Journal of Virology
August 2015, Volume 89, Issue 15
http://jvi.asm.org/content/current

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Rethinking the Response to Emerging Microbes: Vaccines and Therapeutics in the Ebola Era—a Conference at Harvard Medical School
David M. Knipe and Sean P. Whelan
Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA
F. Goodrum, Editor
Author Affiliations
ABSTRACT
Harvard Medical School convened a meeting of biomedical and clinical experts on 5 March 2015 on the topic of “Rethinking the Response to Emerging Microbes: Vaccines and Therapeutics in the Ebola Era,” with the goals of discussing the lessons from the recent Ebola outbreak and using those lessons as a case study to aid preparations for future emerging infections. The speakers and audience discussed the special challenges in combatting an infectious agent that causes sporadic outbreaks in resource-poor countries. The meeting led to a call for improved basic medical care for all and continued support of basic discovery research to provide the foundation for preparedness for future outbreaks in addition to the targeted emergency response to outbreaks and targeted research programs against Ebola virus and other specific emerging pathogens.

The Lancet
Online First
Articles
Feasibility and effectiveness of oral cholera vaccine in an urban endemic setting in Bangladesh: a cluster randomised open-label trial
Dr Firdausi Qadri, PhD, Mohammad Ali, PhD, Fahima Chowdhury, MPH, Ashraful Islam Khan, PhD, Amit Saha, MMed, Iqbal Ansary Khan, MSc, Yasmin A Begum, PhD, Taufiqur R Bhuiyan, PhD, Mohiul Islam Chowdhury, MPH, Md Jasim Uddin, PhD, Jahangir A M Khan, PhD, Atique Iqbal Chowdhury, MSc, Anisur Rahman, MSc, Shah Alam Siddique, MPH, Muhammad Asaduzzaman, MBBS, Afroza Akter, MBBS, Arifuzzaman Khan, MBBS, Young Ae You, MS, Ashraf Uddin Siddik, MSS, Nirod Chandra Saha, MSc, Alamgir Kabir, MSc, Baizid Khoorshid Riaz, MBBS, Shwapon Kumar Biswas, MPH, Farzana Begum, MPH, Leanne Unicomb, PhD, Prof Stephen P Luby, MD, Prof Alejandro Cravioto, PhD, Prof John D Clemens, MD
Published Online: 08 July 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)61140-0
Summary
Background
Cholera is endemic in Bangladesh with epidemics occurring each year. The decision to use a cheap oral killed whole-cell cholera vaccine to control the disease depends on the feasibility and effectiveness of vaccination when delivered in a public health setting. We therefore assessed the feasibility and protective effect of delivering such a vaccine through routine government services in urban Bangladesh and evaluated the benefit of adding behavioural interventions to encourage safe drinking water and hand washing to vaccination in this setting.
Methods
We did this cluster-randomised open-label trial in Dhaka, Bangladesh. We randomly assigned 90 clusters (1:1:1) to vaccination only, vaccination and behavioural change, or no intervention. The primary outcome was overall protective effectiveness, assessed as the risk of severely dehydrating cholera during 2 years after vaccination for all individuals present at time of the second dose. This study is registered with ClinicalTrials.gov, number NCT01339845.
Findings
Of 268 896 people present at baseline, we analysed 267 270: 94 675 assigned to vaccination only, 92 539 assigned to vaccination and behavioural change, and 80 056 assigned to non-intervention. Vaccine coverage was 65% in the vaccination only group and 66% in the vaccination and behavioural change group. Overall protective effectiveness was 37% (95% CI lower bound 18%; p=0·002) in the vaccination group and 45% (95% CI lower bound 24%; p=0·001) in the vaccination and behavioural change group. We recorded no vaccine-related serious adverse events.
Interpretation
Our findings provide the first indication of the effect of delivering an oral killed whole-cell cholera vaccine to poor urban populations with endemic cholera using routine government services and will help policy makers to formulate vaccination strategies to reduce the burden of severely dehydrating cholera in such populations.
Funding
Bill & Melinda Gates Foundation.

The Lancet
Jul 11, 2015 Volume 386 Number 9989 p103-218
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
A plan to protect the world—and save WHO
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)61225-9
Summary
“WHO must reestablish its pre-eminence as the guardian of global public health.” These words resonate throughout the final report of the Ebola Interim Assessment Panel, requested by WHO’s Executive Board, chaired by Dame Barbara Stocking, and published this week. The findings of the panel present a devastating critique of WHO and the chronic inaction of its member states, which together created the conditions for an Ebola virus disease outbreak of unprecedented ferocity and human tragedy. The Stocking Report, as it will come to be known, sets out in agonising detail how the entire global health system fatally let down the people of west Africa.

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Editorial
Cuba: defeating AIDS and advancing global health
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(15)61227-2
Summary
On June 30, Cuba became the world’s first country to eliminate mother-to-child transmission of HIV. As WHO Director-General Margaret Chan noted, this achievement is a “major victory” and “an important step towards having an AIDS-free generation”.

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Comment
The Global Financing Facility: country investments for every woman, adolescent, and child
Hailemariam Desalegn, Erna Solberg, Jim Yong Kim
DOI: http://dx.doi.org/10.1016/S0140-6736(15)61224-7
Summary
On July 13–16, 2015, leaders from around the globe will meet in Addis Ababa, Ethiopia, for the Third International Financing for Development Conference. The promise of this conference is in both finding new resources for development and doing development differently. We are setting a course of bold action for sustainable results to achieve a world in which every woman, child, and adolescent thrives and realises her full potential. The launch of the Global Financing Facility (GFF) at the conference in Addis Ababa will be an essential pillar to support this goal.

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Articles
Social network targeting to maximise population behaviour change: a cluster randomised controlled trial
David A Kim, BSc, Alison R Hwong, BSc, Derek Stafford, BSc, D Alex Hughes, BSc, Prof A James O’Malley, PhD, Prof James H Fowler, PhD, Prof Nicholas A Christakis, MD
Published Online: 04 May 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60095-2
Summary
Background
Information and behaviour can spread through interpersonal ties. By targeting influential individuals, health interventions that harness the distributive properties of social networks could be made more effective and efficient than those that do not. Our aim was to assess which targeting methods produce the greatest cascades or spillover effects and hence maximise population-level behaviour change.
Methods
In this cluster randomised trial, participants were recruited from villages of the Department of Lempira, Honduras. We blocked villages on the basis of network size, socioeconomic status, and baseline rates of water purification, for delivery of two public health interventions: chlorine for water purification and multivitamins for micronutrient deficiencies. We then randomised villages, separately for each intervention, to one of three targeting methods, introducing the interventions to 5% samples composed of either: randomly selected villagers (n=9 villages for each intervention); villagers with the most social ties (n=9); or nominated friends of random villagers (n=9; the last strategy exploiting the so-called friendship paradox of social networks). Participants and data collectors were not aware of the targeting methods. Primary endpoints were the proportions of available products redeemed by the entire population under each targeting method. This trial is registered with ClinicalTrials.gov, number NCT01672580.
Findings
Between Aug 4, and Aug 14, 2012, 32 villages in rural Honduras (25–541 participants each; total study population of 5773) received public health interventions. For each intervention, nine villages (each with 1–20 initial target individuals) were randomised, using a blocked design, to each of the three targeting methods. In nomination-targeted villages, 951 (74·3%) of 1280 available multivitamin tickets were redeemed compared with 940 (66·2%) of 1420 in randomly targeted villages and 744 (61·0%) of 1220 in indegree-targeted villages. All pairwise differences in redemption rates were significant (p<0·01) after correction for multiple comparisons. Targeting nominated friends increased adoption of the nutritional intervention by 12·2% compared with random targeting (95% CI 6·9–17·9). Targeting the most highly connected individuals, by contrast, produced no greater adoption of either intervention, compared with random targeting.
Interpretation
Introduction of a health intervention to the nominated friends of random individuals can enhance that intervention’s diffusion by exploiting intrinsic properties of human social networks. This method has the additional advantage of scalability because it can be implemented without mapping the network. Deployment of certain types of health interventions via network targeting, without increasing the number of individuals targeted or the resources used, could enhance the adoption and efficiency of those interventions, thereby improving population health.
Funding
National Institutes of Health, The Bill & Melinda Gates Foundation, Star Family Foundation, and the Canadian Institutes of Health Research.

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The Lancet Commissions
Defeating AIDS—advancing global health
Prof Peter Piot, PhD, Salim S Abdool Karim, PhD, Robert Hecht, PhD, Helena Legido-Quigley, PhD, Kent Buse, PhD, John Stover, MA, Stephen Resch, PhD, Theresa Ryckman, BA, Sigrun Møgedal, MD, Mark Dybul, MD, Eric Goosby, MD, Charlotte Watts, PhD, Nduku Kilonzo, PhD, Joanne McManus, Michel Sidibé, MSc on behalf of the UNAIDS–Lancet Commission – Listed at end of paper
Published Online: 24 June 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60658-4
Summary
After more than a decade of major achievements, the AIDS response is at a crucial juncture, both in terms of its immediate trajectory and its sustainability, as well as its place in the new global health and development agendas. In May, 2013, the UNAIDS–Lancet Commission—a diverse group of experts in HIV, health, and development, young people, people living with HIV and affected communities, activists, and political leaders—was established to investigate how the AIDS response could evolve in a new era of sustainable development.

PLoS One
http://www.plosone.org/
[Accessed 11 July 2015]

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The Effectiveness of Age-Specific Isolation Policies on Epidemics of Influenza A (H1N1) in a Large City in Central South China
Ruchun Liu, Ross Ka-kit Leung, Tianmu Chen, Xixing Zhang, Faming Chen, Shuilian Chen, Jin Zhao
Research Article | published 10 Jul 2015 | PLOS ONE 10.1371/journal.pone.0132588
Abstract
During the early stage of a pandemic, isolation is the most effective means of controlling transmission. However, the effectiveness of age-specific isolation policies is not clear; especially little information is available concerning their effectiveness in China. Epidemiological and serological survey data in the city of Changsha were employed to estimate key model parameters. The average infectious period (date of recovery – date of symptom onset) of influenza A (H1N1) was 5.2 days. Of all infected persons, 45.93% were asymptomatic. The basic reproduction number of the influenza A (H1N1) pandemic was 1.82. Based on the natural history of influenza A (H1N1), we built an extended susceptible-exposed-infectious/asymptomatic-removedmodel, taking age groups: 0–5, 6–14, 15–24, 25–59, and ≥60 years into consideration for isolation. Without interventions, the total attack rates (TARs) in each age group were 42.73%, 41.95%, 20.51%, 45.03%, and 37.49%, respectively. Although the isolation of 25–59 years-old persons was the most effective, the TAR of individuals of aged 0–5 and 6–14 could not be reduced. Paradoxically, isolating individuals ≥60 year olds was not predicted to be an effective way of reducing the TAR in this group but isolating the age-group 25–59 did, which implies inter-age-group transmission from the latter to the former is significant. Isolating multiple age groups increased effectiveness. The most effective combined isolation target groups were of 6–14 + 25–59 year olds, 6–14 + 15–24 + 25–59 year olds, and 0–5 + 6–14 + 25–59 + ≥60 year olds. The last of these isolation schemas reduced the TAR of the total population from 39.64% to 0.006%, which was exceptionally close to the effectiveness of isolating all five age groups (TAR = 0.004%).

Public Health Ethics
Volume 8 Issue 2 July 2015
http://phe.oxfordjournals.org/content/current
Special Symposium: Migrant Health

Health of Migrants: Approaches from a Public Health Ethics Perspective
Verina Wild, Deborah Zion, and Richard Ashcroft
Extract
‘How do we know when it is dawn? When we have enough light to recognise, in the face of the stranger, that of our sister.’ 1
In 2013, a number of 230 million international migrants was estimated, of which 51.2 million people were forcibly displaced (UNHCR, 2014; United Nations, 2014). The majority of these refugees reside in the global South, in countries that have difficulties providing health care to their own citizens. However, in countries with functioning health care systems, there are also hundreds of thousands of people who are seeking refuge for example from brutal wars in the Middle East, and in the Horn of Africa. Additionally, an unknown number of undocumented migrants or temporary workers are on the move.

Despite the fact that Europe, the USA and Australia have considerably more resources to support health care (among other social and economic benefits) than other reception countries such as Pakistan and Iran, there is little consensus between or within countries about an acceptable standard of health care for different migrant groups, such as undocumented migrants, asylum seekers, refugees and temporary workers. There is also considerable disagreement about how this health care might be accessed, or the philosophical and human rights positions that underpin discussions concerning access and delivery.

