Vaccines and Global Health: The Week in Review 20 December 2014

Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

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pdf version A pdf of the current issue is available here: Vaccines and Global Health_The Week in Review_20 December 2014

blog edition: comprised of the approx. 35+ entries posted below on this date.

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.Vaccines and Global Health: The Week in Review will resume publication on 3 January 2015 following a holiday break.
David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– The Wistar Institute Vaccine Center
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

GVAP Assessment – 2014

Editor’s Note:
The Global Vaccine Action Plan (2011-2020) is the current, overarching framework integrating global immunization strategy, goals and indicators. The GVAP was the product of an extraordinary process – the Decade of Vaccines Collaboration – fueled by hundreds of volunteer experts from across international agencies, governments, INGOs, academia, industry and civil society.

The 2014 technical analysis and evaluation of performance against GVAP’s goals and indicators was recently completed by the GVAP Secretariat, which, in turn, supported an assessment and a set of action recommendations by the WHO SAGE Working Group on GVAP.

This work is captured in three key documents highlighted below, and will be considered by the WHO Executive Board at its January meeting. We recommend downloading and reading this documentation.

EB136/25 – Global vaccine action plan: Report by the Secretariat
12 December 2014
WHO Executive Board – 136th session
26 January–3 February: Geneva
Meeting Documentation:

…3. In accordance with the monitoring, evaluation and accountability process, the Strategic Advisory Group of Experts on immunization reviewed progress against each of the indicators for the goals and strategic objectives of the global vaccine action plan, based on data from 2013, and prepared the 2014 Assessment Report of the Global Vaccine Action Plan…

1. The Global Vaccine Action Plan (GVAP) has two great ambitions, to make 2011–2020 the Decade of Vaccines:
:: To deliver vaccination to all – and through this: to end inequity in vaccination, eradicate polio globally, eliminate maternal and neonatal tetanus globally, and eliminate (guided by regional targets) measles and rubella.
:: To unleash vaccines’ vast future potential – because their impressive history is nothing in comparison to what they could yet achieve.
2. The Strategic Advisory Group of Experts on immunization noted that there has been success in introducing new vaccines, and positive achievements in numerous countries in several areas, including the establishment and strengthening of National Immunization Technical Advisory Groups. However, progress is far off-track. Five of the six goals set by the GVAP with deadlines at the end of 2014 or 2015 still require substantial progress to get the goals on track (poliovirus transmission interruption, maternal and neonatal tetanus, measles and rubella elimination, and DTP3 coverage targets). Indeed, most have seen very little progress. Some have been missed multiple times before.
3. To get the Action Plan back on track, the Strategic Advisory Group of Experts on immunization recommends that action focus particularly on addressing five priority problems. Each problem is major, but each can be tackled, with a reasonable expectation that doing so will improve progress considerably. Each problem is detailed in the full 2014 Assessment Report of the Global Vaccine Action Plan1 of the Strategic Advisory Group of Experts on immunization…

SAGE GVAP Assessment Report 2014
English –
[Initial text from Conclusion]
The Global Vaccine Action Plan was established for very good reasons, to meet major and important needs. Progress towards its key targets is clearly far off-track. This should cause alarm bells to ring loudly. Vaccines are not being delivered equitably or reliably. Through vaccination, diseases such as tetanus and polio should have been consigned to history several years ago – previous targets for doing so have repeatedly been missed.

The five off-track targets are closely related. They are not separate, competing endeavours, but close cousins. The key to achieving all of them lies in strengthening immunization systems.

There are clear areas in which focused action can produce considerable improvement. This report has identified five that are particularly important. If these are acted upon, real progress can be made.

The Global Vaccine Action Plan sets important ambitions. If countries and their partners are to achieve these, dramatic change is needed. If they can do so, millions of deaths will be prevented.

This report’s recommendations need to be implemented with great urgency. The ‘Decade of Vaccines’ is one-third through, and the Global Vaccine Action Plan is an opportunity that should not be lost.

The SAGE, through its Global Vaccine Action Plan Working Group, will reexamine the situation annually.

