV1 outbreak in Cameroon. Outbreak response in the country is currently being planned.
:: On 17 March, the World Health Organization (WHO) had elevated the risk assessment of international spread of polio from Cameroon to ‘very high’. The risk assessment was elevated due to: confirmation of additional WPV1 cases from three new regions of Cameroon confirming continued WPV transmission and geographic expansion of infected areas following detection of four cases in October 2013; gaps in surveillance; and, influx of vulnerable refugee populations from Central African Republic.
:: Immunity levels and surveillance sensitivity are also being assessed in neighbouring countries, in particular in Gabon and the Republic of Congo, and additional immunization activities are being planned in these countries for May.
Pakistan
:: Four new WPV1 cases were reported this week including two from South Waziristan, Federally Administered Tribal Areas – FATA, one from Bannu district, Khyber Pakhtunkhwa (KP), and one from Karachi (Khiorangi), Sindh, bringing the total number of cases for 2014 to 47. The most recent reported case had onset of paralysis on 30 March from Khiorangi, previously a polio-free district…
:: North Waziristan is the district with the largest number of children being paralyzed by poliovirus in the world (both wild and cVDPV2). Immunization activities have been suspended by local leaders since June 2012. It is critical that children in all areas are vaccinated and protected from poliovirus. Immunizations in neighboring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.
:: The densely populated Peshawar valley is considered to be the main ‘engine’ of poliovirus transmission, alongside North Waziristan, due to large-scale population movements through Peshawar from across this region, and into other areas of Pakistan. The quality of operations must be urgently improved in Peshawar, and immunization activities urgently resumed in North Waziristan.
Central Africa
:: In Equatorial Guinea, a new WPV1 case was reported this week from Bata district, Litoral province, with onset of paralysis on 16 March. The total number of WPV1 cases reported from Equatorial Guinea for 2014 is three.
:: Due to continued poliovirus circulation in Cameroon, gaps in surveillance quality and influx of vulnerable populations from Central African Republic (CAR), WHO had elevated the risk assessment of international spread of polio from Cameroon to ‘very high’ in March of 2014.
:: Since confirmation of the outbreak in Cameroon in October, six nationwide campaigns have been conducted. However, the quality of implementation has varied greatly by region, and serious coverage gaps remain. As many as 40% of children remain under-immunized (with 30% having received zero doses) during SIAs.
:: The recent confirmation of new cases in Cameroon has resulted in planning additional emergency outbreak response activities, including converting a subnational immunization campaign to a full nationwide activity on 11-13 April, and implementing nationwide campaigns in May and June. Critical to success will be to ensure substantial improvement in the quality campaigns so that all children are reached multiple times with OPV. Equally important will be efforts to rapidly improve the quality of surveillance so that the full extent of the outbreak can be determined and tracked.
:: Immunity levels and surveillance sensitivity are also being assessed in neighboring countries, in particular in Gabon and the Republic of Congo, and additional immunization activities are being planned in these countries for May.

Militant-infested areas: polio drops to be administered at security checkpoints [Pakistan]
April 15, 2014
BUSINESS RECORDER REPORT/Agence France-Presse
Government officials said Monday they would begin administering polio vaccines to children at security checkpoints in the country’s lawless tribal belt to protect against Taliban attacks. The announcement was made at a ceremony to mark the launch of a three-day anti-polio campaign in Peshawar, and is aimed at children from North Waziristan and other Taliban strongholds.
Farakh Sair Khan, a senior administrative official for the restive tribal areas, told the gathering the new strategy would “vaccinate children belonging to areas that are not accessible for the polio workers.” “North Waziristan is affected most by the polio virus and unfortunately we had not been able to vaccinate the children there for security reasons but we are trying to overcome it,” Khan said.
As many as 2643 polio teams will be participating in the campaign to vaccinate children under five, he added. “We will establish over 50 vaccination sites next to the checkpoints of security forces,” said Shahdab Younis, an official of the UNICEF told AFP. “Establishing these sites next to security checkpoints will minimise the risk of attacks,” she added. She said the move would also pressure parents – many of whom believe polio drops are a Western ploy to sterilise Muslims – into allowing their children to be vaccinated, due to the intimidating presence of armed troops. “We have received 37 new cases of polio in the first three months of this year, 33 of them are from North Waziristan,” Younis said.
“Polio vaccination was banned in North Waziristan since 2012 and the children there have not been vaccinated against polio since,” she added. Meanwhile, a separate official said talks had begun with the army, whose co-operation would be required. “We are discussing it with the army because most of the security checkpoints belong to (them),” the official told AFP on condition of anonymity.
http://www.brecorder.com/general-news/172/1173270/

