International Journal of Epidemiology
Volume 44 Issue 1 February 2015
http://ije.oxfordjournals.org/content/current

Data Resource Profile: The sentinel panel of districts: Tanzania’s national platform for health impact evaluation
Gregory S Kabadi1,3,*, Eveline Geubbels1, Isaac Lyatuu1, Paul Smithson1, Richard Amaro1,
Sylvia Meku2, Joanna A Schellenberg3 and Honorati Masanja1
Abstract
The Sentinel Panel of Districts (SPD) consists of 23 districts selected to provide nationally representative data on demographic and health indicators in Tanzania. The SPD has two arms: SAVVY and FBIS. SAVVY (SAmple Vital registration with Verbal autopsY) is a demographic surveillance system that provides nationally representative estimates of mortalities based on age, sex, residence and zone. SAVVY covers over 805 000 persons, or about 2% of the Tanzania mainland population, and uses repeat household census every 4–5 years, with ongoing reporting of births, deaths and causes of deaths. The FBIS (Facility-Based Information System) collects routine national health management information system data. These health service use data are collected monthly at all public and private health facilities in SPD districts, i.e. about 35% of all facilities in Mainland Tanzania. Both SAVVY and FBIS systems are capable of generating supplementary information from nested periodic surveys. Additional information about the design of the SPD is available online: access to some of SPD’s aggregate data can be requested by sending an e-mail to [hmasanja@ihi.or.tz].

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Infant birthweight and risk of childhood cancer: international population-based case control studies of 40 000 cases
Kate A O’Neill1,4,*, Michael FG Murphy2,4, Kathryn J Bunch3,4, Susan E Puumala5, Susan E Carozza6, Eric J Chow7, Beth A Mueller7, Colleen C McLaughlin8, Peggy Reynolds9, Tim J Vincent4, Julie Von Behren9 and Logan G Spector10
Author Affiliations
1Department of Paediatrics, 2Nuffield Department of Obstetrics and Gynaecology, 3National Perinatal Epidemiology Unit, 4Formerly of the Childhood Cancer Research Group, University of Oxford, Oxford, UK, 5Sanford Research Center, Sioux Falls, SD, USA, 6College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA, 7Fred Hutchinson Cancer Research Center, Seattle, WA, USA, 8New York State Department of Health, Albany, NY, USA, 9Cancer Prevention Institute of California, Berkeley, CA, USA and 10Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
Accepted December 15, 2014.
Abstract
Background: High birthweight is an established risk factor for childhood leukaemia. Its association with other childhood cancers is less clear, with studies hampered by low case numbers.
Methods: We used two large independent datasets to explore risk associations between birthweight and all subtypes of childhood cancer. Data for 16 554 cases and 53 716 controls were obtained by linkage of birth to cancer registration records across five US states, and 23 772 cases and 33 206 controls were obtained from the UK National Registry of Childhood Tumours. US, but not UK, data were adjusted for gestational age, birth order, plurality, and maternal age and race/ethnicity.
Results: Risk associations were found between birthweight and several childhood cancers, with strikingly similar results between datasets. Total cancer risk increased linearly with each 0.5 kg increase in birthweight in both the US [odds ratio 1.06 (95% confidence interval 1.04, 1.08)] and UK [1.06 (1.05, 1.08)] datasets. Risk was strongest for leukaemia [USA: 1.10 (1.06, 1.13), UK: 1.07 (1.04, 1.10)], tumours of the central nervous system [USA: 1.05 (1.01, 1.08), UK: 1.07 (1.04, 1.10)], renal tumours [USA: 1.17 (1.10, 1.24), UK: 1.12 (1.06, 1.19)] and soft tissue sarcomas [USA: 1.12 (1.05, 1.20), UK: 1.07 (1.00, 1.13)]. In contrast, increasing birthweight decreased the risk of hepatic tumours [USA: 0.77 (0.69, 0.85), UK: 0.79 (0.71, 0.89) per 0.5 kg increase]. Associations were also observed between high birthweight and risk of neuroblastoma, lymphomas, germ cell tumours and malignant melanomas. For some cancer subtypes, risk associations with birthweight were non-linear. We observed no association between birthweight and risk of retinoblastoma or bone tumours.
Conclusions: Approximately half of all childhood cancers exhibit associations with birthweight. The apparent independence from other factors indicates the importance of intrauterine growth regulation in the aetiology of these diseases.

