Annals of Internal Medicine
18 August 2015, Vol. 163. No. 4
http://annals.org/issue.aspx

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Ideas and Opinions
Orchestrated Scientific Collaboration: Critical to the Control of MERS-CoV FREE
Trish M. Perl, MD, MSc; and Connie Savor Price, MD

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 22 August 2015)

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Research article
Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya
Sirina Keesara, Pamela Juma, Cynthia Harper
BMC Health Services Research 2015, 15:335 (20 August 2015)
Abstract

Research article
Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana
Kilian Atuoye, Jenna Dixon, Andrea Rishworth, Sylvester Galaa, Sheila Boamah, Isaac Luginaah BMC Health Services Research 2015, 15:333 (20 August 2015)
Abstract

Research article
The elimination of healthcare user fees for children under five substantially alleviates the burden on household expenses in Burkina Faso
Mahaman Abdou Illou, Slim Haddad, Isabelle Agier, Valéry Ridde
BMC Health Services Research 2015, 15:313 (8 August 2015)
Abstract

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 22 August 2015)

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Research article
Global travel patterns and risk of measles in Ontario and Quebec, Canada: 2007–2011
Sarah Wilson, Kamran Khan, Vladimir Gilca, Jennifer Miniota, Shelley Deeks, Gillian Lim, Rose Eckhardt, Shelly Bolotin, Natasha Crowcroft
BMC Infectious Diseases 2015, 15:341 (18 August 2015)
Abstract

Research article
Sustained low influenza vaccination in health care workers after H1N1 pandemic: a cross sectional study in an Italian health care setting for at-risk patients
Antonietta Giannattasio, Miriam Mariano, Roberto Romano, Fabrizia Chiatto, Ilaria Liguoro, Guglielmo Borgia, Alfredo Guarino, Andrea Lo Vecchio
BMC Infectious Diseases 2015, 15:329 (12 August 2015)
Abstract

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 22 August 2015)

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Research article
How intra-familial decision-making affects women’s access to, and use of maternal healthcare services in Ghana: a qualitative study
John Ganle, Bernard Obeng, Alexander Segbefia, Vitalis Mwinyuri, Joseph Yeboah, Leonard Baatiema
BMC Pregnancy & Childbirth 2015, 15:173 (15 August 2015)
Abstract |

Research article
How do Malawian women rate the quality of maternal and newborn care? Experiences and perceptions of women in the central and southern regions
Christabel Kambala, Julia Lohmann, Jacob Mazalale, Stephan Brenner, Manuela De Allegri, Adamson Muula, Malabika Sarker
BMC Pregnancy & Childbirth 2015, 15:169 (15 August 2015)
Abstract

Research article
Birth location preferences of mothers and fathers in rural Ghana: Implications for pregnancy, labor and birth outcomes
Leslie Cofie, Clare Barrington, Kavita Singh, Sodzi Sodzi-Tettey, Akalpa Akaligaung
BMC Pregnancy & Childbirth 2015, 15:165 (12 August 2015)
Abstract

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 22 August 2015)

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Research article
Understanding the socio-economic and sexual behavioural correlates of male circumcision across eleven voluntary medical male circumcision priority countries in southeastern Africa
Fiona Lau, Sylvia Jayakumar, Sema Sgaier
BMC Public Health 2015, 15:813 (22 August 2015)
Abstract |

Research article
Country characteristics and acute diarrhea in children from developing nations: a multilevel study
Ángela Pinzón-Rondón, Carol Zárate-Ardila, Alfonso Hoyos-Martínez, Ángela Ruiz-Sternberg, Alberto Vélez-van-Meerbeke
BMC Public Health 2015, 15:811 (21 August 2015)
Abstract

Research article
Improved coverage and timing of childhood vaccinations in two post-Soviet countries, Armenia and Kyrgyzstan
Schweitzer, G. Krause, F. Pessler, M. Akmatov
BMC Public Health 2015, 15:798 (19 August 2015)
Abstract
Background
Timing of childhood vaccinations has received close attention in many countries. Little is known about the trends in correctly timed vaccination in former Soviet countries. We examined trends in vaccination coverage and correct timing of vaccination in two post-Soviet countries, Armenia and Kyrgyzstan, and analyzed factors associated with delayed vaccinations.
Methods
We used data from the Demographic and Health Surveys; the surveys were conducted in 2000 (n = 1726), 2005 (n = 1430) and 2010 (n = 1473) in Armenia and in 1997 (n = 1127) and 2012 (n = 4363) in Kyrgyzstan. We applied the Kaplan-Meier method to estimate age-specific vaccination coverage with diphtheria, tetanus and pertussis (DTP) vaccine and a measles-containing vaccine (MCV). A Cox proportional hazard regression with shared frailty was used to examine factors associated with delayed vaccinations.
Results
Vaccination coverage for all three doses of the DTP vaccine increased in Armenia from 92 % in 2000 to 96 % in 2010. In Kyrgyzstan, DTP coverage was 96 % and 97 % in 1997 and 2012, respectively. Vaccination coverage for MCV increased from 89 % (Armenia, 2000) and 93 % (Kyrgyzstan, 1997) to 97 % (Armenia, 2010) and 98 % (Kyrgyzstan, 2012). The proportion of children with correctly timed vaccinations increased over time for all examined vaccinations in both countries. For example, the proportion of children in Armenia with correctly timed first DTP dose (DTP1) increased from 46 % (2000) to 66 % (2010). In Kyrgyzstan, the proportion of correctly timed DTP1 increased from 75 % (1997) to 87 % (2012). In Armenia, delays in the third DTP dose (DTP3) and MCV vaccinations were less likely to occur in the capital, whereas in Kyrgyzstan DTP3 and MCV start was delayed in the capital compared to other regions of the country. Also, in Armenia living in urban areas was associated with delayed vaccinations.
Conclusions
Vaccination coverage and timing of vaccination improved over the last years in both countries. Further efforts are needed to reduce regional differences in timely vaccinations.

Research article
Improving child survival through a district management strengthening and community empowerment intervention: early implementation experiences from Uganda
Anne Katahoire, Dorcus Henriksson, Eric Ssegujja, Peter Waiswa, Florence Ayebare, Danstan Bagenda, Anthony Mbonye, Stefan Peterson
BMC Public Health 2015, 15:797 (19 August 2015)
Abstract

Research article
Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review
Emily Carter, Jennifer Bryce, Jamie Perin, Holly Newby
BMC Public Health 2015, 15:788 (18 August 2015)
Abstract

Research article
Multimorbidity and the inequalities of global ageing: a cross-sectional study of 28 countries using the World Health Surveys
Sara Afshar, Paul Roderick, Paul Kowal, Borislav Dimitrov, Allan Hill
BMC Public Health 2015, 15:776 (13 August 2015)
Abstract

BMJ Open
2015, Volume 5, Issue 8
http://bmjopen.bmj.com/content/current

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Research
The impact of HPV vaccination on future cervical screening: a simulation study of two birth cohorts in Denmark
Mie Sara Hestbech, Elsebeth Lynge, Jakob Kragstrup, Volkert Siersma, Miguel Vazquez-Prada Baillet, John Brodersen
BMJ Open 2015;5:e007921 doi:10.1136/bmjopen-2015-007921

Clinical Infectious Diseases (CID)
Volume 61 Issue 5 September 1, 2015
http://cid.oxfordjournals.org/content/current
Field Evaluation of Capillary Blood Samples as a Collection Specimen for the Rapid Diagnosis of Ebola Virus Infection During an Outbreak Emergency
Thomas Strecker, Bernadett Palyi, Heinz Ellerbrok, Sylvie Jonckheere, Hilde de Clerck, Joseph Akoi Bore, Martin Gabriel, Kilian Stoecker, Markus Eickmann, Michel van Herp, Pierre Formenty,
Antonino Di Caro, and Stephan Becker
Clin Infect Dis. (2015) 61 (5): 669-675 doi:10.1093/cid/civ397
OPEN ACCESS
This study demonstrated the applicability of capillary blood samples as clinical specimens for field diagnosis of Ebola virus infection in an outbreak emergency.

Dose-Related Differences in Effectiveness of Human Papillomavirus Vaccination Against Genital Warts: A Nationwide Study of 550,000 Young Girls
Maria Blomberg, Christian Dehlendorff, Carsten Sand, and Susanne K. Kjaer
Clin Infect Dis. (2015) 61 (5): 676-682 doi:10.1093/cid/civ364
In this nationwide study, measurement of dose-related protection by human papillomavirus vaccination against genital warts showed that 3 vaccinations are required for maximal protection with the current regimen; 2 vaccinations may be sufficient if the dosing interval is extended.

Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Pneumococcal Meningitis in US Children
Liset Olarte, William J. Barson, Ryan M. Barson, Philana Ling Lin, José R. Romero, Tina Q. Tan,
Laurence B. Givner, John S. Bradley, Jill A. Hoffman, Kristina G. Hultén, Edward O. Mason, and Sheldon L. Kaplan
Clin Infect Dis. (2015) 61 (5): 767-775 doi:10.1093/cid/civ368
Pneumococcal meningitis cases among 8 children’s hospitals remained unchanged after the introduction of 13-valent pneumococcal conjugate vaccine (PCV13). PCV13 serotypes represented 27% of cases. Antibiotic resistance decreased, largely related to declines in serotype 19A. Morbidity and case-fatality rate remain substantial.

Clinical Therapeutics
August 2015 Volume 37, Issue 8 , Supplement, e1-e170
http://www.clinicaltherapeutics.com/current

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High dose favipiravir: first experience in a patient with Ebola
A.M. Borobia, M. Mora-Rillo, G. Ramírez Olivencia, M. Lago, M. Arsuaga, F. De la Calle, F. Arnalich, J.R. Arribas, A.J. Carcas
DOI: http://dx.doi.org/10.1016/j.clinthera.2015.05.054
Abstract
Background
On October 2014, the first case of human-to-human transmission of Ebola virus (EVOB) outside Africa was admitted in our hospital. Patient received supportive treatment and experimental treatment with convalescent plasma and antiviral was considered. Favipiravir (Toyama-Chemical) is a RNA polymerase inhibitor approved in Japan for the treatment of influenza, but with no previous experience in human EVOB infected patients.
Methods
The rational for favipiravir dose and schedule was based on recent in vitro and in vivo data in mice (Oesterech, 2014) showing an EBOV-IC90: 17 μg/mL and therapeutic efficacy: 300 mg/kg/d. Preclinical toxicology studies in monkeys settled a NOAEL of 100 mg/kg/d. Also pharmacokinetic data in healthy volunteers (loading dose/maintenance: 1200/600 BID) provided by Company was took in consideration: Cmax: 30–56 μg/mL, t1/2: 3.4–5.8 hr and plasma albumin binding: 53%. Based on this limited information, we decided a loading dose of 50 mg/kg BID (3 doses) and maintenance dose of 25 mg/kg TID. This schedule aimed to maintain a free Cmin above IC90 and as close as possible to 60 μg/mL of total concentration. Similar doses had been recommended after our decision (Mentré, 2014).
Results
Favipiravir was initiated on day 9 of illness (DOI-9) and stopped on DOI-20 after two consecutive undetectable EBOV plasma viral loads. Despite the high doses used, favipiravir was well tolerated, without adverse events clearly related to the drug. The patient fully recovered and was discharged on DOI-34.
Conclusions
The contribution of favipiravir to disease resolution is difficult to ascertain because the use of other therapies (convalescent plasma and supportive treatment) and the spontaneous evolution of the disease, which can all be related to the cure of our patient. However, considering the time to treatment initiation, the severity of the disease, and the high viral load, contribution of favipiravir to the outcome of our patient must be considered and support its role as experimental therapy.

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 22 August 2015]

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Case study
Ebola in the context of conflict affected states and health systems: case studies of Northern Uganda and Sierra Leone
McPake B, Witter S, Ssali S, Wurie H, Namakula J and Ssengooba F Conflict and Health 2015, 9:23 (8 August 2015)

Cost Effectiveness and Resource Allocation
http://www.resource-allocation.com/
(Accessed 22 August 2015)

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Research
Cost-effectiveness analysis of routine immunization and supplementary immunization activity for measles in a health district of Benin
Kaucley L and Levy P Cost Effectiveness and Resource Allocation 2015, 13:14 (20 August 2015)
Abstract
Background
This study was carried out at district level to describe the cost structure and measure the effectiveness of delivering supplementary immunization activity (SIA) and routine immunization (RI) for measles in Benin, a country heavily affected by this disease.
Methods
This cost-effectiveness study was cross sectional and considered 1-year time horizon. RI consists to vaccinate an annual cohort of children aged 0–1 year old and SIA consists to provide a second dose of measles vaccine to children aged 0–5 years old in order to reach both those who did not seroconvert and who were not vaccinated through RI. Ingredients approach to costing was used. Effectiveness indicators included measles vaccine doses used, vaccinated children, measles cases averted and disability adjusted life years averted. Data were collected from all the 18 health care centers of the health district of Natitingou for the year 2011. In the analysis, the coverage was 89 % for RI and 104 % for SIA.
Results
SIA total cost was higher than RI total cost (15,796,560 FCFA versus 9,851,938 FCFA). Personnel and vaccines were the most important cost components for the two strategies. Fuel for cold chain took a non-negligible part of RI total cost (4.03 %) because 83 % of refrigerators were working with kerosene. Cost structures were disproportionate as social mobilization and trainings were not financed during RI contrarily to SIA. In comparison with no intervention, the two strategies combined permitted to avoid 12,671 measles cases or 19,023 DALYs. The benefit of SIA was 5601 measles cases averted and 6955 additional DALYs averted. Cost per vaccinated child for SIA (442 FCFA) was lower than for RI (1242 FCFA), in line with previous data from the literature. Cost per DALY averted was 2271 FCFA (4.73 USD) for SIA and 769 FCFA (1.60 USD) for RI. Analysis showed that low vaccine efficacy decreased the cost-effectiveness ratios for the two strategies. SIA was more cost-effective when the proportion of previously unvaccinated children was higher. For the two strategies, costs per DALY were more likely to vary with measles case fatality ratio.
Conclusions
SIA is costlier than RI. Both SIA and RI for measles are cost-effective interventions to improve health in Benin compared to no vaccination. Policy makers could make RI more efficient if sufficient funds were allocated to communications activities and to staff motivation (trainings, salaries).