Focusing on Hard-to-Reach Children for Polio Vaccination Campaign in Syria
Posted: 13/04/2014 23:12
Huffington Post
Razan Rashidi, UNICEF Syria communications officer
Excerpt
More than six months after confirmation of the first polio case in Syria, Unicef continues to support efforts to tackle the outbreak in all parts of the country. The April nationwide polio round which started this week aims to reach 2.8million children across Syria with a special focus on hard-to-reach children in conflict zones and besieged areas. It is essential that all children are vaccinated; of the 26 confirmed polio cases in five different Syrian governorates, nearly all had not been vaccinated at all or had not participated in enough rounds of the vaccine, according to Unicef and the Syrian Ministry of Health…
…To improve access, Unicef is supporting local NGOs and the Syrian Arab Red Crescent. In Qudsaya city, for example, which has been sealed off for more than a month, local youth volunteers from Child Rights Society (CRS) are helping out. “We ride a bus and I use a loud speaker, calling parents to bring their under five children for the polio drops,” says a CRS volunteer.
Last month, more than 75,000 children were vaccinated in areas which were previously classified as inaccessible. “Some parents were totally unaware of the outbreak and the vital need for vaccination,” says another volunteer vaccinator. “The use of mosques to announce the campaign proved to be useful.” Unicef is supporting a national communication plan to raise awareness of the campaign among parents.
“It is very positive to see an increase in the number of vaccinated children across Syria,” says Youssouf Abdel-Jelili, Unicef Representative in Syria. “There is still work to be done to reach every child.”
It is estimated that 104,000 children have not been vaccinated in any of the five rounds to date, mainly in East and West Ghouta areas of Rural Damascus Governorate, including parts of Douma district and some villages in Zabadani district.
The support of many donors, including the Governments of Germany and Kuwait, and the UK Department for International Development (DfID), has been vital. Unicef has provided the Ministry of Health with 15million doses of polio vaccine in support of the campaign, and placed an order for an additional three million to cover the May round.
Full text: http://www.huffingtonpost.co.uk/razan-rashidi/syria-humanitarian-aid_b_5131941.html?utm_hp_ref=uk

The Weekly Epidemiological Record (WER) for 18 April 2014, vol. 89, 16 (pp. 161–164) includes:
:: Severe atypical pneumonia outbreak associated with influenza A(H1N1)pdm09 in Egypt, 2013–2014 season
http://www.who.int/entity/wer/2014/wer8916.pdf?ua=1

WHO: Global Alert and Response (GAR) – Disease Outbreak News [to 19 April 2014]
http://www.who.int/csr/don/2013_03_12/en/index.html
:: Ebola virus disease, West Africa – update 17 April 2014
Excerpt
Guinea
As of 18:00 on 16 April, the Ministry of Health (MOH) of Guinea has reported a cumulative total of 197 clinical cases of Ebola Virus Disease (EVD), including 122 deaths…
Mali
The Ministry of Health (MOH) of Mali has on the 16th April reported that the clinical samples on the 6 suspected cases have tested negative for ebolavirus…
Liberia
As of 16 April the Ministry of Health and Social Welfare (MOHSW) of Liberia has reported a cumulative total of 27 clinical cases of EVD, including 13 deaths attributed to EVD….
Sierra Leone
On 15 April, the Ministry of Health and Sanitation (MOHS) provided a consolidated report of surveillance activities conducted in that country from 19 March onwards…
…WHO does not recommend that any travel or trade restrictions be applied to Guinea, Liberia, Mali or Sierra Leone based on the current information available for this event.
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 17 April 2014
Excerpt
On 17 April 2014, the Ministries of Health of Malaysia and the United Arab Emirates (UAE) reported an additional 5 laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV)…
…This is the first case with MERS-CoV infection in the country [Malaysia]. The Ministry of Health reported that so far no human-to-human transmission has been observed amongst close contacts and in health-care facilities in Malaysia…
…Globally, from September 2012 to date, WHO has been informed of a total of 243 laboratory-confirmed cases of infection with MERS-CoV, including 93 deaths.
WHO advice
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns….
:: Human infection with avian influenza A(H7N9) virus – update 16 April 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 16 April 2014
:: Human infection with avian influenza A(H7N9) virus – update 15 April 2014
:: Ebola virus disease, West Africa – update 14 April 2014
:: Human infection with avian influenza A(H7N9) virus – update 14 April 2014
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 14 April 2014