In this edition of Public Health Ethics, we seek to address these concerns. Our conversation began in 2013 at an international symposium at the Brocher Foundation in Switzerland, in which a group of scholars, and experts from non-governmental organizations and international organizations from five continents explored ethical issues related to different migrant groups and health. We focussed particularly on undocumented migrants, asylum seekers and refugees as some of those who can be rendered most vulnerable. The papers published here trace the arc of philosophical debates and practical …

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

Clinical Journal of Pain
Psychological interventions for vaccine injections in children and adolescents: systematic review of randomized and quasi-randomized controlled trials
Birnie, Kathryn A. BA(Hons), PhD Candidate; Chambers, Christine T. PhD; Taddio, Anna BScPhm, MSc, PhD; McMurtry, C. Meghan PhD, C Psych; Noel, Melanie PhD; Pillai Riddell, Rebecca PhD, C Psych; Shah, Vibhuti MD, MSc; HELPinKids&Adults Team
Abstract
Background:
This systematic review evaluated the effectiveness of psychological interventions for reducing vaccination pain and related outcomes in children and adolescents.
Design/Methods:
Database searches identified relevant randomized and quasi-randomized controlled trials. Data were extracted and pooled using established methods. Pain, fear, and distress were considered critically important outcomes.
Results:
Twenty-two studies were included; two included adolescents. Findings showed no benefit of false suggestion (n=240) for pain (SMD -0.21 (-0.47, 0.05)) or distress (SMD -0.28 (-0.59, 0.11)), or for use of repeated reassurance (n=82) for pain (SMD -0.18 (-0.92, 0.56)), fear (SMD -0.18 (-0.71, 0.36)), or distress (SMD 0.10 (-0.33, 0.54)). Verbal distraction (n=46) showed reduced distress (SMD -1.22 (-1.87, -0.58)), but not reduced pain (SMD -0.27 (-1.02, 0.47)). Similarly, video distraction (n=328) showed reduced distress (SMD -0.58 (-0.82, -0.34)), but not reduced pain (SMD -0.88 (-1.78, 0.02)) or fear (SMD 0.08 (-0.25, 0.41)). Music distraction demonstrated reduced pain when used with children (n=417) (SMD -0.45 (-0.71, -0.18)), but not with adolescents (n=118) (SMD -0.04 (-0.42, 0.34)). Breathing with a toy (n=368) showed benefit for pain (SMD -0.49 (-0.85, -0.13)), but not fear (SMD -0.60 (-1.22, 0.02); whereas breathing without a toy (n=136) showed no benefit for pain (SMD -0.27 (-0.61, 0.07)) or fear (SMD -0.36 (-0.86, 0.15)). There was no benefit for a breathing intervention (cough) in children and adolescents (n=136) for pain (SMD -0.17 (-0.41, 0.07)).
Conclusions:
Psychological interventions with some evidence of benefit in children include: verbal distraction, video distraction, music distraction, and breathing with a toy.

Psycho-Oncology
‘I didn’t even know boys could get the vaccine’: Parents’ reasons for human papillomavirus (HPV) vaccination decision making for their sons
Samara Perez1,2,*, Gilla K. Shapiro1,2, Christopher A. Brown2, Eve Dube6, Gina Ogilvie7,8 and
Zeev Rosberger1,2,3,4,5
Article first published online: 7 JUL 2015
DOI: 10.1002/pon.3894
Abstract
Objective
The study’s objective was to examine parents’ reasons for their decision to vaccinate their 9–16-year-old sons with the human papillomavirus (HPV) vaccine.
Methods
Using the precaution adoption process model (PAPM), parents were classified according to one of six stages of decision making: unaware, unengaged, undecided, decided not to vaccinate, decided to vaccinate, or vaccinated. Parents responded to an open-ended question: ‘What would influence your decision to have your son vaccinated or not against HPV?’
Results
Three thousand one hundred and seventeen parents provided 2,874 interpretable narrative responses that were coded using thematic content analyses. The majority of parents were in the earlier precaution adoption process model stages, that is, unaware that the HPV vaccine could be given to boys (57.0%), unengaged (20.9%), or undecided (9.1%). Needing more information, vaccine cost, risks associated with vaccination, and wanting a doctor’s recommendation influenced these earlier-staged parents’ decisions. Parents who decided not to vaccinate their sons (6.8%) reported their decision was due to the risks, insufficient research, lack of confidence in vaccines, and/or no need for the vaccine (as their sons are not sexually active and/or too young). Parents who had decided to vaccinate their sons (5.0%) or who had vaccinated their sons (1.1%) reported that their decisions were based on protecting their sons’ health and preventing disease.
Conclusion
There are important differences in the factors that influence parents’ decision depending on where they are along the decision-making trajectory. Assuring that parents are well informed about the importance of male vaccination, reducing vaccine cost, accurately communicating vaccine safety, and improving patient–provider communication may augment vaccine coverage and prevent HPV-associated cancers in Canada.

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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Forbes
http://www.forbes.com/
Accessed 11 July 2015
The California Child Vaccination Mandates And The Everlasting Cycle Of Infectious Diseases
Recent legislation mandating child vaccinations in California are a predictable response to an ongoing cycle of outbreaks and increased prevention-oriented behavior. This cycle arises when increasing risk of infection drives burgeoning demand for protection, which in turn drives down the rate of infection and future disease prevalence. Falling […]
Tomas Philipson, Contributor Jul 09, 2015

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New York Times
http://www.nytimes.com/
Accessed 11 July 2015
Health
Promise Is Seen in an Inexpensive Cholera Vaccine
By DONALD G. McNEIL Jr.JULY 8, 2015
An inexpensive, little-known cholera vaccine appears to work so well that it can protect entire communities and perhaps head off explosive epidemics like the one that killed nearly 10,000 Haitians in 2010.
A major study published on Wednesday in The Lancet found that the vaccine gave individuals more than 50 percent protection against cholera and reduced life-threatening episodes of the infection by about 40 percent in Bangladesh, where the disease has persisted for centuries.
In a result that surprised researchers, the vaccine worked far better than supplying families with chlorine for their water and soap for hand-washing.
The study is “really very important, and testing it in 270,000 people is phenomenal,” said Dr. Louise C. Ivers, a health policy adviser at Partners in Health, a medical charity that fights AIDS in Haiti and switched to treating cholera there after the earthquake.
“In the last five years, the conversation has switched from ‘We shouldn’t use vaccine’ to ‘How can we use it best?’ ”…

Facts & Figures: After Outbreaks, Vaccine Support Rises
July 7, 2015
A new poll, conducted after outbreaks of measles and whooping cough in several states, found that about a third of parents see more benefit in vaccines than they did a year ago, and a similar percentage are more supportive of requiring vaccines for school admission…

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

.– Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

– pdf version:  A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_4 July 2015

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

– Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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– Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.
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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

EBOLA/EVD [to 4 July 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Ebola Situation Report – 1 July 2015
[Excerpts]
SUMMARY
:: There were 20 confirmed cases of Ebola virus disease (EVD) reported in the week to 28 June, the same as the previous week. Weekly case incidence has been between 20 and 27 cases for 5 consecutive weeks. In Guinea, 12 cases were reported from 3 prefectures: Boke, Conakry, and Forecariah. All 3 prefectures reported cases the previous week. In Sierra Leone, 8 cases were reported from the same 3 districts as the previous week: Kambia, Port Loko, and the district that includes the capital, Freetown. Challenges tracing and monitoring contacts continue to hamper efforts to end transmission, with a proportion of cases not detected until after death, increasing the risk of further transmission.
:: On 29 June, routine surveillance detected a confirmed case of EVD in Margibi County, Liberia—the first new confirmed case in the country since 20 March. The case is a 17-year-old male who first became ill on 21 June. After presenting at a local health facility the patient was treated for malaria and discharged. He died on 28 June and received a safe burial the same day. An oral swab taken before the burial subsequently tested positive twice for EVD. 102 contacts have been identified, although that number is expected to increase as investigations continue. At this stage the origin of infection is not known. The case reportedly had no recent history of travel, contact with visitors from affected areas, or funeral attendance…
:: Two new health worker infections were reported from Boke, Guinea, for a second consecutive week. No new health worker infections were reported from Sierra Leone. There have been a total of 874 confirmed health worker infections reported from Guinea, Liberia, and Sierra Leone since the start of the outbreak, with 509 reported deaths.

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been a total of 27,443 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1) up to 28 June, with 11,220 reported deaths (this total includes reported deaths among probable and suspected cases, although outcomes for many cases are unknown). A total of 12 new confirmed cases were reported in Guinea and 8 in Sierra Leone in the 7 days to 28 June. …
WHO: News
Ebola diaries: Making things work in a desperate situation 1 July 2015

UNMEER
:: UNMEER Chief says Ebola comeback in Liberia underscores need for rigorous testing 02 Jul 2015

UNICEF [to 4 July 2015]
http://www.unicef.org/media/media_78364.html
UNICEF teams, supplies arrive in areas affected by new Ebola cases in Liberia
MONROVIA/DAKAR/GENEVA, 3 July 2015 – Responding to Liberia’s first confirmed cases of Ebola in more than three months, UNICEF has begun distributing emergency supplies in the affected communities including tents for isolating those under quarantine, hygiene kits and chlorine and buckets for handwashing stations.

ILO International Labour Organization [to 4 July 2015]
http://www.ilo.org/global/lang–en/index.htm
Occupational safety and health
Ebola: How decent work in the health sector saves lives of health personnel
01 July 2015
International labour standards and tools, if correctly applied, are very effective in protecting frontline health workers treating patients with potentially deadly infectious diseases, such as Ebola, says Christiane Wiskow, Senior Health Sector Specialist at the International Labour Organization (ILO).

ODI [to 4 July 2015]
http://www.odi.org/media
After Ebola: why and how capacity support to Sierra Leone’s health sector needs to change
Research reports and studies | July 2015 |
Lisa Denney and Richard Mallett with Ramatu Jalloh
The central argument of this report is that capacity building in Sierra Leone’s health sector has been thought about and operationalised in a narrow, technical way and that a smarter model of capacity building is needed.

POLIO [to 4 July 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 1 July 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx

:: In June, the wild poliovirus outbreaks in Equatorial Guinea, Ethiopia and Kenya were assessed to be over by independent teams, having successfully interrupted transmission of the virus. While this is a sign that supplementary immunization activities and acute flaccid paralysis have been strengthened since all of the outbreaks began in 2013, it is essential for these gains to be maintained and built upon in order to protect children within these countries from the return of the virus.
Read more on Equatorial Guinea: [Polio Transmission Stopped in Equatorial Guinea Thursday, June 25, 2015/ With a polio-free future back in its grasp, Equatorial Guinea must now use gains against polio to build more sustainable protection for the future health of its children], and Ethiopia and Kenya [Ending an Outbreak: The Importance of Strong Surveillance, Friday, June 26, 2015/ The polio outbreaks in Ethiopia and Kenya were declared over this June, emphasizing the importance of strong surveillance in knowing the virus has gone from a country.

:: Five cases of circulating vaccine derived poliovirus type 1 (cVDPV1) have been reported in Madagascar, with dates of onset of paralysis in April and May 2015. These cases are genetically linked to that from September 2014, indicating prolonged and widespread circulation of the virus. The emergency outbreak response is now being intensified to build immunity against the virus in the country, as 25 % of children across Madagascar remain un- or under- immunized.
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Selected excerpts from Country-specific Reports
Afghanistan
:: The Technical Advisory Group met in early June and identified that southern and eastern Afghanistan remains at particular risk of polio. The group identified reasons for missed children, which to a great extent ar e due to remaining operational challenges during campaign implementation. The meeting put forward key recommendations to urgently address these remaining gaps.
:: National Immunization Days are scheduled on 16 to 18 August using bivalent oral polio vaccine. Since the most recent case on the 05 May, Farah has seen two supplementary immunization activities.
Nigeria
:: One new type 2 circulating vaccine-derived poliovirus (cVDPV2) case was reported in the past week, with onset of paralysis in Kwali district, FCT, Abuja, on the 16 May. This case is genetically linked to previous VDPVs found in the environment in Kaduna from August 2014 to January 2015. The total number of cases is now one for 2015. The total number of cVDPV2 cases for 2014 in Nigeria remains 30. Learn more about VDPVs here.
:: In line with national emergency action plans, there is an aggressive and rapid response to any detected virus, including to these recent environmental samples, with large-scale mop-ups using trivalent oral polio vaccine (tOPV) and inactivated polio vaccine (IPV).
:: Subnational Immunization Days (SNIDs) are planned across most of northern Nigeria from 25 – 28 July using tOPV, alongside mop-up activities in high-risk areas with dates to be confirmed.