Eurosurveillance
Volume 20, Issue 33, 20 August 2015
http://www.eurosurveillance.org/Public/Articles/Archives.aspx?PublicationId=11678

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Research articles
Malaria knowledge, attitudes and practices among migrants from malaria-endemic countries in Evrotas, Laconia, Greece, 2013
by I Evlampidou, K Danis, A Lenglet, M Tseroni, Y Theocharopoulos, T Panagiotopoulos

Global Public Health
Volume 10, Issue 8, 2015
http://www.tandfonline.com/toc/rgph20/current

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Legal and policy foundations for global generic competition: Promoting affordable drug pricing in developing societies
Pablo Zapatero Miguel
pages 901-916
DOI:10.1080/17441692.2015.1014824
Published online: 04 Mar 2015
Abstract
The so-called ‘TRIPS flexibilities’ restated in 2001 by the World Trade Organization’s Doha Declaration on TRIPS and Public Health offer a variety of policy avenues for promoting global price-based competition for essential medicines, and thus for improving access to affordable medicines in the developing world. In recent years, developing countries and international organisations alike have begun to explore the potentialities of global generic markets and competition generally, and also of using compulsory licensing to remedy anti-competitive practices (e.g. excessive pricing) through TRIPS-compatible antitrust enforcement. These and other ‘pro-competitive’ TRIPS flexibilities currently available provide the critical leverage and policy space necessary to improve access to affordable medicines in the developing world.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 22 August 2015]

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Research
Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review
Mannava P, Durrant K, Fisher J, Chersich M and Luchters S Globalization and Health 2015, 11:36 (15 August 2015)

Research
Does Pharmaceutical Pricing Transparency Matter? Examining Brazil’s Public Procurement System
Kohler JC, Mitsakakis N, Saadat F, Byng D and Martinez MG Globalization and Health 2015, 11:34 (4 August 2015)

Health Affairs
August 2015; Volume 34, Issue 8
http://content.healthaffairs.org/content/current

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Some State Vaccination Laws Contribute To Greater Exemption Rates And Disease Outbreaks In The United States
W. David Bradford1,* and Anne Mandich2
Author Affiliations
1W. David Bradford (bradfowd@uga.edu) is the Busbee Chair in Public Policy in the Department of Public Administration and Policy at the University of Georgia, in Athens.
2Anne Mandich is a PhD candidate in the Department of Applied and Agricultural Economics at the University of Georgia.
Abstract
Health officials attest that immunizations are among the most successful interventions in public health. However, there remains a substantial unvaccinated population in the United States. We analyzed how state-level vaccination exemption laws affect immunization rates and the incidence of preventable disease. We measured the association between each component of state kindergarten vaccination exemption laws and state vaccination exemption rates from 2002 to 2012, using the Centers for Disease Control and Prevention’s annual school assessment reports. We found that policies such as requiring health department approval of nonmedical exemptions, requiring a physician to sign an exemption application, and having criminal or civil punishments for noncompliance with immunization requirements had a significant effect in reducing vaccine exemptions. Our exemption law effectiveness index identified eighteen states with the most effective laws and nine states with the least effective ones. The most effective states had lower incidences of pertussis, compared to other states. For policy makers interested in decreasing the number of vaccine exemptions in their state, our findings are of particular interest.

Health Policy and Planning
Volume 30 Issue 7 September 2015
http://heapol.oxfordjournals.org/content/current
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Editor’s Choice: Can the health system deliver? Determinants of rural Liberians’ confidence in health care
Theodore Svoronos, Rose Jallah Macauley, and Margaret E Kruk
Health Policy Plan. (2015) 30 (7): 823-829 doi:10.1093/heapol/czu065
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The value of building health promotion capacities within communities: evidence from a maternal health intervention in Guinea
Ellen Brazier, Renée Fiorentino, Mamadou Saidou Barry, and Moustapha Diallo
Health Policy Plan. (2015) 30 (7): 885-894 doi:10.1093/heapol/czu089
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Increased use of recommended maternal health care as a determinant of immunization and appropriate care for fever and diarrhoea in Ghana: an analysis pooling three demographic and health surveys
Natalie McGlynn, Piotr Wilk, Isaac Luginaah, Bridget L Ryan, and Amardeep Thind
Health Policy Plan. (2015) 30 (7): 895-905 doi:10.1093/heapol/czu090
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Review
The effectiveness of community-based loan funds for transport during obstetric emergencies in developing countries: a systematic review
Chidiebere Hope Nwolise, Julia Hussein, Lovney Kanguru, Jacqueline Bell, and Purvi Patel
Health Policy Plan. (2015) 30 (7): 946-955 doi:10.1093/heapol/czu084
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JAMA
August 18, 2015, Vol 314, No. 7
http://jama.jamanetwork.com/issue.aspx
[New issue; No relevant content identified]

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August 11, 2015, Vol 314, No. 6
http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=934298&direction=P
[No relevant content identified]

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August 4, 2015, Vol 314, No. 5
http://jama.jamanetwork.com/issue.aspx?journalid=67&issueid=934282&direction=P
Viewpoint
The State of the World’s Refugees: The Importance of Work, Cash Assistance, and Health Insurance
Paul B. Spiegel, MD, MPH

Psychological Treatments for Orphans and Vulnerable Children Affected by Traumatic Events and Chronic Adversity in Sub-Saharan Africa
Peter Ventevogel, MD; Paul Spiegel, MD, MPH
Abstract
Importance
Orphans and vulnerable children (OVC) are at high risk for experiencing trauma and related psychosocial problems. Despite this, no randomized clinical trials have studied evidence-based treatments for OVC in low-resource settings.
Objective
To evaluate the effectiveness of lay counselor–provided trauma-focused cognitive behavioral therapy (TF-CBT) to address trauma and stress-related symptoms among OVC in Lusaka, Zambia.
Design, Setting, and Participants
This randomized clinical trial compared TF-CBT and treatment as usual (TAU) (varying by site) for children recruited from August 1, 2012, through July 31, 2013, and treated until December 31, 2013, for trauma-related symptoms from 5 community sites within Lusaka, Zambia. Children were aged 5 through 18 years and had experienced at least one traumatic event and reported significant trauma-related symptoms. Analysis was with intent to treat.
Interventions The intervention group received 10 to 16 sessions of TF-CBT (n = 131). The TAU group (n = 126) received usual community services offered to OVC.
Main Outcomes and Measures
The primary outcome was mean item change in trauma and stress-related symptoms using a locally validated version of the UCLA Posttraumatic Stress Disorder Reaction Index (range, 0-4) and functional impairment using a locally developed measure (range, 0-4). Outcomes were measured at baseline and within 1 month after treatment completion or after a waiting period of approximately 4.5 months after baseline for TAU.
Results
At follow-up, the mean item change in trauma symptom score was −1.54 (95% CI, −1.81 to −1.27), a reduction of 81.9%, for the TF-CBT group and −0.37 (95% CI, −0.57 to −0.17), a reduction of 21.1%, for the TAU group. The mean item change for functioning was −0.76 (95% CI, −0.98 to −0.54), a reduction of 89.4%, and −0.54 (95% CI, −0.80 to −0.29), a reduction of 68.3%, for the TF-CBT and TAU groups, respectively. The difference in change between groups was statistically significant for both outcomes (P < .001). The effect size (Cohen d) was 2.39 for trauma symptoms and 0.34 for functioning. Lay counselors participated in supervision and assessed whether the intervention was provided with fidelity in all 5 community settings.
Conclusions and Relevance
The TF-CBT adapted for Zambia substantially decreased trauma and stress-related symptoms and produced a smaller improvement in functional impairment among OVC having experienced high levels of trauma.

JAMA Pediatrics
August 2015, Vol 169, No. 8
http://archpedi.jamanetwork.com/issue.aspx

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Editorial | August 2015
Differentiating Sepsis From Adverse Events After Immunization in the Neonatal Intensive Care Unit – How Is a Physician to Know?
Michael W. Kuzniewicz, MD, MPH1,2,3; Nicola P. Klein, MD, PhD1,4
Extract
In this issue of JAMA Pediatrics, DeMeo et al1 report on the incidence of adverse effects after immunization of extremely low-birth-weight (ELBW) infants in the neonatal intensive care unit (NICU). They report that there is an increase in the incidence of sepsis evaluations, respiratory support, and intubation after immunization.
The findings of this study confirm what a number of other retrospective studies have found—that ELBW infants appear to have an increase in cardiorespiratory events after vaccination. The main strength of this study and what makes it unique is its large sample size of infants born at less than 28 weeks’ gestation, including those born at the most premature ages (ie, gestational ages [GAs] of 23-24 weeks). This study’s large size further allowed evaluation of single antigen vs combination vaccines, with the authors concluding that there was no difference in the incidence of adverse events after varying vaccine types. This finding should provide some reassurances to neonatologists and parents….

Adverse Events After Routine Immunization of Extremely Low-Birth-Weight Infants
Stephen D. DeMeo, DO; Sudha R. Raman, PhD; Christoph P. Hornik, MD, MPH; Catherine C. Wilson, DNP, NNP-BC, FNP-BC; Reese Clark, MD; P. Brian Smith, MD, MPH, MHS
Abstract
Importance
Immunization of extremely low-birth-weight (ELBW) infants in the neonatal intensive care unit (NICU) is associated with adverse events, including fever and apnea or bradycardia, in the immediate postimmunization period. These adverse events present a diagnostic dilemma for physicians, leading to the potential for immunization delay and sepsis evaluations.
Objective
To compare the incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death among immunized ELBW infants in the 3 days before and after immunization.
Design, Setting, and Participants
In this multicenter retrospective cohort study, we studied 13 926 ELBW infants born at 28 weeks’ gestation or less who were discharged from January 1, 2007, through December 31, 2012, from 348 NICUs managed by the Pediatrix Medical Group.
Exposures At least one immunization between the ages of 53 and 110 days.
Main Outcomes and Measures
Incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death.
Results
Most of the 13 926 infants (91.2%) received 3 or more immunizations. The incidence of sepsis evaluations increased from 5.4 per 1000 patient-days in the preimmunization period to 19.3 per 1000 patient-days in the postimmunization period (adjusted rate ratio [ARR], 3.7; 95% CI, 3.2-4.4). The need for increased respiratory support increased from 6.6 per 1000 patient-days in the preimmunization period to 14.0 per 1000 patient-days in the postimmunization period (ARR, 2.1; 95% CI, 1.9-2.5), and intubation increased from 2.0 per 1000 patient-days to 3.6 per 1000 patient-days (ARR, 1.7; 95% CI, 1.3-2.2). The postimmunization incidence of adverse events was similar across immunization types, including combination vaccines when compared with single-dose vaccines. Infants who were born at 23 to 24 weeks’ gestation had a higher risk of sepsis evaluation and intubation after immunization. A prior history of sepsis was associated with higher risk of sepsis evaluation after immunization.
Conclusions and Relevance
All ELBW infants in the NICU had an increased incidence of sepsis evaluations and increased respiratory support and intubation after routine immunization. Our findings provide no evidence to suggest that physicians should not use combination vaccines in ELBW infants. Further studies are needed to determine whether timing or spacing of immunization administrations confers risk for the developing adverse events and whether a prior history of sepsis confers risk for an altered immune response in ELBW infants.

Journal of the Pediatric Infectious Diseases Society (JPIDS)
Volume 4 Issue 3 September 2015
http://jpids.oxfordjournals.org/content/current

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Measles in Latin America: Current Situation
Robério Dias Leite1 and Eitan Naaman Berezin2
Extract
The Region of the Americas (North, Central, and South America and the Caribbean) successfully interrupted endemic measles transmission in 2002, but recent outbreaks in Latin America threaten to reverse this impressive achievement. Before widespread measles immunization in Latin America, measles was a common illness in early childhood and was associated with substantial mortality. During the 1960s, 600 000 measles cases were reported annually in the Region of the Americas [1]. Although measles vaccine was introduced during the 1960s, it was the creation of the World Health Organization (WHO) Expanded Program on Immunization in 1977 that marked the beginning of sustained decreases in case numbers. During 1970–1979, Latin American countries reported 220 000 measles cases annually, with incidence rates of 47–116 cases/100 000 population [2]. The highest mortality rates occurred among young children; from 1971 through 1980, measles associated mortality was 14–55 measles-associated deaths per 100 000 infants and 8–54 deaths/100 000 children aged 1–4 years. By 1980, most countries in the region had established national immunization programs; however, the mean infant measles vaccine coverage in the region was only 42%. In 2002, after more than 30 years of successful strategies and joint efforts of many countries in the region, interruption of endemic measles transmission in the Americas was achieved [3]. However, isolated cases continue to occur, due to the importation of measles from other areas of the world, sometimes causing short chains of transmissions over a few months…

Post-Licensure Surveillance of Trivalent Live-Attenuated Influenza Vaccine in Children Aged 2–18 Years, Vaccine Adverse Event Reporting System, United States, July 2005–June 2012
Penina Haber1, Pedro L. Moro1, Maria Cano1, Claudia Vellozzi1, Paige Lewis1, Emily Jane Woo2 and Karen Broder1
Author Affiliations
1Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
2Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Rockville, Maryland
Abstract
Background
The first trivalent live-attenuated influenza vaccine (LAIV3) was licensed in 2003 for use in healthy persons 5–49 years of age. In 2007, the US Food and Drug Administration expanded its indication to healthy children 2–4 years of age.
Methods
We searched the Vaccine Adverse Event Reporting System (VAERS) for US reports after LAIV3 from July 1, 2005 to June 30, 2012 in children aged 2–18 years. Medical records were requested for nonmanufacturer reports coded as serious (ie, death, hospitalization, prolonged hospitalization, life-threatening illness, disability). We characterized electronic data and clinically reviewed all serious reports and reports of special interest. Empirical Bayesian data mining was used to identify new or unexpected adverse events (AEs).
Results
During the study period, VAERS received 2619 US LAIV3 reports for children aged 2–18 years; 197 (7.5%) reports were serious, including 5 deaths. The 2 most frequent nonfatal serious reports involved neurological and respiratory systems, with 56 (29.2%) and 43 (22.4%) reports, respectively. The most frequent neurological diagnoses were seizures and Guillain-Barré Syndrome, and the most frequent respiratory conditions were pneumonia and asthma or reactive airway disease. Data mining showed increased proportions for reports of medication errors, most commonly vaccine administration errors not associated with an AE.
Conclusions
In this VAERS analysis of reports following LAIV3, we found no new or unexpected AEs patterns. Reports of LAIV3 administration to persons, for whom it is not recommended, including children with a history of asthma or reactive airway disease or wheezing, indicate that ongoing monitoring and education in vaccine indications are needed.

Safety and Immunogenicity of Full-Dose Trivalent Inactivated Influenza Vaccine (TIV) Compared With Half-Dose TIV Administered to Children 6 Through 35 Months of Age
Natasha B. Halasa1, Michael A. Gerber2, Andrea A. Berry3, Edwin L. Anderson4, Patricia Winokur5, Harry Keyserling6, Allison Ross Eckard6, Heather Hill7, Mark C. Wolff7, Monica M. McNeal2, Kathryn M. Edwards1 and David I. Bernstein2
Author Affiliations
1Vanderbilt Vaccine Research Program, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
2Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Ohio
3Center for Vaccine Development, University of Maryland, Baltimore
4Department of Medicine, St Louis University, Missouri
5Department of Medicine, University of Iowa, Iowa City
6Department of Pediatrics, Emory University, Atlanta, Georgia
7EMMES Corporation, Rockville, Maryland
Abstract
Background Children 6 through 35 months of age are recommended to receive half the dose of influenza vaccine compared with older children and adults.
Methods This was a 6-site, randomized 2:1, double-blind study comparing full-dose (0.5 mL) trivalent inactivated influenza vaccine (TIV) with half-dose (0.25 mL) TIV in children 6 through 35 months of age. Children previously immunized with influenza vaccine (primed cohort) received 1 dose, and those with no previous influenza immunizations (naive cohort) received 2 doses of TIV. Local and systemic adverse events were recorded. Sera were collected before immunization and 1 month after last dose of TIV. Hemagglutination inhibition antibody testing was performed.
Results Of the 243 subjects enrolled (32 primed, 211 naive), data for 232 were available for complete analysis. No significant differences in local or systemic reactions were observed. Few significant differences in immunogenicity to the 3 vaccine antigens were noted. The immune response to H1N1 was significantly higher in the full-dose group among primed subjects. In the naive cohort, the geometric mean titer for all 3 antigens after 2 doses of TIV were significantly higher in the 12 through 35 months compared with the 6 through 11 months age group.
Conclusions Our study confirms the safety of full-dose TIV given to children 6 through 35 months of age. An increase in antibody responses after full- versus half-dose TIV was not observed, except for H1N1 in the primed group. Larger studies are needed to clarify the potential for improved immunogenicity with higher vaccine doses. Recommending the same dose could simplify the production, storage, and administration of influenza vaccines.