This report has made 18 recommendations…


GVAP Secretariat Report
The GVAP Secretariat Report is prepared jointly by the GVAP secretariat’s agencies (consisting of the Bill & Melinda Gates Foundation, GAVI Alliance secretariat, UNICEF, US National Institute of Allergy and Infectious Diseases and WHO). This detailed technical report is the basis used by SAGE to assess the progress made towards the achievement of GVAP Goals in its SAGE GVAP Assessment report.
GVAP Secretariat report 2014 -DRAFT-docx, 3.48Mb

POLIO [to 20 December 2014]

POLIO [to 20 December 2014]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 17 December 2014
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report:
:: For the first time ever, no cases of wild poliovirus have been reported in Africa in the last 4 months. The most recent case had onset of paralysis on 11 August in Somalia.
:: In the north of Madagascar, supplementary immunization activities are currently underway in response to the outbreak of circulating vaccine-derived poliovirus type 1. National Immunization Days are planned for 19 – 23 January.
Selected country report content:
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week from Garmser district of Hilmand province, which had not previously reported a case in 2014. The case, which is the country’s most recent, had onset of paralysis on 17 November. The total number of WPV1 cases for 2014 in Afghanistan is now 25 compared to 11 at this time last year.
:: Given the growing wild poliovirus type 1 outbreak in neighbouring Pakistan, Afghanistan continues to conduct supplementary immunization activities (SIAs) to limit the spread of imported polioviruses and to tackle residual endemic transmission. Subnational Immunization Days (SNIDs) are planned in high risk areas of the south and east using monovalent oral polio vaccine (OPV) type 1 on 21 – 23 December, and 11 – 13 January using bivalent OPV.
:: Seven new wild poliovirus type 1 (WPV1) cases were reported in the past week. Four are from the Federally Administered Tribal Areas (FATA) 3 from Khyber Agency and 1 from South Waziristan); and 3 are from Khyber Pakhtunkhwa (KP) province (2 from Peshawar district and 1 from Swat). The total number of WPV1 cases in Pakistan in 2014 is now 283, compared to 75 at this time last year. The most recent WPV1 case had onset of paralysis on 25 November, from Peshawar, KP.
:: Immunization activities are continuing with particular focus on known high-risk areas, in previously inaccessible areas of FATA. At exit and entry points of conflict-affected areas 100 permanent vaccination points are being used to reach internally displaced families as they move in and out of the inaccessible area. Over 1 million doses of vaccine have been used in the past few months to vaccinate people passing through transit points and in host communities, including over 850,000 children under 10 years old.
Horn of Africa
:: Following confirmation at the beginning of November of two cases of cVDPV2 in a refugee camp area of Unity state, South Sudan, outbreak response plans are in place to hold rounds of supplementary immunization activities (SIAs). Subnational Immunization Days are taking place on 16 – 19 December and 20 – 23 January. The objective is to rapidly stop the transmission of cVDPV2 in the infected area, while further boosting immunity to type 1 wild poliovirus and to minimize the risk of renewed outbreaks following wild poliovirus re-introduction from any infected countries and areas.
West Africa
:: The Ebola crisis in western Africa is impacting on the implementation or polio eradication activities in Liberia, Guinea and Sierra Leone. Supplementary immunization activities in these countries have been postponed and the quality of acute flaccid paralysis surveillance has markedly decreased this year.
:: Even as polio programme staff across West Africa support efforts to control the Ebola outbreak affecting the region, efforts are being made in those countries not affected by Ebola to vaccinate children against polio.

Coomentary – Achieving the extraordinary: A world without polio

Achieving the extraordinary: A world without polio
Authors: Geeta Rao Gupta, Deputy Executive Director of UNICEF; John Hewko, General Secretary of Rotary International; Bruce Aylward, Assistant Director-General – Polio and Emergencies of the World Health Organisation (WHO).
[Full text, editor’s text bolding]

This year marks the sixteenth anniversary of the last reported case of polio in the European Region: a reminder of how far we have come in the fight against polio, and an opportunity to reignite international efforts in support of the very few countries that still have a distance to go.

