Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 11, Issue 3, 2015
http://www.tandfonline.com/toc/khvi20/current#.VSCO9OEw1hU

Cost-effectiveness of quadrivalent influenza vaccine in Hong Kong – A decision analysis
DOI:10.1080/21645515.2015.1011016
Joyce H S Youa*, Wai-Kit Minga & Paul K S Chanbc
pages 564-571
Abstract
Trivalent influenza vaccine (TIV) selects one of the 2 co-circulating influenza B lineages whereas quadrivalent influenza vaccine (QIV) includes both lineages. We examined potential cost-effectiveness of QIV versus TIV from perspectives of healthcare provider and society of Hong Kong. A decision tree was designed to simulate the outcomes of QIV vs. TIV in 6 age groups: 0–4 years, 5–9 years, 10–14 years, 15–64 years, 65–79 y and ≥80 years. Direct cost alone, direct and indirect costs, and quality-adjusted life-years (QALYs) loss due to TIV-unmatched influenza B infection were simulated for each study arm. Outcome measure was incremental cost per QALY (ICER). In base-case analysis, QIV was more effective than TIV in all-age population with additional direct cost per QALY (ICER-direct cost) and additional total cost per QALY (ICER-total cost) of USD 22,603 and USD 12,558, respectively. Age-stratified analysis showed that QIV was cost-effective in age groups 6 months to 9 y and ≥80 years from provider’s perspective, and it was cost-effective in all age group except 15–64 y from societal perspective. Percentage of TIV-unmatched influenza B in circulation and additional vaccine cost of QIV were key influential factors. From perspectives of healthcare provider and society, QIV was the preferred option in 52.77% and 66.94% of 10,000 Monte Carlo simulations, respectively. QIV appears to be cost-effective in Hong Kong population, except for age group 15–64 years, from societal perspective. From healthcare provider’s perspective, QIV seems to be cost-effective in very young (6 months-9 years) and older (≥80 years) age groups.

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Pertussis models to inform vaccine policy
Open access
DOI:10.1080/21645515.2015.1011575
Patricia T Campbellab*, James M McCawab & Jodie McVernonab
pages 669-678
Abstract
Pertussis remains a challenging public health problem with many aspects of infection, disease and immunity poorly understood. Initially controlled by mass vaccination, pertussis resurgence has occurred in some countries with well-established vaccination programs, particularly among adolescents and young adults. Several studies have used mathematical models to investigate drivers of pertussis epidemiology and predict the likely impact of different vaccination strategies. We reviewed a number of these models to evaluate their suitability to answer questions of public health importance regarding optimal vaccine scheduling. We critically discuss the approaches adopted and the impact of chosen model structures and assumptions on study conclusions. Common limitations were a lack of contemporary, population relevant data for parameterization and a limited understanding of the relationship between infection and disease. We make recommendations for future model development and suggest epidemiologic data collections that would facilitate efforts to reduce uncertainty and improve the robustness of model-derived conclusions.

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Vaccine attitudes and practices among obstetric providers in New York State following the recommendation for pertussis vaccination during pregnancy
DOI:10.1080/21645515.2015.1011999
Cynthia A Bonvillea, Donald A Cibulab, Joseph B Domachowskea & Manika Suryadevaraa*
pages 713-718
Abstract
To determine factors associated with obstetric provider recommendation of pertussis vaccine (Tdap) to their pregnant patients following the Advisory Committee on Immunization Practices (ACIP) recommendation that Tdap be given in the third trimester of each pregnancy. Obstetric providers across New York State anonymously completed a standard set of questions to assess vaccine recommendation knowledge and practice. Statistical analysis: Descriptive statistical methods were used to define provider characteristics, knowledge and vaccine practices. Factors associated with recommendation were analyzed using odds ratios. 133 obstetric providers were included in the study. 11% and 13% expressed concern with pertussis vaccine safety and efficacy, respectively, in pregnant women. 92% of obstetric providers stated that they knew ACIP recommendations for Tdap during pregnancy, 80% recommended Tdap to all eligible patients, but only 67% provided Tdap vaccine in their office. Provider knowledge of recommendation (OR 23.33), routine provider recommendation of influenza vaccine (OR 12.5), and administration of pertussis vaccine in the office (OR 7.01) were all factors strongly associated with routine provider recommendation of Tdap vaccine to eligible pregnant women (P < 0.05). Providers expressed concerns with cost of Tdap, the need to administer Tdap with each pregnancy, vaccine safety, low incidence of pertussis in the area, and administration of pertussis vaccine at the hospital after delivery. Educational programs are needed to improve provider vaccine confidence and recommendation.