MERS-CoV [to 4 July 2015]

Global Alert and Response (GAR) – Disease Outbreak News (DONs)
:: 3 July 2015 – Republic of Korea: Middle East respiratory syndrome coronavirus (MERS-CoV) –
Situation in Korea
Between 1 and 3 July 2015, the National IHR Focal Point of the Republic of Korea notified WHO of 2 additional confirmed case of Middle East Respiratory Syndrome Coronavirus (MERS-CoV).
Additional information on the outbreak in Korea
To date, a total of 184 MERS-CoV cases, including 33 deaths, have been reported. One of the 184 cases is the case that was confirmed in China and also notified by the National IHR Focal Point of China…

:: 3 July 2015 – Saudi Arabia: Middle East Respiratory Syndrome coronavirus (MERS-CoV) –
Between 19 and 30 June 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 6 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection…

MERS-CoV cases in the Republic of Korea as of 3 July 2015xlsx, 19kb

Managing contacts in the MERS-CoV outbreak in the republic of Korea
1 July 2015

WHO & Regionals [to 4 July 2015]
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WHO validates elimination of mother-to-child transmission of HIV and syphilis in Cuba
News release
30 JUNE 2015 ¦ GENEVA ¦ WASHINGTON – Cuba today became the first country in the world to receive validation from WHO that it has eliminated mother-to-child transmission of HIV and syphilis.
“Eliminating transmission of a virus is one of the greatest public health achievements possible,” said Dr Margaret Chan, WHO Director-General. “This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation” she added.
Michel Sidibé, Executive Director of UNAIDS: “This is a celebration for Cuba and a celebration for children and families everywhere. It shows that ending the AIDS epidemic is possible and we expect Cuba to be the first of many countries coming forward to seek validation that they have ended their epidemics among children.”…

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The Weekly Epidemiological Record (WER) 3 July 2015, vol. 90, 27 (pp. 337–348) includes:
:: Introduction of inactivated polio vaccine and switch from trivalent to bivalent oral poliovirus vaccine worldwide, 2013–2016
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2015.

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GIN June 2015 pdf, 1.47Mb – 3 July 2015

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:: WHO Regional Offices
WHO African Region AFRO
:: WHO Regional Director for Africa calls for greater commitment to improve access to medicines in the Region
Brazzaville, 2 July 2015 – As members of an EU/WHO/ACP partnership* to improve access to quality medicines meet in Brazzaville, Dr Matshidiso Moeti, WHO Regional Director for Africa, praised progress made and called for greater commitment to ensure that Africans have access to the quality, affordable medicines they need.
:: WHO and AUC take stock on joint efforts to improve health on the continent
Brazzaville, 30 June 2015 – High ranking officials from the African Union Commission (AUC) and the World Health Organization (WHO) are meeting in Brazzaville to take stock of their collaborative efforts to improve the health of people in Africa…

WHO Region of the Americas PAHO
:: WHO validates Cuba’s elimination of mother-to-child transmission of HIV and syphilis (06/30/2015)

WHO South-East Asia Region SEARO
No new digest identified.

WHO European Region EURO
:: Second meeting of the Small countries initiative in Andorra: implementing the life-course approach vision 03-07-2015
:: What to do in heatwaves: public health advice 02-07-2015

WHO Eastern Mediterranean Region EMRO
No new digest identified.

WHO Western Pacific Region
:: Scaling-up HIV testing is critical to end the AIDS epidemic in Asia-Pacific
HIV/AIDS programme managers and community groups join hands to strengthen and expand HIV testing
Joint news release of WHO and UNAIDS
MANILA, 02 July 2015 – Ten national HIV/AIDS and sexually transmitted infection (STI) programmes, civil society and development partners in the Western Pacific Region have joined forces to ensure that everyone living with HIV knows their status and is able to access HIV treatment. This push for expanded HIV testing coverage came during a recent two-day meeting organized by the World Health Organization’s (WHO) Regional Office for the Western Pacific and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Manila, the Philippines…

CDC/MMWR/ACIP Watch [to 4 July 2015]
http://www.cdc.gov/media/index.html

CDC awards $216 million to community-based organizations to deliver the most effective HIV prevention strategies to those in greatest need – Press Release – Wednesday, July 1, 2015

New Entry Screening and Monitoring Guidelines for Travelers Entering the United States from Liberia – Media Statement
FRIDAY, JUNE 12, 2015

MMWR July 3, 2015 / Vol. 64 / No. 25
:: Monitoring of Persons with Risk for Exposure to Ebola Virus Disease — United States, November 3, 2014–March 8, 2015
:: Monitoring Exposure to Ebola and Health of U.S. Military Personnel Deployed in Support of Ebola Control Efforts — Liberia, October 25, 2014–February 27, 2015
:: Introduction of Inactivated Poliovirus Vaccine and Switch from Trivalent to Bivalent Oral Poliovirus Vaccine — Worldwide, 2013–2016

IOM and Partners Complete Cholera Vaccination Campaign in Bentiu, South Sudan
06/30/15 – Press Release
South Sudan – IOM (International Organzation for Migration) in South Sudan, in close coordination with the World Health Organization (WHO) and other partners, has completed the second and final round of an oral cholera vaccine campaign at the UN Protection of Civilians (PoC) site in Bentiu, Unity State.

Vaccination of the internally displaced population (IDP) in the Bentiu PoC site is critical in the wake of the 23 June declaration of a cholera outbreak in the capital city of Juba. As of 30 June teams in the country have confirmed over 350 cholera cases in Juba county.

During two rounds of cholera vaccinations between 1–28 June, the IOM Rapid Response Team and partners vaccinated more than 71,200 people, including IDPs, and UN and humanitarian staff.

Although no confirmed cases have been reported outside of Juba, pre-emptive activities – such as, oral vaccination and hygiene promotion – are critical to help contain the spread of cholera, especially in crowded IDP sites like Bentiu.

“With the Bentiu IDP population increasing by hundreds each day and the rainy season setting in, conditions are ripe for the spread of diseases,” stated David Derthick, IOM South Sudan Chief of Mission. “IOM’s cholera vaccination campaign is a vital step to keeping cholera at bay in Bentiu.”

IOM will use the remaining vaccines to vaccinate new arrivals as they enter the PoC site…

“Through the efforts of our Rapid Response Team, IOM has quickly vaccinated the IDP population against cholera, while at the same time enabling our health partners to continue regular medical services that are just as vital to minimizing the spread of diseases,” noted Haley West, IOM Migration Health Programme Coordinator…

…In response to a request from WHO and other health partners, IOM will also lead an oral cholera vaccination campaign in the UN PoC site in Malakal, Upper Nile State, in the coming weeks.

The vaccination campaign at the Bentiu PoC site was

Jerry Brown signs California vaccine bill
June 30, 2015, Sacramento Bee
By David Siders, Alexei Koseff and Jeremy B. White

Highlights
:: Law eliminates religious and personal belief exemptions for vaccines
:: Brown says ‘the science is clear’ on vaccines
:: Opponents vow lawsuit, ballot measure to repeal law

Gov. Jerry Brown on Tuesday signed one of the strictest schoolchild vaccination laws in the country, eliminating personal and religious belief exemptions for vaccines.
The governor’s signature came one day after the state Senate moved the bill to his desk, following months of protests and fierce debate at the Capitol.

“The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases,” Brown said in a signing statement. “While it’s true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community.”

The bill will make California the third state in the nation to require vaccines without religious and personal belief exemptions.

Opponents of the measure said it unfairly restricts parent choice. They immediately vowed to challenge the law in court and potentially through a referendum at the ballot box, arguing it will deprive unvaccinated children of their constitutional right to an education…

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State of California: Governor Brown Signs Legislation
:: SB 277 by Senator Richard Pan (D-Sacramento) – Public health: vaccinations.
Signing message:
June 30, 2015
To Members of the California State senate
SB 277 has occasioned widespread interest and controversy – with both proponents and opponent expressing their opinions with eloquence and sincerity. After carefully reviewing the materials and arguments that have been presented, I have deiced to sign this bill

The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases. While it’s true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community.

The Legislature, after considerable debate, specifically amended SB 277 to exempt a child from immunization whenever the child’s physician concludes that there are “circumstances, including but not limited to, family medical history, for which the physician does not recommend immunization…”

Thus, SB 277, while requiring that school children be vaccinated, explicitly provides an exception when a physician believes that circumstances – in the judgement of sound discretion of the physician – so warrant.

Government of Equatorial Guinea and Oil Companies Agree to $48.5 Million Funding of Malaria Vaccine Development Program with Sanaria Inc.
ROCKVILLE, Md., June 29, 2015 /PRNewswire-USNewswire/ — The Government of the Republic of Equatorial Guinea announced an agreement with industry partners, Marathon Oil Corporation, Noble Energy Inc. and AMPCO, to sponsor the clinical development of Sanaria PfSPZ Vaccine against malaria, including a series of clinical trials from 2015 until 2018…
…As a leader among African governments in support for malaria vaccine research and development, the Republic of Equatorial Guinea, through the Ministries of Health and Social Welfare and Mines, Industry and Energy, and its partners in the oil and gas sector, will invest more than $48.5 million USD to support Sanaria Inc., a U.S. biotechnology company, in its efforts to develop and license a PfSPZ vaccine for protection against malaria. The Government of Equatorial Guinea is the major financial contributor in this initiative, with a commitment of $36.75 million USD, and the industry partners are investing $11.75 million USD. This is a unique international partnership that also involves the Ifakara Health Institute from Tanzania, the U.S. non-governmental organization, Medical Care Development International, the Swiss Tropical Public Health Institute, and the La Paz Malabo Medical Center, which is run by a team of Equatoguineans and Israelis. “The power and grandness of a country is not measured by its size nor its population, but rather by the size of its citizen’s hearts,” noted H.E. Obiang Nguema Mbasogo, President of Equatorial Guinea, on this unique partnership….

Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment
UNICEF and WHO
June 2015
ISBN: 978-92-4-150329-7 :: 90 pages
PDF: http://www.unicef.org/publications/index_82419.html#
Abstract
Looking back on 25 years of water, sanitation and hygiene monitoring, this report provides a comprehensive assessment of progress since 1990. The Millennium Development Goal target for drinking water was achieved in 2010, but, in 2015, 663 million people still lack improved drinking water sources. The world has missed the sanitation target by almost 700 million people, with 2.4 billion still lacking improved sanitation facilities and 946 million practicing open defecation.

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Introduction [excerpts]
In 2000 the Member States of the United Nations signed the Millennium Declaration, which later gave rise to the Millennium Development Goals (MDGs). Goal 7, to ensure environmental sustainability, included a target that challenged the global community to halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. The WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation (JMP), which began monitoring the sector in 1990, has provided regular estimates of progress towards the MDG targets, tracking changes over the 25 years to 2015.

In 1990, global coverage of the use of improved drinking water sources and sanitation facilities stood at 76 per cent and 54 per cent, with respective MDG targets of 88 per cent and 77 per cent by 2015. The challenges were huge, as the global figures hid vast disparities in coverage between countries, many of which were battling poverty, instability and rapid population growth.

The JMP has monitored the changes in national, regional and global coverage, establishing a large and robust database and presenting analysis not only of the indicators detailed in the original framework for the MDGs, but also many other parameters. The analysis has helped shed light on the nature of progress and the extent to which the ambition and vision of the MDGs have been achieved. It has also helped to identify future priorities to be addressed in the post-2015 Sustainable Development Goals.
Despite significant progress in water and sanitation, much still remains to be done. This report shows how the world has changed since 1990. It provides an assessment of progress towards the MDG target, and insight into the remaining challenges….

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Joint press release
UNICEF, WHO: Lack of sanitation for 2.4 billion people undermining health improvements
Final MDG progress report on water and sanitation released
NEW YORK/GENEVA, 30 June 2015 – Lack of progress on sanitation threatens to undermine the child survival and health benefits from gains in access to safe drinking water, warn WHO and UNICEF in a report tracking access to drinking water and sanitation against the Millennium Development Goals.

The Joint Monitoring Programme report, Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment, says worldwide, 1 in 3 people, or 2.4 billion, are still without sanitation facilities – including 946 million people who defecate in the open.