JAMA
February 24, 2015, Vol 313, No. 8
http://jama.jamanetwork.com/issue.aspx

Viewpoint | February 24, 2015
Sharing Clinical Trial Data – Maximizing Benefits, Minimizing Risk FREE
Bernard Lo, MD1
Author Affiliations
JAMA. 2015;313(8):793-794. doi:10.1001/jama.2015.292.
[Excerpt]
…The Institute of Medicine (IOM) has issued a consensus, peer-reviewed, publicly available report that recommends how to promote responsible clinical trial data sharing while minimizing the risks and burdens of sharing.4 The report distinguished sharing trial data from sharing a summary of trial results, which is already expected. Data sharing does not necessarily mean posting data on a public website without conditions.
The committee first articulated principles to guide sharing of clinical trial data: (1) maximize the benefits while minimizing the risks of sharing clinical trial data; (2) respect individual participants whose data are shared; (3) increase public trust in clinical trials and the sharing of trial data; and (4) conduct the sharing of clinical trial data in a fair manner….

Nature
Volume 518 Number 7540 pp456-568 26 February 2015
http://www.nature.com/nature/current_issue.html

Nature | Comment
Data sharing: Make outbreak research open access
Nathan L. Yozwiak, Stephen F. Schaffner& Pardis C. Sabeti
25 February 2015
Establish principles for rapid and responsible data sharing in epidemics
Last April, five months into the largest Ebola outbreak in history, an international group of researchers sequenced three viral genomes, sampled from patients in Guinea1. The data were made public that same month. Two months later, our group at the Broad Institute in Cambridge, Massachusetts, sequenced 99 more Ebola genomes, from patients at the Kenema Government Hospital in Sierra Leone.

We immediately uploaded the data to the public database GenBank (see go.nature.com/aotpbk). Our priority was to help curb the outbreak. Colleagues who had worked with us for a decade were at the front lines and in immediate danger; some later died. We were amazed by the surge of collaboration that followed. Numerous experts from diverse disciplines, including drug and vaccine developers, contacted us. We also formed unexpected alliances — for instance, with a leading evolutionary virologist, who helped us to investigate when the strain of virus causing the current outbreak arose….

…In an increasingly connected world, rapid sequencing, combined with new ways to collect clinical and epidemiological data, could transform our response to outbreaks. But the power of these potentially massive data sets to combat epidemics will be realized only if the data are shared as widely and as quickly as possible. Currently, no good guidelines exist to ensure that this happens….

…The Kenema way
As a first step, we call on health agencies such as the World Health Organization, the US Centers for Disease Control and Prevention and Médecins Sans Frontières, as well as genome-sequencing centres and other research institutions, to convene a meeting this year — similar to that held in Bermuda in 1996. Attendees must include scientists, funders, ethicists, biosecurity experts, social scientists and journal editors.

We urge researchers working on outbreaks to embrace a culture of openness. For our part, we have released all our sequence data as soon as it has been generated, including that from several hundred more Ebola samples we recently received from Kenema. We have listed the research questions that we are pursuing at virological.org and through GenBank, and we plan to present our results at virological.org as we generate them, for others to weigh in on. We invite people either to join our publication, or to prepare their own while openly laying out their intentions online. We have also made clinical data for 100 patients publicly available and have incorporated these into a user-friendly data-visualization tool, Mirador, to allow others to explore the data and uncover new insights.

Kenema means ‘translucent, clear like a river stream’ or ‘open to the public gaze’9. To honour the memory of our colleagues who died at the forefront of the Ebola outbreak, and to ensure that no future epidemic is as devastating, let’s work openly in outbreaks.

New England Journal of Medicine
February 26, 2015 Vol. 372 No. 9
http://www.nejm.org/toc/nejm/medical-journal

Review Article
Enduring and Emerging Challenges of Informed Consent
Christine Grady, Ph.D.
N Engl J Med 2015; 372:855-862 February 26, 2015 DOI: 10.1056/NEJMra1411250
The author summarizes emerging standards for informed consent as the underpinning of ethical research in humans.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 28 February 2015)

Hesitancy, Trust and Individualism in Vaccination Decision-Making
February 25, 2015 • Editorial
Related Articles The article is part of the PLOS Currents Outbreaks “Vaccine Hesitancy Collection“. Editorial Based on recent trends, outbreaks of measles and other vaccine-preventable diseases could be more commonplace in the coming years, even in countries where such diseases have been considered eliminated or under control. In 2014, the United States reported over 600 […]