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Factors affecting uptake of recommended immunizations among health care workers in South Australia
DOI:10.1080/21645515.2015.1008886
Jane L Tuckermanab, Joanne E Collinsab & Helen S Marshallabcd*
pages 704-712
Received: 25 Sep 2014
Accepted: 16 Dec 2014
Abstract
Despite the benefits of vaccination for health care workers (HCWs), uptake of recommended vaccinations is low, particularly for seasonal influenza and pertussis. In addition, there is variation in uptake within hospitals. While all vaccinations recommended for HCWs are important, vaccination against influenza and pertussis are particularly imperative, given HCWs are at risk of occupationally acquired influenza and pertussis, and may be asymptomatic, acting as a reservoir to vulnerable patients in their care. This study aimed to determine predictors of uptake of these vaccinations and explore the reasons for variation in uptake by HCWs working in different hospital wards. HCWs from wards with high and low influenza vaccine uptake in a tertiary pediatric and obstetric hospital completed a questionnaire to assess knowledge of HCW recommended immunizations. Multiple logistic regression was used to determine predictors of influenza and pertussis vaccination uptake. Of 92 HCWs who responded, 9.8% were able to identify correctly the vaccines recommended for HCWs. Overall 80% of respondents reported they had previously received influenza vaccine and 50.5% had received pertussis vaccine. Independent predictors of pertussis vaccination included length of time employed in health sector (P < 0.001), previously receiving hepatitis B/MMR (measles, mumps, rubella) vaccine (P < 0.001), and a respondent being aware influenza infections could be severe in infants (p = 0.023). Independent predictors of seasonal influenza vaccination included younger age (P < 0.001), English as first language (P < 0.001), considering it important to be vaccinated to protect themselves (P < 0.001), protect patients (p = 0.012) or awareness influenza could be serious in immunocompromised patients (p = 0.030). Independent predictors for receiving both influenza and pertussis vaccinations included younger age (P < 0.001), time in area of work (P = 0.020), previously receiving hepatitis B vaccine (P = 0.006) and awareness influenza could be severe in infants (P < 0.001). A knowledge gap exists around HCW awareness of vaccination recommendations. Assessment of the risk/benefit value for HCWs and their patients, determines uptake of HCW immunization programs and should be considered in promotional HCW vaccination programs.

The Journal of Law, Medicine & Ethics
Spring 2015 Volume 43, Issue 1 Pages 6–166
http://onlinelibrary.wiley.com/doi/10.1111/jlme.2015.43.issue-1/issuetoc

Global Justice and Health Systems Research in Low- and Middle-Income Countries
Bridget Pratt1 and Adnan A. Hyder2
Article first published online: 2 APR 2015
DOI: 10.1111/jlme.12202
Abstract
Scholarship focusing on how international research can contribute to justice in global health has primarily explored requirements for the conduct of clinical trials. Yet health systems research in low- and middle-income countries (LMICs) has increasingly been identified as vital to the reduction of health disparities between and within countries. This paper expands an existing ethical framework based on the health capability paradigm – research for health justice – to externally-funded health systems research in LMICs. It argues that a specific form of health systems research in LMICs is required if the enterprise is to advance global health equity. “Research for health justice” requirements for priority setting, research capacity strengthening, and post-study benefits in health systems research are derived in light of the field’s distinctive characteristics. Specific obligations are established for external research actors, including governments, funders, sponsors, and investigators. How these framework requirements differ from those for international clinical research is discussed.

The Lancet
Apr 04, 2015 Volume 385 Number 9975 p1261-1364 e25-e37
http://www.thelancet.com/journals/lancet/issue/current

Editorial
China-Africa Health Collaboration
The Lancet
Summary
The 5th International Roundtable on China-Africa Health Collaboration: Contributing to Universal Health Coverage (UHC), Expanding Access to Essential Medicines, convened by Tsinghua University and the China Chamber of Commerce for Import and Export of Medicines and Health Products, took place in Beijing last week (March 26–28). The roundtable was attended by 350 Chinese, African, and international health delegates, including Chinese drug companies. The roundtable endorsed the Beijing Policy Recommendations 2015—calling for collaboration to reflect local country priorities, enhanced production and access to new health commodities, increased accountability, and investments in research, development, and health financing.