“What the data really show is the need to focus on inequalities as the only way to achieve sustainable progress,” said Sanjay Wijesekera, head of UNICEF’s global water, sanitation and hygiene programmes. “The global model so far has been that the wealthiest move ahead first, and only when they have access do the poorest start catching up. If we are to reach universal access to sanitation by 2030, we need to ensure the poorest start making progress right away.”
Access to improved drinking water sources has been a major achievement for countries and the international community. With some 2.6 billion people having gained access since 1990, 91 per cent of the global population now have improved drinking water – and the number is still growing. In sub-Saharan Africa, for example, 427 million people have gained access – an average of 47,000 people per day every day for 25 years.

The child survival gains have been substantial. Today, fewer than 1,000 children under five die each day from diarrhoea caused by inadequate water, sanitation and hygiene, compared to over 2,000 15 years ago.

On the other hand, the progress on sanitation has been hampered by inadequate investments in behaviour change campaigns, lack of affordable products for the poor, and social norms which accept or even encourage open defecation. Although some 2.1 billion people have gained access to improved sanitation since 1990, the world has missed the MDG target by nearly 700 million people. Today, only 68 per cent of the world’s population uses an improved sanitation facility – 9 percentage points below the MDG target of 77 per cent.

“Until everyone has access to adequate sanitation facilities, the quality of water supplies will be undermined and too many people will continue to die from waterborne and water-related diseases,” said Dr Maria Neira, Director of the WHO Department of Public Health, Environmental and Social Determinants of Health.

Access to adequate water, sanitation and hygiene is critical in the prevention and care of 16 of the 17 ‘neglected tropical diseases’ (NTDs), including trachoma, soil-transmitted helminths (intestinal worms) and schistosomiasis. NTDs affect more than 1.5 billion people in 149 countries, causing blindness, disfigurement, permanent disability and death.

The practice of open defecation is also linked to a higher risk of stunting – or chronic malnutrition – which affects 161 million children worldwide, leaving them with irreversible physical and cognitive damage.

“To benefit human health it is vital to further accelerate progress on sanitation, particularly in rural and underserved areas,” added Dr Neira.

Rural areas are home to 7 out of 10 people without access to improved sanitation and 9 out of 10 people who defecate in the open.

Plans for the new Sustainable Development Goals to be set by the United Nations General Assembly in September 2015 include a target to eliminate open defecation by 2030. This would require a doubling of current rates of reduction, especially in South Asia and sub-Saharan Africa, WHO and UNICEF say.

WHO and UNICEF say it is vitally important to learn from the uneven progress of the 1990-2015 period to ensure that the SDGs close the inequality gaps and achieve universal access to water and sanitation. To do so, the world needs:
:: Disaggregated data to be able to pinpoint the populations and areas which are outliers from the national averages;
:: A robust and intentional focus on the hardest to reach, particularly the poor in rural areas;
:: Innovative technologies and approaches to bring sustainable sanitation solutions to poor communities at affordable prices;
:: Increased attention to improving hygiene in homes, schools and health care facilities.

American Journal of Infection Control
July 2015 Volume 43, Issue 7, p663-784, e19-e38
http://www.ajicjournal.org/current

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What does the public know about Ebola? The public’s risk perceptions regarding the current Ebola outbreak in an as-yet unaffected country
Anat Gesser-Edelsburg, Yaffa Shir-Raz, Samah Hayek, Oshrat Sassoni-Bar Lev
p669–675
Published online: April 24, 2015
Preview
The unexpected developments surrounding the Ebola virus in the United States provide yet another warning that we need to establish communication preparedness. This study examines what the Israeli public knew about Ebola after the initial stages of the outbreak in a country to which Ebola has not spread and assesses the association between knowledge versus worries and concerns about contracting Ebola.

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Ebola infection control in Sierra Leonean health clinics: A large cross-agency cooperative project
Benjamin Levy, Carol Y. Rao, Laura Miller, Ngozi Kennedy, Monica Adams, Rosemary Davis, Laura Hastings, Augustin Kabano, Sarah D. Bennett, Momodu Sesay
p752–755
Published online: April 18, 2015
Preview
The Ebola virus disease outbreak occurring in West Africa has resulted in at least 199 cases of Ebola in Sierra Leonean health care workers, many as a result of transmission occurring in health facilities. The Ministry of Health and Sanitation of Sierra Leone recognized that improvements in infection prevention and control (IPC) were necessary at all levels of health care delivery. To this end, the U.S. Centers for Disease Control and Prevention, United Nations Children’s Fund, and multiple nongovernmental organizations implemented a national IPC training program in 1,200 peripheral health units (PHUs) in Sierra Leone.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 4 July 2015)

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Study protocol
Protocol for the evaluation of a free health insurance card scheme for poor pregnant women in Mbeya region in Tanzania: a controlled-before and after study
Josephine Borghi, Kate Ramsey, August Kuwawenaruwa, Jitihada Baraka, Edith Patouillard, Ben Bellows, Peter Binyaruka, Fatuma Manzi BMC Health Services Res

BMC Medical Ethics
http://www.biomedcentral.com/bmcmedethics/content
(Accessed 4 July 2015)

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Debate
Evaluating community engagement in global health research: the need for metrics
Kathleen MacQueen, Anant Bhan, Janet Frohlich, Jessica Holzer, Jeremy Sugarman, the Ethics Working Group of the HIV Prevention Trials Network BMC Medical Ethics 2015, 16:44 (1 July 2015)
Abstract
Background
Community engagement in research has gained momentum as an approach to improving research, to helping ensure that community concerns are taken into account, and to informing ethical decision-making when research is conducted in contexts of vulnerability. However, guidelines and scholarship regarding community engagement are arguably unsettled, making it difficult to implement and evaluate.
Discussion
We describe normative guidelines on community engagement that have been offered by national and international bodies in the context of HIV-related research, which set the stage for similar work in other health related research. Next, we review the scholarly literature regarding community engagement, outlining the diverse ethical goals ascribed to it. We then discuss practical guidelines that have been issued regarding community engagement. There is a lack of consensus regarding the ethical goals and approaches for community engagement, and an associated lack of indicators and metrics for evaluating success in achieving stated goals. To address these gaps we outline a framework for developing indicators for evaluating the contribution of community engagement to ethical goals in health research.
Summary
There is a critical need to enhance efforts in evaluating community engagement to ensure that the work on the ground reflects the intentions expressed in the guidelines, and to investigate the contribution of specific community engagement practices for making research responsive to community needs and concerns. Evaluation mechanisms should be built into community engagement practices to guide best practices in community engagement and their replication across diverse health research settings.

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 4 July 2015)

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Research article
Implementation of couples’ voluntary HIV counseling and testing services in Durban, South Africa
William Kilembe, Kristin Wall, Mammekwa Mokgoro, Annie Mwaanga, Elisabeth Dissen, Miriam Kamusoko, Hilda Phiri, Jean Sakulanda, Jonathan Davitte, Tarylee Reddy, Mark Brockman, Thumbi Ndung’u, Susan Allen
BMC Public Health 2015, 15:601 (2 July 2015)

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 4 July 2015)

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Research article
Factors associated with the exposure of vaccines to adverse temperature conditions: the case of North West region, Cameroon
Martin Ndinakie Yakum13*, Jérôme Ateudjieu123, Fida Ramsina Pélagie4, Ebile Akoh Walter13 and Pierre Watcho1
Author Affiliations
BMC Research Notes 2015, 8:277 doi:10.1186/s13104-015-1257-y
Published: 30 June 2015
Abstract
Background
Adverse temperature recording in vaccine’s cold chain is a major issue worldwide and this condition is known to compromise the quality of vaccines very rapidly. In Cameroon, with tropical climate, vaccines exposure to abnormal temperatures is very common. This study was conducted to identify factors associated to abnormal temperature recording in cold chain in the North West region.
Results
A total of 65 vaccinating health facilities were visited for the study from eight health districts. Concerning type of health facility, 48 (73.8%) of the health facilities were governmental facilities. About 50 (76.0%) of the facilities had a functional thermometer. Among the 50 health facilities with functional thermometer, abnormal temperatures were registered in 10 (20%) health facilities during data collection and 12 (24%) in the 2 months preceding collection. Factor significantly associated with abnormal temperature recording was the absence of an alternative power source (OR = 6.5, p = 0.03).
Conclusion
The absence of an alternative source of power was significantly associated with abnormal temperature exposure in the 2 months preceding data collection. To improve on the quality of vaccines administered in North West region, each vaccinating health facility must have at least two sources of power supply.

Bulletin of the World Health Organization
Volume 93, Number 7, July 2015, 437-512
http://www.who.int/bulletin/volumes/93/7/en/

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Editorials
Technology, innovation and health equity
Hildy Fong a & Eva Harris a
a. Center for Global Public Health and Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, United States of America.
Bulletin of the World Health Organization 2015;93:438-438A. doi:
[Initial text]
Innovative technologies have enormous potential to improve human well-being. However, technological progress does not guarantee equitable health outcomes. As advances in technology redefine the ways people, systems and information interact, resource-poor communities are often excluded. Where technological fixes have been imposed on communities, the results have included abandoned equipment, incompatible computer programs and ineffective policies….

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Research
A comparative analysis of national HIV policies in six African countries with generalized epidemics
Kathryn Church, Francis Kiweewa, Aisha Dasgupta, Mary Mwangome, Edith Mpandaguta, Francesc Xavier Gómez-Olivé, Samuel Oti, Jim Todd, Alison Wringe, Eveline Geubbels, Amelia Crampin, Jessica Nakiyingi-Miiro, Chika Hayashi, Muthoni Njage, Ryan G Wagner, Alex Riolexus Ario, Simon D Makombe, Owen Mugurungi & Basia Zaba
Abstract
Objective
To compare national human immunodeficiency virus (HIV) policies influencing access to HIV testing and treatment services in six sub-Saharan African countries.
Methods
We reviewed HIV policies as part of a multi-country study on adult mortality in sub-Saharan Africa. A policy extraction tool was developed and used to review national HIV policy documents and guidelines published in Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zimbabwe between 2003 and 2013. Key informant interviews helped to fill gaps in findings. National policies were categorized according to whether they explicitly or implicitly adhered to 54 policy indicators, identified through literature and expert reviews. We also compared the national policies with World Health Organization (WHO) guidance.
Findings
There was wide variation in policies between countries; each country was progressive in some areas and not in others. Malawi was particularly advanced in promoting rapid initiation of antiretroviral therapy. However, no country had a consistently enabling policy context expected to increase access to care and prevent attrition. Countries went beyond WHO guidance in certain areas and key informants reported that practice often surpassed policy.
Conclusion
Evaluating the impact of policy differences on access to care and health outcomes among people living with HIV is challenging. Certain policies will exert more influence than others and official policies are not always implemented. Future research should assess the extent of policy implementation and link these findings with HIV outcomes.

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Policy & Practice
The need to accelerate access to new drugs for multidrug-resistant tuberculosis
Helen S Cox, Jennifer J Furin, Carole D Mitnick, Colleen Daniels, Vivian Cox & Eric Goemaere
Abstract
Approximately half a million people are thought to develop multidrug-resistant tuberculosis annually. Barely 20% of these people currently receive recommended treatment and only about 10% are successfully treated. Poor access to treatment is probably driving the current epidemic, via ongoing transmission. Treatment scale-up is hampered by current treatment regimens, which are lengthy, expensive, poorly tolerated and difficult to administer in the settings where most patients reside. Although new drugs provide an opportunity to improve treatment regimens, current and planned clinical trials hold little promise for developing regimens that will facilitate prompt treatment scale-up. In this article we argue that clinical trials, while necessary, should be complemented by timely, large-scale, operational research that will provide programmatic data on the use of new drugs and regimens while simultaneously improving access to life-saving treatment. Perceived risks – such as the rapid development of resistance to new drugs – need to be balanced against the high levels of mortality and transmission that will otherwise persist. Doubling access to treatment and increasing treatment success could save approximately a million lives over the next decade.