The Lancet
Aug 22, 2015 Volume 386 Number 9995 p717-828 e7-e8
http://www.thelancet.com/journals/lancet/issue/current

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Articles
Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Global Burden of Disease Study 2013 Collaborators(
Theo Vos, et al
Published Online: 07 June 2015
DOI: http://dx.doi.org/10.1016/S0140-6736(15)60692-4
Summary
Background
Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013.
Methods
Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally and at the country level for 2013. In total, 35 620 distinct sources of data were used and documented to calculated estimates for 301 diseases and injuries and 2337 sequelae. The comorbidity simulation provides estimates for the number of sequelae, concurrently, by individuals by country, year, age, and sex. Disability weights were updated with the addition of new population-based survey data from four countries.
Findings
Disease and injury were highly prevalent; only a small fraction of individuals had no sequelae. Comorbidity rose substantially with age and in absolute terms from 1990 to 2013. Incidence of acute sequelae were predominantly infectious diseases and short-term injuries, with over 2 billion cases of upper respiratory infections and diarrhoeal disease episodes in 2013, with the notable exception of tooth pain due to permanent caries with more than 200 million incident cases in 2013. Conversely, leading chronic sequelae were largely attributable to non-communicable diseases, with prevalence estimates for asymptomatic permanent caries and tension-type headache of 2·4 billion and 1·6 billion, respectively. The distribution of the number of sequelae in populations varied widely across regions, with an expected relation between age and disease prevalence. YLDs for both sexes increased from 537·6 million in 1990 to 764·8 million in 2013 due to population growth and ageing, whereas the age-standardised rate decreased little from 114·87 per 1000 people to 110·31 per 1000 people between 1990 and 2013. Leading causes of YLDs included low back pain and major depressive disorder among the top ten causes of YLDs in every country. YLD rates per person, by major cause groups, indicated the main drivers of increases were due to musculoskeletal, mental, and substance use disorders, neurological disorders, and chronic respiratory diseases; however HIV/AIDS was a notable driver of increasing YLDs in sub-Saharan Africa. Also, the proportion of disability-adjusted life years due to YLDs increased globally from 21·1% in 1990 to 31·2% in 2013.
Interpretation
Ageing of the world’s population is leading to a substantial increase in the numbers of individuals with sequelae of diseases and injuries. Rates of YLDs are declining much more slowly than mortality rates. The non-fatal dimensions of disease and injury will require more and more attention from health systems. The transition to non-fatal outcomes as the dominant source of burden of disease is occurring rapidly outside of sub-Saharan Africa. Our results can guide future health initiatives through examination of epidemiological trends and a better understanding of variation across countries.
Funding
Bill & Melinda Gates Foundation.

.
Viewpoint
Responsibility and accountability for well informed health-care decisions: a global challenge
Prof Gro Jamtvedt, PhD, Prof Marianne Klemp, PhD, Berit Mørland, PhD, Prof Magne Nylenna, PhD
Published Online: 14 June 2015

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August 15, 2015 No. 9994, p625-716, e2-e6
http://www.thelancet.com/journals/lancet/issue/vol386no9994/PIIS0140-6736%2815%29X6155-1
[No relevant content identified]

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August 8, 2015 No. 9993, p503-624
http://www.thelancet.com/journals/lancet/issue/vol386no9993/PIIS0140-6736%2815%29X6154-X
Comment
The Vancouver Consensus: antiretroviral medicines, medical evidence, and political will
Chris Beyrer, Deborah L Birx, Linda-Gail Bekker, Françoise Barré-Sinoussi, Pedro Cahn, Mark R Dybul, Serge P Eholié, Matthew M Kavanagh, Elly T Katabira, Jens D Lundgren, Lilian Mworeko, Marama Pala, Thanyawee Puttanakit, Owen Ryan, Michel Sidibé, Julio S G Montaner on behalf of the Vancouver Consensus Signatories (appendix)
[No abstract]

The Lancet Global Health
Sep 2015 Volume 3 Number 9 e501-e576
http://www.thelancet.com/journals/langlo/issue/current

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Comment
Ethics in global health research: the need for balance
Lauren C Ng, Charlotte Hanlon, Getnet Yimer, David C Henderson, Abebaw Fekadu
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(15)00095-9
Summary
Global health research often needs collaboration between various organisations and oversight from many research ethics committees (RECs), including those from partner institutions, national committees, ministries of health, and funders, which increases administrative burden and time. Maintenance of the highest ethical standards in research is paramount; unfortunately ethics breaches are not uncommon.1 In view of the real possibility of ethical wrongdoing, worldwide health research must abide by transparent, rigorous, and effective procedures of ethics review.

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Trends and mortality effects of vitamin A deficiency in children in 138 low-income and middle-income countries between 1991 and 2013: a pooled analysis of population-based surveys
Gretchen A Stevens, James E Bennett, Quentin Hennocq, Yuan Lu, Luz Maria De-Regil, Lisa Rogers, Goodarz Danaei, Guangquan Li, Richard A White, Seth R Flaxman, Sean-Patrick Oehrle, Mariel M Finucane, Ramiro Guerrero, Zulfiqar A Bhutta, Amarilis Then-Paulino, Wafaie Fawzi, Robert E Black, Majid Ezzati
e528
Summary
Background
Vitamin A deficiency is a risk factor for blindness and for mortality from measles and diarrhoea in children aged 6–59 months. We aimed to estimate trends in the prevalence of vitamin A deficiency between 1991 and 2013 and its mortality burden in low-income and middle-income countries.
Methods
We collated 134 population-representative data sources from 83 countries with measured serum retinol concentration data. We used a Bayesian hierarchical model to estimate the prevalence of vitamin A deficiency, defined as a serum retinol concentration lower than 0·70 μmol/L. We estimated the relative risks (RRs) for the effects of vitamin A deficiency on mortality from measles and diarrhoea by pooling effect sizes from randomised trials of vitamin A supplementation. We used information about prevalences of deficiency, RRs, and number of cause-specific child deaths to estimate deaths attributable to vitamin A deficiency. All analyses included a systematic quantification of uncertainty.
Findings
In 1991, 39% (95% credible interval 27–52) of children aged 6–59 months in low-income and middle-income countries were vitamin A deficient. In 2013, the prevalence of deficiency was 29% (17–42; posterior probability [PP] of being a true decline=0·81). Vitamin A deficiency significantly declined in east and southeast Asia and Oceania from 42% (19–70) to 6% (1–16; PP>0·99); a decline in Latin America and the Caribbean from 21% (11–33) to 11% (4–23; PP=0·89) also occurred. In 2013, the prevalence of deficiency was highest in sub-Saharan Africa (48%; 25–75) and south Asia (44%; 13–79). 94 500 (54 200–146 800) deaths from diarrhoea and 11 200 (4300–20 500) deaths from measles were attributable to vitamin A deficiency in 2013, which accounted for 1·7% (1·0–2·6) of all deaths in children younger than 5 years in low-income and middle-income countries. More than 95% of these deaths occurred in sub-Saharan Africa and south Asia.
Interpretation
Vitamin A deficiency remains prevalent in south Asia and sub-Saharan Africa. Deaths attributable to this deficiency have decreased over time worldwide, and have been almost eliminated in regions other than south Asia and sub-Saharan Africa. This new evidence for both prevalence and absolute burden of vitamin A deficiency should be used to reconsider, and possibly revise, the list of priority countries for high-dose vitamin A supplementation such that a country’s priority status takes into account both the prevalence of deficiency and the expected mortality benefits of supplementation.
Funding
Bill & Melinda Gates Foundation, Grand Challenges Canada, UK Medical Research Council.

The Lancet Infectious Diseases
Aug 2015 Volume 15 Number 8 p863-986
http://www.thelancet.com/journals/laninf/issue/current

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Comment
New vaccine strategies to finish polio eradication
Nicholas C Grassly
Published Online: 17 June 2015
Summary
The Global Polio Eradication Initiative (GPEI) currently faces two specific challenges. First, all the cases in the past 9 months caused by ongoing wild-virus transmission were in Afghanistan and Pakistan—Africa has had a remarkable 9 months without detection of the disease. Second, circulating vaccine-derived polioviruses are continuing to cause poliomyelitis in a few countries, a rare outcome associated with continued use of the live-attenuated oral poliovirus vaccine (OPV). In The Lancet Infectious Diseases, the results of two clinical trials of OPV that address these challenges are reported by Fatima Mir and colleagues1 and Concepción Estívariz and colleagues.

Comment
Making mandatory vaccination truly compulsory: well intentioned but ill conceived
Daniel A Salmon, C Raina MacIntyre, Saad B Omer
Summary
The USA, Australia, and about half of European countries have mandatory vaccination requirements.1,2 The experience of the USA and Australia has been well studied. In the USA, vaccine mandates are implemented through requirements for proof of vaccination or exemption at school entry. In Australia, many provinces have school entry requirements and nationally mandated vaccination has traditionally been implemented by denial of childcare benefits to those who refuse vaccines—unless they provide proof of exemptions.

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Monovalent type-1 oral poliovirus vaccine given at short intervals in Pakistan: a randomised controlled, four-arm, open-label, non-inferiority trial
Fatima Mir, Farheen Quadri, Ondrej Mach, Imran Ahmed, Zaid Bhatti, Asia Khan, Najeeb ur Rehman, Elias Durry, Maha Salama, Steven M Oberste, William C Weldon, Roland W Sutter, Anita K M Zaidi

Immunogenicity of three doses of bivalent, trivalent, or type 1 monovalent oral poliovirus vaccines with a 2 week interval between doses in Bangladesh: an open-label, non-inferiority, randomised, controlled trial
Concepción F Estívariz, Abhijeet Anand, Howard E Gary Jr, Mahmudur Rahman, Jannatul Islam, Tajul I Bari, Steven G F Wassilak, Susan Y Chu, William C Weldon, Mark A Pallansch, James D Heffelfinger, Stephen P Luby, Khalequ Zaman

Long-term sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study
Danielle V Clark, Hannah Kibuuka, Monica Millard, Salim Wakabi, Luswa Lukwago, Alison Taylor, Michael A Eller, Leigh Anne Eller, Nelson L Michael, Anna N Honko, Gene G Olinger Jr, Randal J Schoepp, Matthew J Hepburn, Lisa E Hensley, Merlin L Robb
905

Nature
Volume 524 Number 7565 pp265-382 20 August 2015
http://www.nature.com/nature/current_issue.html
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World View
Tackle Nepal’s typhoid problem now
As post-earthquake conditions increase the risk of a typhoid epidemic, Buddha Basnyat calls for a widespread vaccination programme.

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Volume 524 Number 7564 pp137-260 13 August 2015
http://www.nature.com/nature/journal/v524/n7564/index.html
[No relevant content identified]

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Volume 524 Number 7563 pp5-130 6 August 2015
http://www.nature.com/nature/journal/v524/n7563/index.html
Editorial
Trial and triumph
The success of an Ebola vaccine trial shows that clinical trials can be done under the difficult field conditions of an epidemic — if there is enough political and regulatory will.

World View
Train Africa’s scientists in crisis response
To prevent future epidemics, a new international effort must boost West Africa’s scientific and public-health capacity, says Christian Bréchot.

Comment
Disease outbreak: Finish the fight against Ebola
Leaders and health agencies are talking about ‘lessons learned’ from West Africa’s Ebola epidemic. But a major push is needed to end the outbreak, urges Joanne Liu.

Ebola: Embed research in outbreak response
Testing Ebola treatments in West Africa’s epidemic happened too late. Research response during future outbreaks must be more nimble, says Trudie Lang.

Articles
Genetic diversity and evolutionary dynamics of Ebola virus in Sierra Leone Open
Yi-Gang Tong, Wei-Feng Shi, Di Liu, Jun Qian, Long Liang+ et al.
The genome sequences of 175 Ebola virus from five districts in Sierra Leone, collected during September–November 2014, show that the rate of virus evolution seems to be similar to that observed during previous outbreaks and that the genetic diversity of the virus has increased substantially, with the emergence of several novel lineages.

Temporal and spatial analysis of the 2014–2015 Ebola virus outbreak in West Africa Open
Miles W. Carroll, David A. Matthews, Julian A. Hiscox, Michael J. Elmore, Georgios Pollakis
+ et al.
Analysis of 179 new Ebola virus sequences from patient samples collected in Guinea between March 2014 and January 2015 shows how different lineages evolved and spread in West Africa.

Genetic diversity and evolutionary dynamics of Ebola virus in Sierra Leone Open
Yi-Gang Tong, Wei-Feng Shi, Di Liu, Jun Qian, Long Liang+ et al.
The genome sequences of 175 Ebola virus from five districts in Sierra Leone, collected during September–November 2014, show that the rate of virus evolution seems to be similar to that observed during previous outbreaks and that the genetic diversity of the virus has increased substantially, with the emergence of several novel lineages.

Pharmacoeconomics
Volume 33, Issue 8, August 2015
http://link.springer.com/journal/40273/33/8/page/1

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Commentary
Development and Use of Disease-Specific (Reference) Models for Economic Evaluations of Health Technologies: An Overview of Key Issues and Potential Solutions
Gerardus W. J. Frederix, Hossein Haji Ali Afzali, Erik J. Dasbach…
[No abstract]

.
Systematic Review
The Economic Costs of Type 2 Diabetes: A Global Systematic Review
Till Seuring, Olga Archangelidi, Marc Suhrcke
Abstract
Objective
In view of the goal of eliminating tuberculosis (TB) by 2050, economic evaluations of interventions against the development of TB are increasingly requested. Little research has been published on the incremental cost effectiveness of preventative therapy (PT) in groups at high risk for progression from latent TB infection (LTBI) with Mycobacterium TB (MTB) to active disease. A systematic review of studies with a primary focus on model-driving inputs and methodological differences was conducted.
Methods
A search of MEDLINE, the Cochrane Library and EMBASE to July 2014 was undertaken, and reference lists of eligible articles and relevant reviews were examined.
Results
A total of 876 citations were retrieved, with a total of 24 studies being eligible for inclusion, addressing six high-risk groups other than contact persons. Results varied considerably between studies and countries, and also over time. Although the selected studies generally demonstrated cost effectiveness for PT in HIV-infected subjects and healthcare workers (HCWs), the outcome of these analyses can be questioned in light of recent epidemiologic data. For immigrants from high TB-burden countries, patients with end-stage renal disease, and the immunosuppressed, now defined as further vulnerable groups, no consistent recommendation can be taken from the literature with respect to cost effectiveness of screening and treating LTBI. When the concept of a fixed willingness-to-pay (WTP) threshold as a prerequisite for final categorization was used, the sums ranged between ‘no specification’ and US$100,000 per quality-adjusted life-year.
Conclusions
To date, incremental cost-effectiveness analyses on PT in groups at high risk for TB progression, other than contacts, are surprisingly scarce. The variation found between studies likely reflects variations in the major epidemiologic factors, particularly in the estimates on the accuracy of the tuberculin skin test (TST) and interferon-gamma release assays (IGRA) as screening methods used before considering PT. Further research, including explicit evaluation of local epidemiological conditions, test accuracy, and methodology of WTP thresholds, is needed.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 22 August 2015)
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Novel Human-like Influenza A Viruses Circulate in Swine in Mexico and Chile
August 13, 2015 · Research
Abstract
Introduction: Further understanding of the genetic diversity and evolution of influenza A viruses circulating in swine (IAV-S) is important for the development of effective vaccines and our knowledge of pandemic threats. Until recently, very little was known of IAV-S diversity in Latin America, owing to a lack of surveillance.
Methods: To address this gap, we sequenced and conducted a phylogenetic analysis of 69 hemagglutinin (HA) sequences from IAV-S isolates collected in swine in Mexico and Chile during 2010-2014, including the H1N1, H1N2, and H3N2 subtypes.
Results: Our analysis identified multiple IAV-S lineages that appear to have been circulating undetected in swine for decades, including four novel IAV-S lineages of human seasonal virus origin that have not been previously identified in any swine populations globally. We also found evidence of repeated introductions of pandemic H1N1 viruses from humans into swine in Mexico and Chile since 2009, and incursions of H1 and H3 viruses from North American swine into Mexico.
Discussion: Overall, our findings indicate that at least 12 genetically distinct HA lineages circulate in Latin American swine herds, only two of which have been found in North American swine herds. Human-to-swine transmission, spatial migration via swine movements, and genomic reassortment are the key evolutionary mechanisms that generate this viral diversity. Additional antigenic characterization and whole-genome sequencing is greatly needed to understand the diversity and independent evolution of IAV-S in Latin America.