Comment
Achieving universal health coverage is a moral imperative
Carissa F Etienne
Published Online: 15 October 2014
Summary
In the past few decades, important policies and strategic initiatives in health and development have been embraced by Latin America, with the active participation and support of the Pan American Health Organization (PAHO), WHO, and other partners. As democratic processes in the region are consolidated, with increasing decentralisation and greater social inclusion in decision making, there is an increasingly large and structured social demand for equity in access to health care, consistent with the principles of the WHO Constitution of 1948: “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…”.

Towards universal health coverage: applying a gender lens
Michelle Bachelet
e25

Human-rights-based approaches to health in Latin America
Alicia Ely Yamin, Ariel Frisancho
e26

Health protection as a citizen’s right
Alicia Bárcena
e29

Latin America: priorities for universal health coverage
Jeanette Vega, Patricia Frenz
e31

Conditional cash transfers and health in Latin America
Simone Cecchini, Fábio Veras Soares
e32

The right to health: what model for Latin America?
Nila Heredia, Asa Cristina Laurell, Oscar Feo, José Noronha, Rafael González-Guzmán, Mauricio Torres-Tovar
e34

New England Journal of Medicine
April 2, 2015 Vol. 372 No. 14
http://www.nejm.org/toc/nejm/medical-journal

International Health Care Systems: Lessons from the East — China’s Rapidly Evolving Health Care System
D. Blumenthal and W. Hsiao
Free Full Text
At first glance, China might seem unlikely to offer useful health care lessons to many other countries. Its health system exists within a unique geopolitical context: a country of more than 1.3 billion people, occupying a huge, diverse landmass, living under authoritarian single-party rule, and making an extraordinarily rapid transition from a Third-World to a First-World economy.

But first impressions can be misleading. Since its birth in 1949, the People’s Republic of China has undertaken a series of remarkable health system experiments that are instructive at many levels. One of the most interesting lessons from the Chinese experience concerns the value of an institution that many countries take for granted: medical professionalism….

Pediatrics
April 2015, VOLUME 135 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

Article
13-Valent Pneumococcal Conjugate Vaccine (PCV13) in Preterm Versus Term Infants
Federico Martinón-Torres, MD, PhDa, Hanna Czajka, MDb, Kimberly J. Center, MDc, Jacek Wysocki, MDd, Ewa Majda-Stanislawska, MDe, Felix Omeñaca, MDf, Enrique Bernaola Iturbe, MDg, Daniel Blazquez Gamero, MDh, Ana Concheiro-Guisán, MD, PhDi, Francisco Gimenez-Sanchez, MD, PhDj, Leszek Szenborn, MDk, Peter C. Giardina, PhDl, Scott Patterson, PhDc,
William C. Gruber, MDl, Daniel A. Scott, MDl, and Alejandra Gurtman, MDl
Author Affiliations
aTranslational Pediatrics and Infectious Diseases, Pediatrics Department, Hospital Clínico Universitario de Santiago de Compostela and Vaccine Research Unit, Genetics, Vaccines, Infections and Pediatrics Research Group (GENVIP), Healthcare Research Institute of Santiago, Santiago de Compostela, Spain;
bWojewodzki Specjalistyczny Szpital Dzieciecy im. sw. Ludwika–Regional Infectious Diseases Outpatient Clinic, Krakow, Poland;
cPfizer Inc, Collegeville, Pennsylvania;
dPoznań University of Medical Sciences, Poznań, Poland;
eMedical University of Lodz, Lodz, Poland;
fHospital Infantil La Paz, Madrid, Spain;
gServicio de Pediatría y Unidad de Investigación en Vacunas Fundación Miguel Servet Complejo Hospitalario de Navarra, Pamplona, Spain;
hPediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitario 12 de Octubre, Madrid, Spain;
iComplexo Hospitalario Universitario de Vigo, Vigo, Spain;
jHospital Torrecardenas, Almeria, Spain;
kDepartment of Pediatric Infectious Diseases, Medical University, Wroclaw, Poland; and
lPfizer Inc, Pearl River, New York
Abstract
OBJECTIVES: This study evaluated the immune response and safety profile of 13-valent pneumococcal conjugate vaccine (PCV13) in preterm infants compared with term infants.
METHODS: This Phase IV, open-label, 2-arm, multicenter, parallel-group study enrolled 200 healthy infants (preterm, n = 100; term, n = 100) aged 42 to 98 days. All subjects received PCV13 at ages 2, 3, 4 (infant series), and 12 (toddler dose [TD]) months, together with routine vaccines (diphtheria-tetanus-acellular pertussis, hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b vaccine and meningococcal group C conjugate vaccine).
RESULTS: Most subjects achieved an anticapsular immunoglobulin G (IgG) antibody concentration ≥0.35 μg/mL for all serotypes: >85% after the infant series (except preterm infants for serotypes 5, 6A, and 6B) and >97% after TD (except for serotype 3). Preterm infants had overall lower IgG geometric mean concentrations compared with term infants; however, geometric mean fold increases after TD were similar for all serotypes. Opsonophagocytic activity results were consistent with IgG results and titers increased after TD in both groups for all serotypes, including serotype 3. PCV13 was generally well tolerated, with similar safety profiles in all preterm subgroups.
CONCLUSIONS: Immune responses were lower in preterm infants than in term infants. However, the majority of subjects in both groups achieved both pneumococcal serotype-specific IgG antibody levels after the infant series that exceeded the World Health Organization–established threshold of protection and functional antibody responses. Responses were uniformly higher after TD, reinforcing the importance of a timely booster dose. PCV13 was well tolerated regardless of gestational age.