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Perspectives
Redefining shared sanitation
Thilde Rheinländer a, Flemming Konradsen a, Bernard Keraita a, Patrick Apoya b & Margaret Gyapong c
a. Department of Public Health, University of Copenhagen, Øster Farigmagsgade 5, 1014 Copenhagen, Denmark.
b. Africa Sanitation Think Tank, 03 BP 7112, Ouagadougou 03, Burkina Faso.
c. Dodowa Health Research Center and School of Public Health, University of Ghana, Accra, Ghana.
(Submitted: 20 August 2014 – Revised version received: 09 February 2015 – Accepted: 16 February 2015 – Published online: 28 April 2015.)
Bulletin of the World Health Organization 2015;93:509-510. doi:
[Excerpt]
As the Millennium Development Goals reach their deadline, it is clear that the world is not on track to achieve global sanitation targets. With sanitation trends, global developments and local contexts in mind, it is time to adopt a more flexible approach to achieving universal functional sanitation. By functional sanitation, we mean toilet facilities that protect human health by preventing contamination of the environment with human faecal waste….
…Key sanitation stakeholders and donors should recognize the potential of household shared sanitation as an important driver behind sanitation progress in African and Asian high-density areas and low-income populations. Accepting household shared sanitation as a suitable toilet type could have major implications. This would legitimize innovative funding mechanisms, shared maintenance schemes and upgrading of large numbers of existing shared toilets to acceptable standards.
We argue that the focus for future sanitation programmes should be on improving the hygienic standards of shared facilities to a level that satisfies and protects sanitation users – irrespective of the toilet design. If well managed, household shared sanitation can be a feasible, economical, practical and socially acceptable choice for millions of sanitation users.

Current Opinion in Infectious Diseases
August 2015 – Volume 28 – Issue 4 pp: v-vi,283-396
http://journals.lww.com/co-infectiousdiseases/pages/currenttoc.aspx

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Ebola virus disease: preparedness and infection control lessons learned from two biocontainment units
Hewlett, Angela L.; Varkey, Jay B.; Smith, Philip W.; More

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Risks to healthcare workers with emerging diseases: lessons from MERS-CoV, Ebola, SARS, and avian flu
Suwantarat, Nuntra; Apisarnthanarak, Anucha
Abstract
Purpose of review: Several viral diseases have emerged and impacted healthcare systems worldwide. Healthcare personnels (HCPs) are at high risk of acquiring some emerging infections while caring for patients. We provide a review of risk factors, evidence of infection in HCPs, and prevention strategies with Middle East respiratory syndrome coronavirus, Ebola virus disease (Ebola), severe acute respiratory syndrome (SARS), and avian influenza.
Recent findings: HCP-related infections with Middle East respiratory syndrome coronavirus, Ebola, and SARS have been reported among 1–27%, 2.5–12%, and 11–57% of total cases, respectively. The case fatality rate of Ebola in HCPs has been reported up to 73%. The WHO guidelines for the global surveillance of SARS were developed in 2004 and used as a template for other emerging diseases preparedness. Risks to HCPs with emerging diseases are related to inappropriate and insufficient infection control measures during an initial encounter, at the beginning of outbreak and with an overwhelming number of patient cases. To date, there are no reports of avian influenza transmission to HCPs from affected cases.
Summary: Early and rapid detection of suspected infected patients with communicable diseases along with appropriate infection control practice, education, national and global preparedness guidelines would help to prevent disease transmission to HCP

Epidemiology and Infection
Volume 143 – Issue 11 – August 2015
http://journals.cambridge.org/action/displayIssue?jid=HYG&tab=currentissue

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Review
Chemoprophylaxis and vaccination in preventing subsequent cases of meningococcal disease in household contacts of a case of meningococcal disease: a systematic review
L. TELISINGHEa1a2 c1, T. D. WAITEa1a3a4, M. GOBINa1, O. RONVEAUXa5, K. FERNANDEZa5, J. M. STUARTa2a5a6 and R. J. P. M. SCHOLTENa7
a1 Field Epidemiology Services, Public Health England, Bristol, UK
a2 University of Bristol, Bristol, UK
a3 Field Epidemiology Training Programme, Public Health England, UK
a4 European Programme for Interventional Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
a5 World Health Organization, Geneva, Switzerland
a6 London School of Hygiene and Tropical Medicine, London, UK
a7 Dutch Cochrane Centre/Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
SUMMARY
Household contacts of an index case of invasive meningococcal disease (IMD) are at increased risk of acquiring disease. In revising WHO guidance on IMD in sub-Saharan Africa, a systematic review was undertaken to assess the effect of chemoprophylaxis and of vaccination in preventing subsequent cases of IMD in household contacts following an index case. A literature search for systematic reviews identified a single suitable review on chemoprophylaxis in 2004 (three studies meta-analysed). A search for primary research papers published since 2004 on chemoprophylaxis and without a date limit on vaccination was therefore undertaken. There were 2381 studies identified of which two additional studies met the inclusion criteria. The summary risk ratio for chemoprophylaxis vs. no chemoprophylaxis (four studies) in the 30-day period after a case was 0·16 [95% confidence interval (CI) 0·04-0·64, P = 0·008]; the number needed to treat to prevent one subsequent case was 200 (95% CI 111-1000). A single quasi-randomized trial assessed the role of vaccination. The risk ratio for vaccination vs. no vaccination at 30 days was 0·11 (95% CI 0·01–2·07, P = 0·14). The results support the use of chemoprophylaxis to prevent subsequent cases of IMD in household contacts of a case. Conclusions about the use of vaccination could not be drawn.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 4 July 2015]

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Research
A study of mobile phone use among patients with noncommunicable diseases in La Paz, Bolivia: implications for mHealth research and development
Kamis K, Janevic MR, Marinec N, Jantz R, Valverde H and Piette JD Globalization and Health 2015, 11:30 (4 July 2015)
Abstract
Background
While global momentum supporting mobile health (mHealth) research and development is increasing, it is imperative to assess the potential fit of mHealth programs in local settings. We describe the penetration of mobile technologies among Bolivian patients with noncommunicable diseases (NCDs) to inform research on mHealth interventions for the Andean region as well as low- and middle-income countries more generally.
Methods
Five-hundred and fifty-nine NCD patients were identified from outpatient clinics affiliated with four hospitals in the cities of La Paz and El Alto. Respondents completed surveys about their use of standard mobile phones and smartphones. Respondents also provided information about their sociodemographic characteristics, health status, and access to care. We used descriptive statistics and logistic regression to understand the variation in mobile phone use across groups defined by patient characteristics associated with health service access and socioeconomic vulnerability.
Results
Respondents were on average 52 years of age, 33 % had at most a sixth grade education, and 30 % spoke an indigenous language in their home. Eighty-six percent owned a mobile phone and 13 % owned a smartphone. Fifty-eight percent of mobile phone users sent or received a text message at least once a week. Some mobile phone owners reported connectivity problems, such as lacking mobile signal (9 %) or credit to make a call (17 %). Younger age, male gender, high health literacy, more years of education, and having fewer previously diagnosed NCDs were positively related to mobile phone ownership. Among mobile phone users, respondents with lower education and other indicators of vulnerability were less likely than their counterparts to report frequent usage of texting services.
Conclusions
Mobile phones have high penetration among NCD patients in La Paz, Bolivia, including among those who are older, less educated, and who have other socioeconomic risk factors. Smartphone use is still relatively uncommon, even among patients who are younger and more educated. While certain patient characteristics such as age or education impact patients’ use of text messaging, mobile phone-based mHealth interventions are feasible strategies for increasing NCD patients’ access to self-management support between face-to-face clinical encounters.

Health and Human Rights
Volume 17, Issue 1 June 2015
http://www.hhrjournal.org/

Special Section on Bioethics and the Right to Health
in collaboration with the Dalla Lana School of Public Health, University of Toronto

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Editorial
Bioethics and the Right to Health: Advancing a Complementary Agenda
Jennifer L. Gibson, PhD, Lisa Forman, SJD, Stephanie A. Nixon, PT, PhD
Guest Editors
[Initial text]
This special section in Health and Human Rights Journal explores the relationship between bioethics and the right to health. Although bioethics scholars may argue for a right to health, particularly in the domains of universal health coverage and global health governance, and human rights scholars may advance ethical norms in their work, there has been little scholarly attention to the intersections, synergies, and contrasts between these two areas of study. At first glance, this is surprising given that bioethics and human rights share conceptual and normative terrain in articulating guidance for action on health-related issues and international policy and practice is explicitly interrelating human rights and ethics…

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The Foundations of a Human Right to Health: Human Rights and Bioethics in Dialogue
Audrey Chapman

A Sensitive Period: Bioethics, Human Rights, and Child Development
Avram Denburg

Setting a Minimum Standard of Care in Clinical Trials: Human Rights and Bioethics as Complementary Frameworks
Fatma E. Marouf and Bryn S. Esplin

Commentaries
Limiting Rights and Freedoms in the Context of Ebola and Other Public Health Emergencies: How the Principle of Reciprocity Can Enrich the Application of the Siracusa Principles
Diego S. Silva, Maxwell J. Smith
PDF

International Journal of Infectious Diseases
July 2015 Volume 36, p1-84
http://www.ijidonline.com/current

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Editorial
Middle East Respiratory Syndrome– advancing the public health and research agenda on MERS- lessons from the South Korea outbreak
Eskild Petersen, David S. Hui, Stanley Perlman, Alimuddin Zumla
p54–55
Published online: June 10, 2015

Journal of Community Health
Volume 40, Issue 4, August 2015
http://link.springer.com/journal/10900/40/4/page/1

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HBV Outreach Programs Significantly Increase Knowledge and Vaccination Rates Among Asian Pacific Islanders
Tresa Zacharias, Winnie Wang, Doan Dao, Helena Wojciechowski… Pages 619-624

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School-Located Vaccination Clinics for Adolescents: Correlates of Acceptance Among Parents
Lisa M. Gargano, Paul Weiss, Natasha L. Underwood… Pages 660-669

Journal of Medical Microbiology
Volume 64, Issue 6, June 2015
http://jmm.sgmjournals.org/content/journal/jmm/64/6

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Adapting the mobile laboratory to the changing needs of the Ebolavirus epidemic
Timothy J. J. Inglis
J. Med. Microbiol., June 2015 64: 587-591, doi: 10.1099/jmm.0.000063
Abstract
The current Ebolavirus disease (EVD) epidemic in West Africa has now been running for >1 year and has been an international health emergency for >6 months. As the weekly number of new cases falls, the World Health Organization is preparing its response to the final stages of the epidemic. The final totals will exceed 20 000 cases and 8000 deaths. An ability to adapt disease countermeasures including laboratory support to the changing epidemiology of EVD has become a matter of urgency. This article considers the planning, development and modification of a flexible microbiology laboratory response, and describes logistic and operational considerations for clinical and public health microbiologists.

The Lancet
Jul 04, 2015 Volume 386 Number 9988 p1-102
http://www.thelancet.com/journals/lancet/issue/current

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Comment
Keeping score: fostering accountability for children’s lives
Christopher Murray, Ray Chambers
DOI: http://dx.doi.org/10.1016/S0140-6736(15)61171-0
Preview
We live in a remarkable era of accelerated progress in reducing child deaths in the poorest countries.1 The death rate in children younger than 5 years in low-income countries has dropped by 28·1% since 2000. The Millennium Declaration set an ambitious goal of reducing the death rate in this age group by two-thirds in each country.2 Progress has not been even, but since the year 2000 reductions were recorded in 136 of 138 low-income and middle-income countries. In the few months remaining until the end of the Millennium Development Goal period, even more can be achieved.

The Lancet
Jul 04, 2015 Volume 386 Number 9988 p1-102
http://www.thelancet.com/journals/lancet/issue/current

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Comment
Final results from a pivotal phase 3 malaria vaccine trial
Vasee S Moorthy, Jean-Marie Okwo-Bele
Published Online: 23 April 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60767-X
Preview
In The Lancet, the RTS,S Clinical Trials Partnership1 report the most recent results from the pivotal phase 3 trial of RTS,S/AS01 malaria vaccine, the fourth major publication from this randomised controlled trial.2–4 The trial enrolled 15 459 infants and young children at 11 centres in seven sub-Saharan African countries: Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique, and Tanzania. Two age groups were included: 6–12 weeks and 5–17 months at first dose. The schedule involved a primary series of three monthly doses, with a booster dose given 18 months later in one of the three trial groups.