Vaccine Narratives and Public Health: Investigating Criticisms of H1N1 Pandemic Vaccination
February 25, 2015 • Commentary
Vaccine hesitancy is often understood and explored on the level of individual decision-making. However, questions surrounding the risk and efficacy of vaccination are evident in wider public discourse; social narratives of vaccination inform and impact on the individual level. This paper takes a narrative analysis approach from the sociology of health to examine data drawn from a wider study on global public health responses to the H1N1 pandemic. The paper concentrates upon criticisms to mass vaccination as recounted within the Council of Europe’s debate of the handling of H1N1. It shows that three narratives were particularly dominant: problematizing the use of vaccination as a public health response; criticising the efficacy of the vaccines; and, questioning the safety of the strategy. This debate presents an important case study in understanding the way in which vaccines are problematized within the public discourse.

Factors Associated with Intention to Receive Influenza and Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccines during Pregnancy: A Focus on Vaccine Hesitancy and Perceptions of Disease Severity and Vaccine Safety
February 25, 2015 • Research
BACKGROUND: Improving influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccine coverage among pregnant women is needed.
PURPOSE: To assess factors associated with intention to receive influenza and/or Tdap vaccinations during pregnancy with a focus on perceptions of influenza and pertussis disease severity and influenza vaccine safety.
METHODS: Participants were 325 pregnant women in Georgia recruited from December 2012 – April 2013 who had not yet received a 2012/2013 influenza vaccine or a Tdap vaccine while pregnant. Women completed a survey assessing influenza vaccination history, likelihood of receiving antenatal influenza and/or Tdap vaccines, and knowledge, attitudes and beliefs about influenza, pertussis, and their associated vaccines.
RESULTS: Seventy-three percent and 81% of women believed influenza and pertussis, respectively, would be serious during pregnancy while 87% and 92% believed influenza and pertussis, respectively, would be serious to their infants. Perception of pertussis severity for their infant was strongly associated with an intention to receive a Tdap vaccine before delivery (p=0.004). Despite perceptions of disease severity for themselves and their infants, only 34% and 44% intended to receive antenatal influenza and Tdap vaccines, respectively. Forty-six percent had low perceptions of safety regarding the influenza vaccine during pregnancy, and compared to women who perceived the influenza vaccine as safe, women who perceived the vaccine as unsafe were less likely to intend to receive antenatal influenza (48% vs. 20%; p < 0.001) or Tdap (53% vs. 33%; p < 0.001) vaccinations.
CONCLUSIONS: Results from this baseline survey suggest that while pregnant women who remain unvaccinated against influenza within the first three months of the putative influenza season may be aware of the risks influenza and pertussis pose to themselves and their infants, many remain reluctant to receive influenza and Tdap vaccines antenatally. To improve vaccine uptake in the obstetric setting, our findings support development of evidence-based vaccine promotion interventions which emphasize vaccine safety during pregnancy and mention disease severity in infancy.

Why Are Young Adults Affected? Estimating Measles Vaccination Coverage in 20-34 Year Old Germans in Order to Verify Progress Towards Measles Elimination
February 25, 2015 • Research
Background:
The introduction of measles vaccination into routine childhood vaccination programmes has led to a shift of disease burden and incidence among young adults. This was confirmed by the recent rise in measles cases and outbreaks throughout Europe. To prevent outbreaks and eliminate measles, one of the key objectives of the WHO Europe measles elimination framework is achieving overall vaccination coverage of ≥95% in the population on a district level.
In the absence of national registers, data on vaccination coverage in Germany is recorded at the age of school entry, through insurance refund claim data and population studies. Vaccination status (VS) of young adults is largely unknown.
Methods:
We assessed measles vaccination coverage in young adults aged 20-34 years on a district level of the German Federal State of Rhineland-Palatinate. The knowledge and attitude towards immunization of unvaccinated to vaccinated young adults were compared using Likert questions. We used proportional allocation for stratified random sampling across 36 counties. We mailed a self-administered questionnaire with pre-paid return envelopes along with an offer to complete online. Prior to calculating coverage we tested for non-responder bias using logistic regression.
Results:
465 (28%) of 1,637 persons contacted responded (mail: 23%, online: 5%). More women responded than men (odds ratio (OR)=2.1; 95% confidence intervall (CI)=1.7-2.6) but age did not vary between responders and non-responders. Vaccination coverage was 90% (95%CI=87%-93%) for one and 56% (95%CI=51%-61%) for two doses. We found a statistically significant association between receiving two doses and age group. The 20-24 years age group had a 2.3 higher incidence rate ratio (95%CI=1.7-3.2) than the reference group of 30-34 year old to have received two doses of measles vaccination. The group of 25-29 year old had a 1.5 higher incidence rate (95%CI=1.0-2.1) than the reference group to have received two doses of measles vaccination.
Conclusions:
Coverage has failed to reach the WHO Europe elimination goal of 95% measles vaccination in the general population. Targeted approaches including enlistment of occupational health services and checking vaccination status during general practitioner (GP) visits are needed to increase vaccination uptake in this age group in order to achieve measles elimination.