Pediatrics
April 2015, VOLUME 135 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

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Article
Government Health Care Spending and Child Mortality
Mahiben Maruthappu, MA, BM BCha, Ka Ying Bonnie Ng, BMedSci, MBChBa,b, Callum Williams, BAc,d, Rifat Atun, FRCP, MBA, FFPHa,e, and Thomas Zeltner, MD, LLMf,g
Author Affiliations
aImperial College London, London, United Kingdom;
bObstetrics and Gynaecology Department, Chelsea and Westminster Hospital, London, United Kingdom;
cThe Economist, London, United Kingdom;
dFaculty of History, University of Oxford, Oxford, United Kingdom;
eHarvard School of Public Health, Harvard University, Cambridge, Massachusetts;
fWorld Health Organization, Geneva, Switzerland; and
gUniversity of Bern, Bern, Switzerland.
Abstract
BACKGROUND: Government health care spending (GHS) is of increasing importance to child health. Our study determined the relationship between reductions in GHS and child mortality rates in high- and low-income countries.
METHODS: The authors used comparative country-level data for 176 countries covering the years 1981 to 2010, obtained from the World Bank and the Institute for Health Metrics and Evaluation. Multivariate regression analysis was used to determine the association between changes in GHS and child mortality, controlling for differences in infrastructure and demographics.
RESULTS: Data were available for 176 countries, equating to a population of ∼5.8 billion as of 2010. A 1% decrease in GHS was associated with a significant increase in 4 child mortality measures: neonatal (regression coefficient [R] 0.0899, P = .0001, 95% confidence interval [CI] 0.0440–0.1358), postneonatal (R = 0.1354, P = .0001, 95% CI 0.0678–0.2030), 1- to 5-year (R = 0.3501, P < .0001, 95% CI 0.2318–0.4685), and under 5-year (R = 0.5207, P < .0001, 95% CI 0.3168–0.7247) mortality rates. The effect was evident up to 5 years after the reduction in GHS (P < .0001). Compared with high-income countries, low-income countries experienced greater deteriorations of ∼1.31 times neonatal mortality, 2.81 times postneonatal mortality, 8.08 times 1- to 5-year child mortality, and 2.85 times under 5-year mortality.
CONCLUSIONS: Reductions in GHS are associated with significant increases in child mortality, with the largest increases occurring in low-income countries.