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Articles
Efficacy and safety of RTS,S/AS01 malaria vaccine with or without a booster dose in infants and children in Africa: final results of a phase 3, individually randomised, controlled trial
RTS,S Clinical Trials Partnership – Members listed at end of paper
Published Online: 23 April 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60721-8
Summary
Background
The efficacy and safety of the RTS,S/AS01 candidate malaria vaccine during 18 months of follow-up have been published previously. Herein, we report the final results from the same trial, including the efficacy of a booster dose.
Methods
From March 27, 2009, until Jan 31, 2011, children (age 5–17 months) and young infants (age 6–12 weeks) were enrolled at 11 centres in seven countries in sub-Saharan Africa. Participants were randomly assigned (1:1:1) at first vaccination by block randomisation with minimisation by centre to receive three doses of RTS,S/AS01 at months 0, 1, and 2 and a booster dose at month 20 (R3R group); three doses of RTS,S/AS01 and a dose of comparator vaccine at month 20 (R3C group); or a comparator vaccine at months 0, 1, 2, and 20 (C3C [control group]). Participants were followed up until Jan 31, 2014. Cases of clinical and severe malaria were captured through passive case detection. Serious adverse events (SAEs) were recorded. Analyses were by modified intention to treat and per protocol. The coprimary endpoints were the occurrence of malaria over 12 months after dose 3 in each age category. In this final analysis, we present data for the efficacy of the booster on the occurrence of malaria. Vaccine efficacy (VE) against clinical malaria was analysed by negative binomial regression and against severe malaria by relative risk reduction. This trial is registered with ClinicalTrials.gov, number NCT00866619.
Findings
8922 children and 6537 young infants were included in the modified intention-to-treat analyses. Children were followed up for a median of 48 months (IQR 39–50) and young infants for 38 months (34–41) after dose 1. From month 0 until study end, compared with 9585 episodes of clinical malaria that met the primary case definition in children in the C3C group, 6616 episodes occurred in the R3R group (VE 36·3%, 95% CI 31·8–40·5) and 7396 occurred in the R3C group (28·3%, 23·3–32·9); compared with 171 children who experienced at least one episode of severe malaria in the C3C group, 116 children experienced at least one episode of severe malaria in the R3R group (32·2%, 13·7 to 46·9) and 169 in the R3C group (1·1%, −23·0 to 20·5). In young infants, compared with 6170 episodes of clinical malaria that met the primary case definition in the C3C group, 4993 episodes occurred in the R3R group (VE 25·9%, 95% CI 19·9–31·5) and 5444 occurred in the R3C group (18·3%, 11·7–24·4); and compared with 116 infants who experienced at least one episode of severe malaria in the C3C group, 96 infants experienced at least one episode of severe malaria in the R3R group (17·3%, 95% CI −9·4 to 37·5) and 104 in the R3C group (10·3%, −17·9 to 31·8). In children, 1774 cases of clinical malaria were averted per 1000 children (95% CI 1387–2186) in the R3R group and 1363 per 1000 children (995–1797) in the R3C group. The numbers of cases averted per 1000 young infants were 983 (95% CI 592–1337) in the R3R group and 558 (158–926) in the R3C group. The frequency of SAEs overall was balanced between groups. However, meningitis was reported as a SAE in 22 children: 11 in the R3R group, ten in the R3C group, and one in the C3C group. The incidence of generalised convulsive seizures within 7 days of RTS,S/AS01 booster was 2·2 per 1000 doses in young infants and 2·5 per 1000 doses in children.
Interpretation
RTS,S/AS01 prevented a substantial number of cases of clinical malaria over a 3–4 year period in young infants and children when administered with or without a booster dose. Efficacy was enhanced by the administration of a booster dose in both age categories. Thus, the vaccine has the potential to make a substantial contribution to malaria control when used in combination with other effective control measures, especially in areas of high transmission.
Funding
GlaxoSmithKline Biologicals SA and the PATH Malaria Vaccine Initiative.

The Lancet Global Health
Jul 2015 Volume 3 Number 7 e341-e422
http://www.thelancet.com/journals/langlo/issue/current

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Editorial
African children in the spotlight
Zoë Mullan
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)00058-3
Summary
June 16 is the Day of the African Child—an African Union initiative to commemorate the hundreds who died during the 1976 protests by black schoolchildren against racially biased educational practices in Soweto, South Africa. Today the anniversary is an opportunity to highlight the rights of all African children to a quality education, and to a healthy childhood

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Articles
Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration)
Caroline H D Fall, Harshpal Singh Sachdev, Clive Osmond, Maria Clara Restrepo-Mendez, Cesar Victora, Reynaldo Martorell, Aryeh D Stein, Shikha Sinha, Nikhil Tandon, Linda Adair, Isabelita Bas, Shane Norris, Linda M Richter, COHORTS investigators
e366

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Maternal mortality and distance to facility-based obstetric care in rural southern Tanzania: a secondary analysis of cross-sectional census data in 226 000 households
Claudia Hanson, Jonathan Cox, Godfrey Mbaruku, Fatuma Manzi, Sabine Gabrysch, David Schellenberg, Marcel Tanner, Carine Ronsmans, Joanna Schellenberg

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Tanzania’s Countdown to 2015: an analysis of two decades of progress and gaps for reproductive, maternal, newborn, and child health, to inform priorities for post-2015
Hoviyeh Afnan-Holmes, Moke Magoma, Theopista John, Francis Levira, Georgina Msemo, Corinne E Armstrong, Melisa Martínez-Álvarez, Kate Kerber, Clement Kihinga, Ahmad Makuwani, Neema Rusibamayila, Asia Hussein, Joy E Lawn, Tanzanian Countdown Country Case Study Group

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Countdown to 2015: changes in official development assistance to reproductive, maternal, newborn, and child health, and assessment of progress between 2003 and 2012
Leonardo Arregoces, Felicity Daly, Catherine Pitt, Justine Hsu, Melisa Martinez-Alvarez, Giulia Greco, Anne Mills, Peter Berman, Josephine Borghi

The Lancet Infectious Diseases
Jul 2015 Volume 15 Number 7 p747-866
http://www.thelancet.com/journals/laninf/issue/current

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Comment
Ebola: the hidden toll
Mary J Hamel, Laurence Slutsker
Published Online: 23 April 2015
Open Access
DOI: http://dx.doi.org/10.1016/S1473-3099(15)70167-2
Summary
The first anniversary of the west African Ebola epidemic has just passed. In Guinea, Liberia, and Sierra Leone, Ebola virus disease has resulted in more than 10 000 reported deaths while the virtual collapse of the countries’ health-care systems has contributed to countless more. In The Lancet Infectious Diseases, Patrick Walker and colleagues1 describe a mathematical model to estimate the effect of the ongoing Ebola disease epidemic on a less exotic and more familiar killer—malaria. The estimates are sobering, if not surprising: up to 10 900 additional malaria deaths in these three countries in 2014 can be attributed to the disruption of health-care services, with another 3900 attributed to lapses in the delivery of insecticide-treated bednets.

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Articles
Malaria morbidity and mortality in Ebola-affected countries caused by decreased health-care capacity, and the potential effect of mitigation strategies: a modelling analysis
Patrick G T Walker, PhD, Michael T White, PhD, Jamie T Griffin, PhD, Alison Reynolds, MA, Prof Neil M Ferguson, PhD, Prof Azra C Ghani, PhD
Published Online: 23 April 2015
Open Access
DOI: http://dx.doi.org/10.1016/S1473-3099(15)70124-6
Summary
Background
The ongoing Ebola epidemic in parts of west Africa largely overwhelmed health-care systems in 2014, making adequate care for malaria impossible and threatening the gains in malaria control achieved over the past decade. We quantified this additional indirect burden of Ebola virus disease.
Methods
We estimated the number of cases and deaths from malaria in Guinea, Liberia, and Sierra Leone from Demographic and Health Surveys data for malaria prevalence and coverage of malaria interventions before the Ebola outbreak. We then removed the effect of treatment and hospital care to estimate additional cases and deaths from malaria caused by reduced health-care capacity and potential disruption of delivery of insecticide-treated bednets. We modelled the potential effect of emergency mass drug administration in affected areas on malaria cases and health-care demand.
Findings
If malaria care ceased as a result of the Ebola epidemic, untreated cases of malaria would have increased by 45% (95% credible interval 43–49) in Guinea, 88% (83–93) in Sierra Leone, and 140% (135–147) in Liberia in 2014. This increase is equivalent to 3·5 million (95% credible interval 2·6 million to 4·9 million) additional untreated cases, with 10 900 (5700–21 400) additional malaria-attributable deaths. Mass drug administration and distribution of insecticide-treated bednets timed to coincide with the 2015 malaria transmission season could largely mitigate the effect of Ebola virus disease on malaria.
Interpretation
These findings suggest that untreated malaria cases as a result of reduced health-care capacity probably contributed substantially to the morbidity caused by the Ebola crisis. Mass drug administration can be an effective means to mitigate this burden and reduce the number of non-Ebola fever cases within health systems.
Funding
UK Medical Research Council, UK Department for International Development, Bill & Melinda Gates Foundation.

The Lancet Infectious Diseases
Jul 2015 Volume 15 Number 7 p747-866
http://www.thelancet.com/journals/laninf/issue/current

Review
The HIV care continuum in Latin America: challenges and opportunities
Alicia Piñeirúa, MD, Juan Sierra-Madero, MD, Pedro Cahn, MD, Rafael Napoleón Guevara Palmero, MD, Ernesto Martínez Buitrago, MD, Dr Benjamin Young, MD, Prof Carlos Del Rio, MD
DOI: http://dx.doi.org/10.1016/S1473-3099(15)00108-5
Summary
Combination antiretroviral therapy (ART), also known as highly active antiretroviral therapy, provides clinical and immunological benefits for people living with HIV and is an effective strategy to prevent HIV transmission at the individual level. Early initiation of ART as part of a test and treat approach might decrease HIV transmission at the population level, but to do so the HIV continuum of care, from diagnosis to viral suppression, should be optimised. Access to ART has improved greatly in Latin America, and about 600 000 people are on treatment. However, health-care systems are deficient in different stages of the HIV continuum of care, and in some cases only a small proportion of individuals achieve the desired outcome of virological suppression. At present, data for most Latin American countries are not sufficient to build reliable metrics. Available data and estimates show that many people living with HIV in Latin America are unaware of their status, are diagnosed late, and enter into care late. Stigma, administrative barriers, and economic limitations seem to be important determinants of late diagnosis and failure to be linked to and retained in care. Policy makers need reliable data to optimise the HIV care continuum and improve individual-based and population-based outcomes of ART in Latin America.

New England Journal of Medicine
July 2, 2015 Vol. 373 No. 1
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
International Health Care Systems: India’s Aspirations for Universal Health Coverage
K.S. Reddy

Pediatrics
July 2015, VOLUME 136 / ISSUE 1
http://pediatrics.aappublications.org/current.shtml

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Article
Pneumococcal Conjugate Vaccine and Clinically Suspected Invasive Pneumococcal Disease
Arto A. Palmu, MD, PhDa, Terhi M. Kilpi, MD, PhDb, Hanna Rinta-Kokko, MScb, Hanna Nohynek, MD, PhDb, Maija Toropainen, PhDc, J. Pekka Nuorti, MD, PhDc,d, and Jukka Jokinen, PhDb
Author Affiliations
aDepartment of Health Protection, National Institute for Health and Welfare, Tampere, Finland;
bDepartment of Health Protection, National Institute for Health and Welfare, Helsinki, Finland;
cDepartment of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland; and
dDepartment of Epidemiology, School of Health Sciences, University of Tampere, Finland
Abstract
OBJECTIVE: Ten-valent pneumococcal conjugate vaccine (PCV10) was earlier shown to reduce clinically suspected, non–laboratory-confirmed invasive pneumococcal disease (IPD) in a cluster-randomized trial (the Finnish Invasive Pneumococcal disease trial). PCV10 was introduced into the Finnish national vaccination program in September 2010 using a 3-dose schedule. We evaluated the impact of PCV10 on clinically suspected IPD among vaccine-eligible children in a population-based nationwide study.
METHODS: The target cohort eligible for vaccination program (children born June 2010–September 2013) was compared with 2 season- and age-matched (ages 3–42 months) reference cohorts before PCV10 introduction. The trial period (January 2009–August 2010) was excluded. Hospitals’ inpatient and outpatient discharge notifications with International Classification of Diseases, 10th Revision, diagnoses compatible with IPD (A40.3/B95.3/G00.1/M00.1) and unspecified sepsis (A40.9/A41.9/A49.9/G00/G00.9/I30.1/M00/M00.9/B95.5) were collected from the national Care Register. Laboratory-confirmed IPD cases were excluded. Rates of register-based non–laboratory-confirmed IPD (or unspecified sepsis) before and after PCV10 implementation were calculated.
RESULTS: The rate of register-based non–laboratory-confirmed IPD episodes was 32 in 100 000 person-years in the vaccine-eligible target cohort and 94 in the combined reference cohorts. Relative rate reduction was 66% (95% confidence interval: 59–73) and absolute rate reduction 62 in 100 000 person-years. For the more sensitive case definition of register-based non–laboratory-confirmed IPD or unspecified sepsis, the relative rate reduction was 34% (95% confidence interval 29–39), but the absolute reduction was as high as 122 in 100 000 person-years.
CONCLUSIONS: This is the first report demonstrating nationwide PCV impact on clinically suspected IPD during routine vaccination program. The large absolute rate reductions observed have major implications for cost-effectiveness of PCVs.