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Rapid Assessment of Ebola-Related Implications for Reproductive, Maternal, Newborn and Child Health Service Delivery and Utilization in Guinea
August 4, 2015 · Research
Introduction: Since March 2014, Guinea has been in the midst of the largest, longest, and deadliest outbreak of Ebola Virus Disease ever recorded. Due to sub-optimal health conditions prior to the outbreak, Guinean women and children may have been especially vulnerable to worsening health care conditions. A rapid assessment was conducted to better understand how the delivery and utilization of routine RMNCH services may have been affected by the extraordinary strain placed on the health system and its client population by the Ebola outbreak in Guinea.
Methods: Data were collected January-February 2015 in a convenience sample of public and private facilities in areas of the country that were Ebola active, calm and inactive. Monthly data on a number of RMNCH services were collected by facility record abstraction for the period from October 1, 2013 through December 31, 2014. Structured interviews were also held with facility directors and RMNCH service providers.
Results: Data on RMNCH services from forty five public facilities were obtained. A statistically significant decline of 31% was seen in outpatient visits between October-December 2013 (before the Ebola outbreak) and October-December 2014 (the advanced stage of the Ebola outbreak). Service declines appeared to be greater in hospitals compared to health centers. Child health services were more affected by the Ebola epidemic than other assessed health areas. For example, the number of children under five seen for diarrhea and Acute Respiratory Infection (ARI) showed a large decrease over the one-year period in both hospitals (60% for diarrhea and 58% for ARI) and health centers (25% and 23%, respectively). Results also suggest that the negative effects on service availability (such as reduced hours, closures, and service suspensions) are likely to be regional and/or facility-specific. Providers reported a number of improved infection control behaviors as a result of the Ebola outbreak, including more frequent hand-washing and the use of disinfectants. Nevertheless, 30% of interviewed staff had not received any training on Ebola infection control.
Discussion: Although there may be differences in RMNCH service delivery and availability in selected versus non-selected facilities, a large number of indicators were assessed in order to provide needed information on the effects of the Ebola crisis on routine RMNCH service delivery and uptake in Guinea. This information is an important and timely contribution to ongoing efforts to understand and respond to the adverse effects of the Ebola crisis on essential RMNCH services in Guinea.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 22 August 2015)
.
Viewpoints
Responsible Use of Pop Culture and Communication in the Face of Ebola Virus
Brandon Brown, Melissa Nasiruddin, Alexander Dao, Monique Halabi
Published: August 6, 2015
DOI: 10.1371/journal.pntd.0003890
.
…Current Use of Pop Culture in the Ebola Epidemic
The CDC, the World Health Organization (WHO), and other public health agencies have leveraged popular social media to distribute up-to-date and accurate information on Ebola [7,8], while social websites such as Reddit, to which users can submit content organized by areas of interest, allow for the assimilation of unverified information [9]. A literature review on the use of social networking sites for influencing health behavior demonstrated a particularly valuable aspect of social media: its cost-effective ability to reach hard-to-reach underserved and minority populations [10]. Health information reaches consumers at various levels that differ based on demographic and socioeconomic factors. For example, data from the Health Information National Trends Survey found that individuals who sought out health information tended to have regular health care access and were more likely to earn over US$50,000 in income; conversely, males, people older than 65 years of age, and people identifying as Hispanic were less likely to seek out that information [11]. Because of differences in how these groups receive, trust, and process health information, mechanisms by which pertinent health information is disseminated must be diversified in order to maximize the audience reached. This can be done through media accessed by members of multiple socioeconomic and cultural strata. Examples of useful media include film, books, pamphlets, the Internet, and crowdsource mapping, among others. Smart phone apps and health reminders through text messages are some ways that technology has been used to help raise awareness about the epidemic [12,13], but there are still other ways that social media and popular culture can be used to further spread vital public health information. The public is eager for this information, as clearly demonstrated with the success of television programs such as the Dr. Oz show in promoting information-seeking behavior [14]…

PLoS One
http://www.plosone.org/
[Accessed 22 August 2015]

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Towards a Science of Community Stakeholder Engagement in Biomedical HIV Prevention Trials: An Embedded Four-Country Case Study
Peter A. Newman, Clara Rubincam, Catherine Slack, Zaynab Essack, Venkatesan Chakrapani, Deng-Min Chuang, Suchon Tepjan, Murali Shunmugam, Surachet Roungprakhon, Carmen Logie, Jennifer Koen, Graham Lindegger
Research Article | published 21 Aug 2015 | PLOS ONE
10.1371/journal.pone.0135937

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Research Article
Measuring Health Utilities in Children and Adolescents: A Systematic Review of the Literature
Dominic Thorrington, Ken Eames
Published: August 14, 2015
DOI: 10.1371/journal.pone.0135672
Abstract
Background
The objective of this review was to evaluate the use of all direct and indirect methods used to estimate health utilities in both children and adolescents. Utilities measured pre- and post-intervention are combined with the time over which health states are experienced to calculate quality-adjusted life years (QALYs). Cost-utility analyses (CUAs) estimate the cost-effectiveness of health technologies based on their costs and benefits using QALYs as a measure of benefit. The accurate measurement of QALYs is dependent on using appropriate methods to elicit health utilities.
Objective
We sought studies that measured health utilities directly from patients or their proxies. We did not exclude those studies that also included adults in the analysis, but excluded those studies focused only on adults.
Methods and Findings
We evaluated 90 studies from a total of 1,780 selected from the databases. 47 (52%) studies were CUAs incorporated into randomised clinical trials; 23 (26%) were health-state utility assessments; 8 (9%) validated methods and 12 (13%) compared existing or new methods. 22 unique direct or indirect calculation methods were used a total of 137 times. Direct calculation through standard gamble, time trade-off and visual analogue scale was used 32 times. The EuroQol EQ-5D was the most frequently-used single method, selected for 41 studies. 15 of the methods used were generic methods and the remaining 7 were disease-specific. 48 of the 90 studies (53%) used some form of proxy, with 26 (29%) using proxies exclusively to estimate health utilities.
Conclusions
Several child- and adolescent-specific methods are still being developed and validated, leaving many studies using methods that have not been designed or validated for use in children or adolescents. Several studies failed to justify using proxy respondents rather than administering the methods directly to the patients. Only two studies examined missing responses to the methods administered with respect to the patients’ ages.

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Knowledge on HPV Vaccine and Cervical Cancer Facilitates Vaccine Acceptability among School Teachers in Kitui County, Kenya
Moses Muia Masika, Javier Gordon Ogembo, Sophie Vusha Chabeda, Richard G. Wamai, Nelly Mugo
Research Article | published 12 Aug 2015 | PLOS ONE
10.1371/journal.pone.0135563
Abstract
Background
Vaccines against human papillomavirus (HPV) infection have the potential to reduce the burden of cervical cancer. School-based delivery of HPV vaccines is cost-effective and successful uptake depends on school teachers’ knowledge and acceptability of the vaccine. The aim of this study is to assess primary school teachers’ knowledge and acceptability of HPV vaccine and to explore facilitators and barriers of an ongoing Gavi Alliance-supported vaccination program in Kitui County, Kenya.
Methods
This was a cross-sectional, mixed methods study in Central Division of Kitui County where the Ministry of Health is offering the quadrivalent HPV vaccine to grade four girls. Data on primary school teachers’ awareness, knowledge and acceptability of HPV vaccine as well as facilitators and barriers to the project was collected through self-administered questionnaires and two focus group discussions.
Results
339 teachers (60% female) completed the survey (62% response rate) and 13 participated in 2 focus group discussions. Vaccine awareness among teachers was high (90%), the level of knowledge about HPV and cervical cancer among teachers was moderate (48%, SD = 10.9) and females scored higher than males (50% vs. 46%, p = 0.002). Most teachers (89%) would recommend the vaccine to their daughter or close relatives. Those who would recommend the vaccine had more knowledge than those who would not (p = <0.001). The main barriers were insufficient information about the vaccine, poor accessibility of schools, absenteeism of girls on vaccine days, and fear of side effects.
Conclusions
Despite low to moderate levels of knowledge about HPV vaccine among school teachers, vaccine acceptability is high. Teachers with little knowledge on HPV vaccine are less likely to accept the vaccine than those who know more; this may affect uptake if not addressed. Empowering teachers to be vaccine champions in their community may be a feasible way of disseminating information about HPV vaccine and cervical cancer.

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Use of Mobile Information Technology during Planning, Implementation and Evaluation of a Polio Campaign in South Sudan
John Haskew, Veronica Kenyi, Juma William, Rebecca Alum, Anu Puri, Yehia Mostafa, Robert Davis
Research Article | published 07 Aug 2015 | PLOS ONE
10.1371/journal.pone.0135362
Abstract
Background
Use of mobile information technology may aid collection of real-time, standardised data to inform and improve decision-making for polio programming and response. We utilised Android-based smartphones to collect data electronically from more than 8,000 households during a national round of polio immunisation in South Sudan. The results of the household surveys are presented here, together with discussion of the application of mobile information technology for polio campaign planning, implementation and evaluation in a real-time setting.
Methods
Electronic questionnaires were programmed onto Android-based smartphones for mapping, supervision and survey activities during a national round of polio immunisation. National census data were used to determine the sampling frame for each activity and select the payam (district). Individual supervisors, in consultation with the local district health team, selected villages and households within each payam. Data visualisation tools were utilised for analysis and reporting.
Results
Implementation of mobile information technology and local management was feasible during a national round of polio immunisation in South Sudan. Red Cross visits during the polio campaign were equitable according to household wealth index and households who received a Red Cross visit had significantly higher odds of being aware of the polio campaign than those who did not. Nearly 95% of children under five were reported to have received polio immunisation (according to maternal recall) during the immunisation round, which varied by state, county and payam. A total of 11 payams surveyed were identified with less than 90% reported immunisation coverage and the least poor households had significantly higher odds of being vaccinated than the most poor. More than 95% of households were aware of the immunisation round and households had significantly higher odds of being vaccinated if they had prior awareness of the campaign taking place.
Conclusion
Pre-campaign community education and household awareness of polio is important to increase campaign participation and subsequent immunisation coverage in South Sudan. More emphasis should be placed on ensuring immunisation is equitable according to geographic area and household socio-economic index in future rounds. We demonstrate the utility of mobile information technology for household mapping, supervision and survey activities during a national round of polio immunisation and encourage future studies to compare the effectiveness of electronic data collection and its application in polio planning and programming.

PLoS Pathogens
http://journals.plos.org/plospathogens/
(Accessed 22 August 2015)

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The Ebola Virus: From Basic Research to a Global Health Crisis
Robert V. Stahelin
Research Matters | published 13 Aug 2015 | PLOS Pathogens
10.1371/journal.ppat.1005093

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Interdisciplinarity and Infectious Diseases: An Ebola Case Study
Vanessa O. Ezenwa, Anne-Helene Prieur-Richard, Benjamin Roche, Xavier Bailly, Pierre Becquart, Gabriel E. García-Peña, Parviez R. Hosseini, Felicia Keesing, Annapaola Rizzoli, Gerardo Suzán, Marco Vignuzzi, Marion Vittecoq, James N. Mills, Jean-François Guégan
Opinion | published 06 Aug 2015 | PLOS Pathogens
10.1371/journal.ppat.1004992

Science
21 August 2015 vol 349, issue 6250, pages 761-896
http://www.sciencemag.org/current.dtl

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Perspective – Medicine
Global control of hepatitis C virus
Andrea L. Cox
Author Affiliations
Johns Hopkins University, Baltimore, MD, USA.
Summary
Hepatitis C virus (HCV) infection is a blood-borne disease that infects ~185 million people (~3% of the world’s population) worldwide (1). It can result in severe liver disease and is the leading cause of liver cancer in many countries. Although directly acting antivirals (DAAs) that target the viral life cycle have created enormous optimism about controlling HCV infection, achieving that goal remains a substantial challenge. Both acute and chronic infections are largely asymptomatic, infection incidence is rising in the United States (2), and comprehensive screening programs are rare in the most highly endemic regions of the world. As a result, less than 5% of the world’s HCV-infected population, and only 50% of the United States’ HCV-infected population, are aware that they are infected (3, 4) (see the figure). Most of these individuals will not receive treatment and will remain at risk for transmitting the infection to others. Successful control of HCV infection will most likely require a combination of mass global screening to identify those with infection, treatment, and prevention. Prophylactic HCV vaccination would also go a long way to reducing harm for uninfected people who are at risk.

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14 August 2015 vol 349, issue 6249, pages 665-760
http://www.sciencemag.org/content/349/6249.toc
Vaccines
Ebola virus vaccines—preparing for the unexpected
Hans-Dieter Klenk and Stephan Becker
Science 14 August 2015: 693-694.
Many lives might have been saved if clinical studies of Ebola virus vaccines had been done earlier [Also see Report by Marzi et al.]
Summary
The still ongoing Ebola outbreak in West Africa, which began in 2013, and with more than 27,000 cases and 11,000 deaths so far, highlights the need for a vaccine against the disease (1). Hopes to have a vaccine have been nourished in recent years by studies with recombinant vesicular stomatitis virus (VSV) expressing the Ebola virus glycoprotein (VSV-EBOV). VSV-EBOV efficiently protects rodents and nonhuman primates against EBOV from viral strains (Kikwit strain in 1995, for example) that caused past outbreaks, but it was not known if it is also efficacious against the Makona strain responsible for the West African outbreak. On page 739 of this issue, Marzi et al. (2) demonstrate that the recombinant vaccine provides protective immunity in macaques against the Makona strain. Complete protection was achieved within 7 days after vaccination, suggesting that the vaccine will provide an ideal countermeasure for protecting health care workers and other persons at risk in an outbreak situation.

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Research Articles
Diversion of HIV-1 vaccine–induced immunity by gp41-microbiota cross-reactive antibodies
Wilton B. Williams, Hua-Xin Liao, M. Anthony Moody, Thomas B. Kepler, S. Munir Alam, Feng Gao, Kevin Wiehe, Ashley M. Trama, Kathryn Jones, Ruijun Zhang, Hongshuo Song, Dawn J. Marshall, John F. Whitesides, Kaitlin Sawatzki, Axin Hua, Pinghuang Liu, Matthew Z. Tay,
Xiaoying Shen, Andrew Foulger, Krissey E. Lloyd, Robert Parks, Justin Pollara, Guido Ferrari,
Jae-Sung Yu, Nathan Vandergrift, David C. Montefiori, Magdalena E. Sobieszczyk, Scott Hammer, Shelly Karuna, Peter Gilbert, Doug Grove, Nicole Grunenberg, M. Juliana McElrath, John R. Mascola, Richard A. Koup, Lawrence Corey, Gary J. Nabel, Cecilia Morgan, Gavin Churchyard, Janine Maenza, Michael Keefer, Barney S. Graham, Lindsey R. Baden, Georgia D. Tomaras, and Barton F. Haynes
Science 14 August 2015: aab1253
Published online 30 July 2015 [DOI:10.1126/science.aab1253]
The antibody response to an HIV-1 vaccine is dominated by preexisting immunity to microbiota.
Abstract

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Report
VSV-EBOV rapidly protects macaques against infection with the 2014/15 Ebola virus outbreak strain
Andrea Marzi1, Shelly J. Robertson1, Elaine Haddock1, Friederike Feldmann2, Patrick W. Hanley2, Dana P. Scott2, James E. Strong3, Gary Kobinger3, Sonja M. Best1, Heinz Feldmann1,*
Author Affiliations
1Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA.
2Rocky Mountain Veterinary Branch, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT 59840, USA.
3Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
Abstract
The latest Ebola virus (EBOV) epidemic spread rapidly through Guinea, Sierra Leone, and Liberia, creating a global public health crisis and accelerating the assessment of experimental therapeutics and vaccines in clinical trials. One of those vaccines is based on recombinant vesicular stomatitis virus expressing the EBOV glycoprotein (VSV-EBOV), a live-attenuated vector with marked preclinical efficacy. Here, we provide the preclinical proof that VSV-EBOV completely protects macaques against lethal challenge with the West African EBOV-Makona strain. Complete and partial protection was achieved with a single dose given as late as 7 and 3 days before challenge, respectively. This indicates that VSV-EBOV may protect humans against EBOV infections in West Africa with relatively short time to immunity, promoting its use for immediate public health responses.