Global Fund Watch [to 19 April 2014]
http://www.theglobalfund.org/en/mediacenter/newsreleases/

Vulnerable Groups Key to Defeating AIDS
16 April 2014
Excerpt
KINGSTON, Jamaica – Government representatives, civil society and technical partners from nine Caribbean countries held intense discussions on how new funding made available from the generous contributions of major donors to the Global Fund will support their efforts to bring the AIDS epidemic under control and build sustainable health systems.
Many countries in the region fund the majority of their own national programs, but additional resources can play a significant role.
There was agreement among many participants in the meeting that by using the new funding model to help target the most vulnerable they could achieve high impact and a sharper fall in infection rates, thereby helping to put health interventions on a firmer long-term footing.
“We want to use the new funding model as an opportunity to strengthen the health system and we have to emphasize a community-based approach,” said Haiti’s Health Minister Florence Guillaume. “By creating a foundation in countries like Haiti we can have a better health impact and maintain the results obtained.”
“If we can prove that health investment is not a charity but an investment in access to services, people will be in good health. A good labor force is good for growth and that will reduce dependence on external donors,” said Guillaume.
Among partners represented at the meeting were the Pan American Health Organization (PAHO), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Development Program (UNDP) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)….

Congressional Testimony: Written Testimony Submitted by Margaret G. McGlynn, President and CEO of IAVI, regarding Funding for AIDS Vaccine R&D to the U.S. House Appropriations Subcommittee on State, Foreign Operations and Related Programs/FY 2015 President’s Budget Request
April 4, 2014
Full text: http://www.iavi.org/Information-Center/Press-Releases/Pages/Margie-McGlynn-Submits-Written-Testimony-to-US-Congress-On-Funding-for-AIDS-Vaccine-RD.aspx

The American Journal of Bioethics
Volume 14, Issue 4, 2014
http://www.tandfonline.com/toc/uajb20/current

Target Article
Is There an Ethical Obligation to Disclose Controversial Risk? A Question From the ACCORD Trial
Joseph P. DeMarcoa*, Paul J. Fordb, Dana J. Pattonb & Douglas O. Stewarta
DOI: 10.1080/15265161.2014.889240
Abstract
Researchers designing a clinical trial may be aware of disputed evidence of serious risks from previous studies. These researchers must decide whether and how to describe these risks in their model informed consent document. They have an ethical obligation to provide fully informed consent, but does this obligation include notice of controversial evidence? With ACCORD as an example, we describe a framework and criteria that make clear the conditions requiring inclusion of important controversial risks. The ACCORD model consent document did not include notice of prior trials with excess death. We develop and explain a new standard labeled risk in equipoise. We argue that our approach provides an optimal level of integrity to protect the informational needs of the reasonable volunteers who agree to participate in clinical trials. We suggest language to be used in a model consent document and the informed consent discussion when such controversial evidence exists.

British Medical Journal
19 April 2014 (Vol 348, Issue 7954)
http://www.bmj.com/content/348/7954

The impact of antibiotics on growth in children in low and middle income countries: systematic review and meta-analysis of randomised controlled trials
BMJ 2014;348:g2267 (Published 15 April 2014)