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Article
Immunogenicity and Safety of a 9-Valent HPV Vaccine
Pierre Van Damme, MD, PhDa, Sven Eric Olsson, MDb, Stanley Block, MDc, Xavier Castellsague, MDd, Glenda E. Gray, MDe, Teobaldo Herrera, MDf, Li-Min Huang, MDg, Dong Soo Kim, MDh,
Punnee Pitisuttithum, MDi, Joshua Chen, PhDj, Susan Christiano, MSj, Roger Maansson, MSj, Erin Moeller, MPHj, Xiao Sun, PhDj, Scott Vuocolo, PhDj, and Alain Luxembourg, MD, PhDj
Author Affiliations
aCenter for the Evaluation of Vaccination, University of Antwerp, Antwerp, Belgium;
bKarolinska Institute at Danderyd Hospital, Uppsala, Sweden;
cKentucky Pediatric/Adult Research, Inc, Bardstown, Kentucky;
dInstitut Català d’Oncologia, IDIBELL, CIBERESP, L’Hospitalet De Llobregat, Catalonia, Spain;
eDepartment of Pediatrics, University of the Witwatersrand, Johannesburg, South Africa;
fInstituto de Investigation Nutricional, Lima, Peru;
gDivision of Infectious Diseases, Children’s Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;
hDivision of Infectious Disease and Immunology, Department of Pediatrics, Yonsei University College of Medicine, Severance Children’s Hospital, Seoul, Korea;
iFaculty of Tropical Medicine, Mahidol University, Nakhon Pathom, Thailand; and
jMerck and Company, Inc, Whitehouse Station, New Jersey
Abstract
OBJECTIVES: Prophylactic vaccination of youngwomen aged 16 to 26 years with the 9-valent (6/11/16/18/31/33/45/52/58) human papillomavirus (HPV) virus-like particle (9vHPV) vaccine prevents infection and disease. We conducted a noninferiority immunogenicity study to bridge the findings in young women to girls and boys aged 9 to 15 years.
METHODS: Subjects (N = 3066) received a 3-dose regimen of 9vHPV vaccine administered at day 1, month 2, and month 6. Anti-HPV serologic assays were performed at day 1 and month 7. Noninferiority required that the lower bound of 2-sided 95% confidence intervals of geometric mean titer ratios (boys:young women or girls:young women) be >0.67 for each HPV type. Systemic and injection-site adverse experiences (AEs) and serious AEs were monitored.
RESULTS: At 4 weeks after dose 3, >99% of girls, boys, and young women seroconverted for each vaccine HPV type. Increases in geometric mean titers to HPV types 6/11/16/18/31/33/45/52/58 were elicited in all vaccine groups. Responses in girls and boys were noninferior to those of young women. Persistence of anti-HPV responses was demonstrated through 2.5 years after dose 3. Administration of the 9vHPV vaccine was generally well tolerated. A lower proportion of girls (81.9%) and boys (72.8%) than young women (85.4%) reported injection-site AEs, most of which were mild to moderate in intensity.
CONCLUSIONS: These data support bridging the efficacy findings with 9vHPV vaccine in young women 16 to 26 years of age to girls and boys 9 to 15 years of age and implementing gender-neutral HPV vaccination programs in preadolescents and adolescents.

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Article
Personal Belief Exemptions to Vaccination in California: A Spatial Analysis
Margaret Carrel, PhDa,b and Patrick Bitterman, BSa
Author Affiliations
Departments of aGeographical and Sustainability Sciences, and
bEpidemiology, University of Iowa, Iowa City, Iowa
Abstract
BACKGROUND: School vaccination rates in California have fallen as more parents opt for personal belief exemptions (PBEs) for their children. Our goals were to (1) spatially analyze PBE patterns over time, (2) determine correlates of PBEs, and (3) examine their spatial overlap with personal medical exemptions (PMEs).
METHODS: PBE and PME data for California kindergarten classes from the 2001/2002 to 2013/2014 school years were matched to the locations of schools. Nonspatial clustering algorithms were implemented to group 5147 schools according to their trends in PBE percentages among kindergartners. Cluster assignments were mapped and hotspot analysis was performed to find areas in California where schools sharing trends in PBEs over time were colocated. Schools were further associated both with school-level data on minority enrollment and free and reduced price lunch participation and with charter/private and rural/urban status. Spatial regression was implemented to determine which school-level variables were correlated with PBE rates in the 2013/2014 school year.
RESULTS: Distinct spatial patterns are observed in California when PBE cluster assignments are mapped. Results indicate that schools belonging to the “high PBE” cluster are spatially buffered from those in “low PBE” areas by “medium PBE” schools. Further, PBE rates are positively associated with the percentage of white students, charter status, and private schools.
CONCLUSIONS: Hotspots of high PBE schools are in some cases colocated with schools that have elevated PME rates, prompting concern that herd immunity is diminished for school populations where students have no choice but to remain unvaccinated.

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Commentary
Physician Communication With Vaccine-Hesitant Parents: The Start, Not the End, of the Story
Julie Leask, PhD, MPH, Dip App Scia and Paul Kinnersley, MB ChB, MD, FRCGPb
Author Affiliations
aSchool of Public Health, University of Sydney, New South Wales, Australia; and
bInstitute of Medical Education, Cardiff University, Cardiff, Wales, United Kingdom
Extract
In this month’s issue of Pediatrics, Henrikson et al1 report a trial of the impact of communication training for physicians on the vaccine hesitancy of parents. The authors found that a physician-targeted communication intervention did not reduce vaccine hesitancy in mothers nor improve physician confidence compared with standard care. However, the study requires careful interpretation and should be seen as the start, not the end, of the story in finding effective approaches to vaccine hesitancy.
There is a clear need to develop new approaches to vaccine consultation. Although only 0.7% of children in the United States are completely unvaccinated, an estimated 13% of parents delay or select out of certain vaccines,2,3 and the risk of this choice is enhanced by geographic clustering, creating a critical mass for disease outbreaks.4 Even parents who fully vaccinate have some concerns (eg, the number of vaccines, the vaccine ingredients, whether they potentially “damage” the immune system).5,6
To address vaccination concerns, hesitancy, and refusal, some advocate a tougher line with strong physician recommendation, little room for expression of concern, and even …

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 4 July 2015)

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Mistreatment of Women in Childbirth: Time for Action on This Important Dimension of Violence against Women
Rachel Jewkes, Loveday Penn-Kekana
Perspective | published 30 Jun 2015 | PLOS Medicine 10.1371/journal.pmed.1001849

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The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review
Meghan A. Bohren, Joshua P. Vogel, Erin C. Hunter, Olha Lutsiv, Suprita K. Makh, João Paulo Souza, Carolina Aguiar, Fernando Saraiva Coneglian, Alex Luíz Araújo Diniz, Özge Tunçalp, Dena Javadi, Olufemi T. Oladapo, Rajat Khosla, Michelle J. Hindin, A. Metin Gülmezoglu
Research Article | published 30 Jun 2015 | PLOS Medicine 10.1371/journal.pmed.1001847

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Inequitable and Ineffective: Exclusion of Mental Health from the Post-2015 Development Agenda
Alexander C. Tsai, Mark Tomlinson
Editorial | published 30 Jun 2015 | PLOS Medicine 10.1371/journal.pmed.1001846
The Millennium Development Goals (MDGs), adopted at the turn of the century, represented a milestone in global development by committing United Nations member states to eradicating extreme poverty and achieving specific targets over the subsequent decade and a half. At this time the world’s attention is increasingly focused on the post-2015 development agenda, which will be unveiled in September of this year in the form of Sustainable Development Goals (SDGs). Given that mental health and other non-communicable diseases were conspicuously omitted from the MDGs, and have only been weakly mentioned in draft SDG targets, in this essay we argue for a place for mental health on the post-2015 development agenda. Its continued exclusion will not only contribute to the failure of the SDGs given the centrality of mental health in most aspects of human development and well-being but also formalize our collective failure to care for the most vulnerable among us.

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

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Comparative Estimates of Crude and Effective Coverage of Measles Immunization in Low-Resource Settings: Findings from Salud Mesoamérica 2015
K. Ellicott Colson, Paola Zúñiga-Brenes, Diego Ríos-Zertuche, Carlos J. Conde-Glez, Marielle C. Gagnier, Erin Palmisano, Dharani Ranganathan, Gulnoza Usmanova, Benito Salvatierra, Austreberta Nazar, Ignez Tristao, Emmanuelle Sanchez Monin, Brent W. Anderson, Annie Haakenstad, Tasha Murphy, Stephen Lim, Bernardo Hernandez, Rafael Lozano, Emma Iriarte, Ali H. Mokdad
Research Article | published 02 Jul 2015 | PLOS ONE 10.1371/journal.pone.0130697

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Do Pneumococcal Conjugate Vaccines Represent Good Value for Money in a Lower-Middle Income Country? A Cost-Utility Analysis in the Philippines
Manuel Alexander Haasis, Joyce Anne Ceria, Wantanee Kulpeng, Yot Teerawattananon, Marissa Alejandria
Research Article | published 01 Jul 2015 | PLOS ONE 10.1371/journal.pone.0131156

Vaccine
Volume 33, Issue 31, Pages 3605-3778 (17 July 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/3

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Prevention and control of meningococcal outbreaks: The emerging role of serogroup B meningococcal vaccines
Review Article
Pages 3628-3635
Ernesto Oviedo-Orta, Sohail Ahmed, Rino Rappuoli, Steven Black
Abstract
Recently an investigational meningococcal B vaccine has been used in two college outbreaks in the US. This is the first time that a meningococcal B vaccine has been used for outbreak control in the US. However, strain specific vaccines for meningococcal B outbreaks have been developed in Norway, Cuba and to control a large prolonged outbreak in New Zealand. Although meningococcal disease is mostly endemic and baseline rates in the US have fallen over the past decade, outbreaks are not uncommon in the US and globally. In an outbreak, disease risk can rise 1000 fold or more and such outbreaks can last a decade or longer causing significant morbidity and mortality. Here we review the evolution of several serogroup B outbreaks, and, when applicable, the development and impact of meningococcal B vaccines to control these outbreaks. Prior to the availability of “broad spectrum” meningococcal B vaccines, vaccines developed to control meningococcal B outbreaks were strain specific. With the development of two newly licensed meningococcal B vaccines – a four component meningococcal B vaccine (Bexsero®, Novartis) and the two component fHBP vaccine (Trumenba®, Pfizer) that target a broad array of meningococcal B strains, there is now the potential to prevent outbreaks and as well as to shorten the delay between identification of an outbreak and availability of a vaccine.

Vaccine
Volume 33, Issue 31, Pages 3605-3778 (17 July 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/3

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Risk of febrile seizure after measles–mumps–rubella–varicella vaccine: A systematic review and meta-analysis
Review Article
Pages 3636-3649
Shu-Juan Ma, Yi-Quan Xiong, Li-Na Jiang, Qing Chen
Abstract
Background
Considering the febrile seizure rate, there is no longer a clear preference for use of measles–mumps–rubella–varicella (MMRV) vaccine over separate measles–mumps–rubella (MMR) and varicella (V) vaccine. This work was undertaken to assess the risk of febrile seizure after MMRV vaccine in children.
Methods
We searched PubMed, Embase, BIOSIS Previews, Scopus, Web of Science, Cochrane Library and other databases through 12 December 2014. Meta-analysis was conducted using R version 3.1.2 and Stata version 12.0.
Results
A total of thirty-nine studies were included. Thirty-one published or unpublished clinical trials involving about 40,000 subjects did not show significant differences in incidence of febrile seizure or vaccine related febrile seizure between MMRV and MMR with or without varicella vaccine after any doses, in the risk windows of 0–28, 0–42 or 0–56 days and 7–10 days. In addition, these studies showed that the receipt of concomitant use of MMRV and other pediatric vaccines was not a significant predictor of febrile seizure. Eight post-marketing observations involving more than 3,200,000 subjects were included. No evidence suggested elevated risk of febrile seizure associated with MMRV vaccine among children aged 4–6 years old during 7–10 days or 0–42 days after vaccination. However, an approximately 2-fold increase in risk of seizure or febrile seizure during 7–10 days or 5–12 days after MMRV vaccination was found among children aged 10–24 months, although the highest incidence of seizure was still lower than 2.95‰.
Conclusions
First MMRV vaccine dose in children aged 10–24 months was associated with an elevated risk of seizure or febrile seizure. Further post-marketing restudies based on more rigorous study design are needed to confirm the findings.