Polio is a thing of the past across Europe, and indeed across most of the world now, thanks to the power of vaccination. Polio cases have fallen from 1,000 per day worldwide when the Global Polio Eradication Initiative was launched in 1988 to less than one per day so far in 2014. Yet, despite this success, it would be naïve to feel safe from the threat this virus poses to children everywhere. Critical action is needed by European leaders now to protect the world from this threat and realise the promise of global eradication.

Polio is a highly contagious disease which can spread across borders swiftly and silently, leaving in its wake legions of children maimed for life. Last year, in addition to the three countries where polio transmission has never halted (Afghanistan, Nigeria and Pakistan), there were also outbreaks in the Middle East, the Horn of Africa and Central Africa due to reinfection of areas that had long been polio free. This serves as a stark reminder that as long as polio continues to exist anywhere, it remains a threat everywhere.

Europe is no exception. Despite being declared polio-free in 2002, there are still dangerous vaccination coverage gaps in a number of countries, meaning the disease could make a come-back on this continent as well. In fact, if the global effort to eradicate polio slips, the disease will come roaring back all over the world. Within ten years, we could once again see more than 200,000 newly paralysed children – every single year. This could be a catastrophe that must be avoided at all costs.

Recognising this, on 5 May 2014, the director-general of the WHO declared the international spread of polio a Public Health Emergency of International Concern (PHEIC). This is now driving countries affected by the disease to redouble their efforts to eradicate polio within their borders. An increasing number of polio-free countries – such as Australia, China and India – are also taking extraordinary measures to protect themselves, by introducing national vaccination requirements for travellers arriving from infected countries.

That polio, once a leading cause of disability worldwide, can now be prevented and even eradicated through an extremely inexpensive, easily administered vaccine is one of the miracles of modern medicine. It is our collective responsibility to ensure that polio does not continue to paralyse even a single child, anywhere in the world.

UNICEF and Rotary International are driving and coordinating a significant commitment from civil society around the globe, and it is essential that these calls to action are heard by political leaders.

European governments have a particular interest in ensuring the heightened efforts towards eradication are realized, given their investments to date and the risk of re-infection. This can be achieved by rapidly mobilising the financial resources required to eradicate polio from the world; advocating with and assisting the leaders of infected countries in implementing the eradication strategies; maintaining high vaccination coverage across the continent to minimise the risk and consequences of outbreaks; and fully implementing vaccination recommendations for those travelling to polio-affected areas.

On this anniversary, we can reflect how close we are to success. It is the first anniversary since the entire Southeast Asia Region has been declared polio-free, long regarded the most technically-challenging place from where to eradicate polio. It is the first anniversary where Nigeria can be seen to be on the verge of becoming polio-free. It is the first anniversary during which every country worldwide has proven that with the right resources and political will, every child can be reached with the life-saving polio-vaccine.

But ending polio in these few remaining infected areas is not a challenge that can be resolved by any one country or organisation. Nor can it be left at the door of those countries where cases continue to be found. The responsibility lies at the feet of every one of us, as ending polio now will ensure the protection of children all around the world.

On this anniversary, let us intensify all of our efforts to eradicate this disease once and for all. Let us commit to achieving history, for all future generations to come.

EBOLA/EVD [to 20 December 2014]

EBOLA/EVD [to 20 December 2014]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Editor’s Note:
Our extensive coverage of Ebola/EVD activity continues – including detailed coverage of UNMEER and other INGO/agency activity now available at the end of this digest. Please also note that many of the organizations and journals we cover continue to publish important EVD content which is threaded throughout this edition.

WHO: Ebola response roadmap – Situation report 17 December 2014
Summary [Excerpt]
A total of 18,603 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in five affected countries (Guinea, Liberia, Mali, Sierra Leone, and the United States of America) and three previously affected countries (Nigeria, Senegal and Spain) in the seven days to 14 December (week 50). There have been 6915 reported deaths (case definitions are provided in Annex 1).

Reported case incidence is fluctuating in Guinea and declining in Liberia. In Sierra Leone, there are signs the increase in incidence has slowed, and that incidence may no longer be increasing. The case fatality rate in the three intense-transmission countries among all cases for whom a definitive outcome is recorded is 70%. For those patients recorded as hospitalized, the case fatality rate is 60% in each of Guinea and Sierra Leone, and 58% in Liberia.