Editorial
Excerpt
Worth studying in highly selected children, with a close eye on potential harms
Overt infections are a leading cause of death worldwide in children under 5,1 and strategies to prevent and treat infections are a cornerstone of child survival programmes. Recent assessments suggest that despite a net increase in the size of birth cohorts, the number of children dying before their fifth birthday has fallen to 6.6 million (uncertainty range 6.3-7.0 million) per year, a 45% reduction from almost 12 million deaths in 1990.2 In contrast, the fall in undernutrition has been modest at best. An estimated 165 million children under 5 were stunted in 2011 and an estimated 52 million severely wasted; almost 45% of the current burden from child mortality in under 5s can be attributed to malnutrition.3 Although many risk factors for early child mortality are well recognised, the mechanisms underlying chronic enteropathy and growth failure among children in low and middle income countries remain uncertain.4
In a linked paper, Gough and colleagues (doi:10.1136/bmj.g2267) report a systematic review of 10 trials looking for associations between antibiotics, given for a variety of indications, and growth in childhood.5 The review included 4316 children (age range 1 month to 12 years) from low and middle income countries. The authors’ analysis using random effects models suggests that antibiotic use was associated with increased mean height or linear growth (extra linear growth 0.04 cm/month, 95% confidence interval 0.00 to 0.07) and an extra 23.8 g weight gain per month (95% confidence interval 4.3 to 43.3 g). The authors recommend further evaluation of the growth promoting effect of antibiotics and speculate that the effects may operate through reduction in subclinical infections and beneficial effects on intestinal microbiota…
…There is a clear need for further research in this area to help us understand precisely how antibiotics might promote growth in children. Researchers could start by characterising high risk groups of children who might benefit, such as those with clearly defined subclinical or overt infections, HIV, or severe acute malnutrition. Further trials should be done to confirm the interesting findings from Malawi.7 But extending trials of antibiotics to other categories of children, such as those at risk of malnutrition and growth failure, may not be justifiable at this stage. Researchers should instead exploit existing observational cohorts to explore the relation between infections, antibiotic treatment, and nutrition outcomes, including growth patterns, where data are available. The large multicentre Mal-ED studies assessing patterns of growth among infants 0-24 months of age across eight countries (www.fnih.org/work/key-initiatives/mal-ed) are an excellent example of an opportunity to assess the potential impact of antibiotic treatment on linear growth and weight gain using standardised data and definitions. In the interim, continued focus on the 10 recommended evidence based nutrition interventions to promote growth15 must be prioritised.

Abstract
Objectives To determine whether antibiotic treatment leads to improvements in growth in prepubertal children in low and middle income countries, to determine the magnitude of improvements in growth, and to identify moderators of this treatment effect.
Design Systematic review and meta-analysis.
Data sources Medline, Embase, Scopus, the Cochrane central register of controlled trials, and Web of Science.
Study selection Randomised controlled trials conducted in low or middle income countries in which an orally administered antibacterial agent was allocated by randomisation or minimisation and growth was measured as an outcome. Participants aged 1 month to 12 years were included. Control was placebo or non-antimicrobial intervention.
Results Data were pooled from 10 randomised controlled trials representing 4316 children, across a variety of antibiotics, indications for treatment, treatment regimens, and countries. In random effects models, antibiotic use increased height by 0.04 cm/month (95% confidence interval 0.00 to 0.07) and weight by 23.8 g/month (95% confidence interval 4.3 to 43.3). After adjusting for age, effects on height were larger in younger populations and effects on weight were larger in African studies compared with other regions.
Conclusion Antibiotics have a growth promoting effect in prepubertal children in low and middle income countries. This effect was more pronounced for ponderal than for linear growth. The antibiotic growth promoting effect may be mediated by treatment of clinical or subclinical infections or possibly by modulation of the intestinal microbiota. Better definition of the mechanisms underlying this effect will be important to inform optimal and safe approaches to achieving healthy growth in vulnerable populations.

Eurosurveillance
Volume 19, Issue 15, 17 April 2014
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678
Surveillance and outbreak reports
Infectious diseases prioritisation for event-based surveillance at the European Union level for the 2012 Olympic and Paralympic Games
A Economopoulou1, P Kinross 1, D Domanovic1, D Coulombier1
European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
Summary
In 2012, London hosted the Olympic and Paralympic Games (the Games), with events occurring throughout the United Kingdom (UK) between 27 July and 9 September 2012. Public health surveillance was performed by the Health Protection Agency (HPA). Collaboration between the HPA and the European Centre for Disease Prevention and Control (ECDC) was established for the detection and assessment of significant infectious disease events (SIDEs) occurring outside the UK during the time of the Games. Additionally, ECDC undertook an internal prioritisation exercise to facilitate ECDC’s decisions on which SIDEs should have preferentially enhanced monitoring through epidemic intelligence activities for detection and reporting in daily surveillance in the European Union (EU). A team of ECDC experts evaluated potential public health risks to the Games, selecting and prioritising SIDEs for event-based surveillance with regard to their potential for importation to the Games, occurrence during the Games or export to the EU/European Economic Area from the Games. The team opted for a multilevel approach including comprehensive disease selection, development and use of a qualitative matrix scoring system and a Delphi method for disease prioritisation. The experts selected 71 infectious diseases to enter the prioritisation exercise of which 27 were considered as priority for epidemic intelligence activities by ECDC for the EU for the Games.