Pediatrics
April 2015, VOLUME 135 / ISSUE 4
http://pediatrics.aappublications.org/current.shtml

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Physician Response to Parental Requests to Spread Out the Recommended Vaccine Schedule
Allison Kempe, MD, MPHa,b, Sean T. O’Leary, MD, MPHa,b, Allison Kennedy, MPHc, Lori A. Crane, PhD, MPHa,d, Mandy A. Allison, MD, MPHa,b, Brenda L. Beaty, MSPHa, Laura P. Hurley, MD, MPHa,e, Michaela Brtnikova, PhDa, Andrea Jimenez-Zambrano, MPHa, and Shannon Stokley, MPHc
Author Affiliations
aChildren’s Outcomes Research, Children’s Hospital Colorado, Aurora, Colorado;
bDepartment of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado;
cNational Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
dDepartment of Community and Behavioral Health, Colorado School of Public Health, Denver, Colorado; and
eDivision of General Internal Medicine, Denver Health, Denver, Colorado
Abstract
OBJECTIVES: To assess among US physicians (1) frequency of requests to spread out recommended vaccination schedule for children <2 years, (2) attitudes regarding such requests, and (3) strategies used and perceived effectiveness in response to such requests.
METHODS: An e-mail and mail survey of a nationally representative sample of pediatricians and family physicians from June 2012 through October 2012.
RESULTS: The response rate was 66% (534 of 815). In a typical month, 93% reported some parents of children <2 years requested to spread out vaccines; 21% reported ≥10% of parents made this request. Most respondents thought these parents were putting their children at risk for disease (87%) and that it was more painful for children (84%), but if they agreed to requests, it would build trust with families (82%); further, they believed that if they did not agree, families might leave their practice (80%). Forty percent reported this issue had decreased their job satisfaction. Most agreed to spread out vaccines when requested, either often/always (37%) or sometimes (37%); 2% would often/always, 4% would sometimes, and 12% would rarely dismiss families from their practice if they wanted to spread out the primary series. Physicians reported using a variety of strategies in response to requests but did not think they were effective.
CONCLUSIONS: Virtually all providers encounter requests to spread out vaccines in a typical month and, despite concerns, most are agreeing to do so. Providers are using many strategies in response but think few are effective. Evidence-based interventions to increase timely immunization are needed to guide primary care and public health practice.

PLoS One
[Accessed 4 April 2015]
http://www.plosone.org/

Research Article
Can Reproductive Health Voucher Programs Improve Quality of Postnatal Care? A Quasi-Experimental Evaluation of Kenya’s Safe Motherhood Voucher Scheme
Claire Watt, Timothy Abuya, Charlotte E. Warren, Francis Obare, Lucy Kanya, Ben Bellows
Published: April 2, 2015
DOI: 10.1371/journal.pone.0122828
Abstract
This study tests the group-level causal relationship between the expansion of Kenya’s Safe Motherhood voucher program and changes in quality of postnatal care (PNC) provided at voucher-contracted facilities. We compare facilities accredited since program inception in 2006 (phase I) and facilities accredited since 2010-2011 (phase II) relative to comparable non-voucher facilities. PNC quality is assessed using observed clinical content processes, as well as client-reported outcome measures. Two-tailed unpaired t-tests are used to identify differences in mean process quality scores and client-reported outcome measures, comparing changes between intervention and comparison groups at the 2010 and 2012 data collection periods. Difference-in-differences analysis is used to estimate the reproductive health (RH) voucher program’s causal effect on quality of care by exploiting group-level differences between voucher-accredited and non-accredited facilities in 2010 and 2012. Participation in the voucher scheme since 2006 significantly improves overall quality of postnatal care by 39% (p=0.02), where quality is defined as the observable processes or components of service provision that occur during a PNC consultation. Program participation since phase I is estimated to improve the quality of observed maternal postnatal care by 86% (p=0.02), with the largest quality improvements in counseling on family planning methods (IRR 5.0; p=0.01) and return to fertility (IRR 2.6; p=0.01). Despite improvements in maternal aspects of PNC, we find a high proportion of mothers who seek PNC are not being checked by any provider after delivery. Additional strategies will be necessary to standardize provision of packaged postnatal interventions to both mother and newborn. This study addresses an important gap in the existing RH literature by using a strong evaluation design to assess RH voucher program effectiveness on quality improvement.