Interventions in the three most-affected countries continue to progress in line with the UN Mission for Ebola Emergency Response aim to isolate and treat 100% of EVD cases and bury safely and with dignity 100% of EVD-related fatal cases by 1 January, 2015. At a national level, there is now sufficient bed capacity in EVD treatment facilities to treat and isolate all reported EVD cases in each of the three countries, although the uneven distribution of beds and cases means serious shortfalls persist in some districts. At a national level, each country has sufficient capacity to bury all people known to have died from Ebola, although it is possible that in some areas capacity remains inadequate. Every district that has reported a case of EVD in the three intense-transmission countries has access to a laboratory within 24 hours from sample collection. All three countries report that more than 80% of registered contacts associated with known cases of EVD are being traced. Social mobilization continues to be an important component of the response to curb the spread of disease. Community engagement promotes burial practices that are safe and culturally acceptable, and the isolation and appropriate treatment of patients with clinical symptoms of EVD….
WHO Ebola R&D Effort – vaccines, therapies, diagnostics
18 December update
Since August, when the Ebola outbreak was declared a global public health emergency, WHO has convened a series of consultations and high-level meetings with key experts and stakeholders involved in the research, development, regulation and funding of potential medical solutions for Ebola. Based on concerted expert advice, the best evidence available, and ethical oversight, WHO has prioritized a number of products for further investigation through human testing. These products include two candidate vaccines, two antiviral drugs and convalescent whole blood and plasma. In addition, WHO is working on a number of emergency procedures with countries and other partners for assessment and fast-track development of adapted diagnostics, as well as joint reviews of vaccine clinical trial protocols.

Two vaccine candidates are currently being tested in humans – the cAd3-ZEBOV vaccine, developed by GlaxoSmithKline (GSK) in collaboration with the United States National Institutes for Health, and the rVSV-ZEBOV vaccine, developed by NewLink Genetics and Merck Vaccines USA, in collaboration with Health Canada. Both vaccines have shown to be safe and efficacious in animals and initial phase 1 trial results published in November reported that the GSK vaccine is safe. Further Phase 1 results are expected to emerge during December to January.
Phase I clinical trials of the cAd3-ZEBOV vaccine in healthy adults are nearing completion in the United Kingdom, United States, Mali and Switzerland. For the rVSV-ZEBOV vaccine, trials are well advanced or near completion in Canada, the United States, Gabon, Germany, and Switzerland. Trials in Kenya are due to begin this week. All trials are under the auspices of national research institutions in the countries where they are taking place.
Phase II clinical trials of the cdA3-ZEBOV vaccine are expected to begin in Cameroon, Ghana, Mali, Nigeria and Senegal in early 2015. These will test for safety and capacity to induce an immune response in larger numbers and in broader populations, including children. In order to accelerate ethical and regulatory approval of these trials, WHO convened ethics and regulatory experts from the five countries to meet in Geneva on 15-16 December, to agree on a joint review of the trial protocol presented by GSK, the company developing the vaccine. The outcome was provisional approval of the trials pending some minor adjustments to the protocol application requested by the countries concerned. Experts from Guinea, Liberia and Sierra Leone also participated in the meeting.
Phase III clinical trials are planned to start in the first quarter of 2015 in Guinea, Liberia and Sierra Leone to assess the extent to which the vaccines protect against EVD and to gauge the feasibility of full deployment.
Two other vaccines – one developed by Johnson & Johnson and the other by Novavax – are due to enter clinical trials in the coming weeks.
More about Vaccines