Vaccine Hesitancy: Clarifying a Theoretical Framework for an Ambiguous Notion
February 25, 2015 • Commentary
Today, according to many public health experts, public confidence in vaccines is waning. The term “vaccine hesitancy” (VH) is increasingly used to describe the spread of such vaccine reluctance. But VH is an ambiguous notion and its theoretical background appears uncertain. To clarify this concept, we first review the current definitions of VH in the public health literature and examine its most prominent characteristics. VH has been defined as a set of beliefs, attitudes, or behaviours, or some combination of them, shared by a large and heterogeneous portion of the population and including people who exhibit reluctant conformism (they may either decline a vaccine, delay it or accept it despite their doubts) and vaccine-specific behaviours. Secondly, we underline some of the ambiguities of this notion and argue that it is more a catchall category than a real concept. We also call into question the usefulness of understanding VH as an intermediate position along a continuum ranging from anti-vaccine to pro-vaccine attitudes, and we discuss its qualification as a belief, attitude or behaviour. Thirdly, we propose a theoretical framework, based on previous literature and taking into account some major structural features of contemporary societies, that considers VH as a kind of decision-making process that depends on people’s level of commitment to healthism/risk culture and on their level of confidence in the health authorities and mainstream medicine.

Measuring Vaccine Confidence: Introducing a Global Vaccine Confidence Index
February 25, 2015 • Research
Background.
Public confidence in vaccination is vital to the success of immunisation programmes worldwide. Understanding the dynamics of vaccine confidence is therefore of great importance for global public health. Few published studies permit global comparisons of vaccination sentiments and behaviours against a common metric. This article presents the findings of a multi-country survey of confidence in vaccines and immunisation programmes in Georgia, India, Nigeria, Pakistan, and the United Kingdom (UK) – these being the first results of a larger project to map vaccine confidence globally.
Methods.
Data were collected from a sample of the general population and from those with children under 5 years old against a core set of confidence questions. All surveys were conducted in the relevant local-language in Georgia, India, Nigeria, Pakistan, and the UK. We examine confidence in immunisation programmes as compared to confidence in other government health services, the relationships between confidence in the system and levels of vaccine hesitancy, reasons for vaccine hesitancy, ultimate vaccination decisions, and their variation based on country contexts and demographic factors.
Results.
The numbers of respondents by country were: Georgia (n=1000); India (n=1259); Pakistan (n=2609); UK (n=2055); Nigerian households (n=12554); and Nigerian health providers (n=1272). The UK respondents with children under five years of age were more likely to hesitate to vaccinate, compared to other countries. Confidence in immunisation programmes was more closely associated with confidence in the broader health system in the UK (Spearman’s ρ=0.5990), compared to Nigeria (ρ=0.5477), Pakistan (ρ=0.4491), and India (ρ=0.4240), all of which ranked confidence in immunisation programmes higher than confidence in the broader health system. Georgia had the highest rate of vaccine refusals (6 %) among those who reported initial hesitation. In all other countries surveyed most respondents who reported hesitating to vaccinate went on to receive the vaccine except in Kano state, Nigeria, where the percentage of those who ultimately refused vaccination after initially hesitating was as high as 76%) Reported reasons for hesitancy in all countries were classified under the domains of “confidence,” “convenience,” or “complacency,” and confidence issues were found to be the primary driver of hesitancy in all countries surveyed.

PLoS Medicine
(Accessed 28 February 2015)
http://www.plosmedicine.org/

Humanitarian Access to Unapproved Interventions in Public Health Emergencies of International Concern
Jerome Amir Singh
Essay | published 24 Feb 2015 | PLOS Medicine 10.1371/journal.pmed.1001793
Summary Points
– Time-sensitive access to unapproved experimental interventions should be permitted on humanitarian grounds when patients or communities are facing death or irreversible disease progression and no other efficacious diagnostic, preventive, or therapeutic alternative exists.
– Regulatory deficits could stymie time-sensitive efforts to contain public health threats when no efficacious curative, therapeutic, or preventive interventions exist to counter the threat in question.
– United States regulatory mechanisms may provide useful guidance from a regulatory perspective to policy makers grappling with how to adequately prepare for, or respond to, potential or emerging public health emergencies.
– Access to unapproved experimental interventions should be underpinned by a robust monitoring and evaluation component that will inform product development and licensure.
– A global-level rapid-response governance framework for the employment of unapproved interventions in humanitarian contexts should be established as a matter of urgency.