PLoS One
[Accessed 4 April 2015]
http://www.plosone.org/

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Research Article
Determinants of Performance of Health Systems Concerning Maternal and Child Health: A Global Approach
Carlos Eduardo Pinzón-Flórez, Julián Alfredo Fernández-Niño, Myriam Ruiz-Rodríguez, Álvaro J. Idrovo, Abel Armando Arredondo López
Published: March 30, 2015
DOI: 10.1371/journal.pone.0120747
Abstract
Aims
To assess the association of social determinants on the performance of health systems around the world.
Methods
A transnational ecological study was conducted with an observation level focused on the country. In order to research on the strength of the association between the annual maternal and child mortality in 154 countries and social determinants: corruption, democratization, income inequality and cultural fragmentation, we used a mixed linear regression model for repeated measures with random intercepts and a conglomerate-based geographical analysis, between 2000 and 2010.
Results
Health determinants with a significant association on child mortality(<1year): higher access to water (βa Quartile 4(Q4) vs Quartile 1(Q1) = -6,14; 95%CI: -11,63 to -0,73), sanitation systems, (Q4 vs Q1 = -25,58; 95%CI: -31,91 to -19,25), % measles vaccination coverage (Q4 vs Q1 = -7.35; 95%CI: -10,18 to -4,52), % of births attended by a healthcare professional (Q4 vs Q1 = -7,91; 95%CI: -11,36 to -4,52) and a % of the total health expenditure (Q3 vs Q1 = -2,85; 95%CI: -4,93 to -0,7). Ethnic fragmentation (Q4 vs Q1 = 9,93; 95%CI: -0.03 to 19.89) had a marginal effect. For child mortality<5 years, an association was found for these variables and democratization (not free vs free = 11,23; 95%CI: -0,82 to 23,29), out-of-pocket expenditure (Q1 vs Q4 = 17,71; 95%CI: 5,86 to 29,56). For MMR (Maternal mortality ratio), % of access to water for all the quartiles, % of access to sanitation systems, (Q3 vs Q1 = -171,15; 95%CI: -281,29 to -61), birth attention by a healthcare professional (Q4 vs Q1 = -231,23; 95%CI: -349,32 to -113,15), and having corrupt government (Q3 vs Q1 = 83,05; 95%CI: 33,10 to 133).
Conclusions
Improving access to water and sanitation systems, decreasing corruption in the health sector must become priorities in health systems. The ethno-linguistic cultural fragmentation and the detriment of democracy turn out to be two factors related to health results.

Science
3 April 2015 vol 348, issue 6230, pages 1-150
http://www.sciencemag.org/current.dtl
Special Issue
Cancer Immunology and Immunotherapy

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Infectious Diseases
As Ebola wanes, trials jockey for patients
Kai Kupferschmidt
The Ebola epidemic in West Africa has caused enormous suffering, but scientists also see it as a chance to test experimental therapies that could save lives in the future. With declining case numbers, however, it is becoming less likely that all the drug tests will reach a conclusion. Now, scientists are debating whether some trials should be stopped so that tests of more promising therapies that have only now become available have a better chance of reaching a conclusion. An expert panel at the World Health Organization has given ZMapp and TKM-Ebola highest priority but in a recent meeting did not call for ongoing studies of favipiravir and convalescent blood to be stopped. The experts did convince a group of Italian doctors to test ZMapp instead of the heart drug amiodarone and criticized an interferon trial that has now started in Guinea.

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Policy Forum
Vaccine Testing
Ebola and beyond
Marc Lipsitch1,*, Nir Eyal2, M. Elizabeth Halloran3,4, Miguel A. Hernán5, Ira M. Longini6,
Eli N. Perencevich7,8, Rebecca F. Grais9,*
Author Affiliations
1Center for Communicable Disease Dynamics and Departments of Epidemiology and Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA.
2Department of Global Health and Population, Harvard T. H. Chan School of Public Health and Center for Bioethics, Harvard Medical School, Boston, MA, USA.
3Center for Inference and Dynamics of Infectious Diseases, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
4Department of Biostatistics, University of Washington, Seattle, WA 98105, USA.
5Center for Communicable Disease Dynamics and Departments of Epidemiology and Biostatistics, Harvard T. H. Chan School of Public Health, and Harvard-MIT Division of Health Sciences and Technology, Boston, MA, USA.
6Center for Inference and Dynamics of Infectious Diseases, Department of Biostatistics, College of Public Health and Health Professions, and College of Medicine, University of Florida, Gainesville, FL, USA.
7Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
8Center for Comprehensive Access and Delivery Research and Evaluation, Iowa Veterans Affairs Health Care System, Iowa City, IA, USA.
9Epicentre, Paris, France.
Many epidemic-prone infectious diseases present challenges that the current West African Ebola outbreak brings into sharp relief. Specifically, the urgency to evaluate vaccines, initially limited vaccine supplies, and large and unpredictable spatial and temporal fluctuations in incidence have presented huge logistical, ethical, and statistical challenges to trial design.