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7 August 2015 vol 349, issue 6248, pages 557-664
http://www.sciencemag.org/content/349/6248.toc
[No new relevant content identified]

Vaccine
Volume 33, Issue 34, Pages 4155-4218 (14 August 2015)
http://www.sciencedirect.com/science/journal/0264410X/33/34

WHO Recommendations Regarding Vaccine Hesitancy
Edited by Melanie Schuster and Philippe Duclos

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Editorial
Vaccine Special Issue on Vaccine Hesitancy
Benjamin Hickler, Sherine Guirguis, Rafael Obregon
doi:10.1016/j.vaccine.2015.04.034
Open Access
For most readers of “Vaccine,” it is a truism that vaccines represent one of the safest and most effective tools available in global efforts to control and prevent infectious diseases. Yet, parents searching the Internet about whether or not it is safe to get themselves or their children vaccinated will find this consensus recast as a controversy, or even a conspiracy. Many of the top internet search results question or dispute the scientific consensus about the safety and effectiveness of some or all vaccines on a number of grounds, from secular to religious to political-philosophical. The gap between expert consensus and the thinking among many publics around the world is not limited to the Internet. The proliferation of conflicting information and the ease with which misinformation can amplify — via old and new media channels — provide a confusing context for parents seeking additional guidance from health workers, religious leaders, family members, or other trusted sources, many of whom may themselves be misinformed about the risks and benefits of vaccines. In this context, perhaps it is not surprising that some caregivers have become “hesitant” about decisions to vaccinate.

Drawing on examples from around the world, in richer and poorer countries alike, the papers in this Special Issue demonstrate that there is no single form that vaccine hesitancy takes, and that the reasons behind decisions to delay or refuse vaccination are highly variable and context specific. Skepticism and rejection of vaccines among a portion of the public is as old as vaccine technology itself. But there are reasons to believe that new dynamics in the early 21st century have made the question of how to address vaccine hesitancy more acute, including the accelerated introduction of additional vaccines into routine programs, high-profile global initiatives to bring the benefits of immunization to the one-in-five children in developing countries who currently do not receive those benefits, and tectonic shifts in the production and consumption of information associated with the emergence and global penetration of social media. These dynamics set the backdrop for the request by the Strategic Advisory Group of Experts (SAGE) on Immunization to establish a working group on vaccine hesitancy. As vaccine hesitancy trends persist and associated risks have arguably increased in recent years, this supplement represents a timely contribution to the state of knowledge regarding “vaccine hesitancy” halfway into the Decade of Vaccines (2011–2020).

The introductory article in this Special Issue summarizes the history and rationale for SAGE’s initial request to establish a Working Group on Vaccine Hesitancy in March 2012. It notes that reports about declining public trust and acceptance of vaccines and/or immunization programs in some settings are longstanding issues. Since 2001, SAGE has repeatedly acknowledged the need to address the gap between public perceptions of vaccines and the consensus of the scientific and public health communities. By 2008–2009, SAGE reports explicitly recognized the need to actively pursue more methodical and proactive strategies to address misinformation propagated by increasingly vocal and sophisticated anti-vaccine movements, particularly in Europe. By the beginning of the Decade of Vaccines, experiences from polio eradication programs in India and Nigeria made it clear that vaccine hesitancy, public mistrust of vaccines and immunization services, and outright rejection of vaccines, are global issues that threaten to undermine decades of progress, the achievement of Millennium Development Goals, and the objectives of the Global Vaccine Action Plan (2011–2020).

Led by a joint WHO and UNICEF Secretariat, the SAGE Vaccine Hesitancy Working Group issued its final report to SAGE in October 2014. SAGE endorsed the proposed definition of vaccine hesitancy as “[a] delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines [and] includes factors such as complacency, convenience and confidence.” This Special Issue includes many of the products, conclusions, and recommendations endorsed by SAGE based on the Working Group’s progress, including:
[1] the definition of vaccine hesitancy and delineation of its components and potential determinants;
[2] an account of attempts to develop and pilot indicators to measure the scale and character of hesitancy in order to inform the development of strategies and policies and measure the effectiveness of interventions;
[3] suggested steps for adapting the Guide to Tailoring Immunization Programmes (WHO EURO) into a more widely applicable diagnostic resource for generating behavioral insights and identifying the determinants of vaccine hesitancy among specific subgroups in particular contexts anywhere in the world;
[4] an examination of social and commercial marketing applications with consideration of their potential to contribute to interventions to address vaccine hesitancy;
[5] systematic reviews of past strategies to address vaccine hesitancy; and
[6] a brief synopsis of four lessons from the field of health communication that are applicable to efforts to address vaccine hesitancy.

Taken collectively, these papers provide a sense of the current state of understanding regarding vaccine hesitancy as well as a set of high-level recommendations for next steps. They highlight the need to continue to refine our understanding of vaccine hesitancy, including the many forms it can take, the implications it may have in different contexts, its proximal and distal causes, and the changing nature of both the challenge and potential solutions in light of emerging technologies, a rapidly evolving global media environment, and an ever-changing geopolitical terrain. SAGE highlights the urgent need to develop institutional structures and organizational capacity at local, national and global levels to proactively address vaccine hesitancy and prepare for timely response in the event of rumors, media misinformation, adverse events following immunization (AEFI), or organized anti-vaccine movements. They also highlight the need to couple strategies to tackle vaccine hesitancy with efforts to tailor service delivery to match local needs and cultural practices. This issue of Vaccine represents a preliminary step towards critically needed initiatives to systematically share experiences between organizations and contexts, document and build on what works, and develop, validate, implement, and disseminate new tools and resources to deal with a problem that shows no sign of abating.

Looking across the articles and reflecting on lessons learned from other public education initiatives to engage resistant communities in productive dialogue or to counter misinformation about critical public health and development issues (e.g. polio eradication, tobacco, HIV), a number of additional themes and recommendations emerge that deserve highlighting. For example, it becomes clear that reaching out to and involving a broader range of stakeholders needs to take place earlier in processes of decision-making and communicating about the organization and delivery of immunization services or activities like the introduction of new vaccines or the extension of immunization services to non-traditional populations (e.g. adolescents). Too often, this sort of outreach is only done in reaction to a problem that has finally grown too big to ignore. To riff on an immunization key message: prevention is better—and cheaper—than treatment. WHO and UNICEF will continue to work with our national counterparts to be proactive about this outreach, inclusive and open-minded about who should be counted as a stakeholder, and make sure all parties are supported in their efforts to sustain the channels of dialogue and sense of mutual ownership we are collectively working to establish.

The time has come to act on—and invest in—the SAGE recommendation that key immunization partners align their efforts to develop local, national, and global capacities in fields outside of the traditional remit of immunization programs, including medical anthropology, social and behavior change communication, opinion research, behavioral economics, commercial and social marketing, and user-centered design research. It is not an effective formula to have vaccine hesitancy be addressed by one organization or department, whilst plans and activities to introduce new vaccines, enhance coverage, or reduce inequities in uptake are undertaken in isolation by another. A clear lesson from the examples in this Special Issue is that immunization programs must systematically and comprehensively address not only supply-side but also demand-side strategies, and do so from inception through implementation.

As the recent Ebola crisis tragically brought to light, engaging with communities and persuading individuals to change their habits and behaviors is a lynchpin of public health success. Addressing vaccine hesitancy is no different. Proactive preparation and nimble response based on social and behavioral insights requires analytical capacity to detect, assess, and address “hotspot” areas of hesitancy that can quickly become explosive; ongoing engagement with social actors (i.e. media; opinion leaders) that shape public perceptions of risk and safety of vaccines; and predefined roles, prepositioned resources, and crisis mitigation plans that can be triggered to effectively address rumors or misinformation before they adversely affect uptake.

Although this Special Issue focuses on vaccine and vaccination hesitancy, it is important to see the work on hesitancy as only one aspect of a broader agenda of generating public trust in and demand for immunization. One of the six primary strategic objectives in the Global Vaccine Action Plan calls for “individuals and communities to understand the value of vaccines and demand immunization as both their right and responsibility.”1 Achieving this objective requires going beyond addressing vaccine hesitancy issues. But the better we understand the issues described in this Special Issue and the smarter we are about capitalizing on the opportunities that come with the associated SAGE recommendations, the closer we are to tackling the broader agenda of enhancing and sustaining public demand for immunization.
Conflict of interest: None of the authors had any potential conflict of interest.
1 http://www.who.int/immunization/global_vaccine_action_plan/en/ [accessed 02.02.15].

Vaccines — Open Access Journal
http://www.mdpi.com/journal/vaccines
(Accessed 22 August 2015)
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Article: Small Wonders—The Use of Nanoparticles for Delivering Antigen
by Aya Taki and Peter Smooker
Vaccines 2015, 3(3), 638-661; doi:10.3390/vaccines3030638 – published 10 August 2015

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Review: Plant Viruses as Nanoparticle-Based Vaccines and Adjuvants
by Marie-Ève Lebel, Karine Chartrand, Denis Leclerc and Alain Lamarre
Vaccines 2015, 3(3), 620-637; doi:10.3390/vaccines3030620 – published 5 August 2015

Value in Health
July 2015 Volume 18, Issue 5, p549-738
http://www.valueinhealthjournal.com/current

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Cost-Effectiveness Analysis of a Television Campaign to Promote Seasonal Influenza Vaccination Among the Elderly
Minchul Kim, PhD, Byung-Kwang Yoo, MD, PhD
Published Online: July 07, 2015
DOI: http://dx.doi.org/10.1016/j.jval.2015.03.1794
Abstract
Background
The U.S. policy goals regarding influenza vaccination coverage rate among the elderly include the increase in the coverage rate and the elimination of disparities across racial/ethnic groups.
Objective
To examine the potential effectiveness of a television (TV) campaign to increase seasonal influenza vaccination among the elderly.
Methods
We estimated the incremental cost-effectiveness ratio (ICER, defined as incremental cost per additionally vaccinated Medicare individual) of a hypothetical nationwide TV campaign for influenza vaccination compared with no campaign. We measured the effectiveness of the nationwide TV campaign (advertised once a week at prime time for 30 seconds) during a 17-week influenza vaccination season among four racial/ethnic elderly groups (N=39 million): non-Hispanic white (W), non-Hispanic African American (AA), English-speaking Hispanic (EH), and Spanish-speaking Hispanic (SH).
Results
The hypothetical campaign cost was $5,960,000 (in 2012 US dollars). The estimated campaign effectiveness ranged from −1.1% (the SH group) to 1.42% (the W group), leading to an increased disparity in influenza vaccination among non-Hispanic white and non-Hispanic African American (W-AA) groups (0.6 percentage points), W-EH groups (0.1 percentage points), and W-SH groups (1.5 percentage points). The estimated ICER was $23.54 (95% confidence interval $14.21–$39.37) per additionally vaccinated Medicare elderly in a probabilistic analysis. Race/ethnicity-specific ICERs were lowest among the EH group ($22.27), followed by the W group ($22.47) and the AA group ($30.55). The nationwide TV campaign was concluded to be reasonably cost-effective compared with a benchmark intervention (with ICER $44.39 per vaccinated individual) of a school-located vaccination program. Break-even analyses estimated the maximum acceptable campaign cost to be $14,870,000, which was comparable to the benchmark ICER.
Conclusions
The results could justify public expenditures on the implementation of a future nationwide TV campaign, which should include multilingual campaigns, for promoting seasonal influenza vaccination.

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_1 August 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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Editor’s Note:
Vaccines and Global Health: The Week in Review will resume publication on 22 August 2015 following annual leave for the editor. The edition for that date will cover the intervening period from 2 August.

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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 1 August 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

Ebola Situation Report – 29 July 2015
[Excerpts]
SUMMARY
:: There were 7 confirmed cases of Ebola virus disease (EVD) reported in the week to 26 July: 4 in Guinea and 3 in Sierra Leone. This is the lowest weekly total for over a year, and comes after 8 consecutive weeks during which case incidence had plateaued at between 20 and 30 cases per week. Although this decline in case incidence is welcome, it is too early to tell whether it will be sustained. There have been several high-risk events in both Guinea and Sierra Leone in the past 14 days, and past experience has shown that it can take a single high-risk case or missed contact to spark a new cluster of cases. In addition, there are over 2000 contacts still within their 21-day follow-up period in Guinea, Liberia, and Sierra Leone, representing a substantial residual risk of further cases. Refinements to the response continue to yield improvements, with recent weeks seeing a higher proportion of cases arising from contacts and a lower proportion of cases identified post-mortem than at any time previously, but the continued occurrence of high-risk transmission events means that an increase in case incidence in the near term is a strong possibility…

COUNTRIES WITH WIDESPREAD AND INTENSE TRANSMISSION
:: There have been a total of 27,748 reported confirmed, probable, and suspected cases of EVD in Guinea, Liberia and Sierra Leone (figure 1, table 1) up to 26 July, with 11,279 reported deaths (this total includes reported deaths among probable and suspected cases, although outcomes for many cases are unknown). A total of 4 new confirmed cases were reported in Guinea and 3 in Sierra Leone in the week to 26 July…

WHO: World on the verge of an effective Ebola vaccine
News release
Geneva ¦ 31 July 2015 – Results from an interim analysis of the Guinea Phase III efficacy vaccine trial show that VSV-EBOV (Merck, Sharp & Dohme) is highly effective against Ebola. The independent body of international experts – the Data and Safety Monitoring Board – that conducted the review, advised that the trial should continue. Preliminary results from analyses of these interim data are published today in the British journal The Lancet.

“This is an extremely promising development,” said Dr Margaret Chan, Director-General of the World Health Organization. “The credit goes to the Guinean Government, the people living in the communities and our partners in this project. An effective vaccine will be another very important tool for both current and future Ebola outbreaks.”

While the vaccine up to now shows 100% efficacy in individuals, more conclusive evidence is needed on its capacity to protect populations through what is called “herd immunity”. To that end, the Guinean national regulatory authority and ethics review committee have approved continuation of the trial.

A line of defence against a terrible disease
“This is Guinea’s gift to West Africa and the world,” said Dr Sakoba Keita, Guinea’s national coordinator for the Ebola response. “The thousands of volunteers from Conakry and other areas of Lower Guinea, but also the many Guinean doctors, data managers and community mobilisers have contributed to finding a line of defence against a terrible disease.”

“The ‘ring’ vaccination method adopted for the vaccine trial is based on the smallpox eradication strategy,” said John-Arne Røttingen, Director of the Division of Infectious Disease Control at the Norwegian Institute of Public Health and Chair of the Study Steering Group. “The premise is that by vaccinating all people who have come into contact with an infected person you create a protective ‘ring’ and stop the virus from spreading further. This strategy has helped us to follow the dispersed epidemic in Guinea, and will provide a way to continue this as a public health intervention in trial mode.”

The Guinea vaccination trial began in affected communities on 23 March 2015 to evaluate the efficacy, effectiveness and safety of a single dose of the vaccine VSV-EBOV by using a ring vaccination strategy. To date, over 4 000 close contacts of almost 100 Ebola patients, including family members, neighbours, and co-workers, have voluntarily participated in the trial.