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The Movement of Multidrug-Resistant Tuberculosis across Borders in East Africa Needs a Regional and Global Solution
Kevin P. Cain, Nina Marano, Maureen Kamene, Joseph Sitienei, Subroto Mukherjee, Aleksandar Galev, John Burton, Orkhan Nasibov, Jackson Kioko, Kevin M. De Cock
Policy Forum | published 24 Feb 2015 | PLOS Medicine 10.1371/journal.pmed.1001791
Summary Points
– Multidrug-resistant tuberculosis (MDR TB) and other deadly infectious diseases commonly occur in states suffering from political turmoil and armed conflict.
– The same conditions that promote MDR TB and other diseases often diminish the capacity of the public health system to address these needs, leading patients to seek care in other countries.
– In East Africa, a large number of patients from Somalia with MDR TB crossed the border to Kenya seeking treatment. While diagnostic capacity for MDR TB exists in Somalia, treatment capacity does not.
– Identification and management of such diseases need to be a priority for countries in the region both for humanitarian purposes and for the protection of their own residents. Often diseases will need to be diagnosed and treated outside of the country in which they are occurring.
– The solutions must be regional and global. Control of an infectious disease, such as MDR TB, must be focused at its source to be successful. Its control cannot depend on the existing capacity of the country in which it happens to occur.

PLoS One
[Accessed 28 February 2015]
http://www.plosone.org/

Care Seeking Behaviour for Children with Suspected Pneumonia in Countries in Sub-Saharan Africa with High Pneumonia Mortality
Aaltje Camielle Noordam, Liliana Carvajal-Velez, Alyssa B. Sharkey, Mark Young, Jochen W. L. Cals
Research Article | published 23 Feb 2015 | PLOS ONE 10.1371/journal.pone.0117919
Abstract
Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as ‘appropriate’ providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16–18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3–39.3) more likely to be brought for care than children from the poorest households, after controlling for the child’s age, sex, caregiver’s education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic

Pneumonia
Vol 6 (2015)
https://pneumonia.org.au/index.php/pneumonia/issue/current
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Correspondence
Childhood Pneumonia Screener: a concept
Keith Grimwood
Abstract
To the Editor:
I congratulate Räsänen and Gavriely for their recent thought-provoking article describing how mobile ‘smart’ phone technology could assist in diagnosing and managing pneumonia in children from developing countries lacking well-established healthcare systems and infrastructure [1]. In the article they describe their plans for first developing, then validating, implementing and finally evaluating a pneumonia screening tool, which if successful could act as a model for improving healthcare delivery in resource-poor settings. Read the full Letter to the Editor here

Full article – Childhood Pneumonia Screener: a concept

Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP/PAJPH)
December 2014 Vol. 36, No. 6
http://www.paho.org/journal/index.php?option=com_content&view=article&id=151&Itemid=266&lang=en

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ARTÍCULOS DE INVESTIGACIÓN ORIGINAL / ORIGINAL RESEARCH ARTICLES
Agendas de investigación priorizadas: un recurso estratégico para la salud en América Latina [Priority research agendas: a strategic resource for health in Latin America]
Francisco Becerra-Posada, Nelly Salgado de Snyder,Luis Gabriel Cuervo y Gabriela Montorzi

SPECIAL SECTION / SECCIÓN ESPECIAL
Preparación de los adultos mayores en los Estados Unidos para hacer frente a los desastres naturales: encuesta a escala nacional [Preparedness for natural disasters among older US adults: a nationwide survey]
Tala M. Al-rousan, Linda M. Rubenstein y Robert B. Wallace

Science
27 February 2015 vol 347, issue 6225, pages 921-1040
http://www.sciencemag.org/current.dtl