Globalization and Health
[Accessed 19 April 2014]
http://www.globalizationandhealth.com/
Debate
Challenges faced by multi-displinary new investigators on addressing grand challenges in global health
Logie C, Dimaras H, Fortin A and Ramón-García S Globalization and Health 2014, 10:27 (15 April 2014)
Abstract (provisional)
Background
The grand challenges approach aims to spark innovative and transformative strategies to overcome barriers to significant global health issues. Grand Challenges Canada endorses an ‘Integrated InnovationTM’ approach that focuses on the intersection of scientific/technological, social and business innovation. In this article we explore themes emerging from a dialogue between the authors, who are multi-disciplinary recipients of the ‘Rising Stars in Global Health’ award from Grand Challenges Canada, regarding benefits of engaging in integrated innovation research, and recommendations for how this approach may develop in the future.
Discussion
Our dialogue followed a semi-structured interview format that addressed three topics: 1) reflections on applying an Integrated InnovationTM approach for global health; 2) thoughts on participation in the Grand Challenges 2012 meeting; and 3) authors’ visions of Grand Challenges Canada and the Grand Challenge movement towards 2020. The dialogue was transcribed verbatim and we used thematic analysis techniques to identify, analyze and report themes in the data. Benefits of working using the Grand Challenges approach centered on two themes: a) the potential for scientific breakthrough and b) building interdisciplinary collaborations and a community of scholars. Challenges and opportunities for Grand Challenges in moving forward included: a) capacity building, particularly regarding Integrated InnovationTM and scale-up planning; b) interdisciplinary and international mentorship for new investigators; and c) potential for future commercialization.
Conclusions
Our discussion highlighted that Integrated InnovationTM offers the opportunity to develop new theories, methods and approaches to global health while simultaneously fostering a collaborative spirit grounded in international, interdisciplinary collaborations. However, the arguable over-emphasis on corporatization poses a major challenge for new investigators. We propose a more balanced way forward that can harness technology to foster mentorship across time and space to support the development of such skills and ideas among new investigators.

The Lancet
Apr 19, 2014 Volume 383 Number 9926 p1359 – 1436
http://www.thelancet.com/journals/lancet/issue/current

Editorial
Water and sanitation: addressing inequalities
The Lancet
“Water is life”, said UN Secretary-General Ban Ki-moon, at the opening session of the high-level meeting on sanitation and water for all, in Washington, DC, on April 11, 2014. Yet lack of access to safe drinking water, and poor sanitation and hygiene in many parts of the world, often leads to death. The Lancet Series on childhood pneumonia and diarrhoea estimated that in 2011 around 700 000 child deaths occurred from diarrhoeal disease alone. The Millennium Development Goal (MDG) 7c target to halve the proportion of people without sustainable access to safe water by 2015 has been declared on track, yet 768 million people globally are still without access to safe drinking water. In a letter in today’s Lancet, Mira Johri and colleagues argue that the indicator does not consider water quality, and should be reconsidered. Progress for sanitation is alarmingly off track. An estimated 2•5 billion people lack access to basic sanitation (functioning toilets and safe means to dispose of human faeces). A shocking 1 billion people practice open defecation, with one in nine living in rural areas. The high-level meeting gathered ministers and representatives of finance, health, and water and sanitation from 46 countries, donors, international organisations, and civil society to discuss how to reach water and sanitation targets. Margaret Chan and Jim Kim were both in attendance. The UN-Water Global Analysis and Assessment of Sanitation and Drinking—Water (GLAAS) project, led by WHO, simultaneously released a preliminary report – Investing in Water and Sanitation: Increasing Access, Reducing Inequalities Special Report for the Sanitation and Water for All (SWA) High-Level Meeting (HLM). The report comprehensively analysed whether an enabling environment (governance, monitoring and evaluation, financing) for reaching water and sanitation targets exists for each country. The full report will be released in September, 2014, with data from 90 countries.

The good news is that there is progress. Cambodia for example, has increased access to safe water and sanitation in urban areas for all quintiles by implementing pro-poor policies. 7% of the population in urban areas practice open defecation, reduced from 28% in 2005. 75% of countries analysed have pro-poor universal access to water and sanitation policies, and three-quarters of countries have constitutions or legislation recognising the human right to water and sanitation. The alarming news is that although many countries have established policies for disadvantaged groups (poor individuals, populations with disabilities, urban slums, and remote communities), only 30% have financed implementation plans, and household contributions range from 6—97% of water, sanitation, and hygiene financing. More than 50% of the unserved population for water and sanitation live in middle-income countries .
Access to safe water and sanitation is essential to all development outcomes across the life course. It ensures healthy growth and prevention of water-borne and food-borne diseases causing diarrhoea, which contributes to stunting in children. Contaminated and stagnant water also contribute to the global burden of trachoma, and vector-borne diseases. 165 million children worldwide with stunted growth risk compromised cognitive development, physical capabilities, and future school performance; resulting in a less productive generation, with unfulfilled potential to contribute to the workforce and the economy.