The trial stopped randomisation on 26 July to allow for all people at risk to receive the vaccine immediately, and to minimize the time necessary to gather more conclusive evidence needed for eventual licensure of the product. Until now, 50% of the rings were vaccinated 3 weeks after the identification of an infected patient to provide a term of comparison with rings that were vaccinated immediately. This now stops. In addition, the trial will now include 13 to 17-year-old and possibly 6 to 12-year-old children on the basis of new evidence of the vaccine’s safety.

If the vaccine is effective, then we are protecting frontline workers from the virus
“In parallel with the ring vaccination, we are also conducting a trial of the same vaccine on frontline workers,” said Bertrand Draguez, Medical Director at Médecins sans Frontières. “These people have worked tirelessly and put their lives at risk every day to take care of sick people. If the vaccine is effective, then we are already protecting them from the virus. With such high efficacy, all affected countries should immediately start and multiply ring vaccinations to break chains of transmission and vaccinate all frontline workers to protect them.”

The trial is being implemented by the Guinean authorities, WHO, Médecins sans Frontières (MSF) and the Norwegian Institute of Public Health, with support from a broad partnership of international and national organizations.

“This is a remarkable result which shows the power of equitable international partnerships and flexibility,” said Jeremy Farrar, Director of the Wellcome Trust, one of the funders of the trial. “This partnership also shows that such critical work is possible in the midst of a terrible epidemic. It should change how the world responds to such emerging infectious disease threats. We, and all our partners, remain fully committed to giving the world a safe and effective vaccine.”

“This record-breaking work marks a turning point in the history of health R&D,” said Assistant Director-General Marie-Paule Kieny, who leads the Ebola Research and Development effort at WHO. “We now know that the urgency of saving lives can accelerate R&D. We will harness this positive experience to develop a global R&D preparedness framework so that if another major disease outbreak ever happens again, for any disease, the world can act quickly and efficiently to develop and use medical tools and prevent a large-scale tragedy.”

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In Interim Results from Phase 3 Study, Merck’s Investigational Ebola Vaccine Efficacious; Study is Continuing
Global Collaboration Enabled Vaccine to Move from First-in-Human Studies to Initial Phase 3 Results Within One Year
July 31, 2015
KENILWORTH, N.J.–(BUSINESS WIRE)–Merck (known as MSD outside the US and Canada) said today that its investigational Ebola vaccine candidate, rVSV-ZEBOV, was found to have 100 percent efficacy in an analysis of interim data from a Phase 3 ring vaccination trial in Guinea. Preliminary conclusions from this study, which is continuing, were published on-line today in The Lancet. The authors report that vaccine efficacy was 100 percent (95% confidence interval: 74.7 – 100%; p=0.0036) following vaccination with a single dose of the rVSV-ZEBOV vaccine. It appeared that all vaccinated individuals were protected against Ebola virus infection within 6 to 10 days of vaccination.

“Building on pioneering early work by the Public Health Agency of Canada and NewLink Genetics Corporation, the extraordinary efforts of the team in Guinea and other experts have yielded interim results that suggest a potential role for our rVSV-ZEBOV vaccine in the fight against Ebola disease.”

To date, more than 4,000 participants have received the vaccine in this innovative trial, called “Ebola ça suffit” or “Ebola, that’s enough.” The trial was conducted by a team that included researchers from the World Health Organization (WHO), the Norwegian Institute of Public Health, the Health Ministry of Guinea and Médecins sans Frontières, among others. The results from this continuing study, as well as other studies already underway (see below) and additional studies to be conducted, will be used to support worldwide regulatory submissions.

“Merck has an enduring commitment to develop vaccines and medicines that address the world’s most devastating infectious diseases,” said Dr. Roger M. Perlmutter, president of Merck Research Laboratories. “Building on pioneering early work by the Public Health Agency of Canada and NewLink Genetics Corporation, the extraordinary efforts of the team in Guinea and other experts have yielded interim results that suggest a potential role for our rVSV-ZEBOV vaccine in the fight against Ebola disease.”…

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Gavi: Encouraging trial results offer significant hope for rapid availability of Ebola vaccine to end current outbreak
Ring vaccination trial data suggests vaccine is highly effective.
Geneva, 31 July 2015 – An Ebola vaccine should be made available to stop infections in affected communities in West Africa as soon as possible, Gavi CEO Dr Seth Berkley said today, after interim trial results from the World Health Organization suggested it is 100% effective at preventing the disease.

Interim results of the trials of the rVSV-ZEBOV vaccine, which began in the Basse-Guinée area of Guinea in March 2015, were published in The Lancet. Funded and organised by a consortium of partners including the Guinean Government, the Canadian Government, the Norwegian Government, Médecins Sans Frontières, the Wellcome Trust, and the WHO, the trial involved vaccinating more than 3,500 people using ring vaccination, a known public health approach, to study the effects of the vaccine on volunteers.

Ring vaccination involves tracing known contacts of an Ebola patient and vaccinating them as soon as possible, thereby creating a ring of immunised people to prevent further spread of the virus. The trial also showed that infection rates fell in the broader community, beyond those vaccinated, indicating that ring vaccination is an effective strategy to help end the on-going outbreak. The trial also compared the effects of immediate vaccination with delayed vaccination. Following the positive trial results, delayed vaccination was stopped and the vaccine was offered immediately following all cases of Ebola.

“Today’s Ebola vaccine trial results offer tremendous hope to communities that have been blighted by the devastating impact of the outbreak,” said Dr Berkley. “These communities need an effective vaccine sooner rather than later and Gavi stands ready to support the implementation of a WHO-recommended Ebola vaccine while continuing to work closely with all partners involved in the Ebola response.”

“The consortium of partners should be congratulated on the remarkable speed with which it put together these important and practical trials,” added Dr Berkley. “The global community will rightly expect the pace – alongside a high level of diligence – to be maintained so that people in affected communities and others living in countries at risk of Ebola can have access to a vaccine as soon as possible. We need to be ready to act wherever the virus is a threat.”

The Ebola crisis has claimed the lives of more than 11,000 people, with nearly 28,000 infected, in West Africa in the past 20 months. There is currently no treatment for the disease, which, according to the WHO, has an average fatality rate of around 50%.

In December 2014, the Gavi Board agreed to make funding available to purchase doses of Ebola vaccine, once approved by the WHO. The funding is also available to support the operational costs countries face when introducing an Ebola vaccine and to help rebuild severely damaged health systems.

Through the funding, Gavi is also helping Ebola-affected countries to restart their routine immunisation systems, which were devastated by the Ebola outbreak. As well as supporting immunisation campaigns, Gavi funding will enable Guinea, Liberia and Sierra Leone to recruit and retrain health workers, upgrade supply chains and trace children who have missed out on vaccinations.

UNMEER: Statement by Secretary-General Ban Ki-moon on the transition of UN Ebola emergency response
New York/Geneva, 31 July 2015
As we continue to actively strive to end the Ebola outbreak in West Africa, we have reached an important milestone in the global Ebola response.

The UN Mission for Ebola Emergency Response – UNMEER – will close on 31 July. The Mission has achieved its core objective of scaling up the response on the ground and establishing unity of purpose among responders in support of the nationally led efforts. As of 1 August, oversight of the UN system’s Ebola emergency response will fully be led by the World Health Organization (WHO), under the direct authority of the WHO Director-General. UN agencies, funds and programmes, the UN Office for the Coordination of Humanitarian Affairs, the UN Mission in Liberia and national and international partners have undertaken the necessary steps, to enable this seamless transition.

I have determined that, to maintain the high-level, dedicated UN leadership needed to get to zero cases, the Ebola Crisis Managers will remain in the countries under the oversight of WHO and with the support of the UN Resident Coordinators and UN country teams. In Liberia, this high-level UN leadership for the Ebola emergency response will be provided by my Deputy Special Representative and Resident Coordinator, with the support of the UN country team. My Special Envoy on Ebola will continue to provide strategic guidance for the response.

The United Nations remains steadfast in its commitment to supporting the Governments of Guinea, Liberia and Sierra Leone in getting to and staying at zero cases. We have made considerable progress, but the crisis is not yet over. At this critical juncture, additional resources are needed by the United Nations and partners to sustain full support to nationally led efforts to end the outbreak and to support recovery activities in affected countries. I therefore urge Member States to sustain the financial and political support necessary to end the outbreak.

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UNMEER Statement: UN Mission for Ebola Emergency Response (UNMEER)
UNMEER, the first-ever UN emergency health mission, was established on 19 September 2014 and closed on 31 July 2015, having achieved its core objective of scaling up the response on the ground.

The Mission achieved its core objective of scaling up the response on the ground and establishing unity of purpose among responders in support of the nationally led efforts. As of 1 August, oversight of the UN system’s Ebola emergency response is led by the World Health Organization (WHO), under the direct authority of the WHO Director-General. UN agencies, funds and programmes, the UN Office for the Coordination of Humanitarian Affairs, the UN Mission in Liberia and national and international partners have undertaken the necessary steps, to enable this seamless transition.

The Ebola Crisis Managers remain in the countries under the oversight of WHO and with the support of the UN Resident Coordinators and UN country teams. In Liberia, the high-level UN leadership for the Ebola emergency response is provided by the Deputy Special Representative and Resident Coordinator, with the support of the UN country team. The Special Envoy on Ebola continues to provide strategic guidance for the response.

In a statement on 31 July the Secretary-General Ban Ki-moon said ‘the United Nations remains steadfast in its commitment to supporting the Governments of Guinea, Liberia and Sierra Leone in getting to and staying at zero cases’.

UNMEER, was established on 19 September 2014 after the unanimous adoption of General Assembly resolution 69/1, and the adoption of Security Council resolution 2177 (2014) on the Ebola outbreak. UNMEER was set up as a temporary measure to meet immediate needs related to the unprecedented fight against Ebola. The Mission deployed financial, logistical and human resources to Guinea, Liberia and Sierra Leone to support the push to zero cases:

UNICEF [to 1 August 2015]
http://www.unicef.org/media/media_78364.html
More than 70,000 children born during the Ebola outbreak in Liberia at risk of exclusion if not registered, warns UNICEF
MONROVIA, Liberia 31 July 2015 – UNICEF is supporting a drive by the Liberian Government to register more than 70,000 children whose births were not recorded during the Ebola crisis, leaving them vulnerable to marginalization and exclusion.

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Islamic Relief [to 1 August 2015]
http://www.islamic-relief.org/category/news/
Christian and Muslim leaders played “essential role” in tackling the Ebola virus
July 30, 2015
Faith leaders in Sierra Leone and Liberia played an “essential role” in stemming the spread of the Ebola virus, according to a new report, but the delay in involving them in the response cost lives.

Keeping the Faith, a joint report by CAFOD, Christian Aid, Tearfund and Islamic Relief, shows that Christian and Muslim leaders were able to deliver health messages in parts of the two countries that governments and NGOs could not reach. As trusted sources of information, they quashed rumours about the disease – such as that the disease was man-made and being spread deliberately – and encouraged communities to accept life-saving advice from health workers. They also played a crucial role in counselling survivors and challenging stigma.

But many of those interviewed believe that faith leaders should have been involved far sooner. According to a senior member of the Ebola Task Force in Kenema District in Sierra Leone, the country “would have saved more lives and more money had religious leaders been engaged at an earlier stage of the disease outbreak.”…

POLIO [to 1 August 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 29 July 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: 24 July marked one year since a child was last paralyzed by wild poliovirus in Nigeria. Final laboratory results on all specimens for the full 12 month period are expected by September 2015, which, if clear for poliovirus, may lead to Nigeria being removed from the list of polio-endemic countries. The Global Polio Eradication Initiative commends the hard work of the Nigerian government, partners, religious and community leaders, and health workers for such strong progress towards stopping polio. Yet the job is not yet finished, and it is crucial that commitment from all stakeholders is maintained. Read more
:: Despite the deteriorating security situation in Yemen, a humanitarian pause enabled 50,000 children to be reached with the oral polio vaccine during the final week of Ramadan. Read more

Selected excerpts from Country-specific Reports
Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week in Shindand district of Hirat province, with onset of paralysis on 27 June. This is the most recent case reported in Afghanistan. The total number of WPV1 cases for 2015 is now six. .
:: Intensive and strengthened supplementary immunization activities are planned in the coming months. National Immunization Days (NIDs) are scheduled on 16 – 18 August using bivalent oral polio vaccine (OPV). Subnational Immunization Days (SNIDs) will follow across the south of the country on 20 – 22 September, and NIDs using trivalent OPV will take place on 18 – 20 October.

WHO & Regionals [to 1 August 2015]

The Weekly Epidemiological Record (WER) 31 July 2015, vol. 90, 31 (pp. 381–392) includes:
:: Health conditions for travellers to Saudi Arabia for the pilgrimage to Mecca (Hajj), 2015
:: Meeting of the International Task Force for Disease Eradication, April 2015

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Global Immunization Meeting: “Protect, Innovate, Accelerate”
23-25 June 2015, Sitges/Barcelona, Spain.
:: Report pdf, 618kb
:: Conference guide pdf, 1.05Mb

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World Breastfeeding Week: 1-7 August
31 July 2015 — The theme for this year’s World Breastfeeding Week is, “Breastfeeding and Work. Let’s make it work!”, to encourage family-friendly policies in the workplace. Breastfeeding is the key to a child’s survival, health, growth and development. WHO recommends exclusive breastfeeding in the first hour of life and the following 6 months to stimulate brain development, and to prevent childhood obesity and non-communicable diseases later in life.

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WHO Fact sheet: Cholera 29 July 2015
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:: WHO Regional Offices
WHO African Region AFRO
:: World on the verge of an effective Ebola vaccine
:: WHO calls for urgent action to curb hepatitis – 28 July 2015
:: WHO and Gates Foundation agree on ways to strengthen collaboration to improve health in the African Region – 27 July 2015

WHO Region of the Americas PAHO
:: Support for mothers’ breastfeeding can benefit employers’ bottom line (07/31/2015)
:: PAHO/WHO calls for urgent action to curb hepatitis (07/27/2015)
:: Experts seek answers to increasing rates of HPV-related oral cancer (07/27/2015)

WHO South-East Asia Region SEARO
:: WHO sets up advisory group to guide post-quake recovery support in Nepal
The World Health Organization has set up an advisory group to guide its support to earthquake-hit Nepal for rebuilding resilient health systems. Over 80% health facilities have been damaged in 14 districts worst hit by earthquakes that rocked Nepal on 25 April and 12 May this year.
“Improving health system in Nepal as it goes through recovery, requires all of us to rethink and innovate. Long-term development and scaling up risk reduction and preparedness for the health sector are key features of WHO’s ongoing engagement in Nepal, ” Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia, told the first meeting of the advisory group in New Delhi on July 31.
The advisory group, comprising of academicians, policy makers, social scientists, economists, epidemiologists and other experts, will advise on WHO strategic approaches to ensure that the needs of the affected people are met through the process of transition from response to recovery and development…
:: WHO calls for strengthening malaria elimination strategy, says 3.2 billion people still at risk
29 July 2015

WHO European Region EURO
No new digest content identified.

WHO Eastern Mediterranean Region EMRO
No new digest content identified.

WHO Western Pacific Region
:: Intensified public health measures help control MERS-CoV outbreak in the Republic of Korea
Web update
MANILA, 28 July 2015 – Intensified public health measures, including contact tracing, quarantine and isolation of all contacts and suspected cases, and infection prevention and control have brought the Middle East respiratory syndrome coronavirus (MERS-CoV) under control in the Republic of Korea. Since 4 July no new cases have been reported. Yesterday, all remaining contacts were released from quarantine symptom-free, following 14 days of isolation and monitoring…

CDC/MMWR/ACIP Watch [to 1 August 2015]
http://www.cdc.gov/media/index.html

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:: Many adolescents still not getting HPV vaccine
Press Release THURSDAY, JULY 30, 2015
The number of 13- to 17-year-old boys and girls getting the human papillomavirus (HPV) vaccine increased slightly for the second year in a row, according to data from CDC’s 2014 National Immunization Survey-Teen (NIS-Teen), published in this week’s Morbidity and Mortality Weekly Report (MMWR).