Review
Systems integration for global sustainability
Jianguo Liu1,*, Harold Mooney2, Vanessa Hull1, Steven J. Davis3, Joanne Gaskell4, Thomas Hertel5, Jane Lubchenco6, Karen C. Seto7, Peter Gleick8, Claire Kremen9, Shuxin Li1
Author Affiliations
1Center for Systems Integration and Sustainability, Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, USA.
2Department of Biology, Stanford University, Stanford, CA, USA.
3Department of Earth System Science, University of California, Irvine, CA, USA.
4World Bank, Washington, DC, USA.
5Department of Agricultural Economics, Purdue University, West Lafayette, IN, USA.
6Department of Integrative Biology, Oregon State University, Corvallis, OR, USA.
7School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA.
8The Pacific Institute, Oakland, CA, USA.
9Department of Environmental Science, Policy and Management, University of California, Berkeley, CA, USA.
Abstract
BACKGROUND
Many key global sustainability challenges are closely intertwined (examples are provided in the figure). These challenges include air pollution, biodiversity loss, climate change, energy and food security, disease spread, species invasion, and water shortages and pollution. They are interconnected across three dimensions (organizational levels, space, and time) but are often separately studied and managed. Systems integration—holistic approaches to integrating various components of coupled human and natural systems (for example, social-ecological systems and human-environment systems) across all dimensions—is necessary to address complex interconnections and identify effective solutions to sustainability challenges.

ADVANCES
One major advance has been recognizing Earth as a large, coupled human and natural system consisting of many smaller coupled systems linked through flows of information, matter, and energy and evolving through time as a set of interconnected complex adaptive systems. A number of influential integrated frameworks (such as ecosystem services, environmental footprints, human-nature nexus, planetary boundaries, and telecoupling) and tools for systems integration have been developed and tested through interdisciplinary and transdisciplinary inquiries. Systems integration has led to fundamental discoveries and sustainability actions that are not possible by using conventional disciplinary, reductionist, and compartmentalized approaches. These include findings on emergent properties and complexity; interconnections among multiple key issues (such as air, climate, energy, food, land, and water); assessment of multiple, often conflicting, objectives; and synergistic interactions in which, for example, economic efficiency can be enhanced while environmental impacts are mitigated. In addition, systems integration allows for clarification and reassignment of environmental responsibilities (for example, among producers, consumers, and traders); mediation of trade-offs and enhancement of synergies; reduction of conflicts; and design of harmonious conservation and development policies and practices.

OUTLOOK
Although some studies have recognized spillover effects (effects spilling over from interactions among other systems) or spatial externalities, there is a need to simultaneously consider socioeconomic and environmental effects rather than considering them separately. Furthermore, identifying causes, agents, and flows behind the spillover effects can help us to understand better and hence manage the effects across multiple systems and scales. Integrating spillover systems with sending and receiving systems through network analysis and other advanced analytical methods can uncover hidden interrelationships and lead to important insights. Human-nature feedbacks, including spatial feedbacks (such as those among sending, receiving, and spillover systems), are the core elements of coupled systems and thus are likely to play important roles in global sustainability. Systems integration for global sustainability is poised for more rapid development, and transformative changes aimed at connecting disciplinary silos are needed to sustain an increasingly telecoupled world.

Among Brazil, China, the Caribbean, and the Sahara Desert in Africa, there are complex human-nature interactions across space, time, and organizational levels. Deforestation in Brazil due to soybean production provides food for people and livestock in China. Food trade between Brazil and China also contributes to changes in the global food market, which affects other areas around the world, including the Caribbean and Africa, that also engage in trade with China and Brazil. Dust particles from the Sahara Desert in Africa—aggravated by agricultural practices—travel via the air to the Caribbean, where they contribute to the decline in coral reefs and soil fertility and increase asthma rates. These in turn affect China and Brazil, which have both invested heavily in Caribbean tourism, infrastructure, and transportation. Nutrient-rich dust from Africa also reaches Brazil, where it improves forest productivity.

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Perspective
Virology
Delineating Ebola entry
Darryl Falzarano1, Heinz Feldmann2
Author Affiliations
1Vaccine and Infectious Disease Organization–International Vaccine Centre, University of Saskatchewan, Saskatoon, SK Canada.
2Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Hamilton, MT, USA.
The means by which Ebola virus enters a cell are becoming less mysterious. Although a definitive cell surface receptor for the virus, if there is one, remains to be identified, the mechanism of gaining entry is beginning to be fleshed out. Once inside the cell, the importance of numerous sequential processes is becoming better understood. On page 995 of this issue, Sakurai et al. (1) add another element to the viral entry pathway by showing that a calcium channel called two-pore channel 2 (TPC2) is required for release of the viral genome into the host cell.