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Report
Mutation rate and genotype variation of Ebola virus from Mali case sequences
T. Hoenen1,*, D. Safronetz1,*, A. Groseth1,*, K. R. Wollenberg2,*, O. A. Koita3, B. Diarra3,
I. S. Fall4, F. C. Haidara5, F. Diallo5, M. Sanogo3, Y. S. Sarro3, A. Kone3, A. C. G. Togo3, A. Traore5, M. Kodio5, A. Dosseh6, K. Rosenke1, E. de Wit1, F. Feldmann7, H. Ebihara1, V. J. Munster1, K. C. Zoon8, H. Feldmann1, S. Sow5,
Author Affiliations
1Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Hamilton, MT 59840, USA.
2Bioinformatics and Computational Biosciences Branch, NIAID, NIH, Bethesda, MD 20892, USA.
3Center of Research and Training for HIV and Tuberculosis, University of Science, Technique and Technologies of Bamako, Mali.
4World Health Organization Office, Bamako, Mali.
5Centre des Operations d’Urgence, Centre pour le Développement des Vaccins (CVD-Mali), Centre National d’Appui à la lutte contre la Maladie, Ministère de la Sante et de l’Hygiène Publique, Bamako, Mali.
6World Health Organization Inter-Country Support Team, Ouagadougou, Burkina Faso.
7Rocky Mountain Veterinary Branch, Division of Intramural Research, NIAID, NIH, Hamilton, MT 59840, USA.
8Office of the Scientific Director, NIAID, NIH, Bethesda, MD 20895, USA.
Abstract
Editor’s Summary
The occurrence of Ebola virus (EBOV) in West Africa during 2013–2015 is unprecedented. Early reports suggested that in this outbreak EBOV is mutating twice as fast as previously observed, which indicates the potential for changes in transmissibility and virulence and could render current molecular diagnostics and countermeasures ineffective. We have determined additional full-length sequences from two clusters of imported EBOV infections into Mali, and we show that the nucleotide substitution rate (9.6 × 10–4 substitutions per site per year) is consistent with rates observed in Central African outbreaks. In addition, overall variation among all genotypes observed remains low. Thus, our data indicate that EBOV is not undergoing rapid evolution in humans during the current outbreak. This finding has important implications for outbreak response and public health decisions and should alleviate several previously raised concerns.

Media/Policy Watch

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Council on Foreign Relations
http://www.cfr.org/
Accessed 4 April 2015
Chinese Pharma: A Global Health Game Changer?
31 March 2015
The twenty-first century shift in geoeconomic power toward Asia has also spurred a rebalancing in global pharmaceutical research and development (R&D) investment toward emerging economies. China is currently the world’s second-highest investor in R&D and is poised to overtake the United States in R&D spending by 2023. Determined to become a world leader in the pharmaceutical sector, China spent $1.17 billion on promoting life and medical sciences in 2012—nearly ten times its 2004 level of investment. With U.S. funding for medical research on the decline, the surge in Chinese funding has prompted many policymakers to ask if the country’s pharmaceutical industry could be the next game changer for global public health and access to medicine (ATM)…

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The Huffington Post
http://www.huffingtonpost.com/
5 Crucial Lessons From The Recent Measles Outbreak
1 April 2015
While the United States is overwhelmingly vaccinated against preventable viruses like measles, mumps and rubella (on account of them coming altogether in one shot), there are certain pockets around the country where vaccination rates are dipping below the 95 percent needed to maintain herd immunity. These under-vaccinated communities, coupled with travelers bringing the measles over from other countries, have resulted in an unusual amount of measles cases — 644 cases over 23 outbreaks in 2014, and in 2015 to date, 178 cases over four outbreaks. These numbers represent the greatest levels of measles that America has ever seen since measles was first eradicated from the country, in 2000.
The size and scope of the biggest outbreak this year, which links 131 cases to exposure at the Disneyland theme park last December, has focused the nation’s attention like a laser to the tiny communities scattered around the U.S. that have chosen to skip vaccinating their children, without medical justification. In the story below, three infectious disease experts weigh in on what America has learned by turning an ear toward these communities and keeping a wary eye on the growing number of infections…