Blood and blood products
Transfusion of whole blood and plasma from recovered Ebola patients has been prioritized for use as an investigational therapy. Convalescent whole blood donated by EVD recovered patients is currently being administered in Sierra Leone in a trial run by the government. A trial of convalescent plasma has begun in Liberia – under the auspices of ClinicalRM (a clinical research organization) with the US government and the Bill and Melinda Gates Foundation; and Guinea is planning to start a plasma trial in the next weeks through a partnership between its National Blood Transfusion Service, and institutes in Belgium, the UK and France, and MSF.
Assessments of national capacities for delivering safe blood products outside of clinical trial settings and plans for recovery and strengthening of national blood transfusion services in the three countries are expected to continue in the coming months.
A number of pre-existing medicines already approved for treating non-Ebola diseases have been considered for re-purposing to treat Ebola because they have demonstrated efficacy against the virus in test tubes (in vitro). The advantage of considering re-purposing of drugs is that these are readily available, and their safety is known. So far only one of these has demonstrated sufficient activity in animals infected with EVD to warrant testing in clinical trials. This is favipiravir (Toyama, Japan), for which clinical trials have started in Gueckedou, Guinea. Trials are being run by Inserm, MSF and the Guinean government. In addition, one other re-purposed drug, amiodarone, has been used to treat patients in Sierra Leone, but it is not yet known if it has any benefit.
Other products that are still under development and are not yet approved for any disease are also being taken into small efficacy trials early in 2015. One of these is brincidofovir (Chimerix, USA) which was originally developed for treating cytomegalovirus but has activity against Ebola virus.
Others are medicines that were specifically developed for Ebola, including the monoclonal antibody cocktail ZMapp (Leafbio, USA) and small inhibitory ribonucleic acid (siRNA) (Tekmira, USA, Canada). All of these have been used compassionately in a few expatriated Ebola patients. While promising, these medicines are still under development and are not available in quantities adequate for large-scale clinical trials or deployment.
The scientific community is currently testing in monkeys a wide range of other drugs that have been proposed as potential therapies and will be taking the most promising into clinical trials.
More about Therapies

In September, WHO introduced an emergency procedure under its Prequalification Programme for rapid assessment of Ebola diagnostics for UN procurement to affected countries. The first diagnostic was accepted in November. In the same month, WHO called on manufacturers to develop rapid and easy to use point-of-care diagnostics that are better suited for use in the affected countries, where health infrastructure and trained personnel are largely lacking. The call was followed by a consultation, on 12 December, where diagnostic experts joined WHO and the NGO FIND to plan for accelerated development, production and deployment of adapted and rapid Ebola tests.
As a result, two types of rapid diagnostics are expected to be ready for clinical trials in early 2015. The most promising type is a rapid, integrated nucleic acid PCR test, which is believed to be more effective in case finding. The other type is an antigen test that is easier to use but may be less reliable.
More about Diagnostics

Looking forward
WHO will continue to work with key stakeholders and partners on potential interventions to accelerate verification, development, testing and, if safety and efficacy are found, deployment of Ebola medical products. Mindful of the risks involved in compressing clinical trials and data gathering in short timeframes, WHO is also providing technical guidance to affected countries and is strongly advocating for patient safety and strict ethical oversight throughout the testing phases and potential deployment. In parallel, WHO is actively supporting community engagement activities in African countries where trials are already taking place.
At the same time, WHO has begun work with Ebola affected countries, development partners and financing institutions on recovery and building resilient health systems.

WHO: Phase II clinical trial application for ChAd3 Ebola vaccine reviewed by national regulators
18 December 2014 – During a meeting convened by WHO on 15-16 December 2014, representatives from African national regulatory authorities and ethics committees reviewed an application for Phase II clinical trials of the chimpanzee adenovirus serotype-3 (ChAd3) Ebola vaccine.
The two-day review provided a forum for a thorough discussion on all aspects of the proposed trials. Reviewing countries requested additional documentation from the manufacturer of the vaccine, GlaxoSmithKline, before authorization of the trials. The submission of additional information, and subsequent review by the countries planning to host the trials, is expected to take place by the end of January. If these steps are completed to the satisfaction of the national authorities, Phase II trials are likely to begin in February.
Regulatory and ethics officials from the countries where the Phase II trials were being considered (Cameroon, Ghana, Mali, Nigeria and Senegal) were present, as well as from the countries most affected by the ongoing Ebola outbreak (Guinea, Liberia and Sierra Leone, as observers).
:: Announcement of meeting to review Phase II clinical trial application for ChAd3 Ebola vaccine
:: Summary of the meeting to review Phase II clinical trial application for ChAd3 Ebola vaccine pdf, 299kb.