Despite these increases, 4 out of 10 adolescent girls and 6 out of 10 adolescent boys have not started the recommended HPV vaccine series, leaving them vulnerable to cancers caused by HPV infections. Persistent HPV infections can cause cancers of the cervix, vagina, and vulva in women; cancers of the penis in men; and cancers of the anus and oropharynx (back of the throat, base of the tongue, and tonsils) in men and women. CDC recommends the vaccine for girls and boys at age 11 to 12 years.

The latest estimates show that 60 percent of adolescent girls and 42 percent of adolescent boys have received one or more doses of HPV vaccine. This was an increase of 3 percentage points for girls and 8 percentage points for boys from the 2013 NIS-Teen survey estimates.

While there was a 3 percentage point overall increase nationally for first-dose HPV vaccine coverage among adolescent girls, a handful of state and local areas achieved much larger increases in coverage.

“The large increases in these diverse parts of the country show us it is possible to do much better at protecting our nation’s youth from cancers caused by HPV infections,” said Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases. “We are missing crucial opportunities to protect the next generation from cancers caused by HPV.”…

:: Transcript for CDC Telebriefing: Many adolescents still not getting HPV vaccine
Transcript for CDC Telebriefing: Many adolescents still not getting HPV vaccine
THURSDAY, JULY 30, 2015

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MMWR July 31, 2015 / Vol. 64 / No. 29
:: National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2014

Announcements/Milestones

MSF/Médecins Sans Frontières [to 1 August 2015]
http://www.doctorswithoutborders.org/news-stories/press/press-releases
Field News
Tanzania: MSF Vaccinates 130,000 Refugees Against Cholera
July 30, 2015
Kigoma/Geneva, 30th July 2015—A cholera vaccination campaign to protect Burundian and Congolese refugees in the overflowing Nyarugusu camp in Tanzania has been completed by the international medical organization Doctors Without Borders/Médecins Sans Frontières (MSF) this week. However, with people still living in very precarious conditions, there is still an urgent need to improve the sanitary situation in the camp.

The second round of the vaccination campaign, a response to an outbreak that occurred this past May, was finalized on July 27. More than 130,000 refugees were vaccinated in this round. The oral cholera vaccine, which must be administered in two doses, offers a high level of protection against the disease. However, vaccination should be carried out together with other prevention and control measures, which are severely lacking today in the camp.

“Vaccination is an urgent and essential response to prevent lives being lost, but to reduce the risk of new epidemics, sanitary conditions in the camp must be rapidly improved,” said Sita Cacioppe, Emergency Coordinator for MSF.

The vaccination campaign was conducted in collaboration with the Tanzanian Ministry of Health, the World Health Organization (WHO), and the UN High Commissioner for Refugees (UNHCR). In the first round in June, 107,000 people—equivalent to 92 percent of the population at the time—received a first dose of the vaccine. But insecurity around the elections in Burundi continues to push thousands of people across the Tanzanian border, and since the first round of vaccination, around 20,000 more people have been transported to the camp according to the UNHCR. A catch-up round will soon be organized to give a second dose to the newcomers whose overall vaccination status is unclear…

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Texas Children’s Hospital Center for Vaccine Development awarded grant to develop therapeutic vaccine for Chagas disease
HOUSTON, July 28, 2015 /PRNewswire-USNewswire/ — The Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development, also known as the Sabin product development partnership (Sabin PDP), a major research component of the National School of Tropical Medicine at Baylor College of Medicine, received a grant of $1.8 million from the Robert J. Kleberg, Jr. and Helen C. Kleberg Foundation. The grant will fund accelerated development of the first therapeutic vaccine for Chagas disease in humans, in a development program under the direction of Drs. Peter Hotez, Texas Children’s Hospital endowed chair in Tropical Pediatrics, and Maria Elena Bottazzi, deputy director of Sabin PDP…

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IAVI International AIDS Vaccine Initiative [to 1 August 2015]
http://www.iavi.org/press-releases/2015
IAVI Programs Help Strengthen East Africa’s Health Research Capacity
July 30, 2015 – IAVI Press Release
NEW YORK – The International AIDS Vaccine Initiative (IAVI) has made significant contributions to strengthening health research systems in East Africa, according to a study published by RAND Europe on 30 July.

In order to develop effective AIDS vaccines for use throughout the world, it is essential to build partnerships and bolster capacity to conduct vaccine research and clinical trials at the highest technical, regulatory and ethical standards in regions where they are most needed. IAVI has worked with in-country partners to build a network of Clinical Research Centers (CRCs) and laboratories in Africa and India dedicated to conducting AIDS vaccine trials and related epidemiological studies which also help build broader, lasting value in the communities and countries that participate in vaccine research. Click here to read about IAVI’s HIV vaccine trials and epidemiological studies to date.

Commissioned to evaluate IAVI’s capacity building activities in East Africa, where IAVI has operated the longest, RAND Europe reported that IAVI’s mission to develop an AIDS vaccine has become increasingly connected to wider strengthening of health research systems, through its epidemiological and clinical research activities in East Africa.

RAND found that IAVI has made significant contributions in training to support scientific excellence and good clinical practice, and investments in infrastructure and laboratories at CRCs in East Africa. Noting ongoing challenges in ensuring sustained investment, accessing marginalized populations and demonstrating progress, the report finds that “the experiences of IAVI to date suggest that substantial progress is being made towards wider health research systems strengthening in the region.”

“The RAND team spent a great deal of time with field-based stakeholders to capture the perspectives of the people and institutions we strive to benefit,” said IAVI CEO Margie McGlynn. “We are proud of RAND’s validation of the impact achieved by IAVI and our partners and deeply grateful as always for the support of our donors. We are already working to incorporate RAND’s insights about our successes and challenges into our forward planning.”
Full report. http://www.rand.org/pubs/research_reports/RR1147.html

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Gavi [to 1 August 2015]
http://www.gavialliance.org/library/news/press-releases/
31 July 2015
:: Reimbursement of misused amounts identified in Gavi Cash Programme Audit in Nigeria
Statement from Gavi, the Vaccine Alliance.
Geneva, 30 July 2015 – In October 2014, following the completion of the Cash Programme Audit (CPA) of its programmes in Nigeria, Gavi finalised its audit report. The audit scope covered the expenditures incurred and procurement activities conducted at the Federal Ministry of Health, the National Primary Health Care Development Agency (NPHCDA), and states in the fiscal years 2011-2013.
In a joint letter of understanding signed by the then Minister of Health and the Gavi CEO, it was agreed in principle by the Minister to repay any funds identified as having been misused.
The CPA determined that US$ 2.2 million had been misused. In accordance with the joint letter of understanding, and in line with Gavi and Nigeria’s Partnership Framework Agreement (PFA), co-signed by the then Minister of Health, the then Minister of Finance and the Gavi CEO, Gavi requested reimbursement of the identified US$ 2.2 million…

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BMGF – Gates Foundation [to 1 August 2015]
http://www.gatesfoundation.org/Media-Center/Press-Releases
:: The Bill & Melinda Gates Foundation, Global Citizen and FC Barcelona Announce Partnership to Beat Extreme Poverty
SAN FRANCISCO (July 23, 2015) – FC Barcelona, The Bill & Melinda Gates Foundation and Global Citizen today announced they have joined forces and are launching a campaign called “Beat Extreme Poverty” to further the movement to end extreme poverty. The campaign will engage millions of people to learn about global issues, while taking meaningful actions in support of the world’s poor. 2015 marks a turning point for the future of the planet. At September’s United Nations General Assembly, world leaders will set global goals that will form a roadmap for how we’ll tackle poverty, inequality and climate change. Therefore, FC Barcelona, The Bill & Melinda Gates Foundation and Global Citizen’s partnership comes at a crucial time to help make sure millions of people around the world not only understand the goals, but have the opportunity to take effective and meaningful actions.

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European Medicines Agency [to 1 August 2015]
http://www.ema.europa.eu/ema/
:: Calls for civil society members for two EMA committees
29/07/2015 Expressions of interest to represent civil society at committees of the European Medicines Agency (EMA) — the Pharmacovigilance Risk Assessment Committee (PRAC) and the Committee for Advanced Therapies (CAT) — to be submitted to European Commission by 30 September 2015 ..
:: EMA to encourage use of scientific advice for post-authorisation safety studies
12-month pilot will support design of high-quality safety studies ..
28/07/2015
:: Fast track routes for medicines that address unmet medical needs
Launch of two-month public consultations on revised guidelines on accelerated assessment and conditional marketing authorisation
27/07/2015
The European Medicines Agency (EMA) has revised its guidelines on the implementation of accelerated assessment and conditional marketing authorisation, two key tools in the European legislation to accelerate patients’ access to medicines that address unmet medical needs.
The public consultations on the revised guidelines are open until 30 September 2015. Comments should be sent using the forms provided…

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Sabin Vaccine Institute [to 1 August 2015]
http://www.sabin.org/updates/pressreleases
Cecile Hillary Joins Sabin Foundation Europe Board of Trustees
LONDON — July 30, 2015 — Sabin Foundation Europe (SFE), the UK partner of the Sabin Vaccine Institute (Sabin), today announced the election of Ms. Cecile Hillary, managing director at Morgan Stanley and co-head of debt capital markets for financial institutions in Europe, to the SFE Board of Trustees.

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NIH [to 1 August 2015]
http://www.nih.gov/news/releases.htm
:: Dr. Peter Kilmarx appointed Deputy Director of Fogarty International Center
July 30, 2015 — Kilmarx previously oversaw CDC efforts in Zimbabwe.
PATH [to 1 August 2015]
http://www.path.org/news/index.php
Announcement | July 27, 2015
PATH’s Jane Hutchings named “Pioneer of Global Health”
Washington Global Health Alliance award “recognizes a creative and inspirational leader dedicated to solving global health inequity”

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IVI [to 1 August 2015]
http://www.ivi.org/web/www/home
:: Save the Date: IVI’s International MERS-CoV Symposium  – September 10, 2015
Novotel Ambassador Gangnam, Seoul, Korea
The International Vaccine Institute (IVI) is pleased to announce that it will host the International MERS-CoV Symposium on September 10, 2015. Scientists from the Republic of Korea, East Asia, Middle East, United States and Europe will present the latest basic and clinical data, and discuss research opportunities, including vaccine development, related to Middle East Respiratory Syndrome (MERS-CoV), an emerging viral disease responsible for severe acute respiratory infection in more than 1,000 people across 25 countries. Planning is underway. Please mark your calendars and check the website over the next few weeks for more information.

Engaging communities for increasing immunisation coverage: what do we know?
3ie Scoping Paper 3, 2015

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Overview
Immunisation coverage rates continue to stagnate or even decline in some parts of the world. An estimated 21.8 million infants worldwide in 2013 were not covered with routine immunisation services. Nearly half of these children live in three countries: India, Nigeria and Pakistan.

The global community and national governments continue to look for novel ways to improve access to and use of immunisation services to reduce vaccine-preventable deaths. In this context, there is an increasing realisation that communities need to be more than just passive recipients of immunisation services.

In this scoping paper, Shagun Sabarwal, Raag Bhatia, Bharat Dhody, Subashini Perumal, Howard White and Jyotsna Puri, highlight the key role that communities can and should play in building demand for immunisation and in the planning and delivery of services. According to experts in the sector, programmes that are co-managed with the community are more likely to be successful than those that are not. The paper also shows that there is a clear lack of evidence on the effectiveness of community engagement approaches for increasing immunisation coverage.

Download scoping paper (2.0 MB)

Dengue News Alert
Dengue Vaccine Initiative Statement on Results of Studies on the Efficacy and Long-Term Safety of Sanofi Pasteur’s Dengue Vaccine Candidate in Dengue-Endemic Regions
WASHINGTON DC – JULY 28, 2015—A study titled “Efficacy and Long-Term Safety of a Dengue Vaccine in Regions of Endemic Disease” (Hadinegoro et al.), published yesterday in The New England Journal of Medicine, assesses vaccine efficacy and interim long-term safety results of Sanofi Pasteur’s dengue vaccine candidate, CYD-TDV, across three clinical trials in dengue-endemic countries within Asia-Pacific and Latin America. This analysis marks a significant scientific milestone in Sanofi Pasteur’s efforts to develop a dengue vaccine.

Analyses of pooled data from the two Phase 3 trials (CYD14 in Asia-Pacific and CYD15 in Latin America) showed a reduction in dengue disease during the first 25 months of the study among children and adolescents 2-16 years of age who received CYD-TDV, consistent with previously published results from each trial. The pooled data allowed for greater post-hoc analysis of age effects. Among individuals aged 9 years and older, efficacy was substantially higher at 65.6% than in younger children. Children aged 9 and older who had evidence of prior dengue virus infection (i.e., were seropositive) had an efficacy of 81.9%; seronegative individuals in this age group had significant efficacy of 52.5%. Serotype-specific efficacy was also significant in the older age group, ranging from 47.1% against serotype 2 to 83.2% against serotype 4. Among children younger than 9 years of age, efficacy was lower at 44.6% with 70.1% efficacy in seropositive and 14.4% in seronegative children. Efficacy against severe dengue and hospitalization was 93.2% and 80.8%, respectively, in individuals aged 9 years or older; and 44.5% and 56.1%, respectively, in children younger than 9 years.

Long-term safety follow up from the third year of the Phase 3 trials and from the third and fourth years of a Phase 2b long-term follow up study (CYD23/57) conducted in Thailand demonstrated reduction in dengue hospitalizations among individuals 9-16 years of age for up to two years after completion of the three-dose vaccine regimen. The pooled relative risk of hospitalization among individuals aged 9 years or older was 0.50, demonstrating significantly decreased risk in vaccine recipients. However, this risk reduction was not observed among vaccinated children under 9 years old. The pooled relative risk of dengue hospitalization in this younger vaccinated group was 1.58 during the third year, suggesting a trend to increased risk. Among the very young children, this increased risk became more apparent. The relative risk of hospitalization in 2-5 year old vaccinated children during the third year of CYD14 was 7.45 and in 4-5 year old vaccinated children in the third year of CYD 23/57 was 2.44.

The Dengue Vaccine Initiative welcomes the demonstrated vaccine efficacy across age groups and geographic regions. In particular, the Initiative is encouraged by the overall level of protection and prevention of severe dengue and hospitalizations among individuals 9 years of age or older, along with the significant reduction in dengue cases among both seropositive and seronegative individuals within this age group without apparent safety issues. However, DVI considers further evaluation in the population at large, especially in children younger than 9 years of age, to be crucial to better understand the effects of this vaccine, as well as to clarify the duration of protection. Of particular importance will be to understand why there appeared to be an increased risk of hospitalization among the very young during the third year, and whether this risk continues into subsequent years. Safety signals clearly exist for persons aged less than 5, but the mechanism remains unclear. DVI looks forward to further information from the additional years of long-term safety follow up from these three ongoing trials. Additionally, the Initiative continues to be highly interested in whether fewer number of doses could provide similar levels of protection by this candidate, as well as its forecasted price if licensed.

About the Study
The results are based on CYD14, a Phase 3 trial involving 10,275 individuals aged 2–14 years from Indonesia, Malaysia, the Philippines, Thailand and Vietnam; CYD15, a Phase 3 trial of 20,869 individuals aged 9–16 years from Brazil, Colombia, Honduras, Mexico and Puerto Rico; and CYD23/57, a Phase 2b trial and long-term safety study of 3,203 children aged 4-11 years (at time of vaccination) from Thailand.