Beyond direct health outcomes, investing in water and sanitation is essential to achievement of post—2015 sustainable development goals. The Lancet highlights four areas going forward. First, the poor must remain central to all planning, because they pay the highest individual cost in health and finances in efforts to access safe drinking water and sanitation. Donors and governments must target and urgently address open defecation in particular. Second, girls and women must be prioritised. They travel long distances to fetch water, and the lack of private sanitation facilities at schools to ensure their dignity and safety risks absenteeism and drop out. Third, in fragile states and situations, access to health services, clean water, and sanitation must be secured, rapidly and without question. The supply of clean drinking water and sanitation facilities can be the difference between life and death, not to mention risks to personal security. Fourth, and finally, with the rapid and uncontrolled growth of urban slums, climate change, conflict over water resources, and growing global demand for products and food that require water for production, all sectors beyond health must develop governance mechanisms to ensure that access to safe water, sanitation, and hygiene, is a right for all. Only then can the global community return to the notion of water as life.

New England Journal of Medicine
April 17, 2014 Vol. 370 No. 16
http://www.nejm.org/toc/nejm/medical-journal
Perspective
The Calculus of Cures
R. Kocher and B. Roberts
Excerpt
In 2013, the Food and Drug Administration (FDA) approved 27 new drugs for marketing. Eight of these drugs are for orphan diseases, including six rare cancers. In fact, more than half of the 139 drugs approved by the FDA since 2009 are for orphan diseases and cancers.1 This disproportion is not solely the result of scientific breakthroughs; the economics of drug development and the business of health care delivery also play large roles. Although these drugs may end up being critically important to patients with the targeted diseases, we believe we must avoid systematically underinvesting in drugs in other important areas of medicine…

PLoS Neglected Tropical Diseases
March 2014
http://www.plosntds.org/article/browseIssue.action
Electronic Data Capture Tools for Global Health Programs: Evolution of LINKS, an Android-, Web-Based System
Alex Pavluck mail, Brian Chu, Rebecca Mann Flueckiger, Eric Ottesen
Excerpt
Introduction
The rapid expansion of mobile networks globally, coupled with the decreasing cost of mobile equipment [1], is allowing global health programs increasingly to utilize mobile- and cloud-based technology in their efforts to target important challenges to public health. Our initial electronic data collection system employed personal digital assistants (PDAs) [2], [3], but these proved to have significant cost and scalability limitations. The present report describes a second-generation, more efficient, cloud-based, smartphone-based system and the key elements that lead to its greater efficiency.

The LINKS System
While there are a number of tools available for data collection (EpiCollect, FormHub, EpiInfo, and others), these tools were not ideal for our purposes because of either license restrictions or other challenges. The starting point for the new mobile application, called the LINKS system (Figure 1), was the open source project Open Data Kit (ODK) [4], [5]. ODK allows the collection of a wide range of data using only the internal components of smartphone devices, such as the built-in GPS and the camera that can be used as a barcode scanner.

Data flow from the point of entry (cellular phones/tablets), to encrypted transmission to the cloud, to access and management of the data through a web interface.

A server-based application (app) processes incoming data and writes those data to a database. A dynamic web interface was developed to present the collected data to the user in the form of tables, graphs, maps, and downloadable datasets. The system was deployed on Ubuntu Linux, running on Amazon.com’s Elastic Cloud (AWS EC2, http://aws.amazon.com/ec2/) infrastructure. Geotrust secure certificates were installed to encrypt the data during transmission and between the user’s browser and the server. Data are managed through a web interface or downloaded for offline use outside of the system.

The LINKS system was initially developed to address shortcomings of the earlier PDA-based data-capture systems and to support the interests of the Neglected Tropical Diseases (NTDs) community in employing an integrated approach to the NTDs using shared technical platforms. The LINKS system can support mobile technology running on a wide range of locally accessible hardware be used in both highly connected (internet) and connection-poor settings have a mechanism to deploy additional surveys to equipment already in the field be built entirely with industry-standard open source software to avoid costly licensing fees be cloud-based to allow for centralized management and increase scalability for large, highly dispersed projects
Since its launch in June of 2011, the LINKS system has been deployed to over 20 countries by multiple partner organizations (Table 1)…