WHO and partners release manual on psychological first aid during Ebola outbreaks
In times of outbreaks, it is critical that helpers be equipped with the know-how to provide humane, supportive and practical help for people who are distressed, in ways that respect their dignity, culture and abilities.
Consequently, WHO and partners released their first facilitator’s manual, to provide helpers with a comprehensive orientation and materials for use when offering psychological first aid to people affected by an Ebola outbreak. More specifically, this facilitator’s manual includes:
– information on how to prepare for giving an orientation and tips for facilitators
– a full day orientation agenda and a step-by-step description of each module, including learning objectives, narrative and tips for the facilitator
– slides and instructions for group exercises and discussions
– annexes which provide supporting materials to print as handouts for participants.
This facilitator’s manual is to be used together with the guide Psychological first aid during Ebola virus disease outbreaks, launched September 2014.
:: Facilitation manual: Psychological first aid during Ebola disease outbreaks
:: Guide: Psychological first aid during Ebola virus disease outbreaks

European Medicines Agency Watch [to 20 December 2014]

European Medicines Agency Watch [to 20 December 2014]

:: Experimental Ebola treatments still at early stage of development
For robust scientific assessment more information on safety and efficacy needed
At this point in time there is not enough evidence for any of the experimental therapies for Ebola Virus Disease to draw conclusions on their safety or efficacy when used in Ebola patients. This is the finding of an interim report published by the European Medicines Agency (EMA) that is continuing to review all Ebola treatments currently under development.
Any new information that becomes available will be added to the review to provide the best possible overview of data on medicinal treatments for Ebola.
“Treatments for patients infected with the Ebola virus are still in early stages of development,” notes Marco Cavaleri, Head of Anti-infectives and Vaccines at EMA. “We encourage developers to generate more information on the use of these medicines in the treatment of Ebola patients. We will review any new information as soon as it becomes available to support the response to this ongoing public health crisis.”
The EMA review was started by the Agency’s Committee for Medicinal Products for Human Use (CHMP) to support decision-making by health authorities. This first interim report includes information on seven experimental medicines intended for the treatment of people infected with the Ebola virus:
– BCX4430 (Biocryst);
– Brincidofovir (Chimerix);
– Favipiravir (Fujifilm Corporation/Toyama);
– TKM-100802 (Tekmira);
– AVI-7537 (Sarepta);
– ZMapp (Leafbio Inc.);
– Anti-Ebola F(ab’)2 (Fab’entech).
The amount of information available for the seven treatments is highly variable. For some compounds there is no data from use in human subjects available. A small number of treatments have been administered to patients in the current Ebola outbreak as compassionate use. Finally, there are also medicines included in this review that have already been studied in humans, albeit for the treatment of other viral diseases.
Vaccines to protect people against contracting the disease and treatments that do not directly target the Ebola virus have not been included in the review.
EMA’s role in the Ebola outbreak
The review of experimental Ebola treatments is part of EMA’s overall contribution to the global response to the Ebola outbreak in West Africa. The scale and complexity of this outbreak requires an unprecedented level of cooperation of the international health community. The Agency is working together with regulatory authorities around the world to support the World Health Organization and to advise on possible pathways for the development, evaluation and approval of medicines to fight Ebola.
Assessment report for Article-5(3) procedure: Medicinal products under development for treatment of Ebola (16/12/2014)

CDC/MMWR Watch [to 20 December 2014]

CDC/MMWR Watch [to 20 December 2014]

:: CDC Year in Review: “Mission: Critical” – Press Release – Monday, December 15, 2014

:: MMWR Weekly December 19, 2014 / Vol. 63 / No. 50
– Update: Influenza Activity — United States, September 28–December 6, 2014
– Update: Ebola Virus Disease Epidemic — West Africa, December 2014
– Challenges in Responding to the Ebola Epidemic — Four Rural Counties, Liberia, August–November 2014
– Support Services for Survivors of Ebola Virus Disease — Sierra Leone, 2014
– Reintegration of Ebola Survivors into Their Communities — Firestone District, Liberia, 2014
– Notes from the Field: Measles Transmission at a Domestic Terminal Gate in an International Airport — United States, January 2014