American Journal of Infection Control
August 2015 Volume 43, Issue 8, p785-904, e39-e46
http://www.ajicjournal.org/current

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The Ebola transmission paradox
Michael Klompas, MD, MPH, Deborah S. Yokoe, MD, MPH
Published Online: June 11, 2015
DOI: http://dx.doi.org/10.1016/j.ajic.2015.05.006
Abstract
Understanding Ebola’s transmission dynamics is indispensable to arrest its spread and to protect health care workers and community members. The observed dynamic, however, is confusing. Some signals suggest the disease is highly transmissible, whereas others suggest it is not. The disease course of Thomas Duncan, the Liberian national admitted to Presbyterian Hospital in Dallas, Texas, exemplifies the paradox.

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Ebola virus disease: What clinicians in the United States need to know
William A. Fischer II, MD, Timothy M. Uyeki, MD, MPH, MPP, Robert V. Tauxe, MD, MPH
Published Online: June 24, 2015
DOI: http://dx.doi.org/10.1016/j.ajic.2015.05.005
Abstract
In March 2014 the World Health Organization was notified of an outbreak of Ebola virus disease (EVD) in the forest region of Guinea. As of May 2015, the outbreak had become the most devastating EVD epidemic in history with more than 27,000 cases and more than 11,000 deaths. The introduction of EVD into noncontiguous countries, including the United States, from infected travelers highlights the importance of preparedness of all health care providers. Early identification and rapid isolation of patients suspected with EVD is critical to limiting the spread of Ebola virus. Additionally, enhanced understanding of EVD case definitions, clinical presentation, treatment procedures, and infection control strategies will improve the ability of health care workers to provide safe care for patients with EVD.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 1 August 2015)

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Research article
Enhancing governance and health system accountability for people centered healthcare: an exploratory study of community scorecards in Afghanistan
Anbrasi Edward, Kojo Osei-Bonsu, Casey Branchini, Temor Yarghal, Said Arwal, Ahmad Naeem BMC Health Services Research 2015, 15:299 (31 July 2015)
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Research article
The integrated disease surveillance and response system in northern Ghana: challenges to the core and support functions
Martin N Adokiya, John K Awoonor-Williams, Claudia Beiersmann, Olaf Müller BMC Health Services Research 2015, 15:288 (28 July 2015)
Abstract

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 1 August 2015)

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Research article
Why are people with dengue dying? A scoping review of determinants for dengue mortality
Mabel Carabali, Libia Hernandez, Maria Arauz, Luis Villar, Valéry Ridde BMC Infectious Diseases 2015, 15:301 (30 July 2015)
Abstract
Background
Dengue is a viral disease whose clinical spectrum ranges from unapparent to severe forms and fatal outcomes. Although dengue death is 99 % avoidable, every year around 20,000 deaths are estimated to occur in more than 100 countries. We consider that, along with biological factors, social determinants of health (SDHs) are related to dengue deaths as well.
Methods
A scoping review was conducted to explore what has been written about the role of SDHs in dengue mortality. The inclusion criteria were that documents (grey or peer-reviewed) had to include information about dengue fatal cases in humans and be published between 1997 and 2013 and written in English, Spanish, Portuguese or French. The search was conducted using a set of key words related to dengue mortality in several electronic databases: PubMed, LILACS, COCHRANE, Scielo, Science Direct, WHOLIS, OpenGrey, OpenSingle and Google Scholar. Information on SDHs was categorized under individual, social and environmental, and health systems dimensions. A summative content analysis using QDA Miner was conducted to assess the frequency of information on SDHs and its contextual meaning in the reviewed literature. The role of each SDH in dengue mortality was assessed using content analysis results.
Results
From a total of 971 documents retrieved, 78 met the criteria. Those documents were published in the Americas region (50.0 %), Asia (38.4 %), Europe (9.0 %) and Africa (2.6 %). The described SDHs related to dengue deaths included, in the individual dimension: age, ethnicity, education, type of infection and immunological status; and in the social dimension: poverty and care-seeking behavior. The health systems dimension included access, opportunity, and quality of care, as well as health staff knowledge. Ethnicity was considered a determinant that depends on cultural and socioeconomic conditions.
Conclusions
Along with biological factors, there are several SDHs related to dengue mortality. However, only a few of these have been systematically analyzed, suggesting the need for more studies on this subject to inform the design and implementation of sustainable interventions to decrease dengue mortality. These findings nevertheless provide a better understanding of the non-biological factors involved in dengue mortality.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 1 August 2015)

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Research article
Contraceptive adoption in the extended postpartum period is low in Northwest Ethiopia
Zelalem Mengesha, Abebaw Worku, Senafikish Feleke BMC Pregnancy & Childbirth 2015, 15:160 (1 August 2015)

BMC Public Health
http://www.biomedcentral.com/bmcpublichealth/content
(Accessed 1 August 2015)

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Research article
Household antimicrobial self-medication: a systematic review and meta-analysis of the burden, risk factors and outcomes in developing countries
Moses Ocan, Ekwaro Obuku, Freddie Bwanga, Dickens Akena, Sennono Richard, Jasper Ogwal-Okeng, Celestino Obua BMC Public Health 2015, 15:742 (1 August 2015)

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Research article
Socio-economic determinants of disease progression among HIV infected adults in Kenya
Nyawira Gitahi–Kamau, James Kiarie, Kenneth Mutai, Beatrice Gatumia, P. Gatongi, A. Lakati BMC Public Health 2015, 15:733 (31 July 2015)

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Research article
A cost-utility analysis of cervical cancer screening and human papillomavirus vaccination in the Philippines
Anna Melissa Guerrero1*, Anne Julienne Genuino1, Melanie Santillan2, Naiyana Praditsitthikorn3, Varit Chantarastapornchit3, Yot Teerawattananon3, Marissa Alejandria4 and Jean Anne Toral5
Author Affiliations
BMC Public Health 2015, 15:730 doi:10.1186/s12889-015-2046-1
Published: 30 July 2015
Abstract
Background
Cervical cancer is the second leading cause of cancer cases and deaths among Filipino women because of inadequate access to screening and treatment services. This study aims to evaluate the health and economic benefits of HPV vaccination and its combination with different screening strategies to find the most optimal preventive strategy in the Philippines.
Methods
A cost-utility analysis was conducted using an existing semi-Markov model to evaluate different screening (i.e., Pap smear, visual inspection with acetic acid) and vaccination strategies against HPV infection implemented alone or as part of a combination strategy at different coverage scenarios. The model was run using country-specific epidemiologic, cost and clinical parameters from a health system perspective. Sensitivity analysis was performed for vaccine efficacy, duration of protection and costs of vaccination, screening and treatment.
Results
Across all coverage scenarios, VIA has been shown to be a dominant and cost-saving screening strategy with incremental cost-effectiveness ratio (ICER) ranging from dominant to Php 61,059 (1443 USD) per QALY gained. VIA can reduce cervical cancer cases and deaths by 25 %. Pap smear screening was found to be not cost-effective due to its high cost in the Philippines. Adding HPV vaccination at a cost of 54 USD per vaccinated girl on top of VIA screening was found to be potentially cost-effective using a threshold of 1 GDP per capita (i.e., Php 120,000 or 2835 USD/ QALY) with the most favorable assumption of providing lifelong immunity against high-risk oncogenic HPV types 16/18. The highest incremental QALY gain was achieved with 80 % coverage of the combined strategy of VIA at 35 to 45 years old done every five years following vaccination at 11 years of age with an ICER of Php 33,126 (783 USD). This strategy may result in a two-thirds reduction in cervical cancer burden. HPV vaccination is not cost-effective when vaccine protection lasts for less than 20 years.
Conclusion
High VIA coverage targeting women aged 35–45 years old at five-year intervals is the most efficient and cost-saving strategy in reducing cervical cancer burden in the Philippines. Adding a vaccination program at high coverage among 11-year-old girls is potentially cost-effective in the Philippines assuming a life-long duration of vaccine efficacy.

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Research article
Factors influencing full immunization coverage among 12–23 months of age children in Ethiopia: evidence from the national demographic and health survey in 2011
Yihunie Lakew1, Alemayhu Bekele2 and Sibhatu Biadgilign3*
Author Affiliations
BMC Public Health 2015, 15:728 doi:10.1186/s12889-015-2078-6
Published: 30 July 2015
Abstract
Background
Immunization remains one of the most important public health interventions to reduce child morbidity and mortality. The 2011 national demographic and health survey (DHS) indicated low full immunization coverage among children aged 12–23 months in Ethiopia. Factors contributing to the low coverage of immunization have been poorly understood. The aim of this study was to identify factors associated with full immunization coverage among children aged 12–23 months in Ethiopia.
Methods
This study used the 2011 Ethiopian demographic and health survey data. The survey was cross sectional by design and used a multistage cluster sampling procedure. A total of 1,927 mothers with children of 12–23 months of age were extracted from the children’s dataset. Mothers’ self-reported data and observations of vaccination cards were used to determine vaccine coverage. An adjusted odds ratio (AOR) with 95 % confidence intervals (CI) was used to outline the independent predictors.
Results
The prevalence of fully immunized children was 24.3 %. Specific vaccination coverage for three doses of DPT, three doses of polio, measles and BCG were 36.5 %, 44.3 %, 55.7 % and 66.3 %, respectively. The multivariable analysis showed that sources of information from vaccination card [AOR 95 % CI; 7.7 (5.95-10.06)], received postnatal check-up within two months after birth [AOR 95 % CI; 1.8 (1.28-2.56)], women’s awareness of community conversation program [AOR 95 % CI; 1.9 (1.44-2.49)] and women in the rich wealth index [AOR 95 % CI; 1.4 (1.06-1.94)] were the predictors of full immunization coverage. Women from Afar [AOR 95 % CI; 0.07 (0.01-0.68)], Amhara [AOR 95 % CI; 0.33 (0.13-0.81)], Oromiya [AOR 95 % CI; 0.15 (0.06-0.37)], Somali [AOR 95 % CI; 0.15 (0.04-0.55)] and Southern Nation and Nationalities People administrative regions [AOR 95 % CI; 0.35 (0.14-0.87)] were less likely to fully vaccinate their children.
Conclusion
The overall full immunization coverage in Ethiopia was considerably low as compared to the national target set (66 %). Health service use and access to information on maternal and child health were found to predict full immunization coverage. Appropriate strategies should be devised to enhance health information and accessibility for full immunization coverage by addressing the variations among regions.

Clinical Infectious Diseases (CID)
Volume 61 Issue 4 August 15, 2015
http://cid.oxfordjournals.org/content/current

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Clinical Features of Patients With Ebola Virus Disease in Sierra Leone
Enqiang Qin, Jingfeng Bi, Min Zhao, Ye Wang, Tongsheng Guo, Tao Yan, Zhiwei Li, Juan Sun,
Jieli Zhang, Suhong Chen, Yao Wu, Jin Li, and Yanwei Zhong
Clin Infect Dis. (2015) 61 (4): 491-495 doi:10.1093/cid/civ319
The mortality of patients with Ebola virus disease (EVD) was closely associated with age and duration from symptom onset to clinic presentation. Patients with EVD did not necessarily have fever. Early diagnosis and timely symptomatic treatment are important.

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The Use of TKM-100802 and Convalescent Plasma in 2 Patients With Ebola Virus Disease in the United States
Colleen S. Kraft1,2,a, Angela L. Hewlett3,a, Scott Koepsell4, Anne M. Winkler1, Christopher J. Kratochvil5, LuAnn Larson6, Jay B. Varkey2, Aneesh K. Mehta2, G. Marshall Lyon III2, Rachel J. Friedman-Moraco2, Vincent C. Marconi2, Charles E. Hill1, James N. Sullivan7, Daniel W. Johnson7, Steven J. Lisco7, Mark J. Mulligan2, Timothy M. Uyeki8, Anita K. McElroy8, Tara Sealy8, Shelley Campbell8, Christina Spiropoulou8, Ute Ströher8, Ian Crozier9, Richard Sacra10,
Michael J. Connor Jr11,12, Viranuj Sueblinvong11, Harold A. Franch12, Philip W. Smith3, and
Bruce S. Ribner2 for the Nebraska Biocontainment Unit and the Emory Serious Communicable Diseases Unitb
Abstract
Background.
The current West Africa Ebola virus disease (EVD) outbreak has resulted in multiple individuals being medically evacuated to other countries for clinical management.
Methods.
We report two patients who were transported from West Africa to the United States for treatment of EVD. Both patients received aggressive supportive care measures, as well as an investigational therapeutic (TKM-100802) and convalescent plasma.
Results.
While one patient experienced critical illness with multi-organ failure requiring mechanical ventilation and renal replacement therapy, both patients recovered without serious long-term sequelae to date.
Conclusions.
It is unclear what role the experimental drug and convalescent plasma had in the recovery of these patients. Prospective clinical trials are needed to delineate the role of investigational therapies in the care of patients with EVD.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 1 August 2015]

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Research
On est ensemble: social capital and maternal health care use in rural Cameroon
McTavish S and Moore S Globalization and Health 2015, 11:33 (1 August 2015)
Abstract
Background
Every day approximately 1500 women worldwide die due to pregnancy or childbirth related complications. Maternal health care use is critical in reducing maternal mortality worldwide. Cameroon has one of the highest maternal mortality rates worldwide, but there is little knowledge about maternal health care use in Cameroon, particularly in more remote areas. The purpose of this study was to examine the importance of social networks and social capital in maternal health care use in the Far-North province of Cameroon.
Methods
A sample of 110 Cameroonian women was recruited door-to-door in the urban town of Maroua and rural village of Moutourwa in the Far-North province in 2009. A maternal health questionnaire was administered to women between the ages of 18-45. The questionnaire assessed maternal health care history, social network, and social demographic characteristics. Social capital was measured in terms of the average educational level of women’s networks. Bivariate and multivariable poisson regression analysis was used to assess the number of maternal health care visits as a function of social network characteristics, education, ethnicity, age, and urban and rural residence.
Results
Among the 110 participants, 13 percent reported not having visited a health care provider during the last pregnancy – 19 percent of the women sampled in Moutourwa and 6 percent in Maroua. Findings showed that women with higher social capital had a greater tendency to use maternal health care services (IRR: 1.13; 95 % CI: 1.02-1.26). Social network size and social participation were not significant in full models. Ethnic characteristics were also shown associated with MHCU in the Far-North province.
Conclusion
Although the size of women’s health-related networks were not shown significant, the resources to which women might have access through their social networks were associated with women’s maternal health care use in remote areas of Cameroon. Although pregnancy may not be widely discussed in public, women’s social networks may provide key social resources, e.g., information or financial capital, that facilitate MHCU. Leveraging women’s social capital may provide a means to improve maternal health care use among women in low-income countries

Journal of Medical Microbiology
Volume 64, Issue 7, July 2015
http://jmm.sgmjournals.org/content/journal/jmm/64/7

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Epidemiology An update on human immunodeficiency virus vaccine preparedness studies
Shayesta Dhalla
J. Med. Microbiol., July 2015 64: 731-738, doi: 10.1099/jmm.0.000073
Abstract
Human immunodeficiency virus (HIV) vaccine preparedness studies (VPSs) have taken place in both the Organisation for Economic Co-operation and Development (OECD) countries and the non-OECD countries. HIV VPSs are conducted to assess the feasibility of phase 3 HIV vaccine trials. This descriptive review is an update of HIV VPSs in the non-OECD countries, and examines the willingness to participate (WTP) in hypothetical HIV vaccine trials, as well as retention. Few VPSs have been published in the OECD countries since the discontinuation of the STEP/Phambili HIV vaccine trials. Barriers to participation in the non-OECD countries after the STEP/Phambili studies include safety issues and side effects, vaccine-induced seropositivity (VISP) and mistrust among key informants (KIs). HIV VPSs indicate that HIV vaccine trials are still feasible in the non-OECD countries, but barriers must be overcome to improve feasibility. Hypothetical WTP in a VPS may not translate into actual WTP in an HIV vaccine trial.