Vaccine
Volume 33, Issue 31, Pages 3605-3778 (17 July 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/3

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Comparison of text-messaging to voice telephone interviews for active surveillance of adverse events following immunisation
Original Research Article
Pages 3689-3694
A.K. Regan, C.C. Blyth, L. Tracey, D.B. Mak, P.C. Richmond, P.V. Effler
Abstract
Objectives
In 2013, the Follow-up and Active Surveillance of Trivalent Influenza Vaccine in Mums (FASTMum) program began using short message service (SMS) to collect adverse event information in pregnant women who recently received trivalent influenza vaccine (TIV). This study was designed to compare data collected via SMS and telephone for the purposes of monitoring vaccine safety.
Methods
A number of 344 women who received TIV were randomly assigned to a telephone interview group. They were telephoned seven days post-vaccination and administered a standard survey soliciting any adverse events following immunisation (AEFI) they experienced. They were matched by brand of vaccine, age group, and residence to 344 women who were sent a SMS seven days post-vaccination. The SMS solicited similar information. AEFI reported by SMS and telephone interview were compared by calculating risk ratios.
Results
Response rate was higher to SMS compared to telephone interview (90.1% vs. 63.9%). Women who were surveyed by SMS were significantly less likely to report an AEFI compared to women who were surveyed by telephone (RR: 0.41; 95% CI: 0.29–0.59). The greatest discrepancies between SMS and telephone interview were for self-reported injection site reactions (3.1% vs. 16.8%) and unsolicited (or “other”) events (11.4% vs. 4.1%). Data collected by SMS was significantly timelier.
Conclusions
Data collection by SMS results in significantly improved response rates and timeliness of vaccine safety data. Systems which incorporate SMS could be used to more rapidly detect safety signals and promote more rapid public health response to vaccine quality issues.

Vaccine
Volume 33, Issue 31, Pages 3605-3778 (17 July 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/3

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Health benefit for the child and promotion of the common good were the two most important reasons for participation in the FinIP vaccine trial
Original Research Article
Pages 3695-3702
Heta Nieminen, Ritva K. Syrjänen, Taneli Puumalainen, Päivi Sirén, Arto A. Palmu
Abstract
Background and aims
The Finnish Invasive Pneumococcal disease (FinIP) vaccine trial was a nationwide cluster-randomised double-blind trial designed to demonstrate the effectiveness of pneumococcal conjugate vaccine in vaccinated children and indirect effects in unvaccinated populations. Together with the parallel carriage/AOM trial, over 47,000 children were enrolled, 52% of the initial target. We conducted a questionnaire study to find out which factors affected parents’ decision on their child’s study participation.
Methods
A questionnaire designed to evaluate parents’ attitudes to vaccine trial participation in general and the FinIP trial in particular was mailed after the trial enrolment period had ended to parents of randomly selected children: 1484 who participated in the trial and 1485 who did not participate.
Results
Altogether 1438 parents (48%) responded to the questionnaire. The response rate was higher among FinIP participants (65%, 965/1484) than among FinIP non-participants (32%, 473/1485). The two most important reasons for giving consent to the FinIP trial were the potential benefit of immunisation against pneumococcal diseases (75% of consenters) and the promotion of the common good and public health (11%). The reasons reported as most important for declining consent were suspicions of vaccine safety (36%) and the double-blind trial design (12%). Up to 65% of the non-consenters declared that drug and vaccine trials should not be conducted in children at all.
Conclusions
The expected health benefit for the child was by far the most important reason for consenting to the vaccine trial. Safety concern was the main reason for decline. Importance and necessity of clinical drug and vaccine trials among children and the rationale of the blinded studies should be thoroughly explained to the public. This may increase participation in future vaccine trials.

Vaccine
Volume 33, Issue 31, Pages 3605-3778 (17 July 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/3

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Attitude, knowledge and factors associated with influenza and pneumococcal vaccine uptake in a large cohort of patients with secondary immune deficiency
Original Research Article
Pages 3703-3708
Paul Loubet, Solen Kernéis, Matthieu Groh, Pierre Loulergue, Philippe Blanche, Pierre Verger, Odile Launay
Abstract
Background
Immunocompromised patients are at increased risk for severe influenza and invasive pneumococcal diseases. Population-specific vaccine recommendations are thus warranted. This study aimed to estimate the prevalence and predictors of influenza and pneumococcal vaccine uptake in a large cohort of patients with secondary immune deficiency.
Methods
An anonymous online survey was submitted to the members of 11 French associations of immunocompromised patients. The questionnaire included questions concerning underlying disease, care and treatment, flu and pneumococcal vaccine uptake, attitudes and knowledge about vaccination. Factors associated with vaccine uptake were assessed by multivariate logistic regression.
Results
Among the 10,897 solicited patients, 3653 agreed to participate (33.5%): 75% were female, 20% aged 65+, 79% were followed for an autoimmune disease, 13% were solid organ recipients or waiting for transplantation and 8% were treated for hematological malignancies. 3109 (85%) participants were treated with immunosuppressive therapy. Self-reported vaccine uptake was 59% (95%CI [57–60]) against seasonal influenza and 49% (95%CI [47–50]) against pneumococcal diseases. Better knowledge of and favorable attitudes toward vaccination were positively associated with vaccine uptake while being treated with a biological therapy was negatively associated.
Conclusion
Despite specific recommendations regarding immunocompromised patients, influenza and pneumococcal vaccination rates do not reach recommended levels. Targeted information campaigns on vaccination toward these populations should be implemented to improve vaccine coverage and thus reduce the burden of infections.

Vaccine
Volume 33, Issue 31, Pages 3605-3778 (17 July 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/3

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Introduction of a National HPV vaccination program into Bhutan
Original Research Article
Pages 3726-3730
Tandin Dorji, Ugyen Tshomo, Sangay Phuntsho, Tshewang Dorji Tamang, Tshokey Tshokey, Iacopo Baussano, Silvia Franceschi, Gary Clifford
Abstract
Background
Cervical cancer is the most common cancer in Bhutanese women. To help prevent the disease, the Ministry of Health (MoH) developed a national human papillomavirus (HPV) vaccine program.
Methods
MoH considerations included disease incidence, the limited reach of cervical screening, poor outcomes associated with late diagnosis of the disease, and Bhutan’s ability to conduct the program. For national introduction, it was decided to implement routine immunization for 12 year-old girls with the quadrivalent HPV6/11/16/18 (QHPV) vaccine and a one-time catch-up campaign for 13–18 year-old girls in the first year of the program (2010). Health workers would administer the vaccine in schools, with out-of-school girls to receive the vaccine at health facilities. From 2011, HPV vaccination would enter into the routine immunization schedule using health-center delivery.
Results
During the initial campaign in 2010, over 130,000 doses of QHPV were administered and QHPV 3-dose vaccination coverage was estimated to be around 99% among 12 year-olds and 89% among 13–18 year-olds. QHPV vaccine was well tolerated and no severe adverse events were reported. In the three following years, QHPV vaccine was administered routinely to 12 year-olds primarily through health centers instead of schools, during which time the population-level 3-dose coverage decreased to 67–69%, an estimate which was confirmed by individual-level survey data in 2012 (73%). In 2014, when HPV delivery was switched back to schools, 3-dose coverage rose again above 90%.
Discussion
The rapid implementation and high coverage of the national HPV vaccine program in Bhutan were largely attributable to the strength of political commitment, primary healthcare and support from the education system. School-based delivery appeared clearly superior to health centers in achieving high-coverage among 12 year-olds.
Conclusions
Bhutan’s lessons for other low/middle-income countries include the superiority of school-based vaccination and the feasibility of a broad catch-up campaign in the first year.

Vaccine
Volume 33, Issue 31, Pages 3605-3778 (17 July 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/3

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Guillain-Barré syndrome and influenza vaccines: A meta-analysis
Original Research Article
Pages 3773-3778
L.H. Martín Arias, R. Sanz, M. Sáinz, C. Treceño, A. Carvajal
Abstract
Cases of Guillain-Barré syndrome (GBS) have been occasionally associated with influenza vaccines; this possible risk, even if rare, is a matter of much concern. To investigate the strength of this association, a systematic review and a meta-analysis have been conducted; for the purpose, controlled observational studies addressing the risk of GBS associated with different influenza vaccines were sought. We finally selected 39 studies of interest published between 1981 and 2014 (seasonal influenza vaccines, 22; pandemic influenza vaccines, 16; both vaccines simultaneously administered, 1); funnel plot did not identify publication bias. At the association between any influenza vaccine – whether seasonal or pandemic – with GBS, the overall relative risk was 1.41 (95% CI, 1.20–1.66). Pandemic vaccines presented a higher risk (RR = 1.84; 95% CI, 1.36–2.50) compared to seasonal vaccines (RR = 1.22; 95% CI, 1.01–1.48); the latter should be considered as marginally statistically significant. Pandemic adjuvanted vaccines were not found to be related to a higher risk compared to non-adjuvanted vaccines. The results of the present meta-analysis point to a small but statistically significant association between influenza vaccines, particularly the pandemic ones, and GBS, which is consistent with current explanations upon possible mechanisms for this condition to appear.

CJNR (Canadian Journal of Nursing Research
Volume 47, Number 2, June 2015, pp. 81-96(16)

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Immunization Rejection in Southern Alberta: A Comparison of the Perspectives of Mothers and Health Professionals
Vandenberg, Shannon Y.; Kulig, Judith C.
Abstract:
Qualitative grounded theory was used to compare and contrast the understanding and decision-making process of non-immunizing mothers and health professionals’ perceptions of these mothers’ understanding and decision-making process. The sample comprised 8 mothers with purposefully unimmunized children under the age of 6 years and 12 health professionals. Semi-structured interviews were conducted and the data generated were analyzed using data immersion, memo-writing, and 3 stages of coding. The mothers and health professionals identified similar, interrelated factors influencing the mothers’ decision, categorized into 4 groups: emotions, beliefs, facts, and information. Three primary themes were evident: the health professionals emphasized the influence of religion in decision-making to a greater extent than did the mothers, the meaning of evidence appeared to differ for mothers and health professionals, and mothers revealed a mistrust of health professionals. Immunization is a public health issue; collaboration and understanding are necessary to promote positive health outcomes in children

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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Center for Global Development
http://www.cgdev.org/
Accessed 4 July 2015
The Role of Identification in the Post-2015 Development Agenda
Publications
7/1/15
The post-2015 development agenda is being shaped as we speak. The role of identification and its importance to development outcomes places it within the new Sustainable Development Goals (SDG) agenda — specifically as one of the proposed SDG targets (#16.9), but also as a key enabler of the efficacy of many other SDG targets. Although there is no one model for providing legal identity, this SDG would urge states to ensure that all have free or low-cost access to widely accepted, robust identity credentials.
CGD-Essay-Dahan-Gelb-Role-Identification-Post-2015.pdf

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Forbes
http://www.forbes.com/
Accessed 4 July 2015
Vaccines Are Emerging As Pfizer’s USP
The company already has strong presence in pneumococcal vaccines with near monopoly in the U.S. Its Prevenar franchise counters pneumococcal diseases such as pneumonia and meningitis. The recent acquisitions focusing on meningitis caused by Neisseria meningitidis will help Pfizer leverage its strong market position to further strengthen its […]
Trefis Team, Contributor Jul 02, 2015
Jim Carrey Unwittingly Brings Attention To Something Actually Linked To Autism
Jim Carrey, in trying to argue a debunked link between vaccines and autism, accidentally drew attention to one of the few factors that is linked to autism.

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New Yorker
http://www.newyorker.com/
Accessed 4 July 2015
July 3, 2015
A Death from Measles
By Michael Specter
A disease that was practically eradicated in the U.S fifteen years ago, before the anti-vaccine movement, claims its first victim in more than a decade.

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New York Times
http://www.nytimes.com/
Accessed 4 July 2015
Immigrant Children Given Adult Dose of Hepatitis A Vaccine
SAN ANTONIO — About 250 immigrant children were given an adult dose of a hepatitis A vaccine at a Texas detention facility where they were being held with their mothers, according to U.S. Immigration and Customs Enforcement
Washington Woman’s Measles Death Is First in US Since 2003
Schuchat said the best protection is immunization. “We really rely on people who can be vaccinated to protect those for whom vaccine protection isn’t available,” such as the woman with a depressed immune system,

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Washington Post
http://www.washingtonpost.com/
Accessed 4 July 2015
Declining vaccine rates: Mostly a white problem
But Black and Latino adults reported more concern about vaccine safety.
Janell Ross | Politics | Jul 3, 2015