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Report
Two-pore channels control Ebola virus host cell entry and are drug targets for disease treatment
Yasuteru Sakurai1, Andrey A. Kolokoltsov2, Cheng-Chang Chen3, Michael W. Tidwell4, William E. Bauta4, Norbert Klugbauer5, Christian Grimm3, Christian Wahl-Schott3, Martin Biel3, Robert A. Davey1,*
Author Affiliations
1Texas Biomedical Research Institute, San Antonio, TX, USA.
2The University of Texas Medical Branch, Galveston, TX, USA.
3Center for Integrated Protein Science Munich (CIPSM) at the Department of Pharmacy–Center for Drug Research, Ludwig-Maximilians-Universität München, Munich, Germany.
4Southwest Research Institute, San Antonio, TX, USA.
5Institute for Experimental and Clinical Pharmacology and Toxicology, Albert-Ludwigs-Universität Freiburg, Freiburg, Germany.
Abstract
Ebola virus causes sporadic outbreaks of lethal hemorrhagic fever in humans, but there is no currently approved therapy. Cells take up Ebola virus by macropinocytosis, followed by trafficking through endosomal vesicles. However, few factors controlling endosomal virus movement are known. Here we find that Ebola virus entry into host cells requires the endosomal calcium channels called two-pore channels (TPCs). Disrupting TPC function by gene knockout, small interfering RNAs, or small-molecule inhibitors halted virus trafficking and prevented infection. Tetrandrine, the most potent small molecule that we tested, inhibited infection of human macrophages, the primary target of Ebola virus in vivo, and also showed therapeutic efficacy in mice. Therefore, TPC proteins play a key role in Ebola virus infection and may be effective targets for antiviral therapy.

Vaccines — Open Access Journal
(Accessed 28 February 2015)
http://www.mdpi.com/journal/vaccines

Article: Beliefs and Opinions of Health Care Workers and Students Regarding Influenza and Influenza Vaccination in Tuscany, Central Italy
by Guglielmo Bonaccorsi, Francesca Santomauro, Barbara Rita Porchia, Giuditta Niccolai, Elettra Pellegrino, Paolo Bonanni and Chiara Lorini
Vaccines 2015, 3(1), 137-147; doi:10.3390/vaccines3010137 – published 26 February 2015
Abstract:
Immunization of health care workers (HCWs) against influenza has been associated with improvements in patient safety. The aim of this study is to assess the beliefs, attitudes, and knowledge of HCWs and health profession students regarding influenza. An anonymous questionnaire was distributed to HCWs in three local Florentine healthcare units, at Careggi University Teaching Hospital, and to students in health profession degree programs. A total of 2576 questionnaires were fully completed. A total of 12.3% of subjects responded that they were “always vaccinated” in all three of the seasonal vaccination campaigns studied (2007–2008 to 2009–2010), 13.1% had been vaccinated once or twice, and 74.6% had not received vaccinations. Although the enrolled subjects tended to respond that they were “never vaccinated,” they considered influenza to be a serious illness and believed that the influenza vaccine is effective. The subjects who refused vaccination more frequently believed that the vaccine could cause influenza and that it could have serious side effects. More than 60% of the “always vaccinated” group completely agreed that HCWs should be vaccinated. Self-protection and protecting family members or other people close to the respondent from being infected and representing potential sources of influenza infection can be considered motivating factors for vaccination. The results highlight the importance of improving vaccination rates among all HCWs through multi-component interventions. Knowledge of influenza should be reinforced.

From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary
African Journal of Reproductive Health
Vol 18 Issue 4 2014
Effect of school-based human papillomavirus (HPV) vaccination on adolescent girls’ knowledge and acceptability of the HPV vaccine in Ibanda district in Uganda
Turiho, Andrew Kampikaho, Okello, Elialilia S., Muhwezi, Wilson W., Harvey, Steve Byakika-Kibwika, Pauline Meya, David Katahoire, Anne R.
Abstract
From 2008 to 2011, schoolgirls were vaccinated against HPV in two districts in Uganda following sensitization. This study assessed girls’ knowledge of cervical cancer and HPV vaccine, and their acceptance of future vaccination of friends and hypothetical daughters. The cross-sectional, mixed methods comparative study was conducted in two districts. Univariate, bivariate, logistic regression and thematic analyses were done. HPV vaccination was positively associated with knowledge (Crude OR: 5.31, CI: 3.19-8.86; p = 0.000); but knowledge (Adjusted OR: 1.13, CI: 0.56-2.28; p = 0.73) and HPV vaccination (Adjusted OR: 0.92, CI: 0.16-5.36; p = 0.93) did not predict vaccine acceptability. Seemingly important motivations for vaccine acceptance were: its role in cancer prevention and advancement of reproductive health, minimal side effects, and positive peer role models. Major deterrents to vaccine acceptance were: rumours and misconceptions about possible side effects, perceived inadequate information about vaccine, and fear of side effects.

Media/Policy Watch
This section is intended to alert readers to substantive news, analysis and opinion from the general media on vaccines, immunization, global; public health and related themes. Media Watch is not intended to be exhaustive, but indicative of themes and issues CVEP is actively tracking. This section will grow from an initial base of newspapers, magazines and blog sources, and is segregated from Journal Watch above which scans the peer-reviewed journal ecology.

We acknowledge the Western/Northern bias in this initial selection of titles and invite suggestions for expanded coverage. We are conservative in our outlook in adding news sources which largely report on primary content we are already covering above. Many electronic media sources have tiered, fee-based subscription models for access. We will provide full-text where content is published without restriction, but most publications require registration and some subscription level.

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BBC
http://www.bbc.co.uk/
Accessed 28 February 2015
28 February 2015 Last updated at 17:53 ET
Ebola outbreak: Sierra Leone vice-president quarantined
The vice-president of Sierra Leone has put himself into quarantine after one of his bodyguards died from Ebola.
Samuel Sam-Sumana said he would stay out of contact with others for 21 days as a precaution.
There was optimism the virus was on the decline in Sierra Leone at the end of last year but there has been a recent increase in confirmed cases.
Nearly 10,000 people have died in the outbreak, the vast majority in Guinea, Liberia and Sierra Leone.
‘Taking no chances’
Mr Sam-Sumana said on Saturday that he had chosen to be quarantined to “lead by example” after the death of his bodyguard, John Koroma, last week.
He told Reuters news agency that he was “very well” and showing no signs of the illness, but said he did not want to “take chances”.
His staff have also been placed under observation.
He is the country’s first senior government figure to subject himself to a voluntary quarantine…

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Financial Times
http://www.ft.com/home/uk
Accessed 28 February 2015
Ebola spurs healthcare insurance debate
16 February 2015
The one good thing to come from the Ebola outbreak in west Africa is a fresh debate on the urgency of improving access to basic healthcare and, in turn, the need for moves towards universal heathcare coverage. Years of neglect of prevention and treatment help explain why the lethal infection claimed thousands of lives in Sierra Leone, Liberia and Guinea, whereas it was effectively contained in Europe and North America. To some, the events have underlined the broader benefits of investment in health as a way not only to cut illness and death but also to support broader development. Given the poor response, Ebola has sharply set back economies in the region.

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Forbes
http://www.forbes.com/
Accessed 28 February 2015
Naturopaths–Not What The Doctor Ordered For Vaccine Exemptions
There are lots of reasons why measles, having gone to Disneyland, is enjoying a comeback around the United States and Canada. Unfounded fears of autism scare some parents. Others buy the daffy conspiracy theory that pharmaceutical companies are just pushing vaccination to make a buck. Some parents invoke religious concerns […]
Arthur Caplan, Contributor Feb 24, 2015
Anti-Vaxxers Are Spreading Concern
Does the anti-vaxxer movement reflect a generation of parents who are less concerned with the public good?
Neil Howe, Contributor Feb 27, 2015

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The Guardian
http://www.guardiannews.com/
Accessed 28 February 2015
Measles death in Germany prompts calls for mandatory vaccinations
Death of 18-month-old boy is the first fatality among 574 reported cases in the country’s worst measles outbreak in more than a decade
23 February 2015

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New York Times
http://www.nytimes.com/
Accessed 28 February 2015
Fatality Rate Is Falling in West African Ebola Clinics
New York Times | 26 February 2015
As the Ebola epidemic in West Africa wanes, physicians from Doctors Without Borders are confronting a mystery: More of their patients are surviving. They do not know why. “The reasons are really unclear,” said Dr. Gilles van Cutsem, who helped run the agency’s response in Liberia and gave a presentation describing its experience at an AIDS conference here.

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Washington Post
http://www.washingtonpost.com/
Accessed 28 February 2015
Oregon considers banning most vaccine exemptions
Jennifer Margulis has her kids vaccinated and she gets shots herself. But she doesn’t like the idea of government telling parents they must get their children immunized…
Associated Press | Health & Science | Feb 28, 2015